The Gut Histamine Connection | Podcast #384

Dr. Justin and Evan Brand discuss the gut-histamine connection in this video. They point out that many patients with digestive issues, skin problems, mood issues, and fatigue often have sensitivities to histamine-rich foods. They suggest focusing on root causes, such as overgrown bacteria in the gut, gut inflammation, and processed food consumption, as the key to improving histamine issues instead of relying on antihistamines or other medications.

Additionally, Dr. Justin and Evan mention other contributing factors to histamine issues, including tick-borne infections, mold mycotoxins, chemical exposures, and heavy metals. To address these issues, they suggest a holistic approach using herbal medicine and aligning puzzle pieces to help patients get better without worsening.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

00:20 – Common Digestive Issues
06:40 – Can H. Pylori cause Histamine Intolerance
10:05 – Ginger as Stimulant
14:02 – Over the Counter and Natural Remedies
19:47How Do You Know if You Have a Histamine Problem?
21:32 – What is Histamine?
24:33 – Takeaways

Dr. Justin Marchegiani: And we are live! Dr. J. here in the house! Evan Brand here as well, we are excited to talk to you guys about the Gut-Histamine connection. This is a common question that we get a lot while in the trenches daily with our patients. Really excited to dive in, Evan what’s going on man? It’s been a hot minute, how you’ve been?

Evan Brand: Yeah, I’ve been really well, and this issue, I think, I don’t know if it’s because you and I are recognizing it more or if it’s just because it’s more common. Maybe it’s a combination of both. But you know, I see so many issues where people start out with a digestive problem. Like they’ll complain about stomach pain or cramping, or diarrhea, or constipation, maybe some skin issues, maybe some mood issues, anxiety, depression, fatigue and then all of a sudden histamine comes into the equation.

And people start realizing, “Wow! I’m actually allergic or I’m having these sensitivities to histamine-rich foods!” Like, maybe avocado, that was a big one for me. I would eat avocado I’d get a headache from it then I learned about histamines, and sure enough when I went low histamine, a lot of my symptoms resolved. So I think this is an important piece of the puzzle especially, depending on when people are listening, things are starting to bud and bloom.

And so people may be reacting to outdoor allergens, pollutants, pollen, et cetera things, blooming. I think it’s because their bucket is already so full because of gut, in the histamine-producing bacteria, that now they’re reacting to the outdoor environment. So people go to the ENT, they jump on the allergy med but that’s not necessarily the root cause solution.

Dr. Justin Marchegiani: 100%! I see it all the time where you know, you’ve got patients that go to you know, the conventional doctor like, “Oh I have mast cells!” And then they’re just basically managing that patient with a lot of fancy antihistamines, different things like that to kind of decrease the ability to either make histamine or, help your body kind of degranulate it or break it down. And they’re like, “Well this is what I have.” and they’re so focused on the actual diagnosis like the diagnosis is its own entity, where the diagnosis, I always tell patients is just a manifestation of a lot of upstream issues working their way down.

And so it’s kind of like, you have all these systems that are out of whack whether it’s gut, gut bacteria, and we know, for instance, that there’s different bacteria when overgrown can drive histamine, you were mentioning that. Morganella, Klebsiella, Pseudomonas, Citrobacter, Proteus. These are all bacteria that are common, like in SIBO and just in general dysbiosis, and these bugs can actually produce a lot of the histamine.

And then, of course, if your gut’s inflamed, you’re eating lots of processed flours, acellular carbohydrates, that’s what’ll feed a lot of these things and then, God forbade, you come in there and you have some antibiotics, over the course of your lifetime, maybe more than you should. Now you have this perfect storm of like processed foods, you have antibiotics maybe you come in there and you have a lot of glyphosate and roundup exposure, and now that whacks out your brush border, that creates rebound overgrowth as well.

Maybe you have some mold exposure, now you’re overly stressed, you have low stomach acid, low enzymes, low bile salt, so you can see how this storm isn’t just like this, “Oh! I just have a Zyrtec, or an Allegra, or a Pepcid-AC deficiency.” It’s like no no no, that may help you palliatively control some of the histamine symptoms right? Brain fog, dizziness, vertigo, obviously like you to carry a hive skin stuff, it may control some of that fatigue but it’s not going to fix it and so you always want to go upstream to the root.

Evan Brand: Yeah and this is not a sexy idea because it’s not one silver magic bullet that you and I can offer. We have to tease it apart and go, okay, well over here we have on your stool test for example. We see five, six different bacteria, all producing histamine. We see here you have an older home, you don’t have any air purification in the home, so there may be indoor pollutants kind of creating a mast cell reaction.

Then you may have tick-borne infections that I always factor that in, just with my own personal suffering. Lime, Bartonella, Babesia, these things also drive histamine and mast cell activation. Mold, Mycotoxins, those drive it. You mentioned Glyphosate, other chemical exposures, I would assume heavy metals are probably aggravating the mast cells and creating a histamine response as well.

So, when you tell someone, “Hey get rid of the Zyrtec. Let’s do this, that, that, that, and that.” It’s a little bit harder of a cell but I wouldn’t encourage you guys to just take things one at a time, and if you’re working with someone like Dr J or myself, we’re going to help you to align the puzzle pieces in a way that’s going to slowly get you better without getting you worse.

Because the problem is, we’ll see people that’ll go do Rifaximin and this is their naturopath, or some supposedly Integrative Medical Doctor that went functional, and they’ll go put them on Rifaximin or something else for the SIBO, and they flare up worse or maybe they get relief for a month or two, and then they call us. “Hey, I’ve already been to five, six people. Can you help?” And usually we can we like the high pressure environments

Dr. Justin Marchegiani: Yep 100%! And so, I always try to be the most conservative as possible. Try to use more herbals and get to the root first. Obviously, like the first thing is if you’re coming in, and you’re super inflamed, you’re overly sensitive to histamine, and you’re already on some medications, and those medications are typically are they helping you? Whether it’s like an H1 receptor antagonist, or an H2 antagonist, or an H1 blocker right? There’s typically the H1 and H2 kind of antihistamine type of families right? Whether it’s, I think Allegra is one I think Zyrtec one, Pepcid-AC is one, I think Zyrtec is an H2 blocker right?

So there’s different families of drugs that fit into those categories. There’s obviously some more experimental drugs that are coming out down the pipeline but these are just common ways that your conventional doctor may be managing it. I tell patients, “Hey, if you do that medication, how do you feel? Do you have an improvement?” If you do, that tells me something right? Because if your histamine bucket is full and those medications help, well the root cause now is to pull out the antigens or the foreign material that’s filling up that bucket.

Now in some people, I’m like “Hey! What’s your environment like? Do you have a bunch of seasonal allergies coming in and impacting your sinuses? Do you have mold in your home?” Because the easiest thing out of the gate is get your air quality in the home clean and flush out your sinuses because a lot of times you’re outside, and during the daytime, you’re bringing all those weeds and pollens into your sinuses. You’re bringing them in even though you’re inside in a good environment. You got to get those things flushed out so we’ll do saline, we’ll do Xylitol, or some biofilm busters and we’ll flush that stuff out once or twice a day, and we’ll make sure the air in the home is super clean and will rule out any mold issues or environmental issues in the home too.

Evan Brand: Yep they had a question come in about H.Pylori. Can H.Pylori cause histamine intolerance? My gut feeling was yeah. I would throw it in the category of any of the gut bacterial overgrowth. Well, here’s the paper on it right here, from an Immunology Journal 2004. Effects of helicobacter pylori on gastric inflammation and local cytokine production. And long story short, it says here results suggest H.Pylori induces lower TNF Alpha and interleukin-6 secretion in the mice. So this is a mice study, they’re saying here that H.Pylori produces considerable cytokine production in the infected groups.

Now they did something here, this is kind of interesting. I don’t know how they do this. I guess they mess with the enzymes, the histidine decarboxylase, in these mice, so that’s interesting. Because they’re kind of comparing like a regular mice versus this altered mice, and then they gave the mice H.Pylori, and yeah, I mean, it’s a piece of the puzzle right? So I can’t say if you just had H.Pylori would that create a histamine intolerance? But it’s rare to see that by itself wouldn’t you say? Most commonly we’re going to see candida or maybe some other bacterial overgrowth with the H.Pylori.

Dr. Justin Marchegiani: Well, also too. If you have H.Pylori right? We don’t have to go too far to kind of make it make sense just with the deductive reasoning right? So we know H.Pylori can decrease stomach acid and we know low stomach acid impairs digestion. We also know stomach acid also has a mild antimicrobial effect, right? This is the reason why people make you know, homemade topical cleaners out of like white wine or apple cider vinegar because the acidity actually kills stuff.

And so we know if we have good acidity levels in our gut it’s going to make it easier to keep the bug level down in our gut. We also know women that do birth control pills increase the vaginal pH, makes it more alkaline, that makes it easier for yeast to grow, right? We know these! So, we can kind of use deductive reasoning and say, “Hey! If we impact the pH and raise it above where it should be, that can make it easier for bugs to grow. It’s very possible.”

Evan Brand: Yeah and you know, the person commented that they have H.Pylori and histamine intolerance they don’t want to go to conventional doctors. What can you do to feel better? Well, number one would be get a full workup done. You know, we’d like to look at stool and urine to figure out what all is happening and then we come in with herbal antibiotics and you can knock this thing out within a couple of months unless you have a spouse that’s reinfecting you, then we may want to get them on board, but you know, between Dr. J and I, mean we’ve probably fixed thousands of cases of H.Pylori.

So the cool thing is, with herbs we don’t appear to have the same antibiotic resistance that we see with the conventional drugs because now they’re moving on to quadruple therapy, which is four different antibiotics at the same time to treat this. So, it’s a real mess, and as you know, we’ve talked about before, as soon as you wipe out one thing then other things are likely to move back in, so maybe you do clear H.Pylori with triple or quadruple therapy. I have seen it be successful but then we see all the other crap move in. the Klebsiella, the Citrobacter, C. diff, other types of Clostridia, those move in, and then those create other problems.

So, it’s kind of like you played whack-a-mole, right? Like you knocked the one pathogen out and now you’ve got these other histamine-producing bacteria that move in so you’re still in the trenches here.

Dr. Justin Marchegiani: 100%! And so, I look at it like this: Stomach acid is a really good and first important step. We need that. We know most people stomach acid and bile acids drop and bile acids they’re they’re slightly acidic but they can also prevent a lot of bugs from growing, right? So, this is really important. People that have sibo tend to have lower bile acids as well. And so, one of the first things that we’ll use to kind of stimulate motility and stimulate acid production, we’ll use a bitter call Ginger, and Ginger is also a mild H2 blocker.

So, it can also help modulate histamine a little bit which is really cool while also stimulating digestion. which is really interesting. And then we’ll use like, people will use like you know, an H2 blocker like Pepcid-AC, but the problem is that drug actually will block hydrochloric acid levels, where some of the natural H2 blockers like ginger won’t actually block it, it will actually stimulate it which can be much better. This is why drugs have side effects, they tend to disrupt and block inhibit enzyme pathways so you tend to have more side effects. Where herbs just tend to enhance and support.

Evan Brand: Yeah, well said and I was just going to throw in Ginger too is always helpful when you have nausea because a lot of these gut bugs can produce nausea, I told you years ago when I had H.Pylori. Not only did I have anxiety, but man, my nausea was out of control especially on an empty stomach, it was awful. So, I would just do these Ginger chewables and that would really help tamp it down.

Dr. Justin Marchegiani: Yeah! yeah exactly. Now I tell patients like, obviously, lifestyle is a foundation, like the food you eat, diet, sleep. But if you’re eating like really good high-quality grass-fed steak or salmon but you’re not able to break it down well that’s a problem. So that’s why like foundational digestive support is going to be the foundation it’s almost equal that up with food because if you can’t break the food down, the food even though it’s healthy, can also be a stressor on your body.

So, I really want to get the HCL, get the enzymes dialed in. Now some people when their guts really raw and they have a lot of histamine issues, they may not be able to handle much hydrochloric acid and that’s where working with a clinician, like some patients, they kind of jump to conclusions they like try HCL, they have a negative reaction like no it’s not for me and they kind of just jump ship. It’s like, “Wait a minute!” Like utilize the thousands of patients that we have data points from and figure out what does that mean? What’s plan C? What’s Plan D? What’s plan E?

Because there’s ways that we can either lower the dose, increase enzymes and bile acids, use bitters, there’s other little tweaks that we can make to make that work and then also what does it tell you about your body? It tells you you probably have atrophic gastritis. You probably have a really thinned out gut lining, and we really have to work on building up those enterocytes, building up you know those goblet cells, building back up those parietal cells, really that mucosal lining really building it back up.

Evan Brand: Yeah and question came in about gastritis. Well figure out what’s causing it, you know. Gastritis is just the, it’s like the upper GI IBS. What I mean by that is like you go to the conventional doctor if you get referred to the gastro, with diarrhea, constipation, they’ll throw the IBS label on you like they did to me years ago. If you have any kind of issues up north, you know say stomach or higher, then you may get this gastritis diagnosis.

And often what’s going to happen is, they may throw in that acid blocker, reducing stomach acid further, now your food’s not digesting well, now you’re getting a buildup of these histamine producing bacteria, now you develop histamine intolerance all because the doctor was trying to fix the gastritis and put you on the acid blocker. So he screwed up this whole, there’s a negative domino effect that happens once the pharmaceutical is put in for gastritis.

So, our remedy would be to come in and say number one, do a stool test. We would likely run the GI map, that’s our favorite at the time of this recording. And with that stool test, we would look at cow protectant, which is your gut inflammation, we would look at pancreatic enzymes, look for H.Pylori, look for all the bacteria, and then we would do it in the proper order. So maybe there are some soothing herbs like you mentioned in the beginning and then ultimately knocking the infection down that’s causing gastritis.

So, you can’t just glutamine your way out of this. You can’t just chamomile tea your way out of this. Ultimately there’s something driving it. So I’m cool with the the natural, soothing remedies. You could drink a gallon of aloe juice a day if you want but it won’t clear the bugs. So really got to figure out what’s driving it.

Dr. Justin Marchegiani: Yep exactly! And so one of the big things I’ll use, I’ll use Manuka Honey because I find it can have a natural antihistamine benefit. It can release, it can reduce the body’s production of histamine plus it’s very soothing. They use it in burn victim units in hospitals. It’s also antibacterial. So if you have a you know, higher level bacterial load in your gut let’s say H.Pylori, it could probably start knocking it down a little bit. I would say I would never rely on Manuka Honey to addressH.Pylori by itself but it’s a gentle way to start.

Again, I don’t like to come in there and throw heavy herbs out of the gate because I just find if someone’s gut is raw and we throw a whole bunch of clove or mastic, or whatever oregano, or berberine, that can sometimes irritate an already sensitive gut lining. So we want to really work on getting everything dialed in the first month or two and you know, how that food is cooked and prepared makes a big difference as well. So I like ginger, I like Manuka Honey.

Again, glutamine or glycine or collagen, so a good building block, but like Evan said, if I throw a whole bunch of building block, let’s say, wood into a burning building, does that really fix anything? It’s like “No! We got to get the fire down!”, right? So yeah, here’s this building block, but we got to get the fire down, and it’s not bad to throw it in there, maybe with some aloe, or some DGL, or some ginger, or some Manuka Honey, or something that’s really anti-inflammatory and gentle. I have no problem with it, but you got to look at it talk about it with your functional medicine doctor. Have the big picture plan. Don’t just go and throw stuff at it at like willy-nilly.

Evan Brand: Yeah and the truth is, when you’re desperate and you’re miserable, you’re gonna run somewhere and do something. So, I would encourage people, if you are in the current state of suffering, you have histamine issues, you have gut issues, you’re having this gut histamine problem happening. Just either reach out ASAP to us so we can help tamp it down, or do something gentle and slow. Don’t just go jump on three, four, five drugs.

I’ve seen it they get on Chromolin and you named several other pharmaceuticals, they jump on those and then now you have to clean up the issues with that. Now there’s potential Osteopenia or Osteoporosis because they’ve been on acid blockers for 20 years screwing up their mineral absorption. So, now you have a bone density problem, or now there’s a mobility problem because their hips are weak, right? So, it’s like there’s other collateral damage that happens when you are incorrectly tamping down the acute situation of stomach burning, GI pain, gut issues of any kind, histamine problems.

I would encourage people pace yourselves but you know, don’t. I don’t want to talk people out of getting care, I’m not saying that like if you need a colonoscopy because you’re bleeding out of your butt, yeah you got to figure it out. If you’re vomiting blood, yeah you got to figure it out ASAP. But if it’s this subpathological issue, meaning there’s no formal diagnosis you’ve been given, they just kind of brush you off and send you home with a couple over-the-counter remedies, then you really got to start digging.

So get your stool looked, at get your urine looked at, and check out your partner too. Your partner could be a vector. So that’s why I always ask the question, “Hey, you know you have these gut issues what about your spouse or your partner? Do they have the same issues? Yep they sure do! What about your kids? Oh yeah, my kids guts are messed up too.” Okay then we find out this infection is whole family-wide, so if we can, sometimes we’re working on the whole family.

Dr. Justin Marchegiani: Yeah 100%! And again, you know, most diagnoses, you know, really aren’t that helpful like let’s say, you have some inflammation in your stomach, you’re like, “I need to go to my doctor and get a diagnosis.” So, let’s say they just look at symptoms and they say, “Okay, well, you know, we’re gonna just try to give you an acid blocker because, we, you have irritation, right? That sounds like a gastritis, which just means gut tissues inflamed. Itis means inflammation. Gastro means gut, stomach. And then, maybe we’re going to give you Gaviscon, kind of coat that stomach, maybe we’ll recommend Tums or an acid blocker. Maybe we’ll give you a steroid.”

Maybe the next thing is, that doesn’t work then they’re going to recommend a scope. Let’s say they see an ulcer there, they may test for H.Pylori, they may be getting closer. But now they’re throwing a whole bunch of antibiotics at it that only works seventy percent of the time, and can create bacterial overgrowth in other areas. And so, they may not get to the root underlying issue and they may just try to symptom spot and so I always tell patients how does the diagnosis get to the root cause?

Now if you’re bleeding, you have a serious ulcer, you may need something to reduce in the inflammation acutely. But in the end what happens next because you still didn’t get the root cause addressed? Why did you have that to begin with? What foods were you eating? What kind of imbalances do you have in your gut? What kind of lifestyle problems do you have? So you have to look deeper.

If I go to the doctor and I have knee pain, right? All the doctor is going to say is “Oh my gosh! You have arthritis in your knee!” He literally said the same thing back to you, just in Latin, right? She said you have arthritis which means joint, arthro-itis means inflammation of the joint. He literally just said the same thing back to you! You said, “Hey Doc! My knee hurts!” and he just said, “Of course! You have inflammation of the joint.” Which you’re like, “Of course! Like, no crap right?” Now, question is why? They may say, “Well, your cartilage is wearing thin, we need to put a total knee in there.” But how did that happen, right? Should I add in collagen? Is my exercise wrong? What caused that? “Hey! Should I look at Prolotherapy or stem cells?”, right? 

There’s so many other means of looking at things that may have helped you in between, and now again if it’s so far gone, and you’re not willing to make a change in your diet or lose weight, that may be your only option, right? But I always tell patients, “You want to know all your options!” You want to understand kind of the diagnostic language. A lot of times, they’re just telling you the same thing back and they’re just spot treating symptoms. Sometimes that may be necessary but most times you’re just ignoring the root cause.

Evan Brand: Yeah and we jumped into the nitty-gritty quick. So if people got lost in the weeds of “How do you know you have a histamine problem”, a lot of people don’t. So this could be allergies, where you’re reacting strongly to the outdoor environment. Like when pollen starts blooming and the flowers are coming on the trees, all of a sudden you’re reacting, you’re getting stuffy, you’re getting brain fog, you mentioned dizziness, vertigo, you mentioned the rash on the skin, it could be flushing, you could have a stronger reaction to leftovers, so the longer protein is going to sit, you’re going to have more histamine.

So, if you eat yesterday’s burger for lunch and you feel weird after that, that could be a sign. Spices and herbs could aggravate that too.

Dr. Justin Marchegiani: Fermented foods! Do you have a reaction without it? Do you get a lot of brain fog when you have kombucha or sauerkraut?

Evan Brand:  Yeah, spicy foods like chips. Like even if you’re doing these avocado oil barbecue chips and all those spices if you kind of feel weird woozy after that. Alcohol intolerance, if you take a sip and you’re already toasted, you know, that’s a potential histamine issue. what else?

Dr. Justin Marchegiani: Well you see it, you see it with a lot of Asians too, right? Asians typically get that like red glow and and what do they take? They take Pepcid-AC, which is an H2 receptor blocker. So a lot of Asians are very sensitive to alcohol. So they intuitively know that’s why you see Pepcid-AC being consumed typically by Asians because of the alcohol sensitivity, right? And so, it’s important to know that. Now, anything else you want to add there Evan?

Evan Brand: Native Americans too. They’re pretty sensitive to alcohol. I’ve seen that.

Dr. Justin Marchegiani: Oh yeah, oh yeah. I mean you can go back to the, you know, hundreds of years ago. That was clear with, you know, different hard alcohol cause major problems for sure.

Evan Brand: Insomnia because you know, histamine is a neurotransmitter too so it can really make you alert, it can make you anxious too. Fatigue even. I’ve seen histamine issues driving fatigue but the anxiety, heart palpitations. I’ve seen in more extreme cases, chemical sensitivity, reacting to fragrances, that’s a lot of it.

Dr. Justin Marchegiani: Good, now like what is histamine guys? Right, histamine is actually made from the amino acid histidine. So histidine’s a nutrient, it’s an amino acid your body will make it. Now, the more you are inflamed, the more the gut bacteria is off, the more you’re low in certain nutrients, because certain nutrients that actually help you make the DAO enzyme, Diamine Oxidase, which actually helps you break down histamine, right?

Or also, the N-Methyl Transferase, HNMT is another enzyme but these enzymes are commonly found in kidney, kidney tissue but that will help break it down. Now, SIBO can impact it, copper, vitamin C, B6, these are all nutrients that are needed to help break down histamine, by making those enzymes. Now histamine, right? It can actually make acid in your stomach so it could actually potentially cause a little bit of reflux. It can cause issues with sleep, memory, cognitive issue, brain fog.

Histamine is a vasodilator. Think like if someone punched you in the eye, and it gets swollen, there’s actually a histamine response. So, histamine acutely is it’s good, right? You bump your elbow, it’s opening up the vessel so you can get blood cells there to attack and get the damage down and then also bring the inflammation out. So, histamine acutely is totally fine, it gets a bad rap. It’s when you’re in a chronic state that’s where it’s problem because now it’s causing everything to kind of dilate and swell and you have this chronic kind of bloat and inflammation issue, right?

Obviously, chronically inflammation is typically going to cause blood vessels to narrow because that’s typically what chronic inflammation does but histamine the goal is to dilate. So you want to look at a big picture. Now you have the H1 receptors, these are going to be your smooth muscle cells. H2 are going to cause abdominal and nausea issues, right? So when you take a lot of the H2 blockers like Pepcid-AC, that may help with nausea. Your H3 are going to impact sleep and appetite and your central nervous system and then H4 are going to impact your spleen, your white blood cells, your colon.

So again, histamine by itself it’s normal, it’s when it’s in that chronic inflammatory state that it’s a problem.

Evan Brand: Well you know, what’s interesting too, this is all involved in blood flow, kind of a tangent here, but I just think it’s interesting, you know. Erectile dysfunction and loss of libido happens often during the H2 receptor agonist. This is like a 75% occurrence. So these people are having sexual issues now, where maybe they’re getting put on testosterone or something else to try to help the erection issue but really, they’re just on a histamine antagonist that’s screwing up that pathway. So, once again it’s like a side effect if something leads to another issue so.

Dr. Justin Marchegiani: Yeah, but we talked about like Pepcid-AC is an H2 blocker, right? But also ginger can block, pin block H2 as well, but it also can have a stimulatory effect on the hydrochloric acid. Kind of a little bit contradictory from what Pepcid is so it’s interesting.

Evan Brand: Yeah, well, we ought to wrap this thing up, but I do want people to have resources. Well, we’ve covered the test, the urine, the stool, get your gut looked at with the gut bugs. If you’re on drugs, let’s try to find a better solution than being stuck on those. Let’s heal up your gut. If your gut is leaky or you’ve got some gastritis going on, low histamine diet we covered that. Actually, we have a low histamine diet guide that I put together, like a PDF, it’s free, there’s no catch or anything, so I’ll put a link on my podcast when we upload this. There’ll be a link in the show notes for that.

Dr. Justin Marchegiani: Yep! I would say gluten sensitivity of course, anything processed, gluten, any of those, things can increase it. Again, there’s certain medications that can also increase it so if you’re chronically ill, you have a lot of health issues, and now you start getting into this poly-pharmacy cycle, guess what? That could also cause histamine problems. So NSAIDs, if you’re taking ibuprofen, or aspirin every day, could be a problem. If you’re on antidepressants, Prozac’s, Olaf, right? Think about it. I think it was, I saw an article like, is it 20% of boys in fifth grade or on antidepressants. That’s crazy!

Immune modulators right? The big drug by Abbott I think is Humira right? Because the patents running up this year, they use that for a lot of I think, a lot of chronic gut issues right? A lot of chronic inflammation, Humira is a big one. Enbrel, Plaquenil, you have other anti, things that help blood pressure, (inaudiblke) Metoprolol right? Then you have your Allegra, your Zyrtec, and then you have your your Tagamet, your Pepcid your Zantac, all your H2 blockers.

Evan Brand: Yeah, this is a crazy list. I was just looking at medications and histamine and how it affects DAO, yeah you covered almost all of them. Those immune modulators are huge too because you know, let’s say you have some gut issue like, we know, there’s certain bacteria in the gut that can drive things like rheumatoid arthritis, so Proteus, Citrobacter, some of these autoimmune triggering bacteria. So, let’s say you have that bacterial overgrowth from antibiotics, now that drives some sort of autoimmune joint issue like RA, and then you get put on an immune modulator like Humira, now you develop histamine intolerance if you didn’t already have it, then you get put on a mast cell stabilizer like Chromalin or a histamine blocker there. I mean man it turns into a mess quick doesn’t it?

Dr. Justin Marchegiani: Oh my gosh! Yeah! Like you mentioned with the Humera right? You could have RA, or some kind of a chronic gut issue, Psoriasis, and now you’re on this drug and then that creates more histamine issues, and then you never fix the underlying issue to begin with. Now, in functional medicine world right? We’re going to get to the root cause there may be some things that we use that are palliative to work on supporting what’s happening right?

That could be Coresatin, could be vitamin C, it could be stingy nettle, it could be NAC, it could be ginger, right? We may use some natural, just getting inflammation down will actually reduce histamine. So, we may do some of these things, if necessary, we may work on the environment stuff. We may say, “Hey, we’re going to get you an Austin Air or an Air Doctor, high-quality HEPA filter for your home because you’re getting too much antigens from the foreign environment that are stimulating histamine.”, right?

And so, you’ve got to look at the root. Now, we want to just make sure we round everything up. There could be some tests that you do from your conventional medical doctor. You can do the N-methyl transferase, 24-hour urine. You could do a histamine plasma, right? These are some tests, but it’s not going to tell you what to do. It may give you a baseline, “Hey, my histamine’s in the top 10% of the reference range.” “We’re going to do some of these things. Come back in a month.” “Oh, look! It dropped!” So it could just kind of give you an indication that it’s, you’re moving in the right direction. It’s not going to tell you what to do because your conventional doctor will just say, “Hey, here’s some, right, antihistamine medication, fill in the blank to reduce it, that’s not going to fix it. We may do other things, but that at least gives you a baseline or a starting point.

Evan Brand: One other question this really opens up the ability for us to do part two, part three on this, the hormonal connection to histamine. Question came in, Adam asked, “Can women cycles cause issues monthly with histamine?” And then, you wrote about mast cell, and the answer is yeah. That estrogen will actually stimulate the mast cells. I’ve looked at a few papers on this before. So, estrogen will cause mast cells to release more histamine, and it will actually down-regulate DAO.

So, you see, so many women having issues now, I mean there’s so many xenoestrogens and things from the environment, combine that with plastics and other things affecting estrogen. A lot of these women are estrogen dominant, so then when they have the spike in estrogen throughout the menstrual cycle, for sure, you’re going to have a histamine flush.

Dr. Justin Marchegiani: Yeah, so in general what happens with histamine just to kind of echo. Histamine can stimulate the ovaries to actually make more estrogen. That creates more estrogen dominance so think of any of your PMS symptoms, breast tenderness, cramping, mood issues, sleep issues, irritability, back pain, that’s going to cause more of those symptoms.

Progesterone at the same time does stabilize your mast cells. It does upregulate DAO. So it helps you deal with it better. So you’re going to create more estrogen dominance,e and that’s not going to be good. Anytime you create more inflammation also too, your progesterone tends to have a very anti-inflammatory effect, and so the more you stimulate your progesterone to be used for your anti-inflammatory cortisol, you tend to increase this estrogen-dominant situation.

Evan Brand: Yep, all right, well let’s wrap this up. I know I got to run it, you gotta run here. I think we did great but let’s do a hormonal histamine one. I think we could unpack that. I think we could do half an hour just on that topic if not longer.

Dr. Justin Marchegiani: Yeah I’ll come back here after guys to answer some more Q7A stuff. But Evan, great chatting with you all. You guys want to reach out to Evan – Sees patients worldwide, get to the root cause. Dr. J.,, feel free myself. Reach out to patients worldwide. We’re here to support y’all! Take action! Action! Action! Action! Think of one thing you can execute on today guys.

Evan Brand: Heck yeah! All right, man, it’s a pleasure!

Dr. Justin Marchegiani: Hey! Pleasure is mine! Take care all right,! 

Evan Brand: See you soon! Peace! Bye!


Audio Podcast: 


Low Potassium, Adrenal Dysfunction Your Immune System | Podcast #288

For today’s live podcast, Dr. Justin and Evan Brand talk about Potassium and our immune system. Among other minerals, Potassium also acts great especially in our body, energy, mood, blood pressure and a lot more. Let’s dive into why potassium is important for our immune health. Check this podcast’s transcript. Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

2:18 All about Potassium

9:11 Oral Supplementation

18:32 Glucose

20:57 Foods with Potassium

27:11 Vertigo and Dizziness

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Dr. Justin Marchegiani: Hey there, it’s Dr. Justin Marchegiani, we are doing a live podcast here on potassium and your immune system. Potassium is an essential mineral. And it has major effects on the sodium potassium pump, how your cells function, energy, mood, blood pressure has a huge effect on the adrenal glands. I’m excited to dive in here with Evan Brand, Evan, how you doing today man? doing really well.

Evan Brand: So we were looking at some papers on this thing. And turns out a national survey found that approximately 98% not nine not 8, 98% of Americans are not meeting the recommended potassium intake. A Western diet is to blame as it favors processed foods over a whole plant foods such as fruits, vegetables, beans, and nuts. Everybody knows that the American diet is crap. And it’s not just the American diet. Right? This is the standard European diet. This is the standard Australian diet you know, kind of most developed first world Countries they’re doing too much. Too much potassium devoid food. And let’s tie that directly into what we were also looking at which is this paper this based on the names of these doctors. And yeah, actually it shows it right here. When Zhu Zi Yong ha, Province, China, so yeah, so this is a Chinese hospital and Chinese medical universities to study that came out of hyperkalemia and clinical implications and patients with Coronavirus and long story short people that had potassium deficiencies. They had severe hypokalemia, which is the technical term for potassium deficiency. And it said here that the patients responded well to potassium supplements. And they were inclined to recovery so they don’t say directly Hey, low potassium means you’re going to get the virus or low potassium means you’re going to be really sick, but they just talk about how, because of this whole Ace to enzyme thing that you and I’ve covered many times, and the whole relationship to the virus that one of the side effects of the issue can be low potassium, and if you’re already low potassium to begin with, then you can end up in potentially fatal shape, which is not good.

Dr. Justin Marchegiani: 100% in potassium is very important because our sodium potassium pump is requires potassium. So what happens is, you have your cell, and then you have sodium inside the cell and you have potassium outside of the cell. And they do a little switcheroo ski, right. This is called the sodium potassium pump. The enzyme that’s involved in making that happen is ATP. And then you know, it’s an enzyme because of the word Ace next to an ATP ace. So ATP is important because ATP is generated from your mitochondria, right? We have glycolysis outside of the cell in the cytoplasm, and then we have our Krebs cycle, right? And we have our electron transport chain within the cell we generate 36 to 38 or so ATP from that that eight TP part of that ATP runs their sodium potassium pumps that ATP takes that sodium that’s in the cell and that potassium outside of the cell, they do a dance, they switch. So it’s three coming out to come in, right? Boom, just like that. And the cell needs that healthy fluid fluidity to work and to communicate. And if we don’t have that healthy fluidity, we’re going to have side effects. So one of the big side effects is we’re going to have muscle or nerve issues because potassium and sodium are very important for the muscles slash nerves to work, right nerves help control muscles, so very, very important there. You’re also going to see it with you’re going to see it with potential mood issues as well because sodium and potassium play an intricate role with the adrenal glands and part of the reason why people’s potassium gets low outside of a poor diet is going to be because of adrenal function. Now, typically with adrenals. Your dosterone starts to go low, which is a mineral corticoid that exists in The cortex to the adrenals. And what happens is as your dosterone starts going low, your sodium can start to drop. And 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 you are your adrenals are weak and you’re pulling out a lot of your minerals. So muscle and cramps are going to be a big deal, weakness and fatigue because your nerves need that. Also, if you don’t have good sodium potassium pump issues, you probably have energy issues because the mitochondria healthy mitochondrial function for ATP is needed for that sodium potassium pump to work so potassium works better when there’s the ATP so that whole sodium potassium pump works. We talked about cramping as well because of the the muscles needing the wiring the fluid wiring sodium and potassium and minerals. So cramping is gonna be a big deal. We’re also going to have potentially digestive issues right? your bowel movements and your motility starts to Coming slower when your potassium drops, so we need healthy levels of potassium. So we have good bowel movements. Also heart palpitations, we need potassium and magnesium. So our heart could pump right our hearts a muscle as well. So if your heart skipping beats or beating harder or faster, that’s a sign of palpitations, which could be from that. And also just achy muscles, muscle breakdown, feeling tired and stiff, right? the breakdown of muscle was known as rhabdo. My license or my analysis, right? And that breakdown is going to be very much helped with good potassium levels, right, you’re gonna have less muscle breakdown, with potassium levels being adequate, of course, tingling and numbness issues are going to be a big one difficulty, you know, using your lung muscles mood stuff because of the adrenals as well. I’ll pause and give you a chance to comment.

Evan Brand: I’m glad you mentioned magnesium too, because, uh huh. You and I were kind of looking with a microscope today, right? We’re kind of spot picking right? One thing to talk about, but all these people that are deficient in potassium, I’m sure they’re going to be deficient in magnesium as well. I mean, we know how hard it is to get it from the food, even if it’s organic, because the soil is so depleted. So it’s a really common problem. And then on that whole mood changes, I just wanted to talk about that real quick. There was one study, and this wasn’t a necessarily a causation, but just a correlation study that we were looking at here. 20% of patients with mental disorders that came into this psychiatric ward 20% of them had potassium deficiency. So it’s not saying directly, the potassium deficiency caused the mood issue, there could very well be other things going on you and I’ve covered hundreds of times about gut infections, which could lead to mineral and electrolyte imbalances you hit on the adrenals. So, of course, as we know, when we hear something like that, we say, Okay, well, if you just give these people potassium, are they not going to have mood issues anymore? And the answer is, they could still have mood issues, even if they supplement Potassium, but it’s interesting and it’s something that often gets skipped. This is really low hanging fruit. Somebody could go to something very nuanced as this particular herb for this retrovirus or this bug, but the person’s just simply dehydrated and they’re not getting enough electrolytes, it could be something very, very simple like that.

Dr. Justin Marchegiani: 100% and low potassium is so common, just like low magnesium is common. I think you said what 98% are going to have some kind of an issue.

Evan Brand: Yeah, and I think this idea that yeah, I think this study I was referencing was probably just a survey where they looked at diet and figured out whether people were even getting the the the recommended daily amount, and 98% of people are not getting the recommended daily amount are already on the recommended daily intake. So I guarantee magnesium is in the same boat, probably 90 plus percent.

Dr. Justin Marchegiani: Yeah, 100%. I agree. And then also there are medications that are going to affect potassium, right. We know a lot of the blood pressure medications as well as things that like water pills or diuretics. So if you’re on a BP medication, right, there’s a good chance some of that’s going to be actually driving further potassium deficiency. So low potassium levels are super common because of that. Also, we’re going to have problems with potassium if we consume too much alcohol, right, alcohols gonna cause us to pee a lot more potassium out because things like diuretics are going to cause you to lose more minerals, right? diuretics basically activate a hormone that causes you to kind of continue to pee. And the more you pee with a diuretic in your system, whether it’s, you know, excess coffee, or even access alcohol, you’re going to pee out a lot of those minerals. So that’s kind of like vitally important, right?

Evan Brand: And even Yeah, and even tea, I mean, even tea could be to blame. I think herbal teas can be great, but there is somewhat of a diuretic effect of certainties as well. So if you’re just like sipping on tea all day and not drinking enough just straight water or our preference water with a pinch of salt or water with some electrolytes, actually to it, you know, this can happen easily. And this is not just a problem in athletes, people hear the word electrolyte and they think you only need that if you’re in the NFL No, you need electrolytes just to function.

Dr. Justin Marchegiani: Exactly, the problem with a lot of people with their potassium is, it’s hard to get too much if you’re taking it orally, right? Obviously, you go back to like the lethal injection people are actually you know, in the lethal injection in the prison system, people are actually being killed by potassium IV right or injection. Now, it’s hard to get too much potassium orally because some of the vomiting and from some of the vomiting and diarrhea side effects and the nausea side effects that you get from have actually having too low potassium. Well guess what, you actually have similar side effects when you go too high. So usually you get so nauseous, and you’ll either throw off or you’ll get diarrhea. So it’s very difficult. The only way to really do it orally is going to be with an oral supplementation. And you’d have to do a lot of it and all those symptoms would come into place. It’d be really high. The only way you You can get your potassium levels to the point where you’re going to be too high is going to be on an IV. And what they do actually on an IV to reverse potassium overdose is they do a bicarbonate infusion, bicarbonate actually neutralizes that high level of potassium. But some of the major causes are going to be diarrhea, right? So if you have a parasite infection or a gut infection that’s causing chronic loose stools, guess what? You may be having low potassium because of your gut. I have some patients that need five or six or seven grams a day of potassium supplementation, whether it’s because of a stress or a malabsorption issue, but all of their low potassium symptoms go away when they hit that level, meaning like the cramping, the twitching, the heart, the mood stuff all go away when they hit that higher level. So I mean, the goal is let’s fix the stress. So you’re not dumping the minerals as much let’s fix the gut. So we’re absorbing but, you know, I don’t typically don’t recommend doing more than one to two grams of potassium supplementally and we’ll do a good high quality keylight whether it’s a discoloration A or A potassium bicarb or we’ll do a potassium citrate like a new salt, which is a cheap source, and then we’ll try to plug in the recipe of the diet but if we have to go above, you know, we’ll do it incrementally and we’ll start looking for those low potassium symptoms to go away but alcohol is gonna be a big one, chronic kidney issues. uncontrolled Type One Diabetes will do it diarrhea, like we mentioned. So gut issues, diuretics is a big one. So if you’re on a diuretic on a blood pressure meds side, that could be a problem. sweating a lot. So if you’re sweating a lot, yeah, you’re gonna need a lot more minerals. Again how Gatorade was figured out I think it was the 1968 late 60s I want to say was the Orange Bowl one of these big bowl games the Florida Gators were actually playing halftime I think one of the exercise physiologist or PT people, trainers said hey, let’s get these electrolytes in and they had a kick butt second half and they just they killed it and won the game. And part of it was the electrolytes they put it and now we have all these things. Gatorade substitutes, but the real they were called Gator lights, right? Gator lights, not Gatorade. They tasted like absolute crap. So what you have now are a whole bunch of minerals with a whole bunch of sugar and dyes. Back then they just had the minerals and it tasted awful. But from a performance standpoint, they did really well because the other team didn’t have it. So they their muscles were functioning better. So sweating, not having enough full later B vitamins, having high amounts of aldosterone, whether it’s a tumor, or just our adrenals being overstimulated. Some antibiotics can actually have problems as well. And then vomiting vomiting too much can create low potassium too. And then obviously, just that junk food diet, we’ll talk about what it takes to have enough potassium in a minute.

Evan Brand: Yeah, and one thing too, that people miss out on a lot of these new companies, they’re doing a good job because they’re getting away from the corn syrup and the fake sugar and all that stuff, but you still do need based on some of the stuff we’ve looked at. I believe you need a little bit of glucose to help get potassium And your other minerals and electrolytes into the cell. So you’ll see if you look at they call it o RS oral rehydrating solution. This is like the military grade electrolytes. There has to be a little bit of sugar there has to be a little bit of a blood sugar spike, I believe it somehow opens the channel to let the electrolytes in. I’m not sure the exact you know, molecular level stuff that’s going on. But I’ve read into formulas that are just stevia or just monk fruit, some of these natural sweeteners that if they don’t affect blood sugar, you don’t actually get the benefit. So when you look at legit like military grade, electrolytes, they have a little bit of glucose spike associated with it.

Dr. Justin Marchegiani: Yeah, and the glucose is better, right? The problem is a lot of these places they have fructose, the fructose doesn’t target the muscles the same way as glucose does. So if you’re looking for an electrolyte formula, you you really want you can get the electrolytes by itself but then if you want if you’re doing a lot of sweating or a lot of glycogen depleting activity, whether it’s football or some kind of a sport that requires a lot of sprinting or running, then you’d want a formula that’s going to have more glucose in it for the sugar source, not fructose. fructose is a problem because it hits the liver more than the muscles. Glucose hits the muscles more than the liver. And like you mentioned, that helps open up that cell with the insulin and helps deplete the glycogen levels and helps that sodium potassium pump work better if you’re using a lot of glucose or if you’re sweating a lot, but if you’re not, and you’re just the average everyday person, probably getting the minerals in without the extra glucose is probably okay.

Evan Brand: Yeah, we talked about mold and detox and sauna and all of that, but I’m really shocked at how many people are doing sauna 234 or five times a week and they’re just drinking water. I’m like, Are you nuts? You gotta be doing electrolytes that is a critical component of detox in my opinion, is you have to make sure you’re replenishing and rehydrating because you’re losing a lot of minerals. You’re not just magically sweating out heavy metals and mold toxin, you’re sweating out minerals and electrolytes. You have to replenish those and you You were drinking a green juice earlier, I think you said your green juice had like 1200 milligrams per bottle or something crazy. 

Dr. Justin Marchegiani: Yeah, this is a great brand right here. It’s called evolution. They sell them in Austin and Selma, even in target now, which is kind of cool. Like, I like the fact that a lot of these healthier things are coming into kind of more mainstream box stores. But organic greens, I’ll typically drink the celery juice, but I’ve been doing the essential greens, they have the celery is the first ingredient so it’s still great. I love celery because of the minerals in there the electrolytes and then potassium is really high in celery, but it’s got cucumber, spinach, romaine kale, lime and parsley. And then they have a green devotion instead of lime. It’s got lemon, so they go back and forth, but there’s no actual fruit outside of the lemon or lime which is pretty low sugar. And this has got just alone It’s got I’m almost about 1200 milligrams of potassium. So I got about 25 to 30% all my potassium right here. So that’s pretty cool. So I just kill that after I have my really nice good breakfast with collagen and then I’m already a you know, a quarter of the Through my potassium needs for the day, which is great.

Evan Brand: Don’t you feel more like your thirst is quenched to like when I drink regular water compared to something like that. It’s just not as quenching to me as the good stuff, the green juices, they’re more thirst quenching. I’ll do like a little bit of electrolyte through a pinch in, like with some beet powder and stuff like that. And I feel great if I’m just doing filtered water and I’m not using aro I’m using like a carbon system even then though I water just doesn’t cut it for me. I like a little extra bang.

Dr. Justin Marchegiani: Well, I think a lot of people what they’re really craving is they’re craving some water, but they’re also craving minerals, right? And so because they’re craving minerals, if there’s no minerals in there, yeah, you’re going to feel like you’re missing out on something, right? So that’s definitely a big part of what’s happening is your body’s craving the minerals, and if they’re not there, that’s a problem. Also, I’m pretty sure Cushing’s is going to be another potassium issue, right? Cushing’s and potassium is going to be a big problem as well. So now what does that mean? So the kidneys excrete large amounts of potassium when you make a lot of cortisol. So what does that mean? So If you have Cushing’s that’s kind of more tumor induced where the cortisol is so high probably because of some kind of a tumor. But what if you’re in between? Right? What if your your adrenals are just overstimulated, you’re not on the adrenal, you’re not on the Cushing’s disease side but you’re just making a lot of cortisol because of chronic stress. So it’s possible your chronic adrenal stress could be causing you to dump a whole bunch of potassium out. So that’s where when you’re getting stress, under stress, physical chemical emotional, maybe that gluten is causing the stress, right? You’re gonna probably need more potassium, more minerals. potassium and magnesium are the most common ones. It’s so hard to get them most people get enough sodium and chloride because of just it’s in their natural junk food. I don’t get they don’t get the good quality from like a good high quality sea salt or Redmond Real Salt, but they’re getting some it’s really the magnesium and potassium I’m seeing as the big big missing pieces and today we’re really focusing on potassium.

Evan Brand: Yeah, makes sense. I mean, think about what happens when you’re dealing with somebody that’s really stressed right? They may have issues with constipation, they may have issues with Sleep, they may have issues with their blood pressure, they may have issues with anxiety as you hit on earlier, potentially Heart, heart pumps. So all of that, to me sounds like stress induced mineral depletion, which then causes other symptoms and you’re stressed about your blood pressure being elevated. So then that cortisol dump and adrenaline dumps more minerals, and then it become more mineral deficient. So you see how this thing can get out of control. And it sounds really cliche and corny to say, well, stress did it but it really does. And it’s not just the emotional, it’s the gut stress. It’s all of it that we always hit on.

Dr. Justin Marchegiani: 100%. Also people are talking about in the messaging. Well, what about if I’m in ketosis and I don’t have glucose to open the cell? Well, I mean, we’re just talking about with x with extra exercise, right extra exercise, extra sweating. If you’re doing a lot of glycogen depleting kind of movement or exercise, you’re probably going to want to do some type of a glucose kind of refeed the night before the movement. And a lot of athletes who do keto still have a punctuated kind of glide And reefy the night before just other tapping their muscles out, because your muscles can hold anywhere between 250 to three to 400 milligrams or grams of glucose or glycogen, right? glucose in the muscles is glycogen, it’s stored, right? That’s the storage form of glucose in the muscles. So a lot of people, they’ll be in ketosis most of the time, they’ll do a refeed the night before, that way they have access to that glucose The next day, and again, depending on how depleting or how long you’re exercising, you probably want a nice little bit of a glucose, electrolyte drink. And again, that’s not most of the time, that’s going to be just more timed up according to exercise and kind of what your metabolic needs are. But for most people, you know, a good natural Gatorade source, guess what coconut water, got a little bit of glucose, a little bit of sugar in there, and it has a lot of potassium, so that can kind of be mother’s nature’s natural kind of Gatorade. It just depends on what you’re doing. If your kids playing football and sweating a ton, they may need a little bit more than that. You’re going to have to just feel it out. See what works. Test it on your own when your practice To sing and playing and see how you feel with that you may not need pure coconut water, maybe just diluted half and a half with a really good clean mineral water. And then you have a little bit of glucose, a little bit of extra potassium plus the other minerals working for you.

Evan Brand: Yep, you want to hit a little bit of the diet piece. Yes, you and I were kind of looking at some of this before you pointed out. Interestingly, and we’ve probably talked about this in previous but if you look at 100 grams of food as a measurement, the potassium per 100 gram of avocado is higher significantly than bananas. If you look at a full avocado, versus a full cup of banana, which maybe is a full banana, you’ve got almost double in the avocado. So you know as a kid, I remember thinking potassium banana, and that’s just kind of this thing you grow up with. But in reality, there’s things that are much much higher like beet greens takes the cake with number one here. 1300 milligram per cup of potassium that is insanity. 

Dr. Justin Marchegiani:  Exactly. So most people don’t get it. So if you’re sitting Get in there. And you’re on keto, right? Well, what are the biggest easiest things you can do? Well, beet greens is number one. Okay? What’s number two salmon, high quality fish that’s per hundred grams. So what’s 100 grams? 100 grams is about 3.3 ounces ish. Let me just double check that hundred grams and ounces. I’m pretty sure that’s what it

Evan Brand:  sounds about, right? Because it says here, potassium per six ounce filet of salmon.

Dr. Justin Marchegiani: So 3.5. So what does that mean? So Alright, so if you’re keto, right, and you want to really be on top of this, or you’re keeping your carbs down, what does that mean? That means Okay, if I eat seven ounces of meat, seven ounces of fish, I’m at 1300 milligrams of potassium, boom, you’re right there. And then you throw in some beet greens with it right? That’s three ounces worth right hundred grams. You’re at another one gram almost. And then guess what? You cut up an avocado with that. Right big avocados. Another 500 I’m sorry, another per avocado. You’re about one gram per full avocado you’re set. Right?

Evan Brand: I want to look up cassava because I love cassava. And what if you like did some guacamole with like cassava chips? I wonder if we’re getting any?

Dr. Justin Marchegiani:  Oh yeah, so we could do like Yuka in potassium because Yuka in protect you guys same thing as cassava. Yeah. So one cup of cassava is 558 milligrams, boom. 

Evan Brand:  So because our chips and I mean now, some would argue, well, you know, the, the baking process and whatever of the chips, okay, whatever, but it’s still better than zero.

Dr. Justin Marchegiani:  Yeah, but a lot of times if you don’t bake it or cook it, you’re not going to be able to get the nutrients anyway. Like, if you look at broccoli, raw versus broccoli steamed, you’re going to see the nutritional value in the content goes up once you cook it, because then the fiber is broken down so you can actually access some of those nutrients.

Evan Brand:  Yep.

Dr. Justin Marchegiani:  So cooking a lot of times can make certain nutrients more bioavailable, too. It’s not Oh, cooking bad all the time. 

Evan Brand:  No, I’m just thinking. I’m just thinking of the one devil’s advocate out there saying oh well you’re eating. you’re advocating Eating, you know, chips fried and avocado oil. It’s like Yeah, I am. I think it’d be great. 

Dr. Justin Marchegiani:  I think it’s okay. I think it’s fine. I mean, don’t make it a staple. But I mean, I think it’s if you’re gonna have something like that it’s all about not going to the place in your head about like, Hey, what do you have to cut out versus Hey, what can I substitute? When you have a substitution mindset versus the cutting out mindset? One, you feel a lot more free and you feel like you’re not missing out on stuff because there’s always a good healthy stuff the tuition option that works. So let’s let’s kind of just create a simple day like what does a day of potassium look like? So off the bat, you know, on the vegetable side, one cup of you know, your typical vegetable greens will be anywhere between 500 milligrams to about 800 milligrams depending on the vegetables, right? Like one avocados gonna be about a gram, right? One cup of Swiss chard is gonna be about a gram. So you’re really at the top with those. One cup of spinach is about 840 milligrams, and then you have on the lower side, which would be like broccoli and brussel sprouts are closest 500 milligrams. So just to kind of give you a sample day here, let’s say we start out with a full avocado, boom, you got one gram of potassium so that now you’re like you’re like really on the way there. If you do a serving of fish like a good six ounce serving of fish, now what? Well now another gram is added, right? No problem. All right, and then now you’re at about now you’re at about two grams. And then if you throw in a green juice like this, you’re over three. And then if you have a serving of squash, or even white potato, or sweet potato, well now you’re at another 500 to 800 milligrams. Okay, now you’re at 35 to 3800 milligrams. And then you just need about four more servings of vegetables. And most people when they have veggies, they’re probably going to have two servings at a time, right? They’ll probably have close to a gram anyway. So you need about, I would say about four to six servings of a good quality green vegetable, you’re probably going to need one full avocado, and then one full serving of a good quality fish. And then you’ll get right about there and then you can always add in an extra avocado, you could always add in a little bit more fish, you could always add in a little bit more beet greens or green vegetables to get you the rest of the way there which is about 4500 to 4700. And then if you’re doing a lot more sweating, you could always throw in some coconut water. So I would say about six servings of green vegetables one full avocado, a good serving of fish and then you can always plug and play coconut water or banana according to what your metabolic needs are. What do you think?

Evan Brand: Yeah, and yeah, very good. And you didn’t mention any nuts which is another easy low hanging fruit so if you can get away with doing like pumpkin seeds, you can get a ton there if you do almonds or almond butter or you put a scoop of almond butter in a smoothie, you can get some there pistachios are super high and then I was looking on this other foods like-

Dr. Justin Marchegiani:  potatoes potatoes are huge so it means depending white potatoes if you’re trying to keep low carb or autoimmune find Nick’s that go to a squash or a potato but potatoes are very, very high in potassium. He will forget that.

Evan Brand:  Yep, yep. I was looking on this nutrient density chart. Whey Protein is number four 100 grams away, you’re getting over two grams 2200 milligram potassium 400 grams away. So if you can tolerate a good high quality Grass Fed Whey protein, that’d be easy. Think about if you made a smoothie with some greens, some whey protein in there, he threw some pumpkin seeds and a scoop on the butter, man, you’re set.

Dr. Justin Marchegiani:  How many milligrams in the way?

Evan Brand: 2200 for 100 grams of, you know substance 2200 potassium.

Dr. Justin Marchegiani: okay, I put 400 grams in the whey protein. Okay, so your typical servings probably like 25. So how many again, per 120 200? Okay, so if you’re doing maybe 25 or 30 grams of protein, which is what most people do in a scoop, I mean, you’re probably about what 500 milligrams.

Evan Brand: I’m going to look up I’m going to see what the serving size is because you and I use a couple professional grass fed powders. Let me see what the what it looks like. Yeah, so so one scoop Typically is 30 grams. So exactly, exactly, yeah, so you could almost call it you could almost call it one third then so you know 2200 divided by 600

Dr. Justin Marchegiani: ish 656 50 ish. Okay, that’s cool. Someone else also asked about the vertigo and dizziness Yeah, low potassium can cause that vertigo and dizziness kind of feeling. So we kind of gave the general recommendation of 45 to 4700 milligrams of what you need per day on the potassium side. Most people aren’t hitting it, you’re getting six to eight servings of green vegetables, a high quality serving a good fish and some potassium and maybe I’m sorry, potassium from a full avocado or a green drink or some extra say starch, squash or sweet potato or white potato, you’re gonna be there at about 45 to 4700 milligrams. Most people may need more if they’re sweating, or if they’re under a lot of adrenal stress. So you may want to think about supplementing, if you’re still doing a great job on your food and you’re not there. You may want to fill in the gap, or you may want to just try it out. Add in a couple more of these nutrient dense foods that Evan and I just hit, and see if that fixes the issue. So, a lot of times people have these low potassium symptoms and they see it go away the BR and all I see is you’re going to see a lot of heart stuff, and a lot of muscle cramping stuff, those are going to be big things. So if you see the heart start to get better or the cramping get better. That’s an easy sign that you’re on the right track.

Evan Brand: What do you think, Kevin? Well, I think this is fun, and it’s something that can’t be ignored. So please address this, work on this, tweak it and see how you feel, I definitely feel better. I feel in a better mood. I feel more energetic when I’m staying regular with getting enough electrolytes as a whole. So I think he could be a game changer. And we can run some of these analyses on your body. You and I kind of talked before we hit record about how the blood really doesn’t change much. So looking at serum potassium may not be the best. So there are some other panels that we can look at, but as a whole, when we’re looking at organic acids testing and stool testing and we’re looking at gut infections a lot of times We can infer just based on observation symptoms, and what else is going on that you probably got a new issue. So the good news is, you can fix this, it’s relatively cheap to free to fix it outside of just tweaking the diet a bit at the grocery or farmers markets, but you can make it happen and make a big difference.

Dr. Justin Marchegiani: Exactly. Now, someone else chimed in about the evolution drinks and the plastic. I’m not too worried about the plastic with these, these are all cold pressed. Alright, so they’re cold pressed so that the juice that’s put in here is cold and these are refrigerated right away. So you’re gonna have leaching of plastics more when it hits UV light and or higher heat. So not now not that concerned about plastic plus, these things have a short shelf life. So it’s not like the the juice is sitting in there for like a year. It’s just sitting in there a very short amount of time it’s not being exposed to UV light or high temperatures going to being refrigerated, right. So you got to keep all that in mind. So I think if someone’s worried about the plastic, I think the extra extra nutrients that’s in there, it overlays any risk from the planet. Plus you’re not getting the heat you’re not getting warm substances and you’re not getting the UV light so I think the plastic is isn’t as big of a deal versus like a dishonor water that sits in there for a year or two and who knows if it’s going to be exposed to light when it sits out back the the the convenience store or the supermarket thought- 

Evan Brand: That’s what I’m thinking when you go to the gas station. You see the guy taking a smoke break you got the palette of dishonor water sitting there getting blasted by the sun on 100 degree day and then he goes and puts the water in the shelf at the gas station. So yeah, I think you got to choose your battles, right so I mean, the other argument would be well, if you were too busy this morning, you’re working with the kids you got to jump on here with me you got to go into clinic after this. You might not have got that green juice and you would have had zero minerals and zero potassium and zero greens because you didn’t know plastic because you would have tried to go for a blender instead. So you know.

Dr. Justin Marchegiani:  Exactly plus the higher quality grocery stores like Whole Foods for instance, they got a big dock the truck just goes right up to its full containment and some of the stores refrigerating it. If you’re going to a gas station and you’re kind of limited, some gas stations have the Pellegrino so you could always go by glass at the gas station. That’s probably a safer way but I’m not necessarily worried about the plastic with that but in general, a lot of sulfur in here anyway which will help you to toxify any lingering estrogen. So if you have the option I think it’s worth it.

Evan Brand: All right, well, let’s wrap this thing up. I think we covered a lot if you want to reach out clinically, Dr. Jay and I we work around the world with people we’re very grateful we’re very blessed for the opportunity to help you guys so thank you so much for not only commenting on these live videos, but of course just being there clinically because you help us learn we learned so much from working with people one on one way more than you learn in any book or any study is seeing how do people feel Hey, when you recommended this or that my energy went up 20% we love stuff like that it’s addicting for us. So we’re very very grateful and if you do want to reach out clinically, please check out Dr. Justin at Justin Health. and me, Evan brand at and we’ll be back next week to talk more. 

Dr. Justin Marchegiani: Excellent chatting with you guys. And if you enjoyed the content put your comments down below really want to know what you guys think. And if you have any future podcast recommendation topics we’d love to see it as well and sharing is caring. Get this to your families and friends and people that can use this information to help take control of their health. Alright guys, enjoy the fabulous holiday weekend. Take care y’all. See you later. Bye

Evan Brand: Bye.


Audio Podcast:

How To Find A Good Functional Medicine Practitioner – Podcast #52

Dr. Justin Marchegiani and Evan Brand in this podcast talk about how to find the ideal healthcare provider, holistic functional medicine doctor or functional nutritionist, as well as the qualities, traits, and skill sets that a practitioner needs in order to help you. 
functional medicine practitioner

This interview stressed the importance of having a systematic approach that lays down diet and lifestyle as the foundations then find out where stress is coming from and do some labs to  figure out what those underlying chemical stressors are. The next step will be focusing on the hormones then moving on to the gut killing and infections.

In this episode, topics include:

4:33   About nutrition and diet

9:25   Seeing the picture as a whole and lifestyle

23:59   Free information

26:10   Looking and prioritizing labs

28:05   Supplement recommendations








Podcast: Play in New Window|Download


Dr. Justin Marchegiani:  Hey there, it’s Dr. Justin Marchegiani.  Welcome to Beyond Wellness Radio.  Feel free and head over to where you can access our full podcast transcriptions.  While you’re there, you can also sign up for our Thyroid and Female Hormone video series.  This series goes into the root causes of why your hormones are out of balance.  While you’re there, you can also schedule a functional medicine consult with Dr. Justin, myself, where we’ll dig deeper into the root cause of your health challenges.  Feel free and think of sharing this podcast with at least one person.  This podcast grows by people sharing it.  Sharing is caring.  If you think of one person that can benefit from this information, please feel free and share it.  If you’re enjoying the podcast, click below the video or podcast where you’ll see the iTunes review button and leave us a review on iTunes.  You can also sign up for the newsletter at where you can get updates before anyone else.  Thank you so much and enjoy the show.

Hey, it’s Dr. Justin Marchegiani with Beyond Wellness Radio, again my guest co-host, Evan Brand, will be with us today and we’re gonna be talking about how to find the ideal healthcare provider.  How to find your holistic functional medicine doctor or functional nutritionist, what qualities, what traits, what skill sets do you need in your practitioner to find someone that can help you.  So first off, Evan, what’s going on, man?  How we doin’?

Evan Brand:  Hey, what’s up?  I’m doin’ great.  I just avoided a tornado.  I thought I was gonna get blown away and not be able to make this call, but I’m super thrilled to be here and still be alive luckily.

Dr. Justin Marchegiani:  That’s good, awesome, and if we get cut off during the show, we will know why.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So what did you have for breakfast this morning?

Evan Brand:  I just had a shake today.  So I did some organic almond milk, a handful of blueberries from the local farmer at the farmer’s market.  I did 2 scoops of grass-fed whey so probably about 30-35 grams of protein there, and then 1 fat spoonful of coconut oil.  I feel like I said I did that last time but that’s kinda my go-to shake.

Dr. Justin Marchegiani:  That’s good.  Awesome.  And for all the listeners I am upgrading the command center’s bandwidth so we’re gonna be going from 20 megabytes per second to 200 megabytes so the quality will get better.  We apologize for last show having a couple of crackles in there but that’s gonna get better, so just hang in there.  We’ll continue to deliver the high quality.  So for me today, I did beef protein, grass or grass-fed beef protein with just water.  I did a whole scoop of greens, organic green powder in there, and some coffee, MCT and butter.  So I had about 40 grams of protein, got about a scoop of collagen in there, about 4 servings of vegetables and the organic green powder and then some good fats and proteins combined, so I’m–I’m ready to go.

Evan Brand:  Yeah, sounds like a good way to start the day and you’ll be hungry for a real solid food lunch.  That’s why I like doing shakes because when you actually eat a real steak again, it’s amazing.

Dr. Justin Marchegiani:  Yeah, and it’s just nice in the morning to just get those aminos in your body fast.  I’ll do like half my breakfasts will be shake-based just because it’s easy, it’s nutrient-dense, I’m getting a whole bunch of greens in there, too, and I can just make sure it’s highly absorbed really.

Evan Brand:   Yup. Yup, that’s nice.

Dr. Justin Marchegiani:  Cool, man.  So today we talked about kinda in our pre-interview that we wanna to kinda lay out for all of our listeners what kind of qualities that, you know, you should be looking for in your practitioners and you know, obviously a little plug for us, I think we both exhibit a lot of those qualities so if anyone’s needing a healthcare functional medicine doctor or a functional medicine nutritionist in yourself to feel free and check out or if you wanna get more information.  But outside of that, because I know I’m booked out almost 2 months in my clinic.  I know you’re booked out a bit in your clinic, so we’re really busy so we’re not gonna be able to help everyone.  So we wanna make sure anyone that needs help and can’t get to us, they at least will be able to interview their provider and look for the skills that are needed to be successful.

Evan Brand:  Right.  Yup, I agree.  Where do you think we should start?

Dr. Justin Marchegiani:  I think the nutrition part.

Evan Brand:   Yeah.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Well, so for me, I’ve had people that have gone to holistic nutritionist because there’s so many different schools of thought out there now and there’s so many different nutrition certifications that nearly everyone could be considered a nutrition expert and unfortunately, some of those people are training clients to become complete vegans and raw food vegans–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  And things like that and I’m sure you have some stories as well and I’ve definitely had to help people recover.  I mean their hormones have been destroyed.  They’ve become very fragile, low energy after about 6 months.  They feel good at first and they just get sicker and sicker.  So that’s kind have been my experience so it’s not to say that our way is the only way, but that you should be eating some animal–you gotta be eating animal products preferably organic, pasture-raised animals whenever possible, because those amino acids that you’re gonna be hopefully digesting and breaking down from those animals will–are going to be converting into neurotrasmitters and making you feel good so it–it’s no surprise that, you know, veganism routes of–of nutrition and depression go hand in hand.

Dr. Justin Marchegiani:  I totally agree and I don’t like the term diet when I’m talking to my patients.  I like the term template and I do believe a Paleo template is best and I believe a Paleo template really is non-dogmatic because within that template you can be high carb, you can be low carb, you can utilize more of a specific carbohydrate diet approach for patients that have more gut or diarrhea or constipation issues.  You can use gap-side approach or you can use a low histamine approach, a low FODMAP approach.  So there’s a lot of flexibility that you have within that Paleo template.  You can use an autoimmune diet approach.  Again I work with so many vegans and vegetarians and we may just be choosing like, “Hey, we’re gonna get some egg yolks in your diet this week, and then everything will be vegan minus the grains and the legumes.”  So we can have someone who’s eating 95% vegan but getting some animal protein and animal product in there and they–they’re still doing 95% of what they were doing as a vegan but they’re not getting all the other crapohydrate and inflammatory foods and we may give them some extra free-form amino acid and some extra protein powder to maximize the aminos that they may not be getting in let’s say a vegetarian or vegan diet.

Evan Brand:  Right, yeah.  And then if–if it’s not quality soy that we can start pulling that off and weaning people on to real products and opposed to tofurkey and things like that.

Dr. Justin Marchegiani:  Yeah, they aren’t real foods, and I think also you need to have like a non-dogmatic approach or a non-dogmatic filter in which why you choose the foods you choose, so if I’m choosing a Paleo template, why are we choosing those foods?  My filter is, well, they’re anti-inflammatory, they’re nutrient-dense and they’re low in toxins.  It’s that simple.  You go through a vegetarian, you’ll pick out all the phytates and oxalates and the lectins, wheat germ agglutinins, and potential food allergens.  I mean, I just had a vegan last week, great vegan, but she has osteoporosis in early 30s and her teeth are already getting brittle and having extra cavities because of a lack of mineralization.  So why is that?  Because there’s all kinds of other irritants and toxins that are in our food that are affecting absorption.

Evan Brand:  That’s incredible, yeah.  And I’ve had similar stories and I’ve gone, you know, the kind of on the, I guess on the application side, I’ve also added in like some sublingual B12 and things like that just to help them because they’re–they’re so exhausted.

Dr. Justin Marchegiani:  Yup.  Yeah, exactly.  And I find that a lot of like, let’s say, I’m getting someone to transition over from a vegan-vegetarian diet from–on a functional medicine perspective because they’re low on these aminos, they’re–let’s say, there’s fat-soluble nutrients, right?  A, D, E, and K you can’t get in plant foods and again, beta-carotene ain’t vitamin A, so a lot of people can’t make that transition of beta-carotene to vitamin A especially if you’re hypothyroid, especially take a look at your palms, if you see a slight orange tinge to your palms, you’re not converting that beta-carotene to vitamin A.  So on that note, regarding the vegan solution there–where was I going with that?  Oh yeah, there’s a lot of people that are vegan-vegetarian and they’ll start eating a little bit of meat, and they’ll feel like crap.  They’ll be like, “Look, it’s not good.”  And I’m just like, “No.”  Your digestive system is shutdown.  You are not used to making stomach acid.  You don’t have the physiological equipment turned on to even process that kind of protein and fat, so we gotta add in the enzymes and hydrochloric acid and that makes a massive difference when we’re switching someone over onto a diet.  The enzymes and the acids may be a game changer.

Evan Brand:  Yup, so I think you kind of already alluded to what I was gonna bring up in terms of another trait that you want from your practitioner and that’s someone who sees the picture as a whole.  Now, you know, specialization is good in certain aspects but if you have that, if you’re using a magnifying glass or even a microscope in some cases to zoom in on a patient’s health issues, you’re going to miss the point.  You’re gonna miss what you just mentioned.  You’re gonna miss the fact that they may be low on stomach acid, so you don’t–you’re not able to start north to south if you didn’t see that process.  So do you wanna kinda hit on that string a little bit?

Dr. Justin Marchegiani:  Yeah, so once we have the diet in place, we kinda wanna figure out where within that Paleo template, if you will, they’re gonna do best.  So I had 2 vegans this week, “Hey, we’re just trying to get a little bit of egg yolk in and we’re gonna get some pea protein and some additional free-form amino acids.”  So once we have that, because we have such a non-dogmatic approach, we’re gonna be a ble to work with these people.  Now the next thing to layer on top of that is we gotta look at lifestyle, right?  Like forget labs, that’s–that’s gonan be the next thing but where’s the lifestyle?  Like are you chewing your food up?  Are you chewing your food properly?  Are you drinking enough water?  Are you eating within that first 30-45 minutes of getting up if you’re adrenally fatigued?  Are you going 4 or 5 hours without eating?  Are you skipping breakfast?  Are you trying to do intermittent fasting?  Are you doing too much CrossFit and that’s screwing up your adrenals?  Are you going to bed too late, right?  Are you getting cross-contaminated with rice and corn thinking that you’re still gluten-free, right?  These are all other things that need to be factored in to the diet and lifestyle thing and you gotta have a really good nutritional and lifestyle filters and not to bash on the medical doctors, but I find the MDs tend to be ones that miss this because they didn’t have a strong nutritional background in medical school because they don’t have nutrition at medical school for the most part.  I’ve talked to Stanford MDs, they had like a one hour, one credit hour nutritional course that was online, and basically if you just pass the test, you passed the course, and it’s all having to do with like nutritional disease like, you know, beriberi–what’s that?  Oh, that’s a B1 deficiency.  Scurvy–what’s that?  Vitamin C.  So it’s more from a disease perspective, not a functional optimal health perspective.

Evan Brand:  I’m not surprised to hear that, yeah, and Ricketts I’m sure was in there, too.

Dr. Justin Marchegiani:  Oh yeah.

Evan Brand:   Which is–

Dr. Justin Marchegiani:  Vitamin D, yeah.

Evan Brand:  You’re not gonna experience them most of the time.

Dr. Justin Marchegiani:  Right.  So we gotta have the diet perspective and the lifestyle perspective.  So the first thing before any supplements, any labs, any fancy schmancy protocols, is you gotta have the diet and the lifestyle, and you gotta say, “How are we gonna customize this diet for me and where I’m at?”  I think that’s super important and we gotta have a general template but I mean, patients that come in, we’ll, you know, we’ll do an SCD approach, maybe with an autoimmune filter on top of it that have a lot of gut issues.  Patients that are more healthy, we may just use a general Paleo template and we may up the carbs if they’re doing a lot more CrossFit and such.  So we–we figure out where they fall on that spectrum and customize.  So that’s kind of the–the foundational layer, the diet and lifestyle layer that any functional nutritionist or functional medicine doctor needs to have.  And that should be a key thing that you interview them on.

Evan Brand:  I like that and just to kinda harp on that a little bit more.  You’ll see the programs out there that are very cookie-cutter and there’s a lot of–

Dr. Justin Marchegiani:  Yes.

Evan Brand:  A lot of marketing involved in these programs within–within the health space and–and people think that this is a solution because they saw the before and after pictures of someone and hopefully, you know, today we’ve reframed that a little bit and make the distinction that there’s so many unique things going on with your environment, how many toxins you’re exposed to, all of these things that it’s–it’s not in your health decision to go for a cookie-cutter program like that.  So there always needs to be, you know, your specific life factored in to your protocols.

Dr. Justin Marchegiani:  Yeah, exactly.  So what step next should we talk about regarding a practitioner?

Evan Brand:  Well, I think just someone who is actually going to speak to you on the same level.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And you know, that’s what I like about you as well is you have a lot more training and clinic experience and hours than I do but yet we’re still able to connect on the same level.

Dr. Justin Marchegiani:  Right.

Evan Brand:  And that’s a huge off-putting thing when a–a patient’s going to a practitioner and they’re getting maybe not belittled but they’re feeling like they’re, you know, a couple inches tall and that they’re not smart and that they need to just bow down and listen as opposed to a good practitioner approach would be to sit down with this person and they should give you a warm good gut feeling and honestly–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I think you’ll know as soon as the, you know, as soon as the doc comes in or as soon as you just on the phone if you’re doing a, you know, an online consult with one of us, that you’ll know immediately if you’re gonna click or not and based on how you’re treated ultimately I think that’s–it’s a huge thing, man.  Personality is a big deal.

Dr. Justin Marchegiani:  Yeah, I agree.  I always say is you need a plan, right?  When I talk to my patients the big thing that I’m addressing is “When did everything, you know, go south for you?  When did all your symptoms start occurring?  When did that happen?  What was going in your life?  What was–what was the stressors like?”  I wanna know how the broke down because I wanna make sure that we’re incorporating diet and lifestyle strategies that make sure those stressors are neutralized if you will.  But even if they are neutralized, right?  Let’s say the original stress is hitting a nail while you’re driving your car and you get a flat tire.  But if I just drive around in that flat tire for a couple of months, there’s gonna be a lot of collateral damage that happens to my car outside of the original injury.  So let’s say the original injury is stress from work, poor eating, sleep, well, now we changed all that but basically you’ve done the equivalent of driving around on a car with a flat tire for 6 months.  So now you have axle issues, front and alignment issues, everything’s screwed up.  So now we actually have to go in and fix other parts of the car that weren’t even originally damaged in the beginning.  So I kinda see that as how functional medicine works.  The diet and lifestyle strategies fix kind of the environment that set the person up to fail but with functional medicine we’re now digging to the hormonal system damage, right?  Adrenals, thyroid, female hormones or ATM–adrenals, thyroid, and male hormones if it’s a male.  We’re digging into the gut issues, right?  The inflammation, the infections, and the malabsorption.  And then we’re digging into the–the detoxification backup, right?  What’s happening with detox?  So body system one hormones, body system two gut, body system three detoxification.  And I find when the body’s chronically stressed, almost all of my patients who have been sick for at least longer than a year, there’s some kind of infection because their gut has been worn down because of stress, and that infection has come in and is basically preventing them from healing.

Evan Brand:  Yeah, man, you know something that was brilliant you just alluded to without saying it directly is that the healing process is gonna take time and I think that’s another distinction of how to judge your practitioner.  You know, if you go in the conventional model, you go in and, you know, like I–I told you for example, we were thinking that my wife may have had Lyme.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So we go in and you get the quick fix recommendation, you get the pill for the antibiotics and you run out and that’s it and you won’t see them again until 3-5 years later down the road when something happens and you go back in, and so what I’m getting at here is that you should get a realistic approach to your health journey from your practitioner.  If you go and you meet once and they’re telling you all you gotta do is just buy this, this, and this and this magic pill, and then see you later, then you’re not gonna get better that way.

Dr. Justin Marchegiani:  No.

Evan Brand:   You need to find someone that’s–that’s down to join you on this journey and you guys are gonna do this thing together for 6 months and even longer.

Dr. Justin Marchegiani:  Exactly, like most people for instance, if they ever had to go to court, they get a lawyer.  Most people that, you know, are doing a lot, let’s say in business, they get an accountant or someone to help file their taxes, right?  People–higher people that have done something a lot of times, so they can have the ability to know it’s done right and the efficiency.  So it’s the same thing.  The most important thing we have is our health because our health is which–is the vehicle in which we experience everything, right?  Fun, life, our family, friends, our work, so that vehicle is a clunker if you will.  Everything else is gonna be bad.  So we wanna have an expert, like you’ve dealt–you’ve dealt with hundreds if not thousands of patients.  I dealt with thousands of patients a year.  You want that experience because we’re able to connect the dots and see, “Okay, you’re here.  Alright, here’s the next step.  Here’s the next–”  We can put the dots together where if you just have one person who is on there and equals one journey, everything’s new, everything’s foreign, everything’s different, and it’s hard to have confidence to know one, what to do, but also the order in which to do it.

Evan Brand:  Right.  So–so what would be the wrong order?  I guess, maybe we should–we’ve talked some of the rights, so let’s talk about the wrongs of how someone can really derail themselves if they’re trying to do this on their own, like say they just go jump on an adrenal support or an adrenal glandular because they’ve heard that that’s good for them.

Dr. Justin Marchegiani:  Well, the big thing I see number one is people find out they have an infection, they freak out and treat the infection and they get worse.  They haven’t made any of their changes.  So the big thing is jumping towards treating an infection when you don’t have any other foundation before it.  Number two is their fatigued, they just take a whole bunch of adrenal support which just like throwing gasoline on the fire if you don’t make any other changes.  So there needs to be a systematic approach in my system which is similar to your system.  It’s diet and lifestyle as the foundation, right?  We do an audit of where the physical, chemical, and emotional stress is coming from and we collect some data.  We do some labs to figure out what those underlying chemical stressors are, because a lot of time we may have no idea what they are, right?  If you’re fatigued or brain fog or have anxiety because you have a parasite infection, well, how the heck are you gonna know you have a parasite infection?  You may just think your anxiety is caused by Xanax deficiency or Wellbutrin deficiency.  You may not know that there’s a chemical stressor there.  So we gotta get information to dig in deeper.  So once we dig in the information we gotta ensure that the diet’s good, the lifestyle’s good, the sleep’s good, because we wanna make sure those foundational things are there.  Also on top of that, are you breaking down your food?  Are you having a bowel movement once a day?  How does your food look?  Are you breaking it down?  Do you need enzymes and acids to help break down your food?  Because if you can’t break down your food, even if you’re eating a great diet like an autoimmune diet but you can’t break it down, forget it.  And then once we’ve done that, then we’re moving into the phase 1 where we’re really focusing on the hormones, adrenals, thyroid, and/or female or male hormones, and we–we’d like to do it in a sequence.  Adrenal hormones should always be addressed first, followed by male or female hormones second, and then thyroid typically last.  Typically in that order.  It may reverse based on certain situations but that’s a good general order.  Typically thyroid’s either second of third depending on what’s going, and we hit it in that order.  And once we’ve kinda stabilized the hormonal system, then we go to the gut killing.  Then we go to the infections because dealing with an infection can be stressful on the body.  Your body has to deal with the biotoxins and the lithocholic acid and the endotoxins and the mycotoxins, basically all of the dead soldiers if you will from the infection, and we have to process those–those skeletons in you will.

Evan Brand:  Right and yeah.  I–I wanna get better at analogies because I love yours so much.  But–

Dr. Justin Marchegiani:  It’s taken me years to get these things up because doctors create this language that’s like meant to make patients feel disempowered, and I wanna just take that language and say, “Screw it.”  We’re gonna use words and analogies and stories that actually connect with what’s happening because if you–if you understand a concept you never have to memorize it, right?  If the concept–if you understand the concept, it’s there.  You can never forget it, like concept I just said with the, you know, the–the so-called dead soldiers and the debris and like you don’t have to memorize that, you got the concept.  I don’t have to talk about Herxheimer’s reaction and all these things, that’s what it is.  But what the heck’s a Herxheimer?  If I give you the concept and the analogy, you got it.  You never have to memorize it, it’s there.

Evan Brand:   Totally, yeah.  In analogy, I was picturing when you were talking about that kind of why you need to get these support systems in place first is, I mean, that’s basically a flood is coming and all you’re doing is putting up a few sandbags, that’s all you have.

Dr. Justin Marchegiani:  Right.

Evan Brand:  You don’t have a good foundation–

Dr. Justin Marchegiani:  Right.

Evan Brand:  You’re gonna get wiped out and the flood is–is gonna take over.  So–

Dr. Justin Marchegiani:  Exactly.  So and I think that would be another thing is, your doctor needs to tell you what’s going on, where are you now, what’s your vision next month, what’s your vision 3-6 months from now, what’s the plan?  And like with my patients, I graduate them from phase 1 to phase 2 because I need compliance from my patients.  I need to make sure they’re doing what–they’re doing their part, right?  Doctor is latin for teacher.  So I’m doing a lot of teaching.  I’m also doing a lot of coaching and motivation because I need to make sure they’re doing what they’re doing.  I need to hold them accountable.  Sometimes patients need a pat in the back when they’re doing good and sometimes a–a kick in the butt when they’re–when they’re doing bad.

Evan Brand:  Yup.  Yeah, I like that.  Yeah, docēre to teach, yeah, and–and that is part of the process and you’re doing it together.  You didn’t say reprimand or you didn’t say gawk at or–or talk down.  You’re teaching.  It’s a–it’s a–it should be a fun, enjoyable, you know, process for people and so if you’re miserable with your practitioner, maybe this is another good key here, is don’t be afraid to fire the practitioner.

Dr. Justin Marchegiani:  Yeah, yup.  Ab–absolutely and sometimes you know, the practitioner–I’ve had to fire patients.  Because, you know, I put my reputation out there with every patient I work with and some patients, every now and then you get really difficult patients and there’s a lack of compliance and it’s really hard because you wanna be able to help someone but you need a certain level, a baseline of compliance and if that compliance isn’t there, it’s hard.

Evan Brand:   Yup.  So I’m trying to think if I had–I had one more in my brain and I lost it, so I didn’t know if you had any other good qualities for a practitioner.

Dr. Justin Marchegiani:  I think, you know, just kinda tooting our horns is free information.  I mean, you have 300 or hundreds of different podcasts.  I have 160 podcasts and over 200 YouTube videos and almost 100 blog articles, lots of free information that shows people what our brand is about, what our system is about because you need–there’s too much stuff out there to go over in a consult, so you need lots of stuff that can be gone over in a podcast or a YouTube video or, you know, on the weekend by checking out a free blog or something.  So lots of good information to support everything in the consult, I think, is important.  It’s a–it’s a value-added that I make sure all my patients have access to and I know you do the same as well.

Evan Brand:  Yeah, right.  It’s–it’s not like we just popped on and “Here we are, we’re gonna help you.”  I mean, there’s thousands– probably thousands of hours that you can spend reviewing all of the trench work, I guess–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I would call it that you and I have both posted for people.  So all of that stuff’s there if you’re not ready to actually get committed.  This will be kind of the stuff to maybe inspire you to think, “Huh, maybe this isn’t normal for me and feel exhausted but when I try to lay down on the pillow at night, I’m wide awake, and this video here explains why.  Huh, maybe it is time for me to get tested.”  So, you know, that’s kind of a good–just a good way to get familiar with the concepts if you’re just new to this whole space and you’ve been led down the conventional route and it has failed you or made you sicker than, you know, always have hope.  I think that’s maybe my last good quality is you wanna find a practitioner that is going to encourage you and that has hope for you because if you just feel like you’re number 62375, then that’s all you are and that’s how you’re gonna feel, and you’re not going to leave empowered from your consultation.

Dr. Justin Marchegiani:  Yes, I agree.  I think also when the doctor is sitting there and talking with you about the labs they’re recommending, you always wanna ask yourself, “How is this addressing the root cause?  How is this getting to the root cause?”  That’s always a question that needs to be in the back of the patient’s mind and I always stress it with the patient pro-actively, but the patient needs to be asking the doctor, “How is this getting to the root cause?”  And also looking and prioritizing what labs.  So when I sit down with my patients and recommend labs, they’re always on a priority scale.  We’ll recommend between 1 in 5 labs or 1 in 4 labs with each patient depending on how sick they are and how fast they wanna get better, and we prioritize it from 1, 2, 3, 4, and 5.  And I always prioritize them and there’s some labs out there depending on, you know, how much extra income a patient wants to put on labs, I’m not a huge fan of food allergy testing.  I’m not because anyone with a leaky gut, anything they consistently eat, they’re gonna develop a food allergenic response to it.  So I’m not a big fan with food allergy testing, yet sometimes I will use it for patients that are uncompliant.  I’ll use it for autistic children who are eating terrible diets and their parents don’t wanna cut out their food.  And I’ll also use it for patients that are just allergic to everything across the board and maybe we can gleam a little bit of extra info but for the most part, there’s always a relative rotation element to the diet where we’re getting variety in it and we’re rotating what we love so we’re not developing food intolerances based on that food slipping through the tight junctions of that leaky gut because our gut’s inflamed.  So that’s–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  One thing that’s really important.  You wanna comment on that, Evan?

Evan Brand:  Well, no, I was just gonna say that I’ve–I’ve had great experience rotating my diet as well–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Because I’ve loved things like coconut so much that I’ve overdone it.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Things like leafy greens, I’ve loved them so much that I do have to cycle on and off of these different nutrients so that’s something to keep in mind.

Dr. Justin Marchegiani:  Probably eggs and bacon, too, right?

Evan Brand:  Oh, totally eggs, yeah, and bacon.

Dr. Justin Marchegiani:  I mean, Paul Chek, he said something early on in my career that resonated with me.  He said, “If you love it, rotate it.  If you love it, rotate it.”  So if you really love what you’re eating, get a–an element of rotation there.  And again, how fastidious do you have to be?  Again, the more sick you are, the more fastidious you have to be.  Okay?

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And the next thing is supplement recommendations.  So supplements are powerful tools.  So number one, you wanna make sure your doctor is recommending the highest quality supplements.  Not a big fan of MLM products, not a big fan of that stuff.  There are some decent things out there but I’m a fan of dealing with the highest quality supplement companies out there.  Tier 1 companies.  Companies that are independently tested, that use the highest raw materials, and you know, will probably cost more than your products at Whole Foods in general or at Costco.  So a good product will cost you a little bit of money, but again I always tell patients the most expensive supplement is the one that doesn’t work or the one that contains fillers or additives or a whole bunch of junk in it.

Evan Brand:  Totally, yeah, and I–I think a good rule of thumb is if it’s a product that’s available on a shelf or this–not always the case, but if it’s on Amazon and it’s not exclusively sold to practitioners then there may be a chance to raise some eyebrows and I’ve kinda switched away from some of the companies I used to use before becoming–becoming a practitioner and I’ve kinda strayed away from those and really upgraded the quality and I’ve noticed the difference in how it works and when you look at some of the articles on ingredient quality, something could say rhodiola but if it’s not extracted to, you know, the 3% rosavins that you actually need–

Dr. Justin Marchegiani:  Right.

Evan Brand:  Or it’s extracted only 1% or you know, et cetera, then, yeah, it’s expensive.

Dr. Justin Marchegiani:  It is.  It is.  And also I’m very leery of patients buying their supplements on Amazon or eBay.  I have multiple supplement reps from the companies that I work with directly so I purchase directly from the manufacturer so there’s no middlemen, and I have seen these major supplement companies that do their quality assurance, they will actually buy their products on Amazon from some of these third-party distributors and they will buy the product and they will actually send it back to the lab and test it, and they’re finding literally like rice flour.  Like just innocuous supplements, innocuous compounds in the supplements.  And if I get someone who’s taking rice flour and then they’re gluten-sensitive and inflamed, they aren’t gonna get better.  Or if they’re getting a product, you know, that’s counterfeit, they’re just not gonna get better and it’s–it’s really difficult, you know, to help a patient when, you know, they’re trying to say 10% on a product but then they’re getting something that’s totally crap, they end losing 100% in order to save that 10% so it’s gets difficult especially when you wanna make sure you’re delivering the highest quality that can happen and it does happen and the New York Attorney General did a whole raid on GNC and all these different stores and found that majority of their products didn’t even contain what was on the label.

Evan Brand:  Yeah, Walgreen’s I believe.  CVS, too.  I don’t wanna–

Dr. Justin Marchegiani:  GNC.

Evan Brand:  Throw everybody under the bus without knowing.

Dr. Justin Marchegiani:  Yeah.  And not to mention like they found like for instance, I think it was last year, they found 10 mcg of lead in the female multivitamin at the vitamin shop.  So you get–you gotta–you gotta be careful, so I know the people that I work with, the people that you work with, they’re doing third-party independent-tested lab assessments and they’re also buying the highest quality raw material, right?  If you see fish oil, let’s say, Kirkland’s Costco fish oil like 300 caps for $10 and then you see like a higher quality fish oil for $30, there’s a reason why.  And part of the reason why is that fish oil, most of the cost actually goes into the filtration process not the fish oil.  So when you buy a crappy fish oil for cheap, you’re getting what you pay for.

Evan Brand:  Yeah, so here’s the–here’s the official story, I wanted to make sure we were accurate here.  So it was New York State Attor–State Attorney General and he instructed Target, GNC, Walgreen’s and Walmart to immediately cease selling a number of scam herbal supplements, they–4 out–4 out of 5 products did not even contain the herbs and their ingredients listed that contain like you said powdered rice, house plants, and asparagus.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Fraudulent projects–products included Echinacea, ginseng, St. John’s Wort, garlic, gingko biloba, and saw palmetto.

Dr. Justin Marchegiani:  God, that’s terrible.

Evan Brand:  And I use those–I use those specific ingredients and I’m sure you do, too.  So if we were just sending people, “Yeah, just go down to Target and go buy it.”  I mean, that would be not–that’s not a good practitioner quality, there.

Dr. Justin Marchegiani:  No, no, and you really do get what you pay for.  And that’s why I’m working on creating a private label line so I have even more–my own quality, my own custom label line, so I can ensure a higher quality than before, because I–I mean for me, it’s everything.  I want to make sure my patients get the best results.  So if they’re not getting enough of this B vitamin, this B6 or this herb to wipe out an infection, we may not get them better as fast, and I–I need to be able to be confident that what they’re getting is exactly on the label.  So like for instance, with one of the probiotic companies that I use, they put on there for their CFUs, the colony forming units, the put on there how much will be in the probiotic 2 years after it expires.  So when you say–when you see a hundred billion units per serving that’s what’s in there 2 years after it expires.  So they literally put double or triple the amount in there to ensure you’re gonna get what’s on the label 2 years from now.  That’s what you get when you’re using a higher quality company.

Evan Brand:  That’s great.

Dr. Justin Marchegiani:  So Evan, I think the next question after that is how many supplements is right for you?  So dealing with patients, when we create an adrenal program for instance, we’ll start with anywhere between 2-6 products, and we try to work on what the patient needs, where they’re at, how sick they are and how fast they wanna get better, and also what’s their emotional tolerance, can they handle a whole bunch of pills or not?  So we have to have that conversation and some patients that are sicker and wanna get better faster, we need more nutrients, we need–we need extra support especially if they’re life’s stressful, their nutrition isn’t perfect, they’re maybe not sleeping the best, we may have to give a few extra products.  So I think that conversion needs to be had with the doctor and with me, it’s a sliding scale of how much I recommend and I customize that with the patient.  And sometimes if we’re–have an adrenal program lined up with a good multi, a fish oil, and some adrenal support, and let’s say we have a–a gut-killing program lined up and a person has a couple of different gut infections, it may be a fair amount of products.  So you have to sit there and talk with your doctor and figure out what you’re on, why you’re on it, figure out if it’s in your comfort zone and also find the timeframe of how you’re on–how long you’re gonna be on things and when you can consolidate.  Some patients are under so much stress they just–they need that, and that’s just how it is and they feel better and perform better with it.  So there has to be that conversation and it can’t be like, “Oh, you’re on 10 things, your doctor’s, you know, ripping you off,” it needs to be “Why,” like, “Did you have a conversation with your doctor about that?  Does it make sense?  Do you know why you’re on everything?  Is your doctor making sure your diet’s good?  Is the lifestyle and the sleep good?”  You gotta have that conversation.  It’s gotta be individualized.

Evan Brand:  Yeah, I–I’ve find a lot of people that come in and they fill out the–the little form.  What are you taking?  Supplements, herbs, medications, if I do prime them about those, “Why are you taking those?”  “Oh, I don’t know.  I just–I read it was good.”  And so there may be some imbalance created, I mean, especially with things like zinc.  I mean, throwing off the zinc and copper balance for example.

Dr. Justin Marchegiani:  Right.

Evan Brand:  I’ve seen tons of people.  “Oh well, I read zinc is good for testosterone so I just started taking 50 mg of it because I’ve read it on a bodybuilding article.”  That’s not the wisest idea and you–you’re coming in the door with, you know, tons of supplements–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  That you actually may get helped by removing those supplements and then just completely starting from ground zero again.  So–so always being open, I guess would be a–I don’t know–a good–a good way to come into the door because you never know what’s gonna need to be adjusted.

Dr. Justin Marchegiani:  Yeah, I totally agree.  And there’s a site I use called the HealthAliciousNess. and it’s a great site looking at all of the various nutrients in foods.  So like when we have a person that, let’s say, on a test comes back with low in zinc, we’ll look up the top 10 zinc foods and we’ll make sure those foods are in their diet.  Or if they’re low in calcium or-or potassium, we’ll look at those foods and we’ll see if those foods are in their diet, and again, this is part of the reason why we kinda have a Paleo template is because those top 10 foods almost all of the time are staples in a Paleo template, go figure, right?

Evan Brand:  Yup.

Dr. Justin Marchegiani:  So the diet and the supplement part, it needs to be customized and I do with some patients sometimes that are sick and not feeling good but they don’t wanna take a lot of supplements and that’s okay, we just have to make sure the diet’s lined up and perfect and you’re managing stress and your life isn’t too much stressful and you’re sleeping good, and we also have to kinda gauge your expectations of healing.

Evan Brand:  Right, yeah­­–

Dr. Justin Marchegiani:  If you have maj–

Evan Brand:  Yeah.  I was gonna say–

Dr. Justin Marchegiani:  If you have a major infection and you don’t wanna take maybe 1 product, you may not get that infection cleared out.

Evan Brand:  Yeah, or if you’re a teacher and you have the summers off and you have the time that you’re gonna be relaxed enough to actually be more compliant then maybe you can skip out on a couple but if you’re high flying day by night person then you’re gonna need a little bit more support there.

Dr. Justin Marchegiani:  Yeah, and I do adrenal test pre-imposed and it takes a long time to heal the adrenals, just doing lifestyle and diet alone.  Typically it takes like a couple of months of vacation time with perfect diet and lifestyle and the way I look at it is “Well, why don’t you do that and take the supplements and super charge the healing even faster?”

Evan Brand:  Totally, yeah, I mean even if someone’s still working 40-hour work weeks, I mean, sometimes I try to estimate a year even–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Depending on the person.  What would you say?

Dr. Justin Marchegiani:  Yeah, we look at their adrenals test and based on their adrenals whether they’re normal, stage 1, stage 2, or stage 3 and that’s basically an indicator looking at how little cortisol or how much cortisol they’re making in conjunction with the rhythm of their cortisol and in conjunction with DHEA or sex hormone levels, we can base a good timeframe of healing.  So stage 1 is 3-6 months, stage 2 is 6-9, and stage 3 is 9-12 months.  And anyone that’s chronically ill with multiple infections 1-2 years minimum.

Evan Brand:  And that’s actually really fast if you’ve been sick for 20 years.

Dr. Justin Marchegiani:  It’s really fast.  I mean, yeah, especially when conventional medicine will probably just throw you some anti-inflammatory COX2 or NSAID drugs, maybe some prednisone, and maybe some anti-depressants.  I mean, that’s not ever gonna fix the problem and will probably make things worse down the road.

Evan Brand: Uh-hmm.

Dr. Justin Marchegiani:  So I think we went over some really good stuff.  I mean, I think the summary would be make sure your doctor has a approach that addresses and looks at diet and understand why they recommend their diet and make sure there’s customization within that diet, number one.  Number two, make sure there’s lifestyles being looked at, meal timing, stress, meditation, exercise, sleep, blood sugar; make sure that’s being look at.  Number three is what’s the approach, right?  What labs are we gonna order to get to the root cause, right?  And are we addressing the other stressors that were in our life that caused the problem to begin with and then also, how are we gonna recommend the supplements?  How do–how do we prescribe them?  What are the phases of care?  How I do get to the next phase?  What are our markers of success, objective and subjective?

Evan Brand:  Yup.  I think you covered it.

Dr. Justin Marchegiani:  I think it’s a really good place.  Do you want to add anything to that, Evan?

Evan Brand:  No, that–I mean, that was killer, man.  That was more concise that I could have made it.

Dr. Justin Marchegiani:  Alright, good.  And again, I’m available over at and you can take a look at the free Thyroid video series and Female Hormone video series, and again my most successful patients–my most–the patients that I’m able to help the best and the fastest, they are the most educated, so anyone whether you’re gonna work with myself, Evan or another great doctor out there, get educated.  The education process is a huge part in healing because it creates compliance and it’s gonna allow you to not self-sabotage yourself because you’re already gonna have the good subconscious gems of what you gotta do to heal.

Evan Brand:  I love it, yeah.  And it saves us a lot of time not explaining why that piece of bread is not gonna help you.

Dr. Justin Marchegiani:  Oh, my gosh.  I fight with so many patients on things that we could just be putting more of that time towards actionable items versus fighting on the old.  So the more you get educated outside of the doctor’s office in call, the better it is and the more money you’ll save yourself, too.

Evan Brand:  Amen.

Dr. Justin Marchegiani:  Alright, Evan.  Hey, great talking to you, man.  We’ll talk very soon.

Evan Brand:  Likewise.

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