Joint Pain and Functional Medicine | Podcast #247
Joint pains are one of the common problems especially in active, or people of old age. It is often caused by injury affecting ligaments or tendons surrounding the joint. While our daily movements can be a cause to this, the food we eat can also be one of the factors.
Enjoy this podcast as Dr. Justin and Evan Brand laid out infos on joint pains, supplements for healthy joints, lab tests, infections and a lot more.
Dr. Justin Marchegiani
In this episode, we cover:
00:48 An overview on joint pains
14:29 Food then vs. now and how it affects our joints
21:44 Supplements for healthy joints
34:16 Hip pain, glutamate issue, etc.
Dr. Justin Marchegiani: And we are alive. It’s Dr. Jay here in the house with Evan Brand. Today we are chatting about joint pain and functional medicine and how we can get people who are doing pain better. Evan how we doin’ today man?
Evan Brand: Oh I’m doing wonderful. Excellent. And through some stuff here about back pain knee pain. I mean there’s I would say if you did a survey of one hundred people and you said, Hey do you have joint pain I would say 90 percent of those people would say yes occasionally, my elbow, my knee, my wrist, my ankle, I mean the joints are to me one of the first things that really deteriorates and shows that you’re becoming unhealthy. It’s not like your biceps one day just falls off and hurts you know joints I think go first before you start to get weak and decrepit and lose all your muscle mass.
Dr. Justin Marchegiani: 100 percent. So we look at joint pain right. There’s a couple elements. So we also have we have the cartilage which is kind of like the softer connective tissue. You know typically at the ends of the bones. So for instance you know on your femur and tibia right where your knee is you’re going to have cartilage right in between here and the cartilage with the knees and the shoulders and the labrum on the shoulder. So you have this cartilage tissue which is really important that the softer kind of connective tissue and we need certain nutritional building blocks to help with that. Collagen is really important because we are typically consuming connective tissue building blocks like collagen right. We’re typically a muscle meat type of culture but we need to be consuming organ meats and also connective tissue and we can get connective tissue by using a crock pot or an insta pot and throwing the full bone or knuckle of that joint in there. We can also get it through bone broth and we can also get it through collagen amino acids which are higher in protein hydroxide and glycine. These are really important nutrients that we’re just not getting. So we have Cartilage connective tissue and then of course we have the bone connect tissue that’s actually the structure the all the in-between connective tissue structure. That’s the solid portion of the joint so we have cartilage on the ends and then we’re going to have the bone in the middle and the bone people just think Hey the bones, calcium. They say hey a bone looks white, it’s calcium but there’s about 12 minerals that make up a bone. Calcium is predominant but there’s other minerals too. And then people forget your bone is half protein so we’re not eating out of the protein or we are not able to digest adequate protein from food allergens or poor stomach acid or infections or automatically going to have deficits on the bone side and potentially the cartilage side typically cartilage is easier because we aren’t really getting that much cartilage tissue in our diets but we tend to get more protein but if we had other stressors going on- food, poor digestive support, infections or just a poor diet nutritionally we’re going to have significant deficits.
Evan Brand: Check your zoom preferences it sounds like you may be on your headset audio and not your big ole microphone and I’m going to talk about some of the testing that we’ll do with people when they come to us with joint pain because there are functional causes that we can find. So could this be like you said just a deficiency if you look at Dr. West in a Price’s book one of the interesting things was that he said that when he was looking at these tribal cultures they would feed the muscle meat to the dogs. I mean muscle meat. Your microphone sounds much better now. Yes. Thank you for that. He I mean he literally said this was not just him you know talking to be funny. This was literally him documenting he said the organs were the first thing that people would go for and then boom muscle meat just. Here you go doggy. And now we pride ourselves and our grass fed steak which is good but I think yeah we are super deficient as a whole. And I’m taking several different supplements now I’m playing around with some bone marrow supplements and other things so I haven’t been doing it long enough to give full feedback. I’ve been doing bone broth for you know a few years but I’m actually trying real bone marrow now and to see what happens because I’ve had many people report good things.
Dr. Justin Marchegiani: You know I’m doing the same thing as well. Thanks for the mic thing. Anyone listening in the wants higher quality audio click below. We’re going to actually have the podcast link as well where we even have just the E higher audio version. So if you guys want to hear us in crystal clear quality feel free and click below. But yeah you’re 100 percent right. So there’s some supplements out there that will give you some of these building blocks like you mentioned some of the bone marrow some of the organ meat, some of the glandular meat which I think is really important. Bone broth collagen peptides are going to be great. Like in my life we have a product called true collagen and so collagen amino acids are wonderful. And if you have gut issues I love the amino acids because they’re already in broken down form so 50 percent of the energy from protein actually goes into the digestive process. So there’s an expensive transaction fee when you’re digesting protein. So if you use an amino acid product it’s a peptide form you’re going to be able to absorb more of it and there’s less stress on your gut. So of course we love collagen amino acid products. Whole Foods first but in the meantime that there’s digestive issues or deficits in being able to break down those amino acids good collagen amino acid products are great bone broth is gonna be great. And like Evan said. There’s some ancestral health products we use on the bone marrow side in organ meat side. We’ll put some links down below. So you guys want to access some of those we’ll put those links down below so you guys can see that. Anything else I want to highlight there.
Evan Brand: Yeah. So that was it for the food section. Most people I won’t drop names but most people that’s that’s where their knowledge stops. They just say real food real food real food it’ll fix everything and then they stop. Now let’s take it to the functional medicine side and talk about testing when joint pain comes up we’re gonna be looking at different ways to measure some of this nutrient malabsorption that you just spoke about so we could start talking about the stool test. We may be looking at pancreatic elastase, we may be looking at Secretary IGA to look at gut barrier function we may look at steatocrit which is a marker of fecal fat to see if someone’s digesting their fats or not. So we don’t have to guess and just say oh sounds like this person isn’t absorbing they need collagen supplements. No we can prove it on a piece of paper with a combination of stool and urine testing and if someone comes to us with joint pain 90 percent of the time there’s going to be some sort of infection. So why don’t we talk about those whether you want to dive into like bacteria viruses parasites how that may affect joints.
Dr. Justin Marchegiani: Absolutely. So we can see joint pain with certain infections like cytomegalovirus or Epstein Barr virus. That’s very possible. You may see it with Mycoplasma. Mycoplasma is one of these bacterial infections that can drive rheumatoid arthritis. So when we look at joint issues we kind of draw a line. Right. We have kind of the wear and tear of joint issues where you’re just pounding that joint whether it’s exercise or just poor posture or stress. And essentially the build up starts to drop and the breakdown tends to increase. So normally we have this build up and break down and as long as the buildup is at least even or a little bit above with the breakdown. Right. Anabolic to catabolic. We’re OK. All right. Now over time though if the if the build up starts to drop and the breakdown increases that’s where we start to get osteoarthritis and that tends to be that tends to be bilateral right now with rheumatoid arthritis or the autoimmune side of the fence so one side’s wear and tear the other side’s auto immune then. Now we’re breaking down our tissue cartilage our joints and it’s our immune system that’s doing it. So it’s not necessarily wear and tear it may be but now our immune system is coming to the party and it’s certain to beat up the joint tissue. And of course there’s different markers that we can look at to assess that. But infections play a big role like Mycoplasma, like H pylori, EBV, cytomegalovirus. These are really important things to look at from an infection standpoint. Most people ignore the infection connection with a lot of these issues because they think of these infections as hey if I’m not tired or if I don’t have digestive issues I’m OK so we may look at things like antinuclear antibody like RNA. You may look at rheumatoid factor. We may look at anti citrullinated peptide or ACCP is also ESR which is erythrocyte sedimentation right. That’s a marker of inflammation and we can also look at CRP, C reactive protein. These are really good markers of inflammation that’s more associated with the joints and CRP and EST is more a systemic inflammation markers. And then of course the optimal gut markers are gonna be cow protected for inflammation in the gut cow protect and tie. That’s like CRP for the gut. And if we have inflammation in the gut is a really good chance that we’re going to have gut permeability and that gut permeability can drive autoimmune stuff and that auto immune stuff could potentially go after the joints if you after the cartilage the bone etc. So we really have to remember there’s an autoimmune component and there’s also a wear and tear component.
Evan Brand: Yeah. Well said that’s what I wanted to to mention is many people that come to us they’re not exercising you know that’s something we’ll ask you know what type of exercise are you doing how much how often etc.. And a lot of people with joint pain they’re not doing anything. They’re more sedentary. But yet they still have miserable joints. And so we ought to tell the story about my wife about almost five years ago to the day I remember because it was around it was around the first of the year of 2015 almost five years ago my wife woke up one day and she had joint pain everywhere her ankles hurt her knees hurt her elbows hurt and her wrist her and she had trouble putting on her jewelry and I thought What the heck is this. It was very freaky. And so I said hey what do you think this is. And you say well I don’t know it could be X Y Z. So that’s when we ran the bloodwork and confirmed that it was Mycoplasma and per your recommendation we had started on cat’s claw and a strike list to really really good herbs that you and I love and enjoy for many reasons. But there is a sort of an antimicrobial antiviral component to those herbs. And then I mean it maybe took like a week or two and then the joint pain was perfectly gone and it hasn’t bothered her ever since. So it could have been a move or let’s see she would have been pregnant at the time with our first born she wasn’t born yet so she would’ve still been pregnant. Maybe it was something a pregnancy change you know there was some type of stress all of a sudden that allowed this Mycoplasma to thrive and then and then take her down.
Dr. Justin Marchegiani: Yeah. What uses immune support and those significantly help bring down the inflammation from knocking down the infection. So that’s an important one the infections I think are just very very easily missed and we want to make sure that we are on top of that.
Evan Brand: Let me mention prevotella it too because we can’t skip. You have a tell us so prevotella. This is something that Justin and I both tests on the stool panel and we’ve seen time and time and time again the link and just look in pub med for yourself type in prevotella RA and you’ll find that about 75 percent of patients with rheumatoid arthritis have a prevotella infection. And if you get rid of that prevotella the joint pain magically goes away. Now we’re still going to be doing diet and all that actually did a podcast with a client of mine on psoriatic arthritis. She had terrible pain she would cry every morning when she would put her pants on because of the pain and with the help of an autoimmune protocol and addressing got infections her pain went from an eight or nine out of ten to one so wrecked. The good news is you can reverse this stuff but the problem is your doctor is not going to tell you about stuff we’re speaking about today. So these people just end up crippled and it’s really sad because you’ll see a woman that’s not that old but yes she could be using a cane or some sort of other apparatus she’s limping and she’s you know the lady is hurting but she’s never going to get this type of information which is just sad.
Dr. Justin Marchegiani: Exactly. So in general with the joint issues and infections prevotella for instance also club CL is associated with Ankylosing Spondylitis or AS which is an autoimmune issue that affects the spine and will create arthritic like symptoms in the lower spine and the secret iliac joint so enclosing spine the lightest is a big one.
Evan Brand: Proteus doesn’t doesn’t Proteus do something as well I feel like we have we’ve had some education on Protease being linked to something or another autoimmune wise but I can’t.
Dr. Justin Marchegiani: Yeah there’s definitely some autoimmune implications again when you have various infections the major mechanism is going to be gut permeability and the gut permeability is going to increase your immune system and then of course those genetic predisposition to some of these conditions manifesting. So we always look at gut permeability and of course the big things are going to be gluten is going to be one of the bigger ones casein more casein is the major protein in dairy you’re going to have less of it and butter and ghee you’ll have more of it and cheese in and milk inside. So casein can be a big one of course roundup or glyphosate could increase gut permeability. Any foods that you’re going to be very allergenic to the increase gut permeability will increase your chance of an autoimmune attack. And again typically with the wear and tear you’re going to see those things happen unilaterally. Sorry you’re going to see those things happen. More unilaterally typically the wear and tear stuff. And then you’ll see the autoimmune stuff happen more bilaterally because the autoimmune is more systemic. Right. The immune cells aren’t going to just attack one knee over the other. They typically attack both where the wear and tear stuff the osteoarthritis tend to be more unilateral one side versus both. Typically unless there’s a unique wear and tear thing that you’re doing. That’s half that’s affecting it equally. Most people tend to have one knee done before the hip or you know typically they’re not getting both knees are in the same terrible position. So usually unilateral is going to be the osteoarthritis bilateral is going to be more autoimmune of your bilateral issues swelling in the joints you’re seeing a lot of nodes and bumps in the joints. Typically that’s going to be an autoimmune thing and we can always do some of the conventional markers to test it. And it’s nice because when we treat patients and we support them we’re not treating the disease we’re just treating the gut permeability and the inflammation and getting to the root underlying factors. A lot of these markers can go negative again. I’ve seen ANA and CRP and all these markers come down because we’re getting to the root cause of the inflammation.
Evan Brand: Yes. Well said also stomach acid. I think we should give a brief mention to stomach acid. We talked about some of the infections. Let’s just say you have a bacterial overgrowth that’s causing reduced digestive fire. So now you don’t have enough stomach acid or maybe you were doing a proton pump inhibitor you and I could easily paint the picture of the link between using acid blocking medications either over-the-counter or prescription acid blockers and how that would lead to downstream joint pain or other issues. Because now the foods that are rotting in future fighting in the gut feeding the bacterial overgrowth would then create more permeability create more inflammation. So you could [INAUDIBLE] What’s the other one there’s another one? Prilosec you could take those and you could cause joint pain very easily by taking those and people don’t have a clue and also I need to just restate what you already said so people make sure this is clear. You mentioned glyphosate. Here’s the problem. There’s still tons of people. Vast majority of Americans and other people in the world in the developed world eating conventional food. Conventional foods should be titled chemical when you go to the grocery and you see apples and it’s conventional and then you see organic apples it’s not just some special fancy food, people think like I’ve had this debate with people that oh organics no better it’s like OK look all food was organic 100 years ago.
Dr. Justin Marchegiani: So it’s not even that just in the 50s.
Evan Brand: Yeah. Before glyphosate I mean my grandparents they were eating organic food and they were eating grass fed beef and it wasn’t a special label. So you got to know what you’re eating. It’s destroying your joints if you’re eating a regular Apple. That’s it’s almost doing more harm than good to eat non organic fruit.
Dr. Justin Marchegiani: Yeah I had a lady in her 70s tell me that organics a fad and this and that. OK. So walk me through your thinking so was it a fad up until the early 1950s or even late 50s when you were eating organic. She’s like I wasn’t an organic in the 50s and like you realize that that’s all there was because we didn’t have all of the pesticides and the various chemicals till post-World War Two were a lot of the various pesticides were kind of byproducts of of the technology from the war and then we would we use these into the farming and we started applying them into the farming industry. So yeah everything was generally speaking was organic up until late 40s early 50s. So yeah that’s all you had access to. And it’s like Oh people don’t be able didn’t wrap their heads around that because they’d ever label the food back then but it really hit a lot of that criteria. People are kind of a little bit you know they don’t have that level of awareness to know how that came about what the timeline was like.
Evan Brand: It’s a massive change that has happened in our food supply that many people just turn a blind eye to. I read an article the other day which is pretty scary about the world of pollinators and the fact that all these insecticide chemicals in the last 20 to 30 years the world has become like 50 times more toxic. There was some crazy number two to pollinators and I saw this other article this scientific american put out that you stay on is.
Dr. Justin Marchegiani: Are you referring to bees.
Evan Brand: Yes bees and butterflies that for pollinators in general that the planet or at least America has become like 50 times more toxic in the last twenty five years. I think that was the number. And then just over the weekend I saw an article from scientific american talking about the amount of birds that have been lost. They said it was. They call it the silent extinction of birds. And since 1970 we’ve lost over 30 percent of all birds in America. Now some are doing better like Raptors. You know we’ve put in protection for raptors so you know your hawks and bald eagles and all that are making a quite good recovery since we’re not using DDT and other things that destroyed them. But in terms of your small birds your songbirds they’re dying out and disappearing because of our use of agricultural chemicals which are killing the insects and messing up the food chain. So basically the birds are just starving and disappearing and the populations aren’t sustainable because of all the bugs are dead because of all the chemicals. So we’re extinct thing ourselves but we’re extinct and everything else too. So just think about when you’re paying the extra one dollar to get organic strawberries versus conventional strawberries which have an average of 22 different chemicals in them. You’re helping yourself but you’re helping everything else too. So if you care about the planet that you’re going to leave for your kids do organic. Even if you don’t care about yourself hopefully care about your kids and you can do organic to protect their future.
Dr. Justin Marchegiani: Yeah I mean there’s a lot of environmental causes out there and you know some are like you know are they true are they not. But you have a direct control over buying food that we know has chemicals used to grow them and those chemicals affect animals and can get into the groundwater. We know that directly. So you just don’t buy those foods then you’re having a positive impact on a lot of those chemicals getting into the water supply and affecting animals and people that drink that water. So that’s the easiest first thing you can do is just buy healthier quality food that’s your best impact on the environment. And then you know grass fed organic meat because you’re going to have less less junk produced by the animals when they’re eating corn and ingrates. So that’s gonna be huge impact now.
Evan Brand: Good. I just want to say one thing about the meats too. So we you know I love getting on this rant about food quality and getting away from chemicals but remember how this can tie back into joint pain is the fact that if you’re eating quote conventional meats those meats are going to have antibiotics in them. Those antibiotics in the food supply to kill the good bacteria and then you get bacterial overgrowth like the Klebsiella and then you end up with Hashimoto’s or some other autoimmune condition because of the meat. So make sure you know hey my joint pain could be due to me eating a Hardee’s or other fast food burger. It could be directly correlated.
Dr. Justin Marchegiani: 100 percent and also the fact that we know any joint issue there’s and has to be in the environment. Excess inflammation in your body. Right. Because inflammation is what accelerates the breakdown. And then healthy anti inflammatory hormones or nutrients is what accelerates the build up. So when you start to break down faster than you’re building up inflammation has to be part of that. So that omega 3 to omega 6 ratio is gonna be a big component. So animals that aren’t fed grass fed nutrients they’re going to have more mega six lots of refined vegetable oils are going to have more mega six not having good quality fish or a mega three supplementation or consuming good egg yolks from pasture fed chickens like he’s got a look at that omega 3, omega 6 ratio you want at least a one to one or even a four to one. OK. Meaning four times the omega 3 to 1. I’m sorry four times the omega 6 to 1 Omega 3 is acceptable. Ideally a one to one or a four to one and you can do that by just consuming good quality efficient seafood or good quality Omega 3 supplement as well. And then just make sure the animals that you’re consuming are going to have Pastor fed kind of sources so grass fed cows chickens that are kind of free range and pasture fed where they can eat bugs and stocks they’ll be able to produce a much higher quality yolk. So that’s got to be a big component with that.
Evan Brand: Let’s go back to lab testing just for a minute because I only talked about the stool. Let’s spend a few minutes on labs and then let’s talk about some herbs or other nutrients that can be used to help joint issues.
Dr. Justin Marchegiani: Absolutely. So with certain nutrients there of course collagen’s gonna be number one. Typically how you’re [inaudible] is going to be part of the collagen byproduct. OK you can also do things like magnesium and calcium will still be helpful. Vitamin K is really important because that’s going to help get that calcium into the bone. So we need to make sure that we have good vitamin K ideally K2 which is in a come from quality animal product. So if we can consume things like egg yolks and grass fed butter and ghee that’s going to be essential if we have problems with butter or ghee then we probably want to look at making sure we supplement that or get it from a good quality fermented called liver oils we got to keep an eye on if we can get good quality butter again there you’re probably going to be OK with your K2. If not we’ll have to supplement that. I would also say just making sure you have a good multi to get the all those extra other minerals that we need like selenium and zinc and calcium magnesium are going to be typically separate. And then of course you’re going to have copper and of course your fat soluble vitamins are going to be very important. We’ve got to make sure those are all present your vitamin K2 etc. As a female, especially as you get older lower levels of progesterone and estrogen before menopause age are going to be a detriment because progesterone helped stimulate osteoblast which helped build up the bone. Estrogen help stimulate osteo class so if we start getting more estrogen dominant we’re more likely to be breaking down the bones. And then as you go menopausal you want some level of hormone support to help support bone health because going to super low that’s to prevent your body from building healthy bones. So making sure hormones are dialed in and making sure we’re testing the hormones is gonna be ideal. And then of course resistance training isn’t to be helpful right. We we grow our body adapts by demand. This was called the piezoelectric effect where you can stimulate bone building through stimulation whether it’s resistance training or whole body vibration or using bands or doing some kind of an interval on an elliptical or a rowing device something like that can be very helpful to stimulate healthy bone growth. So we need that as well. And then I would say last component is making sure your joints are pliable making sure your muscles are pliable your muscles are shock absorbers for your cartilage and for your bone. So if we have excess of wear and tear because your muscles are your natural shock absorbers aren’t working. That’s really important so you know you can get your muscles turned back on with you apply. Can you see logical techniques various soft tissue techniques like my old fashioned released or air tea or grassed in or like muscle spindle techniques or we can even use bio electric devices like like the newby for instance which really helped stimulate the muscles so they can work again they help reduce inflammation all these things are helpful. Are you seeing a good chiropractor that can test your muscles to see which ones are on or off can be helpful. It’s a lot of people that have a joint issue at the knee may have issues at the ankle or the hip above. So a lot of times were joint issues manifest. The problem is usually above and below the joint and that gets ignored and you see a physical therapist and they only want to work on the knee. They don’t go upstream or downstream. So kind of like in functional medicine we are always looking upstream. If you’re working with a good PT or a Chiro you want to make sure you’re looking upstream from just the knee hip and ankle you got to look at both of those places if you have an issue at the hip you want to look downstream at knee and ankle and upstream at the back. So you’ve got to look at this holistically.
Evan Brand: Yep. Well said a lot of great points. Other supplements too. We’d like to use curcumin, turmeric extracts limited human.
Dr. Justin Marchegiani: CBD oils excellent for extreme pain some people do better with a little bit of THC in there but I try to do mostly CBD initially and then we can topically rub CBD on the joints as well which can be helpful. Systemic enzymes with [inaudible] in between meals away from food. Help with inflammation. Go ahead I got.
Evan Brand: Yeah. No you’re fine. You’re excited. I love it. Digestive enzymes too. You know we always like to throw in enzymes. We talked about the connection of low HCL bacterial overgrowth joint pain so extra enzymes could be helpful. And then testing. So I want to talk about testing so stool that’s gonna be our first thing. Organic acids we can look at amino acid metabolism and then some of this viral and co infection testing so Mycoplasma Epstein Barr the cytomegalovirus that would be something you would find on a blood panel. So you may need to get blood urine and stool to really get to the bottom of your joint pain.
Dr. Justin Marchegiani: 100 percent. So also there’s biologic devices like I mentioned called the newbie put some links below for some of these things. All the nutrition is really helpful. Autoimmune gut stuff’s really helpful. And then I would say if you’re in the stage you definitely want to be working at all these things together and you may even want to be adding in some stem cells if you’re trying to avoid surgery you probably want to be incorporating some stem cell therapy along with it. I’ve seen that work miracles and significantly and help improve patients ability to heal. You can also do prolotherapy which is like an injection of like amenos or a dextrose sugar which kind of creates an inflammatory response which then stimulates the immune system to help kind of heal that area. That those worked too, I tend to favor the stem cells over that just because of what I’ve seen on the recovery side. So let’s kind of give you a couple of really good options. But the soft tissue component I find is what most people chiropractors and physical therapists they ignore. They ignore the pliability component and they don’t get the soft tissue working or pliable again. So think of your muscles as like shock absorbers. It can either be a soft tenderloin kind of spongy spring or it can be beef jerky beef jerky. It’s not going to provide any level of cushioning it’s just tear. We want the soft springy kind of tenderloin for your muscles so kind of think about that. You want to train and get therapies that help provide make your muscles into that softer sponge.
Evan Brand: Yeah I’ve seen insane results with stem cells I haven’t used them but I’ve had clients that have used them and we’ve seen countless stories of athletes you know professional athletes where they were going to end up getting like rotator cuff surgery they do stem cells instead and they’re fine. Yeah.
Dr. Justin Marchegiani: At some point I will do some level of preventative therapy where I just go out of the country and just get stem cells injected everywhere in my body just to promote healthy living and healthy tissue recovery. Not yet. I’m too I’m still in great shape healthwise and an age wise I’ll probably but some somewhere down the road maybe the next decade I’m thinking about I just for preventative.
Evan Brand: What you have to go out of the US?
Dr. Justin Marchegiani: There are some places in the US that some doctors in Vegas or some up in the north west as well I note Tony Robbins talked about going down to Argentina. I think it’s Peru. Or Panama. Panama’s that is the spot. A lot of them are going.
Evan Brand: OK I wonder why.
Dr. Justin Marchegiani: Is it cheaper or they’re better at it. I think a lot of it has to do with the regulations. So a lot of times they’ll do cord stem cells. So which is good. You know it’s not you know you’re not taking any any babies that are aborted or any things they’re using cord stem cells and that’s where they’re extracting it from. So that’s you know a greater supply of that because everyone every baby that comes out has that cord. I think we even donated our cords for for stem cell purposes for burn victims and such. So there is that right. So you can extract those stem cells from that and then they inject it making do an I.V. where they can do localize. So I know people made you both those those are helpful places I know in the U.S. some some people are starting to do it. There’s a couple places I saw in Dallas in the northwest. Vegas is a good podcast with Mel Gibson on the Joe Rogan podcast and he talks about stem cells and his dad’s shoulder injury got significantly better and Joe talks about stem cells on that one. That’s a good little podcast if you want to look at the stem cells.
Evan Brand: Yeah I don’t know enough about it to do a whole podcast on it but I am fascinated by and I have heard good things about it.
Dr. Justin Marchegiani: Exactly. So I think we hit the stem cells we hit nutritional component we hit collagen we hit the autoimmune we hit the gut component. A lot of these things you’re going to need a good functional medicine doctor to do a workup on to get these things better or to kind of line everything up and create a priority list. I’ve had some patients though honest to god people that have had destructive. Arthritis for decades and we just cut like grains out and it was like magic. I know sometimes sometimes one issue could be everything and sometimes it’s a combination of everything combined and you don’t know. So we kind of have our algorithm and how we work through things. We do a really good history. We kind of prioritize what’s going to be the best bang for our buck. We have the foundational things we start with diet and lifestyle and we kind of work off with testing and assessment and we kind of start from there and sometimes things we hit a homerun like you know we’re at the plate we’re calling our shot and we hit a homerun right away and sometimes we have to get a lot of singles and there is that scoring.
Evan Brand: Yeah well said It’s crazy just pulling grains out how effective that could be it can be good to be true yeah and it’s not always like you said sometimes you’ve got enough.
Dr. Justin Marchegiani: Some patients are not so impatient that it’s a long steady road of doing a lot of different things like we’re getting a lot of singles to get some runs. Sometimes we hit a home run and we feel like a million bucks doing it. So you know you kind of have it. It’s tough because if you’re an individual and you had one experience of this being it you tend to associate that that’s going to be the same thing for everyone. And because we work with so many patients we know it’s not the case. We’re a little bit more humble because we failed so many times they had to get more creative to get these things working.
Evan Brand: Yeah well said,like you said you may get 5 percent with the diet and 5 percent by fixing the guy and then all of a sudden you knock out some of these Michael plasma load and boom you’ve got 65 percent better in a month and then.
Dr. Justin Marchegiani: And then the person sleeping better and they’re getting an extra hour or two of sleep and then they’re cutting out the alcohol and then maybe they’re like they’re digesting their proteins better and they’re having regular BMI and it’s like oh wait a minute. Like five percent here two percent they’re 10 percent there and then a year later they’re 60 70 80 90 percent better.
Evan Brand: Yeah. So it’s a miracle I mean the body does have a wonderful capability to heal itself if you give it the right nutrients the right tools and you remove the roadblocks. That’s a lot of what we do is find the roadblocks because you can’t fix what you can’t find. So the hardest part is finding it getting the workup done to where you find what are you up against because you could go take every joint supplement known to man at the grocery store not get any better because you didn’t find what you’re up against so now you’re building up that supplement graveyard.
Dr. Justin Marchegiani: One hundred percent now in general there are conventional drugs that are typically in heavy use like bone IVA or a lot of these supplements that are going to stimulate bone growth. The problem is a lot of the bone growth is kind of haphazard. It’s not as good quality bone. So I typically don’t recommend a lot of the medications to Bill back the bone because it’s not going to really be creating good healthy strong bone number one and then there’s a lot of medications that are like anti inflammatory as or even steroids which may not actually fix the problem and have their own whole whole host of side effects with gut issues or liver issues or even actually breaking down the bone and creating more inflammation especially with steroids and may set out your bones even faster and even drive blood sugar issues too so you’ve got to have to weigh out the options from a medical standpoint is also methotrexate which you’re like which is used for immune issues but it’s actually a chemotherapy. So there’s other medications that can have a lot of side effects with it. I think it’s plaque on X, plaque well that’s going to be used a lot of times for inflammation in the joints as well as blood issues too. So I’ve seen that help to buy again their side effects in a lot of it’s not getting to the root underlying issue. We want to get to the root issues. We want to have a good functional medicine kind of work up and how we get to the bottom of it and of course as other stressors like heavy metals that could be an issue and then you know Even with mold and mycotoxins that can create a stress on your body too. So it’s not the first thing I look at when we have joint issues but it’s kind of in our algorithm and it’s there and we eventually get to it. But we try to prioritize based on symptoms based on history and based on the timeline of how we got here.
Evan Brand: Yeah. And also you may find that you have a relapse after a big stress. So that would want to that would clue you in to maybe a viral component. So like if you just had a baby and then you got joint pain or you had a death in the family and you have joint pain or you had a horse and you had joint pain for sure. Yeah. So you’ve got to kind of peel back the layers of it. Were there any questions that you wanted to hit.
Dr. Justin Marchegiani: Oh yeah. Let’s take a look at questions here and try to engage. All right cool. So if you guys are listening at home and you are enjoying the podcast give us a thumbs up right now. Give us a share we appreciate it. We also love getting reviews JustInHealth.com/iTunes, EvanBrand.com/iTunes for review we appreciate it. Let’s dive three questions here one by one is a repetitive question or it’s not as relevant for the crowd. We’ll probably just skip it. I have hip pain every three years what are my options. All the things we just mentioned. How to handle glutamate. So a lot of collagen’s very high end gluten mean which can convert to glutamate. So I work on just getting the inflammation under control first before you do that. If you can do collagen that’s great. May want to try a Marine base collagen or a fish based collagen see if you can deal with that over the bovine source if you are having issues.
Evan Brand: Yeah. Good recommendation.
Dr. Justin Marchegiani: There if you want to chime in. Evan just just chime in. I’ll try to get to that the more the more meaty questions you’re doing.
Evan Brand: No no you’re doing good. I think the advice on the glutamate issue is good and you know look at the gut because my gosh most people shouldn’t react to glutamate glutamate type conversion issues like that. So there’s something else underlying that’s causing that.
Dr. Justin Marchegiani: Yeah. And if you’re having issues that would just say focus on reducing inflammation more first with digestion, gut, anti inflammatory herbs all the diet and lifestyle things and then come back to it in a month or two if we’re having issues and work into it. Start with an eighth of a teaspoon and then just kind of nudge your way up.
Evan Brand: Yeah. Here’s a question from Riley how beneficial is physical therapy for joint pain arthritis. My mom has chronic arthritis in her lower back and hips. I mean I’ve been to physiotherapy before I got minimally better with it because it wasn’t a root cause I would say if your mom is eating grain step one get her off grains. Step two Look at her gut. Is she moving? Is she sedentary. Yeah get her you know some good ol maggots may help some tumor extract may help some Boswell yeah those type things.
Dr. Justin Marchegiani: Not all chiropractors or physio hours are root cause based. So like the average chiropractor hey there’s back issues. I’m going to just gesture back where the average physio there’s knee issues I’m going to just exercise the knee. That’s the wrong way to do it. You may still do that but you may be looking above and below. So what I was doing more chiropractic therapies I would test the joints I would see how the muscle integrity at each joint was above and below before I provided any therapy because I want to make sure all the muscles in the kinetic chain are working. And then if you’re going to move the joints well that’s fine. But you also want to make sure the soft tissue in the muscles are activated and if you’re going to exercise a joint as a physio, well you want to make sure the muscles are more pliable because imagine having a knot in a string if exercising that muscle is the equivalent of pulling that string tighter will guess what happens when it’s not there the knot gets tighter. So you really want to undo the knots in my opinion professionally before you do a lot of exercise. So that’s where the soft tissue therapies are really important and that’s where making sure the joints are moving. So there’s good Chiros and bad Chiros is good physio and there’s bad physio. My biggest thing is make sure whoever you’re seeing is addressing the soft tissue and make sure they’re looking at the joints above and below. And if they can do some muscle testing that’s great. That way you can objectively see and feel the muscles in and around that area getting stronger which is great.
Evan Brand: Here’s a question here. I like this one going off of Evan. What would come first hypochondria or dysbiosis slash bacterial infection question. I think it could go either way right.
Dr. Justin Marchegiani: So it can. But I typically find and this is just generally speaking there’s exceptions to every rule. Is there some level of stress that happens that stress compounds and activates the sympathetic nervous system then you have less stomach acid and enzymes and then it’s more it’s greater risk now for bacteria and critters to kind of come in there. It could also be something like you took an antibiotic and that drove rebound bacterial overgrowth and then that started driving all of hydrochloric acid or enzymes so it could go both ways. And it’s all going to be about the history.
Evan Brand: Exactly yeah. So I was going to say in the case of bacterial overgrowth happening before stomach acid there’s gonna be an intervention of some sort like antibiotics.
Dr. Justin Marchegiani: Exactly. Yep. Exactly. Wonderful girl and swelling of legs and feet sign of inflammation. It comes from joint problems after operation for artificial hip recovery period five months. What do you think. OK. So in general yeah you’ve got to just do all the things that I mentioned. When people have these kind of they already have their joint replaced you still want to do all the same things because just because you had your joint replaced the kinetic chain, the kinetic chain of imbalance like let’s say your hips replaced right. Well are the muscles working good in your glutes are they muscles working good in your knees in your back. So you just because you fixed the joint that those muscles are actually still not fixed and they actually may be worse because now you cut open to the body. And now there could be subclinical inflammation from just the surgery and the muscles could be more inflamed now because of all the surgery so you need even more work on the soft tissue component and the kinetic chain. All right let’s dive in a little bit deeper the more questions not really related here as to heavy metal detox supplements not related to this podcast sorry. Where to get stem cells. Panama is a good place or some places in Dallas and the north west. Heavy metal supports not going to go there. See here. Yep. We did a podcast on that. A friend is allergic glutamate and protein and lactate and fresh fruit and vegetables don’t remember which one. OK so this is really important. So I’ve seen people who are very allergic. I’ll just give you one person to look up. Mackenzie Petersen. Mackenzie Petersen has a significant autoimmune issue I think in her early 20s. She had both knees and hips replaced in her early 20s and she had significant autoimmunity and what she needed to actually help decrease her autoimmunity was full carnivore because she was actually very sensitive to even the lecterns in fruits and vegetables so she needed to be grain free and autoimmune. Right. But she also needed full carnivore on top of that meaning only high quality meats and fats. And that really made a huge difference in her life.
Evan Brand: Yep. Her name’s McKayla.
Dr. Justin Marchegiani: I’m sorry. Yeah. MCKAYLA Peterson Yeah that’s Jordan Peterson’s daughter correct.
Evan Brand: Question what do you think about the highly erotic acid joint supplements. I mean it could be a part of the puzzle but I wouldn’t put too much faith in it just that by itself.
Dr. Justin Marchegiani: You’ll get some of that I’m pretty sure in collagen for sure you’ll get some holographic assets from the collagen for sure yeah. And then also Vitamin C is really important for building up the collagen do Vitamin C is important cool factor so you can get vitamin C separate and then also you can get it from the collagen as well or you can combine it with the collagen as well that way your body can make collagen as well as have the collagen building blocks. So you got to combine the two.
Evan Brand: Yeah. Perfect. Well that was all the relevant question so let’s wrap this thing up if you’re ready. If you’re suffering there’s probably a reason. So if you want to reach out to Justin we do testing around the world. So no matter where you are we can help you with this issue if you want to reach out Justin’s Web sites. JustInHealth.com and my website is EvanBrand.com. And either way, whether it’s one of us or somebody you’re already working with we just hope that they’re getting to the root cause and helping you because there are solutions and there’s so many people that you know we’re talking about an issue that affects your quality of life. You know people that want to go hiking and biking and go to national parks and be mobile. You know I think we get focused on the health issue but it’s important to look back at what are we trying to help people achieve. We’re trying to help people achieve playing with the kids you know the grandparents that have grandkids and they want to be mobile and active with the grandkids and keep up with them you can’t do that if your joints hurt. So this is an important topic that affects how you navigate through your life.
Dr. Justin Marchegiani: Yeah exactly. I’ll give a shout out to my friend and colleague Garrett saw Peter over at Neu fit in Austin. So NEU.FIT is the website NEU.FIT put the link below. He does a lot of this work as well he has his own bioelectric device that I have different versions of that really work well with stimulating healing helping activate the muscle helping to improve blood flow and getting the muscles to work really well in that kinetic chain. Muscles work like dominoes if you’re missing one of those dominos in the middle that chain doesn’t work appropriately so Gareth’s a great person to reach out to will put his links down below and make sure you let him know that we shot you over here for this podcast. Appreciate that. Anything else you want to mention having I think people are liking this. Sharing is caring we appreciate it. Thumbs up that give us a little boost on the YouTube algorithm. And if anyone wants to reach out to us more on the metabolic or functional Madison medicine site click down below and you can schedule online.
Evan Brand: I think we covered it all. I’m sure we could write about something else but I think we did a great job of looking at the nutrition the gut infections viruses testing herbs and nutrients to briefly hit the medication. So now I think there’s plenty plenty good to wrap up.
Dr. Justin Marchegiani: I’ll do a little summary video on my side here. People wanting to get the condensed version. But if you guys appreciate it put your comments below let us know what you guys have done to help improve your joy and your overall inflammation in your skeletal system. We appreciate it.
Evan Brand: Well, take good care we’ll chat next week.
Dr. Justin Marchegiani: Evan you have a good day man. You take care.
Evan Brand: Bye now. See you later. Bye bye.
Evan Brand – Joint Pain and Bone Health – Podcast #141
Dr. Justin Marchegiani and Evan Brand dive into a discussion about joint pain. Listen to them as they talk about wear and tear issues, lack of nutrition and autoimmune conditions which are all possible causes of joint pain.
Discover how stomach acid, stress and hormones are linked to joint pain and learn some natural solutions and beneficial supplements for joint recovery.
In this episode, we will cover:
00:35 Pathophysiology Regarding Joint Issues
05:39 Stomach Acid with Age and Joint Pain
13:46 Adrenal Issues, Infections and Joint Pain.
19:48 Topical Alternatives and Exercise
32:53 Pharma and Media Over Chiropractic Physiology
Dr. Justin Marchegiani: And we are live on Facebook and YouTube. People that are on Facebook, feel free. We’ll put a link below to the live back and forth conversation – the uhh– YouTube so you can actually see Evan’s pretty face. And, let’s begin Evan. How are you doing, man?
Evan Brand: Pretty good. Good morning.
Dr. Justin Marchegiani: Good morning to you.
Evan Brand: Yes, sir. So, you mentioned joint pain uhh– or I mentioned joint pain. You said, “Okay. Let’s hit it.” This is a fun one. We could go many, many directions. Where do you want to start with joint pain?
Dr. Justin Marchegiani: Yeah. So, let’s kind’a talk about the kind of the pathophysiology regarding joint issues. So, the couple underlying causes, right? Joint issues, typically, can be caused by a wear and tear, and that wear and tear can be excess of exercise-induced. It can be excessive or not enough building blocks to help your body heal and recover, so you’re providing a stimulus. That stimulus is exercise. Exercise causes your body to break down, and then your body then shifts at night and goes anabolic to heal back up. And if you don’t have uhh– building blocks on board: nutrition, protein, amino acids, Collagen, you’re not gonna have that piece building back up as much. Uhh – number three is going to be chemical, so a lot of joint issues these days are gonna be autoimmune in nature. So, the more we have gluten in our diet, the more we have inflammation in our diet. We can actually start breaking down our tissue via autoimmune mechanisms. It has a couple different ways that our joints can be affected. Again, wear and tear, lack of nutrition, as well as, number three is gonna be an autoimmune that’s affecting how the bodies attacking itself and then breaking itself down, not via stress, like exercise stress, but internal chemical immune stress.
Evan Brand: So what do you– what’s your– what’s your coment when someone says, “Oh, I’m just getting old, that’s why my joints hurt.” What do you say to that?
Dr. Justin Marchegiani: Well, it’s a cup-out, right? People say that they’re getting old and that’s the reason why their issues, because what does age do? Age magnifies bad habits, okay? Now obviously, at some point, a 90-year old’s not gonna be the same as a 20-years old, but there are lots of people who have gotten into their 50’s, and 60’s, and 70’s. You know if they were unhealthy in their 30’s and 40’s, actually, they become healthier and healthier. There’s lots of examples of that. Jack Lalanne for one. There’s lots of healthy people that are– have really taken care of themselves and pushed themselves up to the next level that have made the big difference, but age magnifies bad habits. Also, all stress summates and accumulates, right? This is called allostatic load. So, we have, like, a metaphorical stress bucket, right? This is my little coffee mug. All your little stress balls go into that bucket, right? Those stress balls could be gluten. They could be poor sleep. They could be work stress. They could be uhhmm– low dreanal levels, hypothyroidism, leaky gut, low stomach acid, malabsorption – all these things could be present, regarding kind of your allostatic load. And when these little stress balls overflow, this is where your body starts to break down and symptoms occur. So, the goal is, we’re trying to, number one, make our stress bucket bigger, right? We do that after healthy diet and lifestyle. And then we also remove the stressors as well. Removing the stressors, warding the bad foods, having the healthy lifestyle and diet habits. Those are gonna be really important to start with. What do you think?
Evan Brand: Yeah, well– and we know that stomach acid, which we’ve loved talking about, stomach acid, drops with age, so it could say…
Dr. Justin Marchegiani: [inaudible]
Evan Brand: You could say that, yes, age, technically, could lead to joint pain if it’s gonna leave the malabsorption issues. So, we do have to supplement with HCL. I think that is an important part of joint pain. And preventing that, as you get older, you gotta make sure you’re actually getting your amino acids, and your glycine, and your cysteine, and your proline, and all these other things that you get from food. And specially, if you’re doing like a bone broth, I think that could be a good strategy, too, if you’re aging; even if you’re not aging. I drink bone broth, in some shape or form, on a weekly basis. So you’ve gotta make sure you’re getting the raw materials ‘cause no matter how good the diet is, if you can’t absorb anything, it’s just a waste of money. And, then obviously, there’s other issues too, I mean, we have mentioned infections for example. I mean, you and I discussed this a couple of years ago when my wife was having migraine and joint pain throughout her wrist and ankles and elbows and all that, and she had mycoplasma pneumonia infection.
Dr. Justin Marchegiani: We found that. We found that on a comprehensive infection panel, we found mycoplasma. Mycoplasma’s a really big driver, potentially of arthritic issues or dermato-arthritis. It can affect, you know, the immune system, and it can also go after the joints. And those antibiotics, like Minocycline, Nutricap, but we use some herbal formula. We use Rishi, Cat’s Claw and a couple of other herbal formula to help knock it out. And with then a month or two, she was much better with the joint issue, wasn’t she?
Evan Brand: Oh, yeah. I mean…
Dr. Justin Marchegiani: Yeah.
Evan Brand: …she was waking up. For example, she was 25 at the time. She was waking up just for folks listening, and putting on her bracelet, or putting on a watch…
Dr. Justin Marchegiani: [inaudible]
Evan Brand: …was causing pretty severe pain. Now, luckily, we look in– we look for lime, and we did not find lime. So, that’s good but that could be tighten with that, because sometimes, you’re gonna get a lime infection, and you’re gonna get the mycoplasma or other issues. So, you’ve gotta rule in or rule out infections, too? Now that’s something. To me, it’s– I wouldn’t say it’s rare, but it’s less common than other issues like malabsorption, parasite issues, bacterial problems that are gonna cause more joint pain.
Dr. Justin Marchegiani: Totally. I’m adding it right here live ‘cause we are just, like, functional medicine improv so– and everyone know the topic is joint pain of today, in case that people came in late. So we’re talking about joint pain. So, I agree, right? You mentioned the stomach acid thing. Dr. Jonathan Wrights talked about these too. Stomach acid goes down as you age. Now again, stress also affects stomach acid, right? Diet’s gonna affect stomach acid. The more inflammatory your food is, the more that’s gonna affect how your body makes stomach acid. When you have low stomach acid, you have low enzymes. Now, people forget, to make healthy bones, what do you need? Half your bones. What? Half your bone’s protein, the other half of your bone’s gonna be about 13 different minerals. The most common that everyone knows is gonna be calcium, right? But again, protein’s half of that bone, so we can’t breakdown healthy protein sources, we’re really gonna have a hard time producing healthy bone and keeping ourselves in a kind of equilibrium regarding our calcium deposit levels, which is uhh- mineral levels in the bone. So, healthy protein’s really important. The other half’s gonna be minerals. This is where the mineral’s really important. Now with the minerals, we also need healthy stomach acid levels because we need ionized minerals to happen. We ionized minerals are nothing more than Hydrochloric acid hitting that mineral and then ionize it, which means it can kind of uhhmm– infiltrate or kind of be uhhmm– kind of go into a soluble state in the blood. So it can be transferred, and absorbed, and utilized by the body. If it’s no ionized, it’s just kind of like a rock, you gotta break that rock down so it can be utilized in its constituents. So hydrochloric acid’s important for the protein aspect of the bone, but it’s also important for the ionization of those minerals that make up the other half. And again, the most common ones gonna be Calcium, but there are other ones there as well.
Evan Brand: So, let’s chat about the conventional approach to joint pain. Most of the time, if you have joint pain, let’s say you go into the doctor’s office, or for example, like me when I was working at UPS in College, I hurt my back. I went to their doctor, and they said, “Oh! Here’s a strong NSAID and here’s a muscle relaxer. Good luck.” And this is what’s gonna happen. You’re gonna get Tylenol. You’re gonna get some type of over-the-counter medication, that’s got, potentially, some very serious side effects. I mean, there’s what? You and discussed this number before: 18, 000 people dying a year from just standard dose of– Is it Aspirin? Was it Advil? Which one was it?
Dr. Justin Marchegiani: I think it’s Prolifen. Yeah. That’s new in general medicine 1999. Well, fed out 19,900 die a year of Ibuprofen taken properly.
Evan Brand: So, we’ve got kidney, we’ve got liver damage that could occur from all of this. And once again, it’s not gonna address the root cause so then if you get into the more joint pain issue, you could potentially get into pain killers. I’ve had many female clients that, whether it was autoimmune in nature or not, they were killing with joint pain, and the doctor ends up putting them on some type of Opioid. I had a…
Dr. Justin Marchegiani: Totally.
Evan Brand: …[inaudible] actually last week, who was on uhh– What’s it called? Hydrocodone. Like 15 milligrams of Hydrocodone, and I’ve got five milligrams after that major triple molar surgery. So, she’s on triple the amount of that. Oh, my Lord!
Dr. Justin Marchegiani: Yeah the conventional modalities for joint issues really aren’t good, so number one, there’s treating the symptoms – so that’s the pain. So, you’re gonna have drugs like your Ibuprofen. You maybe even have more severe drugs, like your Cox-2 inhibitors, like Vioxx, etc. What these do is these affect the cyclooxygenase enzymes, which are enzymes that help with pain – that help convert that pain signal to the brain. But they also help with gut lining, stomach lining, heart issues. So, we don’t have that healthy enzyme, we can’t build healthy heart and healthy gut lining, and then it also create a lot of stress in the liver, and it can even reduce Glutathione levels. So when we’re taking in medications, like an Ibuprofen, for instance, we’re gonna be reducing Glutathione. Now Aspirin tends to be a little– baby Aspirin tends to be a little safer. Much better off using herbs that tend to have a modulatory effect and uhh– essentially, aren’t gonna de– or downregulate, deregulate your detoxification halfways via Glutathione. So that’s kind of one aspect. The next is you have your Corticosteroid medications, so when it becomes more painful, right? Prednisone Corticosteroids, which actually will increase Osteoclastic activity. Little Osteoclast break down the bones; osteoblast build up. So, B for blast equals builder, C for clast is breaking down, right? Think of catabolic. Is C for clast is catabolic. It’s breaking down. So again, those medications, those steroid types of medications are actually gonna make the problem worse. Again, they work rate on the actual symptom in the moments but they’re not gonna be the best for fixing the underlying issue. And then the last– we talked about ane, two, three. This is the third one. As we had medications like Boniva or Fosamax, which will increase Osteoblastic activity. The problem is it turn and does it in a haphazard form, so you get more thickening the bone but you don’t have it in a strengthening kind of tensile alignment. So, you have more bone but the bone is weaker. And it get knows the big issue down in Florida a few years back or [swallowed] these dentists were seeing kind of people’s jawbone’s like rotting; like they were doing dental work and they were going in there to like, you know, address some of the tooth issues beyond the jaw, and it was just– the jaw was just crumbling away with some of these elderly patients that were on these medications. So again, big problems there because the goal wasn’t just to have thicker bones. The goal was to have thicker stronger functional bones that you can actually, you know, put stress on and create a healthy lifestyle by walking, and hiking, and doing all the things that you want in your life.
Evan Brand: That is unbelievable. So, that– those drugs were just destroying people. They were just whittling away.
Dr. Justin Marchegiani: Exactly. Yep, hundred percent.
Evan Brand: Holy smokes.
Dr. Justin Marchegiani: [agrees]
Evan Brand: Now uhhmm– I– we should also mention Vitamin D too, right? Because, we’ve got this connection with Vitamin D, and we’ve got Vitamin K -the interaction there; we’ve got Calcium regulation with that, so you really, really, really, really want to have optimum Vitamin D levels, especially if you’ve had any history of Osteoarthritis. Because, if you’ve got Vitamin D levels that are low, there’s tons of research linking that so you’ve got to have it, I say minimum 60 but you know, we could say up to what? Eighty (80) maybe, in some cases, is okay for Vitamin D?
Dr. Justin Marchegiani: I would say, even up to a hundred if you have an autoimmune issue. I’d say 50 to a hundred, and 50 would be kind of be okay if you don’t have an active autoimmune issue; up to a hundred if you have an active autoimmune issue for sure.
Evan Brand: Okay. And did you want to mention anything about that, like why Vitamin D is so important?
Dr. Justin Marchegiani: Yeah, Vitamin D. What it’s gonna do is it’s going to increase the absorption of Phosphorus and Calcium, which are important building blocks – mineral building blocks for the bone. When pipe[12:12] Vitamin D is higher, what it does is it decreases Phosphorus excretion and it increases Calcium absorption up to 200 percent. So Vitamin D helps– Vitamin D helps Calcium go from the gut into the blood – the bloodstream.
Evan Brand: You know what’s cool?
Dr. Justin Marchegiani: …[crosstalk] blodstream that could make you go around. Go ahead.
Evan Brand: You know, I was gonna say, “You know what’s cool is that the very bottom of the organic acids, the Phosphoric acid number, most of the time if I see that low number 75 on there, if somebody happen to have the [inaudible] doing, like 99 percent of the time; low phosphoric acid on there, correlates with low Vitamin D.”
Dr. Justin Marchegiani: Yeah. [crosstalk] Makes sense.
Evan Brand: [inaudible] …cool.
Dr. Justin Marchegiani: Vitamin D works on Phosphorus absorption and Calcium absorption. That totally makes sense. Now, if we keep on diving into uhhmm– hormones are really important, especially if you’re a female and you’re in that menopausal age, estrogen and progesterone are really important for building healthy bones. Progesterone helps with the Osteoblastic activity, that’s the builders, and helps in– estrogen helps with Osteoclastic activity. C for clastic equals C for catabolically breaking down. We need a healthy bit because if we don’t, if we don’t break down all bone and put new bone back, we don’t have healthy strong bone there. So, there needs to be this balance of– of give and take, push and pull, break down, build up. It’s happening in the body, so we have hormones having major impact on it. So, if you’re female and you’re Estrogen Dominant, or if you’re menopausal female, and then your ovaries aren’t really working as well and you’re relying more on your adrenals and you’re Estrogen Dominant, or your hormones are just low altogether, we need healthy hormones to help build bones as well.
Evan Brand: Got it. So, if you’ve got infections, therefore, you probably got some adrenal problems, you could potentially have some issues on joint pain just based on that.
Dr. Justin Marchegiani: And if you have infection, that will affect malabsorption, leaky gut, and if you have a mycoplasma infection, right, like your wife did, that could create that autoimmune kind of molecular mimicry thing going on that kind of mimics array of rheumatoid arthritis, which is joint pain, which is typically bilateral presentation. It happens on both sides where Osteoarthritis, which is the wear and tear thing we mentioned, that typically happens unilateral, one side or the other, so array both sides of the body – both hips, both knees, where Osteoarthritis is kind of a more wear and tear. We tend to be more unilateral; one side only.
Evan Brand: Uhh– Well said, yeah. And people listen with like a relaxed ear, and told this actually affects you, and then, you’re gonna be listening frantically to this. But, when that hit my wife, I mean, it happened quick. I told you, it was over like a week, like one day she woke up and then boom! There was a joint pain, and it was just intense. So, this– this stuff is real, and it could hit in an unexpected time, and you got to know what root causes can you look for. So, you…
Dr. Justin Marchegiani: Absolutely.
Evan Brand: You were super helpful. You’re like, “Man, look. We’ve got to get this– this test here. It’s byco-infections.” Boom! You were spot on, once again.
Dr. Justin Marchegiani: Yeah, and we called it, man. I was so happy to see that.
Evan Brand: Yeah.
Dr. Justin Marchegiani: So let’s uhhmm– let’s hit on a couple of other questions here, ‘cause I think they’re really pertinent to the conversation. So, a couple of things regarding exercise. Exercise creates a piezoelectric effect, which basically creates a magnet for Calcium attached into the bone. So exercise is helpful, but if you already have Osteoporosis, you got to be careful because it’s a wear and tear thing that’s happening, where you may create more wear from the exercise and not get enough build back up from the Calcium in that piezoelectric effect. So, you got to make sure the hormones and the nutrition and the extra building blocks are there to help that Calcium and those minerals take effect. So, Collagen’s gonna be super important. When there’s Osteoporosis, 60 to 80 grams a day, daily. Uhhmm– Calcium, I mean, if there are female, for sure, it just regularly, typically, we’ll recommend a couple hundred micrograms, like a Calcium malate and a good quality multi. If there’s a bulding block issue, we’ll give some extra Calcium, for sure. Uhhm– we’ll also make sure there’s Vitamin K2 along with that. We’ll also make sure there’s a Magnesium along with that, as well. Strontium’s also good uhhmm – so, those are really important. We’ll modulate estrogen levels and progesterone, but that’s gonna be specific to the patient. And then, after that, uhhmm– natural things to help reduce inflammation. Fish oils gonna be great. You know, up to eight to ten grams a day’s gonna be fine. We just have to make sure it’s high quality fish oil, in a triglyceride form. Then we take some extra antioxidant so we can stabilize the cell membrane. So, we don’t get lipid peroxidation. Lipid peroxidation is, basically, fish oil to polyunsaturated fat. Polyunsaturated fats can go unoxidized very easily, because they have a double bond between the two Carbons. Double bond makes fat more unstable. Whereas, saturated fat has all of the Hydrogens attached to the Carbon in single bonds. So, this is just, you know, Organic Chemistry 101. More single bonds equal more stable fat. More double bond in between the Carbons equal a more unstable fat, and it can oxidize easier. So, we take in extra Vitamin C, or extra Vitamin E, or extra Curcumin to help stabilize those uhhmm– those polyunsaturated fats getting in there.
Evan Brand: So, somebody smells their fish oil. It’s very smelly. Let’s say, it’s uhh– inferior ethel estro form can we assume that that’s gonna be creating more oxidation there. There’ll all got to be taking like a fully oxidized fish oil, therefore making the problem even worse.
Dr. Justin Marchegiani: Exactly. So, we want to make sure it’s a triglyceride form. A lot of fish oils, like my Omega-3 Supreme actually has Lipase in it because we kind of make the assumption that most people were seeing have compromised digestion. SO we want to ensure that that fat is getting broken down optimally. And, you know, we’ll ups some antioxidant so meili we’ll give some Vitamin C synergy or Curcumin Supreme to help provide stabilization of the cell membrane.
Evan Brand: Perfect. There was a question about Vitamin K. We mentioned it already but they were hearing that the Calcium, Vitamin D and Vitamin K should be taken together. I personally, unless it’s in a blend of something, I personally never use Calcium, but the Vitamin D and K, I do use. I use a liquid for that. Vitamin D plus K – K1, [crosstalk] K2.
Dr. Justin Marchegiani: Yeah. [crosstalk] Yeah. I don’t use it, by itself. It’s gonna be in a blend for the most part. But with my female menopausal patients or patients that have severe Osteoporosis, a product they use, called Osteoben, has a lot of that in there, combined. That works very well.
Evan Brand: It’s good. I’ve used that one, and then also, I’ve used the– I believe it’s called Arthroben too.
Dr. Justin Marchegiani: Yeah, well.
Evan Brand: [inaudible]
Dr. Justin Marchegiani: Yeah. That’s the Collagen peptides. In meili, I use the true Collagen, which is similar.
Evan Brand: Yeah.
Dr. Justin Marchegiani: Uhhmm– which again, we go up to 60 to 80 grams, which is about, like, four to six scoops a day, to really get the building blocks up there for sure.
Evan Brand: That’s a lot of Collagen.
Dr. Justin Marchegiani: It is. Yeah. It’s about, yeah– I mean, it’s what it takes to build those bones up. You know, try to give a bail uhh– ‘cause they’ve been in debt for so long.
Evan Brand: Absolutely.
Dr. Justin Marchegiani: But it can, you know, on an average, typically, one to two scoops, ten to 20 grams, just for like hair and skin and nails, and healthy joints is fine, as a preventative dose.
Evan Brand: For sure, uhhmm– if you wanted to hit another question, but I didn’t want to mention, there’s also topical relief, too, for joint pain. So, there’s a couple different creams that I use. The ArthroSoothe Cream; it’s really good. It’s got like the peppermint essential oil in there. It’s got the MSM. It’s got the White Willow Bark. It’s got the – I believe it’s got the Capsium in there too. Maybe a little bit of Tea Tree. And, there’s actually– I think it’s called Celadon, or something like that. There’s some type of patented ingredient in there, where they’ve actually studied it and they found that people had increased joint mobility with it. So I use that cream. My grandmother uses it after she gets home or before she goes to play Tennis, and she’s noticed bry 20 to 30 percent improvement. So, that’s just from the topical perspective. Now, obviously, you still got to do the other work – working on yourself, internally: ruling in things, ruling out things with infections and such. But, there’s topical solutions, too, right? There’s not gonna be one silver bullet. It’s gonna be just the combination of all these stuff in your toolbox, which what we’re hoping to build up with here today.
Dr. Justin Marchegiani: Yeah, topical things we can also do is gonna be Frankincense essential oil. It’s great. Or the same version Boswellia, which is basically, Frankincense in a capsule form, which is the herb. And you could take that internally. Curcumin; we use light ReSoMal Curcumin or Curcumin Supreme. Uhhmm– systemic-based enzymes, taken on an empty stomach, like zero peptidase, can also help with inflammation too. If it’s acute inflammation, how did it happen? Did it happen because you ate Gluten or some inflammatory food? And that’s a chemical reagent. And we have the just– you know, do the things that help cool down the gut and get the Gluten dissolved. If it’s an exercise-based thing, again, make sure your form’s really well. A lot of people– I was a personal trainer for, like, five years. A lot of people have crappy form when it comes to squatting, lunging, death leaps, or in their arm wrap cycle of their Crossfit Workout. They just do very– you know, they– their form just goes to hel– in a hand basket, right? They push themselves to failure too much, where their form breaks down, and their technique isn’t good. They’re not having perfect wraps. So, really making sure those functional movements are stronger. And a lot of people, they’re exercising on machines, and machines work too two-dimensionally. And the problem is, in the real world, we perform three dimensionally, so you don’t build the stabilization units. You don’t have all the stability module that’s three-dimensional when you work on machines, so a lot of people, essentially, develop these big stupid muscles that don’t necessarily work optimally in the real world.
Evan Brand: Agreed. Yeah. So, I injured myself on a Shoulder Press Machine, because what had happened is I tried to go too heavy with dumbbells. So, once I went too heavy, which is already the first mistake. This is when I was quite 19. Went to heavy with dumbbells, so then I switched to the Shoulder Press Machine, because it allowed me to lift more weight. But that’s a tiny little muscle. Your little three different shoulder muscles there, that’s a small muscle. It didn’t need to be hit with a hundred and a hundred and twenty pounds like I was hitting it with. And so, I’ve learned my lesson, and now I just do free weights with it, and I feel much, much better. So the pain that I was experiencing there is gone, and that was uhh–
Dr. Justin Marchegiani: Yeah. Evan Brand: …all physically-induced.
Dr. Justin Marchegiani: Yep. Absoultely and a lot of people running, for instance, long distance, kind of like your LSD training– Long Slow Distance Training is really gonna be probably one of the worst things for you because it’s just that repetitive. You know, compression movement over and over again, over and over again. And essentially, those movements are gonna really increase Cortisol levels so then that creates more of that Catabolic Effect, where you’re breaking down more of that bone. And then also, running form uhhmm– one of the listeners here, put him to chat. Form’s really important when you run, a lot of people had bad running form. A couple of reasons why, I worked in a Biomechanics Lab at UMass in College Undergrad and with these, like, different Compression Force Plates, and people will run over the Force Plates and we’d see how force is displaced. Now, a lot of people are heel strikers. So, when you’re a heel striker, what you’re doing is you’re hitting the ground, you’re hitting the break, and then rolling over mid strike, and then going forward again. So, it’s like break-gas, break-gas, break-gas. So, the whole goal is, if you can dial-in your strike so you can at least be mid to front foot strike, you can have the effect of running downhill. So really important is go one line and make sure your form is great when it comes to running. You should have a slight lean, and you should be striding so you’re hitting to that front half of the foot, not the back half of the foot. ‘Cause that’s gonna increase compression forces, which is gonna cause more of that wear and tear in that Catabolic Hormone Effect, and break down more of that tissue.
Evan Brand: Yeah, well, and you also want to make sure that you’re using Zero Drop Shoe. Uhh– if you have followed the work, which I’m sure our listeners have, about Marxism, Mark’s Daily Apple or Dr. Mercola. They both were endurance runners. They both did running so much in their life, and [crosstalk] they destroyed themselves, and they’re very, very anti long distance running now. You can read about that, but a Zero Drop Shoe, for me, was a game changer, because a lot of people– you know, pry more about this from a structural standpoint than me, but with a big heel on someone’s shoe, you’re gonna be basically always flexing that calf muscle, and then you’re messing up your hamstring, and then you’re messing up your low back. It’s like the whole chain gets put off. I have the guy– I’m trying to think of his name now. If he typed in like Podiatrist, not just Paleo; you’d find it. But I had a…
Dr. Justin Marchegiani: Got it.
Evan Brand: … a foot doctor on this show, and he talked about how bad a shoe that’s not Zero Drop is for you, and really that’s one of the big issues that can lead to Bunions and all sorts of, like, foot problems. Is the drop of your shoe, which obviously could create joint pain, too. Back pain, hip pain, knee pain, etc., and once I ditched my other shoes and I went to, like, a barefoot shoe, like a Vibram, where I’ve actually got some, like, Zero Drop Boots that I’ve been hiking in. Man, I feel so much better. No more low back pain.
Dr. Justin Marchegiani: I think that’s huge. Also, Chiropractic here, I think, is essential, because joints need movement, and if we have, like, some books say, they’re stuck joints in the spinal column, right, that’s gonna create inflammation. And again, what’s gonna happen, too, is the brain and the spine– the brain, the spine and the muscle communicate via movements. And if we have subluxation, where the joints are not aligned properly, or they’re fixated, they’re not moving properly, we have poor communication from the brain to the joints. So, again, we can help communication via exercise, but again, therapeutically, healthy Chiropractic adjustments specific are gonna be super helpful. Also, if your distance running, making sure your feet are moving properly. There are 26 bones in your feet, and if they aren’t moving properly, how you displace force is gonna be severely impaired. So you got to make sure that part’s dialed-in.
Evan Brand: I wanna mention the running surface that you’re on too, now that we’ve kind of gone on this– this other topic. I hate running on concrete. It’s terrible. You’re not designed to run on hard concrete with rubber-insulated shoes. So…
Dr. Justin Marchegiani: Totally.
Evan Brand: …for me, obviously best-case scenario, which our ancestors do and still do. Hunter gathers today, has their bare foot in dirt. But if you’re in Austin or somewhere, and you have no idea what’s on that trail, some might could had dropped the razor, or a piece of glass, or something, obviously, you don’t want to, you know, get yourself caught up with that, but, you know, bare foot’s gonna be the best, or close to bare foot. And then, natural surfaces, so grass, their leaves, sticks, you know, a pine needles – those surfaces are way better for you than, like, running on asphalt, or even worse, running on a treadmill. So, you’ve really got to zoom out and look at yourself from a third-person perspective. With your great, great, great, great grandfather if they saw what you were doing, well they’ll say, “What the hell are you doing, and why are you doing that?” If so, then, maybe you need to reevaluate what you’re doing and calling it exercise.
Dr. Justin Marchegiani: I tottaly agree, so making sure you have the right exercise dialed-in, the right form dialed-in, whether it’s running, or whether it’s lifting, or resistance training, you know, good Chiropractor, a good massage therapist on board to help, for sure, uhhmm– making sure the metabolic stuff dialed-in, right? Diabetes and Insulin Resistance will also create inflammation and increase your chance of uhhmm– bone issues, as well. Hormone issues, adrenal issues, low stomach acid, low enzyme physiology infections, the infection connection we see of mycoplasma and other parasites that can create malabsorption – anything else, we missed, Evan? I think we hit everything pretty well. Oh! Also, instantaneous pain relief, too, which can be helpful but again, you got to make sure you’re addressing the root cause. So, we talk about palliative things. It has to be dawned in the context of, “Hey, we’re doing this thing. It works to help cut pain fast. But we’re also fixing the root cause over here. That can also be Cryotherapy.
Evan Brand: Yeah, Cryotherapy. I heard a lot of good– a lot of good stuff about that. Actually, a client of mine, now in California, she went to the place where Joe Rogan was at, and she was like, “I got to meet Joe Rogan in person. He was at the CryoStudio, so I knew I was in the right one.”, I was like, “Yeah, that’s cool. Uhhmm– also, CBD oil too. So, it depends on what state you’re in. Obviously, if you are in legal Cannabis state. You can get CBD-THC blends because the THC is gonna work much better. But if you’re in the other states, where only CBD is legal, then you can look into, you know, like a liposomal but just a regular Cannabis oil. And if you hit like a five-, ten- or 15-milligram doses CBD. Uhh– I’ve got a female who, she’s in her 70’s and she wants to nget back to riding horses, and she had all these hip pain.
Dr. Justin Marchegiani: Totally.
Evan Brand: She brought in the CBD. She felt better. So, obviously, like, for dosing and for specific brand and stuff, you have to reach out to someone uhh– like Justin and me, but that is another option. That could be over-the-counter available, an then there’s also if you get like a medical card, you can go get stronger versions that would have THC in there.
Dr. Justin Marchegiani: Totally. And then, last but not the least, too, is making sure your muscles are activated. This is kind of uhh– it may fly on people’s heads but, again, like– As a Chiropractor, you know, I use to be doing a lot of adjusting, which is helpful for getting the joints moving. But also, when I was doing more of that type of work, I was looking at muscle activation, so I would go through TOT and TAS – all of the different muscles. So, I mean, I’ve had experiences where I was working on uhhmm– Olympic level athletes, gold medal sprinters, and we’ll test their hip flexors and just nothing will be on. Like it will just be like, “Pffffft!” Turned off. From a neurological facilitations standpoint, it was just totally inhibited. So, we weren’t getting optimal nerve stimulation. I’ve tested NFL athletes, as well. If we don’t have those muscles turned on, muscles are your natural shock absorbers, so there are so many people out there that don’t have their muscles and those shocks on. So that force goes into sensitive soft tissue – vascular structure. A vasculars– if they weren’t for lacking blood flow. So, when they break down and they get inflamed, they’re so hard to heal because you don’t have that good blood’s flow, bringing Oxygen, nutrition, and pulling the inflammation out. So making sure the muscles are turned on, and get a good Applied Kinesiology Chiropractor. I’ll give a shout-out to uhhmm– Garrett Salpeter at (neufitdot) neufit.– (neudotfit) neu.fit over in Austin. He has some great services there were. Uses the ARP wave, of his newbie in the uhhmm– Applied Kinesiology type of work. To help make sure those muscles turn back on. That works great.
Evan Brand: So how did the muscles turn off?
Dr. Justin Marchegiani: They’re gonna turn off because of stress, because of inflammation, uhh– because of adhesions or trigger points in the muscle belly, because of poor biomechanics, because of inflammation, because of poor lifestyle habits, inflammation tends to shut everything down over time.
Evan Brand: Remember when I was over at your house, you hooked me up to the ARP Wave?
Dr. Justin Marchegiani: Yep.
Evan Brand: That thing was intense.
Dr. Justin Marchegiani: Yeah. Yeah. That thing’s really awesome, because it’s basically inflammation detector, so we can go in there. We can basically shock that inflammation, reduce the inflammation by driving in blood flow. We can also create more efficient neurological patterns by doing correct movements. And then also, adjusting the joint, which provides more mechanoreceptive probe, perceptive input to the brain, and helps the joint work better, for sure.
Evan Brand: You had me hooked up when you were trying to get me to sit down. It was a struggle. I was like, “Whoah!”
Dr. Justin Marchegiani: Yeah.
Evan Brand: Who knew?
Dr. Justin Marchegiani: Yeah. It’s pretty crazy. Yeah, that stuff’s awesome, man. I mean, it’s like working with uhh– that’s hyper technology on patients. It’s like cheating, because you can really hone in your treatment. Just so specific.
Evan Brand: And that was what? Like, 10– 15 thousand-dollar device?
Dr. Justin Marchegiani: Oh, yeah. It’s like a 15 to 20 thousand. I have a couple of them. They’re great. They’re phenomenal. They were awesome with patients. Wow. Love it.
Evan Brand: Anything else we should mention on joint pain. I feel like this was really good coverage.
Dr. Justin Marchegiani: I think we hit everything. I mean, we’re– we’re really hitting everything from a 360 standpoint, ‘cause I guarantee you, there’s no podcast out there that’s hitting the infection piece, or uhhmm– or even a lot of the– just the modality that we hit too. I think we hit a full, kind of, spectrum for all the different potential solutions that are out there.
Evan Brand: Well, here’s the problem, too. There’s a lot of people are selling on their particular dogma, right. So if they got a X-Y-Z podcast, they’re gonna sell people on why their solution is the solution. But that’s not really us. I mean, if we’re really gonna tell you that if it’s a Chiropractor or Applied Kinesiology, a person can help you. We’re gonna tell you, we’re not gonna tell you, we’re not gonna omit some type of therapy just because it’s not something we can offer. And I do see wiith a lot of other people out there. They’re only going to end up at their solution for the problem, but there’s other places out there that you can get help. Now, obviously, you still can benefit a lot from working with us with these other deeper issues: the infection connection, all that. But, you can’t fix everything, you know, with the magic supplements in removing infections, sometimes, you may need that hands-on care. So–
Dr. Justin Marchegiani: I agree, and a lot of Chiropractors, you know, they get their patients lulled in, and just having adjustments all the time, without making any changes. Now, I don’t think it’s that bad, because no one’s – you know, twenty thousand peoples aren’t dying a year from adjustments. You get maybe, one in ten million if that happens, and they, typically, already have a pre-existing stroke, that’s the reason why it happens. It very rarely happens because of a Chiropractic adjustment. So again, if you’re seeing a Chiropractor, and you’re not getting to the root cause. Well, at least, use that time that it’s helping to reduce the pain, to investigate what the underlying cause is, and ideally, your Chiropractor or Physical therapist should be working on all of the diet and lifestyle things as the foundation. And then, using some of the modalities that we talked about to stack on top of that. And then, digging in deeper with some of the Applied Kinesiology or the Cryo or the supplementation, or even the hormones, too, to help improve bone growth.
Evan Brand: And that interesting, the link between big Pharma and the mass media. I mean, that Chiropractor story, where someone, you know, I believe, there was some type of death last year. I mean, it was all over the media.
Dr. Justin Marchegiani: Yeah.
Evan Brand: And I was like, you said, one in ten million. However, you don’t hear about the 19,000 that die every year of the Ibuprofen.
Dr. Justin Marchegiani: No, you don’t hear about that at all. And again, that girl, that was a girl in LA. I think she was a former Miss America, or some kind of model. She was a celebrity of some sort. But she got on a car accident. She, you know, had a Whiplash, and maybe, there was already a little tear in the uhhmm– in the lining of the artery. And that adjustment just was enough to straw off a clot and create that issue. So, going back to my old days, as a Chiropractic Physician, I would never adjust anyone ausiously. You know, with the kind of a crack sound. A post car accident.
Evan Brand: Wow.
Dr. Justin Marchegiani: [inaudible]… more gentle things, more techniques that were more gentle in the beginning. Just more just to ensure from a liability standpoint, you know. I didn’t get caught up with that.
Evan Brand: Yeah that’s a scary place to be.
Dr. Justin Marchegiani: Oh yeah.
Evan Brand: Thinking irresponsible for that. Goodness gracious!
Dr. Justin Marchegiani: Oh, exactly, and the research is pretty clear. Dr. Malig has done a lot of work on this. Uhh – with the one in ten million, about the same risk as having a stroke going to a Chiropractor. The same risk of having stroke walking into your primary care‘s office. Same exact risk factor.
Evan Brand: Wow. That’s a trip. Well, great job today. People can reach out justinhealth.com, notjustpaleo.com. we do block at a few hours a month for free calls, so if you need to see if you’re a good fit, you could reach out, and we’ll see if we could help you out.
Dr. Justin Marchegiani: Evan, great show today, my man. Appreciate it, loved it, and we’re gonna be back next week for more info coming your way.
Evan Brand: Likewise. Take care.
Dr. Justin Marchegiani: Thank you, Evan.
Evan Brand: Okay. Bye.
Dr. Justin Marchegiani: Bye.
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