4 Herbs That Give You The Upper Hand Against Viral Infections

Let’s talk about four herbs with antiviral properties. 

Click here for a consultation with a functional medicine doctor before taking herbal supplements!

Olive Leaf

As part of a Candida protocol, we’ll have a couple of herb combinations that will have olive leaf combined with monolaurin. Stack those two right on top of each other. Monolaurin is a lauric acid coconut extract.  It has been shown to be very, very potent as an antiviral.  With olive leaf, the main compound in it – oleuropein – and that actually prevents the virus from attaching to the cells. We kind of talk about mechanisms a lot and people ask why does that matter.  It is because some herbs may prevent the replication of viruses.  Things like olive actually prevent the virus from attaching to healthy cells. So if you have multiple herbs, you’ve got multiple mechanisms.  You’re just making yourself even more resilient.


They help with either immune modulation, natural killer cell, antibody modulation which is the infantry that comes in afterwards, or it is going to help with viral replication. Typically, it’s going to modulate the inflammation from the immune response.

Usually it is hitting things in about three to four different ways, and most are going to fall into that category. That is kind of the mechanism how they are working.

Cat’s Claws

We use Cat’s Claw or Samento a lot with biofilms.  They work really well.  These are protective shields, bacteria and critters use. We also use it with a lot of Lyme and various co-infections, but Cat’s Claws is great at the immune system, helping with viruses, and really enhancing the body’s ability to deal with infections. Again, everything we are talking about is not necessarily to treat anything.  A lot of the time it is just to support our own immune response to what’s happening, because our body is really the ultimate fighter in all of this.  Everything we are doing is just trying to give our body’s immune system an edge to address the issue to begin with.  The body has dealt and humankind has dealt with viruses since forever.


When we are doing a lot of these herbs, a lot of times we want to make sure the whole root is present. A lot of times with Echinacea, you will see a lot of flower present. I want the whole root.  I find that it has a lot more of the immune-modulating alkaloids that really have the immune benefit. It is excellent in how it reduces virus levels.  It inhibits the growth of bacteria. It inhibits the growth of viruses. It is also going to modulate with the inflammation caused by that immune response and caused by the cytokines and interleukins.

What can you do to try to gain the upper hand?

These things are just going to improve your resilience. It’s important to have the right mindset. A lot of people are selling like cures or solutions and that is not going to be the case, but it is really going to be our body to begin with.  Even antibiotics, when an infection gets cleared, it is still not the antibiotic.  It is the antibiotic lowering the level of the infection and then the immune system can kind of come in and play.  It is like if we are using a lifting analogy, it really gives a very helpful spot when you’re kind of low in that bench press, it really gives you that little spot to kind of get it up through that sticky point.

If you have any questions about herbs with antiviral properties, please reach out to a functional medicine doctor and learn more.

Nutrition is Science-Backed Medicine

By Dr. Justin Marchegiani

Nutrient: “a substance that provides nourishment

essential for growth and the maintenance of life.”

You Are What You Eat

Why do people change their diet? While popular answers are to lose weight (fat), or to get in better shape (adding muscle), good nutrition is in fact about so much more than changing your physical appearance. Proper nutrition–diet and supplementation–is a science-backed way to improve your health. “You are what you eat,” and everyday you have the power to decide how the foods you consume will serve you. Let food be thy medicine: heal your gut, balance your hormones, improve your mood, boost your energy, and more.

Nutrition as Medicine

As kids, many of us were told to eat our vegetables–why? ”Because they’re good for you.”

As adults, we are told to eat our vegetables–why? “To shed some weight.”

Neither of these answers demonstrates the true healing nature of what we put in our bodies, so, without further ado, here are some of the most powerful science-backed healing properties of a healthy diet!

Click here for a personalized health plan from a functional medicine doctor!

Physical Appearance

We all know that changing our diet can help us lose weight, but did you know that a healthy diet can improve the appearance of your skin and hair too? B-vitamins, like biotin, have been shown to improve the appearance of skin and nails. Collagen also supports healthy hair, skin, and joints!

Increased Energy

A poor diet lacking in healthy macro and micronutrients–paired with a diet high in sugar, alcohol, and processed foods–can lead to headaches, brain fog, and fatigue. On the other hand, eating grass fed meat, healthy fats, and lots of fresh vegetables will give your body the fuel it needs to function optimally.

The Standard American Diet (“SAD” – a fitting acronym) is full of inflammatory processed foods and refined carbs & sugar which deplete the immune system, increase the rate of cancer, and increase the risk of developing autoimmune disease. 

Inflammation is the root cause of most diseases: but a diet rich in anti-inflammatory foods is the best gift you can give yourself to feel and function at your best!

Better Sleep

Poor sleep–whether you’re lacking hours, or your sleep quality is not that good– can increase your risk of diabetes, decrease your immune system, and accelerate aging. 

Alcohol and caffeine both impair sleep quality. Caffeine has a half-life of around 6 hours, so ideally you want to have your last cup by 2pm. Alcohol robs you of restorative REM sleep, which in addition to its dehydrating effects, lead to the next day’s dreaded hangover.

Food that positively affect sleep include veggies, grass-fed beef, chia seeds, sweet potato, wild-caught salmon, and those rich in magnesium. On the other hand, simple carbs and sugar negatively affect blood sugar and sleep–especially if consumed in the evening.

Balanced Hormones

Your body *needs* fat! Fat is required for your body to produce various hormones and keep inflammation low. Carbs, especially simple carbs, can actually increase inflammation and disrupt the delicate balance of your hormones.

If you suffer from leaky gut or other gut issues, you may be deficient in gut bacteria. Probiotics, like those from fermented foods–like sauerkraut, kimchi, and kombucha– provide your gut with beneficial bacteria which can help keep your hormones in balance.

Improved Mood

Did you know that dairy, sugar, and gluten are linked to depression? While the Mediterranean diet, rich in saturated fat, fish, and vegetables is associated with both decreased rates of depression *and* a longer lifespan!

Ready to Take Charge?

By now, you should have all the motivation you need to make a change for the healthier. Here are some resources to help you get started:

  • The JustInHealth Eating Plan
    • How to Eat, What to Eat, and the Healthy Meal Matrix
  • Nutrient Support
    • If you or your diet is deficient in certain nutrients, supplementing with high quality supplements shouldn’t be overlooked!
      • Iron Supreme: Hypothyroidism, anemia, and iron deficiency are all linked. Many women are iron-deficient, which can be remedied by eating red meat and supplementing with a high-quality iron supplement, like Iron Supreme.
      • Magnesium Supreme: Magnesium is essential for proper function of over 300 enzymatic reactions and for the performance of many vital physiological functions. A magnesium deficiency can lead to osteoporosis, blood sugar problems, poor sleep, muscle cramps, and more.
      • Multi-Nutrient Supreme: Your daily all-in-one for general nutrient support! Vitamins A, B, C, D, E and so much more!

Questions? Click here if you are ready for help learning how to take your health back into your own hands!



Jun S Lai, Sarah Hiles, Alessandra Bisquera, Alexis J Hure, Mark McEvoy, John Attia; A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults, The American Journal of Clinical Nutrition, 2014;99(1):181–197




Top 3 Ketosis Tips for Success – Dr. David Jockers | Podcast #240

Ketosis is a normal metabolic process that provides several health benefits. It’s a popular weight loss strategy wherein your body converts fat into compounds known as ketones and begins using them as its main source of energy. Ketogenic diets may even have benefits against diabetes, cancer, epilepsy and Alzheimer’s disease.

Read and listen through this podcast as Dr. J and his special guest, Dr. David Jockers discuss the Top 3 Ketosis Tips for Success.

Top 3 Ketosis Tips for Success - Dr. David Jockers | Podcast #240

Dr. David Jockers

In this episode, we cover:

00:43 Ketogenic Diet, Intermittent Fasting

01:10 Importance of Hydration

09:08 Stress Control and Good Sleep

13:54 Keto Adaptations

28:34 Meal Time Strategies


Dr. Justin Marchegiani: Hey guys, it’s Dr. Justin Marchegiani here. We have a great friend, awesome awesome information dude, Dr. David Jockers. He’s got some amazing information we’re going to talk about today regarding ketogenic diet. David has a phenomenal summit out now called, The Keto Edge Summit. I was a speaker in it. Amazing speakers, amazing information, we’re gonna go over some of the top three Keto tips that David applies with himself and his patients to help improve their health. David, welcome to the podcast. How are we doing?

Dr. David Jockers: Hey always great to be on Dr. J, I love listening to you and Evan. Big fan of the show, so always great when I get to be on. And I love our conversation. So thanks a lot.

Dr. Justin Marchegiani: Yeah well thanks for being here, Doc I really appreciate it. So let’s dive in to it, you’ve been utilizing ketogenic diet, intermittent fasting, these tips these techniques to help improve insulin sensitivity, to help with cellular turnover and healthy aging. So what’s the number one thing right now that you find that patients have a barrier with it, when you make this tweak or you make this adjustment, they get to their next level of health utilizing a ketogenic diet?

Dr. David Jockers: Now I would say the number one thing is hydration. You see, in our brain our, our hypothalamus, our hunger center and our thirst center are right next to each other. And whenever we eat, we stimulate dopamine. It helps us feel good. And I think that’s a great adaptation, because you know it’s like, it’s great to feel good when we eat and it helps drive us to eat to consume food. But what happens is because food so prevalent in our society today, whereas as our ancestors didn’t have access to, you know we didn’t have pantries and refrigerators and things like that in years past. So food is prevalent. We could literally be eating all day long and we’re constantly stimulating that dopamine. And so for many people have become addicted to it, and our hunger and our thirst center are right next to each other in that area of the brain. And so for many people they’ve had these neuroplastic changes where the hunger center has now moved into the thirst center. So they’re really thirsty but they experience it as hunger. So they’re like I need something, I need a dopamine hit. There’s something that I’m missing and there’s food, I’m going to go for the food, and really most people are chronically dehydrated meaning more fluid. We need more water. And so I find that drinking more water, hydrating your body really well especially when you first wake up in the morning, so critical, so critical, for intermittent fasting, so critical for fat burning, for cleansing the body, for energy production, for good mental clarity, and for Keto adaptation. And so getting some good water, I recommend drinking you know, if you’re not used to it start with just eight ounces, OK. But ideally, trying to get 16 to up to 32 ounces of water within the first hour of waking up. So really hydrating your body well because when you’re sleeping overnight you’re breathing out water vapor. So you’re actually losing water throughout the night. So when you wake up in the morning really hydrating well, not only will replace that water, but on top of that it’s also going to help stimulate energy production, you’re going to notice that your energy goes up, the better you’re hydrated, more energy production your body’s going to have, you’re also going to poop better, right. We want to get poop out, want to have good bowel movements early in the morning, you’re at your large intestine is most active. So my goal is always to have two really good solid bowel movements within the first hour of waking, and it’s like my energy is just amazing, my mental clarity- I’m so productive when I’m able to do that. So hydration is number one tip.

Dr. Justin Marchegiani:  I think that’s amazing. I’ve been following that for years. When I first discovered the book, your body’s many cries for water by Dr. Batten and Gila. She talked about that. I’ll add some extra like Redman’s real salt or I’ll use a trace minerals support I’ll add to it. Today, I had a little bit of alcohol last night so I before I went to bed I have a drink, I typically drink mineral water in between each alcoholic beverage to get the extra minerals back in and then I did a lot of glutathione before bed and a lot of vitamin C and extra electrolytes to start my day, and those stretch receptors in your tummy when water comes in, it hits those stretch receptors and allows you to feel more satiated and then naturally have an appetite that’s more calibrated with what their nutritional needs actually are. So that’s a great tip.

Dr. David Jockers: Yes so important, I mean we have that ghrelin hormone. And so when we’re when our stomach is empty, ghrelin going to come out and tell us we’re hungry. So yes the eating a big breakfast in the morning, it’s normal for you to want to eat a big breakfast because you conditioned this response that ghrelin pop out. What if you just start by hydrating your body you’re gonna notice you’re gonna be more satiated. This is a great way to get started with intermittent fasting- you just hydrate your body really well in the morning, and then wait for natural hunger to come after that, to start with the hydration, now allow the natural hunger to come, you know, as it comes naturally after that. Yeah definitely getting the electrolytes and to adding some —

Dr. Justin Marchegiani:  Yes it’s very important. And as insulin levels drop too we tend to pee, pee more because insulin tends to pull sodium. Sodium tends to pull water. So that’s why you know someone does a ketogenic diet and drops their carbs really low they’ll lose three or four pounds the first day it’s not going to be fat it’s going to be water. So yeah I mean that’s that’s a really salient point because we are going to be losing a lot of that water so we have to make sure we get it back. And I would even say the key electrolyte to on keto that I find is really low is potassium. So really upping the potassium and or just really focusing on lots of green vegetables and avocados is another awesome tip for sure.

Dr. David Jockers: Yeah. That is important and sodium too actually. When you lose a lot of sodium, so getting a lot of those salts are really the cool thing is in nature you get potassium, and a lot, you get potassium and sodium and good ratios right. So avocados actually have sodium, celery potassium and sodium, C vegetable. Right. So all these natural foods [inaudible], these broccoli cauliflower got potassium and sodium. So if you’re consuming a lot of those things and then salting your food up to your desired case. I don’t think you need to go beyond that. Not like I’m shoveling salt in your mouth. They just flush you out right. Probably just move your bowels, could you loose stools but instead just salting up to your taste. And even if you’ve been told to be on a low salt diet, it’s kind of like what you were saying there, Dr. J you know, basically once you, once your insulin goes down, you turn a lower carb diet or if you are doing some fasting, your insulin is going to drop down and when you when you drop insulin, you start to excrete sodium. With that sodium comes the water so you need to replace that. So adding in these good trace mineral rich foods, even grass fed meets you’re very rich and in minerals, a lot of good salts and they’re really really good stuff. Dark green leafy sea vegetable, a lot of things we we just talked about, fermented foods, olives, pickles, sauerkraut, all really really good stuff when it comes to trace minerals. So getting those in your diet and then just salting up your desired taste, really good. And then I mean it’s really as simple as this when it when we’re talking about taking Redmond’s real salt or Himalayan salt. Yes a little pinch on your on your finger and put it on your tongue. Specially noticing that you’re just feeling a little bit dizzy or especially a lot of people when they start intermittent fasting or if they start going in a low carb diet, they feel a little bit dizzy, a little bit spacey and oftentimes that’s an electrolyte issue. So just taking a pinch of salt putting it on your tongue, drinking you know, two to four ounces of water and shrinking a little water after that can knock that out right away. I’ve also seen people with allergy symptoms, certain having like a runny nose and coughing things like that, taking a little bit of salt and water actually acts as a natural antihistamine. Dissolution, yeah because histamine actually, one of its jobs in Doctor, Doctor Batman is who I helped in that book he talks about it talks about histamine helps triaged water so we become dehydrated. We triaged water into organ systems that are most vital, like the brain, heart rate. And so therefore the mucous membranes get less of it. So we’re more likely to have allergic type responses right and plus we have elevated histamine in our system. So when we hydrate the body, get the electrolytes in, naturally reduces that histamine response and we get more balanced, more balanced histamine response, therefore, less of the congestion right runny nose things like that.

Dr. Justin Marchegiani:  Yeah, totally makes sense. Love it, love it. and then what’s your favorite brand for a good mineral salt? Redmond’s Real Salt?

Dr. David Jockers:  Redmond’s Salt is great. Absolutely. That’s what I think. I think it’s a little bit lower costs than Himalayan, Himalayan sea salt a great one, Celtic is a good one. So any of those are great.

Dr. Justin Marchegiani: And then just people listening. It’s not just sodium chloride, your typical table salt would be sodium chloride. It’ll be bleached as well. So we’re talking about salt that have you know 60 70 different micro minerals as well as just sodium chloride. So you’re getting a lot more in there. I think that’s phenomenal. What’s number two. Dr. Jockers?

Dr. David Jockers:  Yes. So we talked about the water in the electrolytes obviously we’ve got to start with that. Number two is really controlling your stress and focusing on good sleep. So most people understand this but you know we’re under stress, we’re gonna be elevating our blood sugars, so higher amounts of stress hormone are telling our body we’re in a place of fight or flight and when we’re in place or fight or flight we think we might need to sprint at any moment with survival. Right so our bodies naturally can elevate our blood sugar, and when we do that, then you know if we’re not running, so we’re just stressed out like we’re sitting in traffic, whatever it is, your spouse says something, and we’re stressed out about it ,we’re elevating our blood sugar but we’re not giving the response the body needs which would be to run or lift something, I had to climb a tree so therefore we just end up with this elevated blood sugars in the body towns out some insulin to help lower that blood sugar, high blood sugar can be toxic, can actually cause damage to the nerve system, cause advanced location and products, all kinds of all kinds of oxidative stress, so the body gets insulin up to take the sugar out of the bloodstream and of course, when insulin is up, that’s going to inhibit the production of ketone to burn fat. So insulin being elevated because of the stress response is going to cause you to not be able to burn fat, not get into ketosis, and therefore it’s also going to cause kind of this spiral where you’re going to end up with hypoglycemia, because oftentimes you’ll drop that blood sugar too low. Yeah. And another stress response and this is a vicious cycle, you’ve got to really keep your stress under control. Why I never tell anybody to start intermittent fasting or start a ketogenic diet. If you’re already overwhelmed by stress, like if you would describe your life you’d say, I’m just overwhelmed by stress. Not a good time for you know a ketogenic diet or fast. That’s more for somebody that’s got stress under control. Now these are hacks that are going to really take really improve your body’s ability to be more resilient to stress, to improve your fat burning, improve your brain, down regulate inflammation really powerfully. But first you have to get your stress under control and you’ve got to get your sleep under control because if you don’t sleep well, then you’re you’re naturally going to be under a higher amount of stress. If you get if you’re getting consistent poor nights of sleep, even if you don’t feel stressed out during the day you’re going to have higher stress hormones which is again going to cause that cascade of high blood sugar and high insulin.

Dr. Justin Marchegiani:  Totally makes sense, and I see an email in my inbox that you sent me a couple of days ago for your newsletter and you talked about some of your favorite adaptogens. Yes. Again this is kind of what you probably plug in on the supplements that outside of diet and lifestyle modifications. I imagine you’re probably using some adaptogens to help modulate this stress response. Is that true?

Dr. David Jockers: Oh absolutely. I love [inaudible]. A great one. Magnolia fish [inaudible] reishi mushroom. Yeah. Lemon bomb right. Very good relaxing herbs. If you want more energy, something like Rhodiola. Really good siberian ginseng. Another great one for energy. Right. The great thing about adaptogens is they’re going to help balance you. So if you feel anxious, all right, and jittery, they’re going to help bring you down, if you feel fatigued and lethargic, they’re going to help bring you up. and that’s the great thing about them. They just kind of modulate and help balance you out. Also a huge fan of magnesium too. Know I find that most people are deficient in magnesium some magnesium can be really really powerful for helping modulate the stress response, modulation means balancing. Right. That’s what we want. You know we don’t necessarily want to increase or decrease. We want what the body needs at the moment. Right. We want to help balance it out, so we were able to adapt to the environment adapt to the stressors we’re under and be able to perform at our highest level. So those are those herbs and Magnesium here are key.

Dr. Justin Marchegiani:  That makes sense because people I think forget like, they’re so focused on their diet. Hey I’m trying to keep these carbohydrates down because these eventually will break down into glucose or fructose in my body and have potentially a negative effect at burning fats or cause insulin resistance. People forget that their cortisol levels can create surges of glucose through either protein in their body or just releasing glycogen that’s already in their muscles and that can be the equivalent of having an extra carbohydrate that you wouldn’t want to eat but eat you’re not even eating it, it’s being released internally from these different stores and you can still have deleterious effects, so the adaptogens like you mentioned I think are great, just getting those glute four receptors upregulated on the muscle, these are little fingers that help pull glucose into the muscle and you can do that by movement, by taking a walk after after an hour, or doing some bands or some resistance training to help soak up a lot of that glucose, that’s really good points.

Dr. David Jockers: Yeah absolutely. So important. A third big thing is to you know basically, you want to gradually move into Keto adaptations. So for some individuals I say about 25% percent of the population they can start today. They might have eaten 500, 500 grams of carbs yesterday for twenty five percent of the population. They can go down to 20 carbs and actually feel great within the first week. That’s only 25 percent the population. The other 75 percent is gonna feel really crappy. Yeah. So what we want to do to be on the safe side is, gradually reduce your carbohydrate load. So if you were to take it for example, if you were to take this week or the next three days and just count out how many carbohydrates you’re consuming, right. Subtract the fiber, so your net carbs, total carbs minus fiber that you consume on a daily basis, you keep track of your your macros and you can use like chronometer or something like that. See, see where your carbohydrate load is. Let’s say you’re consuming 250 grams of total carbs, right, in a day. OK great. So for the first week, all you do is you reduce it down by 50 grams. So for the first week, you’re going down to 200 grams of net carbs. So total carbs minus fiber, you replace that with a couple grams of, well not a little bit more than a couple, but roughly about 10 grams of healthy fat. Right. So you eat a little bit, eat a few more olives, you know, a teaspoon of olive oil something along those lines, you just add that and while you take out the carbs, and then you do that each week you drop it down roughly about 50 grams each week. So if you started at 250, you know, by the time you get into the ketogenic range, it’s roughly between 20 grams to 50 grams. It’s about five or six weeks. Right. So you give your body time to start to adapt and build the metabolic machinery to be able to run on a lower carbohydrate diet and use fat for fuel. And I think that’s a big thing. A lot of people try to jump right in, they try to go cold turkey and have a bad experience when you gradually shift into it. So you’re leaning into it, shifting into it. You give your body time to build the metabolic machinery to get more familiar with that with ketones in the bloodstream. Right. So if you’re eating 250 grams of carbs a day, your body has not seen ketones. It doesn’t. It’s not familiar with how to use them for energy. You’ve got to give it some time to see that in the bloodstream then it’s going to up regulate the enzymatic systems to sort to use that for fuel. So that’s a really important strategy. Just keep dropping it down roughly 40 to 50 grams of carbohydrates, replacing that with healthy fat or in some cases, healthy protein if you’re on a very low protein diet, but replacing that until you get into that 20 to 50 gram range. And typically for somebody at sedentary. So if you’re not doing a lot of movement, you’re going to need to get your net carbs down in that 20, is certainly under 30 range and some in some cases under 20 if you’re very insulin resistant, you’re more active. You could find that you’re going to get into a state of nutritional ketosis which is zero point five million miles or higher when you’re testing your blood ketones with, you know, you probably are going to be able to handle up to 50 grams of net carbs and be in that range. And if you’re extremely active high level athlete maybe they’ll take up to 100 hundred and twenty grams in that carbs. So you got to kind of find the right zone for you. So once you get into that zone, I tell you, you know my recommendation is spend 30 days in that zone. I think 30 days in nutritional ketosis is extremely powerful for helping clean up cellular debris reset your systems. I mean ketones, epigenetic modulators. So they help to help your body to express genes are gonna have more anti aging benefits, are going to help upregulate mitochondria and support healthy mitochondria. So you spent 30 days in that and then you find a good carb cycling strategy after that. Right. For some people they like to carb cycle, you know, every other day, for some people it’s you know once every 10 days, where you have a higher carb day where basically you’re.. you’re consuming more carbohydrates roughly somewhere between 50 and maybe up to one hundred and fifty grams of of net carbs depending on you. So if you tend to be more insulin resistance, you might do less. Like for me I tend to be more insulin resistant so I.. For me it’s like a higher carb day might be 70 or 80 grams of net carbs. OK. Whereas for somebody else they may be able to tolerate a little bit more especially if they’re very very active. So you’ve got to kind of find the right zone for you and then you drop back into ketosis. OK, find again, find the right strategy. So for some people they’ll do a feast day once a week, where they’re like one day a week where you know, they’re eating 150 grams or 100 grams net carbs, so just consuming more carbs and for them that works great. Right. And then usually takes them two days or so to get back into ketosis. If you do a high carb day like that and it takes you a week to get back into ketosis, then you really shouldn’t be carb cycling once a week right then you would probably want to carb cycle like once every two weeks once every month. Something along those lines. That way you’re you’re splitting your time right. You want to spend some time where your body is utilizing glucose right for fuel and basically resetting your glycogen stores. You also want to spend time in this state of nutritional ketosis. You got to find the right carbs cycling approach, and the strategy I like to apply is more of a carb backloading strategy. Yeah I like to eat less during the day I eat less food during the day hydrate. I do a lot of hydration during the day, keeps my energy high. It allows me to perform at a higher level because stress is the antagonist to good digestion, meaning that when we’re under stress, we’re not gonna be able to produce as much stomach as–

Dr. Justin Marchegiani: Correct.

Dr. David Jockers: The bile pancreatic enzymes to digest our food well so I like to do more smoothies ,right, things that are predigested during daytime. I’ll throw avocado in my my protein shakes so I get more healthy fats. But the blender is the job of the digestion and then the evening that’s when I feast, right. That’s when I had my big meal meat, right. Vegetables. Healthy fats on there. And I find that that approach works well and especially if you’re going to add in more carbs, doing a lower carb during the day. So if you want to eat solid foods, eggs, right. Maybe like a big chicken salad with olives, and I’ll add avocado and olive oil or something like that where it’s low carb throughout the day and then when you add in the carbs, you do it more in the evening, your sweet potato, right, or your your steamed carrots, beets, if you want grains something like Quinoa or or rice or something along those lines, doing it more in the evening you’re going to notice it. That’s going to get better benefits. A lot of research on that for helping stimulate fat burning, right and supporting the sensitivity.

Dr. Justin Marchegiani:  Some people, one of the side effects with Keto sometimes sleep can deteriorate and that could be from a hypoglycemic kind of episode before bed. So if that’s happening, maybe adding a tiny bit of carbs or even a tablespoon of coconut oil to provide some more of those ketone precursors before bed to keep that blood sugar and add an additional fuel source outside of the blood sugar in your bloodstream.

Dr. David Jockers:  Yeah yeah for sure. Absolutely. And I think if you do the slow keto adaptation approach you’ll notice less of a hypoglycemia. Which will definitely help you. Your bio get better and better at using ketones. But a big thing that I do see is that people aren’t feasting. Right. So if you’re under eating for a certain portion of the day you’re eating a lower amount of calories in the evening. Definitely eat a higher amount of calories right to make up for it. And that is a mistake I see a lot of people make is they reduce the carbs but they don’t they’re not as generous with the fat. And therefore, they end up not just not consuming enough calories which can then cause the hypoglycemic type issues especially for like lean women. I see that a lot of lean women having that issue don’t have as much body fat. The body’s trying to protect the body fat tissue.

Dr. Justin Marchegiani:  I see that all the time. You don’t get enough fat in there to replace some of the carbs that are pulled out, then you could still be in a caloric deficit and that can still create a stress response. So I think that’s really important because the whole goal is we have this kind of fuel partitioning mechanism imagine like an air traffic controller. Right. Planes come in. You point this way, you point that way, imagine an air traffic controller saying, OK go to the mitochondria get burnt up or go back into the fat cells and get burnt up get get stored. So we want to be an air traffic controller shuttling everyone to the mitochondria, to the muscle cell to get burnt and not get stored. And we have to change these cellular enzymes. We need more lipolytic, right, lipo meaning fat, lytic meaning to break down some more lipolytic hormone, sensitive light pace Growth Hormone thyroid hormone versus insulin, lin lipo eugenic hormones on the storing or formation side. So I think what you’re saying these are just basically unregulated that air traffic control, what if they get burnt up and this cellular energy can’t be snapped on and the more insulin resistant you are like you’re highlighting, this may take a few weeks maybe even a month and you’re having a tapering protocol just so it’s not so painful. So you don’t develop this Keto flu type of thing where you’re you’re tired, you’re achy. Correct?

Dr. David Jockers:  Oh yeah absolutely. So the keto flu is going to be related to hypoglycemia, you know the light imbalances like we talked about and HIPAA axis dysfunction or you know we’ll be college adrenal fatigue. Right. So it’s kind of a combination of all three of those and they all work together. So you’re absolutely spot on and we want to be able to adapt and teach the body to be able to run and use fats for fuel. Right. That’s the key there. Now another caveat to it. And Justin, you probably test fasting insulin on your patients is that correct? Yes. So I test that on all my patients right fasting insulin levels, and so normally if you’re fasting for 12 to 14 hours you finished dinner let’s say 6:00 p.m. You’re doing your bloodwork at 8:00 a.m. something along those lines. Your ideal fasting insulin should be roughly somewhere around three to five right in that range. If you’re on the lower end, they’re like two three. OK, you probably need to do a little bit more carb cycling, you probably need a bump that insulin a little bit more. OK if you’re on the higher end right. There’s a lot of people out there you know they’re they’re insulin levels fasting insulin is 12 14 16. These are people that are going to do better doing fasting, right. Intermittent Fasting, longer fasting, and lower carb throughout the day to get that insulin level down. OK. So that’s another caveat getting your fasting insulin levels tested. That’s going to help you understand your carb tolerance right.

Dr. Justin Marchegiani:  Just kind of piggyback on that, Christopher Gardner did an amazing study out of Stanford in 2007 called, The A to Z Study, and this study was interesting because he compared four different kinds of diets– he compared and Atkins style diet, and Ornish kind of you know higher carbohydrate more vegetarian diet, the Zone diet which is like a 40 30 30 and then I think a standard American diet. So there were four diets and it was interesting because the Atkins group, the lower carb group had the largest amount of success. But then there were still people that were successful in other groups and then they looked at the people and they tried to extrapolate why a lot of people in the act is that great. But why. There were some people in other groups and what they found in the higher carbohydrate groups, the people that did well were the ones that had their fasting insulin below seven. So in other words, the people that were more insulin sensitive, meaning their pancreas made the less insulin, they could tolerate the higher carbohydrates and that threshold was seven anything greater than 7 they could not tolerate the higher carb, and they only got success on the lower carb group because that helped bring their insulin back into balance. And I agree that study this seven I like two to five, I think gets a good point and I think this is really important people listen like you know we’re practitioners so, we understand that there are some people that do well not following that exactly and the question is why? We don’t want to be dogmatic and say no. Everyone has to and it’s a rule it’s tough but we have to understand why there may be some exceptions and that’s I think one of the biggest data points that we can use to say hey these are the people that are going to benefit these you may be able to break the rules a bit and then we can actually have some objective data on that.

Dr. David Jockers: Yeah, absolutely because you do need insulin, you need insulin in particular for converting T four and T three. So you’re active thyroid hormone and if you don’t get that, know this is where we’ll see people start to for example lose hair, when they get really really fatty, they get constipated, they get really really cold, when they’re fasting, or on a ketogenic diet it’s a sign that it probably ban under consuming calories right as a whole. And possibly not carb cycling enough. Right. And that’s really big. So even on a low even on a low carb diet, if you do like a very high calorie meal once a day. OK. So where you’re doing like maybe under eating, lower amounts of calories for a period of time and then of a larger meal, your body is going to still secrete a lot of insulin like on a low carb diet. When you. Eat a lot of food your body’s excrete a lot of insulin. OK. And so you want to get at least, unless you’re like in a period where you’re just doing an extended fast for a specific reason, you want to get a really good shot of insulin at least once a day. I really once no more than twice a day in my opinion. OK. But you want it when you do get it, you want to get a good shot of it. What happens is in our society it’s like people are just continually spiking it because we’re eating all the time right. We’re eating every several hours just continually getting spikes of insulin that promotes too much inflammation right. Insulin is going to activate your inflammatory home right and amplify inflammation throughout your body. But if you strategically get it, once, maybe twice a day. Right, a really good spike of it then that’s going to get. That’s the right amount to activate thyroid hormone to enhance cellular energy production is a lot of good benefits that are going to come from that.

Dr. Justin Marchegiani:  I think that’s great. And what’s your strategy on mealtime and I know we’ve talked about this as, I think for a while you were doing kind of o mad one meal a day. How are you timing your meals and then how do you dial that in for patients exact.

Dr. David Jockers:  So here’s how I do it personally now. I’m about one hundred, one hundred sixty five pounds strong, I’m an 8 percent body fat it’s mostly just muscle tissue, and the way I do it is I workout four days a week, when I workouts very intense strength training, so I’m usually working out for about 45 minutes or so strength training. Monday Tuesday Thursday Friday are typically my spring training days and what I do is on Wednesday, and on Saturday, I only do one meal one meal on those days, usually it’s lunch dates, whatever’s most convenient for me I’m usually eating lunch I find that I just do best at that time. Right so one o’clock, two o’clock, something like that having a really good really good solid lunch and then that’s it, you know just hydrating outside of that and then on the other days, I’m consuming two meals, lunch and dinner, right now typically my dinners are usually my largest meal of the day. I’m consuming a lot of a lot of food right. I mean I’ll easily consume fifteen hundred calories or so, you know a typical dinner. All right. And usually my lunch, if not, I mean I probably could even consume two thousand calories, my dinner and my lunch is usually probably somewhere around five hundred eight hundred calories, somewhere in that range. OK. And yeah that’s how I do it and I function amazing in fact my best sleep. My heart rate variability gets really high on my fasting days so when I’m, when I’m sleeping. Wednesday night and Saturday night it’s like I wake up the next day. I just feel amazing like so good. And that’s why I do it. In fact if I didn’t lose weight. When I would do one meal a day if I didn’t lose weight when I get it. So what happens is I tried that and I started losing muscle. I started losing weight and I’m already very lean as it is, very very thin. Five foot eleven hundred and sixty hundred sixty five pounds so so I feel amazing when I’m fasting but obviously I don’t want to lose weight. So. So that’s why I do the two meals five days a week. One meal two days a week seems to work amazing for me. Now when I do eat, I eat a lot of food. My wife’s always like, wow I’m fond of food. So in order to be able to digest that food effectively at its most effective level. I think a lot of digestive enzymes. OK. From time to time, if I’m under more stress, I’ll take a little bit of stomach acid support it would be THCL. Typically speaking a bunch of digestive enzymes works great for me. OK. And that works well and then I also take a supplement that has Curcumin, Turmeric, right. It’s also got a whole bunch of bitter herbs. It’s called fermented turmeric right. It’s got a bunch of different bitter herbs are really good for stimulating digestive juices production. So I think a combination of those and my digestion is great. OK. And that’s right I feel really good with it. And that’s typically my lunch most days, my lunch is liquid nutrition so usually I’m making a smoothie with Collagen protein. Yeah. Coconut milk, avocado in there. That’s usually my lunch and I might munch on like a cucumber that that I cut up and put some lemon juice on, some salt and some herbs. Right. Or maybe radishes. I’m crunching you know, chewing on some radishes. So it’s usually some sort of raw vegetable. Along with this sort of smoothie. And then for dinner it’s usually a lot of meat. So whether it’s grass fed beef, or we do like grass fed beef hotdogs and I’m familiar with those. Yeah those were great. Lots of vegetables so like steamed broccoli or cauliflower to make up mashed potatoes, and cauliflower all times calling mashed potatoes, broccoli with butter. So we do a lot of that. You know we started using this thing called [inaudible]. Now if you’re familiar with that, it’s hearts of palm, it’s pasta. It’s pasta with hearts of palm and then it’s great. My wife makes this amazing pesto right. We put pesto on that which has got olive oil and avocado and pine nuts and all kinds of stuff like that. So it’s just a scrape,we put chicken with that. So different things, different meals like that. So typically how I’m doing it.

Dr. Justin Marchegiani:  That’s great. Excellent. I did something similar as well typically in my day in day out. I’m having some level of coffee in the morning with some butter at MCT and a little bit of collagen and that’s my breakfast, somewhere at three four hours later, I’ll have a nice glass of celery juice and I’m definitely drinking mineral water throughout the day ,and then my lunch is going to be a big salad typically, it’ll be about four, maybe five servings of vegetables, it’ll be a full avocado maybe six to eight ounces of chicken chicken thigh, or chicken breast with skin on and then an olive oil, olive oil apple cider kind of sea salt pepper type of salad, and then dinner will be some level of non starchy veg if maybe a little bit of starch, in there squash or sweet potatoes, and then mostly meat and vegetables, and then typically my Saturday, is my wife and I will have a date night and we’ll do like a steak restaurant and now I’ll just fast all day and I’ll just that one meal when I go out to eat. Typically that one day it’s nice. I’ll still do coffee with a little bit MCT just to kind of start my day off and get those ketones up and then I’ll just kind of ride that high all day long. And people listening if you have a lot of hormone issues or thyroid issues or blood sugar issues, you have to have some level of one metabolic stamina imbalance before you do it and to have that really good digestion like you mentioned, because now your meal is probably twice as big when you eat at nighttime and you really need the enzymes in the acids and good digestive function to be able to handle that load.

Dr. David Jockers:  Yeah I mean I think that’s really really important is you know, for me for example, I don’t actually get hungry. I don’t feel hungry throughout the day. I don’t get hungry till I start eating. Once I start eating, I’m like OK my body wakes up it’s like, OK I need a lot I need food, right. And that’s actually when I get hungry. So for me it’s very liberating, fasting is so liberating because I don’t I just need to think about food, I’m not hungry I don’t have cravings my body feels great my brain feels amazing feels alive so it’s so good. But you’re right I mean fasting is a level of fitness. It’s kind of like you know if you were just if you, if you’ve never exercised and then you think OK I’m going to do a 5k and I’m going to sprint 5K obviously it’s not going to happen right. You’re going to be so sore and beat up so you’ve got to kind of lean into it right. I always said people start with twelve hours overnight–

Dr. Justin Marchegiani: 12 to 12 is the easiest to start with, you know, 7 to 7 or 8 to 8.

Dr. David Jockers: Simple fast just like that, and then do the water like we talked about in beginning it. Yes. You just hydrate your body well in the morning and allow for the natural hunger to come out, for a lot of people they notice 14 hours easy. Like my kids they finished dinner with us. We’re usually done eating dinner by 6:30. My kids sleep till like 8:30 in the morning. I don’t know if, I don’t know if, if if you’re if your child is like that too.

Dr. Justin Marchegiani:  Same way same way and it’s all nutrition based. Like my son for dinner last night I mean he had a grass fed organic hot dog, a cut of avocado. And then he’s having a hard time with green vegetables. We’re getting green beans with sea salt on an organic green drink no added sugar no fruit juice in there and that will kind of pile that throughout the day and its meal. So yeah. I see kids that wake up. It’s all a lot of it’s blood sugar and it’s not getting enough fat. If that is humanly you gotta have that.

Dr. David Jockers: Yeah. So important got to have the fat so my kids will go well we’ll finish there by 6:30. We get him in bed by 8:30. They sleep till 8:30. They wake up. They take a bath right by the time they get breakfast. It’s usually like 9:30 or so. Right there. I mean they’re getting late and they’re fast growing kids, three and a half year olds. Right. So they’re getting like a 15 hour fast right there. Yes. And that’s because we have and they’re not on a ketogenic diet. They are, they’re definitely consuming carbs. Healthy carbs but they always have the healthy fats and they’re still on a lower carbohydrate template than your typical modern Americans ,or your typical sad diet. And so because of that they have better metabolic flexibility right. They’re able to go 15 hours here without consuming food. So what I find is that for most people 14 hours as long as you hydrate well as long as you’re sleeping well. Right. Doing those things. Not an issue. Right. And then especially if you do feel like you’re overwhelmed with stress or if you tend to be like a very lean woman or a lean woman that’s doing a lot of exercise. OK then one thing we’ll try to do is something called crescendo fasting, I’m not sure if you’re familiar with that now but that’s basically where we do a 16 hour fast. Two days a week. Non consecutive days. So be like a Monday Friday. Right. So fasting is a stressor on the body just like exercise is a stressor. So exercise may you know exercise is great, but if you do exercise five days in a row. Right. It will too stressful on the body. Yeah. I don’t recommend exercising more than two days in a row. After two days. I recommend taking a rest day. Like for me I do upper body. One day and then a lower body the next day and then the next day is always on resting. OK. So unless you’re like a high level athlete I wouldn’t wreck it there’s just no reason you actually the recovery is is where you get the most benefit. Right. You need to recover. So two days in a row. Same thing with fasting especially if you’re new at it or if you’ve been under stress or if you tend to be leaner. Leaner female then not doing it more than two days in a row and ideally a better way to start would be two non consecutive days a week, Monday Friday for example. Or your, your least stressful days like just you’re doing your long fast on a Saturday. Yep. Less stress on Saturday you’re hanging out with the family. Yeah. So it’s easier for you.

Dr. Justin Marchegiani: Exactly. Well Dr. David this is amazing. Lots of great tips. I think people that are listening to a lot of these tips are clinical as well. So we’re in the trenches working with patients so these aren’t theoretical things you know things that actually works out you know take it to heart, try to find at least one thing in this podcast that resonates and try to apply it. I think there’s some great information and for all you out there, head over to DrJockers.com. Make sure you subscribe to his email list. Also Keto Edge Summit, we’ll put a link down below if you guys are listening, just click there. Make sure you sign up to get access to all the great speakers and great content that’s available. Dr. Jockers, anything else you’d like to leave the listeners with today?

Dr. David Jockers: Yeah, I would just I would say, you know, definitely the Keto Edge Summit is great, we talk about all these types of things how to get fat adapted more effectively, how to kind of lean into fat agitation, like I was talking about before how to navigate through you know things like the Keto flu, how to prevent getting it and you know the tremendous benefits that can come from a state of nutritional ketosis. You know I’m a huge fan of diet variation, meaning that you’re not always in ketosis. Well I mean I would say some people probably about 20 percent of the population, 20 25 percent that will do great. Being in ketosis, you’re rounds right. But then you have the other 75 to 80 percent that are not going to do good. Being in ketosis your rounds. They need to cycle in and out. Right. You know for whatever period of time works best for them. So we go through that, Keto Edge Summit, and you know it’s really the goal of personalized nutrition. You know there’s there’s no cookie cutter approach. You got a kind of find what works best for your own unique individuality.

Dr. Justin Marchegiani: Dr. Jockers, thank you so much for all this great information. We’ll be in touch. You take care.

Dr. David Jockers:  Alright sounds good. Thank you.

Dr. Justin Marchegiani: Bye.




Audio Podcast:  


Recommended Product:


Natural Ways to Improve Your Sleep | Podcast #199

High-quality sleep is essential to one’s overall health. For numerous people, sleep deprivation led to risks in blood pressure, heart disease, obesity, and diabetes. Upkeep your well-being through the natural ways you can enhance your sleep.

Watch this video to know how Dr. J and Evan Brand explain the relationship of sleep to temperature, exercise, gut issues, blue light exposure, and smoking. Don’t forget to like and share!


Dr. Justin Marchegiani

In this episode, we cover:

01:00    Temperature and Sleep Quality

02:45    Top Metabolic Things Moving Sleep Issues

09:42    Benefits of Sleep

04:00    Work Hard, Rest Hard

18:30    What Keeps You Up at Night?


Dr. Justin Marchegiani: Hey, there. It’s Dr. J. Welcome ladies and germs. Hope you guys are having a phenomenal Monday. Evan, what’s going on with you?

Evan Brand: Hey, man. Not too much. Uh– The sun is shining still. Summer is still here. I thank the Lord. Uh– We had some weird like cold weather for a couple of days, and I thought, “Oh, man. I don’t know if I’m ready for this yet.” But today, it’s back to the heat so I’m enjoying it.

Dr. Justin Marchegiani: Summer down here has been hot as you know what. But-

Evan Brand: Yeah.

Dr. Justin Marchegiani: -I got like a little portable air conditioner unit outside of my central air, just good. It’s like, dude, I just can’t keep up with it. I got like my three or four monitors and then my treadmill and my– my– my stepping desk as well. I got like a little step or so. From sitting, I can– I can bike. From standing, I can walk and just all the heat that comes off in like a– a smaller office, it just gets contained in– I think I just get it– get it out.

Evan Brand: Yeah, maybe that should be strategy number one for today’s topic on improving sleep, which is make sure your environment is cool enough, because I’ve seen that some of the literature where they do like sleep studies on people that have the temperatures above like 70-72 Fahrenheit, people start getting restless.

Dr. Justin Marchegiani: Oh, yeah. Hundred percent agree with that. Yep. Sleep quality, sleep– We were talking about sleep today, in case you guys didn’t know yet. But, temperature’s important. I mean, I try to keep it in the upper 60’s, low 70’s. Uh– One thing I’d done recently because, you know, I’m in Texas right now. It’s hot as heck and it’s really expensive to keep everything super cool. So one thing I invested in recently is called the BedJet, and the BedJet’s excellent. I’ll see if I could put a link down below for you guys to get that–

Evan Brand: I love– I love that thing.

Dr. Justin Marchegiani: Have you gotten it?

Evan Brand: No. Remember you showed me when I was at your house?

Dr. Justin Marchegiani: Yeah! Yeah, I showed you at my house. Yeah. So you saw it-

Evan Brand: I love those.

Dr. Justin Marchegiani: -but it’s great. It basically goes underneath your sheets, and then it pumps in air. Now, it can warm the air up, but it can only cool the air as low as the air temperature. But it’s nice because it can pull in if you have like 75° or 76°, you know, temperature in your room, and it’s cool and already air-conditioned. It can pump that air in and it kind of stays underneath there that can kind of cool you a bit, and it’s very, very cool. And I put it on low like– I mean, you know, it’s the very low speed.

Evan Brand: Yup.

Dr. Justin Marchegiani: Maybe like it’s a 10%-20% of max, and it just comes– keeps a little bit of air in there, which keeps me cool, which is really nice. And– You know, especially in the summer, if a little bit of humidity that kind of– it can– the sheets can kind of stick to you. It feels a little uncomfortable. It’s just enough to cool that off.

Evan Brand: Yup. That– That’s– So temperature’s huge. I mean, many people-

Dr. Justin Marchegiani: Temperature’s great.

Evan Brand: -work that.

Dr. Justin Marchegiani: Oh, I agree. Totally. So, the temperature aspect’s great. I mean, I always sleep great when it’s like uhm— when it’s colder, when it’s around 69 or so, and then you can kind of really stay warm underneath through. That’s really the kind of the optimal temperature, 65-69, but in summer, it’s a little hotter, especially if you’re in a hotter place– places in the US. And then next step to that, let’s kind of go into a couple of other metabolic things? What are your– What are your top few metabolic things you want to start with?

Evan Brand: Well– I mean, blood sugar’s the biggest one. I had so many issues with my blood sugar for probably my whole life, just being raised on a Standard American diet, rich in carbohydrates, refined sugars, and so my blood sugar was probably one of the biggest, you know, movers for my health. And if you’re blood sugar’s crashing at night, your adrenals have to kick in to crank up and create some extra Glucose through the Gluconeogenesis process, and then all of the sudden you wake up and your heart could be racing, your mind could be racing, etc. So for me, you got to work on adrenals. I just want to give a couple statistics first. People may, you know, feel like sleep is just their issue and they may not know that many, many people struggle with it. So, if you’re looking at some of the CDC– I mean, they’re– they’re saying 50,000,000+ people have some sort of issue with sleep. Fifty million people in the US alone, so that is huge. And then, of course, they’ve got this whole list of uh– health conditions that are tied in to sleep issues, so it could be things like Stroke, Cancer, Arthritis, Depression, Diabetes. We know that if you’re not sleeping well, you’re blood sugar’s messed up from not sleeping well. And blood sugar can mess up sleep, so it’s like this big connected spiderweb. That’s a lot of people. Fifty million people struggling with sleep.

Dr. Justin Marchegiani: Yeah. Definitely a lot. New study that just came out uhm— over the weekend actually, and the study looked at what’s the optimal amount of sleep for healthy– for– for cardiovascular health. They found six to eight hours was the optimal dosage for sleep. Too high actually had an increased risk factor, and then too low also had an increased risk factor. So six to eight was a sweet spot. They weren’t quite really sure what that mechanism was of that. Could just be a correlation versus causation kind of thing. I really have a hard time thinking that if I get 8½-hour sleep, uhm— I’m gonna increase my risk of heart disease. That doesn’t quite make sense to me from a mechanistic standpoint.

Evan Brand: No, it doesn’t.

Dr. Justin Marchegiani: But, hey. Six to eight, that makes sense, so if you’re getting less than six, for sure, you got to curtail that. But I do think, for me, if I’m not doing a ton of higher exercise– harder exercise– seven hours is essential. I do notice though, if I’m exercising more and I’m lifting more weights, you know, eight to nine becomes like important. So if I’m like more busy, I actually cut down a little bit on the morning tense exercise ‘cause it just requires me to get more sleep to recover.

Evan Brand: Yep. Yep, well said. So the exercise piece– I think exercise is a great sleep inducer, as long as it’s not too stimulating and not too close to bed. So, you know, depending on the weather, like 7:00 PM, if we can go for a walk– you know, I’ll try to take my wife and the baby down the street and back.

Dr. Justin Marchegiani: Yeah.

Evan Brand: You know, 15 to 20-minute walk, I’m much more ready for sleep if I do that.

Dr. Justin Marchegiani: Oh, totally. I– I agree. I mean, the big thing with sleep, in general, and exercise is the fact that it revs up– it revs up your sympathetic nervous system. So the healthier you are, the more you can kind of go on and off. Right? On-off. So, if you can turn off– on and off, and you can regulate and get that sympathetic stress response down, that’s great. Awesome. So maybe, like for me, I do like Tabatas around 7:30. Maybe some push ups, I do like, you know, ten to fifteen thousand steps during the day on top of that. So I get my 10,000 to 15,000 steps and I do like a little bit of Tabata action, and that’s–

Evan Brand: And you’re saying 7:30 PM?

Dr. Justin Marchegiani: I do it, but I mean, my Tabatas five minutes, so it’s not like-

Evan Brand: Okay.

Dr. Justin Marchegiani: -you know, a long thing. But I’m fine with that. That’s not a problem. So that’s– that’s helpful but if you have some neurological adrenal stuff, you may got– you may want to be careful of the timing of when you do your exercise. Maybe do it in the morning, or you may be fine with a Tabata or an interval thing that’s shorter, right? We just want to make sure, number one, we feel good after the exercise; two, we can emotionally repeat it. If the workout’s shorter, it’s u– most people can wrap their head around to it emotionally. It’s not draining them out. And then, three, how do you feel that next day or that next night, if that was a morning workout. That way you can kind of gauge in the intensity, the frequency, and the duration of how long your workout is, and you can adjust those variables accordingly to get you in that place where you can check all three of those boxes. Do you feel better? How do you feel emotionally afew minutes after? Can you repeat the movements? And then how so you feel later that day or that next morning?

Evan Brand: Yep. Well said. The next thing we have to mention is the timing or the schedule of sleep. If you’re working swing shift or night shift, that is bad news. We know, if you just type in “night shift nurses sleep study,” it’s something crazy, like a 50% increased risk of breast cancer if you’re working night shift. I mean, think about it. We didn’t evolve to be up at night. And if we were up at night, we were hanging out by a fire, which is gonna be a pretty orange or red colored light, and we– maybe we were chasing away a hyena or something or a bear that was gonna come eat our children when we were hunter gatherers, but we weren’t up at night under fluorescent lighting working in a hospital, looking at a computer screen. So if you’re a night shift nurse or a night shift anything, like I was when I was in college, I mean, it destroyed me. And I think one of my biggest down– you know, I guess one of my biggest downfalls or the thing that destroyed my health was working at midnight, and would work all the way through the night and I would get off at 5:00 AM and I would go to sleep at 6:00 AM. And I would try to sleep from 6:00 AM to 2:00 PM, and I survived but I did not thrive at all. So, people may yell at us, “Oh! Just, Evan, I have to work this shift.” Okay. If you absolutely can’t change it, you can’t get another job, you can’t work with the sun, I hear you, but I hope that there’s an alternative to where people can get off of that.

Dr. Justin Marchegiani: I a hundred percent agree. If you have the ability, great. Awesome. Make it a priority. Or if you get paid in a lot more and that’s what you need to do, fine. It is what it is. You just kind of have to know that you’re going up to the plate with two strikes against you, so you really gonna have to make sure that your nutrition is– is borderline perfect. You’re gonna have to make sure you have some good adaptogens going and some good adrenal support going. And then, ideally, you know, make sure– It’s tough because then what do you do on the weekend? Do you keep that same cycle going? Do you go back to a normal rhythm? Uhum– That’s where it becomes dicey. I mean, I would probably say, “Keep the rhythm going to keep it consistent so you at least have a good rhythm.” But you got two strikes against you, and you really have to make sure everything else is dialed in regarding hydration, regarding uhm— adrenals, regarding adaptogen and regarding nutrients, and not even say gut function because we got to make sure there’s not a lot of gut stress and we’re absorbing and assimilating and then utilizing our nutrients efficiently.

Evan Brand: Yeah. I tell you, when I worked that shift, my lunch hour was like 3:00 or 4:00 AM. Your body’s not wanting to digest food. I don’t care how long you work night shift, you never feel like you’re fully satiated after a meal at 3:00 or 4:00 AM. I mean, there’s a lot of hormonal stuff going on in the middle of the night that your body’s not really wired to be eating a grass-fed steak and veggie, so I never felt good no matter– no matter how quality the meal was. So I think, in that aspect, you can hack it. Maybe you can hang in there, but eventually, you got to get off the night shift. I mean-

Dr. Justin Marchegiani: Yeah.

Evan Brand: -it is a killer.

Dr. Justin Marchegiani: I agree. Now, regarding sleep, what are some of the benefits of sleep? Now, getting– not getting enough sleep can cause blood sugar issues because part of the sleep is its restoration of your hormones, repairing  your— your organs, repairing all the– the physical and the biochemical structures of the body so you can function optimally. So, 10:00 PM to 2:00 AM is that Growth Hormone Window so we have a lot of physical repair happen at that time. And then, 2:00 AM to 6:00 AM, we have more of the biochemical kind of repair happening. And, ideally, getting closer, going to bed on the other side of midnight is ideal. I mean, for me, I’ll be straight up. I’m not perfect. I typically get to bed around 11:30. I try to do like 11:30 to 7:30. That’s kind of my gig, and then I’m operated to go at 8:00, but you got to figure out what works best for you. I mean, if I had more health concerns and more issues, I would be more on top of that, but I– I feel relatively good and– and I manage my stress and I wind down at night, so I feel pretty good with that. But in general, if you have any health issues, you’d want to be more on the other side of midnight. So getting to bed closer to even 10:00 o’clock would be ideal, just so you maximize that growth hormone output steroids that happen around 10:00 PM.

Evan Brand: Yup. Well said, and bright light in the morning, that’s really important. People don’t talk about what you do during the day to influence your sleep. People think, “Okay. What’s the magic supplement I need to take before bed to help me sleep?” Well, the magic supplement may be getting outside first thing in the morning in getting bright light exposure. So right before we jumped on this call together, I was on my bike. I rode my bike without my shirt, getting as much sun as I can, just down the street– down the street and back, you know, 5-10 times. I felt good. I felt amazing. I still feel good from it. I know I’m gonna sleep better just because of the exercise piece plus the sunlight telling me that it’s morning. It’s daytime. It’s time to get going. It’s time to peak the cortisol.

Dr. Justin Marchegiani: Yes.

Evan Brand: And you and I test cortisol on every client, and we see a lot of times that people in the morning or in the afternoon, they have a lowered or a flatline Cortisol rhythm. And we have to improve upon that because if you don’t have a peak, then you can’t have a drop. So if you’re just flatlined all day, you’re not gonna feel very good. And then sometimes, what you and I see on the testing is we see that they have an inverse cortisol pattern or maybe it’s too low in the noon and afternoon, and then it kind of spikes at night. And then those people are the ones who they laid down but they’re too wired and tired. So we really have to focus. We have to test, first of all, you got  to get the data. We have to test the adrenal function, and then we have to help modulate that cortisol rhythm if it’s off. Otherwise, it doesn’t matter if you take Melatonin or some other magic sleep supplement. It might not work.

Dr. Justin Marchegiani: One hundred percent. So again, that reverse cortisol rhythm is the hallmark of a sympathetic kind of overload or sympathetic dominant person. Their fight or flight nervous system response is more activated and is starting to go up at night. And the WHI ha– HERS II study show the greatest correlation of cancer was a decreased cortisol gap between their cortisol in the morning and their cortisol at night. So the lower their cortisol got in the morning, which should be higher, and the higher their cortisol at night, this gap– this spread between morning and night– the smaller that spread got, showed a greater increased correlation risk of cancer than even smoking.

Evan Brand: Whoah!

Dr. Justin Marchegiani: So, it’s really important that we keep the sympathetic nervous system– you know, we keep it so we can oscillate and adapt between parasympathetic and sympathetic. So a couple things we do is adaptogenic herbs; can be really helpful.

Evan Brand: What are you taking there?

Dr. Justin Marchegiani: That’s just some Ashwagandha-

Evan Brand: Oh, okay.

Dr. Justin Marchegiani: -and some extra vitamins. Uh– On top of that would be, of course, a really good anti-inflammatory nutrient dense diet, uh– along with blood sugar stability, ‘cause sometimes low blood sugar going into bed can create cortisol uhm— surges in the middle of the night.

Evan Brand: I remember when my nervous system was screwed up. This was like 2015. It’s like three and a half years ago. I was about to move back to Kentucky, and– and I called Justin. I was like, “Justin,” I was like, “I’m freaking out, man.” I was like, “My heart is beating a thousand beats a minute. I can’t get it to slow down.” And that was when I was about to move so the house was in boxes. Do you remember this?

Dr. Justin Marchegiani: Yup. I remember this.

Evan Brand: The hou— The house was in boxes. We were getting ready to pack up and move the next day, and you said, “Hey. Just try like a gram of Magnesium.” So that’s what I did, and then I ended up doing like an Epsom Salt Bath too with some essential oils, and I calmed it down. But I’ll tell you from firsthand experience, if your nervous system is screwed up, if you have more stress– you know, people say the term, “Work hard. Play hard.” If you don’t work hard and then rest hard, you’re– you’re gonna be messed up. And for me, you know, I had all of these impending uh– transition of moving and such, and I was not mitigating my stress properly. I was doing my adaptogenic herbs, which is great, but I was probably not getting enough exercise, sunlight, etc. So I’ve been there, done that, and it’s not fun. So, you have to make sure– I’ll just kind of say it in a different way. However much stress you have in your bucket, you’ve got to have an equally large bucket of de-stressing activities: meditation, massage, float tanks, herbs, going to bed on time, blocking blue light at night, etc.

Dr. Justin Marchegiani: One hundred percent. Like in my line, I have a product called Magnesium Supreme, which is a Magnesium dimalate, which is great. There was this other Magnesium uh– powders that are great. I’ll do a little bit of Magnesium with some Collagen, which has Glycine in it, and the Glycine can be really calming and relaxing too at night time. So I’ll do that before bed as well. People can also do some of the decaf Tulsi teas are excellent ‘cause that kind of has an adaptogenic effect. Some people would do even the Ashwagandha, which is great. Ashwagandha Supreme’s awesome. Do that one to two caps before bed. Just do recommend testing it out during the day just to see how you do. Some people, they get really energized with it, so you– you want to just make sure it’s not– you’re not one of those people that really get over– overly stimulated with the Ashwagandha. You can always do some other teas like the Camomile tea. The Tulsi decaffeinated teas are excellent ‘cause that’s Holy Basil, which is kind of a– a similar adaptogen as Ashwagandha, where it help– really helps calm and relax. You can always do some sublingual or liposomal GABA. We can even add some L-Theanine, too, which is an amino acid that’s really calming and– and relaxing as well. Uh– Anything else you wanted to ask, Evan? Al– Also uhm— Phosphorylated Serine is a nice adaptogen that helps calm the Hypothalamus’ response to Cortisol, so it can help really relax that Cortisol response at night, in case you got this reverse Cortisol rhythm pattern that’s happening.

Evan Brand: Yeah, and–

Dr. Justin Marchegiani: What, Evan?

Evan Brand: yeah, I do. Yes, and I’ll first comment on the Phosphorylated Serine. People may think you’re just pronouncing it different or wrong. You’re not. No. This is different than Phosphatidylserine. This is Phosphorylated, so there is a difference that’s he is talking about. I’m a huge fan of Lemon Balm. I have Lemon Balm tincture [crosstalk] in my– Yeah. I’m growing it in my garden but it’s a lot easier to just buy an organic Lemon Balm tincture. So I do that, and then, Motherwort, another favorite. Uh– There’s a couple different herbalist that I look to for education about herbs. And one herbalist said that taking Motherwort is like getting a hug from planet Earth, and I would agree with that statement completely. It’s a weird thing to describe how are you getting a hug from planet Earth? But when you take Motherwort, you just feel like you’re cuddled. You feel like you’re getting swaddled like a little baby. And so I take Motherwort and I just go lay down, and it’s basically– uh– I mean, It just takes all of your worries away. It’s a very, very calming thing to do, and it’s really great for people with heart issues– you know, atrial flutter, atrial fibrillation, any other type of like a sympathetic overdrive heart issue. Obviously, if you’re taking pharmaceuticals, you got to see if that stuff matches up. But if you’re not on pharmaceuticals, Motherwort is a really good go-to.

Dr. Justin Marchegiani: Excellent. We can also do things like Melatonin. I always recommend if you’re using Melatonin, if you have good benefits with Melatonin, try to use more of the 5-HTP with B6 first ‘cause that provides more of the building block amino acids to make the Melatonin hormone. I always like providing more of the building blocks and precursors. Some people, they just have burnt out their Serotonin from stress or from too much sugar or inflammation. So those building block kind of pulls to make their Melatonin can be lower. So I was recommend that utilizing some of the 5-HTP with B6 first. I think that’s great. And if you need Melatonin kind of in a punctuated fashion, I always have some lipo– a sublingual version by my bed. So if I’m just coming off a weekend where I was up a little bit later, [clears throat] or if I’m up at night where I’m more stimulated, I can just get it in my system in five or ten minutes and have it be done ‘cause it’s going to my sublingual tissue so it’s there right away.

Evan Brand: And dosing on that is how much, typically?

Dr. Justin Marchegiani: I tend to always start super low, so anywhere between two to three hundred micrograms and up to one milligram. Most people they all start at even at three milligrams, right? So I try to start super low because I just need the– the kind of the sedation-relaxation, kind-of-going-to-sleep effect. I don’t need it to kind of nurse me throughout the night.

Evan Brand: And most people overdose on Melatonin.

Dr. Justin Marchegiani: Mm–

Evan Brand: What we see when we test people is that people that are doing like 5-10 milligrams Melatonin, well, look at their Cortisol pattern, and they don’t have that morning spike with their Cortisol like they should ‘cause the Melatonin opposes Cortisol and vice versa.

Dr. Justin Marchegiani: Yeah, so– I always say, we’ll give them like a 1 mg like sublingual lozenger and we’ll have them nibble off a third, and just see how they’re doing. And they can gradually increase it if they need it. So I’m fine with that. And also, just– sometimes people wake up in the middle of the night. They have a pattern or a rhythm of having a hard time going back to sleep. There can can be stress that happens just sitting there wondering if they can go back to sleep. So, sometimes, if you’re that person that’s– it’s better to almost as nibble on a little bit of Melatonin ‘cause then at least you’re done what you need to get back to sleep, and that helps negate that Cortisol response from you wondering if you’ll get back to sleep.

Evan Brand: Yeah. I would also like to bring up emotional stress too. If that’s unaddressed, that’s gonna keep you up at night. So if that’s a financial worry, or a relationship problem, or you hate your job and you don’t want to go to work the next day– something like that, you got to address it. So, I would try to write down a big list of all of the stressors. What are the things you can control? What are the things that you can do? What are the action steps to resolve those stressors? And then, for some of the stuff you can’t control, like maybe you’re stuck in this job, you don’t like this boss right now, maybe you can do some EFT– and you tapped about it. You know, even though I don’t like this boss, I deeply love and accept myself, and you just do your tapping and affirmations. That could help too. And then– I know you may have a couple of other things to go into, but we should definitely just really hit on the fact about testing ‘cause you brought up the Serotonin and how people burn that out due to stress. We don’t just guess with that. We always test people, and we can measure it.

Dr. Justin Marchegiani: Oh, totally. Yeah. I mean, on the stress thing– I mean, what I’ll do is I’ll just use my– my to-do list, either on Google Task or just on my iPhone, and I’ll just punch in what are– what are the top three things that are keeping me up. ‘Cause the big thing is, as long as I’m taking action on those things, it’s usually the– the uncertainty and the lack of action taking on a– a stressful task that creates the uncertainty. So– Hey, what are those top three things? And just make sure we’re doing something to close the loop, so we’re always doing something. So we’re not sitting back and kind of being a spectator so to speak.

Evan Brand: Yeah, being paralyzed from it.

Dr. Justin Marchegiani: Hmhm– Yeah. Always make sure you’re doing at least something to get the monkey off your back.

Evan Brand: And then did– did you have other categories or body systems you wanted to hit on? I think we hit the gut briefly. I will say that gut infections can mess up your sleep. When I had parasites, my sleep was terrible.

Dr. Justin Marchegiani: Yeah. Infections can be a stressor, and these infections are more active at night time, so the inflammation they create at night, the body may respond by producing more anti-inflammatory hormone, i.e., Cortisol. Cortisol’s also stimulatory as well, so that could wake you up. So we– you know, we do our best to clear out the gut infections. That could be more of a long-term strategy. We may use palliative things first, like I mentioned, the Magnesium, the Calm, the Motherwort, the– the 5-HTP with B6, the Melatonin, all of the healing and soothing and calming herbs, and adaptogens first. And then, of course, we get the patient ready so they can get to that next step and do the killing efficiently. We may work on the blood sugar stability before bed and have something by their nightstand in case they are waking up with low blood sugar. They have uh– easy smoothie or an easy bar right there at their nightstand, and they access if needed.

Evan Brand: Yeah, good. Like a little fat bomb, you know, like a little big chunk of coconut or something like that that’s gonna give you some fats.

Dr. Justin Marchegiani: Yeah. EPIC Bar, one of these collagen bars, or a little smoothie that’s already made in a shaker cup– It’s already ready to go. We just don’t want you having the to get up, go to the fridge, the bright light pops on, or you having to use your head to make– to mix whatever you’re doing. I just kind of want to on autopilot. So if you need something, it’s just there, ready to go.

Evan Brand: Yup, yeah. So parasites for me, I mean, that was the biggest one. I had an H. pylori infection too. That screwed up my sleep. My sleep is much, much better now. Of course, you know, with the baby, we’re– we’re getting there. We’re almost out of the woods with her sleep, so I’m gonna be sleeping much better. I already am sleeping better than– than previous, but uh– Let’s talk about the testing too because I think it’s important. People can go and buy all these supplements. You can buy Melatonin, Ashwagandha, etc., etc. And as you mentioned, it’s more palliative. It’s not really root-caused. So you hit on the adrenals. We talked about testing for that. We do that with Saliva panel. You can measure the 24-hour rhythm or you could do urine, but either way, you want to look at the morning, how the day progresses, and then evening, take a snapshot there. If there’s Cortisol issues, you have to fix it because that could be messing up your gut, ‘cause if the Cortisol’s too high, that’s catabolic. So then it’s eating your tight junctions away in your gut. Then you have leaky gut. Then you get autoimmune condition. Then you’re really screwed. So, you got to test adrenals, and then step two– you mentioned the brain chemistry, the serotonin– so we run organic acids testing on everyone through urine. It’s a great test, and it looks at, also bacterial infections and yeast, dopamine levels. It looks at your endorphins, amino acids, etc. And then step three– we talked about the gut– getting the gut tested, running a stool test– we do this at home. So if you work with Justin or I, we send a test kit to your house. You collect stool. You look for all the infections, and then we come in and we address those. And then, maybe, we’re doing some of the stuff behind the scenes along the way, but you have to fix those big body systems if you really want to sleep good and have long-term health.

Dr. Justin Marchegiani: Absolutely. So we have kind of the anti-inflammatory, nutrient dense, low toxin diet going. We’re working on the gut. We’re working on the hormones. Oh! Also, low progesterone and some hormonal imbalances, I see it with a lot of my women that have severe PMS or they’re perimenopausal or menopausal, postmenopausal. The hormonal imbalances from progesterone and estrogen, either going low or being out of balance at certain times of the month, can easily throw off the cycle, or– I’m sorry, sleep– easily throw off your sleep.

Evan Brand: Now, would you say that– would you say like Estrogen Dominance is what’s happening?

Dr. Justin Marchegiani: Well, it can because Estrogen Dominance tends to imply lower progesterone, and progesterone kind of open those GABA chloride channels and GABA is an inhibitory neurotransmitter, which means it helps you relax and turn off. So, GABA’s kind of the switch that allows the sympathetic nervous system to go off and the parasympathetic to go on, which is important so you can wind down and chill out. So, that can be helpful. So some of our cycling patients or even our menopausal patients will give some progesterone at or around bedtime, or we’ll have them dosed their progesterone at around that time of the day anyway. So it really help with relaxation.

Evan Brand: And you’re talking like how much?

Dr. Justin Marchegiani: Uh– It depends, but typically with patients, we’ll do anywhere between 25 mg to 50 mg.

Evan Brand: Man, that’s like a typical dose. Like you’ll see like a teaspoon of like a micronized progesterone. It’s like a pretty standard dose.

Dr. Justin Marchegiani: Yeah. Twenty-five to 50 milligrams is pretty good. It just depends on how low the person is. We may go up more, above that– you know, go up to 200, and just if we continue to see benefit or improvements, that’s good. And if we see lower levels that will give us more motivation, then we should go higher. But I always like to start lower with hormones because progesterone can sensitize Estrogen receptor sites, so people can get symptoms of Estrogen dominance as they increase their progesterone because of that receptor site sensitivity. So starting lower tends to help the body adapt to the dose-type of responses. Kind of like it’s easier to get into cold water if you can kind of start with warm water and gently nudge the temperature downward. Kind of like that.

Evan Brand: Yup. Well said. Were there any other body systems or things we didn’t hit on yet?

Dr. Justin Marchegiani: Well, we talked about the amino acids and the neurotransmitters. We talked about uhm— B6. We always like to combine there ‘cause B6 is really important to uhm— these neurotransmitters converting and synthesizing. So, if we have Mitochondrial stress, if we had dysbiosis, B vitamins are made in the gut. A significant amount, obviously a lot, will come with food and– and healthy meats, and good animal proteins, and good plant material. And then after that, uhm— minerals are important. People that tend to eat lots of sugar and excess carbohydrate and refined sugar, they’ll be depleting their Magnesium ‘cause Magnesium’s one of those nutrients that gets burnt up with excess carbohydrate metabolism. So Magnesium’s really important. That will help uh– have a– a really good relaxation kind of effects. So that’s important as well. And then, just some of the diet– some of the lifestyle strategies is keeping the– the lights down at night, blue-blocking glasses can be great. I use them sometimes. For me, I can go from sympathetic to parasympathetic like that, so it’s not like this huge thing. But I think if you have a hard time coming off of a TV or a movie, or just in general, that could be a good thing to kind of help the parasympathetics turn on faster and better, so keep that in mind. I will find like– I find watching TV like at 9:00 o’clock or 8:30, and I have those glasses on. I’ll want to go to sleep so– so much faster.

Evan Brand: Oh, yeah.

Dr. Justin Marchegiani: Really, just like, “Whoah!” I’m just like– So I mean, it’s like go to bed a little too early so– so I like a little bit of stimulation so I know I’m ready.

Evan Brand: Yeah. I mean, I– I’ve got a pair of it I gave my wife to wear, and we both wear them. We get super sleepy quick and we basically just–

Dr. Justin Marchegiani: Yes.

Evan Brand: We have uh– salt lamps on at night, and that’s pretty much it. We don’t really have any overhead lights at night, so we– we try to live like we’re hanging out at a campfire in the evenings-

Dr. Justin Marchegiani: Yeah.

Evan Brand: -and it– and it works great.

Dr. Justin Marchegiani: And for me, we have blue-blocking uhm— night lights so– In my son’s room if we need to or– In our room, if we need to, we have night lights. So if we need a little bit of light, which sometimes we do, is at least not emitting any blue light, so that’s not gonna stimulate the Melatonin. Right? It’s the blue light that gets the Melatonin going, so more of the infrared uh– red frequencies tend to be less Melatonin s– uh– less Melatonin-inhibiting.

Evan Brand: Yep. Yep. Well said. So the light piece you cannot ignore. Like you take all the perfect supplements, you got a big bright light or you’re checking your phone right before you go to bed and you’re not using blue-blocking technologies, then you’re screwing yourself up for sure. I saw a question uh– if you’re ready to hit questions, it was a-

Dr. Justin Marchegiani: Yeah.

Evan Brand: -question about PQQ, and whether it improves sleep or not. I did find a study on that, and it was just titled exactly that, “Oral supplementation PQQ on stress–”

Dr. Justin Marchegiani: Uhmhm–

Evan Brand: “-fatigue and sleep,” and turns out that yes, it definitely does help in terms of sleep onset sleep duration. And it does help to reduce fatigue, tension, anxiety, depression, anger, hostility, and confusion. So, PQQ’s great. I mean, we do use some of PQQ and some of our protocols. It’s a great [incomprehensible]

Dr. Justin Marchegiani: [incomprehensible] from mitochondrial function? It’s– There’s research showing that it actually can help regenerate Mitochondria.

Evan Brand: That’s so cool ‘cause when you hear about Mitochondria, it’s kind of like brain cells. People used to think that once your Mitochondria get damaged, you’re toast, but you’re not. You can actually regenerate Mitochondria, which is cool.

Dr. Justin Marchegiani: A hundred percent. Any other questions you want to highlight here, Evan?

Evan Brand: Yeah. Let’s see here. There was one that said, “If I’m in a toxic environment, is it smart to do fasting if I wake up at night hungry?” That’s kind of a confusing question. Do you understand that one?

Dr. Justin Marchegiani: Well– I mean, I would say– So like, do you mean– I’m gonna make some assumptions– meaning toxic like poor air quality or mold in the environment? I mean, I would say, number one, you’re gonna– as long as you have access to good quality food, I would say, eating is gonna provide the nutrition to run those detoxification pathways. Alright, part of the benefit off fasting is uhm— you’re not putting any food in your body, so you give your gut a chance to rest. So if your gut’s inflamed or stressed, that makes sense, but if your gut’s already healthy and you’re putting really good food in your body, well that nutrition’s important to run your metabolic pathways. Your metabolic pathways either go in debt to run, meaning they– they burn up other tissues, which may be good if it’s fat, but they need nutrition to run. As far as I’m concerned, your fat does not store a whole bunch of uh– vitamins and minerals. It has a lot of caloric reserve. It doesn’t have any mineral or fat reserve, and you may have some fat-soluble vitamins stored in your liver– A, B12– B12 tends to be a little bit– even though it’s a water-soluble vitamin, it tends to be stored in higher amounts in the liver from what I understand. Uhm– But in general, I would say, you– you want to make sure you have good nutrition to run those pathways optimally.

Evan Brand: Another question here. It was about uh– Samuel. He said, “Seems like the blue light blocker fad is winding down. Is it still effective for proper sleep?” Of course it is. It’s not a fad. It should stay here forever. Blue light is never gonna not affect Melatonin. Period. Once the– Once we figure that out, I think that’s a lifetime strategy.

Dr. Justin Marchegiani: I still don’t understand why a lot of people just have them on during the day ‘cause I just like, “What’s the point?” Because don’t you want that stimulation during the day? You want that Cortisol.

Evan Brand: You do.

Dr. Justin Marchegiani: So I don’t understand. I see people like Dave Asprey and uhm— Dr. uh– Jack Kruse. They have them on during the day, and I’m just like– I mean, maybe if you have some kind of timezone switch and you’re trying to adapt to a timezone maybe and you’re overly stressed and you’re trying to decrease that stress response, fine. But during the day, I would think you’d want to have that Lead exposure especially in the first half of the day, and then the last half of the day, maybe after 5:00 PM if you’re trying to get that nervous system to quiet down, maybe you’d throw in the blue-blockers to help accentuate that parasympathetic shift.

Evan Brand: Yeah, I chatted with Dr. Mercola about it. He says the only time and reason that he wears the blue-blockers during the day is if he’s in like a conference hall or something where it’s all artificial lighting-

Dr. Justin Marchegiani: Artificial light.

Evan Brand: -and he has no sunlight. So, if it– if you’re getting exposed to fake blue light during the day, and you still have sunlight-

Dr. Justin Marchegiani: Uhmhm-

Evan Brand: -opposing it with windows or your outside, you’re in good shape. But whe— when you have nothing and you’re in like a dark hall, and all you have are these fake lights, that’s when I know Mercola said he will use the glasses. And so that’s kind of the– the two cents there. Charlie asked, “Should you eat carbs like a sweet potato or honey before bed? How long before bed for optimal sleep?” I don’t worry about the timing, but I do feel like I sleep a little bit better with some starch at dinner.

Dr. Justin Marchegiani: Yeah. I think people that have lower Cortisol at night, tend to go lower at night do little bit better with some carbs. So I think, number one, if you know your adrenals tend to be a little bit lower in the cortisol side, try it. Just try doing a little bit of carbs before bed. If you have a device like a FIT-BED or an Oura Ring but has some HRV attached to it, try it and then see how your HRV, which is kind of uh– window into your nervous system. See how that looks at night time. But I mean, if you’re having times where you’re waking up at night, definitely throw a little bit of carbohydrate in there with some protein and fat, and see if that makes the difference.

Evan Brand: Yup. Uh– Elizabeth said she used to have trouble sleeping and she was told she had parasites, so she got rid of the parasites and she slept. So yes, that’s awesome.

Dr. Justin Marchegiani: Yep. We see that a lot. That’s great. Awesome.

Evan Brand: I know–

Dr. Justin Marchegiani: And you got uh– major questions here you want to run down that are pertinent to the podcast here guys? Do you have any questions? Try to keep it to the sleep podcast. I’m gonna try to, in the notes, always put like in the beginning like, “Hey this podcast is on whatever topic.” In that way, you guys can chime in accordingly.

Evan Brand: Uh– Yeah. Mike asked, “Blue light is for the light of the morning, why would you want that all day?” So– I mean, the sun emits blue light all day until-

Dr. Justin Marchegiani: Yes.

Evan Brand: -the spectrum starts changing and then you start to remove blue light naturally as the sun sets. So that’s how it’s supposed to happen. The atmosphere starts to filter out the blue and greens, and then you transition into darkness. So that’s how it suppose to work, which is why being on the computer at night with no blue-blocking software or the glasses is– is not good. So I don’t do any– pretty much any screen too late, and if I do, it’s always with the blue-blocking glasses or software on.

Dr. Justin Marchegiani: Yeah.

Evan Brand: I think that’s all the pertinent ones.

Dr. Justin Marchegiani: Yeah. On my iPhone, I have the night shift on and I went in and I– I like turned off all the blue so it’s only red at night. And that doesn’t mean I can be on my phone right before bed, like if I’m like– I don’t know– like getting my alarm set or making a couple of notes on my to-do list for tomorrow, doesn’t affect me at all, but I also have to have all of the blue off, 100%. And I have the light on the lowest possible uh– setting as well.

Evan Brand: Yeah, like the brightness itself-

Dr. Justin Marchegiani: Yeah.

Evan Brand: -turned down? Yeah.

Dr. Justin Marchegiani: The brightness all the way down. All of the blue totally off so it’s just red that’s showing and it’s just the– the tiniest bit. But then if I have to like– let’s say I have to go on a comp– the computer like late to do some work, something got missed, then I will use my blue-blocking glasses just because I got all these monitors on. So that’s when it’s really nice. If you have to do work a little bit later, use your glasses for that.

Evan Brand: Yep. Excellent. Kruse said something interesting last time I spoke with him, which is he thinks people should be wearing scarves around their neck because the blue light penetrates through the skin and it can affect the thyroid and cause Hashimoto’s. I think it’s an interesting thought.

Dr. Justin Marchegiani: Oh my gosh! Okay. Uhm– [laughs]

Evan Brand: I’ve been interviewin

Dr. Justin Marchegiani: Here’s the deal. I’m always open to trying it so like if you feel less stimulated, great. Awesome. Give it a try. Will that cause Hashimoto’s, I’m not really worried about it. Uhm– There’s way other– way more triggers that people are already activating with Gluten and with infections and blood sugar. I’m not worried about that. Now, if uhm— And also VItamin D is really important, right? Vitamin D has a major effect on the immune system and can help modulate the immune response, but I wouldn’t– I wouldn’t [laughs] jump to that conclusion on the Hashies first but I think it’s worth trying if it helps you feel less stimulated for sure.

Evan Brand: Right. Right. Yeah. I mean, I think if you’re desperate, that’s something you should definitely look at. If it reduced your antibodies like let’s– I think the only way to track it would be if you had all other variables dialed in and then you put on the scarf at night, so therefore the blue light didn’t penetrate to the thyroid and then all those antibodies went down but you did nothing else. That may be a way to quantify it but that’s hard. It’s hard to quantify.

Dr. Justin Marchegiani: Yeah. For me, like blue light I think is optimal because there is some data, I think, In TS Wiley’s book, uhm— “Lights Out.” She talked about, I think, a study at the University of Chicago where they had people like a sleeping– sleeping, and then they would like shine a light. They would like put a light right in the back of someone’s knee.

Evan Brand: Yes. That’s right.

Dr. Justin Marchegiani: And it would like wake them up or pull them out of sleep. I’m not sure if it woke them up or it just made their– their sleep uhm— their sleep study look, you know, more unfavorable so to speak.

Evan Brand: I– I think it down-regulated Melatonin too.

Dr. Justin Marchegiani: Yes.

Evan Brand: And it was literally a light the size of like a nickel behind the kneecap, and that was enough to affect Melatonin.

Dr. Justin Marchegiani: Right. So I look at like blue-blocking glasses at night time is like the lights are down to a– a dimmable level, and maybe you want to watch TV or some Netflix or check out your iPad or whatever, like that’s where I find it’s really good. Ideally, you want everything kind of dimmed down.

Evan Brand: Agreed.

Dr. Justin Marchegiani: So you don’t want all the lights on, all the lights on, and then the blue-blockers on.You’d want everything down and then you’re using it just so you can engage with your technology, or watch a show and not be– you know, overly sympathetically stimulated.

Evan Brand: Yeah. That’s an important note. Is environmental light needs to be reduced as well. You can’t just blast yourself. “Oh! I have blue-blockers. I’m fine.”  I agree. It’s got to be both-

Dr. Justin Marchegiani: Yes.

Evan Brand: -which is why I did nothing but salt lamps at night.

Dr. Justin Marchegiani: Yeah. Best investment everyone can get is number one, uhm— like for your bedrooms, get blue-blocking night lights and/or like a night– a bulb that’s like a blue-blocking bulb, and/or number two, in all the major rooms that I’m in like around night time, they all have dimmer switches. So if I have to use lights in my bedroom, I put on the absolute lowest setting; of my TV room, lowest setting; or for like– you know, around my TV or bathroom, absolute lowest setting. That way, I can at least, you know, decrease the intensity if light has to go on.

Evan Brand: Yup. Yup. I think that was all the questions. So if people want to reach out– I mean, we always test people. Could you take some of these supplement recommendations and benefit? Probably so, but we do like to test people and figure out what’s really going on. So if you want to reach out, you can do so to Justin at his site, justinhealth.com. Justinhealth.com. And if you want to reach out to me, it’s evanbrand.com. We love helping you all. We love getting the data. We love seeing the difference too, like after we implement something and then the Cortisol rhythm’s fixed and then the sleep is fixed, it’s like, “Oh! That’s why you’re sleeping better. Look at your Cortisol. It went from 12 units at night to now it’s one unit at night.” It’s really satisfying to see the results on paper.

Dr. Justin Marchegiani: One hundred percent. And we appreciate the awesome questions from everyone who kind of chimed in, and we think we’re one of the only people that does a live podcast like this and answers questions just live, right? We’re functional medicine health improv here so we appreciate the great questions. Give us a share. Give us a thumbs up. Make sure you hit the uh– notification bell. And anyone that– your friends or family that that needs more help or wants to chime in and be part of this great conversation, we appreciate uhm— you sharing the word. So thank you so much, everyone and Evan. Today was a– a great podcast as always and let’s talk real soon.

Evan Brand: Take care, bye.

Dr. Justin Marchegiani: Thanks. Bye.


A recent study about Optimal Amount of Sleep for Cardiovascular Health

Night Shift Nurses Sleep Study

The WHI Estrogen/progestin and HERS II Study

“Lights Out” by TS Wiley



What Your Brain is Really Hungry For

What Your Brain is Really Hungry For

By Dr. Justin Marchegiani

Alzheimer, dementia, and other neurodegenerative diseases are on the rise. Many people are under the impression that these diseases happen when you’re older, in your 60s, 70s, 80s… but this belief is wrong. Brain damage and deterioration actually starts when you’re young, in your 20s and 30s. It is only once enough damage has occured and symptoms start to show that a diagnosis is made.

How might a young person be causing such damage to their brain that they could end up with Alzheimer’s or other similar diseases? There are a few common patterns:

1) Insulin resistance: in some circles insulin resistance is even being referred to as Type III diabetes!

2) Autoimmunity: which can drive neurodegeneration in the brain.

3) Environmental toxicity: including heavy metals like aluminum, mercury and lead.

Today we’re going to be focusing on the effects of insulin resistance and its role in neurodegenerative diseases. Insulin is a hormone your pancreas creates that allows your body to use glucose (sugar and carbs) for energy. Insulin resistance is what happens when you consume too much sugar and carbohydrates, and your body stops reacting to insulin.

How does this relate to the brain? Well, it is a scientific fact that while the brain only represents about 5% of our body weight, it consumes nearly 25% of our nutrition and oxygen. When you consume too much sugar and carbohydrates, you become insulin resistant. Insulin resistance keeps the glucose trapped in the bloodstream and unable to be used for energy. Your brain becomes less and less capable of utilizing the glucose found in sugar and carbs for energy, and your begins to starve. If the brain is starving for glucose, the fuel needed to power our higher brain function is no longer accessible.

Optimize brain health by clicking here.

Hearing that these diseases can start if your brain is starving for glucose might lead you to believe that you should just consume more glucose, right?  It’s important to remember that excess glucose is what started this whole problem in the first place. Excess glucose in the blood is what caused insulin resistance, and also causes something called AGES(advances glycation end products). AGES are free radical magnets that damages our DNA, accelerate aging, and even cause wrinkles.

What the most up to date research is showing is that our brain can adapt to burning fat or ketones for energy. Essentially 80% of our brain can run off of ketones, so other areas that were perhaps starving now have access to a new fuel that can bring to life parts of the brain that may have been asleep.  One of the most popular fats that are being used are MCTs (medium chain triglycerides), which are abundantly found in coconut oil. These fats are unique because they are easily digested and converted into ketones which become brain food rather quickly.

Next time your sitting down to a meal, it’s a wise choice to avoid the excess sugar and refined junk and eat organic whole foods, especially vegetables, healthy fats, and proteins.  The solid portion of your brain is 70% fat, so make sure you get an extra serving of healthy grass-fed meat, wild salmon, and coconut oil. This will help your brain function at the highest level possible and help prevent the occurrence neurodegenerative disease in your future.

Click here for more ways to improve brain health and functioning.

Are Artificial Sweeteners Safe?

Are Artificial Sweeteners Safe?

By Dr. Justin Marchegiani

Artificial sweeteners such as aspartame and sucralose are low- or zero-calorie alternatives to natural sweeteners. Without much other information, this sounds like a great option for those trying to lose weight or improve their health, but there are actually many hidden dangers and side effects that stem from the consumption of artificial sweeteners.

How Artificial Sweeteners Affect Your Health

How Artificial Sweeteners Affect Your Health

Time and time again studies have shown that artificial sweeteners negatively impact your health. Researchers were astonished to discover that regular drinkers of diet soda were three times more likely to develop stroke and dementia. Consuming artificial sweeteners has also been linked to higher rates of depression, kidney damage, type 2 diabetes, arthritis, multiple sclerosis, headaches and migraines, hyperthyroidism, lupus, brain tumors, low blood sugar, and cardiovascular disease!

When you consume diet or sugar-free products, the zero-calorie artificial sweeteners play tricks on your taste buds and on your brain. Your brain senses sweetness, and our bodies expect the calories that usually follow with the sweet signal. Studies show your body can still produce an insulin spike, hence the relationship between sugar-free sweeteners and diabetes.

In addition to an unwarranted insulin spike, the lack of calories in artificial sweeteners leaves you very unsatisfied, and research shows people fill the calorie gap with other foods in order to become satiated. And since artificial sweeteners range from 200-20,000 times sweeter than sugar, they are addictive. Consumers of these sweeteners literally become addicted and crave more and sweeter foods.

Another large contributor to the dangers of artificial sweeteners is the effect that they have on the microbiome. Artificial sweeteners disturb the bacteria in your gut, which can cause glucose intolerance even in healthy people, and tampers with the gut-brain connection.

Click here to schedule a consult to determine if autoimmune diseases are causing your health to suffer!

Where to Find Artificial Sweeteners

Artificial sweeteners are often hiding in plain sight. Most products labeled “diet,” “sugar-free,” and “low-sugar” will contain artificial sweeteners. Use the following chart to identify common artificial sweeteners and their brand names:

Artificial Sweeteners and Brand Names

Other sources of artificial sweeteners include:

  • Diet soda
  • Sugar-free desserts (ice cream, sugar-free baked goods)
  • Low-sugar/Sugar-free fruit juice
  • Flavored water
  • Diet iced tea
  • Flavored coffee syrups
  • Yogurt
  • Toothpaste and mouthwash
  • Salad dressing
  • Packaged Meats
  • Sugar-free gum and mints
  • Sports and nutrition bars
  • Meal replacement shakes and snacks
  • Sports drinks
  • Sugar-free candy

Healthy Alternatives

Healthy Alternatives

If you are reducing your sugar intake but still want to sweeten your meal or drink, opt for one of these healthier options instead:

Stevia: Stevia is a plant, and is temperature-stable, meaning you can safely add it to both hot and cold foods and drinks. It is zero-calorie and zero-carb, and has zero of the side effects associated with artificial sweeteners.

*Tip: liquid versions of stevia are easiest to dose.

Organic dates: Dates are another great option. While high in sugar, using dates in moderation provides you with vitamin B, manganese, magnesium, copper, iron, and potassium!

Honey: Raw and local is best! Local honey can help with allergies. Raw honey contains enzymes, antioxidants, iron, zinc, and many other vitamins and minerals that promote healthy gut bacteria. To retain the health benefits of raw honey, keep it away from heat. If you want to use it to flavor a warm beverage, rather than adding it in right after boil, wait until your tea or coffee cools down.

Coconut sugar: Coconut sugar has a low glycemic load, which makes it a great choice as an alternative to sugar. It is also rich in minerals, polyphenols, and antioxidants!

Maple syrup: A sweetener rich in antioxidants and minerals, maple syrup is a simple and natural choice, straight from the tree!

Try swapping diet soda for kombucha, a delicious fermented tea packed with probiotics! They even make kombucha that is flavored to taste like popular types of soda, only the kombucha versions are actually beneficial for your health. If you’re going to have dessert, avoid ‘sugar-free’, ‘diet’, and ‘low-sugar’ packaged foods. While cooking at home, rather than feeling constrained because you are avoiding artificial sweeteners, have fun and experiment with the abundance of natural options available!

Click here to work with a functional medicine doctor and receive the help you need to get back to optimal health!

How Sugar Feeds Illness

 How Sugar Feeds Illness

How Sugar Feeds Illness

By Dr. Justin Marchegiani

America takes first place… as the top consumer of dietary sugar in the world. Our sugar consumption is a major player behind the skyrocketing rates of chronic diseases like diabetes, obesity, and cancer. The average American now consumes an average of 130 grams of sugar per dayfor reference, the daily recommendation for women is a maximum of 20 grams a day! This is more than just sad: it’s dangerous. Today we are going to outline some of the effects of sugar on our immediate and long-term health.

What is Sugar?

What is Sugar

This might seem obvious, but food producers are getting craftier with their labeling as they realize more and more people are making the choice to eat healthier. Sugar goes by many names, with new ones popping up all the time. Some sugars are natural, most are processed, and more and more are being created in labs. Here are just a few names to look out for on product labels:

  • Agave
  • Brown sugar
  • Corn sweetener
  • Corn syrup
  • Fruit juice concentrates
  • High fructose corn syrup
  • Honey (raw, pasteurized)
  • Invert sugar
  • Malt sugar
  • Molasses
  • Raw sugar
  • Sugar
  • Sugar molecules ending in “-ose” (dextrose, fructose, glucose, lactose, maltose, sucrose)
  • Syrup

Click here to consult with a functional medicine doctor and discuss underlying health issues preventing you from living your best life!

What About Fruit?

Yes, fruit technically contains sugar, in the form of fructose. However, there is a big difference between enjoying a piece of fruit as an after-dinner treat, versus having orange juice with breakfast and fruit juices as your beverage of choice throughout the day. Studies have shown that eating fruit whole can lower risk of developing type 2 diabetes, drinking fruit actually increases your risk! The fiber you get from eating fruit whole slows the absorption of the sugar and keeps the glycemic index low. Plus, it takes a lot more squeezed fruit to fill a glass than you could possibly eat in a serving, meaning you’re consuming way more sugar than you realize!

The Effects of Sugar

The Effects Of Sugar

Consuming large quantities of sugar has been linked to an increased risk of a variety of chronic diseases including obesity, cardiovascular disease, diabetes and non-alcoholic fatty liver disease (NAFLD) as well as cognitive decline and even some cancers!

There are also many health issues caused by sugar that aren’t as talked about:

Sugar depletes the body of critical electrolytes, antioxidants, and minerals, which leads to cell death, muscle spasms, insulin resistance, and other health defects. Its effects on the immune system leave you prone to getting sick more often and more severely.

Sugar feeds bacteria and parasites, like yeast and Candida. It also depletes the body of good gut bacteria, promoting Leaky Gut and other gut infections. Chronic pain, vision problems, and even wrinkles can be worsened by sugar!

Sugar causes chronic inflammation in the body, and inflammation is said to be the root cause of almost all disease.

How Sugar Feeds Cancer

Sugar consumption has been proved to feed cancer cells and speed up the growth of tumors. Too much sugar consumption causes insulin resistance, as well as a specific protein to be released from your pancreas. This protein causes your cells to replicate and become immortal, which is how pre-cancerous cells can begin to take over.

Cancer cells prefer glucose over oxygen, but our mitochondria can’t use the glucose as energy. White blood cells are our immune system’s soldiers, and need vitamin C to function properly. A cancer patient needs lots of healthy white blood cells to fight the disease, however, sugar blocks the absorption of vitamin C in our bloodstream, weakening our immune system.

In summary, sugar causes cancer cells to reproduce and thrive, and blocks the mechanisms that would slow down or kill cancer cells and tumors.


Sugar addiction runs deep, and can be hard to kick. Stay tuned for Dr. J’s thoughts on artificial sweeteners, approaches to beating sugar addiction, and healthy alternatives for sugar.

Click here to talk to a functional medicine doctor about staying healthy this holiday season!

Dr. Robert Rakowski – Acid alkaline balance, cancer prevention and the magnificent 7 – Podcast # 129

Dr. Justin Marchegiani and Dr. Robert Rakowski talk about what is new in the Functional Medicine Nutrition as they focus on addressing the root cause of a health problem. Listen to them as Dr. Bob Rakowski shares his experience and expertise in addressing conditions he encounters in his practice including diabetes and cancer.

Learn some knowledge bombs about conventional drugs and vaccines, including its implication to one’s health. Gain tons of information regarding his recommendation when it comes to nutritional needs of his patients depending on different situations and conditions. Also, know the importance of acid-alkaline balance and enzymes in our bodies and how it affects our health.

In this episode, we cover:

3:49   Diabetes

9:40   Improving performance through diet

18:01   Recent studies on vaccinations

25:08   Acid – Alkaline balance

29:26   Nutrition Recommendation for athletes

37:43   Nutrition Recommendation for cancer patients







Dr. Justin Marchegiani: Hey there! It’s Dr. Justin Marchegiani. I got Dr. Bob Rakowski here all the way from Houston Texas. We’re just in his neck of the wood yesterday. Dr. Bob welcome to the show.

Dr. Robert Rakowski: Happy Beautiful day. Honored to be here as always.

Dr. Justin Marchegiani: Thank you. I’m looking forward to some knowledge bombs drop here today like you always do. Well, we got this podcast on video today. So if you’re listening via mp3, check out the YouTube channel link below so you can see Dr. Bob in the flesh. So Dr. Bob, what’s new in your world of uh – Functional Medicine Nutrition?

Dr. Robert Rakowski: You know, that’s a really broad question.

Dr. Justin Marchegiani: I know.

Dr. Robert Rakowski: But let’s just say we get better – we get better, stronger, faster, smarter all the time. The research keeps unveiling that our strategies are simply the absolute best in the history of the game. You know I just had a patient come in take 8 different drugs and uh – you know, for diabetes, right? And some of those medicines just – that’s what they do. But yeah. We have people on good nutrition program where their diabetes resolves the typical case in 60 days or less. So she’s pretty excited to get her health back and uh – you know, stop taking some of those poisons.

Dr. Justin Marchegiani: Its really crazy coz in the world of Conventional Medicine, you have diabetes basically a sugar intolerance, right? Too much carbohydrate too much sugar, receptor issues, metabolic derangement. But nowhere else in medicine that if you have a peanut intolerance or a lactose intolerance, the typical treatment is you avoid the lactose, you avoid the peanuts. But only in Conventional Medicine is it – No, No, No. Keep taking what you’re intolerant to, and let’s give you drugs that shut down absorption of glucose. Let’s shut it – Let’s give you drugs like Glucophage that shut down uhmm gluconeogenesis. Or let’s just give you insulin short-acting, long acting so we can just jam that blood into the cell.

Dr. Robert Rakowski: And all of the above for this patient. So, I wish I met her 20 years ago when she was diagnosed with diabetes. But I’d say, “What happened?” “How did you get diabetes?” She says, “I was fat and I ate a lot of sugar.” It’s like, “Okay, you think that’s what caused it.” Yeah. Well, I think we have a pretty easy solution, right? Like you said, I never have to put it that way. That’s brilliant. It’s essentially sugar intolerance. It’s a carbohydrate intolerance. Uh, but now, she’s post stroke in 8 meds and a lot of them are not doing her any good. And she’s like, “I want my life back.” Well, let’s get it back. You gotta be healthy to get your life back. So-

Dr. Justin Marchegiani: And most doctors that are you know – most people that think the doctors know exactly what’s going on with this. They’re really in the dark. I worked in surgery for four years and I was the one literally holding the limbs on the diabetic as the surgeon will come in and literally tie off the arteries and amputate the limb. Hundreds of limbs passed my possession into the morgue. And I talked to these doctors as they were scrubbing out, I’d say well, “How come we’re in front of this? What’s the prevention? What’s the fore thinking so we can avoid this?” and like, it was just like over their head. They were just there doing what  they were designed to do. And that mindset wasn’t quite in play.

Dr. Robert Rakowski: You know, if you go to a surgeon, you’re gonna get surgery. If you go to a drug doctor, you’re gonna get drugs. If you go to a natural doctor, you’re gonna get uh –

Dr. Justin Marchegiani: Natural Solutions.


Dr. Robert Rakowski: Absolutely. So I got patients in here, they’d be pouring after this podcast. But uh – It’s fun to have a little – a little shift of pace. But even really, our number one focus is education. So – As long as it’s the same line, it’s what we do with every patient at a time.

Dr. Justin Marchegiani. Love it. So you’re uh – we’re kinda talking about diabetes right now. So what are the low hanging free- fruit for anyone that has a metabolic diabetes issue. You can be like PCOS coz a lot of people may not be at that diabetic level. They may have the insulin resistance and kinda be in between.

Dr. Robert Rakowski: Well, you said it first and best. You know, it’s gonna be what we called the Ketogenic Diet. But I like a healthy Ketogenic diet.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: A lot of people – lasted Atkins.

Dr. Justin Marchegiani: Uh-hmm.

Dr. Robert Rakowski: I know some things to blast him about. Like you don’t wanna have the bacon whip cream diet.

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: But you know what, I always tell people my favourite ketogenic diet is leans, greens, nuts and seeds. So lean meats, green vegetables, organic raw nuts, organic raw seeds. That’s a great choice. Now there are some so low glycemic fruits and berries and blueberries are awesome. But as a general rule, we’re gonna do leans, greens, nuts and seeds. We’re gonna exercise. Those are the things that can get us there. Uhm you know, I always tell people, I call them the magnets inside of your gut.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Eat like, drink like, think like, move like, sleep like, talk like everyday if you do that.

Dr. Justin Marchegiani: Love it.

Dr. Robert Rakowski: If you do that, guess what? You can keep diabetes away.

Dr. Justin Marchegiani: I love it. That makes so much sense. And you know, you also mention about lean meats. Now, we know that conventionally, a lot of toxins will get stored in the fat. It’s typically where it goes. So it makes sense with conventional meat for sure. If we’re eating like really good pastured meat, high-quality meat, is it okay to have more full fat meats?

Dr. Robert Rakowski: Yeah. Absolutely so. Uh the president of the Swedish Grass Grows Beef Association – uh I’ve stayed with him at his farm house and a dozen trips to US, Sweden.

Dr. Justin Marchegiani: Wow!

Dr. Robert Rakowski: And they test every single lot of grass-fed beef. And the ratio of Omega 6 to Omega 3 and grass-fed animals is 1:81.

Dr. Justin Marchegiani: Beautiful.

Dr. Robert Rakowski: Which is a very healthy ratio. So you’d eat all that fat that you want.

Dr. Justin Marchegiani: Yeah. And we know if you eat the – the grain, it goes up to 30-40 to 1, right?

Dr. Robert Rakowski: Uh – you know it’s stored in so many ways. The animals get sick. They put them on antibiotics and the meat becomes more anti-inflammatory by multiple mechanisms beside the omega 3, omega 6 ratio. So, not a good strategy there. We want healthy animals. Do you know what you’re animals – Do you know what you’re food is eating? That’s important to know.

Dr. Justin Marchegiani: Yeah. Absolutely. That makes a lot of sense. Now in my clinic, when we look at blood sugar issue, some of the things I look at, obviously, A1C, uh- fasting glucose can be helpful. Uh – triglyceride:HDL ratio, fasting insulin. And even just the good blood sugar mirror to see how they do right after a meal. Kind of like a functional glucose tolerance. Just curious to get your take on that. And uh – what test are you doing in your office to look at these issues?

Dr. Robert Rakowski: You know all of the above. Everything you’ve just said. And those are pretty much gold standard solid and we also have a sugar refractometer that can measure urinary sugar which is pretty sensitive.

Dr. Justin Marchegiani: Wow.

Dr. Robert Rakowski: So it’s gonna be all sugars uh – not just uh – glucose. So that’s –that’s interesting. Coz if we do have some more sugars in the __ than glucose. It’s something called Fructosamine.

Dr. Justin Marchegiani: Fructosamine. 10-day window. Yup.

Dr. Robert Rakowski: And uh – uh – uh yeah. That’s a nice test. So quicker response for sure than A1C.

Dr. Justin Marchegiani: Great. Now I see a lot of patients that have higher A1C’s and all the other markers look good. Do you ever get false positives or just false high readings on the A1C but everything else looks on the better side?

Dr. Robert Rakowski: Not typically. But it can happen and – and so, you got to remember they don’t need value and Physiology behaves on bell shaped curves.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: So for instance, when cholesterol’s gonna elevate, that’s a functional__. Actually the uh – the glucose or the insulin is driving HMG-CoA reductase.

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: Which by the way is what__

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: So that elevates cholesterol.

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: It also impacts cholesteryl ester transfer protein converts HDL to triglycerides. But if those mechanism fail, those numbers can work normally. Even pretty decent or close to ideal – but being on a failure aspect. So, bell shape curves, values rise then fall like insulin, right? We can have a perfect insulin with a perfect blood sugar. Or our insulin rises, rises, rises until our pancreas fail so if we can’t keep up then it falls, falls, falls, falls. So two spots that insulin can be perfect.

Dr. Justin Marchegiani: Yeah. Very good. And that’s the issue, I think – That’s the issue really bankrupting healthcare today. I mean I Think I’ve read that the average diabetic with blood sugar issues, they’re spending $2-3 million managing the disease and it’s – it’s really interesting because in conventional healthcare, there’s like disease management, right? And then with us there’s root cause management. We’re actually getting to the root cause. As we chip away the root cause, we’re actually fixing the underlying issue. Can you talk more about that?

Dr. Robert Rakowski: Well, let’s talk about the cause issue first.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Diabetes is the most expensive problem.

Dr. Justin Marchegiani: Huge.

Dr. Robert Rakowski: And the sick care system. That healthcare – system is sick – their expense on diabetes. And so we do live in a universe of cause and effect. So what did you do that created this challenge? People are sitting on the couch, people are eating chips, drinking Coca-Cola, not making good dietary choices. They don’t eat right, think right, move right, sleep right, poop right or talk right. And they wonder, “Gee, I wonder how I got sick?” Yeah. And doctors will monitor them and then, Well – you know, I think a good doctor would say, “We’re not starting to get out of hand here.” You know, do something a little healthier. Like if they ask them, “Can you be more specific about that?” “Well, sorry I wasn’t trained for that, you know. Maybe go see the dietician. And I haven’t ___In hospitals my diabetic patients peak up high for dessert, you know. So uhm – you really need to go to someone trained natural if you want natural advice. If you want drug advice, go to someone trained in drugs.

Dr. Justin Marchegiani: Yeah. Absolutely. I mean I always tell my patients, “When was the last time you had a good meal in the hospital?” I mean, my god, like never.

Dr. Robert Rakowski: Uh-hmm. Good point, right?

Dr. Justin Marchegiani: Yeah. Absolutely. Now you build your reputation over the last 20-30 years really working with high-end individuals, professional athletes, and then you can name the gamut of the whole field, Yao Ming, and I could think of many off the bat. But working with these guys, what’s – I mean there’s probably some commonalities that you are using, or your addressing with these high-level athletes that you’re also addressing maybe with your – you know, average day person that’s looking to improve their performance? What are those – Let’s say the top three that you can take from the professionals and extract that information for the average Joe’s?

Dr. Robert Rakowski: The big three. From the sickest to the sick and the best of the best. And that’s stress, toxins, and malnutrition. So I think any of these – how are these high level athletes stress? Well there is a performance stress, there’s a recovery stress, there’s a lack of sleep stress. My favourite stress protocol that I use over the last 5 years with a lot  of success even with lab markers is using melatonin, 1-3 milligrams.

Dr. Justin Marchegiani: Wow!

Dr. Robert Rakowski: Every waking hour. We now know that melatonin actually binds to the adrenal cortex and blocks the pituitary gland or at least buffers the pituitary cortisol. And uh – by the way, the gut makes 400x melatanonin as the brain. That’s a proven fact. So it’s not –

Dr. Justin Marchegiani: Right.

Dr. Robert Rakowski: It’s not like the melatonin crosses the blood-brain barrier. Detox – number one thing is you know, keep yourself away from toxins. So create a clean environment. Put clean clothes in your body, clean water in your body. Then you do some medical food based detox –

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Which is really, really solid. Now we start looking at malnutrition. You know, I’ve created my own food pyramid. Now they have the plate out there which is no good at all based on how they have it.

Dr. Justin Marchegiani: Terrible.

Dr. Robert Rakowski: But based only the food pyramid, guess what? There can be food and whole natural clean healthy foods. And we’re gonna have super foods and there’s a number of those with super nature in density. And then I actually have medical foods, functional foods. And then to top that off, we have multivitamin Omega 3’s, probiotics, and vitamin D. And by the way, sicker people, they need a lot more of each of those things but you’re gonna have the best of the best in people that are fighting for their life.

Dr. Justin Marchegiani: It’s really interesting that some of the foundational information that we review everyday with average patients, these are some of the things that professional athletes aren’t even doing themselves. I remember a talk that Paul Chek gave maybe a decade ago. And he talked about being in the New York Giants uh wait room. And there was like Doritos and all this crap everywhere. And for some reason they had to do it because of the sponsorship. I just couldn’t believe it. Uhm, I remem – I recall I’m a big fan – I’m from Boston area, so a big fan of Tom Brady. I know they beat the Texans last month. So maybe a little hard feeling there. Uhm, But –

Dr. Robert Rakowski: They beat everybody last month.

Dr. Justin Marchegiani. They beat everyone. Yes, so- But Brady is the functional medicine guru, right? I mean, he told – his records say in 2008 when he had his ACL injury, that he actually got better from that. That he avoided the standard of care rehab life. He saw uh – people like yourself, get the nutrition dialled in. I mean basically eats uh – alkaline, Paleo diet. 20% meat, lots of veggies, avoids nitrates,10 hours of sleep at night, all of the high-quality supplements. And this guy is getting better 40 Years into it. At age 40 – What’s your take? Coz I think most athletes aren’t even doing these things and some are. And you’ve seen the ones that are thriving.

Dr. Robert Rakowski: Now you – you – This thing is if you master the basics yourself, you don’t need anything else.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: And I literally got that sick when promoting my real champion Kung Fu guys. But uhm – and then we’re going, “Okay, well how are you doing on the basics?” “Tell me about your diet.” “Well, it sucks, you know.” “How are you doing on your sleep?” “Well, that sucks.” “What do you drink?” “Well, that sucks.” Right. And so we’re just talking with this very very basics and you realise that the best of the best, if they sleep better, they’re gonna perform better. Quick study with the US Military, they found out that when a military gets less than 6 hours of sleep for 6 straight nights, they functioned on a level as if they’re legally drunk. So – so just imagine that, right?

Dr. Justin Marchegiani: Six hours of sleep for six months?

Dr. Robert Rakowski: Six hours for six straight nights. No, not six months, just for a week, right? And then so – do we want drunks walking with high-powered weapons? You know, that’s not a good idea. Uh – and so your cognition drops, your coordination drops, reaction time drops. All these things drop, so – When we started swinging that to the athletes – In Stanford, they had an interesting study. They just had their tennis team stay in bed an extra two hours a day. 10 hours a day within 2 weeks time, they have 17% improved performance on first serve. So sleep has been –

Dr. Justin Marchegiani: Wow!

Dr. Robert Rakowski: Our – our athletes, they’re blessed in so many ways, but yeah, they’re still misinformed like the general population.

Dr. Justin Marchegiani: Oh, absolutely. Especially the fact they’re putting wear and tear on their body so they’re breaking down their ligaments, their tendons, their joints, their tissues. And an old expression – I can’t remember who said it first, but – “You can’t make chicken salad on a chicken shit.” So –

Dr. Robert Rakowski: There you go.

Dr. Justin Marchegiani: If you have the poor quality nutrition coming in, the tendons – all those raw material and building blocks get downgraded each time. And eventually that means more time on the DL and you lose a step, then you’re out of the league, right?

Dr. Robert Rakowski: That’s exactly right. I look at Emman Smith, you know. And – and he was one of my favourite running backs and some people my age will remember him as well. But, you know – one step he went from the best of the game to barely in the game. He lost two games – two steps and he’s out of the game. Uh, but how long can you keep that well? Like you said, Tom Brady is a great example, but others pitcher and way back Satchel Paige.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: And I don’t even know how old he was when he was pitching. But he seem to be absolutely timeless. You know, Gordie Howe, the hockey player played – I believe professional hockey in six different decades.

Dr. Justin Marchegiani: Wow!

Dr. Robert Rakowski: I mean how in the world do you do that? Well, one, back then, there’s certainly a lot that are food quality.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: So, uh – pretty remarkable stuff that in today’s environment, goodluck getting good quality food. It’s just harder and harder coz our animals are malnourished and toxic. So when you do supplement – across the border, we need a supplement.

Dr. Justin Marchegiani: Love it. Totally makes sense. I remember Julio Franco the old uh – I think he was uh – outfielder I think from the Cleveland Indians. But he played into his mid-40s. And even – even Nolan Ryan from the uh – Texas Rangers. I mean he played into his mid-40s. Julio Franco – I remember reading articles of him. He had pre-made organic food uh – brought to the ballpark and everyone would look at him eating his own they’re like looking at him like he’s crazy. But the guy played 26 years in major leagues.

Dr. Robert Rakowski: Yeah. Well you look at my athletes that have had longevity, they all got early on that nutrition is important.

Dr. Justin Marchegiani: Yeah. I love it. And what are the most – I mean maybe this is gonna be individual, I know it is. But are there typical muscle imbalances where certain muscles aren’t turned on appropriately that you’re seeing across the board in some of these athletes?

Dr. Robert Rakowski: Well, let’s just go into general population.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: ____ In Geology, there’s something Specific Adaptation__ So we sit longer, we get better at sitting. So –

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: You know it starts pulling our lumbar spine into lordosis. Our spine compensates, we get forward leaning posture. Uh – you know, most of us have our shoulders drawn up, rather than down and back like they should be.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: And there’s a number of imbalances. But literally the imbalances seem universal in our society. And its’ gonna be the – the – the – like what I just described__with shortened hip flexors. So when you do –

Dr. Justin Marchegiani: And that creates reciprocal inhibition with the glutes. So then your hip extension, you’re gonna be utilizing the lower back versus hip extension for the glutes. So then you get lower back pain, right?

Dr. Robert Rakowski: Yeah. I mean, by the way, you’re gonna lose a step or two or three if your glutes aren’t firing, right? That’s the most __ on a solid splint is that glute causing that hip extension, so – Yeah.

Dr. Justin Marchegiani: Absolutely.

Dr. Robert Rakowski: That’s uh– across the board, super important.

Dr. Justin Marchegiani: One of my biggest 2 investments that I made in the last two years is I got a stand desk that can go up and down. And I also got a walking treadmill that could slide under the desk. So when I see patients virtually, like we’re talking on Skype now, I literally  walk 12 miles a day, 60 miles a week while seeing patients.

Dr. Robert Rakowski: Man, that’s awesome.

Dr. Justin Marchegiani: And isn’t that great? It’s amazing.

Dr. Robert Rakowski: And why these companies don’t introduce what treadmill does? You know, I read a book called, Drop Dead Healthy, years ago.

Dr. Justin Marchegiani: Oh, yup.

Dr. Robert Rakowski: It was a writer from New York magazine. And one of his tips was, “Hey, if I’m gonna sit around and write all day, why don’t I just get a standing desk with a treadmill?” And he’d walk 1.5 miles per hour with a 3% incline.

Dr. Justin Marchegiani: That’s what I do.

Dr. Robert Rakowski: And just type away and had his work and sure enough, burn calories to get healthy. Fire the muscles, stay young and get – and be productive at the same time.

Dr. Justin Marchegiani: Love it. Makes sense. You did a YouTube video, I think it was a Facebook video, uhmm maybe a year or two ago. And you touched upon the MMR Vaccine. I was just kinda curious kinda what your thoughts in – in general? I mean we can touch upon it here, but you brought up – you know, when you speak from it, you’re talking about actual peer-reviewed research. That’s why I love it. It’s not a lot of emotion behind it. What’s your take on that? And what are some of the most recent studies you’re seeing about the MMR? Just vaccinations in general?

Dr. Robert Rakowski: Well, luckily the conversation is coming into the light.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: And when you walk at the data right out of CDC you’ll find out that death rate from infectious disease drop 91% –

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: From basically you know, 1900 to 1964 when they started this – started the mass vaccinations. And it hasn’t gone down even a bit. And so – is there justification for some vaccines? Maybe for some kids but certainly not 76 before the age of 6. Uhm – when you look at the child’s immune system, it’s not really fully functional until the age 2. And so they generally are not gonna respond to vaccines. So if you’re injecting a new born with toxins that their immune system isn’t gonna respond to, how can you have anything but a downside to it? So I’m just very much for people making an educated choice. So let’s just look at education for a moment. Guess who does not vaccinate their children? They found out it was people in the highest income quartet, right? The highest IQ, right? And – and therefore, whether we think rich, smart people don’t love their kids –

Dr. Justin Marchegiani: Exactly.

Dr. Robert Rakowski: And the answer is no, they love them enough to look into what’s going their bodies and say, “Hey, something’s not right in this picture.”

Dr. Justin Marchegiani: Yeah. And I totally agree. And if you You look at the World Health Organization info mortality rate, we’re at number 40 just behind Cuba. And if you look at some of the Scandinavian countries that are in top 10, they’ve done some epidemiological studies looking at the trend vaccinations versus the mortality rate. And in- in like Finland, Norway those type of countries only have about 10 Vaccinations in for kids for the first I think 4-5 years, where we have 40 to 50. So these countries are top 10 and they have 75% less vaccinations. So they obviously know something different than we know, right?

Dr. Robert Rakowski: I think they’re not as swayed by money.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: As our government. So by the way, the top lobby of our US government. Number one is gonna be the NRA, number two, pharmaceuticals.

Dr. Justin Marchegiani: Yeah. Interesting.

Dr. Robert Rakowski: So – pretty basic. Yeah.

Dr. Justin Marchegiani: And people also forget, too. The uh – the CDC, I think, make $68 billion dollars a year of off vaccine patent. So there’s a little bit of a conflict of interest there. Also, uhm – you talked about this, too. It’s interesting. In one of your lectures a few years back, you talked about the uh – the Hannah Poling issue. Hannah Poling was vaccine injured. Interesting enough, her father was a neurologist, her mom was a lawyer. So she had pretty good representation in the vaccine courts. One of things that came out of there, I think she had autism and they said that she had autism because she had a potential mitochondrial defect. And very interesting because if the government is admitting that there is potential autism from mitochondrial defects, are we screening mitochondrial defects? How do we even know it? So it’s interesting that that’s out there but we’re not even screening for that. Any take the mitochondrial defect aspect?

Dr. Robert Rakowski: I believe that the stats are just about the exact same challenge that she has. It’s about 1 in 50. But you have to remember that she was developing perfectly normally uh- and now, all of a sudden there’s boom extreme dose of toxins causing extreme brain inflammation uh in – by the way, the brain is the most energy dependent system in the body. So part of that spiralled her into a downward spiral. But to the point that the mitochondria alone is – is blatantly broad.

Dr. Justin Marchegiani: Uh-hmm.

Dr. Robert Rakowski: Uh – uh and so, you know–

Dr. Justin Marchegiani: Right.

Dr. Robert Rakowski: Plenty of these kids that are gonna have mitochondrial problems are more likely to be injured by the vaccine but it’s not a prerequisite to have a vaccine injury.

Dr. Justin Marchegiani: Now, exactly. Yeah.Totally agree. Any other thoughts on that? Any other comments or research articles that you’re coming up?

Dr. Robert Rakowski: Oh, boy. You know, so – So Hannah got a $20 million settlement.

Dr. Justin Marchegiani: Phew!

Dr. Robert Rakowski: And what’s pretty fascinating is – is Sanjay Gupta –

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: Interviewed Julie Gerberding who was the head of the CDC at the time. And she never answered any question directly. And she just basically said, “You know what, very rare case. Parents, whatever you do, please make sure you go out and make sure your kids get their vaccines.” And after that, after she retired from CDC, she got some –

Dr. Justin Marchegiani: Merck.

Dr. Robert Rakowski: mega contract to be a spokesman for a bright and major drug company –

Dr. Justin Marchegiani: Merck. She’s the head of vaccine research of Merck.

Dr. Robert Rakowski: Absolutely insane, right? So uhm – you know I’d like to hope that somehow, someway in their grey matter they’ve really think that this is a good service for humankind. But oh my gosh, there’s plenty of educated people who’d argue with that. So what’s the stance? I think everybody should get educated.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Everybody should get the right decision and have the freedom to make the right decision for their child.

Dr. Justin Marchegiani: And I don’t personally think vaccines cause autism. It can’t be causal because  it would be a one-to-one relationship. Everyone that got a vaccine, would have autism. But we know there’s definitely stressors out there. GMO’s, heavy metals, whether it’s- forget mercury. It could be aluminium, it could be phthalates, it could be squalenes. It could be other compounds. It could just be antigenic load from too many at once. Uh – leaky gut, uh – babies not being breastfed, right? All these different stressors could add up and make someone more susceptible. What are your thoughts on that?

Dr. Robert Rakowski: I agree with you. You know, but let’s take it a step further. Let’s look at risk-benefit always. I mean, look at the risks of these diseases, it’s relatively minor in the population right now. You know, my kids all got the chickenpox. And –

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: You know, none of that – it never lasted more than more than – more than five days. My son got the whooping cough. He beat it and got a lifetime immunity. I had a kid come into my clinic that actually have Rubella. And so found out, I took him home to play with my kids. My kids never got sick. You know, but uh – you know, whether you’re exposed or not, at least there’s a possibility that you can’t beat a natural immunity and a healthy body. And the data is really questionable. What is the risk-benefit? I think for healthy kids, especially the way it’s going right now, it’s more on the side of the risk then benefit.

Dr. Justin Marchegiani: Yeah. That totally makes sense. Uh looking at all the things that are happening to your clinic, is there any new things that you’re delving into clinically right now?

Dr. Robert Rakowski: Uh – Well, there’s the statement there. There is nothing new under the sun, right?

Dr. Justin Marchegiani: Yeah. Fundamentals.

Dr. Robert Rakowski: We always get better, stronger, faster, smarter at what we do, but like you said, the fundamentals. How many people have really mastered the fundamentals? And not many, right? And even if they have, they’re coming in saying, “I’m totally awesome. I feel lots of the charts are amazing. Do you think you can – game up a little bit more?” Uh, so it’s hard to beat the fundamentals, you know. Everybody always wants to come up with a shiny new penny. But reality is you can’t beat good, clean, healthy living. And – and you highlight it. There’s a lot in the basin –

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: And just focus and discipline and then the magnificent seven.

Dr. Justin Marchegiani: Totally makes sense. And what are the foundational lab testing – I mean, obviously we know you’re drinking clean water, eating organic food, you’re doing all that good stuff, your sleep is probably dialled in, you’re exercise is dialled in. What are the more nuanced things you’re doing right now to assess your health? Lab tests or uh – treatments? What’s happening in your neck of the woods?

Dr. Robert Rakowski: You know, in terms of real subtle things, we’ve been doing this for decades at this point. The pH Balance –

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Probably doesn’t get enough press for being so critical. So I always tell patients every single enzyme in our bodies is pH dependent. You know our hormone’s pH dependent. And as we look across the board, we see the sickest people have the worst acid- alkaline balance. Their buffering is actually terrible. Uh – and so how do we buffer it? We buffer it with good elimination, good detoxification.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: High Levels of – of nutrients, quality food choices – But I think pH is one of those markers that we need to spend more time pursuing.

Dr. Justin Marchegiani: Interesting. And how much this diet and food uhm – affect pH? I know we’ve talked about this before. A lot of people say, “Well, we cut out meat.” but then we know that grains are actually 10x more acidic than meat as well. And we know that inflammation plays a huge role on that. What’s your take?

Dr. Robert Rakowski: Well, we have to understand that every process that we have that makes energy, makes acid.

Dr. Justin Marchegiani: Yes.

Dr. Robert Rakowski: So as I explained to doctors and the patients as well, oxygen goes into the cell, product comes out, converts oxide and the one in the blood can form carbonic acid.

Dr. Justin Marchegiani: Carbonic acid. Yeah.

Dr. Robert Rakowski: A hundred trillion cells doing – a trillion times a day. So as we start looking at this process, the Pharmacology Journal say this – They say, “Look, how much acid you eat a day? Maybe a 100 units.” “How many do you produce by living? Probably 15,000 units.” So we have at least a dozen different buffers against acid inside the cell and outside the cell. So we got proteins, we got phosphates, we got minerals, we got bicarbonate buffer. And all our elimination routes get rid of acid. So uh – as I tell patients who contributes very little to acid burden, but it’s basically what makes up our acid buffers. So we wanna make good choices.

Dr. Justin Marchegiani: So what you’re saying is adding the inflammatory foods in there will increase the acid but making sure nutrient rich, lots of greens, lots of rich minerals, magnesium potassium. Those things are gonna help buffer a lot of the – out. A lot of the acidity.

Dr. Robert Rakowski: Well said. Yeah. That’s exactly right.

Dr. Justin Marchegiani: What other lifestyle things are creating more of an acid environment?

Dr. Robert Rakowski: Stress.

Dr. Justin Marchegiani: Yeah. So just emotional stress, physical stress. Yeah.

Dr. Robert Rakowski: All of the above. When you’re- you’re running on a fight or flight mode, understand that the first organ that’s affected is the liver. The second organ that’s affected is the kidney. The third affected organ that’s affected is the brain. Higher-level cognition drops. And so we might not necessarily be a fight or flight circumstance but if we’re sitting under a light of a blue spectrum, where I got a nice screen in front of my computer house –

Dr. Justin Marchegiani: Nice.

Dr. Robert Rakowski: We have a blue blocker app.

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: That it’s – it’s actually blocking the blue light. But I’m being bombarded with blue light. My melatonin’s suppressed, my cortisol’s high. I – I basically am not controlling my stress hormones. I’m inflamed and I’m in trouble, so. Several strategies like that. Modern life creates modern challenges and we’re just beginning to see. Wow, okay they made it so this stuff has a real downside to it. We need to deal with it.

Dr. Justin Marchegiani: So a lot of people may justify a vegetarian-vegan diet because of this acid-alkaline theory. So, you know, looking at a pH chat of food and only choosing foods that are seven or above. You- you’re okay choosing some foods on the acidic side, like high quality, clean lean full fat meats that are good quality, etc.?

Dr. Robert Rakowski: We are omnivores.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: I mean, we have canines.

Dr. Justin Marchegiani: Yeah. Incisors –

Dr. Robert Rakowski: For the purpose of tearing meats, right? So –

Dr. Justin Marchegiani: When you look at the fact there’s certain things we absolutely can’t get from plant based diet. We can’t get B12.

Dr. Justin Marchegiani: Right.

Dr. Robert Rakowski: And as a general rule, we don’t get high enough quality protein and we don’t get  bioavailable iron. So there’s a number of factors that come in. We just wanna make  smart food choices. Predominantly plant is good, you know. You know that’s a real good rule. Michael Pollan who work on the book, “In defense of Food” –

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: His top rule is eat food not too much, mostly plants.

Dr. Justin Marchegiani: Mostly plants –

Dr. Robert Rakowski: That’s really solid advice.

Dr. Justin Marchegiani: I mean look at Tom Brady. He’s a big acid-alkaline guy. 80% vegetables, 20% meat. I think that’s a pretty good way to go for a lot of people.

Dr. Robert Rakowski: Yeah. And you look at his body mass, right? And his – his exercise burden. If that’s good enough to keep him in shape, why wouldn’t it be good for the rest of us?

Dr. Justin Marchegiani: And what’s your take on vegan or vegetarian people that are excelling in professional sports? You work a lot with these people. I know there are people out there that say it. My theory is they have to be doing a whole bunch of pea protein or hemp or rice protein. Something to get the extra aminos in there. What’s your take?

Dr. Robert Rakowski: Well, they are. Certainly if they’re seeing meats. We can manage mind to the lean tissue breakdown but there are also supplement branch in amino acids, they’re doing B12 injections. So, uhm – you know, there’s a way but it takes a lot of effort. And a lot of supplementation on a vegetarian based diet.

Dr. Justin Marchegiani: Yeah. Plus you don’t get the rich sulfur amino acid the 12 that run those glutathione detox pathways, too.

Dr. Robert Rakowski: Absolutely. They can get some in cruciferous vegetables but it’s certainly a higher concentration in meats.

Dr. Justin Marchegiani: Plus I noticed too, you have to really combine your, you know, rice and beans for instance. You really have to combine your proteins well because there are some deficiency in methionine and lysine which are really important for let’s say producing carnitine. Run the carnitine to burn fat for fuel. So you really got to combine things well. But if you look at, let’s say, rice and beans, you know,15 g of protein to 75 g of carbohydrate. People that are maybe insulin resistant, that may be a little bit too high in the carb side.

Dr. Robert Rakowski: I’m with you on that. You know, I mean people – we only need to find a diet that works and we need to find a diet that makes sense. And for the most part to me, the  vegetarian diet doesn’t make sense for too many people.

Dr. Justin Marchegiani: Got it. That makes sense. So just looking at kinda like your pre and post workout, you know, set ups with your professional athletes. What does that look like? So you get them ready for the workout. Are they doing a shake before? Are they doing something during? What are they doing afterwards to recover? And what do you recommend supplement-wise pre and post?

Dr. Robert Rakowski: Well I did train them more than—and there’s a before training and after that’s required. So there’s plenty of data just depends on what kind of training. But branch and amino acids help maintain the lean mass.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: The electrolytes, the fluids, and all that.

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: He’s not gonna eat a meal. You know, meal is gonna take a lot more time to digest than uh – shake. And so I usually want them to eat a minimum of 2 and a half hours    in front of an intense Workout. So it’s at least well digested. And that should be not a super heavy meal, right?

Dr. Justin Marchegiani: Yes. Coz if it’s – once in the stomach, it’s not gonna get to the extremities or if you’re still eating, your digestion is gonna be compromised. So I really like a prework out shake, a post work out shake and something simple during training. Nothing’s gonna tax the digestive system. Pre form amino acids, branch and amino acids, electrolytes and fluids during the training.

Dr. Justin Marchegiani: Typically, with the electrolytes, will there be a little bit of a glucose or fructose with that?

Dr. Robert Rakowski: I do. I do some fructose. Now we’re looking at these athletes that need fluid replacement and electrolyte replacement. They’re training plenty hard. Fructose has ¼ the glycemic index of glucose. With that said, post workout, for certain athletes, there’s a benefit. Actually spiking insulin, lower cortisol.

Dr. Justin Marchegiani: Lower cortisol, yeah. Bingo. Makes sense. Are you using a product like with the Endura, with the electrolytes and with the extra fructose?

Dr. Robert Rakowski: Yeah. So I – I use a couple of different products. One is Endura and we’ve got a product called, Dynamic Fruits and Greens, which is a powder based of 20 different organic super foods, so. Taste good, goes down good, and certainly works good.

Dr. Justin Marchegiani: Excellent. It’s very, very cool. So are there any challenging cases that have come into your office at all recently?

Dr. Robert Rakowski: Yeah. Everybody has their own unique challenge. Uh – you know, probably the most recent real earth-shattering cases, I have one that it was probably somewhere you like to describe when you go to the foot to be amputated.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Uh, she was – she was scheduled for an amputation. The first thing I saw was a picture. I never cover the foot of just a few days. So I added a dose every single waking hour to kill infection to re-enhance uh – circulation to control the control the blood sugar. I would say two weeks she had a tremendous shift in the color of her blood-

Dr. Justin Marchegiani: Wow.

Dr. Robert Rakowski: A lot of gangrene started to recede. Uhm – we got pictures of the entire process.

Dr. Justin Marchegiani: Wow.

Dr. Robert Rakowski: But literally, she did auto like a tips –

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Uh for the toes a lot. But she kept the rest of the foot fully functional. But what’s better about that case is, at first she was taking a mega dose of insulin and half a dozen drugs, and they were all failing. By the time we were done with her, she was taking just the lowest dose of insulin since her diagnosis is you know, since childhood age, she was diabetic. And the no other drugs and really the tissue help up the entire body improve dramatically.

Dr. Justin Marchegiani: Wow. Amazing. I know you mentioned earlier but taking mega doses are you know, higher amounts of melatonin to help increase uh – antioxidants and such. Uh, tell me about the feedback loop. Do you feel like taking that much in for how long – will that affect the feedback loop of the, you know, gland talking and making melatonin?

Dr. Robert Rakowski: It’s highly improbable.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: That the melatonin cross the blood brain barrier. So the Gas – World Journal of Gastroenterology shows that the gut makes 400x times melatonin as the brain. The gut also makes the majority of the serotonin so that’s – that’s nothing new to people who have been studying that. So it’s unlikely that it will cross the blood-brain barrier. And what – the reason I believe is number one, sleep nutrient, is because it puts the break on cortisol. But I only do that for 7 to 10 days.

Dr. Justin Marchegiani: Because I have ___ and maybe a person’s own production could become altered. So we do it to have a quick shift in the metabolism memory__So I haven’t seen any that’s had challenged it. And on the flipside of that, I’ve seen plenty of people that have been feeling better than they have in decades doing that for a short period of time.

Dr. Justin Marchegiani: And when you recommend hydrochloric acid to your patients, do you feel like giving hydrochloric acid affects the feedback loop at all with gastrin and HCL production in general?

Dr. Robert Rakowski: Certainly can.

Dr. Justin Marchegiani: Uh-hmm.

Dr. Robert Rakowski: So what we’re gonna do is, we do a hydrochloric acid challenge.

Dr. Justin Marchegiani: Uh-hmm.

Dr. Robert Rakowski: Which is actually defined by Jonathan Wright –

Dr. Justin Marchegiani: Uh-hmm.

Dr. Robert Rakowski: Over 25 years ago. But basically, when people eat their meal, they’re gonna try supplementing with hydrochloric acid coz if they have a burning in their gut, they probably don’t need it. That’s too much HCl.

Dr. Justin Marchegiani: Uh-hmm.

Dr. Robert Rakowski: Uh they should really have a nice warming sensation, uh –but most people wouldn’t get that. And so what we do is we have to do it after the meal so the body is gonna release whatever they’re gonna release. Then as we start enhancing the digestion to the proteins, the minerals, and to the essential nutrients, the body can be more effective at producing the HCl. Uhm but– you know, we don’t want people to__

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: The guideline is the lowest dose for the shortest duration. So as soon as they can start titrating down their own dose, uh- and by the way, let’s say, you start taking uh- let’s say, 4 hydrochloric acid tabs.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: And you have to do that for a few weeks. Also, and 4 creates a little uncomfortable sensation. Guess what? For now, 3 ½ for 3 and then ultimately, we’d like people to be able to wean off it a little bit.

Dr. Justin Marchegiani: Yeah. That’s really good general idea. And regarding enzymes, do you like taking enzymes before, during or after a meal?

Dr. Robert Rakowski: It’s gonna do different things.

Dr. Justin Marchegiani: Uh-hmm.

Dr. Robert Rakowski: And so enzymes away from food, there’s actually a specialized supplement in the gut called an M cell. And the M is for macromolecules. And in a pediatric gut, new born infant section has a ton of those cells. And by the way, when you look at mother’s milk, it has immunoglobulins in it.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: That’s passive immunity.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: And the only way that it can get to the infant system is by being absorbed intact so they have a higher concentration in each cell. So we all have the ability to absorb certain macromolecules intact. If you take enzymes away from food, it have a number of systemic benefits. Take it with food, I always tell people it digest food. But away from food, it digests into the system like scar tissue, like infection. And there’s even date suggesting that it’s anti- cancer.

Dr. Justin Marchegiani: Yeah. The serrapeptidase enteric coated enzymes work phenomenal. I used a company about called World Nutrition. They do really good pepsin. Great research on dissolving cancer and such as well, tumors, too.

Dr. Robert Rakowski: It’s fascinating. You know the book, “Wellness against all Odds” Started 30 cancer patients off of being cancer with nothing but actual remedies. One of the things they did was natural enzymes and pancreatic enzymes.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Nicholas Gonzalez.

Dr. Justin Marchegiani: Gonzalez – has passed.

Dr. Robert Rakowski: I had a few years ago, last year.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Last year.

Dr. Justin Marchegiani: Last July.

Dr. Robert Rakowski: He published the longest survivability of non-operable pancreatic cancer patients.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: And the only intervention was pancreatic enzymes. So it’s something we need to dive into and look at.

Dr. Justin Marchegiani: I think it’s excellent. Yeah. And you have quite a bit of experience dealing with cancer patient. I know we can do a whole podcast on this. But what are the low hanging fruits dealing with cancer patients? I think you already mentioned the ketogenic diet. So you may – you may add that in there. But what are the top three things that your – we should be listening to or focusing on with cancer?

Dr. Robert Rakowski: Well, you started out right with ketogenic diets.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: We actually did a rat study within a ketogenic diet and I think the exact statistic was it was something like 50, 58, or 59% longer than people who did not eat ketogenic.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: The second thing is gonna be tons – by the way, the entire diet should be organic. But –

Dr. Justin Marchegiani: Of course.

Dr. Robert Rakowski: fruits and vegetables. So-

Dr. Justin Marchegiani: Tons –

Dr. Robert Rakowski: Study goes way back but people that eat the least fruits and vegetables get most cancers than those eating the least. I mean, here’s one that people may not think about, but again, in the book, “Wellness Against All Odds”, daily coffee –

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: Everyone of this patients did that.  And that’s a great way to get the liver dump bile and toxins.

Dr. Justin Marchegiani: Yup. I know you have a little slogan here –

Dr. Robert Rakowski: And if we go –

Dr. Justin Marchegiani: Go ahead.

Dr. Robert Rakowski: Uh – I was gonna say if I tell them one more-

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: But since we’re on the topic of melatonin, National Cancer Institute, talked about mega doses of melatonin at bedtime, 40-50 mg.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: And these patients that have inoperable cancer, live longer with less tissue breakdown. So I think what you’re going with is not by jingle but savaging that live jingle.

Dr. Justin Marchegiani: Yes.

Dr. Robert Rakowski: Way back when 20 years ago, there was a jingle that was the best part of waking up was Folgers in your cup.

Dr. Justin Marchegiani: Yes. Let’s hear it.

Dr. Robert Rakowski: Now the best part of waking up is Folgers in your butt.

Dr. Justin Marchegiani: Yes, I love it.

Dr. Robert Rakowski: But we certainly have better coffee choices, right? We like organic coffee and –

Dr. Justin Marchegiani: Of course.

Dr. Robert Rakowski: But the top super food that is real nice for drinking and detoxing, if that’s how you wanna use it.

Dr. Justin Marchegiani: Yeah. Everytime I see a Folgers commercial now I flashback in to you in seminar, singing that jingle there. So –

Dr. Robert Rakowski: Yeah.

Dr. Justin Marchegiani: Love it. Very cool. So we have ketogenic diet, we have uhm –coffee enemas, obviously the organic greens, organic diet. Anything else? Any other low hanging fruit?

Dr. Robert Rakowski: Well, you have to look at stress management.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: So –

Dr. Justin Marchegiani: Sleep, too.

Dr. Robert Rakowski: The top two enemies of the immune system are gonna be stress and sugar. And  then you threw in sleep in there. You wanna get good sleep. But the first immune cell that drops in a high stress response is a natural killer cell. So daily meditation, visualization. These are things that are proven to have anti-ageing, anti-cancer, certainly long__

Dr. Justin Marchegiani: Yeah. I think the World Health Organisation put shift work. You know, essentially not sleeping when it’s dark out in the same category, in the same cancer category as asbestos and cigarettes smoking. So we know, you know, it’s a non-substance carcinogen.

Dr. Robert Rakowski: I don’t really know why it’s even legal to still do that, you know.

Dr. Justin Marchegiani: I understand that some people need to work the night shift, work the night shift. The idea of shifting your clock so frequently is just so harsh and you’re right. The data is overwhelming. Nobody should do it. It’s toxic on every level to the body.

Dr. Justin Marchegiani: And it’s funny, too, because the people you think of with shift work, you think of doctors and residency, right? The ones that are standing up all night, ER docs, people that are on-call. The people that are supposed to be promoting health will actually making them the sickest. And I think there’s statistics that the average MD lives 10 years less than their average patient.

Dr. Robert Rakowski: Years ago, there was a special on TV – on Youtube uh –and Impaired-

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: And they found out that among all the professions that the medical doctors have some of the highest risk of drug and alcohol dependents, uh – clinical depression.

Dr. Justin Marchegiani: Yup.

Dr. Robert Rakowski: So we gotta take care. These are good people. They’re not in the good system but I hope they got involve to help people. Hey, emergency medicine is great. If you need medicine, medicine is great. But listen, we don’t need to be drugging every man, woman and child for every made up malady on planet earth.

Dr. Justin Marchegiani: Absolutely.

Dr. Bog: It’s just crazy.

Dr. Justin Marchegiani: Absolutely. Absolutely. I had a conversation with Paediatric Oncologist over the weekend. And we’re talking about ketogenic diets and we’re talking about sugar. And one of the most interesting things is oncology – there’s very little nutrition given about cancer. I mean I’ve had many patients seen on-call and they’re like, “No, diet has no implication in it.” And they’ll even don’t take your antioxidants, don’t take your vitamin C, don’t take your curcumin for tumor while we’re doing treatment. So that – that’s always very irritating. But the test that they use to look at cancer, the PET scan, right? Uh Positive Emission Tomography. What the test is, it’s basically giving someone some radioactive glucose. And seeing where that glucose goes because the cancer cells are soaking it up. So we know that we’re using these testing to test in conventional medicine to see where the tumor is going. So essentially we’re feeding it during the test so we can get a radiograph picture. But we’re not even telling people to not eat the foods that’s feeding the cancer in the PET scan got begin with.

Dr. Robert Rakowski: Complete and total disconnect, you know.

Dr. Justin Marchegiani: Total.

Dr. Robert Rakowski: It is uh – cancer cell takes up glucose at about 10x the rate of every other tissue in the body. So, yeah. You nail it right on the head. You know, when you explain it to patients as we just have, they get it. And you know, I got a friend right now who’s finishing  Osteopathic- college. Just an absolutely amazing guy. And he always tells me, he says, “Bob, a big part of education is education against natural medicine.” You know, and a lot of people buy it. But lie in sinker. And that’s why we’re such a sick nation and we started a trillion dollars on sick care.

Dr. Justin Marchegiani: Wow, love it. I mean you said it just so succinctly. Well, is there anything else Dr. Bob, on your mind that you wanted to bring to the listeners?

Dr. Robert Rakowski: You know, it’s always such a joy connecting with you. But I think we hit it pretty well. We don’t need the real extravagant about how we proceed with health. You know the basis of health is love, do what you love, love what you do.

Dr. Justin Marchegiani: Yeah.

Dr. Robert Rakowski: Love yourself, zealously inspect what you put everything in your body. Have a purpose. And in our environment, we need to have discipline. So I was just uh – I’ve read 6 books by Navy Seal in the last year.

Dr. Justin Marchegiani: Wow.

Dr. Robert Rakowski: And listened to a podcast by Navy Seal. But yes, it says “Discipline Is Freedom” you know, and – and so, one of our mentors said we all must suffer one-two pain. The pain of discipline or the pain of regret and disappointment. If we start living an undisciplined lifestyle, eating the garbage that’s stale, watching the garbage that’s on TV, drinking the garbage that they promote to us, guess what? Garbage in, garbage you will be. So uh- master the basics, be very, very careful about everything that you allow in your environment, especially bad TV. I think that’s been my one of my most recent personal discipline is no more TV for about four years and I don’t know that I’ve missed anything. I mean, no news, nothing like that. I haven’t missed anything that happened in the world. I heard we had a presidential elections.

Dr. Justin Marchegiani: Hahaha

Dr. Robert Rakowski: But I mean, seriously, right? How many of us really need to be immersed in the bad news every single day? It’s just crazy.

Dr. Justin Marchegiani: Totally makes sense. And it’s great that you are a physician that totally embodies health. Your practicing and promoting all of it. You’re telling to your patients yourself so you can be a shining example of that.

Dr. Robert Rakowski: Well, back at you. Uhm – when we talk about shining, it’s funny, I’ve been training mixed martial arts and some of my patients look to me, they said, “you get punched in the eye this weekend.” “No, I was playing basketball. We played six hours of basketball.

Dr. Justin Marchegiani: Wow.

Dr. Robert Rakowski: Went up for the board and flicked an elbow to the eye. I wish I had a better story than that. You know, but it’s fun playing basketball with my son who’s 23 and fit.

Dr. Justin Marchegiani: Wow.

Dr. Robert Rakowski: Playing with him for six hours, and everybody else, you know. It’s just – you know, healthy living has so many awards and rewards. I personally don’t understand how can somebody make a choice other than to maximise their wellness. Coz it’s a beautiful way to live longer around this planet and contribute.

Dr. Justin Marchegiani: Absolutely. And last question for you. If you’re stuck on a dessert island, and you only can bring one supplement, one herb, one whatever, what is it?

Dr. Robert Rakowski: Well you know, number one super food I’m planning to get is Ghanaian donuts. It’s got the full complement of vitamins, amino acids, proteins, carbohydrates, fats, fiber and water. I uh – and so-

Dr. Robert Rakowski: It’s considered to cause a sync in nutrition perfection. So that’s what I’m going with. But  let me go with my navy seal buddy. They said, Hey, if they drop you out in any of the world, and you can only have two things with you, whatever weapon, whatever you would take is I’m gonna need two things.  I need oxygen and I need water. And he says the Seals without oxygen, they realize they need it. They go without water, they realize they need it. You know what, guys like us, we can fend for ourselves just give us some air so our brain can work and give us some water so that we can function for about 5 days. Five days anywhere, we’re gonna be okay. We have enough savvy to find what we need to survive and make the world better.

Dr. Justin Marchegiani: Again, anyone that’s listening, thedrbob.com (T-H-E-D-R-B-O-B.com) Dr. Bob lectures to help professionals, physicians, nutritionists, nurses and he also has some excellent coffee in your website, too. I know you’re really big in the coffee that you mentioned as well. So feel free to check out Dr. Bob.  I think you’re also available for appointments worldwide as well?

Dr. Robert Rakowski: Yeah. You gotta love this technology, right? So I do Skype on occasion halfway around the world. We have to get our timing just right. Uh – I always prefer treating patients face-to-face just kinda face-to-face is okay. But I’d rather see them in person. But guess what? We got some pretty good successes across the planet. Just with a different eye looking at the data that they have.

Dr. Justin Marchegiani: Awesome, Dr. Bob. Thank you so much for what you do.

Dr. Robert Rakowski: I appreciate it. You always enjoy making the world better.

Dr. Justin Marchegiani: Thank You.



The Truth About Blood Sugar Imbalances – Podcast #55

Dr. Justin Marchegiani and Evan Brand talk about blood sugar and imbalances that lead to hypoglycemia and diabetes. They discuss about the glycation process to better understand how sugar affects our body. Find out how to tell if you’re insulin-resistant and what a blood sugar meter is by listening to this interesting podcast.
blood sugar imbalances

This interview also gives us pointers on nutrients to take that will help with blood sugar stability.  Discover the benefits of Kombucha, cinnamon and eating every 4-5 hours with enough healthy fats and proteins. Dr. Justin also talks about his Meal Matrix and how to apply blood sugar stability techniques in this podcast. Get to know what supplements to take which can further aid in stabilizing your blood sugar.

In this episode, topics include:

00:51   Blood sugar, imbalance and issues

15:12   Importance of stabilizing blood sugar

23:04   What are some healthy snacks

27:12   Supplements for blood sugar stability

35:43   Where do we get aminos








Podcast: Play in New Window|Download



Dr. Justin Marchegiani:  Hey there, it’s Dr. J!  Evan, how we doing today, man?

Evan Brand:  I am doing great.  What about you?  I never ask you how you’re doing.  How are you?

Dr. Justin Marchegiani:  I’m doing great.  We’re actually stepping it up for all of the listeners today.  I just got a–awesome new microphone based on your suggestion.  So we’re just trying to get the quality better.  We got a better Wi-Fi connection at the office, 200 megabytes per second.  It’s like, man, I’m cooking with fire here.

Evan Brand:  Yeah, totally.  Cooking–cooking your brain, too, if you ask some people.

Dr. Justin Marchegiani:  But if I’m cooking, it’s gonna be a high quality saturated fat with a high smoke point, right?

Evan Brand:  Totally.

Dr. Justin Marchegiani:  I’m not gonna use any of these canola oil or olive oil crap.

Evan Brand:  Definitely not.

Dr. Justin Marchegiani:  Awesome.  Olive oil’s good but it’s better for salad dressing, folks.  I’m not–I’m not dissing olive oil.

Evan Brand:  Yeah, just cold use only.

Dr. Justin Marchegiani:  Cold use only.  Yeah, absolutely.  Well, on that note, we were kinda chatting pre-show that we wanted to chat about blood sugar.  Blood sugar is a super important issue and we kinda have like the blood sugar functional imbalances which is what a lot of people deal with, and then we have the extremes where we have hypoglycemia where people, you know, they get dizzy.  They get lightheaded.  They may even pass out or have a, you know, what’s called syncope in the medical world, or the other extreme which is diabetes, where our blood sugar goes super high and it’s creating all of this glycation and free radical damage and all of the deleterious effects that come with diabetes.

Evan Brand:  Yup.  Yeah, blood sugar issues, they’re not only for people that have diabetes or that have pre-diabetes, I mean, for people listening, if you consider yourself even extremely healthy or you’re an athlete or you’re somebody that uses your brain, you’re high–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Functioning business executive, blood sugar is just as if not more important to you as well.

Dr. Justin Marchegiani:  Absolutely, again it’s like blood sugar goes too high, it creates a stress response because of the fact that it starts coding all of our proteins in our blood vessels with sugar.  This is called glycation and this glycation is kinda the same thing that happens if you go to the restaurant and get crème brulee.  You pull out the blowtorch and you just kinda crisp that top layer of the crème brulee and it turns brown.  That’s kinda what’s happening in your arteries when you have this whole glycation process going.  So when next time you’re, you know, eating a whole bunch of sugar, picture yourself pulling out a blowtorch.  And again, this isn’t like a one-time thing.  This is more of a chronic thing, right?  If we’re healthy, our insulin receptors are gonna be sensitive and we’re gonna be able to pull that blood sugar into our cell but the more those cells become numb, right?  The more you go and play ding dong ditch to the neighbor, they’re just not gonna open up the door after you ring like the fifth time, right?

Evan Brand:  Totally.  Great analogy as always!  Yeah, insulin resistance is huge and how–how do I know if I’m insulin-resistant?  Well, I tell people, if you go look in the mirror and you’re overweight, you’re likely insulin-resistant.  So that’s probably my best way of identifying, obviously you could do lab testing and stuff like that, but what about you Dr. J?  Would you say that’s a–a safe bet there?

Dr. Justin Marchegiani:  Yeah, I would actually say off the bat, your blood sugar meter is right around your tummy.  So for men you want it below 40 inches.  For women, you want it below 35 inches around your tummy.  Also, get a blood sugar meter.  I’m gonna do a live test, so as we’re recording I’m actually gonna pull up my blood sugar and I will share it with all the listeners.

Evan Brand:  Okay, so–so while you’re doing that, we’ll do the caveat that it obviously depends on what you ate, if you did eat breakfast, if you’re fasted, things like that, but typically I like to see people around I’d say 70 starting to get low but I’d say somewhere close between the 70 and 80 range for blood sugar.  Obviously if you’re above a hundred, then you start getting into the pre-diabetic state and things like that.

Dr. Justin Marchegiani:  Yeah, I just pricked myself if you guys heard me scream in the background, that’s what it was.  Alright, yeah, so I agree.  I think somewhere between 75–I would even go up to 90.  I mean, if you’re doing a fasting blood sugar, a healthy stress response can cause your blood sugar to accumulate.  Alright, I’m getting a reading right on it now.  Evan, seeing me, 3 seconds.  Alright, so right now, my blood sugar’s actually a little bit high.  It’s 110.  Now I–

Evan Brand:  What did you eat for breakfast?

Dr. Justin Marchegiani:  I just had 4 eggs for breakfast.  Now so typically you want to be–I ate about 4 hours ago–it could possibly be why my blood sugar is this high right now, I just had 4 eggs and some bulletproof coffee, so I had absolutely zero carbs.  It could be one, I did have some potato chips last night that I typically don’t have.  Or number two, it’s time for me to eat and my adrenals are kinda ramping up some adrenaline.  I mean, I ate around 8 o’clock this morning, so it’s been about almost 5 hours.  So 110 typically is a little high for me, blood sugar-wise.  The problem with a blood sugar meter like this, you don’t really know if it’s dietary-induced or if it’s because your adrenals are ramped up.

Evan Brand:  Right.

Dr. Justin Marchegiani:  Like if you got a little bit of stress, you’re doing some things, that cortisol can push your blood sugar up a little bit and it may not be a bad thing if your body is utilizing it for energy, right?  So you gotta look at it from the perspective of one, you know, what are you eating?  Two, you know, do a functional glucose tolerance, meaning eat your meals, see how it goes, one, two and three hours after a meal, and then leave one of these on your desk and just do it periodically throughout the day.  The biggest problem is you don’t get a window into insulin because you may be pumping out a whole bunch of insulin to drop that blood sugar back down.  Insulin’s job is to pull the sugar into the cell.  Now, if someone’s at 110 like myself but is pumping out twice the amount of insulin that I am, that’s a problem.  So people can overcompensate by having more insulin to pull that blood sugar in.  So the biggest issues with these, they don’t look at insulin and they don’t look at cortisol levels.  If we get a blood sugar meter that looks at insulin and cortisol, man, that is like–that is amazing.  I would just get one of these for every one of my patients.

Evan Brand:  Totally.  Yeah, so you talked about being high for a couple of reasons, also you’re standing up right now, you’re moving around, you’re–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Excited about talking, so I mean, you are kinda rising to the occasion, that may be somewhat of a natural response that you just measured.

Dr. Justin Marchegiani:  Yeah, I mean, I’m at a standing desk here.  I just, you know, we’re–we’re talking, we’re jazzing, I’m moving as we talk.  When we get this podcast on video, people will see how–how annoying I look bouncing back and forth.  So yeah, you can get some of that sugar up there.  I wish you had a meter so we could do yours; we could have a comparison.

Evan Brand:  I know, I need to buy one.  Isn’t there–isn’t there a recommend–a website that you recommended where they basically just hand out free glucometers–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Like it’s nothing.

Dr. Justin Marchegiani:  Yeah, they totally–this one, I’m gonna pull it up right now in my Gmail.  Gimme one second, I’ll do it live for everyone so they get access to it.

Evan Brand:  Cool.

Dr. Justin Marchegiani:  Yeah, the website is choosefreestyle.com.  So www dot choosefreestyle dot com.  Go to beyondwellnessradio.com or notjustpaleo to get the transcriptions of that so you can see the–the link on that.

Evan Brand:  That’s great.

Dr. Justin Marchegiani:  So we have our at-home test like I mentioned.  I talked about some of the limitations that happen in that but the blood sugar rollercoaster that most of our patients, Evan, I think we would both agree are on, it’s this if you’re not at the diabetes state, which is just your blood sugar’s high across the board the whole time, then we’re in this reactive hypoglycemic state where we eat a meal that may be a little bit high in sugar, our pancreas freaks out, shoots out a whole bunch of insulin which brings that blood sugar back down but it brings it back down a little bit too low, maybe in the low 70s, maybe in the 60s, and we get a stress response.  Now our body then comes and brings a whole bunch of cortisol and adrenalin to the table to bring that blood sugar back up.  Now again, the problem with that is you may not see it reflected on the glucose tolerance test if you test too late because again, the adrenals and the cortisol and the adrenalin will raise that blood sugar back up and you may not see it being raised up by the–by the adrenals but a lot of times you can feel it.  You may feel a little bit jittery.  You may feel a little bit lightheaded, a little bit flighty, a little bit hard to focus, kind of a tired but wired feeling.  So you know how that feels.  Everyone can think of a time where they had sugar as a kid, they were bouncing off the walls, then they crashed.

Evan Brand:  Yeah, totally.  And I drink Mountain Dew so I know very well what that Mountain Dew crash did to me.  I mean, I even have a video.  I think was like 3.  It’s so sad.  My–my brain wasn’t even developed.  My skull was probably still soft and here I am drinking Mountain Dew, but–and then I was filmed crashed out with my blanket and my milk probably afterwards.

Dr. Justin Marchegiani:  Wait, did you say that you currently drink Mountain Dew?

Evan Brand:  No, I do not currently.

Dr. Justin Marchegiani:  Oh.

Evan Brand:  I did when I was maybe, I think I was like 3 when I had my first dose of it and I was on video camera.  I think my dad filmed me at the cabin drinking Mountain Dew and it was hilarious and awful.

Dr. Justin Marchegiani:  I almost thought I was gonna have to give you 5 Paleo demerits for that one, Evan.

Evan Brand:  No, I actually did drink a “soda” today.  I have the Live Kombucha Soda.  Thank you Live for the revived root beer.  It is delicious.  9 grams of sugar but this is the best Kombucha that I’ve–that I’ve had.

Dr. Justin Marchegiani:  Oh, that great.  Actually because we’re talking about blood sugar.  We talked about the up and down.  We talked about the blood sugar rollercoaster.  One thing that’s getting super trendy are Kombuchas.  They’re becoming like the new soda and a lot of the Kombuchas have a fair amount of sugar in them.  Now the one that you just mentioned is actually in the middle.  It’s not–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  It’s not good but it’s not bad.  I–I’ll name names, screw it.  Buddha’s Brew, Kosmic.  There’s a couple down here in Austin.  They got as much sugar as Coke and I’m gonna do a video on this real soon.  My fave is GT Dave’s.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  I like the ginger–the Gingerade.  It’s got 2 grams of sugar, so much–

Evan Brand:  Per serving?

Dr. Justin Marchegiani:  Per serving.

Evan Brand:  I think it’s per serving, yeah–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So it’s 4–4 grams per bottle which is what?  16 ounces?

Dr. Justin Marchegiani:  Yeah, I think it’s a little less.  I think less than 16 ounces per bottle, right?  I think it’s like 12 ounces per bottle, so it’s 1-1/2, I think it’s 3 grams.  I was putting hairs there but yeah, it’s around 3-4 grams of sugar per bottle, right?

Evan Brand:  So about a teaspoon?

Dr. Justin Marchegiani:  Not bad.

Evan Brand:  Not bad–

Dr. Justin Marchegiani:  Not bad.

Evan Brand:  Compared to 20 plus of grams of sugar like some of the others.

Dr. Justin Marchegiani:  Yeah, plus you can justify it, 3-4 grams isn’t bad because you’re getting ginger which is an anti-inflammatory herb.  It’s a prokinetic.  It helps with, you know, gastric releasing.  It’s–it helps with the lymphatic system.  It’s also a natural, you know, stimulator of hydrochloric acid.  It’s a bitter.  It’s also–it’s also got B vitamins in the drink.  It’s also got probiotics and lactobacillus–no, more I think, more saccharomyces boulardii which is great for fungus and yeast.  So a lot of good benefits by drinking a conventional Kombucha that’s like, you know, your–the GT Dave’s brand is my fave.  Either Trilogy or ginger–Gingerade.

Evan Brand:  Yeah, as long as you’re not drinking like 5 a day.  I’ve had a couple people drinking like 5 a day and it’s a true addiction, and then you can run into some issues there with yeast.  I don’t have any studies or anything to prove it, but I’ve just seen people that are drinking way too much have problems.

Dr. Justin Marchegiani:  Yeah, I agree.  Like yesterday I went on my boat and typically I’ll avoid drinking alcohol and I’ll justify it to myself by buying like 2 or 3 Kombuchas.  So I get that good, you know, that good feel, that good, you know, elixir feeling that you get when you drink those Kombuchas, but I can at least justify it by not having the alcohol.  It’s kinda my–my exchange if you will.

Evan Brand:  Right, right.  Yeah, so let’s talk about controlling the blood sugar a little bit.  I’m sure you were gonna end up there by I have this–I have this particular nutrient on my mind that I just wanted to talk about, and that nutrient is cinnamon.  And I really love cinnamon.  I add it to my smoothies.  I’ll do some organic–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Blueberries, almond milk, some grass-fed whey, I’ll throw some cinnamon in there and I do that just because it tastes amazing for one and two, cinnamon acts in a way as a–as an insulin substitute so to speak.  There’s a –a compound in there and it’s way too hard to pronounce, but it’s MHCP is what it is.  And it basically gives the same biological activity as insulin itself so it basically increases the uptake of glucose by the cell but it can stimulate glycogen synthesis as well so I mean, it’s kind of a multifactorial little nutrient that you can really do good things with and my wife, she’ll actually add a little bit of cinnamon on top of her–she has a little reusable K-cup for Keurig which I’m not the biggest fan of the Keurigs because of plastic and whatever, who knows?

Dr. Justin Marchegiani:  Yup.

Evan Brand:  But anyway, she’ll add some cinnamon on top of her coffee there and brew it.  If–if you–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Try to stir in the cinnamon to the cup of coffee, it doesn’t really work but if she actually adds it on top of the grounds and then brews it, it–it just smells amazing.  I don’t really drink much coffee, but it smells amazing and I know that it helps her blood sugar because she comes home and she didn’t have to snack between breakfast/coffee and lunch.  So that’s how I know that her blood sugar is better than it used to be.  She used to have to have like a little protein bar or something in her pocket at all times in case she needed a snack, some kinda hypoglycemia sign there, but now she’s able to just kinda leave the house with just a bottle of water and–and be fine.

Dr. Justin Marchegiani:  That’s great.  Yeah, that’s really good.  Like with my blood sugar stability, I do insulin.  I use a Granny Smith apple at night as my dessert, typically on most nights.  I’ll cut it up.  I’ll sprinkle it over with cinnamon and maybe have a little bit of almond butter with it.  Again Granny Smith’s got about half the amount of sugar as normal apples and then you add the cinnamon to it, that’s a pretty good place to go.  Again the big tips I try to follow myself and I just did a video on this recently, I think you had an anecdote last week where you mentioned you had a real stressful day.  You had a light–a light lunch and then you were feeling a little bit of palpitations and anxiety and we were thinking that it probably blood sugar induced.  You wanna–

Evan Brand:  Oh–

Dr. Justin Marchegiani:  Talk about that?

Evan Brand:  Totally, yeah.  We were on the phone for something.  I think we were talking about the microphone but I said, “Man.”  I said, “I don’t know what’s going on.”  I said, “I guess my blood sugar got to me again,” because you and I were doing the podcast, and here it was maybe 3–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  3 or 4 in the afternoon, and I either had a very light lunch or I just didn’t have a lunch.  Maybe I had–maybe I had to see someone and then I had to a podcast and then something, I don’t know.  Anyway, I was not a good 3 square meal a day eater and my blood sugar got low and I was feeling pretty awful at first, you know, kind of the fatigue, the–maybe the irritability, moodiness, things like that and then when it gets to the more extreme level, at least for me, the more extreme low, that’s when I start even having the anxiety, that cortisol-adrenalin feel, the fight or flight mode where I just wanna–I don’t know if I should run down the street or  hide under a blanket.  You know that sort of anxiety feeling.  So as soon as I went and actually ate something–I don’t know if I just ate some Kerrygold butter by the spoonful or what I did, but once I got that blood sugar under control, I had an immediate relief.  So that’s how I know that I’m still dealing with a little bit of hypoglycemia stuff myself.

Dr. Justin Marchegiani:  Yeah, you know, it’s like one of biggest things you can do to take stress off your adrenals is stabilize your blood sugar.  So if you’re under a lot of stress–I’m a big fan of eating every 4 or 5 hours, I don’t necessarily like every 2 or 3, I feel like you’re just pumping out too much insulin and you’re not letting your body utilize ketones for fuel, so I do like the every 4-5 hours.  I think a lot of people in the ketogenic, in the low carb world, because they’re spitting out so much ketones–ketones are natural appetite suppressants as well, so it’s for them just to skip meals, but the problem is ketones aren’t nutrients.  Like ketones aren’t like B vitamins or vitamin C or fat-soluble like, you know, DHEA, E–EPA stuff.  They aren’t nutrients per se.  They are a fuel source just like sugar’s a fuel source, right?  But they aren’t nutrients and we need nutrients.  Our body and our mitochondria and our cells run off of nutrients so eating 4-5 hours delivers the nutrients you need and if you’re under stress, your body’s going to need nutrients and if you’re under stress, your body will spit out sugar via gluconeogenesis and surprise, surprise, but gluconeogenesis is cortisol-dependent.  So that means you gotta mobilize all the sugar or glucose via cortisol, via your adrenal glands.  And that can be a problem if your adrenal glands are already a little bit stressed or if you’re burning the candle at both ends.

Evan Brand:  Oh, totally, yeah.  And that I’d say 80% plus of the people that we see are doing that exact thing, maybe not on purpose but by the time they get in to see us, they’re already so burnt out and now they wanna–that now they wanna get help and it takes time to fix this stuff, you know, it–it didn’t–your blood sugar didn’t just go haywire overnight.  It may have but this–this state–this stuff takes time so it takes time to fix it, too.  But yeah, getting in, you know, the good–I mean, even eggs, that’s awesome.  The Kombucha we’ve mentioned.  We mentioned the cinnamon.  You mentioned the eating frequency every 4-5 hours.  Maybe we should talk just a little bit about more of the food side of things.  I mean, people yet–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  People, they know every 4-5 hours, but I think people forget the importance of getting enough healthy fats and proteins.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Because that is what you need.  You’re not going to stabilize your blood sugar by eating some type of carb or quick, like rice crispy snack.

Dr. Justin Marchegiani:  Yeah.  One of the things that I’ve created that helps is called the Meal Matrix.  And the Meal Matrix is just a simple list of macronutrients.  It’s got your proteins in one column, your carbs in another column, and your fats in the third column, and it’s got herbs and spices in the second column.  But your proteins are your proteins.  And again I like people eating full fat proteins, meaning not boneless skinless chicken breast but you know, if you’re doing chicken breast, you know, do it with the skin on or do the chicken thigh which is even better with the skin on, which is what I’m having for dinner tonight by the way.  And then you have your carbohydrate column, which I break carbohydrates up into 3 categories.  Non-starchy–non-starchy are more of your vegetable-based carbs, high in nutrition, low in sugar.  Your starchy, but safe starchy, meaning no grains, so potatoes, sweet potatoes, yucca, plantains, squash, alright those are our starchy ones.  And then our low sugar fruits or low glycemic fruits.  These are our berries, our lemon, our lime, our grapefruit, our passion fruit.  These fruits are–they dissolve to sugar in our bloodstream slower than let’s say our tropical variety like pineapple and watermelon and–and mango, as good as they are, they could be just like candy.  So–

Evan Brand:  Oh yeah, especially the dried ones.

Dr. Justin Marchegiani:  Oh, my gosh, yeah.  And then the third list is the fats.  So typically we’re either eating a fat that’s combined with a protein or we’re cooking with the fat or we’re putting fat on our veggies like coconut oil or grass-fed butter or avocado oil, or good quality nuts if you’re not autoimmune or you’re not too sensitive.  Things like that and I typically recommend starting between 3-6 ounces of protein per meal and a good recommendation is anywhere between a palm–palm-size to a fist to a full hand.  So again, bigger people, bigger hands, right?  So palm’s about 3 ounces, fist is about 4 and a full hand is about 6.  So I like people using body parts because you’re typically up there and you can like eat, always use that hand as a good frame of reference so when you’re serving yourself some food, and the more stressed you are, the more protein you need because protein gets utilized for neurotransmitters.  It gets utilized for detoxification and if we put it in there, it acts like a log on the fire, on that blood sugar fire.  So again, logs typically last about 4 hours, 5 hours on the fire, so think about it like your metabolic fire–you wanna throw that log on there so you have about 5 hours in between having to put more logs on there.  Logs being protein and fat and then the carbohydrates are like the kindling, right?  We need just a little bit of spark there to get things moving and that could be some non-starchy vegetables, broccoli, asparagus, kale, spinach, etc. and depending on how insulin-sensitive you are, maybe some low sugar fruit, maybe a little bit of starch, again I’m a big fan of backloading my carbs, doing a more at night and then almost doing no carbs outside of the non-starchy variety during the day.  So that’s a good general way in which I teach my patients how to apply blood sugar stability techniques.

Evan Brand:  Good stuff.  Yeah, I’ve also experimented with doing the carbs like some organic white rice.  I’ll try that with dinner and then I’ll try it with breakfast.  It doesn’t work with breakfast as much, man.  I–I crashed.  It’s a completely different feel than if I have the rice with dinner and say some steak and then I’ll throw some aminos on there of some sort.  I sleep way better that way but the morning time, it’s just not a good time so I–I stay, I wouldn’t say ketogenic but maybe, very, very low carb for–for morning, for breakfast time, mostly just pure fat and protein.

Dr. Justin Marchegiani:  Yeah, I think our body is just more naturally insulin-resistant in the morning.  I think a lot of this has to do with the cortisol levels.  So if you look at a–a diurnal cortisol rhythm, our cortisol is much higher in the morning and drops throughout the day, and because cortisol, it’s a glucocorticosteroid–first part of that word is gluco, it helps with blood sugar stability and energy, so if we have a high amount of cortisol, then we’re already gonna be pumping glucose naturally as I just showed you on my blood sugar meter.  So it makes if we already have that natural stimulation, don’t add more fuel to that metabolic fire so to speak.

Evan Brand:  Yeah, we don’t need to add it too high because then that may create a larger hill for you to come back down, you’re saying.

Dr. Justin Marchegiani:  Exactly.  That’s kind of the deal.  So the diet and lifestyle part is super important.  I like doing about 3 meals every 4-5 hours, maybe 1 snack in between there if we have a longer break.  Like let’s say, some patients they are having their lunch around noon or one, then maybe their family gets home and out of school like around 7, so there’s a 7-hour window there.  So they may need a nice need for a good clean protein shake or a mini-meal.  I hate the word snack, because snacks are typically imbalanced, right?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Like I’m gonna go snack on some blueberries.  You mean, you’re gonna just throw some carbohydrate in your body?  That’s gonna probably mess up your blood sugar if you’re just throwing that without anything else in it.

Evan Brand:  Yeah, it–it’s kinda sad.  I don’t know how carbohydrates in general or carbohydrates are snacks.  Snacks have become carbohydrate.  Like–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  When somebody says they want a snack, I think of like pretzels and potato chips and ice cream and cookies.  I don’t think of–I mean, I should think of avocados and coconut oil and spoon feeding butter, but the culture of–of the snack mentality has been so perpetuated by the big food marketing industry–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  That no one even knows what the hell a good snack is.

Dr. Justin Marchegiani:  Yeah, exactly.  And again, carbohydrates are the cheapest foods out there so it makes sense why this is crap that’s, you know, shoved down our–our mouths or, you know, to our faces on TV, right?  So what are some healthy snacks?  Well, one, a good clean protein shake.  I like a good clean whey protein, pea protein or beef protein, you know, without any additives, you know, some good coconut milk in there, maybe you throw a few berries in; maybe a few berries that’s okay because we’re getting some protein and fat which kinda stabilize it out, that could be good.  It could be like an EPIC bar.  EPIC bars are great.  Some good clean grass-fed beef jerky, that’s a really good thing.  Scoop of coconut oil and maybe a couple of bites of an avocado or maybe a bite or two of your lunch’s leftover, that’s always good.

Evan Brand:  I know for you, dealing with autoimmunity yourself, you may stay away from corn at all.  I’m not sure.  Do you do corn at all?

Dr. Justin Marchegiani:  I try to always stay away from that.  I did have some last week at a restaurant but it was confirmed to be 100% gluten-free.  It was even in its own bag and, so there was no cross-contamination or anything.  So if I can confirm its–its quality, I will indulge from time to time–

Evan Brand:  Okay.

Dr. Justin Marchegiani:  Like once or twice a month.

Evan Brand:  Because what I was gonna say is my little guilty pleasure snack, Target of all places, yes, Target the store, they have the best organic blue corn chips.  I feel like I may have even have told you this before, but they do them the traditional way, with the trace of lime and the sea salt then it’s the organic blue corn which has more nutrients than your white or yellow corn and anyway, Hannah, she’ll come home–my wife she’ll come home and she’ll get a fat avocado and she’ll open it up and throw in some–some spices in there and we’ll just eat that as a snack.  I mean, we’ll split an avocado; there’s nothing better.

Dr. Justin Marchegiani:  Evan, that is 3 Paleo demerits.  No, I’m kidding.  That’s good.  That’s good.  I mean, I do the Boulder chips that are organic.

Evan Brand:  Yeah, Boulder’s good.  Yeah.

Dr. Justin Marchegiani:  That are non-GMO certified and that are cooked in the avocado oil.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  And I’ll do that with–we’ll have like some grass-fed beef in a bowl and then we’ll have some avocado that’s like crushed up in a guacamole essentially with a little bit of lime and stuff, and we’ll just scoop the–the meat on there and scoop the guacamole on there and it’s like amazing.  Little bit of carbs, but you get some good quality protein and fat, too.

Evan Brand:  That sounds good.  I actually just got my grandparents to convert from either Lay’s or Ruffles or whatever garbage it was to the Boulder chips and they actually have the avocado oil, you know, there’s a sea salt black pepper one, that’s probably one you get.  That’s the best one to me.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  And then there’s the–there’s an olive oil one now but I’m guessing they cook it in olive oil–

Dr. Justin Marchegiani:  That’s why.

Evan Brand:  They probably ruined it, so–

Dr. Justin Marchegiani:  Yeah, I would not touch it.  Last night I got so–my wife and I got so gassy, we had the–some chips at Whole Food and they were like organic, like non-GMO.  They were cooked in coconut oil, so I’m like, “I’m gonna try this.”  Looked at the back and it has just a little bit of fructose in it and it also had a little bit of rice dextrin.  So like kinda like rice starch.  I’m like, “Why the hell do they put this crap in here?”  I’m like, “I’ll give it try.”  And there was no sugar.  No added sugar on the ingredients, so I’m like, “At the very end, you know, it’s not a big deal.”  I tried it and I could really taste the sweetness on the chips.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  And they were salt and vinegar.  I’m like, “Well, I don’t want sweet when it comes to salt and vinegar.  I want that salty flavor.”  So I said, “Never again.”  So stay away from those chips.  Salt and vinegar.

Evan Brand:  Oh, why would they–why would they add fructose?  That makes no sense.

Dr. Justin Marchegiani:  Dude, I know, man!  I like–I went against my Paleo intuition and said, “I’ll give it a try.  It’s a good company.  It’s GMO, it’s organic-free, I can’t find a better alternative.”  But yeah, you gotta go with that gut instinct sometimes.

Evan Brand:  Oh, gosh!  I know, I can’t think of a particular nutrient or food but I’ve done several times where I go to get something.  I’m like, “Oh, I probably shouldn’t.”  And I just take a couple of bites anyway and it’s like it wasn’t even worth it, like the Reptilian brain overwhelmed my–my prefrontal cortex.

Dr. Justin Marchegiani:  Yeah, I think some of my blood sugar that we just tested here a few minutes ago is potentially part of the repercussions of that.

Evan Brand:  Oh, so that was yesterday.

Dr. Justin Marchegiani:  It could be.  It’s possible.  I’ll do my blood sugar again tomorrow and if it’s better around this time of day, you know, same kind of breakfast, then I’m gonna know that it was–it was the dinner before.  It–

Evan Brand:  Yup, yup.  Well, did you have anything else on this–on this food journey of blood sugar?  I think we covered a lot of it, but I know there’s other pieces to the puzzle that we haven’t even covered and I don’t know if we have time to.

Dr. Justin Marchegiani:  I think let’s just touch upon some of the supplements.  Some of the things that I use with my patients for blood sugar stability is we’ll give some additional support with alpha lipoic acid.  We’ll use chromium.  I’ll use herbs like jemima and bitter melon, and what a lot of these nutrients are doing is they’re helping with the blood sugar receptor site.  It’s helping with insulin receptor sensitivity.  It’s helping with blood sugar sensitivity.  What that means is, is that when our body takes in blood sugar, that blood sugar comes into our bloodstream, the more insulin numb we are, the more insulin we have to make, and that’s a stress around the body.  So if we have these nutrients there, what it does is that it allows us to make less insulin and to pull that blood sugar into our cell and utilize it for energy better and more efficiently without this big bolus of insulin.  Remember the insulin is inflammatory.  You just go into PubMed, type in hyperinsulinemia or hyperinsulin, that means high insulin in medical speak, and disease you want and you will find a correlation between hyperinsulin and cancer and autoimmune conditions and diabetes of course, any type of disease you will find that connection.  So those nutrients help with the receptor site sensitivity and allow your body to need to make less insulin and help your body deal with the blood sugar better.  But if you’re using those supplements and you’re not making a diet change, it’s just a Band-Aid and it’s not gonna work long term.

Evan Brand:  Right and yeah and I mean chromium is found in foods but some of the foods that chromium is–is found in, a lot of people aren’t eating, like calves liver, you have oysters, you have liver, you have onions.  So a lot of people may be avoiding these.  I typically don’t eat onions just in general anyway.  I kinda stay away from peppers and onions and things like that so I’m probably lacking on the chromium.  I personally don’t eat mini oysters because of the sea–you know, it’s always the balance of the ocean toxicity versus chromium, you know, it’s just–

Dr. Justin Marchegiani:  Yeah, exactly.

Evan Brand:  It’s–it’s always a toss-up for me.  I–I’m so on the fence about the seafood issue, but anyway, so that’s why I use sometimes an Aqueous, a liquid chromium, and I enjoy it and I do notice a difference.  So I’m trying to think of what else I use, man.  Honestly, the chromium in the–in the cinnamon are only my two direct ways of supporting blood sugar.

Dr. Justin Marchegiani:  Yeah, when I see patients with adrenal fatigue, we’ll add a blood sugar support.  They’ll take one per meal, because it just gives me that insurance policy that they’re getting those nutrients in each meal.  Because like you said, it’s already hard enough to get them to eat these newer foods that are less inflammatory and better and then now we go extra level and now it’s like, well, it’s gotta have chromium in it and vanadium and all these nutrients.  It just adds another layer.  We forgot magnesium, too.  Another layer of compliance.  So if we can just take a pill that has those extra nutrients along with that, that’s gonna be a great–a great step in the right direction.

Evan Brand:  Yeah and I guess–I guess glutamine would be kind of my other recommendation that almost give–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Every person I see just because I recommend it as sort of like a emergency reserve, like if you’re gonna go eat a cookie, how about just take a capsule of glutamine and open that bad boy up and pour it into the mouth instead.  And it actually tastes decent.  It’s one of the–the decently tasting amino acids compared to some of them.

Dr. Justin Marchegiani:  I agree.  The best is inositol.

Evan Brand:  I haven’t had that.  What’s it taste like?

Dr. Justin Marchegiani:  It tastes like sugar.  It’s actually it’s more of a derived pseudo B vitamin but it actually helps with blood sugar stability.  So if you want a little bit of sugar feel, well, go chew on some inositol.  It’s a good way to help your blood sugar but also give you a little bit of a taste.  Just be careful, it’s like Xylitol where it’ll give the runs if you do too much.

Evan Brand:  Really?  Okay, now explain this to me if you’re familiar with the myo-inositol.  I’ve seen that and I don’t know.  Is that like a better bio available form or what?

Dr. Justin Marchegiani:  Yeah, there’s like a chiro-inositol and a myo-inositol.  There’s some research that it actually is very beneficial with PCOS or polycystic ovarian syndrome, which is a condition where females will grow excessive cysts on their ovaries and again, there’s a massive connection with PCOS and insulin, which insulin then gets connected to blood sugar.  So this inositol is really helping with PCOS indirectly by helping with blood sugar.  And just go Google like I said, insulin and PCOS, and that’s why the main line therapy is Glucophage or Metformin to treat it.

Evan Brand:  Really?

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  So what are they trying to do there?  They’re trying to get that insulin back down to fix that PCOS?

Dr. Justin Marchegiani:  Yup, because the insulin is what’s driving the cyst to grow.  It’s like the–the insulin is like the–the food for cyst, it’s so to speak.  And then the insulin then causes the females estrogen downstream to testosterone and that that’s why you start to see with that whole sequelae of, you know, extra hair along the jawline, thickening of hair, thickening of follicles, things like that.  You’ll just see changes in women.  It’s like this cruel joke when we have high levels of insulin in the body, women become more like men and men become more like women with, you know, the–the gynocomastia and the breast tissue and all that stuff.  So it’s this–this shift in sexuality if you will.

Evan Brand:  That’s incredible.

Dr. Justin Marchegiani:  By our–by our hormones with just hyperinsulinism.

Evan Brand:  Wow.  So this is probably a topic for a entire episode but–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I had always seen stuff about like how estrogen being a cause for or maybe a cause or a symptom or something that’s correlated with PCOS, or was it kind of those two together?  Is it high insulin and high estrogen like estrogen dominant state that’s causing that PCOS or is that just kind of a side effect and the insulin’s really the biggest culprit there?

Dr. Justin Marchegiani:  Well, again, there’s gonna be a combination of the two.  A lot of times when we have estrogen dominance, we may not have high levels of estrogen so to speak but we may have high levels of estrogen in relationship to progesterone.  So because progesterone can go downstream to cortisol and cortisol connects with us because it’s stabilizing blood sugar.  So the more you’re taking your meals and eating a whole bunch of sugar, the more you’re taking your progesterone downstream and it’s gonna convert down to cortisol and if you’re on the second half of your cycle that luteal phase, that’s the phase where you’re more prone for PMS, right?  Day 15-27 of your cycle, so if the first day of your period is day 1, day 15-27 is where your luteal phase is and if you’re eating too much sugar right there, you are setting the stage up for some nasty PMS, because that cortisol is draining all of your healthy progesterone.

Evan Brand:  Interesting.  So someone could be really messing themselves up from kind of a multilevel thing here if they have excess stress in the form of emotional stress for example, but also the nutritional stress where maybe they’re skipping meals and when they are eating meals, they’re having too much carbohydrate, therefore, driving up the insulin likely suffering from blood sugar crashes which is then elevating cortisol which is then you’re saying it’s taking away from the progesterone because the progesterone is not able to do its job because it’s needing to go downstream to create cortisol and, therefore, estrogen just has no–no gatekeeper, no regulator I guess.  Is that the way to put it?

Dr. Justin Marchegiani:  Yeah, it’s just the ratio is starting to go–gets skewed.  And again, there are estrogen issues because we are just flooded with xenoestrogens in our environment, right?  With our plastics and you know, you mentioned the whole–the coffee thing that your–your wife does there.  That’s got an extra plastic in it.  You mentioned all the pesticides are estrogen-based.  You know, the receipts that you get at Whole Foods, right?  There’s a coding of BPA in there, on the inks, so you gotta fold those up and don’t touch your fingers to it.  So lots of different things in our environment are giving us these extra estrogens, so you gotta be careful of that.

Evan Brand:  Right.  So that progesterone, that’s typically always–you’re not gonna have enough in the modern world a lot of times compared to the amount of estrogen that’s out there.  We’re just in an estrogen–estrogen-filled world.

Dr. Justin Marchegiani:  Yeah, we just gotta have our detoxification pathways working well, eat organic food, go exercise and sweat.  The solution to pollution is dilution according to Robert Rackowski.  Again, drinking water is gonna help your body get some of those hormones out.  And again, your detox pathways run with amino acids, don’t forget that.  We need aminos to run those detox pathways and all of these toxins, they screw up the blood sugar receptors.  They make us more insulin resistant.

Evan Brand:  And remind people where they get aminos.

Dr. Justin Marchegiani: Well, aminos, I mean, your best sources are gonna be animal-based proteins because they’re gonna be higher in a sulfur amino acid profile, and if we’re gonna do a powder-based, your next best is gonna be a good quality whey protein that’s grass-fed or a good quality beef protein that’s grass-fed.

Evan Brand:  Yup, and you’re also helping with detox there.  You can increase your glutathione level, your master antioxidant with some–with some grass-fed whey.  So if that’s not in your supplement cabinet, I’d get some in there.

Dr. Justin Marchegiani:  Absolutely.  Anything else you wanna add, Evan?

Evan Brand:  No, that’s it.  This has been a great overview and it’s fun.  Fun as always.

Dr. Justin Marchegiani:  Yeah, I’m really looking forward to our last podcast together.  I mean, we’re just ripping off, you know, thousands by the day, and I just really want the listeners to just get as much out of it, so if they have questions for us, let us know.  And if you’re enjoying the show, give us feedback.  We love feedback.  It’s what gets us out of bed in the morning and motivates us to do these shows.

Evan Brand:  Yes, sir.

Dr. Justin Marchegiani:  Evan, thanks a lot, man!

Evan Brand:  Thanks, see ya!

Dr. Justin Marchegiani:  Bye.

Evan Brand:  Bye.

Dr. Frank Tortorice – Blood sugar and Diabetes – Podcast #35

In this podcast Dr. Justin interviews Dr. Frank Tortorice on blood sugar and diabetes. Dr. Frank reveals the blood test he uses to reveal blood sugar imbalances. Dr. Frank also uses specific blood test to detect metabolic syndrome in the early stages so it can be reversed.

Dr. Frank TortoriceFind out about the functional tests that can be taken before one can be diagnosed with diabetes and other lab tests and markers for CBC, fasting blood glucose, hemoglobin A1c, fasting insulin and frustosamine. They also discuss about the dawn phenomenon by the stimulation of glucose and Dr. Frank tells us the damage that can happen with diabetes and blood sugar and some of these AGEs or advanced glycation end products. Discover what is the recommended standard of care for diabetes which is also discussed in this interview including recommended diet and foods for diabetics.

In this episode, we review:

2:22   Difference between Diabetes Type 1 and Diabetes 2.

9:05   Dawn phenomenon and metabolic syndrome

12:39   AGEs or advanced glycation end products.

28:49   Standard of care and diet

40: 24   Diabetes, cardiovascular, and cancer connection








Podcast: Play in New Window|Download


Dr. Justin Marchegiani:  Hey, there!  This is Dr. Justin Marchegiani.  Welcome back to Beyond Wellness Radio.  Again, just a reminder for everyone, check out beyondwellnessradio.com, click on the Contact Us button to ask us questions.  You can actually speak your questions and we’ll play them back on the show.  You can also subscribe to get your content or the newest episodes of Beyond Wellness Radio emailed to you directly.  Also subscribe on iTunes.  Subscribe on YouTube.  If you like the show, give us 5 stars.  If not, /ve us some feedback.  The show is here for the listeners.  Again, you can always schedule a consult on beyondwellnessradio.com, click on Just In Health or you can click on Really Health Now and get in contact with Baris Harvey.  Again, today this is a real treat.  We have Dr. Frank Tortorice, my Italian brother from another mother.  And today we’re gonna be talking about diabetes and functional medicine and Dr. Frank went to med school over at the University of Rome over in Italy and he did his residency and internship in Youngstown, Ohio.  And it’s really a privilege here to have Dr. Frank Tortorice on the show.  Dr. Frank, how are we doing?

Dr. Frank Tortorice:  Great, Justin.  Nice talking with you.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  Thanks for inviting me.

Dr. Justin Marchegiani:  Oh, thank you, thank you.  So Dr. Frank, how did you get to be known as the diabetes doc?

Dr. Frank Tortorice:  Well, you know, we have some diabetes in my family and many family members have a diabetes or enough have diabetes type 1 and type 2 so it became something personal to me.  And then, you know, when I finished my internal medicine residency and then added the functional medicine, it became clear that the standard way of treating diabetes doesn’t always get a permanent solution, so the–the thought was that it was something I felt that I could–I could make some in rows into and I enjoyed and that I can see people with diabetes all day and–and have some positive influence in their life and their health.

Dr. Justin Marchegiani:  Awesome, Dr. Frank.  Well, talk to me about diabetes type 1 and type 2.  What’s type 1 and what’s type 2?  How are they different?  Can you touch on that?

Dr. Frank Tortorice:  Well, type 1 diabetes traditionally has been due to pancreatic failure where the person cannot–can no longer produce enough insulin and because they could no longer product insulin, they became–can become very ill and–and then have some conditions or  even hospitalizations because of unregulated blood sugar.  Type 2 which is the majority, it used to be only in adults but now we’re seeing it in adolescence and even younger kids, is due to insulin resistance.  The patient produces insulin but the insulin they produce isn’t enough to get their blood sugar back to normal levels.  They have insulin resistance so the insulin doesn’t really help, you know, getting their blood sugars into a–into the normal range.

Dr. Justin Marchegiani:  Got it.  So we have type 1 which is the autoimmune condition where your body is destroying those pancreatic cells and then type 2 essentially is the receptor sites are just getting numb to all of the insulin from all the high blood sugar in our diet.  Is that correct?

Dr. Frank Tortorice:  Yes, it is.

Dr. Justin Marchegiani:  And in your practice, what are you seeing more?  Are you seeing more type 1 or type 2?

Dr. Frank Tortorice:  No, by great majority we see type–type 2 but then we also see type 2 that have to give–on insulin because they’ve–they’ve maxed out of oral medications and they’re put on injections of one type or another.  So that’s becoming, some we’ve seen in the last 10 years that we never used to see. When they are type 2 you just increase the medications, they’re oral medications and usually then you get them back into a reasonable blood sugar.  Now we’re seeing patients that are on 3, 4, 5 oral medications and not doing it.  Even though they produce insulin, they have so much resistance that they need additional insulin from injections to help regulate their blood sugar properly.

Dr. Justin Marchegiani:  Oh, that makes a lot of sense.  So they’re coming in to you, right? They’re blood sugar is high.  So like diabetes for instance, that’s like a blood sugar of 126 or greater and we know that even over 100 potentially could be pre-diabetes.  So can you tell me how you’re diagnosing these people and is there more functional test you’re using to pick them up before they’re full blown diabetes?

Dr. Frank Tortorice:  Yes, Justin, what we do is–you know, if you go to Jack Kruse’s book, he said blood sugar 88 or above already shows insulin resistance so we–we will check the standard, you know, medical tests, laboratory tests that–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  Doctor’s get such as a chem panel.

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  We also add, even if they’re not diabetic, I add a hemoglobin A1c–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Frank Tortorice:  Which is a 3-month measure of their–their average blood sugar. and you can get a lot of information with that, but the one piece I add to that that some doctors don’t add is the C-peptide or an insulin level, and by getting that you see pretty much how much work the pancreas has to do to maintain a normal blood sugar if they’re normal or if it’s abnormal, how much insulin they’re secreting in their present condition.

Dr. Justin Marchegiani:  I like that, so yeah, C-peptide is basically it’s like a–a meter for how strong the pancreas is or how much insulin the pancreas is pumping out.  Is that correct?

Dr. Frank Tortorice:  That’s correct, yes.

Dr. Justin Marchegiani:  And with your some of your type 1 diabetics, you’ll probably see that C-peptide very low if not at all, right?

Dr. Frank Tortorice:  Right.  Yeah, usually, I will manage them sometimes with a diabetic or an endocrinologist and they’ll get–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  GAD, maybe a GAD–G-A-D-65, looking for antibodies.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Frank Tortorice:  With immune component as you mentioned earlier and if we know they’re not gonna produce insulin, it makes no sense to give them a medicine which is gonna stimulate insulin production.  They just don’t have it and they–they have to be on insulin.

Dr. Justin Marchegiani:  Got it.  Yeah, and for all the listeners–and for all the listeners, what stimulates the GAD65 antibodies the most is gonna be gluten.  So if you got type 1 diabetes, getting off grains and gluten is gonna be important.

Dr. Frank Tortorice:  That’s correct.  A lot of times, Justin.  They’ll come to me, they’re not diabetic but they’re pre-diabetic.

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  And we can–and we could even reverse that condition.  We’ve had a number of patients that were right on the cusp for being a diabetic but through their, you know, they’re working through their lifestyle, their–their sleeping, their–their nutrition, getting rid of gluten and getting rid of processed foods, managing their–their stress better, and doing a better job with sleep, getting regular exercise no matter what present state of activity they’re at, it can make a–a world of difference for–for them.

Dr. Justin Marchegiani:  Alright, that’s great.  So if I’m, you know, the average patient here and I’m going into my doctor and I’m–I got my blood test here right in front of me and I’m looking at it, so your basic CBC, we’re gonna have a fasting blood glucose, what’s that–what the number that you’re looking at for potential pre-diabetes?  Are you greater than 100, greater than 105?  What’s that cutoff?

Dr. Frank Tortorice:  Well, I mean, really I–I don’t wanna see it above 88.

Dr. Justin Marchegiani:  Really?  Above 88?

Dr. Frank Tortorice:  Yeah, again, as I referenced earlier in–in Jack Kruse’s book he uses that 88 and I find that pretty true.  Yeah, yeah.

Dr. Justin Marchegiani:  Alright.

Dr. Frank Tortorice:  I mean, if you get an athlete or people–we have some athletes and some people who are high level, you know, either in excellent physical conditioning, their blood sugars will be in the 70s even and–and not–and they’re doing really well or even young people.  We check a lot of adolescents that are of a normal body weight or even young adults, they’re blood sugars can be in the–you know, if they have no insulin resistance, their blood sugars will be in the 70s, maybe 78, maybe 80, 82, they’re–they’re rarely over 90.  We just see 90 so often that we think it’s normal, but it’s really not.

Dr. Justin Marchegiani:  Interesting.

Dr. Frank Tortorice:  So, so I know there’s other experts that may disagree, I don’t know, it’s a 100 is your marker, but again I mean, do you wanna, you know, be two-thirds out of the–in trouble before somebody–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Frank Tortorice:  Does something about it?  I mean, at 88, I think you can–you can really start to make changes.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Frank Tortorice:  I mean, obviously if they’re 95 or 100, you’ll see that their A1c is probably in the mid fives.

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  And I think that Dr. David Perlmutter, once you start getting above 5.6, you’re at risk for type 3 diabetes which to your listeners who don’t know it’s another–he believes that the new, you know, Alzheimer’s, dementia is like a type 3 diabetes because of inflammatory changes in the brain.

Dr. Justin Marchegiani:  Right.  And you said 5.3, that’s for the hemoglobin A1c.

Dr. Frank Tortorice:  No, 5.6, 5.6–

Dr. Justin Marchegiani:  5.6.  Okay.  Alright, so a couple of things here.  I noticed because I’m doing a lot of blood sugar testing in my office and I do notice blood sugar, if you’re using blood sugar as a marker, it tends to take about 10 years for someone with diabetes to really even show up.  So blood sugar on a fasting CBC is–is gonna be a very late stage indicator for diabetes.  So would that be something you agree with Frank?

Dr. Frank Tortorice:  Yeah, I agree, 100%.

Dr. Justin Marchegiani:  Okay, and my biggest concern is I see some patients with their blood sugar, you know, in the 90s when they wake up fasting, and one thing I think maybe isn’t taken account is the dawn phenomenon which is cortisol potentially upregulating or mobilizing glucose.  What’s your take on the dawn phenomenon by the stimulation of glucose?

Dr. Frank Tortorice:  Well–

Dr. Justin Marchegiani:  Or cortisol?

Dr. Frank Tortorice:  Yeah, you–you’d have to get like a 2AM blood sugar.  And I know that some–some doctors tell their patients the first week to prick their finger at 2 in the morning but what I use is a certain marker checking the C-peptide.  If their C-peptide is chronically elevated then, you know, that they have some insulin resistance.  They’re not getting the sugar into the cells, their body secretes more insulin to try to overcome that resistance, so–so I think that’s a good way. The other thing is there’s–there’s a phenomenon called the metabolic syndrome.

Dr. Justin Marchegiani:  Hmm.

Dr. Frank Tortorice:  And if they have overweight, if they have borderline or hyper–hypertensive numbers, if their cholesterol is either fractionated with the bad cholesterol or the total is elevated, all those different things.  Plus if they have central obesity.  All those things are–are telling you that this is a person who–who is–is on the wrong path in terms of their blood sugar management.  I mean, as you know, you know, blood sugar is just one of the things we see.  I mean, these patients come in, they have 3 ort 4 co-morbidities together because they really have been not managing their health well or because they’ve–they’ve, you know, things.  They have stressors in their life and–and you know, things are changed.

Dr. Justin Marchegiani:  That makes sense.  And one of the things that I do on my practice, I wanna get your take on it as well, is using a glucose tolerance test.  So essentially taking your fasting blood sugar and then looking at 1-hour and 2-hour and then getting a sense of where they’re at, because if you read Jenny Ruhl’s book, Blood Sugar 101, she talks about at 1 hour in, you wanna keep the blood sugar under 140, at 2 hours in, you wanna keep it under 120, and then at 3 hours in, you wanna be down to a fasting state.  So what’s your take on fasting glucose or glucose tolerance test?

Dr. Frank Tortorice:  Yes, that’s–that’s an excellent thing you’re doing there, because we will do it well, because sometimes you’ll get a C-peptide as elevated or you’ll get a hemoglobin A1c.  I had a patient today with a hemoglobin A1c, it was 5.9–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  Which is pre-diabetic.  6.5, depending on what lab you’re using is actual diagnostics for diabetes mellitus.  But his C-peptide is only 1.16, which is–but we like to see it below 2 in our–in our clinic.  So–

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  So the question is why is this guy having so much resistance apparently with an A1c of 5.9 but not producing very much insulin at all?  1.16, I expect it to be 3, 4, 5, sometimes you see it 8 or 9.  So something’s not right.  So I said, do you know what, we need to do a 2- or 3-hour fasting glucose–

Dr. Justin Marchegiani:  Yes.

Dr. Frank Tortorice:  Tolerance test, because I gotta figure out what’s going on with your insulin and I’ll also get a C-peptide at all of those 3 stages.  And if you do that, then you see how–it’s kinda like I tell patients, if I want to see how you run 100-meter dash, I can think about it and talk about it in–in the office or we could have you just go down to the local park and–and we’ll just time you.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  The same thing with insulin is a functional type test where we stress the pancreas by giving a–a standardized load of 75 grams of sugar and then we see how the patient performs.

Dr. Justin Marchegiani:  That’s great.  That’s great and I just took my fasting blood sugar about an hour after a meal and I’m at 118 right now which is a little bit high for me.  Typically I never go above 110 but I had a little bit of plantains and squash after my meal so yeah, the–the goal is, the research shows about 140 or higher at any time is gonna create some level of inflammation and/or advance glycation end products.  I want you to talk about some of these–some of the damage that happens with diabetes and blood sugar and some of these AGEs or advanced glycation end products, Dr. Frank.

Dr. Frank Tortorice:  Well, the–the problem with diabetes is not so much just the sugar, it’s what it does to end organs.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  So end organs for diabetics are the eyes, the kidneys, the peripheral vascular system.  It can cause fatty liver which can–can lead to liver damage or even liver cancer according to some reports.  What we–what we worry about is that the–the patient’s cells and–and organs become affected by this sugar which is very noxious and toxic to the body and causes, you know, causes a lot of inflammatory changes which lead to, you know, a lot of bad side effects to the individual organs.  So what we see a lot of is–in this population is kidney damage.  We see patients that are on dialysis, hemodialysis 3 times a week–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  As an end stage.  But then we see that they start–their filtration system starts to diminish and–and the kidneys normally reabsorb most of the–the useful products of the blood and–and give it back to the system and only the waste product goes into the urine which gets discarded.  But when you start having diabetes, it’s like having a SIV and you start losing valuable protein, and when you start getting above a certain level then the kidneys are really no longer able to filter and then you can getting either–either infections or you start getting damaged by these–these products going back into the blood systems that aren’t adequately, you know, gotten rid off by the body.  So that’s–that’s one thing.  The second is the eyes and we’ll have sometimes that patients that haven’t seen me in a while goes–go for an eye exam because they can’t see, and then the ophthalmologist says, “Well, you have these, you know, peripheral, you know, these proliferative damages–”

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  “Into the back of the eye or the retina of the eye.”

Dr. Justin Marchegiani:  Hemorrhages, right?

Dr. Frank Tortorice:  Yeah, they could be that.  There can be, you know, the–the vessels can be swollen.

Dr. Justin Marchegiani:  Glaucoma, right?

Dr. Frank Tortorice:  It could be increased pressure.  Yeah.  And they say, “You better see your doctor and have a blood sugar checked.”  And they’ve caught 1 or 2 before I have because either the patient hasn’t seen me or they, you know, weren’t complaining of anything and hadn’t seen the doctor, had some change in vision and the doctor looked at the back of his eye, and said, “Yeah, these are changes that are consistent with a new diagnosis of diabetes mellitus.”  So those are the two, probably we see the most of, is the kidneys and the eyes.

Dr. Justin Marchegiani:  Right, and so essentially what’s happening here is we have these advanced glycation end products and a good analogy is AGEs, that’s the abbreviation which does kinda make sense because it’s aging you faster.  And imagine what they’re doing is they’re just sugar coating all these proteins in your body, right?  And these proteins are in the kidneys and the vasculature, and it’s like basically taking a blow torch to your crème brulee if you will and browning the crème brulee.  That’s what’s happening to these arteries and it’s basically a free radical magnet.  These free radicals come away and they just chip away your electrons and your DNA, and they create damage.  Is–is that something you would wanna answer, Dr Frank?

Dr. Frank Tortorice:  Yeah, very well said.  Very well said.  The–the proteins usually have structures which allow them to–to somewhat, you know, they are somewhat mobile and they usually are very flexible.  Once you start getting glycated end products, you turn them–you turn them very hard.  So think of the difference between, you know, like rigatoni that’s raw and rigatoni–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  Rigatoni that’s cooked.

Dr. Justin Marchegiani:  Right, right.  That’s makes a lot of sense.

Dr. Frank Tortorice:  So I mean, yeah, if–if these proteins can’t configure themselves properly, then a lot of bad things happen.  So–so, you know, it’s–our bodies are supposed to be very flexible.  Our arteries are supposed to be flexible. That’s how we propagate the blood pressure. When they start getting hardened and you start getting plaque in them because of the inflammatory changes because of the–the glycated end products, that’s not good.  So–so, yes, Justin.  You’re absolutely right.

Dr. Justin Marchegiani:  Well, that makes a lot of sense.  So let’s kinda recap for the listeners here some of the lab tests.  So you’re–you’re taking the fasting glucose 88, which–that’s definitely–that’s very conservative, I like it 95 but 88, we’re–we’re right there in the same–same level.  So 88 fasting glucose–fasting blood glucose.  You like hemoglobin A1c 5.3 and below, is that correct?

Dr. Frank Tortorice:  It’s depending who you talk to.  Some people say above 5.5 you start getting changes.  So, yeah, 5.3 is excellent.  Sometimes I allow them to go as high as 5.5.  It depends on the full picture.  But yeah, I don’t like to see it any–any higher than 5.5.  You think––you start to get a lot–a lot of–some changes that shows that when you have even a little elevated sugar–what people don’t understand is with even without the diagnosis of diabetes, if you’re A1c is elevated you have all the risk for diabetes–if we’re–

Dr. Justin Marchegiani:  Hmm.

Dr. Frank Tortorice:  Diabetic and complications such as nephropathy or kidney damage, eye damage, liver damage–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  And then the cardiovascular effects.  So–so, you know, I tell people, “You don’t have the diagnosis but you’re gonna have all the complications.”  And they don’t, you know, they really don’t get that.  They say, “Well, I’m okay.  It’s not 6.5, so I’m okay.  I can do what I’m doing.”  No, you can’t.  You’re–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  You’re starting to have inflammatory changes even at–at an A1c of 5.6.

Dr. Justin Marchegiani:  Interesting.  And one of the things that I’ve noticed and I’ve–saw it in Jenny Ruhl’s book, Blood Sugar 101.  Chris Kresser also mentioned it, too.  It’s that as you start decreasing the inflammation in your diet and you start eating more low toxin anti-inflammatory nutrient dense foods, auto immune or paleo diet, you know, relatively lower carbs, is your red blood cells start to live a little bit longer.  And one of the things that I notice in some of my patients is because the red blood cells are living longer, you know, maybe past that 90-day window is they have a longer life span to accumulate glucose.  So that glycosylated hemoglobin on the A1c portion of the–of the blood sugar there starts to have a little bit higher of an A1c marker, not because the person’s eating more sugar but because the red blood cells are hanging around longer and is able to accumulate it.  What’s your opinion on that?  Have you noticed that at all?

Dr. Frank Tortorice:  I haven’t really seen that to any tremendous degree.  I will tell you it really depends on what–what your patient population is.  If you have, you know, Olympic athletes and people for whatever reason, they’re in excellent physical shape, probably, you know, you gotta see that.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  With most of my patients, you know, they’re working 1 or 2 jobs–

Dr. Justin Marchegiani:  I see.

Dr. Frank Tortorice:  They’re maybe 25 to 30, 35 pounds overweight.  They’re sleeping 5 hours a night.  They’re–they’re dealing with mortgages.

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  They’re–they’re not people I would think that–that, you know, I think the stress is caused, again, remember we talked about the metabolic syndrome, that they have blood pressure issues, blood sugar recent–

Dr. Justin Marchegiani:  Yes.

Dr. Frank Tortorice:  Control issues, sleep issues.  We’re seeing a lot of that.  It’s really–I mean, we do have some “elite” type patients, but I say for the most part, we–we take care of, you know, just regular families and–and people that they’re just trying to make a living, and–and–

Dr. Justin Marchegiani: I see.

Dr. Frank Tortorice:  Do the best they can.

Dr. Justin Marchegiani:  Got it.  So the population that you have that–that marker may mean more to you.  I see it in my own, like my marker for hemoglobin A1c is 5.7 and yet, I don’t eat any grains.  I keep my carbohydrates around 75 grams of carbohydrates a day.  I exercise.  I’m not overweight.  So I see that in myself and I see it in some of my professional athletes that I see, too.  So–and I hear Kresser talk about it in other people, so that makes sense.  It probably has more value to you in the patient population that you’re–you’re seeing or treating.

Dr. Frank Tortorice:  Yes, you know, you’re absolutely right.  You have to look at the patient as a whole.  I mean–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  You know, I mean, what–what I do and what you do–we don’t cookie cutter medicine.

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  Each person is individualized and we–we treat them as an individual.  So–so the–I’ve seen–I’ve seen some athlete type.  We have a couple of athlete types that I–I’ve been seeing recently and yeah, it’s–that’s funny you mentioned, their A1c is–is not the lowest.  It is a little bit higher.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  But then you look at all their other markers, their inflammatory markers, their–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  Their HSCRP or whatever marker you wanna get and they’re–

Dr. Justin Marchegiani:  Yup.

Dr. Frank Tortorice:  Consistently in the lowest–lowest tertile of the, you know, of the–of the population.

Dr. Justin Marchegiani:  Population.  I’m glad you’re seeing that in your athlete’s ranges.  That’s good.  So let’s cut–touch back on some of the labs.  We mentioned the CBC, fasting blood glucose, hemoglobin A1c.  Are you running a fasting insulin?  You mentioned the C-peptide.  Are you running a fasting insulin?  And if you are, what levels do you like?

Dr. Frank Tortorice:  Yeah, sometimes we’ll–we’ll measure that but not all the time.  It’s–a lot of the patients we’re seeing use their insurance for their labs.  So sometimes if they don’t have a diagnosis of diabetes, it can be a little of a problem, so–I mean, I’ll go with a C-peptide which I like to see 2 or below, sometimes I’ll get insulin.

Dr. Justin Marchegiani:  Yup.

Dr. Frank Tortorice:  I think 7 or below is–

Dr. Justin Marchegiani:  Yup, that’s what I like.

Dr. Frank Tortorice:  Is reasonable.

Dr. Justin Marchegiani:  I like 7 and below.

Dr. Frank Tortorice:  Yeah.  But it depends.  I mean, we have a whole range of patients, some with better insurance plans than others and I kinda–I kinda try to see what I can do for them to make it affordable, yet take excellent care.  I never compromise their care because–

Dr. Justin Marchegiani:  Of the insurance.

Dr. Frank Tortorice:  Of the lab, yeah, I always–

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  The lab is first.  Their health is first.  Insurance is second, then fighting the, you know, the insurance bills is probably third, you know.

Dr. Justin Marchegiani:  Yeah, and that’s kind of the problem with most doctors these days is they have to justify what they’re doing to the insurance and–and the problem is, insurance is more about saving the money than getting the patient the answer.  So I’m glad that you’re not compromising that.

Dr. Frank Tortorice:  No, I think–I think we-we have this discussion many times with our patients.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  And I–I go to–I go to battle with them.  I fight for them in terms of talking to the insurance.  I had one for example that they say, “Well, we’re not paying for a gluten–the gluten HLA genotypes.”

Dr. Justin Marchegiani:  Yup.

Dr. Frank Tortorice:  The person has Hashimoto’s thyroiditis.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  So I had to write a letter and say, “You know what?  There’s a pretty strong correlation between this.”

Dr. Justin Marchegiani:  Absolutely.

Dr. Frank Tortorice:  “I think you should really consider this.”  And then I didn’t hear back from them.  But you know, it’s always things like that.  But, you know, I mean, I think it’s an honor to take care of these patients and they come for you–come to you or me, and sometimes it’s the last stop and they’ve never had a doctor really care about them or they got that feeling.  If the doctor–if the patient doesn’t feel that the doctor really is gonna go the extra mile for them, then it–it’s hard for them, you know, it’s hard for me to say, “You know, take these vitamins or do these exercises or sleep this amount.”  I think it has to be a mutual trust because a lot of times, the relationship with your doctor is a very personal thing and if you feel this person is–is a friend or a mentor or a coach, you’re gonna go the extra mile and I think you’ll get better health results.

Dr. Justin Marchegiani:  Yeah, that makes a lot of sense.  I appreciate that.  Very good.  Well, you used a couple of terms here, Dr. Frank.  Metabolic syndrome.  So I just wanna touch upon that.  Metabolic syndrome is this essential, this kinda sequelae of symptoms, high blood sugar, overweight, high blood pressure, maybe extra adipose tissue in the hip and waist area, increased inflammation, and it’s kinda like a sequelae of all these things and it’s basically like, probably the prime magnet for all chronic to degenerative disease.  Do you wanna add to the whole metabolic syndrome concept you raised, Dr. Frank?

Dr. Frank Tortorice:  I-I think you touched on it very well, Justin.  It’s–it’s a terminology that’s been used, that was used to be called syndrome X.

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  I think, I don’t know if it was Gerald Reaven at Stanford who came up with it or whatever, but now we’re seeing a lot more of it.  The one thing I will say is years ago we never used to see this in kids.  And now we’re seeing it in kids unfortunately.  I think this is very grave for our population.

Dr. Justin Marchegiani:  Yeah, I agree.  So getting back to some of the lab work, just so everyone can write down their list of what they should be getting done or if you’re in the San Francisco Bay Area, go on to look up Dr. Frank and have him run some of these labs for you.  We got the C-peptide and/or fasting insulin.  We got your overall glucose, A1c.  Are you looking at fructosamine at all, Dr. Frank?

Dr. Frank Tortorice:  Sometimes we do but usually–usually I don’t.  Usually I don’t.  I know some doctors get it, I know especially the diabetic doctors like that.  If I wanna like a–a snapshot of what they’ve been doing recently, sometimes I get a fructo–fructosamine but I–I typically don’t. I mean, I don’t have a problem with somebody getting that–that test but usually for what I’m trying to achieve, I really don’t need to know, you know, the latest minute-by-minute blood sugar with them.  And I know that it’s used with a correlation with some other markers but in my practice I haven’t really relied on that as much as the other labs we’ve talked about.

Dr. Justin Marchegiani:  That’s like a 30- to 40-day window of blood sugar, correct?

Dr. Frank Tortorice:  Yes, yes.  It’s shorter term as opposed to a 90- to 100-degree. I–a hundred day test as the hemoglobin A1c.

Dr. Justin Marchegiani:  I see.

Dr. Frank Tortorice:  I think sometimes the diabetic doctors get it because they’ve changed insulin and they don’t wanna wait around for another 6 weeks, they forgot what’s going on with the insulin, so they’ll get and then they’ll tell the patient, “Okay, you take–take more or less of the, you know, some of these injectables.”

Dr. Justin Marchegiani:  Right.  So one thing I’m seeing on a lot of patients and I can’t wait ‘til they come out with blood sugar meters; I have one right here now that has blood sugar on it.  I can’t wait ‘til they have one that actually has insulin because one thing I’m seeing is you have  people with relatively normal blood sugar but I imagine if you ran your C-peptide, while in my practice I’ll run fasting insulin, it’s through the roof.  It’s in that 19 or 20, or I get to thinking in your case you said above 2.0 for the C-peptide, is that correct?

Dr. Frank Tortorice:  Right.  Yeah, usually I like to see 2 or below, but I think as you know, Justin, a lot of times a person that’s gonna be elevated is that they’re post-prandial–

Dr. Justin Marchegiani:  The first thing.

Dr. Frank Tortorice:  Yeah.

Dr. Justin Marchegiani:  Yup.

Dr. Frank Tortorice:  Insulin levels and then their C-peptides.  So a lot of times what will happen is that–the, you know, even diabetics, they take their blood sugar only in the morning on an empty stomach and they think, “Well, I must have not to be too bad just a few points too high.”  I switch to have them taking, you know, within the first hour after a meal, it’s way over 200.  I say, “You know what, you’re either eating the wrong food or you’re not, you know–you know, if you’re on medicine, maybe the medicine is not working, or your–your diet is improper.”  So–so yeah, the first thing you’ll see is you’ll see an elevation of the C-peptide or the insulin level showing that the pancreas is either wearing out and not able to–to control the blood sugar with the amount of insulin it’s secreting or that, you know, if you get a blood sugar right after the meal within the first 60 minutes, it’s sky high.  So those–those are early warning signs that something is–is out of whack.

Dr. Justin Marchegiani:  Yeah, because we know blood sugar is very inflammatory at high levels in the–in the vasculature.  We also know that high levels of insulin is very inflammatory, even with normal blood sugar, and I’m seeing this more and more because we get people that are  able to keep their blood sugar in normal ranges, you know, low 90s or even upper 80s in Dr. Frank’s range, and we’re seeing their insulin levels jacked up.  And so, talk to me about just the–the–are you seeing a lot of people with normal blood sugar yet insulin and C-peptide through the roof?

Dr. Frank Tortorice:  Normally, Justin, those people have elevation of blood sugar to some degree.  They’re maybe 99, 101, 106–

Dr. Justin Marchegiani:  Okay.

Dr. Frank Tortorice:  But then their C-peptide maybe 3, 4, 5–

Dr. Justin Marchegiani:  Okay.

Dr. Frank Tortorice:  I–I try to, I mean, use an analogy with people, I say, “It’s like getting a loan.  If you–you told me I have a loan for 50,000,”  I say, “Yeah, but it makes a lot of difference if your interest rate is 3% or 28%.”

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  And the same thing, you’re producing a little bit of insulin to get your–your blood sugar under control that’s one thing.  If you’re–if you’re got the whole pancreas secreting everything it’s got to keep it down, then you know it’s a whole different story.

Dr. Justin Marchegiani:  Oh, I like that analogy.  I’m writing that one down.  I’m–I’m gonna take that one, if you don’t mind, Dr. Frank.

Dr. Frank Tortorice:  Yeah, feel free.

Dr. Justin Marchegiani:  I like that, very good.  Alright, so we got–talked about some lab testing, I feel like everyone listening has some good markers that they can go out to their local doctor or if you’re in the Bay Area, to reach out to you and get those run.  Now most important out of everything, out of anything I think we’re talking about here when it comes to blood sugar and diabetes, and I think you’ll agree with me, is diet.  So can we talk about kind of what the standard of care is and I know this, what you provide is not–is gonna be above and beyond the standard care.  So what the standard of care is and what you would recommend different than the standard of care.

Dr. Frank Tortorice:  Well, typically or historically, the standard of care was to tell patients to have, you know, a varied diet.  They would get away from obvious things that most of us would figure is not good like cakes, candies, crackers, things of that sort.  But the typically ADA diet included the, you know, like whole grains and the, you know, some other things that probably would not be in the best interest of our diabetic patients.  I think a lot of times it just makes it worse, I mean, I even see what they do with patients who get referred from other–either other facilities or other doctors and I–I read what the dietician puts down there as their ADA diet and it’s, you know, it’s–I don’t think it’s–it’s helping these patients long-term.

Dr. Justin Marchegiani:  ADA diet–

Dr. Frank Tortorice:  Yeah, what I try to say to them is “Listen, there’s certain foods that we know historically or even scientifically cause the pancreas to have us secrete more insulin to help in the digestion and assimilation, and certainly processed grains are in–on the forefront of that.”

Dr. Justin Marchegiani:  Absolutely.

Dr. Frank Tortorice:  I mean, the more grains you have despite all the toxins in the grains and some of the other issues with gluten is the body in order to digest these has to–requires insulin in order to get to–get it into the cells.  So–so if you’re doing that and you’re causing inflamed gut response, then you know, you’re not gonna get what you want in terms of health because you’re–you’re gonna have elevated blood sugars eventually because the pancreas is gonna wear out because it just can’t keep up with that.

Dr. Justin Marchegiani:  I agree.  And I see that all the time and I’m seeing conventional registered dieticians still recommend 50-60 grams of carbohydrate for a lot of these patients which we know is doing them a disservice.  I know that in the foreword of Dr. Diana Schwarzbein’s book, The Schwarzbein Principle, and Dr. Schwarzbein was an endocrinologist for 25 years and she made mention in the foreword of her book that the ADA diet causes diabetes.  Can you touch upon that, Dr. Frank?

Dr. Frank Tortorice:  Right.  Well, I mean, I think– I think, you know, we’re–we’re finding that some of the things that were recommended even as recently as 5 or 10 years ago may not be in the best interest of our patients.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  And I think, you know, healthcare in America is–is a extremely important of our, you know, gross national product–

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  Terms of expenditures.

Dr. Justin Marchegiani:  Yup.

Dr. Frank Tortorice:  So here’s a lot of people who are involved with that.  What I will say is that patients come to me and come to you because they believe us and what I–what I try to do is give them something simple in terms of making dietary changes then have them see themselves the benefit in how they feel, how the look, and–and what they do with their blood sugars.  Well, the problem you–you have I think is patients throw their hands up because they know, “I can’t do all that at once.  I–you know, you’re asking me to do too much.” or “You know, my wife cooks for me, my husband cooks for me, you know, I don’t wanna disrupt the family, the kids are not gonna go–”  So it’s a process of inching forward I think.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  Of a lot of our patients.  I mean, especially if you’re talking about blue collar or–or families that have both–both, you know, husband and wife working.  There’s kids that are in school.  I mean, we really have to do something that’s sensitive to their individual needs.  So–so, you know, either I’ll talk to them or you know, if we have, you know, nutritionist to talk with them.  We’ll make sure it’s a functional nutritionist and that we–we agree on–on what we’re trying to do for these patients and then we see them back and we–we try to have them have wins, Justin.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  If they have wins, they have confidence.  If they have confidence, they’ll change.  I mean, I’ve had people with diabetes, one gentleman I can think of, he came in at 255. Now he’s about 197.  And–

Dr. Justin Marchegiani:  Wow.

Dr. Frank Tortorice:  This guy was just, you know, you never know where the heart of a patient is, you know.  And I think we give each patient the–the full gamut and see who’s gonna step up to the plate, you know.  And this gentleman is–is pretty much just on the border now of being a diabetic, wherein before he was entrenching a lot of medications.  His–you know, he had hypertensive issues.  There can be problems with, you know, sexual function in both men and women because of diabetes because it does a lot of bad things.  So–so, you know, people have motivation to try to get this under–under control and–and they have to really buy in to why you’re doing it, not only, you know, what they have to but why they have to do it and I think that’s why we–we have to spend more time with them and–and speak to them on their terms, on their language, but also give them also small victories that accumulate, you know?

Dr. Justin Marchegiani:  I agree, that makes sense.  So from like a dietary perspective, are you kinda starting out with a–a Paleo template where you’re cutting out grains?  Are you primarily focusing on vegetables for carbohydrates?  Are you allowing your patients any fruits at all?  Could you go into that?

Dr. Frank Tortorice:  Yes, what we found is–you know, we think maybe I-I had the mis–mistake of just cutting too much out, you know.  I mean, you––you can go Paleo where you–you don’t allow any types of carbohydrates and I think for a lot of our patients, yes, maybe it’s better, but are they gonna comply?  So I–I talked to Paul Jaminet, you know, who–

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  Wrote The Perfect Health Diet and we went back and forth.  He is a very nice, generous, brilliant man and we–we talked about his concept of using rice and–and the same thing with potatoes.  If you–if you cook the rice and then you put it in the refrigerator and then you reheat it, the molecular structure changes and it–it changes how it–how it–how the body, the glycemic response to it.

Dr. Justin Marchegiani:  Yup, and the starch.

Dr. Frank Tortorice:  And the same thing, yeah.  And the same thing with white potato.  That if you’d–if you cook it, either if you, you know, put it in the oven or however you cook it and then put it in the refrigerator and then you–then you take it back out again the next day and reheat it, again it’s–it’s altered in a way that it causes less of a blood sugar surge.  So what I try to do is because remember these–there are patients that have been eating pasta and then pounding the bread and, I mean, you gotta give them something that they’re gonna go with at least initially.  I’ve seen sometimes after 3 to 6 months that the patient says, “You know what, doc?  I don’t even want that anymore.”  But initially, if–if you just take too much away from these patients, they just either will not come back or they won’t–they won’t comply.  They just–you know, it’s not a question of willpower.  It’s a question of either, you know, I don’t wanna say food addiction, but it–it’s a question where it’s–it’s hard for them to buy in right off from the bat.  So-

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  We–we give them a little bit of starch but I, you know, I don’t give them a limited amount.  I wouldn’t give them 1 or 2 portions of these–

Dr. Justin Marchegiani:  Yes.

Dr. Frank Tortorice:  You know, starchy carbohydrates but pretty much everything else is off the table in terms of things that you would recognize as, you know, starches or–or matchy carbohydrates.

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:   We have them to have a protein with every meal.

Dr. Justin Marchegiani:  Smart, yup.  Stabilizing the blood sugar.

Dr. Frank Tortorice:  And then all the phytonutrients of vegetables.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Frank Tortorice:  And–and you know, some of the vegetables if they’re organic or even better.  We if they’re organic or even better, we do let them have a limited amount of–of fruits.  Some of the fruits have actually been shown to help with diabetic control, some of the berries–

Dr. Justin Marchegiani:  Berries, right.

Dr. Frank Tortorice:   And then some of the–but it’s limited and–and again, the–the highest quality and the freshest quality is really important with that, so–and then we see where they are.  They’ll–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Frank Tortorice:  They’ll bring in their blood sugars.  We’ll check their weight.  We’ll check their blood pressure.  We’ll check their cholesterol and then we just modify it.  So if they’ve been overdoing it, we–we just cut back a little bit.  If they’re right on target, well, they can keep doing what they’re doing.  So we work–we work with them in a very personalized way to try to be as responsive to them as possible, but yet to get them to go.  I mean, basically, you know, they pay is to–to get them to their goal which is to have, in the case of diabetes, either no more diabetes or at least no more symptoms from end organ damage of diabetes depending on stage of diabetes and how many years they’ve had it.

Dr. Justin Marchegiani:  Right.  Yeah, I used to work in surgery about 10-15 years ago at a hospital nearby when I was in University and I used to–my job was to go on with the surgeon and I would assist in holding the limbs of the diabetic patients as they’d be amputated, and I’d have a conversation with the surgeon afterwards and the conversations was interesting because we’d be outside and he would be smoking a cigarette a lot of times, and I would be asking him, “Hey, doc, you know, what can we do to get ahead of this and prevent all these organs or feet, and toes and such from being cut off?”  And he really didn’t have much to it and I think, you know, his perspective on him smoking a butt outside, you know, kinda said it all.  But hundreds of limbs had crossed through my possession down to the morgue and it was really sad, I think from your perspective and mine, knowing that that’s all preventable.  Can you talk about how much of this can be prevented and how many people, you know, you are able to totally from a laboratory assessment cure them whether off their meds and their blood sugars back under control?

Dr. Frank Tortorice:  Yes, Justin.  So–so, yeah, we–we think that, you know, if they’re early stage of either pre-diabetes or diabetes with no end organ damage, that they–they have an extra chance of being able to live out a full life.  I remember when I was in training, one of my diabetic teachers gave me this article and the lady was like 97 years old, had diabetes since the time she was 18 and never suffered an end organ damage.  So it can be done–it can be done.  I mean, again it’s not so much the diagnosis of diabetes, it’s all the complications you get from poorly controlled blood glucose.  So what we do is we–each and every one of our patients gets those tests I mentioned and then we take it from there.  We’ve discovered a number people that just have no doubt diabetes, they had hemoglobin A1c 7.1, 11.4, or whatever.  At that point, there is no–there is no discussion not to get diabetes.  They already had diabetes.  What–what are we gonna do about it so they don’t suffer end organ damage and lose their limbs like–like you so eloquently mentioned or go into kidney failure–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  Become blind, or so on and so forth.  So–so, you know, I–it’s hard to say there’s not a patient we can’t help except maybe somebody who is really, really end-stage–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  But if they come to me before that then we–we usually are able to help them.  I mean, I just got a new patient.  He’s had both his legs cut off–

Dr. Justin Marchegiani:  Ugh.

Dr. Frank Tortorice:  So I don’t think I can help with that, but I think a lot of his inflammatory changes we can help in terms of, you know, he’s had a triple bypass and just one of those people who–who just doesn’t have a tolerance for, you know, if these–if these were caused by diabetes which he said they were and I haven’t received the records but we can still help a lot of people.  I mean, in, you know, in the end, it comes down to improving their quality of life.

Dr. Justin Marchegiani:  And I think you’d already touched upon it but I think people, the average person doesn’t realize the fact that diabetes and blood sugar and inflammation are the number one predisposing factor for cancer and for heart disease because of the vascular changes and because of the fact that cancer cells love glucose.  Can you touch upon the diabetes, cardiovascular, and cancer connection?

Dr. Frank Tortorice:  Yes.  I think, you know, early on, we–we thought that it was cholesterol causing the heart disease.

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  But then later on with more, you know, sophisticated studies, we found it was oxidized cholesterol that–that caused problems and then we found out that you didn’t get high cholesterol from eating cholesterol.  You got high cholesterol from eating too much sugar and having inflammatory changes in–in the endothelial and the vascular layers.  So–so then it became a no brainer that, you know, we needed to–to cut down this inflammatory change which is at the root of almost everything that we see in terms of the–the major diseases of–of lifestyle in at least in the Western world and especially the United States.  So, that’s why myself and–and your practice as well is we really target on cutting down inflammatory, you know, instigators in the patient’s diet and their lifestyle and their sleep and their stress levels and so on and so forth.

Dr. Justin Marchegiani:  I like that and it is–it’s very rare to find holistic medical doctors that really understand the aspects of sleep and exercise, nutrition, even the more functional ones that are out there, they just want to use hormones and supplements to cover up other issues where, you know, as you already said and you–and you have alluded to that you really can’t replace exercise, you can’t replace sleep, you can’t replace stress management, you can’t replace blood sugar stability between meals, so I think that’s, you know, quite an interesting perspective as a medical doctor to come to those conclusions.  Can you talk about how you as an MD came to them?  Because I mean, you have 10-15 years of indoctrination in–in one arena which we know is great for acute and traumatic care, but the acute and traumatic model does not work too well with chronic disease.  Can you touch upon how you came to where you’re at now, Dr. Frank?

Dr. Frank Tortorice:  Sure, Justin.  Yes, so early on, back even like in the year 2000-2001, I was introduced to the–in functional medicine through some local seminars I gave, then I went up to Gig Harbor in Washington and got some advanced training at the Institute for Functional Medicine.  So when I heard these lectures and saw these doctors and heard what they were doing, it was really something I wanted to become more of a part of.  It was really interesting.  It was exciting and it was what I believed in.  I mean, you know, the patients are sick not because they lack certain medicines because especially, you know, with chronic conditions of lifestyle changes or decisions they have made and–and, you know, they–they may have read or–or saw an advertisement on TV or read–read a newspaper and thought they were doing the right thing but many times we have to re–reeducate them on–on what’s in their best interest and how to become a critical reader and a critical, you know, critic of what kind of information they’re giving.  I mean, to be a doctor to certain extent is to–to really train or–or teach our patients and that’s why everybody on my staff has helped–helps the patient with their–their need to learn and–and to exchange–sometimes the patients will teach me things.  So–so it’s–it’s a way that we’re trying to really up the ante in terms of giving them cutting edge information which we know will have a positive benefit on their–on their health.

Dr. Justin Marchegiani:  Great.  I love that and I actually remember seeing you–I think we talked about this last weekend.  I remembered seeing you 2007 and Dr. Dan Kalish’s office in San Francisco on Fillmore, and so even back then you were still learning, I was learning, and now that was kinda my first interaction with you almost ten years ago.

Dr. Frank Tortorice:  Right, yeah.  It’s a–it’s, it’s gotten on much more exciting since then with all the different changes with the iPhone, the iPhone apps–

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  And all the Internet, I mean, it’s a whole new world out there.  But I think it’s exciting.  I think we’re gonna come up with a–a lot–a lot of patients that are gonna be interested in pursuing their health through–through a partnership.  I mean, with the functional medicine type of model, I mean, the patient and the doctor are like teammates.  It’s not, you know, a condescending thing where somebody with a degree tells somebody who was coming there as a client how to do it.  It’s more like a team, you know, and–and I think I enjoy it, because I–I don’t think I know everything about everything and I think I learn a lot from a lot of my patients and enjoy using my–you know, my background and my experience to help them get to where they need to be and get better and–and the thing about our community is, you know, Justin, is if I don’t know someone I can call you–

Dr. Justin Marchegiani:  Yup.

Dr. Frank Tortorice:  Or I can call somebody else and–and find out and–and the, you know, people are very gracious to–to help us.  And, you know, and it, you know, and sometimes people will call me and wanna know from me what’s going on as well as I–I can add something to some of the cases that they’re working with.  So, it’s pretty much a privilege to do what we do and–and to get up each day and–and try to make the world a little better place, even if it’s one patient at a time.  It really–really has a lot of meaning for us and I think it has a lot of meaning for the–the patients.  You become very close to a lot of them I think because you share a common bond.

Dr. Justin Marchegiani:  Yeah, I agree, I agree, and oh, last weekend we met up in Houston at a big functional medicine conference down there and one of the keynote speakers was JJ Virgin and she’s got that book, New York Times bestselling book, the Sugar Impact Diet, which I think is very relevant to today’s talk and I think one key point she talked about in there was really the glycemic index.  Maybe it’s not all it’s cracked up to be because of the fact that it really ignores fructose and the effects that fructose can have on insulin resistance.  So can you just touch upon some of JJ’s work regarding glycemic index and fructose and how it affects blood sugar and/or insulin resistance, Dr. Frank?

Dr. Frank Tortorice:  Yes.  Yeah, I read that book.  It was really well done.  I mean, she really put a lot of effort into that book and I really–I really wanna applaud her for that.  It was really a good job and she makes it easy for patients who feel overwhelmed to get on board and–and she–she holds her hand all the way through it, so I recommend that book as–as a good start with or without a–a functional doctor but obviously better if you can get some personalized care with a functional doctor.

Dr. Justin Marchegiani:  Absolutely.

Dr. Frank Tortorice:  The problem with fruc–with fructose is–is just, you know, as you know the way it’s metabolized and–and––

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  It kinda–the different way it–different effects it has on the liver and then on–on the body as a whole so–

Dr. Justin Marchegiani:  Right.

Dr. Frank Tortorice:  So, you know, the, you know, when–when they used to say you probably hear–hear this, “Eat all your fruits and vegetables, that’s okay.”  Then it got changed to all the vegetables you want but cut down on your–on your fruit, which even if its organic still has fructose and the negative effects of too much fructose in the–in the diet.  So your–you’re right on about that, is–is we really make sure that they, I mean, people think of fructose is like a high fructose corn syrup but they don’t realized that even too much–for we have people that are frutatrians and they come in and they have a lot of negative health consequences.  So you still have to put–put a–a level on or limit on the amount of fructose in the human diet and even patients who think they’re doing the right thing.

Dr. Justin Marchegiani:  Yeah, I agree.  So essentially fructose doesn’t really register very high on the glycemic index and glycemic index for everyone is just how fast glucose from the–your–from food actually gets in your blood sugar, right?  So the faster glucose get into your blood, then the faster or the higher the insulin spike is.  So the thing with fructose for everyone is it doesn’t have a high glycemic index.  But it goes strictly to the liver primarily, which then can create insulin resistance that is systemic level.  Is that correct?  Because everything is filtered down from the liver.

Dr. Frank Tortorice:  Right, yes.  It does need to be met–metabolized and goes direct to the liver there.  So it–it’s the way the body metabolizes much different than glucose, so–so that’s the problem and then there can be other problems and then, you know, it can cause you to have more hunger, it can cause the cells to become stiffer as well.  It has a lot of negative side effects and that’s, you know, it–especially if you’re eating in–in something that’s been, you know, created like a processed food.  Fructose is used as a common, you know, a sweetener to some degree or even–

Dr. Justin Marchegiani:  Yeah.

Dr. Frank Tortorice:  Combination with so.  So, yeah, we–we are really aware of the fact that we need to educate our patients to what to look out–look out for in that regard.

Dr. Justin Marchegiani:  I think that’s really good and one of the handouts I give to all my patients is by Dr. Johnson.  You probably heard of him.  He’s the doc over in University of Colorado that talks about the correlation with uric acid and fructose and high blood pressure, does he ring a bell?

Dr. Frank Tortorice:  Yes, yes.

Dr. Justin Marchegiani:  One of the handouts I give is his handout basically anyone with insulin resistance or diabetes should not be consuming more than 15 grams of fructose a day and that’s 15 grams from whole food sources, so feel free–we will put on the show notes his handout on fructose and uric acid just for the listeners so they can get a sense of what 15 grams of fructose is.  And just so everyone knows, even something like an apple, an organic apple, regular red Apple would have 10 grams of fructose, just to give people a perspective of what we’re looking at.%

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