Is your brain and immune stress making you tired? – Podcast #84
Dr. Justin Marchegiani and Evan Brand in today’s podcast talk about HPA axis for fatigue and its connection to the immune system, given how cortisol helps with energy and its importance with immune response. They also talk about healthy gut bacteria and B vitamins.
Learn about malabsorption and the effects of surgeries like a gastric band or bypass. Discover how you can transition to a Paleo template and how you can go low calorie naturally. They also emphasize how important it is to get enough absorption to avoid dysbiosis, infections and low stomach acid.
In this episode, topics include:
00:45 Apple cider vinegar
9:40 Supporting the immune system
15:46 Fatigue and immune health issues
16:46 HPA axis
22:46 Poor digestion/poor bacterial balance
Dr. Justin Marchegiani: Evan Brand, it’s Dr. J. What’s going on today?
Evan Brand: Hey, not too much. It’s Friday, feeling good, ready to rock this house.
Dr. Justin Marchegiani: That’s excellent. Today I’m actually drinking my—drinking apple cider vinegar right now. Bragg’s has this new little apple cider vinegar drinks. It’s—this one’s called Ginger Spice. Because I love ginger. Lots of great anti-inflammatory and lymphatic and anticoagulant benefits. This has 0 calories and it’s sweetened with a little bit of Stevia, and it’s a little bit of organic ginger and then it’s just basically distilled water with organic apple cider vinegar. So—
Evan Brand: I’ve had that one. It’s good.
Dr. Justin Marchegiani: Yeah, I love it, because apple cider vinegar’s basically acetic acid and most people are like, “Wait a minute! Wait a minute! You’re—you’re drinking acid. Isn’t that gonna make you more acidic?” Well, the whole acid-alkaline thing I’ve kinda debunked it in many different talks, but most people with stress actually get more alkaline, alright? And the problem is most people whose intestinal tracts are alkaline, or guts are alkaline especially the stomach, they’re gonna have protein issues, they’re gonna have maldigestion; if a urinary tract is too alkaline, you’re gonna get a yeast infection, or a UT—a UTI or E. coli, you know, BB infection. So apple cider vinegar has so many great benefits and it just shows you taking in some apple cider vinegar helps with digestion and also helps mobilize calcium and minerals as well. So lots of good benefits. Most of your acidity issues are gonna come from inflammation typically from extra refined sugar and infections and stress.
Evan Brand: Yeah, I’ll never forget when I worked third shift in college, I had a—the building or general manager—
Dr. Justin Marchegiani: So you were saying third shift when you were in college or when you were working?
Evan Brand: Yeah, when I was working third shift in college, this guy, he was a general manager, some type of big wig. He always looked so good where other third shift people looked like vampires and I asked him like, “What is your secret? How do you look so good?” And he says I take a shot of apple cider vinegar every day, and he was doing the Bragg’s. And so that’s what kind of turned me on to it. I was like, “Man, this guy looks so much better than everyone, all the other vampires working the shift, and so that was my—my entry into apple cider vinegar. And if you go on earthclinic.com, they have a lot of like natural remedies and stuff there. Apple cider vinegar is literally at the top of the chart for everything. I’m talking digestive issues, food poisoning, skin issues, like it’s incredible. I mean that—that is a—a true super nutrient.
Dr. Justin Marchegiani: Yeah, it’s phenomenal just for the fact it’ll help your digestion when you get stressed, digestion goes south, which means, well, you’re not gonna be able to break down protein as optimal. If you’re not making enough acid, well, you’re also gonna have inability to kind of like sterilize your gut so infections that come in are definitely gonna be a problem. Apple cider vinegar has been shown to help with blood sugar and blood sugar stability which is awesome. They did a study where it reduced blood sugar by 34% when eating white bread, right? Not that I’d ever recommend that but it has a beneficial effect on that. Great disinfectant, can help with weight loss, and I think a lot of it has to do with the pH and with digestion and potentially helping with minerals. Like if you get a little eye twitching, a lot of times that’s from calcium, and if you take that you can help mobilize that calcium so it can get to where it needs to get, because a lot of time if you are under stress, your body will pee out alkaline minerals when you have excessive cortisol and taking in the apple cider vinegar will help mobilize those minerals so you can hold on to them better.
Evan Brand: That’s very cool, so you’re saying you’re gonna be dumping magnesium from the stress and therefore, the kidney-magnesium balance is offset.
Dr. Justin Marchegiani: And potassium as well, and that—that’s Guyton’s Physiology, that’s in the textbook.
Evan Brand: Yup.
Dr. Justin Marchegiani: High secretions of cortisol and stress hormone will cause you to dump alkaline minerals.
Evan Brand: It’s like dead fuel.
Dr. Justin Marchegiani: Yes, so on that standpoint, how would your pH look on a urine strip if you’re dumping a whole bunch of alkaline minerals?
Evan Brand: Not well.
Dr. Justin Marchegiani: It may not look that bad, right?
Evan Brand: Uh-hmm.
Dr. Justin Marchegiani: May not look that bad and also go out and do some sprints and then check your pH. Do you think it’ll be more alkaline or more acidic?
Evan Brand: I’d say more alkaline if you’re stressing the body with that high intensity.
Dr. Justin Marchegiani: Actually if you do exercise like that, you’re gonna be creating lactic acid, right? And that—that will shift your pH more acidic. So now, would we say that go out and doing some HIT training, high-intensity interval training, would that be good or bad for the body based on what we know?
Evan Brand: I don’t recommend it.
Dr. Justin Marchegiani: Well, if we–
Evan Brand: Not often.
Dr. Justin Marchegiani: Well, if you’re doing it right, there’s lots of great benefits for interval training, lots of great benefits. You know, if you’re keeping it within 10-20 minutes, it’s—there’s phenomenal benefits with growth hormone and everything. So that would be a beneficial thing. So just because you’re creating some acidity from that exercise in the form of lactic acid, that’s not a problem. But if we just base everything off the pH alone and that’s our only filter for saying something is good or bad, you’d have to say exercise in that form is bad. But it’s not. We know it’s not bad, right? Maybe if you’re doing too much of the CrossFits and doing too many AMRAPs, right? As in many reps as possible for 20 or 30 minutes and not resting and not having that interval downtime, that may be a problem especially if you’re adrenally stressed.
Evan Brand: That’s what I was gonna say. I’m just biased because 9 out of 10 people I’m working with, they’re so adrenally fatigued anyway that they can hardly get to the gym and let alone do 15 minutes on a treadmill walking, you know?
Dr. Justin Marchegiani: Right, so it’d have something that energizes you. So kinda keep that in mind, we went on a little tangent with the apple cider vinegar that I think it’s a—a worthwhile topic.
Evan Brand: Yeah, definitely.
Dr. Justin Marchegiani: So we wanted to talk about just fatigue a little bit, just in the context where fatigue comes from and simple things we can do to help fix it. You wanna start us off, Evan?
Evan Brand: So the first thing for me is gonna be light exposure, bright light exposure.
Dr. Justin Marchegiani: Mmm.
Evan Brand: Because a lot people that we’re working with, they’re working inside of an office environment, so typically they’re going from their house which is a box to their car, which is another box to their parking where their parking garage which is a box and then the office box. They’ve never got exposed to that bright light and we know cortisol is driven by light. Even these people are throwing on sunglasses all the time, maybe because they have adrenal issues so they’re always wearing sunglasses to—to try to cope with the bright light because they can’t handle it, but if you’re never getting exposed to that bright lux, that measurement of brightness like 100,000 lux that you get on a sunny day versus 500 lux that you’ll get in an office, you’re—you’re gonna be tired. Just like that, no matter if you’re having a good diet or not. So that’s why people will go to the caffeine because they never got that cortisol bump from the bright light so now they’re seeking a stimulus to try to artificially boost the cortisol up.
Dr. Justin Marchegiani: Yeah, exactly. So I’m a big fan of like getting up and I’ll have my—my butter, coffee, and MCT out in the sunlight. Like this morning, I do wear a little bit of sunglasses though in the morning, not because of—we got a lot of bright light here in Austin but because I do have some kind of like little bit of specks on the side of my sclera in the eye, and I just wanna mitigate sun damage that I wear—I do wear sunglasses out in the sun especially at the lower latitude here in Texas. But I do get out in the sun. I expose my skin and my face first thing in the morning because it really gets that HPA axis kinda dialed in, right? So I do cold showers in the morning, at least in my 5-minute shower with the last minute being cold and then I do have a little bit of coffee with butter and MCT and then I get that sunlight, that bright light exposure to get my HPA axis woken up saying, “Hey, this is time to get things moving and be productive.”
Evan Brand: Yeah, that is one thing I miss about Austin, the abundant sunshine there.
Dr. Justin Marchegiani: Exactly. And today just on the fatigue perspective, I don’t think we need to go too much into detail on the adrenals and thyroid component because we’ve already done many, many podcast on this. So off the bat, the adrenals and thyroid and mitochondria are all gonna have be ruled as a potential driving factor of the fatigue. So we’re kinda looking at strata just outside, just looking at the adrenals, the thyroid, and the mitochondria. The—the Three Amigos as I call it for energy. Those are the Three Amigos.
Evan Brand: Yup.
Dr. Justin Marchegiani: So outside of that, sunlight is really important. I’m a big fan of blood sugar stability and that kind of falls in the camp of the adrenals and thyroid because it’s gonna help that, right? Everything’s gonna help all of these three body systems, but getting good blood sugar stability, meaning eating that breakfast in that first 30 minutes to an hour of getting up is gonna be a really important one to stabilize the blood sugar. The more you’re under stress, the more your body is gonna need minerals like magnesium and zinc, and B vitamins for energy. So it doesn’t make too much sense to skip breakfast and skip meals especially when you’re stressed, because well, where’s your body gonna mobilize those things from? It’s gonna have to mobilize them from tissue or it’s gonna have to mobilize them from, you know, your mineral—your mineral stores in your body and it’s gonna put stress on your body and it’ll cause more cortisol because your body is gonna have to mobilize it somewhere and cortisol is that catabolic hormone that’s gonna break things down in your body in particular amino acids to help give you energy and convert it over to glucose and sugar.
Evan Brand: Yeah, I figured we could talk about the immune system, too, just because a lot of people that are under stress they have some baseline level of stress—we all do.
Dr. Justin Marchegiani: Uh-hmm.
Evan Brand: The immune system can get taxed and I know you and I, I think we’ve probably done a whole episode on medicinal mushrooms, but supporting the immune system is something that’s really helped me so I’ve been doing a lot of astragulus lately just a daily dose of it and I’ve significantly improved my energy levels and I was reading a book the other day about herbs, just herbs and herbal medicine. It was talking about how astragulus can help to boost your cold tolerance as well and so I really haven’t been that cold even though I’ve been out in the snow and hiking in ice and freezing temperatures. The astragulus has boosted me up. So some good baseline immune support may be helpful for the fatigue picture, too. And we’ve talked about cordyceps before but I’m sure there’s other—there’s other herbs and stuff like that and mushrooms that are helpful.
Dr. Justin Marchegiani: Yeah, I totally agree. I mean astragulus is great for helping the spleen. It’s a good blood filter and it also increases your body’s Th1 immune response, so we–
Evan Brand: Will you talk about that for a minute? Like the Th1, Th2, that’s something that I’m not an expert in.
Dr. Justin Marchegiani: Yeah, so your Th1 is gonna be kind of your—it’s called the cytotoxic immune response. It’s like the—the Special Forces of your immune system. So it’s like the Navy Seals or the—the Delta Force or the Army Rangers so to speak. The people that are in—in the—I should say where all the action is upfront, right? So that’s like your CD8, it’s like your natural killer cells. That’s the Th1 branch. They’re in there upfront, getting in off the bat. And then we have kind of the infantry that may lag behind and keeping the analogy of our immune system. That’ll be the Th2 immune system, so these could be like our helper cells or CD4 helper cells. These could be the various antibodies that are made like IgA, IgM, IgG is a little bit more delayed. These are im—immune antibodies that then come later after the fact like the infantry. So we want a good strong immune system, the Th1 immune system and then it takes about a week for the Th2 guys to come out. Now people talk about vaccines for immunity but vaccines really only touch the Th2 and even that’s debatable with some people because you can have an antibody and that antibody may not be a good antibody to actually fight and then kill an invader. It could be weak antibody. So vaccines only touch the Th2 or the humoral immune system. They don’t do anything to work on the Th1, the cytotoxic natural killer base CD8 immune system.
Evan Brand: So you’ll–
Dr. Justin Marchegiani: And that’s important.
Evan Brand: So you’ll hear about people with an imbalance of Th1 and Th2 which I guess this is another tangent but are people more dominant with that Th2 typically because they’re lacking that Th1? They’re lacking that good immune response out of the gate, the frontline NK killer cells and stuff like that? Or is it are you able to—to say–
Dr. Justin Marchegiani: Yeah.
Evan Brand: The majority of people are X or Y?
Dr. Justin Marchegiani: Yeah, there are some theories out there that some people are more Th1 dominant over Th2 dominant. People that are more sensitive to—to coffee and caffeine, that’s a Th2 type of stimulant. So if you are Th2 dominant already, imagine a see-saw right? AS Th2 goes up, Th1 goes down. Let’s say you have caffeine and that stimulates your Th2 more and you feel worse, well, that may be a sign that you’re Th2. Again there are certain interleukins that you can measure on a blood test, interleukin 1, 2, 6, 12, TNF-alpha. And they kind of—they correspond with each side of the immune system—I don’t know the exact breakdown off the bat, at which ones go to which side, but on the markers you can look at it and you can do a CD8 to CD4 test and you can see kind of what’s—what’s higher or lower. Now ideally we want a CD8, it’s about twice as high as a CD4, right? We want more twice as much natural killers—twice as much natural killers as we do helper cells. Because we want a good, strong Th1 defense. Some people are—are more imbalanced on one side or the other. Now when we look at that, it’s gonna be like your medicinal mushrooms. It’s gonna be like your astragulus, your Echinacea, a lot of your immune-boosting herbs, elderberry, golden seal, all your medicinal mushrooms—Shiitake, Chaga, Cordyceps, Reishi. These are gonna be like your Th1 stimulants and then all of your antioxidants and things like caffeine, green tea, EGCG—Epigallocatechins, resveratrol, pycnogenol, grapeseed, your OPCs, your oligo proanthocyanidins—say that ten times fast. These are all gonna be your antioxidants that drive Th2 stimulation.
Evan Brand: So you need both?
Dr. Justin Marchegiani: You need both, yeah, but again I’m a big fan if you get sick though, stimulate the Th1s.
Evan Brand: Yup.
Dr. Justin Marchegiani: Again, but be—be wary if you notice, if you push one side or the other and you really don’t feel good, it could be that you’re dominant on one side or the other. For me, I don’t really get caught up in that because I call that like window dressing. Because if you have an infection or you have blood sugar issues or you have a lot of gut problems, that’s gonna screw up your immune system already. Now does it matter, you know, what—what direction it’s screwed up in? Well, let’s just fix why it’s screwed up. Let’s fix the stressors. Let’s fix the infection and then we can have a better immune system that’s balanced.
Evan Brand: That makes sense.
Dr. Justin Marchegiani: Simple things like vitamin D and glutathione will balance out the immune system in either direction, whether your Th2 or Th1. Vitamin D and glutathione with help with your T-regulatory cells and help balance it out either way. So those are things you can’t go wrong with is the vitamin D and the glutathione.
Evan Brand: Cool, we’ll have to rename this to the Immunity Show.
Dr. Justin Marchegiani: I know, we’ll have to kind of have like your fatigue and immune system connection show. I mean, this—we’re off the cuff here. We’re going pretty spontaneous and we extrapolate all the information based off what we’ve seen and what we’ve experienced with our patients in the clinic.
Evan Brand: Yeah, immune health issue is a big one because you hear so many people and they will talk about the fatigue as maybe like a main symptom, right? Or their depression or sometimes, you know, we’ll have people come in with anxiety issues that happen with the gut and then they talk about well, I have the year-round sniffles. And so that kind of why I wanted to bring up the immunity piece is because it’s like people don’t really understand what to do about it. So they’ll go in and take the Dayquil or the—what else can we talk about, the conventional antihistamines, the Claritin and all of that, but they’re never really getting to the root cause, but immunity is still on the forefront. And I went to the gym the other day and I saw 3 different TVs with 3 different drug commercials all for immune-based issues, like it was like Claritin and Nasonex or something and something else. And you’re never gonna hear, “Hey, why don’t you just fix your—your gut or thyroid or your adrenals?” Right? It’s like let’s just—let’s just shove something up your nose and fix this immune response, which is just crazy.
Dr. Justin Marchegiani: Yeah, and then also people don’t really talk about the HPA axis, but that’s the—the hypothalamus and the pituitary of the brain, or I call it the thermostat of the brain or the body, which talks to the adrenals is really, really important in your immune system. There’s one article right here from the Journal of Medical Hypotheses and I’m just gonna read the last couple of sentences. It says, further studies of the nature of the beneficial effects of cortisol, and possibly other adrenocortical hormones, upon humans are needed. And it says there’s recent evidence of the feedback relationship between the immune system and the HPA axis, and with the increasing awareness not only that the immune process provides protection against infection, but also that, you know, it—it may get impaired with excessive cortisol stimulation or a drop in cortisol, super low cortisol. So one of the major reasons or one of the major signs of good cortisol-HPA axis function is a nice cortisol rhythm on a 20, or you know, a 6am to 10pm to 12pm, 12am test, that good—I should say maybe a 17 to 18-hour test, we have a nice cortisol rhythm and that’s gonna be really, really important for HPA axis feedback. And starting your day off with a cold shower and that light stimulation can be very helpful at setting the bar for that HPA axis and then stabilizing blood sugar in the morning, that’s gonna help as well. So if we have good energy and good adrenal function, we’re also gonna have good immune function and good HPA axis function, too.
Evan Brand: Right, when you see the people on the commercials, it’s not normal. They show the lady walking her dog through the park and she’s just sneezing and it has like this orange glow to the commercial and then she takes this drug and it’s like, “Oh, everything’s green. I’m not allergic to the environment.” It’s like allergies are not a normal thing to me. Maybe you have a different opinion, but to me I don’t think people should be as hypersensitive to the environment and react to everything, like a lot of people do. People just talk about it like it’s no big deal. “Oh, I’m allergic to this. I’m allergic to that. I’m allergic to grass. I’m allergic to cats, to dogs.” It’s like, “Mmm, maybe.” But I’ve seen improvements and I’m sure you have, too, with—when you support these other systems, the immune response kind of turns off a little bit.
Dr. Justin Marchegiani: Absolutely and if you have chronic allergy issues, it typically means a Th2 immune system type of response. It’s your Th2 system is just so hyperresponsive where you’re developing antibodies and allergies to just dander in the environment, cedar or various things in the environment and that’s not healthy either. Now I most find that allergies can be a really big sign of low stomach acid, right? It can also be a big sign of adrenal dysfunction. Because if you look at a lot of the common allergy medications, like what is it? Well, a lot of them are gonna be corticosteroid-based, right? Or they’ll be like histamine-based. They’ll be like histamine degranulators like Benadryl or whatever other histamine drugs that are out there or they’re gonna be corticosteroid-based, Zyrtec or like an inhaler or albuterol. I mean, there are like 100 different names, it’s impossible to know—know them all but they’re all corticosteroid-based. And if you continue to take a whole bunch of synthetic cortisol, well, that can actually weaken your immune system, too.
Evan Brand: That makes sense. Do you get cedar fever or are you tough enough to beat it?
Dr. Justin Marchegiani: I’ve no—I’ve zero seasonal allergies. Absolutely zero.
Evan Brand: I mean, it—it’s amazing when—when I was down there in Austin how many people are like, “Oh, God, here it comes, the cedar fever.” And—and I was fine. And I just thought that was crazy how many people talked about it like it was an epidemic virus that was gonna spread throughout the city.
Dr. Justin Marchegiani: Yeah, I never had any issue. I—I still don’t. I mean I have no problem with it and you can see it. It really lays out in the cars pretty well, pretty thick bit of pollen there, but if you have good adrenal function, if you have good stomach acid levels, and let’s say, you know, and also good detoxification system, too, because good detox means good gluthathione. Glutathione like I said affects your immune system, right? It’s a good balancer of your immune system. Outside of that, let’s say you did have allergies. Well, what would you do? I mean, if you look at a lot of the really good allergy products, N-acetyl cysteine is a big compound in a lot of these products. What does that affect? Well, that’s gonna affect glutathione. What else is in there? Well, bromelain. Bromin—bromelain is a really good enzyme that will help with the immune response. Also you’ll see things like stinging nettle, which is a natural antihistamine. You’ll see things like vitamin C, which is a really good anti-allergy one. And you’ll even things like quercetin, right? Quercetin also is a big converter over to glutathione as well. So when you look at a lot of these things on the herb side, you have things that are gonna help with histamine. They’re gonna help with your immune system and they’re gonna help with glutathione, which are all super, super great for helping to actually support your immune system versus just, I don’t know, like if you had a house that was on fire and someone kept on lighting the fire and you just came over there and put the fire out. But then as soon you turn around, they’d lit it again. Would that be good? No. You wanna get that person out of there and stop lighting the thing on fire. And that’s kinda how I see cortisol, as like the synthetic cortisol, it may be helpful in the moment and be palliative. But long term, it’s just totally ignoring the underlying cause of why you’re immune system’s there. And not to mention all of these things are gonna affect fatigue, because the reason why you’re having these issues is because your body is not able to deal with inflammation to begin with. And what’s the main system of dealing with inflammation of the body? It’s gonna be your adrenals.
Evan Brand: Yup, great way to tie that back in to—to that fatigue picture.
Dr. Justin Marchegiani: Yeah, so kind of—we’re gonna just keep this podcast on the immune-fatigue connection here, just so we keep a good linear thread. So also when it comes to the fatigue and energy system, if we have poor digestion, we’re gonna have poor bacterial balance. And one of the big things that bacteria produces is B vitamins, right? B vitamins are gonna be really, really important with energy. So we want good B vitamins. Like one of the things I’ll start seeing when I give specific probiotics back in to patients, we’ll start to see their urine get a touch more yellow sometimes. And that’s a lot of times they’re starting to make some extra B vitamins, and they’re starting to pee some out, which are fine. Because if they’re peeing some out, that means they’re also utilizing some, too, right? You don’t just pee them all out. Your body’s gonna pull some of those in and maybe push some out. So that’s okay, because it means that the other parts are getting some. So we’ll see some yellow tinge to the urine happening, which is a really good sign because we’re getting the gut bacteria to make some more B vitamins and maybe even vitamin K, too, as well.
Evan Brand: That’s so cool. Yeah, I—I completely forgot about that whole aspect is so the probiotics are going to start producing—they produce B12, that’s all in the colon, right?
Dr. Justin Marchegiani: Well, we’re gonna absorb B12 in the stomach. We’re gonna bind it to intrinsic factor in the stomach and then we’ll absorb it at the very end of the small intestine called the ileum. So if we have poor stomach health, the same cells that produce intrinsic factor are the parietal cells in the stomach, the same cells that make HCl. So if we have gut, stomach issues, we’re probably gonna have issues absorbing B12 in the stomach, binding it to intrinsic factor and then finally absorbing it in the ileum at the end of the small intestine.
Evan Brand: So what happens in the case of like my dad for example, he’s had like 18 inches of his colon, his large intestine removed, from super bad diverticulitis—are you—can you ever get back to a normal energy and—and health? Or I mean, are you—without that section, are you unable to manufacture things? Like how does that change the whole process?
Dr. Justin Marchegiani: Well, your colon’s gonna be like reabsorbing a lot of like electrolytes and minerals. The big place of absorbing nutrients is gonna be the small intestine. So that’s gonna be the big place of absorbing nutrition, but you definitely wanna run some nutrient-based test like an organic acid test and a SpectraCell test just to make sure nutrient levels are dialed in and supplementing them. I mean, the people that really have the biggest, you know, hurt are the people that get the gastric bypass, because they’re stomach is just may be the size of a thumb or a thimble and it’s just not a good situation, it’s—I call it, surgical-induced anorexia.
Evan Brand: Oh, my God.
Dr. Justin Marchegiani: They—they basically now have to go on like a 500 to 800-calorie diet just because they don’t have the structural anatomy to absorb it. So basically, they’re inducing anorexia.
Evan Brand: Oh, my God. And so typically they do gastric bypass for what, just major obesity?
Dr. Justin Marchegiani: Yeah, they’re just doing it because they—well, one, they don’t have the right strategy on the diet perspective so they’re eating the wrong foods and they’re keeping this whole craving thing going and they’re just oversecreting insulin and eating the wrong foods, and the medical establishment isn’t skilled in the nutritional changes that have to be made so they just throw the only solution they have, which is a surgical intervention. So it’s like, alright, here’s the food pyramid which says 60-70% carbohydrates, mostly gluten and inflammatory grains. No emphasis on quality or pesticides or chemicals. So once that doesn’t work which most people it doesn’t work, then the only other option they have left is a surgical-based option, which is, you know, isn’t the best especially when you’re just inducing—when I say anorexia, I mean starvation. I consider eating a 600 or 800 or 1000 calorie a day diet if you’re supposed to be eating 2, I consider that starvation. Okay, the concentration camp victims in Auschwitz ate 1200 calories. So if you’re inducing starvation beyond that point, right? Well, no one would say, “Oh, well, yeah, these people at Auschwitz are well-fed.” No one would say that. Okay, so you having a gastric bypass procedure and having under 1000 calories now or let’s say, 50% below what you’d need, that’s starvation. That’s not good. And that’s why the rates of these people after these procedures, they risk of depression and all these other conditions just sky high because when you decrease surface area of getting nutrients in your body, now everything you eat has to be incredibly nutrient-dense because you just don’t have room to avoid bad stuff when there could be good stuff that needs to come in.
Evan Brand: Wow. So you’ve taken a cruise ship-sized fishing net and now you have just a little handheld fishing net to catch like a goldfish and that’s pretty much it.
Dr. Justin Marchegiani: That’s it and it’s not fixing the underlying issue. And I get it, these people are reaching and a lot of it comes from the fact that they’re just thinking that their medical doctor just knows it all, and that, hey, that dietician they referred me to, they showed me the food pyramid. If there were something else that was better or different, they would have told me it. So they have this kinda false sense of hope that all their options have been explored because their medical doctor and dietician would have told them otherwise. So there’s this false sense of superiority and that’s where the Internet comes in because you reach 4,000,000 people. I reach hundreds of thousands a month, and people without even seeing us just try it and then write us back, “Wow, I’m doing so much better.” Like we’re not even working with them directly and we’re helping people. But the medical establishment has this false sense of superiority that people are just indoctrinated on from the drug commercials and growing up and the whole idea of doctor’s orders and watching all these shows on TV that glorify doctors, thinking that they know everything and so once, you know, the diet doesn’t work, the next option is gonna be this gastric bypass and at least the newer surgeries, like the lapband or the glove around the stomach, it’s better because at least they can be reversed. Just having the old fashioned gastric bypass is ugh, it’s really—it’s more permanent because they’re really cutting that stomach off versus the glove or the—the band can be—can be loosened up later.
Evan Brand: Talk about fatigue. I guess that’s a good way to probably wrap this thing up, is just to talk about calorie deficit in general because—
Dr. Justin Marchegiani: Oh yeah, huge.
Evan Brand: You mentioned that, I mean, you’d be—you’d be crazy to think you could have enough energy after that surgery and I’ll find, too, that if you look at like someone’s food journal, it’s kinda hard to get enough calories for certain people depending on their activity level. If they have a Paleo style diet because if you are eating a lot of vegetables and say meat’s a little bit more of a—an accessory as a main—as opposed to a main thing, and if they’re not getting enough fat, maybe they’re still a little bit fearful of getting in enough butter and coconut oil, there calories can be pretty low on a Paleo diet. And I think sometimes people are too low and that’s why they’re tried as well.
Dr. Justin Marchegiani: A 100%, because let’s say your diet is 60-70% crap and then you switch over to a Paleo style of eating or a Paleo template as I like to call it, where now you’re eating nutrient-dense, anti-inflammatory, low toxin food. But let’s say 50% of those calories you haven’t replaced. Let’s say you just—let’s say that some of the meat and the fat in your diet you keep over and maybe some of the veggies, but now you’re a 1000-calorie short, well, you’re gonna feel fatigued because you’re telling your body and telling your epigenome—alright, this is the part of your genome that flips switches, genetic switches on or off, that, “Hey, we gotta conserve energy because we are in a famine,” right? We’re in a desert for 40 days and 40 nights so to speak. We don’t have access to nutrition, so let’s start shorting some body systems, right? It’s like you’re in your house and you get a big electric bill, and you and your wife say, “Well, let’s just, you know, put the A/C on in the summer instead of 70, let’s put it on 78. Let’s make sure the lights are turned off.” You’re conserving energy in the house to have a—a lower electric bill. Well, the same thing happens in your body. Instead of turning lights on and adjusting temperatures, it adjusts energy, it adjusts brain power, it adjusts sleep and focus, it adjusts respiration and hormones, all of these systems start to become dampen. And then the question you have to say to yourself, “Well, if you’re trying to start conserving on these things, which body systems do you want to start shorting?” Do you wanna have less detox capacity? Do you wanna have less hormonal strength? Do you wanna have less brain power or neurochemicals? And most people would say, I don’t wanna short anything. I need it all. So the question is, “Well, how can we just—instead of, you know, work on decreasing the amount of energy, how can we just increase the amount of nutrition coming in? So our energy can be as optimal as possible and part of that is if we switch from that Paleo template, we have to make sure we’re also getting enough calories. So the things that I’ll do is, is I’ll do a food log with patients or we’ll use a MyFitnessPal app, and I’ll have them plug in all their foods and we’ll figure out how many calories they need to just to maintain. And if they don’t get that amount of calories, we know off the bat there’s gonna be fatigue and body system shortage just because calories are always gonna have nutrition in them if we’re eating nutrient-dense foods. If we’re eating poor foods, yes, we can get calories with no nutrition. But for just keeping this conversation consistent, all of our calories are gonna have nutrition because we have a Paleo template.
Evan Brand: Right, yeah, and I just came across some research the other day that I was showing to my wife that was looking at women who during pregnancy had calorie deficits. Obviously, the fatigue’s gonna be greater but that the baby or when it grows up to be a child was actually at a greater risk of obesity because if there was a “famine” during the pregnancy, that child’s gonna have to be a little bit more efficient at storing calories and so there you go. This stuff starts even pre-natally which is kinda crazy.
Dr. Justin Marchegiani: It does and then the other piece is—okay, let’s say you’re having enough calories coming in. Well, are you breaking them down? Are you absorbing them, digesting them, and assimilating them? That’s the next question. Because if you have let’s say an infection going on, whether it’s a SIBO or H. pylori or parasitic infection, that could impair absorption because you got critters competing inside your tummy. The next piece is, well, are you super stressed where your hydrochloric acid levels are low because you’re in that fight or flight state. And if you’re hydrochloric acid levels are low so are your enzyme levels. So you may not be extracting nutrition from your calorie—from your food because—because of that stress response. I see people that, you know, aren’t able to go 4-5 hours between meals and they’re eating a lot of food and they’re telling me, “I’m just—I’m eating a lot. I’m eating a lot. I can’t eat anymore.” The next piece would be, well, there could be a malabsorption thing, and we try to fix it by replacing enzymes and acids and bile salts. But the next thing is really getting the infection cleaned out, too.
Evan Brand: Well, see if I have one. My test is done. It’ll be shipped next week, so stay tuned for my test results. Do you have one on hand that you can run? I wanna see what yours says, too.
Dr. Justin Marchegiani: Yeah, I got two tests I’ll be running side by side any day now so I will—I will keep—I will keep you plugged in on what’s happening.
Evan Brand: Okay, cool.
Dr. Justin Marchegiani: And I know you’ll be waiting on—on bated breath.
Evan Brand: Yup.
Dr. Justin Marchegiani: So just to kind of recap here. We talked about HPA axis for fatigue. We kinda connected fatigue to the immune system because cortisol helps with energy and also is important in the immune response. Too high, that can suppress the immune system. Too low, it can sup—it can decrease energy as well. And if we go too high on the allergy meds, that can suppress our immune system because cortisol or synthetic cortisol derivatives can have an effect on our immune system. Next we talked about healthy gut bacteria and B vitamins. How crucial they are to energy especially B6 is so important for the brain function, it helps really kind of escort and bring in a lot of the amino acids for the brain. So we need a lot of B6 and then obviously our B1, our thiamine, our B2 riboflavin and B3 niacin. These are all really important for energy, healthy gut bacteria. We talked about how malabsorption and some of these surgeries and such. The—the gastric band or bypass can decrease surface area. We talked about transitioning to Paleo and how people go low calorie naturally, which can affect nutrition and energy. And then we also talked about—we also talked about last but not the least was making sure we get enough absorption avoiding dysbiosis and infections and low stomach acid, making sure we have the absorption piece to the gut dialed in because we could be eating enough but not absorbing enough.
Evan Brand: Yup. Absolutely.
Dr. Justin Marchegiani: Anything else you wanna touch upon?
Evan Brand: That’s it. I would tell people if you like this show, share it with people, review the show on iTunes, share with one friend even if you are applying everything, there’s what—350 other million people in the United States and another 7+ billion in the world that we need to help get this information before the American medical establishment takes over the rest of the world and—and indoctrinates them with that mainstream attitude. There is another way. There is another solution. So that’s what we hope to provide here and hope you enjoyed it.
Dr. Justin Marchegiani: Oh, yeah, and I wanna just touch one thing. Be afe—all great points, Evan, really, really good points. Last piece though is be a fat burner. Most people are sugar burners, okay? Meaning they have excessive carbohydrate in their diet and they are relying more on sugar for fuel. Okay, relying on sugar for fuel is like going to a campsite, needing to have a fire to cook and provide warmth, and having to put twigs and paper in that fire. Well, if you do that, you’re gonna have to be putting twigs and paper in that fire all night long every few minutes to keep the fire going. That’s what people that do too much carbohydrate and eating too much carbs are like. They have to constantly feed it. If you put a log in that fire, that fire will sit for hours on end. And the logs are akin to healthy proteins and fats and vegetables where the refined sugar or the higher carbohydrate is equal to the twigs and the paper, and the hot—really refined sugar and the alcohol is akin to the gasoline. So if you try to have a fire going with gasoline and twigs and paper, it will be a very long night for you.
Evan Brand: Yes.
Dr. Justin Marchegiani: If you’re using the logs and the proteins and fats, it’ll be an easier night. And depending on how much logs and how much protein and fat and how much paper or kindling and carbs can be adjusted for each person. So don’t freak out, there’s—there’s ways to customize and make it specific to each person, but we wanna push people into being more fat burners versus sugar burners. Now whatever level that may be, are you it should be more where you gotta be at 20 grams of carbohydrate a day? Or can you be somewhere 50, 70, 80, 120? That’s gonna be up for you the individual with your doctor or nutritionist to find what works best for you.
Evan Brand: Yup.
Dr. Justin Marchegiani: And it may change based on your stress levels. And based on what’s happening in your life and how much exercise you’re doing, so again this isn’t a one-size fits all. We’re really customizing it and we’re providing you that clinical functional medicine eye that we use it every day with our patients.
Evan Brand: Yup, I know we’re way over time here, so lastly go to our websites. Check our stuff out. Check out Justin’s YouTube channel. He’s killing it. I tell him he’s gonna be the functional medicine king of YouTube and I’m trying to become close to—a close second behind him. I’ve watched a—a body building video or some type of fitness channel on YouTube where they have hundreds of thousands of subscribers and they—this guy, kind of a real cut guy, he took everybody through his day of eating and his lunch was—or no, his breakfast smoothie was straight mangoes and it was, I don’t know, some protein with like sucralose in it and then he said, “Oh, because I like to have a little crunch in my protein shake, I recommend adding a half cup of Reesy Puffs.”
Dr. Justin Marchegiani: Oh, my gosh.
Evan Brand: And then he—so then he goes to his lunch and then he’s showing a—you know, he’s got egg whites and turkey bacon for kind of a brunch and then a Diet Coke. And it’s like—and this—this is recent. This is not outdated material. This is something that’s come out like over the last like month. This is a huge fitness channel. There’s tons of them like that and you know, these—these videos are getting hundreds of thousands of views and people are doing this and it really scares me. And really think we have to break in to the YouTube model a little bit more. You and I have a lot of work to do there to really bring some more clarity there because that YouTube space of health and fitness and nutrition is still stuck in 1980.
Dr. Justin Marchegiani: Yeah, it’s getting polluted and everyone listening to this, either on iTunes or YouTube, click right below. We’re gonna have links for our YouTube and podcast subscribe, so just click right below. Do it right now, I’ll take a second out and wait for you. Alright, click it, hit subscribe and then you can keep up with Evan and I and what we’re doing on YouTube and the podcast.
Evan Brand: Yup.
Dr. Justin Marchegiani: Evan, great talk today, man. It’s Friday. You have an awesome weekend!
Evan Brand: You, too. Take care.
Dr. Justin Marchegiani: Take care. Bye.
Evan Brand: Bye.
Hypothyroidism Symptoms and Indigestion
By Dr. Justin Marchegiani
Hypothyroidism symptoms can sometimes include low stomach acid and poor digestion. Poor digestion is a major problem today. As nearly 44% of the population experience heart burn monthly and 20% of them experience it weekly. Heart burn is a paradoxical symptom caused by low stomach acid strangely enough, as you would think the problem based on its name, is caused by too much acid. What essentially is happening is the food isn’t fully broken down. So it begins to rot (putrefy and ferment) in the stomach and organic acids from the decaying food rise up and burn the unprotected tissue of the esophagus.
The top 2 medications sold in 2014 were a thyroid medication called Synthroid and an acid-blocking medication called Nexium. This doesn’t prove that one causes the other, but in my clinical experience, there almost always tends to be a link with poor digestion, low stomach acid, and chronic infection when it comes to hypothyroidism or Hashimoto’s.
Low stomach acid is commonly associated with hypothyroidism and or Hashimoto’s. Stomach acid or hydrochloric acid (HCL) has a few different roles in the body, one being the first domino of the digestive process. HCL does this by lowering the pH in the stomach. This activates the digestive enzyme pepsin, which breaks down protein. The acidity produced from the stomach acid stimulates the gallbladder to produce bile salts, which are important for fatty acid break down.
Low Stomach Acid (HCL) and Anemias Can Affect Your Thyroid
When we look at the common nutritional deficiencies associated with low stomach acid, iron and B12 deficiencies commonly show up. These types of deficiencies are also known as anemias. B12 deficiency is known as a macrocytic anemia because our red blood cells can’t mature properly and are stuck in a larger state. Red blood cells actually get smaller as they mature, so the immature ones stay bigger, hence the prefix “macro.”
Cool fact: The parietal cells in the stomach, which produce intrinsic factor (IF), are the same cells that produce hydrochloric acid (HCL). This is why the HCL and B12 connection is so common. When the parietal cells are injured, it makes sense that everything it produces will no longer be at optimal capacity.
When we are dealing with iron deficiency anemias, these are commonly known as microcytic anemias. Iron is needed to help carry oxygen to the cells in our body. Our thyroid gland needs iron to help make thyroid hormone. And our cells need iron so they can take up oxygen as well. When our red blood cells don’t get enough iron, they become very small, hence the prefix “micro.”
The Anemia Breakdown
- B12 anemia: You can’t produce healthy mature red blood cells. The same cells that help carry oxygen and nutrition all over your body for healthy metabolism. The same cells that produce
- Iron anemia: Iron is needed to make thyroid hormone and gives your hemoglobin the ability to carry oxygen throughout your body.
- A Common symptom of anemia is fatigue, which is the most common hypothyroid symptom as well. I hope you are starting to see the thyroid-anemia connection.
Our Gut Lining is Important for Nutrient Absorption
When there is an absence of HCL in our stomach, our food tends to not digest properly. When our food sits in our stomach, it tends to essentially rot. And then various organic acids rise off of it. The maldigestion of these food sources feed various bad bacteria in our gut, and gas is produced as a by-product. The next time you feel gassy after eating, you will at least know what’s happening on the inside.
The low amount of HCL and the increase in intra-abdominal pressure cause our esophageal sphincter to stay open. The acids from the rotting food now have the ability to rise up and touch the area of the esophagus that is typically walled off during healthy digestion. This is now the beginning of gastroesophageal reflux disease (GERD). If this area continues to get irritated, over time ulcers will begin to occur along with atrophic gastritis. It is nothing more than irritation of the stomach followed by a thinning of the stomach lining.
The thinning of the gut lining and the lack of HCL causes low nutrient absorption.
- HCL is needed to ionize and break down minerals, like selenium, iodine, calcium, zinc, iron, magnesium, and chromium, into a suitable state so they can be taken up by the bloodstream.
- A healthy gut lining is needed to absorb these ionized minerals and also break down nutrients, including proteins, fats, carbohydrates, and vitamins (B12, vitamin A, vitamin E, and B vitamins).
- These nutrients are not only needed to make thyroid hormones, but certain nutrients, like selenium, are needed to convert and activate thyroid hormones (converting T4 to T3) and help quench the inflammatory by-products of thyroid hormone metabolism—hydrogen peroxide (H2O2).
- Eating a diet low in these essential nutrients in conjunction with poor digestion is a hormonal disaster waiting to erupt!
Nutrients Needed for Healthy Thyroid Function
- B12, vitamin A, vitamin E, B vitamins, selenium, iodine, zinc, iron, and magnesium are important for healthy thyroid function.
- As your digestive problem gets worse, so does your thyroid problem because the nutrients you need to run your thyroid aren’t present in optimal levels.
Thyroid Hormone Is Needed for Digestion
Thyroid hormone has an effect on cellular metabolism throughout the entire body, including the gastrointestinal tract. Metabolism in the gastrointestinal tract has an effect on gastric motility. A slower thyroid can cause slower transit times, which can also contribute to dysbiosis or a small intestinal bacterial overgrowth (SIBO) and indigestion.
Lower thyroid function can cause lower gastrin levels, which are needed to stimulate HCL production. When patients are brought up to normal thyroid levels, their HCL levels return.
“Fasting plasma gastrin levels measured by radoimmunoassay were found to be low in patients with hypothyroidism. The intravenous infection of arginine caused an increase of plasma gastrin in hypothyroid patients but was significantly lower than those in normal subjects. The decreased gastrin level in patients with hypothyroidism was significantly improved after the thyroid function was normalized by treatment.”
Low HCL and low thyroid levels can cause dysbiotic levels of bacteria in the intestinal tract. About 20% of T4 (inactive) thyroid hormone is converted to T3 acetic acid (AC) and T3 sulfate (S). The conversion of T3AC and T3S into active T3 requires an enzymes called sulfatase. The only problem is, sulfatase is found only in healthy bacteria.
In essence 20% of your thyroid hormone conversion is dependent on healthy digestion as well as a healthy gut biome. It’s amazing the interconnectedness between your hormonal system and your gut. It makes sense why Nobel Prize-winning physician Dr. Mechnikov is quoted as saying, “Death begins in the colon.”
The Infection Connection
The bacterial infection H. pylori is a common infection in the United States and is infamous for causing stomach acid. H. pylori also secretes an enzyme called urease. Urease breaks down urea into ammonia, which can have an effect on lowering your HCL levels.
“In conclusion, gastric acid secretion, as a quantifiable marker for gastric atrophy, was only partially reversed after eradication in the majority of the H. pylori-positive patients with marked body atrophy plus profound hypochlorhydria, despite of long-term follow-up over 5 years.”
In other words, depending on how much damage is present in the patient’s gastrointestinal tract, it may require outside sources of exogenous HCL and/or use of Swedish bitters to help regain the patient’s own HCL productions.
The majority of thyroid conditions diagnosed in this country are Hashimoto’s, an autoimmune thyroid condition. This condition is a little different from your primary hypothyroid condition as it’s the patient’s immune system that causes the damage. Giving someone the standard of care treatment, Synthroid, will not stop the autoimmune thyroid destruction.
Research shows a significant correlation with the eradication of H. Pylori and a reduction in thyroid antibodies. It’s as if the H. Pylori is a contributing factor to the autoimmune thyroid condition.
Duke, J. A. CRC Handbook of Medicinal Herbs. Boca Raton, FL: CRC Press, 1985