The Mold Gut Connection – How Your Digestive Issue Maybe Caused by Mold Toxins | Podcast #371
If you’ve encountered mold from a water-damaged building or contaminated foods, you’ve likely encountered mycotoxins—toxic byproducts of mold. They’re common environmental toxins, and they have adverse effects on many body systems, including the gastrointestinal tract.
While you’ve probably heard about other symptoms that can follow mold exposure, Dr. J and Evan discuss that mycotoxins can also cause severe problems for your gut. They also talk about how mycotoxins impact gut health and the microbiota and what you can do to help restore your gut health once you are exposed to mold.
Dr. Justin Marchegiani
In this episode, we cover:
0:00 – Introduction
1:57 – Mycotoxins
10:16 – Functional Medicine Approach
13:54 – Dopamine Mechanis
15:20 – Mold Inhalation Effects
Dr. Justin Marchegiani: And we are live, It’s Dr. J here in the house with Evan Brand. Today’s topic is gonna be wonderful for the podcast. We’re gonna be talking about the mold-gut connection and how your digestive issues may be exacerbated by mold toxins, so great topic here Evan, personally been affected by himself and we see lots of patients all the time with these issues so let’s dive in. Evan, how are we doing today man?
Evan Brand: Yeah man, doing really well, and a lot of people have been to naturopaths, they’ve been the functional medicine people they’ve been a conventional doctor, they’ve been treated for SIBO and SIFO, whether it’s Rifaximin or natural SIBO protocols, maybe they’ve done SIBO diets or some of these rotational food diets and that sort of things, maybe they’ve tried berberine, oregano, garlic, and maybe they’ve made some progress, but then they’re still stick, they’re still suck, I’m gonna mix up my words, they’re stuck and sick so that’s a bad combination of essays and this is likely due to a mold toxin problem because I’ve seen it too many times and I suffered on my own and even the labs now tell us they give us a cookie-cutter report but that cookie-cutter report nonetheless is still valuable because even the lab has painted the connection between mycotoxins which are essentially mold farts that you breathe in, in a water damage building and the connection to certain bacterial overgrowth, specifically Clostridia but also Candida and the mechanism of why this is so damaging especially to young children is because we know that Clostridia bacteria screw up the organic acid levels called HPHPA and this affects levels of neurotransmitters, so when you get these children, they have behavioral issues, they may be diagnosed with something like PANS, which is a Pediatric Acute Neuropsychiatric Syndrome. These kids usually have sensory problems, food sensitivity, skin issues, histamine problems, allergies, maybe they’re biting children, maybe they’re angry or irritable, this can all be traced back due to this toxicity.
Dr. Justine Marchegiani: 100%. So that’s quite interesting, now you talked about mycotoxins essentially being mold fart, so essentially the mold off-gasses, right? And, your different kinds of mold, right? It could be Penicillium, it could be Aspergillus, right? It could be the black mold, Stachybotrys, these types of things and then they produce various mycotoxins and when we do different tests, like plate testing on homes, supposedly each mold or so can produce about 300 different mycotoxins, whether it’s Ochratoxins, or aluminum is that correct?
Evan Brand: Yeah, which is crazy because we can only test for a very, very small amount on the urine so really, we’re trying to just look for some evidence of this bonfire, we’re looking for the ashes, Oh my god, there must have been a fire here, this big mold exposure, we’re only looking at the tip of the iceberg so yeah, you’re right. Our testing is good but it’s still very primitive compared to the amounts of mycotoxins that are being produced.
Dr. Justine Marchegiani: Yeah. And the type of organic acid testing that we’re doing is on the great plains. We’ll look at some of the organic acid compounds that correlate with, like Aspergillus or different mold toxins. Is that correct? What are those big mycotox? What are the big organic acids again?
Evan Brand: So, it’s all on paper.
Dr. Justine Marchegiani: Membranes
Evan Brand: Yeah. So, you’ll see oxoglutaric. You’ll see citric acid can be high in a fungal overgrowth too so it’s all page 1. Oxaglutaric, you got hydroxybenzoic which is related to bacteria. I could pull up an O but in general it’s just page one. It’s typically numbers 1 through 18. If you see any big red flags on that either a combination of a bacterial overgrowth specifically a clustering problem and or Candida or fungal colonization and the lab indicates that so tartaric acid would also be on there, carboxy citric acid is also on there. So, in parenthesis, you’ll see under these organic acids now which is great because this has improved over the years that you and I’ve been running these labs. It now says Aspergillus so on number 6, which is tartaric acid under number six, it’ll now say Aspergillus. And you’ll know if that’s elevated, you’re colonized for Aspergillus which means that you’ve now been exposed to a couple situations could have happened either you had a large enough amount of mold, you were exposed to mold, long enough or your immune system was weak enough where now you become a mold factory. So, you can be a mold reservoir, more specifically a mycotoxin reservoir where you just have this exposure at the moldy hotel in Mexico and then you come back home and you’re sick or if you were weak enough, now you’re growing mold. Even if you move to the desert to avoid mold, you stay sick because you’ve got that colonization so with
Dr. Justine Marchegiani: Ionization, that’s happening.
Evan Brand: Yeah. So, you can prove that which is very important because now that would justify the use of herbal antifungals to try to remedy this situation.
Dr. Justine Marchegiani: That makes sense. Let me go pull up one of my old tests. Let me see if I can find it. Hold on.
Evan Brand: Now, the conventional treatment is typically antifungal medications that are gonna knock this out. But, as you and I with our functional practice, we don’t like to use that. So, number 4 would be classified as the fungal, the ferran-2,5-tricarboxylic, you’ve that Ferran carbonyl glycine. Yeah. So, number six. Yeah. So, this is old enough where they didn’t have the molds but on the new ones in parentheses
Dr. Justine Marchegiani: Let me say Aspergillus. It is primarily Aspergillus for all three of these.
Evan Brand: Yeah, and the number nine tricarboxylic is Fusarium.
Dr. Justine Marchegiani: Fusarium. Yep. And then Arabinose and Tartaric are also correlated with yeast overgrowth. This test here for instance, I did a great plane and a Genova test at the same time and this one actually came back much higher on the Arabino side than the great plains. then the Genova tested. So, it’s interesting you know different samples and such. But yeah, this one Arabinose is strongly correlated with Candida but then
Evan Brand: I just ran my own, I’ve got Candida right now too so I’m on a protocol, right? Now, I just run. Yeah. I showed up with Candida and I want people to know because you were a speaker on the event. It was called the Candida summit which I ran like five years ago and you know we had like 30 people talking about it and I could look back but I tell you I don’t think anybody had made the connection here which was the mold Candida connection back then and now what I’m finding is basically you’re just playing whack-a-mole with Candida until the mold’s gone meaning you may rotate through various rounds of antifungals but out the back door, you’ve got to be using the appropriate binders to pull out the mycotoxins so if you’re just beating Candida down and it keeps coming back. It’s probably the mold, not the Candida that you need to be after.
Dr. Justine Marchegiani: Yeah. And, that’s where it’s good to run a test like this. Also, maybe a urinary mycotoxin test or just make sure your environment’s good because I always tell patients if the environment’s not good and you’re having reoccurring issues then you’re just not getting to the root cause. So, the first thing is to isolate the environment. Make sure the environment, your home, your apartment wherever you’re living run a high-quality mold plate test on there. We’ll put links down below where you guys can access the plate testing. Isolate that, right? Make sure there’s no water damage or if there’s been leaks. Make sure it’s been addressed and dealt with. Make sure that’s dialed then the second thing is you can run a test like an organic acid test with your functional medicine provider. See if there’s any colonization. And, it that’s chronic, yo can get to the root on that and then you can always run urinary mold where you’re looking at mycotoxins coming out in the urine that can also be helpful but typically if this is good and there’s nothing at the home then you’re probably in pretty good shape and it’s probably more of an acute kind of dysbiosis thing probably from poor diet, poor digestion other bugs, other infections, etc.
Evan Brand: Yeah. And the cool thing is that you can kill two birds with one stone or even three birds with one stone and what I mean by that is let’s say you run that oh and you showed the elevated Arabinose, you know, there’s a Candida problem but if we see tartaric above that’s high and then down below, we see some of the bacterial overgrowth markers, the blends that you and I formulate and have, we might be able to kill bacterial overgrowth, fungal overgrowth and a Candida problem. All in one fell swoop and that’s incredible and you know your gastroenterologist or even your mold doctor is likely not gonna be able to do that. They may come in specifically with itraconazole or fluconazole or nystatin. But as you know, we’re facing this big problem of antifungal resistance just like we’re finding with antibiotic resistance and so now, you’ve got these very virulent strains which are difficult to kill with conventional medications. You and I have talked about this before but the long story short of it is all the different alkaloids and terpenes and beneficial nutrients in the plants, those don’t have this resistance problem. And if you’re mixing this herb and that herb, it’s not one plus one equals two, it’s one plus one equals ten. You get the synergistic effect.
Dr. Justine Marchegiani: Yeah. You see the same thing with addressing bacteria and other bigger bugs and berberines and Artemisia Wormwoods have synergistic effects. Also, the fact that you get a lot of antioxidants in a lot of these herbs. And so, especially if they’re high-quality, you get a lot of antioxidant support because when you start killing bugs, it’s a lot of oxidative stress that’s happening. And then, when you provide like an antifungal like Diflucan or an Amphotericin or a nystatin or a ketoconazole, obviously, there’s no antioxidants in those drugs and so you’re gonna have a lot of oxidative stress so it’s nice to have a blend different herb in there. One, to prevent the resistance. And then, also, people have yeast issues and a lot of times they have bacterial bugs as well and efflux pumps are a big thing that a lot of bacteria and bugs use to kind of protect themselves. So, I cannot say, like bacteria is like a sinking canoe, right? and essentially, you poke holes in that canoe with a lot of the herbals and think of the efflux pumps as the person in the canoe, baling water, right? So, they try to keep on bailing water, bailing water, so they don’t sink, right? And so, think of the herbals when you inhibit the efflux pumps whether it’s a ginger or different antimicrobials, it’s like taking the buckets away from the bacteria that’s bailing water and allows then to sink that allows them to effectively be destroyed that along with addressing biofilms too.
Evan Brand: Yeah. That’s awesome and the cool part too is you can minimize the die off if you’re doing this right. You know a lot of people when they hear these conversations, they get afraid. They go oh my God, Candida, mold, bacteria, parasites, worms like oh my God, this is a lot of stuff in me. I want it out of me but now I’m afraid. Am I going to feel worse before I feel better and the answer is if you do it properly that should be minimal to a nonexistent problem? I think you and I have refined our protocol so much over the years now that we have these tools and these other therapies in place that are standalone products but we often add those in or if we see that we hit a roadblock or a big bump in the road like a die off, we can change dosing. We can rotate. We can add in other support. We’re always talking about liver and gallbladder and binders and hydration and biofilms. These other pieces, these other variables, these are the make-or-break things for some people.
Dr. Justine Marchegiani: 100%. And when people kind of want to go after the gut, we live in an antibiotic like kill, kill, kill generation so people tend to, when they find out they have an issue, they want to go kill, kill, kill and that can be very stressful in the body so it’s always very important to calm down the inflammation, get the immune system stronger, get the hormones that help with anabolic metabolism which is healing, recovering, anti-inflammatory support that kind of sets the table because the more stressed and inflamed you are, your lymphatic system, your detoxification system, your immune system won’t work as good and plus people forget your detoxification system, right? The cytochrome p450 oxidized pathways, especially the phase two pathways, they’re gonna run off of a lot of sulfur-based amino acids and so if we don’t have great digestion and we’re not eating you know good healthy animal protein or good healthy plant cruciferous vegetables. If we can’t tolerate them, we can’t break them down. May not have a lot of those sulfur building blocks to run those phase two pathways and so that’s why kind of getting the deck set so to speak so we can really hit phase two better just not with support but just getting digestion working better and a good diet working better sets the table and allows us to effectively kill so much better.
Evan Brand: Yeah and I know we’ve talked about a lot in a short amount of time, we’ve gone fast so listen back as needed but I want people to understand the connection because of the title of this episode, I want people to understand the mold-gut connection. So, the connection is the following: the mycotoxins weaken the immune system and allow the opportunistic bacterial overgrowth to thrive along with the Candida. So, if you’re working upstream at the SIBO-SIFO situation but you’ve got an underlying mycotoxin problem, you’ve got to address that if you fully wanna get better. The other mechanism of the mycotoxins is a couple. Number one is they damage the microbiome so we know specifically that mycotoxins do the same thing as, like food allergens, they disrupt the gut barrier and create intestinal permeability. So, that’s another reason you want to pull those out of the circulation by using specific binders based on your labs. And then the other mechanism too is we know mycotoxins affect the brain chemistry and specifically lower dopamine so when you get into pain signaling, you get into motivation and mood and just your overall vitality. If your brain chemistry is affected, we can also measure that but it could be directly attributed to the toxin for example in like rat studies when they inject them with mycotoxins or expose them to mold toxin, the dopamine levels crash. So now, all of a sudden, you’ve got this brain chemistry piece to address too, now people have heightened pain sensitivity, they’re depressed. They may be just more flat with their life. Once again, they go to their psychiatrist. They’re not gonna bring up mold toxicity, they’re putting them on an antidepressant medication. They’re never gonna say, “hey, oh your basement is flooded, that’s why you’re depressed and anxious and you have diarrhea”. So, the connection of the gut symptoms too, the diarrhea, any type of bloating, burping, digestive pain especially in children. Children don’t use the same language as adults. So, if your child is complaining about stomach pain that could be one clue that there’s something related. That was my issue for my daughter, Summer. She was complaining of tummy aches so we did run stool on her. She did have H. pylori when she was two. We tested real high. Maybe I gave it to her by sharing water bottles or something but either way, we took care of that and then stomach pain was continuing that was when we had got exposed to mold. Luckily, I got her on binders. Now, she’s in a better place. So, I’ve seen it unfortunately with my own kids and it’s stressful to see your kids suffer but it’s a good lesson. It’s a good learning lesson that your children are not crazy and if your kids are complaining of a chronic issue like this with pain, you know, consider this as a possibility especially if you as the mother are toxic because the toxins go through the placenta and they also go through breastmilk. So, if you have your own digestive skin, whatever problems, mood problems in your kid, has similar issues as you, well, it could be the generational passing of toxins.
Dr. Justine Marchegiani: So, let’s go over that mechanism one more time with dopamine. So, obviously dopamine is a neurotransmitter and when we’re chronically stressed, physical, chemical or emotional, dopamine can go downstream and get converted into adrenaline which kind of helps manage the acute stress response. Is it just a fact that the mold is inflammatory and creating a stress response and activating the sympathetic nervous system that the dopamine is being taken and depleted downstream or is there something else? I want to make sure I get that mechanism hammered down.
Evan Brand: I don’t know. Type in rat dopamine, mold or rat dopamine, mycotoxin. See if you can find it. There were several papers on this. I don’t know if they discussed the mechanism in it or not. My assumption would be that it’s multifactorial. I think the big mechanism would be that the mycotoxins affecting the gut barrier then affecting nutrient absorption then there’s likely less amino acid conversion to dopamine. So, I’m thinking, it’s more of a malabsorption problem but also we know that ochratoxin for example damages
Dr. Justine Marchegiani: Like malabsorption, like it’s affecting the absorption of protein in the gut?
Evan Brand: Yeah. I think that’s one mechanism. I think the other mechanism would be direct brain damage. We know that okra toxin for example damages the cerebellum. We know that the Verrucarin and the Stachybotrys mycotoxins affect the brain and the prefrontal cortex which impairs, like your ability to think clearly. So, I think it’s both. I think it’s the gut damage and I think it’s the direct brain damage too. I am going to pull it up here. Can you see it on screen?
Dr. Justine Marchegiani: Yep.
Evan Brand: Let me make it bigger on my side here.
Dr. Justine Marchegiani: Yeah. So many mycotoxins, trichothecenes. We test that in some of the mycotoxin tests. Yeah. Induced neuronal cell apoptosis so some of that could be you’re just causing the cells in the brain and especially in the substantia nigra of the midbrain. That’s where dopamine cells are being produced. Some of it could be apoptosis that means programmed cell death and or inflammation in the olfactory epithelium.
Evan Brand: Interesting.
Dr. Justine Marchegiani: So, it seems to be a neurodegenerative and then look it says it caught ochratoxin A causes acute depletion of dopamine and its metabolites.
Evan Brand: Look at that.
Dr. Justine Marchegiani: So, I wonder if that’s a, it sounds like it’s possibly a stress response, right? Because dopamine can, tends to go downstream to adrenaline. It could be almost like an autoimmune response because you’re having apoptosis. This is neuronal cell death, program cell death. This is part of the reason why apoptosis is important, right? Because if you don’t have good immune function, this is how cancer forms, right? Your immune system helps program cells to die when they need to die. This is apoptosis but if you can’t do that then cells can overgrow hence you have a tumor, right? And so, this is actually happening to unhealthy or the very healthy tissue that you need to be functionally healthy that produces dopamine in the midbrain. So very interesting.
Evan Brand: Yeah. Talking about the hippocampus too, we know that hippocampus, I’ve got two of them. Remember, that’s why a lot of people have brain fog problems and also I would say that short-term to long-term conversion is impaired.
Dr. Justine Marchegiani: Can you see this one here? The mold inhalation one
Evan Brand: I’m just seeing that you’re highlighted on the hippocampus word for now.
Dr. Justine Marchegiani: Let me switch back to the other one here. This is mold inhalation. This is interesting. Let’s go pull this up. All tight. Mold inhalation causes innate immune activation, neural cognitive and emotional dysfunction.
Evan Brand: So, this is pretty new. July 2020 paper here so relative.
Dr. Justine Marchegiani: Yeah. Yeah. So, the ability of mold to cause such symptoms is controversial since no published research has examined the effects of controlled mold exposure on the brain. Patient symptoms following mold exposure are indistinguishable from those caused by innate immune activation by bacterial or viral exposure. Interesting. So, in this study here they added in. See here. Toxic and nontoxic mold stimuli would cause innate immune activation with concomitant neural effects and cognitive and emotional behaviors. We internationally administered intact stachybotrys. This is black mold extracted non-toxic stachybotrys spores and a saline vehicle to mice.
Evan Brand: You don’t want to be that mouse.
Dr. Justine Marchegiani: Wow. No. As predicted, intact spores increase interleukin 1 beta, immune reactivity in the hippocampus both spore types decrease neurogenesis. This is forming new neurons in the brain and causing striking contextual memory deficits in young mice while decreasing pain thresholds. So, this is another word saying, causing more pain in the body. So, if you have mold exposure, joint pain could happen, right? And enhancing auditory acute memory in older mice. Nontoxic anxiety. Yeah. Also increase anxiety like behavior. Levels of hippocampal immune function correlated with decreased neurogenesis that’s creating new neurons in the brain. Contextual memory deficits, right? Obviously, less memory and or enhance auditory cued feared memory. I wonder what that means. Maybe it’s just like, uh, you’re more sensitive to external stimuli.
Evan Brand: I read that. Yeah. I read that as sound sensitivity which is yeah part of the toxin and light sensitivity too so people will often have to wear sunglasses even when it’s not very bright. You and I talked about that in the context of adrenals years ago but that’s also a mold toxin thing.
Dr. Justine Marchegiani: Yep. And an immune activation may explain how both toxic mold and nontoxic mold, skeletal elements cause cognitive and emotional decline. So, it’s really important. We don’t wanna be in an area where there’s a bunch of mold toxins and we can do a whole other podcast on how to mitigate mold toxins as a whole. I mean, of course, get your home tested. That’s the first thing. If you have water damage, make sure it’s mitigated by a professional right away because mold starts to form when sitting water in as little as two days. Got to make sure that’s under control and then if you’re on the fence, get yourself tested, right? We’ll run an organic acid test. Maybe run a urinary mycotoxin test and see what your actual load is but again one of the big telltale cue signs is you know, get your home. If there’s mold there and you start feeling significantly better and you go back, you notice an increase and definitely get your internal mold tested as well via urine.
Evan Brand: Yeah. Well. I know we got to wrap this thing up. We got calls to get to but I hope this is helpful for people. We can always get geekier and dive deeper and go longer but I think you guys get the gesture, the connection of the brain toxicity, the gut damage. There’s a mitochondrial element with the chronic fatigue piece. So, if you are suffering from any chronic issue whether it’s mood like depression, anxiety, energy problems like chronic fatigue, low libido, poor erectile function, cold hands, cold feet, increased light sensitivity, blurry vision could be other things but this is a big smoking gun and all of us are inside way too much. We’re not outside like the Amish are all day. They might have moldy homes but they’re not breathing it in the majority of time. They’re outside in fresh air where the toxins are diluted. So, us with our indoor lifestyle as modern humans, we’re at more risk of this stuff and our buckets are already full due to pesticides and other toxicity in the environment so this is a really, it’s an epidemic problem, maybe the biggest one.
Dr. Justine Marchegiani: And not everyone is as genetically sensitive, right? Some people, they go into a moldy area. They get brain fog, right away. Some people do fine. Either way, it’s definitely a stressor in the stress bucket and if you know it’s there, you definitely wanna pull it out because it’s gonna help give you more resiliency and more adaptability. Great podcast today Evan. Everyone listening on the audio version, we pulled up some studies and some lab tests on the video version. We’ll put the link down below so you can see the video version. We’ll put some links to some of the labs and the products that we talked about today so you guys can take a look at those. Evan, great chatting with you. Head over to evandbrand.com to reach out to Evan via functional medicine nutritional support worldwide as well as justinhealth.com, Dr. J myself at justinhealth.com for me myself. We are here to help and support you guys wherever you are. Have a phenomenal day everyone.
Evan Brand: Take it easy. Bye-bye.
How to Investigate The Root Cause of Your Gut Issues | Podcast #366
In functional medicine, it has long been familiar that gut health is paramount to the rest of the body. We didn’t fully understand why for years, although we knew the gut was the seat of the chronic inflammation and immune system. With the gut microbiome renaissance, we also need to understand how integral gut bacteria are to our health.
Dr. J and Evan discuss that screening for more serious underlying issues is essential. These may include gastric ulcers from an h.pylori infection, leaky gut, and other digestive system problems. Finding out whether these conditions are an issue also impacts how you manage gut health.
Dr. Justin Marchegiani
In this episode, we cover:
0:00 – Introduction
3:34 – The Signs and symptoms of digestive disorders
7:35 – What tests are effective to find the root cause of gut issues
13:58 – The downside of ordering lab tests on your own
26:21 – Food template modifications that will fit for your gut health
Dr. Justin Marchegiani: Here, Dr. J, with Evan Brand. Really excited to have an excellent podcast today. We’re gonna be chatting about how to investigate the root cause of your gut issues. We see lots of patients come in and they’ve gone to see the SIBO doc or the Candida doc or the parasite doc or the thyroid doc and whatever the symptoms that they’re dealing with, magically that issue, that doc only focuses on is the problem, how coincidental right? And so, we want to talk today about having a holistic mindset not being necessarily attached to what the diagnosis or what we think is the root issue but really be focused on the outcome and the different tools we use and have to investigate and support healing. Evan, how you doing man?
Evan Brand: Doing good. And not to mention too, the conventional approaches, right, maybe they get to the SIBO guy or to the parasite guy or to the worm guy, maybe they went to the endocrinologist first for their hormone symptoms and then they got referred to the gastro doc and then the gastro doc did an endoscopy or a colonoscopy or a barium x-ray scan like you did to me and then they say oh you’ve got gastritis and that’s the only thing they can pull out of you is hey there’s some inflammation and then it ends there so whether you’re coming, listening from the conventional approach whether you have tried to go more natural holistic approach. As you and I’ve talked many times, people over-specialize and that’s the problem. You and I are what I would consider very good specialists but we also have a generalist undertone to us, meaning, we’re not gonna get caught up in just the SIBO, we’re not gonna get caught up in just the parasite, it’s rarely that simple.
Dr. Justin Marchegiani: Absolutely. It’s like, imagine, like you hired a handyman to come over and fix something in your home and the handyman just takes this Phillips flat head screwdriver and it’s like, or, I’m sorry, not, but let’s say a regular Philipps screwdriver and just say hey I’m gonna use this Philipps screwdriver even if it requires a nail, even if it requires a wrench or a drill, I’m married or attached to this Philipps head screwdriver and we don’t want to be attached to the tool, we want to go in, know that we have a myriad of tools in our tool belt and pick the right tool for the right job. There’s a nail, I’m going to pick a hammer. Hey, there’s a, you know, a wrench, you know, we’re gonna use something that is good for a wrench etc. So, we’re picking the right tool for the job and we are focused on the outcome, getting the results and we’re not focused on how we get that outcome, right? The vegan diet people, they’re gonna make it so everything is solved by a vegan diet and that’s it, right? And so, we are independent of the tools that we use to get the success that we need.
Evan Brand: Yeah. Yeah. That’s a great point and a lot of this comes from just experience but also our own personal journey too, I mean, you know, my story, you helped me through my story of having digestive issues and skin issues for decades of my life and we looked at the H. pylori, worked on that then it was parasites then it was bacterial overgrowth then it was Candida then it was mold, I mean, so, I went through the ringer personally and I think personal suffering but of course clinical experience really gives you the non-biased approach and I think that’s what you need because if you’re trying to just sell book or you’re just trying to just get clients in from a book you wrote on SIBO, as you said, everything’s gonna be SIBO and if somebody is not in that box, you’re gonna still give them the same treatment, you’re not gonna get them better and then they’re gonna move on and the average person who comes to us has already been to 5, sometimes 10 or 15 practitioners, so it’s not surprising when we look what they’ve done and they’ve still missed some of the pieces. So, why don’t we talk now about some of the pieces, like when we’re looking at someone with gut issues, what are the pieces we’re trying to lay out on the table in front of us to gather enough information to find what’s truly going on and then of course how to fix it.
Dr. Justin Marchegiani: 100%. So, the first thing that I think is essential is you got to do a good history, you have to understand how everything unwound, right? And so, when you look at most people’s history, a lot of times there’s poor diet, there’s usually some stress issues, a lot of inflammation compounded by junky fats, um, poor digestion, in general, not being able to break down proteins and fats, lots of refined sugar usually processed grains, excess omega-6 or trans fats and these things just continue to put the body in a pro-inflammatory state and what that means is, when you become overall inflamed at a higher level, your body starts to break down faster than it can heal and so the goal of being anti-inflammatory, right, is restricting a lot of the foods that drive inflammation, so your body can heal faster than you break down. So, there’s always this net buildup versus net breakdown and so when you’re breaking down over time what starts to happen is just as you know from a joint standpoint, you’re starting to feel a little bit inflamed, stiff from a mood standpoint, you may have anxiety, depression, obviously fatigue starting to creep in. Because, the more inflamed you are, your body’s having to deal and allocate adrenal resources to deal with the inflammation, to deal with the stress where normally those adrenal resources would help with energy and good mood and good circadian rhythm and so of course then that starts putting stress on the thyroid then you start having mood issues, temperature, hair loose and then of course the more stressed you are, the more that starts to suppress your body’s ability to digest optimally. So, HCl levels, enzymes levels, maybe bile salt levels start dropping. You start to have a harder time breaking down protein, breaking down fat. You may start getting burpee or gassy or more flatulence, now, your motility starts to go south typically more on the constipated side but you can still have more diarrhea too. And then, your absorption starts to go south and when that starts to go south, now you start to have, um, a bottleneck and all the nutrients, whether it’s B vitamins, flat soluble vitamins like A, D, E, K, whether it’s minerals or amino acids to help your brain chemicals or cholesterol to help your hormones. Those building blocks start dropping and then those pathways start getting shorted and they don’t have the resources to run optimally. And, when we don’t have the resources, more symptoms start to happen. And of course, this kind of compound in this whole journey is the immune system starts to drop and then when the immune system starts to get weaker, now, bugs start coming into the situation, whether it’s parasites or yeast overgrowth or SIBO or bacterial overgrowth or H. pylori. And again, we don’t have to be married to which one or which system is the one, right? But we have to look at things objectively and, um, I think it was Dr. Kaler said this to me over a decade ago, it was kind of a good line, he said, ‘patients have the right to have more than one issue, more than one infection, more than one hormonal imbalance going on at the same time, so don’t get married to one thing because you have the right to have lots of things going on.
Evan Brand: Yeah. Yeah. And you illustrated beautifully, just the constellation of symptoms that can happen. So, if someone is coming in with gut symptoms that’s usually the tip of the iceberg. Underneath that iceberg, just like your poster, you got right there. If we put the tip of the iceberg is gut under the water there, it could be the anxiety, the depression, the fatigue, the low sex drive, the cold hands the cold feet, the brain fog, the concentration issues, the memory problems, the skin issues. And so, once you do a good history, you’re also gonna be talking about pharmaceuticals too, what kind of like proton pump inhibitors were you on. That’s a big thing, like were you on acid blocking medications, were you on other things disrupting your gut. So, of course, figuring out, if you’re still on those medications, you’re not fully gonna get better, if you have a ton of drugs that are causing these side effects and then you get into the testing. Now, this is where you and I differ from other people. Some people, they’re married to the SIBO test and I don’t want to speak for you, I’ll ask you about this but me personally, I think a SIBO test is a waste of time because when we look at a GI map stool test, we’re gonna see a more detailed breakdown of specific pathogens like Strep and Staph and Pseudomonas. And the way I look at it is your mouth to your but is one long tube, so, if there’s dysbiosis in there identified on the stool or the urine organic acids, we can assume it’s probably in the small intestine but the protocol, the herbs that you’re gonna use, are gonna treat the whole thing. So, to me, I want to hear your thoughts on this too, but to me, if I see positive hydrogen or methane, all I’m going to go and do and say is gonna to be, ‘yep that makes sense’, but beyond that those breath tests are not really that helpful.
Dr. Justin Marchegiani: Yeah. I mean, a SIBO breath test is just looking, it’s an indirect measurement, looking at the gas created by the bugs, so methane or hydrogen gases that are created. So, if we can find bugs that typically produce those gases or an imbalance in but bugs that shouldn’t be there, then we know more than likely, there’s something going on in that SIBO realm. It doesn’t change the treatment that much because a lot of the herbs we use to knock down those bugs that they’re gonna be similar if not the same on the SIBO side. Now, my philosophy may be a tiny bit different than yours but I find anyone with these type of bug issues we’re running a comprehensive stool test and usually an organic acid test and on one or two of these tests, we’re gonna see either the bugs, the bacteria imbalances, whether it’s Citrobacter, Prevotella, Morganella, Pseudomonas, Klebsiella, or H. pylori or parasites. We’ll see these bugs elevated if we don’t almost always, we catch it on the organic acid side when we’re looking at 2,3 phenol acetate or benzoate or Hippurate or D’arabinitol for yeast, usually we’ll catch it there. If I don’t catch it on any of those tests on the stool test or the organic acid test then I’ll pull out a lactulose breath test but I’d say 99% of the time we never have to go that far.
Evan Brand: Okay. Okay. Good point. Maybe it’s a 1% of the time test for you and I guess what I would do if let’s say we missed it, we felt like we missed it on stool and urine, I might just come in or if sometimes if someone just has no budget to do anything, we may just look at symptoms scan history and just come in with some herbs and see how they do. And, a lot times, a lot of these antimicrobials, antifungals, anti-parasitic herbs, a lot of times it clears up the issue anyway so we don’t like to come in blind but in a few rare cases we have come in blind and we’ve still had good benefits. A lady just chimed in on the live chat here, my gut is not happy, chronic constipation after using pain meds for pain and recovery from five back surgeries. Yeah, that’s a common issue with the opiates, right? Because that’s gonna slow everything down so yeah, I guess the answer is eventually this person’s gonna have to try to get off those opiates, right? But there are some, maybe some brain-gut motility activators we can use, right?
Dr. Justin Marchegiani: Of course, you know, if you’re on those opiates, you probably had some surgeries and surgeries man, meaning typically anesthesia, maybe a lot of antibiotics along the way so that’s probably really screwed up the gut microflora. So, first off, you have to get to the root cause of the pain. Second thing is you have to have a good, uh, doctor to work with to taper you off those medications while providing anti-inflammatory support because you need whether it’s systemic enzymes or anti-inflammatory herbs plus that brain takes time to get rewired from the opiates because you’re processing pain totally differently. Remember, opiates don’t have an anti-inflammatory mechanism, they just block pain at the brain level which isn’t good because pain is a good indication like if I have pain in my ankle and it’s there then I can know okay I shouldn’t walk on it because I’m causing more damage, right? So, even if I were to take Ibuprofen and my pain went away, I would still want to be very careful, I don’t do too much on it because I’m gonna cause damage, right? So, most people that are chronically inflamed by these opiates, they’re just causing more and more damage because just because they can’t perceive the pain, they’re still causing this inflammatory breakdown.
Evan Brand: Yep. That’s true. Someone else has chimed in, my gut has been destroyed by many rounds of antibiotics. And, that’s super common, I mean how many times have you and I see that where someone comes in after a round of antibiotics, I mean that’s probably one of the top five things we see, right?
Dr. Justin Marchegiani: 100%
Evan Brand: They said they’re dealing with IBS-D so that would be diarrhea and eating a limited vegan diet. So, my first thought is, uh, oh vegan diet, raw leafy greens, if you’re dealing with diarrhea, vegetables are gonna irritate the gut, I would push you more towards getting some good animal proteins in even if you could only handle like a carnivore collagen like a beef peptide protein powder or you know collagen shake maybe with some organic berries that’ll be my first thought. How would you think about this one?
Dr. Justin Marchegiani: Yeah. I mean, you could definitely look at reducing some of the fermentable carbohydrates and really look at cooking and steaming a lot of those things so it’s easier to break down but you really got to reach out to a good functional medicine doctor that can kind of help navigate you through it because if you don’t have all the digestive enzymes and acids there, it may be hard to break these things down. Also, someone chimed in, what about Vagus nerve issues. So, this is kind of a classic area in functional medicine where people try to talk about things differently in a nuanced way and they’re just talking about the same thing in a different way but people think it’s a new thing, right? So, when we talked about like inflammation and adrenal stress, when the more stressed you are and the more you activate the sympathetic and the more inflamed you are, right? Guess what happens when inflammation goes up and the sympathetic nervous system goes up, the vagus nerve or the parasympathetic nervous system always goes down, does that make sense? So, when we talk about these things it’s implied that the vagus nerve or the parasympathetic branch of the nervous system that would helps with healing and recovery is always going to be impaired and so people talk about things kind of as a way to nuance themselves make them seem different kind of market themselves in a different way which is fine but, you know, the average person may get a little confused about it and so just know that, that’s kind of under same umbrella that we’re talking about. We talk about the vagus nerve or the parasympathetic, it’s being factored into this whole adrenal stress inflammation umbrella, I think, yeah, inflammation is the bigger umbrella then you can put adrenals and parasympathetic and sympathetic all under that umbrella.
Evan Brand: Yeah. Very true. Very well said. Teri chimed in, I’ve been experiencing constant belching, a new symptom for me. So, once again, you got to get the labs run, I want to look at your organic acid, see what’s going on there. Get a GI map stool test run. Are you on proton pump inhibitors? Are you taking supplemental acids and enzymes? How old are you? If you’re above the age 40, you probably have low acid, low enzymes, maybe gut infections too. So, with stool, urine sample and good workup, you could probably resolve belching. I mean, that’s a pretty easy one.
Dr. Justin Marchegiani: And, I strongly recommend, do not get these labs on your own because, just because you get a lab, you’re not gonna have any ability to know what to do next and that’s everything, right? You gotta know what the plan is next, uh, and then typically you wanna look at like when I order a lab, it’s in conjunction with we’ve done a b c d e f and then not the lab is gonna plug in at g. Does that make sense? So, it’s never just this is a or this is it. There’s a whole bunch of, sequence of things that we’re doing before we get to all the data from the lab. And so, when you work with someone, most people are gonna have that plug in at some level in the clinical chain downstream. So, most people think, oh this is just it, this is a, this is the whole piece of the puzzle and it’s not. So, just kind of keep that in the back of your head. I know that can be a little bit confusing when you’re a lay person coming in there but it’s important information. I think, just start off with a lot of the foundational things first, just kind of wrap your head around it. Don’t get kind of myopic in this tunnel vision. Oh, it has to be Candida, it has to be this, be very open minded that it could be many different stressors and just have that really good differential kind of diagnosis list of all the things that we’re gonna go and hit and not get overly focused on one thing.
Evan Brand: Yeah. Good point. I’ll also say too, I’m not saying go to your doctor who’s failed here for the last 10 years and try to ask them for organic acids test or stool test because even if they were able to run it which most of the time, they don’t have accounts set-up with the lab so they’re not going to. But even if they were able to and they run it, they’re not gonna know how to interpret it, they’re not gonna know how to make a protocol based on it. So, this is a shameless plug for you and I and what we do as functional medicine practitioners, we work clinically around the world with people. So, uh, Teri’s asking where she can get the labs from. It depends, uh, we use a couple different companies. It depends on where you live and what you got.
Dr. Justin Marchegiani: We’ll do this, we’ll put some links on the videos below so for you and on your site and mine. So, if you want to get it from us, I recommend getting it from us and then work with Evan or work with myself. We’re here to help you. We’ll put the links below or you can go to evanbrand.com for Evan or Dr. J here, justinhealth.com for me. And then, just to kind of highlight what you’re saying, I see so many people that have some of these tests sometimes and the first question is walk me through what your doctor ordered this test, said about it. Did they give you a real thorough review? How much time, oh, hey they just spent a minute, they just said x y z and it really was, I’m like wow, you know, you have all this information here and yet it really isn’t thoroughly addressed, I would say 90 plus percent of the time. So, it’s really important when you get these tests ordered. You really want to come through it thoroughly, so you can extract as much actionable information as possible. And, if your doctor doesn’t have that level of, uh, skill set of information on it, that’s fine, just find someone else.
Evan Brand: Yeah. You make a great point. I mean, so many times, I know, you and I have a section on our intake form where you can, like attach previous labs. I’ll see 5, 10, 15, 20 labs and I’ll be from a medical doctor or a chiropractic or some other type of practitioner. I’m like wow, they did a really good work-up on you. Like, how did this go, why are you coming to me, what was the protocol? Oh, they didn’t have a protocol. Like, well, why’d they run the labs? ‘Because I wanted them to’. Okay, then what did they say about the labs? ‘Oh, well, that was not bad but I could use a little improvement and so they gave me an enzyme’. And it’s like, they give you an enzyme, you’ve got 20 pathogens, you’ve got parasites, you’ve got H. pylori, you’ve got major gut inflammation and the sequencing of this is important too. So, even if they read a cookie cutter protocol where it says like take oregano oil, you might not be a good candidate for that if you’ve got a bunch of inflammation. Your gut’s irritated, you go throw a, you know, a nuclear bomb in there, you’re gonna irritate your gut more. So, the sequencing is important. So, I guess, just to highlight here what we’re talking about, it’s the sequencing. As you mentioned, when does the lab come in? That’s not just the end all BL tool, there’s other strategies you’ve implemented up until that point. And then, when you work in the killers, is it right out of the gate? Do you got to settle the gut first?
Dr. Justin Marchegiani: Yeah. It’s never. The problem is people have done, the patients come in and they’ve done a lot of different things. So, like maybe, they’ve tweaked their diet and so they think, okay I’ve made these diet changes, right, whether it’s enough or not is besides the point but they think, okay I’ve done these diet changes, check. Diet isn’t part of the equation, so in their mind they kind of check that off. So, when they see another practitioner, they kind of have this list of things in their mind they’ve checked off. And then, they’re like okay, I’ve already worked on the diet stuff. Yep, I’ve already done some digestive support. So when I lay out my plan, there’s kind of like, we’ll I’m not gonna do this because I’ve already done some of this or I’m not gonna do that. No. it’s like, if I give you a safe and the combination is 6 or 7 numbers. You don’t say we’ll spin number 33 on my other state therefore I don’t have to do it this time around. The combination has to be done in sequence together. The other analogy is cooking. If you want to crack the eggs after you bake the flour, well that cake’s gonna be pretty nasty, okay. So, it’s kind of the same thing as a sequence and just because someone has done something before in the past. One, it may not have been all the way there but we still have to plug that sequence back into the overall flow of things. Does that make sense?
Evan Brand: Yeah. It does. And I know
Dr. Justin Marchegiani: You’re smiling, so it sounds like that’s something that you deal with and hear a lot.
Evan Brand: Oh yeah. Yeah. Well, it’s just, you know, once
Dr. Justin Marchegiani: It’s so much easier dealing with patients that have done nothing that have no, um, no predisposition to like what’s next, they’re like a blank state because then you can kind of come in and there’s zero resistance and you can work through your flow. When people have done a lot of things and they think they’ve done everything in that area, it’s always hard, you kind of have to convince them to redo these things over again. That could be tough.
Evan Brand: Now, well, I’m just smiling because of the safe analogy, you know, you always kill it with the analogies and I’m also smiling because I don’t know if it was your kids or my kids screaming, I’m like, I’m pulling my headphone out like is that my kids is that Justin’s kids. And, one of the things that I hope you guys love and appreciate about us is that we’re dads, we’re family men at the end of the day. And so, we’re working, we’re hustling, we’re grinding with our clients but we’re implementing this stuff into our family we’re helping kids, our own personal kids, we’re working with kids clinically. I’ve got kids that are 1 year old, 6 months old, 3 years old that are clinically working with us to get help. And so, we’re practicing what we’re preaching with our family too and I just want to highlight that because there’s so many people out there, so many practitioners that they were so focused on medical school or their practice that they never have the chance to even start a family, you’ve got these mid 40s late 40s upper 50s practitioners out there. They have no family experience and I think that’s where you and I are different because we know when you’re working on a gut protocol. Let’s talk about that for a minute. When you’re working on a gut protocol with a kid and you’re like okay, we’ve got terrible tasting tinctures that we can try, we’ve got some capsules that maybe mom or dad can open up and put into apple sauce. You know, you and I have personally and clinically dealt with the logistics of implementing this stuff so even if you’re gonna get this perfect gut protocol put together, the logistics of following it and getting your kids to take it, 3-year-old Johnny who doesn’t want to take the Artemisia, you know, it’s like, well how do you get that in. That’s the important thing because the proper labs is a step, the proper nutrition is a proper step, the protocol is a step, but the implementation of it and then what do you do after step one and then you if they react to that herb, how do you go to step 2, this is where the hand-holding is necessary. So, you know, when we talk about labs, I think, it kind of devalues the art of medicine a little bit because you and I have so much artist, you know, artistry to what we do and it’s hard to translate that just with a lab test because, you know, anybody could start running labs and like you said we’ve seen 5, 10, 15 labs come in from previous practitioners but they did nothing with it. So, the real art is when you take the protocol, you take it with, you and I are injecting confidence and we’re injecting motivation. I talked with the client this morning who said that she came to me because she was so afraid of her gut symptoms and she came out of fear but now we have basically transformed that fear into empowerment and education and the labs were a tool to help change that. So, don’t put all your eggs in this lab basket, they’re still amazing, you and I still run them on everyone but there’s other stuff that’s injected into that lab that really makes the magic happen.
Dr. Justin Marchegiani: Yeah. 100%. I think, the hardest part too is you work on dealing with the stressors, with patients. You fix their stress. You get your digestion better. You fix a lot of the microbiome. You knock down a lot of the bugs. Again, in the realm of Candida or dysbiotic bacteria, it’s still going to be there. You’re never ever gonna knock it out 100%. So, there’ll always be a small residual bit, maybe lingering in the background, way beneath threshold but if the stress starts to come back or if people start to add too much of food that’s questionable into their diet, sometimes these things can come back and the amount of flexibility, some kind of can follow the 80-20 principle. If they’re right 80% of the time on things 20% they have a little bit of flexibility. Some got to do 95.5 or some got to be 100 but just really try to make sure if they cheat, they still keep grain free anti-inflammatory etc., like last night, I went to True Food Kitchen for my birthday, and I had some of the, um, their chocolate cookies which inside the cookie, it’s like cassava and banana based. So, that’s great. If I’m gonna cheat, I’m gonna try to do it in a way that’s not gonna cause me to get bloated or gassy or have any skin issues or you know, digestive problems.
Evan Brand: Uh, a lady commented and Dr. J seems super energetic today. Yeah. He’s a birthday boy. That’s why he’s feeling better.
Dr. Justin Marchegiani: Oh, yeah. No problem there.
Evan Brand: So that’s good. Another comment here, I wonder which lab test should I run, uh.
Dr. Justin Marchegiani: I would say just here, out of the gates, regarding labs, I don’t wanna name specific companies on these videos because if we change it in the future and someone just watches the video, um, that they may just go to the old one. So, we’ll put links down below. That way, if we decide to change things in the future then you could just go look at the links down below and so my staff typically will update this in the next 12 hours or so. Just check back at the end of the day or tomorrow, we’ll have everything in there so just keep an eye on that. In that way, if something changes, um, it’ll be reflected in the description below.
Evan Brand: But here’s what we can say, we’re still gonna run a stool sample, now, maybe that type or whatever.
Dr. Justin Marchegiani: Cutting edges, some kind of stool testing is gonna be great, right? Organic acid is gonna be excellent. I love that because of the, I mean, every now and then I’ll get a stool test coming back and the gut issues look pretty good like not too bad nothing crazy but then you’ll see a lot of yeast because sometimes you miss the yeast on the stool test, that’s common or you’ll see 3 or 4 markers like Hippurate, benzoate or 2,3-phenylacetate right or D-lactate really hides. Okay, good, I’m glad I had this extra net to catch it because the stool test missed it.
Evan Brand: I had that last week actually. You know, I had a lady and I kind of got freaked out at first, you know, I was looking at the stool and I’m like, oh my God, this lady has every gut symptom in the book and normally on page 3, page 4 you’ll start to see some crazy stuff going on. In this lady, it was clean, oh man, like, is she crazy, I didn’t really think that but you know partly it is like, uh-oh, where’s it coming from, is this really her stool test. Then we get to the organic acids and holy smokes, as you mentioned, oxoglutarate, D-arabinose, tartaric acid, tricarbolic acid, everything was off the charts and I go, oh, thank you Jesus we have the answers on the organic acid. So, that’s why we love to run both urine and stool because certain things get missed and it’s the synergy of the information from the labs. You may find a parasite on stool and then you may find the Candida on urine then you really go, oh holy crap, that’s where it’s coming from. So, um, let’s hit this other one here. There was a person
Dr. Justin Marchegiani: I want to hit one of the questions. Anthony wrote to me there, thanks Anthony for the great feedback, and again guys, we’re trying to interact with you guys live and I want to answer questions live, so this is like I call it, uh, functional medicine improv, right? You know, you get your comedy shows, this is our functional medicine show so I appreciate that. Thanks for the feedback Anthony. Isabella writes in waking up distended, right in the morning. So, with that, a lot of times, you got to calm down a lot of the fermentables in the diet. If you’re waking up distended in the morning, almost always there’s a lot of fermentation happening in the gut and these gases are being produced. Now, there’s a couple of variables that you can do to help that. One, you starve it out by reducing all the foods that feed that. Two, you have to be able to break down your food because even if it’s good food, if you’re not breaking it down well, it’s gonna essentially have the ability to rot and rancidify and putrefy. So, you got to make sure enzymes, acids, and potential bile salts are addressed because HCl, hydrochloric acid, and bile salts, if you have low levels of that, those things in and off themselves are actually antimicrobial. They have a mild antimicrobial effect, not like oil of Oregano, but they have a mild antimicrobial effect. So, if you have, like, digestive distress and you have poor levels of these things, guess what, these bugs are more likely to grow and of course we have to come in there and do some killing, you know, making assumptions that like if you have a lot of distention like there’s no fiber, there’s no raw vegetables even though you read all these things have this big salad, you know, you could steam some of these things, you may want to look at low fermentable things that’s great. You may want to make sure your stress is good and you’re chewing your food up really well and you’re you know avoiding hydrating outside of an ounce or two of, you know, water to swallow and some supplements so that’s kind of your starting point. And if you wanna reach out, Isabella, you feel free to use the link down below, you can reach to Evan and I.
Evan Brand: Let’s read the rest of her comment here because I think it’s helpful for people. So, she said that she tested negative for SIBO, I’m guessing that might have been a breath test and she said she’s 21 years old and it affects her daily life. So, when I hear 21-year-old female, a lot of bloating as you mentioned, I think the veggies, I think cutting out leafy greens, no salads, maybe or
Dr. Justin Marchegiani: If you do it, keep them low FODMAP and steam it or sauté it like I’m pretty sure Bok Choy and Kale. That’s low FODMAP, if you sauteed that in some coconut oil or some ghee or some kind of good animal fat, you’d probably be okay but test it, right. I’m all about testing not guessing.
Evan Brand: True. True. So, I think about hormones, I think okay, she’s 21, right? This is a healthy fertility age. Is there some sort of issue with hormone imbalances? Are there estrogen dominance type issues as well? What about breast tenderness? What about PMS, irritability? Are there mood issues as well or is it just an extremely distended belly?
Dr. Justin Marchegiani: Now, in the history that’s gonna come out with a good history because you’re gonna see it cyclically happen typically premenstrual or typically ovulation. So, a good history will fret that out. Let’s assume it’s every day, hormones are probably not the root cause but of course we know we’ve already talked about it, chronic digestive issues will eventually cause hormone problems because of the inability to digest the nutrients to make the hormones overtime.
Evan Brand: Good point. And, the bacterial overgrowth which will crank up beta glucuronidase. That creates the recirculation of toxins. So maybe that. What about birth control too? Is that in the equation? I start thinking about that so
Dr. Justin Marchegiani: Birth control pill will, it definitely has an effect on, um, alkalizing some of that tissue in the intestinal tract and the vaginal tract. That’s why one of the big effects that you see with, like birth control pills is yeast infections, right? Because it’s shifting the pH. It’s also creating a lot of nutrient deficiencies. So, if you have birth control pill issues, they can definitely put you in that microbiome, um, area where it kind of goes the wrong way there.
Evan Brand: Yeah. So, hopefully that helps and as you mentioned if you wanna reach out, you can. Dr. J at justinhealth.com and me at evanbrand.com. With a stool and a urine and a good workout, we could probably get to the bottom of that. I would say that digestive issues are something you and I have the most experience of out of anybody that I know because all the people that have failed others then they come to us.
Dr. Justin Marchegiani: Absolutely. The hardest part too is once you kind of get on that straight and narrow, finding out how much latitude you have, right? Some people, they may not be able to do dairy afterwards. Some may still have to be grain free, they can’t even do rice or, um, oatmeal, right? So, some people they got to be a little bit tighter on their diet. Some can be a little bit looser. And it’s hard. The hardest thing I think is with kids because kids, I mean, I have two, a two- and four-year-old boys, right? And most kids in their age eat like crap. It is just like absolutely mortifying to see how most kids eat. And, normal and typical are two different things, right? So, people say, I wanna be a normal kid, I wanna eat like a normal kid. It’s like no, you wanna eat like a typical kid, like normal 60 years ago was a totally different diet than normal today, right? 60 years ago, everything was mostly organic. Kids ate relatively, you know, whole foods and there wasn’t all the GMOs and all the crap and all the excess omega-6 fats and trans fats and people were eating good proteins in every meal and we had actually home-cooked meals and home-cooked dinners. That’s totally different today, right? And so, typical and normal are two different things.
Evan Brand: Yeah. Not many seed oils or non-existent seed oils or go back a little further, go back 5000, 15-20000 years in United States, even just a few hundred, you read the native American stories, I mean those kids were eating Bison, breakfast, lunch, dinner, you know, what were having, they were having Bison. If it was a time where they maybe didn’t get a kill, they had pemmican which is gonna be like a dried meat product, maybe some tribes, they would integrate berries into it. But if your food has a brand to it, now there are some exceptions like there are some really good companies that make Bison meat and all that but in general
Dr. Justin Marchegiani: The jerky, yeah, there’s some good stuff, there’s some decent paleo granola. If you can handle nuts and seeds then that stuff’s okay as well.
Evan Brand: But in general, my point is if your food has a brand to it, it probably has some level of processed. Now, if you say a farm, like a farm name, I don’t consider that a brand. I’m talking about, like Kellogg, that’s a brand. If your food has a brand to it, it’s probably not something good. I’m not looking at the brand of my wild blueberries, I guess technically they have a name or a store but they’re blueberries. So, you just got to think simply and as you mentioned long term, there may be dietary changes but overall, I think a lot of people can get back to foods that they previously avoided or were previously afraid of, not to mention, people that are afraid of meat, so many people are afraid of red meat. We interview people all the time and they say, oh, I eat red meat a couple times a month, I eat red meat every day, like why, and oh well you know, my cholesterol or my heart or my doctor said this and so there’s still so much programming. I think you and I forget, now, I know you have TVs and you probably have some exposure to this but in general I don’t have any exposure to pharmaceutical ads and so I forget just how much indoctrination and programming of dietary information people have and so part of the art of what we’re doing too is just removing any of the historical programming, they’ve had about certain foods. I think some people freak themselves out so much, they’ve been told a certain food is so bad for them, they go into it, thinking if I eat this steak, I’m gonna have problems and they literally will put so much stress and emotion into the worry of food. That then drives further symptoms.
Dr. Justin Marchegiani: Yeah. I always start with you gotta have a framework on how you analyze any data or any concept, right? So, my first framework that I look at anything with is old foods don’t cause new diseases, right? When you look at most of the diseases we have today, the regular there routinely Neolithic, right? They weren’t at the same level that we saw a hundred years ago, right? Obviously, we had different problems back then because we didn’t have the same level of water sanitation, indoor plumbing, antibiotics which you know for like, you get a major cut, you had an infection, you don’t have antibiotics, you could die, right? So, we have that, that’s different. So, Neolithic foods cause most diseases. And so, when you look at good proteins and animal fats and these kinds of things, they have been eaten for as long as you can go back. So, those typically aren’t going to be the problem, right? It’s mostly gonna be the processed foods, the excess omega-6. And also, you know, the whole vegan bent that’s something that’s not really supported by anthropological data. You look at the works of western price so you look at people that studied indigenous societies, almost always meat was consumed when it was available. The only societies that typically didn’t consume meat were societies that didn’t have access to it. And if you look at the works of Western price when meat was accessible, it was typically consumed. It wasn’t like, oh let’s just not consume it. It’s typically, they didn’t have access to it and when they did eat it. And so, people that tend to do really good on a non-vegan diet are your ectomorphs, these are people that can handle lots of carbohydrates. It’s impossible to do a vegan vegetarian diet for the most part and not be very, very high carbohydrate and also, typically, you also got to plug in a lot of protein powders to do it well, whether it’s free form amino acids, whether it’s collagen or pea protein or rice protein or hemp protein, mostly having to plug in a lot of amino acids to get enough especially if they’re trying to put on muscle and be, you know, on the fit side.
Evan Brand: It’s hard to be Vegan, it’s easy to be an animal-based person, I’ll tell you that. There’s just a lot of hacking, have to do. So, Isabella chimed back in, she was a little bit behind on the live stream so she chimed in here. So, here we go, we got some more evidence guys. I hope you’re having as much fun as we are because this is like a, you know, on the fly functional medicine, uh, workup here. So, she said, loss of period for six months as well, mood issues like anxiety and racing heart upon waking irritability which is what I was thinking some kind of hormone stuff. I’m a bit behind wanted to input that so.
Dr. Justin Marchegiani: The problem with a lot of those symptoms, it requires me having to ask a very important question, I won’t ask that question but we’ll just say the meat of that question begins with a letter v and we’ll just let people linger on that and Isabelle, if you want to reach out feel free. I think we chatted in the part, so feel free to reach out, I’m happy to help you.
Evan Brand: Yeah. Yeah. That’s a very, very good point and would make perfect sense especially with the timeline here. I would be wanting to look at some blood work. You know, actually, I had a woman last week, 33 years old, loss of period, other issues, we ran her blood, elevated D-dimer that indicates breakdown of clotting so we’ll leave it at that for today but mid-30s women should not be having elevated D-dimer.
Dr. Justin Marchegiani: Yeah, and we’re speaking kind of like we are in a very, uh, discrete type of manner because we want to keep this information flowing to you, okay, so people out there hopefully you most, you mostly get that and you want to continue to see us on the air. That’s our goal.
Evan Brand: Here’s another question then you and I can wrap this up here in a minute. So, can gut health issues cause high resting pulse and arrhythmias. Let me tell you my personal experience and maybe we could chime in on the clinical side too but when I had gut issues when I had H. pylori, I was anxious, I had issues with my blood pressure. I had heart palpitations. I had panic attacks. I had all sorts of mood issues. I had heart issues. I had sleep issues. I had skin issues. So, 100%, gut issues can cause this.
Dr. Justin Marchegiani: Yeah. The bugs in and of themselves definitely can cause anxiety so you can go type in their scientific studies, type SIBO or H. pylori and anxiety, there’s definitely mental health association, connection with the two. Also, if you have digestive issues, you tend to have hydrochloric acid issues. When you have hydrochloric acid issues, you tend to not ionize minerals and absorb minerals optimally. The two big minerals that are intimately connected with your heart and heart rate and heart rhythm are potassium and magnesium and a lot of times people aren’t getting sodium and chloride as well. So, the electrolytes have to be looked at and potassium and magnesium have to be looked at and most don’t get enough, you need 4 7 00 of potassium a day, most get half that and so I have a product called potassium synergy that does about 13 00 per 150 in magnesium or so side by side. It’s really hard to get enough. Most supplements for potassium stink, they’re like 50 or 100 milligram capsules so you got to take like 15 or 20 capsules a day so sometimes, you need to plug in a supplement if you’re having issues, I mean you can go look at the most potassium-rich foods, salmon, avocadoes, sweet potato. Those are really good options of course, um, some animal products as well, are going to be right up there as well. And again, avocados have twice the amount of potassium as bananas, I know we’re kind of o a carb-centric society. If I say potassium, you’re gonna say bananas, right? But avocados have twice the amount.
Evan Brand: Yep. Good call. Good call. So, long story short, gut issues definitely cause other issues, mood issues are very common. Fatigue is also very common and so that’s gonna affect neurotransmitters so we would be looking at all that. We’d be looking at neurotransmitters, gut inflammation, um, secretory IgA. You can look at fecal fat. There’s a lot of stuff that goes into that, that may affect the high resting pulse. Also, seeing a lot of things right now with viruses and high resting pulse rate. So, if there was a current infection, previous infection, pulse rate could be there. You mentioned potassium.
Dr. Justin Marchegiani: Hydration, sodium chloride and then your potassium, magnesium. Those are gonna be your big ones out of the gates. And then also, blood sugar, you know, some people, they really get into a stressed-out state if they wait more than an hour or so to eat. And if you have digestions, a little wonky, you may want to start with something really simple like some gentle ginger tea or some collagen amino acids or something really light and simple in the morning and some electrolytes even before that.
Evan Brand: Yeah. Yeah. Good call. Sometimes, you know, herbals, I might come in with like motherwort or passion flower, valerian, some kind of like calming ginger.
Dr. Justin Marchegiani: Yeah. I was looking at the nutrients first because the nutrients could be actually root cause and the herbals will never be root cause but they are a palliative supporting mechanism, right? You know, it’s like, you can do passion flower or lemon balm or you can do a benzo on the pharmaceutical side. It’s like obviously the herbs are better and then even before the herbs the actual nutrients that may be deficient that are driving it.
Evan Brand: Very good at all. I’m ready to wrap this up, if you are
Dr. Justin Marchegiani: Herbs aren’t going to have the, you know, the side effects so I’m always down with supporting something palliatively if they aren’t going to have the side effects or you know any of the negative consequences like some of the meds may.
Evan Brand: Yeah. Well said. Are you ready to wrap this up?
Dr. Justin Marchegiani: Yeah. Great chat with everyone here today. I’m glad everyone’s on the chat interacting. We really appreciate it. Functional medicine improv is our flow here, uh, you guys wanna reach out to evanbrand.com for Evan, Dr. J here, myself at justinhealth.com. We’ll put links down below. If you’re seeing it on youtube, you know, great, excellent. If you’re listening to this on itunes or any of the podcast places, there will be a video link below. If you wanna see us interacting as well, there’s that as well. And phenomenal chatting. Anything else, Evan?
Evan Brand: Yeah. If people wanna chime in and they want to watch, if you guys are listening or if they’re on my podcast because we’ll upload these on my show as well. If you want to check us out here on video, give or take somewhere around 11 to 12 eastern on Mondays on Dr. J, justinhealth YouTube channel. So, if you wanna look for us, join the party. Look up Justin on YouTube justinhealth, Justin Marchegiani, Dr. J something like that. You’ll find him on there and, uh, we’ll put the link in the show notes too. So, if you wanna join the YouTube community, you can. There’s what 60 something thousand on there. So, that’s pretty
Dr. Justin Marchegiani: Also on Rumble, also on Betshoot, also on a couple other places. So, we’ll put the links on the websites so you can get the banners, get the links but Rumble’s our new one that we’re going to just get more exposure, people.
Evan Brand: And you’re reuploading the YouTube videos too there, right?
Dr. Justin Marchegiani: Yep. You got it.
Evan Brand: No live function on there or anything yet?
Dr. Justin Marchegiani: Not yet. Not yet.
Evan Brand: Okay. Okay. All right, well, you guys take it easy, we look forward to helping you get your gut health back, just stay patient and don’t give up. And so, we’ll see you next week.
Dr. Justin Marchegiani: Take care of you all. Bye now.
Dr Bernd Friedlander – Immune Support, Extend Life Span, Best Supplement, Perfect Diet- Podcast #353
In this video, Dr. J and Dr Bernd Friedlander talk about immune system in general. Immune system is the natural defense and it’s an complex network of cells, tissues, and organs that band together to defend your body against invaders. Those invaders can include viruses, bacteria, parasites, even fungus, all with the potential to make us sick. They are everywhere – in our offices, homes, and backyards. A good immune system protects us by first creating a barrier that stops those invaders, or antigens, from entering the body.
The immune system can acknowledge millions of contrasting antigens. And it can make what it needs to eliminate nearly all of them. This detailed defense system can keep health problems ranging from cancer to the common cold at bay when it’s working correctly.
Dr. Justin Marchegiani
In this episode, we cover:
0:00 – Introduction
2:20 – The issue behind immune stress
6:25 – Things to know about natural light
17:04 – Who are good candidate for extra glucose?
26:37 – How and when does adding sugar good?
46:46 – The important role of full spectrum light
Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house with Dr. Bernd Friedlander. Dr. Bernd Friedlander has been around, uh, the health space for I’d say more than 50 years. He’s been a health consultant to many professional sports teams and he’s a, let’s just say a quite a figure in the health expansion national health community in the Silicon Valley area for many many decades. Bernd, how are you doing? Welcome to today’s show.
Dr. Bernd Friedlander: Thank you. I appreciate it.
Dr. Justin Marchegiani: Well, tell us a little bit more about yourself. You’ve been around the block, I mean professional sports, natural health kind of life extension community for quite a long time. How long has it been and how did you get into the space?
Dr. Bernd Friedlander: Um, I’ve been sort of like when I graduated from college, I got into physical therapy and I was an assistant physical therapist for about ’72 – ‘78 and I worked with, you know, clients with structural injuries and back problems, neck problems, and physical therapy and rehab and recovery from ‘72-‘78. And then I went back to chiropractic school in ’78 and graduated in ’81 and I started working out at UCLA and I was asked by a number of coaches and athletes to work with them since they found out that I was, my background was physical therapy nutrition, which I picked up in 1972 and my other background was chiropractic. So, it, you know, marriage was perfect and I was also a track and field runner in college and I also played, um, semi-professional soccer. So, I had a very good foundation and tool and so, because of that, I started working with UCLA athletes and then later on, they asked me to come in and start working with the Olympic team and develop them for the ’80 – ’84 and ’88 Olympics and we have people from all over the world coming to us at UCLA to work out with us and to perform with us and to learn about that we have and nutrition and all that.
Dr. Justin Marchegiani: Okay. Very cool. So, you’ve been even in this space for 40 – 50 plus years. That’s amazing. Let’s kind of dive in, we have a couple of topics that we chatted about ahead of time that we really wanna dive into. So, immune stress is a big issue that we have today. A lot of immune stressors from our environment from food to different infections, etc. You know, one of the top things you are doing to help improve your immune system, like you know, let’s forget about hydration obviously getting some sunlight, you know, good whole food diet, you know, just kind of all the foundational things. What things that people talk about, um, that you want to add here, people that haven’t, different things, people haven’t talked about enough that you wanna add in that really would help improve people’s immune function and stress?
Dr. Bernd Friedlander: Yeah. Well, the first thing I look at is quality of life they have, how do they sleep at night, how do they get up in the morning, how much indoor activity are they getting in front of a computer, a cellphone, all these EMF is affecting our own system, our immune system. It’s, um, not able to function as well as we want to so I just tell them to get out in the sun in the morning, in the afternoon and in the evening, go for walks, just be in outdoor not indoor. You know, we were trained to be outdoor most of our lives. Our ancestors are outdoor. We developed from, uh, from the sun and from nature and from the ocean. And that’s why we got here. And by ruining us by being indoor, we’ve changed the attitude of our DNA and RNA and how it functions and that’s why we’re seeing a lot of people getting sick today. It’s not getting out in the sunshine, not developing natural vitamin D. So, I have to tell them to take additional vitamin D everyday and some vitamin A and E and I always include aspirin at night because that promotes many anti-inflammatory mechanisms and it has a tremendous benefit in our blood, in our circulation, in our mitochondria. And first thing I do, because of my background, I wanted to know who we were, how we did get to this stage, where we are today as humans, how did our brain develop and that’s important and it was all related to four billion years ago. Our mitochondria, an organelle bacterial mitochondrion that created everything and started the living systems life in on the planet earth and plants. Everything is developed through these mitochondria and so I went into it and I wanted to research it so much as I can become a sponge for this one organelle, how it works and how important it is. And there’s a fellow named Douglas Wallace, who wrote many articles and is like the father of mitochondria. So, by researching him and reading about him and also about repeating his work in mitochondria, I started learning that everything is based on this one organelle, how do we improve that organelle that mitochondria efficient energy that’s what gives us energy to every cell in our body. And I wanted to learn everything I can about what makes these mitochondria efficiently. An immune system functions on mitochondria, stem cells function on mitochondria repair, regeneration and all disease and aging is a factor due to this efficient mitochondrial function. And cancer cells also are involved because of the mitochondria, how effective is the mitochondria is producing energy, it’s oxidative metabolism and that’s the foundation.
Dr. Justin Marchegiani: Okay. So, you get put a couple of things out there, I want to just break them up one by one. Some people maybe listening to this saying, “hey I can’t get outside that many times a day, what can I do to improve, uh, healthier monitors, low blue light, low flicker light, full of spectrum lightning”. What can people do to kind of change their office and their house where they’re out all day to improve light, um, um, uh, light activation via says, um, say like I have full light spectrum on now? What can people do inside their home to improve light, if they can’t get outside as much?
Dr. Bernd Friedlander: Good question, Justin. I see a lot of patients, uh, there are in cubicles, you know, in dark rooms working. The first thing, I tell them is get close to a window or get enough natural from the sun by being exposed to, uh, somewhere that has windows or in condensing lights that are natural lights, you know. We want to bring back the natural state of light closes to the sun, so we can bring. All these LED lights are not natural. We’re not getting the natural lightning and like you said blue light is dangerous and that’s where the computers and cellphones and nighttime television and nighttime to, you know, working on texting or using cellphones for, you know, um, you know, being on it too much is creating problems and neurological problems as well and that’s why people can’t sleep well because they’re bombarded by blue light which is dangerous to our brain.
Dr. Justin Marchegiani: There are some good monitors out there that are eye care monitors that are low flicker, low blue light monitors. Those are great, I have three big ones in front of me that will help decrease the flicker and the blue light, the lighting I have here are full spectrum, so you can look at investing some full spectrum light bulbs to plug into those sources where you have lighting in your office. That helps a lot. Anything else that you personally, um, apply or do in your home or office?
Dr. Bernd Friedlander: Well, I also to get them out for several minutes at a time. So, if they’re indoors, just go outside for about 5 – 10 minutes, at least expose yourself to some light and then you can go back to work. Don’t stay indoors all day long without exposing yourself to natural light. Because that what creates mitochondrial function, that’s what creates, um, all that natural biochemical process that we need to perform better.
Dr. Justin Marchegiani: Okay. That’s great. Let’s talk about the mitochondria. You kind of already hit it right? The mitochondria are essentially the powerhouse of our cells. They generate ATP, which is like the cellular currency of our body. Vitamin D or I should say sunlight helps charge it. What about diet? There’s a lot of, I should say, a lot of, um, conflicting ideas about it right? I’ve seen many places where the mitochondria runs off of glucose and creates dirty fuel that we really wanna be using the carnitine shuttle and using fatty acids and being a little bit more ketogenic to run the mitochondria and not fueling up with too much carbs. I know guys like Ray Peat talk about more using orange juice and more refined juices. What’s your take on that? I know you’re a little bit more controversial on some of the carb stuff but go ahead.
Dr. Bernd Friedlander: Um, well, I’ve been, you know, I’ve been following Ray Peat but I’ve also had a chance to meet and work with, um, Linus Pauling and he was a big advocate of orange juice and he explained to me the importance of orange juice with the flavonoids, the vitamin C is natural in orange juice. And the flavonoids, like Apigenin, Arginine and Naringin and Fisetin. These are very important compounds that increase the electron flow into the mitochondria so there’s efficient ATP production and CO2 is the byproduct of efficient ATP. Lactic acid is inflammatory. It becomes an inflammatory nature, and that’s how cancer cells derived themselves by lactic acid.
Dr. Justin Marchegiani: Is lactic acid a powerful stimulator for growth hormone too? Don’t we make that when we exercise as well.
Dr. Bernd Friedlander: Um, we do but lactic acid causes inflammation in our body and we get cramps and deterioration and joint problems and we break down cartilage and ligaments and tendons. And just simply I used to do with my athletes, I used to give them baking soda, a quarter of a teaspoon to a teaspoon every day, twice a day to help them recover from lactic acid so they have more energy and their recovery is much faster and they don’t break down as fast and then I started adding the collagen bases, the vitamin D, the calcium, and the vitamin C from orange juice. That all helped. So, what I wanted to look at is how do we increase the oxidative metabolism and reduce the reduction state. So, you have oxidation and you have reduction state. And the reduction state is the byproduct of ATP burning in our body for fuel and energy and we wanna be able to bring back the oxidative state so we have the electron flow that breaks the food that we eat into energy which is glucose and that glucose is the metabolism of the gasoline of our body that fuels us and allows us to produce and function and be able to repair ourselves.
Dr. Justin Marchegiani: So, what kind of glucose sources are we talking in, um, from fruit which is gonna be mostly fructose but some glucose or starch which will be more glucose. I mean we’re not advocating lots of refined sugar or processed grains right. What kind of sources and then would this still be a good idea if someone’s maybe more sedentary and insulin resistant? Are these people from who are more flexible, metabolically flexible and more active, how do you make that prescription?
Dr. Bernd Friedlander: Well, myself in working with many patients, many athletes, I found that one of the best things I did in the morning for my athletes to perform better and I work with the Rams, Raiders, Lakers, uh, you know, all these, um, Kansas City Chiefs as you can sees in the background, I have Howie Long back there, who was one of my patients, is I found that if I can increase uncoupling protein, increase mitochondria, what increases mitochondria, it’s what we eat and the supplements we take like anything that we, uh, if we have coffee. We did a study and we found out that coffee with sugar and cream, actually the athletes perform better and we saw an increase in mitochondrial function. And if we, did it with tea, we found that if we put sugar and cream of milk, we found the same result. So, it’s that, process of in the morning, have the orange juice, have your coffee with sugar and cream and the same thing with tea, we need sugar to operate on glucose metabolism.
Dr. Justin Marchegiani: Is these for every person, I mean obviously you’re a lean kind of more ectomorphic kind of body type, you’re active. So, for you, is that makes sense but that makes sense if you’re overweight though as well? And you’re more insulin resistant, would that be a good recommendation for them or should we allow some of these people to go off of gluconeogenesis to help convert maybe glucose in their body via protein, which is more time released? How do you make that more specific?
Dr. Bernd Friedlander: Working with, you know, going back to this ‘80s, ’81, ’82, I wanted to study on performance and recovery. That was my job at UCLA. That was what given a job and I worked n caloric restriction diet, I worked on you know mitochondria performance, uh, with the university. And what I found is that, since we start consuming too much carbs, you know pastas and breads and flours and iron rich foods, we have caused more obesity and diabetes and heart attacks. When the oils came into play, all the seed oils from canola to sunflowers, pollock, cotton, all those, we had an increase in heart disease and diabetes and cancer. So, the two things we saw was, when we start producing grains and pastas and breads and flowers, this is a new part of our diet, you know, it wasn’t in a thousand years ago or a hundred thousand years ago, we were a gatherer and a hunter and we ate from the roots and we ate fruits. So, when we changed our diet, we saw a difference in disease stages increasing. And so, people who are, uh, overweight, it has nothing to do with sugar. Its people are not getting enough calcium and vitamin D in their diet, they’re consuming too much phosphorus and there’s a gene called Klotho, k-l-o-t-h-o, and that gene regulates kidney function, biologically all our function is controlled by that one gene, uh, upregulating calcium into our bone. Osteoporosis, arthritis, heart disease, cancer, if we have too much phosphorus, we’re removing calcium out from the bone, and we’re generating as an inflammatory condition in the body and that’s why we have osteoporosis, arthritis, and cancer and heart disease. But if have more calcium in our diet from dairy products, from eggs, from cheeses and predominantly those kinds of foods and they’re higher in amino acids utilization foods. You know, we found that eggs and milk are the two highest in AAU, amino acids utilization, in our body and by consuming those kinds of foods, we found that people are healthier.
Dr. Justin Marchegiani: So, what about, so, you’re talking about, um, calcium is good, we need more of that. What about magnesium? Where does magnesium sits on that hierarchy?
Dr. Bernd Friedlander: It is essential. There’s no doubt because of cardiovascular disease and also it helps calcium absorption into the cells, into the bones, into our bone marrow.
Dr. Justin Marchegiani: And other patients that you would say, you shouldn’t be doing these orange juice, you shouldn’t be doing the extra sugar, who are these people? You’re dealing with a lot of athletes, someone who’s 30, 40, 50 pounds overweight and more insulin resistant, would you say hey maybe be careful on that stuff?
Dr. Bernd Friedlander: I’ve taken on a lot of patients, uh, since I retired from chiropractic and I have a group of people that I work with and I have a friend at Ohio State University food and science department and he and his mother have diabetes. They’re not active, you gotta understand, so when I started giving them more sugar fructose or sucrose in their diet, I was able to completely reverse their diabetic problems.
Dr. Justin Marchegiani: So, I would, I’d wanna know what was their diet before. Are you reducing the amount of glucose because, we know diabetes has to do with high amounts of, um, glucose in the bloodstream, so there tends to be a resistance to the insulin right and so we have glucose accumulating, so how does giving more of that actually lower your glucose level? Physiologically that doesn’t make sense to me.
Dr. Bernd Friedlander: Okay. I had a chance, there was a fellow at UCSF and he and I spoke about two years ago right before the COVID came on, we met at, uh, we met and he was doing stem cells for, uh, the pancreas, how to improve, uh, insulin function again, how we repair the body back to natural state where we don’t have to give them diabetes medication and I had, uh, I asked them one thing, would you do me a favor when you do a stem cells, would you do me a favor, increase the sugar intake in the patient. He reported back to me that he double the effects of the stem cells in diabetic patients and we came into conclusion that glucose and fructose improve the mitochondrial function and produces insulin more efficiently. And he was, he didn’t even thought about that, he didn’t even think that glucose was that essential and
Dr. Justin Marchegiani: And that’s in the presence of stem cells, right? What if you don’t have stem cells because I mean we know that, we know that, um, type 2 diabetes over 20,30 years, we know beta cell function of the pancreas and insulin production actually drop and they become insulin dependent over a long period of time. So, if that theory were to make sense, why are people becoming insulin dependent over decades later.
Dr. Bernd Friedlander: I want you to go back and study a guy named Peori and Bronk, B-r-o-n-k and Peori is another fellow. One from France and one from England. Ray Peat has it in his newsletters, I reviewed their studies. They gave 16 ounces of sugar to diabetic patients and they give a collagen type of diet with, you know, oxtail soup or a lamb shank, things that were high in collagen. They completely reverse all diabetic patients. I have taken retired athletes, you know, had diabetes and heart issues, okay. I studied their diet, I looked at them and these guys are not like active anymore. They’re not like football players or athletes that they were when they were young. They had all these issues with, uh, diabetes and heart disease and I look at their diet and I stopped them having them have breakfast with just toast and peanut butter or oatmeal or you know, without protein. I asked them to start using orange juice, apple juice, grape juice and sugar in their coffee and tea. I monitored them. I was able to get them off any diabetic medication completely and these about 30 to 40 people I monitored and I have so many people that are, uh, one person came to me, um, that was, uh, a fellow who started, was involved in a company that got the solar technology going especially in one of the ballparks that the 49ers played and he was a retired football player as well and he had diabetic problems and he was gonna be put on insulin and he asked me if I would work with him and I said, absolutely. He trusted me enough because of other people in the family that use, uh, were, you know, using me for nutritional consultation all recovered and one of them was a lung cancer patient who recovered 100 percent. And I put them on this higher sugar diet meaning fruits, orange juice, coffee and sugar and all that and his doctor in San Jose says, a month later, two months he came back and he says all your blood report came back perfect. He’s never seen anybody recover that fast.
Dr. Justin Marchegiani: Well, it’s interesting because I have, I have hundreds of, you know, observations the opposite right? Restricting a lot of those sugars and allowing the body to start burning more fat and then the cells become more sensitive. I guess, the question I would ask is, what was their diet like ahead of time because if someone’s diet’s worse and even though you’re adding all this sugar it could be less sugar and then three would be, how much activity are they getting? Are they burning it all up with their muscles and mitochondria right after they consuming it? Are they sitting all day doing an office job and still, um, maintaining insulin sensitivity while being sedentary?
Dr. Bernd Friedlander: Yeah. No, I got it. I understand, you, uh, nutrition and diet is very important. What I look at, I look at things that causes oxidative damage to the thyroid and to the mitochondria. What are they? High phosphorus foods, unsaturated fats, okay, those and, and overload with iron. Too much iron, causes damage to our blood cells okay. And so, I’m looking at increasing cytochrome oxidase enzymes by increasing copper, by increasing NAD output, so that’s your B3 niacinamide, your B1, B2. All of these are important. Vitamin D and vitamin A and breaking, and having them eat more of high protein, high cholesterol diet. In my study, I did a lot of research in longevity, and the people that I’ve study and I just lost one patient, three months four months ago, it was on national television. She was 114 years old. Her diet was very high in dairy. That’s how I had her on since ’92 and she was eating that before. Her diet was basically milk, cheeses and a piece of bread. That was her diet pretty much and her coffee and sugar and that’s it. And so, I’ve been looking that for a long time, is studying people that live the longest like in Bolivia, in the area of Georgia and Turkey, and what do they consume is they consume mostly dairy products and they consume things that are natural. They don’t eat much of the pastas and breads and grains and oat meals because that’s not their diet. So, I look at their diet, I wanna make sure if I can raise the NAD+ levels, you know, the oxidative metabolism, that’s the secret. How did I do that? I studies with Douglas, uh, I studied with so many of the great minds out their in mitochondrial research and Klotho research, and I found out that glucose metabolism is a secret, how do we increase that and how do we bring down unsaturated fats, increase saturated fats because high cholesterol actually increases longevity and most of my..
Dr. Justin Marchegiani: It’s an antioxidant
Dr. Bernd Friedlander: Yep. It’s an antioxidant. It helps with brain development. It helps with libido and hormones. And I put everybody at not to worry about high cholesterol, I put them in a diet that’s rich in cholesterol, saturated fats, steric acid, all these things that we need to develop with. And I found by doing all of these with my patients and increasing the glucose metabolism and giving them sugar because most of my patients are very fatigued, they’re tired, they’re depressed, they have anxiety issues, and by just changing them, increases some sugar in their body, I’ve been able to see a difference in all of them.
Dr. Justin Marchegiani: But I would imagine though, these people that are already sick though, probably have a lot of sugar in their body already. They’re probably eating lots of processed grains and flowers and sodas. So, my chole rationale on this whole thing, how does adding more of what’s already there, how does that fix anything because they’re already eating a lot of processed grains and processed sugars, how does adding that in a different form fix it?
Dr. Bernd Friedlander: Okay. You set the magic work. We’re eating too much grains, pastas breads, what is, those are very high of what? Phosphorus foods.
Dr. Justin Marchegiani: But they’re also going to break down the sugar in the body, they still break down the sugar.
Dr. Bernd Friedlander: Yes. They break it down differently than if I eat a fruit, okay. If I eat a fruit. What is around that fruit? Minerals.
Dr. Justin Marchegiani: Potato fiber. Fiber as well. Some vitamin C and bioflavonoids.
Dr. Bernd Friedlander: Yes. So, If I’m eating that, I have sugar from a natural source that is not converted, doesn’t have anything to do with phosphorus. Phosphorus is one of the leading causes of diseases today and I’ve studies the Klotho gene from universities, from Stanford, from UCSF, from UCLA and I’ve learned that most of the grains and pastas and breads and processed foods are very rich and high in phosphorus and we’re losing vitamin K, we’re losing calcium in our body and it’s affecting vitamin D levels. And that’s why I agree with you, these processed foods are not our, uh, the foods that we should be eating and they’re not nature, you know, they’re not coming from nature.
Dr. Justin Marchegiani: Isn’t there a natural ratio too with calcium, phosphorus. So, is it the fact that phosphorus is a problem or is it more that we’re not getting enough calcium to combat the phosphorus?
Dr. Bernd Friedlander: Both. You hit it both.
Dr. Justin Marchegiani: So, if you’re getting phosphor, because you’re going to get phosphorus in animal products too, right? You’ll be getting in meat so, we’re not saying meat ‘s bad, you’re just saying make sure you get enough calcium to balance it off is that what you’re saying?
Dr. Bernd Friedlander: I don’t eat much meat anymore. Okay. I’m learning..
Dr. Justin Marchegiani: How much meat are you consuming but you’re still doing a lot of collagens though, right?
Dr. Bernd Friedlander: I do collagen but my predominant diet is now shellfish
Dr. Justin Marchegiani: Okay. So, you’re still doing animal protein, you’re just choosing on the crustacean side. You’ve got it.
Dr. Bernd Friedlander: I’m using more copper rich foods in my diet because cytochrome oxidase enzyme, a complex for, is essential for mitochondrial function and we’re not getting enough copper rich foods anymore. We’re getting too much iron, we’re getting too much phosphorus, we’re not getting enough copper in our diet. So, I’m choosing foods that are higher in copper and less in iron and less in phosphorus and I see a difference in myself. You know.
Dr. Justin Marchegiani: But I know for a long time, you were a big fan of grass-fed meat. Are you still a fan of grass-fed meat?
Dr. Bernd Friedlander: No. I think, grass-fed beef, if you’re gonna go for meat, grass-fed is the only one because, it is higher in vitamin E and less in unsaturated fats than the hormone or the estrogenic meats that we’re seeing today because of the hormones and they [inaudible]
Dr. Justin Marchegiani: The hormones. And then also you’re getting a lot of goof fatty acids because these grass-fed cows, they’re essentially bioaccumulating the GLA fats from the grass, correct? So, you’re getting a really good high quality, um, uh, I think saturated fat from a lot the, um, fats that are concentrated from the grass. Is that correct?
Dr. Bernd Friedlander: Exactly!
Dr. Justin Marchegiani: So, you talked about these polyunsaturated. Why are these fats so bad, obviously, the processing of a lot of these fats whether it’s canola or soy, etc., damages a lot of them, right? And so, once they’re damaged and oxidized, they essentially create our building blocks for our membrane. So now, we have a really crappy cell membrane it’s depleting our antioxidant reserves. So, it’s depleting vitamin E, vitamin C. Is that correct? And these fats stay in our cells for a long time. Can you talk more about that?
Dr. Bernd Friedlander: Okay. In lipid chemistry at Stanford. I had a chance to meet several people there and at the Back institute. And I was asking them questions about cell membrane and mitochondria, and Linus Pauling Institute. They told me in their research that if it’s not saturated fats, if it’s not mono or medium chain triglycerides, anything that is high in unsaturated fats causes cell membrane oxidative damage to the mitochondria, uh, lipids okay, and they become oxidize and become damage, the RNA and DNA of the mitochondria gets damaged. And so, all unsaturated fats will do that to the, um, mitochondrial lipids, okay? And, um, I read several, major published articles on it and also not only does it damage our mitochondria. It also damages our cells in all other parts of the body and parts of the brain as well. And it causes oxidative damage to the thyroid. The thyroid is so important. It’s the organ that controls metabolic function, hormonal function, metabolism, everything. Polyunsaturated oils damage the T4 – T3 conversion. Okay?
Dr. Justin Marchegiani: Okay. Yeah. Make sense.
Dr. Bernd Friedlander: And so, every..
Dr. Justin Marchegiani: Probably effects the autoimmunity, right? Because most thyroid issues have autoimmune component. So, if you drive these polyunsaturated that are damaged, you’re probably just driving more inflammation, right, and you’re depleting a lor of these antioxidants which are anti-inflammatory as well.
Dr. Bernd Friedlander: You’re absolutely right, Justin, that we’re seeing an increase in inflammation due to these fats. In nature, we weren’t using oils from seeds. That’s something else. Seeds were made to grow things. They weren’t made to eat and..
Dr. Justin Marchegiani: Or if we ate them, we soaked them. There was a way that we try to deactivate a lot of these anti-nutrients and lectins via certain methods.
Dr. Bernd Friedlander: Yes. You mean sprouting?
Dr. Justin Marchegiani: Yes. Exactly. Yep.
Dr. Bernd Friedlander: So, that’s the other problem with the, um, with the unsaturated fats and there was a lot of, uh, Gilbert Ling showed that it was causing a lot of, uh, cell membrane issues to and, um, the other thing also not only that but it can, it raises estrogen in our body and estrogen is a promoter of growth of cancer and it’s also an inflammatory marker and lowers oxidative metabolism in the mitochondria. Vernon Stevens at Ohio State university and Cleveland, um, cancer clinic showed that estrogen is a predominant marker of all cancer cells. It’s in the cell membrane of all cancer cells and he showed that in his studies that estrogen leads to all these processes and by reducing unsaturated fats, therefore reduce some of the estrogen. By increasing progesterone and DHEA in our diet, we also lower estrogen. And estrogen can cause many oxidative damages, inflammation and raises serotonin and histamine and we have autoimmune disease from that as well.
Dr. Justin Marchegiani: Makes sense. Now, with estrogens, are you also worried about aromatase in men for instance high levels of insulin primarily driven by too much sugar. Are you worried about aromatase causing that high level of estrogen and thus increasing cancer risk n men for instance?
Dr. Bernd Friedlander: Can we put a hole for a second? I have the people here. Hold on.
Dr. Justin Marchegiani: Sure, no problem, we’ll pause it really quick here. Or actually, I’ll just, I’ll keep chatting here while you, uh, jump over. So, it’s a couple of things that we want to highlight here, mitochondria, very important, I mean, I guess some of the things that Dr. Bernd and I may disagree on is about how much glucose a person needs. I would say out of the gates, um, glucose you can get away with more processed glucose and more refined sugars, the more active you are and the more genetically you ten to be more towards an ectomorph, right. Look at Michael Phelps back and I think it was maybe, two Olympics ago, they showed his breakfast or what he ate during the day. It was like pancakes and junk. I’m just saying, it was 10,000 calories, I was thinking, I’m like man, if that guy actually ate 10,000 calories of food that was more nutrient dense imagine how much better he performed. But again, when someone’s that active, they can deal with all the refined carbohydrates and sugars and they can handle it. Now, again, if someone has a gluten sensitivity and, uh, other food allergens such as dairy and cheeses that maybe problematic and that may cause IBS and other types of issues. So, I would say carbohydrate loads should really be dependent upon on how active someone is, um, their genetic predisposition to be able to handle that high level of carbohydrate and also with their what their activity level is. Some people they consume a bunch of carbohydrates bunch of pasta. They are prone to getting tired. Some eat a bunch of glucose and pasta and they actually get more active. Now, I would say also better to do things that are more starchy, squash, sweet potato, an anti-inflammatory because gluten sensitivity is a big deal, uh, the more gluten that you’re consuming and the more sensitive you are to it, the more that may drive inflammation, uh, create gut permeability issues and also, um, increase chance of autoimmunity and so we want to choose safe starches that are gonna be anti-inflammatory, nutrient dense and low toxin. All right, he’s back. I was just chatting with everyone here as we go. So, let’s just kind of dive into the mitochondria, you mentioned aspirin. Now, are you worried about any of the side effects of the acetylsalicylic acid which is essentially is aspirin and then could people also do white willow bark as well if they wanted to avoid the actual pharmaceutical maybe due to the actual bark it said? And are you worried about those side effects?
Dr. Bernd Friedlander: Not at all. I’ve been using aspirin for I’ve got 40 years for now.
Dr. Justin Marchegiani: For listeners, aspirin is derived from white willow bark. So, if you want to try it, you can also get the actual whole herb, the whole bark, can do it that way too. Go ahead.
Dr. Bernd Friedlander: So, about 1984, when I was working with, uh, Olympic athletes then I became, uh, I worked with the Raiders and Rams that year and then Lakers, the following year. I studied from a cell physiologist at UCLA. How to improve, you know, mitochondria, uncoupling protein, energy into the, uh, individual performance. And there was a study that somebody showed me that, um, aspirin helps with coffee in raising uncoupling proteins. So, when I gave people aspirin with coffee, with sugar and cream, they doubled their performance level. It was almost like a steroid they said. It was so much they couldn’t believe it. Not only that, we saw, uh, less injuries in our athletes. Our injuries levels were going down dramatically. So, we knew it had to be what the aspirin as well because weren’t getting the strains and strains of calves and ankles, that you know, in athletes that were performing.
Dr. Justin Marchegiani: So, hold on. One second, what does that mean uncoupling proteins. Can you kind of break that down what that means?
Dr. Bernd Friedlander: That means your improving the electron flow into the mitochondria. You’re getting more, new, uh, ability to take electrons and oxygen and there’s a chemical reaction in the mitochondria, there’s a spin there that goes on. The ATP spin, you know, that gives us that spin to make energy in the mitochondria.
Dr. Justin Marchegiani: And what’s the mechanism is that from aspirin decreasing inflammation and improving just the flow, it’s improving the blood flow of these nutrients? What’s the mechanism?
Dr. Bernd Friedlander: It has to be the combination of the coffee, the caffeine,
Dr. Justin Marchegiani: Yeah. The alkaloids
Dr. Bernd Friedlander: the high magnesium and the anti-inflammatory mechanism of the coffee and the aspirin that increased that electron flow through the cell membrane and it created a faster spin, so you’re getting more efficient ATP production. And you know, aspirin is also can lower fatty acid sequences which is a major factor in all cancer cells. It’s Otto Warburg says, if you don’t have sufficient oxygen to, uh, as a respiratory function in a cell, then you’re not gonna have efficient energy and cancer cells don’t have efficient energy. They break down to lactic acid and that’s the problem. Well. Aspirin protects us from the lactic acid production, that’s another factor and helps with raising CO2, carbon dioxide, which is the byproduct of energy and why we train in high altitude is because we want more CO2 which helps us in energy and metabolism and this improvement and quality of endurance because of steel too and so we found that aspirin also helps with raising CO2 levels which is essential form more energy and recovery from injuries and all that.
Dr. Justin Marchegiani: Okay. Well, anything else you want to leave the listeners with? And by the way would you recommend just any day generic baby aspirin or do you have any brands that have less fillers or dyes or preservatives in there?
Dr. Bernd Friedlander: I go and I want you to have. I just get Walgreens brand. Their brand, it’s aspirin Walgreens or any brand that’s not, you know, like bears it’s I see less recipients.
Dr. Justin Marchegiani: Okay. And if people wanna still get that benefit, they could still try to find some White Willow bark which is what aspirin is made from. So that’s another option natural alternative. If someone wants it to be a little bit more natural in their approach that’s a good option as well.
Dr. Bernd Friedlander: About 13 years ago, I was lecturing at an anti-aging conference in Las Vegas and San Jose, and one of the cardiologists, who was also lecturing, we started talking about the importance, there was a lecture on aspirin at the same conference by one of the scientists at Bayer. He showed that aspirin increases a gene called Foxo, f-o-x-o, which is a longevity gene that’s found in longevity people. And aspirin increases this function of Foxo gene to be more efficient and to keep it from burning down or help to over express it. So, we found that it works phenomenally well. And we went to that conference and we saw all the values of aspirin. It helps with bone growth and bone development and cartilage repair and lowers inflammation, increases CO2 levels. The cardiologists, I asked them, how does this work in your sense of understanding of the heart and the blood flow. He says that aspirin protects us, if we take it every night, from developing a clot, from developing a stroke, from platelets aggregating each other, from oxidative damage.
Dr. Justin Marchegiani: But, what would you recommend other things like systemic enzymes or higher dose fish oil, would you recommend other natural things or curcumin or ginger first or do you really think aspirin is just as good or if not better than those natural compounds too?
Dr. Bernd Friedlander: I have studied every herb out there with Elizabeth Mazzeo. She’s the world leading expert in inflammatory plants. Aspirin was by was far, the only plant, the only natural thing that has prostaglandin 1, prostaglandin 2, which is COX1 and 2 inhibitors. There’s not a compound out there that inhibits both prostaglandins 1 and 2 and many do 1, many do 2, but nothing comes close to doing 1 and 2. Boswellia was the second most powerful under aspirin, Boswellia.
Dr. Justin Marchegiani: Boswellia, okay, which is essentially Frankincense. And were not putting things like Ibuprofen or NSAIDs in the same category that increased chance of ulcers and liver damage, right? I mean those kill about 20 thousand people taking a year. Taking correctly, they work great but they have some side effects. You wouldn’t put aspirin in that same camp, right?
Dr. Bernd Friedlander: No, aspirin by far so much better because it doesn’t cost liver damage and the other, you said something very interesting, all these other ones, they have a problem, they cause a hypometabolic function. They don’t improve mitochondrial function. That was the second thing that we did a study with. In lipid chemistry is what increases mitochondrial function and aspirin seems to be the only one besides Fisetin, which is gonna be the next future, that increases electron flow into the mitochondria. And that’s what we’re seeing and I take 325 milligrams every night before I go to bed. That’s what the cardiologist told me that protects us against strokes, blood clots by, uh, you know, anything that causes platelet damage or anything like that, 325. 81 did not do much at all in that.
Dr. Justin Marchegiani: Okay. Okay.
Dr. Bernd Friedlander: And then, I have many athletes still that I work with, I haven’t taken aspirin in the morning as a protective mechanism against injury, inflammation and at night and they seem to do better when they’re doing that then their recovery is better, the less injuries. And again, anything that I can raise the oxidative function of our metabolism, our mitochondria is what I consume in foods and also what I do with nutrients like B1, B2 and niacinamide and vitamin D and vitamin K. All the quinones are very powerful that’s what William Coker came up with his cancer treatment. How to increase quinones in our body and it was basically oxidative metabolism improvement.
Dr. Justin Marchegiani: And what was the dose of aspirin again? Was it 350 milligrams?
Dr. Bernd Friedlander: I take 325. I’ll share with you, there’s a doctor in San Diego who called me up 15 – 20 years ago. I did an article, I did a lecture podcast on Methylene blue, which also helps with increasing oxidative metabolism and increases mitochondria. I got a call from this doctor, he’s very well known in San Diego, very alternative of thinking, you know, he’s not your conservative doctor, but he thinks above the outside the box. And he wanted, he had a patient that had Parkinson’s or Alzheimer’s. I forgot, I think, it was Alzheimer’s and he saw my, uh, video on podcast from Silicon Valley, and he asked me about methylene blue dosage. He wants to try it on his patient and I told him what to do, how much milligrams per day and all that. Then he asked me, I got a question for you, my father has stomach cancer. So, he asked me what can he do. So, I gave him a hope program and everything and I told him to do a thousand milligrams of aspirin to 2,000 because I saw the research that aspirin and vitamin D3 can reverse cancer. Okay. So, I told him about the D3 and I told him about the aspirin. Six months later, he calls me up wants to know about Parkinson’s and methylene blue and then I realized I was, I realized who he was, I said how’s your father with the cancer? He said, he’s completely cured. I said, “how long did it take him”. “Six months”. “Wow. What did you do with him, I said, “What did I tell you because I forgot it was six-seven months ago”? Yeah. He took a thousand milligrams of aspirin every day, 3 aspirins, morning, afternoon, evening with vitamin K and also baking soda, so he didn’t have an upset stomach. He’s one of the third people that I talked to with colon or stomach cancer that reversed it just by using aspirin. I was amazed, you know, that it just took aspirin to do that.
Dr. Justin Marchegiani: Wow. That’s great.
Dr. Bernd Friedlander: Many reports and I went to PubMed and Medline and PLOS and I read of Ray Peat’s articles. Aspirin is a wonder drug and I didn’t realize until that study that we went to the anti-aging conference in Las Vegas, where the fellow from Bayer spoke about the importance of aspirin, not only inflammation but prolonging longevity and other factors that are necessary.
Dr. Justin Marchegiani: Okay. Very cool. I mean, I think anyone listening here, if they’re on the fence that’s an option. They can also jump on the herb, I think also keeping inflammation down be your diet’s probably, you know, probably the best thing out of the gates like you mentioned like vitamin D. Anything else you want to leave the listeners with here, Bernd, that you we didn’t have enough time to get but you wanna highlight it before we go here?
Dr. Bernd Friedlander: Well, again, like I said, I think the most important is reduce the indoor, you know, climate, uh, get more sunlight, get natural lighting like you said in condensing, full spectrum lighting is important.
Dr. Justin Marchegiani: Correct, full spectrum, that makes sense
Dr. Bernd Friedlander: You know, and make sure the most important thing here is what I found in people with weight problems and anybody. I try to get them to have a good breakfast. Breakfast is the most important meal. If you’re gonna have it at 7, 8, 9, 10, 11, 12, it is the most important meal and it should be 50 grams, 25 to 50 grams of protein. Don’t have a starch, don’t have a croissant, don’t have a peanut butter sandwich, don’t have an oat meal. Worst thing to do in the morning, you wanna build that thyroid function and you wanna increase mitochondrial function. So, good protein, I love pasteurized, uh, pasture eggs, I love cheeses like Manchego, anybody know or Feta cheese or goat cheese and cottage cheese and I have my orange juice and my coffee every single day. Never have any problems with weight problems or tiredness or fatigue and I sleep like a log every day.
Dr. Justin Marchegiani: Good. Excellent. Well, I appreciate the really good feedback here, Bernd, I mean your wealth of knowledge. You’ve been in this field for nearly 50 years, so I appreciate it the clinical information. Hopefully listeners can take one thing out of this here. I think it’s great, um, again, Bernd website, is it berndfriedlander.com?
Dr. Bernd Friedlander: Yeah. berndfriedlander.com
Dr. Justin Marchegiani: berndfriedlander.com. We’ll put the link down below here for you all. Bernd is a great friend and a wealthy of knowledge. Bernd, thanks for everything. Thanks for chatting here today.