Investigating Your Adrenal and Hormones With a DUTCH Test | Podcast #327

In this video, Dr. J and Evan talk about the adrenal glands in our body – to produce certain hormones directly into the bloodstream. These hormones will respond to stress and other necessities to our existence. Also, they are discussing the detailed test needed to identify the root cause of problems and what other materials and hormones are essential to keep our adrenals and body healthy.

To support the body naturally, Dr. J recommends using herbs such as maca and ashwagandha. Progesterone, estrogen, and estriol may be fit for a patient. However, it is essential to know that protocols may be different for every patient since presentations and lab results may differ.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:20     Labs At Home

5:07     Low Cortisols

9:37     Hormones

11:09   Dutch Tests

28:19   Useful Herbs

34:47   Healthy Estrogens

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Dr. Justin Marchegiani: And we are live. It’s Dr. Justin Marchegiani in the house with Evan Brand. Today we’re going to be talking about hormone and adrenal lab testing what we’re actually using in our virtual clinic to assess our hormone imbalances in our patients and different things that we’re doing to address those imbalances. Evan, how are we doing, man? 

Evan Brand: Good, excited to get back in the saddle here and talk about something that we can test at home, which is amazing. I think that’s the first benefit to point out about some of the testing you and I are utilizing is that many people now they care more about their health than ever obviously, the state of the world has convinced people that health does matter. You need to prioritize this stuff. And so we can send these labs to your door. And so the test that you’re going to be showing people today will be something that you can do if you’re listening via audio, you might miss the visual, you can go to Justin health YouTube channel and see the video, but we’ll be sure to make sure we talk about it in a way that you can still understand even if you’re just audio only today.

Dr. Justin Marchegiani: Yeah, if you’re listening to the audio, we’ll put a link down below for the video so you can see it. And also if you’re listening, you can go to Justin slash YouTube and hit subscribe. Alright, so let’s dive in. And so we deal with patients from all over the world virtually that have all kinds of different hormonal imbalances. It can range from a menopausal woman with lots of hot flashes, mood issues, vaginal dryness, depression, skin elasticity, hair loss issues, it could be a cycling woman that has a lot of PMS. pmdd breast tenderness, cramping, back pain, mood issues, irritability, also infertility as well. And then it was a lot of different imbalances in between excess androgen issues like we see in pcls, polycystic ovarian syndrome, we may even see estrogen dominant issues just like which could be PMS as well. Could be infertility, could be fibroids could be endometriosis could be fibrocystic breast issues, all of these things are on the table and of course, even manage a male issues to could have men could have excess estrogen and or low androgen and or low or high cortisol and or low or high Da, da all these imbalances are potential, I always tell my patients, you have the right to have more than one issue at the same time. And you can also have a hormone imbalance and also have multiple gut infections too. Of course, it’s all possible, right?

Evan Brand: Yeah, people hearing that too. They’re like, what the heck kind of mumbo jumbo? Did he just say, and how does that manifest? Well, you know, low libido, too. I mean, that’s one that I’d say at least 90% of the people I’m working with, that’s a question we always ask is, you know how you drive. And sex drive is always terrible for people. I was actually a study that came out. And the vast majority of people surveyed said that they would rather scroll on their smartphone on social media than have sex with their partner. And I thought, Oh, God, is that where we are in the technology world that the phone is more desirable than our partners? That’s no good.

Dr. Justin Marchegiani: Yeah, definitely not good. 100%. So I just kind of laid out a couple of potential patterns there, we’ll kind of dive into them one by one will actually show you a real live patient lab here for y’all to kind of look at obviously, it’ll be centered regarding who the patient is. But we’ll put all that information out there for y’all. So you can kind of see how a lab looks out of the gate. So one of the first things that we do when we look at a patient, male or female, we’re going to look at adrenal function. And adrenal function is very important because your adrenals make cortisol. Cortisol is an anti inflammatory hormone. Most people in today’s day and age, they’re not under inflamed, they’re over inflamed. So having your body’s natural anti inflammatory system on board is vital, very, very important. Second is cortisol rhythm. Cortisol rhythm plays a major role in your circadian rhythm, which is waking up energy in the morning. Having good rhythm helps a lot with mood, and also lower cortisol at night. And that nice gentle taper of cortisol. So cortisol starts, it starts mid range, when you wake up, and in that first 30 minutes to an hour, it almost doubles. And then from there, it tapers down throughout the whole day. And we want a nice lower cortisol rhythm, lower cortisol level at nighttime, so we can wind down and relax not too low, when we start having maybe blood sugar issues, which could wake us up at night and not too high, where we could have problems going to bed because we’re too wired right, or not a reverse pattern, we’re lower in the morning, which means low energy and higher at night, relatively speaking, which could cause us to have too much energy at night and then we don’t get good sleep. So the adrenals play a really big role because of cortisol and its effects on anti inflammatory mood, rhythm, sleep, and then also especially for women listening men too, but da da da da sulfate is a precursor to a lot of our sex hormones, that helps with our female hormones. And that plays a big role in healthy, healthy reproduction. people. People think when they talk about female hormones or just thinking about having babies no your hormones there to reproduce you Yeah, reproduce the baby but also reproduce you which means healthy aging, healing recovery as a man to healing recovery. Healthy libido, good muscle building. In good building the ability to turn over your tendons and ligaments and bones, all these things require good healthy anabolic metabolism.

Evan Brand: Yeah, great point. You know, one thing you pointed out, which I think a lot of people miss with cortisol is you mentioned cortisol being too low at night and that impairing your sleep. See most people just a buzzword, or if they’ve ever heard of cortisol, they’ve heard of adrenal testing and things like that. They think, okay, high cortisol at night equals poor sleep. But you mentioned low cortisol at night or too low cortisol at night could also be an issue because of that blood sugar. And then what can happen is you and I’ve covered this before, but there’s some sort of a spike, right? Maybe an adrenaline cortisol spike in the middle of the night, is that what you think is happening?

Dr. Justin Marchegiani: Yeah, so with sleep issues, you could definitely see a low cortisol kind of going into nighttime or low cortisol during the night. And that can cause a drop in blood sugar, and that drop in blood sugar can then signal a increase in adrenaline. So adrenaline tends to come to the scene first, cortisol tends to come to the scene 1020 minutes later, or so. So you get this spike of adrenaline that’s very stimulatory, that increases cortisol. And then now you’re alert and you’re waking up, right? So we want to make sure higher cortisol, lower cortisol at night that’s causing a increase in cortisol is not happening due to blood sugar regulation. So we want good blood sugar, good healthy protein, and fats, maybe work on amino acids and melatonin production at around bedtime, and maybe have something by your nightstand to help stabilize blood sugar before in your end. Or if you get up like a nice simple college and smoothie, or a really good protein and fat base, simple bar by your nightstand to stabilize blood sugar, those are all really really good options to help you on the sleep side.

Evan Brand: So like if you had a good quality protein, fat, maybe some carb starts with dinner, but let’s say I don’t know, 9:10pm, you go to have a snack and you just do. I don’t know popcorn or I don’t know, handful of strawberry, some kind of a simple sugar, you think it’s possible that your glucose could spike and then it will crash in the middle of the night if you’re doing something too simple or too high on the glycemic index?

Dr. Justin Marchegiani: Well, it depends on how blood sugar sensitive you are. I mean, the two examples you gave are two different things, right? Because grains and popcorn are going to be a little bit more higher glycemic, higher sugar stuff, strawberries, pretty low glycemic and a lot of fiber there, so probably not as much with the strawberries. But could you have some strawberries and maybe a spoonful of almond butter, right or some kind of a good fat or protein probably better, right? It just depends upon what time you’re going to bed and what time you’re eating. Usually you see people that are eating around five or six o’clock dinner, and they’re going to bed like around 11. And there’s like a five hour gap between their last meal and sleep potentially. And again, it has to do with how dysregulated their blood sugar is and how weak their adrenals are. So it really depends. But if sleeps an issue, that’s one pattern we want to look at. We talked about da da playing a big role. If you’re a female going into menopause, that means your egg follicles are being used up essentially. And you’re not going to get that hormone production from that follicle that’s now no longer there. So we require a lot of the DA DA from our adrenals to now be made. And if our adrenal reserves on da, da are low, guess what? We’re not going to have that that backup battery that we had already to go right we’re in middle of, we’re just coming out of a bunch of storms in Austin here. And if you didn’t have a generator ready to go, guess what you you went without power for a while, well, that’s kind of like going into a spa, menopause is going into a storm with a generator that’s maybe three quarters empty. And so the adrenal is play a really important role as the backup generator for sex hormones. And so the better that generator is charged up, the easier you’re going to sail into menopause and not have all the hot flashes and mood issues and sleep issues and skin issues and hormone issues and vaginal dryness issues that you may have with lower sex hormone reserves.

Evan Brand: Yep, well said you’re ready to show us this thing. I’m sure people that are on video want to see what the heck we’re talking about. We can see some of the rhythms and also da da is measure two, which is cool. So when we talk about a cortisol test, we’re getting a lot more than cortisol to right we’re getting melatonin also.

Dr. Justin Marchegiani: Exactly. And then one last thing to look at is PCOS, which is also common. You see it more in younger women, you know, 20s and 30s. But blood sugar issues high level of insulin, this can really jack up testosterone and this can do a whole bunch of issues in regards to abnormal hair growth, you may see an increase in libido, some still go down. And then of course, weight gain is going to be another another big side effect there. Let me share my screen with you so you guys can see an actual lab test for y’all. Okay. All right. So while I get that going here, in the meantime, anything else you want to say about that, Evan?

Evan Brand: Well, you and I were talking about this before we hit record and that was the idea of retesting hormone. And so you thought well, based on a lot of people with progress, you don’t necessarily need to incur the cost again. So a lot of times you and I may run this as an initial snapshot, but depending on symptoms, you may not need to do this over and over and over again because a lot of the support We’re using a pretty broad spectrum. And they’re going to help regulate your rhythm regardless of where it’s at. Right? So initially, we may want to tweak one thing a certain direction or the other, but long term care wise, you and are using things that are pretty, would you just stay state stabilizing, not necessarily a big sledgehammer to the hormones.

Dr. Justin Marchegiani: It depends for me. So if someone has very, very low cortisol levels, or very, very high cortisol levels, and or significant estrogen dominance and low progesterone, the more significant the hormonal pattern, the more significant the imbalance, the more I want to retest less significant if we see corresponding symptomatic improvement, usually it becomes less necessary because the patient knows they’re getting better we can feel it, we can see it in their their physiological activation and how they’re sleeping, their mood, their energy, their libido, we can you know, their cycle, there’s just so many things that are improving that the patient is confident that we’re good. And if the imbalance isn’t major, right, they’re not a fertility case. They don’t have a major hormonal imbalance right there that may not be necessary, but I always kind of I’m on the fence always give the patient the ability to to make a decision on that. So this is my screen here, Evan, are you able to see it?

Evan Brand: Yep, we see it just fine.

Dr. Justin Marchegiani: So here’s a Dutch test that’s done with a patient whose kind of perimenopausal menopausal, meaning their cycles kind of been on and off hasn’t really had it for six to eight months or so kind of in that area of transitioning into full menopause, which is usually not having a cycle for a full year 12 months in a row. So they’re kind of in this Peri menopausal phase, and usually perimenopause and start to hit in your, in your early to mid 40s. When you start skipping months, maybe you start having some hot flashes like symptoms, whether it’s mood or libido or a hot flash stuff. And again, it’s always tough to say because perimenopause can easily feel like PMS too, right? I think that the biggest differentiating factor is not having all the hot flashes and not having the skip cycles. When it comes to more of the PMS like stuff, that’s usually a distinguishing factor. But we look at the Dutch test a couple things here. This is our cortisol pattern, our daily free cortisol pattern. And you can see you wake up here at a and your cortisol should taper up in the morning, this isn’t within the first hour and then go down throughout the day. So this patient actually started with a here, right, this is cortisol with a pretty good rhythm out of the gates. But instead of picking up 100% or so they actually went down. So they started here that having that nice rise, they went down This is big, this is a big problem, right not going to have the energy you’re not going to have that good rhythm that good up and Adam kind of energy in the morning and they trace low the entire day, relatively low and flat the entire day. So we call this a flat cortisol rhythm relatively speaking, it’s flat, they should be starting here a peaking up at B and then gently tapering down throughout the day. And they basically start at a at their highest point. And they go down throughout the day. So very low and flat cortisol rhythm. Now when we look at their cortisol levels, they’re free cortisol, which is a+b+c+d, this is what’s represented on the graph here. And again, if you’re listening on the podcast, click down below to watch the video link if you want, if not, we’ll just try to describe it. They’re free cortisol when you add a plus b plus c plus d is 73. That’s very low. So if you see this little gauge here, imagine this is like the volume knob on your stereo, this is all the way up high this star and this on the left all the way up low. So they’re almost all the way till the to the left. It’s like their volume knob is like 5% on it’s like having a whisper out of their stereo. So 73 is very, very low. Now this is the cool part, right? So normally with a salivary test, right, the Dutch test is the dried urine for testing comprehensive hormones. The benefit of this test is we get a window into free cortisol, but also total cortisol could its urine with a salivary test, we’d only be able to see this 73 number, which is the which is the free cortisol, that’s two to 5% of all cortisol is free, and biologically available. The other total, which looks at the free, which is the two to 5% Plus, everything else that’s protein bound, is give us a window into all of our cortisol, we’re making them this is the cool thing. We never would have this number on a free cortisol test from saliva. But you can see their total cortisol, which is everything is very high. It’s 93 04. Right? It’s way off the charts. Hi. So they have very, very, very low free cortisol, very, very, very high total cortisol. So there’s not like an adrenal fatigue issue or like a low adrenal pattern. Even though the cortisol is low, their adrenals are making a lot of it right. And this is a common pattern we see when there’s HPA access dysfunction. So if you go down to this page over here, you’re gonna see what the HPA axis is. I’ll go back and I’ll just explain this in a minute. But if we go down to this page here, the HPA axis we have this feedback loop from the hypothalamus and the pituitary. This is the HP portion of the HPA axis. And this communication feedback loop talks to the adrenals where we make cortisol with We make DAGA. And we have our free cortisol, we have our total cortisol, we have our DAGA, this feedback loop from our corticotropin releasing hormone to the adrenal corticotropin releasing hormone. This feedback loop is our HPA access. And when this starts to break down, and that feedback loop that miscommunication happens, this is where we start seeing a very high amount of total cortisol and a very, very low amount of free cortisol. Does that make sense out of the gates questions they’re having?

Evan Brand: Makes perfect sense. So what do you do?

Dr. Justin Marchegiani: Yeah, so let me continue to roll with that. Let me go back up here a little bit more.

Evan Brand: DAGA production look good there, though. That was nice to see.

Dr. Justin Marchegiani: Let’s kind of break it down. So I always hit things like this. I might order of doing things that way. I don’t miss anything. So the first thing I look at is cortisol rhythm. How’s the cortisol rhythm? Good in the morning. A and then B, C, and D morning after night are low, low, low. So normal, low, low, low. So definitely poor cortisol rhythm. How’s the cortisol amount? Well, free cortisol is low. Okay, total cortisol is high. Now, so I tend to treat someone more in the middle in regards to their adrenal support, I won’t over support their cortisol too much, because we know they’re making a lot. So we’re really going to focus on an in between amount of cortisol and more HPA access support in regards to adaptogenic herbs, we really have to support good adaptogens. This being a menopausal woman, or Peri menopausal, we’re going to support the adrenals. We’re going to support HPA access. And we’re also going to use herbs to support the estrogen and progesterone receptor sites, we’re going to do both Okay, so you can see her now the next part is sex hormones. So we talked about the total cortisol right free cortisol, low total cortisol high strong HPA access pattern, and then the sex hormone wise, estrogen Astra diawl is low. This is primarily the hormone that’s going to be used in cycling women, progesterone is low, they’re both equally low, you see how they fall in the same place in the dial. So if you’re looking at the volume knob, they’re both in the same place, they’re both low on the volume knob. Usually with estrogen dominance, we’ll start to see the estrogen knob higher up relative to progesterone. So that tends to give us a good ratio if we’re intact. So estrogen to progesterone ratio is good. But the hormones are just low altogether. And then testosterone for a perimenopausal woman it’s in the bottom 25% of the range. Not bad. For a perimenopausal woman, you know, top 25 or top third to half is ideal. Not bad at all.

Evan Brand: And this woman was not doing anything correct. She wasn’t doing any dapa or testosterone support-

Dr. Justin Marchegiani: Correct. And then I ignore total da da, I look at these numbers individually here, I look at da da sulfate, eat a clan alone and I look at them all separately. Her total da da number it looks okay. But that can give you a false interpretation. And again, I’ve been doing labs like this lab for six years, I’ve been looking at hormone labs for over a decade. So I mean, I’ve done 1000s of these things. So I always try to boil it down to the to the patterns and the data that matters and ignore the fluff.

Evan Brand: So how would this woman feel I think important to mention, you know, all these numbers, people may look at this and think okay, this looks like Greek so can you just explain how would a woman with that pattern be feeling we’re seeing that cortisol was okay?

Dr. Justin Marchegiani: Peri menopausal symptoms, a lot of Peri menopausal symptoms, libido, mood, hot flush stuff, skipping cycles, of course, low energy, mood stuff, all of those things are present for sure. And then look at her DAGA sulfate here, right? This is the backup generator of the sex hormones to the bottom 25% of the range. So this is the dial here, right? 170 she’s definitely on the lower part here that bottom 25% I like to group things based off a percentage, then the actual numbers don’t matter as much like I just say, hey, you’re in the bottom 25% of the reference range. I like my patience in the top half the top 25% or so. So I always look at things as a percentage. That way you don’t get overly infatuated on the numbers, the numbers can kind of confuse things testosterones in the bottom 25% not as bad there. But I mean, if we get the DAGA to the mid range, that testosterone should take care of itself because that’s gonna trickle downstream from DAGA to Android to testosterone. All of her androgens are okay, they’re all mid to upper 25% no problem. They’re her hormones are pretty balanced in regards to five alpha reductase. This is kind of the enzyme is very important to things going down a less androgenic pathway versus like DHT, which can be more associated with hair loss and prostate issues. And then if we go look at her estrogen levels over here, so this is progesterone, progesterone is calculated by pregnant a dial press plus alpha prineta dial so alpha and beta combined and we already saw her levels here. This is 1.9. I don’t know why the lab doesn’t show that number here. It should it’s like an error, but it’s 1.9 should be the progesterone number Now go look at the estrogen and that’s low. I mean from a cycling female we want at least 10 ideally 15 on the progesterone and then if we go look on the estrogens right, she’s low across the board. So estrogen is he one you know how you know it’s you want it has plenty in it, right? And that’s how we know it’s a one. And then Astra dial, this is your primary cycling estrogen. And it’s easy to because it’s got the prefix di and their di meanings two right, like two sets of dice die. And then we have estria, which is e three and the TRI prefix is how we know it’s e three. So for short e one e two, e three, or estrone estradiol estriol. And again, Esther dial will predominate when you’re cycling more, and estriol we should shift when you’re more menopausal, okay. And we tend to support more estria when they’re men appointment, women are menopausal. So her estrogens are pretty low across the board, you can see that you know, it’s gonna, these are all the metabolites downstream. But you can see, and again, if we want healthy estrogen metabolism, right, we have e to e4 and e 16, which are a different estrogen metabolites. And then you can see here, it goes down this protective pathway from a one to two hydroxy astone. And then that goes down into it and gets methylated into two methoxy. estrogen. And you can see here, right to keep it really simple. This 2.5 number on the estrogen metabolite should go down this pathway, at least half of that should be metabolized. It’s not so you can look at this at this methylation gauge. Don’t look at the numbers, just look at the gauge. So her methylation activity for metabolizing. Estrogen is actually low. So this is not getting fully metabolized. Now, why is that a problem? Well, one, she’s not metabolizing estrogen to her estrogen levels are low to begin with. So it just tells me that there’s some methylation detoxification issues that are a problem. Why could that be a bigger problem? Well, if we start supporting more da, da, maybe start supporting hormones better, this could cause a backup in regards to her hormones being metabolized, we may want to really work on supporting extra sulfur groups extra methylating nutrients, so there’s not a clog in these hormones getting metabolized. So, in general, we want to see at least half of this getting metabolized downstream. So if we look at two hydroxy, one, we want at least 1.25 there. And again, forget the numbers, it’s all represented in the gauge. So I want this gauge at least mid range. If the gauge is not mid range, and it’s on the lower side, it tells me we’re not metabolizing or methylating, our hormones actively, you know, as optimally as possible, and we may want to provide supporting nutrients to help that.

Evan Brand: So let me ask you this, if a woman, maybe she had run this and got the analysis from you, but then she just went to her conventional hormone doctor down the street, and he goes and puts her on some estrogen and maybe some progesterone, maybe some testosterone, how would that differ in terms of outcome based on this versus what you’re going to do?

Dr. Justin Marchegiani: Well, number one is they’re going to look at your extra dial just via the blood. And that’s okay. But it may not be able to look at free SSL dial as well. And most of the time, they’re not going to time it up at the right time of the cycle, you really want to time some of these things up around day 20 of the cycle to get a window of where progesterone is at. And then of course, you have to compare it to where in the cycle it is. And the next thing is no one’s going to look at how it’s being metabolized downstream. So we get a window into our total estrogen. All of our estrogens e one, e two e three, not just extra dial, we’re getting a window of progesterone as well. We’re getting a window into our androgens, we’re getting a window into d h, EA and our testosterone. And then we’re also looking at how it metabolizes downstream from 16 hydroxy from four hydroxy and to two hydroxy to four and 16.

Evan Brand: And then what’s the protocol? What’s the protocol for this woman?

Dr. Justin Marchegiani: So it depends. So off the bat, we may want to support estrogen metabolism a little bit better. That could be giving something like NAC it could be giving something like glutathione, it could be doing something like indole, three carbinol DIMM, or calcium to glucose, they could all be really good options. Even just giving some extra fiber could also be really helpful. Just to help out of the gates just to make sure there’s no bottlenecks there. Number two, we would support the adrenals accordingly, okay, we would support sex hormones as well. So depending on if she’s cycling or not, because remember, this woman kind of was skipping cycles. We would definitely do herbs like different kinds of phenotypes of Makkah that we use I use a product called feminine essence menopause as a special phenotype of Makkah. You can get that adjusted slash shop and the female hormone section that’s wonderful because it works on upstream HPA axis. We may work on the in different herbs to help the HPA access to like ashwagandha which is wonderful at modulating that hi level of cortisol. And then depending on hormones, we may want to throw in some progesterone, especially if she’s cycling in the last half of the month. And we may want to throw in a little bit of estriol. It depending on if she’s cycling or not, if she’s transitioning into menopause at her age, right 52, I think is the age of this patient. Well, the average age of menopause is 4852. So she’s definitely on the later side. So she may be transitioning into menopause. And if she has no cycles for a period of time, we may want to throw a little bit of estriol in, but if she’s not, if she’s still cycling, we don’t want to do any sgl. Right now, we want to focus on good healthy herbal support for astron production, we want to focus on good da ta support, we want to focus on progesterone, the last half of the month, we want to also focus on good estrogen metabolism. We want to focus on really, really, really good HPA access, support, all of those things are going to be really, really important. I’m not going to give like an exact protocol on dosing, just because it’s you know, this is a very general kind of thing right now, I don’t have the patient in front of me, but it just kind of gives you a good idea. What what I’m looking at there.

Evan Brand: Totally. So someone may think, oh, they saw that high metabolized cortisol and they may need, they may think they need to come in and do something like relora, which a lot of people talk about to lower cortisol, that is not the right choice to do because her total, or the free cortisol is already on the low end. Correct. So like at nighttime, like if this woman says, Hey, I’m not sleeping good at night, you’re not going to come in and use relora are you because that would take the low situation and make it lower? Is that right?

Dr. Justin Marchegiani: I wouldn’t give something that would lower the free cortisol more like something like a phosphatidylcholine or serine. Right. But I would do some things to calm down the HPA axis for sure. So things that really can help calm it down. Because that total cortisol being really high is what’s telling me that there’s definitely HPA access issues. But I mean, you know, it’s possible some of these symptoms could could kind of conflict because our free cortisol so low and our total cortisol so high, but I wouldn’t overly lower the free cortisol, I would just focus more on adaptogens to help modulate over cortisol. Just the the overactivity, the overstimulation of the adrenals the whole, and that would still come in there and support with some pregnenolone and dapa as well. I wouldn’t overdo it either, though, because her cortisol is total on the higher side. So this is where it’s really important. Like, it’d be really easy to want to give this woman a lot of licorice and a lot of pregnenolone. Some of that may be necessary, but you may want to just take the fact take into consideration that she has a total cortisol level that’s very high. And we may want to have some kind of in between those. So we got to really look at that total cortisol production in relationship to the free not overdo it.

Evan Brand: Yeah, what you’re saying is because she’s desperate to feel better, right? And you want to give her more energy and you’re going to look at that rhythm and say, Okay, yeah, it’d be great to give her a boost here some licorice at breakfast time and maybe some lunchtime dose to perk her up. But you’re saying you can overdo it because of how high the total is in this case.

Dr. Justin Marchegiani: Yeah, very easy to do that.

Evan Brand: Yeah. And so then that would manifest how maybe anxiety heart palpitations, insomnia.

Dr. Justin Marchegiani: If we overdo it, yes, harpy, potentially heart pals, potentially insomnia, potentially, anxiety, all of those things are potential issues that you may see a problem with.

Evan Brand: Yeah, and this is why we love to to mix herbs to right you’re rarely going to be using an urban isolation, right? You’re going to be coming in possibly with ashwagandha. But you may come in possibly morning. Maybe she could benefit from something like some eleuthero. Some holy basil, maybe some other more stimulating things. If you don’t want to go too high on the licorice. Is that what you would do?

Dr. Justin Marchegiani: Correct. Yep. 100%. Cool. Any other questions there so far? It’s great to see it.

Evan Brand: I think this should should help a lot of people.

Dr. Justin Marchegiani: Yeah, in general, you really want to make sure you kind of clearly delineate where the patient is in their in their hormonal pattern. I think it’s really tough. The hardest part is when you have a woman who’s perimenopausal who’s still cycling, but is starting to not cycle and starting to switch into menopause. Because you’re kind of you kind of have two ways to handle a woman if they’re still cycling versus they’re not because hormones have a rhythm, rhythmic fashion, and you want to add them in, pull them out. And if a woman is more menopausal, you can keep hormones really in throughout the month, you’ll have to cycle them as much. And so I always err on the side of treating a woman like they’re cycling until they clearly delineate that they aren’t cycling, because if I start getting hormones monthly, daily, and that could throw off their their cycling pattern. I don’t want to do that right first, do no harm. Let the body clearly delineate where it’s at in regards to its natural hormonal patterns. So the hardest part in dealing with women, is if they’re perimenopausal transitioning to menopause, I really want their bodies to clearly show me that they’re ready to stop cycling and that’s why I always treat them like they’re cycling until it’s crystal clear they aren’t.

Evan Brand: Yeah, and then that The most common time for symptoms, right? So that’s probably the majority of what what people are going to feel in that stage of their life, they’re going to feel the most symptomatic in that transition time, or at least in what you and I’ve seen, this is probably the most common time a woman’s going to reach out for help.

Dr. Justin Marchegiani: 110% Yep. So it’s really, really important to kind of take a look at that and make sure that we keep that in mind. Absolutely. And then also, you know, we have different estrogen metabolism risks, right, we have different estrogen metabolites. So if we look over here, we have e one, e two, and E three. And when you look at these different metabolites, you know, he one tends to be a little bit more, you know, safer, right? He one tends to be a little bit more safer in regards to his to his detoxification, okay. And then when you look at e4, or sorry, two hydroxy, estrogen, right, or Astra dial here, this can go down pathways as well, are four that could be a little bit more damaging to DNA. So our four hydroxy, could be a little bit more damaging, as you can see.

Evan Brand: Let me ask you this real quick. So if you scroll down a little, it’s showing how on that pathway, you can get DNA damage, it’s showing reactive there. So we have to factor in what we learned from the stool test into this also, right, because if we see like a high beta glucuronidation problem due to bacterial overgrowth, isn’t that going to mess up this same pathway or my..?

Dr. Justin Marchegiani: Yep, it definitely can. And you can see here with the different, you know, metabolites, right, your four is going to be a problem area, right? So you’re for your your two hydroxy. Your two hydroxy going into the this four hydroxy right here could be a problem. Two hydroxy tends to be a little bit less damaging right here, especially if you have good CMT and methylation, when you go when you because all these things can can conglomerate. So you can see how e one e two and E three can all go side by side, they can all transition. But then you can see they can go down to 16 pathway, which tends to be a little bit more gentler. It can go down the four pathway, which can go into reactive oxygen species, it can also get methylated, right? What’s methylation, full eight, B six, right? b 12 really helps support methylation, Coleen, and then also gluta phi m can help decrease a lot of this too. So healthy gluten diet and healthy sulfur, healthy cruciferous vegetables, healthy digestion of our animal products. And that can help a lot of this, this methylation issue, and detoxification. And then of course, we have our E, two hydroxy. Over here, which again, methylation is very important, full A B 12. b six, Coleen, right, healthy cruciferous vegetables are going to be really important if you’re here. And we can even if it’s really high, we can even do things like dim, we can do things like calcium to glucose, we can do extra fiber, things like that to help bind it up.

Evan Brand: And the reason you’re saying this is so important is because we need to get out these excess hormones, right, we don’t want them just sitting in the tank, so to speak, after they’ve gone through this process. So you’re saying the gluco rate, the Bluetooth ion, the methylation, these are all the processes in the body to get rid of these, once they’re done is I don’t know what the right word is. But once they’ve been used by the body-

Dr. Justin Marchegiani: -agreed, though, your body will conjugate them bind that proteins to them and excrete them. And so we’re gonna really focus on a lot more gluta phone support more sulfur amino acids. If we see this guy over here, the four hydroxy ones higher. And then of course, you know, you can always give sulfur support methylation as well, which is going to be the B six, b 12, full eight, Coleen all of that as well. And this will support both of these two methoxy, two hydroxy, as well as four hydroxy. One, all of these are going to be very helpful, you can’t hurt to support any of those. And if we have anyone that has, you know, estrogen cancer, you know, risk? Well, we tend to if we need estrogen in someone’s more menopausal, we’re going to try to support more estria, which is going to be more cancer protective. But if someone has a previous cancer history, we probably will not do any hormones at all on the estrogen side. And just focus on progesterone as long as their their cancer is not progesterone sensitive, and good, healthy herbal support to help modulate some of the receptor sites.

Evan Brand: Yeah, awesome, awesome question there. This ties into a lot of stuff we do with the gut to which is really cool, because we’re often going to be in detox to we’re often going to be using Bluetooth ion for mold or chemical toxins, we’re going to be using calcium D glue, great to help with zero unknown or other mycotoxin removal, we’re going to be using possibly a methylated multi based on what we see with poor mitochondrial function on the organic acids test. So the cool thing that I’m seeing here, the trend is that the whole picture works together. So by working on the other body systems, we’re already really fixing the majority of stuff we’re seeing here plus the addition of some of the extra hormonal support.

Dr. Justin Marchegiani: Yeah, exactly. And then kind of the general ratio of healthy estrogens, is we like to see a kind of, you know, we have the, what’s called the estrogen ratio, where we look at Astra dial thrown relative to 16 hydroxy. Right? So it’s like we’re looking at basically each one. I’m sorry, e to e4 and 16. We like to see a higher level of 16 in relationship to four and two, right? 16 tends to be more cancer protective. Why? Because most of its coming from estriol. And then you can see two and four tend to be a little bit more from stronger estrogens, e two and E one are stronger estrogens, e three is a weaker estrogen. So we kind of have our two, four and 16 metabolite ratios, right. So you could say to four and 16, we want to have higher levels of 16 in relationship to lower levels of two and four. And again, it just depends upon how the metabolism is to right. If we’re metabolizing these things well, not as big of a deal, right? Because why these hormones come up higher typically is where they’re getting the hormones in our body from, from hygiene products, from plastics, from chemicals in our environment, or we’re just not metabolizing them. So we make sure the lifestyle components are dialed in, where we’re not getting them in our body and to we make sure that we’re metabolizing them as well. Does that make sense?

Evan Brand: It does it does and why we’re not metabolizing metabolizing them, I just wanted to make that clear to people that could be due to gut issues, right, there is a gut hormone component here.

Dr. Justin Marchegiani: Yeah, so the beta glucuronidaze enzyme really helps metabolize a lot of estrogens. And when beta glucuronidaze goes high, it takes the SD estrogens that would have handcuffs on them or a straitjacket on them that would be escorted out of the body. And it breaks those handcuffs and allows them to go back into general population. And so having good healthy gut levels is very important. Now, if you come down here a little bit more, this is kind of cool. We look at melatonin levels, patients mid range, not that big of a deal. These are the same markers over here. So we’re not worried. This is cortisone pattern, I don’t really care about it, it almost always is congruent. What we see on the cortisol side, you can see this kind of with more emotional stress issues. This is more like inflammatory stress. But almost always, they always tend to have a similar pattern as the other side. So I don’t really care as much, because you can see the cortisone pattern is almost the same as the cortisol pattern, right? And that’s not going to change protocol. It’s not going to change protocol. And the cortisol is the more physiological active compound, right? cortisol gets gets broken down downstream to cortisone, which is a weaker kind of metabolite, it’s the weaker sibling. So it’s not quite as it’s not going to be the stronger one we’re worried about. And these are all the same numbers on here. This test is very confusing if you don’t know what you’re looking at, because there’s a lot of repetitive data. That’s just more I think, so people don’t have to scroll around as they’re going over the labs. It’s kind of repetitive for the doctor so they can explain it to the patient. But if the patient’s looking at it, they think, wait, this is new, this is new, this is new. It’s just like this is like the third time they’re saying it not a big deal. All right, and then this is where we’re looking at some of the the markers here in regards to organic acids.

Evan Brand: How you can correlate to the Oh, I mean, have you-

Dr. Justin Marchegiani: It’s pretty good. It’s it’s on point, most of the time, sometimes it can be off, I always tell patients, if we have an organic acid test, like the gray plant lab or the Genova, we’re going to always listen to that one as the most important because that test is specific for organic acids. And there’s a greater sample there too, so it’s going to be more accurate. But if we have this test in by itself, we’ll still utilize it. So out of the gates, you can see here, b 12, this is for methylation looks pretty good 1.5, Santhi RNA can be six marker, kind of urinate look pretty good. glutathione is on the lower side, right? So with this patient, we may want to support either some kind of a sulfur amino acid or some kind of fluid found to help with estrogen metabolism. And again, it just depends out of the gates if we’re not providing a ton of hormone support. Her hormones are so low as well, it may not be a top priority out of the gate. If the person’s hormones were higher, definitely a top priority out of the gates. Okay. And then this is interesting. This looks at the catecholamines it looks at basically adrenaline, or catecholamine. do the exact same thing. By the way, norepinephrine, epinephrine, exact same thing. Three words that mean the same thing. I know it’s really confusing. So we have dopamine, which is the home of anolyte metabolite, and then we have vandalia Mandalay, which is a which is a metabolite of adrenaline or epinephrine. And so dopamine is a precursor to norepinephrine or epinephrine. So the more chronically stressed you you are you will pull dopamine, and so they have high levels of dopamine metabolism and high levels of adrenaline metabolism. What does that mean? It means this pathway, this pathway here is is redlined. So we’re really breaking down and metabolizing lots of dopamine, a lots of adrenaline, and that could be part of the reason why the adrenals are more depleted here, right. And so we may want to add in some amino acids to support some of the catecholamines catecholamines. Definitely stressed. Now, we just have to make sure as we add some of those support in that we’re fixing underlying issues. So we’re fixing diet, we’re fixing blood sugar, we’re trying to get sleep better. We’re not over exercising, we’re making sure all those things are, are pretty good. And then again, Melatonin is on the lower end of the range, but it’s at 24. The range is 10 to 85. So it’s not that bad. I mean, it’s in the bottom third. I only work on this if there’s sleep issues. And typically, I’m always going to be supporting melatonin with amino acid precursors. First, I’m never going to target melatonin by itself unless we absolutely have to. I rather give building blocks and let the body do with it what it’s going to do first, then force melatonin, but if we have to, we can at the lowest possible dose, like-

Evan Brand: What are you doing? What are you going to do for aminos on the homo vanolate vandal mandalay you’re mentioning there, you may come in and support aminos.

Dr. Justin Marchegiani: Yeah so if you look at the range, they’re not super high. It’s six remember, this goes six point four um high end of the range four to thirteen. So i’d probably come in there with some tyrosine. Definitely i throw in some extra b vitamins, extra b6, even though b6 looks good. Just because these pathways are going to be stressed, so i really want to make sure some of the b vitamins are there. Some of the extra amino acids are there. I’m going to work on some of the adaptogens for the adrenals, i’m going to work on some of the adaptogens for the female hormones, uh we’ll throw in a little bit of DAGA, we’ll throw in a little bit of pregnanalone building blocks as well, if we go look here –

Evan Brand: So would you come in and never do dlpa over tyrosine in that situation, would you go based on symptoms like if somebody was like super weepy and crying at the drop of the hat, would you say okay we’re going to go dlpa instead or you’re just going to have tyrosine?

Dr. Justin Marchegiani: I would just do tyrosine out of the gates. I’d only do more dlpa stuff if there’s like a lot more chronic pain because dlpa will tend to go down more of that beta endorphin pathway which could be helpful for chronic pain stuff. If not i would just hit more of the the tyrosine and the b6 and then really calm down the hpa axis. Does that make sense?

Evan Brand: Yeah it does.

Dr. Justin Marchegiani: And then again you could see here pregnanalone is an important building block that we like to use because it’s it’s the mother of all hormones. Now i like it but you don’t want to just take it willy-nilly. I like to always use the lowest possible dose and i like to use it sublingually to bypass the gut and you can see chronic. So you can see here pregnenolone can go downstream to progesterone, right and then you can see pregnenolone, um can also go downstream to DAGA which can then go downstream to our sex hormones right, potentially some of the androgens. Potentially some of the female hormones right go right from here to andro to e1, that goes to e2 and then that can go to e3, all right and then it can also go downstream to testosterone too. Okay and then it can also go downstream to your mineral corticoids which are right here DAGA to where’s um.. Aldosterone here? Help me find aldosterone, where is it there.. Uh andro e1 let me know if you can see it but there should be a pathway where it goes downstream to aldosterone which helps hold on to our minerals.

Evan Brand: Is it at the bottom scroll down i’m seeing it.

Dr. Justin Marchegiani: Maybe they left it out on this graph but there should be a pathway that goes down to aldosterone which is a mineral corticoid, which helps you hold on to your minerals as well. Now also too if you have progesterone right, but then you’re having a lot of like um inflammation right, you can go progesterone down to 17 hydroxy progesterone and then that can go down to cortisol right, so if you’re chronically inflamed you can create low levels of progesterone. Because progesterone is going from here right downstream to cortisol. So that’s why chronic stress and chronic inflammation could throw off your female hormone balance. Does that make sense?

Evan Brand: Yeah it does. Yeah it shows there too uh mother’s diet during pregnancy. Insulin, resistance, obesity, inflammation, hypothyroidism, licorice phthalates, I like how they put the information about what’s going to contribute to the problem that’s really cool.

Dr. Justin Marchegiani: Yep exactly. And then also you can see here you can go your cortisol right and then your cortisol this is your free cortisol here. Right, this is your your active cortisol. Um so this is your this is your free cortisol here, and that the free cortisol is going to be what we measure on the cortisol rhythm graph and then it can go down the um the cortisol. That’s more inactive right we have our the cortisol as well, which is part of our cortisone.

Evan Brand: We need to do a show. Let’s do let’s do another one on this and review our own. I’m going to get a new one. And let’s do it.

Dr. Justin Marchegiani: Yeah, absolutely. So our metabolized cortisol is thf plus th e right, this is our total cortisol and then our free cortisol which is the th the thf so f for free right, so when we look at this here when we look at this here the cortisol, right this is the free cortisol right and then the total cortisol is the free plus the e just an fyi so we’re looking at the cortisone plus the cortisol is what the total cortisol is on that on that graph above. Just so you guys kind of wrap your head around that. And they they left out the uh the aldosterone here. Let me just see if it’s there albosterone. No not there. So yeah. They left that out but that should be in there somewhere as well. I’ll put a i’ll put a graph on that all right. Anything else you want to highlight there evan?

Evan Brand: No. I would just tell people that this is a really good starting place. But i just want to make sure that if you go to just the hormone person that they don’t just treat this because i think it’s really important to understand that there is a massive issue with bacterial overgrowth messing up some of these pathways. So if you come in and you’re doing all these hormones but you’ve got the build up because of those glucuronidation pathway issues. I’m seeing that with mold too that these glucuronidation issues people are on hormones and sometimes they feel worse and i think it’s because they’re not addressing some of these other pathways. I don’t think it shows glucoronidation on this does it this this panel.

Dr. Justin Marchegiani: No no. That’s gonna be more on the detoxification side okay. Any question there?

Evan Brand: No. I’m i’m good.

Dr. Justin Marchegiani: Cool and then just so you guys can see i’ll pull this over here real fast so if we look at this one right here just so you guys can see it so normally progesterone. Um it can go from progesterone down here into aldosterone and so in general if we look here it should go progesterone to aldosterone. So this pathway here you’d see aldosterone kind of coming down here if it really extends it all the way. Just an fyi on that all right. Anything else?

Evan Brand: I think we hit everything pretty good here. So are you saying progesterone could help aldosterone problems?

Dr. Justin Marchegiani: Yeah exactly so if we support pregnenolone that could also help aldosterone issues also supporting licorice can help aldosterone there’s a basically a drug called fluorine f right there’s cortef that’s supports cortisol levels that are very low okay and there’s fluorina which supports aldosterone and licorice has a an effect of mimicking um aldosterone so that can be helpful because when your adrenals are really weak you may have a hard time holding on to your minerals and so that’s important because we need healthy blood pressure to perfuse blood to the brain oxygen to the brain and we also need good minerals to help our sodium potassium pump to work properly we need electrolytes for our nerves to work so. All these are really really important.

Evan Brand: So one last question then we should wrap it up. So if someone is taking adaptogenic herbs or doing adrenal supports they’re doing hormones they’re doing licorice. What’s the approach or protocol to doing this test if we get the test kit in their hands and they’re on let’s say an adaptogen blend. They’re Doing the ashwagandha, the licorice, and everything do you suggest taking a break or does it not matter we gonna we’re gonna see how the body’s functioning while on those herbs?

Dr. Justin Marchegiani: You’re talking about down the road?

Evan Brand: No i’m saying like right now they’re already on them.

Dr. Justin Marchegiani: If they’re yeah if they’re already on them it may not be bad to take a look at kind of where they’re at with them already on them yeah for sure that i don’t see that  being a bad a bad situation if they’re taking hormone support it just depends where they’re at i usually don’t like it the day of just because you can get an artificially high reading.

Evan Brand: Yeah.

Dr. Justin Marchegiani: If it’s if it’s in your system that day so usually maybe take 24 hours off that way it’s not overly high in the system.

Evan Brand: but you still see the trend. Yeah i’m always on the fence about it because you’ve got so many people taking blends which is great. I think you and I have really helped educate people about adaptogens but you’ve got people taking so much and it’s like well are we seeing an artificially good cortisol pattern or is this really how your cortisol pattern looks so i think maybe a day or two off sounds smart.

Dr. Justin Marchegiani: Yeah if it’s herbs i’m not worried about those as much because that’s they’re going to be more modulating and it’s just where they’re at you know and if they tell me that hey i’ve been on them for the last couple of months and i’m feeling better good we’ll just have you stay on and we’ll just take that into consideration  on the test.

Evan Brand: Okay.

Dr. Justin Marchegiani: When we’re interpreting it because if they have some adrenal issues and they’re doing well with that well guess what we probably still want to make that part of their plan anyway we’re not going to change it too much right.

Evan Brand: Yeah well said.

Dr. Justin Marchegiani: Any questions there so far?

Evan Brand: No that no that’s it i think we should do a part two and review our own that’ll be fun i’m gonna get another one and run one on myself and you should do one too yeah i think that’s a great idea i like it a lot so.

Dr. Justin Marchegiani: I think we hit a lot of good stuff here hope um you know anyone listening you can see that you know Evan and i are kind of the real deal when it comes to this like we actually do this we’re in the trenches a lot of people that you may see online are kind of they’re like thought leaders from a um let’s say esoteric standpoint meaning they’re not actually doing this to not actually practicing so we try to differentiate ourselves by bringing actual information so just kind of know this isn’t theoretical stuff this is Kind of the real deal and and hopefully that gives you confidence to take action and to try some of the things maybe you want to dig in. Maybe you want to get testing maybe you want to reach out to Evan or myself. We’re here to help you out, if you need more help. Of course start with all the foundations, we have thousands of hours of free content because we know 99.9 of patients that that we work with or help, they’re doing it with our free content. We’re not even seeing them now if you’re ready for that next step and you want to dive in. We’ll put links down below so you guys can reach out and reach out to Evan. Evan’s available worldwide and myself, Dr. J at to schedule with myself as well. We appreciate you guys um connecting with us all anything else you want to say Evan?

Evan Brand: No people really appreciate it and yeah we’ll make sure  to have the link if you listen on audio your mind’s probably blown right now you thought what the heck just happened we will make sure to give you the link that way you can see this thing because the screen share is great and you just want to give you kudos you’re a great teacher and you’ve taught me a lot about the dutch too so i really appreciate it and your eye to detail on this thing is awesome and most people don’t have that eye so we we really look up to it and really appreciate it.

Dr. Justin Marchegiani: Hey thanks Evan really appreciate it. And if anyone has any hormone issues that are way out of balance and you want to double check it with some blood work too. I don’t have a problem with that either especially some of the androgens I always like to double check with blood if we’re seeing some chronically high stuff um feel free to do that as well. And i hope you guys enjoyed it. Feel free give us a share as well thumbs up and if you want to write us a review that gets us motivated. Um we’ll put a review link right down below if you want to write us a review on itunes. Appreciate it you guys have a phenomenal day. Take care now.

Evan Brand: Bye-bye. Take care y’all.


Audio Podcast:

Recommended products:

DUTCH Adrenal Test

DUTCH Complete Hormone Test

DUTCH Sex Hormone Metabolites


Stomach Acids, Enzymes and Insulin-Driven Issues and Supplementation | Podcast #191

Welcome to today’s live podcast with Dr. J and Evan Brand! Watch as they dig into the different issues concerning gut health and supplementation, like Insulin-driven skin problems, malabsorption, enzymes, kidney stones, detoxifying and other digestion-related topics they randomly answer.

Stay tuned for more functional health information, and don’t forget to share!

Dr. Justin Marchegiani

In this episode, we cover:

02:15  Estrogen and Insulin-Driven Skin Issues

05:50  Enzyme Synergy Versus Digest Synergy

10:00  When to take what Supplements

16:25  HCl, Enzymes and Digestive Supplements

19:49  Organic Buckwheat Crisp



Dr. Justin Marchegiani: Hey, there! It’s Dr. Justin Marchegiani. Evan Brand is here in the house as well. Evan, how is your Father’s Day, man?

Evan Brand: Oh, dude, Father’s Day was great. It was my second. Was this your first…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …Father’s Day?

Dr. Justin Marchegiani: I may— I guess it’s my First. My— My son last year at this time was in my wife’s belly…

Evan Brand: [laughs]

Dr. Justin Marchegiani: …I think six months— s— so, six to seven months in. So he was still— he was still alive and kicking, so it felt like my second. But, yeah. It was great. I got this awesome little gift from my wife.

Evan Brand: What did you get?

Dr. Justin Marchegiani: This. She made this little thing…

Evan Brand: [crosstalk] Oh! Dude, that’s great!

Dr. Justin Marchegiani: Yeah, and then that’s me with him. That’s Aden right there.

Evan Brand: Oh, man.

Dr. Justin Marchegiani: And he’s a super little healthy dude. [crosstalk] Really healthy…

Evan Brand: Actually nice.

Dr. Justin Marchegiani: But yeah. That’s— Melts my heart. [inaudible]

Evan Brand: [crosstalk] Yeah. Your wife was uh— Your wife was showing me his swimming skills when I was over at your house so we went to the pool. Uh— He— He’s doing pretty good for a little guy.

Dr. Justin Marchegiani: He’s doing great. I, too, took him out to a steak restaurant in Austin, and he had a little meltdown halfway through. He forgot to check his diaper. Like— It’s this like…

Evan Brand: Uuuh—

Dr. Justin Marchegiani: …the most obvious thing sometimes.

Evan Brand: [laughs]

Dr. Justin Marchegiani: It’s like phew!

Evan Brand: [laughs]

Dr. Justin Marchegiani: But he was eating a whole bunch of steak and and red wiine. He’ll pound down five ounces for a steak in a meal.

Evan Brand: That’s amazing.

Dr. Justin Marchegiani: Yeah. He just crushed it. And the thing is he has had no real exposure to sugar outside of like having berries so it’s really interesting because he is totally carnivorous, will choose meat over anything else. Where— I see lots of other parents, where their kids are getting like lots of these like eating Yogurt, sweetened things, a lot of juices. I really feel like like that numbs your taste buds ‘cause they really don’t want to eat meat or these higher protein and fat-rich foods. They’re just like all about the sugar. So that’s one thing I’ve noticed. So any parents out there— you know, your kid’s coming to this world with this blank slate. Keeps their taste buds as “El Natural” as possible.

Evan Brand: Do you do uh— applesauce with them?

Dr. Justin Marchegiani: Uhm— Actually, we’ll just cut up apples.

Evan Brand: But no applesauce?

Dr. Justin Marchegiani: Uhm— In the beginning, we did a little bit but not much. I mean, we do like a little bit of mashed sweet potatoes or mashed Avocado. Uhm— But no, not a ton of applesauce. He’s able to just— We do a lot of baby like weanings so we just cut up the thin strip of apple or the thin strip of pear, or the thin nectarine, and then just let him eat— let him eat it like that.

Evan Brand: That’s smart.

Dr. Justin Marchegiani: Yeah.

Evan Brand: That’s smart.

Dr. Justin Marchegiani: Yeah, absolutely. So I know we only have a little bit of time today so we’re gonna just do a live Q&A. We had a couple of questions here. So, we’re gonna just dig in. Let’s go through them.

Evan Brand: yes, let’s do it.

Dr. Justin Marchegiani: Uh— Gabe writes in, “Lately, my wife spends seeing more tiny moles started to appear on her face. Any explanation why?” So, couple of things. When you see moles grow, the first thing I always want to know is Estrogen and Insulin. So, really make sure carbohydrate and Insulin is under control. Insulin will cause things to grow. And then, we can just do a little bit of Google Search and do Hyperinsulin— Hyperinsulinemia and Moles, right— and you’ll see it. Skin manifestations of Insulin resistance, and you’re gonna see that a lot of uhm— skin stuff can be driven by Insulin. A lot of Acne as well. Right? A lot of Acne as well, because Insulin causes things to grow.

Evan Brand: Yeah. You got— You always got to start with the diet. I think that’d be the most simple thing, right? Make sure…

Dr. Justin Marchegiani: Uhmhm—

Evan Brand: …she got like a Paleo template to start with, she’s regulating Insulin, and there’s always other root causes that could affect Insulin too. Like gut issues can affect blood sugar, which could affect these Moles.

Dr. Justin Marchegiani: Yup. So I would always look at the— the blood sugar, the quality of food. I’d look at pesticides and chemicals in the environment. I want to make sure those things are under control. And then, of course, you know, the gut’s a mirror of the skin. So, everytime I see a gut— a skin issue, I always think gut, so you can always do a nice little gut cleanse. Uh— You get to do some gut testing, do some gut clearing, and then uhm— you can always work on some detox as well because things will get pushed out via the detoxification system, which will be the skin as well. So, activated charcoal, glutathione, Sulfur amino acids are gonna be great, and then uhm— You know, there’s always a chance that it could be a viral thing, too, like a Papillomavirus thing.

Evan Brand: Good point.

Dr. Justin Marchegiani: Uhm— But— Yeah. But, you know, a lot of the herbs we may use. Like in my GIClear 4 and 6, there’s a lot of Olive leaf, so I would just use a 4 and 6 in there and that extra Olive leaf will have some good antiviral effects too.

Evan Brand: Yeah. You— You kind of briefly mentioned some of your supplements, but I want people to understand that uh— you know, part of your goal is to provide professional grade supplements to people even if they’re not your clients or patients. So if you guys tune in to this in the future, if you’re tuning in right now, you can go check out— There’s an entire library, basically online natural pharmacy so to speak, of various nutraceuticals and things that Dr. J has formulated. So when he says like, “Hey! My GI Clear 4,” that’s what it means. And you can go check out those formulas. So, we’re always happy for people to piece together these herbs but, obviously it’s better if you get some lab testing to figure out if you actually need them. But if you’re searching fish oils, Collagen, proteins, which his is amazing, uh— all that stuff is on that Just in Health store. So if you’ve not browsed it, now’s a good excuse to do that.

Dr. Justin Marchegiani: Thanks, Evan. Thanks for the plug. And then, topically, you can always do like a higher quality Vitamin C serum or high-quality Retinol or Vitamin A serum with antioxidants. That’ll always be good topically as well.

Evan Brand: Yep. Good advice. Uh— Let’s go over here to uh— Juan. He was asking, “A Glutathione injection, is it great in an IV?”

Dr. Justin Marchegiani: Uh— IV, I think is great if it’s— if it— if you have a really acute exposure. The problem is most people can’t afford or do an IV daily. So, I think an IV, acutely, is a good situation, uhm— but daily, it may not be the best. So you get like a Liposomal Glutathione like this, and then you just give it a little squirt a couple times a day if you want that.

Evan Brand: That’s far smarter. You don’t need an IV. I think an IV is unnecessary because of the Liposomal technologies.

Dr. Justin Marchegiani: Yeaah. Liposomal technology has really helped. Now, if you get an acute issue, that’s fine. Like if you’re sick or your kid drops a  th— you know— a Mercury-based thermometer kind of thing, right? That’s— You know, for an acute thing, I’m— I’m okay with it, but in general, you want something that you can use daily.

Evan Brand: Yeah. I agree.

Dr. Justin Marchegiani: And then, uh— Charlie writes in, “What’s the difference between Enzyme Synergy and Digest Synergy?” Uhm— Digest Synergy, basically has some different types of acids and a little bit of Pepsin. It— It’s lower on the HCl and has a little bit of enzymes. The Enzyme Synergy’s pure enzyme. So, typically in my line, I use Enzyme Synergy and HCl Supreme together because I get a high dose of HCl and a high dose of enzymes. So if I have digestive issues, I can more therapeutically hit that. Digest Synergy kind of consolidates two into one so it’s lower on the enzymes and it’s lower on the HCl, but for most people that don’t have an active digestive issue, it’s enough. So it’s basically just consolidating the two together. People that don’t have core or very minor digestive issues.

Evan Brand: Yup. Good. Good. Good, good.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Both great products. So here’ another one from uh— Juan, “I took Lamisil. It worked great for my fingernail, fungus and toenail fungus. How can I detoxify my liver from the medication? I tried other things like T3, Oil Oregano, oil, and nothing worked.” Well, first, uh— I mean, you give me your two cents here, Dr. J, but I would say, you got to get tested. I mean, you’ve got to take a look at your liver. If you’re concerned, and you want to detoxify, why don’t you look at your AST. Look at your ALT. Look at your GGT. See if there’s anything like, actually manifesting…

Dr. Justin Marchegiani: Uhmhm—

Evan Brand: …before you go down some like liver detox program. You might not need that.

Dr. Justin Marchegiani: Yeah. I think that’s great. And then, if you’re really having a hard t— You said, “I took Lamisil. It worked great on your fingernail fungus and toenail fungus.” So you’re saying— I sounds like the toenail fungus and all that stuff’s better. So, ideally, if you’re gonna take that stuff, you should be on Glutathione uhm— and/or like milk thistle and liver tonifying support. So, like in my line, it’d be Liver Supreme and Detox Aminos, and you can even add in extra liposomal Glutathione along with it while you’re doing it. So you typically want to do it while doing it because— I mean, what’s the half-life on that stuff? It can’t be that long. So, it’s probably out of your system already. So, you just want to build back your system up to make sure it’s fine. That probably iis fine. It’s unless you use it for a incredibly long time. So I wouldn’t worry about it, but better to do it while you’re actually doing the treatment.

Evan Brand: Yup. Yup, well said. Let’s go over here. Uh— Don’t know who this is. Kind of weird name. Uh— “Small amounts of Calcium citrate a meal’s okay with kidney stones?”

Dr. Justin Marchegiani: Well, with uhm— kidney stones, you’re typically gonna be doing more Magnesium— more Magnesium with kidney stones ‘cause a lot of the kidney stones are oxalate-based. So Magnesium tends to be good, and then also Potassium. I don’t think you want to be doing Calcium citrate. Let me see. I think the citric acid may—

Evan Brand: I don’t think you want Calcium, period. Nora Gedgaudas, a mutual friend of ours, has a great article on Calcium. You really just don’t need Calcium supplementation uh— hardly, ever. There’s very rare situations where you will need that.  

Dr. Justin Marchegiani: Yeah. So, basically, Calcium citrate does reduce the risk of oxalate deposition in the kidneys. So does the Potassium. So does Magnesium. I just rather be using Magnesium and Potassium personally. Uh— it’s harder to get those minerals, nd they have more enzymatic roles than Calcium. So I wouldn’t worry. I would use the Potassium and Magnesium over the Calcium, personally.

Evan Brand: Yup. Yup. Let’s keep going here.

Dr. Justin Marchegiani: I had a large in my back. It fell off after Keto and fasting. Totally makes sense. That’s all about Insulin, right?

Evan Brand: That’s cool.

Dr. Justin Marchegiani: Yup. Makes a lot of sense. Seen that before.

Evan Brand: Here’s Tom. I’ll read this one for you. “Vitamin D, trying to optimize absorption one meal a day in the evening. Should I take Vitamin D on an empty stomach or with the meal in the evening and risk melatonin interference? Any suggestions?”

Dr. Justin Marchegiani: I mean, I would just try to do it in the morning because it makes sense. Vitamin D is typically gonna happen when the Sun’s up, not when the Sun’s down so try to time it in the morning. If you forget, as long as you can take it, and it’s not gonna mess up your sleep and you can relax and wind down, I think it’s fine. A lot of my uhm— Vitamin D’s gonna be at a beta MCT Oil, so take it with a meal.

Evan Brand: Yep. Sounds good. Keep going here. Anita, “Can you talk about the best time to take probiotics, Vitamin D, Vitamin C, Biotin, Zinc? Is it too much to take all together with a meal?” The answer is no. You can take all of that together. The main issue is standing here. So first, I’ll have my two cents. You need to get…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …your Ferritin look there. So, I’d get a blood panel run to look for Anemias ‘cause you can take these magic— magical mira— miracle supplements like Biotin, which every woman under the sun is taking now, and it might not resolve your hair uh— thinning issue. So get the blood work done. Investigate, first of all, and then, in terms of probiotics, we always recommend that you do those on an empty stomach or maybe around bedtime, because then you’re not competing with stomach acid. So, the probiotic can kind of do its job on its own. Vitamin D, do it with a meal ‘cause it’s fat-soluble. Vitamin C, recommended in the morning ‘cause it can help stimulate the adrenals a little bit. Zinc, I don’t think it matters.

Dr. Justin Marchegiani: Yeah. I would just say, anything mineral or amino acid-wise, do it with the food and I’m fine with it. Probiotics, empty stomach, unless, let’s say, acid resistance strain like Omega Support, that can be done with food.

Evan Brand: Yup. Yup. Uh— Let’s go over to Oliver here. Would drinking Water Kefir with mears— meals help or hinder digestion as regular water would?

Dr. Justin Marchegiani: Uhm— I would just say, it probably would help ‘cause a lot of the Kefir uhm— tends to have like a lot of acids in it, like glucuronic acid or a lot of uhm— various acid from the fermentation process. And that may be helpful with the digestion, so I would just say, see how you feel. How do you feel when you have that with the fo— with meals. Do you feel bloated or gassy, or do you feel better. Uhm— So I would give it a try and see how you do. I— I will do my ow— one exception to drinking water with food is uhm— Well, number one, the healthier you are, the more you can do it, right? I would still would do it sometimes, like I ate 30 minutes ago. I’m drinking a little I’m sipping on a little bit of water. I’m not downing it, right? But I always try to drink five to ten minutes before food. But in general, uhm— a good rule of thumb is, if you’re burping a lot and you’re smelling the food, ann your burps right after a meal, you drank too much water. Right?

Evan Brand: Yeah

Dr. Justin Marchegiani: That’s a pretty good rule of thumb. And also, do you feel undigested? But when your digestion is more compromised, you got to be by the book. When your digestion is less compromised, you can have a little bit more uh— latitude in what you do. But as long as you feel good, you’re okay.

Evan Brand: Yup. Let’s keep going here. What’s your time? I know we got— How many minutes more do you have like?

Dr. Justin Marchegiani: We got five more minutes.

Evan Brand: Okay. Uh— Here’s a question from uh— Charlie. Can you just do the H. pylori part of the diagnost— diagnostic solutions test? The GI Map is too expensive. Charlie, I don’t know if you can do it on the GI Map. I know you can with BioHealth. You can do just an H. pylori antigen. However, I would hardly not recommend you do that because if you’re gonna spend money, period, to get any testing done— you know, whether it’s Dr. J or my protocol, our protocols are very importantly based on having a full picture. So imagine like trying to estimate what your— what a puzzle is just by looking. What’s that analogy where you look at the tail of something and you’re like you have no idea there’s an elephant in the room ‘cause all you saw was the tail.

Dr. Justin Marchegiani: Yeah. Yeah. It’s basically you’re walking in around— you’re walking in there blind, or you’re just each person stealing the part…

Evan Brand: Oh, yeah.

Dr. Justin Marchegiani: …of the elephant trying to guess what it is, right? And, there’s also an assumption too. The assumption is, “Oh, I treated the H. pylori— or I treated the other parasites. I only had the H. pylori. Therefore, I only want to look at that.” And a lot of times, you may have other infections that come back on the retest ‘cause these infections were barred in deeper into the gut lining. So you want to rule that out.

Evan Brand: Well, use me as an example.

Dr. Justin Marchegiani: Yeah.

Evan Brand: I— I had Crypto. I had Giardia. We came up with the protocol and guess what? On the retest, the parasites were gone and H. pylori showed up. So then I had to do a second protocol to kill H. pylori ‘cause it was barely in.

Dr. Justin Marchegiani: Exactly. Now, some people like ninety or a hundred percent of their symptoms go away. Okay. Fine. You know, you’re feeling amazing. You only want to test for one thing. Money’s tight, fine. But, if not, I will always retest the whole thing, just to be in the safe side.

Evan Brand: Okay. Okay. Yup. I would agree. If so, how much is it? Uh— Pricing varies. Pricing changes.

Dr. Justin Marchegiani: Yeah. You can go to my site, GI Map test cash is 3.99 and then, we provide the superbill codes so you can always submit it with insurance and you can also use uhm— your HSA of Flex Spending too.

Evan Brand: Yup. Yup. Uh— Let’s see here. Gabe, “Uh— I like to make my 7-year old smoothies, which he enjoys (he does look a bit underweight) Is it okay to add a bit of your guys’ Collagen…

Dr. Justin Marchegiani: Yes.

Evan Brand: …and protein pow— Yeah.

Dr. Justin Marchegiani: Uhmhm— [crosstalk] Of course, without a doubt.

Evan Brand: Super high-quality. Uh— “Iron.” This is a question from Michelle, “Iron-68, Ferritin-51 after a high-dose Vitamin C IV, which resulted in oxalates everywhere. It caused hair loss too. Trying to recover. All those levels suboptimal? I feel oxalates were chelating minerals.”

Dr. Justin Marchegiani: I don’t know. Those le— Those levels are good.

Evan Brand: Yeah. I think so.

Dr. Justin Marchegiani: Again, I like to see Iron saturation in your— in your UIBC and TIBC, but overall, those look good.

Evan Brand: Yep. Uh— Mike, “I got my Viome Test in 23andme Test done. Just wondering which other labs I should run? (many health symptoms)” Mike, you got to get an adrenal test run uh— Justin and I would point you towards the Dutch, which is a urine or do the…

Dr. Justin Marchegiani: Yup.

Evan Brand: …BioHealth #201 CAR…

Dr. Justin Marchegiani: Yep.

Evan Brand: …Adrenal panel. And also, we would recommend you would get the GI Map. The Viome Test sounds sexy and the marketing is great but the read out is terrible and not very clinically usable this time, so we still would highly recommend you get a GI Map in Organic acids uh— test done, which is urine.

Dr. Justin Marchegiani: Yeah. I’m gonna go uhm— I’m gonna go have Steven Berry on my show. Uh— He use the one on the inventors of this test. I think it goes Naveen something. Uugh! I forget his name, but he created the Viome test. I saw him at a conference. He’s like a multi-billionaire Indian dude. Really…

Evan Brand: Yeah.

Dr. Justin Marchegiani: …really smart guy. But I mean, they’re just on his Viome test. They’re just recommending foods to put there like your gut bacteria back in the balance. And it’s like— It’s like sweet potato, Avocado, Romaine lettuce. It’s like really like is that gonna be the key? ‘Cause there’s always people that I’m already seeing. They’re already eating a really good Paleo template where they’re getting a variety of those kinds of foods are ready.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Uhm— I just don’t— I— I’m just really underwhelmed by that intel. [crosstalk] And the biggest issue I see is, you know, you got to get rid of the infections that may be present, that may be driving the Malabsorption. So, I think it can be helpful but I would not put all your stock in it.

Evan Brand: Yep, right. Just a couple more then we’ll wrap up here.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Josh, “Can long-term Ox bile cause problems? I’m having less bloating with eating fat but much more constipation than some nausea.” I’m guessing he means while taking Ox bile.

Dr. Justin Marchegiani: Yeah. So, I want to know. Are you taking Hydrochloric acid and enzymes with it? I want to make sure that’s dialed in. I want to make sure that you actually got to the root cause of your low bile issues. So, were you having a lot of gallbladder issues, or are you having a lot of floaters? If you were and that helped, that’s a good sign. You can always taper off the bile a little bit and see if that helps. But make sure the HCl and enzymes are there, and then also make sure that you really fully address the gut issues ‘cause sometimes parasites like Giardia and stuff can kind of cause bile issues, so can SIBO. So I’d want to make sure all of the root issues are addressed but all the other digestive secretions are also supported as well.

Evan Brand: Yeah, well said. Uh— Digestive supplements are great but there’s a reason you’re having to use those to mitigate symptoms. So there’s probably something under the hood. Uh, Shanice, uh— “Which herbs are best to treat H. pylori?” There’s a ton. We use many different ones.Dr. J’s got a whole line that he uses for H. pylori. I’ve got a whole line that I use for H. pylori. So, it depends because if it’s just H. pylori by itself, which is pretty rare, usually there’s uh— other bacterial overgrowth, we may switch up the herbs a bit. So—

Dr. Justin Marchegiani: Bingo!

Evan Brand: Uh— I want to see. Don’t think we could just give you a list and then, you throw it together and have success. You need to get tested.

Dr. Justin Marchegiani: Yeah. But in general, like Mastika’s gonna be uh— one that’s used for a while. I like Clove. I like Berberines. In my line, it’s like GI Clear 2. It’s my H. pylori killer. But you really want to get treated ‘cause most people very rarely just had H. pylori so you don’t want to fall for that.

Evan Brand: The domestic gum, yeah, that is one thing you could—

Dr. Justin Marchegiani: Yeah.

Evan Brand: …you could throw at it and it could definitely help mitigate it.

Dr. Justin Marchegiani: Yeah. Mastic gum has adaptogenic qualities too so it is a very safe herb too.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Yep. Absolutely.

Evan Brand: Yeah. “There is Candida too,” she says, so yeah. That— That’s very common.

Dr. Justin Marchegiani: Exactly! So you want to combine that. And then Josh writes in, “No floaters but uh— no poor Steatocrit on my GI Map.

Evan Brand: Good.

Dr. Justin Marchegiani: So that’s a good sign. So uh— I don’t know why you’re pushing uhm— bile salts the, if that’s the case, you know, therapeutically. I’d only push bile salts if I saw uh— floaters or if I saw high Steatocrit on my stool. If not, I push more enzymes and Hydrochloric acid because the Hydrochloric acid’s really important because if you have low Hydrochloric acid, that’s gonna be the stimulator to stimulate Cholecystokinin, which is this hormone that’s released in the small intestine  that stimulates the gallbladder to contract. So I’m more concerned about the Hydrochloric acid because that gets the gallbladder moving.

Evan Brand: Yep. I just want to add two more cents to the question…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …form Shanice about the H. pylori. And then, she said that, “Yes. There also is Candida.” Uh— when you lower stomach acid levels, that low stomach acid causes these foods to rot in putrefying the gut…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …which generally does in a Candida Overgrowth. So it’s very common. I’d say, 90+ percent of the time, we see Candida and H. pylori together.

Dr. Justin Marchegiani: Yes! One hundred percent.

Evan Brand: Uh— last question then we got to roll. Uh—

Dr. Justin Marchegiani: Yeah.

Evan Brand: Cha— Charlie says Dr.J have you killed H. pylori with your patients in 30 days using GI Clear 4?

Dr. Justin Marchegiani: Uhm— I would never do it by itself, but if I were to do a minimalist protocol, I would do at least GI Clear 4 and 2, or typically, 1, 2 and 4. One (1), 2, and 4, or if there’s Yeast along with it, we’ll do 1, 2 and 5. So, it just depends on what other stuff is going on, but 2 has to be in there. And if there’s no Candida, I would probably throw a 4 in there with it ‘cause it’s very high in Berberine and Goldenseal.

Evan Brand: And— And just to also add ‘cause I know how you work. Uh— You’re likely gonna be doing some type of adrenal support, potentially, some binders [crosstalk] or detox for it too. So—

Dr. Justin Marchegiani: Bingo.

Evan Brand: Uh— We— We can’t just come in and kill, kill, kill! Uh— We got to support the other body systems or you won’t make it through the protocol.

Dr. Justin Marchegiani: Yeah. I mean, most people, you know, they’re used to like, “Oh! I have chapped toe. It’s antibiotics.” Or, “Oh, hey! I get an STD. Here’s— Here’s antibiotics. Here’s a Ziprac.” Right? So most people are like, they find something. They want to kill it right away. But with these chronic infections, it’s a little bit different of a mindset.

Evan Brand: Yup. Yup. Let’s wrap up if you’re ready.

Dr. Justin Marchegiani: Yeah. And then, hold on. One last thing, “Organic Buckwheat Crisp because of bre—” Uh— So, yeah. Buckwheat is more of a root, so it tends to be okay. But if you’re Gluten-sensitive, definitely cut it out for a month. But that could be something you try to add back in. And then, Ali Mo writes in, “Is DiatomaceA, D.A., okay for humans?” Yeah. D.E.— .D.A. is based— or D.E. is basically uhm— just super, super high in Silica. How it works is basically is it dehydrates the exoskeleton on the bugs, and they basically die.

Evan Brand: Yeah.

Dr. Justin Marchegiani: That’s how it works.

Evan Brand: M— My uh— My— I just saw that coming— come through about the Buckwheat. My comment would be that it is a cross-reactive food. So—

Dr. Justin Marchegiani: Can cross-react.

Evan Brand: Uh— Your body can still think that it’s Gluten and could still trigger an autoimmune issue or something. Or if you ar— already have autoimmunity, you probably need to step away from buckwheat and its— and the other pseudograins.

Dr. Justin Marchegiani: Yeah. At least an AIP Protocol for uh— a month, and then you can add it back in. Don’t make it a staple, but if you want to have it a couple of times a week, uh— I’m okay with it. Just make sure it’s— you know, your issues are under control and you add it back in methodically.

Evan Brand: Yeah. And if your gut is healthy, you might be able to get away with it. If your gut’s not healthy, you may have a flare of some sort. You just have to pay attention.

Dr. Justin Marchegiani: Very cool. Hey, I like that picture of the bird over your right shoulder there.

Evan Brand: Oh, thanks, man. Yeah. I took that picture. Let’s say uh— female cardinal.

Dr. Justin Marchegiani: Whoaf! Beautiful!

Evan Brand: I got a bunch of uh— whenever you come over to my house, I’ve got a bunch of canvasses everywhere of pictures I’ve taken of different birds and stuff over the years.

Dr. Justin Marchegiani: Yeah, and you recommended that bird idea. Bright…

Evan Brand: [crosstalk] Oh! You’ve got birds in?

Dr. Justin Marchegiani: [crosstalk] …a lot of kind of birds.

Evan Brand: Oh, yeah. I was playing actually. I heard a pileated woodpecker, which is the largest woodpecker in North America, the other day, about this tall. I heard him calling so I got out the bird app and I played the song— his song. And then, he flew in to go see who is singing. And, he flew right over my head.

Dr. Justin Marchegiani: Oh, my gosh! That is cool, man. Yeah, the older I get, I kind of get into things like that. Like when I was younger, I was like, “Who cares?” But now, I’m like, “Oh! That’s cool.” [crosstalk] It’s cool watching birds.

Evan Brand: I love watching birds. I love birds, trees. Yeah, I love it all.

Dr. Justin Marchegiani: Awesome, man. Oh, hey! Today was a great chat. Appreciate it. We’ll be back next week, my man.

Evan Brand: Yeah. Tell— Uh— Tell people about the— the links.

Dr. Justin Marchegiani: Oh, yeah. So, uh— click below for the Thyroid Summit, And also, Evan’s got his summit going on right now, [emphasis], to get signed up for Evan’s [crosstalk] Candida summit.

Evan Brand: I got to go check out. Go check out the Candida Summit ‘cause we had a couple people in here talking about gut issues. There’s 30 talks in this Candida Summit. It launches July 9th, so go register. Use Justin’s link. Go register. It’s free. Then, you can choose to buy the talks and support the mission. Uh— It’s gonna be a great— great event. It’s all online. Coming up in what? Two or three weeks? So—

Dr. Justin Marchegiani: Yeah. And we need to get you a link for your— for my— for the summit for me, so then you can get some credit there.

Evan Brand: For sure.

Dr. Justin Marchegiani: Awesome, man. Hey! Great chat with you brother. Everyone, give us a thumbs up. Give us a share. Smash the like button. Subscribe. We appreciate you guys, uhm— tuning in. Have a great day. Bye.

Evan Brand: Bye.



“Hyperinsulinemia and Moles”….0…1.1.64.psy-ab..7.3.1181…0j0i22i30k1.0.grg19B8Fk0Y

Viome a Breakthrough in Gut Microbiome Testing with Naveen Jain Viome Founder Metatranscriptome

Tips for a Healthy Pregnancy – Dr. Justin Podcast #153

Dr. Justin Marchegiani and Evan Brand dive into a discussion about having a healthy pregnancy. Gain some valuable information as they talk about nutrition, diet and lab tests before and during pregnancy.

Learn how different factors such as estrogen dominance, autoimmune  diseases, toxic substances and nutrition issues affect fertility. Find out about In Vitro Fertilization (IVF), understand the reason why some people choose this option of conceiving and discover some of the natural solutions and recommendations to health-related and nutrition issues that hinder people from having a natural and healthy pregnancy.

 Tips For A Healthy Pregnancy

In this episode, we cover:

11:08   Factors affecting fertility 

21:36   Food sensitivities and miscarriages

25:00   In Vitro Fertilization

35:14   Blood sugar in pregnancy

36:08   Thyroid issues in pregnancy



Dr. Justin Marchegiani YouTube channel




Dr. Justin Marchegiani: And we are live here. Dr. J in the house with Evan. Evan, how you doin’ man? How’s your day goin?

Evan Brand: Life is good. How are you doin’?

Dr. Justin Marchegiani: Very good. The first podcast officially as a dad—feels really good and really rewarding. Little bit sleep deprived and my wife is taking the brunt of it, but I’m doing my best to uh— be a supporting about— a very supportive husband providing all the nutrition she needs, cooking all her meals. We got a little fridge right outside the baby’s room put upstairs. And I got—it’s stuffed with bone broth, Kombucha, sparkling mineral water, uh— filtered water electrolyte and hence, she’s got a handful of meals. Paleo meals I already prepared. She’s got some really good healthy snacks. She gets some collagen smoothies and shakes up there, so I got her like stock up some. My goal is to try to feed the baby uh—kinda proxy, right? getting all the nutrition she needs and therefore, she could take it in as easy as possible and then provide the best nutrition for the baby.

Dr. Justin Marchegiani:  Absolutely, man. Well, congratulations. I’m super happy for you. It’s been a— been a long time coming. When you’re waiting for stuff like this, a day feels like a week and a week feels like a year, so—

Dr. Justin Marchegiani: Yeah. And the baby’s name is Aiden Raymond Marchegiani. And Aiden means little fire, so. The boy— we’re really, really stoked to have him and we’re just trying to provide him as much nutrition as possible. He was in the NICU for a day and a quarter. Maybe two days, let’s just say. He had a slight collapsed lung birth. He was doing great and then as soon as the cord was cut, which we’re trying to delay clamping as much as possible—but it’s a C-section, right, so like you know while the baby’s got the cord attached, you know, mom’s open bleeding, right, so with the weighing out the benefits—

Evan Brand: Ahh..

Dr. Justin Marchegiani: Normally we’d wait ‘til that cord with pulse turn til it’s white. You know, go white and such, which maybe 10 minutes or so. We didn’t quite have that luxury, so, you know, we framed it out with the OB. Had a time we delayed as long as we could, and as soon as that cord was cut, he crashed. His O2 suction levels dropped. They put a  C Pap on him. They got his O2 up; they run a chest x-ray and right after there’s a slight collapsed lung. But in a day and a quarter, day and a half—healed.

Evan Brand: Wow!

Dr. Justin Marchegiani: So he was super, super resilient. And we just—you know, we have to contribute the fact that my wife’s nutrition and sleep and all that stuff was just really great during her pregnancy. And that probably attributed to his resilience.

Evan Brand: I’m glad it all worked out.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And you guys are home safe.

Dr. Justin Marchegiani: Yeah. I mean the NICU docs were pretty—I think very shocked. They were telling me if we could be in there up to three weeks. And she was like, two days.

Evan Brand: Wow!

Dr. Justin Marchegiani: So it was pretty great to see that.

Evan Brand: So the people are probably like, “what happened?” you know, “You guys talk so much about holistic self why a C-section? Do you care to elaborate some of that?”

Dr. Justin Marchegiani: Oh, yeah. Let’s talk about that. I’ve talked about it in other podcast, in other episode, but people may not listen everything, so will kinda make it so it all connects. My wife had a large fibroid removed about a year and a half ago— about the size of a baby’s head. There’s a very big fibroid. She’d taken birth control pills for 15 years, you know, in her late teens into her early 30s.

Evan Brand: You think that might have caused it?

Dr. Justin Marchegiani: I think that’s a contributing factor if you listen to my podcast with Dr. Horwitz, he’s a fibroid expert and he says that you know, estrogen dominant states can definitely drive fibroid growth. There’s not a lot of research on it. I don’t think there’s gonna – there’s gonna be a lot of motivation to do a lot of research on it, but we know estrogen dominance can cause things like fibroids to happen. And then the question is, what can drive estrogen dominance, right? We know stress drives it. we know, you know, estrogens drive it. We know phyto estrogens, right? We know low progesterone states can drive it. We also know birth control pills can drive estrogen dominance, right? So it’s the milieu, the hormonal milieu. And also, just not getting pregnant. Getting pregnant later in life can also drive it because when you get pregnant, you’re really driving a progesterone dominance state. And then breast feeding, right, you’re keeping progesterone levels really high, too. So my wife got pregnant at age 40 and we decided that to get the fibroid removed just because one, it was so big and number two, we just have a smaller fertility window.

Evan Brand: Yeah.

Dr. Justin Marchegiani: The fertility window’s a lot smaller and we can get that fibroid removed we can get pregnant like that. And again, her hormones are that of a young 30 year old woman. So we had done work with her, helping her hormones, PMS, all that was really good. Her hormones were that of someone 10 years younger. She just had this big fibroid which acted like an IUD, right?

Evan Brand: Wow!

Dr. Justin Marchegiani: Intra Uterine Device which basically just— imagine this fibroid there just sucking up blood flow so that when an egg comes in, it’s not gonna be able to stick because there’s not enough blood flow to sustain it, right? So soon as that fiber was removed, we get pregnant. Two weeks after it was removed. And the doctor was like, “Okay, you know, you can try.” But he’s kinda not expecting much. But as soon as we tried the first time, we got pregnant. And yeah, we actually uhm— lost that baby but it was a blighted ovum. So none—is really a baby. There was no like heartbeat or anything, which is the sack but we lost it which was tough, but you know, we just kind of attribute it to the fact that she’s went to a major surgery, right? She was under general anesthesia. She’s on pain meds. Probably wasn’t the best time to try to get pregnant. We only did because the doctor said it would be okay. But as soon as you know, that— the hCG dropped and she got her period back, we tried again and then we got pregnant. So uh—that’s the baby we had now, Aiden, so, we’re very stoked. So the reason why we had to do the C-section, coming back, is because the incision was along the posterior section of the uterus which had kinda weaken the uterus which had her increase her chance of a uterine rupture. And because of that increased chance of a uterine rupture—the uterus rupture is you know baby and mom can die. So they had to pull the baby out four weeks sooner week 36 just to ensure that uterus wouldn’t rupture. It’s only a 1% chance but you know we spoke to midwives and OBs and no one recommended— no one would even do a natural birth.

Evan Brand: Oh, wow!

Dr. Justin Marchegiani: Just because of the liability was so high. But I was able to watch the whole entire surgery. And I literally—you know, they her uterus in her hand and I was like, “Hey, can you look at the backside?” This is after the baby was born. They turn at the backside. “How’s the posterior incision? Let’s look at it.” And she was like lookin’ at it, “I can’t even see an incision.” So the uterus healed up so strong and what I attribute that to is I have my wife on the Tru Collagen every day. She was doing about 30 g of collagen every single day. And I know that those collagen, amino acids had to— made a huge difference in helping to provide extra building blocks to the— to her uterus to heal up. But they couldn’t even see an incision to the back.

Evan Brand: Well, also, you mentioned she had no stretch marks, too, which is a pretty remarkable testimonial.

Dr. Justin Marchegiani: Yeah. She had no stretch marks. Again, the baby came four weeks early so some women will say, “the stretchmark comes that last 2 to 4 weeks” But again, in my opinion a lot of people are getting a lot of their protein from muscle meats which is, you know, still good. But, again, collagen is gonna be connective tissue protein. That’s ligaments, tendons, cartilage, hide skin, right? So you’re getting a lot more building blocks that are gonna help the connective tissue and the skin. And a lot of what’s happening with the stretching of the skin and the fascia and all that tissue is gonna be connective tissue-based. So I think that providing one, lots of healthy fats and two, providing all the extra collagen peptides really help number one, her uterus heal, number two help the skin heal and number three, I also think it will help uhm—the breast. A lot of women, their breast tissue kinda gets flattened and kind of, you know, really just kind of uhm—just flattened a bit. Maybe the breast will start sagging and hanging and such after a long time of breastfeeding. I think the connective tissue support will also help the integrity of the breast tissue as well.

Evan Brand: Ahh.. That’s interesting.t I believe that there’s probably gonna be benefits. I mean, I wonder if we compared standard American women compared to hunter-gatherer women. Like what was the difference in their skin quality probably huge difference coz the hunter gatherers eating the marrow and the collagen and the bones and doing more stuff than typical women do.

Dr. Justin Marchegiani: Yeah. I mean if you look at some of the anthropomorphic kind of research, like they talk about literally taking the organs and like harvesting them. And the organs would be like literally given to the women that were fertile, that were trying to get pregnant because they knew the organs were incredibly, you know, nutrient dense. And there’s also research to these women like would literally give birth uhm— that— that day and be back out on the field later on that day or that next day working.

Evan Brand: Wow!

Dr. Justin Marchegiani:  It’s crazy, right? I mean they probably had a lot less stress in her life, too, right?

Evan Brand: True.

Dr. Justin Marchegiani: Very, very little stress, but still uhm— it’s amazing what the body is capable of doing. So that is kinda like my back stories that just kinda summarizing uh—history of fibroid and there are natural ways to reduce fibroids and I’ve seen them reduced and it help with those kind of situation in the past. We just—we’re dealing with the time window, right? And if a woman’s like in her 20s or early 30s and has a few years, hey, that may be a good thing to try, but in my opinion, uhm— you know, if you’re up against a pregnancy window, getting it surgically removed is good. But if you listen to my interview Dr. Horwitz he said women that he’s removed the same fibroid three times. So what does that tell you? That just because you remove a fibroid, that does not fix the underlying issue of why that fibroid is growing anyway, right?

Evan Brand: That makes sense. So the birth control, for example, could’ve been one thing. There gotta be an insulin components, my guess.

Dr. Justin Marchegiani: It’s probably an insulin component, too, for sure. There’s probably toxicity component too, right? Coz a lot of toxins are estrogenic compound.

Evan Brand: Yup. Right.

Dr. Justin Marchegiani: So there’s some of that. So we’re trying to do our best to support all that and again one, of the protocols will be doing is using some systemic-based enzymes or peptidase etc. to really help. She has one tiny fibroid still there. It’s in around the fallopian tube. The fallopian tubes is so patent. So it’s still open and I literally was like, you know, you’re yellin’ at the OB, “Hey, can you check out her left fallopian tube. How does it look?” She’s like, “Oh, that little, tiny fibroid—like you know, half of the fingernail, still there in the fallopian tube, but it’s not growing. So, you know, our goal is we’re gonna try to work on dissolving that one naturally uhm—you know, over the next few years.

Evan Brand: That’s amazing. So when it had to be cut out, you can just go in there with tweezers and yank it off or something, it’s not that easy.

Dr. Justin Marchegiani: Yeah. The fallopian tube’s kinda—you could, but you’d compromise the fallopian tube.

Evan Brand: Oh, wow!

Dr. Justin Marchegiani: And the fallopian tube is still open, so it doesn’t make sense. She had one little, tiny fibroid actually uhm— there at the incision site, where they cut the uterus to deliver the baby. So actually, she got two for one. They removed that little baby fibroid at the incision.

Evan Brand: Wow! Did you see that? What did it look like?

Dr. Justin Marchegiani: I mean, it’s just—I got pictures of it, but uh—yeah, it’s just like a little, like mini golf ball.

Evan Brand: Really? And what—what’s the texture of it?

Dr. Justin Marchegiani:  It’s kinda like uh—fibrous.

Evan Brand: Oh, that makes sense.

Dr. Justin Marchegiani: So like uhm—I’m trying to think of a consistency— it’s just— it’s dense but it’s a slight bit of squishiness to it, but it’s still—

Evan Brand: Yeah. That makes sense. That’s amazing.

Dr. Justin Marchegiani: Yeah. Almost like a tennis ball-like consistency.

Evan Brand: Yup.

Dr. Justin Marchegiani: But it’s still pretty firm.

Evan Brand: Yup, I understand.

Dr. Justin Marchegiani: So that’s kinda like the back— the back history on myself and my wife but when you’re looking at fertility, right, we look at a couple of things. Number one: How are the hormones, right? How are the hormones? Number two: How—how are the pipes, right? Are the fallopian tubes open? How’s the endometrial lining? Is it—is it okay for something to be able to, you know, implant there. And then number three: is we look at the dad.

Evan Brand: Exactly.

Dr. Justin Marchegiani: How’s the sperm count, motility, morphology. I was actually, really has no problem at that moment—that I was rock solid on all those numbers. So I felt very, very good about that.

Evan Brand: See that’s the problem, you know, You and I worked with so many— so many women. Primarily, men aren’t coming to us for fertility issues, but they have to come on board because it’s part of the equation. And a lot of these women that we speak with, the men, they just have a terrible diet. So we may put the mom or the future mom on AIP, but then the dad is still eating ice cream and pizza. And then they end up at the—in the—what do they call it, the vitro fertilization doctors, who want to spend what? 10-12-15 grand. But they may be unnecessary in most cases if we get the dad straightened out as well.

Dr. Justin Marchegiani:  Exactly. I mean, a lot of times, you know, what’s gonna affect the fertility is number one: having a nutrient poor diet; not having enough high-quality nutrients like zinc and arginine and healthy fats and proteins. And then also uhm— mitochondrial support coz sperm needs mitochondria to move or needs a healthy mitochondrial nutrients to be able to the kind of propel it, so to speak, right? So we have to make sure a lot of the good mitochondrial support there. And then we’re just not putting a bunch of toxins in there, right? Like we’re avoiding the plastics, we’re avoiding the pesticides, the chemicals, the round up, the glyphosate—all these compounds that are not gonna be so good for it.

Evan Brand: Yeah. The endocrine disruptors like you mentioned, like the plastic, so getting men and women off of Tupperware. I guess, by the way, if you haven’t figured out, this topic we’re— we’re talking about fertility today. Since Justin and I are both dads and our wives are both moms. This is a good topic for us. We’ve had first-hand experience on. So this is not theory and there’s also some science behind what we talk about. But that the endocrine disruptors that can cause things like the PCOS, which a lot of women that come to us, they’ve had PCOS. Previously are there—they’re trying to get help in reversing PCOS. That can be a huge, huge hormonal function disruptor that can affect fertility. So we’ve got to get rid of the the plastics. Plastic straws are a big one because your saliva, you know, my opinion, you’re breaking down that plastic a bit and you’re absorbing some of the— the phthalates in the plastic softeners when you’re chewing and using straws as toothpicks, that’s not a good one. Also, you’ve got flooring, too, like vinyl flooring. So if you’re walking barefoot on a vinyl floor, that’s typically gonna have phthalates in it. You’ve also got issues with the men as well. They’re just as susceptible to exposure to phthalates and other type of toxins. You mentioned pesticide so definitely going organic. If someone’s a mom, a lot of times women they’ve already had her first kid but they wanna have another kid and they are coming to you or I would see that a lot, too. You know,  I tell a lot of moms have got to stay away from a lot of the playgrounds because they use the rubber tires, the recycled tire playgrounds and those are very, very toxic and I’ve measured moms with the GPL tox chemical profile test from Great Plains and they’ve got the rubber toxins off the chart. And I say, “where are you playing?” And they say, “Oh, we go to one of those playgrounds with the recycled rubber tires” And that stuff is just super toxic or let’s say the mom has a kid who started sports, my God, I work with the woman last week who lived in London, and her child he was off the charts himself. So we haven’t tested mom yet, but we tested the kid coz we’re working more with him than her. And the kid was off the charts with 2,4-D— the agent orange chemical that they used in Vietnam. And I said you know, “Where are you guys playing?” And she goes, “Oh, he plays soccer” I said, “Is that football or soccer?” Coz she call it football. So is that football football or is that soccer?

Dr. Justin Marchegiani: Right.

Evan Brand: And so she’s on the field with this kid multiple times a week. In the field, just sprayed, I’m sure, pounds and pounds and pounds of glyphosate and 2,4-D

Dr. Justin Marchegiani: Yeah. I mean I kinda go back and forth, what’s worse, right, being on the artificial turf stuff or being on the grass? Coz you know the grass has given a whole bunch of chemicals, right?

Evan Brand: I Know.

Dr. Justin Marchegiani: So I—for me, and again, how many research? I’m just—a lot of what I do is common sense and based clinically.

Evan Brand: Yup.

Dr. Justin Marchegiani: Coz I probably rather be on the synthetic turf grass because at least you know it’s not being spray with round up.

Evan Brand: Yeah.

Dr. Justin Marchegiani: ..and pesticides all the time.

Evan Brand: I know. I don’t think they spray anything. One other thing about men, you know, when we’re talking about fertility for men, sperm quality. Heavy metals is huge. Mercola had an article about infertility where he was talking about how men are much more susceptible to issues in their fertility with heavy metals than eggs. So the eggs in the female were less affected by heavy metals and other pollutants than men. So that’s pretty interesting. A lot of guys have metal amalgams in their mouth. So we may— I’ve not personally had to go that far with any of my clients but what would you say? Would you say that could be a possible step? Does the man have to— may have to get a amalgam removal is done?

Dr. Justin Marchegiani: Yeah. I mean I think that’s definitely an option. If we’re seeing elevations in heavy metals—anytime I have someone a male with fertility issues, once the diet’s good and we’ve eliminated toxin exposure, then it’s about what nutrients can we add to enhance sperm quality, and then what things can we add to enhance detoxification.

Evan Brand: Right.

Dr. Justin Marchegiani: Maybe phase I or phase II detoxifying nutrients and maybe things to help push the heavy metal binding. So again, I’d wanna look at all that and if we’re seeing high levels of metals, and we know Mercury’s there, and then we’re seeing the person also the history of fillings— heavy metal fillings and then we wanna get that removed.

Evan Brand: Tapwater. Gotta have a good clean water that the person is drinking. We talked about the— the phthalates. So the xeno estrogens—coz that’s gonna affect the males.

Dr. Justin Marchegiani: Yeah. So if the male is more like a woman, you know, he’s got a lot of excess breast tissue and things like that, and we can assume, “okay you’ve probably got some estrogen problems” So just like you mentioned about females. Same thing for men, it could be an estrogen dominance problem.

Dr. Justin Marchegiani: Yeah. And we can look at that from two perspectives. I did a video called the “Hormone Switch” I recommend everyone to take a look at that. Will try to put links below for the “Hormone Switch” But when men’s blood sugar’s off, when they start moving into a direction of insulin resistance, they increase this enzyme called aromatase, which causes the hormone to switch. It will cause their testosterone to go more towards estrogen. And we see that quite frequently. And again, one of the best thing get one of the best thing you can do is put on more muscle. That will make you more insulin sensitive. A high intensity training type of regimen where you’re doing like a long, slow movement to get muscle activation or to get HGH, where you’re doing interval stuff. That’s gonna help significantly get the blood sugar under control and get the inflammation under control. A lot of these stuff, we always go back to the foundation coz we know there are people that are new that are listening every day so we don’t want to assume that the foundation is there. And all of our patients that listen, you know, listeners they get that. We kinda feel like a broken recored, but just to emphasize for new listeners.

Evan Brand: Yeah. We wanna get rid of dairy. I mean that’s gonna be huge on the diet piece. We’re talking about or talk about stabilizing blood sugar; we’re getting refined carbs out; were getting sugars out, but dairy, too. You know, depending on what piece of research you look at, that could be 60 to 70% of the estrogens consumed is coming from dairy, especially these cows that are not organic. So for us, the dairy is always gonna come out. Organic veggies are always good come in, organic fats, your nuts, your seeds, your vegetables. Unless the woman has some type of like Hashimoto’s problem which that can complicate things with fertility. Sometimes if there’s a thyroid issue, but let’s just assume that the person can do a good quality butter, can do some nuts, some seeds, maybe a little game meat even. That’d be cool. If we could get the mom eating some—some deer, or some type of game organ meats, or sardines.

Dr. Justin Marchegiani: Yeah.

Evan Brand:..or other home-cooked, home-sourced wild turkey, which we have ton of turkeys here. Those are awesome, too. Unfortunately, it doesn’t seem like local fish is an option here in Kentucky. I was reading the report by the Kentucky Department of Fish and Wildlife. They said that most of the fish are toxic here, unfortunately. With the— with high levels of mercury. So they set for people wanting to get pregnant or pregnant people should avoid the fish, which kinda sucks.

Dr. Justin Marchegiani: Yeah. Actually when it comes to the fish component, uhm—I have an article that I give my patients but really, it comes down to number one: trying to get the wild—you know, the wild Alaskan or like some kind of flash frozen, kinda wild fish, I think is great, is ideal. But it’s looking at the selenium to mercury ratio. Because fish are going to have a little bit mercury. The question is, “Is there enough selenium to combat it?” Because the selenium is the natural chelator of mercury. So just try to choose high selenium to mercury ratio fish. So skip Jack tuna. It’s gonna be the best type of fish off the bat uh—cod, haddock, sole, halibut. Those things are good. I have a good article in my member’s area for my patients. But if you just google like “high selenium to mercury ratio fish” you’ll get a nice list there.

Evan Brand: Uh—cool. I love cod, haddock. Those are awesome. I had something pulled up. I was trying to see I may have lost it, but just mentioning the link between food sensitivities and also miscarriages. Basically what happened is the link between having some type of allergenic reaction, you’ve got the cytokines that are basically suppressing the killer cells.

Dr. Justin Marchegiani: Yup.

Evan Brand: But when the immune system is off, the body can accidentally attack the egg. So basically, long story short, it sounds like just searching, investigating and finding out for food intolerances, which we’re gonna push most people into kind of a Paleo template as the starting place. Probably no grains, but at least no gluten, no dairy as a starting place. Will probably gonna rule a lot of those food intolerances out within the first month.

Dr. Justin Marchegiani: Yeah. Even push to autoimmune shtick as well. I know you kinda talk about a deer. That’s good when you’re doing autoimmune shtick, but I think adding at least back in the ghee and definitely the butter, as long as you can tolerate it, as long as like, there my patients are following the reintroduction protocol, which is adding the food back in over a three-day period. Gently increasing the amount as long as no negative reactions that’s fine coz you know, butter butyric acid’s a 1:6 uhm— carbon fatty acids. So it’s a medium chain triglycerides, so to speak, right? It’s very short chain length. It’s four carbons or six carbons, but it’s a really good fat; it’s a lot of nutrition, a lot of vitamin K which is really, really good for fertility uhm— so that’s uh—excellent fat as long as you can tolerate it, I think that’s great.

Evan Brand: And other bad things, too, like alcohol.

Dr. Justin Marchegiani:  Of course. Like alcohol number one: it’s a toxin. Again, in moderation maybe okay but number two: it gets metabolized to sugar. So if you have a little bit insulin resistance or blood sugar stuff, that can be a stressor. Again there’s ways to hack it by just using higher-quality alcohol and by timing it with protein and a little bit of fat uh—with your meals. It can slow down some of the absorption but you know, for a time period, if you have health issues, cutting it out for a month or two maybe a good idea to start with. And then choosing some of the drier, you know, white wines or drier champagne or Presecco or doing a really clean tequila or really clean vodka. Again, my Dr. J Moscow mules is one of my go-to’s  use with uh—Tito’s vodka and the ginger Kombucha and some lime. Or I just do a really good like Sean Don or like a really good brewed Presecco, very dry. I like the bubbles. Bubbles are uhm—you know the uh— the seltzer or like the CO2 carbonation. The bubbles are actually—there is actually research studies where they increase alcohol absorption with the bubbles. I was reading one study. I was like, “Damn, I love  to be in the study.” Like— you know, 15 years ago when I was in college, they were like, “ Yeah. We had a group of college kids and we gave one group alcohol and one group alcohol with you know carbonation and soda water.” I’m like, “that’s a great study for college.” Right? I know like, yeah, the group that got the carbonation with their alcohol uhm—you know, felt the effects, felt the intoxication effects or the buzz, you know, the so-called buzz effects sooner. So there’s some research with the carbonation in there helping to absorb the alcohol. So what does that mean, right? It means you’re a cheaper date.

Evan Brand: Yup.

Dr. Justin Marchegiani: You— less of it to get that same buzz, which means less toxicity on the liver. So that’s why like add the bubbles in there, that’s better. And you get that with my Dr. J Moscow Mule. Uh—you can do it as well with my Norcal margarita and we just you know, do a little bit of soda water in there when you can also do a really dry Sean Don or brewed Prosecco kinda drink there.

Evan Brand: Perfect. Let’s talk about IVF just for a minute. A lot of people and you know, the in vitro fertilization is like the first step if they are struggling. Diet, lifestyle, stopping smoking, which is insane. My wife had some friends that she’s not friends with them anymore because they’re just there were not good people overall. So we— we cut them out. They were too toxic in many ways.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Emotionally and physically, smoking cigarettes around her when she was pregnant, all sorts of crazy stuff. So we got rid of them.

Dr. Justin Marchegiani: It’s hard for someone to truly be emotionally balanced and healthy if they’re not physically healthy because the mind-body connection is just— it’s so strong, right?

Evan Brand: I know. Uhm—so anyway— but these people that used to be her friends.

Dr. Justin Marchegiani: Uh-hmm.

Evan Brand: The guy, the dad, they were struggling with years. I think they were in their early 30s. They were struggling for years. They still do not have a child to this day. The guy was drinking beer almost every weekend, daily smoking of cigarettes, Mountain Dew’s. But yet they went to an in vitro fertilization doc and they were gonna spend 10 or 15,000 for the therapy.

Dr. Justin Marchegiani: Yeah.

Evan Brand: It’s just insane. You’re not addressing the root cause.

Dr. Justin Marchegiani: No, you’re not. I mean, typically the first, you know, thing they’re going to do is they’re gonna do some kind of Clomid or FSH stimulating drug. The core goal of that is to increase the eggs, increasing amount of eggs, right? So they’ll do like Clomiphene Citrate or some kinda Clomid and then depending on sperm quality. If the sperm count is low, they may do IUI which is like intrauterine insemination kinda fancy turkey baster.

Evan Brand: Yeah.

Dr. Justin Marchegiani: The sperm up and they may wash it and stuff and pick the best ones and then they’ll inject it right into the uterus. So then there’s no journey of these guys have to— the sperm cells have to make to get up there, right? Coz if they’re a little bit more mitochondrial depleted, or they don’t have good mor—motility, like they’re not moving in the right direction or their shapes not good. They may not be able to make the journey. So the whole idea is to use that uhm—artificial turkey baster. You can get it right there, so their journey is shorter, right? You’re cutting their journey down by 80% and then they’re stimulating the heck out of the eggs. That’s the first step. And the next step is full IVF which is they’re basically giving you drugs like Lupron to shut down your HP AG access, you know, your hypothalamus pituitary axis, And they’re gonna give drugs to stimulate FSH. Uh—they’re gonna give drugs to then manipulate ovulation. And then they’ll probably give some kind of uh—progesterone afterwards to help hold the implantation of the egg. That’s pretty much the cookbook. There are new medication that comes in—Gonal-F, Follistim, Lupron. All these different drugs may be used uhm—but the goal is kinda the same— stimulate, you know, egg production, enhance ovulation, help hold onto uhm— progesterone levels so the eggs stick better.

Evan Brand: Well, I remember seeing a picture. I think it’s a picture of my wife that showed me where this couple had had hundreds of vials— like an entire couch or an entire floor full of vials that were daily injections, I believe, for that whole process. Which this is one: it’s expensive; two: that just doesn’t sound very fun; and three: in a lot of cases, I don’t have any numbers. I’m not gonna make up a number on the spot, but in so many cases, if you just address diet, lifestyle infections, thyroid health, adrenal health, you’re doing the fatty acids like you talked about, the collagens, your zincs and selenium’s, and your natural folate’s, and your vitamin C, and your omega-3’s, it’s like that’s a prescription that’s gonna have far higher success rate and it’s gonna be virtually free because you have to eat to survive. So you’re going to be eating all these good things, anyway.

Dr. Justin Marchegiani: Totally. And we do things like chase tree and tribulus to modulate LH and FSH. So like that will modulate FSH; the tribulus will modulate LH with chase tree. And these are things that help talk—help the brain talk to the end gonads, you know and create stimulate the follicle or help the progesterone, right? So will do that with some herbs. We can always c_  augmentation protocol where we put estrogen—I’m sorry—progesterones in there, right? at certain times of the cycle, day 15-27. We can even add in some uterine supporting herbs like maca, m__, dong quia, alpha alpha, raspberry leaf extract. These are great uterine tonic herbs that really help the blood flow get to the uterus which is good because that uterus— these adequate blood flow to help support that egg when it sticks. So I tell patients think of progesterone as a sticky glue that helps the egg hold, but we need good uterine flow. That’s why my wife and I had a hard time getting pregnant at first because we have this fibroid that was sucking a lot of the angiogenesis out, right, the angiogenesis’ blood flow. So it’s creating a lot of blood flow to the fibroid and not to whatever else was gonna stick there i.e. the egg.

Evan Brand: So did you all have to do herbs? Or did you do herbs or just the diet lifestyle is all you needed?

Dr. Justin Marchegiani: Uh—we had herbs going in the background the whole time.

Evan Brand: Okay.

Dr. Justin Marchegiani: Yeah. We had that the whole time there and uhm— a little bit of progesterone going as well. And again, we just— I measured it, like I want 15 or higher, 20 is ideal. So Iike after she got pregnant, we measured progesterone. We make sure it was adequate. And it was, so we pulled off it.

Evan Brand: And what were you doing? Like drops or—

Dr. Justin Marchegiani: Progesterone drops. Yup. Exactly. So, like typically like a 100 mg is a good starting point once you get pregnant. And again, we just monitor it and it just kept on rocking. And again, if the ACG is high enough, typically the progesterone will be high enough because the hCG is uhm—gonna be produced by you know the follicle and also the placenta will kick in and produce it as well. And that hCG will then jack up the progesterone, too.

Evan Brand: Oh, that’s cool. all that’s cool okay you didn’t you didn’t have to continue, you’re saying?

Dr. Justin Marchegiani: Correct. You know, we didn’t have to. But some women who have lower progesterone, they may have to keep that progesterone going for the first trimester.

Evan Brand: Now is that something you have to get via prescription or are there over-the-counter natural ones you can get?

Dr. Justin Marchegiani: It depends. I mean, I typically give my sublingual one until I can get the fertility OB to write one, just more from a legal standpoint. I rather have the OB write about identical prescription just so, you know, if they’re working with that person that we know it’s covered. But the protocol is gonna be the same and typically will do like an intervaginal uhm— progesterone just so we know it’s getting right to the tissue. It’s—it’s— it’s being released closest to the tissues. So will do that. If we have an option, some OBs that they won’t do it uhm— just because they’re not looking at the progesterone or because a woman doesn’t have a—a history of miscarriage. They’re not gonna even look at it. But I mean, do you really wanna go through a miscarriage then know your at risk to then wait to the next time to do it?

Evan Brand: No joke. Right.

Dr. Justin Marchegiani: Yeah. I rather be monitoring it. And you know, if it’s below 15 or you know, I’m gonna be supplementing with some progesterone to make sure their support there. You can’t go wrong with it. Just make sure you’re using the good-quality progesterone. And again, we’re giving a lot of clinical advice here. And there maybe a lot of people that are just lay people listening. I don’t recommend doing this by yourself if you really want to work with the provider that’s done this a lot, so uhm— you know what’s going on and you wanna have everything looked at. So you want to make sure that we’re supporting the adrenals. Typically when someone’s pregnant, the only thing I’ll keep them on are nutrition, nutrients, whether it’s vitamins, minerals, amino. I’ll typically keep them on probiotics, I’ll keep them on digestive support, HCL enzymes and the only hormone I’ll typically keep them on, when they are pregnant, if it’s necessary “necessary” is the progesterone.

Evan Brand: Yup. Well said. Well that’s the thing. We love talking about adaptogens so much but nobody’s gonna do the research on rhodiola or these other herbs and how they could impact the fetus. So we just, you know, we love those things but we just can’t safely recommend them because we just don’t know.

Dr. Justin Marchegiani:  It’s probably safe, but again, like, think about it, who’s gonna sign up for that study?

Evan Brand: I know.

Dr. Justin Marchegiani: Right. Whose gonna sign up? “Hey, by the way, congrats! You’re pregnant. Hey we’d love to have you sign up for this study where we test these adaptogenic herbs on health and viability”  “Uh—no, I’m good.

Evan Brand: Right. So I mean—some of it we can draw from—from ancient peoples what they’ve used. Like you mentioned the chase tree which has been used in extreme long time. So a lot of it, we’ve probably already lost due to just modern life. We’ve lost touch with our hunter-gatherers, what herbs and plants and trees and stuff that they use during pregnancy, unfortunately. But like you said, diet lifestyle, foundations, HCL, enzymes, probiotics, fish oils, vitamin D. Did you hit— did you mention that one?

Dr. Justin Marchegiani: We did not. But vitamin D is definitely important. We have to have to look at potentially even give my baby a little bit extra. I was speaking to one of the in the neonatal uhm— docs there and he was telling me you know, you may want to give your child an additional above and beyond what’s in the breast milk 400IU sublingually uhm— for the baby. So we’re looking at getting some extra bit of that, but, you know, we’re gonna weigh it out. If we can get the kid out there at 8 AM in the morning 15 minutes out in the sun at 8 AM that may be enough, right?  We don’t even need the drops.

Evan Brand: Yeah. What the—lady we spoke with said. She said as long as my wife was getting 6 to 8000 units that which I think this is just probably her making up numbers on the spot but she said that if my wife were supplementing with 68,000 units daily that the baby would probably end up getting at least 500 to 1000 units from that that would pass through.

Dr. Justin Marchegiani: I think that, too. I asked that and they were like, well you should still give it. But it’s probably like a CYA comment.

Evan Brand: Exactly.

Dr. Justin Marchegiani: You don’t know exactly, but I think if she’s getting 6 to 10,000 the day, I think you’re gonna get 5% transfer to the—the baby in the breast milk.

Evan Brand: I guarantee it.

Dr. Justin Marchegiani: I think it’s probably good. So we’re probably gonna make sure she just getting 10,000 a day with the K2 and just get the kid out in the sun a couple times a week in those early morning hours and you know, just enough to give him a little sun kiss. Nothing else.

Evan Brand: Yup. Do you wanna talk about lab test for a couple minutes and just talk about what we would recommend someone get if before they even think about conceiving. You know, we kinda talk about pregnancy and birth and delivery and all that, but really, it begins far before that. So you and I kind of talk a bit like a five or six trimester is really what pregnancy is coz you gotta do the preparation then the postnatal care is important, too. So vitamin D—we hit on that. As a blood panel, insulin or blood sugar if you knew you, had a history, you could get the stuff done. Uh—fasting insulin.

Dr. Justin Marchegiani: The fasting insulin’s great. We want less than seven, ideally, less than five. We may even want to just do some functional glucose tolerance testing, i.e. just testing your blood sugar with a blood sugar meter. Fasting one hour, two hour, three hours after a meal. Choose a couple of different meals a couple times a week, breakfast, lunch and dinner. Some people we hire in the morning coz of the somogyi effect which is totally cortisol driven. So you’ve gotta keep that in mind.

Evan Brand: Yup.

Dr. Justin Marchegiani: And uhm–  I would say, we’re gonna do an adrenal test, for sure. And we may just do a female hormone test around day 20. We’re looking at estrogens and progesterones and such and testosterone, but if there’s a more of a fertility history there, we may run was called the “month-long test” or on the 209 panel from Bio health which is a month-long panel. Will look at progesterone level starting at day 2 every other day in the cycle.

Evan Brand: Thyroid markers. I’m gonna look for antibodies, your TPO, your TG antibodies..

Dr. Justin Marchegiani: Yeah.

Evan Brand: To see if there’s autoimmune going on.

Dr. Justin Marchegiani: Yeah. If there’s some history going on, or symptoms, will definitely do it, but you know, TSH, T4,T3 antibodies, reverse T3’s is great. And you know, one of the things that I give my wife during pregnancy is a couple hundred extra micrograms of iodine a day. There’s some good research about helping the babies IQ. So we did a little bit of that.

Evan Brand: You can have a genius baby now.

Dr. Justin Marchegiani:  Now the goal is to give the kid all of the all the resources it possibly can, right? That’s the goal of you know, being a great mom and great dad is giving your kid as much potential as possible. And a lot of that’s gonna be uhm— healthy pregnancy, right? Healthy nutrition, healthy prenatal nutrition.

So healthy fats, healthy protein, healthy carbs, nutrient density has to be high, inflammation has to be low and uhm— making sure there’s enough calories and good macros. And we’re going a little bit higher on the carbs right now. But this is true when you eat for two.

Evan Brand: A 100% man. Tell me, my wife, she— she ate way more than me and she still—she actually weighs now than she did before she got pregnant which is interesting. I mean—

Dr. Justin Marchegiani: It’s a great benefit in breast feeding.

Evan Brand: It’s definitely depleting, though. It can be depleting, so we’re doing our best to keep her— to keep her full and—and satiated.

Dr. Justin Marchegiani: Yeah. We also did placenta encapsulation as well.

Evan Brand: Oh, sweet man. Yup. Cool.

Dr. Justin Marchegiani: I actually have pictures of a placenta. It’s pretty cool.

Evan Brand: I planted my wife’s with a tree.

Dr. Justin Marchegiani: Really? Wow!

Evan Brand: A little tree sprout, a little maple tree sprout at our old house. I had the placenta coz we’re going to do encapsulation. We had a doula that’s gonna do it for us, so we decided—she felt so good postnatally that she didn’t need it. And—and so I had the placenta in the freezer, took it out so I could actually mold at first, you know, mold it a little bit and dug uh— dug a giant hole, buried it couple feet under with the— with the little maple sapling right there. So there should be a tree there one day.

Dr. Justin Marchegiani: Wow! That’s amazing. So we had it encapsulated, so she’s doing three capsules 3 to 4 times a day. And then we have uhm—we actually had a  tincture made, too, which is pretty cool.

Evan Brand: A placenta tincture?

Dr. Justin Marchegiani:  Yeah. And we’re gonna save that for menopause for her.

Evan Brand: Really?

Dr. Justin Marchegiani: When she transition to menopause, we’ll use that tincture.

Evan Brand: That’s a thrift.

Dr. Justin Marchegiani: Yeah. Isn’t that cool?

Evan Brand: I did not know that. So what’s—what’s the idea there? There’s gonna some naturally occurring hormones in the placenta that will help to ease menopausal symptoms?

Dr. Justin Marchegiani:  Exactly.

Evan Brand: Ahh—Okay. We’ve got uhm—we’ve got a couple questions. I think they may not be related to our topic because our topic’s pretty niche today. But do you want to look at these questions here?

Dr. Justin Marchegiani: Yeah. We try to grab the ones that are most relevant for sure.

Evan Brand: Okay. There was a person named, Chris here, that said he was diagnosed with Hashimoto’s and is displaying signs of hypoglycemia with perfect blood sugar, what could it be? That’s gonna be a good question. Do you get that question?

Dr. Justin Marchegiani: Yeah. So his blood sugar may look good but why does it look good, right? The question is— are the adrenals coming to the rescue to make that

Evan Brand: Uh-hmm.

Dr. Justin Marchegiani: Coz if the adrenals are coming to the rescue and lifting that blood sugar up, there’s gonna be a lot of cortisol and adrenaline in the background which are gonna create a lot of anxiety, and mood issues, and irritability, and a lot of things where your blood sugar may look good, but the question is, what’s lifting that blood sugar up? Ideally, we want healthy blood sugar by diet, meal timing, nutritional density so the blood sugar is lifted up naturally not relying on the adrenals to keep it lifted.

Evan Brand: Yeah. With the adrenals are kind of the backup generators of the adrenals are getting involved with your blood sugar regulation, that’s not good. That means something else is off elsewhere, but if the diagnosis of Hashimoto’s is there, too, could we say that if—if there signs of hypoglycemia maybe it’s not hypoglycemia, maybe it’s thyroid as well because I mean the thyroid can make you feel like your fatigued and lethargy and then all of a sudden, you’re over stimulated.

Dr. Justin Marchegiani: Totally. If you have hyp—If you have Hashimoto’s there’s probably potentially some T4 to T3 conversion issues.

Evan Brand: Yeah.

Dr. Justin Marchegiani: And there’s probably some adrenal issues so all that stuff needs to be looked at and then again, we don’t even know where that— this person is in the hierarchy of diet and lifestyle.

Evan Brand: Right.

Dr. Justin Marchegiani: So we’re assuming that diet and lifestyles are already even adjusted. 30 g of protein in the first waking, eating— eating healthy proteins, fats and the right amount occurs every 4-5 hours or assuming that that’s already dialed in.

Evan Brand: In preferably on an AIP approach and until the antibodies are very, very minimal in the single digits or less.

Dr. Justin Marchegiani: Yeah. If possible, I typically wait till there’s a there’s plateauing of uh symptoms. Some people may not be able to get them all the way low but you know, we at least want to get them under 500 or so. It depends. If we could get  someone under 500, that’s a pretty good reduction.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Again—

Evan Brand: What’s the highest you’ve seen with TPO? I think the highest I’ve seen was like 1600 on a TPO.

Dr. Justin Marchegiani: I’ve seen over 2000. I mean I have patients literally go from over 2000 to under hundred.

Evan Brand: Yup. What’s the timeline? A year?

Dr. Justin Marchegiani:  I’ve seen it happen in six months to a year.

Evan Brand: Yup.

Dr. Justin Marchegiani: Yup. The average person that I work with, we have at least a 50% reduction in antibodies.

Evan Brand: Right. That’s awesome. I love seen that on a piece of paper. When you actually get to validate it, but then their symptoms are better, too. It’s such a double win.

Dr. Justin Marchegiani: Oh and I had so many patients say their endocrinologist just says, “there’s nothing you can do about that”

Evan Brand: No.

Dr. Justin Marchegiani: And it’s like over and over again, and we just continue to prove them wrong and it’s just like, “man!”

Evan Brand: It’s a great feeling.

Dr. Justin Marchegiani: I feel so bad. It’s just like, you know, imagine having someone like, you know, hiring someone to fix your house and all they have is just a hammer. It’s like, “dude, you’re missing the saw and the screwdriver, this and everything” It’s like functional medicine is that we get so many tools at our disposal. We’re not limited to just like that one pharmaceutical tool that’s supposed to be in our toolbox, right?

Evan Brand: Yup. Well the same thing with fertility question. I mean, you and I have  talked to dozens and dozens of men and women who’ve been told that they will never be able to have children, yet we’ve aided, and many, many babies, you know, just being made by helping women get their hormones back on line and fixing the underlying issues, so—

Dr. Justin Marchegiani: That’s it, man. I 100% agree. So, I hope that helps there. Anything else we can grab before__

Evan Brand: Yeah. Let’s see what we have here. That was unrelated questions—

Dr. Justin Marchegiani: Someone was asking about Probio Flora and Sacro Flora. And again, those are some of my probiotic products. Sacro Flora is a high-dose saccharomycin, Probio Flora is a high-dose bifido-lactobacillus uhm—probiotic. We typically do that for at least 60 days after a parasite killing protocol.

Evan Brand: Here’s a good— here’s a good question here from Naomi. She said she’s been diagnosed with blastocystis hominis, which for those listening, that’s a common parasite infection we see. She’s exclusively breast-feeding a six-month-old and the antibiotic metronidazole did not seem to work. “Is it possible to treat while still feeding baby?

Dr. Justin Marchegiani: The only way I would treat it is with probiotics right now. I would not do any herbs. I would choose two probiotics. I would do Saccharomyces and high-dose probiotics that’s the only thing I would do right now to treat it.

Evan Brand: Yup. So, Naomi, when the time comes for you to wean off the baby which if it six months this may be another year or so, we don’t know how long you intend to breast-feed, at that time, reach back out to us. Justin and myself we can help you get rid of the blasto using herbs but, yeah, with these anti-parasitic herbs, we—we just— it’s just not—not a safe. Well it might be safe, but we just don’t know. We don’t know if that’s—

Dr. Justin Marchegiani:  It probably would be safe, but we don’t want a chance and we rather be just conservative, right? Always do no harm. So I feel very comfortable recommending probiotics. There’s been studies done on kiddos, actually, looking at Saccharomyces polarity uh—compared to Flagyl Metronidazole Tri and Blasto, and it’s just as good, if not better.

Evan Brand: Yup. So look it up, Saccharomyces polarity. Check out Justin’s, we both got Saccharomyces polarity products. There’s a lot of good ones out there. Just make sure you get professional grade, so that actually works.

Dr. Justin Marchegiani: Exactly.

Evan Brand: Cool. Yeah, I think that’s it, man. We can wrap it up. Will send people back to your site if you wanna learn more about you or work wit you.  myself,  Check us out. We’ve got hundreds and hundreds of episodes. So if we just hit the surface of one piece of the conversation you like today, then I’m sure we dove deep somewhere else and give us a review. I know you may be watching elsewhere, YouTube, Facebook etc. but iTunes is where it counts. So we need to continue to beat out people like Jillian Michaels who promotes just not sound advice and so we wanna really bring functional medicine to the forefront of humanity and help to save some of the crises that are going on in terms of depression, anxiety, infertility, obesity diabetes, cancer. We want to put a dent in the universe. So give us a review so that we can do that and stay in the top of the charts.

Dr. Justin Marchegiani:  Awesome! And you guys, subscribe right now, my YouTube,; Evan’s YouTube. Uh— click on our YouTube link. We appreciate the subscriptions, care—you know, sharing is caring. We love it. And again, give us feedback. We want feedback about what you guys want to hear because this is all about how we can serve you guys better. So let us know so we can provide more awesome information. And again, what makes us different Evan I different is, we keep it real. You’re gonna walk away from our show and our podcast with actionable item not esoteric BS that’d gonna make sense you up in the ether, right? But what can you actually do. So that’s how we’re different. We’re trying to keep it real and make it actionable for you guys. So we appreciate you listening. And everyone have a great day.

Evan Brand: Take care.



What Causes PMS? Premenstrual Syndrome Holistic Approach

What Causes PMS

By Dr. Justin Marchegiani

Let’s go into a discussion about PMS or Premenstrual Syndrome – the symptoms and hormones involved and why it occurs in some women. Watch the video and see the overview of what’s really happening in a woman’s body to gain an understanding of this issue.


Symptoms of PMS

A lot of women are probably very familiar with it. Whether it be causing headaches, cramping, abnormal blood flow, breast tenderness. You name it, I’ve seen it.

Overview of the cycle

The average female cycle is 28 days. And 14 days is the halfway point. And what you see in the first half of the cycle, you’re going to see a lot of estrogen in that first half of the cycle, from there, it’s going to drop, and come back a little bit in the second half.

The first half, this is the estrogen-based part of it and your second half of the cycle, will be progesterone. What you’re going to see is nice, low-dose of progesterone in the beginning, and its’ going to come right up, and then nice crash at the bottom here. And you’re going to see the second half of your cycle, predominated with progesterone. Estrogen is going to really happen in the first half. Why is that? Well, what estrogen is doing is use your uterine lining like cells, thickening that uterine lining up nicely.

And then what happens in the second half of the cycle with that nice, thick uterine lining, you get the egg right there.

So important now is this middle area right here, this is where ovulation occurs. It’s kind of the intermediary between the estrogen and the progesterone and that’s where ovulation occurs.

So I think it’s really important to actually know what’s going on in your cycle.

Want to learn more about your ovulation cycle and PMS? CLICK HERE 


Causes of PMS

When the progesterone drops in that second half, this is where menstruation occurs. This is where you actually have your period. What we find is majority of women that have PMS symptoms- the breast tenderness, the cramping, the whole nine yards- their progesterone is actually much lower. So imagine this line, it’s much lower.

So we have low amounts of progesterone in the second half of the cyle. And that can trigger a lot of the symptoms we’re referring to.

So you’re probably thinking, what’s causing this low progesterone?  Well, the question is, where is the progesterone going? Well progesterone is actually getting converted into a hormone, called cortisol.

Cortisol is essentially a glucocorticosteroid. Alright. So, gluco – glucose. Alright. To watch sugar stability is one of the main role of cortisol. Steroid – inflammation, pain.

So one of the most common things that drive low progesterone in the second half of the cycle is blood sugar issues. You’re not getting enough high-quality fat and protein. It’s very important – Inflammation, Pain. This could be chronic back pain, knee pain, neck pain. This could be from too much or too little exercise. This could also be from food allergens. This could also be from infections. There’s really no magic pill for it. PMS, there’s no magic pill for it coz it can be a combination of these issues.



So what we do here is, we actually address the adrenal glands. The adrenals are really responsible for producing cortisol, as well as progesterone.

If we can address adrenal glands, we’re going to have a huge impact and balance in this last half of the cycle here. We’ll also have a huge impact for the rest of the lifestyle concern, which is blood sugar, exercise lifestyle, diet and things like that.

We also use some specific herbal blends and even adrenal support to actually help balance this last half of the cycle up.


If you have any more questions, please shoot me an email or schedule the consultation and we can go a little bit deeper with your concerns.

Schedule a consult and get more information regarding PMS by CLICKING HERE

Natural menopause solutions – Podcast #123

Dr. Justin Marchegiani and Evan Brand engage in a discussion about menopause. Join them as they share their expertise on women dealing with menopause, including the associated symptoms, hormones, and health factors creating an impact to this period.

Menopause is a naturally occurring transition in a woman’s life. It is a period wherein women undergo a lot of changes in their bodies. This talk will give you important information about these changes caused by hormones, including hormone function and drug interaction. Find out about the effects of infection, as well as other health related issues involving the adrenals, blood sugar and stress making menopause a more challenging experience than it already is. Learn about the natural ways and solutions to keep your health in check during the menopausal period.

In this episode, we cover:

6:26   Menopause: definition and symptoms

9:17   Adrenal gland and hormones

13:40   Conventional Solutions

17:08   Testing hormone preparations

19:31   Bioidentical hormones & herbs

29:20   Dietary recommendations










Dr. Justin Marchegiani: Hey, there! It’s Dr. Justin Marchegiani, alright. I’m hooked on this Youtube live thing. We’re doing our podcast today, Evan and myself. So we are- So we talked about doing menopause uh, today. That was a topic I was listening and learning and reading a lot about it yesterday. I’m honestly dealing with menopause patient for the last decade but always brushing up on my info. Evan what’s going on, man? How you doing?
Evan Brand: Hey, I’m doing awesome. This is fun. Isn’t it great today?

Dr. Justin Marchegiani: It is. I love it. Very cool. So how’s your morning goin’?

Evan Brand: It’s pretty good. I still think that the, the best car for me is gonna be the Tesla because it is the HEPA air purifier in it.

Dr. Justin Marchegiani: Oh, nice. You in the market for a new car?

Evan Brand: Well the Honda Accord, I mean I love it, trust me but, taking in all those diesel fumes like I was telling you about even with the re __ on, I went over to the dealership and they were like, “Sir, you’re never gonna be able to block all of the fumes outside.” I said, “I will if I could have a HEPA filter.”

Dr. Justin Marchegiani: Totally, man.

Evan Brand: I think those Tesla’s are like biologically, like they put biological warfare down or something they will still be safe.

Dr. Justin Marchegiani: Yup, yup. Crazy. Oh, we’re live today. And we’re gonna be chatting aboutmenopause which is an exciting topic for me. I love my menopausal female patients because they’re really motivated. Number one, uh they need a lot of help. Number two, in the conventional medical options for them is pretty poor. So, yeah.

Evan Brand: I’m excited to be able to help. Yeah. Totally.

Dr. Justin Marchegiani: And we got a live chat going in the background which is exciting. So people wanna ask some questions. We may interject here and go live to some of their questions. That’s really exciting, too.

Evan Brand: Where shall we start?You wanna go over symptoms? Talk about- what, I mean most women if they’re dealing with menopause, they’re gonna know about the symptoms but people listening you know- Hey, Butter. Sometimes-

Dr. Justin Marchegiani: She’s Independence. She’s my biggest fan.

Evan Brand: Awesome.

Dr. Justin Marchegiani: Actually, my wife’s my biggest fan. She’s probably second.

Evan Brand: Sometimes you know- whatwe’ll find is with women you know- if they get their ovaries removed, they’re basically gonna skip perimenopause or just gonna go straight to full-blown menopause. Which is what’s happened, for example with my mom, getting the full hysterectomy, for example. You know at 40 something years old, she had already been put into full-blown menopause, basically. And so, she was experiencing a lot more symptoms a lot more rapidly. And say a woman who’s naturally gonna transition.

Dr. Justin Marchegiani: Totally. I have to say, Evan. Honestly, I’m mesmerized by that chest hair that’s coming out, man. I’m sorry.

Evan Brand: I know.

Dr. Justin Marchegiani: I was just like “Whoa! okay.”

Evan Brand: Can you believe that?

Dr. Justin Marchegiani: I know.

Evan Brand: I just actually, I just, I just show my wife last night and said,“Babe, this thing is growing north right now.”

Dr. Justin Marchegiani: Absolutely. Well on hormones, you know- hair,or hair growth will be a big connection with that. So we can chat about that today. Very cool.

Evan Brand: First thing, I need to button up this extra button here, so I’ll do it.

Dr. Justin Marchegiani: I don’t know, man. It’s gonna be really hard for me to pay attention during –

Evan Brand: Alright, alright. Let me button this up then. I apologize for my manliness.

Dr. Justin Marchegiani: No. You’re good, man. You’re good.

Evan Brand: Alright. Go over symptoms. What should we- I mean hot flashes are gonna be very common. Of course, everyone’sgonna know about hot flashes. They’re probably bored of hearing about that. But something that we see a lot, too is depression and mood swings. Something that could definitely be fixed if we take a look at the adrenal glands. And I guess were to hit on that adrenal connection, too. Because the backup generators, which are the adrenals, which should hopefully be kicking in and supporting women. A lot of times they had adrenal fatigue already. So when the ovaries and hormones go down, the adrenals are already tanked. So you’re not gonna have that backup generator that’s gonna help you out.

Dr. Justin Marchegiani: Exactly. I’d say the big is, let’s define menopausal a bit more. So menopause is that time where typically the ovarian function, the ovarian output of hormones is-is running low. It starts to get depleted. And that’s typically because the follicles that a woman is born with, they start to run out. So a woman typically has you know, hundreds of thousands of follicles at birth. And then eventually, only maybe 400 or so are viable. So you fertility for a woman typically, let’s say on average, is gonna be from maybe 13 to 15, depending on when they have their period at first all the way up to the early to mid 40s. Some even late 40s uhm, today as well. So that’s kinda like your- your viable uhm, window for fertility. So when those eggs start to run out, and what starts to happen is your ovarian function starts to diminish. And then that typically, it’s about, consider it about a one year time frame until you actually get in to uh-menopause. That’s the perimenopausal timeframe. It’s about one year until you- One year without a period is what you consider to be menopause. And obviously if you get a, your ovaries removed, like hysterectomy wise, obviously that’s instantaneous menopause, right. Coz you’re missing the hormone output. For most women it’s about 12 months about a cycle. And that’s when you technically hit menopause. And then menopause typically can last until you’re instantly postmenopausal. Can typically last about 10 years. So that can kinda scare some women. And if you get your universal move, like a partial hysterectomy- you keep your ovaries but you get your uterus removed- women typically will go through menopause about four years faster. So the uterus does have some hormonal interplay. So again, because you- let’s say have a partial hysterectomy and still have your ovaries, you still will go through menopause. And it’s important that you get that support. And a lot of women they get their uterus removed. It’s typically because, maybe endometriosis or severe fibroids, or some kind of excessive hemorrhage, or bleeding. They cause them to get removed in the first place.

Evan Brand: Well even I’ve heard of some women saying just because they don’t wanna have a period anymore and doctor will still do the surgery.

Dr. Justin Marchegiani: Yeah. That’s not a good move because your uterus does have some effect on hormonal output. Again the research and people don’t quite have their head around it, that you have, around hundred percent. But there’s still a reason why that is there. So the first aspect is you know, the definition, one year without a period. That’s number one. Number two we have that perimenopausal timeframe, which is about 12 months. And then once you’re in menopause, about 10 years until your technically postmenopausal. Now all the symptoms that we talked about earlier, what are they? There gonna be hot flashes, of course, right.There gonna be mood issues, lack of femininity, right. Feeling less like a female, less like woman, uhm called the sagging breasts. Uhm, I would say a little loss of elasticity in skin. As your estrogen drops, that can shrink breast tissue. It can also stimulate or decrease the stimulation of collagen. So the skin starts getting- losing that quality, and that elasticity, and that nice healthy useful tone, hair loss, mood issues, brain fog, osteoporosis, obviously vaginaldrynesss, depression. So these are all symptoms of the ovaries losing their ability to function. And then what starts to happen is your adrenal glands really have to pinch-hit and come to the table.

Evan Brand: Yup. So if you got infections or your adrenals are tanked, when the- if we use the pinch-hit term, they’re not gonna be able to doit very well because you’ve got these other problems. Or the diet is not good, you’ve got blood sugar swings. So without healthy blood sugar, it’s gonna be tough to have healthy adrenal function.

Dr. Justin Marchegiani: Exactly.

Evan Brand: You know the thing that’s interesting is a lot of women get talked to about menopause like it’s a disease. But it’s not really a disease. It just seems that the modern world in terms of either too much or too little exercise, and a diet that’s not rich in good fats and good proteins, those are the modern things that we’re up against. So menopause is becoming more prevalent. And then also, it’s gonna be more severe, too. Because our ancestors they’ve dealt with menopause. You know, this is a natural transition, but now we’ve- were up against these new things that the modern world present. So therefore, we have to play the cards a little bit smarter, make sure we’ve got the nutrition down, make sure we’ve got the exercise portion down, and then we always get to the underlying issues that could still be affecting things or making things more intense. Like say, an infection which you and I find hundreds and hundreds a year. And menopausal women, a lot of times there is adrenal issues calls from infections.

Dr. Justin Marchegiani: Absolutely.And to- I wanna add, we’re actually doing this podcast live. So anyone watching live right now, feel free and write in a question or two. And we’ll be able to see if we can intermingle the questioning with the podcast. Sothis is gonna be this kinda new little set up here. If people are likin’ this, we may do more of it. So we’re pretty excited about it. I did a couple YouTube lives this morning and people want a couple questions answered. But still do it as long as we can get a turn into the topic.

Evan Brand: Yup. So-

Dr. Justin Marchegiani: I got a little Kombucha right now. I’m getting my ginger Kombucha in here.Nice.Love it, love it. Nice.

Evan Brand: I’m drinking uh, Vitamin C actually right now. Vitamin C tonic out ofout of little mug that says having tea with a friend brightens any day.

Dr. Justin Marchegiani: Here, here. Touche on that one. Excellent. So we talked about hot flashes a little bit. Can you talk about- Can you go into like, the adrenaland why the adrenals are so important for women that are getting ready to go into menopause?

Evan Brand: Yeah. Absolutely. Well so, if we look at the top of the food chain of hormones, if you type in steroid hormone pathway chart online, you can see where cholesterol, which is going to come from diet. Also of course the liver and all of that. But you got cholesterol at the top of the food chain here. Then downstream we’ve got progesterone. You’ve got pregnenolone. You’ve got your estrogen, your estriol, your estradiols, your testosterone, your DHEA’s. You’ve got your aldosterone. You’ve got cortisol. You got all these hormones that are depending on a pretty good balance. But as we pry talked about before, what happens is the pregnenolone steal, some people debate that. Some people say that it’s not true. But just based on what we have done, and what we do, to me it makes perfect sense of the pregnenolone steal is perfectly real. Which is the process where men and/or women that are under significant stress, the body is going to prioritize cortisol production over the production of these other hormones like your estrogens. And so when menopause is occurring, and the levels of estrogen and progesterone are dropping, now you’re just dependent on the adrenals and this cortisol, this whole adrenal cortisol- and I guess we’ll call it backup generator- to do the work that was being done by two generators before. Now you’ve got one generator doing the same amount of work. Now, if you’ve already been in sympathetic fight or flight mode, for significant amount of time, you’re gonna have trouble. So when we pull your adrenal cortisol results, we’re gonna see that you’ve likely got low free cortisol. Which means since you’re not outputting the amount that you should be. So the analogy I use is the smartphone. So a lot of women where looking at, they could be, we would like to seem around 28 or 30 units of free cortisol. I’ll make a bio health test, for example. But a lot of women are showing up anywhere say 10 to 15 units of cortisol. So that’s like you starting your day with your smart phone battery charged at 50%.

Dr. Justin Marchegiani:  Yeah

Evan Brand: And you’re trying to get through the whole day. It’s gonna be tough. And so this is why having healthy adrenals and having a good adrenal protocol in place, for me is essential not only for men and women that are you know, younger. But older women especially are going to benefit from some of the adaptogens and strategies that we can chat about.

Dr. Justin Marchegiani: 100%. Now, looking at the adrenals, I always thought patients are like a backup generator, right. They’re gonna produce a significant amount of DHEA which can go down the hormonal cascade and can become testosterone andro and primarily at a female, we’re gonna go down more of the estrogen pathway. So if you look at testosterone andro it can also float downstream into either estrone, or estradiol estrone, and estradiol.And then from there it can get converted in the liver to estriol. Estriol is gonna be about 80% of all the estrogens in your body will be estriol. During reproductive age, estradiol will predominate as your main estrogen. And then when you go into menopause, estrone will be what predominates when you’re menopausal. So let’s break that down. We have E1, E2, E3-really simple. The names have a good giveaway. Estrone has O-N-E in it. So that’s E1. Estradiol, D-I, right. like 2 dice, E2.And then estriol, T-R-I, that’s gonna be E3. So you’ve E1, E2, E3. E1, estronethat predominate when you’re menopause. E2, during reproductive age. E3 will be what’s there the majority of the time. Uhm- but it’s weaker, and it will significantly predominate when you’re pregnant. So what happens is when you’re going to menopause, E2 starts to decrease, and we start to get more dependent upon the E1. The problem is E2 and E1 are stronger estrogens and could be proliferative. Meaning, they can increase risk of cancer and other health issues. So, if we are gonna support a female with some bioidentical hormone preparation- Bioidentical meaning the hormone molecule matches what’s in your body, typically plant-based.We’ll do it with estriol, E3. And we’ll even typically combine a tiny bit of progesterone in there to support the female hormones.

Evan Brand: Should we talk about the conventional solutions,like hormone replacement therapy? Like the one that comes to mind here about a lot as Premarin?

Dr. Justin Marchegiani: Yeah. But yeah- yet but you Prempro or Premarin Provera?

Evan Brand: Yeah. I mean- That’s- that’s it. That’s linked with increased risk of heart disease now.

Dr. Justin Marchegiani: Yeah, in cancer- I mean the women’s health initiative study uhm- found that about 10-15 years ago. So it’s- it hasn’t been prescribed as much for hot flashes and menopausal symptoms. But it’s still is being prescribed. Their more natural, kinda anti-aging doctors are out there, typicallymedical-based. They’re prescribing hormones. The problem with it is they prescribe like it’s candy. They prescribe it like it’s a vitamin or nutrient. And hormones are really, really powerful, right. Hormones are measured in like nanograms, which is like one speck of salt in like a swimming pool, right. So it’s like very- you know- very, very sensitive. You know, amounts of these things. So looking at hormones, we wanna make sure we don’t give it like a supplement. We wanna make sure we actually test. So, we’re not guessing when we prescribe it. It’s specific to what the patient needs. Number two- number two, is we actually have to make sure the diet and lifestyle is dialed in coz that’s a really, really important starting point. And I would say even more important, most medical doctors or bioidentical doctors totally ignore the adrenal portion of that. So the adrenal is just totally not even on site. And we know how important the adrenals are for that backup generating of the sex hormones, especially when you on menopause. So imagine that backup generator, if it’s on empty, or the smartphone analogies on low, that means symptoms. So you gotta turn the generator when the storm comes in, it’s not on full. Guess what? Your power is not gonna work. There’s gonna be a lot of things in your house aren’t gonna work, like you have full power. And what that equates to a menopausal female, is symptoms. Mood issues, skin issue, hot flashes, of course, vaginal dryness, low libido, right. So those are the things we gotta be very mindful of, when we’re dealing with menopausal females.

Evan Brand: Let’s talk about what the options are. I mean even if you do go bioidentical, a lot of times you’re going to get hormone creams. But the more, more that we develop hormone creams, I’m finding that- that can disrupt other hormones, and it’s gonna be tough to measure, it’s gonna to be tough to get the right dose. And so now, I’ve been reading a lot about sublingual drops- for bioidentical hormones. Supposedly, that’s the best because you can determine exactly what dose you’re taking. For me that goes out of my- you know, that goes out of my pay grade coz I’m not a prescribing medical doctor. But it’s at least good to know that there are options out there for women because if they are going to go talk to their endocrinologist, or you know- some type of MD that’s more integrated. Hopefully they can know that, you definitely don’t want to go oral, you definitely don’t want to go with the cream. But if you can go sublingual drops, with the bioidenticals. However, in a lot of cases, if we are getting the diet dialed in, orgetting like some omega-3, fatty acid supplements in, we’re removing synthetic estrogens, the plastics, and all the other exposures, the phthalates, and all the other endocrine disruptors, and health and skincare products, and then we’re addressing underlying issues, I’ve had great success with many women- women. I know you have, too. In- we’re not- we’re not saying,“hey, go get this drug”, “go get the struggle get this prescription”

Dr. Justin Marchegiani:  Exactly. So when it comes to hormone preparations, number one, how do you test it?Most medical doctors they’re gonna primarily use a serum bound test, a serum blood test to look at hormonal levels. Now the problem is, serum represents a 100% of all the hormones that are in your blood, right. The problem is only about 2% maybe 2 to 5% hormone’s a free fraction. So the problem is because a small- for such a small small percent of the hormones that are free, it’s such a small percent out of the hundred percent. It’s really hard to measure it because you don’t have a small enough gauge to sense it.

Evan Brand: That make sense.

Dr. Justin Marchegiani: So it’s like using a thermometerthat only tells youyou’re either 97- 98- 99.Doesn’t tell you the in between temperatures. So your 97-9, it may say you’re still 97, right. So imagine that’s kinda like the blood testing. So we use a free fraction test that will break it up and look at the free fraction of the hormone. Whetherwe’re using bio house salivary cortisol, or salivary progesterone or estrogen test. That’ll look at the free fraction. Or we use the Dutch testing, that will also look at the free fraction. Excuse me.The Kombucha gets uh- gets me a little bit burpy.

Evan Brand:Ha ha

Dr. Justin Marchegiani: I apologize for that. Uhm- so looking at that, we will wanna do tests that look at the free fraction. Number one- so salivary test or like a really good Dutch test by Precision Analytics is great. Because we get a more fine two-metric of where those free fraction of the hormones are at. Again, there are some blood tests that can- I think you can look at estradiol-free. I don’t think you can look at progesterone-free or cortisol-free on a blood test, yet. You can look at serum cortisol, you- you can look at estradiol-free, you can look at testosterone-free. I do not think you can look at progesterone-free. So again, we wanna be able to look at the free fraction coz that’s what bioavailable and combined into a receptor site.

Evan Brand: Yeah, I wanted to mention the- Dr. Jonathan Wright, which- I believe it’s the same- it’s the same guy who wrote the book on stomach acid, which is I know one your favorites on my favorite books.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  That he’s got some good info with Mercola about administering bioidentical hormones. And are talking about the version that they call tri S, which is supposedly 80%, estriol, 10% of each estrone and estradiol. So it sounds like- for even you know people like my mom, any woman that’s had you know- a full hysterectomy, it sounds like this is gonna be pretty foundational to- to overall health. It sounds like you can’t really out supplement your way if you have had you know- a full hysterectomy like this. What’s your take?

Dr. Justin Marchegiani: Right. Remember what I said? I said 80% estriol, right. So think about it, right. With a tri S, what is it? 80-10-10. 80% E2- I’m sorry-E3, estriol that’s the tri S. So 80% estriol, E3. 10% estradiol and 10% estrone. And that’s good if you can get it compounded that way. That’s fine. Again it’s still gonna be a cream and the problem is some women don’t do well with the cream because it super saturates in the subcutaneous tissue and starts coming out in uncontrollable amounts. You don’t get dosed into the bloodstream as efficiently let’s say, as a sublingual. They can go right into your sublingual tissue in your buccal tissue, go right to the blood, and there’s no like real fat in the mouth. Soright in there, and your good. Now the differenceis Dr. Jonathan Wright’s talked about this. If he does sublingual’s- I’m sorry-If he does the creams, he typically does it inter vaginally because of the submucosa down there. They can go right into the bloodstream. So that’s helpful. But again, you know, I’ve dealt with a lot of women that do the creams and such,inter vaginally, which can work decent on menopausal women. Not so much on cycle, and I’ll tell you why.But again– it’s some issues issues. I mean not to get too graphic here, you can get to the underwear, you can come out. Uh- it’s okay if you can do it at nighttime when you’re lying down. But sometimes you get discharge and they can wrap women’s underwear. They can be a little uncomfortable. So it just depends on what you like. If women have already done that- done it that method. And then they’re doing well, and the hormones are stable, and they didn’t have any of those issues that I mentioned, fine. If not, we’ll typically recommend some of the sublingual drops. Some of the estriol and/or progesterone drops. We’ll also support the adrenal glands themselves. And then will also use some specific herbs to help modulate the sex hormones. We’ll use wild yam. We’ll use chaste tree, or vitex. We’ll use dong quai. We’ll use black cohosh. Uh- we’ll use some of those herbs to help modulate the receptor sites. I’ll even use some specific phenotypes of mock guys. Some specific phenotypes for cycling women and/or menopausal women that- that will help with even some of those symptoms of the receptor site level, depending if we have a cycling or a menopausal issue.

Evan Brand: How about soy during this time?

Dr. Justin Marchegiani: Well if you’re using specific soy isoflavones, that can be helpful to modulate estrogen receptor sites. Again, we’ve talkedvery negatively about soy, but again soy if you extract the isoflavones, you’re also not getting all of the proteins and the  in the goitrogens, and the trypsin inhibitors. All of the negative effects. And of course, it’s gonana be extracted from a non-GMO source. So my opinion, you can still get some significant benefits. But where it’s the genestein the other types of soy isoflavones can be helpful for modulating, yes, receptor sites.

Evan Brand: Sure, sure. And I briefly mentioned omega-3’s but that’s another good one. Just plenty of omega-3 fats so good, high-quality triglyceride form of fish oils, which is what you and I use. So if you are takin’ a fish oil and you get fish burps, it’s probably ethyl ester. And that’s not good. If it smells fishy, most of the time,that’s not good, either. And you want to-

Dr. Justin Marchegiani: You want the triglyceride form.

Evan Brand: Yeah.

Dr. Justin Marchegiani: That’s it.

Evan Brand: Which is basically is as close as you can get to the raw form or the form that you would get if you’re just actually eating the fish.

Dr. Justin Marchegiani: Absolutely. So looking back at all the different things we talked about some herbs to help modulate receptor sites. We talked about using potential bioidentical hormones, our biases more towards the sublingual. If you were to do intravaginal cream, if have to be intravaginal, ideally not on the skin as much. Because of the super saturation in the subcutaneous tissue. And I see it on test. When you see like literally women are off the charts. You’re like, “hey, your doctor’s just measuring blood.”And because it doesn’t have a small metric to pick up that unit 2% or so, it may look okay in the blood, but not the okay in reality in- in the spectrum of looking at the free.

Evan Brand: Yeah. I’ve seen that, too. I’ve seen it with men, too. Which is all other conversation but testosterone replacement therapy, where just go so far above the 6, 6000 about 6000. That’s like where the test maxes out. And its like, “whoa! something’s not right.”

Dr. Justin Marchegiani: Exactly. Now, looking at cycling women, why do I wanna avoid creams altogether? Well for the most part with cycling women, their hormones are gonna be at different place in the cycle. The first half of the cycle is gonna be the follicular phase, where estrogen starts to go up around day 2. Day 3, it taps out around day 12 to 13. And then it drops as progesterone rises. That’s where your ovulation is.That estrogen drops and progesterone rise is where ovulation is. Progesterone comes up to the top. Estrogen nears down low and they both dropped together around day 27 and day 28 to signal bleeding. And again, the reason why this is an issue is, because if you if you can’t pull estrogen or pull progesterone all at the right time, then that can throw off the cycle. Because if estrogen and progesterone aren’t dropping exactly when it should, you’re not gonna have adequate menstruation. It may delay things. It may slow off your cycle. So because of that, I don’t like creams on my cycling female patients. I like to be really specifically progesterone exactly what days. I don’t want any spillover on either end. And I typically don’t use any estrogen with female hormone patients that are cycling because most women are estrogen dominant. And will typically be able to support the estrogen via the adrenal side via some of the DHEA and pregnenolone and some of the modulating herbs.

Evan Brand: So if you went to a standard MD or like an integrative MD, are they can be able to provide those sublinguals? I mean- how common is that? I know were talking about- sometimes we talk about subjects where the optimal thing is just unheard of in conventional. But I mean- is this sublingual, is this popular enough for some woman could go down the street to a clinic and get- get help with that?

Dr. Justin Marchegiani:  Uhm, most conventional medical doctors aren’t gonna- aren’t gonna be able to do the sublingual coz it’s just not in their wheelhouse. Uhm- some do troches which maybe a close second, right. A lot of them will do the pellets, and then most of them will do the creams. Just how they’re taught. You know, if you look at a lot of the ___, some of the anti-aging physicians, they’re gonna do more the creams. Dr.Jonathan Wright does this, but at least respect that it’s intravaginal. So you don’t have the subcutaneous build up. But again, I think the more important piece here to look at, is the adrenal aspect. We gotta look at the adrenals. And if anyone’s viewing right now, and wants to chime in, and ask a question via chat, feel free to do that. And we’d love to answer any of the questions that are on or related to the topic. This is a new thing we’re testing out. So the more people that engage or comment on this afterwards, that’s gonna motivate us to do more of these.

Evan Brand: Totally. Yes. So, the- you’ve hit on the good point, which is, yes- you can go there with the hormone replacement therapy. It has done good things. It can do good things, but I’m not prescribing it and I’m getting- I canprescribe but I’m not a prescribing MD. But just doing the stuff that I’ve done, I’ve been able to make 80, 85, 90% better in terms of symptoms that menopausal women are experiencing. And that’s with no drugs. That’s looking at the adrenals, that’s getting the gut infections taken care of, that’s looking at mitochondrial health, that’s getting rid of candida problems, that’s making sure they’re going to bed on time, that’s making sure they’ve revamped any type of cleaning products in their house. They’ve got the chemicals out, they ditch the plastic Tupperware’s. So all that stuff your adding 5%, 10%, 15% and then it just keeps adding up and then eventually, people are gonna feel much, much better.

Dr. Justin Marchegiani:  Oh, absolutely. And I think the bit thing is you’re working on the adrenal piece like I mentioned. You’re also working on the diet, right. Your stabilizing blood sugar. One of the biggest stressors on the hormonal system is going to be blood sugar swings. The more you stabilize those blood sugars and keep that dialed in, you’re gonna takea lot of stress off the hormonal system. Also stress is gonna eat up progesterone. So kinda like the pregnonolone steal, which is you know-it’s theoretical. It makes sense. It’s just- Here’s howI tell patients. We’re prehistorically hardwired to allocate our resources to stress and inflammation now versus healing and recovery in fertility tomorrow. Why? Why is that? Well because if we don’t get through now, tomorrow never comes. So it’s like the 12-year-old boy procrastinating on the homework. If you’re chronically stressed, you keep on putting off the fertility in the recovery, in the- the recuperation that is needed. So we’re chronically hardwired to deal with stress right now. So the goal is to decrease that stress, so then your body can start to allocate that, and put the healing and recovery in the fertility higher up on the priority list.

Evan Brand: Well said. Yeah. And it’s crazy to me how you can go and you could complain of the symptoms up sounds like you’re in or you’re going to menopause.Here’s cream and have a nice day. And none of this other stuff is discussed. I mean, we’re looking at massive pieces of the pie that are just completely ignored.

Dr. Justin Marchegiani:  Oh, yeah. Absolutely I would say the biggest issue I have when I was at the menopause summit last week with the with uh- with Bridget- Bridget Dainer, and one of the things they came off that we talked about was, I would say, one of the biggest things that is driven more menopausal patients to me, is this low-fat era. Avoiding animal proteins and healthy fats because that’s where a lot of your hormones come from. So if you don’t have that diet piece dialed in with the hormonal substrates, and the building blocks, and the healthy amino acids, you’re really at a significant disadvantage to being able to make your hormones on your own. So healthy fat-soluble nutrients, through grass-fed meat and Pasteur-fed meat and Pasteur-fed eggs, organic, free range, none of the chemicals. You don’t wanna add more Zeno estrogens in our meat to the- to the table, right. And throw off our hormones more. Healthy fish, egg yolks, if you can handle grass-fed buttering ghee, that’s great. Lots of vegetables, a glycemic or carbohydrate uh- balanced meal for you. So depending on starch, or no starch.Keeping grains out, keeping inflammatory foods out, keeping toxins out, and stabilizing your blood sugar, or not letting your blood sugar drop and not letting yourself get hungry is gonna be a great starting point for most people.

Evan Brand: Yes, I mean vegetarians, vegans specifically for women at this time, it’s gonna be brutal on them. If you’re vegetarian, vegan and you’re going into this phase in life, it’s gonna be really, really tough on you.

Dr. Justin Marchegiani:  It definitely will be now. If you are in that place, you know- I would try to coerce you in- and sell you on the fact that you probably want to eat some of these healthy animal proteins. At least cajole you and maybe some egg yolks, or tiny bit of fish, if I can do that. If I couldn’t do that, I will at least try to get you on some collagen proteins, uh- some really good P-protein. I’d even recommend you get some free form amino acid supplementation. I recommend lots of healthy fats via avocado- avocado oil, coconut oil. I will do Chia seed. Uhm- again, olive oil, low temperature. AndI would really work on the good fats, and I would make sure not going excessively high in the carbs. A lot of vegetarian by default become carbotarians. Again, I got in a lot of flak on this on YouTube, but it’s true. I’ve looked at hundreds of food logs of these types of patients and people. And I’ve seen it over and over again. The difference between me and you Evan, and the general public, is most people in the public, they only have an N=1. They have a torr experience. So if they extrapolate themselves, as is what everyone does, we seen it many, many hundreds, if not thousands of times over, most vegetarians become carbotarians with the grains and the excessive starch. So again, may not be an issue for you. I may not be speaking to you directly, but again that’s an issue that we do find on the vegetarian side.

Evan Brand: Agreed. Yeah. And we can look at the lab results, too. And I notice YouTube is the place where you get the most hate comments about vegetarian or, or- or veganism. If you’re- if you’re saying that that’s not a good- not a good thing to do, but we got the lab results to prove it. So when you got people out there saying look at this person, or look at this one doctor, or look at this one study, it’s like,“Hmm, I’m gonna look at the stuff that we’re doing in the trenches. I mean,  you and I are in the thousands of people that we’ve worked with now. And we see the direct correlation where when people start adding in the eggs, or they start adding in the good fats on a retest of let’s just say, adrenal cortisol pattern, for example. We may notice that the cortisol could get back into a good rhythm. Now granted there’s lifestyle components that were helping, there’s- there’s stress management, there’s the sleep, there’s the watching off of the blue light, etc. Getting good bright light in the morning, which is gonna be helpful. If you’re spending time in a dark room, cortisol is a light driven hormone, so if you’re waking up and you’re not opening the blinds, that’s a big issue, too. Wearing sunglasses, for example, but if your adrenals are stressed, you’re gonna want to wear sunglasses.  Some women they’re complaining of a bright light coming in, you definitely wanna get your adrenals tested. Because I’ve noticed that people I suspect- like I look around my family to see,  “Oh, I bet she’s got some adrenal issues”,“she’s always wearin’ those sunglasses”. That gets better when we support the adrenals. Bright lights don’t bother you as much.

Dr. Justin Marchegiani: Absolutely. That’s a 100% true. I totally agree. Well, anything else we want to touch upon with menopause. We hit the adrenals. We hit the diet. We hit the blood sugar. We hit some of the supplementation. Again, some womendon’t necessarily need the bioidenticals, but some women do. And it really depends on what’s going on, how unbalanced the hormones are, and how bad their symptoms are. Again, the more their hormones are depleted, you may need a strong bailout, a fast bailout with a little bit of hormone support. So I don’t wanna keep my female patient suffering. So we’ll use a little bit of that. And as long as we’re testing, and were not guessing, were assessing, I feel very confident moving forward  with that.

Evan Brand: Agreed. Yeah. Well said. Well people let us know what you think of the live YouTube thing. I’ll be curious to hear the audio quality. I mean, you talking to me it sounds- it sounds perfect. So if it’s as good as us recording through Skype, and other methods, then I say we could just keep doing our shows like this.

Dr. Justin Marchegiani:And again, we didn’t plan uhm- to do this show today. So I did one this morning off the cuff. I posted last night. So we had more viewers, but today was off the cuff so we don’t have too many viewers listening. But if anyone’s listening and wants to ask any questions, let us know. But I plan on- we’ll probably have hundreds, if not thousands, of people listening live very soon. When we start planning these out and it we’ll put it out in our emails. We’ll put on Facebook ahead of time so people know and they can come with your questions. Bzut anyone has any questions, actually we got a question here.What about liver health? And where to metabolize estrogens? Yeah. So regarding estrogen metabolism, this is important because I mentioned this earlier. We had E1, which is estrone and we have E2, which estradiol gets funneled downstream into estriol, okay. And what happened- this conversion happens to be at the liver. So E1 to E3 and E2 to E3, all happens in the liver. So anyone that has a liver issue, is gonna have a female hormone estrogen issue. So we wanna work on the liver. And also on the Dutch testing, we’ll look at the 2- hydroxyl, the 2-methoxy estrogen metabolism and we’ll look at the methylation meter and see if we’re having that one-to-one ratio of estrogen metabolism. So for 2-hydroxy estrogen of 1, do we have a 2- methoxy 1? Do we have this one-to-one metabolism? And that’s the methylation meter that we’re looking at on the test. If not, we could be uhm- essentially not getting rid of all the ashen. We could be re-absorbing that. Also, increase estrogen issues are gonna cause gallbladder issues. So again, you know- that the FFF role gallbladder issues, women that are overweight or fat, women that are- that’s the FFF, that’s just the accrued abbreviation. So overweight female, and 40 or up. So that this estrogen dominance thing. This is what goes, you list- I mean- I remember sitting in the many gallbladder surgeries, and those like FFF. Those are the three things the surgery would say. Are your overweight, female and over 40? Because the high amount of estrogen dominance, right. Makes the gallbladder- makes the bile flow from the gallbladder sluggish. So then what happens is two things. You can’t metabolize your hormones. A lot of that happens via the bile excretion. And then number two, you lose the ability to break down your uhm- fat-soluble vitamins. So gallbladder issues, and then fat metabolism, and then detox are common side effect of estrogen dominance. And that can happen leading into menopause. I can’t tell you how many of my female patient that are cycling have lost her gallbladder. And it really sets them up for nutritional efficiency and poor detoxification down the road.

Evan Brand: Oh, gosh. Well said. I mean- when I hear liver too, I just think of, like the GPL talks that you and I’ve chatted about with the gasoline additives and all these other chemicals in people’s bodies, aspirin and other- you know, pharmaceutical medications that increase the burden on the liver. So whether it was like statins, or hard drugs, or any of the stuff that that’s really tough on the liver. Alcohol, which a lot of women over 40, their stressed, they’ve got these symptoms, so they’re using wine you know, to put themselves to sleep. A glass or two a night which could increase the burden on the liver and messed this whole process up. Plus we’ve got parasite infections. You know 1 in 3 is what we’re seeing of infected people. Say you’ve got the toxic load there. And then if you got methylation issues, like you’ve mentioned, and you’re unable to detoxify, or you’ve got problems with the phase I or the phase 2. And you’re not taking something to conjugate those toxins and rattle them up and get them out your toes. So there’s a lot of different pieces that- that can be improved upon, for sure. Sço we always factor liver in. It’s not a matter of if we factor liver and detox into the protocol, it’s just a matter of when.

Dr. Justin Marchegiani: Absolutely. Now we just say- making sure we- you toss upon earlier with the gut stuff and I think so many mainstream functional medicine practitioners, and I would say even the medical doctors, ignore the digestion part coz again, a lot of the detoxification happens with sulfur amino acids. So we have to make sure we have the sulfur amino acids, the phase 2 sulfur amino acids to run those liver pathway. Socysteine, glutamine, glycine, and the glutathione precursors uh- methionine, taurine, especially for the gallbladder, are gonna be super helpful for liver detox. Also making sure we eat a lot of the cruciferous vegetables. And again, if you have gut issues, make sure they’re cooked so the fiber’s broken down. So we can get the diindoylmethane and indole-3-carbinol, which is gonna be really important for estrogen detox. And again, this is your broccoli, your brussel sprouts,your cauliflower, your asparagus, your kale, spinach

Evan Brand: And your broccoli sprouts. I love broccoli sprouts.

Dr. Justin Marchegiani: Yes, broccoli sprouts. And again we have someone answering uh- or asking this question live. So we’re answering anyone else that wants to ask a question live. We’re both ready to sign out. So anyone else,uh- put something in the chat window, we love the answer to it. So to finish that question, what other herbs can we give? So for gallbladder, we wanna add maybe some extra bile salts. We wanna do some fringe trees, some artichoke roots, and phosphatidylcholine, some X taurine. These are great for the liver. Extra milk thistle, silymarin. These are great things and we may even give extra sulfur amino acids, antioxidants, B vitamins, extra folate. These are all great things to support the liver. And I’d also say make sure you’re not doing all the bad things regarding the pesticides, the chemical, the exogenous hormones. And again, this is where a little bit estriol may need to be given coz that if we have toxic liver, we may not be able to have that liver conversion goin’.

Evan Brand: Well said. Great job.

Dr. Justin Marchegiani: Excellent. And we have a couple of other questions here. Uh- No, I did not go to the Super Bowl. No, not this year. It’s in Houston. I was thinking about it, didn’t make it down there. But I’m a huge Tom Brady fan. I think I know a lot of haters for that. But Tom Brady is the poster child for functional medicine, natural medicine. And the guy’s 40 years old and better shape than ever. And part of it is because of his diet,his eating,his sleeping, his training he sees a chiropractor, he sees an acupuncturist. The guy’s dialled in and is using natural medicine and functional medicine as his go to and not conventional medicine for his go to. So,huge fan of that. Anything else here, Evan?

Evan Brand: I don’t think so. Some people back to the website, check out Justin, Check me out or type in Evan Brand. You’ll find us both. More content, more info, the ability to schedule consults with us. All of that’s there. So we do both offer 15-minute free call. So if you got questions, you wanna get your questions answered, reach out. You know, there’s no sense in suffering if you know that there’s a possibility to get better, go for it, time’s wastin’.

Dr. Justin Marchegiani: And if you guys listening, like this type of format, we want to do it more frequently. So give us- give us some love,give us the thumbs up. Uh- share it, put it on Facebook, email to your friends. We absolutely love it. And the more feedback we have, the more we wanna do this.

Evan Brand: Absolutely.

Dr. Justin Marchegiani:  Excellent. Alright, Evan. Well this- the beautiful thing about this is,this thing goes live right away.So kinda exciting, instantaneous feedback for the listeners. Anything else in your end?

Evan Brand: No man, that’s it.

Dr. Justin Marchegiani: Alright, man. Great chattin’.

Evan Brand: You too.

Dr. Justin Marchegiani: Take Care.

Evan Brand: Bye.

Dr. Justin Marchegiani: Bye.


The Top 5 Birth Control Pill Side Effects – Functional medicine options

Birth Control PillsBy Dr. Justin Marchegiani

Birth control pills are often prescribed for reasons outside of just avoiding pregnancy. Many times birth control pills are prescribed for acne, migraines, excessive menstruation and PMS symptoms.

The problem with this type of approach is it doesn’t fix the root cause of why those symptoms are there in the first place. At some point, these old symptoms will reveal themselves again and maybe worse than they were originally.
Today we’re going to dig into how birth control works, potential side effects, and natural contraception options.

Birth Control Pills

Birth Control Pills

The conventional route of preventing pregnancy is either through chemicals or pharmaceuticals: A.K.A. birth control. The most prescribed medications out there are birth control pills, which pump your body with estrogen and progesterone.

There are couple of different kinds of birth control, including: shots, subdermal pellets, pills, NuvaRing, and IUDs like Marina (synthetic progesterone).

Are you on a birth control pill but would like more natural options? Click here to consult a functional medicine expert!

Other Uses of Birth Control Pills

Uses Of Birth Control Pills

Birth control pills are also prescribed for other hormonal issues (acne, mood issues, migraine headaches, heavy menstruation…) In other words, if you suffer from bad PMS, the conventional route is to give you birth control to artificially stop or control your periods. However, these issues are generally driven by imbalances in the body- so birth control is covering up the underlying issues, rather than fixing them.

How Do Birth Control Pills Work?

Effects of Birth Control Pills

Birth control affects organs like the cervix, vagina and uterus. Here are a few things that happen to you, physically, when you take birth control:

Decrease in FSH and LH

These are your pituitary hormones that talk to the ovaries to make progesterone and estrogen. When you’re taking a birth control pill, essentially you’re telling your brain that you’re pregnant. That’s why these hormones start to drop. When these hormones drop, they stopped talking to the ovaries to make estrogen and progesterone. So typically, FSH is going to then talk to the egg, and stop that egg from growing if it’s low. It’s going to stimulate egg growth if it’s high.

So if FSH is low, that egg is not going to grow. When FSH and LH both low, what tends to happen is you get a thickening of the cervical cap so it’s harder for sperm to make their way into the uterine lining.

In a natural cycle, estrogen rises in the first half of the cycle and that starts to thicken the uterine lining. But when you’re taking a birth control pill with synthetic progesterone, the Drospirenone, that actually thins out the uterine lining. It thins it out, making it harder for an egg (if it is released) to actually stick into the uterine lining.

Mechanisms Involved

Birth control pills works a couple different ways:

  1. Inhibiting ovulation.
  2. Preventing sperm from getting into the uterus area to begin with.
  3. Preventing the sperm and the egg from sticking into the uterine lining and fertilizing.

Women’s Menstrual Cycles

The first half of the cycle is predominated by estrogen. So estrogen is up like this in the first half of the cycle; then we have progesterone that predominates the second half of the cycle. And you can see what happens is progesterone rises and falls and estrogen rises and falls right at the end of the cycle which triggers menses.  And then we have the part here in the middle of the cycle where ovulation happens and that’s where pregnancy can occur.

Effect of Pill on the Cycle

With the birth control pill, these hormones aren’t going to fluctuate because the LH and the FSH is dropped. Because the LH and the FSH is dropped, we’re not going to have that nice, natural rhythm of hormone because essentially our brains think we’re pregnant.

With birth control, instead of there being drops in progesterone level, we are now getting a high amount of progesterone and estrogen above where we’re supposed to be at. And so, we now have a flat line instead of a natural rhythm. Then typically around Day 21 and 22, we take those five to seven days of reminder pills which then allows the hormones to drop like so and that allows menstruation to happen. With a progesterone-only pill, that may not happen; but on an estrogen or estrogen-progesterone combo, that’s what’s going to happen.

Side Effects of Birth Control Pills
Birth Control Pills Side Effects

There are many under-acknowledged side effects from conventional birth control methods. These include depression, weight gain, acne, nutritional deficiencies, thyroid issues, and even cancer!


The birth control pill may affect your mood; depression is one of the most prominent side effects because you’re affecting hormones. Hormones are intimately connected to our moods. So if you’re taking hormones and bringing them above a physiological or bringing them to a super physiological level, it may cause depression and anxiety.


Birth control pills affect the pH in the vaginal tract, making it a little more alkaline. When the pH is more alkaline (above a 7 pH), it becomes more inhabitable for yeast and bacteria to grow. So when you’re stressed and when you’re on birth control pills, you have an increased chance of a UTI or a fungal infection.

Nutritional Deficiencies

Birth control pills are notorious for creating B vitamin deficiencies: folate, B9, B12, B1, thiamine, riboflavin, niacin. All these are important for your overall health, and for your thyroid as well. You have to be mindful that if you’re going to use the pill, you have to make sure you’re taking high-quality multivitamin because of the deficiencies it leads to.

Decreased Libido

Because your birth control pill is increasing sex hormone-binding globulin, testosterone binds to protein. Called “sex hormone-binding globulin,” when testosterone starts binding to protein it makes it harder for that testosterone to bind into the receptor site. It gets too large and can’t fit where it needs to go.

So that protein there renders your testosterone or your sex hormones to be a little bit lower functionally. So guess what happens? Libido goes downhill and also because the testosterone drops a little bit, guess what happens to women’s skin on the birth control pill? It tends to get a little better.

Weight Gain

This is kind of a controversial one, but if you look at the side effects on the bottle or on the drug, it’s going to say weight gain. Birth control generally increases estrogen; synthetic estrogen increases insulin resistance. As we know, insulin resistance us a huge cause of weight gain (and also leads to trouble shedding excess fat).

Thyroid Issues

Sex hormone-binding globulin and thyroglobulin increase when you take birth control. Thyroglobulin is a thyroid hormone, which, like testosterone, also has trouble binding. Thyroid issues are linked to weight gain, fatigue, hair loss, and more.

Increased Risk of Cancer

Birth control pills may increase cervical cancer 300%, and increase breast cancer by 200%!


If you’re trying to prevent pregnancy, check out my natural birth control pill video.

If you’re taking birth control for PMS symptoms, address the root cause of those issues. Don’t turn to a pill to mask the symptoms- it will just cause you even more trouble down the line.

To find out more about more natural ways to prevent pregnancy, ask a functional medicine expert HERE!

If you’re trying to get your hormones balanced, or trying to get yourself back on track hormonally from some of the side effects of being on birth control pill, or trying to avoid it, click on screen, subscribe. You can always schedule a consult with myself.

Estrogen dominance, female hormones and your health.

By Dr. Justin Marchegiani

Estrogen, one of the two main sex hormones that women have, is responsible for female physical features and reproduction. Today’s talk is going to be on estrogen dominance.  Again, anyone that has female hormone symptoms for the most part, it is going to be a contributing factor to why you’re having those symptoms.

So I’m fresh off an interview I did today where we talked about estrogen dominance in one of the local summits that went here and I want to dig in a little bit deeper and give you some of the tidbits and the factoids of what causes estrogen dominance. Also, how it actually looks on the lab work, and what are some simple things that you can do to help to start improving it in the right direction.

What is Estrogen Dominance?

We have this ratio of estrogen that’s a little bit higher in relation to what the normal ratio of progesterone should be.  So let’s establish what those norms are.  So Dr. John Lee talks about the fact that progesterone to estrogen, that amount of progesterone to estrogen can be anywhere between 200 to 300 times.  So progesterone can be 200 to 300 times more than 1 molecule of estrogen.

Now typically, we see this 200 to 300 per ratio right around day 20 of our female cycle.  Day 20, so right here is where we typically see this ratio intact.  Now right around day 20, we could be making about 200 micrograms of estrogen. While we’re making 20 to 25 milligrams of estrogen, that 200 or 300 time ratio can be seen.

Now if you add all the plots of progesterone up in blue and all the plots of estrogen in red typically on average, this will be day 18 to 22 roughly.  But if we’re looking at an average, typically you’re looking at about the 23 to 25 times ratio for progesterone in relationship to 1 estrogen.

To delineate, typically around Day 20, we’re looking at a 200-300 progesterone:1 estrogen. While over here, a 23-25x progesterone:1 estrogen, in general.

So, this is from a research of what Dr. John Lee.  He’s written a couple of books on this topic.  So when we do a month-long cycle, we can really delve in and see some of these imbalances.

Got female cycle problems? Click here to get more in-depth information on how female hormones work in your body.


Female Hormone Cycle Overview

Let’s walk through normal female hormone physiology briefly.

  1. Drop in hormones: This triggers menstruation or bleeding. That’s important because it’s causing the endometrial lining to slough off.
  2. Menstruation / Bleeding / Period
  3. Increase in FSH. This increase in FSH grows that follicle into an egg. That follicle then starts to produce an increase in estrogen.
  4. Increase in estrogen: Increase in this hormone causes LH or luteneizing hormone to trigger increase in progesterone. It peaks typically around day 12 or 13.
  5. Increase in Progesterone: It spikes typically around day 18 to 22. That’s where the ratio 200-300 progesterone:one molecule of estrogen can be seen.
  6. Drop in Progesterone

That’s our normal female hormone cycle and typically we start to see the ratios skewed. Our average Progesterone:Estrogen (P:E) is 23-25x. And at day 18-22, it is about 200-300x.

That is estrogen dominance affecting the female cycle. We start to see these ratios skewed.  So estrogen dominance would be occurring when we start dropping below 20. Most women I see are in that 20- 50 to 20-80 around their peak, where they have significant less progesterone, but they also have a lot less estrogen, too.

Female Hormone Level Imbalance

I see a lot of women whose hormones are very depleted where the ratio may not be great, but it’s the hormone level by itself that is may be even worse.  So estrogen dominance is really just looking at a ratio.  You can still have low estrogen and low depleted hormone levels and still be estrogen-dominant.  That’s kind of a big myth and depleted hormones make it really hard for you to heal and regenerate.

So looking at estrogen dominance symptoms, we have bloating, cramping, fibroids, tissue growth, moodiness, and endometriosis. It is a hormone signal that causes cells to grow.

Progesterone is a hormone signal that causes cells to grow up, ideally mature. So growing is like me lifting weights and just getting big. So that’s the estrogen analogy. The progesterone analogy is like a child growing into an adult. One is maturation.  One is just bulk.

Now estrogen is important because we need that when it comes to certain tissue like in the endometrial lining, but progesterone is important to help that egg bond to the endometrial lining and then essentially maturize into a grown baby.  That’s the goal and that’s why these hormones, they’re on a teeter totter and they’re incredibly important.  But if we have this imbalance in progesterone and estrogen, all of those estrogen dominance symptoms can happen.

Kinds of Estrogen

So we have a couple of different kinds of estrogen.  We have DHEA which is a part of the adrenal hormones, but it’s also part of the ovaries, too.  That converts to our main estrogen, estradiol.  Estradiol, otherwise known as E2–look at that prefix here with the di, E2 can get converted into E1.  You can see the estrone–look at the O-N-E.  And this can go either one of two ways.  It can go to our 2, which is our more healthy estrogen or it can go to our 16, which is our more anti-healthy, unhealthy, disease-promoting estrogen.

And again, our ratio is we like to have greater than 2 over here to 1.  So we like a 2:1 ratio or greater for healthy estrogen balance.  Estrogen dominance is kind of the macro view, the telescope view.  Now we’re looking at estrogen metabolism.  That’s more of the microscope and the microcosm view.  These are just how estrogen is being metabolized.  But this is important, too, because you can have more bad estrogens on this side of the fence, and then you may experience more estrogen dominance symptoms because of the fact you have this imbalance ratio.


The Metabolic Process in relation to Estrogen

Estrogen dominance is estrogen in relationship to progesterone. But we also know that how estrogen is metabolized can also create estrogen dominance symptoms.  So a lot of people that we see–we’ll run organic acid testing and we’ll look at these various organic acids like sulfate or pyroglutamate, hippurate, glucarate,. Also, we’ll see backed up metabolic processes or pathways to metabolize these hormones.  Another is we see something known as beta-glucuronidase, where we have an inability to metabolize some of these estrogen hormones.

So think of beta-glucuronidase as an enzyme and it’s there to take the straitjacket off of our metabolized estrogen.  So when our body goes and metabolizes hormones, it conjugates it.  It binds a protein to it. In other words, puts a straitjacket around it so it can escort it out to the kidneys and the liver and the stool.

Now beta-glucuronidase, this enzyme occurs when we have dysbiosis, a high amount of bad bacteria in the gut, in relationship to good bacteria. That beta-glucuronidase comes in, it unhooks the straitjacket and now the estrogen can go back and become reabsorbed and create lots of hormonal issues.

Again, estrogen also makes bile sludgy and this is why people that have estrogen dominance can also have digestive issues because bile is so important for fat breakdown. And you actually need good fats to make your hormones. So you can see how estrogen and digestion actually compound each other and make your hormone issues worse in the future. If you can’t make bile, you can’t break down fat. And if you can’t break down fat because bile is needed to break down fat, then you can’t make the fat into your hormones.  So you can see how one problem actually makes the other problem worse and worse as you go on.

Estrogen in the Body and in the Environment

Bad amount of beta-glucuronidase from this imbalance in bad bacteria and infections then takes the straitjacket off all these metabolized estrogens.  They get reabsorbed into the system and that can create more hormonal havoc.  So you can see, estrogen dominance in our cycle.  We can see it through our metabolites and then now we can break it down via the environmental causes.


The gut, through the beta-glucuronidase, through the dysbiosis, through the SIBO, through parasitic and fungal and bacterial issues.  All of these things cause low stomach acid and low enzymes, inability to break down food.  We can’t break down our food.  Our food sits in our tummy.  It rancidifies.  It putrefies and it makes the problem worse.  So one problem kind of begots the next.


So the pesticides, the chemicals, the GMOs.  Again, these pesticides are estrogenic-based.  So they go into our body and they have an estrogenic load to our body.  So pesticides add more estrogens.  The plastics contain estrogens as well.  And again, estrogen cause cells to grow.  The scientists back in the late 1990s, Dr. Sotomayor, over at Tufts found that when she put her cells into the plastic test tubes, that the cells would grow more vigorously in these test tubes, kind of like cancer does. She found that it was the plastic test tubes especially the BPA was causing those cells to grow.


So now flash forward, people are putting their food and their water in plastics all over the place and we’re reabsorbing those chemicals which cause our cells to grow. This is because they have an estrogenic like effect.  So environmental estrogens from food and from plastics and then also from phytoestrogens contribute to estrogen dominance.


Soy can be devastating because there’s a lot of gut and enzyme inhibitors in it such phytic acid and oxalic acid and chymotrypsin in various trypsin inhibitors, which affect protein breakdown but they’re also estrogenic.  They can add to your hormone levels of estrogen and for many, can be incredibly devastating because estrogen is the opposite of testosterone.  And men need testosterone to be healthy and virile.


So again, we have the gut and we have food.  We have phytoestrogens and we have plastics, and again all of these are so important. Also, if we don’t have the gut working, we don’t have the building blocks to make the hormones, which then makes the problem even worse.  For so many people, it’s hard for them to wrap their head around the fact that their gut could be a potential hormonal causing factor that could be driving a lot of their hormone issues.  People think the gut and the hormones are like two separate things.  “Hey, if I don’t have digestive issues, well, there’s no way that’s part of my hormonal issues,” but it can be.


If you have a hormonal issue or long-term issue, we may want to run a month-long test, if not, a test that looks at hormones especially in the sensitive time of your cycle around day 18 to 22.  We may also want to do an adrenal test to get a window into how your adrenals are functioning because your adrenals produces a significant amount of DHEA, which is depleted in people that are chronically ill.

We also want to dig into the environmental and lifestyle causes over here that could be driving the issue.  And there’s a lot of natural cyclical augmentation programs and adrenal programs and gut-healing programs that we do on the functional medicine side to address the underlying cause of what’s driving these issues.

So click on screen, subscribe to my female hormone balancing video series. And if you’re struggling with this issue, and you want to take it to the next level and get to the root cause, reach out on screen or below and I’m always here to help.

Discover the root causes of your female cycle issues by contacting a functional medicine doctor.

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.