Investigating Your Adrenal and Hormones With a DUTCH Test | Podcast #327

In this video, Dr. J and Evan talk about the adrenal glands in our body – to produce certain hormones directly into the bloodstream. These hormones will respond to stress and other necessities to our existence. Also, they are discussing the detailed test needed to identify the root cause of problems and what other materials and hormones are essential to keep our adrenals and body healthy.

To support the body naturally, Dr. J recommends using herbs such as maca and ashwagandha. Progesterone, estrogen, and estriol may be fit for a patient. However, it is essential to know that protocols may be different for every patient since presentations and lab results may differ.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:20     Labs At Home

5:07     Low Cortisols

9:37     Hormones

11:09   Dutch Tests

28:19   Useful Herbs

34:47   Healthy Estrogens

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Dr. Justin Marchegiani: And we are live. It’s Dr. Justin Marchegiani in the house with Evan Brand. Today we’re going to be talking about hormone and adrenal lab testing what we’re actually using in our virtual clinic to assess our hormone imbalances in our patients and different things that we’re doing to address those imbalances. Evan, how are we doing, man? 

Evan Brand: Good, excited to get back in the saddle here and talk about something that we can test at home, which is amazing. I think that’s the first benefit to point out about some of the testing you and I are utilizing is that many people now they care more about their health than ever obviously, the state of the world has convinced people that health does matter. You need to prioritize this stuff. And so we can send these labs to your door. And so the test that you’re going to be showing people today will be something that you can do if you’re listening via audio, you might miss the visual, you can go to Justin health YouTube channel and see the video, but we’ll be sure to make sure we talk about it in a way that you can still understand even if you’re just audio only today.

Dr. Justin Marchegiani: Yeah, if you’re listening to the audio, we’ll put a link down below for the video so you can see it. And also if you’re listening, you can go to Justin slash YouTube and hit subscribe. Alright, so let’s dive in. And so we deal with patients from all over the world virtually that have all kinds of different hormonal imbalances. It can range from a menopausal woman with lots of hot flashes, mood issues, vaginal dryness, depression, skin elasticity, hair loss issues, it could be a cycling woman that has a lot of PMS. pmdd breast tenderness, cramping, back pain, mood issues, irritability, also infertility as well. And then it was a lot of different imbalances in between excess androgen issues like we see in pcls, polycystic ovarian syndrome, we may even see estrogen dominant issues just like which could be PMS as well. Could be infertility, could be fibroids could be endometriosis could be fibrocystic breast issues, all of these things are on the table and of course, even manage a male issues to could have men could have excess estrogen and or low androgen and or low or high cortisol and or low or high Da, da all these imbalances are potential, I always tell my patients, you have the right to have more than one issue at the same time. And you can also have a hormone imbalance and also have multiple gut infections too. Of course, it’s all possible, right?

Evan Brand: Yeah, people hearing that too. They’re like, what the heck kind of mumbo jumbo? Did he just say, and how does that manifest? Well, you know, low libido, too. I mean, that’s one that I’d say at least 90% of the people I’m working with, that’s a question we always ask is, you know how you drive. And sex drive is always terrible for people. I was actually a study that came out. And the vast majority of people surveyed said that they would rather scroll on their smartphone on social media than have sex with their partner. And I thought, Oh, God, is that where we are in the technology world that the phone is more desirable than our partners? That’s no good.

Dr. Justin Marchegiani: Yeah, definitely not good. 100%. So I just kind of laid out a couple of potential patterns there, we’ll kind of dive into them one by one will actually show you a real live patient lab here for y’all to kind of look at obviously, it’ll be centered regarding who the patient is. But we’ll put all that information out there for y’all. So you can kind of see how a lab looks out of the gate. So one of the first things that we do when we look at a patient, male or female, we’re going to look at adrenal function. And adrenal function is very important because your adrenals make cortisol. Cortisol is an anti inflammatory hormone. Most people in today’s day and age, they’re not under inflamed, they’re over inflamed. So having your body’s natural anti inflammatory system on board is vital, very, very important. Second is cortisol rhythm. Cortisol rhythm plays a major role in your circadian rhythm, which is waking up energy in the morning. Having good rhythm helps a lot with mood, and also lower cortisol at night. And that nice gentle taper of cortisol. So cortisol starts, it starts mid range, when you wake up, and in that first 30 minutes to an hour, it almost doubles. And then from there, it tapers down throughout the whole day. And we want a nice lower cortisol rhythm, lower cortisol level at nighttime, so we can wind down and relax not too low, when we start having maybe blood sugar issues, which could wake us up at night and not too high, where we could have problems going to bed because we’re too wired right, or not a reverse pattern, we’re lower in the morning, which means low energy and higher at night, relatively speaking, which could cause us to have too much energy at night and then we don’t get good sleep. So the adrenals play a really big role because of cortisol and its effects on anti inflammatory mood, rhythm, sleep, and then also especially for women listening men too, but da da da da sulfate is a precursor to a lot of our sex hormones, that helps with our female hormones. And that plays a big role in healthy, healthy reproduction. people. People think when they talk about female hormones or just thinking about having babies no your hormones there to reproduce you Yeah, reproduce the baby but also reproduce you which means healthy aging, healing recovery as a man to healing recovery. Healthy libido, good muscle building. In good building the ability to turn over your tendons and ligaments and bones, all these things require good healthy anabolic metabolism.

Evan Brand: Yeah, great point. You know, one thing you pointed out, which I think a lot of people miss with cortisol is you mentioned cortisol being too low at night and that impairing your sleep. See most people just a buzzword, or if they’ve ever heard of cortisol, they’ve heard of adrenal testing and things like that. They think, okay, high cortisol at night equals poor sleep. But you mentioned low cortisol at night or too low cortisol at night could also be an issue because of that blood sugar. And then what can happen is you and I’ve covered this before, but there’s some sort of a spike, right? Maybe an adrenaline cortisol spike in the middle of the night, is that what you think is happening?

Dr. Justin Marchegiani: Yeah, so with sleep issues, you could definitely see a low cortisol kind of going into nighttime or low cortisol during the night. And that can cause a drop in blood sugar, and that drop in blood sugar can then signal a increase in adrenaline. So adrenaline tends to come to the scene first, cortisol tends to come to the scene 1020 minutes later, or so. So you get this spike of adrenaline that’s very stimulatory, that increases cortisol. And then now you’re alert and you’re waking up, right? So we want to make sure higher cortisol, lower cortisol at night that’s causing a increase in cortisol is not happening due to blood sugar regulation. So we want good blood sugar, good healthy protein, and fats, maybe work on amino acids and melatonin production at around bedtime, and maybe have something by your nightstand to help stabilize blood sugar before in your end. Or if you get up like a nice simple college and smoothie, or a really good protein and fat base, simple bar by your nightstand to stabilize blood sugar, those are all really really good options to help you on the sleep side.

Evan Brand: So like if you had a good quality protein, fat, maybe some carb starts with dinner, but let’s say I don’t know, 9:10pm, you go to have a snack and you just do. I don’t know popcorn or I don’t know, handful of strawberry, some kind of a simple sugar, you think it’s possible that your glucose could spike and then it will crash in the middle of the night if you’re doing something too simple or too high on the glycemic index?

Dr. Justin Marchegiani: Well, it depends on how blood sugar sensitive you are. I mean, the two examples you gave are two different things, right? Because grains and popcorn are going to be a little bit more higher glycemic, higher sugar stuff, strawberries, pretty low glycemic and a lot of fiber there, so probably not as much with the strawberries. But could you have some strawberries and maybe a spoonful of almond butter, right or some kind of a good fat or protein probably better, right? It just depends upon what time you’re going to bed and what time you’re eating. Usually you see people that are eating around five or six o’clock dinner, and they’re going to bed like around 11. And there’s like a five hour gap between their last meal and sleep potentially. And again, it has to do with how dysregulated their blood sugar is and how weak their adrenals are. So it really depends. But if sleeps an issue, that’s one pattern we want to look at. We talked about da da playing a big role. If you’re a female going into menopause, that means your egg follicles are being used up essentially. And you’re not going to get that hormone production from that follicle that’s now no longer there. So we require a lot of the DA DA from our adrenals to now be made. And if our adrenal reserves on da, da are low, guess what? We’re not going to have that that backup battery that we had already to go right we’re in middle of, we’re just coming out of a bunch of storms in Austin here. And if you didn’t have a generator ready to go, guess what you you went without power for a while, well, that’s kind of like going into a spa, menopause is going into a storm with a generator that’s maybe three quarters empty. And so the adrenal is play a really important role as the backup generator for sex hormones. And so the better that generator is charged up, the easier you’re going to sail into menopause and not have all the hot flashes and mood issues and sleep issues and skin issues and hormone issues and vaginal dryness issues that you may have with lower sex hormone reserves.

Evan Brand: Yep, well said you’re ready to show us this thing. I’m sure people that are on video want to see what the heck we’re talking about. We can see some of the rhythms and also da da is measure two, which is cool. So when we talk about a cortisol test, we’re getting a lot more than cortisol to right we’re getting melatonin also.

Dr. Justin Marchegiani: Exactly. And then one last thing to look at is PCOS, which is also common. You see it more in younger women, you know, 20s and 30s. But blood sugar issues high level of insulin, this can really jack up testosterone and this can do a whole bunch of issues in regards to abnormal hair growth, you may see an increase in libido, some still go down. And then of course, weight gain is going to be another another big side effect there. Let me share my screen with you so you guys can see an actual lab test for y’all. Okay. All right. So while I get that going here, in the meantime, anything else you want to say about that, Evan?

Evan Brand: Well, you and I were talking about this before we hit record and that was the idea of retesting hormone. And so you thought well, based on a lot of people with progress, you don’t necessarily need to incur the cost again. So a lot of times you and I may run this as an initial snapshot, but depending on symptoms, you may not need to do this over and over and over again because a lot of the support We’re using a pretty broad spectrum. And they’re going to help regulate your rhythm regardless of where it’s at. Right? So initially, we may want to tweak one thing a certain direction or the other, but long term care wise, you and are using things that are pretty, would you just stay state stabilizing, not necessarily a big sledgehammer to the hormones.

Dr. Justin Marchegiani: It depends for me. So if someone has very, very low cortisol levels, or very, very high cortisol levels, and or significant estrogen dominance and low progesterone, the more significant the hormonal pattern, the more significant the imbalance, the more I want to retest less significant if we see corresponding symptomatic improvement, usually it becomes less necessary because the patient knows they’re getting better we can feel it, we can see it in their their physiological activation and how they’re sleeping, their mood, their energy, their libido, we can you know, their cycle, there’s just so many things that are improving that the patient is confident that we’re good. And if the imbalance isn’t major, right, they’re not a fertility case. They don’t have a major hormonal imbalance right there that may not be necessary, but I always kind of I’m on the fence always give the patient the ability to to make a decision on that. So this is my screen here, Evan, are you able to see it?

Evan Brand: Yep, we see it just fine.

Dr. Justin Marchegiani: So here’s a Dutch test that’s done with a patient whose kind of perimenopausal menopausal, meaning their cycles kind of been on and off hasn’t really had it for six to eight months or so kind of in that area of transitioning into full menopause, which is usually not having a cycle for a full year 12 months in a row. So they’re kind of in this Peri menopausal phase, and usually perimenopause and start to hit in your, in your early to mid 40s. When you start skipping months, maybe you start having some hot flashes like symptoms, whether it’s mood or libido or a hot flash stuff. And again, it’s always tough to say because perimenopause can easily feel like PMS too, right? I think that the biggest differentiating factor is not having all the hot flashes and not having the skip cycles. When it comes to more of the PMS like stuff, that’s usually a distinguishing factor. But we look at the Dutch test a couple things here. This is our cortisol pattern, our daily free cortisol pattern. And you can see you wake up here at a and your cortisol should taper up in the morning, this isn’t within the first hour and then go down throughout the day. So this patient actually started with a here, right, this is cortisol with a pretty good rhythm out of the gates. But instead of picking up 100% or so they actually went down. So they started here that having that nice rise, they went down This is big, this is a big problem, right not going to have the energy you’re not going to have that good rhythm that good up and Adam kind of energy in the morning and they trace low the entire day, relatively low and flat the entire day. So we call this a flat cortisol rhythm relatively speaking, it’s flat, they should be starting here a peaking up at B and then gently tapering down throughout the day. And they basically start at a at their highest point. And they go down throughout the day. So very low and flat cortisol rhythm. Now when we look at their cortisol levels, they’re free cortisol, which is a+b+c+d, this is what’s represented on the graph here. And again, if you’re listening on the podcast, click down below to watch the video link if you want, if not, we’ll just try to describe it. They’re free cortisol when you add a plus b plus c plus d is 73. That’s very low. So if you see this little gauge here, imagine this is like the volume knob on your stereo, this is all the way up high this star and this on the left all the way up low. So they’re almost all the way till the to the left. It’s like their volume knob is like 5% on it’s like having a whisper out of their stereo. So 73 is very, very low. Now this is the cool part, right? So normally with a salivary test, right, the Dutch test is the dried urine for testing comprehensive hormones. The benefit of this test is we get a window into free cortisol, but also total cortisol could its urine with a salivary test, we’d only be able to see this 73 number, which is the which is the free cortisol, that’s two to 5% of all cortisol is free, and biologically available. The other total, which looks at the free, which is the two to 5% Plus, everything else that’s protein bound, is give us a window into all of our cortisol, we’re making them this is the cool thing. We never would have this number on a free cortisol test from saliva. But you can see their total cortisol, which is everything is very high. It’s 93 04. Right? It’s way off the charts. Hi. So they have very, very, very low free cortisol, very, very, very high total cortisol. So there’s not like an adrenal fatigue issue or like a low adrenal pattern. Even though the cortisol is low, their adrenals are making a lot of it right. And this is a common pattern we see when there’s HPA access dysfunction. So if you go down to this page over here, you’re gonna see what the HPA axis is. I’ll go back and I’ll just explain this in a minute. But if we go down to this page here, the HPA axis we have this feedback loop from the hypothalamus and the pituitary. This is the HP portion of the HPA axis. And this communication feedback loop talks to the adrenals where we make cortisol with We make DAGA. And we have our free cortisol, we have our total cortisol, we have our DAGA, this feedback loop from our corticotropin releasing hormone to the adrenal corticotropin releasing hormone. This feedback loop is our HPA access. And when this starts to break down, and that feedback loop that miscommunication happens, this is where we start seeing a very high amount of total cortisol and a very, very low amount of free cortisol. Does that make sense out of the gates questions they’re having?

Evan Brand: Makes perfect sense. So what do you do?

Dr. Justin Marchegiani: Yeah, so let me continue to roll with that. Let me go back up here a little bit more.

Evan Brand: DAGA production look good there, though. That was nice to see.

Dr. Justin Marchegiani: Let’s kind of break it down. So I always hit things like this. I might order of doing things that way. I don’t miss anything. So the first thing I look at is cortisol rhythm. How’s the cortisol rhythm? Good in the morning. A and then B, C, and D morning after night are low, low, low. So normal, low, low, low. So definitely poor cortisol rhythm. How’s the cortisol amount? Well, free cortisol is low. Okay, total cortisol is high. Now, so I tend to treat someone more in the middle in regards to their adrenal support, I won’t over support their cortisol too much, because we know they’re making a lot. So we’re really going to focus on an in between amount of cortisol and more HPA access support in regards to adaptogenic herbs, we really have to support good adaptogens. This being a menopausal woman, or Peri menopausal, we’re going to support the adrenals. We’re going to support HPA access. And we’re also going to use herbs to support the estrogen and progesterone receptor sites, we’re going to do both Okay, so you can see her now the next part is sex hormones. So we talked about the total cortisol right free cortisol, low total cortisol high strong HPA access pattern, and then the sex hormone wise, estrogen Astra diawl is low. This is primarily the hormone that’s going to be used in cycling women, progesterone is low, they’re both equally low, you see how they fall in the same place in the dial. So if you’re looking at the volume knob, they’re both in the same place, they’re both low on the volume knob. Usually with estrogen dominance, we’ll start to see the estrogen knob higher up relative to progesterone. So that tends to give us a good ratio if we’re intact. So estrogen to progesterone ratio is good. But the hormones are just low altogether. And then testosterone for a perimenopausal woman it’s in the bottom 25% of the range. Not bad. For a perimenopausal woman, you know, top 25 or top third to half is ideal. Not bad at all.

Evan Brand: And this woman was not doing anything correct. She wasn’t doing any dapa or testosterone support-

Dr. Justin Marchegiani: Correct. And then I ignore total da da, I look at these numbers individually here, I look at da da sulfate, eat a clan alone and I look at them all separately. Her total da da number it looks okay. But that can give you a false interpretation. And again, I’ve been doing labs like this lab for six years, I’ve been looking at hormone labs for over a decade. So I mean, I’ve done 1000s of these things. So I always try to boil it down to the to the patterns and the data that matters and ignore the fluff.

Evan Brand: So how would this woman feel I think important to mention, you know, all these numbers, people may look at this and think okay, this looks like Greek so can you just explain how would a woman with that pattern be feeling we’re seeing that cortisol was okay?

Dr. Justin Marchegiani: Peri menopausal symptoms, a lot of Peri menopausal symptoms, libido, mood, hot flush stuff, skipping cycles, of course, low energy, mood stuff, all of those things are present for sure. And then look at her DAGA sulfate here, right? This is the backup generator of the sex hormones to the bottom 25% of the range. So this is the dial here, right? 170 she’s definitely on the lower part here that bottom 25% I like to group things based off a percentage, then the actual numbers don’t matter as much like I just say, hey, you’re in the bottom 25% of the reference range. I like my patience in the top half the top 25% or so. So I always look at things as a percentage. That way you don’t get overly infatuated on the numbers, the numbers can kind of confuse things testosterones in the bottom 25% not as bad there. But I mean, if we get the DAGA to the mid range, that testosterone should take care of itself because that’s gonna trickle downstream from DAGA to Android to testosterone. All of her androgens are okay, they’re all mid to upper 25% no problem. They’re her hormones are pretty balanced in regards to five alpha reductase. This is kind of the enzyme is very important to things going down a less androgenic pathway versus like DHT, which can be more associated with hair loss and prostate issues. And then if we go look at her estrogen levels over here, so this is progesterone, progesterone is calculated by pregnant a dial press plus alpha prineta dial so alpha and beta combined and we already saw her levels here. This is 1.9. I don’t know why the lab doesn’t show that number here. It should it’s like an error, but it’s 1.9 should be the progesterone number Now go look at the estrogen and that’s low. I mean from a cycling female we want at least 10 ideally 15 on the progesterone and then if we go look on the estrogens right, she’s low across the board. So estrogen is he one you know how you know it’s you want it has plenty in it, right? And that’s how we know it’s a one. And then Astra dial, this is your primary cycling estrogen. And it’s easy to because it’s got the prefix di and their di meanings two right, like two sets of dice die. And then we have estria, which is e three and the TRI prefix is how we know it’s e three. So for short e one e two, e three, or estrone estradiol estriol. And again, Esther dial will predominate when you’re cycling more, and estriol we should shift when you’re more menopausal, okay. And we tend to support more estria when they’re men appointment, women are menopausal. So her estrogens are pretty low across the board, you can see that you know, it’s gonna, these are all the metabolites downstream. But you can see, and again, if we want healthy estrogen metabolism, right, we have e to e4 and e 16, which are a different estrogen metabolites. And then you can see here, it goes down this protective pathway from a one to two hydroxy astone. And then that goes down into it and gets methylated into two methoxy. estrogen. And you can see here, right to keep it really simple. This 2.5 number on the estrogen metabolite should go down this pathway, at least half of that should be metabolized. It’s not so you can look at this at this methylation gauge. Don’t look at the numbers, just look at the gauge. So her methylation activity for metabolizing. Estrogen is actually low. So this is not getting fully metabolized. Now, why is that a problem? Well, one, she’s not metabolizing estrogen to her estrogen levels are low to begin with. So it just tells me that there’s some methylation detoxification issues that are a problem. Why could that be a bigger problem? Well, if we start supporting more da, da, maybe start supporting hormones better, this could cause a backup in regards to her hormones being metabolized, we may want to really work on supporting extra sulfur groups extra methylating nutrients, so there’s not a clog in these hormones getting metabolized. So, in general, we want to see at least half of this getting metabolized downstream. So if we look at two hydroxy, one, we want at least 1.25 there. And again, forget the numbers, it’s all represented in the gauge. So I want this gauge at least mid range. If the gauge is not mid range, and it’s on the lower side, it tells me we’re not metabolizing or methylating, our hormones actively, you know, as optimally as possible, and we may want to provide supporting nutrients to help that.

Evan Brand: So let me ask you this, if a woman, maybe she had run this and got the analysis from you, but then she just went to her conventional hormone doctor down the street, and he goes and puts her on some estrogen and maybe some progesterone, maybe some testosterone, how would that differ in terms of outcome based on this versus what you’re going to do?

Dr. Justin Marchegiani: Well, number one is they’re going to look at your extra dial just via the blood. And that’s okay. But it may not be able to look at free SSL dial as well. And most of the time, they’re not going to time it up at the right time of the cycle, you really want to time some of these things up around day 20 of the cycle to get a window of where progesterone is at. And then of course, you have to compare it to where in the cycle it is. And the next thing is no one’s going to look at how it’s being metabolized downstream. So we get a window into our total estrogen. All of our estrogens e one, e two e three, not just extra dial, we’re getting a window of progesterone as well. We’re getting a window into our androgens, we’re getting a window into d h, EA and our testosterone. And then we’re also looking at how it metabolizes downstream from 16 hydroxy from four hydroxy and to two hydroxy to four and 16.

Evan Brand: And then what’s the protocol? What’s the protocol for this woman?

Dr. Justin Marchegiani: So it depends. So off the bat, we may want to support estrogen metabolism a little bit better. That could be giving something like NAC it could be giving something like glutathione, it could be doing something like indole, three carbinol DIMM, or calcium to glucose, they could all be really good options. Even just giving some extra fiber could also be really helpful. Just to help out of the gates just to make sure there’s no bottlenecks there. Number two, we would support the adrenals accordingly, okay, we would support sex hormones as well. So depending on if she’s cycling or not, because remember, this woman kind of was skipping cycles. We would definitely do herbs like different kinds of phenotypes of Makkah that we use I use a product called feminine essence menopause as a special phenotype of Makkah. You can get that adjusted slash shop and the female hormone section that’s wonderful because it works on upstream HPA axis. We may work on the in different herbs to help the HPA access to like ashwagandha which is wonderful at modulating that hi level of cortisol. And then depending on hormones, we may want to throw in some progesterone, especially if she’s cycling in the last half of the month. And we may want to throw in a little bit of estriol. It depending on if she’s cycling or not, if she’s transitioning into menopause at her age, right 52, I think is the age of this patient. Well, the average age of menopause is 4852. So she’s definitely on the later side. So she may be transitioning into menopause. And if she has no cycles for a period of time, we may want to throw a little bit of estriol in, but if she’s not, if she’s still cycling, we don’t want to do any sgl. Right now, we want to focus on good healthy herbal support for astron production, we want to focus on good da ta support, we want to focus on progesterone, the last half of the month, we want to also focus on good estrogen metabolism. We want to focus on really, really, really good HPA access, support, all of those things are going to be really, really important. I’m not going to give like an exact protocol on dosing, just because it’s you know, this is a very general kind of thing right now, I don’t have the patient in front of me, but it just kind of gives you a good idea. What what I’m looking at there.

Evan Brand: Totally. So someone may think, oh, they saw that high metabolized cortisol and they may need, they may think they need to come in and do something like relora, which a lot of people talk about to lower cortisol, that is not the right choice to do because her total, or the free cortisol is already on the low end. Correct. So like at nighttime, like if this woman says, Hey, I’m not sleeping good at night, you’re not going to come in and use relora are you because that would take the low situation and make it lower? Is that right?

Dr. Justin Marchegiani: I wouldn’t give something that would lower the free cortisol more like something like a phosphatidylcholine or serine. Right. But I would do some things to calm down the HPA axis for sure. So things that really can help calm it down. Because that total cortisol being really high is what’s telling me that there’s definitely HPA access issues. But I mean, you know, it’s possible some of these symptoms could could kind of conflict because our free cortisol so low and our total cortisol so high, but I wouldn’t overly lower the free cortisol, I would just focus more on adaptogens to help modulate over cortisol. Just the the overactivity, the overstimulation of the adrenals the whole, and that would still come in there and support with some pregnenolone and dapa as well. I wouldn’t overdo it either, though, because her cortisol is total on the higher side. So this is where it’s really important. Like, it’d be really easy to want to give this woman a lot of licorice and a lot of pregnenolone. Some of that may be necessary, but you may want to just take the fact take into consideration that she has a total cortisol level that’s very high. And we may want to have some kind of in between those. So we got to really look at that total cortisol production in relationship to the free not overdo it.

Evan Brand: Yeah, what you’re saying is because she’s desperate to feel better, right? And you want to give her more energy and you’re going to look at that rhythm and say, Okay, yeah, it’d be great to give her a boost here some licorice at breakfast time and maybe some lunchtime dose to perk her up. But you’re saying you can overdo it because of how high the total is in this case.

Dr. Justin Marchegiani: Yeah, very easy to do that.

Evan Brand: Yeah. And so then that would manifest how maybe anxiety heart palpitations, insomnia.

Dr. Justin Marchegiani: If we overdo it, yes, harpy, potentially heart pals, potentially insomnia, potentially, anxiety, all of those things are potential issues that you may see a problem with.

Evan Brand: Yeah, and this is why we love to to mix herbs to right you’re rarely going to be using an urban isolation, right? You’re going to be coming in possibly with ashwagandha. But you may come in possibly morning. Maybe she could benefit from something like some eleuthero. Some holy basil, maybe some other more stimulating things. If you don’t want to go too high on the licorice. Is that what you would do?

Dr. Justin Marchegiani: Correct. Yep. 100%. Cool. Any other questions there so far? It’s great to see it.

Evan Brand: I think this should should help a lot of people.

Dr. Justin Marchegiani: Yeah, in general, you really want to make sure you kind of clearly delineate where the patient is in their in their hormonal pattern. I think it’s really tough. The hardest part is when you have a woman who’s perimenopausal who’s still cycling, but is starting to not cycle and starting to switch into menopause. Because you’re kind of you kind of have two ways to handle a woman if they’re still cycling versus they’re not because hormones have a rhythm, rhythmic fashion, and you want to add them in, pull them out. And if a woman is more menopausal, you can keep hormones really in throughout the month, you’ll have to cycle them as much. And so I always err on the side of treating a woman like they’re cycling until they clearly delineate that they aren’t cycling, because if I start getting hormones monthly, daily, and that could throw off their their cycling pattern. I don’t want to do that right first, do no harm. Let the body clearly delineate where it’s at in regards to its natural hormonal patterns. So the hardest part in dealing with women, is if they’re perimenopausal transitioning to menopause, I really want their bodies to clearly show me that they’re ready to stop cycling and that’s why I always treat them like they’re cycling until it’s crystal clear they aren’t.

Evan Brand: Yeah, and then that The most common time for symptoms, right? So that’s probably the majority of what what people are going to feel in that stage of their life, they’re going to feel the most symptomatic in that transition time, or at least in what you and I’ve seen, this is probably the most common time a woman’s going to reach out for help.

Dr. Justin Marchegiani: 110% Yep. So it’s really, really important to kind of take a look at that and make sure that we keep that in mind. Absolutely. And then also, you know, we have different estrogen metabolism risks, right, we have different estrogen metabolites. So if we look over here, we have e one, e two, and E three. And when you look at these different metabolites, you know, he one tends to be a little bit more, you know, safer, right? He one tends to be a little bit more safer in regards to his to his detoxification, okay. And then when you look at e4, or sorry, two hydroxy, estrogen, right, or Astra dial here, this can go down pathways as well, are four that could be a little bit more damaging to DNA. So our four hydroxy, could be a little bit more damaging, as you can see.

Evan Brand: Let me ask you this real quick. So if you scroll down a little, it’s showing how on that pathway, you can get DNA damage, it’s showing reactive there. So we have to factor in what we learned from the stool test into this also, right, because if we see like a high beta glucuronidation problem due to bacterial overgrowth, isn’t that going to mess up this same pathway or my..?

Dr. Justin Marchegiani: Yep, it definitely can. And you can see here with the different, you know, metabolites, right, your four is going to be a problem area, right? So you’re for your your two hydroxy. Your two hydroxy going into the this four hydroxy right here could be a problem. Two hydroxy tends to be a little bit less damaging right here, especially if you have good CMT and methylation, when you go when you because all these things can can conglomerate. So you can see how e one e two and E three can all go side by side, they can all transition. But then you can see they can go down to 16 pathway, which tends to be a little bit more gentler. It can go down the four pathway, which can go into reactive oxygen species, it can also get methylated, right? What’s methylation, full eight, B six, right? b 12 really helps support methylation, Coleen, and then also gluta phi m can help decrease a lot of this too. So healthy gluten diet and healthy sulfur, healthy cruciferous vegetables, healthy digestion of our animal products. And that can help a lot of this, this methylation issue, and detoxification. And then of course, we have our E, two hydroxy. Over here, which again, methylation is very important, full A B 12. b six, Coleen, right, healthy cruciferous vegetables are going to be really important if you’re here. And we can even if it’s really high, we can even do things like dim, we can do things like calcium to glucose, we can do extra fiber, things like that to help bind it up.

Evan Brand: And the reason you’re saying this is so important is because we need to get out these excess hormones, right, we don’t want them just sitting in the tank, so to speak, after they’ve gone through this process. So you’re saying the gluco rate, the Bluetooth ion, the methylation, these are all the processes in the body to get rid of these, once they’re done is I don’t know what the right word is. But once they’ve been used by the body-

Dr. Justin Marchegiani: -agreed, though, your body will conjugate them bind that proteins to them and excrete them. And so we’re gonna really focus on a lot more gluta phone support more sulfur amino acids. If we see this guy over here, the four hydroxy ones higher. And then of course, you know, you can always give sulfur support methylation as well, which is going to be the B six, b 12, full eight, Coleen all of that as well. And this will support both of these two methoxy, two hydroxy, as well as four hydroxy. One, all of these are going to be very helpful, you can’t hurt to support any of those. And if we have anyone that has, you know, estrogen cancer, you know, risk? Well, we tend to if we need estrogen in someone’s more menopausal, we’re going to try to support more estria, which is going to be more cancer protective. But if someone has a previous cancer history, we probably will not do any hormones at all on the estrogen side. And just focus on progesterone as long as their their cancer is not progesterone sensitive, and good, healthy herbal support to help modulate some of the receptor sites.

Evan Brand: Yeah, awesome, awesome question there. This ties into a lot of stuff we do with the gut to which is really cool, because we’re often going to be in detox to we’re often going to be using Bluetooth ion for mold or chemical toxins, we’re going to be using calcium D glue, great to help with zero unknown or other mycotoxin removal, we’re going to be using possibly a methylated multi based on what we see with poor mitochondrial function on the organic acids test. So the cool thing that I’m seeing here, the trend is that the whole picture works together. So by working on the other body systems, we’re already really fixing the majority of stuff we’re seeing here plus the addition of some of the extra hormonal support.

Dr. Justin Marchegiani: Yeah, exactly. And then kind of the general ratio of healthy estrogens, is we like to see a kind of, you know, we have the, what’s called the estrogen ratio, where we look at Astra dial thrown relative to 16 hydroxy. Right? So it’s like we’re looking at basically each one. I’m sorry, e to e4 and 16. We like to see a higher level of 16 in relationship to four and two, right? 16 tends to be more cancer protective. Why? Because most of its coming from estriol. And then you can see two and four tend to be a little bit more from stronger estrogens, e two and E one are stronger estrogens, e three is a weaker estrogen. So we kind of have our two, four and 16 metabolite ratios, right. So you could say to four and 16, we want to have higher levels of 16 in relationship to lower levels of two and four. And again, it just depends upon how the metabolism is to right. If we’re metabolizing these things well, not as big of a deal, right? Because why these hormones come up higher typically is where they’re getting the hormones in our body from, from hygiene products, from plastics, from chemicals in our environment, or we’re just not metabolizing them. So we make sure the lifestyle components are dialed in, where we’re not getting them in our body and to we make sure that we’re metabolizing them as well. Does that make sense?

Evan Brand: It does it does and why we’re not metabolizing metabolizing them, I just wanted to make that clear to people that could be due to gut issues, right, there is a gut hormone component here.

Dr. Justin Marchegiani: Yeah, so the beta glucuronidaze enzyme really helps metabolize a lot of estrogens. And when beta glucuronidaze goes high, it takes the SD estrogens that would have handcuffs on them or a straitjacket on them that would be escorted out of the body. And it breaks those handcuffs and allows them to go back into general population. And so having good healthy gut levels is very important. Now, if you come down here a little bit more, this is kind of cool. We look at melatonin levels, patients mid range, not that big of a deal. These are the same markers over here. So we’re not worried. This is cortisone pattern, I don’t really care about it, it almost always is congruent. What we see on the cortisol side, you can see this kind of with more emotional stress issues. This is more like inflammatory stress. But almost always, they always tend to have a similar pattern as the other side. So I don’t really care as much, because you can see the cortisone pattern is almost the same as the cortisol pattern, right? And that’s not going to change protocol. It’s not going to change protocol. And the cortisol is the more physiological active compound, right? cortisol gets gets broken down downstream to cortisone, which is a weaker kind of metabolite, it’s the weaker sibling. So it’s not quite as it’s not going to be the stronger one we’re worried about. And these are all the same numbers on here. This test is very confusing if you don’t know what you’re looking at, because there’s a lot of repetitive data. That’s just more I think, so people don’t have to scroll around as they’re going over the labs. It’s kind of repetitive for the doctor so they can explain it to the patient. But if the patient’s looking at it, they think, wait, this is new, this is new, this is new. It’s just like this is like the third time they’re saying it not a big deal. All right, and then this is where we’re looking at some of the the markers here in regards to organic acids.

Evan Brand: How you can correlate to the Oh, I mean, have you-

Dr. Justin Marchegiani: It’s pretty good. It’s it’s on point, most of the time, sometimes it can be off, I always tell patients, if we have an organic acid test, like the gray plant lab or the Genova, we’re going to always listen to that one as the most important because that test is specific for organic acids. And there’s a greater sample there too, so it’s going to be more accurate. But if we have this test in by itself, we’ll still utilize it. So out of the gates, you can see here, b 12, this is for methylation looks pretty good 1.5, Santhi RNA can be six marker, kind of urinate look pretty good. glutathione is on the lower side, right? So with this patient, we may want to support either some kind of a sulfur amino acid or some kind of fluid found to help with estrogen metabolism. And again, it just depends out of the gates if we’re not providing a ton of hormone support. Her hormones are so low as well, it may not be a top priority out of the gate. If the person’s hormones were higher, definitely a top priority out of the gates. Okay. And then this is interesting. This looks at the catecholamines it looks at basically adrenaline, or catecholamine. do the exact same thing. By the way, norepinephrine, epinephrine, exact same thing. Three words that mean the same thing. I know it’s really confusing. So we have dopamine, which is the home of anolyte metabolite, and then we have vandalia Mandalay, which is a which is a metabolite of adrenaline or epinephrine. And so dopamine is a precursor to norepinephrine or epinephrine. So the more chronically stressed you you are you will pull dopamine, and so they have high levels of dopamine metabolism and high levels of adrenaline metabolism. What does that mean? It means this pathway, this pathway here is is redlined. So we’re really breaking down and metabolizing lots of dopamine, a lots of adrenaline, and that could be part of the reason why the adrenals are more depleted here, right. And so we may want to add in some amino acids to support some of the catecholamines catecholamines. Definitely stressed. Now, we just have to make sure as we add some of those support in that we’re fixing underlying issues. So we’re fixing diet, we’re fixing blood sugar, we’re trying to get sleep better. We’re not over exercising, we’re making sure all those things are, are pretty good. And then again, Melatonin is on the lower end of the range, but it’s at 24. The range is 10 to 85. So it’s not that bad. I mean, it’s in the bottom third. I only work on this if there’s sleep issues. And typically, I’m always going to be supporting melatonin with amino acid precursors. First, I’m never going to target melatonin by itself unless we absolutely have to. I rather give building blocks and let the body do with it what it’s going to do first, then force melatonin, but if we have to, we can at the lowest possible dose, like-

Evan Brand: What are you doing? What are you going to do for aminos on the homo vanolate vandal mandalay you’re mentioning there, you may come in and support aminos.

Dr. Justin Marchegiani: Yeah so if you look at the range, they’re not super high. It’s six remember, this goes six point four um high end of the range four to thirteen. So i’d probably come in there with some tyrosine. Definitely i throw in some extra b vitamins, extra b6, even though b6 looks good. Just because these pathways are going to be stressed, so i really want to make sure some of the b vitamins are there. Some of the extra amino acids are there. I’m going to work on some of the adaptogens for the adrenals, i’m going to work on some of the adaptogens for the female hormones, uh we’ll throw in a little bit of DAGA, we’ll throw in a little bit of pregnanalone building blocks as well, if we go look here –

Evan Brand: So would you come in and never do dlpa over tyrosine in that situation, would you go based on symptoms like if somebody was like super weepy and crying at the drop of the hat, would you say okay we’re going to go dlpa instead or you’re just going to have tyrosine?

Dr. Justin Marchegiani: I would just do tyrosine out of the gates. I’d only do more dlpa stuff if there’s like a lot more chronic pain because dlpa will tend to go down more of that beta endorphin pathway which could be helpful for chronic pain stuff. If not i would just hit more of the the tyrosine and the b6 and then really calm down the hpa axis. Does that make sense?

Evan Brand: Yeah it does.

Dr. Justin Marchegiani: And then again you could see here pregnanalone is an important building block that we like to use because it’s it’s the mother of all hormones. Now i like it but you don’t want to just take it willy-nilly. I like to always use the lowest possible dose and i like to use it sublingually to bypass the gut and you can see chronic. So you can see here pregnenolone can go downstream to progesterone, right and then you can see pregnenolone, um can also go downstream to DAGA which can then go downstream to our sex hormones right, potentially some of the androgens. Potentially some of the female hormones right go right from here to andro to e1, that goes to e2 and then that can go to e3, all right and then it can also go downstream to testosterone too. Okay and then it can also go downstream to your mineral corticoids which are right here DAGA to where’s um.. Aldosterone here? Help me find aldosterone, where is it there.. Uh andro e1 let me know if you can see it but there should be a pathway where it goes downstream to aldosterone which helps hold on to our minerals.

Evan Brand: Is it at the bottom scroll down i’m seeing it.

Dr. Justin Marchegiani: Maybe they left it out on this graph but there should be a pathway that goes down to aldosterone which is a mineral corticoid, which helps you hold on to your minerals as well. Now also too if you have progesterone right, but then you’re having a lot of like um inflammation right, you can go progesterone down to 17 hydroxy progesterone and then that can go down to cortisol right, so if you’re chronically inflamed you can create low levels of progesterone. Because progesterone is going from here right downstream to cortisol. So that’s why chronic stress and chronic inflammation could throw off your female hormone balance. Does that make sense?

Evan Brand: Yeah it does. Yeah it shows there too uh mother’s diet during pregnancy. Insulin, resistance, obesity, inflammation, hypothyroidism, licorice phthalates, I like how they put the information about what’s going to contribute to the problem that’s really cool.

Dr. Justin Marchegiani: Yep exactly. And then also you can see here you can go your cortisol right and then your cortisol this is your free cortisol here. Right, this is your your active cortisol. Um so this is your this is your free cortisol here, and that the free cortisol is going to be what we measure on the cortisol rhythm graph and then it can go down the um the cortisol. That’s more inactive right we have our the cortisol as well, which is part of our cortisone.

Evan Brand: We need to do a show. Let’s do let’s do another one on this and review our own. I’m going to get a new one. And let’s do it.

Dr. Justin Marchegiani: Yeah, absolutely. So our metabolized cortisol is thf plus th e right, this is our total cortisol and then our free cortisol which is the th the thf so f for free right, so when we look at this here when we look at this here the cortisol, right this is the free cortisol right and then the total cortisol is the free plus the e just an fyi so we’re looking at the cortisone plus the cortisol is what the total cortisol is on that on that graph above. Just so you guys kind of wrap your head around that. And they they left out the uh the aldosterone here. Let me just see if it’s there albosterone. No not there. So yeah. They left that out but that should be in there somewhere as well. I’ll put a i’ll put a graph on that all right. Anything else you want to highlight there evan?

Evan Brand: No. I would just tell people that this is a really good starting place. But i just want to make sure that if you go to just the hormone person that they don’t just treat this because i think it’s really important to understand that there is a massive issue with bacterial overgrowth messing up some of these pathways. So if you come in and you’re doing all these hormones but you’ve got the build up because of those glucuronidation pathway issues. I’m seeing that with mold too that these glucuronidation issues people are on hormones and sometimes they feel worse and i think it’s because they’re not addressing some of these other pathways. I don’t think it shows glucoronidation on this does it this this panel.

Dr. Justin Marchegiani: No no. That’s gonna be more on the detoxification side okay. Any question there?

Evan Brand: No. I’m i’m good.

Dr. Justin Marchegiani: Cool and then just so you guys can see i’ll pull this over here real fast so if we look at this one right here just so you guys can see it so normally progesterone. Um it can go from progesterone down here into aldosterone and so in general if we look here it should go progesterone to aldosterone. So this pathway here you’d see aldosterone kind of coming down here if it really extends it all the way. Just an fyi on that all right. Anything else?

Evan Brand: I think we hit everything pretty good here. So are you saying progesterone could help aldosterone problems?

Dr. Justin Marchegiani: Yeah exactly so if we support pregnenolone that could also help aldosterone issues also supporting licorice can help aldosterone there’s a basically a drug called fluorine f right there’s cortef that’s supports cortisol levels that are very low okay and there’s fluorina which supports aldosterone and licorice has a an effect of mimicking um aldosterone so that can be helpful because when your adrenals are really weak you may have a hard time holding on to your minerals and so that’s important because we need healthy blood pressure to perfuse blood to the brain oxygen to the brain and we also need good minerals to help our sodium potassium pump to work properly we need electrolytes for our nerves to work so. All these are really really important.

Evan Brand: So one last question then we should wrap it up. So if someone is taking adaptogenic herbs or doing adrenal supports they’re doing hormones they’re doing licorice. What’s the approach or protocol to doing this test if we get the test kit in their hands and they’re on let’s say an adaptogen blend. They’re Doing the ashwagandha, the licorice, and everything do you suggest taking a break or does it not matter we gonna we’re gonna see how the body’s functioning while on those herbs?

Dr. Justin Marchegiani: You’re talking about down the road?

Evan Brand: No i’m saying like right now they’re already on them.

Dr. Justin Marchegiani: If they’re yeah if they’re already on them it may not be bad to take a look at kind of where they’re at with them already on them yeah for sure that i don’t see that  being a bad a bad situation if they’re taking hormone support it just depends where they’re at i usually don’t like it the day of just because you can get an artificially high reading.

Evan Brand: Yeah.

Dr. Justin Marchegiani: If it’s if it’s in your system that day so usually maybe take 24 hours off that way it’s not overly high in the system.

Evan Brand: but you still see the trend. Yeah i’m always on the fence about it because you’ve got so many people taking blends which is great. I think you and I have really helped educate people about adaptogens but you’ve got people taking so much and it’s like well are we seeing an artificially good cortisol pattern or is this really how your cortisol pattern looks so i think maybe a day or two off sounds smart.

Dr. Justin Marchegiani: Yeah if it’s herbs i’m not worried about those as much because that’s they’re going to be more modulating and it’s just where they’re at you know and if they tell me that hey i’ve been on them for the last couple of months and i’m feeling better good we’ll just have you stay on and we’ll just take that into consideration  on the test.

Evan Brand: Okay.

Dr. Justin Marchegiani: When we’re interpreting it because if they have some adrenal issues and they’re doing well with that well guess what we probably still want to make that part of their plan anyway we’re not going to change it too much right.

Evan Brand: Yeah well said.

Dr. Justin Marchegiani: Any questions there so far?

Evan Brand: No that no that’s it i think we should do a part two and review our own that’ll be fun i’m gonna get another one and run one on myself and you should do one too yeah i think that’s a great idea i like it a lot so.

Dr. Justin Marchegiani: I think we hit a lot of good stuff here hope um you know anyone listening you can see that you know Evan and i are kind of the real deal when it comes to this like we actually do this we’re in the trenches a lot of people that you may see online are kind of they’re like thought leaders from a um let’s say esoteric standpoint meaning they’re not actually doing this to not actually practicing so we try to differentiate ourselves by bringing actual information so just kind of know this isn’t theoretical stuff this is Kind of the real deal and and hopefully that gives you confidence to take action and to try some of the things maybe you want to dig in. Maybe you want to get testing maybe you want to reach out to Evan or myself. We’re here to help you out, if you need more help. Of course start with all the foundations, we have thousands of hours of free content because we know 99.9 of patients that that we work with or help, they’re doing it with our free content. We’re not even seeing them now if you’re ready for that next step and you want to dive in. We’ll put links down below so you guys can reach out and reach out to Evan. Evan’s available worldwide and myself, Dr. J at to schedule with myself as well. We appreciate you guys um connecting with us all anything else you want to say Evan?

Evan Brand: No people really appreciate it and yeah we’ll make sure  to have the link if you listen on audio your mind’s probably blown right now you thought what the heck just happened we will make sure to give you the link that way you can see this thing because the screen share is great and you just want to give you kudos you’re a great teacher and you’ve taught me a lot about the dutch too so i really appreciate it and your eye to detail on this thing is awesome and most people don’t have that eye so we we really look up to it and really appreciate it.

Dr. Justin Marchegiani: Hey thanks Evan really appreciate it. And if anyone has any hormone issues that are way out of balance and you want to double check it with some blood work too. I don’t have a problem with that either especially some of the androgens I always like to double check with blood if we’re seeing some chronically high stuff um feel free to do that as well. And i hope you guys enjoyed it. Feel free give us a share as well thumbs up and if you want to write us a review that gets us motivated. Um we’ll put a review link right down below if you want to write us a review on itunes. Appreciate it you guys have a phenomenal day. Take care now.

Evan Brand: Bye-bye. Take care y’all.


Audio Podcast:

Recommended products:

DUTCH Adrenal Test

DUTCH Complete Hormone Test

DUTCH Sex Hormone Metabolites


Peri-Menopause and Female Hormone Balance Solutions | Podcast #213

Peri-menopause can be hard on some women. It brings fatigue, mood swings and sleep troubles, a stressful transition that can last for months or years before menopause.

In today’s podcast, Dr. Justin Marchegiani explains the process of peri-menopausal stage and its effect to the body. Learn how the lowering levels of progesterone make one’s system more estrogen-dominant, the different issues brought by peri-menopause especially stress, mood issues, hot flashes, depression. Also, learn how to minimize its effect. Continue for more and don’t forget to share. Sharing is caring!

Dr. Justin Marchegiani

In this episode, we cover:

02:26    Adrenal Gland

04:31    Female Hormone Cycle

07:31    Hormone Physiology 101

26:27    Stress Response Buffering

12:35    Effects of Estrogen Exposure to Men


Dr. Justin Marchegiani: Hey guys! It’s Dr. Justin Marchegiani, welcome to today’s podcast. Uh, congratulations to Tom Brady and the New England Patriots, great go- not really a great game on the offensive side, great defensive game. Uh, 6 superbowl victory for Tom. And I did a podcast on Tom’s performance secrets 2 weeks ago which become even more pertinent today based off of his victory. He is officially the go- greatest of all time. So, really good uhm- to go back and revisit that podcast, lots of good insights in regards to sleep, in regard to hydration, in regards to nutrition, reducing inflammation, uh various training techniques, all these things I think are, a conglomerate of tools that uh- Tom uses to improve his performance, heal fast and keep his uh, pliability and performance up the uh- at the, you know, at the highest age possible. Really, to be a successful quarterback in the NFL, it’s pretty amazing.

So, today, we’re gonna open it up here for uhm… here, I kinda like- maybe a little live podcast here. Anyone wants to chime-in in these specific topics they want me to go into today, we can just choose a topic and just go off the cup and go live. I’m on Facebook as well so, feel free and check in with me on any of these mediums here so far. I’m gonna dive in one topic here today. We’ll go in on peri-menopause. So peri-menopause is really interesting. This is the kind of the phenomenon where you’re in this transition time of going into full menopause or- typically peri-menopause is just starting to miss some periods, you’re maybe in your mid- ty- typically upper 40s. Usually menopause starts between 48 to 51 and it can take 10 years, meaning the symptoms that you deal with during menopause, that can take up to 10 years sometimes. The hot flashes, the mood issues, the depression, uh anxiety, uhm those type of sleep issues, scrappy skin, all those things can kind of con- you know, consolidate and happen over a long period of time. Typically, peri-menopause is that- one year. Once you get in the menopause- menopause typically is like, once you’re been no cycle for 12 months. So, peri-menopause is this in-between time  where skipping cycles, maybe you have a period every 4 months, or 6 months, or you’re kinda lost your cycle regularity, you know, fertility may not quite be there, you may not be ovulating as much- uhm- you start to see your cycles just getting more and more irregular, typically in you’d mid- typically upper 40s when that starts to happen.

Now, what do we do about that? So, first thing is, make sure you’re not getting exposed to toxic hormones in your foods or in the environment. That’s number 1. Uh, number 2, the biggest hijacker of your hormones is gonna be your stress hormones, A.K.A. cortisol and adrenaline. So it’s really important that you get your adrenals looked at if you’re worried about peri-menopause because, DHEA Sulfate, this is the major sex hormone precursor that’s made by your adrenal glands. This is actually coming from your adrenals and it’s a precursor to make more estriol in women. It can go more testosterone in men. But estriol is that predominant estrogen that you’re gonna have when you start becoming more menopausal. Typically when you’re cycling and fertile, it’s more estradiol, E-2, the “di” is kinda- right, 2. And then estriol, or the TRI, that prefix for 3. So you start to make more estriol, and that’s gonna be more anticancer. It’s gonna be- it’s have some really good anti-aging benefits. Estriol’s really important for hydration, that’s why low estriol- low estriol can- can create vaginal dryness. It’s also a really good anti-inflammatory, it really helps with brain inflammation. This is why a lot of mood issues and brain fog and cognitive issues start as you become more and more uhm- peri-menopausal into menopause.

So we have to look at the adrenal glands, that’s number 1. Because these adrenals make DHEA, also cortisol hijacks your hormones. Cortisol increases blood sugar, and also decreases protein synthesis, meaning, you have less protein going to build up your brain chemicals and build up your muscle tissue, and that protein is primarily running through gluconeogenesis where it’s shredding up that protein and making more glucose out of it. That’s what stressed us. People get more flabby, they get more cellulite because of cortisol. Breaks down connected tissue, and it breaks down amino acids. So, your- getting your adrenals looked at is really important.

Uh, number 2 is looking at your female hormones as many women as they go more into peri-menopause, they become more estrogen-dominant. And the reason why is, because we talked cortisol hijacking, your hormones- it does so, ’cause it pulls progesterone downstream to make your stress hormone. So this is important. The more stressed you get, the more you deplete progesterone, that puts you more into an estrogen-dominant state. Typically, we have more progesterone than estrogen. It’s about a 20 to 25 to 1 ratio progesterone to estrogen, and when you start going estrogen-dominant, people think, “Oh, that means estrogen goes higher”. No, it just means there’s ratio, it starts to drop. So you still may have more progesterone, there’s that ratio drops down a little bit, and you start to see estrogen creep up, but you may not see estrogen ever go above progesterone. Just keep that in the back of your mind. That’s gets commonly confused.

So we have the progesterone there. And typically, when cortisol’s prolonged, this also affects the HPA, H-P-A-T, H-P-A-T-G-G: hypothalamus, pituitary, thyroid, adrenal, gonadal, gut access. So it affects that feedback loop from the brain, and the hypothalamus and the pituitary ups- upstairs to that feedback loop of the glands secreting hormones downstairs. And this is important, so we start to see cortisol rhythm operations. The cortisol rhythm starts fluctuating. We start to see it in women with their cycle operations. A lot of times we just see a lot of PMS or the extreme PMS is PMDD, which is that week or so, before you actually menstruate or bleed. And then we also see a lot of- a lot of times, sometimes shorter cycles, going from 28 to 26 to 24 to 22. So we start to have a shorter luteal phase, just really important ’cause your luteal phase is that primary phase where you’re making more progesterone. So we do test while we actually look at progesterone every other day for a full cycle. And one of the things we’ll start to see is, your overall progesterone that you make throughout the whole month, typically should be above that 3000 marker so, it starts to drop. You start to see it drop. And that’s big, ’cause that’s kind of like looking at your overall progesterone sum, we start to see it drop, and a lot of times that can happen when you compress that luteal phase when you shorten it, ’cause you just have less days where you’re even making progesterone. Uhm, that’s a big one. So we start to see cycle aberrations there, we could see a shorter luteal phase, we could see a longer follicular phase, we may be out of sync, or we’re not ovulating at that right time and your ovulation could be totally off, or maybe you’re not even ovulating. ‘Cause, you know, to have that good ovulation to signal, we need a- [clears throat] a rise in estrogen followed by rise in progesterone and then estrogen kinda pitters out while progesterone stays high and drops. This is kind of our typical rhythm, and how women’s cycle work. So, just kinda first thing that happens, those gotta- kind of hormone physiology 101.

So, we start off by menstruating. That menstruation is typically signaled by a drop in progesterone and estrogen. First thing, progesterone and estrogen drop. That’s step 1. 2, menstruation happens after that, that’s the shedding of the uterine lining. We want brighter blood that’s more oxygenated, more fresh, for starting to see browner, thicker kind of clottier stuff, it just could be- uhm- the uterine lining from previous cycles that didn’t flush out. So, 1, drop in progesterone and estrogen, 2, menstruation, that’s gonna happen for a few days, anywhere between 3 to 7 days, okay? We don’t wanna go more than 3 to 4 tampons per day on average. For our average high, is if not we lose too much blood, we go hemorrhagic, we go anemic because of that. Step 2 is FSH starts to increase. FSH is our brain hormone, follicle stimulating hormone. That FSH start to make the follicle grow a little bit. That follicle starts to produce estrogen. Estrogen starts to rise, right? As estrogen starts to rise, that starts to signal luteinizing hormone, which is our other brain hormone that talks to our ovaries. And then progesterone starts to rise typically around day 12 to 13 after that. So here we are at day 12 or 13, estrogen’s kinda topped out, that signals LH, then we have progesterone going up like this. So progesterone’s going up, and then at some point, estrogen starts to fall again, progesterone stays up, and then around day 28, they crash together and that signals the whole entire step again.

So, drop in estrogen progesterone, signals bleeding, FSH, increases, FSH creates more estrogen, more estrogen creates more LH, more LH creates progesterone, estrogen starts to drop, progesterone stays high, estrogen and progesterone drop and then signal bleeding at the end. So that’s kind of a general uhm, cycle physiology 101, Most people are clueless about that. When I talk to a woman, I say, “Hey how long is your cycle?”, the biggest kind of common misconception, “Oh, it’s 3 days or it’s 7 days”, like no, not your menstruation, your full cycle. Your cycle is from day 1, first day of bleeding to next day 1, typically 28 days later. Uhm- most people get that confused your cycles, your full hormonal rhythm, day 1 to day 1, how much you menstruate is gonna be your- your bleeding, your period time so to speak. Hope that helps. That’s a common misconception.

Alright, so we talked about adrenals, we talked about our female hormone cycle, we talked about hormones in the environment toxins. These things are really important because they disrupt, they put more stress on our metabolism to be our- to be our detoxification system to be able to metabolize hormones. Gut functions’ so important because this is where we absorb a lot of the nutrients from our food to make our hormones, right? Hormones are made from good cholesterol, right, it goes cholesterol pregnant alone and then 27 different hormones that spit out on the stress side, on the mineralocorticoid side and on- then on the anabolic estrogen progesterone, testosterone side. So we- we need to be able to absorb these nutrients so we can make our hormones. We need to be able to absorb nutrients to help buffer the stress response. Magnesium, L-Theanine, GABA, they help us buffer that stress response so we could- think of it as like, imagine buying a car where you can only shift it from first gear to second to third or fourth, fourth to fifth. So, all you can do is bring that car up from low to high but you can’t downshift. And a lot of people are in this place where they cannot downshift their metabolic car, so they constantly feel stressed, they cannot ever bring it down from fifth gear back to first gear. And this is one of the biggest issue- biggest issues we see, and if we can’t absorb our good amino acids, and- and- and make our good inhibitory nerves, transmitters like GABA, through L-Theanine, through magnesium, through dopamine through serotonin, we’re gonna have problems. And typically, this starts to mess up sleep. Starts to mess up our melatonin cortisol rhythm which is the next step. And that’s gonna be basically- melatonin goes up at night, cortisol goes down at night. We have this inverse relationship – melatonin up, cortisol down, right? We get this big “X”. And when cortisol stays high at night time, it disrupts sleep, it prevents melatonin from coming up. Melatonin is a powerful antioxidant, it’s powerful anti-cancer, it’s very anabolic, it helps you heal, recover, turn-over your neurotransmitter successfully and heal your body, ’cause you really tap into ’em, make a lot of your growth hormone in that first half of the night, 10:00PM to 2:00AM. So we wanna be asleep so we can plug in and access that growth hormone.

Okay, so we got our rhythm, cortisol, adrenals, digestion, absorption, and then also, the amino acids that we absorb through our digestive system, also help run our detoxification system. So, we wanna stop the toxins on one side, not drink out of plastics, not consume pesticides, consume organic, right, get, you know, higher quality step-4, step-5, if we’re using the whole food, step-method works, more grass-fed, pasture-fed, organic, the whole nine yards that’s gonna help us make more of the nutrients, absorb more of the nutrients where we can actually detoxify as well.

And then we talked about those hormones helping with sleep, helping to buffer stress. Uh, very-very important components to female hormone health, as well as make hormone health. Uhm- males really get the sure end of the stick, because there’s a lot of estrogens in the environment, you don’t have a lot of synthetic androgens in the environment, so men really get clavier because when men get a whole bunch of estrogen exposure, it starts to inhibit LH. LH is that upstream hormone in the brain that talks to the gonads, right? With the uh- the cells lay dig in the testicles to make more estrogen… I’m sorry, to make more testosterone so that estrogen disrupts that signal. Now we don’t talk to our testicles to make more testosterones, it starts to inhibit that. And it’s a- it’s a really a vicious cycle. With women, they just become more estrogen dominant, which is a good, that starts to mug their cycle. With men, it starts to decrease testosterone. And you start to see things like gynecomastia – man boobs. Uhm, maybe guys even being overly emotional because they’re- it starts throwing off testosterone-estrogen balance as well. So that’s gonna affect their mood and- and focus on- on the male side as well. And of course for the woman, it- it causes same things, ’cause they can create more PMS which can create irritability, breast ___[13:48], back pain, moodiness, irritability, sleep issue, all those things that you know, women do not like. And men don’t like them either, of course. It’s a two-way cycle in that for sure.

So we think we hit all the major things. I’m gonna open it up to questions, primarily on the peri-menopause, female hormone side of the fence. And again, this is total live podcast here. Uhm- again, I just- I interject a lot of clinical information ’cause I work with patients in the trenches. So if you have any of these issues and you wanna dive in, click below to make sure you subscribe, hit the bell, and schedule a consult with me and my staff. Let’s see what kind of questions we have here off the bat. Try to keep it pertinent on the topic if you can.

Alright, let’s see here. Uh, “How bad- how can a bad gut affect hormone?”. So it’s going to affect the two-wa- oh, couple of ways. We absorb all of our nutrients to create our hormones to our gut. Number 2, we absorb the nutrients to our gut to help us detoxify – number 2. And then number 3, dysbiotic bacteria increases an enzyme called beta-glucuronidase. And beta-glucuronidase, uhm deconjugates estrogen. So we have an estrogen molecule right? It is floating in our bloodstream, we conjugate it, we bind it to a protein, to escort it out of the body. It’s kinda like, hey guys in the night club, whatever rock and rowdy, security guard comes up, like puts the guys hands behind his back and like escorts him, out of the club, right? That’s kind of, when you conjugate, think about as putting- err- handcuffs on that rowdy hormone. And de-conjugation is just someone coming around with a handcuff key, and uncuffing each person, right? Think- that’s what’s happening with dysbiotic bacteria… dysbiotic bacteria, bad bacterial overgrowth, increases beta-glucuronidase, then we have the- the handcuffs, are taken off the hormone, and they can be rowdy again. So those are the big 3 ways that can affect that.

Okay, excellent. Any other questions, feel free- uhm, feel free and chime in. I’m- I’m more than like- I’m more than willing to answer any more questions. Okay. I think we hit all the major things here. Try to think of anything else we can do. Pa-pa-pa-pa-pa, awesome… Tssssss… ‘Kay. “What’s a good mindset to have when you are feeling hard bowel, and of crohn’s flare up right now?” So, ob- obviously, gut issues can affect hormone health too, right? So question is, how did it happen? I want to feel like I’m in control of the vicious cycle. I wanna know what the heck happened. So, I wanna look back and at least gain control over how I gotten into this flare up. Maybe the first thing I wanna know. And the second thing is what actions are you gonna take to get out of that flare up? So, feel free and check video 2 to 3 weeks ago on how to, you know, reverse an autoimmune condition flare. Take a look at that video. I go over a lot of good steps that are needed to- to be addressed.

Uhm, “Is fatty liver curable? What supplements would you recommend to help?”. So, yeah, it is, I mean, it’s typically gonna be a combination of insulin resistance. And insulin resistance has a major effect on female hormones. How? Because high amounts of insulin, are going to up-regulate specific enzymes that can increase androgens in women. So that can really throw off androgens, and then of course high amounts of androgens can- can mess up proactive, and prolactin can screw up uhm, estrogen and progesterone, right? So, this is a really, you know, concerning thing. So, high fructose, corn syrup, insulin-resistance are gonna be the big things that are going to cause that.

Uhm, “Thoughts on IF in regaining cycles, avoiding IF until cycle returns”. So, uhm- typically, what I would recommend, is that you do not engage in any intermittent fasting until you get your hormones back and under control. Not eating food for a long periods of time can actually be a stressor on your hormones. ‘Cause we need nutrition to run our metabolic systems. But if you are more stressed, it- it may be too much stress on your body avoiding these foods, these nutrients. ‘Cause then, longer periods of time may cause your adrenals to make more cortisol, and adrenaline and gluconeogenesis to regulate your blood sugar. The more stressed you’re at, uhm- the more stressed you’re at, the better you’re going to absor- the more stressed you are, the more gluconeogenesis, the more you’re gonna rely in other hormones to pick up your blood sugar. If those hormonal systems are weaker, you’re essentially gonna need more of those other systems to pick it up. Now, by eating and stabilizing your blood sugar, that’s gonna take stress off those hormonal systems that are weaker, and give them the chance to get stronger. It’s kinda equivalent if you break your ankle. You walk around on crutches for a bit, the goal of walking around on crutches is going to be to take weight off your ankle so it can heal.

Alright, excellent. Very good. Uhm, “Can low progesterone in ladies cause low libido?” It definitely can. Low progesterone can definitely cause, uhm, low libido in ladies. Uh- lot of times it’s just the estrogen dominants that starts to pick up, that can be the big issue.

Uh, Samuel writes in “Hey doc, been drinking a little more alcohol recently due to football games and hunting season, seems to have messed up my circadian rhythm a bit. Uh- what would you recommend for a reset?”. Uhm, more than likely, I would just stop with the uhm- stop with the alcohol kind of down a bit. You could do more vitamin-C and more sulfur amino acids, uhm, to help your body heal.

Excellent. Uh, let’s see here. Any other questions? Barbara Scott writes in, “Could chronic muscle pain impart of the menopause phase of life?”. Well, yeah, I mean, it definitely could. I mean, it’s very possible that, uhm, your adrenals are weaker, and then that’s gonna help- that’s gonna impair your body’s ability to manage inflammation well. It’s very possible. Uh, a lot your hormones have really good anti-inflammatory fats-progesterone estrogen, it just depends on what the root cause is. Did it happen from food? Did it happen from… uhm- stress? Did it happen from poor sleep? So, I wanna get a- a window in what the heck is happening there as well.

Okay, excellent. Let me keep on rolling here. Uh, “Can a hair analysis tell you a lot of accurate info?” Uh, I think a hair analysis can potentially give you some good info, the problem is, it’s all downstream information because all those nutrients that get into your hair, the half that come in through the gut. So if you have impaired gut issues, that’s going to affect what’s in the hair. So if people are looking at the hair, they’re looking at all these different mineral ratios in the hair, but if we have a gut issue, I consider that to be a lot more upstream.

Uh, “What’s the best way to balance out estrogen and progesterone in ladies?”. So, off the bat, uhm- you gotta at what the underlying reason is. Is there toxicity issues, number 1? Is there uh, absorption issues in the gut, number 2? What’s your adrenal strength at, number 3? How is your hormonal rhythm, number 4? And then I also wanna look at just uhm, you know, exposure to conventional, uhm hormones in the food. Those are all gonna be big ones, they’re off the bat.

Ugh, let me just see if I can continue to do that. “Tom Brady’s a beast last night”, not in- actually, all I had during the game was one kombucha, during the game, I got some keto-cups which are like one gram of sugar, uh- coconut, like peanut butter cups but that uses coconut oil instead. And then I had a pizza which is a cauliflower crusted, and then I use the dial almond cheese. So that was the big one that I had there.

Uh, “What would you recommend to naturally treats- treat sinus-headaches brought on by cold?” So, if you go to my site, and look at recommended products,, and then you look at recommended products. I have a couple of links to amazon products that I like for that. I like either a combination of the nasaline or a sinus- just injector, and essentially uhm, the Xlear Sinus Rinse. I think that works really good. The NeilMeds, good but the Xlear has a lot of the xylitol in there, which is great at killing different kinds of bacteria and also flushing things out, and it’s really helpful with that post-nasal drip as well.

Uhm, I think we hit a lot of good things here. JACK ATTACK writes in, “How do you feel about citrus pectin?”. Well on the context of hormones and peri-menopause, it’s really good at binding up a lot of these metabolized hormones that may have a problem getting escorted out, and it kinda puts the handcuff back on these hormones to help it escort outside the- of the body. So I think it really helps with detoxification of hormones. Thanks Jack, appreciate it.

“I’m an active 30-year-old male on a paleo diet suffering from bloating, loose stools every morning, find myself wanting to eat more starchy vegetables for energy.” Yeah, so I mean, that’s kind of a broad statement, but in general, I would look at the gut and figure out what- uh, the next step is there because the gut needs to be addressed.

Okay, try to keep all questions related to the topic of peri-menopause. Uhm, that’d be super helpful for me so I know what’s going on. ‘Kay, very good… Anything else guys? What else is going on? “What cauliflower crust pizza did you do?”. It’s a local place by my house that- that does an organic cauliflower crusted pizza, I’m not sure the actual brand. Uhm, and I did the diet cheese. So it’s kinda  lower carb too which is nice, so, I don’t get all bunch of a carbs either, feel pretty good afterwards too which is nice.

Alright guys, hope everything’s going well. Make sure you guys subscribe over to my thyroid reset summit,, we’re going live in a month. We got a whole bunch of free stuff I’m giving out as well. I’m giving out the first like, 25% of my thyroid book. So, really excited for that get out. Hopefully it’ll provide a lot of great information. Everything I try to put out there s- I wanted to be action-oriented, so you guys can use it to actually start getting better. I help more people through my content than I actually do in person. Obviously, you know, having a personal relation, if you can’t substitute that, but this is a great way to get good information out to people here. So, make sure you sign up.

“Best lab to discern HA versus early menopause?”. Uhm, can you define what HA is? Uhm, much or- I mean, it’s probably something very common. I just- give me what that meaning is there…

Uhm, “What’s the difference between ox bile and bile used by conventional docs…”, uh- I think you mean “urso… “, uh- I’m not sure how you pronounce that – ursodeoxycholic acid. So typically, a lot of bile- ox-bile’s typically used as a bile salt supplementation when they take it from oxes or- I think bovine sources it sounds like, and they’re using that supplement as wise. Now, my line and Liver Supreme, we will use bile salts, we will use beet roots, we will use… uhm- french tree, or ___[24:47], things that are really supportive for the liver, supportive for the gallbladder, thinning out the bile, and then we’ll also help provide uhm- extra bile as well because if we can’t break down our fats, typically we’re gonna have a hard time breaking down our cholesterol, right? And if we can’t break down our cholesterol, that’s gonna really hurt our hormones. This is a really important question ’cause if you’re dealing with peri-menopause, this may significantly affect your hormones not being able to break down good quality fats.

Uhm, so- “Hypoth- hypothalamic- hypothalamic amenorrhea versus early menopause?”. Okay, so amenorrhea. So amenorrhea is like you’re still in that cycling age, it’s premature, you’re not having your period, okay? I have a woman who is 40 years old, uhm, this last couple months, started to get her period back. I see that happen many times, she wants to have a second child. Her period’s back for the first time in two years. Why does that happen? It’s a combination of typically poor gut issues, you’re typically under- you’re getting underneath nutrition, and it can be a combination that you’re not eating enough, or you’re not breaking down and absorbing enough. And then of course, all of the hormonal stress that compound for math, ’cause of course that creates adrenal issues, and that creates female hormone issues, and that detoxification issues ’cause if you don’t absorb, then you can’t run- put the nutrients in and run detoxification systems as well. Uh, so best labs to discern that, I mean, you wanna run a high-quality month-long test, and then also want to run some blood work and also some uhm- some adrenal testing as well. So you’d wanna dig in, find a good functional medicine doc to get that set up for ‘ya.

Oh, great to hear Irma, glad you’re registered, awesome. Uh, another great question just came in here. Try to keep it to the female hormones today guys… Uhm, “If I see anything remotely sad or happy tears, is that an estrogen issue? Will that affect gut health?” So, it’s hard to say, is this a- a guy you asking this question or female? Uhm, but, yeah, definitely, hormonal imbalances can affect the emotions. And you know, it’s gonna be- you’re gonna be looking for that change in emotions, maybe more emotional’s typically what you’re gonna see, but yeah, that can definitely have major effects on your emotions as well.

Nora writes in. Hey Nora, “Got acne around my jaw since June 2018. Last consult you asked if I had started doing anything different around that time but I didn’t recall. Later I found I re-introduced some thyroid support for hypothyroidism around that time. Since tests show no more hypothyroidism now, is it okay to stop the ‘Thyro balance’?”. Uhm, so in general Nora, we’d wanna make sure that we’re testing your hormones on the thyroid side, and as you’re dropping that down, we’d wanna make sure that your hormo- your TSH stays within a good functional range, as well as your hormones stand a functional range. So, it’s not something you’d wanna just drop out by itself, you’d- you’d wanna test you, and make sure as we drop it out, there could be, you know, that you’re doing good there. And then regarding any jaw acne that happens, I mean, we’d want to make sure number 1, insulin is okay, right? Insulin’s good. Uhm, ’cause if you’re doing too much insulin that’s gonna drive more androgens and then that’s gonna activate the sebaceous glands to make more oil, and that can cause the acnes. So we wanna make sure insulin’s good, wanna make sure detoxification’s really good. So- and for me to add in more sulfur amino acids and detoxifying support to run those systems, that’s good. Number 3, potentially various fibers to help bind up some of these junks so it gets or- escorted out your gut better, and then I would say number 3, if we’re still having issues you may wanna add in some prostate glanding support like black currant seed oil, and email my office if we- if we-  I don’t have your protocol up in here in front of me yet, so when patients ask me about questions here, I- I may be having some incomplete info to go off of, so if we haven’t added any black currant seed oil, we may wanna do that to help with the prosta gland and then some help with the jaw issue. And the next thing will be to- to retest your hormones with the DUTCH test to look at also how you’re metabolizing your estrogens to make sure that’s getting better. But don’t adjust anything until we chat.

Yeah, vitex is gonna be a great hormone- a great herbal support, A.K.A chastry, that’s gonna be really good at helping progesterone balancing for sure, really good.

Uh, “After getting through menopause does one need to stay on additional hormone help continually through life?”. It really depends. So what I recommend is get all your hormones symptoms under controlled, number 1. Test your hormones, make sure your adrenals and your female hormones are relatively good, uhm, from lab-testing standpoint based on your age. And then I recommend gently tapering down your hormones and see how well you do. See if you can keep your symptoms, your menopausal, se- was under control, sleeping good, your mood’s good, vaginal dryness is okay, brain fog’s good, and if you can maintain that benefit while dropping that bioidentical hormone support, that may be an option but Barbara, you’d have to deal with that at a consult, and continue to monitor that and keep that dial on going, but that’s a great question.

Okay, great. Uhm… just kinda kind of- come in here guys if I skip your question, don’t take it personal, tryna go to the questions that are most pertinent to this conversation. Zoe-Holistic writes in, “Would you be worried about a 54-year-old woman, still cycling and ovulating? Would you recommend supplementation as a- oestrogen is very high”. It just depends if you’re 54 and you’re still cycling and- and- the cy- cycle’s relatively stable and lengthen, PMS-wise, I wouldn’t too wor- I wouldn’t be too worried, I wanna know more about your parents and this is something that your sisters or- aunts- aunts, and/or mom or, you know, mom went through as well, our grandparents went through? I wanna know a little more about the history. And doing some testing, right- I think would also be good just to see where your levels are at, I think that’s a really good thing. I’ve- I typically more concerned Zoe with people, uhm, prematurely going into menopause, that’s my bigger concern, that’s the thing I’m seeing these days. But I think it’s always good to get tested.

“Is there a connection between hypoglycemia and adrenal fatigue?”, yes! Great- great question Olga. I see a lot of low-blood sugar symptoms’ really being a big stressor on the adrenals, and then that can create a lot of lower progesterone issues, creates a lot of stress. I definitely see that being a concern.

“What is the average acceptable age for menopause?”, typically 48 to 51-ish.

Ik O, “Best test for progesterone levels?”. I mean, you can run a typical progesterone blood test, you know, we like to be at least 10 to 15 on that, around day 20 of your cycle, right? Considering your cycle being like 26 to 30 days, and/or like a- a good high-quality DUTCH complete panel that we’ll run around day 19 to 22.

Nora, you’re totally welcome. So, email my office if you need that black currant seed oil, I’ll put you on 2 capsules of that twice a day if your skin is still having some issues. Two caps, twice a day and I have a couple recommended brands.

Jessica Lynn writes in, “Does liquid vitamin-C raise estrogen? I read studies say that there’s a connection”. I’m not sure that it would raise it. I will typically give vitamin-C in fiber to actually help with estrogen detoxification, so I don’t think it would raise it, maybe there’s some modulate- maybe there’s some modulation effects, or may help modulate it but I couldn’t imagine it actually raising it, like taking maybe uh, hormone would.

“My kidney pain by eating a honey, age 27, serious problem?”. Uhm, yeah that’s a good question, kinda little off-topic, but in general, I would be careful with the too much fructose.

“Will chaste tree help with progesterone?”. It will, it’s gonna help with LH, luteinizing hormone which is gonna help talk to your- your ovaries, and that kind of female hormone area to make more progesterone?

DesignLover writes in, “Took birth control pills for 1 year for adult acne, it worked. Now I’m 37 and it’s creeping back around the jaw line. Connection to sugar or more estrogen related? Or more cortisol? Also, hard time sleeping.” Now again, like birth control pills can help, even though you’re actually giving more estrogen with the birth control pill, it does kinda level out your hormones, so you’re not getting swings. So, I think a lot of the hormone swings can really be a big effect there so we can kind of level stuff off. But I also see, you know, birth control pills cause more issues. You can see melasma as well, which is the estrogen, kind of stimulates the melanocytes and more pigmentation, you can kind of get that pregnancy mask, while on the birth control pill, and someone that can actually make their acne worse. I’ve seen it on both sides. Is there connection to sugar and more estrogen-related, yeah, there’s definitely a big connection with sugar because sugar will actually increase more insulin. And insulin will create more ___[33:23], which will cause the bacteria to feed off of your skin and create more acne.

“My natural doctor put me on liquid vitamin-C and I’m having short cycle, 26-27 days with very light bleeding and prolonged bleeding”. Yeah, I would need more info, I’d wanna test your hormones, see where you’re at. A lot of my younger female patients will use herbs to help the signaling upstream from the brain to your ovaries and then we’ll also- a lot of times give a little bit of bio-organical progesterone, but we’ll give it in a specific cyclical augmentation fashion while we’ll taper it up and down. But we really wanna be specific in how we do that.

Amelia V writes in, ” If taking T3 you mentioned in past, needing it uh- multi-x-day due to half life. Why am I only- why am I only RX dosage for the AM?” Uhm, so, yeah, if you’re just taking T3, I don’t recommend only taking it in the AM, and like if you’re doing a Cytomel or liothyronine, you’re gonna be dropping off on your- uhm- on your T3 within 4 to 5 hours, so you definitely want to uh, not do it that way. In the thyroid re- reset summit, we had ___[34:26] on the uhm- summit talking about these exact things. So make sure you subscribe, make sure you subscribe.

Olga writes in, “Can longtime use of Mirena iud cause energy problems?”. Yeah, Mirena can cause a lot of side effects. Merina is a synthetic progesterone, and there’s an iud to secretes that. So, yeah, it can definitely- I mean, my biggest issue with that is it just kind of seeps in your bloodstream throughout the whole month at least with like, birth control pills, you kinda take a reminder session, you know a 6 to 7 day reminder where you kinda- drop out your hormones and then- and then that can cause bleeding where you kinda have this steady state of hormones with the Merina, which I think’s a little bit unnatural because you don’t have any drop at all. That’s concerning, so- I always recommend my female patients if they want- uhm- an iud to try the ParaGard which is a copper-iud that’s non-hormonal.

Uhm, “‘Can’t miss’ interview from the thyroid summit? What was your favorite interview?”. It’s a great one, I’d had a lot of a really good interview. It’s hard to say which one was the best. It really depends on the topic. ‘Cause we’re really connected the thyroid to the gut, thyroid to the emotions, thyroid to the adrenals, thyroid to fertility, thyroid to female hormones, thyroid to- even male hormones or gut inflammation, or gluten, or autoimmunidase. So those, you know, it- it was so many different areas, it’s really hard to say.

Paul writes in, “In menopause, how to stop hot flashes?”. Well, a lot of times, the hot flashes can be from a lot of these upstream hormones in the brain like FSH going really high. ‘Cause think of the ovaries, right? Your brain makes hormones that talks to the ovaries to make more hormone, more female hormone. So, as the brain- as the ovaries aren’t, you know, don’t have the follicles coming in, and we’re not making as much hormone, the brain is trying to rev up the volume that talk to the uhm, downstream glands. And that FSH as it goes higher can really increase vasodilation so, giving certain herbs can really help with the signaling and help kind of decrease the volume a little bit, modulate the volume, and then giving some bioidentical hormones can also help modulate the volume as well. ‘Cause the brain says, “Hey, I’m getting a little bit more hormone in there naturally, we can lower the volume as well”, and then we deal with the herbs to help with the receptor sites too. So there’s a couple different ways that we can do it. But that’s kinda one of the major philosophies regarding FSH, and regarding a lot of the hot flashes.

Uhm, ” Is Chaste Tree something you can take to see how you feel…?”, I mean, you really want to be working with the functional med doc on this. A lot of variables when it comes to that.

DesignLover , “Is there a connection to an imbalance of hormones in women who haven’t bore any children?”. Potentially, I mean, women that haven’t born- birthed children, they don’t have that progesterone increase that happens, uhm- throughout pregnancy, so that- you that- 8 or 9 months where progesterone goes up because of HCG, that goes up significantly higher. So that may- let’s just say, you have a greater chance just kind of being more an estrogen dominance, over your- your cycling fertility time-frame so to speak, where hormone, who is uhm- pregnant one, they’re not gonna be using up the follicles as much ’cause you’re not cycling when you’re pregnant and a lot of time during the breastfeeding process. So, you’re not going to cycle through your eggs as fast. And then number 2, you’re more overall an average having a higher input of progesterone, so that has some effects as well.

Uhm, Zoe writes in, “Do you find the people with more severe menopause symptoms always have more adrenal issues when testing, is that your finding?”. I wouldn’t say always but I- ’cause it’s- it’s-  I don’t- I’m not a big fan of absolutes but I would say yes. I would say on average, that is a significant correlation, more menopausal issues have more adrenal issues. And also, peri-menopausal issues, more adrenal issues, and I’ll even go one step further, cycling female issues, right? Definitely adrenal issues.

Uh, Amelia writes in, ” I’ve heard it takes one month to re-balance cycle for every year you haven’t had one?”. Yeah, that pro- that makes sense, I definitely agree with that, I mean, I typically see a major rebalancing in a- in a woman’s cycle within 6 to 12 months. And a major rebalancing is- I thi- I would s- call that, is about a 50% improvement. Alright, and then from there, we continue to compound that improvement month after month.

“Can someone with copper toxicity use a copper iud?”. Yeah, I mean, you can just make sure you’re doing extra zinc, put some extra zinc in your supplementation regime to help balance out the copper toxicity. That would be a good helpful approach ’cause you have the paragard or- is a copper iud and of course that can increase your copper levels. So you gotta be careful with that. You gotta weigh that out with your doc and see if you are really are copper sensitive. I have some patients that cannot do a paragard copper iud, they just can’t do it. Uhm, some can do it great and they have no problems. So you really gotta weigh those options out.

Uhm, “Can peri-menopause cause weight gain in the stomach? I’m 49 years old, no period for 7 months, gained 20 lbs. in the stomach in the last year and I can’t seem to lose it, is it just from unbalanced hormones?” So, remember, a lot of uhm, adrenal issues connect to peri-meno- menopausal issues. And a lot of adrenal issues are coming from cortisol imbalances. And cortisol has a direct effect on your tummy through just cortisol itself, the stress hormones can aff- affect the gut, and also through more sugar being released which can have an effect in insulin which can also affect your tummy. So, adrenal issues, have a major effect with cortisol, and also plug in and connect to insulin as well. So, great questions there.

“Do you think women with polymorphisms in COMT and MTHFR should not take the contraceptive pill? Controversial topic”, I know. Well, I know, in general like COMT like uh- catechol-O-methyltransferase. So when you see, uhm these types of issues, you may have issues with various adrenaline and just being able to deal with stress because these catecholamines are- like, you know, basically your stress hormones, your stress neurotransmitters. And MTHFR typically is gonna have a major effect on folate and then also affect B-12 and can affect methylations. So, uh- birth control pills deplete a lot of those nutrients. So yeah, I think what you’re saying is a very valid topic ’cause those issues can really have an effect on those nutrients. So if you are taking the pill, uhm- you really wanna make sure you’re supplementing with extra methylating nutrients, magnesium. In my line we’d recommend like B-vitamins synergy which has like the extra-activated folate, activated B-12, activated B-vitamins, and also a good multi on top of that, with magnesium and calcium, other important minerals that tend to get depleted.

Uh, “What would cause early spotting and irregular monthly cycle?”. That’s gonna because by typically lower progesterone or progesterone dropping out too soon in your cycle.

“Are there other conditions that cause hot flashes after menopause?”. Uhm, hard to say. I mean, you could- you may notice issues with blood sugar. Blood sugar ___[41:27] may get problem. A low thyroid, you may see some issues with that like if you have autoimmune flares on the hashimoto’s side. So yeah, there’s some potential connections there.

“Thoughts on carb cycling/keto for women with hormone imbalances? Ideal balancing diet?”. So, a lot of women do go with keto initially because they have insulin-resistance, and keto is very helpful with insulin resistance. But if you’re insulin-resistance is dialed in and you’re doing good with your blood sugar, some women starts to do better as they add in a little bit of safer carbohydrates, starches, squash, sweet potatoes, and they may even be better doing it cyclically. What does that mean? You’re kind of lower-carb keto for 2 or 3 days and maybe you have a sweet potato for dinner with your veggies and your meat. So, that I think is- is a very valid point, and I see that clinically.

Uhm, let me see here. Any other questions on hormones? I think we hit everything guys. Give me a thumbs up, give me a share, I appreciate it, make sure you hit that bell. People magically just go off my subscribe list if the bell is not hit. So make sure that bell’s hit, so you get all my notifications. Appreciate, uh today’s chat. Hopefully en- you enjoyed it, if you enjoyed it, give me a comment below. Let me know what you think. Any questions related to the topic, I’ll be back in and address them in future podcast or- we’ll respond here and I’ll look forward to connecting with you guys tomorrow, for a live Q&A.

You guys have an awesome day, and uh, go Patriots! Take care. Bye.


Xlear Sinus Rinse Kit

Menopause, Perimenopause, Hot Flashes, and their Natural Solutions | Podcast #207

In today’s podcast, Dr. J. and Evan Brand discuss the different symptoms of the menopausal stage. Watch as they tackle in detail the transitional years of menopause, or perimenopause and the different natural ways to minimize the effects of hot flashes.

Stay tuned for more and don’t forget to share. Sharing is caring!

Dr. Justin Marchegiani

In this episode, we cover:

00:28    Hot Flashes

07:31    Progesterone

13:57    Surgical Induced Menopause

22:16    Pueraria Mirifica

27:10    Perimenopausal on an Early Age?


Dr. Justin Marchegiani: Hey it’s Dr. Justin Marchegiani here. Hope everyone is having a phenomenal day. I’m outside of my office today. Get a little construction down, so I got my little mobile office setup here goin’. Excited to chat today about hot flashes. Evan, how you doing today?

Evan Brand: Hey man, happy Monday to you. I’m doing pretty well. I got from the chiropractor this morning, they’re working on my neck, so hopefully they’re gonna be a miracle worker. I wish I could come to you but, I’d have to drive kind of far.

Dr. Justin Marchegiani: [Laughs] Totally. I get it, yeah, finger’s crossed. So they– they figured out kind where the issue are— where were the issue as in the spine in there, workin’ on. So that’s really good. Excellent. So why do we chat about hot flashes? So first off, hot flashes tend to happen as the follicles in the ovary, you know, go down, and you goin’ to what– what’s called menopause. So average age of menopause is 48 to 51. And typically, what happens, you only have a set amount of follicles in the ovary that eventually turn into eggs, right? And those, you know, responsible for a significant amount of estradiol that’s produced throughout the month. So we have like the first couple days, so you fir– the start of the cycle is basically kind of be when you have your period. And then you’re gonna have FSH starting to creep up which is your follicle stimulating hormone. So it’s stimulating the follicle to grow. As the follicle grow, it spits out estrogen. And estrogen kind of maxes out in your cycle at around day 12, 13th. Where then progesterone starts to come up because LH is increasing right after FSH increase. So FSH kind of, what’s the follicle, the follicle makes some estradiol. Estradiol that helps the follicle also grow and mature. And then right around day 12, 13, right before ovulation, LH is already going up in the background and progesterone starts to grow up. So you kinda have this like– you bleed, okay, then you have FSH kind of creeping up like this, and then estrogen kind of goes up like this, and then right around day 12 or 13, LH is already creeping up, then progesterone starts to go up. And this is where the– your ovulation starts. Right in this area, right between day 13 or 15 or so. And then right after that, progesterone continues to go– go– go– go. And then at some point, it either drops out if there’s no egg that’s fertilized, right? So sperm comes in feds the egg and fertilizes, that progesterone kind of keeps going and it’s supported by human chorionic gonadotropin, HCG. Or there’s no e– there’s no uhm— you know, the egg isn’t fertilized and then you have a period and then it all starts all over again, so this is important. So as the follicle start to– you have a set amount of follicles, as a follicle start to drop, then you don’t have that estradiol output. And then you start to go into menopause. And estriol now becomes that primary hormone. And this is important because estriol can be made from DHCA. And DHCA is a precursor hormone that comes from– in your adrenal gland. So if you’re really stressed, if you’re in a situation where you’ve been under a lot of stress and your adrenals are on top position, you’ve lot of blood sugar issues, a lot of cortisol– dysregulation, your adrenals are gonna take a lot of the ___[03:02], and the DHCA will start to be depleted over time as your adrenals have dysfunction. And that lower DHCA will decrease that kind of stored capacity to buffer estrogen with estro— estriol. So we have estradiol primarily when you’re cycling. You have estriol more, it starts to become what you rely more on when you’re menopausal. And then you have this other one in there in the background called oestrones. So oestrone– O-N-E– that’s E1, oestrodi–dial, di for 2, that’s E2 for short, and then estriol that are tri for 3. So we have E1, E2, E3. So we got a window in all three of those estrogen. Then E2 is more when you’re cycling, E3 or estriols more when you’re menopausal. And then what happens overtime is that FSH and LH signaling start to go up as the ovary’s– as the follicle starts to deplete. The uhm— LH and FSH start to go up and up, and up, and up, and up, they’re raising the volume. It’s like having an alarm clock where if you don’t hit the sleep button on it, the volume keeps going up, and keeps going up, and keeps going up, so that’s kind of what’s happening. And then if that FSH and LH go up, they can– they can have especially the FSH a– a lot of vasodilating effe— effect. So that’s what happens for a lot of these hot flashes.

Evan Brand: Aaah– Okay, so you’re saying that this– this process is gonna happen no matter what. But you’re saying to what extreme may be determined by the adrenal status?

Dr. Justin Marchegiani: That has a big– big effect, absolutely.

Evan Brand: Okay, so, if a woman is having– let’s say she’s having a good– a good healthy lifestyle, she’s got stabilize blood sugar, she’s going to bed on time, maybe she’s taking some adaptogenic herbs, you’re saying she’s can– she still wanna go on to menopausal and likely have symptoms of that, but you’re saying she may have minimal to no hot flashes versus a woman who has bad blood sugar balance: eating processed carbohydrates and sugars, maybe has synthetic estrogens from her environment, eating lot of plastic–

Dr. Justin Marchegiani: Right.

Evan Brand: —she’s gonna have more issue?

Dr. Justin Marchegiani: Yeah, because we’re gonna have more fluctuations of cortisol to help curb the inflammation, to curb the blood sugar swings, and that’s gonna then put stress on her progesterone, and it’s also gonna put stress on our DHCA. Remember the more stressed the adrenals are, DHCA output can decrease. And then the more stressed our cortisol is, the more cortisol can pull from progesterone. So then we can start to have these kind of estrogen dominant swings where progesterones starts to drop a little bit relative to estrogen and make it start– start to have some of these uh– c– we– get– we get push more into estrogen dominants, we begin start to see more cramping, more bloating, uh– increased bleeding, hemorrhagia, those kind of things. And then of course uhm— if we don’t have enough DHCA from adrenal stress, DHCA is gonna buffer that estriol more as well. And that’s important for some of these issues too. So we gotta get to the root cause, right? You know, what’s the underlying cause of the physiology to move in that direction? Stress, diet, infections, not enough fat and cholesterol. Remember hormones are made from healthy cholesterol and fat. So I’ve seen lots of women, you know, that were a victims of the 80’s and 90’s in this low fat, low cholesterol era. And a lot of them have– are going in the menopause over the last 10 years. And they don’t have just a lot of building blocks even there because of all of their poor dietary stressors.

Evan Brand: What about if they were on a statin medication?

Dr. Justin Marchegiani: Well statin will definitely effect because that’s gonna decrease cholesterol internally. Remember most of your cholesterols made in your body, so we take a lot in, we take some of your– your diet, which has a lot of fat soluble vitamins, but then we’re also make a lot too. So if we take a statin which is an HMG-CoA reductase inhibitor. That stands for hemato— ___[06:46]. And if you block that enzyme you don’t make statins but if you block that enzyme, this– this pathway called the mevalonic acid pathway, and that pathway is also responsible for internal CoQ10 production. And then if you start mugging that pathway then you’re gonna have less CoQ10 to run your mitochondria and generate– and generate ATP which is really important. So then you could start to have more energy issues and you start to have mitochondrial dysfunction. And then it’s common with that to have more pain, to have less energy, cognitive issues, mood issues, chronic muscle soreness, rhabdomyolysis, those kind of things can happen with those kind of stressors.

Evan Brand: So, can we talk about progesterone a bit? I mean you look at like T.S. Wiley in her book “Lights Out”, you look at a lot of people talking about hormones, menopause, progesterone always comes up in conversation. And people say, “Oh, it’s natural, oh, it’s bioidentical”. I mean, is it a– is it destiny for these women to have– to end up on progesterone, or is it just the ___[07:52]?

Dr. Justin Marchegiani: So there’s a couple strategies like number 1, if they’re perimenopausal, meaning they’re like im— you know, they’re late 40’s, early 50’s and they’re starting to transition to menopause, we’ll use progesterone as synthecal augmentation fashion, certain times of the month, to help kind of gently nudge and easier transition in the menopause, that can be really helpful. And we try to use lower levels like– like– you know, if here’s is our physiological level of progesterone, we try to use lower levels and just try to fill in the gaps if you will.

Evan Brand: Okay.

Dr. Justin Marchegiani: So it’s kinda like you got– you got a rough table, we’re just tryna use a little sandpaper just to fill in the gap, smooth everything out, just to nudge– nudge up or nudge down the high’s or lows, uhm— that can be helpful. And then uhm— your question was–

Evan Brand: Is it destiny?

Dr. Justin Marchegiani: Now with the T.S. Wiley method, that’s different because she’s basically trying to get menopausal women to cycle again.

Evan Brand: Aaah–

Dr. Justin Marchegiani: I think you can do that too, I mean, a lot of women that are menopausal, are like, “Wohoo!”, like no more periods, like, they’re– they’re happy about that. So then, we just– we’ll supplement a little bit of progesterone and estrogen throughout the month at a very low level just to curb out some of the hot flashes. We may keep them kind of in the upper physiological end of the range for menopausal. I mean, mid to lower physiological end of the range for a cycling women. And we just kind of give it every day, we’re not cycling. Were T.S. Wiley would probably do like an estrogen in the first half of the cycle, a progesterone in the last half. So that’s like, oh I think she times it up, uh– according to the lunar phase. So typically, full moon equals fertility, so that’s like day 14 or so. So you’d start your progesterone on the full moon, and then you’d stop it on the new moon, and then start your estrogen the following day or so. And for– for 12 days. So that’s kind of how T.S. would do it, she would do like a progesterone for– 2 weeks, lu– lunar cycle unless we– you know, have a calendar on when your normal cycle was, or you could just plug in those dates so that was continuous. So progesterone day 14 to 28, full moon to new moon, wait a day or so, estrogen day 2 to 12, stop, allow a couple of days in there for ovulation and then she would typically– even though there’s no egg, right? We’re just trying to mimic normal physiology, and then throw a little bit of DHCA or testosterone in the background as well. We like to use DHCA over that because [sighs] uhm— just– it’s a building block to more hormones. Does that make sense?

Evan Brand: Even if you’re saying DHCA is a preference over using testosterone? is that what you’re saying?

Dr. Justin Marchegiani: Uhm– yeah, just because it has more– it can go more directions–

Evan Brand: Yes, understood.

Dr. Justin Marchegiani: And again, testosterone can work, a woman has low testosterone, it can really help. Uhm– but my concern is just to fix the underlying issue and try to give more building block precursor hormones. Building block hormones are here and they can to lots of different things, and stage hormones are down here. Now, sometimes that’s good. It can be helpful because it can have a more therapeutic effects and– and we’ll use it with progesterone. We’ll even use a little bit estriol as well from time to time.

Evan Brand: Okay, so– take the conversation in the different direction if you would like, but a question that I have that many others probably have is, how would you compare and contrast something like a progesterone cream? First is some of these herbs that are commonly recommended that we use for menopausal symptoms like progesterone cream versus a vitex or chaste tree versus, say, red clover, or American ginseng, maca, things like that.

Dr. Justin Marchegiani: Yeah, so there are herbs that can help some of the FSH and the LH levels to calm ’em down. They can also help the feedback; they can also improve follicle health as well which can help with internal hormones. They help with the receptor sites, they can have a down regulator, up regulate the receptor sites. So imagine like uhm— uh– a lock sometimes, you have a lock in your house or you may have locks and you try to put the key in and then get a really jiggle it around to get it in the– the keyhole, the receptor sites kind of not quite working properly. Uhm– it’s either mo– more sensitive or more dough, hard to get the key in or too easy or hard to turn, right? So think of some of these herbs, it really helps clean out the receptor sites, make the receptor sites work better. Think of that as, you know, getting a better, you know, key hole for the– for the key to work. And then some we may actually give a little bit of hormone as well to help, that can make a big difference. So we’ll get maybe a little bit of progesterone or estrogen. And we’ll time that up accordingly, that can make a big difference. And like you mentioned some of the progesterone herbs will be like chaste tree or shepherd’s purse. I’m a big fan of the specific types of maca. I have a menopausal formula and a cycling formuformula that I use that have different phenotypes of maca that work well. If you go to and you click on the female hormones category, you can see some of those. But with female hormone issues, you really wanna see a trained functional medicine doctor that can do specific test and to see where you’re at. And that can be tricky. And a lot of times people, especially when they don’t– and a lot of even medical doctors they don’t understand how the gut interplays with the hormones, so they come in there and they’re just giving hormones, or they’re not even looking at the adrenals, or not looking at the gut and they have really poor absorption all these important amino acids and minerals and essential vitamins. And they need these nutrients to actually have good hormonal output on their own. And they’re just– they’re just supplementing that with extra hormones. We really wanna make sure we’re looking at the gut. And the gut is so overlooked when it comes to hormonal issues.

Evan Brand: Absolutely. Well, I’ll add on to that. And we’re looking at the marker on the stool test. That beta glucuronidase marker, we’ll see that people are recirculating toxins and hormones, and so this maybe why they actually could be overdosing on their hormones. If their doctor keeps bumping up and bumping up their hormones, if they have a recirculating problem, that’s not good. The liver plays into this too, you mentioned the gut bugs affecting absorption. We know too, if you’re filtering bugs all the time, all these different toxins, bacteria are creating, isn’t that adding liver stress, which is then creating even– a bigger cascade of hormonal symptoms?

Dr. Justin Marchegiani: A hundred percent. Yup, so we wanna get to the root issue. We got a great question in here from Susan, wrote, “What’s the best supplement to take for surgical induced menopause? I’ve hysterectomy 18 years ago, I’m now 45, uhm— I have breast cancer in all female immediate family members.”  So, couple of things, I wanna know why did you have your hysterectomy? What was the cause of it? What’s there endometriosis? Were there fibroids? Were there ovarian cyst? I wanna know the underlying issue. Okay, that’s number 1. Uhm– number 2, I mean, your family members may have a predisposition, but you’d want to really look at estrogen dominance. I mean, the big thing is, a lot of these estrogen sensitive cancer. Now of you don’t have a cancer, right? That’s– that’s good. You may do really well with some specific herbs and a little bit of progesterone. ‘Cause progesterone’s tend to antagonize estrogen. And even people that have hormone sensitive cancers you’d wanna check with your oncologist and say, “Hey, is my cancer estrogen-sensitive or not?”. And then I would look at potentially using a small palliative level of progesterone. But just confirm with your oncologist first and make sure your cancer’s not progesterone-sensitive. Most are just estrogen-sensitive that’s it’s breast-induced. So you really wanna get some info on that. And I wanna understand the root cause of why you had a hysterectomy, fibroids, uhm— adenomyosis, ovarian cyst, all those types of things. I wanna understand what the root issue ’cause almost all the time, those underlying pathological situations tend to be induced from estrogen dominance. So we can work on the root cause because the root cause is still there. Just a tissue that was being destroyed is being cut out. So the underlying imbalance that cause everything is still there and something else will not happen. That make sense?

Evan Brand: It makes perfect sense. Yeah, my mom, she– I don’t think she had really any issues. I don’t remember, maybe it was like cramping or something but she got a hysterectomy at like 38. For hysterectomy, they took out the uterus as well.

Dr. Justin Marchegiani: Yeah. So Susan ___[15:57], I had endometriosis. So, there’s a couple of strategies, you wanna work with the good functional medicine doctor, you wanna get your hormones looked at, uhm— if you– err– on the fif— if you don’t have cancer, then I would just lean more to progesterone and specific herbal support to help. You gotta get your adrenals looked at. You gotta work with someone that can test you and see where your hormone profile is at. And then it’s up to you, I mean, there may be some preventative m– cancer markers you can look at like the CA 125 androgen for various cancers. And you can kind of look at some of those markers prevented and lets you to see how you’re doing in those areas. That may give you more uhm— let’s just say peace of mind that you’re on the right track. And then of course, uhm— if you have a full hysterectomy, the question is do you still have your ovaries, or was it the partial and your uterus uh– was the only thing removed? So if your ovaries are gone, you really wanna work on supporting the hormones too.

Evan Brand: Okay let me ask you this: if– yeah, let me go a little further with that. So if you have a full hysterectomy, ovaries, uterus, everything’s gone, can you out supplement your way out of this using herbs or you suspecting there’s gotta be some hormone support added in–

Dr. Justin Marchegiani: Yeah. Yeah you’re gonna need some hormone support. The question is, if there’s underlying cancer in the background, we– we gotta be really careful with estrogen potentially, and we can just confirm with the oncologist. A lot of times that can be tested. Typically, progesterone tends to be good, ask the oncologist though. Uh– and then if there’s no cancer issues, that definitely we can use a little bit of estriol and progesterone and we can use some specific herbs to help modulate those receptor sites, and that can make a big difference. Kind of get that key hole to work a little bit smoother so that key can turn better– far better.

Evan Brand: That makes sense. Well ’cause I– I get this question a lot from women. It’s like, “Well am I gonna have to be on this bioidentical progesterone forever, or can I end up taking say maca instead and get off progesterone”.

Dr. Justin Marchegiani: The stronger your adrenals are, yes. But you may have to be on it for a period of time to get stable.

Evan Brand: Okay.

Dr. Justin Marchegiani: And then from there, as the adrenals get stronger, and if you’re managing stress well and you have your sugars under control, and your diet’s really good, nutrient-dense, you have good blood sugar stability, you’re eating and digesting good proteins and fats, your detoxification’s working. Remember, gut dysbiosis can increase in enzyme called beta glucuronidase which can uncleave conjugated estrogens. Meaning, estrogens that are put in the strait jacket, they’re being escorted out of the body. And then this enzyme comes in and unzips that straight jacket and allows that estrogen to go back into circulation. So a lot of women and doctors don’t understand that gut dysbiosis can affect your body’s ability to get hormones removed. And that can be another driving factor of estrogen dominance which is gut issues. Or dysbiosis or sibo.

Evan Brand: Yeah, and–  yeah– and– and this all could’ve started because a woman had say, urinary tract infection and got pumped full of antibiotics, we killed off all the good bacteria in the gut, candida moved into the neighborhood, maybe some dysbiotic flora moved in like we see a lot of clusterity infection, and then you– maybe go to a gastro doc, maybe they pumped you full of more– more antibiotics because they’re trying to kill h-pylori, or maybe they’re trying to kill sedef, and then you get even more dysbiosis. So if you’ve been through the ringer with your gut, if you’re having constipation, diarrhea, stomach cramps, if you’ve got skin rashes, that could be a manifestation from your gut. If you’ve got dark circles under the eyes, that could be a symptoms going in the gut. So this is why it’s so foundational. It’s amazing to me that even though, you know, I am not a hormone expert like you, but I’ve still been able to resolve hormone issues just by resolving gut issues. And it’s really fun to see how the body systems connect like that.

Dr. Justin Marchegiani: Absolutely. Someone writes in uh– about antimicrobials for dogs. I’ll answer this one question. Uhm– you can do diatomaceous earth is really good. But you can also do mimosa pudica that works really good as well. And you can also do some garlic too, be careful if it can caught— it– sometimes it can cause an anemia, more in cat’s though. But I definitely recommend getting some good probiotics in powder for afterwards. So mimosa pudica, you can do DE, diatomaceous earth, those can be really helpful, you know, ways to address that with animals.

Evan Brand: Well did you know, uh– the formula that you’ve recommend that I take several years ago, AP-Mag, remember that one?

Dr. Justin Marchegiani: They have a better veterinary formula too, yes.

Evan Brand: The one for pets–

Dr. Justin Marchegiani: Yes.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Hard to get down, I mean, it just depends. Some animals– some pet owners have dogs or cats typically dogs that will eat anything.

Evan Brand: Yeah [laughs].

Dr. Justin Marchegiani: Oh, my dog, I could not get the Ap-Mag down–

Evan Brand: Ooh.

Dr. Justin Marchegiani: Like it’s just impossible. But uhm— I can get powdered probiotics in her, I can give like mix a little bit of cod liver oil in her food. My pets, I have a powdered multi though, I mix them with their food with a little bit of probiotics every now and then and they’ll do okay with it. Uhm– so yeah, just depends on how f– how fastidious or difficult the animal is. Some dogs when you just put peanut butter on anything, I mean, there could be anything and they’ll just eat it. So you just gotta do your best with that.

Evan Brand: Yeah, pets can be a vector for infection. So if you all have pet, so we’re not saying that that is the cause, but I mean, we know lot of pets like random, you know, adventures I’ve taken with my dog out, you know, she’ll go start drinking out of a random pond in the woods and that could have giardia in it and then if I’m playing with her slobbery toy and then I pick my nose, I mean I could’ve passed bugs to myself from the dog.

Dr. Justin Marchegiani: Yeah. And you can probably dilute some ___[21:09] silver in– in water with them. I would just kind– kind of dose it up according to weight. But I think anywhere between you know, a teaspoon or so for 25 pounds I think would be fine. But you can dose it out.

Evan Brand:test that with people like how common that the dog is the vector for people when you see their infection?

Dr. Justin Marchegiani: I always ask like do you do a lot of kissy face with your dog, I mean, like I kiss my dog a lot but right on top of the head. So– ’cause– ’cause that feeling [laughs]. I do the math and like, where is it– where does her– where can her tongue not reach? And I’m like, okay right on top of her head. So I’ll kiss her like right on top of the head, and that tends to be uh– a pretty safe place to kiss her, but everywhere outside, I try to stay clear and uhm— we’ll do, yeah, so she gets baited once a week with some good stuff and then we’ll throw some DE in or some probiotics in. I’ve a good multi– whole food multi powder with– there’s a whole bunch of like ground up glandulars uhm— in there– we’ll throw that in her food and that works pretty good.

Evan Brand: Cool.

Dr. Justin Marchegiani: Excellent. Uhm– any other things you wanted to address here Evan regarding female hormones, regarding menopausal issues, hot flashes, anything else?

Evan Brand: So there was an herb, and this is just like an off the cup thing that I have read about and recommended to couple females that have had great results with it. And I don’t– I don’t know if you’ve heard of it but it’s called a– a pri— can’t even pronounce it correctly, it’s called pueraria, it’s spelled P-U-E-R-A-R-I-A, and then mirifmirifica, pueraria mirifica. There’s a brand who carries it called nature’s answer. And I gave this to a female client and she had tried everything for– 15, 20 years, including bioidentical progesterones, etc., and this supplement, within 6 weeks, knocked down her hot flashes 98%. Did you find it?

Dr. Justin Marchegiani: Uhm– I’m not familiar with that herb, I mean, there’s a lot of herbs that are out there especially some of the more oriental ones that are like, you know, they’re just more, they’re not like in the mainstream functional medicine world that can have a lot of estrogen me– me— uh– metabolizing, or– estrogen receptor site modulation effects.

Evan Brand: I believe that’s what it’s doing. Some women have said their breast have grown, which is pretty weird ’cause that makes it sound like it’s an estrogenic type formula. So–

Dr. Justin Marchegiani: Yeah, may– it may just have– I mean, you know, it just depends. Are these menopausal women?

Evan Brand: Yeah, these are menopausal.

Dr. Justin Marchegiani: I mean, you know, there’s a lot of of receptor sites for estrogen in their– in the breast tissue and as women go in the menopause, the breast can just get flatter. And– and that may help kind of uh– bring some life back into the breast tissue because estrogens’s important for like collagen integrity, right? And then also can attract some fluids, so that may bring the breast integrity back. But like with menopausal women, you know. sometimes we’lls use chaste tree or motherwort. A lot of times, things like black cohosh, ___[23:56], and some of the, you know, the specific maca blends, with PMS we’ll use a higher dose typically a chaste tree. And then a lot of times uh– like ginger or red root can be great because those really help with uhm— the lymph. So if you have like a lot of fluid retention from the hormones, that can really help kind of drain the fluid. And then sometimes we’ll do like the uhm— the dong quai can be really helpful, the motherwort can be really helpful, those can work really well, modulating what’s going on. And then of course, you know, we wanna work on the adrenals. The adrenals become a significant reserve site for a lot of the hormones. We wanna make sure the adrenals are working very well.

Evan Brand: What did you say for the– the lymphatic water retention? ___[24:37].

Dr. Justin Marchegiani: Yeah, red roots’ really good. Uhm– and then ginger is really good for that too so if like you’re a patient of mine listening, you can do the ginger tea’s really good. You can always get some red root, I think they sell some red root tea–

Evan Brand: Yeah.

Dr. Justin Marchegiani: And you can get that, that’s really good. You can also do I think just juice celery, can also, I think Anthony Williams talks about that, the medical medium guy. But like ju— celery juice can be really helpful with lot of minerals in it and that can be helpful for kinda fluid retention as well.

Evan Brand: Cool. Excellent. I didn’t have the questions pulled up. So that I know if there’s anything else you wanted to– to read off?

Dr. Justin Marchegiani: I think we hit all the major stuff. I’ve got a lot of questions coming in here. Some are off topic so—

Evan Brand: Okay.

Dr. Justin Marchegiani: The best– the best time for off-topic questions guys is when I’m doing a live FAQ. Anything uhm— that’s like pertained to the topic, I try to put it in the– the show knows at the top. Uhm– like hey, this topic is menopause, this topic is– whatever. And then just try to keep your question pertinent to that, that way we can answer it so it stays on top– on topic. But I’m gonna be trying to do more FAQ’s. Just give us that thumbs up guys give us uh– give us the share, make sure you subscribe. A lot of people listening are like, you know, they listen to the recording and like, “Well how do I get notifications?”. Subscribe but also hit the bell, the bell’s really important. Make sure your YouTube application on your phone, like make sure it pops up or gives you a little noise. So if you’re not sure, if I’m not sure, what I’m gonna do at some of my schedule’s super busy, so if I have a– half hour between patients, I’ll jump on and do one of these chats. That way you get notified. And I’m trying to put these notifications up sooner so then you can kind of put your questions in there the night before. And that way it can kind of queue up over the next night.

Evan Brand: Cool.

Dr. Justin Marchegiani: So I hope that helps you all. Anything else you wanted to let me know about?

Evan Brand: If people wanna reach out, they can uh– get a hold of Justin at his site. It’s justinhealth— so, and you could schedule consults. Uh– him and I both, we work with clients around the world. So, you know, we’ve got clients in places you would not believe. And so, we can send these lab testing kits that we’re talking about through the mail. So especially for the dutch test that Justin often runs on female patients, that is done using urine. And you could ship that through the mail. And it’s not too bad, so feel free to reach out at And if you’d like to check out my site, you can do so–, either way, we don’t care, as long as you all get help. So if you can find somebody on your own that knows what they’re talking about, and you wanna be seeing locally, great. If you want us to help you, that’s what we’re here for. We love our jobs, we’re super grateful for the opportunity to help you all.

Dr. Justin Marchegiani: Absolutely. Let me answer to ___[27:12] question here. This is good. He wrote, “My girlfriend is only 26 years old and she has hot flashes. Do you know if uhm— the supplements you spoke of will work for someone like that?”. So number 1, that’s significant and it’s really sad I’m seeing more younger women, just their hormones are decimated, like– this girl is 26, seems like she’s already starting to go into almost like an early perimenopause uh– kind of thing, and this is sad because the hormones– hormones should not be this out of flux, out of balance this early in someone’s life. So I would ___[27:43], I would not be just jumping on herbs right now, I would get your girlfriend tested, with some of these comprehensive functional  medicine test. See a good functional medicine doctor. And uhm— get that looked at. I mean, of course, like the diet can be done right away, that’s foundational stuff. ‘Cause a lot of people, their diet are just do bad they don’t have the good hormonal building blocks, but we need to get tested to see how out of balance or not your girlfriend’s at. We really wanna work on supporting them with herbs and maybe even some bio-organicals to kind of jump start the hormones if you will.

Evan Brand: Yeah, I– I mean there could be adrenal issues there—

Dr. Justin Marchegiani: Yes.

Evan Brand: –could be thyroid, could be gut, could be all of it.

Dr. Justin Marchegiani: Yeah it’s really sad, I see lots of women hormone levels on these test, and they’re just decimated. And I think it’s just the combination of the foods getting worse, I think uh– oral contraceptives are thrown around too much–

Evan Brand: Yeah.

Dr. Justin Marchegiani: That can really have some negative effects, I mean, you can google post-birth control syndrome, and that can have some negative consequences. I think  a lot of women are also thrown on antidepressants, ’cause a lot of their– their mood related issues, from the hormone imbalances, and then you can get uhm— tardive dyskinesia which are other issues that happen from long term anti depression, used to– so becomes really– it’s really tough for women out there because their cycles can cause so many symptoms that other drugs like antidepressants typically get used, and birth control pills typically get used, which then have more side effects, which then creates more problems. And then if you’re on this medication for 10, 20 years, it really can screw up your biochemistry and your physiology, and it can– you know, it can make you not the person you are. You’re more moody, you’re more irritable, your patience is less, uhm— you just don’t get the same satisfaction out of dealing with life that you normally would if your hormones were more balanced and your biochemistry is more balanced. So, we wanna get to the root cause, and– I always recommend try to use more, like you know, a paragard for birth control pill like a copper iud, uhm— or a diaphragm, or just something a little bit more natural in origin, if you can. Uhm– on the profile active hide and see side, that way your hormones aren’t getting mug this much.

Evan Brand: Yeah, well said, I was gonna ask what do you think happened to this girl if it was like a birth control thing, ’cause that was my first ___[29:52]. When I heard 26, I mean, man that’s young.

Dr. Justin Marchegiani: Birth controls, I mean, just having really-really poor adrenal function.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Yeah. That’s common, so–

Evan Brand: Could’ve been trauma, right? Could’ve been trauma is part of this too–

Dr. Justin Marchegiani: That’s gonna put stress on the adrenals–

Evan Brand: Yeah.

Dr. Justin Marchegiani: Of course. You know, that’s gonna be big especially– you know, any sexual abuse trauma, you wanna get that neutralized to EMDR, NLP, EFT kind of techniques. Uhm– techniques that work on the subconscious, uh– a lot of people have done talk therapy, but you know, that just only addresses the conscious mind which is still good to do. But you wanna make sure the unconscious mind is addressed. I mean this is why someone that comes back for more, they’re here, you know, a shackle off, and they drop to the ground, right? ‘Cause that subconscious mind is so prime, you really got to release the trauma in the subconscious. So these things don’t happen because they’re just like– you know, they’re just like uhm— you got a lot of programs going on in the background of your phone, and you’re like, well your phone’s dead half ___[30:48]. What’s going on, right? It’s kinda like that. People have that kind of, you know, issue with their subconscious sucking from their hormones. We wanna make sure that’s resolved.

Evan Brand: Great analogy–

Dr. Justin Marchegiani: ‘Kay? Excellent. Oh, it’s To– ___[31:03] write in, “She’s extremely athletic and fit so of course, my biggest thing is excessive exercise–

Evan Brand: Yeah.

Dr. Justin Marchegiani: —can be a driving factor hormone issues. Uhm– not eating enough calories, and or not getting enough high quality fats or proteins. Like I said, the diet’s really important too.

Evan Brand: Yeah we work with a lot of women and their periods have stopped due to their excess training. You know, we’ve had a lot of crossed fit burn out victims–

Dr. Justin Marchegiani: Yes.

Evan Brand: —where the period stops. So, I mean, man, I– I’m glad you’ve got further intel. ‘Cause that would– that would be a totally plausible mechanism.

Dr. Justin Marchegiani: Yeah. I mean it– as a woman, you can be fit as heck, but if your cycle stopped because of your exercise, your mother nature is telling you that your body is stressed to the point where it is not comfortable bringing life into this world. And that’s always the big indicator like how healthy you are, typically, you know, during cycling years, is gonna be indexed upon fertility. Uhm– and it’s hard too because lot of women are healthy but they just get exposed to things in the environment that can have an implication like toxins or pesticides. So it’s not just all what you do, sometimes the environment can have implications there too.

Evan Brand: Yup, well said.

Dr. Justin Marchegiani: Cool. Well today was a great show. Appreciate you guys feedback and thumbs up. And uhm— give us the share, give us the subscribe, hit– hit the bell for notifications. And we look forward to chatting with you very soon.

Evan Brand: Take care. Bye, bye.

Dr. Justin Marchegiani: Evan, take care. Bye.


“Lights Out” by TS Wiley

What Causes PMS? Premenstrual Syndrome Holistic Approach

What Causes PMS

By Dr. Justin Marchegiani

Let’s go into a discussion about PMS or Premenstrual Syndrome – the symptoms and hormones involved and why it occurs in some women. Watch the video and see the overview of what’s really happening in a woman’s body to gain an understanding of this issue.


Symptoms of PMS

A lot of women are probably very familiar with it. Whether it be causing headaches, cramping, abnormal blood flow, breast tenderness. You name it, I’ve seen it.

Overview of the cycle

The average female cycle is 28 days. And 14 days is the halfway point. And what you see in the first half of the cycle, you’re going to see a lot of estrogen in that first half of the cycle, from there, it’s going to drop, and come back a little bit in the second half.

The first half, this is the estrogen-based part of it and your second half of the cycle, will be progesterone. What you’re going to see is nice, low-dose of progesterone in the beginning, and its’ going to come right up, and then nice crash at the bottom here. And you’re going to see the second half of your cycle, predominated with progesterone. Estrogen is going to really happen in the first half. Why is that? Well, what estrogen is doing is use your uterine lining like cells, thickening that uterine lining up nicely.

And then what happens in the second half of the cycle with that nice, thick uterine lining, you get the egg right there.

So important now is this middle area right here, this is where ovulation occurs. It’s kind of the intermediary between the estrogen and the progesterone and that’s where ovulation occurs.

So I think it’s really important to actually know what’s going on in your cycle.

Want to learn more about your ovulation cycle and PMS? CLICK HERE 


Causes of PMS

When the progesterone drops in that second half, this is where menstruation occurs. This is where you actually have your period. What we find is majority of women that have PMS symptoms- the breast tenderness, the cramping, the whole nine yards- their progesterone is actually much lower. So imagine this line, it’s much lower.

So we have low amounts of progesterone in the second half of the cyle. And that can trigger a lot of the symptoms we’re referring to.

So you’re probably thinking, what’s causing this low progesterone?  Well, the question is, where is the progesterone going? Well progesterone is actually getting converted into a hormone, called cortisol.

Cortisol is essentially a glucocorticosteroid. Alright. So, gluco – glucose. Alright. To watch sugar stability is one of the main role of cortisol. Steroid – inflammation, pain.

So one of the most common things that drive low progesterone in the second half of the cycle is blood sugar issues. You’re not getting enough high-quality fat and protein. It’s very important – Inflammation, Pain. This could be chronic back pain, knee pain, neck pain. This could be from too much or too little exercise. This could also be from food allergens. This could also be from infections. There’s really no magic pill for it. PMS, there’s no magic pill for it coz it can be a combination of these issues.



So what we do here is, we actually address the adrenal glands. The adrenals are really responsible for producing cortisol, as well as progesterone.

If we can address adrenal glands, we’re going to have a huge impact and balance in this last half of the cycle here. We’ll also have a huge impact for the rest of the lifestyle concern, which is blood sugar, exercise lifestyle, diet and things like that.

We also use some specific herbal blends and even adrenal support to actually help balance this last half of the cycle up.


If you have any more questions, please shoot me an email or schedule the consultation and we can go a little bit deeper with your concerns.

Schedule a consult and get more information regarding PMS by CLICKING HERE

Natural menopause solutions – Podcast #123

Dr. Justin Marchegiani and Evan Brand engage in a discussion about menopause. Join them as they share their expertise on women dealing with menopause, including the associated symptoms, hormones, and health factors creating an impact to this period.

Menopause is a naturally occurring transition in a woman’s life. It is a period wherein women undergo a lot of changes in their bodies. This talk will give you important information about these changes caused by hormones, including hormone function and drug interaction. Find out about the effects of infection, as well as other health related issues involving the adrenals, blood sugar and stress making menopause a more challenging experience than it already is. Learn about the natural ways and solutions to keep your health in check during the menopausal period.

In this episode, we cover:

6:26   Menopause: definition and symptoms

9:17   Adrenal gland and hormones

13:40   Conventional Solutions

17:08   Testing hormone preparations

19:31   Bioidentical hormones & herbs

29:20   Dietary recommendations










Dr. Justin Marchegiani: Hey, there! It’s Dr. Justin Marchegiani, alright. I’m hooked on this Youtube live thing. We’re doing our podcast today, Evan and myself. So we are- So we talked about doing menopause uh, today. That was a topic I was listening and learning and reading a lot about it yesterday. I’m honestly dealing with menopause patient for the last decade but always brushing up on my info. Evan what’s going on, man? How you doing?
Evan Brand: Hey, I’m doing awesome. This is fun. Isn’t it great today?

Dr. Justin Marchegiani: It is. I love it. Very cool. So how’s your morning goin’?

Evan Brand: It’s pretty good. I still think that the, the best car for me is gonna be the Tesla because it is the HEPA air purifier in it.

Dr. Justin Marchegiani: Oh, nice. You in the market for a new car?

Evan Brand: Well the Honda Accord, I mean I love it, trust me but, taking in all those diesel fumes like I was telling you about even with the re __ on, I went over to the dealership and they were like, “Sir, you’re never gonna be able to block all of the fumes outside.” I said, “I will if I could have a HEPA filter.”

Dr. Justin Marchegiani: Totally, man.

Evan Brand: I think those Tesla’s are like biologically, like they put biological warfare down or something they will still be safe.

Dr. Justin Marchegiani: Yup, yup. Crazy. Oh, we’re live today. And we’re gonna be chatting aboutmenopause which is an exciting topic for me. I love my menopausal female patients because they’re really motivated. Number one, uh they need a lot of help. Number two, in the conventional medical options for them is pretty poor. So, yeah.

Evan Brand: I’m excited to be able to help. Yeah. Totally.

Dr. Justin Marchegiani: And we got a live chat going in the background which is exciting. So people wanna ask some questions. We may interject here and go live to some of their questions. That’s really exciting, too.

Evan Brand: Where shall we start?You wanna go over symptoms? Talk about- what, I mean most women if they’re dealing with menopause, they’re gonna know about the symptoms but people listening you know- Hey, Butter. Sometimes-

Dr. Justin Marchegiani: She’s Independence. She’s my biggest fan.

Evan Brand: Awesome.

Dr. Justin Marchegiani: Actually, my wife’s my biggest fan. She’s probably second.

Evan Brand: Sometimes you know- whatwe’ll find is with women you know- if they get their ovaries removed, they’re basically gonna skip perimenopause or just gonna go straight to full-blown menopause. Which is what’s happened, for example with my mom, getting the full hysterectomy, for example. You know at 40 something years old, she had already been put into full-blown menopause, basically. And so, she was experiencing a lot more symptoms a lot more rapidly. And say a woman who’s naturally gonna transition.

Dr. Justin Marchegiani: Totally. I have to say, Evan. Honestly, I’m mesmerized by that chest hair that’s coming out, man. I’m sorry.

Evan Brand: I know.

Dr. Justin Marchegiani: I was just like “Whoa! okay.”

Evan Brand: Can you believe that?

Dr. Justin Marchegiani: I know.

Evan Brand: I just actually, I just, I just show my wife last night and said,“Babe, this thing is growing north right now.”

Dr. Justin Marchegiani: Absolutely. Well on hormones, you know- hair,or hair growth will be a big connection with that. So we can chat about that today. Very cool.

Evan Brand: First thing, I need to button up this extra button here, so I’ll do it.

Dr. Justin Marchegiani: I don’t know, man. It’s gonna be really hard for me to pay attention during –

Evan Brand: Alright, alright. Let me button this up then. I apologize for my manliness.

Dr. Justin Marchegiani: No. You’re good, man. You’re good.

Evan Brand: Alright. Go over symptoms. What should we- I mean hot flashes are gonna be very common. Of course, everyone’sgonna know about hot flashes. They’re probably bored of hearing about that. But something that we see a lot, too is depression and mood swings. Something that could definitely be fixed if we take a look at the adrenal glands. And I guess were to hit on that adrenal connection, too. Because the backup generators, which are the adrenals, which should hopefully be kicking in and supporting women. A lot of times they had adrenal fatigue already. So when the ovaries and hormones go down, the adrenals are already tanked. So you’re not gonna have that backup generator that’s gonna help you out.

Dr. Justin Marchegiani: Exactly. I’d say the big is, let’s define menopausal a bit more. So menopause is that time where typically the ovarian function, the ovarian output of hormones is-is running low. It starts to get depleted. And that’s typically because the follicles that a woman is born with, they start to run out. So a woman typically has you know, hundreds of thousands of follicles at birth. And then eventually, only maybe 400 or so are viable. So you fertility for a woman typically, let’s say on average, is gonna be from maybe 13 to 15, depending on when they have their period at first all the way up to the early to mid 40s. Some even late 40s uhm, today as well. So that’s kinda like your- your viable uhm, window for fertility. So when those eggs start to run out, and what starts to happen is your ovarian function starts to diminish. And then that typically, it’s about, consider it about a one year time frame until you actually get in to uh-menopause. That’s the perimenopausal timeframe. It’s about one year until you- One year without a period is what you consider to be menopause. And obviously if you get a, your ovaries removed, like hysterectomy wise, obviously that’s instantaneous menopause, right. Coz you’re missing the hormone output. For most women it’s about 12 months about a cycle. And that’s when you technically hit menopause. And then menopause typically can last until you’re instantly postmenopausal. Can typically last about 10 years. So that can kinda scare some women. And if you get your universal move, like a partial hysterectomy- you keep your ovaries but you get your uterus removed- women typically will go through menopause about four years faster. So the uterus does have some hormonal interplay. So again, because you- let’s say have a partial hysterectomy and still have your ovaries, you still will go through menopause. And it’s important that you get that support. And a lot of women they get their uterus removed. It’s typically because, maybe endometriosis or severe fibroids, or some kind of excessive hemorrhage, or bleeding. They cause them to get removed in the first place.

Evan Brand: Well even I’ve heard of some women saying just because they don’t wanna have a period anymore and doctor will still do the surgery.

Dr. Justin Marchegiani: Yeah. That’s not a good move because your uterus does have some effect on hormonal output. Again the research and people don’t quite have their head around it, that you have, around hundred percent. But there’s still a reason why that is there. So the first aspect is you know, the definition, one year without a period. That’s number one. Number two we have that perimenopausal timeframe, which is about 12 months. And then once you’re in menopause, about 10 years until your technically postmenopausal. Now all the symptoms that we talked about earlier, what are they? There gonna be hot flashes, of course, right.There gonna be mood issues, lack of femininity, right. Feeling less like a female, less like woman, uhm called the sagging breasts. Uhm, I would say a little loss of elasticity in skin. As your estrogen drops, that can shrink breast tissue. It can also stimulate or decrease the stimulation of collagen. So the skin starts getting- losing that quality, and that elasticity, and that nice healthy useful tone, hair loss, mood issues, brain fog, osteoporosis, obviously vaginaldrynesss, depression. So these are all symptoms of the ovaries losing their ability to function. And then what starts to happen is your adrenal glands really have to pinch-hit and come to the table.

Evan Brand: Yup. So if you got infections or your adrenals are tanked, when the- if we use the pinch-hit term, they’re not gonna be able to doit very well because you’ve got these other problems. Or the diet is not good, you’ve got blood sugar swings. So without healthy blood sugar, it’s gonna be tough to have healthy adrenal function.

Dr. Justin Marchegiani: Exactly.

Evan Brand: You know the thing that’s interesting is a lot of women get talked to about menopause like it’s a disease. But it’s not really a disease. It just seems that the modern world in terms of either too much or too little exercise, and a diet that’s not rich in good fats and good proteins, those are the modern things that we’re up against. So menopause is becoming more prevalent. And then also, it’s gonna be more severe, too. Because our ancestors they’ve dealt with menopause. You know, this is a natural transition, but now we’ve- were up against these new things that the modern world present. So therefore, we have to play the cards a little bit smarter, make sure we’ve got the nutrition down, make sure we’ve got the exercise portion down, and then we always get to the underlying issues that could still be affecting things or making things more intense. Like say, an infection which you and I find hundreds and hundreds a year. And menopausal women, a lot of times there is adrenal issues calls from infections.

Dr. Justin Marchegiani: Absolutely.And to- I wanna add, we’re actually doing this podcast live. So anyone watching live right now, feel free and write in a question or two. And we’ll be able to see if we can intermingle the questioning with the podcast. Sothis is gonna be this kinda new little set up here. If people are likin’ this, we may do more of it. So we’re pretty excited about it. I did a couple YouTube lives this morning and people want a couple questions answered. But still do it as long as we can get a turn into the topic.

Evan Brand: Yup. So-

Dr. Justin Marchegiani: I got a little Kombucha right now. I’m getting my ginger Kombucha in here.Nice.Love it, love it. Nice.

Evan Brand: I’m drinking uh, Vitamin C actually right now. Vitamin C tonic out ofout of little mug that says having tea with a friend brightens any day.

Dr. Justin Marchegiani: Here, here. Touche on that one. Excellent. So we talked about hot flashes a little bit. Can you talk about- Can you go into like, the adrenaland why the adrenals are so important for women that are getting ready to go into menopause?

Evan Brand: Yeah. Absolutely. Well so, if we look at the top of the food chain of hormones, if you type in steroid hormone pathway chart online, you can see where cholesterol, which is going to come from diet. Also of course the liver and all of that. But you got cholesterol at the top of the food chain here. Then downstream we’ve got progesterone. You’ve got pregnenolone. You’ve got your estrogen, your estriol, your estradiols, your testosterone, your DHEA’s. You’ve got your aldosterone. You’ve got cortisol. You got all these hormones that are depending on a pretty good balance. But as we pry talked about before, what happens is the pregnenolone steal, some people debate that. Some people say that it’s not true. But just based on what we have done, and what we do, to me it makes perfect sense of the pregnenolone steal is perfectly real. Which is the process where men and/or women that are under significant stress, the body is going to prioritize cortisol production over the production of these other hormones like your estrogens. And so when menopause is occurring, and the levels of estrogen and progesterone are dropping, now you’re just dependent on the adrenals and this cortisol, this whole adrenal cortisol- and I guess we’ll call it backup generator- to do the work that was being done by two generators before. Now you’ve got one generator doing the same amount of work. Now, if you’ve already been in sympathetic fight or flight mode, for significant amount of time, you’re gonna have trouble. So when we pull your adrenal cortisol results, we’re gonna see that you’ve likely got low free cortisol. Which means since you’re not outputting the amount that you should be. So the analogy I use is the smartphone. So a lot of women where looking at, they could be, we would like to seem around 28 or 30 units of free cortisol. I’ll make a bio health test, for example. But a lot of women are showing up anywhere say 10 to 15 units of cortisol. So that’s like you starting your day with your smart phone battery charged at 50%.

Dr. Justin Marchegiani:  Yeah

Evan Brand: And you’re trying to get through the whole day. It’s gonna be tough. And so this is why having healthy adrenals and having a good adrenal protocol in place, for me is essential not only for men and women that are you know, younger. But older women especially are going to benefit from some of the adaptogens and strategies that we can chat about.

Dr. Justin Marchegiani: 100%. Now, looking at the adrenals, I always thought patients are like a backup generator, right. They’re gonna produce a significant amount of DHEA which can go down the hormonal cascade and can become testosterone andro and primarily at a female, we’re gonna go down more of the estrogen pathway. So if you look at testosterone andro it can also float downstream into either estrone, or estradiol estrone, and estradiol.And then from there it can get converted in the liver to estriol. Estriol is gonna be about 80% of all the estrogens in your body will be estriol. During reproductive age, estradiol will predominate as your main estrogen. And then when you go into menopause, estrone will be what predominates when you’re menopausal. So let’s break that down. We have E1, E2, E3-really simple. The names have a good giveaway. Estrone has O-N-E in it. So that’s E1. Estradiol, D-I, right. like 2 dice, E2.And then estriol, T-R-I, that’s gonna be E3. So you’ve E1, E2, E3. E1, estronethat predominate when you’re menopause. E2, during reproductive age. E3 will be what’s there the majority of the time. Uhm- but it’s weaker, and it will significantly predominate when you’re pregnant. So what happens is when you’re going to menopause, E2 starts to decrease, and we start to get more dependent upon the E1. The problem is E2 and E1 are stronger estrogens and could be proliferative. Meaning, they can increase risk of cancer and other health issues. So, if we are gonna support a female with some bioidentical hormone preparation- Bioidentical meaning the hormone molecule matches what’s in your body, typically plant-based.We’ll do it with estriol, E3. And we’ll even typically combine a tiny bit of progesterone in there to support the female hormones.

Evan Brand: Should we talk about the conventional solutions,like hormone replacement therapy? Like the one that comes to mind here about a lot as Premarin?

Dr. Justin Marchegiani: Yeah. But yeah- yet but you Prempro or Premarin Provera?

Evan Brand: Yeah. I mean- That’s- that’s it. That’s linked with increased risk of heart disease now.

Dr. Justin Marchegiani: Yeah, in cancer- I mean the women’s health initiative study uhm- found that about 10-15 years ago. So it’s- it hasn’t been prescribed as much for hot flashes and menopausal symptoms. But it’s still is being prescribed. Their more natural, kinda anti-aging doctors are out there, typicallymedical-based. They’re prescribing hormones. The problem with it is they prescribe like it’s candy. They prescribe it like it’s a vitamin or nutrient. And hormones are really, really powerful, right. Hormones are measured in like nanograms, which is like one speck of salt in like a swimming pool, right. So it’s like very- you know- very, very sensitive. You know, amounts of these things. So looking at hormones, we wanna make sure we don’t give it like a supplement. We wanna make sure we actually test. So, we’re not guessing when we prescribe it. It’s specific to what the patient needs. Number two- number two, is we actually have to make sure the diet and lifestyle is dialed in coz that’s a really, really important starting point. And I would say even more important, most medical doctors or bioidentical doctors totally ignore the adrenal portion of that. So the adrenal is just totally not even on site. And we know how important the adrenals are for that backup generating of the sex hormones, especially when you on menopause. So imagine that backup generator, if it’s on empty, or the smartphone analogies on low, that means symptoms. So you gotta turn the generator when the storm comes in, it’s not on full. Guess what? Your power is not gonna work. There’s gonna be a lot of things in your house aren’t gonna work, like you have full power. And what that equates to a menopausal female, is symptoms. Mood issues, skin issue, hot flashes, of course, vaginal dryness, low libido, right. So those are the things we gotta be very mindful of, when we’re dealing with menopausal females.

Evan Brand: Let’s talk about what the options are. I mean even if you do go bioidentical, a lot of times you’re going to get hormone creams. But the more, more that we develop hormone creams, I’m finding that- that can disrupt other hormones, and it’s gonna be tough to measure, it’s gonna to be tough to get the right dose. And so now, I’ve been reading a lot about sublingual drops- for bioidentical hormones. Supposedly, that’s the best because you can determine exactly what dose you’re taking. For me that goes out of my- you know, that goes out of my pay grade coz I’m not a prescribing medical doctor. But it’s at least good to know that there are options out there for women because if they are going to go talk to their endocrinologist, or you know- some type of MD that’s more integrated. Hopefully they can know that, you definitely don’t want to go oral, you definitely don’t want to go with the cream. But if you can go sublingual drops, with the bioidenticals. However, in a lot of cases, if we are getting the diet dialed in, orgetting like some omega-3, fatty acid supplements in, we’re removing synthetic estrogens, the plastics, and all the other exposures, the phthalates, and all the other endocrine disruptors, and health and skincare products, and then we’re addressing underlying issues, I’ve had great success with many women- women. I know you have, too. In- we’re not- we’re not saying,“hey, go get this drug”, “go get the struggle get this prescription”

Dr. Justin Marchegiani:  Exactly. So when it comes to hormone preparations, number one, how do you test it?Most medical doctors they’re gonna primarily use a serum bound test, a serum blood test to look at hormonal levels. Now the problem is, serum represents a 100% of all the hormones that are in your blood, right. The problem is only about 2% maybe 2 to 5% hormone’s a free fraction. So the problem is because a small- for such a small small percent of the hormones that are free, it’s such a small percent out of the hundred percent. It’s really hard to measure it because you don’t have a small enough gauge to sense it.

Evan Brand: That make sense.

Dr. Justin Marchegiani: So it’s like using a thermometerthat only tells youyou’re either 97- 98- 99.Doesn’t tell you the in between temperatures. So your 97-9, it may say you’re still 97, right. So imagine that’s kinda like the blood testing. So we use a free fraction test that will break it up and look at the free fraction of the hormone. Whetherwe’re using bio house salivary cortisol, or salivary progesterone or estrogen test. That’ll look at the free fraction. Or we use the Dutch testing, that will also look at the free fraction. Excuse me.The Kombucha gets uh- gets me a little bit burpy.

Evan Brand:Ha ha

Dr. Justin Marchegiani: I apologize for that. Uhm- so looking at that, we will wanna do tests that look at the free fraction. Number one- so salivary test or like a really good Dutch test by Precision Analytics is great. Because we get a more fine two-metric of where those free fraction of the hormones are at. Again, there are some blood tests that can- I think you can look at estradiol-free. I don’t think you can look at progesterone-free or cortisol-free on a blood test, yet. You can look at serum cortisol, you- you can look at estradiol-free, you can look at testosterone-free. I do not think you can look at progesterone-free. So again, we wanna be able to look at the free fraction coz that’s what bioavailable and combined into a receptor site.

Evan Brand: Yeah, I wanted to mention the- Dr. Jonathan Wright, which- I believe it’s the same- it’s the same guy who wrote the book on stomach acid, which is I know one your favorites on my favorite books.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  That he’s got some good info with Mercola about administering bioidentical hormones. And are talking about the version that they call tri S, which is supposedly 80%, estriol, 10% of each estrone and estradiol. So it sounds like- for even you know people like my mom, any woman that’s had you know- a full hysterectomy, it sounds like this is gonna be pretty foundational to- to overall health. It sounds like you can’t really out supplement your way if you have had you know- a full hysterectomy like this. What’s your take?

Dr. Justin Marchegiani: Right. Remember what I said? I said 80% estriol, right. So think about it, right. With a tri S, what is it? 80-10-10. 80% E2- I’m sorry-E3, estriol that’s the tri S. So 80% estriol, E3. 10% estradiol and 10% estrone. And that’s good if you can get it compounded that way. That’s fine. Again it’s still gonna be a cream and the problem is some women don’t do well with the cream because it super saturates in the subcutaneous tissue and starts coming out in uncontrollable amounts. You don’t get dosed into the bloodstream as efficiently let’s say, as a sublingual. They can go right into your sublingual tissue in your buccal tissue, go right to the blood, and there’s no like real fat in the mouth. Soright in there, and your good. Now the differenceis Dr. Jonathan Wright’s talked about this. If he does sublingual’s- I’m sorry-If he does the creams, he typically does it inter vaginally because of the submucosa down there. They can go right into the bloodstream. So that’s helpful. But again, you know, I’ve dealt with a lot of women that do the creams and such,inter vaginally, which can work decent on menopausal women. Not so much on cycle, and I’ll tell you why.But again– it’s some issues issues. I mean not to get too graphic here, you can get to the underwear, you can come out. Uh- it’s okay if you can do it at nighttime when you’re lying down. But sometimes you get discharge and they can wrap women’s underwear. They can be a little uncomfortable. So it just depends on what you like. If women have already done that- done it that method. And then they’re doing well, and the hormones are stable, and they didn’t have any of those issues that I mentioned, fine. If not, we’ll typically recommend some of the sublingual drops. Some of the estriol and/or progesterone drops. We’ll also support the adrenal glands themselves. And then will also use some specific herbs to help modulate the sex hormones. We’ll use wild yam. We’ll use chaste tree, or vitex. We’ll use dong quai. We’ll use black cohosh. Uh- we’ll use some of those herbs to help modulate the receptor sites. I’ll even use some specific phenotypes of mock guys. Some specific phenotypes for cycling women and/or menopausal women that- that will help with even some of those symptoms of the receptor site level, depending if we have a cycling or a menopausal issue.

Evan Brand: How about soy during this time?

Dr. Justin Marchegiani: Well if you’re using specific soy isoflavones, that can be helpful to modulate estrogen receptor sites. Again, we’ve talkedvery negatively about soy, but again soy if you extract the isoflavones, you’re also not getting all of the proteins and the  in the goitrogens, and the trypsin inhibitors. All of the negative effects. And of course, it’s gonana be extracted from a non-GMO source. So my opinion, you can still get some significant benefits. But where it’s the genestein the other types of soy isoflavones can be helpful for modulating, yes, receptor sites.

Evan Brand: Sure, sure. And I briefly mentioned omega-3’s but that’s another good one. Just plenty of omega-3 fats so good, high-quality triglyceride form of fish oils, which is what you and I use. So if you are takin’ a fish oil and you get fish burps, it’s probably ethyl ester. And that’s not good. If it smells fishy, most of the time,that’s not good, either. And you want to-

Dr. Justin Marchegiani: You want the triglyceride form.

Evan Brand: Yeah.

Dr. Justin Marchegiani: That’s it.

Evan Brand: Which is basically is as close as you can get to the raw form or the form that you would get if you’re just actually eating the fish.

Dr. Justin Marchegiani: Absolutely. So looking back at all the different things we talked about some herbs to help modulate receptor sites. We talked about using potential bioidentical hormones, our biases more towards the sublingual. If you were to do intravaginal cream, if have to be intravaginal, ideally not on the skin as much. Because of the super saturation in the subcutaneous tissue. And I see it on test. When you see like literally women are off the charts. You’re like, “hey, your doctor’s just measuring blood.”And because it doesn’t have a small metric to pick up that unit 2% or so, it may look okay in the blood, but not the okay in reality in- in the spectrum of looking at the free.

Evan Brand: Yeah. I’ve seen that, too. I’ve seen it with men, too. Which is all other conversation but testosterone replacement therapy, where just go so far above the 6, 6000 about 6000. That’s like where the test maxes out. And its like, “whoa! something’s not right.”

Dr. Justin Marchegiani: Exactly. Now, looking at cycling women, why do I wanna avoid creams altogether? Well for the most part with cycling women, their hormones are gonna be at different place in the cycle. The first half of the cycle is gonna be the follicular phase, where estrogen starts to go up around day 2. Day 3, it taps out around day 12 to 13. And then it drops as progesterone rises. That’s where your ovulation is.That estrogen drops and progesterone rise is where ovulation is. Progesterone comes up to the top. Estrogen nears down low and they both dropped together around day 27 and day 28 to signal bleeding. And again, the reason why this is an issue is, because if you if you can’t pull estrogen or pull progesterone all at the right time, then that can throw off the cycle. Because if estrogen and progesterone aren’t dropping exactly when it should, you’re not gonna have adequate menstruation. It may delay things. It may slow off your cycle. So because of that, I don’t like creams on my cycling female patients. I like to be really specifically progesterone exactly what days. I don’t want any spillover on either end. And I typically don’t use any estrogen with female hormone patients that are cycling because most women are estrogen dominant. And will typically be able to support the estrogen via the adrenal side via some of the DHEA and pregnenolone and some of the modulating herbs.

Evan Brand: So if you went to a standard MD or like an integrative MD, are they can be able to provide those sublinguals? I mean- how common is that? I know were talking about- sometimes we talk about subjects where the optimal thing is just unheard of in conventional. But I mean- is this sublingual, is this popular enough for some woman could go down the street to a clinic and get- get help with that?

Dr. Justin Marchegiani:  Uhm, most conventional medical doctors aren’t gonna- aren’t gonna be able to do the sublingual coz it’s just not in their wheelhouse. Uhm- some do troches which maybe a close second, right. A lot of them will do the pellets, and then most of them will do the creams. Just how they’re taught. You know, if you look at a lot of the ___, some of the anti-aging physicians, they’re gonna do more the creams. Dr.Jonathan Wright does this, but at least respect that it’s intravaginal. So you don’t have the subcutaneous build up. But again, I think the more important piece here to look at, is the adrenal aspect. We gotta look at the adrenals. And if anyone’s viewing right now, and wants to chime in, and ask a question via chat, feel free to do that. And we’d love to answer any of the questions that are on or related to the topic. This is a new thing we’re testing out. So the more people that engage or comment on this afterwards, that’s gonna motivate us to do more of these.

Evan Brand: Totally. Yes. So, the- you’ve hit on the good point, which is, yes- you can go there with the hormone replacement therapy. It has done good things. It can do good things, but I’m not prescribing it and I’m getting- I canprescribe but I’m not a prescribing MD. But just doing the stuff that I’ve done, I’ve been able to make 80, 85, 90% better in terms of symptoms that menopausal women are experiencing. And that’s with no drugs. That’s looking at the adrenals, that’s getting the gut infections taken care of, that’s looking at mitochondrial health, that’s getting rid of candida problems, that’s making sure they’re going to bed on time, that’s making sure they’ve revamped any type of cleaning products in their house. They’ve got the chemicals out, they ditch the plastic Tupperware’s. So all that stuff your adding 5%, 10%, 15% and then it just keeps adding up and then eventually, people are gonna feel much, much better.

Dr. Justin Marchegiani:  Oh, absolutely. And I think the bit thing is you’re working on the adrenal piece like I mentioned. You’re also working on the diet, right. Your stabilizing blood sugar. One of the biggest stressors on the hormonal system is going to be blood sugar swings. The more you stabilize those blood sugars and keep that dialed in, you’re gonna takea lot of stress off the hormonal system. Also stress is gonna eat up progesterone. So kinda like the pregnonolone steal, which is you know-it’s theoretical. It makes sense. It’s just- Here’s howI tell patients. We’re prehistorically hardwired to allocate our resources to stress and inflammation now versus healing and recovery in fertility tomorrow. Why? Why is that? Well because if we don’t get through now, tomorrow never comes. So it’s like the 12-year-old boy procrastinating on the homework. If you’re chronically stressed, you keep on putting off the fertility in the recovery, in the- the recuperation that is needed. So we’re chronically hardwired to deal with stress right now. So the goal is to decrease that stress, so then your body can start to allocate that, and put the healing and recovery in the fertility higher up on the priority list.

Evan Brand: Well said. Yeah. And it’s crazy to me how you can go and you could complain of the symptoms up sounds like you’re in or you’re going to menopause.Here’s cream and have a nice day. And none of this other stuff is discussed. I mean, we’re looking at massive pieces of the pie that are just completely ignored.

Dr. Justin Marchegiani:  Oh, yeah. Absolutely I would say the biggest issue I have when I was at the menopause summit last week with the with uh- with Bridget- Bridget Dainer, and one of the things they came off that we talked about was, I would say, one of the biggest things that is driven more menopausal patients to me, is this low-fat era. Avoiding animal proteins and healthy fats because that’s where a lot of your hormones come from. So if you don’t have that diet piece dialed in with the hormonal substrates, and the building blocks, and the healthy amino acids, you’re really at a significant disadvantage to being able to make your hormones on your own. So healthy fat-soluble nutrients, through grass-fed meat and Pasteur-fed meat and Pasteur-fed eggs, organic, free range, none of the chemicals. You don’t wanna add more Zeno estrogens in our meat to the- to the table, right. And throw off our hormones more. Healthy fish, egg yolks, if you can handle grass-fed buttering ghee, that’s great. Lots of vegetables, a glycemic or carbohydrate uh- balanced meal for you. So depending on starch, or no starch.Keeping grains out, keeping inflammatory foods out, keeping toxins out, and stabilizing your blood sugar, or not letting your blood sugar drop and not letting yourself get hungry is gonna be a great starting point for most people.

Evan Brand: Yes, I mean vegetarians, vegans specifically for women at this time, it’s gonna be brutal on them. If you’re vegetarian, vegan and you’re going into this phase in life, it’s gonna be really, really tough on you.

Dr. Justin Marchegiani:  It definitely will be now. If you are in that place, you know- I would try to coerce you in- and sell you on the fact that you probably want to eat some of these healthy animal proteins. At least cajole you and maybe some egg yolks, or tiny bit of fish, if I can do that. If I couldn’t do that, I will at least try to get you on some collagen proteins, uh- some really good P-protein. I’d even recommend you get some free form amino acid supplementation. I recommend lots of healthy fats via avocado- avocado oil, coconut oil. I will do Chia seed. Uhm- again, olive oil, low temperature. AndI would really work on the good fats, and I would make sure not going excessively high in the carbs. A lot of vegetarian by default become carbotarians. Again, I got in a lot of flak on this on YouTube, but it’s true. I’ve looked at hundreds of food logs of these types of patients and people. And I’ve seen it over and over again. The difference between me and you Evan, and the general public, is most people in the public, they only have an N=1. They have a torr experience. So if they extrapolate themselves, as is what everyone does, we seen it many, many hundreds, if not thousands of times over, most vegetarians become carbotarians with the grains and the excessive starch. So again, may not be an issue for you. I may not be speaking to you directly, but again that’s an issue that we do find on the vegetarian side.

Evan Brand: Agreed. Yeah. And we can look at the lab results, too. And I notice YouTube is the place where you get the most hate comments about vegetarian or, or- or veganism. If you’re- if you’re saying that that’s not a good- not a good thing to do, but we got the lab results to prove it. So when you got people out there saying look at this person, or look at this one doctor, or look at this one study, it’s like,“Hmm, I’m gonna look at the stuff that we’re doing in the trenches. I mean,  you and I are in the thousands of people that we’ve worked with now. And we see the direct correlation where when people start adding in the eggs, or they start adding in the good fats on a retest of let’s just say, adrenal cortisol pattern, for example. We may notice that the cortisol could get back into a good rhythm. Now granted there’s lifestyle components that were helping, there’s- there’s stress management, there’s the sleep, there’s the watching off of the blue light, etc. Getting good bright light in the morning, which is gonna be helpful. If you’re spending time in a dark room, cortisol is a light driven hormone, so if you’re waking up and you’re not opening the blinds, that’s a big issue, too. Wearing sunglasses, for example, but if your adrenals are stressed, you’re gonna want to wear sunglasses.  Some women they’re complaining of a bright light coming in, you definitely wanna get your adrenals tested. Because I’ve noticed that people I suspect- like I look around my family to see,  “Oh, I bet she’s got some adrenal issues”,“she’s always wearin’ those sunglasses”. That gets better when we support the adrenals. Bright lights don’t bother you as much.

Dr. Justin Marchegiani: Absolutely. That’s a 100% true. I totally agree. Well, anything else we want to touch upon with menopause. We hit the adrenals. We hit the diet. We hit the blood sugar. We hit some of the supplementation. Again, some womendon’t necessarily need the bioidenticals, but some women do. And it really depends on what’s going on, how unbalanced the hormones are, and how bad their symptoms are. Again, the more their hormones are depleted, you may need a strong bailout, a fast bailout with a little bit of hormone support. So I don’t wanna keep my female patient suffering. So we’ll use a little bit of that. And as long as we’re testing, and were not guessing, were assessing, I feel very confident moving forward  with that.

Evan Brand: Agreed. Yeah. Well said. Well people let us know what you think of the live YouTube thing. I’ll be curious to hear the audio quality. I mean, you talking to me it sounds- it sounds perfect. So if it’s as good as us recording through Skype, and other methods, then I say we could just keep doing our shows like this.

Dr. Justin Marchegiani:And again, we didn’t plan uhm- to do this show today. So I did one this morning off the cuff. I posted last night. So we had more viewers, but today was off the cuff so we don’t have too many viewers listening. But if anyone’s listening and wants to ask any questions, let us know. But I plan on- we’ll probably have hundreds, if not thousands, of people listening live very soon. When we start planning these out and it we’ll put it out in our emails. We’ll put on Facebook ahead of time so people know and they can come with your questions. Bzut anyone has any questions, actually we got a question here.What about liver health? And where to metabolize estrogens? Yeah. So regarding estrogen metabolism, this is important because I mentioned this earlier. We had E1, which is estrone and we have E2, which estradiol gets funneled downstream into estriol, okay. And what happened- this conversion happens to be at the liver. So E1 to E3 and E2 to E3, all happens in the liver. So anyone that has a liver issue, is gonna have a female hormone estrogen issue. So we wanna work on the liver. And also on the Dutch testing, we’ll look at the 2- hydroxyl, the 2-methoxy estrogen metabolism and we’ll look at the methylation meter and see if we’re having that one-to-one ratio of estrogen metabolism. So for 2-hydroxy estrogen of 1, do we have a 2- methoxy 1? Do we have this one-to-one metabolism? And that’s the methylation meter that we’re looking at on the test. If not, we could be uhm- essentially not getting rid of all the ashen. We could be re-absorbing that. Also, increase estrogen issues are gonna cause gallbladder issues. So again, you know- that the FFF role gallbladder issues, women that are overweight or fat, women that are- that’s the FFF, that’s just the accrued abbreviation. So overweight female, and 40 or up. So that this estrogen dominance thing. This is what goes, you list- I mean- I remember sitting in the many gallbladder surgeries, and those like FFF. Those are the three things the surgery would say. Are your overweight, female and over 40? Because the high amount of estrogen dominance, right. Makes the gallbladder- makes the bile flow from the gallbladder sluggish. So then what happens is two things. You can’t metabolize your hormones. A lot of that happens via the bile excretion. And then number two, you lose the ability to break down your uhm- fat-soluble vitamins. So gallbladder issues, and then fat metabolism, and then detox are common side effect of estrogen dominance. And that can happen leading into menopause. I can’t tell you how many of my female patient that are cycling have lost her gallbladder. And it really sets them up for nutritional efficiency and poor detoxification down the road.

Evan Brand: Oh, gosh. Well said. I mean- when I hear liver too, I just think of, like the GPL talks that you and I’ve chatted about with the gasoline additives and all these other chemicals in people’s bodies, aspirin and other- you know, pharmaceutical medications that increase the burden on the liver. So whether it was like statins, or hard drugs, or any of the stuff that that’s really tough on the liver. Alcohol, which a lot of women over 40, their stressed, they’ve got these symptoms, so they’re using wine you know, to put themselves to sleep. A glass or two a night which could increase the burden on the liver and messed this whole process up. Plus we’ve got parasite infections. You know 1 in 3 is what we’re seeing of infected people. Say you’ve got the toxic load there. And then if you got methylation issues, like you’ve mentioned, and you’re unable to detoxify, or you’ve got problems with the phase I or the phase 2. And you’re not taking something to conjugate those toxins and rattle them up and get them out your toes. So there’s a lot of different pieces that- that can be improved upon, for sure. Sço we always factor liver in. It’s not a matter of if we factor liver and detox into the protocol, it’s just a matter of when.

Dr. Justin Marchegiani: Absolutely. Now we just say- making sure we- you toss upon earlier with the gut stuff and I think so many mainstream functional medicine practitioners, and I would say even the medical doctors, ignore the digestion part coz again, a lot of the detoxification happens with sulfur amino acids. So we have to make sure we have the sulfur amino acids, the phase 2 sulfur amino acids to run those liver pathway. Socysteine, glutamine, glycine, and the glutathione precursors uh- methionine, taurine, especially for the gallbladder, are gonna be super helpful for liver detox. Also making sure we eat a lot of the cruciferous vegetables. And again, if you have gut issues, make sure they’re cooked so the fiber’s broken down. So we can get the diindoylmethane and indole-3-carbinol, which is gonna be really important for estrogen detox. And again, this is your broccoli, your brussel sprouts,your cauliflower, your asparagus, your kale, spinach

Evan Brand: And your broccoli sprouts. I love broccoli sprouts.

Dr. Justin Marchegiani: Yes, broccoli sprouts. And again we have someone answering uh- or asking this question live. So we’re answering anyone else that wants to ask a question live. We’re both ready to sign out. So anyone else,uh- put something in the chat window, we love the answer to it. So to finish that question, what other herbs can we give? So for gallbladder, we wanna add maybe some extra bile salts. We wanna do some fringe trees, some artichoke roots, and phosphatidylcholine, some X taurine. These are great for the liver. Extra milk thistle, silymarin. These are great things and we may even give extra sulfur amino acids, antioxidants, B vitamins, extra folate. These are all great things to support the liver. And I’d also say make sure you’re not doing all the bad things regarding the pesticides, the chemical, the exogenous hormones. And again, this is where a little bit estriol may need to be given coz that if we have toxic liver, we may not be able to have that liver conversion goin’.

Evan Brand: Well said. Great job.

Dr. Justin Marchegiani: Excellent. And we have a couple of other questions here. Uh- No, I did not go to the Super Bowl. No, not this year. It’s in Houston. I was thinking about it, didn’t make it down there. But I’m a huge Tom Brady fan. I think I know a lot of haters for that. But Tom Brady is the poster child for functional medicine, natural medicine. And the guy’s 40 years old and better shape than ever. And part of it is because of his diet,his eating,his sleeping, his training he sees a chiropractor, he sees an acupuncturist. The guy’s dialled in and is using natural medicine and functional medicine as his go to and not conventional medicine for his go to. So,huge fan of that. Anything else here, Evan?

Evan Brand: I don’t think so. Some people back to the website, check out Justin, Check me out or type in Evan Brand. You’ll find us both. More content, more info, the ability to schedule consults with us. All of that’s there. So we do both offer 15-minute free call. So if you got questions, you wanna get your questions answered, reach out. You know, there’s no sense in suffering if you know that there’s a possibility to get better, go for it, time’s wastin’.

Dr. Justin Marchegiani: And if you guys listening, like this type of format, we want to do it more frequently. So give us- give us some love,give us the thumbs up. Uh- share it, put it on Facebook, email to your friends. We absolutely love it. And the more feedback we have, the more we wanna do this.

Evan Brand: Absolutely.

Dr. Justin Marchegiani:  Excellent. Alright, Evan. Well this- the beautiful thing about this is,this thing goes live right away.So kinda exciting, instantaneous feedback for the listeners. Anything else in your end?

Evan Brand: No man, that’s it.

Dr. Justin Marchegiani: Alright, man. Great chattin’.

Evan Brand: You too.

Dr. Justin Marchegiani: Take Care.

Evan Brand: Bye.

Dr. Justin Marchegiani: Bye.


Dr. Allan Warshowsky – Functional medicine solution heal your fibroids naturally – Podcast #95

Dr. Justin Marchegiani interviews Dr. Allan Warshowsky where they discuss everything you need to know about fibroids, their locations and who may need surgery for it including strategies you can do. Dr. Allan shares his wealth of knowledge about hormones likes progesterone and estrogens. In this episode, you’ll also learn about angiogenesis.

Discover about the different enzymes you can take to help break down fibroid tissue. Find out what herbs can be used to modulate the receptor sites and learn about the detox and how important proper methylation is when you listen to this interview.

Dr. Allan WarshowskyIn this episode, topics include:

5:55   Diet and nutritional recommendations

11:14   Treating inflammatory conditions

18:41   All about fibroids and abdominal surgeries

27:18   Hormones

36:55   Herbs used for treatment

41:11   Detox and lab tests

heal your fibroids naturally







Dr. Justin Marchegiani:  Hey, there! It’s Dr. Justin here. We have an awesome show with a great guest here today, Dr. Allan Warshowsky. Dr. Allan is the author of the book, Healing Fibroids Naturally. Great book! I’ve gone through it. I think it provides some extra—excellent solutions where conventional medicine falls short in getting to the root cause a lot—with a lot these—these female issues, that tend to be just used for—with drugs and surgery to address them. So I wanna welcome Dr. Allan to the show. Dr. Allan’s website is Doctor—D-O-C-T-O-R-A-L-L-A-N—dot com. We’ll put links in the show notes. Other than that, Dr. Allan, welcome to the show!

Dr. Allan Warshowsky:  Well, thanks a lot, doctor—Dr. Justin. I’m—I’m really pleased to be here. I just love speaking about my passion which is an integrated holistic approach to healthcare. So­‑

Dr. Justin Marchegiani:   That’s phenomenal.

Dr. Allan Warshowsky:  So thank you for inviting me and—and I’m hoping for a great—great conversation here and a great show.

Dr. Justin Marchegiani:   I totally agree. Now I’m really interested in your background, because I know you started practice I think in 1977, I’m aware, and you were an ObGyn, meaning you deal with the—the birth of the babies and also women’s health issues, and I think you mentioned recently that you’re only dealing with the women’s health stuff now. And I’m just curious, how the—how you came across this philosophy of functional medicine, integrative medicine, holistic medicine when you know, frankly we know you go through medical school of 4 years. You go through a 5-year ObGyn residency, 1 year internship—that’s 12 years of your life dedicated to a conventional medical approach. How did you evolve and grow into that more holistic, integrative, functional medical approach for women’s health issues?

Dr. Allan Warshowsky:  Yeah, I guess I was always kind of a seeker and looking for answers that other people did not have answers for or didn’t really care. I mean, even before getting into medical school, I was interested in the mind-body connection and life after death and near-death experiences. These are things that really interested me and I did a lot of my own research in. I had to put that all aside when I went to medical school because as you said, it’s very conventional and it’s very straight and to get through, which you’ve gotta, you know, you gotta do the work and you gotta get through it but I was, you know, kinda of blessed to be in a residency program where there were a number of attending physicians who were interested in mind-body medicine. I got introduced to the work of Mindfulness Meditation with Jon Kabat-Zinn.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Who—one of the attending physicians. We—our—our late night chats waiting for babies to be—to be delivered were discussions about how garlic is helpful and the—the role of nutrition and vitamins.

Dr. Justin Marchegiani:  Wow!

Dr. Allan Warshowsky:  So there were one or two people who were really before their time, people who were doing natural childbirths, like in the 70s, you know, it was a—it was really an amazing residency that allowed me to come into practice as you said in ’77 with a—a different approach to what was going on. So I was doing talk therapy for women with PMS.

Dr. Justin Marchegiani:  Wow!

Dr. Allan Warshowsky:  In the early 80s. I was using vitamins, you know, to treat, you know, cert—certain PMS symptoms and other conditions related to hormone imbalance and it was hormones that really was—were my major interests along with the connections between mind and body and spirit, because going through medical school I didn’t know what I wanted to do. I—I wanted to be the greatest cardiologist at one point, then the greatest surgeon at another point, and I bounced around until I delivered my first baby–

Dr. Justin Marchegiani:  Wow.

Dr. Allan Warshowsky:  And then that was kind of an instant, you know, kind of energy hit. It was my, “Aha!” experience.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, just energy of the birth experience is what propelled me into ObGyn, whereas it was just—for other people it was the surgery. It was, you know, some of the endocrinology. But for me, it was the birth experience and—and then wanting to understand that more from a—a conventional perspective led me into, you know, this kind of life-long evaluation of hormones.

Dr. Justin Marchegiani:  Got it.

Dr. Allan Warshowsky:  And how that’s—how that’s all connected with everything else.

Dr. Justin Marchegiani:  And I’m just curious, too, because you were coming out in the late 70s here and it was all the rage was this low-fat kick that was going on starting in the 70s and the early 80s. How much did you see all these low-fat fad diets affecting your women’s hormonal health back then?

Dr. Allan Warshowsky:  I can’t say I was aware of that aspect of it at that time–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, at that time we were—I was working more against the conventional hormone, you know, ideas.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  So the conventional hormones Premarin and Provera.

Dr. Justin Marchegiani:  Right, the horse hormones.

Dr. Allan Warshowsky:  With the poisons.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  Which are poisons. Horse hormones and—and synthetics, you know, my battle at that time against conventional medicine was trying to get people to understand the use of bio-identical progesterone and estrogens. So I wasn’t really doing all that much in terms of diet until I got into the Holistic Medical Association in the early 90s and–

Dr. Justin Marchegiani:  Got it.

Dr. Allan Warshowsky:  People like Bernie Siegel and Norm Shealy and–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:   Chris Northrup and you know, some of these 2 pion—8 pioneers, you know, and then, you know, everything chained together for me and, you know, then, you know, showed me the nutrition aspects of health and, you know, more of the spiritual aspect—aspects of health, you know, came with the clear focus and how that all connected with my passion which was evaluating and—and re-balancing hormones.

Dr. Justin Marchegiani:  Very good. So you’ve started getting into the more nutritional elements in the—in the early mid-90s. What’s your perspective right now? We know people are individuals but what kind of macronutrients, proteins, fats, and carbs are you recommending? Do you kind of have a Paleo approach where we’re trying to get, you know, good, clean, organic meats; healthy fats, lots of good organic veggies; staying away from pesticides and GMOs. Is that kinda your philosophy? How would you interject the nutritional recommendations to your patients today?

Dr. Allan Warshowsky:  You know, for most people, you know, what we wanna do is we wanna reduce inflammation and toxicity–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  As much as possible. We wanna keep, you know, the chemicals out of our diet as much as we can. You know, so, you know, a—a non-GMO, so I tell people, when you go shopping, the mantra is local, in season, and organic.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know? And—and that way you can mostly get healthy foods.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  They should all be non-GMO even though there’s a major push now to show how GMO is not too bad.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  And I tell them, patients come in and say “I saw this article and they said, GMO is not so bad. And I said, “Well, look if you’re in the Sahara and there’s no food around, and they off—only offer you GMO food–“

Dr. Justin Marchegiani:  Alright.

Dr. Allan Warshowsky:  “That’s great.” But here we have a choice. And when your food is genetically modified, it could be Roundup or Glyphosate Ready, or now 2,4-D Ready which comes from Agent Orange–

Dr. Justin Marchegiani:  Wow. Yup.

Dr. Allan Warshowsky:  Which means that the seed are genetically modified so they could spray these poisons on them that kill the bugs ostensibly but we still have servicemen that are suffering from exposure to Agent Orange in Vietnam.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  And that’s where Dow Chemical is producing 2,4-D comes from.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So we want you to—the stuffs out of our diet, you know, so that’s the basic. And then, you know, I—I eat myself a Paleo type diet.

Dr. Justin Marchegiani:  It’s great.

Dr. Allan Warshowsky:  And that works for a lot of people. It doesn’t work for everybody.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  But a Mediterranean style diet–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, we do 4 of the above ground vegetables and we, you know, the leafy greens, the deep sea coldwater Mediterranean fishes, and you know, maybe some grass-fed red meat can be added to that. A lot of good oils, the olive oils; certainly big on—on coconut oil and avocado, and you know, so that’s the diet that we promote to most people. I think that the—the low-fat high, carb diet—the low-fat, you know, the American Diet—Diabetes Association is still saying 5-7 servings of whole grains a day. I think that’s crazy.

Dr. Justin Marchegiani:  Oh, absolutely. I think it’s even more. It’s 9-11 a lot of times.

Dr. Allan Warshowsky:  Yeah, I—I think that’s, you know, that—that should be malpractice. You know?

Dr. Justin Marchegiani:  Oh, my gosh! Absolutely. Now I see a lot of–

Dr. Allan Warshowsky:  That–

Dr. Justin Marchegiani:  Go ahead. Yup?

Dr. Allan Warshowsky:  No, go ahead.

Dr. Justin Marchegiani:  I see so many patients come in, right? The diet isn’t right, like you already mentioned. And then they have either endometriosis or they have some type of fibroid or some type of ovarian cyst, and you know, the conventional medical cookbook, ObGyn approach is predictable. If you have PCOS, it’s metformin. If you have endometriosis, let’s go in there and—and burn it out. If you have a fibroid, let’s cut it out. If you got PMS, we’ll throw you on a birth control pill, maybe an antidepressant. It’s kinda like this cookbook shop in the ObGyn world and I’m just fascinated on some of the things that you went above and beyond the conventional standard of care. What kind of things were you doing early on in your career to start fixing let’s say endometriosis, fibroids, PMS, just to start there.

Dr. Allan Warshowsky:  It—it all really started with me with one of these, “Aha!” experiences in the operating room because I mean, for many years I was doing all the surgeries–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  That I’m now trying to keep women from having.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, so I was walking through the OR and watching a—a colleague take out a totally normal uterus from a young woman. So, you know, we—we have a very collegial kind of group and I went–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  Over them and I said, “Well, what’s your indications of taking out this normal uterus in this 40-year-old woman?” And he said, “She just had heavy bleeding and I couldn’t stop it.”

Dr. Justin Marchegiani:  Oh, my gosh!

Dr. Allan Warshowsky:  So, you know, for, you know, for menorrhagia which right now we–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  There’s an FDA-approved medication for it even called Lysteda. Lysteda is the—the prescription form of Tranexamic acid–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Which is antifibrinolytics, so it prevents the breakdown of clots in the uterus. So this was just approved about 2 years—2 to 3 years ago by the FDA but I’ve been using Tranexamic acid to 20 years. For all the time I’ve been working on my fibroid protocol which basically happened after that episode in the OR. So we—I looked for ways of—I looked for, first of all, you need to find the reasons for these things going on. So the conventional approach, all the things you mentioned are just taking away the problem.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  It’s either putting on blinders, putting on a Band-Aid, taking out the tumor, but it doesn’t take away the underlying issue. The underlying issue is all about a chronic inflammation. So I became an inflammation doctor. So I went from a hormone doctor to both a hormone and inflammation doctor so the—from my perspective, you know, what we could see, you know, the tip of the iceberg at least—what we could see conventionally even if you do the labs, is that all of these chronic conditions—fibroid tumors, endometriosis, they’re all based on some underlying inflammation, inflammatory cytokines–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  And some kind of hormone imbalance, and you could identify those issues. You can, you know, correct the imbalances once you find them and if you certainly bring in the—this—the mind-body connection which is what we do, so for fibroids, endometriosis, we always have patients doing the meditation, visualization exercises while they’re using castor oil packs. So each patient gets their own individualized exercise that’s done–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  in conjunction with the castor oil packs. They meditate by doing—teach them to do belly breathing, diaphragmatic breathing. So if they’re in calm, relaxed state while they’re doing it, and so in addition to the physical anti-inflammatory aspects of this treatment and bringing in the mind issue, you know, getting rid of the feelings of frustration and anger–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  And this feeling that women have when they have to deal with these difficult issues and bring in instead feelings of gratitude, thankfulness that the fibroid, the endometriosis is bringing up and what’s out of balance in their lives, that’s what helps bring on the healing.

Dr. Justin Marchegiani:  Got it and you’re recommending–

Dr. Allan Warshowsky:  You can–

Dr. Justin Marchegiani:  Go ahead, yup.

Dr. Allan Warshowsky:  You don’t heal the fibroid by–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Taking it out, because I—I work with women who’ve had 3 and 4 myomectomies. They’ve had their fibroids removed 3 or 4 different major surgical times, and they just keep coming back.

Dr. Justin Marchegiani:  I‘ve seen that, too.

Dr. Allan Warshowsky:  Because no one’s looking at the under—the underlying issues.

Dr. Justin Marchegiani:  I agree. And you’re recommending a lot of the castor oil packs to help with the lymphatic circulation to kinda clean out the—the lymph. Is that what I’m hearing?

Dr. Allan Warshowsky:  Right. It’s been shown to be an anti-inflammatory.

Dr. Justin Marchegiani:  Got it.

Dr. Allan Warshowsky:  I—I also bring in things like dry skin brushing for lymphatic drainage.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  There are some herbal compounds that can be helpful with lymphatic drainage. So we’re—we’re concerned about that because if we’re breaking down toxins, if we’re helping to eliminate toxins, we wanna support the body’s way of doing that, and that’s certainly part of the lymph system.

Dr. Justin Marchegiani:  So we’re gonna make that pack, we’re gonna put it right over the—the uterus, ovary area? Is that where we’re putting it on the body?

Dr. Allan Warshowsky:  Right, so the pack is made with generally wool flannel and–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  We use hec—hexane-free castor oil, so you don’t wanna use anything that’s toxic. Sometimes we use Phytolacca or poke oil first. Poke oil has been used, I believe, for like decades as a—as an essential oil to break down breasts cysts and fibroadenomas in the breast.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  We use it, the fact that I just brought it down to use for fibroid tumors as well, so that’s applied first to the fibroid when you can feel it. So a woman who has a—a uterus that’s larger than a 3-month size pregnancy, that uterus already to be felt abdominally, so you know, we—we explore the uterus, the fibroids together, myself and the patient, through an ultrasound so they see where their fibroids are. They apply the poke oil with visualization that is getting into the fibroid and then they put the pack on top of that. They continue with the visualization exercise.

Dr. Justin Marchegiani:  So the castor oil packs–

Dr. Allan Warshowsky:  So–

Dr. Justin Marchegiani:  Go on right over that fibroid, how long is that there? For half hour?

Dr. Allan Warshowsky:  I—I look—you know, you know, a major piece of this, Dr. J, is the stress piece.

Dr. Justin Marchegiani:  Yeah.

Dr. Allan Warshowsky:  So these patients are coming in in major stress already. Their lives are being totally disrupted whether it’s severe PMS or fibroid tumors, or endometriosis, it’s—it’s all, you know, the same. Their lives are being totally disrupted. So you don’t wanna give them more things that are–

Dr. Justin Marchegiani:  Yeah.

Dr. Allan Warshowsky:  Gonna be stressful. So I tell them, this is what, you know, this is how you do it. The frequency is up to you. You know, so I—I explain to them the importance of carving out some time for themselves, because self-nurturing is an extremely important piece of any kind of healing process.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You—you know, if you don’t do the self-nurturing, you’re back to the conventional way or taking a pill or cutting it out or burning it out.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, I don’t wanna do any work, just give me something and get rid of it.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  So that’s the conventional approach, we wanna—we wanna avoid that. So you know, the—the patient, the client needs to be a—a partner in the healing process.

Dr. Justin Marchegiani:  I understand.

Dr. Allan Warshowsky:  And then—yeah.

Dr. Justin Marchegiani:  And you also said poke oil. Tell me about that. Are you applying that topically when you’re—when you’re inside the–

Dr. Allan Warshowsky:  Right.

Dr. Justin Marchegiani:  The vaginal area there? How are you—how does that work?

Dr. Allan Warshowsky:  No. I use the poke oil to—to massage, to have the patient massage it into the fibroids that they can feel abdominally–

Dr. Justin Marchegiani:  Okay, got it.

Dr. Allan Warshowsky:  So before they’re—before they’re applying the pack, they’re massaging a little bit, a few drops of the poke oil in maybe an ounce or so of the castor oil and just massaging that into the fibroids that they can feel abdominally.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  And then they can pack on top of that.

Dr. Justin Marchegiani:  Got it.

Dr. Allan Warshowsky:  So it’s kind of a ritualistic session, you know, that self-nurturing and then the other major piece of it that I haven’t addressed yet is working with the emotional issues that come up.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So here we’re talking about in the Eastern traditions we call it the energy on the pelvis, the second chakra.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  The second chakra has associations with your relationships. The relationships not only to people but to your work, to your finances, to you and the entire outside world. Certainly in women, it’s associated with creativity.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So what’s in your life that you don’t want or what’s not in your life that you do want? And all kinds of abuse. These are the issues that sit right in that second chakra in the pelvis and when these emotional issues are there, you know, we could say, you know, because we—we understand these issue, we understand that we’re all energy beings, we could say that these stored emotional issues are blocking the flow of energy in our meridians.

Dr. Justin Marchegiani:  Uhmm.

Dr. Allan Warshowsky:  And these are the meridians that acupuncturists are needling to get that flow going again. And my—my opinion is that this stored emotional energy is blocking the flow and when Einstein said, “When energy doesn’t move, it turns into mass.”

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So e=mc² says, “Energy that’s not moving is gonna turn into mass.”

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So what—what I feel is that these fibroids are the physical manifestation of blocked bandaging in the second chakra and we need to get that out. So we need to be aware of what comes up during these castor oil pack sessions and then journaling has been shown to be an extremely effective way–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Of releasing the stored emotional issues.

Dr. Justin Marchegiani:  Got it, so we were dealing with the emotions through meditation, through—through journaling. Do you do any type of other work, like for the deeper emotional trauma, maybe like EMDR or EFT? Any other energetic psychology techniques?

Dr. Allan Warshowsky:  I—I refer out to that–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know there are good business in my area. I, you know, it would be great if I could do everything, but–

Dr. Justin Marchegiani:  Yeah.

Dr. Allan Warshowsky:  You know, they’re going to be on my scope–

Dr. Justin Marchegiani:  Got it.

Dr. Allan Warshowsky:  So we have—we have, you know, the—the kind of partnership without walls, you know–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So there are a number of practitioners that, you know, I could refer patients to for these more sophisticated mind-body techniques.

Dr. Justin Marchegiani:  Got it. And I’ve had a lot of patients come to me recently that do have fibroids and I wanna just kinda break down, you know, the fibroids, what they are—they’re the most common tumor out there. They are leiomyoma, benign tumor, I think about 20% of females will get one in their lifetime, and for the most part they happen in 3 different places. They happen in the uterine lining, submucosal. It’s kinda like, imagine you’re wearing—for people listening at home—imagine you’re wearing a t-shirt and a jacket on, so a fibroid in between the skin and the t-shirt is like a submucosal fibroid. A fibroid between the t-shirt and the jacket, it’s like an intramural fibroid, and the fibroid on the outside of the jacket is like a—subserosal fibroid. You get the endometrium, the first layer; the myometrium, the middle; and the perimetrium on the outer layer. So just giving people a visualization of where these fibroids are and just kinda, so you get your mind around that, and then I want Dr. Allan here to talk about women that may have to get the surgical option. Some people they’re in that biological clock time where they may only have a few more years left to get pregnant, tell me about the surgical options if someone is gonna go the surgical route. How does that work with you?

Dr. Allan Warshowsky:  Well, the—the fibroid that causes the most problems with any kind of a pregnancy would be the submucous one–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  Because that one—that one is growing where the baby needs to grow.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, and if the fibroid grows in that area it could interfere with the baby’s growth. It could interfere with where the placenta develops. So that fibroid would need to be removed before pregnancy–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  If you know it’s there.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  So many pregnancies have probably gone one without knowing that there’s a small submucous fibroid and have been fine, and others are probably miscarried and we didn’t realize it was because of a small submucous fibroid. Those are generally removed fairly easily through a—a vaginal operation that goes through the cervix, and that’s called a hysteroscopic resess—resection. So a hysteroscope, the uterus is the hystero part of it, that’s why we call it a hysterectomy, but the hysteroscope would go into the uterus through the cervix like doing a D&C–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Scraping and then this is attached to a video camera and then through direct visualization, the submucous fibroid could be basically shaved off by an instrument that goes along with the hysteroscope. Any other fibroids in the wall of the uterus and on the outside if the uterus or the—the one that kind of connects via stalk called the pedunculated fibroid–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  Those would be removed through an abdominal incision in the old days—the old days being the 70s, the 80s, and probably early 90s. This was all done through a large abdominal incision, either a vertical or horizontal abdominal incision, big enough to take out these large fibroids, some of which could be the size of a newborn baby’s head, about 10cm or 8 or so inches. And fibroids, you know, 20% is really a short number, it’s a small number. I would say more like up to 70% of women have some devel—some development of fibroids, they may be very small but they’re there.

Dr. Justin Marchegiani:  Got it.

Dr. Allan Warshowsky:  So, you know, all you need is the inflammation and the hormone imbalance to drive that growth. Because inflammation wherever it’s coming from, could be coming from gingivitis, mouth inflammation—we know the association with mouth inflammation and cardiovascular disease and even Alzheimer’s disease. So certainly inflammation could affect the uterus and we know that the leiomyoma cells, the fibroid cells, they support their own existence by developing a blood supply.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  Bringing in nutrients, getting rid of toxins by virtue of these inflammatory chemicals–

Dr. Justin Marchegiani:  Interesting and then–

Dr. Allan Warshowsky:  But–

Dr. Justin Marchegiani:  Uh-hmm. Go ahead.

Dr. Allan Warshowsky:  You know, just the surgical aspect changed when—when many surgery became the vogue–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  And laparoscopic attempts at removing these fibroids became the way to do it and that went on. It was very successful. People became very good at it until very recently the mainstay of the removal of these large fibroids which is called morcellation–

Dr. Justin Marchegiani:  Yeah.

Dr. Allan Warshowsky:  Basically means breaking up these large fibroids into tiny little pieces in the abdominal cavity so you could take out small pieces of the fibroid through these tiny incisions in the abdomen.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  But because of the 1 in 300 risk of a fibroid being malignant, there were several cases of these women having a morcellation procedure which then seeded the entire abdominal cavity with tumor and–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, unfortunately these women had a—a quick demise and morcellation is now, you know, not done. It could only be done if the—if the operator can take the fibroid out of the uterus, and put it in a bag, so this is now taking an overcoat on top of the outer coat–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  Putting a bag inside the abdomen and breaking up the fibroid in the bag so it doesn’t seed the entire cavity. But very few laparoscopic surgeons are capable of doing that. It’s a very—the learning curve on that is extremely steep.

Dr. Justin Marchegiani:  Interesting. And I know Dr. Pritz, she a researcher, I think she did a study or it was in the Cochrane database where she was actually finding that the intramural, the in-between fibroids between the—the t-shirt or the shirt and the coat so to speak with my analogy—were even having an effect on reducing fertility, and the—the mechanism is best—is suggested as decreased blood flow or decreased angiogenesis. Do you have any thoughts on the in-between fibroids, the intramural ones affecting fertility at all?

Dr. Allan Warshowsky:  Yeah, the—the reproductive endocrinologist believes that any fibroid in the uterus, anywhere can affect fertility.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  And if go into—if a woman gets to the point where she’s seeing a specialist, they—they generally would recommend removal of that fibroid. My—my concern, you know, with the intramural fibroids is, you know, more about the potential of damaging the—the endometrial cavity itself.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  And then once that happens, the, you know what, the cesarean delivery is essential because of the risk of rupturing of the uterus.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  So, you know, that—that certainly would be a more of a risk with the intramural fibroids weakening the uterus, and then the other issue about the weakening the uterus which you know, they’re still studying is that can you put the uterus back together again, you know, using a—a mini surgical approach which is not using your hands really, you’re using instruments or robotics, to tie knots and to bring the, you know, incised portions of the uterus back together again. Can you do that as well robotically as you could do with your hands feeling the tightness of your—of your closure?

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So that’s still being looked at and they still do studies, you know, is—is an abdominal myomectomy with the hand closure as secure as the laparoscopic one and does the laparoscopic one increase the risk of rupture of the uterus.  You know, so we don’t have answers on that yet, but it’s still I would say, a concern.

Dr. Justin Marchegiani:  So ideally–

Dr. Allan Warshowsky:  Research–

Dr. Justin Marchegiani:  Go ahead, yup.

Dr. Allan Warshowsky:  That’s because recently there’s been some studies looking at another aspect of this cutting into the uterus and then future pregnancies and that’s the issue of just doing a hysterectomy for whatever reason and leaving the ovaries, so in taking the hyster—taking out the uterus and leaving the ovaries ostensibly as because you don’t want to disrupt the hormones being produced by the ovaries but we—what we see very often is that the ovaries go into shock. When you do pelvic surgery, the ovaries go into shock and for a portion of time don’t produce any hormones and depending upon the underlying status of the woman if they’re—if she’s older or if she’s got some underlying physiologic problems, her ovaries may not come back at all. So there may be and we don’t know exactly why, it could be this ovarian shock issue or it could be related to something that the uterus is being—is producing, some hormone–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  That we have not yet identified that the uterus is producing that also affects ovarian hormone production.

Dr. Justin Marchegiani:  Got it.

Dr. Allan Warshowsky:  And in that—in cutting into the uterus at any point, you know, could be affecting that.

Dr. Justin Marchegiani:  That makes sense. And can you talk about some of the hormonal factors that are driving this. We know we have lots xenoestrogens from estrogens in the water supply, such as you know, fluoride even could be an estrogen mimicker. We have all the pesticides and the GMOs, which are estrogen mimickers. Plus we also have the birth control pills which have a significant amount of synthetic estradiol in there. So I wanna get your take on the estrogen dominance and also do birth control pills increase your chance of growing a fibroid?

Dr. Allan Warshowsky:  In my opinion, it does. I don’t think that–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  There’s been a study that shows that, you know, but we certainly see, you know, patients that are put on birth control pills extensively. There are reduced role for the thyroids and they just grow.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  Now these things are being done, you know, these kinds of treatment are being done in the dark. You know, doctors are just throwing these drugs at patients. I had a patient come in just the other week. You know her fibroids are under control. She had seen me years and years ago when things were under control, and then she started having some bleeding problems and her doctor put her on—you know, examined her. The fibroid was growing, so gave her injection of Depo-Provera.

Dr. Justin Marchegiani:  Mmm.

Dr. Allan Warshowsky:  To—so stop the growth of the fibroids. And you know, it’s just unbelievable that what we know about regular Provera that doctor—you know, Provera has been shown to cause malignant breast tumors in dogs–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  And then in the PDR, the Physi—Physician’s Desk Reference—for years and years, they took it out now. I, you know—somebody took it out, but for years and years, Provera had as a quack doc’s warning, this drug increases breast cancer in dogs but yet they give it to women and now they give a Depo-Provera which is like a 3 month’s shot that doesn’t even go away, you know, which is even worse and sure enough this woman’s fibroid came and it twice the size that it was–

Dr. Justin Marchegiani:  Wow.

Dr. Allan Warshowsky:  Before she got her shot. So I think this synthetic certainly in—in women who have the right combination of hormonal issues. And it’s not just hormones. We keep just saying hormone imbalance but you know, it’s more complicated than that because it’s the receptor sites for the hormones–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  in your cells. And it’s the—the enzymes that detoxify the hormones.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So all of these—it’s safe to say that they work altogether, you know, so it’s hormone change, receptor sites change, enzymatic enz—enzymes that metabolize hormones change. These foreign hormones come in and they affect the same receptor sites so it becomes very complicated. I would just say in the last 5 or 6 years, they’ve discovered that there is a second progesterone receptor in our cells and depending upon whether or not you have inflammation, you either stimulate progesterone receptor A or B–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  There’s no doubt to figure out which one it is. If you stimulate A, you get fibroid growth. If you stimulate B, you may not. So it’s that—that, you know much of a—of a blind issue that this point. There’s so much that we don’t know. What we do know is what—that’s—those are the issues that I try to work with. So what we do know–

Dr. Justin Marchegiani:  Do you have any thoughts on using progesterone, bio-identical progesterone specifically in the luteal phase or the second half of a female cycle? Would that help—that will help with the PMS but will that grow the fibroid at all without having negative effects of maybe shrinking the fibroid?

Dr. Allan Warshowsky:  In some women, it’ll grow it and in some women, it’ll shrink it.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  And that’s been my experience, and you know, at this point in my career, I don’t use progesterone in—with women who are having fibroid problems.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So fibroid problems would mean—would mean a fibroid that’s growing, causing heavy bleeding, pressure symptoms and pain symptoms, quality-of-life issues. So a fibroid that’s causing quality-of-life issues, I would not treat with progesterone. I would be looking to keeping hormones in balance, you know, the three different estrogens–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Es—estradiol and estriol, estrone, being the most problematic–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Because it’s to be the one that support an inflammatory environment, so we—we can do things to modify the—the balance between those 3 estrogens to keep the estradiol and the estriole in a higher level and keep estrone at a lower level by influencing again some of these enzymes. In here, the aromatase enzyme–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, we—from breast cancer treatment, they try to use aroma—aromatase inhibitors–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  So medications like Arimidex that would inhibit–

Dr. Justin Marchegiani:  Arimidex, Uh-hmm.

Dr. Allan Warshowsky:  The aromatase enzyme, but we can do them naturally.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  We do that with flaxseed, with melatonin–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  The sleep hormone, very powerful aromatase-inhibitor–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, we could use natural progesterone. Again if there were not quality-of-life issues. I use a lot of natural progesterone cream, a 3% cream for PMS is—issues, you know, certainly for women who’s symptoms go away when their bleeding begins. So to me that’s like a keynote sign–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  You know, a women who’s had horrible, horrible symptoms and then I bleed and then I’m fine. To me that’s like a curtain comes down on their PMS, that’s an indication for progesterone. When the symptoms linger through the cycle, then I’m more concerned about things like thyroid, yeast issues.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Other times, issues that progesterone could actually make worse. So women often have an increase in yeast overgrowth in the week or so before a period because that’s when progesterone is the highest. And then obviously the treatment is not getting rid of that progesterone. It’s finding out why they’ve got yeast problems which usually goes back to their Hy—called the Hydra diet.  So–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  You know, we—you can deal with all that. And then progesterone also could be very effective as part of the therapy we use for endometriosis which we really haven’t talked too much about, but I—you know, you could think about endometriosis, kind of in the same vein as—as fibroids and then–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Throw in autoimmune disease at the same time. So endometriosis has a—a total connection with autoimmune issues. There’s a high incidence of illnesses like lupus­‑

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  And when we’re thinking autoimmune, then that brings us right back to the gut, because you know, if you have autoimmune conditions, you probably have what we call leaky gut.

Dr. Justin Marchegiani:  Got it.

Dr. Allan Warshowsky:  So—so most of our work here, I would, you know, think—I forget who said, “Life and death begins in the gut.” You know, that’s kind of, you know–

Dr. Justin Marchegiani:  Yup.

Dr. Allan Warshowsky:  How we look at into health.

Dr. Justin Marchegiani:  Got it. Yup, that is Dr. Metchnikoff. That’s his quote there. That’s a good one.

Dr. Allan Warshowsky:  Thank–

Dr. Justin Marchegiani:  And I wanted—

Dr. Allan Warshowsky:  Thank you.

Dr. Justin Marchegiani:  I wanted to just—yeah, no problem with that. I wanted to just touch upon some of the strategies that you’re using to help reduce fibroids. So if we’re not gonna be progesterone or any hormones, are we gonna be using things like systemic enzymes like serepeptidase or are we gonna be using hormone modulating herbs such as Chaste tree or Dong Quai or Black cohosh or any other herbs like—in a—a Myomin herbal support. Anything like that? DIM, indole-3-carbinol, green tea extract? What’s your take on some of these natural things to help reduce fibroid size?

Dr. Allan Warshowsky:  We have a basic protocol that we start women on and that consists of a good curcumin product.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So curcumin and green—green tea as you mentioned. There are good studies that show that both of these are natural anti-angiogenesis factors.

Dr. Justin Marchegiani:  Mmm.

Dr. Allan Warshowsky:  And both major anti-inflammatories and there are studies with both of those, you know, that you can pick up on PubMed.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, showing the reduction in growth of leiomyoma cells. So those—those two and then we use resveratrol.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Resveratrol because it’s been shown to be effective in down—downgrading the—to reducing the activity of the cytochrome P450 enzyme, 1B1. You know, so the detoxification enzymes usually have 2 different or 3 phases. The first phase, these group of 57 enzymes and they have these funny names, 1B1, 1A2, things like that.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  But the 1B1 enzyme, which has been shown to be overexpressed in both tumor cells, cancer cells and fibroid cells can be affected by resveratrol because resveratrol’s–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Been shown to be the—inhibit the 1B1 enzyme. So we use resveratrol, we use the systemic enzymes as you mentioned, serratiopeptidase.

Dr. Justin Marchegiani:  Yup.

Dr. Allan Warshowsky:  There are a number of good ones out there and these are the only things that really need to be taken on an empty stomach.

Dr. Justin Marchegiani:  Is there a favorite brand for the enzymes you have?

Dr. Allan Warshowsky:  No, I, you know, I’ve used, you know, Wobenzym and Neprinol–

Dr. Justin Marchegiani:  Yup.

Dr. Allan Warshowsky:  And you know, there was one called Proteo-Zyme that works well–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Also and you know, so a number of them are—are pretty much equivalent in their effectiveness. It’s just a matter of getting a—you know, usually looking between 9 and 15 of these a day on an empty stomach, splitting it in 3 doses a day. So again, it goes back to are you committed to your own health that you’re gonna take time, pause time out of your busy schedule as you know, a professional, a mom, a partner or whatever to take care of your own health? So it always kind of boils down to that as well. But the, you know, the symptom, the quality-of-life issues are key as well. So then the packs come into play. We use the tranexamic acid for the bleeding. We also use a number of herbs. So I have a protocol using raspberry, yarrow and Shepherd’s purse–

Dr. Justin Marchegiani:  Oh, great.

Dr. Allan Warshowsky:  In a—in a protocol to reduce bleeding. That works very well. It’s generally 30 drops of the yarrow and the raspberry before the period–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  To tone the uterus and to get the—the—the extra fluid out of the tissue spaces and then the Shepherd’s purse is added when the bleeding starts. Shepherd’s purse being more of a—a contractinger. So that works well and if that’s not doing the job, we add in the tranexamic acid and that—that really helps quite a bit.

Dr. Justin Marchegiani:  Did you also use any cramp bark, too?

Dr. Allan Warshowsky:  You know, if we need it, I—I find Black cohosh works fairly well–

Dr. Justin Marchegiani:  Okay.

Dr. Allan Warshowsky:  The—the black haw, the cramp bark, those—those Viburnums they also work. I think a little bit more difficult to find.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  The Black cohosh is, you know, it’s—in addition to being very good for night sweats and hot flashes in menopause, it was originally used for rheumatism.

Dr. Justin Marchegiani:  Oh.

Dr. Allan Warshowsky:  So it was a nerve—for joint pain.

Dr. Justin Marchegiani:  Joints, wow.

Dr. Allan Warshowsky:  And also for pelvic pain, so it’s an effective herb for—for that and we, you know, we use some that, you know, if women—you know, some of these women come in and they’re pretty sad about herbs or some other, you know, integrative approach to healthcare and if they’re using things like the Viburnums, black haw, or cramp bark, you know, and they—they’re getting a good response from it, then they can certainly continue it.  

Dr. Justin Marchegiani:  How about Chaste tree or—or Vitex?

Dr. Allan Warshowsky:  I used that quite a bit in the beginning and didn’t really see much benefit from it, so, you know, in, you know, in—in lieu of adding—I always find more—you know, less is more—is—is better.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, when you start adding on supplements to patients, you could break the camel’s back.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You reach a point of saturation with people, so I try to keep it to, you know, a reasonable number of supplements. I tried it so, you know, I was doing some of these herbs for lymphatic drainage, you know, and I backed off on some of that in lieu of things like dry skin brushing. You know, I’d bring in things like oil pulling for—for oral inflammations. So I try to bring in things that are, you know, not a supplement. You know we try to work with, you know, the mind-body, you know, as often as we can. You know, and—and after our approach, so that would be our initial visit. You know, people walk out, they’re usually kind of blown away. It’s a 2-hour visit, our initial visit. They walk out with a folder of, you know, maybe 20 pages of things that we’ve gone over, and then you know, our next visit which is 2 weeks later when we review the labs that we’ve done, we go over everything again. So, you know, the first visit is really planting seeds. The second visit is not only rehashing the first visit, but looking at what the individual issues are. So we look at estrogen metabolism. We look at the 2:16 hydroxy ratio to see if we wanna bring, you know, indole-3-carbinol or DIM into the picture. So you know, and again I would try to work first, you know, with increasing cruciferous vegetables.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  And—and bringing in more flaxseed. Down flaxseed into the diet, you know. And you know and certainly working on maybe exercise and fish oils. So you know, wherever I can, I’m gonna try to at least initially to keep the supplements low­‑

Dr. Justin Marchegiani:  Uh-huh.

Dr. Allan Warshowsky:  And to have other, you know, the other lifestyle changes, you know, work to make a difference because ultimately—ultimately these patients are not gonna be on 30 supplements a day. They’re gonna want to have–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  You wanna instill in them some tools that they can then continue to just incorporate in their lives, whether it would be oil pulling, dry skin brushing, belly breathing when necessary, making sure that they’re exercising appropriately, getting the body weight and fluid ounces every day, you know, flossing nightly. So these are the things that we stress, you know, above everything else. So the patient says I can’t be your program, you know, it’s just too much to do, but I like all your other stuff, to me that’s a win.

Dr. Justin Marchegiani:  Okay.

Dr. Allan Warshowsky:  You know, but daily they—they’re gonna change their lifestyle and they’re gonna bring all these healing modalities. They’re gonna be—they’re gonna have a commitment to their—to their health. To me, that’s a win.

Dr. Justin Marchegiani:  So when you talk about the detox. You mentioned the 2, 4, and the 16 estrogens there, the metabolites, and you also mentioned the detox pathways. Question number 1, part 1 is do you have an objective way of looking at detox or using an organic acid test or hormone metabolite test? Number one. And then number two, give us the story. Which ones are the bad ones and which ones are the good ones in those hormonal metabolites.

Dr. Allan Warshowsky:  I—I do organic acid testing–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  On every—for every new patient.

Dr. Justin Marchegiani:  Good.

Dr. Allan Warshowsky:  So, you know, in addition to a—a lot of the blood tests, so I’ve been accused of going on fishing expeditions with my blood work–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  And I ___41:47___, that’s exactly what we’re doing because I don’t know what’s your underlying issues. You’ve—you’ve seen 3, 4, 6 different professionals already, different doctors. They all tell you that you’re fine. So I’m gonna do a lot of things. I’m throwing out a wide net. When you go fishing, you throw out a wide net, everything you pull in is not edible. You’re gonna throw some stuff back. So I go on this fishing expedition with lab work and we look at all, you know, certainly we look in liver enzymes for detox.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  You know I do a—a GGT or–

Dr. Justin Marchegiani:  Yeah.

Dr. Allan Warshowsky:  Gamma glutamyl transpeptidase base–

Dr. Justin Marchegiani:  Yeah.

Dr. Allan Warshowsky:  Again we’ll keep a toxicity. We do a lot of inflammatory tests as well.

Dr. Justin Marchegiani:  Yup.

Dr. Allan Warshowsky:  We do oxidized LDL, C-reactive protein, homocysteine–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Hemoglobin A1c, so all of these tests toxicity and inflammation and then the organic acid test, so those are—those are tests that’s showing us breakdown. You know, so those are the breakdown tests, your—your cells are now spewing out enzymes into the bloodstream, they’re breaking down. So then I turn to the organics test which tells me if you need an oil change before the breakdown.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  So this is telling me—do we need any—are we running out of gas? Do you need more glutathione? Do you need more NAC? Do you need more lipoic acid, the B vitamins, etc. So we could prevent the breakdown. So we’re looking at this, you know, through the organics, through the routine labs, and then certainly with, you know, what the patient’s story is. Patients come in, they tell you, “I’m fatigued every day. Everything hurts. I can’t think. I can’t remember. My head is just brain fogged.” I mean that’s toxicity. That’s inflammation.

Dr. Justin Marchegiani:  Right. Uh-hmm.

Dr. Allan Warshowsky:  We do a—a body composition test. We do a bio—bio-impedance analysis on every new patient as well, and we could see what’s going on with the mitochondria. We could see that the mitochondria not making energy or that there’s no permeability through membranes, and we could look at, you know, by virtue of intra and extra—intra and extracellular mass in water, you know, the ramifications of inflammation. So we do that one every patient. So we’re picking up from the gecko, you know, where the issues are. And now if we see significant toxicity, you know, based upon our history, our labs, you know, we’re gonna suggest doing a—a some kind of a detox which is usually, you know, involves eating a very clean diet, getting rid of the foods you’re eating every day, because once you have—show this level of toxicity, and so you wanna heal the gut, you wanna support detoxification and reduce inflammation. So you need a very clean diet, and you need some kind of detox powder which we use, maybe infrared sauna, maybe adding in the—the dry skin brushing and things like that.

Dr. Justin Marchegiani:  Got it. So we want—we want more upregulation of the two estrogen pathways, right? Less of the 4 and 16 and more of the 2. Is that correct?

Dr. Allan Warshowsky:  Correct and that’s where the crucifers with the indole-3-carbinol and the DIM are gonna come in. That’s where flaxseed is gonna come in. Fish oils—they’re all gonna promote the—the development of the 2 hydroxy estrogen. You know, we don’t have a way of reducing the 16 or the 4. You know, we don’t—we don’t have any studies showing ways of lowering that, but we have ways–

Dr. Justin Marchegiani:  Of the 2.

Dr. Allan Warshowsky:  Of increasing the—the 2. And the indole-3-carbinol, DIM, the diindolylmethane combination sometimes works better than one or the other. You know, we don’t why but people do respond to one or the other. And then, you know, methylation. You know, so we haven’t spoken about methylation but, you know, then we have need another hour I guess.

Dr. Justin Marchegiani:  We’re gonna have to have you back again for a part 2 on this. This is great.

Dr. Allan Warshowsky:  30% of the population do not—do not methylate correctly.

Dr. Justin Marchegiani:  Yeah, they have MTHFR issue, right?

Dr. Allan Warshowsky:  Absolutely. So and you need methylation, you know, to further promote the detoxification of your estrogens because–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  If you can’t methylate, you can’t make the methyl estrogens–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  The 2, 4 , the 16—methyl estrogens which do the work. So we say the 2 hydroxy is a good one because we can methylate it to 2 methyl estrogen and that’s the one that shows reduction in breast cancer. It shows reduction in other cancers as well, and the 16 hydroxy and the 4 hydroxy which are carcinogenic, you can take the teeth out of those by methylating them. So they’re no longer carcinogenic if you can make them the 16 and the 14 methyl estrogens which is basically estriol. So methylation extremely important and it’s something that you still have to fight the insurance companies–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Just to even cover the tests in their labs.

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  I write letter almost weekly to explain why I’m checking MTHFR in these patients’ labs when there’s just thousands of studies already on methylation and all the different aspects, everything from ADD, ADHD, and schizophrenia and hormone imbalance. Who would have thought? So–

Dr. Justin Marchegiani:  I know. I just wanna give everyone a summary here of everything you said so far because you just dropped some serious knowledge bombs on us. So number one, we talked about kind of the fibroid locations, who may need surgery, and then if we have time, strategies to do. We talked about off the bat leaving out things like progesterone because they may cause some growth, some people may or may not, but we wanna keep it out to be safe. We talked about some things to help with decreased angiogenesis. That means decreased blood flow to the benign tumor, that being the turmeric and the green tea. We also talked about the resveratrol and how that can help modulate the estrogen receptor sites. We also mentioned the different enzymes taken on the empty stomach to break down that fibroid tissue. You also mentioned some herbs to modulate the receptor sites as well such as the black cohosh, the Don Quai, the raspberry root and the Shepherd’s purse, and then you also mentioned some of the detox stuff. You mentioned increase in the cruciferous vegetables, the DIM, the indole-3-carbinol, and you also talked about doing the testing to figure out methylation, to figure out your detox pathways and really improving the 2 hydroxy estrogens while trying to basically push the ratio more in favor of the 2 versus the 4 and 16. Is that a good summary so far, Dr. Al?

Dr. Allan Warshowsky:  That’s—that’s excellent, J—Dr. J.

Dr. Justin Marchegiani:  Okay, excellent. Do you wanna add a little bit more into this? I wanna have you back on a part 2 in a few months to go into endometriosis. I don’t wanna sell us short on the fibroid part here. Is there anything else you wanna dig in that ‘s clinically relevant and important to any patients that have this issue?

Dr. Allan Warshowsky:  Well, you know, I—I think again we need to look at what—what’s going in your lives. You know, what—what is not working in your life because the energy of these fibroids is all about the–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Really I think investigating what is not working for you because those are the issues that need to be addressed. The fibroid is there as an indicator.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  The fibroid, it’s not a punishment. You know, it’s not something that just happened. It’s there for a reason and generally, the reason is approachable, you know, once you start doing this work and looking into it and then—then the true healing begins. ‘

Dr. Justin Marchegiani:  Got it. And do you have your patients avoid phytoestrogens like soy?

Dr. Allan Warshowsky:  I more avoid soy these days because of the GMO.

Dr. Justin Marchegiani:  Uh-hmm. Uh-hmm.

Dr. Allan Warshowsky:  You know, I just don’t—I have a problem with glyphosate or 2,4-D getting into my patients’, you know, physiology. But soy itself has been shown to be in small amounts an estrogen modulator.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, soy and flaxseed, these are just estrogen modulators–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Just like ginseng as a tonic. You know, if your estrogen levels are low, the isoflavones will raise them a little bit. If you’re too high, they compete for the same receptor sites, so they’ll drop your estrogen by competing for those same receptor sites. So I don’t have a—a major problem with soy other than the GMO issue and—and then other people are just overdoing soy. I mean there are people who could have soy at every meal because they’re vegetarian or vegan–

Dr. Justin Marchegiani:  Right.

Dr. Allan Warshowsky:  And that could lead to major problems.

Dr. Justin Marchegiani:  So would you recommend if you’re gonna do soy, do it in condiment amounts? And maybe do the fermented varieties that have all the trypsin inhibitors pulled out like the—the miso, the nato and the tempe?

Dr. Allan Warshowsky:  I—I would go along with that and the only other brand of soy milk, the only one I’ve seen is—is WestSoy which has a non-GMO sticker on it. That—other than that I, you know, I have difficult time with soy. You know, obviously if you’re gonna have a—a serving of tofu once every other week or so and you’re generally healthy, you should be able to tolerate that. You’re probably getting more toxicity just walking out the front door and taking a breath of what we think is fresh air.

Dr. Justin Marchegiani:  Got it. But if you’re a male patient, you definitely wouldn’t do the soy, right?

Dr. Allan Warshowsky:  I have problems with, you know, the male patients having their own problems with the phytoestrogens and–

Dr. Justin Marchegiani:  Yup,

Dr. Allan Warshowsky:  Xenoestrogens, you know.

Dr. Justin Marchegiani:  Yup.

Dr. Allan Warshowsky:  They’re—they would get more gynecomastia–

Dr. Justin Marchegiani:  Yeah, men boobs.

Dr. Allan Warshowsky:  You know, and there’s a—you know, an epidemic or male—male cosmetic surgery to remove gynecomastia and then as men age, they look more like pregnant women, you know, with their big bells and the—and their chest hanging down. So men having—having a real hard time, and I would stay away from soy but I would bring flaxseed—I would bring flaxseed into—into the diets of men because it is an estrogen modulator for them. And I check estrogens in all men patients, so I do see men, I do see children these days. I only do office work. I don’t work in hospitals any longer.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  And I do—I—I really I do an integrative holistic approach to healthcare for men, women, and children down to about the—the prepubital years, down to about 12 years old. So I bring this approach that—of what I do now to families.

Dr. Justin Marchegiani:  Got it.

Dr. Allan Warshowsky:  That changed about 10 years ago.

Dr. Justin Marchegiani:  And do you have any thoughts at looking at the free fraction of the hormones like the estradiol free, progesterone free versus just looking at the total serum levels of the hormones?

Dr. Allan Warshowsky:  Whenever we do look at free levels, we can—I—I’m not seeing in the labs that I use in New York is a bit restrictive, and maybe other labs–

Dr. Justin Marchegiani:  It is.

Dr. Allan Warshowsky:  That are doing free estrogen levels. We can do a bio-available testosterone so that’s–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Giving you your free testosterone but you know, you do free thyroid hormones–

Dr. Justin Marchegiani:  Uh-hmm. So you do free T3 or free T4 and wherever I can do free hormones I would, because that’s telling you the—the hormone in your bloodstream that can get into your cells. We have no way of knowing if it is or it isn’t, even if you’re doing saliva testing which is really the next step. Now you got the—the hormone from the bloodstream into the interstitial spaces but still we don’t know what’s getting into the cells.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  So it is important to—to look at, you know, as specific as hormones as you can so I always measure, you know, the estrone, the estradiols–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Men and in women. Other hormones like androstenedione and certainly dihydrotestosterone in men–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  As you said, check out these pathways. You know, so if you have, you know, variable pre-cursor hormones like androstenedione is very low in a woman or man, then her estrone or his estrone is sky high, you know that their aromatase enzyme is being stimulated and that’s an inflammatory issue. So usually we see that from, you know, things like insulin resistance.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  You know, with the—whether it’s a metabolic insulin resistance or a dia—true diabetic insulin resistance, that’s gonna drive that aromatase enzyme. So–

Dr. Justin Marchegiani:  Got it, and if a woman comes in to you with a—a fibroid, let’s say, you know, 6 or 7 or even 9 cm, have you had success in the past, and let’s say time isn’t an option, right? I mean, let’s say the woman’s not at that biological ticking clock where they need to get pregnant. Let’s say they have time. Let’s say they’re already menopausal, or let’s say they’re very young and they’ve—they’re not gonna get pregnant for a while, what’s the biggest fibroid you’ve been able to reduce naturally with some of these holistic medical techniques.

Dr. Allan Warshowsky:  I would say, you know, 10-12 cm, you know–

Dr. Justin Marchegiani:  Wow.

Dr. Allan Warshowsky:  We’ve certainly reduced some to the point of not being an issue. So will they go away completely? Probably not. But when time is not an issue and we can control the quality-of-life issues, those are key. You have to control the quality-of-life issues, I would say that almost 100% of the time these fibroids are gonna get to a point where it’s not gonna be an issue.

Dr. Justin Marchegiani:  So let’s say you’ve dropped all these brain candy on everyone so far. Let’s say the average listener is incredibly overwhelmed, they’re listening, and they’re saying, “Alright, what’s the top 3?” If I could do Dr. Allan’s top 3, what would those top 3 be for those women that are just feeling a little bit overwhelmed right now?

Dr. Allan Warshowsky:  Yeah, so I go back to, you know, the mainstays, you know, so it’s lifestyle and diet–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Allan Warshowsky:  Nutrition, and—and stress—stress modification. So you need this—modify your stress. Everybody has stress, but you need to find ways of getting rid of it, whether it’s meditation or belly breathing or exercise, it’s healthy diet, exercise and stress modification. Those are key. You know, without that and you’re not having ,you know, healthy digestion that comes with it, without having healthy excretion of toxins, that’s what a regular bowel movement every day is necessary for, you’re not gonna heal. So if you’re not gonna do anything else, get started on that, get down to an ideal weight, you know, get stretching or if you’re carrying a lot of extra weight as fat, we know fat cells are not inert, they’re producing hormones and they’re inflammatory hormones–

Dr. Justin Marchegiani:  Umh.

Dr. Allan Warshowsky:  And they’re producing cytokines and they’re inflammatory cytokines. So these are the basic things that need to get started on. People don’t heal when they’re—you know, you can’t—you can’t fix the roof when the—when their foundation is shattering.

Dr. Justin Marchegiani:  Got it, that’s great. That’s great. And doc, you got a book here, Healing Fibroids Naturally, so everyone can go take a look at that on Amazon, we’ll put some links on the show notes. Also doc’s available here over in Rye, New York at 150 Purchase Street is the address. His email—or I should say his website is Doctor, D-O-C-T-O-R-A-L-L-A-N dot com. You can obviously see Dr. Allan over in New York. Doc, do you also do phone consults for people that are outside of the New York area that wanna run through your case—or run through their case with you.

Dr. Allan Warshowsky:  I—I don’t—I don’t do phone consults until I’ve had one face-to-face visit and we see people—people almost every state in the country. We have patients that are international from the Middle East, from India, from UK, from all over Eastern Europe and the Middle East. And we do one face-to-face visit and then we work over the phone.

 Dr. Justin Marchegiani:  That’s great.

Dr. Allan Warshowsky:  You know, we do a lot of emails. We do a lot of emails so we stay in touch via email and we stay in touch periodically via phone consultation and many of the patients come back. You know, we’ve had one patient came back from Dubai.

Dr. Justin Marchegiani:  Wow.

Dr. Allan Warshowsky:  And then—and she actually—she shared another colleague of her, she’s also gonna come in from Dubai for her follow-up, so–

Dr. Justin Marchegiani:  Wow. That’s amazing.

Dr. Allan Warshowsky:  That is pretty amazing to me. I never—never anticipated this with—after I wrote the book, but I understand the book is in—it’s in a lot of the bookstores in the Middle East and it seems fibroids seem to be a—a large issue. I would suspect because of the environmental toxins.

Dr. Justin Marchegiani:  I agree. Are there any other ways my listeners can get a hold of more of your information outside of what I already mentioned?

Dr. Allan Warshowsky:  The book and the website are the two best ways and that’ll—that’ll direct you to your next step if you wanna take it.

Dr. Justin Marchegiani:  That’s great and I look forward to having you back in the next few months. I really wanna go into endometriosis. You’re such a wealth of knowledge. I felt like we should just focus on the fibroid area and we’ll have you come back for a part 2 and we’ll go over some—some more gems you have to offer them.

Dr. Allan Warshowsky:  My pleasure.

Dr. Justin Marchegiani:  Dr. Allan, thanks. You were a phenomenal guest. Have a great day!

Dr. Allan Warshowsky:  You, too. Take care now. Bye-bye.

Dr. Justin Marchegiani:  You, too.

Natural Remedies for Hormonal Imbalance, Infertility, PCOS and PMS

Natural Remedies For Hormonal Imbalance Infertility PCOS And PMS

By Dr. Justin Marchegiani

There are many natural remedies for hormone imbalance in the functional-medicine world, yet they tend to the be the last line of defense most women reach for. It’s easier to get a birth control pill or antidepressant to fix the symptoms of hormone imbalance, but this does nothing to address the underlying cause.

If you’re a female and suffering from infertility, PMS, polycystic ovarian syndrome (PCOS), or other hormonal symptoms, this is a strong sign your body is out of balance and not expressing optimal health. Fertility and hormone balance is a natural by-product of health, and without it, our species wouldn’t be here today. I urge every woman to dig a little deeper into what’s driving her infertility and/or female hormone imbalances.

Just 30 to 40 years ago, women would routinely get pregnant on their honeymoon. Today, women are spending upward of $15,000 per in vitro fertilization (IVF) treatment, some needing multiple treatments to conceive.

Why can’t I get pregnant?

It is possible to mimic your hormones with Follistim, Lupron, or Clomid to manipulate your brain into thinking you are healthy enough to get pregnant. Your body is wise, and is not letting you have a child for a reason; it knows the hormonal environment is not optimal to produce a healthy baby.

The hidden chemical stressors in your body can activate certain genes epigenetically. When these genes are activated, it predisposes you and your child to autoimmune/chronic inflammatory conditions, like asthma, heart disease, allergies, and learning disorders (1, 2, 3).

When we look at the underlying cause of infertility, 40% is on the woman’s side, 40% is on the man’s side, and 20% is unknown.



Both men and women should adhere to similar dietary and lifestyle principles to help support and nourish their bodies. A diet that is nutrient dense, anti-inflammatory, and low in toxins is essential for optimal health and for a growing a baby.

Factors to Consider

Women who are trying to get pregnant need to make sure their diet has adequate fat for the formation of their soon-to-be child’s nervous system; adequate meal timing to stabilize blood sugar; and the avoidance of all toxins from pesticides, grains, and refined foods.

If you are trying to get pregnant, you need to form a cohesive team with your partner. There needs to be a combined effort of the couple engaging in health-sustaining habits. Though the female grows the child inside her body, the quality of the sperm and the support regarding nutrition and lifestyle habits are just as important.

One Caveat

As long as your partner’s sperm count, motility, and morphology have been assessed and there are no issues regarding the female’s reproductive anatomy, then you are a great candidate to start a natural female-hormone-balancing program.

There may be 5% of women that need IVF treatment to conceive. I personally would recommend IVF last. The natural hormone-balancing diet and lifestyle programs can work over 90% of the time. IVF may help you get pregnant, but it does nothing to ensure a healthy pregnancy and optimal health for your child.

According to research, as well as my clinical experience, women that have IVF or go into a pregnancy unhealthy to begin with tend to suffer from more hormonal related issues post pregnancy, have a more difficult time losing weight, and have an increased risk for postpartum depression (4).

To All Men out There

Sperm counts have been dropping over the last 40 years significantly and so have the reference ranges regarding what normal may be. Due to these drops in the reference range, I urge men to be in the top 25% of the range to ensure adequate health. Consider anything in the middle of the range inadequate to standards just 30 to 40 years ago. (5)

Women’s Cycle: The Two Phases of Your Cycle

Womens Cycle Phases

The first half of your cycle is the follicular phase. This is where estrogen predominates. The second half of your cycle is the luteal phase. This is where progesterone predominates.

The Domino Effect of Healthy Hormones and Pregnancy

Step 1

Progesterone and estrogen drop at the end of the cycle, which signals bleeding, or your period. The sloughing off of your endometrial lining is important to reset your body so it has a chance for pregnancy the next time it ovulates.

Step 2

 The bleeding that occurs during your period stimulates FSH—a brain hormone. FSH stands for follicle-stimulating hormone which stimulates the follicle to start growing.

Step 3

As the follicle starts growing, it stimulates estrogen to increase. As estrogen increases, it starts to thicken the endometrial lining. Estrogen stimulates growth, which is needed for the uterine lining.

Step 4

As estrogen reaches its peak around day 12 or 13 of your cycle, ideally, it stimulates an increase in LH (luteinizing hormone).

Step 5

When LH increases, it stimulates progesterone to increase around day 15 of your cycle.

Step 6

The rise of progesterone, which was preceded by a rise in estrogen, signals ovulation. This when you can get pregnant, and it’s only about a three-day window. Progesterone causes the uterine tissues to mature (to grow up), which provides the right environment for the egg to implant into it.

Step 7 (optional)

The egg is ejected into the fallopian tube where it has the potential to come in contact with sperm as the egg makes its way down to the uterus.

Step 8 (optional)

The fertilized egg embeds itself into the uterine lining as the corpus luteum (the scar from where the egg formed in the ovary) stimulates progesterone through the production of human chorionic gonadotropin (HCG).

Step 9

Progesterone and estrogen drop out around day 27 or 28 of the cycle, which then signals menstruation (your period). The whole process then repeats itself again.

Fun Fact: HCG is what is typically tested to confirm pregnancy. Elevated HCG will get you a positive on your home pregnancy test.

If you are trying to fix your hormones, feel free and click here to schedule a complimentary consult to see what your options are.

female cycle

Problems in the Luteal Phase

The luteal phase needs to be at least 12 to 15 days long to ensure there is enough time for adequate progesterone to be made. If progesterone levels fall off early in the luteal phase (symbolized by the red lines above), it’s because of stress. Stress comes in physical, chemical, and emotional factors. Essentially, progesterone, your pro-gestational hormone that holds the egg in place, actually can get converted downstream in the cortisol.

With chronic stress we see progesterone falling out early in the cycle, which can make it very difficult to sustain a pregnancy. This progesterone deficit makes it very difficult for the egg to stay implanted, and it will eventually slough off causing a potentially thicker period that particular month, or maybe even no period at all. Low progesterone over time can cause your cycle to be anovulatory (without a period), or you may have even been told you have premature ovarian failure.

Throughout our cycle, on average, we have 22 to 25 times more progesterone than estrogen. This is a normal, healthy balance. When stress occurs and progesterone gets converted downstream, we start seeing a state of what’s called estrogen dominance. We start seeing an excess of thickening of the uterine lining. Women may notice fibroids, endometriosis, and fibrocystic breasts.

These hormone imbalances may manifest themselves at the end of your cycle as PMS, headaches, fatigue, migraines, breast tenderness, and uterine pain. All these symptoms are primarily driven by a state of estrogen dominance.


PCOS (polycystic ovarian syndrome) occurs when androgens in the female cycle become elevated. As androgens elevate in the cycle, it throws off the upstream brain hormones, so communication from the brain to the ovaries becomes disconnected (6).

One of the most important triggers of PCOS is chronic ups and downs in blood sugar (reactive hypoglycemia), or insulin resistance. The elevation in insulin up-regulates certain enzymes in the body (17–20 lyase), which can accelerate the conversion of female hormones to male hormones (testosterone). That’s why it’s common to see acne, abnormal hair growth, and ovarian cysts as a by-product (7, 8).

What’s the Deal with Birth Control Pills?

When we take birth control pills (BCPs), we shut down the upstream signaling to our brain known as the HPG axis (hypothalamus, pituitary, gonadal axis—see picture below). FSH and LH, essentially, are the conductors of this beautiful hormonal orchestra. In this orchestra we have the strings, the flutes, and all the different instruments you can imagine. If the conductor of the orchestra goes on vacation, it’s very easy for this beautiful music to sound like noise.

Taking this analogy back to hormone land, as hormonal imbalances occur due to physical, chemical, and emotional stressors, they essentially mug the conductor. They knock the conductor off the stand, and the hormones start to go awry.

Women who take BCPs do see a benefit. Their hormones may stabilize, which may help their mood, PMS, and skin issues in the short term. The ups and downs of the hormones in the cycle are somewhat leveled out by this artificial, yet steady, bombardment of hormones.

The symptom-relief experience from BCPs is real. There are ways to produce the same results, if not better, through natural hormone-balancing protocols that address the underlying cause of the issues. When the underlying cause is addressed, there is less chance of the typical side effects of BCPs, including weight gain, blood clots, increased risk of a breast cancer, and potential difficulty conceiving down the road.

“Women who were on oral contraceptive birth control pills may experience a few months of being infertile while the synthetic hormones work their way out of their body. Women who were on the Depo shot on the other hand, can experience infertility between six months to a year.”

~Dr. Lauren Streicher of Gynecologic Specialists of Northwestern

Other Available Methods

If you are using a BCPs to prevent pregnancy, there are other natural non-hormonal methods out there. My favorite is the rhythm method (if you are in a stable long-term relationship). Other methods can be used, including a non-hormonal IUD (ParaGard). This can be used in conjunction with a diaphragm and/or a condom for extra security. If your hormones are stable, there is only a small window in your cycle when pregnancy can occur, so make sure proper precautions are made.

HPG and HPA Axis

What You Need to Do!

If you are struggling with hormonal-related symptoms and are looking to get pregnant, there are some action items you should make ASAP!

Step 1

Make the right diet and lifestyle changes to stabilize your hormones and blood sugar for success.

Step 2

Avoid common toxins that may come from pesticides in your food and chemicals in your makeups and hygiene products. The toxins in these products are xenoestrogens in nature and can mimic the hormone estrogen. Most women are already in a state of estrogen dominance, and this bombardment off additional synthetic estrogen only makes the problem worse.

Step 3

Get assessed! If you are not assessing, you are guessing! If you are having hormonal issues and you want to get pregnant, you need to see where the root of your hormonal issues are coming from.

Are the hormonal imbalances coming from a thyroid issue, adrenal issue, female hormone issue, or chronic infection? It may even be a combination of all of them like I see with most patients.

Step 4

If you are confused and not quite sure what the next steps are for you, feel free to click here to schedule a complimentary consult to see what your options are.

Step 5

Take action now! Hormone imbalances left untreated over time always tend to get worse and never improve on their own.



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.