Functional medicine hair loss solutions – Podcast #94
Dr. Justin Marchegiani and Evan Brand talk about supplements, hormones and how the adrenals affect the thyroid in relation to hair loss. This interview is geared towards educating people all about hair loss and functional medicine solutions. Learn all about alopecia areata when you listen to this podcast.
Also find out about the different things that you can do to help improve your hair quality and even grow it back. Get to know about ferritin and iron saturation and why you should pay attention to these. Discover the possible causes of hair loss and what hair supplementation to take which are proven to be very helpful. Learn how the functional medicine approach to hair loss can be very effective at addressing this issue.
In this episode, topics include:
00:23 All about hair loss and alopecia
02:32 Gut issues
04:35 The thyroid connection
06:37 Blood tests and hormones
Dr. Justin Marchegiani: Hey, Evan! It’s Dr. J. It’s a great Friday here over in Austin. How’s it up in Louisville?
Evan Brand: Howdy! Blue skies and the grass is green. We’ve had about 3 feet of rain it feels like over the past weeks, so everything is super lush.
Dr. Justin Marchegiani: That’s great. Another great Friday. Well, we talked pre-show we wanted to discuss a little bit more about hair loss and different things that we can do to help improve hair quality and potentially even grow back hair as well.
Evan Brand: Yes, sir. Yeah, so I’ve had a quite a few—quite a few women, I mean, and it’s—it’s always there. Hair loss is always the symptom, but I’ve found this week especially that alopecia has been popping up, and it almost makes you think it’s more common when you’re hearing it multiple times a week. It’s like, “Whoa! Does everybody have alopecia?” And so we know one of our online friends, Yuri–
Dr. Justin Marchegiani: Yup.
Evan Brand: He has alopecia and he talked about it. I believe he’s talked about it at least where he’s basically he’s lost his eyebrows, he’s lost everything, and obviously that’s an extreme case to lose everything, but there’s definitely some—I guess a spectrum of hair loss that can happen. So maybe it’s not a full state like the alopecia but there’s also like some thyroid dysfunction and some other stuff, I suppose we can chat about that it’s gonna be tied into mild hair loss.
Dr. Justin Marchegiani: Got it. Yeah, I actually had a conversation with Yuri Elkaim about his hair loss and he mentioned a lot of it had to do with poor diet when he was younger as well as gut health issues. And if you look at alopecia or alopecia areata as it’s known in the conventional medical world. It’s kinda fun to say—areata, that’s autoimmune and we know with autoimmune stuff, there’s almost always a gut element connected, right? Because we know leaky gut is when those tight junctions, the epithelial tight junctions open up, undigested, whether it’s bacteria, lipopolysaccharide particles or undigested food antigens which are foreign food proteins get into places in the bloodstream where the immune system isn’t used to it and that can really drive immune attack or an autoimmune attack, and alopecia is nothing more than a disease that describes where the immune system is attacking especially the hair follicles.
Evan Brand: Interesting. So we would have to assume that any person who has this hair loss issue has some sort of gut issue. Is that a safe statement to say?
Dr. Justin Marchegiani: I would say anyone that has hair loss and I hate absolutes, but I would say there’s a very strong chance that if you have hair loss, outside of it just strictly being a genetic factor, there’s more than likely a gut issue. And when we look at gut issues, it could be a gut issue where there’s a full on infection, like a parasitic or fungal overgrowth or a bacterial infection. It could be just something like a small intestinal bacterial overgrowth or it could even be something like hydrochloric acid and amino acid or protein—prote—proteolytic enzyme deficiencies where you can’t break down those amino acids, where you can’t ionize those minerals. Now typically any type of deficiency in the gut where there’s lower enzyme levels and lower hydrochloric acid, after a period of time, they’ll typically be an infection present because we need the hydrochloric acid to sterilize the—the gut environment, especially the stomach. That sterile environment is akin to you going to a—a dirty picnic table and maybe spraying some bleach or some kind of sterilizer on the table. It keeps that area clean. Well, that’s what happens in your gut and hydrochloric acid is also important for cleaning the environment but also activating enzymes. So if we aren’t activating enzymes and we aren’t keeping that environment clean, overgrowths can happen and if food doesn’t get broken down, the food rots and ferments, and then typically bacteria will then feed on the remains if you will.
Evan Brand: That makes sense. Yeah, and I actually had several—several people like I mentioned over the last week with alopecia and one woman, I think she ended up not proceeding with her lab test. I’m not sure what—what ended up happening but I really wanted to take a look at the gut, so at this point I don’t know what’s going on with her gut if we’re not gonna proceed with testing, but I think it sounds like that’s an important place to start. And then maybe you could shed some light on the thyroid issue, because any time we talk about hair loss, women think that it’s automatically the thyroid. Is that a place that you’re gonna look for issues as well?
Dr. Justin Marchegiani: Yeah, so one of the common symptoms of thyroid or of hair issues can be low thyroid. A lot of women will see it with the outer third of their eyebrows, it’ll start to thin out. We need thyroid hormone for adequate hair growth. So on the things we see with lower thyroid hormone—thyroid hormone can be a really powerful growth factor for that hair follicle to produce hair. So if we have lower thyroid function, and it could easily be from an anemia because a big building block for thyroid hormone is iron—that’s part of the whole iodination process involves iron. So if you’re a female that’s vegetarian or has a gut issue, low stomach acid, which typically also means low enzymes, and malabsorption and/or you’re a vegan-vegetarian, you’re really set up for a world of hurt, of having a high risk factor for thyroid issues because we need that iron to make healthy thyroid hormone, and I did a blog over this a couple of years ago over at FixYourThyroid.com—you can take a look at it—where we talked about thyroid function and hair loss. And that’s an age-old tell-tale symptom for low thyroid function. So we always wanna look at thyroid issues when we see hair loss and we always wanna look at anemia especially for women when they’re either vegetarian, they have gut issues and malabsorption problems, and/or they’re ec—they’re menstruating excessively. They have a lot of PMS and they’re bleeding—they’re going through more than, you know, 4 or so tampons, or they’re having just a prolonged bleeding period and they’re losing a lot of their iron that way.
Evan Brand: Interesting. So there’s a few things here. So it could be some iron anemia going on. So we would wanna look at ferritin levels, and then you and I were also chatting off air earlier about iron saturation, correct? Would that be the two most important blood tests to look for?
Dr. Justin Marchegiani: Yeah, so ferritin and iron saturation are gonna be important to look at. We like iron saturation 25 or above. We like ferritin, at least for a female, 30 or above. Now we can go above and beyond that, we can also look at your iron binding proteins like TIBC and UIBC. These are inverse proteins, so they go high—they go high when iron goes low. So think about it as like LittleFingers, right? The more you need the iron, the more fingers are gonna be up there to try to grab and pull that iron into where it needs to go. So binding proteins go up when iron goes low. So it’s kind of an inverse thing. It’s kinda like TSH, right? TSH screams louder to the thyroid when the thyroid goes lower, like you’re trying to get someone’s attention, right? You’re talking to them across the room, they’re not responding to your voice, so you raise the volume. Same thing, you’re raising the volume and trying to pull that iron and get it into your body so you can carry oxygen and make thyroid hormone.
Evan Brand: Okay, so you’re talking about thyroid, so when TSH is high, that’s when we know the thyroid function’s gonna be low. So if we’re kind of mixing lab tests here, we’re kinda talking about a few different things that we’re gonna be looking for this whole hair loss picture, the thyroid’s a good place to look. The iron levels are another good place to look. And then what about the adrenals because typically we’re gonna see adrenal issues happening that could be tied into thyroid issues, correct?
Dr. Justin Marchegiani: Yeah, it’s very possible. I mean, stress hormone will do a lot of different things to our body, right? So stress hormone will typically catabolize tissue and amino acids. So we’ll catabolize amino acids that could be used to make muscle or neurotransmitters, and amino acids can also go and make hair. So it’s very possible the more you are in a stressed out state, the more—the more the adrenals are hyperresponding or being whipped like a tired horse, you could potentially catabolize those building blocks that could go and make quality hair. That’s why many people have had experiences of extreme stress in their lives, like you know, really punctuated stress like someone dies or you know, something really catastrophic happens and they start losing hair. So it’s very possible that extreme stress and higher secretions of cortisol can really drive that hair loss and also we know we need cortisol healthy levels of it for thyroid conversion. So if we’re not activating our thyroid hormone because now our cortisol’s in the dump, we can also have it because of chronic cortisol imbalances that are driving low thyroid activation or low thyroid conversion.
Evan Brand: Yeah, that makes perfect sense. So now the first place that people like to jump is supplementation. There’s who knows how many millions of products out there that are designed or marketed for women especially for hair, skin and nails. Is that something that we would wanna do right out of the gate, or obviously it sounds like the better alternative is we need to kinda look for these other deeper underlying causes first and then maybe the supplements are gonna be kinda phase 2 or phase 3 in terms of treatment.
Dr. Justin Marchegiani: Yeah, absolutely, so obviously the diet stuff is really important. We kinda echo this stuff. Supplements are meant to supplement a good diet and lifestyle, so we’re making sure we have an anti-inflammatory diet because inflammation will drive cortisol because cortisol is our body’s natural inflam—anti-inflammatory. So cutting out the grains and a lot of the food allergens, plus we know that alopecia or alopuc—alopecia areata is going to be autoimmune and we know gluten, how important gluten is at being an autoimmune—part of the autoimmune mechanism, being an autoimmune stimulator, we know it can open up those tight junctions. We know it can drive inflammation, it also can be very high in sugar, right? A lot of the carbs, gluten, and a lot of refined sugar can drive your insulin levels up and high blood sugar can also feed fungus and a lot of people will have like cradle cap or aka dandruff or they’ll say—call it seborrheic dermatitis. A lot of times this is driven by fungus. I’ve had a handful of patients just this week that have come in with dandruff and with like psoriasis and things like that, and a lot of the seborrheic dermatitis and dandruff stuff is fungal in origin, like a lot of the—the Nizoral or these anti-fungal Head & Shoulder shampoos, they’re all trying to reduce fungus and we can do that by stopping to feed the fungus in our diet and the sugar and stop driving the leaky gut which could drive the autoimmune element with the alopecia areata.
Evan Brand: Absolutely, so now are you gonna see—I guess if they’re new patients, then you’d probably don’t have the results yet, but are you expecting to see some elevations of some markers on an Organix to see maybe that there’s some fungus or maybe even some yeast and fungus together that’s causing these issues, too?
Dr. Justin Marchegiani: Absolutely and if we see imbalance in gut bacteria, whether it’s SIBO, or whether it’s just a kind of run-of-the-mill dysbiosis, whether it’s a fungal overgrowth and H. pylori infection or a parasite infection, we wanna make sure all of those things are eradicated and then at the same time make sure we have enough good clean amino acids and protein in the diet and we’re actually able to digest it. So we wanna make sure we’re at least adding the secretions like the hydrochloric acid, enzymes, bile salts so we can break down these really good fats and proteins so we have the building blocks going right into our system.
Evan Brand: Absolutely, and the thing that’s beautiful about this model that we use is it doesn’t really matter what the condition or what the symptom is, this net is—is both broad spectrum and specific in terms of the labs that we usually discuss and run to find things. So if it’s gut symptoms, if it’s hair loss in this case, you know, it may seem like just a general blanket approach, but really it’s general and specific at the same time to try to identify the underlying causes of what’s going on and really, there’s only so many ways it seems like that things can dysfunction or function properly.
Dr. Justin Marchegiani: 100%, yup, absolutely. So when you have a systems-based approach, we’re just going in and we’re assessing the body system. So we go and we look at the foundational system which is gonna be diet and lifestyle. Blood sugar? Check. Do we have our macronutrients dialed down? Check. Too much carbs, too much proteins. Are we breaking our food down? Check. Sleep, stress, all those things, and once we have those all checked off, then we can go into body system one where we look at the hormones in particular—adrenals, thyroid, fi—female or male hormones, ATM or ATF, and then we can go into the next system which is the gut and that’s where it gets interesting because we can go through the 5R’s there which are removing the bad foods or placing enzymes and acids, repairing the gut lining, removing infections, reinoculation with good bacteria. So we go through a lot of that there and then we can also look through other deeper infections, too, and then we can go down into detox and other nutrient deficiencies on body system three. So we really have this really great big net so we can catch as many potential intruders or imbalances before they become a major problem.
Evan Brand: Definitely and that’s the goal about this whole functional medicine approach that we’re using which some people say like you said some people say they’re doing functional medicine but it’s different or it’s not quite this type of approach. This method is simple enough but it’s effective enough, too. So people, you know, when they’re looking on the Internet, say for hair loss supplements, you know, you could probably get locked in to some multilevel marketing scheme product or something similar where it’s really just a lot of hype and marketing but it doesn’t really have any solid foundation in science behind it and so people get frustrated and they go and they drop their money into these products and they don’t really move the needle. So maybe we can talk about some of the—the ethical or the intelligent ways that you could supplement if you really were trying to support, you know, optimal hair, skin, nails, hair growth, etc.
Dr. Justin Marchegiani: Absolutely. So off the bat, I’ve—I skipped one thing—we also know that blood sugar swings and adrenal stress will encourage more reverse T3 which are like the metabolic blanks in our gun cartridge so to speak, in our magazine, because when you pull a gun—pull a trigger or the—on the gun, right? A bullet comes out, right? You actually have an effect. Well, metabolically, reverse T3 is supposed to bind to the receptor sites where T3 would go, but the problem, reverse T3 is like putting a blank in that gun. So you get the sound, but you don’t get the effect, right? You get the hormone in the receptor site, but you don’t get the increase in metabolic activity, that typical T3 thyroid hormone will produce. So that can cause less thyroid hormone via the reverse T3 mechanism, and we know that blood sugar issues will drive that, too. We know overall stress will drive that as well. So that’s one other mechanism I wanted to add.
Evan Brand: That’s great. Now so you’re saying here that if we are looking at a blood panel that reverse T3 if that’s elevated, and maybe you can shout out some of the more appropriate ranges that that is gonna be an issue.
Dr. Justin Marchegiani: Yeah, typically we like it below 24 or 23. Typically in the—in the mid-teens is okay. We actually would look at like a reverse T3 to free T3 ratio or a total T3 to T3 ratio. And pretty sure my free T3 to reverse T3—T3 ratio is around 10:14 is optimal. I’ll pull up my—my little reference range here right now and I’ll confirm that while we’re live, but that’s the general gist. Yeah, and total T3 to reverse T3—T3 ratio is 10:14. Free T3 to reverse T3 ratio is 20:30.
Evan Brand: Okay.
Dr. Justin Marchegiani: So that’s the ideal range there. And you can just google those ranges online. There are a couple of good sites that will provide an actual kind of algorithm where you can plug in the T3, plug in the reverse T3, set the standard deviation, you know, whether it’s ng/dL or µg/dL and it’ll give you that number. So total T3 to reverse T3 is 10:14 and then free T3 to reverse T3 is 20:30, and we like to have that reverse T3 ideally in the very low 20s or mid-teens or so.
Evan Brand: How high have you seen that number?
Dr. Justin Marchegiani: I’ve seen it, you know, up into the—into the 30s very easily and that could easily happen with stress, emotional stress, blood sugar stress and/or just overall inflammation in the body because that creates internal stress as well. So the reverse T3 is important because it’s gonna take that T3 that would be active and make it go downstream, and then it not only makes less T3 but then it prevents the T3 that’s actually floating around in your bloodstream from binding into the receptor site and doing what it was designed to do in the first place.
Evan Brand: Makes sense. That’s a big issue there and a lot of people are like I’m not stressed. It—it’s the invisible stressors, too, that we’re factoring in and we can see that. So you don’t have to actually identify as a person that is stressed, that could be invisible stress that we’re gonna see on these lab results here.
Dr. Justin Marchegiani: Absolutely and also estrogen-dominance can provide problems, too, because that will increase thyroglobulin and thyroglobulin will decrease the amount of free T3 in your bloodstream. So it’s kinda like reverse T3. The difference is reverse T3 is more or less blocking the receptor sites, where thyroglobulin is decreasing the amount of free fraction. So 2% of your thyroid hormone is actually free, the other 98% is protein-bound, and what it’s doing is the thyroglobulin is decreasing the percent of free T3. So instead of having 2%, maybe now you have 1.9 or 1.8, or just having less free fraction available, so when we look at our total numbers, right? Maybe our total T3 is 110, 120 which isn’t bad, but now our free T3 instead of being at 3 or 3.1, now it’s at 2.9, 2.8, 2.7, and it’s dropping because of that estrogen dominance.
Evan Brand: Yup, so estrogen dominance which we’ll probably have to do a whole show on that if we haven’t already, a lot of that’s gonna be exposure to synthetic estrogens?
Dr. Justin Marchegiani: Yeah, it’s gonna be exposure to plastics, chemicals, pesticides, fluoride in the water, and also just being stressed, right? Because in women, progesterone predominates that second half of the cycle, and when women are stressed, they can use progesterone as a building block to make more cortisol. So more stress will actually steal from their progesterone. It’s kinda like a progesterone stealer or progesterone escape. We’re pulling progesterone in to make more stress hormones because our body’s epigenetically hard wired to deal with the stress of today versus the healing of tomorrow. The problem is most people live in a perpetual state of stress so tomorrow never comes.
Evan Brand: Yeah, exactly. It’s crazy, isn’t it?
Dr. Justin Marchegiani: So, I—I did the political side-step, I—you asked me a question and I gave you the answer that I wanted to give. It had nothing to do with that. So let me go back to your question. I’ll reiterate it for the listeners here. What supplements in particular? So number one, we can add good quality hair support from fatty acids, right? Omega 3s, whether it’s good quality fish oil or cod liver oil or sardines and things like that, salmon, mackerel, those are all really good quality Omega 3 fatty acids that can help with hair. Next you have conventional things that have been around a while like Biotin, which is kinda like, almost like a B vitamin so to speak, and that can very much help with the skin, help with hair as well. Next, I would say collagen is one of my favorite–
Evan Brand: Yup.
Dr. Justin Marchegiani: Things. Collagen’s amazing. It’s very high in glycine and proline and hydroxyproline, helps provide building blocks for skin, hair, and nails, and I was talking to Dave Asprey last year when he was growing his hair out longer, and I noticed it just being longer and more full. And I’m like, “Dave, what the hell are you doing with your hair? It looks great.” He goes, “I’m megadosing collagen, like 40g a day, 50g a day.” So since then, I’ve been really upping my collagen to really have good high quality hair and skin building blocks, and that’s I think one of the most important things you can do is good quality grass-fed collagen, and by the way we have a collagen product coming out very soon called True Collagen and I was able to source one of the biggest and best distributors for collagen that is grass-fed, hormone-free, pesticide-free. So stay tuned for my True Collagen which is something that we’ll be coming out very soon and I’m already using it now and I love it.
Evan Brand: I want my sample pack in the mail.
Dr. Justin Marchegiani: You got it, man.
Evan Brand: Okay.
Dr. Justin Marchegiani: Coming your way. So–
Evan Brand: Awesome.
Dr. Justin Marchegiani: So we talked about Biotin, collagen, fish oils, anything you wanna add to that?
Evan Brand: No, I think that was good, you know, the fatty acids for sure. Basically, things that are gonna help to reduce the inflammation in general, because if there is something going on in the gut, the gut has to be healthy so if you just or somebody listening and maybe you’re already taking collagen which a lot of women are, they’re frustrated, they’re almost like they’re mad at me. It’s like, “Evan, I’m already taking collagen and my hair is still falling out or my hair is still very thin.” It’s like, well, that’s—that’s the supplement, you know, let’s see what else is going on deeper and usually something pops back up on the stool test, and like, “Okay, well, you know, your digestion’s been impaired, here you are feeding these bacteria or feeding these parasites, not you,” so maybe it’s been good nutritional insurance to get the collagen, but if you have someone stealing your energy, you know, someone like kinda how they used to do in the—they used to steal cable, you know, they’d go up to the main line and–
Dr. Justin Marchegiani: Yeah.
Evan Brand: Slice the cable wire down to your house, if that’s going on in the gut with your nutrients, then you could still have issues regardless of, you know, what you’re supplementing with.
Dr. Justin Marchegiani: Yeah, I remember Dr. George Goodheart saying in various seminars, you know, years back, “The highest good is to get to the root cause.” The highest good and that’s always in my head. Like alright, “Are we getting to the root cause?” Right? And a lot of times, supplements may be getting to the root cause or they may be palliative and supportive with the fact that we are addressing the root cause but also adding these extra nutrients in so i.e., let’s say we have a gut issue and our diet stinks, but we’re adding in a whole bunch of collagen. Well, is that a bad thing? No. It’s not a drug. It’s not gonna have side effects and kill over a hundred thousand people a year like pharmaceutical drugs do in general taken the right way. So that’s a good thing. We don’t have that nasty side effects. Is it providing more building blocks than would be there anyway? Yes. But we wanna make sure the underlying cause is addressed. So I’m a big fan of if we’re gonna add something in that’s supportive and palliative, at least make sure the underlying cause is addressed or there’s a program set up in place to address it.
Evan Brand: Right. So there’s nothing wrong with treating the symptoms and sometimes we have to treat the symptoms first to keep people motivated, move the needle enough with them to keep them on their program, but eventually we’re always kinda backtracking from this symptom back to the underlying cause.
Dr. Justin Marchegiani: 100% and like there’s another element here I didn’t talk about which was DHT, which is dihydrotestosterone. So if we look at kind of the breakdown or the formation of testosterone, it goes from DHEA to testosterone or I should say androstenedione then to testosterone and then to DHT. So in each downward cycle, the hormonal molecule gets more potent, more—more strong. So DHEA is weaker than andro. Andro is weaker than testosterone. Testosterone is weaker than DHT. So essentially said in the different way, DHT is the strongest and most powerful out of all of them, and DHT is shown to potentially starve out blood flow to some of the hair follicles. So that’s important. So if we run a profile, we can look at women with elevations like PCOS can drive elevations in androgens, and we can use things like GLA fatty acids like evening primrose oil or black currant seed oil to help with reducing that DHT. It’s a 5-alpha-reductase inhibitor. In men we can also use—I think women, too, this would work—but we can do zinc and selenium, which happen to be great for the thyroid, go figure. And then men we’ll do it a lot. We’ll use saw palmetto and/or pumpkin seed extract as a natural 5-alpha-reductase inhibitors, and you know, a lot of the medications, right? Like the—the names are fleeting me—I can think of all the commercials from the 90s, the—the Rogaine–
Evan Brand: Yup.
Dr. Justin Marchegiani: And a lot of those types—I forget the actual trade name of it—Propecia. That’s what it is. Those are typically 5-alpha-reductase inhibitors as well at a pharmaceutical level. But we can do it naturally, too. They won’t have all the side effects. So my big 5-alpha-reductase inhibitors for females are really easy one is gonna be the nutrients, selenium and zinc, and then one, I’ll add in the GLA fatty acids like the evening primrose or the black currant. Men can do that as well and they can also go the extra mile and add in some pumpkin seed or saw palmetto along with that.
Evan Brand: Beautiful, awesome! I’m glad you got there because I—I’ve had that in my radar, you know, the 5—the—the DHT and I was thinking about, you know, men that have used steroids and they have the increased conversion of hormones there so they’re more likely to go bald and I’m glad that you were able to—to pull that out and digest it for us.
Dr. Justin Marchegiani: Absolutely. So if we kinda break everything down. We talked about the supplements, those are great. Really, really important things. We talked about the hormones. We talked about how the adrenals affect it, right? Cortisol high or cortisol low will affect the thyroid. So if the thyroid’s affected by the adrenals, that’s gonna cause a problem. If the thyroid’s affected by autoimmunity, right? We’re attacking the thyroid gland because of gluten that can reduce thyroid hormone. That can cause a problem. Too much iodine with thyroid issue can drive hair loss. I’ve seen people do excessive iodine with an autoimmune mechanism in the background, massive hair loss.
Evan Brand: Wow.
Dr. Justin Marchegiani: Massive. So we have the I—we have the thyroid piece. We have the nutrients that can exacerbate autoimmunity. Gluten potentially. Iodine if there’s already an autoimmune mechanism to process. The leaky gut. Poor nutrients in the diet regarding fats and proteins, not digesting these things, these compounds well. Infections can drive a lot of these things. I’ve heard Yuri talk about it with the gut and the infections causing his alopecia areata. So all of these different mechanisms—we have individual things that like the thyroid. We have individual things that affect the adrenals and thyroid together. We have nutrients that play a factor and then we have different hormonal things like the DHT and the progesterone as well.
Evan Brand: Great! Great summary there.
Dr. Justin Marchegiani: Anything else you wanna break down there?
Evan Brand: Honestly, I think that was great. I think it would just be me doing a broken record pitch there. So I think you did great. You know, the—the takeaway from this is—this is kind of a complex situation so it may sound just easy on the surface. You know, you go to Walgreen’s, you see a hair supplement. “I’m gonna try it. My hair’s gonna grow back.” Maybe not. So if you do have this issue, you know, it would be important to reach out to Justin or myself, you know, let us look for you and see what’s there, at least rule things in and rule things out. And if, you know, run a test and Justin says, “Oh, look, you’re free and clear.” Well, that’s good. But we still need to try to figure out what’s going on. But you’d never know if you don’t test. If you haven’t test, you’ve guessed. So keep that in mind anytime you’re gonna go invest your money into a supplement. You may need to invest into the clinical data that’s really gonna find out why this is causing it before you can actually work on fixing it.
Dr. Justin Marchegiani: Absolutely. So let’s kinda back up here, alright. So I’m a male or female that’s dealing with hair loss, kinda what’s—what’s the action tree here? Alright if–
Evan Brand: Yeah, so–
Dr. Justin Marchegiani: Go ahead.
Evan Brand: No, you go ahead. What you got?
Dr. Justin Marchegiani: Okay, so you’re man, right? Figure out, this hair loss fall in your family. This is a male potter—male pattern baldness thing. Well, number one, we gotta first realize that a lot of how we deal with stress and how we, you know, eat, sleep and drink typically is passed down through our family. So is this purely a genetic thing or is this, “Hey I’m just following the footsteps that my parents did and, therefore, I’m gonna have the same genetic predispositions because I’m eating crap and taking care of myself in a very poor way.”? So figure out how much of this is in your control and how much isn’t. Either way, if it’s totally male pot—male pattern baldness and you don’t have any control, you still wanna be doing all the things we mentioned anyway. So don’t ever let that be your excuse, because you still get other benefits by doing all of these things there, like brain health and performance and muscle and libido and virility and energy. So keep that in mind.
Evan Brand: Definitely.
Dr. Justin Marchegiani: If you’re a woman, you g—you have a lot of control over this as well. So the first thing we do is diet. Cut out the crappy foods. Grains are gonna be the first thing. Get your sugars under control. Next, make sure you’re digesting foods and proteins and fats well. You’re having digestive symptoms and things like HCl and enzymes aren’t working, well, guess what? Get on those. Now next, if that’s not working, then we have to do some testing. We have to look at the adrenals. We have to look at the thyroid. We have to look at the gut. Alright, so that’s where you wanna reach out to Evan or I and figure out the next steps, but in the meantime, you can go pick up a high quality collagen. You can try some HCl and enzymes. You can try some of the nutrients we mentioned. But if that’s not working, you’ve already exhausted the low hanging fruit, so just make sure after that you reach out to a good functional medicine doc to get to the next step. But in the meantime though, don’t let the male pattern baldness genetic stuff if you’re a man stop you from taking action. You don’t know how much of it can be slowed or how much can go back. And if you’re a woman, this is a deeper sign that something underneath is happening. So I hope that helps and empowers everyone listening that’s dealing with this problem.
Evan Brand: Absolutely. Well-said. Yeah, so it’s the gun. You know, you may have the gun there, and it could be loaded with your genetics and your family, just all of that, you’re—you’re susceptibility to stress, your environment, etc. but you have the ability to not pull that trigger, you know? So don’t just, “Oh, screw it! I’m just gonna binge eat on pizza.” That may not be the step that’s best for you. You know, sometimes we get frustrated with our health conditions and we just say, “Screw it! I’m going all in. I’m gonna go off the rails,” but oftentimes, you know, just pause, take a breath, and then think, “Okay, what can I actually do that’s gonna work me towards my goals? And not just self-sabotage myself,” and that is common for people to—to hit this point, and they do wanna just—it’s all over. They get this kind of a—what do you call that—like a black and white approach I guess.
Dr. Justin Marchegiani: Yeah, absolutely. Absolutely, so we wanna make sure we have a multifaceted systems based approach, alright? And we wanna have objective testing to quantify it. And even things like temperature-testing can be a really good objective kind of test that doesn’t require any resources to do it outside a—a really good fertility thermometer. So kinda grab those low hanging fruits tests, right? We wanna assess, not guess. So get the assessments to figure out what’s going on and if you guys gotta reach out to someone like Evan and I to get more info, we are here at your disposal.
Evan Brand: Well-said.
Dr. Justin Marchegiani: Alright, Evan. Hey, it’s a great Friday, man! I’m looking forward to heading out in the water today in Lake Austin, probably tomorrow morning, do a little water skiing and get some good cardio in or I should say, it probably be more—more anaerobic with some of those movements that I’m doing. But anything else on your agenda for this weekend you wanna share with our crowd?
Evan Brand: Oh, we’re just gonna get out and enjoy the sun. You know, we got 4 weeks left ‘til the baby comes, so we’re gonna be soaking up the blue sky and the sunshine while it’s here. And before you know, we’ll have a baby and who knows? I mean, maybe trapped inside and changing diapers all day. So–
Dr. Justin Marchegiani: I know. I hear you. Well, make sure you say “Hi!” to Anna for me and you have a great weekend.
Evan Brand: I sure will. Take care.
Dr. Justin Marchegiani: Take care. Bye!
Evan Brand: Bye!
My Lab Tests Are Normal But I Still Have Symptoms
By Dr. Justin Marchegiani
I see patients all the time in my practice that tell me they don’t feel right, yet their medical doctor tells them their lab tests are normal. The typical response from the average medical doctor will be something like this: “It’s all in your head. You may benefit from taking an antidepressant.” Or if you’re a woman, it may be blamed on female hormone issues, and the next solution may be to go on a birth control pill to help normalize your cycle.
Intuitively, people know something’s wrong even if their lab tests aren’t totally in the red. The most common response I hear in my practice—
“My lab tests are normal, but I still don’t feel well!”
The problem with this scenario is there are physiological, biochemical, and hormonal explanations for why patients feel the way they do. Conventional medicine typically gives these patients no answers and worst of all, can sometimes make them feel as if they’re making it up.
In the world of functional medicine, we tend to look at things differently than your conventional medical doctor. Most lab tests have originated to include 95% of the population into the normal values. So if your medical doctor tells you your labs look fine, that just means you fit into that 95% category, or two standard deviations away from the mean if you are into statistics.
Anyone that has walked around an airport for just a little bit of time will be able to tell you 95% of the population doesn’t fit into the healthy category. Conventional medicine makes a massive assumption that the absence of disease is health. This is like saying the absence of being poor on the street means you’re rich! I hope my analogies help drive the point home that these assumptions are absurd!
Why the Answers to Symptoms Get Missed by Conventional Lab Testing
As society gets sicker and sicker and sicker, we know the reference ranges get wider, and wider, and wider. So if you are someone that may have been healthy to begin with, and then have a sudden drop in your health, you may still fall within that normal reference range. Thus, being told nothing is wrong.
It’s really not your medical doctor’s fault. Conventional medicine trains physicians to look for pathologies or disease, and this is a good thing. Where this paradigm falls short is when you aren’t sick enough to fall into the category of being diagnosed with a disease. So what do you do next?
Essentially, conventional medicine is saying, “Go home, continue doing what you’re doing, get sicker, and then maybe we’ll be able to diagnose you with something in a few years.” Intuitively, that doesn’t sound right to me. We need to look at things in a more sensitive way so we can pick up this slow and steady breakdown before it becomes a major problem.
Your body is designed to adapt to stress. Maladaptation is the number-one sign that your health is starting to decline. If your body loses the ability to adapt to the various stressors in your life, you will eventually come down with some type of disease. The goal of functional medicine is to figure out where the underlying stressors are coming from. Using specific lab markers that are sensitive, we can chart your overall health function on a spectrum so as we start incorporating treatments, we have objective and subjective markers of improvement.
Functional medicine can look at the exact same labs and potentially pick up subtle things that conventional medicine may not. Click here to get your labs assessed.
Thyroid Lab Testing and the Inadequate TSH Test
Most people have low thyroid symptoms even though their thyroid lab tests are normal! The standard panels that are looked at are typically a TSH test (a brain hormone) and T4 test (a storage thyroid hormone). It always bothers me that conventional doctors very rarely look at the active thyroid hormone (T3) to assess a thyroid problem. Especially since the research over time has shown that TSH testing isn’t the best to assess thyroid function. If TSH is elevated, it’s a surefire sign of thyroid dysfunction, but it’s a marker that tends to elevate late in the game.
Above are the markers that I commonly run on my patients to assess which pattern of thyroid dysfunction they have. Thyroid antibodies are also looked at to assess if there is an autoimmune disease at play. Most conventional physicians totally ignore thyroid antibody testing completely because it doesn’t change the conventional treatment; Synthroid will be given either way. Knowing whether or not a patient has an autoimmune thyroid disease (Hashimoto’s thyroiditis) can make all the difference in the world.
When we are dealing with Hashimoto’s, it’s the immune system that is out of balance. It is destroying the thyroid gland. It doesn’t make sense to put all of our focus on the thyroid gland if the immune system is attacking it daily. Some people with Hashimoto’s (hypothyroidism) may need thyroid hormone depending on how bad the damages is. I always recommend getting a full assessment like the one above before it is recommended. Hashimoto’s patients will typically respond better on a combination of T3 and T4, like in Nature-Throid, or a bioidentical thyroid glandular instead of a synthetic T4 medication.
Assessing the glands that help control and regulate stress is very important to your health. Your body is designed to be healthy, and part of being healthy means adapting to stress. Your adrenals are instrumental at producing hormones throughout the day that are designed to do just that.
Cortisol is secreted in a pulsatile fashion, higher in the morning and then tapering off throughout the day. Cortisol is designed to help stabilize blood sugar and help deal with stress and inflammation. The more dysfunctional our adrenals become, we start progressing into deeper stages of adrenal fatigue. This is where our brain (the master controller) isn’t able to communicate with our adrenals properly and we develop HPA axis dysfunction. This is nothing more than communication breakdown that can be fixed with proper diet, lifestyle, stress management, and a properly prescribed adrenal program (specific to your pattern of adrenal fatigue).
Blood Test Markers for Health
Looking at blood test markers from a CBC, CMP, or lipid panel can provide a pretty good idea of how the body’s systems are functioning.
When we see digestive markers, like albumin, globulin, creatinine, BUN, or serum protein, out of balance, it can tip us off that we may be dealing with some digestive inflammation, low stomach acid, leaky gut, and/or malabsorption.
We can look at markers like RBC, Hgb, Hct, MCV, MCH, MCHC, and ferritin, which are markers for an anemia. An anemia typically deals with deficiencies in certain B vitamins, like folate or B12 and/or iron. Most conventional doctors tend to miss these subtle imbalances. And they can contribute to a person’s inability to transport oxygen, create energy, and convert T4 (inactive thyroid hormone) to T3 (active thyroid hormone).
When we see blood sugar markers, like fasting blood sugar, hemoglobin A1C, or insulin, out of balance, it is a good sign there is inflammation. There are more specific markers that can be looked at, like C-reactive protein, ESR (erythrocyte sedimentation rate), fibrinogen, and a triglyceride-to-HDL ratio greater than 2.
When we assess white blood cell (WBC) function, long-term low WBC can be indicative of a chronic infection, while elevated WBC can be a sign of an acute infection. This rule is the same for the WBC’s constituents as well. Below is a list of the specific components of WBCs. We are looking at the markers below in a more sensitive range than the standard lab range, so we can pick up more subtle infections.
- Neutrophils: Potential bacterial infection including H.pylori
- Lymphocytes: Potential viral infection
- Monocytes: Potential parasitic infection and recovering from an infection
- Eosinophils: More specific for a potential parasite infection
- Basophils: Can increase due to allergies, inflammation, or parasites.
- Alkaline phosphatase: When low, a sign of zinc deficiency, which is a key immune-system nutrient
Most people who are tired and moody and have weight gain and hormone imbalances tend to have an infection! I have tested hundreds of patients, and I would say, based on my experience, over 70% have a parasite, bacteria, or fungal infection.
Yet in First World countries, it still isn’t accepted, by and large, that these infections can cause a problem. But having worked with many patients with these infections and having helped to remove the infections, I can tell you I’ve seen significant changes, and my patients will tell you the same.
These infections can cause classic GI symptoms, like bloating, gas, constipation, diarrhea, and acid reflux. These infections, at the same time, can cause symptoms that are more nuanced, like depression, hormone imbalances, fatigue, neurological issues, skin issues, and weight gain. It’s hard to connect the dots when these infections aren’t causing the typical symptoms you would see in Third World countries (distended bellies and such).
So What Do I Do Next?
If you are told that your lab tests are normal but you know something deeper is wrong, you are probably correct. Most of these problems if left alone only get worse and take more time and money to fix later on.
Iodine and Hashimotos… Friend or Foe?
By Dr. Justin Marchegiani
Iodine and Hashimotos thyroiditis are two very controversial yet very popular areas of discussion in regards to the treatment of hypothyroidism. Most people who hear of someone suffering from low thyroid symptoms will think of iodine as the first magical solution. Iodine is an essential nutrient needed for thyroid-hormone synthesis, so it’s understandable that these inferences would be drawn. There are people in the United States that suffer from iodine deficiency because of poor nutrition, and some might live in certain parts of the world (like the goiter belt in the United States) where iodine is deficient in the soil. Most people aren’t aware that the majority of thyroid issues are an an autoimmune disease called Hashimotos thyroiditis.
Iodine and Selenium
There’s one problem: when iodine is given in high amounts in the presence of inadequate amounts of selenium, inflammation can occur. Selenium is also needed to activate thyroid hormone from T4 (inactive) to T3 (active). Most patients I see, even when given Synthroid, the standard-of-care treatment, have a difficult time converting it into T3. The scientific literature also supports that the majority of thyroid conditions are autoimmune in nature, making the necessity of selenium even more important.
Too much Iodine
Too much iodine can cause a condition known as the Wolff–Chaikoff effect, which, in effect, causes short-term hypothyroidism. This is a process where too much iodine is given and the thyroid gland responds by shutting down thyroid hormone production for up to 10 days. During this time, the thyroid gland uses an escape mechanism in which more iodine accumulates in the blood by blocking its transport into the thyroid tissue via the sodium-iodide symporter (NIS). By blocking the thyroid gland’s uptake of iodine, the body has time to urinate out the extra iodine.
On the other side of the fence, we see another effect known as the Jod-Basedow phenomenon in which patients with a goiter (low iodine causes an enlarged thyroid gland) who are given too much iodine will go into a hyperthyroid state.
Iodine and the Double-Edged Sword
So you can see that it gets a little confusing regarding iodine and its effects on the average person. On one side of the coin, you may get a hyperthyroid effect; on the other, you may get a hypothyroid effect.
I strongly recommend you see your functional-medicine doctor before taking large amounts of iodine. If you want to get your thyroid assessed, please click here!
When iodine is used, it should always be used in smaller amounts, tapering up to a higher dose. There are doctors who are famous for using higher amounts of iodine to treat thyroid disorders. Dr. Brownstein for instance. Even when treating Hashimoto’s, he has made comments referencing that using iodine early on is akin to throwing gasoline on the fire. I am also aware that he typically uses selenium, magnesium, zinc, vitamin C, and sea salt in conjunction with iodine. As you can see, iodine is never used alone.
What Types of Iodine Are Best?
Using a combination of iodine and iodide is always best. There are solutions on the market, such as Lugols or Iosol, that contain the proper balance of iodine to iodide. When iodine is given in supplement form, it’s primarily taken up by the breast tissues, prostate, uterus, and ovarian tissues. I always give a solution that contains both iodine and iodide.
Below is some technical scientific jargon, but as long as you understand the three key steps I share below, you will have a good grasp of what’s going on in your thyroid gland.
The Key Steps to Making Thyroid Hormone
- NIS (sodium-iodide symporter): The NIS brings iodide from the blood into the thyroid tissue. Iodide is then converted to iodine via an oxidation reaction. This is just a fancy term that means it loses some electrons.
- Iodine is bound to thyroid-binding globulin in a process known as organification.
- Iodine plus thyroid-binding globulin is bound to a molecule of tyrosine. Three other molecules of iodine are also present, making it four iodine molecules total. This is our storage, or inactive, thyroid hormone T4.
The By-products of Thyroid Metabolism
The key thing to focus on in the picture above is that when thyroid hormone is made, hydrogen peroxide (H2O2) is pumped out as a by-product of the reaction. Hydrogen peroxide can be very inflammatory and can even call some B-cell lymphocytes to the scene. The B cells are there to help clean the inflammation yet can cause more inflammation as the hydrogen peroxide accumulates.
You can think of selenium, the main ingredient to glutathione peroxidase, as the water that is needed to put out the fire in the thyroid tissue. Without selenium, thyroid will continue to burn and the immune system will continue to call more antibodies to the scene, including thyroid peroxidase antibodies (TPOAb) and TBG ab, to fight the good fight. Over time, through collateral damage, the thyroid will burn a slow death. Typically, in about 8–10 years, you will start seeing thyroid symptoms during autoimmunity.
For most patients, as they’ve probably already experienced, their doctor won’t have too many answers outside of a Synthroid prescription. You have already read this above, but in the video as well, you will see that Synthroid does nothing to address the underlying inflammation and autoimmunity that is occurring. It also doesn’t address any of the key nutrients that would be necessary to help put the fire out.
Selenomethionine (selenium) has been shown to reduce thyroid antibodies in as little as three months! Selenium is an essential nutrient that every thyroid patient needs to be supplemented with. Not all patients may need iodine initially; you may be accidentally waking a sleeping dragon if iodine is given.
Chapter 48, “SYNTHESIS OF THYROID HORMONES” in: Walter F., PhD. Boron (2003). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 1300.