Fatigue, Tiredness, and Lethargy: Link to Gut Infection | Podcast #311

Tiredness is not a symptom that defines any one particular disease. Rather, tiredness can be a symptom of many different diseases and conditions. Causes of tiredness range from lack of sleep and over exercise to medical and surgical treatments. The lack of energy (lethargy) associated with tiredness can sometimes cause difficulty with normal daily activities, leading to attentiveness and concentration problems.

Dr. J suggested considering to support protein breakdown by extra amino acids and enzymes. Dr. Evan also added that if you have issues, always reach your conventional Dr. or functional Dr., be tested, find the root cause and guide to fix possible infections that cause you to feel tired before you reach a crisis level.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:10 Mechanisms to Gut Infection

4:05 Where Gut Stressors Come From

12:12 Infections that causes Fatigue

17:41 Probiotics and Beneficial Bacteria

22:32 Supplements to Gut Infection

24:18 Immune Issues

Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house with Evan brand. Today we’re going to be chatting about your gut infections may be making you tired. Many people don’t think about how their gut maybe having an impact on your energy, your mood, your emotions, but it’s totally true. Most people think, oh, if I have a gut issue, I’m just gonna have bloating or diarrhea or constipation or acid reflux. Oh contraire. We’re gonna dive into that today, Evan, how are we doing today, man?

Evan Brand: Doing really well. How about should I just go straight into my story, then? I mean, I suffered with this thing firsthand, as you know.

Dr. Justin Marchegiani: Yep. Let’s do it.

Evan Brand: So when I was down in Austin, I was losing weight. And I didn’t know why I was losing weight. And turns out and I was exhausted. That was that was the main thing. I mean, I was drained, like, it was really tough for me to get through the day. I mean, I was to the point where, at some point, it’s kind of embarrassing. I mean, I was like, okay, am I do I have enough energy to cook a meal at night, you know, for dinner, like, the workday just drained me. And so fortunately, after I got the gut infections resolved, I mean, the story is not much longer than that my energy came back online. So I mean, we can say clinically, and personally, that this is a big, big smoking gun for anybody who’s been dealing with chronic fatigue.

Dr. Justin Marchegiani: Oh, totally 100%. Now, let’s talk about some of the mechanisms why like, you could have constipation, you could have diarrhea, you could have all these digestive issues, that’s fine. And it makes sense why some of these issues may be causing problems. Because if you’re going to digest a lot of the nutrients that energize you, right, B vitamins, your amino acids, your essential fatty acids to burn them in the mitochondria for fuel, all of these things require optimal absorption, right? So if we don’t have adequate enzyme, or acid level or biliary level to break down fats, proteins, and carbohydrates, we’re going to have a problem with those nutrients getting into our bloodstream and making their way to ourselves and our mitochondria to be burned for fuel. So that’s one big mechanism. And the other big mechanism out of the gates, and we’ll kind of expound deeper into each one is the fact that your immune system sucks up lots and lots of resources. So think back to when you maybe got the flu or had some kind of illness. Were you energized? Are you tired? Most people were very tired. Now, why is that? It’s because your immune system allocates lots and lots of resources when it’s stressed. And it will make you tired, because it’ll pull some of those energy resources to put it towards fighting an infection. All right. So if your immune system is caught chronically in that state of trying to fight something, whether it’s a gut infection, cebo, or parasite, or just gut permeability issues that are upregulated, due to bad foods, and food allergens, you’re going to be really over stimulating and over allocating resources to deal with whatever’s happening with the immune system, aka the gut. Don’t forget 80% of your immune system is located in the gut, people forget that so important. So if you’re over stressing your immune system, you’re gonna have problems.

Evan Brand: Yeah. And so for me, I was taking some immune support, but it was all just kind of a bandaid, right? Because I wasn’t focused on the underlying infection. So this time of the year, we’re, we’re talking in the fall here coming up on winter, you have a lot of people that will say, Well, you know, I really just want to strengthen my immune system. So they’ll go and do maybe some extra vitamin C, maybe some medicinal mushrooms, or maybe some other herbs, astragalus, things like that. But it doesn’t matter if you do all those if you don’t address the infection. So if someone’s like, tired and they feel weak, they feel depleted. They feel like they’re possibly immunocompromised. Sure, you could do some of the tools, like we talked about those herbs, but really, you got to test first of all, figure out what kind of infections you have. And then step two, is you come in and make a protocol to fix those infections. And not to mention, you know, like h pylori is super contagious. So, I mean, you and I’ve seen hundreds and hundreds of cases where, you know, husband and wife have reinfected each other. And so we’re not doing this to try to make more money. We’re doing this to help the family when we say, Hey, what about your husband? What about your wife when we try to get them on board? It’s because we know about this potential, you know, cross contamination.

Dr. Justin Marchegiani: 100%. So we kind of look at the gut, and we’re like, Alright, where are the gut stressors coming from? So the first stressor we look at are food allergens, because if your immune system is kind of responding negatively to food, that could be a big a big issue, right? And what happens is, when food allergens kind of come in, whether it’s gluten or dairy, or just you know, processed grains, or sugars, or even things like nuts, or seeds, or just more allergenic foods, soy those kind of things. Your immune system is upregulated dealing with those foods, and that’s going to suck away resources. And also, these foods if you have an allergen to them, if your body’s hyper allergenic, meaning your immune system is over responsive. There may be some gut permeability. And gut permeability is like these little tight junctions in the epithelium in the small intestines. They’re like this. So imagine you’re putting your hands together like you’re saying a prayer now, start pulling your fingers apart a little bit, you see the little gaps that happen that’s happening at a microscopic level with the tight junction cells in the small intestine. So the more you’re stressing your gut lining, these tight junctions open up, like I mentioned, the fingers come further apart. And then food particular we call it antigens, right? These foods aren’t supposed to be in the bloodstream at the size they’re in. Now you start having these antigens go into the bloodstream at a larger level, and now the immune system’s going to start going after it with full force. And that’s gonna start sucking up a lot more of your resources. So the first thing when we’re working with patients worldwide, we’re trying to cut down the food allergenicity we’re trying to decrease the immune response by helping the foods not become so bad or stressful on the immune system. So some people coming in on a standard American diet, a paleo template, maybe enough. Some people that are really have an autoimmune issue or Irritable Bowel Disease, we have to go to a paleo template where we’re cutting out extra allergenic foods, some we have to even go to a carnivore or some kind of an STD low lower fodmap diet because the bacteria is overgrown, and it’s reacting to even fodmap foods like broccoli and onions and garlic like healthy foods, were reacting to it. And so it this whole thing becomes a little bit more nuanced with food, the more unhealthy you become, or the longer your conditions progress. So as a practitioner, right, we’re trying to meet people where they’re at some people come in at a really easy phase, they’re just diets crap. And we can just make a simple change with the Paleo some we have to get a lot more nuanced.

Evan Brand: So let me ask you, you brought up garlic. I had a woman last week, actually. And she was complaining that garlic was a big issue for her. So we’ve already cleared out gut infections, and we’ve done a great job. We’ve retested we’ve confirmed that we got rid of all the gut infections, we are doing some leaky gut support, but she says every time I eat garlic, I get really bloated. What would you What would you do? What would you say to that garlic person?

Dr. Justin Marchegiani: Well, it could be a SIBO thing. So I’d want to test other fodmap foods. So if there’s some kind of a gut issue or like a bloat or a motility issue, or a diary or a constipation issue, we’re going to be cutting out fodmaps fermentable carbohydrates, fructose, oligo, disaccharide, mono and polyols. And we’re going to do that and then we’ll eventually do a reintroduction. And when we reintroduce foods, we’re going to start with moderate fodmaps first and then go to higher fodmaps. Last, so those foods are higher fodmap. So the question will be How did she do adding in the moderate ones? First, I want to know how she did incrementally adding things in.

Evan Brand: So like apples, she does fine, which was interesting, because to me, I’ve had a lot more people have issues with apples than I have with garlic. So I thought Hmm, you know, is it really a bacterial overgrowth thing? The stool test didn’t really show much in the in the bacterial category. So it’s kind of like, well-

Dr. Justin Marchegiani: when people like that, I just want to see is it a one off? Is it just garlic? Or is it other foods like onions and broccoli and avocado, which is a moderate or sweet potato, which is a matar, I want to test more of the moderate fodmaps? Maybe add in some fermented foods like a kombucha or a sauerkraut? Did it happen with those two, if it’s just a one off, then it could be some die off, it could just be she’s having an issue with that food. So if it’s a one off, I don’t really worry about one offs, I look for patterns, like patterns or like part of being a good functional medicine doctor, it’s pattern recognition, you’re looking for patterns, like some patient that can be Well, last week I had this happen or that like, we got to look at bigger picture, we got to have enough data points. So we can look at patterns. Anything can happen one off due to stress or a poor night’s sleep, or you got exposure to some bad foods. And now your guts a little bit rocky for a few days. So we got to look at longer trends and really have a lot of good pattern recognition. Part of what we do, we’re kind of CSI detectives, and we got to look for things repeating itself, because anything can happen one off, we don’t want to change what we’re doing, or the programs that people are on, off of just a one off issue.

Evan Brand: And that’s what it was, it was a one off and it was kind of, you know, frustrating for me because I’m thinking well, crap, you know, everything else, she’s tolerating good and any other problematic foods, I’d kind of put in that same category that we thought would be a problem. They’re not a problem. So I’m sitting here thinking, Okay, well, what kind of explanation Can I give her? Because she wants some kind of good functional medicine answer for me, right? And so that’s what I told her. I’m like, well, this sounds like just Oh, to be honest, kind of like a food sensitivity, particularly to the garlic. You know, I don’t looking at the testing. I told her I didn’t really see anything that was compelling to indicate any other sort of issue and all the other foods were tolerated. So I kind of just gave it like a political answer. It was like, wow, hmm. You know.

Dr. Justin Marchegiani: Yeah, well, we’ll come it’s possible there could be just a, her immune response is just a little bit more sensitive to if we don’t see extra data points correlating to it, then I just tell patients, hey, let’s just we’ll come back. We’ll work on probiotics. We’ll work on good re inoculation of good healthy bacteria while adding some prebiotic fibers every month. We can try testing it again. But as long as there’s no yeah, as long as there’s no, let’s just say, family of other foods that are interacting like this, then we’re not going to really worry about it too much. But you can always retest, make sure that gut’s doing good, but it’s possible you have one off allergen issue that’s possible. But every month, we can always retest it and see.

Evan Brand: Yeah, good point, I did end up throwing in a high dose, multi strain probiotic. So we’re with a high amount of bifido. So we’re gonna see what happens.

Dr. Justin Marchegiani: Yeah, and this person could tolerate fermentable carbohydrates, like sauerkraut and, and maybe a little bit of kombucha it’s probably not a fodmap issue, because those things are very, very high in fodmaps. It could be she’s killing some stuff off. It could just be she sensitive to garlic. It’s possible. Yeah. And so I mean, I just tell patients, hey, you know, that’s an artifact, we just kind of make a note on it. When we follow it down the road later on. If things kind of connect back to it down the road. That’s nice. But if not, things that are one offs. You don’t want to you don’t want to one off to derail your whole investigation.

Evan Brand: Yes. Yes. That’s a great point. You know, it’s like you’re, you’re you’re like, you know, investigating a crime scene, and you have his weird piece of evidence. That does not make sense.

Dr. Justin Marchegiani: Yeah. Right. Okay. Well, we’ll make a note on that. And we’ll come back to it if there’s any patterns that they point back to it down the road.

Evan Brand: Yep. Yep. Great. So so small tangent, but really helpful. I think it’s, it’s helpful for people to see how do you have to think when you’re approaching these issues, it’s not always black and white, you know, we try to refer back to clinical experience, we kind of sprinkle in some of the data sprinkled in some previous case studies that we’ve done with people. So it’s really fun. But back to the fatigue piece.

Dr. Justin Marchegiani: So I just wanted to highlight one component, because while you’re on it, is when we are talking about these things, because we’re clinicians, and we see thousands of patients, we’re operating more off of clinical concepts than like rote memorization of like, a fax. And so when people listen to our podcasts, we really want them to understand the overarching concepts of health. If you understand a concept, you don’t really have to memorize it, if you’re trying to memorize random facts and randomness, and that becomes a little bit convoluted and a little bit stressful. So just try to get the overarching concepts that we’re talking about here. Once you get the concept, you never have to worry about memorizing, and it’s just there.

Evan Brand: Yeah, yeah, good. So I just wanted to go back to the to the fatigue piece, because for certain people, there may be multiple layers of infections that are causing your fatigue. So for me it was H. pylori, and then once I got rid of the H pylori, then it was the parasites that were still causing me to be tired. And once I got rid of that, then I did have some Candida that I had to address. So what I want people to know is that if you double down or triple down on something, you know, the guy tells you it’s parasites, or the girl tells you it’s this, and you pursue that, and you’re not better, it’s possible that you’ve, you’ve missed something. And so I just want people to wrap their head around you, like you say, you have permission to have multiple things wrong at the same time. So you could have a bacterial issue, a parasite issue, a Candida problem, all at the same time. And so you got to make sure you get all the data if you just run a stool test. Candida rarely shows up on the stool test, you and I’ve talked about this many times. So the urine test will often fill in the blank. So if you had one test done, or your doctor ran this or that, and you feel like you’re missing something you probably are so keep, keep digging.

Dr. Justin Marchegiani: You also there’s one study here just looking at h pylori and mitochondrial function, I’ll put it up on my screen. But this is important, right? And the reason why it’s important, I’m going to just I’m going to do a share here. So if you guys are listening to the podcast on YouTube, you’ll be able to watch the video. If you’re on iTunes, you know, you have to just click the YouTube link, and you’ll be able to see what we’re talking about. If not, I’ll try to describe it pretty well. But you can see my screen you see my screen.

Evan Brand: Yep. h pylori affects the mitochondrial function.

Dr. Justin Marchegiani: So this is important right here. So mitochondria are the powerhouse of the cells. This is really important and the powerhouse of your cell generates ATP for energy. Now, if you look here at the bottom they talked about, they wanted to investigate whether there’s an increased mutational load and mitochondrial genome and what they found was there believe that the there’s a downregulation in the mitochondrial DNA repair pathway? What does that mean? It means how your mitochondria are repaired and regenerated. It’s going to be down regulated, so you’re not going to be able to repair your your mitochondria as fast. It’s believed to be involved in mitochondrial base excision repair. Our results suggest that these genes A p one and y b one, just know that their DNA is that are involved in mitochondrial DNA repair. They’re they’re demonstrated to be involved and they’re demonstrated to be down regulated when there’s an H pylori infection. So it just means that your body’s ability to generate ATP which has decreased respiration coupled aptr. So you’re not able to generate as much ATP and repair your mitochondria as well when you have an H pylori infection. And this is something that we think is there with a lot of gut infections. It affects your mitochondria. Your ability to repair it, which then affects your ATP synthesis.

Evan Brand: That is pretty crazy. I mean, especially if we’re talking about an athlete who wants to perform right you’ll have all these big celebrity personal trainers and stuff and they’ll just get people on different diet changes or no, you need to do this exercise or this exercise and they missed the boat. They don’t have a clue about H. pylori being the root cause of the of the fatigue or the exercise performance. So yeah, it’s just crazy.

Dr. Justin Marchegiani: And then also, there’s a lot of right here, right here one study, I’ve already looked at it before, if people are having gut issues, and they go to their conventional gastroenterologist, what are they typically prescribing? Well, a lot of times they’re prescribing antibiotics, right, and there’s a lot of data, bacterial Seidel, antibiotics induce mitochondrial dysfunction and oxidative damage. And so we know this is something that’s actually present, where there’s damage to the mitochondria with antibiotics.

Evan Brand: Well, and and, and to be clear, for H pylori, it’s not just one antibiotic, it’s three or even four, they have what they call quadruple therapy now, which just the name of it scares me, it’s literally four antibiotics at the same time. And you and I have both seen patients that have had triple or quadruple therapy done and guess what we retest them, and unfortunately, due to antibiotic resistant bacteria, the infections are still there. So now we have to come in, repair all the mitochondria that were damaged, plus use herbs, which are much, much safer, and in my experience, just as if not more effective, and then we actually get rid of the bugs.

Dr. Justin Marchegiani: Yeah, she’s a summary of your mitochondria dysfunction and oxygen damage induced by bacterial Seidel antibiotics, which is interesting, because bacteria, all antibiotics are bacterial Seidel, so interesting. They use that description. It’s mammalian cells. I’m not sure which mammals they use. But they talked about that it’s alleviated by antioxidants. Well, guess what, when we use a lot of the clearing herbs that we use, guess what they’re rich in, I mean, tons of antioxidants, polyphenols. And that’s the benefit, a lot of the herbs that we use, they have a lot of antioxidants in them to help buffer the oxidative stress. Because remember, oxidative stress is part of what happens with the antibiotics. And we have a similar effect with herbs. But the herbs have a lot of antioxidants, which is helpful. Any comments on that?

Evan Brand: Well, what you’re saying makes us look really good, because not only are we giving nutrients that can effectively get rid of the infections, but we’re also protecting the system or even replenishing antioxidants, because in general, and the oxidants are going to be reduced because of all the oxidative stress from the infection in the first place. So it’s literally like a win win, for us and for the person under the protocol.

Dr. Justin Marchegiani: Yep. And there’s lots of different studies here as well on probiotics and beneficial bacteria, correcting mitochondrial dysfunction with probiotics. There’s there’s definitely studies on this as well. And again, you know, these are things that we’ve seen in our practice, like when you see someone get better. So protection of hepatocyte mitochondrial function by blueberry juice probiotics. So there’s lots of studies on this, because when you see patients get better with certain beneficial bacteria, after you do an elimination, you’re like, why does that work? And so what happens is you see a clinical outcome, patient getting better when you do something. And then you’re like, Huh, what could the mechanism B and then you chase it down online? And you’re like, oh, maybe that’s it? You know, maybe it has to do with the fact that it’s helping the mitochondria and people’s feel better afterwards? Maybe that’s the mechanism. It’s possible, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: We have to comment on that.

Evan Brand: Well, it’s a lot of good things happening. And then you mentioned the probiotic piece. So that’s going to help even more. So after we get someone on a killing protocol, there’s going to be good benefits there, your energy is probably going to get better just based on doing that. And then when you go to the next phase, if we’re going to come into the gut healing phase, you’re going to get even better than so it’s it’s really fun for us to kind of paint the picture here of just how how is someone going up, up up up better, better, better? And you’ve just outlined how so pretty I talked about it right here.

Dr. Justin Marchegiani: They talked about a collusion the studies show this is BP stands for blueberry juice and probiotic exhibit a synergistic effect preventing the development of a and that’s non alcoholic fatty liver disease by protecting mitochondrial function, suppressing the damage of mitochondrial ultrastructure by reducing mitochondrial swelling, right. So mitochondrial damage by antibiotics, as well as we could do the same thing when we search, let’s say pesticides, or heavy metals or mold toxins, so we know that gut plays a big role and one helping to absorb those nutrients. But number two, also helping to have beneficial bacteria that modulate these, this inflammation and mitochondrial damage as well.

Evan Brand: Yeah, yeah. Well said. Excellent.

Dr. Justin Marchegiani: Well, it’s good that just a couple of studies. I mean, when we look at like we look at research a lot differently, so just kind of everyone there. We look at clinical outcomes in patients. And then we chase them back to what the literature says. The problem is a lot of people who are clinicians, they’ll look at the literature, and then they’ll try to then come up with a clinical like decision based on the literature. And that’s sometimes it’s really hard to do, because a lot of the PhDs and a lot of the research out there isn’t necessarily clinically driven, and maybe driven because someone has a PhD in this area. And they’re just they’re just studying that topic, because or maybe it’s an NIH funded study. Who knows, right? So we’re looking at things that are clinically driven, not research driven, because someone has decided to dedicate their life to this topic. And this is the study they’re choosing right?

Evan Brand: Now. It’s good that we can kind of pull out some studies to help backup what we’re saying. But it’s not like we go into PubMed to try to figure out exactly what we’re going to do the clinical stuff is really that’s where all the magic happens.

Dr. Justin Marchegiani: Yeah. And some may say we have a confirmation bias and how we look for these things. But we’re not looking for out of the blue we’re looking for, because we’ve seen clinical outcomes support something is happening in that direction. And then we use the data, the research to say what could be if positive things are happening in this direction? A to B, what could be the mechanism of why that is? And so we kind of chase it backwards. versus the other way around?

Evan Brand: Yeah, yeah. And it’s just it’s a blast. It is fun for you to pull that stuff up. Right? Because, you know, we get we get used to our our methods, we get used to our results. But when you get to see in the literature like that antibiotics, causing mitochondrial damage is like, Oh, yeah, I forgot. That’s why we do this. It’s Yeah, we’re Exactly. We don’t want people to get damaged.

Dr. Justin Marchegiani: And you get confident when you see things repeat itself. Clinically, you’re like, Okay, something’s happening here. Now what? So you’re going at it with a lot more confidence versus like, Hey, I think maybe, you know, I’ve heard this, it’s a hearsay kind of thing. No, you’ve seen it, you’ve seen it clinically? Well, here’s the confidence.

Evan Brand: Here’s the thing that’s always fun for me is when we’re on the topic of fatigue and gut infections. And so when you have a case where you do the follow up, and someone is reporting that they have significantly more energy, and you didn’t give them any energy supplements, you just fix their gut, you just gave them some liver, maybe some enzyme support, some gallbladder support, and then you killed the infections and all the sudden, boom, I’m 20% more energetic. I always smile and laugh simultaneously. Because it’s like, This is so fun. We have 20% more energy. And we did zero energy supplements. That’s just super cool.

Dr. Justin Marchegiani: Yeah, it’s powerful. Now, if people start feeling a little bit worse, then we got to be very careful. So when people start feeling worse, I’m like, all right, we got to spend more time building up the adrenals, we got to make sure the diets clean, because if someone’s got his or, like, if you’re putting lots of bad foods in and you’re inflaming the gut, then your immune system and also your adrenals may be making more resources to deal with the inflammation in your gut. So we have to decrease the inflammation in our gut and support the adrenals by calming it down. Now, the adrenals have more resources. And of course, we always like supporting the adrenals ahead of time. So then you have natural, your more of your natural anti inflammatories, because conventional medicine when there’s serious gut issues, they’re going to give prednisone cortisol, well, let’s just support your body’s ability to make that naturally. And then when we go into a gut clearing phase, then we have more of those resources on board. And then patients are sensitive. I’m titrating the herbs in there slowly so we’re not overwhelming the system by killing more, you know bacterial toxins, LPs endotoxins, mycotoxins, we’re not overwhelming the lymphatic system that a toxification immune system. So we’re going to kind of really titrate things in a little bit slower if you’re more sensitive. And we may even add things like binders and glutathione too.

Evan Brand: Yeah, yeah, the glutathione is good for me. I had to take a break from it for a little while. It was just too strong. It does mobilize toxins to so this is all case by case basis. But yeah, I love glutathione when it works. But when you take too much, that’s no good. There’s always a right dose.

Dr. Justin Marchegiani: Yeah, if you’re slow, if you’re like more sensitive, always start low, work your way up. And then if you’re sensitive, you can always start with just a gentle binder first, as long as you’re not getting constipated. That’s a good first step on increasing things.

Evan Brand: Yeah, that’s great. So let’s see here.

Dr. Justin Marchegiani: Um, the other component, I would say is people that have got issues tend to also have immune issues. We already talked about why 80% of your immune systems in the Galt, that’s the gastric associated lymphoid tissue that’s in the stomach. And then also the model that’s the mucosal associated lymphoid tissue, lymphoid meaning like lymphocytes, white blood cells, and that’s in the small intestine. And so if you have a lot of gut permeability issues, if your guts over responding well, what’s the most common autoimmune condition that affects people and mostly women, five times more women is autoimmune thyroid. And so if you have an autoimmune thyroid, that could also be affecting your energy because you know your thyroid gland is being attacked and your body is ability to generate thyroid hormone may be decreased. And it’s possible that your conventional doctors overlook that. And so knowing that there’s an autoimmune thyroid could be affecting your energy too. And if you have an attack, you could feel hyper where you’re like anxious, can’t sleep irritable, sweating, right? first and then you go into a hypo where you’re like tired, fatigued, depressed, right? So you could easily be going hyper and hypo swings based on autoimmune tax of the thyroid.

Evan Brand: Yeah, and once again, the hashimotos could be a side effect of something else. So even if you go to the endocrinologist, let’s say they were a more advanced endocrinologist, for example, hopefully they’re running thyroid antibodies TPO, TG maybe TSI. And they’re looking at that and maybe they’re treating your thyroid giving you desiccated glandulars, or nature thyroid, or just Synthroid or side ml. Even then you see how people can fall between the cracks and not get better. Because yeah, you’ve kind of cranked up the thyroid that was hypo due to autoimmunity. But you still never got to the gut infection that started at all.

Dr. Justin Marchegiani: BINGO, BINGO, BINGO, BINGO 100%. That’s what we got to look at always the root cause. So anything else you wanted to talk about here on the gut and fatigue I did, we hit the thyroid, of course, I alluded to the adrenals earlier, because they play a huge role in regulating inflammation. And we know acute gut issues, they may be, they may be given a corticosteroid to calm down the gut inflammation, that’s possible too. So we want to support your body’s ability to do it naturally. I would also say supporting protein breakdown. So with maybe adding in free form amino acids, because protein can be very hard on the body to break down. So of course, dialing in enzymes and acids and maybe giving extra free form amino acids. So it’s taking stress off the digestive system to be able to access those amino acids as well.

Evan Brand: I think I think you’ve hit it all. I mean, I would just say, kind of where do you go next is you really have to get the data. I mean, we’ve talked about a lot, right. But if you don’t have the data, you don’t know what you’re up against. You don’t know what you’re doing. So, you know, I think the best advice I could give is if you’re dealing with these issues, test, don’t guess. And so, you know, feel free to reach out to Dr. J. Justin at JustinHealth.com. And he can run labs on you anywhere in the world and send them to your door and jump on a call and discuss it make a great protocol to help you to get better. Same thing for me my website, EvanBrand.com. And we’re available we love helping you all we’re grateful to be in this position. So you know, sure you know a lot of you listening or kind of do it yourselfers. That’s what led you to be smart and find a podcast anyway. Because you want to kind of educate yourself, but there’s a certain point where it’s okay to reach out. And I tried to fix myself for a long time. And you spend more money and you spend more time doing that. So you know, feel free to reach out and get a guide.

Dr. Justin Marchegiani: 100% and then you’re available at EvanBrand.com worldwide. We’re available worldwide and we’re clinicians, we have our sleeves rolled up and we’re in the trenches every day, dealing with patients. Also, if you’re listening to this don’t just kind of glom on to one thing. So we see lots of people they’re like, they come in like Oh, I know what’s h pylori or I know it’s Candida or I know it SIBO keep an open mind on what’s happening because you have the right to have more than one issue going on at the same time. And for instance, Evans original story was Evan had not could have it wrong if you had h pylori, Giardia and crypto. That’s correct. Yeah, yeah, h pylori, giardia crypto, those are some serious infections. Any one of those infections is serious and could could have created the symptoms Evan was having yet he had all three at the same time. So if Evan was like, Oh, it’s only H. pylori, you know, he may have missed the fact that grd and crypto were involved too. So go into with an open mind and you have the right to have more than one infection happening at same time. Sad but true. But either way there are solutions to work on it and fix it.

Evan Brand: I was tired. Man, I was tired. Now that was a that was a that was a level of exhaustion that just doesn’t even seem real. I mean, that’s how you know something’s wrong when you’re that tire. But you know, hopefully, with this education we’re providing people can reach out and work on this before it gets to that crisis level because it’s much easier to pull you out if you’re not that deep.

Dr. Justin Marchegiani: Now Evan can you go to your conventional medical doctor or a gastroenterologist and typically get these infections picked up on?

Evan Brand: No, definitely not the testing is just so outdated, you know, it’s not sensitive, like the DNA stuff we’re using. So that’s the downside is if you go to the gastro doc down the road, say, Hey, I think I’ve got Giardia, I heard these two guys on the internet talk about it. They’ll probably just laugh in your face and say, Well, you didn’t travel to any third world countries. So you don’t have it. But if you if you really want to Sally, I’ll test you on they’ll run the outdated test and then everything comes back negative and then we’ll say see, I told you it was all in your head, just, you know, take an acid blocker.

Dr. Justin Marchegiani: So yes, my opinion is very similar. So the more acute you are, especially with typical gastrointestinal symptoms, the greater chance they’ll pick you up, especially if you came back from like Mexico or some kind of a country like Bali where infections are probable, right? But now what do you do? If your infections aren’t really gut based symptoms, they’re the fatigue or the brain fog, well, then how does that get picked up, you’re typically never going to get picked up for that you’re more than likely to, to get a psych referral for an antidepressant, right, then to get a gut test, and Evan already alluded to some of the technology they have isn’t going to be as up to par. So we have a little bit you know, more access to the DNA technology a little bit more sensitive. And then also like H. pylori testing that they may run a breath test, right? Urea breath test and look for elevated levels of co2, it’s possible, but that may miss an infection. And if it’s more subclinical, you may need a more sensitive test to pick it up. So if you’re listening, and you’re like, Hey, I’m gonna go to my MD that may not be the solution, I may not get you the answers you want. And if you don’t have the typical gut symptoms, diarrhea, bloating, gas, a lot of stomach discomfort, and irritability, you may not even they may not even want to run a test, because those symptoms don’t match with what they think the problem could be.

Evan Brand: Yeah, yeah. And you know, it sounds like we’re like picking on him. Right? And we sort of are and that’s fine. I love picking on them, because they’re failing people. And it makes me sad. Because I was there I was sitting in the doctor’s office trying to get help. And I was told that I just needed an acid blocking medication. I told the doc, no, I feel better when I take it. enzymes that actually increased my stomach acid, I think you’re wrong. She said, That’s not possible. You’re gonna hurt yourself, you need to stop taking supplements stop all dietary supplement, the FDA, blah, blah, blah, blah, blah. And and that was it. And that’s when I signed off and said, No, I’m done.

Dr. Justin Marchegiani: Yeah, and I do recommend, and I think you’re in the same way, I do recommend patients that have chronic issues, or acute issues, at least go see your conventional medical doctor just to get checked off that there’s nothing glaring that’s going on. And that that way, if you work for someone like myself, for you, and then they’ve kind of already been looked at, and they’ve kind of already know, okay, conventional medicine is kind of done all they can do. And, you know, functional medicine is the next best option at that point.

Evan Brand: Yeah, I’m not saying we’re the all knowing at all, if you’re bleeding out of your butt, you need to go confirm you don’t have some type of a bleeding ulcer or colon cancer or you have some type of a polyp issue or diverticulitis and you need colon surgery. I mean, there are certain things that we can’t help with. But for these more functional, non pathological issues, we’re definitely going to be able to help.

Dr. Justin Marchegiani: And we can help with all those issues. Once they’re stable. If they’re unstable, though, conventional medicine does a really good job on stabilizing very sensitive issues. But once they’re stable, now what because for the most part, it’s going to be just symptom drug management for the rest of your life. Right? If you look at what they talked about, it’s, hey, we’re managing your gut issue versus let’s actually get to the root underlying issue. And sometimes management’s good when things are acute and flared. But now when they’re stable now what we want to go beyond just who wants to just manage their diarrhea for the rest of their life? That’s crazy, right?

Evan Brand: Oh, God. Well, that happens every day, doesn’t it? It’s happening today while we’re doing this call somebody is in the doctor’s office right now about to get an antispasmodic drug for their diarrhea.

Dr. Justin Marchegiani: Yeah, and that may be fine acutely, but then what’s next? So get your health issues under control from a you know, stable standpoint, and then work on the next step with a good functional medicine doctor. Well, everyone was excellent chatting with y’all anything you want to leave us with Evan?

Evan Brand: No, that’s it. We’re just ranting at this point. So if you need help, please reach out. JustinHealth.com, EvanBrand.com. Take great care yourself. We’ll be back. Have a good one, y’all.

Dr. Justin Marchegiani: Take care. Bye now.

Evan Brand: Bye.

Natural Solutions to Heavy Menstrual Bleeding and PMS | Podcast #299

Dr. J is tackling menstrual irregularities and heavy menstrual flow, symptoms, what your cycle should look like, looking at hormones, when to best test, triggers of irregular cycles, and some tips for helping regulate menstruation.

Most women cope with their PMS and irregular cycles like it’s a normal thing, but really heavy menstrual flow can be a sign of something deeper, maybe even estrogen dominance. Heavy menstrual flow can cause fatigue, lethargy, mood issues, irritability, brain fog, hair loss, and most importantly low iron. Heavy menstruation can drive anemia and low iron which is essential to the body, then it can take weeks to replace iron, by the time you feel more yourself the cycle starts all over again. What can we do? Well Dr. J has much to say from the perspective of a functional practitioner.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

2:54 Menstrual Issues and Terminologies

11:12 Social Isolation, Supplements and Herbs

15:10 Tests for Menstrual Irregularities

17:44 Fasting as Stressor

20:16 Diet Restrictions

Dr. Justin Marchegiani: And we are alive. It’s Dr. J here in the house. Evan and I will be chatting about menstrual irregularities and heavy menstrual flow. Evan, how are we doing today man?

Evan Brand: Doing really well excited to dive in. This is an issue that many women just deal with. And they don’t really get help with. They just assume that hay, it’s normal to have PMS. It’s normal to have this happen with my cycle where this month, it’s 28 days. And then the next month, it’s 17 days and the next month, it’s 36 days. And I mean, we hear these stories all day every day.

Dr. Justin Marchegiani: 100% and the problem with heavy menstrual flow off the bat, it’s a sign of something else deeper, usually some kind of estrogen dominance. And then what’s driving that right? A lot of times progesterone is falling out too soon in the woman’s cycle. And then you have all this heavy menstrual flow, and that can drive in anemia that can drive low iron and that’s a problem because we need iron to bind a hemoglobin to carry oxygen. And we need oxygen for aerobic metabolism right for our mitochondria today. burn fuel, generate energy and burn fuel. So we need adequate oxygen. So if we have heavy menstrual flow, you can easily see fatigue and lethargy and mood issues. And a lot of times takes a couple of weeks to even replete that iron back up, and then you do it all over again. So it becomes this really, you know, you’re in the boxing ring every month, and you’re just getting beaten up, and it’s really tough. So you got to fix the anemia, and you got to fix that heavy menstrual flow for sure.

Evan Brand: Would you say this is a functional problem, meaning if you go to your doctor and you’re getting conventional bloodwork done, it’s going to get missed or even on conventional bloodwork. Are you going to see certain things pop up? That would be a red flag to even a conventional doctor that they would see.

Dr. Justin Marchegiani: It depends. A lot of times conventional doctors aren’t going to run like a functional iron panel, they won’t run like ferritin or iron saturation or iron binding proteins. A lot of times they don’t do that they’ll run a CBC and they may look at RBC see if it RBC is below four or a hemoglobins in the elevens or dramatic rates in the middle Low 30s they may run that but it just takes a lot. Like the issue has to be a lot more severe for the RBC, hemoglobin hematocrit to be a problem. So, you know, I’ll run a CBC to see where you’re sitting, right? We don’t want the RBC below 4.2 we ideally want the hemoglobin in the 13th, we want to get in the upper Upper 30s. So we want to make sure that’s good. But if you’re using a late stage indicator, the problem needs to be going on for a lot longer to fix it. That’s the issue.

Evan Brand: Okay, let’s go into symptoms briefly. I think this would be helpful for women because they’ll say okay, menstrual irregularity, you know, what, what do you how do you classify that? And then what symptoms would be associated with this? Are we talking to typical PMS issues where, you know, there’s breast tenderness stuff, or are we talking where the the cycle is changing? Where, like I mentioned, you know, some months it’s 28 days, others it’s 36 others, it’s 17? Are we talking headaches? What are we talking?

Dr. Justin Marchegiani: Yeah, so let’s kind of get a couple. Let’s get some terminology stuff out here. First, I find it I’m not sure if It’s an educational issue. I speak to a lot of women, I say how long is your cycle? And the first thing they tell me is how long they man straight for. So it’s this weird kind of disconnect. And I think it’s just people aren’t really educated in school about this. People, most people conflate their cycle is to how long they men straight. So a woman’s cycle is their entire hormonal cycle. Usually it’s 26 to 30 days right from day one’s the first day of leading to the next day one. That’s their whole cycle, right, which is built on a follicular phase right where the follicle grows, and estrogen predominates. It’s built on oscillation where estrogen predominates and progesterone rises. That’s oscillation and that it’s built on the luteal phase, the last half. So think f follicular first, think l luteal last, okay. And then luteal is where progesterone predominates. And a lot of the cycle irregularities may happen because of estrogen bouncing around or progesterone being either too low or dropping out too soon. And so when we talk about a woman cycle, that’s the full cycle when we talk about menstruation. That’s the period right? So most women they confuse menstruation and cycle length. So menstruation is when flow is happening period blood flow, and the cycle is going to be the entire length of that hormonal rhythm day one the first day they’re bleeding blood flow to the next day one, that’s your cycle. So just from a terminological standpoint, so when we’re looking at the heavy menstrual flow and a lot of the irregularities, it tends to happen a couple of days to even a week before we have blood flow. And of course, some women when there’s a lot of estrogen dominance occurring in that progesterone drops out too soon in the cycle and I’m doing a lot of hand gesture stuff so people are aren’t quite following on the auditory side. We’ll put the video link below so you can see the video. But when that progesterone drops out a little too soon in the cycle, that’s where we have a lot of menstrual flow. And this can really mess a lot of women up because of what I said earlier. You’re going to have a lot of low iron here, low low iron, low hemoglobin, and then you’re ability to carry oxygen really get some hair, and that’s gonna make it harder to generate a Robic metabolism and support the mitochondria. Mitochondria needs oxygen. So we need that. So that’s one of the collateral damages of menstrual irregularities is the menstrual flow. And then of course, other things can happen like irritability, breast tenderness, back pain, mood issues, brain fog, but the key thing that that’s going to happen after that is going to be a lot of that blood flow driving the anemia and the low iron, low hemoglobin. And the I was-

Evan Brand: I would Oh, yeah, I was gonna say the fatigue is probably the big one, right? Maybe exercise intolerance. These are women that they feel like they have to do some exercise. Maybe they’re pushing themselves hard, but they just don’t feel like they have enough gas in the tank to get the exercise done. It just feels abnormally difficult to do physical things. And then hair loss is big too. I mean, we’ve seen countless times on bloodwork where women will show up with really low ferritin. And they’ll say that every time they take a shower, I mean they’re losing a clump of hair, you know, per shower, and that’s just insane.

Dr. Justin Marchegiani: Yep 100% 100% so it’s always really good to take a look and test where you’re sitting during the luteal phase like right around day 21. The 22 is usually a good time to test where that progesterone sits to make sure it’s high enough. If you’re having a lot of heavy bleeding early, a lot of times that progesterone just falling out a little too soon in that cycle. And so we may support there’s a lot of stress, we may support the hypothalamic pituitary, go Natl axis, right that’s the brain talking to the to the gonads or to the ovaries in this example or to the adrenals. So we can support adequate levels of progesterone output. And we may use herbs like you mentioned shepherd’s purse, we may use things like chase tree, we may use estrogen modulators like Don Chi or black cohosh may use things like that we may use special phenotypes of Makkah, we may even use byway denticle progesterone as well to kind of carve out and work on supporting that healthy female rhythm too.

Evan Brand: And What led to these issues in the first place? I mean, we’re talking just age, we’re talking stress, we’re talking pregnancies having babies, like the xeno estrogens in the environment. I mean, what are you thinking are some of these big triggers?

Dr. Justin Marchegiani: Um, so in regards to the biggest trigger, in my opinion, is going to be the fact that progesterone can make cortisol. So when women get stressed, their stress hormone is cortisol. So they’re going to take a lot of that progesterone, and they’re going to, they’re going to pull it from their cortisol. All right, I’m sorry. They’re going to take a lot of progesterone and they’re going to pull it down to cortisol. So then that starts to skew the relationship. So stress, takes progesterone shunts it downstream to cortisol that can create some functional estrogen dominance, okay. Number two is just they’re depleting a lot of their cortisol output from the adrenals. And their adrenals are, you know, are making some other hormones but there’s needles are just more depleted. That can be a big thing too. And then three would just be potential Xena And exposure, there’s three big variables there. That’s gonna be from pesticides, right? These chemicals, they kill plants by disrupting their hormonal system and nervous system. So that’s one. Number two is gonna be plastics. Plastic does you know estrogens, right BPA or even some of the BPA free ones have other types of xenoestrogens that aren’t good. And the third one is going to be hormones and meats, animal products were to dairy milks, beef, chicken, right, just the hormones that are given to the animals to fatten them up. And so it’s going to be plastics, pesticides, and hormones in the meat and animal products. So those are the big ones. So of course, eating organics and to be good. Using Pyrex, or glass containers is great, especially when heating plastic isn’t that bad, as long as everything’s cool, and isn’t in the sun, not as big of a deal. Once it’s in the sun and you’re heating it forget about especially a microwave forget about ovens. Obviously, that’s a no brainer. And then of course, um pesticides and pesticides could be in the food Okay, so organic helps that it could also be in the water. So high quality water filter, reverse osmosis, or at least a carbon filter will filter a lot of that junk out.

Evan Brand: Yeah. And people listening, they may say, God, why does everything have to be so complicated? It’s like, Well, we’ve just changed a lot. I mean, you mentioned the adrenal thing. Women now where historically they were in the tribe, and they had other women to help with the kids. Now you’ve got the stay at home mom, parents-

Dr. Justin Marchegiani: -and grandparents, man. Yeah, I mean, that’s back in the day. Think about it. grandparents would be like in their 40s and 50s, probably right. You have kids in your late teens, your kids would have kids in their late teens, that puts you like, you know, that puts your grandparents in their in their 40s, early 50s. And typically, you know, you’d be out earning a living paying for the home and maybe rearing the kids a lot, maybe taking care of the kids. So there was a little bit less stress on the child rearing aspect of it, because you had someone there. And then typically, you didn’t have a big mortgage, you didn’t have all this. So usually One income was enough. So then, you know, one person could help out with the family, grandparents helped raise the kids, one person required for the income. So there wasn’t a ton of stress. And the income back then could be hunting. Right? It could be hunting or fishing, right? It could be doing something that were just really providing food and shelter. And that’s it. That’s all you need it. So our society has evolved and changed, and there’s a lot more financial stress, and some people have to have two incomes to survive to and, and grandparents are older and have their own health issues and can’t really participate on the day in day out of raising kids. So a lot of good things have shifted.

Evan Brand: Yeah, well, then you go further back, and before there was even bills and currency and you had the tribe that was hanging out with each other where you’d have, like you said, multi generational tribes, and then you would have potentially other people that are related somehow or maybe not related. They’re just part of the tribe. And, I mean, you read about these, you know, hunter gatherer societies where you’ve got women that would sometimes be nursing the children of the They’re not theirs, you know. So there must be a shared motherhood experience. And now you’ve got the stay at home mom driving the minivan with the three, four kids running them to the park and then doing the groceries and all that alone. So, you know, I think a lot of the social isolation aspect is really big for this stress component you’re talking about with this whole pregnenolone, progesterone, cortisol, everything getting robbed and diverted. And, yeah, I mean, it’s like, it’s a big hormonal chaos, really. And it’s because the, we know, there was actually a study done on that isolation issue. And that isolation, being socially isolated, was comparable to like smoking a pack of cigarettes a day. In terms of the the toxicity, we’re just not, we’ve never been a species like this. And now with shutdowns and everything going on, you’ve got people even more isolated. I mean, I have a client who’s a therapist, and she said, Man, everybody’s a wreck. And I said, What do you mean? And she goes well, because everybody’s separated from each other people are afraid to be next to one another. She said, I’m hearing all sorts have new symptoms for my clients. I thought Wow, that’s really interesting. So what’s the remedy? Well, you mentioned some of the herbs already some of the adaptogens will use and maka extracts and shepherd’s purse and wild yam and cohosh and chase tree and all those things are amazing. But I think at the end of the day, you’ve got to try to build some type of a community. You know, like Facebook, moms groups are one thing, but you actually have to have like an in person, place where you can sit down with other people have a conversation, you know, let somebody else handle the kids chaos for a minute. While you can just relax. I think we’re all just stuck in fight or flight. And that’s really one of the big root causes is our nervous systems are just so turned on. And especially if you’re watching the news, you’re not turning off. And I think that’s a big root cause outside of the environmental dietary pieces.

Dr. Justin Marchegiani: Yep, I totally agree. There’s some data also Showing that there’s more relaxing, which is a hormone produced by women’s bodies that can relax a lot of the ligaments and tendons. There’s some data showing that there may be more ligament laxity in the last half of the cycle where progesterone is. So just be careful of over exercising or doing too strenuous exercise. During the last half of the cycle. Just keep that in the back of your mind exercise stress could be a big one. We don’t want to be over exercising that’s important. Of course, nutrient density is essential. So nutrient dense, anti inflammatory, low toxin foods are going to be key one because we provide building blocks and two hormones are made from good high quality cholesterol compounds and cholesterol is connected with animal products and that’s usually connected with fat soluble vitamins at Okay, so we got to make sure all those foods are dialed in egg yolks. High quality grass fed beef by the grass that are by last night with some organic green beans was wonderful, right? So you can do all these things with the food good paleo template and you know, line up your macronutrients according to what you need. As a woman, if you’re more of an ectomorph, you’re more lean, you’re more skinny, you may be able to handle some more starch starch on the reg. Right? Every day, you can handle more starch. If you’re more on overweight, you may have to lean more on your non starchy vegetables and less fruit and starts maybe some but just a little bit less. So really get your macros dialed into.

Evan Brand: Yeah, I would say on the supplement side to one thing we didn’t mention would be like calcium D glucoerate could be really helpful. And then also, you know, since we haven’t gone down the rabbit hole yet on this podcast about it, you know, we could briefly mention the gut and how the gut is involved in these hormonal issues and how we’ve had many women that have had issues with their cycles that have spontaneously resolved just by fixing gut infections because we’ve hit on this idea of the beta glucuronidation enzyme being elevated, which causes the research ulation of toxins and hormones due to bacterial overgrowth. So if you’re having menstrual irregularities and you’re not addressing or looking into your gut, you know, you could work on the diet piece all day and still have issues. We have many women that have come to us that they’ve done a great job on the diet. But there’s still suffering. And so that’s where we dig deeper. And then something like calcium D glucorate may be used. And it can do a lot of good really, really quick with the detox piece, even for mold. It’s been helpful.

Dr. Justin Marchegiani: Yeah, so when we test a lot of these, we’ll do a Dutch test. And we’ll look at things like right around day 20 or so. So we can see where progesterone peaks out. And we’ll also look at estrogen levels and ashra metabolism. We’ll look at two methoxy, two hydroxy. Estrogen we’ll look at methylation markers. We’ll look at pirate glutamate, including violence that can give us a pretty good window for impaired on the detoxification side and we can add in phase one, phase two detoxification support whether it’s B vitamins and antioxidants, or sulfur amino acids, or extra binders or extra vitamin C or extra fibers to kind of bind up some of that that’s a really good option to therapeutically support detoxification, as well as just to help excrete extra hormones that may be laying around from some of the other reasons we chatted about.

Evan Brand: Yep, absolutely. So the testing piece, you know, Dutch is going to be important. I would say stool test is going to be amazing. Blood panels could be important. You know, if we did have a history like heavy bleeding, we’re going to look into ferritin do like a full iron panel, potentially thyroid could be important as well. organic acids. I mean, I would argue that be important too, we always run those for looking at the gut piece, the mitochondrial piece, if a woman’s complaining of, you know, major fatigue associated with this wells is related to the iron ore is is related to possibly the mitochondria as well that have gotten damaged by some sort of toxicity issue. So I think those would be top priorities. What about anything else? Are there any other tests that you would you would run to investigate this issue?

Dr. Justin Marchegiani: Well, if there’s a lot of insulin resistant issues, insulin is a big one. So carbs are out of out of whack and they want to look at insulin levels, make sure they’re closer to five, five to sevens ideal. They’re too high, there could be some resistance going on. Of course, I always get worried about pcls right. pcls is primarily driven by high insulin and then that can cause elevations in androgens and testosterone and that can also cause an increase in something thing called prolactin and prolactin can start to dis regulate the HPA axis that can kind of dis regulate the cycle. And again, that’s all supported by getting blood sugar stable, right. dysglycemia is a major hormonal stressor. And I asked them and don’t, don’t jump into hormonal stress and start fasting and doing all this stuff. Get your blood sugar relatively stable, you know, make up proteins and fats as the foundation of your meals. And make sure make sure 100% you’re getting enough nutrition, go look at go look at your chronometer, or My Fitness Pal and look at your calories. Make sure you’re getting enough. Make sure those calories are all nutrient dense, anti inflammatory, low toxin. Make sure you’re getting enough magnesium and potassium and high quality minerals. Very, very important.

Evan Brand: Well, you said it quick. So let me just restate it and confirm to make sure it’s clear. You’re mentioned you’re mentioning fasting as potentially being a big stressor that could make this situation worse, correct because you’re saying if a woman’s already nutrient deprived, or she’s having major issues Potentially too much blood loss. Fasting is something that could throw off blood sugar balance. But also, as you mentioned before, there’s no nutrition and starving. So you’re saying in this case, three meals a day maybe better than doing a fasting protocol?

Dr. Justin Marchegiani: Yeah, the problem with fasting fasting can help when there’s insulin resistance, but one there needs to not be a lot of blood sugar stress meeting up and down, right? So people think like, oh, if I have blood sugar issues, then fasting is great. Well, not if there’s display see me because this glycemia means your blood sugar’s up and down and up and down. And every time it goes up, your pancreas kicks in every time it goes low, your adrenals kick in with cortisol and adrenaline. So there’s stress on those glands. So the problem with that is you want to make sure you buffer that with healthy proteins and fats, it’s like putting a fire going and having putting, you know, twigs and paper on it. If you ever started a fire that way, you’d be feeding the fire every 30 minutes to an hour or even more because the fire would burn out fast. So a log on the fire that stays For hours, it’s like proteins and fats. And most women, they metabolically keep their fire going with twigs, and paper and gasoline, and you just can’t you’re going to be next to the fire all day. Those are your grazers, okay? Or if you’re trying to fast, well, eventually the fire is just not on you’re going to get cold, ie your metabolism is going to decrease. And if you’re already nutrient deprived, and now you’re fasting and not getting enough nutrition, that’s a problem. Now, of course, if you’re going too fast, and you’re compressing your feeding window, the key mistake is not getting enough nutrients. So you have to get enough nutrients. Now, if you’re doing it a day or two a week and you’re already healthy, and you’re getting an overabundance of nutrients those other five days, of course, you get your body can handle that right. But most aren’t in that over abundant state, they’re already depleted. And that’s where it’s a problem.

Evan Brand: Yeah. And you’re mentioning the grazers. I mean, these people are not grazing on grass fed beef jerky, typically they’re going to be grazing on, I don’t know, maybe some gluten free pretzels or something. I mean, it’s going to be more of a A process thing it’s not going to be. I mean, maybe it is maybe you’re grazing on macadamias or something like that, and you’d be okay. But in general, you want to be able to have three solid meals per day. I find, once women do actually calculate how much they’re eating, most of them are under eating.

Dr. Justin Marchegiani: Most are and then also, I’m not a big fan of snacks. Snacks typically mean a carbohydrate, primarily a carbohydrate macronutrient balanced meal, it’s smaller, and it’s primarily carbs and it’s usually not enough. And a lot of times snacks can be used to compensate for a poor meal previously. So I like the word mini meal, because it provides a there’s a balanced like a meal, meaning there’s some protein fat, maybe a little bit of carbs in there. Ideally, you’re doing a mini meal because your next meal is just a longer gap. So like if you had lunch at noon, but you and your husband are going out to eat at seven, well that may be a little bit long for you. So maybe you want like a good protein, fat, kind of keto bar here or a little more Any smoothie like around five o’clock, right? to kind of give you a little bump so your blood sugar doesn’t go super low until you feel good. Now if you’re healthy, you could maybe be able to handle it if you have blood sugar issues, and maybe a little mini meal is good right there to provide balance. Does that make sense?

Evan Brand: Yeah, it does. It does. And you’re mentioning to like the meals should be nutrient dense enough to where you shouldn’t have to snack But yeah, I mean, I don’t go much more than five hours. I will start to get a little shaky if I go six, seven hours. It’s too much for me.

Dr. Justin Marchegiani: Yeah, also just go to chronometer, man, just try to like put a sample me at like people that do omad stuff one meal a day. I’m like, dude, go to chronometer and put all the things you have to eat in that one meal and you tell me if you’re getting six to eight servings of vegetables, you tell me if you’re getting a pound and a half of me, you tell me if you’re getting that much fat, it’s really hard. Like, you’re going to literally be eating like eating probably for over an hour like eating chewing. It’s probably gonna be hard. Oh, yeah. Really full and you’ll probably take a break. That’s why two meals is doable, but you really have to be like There can’t be slack in the meal. It’s got to be a very intentional awesome meal. And you have to do it three meals. It’s relatively easy. Yeah, you know, you have two really good meals and one pretty good one and that you’re there. One is very hard. Yep. Yep. I would agree if you have tummy issues, if you have SIBO and you already have low stomach acid, well, now you’re just now you’re eating all that calories in one sitting. It’s like, Whoa, yeah. And how would you possibly digest and assimilate all that without having any issues to that’d be very, very difficult. It’s harder now people can do it if they have a really chill night and they can just sit around and relax for two three hours and in their lives aren’t that stressful, right? But in their digestion is really good. They can maybe get away with it, but I think minimum two meals is gonna just make your life easier.

Evan Brand: Yep. I just want to point out that if you have menstrual irregularities, you may need to come in and do some specific herbs to address those but sometimes this issue in the same category as many other issues we’ve talked about, where it gets fixed as a side effect of just getting healthy, just running you through kind of our functional medicine workup, supporting and looking at adrenal supporting and working on gut, the mitochondria, the nutrient absorption, the acid and enzymes, the probiotics, sometimes just those simple steps fix this. But if they’re having an issue that’s not resolved, then we can come in with these extra tools. Yep, that and vice versa. And maybe we should mention this to vice versa. You can’t just come in and do the chase tree, or the vytex, or the wild yam or whatever, and call it a day. You can’t do that either, because now you’ve ignored the issues that led to this problem in the first place, whether it was the glucuronidation pathway, or the bacterial overgrowth or the parasite infections and messed up the nutrient absorption which caused the nutrient deficiency which caused the hormonal issue. So you really have to do all of it. But I don’t want this to be Hey, let’s go to the hormone section at Whole Foods, buy a supplement and call it there. You don’t want to do that either.

Dr. Justin Marchegiani: Yes, you want to really get to the root cause of the food. stuff is important. We talked about some of the herbs we talked about even doing a kind of a cyclical augmentation kind of reset by using progesterone accordingly. And of course, we’re supporting the adrenals. The adrenals play a big part. So when I always test, when I test hormones, I’m always looking at female and adrenal together, they tell a really big role. And it’s nice to be a look at hormone detoxification. That’s really helpful too. Because it really gives me a window in all three sides of it.

Evan Brand: Yep. I think I’ve said all I need to say, do you have anything else you want to go into?

Dr. Justin Marchegiani: Yeah, so blood sugar, nutrition, right diet stuff’s very important. The gut plays a big role, because that’s where we digest and absorb all the building blocks to make our hormones. So if we have bloating or digestive issues, that could be a problem. Don’t just get myopic on the female hormones. Don’t you got to remember the adrenals play a huge role. So female and adrenals. And, you know, don’t jump on these fat things. Oh, just fast and do this and you’ll get better. You know, get your nutrition gets your blood sugar. Get it dialed in. And then if there’s things like iron, that’s a problem in the interim, you know, you really want to support that I have a product called Iron Supreme, it’s a bisglycinate iron. That’s a really better iron ore. If you’re more sensitive, a high quality liver, glandular is great. And then obviously eating a lot of high quality red meat before and during menstruation if flow is heavy, just to really make up some of that extra iron if needed.

Evan Brand: You know, good news is you can reverse this is not something you have to live with. So like I said, in the beginning, many women just kind of live with this and they just know hey, I’m quote messed up, you know, my cycle does this or that and they just live with it. But you can get it resolved to where if you track it on an app, I mean, my wife, she’ll track it on an app, and it says, cycles supposed to start boom 28 it’s 28 day cycles. So you know, and before due to birth control and other issues, I mean, her cycle was not always perfect. So you can fix these things. You can adjust them you can modulate them and there is hope.

Dr. Justin Marchegiani: 100% so if you guys want additional help and support, we are available worldwide. Feel free to head over to EvanBrand.com you could schedule a consult with Evan or JustinHealth.com you could schedule a console with myself we’re there to help you. Click down below for links and if you enjoy the content give us a review we really appreciate it EvanBrand.com/iTunes, JustinHealth.com/iTunes, and share with family and friends. And we appreciate you guys for joining. Take care y’all.

Evan Brand: Take care. Bye now.