The Top 7 Root Causes of Inflammation with Dr. Jockers | Podcast #372

When your body activates your immune system, it sends out inflammatory cells. These cells attack bacteria or heal damaged tissue. If your body sends out inflammatory cells when you are not sick or injured, you may have chronic inflammation or other underlying issues.

Dr. J and Dr. Jockers suggest checking in with your healthcare provider if you experience a problematic injury or health issues. Also, talk with your functional doctor if you have ongoing pain, swelling, stiffness, or other symptoms. They can narrow down the cause and find ways to help you feel better.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:00 – Introduction
0:36 – Inflammation
4:41 – Acute Inflammation
5:21 – Root Causes
10:30 – Food Recommendations
18:22 – Herbs and Compounds

Dr. Justin Marchegiani: Hey guys! Dr. Justin Marchegiani here. Today, we have an awesome podcast in the queue, the top seven root causes of inflammation. I am here with Dr. David Jockers. Really excited to have him today to chat with David. How are we doing man? 

Dr. David Jockers: I’m doing great, Justin. Always great to connect with you. You’re one of the leading minds in functional health, functional medicine and so always great to collaborate and discuss really important topics that are affecting so many people around the world. 

Dr. Justin Marchegiani: Oh. Excellent man. I’m really excited to chat with you. I mean, you could just pull up one of your blog posts and just have the infographic run the whole entire podcast, right? So, uh, I’m really stoked to chat about it. So, first off out of the gate, I think we should just kind of define inflammation for listeners. How would you define it pretty simply? 

Dr. David Jockers: Inflammation is an immune response that’s actually designed to help protect your body. See our body is hardwired to protect us from dying from an infection so you know our ancestors when you know they would go out hunting or let’s say they were in war or something like that, it would be attacked, they would have some sort of a flesh wound and then bacteria could get into that flesh mood into their bloodstream and then spread throughout their body and get into their lungs cause pneumonia, get into their nervous system cause meningitis and kill them. This is really the leading cause of death throughout the history of mankind. Even when people were in war, they really, they tended not to die like it was they were more commonly were dying from an infection they got from a wound than the actual wound itself and so the body is adapted to create this inflammatory response whenever you have an injury, right, and when we think about injuries we think about, okay, a sprained ankle. Let’s say what happens? You end up with a lot of inflammation in that joint and that inflammation is there to help protect against any pathogens getting in. It also helps break down damaged, uh, ligaments, tendons, different structures that are in there that are involved and it’s all part of the healing and remodeling process and so inflammation itself is actually very therapeutic, very healing and it’s designed to keep you alive. The problem is that most people in our society now are dealing with chronic inflammation because their main injury is actually in their gut. It’s in their digestive system. So, the gut when that becomes damaged, the body responds just like if we sprained an ankle or if we got a cut or a burn it creates this inflammatory response. You just don’t see it. So, you don’t actually see it and oftentimes, you don’t even feel it at least not in your gut like a lot of people are not feeling gut pain or even you know just like a stabbing pain even though the gut is damaged but when that happens when the gut becomes damaged, now proteins are seeping into the bloodstream and the body says okay these are abnormal proteins, abnormal bacteria in here. Let’s turn up inflammation throughout the body so that person may experience eczema or some sort of skin inflammation, acne, rashes. Another person may experience joint pain so when they have a leaky gut and their body’s ramping up inflammation, they notice it in their joints. Different joints are hurting. Another person may have a lot of brain fog and fatigue so it can impact us in different ways but in our society today, the inflammation is less so coming from like a physical injury and more so coming from injury in the gut. 

Dr. Justin Marchegiani: 100%. So, kind of my simple kind of metaphor to understand inflammation is you have breakdown and build up catabolic anabolic. Anabolic builds you up. Catabolic breaks you down. Things that are responsible for the breakdown like cortisol, stress hormone, interleukin, cytokines, right? Inflammation, in general, is a good thing. When you go to the exit, when you go to the gym and you lift weights and you do push-ups, you’re creating an inflammatory response in the pec area but then you have this anabolic build up of remodeling proteins so your chest gets stronger and bigger but there’s a healthy balance, right? And so, what we’re talking about here is the inflammation causing a little bit more of a breakdown than you’re able to build up and so over time, whether it’s your brain, connective tissue, joints, cartilage, gut lining, all of this inflammation is causing the body to break down and depending on where that tissue breaks down is where the symptoms occur if it breaks down on the cartilage, arthritis. It breaks down on the blood brain barrier, brain fog, mood issues. If it breaks down the gut, you can have more autoimmune issues, you can have digestive issues, it breaks down, let’s just say in other tissues in the body it could be MS or type 1 diabetes. And so, yeah, so, depending on where the tissue is, is where conventional medicine puts that ICD-10 code but we’re looking deeper under the hood and we’re trying to get to the underlying mechanism. So, first off, we kind of define terms and then now we can go into, you know, other, um, other root causes and root palliatives to kind of support it. Any thoughts?   

Dr. David Jockers: Yeah. For sure. And you have, you know, that acute inflammation which again is very therapeutic and healing and then you’ve got chronic inflammation. The big difference there is, the body when it’s in this breakdown, build up cycle. That is normal and healthy but when that never gets turned off and the body is continuously in this sort of healing cycle and it never gets turned off, that’s when we end up causing a lot of long-term problems that are happening in our society.

Dr. Justin Marchegiani: Yeah. Inflammation is a good thing because of the remodeling that takes place. It’s the out-of-control chronic-ness and especially when we look deeper at the hormones like cortisol, adrenalines if that’s kind of chronically high or even chronically depleted that’s where we’re gonna start to have big symptoms. What would you say are the next big root causes?  

Dr. David Jockers: Yeah. So, you know, at the root a leaky gut is a huge factor with all of this, right? Because, again, if the gut is damaged now we’ve got proteins, we’ve got bacteria, yeast, different things like that seeping into that bloodstream and that tells the body, okay wow we need to signal the alarm because these things, we shouldn’t have abnormal proteins or bacteria going around in our bloodstream that puts at risk for pneumonia, for meningitis for something like that so we’ve gotta turn up and ramp up inflammation and the body kind of has this threshold level for how much abnormal protein and bacteria should be in the bloodstream and once we get over that threshold, it’s like a massive alarm throughout the whole body and then we’re releasing a lot of cortisol, right? We’re releasing a lot of hormones that are associated with fight-or-flight and that suppresses the hormones that have to do with healing and repairing, sexual reproduction, you know, our anabolic, our testosterone, our estrogen, our progesterone because we’re putting all of our energy into fight or flight cortisol and epinephrine and this is why leaky gut can cause issues with sleep for example. A lot of times people have insomnia. It’s really related to leaky gut and damage in their gut. So, that’s always the first thing that I look at and then kind of building off of that is just we have to look at their diet, right? Inflammatory foods are one of the main triggers for leaky gut.   

Dr. Justin Marchegiani: Yep. 100%. So, of course, like the big, you talked about proteins, right? So, the big proteins I think, you agree, would be your glutinous proteins from grains and it could even be gluten free grains too. Sometimes rice can be a problem, corn can be a problem, especially if there’s GMO residue on that, right? Like, uh, the pesticides that are used, right? Round-up, etc. and then of course high fructose corn syrup can have a lot of different corn residue as well. Casein and a lot of dairies especially if it’s more conventional based dairy with a lot of the hormones and things in there. So, all those things can be a problem and then of course, the more our digestion is optimal. So, if you don’t have enough acid and enzyme and bile salts, we got to break these proteins down into smaller units called peptides and amino acids when these globules are just too big, that can create more food allergies because our bodies have these big proteins, they’re seeing in the bloodstream and that can create more stress so we got to break things down and if that fight-or-flight sympathetic nervous system is going, those enzymes and acids and bile salts may be really um, and at non-optimal levels and we have these bigger food globules in our intestines. 

Dr. David Jockers:  For sure we weren’t meant to eat on the go, right? So, we really need to be in a more relaxed state. Take a few deep breaths, you know, always pray before we eat, right? That puts us in a state of gratitude, activates that parasympathetic nervous system, the vagus nerve which travels from your brain down into the stomach into the gut and activates the production of those key digestive juices so you can really break down the foods effectively. So, yeah, we definitely need to eat with the you know we have to have mindful eating habits and eat foods that are nutrient dense and not foods that are higher on the inflammatory spectrum like you talked about. So, yeah. That’s huge. And then, we got numbers, you know, the third big thing is keeping our blood sugar stable, right? So, blood sugar stability is super important. So like, if you’re eating breakfast and your breakfast consists of let’s say, you know an apple or a banana or something like that and you’re only eating let’s say fruit even though it’s a healthier you know, more nutrient dense food basically all it is is sugar and so what happens then your blood sugar goes up, insulin comes out, brings that sugar down and now your blood sugar is down and now your body says okay blood sugar’s down and if you’re not metabolically flexible, your body’s not very good at burning fat for fuel that becomes, you know, again, the alarm gets signaled because it says okay wow we don’t have enough sugar to fuel the brain so we’re hypoglycemic now. So now, we need to pump out more cortisol, more epinephrine to get the blood sugar up because cortisol is a glucocorticoid meaning that it activates, uh, blood sugar released from the liver from the muscles into the bloodstream to get the sugar back up but with that we also kind of get this effect on our brain, this high cortisol, epinephrine, where it can cause us to have cravings, it can cause us to have mood swings, irritability, anxiety a lot of different issues like that and that just drives up inflammation in our body as well. For sure we weren’t meant to eat on the go, right? So, we really need to be in a more relaxed state. Take a few deep breaths, you know, always pray before we eat, right? That puts us in a state of gratitude, activates that parasympathetic nervous system, the vagus nerve which travels from your brain down into the stomach into the gut and activates the production of those key digestive juices so you can really break down the foods effectively. So, yeah, we definitely need to eat with the you know we have to have mindful eating habits and eat foods that are nutrient dense and not foods that are higher on the inflammatory spectrum like you talked about. So, yeah. That’s huge. And then, we got numbers, you know, the third big thing is keeping our blood sugar stable, right? So, blood sugar stability is super important. So like, if you’re eating breakfast and your breakfast consists of let’s say, you know an apple or a banana or something like that and you’re only eating let’s say fruit even though it’s a healthier you know, more nutrient dense food basically all it is is sugar and so what happens then your blood sugar goes up, insulin comes out, brings that sugar down and now your blood sugar is down and now your body says okay blood sugar’s down and if you’re not metabolically flexible, your body’s not very good at burning fat for fuel that becomes, you know, again, the alarm gets signaled because it says okay wow we don’t have enough sugar to fuel the brain so we’re hypoglycemic now. So now, we need to pump out more cortisol, more epinephrine to get the blood sugar up because cortisol is a glucocorticoid meaning that it activates, uh, blood sugar released from the liver from the muscles into the bloodstream to get the sugar back up but with that we also kind of get this effect on our brain, this high cortisol, epinephrine, where it can cause us to have cravings, it can cause us to have mood swings, irritability, anxiety a lot of different issues like that and that just drives up inflammation in our body as well. 

Dr. Justin Marchegiani: Yep. 100%. And also, just having blood sugar go up and down, up and down, if you’re relying on lots of glucose to be your fuel source unless you’re doing lots of exercise and burning it up and you kind of have that ectomorph body type. These are the people that are kind of your basketball players, your marathon runners. These are the ones that when they eat a bunch of carbs, they just have to go right around the block because their glucose just triggers their bodies. They need to move. If you’re not, you know keto adapted, right? Glucose is a dirty fuel in your body, and tends to cause a lot of oxidative stress. This is why diabetics with high blood sugar that kind of oxidation is gonna create problems with the eyes the vasculature, peripheral nerves and so it’s good especially if you’re not super active to be doing a lot more to be more keto adapted and to kind of really switch your fuel source to be more kind of fat based which creates less oxidative stress. 

Dr. David Jockers: Yeah. So, you really wanna build your diet around protein and healthy fats, right? I recommend typically when you eat, you want to eat roughly about 30 maybe 40 grams of protein if you’re trying to put on muscle mass, let’s say your weight lifting or something like that, you may even need more but when you sit down and eat a meal you should be looking at somewhere around 30 to 40 grams of protein in there. You know, roughly around 30 grams or so of fat in there, um, somewhere in that range is usually a good range depends you know can obviously range a little bit depending on the individuals body size or gender their activity level but somewhere in that range where you’re getting the fat, you’re getting the protein and then you know, you might have a little bit of carbs and some vegetables or maybe some berries, some low glycemic fruit but you know, you don’t want a tremendous amount, you don’t, you really want to minimize the amount of starch that you’re consuming throughout the day. Starch and sugars and just get them from real foods after you have your protein and your fat levels, your macros right on your protein and fat.  

Dr. Justin Marchegiani: 100%. And kind of my philosophy is anywhere between a palm to a full hand of protein, that’s usually three to six ounces again if you’re bigger and may go higher to eight ounces, if you’re done doing a lot of lifting of weights, you know, you may be able to shift that and then usually carbohydrate-wise, I kind of say between two fish the two full hands and I would say mostly vegetables is pretty good. And if you’re gonna throw some starch in there, you know, there are some theories, I tend to go later in the day because of the carb backloading theory of just being more insulin sensitive later in the day and I try to stack in the fast at night with really lower carb throughout lunch to really tap into more being able to utilize ketones and fat for fuel. What’s your thoughts on that?  

Dr. David Jockers: I completely agree about that. In fact, that’s what I talked about in my book keto metabolic breakthrough when I talked about carb cycling and even getting keto adapted in the beginning is really trying to push those carbs into the later in the day. Even a lot of people say well then you’re gonna store them as fat it’s not necessarily true because if you go low carb throughout the day, your body’s actually gonna burn up all your sugar stores in your liver and your muscles and so now you’re gonna have this wide open available storage for those carbs when you consume them to put it right back into the liver, right back into the muscle in the form of glycogen so you’re not just gonna turn it right into fat and I think that’s a much much better strategy and what I’ve noticed is that when people go lower carbs throughout the day. They have less cravings throughout the day. The earlier you eat more carbs earlier in the day, cravings go up and your overall, the amount of calories and the amount of carbs that you’re gonna consume throughout the day goes up.   

Dr. Justin Marchegiani: So yeah. A part of the big reason why exercise, especially lifting or interval training is so beneficial is one it makes your muscles a little bit bigger and then muscles are like a sponge for glucose and so one you’re wringing out the sponge when you exercise so you’re burning the glucose but then you’re also hypertrophy in the muscle making it bigger so it’s like taking a big sponge and cleaning up that messy table I had a patient just do this as an experiment, he tested his blood sugar after meal, it was 140, 140, right, mg/dL and I tell patients, if you, you know, make a mistake with your carbohydrate or just too much junk after meal just do a five or ten minute walk. Well, he did an elliptical, a ten-minute kind of like interval on the elliptical that measured his blood sugar. 10 minutes later it went from 140 to 85. 

Dr. David Jockers: He was activating that skeletal muscle. And another quick tip there too is you could even just do, if you know, you’re gonna have a higher carb meal, do 50 air squats right or 20 air squats or whatever you’re able to do, just do that. Get yourself kind of in a state where you’re breathing heavily. Give yourself a few minutes just kind of calm down, take some deep breaths and then eat your meal. Now, you’ve activated the Glut-4 receptor, right? So, the Glut-4 receptor, right? So, the Glut4 transporter protein that actually acts like insulin to pull the sugar into the cell and again you gotta get that sugar out of that cell because the sugar will create more oxidation and will create a process called glycation or browning inside of your body. If it’s stuck in the bloodstream at a high level like that 140 like your client there. So, we want to pull that out and we don’t wanna do it with a lot of insulin, right? So, we want to be able to get the sugar out of the bloodstream and into the cells with the least amount of insulin production and that’s what the exercise will help with. 

Dr. Justin Marchegiani: Yeah, and that’s why I recommend like during the day I have a stand desk here so I have a treadmill over here that I can control with the remote so I’ll move my desk over there like yesterday on my fitbit here, I walked 18 to 19000 steps yesterday. So, I moved it over my treadmill. I’m working with patients and then I have my little Cubii stepper over here so I lower my desk and now I’m able to pedal so I’ll go from pedaling to just standing and then doing actual walking at three to four miles per hour. I can go one or two miles per hour if I want. If I’m really focused, I don’t want to put a lot of energy out and put more brain energy. So, it’s good if you’re in those work environments. Start with just the Cubii where you just get the little pedals, put them onto your desk and just try to get an extra 5000 steps a day with just that alone. That makes a huge difference. 

Dr. David Jockers: Yeah. That’s great. And I can tell, you know, from the last time I talked to you, you actually look more muscular and trimmer as well.

Dr. Justin Marchegiani: Oh yeah. Thanks. Appreciate it. 

Dr. David Jockers: It’s working.

Dr. Justin Marchegiani: You got it. You got it. Uh, What’s number four? 

Dr. David Jockers: Yeah. So, number four is gonna be infections. So sometimes, you can eat a great diet, right? You can really try to put your body in the right mindset, right, and in parasympathetic mode so you’re able to produce the right amount of digestive juices but you’ve got infections particularly gut infections that are driving up inflammation in your gut, driving up inflammation, driving up cortisol levels and these bad gut microbes which could be Candida, right, or some sort of a yeast or fungal overgrowth. It could be bacteria like Klebsiella for example, it could be parasites, it could be worms, it could be, um, you know, Blastocystis hominis and different Amoeba and different things like that. These things are gonna eat the nutrients that you’re consuming. They’re going to poop out toxins, right? Toxins are gonna drive up inflammation in your system. So, sometimes, we need to use some herbs and different compounds to help remove these infections and follow specific protocols, uh, to get rid of these infections. That’s really the next thing that we got to focus on there. 

Dr. Justin Marchegiani: Yep. 100%. So, first off, just being in a really healthy parasympathetic state with good acid and enzyme and bio levels. Those actually provide like almost like natural bleach for like the dirty picnic table so it makes it harder for microbes to grow when there’s good acids there, a good bile, these things have a natural antimicrobial effect, number one and then typically good beneficial bacteria in the gut it’s also gonna produce some level of acids whether it’s glucuronic acid or different acids that are very helpful for keeping bugs in check but then when you’ve eaten too much sugar or been exposed to antibiotics or your sympathetic fight-or-flight’s off, these microbes start to overgrow and then you’re in this then it starts to shift the whole milieu so then you kind of have to fix everything. You have to fix the digestion, fix the diet, use the herbs to knock down whatever microbes are going on. There can be different microbes and sometimes when those microbes are in there, you can’t just go back to doing lifestyle things changing your diet and digestion that may not be enough and sometimes the herbs are really necessary to kind of knock things down. 

Dr. David Jockers: Yeah. Absolutely. So, just like you said, I mean, naturally if you’re producing enough stomach acid, bile, stomach acid really helps to sterilize the stomach and then bile is very alkaline, stomach acid is very acidic, bile goes in, really helps clean out the small intestine, you know, a lot of people are developing bacterial overgrowth in the small intestine. Sometimes, these are good bacteria but they’ve translocated from the large intestine into the small intestine and now they’re fermenting foods, you know, they’re eating foods before they should be creating a lot of extra gas causing poor nutrient absorption and this is oftentimes related to poor stomach acid, poor bile flow, not really creating the right environment and now these bacteria are translocating up there. So, yeah, these are all things that we need to get rid of. We need to really optimize stomach acid bile flow. So that’s key. And then sometimes, some different herbs, different compounds can be really helpful. Things like garlic, um, let’s see Berberine, can really, really be helpful here. Olive leaves can be a great one. Black walnut, right? What are some of your other favorite antimicrobials? 

Dr. Justin Marchegiani: I’d say, the oil of Oregano’s wonderful. Ginger, um, silver, I like wormwood a lot too. These are all excellent compounds that are very helpful. And then, typically, when we do a lot of killing, we may even throw some biofilm boosters in there whether it’s ginger or silver or an acetylcysteine can work wonderfully to help the herbs work even better, kind of disarm the bug so to speak.  

Dr. David Jockers: Yeah. Super important. And I know we’re running low on time so the next two I’m gonna put together. Chronic stress and poor sleep habits. So, these kind of go hand in hand, obviously, if you’re under a lot og stress, it’s gonna cause higher cortisol levels, higher epinephrine levels, which is gonna cause more laxity in that gut so when you have high cortisol, the tight junctions that keep the gut, uh, connected and with a lot of integrity become loose also high cortisol will cause a reduction in the mucous membrane which is kind of like the first line of defense in your gut before you get to the gut lining so you’ll have less mucus production, lower levels of secretory IgA which is your key immune component that helps protect your gut lining, it helps protect against pathogen buildup in your gut and then the gut junction will become more leaky or more loose and will tear more easily so it predisposes you to leaky gut and of course we know chronic stress will also impact your sleep quality and then if you’re not sleeping well that also is gonna cause more issues with stress with higher cortisol, higher adrenaline and you know, obviously, that’s gonna compound your gut health and your ability to just heal and repair and produce the right amount of anabolic sex hormones in order to repair and really thrive.  

Dr. Justin Marchegiani: 100%. We talked about anabolic building up and catabolic breaking down. Well, cortisol, our stress hormone, the glucocorticosteroid, you mentioned, is on a circadian cycle so it’s higher in the morning and lower at night. Now, the problem is it goes down at night which allows melatonin, the sleep to come up but the problem is when we start to have overstimulation sympathetic nervous system stress, that rhythm can start to almost, it can actually pick up at night which then throws off our ability to make melatonin which throws off the parasympathetic restoration that happens when you sleep and growth hormone going up and all of your neurotransmitter turning over so like you kind of mentioned that sleep, it’s so important because when that throws off that prevents the healing and recovering and so it’s almost like a double whammy so to speak. 

Dr. David Jockers: Yeah. You really can’t recover if you’re not sleeping well. That’s actually, it’s one of the most foundational things. I know I can help somebody if we can get them sleeping well. The faster we get them sleeping well, the faster their body is gonna heal. 

Dr. Justin Marchegiani: Yeah. You can get like, um, like a fitbit where they have an HRV function or like the whoop or the aura ring and you can test kind of your HRV and your sleep depth and I’ll do different things, I’ll like take extra GABA or Athenian or Magnesium or avoiding alcohol like I’ll just have one like night alcoholic drink like two to three hours for bed and my HRV score will be way lower that next morning so get a device where you kind of test and see the different inputs and outputs in regards to healthy supplements and lifestyle strategy and see how that moves the needle. You may see it with blue blocking glasses or prayer or meditation or breathing or cold showers. These are all important inputs and then you can see how your body responds as a result. 

Dr. David Jockers: Yeah. Totally. Totally. And the last thing is just environmental toxins. So, we’re being exposed to pesticides, herbicides, mold, you may have mold in your home that you’re being exposed to or in your office or something along those lines. Heavy metals, let’s say you’ve got Amalgam fillings in your mouth, um, you know, you can obviously get, get, get toxins from that, um, lead, let’s say you’re in an old home and there’s lead paint or something along those lines or you’re using conventional lipstick which actually has lead and you’re putting that on every single day. So, there’s a lot of different exposures to environmental toxins that you know may be causing you not to be able to heal effectively and drive up inflammation in your body. So, we gotta do the best we can so I always recommend trying to go as organic as possible with food at least trying to get non-GMO for sure and organic as possible with your food. That eliminates one of the major causes of you know toxicity and just a build up of toxins in your body. It’s like, we all have this bucket of toxins we can handle, we have a certain threshold that we can handle and our body will eliminate those things. And so, when we build it up though once that bucket gets to the point where it’s overflowing, that’s when we start to have the major symptoms. All our systems start to shut down so the more that we can reduce the amount that we are going into this bucket the better off we’re gonna be at eliminating them and so you know just trying to reduce exposure is key. Get natural household cleaning products. You know, try to get outside a lot, breathe fresh air as much as you can and uh and exercise, right? So, trying to exercise, you can obviously get in a sauna and try to sweat, try to open up all the drainage pathways and try to minimize your exposure to these toxins. That’s really the key. 

Dr. Justin Marchegiani: Totally. And, each one of those seven could be a podcast in and of itself and of course we got lots of recommended supplements as well. We’ll put maybe a link below and you can put some of your favorite products and uh below. So listeners that are wanting to understand. Hey, what can I do to sleep? What can I do for inflammation? Like, I will put our favorite ones below and you guys can take a look at that, um, and then also feel free to reach to Dr. Jockers. J-o-c-k-e-r-s dot com. David’s got all kinds of supplements and tools and great information there and I’m Dr. J,, you can reach out to podcast videos and functional medicine consult worldwide there. Dr. David, anything else you want to add?

Dr. David Jockers: You know, I just want to inspire you guys to know that you can heal if we can find the root causes and move those right and eliminate and reduce those. Your body has this natural built-in mechanism to heal, right? It’s the innate intelligence that runs you that God designed you with. And, you can heal and you can repair and can get inflammation under control. Inflammation is there to support you, you’ve got to just find out what’s causing it to be chronic, what’s causing it to be turned on all the time, start reducing that and now your body is going to be back into a mode where it can heal repair and you can really thrive in life even if you’ve tried these things we’ve talked about and you’re not getting results, reach out somebody like Dr. J here or my health coaching team. You’re gonna need a professional to help, walk you through the process, put you on protocol and get you the results that you want. 

Dr. Justin Marchegiani: I love it and there’s a lot of foundational information out of the gates. People can kind of take and turn with and then kind of get that extra, you know, uh, that extra guide or that Sherpa helps that kind of get to the top of the mountain so to speak. So, Dr. Jockers, I really appreciate today’s podcast. Great intel, great information. Awesome man, you have a great day. Good chatting with you. 

Dr. David Jockers: Awesome. You too Dr. J. You’re blessed.  

Dr. Justin Marchegiani: Thanks Doc. 


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How to Address Sinus Infections Naturally | Podcast #368

A sinus infection, also called sinusitis, is a common problem that causes your sinuses to swell up. The sinuses become inflamed and cause symptoms similar to the common cold. Many people can contract a sinus infection after having a cold or the flu. A bacterial infection usually causes sinus infections, but viruses or fungi can also cause them. These infections can either be acute or chronic.

Dr. J and Evan discuss nasal flushing, which can help clear the mucus out of your sinuses. It is one of the most effective home treatments for a sinus infection. They also emphasized the importance of rest, filtered air system, and other nutrients to boost the immune system.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:00 –   Introduction
2:17 –   Nasal flushing products
10:03 – Mucus and nebulizer
16:54 – Sinus anatomy

Dr. Justin Marchegiani: For today’s podcast, we’re gonna be talking about how to address sinus infections naturally with Evan today. Really excited. Good topic here. It’s a common topic that people are experiencing especially in the winter season so we’re gonna go through it. What we gotta do to heal fast from sinus infections naturally. Evan, how are we doing today? 

Evan Brand: Hey, doing really well. Why don’t we start with the conventional approach? What is that? If you go to your ENT with a sinus infection, what are they doing? 

Dr. Justin Marchegiani: Well, it depends, I mean, some are gonna be more antibiotic hesitant and say well you know it could be a viral infection, right? You know, almost a quarter of all antibiotics are actually prescribed for sinus infections. You know that? It’s crazy. So, most of the time, they’ll wait and see how bad it is. See if you have a fever, uh, usually like you have that punch in the face kind of feeling where your teeth are really starting to hurt, chronic headache and then you’re having a fever usually they’re waiting seven to ten days or if it’s gotten better and then gotten worse again and it’s usually seven to ten days out with a fever then they’ll start to, you know, typically prescribe antibiotics. Again, most sinus infections are viral so you know, you have to get to the root cause of that so a lot of times antibiotics won’t work. The problem with antibiotics is you’re swallowing it, it’s going 2 or 3 feet away from the actual issue so you’re basically dropping a systemic bomb to instead of hitting a localized area. Now, there are some more, I would say functional based medical doctors that may do some kind of an antibiotic in a compounded powder like an amoxicillin, something like that in a suspended solution or powder and they put it in a sinus rinse bottle like this and then you can flush your nose with that. Better, right? At least it’s more localized. We’ll talk about some strategies using saline flushes and different things that I recommend to help get that under control, naturally and not have to destroy your microflora in the gut. So, that’s a big thing out of the gates which can be very helpful. I got a sinus infection last week from a viral infection that my kids brought home. I never have been exposed to so many bugs since I have two young kids, 2- and 4-year-old boys that go to an outdoor wilderness school and they bring stuff back home from all their classmates and so I’m getting inoculated every single day and so we’ll talk about some of the strategies that I take so I can recover fast. 

Evan Brand: Yeah. I still hear a little bit of you. So, what are you doing? You mentioned you got some kind of tools on your desk there. 

Dr. Justin Marchegiani: Yeah. So, couple of things out of the gate, you know, to irrigate or flush that area out can be very very helpful. One, to flushing the viral particulate out. Two, we may add in some components to actually help kill what’s up in the nose as well. So, we have our saline, so you can either do NeilMed saline, which is really good. We’ll put links down below. The Neti Xlear is really great. I’ll kind of go back and forth between those. I have both. And so, we’ll take this and you’ll add eight ounces of water in one of these types of bottles. This is actually the best bottles. It’s made by Xlear. It’s Xlear’s bottle. It’s the best because of the plastic isn’t cheap so when you press it, it recoils really fast so when you’re doing good flushes, sometimes you’re pressing and then you’re having to let it reload so to speak and it’s just a really good plastic. Some of the plastics are weak so then, it kind of just stays sunken in so I also have a NeoMed bottle, definitely a cheaper plastic. And there’s another bottle by Walgreens. It’s even cheaper. So, this one is okay, you know, they give it away with like 60, 70 packets of saline so it’s pretty cheap. It’s a nice bottle. I have like three or four of them lined up in my office sink so when I’m in between patients, I’ll just give it a good flush. And so, we’ll take the saline packet. We’ll mix 8 ounces of water; we’ll add it to it and then I’ll take either food grade hydrogen peroxide. You could do regular hydrogen peroxide from the drug store. It’s not as big of a deal if you’re nebulizing it. Again, it you’re flushing it, if you’re nebulizing it, you probably wanna go more food grade just to make sure any stabilizers are out. And then, I typically just fill it up just enough to cover the bottom part of the cap. That’s it. Just about that.  

Evan Brand: That’s like a dash. I mean just a tiny amount. 

Dr. Justin Marchegiani: Yeah. And you know, you went too much if you put it into the water and then I would just pour it into the saline, my finger over and just shake it up and then you know you did too much if you feel any kind of irritation or burn. You can so you can always start less and kind of work your way up and then if you do too much you can just add a little bit more water to it and back off so that’s a good option right there. Another option I have is I’ll do like my GI clear 3 silver and I’ll add a cap full of that to it. You can do that. You can add just straight up betadine iodide. I’ve stopped doing that because of the orange color. It just stains. It’s really annoying so I’ll go to, like, a clear simple potassium iodine which is good. Those are a couple good options out of the gates and so we’ll basically irrigate 2 to 3 seconds of flow, clear everything out and blow your nose in between. 2 to 3 seconds of flow below your nose. That’s a good way to do it out of the gate. Now, there’s a couple of other strategies that you can do, so some of my sinus sprays that I’ll use and so I have 3 big sprays so here’s extra rescue which is really a good one because it has six different herbs in there. It has, like pau d’arco, parsley, eucalyptus, oil of oregano, tea tree, right, so it’s really good. Six different herbs and so what I’ll typically do out of the gates if you’re new to using the product. I’ll do it, about 2 sprays in each nose, about ten minutes before a sinus flush. What I find is, it starts to, like, agitate and release all the mucus. That’s kind of stuck to the inside of the sinus cavity and so like five to ten minutes before spray it, wait, and then do a sinus flush. I find that it releases things a lot better. So, that’s really good there. And once you’re better with it and you feel more comfortable, you can do it after as well. Just see how you feel. If you’re really, really inflamed too, there’s another product called Xlear max, which is a good one.  

Evan Brand: I’ve never tried that one. I’m scared of that one. 

Dr. Justin Marchegiani: Yeah. Well, the rescue one, I think, is like the strongest form, like a killing perspective. The Xlear max is more, like anti-inflammatory. So, the big difference is, this, the last one was grapefruit by the way and the Rescue.  

Evan Brand: Okay. 

Dr. Justin Marchegiani: And so in the max, the difference is it still has the same saline, still has the same xylitol. So, this has xylitol plus six herbs, okay, saline. This says xylitol saline, the difference is it has aloe so it’s a little bit more soothing, all right, for the sinus. It has the grapefruit as well, which, so it still has some killing effects in it and it has some capsicum which is like a homeopathic anti-inflammatory. So, this is like, if you’re like the tissue is really inflamed, really raw, this is a better one. This one’s really good for killing because of the different herbs that are in there. And then, there’s a regular one out there. I have it upstairs, as well, which is the regular Xlear and that’s more like people that have chronic sinus issues, you can use that more every day and it’s a little bit more gentle where it’s just the xylitol and the grapefruit extract and it has the saline and again the benefit of that, the xylitol, it really kind of knocks down some of the bacteria that could be there. It prevents biofilms from adhesions so biofilms are like the protective shields that a lot of the bacteria used to protect against the bugs. So, that’s very helpful. And so, the nice thing is if you do the saline, right? Oh, by the way, the water reverse osmosis or distilled, make sure it’s high quality filtered water. Do not use your general tap water, very bad, so make sure it’s really good. Don’t even use, like, river water, it’s gotta be really good clean filtered water. Like even now and then, I’ll use the water out of my faucet because I have a whole house activated charcoal system so it’s still good but I also have a RO system where my countertop is, so that’s where we cook in and drink out of that water so I use that 99% of the time. So, I’ll use that, I’ll add the packet, fill it up to 8 ounces, pack it and then I’ll add either hydrogen peroxide or silver. It’s good to have a couple that you rotate through just in case there’s some resistance which is, you know, meaning like there’s some bacteria or viral resistance. It’s going to have a couple of things there and then I also have just a straight grapefruit and saline solution as well. This one is okay. It’s gentle and so those are good ways to do it. I recommend, start to do it before you flush like 5-10 minutes before because a lot of times it just releases a lot of mucus and then it allows the flush to do really well and then depending on how you feel afterwards, you can also try it after a flush and then give it a sprayer. So, once everything’s really clean and see how you do afterwards. So that’s a good start out of the gates. Of course things like N-acetylcysteine are wonderful. NAC is great. That helps with the inflammation. Really helps drying up the sinuses. I’ll do glutathione, as well. I’ll do high-dose vitamin C. We’ll add in some different nutrients, zinc, those kinds of things as well. All the good immune nutrients, vitamin D decrease all the sugar consumption. A lot of that is very very helpful. I also have a red light in the office and so I’ll kind of go up against it and let the red light get in there because that’s very anti-inflammatory as well. 

Evan Brand: Man, I should have paid better attention to the label on that Max. I was afraid of that one because I thought that one was more intense than the rescue. I’ve done the Rescue forever. I kind of like the berm. You will get a little burn with that Rescue one but the way you talk that Max is actually more soothing than the Rescue. The Rescue is more hardcore so I need to try the Max, I’ve never experimented with it. 

Dr. Justin Marchegiani: Yeah. I think the big thing in the Max is just people are already, like more inflamed because there’s less killers in there, it’s grapefruit. It’s got the same sodium chloride, it’s got the aloe which is soothing and that has the Capsicum. I’ll do that right now actually. 

Evan Brand: That’s very cool and the question came in about colloidal silver so in some of the rinses you could do a little bit of silver. We, also, have talked about it. 

Dr. Justin Marchegiani: I already talked about that so I said you can do the hydrogen peroxide, add it or like I’ll do my nano silver like my GI Clear 3 or some kind of a silver so you’d add like a dropper or 2 worth of silver in there which is what I have for there. So, you can do silver, you can do hydrogen peroxide and you can also do some iodine. Those are your three good ones that you could do. You could also throw in like someone in the chat wrote about like oil of oregano or tea tree or something of that. Maybe overkill if you’re already using the Rescue afterwards or before because you’re already adding that to it.  

Evan Brand: Yeah. And so, we could do that in a nebulizer protocol too, so if we’re doing a hydrogen peroxide or a glutathione or a silver nebulizer that could be another sinus support. 

Dr. Justin Marchegiani: Yeah. The problem with the nebulizer, I find it’s just, it’s deeper, it’s better for, like lower respiratory stuff. The problem with, like the mucus that comes out of the nose, it’s very tarry. It’s very sticky, right? And so, what is the mucus? Well, you have one just mucus which is clear which is like your body trying to flush bacteria or virus out and then you have the immune system interacting with the infection and then the dead soldiers, right, of that fight, that battle are essentially all the green and yellow and so the more dead soldiers, right, the more battle we go from like light yellow to yellow to darker yellow to green, right? So, the darker, right, and the, the more chunky the mucus is, the more there’s an immune fight happening up there and so what happens is, you have, you know not that, this is the best analogy I can think of is you have all these dead soldiers from the immune reaction just like sitting up there and sticking all to the sinus cavity preventing breathing oxygen exchange and also some of that can eventually go down the eustachian tubes which connects to the back which can go to your ears then you can start to get an ear infection and all that dead debris can also become like fertilizer for like a bacterial infection down the road. So, you got to get it out. So the problem with nebulizer, it’s in a vapor form so it doesn’t have the ability to push the junk out and so with a nice bottle like this pressurized, you can come in there and you can really pull all that stuff out and push it out where you’re not gonna get that with a nebulizer so your nebulizer is gonna be, you can still do it, I still did it daily but it’s gonna be better for lower respiratory issues and this have all the same stuff in it a nebulizer will, the difference you’ll have the pressurized force behind it to really get it out. Push it out. That’s the difference. And there’s some like I mean there’s sometimes, I mean I won’t get graphic but like I’ll blow my nose I’m good right? I’m good, go flush it out and then there’s twice the amount of junk left behind after the flush that was that what I couldn’t get out through blowing and so you get a much deeper cleanse of the sinus cavity with this because a lot of times you’re getting stuff out literally in this upper forehead area in here and so you’re just getting a lot better release.  

Evan Brand: Yeah, you mentioned NAC already, which NAC got banned from amazon so if you need access to it, Justin seems on your store, I believe I’ve got a glutathione NAC combo. I do not have an NAC by itself. What do you do, do you have something to offer there? 

Dr. Justin Marchegiani: Yeah. We have different products like in my line have a detox amino product that has more other stuff in it. I just have a straight NAC here. I’ll go, there’s a couple of brands that I’ll go back to before, in between 90% are out so a lot of times I just have to get brands right now. That I typically wouldn’t get if we had a better supply chain with NAC right now but yeah we’ll put a link down below anyone needs NAC, they can reach out to the office but to highlight back on what you’re saying there, NAC is super helpful and then also there’s a Nasaline you can get which is like a pressurized syringe which is great. So, you suck up the saline from the bottle, it’s like a syringe, you put it up against your nose and you press it, that’s helpful. Also, I find too if things are really stuck, sometimes you need to go like pulsations so you need to like squeeze hard, relax, squeeze hard, relax, squeeze hard, relax because I find that the pulsation sometimes will free up some of these mucus that’s really tarry and sticky so that can be very very helpful.     

Evan Brand: Knock on wood, I never ever get sinus infections. 

Dr. Justin Marchegiani: I don’t either. It’s my first time. 

Evan Brand: I don’t know what to, what to attribute them to like you said is it an exposure, is it a weak immune system, is there a gut connection to it?

Dr. Justin Marchegiani: It’s just part of the viral infection so viruses tend to go in two major areas. They go upper respiratory or lower respiratory, right? So, a viral infection that goes too deep can eventually become pneumonia. A viral infection here can become a major sinus infection and so by being on top of this, you have your tools, your sinus flush is your best for your upper respiratory, your nebulizer is best for your lower respiratory and so you can prevent those things once you have viral infection, it’s replicating it creating inflammation. You could prevent these things from going too far with those tools. 

Evan Brand: Well, that’s a great point you just made which is the possibility of it turning into pneumonia so people listening are like well why should I care, why should I try to do this and speed the process up, why should I try to intervene? Well, because you don’t want to create more systemic inflammation or lead to something more serious especially in a person who’s 80 years old or above, you know, that could create much more problems if they didn’t treat it while it was just up here and it went further south. 

Dr. Justin Marchegiani: Yeah and if someone’s sick and they’re trying to prevent it, I think two to three flushes a day is good for, like, prevention especially while you’re sick. I think it can’t hurt just doing straight saline rinse once a day in general. I wouldn’t add any killers or anything to it. Just a straight saline. I think it is fine, just to kind of keep your nose clean at the end of the day. You wanna do that, I think it’s fine. If you’re sick, I’m going like every hour or two, I’m flushing my nose out just because at one it feels really good. It’s really clean and just as long as you’re not irritating the mucus, you know, its isotonic solution, so you have like the sodium, the chloride, it has the bicarbonate in here. Those are the two major compounds, right? Like sodium chloride is basically your sea salt, right? And then, you have your bicarbonate in there. So those are the two major ingredients and then of course this is like USP grade so it’s just really really clean.

Evan Brand:  And what do you mean by that? For people listening, what you’re saying is that pH balance so it’s not gonna irritate your sinus cavity. 

Dr. Justin Marchegiani: Yeah. You can’t just take regular, like, clean water and put it in your nose. If you will absolutely burn it and irritate it. It would feel like someone punched you in the face because the mucous membranes need a certain pH and a certain level of sensitivity so it’s kind of like using eye drops, right? Same thing. You need to have, like, saline-based eye drops. This is, you’re using sodium chloride.  Pharmaceutical grade plus the bicarbonate which is baking soda. That’s everything nice and balanced for the tissues. So, when you flush it, it shouldn’t irritate the sinuses and it should have allow it too feel nice and smooth and gentle afterwards and then if you have some kind of infection brewing even preventative for a bug just add a little bit of silver or hydrogen peroxide in there or a couple of drops, you know, some iodine that’ll give you enough killing capacity to knock down any bugs that could be multiplying but I’m going every hour or two, for me it just feels really good very soothing. It feels like plus if you blow your nose too much, you just keep your nose all raw around the side so it’s nice to have a nice clean flush. I kind of call it like, it’s like a bidet for your nose. It’s kind of how I look at it. 

Evan Brand: That’s hilarious. You know, this would be a good strategy for travel too. So, if you need something portable like the excellent Rescue. If you’re on a plane or after you get off a plane it’d be a good idea to boom boom do a couple of sprays that’ll be great. 

Dr. Justin Marchegiani: Oh, also, amazing for kids. Kids cannot honk their nose, blow their nose or the damn right. They just cannot get a good blow in there and you get these things on the market like a nose Frida which you know we have one you get like that deep in the cavity. We’ll do the whole nose Frida for you to think about the nose and then we’ll do this with my kids, flush it out and you’ll see so much junk come out. This is how kids get ear infections right? If you look at sinus anatomy, once you go up this far, there’s this canal, right here that goes straight to the ears and it’s called the eustachian tube and with kids it’s a little bit flatter a delta kind of angles up a little bit so it’s harder to get things uphill with kids because it’s a little bit flatter so it’s easy for the mucus and the junk to go into the ear and then you have an ear infection and of course like if your kids are getting ear issues to the food, sugar and of course high dairy products are gonna create more mucus, more mucus in the sinus cavity can make their way and so if your kids are more mucusy, one make the diet changes but two get their nose cleaned out as well so it doesn’t travel to the ear and this is why you want the mucus cleared up because if you let all the mucus and all this coagulation of all the immune soldiers so to speak, stay up there, it can make its way to the nose and now you have an ear infection. 

Evan Brand: Yeah. Good point about the diet. I know we got to run here in a minute or two but that’s a good point about the diet if you are looking for like preventative maintenance strategies, I mean obviously you can’t just live in a bubble and not get exposed to things but you wanna have the good foundation of your diet to reduce inflammation, I mean so many people come in and say they have quote sinus problems, really it appears that they’re food allergies because once they clean up their diet, they get rid of gluten, they get rid of dairy all of a sudden their sinus is clear. 

Dr. Justin Marchegiani: Yeah. And people have, like, allergies to the environment. One, have a really good high quality air filter. We recommend the Austin air because it has the activated charcoal, the Zeolite plus the Hepa. Hepa is, like, usually standard in most if you’re on a budget. You know, go with the Hepa to start but definitely get one that has an activated charcoal, Zeolite, the Austin air, the filter lasts five years per replacement so you don’t have to spend as much money replacing it every six months and the activated charcoal and the zeolite filters out more toxins but I’ll tell patients like you know, do a flush you know in the morning when you get up, do one after you’re outside working and then do one before bed. Just the saline’s fine. You could do a little bit of spray, you know, before or after. Try before that’s helpful but just try to get the allergen out especially before bed because if you have all these allergens way up here and they’re creating inflammation that could be a stress response during sleep that’s preventing you from deeper restorative sleep and so the sinus can be flush really helpful along with some of the uh some of the remedies that we have here. 

Evan Brand: It’s a good call. Well, if people need help, they can reach out. You can book a consultation with Dr. J at So, if you have sinus issues or other health symptoms, you wanna talk, see what’s going on, see if we can help that would be for Dr. J, or if you need help from me, that’s Evan, We’re available worldwide. So, most of these products we can get and we can ship to you. I know a lot of people internationally have trouble getting some of this stuff, silver and NAC. Some countries are just weird and it’s hard to import stuff but usually we have. Our team is great with logistics. So, I think it’s good to just have a stash of this stuff if you don’t already, don’t wait till you get the sinus infection then try to order, get it. Get it now. Get it, get prepped. 

Dr. Justin Marchegiani: They have a bottle of it there. Someone said, can you do too much of it. I would say it depends, right. I would say, if you have an active infection, I think you’re gonna be fine just make sure the water is clean, RO high quality water. Make sure you’re using a good quality sodium bicarb, I think if the killers are making you more sensitive, right? You could always do your spray or killers before and then do the just the saline without anything in it after so then everything’s clean and flushed out so then you don’t have anything overly abrasive in your sinus after the fact, that’s a good way to do it and if that’s still a problem you could even, you could even just do a saline flush and not anything else after that. It’s still better than nothing just to get everything out of the sinus cavity but worst case do your spray before and then afterwards just the flush. And they have spray that are just silver too, so you have, I have a silver spray too. You can just do that, I’ll do that for my kids sometimes because they’ll complain about it like just the feeling it’s a tiny tinge of a burn for like 10 seconds and so I’ll do the silver sometimes with them. Oh by the way, my kid had a pink eye issue, used to silver spray, opened his eye up, I just like this, I went, gone in two days. So, silver is excellent for some of the pink eye stuff, I would never do it with this. That would burn but the silver is good. I hope that makes sense. Any other questions about that so far?  

Evan Brand: I think we got most of the questions answered here, there was one question about getting mucus after food and these were things like yogurts, ice cream, soy sauce, wheat products, well yeah, I mean it sounds like food allergy so obviously I would clean up your diet. I don’t recommend any of those foods, maybe if it’s like a coconut cream ice cream with low sugar maybe but beyond that all of those foods to me sound like potential irritants. 

Dr. Justin Marchegiani: Sugar and inflammatory foods, especially excess sugar and inflammatory foods will cause mucus, that’s part of the inflammatory response, that’s just part of it. Yep. That’s part of the reason why people have sinus infections outside of just getting upper respiratory tract viral issues.  

Evan Brand: Yeah. Absolutely. How many people are going to the ENT and getting a paleo diet prescription, probably not many.

Dr. Justin Marchegiani: No, and there just gonna recommend steroids, Flonase, steroids, antihistamine, they’re not really ever get to the root cause that’s the problem and so It’s really good that people are bringing these things to the light, you know, this guy Dr. Mehta, I think it’s Dr. the NeilMed guy, he’s really been on top of it, which is great. I mean this is an MD that’s talking about using really good options to clean out your nose and then you know having more of these sprays together is really good and having things that can add to them, I mean, just amazing and a lot of these viruses live in your nose so preventatively we can be on top of it, you’re out with a bunch of people, you know, instead of being overly worried about washing your hands which you know, that’s fine, wash your hands but flush your nose, easiest thing, flush your nose.    

Evan Brand: Totally more valuable in my opinion for sure.

Dr. Justin Marchegiani: Yeah. So guys, to reach out to Evan, Evan is available worldwide for health consultation support. I am as well, Dr. J,, we are here to help you out. We’ll put some links here. Give us a little bit of time. I’ll put the links down below very soon so you can see some of the products that we use. Also, we’ll put some of the products that we recommend from our own store so you guys can get an idea of what we like. All right, any questions feel free to put them in the chat. We appreciate it. Share with family and friends, they could benefit and have a phenomenal day. Take care.

Evan Brand: Take care. See you next week.

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

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

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

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

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

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

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

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

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

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

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

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

Evan Brand: Zoom in so, 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Evan Brand: Take care, now. Bye-Bye. 

Dr. Justin Marchegiani: Bye. 


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Top 5 Ongoing Immune Supports | Podcast #341

Your first line of defense is to select a healthy lifestyle. Following general good-health guidelines is the best step you can take toward naturally keeping your immune system working correctly. Every part of the body, plus the immune system, functions better when protected from environmental strikes and bolstered by healthy-living strategies such as taking vitamins and some natural herbs that are evidence-based and fit you.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:35   Benefits of Glutathione and NAC

7:31    Vitamin D Levels

9:14    Zinc and Quercetin

11:11   Vitamin C as an antioxidant

13:38  Herbal Compounds

15:41  Medicinal Mushrooms and Herbs;

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Dr. Justin Marchegiani: Hey, guys! It’s Dr. Dr. Justin Marchegiani here today. I’m with Evan Brand and we’re going to talk about the top five ongoing immune supports. These are nutrient and or herbal compounds that we use to our patients to support a good, healthy, strong immune system. It’s obviously a couple of different areas and avenues we may use these preventively and as well as acute onset issues. So we’ll kind of talk about our experience clinically and how we use these in our practice. Excited. Evan, how are you doing today, man?

Evan Brand: Awesome! Doing really great and ready to dive in. So it’s going to start out with maybe that most important nutrient of all time, and certainly the most important nutrient for the past one to two years which is glutathione. And you and I did a podcast early on, I think it was last spring, all about glutathione and how we use oral acetylated glutathione. We’ll use liposomal glutathione, we’ll even used nebulized glutathione, and it’s been an absolute game changer  for so many people. I would even go as far as to say I’ve saved lives using glutathione. I will just leave it at that but, it’s an amazing compound, probably the most important compound, and our our mentor, awesome guy, Dr. Kalish. He did a great talk very recently about glutathione, and he was showing how important glutathione is with the body, and the body will prioritize production even over methylation and how important it is to really get this system working properly, and everyone is focused so much on methylation and they’re ignoring glutathione production. Everyone gets so caught up in mthfr, and genetic defects, and all that but they’re totally missing the boat on glutathione and this is your master antioxidant that is depleted during times of stress and during toxin exposure. So that could be any type of pathogen that could be mycotoxin we know that moltoxin will deplete glutathione, and you and I measure this routinely on urine testing, and I see low glutathione all the time. If we see organic acids that are too low or too high, we know that there’s a dysfunction going on, and this is something that can easily be remedied and supplemented and we have very very high quality sources that we use for people.

Dr. Justin Marchegiani: 100%. So glutathione is a tripeptide, right? So when we use glutathione, we’re going to kind of put glutathione and NAC in a similar camp. It’s good to have both, NAC helps with your, helps your body with endogenous production. Meaning, helps your body make it, as cystine tends to be the rate limiting amino acid in making glutathione. So glutathione is a tripeptide. So it’s got cysteine, glutamine, glycine. Glycine is really great in collagen and bone broth. Um, glutamine you’re going to just see in a lot of gut healing formulas because glutamine is needed for healthy gut function. So if you have healthy guts, or you have an unhealthy gut and inflamed gut, you can see how glutathione, one absorption, and um, of course stress is going to deplete a lot of those amino acids just in the stress process. And so then uh, you make glutathione via those three amino acids and then also you have exogenous glutathione that’s giving someone’s acetyl glutathione or liposomal, or some kind of a reduced glutathione which are all great. Um, those are all going to be exogenously you know, from the outside in. Endogenous is making it inside with the amino acid. So it’s good to help with both. We know the data on glutathione, it helps with inflammation, it has and effect on modulating the immune system, modulating the or t regulatory cells and balancing that th1, th2 immune response . Th2 is going to be the antibody response the, the th1 response is going to be the natural killers of the special forces of our immune system, and then of course, glutathione helps produce compounds like um, catabolic enzymes like catalase and a lot of good natural disinfectants like superoxidise mutase and things that help with lung, and inflammatory health inside the lungs. You’re going to make a lot of these compounds with glutathione which are very powerful on the immune side. Excuse me, I need some glutathione now. On the immune side and also on the anti-inflammatory side. So like for instance, with a lot of lung health issues or breathing issues, we may even give reduced gluathione and a nebulizer because, that is shown according to research, to help with inflammation, and help with vasodilation in the lungs. So very powerful anti-inflammatory, very powerful disinfectant because of the superoxide dismutase, and that catalase enzymes which is really important for inflammation.

Evan Brand: Yeah, well said. I mean every hospital, especially every ICU, especially when it with luncg issues, I mean, every ICU should be passing out glutathione nebulizers. It’s amazing that that’s not standard practice, that’s not standard procedure. We would see much, much, much healthier people faster recovery times if that were part of the protocol.

Dr. Justin Marchegiani: Yeah. That’s a patient with some serious lung issues who we nebulized some reduced glutathione and within a day, we saw a massive massive improvement. And we know things like NAC for instance is shown to reduce virus replication. So that’s very powerful. So when you’re, when a virus kind of gets into your cells, it replicates and that’s how it create symptoms. The viral load has to replicate and if you have nutrients in there like NAC , android glutathione that’s going to prevent the virus from replicating the higher number. So very very important there and of course, the higher the viral load is, the more you can spread it. If you keep the viral load down, the less chance of spreading and infection so that’s powerful there. Anything…

Evan Brand: An you and I take that ongoing. Yeah, you and I take that ongoing. We do depending on what’s going on. We’re not telling you to do this dose but, what you and I are doing, at least I know for me, I’ve got a combo product. So we’re using glutathione, give or take a couple of milligrams per day of an s-acetylated glutathione which in studies is just as good if not better than liposomal because with liposomal, we have some really sensitive people, me included. I don’t really do well with ethanol, and a lotof the alcohol that is in some of these liposomal formulas so I personally stay away from those. I like the acetylated, I fell great. It works really really well. Papers prove how well it works and then about a gram of give and take of NAC. So that’s kind of my on going protocol. And also for toxin exposure, that also helps protect against the oxidative stress that also helps to deal with mold tox and we know glutathione can help mobilize toxins. So that’s something we use in detox protocol too. Not just for immune and viral support .

Dr. Justin Marchegiani: 100% and virus replication, prevention, prevention, acute respiratory issues, all wonderful applications. I do about two grams a day of glutathione of and acetylcysteine, and one to two hundred milligrams of a glutathione whether it’s reduced as acetyl or liposomal. I’ll kind of rotate between the two. So that’s powerful out of the gates.

Evan Brand: Last call. Let me make one comment on the NAC and then we’ll move on. So at the time of this recording, uh, amazon has taken all NAC off of its marketplace. And there’s a lot of reasons that I could get into and probably  and get deleted for but, we’ll just say that NAC is gone but, you and I, we work with professional healthcare companies. We do still have availability so we will put link in the show notes because this is something I would recommend you have on hand, and if amazon’s going to take it away, at least we have it. So I think that’s important to know.

Dr. Justin Marchegiani: I think so too. I like it, NAC. In my product detox aminos, we have reduced glutathione plus NAC in there as well. I know you have a product similar as well. We’ll put links below so you guys can see that. And we’re gonna kind of a lot of the compounds like five herbals slash immune compounds and then we’ll kind of look at the nutrients. And I always tell patients like focus on the nutrients first just because they’re nutrients. They have other roles in the body and it’s good there. So NAC and I think glutathione are going to be there. Low-hanging fruit, next is vitamin D. If you’re not getting enough sun, or you have darker skin, you’re going to need some vitamin D. Vitamin D plays a major role in th1 th2 balance. And also helps modulate t-regulatory cells which keep your immune system in balance. A lot of studies showing people that have lower, higher vitamin D levels are more resistant to different virus, infections. Our vitamin D also produce an antibacterial enzyme called cathelicidin which helps decrease bacterial load so there’s a lot of powerful benefits of vitamin  D and of course, in the winter months, when colds and flues are at the highest. Guess what? That’s when the vitamin D is the lowest on average because of the sun. So vitamin D is very powerful there out of the gates.

Evan Brand: Man, I just got my blood work back. My vitamin D was like a 45 which is too low. And I was kind of putting a false sense of security I guess into my sun exposure. I mean, I’ll get my legs exposed, my chest, my back. I mean, I’ll be outside for sometimes, couple of hours few hours a day, during the peak hours and my vitamin D was still below optimal. We like poeple give or take, we want to be 60 to 80, and I was at a 45 so I’m back on supplementing 5000iu plus a k1 k2 formula just to try to make sure I get up to that peak where I need to be so if you’re like oh, I’m outside in the garden. Don’t use that as your reasoning for not supplementing. If you have to supplement, it’s okay. Dr. Justin Marchegiani: Yeah, absolutely. And I would just say 50-70 on an average is probably reasonable. If you have an autoimmune isse, or any cancer issues, you know. Being 70-100 is probably even better. But at least 50 I think is good. So you’re not too far away from that but yeah. If you’re like below 20s or 30s, or below that, you get problems for sure. So vitamin D is really good. Obviously, I think next low-hanging fruit is gonna be zinc. Zinc has major effects, zinc fingers have a major effect on your genetics and DNA activation. Zinc also plays a major role in hormones, making testosterone, making uh, stomach acid. So zinc helps with digestion. Zinc helps with on the hormone side, and zinc also plays a major role on helping viral loads. So lots of studies on zinc losses, zinc helps get into the cells, and it decreases virus replication, so we have natural zinc ionophores, right. Their medications that do it but there’s also some natural compounds like quescitin that actually help zinc get into the cells at higher level and zinc, zinc levels when higher can prevent the virus from replicating kind of like NAC. So zinc is a very important natural compound and so is quercitin as well. We could add quercetin and zinc together ro really help flood ourselves with good high quality zinc.

Evan Brand: And we don’t go too crazy. I mean, we’ve had people that are doing like 50-100 milligrams of zinc long term. That’s too much. Maybe on going for females, maybe 10-15 milligrams, males maybe a tiny bit higher but, I had one lady doing 100 milligrams of zinc and she was not feeling good. So that was too much.

Dr. Justin Marchegiani: Yeah. If your’re doing that much probably 50, it depends on the type, right? If you’re doing a crappy like  zinc acetate or something, if you’re doing like a zinc biscynade or eally good zinc bound to an amino acid, probably 50-70 acute like an acute type of situation. But outside of that, probably 10 to 30 max kind of from an ongoing basis. You’re gonna get zinc in pumpkin seeds and a lot of your grass-fed organic meat and or high-quality animal products.

Evan Brand: yeah. That’s the question. I mean, if you’re eating the way we are, I mean, I’m doing a grass-fed steak for breakfast some mornings. I mean, I wonder if I even need extra. I guess it depends on the situation. I will throw a little in; I’ll sprinkle a little in but, it’s not a big one I take all the time.

Dr. Justin Marchegiani: Yeah. I mean it’s more going to be during stress and your immune system being more compromised, your nutrient levels are going to need to be higher and so that’s powerful there. I would say next out of the gates, vitamin C is important. Vitamin C are really important nutrients. Obviously, it has major role in oxidative stress; it’s an antioxidant. I would say the macrophages which are like the little pac-man, pac-woman that gobble up bacteria and viruses in the bloodstream. There’s a docking station for vitamin C on to that macrophage. And vitamin C can help potenciate the strengthof those little pacmen and pacwomen; very powerful. Now vitamin C has a molecular structure; very similar to glucose. Guess what happens if you consume too much glucose or I.e sugar. That glucose can dock on to that macrophase and actually weaken it. And so it’s important when you’re sick and your immune system is compromised, higher levels of glucose will mimic vitamin C and kind of dock on that receptor site and will make your immune system weaker. So keeping your immune system stronger by keeping the glucose under control is important. And then getting that good vitamin C in there is going to be important especially you know, acute right? You can always work on what I call a vitamin C callibration where you get your vitamin C levels up to just before, or just past the point where you have loose stools and then back up until they solidify, and you can do that during acute phase, if you’re sick, to keep your immune system nice and strong.

Evan Brand: I love my vitamin C but, I over did it because then, my iron was too high and I think I was doing like three grams of vitamin C for a long time and I was drinking my vitamin C powder with my grass-fed bison steak so that will increase iron absorption. So for anemic people, that’s a great strategy but, for males if you irons are really high, that’s one thing to consider and just track it with blood. Dr. Justin Marchegiani: Yeah. Retract your blood. You know, the natural solution for high iron if you’re a guy is gonna be therapeutic phlebotomy. So getting your blood tested, giving blood all those things are wonderful out of the gates. So we talked about zinc, we talked about vitamin C, we talked about NAC, glutathione, we talked about vitamin D… Is there anything else we missed there? We can add more nutrient. What would it be, Evan?

Evan Brand: Mm. I would say the B vitamins would be very important because, B vitamins are going to be helping mitochondria; we know that a lot of the toxins and things we’re exposed to damaged mitochondria. B vitamins can help support the kreb’s cycle. So in a roundabout way, I think that would be part of an ongoing protocol. If I wanted to keep myself up, keep myself feeling great, I think some Bs would be in the picture.

Dr. Justin Marchegiani: Yeah, I think some B vitamins are always good. So I think we have vitamin C , D, zinc, NAC, and glutathione so we have five there and we’ll add a little bonus with um, with what you just said with the B complex. So that’s fine right there out of the gates. Why don’t we switch gears and talk about herbal slash compounds? So we have silver, colloidal silver or we use a nano silver so it’s better absorbed; you need less of it. Silver is very helpful because it can it moves through your body; it’s very small in its molecular structure; you’re not going to worry about algeria, or turning blue when you use a high quality silver because, the silver molecules are so small, they flush right by your body and go out through your kidneys, no problem. If you make silver, you have really big silver molecules, you know. Bigger than 20 part per million; like in the hundred per million plus then maybe that can get stuck in yous cells and turn you blue; but most of the archery are turning blue and turning blues and come from home made crappy silver. Uh, we use manufactures that have been around decades, and have never had a case of argyria or turning blue  because one, we’re just using high quality silver and it’s going to be tested, so we know the exact ppm-part per million. And so silver is great. Natural antiviral, and it also um, actually an anti-biofilm; so it actually helps the body deal with bacteria better because it decreases bacterial biofilms, which are the little protective shields if you think of the movie 300, right? The spartans, they have their shield and their spear, right? Well biofilms on bacteria are like the shield, right? So imagine like in the movie 300, you pull away their shields, now they’re a lot more vulnerable to attack. Well that’s what silver does to a lot of these biofilms on bacteria; and so it can allow the herbs that you’re using to actually kill that bacteria better. So silver is really powerful. Conventional medicine is even using silver. They use a lot of silver cellophane now. So If they do a total joint or total hip, or total knee, they’ll actually take the joint and they’ll wrap the cellophane around the joint because they found that it prevents mersa or antibiotic resistant bacteria which is powerful.

Evan Brand: Wow! That’s cool. I didn’t know that. So it’s funny a lot of things we talked about eventually will be mainstreamed. Like we talked about, I think glutathione with nebulizers should be in every ICU especially for long and viral issues and it’s not. So maybe one day that will become true just like the silver.

Dr. Justin Marchegiani: 100%. So we have silver there, I will also hit some medicinal mushroom. There’s a couple that are out there. I mean, I like reishi. There’s some other ones that are really good but, reishi and a lot of these mushrooms one have an affect on in increasing the immune system. Whether it’s usually the th1 immune repsonse, uh some of them can actually deactivate viruses, right? A lot of the beta 1, 3 glucan, or the tritipines that are in there can deactivate viruses. That’s pretty powerful out of the gates.

Evan Brand: Yeah. I’d say turkey tail. I think turkey tail and reishi. Those would probably be my top two. I mean you and I do cycle in some mataki and chaga, and some lions maine. I really love lions main for cognitive issues or for helping with ngf which is called nerve growth factor. I had a woman who had chronic burning tongue for 20 years, and we’re able to completely reverse that using lion’s maine mushrooms. So we suspected it was a nerve injury because after a general procedure, her tongue was burning, and dealt with there for 20 years. Lion’s mane took care of it. So I just love lion’s mane but, for this conversation I think rishi, and I’d say turkey tail would be the best if you are having issues with oxygenation, and chronic fatigue, a lot of people having some post viral chronic fatigue, cordyceps, I love cordyceps mushrooms. I use that quite often as well. So those three would be awesome. Turkey tail mushroom, uh, rishi, and cordyceps.

Dr. Justin Marchegiani: 100%. So rishi, cordyceps, I like other compound like golden seal’s wonderful. I had that on my Gi Clear four. That’s kind of in the berberine family. Um, that’s wonderful. I see a lot of berberines do amazing, working great, barbary. I like golden seal; it gets wonderful out of the gates.

Evan Brand: In what form? What are you referring to the berberine compounds for? What are you talking about?

Dr. Justin Marchegiani: Well it’s an antibacterial. Berberines mix with wormwood. If you look at Stephen Buehner’s book, he talks about that having a very powerful anti-viral kind of synergist? So berberines with artemisia are very powerful there as well so I like that too. I would also say um, astragalus is also powerful. It’s a good blood cleanser, it helps with the spleen, it helps with B cell antibody production; helps clean out the blood a little bit. Any feedback on astragalus?

Evan Brand: Oh, love astragus. I’ve got tons of bottles of it and we made, we made astragalus for, for a long time. We had really good quality source, glass bottle, good stuff. I take astragalus all the time and especially for tick bites. If you’re listening and hey I want to improve my immune system and all of a sudden, I got a tick bite, uh per Stephen Buhner’s protocol, he recommends three grams of astragalus for the first 30 days to really ramp up the immune system. IF you have chronic lyme, though that would be a situation where you don’t do that because it can send the immune system the other direction. So that’s a one of my favorite herbs. I’m glad you brought it up and it’s often the root. Technically, we say the herb but astragalus root is what’s being used.

Dr. Justin Marchegiani: Correct. So we hit astragalus, we hit golden seal, we hit some of our medicinal mushrooms, we hit silver. Let’s hit one more out of the gates. Andrographis is another good one. And again, a lot of these herbs work by one, supporting or stimulating your immune response, and typically, a lot of them are going to work more on the th1 side, so they’re going to really help mobilize natural killer helper cell production and of course, that the also help support antibody production later in the game. And a lot of these herbs can also decrease the virus from being able to replicate. And so that’s helpful because the more replication of the virus we have, the more the symptoms increase. So we can decrease virus load while improving our immune response, then we kind of hit it in both angles. Now, people that are autoimmune, some of these herbs could make you feel worse right? But the way I look at it, as most people are going to be th2 dominant in a lot of these autoimmune issues and so naturally supporting th2 could be a good thing out of the gates. So I always say, work on supporting the nutrients first, and then you can kind of come in there with the herbals come in there one at a time and just see how you deal with them, and then add that to your medicine-functional medicine toolbox later on down the road. So if you get sick, you know different strategies that are going to help you.

Evan Brand: Yeah. It’s a good point. You’re hitting on the multiple mechanisms right? You’ve got vitamin D increasing the immunity, and reducing cytokines storms, you mentioned some of the antimicrobial benefits to it, you’ve got the biofilm support in there, you’ve got the intracellular support with the zinc and the quircetin, you’ve got just the standard immune support with your mushrooms, you’ve got your protection from glutathione and NAC. You know, last thing I’d like to mention on the herbal front, I would say some sort of adaptogen, we kind of talked about this off air.

Dr. Justin Marchegiani: Oh, yeah.

Evan Brand: Adaptogens in a roundabout way, would be very beneficial and that’s something you and I take every single day, as far as I know you do at least.

Dr. Justin Marchegiani: Right here! Ashwagandha is one of my favorites. My ashwagandha supreme. Um, ashwagandha has been shown to be taken long-term, very helpful for immune function, immune modulation. Obviously, ashwagandha can help cortisol surges too. We know that high cortisol stress can decrease you immune function. So if you’re having high cortisol due to some kind of acute response, ashwagandha may be a good solution to help get that cortisol response under control.

Evan Brand: If I had to pick two, I I think ashwagandha is up there. Maybe number three for me. I’d say number one based on what’s going on, rhodiola because of the antifatigue effects, the anti-anxiety, the anti-depressive effects. Also, amazing for hypoxia. For athletes, for anybody struggling with oxygenation issues, rhodiola is amazing. Second, I gotta go with eluthero, I love siberian ginseng, that combo of eluthero, and rhodiola, oh man. Holy basil’s also awesome too! I mean, God! You know we love adaptogens. So I would just say that any or all of those could be worked into a protocol, would provide an extra support to keep you up on your feet.

Dr. Justin Marchegiani: 100%. And also with vitamin D, yeah. Taking vitamin D with k2 is going to be helpful or at least vitamin k. Again, if you’re going to have a tablespoon or two of high quality grass-fed butter or ghee a day, that’s great. If you’re getting any sauerkraut or good greens, that’s gonna be more k1. So you have those good quality fat soluble vitamins in your diet, you’re probably going to be okay. But if you’re not, that’s where it’s good to just have a little bit of vitamin K2 in there as an insurance policy.

Evan Brand: Cool! I think we covered it unless you want to throw any other herbs? And I think that’s a good, good stack though.

Dr. Justin Marchegiani: I mean, yeah. We hit a good amount, you know. Now regards to the amounts, I mean typically we may double or triple that the typical recommended dose on the back of the bottle if it’s an acute type of phase depending on what’s happening. And so that’s kind of a goo I think rule of thumb out of the gates, is at least double or triple for the first few days to a week during an immune response. Evan Brand: Yeah. On going though, for me rhodiola a couple hundred milligrams is plenty for me too much. I get over stimulated, same thing with elutheral couple hundred milligrams typically per day, early in the morning. And ashwagandha, I mean, you could go up to 500 milligrams or so would be I think a great ongoing dose for actually.

Dr. Justin Marchegiani: I think, I think 500 to a 1000. You can go up to 2 grams on that, and again, it matters if it’s like, this is a whole herb right. Some are like a standardized extract but much smaller that could be more concentrated but, if it’s a whole herb you know. A gram to 2 grams is usually going to be fine, a gram on the lower one’s fine.

Evan Brand: Yeah, and we’re not. Yeah, and we’re not making your protocol here, so like if you go and you look at the bottle, and like well this is 80 milligrams of ashwagandha, so I’m gonna go take freaking 40 to get to what he recommended, no. You gotta pay attention like you mentioned to the label. Because like you said, standardized extracts , 80 milligrams could be equivalent to 800 milligrams if you’ve got like a 10 to 1 extract. So you gotta pay attention to your labels and know what you’re getting.

Dr. Justin Marchegiani: And also if you’re really night shade sensitive, and you have a lot of autoimmunity, be careful because ashwagandha is a night shade. But again, if you’re really sensitive to nightshades and via tomatoes, potatoes, eggplants, peppers, then be careful with that. Do it one at a time.

Evan Brand: Yes.

Dr. Justin Marchegiani: So outside of that, today was a great chat. I’m just, for the listeners here, if you guys want to reach out and get specific functional nutrition, functional medicine care, by either Evan of Dr. J myself, feel free to head over, you can reach out to Evan there; there will be a link for you, as well as my site, We are available worldwide via phone, zoom, facetime, we’re here to provide all your natural health services if you need that. Also, click down below, send us a review, give us a little comment on today’s podcast if you enjoyed us. Let us know, kind of put down what immune support is your favourite and what’s been helpful for you in the past. We’d love having clinical experiences shared. That’s how you learn a lot. Anything else, Evan?

Evan Brand: Absolutely. I think it’s, I think you covered it all. Just keep your head up. Keep moving forward. That’s all you can do. So I hope these tools will help people.


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