Top 3 Ketosis Tips for Success – Dr. David Jockers | Podcast #240
Ketosis is a normal metabolic process that provides several health benefits. It’s a popular weight loss strategy wherein your body converts fat into compounds known as ketones and begins using them as its main source of energy. Ketogenic diets may even have benefits against diabetes, cancer, epilepsy and Alzheimer’s disease.
Read and listen through this podcast as Dr. J and his special guest, Dr. David Jockers discuss the Top 3 Ketosis Tips for Success.
Dr. David Jockers
In this episode, we cover:
00:43 Ketogenic Diet, Intermittent Fasting
01:10 Importance of Hydration
09:08 Stress Control and Good Sleep
13:54 Keto Adaptations
28:34 Meal Time Strategies
Dr. David Jockers: Hey always great to be on Dr. J, I love listening to you and Evan. Big fan of the show, so always great when I get to be on. And I love our conversation. So thanks a lot.
Dr. Justin Marchegiani: Yeah well thanks for being here, Doc I really appreciate it. So let’s dive in to it, you’ve been utilizing ketogenic diet, intermittent fasting, these tips these techniques to help improve insulin sensitivity, to help with cellular turnover and healthy aging. So what’s the number one thing right now that you find that patients have a barrier with it, when you make this tweak or you make this adjustment, they get to their next level of health utilizing a ketogenic diet?
Dr. David Jockers: Now I would say the number one thing is hydration. You see, in our brain our, our hypothalamus, our hunger center and our thirst center are right next to each other. And whenever we eat, we stimulate dopamine. It helps us feel good. And I think that’s a great adaptation, because you know it’s like, it’s great to feel good when we eat and it helps drive us to eat to consume food. But what happens is because food so prevalent in our society today, whereas as our ancestors didn’t have access to, you know we didn’t have pantries and refrigerators and things like that in years past. So food is prevalent. We could literally be eating all day long and we’re constantly stimulating that dopamine. And so for many people have become addicted to it, and our hunger and our thirst center are right next to each other in that area of the brain. And so for many people they’ve had these neuroplastic changes where the hunger center has now moved into the thirst center. So they’re really thirsty but they experience it as hunger. So they’re like I need something, I need a dopamine hit. There’s something that I’m missing and there’s food, I’m going to go for the food, and really most people are chronically dehydrated meaning more fluid. We need more water. And so I find that drinking more water, hydrating your body really well especially when you first wake up in the morning, so critical, so critical, for intermittent fasting, so critical for fat burning, for cleansing the body, for energy production, for good mental clarity, and for Keto adaptation. And so getting some good water, I recommend drinking you know, if you’re not used to it start with just eight ounces, OK. But ideally, trying to get 16 to up to 32 ounces of water within the first hour of waking up. So really hydrating your body well because when you’re sleeping overnight you’re breathing out water vapor. So you’re actually losing water throughout the night. So when you wake up in the morning really hydrating well, not only will replace that water, but on top of that it’s also going to help stimulate energy production, you’re going to notice that your energy goes up, the better you’re hydrated, more energy production your body’s going to have, you’re also going to poop better, right. We want to get poop out, want to have good bowel movements early in the morning, you’re at your large intestine is most active. So my goal is always to have two really good solid bowel movements within the first hour of waking, and it’s like my energy is just amazing, my mental clarity- I’m so productive when I’m able to do that. So hydration is number one tip.
Dr. Justin Marchegiani: I think that’s amazing. I’ve been following that for years. When I first discovered the book, your body’s many cries for water by Dr. Batten and Gila. She talked about that. I’ll add some extra like Redman’s real salt or I’ll use a trace minerals support I’ll add to it. Today, I had a little bit of alcohol last night so I before I went to bed I have a drink, I typically drink mineral water in between each alcoholic beverage to get the extra minerals back in and then I did a lot of glutathione before bed and a lot of vitamin C and extra electrolytes to start my day, and those stretch receptors in your tummy when water comes in, it hits those stretch receptors and allows you to feel more satiated and then naturally have an appetite that’s more calibrated with what their nutritional needs actually are. So that’s a great tip.
Dr. David Jockers: Yes so important, I mean we have that ghrelin hormone. And so when we’re when our stomach is empty, ghrelin going to come out and tell us we’re hungry. So yes the eating a big breakfast in the morning, it’s normal for you to want to eat a big breakfast because you conditioned this response that ghrelin pop out. What if you just start by hydrating your body you’re gonna notice you’re gonna be more satiated. This is a great way to get started with intermittent fasting- you just hydrate your body really well in the morning, and then wait for natural hunger to come after that, to start with the hydration, now allow the natural hunger to come, you know, as it comes naturally after that. Yeah definitely getting the electrolytes and to adding some —
Dr. Justin Marchegiani: Yes it’s very important. And as insulin levels drop too we tend to pee, pee more because insulin tends to pull sodium. Sodium tends to pull water. So that’s why you know someone does a ketogenic diet and drops their carbs really low they’ll lose three or four pounds the first day it’s not going to be fat it’s going to be water. So yeah I mean that’s that’s a really salient point because we are going to be losing a lot of that water so we have to make sure we get it back. And I would even say the key electrolyte to on keto that I find is really low is potassium. So really upping the potassium and or just really focusing on lots of green vegetables and avocados is another awesome tip for sure.
Dr. David Jockers: Yeah. That is important and sodium too actually. When you lose a lot of sodium, so getting a lot of those salts are really the cool thing is in nature you get potassium, and a lot, you get potassium and sodium and good ratios right. So avocados actually have sodium, celery potassium and sodium, C vegetable. Right. So all these natural foods [inaudible], these broccoli cauliflower got potassium and sodium. So if you’re consuming a lot of those things and then salting your food up to your desired case. I don’t think you need to go beyond that. Not like I’m shoveling salt in your mouth. They just flush you out right. Probably just move your bowels, could you loose stools but instead just salting up to your taste. And even if you’ve been told to be on a low salt diet, it’s kind of like what you were saying there, Dr. J you know, basically once you, once your insulin goes down, you turn a lower carb diet or if you are doing some fasting, your insulin is going to drop down and when you when you drop insulin, you start to excrete sodium. With that sodium comes the water so you need to replace that. So adding in these good trace mineral rich foods, even grass fed meets you’re very rich and in minerals, a lot of good salts and they’re really really good stuff. Dark green leafy sea vegetable, a lot of things we we just talked about, fermented foods, olives, pickles, sauerkraut, all really really good stuff when it comes to trace minerals. So getting those in your diet and then just salting up your desired taste, really good. And then I mean it’s really as simple as this when it when we’re talking about taking Redmond’s real salt or Himalayan salt. Yes a little pinch on your on your finger and put it on your tongue. Specially noticing that you’re just feeling a little bit dizzy or especially a lot of people when they start intermittent fasting or if they start going in a low carb diet, they feel a little bit dizzy, a little bit spacey and oftentimes that’s an electrolyte issue. So just taking a pinch of salt putting it on your tongue, drinking you know, two to four ounces of water and shrinking a little water after that can knock that out right away. I’ve also seen people with allergy symptoms, certain having like a runny nose and coughing things like that, taking a little bit of salt and water actually acts as a natural antihistamine. Dissolution, yeah because histamine actually, one of its jobs in Doctor, Doctor Batman is who I helped in that book he talks about it talks about histamine helps triaged water so we become dehydrated. We triaged water into organ systems that are most vital, like the brain, heart rate. And so therefore the mucous membranes get less of it. So we’re more likely to have allergic type responses right and plus we have elevated histamine in our system. So when we hydrate the body, get the electrolytes in, naturally reduces that histamine response and we get more balanced, more balanced histamine response, therefore, less of the congestion right runny nose things like that.
Dr. Justin Marchegiani: Yeah, totally makes sense. Love it, love it. and then what’s your favorite brand for a good mineral salt? Redmond’s Real Salt?
Dr. David Jockers: Redmond’s Salt is great. Absolutely. That’s what I think. I think it’s a little bit lower costs than Himalayan, Himalayan sea salt a great one, Celtic is a good one. So any of those are great.
Dr. Justin Marchegiani: And then just people listening. It’s not just sodium chloride, your typical table salt would be sodium chloride. It’ll be bleached as well. So we’re talking about salt that have you know 60 70 different micro minerals as well as just sodium chloride. So you’re getting a lot more in there. I think that’s phenomenal. What’s number two. Dr. Jockers?
Dr. David Jockers: Yes. So we talked about the water in the electrolytes obviously we’ve got to start with that. Number two is really controlling your stress and focusing on good sleep. So most people understand this but you know we’re under stress, we’re gonna be elevating our blood sugars, so higher amounts of stress hormone are telling our body we’re in a place of fight or flight and when we’re in place or fight or flight we think we might need to sprint at any moment with survival. Right so our bodies naturally can elevate our blood sugar, and when we do that, then you know if we’re not running, so we’re just stressed out like we’re sitting in traffic, whatever it is, your spouse says something, and we’re stressed out about it ,we’re elevating our blood sugar but we’re not giving the response the body needs which would be to run or lift something, I had to climb a tree so therefore we just end up with this elevated blood sugars in the body towns out some insulin to help lower that blood sugar, high blood sugar can be toxic, can actually cause damage to the nerve system, cause advanced location and products, all kinds of all kinds of oxidative stress, so the body gets insulin up to take the sugar out of the bloodstream and of course, when insulin is up, that’s going to inhibit the production of ketone to burn fat. So insulin being elevated because of the stress response is going to cause you to not be able to burn fat, not get into ketosis, and therefore it’s also going to cause kind of this spiral where you’re going to end up with hypoglycemia, because oftentimes you’ll drop that blood sugar too low. Yeah. And another stress response and this is a vicious cycle, you’ve got to really keep your stress under control. Why I never tell anybody to start intermittent fasting or start a ketogenic diet. If you’re already overwhelmed by stress, like if you would describe your life you’d say, I’m just overwhelmed by stress. Not a good time for you know a ketogenic diet or fast. That’s more for somebody that’s got stress under control. Now these are hacks that are going to really take really improve your body’s ability to be more resilient to stress, to improve your fat burning, improve your brain, down regulate inflammation really powerfully. But first you have to get your stress under control and you’ve got to get your sleep under control because if you don’t sleep well, then you’re you’re naturally going to be under a higher amount of stress. If you get if you’re getting consistent poor nights of sleep, even if you don’t feel stressed out during the day you’re going to have higher stress hormones which is again going to cause that cascade of high blood sugar and high insulin.
Dr. Justin Marchegiani: Totally makes sense, and I see an email in my inbox that you sent me a couple of days ago for your newsletter and you talked about some of your favorite adaptogens. Yes. Again this is kind of what you probably plug in on the supplements that outside of diet and lifestyle modifications. I imagine you’re probably using some adaptogens to help modulate this stress response. Is that true?
Dr. David Jockers: Oh absolutely. I love [inaudible]. A great one. Magnolia fish [inaudible] reishi mushroom. Yeah. Lemon bomb right. Very good relaxing herbs. If you want more energy, something like Rhodiola. Really good siberian ginseng. Another great one for energy. Right. The great thing about adaptogens is they’re going to help balance you. So if you feel anxious, all right, and jittery, they’re going to help bring you down, if you feel fatigued and lethargic, they’re going to help bring you up. and that’s the great thing about them. They just kind of modulate and help balance you out. Also a huge fan of magnesium too. Know I find that most people are deficient in magnesium some magnesium can be really really powerful for helping modulate the stress response, modulation means balancing. Right. That’s what we want. You know we don’t necessarily want to increase or decrease. We want what the body needs at the moment. Right. We want to help balance it out, so we were able to adapt to the environment adapt to the stressors we’re under and be able to perform at our highest level. So those are those herbs and Magnesium here are key.
Dr. Justin Marchegiani: That makes sense because people I think forget like, they’re so focused on their diet. Hey I’m trying to keep these carbohydrates down because these eventually will break down into glucose or fructose in my body and have potentially a negative effect at burning fats or cause insulin resistance. People forget that their cortisol levels can create surges of glucose through either protein in their body or just releasing glycogen that’s already in their muscles and that can be the equivalent of having an extra carbohydrate that you wouldn’t want to eat but eat you’re not even eating it, it’s being released internally from these different stores and you can still have deleterious effects, so the adaptogens like you mentioned I think are great, just getting those glute four receptors upregulated on the muscle, these are little fingers that help pull glucose into the muscle and you can do that by movement, by taking a walk after after an hour, or doing some bands or some resistance training to help soak up a lot of that glucose, that’s really good points.
Dr. David Jockers: Yeah absolutely. So important. A third big thing is to you know basically, you want to gradually move into Keto adaptations. So for some individuals I say about 25% percent of the population they can start today. They might have eaten 500, 500 grams of carbs yesterday for twenty five percent of the population. They can go down to 20 carbs and actually feel great within the first week. That’s only 25 percent the population. The other 75 percent is gonna feel really crappy. Yeah. So what we want to do to be on the safe side is, gradually reduce your carbohydrate load. So if you were to take it for example, if you were to take this week or the next three days and just count out how many carbohydrates you’re consuming, right. Subtract the fiber, so your net carbs, total carbs minus fiber that you consume on a daily basis, you keep track of your your macros and you can use like chronometer or something like that. See, see where your carbohydrate load is. Let’s say you’re consuming 250 grams of total carbs, right, in a day. OK great. So for the first week, all you do is you reduce it down by 50 grams. So for the first week, you’re going down to 200 grams of net carbs. So total carbs minus fiber, you replace that with a couple grams of, well not a little bit more than a couple, but roughly about 10 grams of healthy fat. Right. So you eat a little bit, eat a few more olives, you know, a teaspoon of olive oil something along those lines, you just add that and while you take out the carbs, and then you do that each week you drop it down roughly about 50 grams each week. So if you started at 250, you know, by the time you get into the ketogenic range, it’s roughly between 20 grams to 50 grams. It’s about five or six weeks. Right. So you give your body time to start to adapt and build the metabolic machinery to be able to run on a lower carbohydrate diet and use fat for fuel. And I think that’s a big thing. A lot of people try to jump right in, they try to go cold turkey and have a bad experience when you gradually shift into it. So you’re leaning into it, shifting into it. You give your body time to build the metabolic machinery to get more familiar with that with ketones in the bloodstream. Right. So if you’re eating 250 grams of carbs a day, your body has not seen ketones. It doesn’t. It’s not familiar with how to use them for energy. You’ve got to give it some time to see that in the bloodstream then it’s going to up regulate the enzymatic systems to sort to use that for fuel. So that’s a really important strategy. Just keep dropping it down roughly 40 to 50 grams of carbohydrates, replacing that with healthy fat or in some cases, healthy protein if you’re on a very low protein diet, but replacing that until you get into that 20 to 50 gram range. And typically for somebody at sedentary. So if you’re not doing a lot of movement, you’re going to need to get your net carbs down in that 20, is certainly under 30 range and some in some cases under 20 if you’re very insulin resistant, you’re more active. You could find that you’re going to get into a state of nutritional ketosis which is zero point five million miles or higher when you’re testing your blood ketones with, you know, you probably are going to be able to handle up to 50 grams of net carbs and be in that range. And if you’re extremely active high level athlete maybe they’ll take up to 100 hundred and twenty grams in that carbs. So you got to kind of find the right zone for you. So once you get into that zone, I tell you, you know my recommendation is spend 30 days in that zone. I think 30 days in nutritional ketosis is extremely powerful for helping clean up cellular debris reset your systems. I mean ketones, epigenetic modulators. So they help to help your body to express genes are gonna have more anti aging benefits, are going to help upregulate mitochondria and support healthy mitochondria. So you spent 30 days in that and then you find a good carb cycling strategy after that. Right. For some people they like to carb cycle, you know, every other day, for some people it’s you know once every 10 days, where you have a higher carb day where basically you’re.. you’re consuming more carbohydrates roughly somewhere between 50 and maybe up to one hundred and fifty grams of of net carbs depending on you. So if you tend to be more insulin resistance, you might do less. Like for me I tend to be more insulin resistant so I.. For me it’s like a higher carb day might be 70 or 80 grams of net carbs. OK. Whereas for somebody else they may be able to tolerate a little bit more especially if they’re very very active. So you’ve got to kind of find the right zone for you and then you drop back into ketosis. OK, find again, find the right strategy. So for some people they’ll do a feast day once a week, where they’re like one day a week where you know, they’re eating 150 grams or 100 grams net carbs, so just consuming more carbs and for them that works great. Right. And then usually takes them two days or so to get back into ketosis. If you do a high carb day like that and it takes you a week to get back into ketosis, then you really shouldn’t be carb cycling once a week right then you would probably want to carb cycle like once every two weeks once every month. Something along those lines. That way you’re you’re splitting your time right. You want to spend some time where your body is utilizing glucose right for fuel and basically resetting your glycogen stores. You also want to spend time in this state of nutritional ketosis. You got to find the right carbs cycling approach, and the strategy I like to apply is more of a carb backloading strategy. Yeah I like to eat less during the day I eat less food during the day hydrate. I do a lot of hydration during the day, keeps my energy high. It allows me to perform at a higher level because stress is the antagonist to good digestion, meaning that when we’re under stress, we’re not gonna be able to produce as much stomach as–
Dr. Justin Marchegiani: Correct.
Dr. David Jockers: The bile pancreatic enzymes to digest our food well so I like to do more smoothies ,right, things that are predigested during daytime. I’ll throw avocado in my my protein shakes so I get more healthy fats. But the blender is the job of the digestion and then the evening that’s when I feast, right. That’s when I had my big meal meat, right. Vegetables. Healthy fats on there. And I find that that approach works well and especially if you’re going to add in more carbs, doing a lower carb during the day. So if you want to eat solid foods, eggs, right. Maybe like a big chicken salad with olives, and I’ll add avocado and olive oil or something like that where it’s low carb throughout the day and then when you add in the carbs, you do it more in the evening, your sweet potato, right, or your your steamed carrots, beets, if you want grains something like Quinoa or or rice or something along those lines, doing it more in the evening you’re going to notice it. That’s going to get better benefits. A lot of research on that for helping stimulate fat burning, right and supporting the sensitivity.
Dr. Justin Marchegiani: Some people, one of the side effects with Keto sometimes sleep can deteriorate and that could be from a hypoglycemic kind of episode before bed. So if that’s happening, maybe adding a tiny bit of carbs or even a tablespoon of coconut oil to provide some more of those ketone precursors before bed to keep that blood sugar and add an additional fuel source outside of the blood sugar in your bloodstream.
Dr. David Jockers: Yeah yeah for sure. Absolutely. And I think if you do the slow keto adaptation approach you’ll notice less of a hypoglycemia. Which will definitely help you. Your bio get better and better at using ketones. But a big thing that I do see is that people aren’t feasting. Right. So if you’re under eating for a certain portion of the day you’re eating a lower amount of calories in the evening. Definitely eat a higher amount of calories right to make up for it. And that is a mistake I see a lot of people make is they reduce the carbs but they don’t they’re not as generous with the fat. And therefore, they end up not just not consuming enough calories which can then cause the hypoglycemic type issues especially for like lean women. I see that a lot of lean women having that issue don’t have as much body fat. The body’s trying to protect the body fat tissue.
Dr. Justin Marchegiani: I see that all the time. You don’t get enough fat in there to replace some of the carbs that are pulled out, then you could still be in a caloric deficit and that can still create a stress response. So I think that’s really important because the whole goal is we have this kind of fuel partitioning mechanism imagine like an air traffic controller. Right. Planes come in. You point this way, you point that way, imagine an air traffic controller saying, OK go to the mitochondria get burnt up or go back into the fat cells and get burnt up get get stored. So we want to be an air traffic controller shuttling everyone to the mitochondria, to the muscle cell to get burnt and not get stored. And we have to change these cellular enzymes. We need more lipolytic, right, lipo meaning fat, lytic meaning to break down some more lipolytic hormone, sensitive light pace Growth Hormone thyroid hormone versus insulin, lin lipo eugenic hormones on the storing or formation side. So I think what you’re saying these are just basically unregulated that air traffic control, what if they get burnt up and this cellular energy can’t be snapped on and the more insulin resistant you are like you’re highlighting, this may take a few weeks maybe even a month and you’re having a tapering protocol just so it’s not so painful. So you don’t develop this Keto flu type of thing where you’re you’re tired, you’re achy. Correct?
Dr. David Jockers: Oh yeah absolutely. So the keto flu is going to be related to hypoglycemia, you know the light imbalances like we talked about and HIPAA axis dysfunction or you know we’ll be college adrenal fatigue. Right. So it’s kind of a combination of all three of those and they all work together. So you’re absolutely spot on and we want to be able to adapt and teach the body to be able to run and use fats for fuel. Right. That’s the key there. Now another caveat to it. And Justin, you probably test fasting insulin on your patients is that correct? Yes. So I test that on all my patients right fasting insulin levels, and so normally if you’re fasting for 12 to 14 hours you finished dinner let’s say 6:00 p.m. You’re doing your bloodwork at 8:00 a.m. something along those lines. Your ideal fasting insulin should be roughly somewhere around three to five right in that range. If you’re on the lower end, they’re like two three. OK, you probably need to do a little bit more carb cycling, you probably need a bump that insulin a little bit more. OK if you’re on the higher end right. There’s a lot of people out there you know they’re they’re insulin levels fasting insulin is 12 14 16. These are people that are going to do better doing fasting, right. Intermittent Fasting, longer fasting, and lower carb throughout the day to get that insulin level down. OK. So that’s another caveat getting your fasting insulin levels tested. That’s going to help you understand your carb tolerance right.
Dr. Justin Marchegiani: Just kind of piggyback on that, Christopher Gardner did an amazing study out of Stanford in 2007 called, The A to Z Study, and this study was interesting because he compared four different kinds of diets– he compared and Atkins style diet, and Ornish kind of you know higher carbohydrate more vegetarian diet, the Zone diet which is like a 40 30 30 and then I think a standard American diet. So there were four diets and it was interesting because the Atkins group, the lower carb group had the largest amount of success. But then there were still people that were successful in other groups and then they looked at the people and they tried to extrapolate why a lot of people in the act is that great. But why. There were some people in other groups and what they found in the higher carbohydrate groups, the people that did well were the ones that had their fasting insulin below seven. So in other words, the people that were more insulin sensitive, meaning their pancreas made the less insulin, they could tolerate the higher carbohydrates and that threshold was seven anything greater than 7 they could not tolerate the higher carb, and they only got success on the lower carb group because that helped bring their insulin back into balance. And I agree that study this seven I like two to five, I think gets a good point and I think this is really important people listen like you know we’re practitioners so, we understand that there are some people that do well not following that exactly and the question is why? We don’t want to be dogmatic and say no. Everyone has to and it’s a rule it’s tough but we have to understand why there may be some exceptions and that’s I think one of the biggest data points that we can use to say hey these are the people that are going to benefit these you may be able to break the rules a bit and then we can actually have some objective data on that.
Dr. David Jockers: Yeah, absolutely because you do need insulin, you need insulin in particular for converting T four and T three. So you’re active thyroid hormone and if you don’t get that, know this is where we’ll see people start to for example lose hair, when they get really really fatty, they get constipated, they get really really cold, when they’re fasting, or on a ketogenic diet it’s a sign that it probably ban under consuming calories right as a whole. And possibly not carb cycling enough. Right. And that’s really big. So even on a low even on a low carb diet, if you do like a very high calorie meal once a day. OK. So where you’re doing like maybe under eating, lower amounts of calories for a period of time and then of a larger meal, your body is going to still secrete a lot of insulin like on a low carb diet. When you. Eat a lot of food your body’s excrete a lot of insulin. OK. And so you want to get at least, unless you’re like in a period where you’re just doing an extended fast for a specific reason, you want to get a really good shot of insulin at least once a day. I really once no more than twice a day in my opinion. OK. But you want it when you do get it, you want to get a good shot of it. What happens is in our society it’s like people are just continually spiking it because we’re eating all the time right. We’re eating every several hours just continually getting spikes of insulin that promotes too much inflammation right. Insulin is going to activate your inflammatory home right and amplify inflammation throughout your body. But if you strategically get it, once, maybe twice a day. Right, a really good spike of it then that’s going to get. That’s the right amount to activate thyroid hormone to enhance cellular energy production is a lot of good benefits that are going to come from that.
Dr. Justin Marchegiani: I think that’s great. And what’s your strategy on mealtime and I know we’ve talked about this as, I think for a while you were doing kind of o mad one meal a day. How are you timing your meals and then how do you dial that in for patients exact.
Dr. David Jockers: So here’s how I do it personally now. I’m about one hundred, one hundred sixty five pounds strong, I’m an 8 percent body fat it’s mostly just muscle tissue, and the way I do it is I workout four days a week, when I workouts very intense strength training, so I’m usually working out for about 45 minutes or so strength training. Monday Tuesday Thursday Friday are typically my spring training days and what I do is on Wednesday, and on Saturday, I only do one meal one meal on those days, usually it’s lunch dates, whatever’s most convenient for me I’m usually eating lunch I find that I just do best at that time. Right so one o’clock, two o’clock, something like that having a really good really good solid lunch and then that’s it, you know just hydrating outside of that and then on the other days, I’m consuming two meals, lunch and dinner, right now typically my dinners are usually my largest meal of the day. I’m consuming a lot of a lot of food right. I mean I’ll easily consume fifteen hundred calories or so, you know a typical dinner. All right. And usually my lunch, if not, I mean I probably could even consume two thousand calories, my dinner and my lunch is usually probably somewhere around five hundred eight hundred calories, somewhere in that range. OK. And yeah that’s how I do it and I function amazing in fact my best sleep. My heart rate variability gets really high on my fasting days so when I’m, when I’m sleeping. Wednesday night and Saturday night it’s like I wake up the next day. I just feel amazing like so good. And that’s why I do it. In fact if I didn’t lose weight. When I would do one meal a day if I didn’t lose weight when I get it. So what happens is I tried that and I started losing muscle. I started losing weight and I’m already very lean as it is, very very thin. Five foot eleven hundred and sixty hundred sixty five pounds so so I feel amazing when I’m fasting but obviously I don’t want to lose weight. So. So that’s why I do the two meals five days a week. One meal two days a week seems to work amazing for me. Now when I do eat, I eat a lot of food. My wife’s always like, wow I’m fond of food. So in order to be able to digest that food effectively at its most effective level. I think a lot of digestive enzymes. OK. From time to time, if I’m under more stress, I’ll take a little bit of stomach acid support it would be THCL. Typically speaking a bunch of digestive enzymes works great for me. OK. And that works well and then I also take a supplement that has Curcumin, Turmeric, right. It’s also got a whole bunch of bitter herbs. It’s called fermented turmeric right. It’s got a bunch of different bitter herbs are really good for stimulating digestive juices production. So I think a combination of those and my digestion is great. OK. And that’s right I feel really good with it. And that’s typically my lunch most days, my lunch is liquid nutrition so usually I’m making a smoothie with Collagen protein. Yeah. Coconut milk, avocado in there. That’s usually my lunch and I might munch on like a cucumber that that I cut up and put some lemon juice on, some salt and some herbs. Right. Or maybe radishes. I’m crunching you know, chewing on some radishes. So it’s usually some sort of raw vegetable. Along with this sort of smoothie. And then for dinner it’s usually a lot of meat. So whether it’s grass fed beef, or we do like grass fed beef hotdogs and I’m familiar with those. Yeah those were great. Lots of vegetables so like steamed broccoli or cauliflower to make up mashed potatoes, and cauliflower all times calling mashed potatoes, broccoli with butter. So we do a lot of that. You know we started using this thing called [inaudible]. Now if you’re familiar with that, it’s hearts of palm, it’s pasta. It’s pasta with hearts of palm and then it’s great. My wife makes this amazing pesto right. We put pesto on that which has got olive oil and avocado and pine nuts and all kinds of stuff like that. So it’s just a scrape,we put chicken with that. So different things, different meals like that. So typically how I’m doing it.
Dr. Justin Marchegiani: That’s great. Excellent. I did something similar as well typically in my day in day out. I’m having some level of coffee in the morning with some butter at MCT and a little bit of collagen and that’s my breakfast, somewhere at three four hours later, I’ll have a nice glass of celery juice and I’m definitely drinking mineral water throughout the day ,and then my lunch is going to be a big salad typically, it’ll be about four, maybe five servings of vegetables, it’ll be a full avocado maybe six to eight ounces of chicken chicken thigh, or chicken breast with skin on and then an olive oil, olive oil apple cider kind of sea salt pepper type of salad, and then dinner will be some level of non starchy veg if maybe a little bit of starch, in there squash or sweet potatoes, and then mostly meat and vegetables, and then typically my Saturday, is my wife and I will have a date night and we’ll do like a steak restaurant and now I’ll just fast all day and I’ll just that one meal when I go out to eat. Typically that one day it’s nice. I’ll still do coffee with a little bit MCT just to kind of start my day off and get those ketones up and then I’ll just kind of ride that high all day long. And people listening if you have a lot of hormone issues or thyroid issues or blood sugar issues, you have to have some level of one metabolic stamina imbalance before you do it and to have that really good digestion like you mentioned, because now your meal is probably twice as big when you eat at nighttime and you really need the enzymes in the acids and good digestive function to be able to handle that load.
Dr. David Jockers: Yeah I mean I think that’s really really important is you know, for me for example, I don’t actually get hungry. I don’t feel hungry throughout the day. I don’t get hungry till I start eating. Once I start eating, I’m like OK my body wakes up it’s like, OK I need a lot I need food, right. And that’s actually when I get hungry. So for me it’s very liberating, fasting is so liberating because I don’t I just need to think about food, I’m not hungry I don’t have cravings my body feels great my brain feels amazing feels alive so it’s so good. But you’re right I mean fasting is a level of fitness. It’s kind of like you know if you were just if you, if you’ve never exercised and then you think OK I’m going to do a 5k and I’m going to sprint 5K obviously it’s not going to happen right. You’re going to be so sore and beat up so you’ve got to kind of lean into it right. I always said people start with twelve hours overnight–
Dr. Justin Marchegiani: 12 to 12 is the easiest to start with, you know, 7 to 7 or 8 to 8.
Dr. David Jockers: Simple fast just like that, and then do the water like we talked about in beginning it. Yes. You just hydrate your body well in the morning and allow for the natural hunger to come out, for a lot of people they notice 14 hours easy. Like my kids they finished dinner with us. We’re usually done eating dinner by 6:30. My kids sleep till like 8:30 in the morning. I don’t know if, I don’t know if, if if you’re if your child is like that too.
Dr. Justin Marchegiani: Same way same way and it’s all nutrition based. Like my son for dinner last night I mean he had a grass fed organic hot dog, a cut of avocado. And then he’s having a hard time with green vegetables. We’re getting green beans with sea salt on an organic green drink no added sugar no fruit juice in there and that will kind of pile that throughout the day and its meal. So yeah. I see kids that wake up. It’s all a lot of it’s blood sugar and it’s not getting enough fat. If that is humanly you gotta have that.
Dr. David Jockers: Yeah. So important got to have the fat so my kids will go well we’ll finish there by 6:30. We get him in bed by 8:30. They sleep till 8:30. They wake up. They take a bath right by the time they get breakfast. It’s usually like 9:30 or so. Right there. I mean they’re getting late and they’re fast growing kids, three and a half year olds. Right. So they’re getting like a 15 hour fast right there. Yes. And that’s because we have and they’re not on a ketogenic diet. They are, they’re definitely consuming carbs. Healthy carbs but they always have the healthy fats and they’re still on a lower carbohydrate template than your typical modern Americans ,or your typical sad diet. And so because of that they have better metabolic flexibility right. They’re able to go 15 hours here without consuming food. So what I find is that for most people 14 hours as long as you hydrate well as long as you’re sleeping well. Right. Doing those things. Not an issue. Right. And then especially if you do feel like you’re overwhelmed with stress or if you tend to be like a very lean woman or a lean woman that’s doing a lot of exercise. OK then one thing we’ll try to do is something called crescendo fasting, I’m not sure if you’re familiar with that now but that’s basically where we do a 16 hour fast. Two days a week. Non consecutive days. So be like a Monday Friday. Right. So fasting is a stressor on the body just like exercise is a stressor. So exercise may you know exercise is great, but if you do exercise five days in a row. Right. It will too stressful on the body. Yeah. I don’t recommend exercising more than two days in a row. After two days. I recommend taking a rest day. Like for me I do upper body. One day and then a lower body the next day and then the next day is always on resting. OK. So unless you’re like a high level athlete I wouldn’t wreck it there’s just no reason you actually the recovery is is where you get the most benefit. Right. You need to recover. So two days in a row. Same thing with fasting especially if you’re new at it or if you’ve been under stress or if you tend to be leaner. Leaner female then not doing it more than two days in a row and ideally a better way to start would be two non consecutive days a week, Monday Friday for example. Or your, your least stressful days like just you’re doing your long fast on a Saturday. Yep. Less stress on Saturday you’re hanging out with the family. Yeah. So it’s easier for you.
Dr. Justin Marchegiani: Exactly. Well Dr. David this is amazing. Lots of great tips. I think people that are listening to a lot of these tips are clinical as well. So we’re in the trenches working with patients so these aren’t theoretical things you know things that actually works out you know take it to heart, try to find at least one thing in this podcast that resonates and try to apply it. I think there’s some great information and for all you out there, head over to DrJockers.com. Make sure you subscribe to his email list. Also Keto Edge Summit, we’ll put a link down below if you guys are listening, just click there. Make sure you sign up to get access to all the great speakers and great content that’s available. Dr. Jockers, anything else you’d like to leave the listeners with today?
Dr. David Jockers: Yeah, I would just I would say, you know, definitely the Keto Edge Summit is great, we talk about all these types of things how to get fat adapted more effectively, how to kind of lean into fat agitation, like I was talking about before how to navigate through you know things like the Keto flu, how to prevent getting it and you know the tremendous benefits that can come from a state of nutritional ketosis. You know I’m a huge fan of diet variation, meaning that you’re not always in ketosis. Well I mean I would say some people probably about 20 percent of the population, 20 25 percent that will do great. Being in ketosis, you’re rounds right. But then you have the other 75 to 80 percent that are not going to do good. Being in ketosis your rounds. They need to cycle in and out. Right. You know for whatever period of time works best for them. So we go through that, Keto Edge Summit, and you know it’s really the goal of personalized nutrition. You know there’s there’s no cookie cutter approach. You got a kind of find what works best for your own unique individuality.
Dr. Justin Marchegiani: Dr. Jockers, thank you so much for all this great information. We’ll be in touch. You take care.
Dr. David Jockers: Alright sounds good. Thank you.
Dr. Justin Marchegiani: Bye.
Nutrition Basics: Macronutrients and Micronutrients
By Dr. Justin Marchegiani
In today’s Nutrition 101, discover what micronutrients and macronutrients are, and learn how to customize your diet to suit your individual needs and goals.
The basic template for a healthy diet is exemplified by the paleo diet: high in fresh vegetables, healthy fats, and high-quality meats. In the paleosphere, or in any diet, you can go high-carb/low-carb, high-fat/low-fat, high-protein/low-protein. These are “macronutrients,” and your ratios will vary depending on your body and your goals. What we want to focus on are getting in lots of nutrient-dense, low toxin, and anti-inflammatory foods. From there, we can play around with macronutrients.
In the 50’s and 60’s, fat was demonized because it packs a higher-calorie punch, and was measurable in blood cholesterol. We have since learned that not only is fat not bad for you- it’s actually very good for you! (So long as you are eating healthy fats).
Let’s look at the different hormonal effects of the different macronutrients.
Carbohydrates raise insulin more than any other macronutrient. So based on endocrinology, it is carbs that are driving fat gain. Insulin resistance is becoming increasingly common, and a large factor in the obesity epidemic.
Non-starchy carbs come mainly from vegetables. Non-starchy carbs are low in sugar, high in nutrition. Broccoli, kale, spinach, asparagus, carrots…
Starchy can be nutritious but are generally higher in carbohydrates. Sweet potato, yam, jicama, a starchy tuber, squash, etc.
Low sugar fruit
There are low-sugar, lower carb fruits. These include strawberries, raspberries, passion fruit, lemon, lime, & grapefruit.
High sugar fruits
Tropical fruits like papayas, mangoes, watermelon, bananas, and pineapple are higher in sugar and in carbs.
Why separate low and high sugar fruits? Fruit is primarily fructose. Sugar creates insulin resistance, and while fructose is milder, it can still create insulin resistance. So when dealing with fruit, or any sugary carbs, it’s important to take into consideration the glycemic index.
Protein primarily comes from two sources: animals and we have plants. Animal protein will include fat unless you’re going for super lean cuts. The carbs in animal protein (i.e. meat) are virtually zero.
Plant protein (not including low-carb plant-based protein powders) includes a lot more carbohydrates. Typically two-thirds to seventy-five percent of the bulk of that item will be carbohydrate. For example, rice and beans are about 15‑18 grams of protein to about 60-70 grams of carbohydrate.
So as you can see, animal protein is a superior source of protein. It’s much more protein-dense, and it is much higher in sulfur-based amino acids. Amino acids help run glutathione pathways, which is a natural antioxidant.
The Misunderstood Macro: Fat
The third macronutrient is fat, which can be broken up into subcategories. Mainly:
Monounsaturated fats: Good fat from avocados, olives, olive oil.
Polyunsaturated fats: There are better and worse types of polyunsaturated fats. Good sources include the omega-3s from fish. It’s best to avoid high omega-6 sources, like from corn and soy (foods you probably want to be avoiding anyways!).
Saturated fats: These had a bad rap, but are actually pretty excellent. Saturated fat primarily comes from animal sources, with the exception of coconut oil. Butter, tallow, bacon lard, as well as the fat you get when you eat meat and seafood. These are important to include in your diet!
Adjust Macronutrients According to Your Needs
Depending on your body composition, lifestyle, and goals, we can dial the carbs up and down. More carbs for those doing high-intensity workouts like CrossFit or triathlons. We can up the starchy and possibly the non-starchy if we have insulin resistance. If weight loss is the goal, we will go low carb, getting our carbohydrates just from green vegetables.
What should you eat?
There are three criteria the foods we eat need to meet:
If we’re eating foods that are driving inflammation, it’s going to cause our body to break down excessively fast, create pain, and put stress on our adrenal glands. Those are not good since that is going to break our body down faster.
Next, the foods have to be nutrient-dense. This is very important. Outside of macronutrients, we have micronutrients–vitamins, minerals, water. We have to make sure the foods we’re eating are nutrient-dense.
You’ll notice that one of the food categories I did not talk about are grains, and that’s because grains are very nutrient-poor. And then when you actually factor in gut irritation, lectins, phytate, oxalic acids (which can actually steal nutrients you’ve gotten from other foods!), grains are even more nutrient-poor and very inflammatory.
Low in Toxins
This is important, because even if you’re having some healthy broccoli- if it was grown with a bunch of pesticides, you’re eating all those toxins. Looking at quality is so important because you can eat the same macronutrient ratio, but if the foods you eat have carcinogenic pesticides, it can put stress on the body, stress on the liver, and disrupt your health.
Our macronutrient ratio can change depending on where we are in life, but getting high-quality food, rich in micronutrients, is something that should always remain a priority. If you’re doing that right, then the macros can be adjusted at any time. If you’re having trouble dialing in your macros or knowing which foods are best for you, schedule a consult today!
Improving Gallbladder Function with Functional Medicine | Podcast #216
Digesting fat is so important for one’s hormone growth and for healthy cell membranes as every single cell has a lipid bilayer. If one wants to be a good fat burner on a ketogenic template, it is really important to have great gallbladder function.
In today’s podcast, Evan Brand and Dr. Justin Marchegiani talk about utilizing functional medicine principles and assessment to figure out how one’s gallbladder is doing. Listen as they talk about what can one do about it, the common gallbladder symptoms, root cause solutions, and how can one get better from these symptoms. Stay tuned for more!
In this episode, we cover:
00:35 What is Gallbladder?
04:47 Consistency of Chewing Foods
08:16 Bile Surgeries
14:18 Autoimmune Issues that Affect Gallbladder
17:28 The 3 F’s of Gallbladder Issues
20:26 Some Advises if Your Gallbladder was Removed
26:32 Comprehensive Stool Test
Dr. Justin Marchegiani: Hey there, it’s Dr. Justin Marchegiani, welcome to today’s podcast. We’re gonna be talking about utilizing functional medicine principles and assessment to figure out how your gallbladder is doing. Also talking about what we can do about it, what are the gut- what are the common gallbladder symptoms, what are root cause solutions, and how we can get you better. We know, digesting fat is so important for your hormone growth, for healthy cell membranes. Every single cell has a lipid bilayer. And also, if you wanna be a good fat burner on a ketogenic template, it’s a really important we have great gallbladder function. So Evan, welcome to today’s podcast, man!
Evan Brand: Hey man, thanks for having me.
Dr. Justin Marchegiani: Awesome. Well, let’s dive in brother. I’m excited to- to dive in. So, first off, let’s just first dive in just to kinda physiology 101: what is the gallbladder? Why is it even so important? So, off the bat, gallbladder is kinda in this upper right quadrant here just beneath the rib cage, ‘kay? If it’s tender in that area like they’ll do a- a palpation that’s called Murphy sign, uhm, in that area where they’ll look for tender type of gallbladder issue where the gallbladder’s inflamed. But the gallbladder, it- it basically concentrates bile at about a 15 times above than the common hepatic bile duct in the liver wood. So when you’re having your gallbladder removed, that common hepatic bile duct up in the liver just drips bile all the time, it’s not specific, it’s not during a fatty meal, just kinda hits, and you can definitely have some bile acid diarrhea issues. When you have a gallbladder it concentrates that bile 15 times and then allows it to come out and time it, it- it squeezes, it contracts, and s- puts up that bile especially during a fatty meal ’cause you have these hormones in your stomach when that food- when that uhm, kind, that mixed up food in your stomach gets released into the small intestine. Uh, the nice acidity of that stimulates this uhm- neuropeptide called cholecystokinin or CCK for short. And that cause the- the gallbladder to contract and stimulate all these bile release which helps with fat digestion. If we don’t have a gallbladder, we’re not gonna be able to breakdown fat optimally through biliary concentration.
Evan Brand: Yup. So, you’re in to that fast, I’m just gonna repeat it so it gets into some people’s heads.
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: So, you say, when your- you put food down the hatch, especially fat, it enters the digestive tract, the body says “Okay, boom. There’s fat in here now, I’m gonna start making CCK”, and that comes from your duodenal, and I believe the jejunal as well, and then- it- to respond to the CCK, then the gallbladder goes “Oop, CCK is in the neighborhood, now I’m gonna release my stored bile because we’ve got fats to take care of”. So then the bile, or they call gall, will start working on these fats and then turning those fats into usable fuel.
Dr. Justin Marchegiani: Yeah, think of emulsification is like you have a greasy pan, and you put a drop of like soap, right, like some- some dish soap like dawn dish soap, and it kinda breaks it up, it emulsifies it. Think of that’s what’s happening if you got this greasy pan in your stomach, which is all the fat in your stomach going into your small intestine, that emulsifies it and allows your body to break it down and absorb it. It goes in these little things that form uhm- a- uh- a- a- a micelle, and that allow it to get into your body and be able to utilize it. Now, going up one kind of marker is hydrochloric acid levels. This is even important, this is more important because hydrochloric acid stimulates, it lowers the pH, and a nice low pH triggers cholecystokinin. So, we also need good pH function, good hydrochloric acid function and then that then, in the small intestine really gets the bile going, and then we also have some enzymes in the pancreas called lipolytic enzymes, lipase enzymes that also help with the pacre- with the- with the gallbladder in the- in the bile digestive process.
Evan Brand: Well, you make a good point, ’cause when we jump into this conversation, if we’ll look at the whole digestive cascade, as a big row of dominos, when you get to CCK and you get to the gallbladder, you’re really talking 3 or 4 dominos down the list but it’s good that you went upstream first to the mouth, where that’s where you’re chewing your food – hopefully you’re chewing your food, you’re not rushing through your meal. That’s why I don’t like things like chipotle, I enjoy the food itself, but it’s all soft, it’s mushy, meat and rice and guacamole, and you can just shove it down the hatch and you really have to chew the stuff. So, if I eat a soft meal, I still try to be very condescend about chewing, chewing, chewing, chewing, tellin’ the digestive system, “Hey, something’s coming down the hit- down the hatch”, but, you make the point about HCL. It’s why it’s so important when we- uh, talking about gallbladder symptoms which we’re getting to in a minute, to look for, and to treat if you have them, H-Pylori, and other infections ’cause, if H-Pylori is reducing your HCL levels, well, you can’t go straight to the gallbladder. I mean, you- you can, you can take bile salts to help it, but you didn’t fix the root cause, it was H-Pylori.
Dr. Justin Marchegiani: Exactly. So, kinda highlighting, we went from the gallbladder. What’s happening at the gallbladder, upstream to HCL, and that- that also activates other enzymes in the stomach called pepsin, and also gets the pancreas producing lipolytic fat breaking down enzymes, and then proteolytic protein breaking down fat enzyme, it’s- it’s very rare that you just have fat by itself, typically fat, protein and cholesterol tend to come together. And then, up one stream above is the chewing part. We wanna make sure we’re chewing our food at least 32 times, that’s about one chew per tooth, right, you have 32 teeth, so think of 32 chews, 32 teeth. And in general, getting your food’s to like an oatmeal like consistency, like- if you’re having a food that’s kind of more predigested like a chipotle meal, you gotta just make sure you at least chew to that good oatmeal-like consistency, and try to be in a relatively stress-free environment because the parasympathetic nervous system is really important for HCL secretion, thus enzyme secretion, and thus, uhm- bile secretion because we need that nice acidity, we need the enzymes, we need the digestive secretion. And for a sympathetic state, all that blood flow is going out extremities, our arms and our feet to run, fight and flee. So, it’s very important that we have good parasympathetic, so good breathing, gratitude, being in a quiet kind of relaxed setting to start our digestive processes.
Evan Brand: You know, I was trying to find some research on this, I am just gonna guess based on the mechanisms we discussed, that people on acid blocking medications probably have more issues with gallbladder. Would that make sense, ’cause let’s say you don’t have H-Pylori infection but you’re on an acid-blocking drug, isn’t that gonna just down-regulate this whole process we’re talking about?
Dr. Justin Marchegiani: Yeah, we need good acidity to trigger that CCK. So, that totally makes sense, right? And then we need- to be able to break down god fats. What are good fats? Well, we have our mono unsaturated fats are gonna be things like olive oil, avocado oil, and then maybe even some nuts and seeds. We have more saturated fats which are gonna be animal products, right? Grass-fed beef, uhm- any of our like, you know, fish, chicken, beef stuff, you’re gonna have omega-3 fats which are on the polyunsaturated category. Omega-3 is more polyunsaturated, and then you also have your saturated coconut oil which I think is your only plant fat that’s saturated, maybe that and palm I think are the only 2 big saturated ones that are plant-based. So, we have our saturated fats, right? Coconut, plant-based fat- coconut, and animal-based fats. We have our mono-unsaturated which typically are gonna be uh- a lot of the olive oil, potentially avocado oil, we have our polyunsaturated, a lot of times which are fish, and then maybe some of the nuts and seeds kind of fit into that monounsaturated category omega-6 kind of category as well. And then we have our uhm- Vitamins-A, D, E and K, “ADEK”, these our fat-soluble vitamins. So if we don’t have good bile-support, we’re not gonna be able to break fat down by the minute which is really good for our uhm thyroid function, it’s good for our skin, right? Higher dose Vitamin-A is great for skin that’s why they use uhm- Accutane which is- is a Vitamin-A analog to shrink the oil cells on the skin, also great for our eyes. Vitamin-D obviously great for our immune system, we make it too from the sun. Vitamin-E is great for our heart, it’s a natural antioxidizing, great for inflammation. Vitamin-K is really good is found in butter fat. It helps get calcium into our bone, right? Vitamin-K2, consider activated- a- activated X by western price, really important nutrients. So, these fat-soluble vitamins, we really need good gallbladder function to absorb them.
Evan Brand: Yeah, and if you don’t have a gallbladder, we’ll get into that in a minute, you know, I was just looking up, uh- reading the bile, the surgeries that people get. When you get into the gallbladder world, gallbladder surgery is just such a huge, huge money maker and it’s done often times in cases where it didn’t have to be done. And I told you we need to get a lady on whose uh, got a specific website about protocols for people with gallstones to try to help give them relief and to save their gallbladder. But another surgery which is crazy to me is called fundo- fundoplication, and it’s what they do to relieve chronic acid reflux. The surgeon tries to recreate your lower esophageal sphincter, by taking the upper portion of your stomach and wrapping it around the lower part of your esophagus and sewing it into place.
Dr. Justin Marchegiani: Wow.
Evan Brand: That just seems insane to me, they call it anti reflux surgery. How many of those people, just have H-Pylori infections that were put on acid blockers, therefore that LAS, that lower esophageal sphincter wasn’t working properly, or maybe they had a mineral deficient or maybe it was a ___[09:18] issue and structurally, that could get adjusted, but instead, they go get their stomach wrapped around their esophagus and sewing together. That’s insane!
Dr. Justin Marchegiani: It really is, and that’s kinda what conventional medicine does. They can go to some extremes to fix things that in my opinion are much more foundational and much more simple. And most of the time I would say 99% of the time, the surgeries aren’t root cause, right?
Evan Brand: Yeah.
Dr. Justin Marchegiani: So if we look at the conventional side, we have things like a HIDA scan which is like a nuclear image, they swallow s- solution that’s nuclear, and uhm- they kind see kind of biliary function, right? You want typically a 33 to 40 percent kind of dejection fraction that’s normal, on the gallbladder. So, you can look at that with the HIDA scan, you can even look at, an ultrasound, uhm, to give you a window of the inflammation in the gallbladder. It’s not gonna give you how much uh, bile is flowing to the duct but at least give you- okay it- it- is there- is it stagnant, or just stuffed in there, is it inflamed. You can kind of get that sense as well. A lot of times they’ll do some conventional testing, ’cause if your gallbladder is inflamed, and there’s an immune response, you may see white blood cells uh- on the higher side, right? Uhm, you may also see certain liver enzymes, ALT is a common liver enzyme, AST is another enzyme that can be effective in the skeletal muscle, you can see GGT, think of the “G” in gallbladder, GGT is a big gallbladder enzyme. Bilirubin is a byproduct of red blood cell metabolism that comes out in the gallbladder. With high bilirubin, we may have some- some backed up gallbladder bile issues. And then a- also, I think alkaline phosphatase is another big one that we may see on the higher side. So, we’re gonna see bilirubin on the higher side, alkaline phosphatase on the higher side, and then we’re also gonna see potential HIDA scan issues, that can- those are- HIDA scans more like pathological.
Evan Brand: Yep.
Dr. Justin Marchegiani: There are a lot of people that are in between that may be okay on the ultrasound or maybe okay on the HIDA scan and we can use some of this functional test as well. Uhm, but really important we gotta dig to the root, underlying issue on what’s going on there. And again, AST is more skeletal muscle but there’s some crossover with the liver, ALT is more liver. Think of the “L” in ALT as liver and then the alkaline phosphatate is a big gallbladder one, also a big one for zinc. Alanine transferase or ALT, asphotate transferase, and then alkaline phosphatase for ALP.
Evan Brand: Well, the good thing is, a lot of the blood markers you just mentioned are pretty standard. So, even if you’re not working with the functional medicine practitioner like one of us, you may be able to get your doctor to just run these labs, refer back to this podcast and look and see if you have an elevation. Now, the only problem is, the conventional reference range for blood testing is very bad. So, you may be quote, “normal” by your doctored standards but our reference ranges maybe tighter. So if we start to seal your ALT or your AST enzymes go up, it may not be up enough to flagged. So, that’s why it takes a trained eye to look at these numbers and see, and we’ve seen it time and time again, we get somebody on gallbladder supplements their AST and ALT go down. So, it’s amazing to see, we gave this nutrient, “boom” look at the blood changing just based on this nutrients, it’s really cool. Let’s talk about symptoms now, I think we’ve given a good-
Dr. Justin Marchegiani: Yeah, just to highlight one thing, you just wanna get that CBC done at- which is a complete blood count, and then also a CMP – Comprehensive Metabloc Panel profile, and it’s important, you need to work with a good functional doc because you may be okay in a lot of these areas and you still may have issues, so now what, right? So you don’t wanna just rule it out ’cause some of these testing are good, you wanna look at subjective symptoms, connected to the anatomy, connected to how your stools look, right? If we have fatty stools, blond stools, excessive amount of wipes to clean out your- you know, to clean yourself after going number 2 or just, you get skin marks on the toilet seat, we’re probably not breaking down fat. And again, if you have too much MCT oil in the morning, that can also do a tube instead as a laxative effect. So, you gotta look at it the trend in general, clinical symptoms, subjective symptoms, and then lab symptoms to really make a complete picture of what’s going on.
Evan Brand: That’s a good point ’cause my AST and my ALT on my blood looked perfectly fine. But when I had parasite infections, I had that low right side pain under my rib cage where my gallbladder and liver are. Your gallbladder is kinda tucked in with your liver under there, so if you look down at yourself on your right side up where that rib cage, if you’re having pain there, when I had parasites, I had ton of pain there, my blood looked perfectly fine. So I don’t want, like you said, you don’t wanna give a- a false sense of hope just ’cause your blood looks okay. There may be other functional problems that you’ll find by looking at stool testing for example. But let’s hit- let’s hit-
Dr. Justin Marchegiani: Yes.
Evan Brand: -on these symptoms, because you mentioned some but we needed just go through symptoms here and tell people, “okay, what would you be experiencing?”.
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: So, you mentioned, fatty, greasy stools-
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: You mentioned it takes a lot of wipes to clean your butt, you mentioned the skid marks in the toilet which if everybody is going on a high-fed diet these days, sure, that may be okay but if you’ve got gallbladder problems to start and then you try to go on to ketogenic diet and you don’t feel well or you don’t lose weight and you’re complaining to your doctor, that may be the part of the problem is gallbladder.
Dr. Justin Marchegiani: 100%. Also, autoimmune issues can affect the gallbladder as well. Gluten’s a big one, it creates those condition called primary biliary- what’s that last?
Evan Brand: I think you call it cholangitis.
Dr. Justin Marchegiani: Yeah, primary biliary cholangitis. I mean, typically just “PBC” for short. But basically you can have some scla- scarring of this uhm- on the- the kind of biliary tubes that go out of the gallbladder, and as well as the- you know, the gut- the liver goes to the gallbladder, the gallbladder kind of comes out together with the pancreas and comes out the sphincter of oddi, or the hepato biliary kind of ampulla, and that- that can kind of scar and it can sclerose, it can kind of have uhm narrowing of the- of that vasculature. Of course, it can back up, and if that backs up, and those enzymes can’t get out you can have pancreatitis as well. But that’s an autoimmune condition where your body is attacking a lot of that tubing that goes up to the gallbladder and maybe even can help with the pancreas, and that can narrow and prevent a lot of that stuff from coming out. So of course, gluten is a big component because that can really activate a lot of au- autoimmunity and you can also have a leaky gut, you can also have a leaky gallbladder which does aggravates more autoimmune attack because things that shouldn’t be out in the bloodstream are out and that exacerbates the immune system going after it.
Evan Brand: Yeah, so let me just read a few sentences on these whole PBC thing ’cause I think this is critical. We know, even just this is just standard you know, medical textbook stuff that says “it’s the most common among women”. And we know that Hashimoto’s is more common in women and men. So it says here, “the cause is not clear but we know it’s more common in people with…” guess what, “…hashimoto’s thyroiditis”.
Dr. Justin Marchegiani: Yes.
Evan Brand: So, it says here, “An autoimmune cause is- is thought possible because more than 95% of people with PBC have certain abnormal antibodies in their blood. These antibodies attack mitochondria. What triggers these attack is unknown…”, of course they say that but it may be exposure to a virus or toxic substance A.K.A. ‘gluten’, maybe dairy, I mean, you and I talk so much auto about- about autoimmunity so I’m glad that your brought this up because, you know, these people may have these symptoms, and they’re not gonna know what’s autoimmune in nature, they may just get the- the knife and say, “Hey, we’ve gotta pull this gallbladder out”. Not necessarily, what if we can shut down this autoimmune attack?
Dr. Justin Marchegiani: 100%. Also, here’s the bigger issue too. Okay, great, the gallbladder is removed, your digestion is now forever altered. I’ve yet to meet a conventional patient of a gallbladder procedure, whether surgeons that “oh, by the way, you’re gonna have to add in HCl, pro- or- lipolytic enzymes and bile salts for the rest of your life”. I’ve never really heard that, at least bile salts seem to be added in. I would say HCl and enzymes too, but I’ve never heard someone do that. Now, your digestion is forever altered, do you think there’s a connection with now you’re not being to breakdown cholesterol optimally ’cause that’s gonna be in the bile, right? The bile is 97% water, then you have some cholesterol, and cholesterol salts as well, and you also have some toxins coming out, that’s why if you have uhm- poor, you know, gallbladder-emptying, then you’re not getting rid of potential toxins that are in there too. So, we gotta be emptying that gallbladder. If we’re not breaking down Vitamin A, D, E, and K, if we’re not breaking down our fat-soluble vitamins, which I just mentioned, if we’re not breaking down cholesterol which is the building block for all of our hormones, do you think we’re gonna have problems ladies, uh- as you get into your 40’s and 50’s, with menopausal issues, perimenopausal issues, PMS, and we know the main connection, it’s kind of a slang but, I’ve heard many uhm- let’s just say general surgeons say it, it’s the 3 ‘F’s’ of gallbladder issues: fat, female and forty. And that’s the time to- late 40’s, early 50’s where hormonal transitions happen, and if you can’t breakdown those nutrients, you are setup for a menopause uh- of “hell”, so to speak.
Evan Brand: Yeah, in terms of side-effects, possible side effects of gallbladder remover- removal, it could be anything from pancreatitis, to increased risk of choline cancer to increased digestive sy- symptoms like heartburn, could be constipation. So, we’ve seen people that- they don’t feel well, after they get the gallbladder removed. And uh, like you said, there’s no surgeon out there saying, “Hey, I’m gonna put you on this comprehensive digestive support protocol, after we remove it”, no, they’re gonna you out with anesthesia, cut that bad boy out, and send you home in a day or 2. Uh, there’s a- a whole lists symptoms here I’m looking at now, symptoms of- uh- symptoms after gallbladder removal. I’ve had women have gallbladder attacks, but they don’t have a gallbladder. You know, it’s like, “well, how the heck does that happen?”. So, you know, the- the- the removal is not the “cure all”. Anything from nausea to gas and bloating, distension, burping, belching, feelings of fullness, heartburn, barrett esophagus, diarrhea, dumping syndrome, weight gain. There’s a whole article here all about post gallbladder removal weight gain happening.
Dr. Justin Marchegiani: And part of the reason why women get targeted so much – I hate to say it – is the estrogen. The estrogen kind of makes things sluggish and slow, it kinda takes- it kinda makes it turn into molasses. So, things really are very sluggish, very viscous, and of course, that can affect gallbladder and bile flow. Women that are on, you know, uh, birth control pills, that’s gonna- in- obviously increase estrogen levels, obviously just being stressed, right? You’re gonna take your progesterone, you’re gonna shoot it downstream to cortisol, and that’s gonna basically cause estrogen dominance there because you’re already starting to lower progesterone in relationship to estrogen. You’re getting estrogen in the environment from the conventional meat products, uh, water, plastics, chemicals, hormones in the meats as well, and then you’re also gonna be just getting it, just from uhm- being a woman, having 10 times more estrogen than a man. So, you’re- you’re already predisposed, and then when you add stress to it, it’s going to exacerbate it uh, big times. So, you really wanna make sure that you’re fixing the- like if you’re having- if you know you have a gallbladder issue, you also need to be going after the- the hormonal issues as well. And then we can dive deeper into the food allergies stuff too, so you gotta go after the hormones, gotta make sure you fixed the estrogen dominance, you gotta make sure you fix the digestive aspects, and then we can go into foods later.
Evan Brand: Well, I’m sure there’s gonna be a ton of people that are just yelling at us right now through they’re podcast app or YouTube or wherever they’re listening to us, and they’re saying, “Well, this is not fair, I already have my gallbladder removed, so what the heck do I do now?”. So, do you wanna address that now or should we talk about that later?
Dr. Justin Marchegiani: Yeah, so, off the bat, the underlying mechanism that was driving that inflammation in the body’s still there. Just the end target, the end uh manifestation of it is removed, but now other tissues may start to, uh, have issues, then also if you don’t fix the underlying uhm, digestive im- impediment which is, your fat-soluble vitamins, your cholesterol, your hormone building blocks are now gonna be thwarted in their digestive processes. So, you have to fix that to prevent compounding hormonal issues, 10, 20, 30 years later, number 1. Uhm, and then so obviously this- so- err- if you’re- if you still have your gallbladder, we wanna keep it by doing a lot of the preventative things. But on the food side, I outlined this in a couple of my gallbladder videos are down in the past. But there’s some common foods that are even uhm- let’s just say paleo-approved, but should probably be looked at- look at removing. So, of course we have the refined sugar in the guts. That’s kind of a no-brainer right here. But, uhm, in order of kind of like uhm, the most likely offender are gonna be eggs.
Evan Brand: Yes.
Dr. Justin Marchegiani: So definitely autoimmune template, cut out the eggs, pork, onions, chicken turkey, milk, coffee, corns, beans, nuts, apples, tomatoes, peas, cabbage, spices, peanuts, fish, rye. I’m gonna link my article that goes into this. So, everyone’s probably like, “Say it again!”, no, I’ll put the link below, don’t worry, take a look at the article, alright? But, I have them in most likely to offend to least. So, if you’re overwhelmed after hearing that like, “What the hell am I gonna eat?”. Just start with the biggest 3 or 5, or look at that list and say, “What are the biggest 3 or 5 that I eat on a daily or weekly basis” and just pull that out. Once we get the inflammation under control, we support HCl, we support enzymes, we support bile salt production, we look at the gut ’cause sometimes there can be infections like H-Pylori and giardia, and of course SIBO in and around that ___[22:31] that can exacerbate everything too. So, we get the infections clear, if we get the acidity and the enzymes dialed in, if we cut out some of the common offending foods, we may be able to start adding some of these foods in overtime. But I find pork’s a big one, eggs are a big one, those are like my- my 2 biggest right there off the bat, and they’re kind of paleo-friendly too.
Evan Brand: Yeah, eggs are huge and people over-eat them and, if you have gallbladder issues, uh- when I interviewed Ann Louise Gittleman, she said the same thing, she said eggs are the biggest offender. I’m like, “Wow, I thought that was just me”, no, it’s- it’s a real thing, and then also onion. I think she said onion are ready-
Dr. Justin Marchegiani: Yes.
Evan Brand: But that was- that was a problem for me when I had parasites and I would try to do like stir or fry and throw some onion in there, I’d end up with that lower right side stomach pain, I’m like, “What the heck is it”, or if it was I had parasite infections but, the other- the other part of it was the onion. So, yeah, I at least temporarily, like you said going on an autoimmune protocol while you’re working with your practitioner to fix the other underlying causes, you’re gonna be in good shape if you do that.
Dr. Justin Marchegiani: Onions are also a ___[23:28] too. So there could be some underlying SIBO or small intestinal bacterial overgrowth going on as well. So, you gotta look deeper at everything. So, kinda like piggy-backing everything, alright? Women are gonna be the- more bigger offenders ’cause of the hormones, because of the- you know, the pregnancy prevention with the birth-control pill, so you have that, right? So we gotta fix the hormones, fix the hormones, number 2, cut out the foods, at least paleo to autoimmune paleo with those additional 3 to 5 to 8 foods I just mentioned. Get enzymes dialed in, get acids dialed in, and definitely bile salts added in, and if you already had your gallbladder removed, definitely do all 3, and those that up and watch your stools and make sure your stools go floating to sinking, right? Oil and water mix, so if you had the stool, with the whole bunch of undigested fat, and oil and water mix, the stools stay on top of the water, they don’t sink. So, you wanna see the stools sink, and ideally you wanna be able to clean yourself, you know, 3 to 5 wipes on average, and you wanna make sure when you flush, you’re not seeing big skid marks all the time. If you’re doing some MCT oil in your coffee there may be some issues there, too much of that can cause some undigested MCT, so be mindful of that. So, foods, acid, enzyme, bile salts, get the infections cleared, and if you’re a woman, get the estrogen dominance fixed, get the hormones balanced.
Evan Brand: Yup, and, how can you do that from a testing perspective, we mentioned the blood, but I’ll just throw a few other components of this in. Number 1 is the stool test, so we’re always gonna be running a PCR stool panel, or gonna be looking for all this. As you mentioned, we’re gonna look at H-Pylori, we’re gonna look for giardia, we’re gonna look for cryptosporidium, blastocystis hominis, there’s a ton of different bugs, there’s worms, there’s parasites, there’s bacterial overgrowth we look at, there’s candida that we look at, that’s all done with the combination of stool and urine testing. And on the stool, there’s a couple markers that we can track, obviously, you looking in the toilet is gonna be the best way to track. Well, we like numbers, you know, Justin and I like data. So, when we look at steatocrit, which is a fecal fat marker that usually is expressed as a percentage. I like to see it, you know, 10% or below, we’ll see some clients, they’re 30, 35, 40 percent steatocrit, that means they’re not digesting their fats at all, and they while I’m doing a ketogenic diet and I feel like crap, it’s ’cause they’re not digesting anything.
Dr. Justin Marchegiani: That’s it.
Evan Brand: So, we gotta get that steatocrit down, and how you do that, well, one, clear the bugs too, supplement, and then, what was the other part of my brain? The blood, we talked about the blood, we talked about the stool, oh, the beta glucuronidase. So, beta glucuronidase at enzyme on the stool test we look at, that enzyme gets messed up due to bacterial overgrowth. When we see the enzyme is high, that’s when the estrogen dominance probably becomes more problem- problematic because now, they’re re-circulating the hormones. So, we do some like a calcium d-glucarate or a DIM, or something else, maybe a broccoli seed extract to try to get, or could be probiotics, could just be clearing bugs, taking care of the SIBO, the glucuronidase goes back down, and now all these quote, “estrogen-dominance symptoms” just disappear, and it’s really fun to see that.
Dr. Justin Marchegiani: 100%. So, kinda highlighting the test again, look at your symptoms, if you have pain in the upper right quadrant, under the rib cage, if you have problems breaking down fat, if you’re seeing a lot of your fat, your stool sinking or floating on top, not sinking. If we run a ho- comprehensive stool test and we see a lot of uhm, steatocrit, undigested stool, we see that greater than 10 or 15, whatever that lab marker is right in that area, we got problems, and then we gotta dig in deeper, and this could be the reason why you have hormonal issues too so we have to highlight that. Is there anything else in this topic Evan that you wanna go into that we haven’t gone in deep enough?
Evan Brand: I don’t think so, I would just tell people that if you feel discouraged, or, you know, you’re facing surgical removal of your gallbladder, I’m not saying the gallbladder can always be saved. I have a friend of mine, she’s in her late 50’s, maybe early 60’s at this point, and she was having major, major gallbladder pain, and I told her about taking digestive enzymes, but the pain just continue to grow. So, you know, I said hey, you might have to, you know, go to a doctor and get this checked out. This is very recent, so she did. And her gallbladder function was basically nothing, and she went in and she had to get surgical removal and because of with so much inflamed tissue around her gallbladder they couldn’t do the- the- the uh, laparoscopy, where they just give you a small- a small uh surgical side, they had to really cut her open like 6 to 8 inches, they hadn’t take out the gallbladder, and the surgeon told her, that her gallbladder was so heavy, full of stones that it felt like a concrete block. He said there was no way you were gonna save this gallbladder. So, I think there is a point of no return, where surgical removal does happen, we’re not shaming anybody or making fun of anybody if you got your gallbladder removed, that sucks, like she had to get it out, there was no turning back. And now, you know, she’s got tubes coming out of her stomach to drain her bile until she recovers from the surgery. So, obviously, that’s an extreme case but man, uh, you know, it can- it can get to a point where surgery is the only option but we’re just trying to help you before you get to that point.
Dr. Justin Marchegiani: Yeah, so if we don’t have enough, if you don’t eat good fats, then we don’t have good gallbladder flow, then, what happens is, it’s like not changing the oil. A lot of that bile uhm, and that cholesterol can crystalize. And then overtime those crystals can- can produce more and more crystals. And then imagine these little crystals that are like- a little mini or- miniature-like porcupines. And imagine that gallbladder contracting, it’s like giving a- a big porcupine a nice hug, right? Probably not the best thing. So, that can create a lot of inflammation, and the more little porcupine you’re having your gallbladder, the bigger issue every time you have fat that contracts. And then also, we can have potential pancreatitis because of it ’cause those gallstones can eventually produce, can block the bile flow, and that can stop pancreatic enzymes from flowing into the small intestines. So, that can create more inflammation. So, the more this thing, err- there’s more of this issue, the underlying cause goes unaddressed, the more the inflammation accumulates, accumulates, accumulates, accumulates, there may be a drastic solution of cutting out the gallbladder. Now, I would say, the vast majority of the time, it can be saved. We have to make the food changes, uhm, we also do a lot of gallbladder bile support, we’ll also use things like phosphatidylcholine, we’ll do beet root powder, we’ll do taurine, we’ll do dandelion, we’ll do artichoke, French trees, or herbs that’re designed to help to help one thin out bile flow, they can smooth out the little crystals, so imagine like kinda coming in there and smoothing out all the little porcupine barbs. Uh, that way they aren’t as sharp, and then we can be very careful with our fat consumption, maybe we do the tiniest amount possible. A lot of the coconut fats are easier to process and digest. So, maybe we’ll do more coconut fat, we’ll just do- just the- the largest amount of fat we can handle without issues, we up the enzymes, we up the bile salts, and then we give a lot of those herbs to smooth out the bile flow, thin out the bile, and smooth down the crystals. We’ll even do some- some like extra phosphorus drops to even thin out the bile uhm stones as well.
Evan Brand: Yeah, I do beet powder every day. You know, part of that for my circulation issues dues to all the mold in my body, so- so the beet powder’s been really helping. But, you know, back to my friend, you know, she was, she’s a woman, she’s over age 40, she does have excess weight, you know, she is overweight, she is very sedentary, uh, she did have some familiar health issues as well, you know, any- any family history of uhm- diabetes, other type issues like that can- can increase the risk of gallstones which then increase the risk of these problems, so, if you were to take all of the things you don’t wanna be sedentary, you know, overweight, uh, etc., poor diet, she had all those things against her. So, I’m not gonna- I’m not saying that everyone’s gonna end up like that with her case which is extreme but, you know, I just wanted to point out, hey, sometimes there may need to be a surgical removal. But, we just- we wanna try to prevent that. Statistics I found say there is about uh- 3 quarters of a million surgeries every year for gallbladders.
Dr. Justin Marchegiani: Exactly. Then we kinda talked about, our women- right- our- our fat, 40 and female. The big issue is, estrogen is a big uhm cause of kind of making the- the gall uhm, making the bile more sludgy, so is insulin. So, insulin is also another stimulating factor, this is part about I think where the fat comes in there, because the more weight you have typically is more insulin-resistance, insulin’s that hormone that sticks sugar into the cell, converts it to fat, so if you have more insulin, that’s a greater likelihood of making the bile flow more sludgy. So, if you have high levels of insulin, that’s gonna slow up the bile flow, and then if we have uhm, high levels of estrogen or just estrogen dominance, that’s gonna sludge up the bile flow as well.
Evan Brand: Yup. I’m sure we could keep going on this topic all day but, we should probably wrap it up. Reach out if you do need help, you can go to justinhealth.com, and Justin’s summit is coming up very-very darn soon. So, I don’t know when you’re listening to this, if you listen to it in the future, and you already missed out, well, you can purchase his summit, but if you’re listening to it ahead of time, his summit is going live very soon, in two weeks at the first week of March. So, go to thyroidresetsummit.com. Go register for Justin’s event, it’s gonna be awesome, I interviewed him, which I thought was probably one of the best interviews possible, and interviewed me, and I talked about some other stuff that he hadn’t talked about. So make sure-
Dr. Justin Marchegiani: [Crosstalk] …interviews too.
Evan Brand: Thank you, thank you [crosstalk].
Dr. Justin Marchegiani: …for sure.
Evan Brand: So, so go register, uh, it’s- it’s gonna be probably one of the biggest events of the year called Thyroid Reset Summit. So, thyroidresetsummit.com, go check it out and to run through health talks which is like the apple of summits, they do a great job of putting things on, and there’s, I don’t know what, 30 other experts on there. So-
Dr. Justin Marchegiani: 30 great experts. And also, I’m giving way the first uh- 3 to 4 chapters of my new book coming out, the thyroid reset. That book will be coming out in the next uh, few months here, so, get your free intro copy and then I really appreciate you guys picking up the book as well. Get me up there on the Amazon ranking so we can help more people, I appreciate it. And also, just to finish with this uh, article, here, the uhm conclusion, very important here for gallbladder issues, just to tight home, repeat yourselves a lot because repetitions some other skill, here’s the conclusion, insulin resistance is a risk factor for the incidence of gallbladder sludge and stones during pregnancy and after. And then it says insulin resistance may represent a causal link between obesity, overweight and gallstones. So our big mechanisms here, just kind of- f- coming in full summaries, if you missed the whole entire podcast, if you get this one thing, you got it. High levels of insulin, increased gallbladder sludge. High levels of estrogen, or estrogen-dominance, increased gallbladder sludge. Inflammatory foods, right, that drive insulin and inflammatory foods that are paleo friendly like, pork, like onions, like eggs, like coffee, maybe an issue, and then of course the low HCl levels, uhm, the low-fat diet, uh, all of those things and eating in the stressed out environment, those are gonna be your big 3 or 4, then also infections, giardia, gluten-sensitivity, SIBO, all of those things are gonna drive, probably the big 5 factors. Infections, insulin, estrogen dominance, low HCl enzymes, and then hidden food allergens. Those are your big 5 factors of this gallbladder issue here.
Evan Brand: Yeah, well said. And I love my friend to death but my wife and I were driving in the parking lot the other day, and she’s- and- and then we see our friend who just got her gallbladder taken out, and she’s sitting in the Taco Bell Drive Thru, and I’m just like, “No, that’s exactly what got you in this problem in the first place”. So, the diet is so critical, you can’t skip it.
Dr. Justin Marchegiani: Hundred percent, excellent. And for anyone enjoying this, I’m gonna do another live Q&A here tonight, this at- you know, the very end of the day, probably around 5, 6 o’clock here central time. Make sure you subscribe to the YouTube channel, we do a lot of live Q&A. So, go to justinhealth.com/YouTube. If you’re listening to the channel now, make sure you hit that bell, that gives you the notification. So, if you’re on your phone, it’ll pop-up as it ___[35:35] doing a live chat. Even if you’re not around for it, just your little- little question in. So, we do a live Q&A, it’s op-in question, if there’s a topic, keep your question to that topic, if it’s a podcast, we may or may not get to questions ’cause we kinda get in our flow state and uhm, we may just be really focused on our conversation.
Evan Brand: Take care.
Dr. Justin Marchegiani: Hey Evan, you have a good one, take care.
Evan Brand: You too, bye.
Dr. Justin Marchegiani: Bye everyone.