Lowering Histamine Naturally – Getting to the root cause of high histamine – Podcast #154

Dr. Justin Marchegiani and Evan Brand engage in a discussion about histamine. Listen as they talk about finding the root cause and driving factor of the issues related to histamine. Learn all about the symptoms associated with histamine issues and find out how problems with the adrenals, hormones, gut, diet and lifestyle contribute to these issues.

Know how some of the medications like anti-depressants, immune modulators and beta-blockers are related to nutrient deficiency. Gain information regarding higher histamine foods and natural supplements. Apply some of the natural solutions and recommendations regarding diet and lifestyle that would address histamine issues.


In this episode, we cover:

04:12   DAO& HNMT: role in our bodies

08:13   Medications and nutrient deficiencies

10:38   Higher Histamine Foods

18:39   Natural Supplements to lower histamine

21:57   Toxic mold

28:42   Diet and Healthy enzymes






Dr. Justin Marchegiani: And we are live on YouTube. Evan, to it’s Dr. J here. How are we doing today, man?

Evan Brand: Hey, man, Happy Wednesday! You and I have been pulling out the research books today. We’re like, “Hey, let’s make sure we know everything as— as much as possible about histamine.” A few have been asking you, asking myself, you’ve done interviews with histamine experts and what was it, the histamine chef is that who you chatted with?

Dr. Justin Marchegiani: Yeah. Yup. Yasmina Ykelenstam. She’s the histamine chef and we did a podcast last year on this topic. And uhm lot of good stuff, we’re kinda rehash some of the key take homes, we’ll talk about getting to the root cause and we’ll also talk about ways that we can supplement and just support histamine issues in general, more specifically.

Evan Brand: Yeah. So what you and I were talking about affairs. We— we don’t really market ourselves necessarily, it’s like, “Hey, histamine practitioner” There’s a lot of people the kind of attached the word “histamine” to their name or to their marketing efforts, but, you and I, as we start to dig deeper and find root causes of the histamine intolerance which we’ll talk about exactly what this means, we’re fixing histamine intolerance just as a side effect of doing all the other good work we’re doing to support the adrenals and support the immune system and ensuring that people are free of infections and fixing neurotransmitters like all the stuff, Oopp, it just happens to fix histamine intolerance.

Dr. Justin Marchegiani: Exactly. Like in the functional medicine world, you know, there is ways that you can market to so you can kinda row people in specifically coz you talk to their issues, but again, if you really are a good functional medicine practitioner, clinician, you’re hitting all of the body system. So in general, you’re not gonna really miss anything but there are ways that we can dive in deeper to issues such as histamine. And we’re gonna try to do that today. We’ll kinda zone out a bit. So we have like the big picture perspective, so people don’t forget what the root causal things that can’t be ignored are, and then we’ll also talk about you know, palliative things we can do on top of just the—the functional medicine principal stuff to get even better results.

Evan Brand: Sure. So should we start with some symptoms? What exactly people are noticing when they’re coming to us and they’re saying, “Hey, I think I have a histamine issue and I believe it could be coming from my diet.” We’ve got symptoms like headaches, could be anxiety, it could be your face flushing, it could be an itchy tongue or runny nose. What— what else am I missing symptom wise?

Dr. Justin Marchegiani: Yeah. Headaches. All those different things. It could be flushing, it could be even hives or the eukaryotes, those wheels that come up on the skin uhm— those can be all, you know, things that are happening. And again, what’s histamine doing? Histamine is a neurotransmitter. And there are various receptor sites for histamine in the body. There’s you know, H1 or histamine 1. Histamine 2, 3 and 4. And again, these things can control for instance, smooth muscle and endothelial tissue that affects blood vessels. This is what like Benadryl and like Claritin would—would utilize. So if you have like an allergic reaction and like your skin get super blown up, right? That’s why you do like Benadryl, right? Or histamine two controls acid secretion and abdominal pain. So histamine can also increase acid as well. It can also increase the heart rate. Histamine three has an effect on controlling the nerves, sleep behavior, appetite. Histamine four has an effect on the intestines, the spleen the colon, white blood cells and the inflammatory response. So it’s kind like this, right? You take your hammer; you whack your thumb, and all of these different reactions that happen, right? So you can look at all of the clotting factors and the cytokines and all of the inflammation and the white blood cell mobilization. And if you just kinda zone back, zone back, zone back, what caused it all? The hammer. So we’ll kinda zoom in, alright, what’s happening and the nitty-gritty, but then we’ll kinda zoom out and say, “Okay, what’s the hammer in this analogy?”  Coz if we can focus on the hammer, it’s way easy to wrap your head around, “Don’t whack your hand—don’t whack your thumb with a hammer than it is to look at all of the nitty-gritty. But we’ll kinda do both. So people that are looking to nerd out a little bit, kinda get satisfied and the people that just want the action items get satisfied, too.

Evan Brand: Sure. So let me just pronounce what we’re actually talking about. Diamine Oxidase also known as DAO, so basically, this is an enzyme that we’re making on our own in our body which is basically just like when we’re talking about proteases and lipases and lactases and just different digestive enzymes. DAO is an enzyme that’s basically going to find, it’s gonna seek out like the CIA, it’s gonna find the bad guy which is gonna be excess histamine in your foods and it’s can help break those down it could be foods or beverages so we’ll talk about the alcohol component in DAO when it works properly, it can break down up to 99% of the histamine. And then there’s 1% of histamine that actually enter circulation but we’ll talk about some of the root causes here. There could be going on with the gut. When you’re deficient in DAO, which is why you can supplement, which Justin told me off air, “Man, this stuff is sold out everywhere.” But when you’re supplementing with it or you’re fixing the root causes, and your getting your DAO in time to be back in adequate amounts, you’re able to break down the histamine and you no longer have histamine intolerance, which is why people can take DAO supplements and they can feel better but you’ve always got to work back to the root cause of other issues why is it not working in the first place.

Dr. Justin Marchegiani: Yeah. It’s also this DAO which is Diamine Oxidase and there is also another one called HNMT Histamine N-Methyl Transferase and these both have an effect of breaking down histamine. So if we take off our functional medicine root cause hat and we put on our palliative natural medicine hat, we wanted to just control symptoms, well, we can give enzymes like DAO which has been backordered for years. They are typically extracted from kidney or thymus tissue and big back order for a while, but we can give those to help lower histamine, alright? Coz that enzyme helps break histamine down so, you know, it’s like someone that has a lactose intolerance issue, they may take Lactaid which is milk enrich with lactase, the enzyme, right, to break down the milk, the milk sugar and they have less diarrhea. So kinda into that perspective where we’re adding in the enzyme to be able to break things down uh— which can be helpful from a palliative perspective. Uh— number two, we can avoid— we can make sure we have all the nutrients required to make a lot of these enzymes. So like the HNMT enzyme, we need SAMI, right? We need SAMI, S- Adenosyl Methionine which is really important for MTHFR. Uhm the Diene Oxidase we also need B6, we need copper, some of these other enzymes to for histamine processing, right? We need B2; we need iron; we need B5, right? And a lot of these nutrients we’re also gonna deplete with adrenal dysfunction, too. So you can see how adrenal issues and low histamine can be affected. Anytime you see B vitamins we know how important healthy gut bacteria is for producing B vitamins. So you can see, if we have a dysbiosis or SIBO, we have food allergens driving inflammation, driving leaky gut and/or gastrointestinal permeability, that can all affect our ability to make enzymes to lower and process histamine.

Evan Brand: Well said. So any gut infection, I mean, Justin and I that’s one of the things that we work on so much because it’s so common you probably heard our stories but, you know, I had H. pylori, I had parasites, I had bacterial overgrowth, I had yeast and all that’s driving leaky gut. So if you got something like H. pylori, for example, which we see every single week on lab results when we’re looking at people, the H. pylori is going to suppress the stomach acid and so if you’ve got undigested food, even that alone, could be causing leaky gut, therefore causing low DAO, therefore causing you to have “cortical histamine intolerance”. So if you work with a practitioner on histamine, we’ll talk about the diet piece in a second, but you’ve got to get the gut in healthy spot. You’ve got to fix the—the diet. Make sure that the gluten is out of the diet, or anything that could be causing a leak ego situation; otherwise, you’re just setting yourself up for failure. And then, surprisingly enough, which maybe you know more about this than I do, but it’s interesting that a lot of these medi—medications, I don’t know the mechanism but like antidepressants like Cymbalta, Prozac, Zoloft, you’ve got the immune modulators like Humira and Enbrel. You’ve got the Metaprololol, the beta-blockers; you’ve got Zyrtec and Benadryl. All of these things are causing the DAO enzyme to become deficient. I mean I guess the mechanism isn’t too important but it is interesting.

Dr. Justin Marchegiani: Well I think some of the mechanism pretty straightforward. Uhm— a lot of this is via nutrient deficiencies. A lot of these medications create nutrient deficiencies and a lot of these nutrition these nutrient deficiencies and a lot of these nutrition deficiencies revolve primarily around B vitamins and minerals. So it makes sense. If we create deficiency with B vitamins and minerals, of course, that’s gonna create more issues. I mean it’s like blood pressure. If you look at the acid block—the beta-blockers or the uhm—water pills like hydrochlorothiazide or the Lasix.

Evan Brand: Yup.

Dr. Justin Marchegiani: They are either diuretics but they create deficiencies with potassium and magnesium, which are really important for blood pressure. So you can see a lot of these drugs actually can make the problem worse. It’s an amazing business model if you’re only looking at you know the money factor, but if you’re looking at fixing the root cause, like we are, it’s definitely not good. You wanna really back up.

Evan Brand: Agree. Well said. You wanna talk about diet?

Dr. Justin Marchegiani: Just to kinda—just to kinda back out just a little bit. Uhm—we talk about the nutrient deficiencies, right? We talked about medications and antibiotics, antacids, antihistamines, right? Uhm—We talked about uhm—well, I’m gonna add it, nutrient stressors. So if we have more stress, more adrenal stress, more fatigue, poor sleep, inflammatory diet, that’s gonna drive more in a higher increase in histamine. If we have hormonal imbalances whether we’re estrogen dominant or that we have adrenal dysfunction, right? Imbalance in our stress hormones, cortisol, rhythm issues, a lot of that’s gonna be driven by a lot of these lifestyle stressors. That’s gonna really create more histamine issues. Now, I always backup. How do we know someone has a histamine issue? Well, do they have any of those histamine symptoms we mentioned in the beginning? Coz we know histamine does a few things. It helps increase heartbeat; it helps with gastric acid secretion; it opens the blood vessels, hence why when, you get allergies or allergic reaction, you swell. It helps increase bronchial dilation; it helps with gut permeability; it increases adrenaline. But if people get headaches or flushed or rashes or headaches with higher histamine foods, we definitely take notice. And those higher histamine foods, the big one, is going to be fermented foods. Do you get worse with fermented foods? Do things like teas create, you know, problems? If you have bone broth, does that create problems? Does citrus fruits create problems? Do meats over, you know, they’re too old, create problems? Uhm—does chocolate and coffee create problems? So if we start seeing issues with some of those symptoms, I really look a little bit closer to see what could be the driving factor.

Evan Brand: Yeah. I’ll list down a couple of more, too. Kombucha—that’s gonna be popular for our crowd, our community.

Dr. Justin Marchegiani: Yup.

Evan Brand: Yogurts, even if it’s like a grass-fed yogurt, your sauerkraut, if you’re having flare-ups, I’ve had some women that said have flare-ups on their skin after doing sauerkraut, that’s a sign right there and then alcohol, too. So wine, beers, champagnes even if it’s organic wine, it’s not gonna matter. Cured meats— so salami, could be pepperoni, the beloved bacon—bacon an issue, unfortunately for the time being. You mention the citrus fruit, aged cheese and then nuts— walnuts, cashews, peanuts, avocados. I believe— I don’t know if it was histamine, but I had something going on where I had to pull out avocados for like six weeks. I was having headaches from them. It was no other foods. It wasn’t any other nuts and seeds but I believe I had—I’m gonna guess a histamine issue because why else would avocados give me a headache?

Dr. Justin Marchegiani: Oh, exactly. Yeah, totally. So—

Evan Brand: I was doing like everyday they’re so good and so easy to add to a meal, so.

Dr. Justin Marchegiani: Totally. And then we also have things like mast cell activation disorder, right? Histamines produced by mast cells, so you got these like basophils, which are like in our white blood cells, right? They’re like one of the smallest amount of white blood cells are basophils. And these basophils go into our blood straight to our tissue. They become uhm—mast cells. And these mast cells will produce histamine, alright? So then you have this thing like called mast cell activation disorder. So like the more inflamed you become, right, the more your body tends to dysfunction. And—and you get more names for that kind of inflammation whether it’s IVD or IBS or mast cell activation disorder or some type of you know, allergic issue or some type of autoimmune issue. You can just go through all the different names. The more inflamed someone gets, the more symptoms. And basically diseases are nothing more than grouping a constellation of symptoms together. That’s why it’s funny when people tell me, “I just need a diagnosis.” Well, a diagnosis is nothing more than someone in the medical field taking a set of symptoms that have been, you know, trace for you know, many, many years into a disease name and someone studied and published. But it doesn’t do anything, it just basically groups these symptoms together and maybe there’s a drug for it, which is typically how a disease, you know, gets name because of the drug or treatment for the most part. But in the end, does it really help you fix the issue? A lot of times, “No”. But it gives people relief to know that it’s something, but again, if you’re depressed and you’re stuck on antidepressant your whole life, well, do you really feel good about that if you’re not fixing the issue? Maybe not.

Evan Brand: Right and I had a—I had a diagnosis of IBS, right?

Dr. Justin Marchegiani: Yes.

Evan Brand: We have no idea what’s going on but here’s some acid blockers I was never talked to about the root cause ever. So, for me, if you’re seeking a diagnosis, I would just let that attachment go because you really don’t need a term for the symptoms. We just need to figure out what’s going on. So, you mention the diet piece, we hit the gut piece, we hit the—

Dr. Justin Marchegiani: Adrenal and hormone deficiency, too, I think.

Evan Brand: Say that again.

Dr. Justin Marchegiani: We hit the adrenal and hormone piece, too.

Evan Brand: Yeah. Adrenals. That’s very important. So, how should we go about this? I mean, we’ve— we put all the pieces on the table, now how should we arrange this kinda step 1-2-3-4-5? Diet first?

Dr. Justin Marchegiani: So, off the bat, I would say, look at like kind of like your histamine bucket or your stress bucket. Everything goes in that bucket. Some people—it just sucks, they are brought into this world with the poor genetic constitution and their bucket’s smaller. What that means is they just can’t tolerate as much stuff. That means, hey, if they got a little bit of gluten and a little bit of stress, their bucket is full. Some people can have a lot more things. They could have some medications in there, some stress and sleep, some poor food, some nutrient deficiency, and then maybe their symptoms start to increase. Now, again, over time, we naturally have a smaller bucket overtime because our hormones become less restorative the older we get. So we just want to make sure that we know that theirs is bucket mindset and the more we take stressors out of the bucket, we can make a small bucket uhm— we can add more space to it. So someone that’s got a big bucket but is three quarters full, well, if we have a smaller bucket that’s a hundred percent empty, we may create more resiliency for us, even though our bucket, genetically, is smaller. So we have control. We’re not victims. We just got to be honest with ourselves. If we got a small bucket, we just gotta be on point more frequently. So, we do that by working on blood sugar stability, we do that with the baseline Paleo template, that you can work on customizing with your functional medicine doc regarding what that looks like macro wise and whether or not uhm—you have to add an extra digestive support to be able to breakdown the proteins and fats that’s important. Now we can look at the hormones, if there are significant hormone or adrenal issues, we gotta work on it because that helps improve our ability to regulate blood sugar inflammation and stress. And then, we also got to look at our hormones, too. We have significant hormonal imbalances, we have to work on supporting that so we can develop our healthier cycle or healthier anabolic hormones. We could put on muscle and recover. And then, of course, this goes without saying, gut issues. Coz if we have dysbiosis, leaky gut, we have chronic infections like H. pylori or Blasto or Crypto or Entamoeba histolytica or Giardia. Any of these parasites are gonna create leaky gut. They’re gonna create more nutrient deficiencies. And a lot of these nutrient deficiencies are needed to make healthy DAO or HNMT enzymes to break down histamine. And these enzymes, all these nutrients also help make healthy uh— nutrients for a detoxification system as well.

Evan Brand: Well said. So you got to get tested. That’s our philosophy—Test, don’t guess. I mean, you could probably fix maybe 50% of the issue just by working with a good nutritionist, their practitioners are gonna help you dial in the diet, right? Just getting that piece started even if you’re closer to an AIP approach, you are already gonna be eliminating a lot of the problematic foods including alcohol. So if you’re working with a nutritionist, you make it 50% there, but to get fully better, adrenals— test them, we’re gonna run the stool panel, we’re gonna look for infections that way. We’re gonna look for a lot of problems on the organic acids, too. Fungus, yeast Clostridium bacteria, uh— detox problems. I mean, all of that is a factor, so there’s never gonna be just one silver bullet. If somebody tries to sell you my online histamine course and there’s like one silver bullet they’re promoting, I would be skeptical because like any topic we discussed, there’s 20-30 maybe 50 factors that all need to be factored into that pie chart which is the pie chart being your problem. How is that problem broken down? Maybe it’s 50% adrenals for one person, but it could be 5% adrenals for another person. If they’ve got a super positive attitude about it, that could change things, too.

Dr. Justin Marchegiani: Exactly. So we fix the nervous system stimulation, the stress— that’s the diet and lifestyle,  that’s also the adrenals. We fix the gut bacterial imbalance, which could be infections, it could be just low beneficial bacteria. We cut out the high histamine foods. We cut out the histamine blocking, the DAO blocking foods: coffee tea etc. And we try to add lower histamine, paleo foods, in the meantime, which typically are gonna be uhm— low sugar fruits, the citrus-free, typically vegetables are gonna be okay, uh—typically fresh meats are gonna be okay. Healthy fats, maybe minus avocado, are gonna be okay. Uh— avoid the—you know, the aged meats and fermented foods for a period of time. But as we get the gut healed and we fix these issues, we should be able to get better and better and better. And then there also additional supplements we can add in as well. They can make a difference. So in my line, we use one called, Aller Clear, that I formulated that has things like, stinging nettles, it’s got promalin, potassium bicarb uh—these are things that have been used for a long time to help lower histamine naturally. Uhm— big big fan of that. Uhm—let’s see. What else can we do on top of that? I got my list here. Quercetin, like I mentioned, vitamin C, these are in Aller Clear as well to help lower histamine levels naturally. Well I also did a research on that. Grapefruit, seed extract and pycnogenol, which are in these kinda category of league Proantothocyanidin which are these kinda antioxidant bioflavonoid and some of these really good uhm—fruits that can be helpful. We have green tea. Again, it can be a natural antihistamine but can also be a DAO blocker so you got take that with a grain of salt. Uh—magnesium can also be very helpful, stinging nettle can helpful, omega-3 fatty acids uh—can be helpful, uh— some essential oils— peppermint, lavender, lemon can also be helpful. Again, but be careful because some of them are citrus there. You just got to test it out. And of course, a lot of the herbs to help knock down dysbiosis can help in the long run so like the berberines and the goldenseal can also be very helpful as well. So a lot of different alternatives there. Any other comments or concerns, Evan?

Evan Brand: Yeah. I’m guessing some of the medicinal mushrooms can help, too. I’m  not too familiar on the exact mechanism, but I’m assuming things like reishi, cordyceps mushrooms. I’m guessing those may help too depending on how they were grown, of course, uh—would probably make a difference modulating the immune system can be helpful.

Dr. Justin Marchegiani: Absolutely. Is there any other questions or comments you wanna add before we start hitting up some of our listeners questions. I don’t think so. Let’s hit the questions. I’m gonna pull them up, so I can see here, too.

Dr. Justin Marchegiani: Cool. And if you guys uhm—putting comments in the live chat  if you can kinda keep the questions kinda pertinent to the topic, it always helps and again, right now, for answering your question and you like it, give us a thumbs up right now, give us a share, give us a like. We appreciate it. We get really pumped and motivated coz of that.

Evan Brand: Should you—should you interview—uh, not interview—Should you introduce us, I mean I don’t know, maybe we’ve got new people that don’t even know who are these two guys talking about histamine all of a sudden. Should we briefly do that?

Dr. Justin Marchegiani: Yeah. Absolutely.

Evan Brand: Alright. Tell us who you are.

Dr. Justin Marchegiani: Well, I’m Dr. Justin Marchegiani, a functional medicine specialist, a functional medicine Doc and yeah, I see patients all over the world and we work on chronic health issues, from hormone to gut, to detox autoimmune issues and you know, we’re trying to always get to the root cause so that’s me.

Evan Brand: Absolutely.  I’m Evan Brand, functional medicine practitioner and Justin and I been doing this— doing this hustle on the podcast for— for several years. We’ve got hundreds of episodes together and I also work virtually with people via Skype and phone. And we do the live thing because we get comments like this, so let’ dive in.

Dr. Justin Marchegiani: And we’re the real deal. We don’t get a script here. We’re, we’re on-the-fly taking our clinical knowledge and plugging it into you guys, so you guys, the listeners can get healthier which—which is our purpose here.

Evan Brand: Yup.

Dr. Justin Marchegiani: So off the bat, couple things, uhm— I just saw here, Dale made a comment here about toxic mold. So yeah, I’ll connect Dale’s comment to toxic mold. But yeah, mold can definitely be a stressor that can fill up that histamine bucket.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So of course, things that we use to help with mold is number one: good quality or filtration. If the house is really bad with mold, we got to get that remediated maybe even move depending on how bad it is. I never have someone move unless they can—they leave the house for a week or two and they’re like, “Oh my God, all of my issues got so much better!” And again, we gotta be careful because if you’re leaving for a week or two, it may be a vacation where you’re not –

Evan Brand: Yeah.

Dr. Justin Marchegiani: We gotta kinda like control those variables. Maybe you get a hotel room or you go somewhere else and you work outside of the house for a week. But if you notice significant improvement, there could be a mold issue. So air filtration can be good uh—do that little one to two-week test that I mentioned and binders such as modified citrus pectin, zeolite activated charcoal, liposomal glutathione these are all great things to use. A lot of the nutrients to help improve phase I and phase II detoxification. So, in my line, we use Liver Supreme or  antioxidant uhm— Antioxidant Supreme or  we’ll do Detox Aminos. which have a lot of those phase I and phase 2 nutrients. That’s very helpful there.

Evan Brand: Good. I just wanna double comment on that with the recent hurricanes that have hit people in Florida, Georgia, Texas, all the other states affected this mold issue is probably gonna be a lot bigger. A lot of people will probably try to remediate their old mold. Uh—one of my wife’s friend down in Texas posted a picture of her car, they got flooded in Houston. Her entire car, I believe it was leather, may be a fake leather, her entire car was covered in mold that look like a lab experiment, so—

Dr. Justin Marchegiani: Oh my gosh! Sounds terrible.

Evan Brand: So if there’s mold there, please please please don’t try to mitigate that stuff unless you’ve got like proper mask and all that coz you can make yourself sick.

Dr. Justin Marchegiani:  Totally. Couple of questions here. “What are the best herbs for parasites?” Again, I would go look at some of our parasite podcast, we dive into it. Again, in my line, we have GI Clear 1-6 that we use for herbs uhm—to help knock down these infections. Evan has some similar ones in his line as well. So you can check out either Evan site, evanbrand.com or mine at justinhealth.com for more information on that by clicking on the store button.

Evan Brand: Yeah. I’ll hit the second part of the question there. “Are herbs usually enough to beat up parasites?” The answer is, “Yes” We do not prescribe drugs herbs is what we use for bugs and yes bacteria fungus, yeast, parasites. With the right protocol, the right approach, all the other factors, yes, you can successfully get rid of it. I’m a success story. Justin is a success story.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And you know, thousands of people in our belts that we’ve been able to successfully eradicate parasites with herbs.

Dr. Justin Marchegiani: And just to highlight one thing, I think you put in there, but just to make sure any new listeners don’t assume it, we’re also factoring in diet and lifestyle changes into that because that is a massive effect on changing and making the immune system more resilient which has a huge effect on decreasing the chance of reinfection, too.

Evan Brand: Yup, well said, well said. Yeah, you can just take one magic pills, you got to do the hard work, too, which is putting a fork to your plate with good food on it, is organic as much as possible.

Dr. Justin Marchegiani: Totally. 100%. And then, again, some people here talking about H. pylori and SIBO and eradicating H. pylori, uh—they still have stomach issues. So I’ll connect this persons question to the issue. But if you have SIBO and H. Pylori, does that go into your histamine bucket? Yes. So these type of critters and infections can increase that histamine bucket which can create more histamine reactions like Evan and I talked earlier and the breathing issues and the burping constantly, yep. Those are all symptoms of that and that can drive histamine problem. So we got to get to the cause of those infections and again, I refer you back to our H. pylori or SIBO podcast where we spent a full hour talking about that one topic.

Evan Brand: Yup. Well said. Get that test to get that treated. Rosalin, she has itchy skin, scalp. “Is that a symptom of too much histamine in the body always itchy?” What would you say? Sounds like probably.

Dr. Justin Marchegiani:  It could be a histamine issue, it could also be just a fungal issue, too. Seborrheic dermatitis is what affects scalp like that or a.k.a. dandruff and that can be fungal in nature. So I would just look at just the whole gut biome imbalance and/or histamine as a byproduct of that, right? Remember I gave you the a hammer and the thumb analogy, right? The— the histamine is just the collateral damage caused by the— the hammer, right? That’s kinda the whole idea. But, yes, it could definitely be— be part of it but more than likely, not the whole thing.

Evan Brand: Yeah. Kelly had a question, “Thoughts on the Biome test worth the money?” So Biome is a pretty new company who’s running stool testing. I met the guy who created the test. I’ve had a few clients who’ve had that run and they sent it to me. And the readout is— is terrible. I hope they improve on it, but currently, I’ve had a few clients send me their readouts, it’s crap. There’s a bunch of information but there’s no real action.

Dr. Justin Marchegiani:  Not  actionable, right?

Evan Brand: Yeah. It’s not actionable at all. It’s just too much data. So, Kelly, I do not use and Justin. Neither of us use the Biome test. We use more functional test that are available through practitioners. Which I like the idea Biome give people the power to get their own testing, but we still are gonna use other companies like the G.I. MAP on our clients.

Dr. Justin Marchegiani:  Exactly. But the biggest issue is like you get companies that are trying to give you like more information, they’re trying to like dazzle you with all this information, but then you sit back and you’re like, “What the hell can I actually do with it?”

Evan Brand: Yup.

Dr. Justin Marchegiani: What lifestyle change? What diet change? What supplement? What can I eradicate? What can I support or balance based on this information that will help the patient get better? That’s always the question. And the second question is, well does this test allow me to leverage my patient to make an action to allow them to get healthier? And if I don’t get one or two—if I don’t get an answer for one, primarily maybe two, then it just—it becomes not worth it. Kind of you know, glittery, you know, it’s very like, it’s kinda like glittery and flashy and like, “Ooh, look at this!” but it doesn’t really do much to me.

Evan: Yup. Should we get James’ question.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Yeah. So James put friends nine-year-old sons on a new drug, which I looked it up here, Spinraza for spinal muscular atrophy. And it’s a brand-new drug looks like December 2016, it was the first drug approved for this disorder. Now  he’s having swollen lips and hives. Any suggestions will DAO help enzymes? That’s a hard one. Coz who knows if that’s a side effect of the drug or is that some type histamine issue.

Dr. Justin Marchegiani: Yeah. Number one, the kids—Again I don’t know enough about this patient. So this is, take it with a grain of salt, this is a medical—medical uh—you know, uhm—advice. This is just me kinda talking here. So off the bat, kids notoriously have the worst, freaking diets in the world, okay? Especially if they go to school and they’re eating the school lunch and they trade in with their kids. They eat like crap. So number one, clean up the diet. And again, it’s hard because if you’re a parent who’s not eating healthy then it’s your house is full of crap. So first thing is the parent, get all the crap out of your house, create a really good environment, have really healthy snacks, get all of the crap out. So  get on the Paleo template to start. Do that for at least a few weeks to a month. That may fix so many of the issues, but in the meantime, yeah, can you had add  in enzymes like DAO can maybe hard to get them, but can you add in regular digestive enzymes and HCl, yes. Can you add in things like stinging nettle and bromolein and an acetylcysteine and all of the nutrients that I mentioned, yes, you can. So I would definitely add in all those histamine nutrients. Uhm— I would try maybe be going lower histamine, kind of a Paleo template and really get the diet a hundred percent and make sure they’re able to digest their food. HCl enzymes, all of those really good things and that’s a great starting point and then from there, if that still not helping, our only getting part of the way there, you want to really get a functional medicine doc to look deeper at what’s happening with the gut and things.

Evan Brand: Yeah. Well said. That was what—my next thing I was gonna say I’ve seen uh— little girls as young as three and little boys four, five years old with massive gut infections, parasites, and H. pylori and the rest of it. So it’s very possible that that’s going on in the gut depending on the history and use of antibiotics in the kid and things like that.

Dr. Justin Marchegiani: Exactly. Patient here— my w— My mom has been diagnosed with lichen sclerosis, that’s an autoimmune condition that affects the skin. I’ve seen a handful of patients after that cream after cream the probably referring to hydrocortisone, a corticosteroid cream. It gets worse, any tips regarding the root cause of this? Yes. Autoimmune. Get the autoimmune stuff dialed in. I’ll use some stem cell types of creams like J Bio Serum, it’s one of the nice sell that I sell it works great. It’s got some stem cells in it, but you gotta make the diet and lifestyle change. Autoimmune template to start with and then dig in with all the functional medicine principles, next. One of the symptoms of histamine tolerance all the things that we mentioned earlier, from swelling to flushing to headaches to rashes. Anything you wanna add there, Evan?

Evan Brand: Yeah. Fast pulse or a rapid heartbeat. I’ve had women say they eat the food and then their heart starts racing. So could be mood issues, could be physical changes as well.

Dr. Justin Marchegiani: Yeah. And the best way to test for histamine issues, in my opinion, is I just look at people symptoms and I connect them to higher histamine foods and we just pull those foods down a little bit and if their symptoms get better, then we know. I think for me the telltale sign for histamine issues, fermented foods and citrus fruits.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Those are the big telltale for me. Coz they’re relatively healthy foods. No one’s gonna say like, “Oh, eating a grapefruit is bad.” You know having some low sugar Kombucha or you know some sauerkraut is bad. It’s relatively good but if you’re –if we’re doing that history and we see symptoms of those food, then we’re like, “Ooh, there probably is a histamine issue.”

Evan Brand: Yeah. Well said. See, what else we got here. I’ll read a couple off here for you. “Does everyone have some degree of histamine tolerance, don’t think I have histamine problems but not sure.” Well, if you say everyone— the average person is very unhealthy. Autoimmune diseases ramp it, the standard American diet which is the same in Australia, the same in Europe, the same and most developed countries are following kind of a standard American diet— processed grains, sugars, conventional pasteurized dairy, meats that are not organic, they contain hormones and antibiotics. So, yes, most of people are taking Ibuprofen and over-the-counter drugs, they’re taking steroids and doing in antibiotics. They’re getting them in the diet. They’re doing acid blocking drugs, they’re not sleeping well, they’re addicted to their smart phones. So, yes, so many people have things in their bucket. Then, yes, I would say everyone has a degree. Now, kind of our tribe that Justin and I are building of you know, healthy people that are doing as many right things as possible, they’re probably gonna have a less risk of—of histamine intolerance.

Dr. Justin Marchegiani:  Totally. Hundred percent. Makes sense. And how about the bone broth stuff? I mean, I see, you know, I see uhm— lots of people with issue with bone broth and it kinda falls in and around the fermented food issue, right? If you’re having issues fermented foods or things that are slowly cooked, like bone broth, that can increase histamine and that can create a problems. So, again, we may hold off on the bone broth or cook it in a way where it’s cooked shorter. What kind of preparations for bone broth do you do to help lessen it? I know there are some out there.

Evan Brand: Well, I’m spoiled. I haven’t been making it because I’ve been using Kettle & Fire Bone broth that they sent me, so I literally does have to throw it in a in a pot and heat it up. I’ve been fine. I know they slow simmer or slow cook theirs for like 48 something hours like it’s an extremely long simmer time. So I don’t know how that would affect somebody that they were sensitive. But for me, I feel quite well with that. I don’t have any symptoms.

Dr. Justin Marchegiani: Yeah.

Evan Brand: I don’t know. I haven’t had to modified it at all.

Dr. Justin Marchegiani: Yeah. So a couple, you can skim off the scum of the top of the bone broth. You can skim that out. Uh—it may be helpful, you can also do just the shorter brew maybe an 8-12 hour one. Uhm—that can be good. You can also just try buying some maybe your higher-quality or they may have a way of you know, producing it that produces low histamine like the Kettle & Fire. So that could be some good options. But again, if you have a food that we consider to be healthy like bone broth or Kombucha or fermented foods and you can’t respond to it, you can always put that food aside. That’s kind of like that’s like you’re free-histamine test, right?

Evan Brand: Yup.

Dr. Justin Marchegiani: So you can work on the gut. You can work on a lot of these hormone and diet things. And then you can add that thing as your free test add back in the future and that’s a good objective marker to see how you’re doing with your gut. And if it’s starting to heal, you may be able to handle more of that yet.

Evan Brand: Yup. Well said.

Dr. Justin Marchegiani: I believe my link should still be active Kettle & Fire sponsored my show for a while. They’re not anymore but they should still be giving people 20% discount so you can try it. If you do, evanbrand.com/chicken you should be able to get 20% off— so try it out. I think they pay me like a buck if you buy some, but that’s good bone broth and definitely—

Dr. Justin Marchegiani: We’ll support the cause. I know the products—only products that we ever mentioned on our shows are things you believe in. So again, you guys gotta know that we’re coming from a place of authenticity. So if you want to support us and we reference something, just know that it’s got to go to the filter of actually being a high-quality product and we actually have to use it on ourselves and our friends and family for us to recommend it.

Evan Brand: Yup.

Dr. Justin Marchegiani: We appreciate that support.

Evan Brand: Another question here. “What herbs do you suggest for fungal issues?” Once again, I’m gonna say it depends. And I know Justin would say the same thing because we’re gonna make our protocols based on what you’re up against. So if it’s bacteria plus fungus plus yeast plus parasite, that’s gonna be far far more heavy hitting protocol. If it’s just fungus by itself, which is not too common, because most people have a lot of issues together, you may be able to get away with some garlic or some oregano or like Justin mentioned earlier, Berberi or the barberry or the—

 Dr. Justin Marchegiani: Yup. Berberines.

Evan Brand: Berberines. That whole can be great and we’ve got several formulas if you just stalk our stores a bit look on justinhealth and look into his categories and you can check out mine, too. We’ve got many, many different combinations of herbs. Could you go and technically just buy a couple herbs and just you know, shoot a shotgun approach and maybe get success, yes. But I would of course, advise you to get tested because if you have fungal issues, you probably have other issues, too.

Dr. Justin Marchegiani: Yeah. And here’s one like clinical pearl that I’ve kinda find over the years. I’ll throw it out there for everyone listening. How I know fungal issues are more of an issue for— for some people than others, is number one, we’ll see the fungus on a stool test, which will be helpful. We can see either multiple kinds of yeast or fungus where it’s Geotrichum, Microsporidia, Candida, etc. We’ll see different kinds of species. But also on a organic acid test, we’ll see the uhm— D-arabinose, which is a metabolite of Candida but that also kinda means it’s gone systemic. It’s gone more more systemic coming up the urine. So if we see something like the D-arabinose is more of a systemic marker in the urine and we see in the gut, then we know that fungal issue is—is a lot deeper. Now a lot of fungal issues tend to be driven by other issues like H. pylori, other parasites are bigger but some people just gonna have a rip-roaring fungal infection. We’ll see it systemically via the organics as well as on the gut, too.

Evan Brand: Let me ask you this. I mean let’s say you see somebody with a really, really gross fungus fingernail like it look like their fingernails about to falloff because it’s so infected. Would you assume that person has got a massive amount of fungus in the gut and it’s manifesting on the nail on the—on the fingernail?

Dr. Justin Marchegiani: To a certain degree, I would say that’s a good, you know, you can’t hurt yourself faulting that, coming to that conclusion. But again, if you knock out some gut stuff, it can be hard for those herbs and for your immune system to get all the weight at that peripheral tip of that nail to knock out the infection. So sometimes we got topically hit things coz they just got to travel a long way so we’ll either topically hit our herbs there or we’ll uhm—have to do some kind of a soak to hit it as well. Even if we were to address the gut, it may not be enough to make its way down there.

Evan Brand: Coz I’ve seen that. I remember it was a cashier or somewhere, I saw a guy with his finger like his index finger, the nail was literally about the come off and it was completely—

Dr. Justin Marchegiani: There are different degrees, right? There’s like, “Oh, I had a slight fungal nail and I knocked it out with some oregano and a soak and just a few—in a few weeks.” There’s somewhere it’s like nail is incredibly like sclerotic and—

Evan Brand: It was extreme, yeah.

Dr. Justin Marchegiani: Almost falling off and then like totally dis_ that’s like the highest degree. I mean it’s just like, “Oh, it’s a little bit rough and then it’s got a slight yellowish hue.”

Evan Brand: No. I’m talking when it was like—it look like if you flicked it, it would fly off.

Dr. Justin Marchegiani: That’s one of the extreme.  And then the other extreme is maybe– is a light, it’s kinda like a little bit sclerotic like it’s rough.

Evan Brand: Yeah.

Dr. Justin Marchegiani: And if you were to file it, it would get smooth but it would grow out of the bottom again rough. That’s how you know it’s fungal. And typically it’s slightly yellowed. And again, it can go really dark and brown, like dark yellow brown the longer it’s there.

Evan Brand: So what is that? When is that extreme? I mean how in the world would that happen? What sets the stage for that since we talked about—

Dr. Justin Marchegiani: Just chronicity. It’s just deeper and deeper and deeper and deeper into that nail bed.

Evan Brand: Yeah. Wow! Last question here: “What does it mean if a rash shows up only on the legs and not other parts of the body?”

Dr. Justin Marchegiani:  I have no idea. Uhm—again typically the body’s just gonna push stuff out. And again, if things are in the body systemically, where or why the body pushes it out there, beats me. Maybe that’s a stronger area for the body to push it out, hard to say. Again, as things get worse and worse, problems tend to be more systemic, so I wouldn’t worry about why it’s there. Uh the fact that it’s in a local spot is better. I would just want to make sure there’s nothing constant— contact dermatitis issue where things are in contact in that spot. And when nothing is contacting, I wouldn’t worry about it. We’re treating the body systemically as a whole. We’re really work on lymphatics and the detox so everything will get better.

Evan Brand: Yeah. Well said. And I mean—in a rash in the leg, that could be so generic. I mean, that could be something from your skincare products. That could literally be allergy to parabens or something. My wife—

Dr. Justin Marchegiani: A contact dermatitis issue where something is actually touching it.

Evan Brand: Right. Yeah. My wife she had a reaction on her legs and it had nothing to do with diet or histamine or anything. It was just uh—uh she had a sample of the skincare product and it must had some ingredient in it that we didn’t know about and she had a rash on her leg. So don’t—maybe don’t freak out, don’t think too deeply. It could be something that simple.

Dr. Justin Marchegiani: Yeah. And my baby just had some baby acne. My wife is freaking about it a little bit. But it’s just you know, he’s just metabolizing her hormones. So he’s getting over it pretty fast uh— which is good. But again, things happen and if it’s a contact issue like control all the vectors of what’s going on your skin. And then second is like, what’s in your body and just try to decrease inflammation.

Evan Brand: Yup. We got uh—you got time for one or two more?

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

Evan Brand: Alright. James he said, he’s not allergic to nuts and seeds but every time he eats peanut butter, he always gets a fungal rash around his glute region.

Dr. Justin Marchegiani: Don’t touch peanut butter, man. I mean it’s known to be higher in aflatoxin, it’s a legume as well. So that could be some gut-irritating stuff in it. Stay away from that. Switch over to high-quality almond butter instead and let us know how that works.

Evan Brand: Yeah. There’s a brand I use—what is it? Cadia. C-A-D-I-A. It’s like the only organic almond butter I found that’s less than 20 bucks a jar.

Dr. Justin Marchegiani: I actually created my own brand called Justin’s. You’ve seen that brand at Whole Foods?

Evan Brand: I did. Good job!

Dr. Justin Marchegiani: Nah, I’m just kidding. It’s convenient to say it, but, no. Not my brand.

 I won’t take credit for it. But I do like Justin’s. Uh—I will do that a little bit sometimes. And I do like just the whole food 365. I’ll get the organic. It’s also a cool one. Its’ really expensive! It’s called, NuttZo, in an upside down container so like the lid is on the  bottom and it’s upside down kinda thing. That’s kinda cool. Really expensive, but it’s really a nice treat.

Evan Brand: Here’s another question. Uh—little bit off-subject. How is holy basil an adaptogen for stress?” Uh—we’ve done—I could go so long on this.

Dr. Justin Marchegiani: Yeah.

Evan Brand: That I’ll have to shut myself up right now. You just have to check out our other episodes on adaptogens  because I love them and Holy basil, __rhodiola, ashwagandha, all the ones you mentioned.

Dr. Justin Marchegiani: Good.

Evan Brand: We do use all those. They’re great.

Dr. Justin Marchegiani: Yup. I think it’s good. It’s good to kinda rotate through some or use a combination to use them individually and have a rotation to it. I think that’s great. Evan Brand: Yeah. “Is water sounding in ears related to histamine?”

Dr. Justin Marchegiani: The first thing I would look at are just food allergens in general. Uh– especially mucus-producing food, so like dairy and things coz anytime you get more mucus that could go in the ear and that can create issues. Just gluten and inflammatory foods to begin with. So, yeah. Definitely kinda hit that overall  Paleo template, you’ll hit a lot of those things out.

Evan Brand: I think that’s it. We should probably wrap it up. We’re gonna turn into a pumpkin here.

Dr. Justin Marchegiani: I know.

Evan Brand: If there’s any last questions please ask us.

Dr. Justin Marchegiani: How much salt did you ingest for every liter of water you drink replenish lost—I mean, I would just do half a teaspoon to a teaspoon twice a day of high quality mineral base salt. So like my favorites, Real Salt, or you can do Celtic, or Himalayan, just really good minerals that you’re gonna put back into your body. I like that.

Evan Brand: Yeah. I saw a new study about sea salt. I posted it up—I think I put it up on my twitter account where all the sea salt from US and Europe was contaminated with micro particles of plastic and so I’d support your idea of using the real salt which is gonna be an inland sea as opposed to the ocean sea salt that’s contaminated. Dr. J, do you think Tom Brady is on a low histamine diet?

Dr. Justin Marchegiani: Well, let’s breakdown Tom Brady’s diet. He’s eats 20% meat. There’s a lot of means out there. If Tom Brady goes vegan, no—you’re not vegan if 20% of what you eat is meat—not even close. But, as a qualifier there his meats are organic and grass-fed, so there’s really good quality meats. He avoids nightshades, tomatoes, potatoes, eggplants, peppers. He eats lots of vegetables. He eats very little starch. He eats a little bit of fruit. So I would say relatively speaking, yeah. I mean, his kinda thing is, “Oh, I’m eating acid alkaline kinda thing”, right? That may be the result of—that may be what he thinks he’s doing, but my thing is he’s really just doing an anti-inflammatory diet.

Evan Brand: Yup.

Dr. Justin Marchegiani: I’m not worried about acid alkaline. If he is worrying about so being alkaline a hundred percent, he’d avoid the meat, right? But we know that meat has a lot of important nutrients and it’s balance the meat with a lot of the veggies that are very alkaline. I don’t worry about that so much. Most of the acid your body’s gonna get is from inflammation. Inflammation is like 1000 times more acidic than actually eating an acid-base food. So I’m more worried about the food’s inflammatory qualities that I am about whether it’s acid or alkaline. But, again, grains are 10 times more acidic than meat. So if I can leverage that conversation or that idea with the patient, I’ll say, “Hey, if you really wanna be more alkaline, at least meat’s 10 times less acidic than grains.

Evan Brand: Well said.

Dr. Justin Marchegiani: I would think he would be indirectly not his goal but again, anyone that’s on anti-inflammatory diet indirectly, would be lower histamine outside it may be citrus and fermented foods and such.

Evan Brand: Yup. Well said. Well, we’ll wrap this thing up. We hope you enjoy it. If you have more questions, more ideas, more things that you want to hear us cover in terms of topics, reach out. We both got contact forms on our website. Send as an email.

Dr. Justin Marchegiani: Subscribe. We appreciate it. Give us a share, give us a thumbs up.

Evan Brand: Yeah. Justin— Justin’s over 30,000 on the YouTube, man. So great job! Keep it up. Hit the subscribe button so that we can keep pushing up this content in helping you guys achieve the most optimal health on the planet to help us get more people healthy we really appreciate health on the planet.

Dr. Justin Marchegiani: Help us get more people healthy. We really appreciate it. Healthy people make healthy decisions. They’re better parents, they’re better employees they’re better bosses, they’re better everything, so—

Evan Brand: Yeah. I saw Mark Hyman he was talking about autoimmunity and how it’s twice or even up to 10 times more expensive to take care of a sick patient with autoimmune disease and so we guys want you to be healthy because to save our population from collapsing. We’re kind of in the midst of healthcare collapse. Basically, the health of society falling apart. We’re trying to make a healthy dent in the universe by helping you guys. So thanks for the feedback. It means a lot to us.

Dr. Justin Marchegiani: Love it, Evan. Alright, man. Great chat today. I appreciate it.

Evan Brand: Take care. Bye.

Dr. Justin Marchegiani: You too, take care.
















Organic Grass Fed Meat

The 5 Causes of Nutrient Deficiencies

Causes of Nutrient Deficiencies

By Dr. Justin Marchegiani

Good nutrition is what our body needs to prevent us from having issues that will compromise our health. Watch this video and increase your awareness when it comes to different causes of nutrient deficiencies.

5 Different Causes of Nutrient Deficiencies:

  1. Inflammation
  2. Conventional food
  3. Inadequate Supplements
  4. Infection
  5. Medication



There are couple of different kinds of inflammation. We have an acute inflammation, wherein you cut your finger, a scab forms or above your elbow, a bruise forms. It healed up in a few days and it’s not a big problem. 

What we’re talking about is systemic inflammation. Meaning, it’s systemic throughout the whole body based on diet, lifestyle, exercise. All of these factors.

One of the biggest things that affects inflammation is which kind of diet we eat. We’re eating a pro-inflammatory diet, high in sugar, high in inflammatory compounds like grains and sugar. Those are going to put our body in a more inflammatory state. The more inflamed we are, the more we decrease ability of our body to absorb nutrition. 

Now we have little finger-like projections called microvilli in our small intestine. Think of these finger-like projections like a vacuum cleaner. It’s job is to suck up nutrition. The more inflamed we are, systemically, think of that vacuum cleaner, each finger being a vacuum cleaner. Each one gets clogged and you see less vacuum cleaner until we have knocked – our vacuum cleaner is essentially fully clogged which does not absorb nutrition as effectively.

Conventional Foods

Conventional Foods

We’re just eating foods that are conventional. Conventional foods – meaning foods that aren’t organic. They’re not going to be as high in nutrition because the fact they are sprayed with pesticides and herbicides. Even GMO things like Roundup. These compounds with chemicals essentially devoid will make the nutrients in the soil very much devoid. Minerals are needed for the plant to essentially produce an optimal spectrum of nutrients. Studies have shown that certain soil that are devoid of manganese, certain vegetables and the fruit will actually have 50-60% less Vitamin C. If we have low mineral soils due to the chemical that our farmers are putting on it, that’s going to affect our ability to get much nutrition from that in the first place.


Supplements to Counter Nutrient Deficiencies

Having high quality supplement is going to be really important. Even if you are actually taking high-quality organic vegetables and eating high-quality organic meat, you’re still going to have some holes there. That is why supplement is there, essentially supplementing the gaps and the holes in the diet. You never want to supplement and eat bad, either. You really want to do your best to make some big change with your diet and also add those in helping building the gap to prevent nutritional deficiencies.

CLICK HERE to know more about the supplements which prevent nutrient deficiency



Infections are very common. These are these low-grade kind of inflammatory zombies, so to speak, in your intestinals. Just sitting there and its causing this drain on your immune system, this drain in your adrenals. If we can really cut down and figure out what kind of infection to go along with (H pylori infection, or a fungal infection, or a parasite infection) and if we can diagnose where the infection is, we can create a protocol that will help remove that.


MedicationsMedications are common and are known to cause nutritional deficiencies. There are actually textbooks on nutritional deficiencies caused by medications. So did you know the most common nutritional deficiency caused by a medication is a statin? This statin medication, which control cholesterol being produced by the liver, they actually decrease your production of your nutrient called coQ10.

CoQ10 is actually really important because the hearts need coQ10 to actually beat each time. We’re having our heart issues, congestive heart failure, atrial fibrillation, blood pressure. You should really want to make sure our heart has all the nutrients it needs. Two, coQ10 is really important for muscle production. One of the most common symptom you see when you’re on a statin is rhabdomyolysis or you see infected muscle pain or extra muscle soreness. These are very, very common things. Also, in diabetics taking Metformin or Glucophage. These medications cause mixing conditions B12 anemia.

If you’re on medication, give the office a call. At least make sure you’re being supported or the potential nutritional deficiencies that could be caused by the medication you’re up. If you really want to address the underlying cause of your condition, or what medication to prescribe, let us know and we’ll do our best to help.

CLICK HERE to know if your medication is causing nutrient deficiency

Dr. Tom Bilella – Nutrition secrets and natural solutions to the drug epidemic – Podcast #119

Dr. Justin Marchegiani and Dr. Tom Bilella talk about nutrition and ending the drug era in this special podcast episode where they go into nutrition secrets and natural solutions available in the modern world.

They discuss about sugar and how it affects our health in ways leading to nutrient deficiency. Find out about carbohydrates portions and intake at different times of the day and how such factors contribute to achieving healthier body. Learn about intermittent fasting as well as its effects on different types of people. Get valuable information about nutritional timing, pre- and post work out nutrition, the essential amino acids and its effects on body systems which in turn help people improve their performance and attain lean body mass.

Dr. Tom Billela

In this episode, topics include:

01:40   Avoiding sugar

13:02   Nutrient Debt

23:16   Intermittent Fasting and Macronutrient

33:42   Nutrition for building muscle

43:16   Movement patterns for building muscle








Dr. Justin Marchegiani: Hey, there! It’s Dr. Justin, welcome back to Beyond Wellness Radio. I have a good friend and awesome physician here, Dr. Tom Bilella and Tom likes to drop what are called Bilellaisms. Say that ten—

Dr. Tom Bilella: Yeah.

Dr. Justin Marchegiani: Times fast. Lots of brain candy will be a dropped throughout the show, sugar-free though, sweetened with Stevia. How we doin’, Tom?

Dr. Tom Bilella: I love it, man! Again, great opportunity with you. Haven’t seen you in a while from our success summit. We had a great time around some great, you know, great minds in functional medicine. So thanks for the opportunity. Loving this.

Dr. Justin Marchegiani: I’m just waiting for the knowledge to be dropped, baby.

Dr. Tom Bilella: Well, now’s a little pressure, but that’s fine, man. So I’m sitting here in Red Bank, New Jersey. It just snowed but it’s cleaned up. I’m feeling good. It’s a Motivational Monday and we’re ready.

Dr. Justin Marchegiani: Awesome! Well, why don’t you just walk me through just kinda your—your biggest. Well, it’s only Monday here. Why don’t we go through last week? What was your biggest clinical success last week with a patient?

Dr. Tom Bilella: Yeah, I’ll tell you right now. Call him Big Al. Big Al is from New York, now he relocated to New Jersey here, but Big Al is a 60-year-old Italian guy, diabetic for 15 years, the belly fat, the whole 9 yards. His son was a success client. He finally got his dad to commit to come in. Hemoglobin A1c on medication about 8-1/2.

Dr. Justin Marchegiani: Oh, my God!

Dr. Tom Bilella: Triglycerides through the roof. I’m not gonna bore with all his, you know, blood chemistry. You know, what I’m talking about and this guy was fatigued. He had 14-hour days because he commuted to his business in New York, etc. Long story short, eight weeks later he’s down 22.5 pounds of fat and his blood work improved tremendously. His hemoglobin A1c went from like 85 to 68. But here’s the story.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: He went to his—back to his medical doctor about a week and a half ago, waited an hour and half to see the doctor. Doctor comes in, puts him on the scale and loses 22 pounds, and he tells the doctor. He says, “Listen I’ve been seeing a clinical nutritionist.” You know what the medical doctor said to him?

Dr. Justin Marchegiani: What?

Dr. Tom Bilella: Well, if you’re seeing a nutritionist, you should have lost a lot more body fat than that.

Dr. Justin Marchegiani: Oh, my God.

Dr. Tom Bilella: Condescending, non-supportive, and Al was blown away. And Al made up his mind at that point; he’s not coming back. He then told me the whole story. We looked at his blood work. The point is Dr. Justin is that great success story—his medications are cut in half. We’ve—we’ve changed his life. We’re probably saving his life and did not get the support from his medical doctor. I got a video on that that’ll blow your mind. So that was my biggest success of last week, diabesity—it’s out of control. This drives me crazy.

Dr. Justin Marchegiani: And you know, the conventional medical doctors this day and age, they’re really not equipped on the diet and lifestyle and nutritional and supplement changes that have to be made to get their patients the next level, just—and a case in point, a few years ago I had a patient who went to the cardiologist and said, “Hey, I’m thinking about making these diet changes to the kind of this Paleo-lower-carb-type of diet, etc., etc., what you think?” And the cardiologist he was seeing for about five years and the cardiologist turned him and said, “Well, you know what, that’s exactly how I eat, but personally, legally, I can’t tell you that because I’m bound by the American Board of cardiology—

Dr. Tom Bilella: Oh.

Dr. Justin Marchegiani: And that’s not quite what our board allows us to say. So a lot of these doctors, they’re hamstrung, especially if they work in a hospital setting. So it’s tough. People like us, we’re like, you know, we’re—how should you say it—we’re—we got no ball and chain on our legs so to speak.

Dr. Tom Bilella: Yeah.

Dr. Justin Marchegiani: So we can go out there and just call it like we see it and give the information.

Dr. Tom Bilella: Exactly right and thank goodness there’s more people like you and I, and you’re doing your podcast, you know, getting people inspired and doctors inspired to do more functional medicine so we can make these type of changes, because you know what? I ain’t gonna happen in the White House. It’s gonna happen in your house.

Dr. Justin Marchegiani: Love it.

Dr. Tom Bilella: And I’m—I’m all about inspiring other doctors, functional medicine doctors or chiropractors, whomever, to start doing more functional nutrition functional medicine, so we can support people at different level because you know this healthcare system is broken. It’s backwards. People are suffering and they’re ticked off.

Dr. Justin Marchegiani: Exactly, and you really talked about getting people gonna get—ending that—ending the drug era. I think it’s, I know it’s like—

Dr. Tom Bilella: Yeah.

Dr. Justin Marchegiani: Like 20% of fifth graders are on some type of ADD/ADHD medication and you really talked about getting people off the lifestyle drugs, but not just pulling them off but fixing the root underlying cause—

Dr. Tom Bilella: Yeah.

Dr. Justin Marchegiani: Of why they’re on it to begin with. Let’s start with that—

Dr. Tom Bilella: Yes, well I—yeah, I don’t have to explain the premise of functional medicine, it’s getting to the roots. You know, not trying to glue the leaves back on the trees when they fall off, like you know looking for a meditation.

Dr. Justin Marchegiani: Love it.

Dr. Tom Bilella: You know, looking for more glue to—to glue it back on the—the tree branch. Hello? You go to the roots. So I—you know, I’ve been doing this for 28 years now, seen thousands of patients and if we’re gonna drug era in our lifetime, you know, it’s gonna take a collective effort and it’s happening but here’s a story. The drug era started in 1983 when this country or someone allowed pharmaceutical companies to advertise on TV. That’s when the drug era started. You can trace it back to then. America’s 4% of the world’s population, consuming up to 54% of the medications, the majority of which are lifestyle induced medications. It’s an outrage.

Dr. Justin Marchegiani: Only 2 countries. I think us and Australia.

Dr. Tom Bilella: Yeah, I think its—

Dr. Justin Marchegiani: Right?

Dr. Tom Bilella: Australia or New Zealand, exactly are—

Dr. Justin Marchegiani: Yeah, it’s one or the two.

Dr. Tom Bilella: It’s—or allowed to advertise. Now let’s take a step further. So now you’re a 9-year-old kid or 11-year-old kid. You’re watching these commercials. You know, even 4 years old and you see this lady with a pounding headache, she goes to her medicine cabinet, pops 2 pills, 8 seconds later she’s on the tennis court with her husband, enjoying an iced tea. So then this poor kid gets to high school, 14 years old having some stress and some difficulties, and remembers back in the brain probably subconscious that tells her the answer. And you wonder why we have all these young people on drugs and medications. So it’s a real problem, Dr. Justin.

Dr. Justin Marchegiani: It is. It totally is, and you know, I always tell patients, drugs don’t have side effects. They have effects.

Dr. Tom Bilella: Yup.

Dr. Justin Marchegiani: And again what are these drugs doing? They’re typically blocking enzyme or reuptake ports in the biochemistry. So the difference is when we’re doing nutrition and diet and lifestyle and functional medicine interventions we’re about up regulating and enhancing the physiology where a lot of these medications are about down regulating and suppression—suppressing. But in the short term, that may be okay if someone has an acute issue, but then what are we gonna do to transition them off? The conventional medical system has no path for that. There’s no conveyor belt that puts them on to a functional medicine. So can you talk more about the things that you’re doing to get to the root cause with some of these common medications?

Dr. Tom Bilella: Sure. Yeah, well, it starts for me—it starts with good paperwork, thorough cons—

Dr. Justin Marchegiani: Uh-hmm.

Dr. Tom Bilella: Thorough paperwork—

Dr. Justin Marchegiani: Chemistry.

Dr. Tom Bilella: Coming in for a comprehensive consultation and lifestyle analysis, of course, we do a body comp analysis here and I do a nutrition exam. You know, checking hair, skin, nails. Checking things you gotta check, palpating the thyroid, okay? Looking for—looking for—looking into nail beds. Looking at postural faults.

Dr. Justin Marchegiani: Huge.

Dr. Tom Bilella: And then I use functional chemistry. You know, I’m running a full thyroid panel to everyone and I’m screening for antibodies. I’m free T3, reverse T3. I’m looking at, of course, homocysteine C-reactive protein. We’re looking at hormonals, hormonal levels that are men and women. So it starts to me with functional chemistry. I’m a big advocate of food sensitivity testing, about 80% my patients choose they get it. I explain it becomes like a nutritional pilot light to reduce the inflammatory effect of certain foods. It could be a good food, Justin, but not good for this particular person and I’m a big advocate of vitamineral analysis. You know, typically through a SpectraCell or maybe an organic acid testing. So if you’re not testing, you’re guessing, alright? And I explained this to my patients so in doing such a way where they totally get it. So it starts with the labs. They come back for their second visit. We talk about what’s most pertinent and there’s three phases of my program. I call it the education phase. They always leave the first visit with some homework and some reading and the education diagnostic phase I have to say. Get the diagnostics. They come here for their second visit and we typically launch with the cleanse phase, and I just say, “Think of the word clean. It’s not like a cleanse or fasting. We’re gonna get the good foods in, rid out the bad foods, take care of these nutritional potholes that you have with all these vitamineral deficiencies, do that for 2-3 weeks, and then talk about what’s called their transformation phase. Continue to working on the imbalances in their chemistry.” So we have really good results here, really good compliance because what’s—how we educate our patient visit to visit.

Dr. Justin Marchegiani: I love it. I love it. And it’s really interesting because I work with lots of patients as well and the big thing that I hear over and over again is I’ve never had a doctor spend that much time with me. I never had a doctor roll up their sleeves and dig in deep and look at like the nail beds, you know? Let’s look at protein—

Dr. Tom Bilella: Mmm.

Dr. Justin Marchegiani: And fat soluble vitamins. Let’s look at—

Dr. Tom Bilella: Uh-hmm.

Dr. Justin Marchegiani: The skin. Let’s look at the hair. Let’s dig in and try to connect the dots—

Dr. Tom Bilella: Uh-hmm.

Dr. Justin Marchegiani: To the outer exterior to what’s going on the physiology and I love because we operate outside of that insurance model where we don’t have that ball and chain holding us back, again just like on the nutrition side, too.

Dr. Tom Bilella: Yeah, exactly and what I’m proud of is I also have a nice team here and I have health coaches that will work with me, not all at the same time. I’m always working with my health coaches who’s helping me educate these patients, allows me to see up to four people an hour, after the first and second workup, and they’re getting this 30 minutes worth of service, 15 minutes with me. I tell my clients, “I’m the Why, she’s the How, I’m the good cop, she’s the bad cop, yeah? But we work together to get you to your goals.” And it’s a really good system I created here where you can help a lot of people, be profitable, but our patients are getting an end result which is educating them

Dr. Justin Marchegiani: I love it and you know, it’s interesting because I’m around a lot of healthy people and their kids still not—not eat so well so to speak.

Dr. Tom Bilella: Mmm.

Dr. Justin Marchegiani: And it’s—you kinda tiptoe around it. You showed me—

Dr. Tom Bilella: Mmm.

Dr. Justin Marchegiani: A video last year of your daughter who’s like a little YouTube celebrity, talking about sugar and then you are—I think you were offering her sugar and she kinda went off in this little speech educating you on why that’s not good. You wanna talk about that?

Dr. Tom Bilella: Yeah.

Dr. Justin Marchegiani: We’ll post the video on the notes, too. That’s a good one.

Dr. Tom Bilella: Yeah, so Sofia Bilella, she’s now 9. I’m really proud of her. She does an adlib and I’ve been teaching since she’s a young girl, you know, proper diet, not being you know, not too crazy. But between the ages of 1 and 2, I made it a point not to give her any sugar because I once read that that’s when a young—

Dr. Justin Marchegiani: Huge.

Dr. Tom Bilella: Young person’s palate is forming.

Dr. Justin Marchegiani: Huge.

Dr. Tom Bilella: And if you—if you can keep the sugar out their body from ages 1 to 2, they’re not gonna create this sugar—I hate to say almost addiction or—or need.

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: So we did that, okay? And now she’s allowed maybe, you know, maybe one little treat a day but it has to be a treat, but the point is that in school in the second grade, she won the contest where she had to count how many Smarties were in the jar.

Dr. Justin Marchegiani: Oh yeah?

Dr. Tom Bilella: So it was like 100. So the prize that the second-grade teacher gave out, she got 100 Smarties. She brought them home. I come home; I see 100 smarties in a bag. I’m like, “Oh, baby.” So my—my Sofia knows the kind of, you know, she doesn’t hide anything. She’s got great confront and I said Sofia we gotta do a video. And part of the video which you’ll see is that she’s ticked off and she tells me because there’s red dye in there, okay? It causes childhood obesity. She tells—and she was 8 at the time, alright? And there’s been other considerations. Her first grade teacher was giving out little marshmallows for math assignments and my daughter told me this, either write a letter or an email to the first grade teacher but Sophia Bilella, little kid natural here so to speak, is—is on the same page. She’s educating and she’s totally into it. It’s not an act.

Dr. Justin Marchegiani: Exactly. I think the big thing is, too, when you get yourself healthy, you can’t help but create that ripple effect, the health—your—your spouse, your family members, and your—and your kids as well which is great.

Dr. Tom Bilella: And it’s got this—this next generation, you know, it’s really important that we have this—we disseminate this information because last glance like a 4th grader on 55% of the calories is in the form of sugar—

Dr. Justin Marchegiani: Oh, my God.

Dr. Tom Bilella: And there’s a gross protein deficiency, a gross vitamin D deficiency, gross essential fatty acid deficiency in our culture with you know, with young people and what drives me insane is when the—the parents as well. Well, my pediatrician said, you know, we don’t really need them. You can take a multivitamin or Flintstone. I’m like, “Were you checking the kids’ vitamin D?” No. It’s an outrage. Pediatricians by and large are still telling the parent we are the wealthiest nation on earth and we have the best. Don’t worry about it. Are you kidding me?

Dr. Justin Marchegiani: Yeah, it’s terrible. We have an excess of calories but the problem is a lot of calories, but the problem is a lot of calories aren’t attached to nutrition these days. You can get a ton of calories with virtually zero nutrition. People forget that when you give your body a whole bunch of sugar, it has to run them through glycolysis in the Krebs cycle and it actually takes nutrients to metabolize sugar, so you can actually go into nutrient debt. It’s like using your credit card when you don’t have enough money in the bank to pay for the bills. It’s the same thing when you do all this extra sugar as you know.

Dr. Tom Bilella: Yeah, and then let’s augment nutrient debt and then like—

Dr. Justin Marchegiani: Uh-hmm.

Dr. Tom Bilella: A young woman who then starts menstruating—

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: Six months later, she’s totally iron deficient. She’s depressed and fatigued, and unfortunately conventional medicines do one of two things—birth control pill and/or an anti-psych drug.

Dr. Justin Marchegiani: That’s it.

Dr. Tom Bilella: I mean this is what’s happening out there, ladies and gentlemen. So I’m not saying you never need a birth control pill or anti-psych drugs have your place, but that should not be first line of therapy when you have 14-year-old girl who is tired, fatigued, and depressed. Let’s check her nutrition.

Dr. Justin Marchegiani: And I guarantee—I know I saw the stat of 25%, 20% of 5th graders are on some type of like ADD, Adderall, Ritalin, etc. If—and I believe firmly, if you look at the research, this starts with the sugar and the inflammation. If you get up, the nutrient density and you drive down the sugar and the inflammatory foods, these kids’ brain chemistries are gonna be so much better and they’ll be able to focus better in the classroom, too.

Dr. Tom Bilella: Yeah and we’ll—what I do as a clinician when a parent comes in, is we have some call the Healthy Kids Club. And of course—

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: Sofia Bilella is president of the Healthy Kids Club.

Dr. Justin Marchegiani: Right.

Dr. Tom Bilella: But I have a really—a really easy 2-page sheet. It’s actually one page that I give to the parent. It’ll say, you know, child’s name, weight, height, any medications, how proteins a day, how many fruits and vegetables a day, how many rounds of—rounds of antibiotics and are they currently taking probiotics? They bring it back to me. I say, “Hey, listen, your most important job as a parent is making sure your child is developed well.” That doesn’t mean another karate class or another soccer tournament. I—I don’t say that. Sometimes I do.

Dr. Justin Marchegiani: Right.

Tom Bilella: I’m like, “Listen, fundamental. Let’s get your child—here’s what I’m recommending. A multivitamin, some—probably some extra vitamin D, certainly a fish oil, and periodic probiotics. If we can just—every person, if every parent understood that you just work with the fundamentals and I do believe in nutrition shakes. My daughter since she’s 2 years old has been on a nutrition shake 1 to 2 a day over the last 7 years. My daughter is 9 years old. I don’t wanna brag but she’s like a beef. She’s so strong. She’s so solid. She’s smart and I’m telling you nutrition is a big part of that.

Dr. Justin Marchegiani: I agree. I’m a big fan of the shakes, too, because one, if you’re in a rush in the morning, you can have those things pre-made in a shaker cup ready to go. You walk out the door and you shake it. You’re good to go. You can make it taste sweeter with a little bit of Stevia and some berries so you pack the nutrition—

Dr. Tom Bilella: Yup.

Dr. Justin Marchegiani: But you keep the sugar low and you can sneak in some veggies and some high quality amino acids, and a lot of people got low—

Dr. Tom Bilella: Yup.

Dr. Justin Marchegiani: Hydrochloric acid, so it makes it very absorbable.

Dr. Tom Bilella: Yeah, and with my daughter I negotiate, too, man. She loves her gluten-free pancakes in the morning—

Dr. Justin Marchegiani: Uh-hmm.

Dr. Tom Bilella: And gluten-free French toast. So the deal I have with my wife and my daughter, as long as you’re getting some organic fruit with that and your nutrition shake, I’m cool. Okay? She loves her—the organic maple syrup on her pancakes. It used to drive me crazy. I said, “Listen, you get some fruit with that and your shake, that’s a good way to start the day.”

Dr. Justin Marchegiani: Yeah, yeah, I agree and how are you looking at your patients and examining outside of the lab testing the essential fatty acid and the protein deficiencies.

Dr. Tom Bilella: Good. So with the essential fatty acids, I am doing a red blood cell membrane essential—

Dr. Justin Marchegiani: Okay.

Dr. Tom Bilella: Fatty acid test, okay? And most everyone comes back less than 5.5% of the—

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: Red blood cell membrane deficient EPA, DHA, DPA, alright?

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: So I’m using that test. I’ve got to mention that. So then I can look at vitaminerals in fish oil, etc. and as far as from protein standpoint I’m using in body, I‘m doing a body composition test on every—

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: Single person. I’m looking at their lean body mass and I’m using that number as a kind of reference or barometer of how much protein I believe they need for their dietary protein, okay, and of course questionnaires and other considerations will clue me in including blood work if they have the digestive capacity, i.e. hydrochloric acid to digest this. But I gotta teach the mindful eating, chew your food, not a lot of liquid when you’re eating your solids.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: So it comes back to the fundamentals, man, you know chewing your food. Even my daughter, nine years old, I go, “You have to chew your food nine times before you swallow. When you hit 10, it’s gonna be 10 times.” There’s little—little reference there. But back to your question, you know, teaching them what they need to do and getting very specific without overwhelming them. I go, “And here’s your body composition analysis, Mrs. Joe and your hundred pounds of lean body mass, we a hun—80 to 100 grams of protein per day, but we’re gonna pulse that through the day. And then I’ll say something like remember 3 x 3, 5 x 9.” They go, ”What are you talking about, Dr. Tom?” And I show my little PowerPoint, by 3 PM you better have three feedings and by 9 PM, you better have 5 feedings. It’s not diet and exercise. It’s eating and training.

Dr. Justin Marchegiani: Love it.

Dr. Tom Bilella: Teaching you to feed your—yeah, teaching you to feed your body through the day and if you need 80 grams of protein, I might say, “Hey, you know, up to 15 to 20 grams of protein, 4 or 5 times a day.”

Dr. Justin Marchegiani: I love it, very good, and you know, one of the old adages I learned from a Paul Chek, he always said, “If you’re a health advocate, a physician, you should be able to go deliver your health talks in a—in a—a thong so to speak, and like you know, kinda be able—

Dr. Tom Bilella: Yeah.

Dr. Justin Marchegiani: To expose yourself and show, “Hey, this is the product of my health advice.” One of the things I appreciate you being in this business for a long time, 30+ years. You were a bodybuilder as well. You did it the healthy way and—

Dr. Tom Bilella: Uh-hmm.

Dr. Justin Marchegiani: Even in your 50s, which you look 15 years, you know, younger than what you do, easy.

Dr. Tom Bilella: Yeah.

Dr. Justin Marchegiani: You’re still walking the talk, talking the walk so to speak and I’m just curious, can you just walk-through for some of the listeners, some of the simple things you’re doing—

Dr. Tom Bilella: Uh-hmm. Good.

Dr. Justin Marchegiani: To stay healthy, to stay ripped and lean.

Dr. Tom Bilella: Yeah, so thanks, Justin. I wouldn’t say I’m ripped anymore. I’m about 16% body fat, you know, back in 1995, I was—I did a Natural Bodybuilding show, when I’ve been, you know, a graduate _____ in 1988, but you know, what I do is, you know, I—I try to eat super clean Monday through Saturday, and I can’t really tolerate the amount of carbohydrates I used to.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: I’m still working out 4 to 5 times a week but it’s only for 30 minutes. I’m a big advocate of burst training.

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: And some that’s even a one-minute workout where I’m warming up but then I’m just doing 1 minute on a stationary bike which is 2 minutes, 20 seconds, 2 minutes, 20 seconds, 2 minutes, 20 seconds. The 1-minute being the intensity component. So I work out 4 to 5 days a week, 30 minutes at a clip. I get each body part once a week. I’m all about muscle preservation now, alright. But during the course of the week, I’m eating clean, up to 2 shakes a day, and I’m usually keeping my cards pretty low now like under 80 to 100 grams were years ago I could do 300 grams.

Dr. Justin Marchegiani: Right.

Dr. Tom Bilella: And I’m also relying on oftentimes some exogenous ketones, some keto—

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: OS through the day.

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: Usually twice a day to really help with that duel fuel, you know, using ketones as a fuel. You know, ketones are 4-carbon fatty acid that can be—

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: You know, it’s a fantastic fuel. So I’m doing that and on Sunday quite frankly, I give myself a little wiggle room, alright.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: And when I’m really, really, really good which is most of the time, I’m gluten or grain-free.

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: There are occasions where I will have a non-gluten bagel this and that, on a very rare occasion, Justin, I’m gonna tell you, sometimes gluten sneaks in, oh my goodness, it’s not a felony, folks, okay? But listen we all know that grain-free is the way to be, and of course, wheat, gluten is not your friend in this country. So that’s what I do, man.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: 6 days a week and you know, with my patients, I give them a pearl. Because another problem patients have—

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: Is the whole alcohol thing because alcohol is sugar, maybe even do one or two drinks a night or a couple a week. I like the ak—exercise alcohol rule.

Dr. Justin Marchegiani: Yup.

Dr. Tom Bilella: Never have more alcoholic beverage a week than exercise sessions. So these are little pearls that I, you know, disseminate, explain to my patients, but me personally, I try to stay clean 90% of the time.

Dr. Justin Marchegiani: Love it. Now with—with your carbohydrates, what does that look like? Because typically veggies will get you—if you’re doing like a veggie or two at each meal, you’ll be—be maybe around 20 or 30 grams of carbs especially if you minus the net fiber in there.

Dr. Tom Bilella: Yeah.

Dr. Justin Marchegiani: How’d that look for you? What do—what do your carbs look like?

Dr. Tom Bilella: Well, yeah, I pretty much—pretty much go low carb all through the day. I’m doing my veggies and at night, I’ll oftentimes get a starch.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: Potatoes, sweet potato, okay. Because I sometimes just feel a lot better with that starch in with my veggies and my protein. I think health my serotonin levels. I think it really helps my cortisol curve, you see. So oftentimes—

Dr. Justin Marchegiani: I agree.

Dr. Tom Bilella: If I do my starch I’ll do it at dinner. A lot of people thing you should do it breakfast and if that works for you, fine. But I like my protein and my fats through the day and at night I’ll do a carb. Now quite frankly, if I do a body composition analysis or I’m gonna be speaking or going somewhere and I wanna get a little bit leaner, I might even reduce my carbs further. But as a general rule, I like to get my clean carbohydrate at dinner, and I like to eat my protein first. I like to eat my protein food first then have my carbohydrate to blunt that insulin spike.

Dr. Justin Marchegiani: I 100% agree, a lot of research on carb back loading, we’re a little more insulin sensitive at night. We have more cortisol in the morning, mobilizing sugar, so we don’t need the extra carbohydrate converting the sugar in the a.m. Done studies on firefighters, they took the carbohydrate portion, spread it out evenly for one group, took the other group, had it all at night and they were already obese to begin with, and the other group lost the most weight. Same calories.

Dr. Tom Bilella: Absolutely. Yeah, I mean, you ever watch Seinfeld? Remember George the day he did everything opposite his impulses—

Dr. Justin Marchegiani: Mmm.

Dr. Tom Bilella: Sometimes the opposite, you know, instead of oh, do carbs at night, you know, if you remember Seinfeld, George did the opposite impulse. He told George Steinbrenner off when he got the job. He was at the diner. He went right up to the girl and he said, “I—I’m—am unemployed and I live at home,” and he got a date with the girl. So the point is that in nutritional medicine, you know, be open-minded. Because I would have never said that 5 or 10 years ago. I’d be like, “No, you gotta get protein and veggies at night and go to sleep.” Not everybody and especially if there’s an HPA axis dysfunction.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: Oftentimes that carbohydrate night is crucial.

Dr. Justin Marchegiani: Right and the same thing in—in real world. If you’re getting conventional, medical or nutritional information, right? Eat 11 servings of grains a day.

Dr. Tom Bilella: Ugh.

Dr. Justin Marchegiani: Do the opposite, you’re better.

Dr. Tom Bilella: Yeah.

Dr. Justin Marchegiani: You know, high cholesterol is gonna cause all these problems, do the opposite.

Dr. Tom Bilella: Do the opposite.

Dr. Justin Marchegiani: You know, eating eggs is gonna cause problems. Do the opposite, right? Bacon. Do the opposite.

Dr. Tom Bilella: Yeah, someone once said, that’s better than me, the masses are Asses. Now I hate to say that, but if you’re doing what everyone else is doing, there might be a problem there. But be , you know, the point is be open-minded. And I like what JT that once said on a—on a podcast. He’s a naturopath.

Dr. Justin Marchegiani: Uh-hmm. Yeah.

Dr. Tom Bilella: You know, the perfect diet 22:50 e to one set on up on a podcast is not the math you provide is ever found it’s created you know so you like to my client be open-minded weren’t work together for it was best for you: Leah macronutrient way you know or you need to use key tones you know I’m at eugenic I use misogynist key tones in your program so I’m very open-minded I certainly have some you know some backbone things are some rudimentary things but is different

Dr. Justin Marchegiani: Love it love it it’s really good know what your take on skipping breakfast in the morning got so you know in fasting was first introduced of a Giambrone years ago I like that set against the like you know bodybuilding.

Dr. Tom Bilella: Yeah. So you know intermittent fasting was first introduced by John Breadrid. Talk about it years ago. I was like dead set against it because I came from the old body building school, like “Oh, you gotta use the one hour waking up and uhmm–so you know and then people do had HP axis dysfunction. You gotta be careful you know because you can’t stabilize your sugar if you naturally, if you have low cortisol because you have phase III. You gotta be really careful. Yeah-Uhm but some people do well with it. But I will say this too. I also will see people come to see me, a lot of cross fitters who ranges helps fitness things. They start getting fatigue or they start getting performance deficits then they come see me. I run their blood work and it’s atrocious. I mean reverse T3 is high, their thyroid is down, their testosterone levels are down, their C rec to protein levels are up. They are overstressed. They are training too intensely, not eating and they are going too long between meals. These people, they need to start eating in like often times, start training less.

Dr. Justin Marchegiani: Yes

Dr. Tom Bilella: If I recommend missing breakfast, maybe using some ketones in the morning or coconut oil. Okay. But uhmm I’m having success with some ketones in the morning. I think there’s something too with 12 or 16 intermittent fasting especially those with insulin resistance. If you got a guy at 3rd percent body fat and his insulin level is really high, you gotta get them down.

Dr. Justin Marchegiani: Yeah

Dr. Tom Bilella: So you get him to go 12-14-16 hours without eating in the beginning, your gonna see good changes physiologically.

Dr. Justin Marchegiani: I appreciate that. I think it’s important to talk to clinicians about these things because we’re not into jamming a square peg in a circle hole. We are about giving the right information for the right patient. We know different things work at different times. You got a lot of people online where intermittent fasting work for them therefore some in that everyone has to do without any exceptions or you know metabolics, specifics, have this issue or adrenal or female hormones. So like how you add the clinical aspect. You really tailor it. It’s really important.

Dr. Tom Bilella: Yeah. And I have some clients who actually need 25 percent of their calories at breakfast. I have the opposite. I have people who have a hard time keeping at all their health in check, hunger energy cravings. Okay, so their health is not in check. And I then would have to say, “listen, I want you getting five to six hundred calories at breakfast with a good macronutrient breakdown and like “Oh, Doctor Tom, I felt so much better all day long”

Dr. Justin Marchegiani: Oh, I agree. And I think you kinda valued it to Sunday being your cheat day. I think once you get really healthy you can play around with and cheat a little bit. Like you see guys in the major leagues with this crazy swing and this and that. Well they had to get the fundamentals down first once you get the fundamentals, you can always cheat and kind of you know, adlib if you will.

Dr. Tom Bilella: Yeah, I agree a hundred percent. What I’d like to do, though and I think people should try this. Every year, I get this from my friend Shawn Philips. I try to get the best shape of my life at that timeframe. So I used to start mid March and go to Memorial day and I got a good body in mind and every year we do a physique transformation challenge and we gotta get my buddies to do it. We do body comps, we do before pictures and we do a 10-week program. So for this10 weeks, I don’t have a cheat meal on Sunday. I’m trying to go for maybe 17% body fat down to 12-13% body fat. So once a year, I try to get in really good shape for me and for the rest of the year, I give myself some wiggle room.

Dr. Justin Marchegiani: Got it. And when you’re doing that, are you counting calories at all? Or more focused on the carbs?

Dr. Tom Bilella: Good question, man. Uhm, in the beginning I keep a food journal which I recommend all my clients in the beginning. In the beginning I usually am, uhmm until it starts to get like instinctual going okay that I do my weekly body comps. If I feel like I nailed it with my macros, okay. Then I’m just like gonna ease up but good question. The first couple of weeks, I’m gonna chart everything. I’m gonna add up my calories, I’m gonna add up my protein, carbs and fat. I’m usually gonna do my body comp at 180 pound lean body mass, weigh about 216. So I’m really gonna target getting about 180 grams of protein for today. And I will kinda do some carbohydrate patterning. Some days higher, some days lower. So it’s all different and every year it’s interesting I’ll be 53 my body changes. So what worked three years ago, might not work with me today.

Dr. Justin Marchegiani: Interesting. And with your carbohydrate or with your calorie consumption, do you ever go so low calorie where you’re hungry throughout the day.

Or you try to just have enough so you feel satiated?

Dr. Tom Bilella: Yeah, I never try to get hungry especially from working because if I’m hungry and working, it’s not good for the client or the staff or me.

Dr. Justin Marchegiani: Yeah, hungry. Yeah.

Dr. Tom Bilella: But uhm but you know this year, Uhm the first year I’d probably be incorporating some exogenous ketones. So you don’t really get hungry on those. So it’s kind of a secret weapon.

Dr. Justin Marchegiani: It is.

Dr. Tom Bilella: If I do need to drop my calories and I think you can do that from time to time. Maybe two days a week. Uhm to get that extra fat loss. Uhm it’s not gonna, it doesn’t pain you at all. You don’t feel the actual cravings when you got the therapeutic exogenous ketones.

Dr. Justin Marchegiani: And you mix that in your coffee?

Dr. Tom Bilella: Uhm sometimes I do. They do make cute little cream but typically I’m gonna put it mid morning – mid afternoon. Uhm I’m just gonna ring my ketones.

Dr. Justin Marchegiani: God. People wanna get more information about the keto OS. Beside with that, you have info on it?

Dr. Tom Bilella: Yeah. At my site, which is nutritioncenter.com, there’s a site and I believe it’s, I have a thing. At the end I have shopketontc.com but I’ll get the exact email site for you. But yeah and there’s something called the five-day experience pack. If you’re interested, we could mail you the uh five pack and see if you’re noticing what most people notice which is simply this, direct improvement, mental focus and clarity, unlimited flow of energy and significant appetite control. And that’s what you will notice with the ketones.

Dr. Justin Marchegiani: Yeah, I like it too because you don’t have to go low calorie to get there, right. There’s nutritional ketosis and there’s starvation ketosis, right? So you can get there whether its with like the betahydroxybutyrate ketones or high dose MCT. Uh the great way is to get your ketones up. And you measure them at all?

Dr. Tom Bilella: I sure do. Uhm I actually don’t even do the urine anymore. Coz urine is not that accurate. I use the ketonic meter, I use the breath meter. And when I chose to uhh a ketogenic product to drink- exogenous ketones. I actually did the research and then bought them and determine which one raise my ketone levels the most. Coz we’re all walking around with some ketones, right?

Dr. Justin Marchegiani: Yeah

Dr. Tom Bilella: You’re a .3millimolar. You gotta get to like 1.0 to 1.5 to be in a therapeutic ketones, to feel the therapeutic benefit from a central nervous system stand point. And one dose of the Keto OS typically raise you 0.5 and that’s gonna put you in your sweet spot. So to answer your question, absolutely, I love the ketonic breath meter. Super convenient, not quite as accurate as the blood droplets. But you know me Just, you know me I’m a quick guy from Jersey, I like to get things done fast. So I don’t have the time, well I do have the time but I prefer not to do the blood droplet and wait so I just blow into the meter, within two minutes I get data.

Dr. Justin Marchegiani: It’s not quantitative, right? It more gives you the color and tells you what zone meant.

Dr. Tom Bilella: Exactly. Blue, yellow, green and red. Red indicating ketoacidosis which will never probably happen in the therapeutic ketones. But, right so you’re not gonna get a 1.3 millimolar read out.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: But you do know and you can feel it as long as you get into the yellow which is trace and uhm blue which is moderate, you’re measuring acetone in the breath which is an indication direct correlation with betahyroxybutyrate in the blood.

Dr. Justin Marchegiani: Exactly. And here’s the other meter I use. The precision xtra by Abbott.

Dr. Tom Bilella: That’s the best.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: That’s the best for sure.

Dr. Justin Marchegiani: And I find like in the morning I sit between a .5 and 1 on the millimoles and I feel phenomenal with that and I agree with the Keto OS I’ve seen it, I’ve done experiments and videos where I can get it to pop up uhm .3 – .5 millimoles

Dr. Tom Bilella: Yeah, exactly. And people like Tim Ferriss, you know, he actually will only write and do lab at his work when his ketone level and his blood is at a certain point coz he knows that’s the most efficient time for him.

Dr. Justin Marchegiania: Absolutely. And if you have image neurological damage, whether it’s Parkinson’s or severe insulin resistance, you’re gonna have to do synthetic extra ketones as well because the brain, the minerologies, dysfunctional maybe even uhm destroyed. It has lesions in the brain and those fuel centers aren’t quite ready to pick up glucose anymore so that’s where it’s really important. Especially, the Alzheimer’s data is quite compelling.

Dr. Tom Bilella: Yeah, I think we’re really scratching the surface right now on the therapeutic benefit of ketones for the neurodegeneration, the neurodegenerative disease. But well you know the whole ketone thing started years ago with seizures. But uh yeah, there’s no doubt about it. There’s a lot to it and uhm I think the research is gonna grow stronger. And oftentimes, the first time that you get your ketones at a certain place at 1.0, something happens in your brain. It’s like, to me its the biggest nutritional breakthrough since creatine monohydrate times a hundred.

Dr. Justin Marchegiani: Yeah, I agree and I was looking at Mayo Clinic in 1910-1915 unreal over hundred years ago, they were using ketogenic diets for epilepsy.

Dr. Tom Bilella: Absolutely. Yeah

Dr. Justin Marchegiani: It’s crazy. I see kids with epilepsy they weren’t even told about ketogenic diet by their conventional medicine. This stuff has been in the medical journal for over a hundred years. And folks, frankly your medical doctors aren’t educated in nutrition so you really have to understand where their specialty is which is trauma and acute care medicine but outside of that, you really gotta see a functional nutritionist.

Dr. Tom Bilella: Represent, man. And that’s why you know I’m all about helping as many doctors increase their practice profitability and really their productivity capacity and skill to see more people through my legends club so we can help more people. We were at seminars together and the stat was this is at you know, a hundred million people in this country who need functional medicine. And there’s only like ten thousand or twenty thousand practitioners max that do what we do. No, it’s not even that. I’m sorry, like twenty thousand patients for every one functional medicine functional nutrition doctor. We can’t handle all this. And the problem with most functional medicine doctors only seeing seven patients a day. This is from the IFM report, okay. Tom Blue did the research, 7.2 patients a day, okay. You’re not gonna change the world seeing twenty patients a week. So we know that nutritional medicine, functional medicine it’s here. It works it gets to the root cause and it changes lives.

Dr. Justin Marchegiani: Love it, love it. Now you did a post on Facebook a few months ago and I love it. It was like your top seven ways to build muscle and get back in shape. Uhm may I put you on the spot right now uhm we can pull up your Facebook and reference it if you need to but you remember those top seven things?

Dr. Tom Bilella: Well, yeah. Basically I did a book with Sean Philips years ago. Sean Philips started from the EAS camp, okay. So was it building muscle or getting leaner or both?

Dr. Justin Marchegiani: I think it was both but you talked about carbohydrates, you talked about post work out and pre work out, nutrition. I wanna pick your brain on that. You have that dialed in.

Dr. Tom Bilella: So interesting, much is as much as we talk about therapeutic ketones, there’s still something to nutritional timing. And for my young athlete high school and college who are looking to increase lean body mass and performance. There’s still something about pre exercise snack, protein and carbs and then during the workout, drinking a glucose electrolyte solution with some branch chains. Then post workout within 30-4 minutes, getting a carbohydrate protein drink with a certain ratio to actually promote an insulin spike with the right amount of leucine and branch chains to evoke protein synthesis, okay? So that’s really what I was really probably talking about in that post don’t still underestimate the value of nutrient timing as taught or the research on the VA University years ago. The research there was 4:1 ratio carb:protein for aerobic.

Dr. Justin Marchegiani: Aerobic?

Dr. Tom Bilella: Yeah, That was anaerobic, but if you anaerobic uhm football player, soccer player I dial it in maybe 2:1 or maybe 2.5 : 1 carb:protein post workout or depends on how lean the athlete is to actually, you know kind of getting the chemistry right to quench cortisol. And you quench cortisol by increasing insulin right cortisol insulin or indirect. So you can start brining cortisol levels down by spiking insulin. Insulin is still the most anabolic hormone in the body.

Dr. Justin Marchegiani: It is.

Dr. Tom Bilella: And as long as you have the essential amino acids, like leucine, you’re gonna actually turn on the mTor pathway which is how actually you make protein in the body or make muscle. So that was that post was about getting the right amount of calories, you know, frequent eating. Make sure you’re actually burning more calories a day than you actually burn, okay. So that’s again for that person whose sole purpose increase in body mass, you know, coming from a body building background you know as a former Jets nutritionist, New York Jets nutritionist years ago.

Dr. Justin Marchegiani: Oh yeah.

Dr. Tom Bilella: So these are things we had to apply for these athletes.

Dr. Justin Marchegiani: That’s great. So kinda reader’s digest version, what is the best pre workout nutrition of like, do you add creatine in there? Branch chained amino during or after or before?

Dr. Tom Bilella: Good. So let’s just start with the macros. I like to get easy about 20-35 grams of carbs so you can use something like apple sauce. And about 10 grams of protein, like uh half a scoop of protein powder. Some people do an orange and uh a hardboiled egg. Quite frankly do you wanna talk to me he best pre exercise it’s generation UCAN, okay. So generation UCAN is a superstar which is a proprietary product that’s the slowest releasing carbohydrate you can get. You put some protein with that. So 30 minutes before you wanna tap off glycogen level, get some carbs in there, some protein and then during the workout you’re actually you’re consuming uhm protein and carbs during the workout. So you’re raising glycogen, raising glucose and you’re putting amino acids in your body. So while you’re training, you’re almost like recovering as you’re exercising. Coz exercise is catabolic.

Dr. Justin Marchegiani: Yeah.

Dr. Tom Bilella: Recovery is anabolic. Catabolic means your body is breaking down. So you wanna actually have a pool of amino acids and carbs to draw from by not depleting glycogen and amino acid reserves.

Dr. Justin Marchegiani: So what kind of protein powder during the workout? Is that a branch chain amino? Is it whey protein MCT?

Dr. Tom Bilella: That’s a good question. You can do any of those man. I mean using this branch chain amino acid with a 2:1 ratio leucine to valine isoleucine. You could do something simply easy.

You can do a product and put uhm, like, I use a product Endure or you can do many different products. Like a little bit of whey protein in there and drink it like a creamsicle.

Dr. Justin Marchegiani: And how much branch in amino, do you uh 20 grams?

Dr. Tom Bilella: No, during the workout, you just need about 6 grams. 4-6 grams during the workout with approximately 25 grams of carbs, uhm depends on the size of the athlete.

But as a general rule, during the workout, 25-30 grams carbs and about 6 grams of protein or ideally 4-6 grams of branch chains. Now for example, whey protein is a really great protein for building muscle because it’s 11 % leucine. Whey has the highest branch chains in leucine.

Dr. Justin Marchegiani: why?

Dr. Tom Bilella: Yeah, which is why- yeah right. Whey protein is like the gold standard and when I teach my staff or my health coaches like what’s the most important amino acid for protein building, it’s leucine remember. I love leucine. Well-

Dr. Justin Marchegiani: Ha ha

Dr. Tom Bilella: So the point is its that it’s actually probably better to just do the straight branch chains but as long as you’re, you know getting pre exercise while you’re training you’re consuming water and glucose electrolyte solution and what do I mean by that? Some sort of carbohydrate. The one I use is glucose polymers and a crystalline fructose with sodium chloride, magnesium glycinate. So you’re getting glucose, electrolytes and branch chains or essential amino acids. And then post workout to top it all start the recovery program. Start the recovery program with a post workout shake.

Dr. Justin Marchegiani: That’s great. And a post workout shake can be any like, let’s say 30 or 40 grams protein is fine?

Dr. Tom Bilella: Yeah. At least 20.

Dr. Justin Marchegiani: I know Polycom was doing a lot of the cytomax. Like a lot of the-

Dr. Tom Bilella: Yeah, cytomax. I was uh watching uhm a quick video from the society of the weight training injuries specialist at —I speak there a year, almost every year and Darryl Willoughby, I think his name is.

Dr. Justin Marchegiani: Uh huh

Dr. Tom Bilella: One of the authors of the sport nutrition book. A minimal about 3 grams of leucine necessary to start protein synthesis. So if you’re doing 20 grams of whey protein, that’s like 2.2 grams of leucine so wanting to bump that up to about 30 to ensure about 3 grams of leucine. I’m talking for a guy here. For a woman it might be a little bit less but post workout 30 grams of protein, they say “Tom, how many carbs?” Depends on the individual, depends on the sport, might be 30 grams of carbs, might be 120 grams of carbs post workout.

Dr. Justin Marchegiani: God. So you’re doing some maybe half a scoop pre then you do protein/BCAA during and you have another post shake right after the workout.

Dr. Tom Bilella: Yeah. Just one correction there. During its BCAs and glucose electrolyte solution.

Dr. Justin Marchegiani: Got it. Uh- No I mean uh

Dr. Tom Bilella: You’re still getting carbs and protein each time-pre, during and post.

Dr. Justin Marchegiani: And where does creatine fit in there?

Dr. Tom Bilella: Yeah, creatine again love creatine. Uhm certainly before and after it’s an excellent time to take creatine. So after we talk with the macros, I’ve work with the high school athletes and I work with some of the best college athletes in the country. You know we get that down. But creatine is not just for building muscle its certainly for recovery and explosive power, okay- So I like to do creatine before and after workout.

Dr. Justin Marchegiani: How many grams?

Dr. Tom Bilella: Yeah, depends on the size of the athlete. But a general around 10 grams a day if you say for a 150 lb., male athlete. And of course research shows that if you do a lot of load phase, you can saturate yourself with creatine and I do believe the load phase works. I used to do a load phase in my body building days and that could go up to 25-35 grams of creatine for 5-7 days. So I’ve seen good results with power lifters and body lifters. But as a general rule, using creating 5-10 grams more to 10 grams a day. 10 grams if you work out, 5 grams when you don’t’ work out is a good fundamental protocol for creatine.

Dr. Justin Marchegiani: That’s great. And the major benefit is that you’re giving extra fuel source for the muscle for the high intense movements but also doesn’t it increase growth hormone, too?

Dr. Tom Bilella: They say yeah- lot of benefits. I don’t know the exact research on that but I believe that it’s true. You’re certainly getting new fuel source and you know-creatine gets into the muscle and there’s a solubilizing effect where water will then follow creatine and the muscle cell be actually larger and better hydrated which is less likely to get to catabolic process. Well you actually get creatine as an energy source per 6 seconds of explosive activity or running can be actually drawn from creatine before you go on ATP.

Dr. Tom Marchegiani: Yes, right.

Dr. Tom Bilella: You can break down the creatine phosphokinase so you can release, you know energy from the ethyl phosphokinase. I guess it is phosphocreatine I’m trying to say.

Dr. Justin Marchegiani: Yeah, yeah.

Dr. Tom Bilella: And then going through ATP then run glycolysis. Alright.

Dr. Tom Marchegiani: I love it.

Dr. Tom Bilella: So you’re getting a new, you’re getting a fuel source that maybe wasn’t there until you do exogenous creatine.

Your body makes creatine but I think the Russians and the Eastern Europeans showed 50-75 years ago the benefit of creatine.

Dr. Justin Marchegiani: Love it. And now you’ve been doing like doing a kre-alkalyn or monohydrate?

Dr. Tom Bilella: Yeah. I was uh- recommending a kre-alkalyn a buffer creatine. You tend to eat less and it’s easier on the digestive tract.

Dr. Justin Marchegiani: Love it. See, these are all actionable bits information. You’re not gonna hear these anywhere, folks. Love it. Very cool. So we got the performance nutrition aspect. What are the key movement patterns you’re doing in? Coz you got 30 minutes exercise. I love that. It’s efficient. It’s practical. What are the movement patterns that you’re doing?

Dr. Tom Bilella: Okay, good. So I uh- Good question. So I’m trying to get to different phase of cardio or to this phase, right. I never do the cardio late in the same day. Yes, I’ll do a warm up and yes I spend a lot of time rolling and stretching. So as I get older, I realize you need everything. But if I’m doing a weight training, I’m actually I uh- oftentimes I do a 4-4-4 program. Something I kinda came up with which is 4 sets per body part and this is what you’re at too. 4 steps per body part. I’m doing chest, might be 2 sets of a bench press and 2 sets of say, flies. Now that’s after warm up set or two. A lot of people are doing 8-10-12-14 set for a body part. I’ve seen people do 30 sets. It’s ridiculous. But the 4-4-4 is the four second concentric, that is where your muscle is shortening, okay. So if you’re doing a bicep curl when you’re hand comes up to your shoulder, that’s concentric. And then eccentric is the opposite. When you’re going down against gravity. If you’re doing a 4-second concentric and a 4-second eccentric, that’s a lot of time of tension on the muscle. That’s time of tension training. You have to use 30% less weight. Easy on the joints- four seconds up, four seconds down, four sets per body part. You’re done.

Dr. Justin Marchegiani: I love it. And isn’t it also known as lactic acid training, as well?

Dr. Tom Bilella: Yeah. I don’t, I don’t know if it’s exactly like the lactic acid training. But we do know that lactic acid training is highly effective in getting lean but I think there’s some crossover there. I just know this is more time of tension training. We know that on an eccentric contraction, you’re breaking more muscle. This is for hypertrophy, Justin. This will not be for like a college football player looking to get faster, okay. This is for hypertrophy training and hypertrophy means getting the muscle bigger using free weight or dumbbells. Easy on the joints and you’re getting and improvement in insulin sensitivity, okay. So you’re actually getting muscle isolation. Coz a lot of people on the gym when they’re training, they’re just using momentum. They’re just throwing the weight up and then let it drop down. If I put EMG on the muscle man, that’s not an 8 second contraction. That’s maybe a .5 second.

Dr. Justin Marchegiani: Right.

Dr. Tom Bilella: So you get done in 4 sets but some of these people are doing in 16 sets.

Dr. Justin Marchegiani: Love it. So we got the 4-4-4. That was a question I actually texted you. Thanks for answering that. That’s great.

Dr. Tom Bilella: Yeah, You got it.

Dr. Justin Marchegiani: And what are some of the other movements? Are you doing like squats, are you doing deadlifts, lunges?

Dr. Tom Bilella: Yup, I’m squatting, you see, every week still. I don’t go up real high anymore. I used to go up high instead uh- Believe it or not once I did 315 for 29 reps.

Dr. Justin Marchegiani: Holy God. That’s crazy.

Dr. Tom Bilella: Ha ha.. It’s crazy. 27 actually, no- 37. I was sore for 2 weeks. It was a contest against my friend but that’s another story. I know go up to 225 maybe 245-50. From going very slow and controlled, alright. So I’m squatting, see, twice a month. The other two days a month, I might be doing trap or deadlifts. Trap or deadlifts , so I’m in there and very controlled. So I’m not putting a lot of load on my spine anymore and little load on my spine maybe be two times a month and barely go above 240-250, alright. I used to do a lot more on my body building days. I do believe that there’s something very important and special about the squat. And I only go as low as my body takes me. I think of this and go, ” You gotta get your butt down to your feet”. Not at 52, man. I stretch and if I try to get parallel, great. If I’m just slightly parallel, so what? It doesn’t matter. I’m not going to stress my joints and my biomechanics because trainer next to me at 30 years old is going, “get your butt to the ground”. That’s ridiculous. So I’m still doing compound movements. I bench yesterday. So I’m doing maybe 3, 2-4 sets of bench, trap or deadlifts. I’m doing barbell squats. Uhm that’s what I’m doing.

Dr. Justin Marchegiani: Now, what’s your take on back squats vs. front squats?

Dr. Tom Bilella: Good question. I used to do front squats. I don’t anymore because they’re too dang hard. And uhm but I think there are some benefit to front squats. A lot of the cross fitters are doing the front squats. Uhm again, I think the risk does not weigh the benefit for some people with that with respect to the stability because what is the first rule of exercise, Doctor Justine, don’t get hurt.

Dr. Justin Marchegiani: Right

Dr. Tom Bilella: That’s the first rule of exercise. Second rule is progressive and variable. I don’t think most people need to do front squats unless you’re going to a cross fit game or front squat competition. Does it change the forces and the activated muscles? Of course it does. But for me, I like the stability of the barbell on my back. You know, up my back and below my traps where it feels more stable. I can engage my core, I can contract my lats and I can go up and down slowly. So for me, I like the back squat.

Dr. Justin Marchegiani: It was a bit with the front squat is you start to fatigue in the upper arms before you, before your glute and your legs get tired.

Dr. Tom Bilella: Yeah. And if you look at basic primal motions, if you had to put something and lift it up, you will never put it in your front. You’d put it on your back.

Dr. Justin Marchegiani: You would’ve have to put it over your back and you’d hold it that way.

Dr. Tom Bilella: You would put it over your back, you know. Paul Cheng would say that, right. So you would, you would put it over your back. That would be more of a primal movement and pattern than putting it on the front. Doesn’t make a lot of sense. Uhm but again, it’s all about the person’s goal and if you know they feel better with the front than in the back then maybe that works for them. But I like the back squats.

Dr. Justin Marchegiani: Love it. I’m ready to go to the gym right now work out, man. I’m pumped, love it.

Dr. Tom Bilella: Yeah

Dr. Justin Marchegiani: So let’s transition back to functional medicine coz you do a lot of different lab test. What are you big, what are your favorite lab test and why for your patients coming in?

Dr. Tom Bilella: Well the big question. Well what I do and this is kind cool uh I started doing this a month ago. A lot of my clients are coming to me for fatigue and weight loss resistant, right. So when I’m looking at my functional chemistry, I now take a red dot. And every time there’s some marker, like low ferritin, high cerebroprotein, low vitamin D, low 3T3, high homocysteine, okay. I’m putting a red dot right there and on that red dot, a little sticker I put fat burner and put an X through it. I’m saying “Mrs. Jones, you did not have a chance of burning any fat or having good energy because uh look at your labs.” So I’ll actually go, “you have 5 or 6 crucial indications in your blood chemistry why your fatigued and you can’t burn fat.” They inevitably say what my doctor told me this. And I’m used to taking the high road now, Justin – I’m 52. When I was 24 doing this, I didn’t take the high road and I would just kinda say, well- doesn’t matter what I said. Now uhm like “listen, we’re doing specialized test. If you’re not asking the right questions, you won’t get the right answers”. Or sometimes I’ll say “your doctor is running ante graded blood work” or “here she just haven’t interpret them”, if I need to go there. But the point is, I just need to name some things that are very important markers on blood chemistry that are crucial for longevity, fat burning, etc. alright. So I think that’s my best answer.

Dr. Justin Marchegiani: Love it, love it. Very cool. Outside of that, I mean kinda cropping up here, is there anything else you wanna address or kinda bring to the listener ‘s that we haven’t already addressed so far?

Dr. Tom Bilella: Yeah. Well a little plug if you don’t mind. You know my passion is help as many as people as I can to live a healthier, more productive life.

Dr. Justin Marchegiani: Yeah, yeah.

Dr. Tom Bilella: That’s my mission-my nutrition treatment center practice mission. But my other mission now is to help end the drug era in our lifetime.

And you know, I wanna help as many practitioners as I can uhm be successful means more profitable and have a mission to help as many people as they can. And that’s my legend’s club. Doctor TomBillela.com, that’s B-I -L-E-L-L-A .com If you want more information, let this club, just shoot me an email we’re gonna phone for 50 minutes like explain my program. It’s super cost effective. Every two weeks, we do a module. We do a live —cal every two weeks. It’s a twenty-week program and it’s the fundamentals, the essentials of business uhm in your practice. So I little plug there coz I think, united we’re better and uhm if someone would like to try the ketones like at side here it’s NTC.shopketo.com

Dr. Justin Marchegiani: We’ll put all the links below.

Dr. Tom Bilella: Yeah, yeah. Perfect.

Dr. Justin Marchegiani: To all listening, just click it, it will be right there for you.

Dr. Tom Bilella: Yeah. So that’s really it, man. And I would just like to recognize and appreciate your work. We met at some seminars, I was impressed with you the first day I met you-with your knowledge and with what you’re doing. I encourage people to go on your website and just keep tapping in to what you’re doing. You’re actually just pretty darn young just you’re a leader in functional medicine and this podcast is an example of that.

Dr. Justin Marchegiani: Well I appreciate that. And also, are you seeing patients virtually at all?

Dr. Tom Bilella: Not yet. I’m actually, I’m just starting now. Believe it or not. I’m actually doing something called an MRT macro program where people can actually get on my site and get a food sensitivity test. And they can be anywhere and I or whoever we do the food test. To be test, I get on the phone and I help them dial in their macros but I’m certain do more zoom and Skype coz I’m having patients travel over so. It’s not a big component of my practice. If someone is interested in an MRT macro program, like “Hey Tom, let’s figure out how I should be eating”. They can go on nutritioncenter.com click the shop button, boom we’ll send you an MRT kit. That’s a food sensitivity kit. We can phone a couple of times or with zoom or Skype, and I go listen- let’s dial in your program.

Dr. Justine Marchegiani: I love it. Love it. That makes so much sense. Alright, last question here. You’re stuck in a dessert island. You can only bring one supplement with you. What is it?

Dr. Tom Bilella: You know Justin, I like to question most severances, you know vitamin D. But if I’m in an island I hope I’m getting some sun. You know, I’m gonna bring a B-complex, man. Because, you know, B Vitamins so important for your Krebs cycle. I wanna make sure I make an ATP and I don’t want any micronutrient deficiency and there’s lot other benefits of B vitamins. Just making sure its co factor in your Krebs cycle. So I’m gonna be probably bringing my B Vitamins but a close second is my keto OS. If I get ketones floating in my blood, maybe I can have energy just to swim off the island and get to the mainland.

Dr. Justin Marchegiani: Plus if there are any coconuts on the island you can always eat that coconut meat. That will give you a lot of XCT.

Dr. Tom Bilella: So I used to say B vitamins but now I might have to say the fourth macronutrient with my keto OS to give enough fuel to do what I need to do- to fight the cannibals and I can go up the mountains and make a hammock.

Dr. Justin Marchegiani: I love it. love it. It’s very cool. And what’s your website again, Dr. Tom?

Dr. Tom Bilella: nutritiontreatmentcenter.com all one word. And for legends club its DoctorTomBilella.com Uhm if you wanna get my newsletters, you know I do what’s ticking off Dr. Tom a lot. You can watch a Sophia Bilella videos. It’s really entertaining. We get a point across and the last one is NTC.shopketo.com You’ll have the links there. But I really appreciate this platform. I had a good time.

Dr. Justin Marchegiani: Awesome, Doctor Tom. Well I appreciate you. You’re an inspiration to myself. Being at your age, with your energy and your health and just kind of overall uhm presence with uhm how much muscle how just overall good shape you’re in. I love it, I really appreciate it. It gives a good kinda bullseye to attain when I’m there.

Dr. Tom Bilella: Thank you so much.

Dr. Justin Marchegiani: Thanks, Doctor Tom. You have a great day.

Dr. Tom Bilella: You too.



Low stomach acid could be causing your digestive problems – Podcast #99

Dr. Justin Marchegiani and Evan Brand go in depth and reveal the truth about PPIs or proton pump inhibitors when taken especially over long periods of time. Discover what they do for your body, how it affects digestion, and what other issues they can possibly lead to. 

stomach acidFind out about the roles of hydrochloric acid and enzymes. Listen to this podcast to understand how proton pump inhibitors could be affecting organic acid markers and your body’s ability to generate ATP and energy. Learn how you can get off these medications and do away without taking proton pump inhibitors and then deal with your symptoms in a much better way starting with diet and lifestyle changes and getting in touch with a functional medicine expert to help you and then you can also proceed with any testing needed.

In this episode, topics include:

1:36   Proton pump inhibitors

6:50   The risks of taking PPIs

10:49   PPI and hydrochloric acid levels

17:40   Nutrient deficiency

19:30   Summary and take aways












Dr. Justin Marchegiani:  Evan Brand, it’s Dr. J. How we doin’ today, man?

Evan Brand:  Hey, I’m doin’ great and fired up about drugs. So let’s talk about some drugs today.

Dr. Justin Marchegiani:  Nice. Oh, by the way, this is your podcast after your newborn.

Evan Brand:  I guess it is. I didn’t realize that. Yeah, she–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  One of our friends actually made us a Not Just Paleo branded onesie.

Dr. Justin Marchegiani:  Onesie, nice,

Evan Brand:  And she’s wearing that today, so I have to put a picture up on my social media if people wanna stalk me, they can.

Dr. Justin Marchegiani:  Awesome. And your daughter’s name is summer, right?

Evan Brand:  That’s right.

Dr. Justin Marchegiani:  Love it. Excellent! Very cool.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And I actually in between I got a dog and my new dog’s name is Butter.

Evan Brand:  Nice.

Dr. Justin Marchegiani:  Which I love because she melts in my lap. She sits on my lap almost all day, even while on the calls of my patients. It’s really cool.

Evan Brand:  What is she? She looks like a shih tzu kinda but not really.

Dr. Justin Marchegiani:  Yeah, she’s kinda like a Jack Russell and a Yorkie, just about 10 pounds. She’s a little Paleo doggie. She gets all grain-free, biologically appropriate, raw, good quality foods, grass-fed meat, you know, because dogs are pretty much obligated carnivores, you know, mainly meat and such. So yeah, she does really good. She’s pretty healthy.

Evan Brand:  Good to hear.

Dr. Justin Marchegiani:  Love it. Cool, man! Well, we both got some major changes in our life, probably a lot more for you than for me.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  With the—with the child here and then me got my nice little dog, so love it! And I got two—two cats and a dog and you’re just on—what, you got one dog and a–

Evan Brand:  One dog and one baby.

Dr. Justin Marchegiani:  And a—and a daughter.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Nice. Great! Very cool. Well, let’s riff on here the proton pump inhibitor topic. A whole bunch of different drugs out there and that family, a couple of common names are Nexium, Prilosec or—or omeprazole. There’s also the purple pill, Nexium. Let’s see—Pepto—no, Pepto-Bismo. Prilosec, omeprazole, Nexium, any others that you—you can come by. There’s like about 8 of them, 10 of them out there.

Evan Brand:  They have so many different names.

Dr. Justin Marchegiani:  Yeah, so many.

Evan Brand:  It’s honestly hard to keep up.

Dr. Justin Marchegiani:  Yeah, pantoprazole, esomeprazole, yeah, I mean anything that ends in a -prazole is basically gonna be your proton pump inhibitor. You have the purple pill which is Nexium, your Prilosec, omeprazole is the over-the-counter version of Prilosec. And again, all these drugs they just block hydrochloric acid. So they’re proton pump inhibitors. What’s a proton? That’s basically hydrogen. So it’s preventing hydrogen, which is a positive charged atom from binding to chloride and forming hydrochloric acid. So that’s how it’s working. It’s mechanism of action is—is preventing those hydrochloric acids from being secreted in the stomach and binding into chloride and performing that nice acidic pH which is really important we know from activating proteolytic enzymes, enzymes that help break down protein.

Evan Brand:  Absolutely and if you look at Dr Wright’s Why Stomach Acid is Good For You, we see he tracked several different people. I believe he used—can’t remember the name of it, but the capsule that was actually like inserted, the—the piece of technology they inserted into the stomach to measure–

Dr. Justin Marchegiani:  Yeah, it’s called–

Evan Brand:  The acid level.

Dr. Justin Marchegiani:  It’s called the Heidelberg test.

Evan Brand:  Yeah, I believe he did the Heidelberg test on all these patients or people in his studies and he showed after age 20, your hydrochloric acid production begins to steadily drop until you die basically and so we’re taking people that already have low stomach acid if they’re 40-45 years old and starting to get heartburn, indigestion, bloating and these other symptoms and they’re lowering that HCl level even more which I just had a note here from Healthline that was talking about PPIs, several studies now link to PPIs to a high risk of pneumonia and an infection of bacteria which is C diff., the Clostridium difficile that you and I see often on organic acids results. So this is not just your gut that’s affected here. There’s other places in the body that can really start to dysfunction if you have low stomach acid and, therefore, you’re not breaking down your food and absorbing your nutrients anymore.

Dr. Justin Marchegiani:  Right, and then again, where these proton pump inhibitors work is they work on the stomach in particularly the parietal cells, and the parietal cells these cells also produce intrinsic factor which is like this binding compound that helps bind to B12. So B12 in your diet then hits the intrinsic factor made by the parietal. It then gets reabsorbed at the end of your small intestine in an area called the ileum. So binds the B12 in the stomach and then it reabsorbs it in the ileum. So when we have issues with the parietal cells, we can also—we also may have issues with intrinsic factor. There are things called pernicious anemia. So the more we have gut dysfunction, greater chance we’re gonna have stomach breakdown issues, and then we typically go on proton pump inhibitors and there’s a greater chance that there we may have B12 or anemia issues that are B-vitamin based after the fact.

Evan Brand:  Great, so I mean in terms of PPIs, I remember not long ago they were all prescription drug commercials. Now things like Nexium are available over-the-counter, isn’t that right?

Dr. Justin Marchegiani:  Yeah, well, I’m pretty sure omeprazole is over-the-counter now for sure and that was basically Prilosec. That was, you know, a big, big multibillion-dollar drug. I think these drugs we mentioned before the show, they’re like in—always in the top 4 or top 5 money-making drugs. And the problem is when you—when you take a proton pump inhibitor, right? I mentioned the proton something like hydrogen, and it works with your hydrogen potassium pump system in the body, which we mentioned affects hydrogen being produced via the parietal cells in the stomach, forming hydrochloric acid but there’s other areas of the body where these hydrogen potassium pumps are being interfered with and that can affect ATP production, thus your mitochondria. So we see lots of people come back on their organic acids testing with weakened mitochondrial dysfunction. We’ll see the organic acids super low or super high. We’ll see things like cis-aconitate or aconitate. We’ll see different markers like lactate and amino acid markers low for CoQ10, various B vitamins, and it’s possible that a proton pump inhibitors could be affecting some of those organic acid markers, thus affecting your body’s ability to generate ATP and energy.

Evan Brand:  Ah, so let me probe you a little bit further on that. So you’re saying here the cascade of problems that happens is we have this PPI. We’re lowering the stomach acid, so now we’re spending our hard-earned money on grass-fed beef but we’re not actually cleaving the iron and the vitamins and the amino acids from that protein, right? So we’ll show up with very low amino acids on the organics, is that what you’re saying?

Dr. Justin Marchegiani:  Correct and there’s even research showing that people that take thyroid hormone and are on PPIs have to actually increase their thyroid hormone dosage. So it doesn’t only just affect that, it can even affect medication that are natural in origin. So being on this PPIs, I call it like it’s the first domino of—of your health destruction. Because anytime you impair digestion, you impair all the nutrients that are needed to run your body’s energy systems, hormone systems, detox systems, neurotransmitters and mood systems. So once you start shorting those systems out, any type of short means increase in symptoms. It means depression. It means anxiety. It means PMS. It means fatigue. And so basically our ATP is part of how our body generates energy aerobically and the more our body is forced to generate energy anaerobically, it’s gonna lead to more fatigue.

Evan Brand:  Right, so now–

Dr. Justin Marchegiani:  It’s gonna lead to more fatigue. Go ahead.

Evan Brand:  And I was just gonna say now if you stack someone who already has mitochondrial issues, they’re not producing enough ATP and then you take that and combine it with a toxic load, say there’s still getting exposed to glyphosate, which a new piece of research came out and said 93% of people have glyphosate, the pesticide used in non-organic food, that is going to increase the toxic load, the mitochondria can’t do their work even more, so things like organic diet become even more important than before especially if you have this compromised gut issue. The number—number 2 drug in all US pharmaceuticals is Nexium and you and I were looking at the stats–

Dr. Justin Marchegiani:  And that’s the purple pill–

Evan Brand:  Yeah, so it looks like less than 10 million but well, on the way to 10 million dollars’ worth of this drug is being sold per year.

Dr. Justin Marchegiani:  Right, now here’s the triad, right? People come in or they first get their medication for a Prilosec or a proton pump inhibitor, right? Then the next thing that’s gonna happen is they may start to have mood issues. Now they’re gonna be on antidepressant. Okay, so now they have acid-blocking meds. Now they have a mood issue. And now they start having fatigue, right? And then with fatigue comes like ADD. So now they’re on like an upper. They’re on like a methamphetamine, Strattera–

Evan Brand:  Like a Vyvanse.

Dr. Justin Marchegiani:  Like a Strattera, a Vyvanse or an Adderall. So now they’re on an upper. They’re on a proton pump inhibitor and they’re also on a mood medication for the depression. Now they’re anxious all the time because they’re on a mem—methamphetamine half the day, right? So now they’re on Xanax or some kind of benzodiazepine. So all these things start to happen. If they’re a guy, they’ll probably start to have low libido because a lot of the side effects of antidepressants are low libido. So now the libido starts going down. They can’t get it up in the bed. Now they’re on Viagra an d now because they’re so inflamed, their cholesterol is going high because their body is ridiculously inflamed so you can see, right? The domino of destruction is acid-blocking medication followed by mood drug, followed by stimulant, followed by anti-anxiety, followed by anti-libido, followed by statin.

Evan Brand:  Ugh!

Dr. Justin Marchegiani:  And it’s a—it’s a common—it’s a common, common pattern. And not to mention people that tend to have all those types of problems, also gonna be inflamed, and when they’re inflamed, they’re also on what else? Pain medication, right? So then it’s gabapentin, then it’s the Enbrel, then it’s an ibuprofen, NSAID, the older meds would have like the Celebrex or a Vioxx and those killed a lot of people, too. So again these medications aren’t—be on, the more problems, the more mitochondrial dysfunction, the more energy, and then as soon as you get on an ibuprofen even though it’s over-the-counter, I mean Wolf et al, 1999 American Journal of Medicine, 20,000 people die a year taking it properly.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  These aren’t meds you wanna be on as a lifestyle medication.

Evan Brand:  Right, right. And then you already alluded to it a little bit, it’s the leaky gut situation going on, the liver burden there, potential autoimmune disease from all of this because now you’re set up for bacterial overgrowths and candida problems and parasitic infections and it gets scary pretty quick, doesn’t it?

Dr. Justin Marchegiani:  It does and I didn’t even touch upon the SIBO part.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Because you mentioned it earlier, right? When you lower—I should say, when you lower the hydrochloric acid levels, you essentially raise the pH, right? Because we need hydrochloric acid levels to be high for the pH to be low. So essentially when we—when we decrease hydrochloric acid levels, that pH goes high, we have impaired digestion, and that increases chance for opportunistic pathogens—your Staph, your Strep, your Clostridia like you mentioned, your Campylobacter. All those different pathogens start overgrowing that increases chance of leaky gut. We talked about these pathogens having these dangerous metabolites such as lithocholic acid or endotoxin or LPS which can go and create leaky gut and then cross the blood-brain barrier and create mood issues, but it also can drive more SIBO, right? Because SIBO is gonna be essentially bad bacteria moving its way up and we know SIBO symptoms cause IBS so then it’s more medications, right? You’ll be on mesalamine or some type of prokinetic or antidiarrheal medication. I know you were diagnosed with IBS and they put you on a whole litany of meds and this could all potentially stem from proton pump inhibitors.

Evan Brand:  Yeah, they tried to. I never filled the prescriptions. Thanks God. I denied them all. And you and I were looking at some other research which I just sent you the link to that we can put in the show notes is 73,000 people that were 75 years of age or older and free of dementia were analyzed and they found that people had—people that were receiving regular PPI medication, 77% of them had a significant increased risk of dementia compared to patients that were not receiving PPI. So we look at all of these places. I just saw a new giant complex got built right down the street like an assisted senior care facility primarily targeted towards Alzheimer’s and dementia. Think of how many of those people are put on PPIs. I know we have parents and grandparents listening, that’s—that’s a big deal and we’re always seeing these campaigns of Fight for the Cure, Run for the Cure—how about just avoidance? And that was the conclusion of this research here, the avoidance of PPI medication may prevent the development of dementia. So this literally, you’ve done a great job of elaborating this. This literally spreads out like a spider web into every aspect of our civilization.

Dr. Justin Marchegiani:  Yeah, absolutely and by the way, any type—anyone that tells you they have a cure for something, run for the hills. And the reason why—even when it comes to cancer. When it comes to any type of disease, the reason why there can’t be a cure it’s because when there is multiple causes, there can never be a cure, right?  Because think about it, for there to be drug, a drug has to work on—it works on a mechanistic level. So for instance, proton pump inhibitors, what’s the mechanism? It re—it inhibits proton pump—it inhibits the proton pumps. It inhibits the hydro—hydrogen crossing that, you know, potassium membrane and creating hydrochloric acid. That’s how it works. But what if your acid burn was from drinking too much water while you ate or eating too much gluten or having a lot of emotional stress and eating while you’re driving. So you see how there could be multiple different causes or it could just be old age because Dr. Jonathan Wright show that as you grow older hydrochloric acid levels drop. It could be a gut infection. So how can we have a cure that fixes all of those different causes? We can’t. Now what may happen, let’s say I just got you meditating and got you eating in a more quiet environment, that may help a lot of people but it will never be the cure for everyone. It’ll never be the catch all. But it’ll probably help everyone else. But in conjunction, we can never say it’s a cure because only drugs can essentially cure someone, right? According to FDA rules. But what we are trying to do and what our focus is on is getting the underlying causes addressed and someone may have the same diagnosis, disease or set of symptoms that are caused by different set of underlying causes, so we kinda focus on the big 5 or 10 underlying causes for each issue and that gives the greatest chance of helping that person’s symptoms resolving.

Evan Brand:  Absolutely, well said. If that segment, that 2 to 3-minute segment were aired on national news, it would be the most viral piece of health nuggets that the—the mainstream population has ever heard.

Dr. Justin Marchegiani:  Right. I mean how can you have a cure for cancer when maybe that woman’s cause of breast cancer was because of her pesticide exposure everyday where the other person over here is because she’s eating too much sugar, and this guy down the street because he’s getting exposed to round-up on a daily basis and then maybe the person that came from, you know, Japan near the—the nuclear spill 3 years ago got exposed to something there, right? But maybe–

Evan Brand:  Or—or just the person who goes and gets the yearly annual recommended mammograms which we’ve seen–

Dr. Justin Marchegiani:  Right.

Evan Brand:  Bad research about those now.

Dr. Justin Marchegiani:  Yeah, increases your chance of cancer I think 1% every year. So if you start getting them at age 30, and the time your 60, you got 30% increase there.

Evan Brand:  Right.

Dr. Justin Marchegiani:  So how can we create a drug that actually will fix all those underlying causes? You can’t.  You can’t. So we just gotta make sure we understand that, that there is no such thing as a catch all, even in functional medicine, we focus on body systems that typically get affected when people present with certain symptoms and for the most part, if there’s any catch all that you could—I would let you air on the side of, typically the gut’s a pretty big catch all for everything.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Now it may be the gut and the adrenals and the gut and something else, but typically the gut is almost always gonna be a piece of the puzzle, but it may not be the whole puzzle.

Evan Brand:  Right. So you would say, I mean, in most cases, it’s at least half of the battle is getting the gut straightened out because that is going to affect the ability to produce hormones like you mentioned, the ability to uptake thyroid hormones and have all these other systems working properly so it’s not necessarily our starting place but it’s a big piece of the pie.

Dr. Justin Marchegiani:  Yeah, and a lot times we can’t start there per se because people’s energy systems, their adrenals, their thyroid are so flogged, they can’t generate the energy and if we went after infections, they would feel like crap.

Evan Brand:  Oh yeah.

Dr. Justin Marchegiani:  So one of the first places we do work on is cutting the foods out, the bad foods, and adding the good foods. And then number two, right next to that, is adding the digestive secretions so our patients can break down their foods. Remember good food can be toxic to the body if it’s sitting there rotting. Who wants to go eat the organic spinach that’s sitting on your counter for a week versus, you know, in the fridge for a day or two and then eaten later, right? You wouldn’t wanna eat that. And then also we just touched upon the nutrient deficiency. We talked about B12, right? B12’s important for creating healthy, mature red blood cells. We also need iron for energy and oxygen carrying capacity. We need iron to make thyroid hormone. So if someone’ got a thyroid issue, we gotta look at hydrochloric acid. We gotta make sure PPIs aren’t part of the mix. What about osteoporosis? We need calcium and magnesium digestion. Well, if we got—if we’re on Boniva or if we’re on Osteo—whatever the other medications are out there—Boniva’s the big one, then you know, you’re not getting to the root cause if  you’re also on a proton pump inhibitor and not digesting your minerals or ionizing your minerals, too.

Evan Brand:  Right.

Dr. Justin Marchegiani:  Lots of studies on that.

Evan Brand:  So you literally—you literally fall apart in every aspect.

Dr. Justin Marchegiani:  Oh, my gosh! I know! And then also there’s some studies on that talking about basically PPIs having a higher risk of heart attack and—and what could be the potential mechanism? Well, I think it’s partly some of the minerals. Alright, we need magnesium. It’s a natural beta blocker to keep our heart in check. Healthy minerals help conduct nervous system impulse. We also need it to break proteins which typically have antioxidants in them and healthy cholesterol which is an important antioxidant, building block for our hormones. Also things like CoQ10 and L-carnitine.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  To help our heart have the energy and generate the ATP for our heart to pump. So that kinda make sense, right? We got increased cardiovascular, increased nutrient absorption. We altered the gut with the SIBO and with the malabsorption. So a lot of different things come and you also mentioned the cognitive things, too. So you can see how everything gets affected here.

Evan Brand:  Yeah. So where should we go? Where should we go from this? We’ve outlined and everybody’s like, “Holy smokes! Now what?”

Dr. Justin Marchegiani:  Alright, so you’re listening to this podcast, great. You’re just listening to it for the—for the brain candy, awesome! Grab some popcorn or maybe some chocolate avocado pudding, right? To keep it more Autoimmune Paleo and just enjoy the show but if you’re like listening to it with a perspective of like, “Yeah, I got some of those symptoms.” Well, what’s your first step? Well, obviously we always talk about diet piece. So I would start with a good autoimmune diet. That’s a good important thing. So that’s no grains, no legumes, no dairy, that the auto—that’s the Paleo filter. The second filter on top of that is the autoimmune one, that’s where we cut out the nuts, the seeds, the nightshades, and the eggs. Patients do that for a minimum of 4 weeks, but if they’re continuing to get benefits at 4 weeks, don’t stop until you plateau. Patients go like, “Oh, 4 weeks in, even though I’m so much better in this area and that area, I’m gonna go back on nuts and eggs.” It’s like, “Well, hold on!” if you’re getting great results, don’t—don’t, you know, mess with the good thing. If it ain’t broken, don’t fix it. So I always say don’t go on the old foods again—autoimmune foods until you plateau. Number two, once you do that, making sure your digesting your foods is essential. Adding in a good enzyme product. I mean, I have my enzyme synergy product, probably like you have one as well. A good enzyme would be great. Now if you have acid, over acid symptoms, start with an enzyme without hydrochloric acid because people that do have digestive issues, their gut lining is so thin, even something like hydrochloric acid may be too much. Something that’s just an all enzyme would be helpful and then tinker around with a shot of lemon juice or a teaspoon to a tablespoon of apple cider vinegar. If you can tolerate that then you can start to taper in hydrochloric acid down the road. When you have been on a medication like this long-term, you really wanna work with a functional medicine professional. I always recommend letting the prescribing doctor know what you’re doing, say, “I wanna go off it.” And make sure they’re okay with it. If you have an ulcer and they’re like don’t go off it yet, let’s give it time for the ulcer to heal, you wanna heed that recommendation. So let your prescribing doctor know what’s going on. Make sure they’re okay with it and then do all the diet and lifestyle things. You can always add in enzymes while you’re on the proton pump inhibitor and then you can always make the diet changes and then work with a good functional medicine provided that can help dial in the hydrochloric acid and then go to the 5Rs because what’s inevitable is an infection’s probably present that needs to be addressed next.

Evan Brand:  Yeah, so the mainstream practice is not always bad in the case of ulcers like you mentioned. You may need a PPI for a short-time so that you can let that thing heal, but generally speaking, there’s something going on that led to that in the first place so if you’re there, then you may have to dig yourself out of that first before you can jump on it but—but yeah, that’s great advice. So then it sounds like the next step once we get the foundations in order is looking into testing. So let’s rule things in—bacterial problems, yeast problems, parasitic infections.

Dr. Justin Marchegiani:  So SIBO testing, yeast, fungal testing, parasite testing. Also just know that your conventional medical doctor, it’s not in their scope to get you off these meds for the most part.

Evan Brand:  Right.

Dr. Justin Marchegiani:  If that’s prescribed, then you’re typically gonna be on for a very, very long time. I’ve had many patients that have been on these meds for years. Now most of the time, the underlying cause is never addressed. Therefore, they need it. They have to be on it. So the medical doctor really isn’t motivated, because when the patient misses it, they’re like, “Oops, that hurt. I got that burning.” So it kinda motivates the patient to stay on it and not really look to the—the root cause. But in functional medicine land, we look deeper and we’re able to help a lot of people get off these medications with their doctors help and, you know, and backing essentially so we do it the right way.

Evan Brand:  Exactly. That’s well said. So stool testing–

Dr. Justin Marchegiani:  But also the next–so yeah, stool–go ahead.

Evan Brand:  I was just gonna outline that, so stool testing–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Maybe some SIBO breath testing. Just getting the baseline, ruling things in, ruling things out, and then what were you gonna say next?

Dr. Justin Marchegiani:  Well, when we’re on acid blocking medications, especially if our gut lining’s thin, it almost always means we have weak IgA levels and weak adrenals. So we always wanna look at the adrenals because the adrenals help reduce inflammation if we’re inflamed. We wanna make sure our adrenals, our natural anti-inflammatory, our natural ibuprofen’s working to help reduce inflammation, okay? That’s gonna help build up our gut lining, too. We need healthy cortisol levels to build our IgA up. And then also number three, we gotta have good energy, right? So if our adrenals aren’t working properly because they are too busy putting out the fire in your gut. Well, you’re gonna feel fatigued and you’re probably gonna even have brain fog, too. So the adrenals are important and then if you’re having thyroid symptoms, right? Cold hands, cold feet, constipation, mood issues, depression, outer third of the eyebrow thinning, hair loss, right? Any of those symptoms you wanna look at the thyroid, too, because that may be affected as well.

Evan Brand:  Yup. I was gonna say also making sure that you—you outlined it already, but the order of things, too. And like there’s a lot of gut-healing supplements that people may do like I’ve seen just over the past week a lot of people just taking things kind of willy-nilly just because they read about it like slippery elm and marshmallow and all of these gut-soothing herbs, aloe vera, but you may not need to jump straight to that if they infection has not been identified and removed yet. Those things may help and likely can’t hurt, but you’re gonna just be kinda be spinning your wheels and wasting your money at some level.

Dr. Justin Marchegiani:  Yeah, if you’re doing that, like in my line I have a product called GI Restore we use. I know in your line you have one as well, we’ll use those but we’re always using them in conjunction with getting to the root cause, if not now or in the next month or so. A lot of people use those just to control symptoms. It’s like, alright, instead of an acid-blocking med, here are some enzymes and hydrochloric acid and some soothing herbs and nutrients and L-glutamine. A lot better. A lot of the underlying causes are addressed there but if we’re not causing the lifestyle causes or the food causes, you know, that’s strike 1. If you’re not addressing the infections, that’s strike 2, and if you’re missing the adrenal piece, that’s strike 3, right? So we wanna really have a comprehensive approach that looks at everything. So let’s say we forget everything up to this point, right? Number one, change your diet. Paleo/Paleo-Autoimmune, that’s step one. Step two, get on some enzymes at least. This is where you wanna start working with a functional medicine professional before you go deeper. Step three would t hen be doing the testing to assess the gut and if you have deeper symptoms, address the adrenals and thyroid and then even deeper, maybe the organic acids especially because of the mitochondrial dysfunction that can happen with these medications long-term.

Evan Brand:  Well-said.

Dr. Justin Marchegiani:  Any other clinical anecdotes you wanna give about patients that you’ve seen on PPIs, Evan?

Evan Brand:  Yeah, well, one thing that was interesting last week is a female who her adrenals actually showed up fine, which I was surprised because she had so much fatigue going on but then she showed with Clostridia bacterial overgrowth and she actually had a history of a PPI. I don’t believe she’s on one currently. I think she had a history of one for 10 years, and so she showed with Clostridia bacteria. It didn’t show up on the stool panel but it showed up on the organics and then all the–

Dr. Justin Marchegiani:  Ah.

Evan Brand:  All the mitochondria markers were very high, succinic acid and others were very high and then the amino acid portion, it was so low that it hardly registered. And I was like–

Dr. Justin Marchegiani:  Right.

Evan Brand:  Oh my—oh my God. I said, “Do you feel—like how do you feel after you get done with a meal?” She was like, “I feel like I don’t absorb anything.” I’m like, “Well, we can clearly see it here. Your amino acids are flat lined.”

Dr. Justin Marchegiani:  Right.

Evan Brand:  And so it was just really interesting to me because you and I talk so much about adrenals and we work with so many people with adrenal issues that to find someone that has decent adrenals was shocking.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And then I was like, “Okay,” and then you have to wait a few days, you know, to get the other labs and it’s like, “Oh, now the light bulb went off. Here’s why.” It’s a whole another system that’s dysfunctioning that you’re never gonna get that measured by going to the clinic down the street and getting your standard of care yearly check-in. It’s just never gonna happen.

Dr. Justin Marchegiani:  Absolutely and also I’m gonna leave everyone here with a couple of clinical pearls. Because the big benefit of this show really is you’re working with two clinicians that are in the trenches working with patients. We aren’t just doing research all week long and making theoretical statements. We’re understanding the big picture. We’re working with people and we’re taking our clinical information and sharing it. Quick clinical pearl number one, separate your enzymes and your hydrochloric acid. A lot of people are taking like an enzyme HCl product, like maybe Super Enzymes is a common one. Good product. But if you were on a proton pump inhibitor and have gut issues, you wanna separate your enzymes from your hydrochloric acid. Why? Because your gut lining may be so thin that you may not be able to handle more than a couple hundred milligrams of hydrochloric acid and now if your enzymes are bound up with that, now your enzymes are limited to whatever amount of hydrochloric acid you can take because there it’s a packaged deal. Where if you get them on separately, let’s say you can only handle a quarter of a capsule of hydrochloric acid, but you can still ramp up the enzymes to 2, 3, 4 caps where before you’ll be stuck with maybe an eighth of a dose.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Number one is that. Number two is don’t go on hydrochloric acid off the bat. Focus on enzymes. Add in a—a tablespoon of apple cider vinegar, see if you can tolerate it. See if it makes your symptoms better. Take it with food. Some people with mess up the hydrochloric acid stuff by taking it at the end of their meal and it stacks on top of their food and burns their esophagus. So we really wanna emphasize that and last thing, I didn’t really go under the main mechanism, I missed it, I say it so many times with my patients, but I forgot it today. One of the main causes of hydrochloric acid issues, one of the main mechanisms is actually low levels of hydrochloric acid, right? Because GERD and acid reflux happen because of low levels of hydrochloric acid. The food rots, rancidifies, putrefies. Organic acids from that food rotting rise up and then burn the esophagus—the top part where that cardiac sphincter comes in and tightens up and basically closes down the stomach environment from the esophagus environment, and most people with low levels of hydrochloric acid, they don’t get that tightening of the esophageal sphincter, that cardiac sphincter, number one and number two, the get their food rotting and then the get the organic acids rising up. Where if the hydrochloric acid levels were high enough off the bat, they probably would have broke down those foods without any problems.

Evan Brand:  And it would have killed off the potential pathogens in that food as well.

Dr. Justin Marchegiani:  Absolutely.

Evan Brand:  Undercooked—undercooked food, mishandled food, sushi, etc. Like I had a female that she went to India, showed up clean stool test, went to India—I think, I don’t know if I had her on enzymes at that time or not—it’s been about a month or so, came back, symptoms and infection. And I was like I wonder what would have happened if the high dose of enzymes and HCl would have been in her travel kit, maybe we could have prevented that situation from happening.

Dr. Justin Marchegiani:  Big time. I got a whole video coming out on what to do when traveling, supplement-wise, and then also some people gotta go a little deeper. They gotta do some GAPS stuff or FODMAP or SCD, specific carbohydrate diet stuff because their guts is really messed up. This is where people like me and you are great resources, so again everyone listening, grab whatever you can from this info here. Listen to it twice. Check out the transcripts. Give us a review. If you’re really liking it, go over to iTunes, BeyondWellnessRadio.com/iTunes, NotJustPaleo.com—what’s your little end link after that?

Evan Brand:  I’ll make it iTunes.

Dr. Justin Marchegiani:  Okay.

Evan Brand:  It’ll be NotJustPaleo/iTunes.

Dr. Justin Marchegiani:  ITunes, yeah, give us some reviews, guys. We’d love hearing back from you. We wanna provide great information. Our goal is to be able to touch over a million people. I know Evan has. I have, too. Let’s say 10 million people so we can really help change the world and get them off the—the addiction to the conventional medical treatment pathway so to speak.

Evan Brand:  Yup, yup, amen. I know when people hear, “Oh, leave us a review.” It’s so easy for this podcast to end and then you just put your phone away or your laptop, but I know it takes a little bit of effort. You actually have to go into BeyondWellness, go into NotJustPaleo on iTunes and you have to literally click Write a Review button on your iPhone or your computer, PC or Mac, in the iTunes app. And then you have to click some stars, whatever stars you think we deserve, and then you actually have to type.

Dr. Justin Marchegiani:  That’s it.

Evan Brand:  Type the review. Submit. That’s how you do it. I’ve gotten over 200 5-star reviews worldwide but we should get that number to a thousand, 5 thousand, 10 thousand, however many it needs to take so that we continue to beat out Jillian Michaels in her podcast.

Dr. Justin Marchegiani:  I know, my gosh. I just can’t stand the eat less, exercise more mindset. It’s so much more nuisance than that, and also everyone knows someone on these medications. Shoot this podcast over to them. Have them listen to it. It could change their life.

Evan Brand:  Amen.

Dr. Justin Marchegiani:  Evan, it’s been awesome. Make sure you hi to your wife and Summer for me.

Evan Brand:  I sure will.

Dr. Justin Marchegiani:  Oh, and then by the way, I got Butter here. She says hi, too.

Evan Brand:  Hey, Butter.

Dr. Justin Marchegiani:  Take care. She’s unsalted by the way.

Evan Brand:  Cool!

Dr. Justin Marchegiani:  Take care.

Evan Brand:  See ya!

Dr. Justin Marchegiani:  Bye.

Evan Brand:  Bye.


References: http://www.altmedrev.com/publications/16/2/116.pdf

The entire contents of this website are based upon the opinions of Dr. Justin Marchegiani unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Justin and his community. Dr. Justin encourages you to make your own health care decisions based upon your research and in partnership with a qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Dr. Marchegiani’s products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using any products.