Natural Solutions to Heavy Menstrual Bleeding and PMS | Podcast #299
Dr. J is tackling menstrual irregularities and heavy menstrual flow, symptoms, what your cycle should look like, looking at hormones, when to best test, triggers of irregular cycles, and some tips for helping regulate menstruation.
Most women cope with their PMS and irregular cycles like it’s a normal thing, but really heavy menstrual flow can be a sign of something deeper, maybe even estrogen dominance. Heavy menstrual flow can cause fatigue, lethargy, mood issues, irritability, brain fog, hair loss, and most importantly low iron. Heavy menstruation can drive anemia and low iron which is essential to the body, then it can take weeks to replace iron, by the time you feel more yourself the cycle starts all over again. What can we do? Well Dr. J has much to say from the perspective of a functional practitioner.
Dr. Justin Marchegiani
In this episode, we cover:
2:54 Menstrual Issues and Terminologies
11:12 Social Isolation, Supplements and Herbs
15:10 Tests for Menstrual Irregularities
17:44 Fasting as Stressor
20:16 Diet Restrictions
Dr. Justin Marchegiani: And we are alive. It’s Dr. J here in the house. Evan and I will be chatting about menstrual irregularities and heavy menstrual flow. Evan, how are we doing today man?
Evan Brand: Doing really well excited to dive in. This is an issue that many women just deal with. And they don’t really get help with. They just assume that hay, it’s normal to have PMS. It’s normal to have this happen with my cycle where this month, it’s 28 days. And then the next month, it’s 17 days and the next month, it’s 36 days. And I mean, we hear these stories all day every day.
Dr. Justin Marchegiani: 100% and the problem with heavy menstrual flow off the bat, it’s a sign of something else deeper, usually some kind of estrogen dominance. And then what’s driving that right? A lot of times progesterone is falling out too soon in the woman’s cycle. And then you have all this heavy menstrual flow, and that can drive in anemia that can drive low iron and that’s a problem because we need iron to bind a hemoglobin to carry oxygen. And we need oxygen for aerobic metabolism right for our mitochondria today. burn fuel, generate energy and burn fuel. So we need adequate oxygen. So if we have heavy menstrual flow, you can easily see fatigue and lethargy and mood issues. And a lot of times takes a couple of weeks to even replete that iron back up, and then you do it all over again. So it becomes this really, you know, you’re in the boxing ring every month, and you’re just getting beaten up, and it’s really tough. So you got to fix the anemia, and you got to fix that heavy menstrual flow for sure.
Evan Brand: Would you say this is a functional problem, meaning if you go to your doctor and you’re getting conventional bloodwork done, it’s going to get missed or even on conventional bloodwork. Are you going to see certain things pop up? That would be a red flag to even a conventional doctor that they would see.
Dr. Justin Marchegiani: It depends. A lot of times conventional doctors aren’t going to run like a functional iron panel, they won’t run like ferritin or iron saturation or iron binding proteins. A lot of times they don’t do that they’ll run a CBC and they may look at RBC see if it RBC is below four or a hemoglobins in the elevens or dramatic rates in the middle Low 30s they may run that but it just takes a lot. Like the issue has to be a lot more severe for the RBC, hemoglobin hematocrit to be a problem. So, you know, I’ll run a CBC to see where you’re sitting, right? We don’t want the RBC below 4.2 we ideally want the hemoglobin in the 13th, we want to get in the upper Upper 30s. So we want to make sure that’s good. But if you’re using a late stage indicator, the problem needs to be going on for a lot longer to fix it. That’s the issue.
Evan Brand: Okay, let’s go into symptoms briefly. I think this would be helpful for women because they’ll say okay, menstrual irregularity, you know, what, what do you how do you classify that? And then what symptoms would be associated with this? Are we talking to typical PMS issues where, you know, there’s breast tenderness stuff, or are we talking where the the cycle is changing? Where, like I mentioned, you know, some months it’s 28 days, others it’s 36 others, it’s 17? Are we talking headaches? What are we talking?
Dr. Justin Marchegiani: Yeah, so let’s kind of get a couple. Let’s get some terminology stuff out here. First, I find it I’m not sure if It’s an educational issue. I speak to a lot of women, I say how long is your cycle? And the first thing they tell me is how long they man straight for. So it’s this weird kind of disconnect. And I think it’s just people aren’t really educated in school about this. People, most people conflate their cycle is to how long they men straight. So a woman’s cycle is their entire hormonal cycle. Usually it’s 26 to 30 days right from day one’s the first day of leading to the next day one. That’s their whole cycle, right, which is built on a follicular phase right where the follicle grows, and estrogen predominates. It’s built on oscillation where estrogen predominates and progesterone rises. That’s oscillation and that it’s built on the luteal phase, the last half. So think f follicular first, think l luteal last, okay. And then luteal is where progesterone predominates. And a lot of the cycle irregularities may happen because of estrogen bouncing around or progesterone being either too low or dropping out too soon. And so when we talk about a woman cycle, that’s the full cycle when we talk about menstruation. That’s the period right? So most women they confuse menstruation and cycle length. So menstruation is when flow is happening period blood flow, and the cycle is going to be the entire length of that hormonal rhythm day one the first day they’re bleeding blood flow to the next day one, that’s your cycle. So just from a terminological standpoint, so when we’re looking at the heavy menstrual flow and a lot of the irregularities, it tends to happen a couple of days to even a week before we have blood flow. And of course, some women when there’s a lot of estrogen dominance occurring in that progesterone drops out too soon in the cycle and I’m doing a lot of hand gesture stuff so people are aren’t quite following on the auditory side. We’ll put the video link below so you can see the video. But when that progesterone drops out a little too soon in the cycle, that’s where we have a lot of menstrual flow. And this can really mess a lot of women up because of what I said earlier. You’re going to have a lot of low iron here, low low iron, low hemoglobin, and then you’re ability to carry oxygen really get some hair, and that’s gonna make it harder to generate a Robic metabolism and support the mitochondria. Mitochondria needs oxygen. So we need that. So that’s one of the collateral damages of menstrual irregularities is the menstrual flow. And then of course, other things can happen like irritability, breast tenderness, back pain, mood issues, brain fog, but the key thing that that’s going to happen after that is going to be a lot of that blood flow driving the anemia and the low iron, low hemoglobin. And the I was-
Evan Brand: I would Oh, yeah, I was gonna say the fatigue is probably the big one, right? Maybe exercise intolerance. These are women that they feel like they have to do some exercise. Maybe they’re pushing themselves hard, but they just don’t feel like they have enough gas in the tank to get the exercise done. It just feels abnormally difficult to do physical things. And then hair loss is big too. I mean, we’ve seen countless times on bloodwork where women will show up with really low ferritin. And they’ll say that every time they take a shower, I mean they’re losing a clump of hair, you know, per shower, and that’s just insane.
Dr. Justin Marchegiani: Yep 100% 100% so it’s always really good to take a look and test where you’re sitting during the luteal phase like right around day 21. The 22 is usually a good time to test where that progesterone sits to make sure it’s high enough. If you’re having a lot of heavy bleeding early, a lot of times that progesterone just falling out a little too soon in that cycle. And so we may support there’s a lot of stress, we may support the hypothalamic pituitary, go Natl axis, right that’s the brain talking to the to the gonads or to the ovaries in this example or to the adrenals. So we can support adequate levels of progesterone output. And we may use herbs like you mentioned shepherd’s purse, we may use things like chase tree, we may use estrogen modulators like Don Chi or black cohosh may use things like that we may use special phenotypes of Makkah, we may even use byway denticle progesterone as well to kind of carve out and work on supporting that healthy female rhythm too.
Evan Brand: And What led to these issues in the first place? I mean, we’re talking just age, we’re talking stress, we’re talking pregnancies having babies, like the xeno estrogens in the environment. I mean, what are you thinking are some of these big triggers?
Dr. Justin Marchegiani: Um, so in regards to the biggest trigger, in my opinion, is going to be the fact that progesterone can make cortisol. So when women get stressed, their stress hormone is cortisol. So they’re going to take a lot of that progesterone, and they’re going to, they’re going to pull it from their cortisol. All right, I’m sorry. They’re going to take a lot of progesterone and they’re going to pull it down to cortisol. So then that starts to skew the relationship. So stress, takes progesterone shunts it downstream to cortisol that can create some functional estrogen dominance, okay. Number two is just they’re depleting a lot of their cortisol output from the adrenals. And their adrenals are, you know, are making some other hormones but there’s needles are just more depleted. That can be a big thing too. And then three would just be potential Xena And exposure, there’s three big variables there. That’s gonna be from pesticides, right? These chemicals, they kill plants by disrupting their hormonal system and nervous system. So that’s one. Number two is gonna be plastics. Plastic does you know estrogens, right BPA or even some of the BPA free ones have other types of xenoestrogens that aren’t good. And the third one is going to be hormones and meats, animal products were to dairy milks, beef, chicken, right, just the hormones that are given to the animals to fatten them up. And so it’s going to be plastics, pesticides, and hormones in the meat and animal products. So those are the big ones. So of course, eating organics and to be good. Using Pyrex, or glass containers is great, especially when heating plastic isn’t that bad, as long as everything’s cool, and isn’t in the sun, not as big of a deal. Once it’s in the sun and you’re heating it forget about especially a microwave forget about ovens. Obviously, that’s a no brainer. And then of course, um pesticides and pesticides could be in the food Okay, so organic helps that it could also be in the water. So high quality water filter, reverse osmosis, or at least a carbon filter will filter a lot of that junk out.
Evan Brand: Yeah. And people listening, they may say, God, why does everything have to be so complicated? It’s like, Well, we’ve just changed a lot. I mean, you mentioned the adrenal thing. Women now where historically they were in the tribe, and they had other women to help with the kids. Now you’ve got the stay at home mom, parents-
Dr. Justin Marchegiani: -and grandparents, man. Yeah, I mean, that’s back in the day. Think about it. grandparents would be like in their 40s and 50s, probably right. You have kids in your late teens, your kids would have kids in their late teens, that puts you like, you know, that puts your grandparents in their in their 40s, early 50s. And typically, you know, you’d be out earning a living paying for the home and maybe rearing the kids a lot, maybe taking care of the kids. So there was a little bit less stress on the child rearing aspect of it, because you had someone there. And then typically, you didn’t have a big mortgage, you didn’t have all this. So usually One income was enough. So then, you know, one person could help out with the family, grandparents helped raise the kids, one person required for the income. So there wasn’t a ton of stress. And the income back then could be hunting. Right? It could be hunting or fishing, right? It could be doing something that were just really providing food and shelter. And that’s it. That’s all you need it. So our society has evolved and changed, and there’s a lot more financial stress, and some people have to have two incomes to survive to and, and grandparents are older and have their own health issues and can’t really participate on the day in day out of raising kids. So a lot of good things have shifted.
Evan Brand: Yeah, well, then you go further back, and before there was even bills and currency and you had the tribe that was hanging out with each other where you’d have, like you said, multi generational tribes, and then you would have potentially other people that are related somehow or maybe not related. They’re just part of the tribe. And, I mean, you read about these, you know, hunter gatherer societies where you’ve got women that would sometimes be nursing the children of the They’re not theirs, you know. So there must be a shared motherhood experience. And now you’ve got the stay at home mom driving the minivan with the three, four kids running them to the park and then doing the groceries and all that alone. So, you know, I think a lot of the social isolation aspect is really big for this stress component you’re talking about with this whole pregnenolone, progesterone, cortisol, everything getting robbed and diverted. And, yeah, I mean, it’s like, it’s a big hormonal chaos, really. And it’s because the, we know, there was actually a study done on that isolation issue. And that isolation, being socially isolated, was comparable to like smoking a pack of cigarettes a day. In terms of the the toxicity, we’re just not, we’ve never been a species like this. And now with shutdowns and everything going on, you’ve got people even more isolated. I mean, I have a client who’s a therapist, and she said, Man, everybody’s a wreck. And I said, What do you mean? And she goes well, because everybody’s separated from each other people are afraid to be next to one another. She said, I’m hearing all sorts have new symptoms for my clients. I thought Wow, that’s really interesting. So what’s the remedy? Well, you mentioned some of the herbs already some of the adaptogens will use and maka extracts and shepherd’s purse and wild yam and cohosh and chase tree and all those things are amazing. But I think at the end of the day, you’ve got to try to build some type of a community. You know, like Facebook, moms groups are one thing, but you actually have to have like an in person, place where you can sit down with other people have a conversation, you know, let somebody else handle the kids chaos for a minute. While you can just relax. I think we’re all just stuck in fight or flight. And that’s really one of the big root causes is our nervous systems are just so turned on. And especially if you’re watching the news, you’re not turning off. And I think that’s a big root cause outside of the environmental dietary pieces.
Dr. Justin Marchegiani: Yep, I totally agree. There’s some data also Showing that there’s more relaxing, which is a hormone produced by women’s bodies that can relax a lot of the ligaments and tendons. There’s some data showing that there may be more ligament laxity in the last half of the cycle where progesterone is. So just be careful of over exercising or doing too strenuous exercise. During the last half of the cycle. Just keep that in the back of your mind exercise stress could be a big one. We don’t want to be over exercising that’s important. Of course, nutrient density is essential. So nutrient dense, anti inflammatory, low toxin foods are going to be key one because we provide building blocks and two hormones are made from good high quality cholesterol compounds and cholesterol is connected with animal products and that’s usually connected with fat soluble vitamins at Okay, so we got to make sure all those foods are dialed in egg yolks. High quality grass fed beef by the grass that are by last night with some organic green beans was wonderful, right? So you can do all these things with the food good paleo template and you know, line up your macronutrients according to what you need. As a woman, if you’re more of an ectomorph, you’re more lean, you’re more skinny, you may be able to handle some more starch starch on the reg. Right? Every day, you can handle more starch. If you’re more on overweight, you may have to lean more on your non starchy vegetables and less fruit and starts maybe some but just a little bit less. So really get your macros dialed into.
Evan Brand: Yeah, I would say on the supplement side to one thing we didn’t mention would be like calcium D glucoerate could be really helpful. And then also, you know, since we haven’t gone down the rabbit hole yet on this podcast about it, you know, we could briefly mention the gut and how the gut is involved in these hormonal issues and how we’ve had many women that have had issues with their cycles that have spontaneously resolved just by fixing gut infections because we’ve hit on this idea of the beta glucuronidation enzyme being elevated, which causes the research ulation of toxins and hormones due to bacterial overgrowth. So if you’re having menstrual irregularities and you’re not addressing or looking into your gut, you know, you could work on the diet piece all day and still have issues. We have many women that have come to us that they’ve done a great job on the diet. But there’s still suffering. And so that’s where we dig deeper. And then something like calcium D glucorate may be used. And it can do a lot of good really, really quick with the detox piece, even for mold. It’s been helpful.
Dr. Justin Marchegiani: Yeah, so when we test a lot of these, we’ll do a Dutch test. And we’ll look at things like right around day 20 or so. So we can see where progesterone peaks out. And we’ll also look at estrogen levels and ashra metabolism. We’ll look at two methoxy, two hydroxy. Estrogen we’ll look at methylation markers. We’ll look at pirate glutamate, including violence that can give us a pretty good window for impaired on the detoxification side and we can add in phase one, phase two detoxification support whether it’s B vitamins and antioxidants, or sulfur amino acids, or extra binders or extra vitamin C or extra fibers to kind of bind up some of that that’s a really good option to therapeutically support detoxification, as well as just to help excrete extra hormones that may be laying around from some of the other reasons we chatted about.
Evan Brand: Yep, absolutely. So the testing piece, you know, Dutch is going to be important. I would say stool test is going to be amazing. Blood panels could be important. You know, if we did have a history like heavy bleeding, we’re going to look into ferritin do like a full iron panel, potentially thyroid could be important as well. organic acids. I mean, I would argue that be important too, we always run those for looking at the gut piece, the mitochondrial piece, if a woman’s complaining of, you know, major fatigue associated with this wells is related to the iron ore is is related to possibly the mitochondria as well that have gotten damaged by some sort of toxicity issue. So I think those would be top priorities. What about anything else? Are there any other tests that you would you would run to investigate this issue?
Dr. Justin Marchegiani: Well, if there’s a lot of insulin resistant issues, insulin is a big one. So carbs are out of out of whack and they want to look at insulin levels, make sure they’re closer to five, five to sevens ideal. They’re too high, there could be some resistance going on. Of course, I always get worried about pcls right. pcls is primarily driven by high insulin and then that can cause elevations in androgens and testosterone and that can also cause an increase in something thing called prolactin and prolactin can start to dis regulate the HPA axis that can kind of dis regulate the cycle. And again, that’s all supported by getting blood sugar stable, right. dysglycemia is a major hormonal stressor. And I asked them and don’t, don’t jump into hormonal stress and start fasting and doing all this stuff. Get your blood sugar relatively stable, you know, make up proteins and fats as the foundation of your meals. And make sure make sure 100% you’re getting enough nutrition, go look at go look at your chronometer, or My Fitness Pal and look at your calories. Make sure you’re getting enough. Make sure those calories are all nutrient dense, anti inflammatory, low toxin. Make sure you’re getting enough magnesium and potassium and high quality minerals. Very, very important.
Evan Brand: Well, you said it quick. So let me just restate it and confirm to make sure it’s clear. You’re mentioned you’re mentioning fasting as potentially being a big stressor that could make this situation worse, correct because you’re saying if a woman’s already nutrient deprived, or she’s having major issues Potentially too much blood loss. Fasting is something that could throw off blood sugar balance. But also, as you mentioned before, there’s no nutrition and starving. So you’re saying in this case, three meals a day maybe better than doing a fasting protocol?
Dr. Justin Marchegiani: Yeah, the problem with fasting fasting can help when there’s insulin resistance, but one there needs to not be a lot of blood sugar stress meeting up and down, right? So people think like, oh, if I have blood sugar issues, then fasting is great. Well, not if there’s display see me because this glycemia means your blood sugar’s up and down and up and down. And every time it goes up, your pancreas kicks in every time it goes low, your adrenals kick in with cortisol and adrenaline. So there’s stress on those glands. So the problem with that is you want to make sure you buffer that with healthy proteins and fats, it’s like putting a fire going and having putting, you know, twigs and paper on it. If you ever started a fire that way, you’d be feeding the fire every 30 minutes to an hour or even more because the fire would burn out fast. So a log on the fire that stays For hours, it’s like proteins and fats. And most women, they metabolically keep their fire going with twigs, and paper and gasoline, and you just can’t you’re going to be next to the fire all day. Those are your grazers, okay? Or if you’re trying to fast, well, eventually the fire is just not on you’re going to get cold, ie your metabolism is going to decrease. And if you’re already nutrient deprived, and now you’re fasting and not getting enough nutrition, that’s a problem. Now, of course, if you’re going too fast, and you’re compressing your feeding window, the key mistake is not getting enough nutrients. So you have to get enough nutrients. Now, if you’re doing it a day or two a week and you’re already healthy, and you’re getting an overabundance of nutrients those other five days, of course, you get your body can handle that right. But most aren’t in that over abundant state, they’re already depleted. And that’s where it’s a problem.
Evan Brand: Yeah. And you’re mentioning the grazers. I mean, these people are not grazing on grass fed beef jerky, typically they’re going to be grazing on, I don’t know, maybe some gluten free pretzels or something. I mean, it’s going to be more of a A process thing it’s not going to be. I mean, maybe it is maybe you’re grazing on macadamias or something like that, and you’d be okay. But in general, you want to be able to have three solid meals per day. I find, once women do actually calculate how much they’re eating, most of them are under eating.
Dr. Justin Marchegiani: Most are and then also, I’m not a big fan of snacks. Snacks typically mean a carbohydrate, primarily a carbohydrate macronutrient balanced meal, it’s smaller, and it’s primarily carbs and it’s usually not enough. And a lot of times snacks can be used to compensate for a poor meal previously. So I like the word mini meal, because it provides a there’s a balanced like a meal, meaning there’s some protein fat, maybe a little bit of carbs in there. Ideally, you’re doing a mini meal because your next meal is just a longer gap. So like if you had lunch at noon, but you and your husband are going out to eat at seven, well that may be a little bit long for you. So maybe you want like a good protein, fat, kind of keto bar here or a little more Any smoothie like around five o’clock, right? to kind of give you a little bump so your blood sugar doesn’t go super low until you feel good. Now if you’re healthy, you could maybe be able to handle it if you have blood sugar issues, and maybe a little mini meal is good right there to provide balance. Does that make sense?
Evan Brand: Yeah, it does. It does. And you’re mentioning to like the meals should be nutrient dense enough to where you shouldn’t have to snack But yeah, I mean, I don’t go much more than five hours. I will start to get a little shaky if I go six, seven hours. It’s too much for me.
Dr. Justin Marchegiani: Yeah, also just go to chronometer, man, just try to like put a sample me at like people that do omad stuff one meal a day. I’m like, dude, go to chronometer and put all the things you have to eat in that one meal and you tell me if you’re getting six to eight servings of vegetables, you tell me if you’re getting a pound and a half of me, you tell me if you’re getting that much fat, it’s really hard. Like, you’re going to literally be eating like eating probably for over an hour like eating chewing. It’s probably gonna be hard. Oh, yeah. Really full and you’ll probably take a break. That’s why two meals is doable, but you really have to be like There can’t be slack in the meal. It’s got to be a very intentional awesome meal. And you have to do it three meals. It’s relatively easy. Yeah, you know, you have two really good meals and one pretty good one and that you’re there. One is very hard. Yep. Yep. I would agree if you have tummy issues, if you have SIBO and you already have low stomach acid, well, now you’re just now you’re eating all that calories in one sitting. It’s like, Whoa, yeah. And how would you possibly digest and assimilate all that without having any issues to that’d be very, very difficult. It’s harder now people can do it if they have a really chill night and they can just sit around and relax for two three hours and in their lives aren’t that stressful, right? But in their digestion is really good. They can maybe get away with it, but I think minimum two meals is gonna just make your life easier.
Evan Brand: Yep. I just want to point out that if you have menstrual irregularities, you may need to come in and do some specific herbs to address those but sometimes this issue in the same category as many other issues we’ve talked about, where it gets fixed as a side effect of just getting healthy, just running you through kind of our functional medicine workup, supporting and looking at adrenal supporting and working on gut, the mitochondria, the nutrient absorption, the acid and enzymes, the probiotics, sometimes just those simple steps fix this. But if they’re having an issue that’s not resolved, then we can come in with these extra tools. Yep, that and vice versa. And maybe we should mention this to vice versa. You can’t just come in and do the chase tree, or the vytex, or the wild yam or whatever, and call it a day. You can’t do that either, because now you’ve ignored the issues that led to this problem in the first place, whether it was the glucuronidation pathway, or the bacterial overgrowth or the parasite infections and messed up the nutrient absorption which caused the nutrient deficiency which caused the hormonal issue. So you really have to do all of it. But I don’t want this to be Hey, let’s go to the hormone section at Whole Foods, buy a supplement and call it there. You don’t want to do that either.
Dr. Justin Marchegiani: Yes, you want to really get to the root cause of the food. stuff is important. We talked about some of the herbs we talked about even doing a kind of a cyclical augmentation kind of reset by using progesterone accordingly. And of course, we’re supporting the adrenals. The adrenals play a big part. So when I always test, when I test hormones, I’m always looking at female and adrenal together, they tell a really big role. And it’s nice to be a look at hormone detoxification. That’s really helpful too. Because it really gives me a window in all three sides of it.
Evan Brand: Yep. I think I’ve said all I need to say, do you have anything else you want to go into?
Dr. Justin Marchegiani: Yeah, so blood sugar, nutrition, right diet stuff’s very important. The gut plays a big role, because that’s where we digest and absorb all the building blocks to make our hormones. So if we have bloating or digestive issues, that could be a problem. Don’t just get myopic on the female hormones. Don’t you got to remember the adrenals play a huge role. So female and adrenals. And, you know, don’t jump on these fat things. Oh, just fast and do this and you’ll get better. You know, get your nutrition gets your blood sugar. Get it dialed in. And then if there’s things like iron, that’s a problem in the interim, you know, you really want to support that I have a product called Iron Supreme, it’s a bisglycinate iron. That’s a really better iron ore. If you’re more sensitive, a high quality liver, glandular is great. And then obviously eating a lot of high quality red meat before and during menstruation if flow is heavy, just to really make up some of that extra iron if needed.
Evan Brand: You know, good news is you can reverse this is not something you have to live with. So like I said, in the beginning, many women just kind of live with this and they just know hey, I’m quote messed up, you know, my cycle does this or that and they just live with it. But you can get it resolved to where if you track it on an app, I mean, my wife, she’ll track it on an app, and it says, cycles supposed to start boom 28 it’s 28 day cycles. So you know, and before due to birth control and other issues, I mean, her cycle was not always perfect. So you can fix these things. You can adjust them you can modulate them and there is hope.
Dr. Justin Marchegiani: 100% so if you guys want additional help and support, we are available worldwide. Feel free to head over to EvanBrand.com you could schedule a consult with Evan or JustinHealth.com you could schedule a console with myself we’re there to help you. Click down below for links and if you enjoy the content give us a review we really appreciate it EvanBrand.com/iTunes, JustinHealth.com/iTunes, and share with family and friends. And we appreciate you guys for joining. Take care y’all.
Evan Brand: Take care. Bye now.
How to Regrow Hair | Podcast #243
A large population in our community worries about hair loss. This type of problem is common. Some may think of the products that they use contributes to their hair fall, but Dr. Justin and Evan Brand thinks it’s more of a side effect, especially when you are unhealthy on the inside.
Listen and read this podcast as Dr. Justin Marchegiani and Evan Brand laid out information on how we can prevent hair loss on the functional medicine side.
Dr. Justin Marchegiani
In this episode, we cover:
01:21 Medications contributing to Hair Loss
10:03 Healthy diet, organic foods
22:07 Nutrient supplements
30:13 Hair Supplements
39:53 Hair Transplants
Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house. We have Evan Brand here as well. Today’s going to be an exciting topic — we’re going to be chatting about hair loss and how to naturally regrow your hair so, really excited about this topic. Evan how are you doing today.
Evan Brand: I’m doing pretty well we were just taken through some research before we jumped on here and it turns out there’s a lot of stuff that people are doing that’s contributing to their hair loss. And then people go to their doctor and the doctors don’t know the stuff that we’re about to tell you. Like all these different medications that we found that have been linked to hair loss and tons of people like the vast majority of Americans are on one or multiple of these different medications. So why don’t we just start there– talking about drugs because people love drugs, Americans like the land of pharmaceuticals compared to other countries. So why don’t we go down this list real quick of any medication that could be contributing to your hair thinning or hair loss.
Dr. Justin Marchegiani: Yeah that’s definitely the low hanging fruit because if you’re on a medication we already know the side effects are already documented. It’s not really that controversial. It just may not be talked about so let’s bring that to the forefront. Go ahead.
Evan Brand: All right. So I’m just gonna run through the list here and if you want to go further into these we can. But acne medications, antibiotics, antidepressants, antifungal medications, blood thinners, chemotherapy of course, cholesterol lowering medications ,epilepsy medications, high blood pressure medications, hormone replacement therapy, immunosuppressants, interference, mood stabilizers, insane oral contraceptives, Parkinson’s disease medications, steroids thyroid medications. That’s basically every drug that people use. I mean that’s like all of them. So if you’re on any of those and you have hair loss and you’re complaining about your hair loss that’s the first place to start.
Dr. Justin Marchegiani: 100 percent 100 percent. So let’s kind of just dive in and just talk about a couple of simple mechanisms that could be at the root because we have foundational things that can be done and then we have more nuance thing. So it’s like when you build a house you know you may not be worried about picking out the crown molding and the fancy tile that you’re going to use in your master bedroom when we haven’t even laid out the foundation yet. So let’s start at the foundational principles. So first thing is going to be just generally inflammation. Why is inflammation. What’s that. Why is inflammation important. So when we have excess inflammation that’s gonna cause ourselves and our tissue to breakdown fashion than we build up. That’s big. And the big vectors of inflammation are going to come from physical sources, chemical sources, and emotional sources, and all of these stressors interplay on our hormones, on our gut, on our immune system. And then of course if we’re driving inflammation the nutritional means nutritional kind of fits into that chemical category. Chemical could be heavy metals mold it could be inflammatory foods like gluten and refined sugar, could be hormonal imbalances female thyroid, it could be autoimmune issues like he got gluten sensitivity so a lot of things kind of fit into that chemical stressor bucket. Of course the emotional stress is a big thing, a lot of people have had experiences with like maybe you know death of a loved one and you start losing hair and there’s that or you’re over exercising right you see it women they over exercise they may lose their period their hair starts thinning they start getting colder. So a lot of those symptoms are common on the emotional side, common on the physical side. We’re gonna go into the more nuanced chemical stress, so of course if we’re not getting enough nutrition to build our hair that’s numero uno, so essential fatty acids right, healthy amino acids, these fat soluble vitamins– vitamin A, selenium zinc, magnesium, these are important biotin or B7 right. These are very important building block nutrients. So the first thing is if we’re eating kind of a paleo template it’s automatically going to be nutrient dense low and toxin and anti inflammatory. We may adjust the macronutrients protein fat and carbs according to what you need. But every bite of food is going to be anti inflammatory nutrient dense and low in toxins and low in toxins and being organic you’re not getting pesticides, you’re not getting roundup glyphosate, remember glyphosate is a chemical cue later so it’ll pull out the zinc, it’ll pull out important minerals selenium, that are important for hair growth, the catalysts enzyme is really important for hair growth and hair color and that’s a glutathione based enzyme and we need selenium for glutathione and if you’re eating your plants that are grown in depleted soils because of pesticides and roundup that can easily deplete some of these nutrients. So just highlighting the nutrients is going to be healthy proteins, healthy fats, vitamin A, fat soluble vitamins, your selenium, your zinc, very important for hair, and also skin and nails tend to connect with that and then the next thing I would say is OK great you’re eating these things now we have to be able to digest them we have to have enough hydrochloric acid and enzymes and enough gut integrity to be able to break everything down so that’s kind of foundation. I’ll let you comment.
Evan Brand: Yeah, you may need to go more straight to a diet we may need to go more autoimmune paleo if this is like an alopecia type situation where you’ve had maybe a family history of immune system issues ,but when you have alopecia you know you could potentially lose everything. I mean you could literally be your eyebrows, your eyelashes. I mean every hair on your body could disappear. So if you’re in that bad of shape and we’ve had those alopecia cases before, we got to go with an autoimmune paleo template. I’m so glad you brought up the point about glyphosate being a key later. I don’t think many people discuss the fact that it’s pulling minerals out. That’s, that’s huge because you could be on a paleo diet but if you’re still getting exposed to a lot of chemical toxins like let’s say, you do like some meal prep surface and they do sweet potatoes and strawberries and those are not organic but they’re still quote paleo because they’re real food. The average sweet potato has 20 plus pesticides, the average strawberry 22 pesticides and herbicides in it. And so you’re actually doing more damage to yourself by doing those foods even though it’s called real food if it’s chemical it’s just not worth it. So really really really focus on organic. This is key. I looked at the price difference. People complain, Oh you got to be rich eat organic at Whole Foods. I’ve seen a pound of strawberries for two ninety nine which is chemical conventional garbage. Organic was three ninety nine for the same size it was one dollar or more. And that extra dollar is going to provide you more nutrient density more trace minerals. You’re not going to be getting genetically modified things and you’re saving your gut because we know that glyphosate is damaging your gut bacteria too. So you and I are going to talk about that today. You’re already giving us the preface talking about stomach acid levels. If you’re damaging your gut bacteria by consuming pesticide foods. Now you have bacterial overgrowth and that bacterial overgrowth prevents you from digesting your food and then you don’t have enough of those raw nutrients to build your hair. So the whole domino effect can fall apart just by you not doing enough organic, which sounds crazy but it’s true.
Dr. Justin Marchegiani: One hundred percent and just get off the bat. I was a poor doctoral student for a long time being in school in San Francisco California which is obviously one of the most expensive places to live. I think I was living on like fifteen or sixteen thousand dollars a year for financial aid which anyone knows the poverty level. Francisco is like 80 grand a year. I was like living maybe six or seven times below the poverty level and I just had a really strict budget. So I had a budget. I would spend seventy five to eighty dollars a week on food and I would get a lot of my vegetables would be frozen organic. I would do some fresh spinach or fresh leafy greens that were organic. That you know five dollars you get a big thing and then a lot of my meats I would just do free range or grass. I was a little bit too expensive but I could do something at four or five dollars a pound. And because Amazon’s bought whole foods, some of their grass fed meat is under that price now. So you’re actually have better quality now. I would do a lot of chicken thighs which would be very helpful. I would do a lot of skipjack tuna which is pretty good because the sledding to Mercury ratio and that’s really good. And then I would do more free range eggs. I wouldn’t quite get organic so if you don’t, if you’re not all the way on the organic try to at least be hormone free antibiotic free, if you can’t quite get the pasture fed grass fed. So there is an in-between. It’s not an all or nothing. So do your best just to make sure the foods are nutrient dense and anti inflammatory and then try to see if we can at least get an in-between quality. Maybe you go organic on the frozen vegetables, you get some fresh vegetables that are organic. You do some fish. You try to get some wild Alaskan sockeye frozen maybe go to Costco to get some stuff there and then try to choose chicken thighs skin on over like a breast or any of the more expensive cuts you know stay away from the big steaks, ribeye filet, those things but you can at least do ground meat. You can at least do tuna fish, you can at least do a chicken thighs skin on those are really good starting points and I’ve done it. I did that for four or five years so I understand it and I hope it helps.
Evan Brand: And people go to Hardy’s and they’ll go get like a double cheeseburger with fries and a large coke and it’s like seven ninety nine. So you take two people going to get a fast food meal that’s six. That’s 16 bucks. You could go to Whole Foods and you get an already cooked organic rotisserie chicken for eight or nine dollars and let’s say you buy at the salad bar you get like a cup full of organic blueberries, that’s maybe a buck or two and then maybe you buy a bag of like Seattle cassava chips for like four bucks, your total meals like sixteen dollars for two people and the food nutrient density was way better than the hardy seven ninety nine double cheeseburger with fries and a large Coke.
Dr. Justin Marchegiani: Hundred percent. My goal when I was a poor doctoral student was always to get my meal below five dollars total if I could get it under five. Then I am doing better than going to a fast food restaurant right. That’s kind of where I was at. Plus I’m getting a lot better nutrition. So just kind of people out there that are struggling with that just make it a priority. It’s got to be a priority number one, you’ve got to see the value in at, number two junk foods artificially cheap because our government subsidizes soy and corn and wheat. So it’s artificially cheap or you’re not really paying the real cost of it. And then number three is we got to look at what we’re eating as the quality components are really important. You can’t just eat it and think it’s good the quality has to be there too. So that’s the food component. Next let’s dive into hormones. So hormones are vitally important. So the first thing is if we consume too much carbs or too much refined sugar, insulin resistance is going to be a key key problem with hair issues. So one of the first things insulin is going to do is you’re going to be depleting more minerals that run your energy cycle as your Krebs cycle, your mitochondria when your blood sugar is higher. Is that Krebs cycle then has to run and it requires amino acids magnesium minerals to help run it. So that’s number one. So you’re going to deplete a lot of those nutrients when you eat more sugar. So then it’s like using a credit card. But you don’t pay the bill so then your next month’s bills higher because of the interest get to pay. It’s kind of like that. And so when you have a high levels of insulin certain enzymes are going to be up regulated. As a guy you’re going to regulate an enzyme called aromatase, that enzyme will cause problems with your testosterone having it convert downstream to estrogen and when estrogen goes downstream you start to up regulate enzymes called the Five Alpha Dihydrotestosterone, so the five Alpha reductase is the enzyme, and that the enzyme is important from testosterone going to the source around to die. Hydro testosterone so, dihydrotestosterone is the stronger testosterone. And that can is associated with causing hair loss. That’s what a lot of these medications the finasteride. They block that enzyme five Alpha reductase and they block it. Now there are natural things that block it. Two really important ones are zinc and selenium also are natural five Alpha reductase inhibitors. So what happens is this here’s the mechanism: we have high levels of insulin, too much carbs, too much sugar the high level of insulin starts to upregulate aromatase, aromatase causes testosterone to start going to estrogen, as testosterone goes to estrogen. Testosterone starts to drop and our body starts freaking out and it makes this stronger testosterone called Dihydrotestosterone DHT for short, DHT starts going up and the enzyme that goes from testosterone to DHT is the five Alpha reductase enzyme and as your diet becomes poor and nutrients drop the minerals that help regulate that enzyme selenium and zinc start going low which starts to increase a DHT more. So you can see low selenium, low zinc, more right more dihydrotestosterone as those minerals are the break that prevents that DHT or from going up and that DHT is associated with decreasing blood flow to the hair follicles. So insulin is a big big component with raising DHT, raising estrogen in men and lowering testosterone so that’s one component there. You’re also going to see it in women as well. You’ll see it with testosterone you’re actually gonna see different things. You’ll see ovarian cysts start to form in women, and you’ll start seeing more hair growth and you can start seeing hair loss on the head, when you start having excess cortisol surges especially in women and men you can start losing hair there as well. So you can see it with high cortisol. You can see it with high insulin, and then high insulin in women increases testosterone, high insulin in men decreases testosterone and increases DHT. So it’s a little bit switch for men and women. So I know it’s hard to kind of wrap your head around that. You may have to listen to it twice. So I’ll say it one more time. Women– high levels of insulin, increase testosterone increase cortisol, hair loss from the high cortisol. Men increase insulin, you’re going to have increase in aromatase, aromatase is going to decrease testosterone, increase estrogen and then DHT, the stronger testosterone starts to go up that pinches blood flow off to the hair follicles. Hair loss, that’s one major mechanism.
Evan Brand: Well said that was very very clear. Crazy how you would think oh this high fructose corn syrup soda. You know this is bad because it’s sugar but you don’t think wow I could be messing up my hair by drinking a soda. And so when we talk about herbs we’ll get into that soon. I do want to hit on the gut though are you ready to talk about the gut.
Dr. Justin Marchegiani: Let’s do it. Let’s hit it.
Evan Brand: OK. So I’ll go on a little bit of a rant about the gut just because I’ve seen so many cool things happen with men and women that have had hair loss issues. You mentioned earlier it was connected to the skin into the nails too, which is huge because that was an indicator that my gut was messed up or my fingernails.
Dr. Justin Marchegiani: Correct.
Evan Brand: Oh you can look at your fingernails if you’re seeing vertical ridges vertical lines. You’ve got real brittle nails the quality of your nails is not good. You’ve got skin issues then you probably have gut issues. And so obviously if you’re working with us one on one we would be doing functional testing on you to look at your urine and look at your stool to investigate and find rule in or rule out various infections that are affecting digestion like H Pylori, which reduces stomach acid then your food doesn’t digest then you can’t get these nutrients adjusters talking about to fuel these pathways for optimal hair growth, then you got other bacterial overgrowth, you’ve got Candida, you’ve got parasites, you’ve got worms, all these issues in the gut can totally affect digestion which long story short affects the hair. So you’ve got to get the data and don’t just guess. Don’t just go and take like olive leaf because you read olive leaves good for candida or […]. Yeah those are cool but you want to know what you’re up against for, so we really like you to get the data because you could go and take a probiotic and feel worse and don’t know why you say, oh I heard probiotics are good for my gut. You said the gut is why I’m having hair loss. It’s not that easy. You, you might find that probiotics make you worse you may get bloated or you may feel bad. So get your functional medicine testing done first and then you can make the order of operations. Well I’ve got these infections so first I need to work on getting rid of bad guys before I go into doing probiotic replenishment later. So that’s really all I have to say about the gut is that it’s huge. But you have to get the data because if you don’t know what you’re up against we literally can’t just say, here’s a supplement for your gut like aloe vera extract. Yeah. Maybe that reduces inflammation in the gut but it’s not root cause.
Dr. Justin Marchegiani: One hundred percent. All of the important nutrients that we talked about from a dietary perspective and how the nutrient density and also the food quality affects the nutrient density, that is important but above and beyond we have to be able to digest that. So if we’re not breaking it down digesting assimilating absorbing and utilizing then that just everything goes well from there. So one hundred percent. We talked about the hormone issues now in women. If we start going more into menopause late 40s early 50s estrogen and progesterone start dropping that can definitely influence hair as well. We start to see more skin dryness, hair quality. Those type of like connective tissue things start to decrease as women go into menopause. We see more wrinkles increase. We see more libido issues. And then of course the hair is going to be part of that connective tissue cascade. So we have to make sure if we’re going into menopause we’re supporting the adrenals and we’re supporting those hormone pathways to to a place of balance. So that’s going to be different for every person. So if you’re a female and that you know, late 40s early 50s and that’s happening to you or even if you’re postmenopausal in your 50s 60s or 70s, you really want to find a good functional medicine doctor that can work on your hormone balance. But it’s really important that you’ll look at the adrenals, because as those ovaries start to drop those follicles start getting depleted, your adrenal is are going to be utilized a lot more to fill in the gap where those hormones from the ovaries are not. So that’s really important is the adrenal is the second thing and this affects men and women equally. But women five times more is going to be thyroid issues. So low thyroid or hypothyroid or Hashimoto’s which is an autoimmune attack on the thyroid that causes Lothar what function is important cause we know thyroid hormone is really important for follicle growth and if you don’t have enough thyroid hormone, we’re not going to have that that milieu you to cause healthy follicles to grow. And that can cause hair loss too. You may also see eyebrow thinning which is a patented low thyroid symptom so outer third of the eyebrow thinning you may also see cold hands, cold feet, constipation, mood issues, depression anxiety. So typically there’s not just hair as being an isolated symptom you’re going to have hair issues and a whole bunch of other cascade of symptoms as well. So thyroid is really important. Now it may be as simple as getting on a bioidentical thyroid support and that can fix it. Most thyroid issues are autoimmune so typically you’re going to have to fix the autoimmune attack and we may use certain herbs and nutrients and diet changes like an autoimmune template, we may use natural anti inflammatory compounds to help modulate the immune system like curcumin or glutathione, the enzymes that are really important for hair growth and hair color are catalysts enzymes, and these enzymes are strongly connected to glutathione. And it’s interesting because selenium is a really powerful glutathione building block but solarium is also really important for hair color and hair growth but it’s also really important for thyroid conversion and it’s also really important for helping to decrease thyroid inflammation when this autoimmunity. So it’s amazing how so many of these things kind of dovetail and a lot of people are taking synthetic thyroid medications which Even mentioned have side effects of hair loss. So the first thing is look at those medications. Number two, if you’re on a conventional thyroid medication, you really want to look at the full hormone cascade,TSH T4 T4 free, T3 free, reverse T3 TPL thyroid glob an antibiotic you may even want to throw in T4 total and T 3 total as well, because you may not be converting T 4 to T3. You still may have very high amount of antibodies you may have high amount of reverse T 3 which tells me there’s adrenal stress. So there could be other things in this whole cascade and you really want to zoom out and get a complete picture and we may need to have a natural thyroid support that actually has T3 in it that can help.
Evan Brand: I mean I’ve seen that where women have switched over from like a centroid over to sometimes just a Cytomel, just a straight T3 and sometimes that’s enough or we get them over to like essella that can NP thyroid nature throid. There’s a couple that you and I’ve used like thyroid gold which is a desiccated thyroid and I’ve heard massive massive improvements on that just based on that. Also anemia you know that’s kind of a low hanging fruit that we haven’t mentioned. Why don’t we talk about anemia real quick just because a lot of women that have come to us have had different issues with their menstrual cycle, maybe they’re heavy bleeders or they’re having long cycles and if these women are now postmenopausal, they don’t have a cycle anymore all the terrible hormone issues they had, they didn’t just magically disappear just because they don’t have a cycle those lasting effects of anemia is could still be a big factor.
Dr. Justin Marchegiani: One hundred percent. So when we talk about various things or nutrients I don’t want you to just think of the nutrient and say just take it. I want you to go upstream and think about the mechanism because the nutrient being helpful or not that’s downstream. Right. The root cause and the mechanism is upstream. So iron is really important why. Because iron binds the hemoglobin to help you carry oxygen. Why is oxygen important. Well because oxygen helps with a robust metabolism. And part of the reason why let’s say DHT is harmful for men is because DHT can decrease blood flow to the hair follicles. What happens when there’s decreased blood flow, decreased oxygen, so you can see how some of these mechanisms when you look at Iron, low iron especially in women, why women. Because women can menstruate, guys don’t, when they menstruate they had their periods they lose blood there. So if your estrogen dominant and you’re losing a lot of blood there’s another hormonal mechanism, you lose a lot of blood. You have low iron low iron. Not enough healthy oxygen carrying capacity, not enough healthy oxygen capacity going to the hair follicle, not that’s important for healthy hair generation. Right you choke out the hair. You don’t give it enough blood flow and oxygen. It’s going to die. Right. So there’s that mechanism, two is we could be vegan or vegetarian and not getting enough high quality heme based iron. Right. We can’t just base it off of spinach. We actually even though spend it behind our and we need actual animal products to get good quality iron in there, and the number three there could be a lot of malabsorption. So I see a lot of patients who have a lot of gut inflammation. It could be autoimmune where there’s irritable bowel disease like Crohn’s or all sort of colitis. It could be something in between where there’s a gluten sensitivity issue, or some kind of an IBS or some kind of just low grade gastritis or gut inflammation and they’re not breaking down the nutrition is adequate and then they’re not getting enough of their animal products broken down. So those are the three big mechanism when it comes to iron. Yes. So when we do blood work, we would want to look at a marker called ferritin. It’s an iron storage protein. When women start to get down to like a 20 or 30 with ferritin, number one there’s going to be a lot of hair loss. But number two these women may complain that they can’t catch their breath like they’ll go up a flight of stairs and they’re just like, oh I can’t breathe like I can’t catch their breath. And that’s exactly what you talked about. There’s just it’s it’s a starvation you’re starving from not enough oxygen. So when we really want to get to optimal hair growth levels, the ferritin usually going to be somewhere like 90 and I believe it’s like in G nanograms over deciliter NG over DL. I believe that’s the normal reference range either way regardless of whether you’re in U.S. or somewhere else and uses a different reference range you want to be on the upper end of the reference range for ferritin and you don’t want to be just at the low end and the doctor is going to miss that they may look at ferritin, 30 is fine but 30 is not optimal.
Dr. Justin Marchegiani: Yeah at least 30 ideally above 40. You may want to look at Iron served to make sure it’s more mid reference range. We also want to look at Iron saturation make sure it’s at least twenty five. We can also look at TIBC and UIBC binding proteins those actually go high when iron goes low. So somewhat in the middle high doesn’t mean necessarily good when it comes to those binding proteins because they’re kind of on the reverse side. So that’s really important. But again we want to look at the root cause and vegans and vegetarians definitely are going to have a harder time with that. If it’s really important that you be vegan and vegetarian. Well I would I would advise having some level of protein in there or protein at least maybe the liver capsules if you could if you can wrap your head around doing liver capsules there are some vegan vegetarian iron sources that are decent ones called Flora vital or Floradix. It’s a German herbal product that’s been around for about 100 years. Flora vital is the gluten free source of that. So if that’s really important that you maintain a vegan status or vegetarians that if that’s at least one good option I always try to at least push for at least deliver capsules. Hey you’re not tasting it maybe you can wrap your head around it. That’s a good source right there off the bat.
Evan Brand: Good idea. Good idea. I’m glad you’re putting solutions because I like to make fun of vegans and say hey what you’re doing is not sustainable quit doing it. But I like that you put in a sustainable idea.
Dr. Justin Marchegiani: Yeah. I mean hey it’s like I’m real it like my first goal was getting you a result. That’s number one. So if you’re fully onboard with what I’m saying or you still want to be on board is there a middle kind of road. Right. So that’s the least the middle of the road thing. The second thing we already highlighted in some of these things there’s gonna be tips here that people listening can just do on their own. That’s great. And there’s gonna be some tips that you’re going to really need a good skill a practitioner like looking at the gut. Making sure there’s no infections like Candida or H Pylori that could be affecting absorption. Also looking at gut permeability you’re looking at parasitic infections that could be creating more gut stress. Right. Making sure these nutrients are being absorbed we may run nutrient panels whether it’s an iron panel or a neutral eval or spectrocell. We may see some of these intracellular nutrients are very low. We may want to support them as well. Right. But we’re going to support them in conjunction with, Hey why are we low to begin with. Is this just a poor diet thing is it a hormone thing is it a good thing. So we may use palliative support with the focus still being on the upstream root cause.
Evan Brand: Make sense and there’s different multivitamins like for the hair skin nails that we can use, we could throw in collagen peptides, we could throw in like sol palmetto which helps to block DHT, you could throw in like pumpkin seeds. I’ve read pumpkin seeds can help with the DHT by blocking the binding sites. Fish oil could be a good and antiinflammatory adaptogenic herb supporting adrenal is like we talked about, aloe for reducing inflammation in your gut. Zinc you mentioned that selenium so there are supplements you can throw in but I just want to point out that this whole way of thinking which hopefully you all are adopting this by listening to Justin and I over and over and over again, which is the fact that you’re going to find a symptom or a complaint like hair loss. OK so you’ll come to us and you’ll say, oh my my I want to lose weight and I’m losing too much hair, like very I’m not going to say they’re vain but I’m going to say they’re very like vanity based. Like OK you really care about your hair and you care about your weight. But then after we do all the diagnostics and we pull all these labs out and put them in front of you, we’re actually showing you, hey look really what you should care about is look at your mitochondrial function, it’s not good. Look at your gut inflammation it’s really high. Look at your nutrient absorption, we’re assuming it’s low based on how low you are in these amino acids, look at your neurotransmitters, your brain chemistry is burned out. Are you sure that you’re not eating a chocolate bar every day. Oh yeah I am I craved chocolate at all the time. OK so your endorphins are burned out and your adrenal hormones look like this and your vitamin D too low and you’ve got anemia and you’ve got high insulin and your A1 sea levels too high and you’ve got this parasite and you’ve got this bacterial overgrowth. Now you have some candida too, and oh look you’re deficient all these trace minerals and you’ve got some thyroid antibodies. So when we really pull all that other stuff out it’s like OK here’s what you should really care about, and you have to fix all this to work to fix that one goal of, Hey I’m losing too much hair and I want to lose 10 pounds. So I just it’s, it’s a whole ‘nother way of thinking but it is like the best way to approach these issues.
Dr. Justin Marchegiani: Exactly. I want people to walk away from our podcast not with just random factoids but with a new perspective on how to think if I can get people to think better when they come to a conclusion or an understanding of something they’re going to be able to understand how they got there what the mechanism is when you understand the mechanism. You don’t ever you know, you don’t forget it’s locked. Right. You understand a concept versus memorizing a fact the concept sticks forever. So that’s really important. So let’s go look at one. There’s a common sentiment out there. It’s called Nutrafol. I want to break people kind of mindset down so they can understand why that product may work.
Evan Brand: What is it how do you spell this.
Dr. Justin Marchegiani: N U T R A F O L nutrafol.com. Now I’ve seen it help some patients I’ve seen it not. We use a lot of these ingredients even in our supplements already. So if you’re a patient working with me we typically use a lot of these nutrients anyway in different formulas that we have. But here’s just one product. Let me walk you to the thinking. So the first ingredient is tocotrienols. What’s that. That’s Vitamin E right. Where does Vitamin E fit in, vitamin D a fat soluble vitamin. So we already talked about how fat soluble vitamins actually vitamin A D E and K which you’re gonna get in healthy animal products is gonna be very helpful. We may supplement it as well it’s in my multi support packets. We have a full spectrum to cover all complex in there. So vitamin E is important. Next one, ashwagandha. Why is that important. Well if you remember the hormonal mechanism we talked about earlier cortisol in stress is really important. Ashwagandha has various glycoloids which help with the HP axis the pituitary adrenal feedback loop to the adrenal. And it can help kind of curtail high amounts of cortisol. It can help curtail stress perception the less you perceive stress, the less stress hormone you make the more you feel relaxed etc. It’s a self-defeating cycle. So ashwagandha can help break that up. Third is curcumin. Why Curcumin. We talked about curcumin is a natural anti inflammatory. Earlier we mentioned how inflammation does what it decreases blood flow. So when we decreases inflammation we can help improve blood flow and we can help improve oxygenation. Next sol palmetto. Why sol palmetto important? Remember earlier we talked about blood sugar and we talked about high amounts of insulin upregulate aromatase, aromatase in men. It’s going to decrease testosterone increase estrogen and then it increases this hormone called DHT Di hydro testosterone that inhibitor that enzyme that goes from testosterone the DHT that’s five Alpha reductase that enzyme is going to be downregulated with sol palmetto. So sol palmetto is a five Alpha reductase inhibitor. It’s a little bit more gentle than like a lot of the finasterides, right finasterides can decrease that enzyme as well but there’s also a lot of symptoms associated with that. So like Rogaine minoxidil, flowmax a lot of these are like finasterides and they can decrease that enzyme. But there’s also you can just google post finasteride syndrome. So there is some of those medications we got to be careful of. All right. Next is gonna be Marine Collagen and me back up. So Sacramento’s a five Alpha reductase inhibitor. Great. So is zinc so with selenium. Right. So there’s other nutrients that can be used outside of supplements to down regulate that enzyme. Fifth is collagen and I use collagen and all the time college is really important. I have a product called true collagen and why do I like it. We don’t get enough connective tissue amino acids in our diet active tissues are bone broth right. Most people aren’t making foods where they’re putting the all the bones everything in there. And when you do an eye soup you can extract a lot of those amino acids people that aren’t drinking bone broth may not get enough good collagen amino acids these collagen amino acids are more connective tissue base and they’re going to have a lot of building blocks for good quality hair integrity. So just kind of walking people through my thinking. Most people see this supplement and they’re just like OK great. Now you understand the deeper thinking so I think these are some good things that can be used. I would also add bites into that. I would also add things like horse tail I would add in zinc I would add selenium I would add more vitamin A as well. These are other things that I would utilize in conjunction with that to help it be even better.
Evan Brand: It sounds like they’ve got a really good marketing though, you promote this product for hair, hair wellness from within. Eighty eight bucks a bottle. I mean they’re making a lot of cash on that. Eighty eight bucks.
Dr. Justin Marchegiani: Yep it’s definitely expensive you can do these things when we put them into our program they’re going to be cheaper because we’re we’re doing them. It’s not by itself it’s going to be part of an adrenal support. A lot of time we’ll have some of those products in it. We may be using things like curcumin for inflammation regulation we may be doing sol palmetto in a natural 5 alpha reductase enzyme formula which will have more things that will have lycopene in a pumpkin seed it will have more things than just that. So for sure it is.
Evan Brand: It’s funny though isn’t it the world of supplement marketing you know you could market something for hair loss but like you mentioned you and I are already basically implementing this entire protocol of these different nutrients just as part of our functional medicine philosophy of supporting hormones, restoring gut balance, giving collagen, reducing inflammation but we don’t market it as a hair loss protocol. We just make it a protocol to get you really healthy and as a side effect of you getting really healthy your hair grows.
Dr. Justin Marchegiani: Yep MSM is also great as well. That’s a sulfur based kind of amino acid compound that’s really really good. We already talked about sol palmetto, fully and B12 are also going to be really important. We already mentioning Millennium and biotech being helpful. Go ahead.
Evan Brand: The last thing I wanted to mention was we did look into the research on the low. They call it LLLT low level laser or light therapy. And it does work. So you’ve seen I’ve seen some of these ads on Facebook and other places where they’ll promote these men or women wearing this crazy contraption looking like Dr. Emmett Brown from Back to the future and he’s got a bunch of like laser beams beaming his head to regrow hair. They do work. There are studies on this and it does appear within. I think it was a 16 week trial that I found it was like a six hundred and fifty five nanometres laser. Let’s see here. So this was a six month study. A six month study, 55% increase in women who did this.74% increase in men who did this. There was another double blind trial on a different type of laser for hair. Twenty six week trial and they didn’t give us a percentage they just said significant hair density improvements we’re seeing. So the lasers do work but I don’t want people to still eat McDonald’s and just do a laser on their hair and most people do that.
Dr. Justin Marchegiani: Yeah. I think the major mechanism that lasers are going to work is number one, lasers tend to have stimulatory effects in the mitochondria. So that’s going to be helpful and they’re going to help reduce inflammation. So anytime you reduce inflammation you increase blood flow and that’s going to provide better nutrition. And then in and of itself they’re naturally going to stimulate blood flow as well. So if you get better blood flow less inflammation, less inflammation helps blood flow you stimulate the mitochondria. Right. You provide stimulation to the cell and then as long as the nutrition and all the other building blocks are there and you reduce all the other internal stressors like pesticides and all the junk in the diet, it could be more helpful from a root cause perspective but it will definitely be palliative but at least that’s palliative without all the side effects of maybe an Astra medication.
Evan Brand: True. We just don’t want your average person who’s eating a Standard American Diet go into Chick Fil A drive through on a Saturday morning and shoving their breakfast sandwich with MSG. By the way, Chick fil A. They promote themselves as like higher quality fast food. There’s MSG in all their products just look them up look up their sausage biscuits got MSG. The eggs are fake. The chicken nuggets have MSG and other garbage even dairies and a lot of their products. So you go oh I’m going to go get my morning Starbucks then I’m going to Chick fil A and I’m gonna get my morning drive through you know sausage egg and cheese biscuit and then I’m gonna go get my laser therapy. No that’s not you’re not thinking about it the right way. You gotta do the other stuff and I don’t even know how much a laser cost. So ditch the garbage fast food get real food in your price save more money and not even need a laser.
Dr. Justin Marchegiani: Hundred percent and there’s also other things as well like a PRP injection which is a platelet platelet rich plasma and also various stem cell injections that can be used in the scalp as well. Again these are gonna have really good important building blocks and growth factors that will help stimulate the hair to grow which I think is beneficial but still it’s going to be palliative. It will not fix the root cause mechanisms of your guy and you’re like, Hey I really want to get my hair turned around. These are other options that I would look at but make sure you have the foundation already dial them because these procedures are expensive. So if you are gonna go into it you want to give it the highest chance of it working. Therefore you want to get the cortisone check, selenium all the minerals all the nutrients, make sure your hormones are good, make sure your guts good make sure your blood sugars are good and that’s gonna give you the first best step. And I understand. Like if you’re a guy and you’re losing hair you know and you’re trying a lot of these things you know some of these topical Rogaine or Minoxidil they can be helpful. So if you’re a guy coming in there maybe a tiny amount of these things topically on on that area versus taking it systemically like you would with kind of a flomax med maybe more beneficial. It’s kind of like if someone had a skin infection. Well I think it’d be better to use an antibiotic cream than taking a whole systemic antibiotic in itself right orally. So you kind of have to figure out that and again if you’re on the prescription side of the fence make sure you talk to your prescribing doctor about that to adjust it. So it’s more specific and more localized versus doing a kind of systemic thing.
Evan Brand: Yeah. Well said that’s great advice.
Dr. Justin Marchegiani: And then of course the last but not least thing is going to be a hair transplant. And again the hair transplants have done you know they’re much better today there’s less scarring they’re more exact and how they do it. And a lot of times they’ll combine it with PRP or stem cells to help the hair grow even better. Big thing is though if you’re gonna do it’s definitely definitely definitely definitely do it with all the other conjunctions. In fact I mean it’s a lot of celebrities you can see that have definitely had hair loss and then their hair. You can see it’s grown back a ton. I mean for instance Ellen Moss just look at his pictures in the late 90s. He was basically bald and look at his hair. So it’s a beautiful set of hair. Same with Matthew McConaughey late 90s. Look at his mug shot online right. Basically balding. Look at him today. Beautiful head of hair. So some of these procedures do work combine them with all the other things that we’re talking about. And then you got a winning team.
Evan Brand: Yep. Amen.
Dr. Justin Marchegiani: Yeah that’s got to be on the extreme side say most people, especially women, they’re going to have a better chance because a lot of it’s hormonal and gut based. There are some genes that will skip generations the gene is a big one that can encode for androgen receptor protein and these are the ones that are going to be really affected when free testosterone drops and that can have a significant effect on hair loss. And again that’s typically going to be on the mother’s side. Usually skips generation and it’s on the mother’s side. So that’s the big genetic component there.
Evan Brand: So you’re saying look at your grandma and if she balding then you might bald.
Dr. Justin Marchegiani: I think it’s gonna be your grandmother’s Dad.
Evan Brand: Oh yeah.
Dr. Justin Marchegiani: And that’s the ARG. But I’ve had some people where you know that didn’t quite ring true and then some people it may just be a genetic predisposition and let’s say they did other things to combat that and maybe they were able to starve it off longer or have less. So you know it’s not going to be you know something that happens right away. It’s not a guarantee but it’s definitely a strong strong predisposition. And let’s just say there’s a more. Let’s just say sensitive environmental factors if they’re in a play. Yeah you’re going to lose your hair but you may be able to starve it off by doing all the things we talked about today and that may give you the best possible chance of keeping your hair and then that’s where you’d want to look at something that a more natural surgical type of things while doing all the foundational things to.
Evan Brand: Make sense. I have had so many women that reported on their follow up so I went to my hairdresser and they said I’m growing so much more new hair. I was not intending to do that. I’m just fixing what I see. I’m working on the gut the adrenal is like we talked about. So you and I really we’ve become able to speak on this topic because from clinical experience it’s not like we took a course on how to regrow hair naturally. No we just we just help people improve their health and as a side effect the hair grows so now we feel that we have enough information to share on this. But you know when we’re working with someone we don’t say hey, my goal is to help you grow more hair. I always tell him straight out my goal is to fix your gut and all these other issues I see. And you’re probably going to grow more hair as a side effect of getting healthy.
Dr. Justin Marchegiani: A lot of these superficial types of goals or symptoms which they’re still important they’re all downstream. Right yeah. The guy gets better and all these root cause upstream things happen. Right. It’s always top down inside out. Right you work inside out top down and a lot of these things are in the downward kind of manifestation. So if we go inside out top down we’re going to fix a lot of these things downstream so I think it’s really important. And if people are listening to this now. All right. Dr. J. They haven’t just listed out a whole bunch of like mechanisms and a lot of science like I’m overwhelmed like what the heck do I do. All right. Let me break it down. So number one if your issues are severe and hair loss is just one thing out of many. You really got to find a good functional medicine doctor were available. EvanBrand.com, JustInHealth.com number one. Number two what can you take action on right away. Cut grains out of your diet right. Cut you go on a paleo or at least autoimmune paleo template no to get adequate amount of selenium and zinc. What does that look like at least two hundred micrograms supplement it through selenium and 30 milligrams so automated through zinc. So two hundred micrograms of selenium, 30 milligrams of zinc different metrics there will not be doubt you know make sure the recall that get enough collagen in your diet. What does that look like. That could be about 30 grams a day maybe 40 or 50 if we have hair loss issues. That’s to give you extra building blocks and then we could also use extra vitamin an extra fish oil extra Vitamin E. These are good low hanging fruit to kind of start off with one, nutrient based, two you already need them anyway. And if we don’t get enough there at least low hanging fruits to bumpy in that right direction and then everything else find a good functional medicine doc if that’s not getting you where you want to be to figure out the next steps.
Evan Brand: Well said. you mentioned the websites but I’ll mention them again. Justin and I work with people around the world. So if you do want to reach out we can send lab tests to your door except for blood. We send you to a local lab for that but still you’re in a lot of the functional testing we do. Urine, saliva, Hormone Testing, et cetera. That’s all done at your house. So pretty awesome, pretty easy and very effective. Far better than the standard care you get done from your once a year blood work with your doctor, you’re once a year hormone check with your endocrinologist, this is far and above that we’re not saying, Ditch those people we’re saying we’re just going to go beyond what they’re doing. So if you want to reach out to Justin, JustInHealth.com or me EvanBrand.com. We love to help people were super blessed, we’ve got really really cool jobs because we send people back into the world feeling better. And if you want to change the world the best way in my opinion is to help multiply ourselves. So I feel like we’re pretty awesome. We put out good stuff to the world. So if we can help other people get their energy better, get their sleep better help the relationships with their kids because now they have enough energy to play with their kids and now they’ve got enough energy to do the dishes. So the wife’s not complaining the dishes are piling up, and then their marriage gets better because they’re both sleeping better, so they’re not grumpy, and we doubt in their diet. So they’re not hungry and having blood sugar crashes like all the stuff we’re doing is making people better people. And then those people are hopefully nicer and better to their people and then it just kind of spreads like a healthy virus. That’s our goal.
Dr. Justin Marchegiani: One hundred percent and if you guys love this then and you enjoy it. Give us a thumbs up. Share it with a friend or family member that’s dealing with this problem and then also if you really enjoy it too. Right below there’ll be a link to go write us a review so if you go to JustInHealth.com/iTunes and I imagine Evan probably has a similar link, EvanBrand.com/iTunes that will show right up to our review pages and feel free to write us a great review and if you want to give us the same review and just cut copy and paste it to make it easier and just change the names. That’s cool too. We know you guys are busy. We appreciate the review, we appreciate the feedback, and if you’re a little bit overwhelmed which is normal. We’re still here for you as well and we’ll put the contact info below. Hey Evan today was a phenomenal podcast. Anything else you want to leave the listeners with?
Evan Brand: This was fun. I would just say pick a step and start there. And don’t give up. This is a fixable problem.
Dr. Justin Marchegiani: Absolutely also. I’m having my second son this Friday so really excited. His name is gonna be Hudson. So we’re really really excited about that. Putting the name out there early so keep your fingers crossed and probably won’t be here next Monday but the following Monday I’ll be back in the saddle. Right now I’ll be on terrorism late nights but I got my adrenal support I’ll be all right.
Evan Brand: Oh Man I’m excited for you. Congratulations. I hope everything goes well.
Dr. Justin Marchegiani: Hey Evan thanks so much man. It was great chatting. You have a great day.
Evan Brand: You too. Take care.
Dr. Justin Marchegiani: Bye.
Functional medicine hair loss solutions – Podcast #94
Dr. Justin Marchegiani and Evan Brand talk about supplements, hormones and how the adrenals affect the thyroid in relation to hair loss. This interview is geared towards educating people all about hair loss and functional medicine solutions. Learn all about alopecia areata when you listen to this podcast.
Also find out about the different things that you can do to help improve your hair quality and even grow it back. Get to know about ferritin and iron saturation and why you should pay attention to these. Discover the possible causes of hair loss and what hair supplementation to take which are proven to be very helpful. Learn how the functional medicine approach to hair loss can be very effective at addressing this issue.
In this episode, topics include:
00:23 All about hair loss and alopecia
02:32 Gut issues
04:35 The thyroid connection
06:37 Blood tests and hormones
Dr. Justin Marchegiani: Hey, Evan! It’s Dr. J. It’s a great Friday here over in Austin. How’s it up in Louisville?
Evan Brand: Howdy! Blue skies and the grass is green. We’ve had about 3 feet of rain it feels like over the past weeks, so everything is super lush.
Dr. Justin Marchegiani: That’s great. Another great Friday. Well, we talked pre-show we wanted to discuss a little bit more about hair loss and different things that we can do to help improve hair quality and potentially even grow back hair as well.
Evan Brand: Yes, sir. Yeah, so I’ve had a quite a few—quite a few women, I mean, and it’s—it’s always there. Hair loss is always the symptom, but I’ve found this week especially that alopecia has been popping up, and it almost makes you think it’s more common when you’re hearing it multiple times a week. It’s like, “Whoa! Does everybody have alopecia?” And so we know one of our online friends, Yuri–
Dr. Justin Marchegiani: Yup.
Evan Brand: He has alopecia and he talked about it. I believe he’s talked about it at least where he’s basically he’s lost his eyebrows, he’s lost everything, and obviously that’s an extreme case to lose everything, but there’s definitely some—I guess a spectrum of hair loss that can happen. So maybe it’s not a full state like the alopecia but there’s also like some thyroid dysfunction and some other stuff, I suppose we can chat about that it’s gonna be tied into mild hair loss.
Dr. Justin Marchegiani: Got it. Yeah, I actually had a conversation with Yuri Elkaim about his hair loss and he mentioned a lot of it had to do with poor diet when he was younger as well as gut health issues. And if you look at alopecia or alopecia areata as it’s known in the conventional medical world. It’s kinda fun to say—areata, that’s autoimmune and we know with autoimmune stuff, there’s almost always a gut element connected, right? Because we know leaky gut is when those tight junctions, the epithelial tight junctions open up, undigested, whether it’s bacteria, lipopolysaccharide particles or undigested food antigens which are foreign food proteins get into places in the bloodstream where the immune system isn’t used to it and that can really drive immune attack or an autoimmune attack, and alopecia is nothing more than a disease that describes where the immune system is attacking especially the hair follicles.
Evan Brand: Interesting. So we would have to assume that any person who has this hair loss issue has some sort of gut issue. Is that a safe statement to say?
Dr. Justin Marchegiani: I would say anyone that has hair loss and I hate absolutes, but I would say there’s a very strong chance that if you have hair loss, outside of it just strictly being a genetic factor, there’s more than likely a gut issue. And when we look at gut issues, it could be a gut issue where there’s a full on infection, like a parasitic or fungal overgrowth or a bacterial infection. It could be just something like a small intestinal bacterial overgrowth or it could even be something like hydrochloric acid and amino acid or protein—prote—proteolytic enzyme deficiencies where you can’t break down those amino acids, where you can’t ionize those minerals. Now typically any type of deficiency in the gut where there’s lower enzyme levels and lower hydrochloric acid, after a period of time, they’ll typically be an infection present because we need the hydrochloric acid to sterilize the—the gut environment, especially the stomach. That sterile environment is akin to you going to a—a dirty picnic table and maybe spraying some bleach or some kind of sterilizer on the table. It keeps that area clean. Well, that’s what happens in your gut and hydrochloric acid is also important for cleaning the environment but also activating enzymes. So if we aren’t activating enzymes and we aren’t keeping that environment clean, overgrowths can happen and if food doesn’t get broken down, the food rots and ferments, and then typically bacteria will then feed on the remains if you will.
Evan Brand: That makes sense. Yeah, and I actually had several—several people like I mentioned over the last week with alopecia and one woman, I think she ended up not proceeding with her lab test. I’m not sure what—what ended up happening but I really wanted to take a look at the gut, so at this point I don’t know what’s going on with her gut if we’re not gonna proceed with testing, but I think it sounds like that’s an important place to start. And then maybe you could shed some light on the thyroid issue, because any time we talk about hair loss, women think that it’s automatically the thyroid. Is that a place that you’re gonna look for issues as well?
Dr. Justin Marchegiani: Yeah, so one of the common symptoms of thyroid or of hair issues can be low thyroid. A lot of women will see it with the outer third of their eyebrows, it’ll start to thin out. We need thyroid hormone for adequate hair growth. So on the things we see with lower thyroid hormone—thyroid hormone can be a really powerful growth factor for that hair follicle to produce hair. So if we have lower thyroid function, and it could easily be from an anemia because a big building block for thyroid hormone is iron—that’s part of the whole iodination process involves iron. So if you’re a female that’s vegetarian or has a gut issue, low stomach acid, which typically also means low enzymes, and malabsorption and/or you’re a vegan-vegetarian, you’re really set up for a world of hurt, of having a high risk factor for thyroid issues because we need that iron to make healthy thyroid hormone, and I did a blog over this a couple of years ago over at FixYourThyroid.com—you can take a look at it—where we talked about thyroid function and hair loss. And that’s an age-old tell-tale symptom for low thyroid function. So we always wanna look at thyroid issues when we see hair loss and we always wanna look at anemia especially for women when they’re either vegetarian, they have gut issues and malabsorption problems, and/or they’re ec—they’re menstruating excessively. They have a lot of PMS and they’re bleeding—they’re going through more than, you know, 4 or so tampons, or they’re having just a prolonged bleeding period and they’re losing a lot of their iron that way.
Evan Brand: Interesting. So there’s a few things here. So it could be some iron anemia going on. So we would wanna look at ferritin levels, and then you and I were also chatting off air earlier about iron saturation, correct? Would that be the two most important blood tests to look for?
Dr. Justin Marchegiani: Yeah, so ferritin and iron saturation are gonna be important to look at. We like iron saturation 25 or above. We like ferritin, at least for a female, 30 or above. Now we can go above and beyond that, we can also look at your iron binding proteins like TIBC and UIBC. These are inverse proteins, so they go high—they go high when iron goes low. So think about it as like LittleFingers, right? The more you need the iron, the more fingers are gonna be up there to try to grab and pull that iron into where it needs to go. So binding proteins go up when iron goes low. So it’s kind of an inverse thing. It’s kinda like TSH, right? TSH screams louder to the thyroid when the thyroid goes lower, like you’re trying to get someone’s attention, right? You’re talking to them across the room, they’re not responding to your voice, so you raise the volume. Same thing, you’re raising the volume and trying to pull that iron and get it into your body so you can carry oxygen and make thyroid hormone.
Evan Brand: Okay, so you’re talking about thyroid, so when TSH is high, that’s when we know the thyroid function’s gonna be low. So if we’re kind of mixing lab tests here, we’re kinda talking about a few different things that we’re gonna be looking for this whole hair loss picture, the thyroid’s a good place to look. The iron levels are another good place to look. And then what about the adrenals because typically we’re gonna see adrenal issues happening that could be tied into thyroid issues, correct?
Dr. Justin Marchegiani: Yeah, it’s very possible. I mean, stress hormone will do a lot of different things to our body, right? So stress hormone will typically catabolize tissue and amino acids. So we’ll catabolize amino acids that could be used to make muscle or neurotransmitters, and amino acids can also go and make hair. So it’s very possible the more you are in a stressed out state, the more—the more the adrenals are hyperresponding or being whipped like a tired horse, you could potentially catabolize those building blocks that could go and make quality hair. That’s why many people have had experiences of extreme stress in their lives, like you know, really punctuated stress like someone dies or you know, something really catastrophic happens and they start losing hair. So it’s very possible that extreme stress and higher secretions of cortisol can really drive that hair loss and also we know we need cortisol healthy levels of it for thyroid conversion. So if we’re not activating our thyroid hormone because now our cortisol’s in the dump, we can also have it because of chronic cortisol imbalances that are driving low thyroid activation or low thyroid conversion.
Evan Brand: Yeah, that makes perfect sense. So now the first place that people like to jump is supplementation. There’s who knows how many millions of products out there that are designed or marketed for women especially for hair, skin and nails. Is that something that we would wanna do right out of the gate, or obviously it sounds like the better alternative is we need to kinda look for these other deeper underlying causes first and then maybe the supplements are gonna be kinda phase 2 or phase 3 in terms of treatment.
Dr. Justin Marchegiani: Yeah, absolutely, so obviously the diet stuff is really important. We kinda echo this stuff. Supplements are meant to supplement a good diet and lifestyle, so we’re making sure we have an anti-inflammatory diet because inflammation will drive cortisol because cortisol is our body’s natural inflam—anti-inflammatory. So cutting out the grains and a lot of the food allergens, plus we know that alopecia or alopuc—alopecia areata is going to be autoimmune and we know gluten, how important gluten is at being an autoimmune—part of the autoimmune mechanism, being an autoimmune stimulator, we know it can open up those tight junctions. We know it can drive inflammation, it also can be very high in sugar, right? A lot of the carbs, gluten, and a lot of refined sugar can drive your insulin levels up and high blood sugar can also feed fungus and a lot of people will have like cradle cap or aka dandruff or they’ll say—call it seborrheic dermatitis. A lot of times this is driven by fungus. I’ve had a handful of patients just this week that have come in with dandruff and with like psoriasis and things like that, and a lot of the seborrheic dermatitis and dandruff stuff is fungal in origin, like a lot of the—the Nizoral or these anti-fungal Head & Shoulder shampoos, they’re all trying to reduce fungus and we can do that by stopping to feed the fungus in our diet and the sugar and stop driving the leaky gut which could drive the autoimmune element with the alopecia areata.
Evan Brand: Absolutely, so now are you gonna see—I guess if they’re new patients, then you’d probably don’t have the results yet, but are you expecting to see some elevations of some markers on an Organix to see maybe that there’s some fungus or maybe even some yeast and fungus together that’s causing these issues, too?
Dr. Justin Marchegiani: Absolutely and if we see imbalance in gut bacteria, whether it’s SIBO, or whether it’s just a kind of run-of-the-mill dysbiosis, whether it’s a fungal overgrowth and H. pylori infection or a parasite infection, we wanna make sure all of those things are eradicated and then at the same time make sure we have enough good clean amino acids and protein in the diet and we’re actually able to digest it. So we wanna make sure we’re at least adding the secretions like the hydrochloric acid, enzymes, bile salts so we can break down these really good fats and proteins so we have the building blocks going right into our system.
Evan Brand: Absolutely, and the thing that’s beautiful about this model that we use is it doesn’t really matter what the condition or what the symptom is, this net is—is both broad spectrum and specific in terms of the labs that we usually discuss and run to find things. So if it’s gut symptoms, if it’s hair loss in this case, you know, it may seem like just a general blanket approach, but really it’s general and specific at the same time to try to identify the underlying causes of what’s going on and really, there’s only so many ways it seems like that things can dysfunction or function properly.
Dr. Justin Marchegiani: 100%, yup, absolutely. So when you have a systems-based approach, we’re just going in and we’re assessing the body system. So we go and we look at the foundational system which is gonna be diet and lifestyle. Blood sugar? Check. Do we have our macronutrients dialed down? Check. Too much carbs, too much proteins. Are we breaking our food down? Check. Sleep, stress, all those things, and once we have those all checked off, then we can go into body system one where we look at the hormones in particular—adrenals, thyroid, fi—female or male hormones, ATM or ATF, and then we can go into the next system which is the gut and that’s where it gets interesting because we can go through the 5R’s there which are removing the bad foods or placing enzymes and acids, repairing the gut lining, removing infections, reinoculation with good bacteria. So we go through a lot of that there and then we can also look through other deeper infections, too, and then we can go down into detox and other nutrient deficiencies on body system three. So we really have this really great big net so we can catch as many potential intruders or imbalances before they become a major problem.
Evan Brand: Definitely and that’s the goal about this whole functional medicine approach that we’re using which some people say like you said some people say they’re doing functional medicine but it’s different or it’s not quite this type of approach. This method is simple enough but it’s effective enough, too. So people, you know, when they’re looking on the Internet, say for hair loss supplements, you know, you could probably get locked in to some multilevel marketing scheme product or something similar where it’s really just a lot of hype and marketing but it doesn’t really have any solid foundation in science behind it and so people get frustrated and they go and they drop their money into these products and they don’t really move the needle. So maybe we can talk about some of the—the ethical or the intelligent ways that you could supplement if you really were trying to support, you know, optimal hair, skin, nails, hair growth, etc.
Dr. Justin Marchegiani: Absolutely. So off the bat, I’ve—I skipped one thing—we also know that blood sugar swings and adrenal stress will encourage more reverse T3 which are like the metabolic blanks in our gun cartridge so to speak, in our magazine, because when you pull a gun—pull a trigger or the—on the gun, right? A bullet comes out, right? You actually have an effect. Well, metabolically, reverse T3 is supposed to bind to the receptor sites where T3 would go, but the problem, reverse T3 is like putting a blank in that gun. So you get the sound, but you don’t get the effect, right? You get the hormone in the receptor site, but you don’t get the increase in metabolic activity, that typical T3 thyroid hormone will produce. So that can cause less thyroid hormone via the reverse T3 mechanism, and we know that blood sugar issues will drive that, too. We know overall stress will drive that as well. So that’s one other mechanism I wanted to add.
Evan Brand: That’s great. Now so you’re saying here that if we are looking at a blood panel that reverse T3 if that’s elevated, and maybe you can shout out some of the more appropriate ranges that that is gonna be an issue.
Dr. Justin Marchegiani: Yeah, typically we like it below 24 or 23. Typically in the—in the mid-teens is okay. We actually would look at like a reverse T3 to free T3 ratio or a total T3 to T3 ratio. And pretty sure my free T3 to reverse T3—T3 ratio is around 10:14 is optimal. I’ll pull up my—my little reference range here right now and I’ll confirm that while we’re live, but that’s the general gist. Yeah, and total T3 to reverse T3—T3 ratio is 10:14. Free T3 to reverse T3 ratio is 20:30.
Evan Brand: Okay.
Dr. Justin Marchegiani: So that’s the ideal range there. And you can just google those ranges online. There are a couple of good sites that will provide an actual kind of algorithm where you can plug in the T3, plug in the reverse T3, set the standard deviation, you know, whether it’s ng/dL or µg/dL and it’ll give you that number. So total T3 to reverse T3 is 10:14 and then free T3 to reverse T3 is 20:30, and we like to have that reverse T3 ideally in the very low 20s or mid-teens or so.
Evan Brand: How high have you seen that number?
Dr. Justin Marchegiani: I’ve seen it, you know, up into the—into the 30s very easily and that could easily happen with stress, emotional stress, blood sugar stress and/or just overall inflammation in the body because that creates internal stress as well. So the reverse T3 is important because it’s gonna take that T3 that would be active and make it go downstream, and then it not only makes less T3 but then it prevents the T3 that’s actually floating around in your bloodstream from binding into the receptor site and doing what it was designed to do in the first place.
Evan Brand: Makes sense. That’s a big issue there and a lot of people are like I’m not stressed. It—it’s the invisible stressors, too, that we’re factoring in and we can see that. So you don’t have to actually identify as a person that is stressed, that could be invisible stress that we’re gonna see on these lab results here.
Dr. Justin Marchegiani: Absolutely and also estrogen-dominance can provide problems, too, because that will increase thyroglobulin and thyroglobulin will decrease the amount of free T3 in your bloodstream. So it’s kinda like reverse T3. The difference is reverse T3 is more or less blocking the receptor sites, where thyroglobulin is decreasing the amount of free fraction. So 2% of your thyroid hormone is actually free, the other 98% is protein-bound, and what it’s doing is the thyroglobulin is decreasing the percent of free T3. So instead of having 2%, maybe now you have 1.9 or 1.8, or just having less free fraction available, so when we look at our total numbers, right? Maybe our total T3 is 110, 120 which isn’t bad, but now our free T3 instead of being at 3 or 3.1, now it’s at 2.9, 2.8, 2.7, and it’s dropping because of that estrogen dominance.
Evan Brand: Yup, so estrogen dominance which we’ll probably have to do a whole show on that if we haven’t already, a lot of that’s gonna be exposure to synthetic estrogens?
Dr. Justin Marchegiani: Yeah, it’s gonna be exposure to plastics, chemicals, pesticides, fluoride in the water, and also just being stressed, right? Because in women, progesterone predominates that second half of the cycle, and when women are stressed, they can use progesterone as a building block to make more cortisol. So more stress will actually steal from their progesterone. It’s kinda like a progesterone stealer or progesterone escape. We’re pulling progesterone in to make more stress hormones because our body’s epigenetically hard wired to deal with the stress of today versus the healing of tomorrow. The problem is most people live in a perpetual state of stress so tomorrow never comes.
Evan Brand: Yeah, exactly. It’s crazy, isn’t it?
Dr. Justin Marchegiani: So, I—I did the political side-step, I—you asked me a question and I gave you the answer that I wanted to give. It had nothing to do with that. So let me go back to your question. I’ll reiterate it for the listeners here. What supplements in particular? So number one, we can add good quality hair support from fatty acids, right? Omega 3s, whether it’s good quality fish oil or cod liver oil or sardines and things like that, salmon, mackerel, those are all really good quality Omega 3 fatty acids that can help with hair. Next you have conventional things that have been around a while like Biotin, which is kinda like, almost like a B vitamin so to speak, and that can very much help with the skin, help with hair as well. Next, I would say collagen is one of my favorite–
Evan Brand: Yup.
Dr. Justin Marchegiani: Things. Collagen’s amazing. It’s very high in glycine and proline and hydroxyproline, helps provide building blocks for skin, hair, and nails, and I was talking to Dave Asprey last year when he was growing his hair out longer, and I noticed it just being longer and more full. And I’m like, “Dave, what the hell are you doing with your hair? It looks great.” He goes, “I’m megadosing collagen, like 40g a day, 50g a day.” So since then, I’ve been really upping my collagen to really have good high quality hair and skin building blocks, and that’s I think one of the most important things you can do is good quality grass-fed collagen, and by the way we have a collagen product coming out very soon called True Collagen and I was able to source one of the biggest and best distributors for collagen that is grass-fed, hormone-free, pesticide-free. So stay tuned for my True Collagen which is something that we’ll be coming out very soon and I’m already using it now and I love it.
Evan Brand: I want my sample pack in the mail.
Dr. Justin Marchegiani: You got it, man.
Evan Brand: Okay.
Dr. Justin Marchegiani: Coming your way. So–
Evan Brand: Awesome.
Dr. Justin Marchegiani: So we talked about Biotin, collagen, fish oils, anything you wanna add to that?
Evan Brand: No, I think that was good, you know, the fatty acids for sure. Basically, things that are gonna help to reduce the inflammation in general, because if there is something going on in the gut, the gut has to be healthy so if you just or somebody listening and maybe you’re already taking collagen which a lot of women are, they’re frustrated, they’re almost like they’re mad at me. It’s like, “Evan, I’m already taking collagen and my hair is still falling out or my hair is still very thin.” It’s like, well, that’s—that’s the supplement, you know, let’s see what else is going on deeper and usually something pops back up on the stool test, and like, “Okay, well, you know, your digestion’s been impaired, here you are feeding these bacteria or feeding these parasites, not you,” so maybe it’s been good nutritional insurance to get the collagen, but if you have someone stealing your energy, you know, someone like kinda how they used to do in the—they used to steal cable, you know, they’d go up to the main line and–
Dr. Justin Marchegiani: Yeah.
Evan Brand: Slice the cable wire down to your house, if that’s going on in the gut with your nutrients, then you could still have issues regardless of, you know, what you’re supplementing with.
Dr. Justin Marchegiani: Yeah, I remember Dr. George Goodheart saying in various seminars, you know, years back, “The highest good is to get to the root cause.” The highest good and that’s always in my head. Like alright, “Are we getting to the root cause?” Right? And a lot of times, supplements may be getting to the root cause or they may be palliative and supportive with the fact that we are addressing the root cause but also adding these extra nutrients in so i.e., let’s say we have a gut issue and our diet stinks, but we’re adding in a whole bunch of collagen. Well, is that a bad thing? No. It’s not a drug. It’s not gonna have side effects and kill over a hundred thousand people a year like pharmaceutical drugs do in general taken the right way. So that’s a good thing. We don’t have that nasty side effects. Is it providing more building blocks than would be there anyway? Yes. But we wanna make sure the underlying cause is addressed. So I’m a big fan of if we’re gonna add something in that’s supportive and palliative, at least make sure the underlying cause is addressed or there’s a program set up in place to address it.
Evan Brand: Right. So there’s nothing wrong with treating the symptoms and sometimes we have to treat the symptoms first to keep people motivated, move the needle enough with them to keep them on their program, but eventually we’re always kinda backtracking from this symptom back to the underlying cause.
Dr. Justin Marchegiani: 100% and like there’s another element here I didn’t talk about which was DHT, which is dihydrotestosterone. So if we look at kind of the breakdown or the formation of testosterone, it goes from DHEA to testosterone or I should say androstenedione then to testosterone and then to DHT. So in each downward cycle, the hormonal molecule gets more potent, more—more strong. So DHEA is weaker than andro. Andro is weaker than testosterone. Testosterone is weaker than DHT. So essentially said in the different way, DHT is the strongest and most powerful out of all of them, and DHT is shown to potentially starve out blood flow to some of the hair follicles. So that’s important. So if we run a profile, we can look at women with elevations like PCOS can drive elevations in androgens, and we can use things like GLA fatty acids like evening primrose oil or black currant seed oil to help with reducing that DHT. It’s a 5-alpha-reductase inhibitor. In men we can also use—I think women, too, this would work—but we can do zinc and selenium, which happen to be great for the thyroid, go figure. And then men we’ll do it a lot. We’ll use saw palmetto and/or pumpkin seed extract as a natural 5-alpha-reductase inhibitors, and you know, a lot of the medications, right? Like the—the names are fleeting me—I can think of all the commercials from the 90s, the—the Rogaine–
Evan Brand: Yup.
Dr. Justin Marchegiani: And a lot of those types—I forget the actual trade name of it—Propecia. That’s what it is. Those are typically 5-alpha-reductase inhibitors as well at a pharmaceutical level. But we can do it naturally, too. They won’t have all the side effects. So my big 5-alpha-reductase inhibitors for females are really easy one is gonna be the nutrients, selenium and zinc, and then one, I’ll add in the GLA fatty acids like the evening primrose or the black currant. Men can do that as well and they can also go the extra mile and add in some pumpkin seed or saw palmetto along with that.
Evan Brand: Beautiful, awesome! I’m glad you got there because I—I’ve had that in my radar, you know, the 5—the—the DHT and I was thinking about, you know, men that have used steroids and they have the increased conversion of hormones there so they’re more likely to go bald and I’m glad that you were able to—to pull that out and digest it for us.
Dr. Justin Marchegiani: Absolutely. So if we kinda break everything down. We talked about the supplements, those are great. Really, really important things. We talked about the hormones. We talked about how the adrenals affect it, right? Cortisol high or cortisol low will affect the thyroid. So if the thyroid’s affected by the adrenals, that’s gonna cause a problem. If the thyroid’s affected by autoimmunity, right? We’re attacking the thyroid gland because of gluten that can reduce thyroid hormone. That can cause a problem. Too much iodine with thyroid issue can drive hair loss. I’ve seen people do excessive iodine with an autoimmune mechanism in the background, massive hair loss.
Evan Brand: Wow.
Dr. Justin Marchegiani: Massive. So we have the I—we have the thyroid piece. We have the nutrients that can exacerbate autoimmunity. Gluten potentially. Iodine if there’s already an autoimmune mechanism to process. The leaky gut. Poor nutrients in the diet regarding fats and proteins, not digesting these things, these compounds well. Infections can drive a lot of these things. I’ve heard Yuri talk about it with the gut and the infections causing his alopecia areata. So all of these different mechanisms—we have individual things that like the thyroid. We have individual things that affect the adrenals and thyroid together. We have nutrients that play a factor and then we have different hormonal things like the DHT and the progesterone as well.
Evan Brand: Great! Great summary there.
Dr. Justin Marchegiani: Anything else you wanna break down there?
Evan Brand: Honestly, I think that was great. I think it would just be me doing a broken record pitch there. So I think you did great. You know, the—the takeaway from this is—this is kind of a complex situation so it may sound just easy on the surface. You know, you go to Walgreen’s, you see a hair supplement. “I’m gonna try it. My hair’s gonna grow back.” Maybe not. So if you do have this issue, you know, it would be important to reach out to Justin or myself, you know, let us look for you and see what’s there, at least rule things in and rule things out. And if, you know, run a test and Justin says, “Oh, look, you’re free and clear.” Well, that’s good. But we still need to try to figure out what’s going on. But you’d never know if you don’t test. If you haven’t test, you’ve guessed. So keep that in mind anytime you’re gonna go invest your money into a supplement. You may need to invest into the clinical data that’s really gonna find out why this is causing it before you can actually work on fixing it.
Dr. Justin Marchegiani: Absolutely. So let’s kinda back up here, alright. So I’m a male or female that’s dealing with hair loss, kinda what’s—what’s the action tree here? Alright if–
Evan Brand: Yeah, so–
Dr. Justin Marchegiani: Go ahead.
Evan Brand: No, you go ahead. What you got?
Dr. Justin Marchegiani: Okay, so you’re man, right? Figure out, this hair loss fall in your family. This is a male potter—male pattern baldness thing. Well, number one, we gotta first realize that a lot of how we deal with stress and how we, you know, eat, sleep and drink typically is passed down through our family. So is this purely a genetic thing or is this, “Hey I’m just following the footsteps that my parents did and, therefore, I’m gonna have the same genetic predispositions because I’m eating crap and taking care of myself in a very poor way.”? So figure out how much of this is in your control and how much isn’t. Either way, if it’s totally male pot—male pattern baldness and you don’t have any control, you still wanna be doing all the things we mentioned anyway. So don’t ever let that be your excuse, because you still get other benefits by doing all of these things there, like brain health and performance and muscle and libido and virility and energy. So keep that in mind.
Evan Brand: Definitely.
Dr. Justin Marchegiani: If you’re a woman, you g—you have a lot of control over this as well. So the first thing we do is diet. Cut out the crappy foods. Grains are gonna be the first thing. Get your sugars under control. Next, make sure you’re digesting foods and proteins and fats well. You’re having digestive symptoms and things like HCl and enzymes aren’t working, well, guess what? Get on those. Now next, if that’s not working, then we have to do some testing. We have to look at the adrenals. We have to look at the thyroid. We have to look at the gut. Alright, so that’s where you wanna reach out to Evan or I and figure out the next steps, but in the meantime, you can go pick up a high quality collagen. You can try some HCl and enzymes. You can try some of the nutrients we mentioned. But if that’s not working, you’ve already exhausted the low hanging fruit, so just make sure after that you reach out to a good functional medicine doc to get to the next step. But in the meantime though, don’t let the male pattern baldness genetic stuff if you’re a man stop you from taking action. You don’t know how much of it can be slowed or how much can go back. And if you’re a woman, this is a deeper sign that something underneath is happening. So I hope that helps and empowers everyone listening that’s dealing with this problem.
Evan Brand: Absolutely. Well-said. Yeah, so it’s the gun. You know, you may have the gun there, and it could be loaded with your genetics and your family, just all of that, you’re—you’re susceptibility to stress, your environment, etc. but you have the ability to not pull that trigger, you know? So don’t just, “Oh, screw it! I’m just gonna binge eat on pizza.” That may not be the step that’s best for you. You know, sometimes we get frustrated with our health conditions and we just say, “Screw it! I’m going all in. I’m gonna go off the rails,” but oftentimes, you know, just pause, take a breath, and then think, “Okay, what can I actually do that’s gonna work me towards my goals? And not just self-sabotage myself,” and that is common for people to—to hit this point, and they do wanna just—it’s all over. They get this kind of a—what do you call that—like a black and white approach I guess.
Dr. Justin Marchegiani: Yeah, absolutely. Absolutely, so we wanna make sure we have a multifaceted systems based approach, alright? And we wanna have objective testing to quantify it. And even things like temperature-testing can be a really good objective kind of test that doesn’t require any resources to do it outside a—a really good fertility thermometer. So kinda grab those low hanging fruits tests, right? We wanna assess, not guess. So get the assessments to figure out what’s going on and if you guys gotta reach out to someone like Evan and I to get more info, we are here at your disposal.
Evan Brand: Well-said.
Dr. Justin Marchegiani: Alright, Evan. Hey, it’s a great Friday, man! I’m looking forward to heading out in the water today in Lake Austin, probably tomorrow morning, do a little water skiing and get some good cardio in or I should say, it probably be more—more anaerobic with some of those movements that I’m doing. But anything else on your agenda for this weekend you wanna share with our crowd?
Evan Brand: Oh, we’re just gonna get out and enjoy the sun. You know, we got 4 weeks left ‘til the baby comes, so we’re gonna be soaking up the blue sky and the sunshine while it’s here. And before you know, we’ll have a baby and who knows? I mean, maybe trapped inside and changing diapers all day. So–
Dr. Justin Marchegiani: I know. I hear you. Well, make sure you say “Hi!” to Anna for me and you have a great weekend.
Evan Brand: I sure will. Take care.
Dr. Justin Marchegiani: Take care. Bye!
Evan Brand: Bye!