How to Get Your Energy Back Post-Infection | Podcast #365

When people start to feel better after an infection, it is often tempting to return to previous levels of work, leisure, and social activities. However, too soon, trying to do too much can often be counter-productive. It is easy to get caught up in a ‘boom and bust cycle of activity that can prolong your recovery.

Dr. J and Evan discuss that if fatigue and other symptoms persist, it’s important to remember to allow yourself time to recuperate by finding the right balance of rest, relaxation, and activity for your circumstances. It is essential to listen to your body and gradually build a physical and emotional recovery plan that can help you get back to your life and stay on track without experiencing too many setbacks.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:00 – Introduction
5:11   – The essential vitamins to boost your immune system
10:12 – What is the goal of the Krebs Cycle?
14:06 – Mitochondria and microbiota dysfunction in viral pathogens;
17:12  – The role of mitochondria, oxidative stress, and the response to antioxidants in chronic fatigue
20:08 – The neurotransmitters from amino acids and tryptophan pathways in B6 deficiency

Dr. Justin Marchegiani: With Evan Brand, really excited today. We’re gonna have a nice conversation on how to get your energy back post-infection. This is the topic that we’ve been getting a lot from our patients and again a lot of our inspired podcasts and videos come from real life clinical work with patients. So, we’re excited to bring you the real-life actionable information here to improve your health. Evan, how you doing today man? What’s cooking?

Evan Brand: Hey. Doing pretty well, uh, cooked some bacon this morning and that was about it with some organic blueberries and so I’m feeling good. my brain is clear and I look forward to helping people on this energy conversation, you know, so many people have chronic fatigue post-infection and they’re not fully bouncing back and so, I think that there are some easy low hanging fruit strategies that we can talk about but I’m just gonna jump straight to the big smoking gun which is looking at your mitochondria. We’re seeing a lot of issues with mitochondrial dysfunction or mitochondrial damage. I’m also seeing issues with neurotransmitters. So, I think, if you are to pick one and only one functional medicine test to look at to investigate yourself after this infection and fatigue, it would be the organic acids because you can get a great window into not only your gut health. We know that with infections, it does damage the gut, we know that there are ACE2 receptors in the gut so people that are ending up with irritable bowel or diarrhea or other problems during and post infection, we can look at that. A stool might be smart too but if you had to start with only one thing maybe the window into your gut via urine organic acids would be good enough. But more importantly, I want to see what the heck is going on with mitochondria and what kind of damage do we have because once you have the data then you can put together a protocol to fix it. 

Dr. Justin Marchegiani: 100% agree. So, we know with chronic inflammation, especially like, post-viral inflammation. We know one of the biggest drivers is gonna be oxidative stress, right? So, oxidation is nothing more than your body losing electrons, right? And one of the big things that helps oxidation within any type of infection pre, ideally, we’re doing these things pre to mitigate al of the oxidative stress that’s happening at the mitochondrial level but simple low hanging fruit, out of the gates, is gonna be glutathione, vitamin C, these are really powerful antioxidants. Vitamin D even kind of fits in that category, right?  Your big antioxidants are ADEK, um, I’m sorry, no, those are your fat-soluble vitamins but E is gonna be an antioxidant A is gonna be an antioxidant, right? I would even say E and K would for sure but your B and C are gonna be your water-soluble kind of more antioxidants for sure but the big are gonna plug in, you know, post-viral oxidative stress and/or pre is glutathione and vitamin C, out of the gates. And we can also look at low-hanging fruit on the mitochondrial side, which plugs into the Krebs cycle and the electron transport chain is gonna be B1, which is thiamine. I would say B vitamins as a whole was great but B1 has a major, major role and I’d even say B5, as well, pantothenic acid. So, you have thiamine, B1, right? You have Riboflavin, B2. You have niacin, B3; Pantothenic acid, B5; Pyridoxine, B6; biotin, B7; folate, B9; B12 is your methylcobalamin or hydroxyl or adenosine. And so, we’re talking B1 and B5 are gonna be big when it comes to post-viral fatigue. Those are really, really important nutrients that we can add in out of the gates and, why it’s all of this oxidative stress that’s happening when this infection is present. And so, the more you can do things like hydrate, keep inflammatory foods down like the excess Omega-6 fatty acids, um, keep the carbohydrate and the sugar in check, right? That’s gonna play a major, major role in not adding fuel to the fire if you will as well.  

Evan Brand: Yeah, and you can do oral glutathione. So, we have a combination product, which is an acetylated glutathione along with an acetylcysteine. So, you can give your body the nutrients to make more. You can give the precursors but then you can also take just straight glutathione. There are some liposomal versions. There’s reduced glutathione. There’s a nebulizer version that you can take so you can inhale glutathione if you feel that there was some lung involvement. You may consider doing both. I personally did both. I did oral and I continued to do oral glutathione daily and then, also, during the acute situation, nebulized glutathione with silver. And then, you mentioned B vitamins and you can measure all this, right? So that’s the important thing is, you know, you’re shouting out all these different names but people can look at this, right? We can look at this on organic acids. We can look at the various B6, B12. You can’t look at every single nutrient in the body but you can look at a ton of nutrients from one urine sample. So, it’s pretty awesome. And then, vitamin C, believe it or not, we’re seeing a lot of issues with viral infection and acute scurvy, which is pretty interesting. If you just put it some of this data and scurvy into the research, I guess, it’s due to the oxidative stress. It’s happening quickly and every single person I’m seeing post-infection is showing low vitamin C. So, we’re just keeping people on 2 to 3 grams every day. We’re doing a powdered version with a mixed ascorbate. So, you probably don’t want to do just straight ascorbic acid and you probably wanna do like a sodium ascorbate, magnesium ascorbate, if you can get some citrus bioflavonoids in there too and just take it ongoing. Don’t wait until you’re sick. We, as a family, we just take vitamin C ongoing because we know it’s important for the health of your capillaries and all that. Can you speak on that for a minute? Like vitamin C and skin and collagen, I mean there’s a role in other things. People think vitamin C, immune, but there’s other benefits to see, right?

Dr. Justin Marchegiani: Yeah. Vitamin C plugs into making collagen, which is all of the connective tissue for your skin, uh, hair, you know, cartilage, vitamin C is really important for that. Vitamin C is a very similar molecular structure as glucose, right? Don’t quote me but it’s similar to I think C6H12O6 or O8, it’s right in that molecular area, looks very similar. So, what does that mean?  That means, vitamin C has a docking site on the macrophage that actually goes and gobbles up bacteria and potential viruses and it’s gonna use that vitamin C that docks onto that macrophage to deal with the oxidation. So, I kind of think of it as like a firefighter going into a house and the vitamin C is like that fire fighter bringing that hose to squelch that fire, to squelch it, right? That’s kind of what I see vitamin C as, right? And, it’s almost like with the macrophage, it has a docking site and that glucose can actually come in there because it looks very molecularly similar to vitamin C and it can almost dock on that receptor site on that macrophage and take that vitamin C where to be used. It’s almost like giving the fire fighter a water hose, taking the water hose out and giving him a gas hose and he doesn’t even know. It’s almost like that and that’s why glucose and high levels of glucose and when it comes to a lot of these post-viral illnesses, you’re gonna see people that have very high levels of blood sugar, insulin resistance and even the extreme on the diabetes side are gonna have most of the side effects of most of the issues partly because of the oxidative stress, partly because of poor levels, you know, when you have insulin resistance that’s gonna affect oxygenation, right? Because, you’re not gonna have good blood flow and when you have poor blood flow and poor oxygenation, we need oxygen to plug into that mitochondria as well. It’s part of, you know, the key nutrients, right? We talked about B vitamins, B1, B5, very important to plug into the Krebs cycle. Well, guess what, when you have a high level of blood glucose and you’re on that pre-diabetic to diabetic side, right, 110 to 126mg/dl on the blood glucose side, your body has to process that and if you just go pull up, you know mitochondria, Krebs cycle and nutrients, right, you’re gonna see all the nutrients that are involved in that Krebs cycle to process that glucose because how it works in the Krebs cycle, everything gets funneled down to acetyl CoA, right? So, you have glucose comes to acetyl CoA, fatty acids come to acetyl CoA, they can also go this way into ketones and then you have protein coming down to acetyl CoA. Acetyl CoA pumps around the Krebs cycle twice and if you look, there’s gonna be nutrients that have to come in there to help that acetyl CoA to come around and a lot of those nutrients are gonna be B vitamins, magnesium, amino acids and so, if you’re coming in with lots of glucose and you’re not bringing in a lot of nutrients to funnel down to the acetyl CoA side, you’re gonna run that Krebs cycle twice and you’re gonna be using more B vitamins than you’re coming in. So, you can actually create a lot of nutrient deficiencies and oxidative stress when you consume a lot more glucose because it’s a transaction fee for your body to process energetically. 

Evan Brand: Nice. Nice. That’s a great way to put it. And, the truth is people are coming into this infection with nutrient deficiencies already due to bacterial overgrowth problems, Candida problems, maybe post-antibiotic therapy, you know, they have issues with the gut now and they’re not making enough of their nutrients in their gut. And so, a lot of people will just depend on diet and they’ll simply, well, can I just get enough on diet, can I just eat liver and grass-fed steak and all that and get enough nutrients from that and I’ll say, look I’ve tested and I know, you have too. Over a thousand people and many of those people were already dialed in with their diet for years before they got to us. Paleo, carnivore, autoimmune, paleo, we’ve had people that have been doing an incredibly job with nutrient density and they still show up with nutrient deficiencies and so I would love if everyone could just eat their way out of this situation but I just think with the modern stress that we’re under we’re dumping a lot of those Bs. You’re mentioning all these that are fueling this cycle. We’re so depleted and burned out emotionally, physically, chemically, we’re exposed to toxins. We’re just not living in Paleo time, so Paleo, you can’t just like paleo your way out of this and you know, that’s why I used to call my podcast years ago ‘Not just Paleo’ and then I got rid of it, just call it Evan Brand now but, um, that was my whole thought at the beginning. It was like, man, if everybody could just eat their way out this and get enough Bs in the diet then you and I wouldn’t be needed. 

Dr. Justin Marchegiani: 100%. Let me just kind of break this down for people just so they can get a better understanding of what’s happening here. So, when we have oxidative stress, oxidative stresses, we’re losing electrons. What’s the whole goal of the Krebs Cycle? The whole goal of the Krebs cycle is essentially gathering up electrons. Okay, so, you have fats like I mentioned before, they’re all funneling down to Acetyl-CoA. Proteins all funneling down to acetyl-CoA, right? Then you can see on the carbohydrate side like I mentioned, look at a lot of the nutrients that are involved in funneling the carbohydrates down to acetyl-CoA, different B vitamins, okay?   

Evan Brand: Zoom in so, 

Dr. Justin Marchegiani:  B1, B2, B3, magnesium, all play really important roles and then look at the carbohydrates, look at the amino acids that are involved. Cysteine, that’s a major precursor of glutathione, serine, really important for stress. Glycine, that’s your major amino acid in collagen, right? This is why, when you’re stressed and you’re sick, it’s why your grandma tells you to have chicken soup, right, especially with the whole bone in there because you’re getting a lot of these amino acids in a liquid form. So, if your tummy doesn’t feel good and you’re nauseous, right, because the infections tend to really cause nausea because your energy is going to fight an infection versus digestion. So, it’s trying to shut that down. That’s why your grandma said chicken soup, right? Ideally, we keep the noodles out now. Now, look at the fats, right, look at where the fats can go so the fats go down to acetyl-CoA but it can also go and create these ketones, right. This is beta-hydroxybutyrate. This is a ketone, okay? Now, really important here. So, we have this acetyl-CoA, right, this is kind of our energy currency that everything gets converted from our three major macronutrients, fats, carbs and proteins. And again, if you’re listening at home, there’s a video version of this of me going through it. I know, it’s a little confusing but I’m going to try to make, break it down. Acetyl-CoA comes around this citric acid cycle or Krebs cycle. It’s the same thing. It goes around twice, okay? And you can see GSH that stands for glutathione. Fe stands for Iron. So, if you’re a female and you’re very low iron or you’re anemic or vegetarian vegan, that could be a problem. 

Evan Brand: So, let me pause there, really quick, because I want to point out something. You’re showing here on this cycle that you’ve got to have not only glutathione but you’ve got to have iron so you gave a shout out to the anemic women and what I want to point out is that the women that came into this infection, anemic, which is extremely common. Women have hormonal imbalances. It’s an epidemic problem so many women have heavy periods or maybe post childbirth, their period was screwed up and they’re having heavy menstruation. So, they’re coming into this anemic or they’re coming into this with low ferritin and then that’s compounded by maybe a mold exposure where now they have low glutathione levels. The way you’re showing this cycle here, if you come in with low iron and low glutathione, you’re in big trouble.   

Dr. Justin Marchegiani: You’re in big trouble. And, women are more predisposed because if they have hormonal imbalances, guess what happens to their period, they get heavier. Heavier period, they’re just gonna lose that iron. Now, men on the other side, men have it, you know, they can have increased iron. They can cause oxidative stress because iron is like, you know can be like gasoline on the fire if it does get too high, right? But you can see glutathione, iron, you can see B vitamins, you can see magnesium, you can even see manganese here and you can see different B vitamins. And, what they do is you’re creating NAD and FADH and they’re grabbing hydrogen, they’re grabbing electrons, okay? So, typically comes around here twice and you get usually two NADHs and one FADH2 per cycle and then essentially all of these things will jump into the electron transport chain next. If I could find that section here, but the electron transport chain is the next big step for that kind of gathers nutrients but for really, for today’s talk, this is the really most important thing and then just kind of highlight, you can see some of these toxins over here that come in, right? You can see fluoride, Hg is Mercury, As is gonna be, uh, arsenic, Al is gonna be aluminum. So, you can see some of these toxins, how they can kind of come in there and sabotage some of these things. And, to kind of highlight one thing, this is an article we saw here. Mitochondria and Microbiota dysfunction with post-viral issues, you can see how the gut microbiome also plays a certain role and why is that? Well, I think, because 80% of the immune is in the gut so if you have a pathogenic or dysbiotic microbiome, it’s gonna affect toxins being produced, right? It’s gonna put you right here in a hyperinflammatory state, right? We already have a lot more cytokines being produced if we have an illness and so we have to be able to calm down our immune system’s inflammation to what’s happening from an immune stress standpoint. And so, the microbiome plays a big role, iron dysregulation, reactive oxygen species, right? Vitamin C plays a major role here. Vitamin, uh, glutathione plays a major role there as well.

Evan Brand: Yeah, right there, look at that one, the mitochondrial, the heightened inflammatory oxidative state may lead to mitochondrial dysfunction and so this is what we’re seeing on paper. We’re seeing this in the stool test. We’re seeing this in the organic acid test, this issue with the gut with the mitochondria. 

Dr. Justin Marchegiani: Yeah. It talks about platelet damage too which is important because what do platelets do, those are your clotting factors. And so, if we can have increased coagulation cascades, that means more clotting, right? And, you can see more clotting events, more thrombosis is that’s a blood clot, right? And so, you can see furthermore, mitochondrial oxidative just make, may contribute to microbiota dysbiosis altering coagulation and fueling inflammatory oxidative response leading to vicious cycles of events. So, this is really important and so things that we can do to be on top of the fatigue is gonna be the same things that we can do to help mitigate a lot of the inflammation. That’s gonna be keeping blood sugar in check, adding in some of these additional B vitamins, um, adding in anti-inflammatory anticoagulants. What do those look like? That could be ginger. That could be curcumin, which has anti-inflammatory and anticoagulation effects. That could be adding some extra Cod liver oil that has more vitamin A in it, which is a really powerful antioxidant but it also has natural blood thinning aspects because of the extra omega-3s in there. So, there’s different things we can do to really help reduce a lot of that inflammation. Any comments on that, Evan?  

Evan Brand: Yeah. On the more intense side of supporting hypercoagulability, lumbrokinase is gonna be your most powerful. That’s your earthworm-based enzyme, which is just a cool, cool thing. Natto, there’s also serratiopeptidase, so there are other enzymes that you can use and I personally take those. I take lumbrokinase, one per day just ongoing and it’s been very helpful. I also did a podcast with Dr. Thomas Levy, all about vitamin C IV and he’s got some dark field microscopy photos of people that we’re having blood clotting issues and the vitamin C along with ozone and IV was like a game changer and vitamin C can help energy too, so I don’t want to get too deep in the rabbit hole of blood clots but we’ll just say that the vitamin C is helpful for energy also. 

Dr. Justin Marchegiani: 100%. I want to show you guys one other journal article here, role of mitochondrial oxidative stress and antioxidants when it comes to chronic fatigue and so one kind of thing here, it talks about the known role of oxidative stress and how it can relate to essentially fatigue, as well as, potential, uh, specific therapeutic treatments for the mitochondria so that’s really powerful. And, you know, here are some of the big things, they’re gonna talk about vitamin C, talk about B vitamins, talk about glutathione and then also some of the more natural anti-inflammatory things but you know, each study is going to find out focus on a couple of their major things but, people in the literature are looking at these things. It is real and, um, we’re seeing it in our patients and we’re trying to apply some of these things to get people’s health back.  

Evan Brand: Yeah. So, the way you look at this is what you can do to protect against oxidative stress, we covered that glutathione. What can we do to help support the Krebs cycle? We talked about B vitamins. You’ve also got just things that are gonna help the mitochondria in general, like CoQ10 and then also you can do things like PQQ and there’s other nutrients that actually create what’s called mitochondrial biogenesis where you can literally make new mitochondria. And so, I don’t think it’s in that paper, it does mention CoQ10 there but 

Dr. Justin Marchegiani: Right here in the mitochondria, there are enzymes and coenzymes such as vitamin E, CoQ10 to remove ROS, that’s reactive oxygen species to prevent DNA damage. So, these are really powerful things that we can add in. For example, low CoQ10, they’ll see an increase in damage, so Coq10, PQQ, you know pyro quinolone, right? Vitamin E, and then, you know, we try to give Coq10 with vitamin E together for that same reason to prevent a lot of the oxidative stress while fueling the mitochondria. Any comments on that? 

Evan Brand: Yeah. Look at the next part there too, talking about exercise. People that come in with chronic fatigue and how they’re having an increased oxidative stress after exercise and that’s a problem that we’re seeing a lot too is people that now are having, uh, post-exertional fatigue, people that are crashing. Even athletes that were really high performing people that now their performance is just in the tank and a lot of that is just this ongoing oxidative stress and mitochondrial damage that’s not, that’s not been supported and you can’t just exercise your way out of this and I get kind of annoyed when I see like those motivational videos of people that are really sweaty like you just nee to suck it up, you know, pain is weakness leaving the body. It’s like, no, you’re wrong, you got to fix the mitochondrial damage. I hate those like raw-raw videos because it’s ignoring all the nutrients. That video really needs to be talking about, hey get your glutathione up, get your ribose up, get your CoQ10 up, come on people, like that’s what he used to say.  

Dr. Justin Marchegiani: And this is a similar marker that we use on the organic acid test, the one that we use 8-hydroxy-2-deoxyguanosine, this is very, very similar to that. But this is a marker for oxidative stress so we’ll actually use the same marker on a, um, on a mitochondrial test on the organic acid. So, we’ll look at some of these things to get a window of how stress these pathways are so that’s very powerful. 

Evan Brand: Yeah. Ribose is amazing. Carnitine is amazing. Acetyl-L-carnitine is amazing. Also, you know, let’s hit the, let’s go up a little bit like that picture there was a like a neurotransmitter picture there that you had. Maybe, we should talk about that a little bit because it’s not directly gonna be a mitochondrial support, yeah, right there, but I think, that’s cool to point out too, which is that, if we’re coming in with nutrients like phenylalanine or tyrosine, eventually some of that may convert over to your neurotransmitters but then also your adrenal hormones like epinephrine and I think a lot of people and I know you see this too, a lot of people are showing up with just low brain chemistry across the board. And so, I’m thinking out loud with you that like, the real magic remedy is the mitochondrial support plus throwing in some of these neurotransmitter supports as well. 

Dr. Justin Marchegiani: Well, that’s why we talked about B vitamins and I kind of went to the gamut, look how important B6 is in regarding the synthesis of tryptophan to serotonin, really important so you can see how B6 deficiency is really important in this process to convert this inflammatory product here, quinolinic acid, uh, back to tryptophan, it needs B6 or to avoid that whole thing it needs B6 so that’s really important. So, B6 is really important in the synthesis of amino acid tryptophan to serotonin, very important.   

Evan Brand: And so, vegetarians, vegans, obviously, you’re gonna be at increased risk of issues and your recovery is not gonna be as good as someone who’s getting these good animal proteins because you’re gonna be getting adequate tryptophan and other nutrients from your animal-based products. So, even if we could get these people on eggs, if we could get these people on organ capsules, if we could get these people on even like a protein like, I’ve got one we call carnivore collagen, which is a like a beef peptide, I mean something you gotta supplement at some level if you’re not eating those foods. So, please, if you’re a vegetarian vegan and you’re exhausted then look at some of this and hopefully we can convince you to change and improve your diet a bit. 

Dr. Justin Marchegiani: Yeah. No, I totally agree. I think that’s really important. I want to see if there’s anything else here, I want to highlight now because that’s enough, that’s powerful enough. Anything else, you wanted to highlight there?

Evan Brand: Well, we hit the urine, we hit the stool. Looking at the gut, you showed the study about the gut changing, we’ve seen that, I mean, you and I were talking about that march of 2020, I mean that was 2 years ago. We were talking about being affected. And so, obviously, our message is the same that it’s always been is get your stool looked at so we can see what kind of dysbiosis do you have going on because if you’re taking all these supplements, you’re doing all these foods but you’ve got malabsorption or you’ve got gut inflammation. You’re not gonna, you know, people say you are what you eat but you really what you digest from what you eat. So, if you have all these other issues in your gut, the grass-fed steak is not gonna be as valuable to you. Now, I’m not saying stop eating it, I’m saying still eat it but we’ve got to improve the digestion and assimilation of that. 

Dr. Justin Marchegiani: 110%. And one thing here, I just want to highlight here, just to kind of this article, it’s talking about mitochondrial function in infections in the gut because we’re trying to talk about mitochondrial and energy post-illness, that could be a viral illness, it could also be a gut illness, right? Because, it’s talking right here, even virus dedicated virulence factors and talks about downstream of an infection. It’s fascinating that a plethora of immune responses but, uh, be it against viruses, bacteria or LPS. LPS is lipopolysaccharides or endotoxin, this can come from H. pylori, this can come from SIBO, or dysbiotic bacteria and they strongly impact tht mitochondria which is really, really important because they’re toxic, they kind of throw a monkey wrench in how the FADH and the NAD is kind of moving around the Krebs cycle, collecting hydrogens and then bringing into electron transport chain. It talks about, um, governed by the mitochondria can be translated into active therapeutics to boost immunity against pathogens to over immune responses under control in the case of inflammatory disorders. So, essentially, the more you have these infections there, the more inflammation your immune system creates that can actually impact your mitochondria. Again, when you have a lot of these illnesses, it’s not just the stress from the illness, it’s the immune response from your own immune system that creates inflammation that can actually disrupt your energy pathway. So, sometimes, you’re just fighting against yourself. And so, using nutrients to help modulate the immune response i.e., glutathione, Vitamin D, vitamin C, right, really important nutrients there. I’d also say, you can do things like curcumin, or resveratrol as well. You can have immune modulating effects. These are powerful. So, it’s good to kind of get your immune system in check. Most people that are having longer term, we call it kind of long haulers type issue. It’s typically their immune system has over responded and it’s just creating so much inflammation. So here, this illness, they’re no longer testing positive for whatever this illness is and they’re prolonged 2 to 3 months out and they’re feeling like crap still, it’s because they really didn’t get their immune system’s inflammatory cascade in check afterwards.    

Evan Brand: Yeah. Well said. So, a couple comments. Number one, you can improve your energy by simply fixing your gut and that’s exactly what that data is showing and that’s exactly what you and I have seen and done clinically, hundreds and hundreds of times. People that were exhausted coming in, we give them a gut protocol, sometimes, not even giving them energy supplements because on paper they look good and all of a sudden, their energy level doubles and all we did is fix their gut so that’s the number one comment. And then number two comment is that, people need to stop waiting for some illness like this to take them down before they take this stuff serious. I mean, you and I are all about preventative approaches meaning getting your mitochondria, you gut, your brain chemistry getting all that stuff optimized now so that you’re a warrior on a daily basis so that when you do come across something like this and there probably will be more things like this that you do to get exposed to, you’re ready and you’re able to handle it and you’re not coming in so sick and looking for this emergency therapy at the end stage, it’s, in some cases, it’s too late. I think, a lot of times you can turn it around but you should have been working on your health years ago before you got this stage.  

Dr. Justin Marchegiani: Yeah. And a lot of it is, you know, anytime you have some type of illness coming up, the more you can be on top of a lot of these key immune modulating anti-inflammatory nutrients ahead of time and or during versus coming in at the end when the inflammation is super high. It’s like coming in when the fire is a little baby fire and knocking it out versus having a full five alarm and trying to stop it, right? That’s kind of the analogy. So, I always recommend telling people have a couple of nutrients. You may not be taking it everyday but they may in your medicine cabinet is kind of like a, um, you know, last ditch kind of effort to kind of come in there if you start to feel a little bit ill so on my line, we have Immune Supreme, which is nice because you have some green tea in there, you have some echinacea, you have some medicinal mushrooms, you have some antioxidants and some immune modulators, that’s kind of cool. Have that in your medicine cabinet. You start to feel the tiniest thing, start taking that to get that immune system, obviously, you can ratchet up, vitamin D, vitamin C. These are easy first line things, if you have any NAC or glutathione, we can ratchet that up. These are easy things that we can do to kind of take charge of our health and prevent our immune system from throwing us off.  

Evan Brand: Yeah. Well said. And, if you need help clinically, we do offer one-on-one consults around the world with people so we’re very blessed to be able to help so many people by getting the proper testing done, making the proper protocol to get you better. So, if you don’t test, you guess, you got to see what you’re up against first, look at your Bs, look at your gut, you know, once we get the data, we can help you more accurately and you’re gonna save a lot more money, a lot more time and a lot more suffering and you’re gonna get out of the dumps out of the trenches, out of the depths of hell, depression, whatever you’re dealing with. You’re gonna get out of that faster if you’re using clinical data and you have a tour guide to your body. So, if you need help clinically, you can reach out to Dr. J at for consults worldwide or me, Evan Brand at and we’re here for you guys. So, we look forward to helping you out.  

Dr. Justin Marchegiani: 100%. I appreciate it. Yeah. Anyone that wants to reach out, Evan already gave you the links, really appreciate it. Comments down below, I really appreciate your feedback on that and also, we’ll put links down below with some products that we chatted about. We have different ones that we recommend in our line. Just wherever you go, make sure you get them from a professional grade company because raw material does matter in the supplement world. You can buy, you know, the equivalent of the grass-fed steak from the local farmer or you can get it from McDonald’s, right? And so, we want to get the high-quality raw material that’s tested to make sure there’s no impurities and just building blocks are excellent. Evan, excellent chatting with you man, really appreciate it. Guys, um, have an awesome week and we’ll talk soon. Take care you all. 

Evan Brand: Take care, now. Bye-Bye. 

Dr. Justin Marchegiani: Bye. 


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Click here to consult with a functional medicine doctor for recommendations on natural pain relievers.

Where to find anti-inflammatory agents:

  1. Natural herbs like ginger can help with COX-1.

  2. Fish oil is excellent for COX-2 at high doses. If you do high doses of fish oil, you can increase what’s called lipid peroxidation because fish oil is a polyunsaturated fatty acid. It’s more unstable. It’s got more double bonds in it. Omega-3 means three double bonds. The more double bonds that are they are, the more unstable the fatty acid is to heat things like that and the more, let’s say it can be oxidized. So, having extra vitamin C or extra vitamin D on board when you’re taking extra fish oil just to make sure you don’t have oxidation is great, and we already talked about things like systemic enzymes.

  3. There is also curcumin but liposomal curcumin is better due to the absorption or something with black pepper in it helps with absorption, too.

  4. Frankincense or Boswellia.

  5. White willow bark which is kind of how aspirin is naturally made though aspirin works more on COX-1. So, aspirin can be your other natural source and you can do white willow bark which is the natural form of aspirin.

  6. There are things like Tylenol but Tylenol works more on the central nervous system perception. So, it decreases the nervous systems’ perception of pain. Note: We have to be careful of Tylenol as it can actually chronically reduce glutathione. So, if you’re taking Tylenol longer-term, you definitely want to take it with NAC and/or some glutathione, just to be on the safe side.

  7. At the extreme example, we have opiates which block pain receptors in the brain, the opiate perception of the brain. It’s not the best thing because you’re just decreasing perception of pain. Obviously, the opiates are way more addictive.

  8. We can block some of these natural pain perceptions with CBD oil. So, CBD is another great way to reduce the perception of pain.

In general, we want you to try to do more of the herbals and more of the natural stuff out of the gates because that really, really, really can help reduce inflammation.

If you have osteoarthritis, rheumatoid arthritis, sports injury, or you’re just trying to heal maybe postoperation, these things may be something to implement and then obviously work in all the other root causes, too. You are not just what you eat. You are what you digest from what you eat.

So, if you’re doing all these good nutrients, but you’ve got some type of malabsorption issue in the gut, you’ve got ridges on your fingernails, you’ve got thinning hair or falling out here, you may need to look deeper at the gut and try to find some of these more root cause issues that led you to that amount of inflammation or slow recovery in the first place.

If you need to reach out to talk about your pain and inflammation issues, click this link to schedule a chat with me!

Vitamin D Benefits You Should Know

Vitamin D has a couple of different benefits. Let’s go over some of the benefits. We’ve talked about the natural antibiotic that’s being produced by vitamin D, which is called cathelicidin, a kind of antibacterial enzyme. It is super helpful at being able to knock down bacteria. It also has antiviral mechanisms, as well as antimicrobial peptides and antiviral mechanisms.

Click here to consult with a functional medicine doctor to learn about proper Vitamin D supplementation.

Part of that is it stimulates and it can modulate the Th1 immune response in the Th1 immune system where you’re making a lot of your natural killer cells and your helper cells. Good helper cells can also help your antigen-presenting cell and it can help make antibodies more efficiently. So, you’re also going to have a better Th2 immune response. You’re going to make antibodies to whatever that infection is. Those tend to come a little bit later in the game, but good signaling to make your antibodies is super helpful as well.

There is a couple of other studies here that are talking about different things. We have a reduction in our MMP-9 concentrations. We have a reduction in bradykinin storms and reduction in our cytokine storm. So, basically we have a lot of inflammatory molecules that get produced such as bradykinin, cytokines, interleukins MMP-9. These are inflammatory types of chemical messengers. Vitamin D can help modulate that and prevent that from being overproduced. The more we overproduce those, the more our immune system responds. So, we can create more cytokine storm issues because our immune system will be on this positive feedback loop, responding and creating more issues with the cytokines. When there are less cytokines, there’s less chance of a cytokine storm, which is basically our immune system responding.

Imagine a fight between two people where one person yells out first and the other person yells back. Then they’re pushing, shoving, and hitting and the violence escalates. That’s what happens with the cytokine storm with your immune system and all the different cytokines and immune chemical signal. So, we can keep that modulated a bit which is very helpful. Vitamin D plays a really important role in that.


Get vitamin D supplementation from Thanksgiving to spring. At least, make that investment. If you want to come off the rest of the year, as long as you’re getting some sunlight, it’s fine. At least do that vitamin D supplementation to give you a good bump and the fat-soluble nutrients you’ll get over those four or five months will hang around months afterward because it takes a while for that vitamin D level to build up.

If you want to learn more about Vitamin D, click this link where you can schedule a chat with me!

Top 5 Warning Signs of Hormonal Imbalance

Let’s talk about hormones. I’m going to dive into a couple of clinical pearls that I see in my practice from working with hundreds of female patients and male patients which have a major effect on modulating and supporting hormonal balance.

Click here for a consultation with a functional medicine doctor if you want to learn more about hormonal imbalance.


These are my top 5 hormonal balancing strategies:


  1. One of the first things in regards to hormones that’s very important, and this may be common sense but I try to give a lot of knowledge guided by experience, is nutritional building blocks for your hormones. Healthy cholesterol from animal products are very essential. Fat soluble vitamins like A, D, K are very important. Lots of good protein are also very important. We have steroid-based hormones that are going to be more cholesterol-based and we have peptide-based hormones that will also be protein-based. So, a lot of these protein, fat-soluble vitamins, and cholesterol especially healthy animal cholesterol are very helpful for hormonal building blocks. If you have a vegan-vegetarian diet or if it’s very nutritionally poor or there’s a lot of processed food, that may set you up with a deficit out of the gates for just hormonal issues. Remember: Make sure the food is nutritionally dense, anti-inflammatory, and low in toxins. That’s vital.

  1. Now, if you’re having a lot of good nutrition in there, the next thing is we have to make sure we’re able to digest it and break it down. So, if we have a lot of chronic acid reflux, poor digestion, constipation, or bloating, we know we’re not quite breaking down our food and our nutritional building blocks. That could tell us that we may have hormonal issues because we’re not breaking that down. Therefore, those nutrients can’t get into our body or get in our bloodstream and be taken throughout the body to be used as building blocks. So, if we have a bottleneck in the nutritional side, that could be a big factor.

  1. Stress, whether it’s emotional or chemical stress. If we’re eating foods that are inflammatory or we’re nutritionally deficient and we have a lot of emotional stress, what tends to happen is our hormones kind of go on two sides. We have an anabolic side which are the growth hormones — testosterone, estrogen, and progesterone — that kind of help deal with growing. Then we have anti-inflammatory hormones which would be cortisol and are catabolic. I always put progesterone in that category because progesterone can be used to make more cortisol. So, we have our anti-inflammatory and then our anabolic. In some, they kind of cross over. Insulin, growth hormones, and testosterone are anabolic. The more inflamed we get, we could have high amounts of testosterone because of PCOS and because of inflammation. So, some of these hormones kind of interact and cross over. With men for instance, the more inflamed men get and the more stressed they get, that can actually cause an upregulation of aromatase and could increase their estrogen. So, see how these things kind of cross react. Your hormones are going to be either pro-building or anti-inflammatory to reduce stress. So, for chronically and stressed out state, cortisol is going to rip up your protein and kind of decrease your muscle mass. As a woman, you’ll see your progesterone level start to drop and that will start putting you into an estrogen-dominant state because if we normally got 20 to 25 times estrogen than progesterone, that ratio starts to drop. Even if you still have more progesterone than estrogen, that ratios is going to throw you off and that can create breast tenderness, cramping, mood issues, excessive bleeding/menorrhagia, infertility, a lot of mood issues, back pain, and fluid retention. All those are possible situations.

  1. Xenoestrogens from the environment and foreign estrogens. They can come from plastic components, pesticides, herbicides or rodenticides, mold toxins, and heavy metals. They are going to disrupt our hormones. The easiest thing is eat organic, avoid plastics, and avoid a lot of the chemicals in the water because a lot of times you can get pesticide runoff or hormone runoff in the water. So, clean water and clean food, and then make sure it’s organic avoid the plastics as well. That’s a big, big thing. Plastics are probably okay if they are in a refrigerator or in a cold environment but ideally if you’re heating stuff up or it’s going to get exposed to light, you want some kind of a Pyrex or a glass container. It’s much better and really important.

  1. Last but not the least would be just making sure our detoxification pathways are running well. So, if we have good hormonal balance but we can’t detoxify it, then a lot of times we can reabsorb it. So, if we don’t have good sulfur, good glutathione precursors, good B vitamins, good methylation, N-acetylation and glucuronidation, we may have a hard time eliminating. Hence, we are re-absorbing a lot of our hormones. So, being able to break down your proteins, break down your amino acid and your B vitamins is going to help with your body’s ability to eliminate a lot of these toxins.


Blood sugar, digestion, stress, xenoestrogens, and toxicity are really big. Those are the big 5 across the board. Try to apply at least one of these things.

If you’re struggling with hormonal issues and you want to dive in deeper, feel free to schedule a consult with myself.

The Root Causes of Constipation & Slow Motility | Podcast #331

Wouldn’t it be easy if you could blame your constipation on one thing? While that typically isn’t the case, your irregularity could be pointing to either one or multiple causes. Let’s watch and listen to Dr. J and Evan here, helping you learn what your gut may be trying to tell you, and what you can do about it. 

Dr. J and Evan emphasized to make a few changes to your lifestyle and see if they result in any positive bowel changes. Such as more high-fiber foods in your meals: fruits, vegetables, whole grains.  These steps will help you observe health changes – what works and what’s not via tests results as well.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:56       Slow Motility, Bowel Motility

8:06       Detoxification

15:57     Food for Detox

22:00     Vegan Honeymoon

27:40     System Approach, Solutions

30:51     Conventional Side

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Dr. Justin Marchegiani: We are live. It’s Dr. J here in the house with Evan Brand. Today we are going to be having a podcast all about constipation and bowel motility issues. This is a topic that we deal with all the time with our patients, especially when we’re dealing with and addressing potential infections. This can be a common side effects. So we’re going to dive into the underlying mechanisms and what you can do what we do about it with patients. Evan, what’s going on, man? How we doing?

Evan Brand: Doing really well. If someone listening is still embarrassed to talk about their poop, then I would encourage you to shed that shit shed the shame or embarrassment. We talk about poop all day. We love it, we enjoy it. This is part of being a human number one being a healthy human number two, because if you’re not pooping, you’re reabsorbing toxins, whether that’s xeno estrogens from environmental exposure or pesticide and herbicide or mold toxins, I mean, how we get rid of our toxic waste and chemicals and things we’re making internally and that we’re exposed to is peeing and pooping. And so when you look at someone who feels bad, they have dark circles under their eyes, they have skin issues, they’re irritable, they’re fatigued, they have headaches, a lot of times constipation is one of the underlying issues with those people. And if we can just get them pooping properly good amount in good shape, good size, good consistency, good frequency, we can really increase their productivity, their energy, their mental cognition, we can get rid of sugar cravings. I mean, there’s a lot that can happen when you just regulate the bowels. So we’re going to dive in today on some of the big root causes root triggers, I’m going to go straight to number one for me, which is going to be gut infections. Now, you and I were just talking before we hit record about different gut bugs and how some people with IBS, they’ll end up IBS constipation, others end up IBS D diarrhea. And so depending on what type of infections you have, your bowels may become dysregulated.

Dr. Justin Marchegiani: 100%. And so, when you have different gut stressors, slow motility can easily be a result. So you can easily see on the on the fast side, motility is too fast. Our body doesn’t have the ability to reabsorb water and electrolytes in time, because usually electrolytes and water kind of follow each other. So as the colon kind of pulls out the electrolytes, usually the water comes out with it. And so when we have slower bowel movements, right, they’re usually harder, more compact kind of stools. So if we look at like, for instance, the Bristol stool chart, I’ll pull that up on screen. So anyone that’s watching the podcast can take a look at it. The Bristol stool chart, the chart that’s used by gastroenterologist and such, but it’s just a way of kind of assessing where you’re still fit. So the typical number four is like the poopy policeman. And that’s like just a really good solid looking snake, like not overly hard not overly soft stool. That’s number one. If you go to the actual number one on the Bristol stool chart that’s like kind of the rabbit poop, right, the rabbit pellets really hard, hard to move. And then number seven is just pure liquid. So four is kind of right in the middle, and in between. So let me just show you what I’m talking about here. So you guys can visualize if you’re watching the podcast video along with it. So here is the Bristol stool charts that you guys can see. Okay, so number one, right separate heart clubs, nuts hard to pass. This is like the rabbit poop, right? That’s type one. And then it gently progresses back to two and three, right? where it starts to get more sausage shaped like it says except it gets more smoother, and that as it goes to three. And then step type four is the perfect poopy policeman kind of more of a sausage like more smooth, not overly cracked or not overly soft. And then you can see as you go to five and six, it becomes more liquid and then seven and just entirely liquid watery, no solid. And so that gives us a pretty good window. And so we usually when we have when the guts really inflamed, and we have usually a lot of toxicity in the gut, we can usually see it go to number seven where it’s pure liquid. And that’s because the body is just trying to flush things out. And when things go a little bit slower, you could still have inflammation and have type one right so you could have h pylori, that’s lowering stomach acid, you could have a lot of cebo that is meth that’s producing a lot of methane based back gases. And how do you know it’s methane is you have a lot of foul smelling gas or flatulence that’s a sign that there’s a lot of methane present. And methane can easily screw up that migrating motor complex and make the bowels go more on the slow side. But you can have the same level of infections like h pylori, or maybe histo or Giardia. And that could also cause it to go on the diarrhea side. So it just kind of depends. Everyone’s a little bit different. But we always you could have cebo you could have h pylori, you could have low enzyme and low acid levels that can easily be causing type one. But for someone else, those same infections could easily be driving steps type seven, right where it’s pure liquid. So you got to look at everyone as an individual on that. And really, you know, come up with the right plan.

Evan Brand: Yeah, and it can Alternate to write. I mean, that was my situation when I first had gut issues and I was losing weight uncontrollably when I had H. pylori and parasites and bacterial overgrowth and Candida the whole nine yards. You know, there’d be some days the gut was good. And most days the gut was not good. Luckily, I’m over that now. But man, I’ll tell you, I have a lot of empathy for people that, you know, you never know what you’re going to get, you kind of wake up and it’s like, Is today a good day or not a good day. And now that I’ve learned so much, you and I, both over the past few years about mold toxicity, that’s a big trigger for gut issues, too. So I’m get constipated, but a lot of diarrhea. And I think that’s the body’s way of trying to get rid of the toxin, but also the gut is so irritated. And you can have leaky gut from mycotoxin exposure, that that can be a factor too. So eventually, we’ll get into the gut healing phase of our conversation. I think that’s critical to healing constipation.

Dr. Justin Marchegiani: 100%. And so on the constipation side, there could be issues with obviously, the bowel motility has to be slow. So what’s constipation. So if you’re not having a BM, you’re not passing about 12 inches of stool in about a 24 hour period. That’s typically constipation. And there are millions of people in this country that aren’t able to have a BM every day. Now, once you start going 2 3 4 5 6 7, I see some patients that go up to seven days about a BM, that’s a problem because half of your stool is going to be bacteria. The other half is going to be you know, fiber and such. And within that stool, some of that bacteria and toxins needs to leave your body. If you’re not having that pass through your intestinal tract into the toilet, your chance of reabsorbing a lot of those toxins goes up really high. That’s definitely not good. Because those toxins get reabsorbed into your body. There could be xeno estrogens, there could be mold toxins, there could be a whole bunch of junk in there that you could be reabsorbing, and that could be really stressing out your body. So the first thing we talked about with detoxification is people talk about Detox Detox Detox, right? Well, if you’re not pooping every day, and that’s because of a gut infection or not chewing your food well enough or having insufficient hydrochloric acid or enzyme levels, or having some kind of a h pylori or SIBO issue. All of those things can easily affect your detoxification people are really focused on detox. Just by getting your digestion and your motility better. That makes a huge difference on your liver, and all your detoxification pathways, your lymphatics, your immune everything.

Evan Brand: Yeah, it’s funny, you’ll see women on Instagram, they’re all done up their hair and their makeup and their lipstick, and they’re like marketing, hashtag add hashtag detox hashtag tea. And they’ve got these like, I don’t know, you know how it is like, these ridiculous products that they’re marketing and they’re not talking about poop. To me, that’s the best way to detox is get poop out. I’m not going to buy detox tea, maybe like a little bit of dandelion or some who knows milk thistle, blend it in. Yeah, I mean that that’s part of it. But unfortunately, detox has kind of gotten co opted by the marketing industry. And so most people don’t even focus on that, though. You know, they’ll poop once a week, but then they take a detox tea and they think they’re doing it correctly.

Dr. Justin Marchegiani: Yeah, I mean, my whole take on detoxification out of the gates is very simple. Okay, first, get enough good clean water in your system, to make sure you’re digesting your amino acids and all your nutrients. Well, remember, sulfur based amino acids run the majority of your detoxification pathways, along with B vitamins, right. So we need good B vitamins, good antioxidants, good sulfur amino acids. So if we’re breaking down those nutrients, well, there’s not a bottleneck with HDL levels or enzyme levels. We’re getting enough good clean water. And we’re not overly stressing our sympathetic nervous system because remember, the more we overly overly stress the adrenals the sympathetic nervous system decreases that migrating motor complex, which are the wave like contractions that move stool through your intestinal tract just like you kind of roll up the to pace roll at night, I get that toupees moving through to get your toothpaste out to brush your teeth. your intestines do the same thing. So if you can do those top three things, right, you’re on the right track. Now there may be extra things where we need extra sulfur or extra antioxidants or compounds or binders to help with mold or heavy metals. That’s true and that that would be addressed down the road but a lot of toxic patients detoxification happens hepatobiliary liver gallbladder back into the intestines and then out the intestinal tract. So we need to have really good motility and really good absorption of nutrients and a lot of good clean water to help fuel that.

Evan Brand: Yeah, good point. Good point. Yeah, so we both manufacture our own custom blends of supplements that are professional grade, and we both have a liver support that has some gallbladder nutrients built into it. That can be really helpful because, as you mentioned, with sluggish bowels, a lot of times there’s also sluggish bile production. So just helping to thin the bile, whether it’s using supplemental ox bile or muthoni, taurine, beet powder, whatever else we could do to increase bile flow that’s going to be helping and then why don’t we hit on the diet piece. I mean, I think this is the low hanging fruit that you’re having. American is still really really blowing it on, which is just the fact that they’re not doing enough good meats, good fats, good veggies, you know, your average, American might wake up and I don’t know, do a piece of toast and maybe in 2020, or 2021, it’s an avocado toast. But still, you know, that’s not the optimal thing for good poops.

Dr. Justin Marchegiani: Yes, so inflammation in the diet can easily mess up the intestinal tract, inflammation in the diet can easily create inflammation in the gut. And that could either move the body more to diarrhea or more constipation. Now, for the sake of this podcast, if we start moving more to constipation, not good. And of course, you know, these foods can stress out the intestinal tract. And then when we start creating inflammation in the intestinal tract, and then we already have indigestion, and we don’t have adequate enzymes and acids, so we’re kind of burping a lot after our meals, food sits longer in our tummy, right, and we’re not in a lot of gases are produced because the foods are not being broken down properly, that’s a problem. So we got to really make sure we’re masticating and chewing our food very, very, very well, we got to make sure that increases surface area for enzymes and acids to work, we also have to make sure we’re not overly hydrating with our meals. So hydrate 10 minutes or more before meal. And then if you’re consuming a little bit of liquid with a meal, just do it to kind of help with swallowing pills, don’t do it for hydration purposes. Because water has got a pH of seven, your intestinal tracts a pH of 1.5, or two. So if you start adding a whole bunch of seven, Ph to a to a pH of two, you’re going to move that pH more in the alkaline direction away from the acid at direction. And we need good acidity to help activate our enzymes and our acid levels very important. So that’s low hanging fruit is chew your food up well. Second, is make sure you’re not overly hydrating with the food do all your hydration two minutes before.

Evan Brand: I’ve got my grandfather so many times till this drink liquid with almost every bite of his food, held his Drink, drink drink, like take a bite of food and wash it down with liquid. I’m like no, like you’re literally just pouring water on your digestive fire don’t do that. So yeah, it’s it’s easy. And it actually does make a difference. I mean, you know, I’ve probably talked about that before. But it does make a difference. Like if I, I’ve got a mason jar here, my goal, if I sit at the dinner table, I will try to not have it more than like two ounces of liquid. You know, if I have a full cup, I’m more I’m liable to drink it. If I’ve just got a little bit I know, hey, this is the only liquid I have if I need a little help with the meal. Otherwise it just food, no liquid with the meal. 

Dr. Justin Marchegiani: Yeah, for me, as soon as I know, like a meal is coming, I’m gonna go just maybe take two mason jars, add some sea salt to it, I’m going to down them and then I’m good. And then you know, 510 minutes later, I can start the eating process and I chew my food out very well. So then that gets the digestive juices rolling as well. So on top of that another low hanging fruit is let’s say you eat good quality proteins or fats, and that makes you constipated. That’s almost a surefire sign. You’re not making enough enzymes or acids. So some people they really do poor with enzymes, and acids, and it reveals itself through animal products. Now, a lot of people when that happens, guess what their natural tendency is, unfortunately, either going to go vegetarian or yeah, oh, it’s the meat that’s so bad for my gods, the meat that’s in my intestinal tract for days and days. It’s rotting in there, you know, yeah, documentaries, I have to cut out the animal products. Well, it’s just a sign that your enzymes and your acids are really poor. And the meat is revealing that now what’s the solution? Now in the meantime, you may want to drop down some of the meat that you’re doing, or some of the protein or fat you’re doing, just to kind of lessen some of the stress off the intestinal tract. But the first thing we’ll do before that is we’ll add in some HCl and some enzymes, maybe even some bile salts, we’ll see how much that starts to correct it. And then if we need then we can drop the animal protein and fat down a little bit if we need. Now, if your intestinal tracts really messed up, you may have to do an elemental or a bone broth faster, or something more liquid based to make it easier on your intestine. So everyone’s a little bit different. And we have a lot of clinical experience about being able to meet someone where they’re at so we can get optimal results.

Evan Brand: Yeah, and it’s sad that the meat gets the blame, you know, and like you said, all these documentaries that will pop up on Netflix, they’re all like, majority, you know, anti meat vegetarian vegan documentaries, and then you kind of have to help clients because sometimes we’ll get clients that have not listened to enough of us where the we haven’t convinced them to get back on me actually had a vegan or ex vegan client come to me last week. She said she was vegan for six years. And she got back on me with the help of listening to our podcasts. And she says she feels better than she ever has, which is amazing. She was able to transition back onto me without necessarily a bunch of supplemental enzymes, but in most cases, yeah, we’re going to come in due to and people may say why why do I need the supplement? Well, we don’t live in a world where you’re sitting on the edge of a cliff overlooking a river valley with no stress. And you know, hunter gatherer average work 18 hours a week. We’re not doing that anymore. We’re working 40 60 hour work weeks. We’ve got kids, we’ve got technology we’ve got Got smartphones taking our attention away, we’re scrolling in Bowling at chipotle looking at our phone while we’re eating, or we’re stressed from bills and mortgages and obligations and whatever and age, by the time you’re age 40 50 60, you’re not making hardly any enzymes and acids compared to when you were younger. So all those factors add up that is the answer of why why do you need enzymes to support you? And how do enzymes help you poop? Well, because when that food is digesting better, your body’s going to be able to get rid of what it doesn’t need. And if you have a lot of malabsorption problems, you know, you may see on digested food in the stool. And over time, I’ve noticed people just adding in a handful of berries a day was all we needed to really clear up their their issues. Once we got all the gut infections enzymes in, you know, infections resolved, enzymes put in if they still needed help, we’ll go into a couple other things you want to get into. But handful of blueberries, I mean, that does a lot.

Dr. Justin Marchegiani: So it just kind of going back to some of the the vegan stuff. So I always tell my patients will in general, ie more non starchy vegetables, most paleo people eat more non starchy vegetables than vegans do. Most vegans I find have lots of processed carbohydrate, they have lots of grains, lots of lentils, or legumes and they don’t typically eat tons of non starchy vegetables, it’s it’s difficult. On the vegan side, most don’t do it right now, if you’re going to be a vegan, you need to do lots of good fats from avocado and coconuts. And you probably need some kind of an amino acid supplement from rice or pea protein or some kind of some kind of an algae kind of protein source because most aren’t doing it right if you’re going to do it that way. But number two is sometimes the vegetables can jack you up to especially if they’re raw, because a lot of that fiber or if the vegetables are higher in fermentable, carbohydrates, some can be like garlic and onions and, and broccoli and asparagus, they can be higher and fodmaps. And fodmaps can be fertilizer for a lot of the SIBO base bacteria. So if you have a lot of bad bacteria that’s producing maybe more methane, and some of those vegetables start to feed some of that methane producing bacteria that may make you more constipated too. So I’ve seen some patients do better more with the meats than with a lot of the plants. So I’ve seen it go both ways. And you know, it’s hard because if you’re let’s say you’re one person, and you had an experience where you went vegan, and you felt great, well guess what, you only have your experience, I see patients that have gone carnivore and felt great. And so because we have this perspective, where we’ve seen dozens of people do great from different things, that allows us to form a unbiased clinical recommendation on what we think is best for the patient, because we’ve seen successes work from both sides. And the question is, we don’t have a dogmatic belief in Oh, well, this is what does it well, this is why it would do it for this person. And this is maybe why it doesn’t for you. And we’re going to we’re going to move the levers around because the goal isn’t to do this thing is to get you the result. So it’s really important that if you’re working with someone, you know, kind of talking to patients that are out there, you want someone you want to work with someone that’s results driven, not process driven, meaning, hey, this, you have to do this diet, this is the most important thing, this should get you the results versus Hey, no, I want to get you these results, we’re going to try pulling some of these levers and see what happens as a result. And then we’ll we’ll go backwards from there. So just really important. You want to make sure you’re working with someone that’s results driven, not necessarily, you know, dogma driven, if you will.

Evan Brand: That’s another great soundbite. You’re just rolling out these things. I love it. This is exactly the point that we needed to hit on. Because in this day and age, unfortunately, everything is kind of a soundbite. So you go to the lectin guy, you’re going to get the lectin diet, you go to the carnivore guy, you get the carnivore diet, you go to the vegan guy, you get the vegan, and you and I don’t really have any labels for us, we’d like you said we were results driven. And so we’re able to be more flexible. I love that we’re not in a box, like these people, because once you write the carnivore book or the lectin book, you’re kind of that guy, and then you’re stuck in that box. And it’s like, oh, wait a second, I’ve got all these other people doing really good with some cooked lightly steamed veggies and blueberries over here. But you told me I need to be carnivore. So what the heck, and then it just blows your credibility. So I yeah, I don’t want to be in a box.

Dr. Justin Marchegiani: Now I tend to lean more on the Paleo template, but I use the word template, not diet, so I can have flexibility. And there’s some patients that I’ve seen that haven’t been able to tolerate any meat, we’ve had to just lean on free form amino acids, with some good vegetables or starches that are easy to handle. And I’ve had to go to that extreme with some patients. And if my dogma was no, you must eat animal products all the time. While I may not have been able to help that Paris person so we try to have the levers that we work with. We kind of have like a foundational bias, but it’s a bias that is flexible and that we can adjust according to the patient.

Evan Brand: Yeah. And eventually I would argue that that person you’re referring to could probably get back in and they may have been able to get back here forever later.

Dr. Justin Marchegiani: Not the case, not a forever thing. It’s kind of a starting point where, hey, you break your ankle, you probably may have to be in a wheelchair out of the gates. And then we progress you to, you know, some crutches and they put you on a boot and then you just maybe Walk slowly, you don’t run and now you start jogging and majesty, right, there’s a progression and how you how certain things heal? Well, it’s the same thing, the four year digestive system that’s not quite as outward, it’s inward, right and how it looks and performs. But you can feel it just the same as an outward injury to your foot or hand.

Evan Brand: Yeah, I’m gonna keep this thing going a little more philosophical than action based for a minute, just to to further this conversation, which is that let’s say someone goes to the bookstore. It’s funny, everything’s changing with society, isn’t it now it’s the Amazon bookstore, the Kindle bookstore, it used to be the real physical brick and mortar, there’s still a need that exists out there. I know there are some. So you go into the store, right, and you go to the diet section, and then someone picks up like, the, like I said, the Paleo book, The lectin book, The carnivore book, they do that, and then they get different or weird results. And then they kind of just give up, and that’s why they get so opposed to the word diet, or they get so opposed to the idea of changing the way they eat to change their symptoms. But the problem is, all these people writing these books are missing all the other root causes. So just because Jane didn’t do well, with a lot of meats, she might give up on meats, like you said, or she saw the documentary and give up on meats, but she never worked with somebody like us. So when we have these clinical tools that we have, where we’re going to be measuring the stool measuring the urine and looking at different infections. If we could just resolve those for Jane, get some of the enzymes back in clear the infections, guess what now she does great with the meat. So it’s sad, because there’s so many people that may have tried stuff like this, but they got so turned off with the non amazing results that they thought it was the diet to blame. But it wasn’t it was just the root causes. And like you said, the indicator is it sort of for us, it’s a clue Oh, that happens when you do meets, that doesn’t mean give it up. That means let’s figure out why. And the H Pylori could be the big one.

Dr. Justin Marchegiani: It’s true. And I call it the vegetarian or vegan honeymoon. A lot of people that do go vegan, they can feel great their first year, it all depends where they’ve come from if they ate a lot of processed food or crappy food. And they’re eating lots of organic vegetables, and maybe some good healthy or plant fats like olives, or avocado or coconut oil. And they’re just getting a lot of organic food in their system, they may feel a lot better now over time is essential fatty acids and amino acids start moving more in the deficient side. And a lot of those fat soluble vitamins like a d k start moving downward, they’ll start having more problems over time. And that’s kind of I call it the vegan honeymoon where they’re kind of chasing that honeymoon. They’re like, I don’t feel as good as I did last year. And they kind of get stuck. And usually it’s a protein, fatty acid kind of issue, or maybe even a carbohydrate issue too much carbs. And then you got to look deeper. So getting back to the constipation part right, we have the six hours that I used to work with my patients. And we kind of start with that as a framework, removing the bad foods, or placing the enzymes and acids to the first two hours. And we adjust the diet accordingly. So it could be cutting out cutting down a lot of the fiber or a lot more cooking or going lower fodmap. or cutting out salicylates or females or going on to a moon, it could be a combination of all of that could be an elemental diet, of course, adding in enzymes and acids. And bio, especially if the stools are floating more, that’s a sign that we’re not breaking down fat, so we may adjust those first two hours. And if we’re having bowel movement issues, I may add in things like ginger, or bitters or D lime any, we may have to even add in some natural things like trifle or magnesium to really get the bowels moving. It just depends. I don’t like to add in bow movers unless I really can’t move the bowels with those first two hours, right. If I can’t move the bowels with those first two hours changing the diet and changing enzymes, acids and bile support, then we may lean on things to kind of get the ball moving. But I always want to see how the body responds before we have to add those things in first.

Evan Brand: Well, you make a great point. And even clinically, the things you would recommend to be used directly for moving the bowels those things are still a hell of a lot safer and more effective than some of the conventional stuff you’re going to get. So I mean, if you go to your conventional doc and they refer you to the GI doc and you’re diagnosed with let’s say IBS, C constipation, IBS type issue, there’s going to be some type of a pharmaceutical involved and there’s likely going to be side effects with that. And once again, it’s not the root cause so in your case like you mentioned clinically, you may not go straight to the magnesium hydroxide to help move the bowels by adding water to the bowels However, there’s so many people deficient in magnesium anyway that you could be actually fixing simultaneously fixing an underlying mineral deficiency plus helping to move the bowels. So the cool thing about what we do, is there a positive side effect so we can kill multiple birds with the same stone?

Dr. Justin Marchegiani: Yes, I’d much rather use a nutrient than like an abrasive herb like Cena or Cascara Sagrada, right? No one has a deficiency of that, but they may have some deficiencies in some of these magnesium so that can be helpful. Now if I get bowels moving out of the gates, usually one or two months in, I’m going to try pulling back on some of these compounds to see if the bowels can move on its own. So it just depends, right? We’re getting the body hydrated, we’re chewing better. We’re working on eating and a non stressful environment, we’re getting enzymes and acids better. We’re cutting out the inflammation. And we may be changing some of the format, the building and the food. So all of those things are moving so many levers. So when I work with patients, patients are like, want to know like, what’s the solution for this? What’s the solution for that? It’s like, I don’t know, I’m going to just give you what I’ve seen to work. And we’re going to do eight or nine or 10 things out of the gates. And we’re going to see what works. But in general, to know exactly which one it is, it’s really hard because you’d have to like make one change, wait a couple of weeks, make one change, wait a couple of weeks. And it would take patients years to get better versus weeks and months. And so we make a whole bunch of changes at once. And then we monitor and we check in on those changes.

Evan Brand: Yeah, good point. So just to give a little more clarity, somebody who’s listening, like what does that even mean? Eight or nine changes. Oh, my God, that’s overwhelming. No, I mean, it could be Hey, look, we’re going to give a little more enzymes and acids, we’re going to pull this food out, we’re going to get you to do a little bit more water and a cleaner water source, we may throw in a little bit of this extra mineral, or maybe a little extra vitamin C, you’re going to do a handful extra of some blueberries, you’re going to make sure you’re getting enough adequate movement because you’re a sedentary job. So we’re going to get you a standing desk. And now you can stand up and move around, we’re going to get you to do a 10 minute walk a day, we’re going to get you to you know, take a couple deep breaths, we’re going to get you to chew your food better, we’re going to make sure that you’re not sitting in, I don’t know a crazy loud restaurant with like, you know, speakers blasting, you know, techno music in the background, we want you to just settle down, we want you to go to bed on time. I mean, yeah, those things give you 5 10 15%. And then by the time you add it all up, you’ve got really good success.

Dr. Justin Marchegiani: Yeah, you’re not chewing your food. I’m sorry, you’re not hydrating when you’re eating right? All these things matter. And maybe getting a little bit more sunlight, right? All these things matter. And so that’s why it’s so hard to be like, well, what’s the solution? for this? It’s like, well, there’s a lot of things that can be a contributing factor, it could be 10%, for this 5% for that 20%. For that it’s very rare that this one thing is at 90 100%. Sometimes you get big, like you just make one simple change. And you the next week you check in with the patient. They’re like, well, I’m 80 or 90% better, it’s like whoa, that’s a home run, that can happen too. But we don’t count on it. And that’s why we do things kind of in a systematic fashion of what’s going to be the low hanging fruit and then we kind of move up from there, right? You got to build up the foundation of the house once the foundation solid, now you can you can build up, the foundation is not solid, then you have a whole bunch of problems that have happened with with the building of the house as you start going up.

Evan Brand: Good point. Good point. And this is the whole reason that we do a workup and we run people through a sort of a system. You call it a system approach. Because if you come in and you go to the doc, hey, I’ve got constipation. Pharmaceutical laxative, see you later. If you come to us constipation, it’s like, Huh, Interesting. Interesting. Okay, let’s figure out why. And if you ask why enough and you do the proper testing, you’re going to get to that why. So I just want to make sure we’re always comparing and contrasting because you ask, you know, Bobby, who hasn’t pooped all week what he’s going to do for his constipation, he might go to Walgreens, he’s going to go to the laxative section. Oh, I found this laxative. This one looks good. Let me drink some of this stuff. Oh, yeah, I poked Problem solved. It’s like, huh, yeah, you solve the constipation problem, but you didn’t solve why that’s happening in the first place. So I just, it shouldn’t have to be revolutionary to think root cause, but it still is not the mainstream. So until it’s the mainstream, our job is not done.

Dr. Justin Marchegiani: Yeah. And so when for most conventional, like gastro people, for instance, they’re just like, hey, motility support, here you go laxative support, here you go. It’s very rare, you may get one that say, hey, let’s do a Siebel breath test, maybe that, and then what after that, maybe they’re gonna just recommend, hey, you know, do this quick little diet thing, because a lot of the conventional fodmap diet still have a lot of grains and other crap in there. So you may not change the inflammation. And they may throw some Rifaximin or neomycin at you, boom. And then now maybe you have a fungal overgrowth or something on the backside, because they don’t do or address the gut bacteria, right? And then that can create other rebound overgrowth down the road. So let’s say you have a very progressive kind of forward thinking gastro Doc, maybe that’s what happens that I just mentioned, but most that’s going to be hey, here’s your motility enhancer. And you know, you got to just learn to relax and meditate and hey, maybe taking antidepressant a lot of time. That’s it. So you’re kind of stuck. And that’s just the insurance space model. When you have three to five minutes with a doc, that’s typically all they’re going to recommend for you. They don’t have enough time to really dive in deeper. And that model doesn’t give them the ability to dive in deeper. So you really need to see a functional medicine doctor to really have the ability to go deeper and get to the root cause.

Evan Brand: Yeah, I get so frustrated with that term, integrative it just makes me angry because I’ve had so many people and I know you have to hundreds and hundreds and hundreds of clients and patients that have said I’ve worked with this angle. Right of guy, Mike Oh, integrative What did he do? And you know, they kind of market it as it’s like so forward thinking, but like you said, it may be the Rifaximin at most. And then guess what a lot of these people they have antibiotic resistant infection. So we’ll test them and guess what the SIBO situation is still going on. Maybe they have parasites or like you said, there’s a fungal overgrowth component to it as well, their guts leaky, their guts inflamed. Now they’ve got all sorts of other problems as a side effect of hitting this Rifaximin. In some cases, it can help maybe play whack a mole a little, it may knock some things down, but they still have enough problem when they come to us that we need further work. So I get frustrated with this integrative idea. Because and I know there’s good intention behind it. But as you mentioned, with that model, the way the model exists, it doesn’t doesn’t allow enough time and there’s not enough advanced testing, like we’re doing to to fully get to the bottom of it

Dr. Justin Marchegiani: Correct. And once you kind of talk to your conventional medical doctor, and you say, hey, walk me through your thinking on what you think the root cause of this could be. Usually it kind of reveals their that they really don’t know. Because if you’re just providing a drug to treat the symptoms, well, obviously, they’re not worried about the root cause because it’s Band Aid down below, right? So we kind of look at everything in my line, kind of as the SSS approach, right? You have the underlying stressors here, could be physical stress, chemical stress, emotional stress, food allergies, bacterial overgrowth, sibo, right, all of these stressors, increase our stress bucket, and then the body systems start to dysfunction, hormones, digestion, immune detoxification, as the system starts to dysfunction, then you have all this, the symptoms happen down below. And so conventional medicine just band aids, these symptoms down below, they don’t ever go upstream. So you got to have conversations with your doctors that talk more about the upstream issues. And so we try to nullify all of the underlying stressors, make sure foods good chewings, good, hydrations. Good. And then we’re going to do tests that look at the function of the systems. So it’s a lot different of approach. So if you’re working with someone, you know, you want to be able to ask the right questions, what do you think the underlying root causes are, and as a patient, make sure you walk into it with an open mind that there’s probably not one underlying issue, it’s probably a bunch of things that are spread out, that are part of the underlying cause, from a stress standpoint, and the body system standpoint that are emanating the symptoms downstream?

Evan Brand: Yeah, well said Well said, that’s a great, great visualization, and you have permission to have 4 5 6 7 8 9 10 things going on.

Dr. Justin Marchegiani: That’s the key, that’s that that’s the missing assumption, you could have a lot of different things. And then as you walk through with the clinician, and you’re making changes, you need to not go into it as Oh, I made this diet change and the supplement, I don’t feel better yet. It’s okay. There’s always a plan B, a Plan C, a plan D, a plan E. And if the answers down here, and E and F and you, you quit and get discouraged that B and C, then you never get a chance to kind of go deeper. So just as patients are listening here, always make sure you have that ability to kind of just like, have a good attitude and keep on progressing down the line.

Evan Brand: Yeah, and you can’t blame them on me. This is the way that people have been conditioned over decades and decades of conventional medicine, but it still does frustrate me when someone will approach us whether it’s a friend or a family member or something and they’ll say, Hey, you know, I’ve got autoimmune. I’ve got sjogrens or I’ve got alopecia or I’ve got, you know, diabetes type two. What’s wrong with me? Like, why did this happen? Where did this come from? It’s like, Where do I even start? You stay up till 1am? You posted a picture the other day on your Facebook page? Have you eating an ice cream Sunday? Yeah, never get exercise. I know what you do. You sit all day, you don’t get outside and you’ve never had a tan in your life. So you’re afraid of the sun. If you do go outside, you lather yourself in sunscreen chemicals. You don’t eat organic, you’re super stressed. I mean, you know, so when people ask, well, what’s wrong? Why is this happening? It’s almost like, Oh, are you ready for this? Because I’m about to open up Pandora’s box here. And I’m going to tell you 20 things of what’s happening, I’m gonna tell you 30 things of why this has happened to you. So it’s just a reeducation really, of telling people look, it’s there’s not a one smoking gun, rarely to you and I find one smoking gun.

Dr. Justin Marchegiani: Yep, I 100% agree. It’s nice every now and then where you kind of get a home run and functional medicine, when you kind of make a couple of changes. And it’s like boom, and you blast it out of the park. It’s always a good luck little ego check. Because you know, you work with a lot of difficult patients over over time. And so it’s nice to get a couple of home runs every now and then. But if you work with a good clinician that has the right algorithm and kind of goes through the things goes to the options that give you the greatest chance of success out of the gates, and then work to the things that give you the less success at the end, then you have the greatest chance of success as a patient early on. And you set the foundation for greater healing over time. So I think that’s really the most important mindset is clinically go with the high percenter options.

Evan Brand: Yeah, and I’m not being a bully here. And I’m not making First of these people, I’m just saying, we really need to re education. You know, you you people eventually come out of the woodwork at at you when you and I do what we do and they’re not ready for the red pill. They’re not you know, they’ll ask what’s wrong me? Why do I have diabetes? Or why do I have this headache? It’s like, ah, are you ready? Are you ready? Because there’s there’s a lot to uncover. There’s a lot to unpack.

Dr. Justin Marchegiani: Yeah, I think most people once they’ve kind of gone through the conventional medicine model, and they’ve kind of said, Hey, all right, well, I just don’t want to be relying on laxatives or enemas my whole life. What’s next? Usually, once there’s, they kind of have this level of like, okay, these are the only options I have from conventional medicine. There’s a level of openness that occurs from that, where they’re like, Alright, what’s next? What’s next? I’d see functional medicine and nutrition is helping people all the time, what’s next outside of this because they just kind of have this yearning that there’s got to be something more. And I think that’s creates a level of openness and readiness to. 

Evan Brand: Good point. Good point. Yeah. I often say people have to hit rock bottom or they have to be miserable enough to listen, I mean, you and I’ve heard countless stories of husbands and wives that are stubborn and they want to eat the pizza while the other spouse has to eat the grass fed steak and sweet potato that grass fed steak sweet potato tastes better anyway. So I don’t know what they’re doing. But But anyway, they’ve got to have their own issue right? And then finally, once the other person once they get miserable enough, then finally they’re they’re willing and you don’t have to drag them into this whole thing as much.

Dr. Justin Marchegiani: No, I totally agree. Well, if you guys are listening, and you enjoy the podcast here, put your comments down below. Really appreciate the thumbs up and a share. We also reviews are great, It’s great. If you feel free to head over to you can schedule an appointment with Evan anywhere in the world. Vice versa with myself Dr. J at We’re here to help y’all. And I appreciate you guys listening and just feel free to share this content with some friends or family that can benefit. Again, we’re clinicians that have had 10s of thousands of patients experience kind of combined, and we want to provide actionable information with y’all so you can take action and get your health back in your hands. So we really appreciate you guys being listeners and attending. 

Evan Brand: Take great care yourself. We’ll be back next week. 

Dr. Justin Marchegiani: Thanks.


Audio Podcast:

Fatigue, Tiredness, and Lethargy: Link to Gut Infection | Podcast #311

Tiredness is not a symptom that defines any one particular disease. Rather, tiredness can be a symptom of many different diseases and conditions. Causes of tiredness range from lack of sleep and over exercise to medical and surgical treatments. The lack of energy (lethargy) associated with tiredness can sometimes cause difficulty with normal daily activities, leading to attentiveness and concentration problems. 

Dr. J suggested considering to support protein breakdown by extra amino acids and enzymes. Dr. Evan also added that if you have issues, always reach your conventional Dr. or functional Dr., be tested, find the root cause and guide to fix possible infections that cause you to feel tired before you reach a crisis level.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:10      Mechanisms to Gut Infection

4:05      Where Gut Stressors Come From

12:12     Infections that causes Fatigue

17:41     Probiotics and Beneficial Bacteria

22:32     Supplements to Gut Infection

24:18     Immune Issues

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Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house with Evan brand. Today we’re going to be chatting about your gut infections may be making you tired. Many people don’t think about how their gut maybe having an impact on your energy, your mood, your emotions, but it’s totally true. Most people think, oh, if I have a gut issue, I’m just gonna have bloating or diarrhea or constipation or acid reflux. Oh contraire. We’re gonna dive into that today, Evan, how are we doing today, man? 

Evan Brand: Doing really well. How about should I just go straight into my story, then? I mean, I suffered with this thing firsthand, as you know.

Dr. Justin Marchegiani: Yep. Let’s do it. 

Evan Brand: So when I was down in Austin, I was losing weight. And I didn’t know why I was losing weight. And turns out and I was exhausted. That was that was the main thing. I mean, I was drained, like, it was really tough for me to get through the day. I mean, I was to the point where, at some point, it’s kind of embarrassing. I mean, I was like, okay, am I do I have enough energy to cook a meal at night, you know, for dinner, like, the workday just drained me. And so fortunately, after I got the gut infections resolved, I mean, the story is not much longer than that my energy came back online. So I mean, we can say clinically, and personally, that this is a big, big smoking gun for anybody who’s been dealing with chronic fatigue.

Dr. Justin Marchegiani: Oh, totally 100%. Now, let’s talk about some of the mechanisms why like, you could have constipation, you could have diarrhea, you could have all these digestive issues, that’s fine. And it makes sense why some of these issues may be causing problems. Because if you’re going to digest a lot of the nutrients that energize you, right, B vitamins, your amino acids, your essential fatty acids to burn them in the mitochondria for fuel, all of these things require optimal absorption, right? So if we don’t have adequate enzyme, or acid level or biliary level to break down fats, proteins, and carbohydrates, we’re going to have a problem with those nutrients getting into our bloodstream and making their way to ourselves and our mitochondria to be burned for fuel. So that’s one big mechanism. And the other big mechanism out of the gates, and we’ll kind of expound deeper into each one is the fact that your immune system sucks up lots and lots of resources. So think back to when you maybe got the flu or had some kind of illness. Were you energized? Are you tired? Most people were very tired. Now, why is that? It’s because your immune system allocates lots and lots of resources when it’s stressed. And it will make you tired, because it’ll pull some of those energy resources to put it towards fighting an infection. All right. So if your immune system is caught chronically in that state of trying to fight something, whether it’s a gut infection, cebo, or parasite, or just gut permeability issues that are upregulated, due to bad foods, and food allergens, you’re going to be really over stimulating and over allocating resources to deal with whatever’s happening with the immune system, aka the gut. Don’t forget 80% of your immune system is located in the gut, people forget that so important. So if you’re over stressing your immune system, you’re gonna have problems. 

Evan Brand: Yeah. And so for me, I was taking some immune support, but it was all just kind of a bandaid, right? Because I wasn’t focused on the underlying infection. So this time of the year, we’re, we’re talking in the fall here coming up on winter, you have a lot of people that will say, Well, you know, I really just want to strengthen my immune system. So they’ll go and do maybe some extra vitamin C, maybe some medicinal mushrooms, or maybe some other herbs, astragalus, things like that. But it doesn’t matter if you do all those if you don’t address the infection. So if someone’s like, tired and they feel weak, they feel depleted. They feel like they’re possibly immunocompromised. Sure, you could do some of the tools, like we talked about those herbs, but really, you got to test first of all, figure out what kind of infections you have. And then step two, is you come in and make a protocol to fix those infections. And not to mention, you know, like h pylori is super contagious. So, I mean, you and I’ve seen hundreds and hundreds of cases where, you know, husband and wife have reinfected each other. And so we’re not doing this to try to make more money. We’re doing this to help the family when we say, Hey, what about your husband? What about your wife when we try to get them on board? It’s because we know about this potential, you know, cross contamination.

Dr. Justin Marchegiani: 100%. So we kind of look at the gut, and we’re like, Alright, where are the gut stressors coming from? So the first stressor we look at are food allergens, because if your immune system is kind of responding negatively to food, that could be a big a big issue, right? And what happens is, when food allergens kind of come in, whether it’s gluten or dairy, or just you know, processed grains, or sugars, or even things like nuts, or seeds, or just more allergenic foods, soy those kind of things. Your immune system is upregulated dealing with those foods, and that’s going to suck away resources. And also, these foods if you have an allergen to them, if your body’s hyper allergenic, meaning your immune system is over responsive. There may be some gut permeability. And gut permeability is like these little tight junctions in the epithelium in the small intestines. They’re like this. So imagine you’re putting your hands together like you’re saying a prayer now, start pulling your fingers apart a little bit, you see the little gaps that happen that’s happening at a microscopic level with the tight junction cells in the small intestine. So the more you’re stressing your gut lining, these tight junctions open up, like I mentioned, the fingers come further apart. And then food particular we call it antigens, right? These foods aren’t supposed to be in the bloodstream at the size they’re in. Now you start having these antigens go into the bloodstream at a larger level, and now the immune system’s going to start going after it with full force. And that’s gonna start sucking up a lot more of your resources. So the first thing when we’re working with patients worldwide, we’re trying to cut down the food allergenicity we’re trying to decrease the immune response by helping the foods not become so bad or stressful on the immune system. So some people coming in on a standard American diet, a paleo template, maybe enough. Some people that are really have an autoimmune issue or Irritable Bowel Disease, we have to go to a paleo template where we’re cutting out extra allergenic foods, some we have to even go to a carnivore or some kind of an STD low lower fodmap diet because the bacteria is overgrown, and it’s reacting to even fodmap foods like broccoli and onions and garlic like healthy foods, were reacting to it. And so it this whole thing becomes a little bit more nuanced with food, the more unhealthy you become, or the longer your conditions progress. So as a practitioner, right, we’re trying to meet people where they’re at some people come in at a really easy phase, they’re just diets crap. And we can just make a simple change with the Paleo some we have to get a lot more nuanced. 

Evan Brand: So let me ask you, you brought up garlic. I had a woman last week, actually. And she was complaining that garlic was a big issue for her. So we’ve already cleared out gut infections, and we’ve done a great job. We’ve retested we’ve confirmed that we got rid of all the gut infections, we are doing some leaky gut support, but she says every time I eat garlic, I get really bloated. What would you What would you do? What would you say to that garlic person? 

Dr. Justin Marchegiani: Well, it could be a SIBO thing. So I’d want to test other fodmap foods. So if there’s some kind of a gut issue or like a bloat or a motility issue, or a diary or a constipation issue, we’re going to be cutting out fodmaps fermentable carbohydrates, fructose, oligo, disaccharide, mono and polyols. And we’re going to do that and then we’ll eventually do a reintroduction. And when we reintroduce foods, we’re going to start with moderate fodmaps first and then go to higher fodmaps. Last, so those foods are higher fodmap. So the question will be How did she do adding in the moderate ones? First, I want to know how she did incrementally adding things in.

Evan Brand: So like apples, she does fine, which was interesting, because to me, I’ve had a lot more people have issues with apples than I have with garlic. So I thought Hmm, you know, is it really a bacterial overgrowth thing? The stool test didn’t really show much in the in the bacterial category. So it’s kind of like, well-

Dr. Justin Marchegiani: when people like that, I just want to see is it a one off? Is it just garlic? Or is it other foods like onions and broccoli and avocado, which is a moderate or sweet potato, which is a matar, I want to test more of the moderate fodmaps? Maybe add in some fermented foods like a kombucha or a sauerkraut? Did it happen with those two, if it’s just a one off, then it could be some die off, it could just be she’s having an issue with that food. So if it’s a one off, I don’t really worry about one offs, I look for patterns, like patterns or like part of being a good functional medicine doctor, it’s pattern recognition, you’re looking for patterns, like some patient that can be Well, last week I had this happen or that like, we got to look at bigger picture, we got to have enough data points. So we can look at patterns. Anything can happen one off due to stress or a poor night’s sleep, or you got exposure to some bad foods. And now your guts a little bit rocky for a few days. So we got to look at longer trends and really have a lot of good pattern recognition. Part of what we do, we’re kind of CSI detectives, and we got to look for things repeating itself, because anything can happen one off, we don’t want to change what we’re doing, or the programs that people are on, off of just a one off issue.

Evan Brand: And that’s what it was, it was a one off and it was kind of, you know, frustrating for me because I’m thinking well, crap, you know, everything else, she’s tolerating good and any other problematic foods, I’d kind of put in that same category that we thought would be a problem. They’re not a problem. So I’m sitting here thinking, Okay, well, what kind of explanation Can I give her? Because she wants some kind of good functional medicine answer for me, right? And so that’s what I told her. I’m like, well, this sounds like just Oh, to be honest, kind of like a food sensitivity, particularly to the garlic. You know, I don’t looking at the testing. I told her I didn’t really see anything that was compelling to indicate any other sort of issue and all the other foods were tolerated. So I kind of just gave it like a political answer. It was like, wow, hmm. You know. 

Dr. Justin Marchegiani: Yeah, well, we’ll come it’s possible there could be just a, her immune response is just a little bit more sensitive to if we don’t see extra data points correlating to it, then I just tell patients, hey, let’s just we’ll come back. We’ll work on probiotics. We’ll work on good re inoculation of good healthy bacteria while adding some prebiotic fibers every month. We can try testing it again. But as long as there’s no yeah, as long as there’s no, let’s just say, family of other foods that are interacting like this, then we’re not going to really worry about it too much. But you can always retest, make sure that gut’s doing good, but it’s possible you have one off allergen issue that’s possible. But every month, we can always retest it and see.

Evan Brand: Yeah, good point, I did end up throwing in a high dose, multi strain probiotic. So we’re with a high amount of bifido. So we’re gonna see what happens. 

Dr. Justin Marchegiani: Yeah, and this person could tolerate fermentable carbohydrates, like sauerkraut and, and maybe a little bit of kombucha it’s probably not a fodmap issue, because those things are very, very high in fodmaps. It could be she’s killing some stuff off. It could just be she sensitive to garlic. It’s possible. Yeah. And so I mean, I just tell patients, hey, you know, that’s an artifact, we just kind of make a note on it. When we follow it down the road later on. If things kind of connect back to it down the road. That’s nice. But if not, things that are one offs. You don’t want to you don’t want to one off to derail your whole investigation. 

Evan Brand: Yes. Yes. That’s a great point. You know, it’s like you’re, you’re you’re like, you know, investigating a crime scene, and you have his weird piece of evidence. That does not make sense. 

Dr. Justin Marchegiani: Yeah. Right. Okay. Well, we’ll make a note on that. And we’ll come back to it if there’s any patterns that they point back to it down the road.

Evan Brand: Yep. Yep. Great. So so small tangent, but really helpful. I think it’s, it’s helpful for people to see how do you have to think when you’re approaching these issues, it’s not always black and white, you know, we try to refer back to clinical experience, we kind of sprinkle in some of the data sprinkled in some previous case studies that we’ve done with people. So it’s really fun. But back to the fatigue piece. 

Dr. Justin Marchegiani: So I just wanted to highlight one component, because while you’re on it, is when we are talking about these things, because we’re clinicians, and we see thousands of patients, we’re operating more off of clinical concepts than like rote memorization of like, a fax. And so when people listen to our podcasts, we really want them to understand the overarching concepts of health. If you understand a concept, you don’t really have to memorize it, if you’re trying to memorize random facts and randomness, and that becomes a little bit convoluted and a little bit stressful. So just try to get the overarching concepts that we’re talking about here. Once you get the concept, you never have to worry about memorizing, and it’s just there. 

Evan Brand: Yeah, yeah, good. So I just wanted to go back to the to the fatigue piece, because for certain people, there may be multiple layers of infections that are causing your fatigue. So for me it was H. pylori, and then once I got rid of the H pylori, then it was the parasites that were still causing me to be tired. And once I got rid of that, then I did have some Candida that I had to address. So what I want people to know is that if you double down or triple down on something, you know, the guy tells you it’s parasites, or the girl tells you it’s this, and you pursue that, and you’re not better, it’s possible that you’ve, you’ve missed something. And so I just want people to wrap their head around you, like you say, you have permission to have multiple things wrong at the same time. So you could have a bacterial issue, a parasite issue, a Candida problem, all at the same time. And so you got to make sure you get all the data if you just run a stool test. Candida rarely shows up on the stool test, you and I’ve talked about this many times. So the urine test will often fill in the blank. So if you had one test done, or your doctor ran this or that, and you feel like you’re missing something you probably are so keep, keep digging. 

Dr. Justin Marchegiani: You also there’s one study here just looking at h pylori and mitochondrial function, I’ll put it up on my screen. But this is important, right? And the reason why it’s important, I’m going to just I’m going to do a share here. So if you guys are listening to the podcast on YouTube, you’ll be able to watch the video. If you’re on iTunes, you know, you have to just click the YouTube link, and you’ll be able to see what we’re talking about. If not, I’ll try to describe it pretty well. But you can see my screen you see my screen. 

Evan Brand: Yep. h pylori affects the mitochondrial function. 

Dr. Justin Marchegiani: So this is important right here. So mitochondria are the powerhouse of the cells. This is really important and the powerhouse of your cell generates ATP for energy. Now, if you look here at the bottom they talked about, they wanted to investigate whether there’s an increased mutational load and mitochondrial genome and what they found was there believe that the there’s a downregulation in the mitochondrial DNA repair pathway? What does that mean? It means how your mitochondria are repaired and regenerated. It’s going to be down regulated, so you’re not going to be able to repair your your mitochondria as fast. It’s believed to be involved in mitochondrial base excision repair. Our results suggest that these genes A p one and y b one, just know that their DNA is that are involved in mitochondrial DNA repair. They’re they’re demonstrated to be involved and they’re demonstrated to be down regulated when there’s an H pylori infection. So it just means that your body’s ability to generate ATP which has decreased respiration coupled aptr. So you’re not able to generate as much ATP and repair your mitochondria as well when you have an H pylori infection. And this is something that we think is there with a lot of gut infections. It affects your mitochondria. Your ability to repair it, which then affects your ATP synthesis. 

Evan Brand: That is pretty crazy. I mean, especially if we’re talking about an athlete who wants to perform right you’ll have all these big celebrity personal trainers and stuff and they’ll just get people on different diet changes or no, you need to do this exercise or this exercise and they missed the boat. They don’t have a clue about H. pylori being the root cause of the of the fatigue or the exercise performance. So yeah, it’s just crazy. 

Dr. Justin Marchegiani: And then also, there’s a lot of right here, right here one study, I’ve already looked at it before, if people are having gut issues, and they go to their conventional gastroenterologist, what are they typically prescribing? Well, a lot of times they’re prescribing antibiotics, right, and there’s a lot of data, bacterial Seidel, antibiotics induce mitochondrial dysfunction and oxidative damage. And so we know this is something that’s actually present, where there’s damage to the mitochondria with antibiotics. 

Evan Brand: Well, and and, and to be clear, for H pylori, it’s not just one antibiotic, it’s three or even four, they have what they call quadruple therapy now, which just the name of it scares me, it’s literally four antibiotics at the same time. And you and I have both seen patients that have had triple or quadruple therapy done and guess what we retest them, and unfortunately, due to antibiotic resistant bacteria, the infections are still there. So now we have to come in, repair all the mitochondria that were damaged, plus use herbs, which are much, much safer, and in my experience, just as if not more effective, and then we actually get rid of the bugs. 

Dr. Justin Marchegiani: Yeah, she’s a summary of your mitochondria dysfunction and oxygen damage induced by bacterial Seidel antibiotics, which is interesting, because bacteria, all antibiotics are bacterial Seidel, so interesting. They use that description. It’s mammalian cells. I’m not sure which mammals they use. But they talked about that it’s alleviated by antioxidants. Well, guess what, when we use a lot of the clearing herbs that we use, guess what they’re rich in, I mean, tons of antioxidants, polyphenols. And that’s the benefit, a lot of the herbs that we use, they have a lot of antioxidants in them to help buffer the oxidative stress. Because remember, oxidative stress is part of what happens with the antibiotics. And we have a similar effect with herbs. But the herbs have a lot of antioxidants, which is helpful. Any comments on that? 

Evan Brand: Well, what you’re saying makes us look really good, because not only are we giving nutrients that can effectively get rid of the infections, but we’re also protecting the system or even replenishing antioxidants, because in general, and the oxidants are going to be reduced because of all the oxidative stress from the infection in the first place. So it’s literally like a win win, for us and for the person under the protocol. 

Dr. Justin Marchegiani: Yep. And there’s lots of different studies here as well on probiotics and beneficial bacteria, correcting mitochondrial dysfunction with probiotics. There’s there’s definitely studies on this as well. And again, you know, these are things that we’ve seen in our practice, like when you see someone get better. So protection of hepatocyte mitochondrial function by blueberry juice probiotics. So there’s lots of studies on this, because when you see patients get better with certain beneficial bacteria, after you do an elimination, you’re like, why does that work? And so what happens is you see a clinical outcome, patient getting better when you do something. And then you’re like, Huh, what could the mechanism B and then you chase it down online? And you’re like, oh, maybe that’s it? You know, maybe it has to do with the fact that it’s helping the mitochondria and people’s feel better afterwards? Maybe that’s the mechanism. It’s possible, right? 

Evan Brand: Yeah. 

Dr. Justin Marchegiani: We have to comment on that. 

Evan Brand: Well, it’s a lot of good things happening. And then you mentioned the probiotic piece. So that’s going to help even more. So after we get someone on a killing protocol, there’s going to be good benefits there, your energy is probably going to get better just based on doing that. And then when you go to the next phase, if we’re going to come into the gut healing phase, you’re going to get even better than so it’s it’s really fun for us to kind of paint the picture here of just how how is someone going up, up up up better, better, better? And you’ve just outlined how so pretty I talked about it right here. 

Dr. Justin Marchegiani: They talked about a collusion the studies show this is BP stands for blueberry juice and probiotic exhibit a synergistic effect preventing the development of a and that’s non alcoholic fatty liver disease by protecting mitochondrial function, suppressing the damage of mitochondrial ultrastructure by reducing mitochondrial swelling, right. So mitochondrial damage by antibiotics, as well as we could do the same thing when we search, let’s say pesticides, or heavy metals or mold toxins, so we know that gut plays a big role and one helping to absorb those nutrients. But number two, also helping to have beneficial bacteria that modulate these, this inflammation and mitochondrial damage as well. 

Evan Brand: Yeah, yeah. Well said. Excellent. 

Dr. Justin Marchegiani: Well, it’s good that just a couple of studies. I mean, when we look at like we look at research a lot differently, so just kind of everyone there. We look at clinical outcomes in patients. And then we chase them back to what the literature says. The problem is a lot of people who are clinicians, they’ll look at the literature, and then they’ll try to then come up with a clinical like decision based on the literature. And that’s sometimes it’s really hard to do, because a lot of the PhDs and a lot of the research out there isn’t necessarily clinically driven, and maybe driven because someone has a PhD in this area. And they’re just they’re just studying that topic, because or maybe it’s an NIH funded study. Who knows, right? So we’re looking at things that are clinically driven, not research driven, because someone has decided to dedicate their life to this topic. And this is the study they’re choosing right? 

Evan Brand: Now. It’s good that we can kind of pull out some studies to help backup what we’re saying. But it’s not like we go into PubMed to try to figure out exactly what we’re going to do the clinical stuff is really that’s where all the magic happens. 

Dr. Justin Marchegiani: Yeah. And some may say we have a confirmation bias and how we look for these things. But we’re not looking for out of the blue we’re looking for, because we’ve seen clinical outcomes support something is happening in that direction. And then we use the data, the research to say what could be if positive things are happening in this direction? A to B, what could be the mechanism of why that is? And so we kind of chase it backwards. versus the other way around? 

Evan Brand: Yeah, yeah. And it’s just it’s a blast. It is fun for you to pull that stuff up. Right? Because, you know, we get we get used to our our methods, we get used to our results. But when you get to see in the literature like that antibiotics, causing mitochondrial damage is like, Oh, yeah, I forgot. That’s why we do this. It’s Yeah, we’re Exactly. We don’t want people to get damaged. 

Dr. Justin Marchegiani: And you get confident when you see things repeat itself. Clinically, you’re like, Okay, something’s happening here. Now what? So you’re going at it with a lot more confidence versus like, Hey, I think maybe, you know, I’ve heard this, it’s a hearsay kind of thing. No, you’ve seen it, you’ve seen it clinically? Well, here’s the confidence.

Evan Brand: Here’s the thing that’s always fun for me is when we’re on the topic of fatigue and gut infections. And so when you have a case where you do the follow up, and someone is reporting that they have significantly more energy, and you didn’t give them any energy supplements, you just fix their gut, you just gave them some liver, maybe some enzyme support, some gallbladder support, and then you killed the infections and all the sudden, boom, I’m 20% more energetic. I always smile and laugh simultaneously. Because it’s like, This is so fun. We have 20% more energy. And we did zero energy supplements. That’s just super cool. 

Dr. Justin Marchegiani: Yeah, it’s powerful. Now, if people start feeling a little bit worse, then we got to be very careful. So when people start feeling worse, I’m like, all right, we got to spend more time building up the adrenals, we got to make sure the diets clean, because if someone’s got his or, like, if you’re putting lots of bad foods in and you’re inflaming the gut, then your immune system and also your adrenals may be making more resources to deal with the inflammation in your gut. So we have to decrease the inflammation in our gut and support the adrenals by calming it down. Now, the adrenals have more resources. And of course, we always like supporting the adrenals ahead of time. So then you have natural, your more of your natural anti inflammatories, because conventional medicine when there’s serious gut issues, they’re going to give prednisone cortisol, well, let’s just support your body’s ability to make that naturally. And then when we go into a gut clearing phase, then we have more of those resources on board. And then patients are sensitive. I’m titrating the herbs in there slowly so we’re not overwhelming the system by killing more, you know bacterial toxins, LPs endotoxins, mycotoxins, we’re not overwhelming the lymphatic system that a toxification immune system. So we’re going to kind of really titrate things in a little bit slower if you’re more sensitive. And we may even add things like binders and glutathione too. 

Evan Brand: Yeah, yeah, the glutathione is good for me. I had to take a break from it for a little while. It was just too strong. It does mobilize toxins to so this is all case by case basis. But yeah, I love glutathione when it works. But when you take too much, that’s no good. There’s always a right dose. 

Dr. Justin Marchegiani: Yeah, if you’re slow, if you’re like more sensitive, always start low, work your way up. And then if you’re sensitive, you can always start with just a gentle binder first, as long as you’re not getting constipated. That’s a good first step on increasing things. 

Evan Brand: Yeah, that’s great. So let’s see here. 

Dr. Justin Marchegiani: Um, the other component, I would say is people that have got issues tend to also have immune issues. We already talked about why 80% of your immune systems in the Galt, that’s the gastric associated lymphoid tissue that’s in the stomach. And then also the model that’s the mucosal associated lymphoid tissue, lymphoid meaning like lymphocytes, white blood cells, and that’s in the small intestine. And so if you have a lot of gut permeability issues, if your guts over responding well, what’s the most common autoimmune condition that affects people and mostly women, five times more women is autoimmune thyroid. And so if you have an autoimmune thyroid, that could also be affecting your energy because you know your thyroid gland is being attacked and your body is ability to generate thyroid hormone may be decreased. And it’s possible that your conventional doctors overlook that. And so knowing that there’s an autoimmune thyroid could be affecting your energy too. And if you have an attack, you could feel hyper where you’re like anxious, can’t sleep irritable, sweating, right? first and then you go into a hypo where you’re like tired, fatigued, depressed, right? So you could easily be going hyper and hypo swings based on autoimmune tax of the thyroid. 

Evan Brand: Yeah, and once again, the hashimotos could be a side effect of something else. So even if you go to the endocrinologist, let’s say they were a more advanced endocrinologist, for example, hopefully they’re running thyroid antibodies TPO, TG maybe TSI. And they’re looking at that and maybe they’re treating your thyroid giving you desiccated glandulars, or nature thyroid, or just Synthroid or side ml. Even then you see how people can fall between the cracks and not get better. Because yeah, you’ve kind of cranked up the thyroid that was hypo due to autoimmunity. But you still never got to the gut infection that started at all.

Dr. Justin Marchegiani: BINGO, BINGO, BINGO, BINGO 100%. That’s what we got to look at always the root cause. So anything else you wanted to talk about here on the gut and fatigue I did, we hit the thyroid, of course, I alluded to the adrenals earlier, because they play a huge role in regulating inflammation. And we know acute gut issues, they may be, they may be given a corticosteroid to calm down the gut inflammation, that’s possible too. So we want to support your body’s ability to do it naturally. I would also say supporting protein breakdown. So with maybe adding in free form amino acids, because protein can be very hard on the body to break down. So of course, dialing in enzymes and acids and maybe giving extra free form amino acids. So it’s taking stress off the digestive system to be able to access those amino acids as well. 

Evan Brand: I think I think you’ve hit it all. I mean, I would just say, kind of where do you go next is you really have to get the data. I mean, we’ve talked about a lot, right. But if you don’t have the data, you don’t know what you’re up against. You don’t know what you’re doing. So, you know, I think the best advice I could give is if you’re dealing with these issues, test, don’t guess. And so, you know, feel free to reach out to Dr. J. Justin at And he can run labs on you anywhere in the world and send them to your door and jump on a call and discuss it make a great protocol to help you to get better. Same thing for me my website, And we’re available we love helping you all we’re grateful to be in this position. So you know, sure you know a lot of you listening or kind of do it yourselfers. That’s what led you to be smart and find a podcast anyway. Because you want to kind of educate yourself, but there’s a certain point where it’s okay to reach out. And I tried to fix myself for a long time. And you spend more money and you spend more time doing that. So you know, feel free to reach out and get a guide.

Dr. Justin Marchegiani: 100% and then you’re available at worldwide. We’re available worldwide and we’re clinicians, we have our sleeves rolled up and we’re in the trenches every day, dealing with patients. Also, if you’re listening to this don’t just kind of glom on to one thing. So we see lots of people they’re like, they come in like Oh, I know what’s h pylori or I know it’s Candida or I know it SIBO keep an open mind on what’s happening because you have the right to have more than one issue going on at the same time. And for instance, Evans original story was Evan had not could have it wrong if you had h pylori, Giardia and crypto. That’s correct. Yeah, yeah, h pylori, giardia crypto, those are some serious infections. Any one of those infections is serious and could could have created the symptoms Evan was having yet he had all three at the same time. So if Evan was like, Oh, it’s only H. pylori, you know, he may have missed the fact that grd and crypto were involved too. So go into with an open mind and you have the right to have more than one infection happening at same time. Sad but true. But either way there are solutions to work on it and fix it. 

Evan Brand: I was tired. Man, I was tired. Now that was a that was a that was a level of exhaustion that just doesn’t even seem real. I mean, that’s how you know something’s wrong when you’re that tire. But you know, hopefully, with this education we’re providing people can reach out and work on this before it gets to that crisis level because it’s much easier to pull you out if you’re not that deep. 

Dr. Justin Marchegiani: Now Evan can you go to your conventional medical doctor or a gastroenterologist and typically get these infections picked up on? 

Evan Brand: No, definitely not the testing is just so outdated, you know, it’s not sensitive, like the DNA stuff we’re using. So that’s the downside is if you go to the gastro doc down the road, say, Hey, I think I’ve got Giardia, I heard these two guys on the internet talk about it. They’ll probably just laugh in your face and say, Well, you didn’t travel to any third world countries. So you don’t have it. But if you if you really want to Sally, I’ll test you on they’ll run the outdated test and then everything comes back negative and then we’ll say see, I told you it was all in your head, just, you know, take an acid blocker. 

Dr. Justin Marchegiani: So yes, my opinion is very similar. So the more acute you are, especially with typical gastrointestinal symptoms, the greater chance they’ll pick you up, especially if you came back from like Mexico or some kind of a country like Bali where infections are probable, right? But now what do you do? If your infections aren’t really gut based symptoms, they’re the fatigue or the brain fog, well, then how does that get picked up, you’re typically never going to get picked up for that you’re more than likely to, to get a psych referral for an antidepressant, right, then to get a gut test, and Evan already alluded to some of the technology they have isn’t going to be as up to par. So we have a little bit you know, more access to the DNA technology a little bit more sensitive. And then also like H. pylori testing that they may run a breath test, right? Urea breath test and look for elevated levels of co2, it’s possible, but that may miss an infection. And if it’s more subclinical, you may need a more sensitive test to pick it up. So if you’re listening, and you’re like, Hey, I’m gonna go to my MD that may not be the solution, I may not get you the answers you want. And if you don’t have the typical gut symptoms, diarrhea, bloating, gas, a lot of stomach discomfort, and irritability, you may not even they may not even want to run a test, because those symptoms don’t match with what they think the problem could be. 

Evan Brand: Yeah, yeah. And you know, it sounds like we’re like picking on him. Right? And we sort of are and that’s fine. I love picking on them, because they’re failing people. And it makes me sad. Because I was there I was sitting in the doctor’s office trying to get help. And I was told that I just needed an acid blocking medication. I told the doc, no, I feel better when I take it. enzymes that actually increased my stomach acid, I think you’re wrong. She said, That’s not possible. You’re gonna hurt yourself, you need to stop taking supplements stop all dietary supplement, the FDA, blah, blah, blah, blah, blah. And and that was it. And that’s when I signed off and said, No, I’m done. 

Dr. Justin Marchegiani: Yeah, and I do recommend, and I think you’re in the same way, I do recommend patients that have chronic issues, or acute issues, at least go see your conventional medical doctor just to get checked off that there’s nothing glaring that’s going on. And that that way, if you work for someone like myself, for you, and then they’ve kind of already been looked at, and they’ve kind of already know, okay, conventional medicine is kind of done all they can do. And, you know, functional medicine is the next best option at that point. 

Evan Brand: Yeah, I’m not saying we’re the all knowing at all, if you’re bleeding out of your butt, you need to go confirm you don’t have some type of a bleeding ulcer or colon cancer or you have some type of a polyp issue or diverticulitis and you need colon surgery. I mean, there are certain things that we can’t help with. But for these more functional, non pathological issues, we’re definitely going to be able to help. 

Dr. Justin Marchegiani: And we can help with all those issues. Once they’re stable. If they’re unstable, though, conventional medicine does a really good job on stabilizing very sensitive issues. But once they’re stable, now what because for the most part, it’s going to be just symptom drug management for the rest of your life. Right? If you look at what they talked about, it’s, hey, we’re managing your gut issue versus let’s actually get to the root underlying issue. And sometimes management’s good when things are acute and flared. But now when they’re stable now what we want to go beyond just who wants to just manage their diarrhea for the rest of their life? That’s crazy, right? 

Evan Brand: Oh, God. Well, that happens every day, doesn’t it? It’s happening today while we’re doing this call somebody is in the doctor’s office right now about to get an antispasmodic drug for their diarrhea. 

Dr. Justin Marchegiani: Yeah, and that may be fine acutely, but then what’s next? So get your health issues under control from a you know, stable standpoint, and then work on the next step with a good functional medicine doctor. Well, everyone was excellent chatting with y’all anything you want to leave us with Evan? 

Evan Brand: No, that’s it. We’re just ranting at this point. So if you need help, please reach out., Take great care yourself. We’ll be back. Have a good one, y’all. 

Dr. Justin Marchegiani: Take care. Bye now. 

Evan Brand: Bye.


Audio Podcast:

Natural Solutions to Heavy Menstrual Bleeding and PMS | Podcast #299

Dr. J is tackling menstrual irregularities and heavy menstrual flow, symptoms, what your cycle should look like, looking at hormones, when to best test, triggers of irregular cycles, and some tips for helping regulate menstruation.

Most women cope with their PMS and irregular cycles like it’s a normal thing, but really heavy menstrual flow can be a sign of something deeper, maybe even estrogen dominance. Heavy menstrual flow can cause fatigue, lethargy, mood issues, irritability, brain fog, hair loss, and most importantly low iron. Heavy menstruation can drive anemia and low iron which is essential to the body, then it can take weeks to replace iron, by the time you feel more yourself the cycle starts all over again. What can we do? Well Dr. J has much to say from the perspective of a functional practitioner.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

2:54      Menstrual Issues and Terminologies

11:12     Social Isolation, Supplements and Herbs

15:10    Tests for Menstrual Irregularities

17:44    Fasting as Stressor

20:16    Diet Restrictions

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Dr. Justin Marchegiani: And we are alive. It’s Dr. J here in the house. Evan and I will be chatting about menstrual irregularities and heavy menstrual flow. Evan, how are we doing today man?

Evan Brand: Doing really well excited to dive in. This is an issue that many women just deal with. And they don’t really get help with. They just assume that hay, it’s normal to have PMS. It’s normal to have this happen with my cycle where this month, it’s 28 days. And then the next month, it’s 17 days and the next month, it’s 36 days. And I mean, we hear these stories all day every day.

Dr. Justin Marchegiani: 100% and the problem with heavy menstrual flow off the bat, it’s a sign of something else deeper, usually some kind of estrogen dominance. And then what’s driving that right? A lot of times progesterone is falling out too soon in the woman’s cycle. And then you have all this heavy menstrual flow, and that can drive in anemia that can drive low iron and that’s a problem because we need iron to bind a hemoglobin to carry oxygen. And we need oxygen for aerobic metabolism right for our mitochondria today. burn fuel, generate energy and burn fuel. So we need adequate oxygen. So if we have heavy menstrual flow, you can easily see fatigue and lethargy and mood issues. And a lot of times takes a couple of weeks to even replete that iron back up, and then you do it all over again. So it becomes this really, you know, you’re in the boxing ring every month, and you’re just getting beaten up, and it’s really tough. So you got to fix the anemia, and you got to fix that heavy menstrual flow for sure.

Evan Brand: Would you say this is a functional problem, meaning if you go to your doctor and you’re getting conventional bloodwork done, it’s going to get missed or even on conventional bloodwork. Are you going to see certain things pop up? That would be a red flag to even a conventional doctor that they would see.

Dr. Justin Marchegiani: It depends. A lot of times conventional doctors aren’t going to run like a functional iron panel, they won’t run like ferritin or iron saturation or iron binding proteins. A lot of times they don’t do that they’ll run a CBC and they may look at RBC see if it RBC is below four or a hemoglobins in the elevens or dramatic rates in the middle Low 30s they may run that but it just takes a lot. Like the issue has to be a lot more severe for the RBC, hemoglobin hematocrit to be a problem. So, you know, I’ll run a CBC to see where you’re sitting, right? We don’t want the RBC below 4.2 we ideally want the hemoglobin in the 13th, we want to get in the upper Upper 30s. So we want to make sure that’s good. But if you’re using a late stage indicator, the problem needs to be going on for a lot longer to fix it. That’s the issue.

Evan Brand: Okay, let’s go into symptoms briefly. I think this would be helpful for women because they’ll say okay, menstrual irregularity, you know, what, what do you how do you classify that? And then what symptoms would be associated with this? Are we talking to typical PMS issues where, you know, there’s breast tenderness stuff, or are we talking where the the cycle is changing? Where, like I mentioned, you know, some months it’s 28 days, others it’s 36 others, it’s 17? Are we talking headaches? What are we talking?

Dr. Justin Marchegiani: Yeah, so let’s kind of get a couple. Let’s get some terminology stuff out here. First, I find it I’m not sure if It’s an educational issue. I speak to a lot of women, I say how long is your cycle? And the first thing they tell me is how long they man straight for. So it’s this weird kind of disconnect. And I think it’s just people aren’t really educated in school about this. People, most people conflate their cycle is to how long they men straight. So a woman’s cycle is their entire hormonal cycle. Usually it’s 26 to 30 days right from day one’s the first day of leading to the next day one. That’s their whole cycle, right, which is built on a follicular phase right where the follicle grows, and estrogen predominates. It’s built on oscillation where estrogen predominates and progesterone rises. That’s oscillation and that it’s built on the luteal phase, the last half. So think f follicular first, think l luteal last, okay. And then luteal is where progesterone predominates. And a lot of the cycle irregularities may happen because of estrogen bouncing around or progesterone being either too low or dropping out too soon. And so when we talk about a woman cycle, that’s the full cycle when we talk about menstruation. That’s the period right? So most women they confuse menstruation and cycle length. So menstruation is when flow is happening period blood flow, and the cycle is going to be the entire length of that hormonal rhythm day one the first day they’re bleeding blood flow to the next day one, that’s your cycle. So just from a terminological standpoint, so when we’re looking at the heavy menstrual flow and a lot of the irregularities, it tends to happen a couple of days to even a week before we have blood flow. And of course, some women when there’s a lot of estrogen dominance occurring in that progesterone drops out too soon in the cycle and I’m doing a lot of hand gesture stuff so people are aren’t quite following on the auditory side. We’ll put the video link below so you can see the video. But when that progesterone drops out a little too soon in the cycle, that’s where we have a lot of menstrual flow. And this can really mess a lot of women up because of what I said earlier. You’re going to have a lot of low iron here, low low iron, low hemoglobin, and then you’re ability to carry oxygen really get some hair, and that’s gonna make it harder to generate a Robic metabolism and support the mitochondria. Mitochondria needs oxygen. So we need that. So that’s one of the collateral damages of menstrual irregularities is the menstrual flow. And then of course, other things can happen like irritability, breast tenderness, back pain, mood issues, brain fog, but the key thing that that’s going to happen after that is going to be a lot of that blood flow driving the anemia and the low iron, low hemoglobin. And the I was-

Evan Brand: I would Oh, yeah, I was gonna say the fatigue is probably the big one, right? Maybe exercise intolerance. These are women that they feel like they have to do some exercise. Maybe they’re pushing themselves hard, but they just don’t feel like they have enough gas in the tank to get the exercise done. It just feels abnormally difficult to do physical things. And then hair loss is big too. I mean, we’ve seen countless times on bloodwork where women will show up with really low ferritin. And they’ll say that every time they take a shower, I mean they’re losing a clump of hair, you know, per shower, and that’s just insane.

Dr. Justin Marchegiani: Yep 100% 100% so it’s always really good to take a look and test where you’re sitting during the luteal phase like right around day 21. The 22 is usually a good time to test where that progesterone sits to make sure it’s high enough. If you’re having a lot of heavy bleeding early, a lot of times that progesterone just falling out a little too soon in that cycle. And so we may support there’s a lot of stress, we may support the hypothalamic pituitary, go Natl axis, right that’s the brain talking to the to the gonads or to the ovaries in this example or to the adrenals. So we can support adequate levels of progesterone output. And we may use herbs like you mentioned shepherd’s purse, we may use things like chase tree, we may use estrogen modulators like Don Chi or black cohosh may use things like that we may use special phenotypes of Makkah, we may even use byway denticle progesterone as well to kind of carve out and work on supporting that healthy female rhythm too.

Evan Brand: And What led to these issues in the first place? I mean, we’re talking just age, we’re talking stress, we’re talking pregnancies having babies, like the xeno estrogens in the environment. I mean, what are you thinking are some of these big triggers?

Dr. Justin Marchegiani: Um, so in regards to the biggest trigger, in my opinion, is going to be the fact that progesterone can make cortisol. So when women get stressed, their stress hormone is cortisol. So they’re going to take a lot of that progesterone, and they’re going to, they’re going to pull it from their cortisol. All right, I’m sorry. They’re going to take a lot of progesterone and they’re going to pull it down to cortisol. So then that starts to skew the relationship. So stress, takes progesterone shunts it downstream to cortisol that can create some functional estrogen dominance, okay. Number two is just they’re depleting a lot of their cortisol output from the adrenals. And their adrenals are, you know, are making some other hormones but there’s needles are just more depleted. That can be a big thing too. And then three would just be potential Xena And exposure, there’s three big variables there. That’s gonna be from pesticides, right? These chemicals, they kill plants by disrupting their hormonal system and nervous system. So that’s one. Number two is gonna be plastics. Plastic does you know estrogens, right BPA or even some of the BPA free ones have other types of xenoestrogens that aren’t good. And the third one is going to be hormones and meats, animal products were to dairy milks, beef, chicken, right, just the hormones that are given to the animals to fatten them up. And so it’s going to be plastics, pesticides, and hormones in the meat and animal products. So those are the big ones. So of course, eating organics and to be good. Using Pyrex, or glass containers is great, especially when heating plastic isn’t that bad, as long as everything’s cool, and isn’t in the sun, not as big of a deal. Once it’s in the sun and you’re heating it forget about especially a microwave forget about ovens. Obviously, that’s a no brainer. And then of course, um pesticides and pesticides could be in the food Okay, so organic helps that it could also be in the water. So high quality water filter, reverse osmosis, or at least a carbon filter will filter a lot of that junk out.

Evan Brand: Yeah. And people listening, they may say, God, why does everything have to be so complicated? It’s like, Well, we’ve just changed a lot. I mean, you mentioned the adrenal thing. Women now where historically they were in the tribe, and they had other women to help with the kids. Now you’ve got the stay at home mom, parents-

Dr. Justin Marchegiani: -and grandparents, man. Yeah, I mean, that’s back in the day. Think about it. grandparents would be like in their 40s and 50s, probably right. You have kids in your late teens, your kids would have kids in their late teens, that puts you like, you know, that puts your grandparents in their in their 40s, early 50s. And typically, you know, you’d be out earning a living paying for the home and maybe rearing the kids a lot, maybe taking care of the kids. So there was a little bit less stress on the child rearing aspect of it, because you had someone there. And then typically, you didn’t have a big mortgage, you didn’t have all this. So usually One income was enough. So then, you know, one person could help out with the family, grandparents helped raise the kids, one person required for the income. So there wasn’t a ton of stress. And the income back then could be hunting. Right? It could be hunting or fishing, right? It could be doing something that were just really providing food and shelter. And that’s it. That’s all you need it. So our society has evolved and changed, and there’s a lot more financial stress, and some people have to have two incomes to survive to and, and grandparents are older and have their own health issues and can’t really participate on the day in day out of raising kids. So a lot of good things have shifted.

Evan Brand: Yeah, well, then you go further back, and before there was even bills and currency and you had the tribe that was hanging out with each other where you’d have, like you said, multi generational tribes, and then you would have potentially other people that are related somehow or maybe not related. They’re just part of the tribe. And, I mean, you read about these, you know, hunter gatherer societies where you’ve got women that would sometimes be nursing the children of the They’re not theirs, you know. So there must be a shared motherhood experience. And now you’ve got the stay at home mom driving the minivan with the three, four kids running them to the park and then doing the groceries and all that alone. So, you know, I think a lot of the social isolation aspect is really big for this stress component you’re talking about with this whole pregnenolone, progesterone, cortisol, everything getting robbed and diverted. And, yeah, I mean, it’s like, it’s a big hormonal chaos, really. And it’s because the, we know, there was actually a study done on that isolation issue. And that isolation, being socially isolated, was comparable to like smoking a pack of cigarettes a day. In terms of the the toxicity, we’re just not, we’ve never been a species like this. And now with shutdowns and everything going on, you’ve got people even more isolated. I mean, I have a client who’s a therapist, and she said, Man, everybody’s a wreck. And I said, What do you mean? And she goes well, because everybody’s separated from each other people are afraid to be next to one another. She said, I’m hearing all sorts have new symptoms for my clients. I thought Wow, that’s really interesting. So what’s the remedy? Well, you mentioned some of the herbs already some of the adaptogens will use and maka extracts and shepherd’s purse and wild yam and cohosh and chase tree and all those things are amazing. But I think at the end of the day, you’ve got to try to build some type of a community. You know, like Facebook, moms groups are one thing, but you actually have to have like an in person, place where you can sit down with other people have a conversation, you know, let somebody else handle the kids chaos for a minute. While you can just relax. I think we’re all just stuck in fight or flight. And that’s really one of the big root causes is our nervous systems are just so turned on. And especially if you’re watching the news, you’re not turning off. And I think that’s a big root cause outside of the environmental dietary pieces.

Dr. Justin Marchegiani: Yep, I totally agree. There’s some data also Showing that there’s more relaxing, which is a hormone produced by women’s bodies that can relax a lot of the ligaments and tendons. There’s some data showing that there may be more ligament laxity in the last half of the cycle where progesterone is. So just be careful of over exercising or doing too strenuous exercise. During the last half of the cycle. Just keep that in the back of your mind exercise stress could be a big one. We don’t want to be over exercising that’s important. Of course, nutrient density is essential. So nutrient dense, anti inflammatory, low toxin foods are going to be key one because we provide building blocks and two hormones are made from good high quality cholesterol compounds and cholesterol is connected with animal products and that’s usually connected with fat soluble vitamins at Okay, so we got to make sure all those foods are dialed in egg yolks. High quality grass fed beef by the grass that are by last night with some organic green beans was wonderful, right? So you can do all these things with the food good paleo template and you know, line up your macronutrients according to what you need. As a woman, if you’re more of an ectomorph, you’re more lean, you’re more skinny, you may be able to handle some more starch starch on the reg. Right? Every day, you can handle more starch. If you’re more on overweight, you may have to lean more on your non starchy vegetables and less fruit and starts maybe some but just a little bit less. So really get your macros dialed into.

Evan Brand: Yeah, I would say on the supplement side to one thing we didn’t mention would be like calcium D glucoerate could be really helpful. And then also, you know, since we haven’t gone down the rabbit hole yet on this podcast about it, you know, we could briefly mention the gut and how the gut is involved in these hormonal issues and how we’ve had many women that have had issues with their cycles that have spontaneously resolved just by fixing gut infections because we’ve hit on this idea of the beta glucuronidation enzyme being elevated, which causes the research ulation of toxins and hormones due to bacterial overgrowth. So if you’re having menstrual irregularities and you’re not addressing or looking into your gut, you know, you could work on the diet piece all day and still have issues. We have many women that have come to us that they’ve done a great job on the diet. But there’s still suffering. And so that’s where we dig deeper. And then something like calcium D glucorate may be used. And it can do a lot of good really, really quick with the detox piece, even for mold. It’s been helpful.

Dr. Justin Marchegiani: Yeah, so when we test a lot of these, we’ll do a Dutch test. And we’ll look at things like right around day 20 or so. So we can see where progesterone peaks out. And we’ll also look at estrogen levels and ashra metabolism. We’ll look at two methoxy, two hydroxy. Estrogen we’ll look at methylation markers. We’ll look at pirate glutamate, including violence that can give us a pretty good window for impaired on the detoxification side and we can add in phase one, phase two detoxification support whether it’s B vitamins and antioxidants, or sulfur amino acids, or extra binders or extra vitamin C or extra fibers to kind of bind up some of that that’s a really good option to therapeutically support detoxification, as well as just to help excrete extra hormones that may be laying around from some of the other reasons we chatted about.

Evan Brand: Yep, absolutely. So the testing piece, you know, Dutch is going to be important. I would say stool test is going to be amazing. Blood panels could be important. You know, if we did have a history like heavy bleeding, we’re going to look into ferritin do like a full iron panel, potentially thyroid could be important as well. organic acids. I mean, I would argue that be important too, we always run those for looking at the gut piece, the mitochondrial piece, if a woman’s complaining of, you know, major fatigue associated with this wells is related to the iron ore is is related to possibly the mitochondria as well that have gotten damaged by some sort of toxicity issue. So I think those would be top priorities. What about anything else? Are there any other tests that you would you would run to investigate this issue?

Dr. Justin Marchegiani: Well, if there’s a lot of insulin resistant issues, insulin is a big one. So carbs are out of out of whack and they want to look at insulin levels, make sure they’re closer to five, five to sevens ideal. They’re too high, there could be some resistance going on. Of course, I always get worried about pcls right. pcls is primarily driven by high insulin and then that can cause elevations in androgens and testosterone and that can also cause an increase in something thing called prolactin and prolactin can start to dis regulate the HPA axis that can kind of dis regulate the cycle. And again, that’s all supported by getting blood sugar stable, right. dysglycemia is a major hormonal stressor. And I asked them and don’t, don’t jump into hormonal stress and start fasting and doing all this stuff. Get your blood sugar relatively stable, you know, make up proteins and fats as the foundation of your meals. And make sure make sure 100% you’re getting enough nutrition, go look at go look at your chronometer, or My Fitness Pal and look at your calories. Make sure you’re getting enough. Make sure those calories are all nutrient dense, anti inflammatory, low toxin. Make sure you’re getting enough magnesium and potassium and high quality minerals. Very, very important.

Evan Brand: Well, you said it quick. So let me just restate it and confirm to make sure it’s clear. You’re mentioned you’re mentioning fasting as potentially being a big stressor that could make this situation worse, correct because you’re saying if a woman’s already nutrient deprived, or she’s having major issues Potentially too much blood loss. Fasting is something that could throw off blood sugar balance. But also, as you mentioned before, there’s no nutrition and starving. So you’re saying in this case, three meals a day maybe better than doing a fasting protocol?

Dr. Justin Marchegiani: Yeah, the problem with fasting fasting can help when there’s insulin resistance, but one there needs to not be a lot of blood sugar stress meeting up and down, right? So people think like, oh, if I have blood sugar issues, then fasting is great. Well, not if there’s display see me because this glycemia means your blood sugar’s up and down and up and down. And every time it goes up, your pancreas kicks in every time it goes low, your adrenals kick in with cortisol and adrenaline. So there’s stress on those glands. So the problem with that is you want to make sure you buffer that with healthy proteins and fats, it’s like putting a fire going and having putting, you know, twigs and paper on it. If you ever started a fire that way, you’d be feeding the fire every 30 minutes to an hour or even more because the fire would burn out fast. So a log on the fire that stays For hours, it’s like proteins and fats. And most women, they metabolically keep their fire going with twigs, and paper and gasoline, and you just can’t you’re going to be next to the fire all day. Those are your grazers, okay? Or if you’re trying to fast, well, eventually the fire is just not on you’re going to get cold, ie your metabolism is going to decrease. And if you’re already nutrient deprived, and now you’re fasting and not getting enough nutrition, that’s a problem. Now, of course, if you’re going too fast, and you’re compressing your feeding window, the key mistake is not getting enough nutrients. So you have to get enough nutrients. Now, if you’re doing it a day or two a week and you’re already healthy, and you’re getting an overabundance of nutrients those other five days, of course, you get your body can handle that right. But most aren’t in that over abundant state, they’re already depleted. And that’s where it’s a problem.

Evan Brand: Yeah. And you’re mentioning the grazers. I mean, these people are not grazing on grass fed beef jerky, typically they’re going to be grazing on, I don’t know, maybe some gluten free pretzels or something. I mean, it’s going to be more of a A process thing it’s not going to be. I mean, maybe it is maybe you’re grazing on macadamias or something like that, and you’d be okay. But in general, you want to be able to have three solid meals per day. I find, once women do actually calculate how much they’re eating, most of them are under eating.

Dr. Justin Marchegiani: Most are and then also, I’m not a big fan of snacks. Snacks typically mean a carbohydrate, primarily a carbohydrate macronutrient balanced meal, it’s smaller, and it’s primarily carbs and it’s usually not enough. And a lot of times snacks can be used to compensate for a poor meal previously. So I like the word mini meal, because it provides a there’s a balanced like a meal, meaning there’s some protein fat, maybe a little bit of carbs in there. Ideally, you’re doing a mini meal because your next meal is just a longer gap. So like if you had lunch at noon, but you and your husband are going out to eat at seven, well that may be a little bit long for you. So maybe you want like a good protein, fat, kind of keto bar here or a little more Any smoothie like around five o’clock, right? to kind of give you a little bump so your blood sugar doesn’t go super low until you feel good. Now if you’re healthy, you could maybe be able to handle it if you have blood sugar issues, and maybe a little mini meal is good right there to provide balance. Does that make sense?

Evan Brand: Yeah, it does. It does. And you’re mentioning to like the meals should be nutrient dense enough to where you shouldn’t have to snack But yeah, I mean, I don’t go much more than five hours. I will start to get a little shaky if I go six, seven hours. It’s too much for me.

Dr. Justin Marchegiani: Yeah, also just go to chronometer, man, just try to like put a sample me at like people that do omad stuff one meal a day. I’m like, dude, go to chronometer and put all the things you have to eat in that one meal and you tell me if you’re getting six to eight servings of vegetables, you tell me if you’re getting a pound and a half of me, you tell me if you’re getting that much fat, it’s really hard. Like, you’re going to literally be eating like eating probably for over an hour like eating chewing. It’s probably gonna be hard. Oh, yeah. Really full and you’ll probably take a break. That’s why two meals is doable, but you really have to be like There can’t be slack in the meal. It’s got to be a very intentional awesome meal. And you have to do it three meals. It’s relatively easy. Yeah, you know, you have two really good meals and one pretty good one and that you’re there. One is very hard. Yep. Yep. I would agree if you have tummy issues, if you have SIBO and you already have low stomach acid, well, now you’re just now you’re eating all that calories in one sitting. It’s like, Whoa, yeah. And how would you possibly digest and assimilate all that without having any issues to that’d be very, very difficult. It’s harder now people can do it if they have a really chill night and they can just sit around and relax for two three hours and in their lives aren’t that stressful, right? But in their digestion is really good. They can maybe get away with it, but I think minimum two meals is gonna just make your life easier.

Evan Brand: Yep. I just want to point out that if you have menstrual irregularities, you may need to come in and do some specific herbs to address those but sometimes this issue in the same category as many other issues we’ve talked about, where it gets fixed as a side effect of just getting healthy, just running you through kind of our functional medicine workup, supporting and looking at adrenal supporting and working on gut, the mitochondria, the nutrient absorption, the acid and enzymes, the probiotics, sometimes just those simple steps fix this. But if they’re having an issue that’s not resolved, then we can come in with these extra tools. Yep, that and vice versa. And maybe we should mention this to vice versa. You can’t just come in and do the chase tree, or the vytex, or the wild yam or whatever, and call it a day. You can’t do that either, because now you’ve ignored the issues that led to this problem in the first place, whether it was the glucuronidation pathway, or the bacterial overgrowth or the parasite infections and messed up the nutrient absorption which caused the nutrient deficiency which caused the hormonal issue. So you really have to do all of it. But I don’t want this to be Hey, let’s go to the hormone section at Whole Foods, buy a supplement and call it there. You don’t want to do that either.

Dr. Justin Marchegiani: Yes, you want to really get to the root cause of the food. stuff is important. We talked about some of the herbs we talked about even doing a kind of a cyclical augmentation kind of reset by using progesterone accordingly. And of course, we’re supporting the adrenals. The adrenals play a big part. So when I always test, when I test hormones, I’m always looking at female and adrenal together, they tell a really big role. And it’s nice to be a look at hormone detoxification. That’s really helpful too. Because it really gives me a window in all three sides of it.

Evan Brand: Yep. I think I’ve said all I need to say, do you have anything else you want to go into?

Dr. Justin Marchegiani: Yeah, so blood sugar, nutrition, right diet stuff’s very important. The gut plays a big role, because that’s where we digest and absorb all the building blocks to make our hormones. So if we have bloating or digestive issues, that could be a problem. Don’t just get myopic on the female hormones. Don’t you got to remember the adrenals play a huge role. So female and adrenals. And, you know, don’t jump on these fat things. Oh, just fast and do this and you’ll get better. You know, get your nutrition gets your blood sugar. Get it dialed in. And then if there’s things like iron, that’s a problem in the interim, you know, you really want to support that I have a product called Iron Supreme, it’s a bisglycinate iron. That’s a really better iron ore. If you’re more sensitive, a high quality liver, glandular is great. And then obviously eating a lot of high quality red meat before and during menstruation if flow is heavy, just to really make up some of that extra iron if needed.

Evan Brand: You know, good news is you can reverse this is not something you have to live with. So like I said, in the beginning, many women just kind of live with this and they just know hey, I’m quote messed up, you know, my cycle does this or that and they just live with it. But you can get it resolved to where if you track it on an app, I mean, my wife, she’ll track it on an app, and it says, cycles supposed to start boom 28 it’s 28 day cycles. So you know, and before due to birth control and other issues, I mean, her cycle was not always perfect. So you can fix these things. You can adjust them you can modulate them and there is hope.

Dr. Justin Marchegiani: 100% so if you guys want additional help and support, we are available worldwide. Feel free to head over to you could schedule a consult with Evan or you could schedule a console with myself we’re there to help you. Click down below for links and if you enjoy the content give us a review we really appreciate it,, and share with family and friends. And we appreciate you guys for joining. Take care y’all.

Evan Brand: Take care. Bye now.


Audio Podcast:

The Top 5 Causes of Chronic Headaches

Today we are going to be talking about the top underlying reasons why you may be having a chronic headache. I had a patient come in today who had headaches for 25 years, monthly and chronically, and we were able to get to the root cause and there are many different root causes for every person. Let me lay out the common ones that I find to be a major vector of my patients.

Click here for a consultation with a functional medicine doctor if you are experiencing chronic headaches!

So we have headaches and head pain or migraines where you kind of have that aura and sound sensitivity. There are a couple of different major reasons why headaches may happen.

1. Food Allergens

Most common food allergy is gluten and dairy. There are some studies on gluten affecting blood flow up to the brain. We have these garden hoses on the side of our neck called our carotid arteries. When we have inflammation especially caused by gluten that can decrease blood flow and blood profusion to the frontal cortex, and when you have less blood, you’re going to have decreased performance of the brain. You can see that manifesting in a headache. People don’t know but headaches are actually an issue with vasodilation in the brain.  Caffeine can help as caffeine actually causes constriction and brain’s typical headache signal is caused by vasodilation.

2. Food Additives.

These could be things like MSG, aspartame, Splenda or various artificial colors and dyes.

3. Blood Sugar Fluctuation.

We want to have healthy proteins and healthy fats with every meal. If we skip meals or we eat foods that are too high in carbohydrates and refined “crapohydrates” and sugar, and not enough fats and proteins, our blood sugar can go up and then drop. This is called reactive hypoglycemia. We react by putting a whole bunch of sugar in our bloodstream because all of these carbohydrate sources break down into sugar — processed sugar, grains, flours and acellular carbohydrates. These type of flours and refined processed carbs get converted to glucose in our bloodstream. When glucose goes up, our pancreas goes, “Holy smokes! We got a lot of glucose there. We got to pull it into the cell.” It spits out a whole bunch of insulin and pulls that glucose right down, and we have his blood sugar going up with a lot of insulin driving that blood sugar back down. When that blood sugar goes back down, this is where we have cravings.  This is where we have addictions, mood issues, energy issues, jitteriness, and cognitive issues. Our body makes adrenaline and cortisol to bring that blood sugar back up. Most people literally live on this high insulin where they are making fat, storing fat and engaging in lipogenesis which makes us tired. Then blood sugar crashes which makes people jittery, anxious, and moody. Most people live on this reactive hypoglycemia rollercoaster and that can drive headaches.

4. Gut Infections.

Patients with a lot of gut inflammation, gut permeability, and infections whether it’s H. pylori, SIBO (small intestinal, bacterial overgrowth) or fungal overgrowth have gut stressors can create inflammation in the gut. When we have inflammation in the gut, we have gut permeability. So our tight junctions in our intestines start to open up and undigested bacteria, lipopolysaccharides, food particles can slip through and create an immune response. You can see histamine along with that immune response and histamine can create headache issues.

5. Hormonal Issue.

A woman’s cycle is about 28 days and in the middle is ovulation. Some women have it during ovulation and most have it right at the end just before they menstruate. This is called premenstrual syndrome that is right before menstruation. A lot of women may also have it during menstruation, too. What happens is progesterone can drop out early and that drop in progesterone can actually cause headache manifestations and also the aberrations in estrogen can also cause headaches as well. We may also see it with excessive bleeding too. So if you’re bleeding a lot or too much, what may happen is you may lose iron and that low iron may cause oxygenation issues.  That low level of oxygen may also cause some headache issues as well.  Because if you can’t carry oxygen, that is going to be a stressed-out situation for your mitochondria and your metabolism. For menopausal women who have chronically low hormones and they’re not in an optimal place, that can create issues. Progesterone and estrogen can be very anti-inflammatory. So if there is inflammation in the brain, progesterone is a powerful anti-inflammatory and that can really help a lot of inflammation in the brain.

If you have any questions about headaches, please reach out to a functional medicine doctor to find a way to fix your issue.

Symptoms and Dangers of Low Potassium

Symptoms and Dangers of Low Potassium

Do you know how much potassium you’re getting? I was looking at some recent research including a national survey which indicated that approximately 98% of Americans are not meeting the recommended potassium intake.

We all know the Standard American Diet is not good–but it’s not just the American diet that favors processed foods over whole plant foods, such as fruits, vegetables, beans, and nuts. This is the standard European diet. This is the standard Australian diet. Most developed first-world countries are primarily consuming processed, potassium-devoid food.

Let’s tie that directly into the research I mentioned at the beginning. A study done by a Chinese hospital and Chinese medical university in Wenzhou, Zhejiang Province, China on hypokalemia and clinical implications in patients with coronavirus. The researchers found that people that had severe hypokalemia–the technical term for potassium deficiency–and took potassium supplements were inclined to recovery. While the study results don’t directy say a potassium deficiency means you’ll get sick, it does indicate that because of the ACE-2 enzyme and the whole relationship to the virus, that one contributing factor may be low potassium levels.  And if you already have low potassium to begin with, then you may have a higher risk of fatality.

Click here for a consultation with a functional medicine doctor to learn about the symptoms of potassium deficiency!

Sodium and Potassium Pump

Why Does Potassium Matter?

Potassium is a key part of the sodium-potassium pump. A cell has sodium inside the cell and potassium outside of the cell, and the sodium-potassium pump uses active transport to move molecules from a high concentration to a low concentration by moving sodium ions out of and potassium ions into the cell

The enzyme that’s involved in making this happen is an ATP enzyme. You can identify enzymes because of the suffix “-ase” at the end: ATPase. ATP is important because it is the energy generated by your mitochondria.

Side effects of a potassium deficiency include:

  • Muscle or nerve problems
  • Mood issues
  • Adrenal dysfunction
  • Energy issues
  • Digestive issues
  • Heart palpitations
  • Achy muscles, muscle breakdown
  • Feeling tired and stiff
  • Tingling and numbness issues

Symptoms and Dangers of Low Potassium

One of the big side effects of a potassium deficiency is muscle or nerve issues, because potassium and sodium are very important for the muscles and nerves to work

There is also a potential for mood issues because sodium and potassium play an intricate role with the adrenal glands. Part of the reason why people’s potassium gets low–outside of a poor diet–is going to be because of adrenal function. Typically with the adrenals, aldosterone starts to go low.  Aldosterone is a mineralocorticoid that exists in the cortex of the adrenals. As aldosterone starts going low, sodium can start to drop too. As your sodium drops, sometimes your potassium can look like it’s not too bad. It can look actually a little bit high, but you could still actually have potassium issues because of the fact that your adrenals are weak and you’re peeing out a lot of your minerals. 

If you have sodium-potassium pump issues, you probably have energy issues too. Healthy mitochondrial function is needed to make ATP for the sodium-potassium pump to work.

Cramping is another potential side effect of being potassium-deficient, because the muscles need the fluid wiring, sodium and potassium, and minerals.

Your bowel movements and your motility starts becoming slower when your potassium drops. We need healthy levels of potassium so we have good bowel movements; otherwise there can be digestive and elimination problems.

Heart palpitations are another potential effect of low potassium, since we need potassium and magnesium for our heart to pump. Our heart is a muscle as well. So if your heart is skipping beats or beating harder or faster, that’s a sign of palpitations, which could be from low potassium.

And other symptoms include tingling, numbness, achy muscles, muscle breakdown, feeling tired and stiff. The breakdown of muscle is known as rhabdomyolysis and that breakdown is going to be very much helped with good potassium levels. You’re going to have less muscle breakdown with potassium levels being adequate.

If you have any symptoms of a potassium deficiency, please reach out to a qualified professional to test your levels and determine your next steps.

Histamine Intolerance and Root Causes | Podcast #289

Hey, guys! We have a new podcast today with Dr. J and Evan Brand talking about histamine intolerance and possible root causes. We start with symptoms of histamine intolerance. While mostly linked to allergic reactions, they can be IBS, cramping, anxiety, dizziness/vertigo, fatigue, flushing, hives, brain fog, and more. Often, you’ll see these overlap as symptoms of hypothyroid, adrenal issues, or Hashimotos. So, what next?

Nutrients important to helping break down histamine are DOA enzymes, Vitamin C, Copper, and B6 (very important to neurotransmitters). We know that gut permeability and absorbing the nutrients you need can be difficult in itself when mixed with gut irritation, stress, and/or certain symptoms and this becomes a triple-edged sword. You need the nutrients to break down the histamine but your body can’t break them down because it’s stressed, overwhelmed, or not working as it should and you don’t want to eat certain foods you used to be able to consume because the histamine’s memory is messed up and you’re exhibiting more food allergies. It can be overwhelming, so then what?

Dr. Justin Marchegiani shares common foods that increase the histamine response, palliative solutions for relief, and the reality behind finding the root cause.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:00 Symptoms of histamine intolerance

10:57 How to metabolize histamine

12:59 Testing for histamine, histamine markers and root cause

19:03 Histamine medications

24:06 Hormonal link


Dr. Justin Marchegiani:  Hey, guys! It’s Dr. Justin Marchegiani here.  I hope you guys are having a fabulous week.  We are gonna be diving in to histamine intolerances and functional medicine solutions and what we do in our clinics.  Evan, welcome to the show, man.  How are we doing brother?

Evan Brand:  Hey, I’m glad to be here and glad to talk about this subject.  Something that I used to look at and I was confused by.  I would look at these histamine issues and I would say, “This just doesn’t make sense.”  Why does Jane Doe over here, why is she able to eat XYZ food and then you’ve got the other lady over here, and she can’t eat leftovers and she can’t eat mushrooms, and she can’t eat smoked meats, and she can’t eat ketchup, and she can’t do dried fruit without having problems?  And I was like, “Okay, what the heck is going on?”  Why, why, why.  I didn’t understand it and now that you and I have worked on this issue a thousand plus times, we start to find some connections.  And so, let’s first talk about some of the symptoms of histamine intolerance.  Many of these are similar to allergic reactions and allergic reactions can create histamine.  It could be anything from gut symptoms like IBS could be related to histamine, so abdominal cramping.  Anxiety could be part of it.  Dizziness, believe it or not, dizziness, vertigo could be part it.  Fatigue could be related.  Flushing, so when you rash out like on your skin or it could be your face from certain foods, like when you see people rashing out from alcohol, like red-faced from alcohol that could be histamine.  Alcohol is high in histamine and then it’s also gonna reduce DAO, right?  It’s gonna block the enzyme that helps metabolize histamine.  I believe that’s true.  Is that right that alcohol is high histamine?  I know it messes with DAO but is it high histamine as well?

Dr. Justin Marchegiani:  Um, alcohol—what alcohol does, it’s also a histamine blocker.

Evan Brand:  Right.

Dr. Justin Marchegiani:  It also blocks the metabolism of histamine and it just depends because a lot of alcohol, there’s fermentation in the alcohol.  So of course, the fermentation will create histamine as well.  So it’s a combination of the two.  I’m pretty sure there’s gonna be histamine in it due to fermentation, right?  Like wine will be, you know, fermented or beer, and then of course, if there’s gluten in there, the inflammation could create more histamine and then you have the effects of blocking histamine as well.

Evan Brand:  Yeah that, it is a double whammy.  Yeah, here it is right here.  It talks about how like for example, red wine has up to 24 mg per liter of histamine while champagne has 670 mg of histamine per liter.  So of course, heart rate, flushing, those type of symptoms from drinking alcohol is no good.  But the problem is you’re depleting DAO.  DAO is what’s gonna help you—diamine oxidase.  It’s gonna help you to break down histamine that you ingest and so if you’re putting in histamine and reducing the ability to metabolize it.  You get in bad shape.  I got a few more symptoms and we can go on and on and one.  I mean, any list online you look at may have 50 different symptoms.  So blood pressure issues or blood pressure changes, itching—

Dr. Justin Marchegiani:  Yup.

Evan Brand:  So like the back of legs, you could just have itching.  I mean, for lack of a better word, it’s not necessarily a rash there but you could just be itching.  Nasal issues, sinus problems, nausea, and then swelling.  So like—

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Tissue swelling.

Dr. Justin Marchegiani:  Yeah.  I mean you see a lot of it with Asians and alcohol.  For instance, Asians typically will get flushed when they drink alcohol because they’re missing genetically some enzymes to be able to handle it and they take a lot of Pepcid AC which is like an H2 blocker.  So a lot of times you’ll see that with alcohol and you’ll see it in certain ethnicities.  They’ll miss certain enzymes to be able to metabolize it.  I’d be curious how someone of that ethnicity would do with like extra DAO.  I wonder if the DAO would work over just a—over a histamine blocker so to speak.  Because we know the side effects in some of those medications, you know, can be drowsiness, brain fog, you know, not so good symptoms either and a lot of times you’re just trading one symptom for another.  Hope—

Evan Brand:   I bet it would—

Dr. Justin Marchegiani:  Side effects or less.

Evan Brand:  I bet it would work great.  I mean, I’ve done some experimentation with DAO.  If I have certain foods that will irritate me, like a big spice blend of you know, curry and cayenne and chili powder and cinnamon and those type of things.  Those can all irritate things, so I’ll take some DAO if I’m gonna do something with like a mixed spice blend and I feel fine with it.  I don’t really have any issue with dried fruit.  I know that’s an issue for some people but I’ll do like some freeze-dried blueberries just to see what happens and I feel fine.  So I think some of this stuff is there’s gonna be a spectrum of sensitivity with this.  Some people are gonna be extremely histamine-intolerant and then some people are gonna be totally fine.  So we’re trying to cater to all of those people.  If you’re somebody who—you can’t do fish, for example.  If it’s fresh-caught and freshly eaten or fresh-caught and flash-frozen for example.  That should be okay but if you’ve had, you know, fish that’s kinda sitting out at the market, open-air, you know that may be a bigger problem than if it were flash-frozen like on the ship,  I know there’s a couple of companies out there like Vital that they’ll freeze the fish as soon as they catch it.

Dr. Justin Marchegiani:  Yes.

Evan Brand:  And those are supposed to be well-tolerated.

Dr. Justin Marchegiani:  100%.  So you kinda went over like some of the symptoms, right?  The common ones, the flushing, the wheels or the urticaria, kinda hives on the skin, brain fog stuff, headache stuff.  It could just be allergy stuff like itching or sneezing or eye wateriness.  It could be fatigue.  It could be breathing issues.  It could be just swelling or inflammation or heart rate.  It’s just pounding, kind of the abnormal heart rate beating.  Now the problem is a lot of these symptoms can overlap with hypothyroid.  A lot of these symptoms can overlap with Hashimoto’s and adrenal issues.  This is the problem.  It’s this big overlap so that you get people that are like the histamine person or the adrenal person and you’re like, “But what’s the issue?  Is it an adrenal issue?  Is it a histamine issue?”  And this is where it gets really tough because you’re trying to seek out whose that person that can help me with this issue and the problem is everything overlaps.  So imagine like a venn diagram and then you have all these different issues, adrenal or thyroid, or histamine or gut, and then they all overlap in the middle and a lot of times that’s where people’s health issues, you know, really sit and you need a very good generalist to kinda parse these out because sometimes when we have these issues we don’t really focus on histamine, we focus on other things.  Like when you just magically reduce inflammation in the body through diet, lifestyle, supplement strategies, magically histamine can drop.  And we actually do need some histamine because histamine is a big stimulator of hydrochloric acid.  So it’s like, well, if you don’t have no histamine then we’re not gonna have good HCl stimulation and we know HCl is so important for digestion.  So it’s this, you know, it’s not like one of these things where we wanna just knock histamine down to nothing, right?  But we wanna modulate and prevent the, you know, the abnormal highs of it which tends to be driving a lot of the symptoms.

Evan Brand:  Yeah, that’s a great point and many people don’t hit that if you talk about the word histamine.  It’s sort of like a bad bacteria.  It’s just kill, kill, kill, kill, knock it down, knock it down, knock it down, knock it down but yeah, you’re right.  I mean, it’s a neurotransmitter and it does affect the immune system, too.  So it’s not something that you want zero off.  I know—I don’t know the exact mechanism but I know histamine has some role on energy like your sleep-wake cycle is somehow related to histamine.  Appetite, I know is involved with histamine.  So there’s a lot of things that people just, they skip out on and then they get on these H1, H2 blockers and then who knows what’s happening downstream?

Dr. Justin Marchegiani:  Yeah, I mean histamine is part of the stress or inflammation response.  I mean, it can cause clots.  It can cause cells to get more sticky.  It can cause your lungs to constrict a little bit more.  It can cause more swelling and fluid retention.  It can open up the blood vessels partly because imagine if you bang your elbow, right?  What happens?  Does it get more swollen or less swollen?  It gets more swollen.  Why?  Because of the inflammatory response.  It’s driving vasodilation, meaning it’s opening up the blood vessels.  Why?  Well, to help bring the immune cells there to help kind of bring the inflammation and recovery process under control.  So the problem is a lot of these mechanisms, they’re acute punctuated mechanisms.  They’re on then they’re off.  With chronic inflammation in the system through gut or other hormonal imbalances, it’s on and then it stays on and then now that it’s on, certain foods that may have been—may have not been a problem before, now perpetuate the problem.  Does that make sense?

Evan Brand:  Yes, it does.

Dr. Justin Marchegiani:  So it becomes this vicious cycle where like, yeah, you may be fine.  You should be able to have some kombucha and some bacon, but now because of the inflammation.  Now that bacon’s a trigger, now the kombucha is a trigger, now the citrus fruits are a trigger, now the good avocados are a trigger, and it’s like people are pulling their hair.  They’re like, “What is going on?  I don’t get it.  These are good foods.  What’s happening?”  And they have to look deeper at of course, you know, when we look at the symptoms, the first thing I do is I say, “Okay, let’s try cutting some of these histamines out of our diet food-wise, do we feel better?  Yes or no?”  That tells me something and if that helps, then we look at, okay, let’s work on better digesting our foods, number two.  Let’s work at gut infections because we know the microbiome, if out of balance, can really create these abnormal histamine responses and we know how the microbiome is so important with gut permeability and that increases autoimmune issues, hence, thyroid, hence adrenal, hence gut issues, irritable bowel disease, so everything can just really spiral out of control if the microbiome is not there, if the food is not there, and of course, if stress is there, we know what the sympathetic nervous system response does in regards to burning up our B vitamins and decreasing HCl and enzymes and decreasing dopamine and adrenaline over the time and then we also know that certain nutrients are gonna be vital for histamine—for making the enzymes to break down histamine, right?  We know certain enzymes, the DAO enzymes are really important and we know vitamin C.  We know copper.  We know B6.  B6 gets burnt down so much during stress, it’s very important for our neurotransmitters, and we also know that if we have low stomach acid levels and we’re stressed, we’ll be burning them up at a much higher level and we know that when our gut microbiome is out of balance, we have more bad stuff than good stuff.  We know that the bad microbes will be eating those nutrients versus making it and we know those bad microbes will be actually making more histamine byproducts as well.  So it’s this double-edged sword, when the gut’s out of balance, we eat the nutrients we need to break down histamine, the bad bacteria makes more of the histamine and then we don’t get a lot of those nutrients absorbed that help us make the enzymes to degrade histamine.  It’s a triple-edged sword.

Evan Brand:  Yeah and then think about, too, you need vitamin C to help reduce or sort of metabolize histamine for lack of a better word and a lot of people are gonna be pulling out citrus, even like lime-lemon.  Those are kinda demonized in the histamine world, if you are reacting to it.  So now, you don’t have enough vitamin C.  So I’ll try to supplement vitamin C personally and clinically and see if it helps and in many cases, it does.  So we’ll have people do quercetin which is in the vitamin C family to help stabilize mast cells that way we can prevent the release of histamine.  At least in theory, if we take a, you know, a shot of 500 mg of quercetin before—when I say a shot, I mean a powder, put in a shot glass with a shot of water and I’ll shoot it down like a 500 mg quercetin before a meal and then mix a little vitamin C with it and that tends to help reduce some of the reactions and then also the DAO before meals.  Let’s go in, just real quick list and then we’ll keep talking because you hit on something that I think people miss the boat on which is that and this is something you and I talked about before we hit record, which is that histamine intolerance or histamine issues are in effect.  What is the cause?

Dr. Justin Marchegiani:  Correct.

Evan Brand:  So if histamine issues—

Dr. Justin Marchegiani:  Correct.

Evan Brand:  Are in effect, what is the cause?  So let’s rant on that more in a minute but we hit the alcohol, fermented foods, cheeses, smoked foods, shellfish—many people that say they have a shellfish allergy, we suspect it’s a histamine issue—beans, nuts—my voice cracked, I said nuts, almonds, nuts.  I don’t know why but certain nuts get moldier than others, so for example like macadamias, for some reason, those and cashews tend to be more intolerable versus I find a lot of people do well with almonds.  Chocolate, vinegar, tomatoes, citrus.  So those are kinda like the histamine triggers but let’s go back to the gut because what you were saying is that the gut bacteria are gonna be doing several things.  They’re gonna messing up the gut barrier.  They’re gonna be producing histamine.  So regarding testing, if someone says, “Hey, how are you gonna test me for histamine?”  Let’s dive into that because the answer is we’re not directly gonna test you for histamine, correct?  We’re gonna be—

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Looking deeper.

Dr. Justin Marchegiani:  Correct.  I mean, there’s the markers like the, you can do the tryptase marker.  It’s a tryptase enzyme marker that you can do.  When you break down histamine.  DAO is one of these enzymes that helps break it down and there’s also histamine N-methyltransferase (HNMT).  I think you can also test some of those enzymes.  But for me, I just—I make clinical changes with the diet and I also give specific supplements and I let those symptoms kinda dictate.  But we also understand that that’s not root cause and this is where it’s very important where a lot of functional medicine people.  I see it a lot with naturopaths where they’ll kinda come in there and they’ll use supplements to just treat symptoms and they’re not getting to the root cause.  So we always have—I always draw a line with patients.  What’s gonna be palliative changes to allow you to feel better in the meantime and then number two is what’s gonna be more root cause.  Because sometimes root cause stuff’s a little bit slow and that’s not good if you need relief now.  So we need to figure out a way to get relief now, like you mentioned some of the natural antihistamines—stinging nettle, quercetin, NAC, bromelain, kidney tissue that has the DAO enzyme, maybe B6, copper, zinc, good quality multi.  So we’ll do those things.  We’ll make the diet changes.  We’ll look deeper at the gut and the adrenals because we know steroids also are part of what’s given to address some of these issues, right?  From a symptomatic standpoint.  We know steroids, like the big medication we know are the H1 receptors and H2 receptors are the big ones, right?  We know the H1s like your Benadryl and your Claritin, these are the H1 histamine receptor blockers.  The Benadryl, the Claritin, right?  And then the H2 ones are gonna be like your Peptid AC, right?  H1 is gonna be more the histamines in the muscles, where H2 histamine is gonna be more in the intestines in the abdomen and that’s gonna be affect the heart.  So H1, H2, so keep that in mind.  Those are the big ones.  There’s actually H1 through H4, but the big meds are H1, H2 and we know that the medications can be helpful but they have a lot of side effects and we have to be very careful with that.  And we also know that the gut and all these nutrients play a huge role and when we look at the nutrients, we have to one, get a good quality multivitamin there that’s gonna have a lot of these nutrients that are gonna be bio-available so we can absorb it easily and number two, we have to get our digestion under control and number three, we have to look at other issues deeper.  That could be a mold issue or it could even be a Lyme or a co-infection issue.  I always table Lyme stuff unless there’s a strong history of tick bites, I always table it and deal with the gut first and the adrenals and hormones even before that and then personally after that I’ll—I typically will deal with mold—Evan and I may differ on this.  I’ll typically look at and test mold right away if there’s a strong history, water damage in the home, history of visible mold or if we’re on the fence, we do a plate test or a urinary mold test or hey, do you feel better when you leave your house for a week, right?  If those symptoms are there, we’ll look a little bit deeper and we’ll test.  I typically don’t go after and address mold right away because a lot of how the mold is removed is via the hepatobiliary system so that’s liver, gallbladder, gut, and the stools.  So if we don’t have great gut issues, a lot of times we can re-absorb stuff.  A lot of the binders that we may give to help pull out mold can actually cause constipation, so I always fix the gut, fix the gut motility, fix digestion before going after mold but we can at least test in the person, the patient.  Test it in the house and we can at least start making house changes right away.

Evan Brand:  Yeah, so I go after it straight away regarding testing but yeah, you’re right.  You gotta get people pooping before you go and do binders.

Dr. Justin Marchegiani:  Yes.

Evan Brand:  And a lot of times like some of the binders you and I are using have folic acid so constipation is really an issue and if you’re bumping up magnesium and vitamin C and that kinda stuff, generally it’s no big deal but how I approach it is that way you mentioned, plus what will make me go after it more beyond just history is just looking at the mold symptoms.  So in my intake form now, I’ve got like 25 different symptoms and if they check off more than a handful, we’re like, “Huh, this doesn’t look good.”  So we’ll look into it and a lot of times, I mean, it’s showing positive.  One thing I wanted to mention on the drug piece, you did a great job talking about like all the over-the-counter stuff that people get into on their own now.  So the Zantac and the Pepcid and the Benadryl and the Zyrtec and the Allegra that kinda stuff, those antihistamines may work in the short term but we’re gonna downregulate DAO and you get for lack of a better word, you get stuck on it because now you don’t have enough DAO so, therefore, histamine rises more than it did before.  And then one other thing, too, is that—and there’s a lot of people talking in forums about this on antidepressants and I don’t know exactly the mechanism.  Maybe it’s depleting DAO, maybe it’s increasing histamine.  I don’t have the mechanism and the study right in front me but if you just look at histamine intolerance Zoloft or histamine intolerance Cymbalta, Effexor, these really, really extremely in fact common prescribed and commonly dosed antidepressants—those cause histamine problems.  So how many people out there, in fact, there was a lady who had a big website dedicate to this which was histamine intolerance after discontinuing Zoloft, and so I don’t even know if the science is clear on it but a lot of people are talking about this.  So if you have been doing an antidepressant and now you’re reacting to more foods that may be something to look into.

Dr. Justin Marchegiani:  Yeah and also, so we talked about some of the big medications, right?  A lot of the Allegra, the Zyrtec, the Benadryl, a lot of the H2, 1 blockers, right?  Here’s the rub here and this is where it gets really, really, really, really confusing is that we talked about how histamine is actually needed to make hydrochloric acid.  So guess what happens with this histamine medications.  They also reduce acid levels and guess what happens when you reduce your acid levels.  Now your digestion goes down south.  What happens when your digestion goes down south?  Now you start to have more SIBO and bacterial overgrowth.  Guess what SIBO and bacterial overgrowth does.  It produces more histamine metabolism.  So it’s this unbelievable vicious cycle people get on and it’s—

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Very, very frustrating.  Not to mention that okay, there’s the other class of medications that help with histamine, guess what.  They’re corticosteroid-based.  You see it with Singulair, right?  Or a lot of these steroid-based medications, well, maybe our adrenals are so weak, we don’t have enough of our natural cortisol, corticosteroids, so we’re not—we have to fix the adrenals with it as well because the adrenals help make that that corticosteroid called cortisol which helps with our natural inflammation and if we can’t put the fire of inflammation in our body out every day that fire is gonna run rampant and create more inflammation and that inflammation is gonna drive more histamine issues and like we talked about before, all of those histamine medications, they deplete the DAO enzyme so then the histamine that’s made, it hangs out way, way longer so it’s not just about making histamine.  It’s about now you can’t break it down so now it stays at the party.  It’s like it’s the guy at the party that just lingers way too long.  It’s like you should be out of here, dude, right?  Closing time.  But that’s what’s happening with histamine in our body.

Evan Brand:  Oh, man.  Well, it’s not to say that we’re saying, “Hey, don’t do those drugs.”  But man, it would be a lot of better if before you get to the point where you get put on a daily Zyrtec or a daily Allegra or something like that or a Zantac or a Pepcid, it would be so much better if we could just stop those people and just say, “Hang on, hang in there.  I know you’re symptomatic.  I know you need relief.  Hang on.  Let’s try some of these herbal antihistamines.  Let’s give you some extra Vitamin C, maybe some extra DAO.  Let’s get you on maybe some leaky gut support.  Let’s get you on low histamine diet for now.  Let’s run a stool test.  Let’s run organic acids.  Figure out what’s going on.  Let’s test your environment.  Hang tight.”  And then if we could do that, it’s just such a deep rabbit hole.  It seems like every time you and I do a conversation on a different health aspect, there’s always a drug that’s involved in terms of being palliative but it seems like there’s always a double-edged sword to that.  No matter what the topic is.  Isn’t it funny how you and I always end up here?  It’s like crap.  The drug helped but now it actually put us in a bigger hole and now we gotta get them out of this hole because now they are downregulated of DAO even more than they were before.  It’s like, ugh!

Dr. Justin Marchegiani:  Exactly.  This is the problem, right?  And so, in general we gotta look at the adrenals, gotta look at the inflammation because if you’re taking steroids, we need to have our natural anti-inflammatories going.  We have to be very careful of the medication.  If we’re using the medication, fine, use it sparingly, but just know it’s gonna create more dependency in the long run.  Also, I’d say a big thing is environmental allergens.  Environmental allergens can dry histamine.  So imagine like we have this big stress bucket, right?  And I’ve given this analogy a lot over the years.  We put our stress balls in this bucket.  When that bucket fills up and overflows, this is where symptoms happen.  So, some people they come in genetically with a big bucket.  They can handle a lot.  They can deal with more stress and they have more adaptability.  Some come in with a small bucket and that bucket is already half full because they are exposed to mold, right?  Or heavy metals or they’re not eating organic.  So that now they’re bucket’s already at the very top and then you add in a little bit of gut dysbiosis or you add in some environmental allergens—BOOM! Histamine symptoms are going crazy now.  So we have to look at that.  So one of the first things is get the stressors out of that bucket and a lot of times so those stressors could be things unrelated to histamine, right?

Evan Brand:  Yup.

Dr. Justin Marchegiani:  So that could be just eating organic, clean water.  The other component is environmental allergens can be a big deal.  If you’re out in Austin.  Cedar is big this time of the year.  You’re breathing in cedar and that hangs out in your sinuses all day and you don’t have a good air filter at home at night then you’re in this stressed-out state because that cedar’s up in your nose causing problems.  So my protocol with patients is we have a really good sinus irrigation system to flush thing’s out.  We clean it out with saline and Xly or Xylitol to knock out any biofilm.  We do it twice a day especially once we come in for the day, we are flushing our sinuses out so it’s clean for the day and we have really good air filtration so then when we are resting at night we are not in this fight or flight state because all the cedar is up in our frontal sinuses creating inflammation all night.  We flush it out once we come inside.  We flush it out when we start the day.  We may even do it midday if we’re really bad just to keep our immune system from overreacting and then we gotta have that clear air filtration at night so when we come home our immune system can relax.  Because if these environmental things are just keeping us in a fight or flight state, it’s gonna be hard to feel better.

Evan Brand:  Yeah, so you’re basically saying, “Let’s try to get some of the things in the bucket, the external histamine bucket down, that way potentially you could tolerate that food and then we’re working behind the scenes to work on the gut and reduce some of the bacteria making histamine there.”  Now here’s one thing we didn’t hit upon yet which is the hormonal link and so I have had many women say that they’re symptoms are worse right before their period starts and I’ve heard of many women who are postmenopausal who are now doing like estrogen replacement and other hormones and estrogen decreases the breakdown of histamine because it actually messes up with DAO, too.  Estrogen can lower DAO.  So if you think about all these women that were doing birth control pills or hormones or anything to mess up estrogen or you just think about the thousands of ways we’re exposed to the xenoestrogens in the environment like reheating our food in plastic and drinking from single-use water bottles that got exposed to sun and things like that.  The whole estrogen-histamine link is big and maybe that’s why we see so many more women than men, you know, I would say it’s a vast majority.  We see a lot more women deal with histamine problems than men.  I think it’s probably due to the hormonal changes and so like if we’re looking at that stool, you hit upon the gut bugs.  When we’re looking at the stool, we’re also gonna look at that glucuronidation pathway and if we see that that’s messed up, and if they’re taking hormones or if they just have estrogen dominance as a history, that’s gonna mess them up more.  So we have to address that as well.  So if you go to the gut guy and he hits on your gut and gives you some herbs there and you don’t get better, the hormonal piece and I guess that would factor in to your adrenals, too, because the adrenal test that we’re looking at, you know, that’s gonna look at hormones, too.  So we’d probably kill 2 birds with 1 stone there.

Dr. Justin Marchegiani:   Exactly and also I would say, so you’re—what you’re proposing as a mechanism is that estrogen helps break down histamine?

Evan Brand:  No, so estrogen depletes DAO.

Dr. Justin Marchegiani:  Okay, so when you’re estrogen’s too high, you’re depleting DAO.

Evan Brand:  That’s right.

Dr. Justin Marchegiani:  Okay, so if you’re estrogen-dominant, you’re gonna be depleting DAO.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  I would also say that when a woman goes through PMS, what’s happening in PMS, right? PMS is premenstrual syndrome, so right before menstruation that’s right at the heart of the luteal phase, if progesterone drops out early, that’s a lot of times what’s driving PMS.  That one, that enhances the estrogen dominance, right?  So high levels of estrogen deplete DAO, that supports and kind of, you know, backs up your mechanism there.  The other thing is progesterone is an anti-inflammatory.  Progesterone is a precursor to steroids like cortisol.  What do you get when you take Singulair?  You’re increasing cortisol.  If your progesterone is dropping out too soon?  What does that mean?  Less anti-inflammatory building block, right?  So all of this makes sense.  We’re trying to be the bridge to connect these hormonal issues to the deeper histamine but also connect the gut issues because it’s all connected, you know, in the interwebs of functional medicine.  So progesterone, estrogen dominance, all makes sense.  Progesterone anti-inflammatory.  Progesterone drops out too soon, that’s the PMS symptomatology there and that’s what driving the inability to regulate inflammation and then also estrogen dominance, right?  Estrogen higher in relation to the progesterone will deplete DAO which is the enzyme that cleans us histamine.  So all of this makes so much sense.

Evan Brand:  Yeah, and there’s a couple of papers on this, too, about the estrogen effects and allergy and asthma, and there are these papers kinda talking about women that are doing supplemental hormones and all of a sudden they’ve got new-onset asthma when they’ve never had it before and it started after they were doing hormones, and so that talks about how boosting up the hormones is affected the mast cells too much and then that’s creating more of an inflammatory chemical-release of histamine and probably other mediators, too.  So this is interesting and I think this is probably the answer.  I didn’t really know this but until I looked at it but it makes sense why we see so many more women than men suffering.  What you say clinically, I mean, women as a whole more in general but with this specific issue, would you say what you’ve seen is more women than men?

Dr. Justin Marchegiani:  Women’s hormones are much more of a symphony that happens throughout the month and it’s very easy for a symphony to turn into noise, right?  If the strings aren’t in there with the percussion instruments, you’re gonna get noise.  So when you start to have hormones a little bit out of balance, it’s gonna affect women in their ability to deal with stress and part of those stressors could be histamine.  So that’s really important and with stress in our environment, we are going to knock down progesterone and with a lot of the estrogens being in our environment, in plastics, pesticides, various chemicals, water, it just only drives more estrogen dominance, right?  It just drives more of these histamine issues.  So it totally makes sense but we have solutions and functional medicine is gonna be the best thing because we know just throwing birth control pills in there, guess what?  That depletes DAO further because that’s just heightening estrogen dominance, right?  And then just throwing in there antihistamines, well, guess what?  That creates more low stomach acid situations.  That’s gonna make digestion harder, breaking down proteins and fats harder, and that’s gonna perpetuate more SIBO, right?  Because if we don’t have good digestion, bacteria proliferate and an environment where there’s not good digestion.

Evan Brand:  Humans always have to complicate things, don’t they?  Will all the drugs, it’s like, “Darn it!”  I mean, without the drugs, I know drugs save lives, drugs save people, antidepressants prevent people from committing suicide and you know, heart drugs help stabilize the heart rhythm and blood pressure drugs help get the blood pressure down so they don’t have stroke.  I mean, I know drugs are needed, but man, every time we uncover some of these connections between the medications and these deeper issues, it’s just like ahhh.  I wish—

Dr. Justin Marchegiani:  I know.

Evan Brand:  We could save people from getting on them.  Yeah, if people just wanna look up, you just put in like estrogen DAO or you put in like sex hormone DAO, you’ll find some papers on this stuff.  It’s just—it’s pretty crazy how connected this stuff is and so.

Dr. Justin Marchegiani:  It is.

Evan Brand:  We’re trying to cover it all.  It’s tough to do what we’re doing in half an hour but we’re trying to make sure you address hormones, you address gut, you address adrenals, you address the sleep, you address the diet, you have to hit all of these pieces if you fully wanna beat this issue.

Dr. Justin Marchegiani:  Exactly.  Well, to get more info on this, guys, head on to to reach out to Evan and schedule with him.  You can also head over to Dr. J, myself, at  We’re here to help you guys.  We’re available worldwide via Skype, Facetime, phone, video consultation.  We’re here to help.  Just make sure you guys take one piece of intel from this conversation today.  Apply it to your health and life.  We hope that you guys understand some of the deeper mechanisms and why some of the medications may help acutely but long term may set you up for more problems.  I hope you guys enjoyed it.  Sharing is caring.  Give us a share.  Put your comments down below.  If you’re suffering from histamine, let us know.  We’re curious about it.  We wanna engage in a deeper conversation and hope you guys enjoyed the podcast.  Evan, anything else?

Evan Brand:  No, that’s it.  Y’all take care.  Have a great day.

Dr. Justin Marchegiani:  Take care, guys.  Bye y’all.

Evan Brand:  Bye.


Audio Podcast:

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