Gut Health and Anxiety | Podcast #227

The good bacteria in our gut are the ones responsible for the chemicals in our brain. Inflammation or anything that can affect your gut especially when it comes to digesting nutrients can cause a big impact on your brain chemicals. But how does really your gut affect or cause anxiety? Find out more!

Today’s episode talks about giving importance to the gut health which is the one responsible for the digestion of our food and vitamins that are needed by our body. One deficiency in the vitamins needed by our body can already affect our brain chemicals, thus creating mood issues and cause anxiety. Listen as Dr. J discusses the topic together with Evan Brand which gives his own personal experience to highlight the importance of gut health. Continue to find out that anxiety is more than just anxiety. Stay tuned.

Dr. Justin Marchegiani

Dr. Justin Marchegiani 

In this episode, we cover:

00:35    Effect of Various Medications, Digestion and Brain Chemicals

08:12    Lab Testing

11:05    Bad Bacterias

12:22    Home and Environment

19:44    Seeing the Whole Picture

16:55    Adrenal Testing

24:48     Thyroid Issues

26:24    Blood Sugar Level Optimization


Dr. Justin Marchegiani: Hey there its Dr Justin Marchegiani we are live here with Evan Brand in the house. Feel free and chime in some of your questions. Today’s podcast is gonna be a part two on anxiety. We’re gonna be connecting gut health to anxiety. We’re gonna be talking about some lab test that we can use to assess the root cause of a-why you may be anxious or moody. So I’m really excited to dive in.

Evan Brand: Yeah man, me too. So I’ll just start with my personal, and I don’t know if you experience much anxiety. I don’t think you’ve ever really said “Hey, I’ve had anxiety” but I definitely did, when I had gut infections. When I had ___[0:35], when I had parasites, when I had bacterial overgrowth, when I had candida overgrowth and when I had kind of a quadruple ___[0:43] that I really think stemmed from me during a round of antibiotics after I got my wisdom teeth and my 12-year molar extracted, you know I had a round of antibiotics after both of those procedures. I think that’s what led to the candida and then probably started to tore away, uh, tear away my gut barrier and then I ended up getting leaky gut situation. You go swimming Barton springs a few times, you swallow some creek water, you get some parasites down in your gut and then all of a sudden everything falls apart and you’re anxious for no reason. So that was at least my, my story, my unusual experience with anxiety ‘cause I’m not an anxious person by nature, but that made me anxious when I had those gut bugs.

Dr. Justin Marchegiani: Totally makes sense. I mean gut health is so important because all of your nutrients get absorbed through your gut. So, just a kind of review of physiology because we wanna connect the physiology and the biochemistry to why you feel the way you feel. That way you’re not just taking doctor’s orders, you’re understanding how these things are working. So, so we have our stomach, where we chew up our food, we swallow, it goes down our esophagus into our stomach. Digestion starts when the mouth gets chewing so just chewing up our good proteins is gonna be huge. That starts the digestion process and increases the surface area for hydrochloric acid, and enzymes in the stomach. So we increase hydrochloric acid in the stomach that lowers the pH it makes it more acidic, like ‘cause pH is lower. And that activates certain ___[02:07] enzymes in our stomach like ___[02:08] which starts that protein digestion process, that nicely enters, that enters into our small intestine, which then triggers ___[02:16] so we start breaking down the fat, fats are important because vitamin A, D, E, and K have instrumental effects on our physiology. Fats ___[02:25] vitamins especially, uhm, you know vitamin d for example, for instance has some effects at helping with mood as well. And we also know vitamin K, and vitamin A are really important for, uh, thyroid function and we know thyroid can have a major implication on mood as well, so low vitamin A, low thyroid. But in general all of these proteins and amino acids and even these minerals, these tranquilizing minerals, like magnesium, help our body relax. They chill out our heart, they chill out our mood. ___[02:55] amino acids get broken down in our stomach. They get ionized in our stomach and get reabsorbed again our small intestine. So we know that digestive processes are so important for these nutrients getting to where they need be is important so we can feel good.


Evan Brand: Talking to your microphone go close like this.


Dr. Justin Marchegiani: Yeah.


Evan Brand: I’m not sure if that’s – I think you might be using your built in microphone.


Dr. Justin Marchegiani: Oh lemme double check that.


Evan Brand: ‘Cause I sounds a little echoey. Go on, uh, go on your little gear box on Hangouts there, see if you see


Dr. Justin Marchegiani: Oh yep, you’re right. How about now?


Evan Brand: Much – a million times better.


Dr. Justin Marchegiani: Okay, I apologize for that everyone. So we got a better mic up and ready to go, ex-


Evan Brand: We, we still heard you but, now we’ve got that show, that studio quality gone.


Dr. Justin Marchegiani: Love it.


Evan Brand: So here’s the deal. Everything you said makes a perfect sense, assuming, you’re actually digesting and assimilating all these nutrients and breaking everything down like you said. And so where the domino goes bad, I mean for a lot of people, it’s just being prescribed in acid blocking medication. So you may think, well, how in the world does anxiety tie in to me being ___[02:55] or some acid blocker. Uhm, the way Justin described it, it was perfect. You take all these amino acids from your dietary protein, assuming you’re eating those. You know for eating a bagel, and, you know, cream cheese for breakfast, that’s not gonna cut it, you know. We’re eating a good, you know, we’re eating a good quality meat, a bacon, a sausage, you know handful of pecans, uh, half of avocado, you know, some blueberries, that’s a hell of a breakfast. If you’re eating that, you’re gonna beginning some amino acids that can be broken down and therefore turned into, for one, create muscle tissue-


Dr. Justin Marchegiani: ___[02:55]


Evan Brand: Uh, create neurotransmitters. But, if you’re on an acid blocker because you had heartburn and you in one visit with your doctor and they say “Okay you need to be on an acid blocker” you could start that whole domino effect against your health just from something that simple and then you end up with anxiety so then you get referred to your psychiatric doctor and they put you on Xanax and, and, and it’s not a Xanax deficiency, it was the acid blocker messed up our digestion, your digestion issues created the inability for you to absorb your amino acids and make brain chemicals. Now you’re anxious and depressed, so then you get put on anti-depressants. So before you know it in three seconds you’re on an anti-depressants, an anti-anxiety, and on acid blocker. And then maybe you can’t sleep good because just as mentioned you’re breaking down these relaxing things like you’re getting magnesium from your diet. So if you don’t have enough of that, or let’s say you don’t have enough B6 to convert serotonin to melatonin, now you’re not sleeping well so then you get on the fourth med which is a sleep drug. I mean this is how what happens, this is why an average person is on multiple pharmaceuticals.


Dr. Justin Marchegiani: Yeah, and I don’t even think you talked about uh, cholesterol medications on there as well, right?


Evan Brand: No I didn’t.


Dr. Justin Marchegiani: Because cholesterol is gonna be the building block for all your hormones so then you have, maybe your cholesterol’s starting to creep up because of inflammation or you’re doing too much carbohydrate which stimulates insulin, insulin jacks up your cholesterol inflammation will also do it too, so for eating inflammatory foods that could do it. And then now your cholesterol’s high, you’re prescribed to ___[05:58] and then the ___[05:59] gonna decrease your, uhm, ___[06:01]  production so now your  ___[06:02] lower. Your building blocks for your hormones are lower and we know ___[06:05] have other conitive mood side effects as well so that’s gonna create more issues. And then from there after that you’re on a libido medication like a viagra, uhm, or something like or xalexa to help with ED and that’s create more side effects and more issues and then God forbid you got some mood issues. You go, if you’re a female now, you got top your conventional doctor, their typically gonna recommend birth control pill or even ___[06:33] on top of that, then you’re just screwed. Because stacking one medication on top of another medication and then all these medication have various side effects that you treat with other medications. And then these medications also create nutritional deficiency. So birth control pills will lower Magnesium, Zinc and certain B vitamins which are really important in ethylating ___[06:55] your neuro transmitters so it’s just really important especially Magnesium for calming and relaxing your heart. For helping, let’s say, be the shifter between your sympathetic and parasympathetic nervous system. Meaning, parasympathetic, relaxation. Sympathetic, stress, go, go, go. We need the ability to downshift from sympathetic of stress and go, to the parasympathetic, relaxation and chill out.


Evan Brand: Well let’s add one more drug to the mix, that are hundred, that are hundred million Americans are on which is blood pressure medication. 


Dr. Justin Marchegiani: -Right.


Evan Brand: And Valsartan and all these commonly prescribed blood pressure medications are all getting recalled now due to containing carcinogenic chemical, you know. There’s like, this type in Valsartan cancer, you can look the research yourself, and these people get put on blood pressure medication because they can’t regulate their blood pressure because as you mentioned, you lose that parasympathetic-sympathetic balance, you’re depleted in Magnesium because you’re not digesting, because you got gut infections or you’re on acid blocker. So now you’re  acid blocker, antianxiety, antidepressant, you’re on like you said, Xalexa, and now you’re on blood pressure, and then you’re on  ___[08:01] at all the same time. None of that is gonna, you know, none of that is gonna contribute to a long healthy life.


Dr. Justin Marchegiani: No, none of it will, man. So really important, we’re trying to get to the root underlying cause here. So, let’s shift gears on the lab testing. There are some lab testing we go to see what’s going on. Number one, just looking at your digestion. Just doing a comprehensive gut test, look at inflammation in your gut. Inflammation in our br- inflammation in our gut will create an inflammation in our brain. That activates the cell called microglial cell, which are essentially immune cells in our brain. When they are activated, they will create a, you know, brain fog. So you know, you know obviously that the more foggy you are, the more anxious you could feel as well. So inflammation in the gut could create inflammation in the brain. So we gotta look at gut functions. We wanna look at a comprehensive gut test, that’s gonna assess inflammation in the gut, like ___[08:50]. Wanna look at your IGA, your immune levels, because your immune system is over active, that could be a sucking up a lot of resources, right. So, for instance, the more your immune system is overactive, that’s like the equivalent of you, let’s just say, leaving the water on in one of the guest bedrooms in your house that you never go to. Water builds huge, and you don’t know why, because you’re not using a lot of water but there’s water being used in the background, it’s kinda like that. You have all these immune resources that are being used in the background, cause your immune system is chronically firing off, so your immune function. Next is looking at various candida overgrowth, yeast overgrowth, which have a huge effect because they produce various acid ___[09:32] and toxic byproducts. And they also create chemicals that makes you crave a whole bunch of sugary stuff. So it becomes harder to stay on a good diet to your template. Next would be SIBO or various bacterial overgrowth. Whether it’s ___[09:44 – 09:48]. These are all bacterial overgrowth that are despotic meaning bad, so we have more of the bad stuff and less of the beneficial probiotics like lactobacillus ___[09:55] and then we have various parasitic infections. ___[10:00 – 10:06] various parasitic infections. And ___[10:08] h pylori which is some kind of bacterial infection too, or worms.     


Evan Brand: I’ve seen a lot of crypto the last few weeks, it’s very interesting because during the winter I didn’t see much crypto so I don’t know if that’s because people, for their self maybe are like, Texas, Florida, California clients maybe they’re getting back in Creekson rivers or streams or lakes for the season or what. But I haven’t seen much crypto and then over the last three weeks I’ve seen, I don’t know, probably fifteen to twenty people, including children, even as young as age 2 or 3 years old,


Dr. Justin Marchegiani: (Crosstalk.) Wow.


Evan Brand: Those cryptosprodium, I tell you for personal experience it causes a lot of stomach pain, nausea, it can cause appetite swing, or sometimes you sit down at the dinner table you just can’t eat, you’re just not hungry and obviously, anxiety belong with that because now, if you’re getting robbed of your nutrition because of crypto, you’re not gonna be absorbing your amino acids, and then you can’t make your ___[11:01] for example. Now, you’re tired, you’re wired, you’re stressed, and you just don’t know why. So, um, you did a great job on talking about stool test, you mentioned the candida, we, you find candida on the stool test when you and I look at that. However, we often find it more accurately on the organic acids panel because we’re gonna measure the gases that candida produces rather than the actual candida itself. So in the stool, we’re trying to find the DNA of candida which is a little harder to do, so we often see a lot of false negatives on stool testing. So this is why, we just can’t quickly compare or contrast your conventional gastroenterologist that you get referred to. They’re not gonna be running these type of tests, maybe on ten or twenty years, that could be the whole standard, for right now they’re not running these tests. So even if they did they called it “stool test”, their stool test could not be probably as intensive as the technology we are using because we are kinda on the bleeding edge here. So that being said, the organic acids’ profile, we’’l look at the gacids. And when we look at the gacids, you can also look at the other fungus too, so we can even look at the things in their environment like mold, because on page 1, of the ___[12:05]  there’s different markers that hide in candida but there’s also different markers that we’ve found that indicate ___[12:11] of mold. So you could have mold in your sinus cavity as so close to your brain it can go to the blood brain barrier and that will cause anxiety too. So now we’re talking about, fixing someone’s sinus infection as well as fixing their gut infection, and fixing their home environment. Their home environment because potentially as we’ve seen people like in Florida had one client who shits too much candida in their house. We did this little petri dishes for her house, she shits so much candida in her house, so much anxiety and we fixed her gut and three months later she’s got a white tongue again. The candida comes back and so we give her herbs again, her gut gets better, and then candida comes back. Say we need to test your house, so we test her house, the candida in her house is off the chart. So now what we did is we did the fogger, we fogged her house with the essential oils and the candida in the house is gone. So now she’s staying free and clear of the candida overgrowth. So, this is why you gotta take a step than even the functional medicine people saying “fix the gut, fix the gut, fix the gut” now you gotta fix the home, microbio home as well as well as your internal microbio home. You can’t just cherry pick.


Dr. Justin Marchegiani: Yeah, and for every person this may not be the root issue but it’s important. Yeah especially if we can do history and you feel bad or coming out of the house or we can even just start with a decent play testing. And even from the ___[13:26] micro toxin collection after that and if we can see, we can put a check in each one of those boxes ___[13:34] confidence that what we have to start dealing with the home environment right?


Evan Brand: Yeah, exactly yes. The home, you know, like, like you said it’s not everyone. Like, I’m kinda over paranoid about the issue now so I’m checking some of the houses. But I’m only finding maybe 20% of the people were testing their home or showing up with the problem. There’s a lot of people coming out, their home is perfectly fine and I just say you know what for a hundred fifty bucks US it’s worth the peace of mind. Work the plates, check your numbers, and worst case scenario I’m wrong and your home is not contributing to your anxiety or other health problems.


Dr. Justin Marchegiani: I hundred percent agree, and also uhm, one of the things that you brought to my attention is very interesting is that you may have no history of water damage or no apparent water damage in your house at all but you may just have a high amount of moisture in your house because of the climate you live in, and one of the things that you did was you invested in a good quality dehumidifier attached to your ___[14:29] to pull the humidity out of the air. Which then makes harder for mold to grow because mold needs that humidity over fifty percent in the house for it to grow so you were able to decrease the humidity because there’s certain times where you may not have an air-conditioner on. Uhm because you know it’s, it’s sixty or seventy degrees out or fifty degrees out but the humidity still high even though the temperature’s low and that’s one of the benefits that you have of having a cool house to humidifier attached to your ___[14:56] to suck out that moisture which prevents the fuel source for this mold to grow.


Evan Brand: Right, and in the spring you’d love to have the windows open right so actually we did this over the weekend, we opened up all the windows. There was one day we have like seventy, seventy-two degrees out so it’s perfect. We opened all the windows up but then I go downstairs and I heard the dehumidifier’s running just in overtime and I go look at the percentage and their up to fifty two percent. So people they opened up their window and mold grows on fifty or above. When you’re like oh, the weather’s beautiful, let’s leave the window’s open for a week straight, you know, or let’s leave the windows open all night or let’s leave the windows open every day all day. That’s allowing all that moist air from outside, assuming that’s the climate’s moist, to come inside, and that’s increasing the humidity in the home. I love the idea, you know, open the windows, ten to fifteen minutes a day, let fresh air come in, wash out from all the ___[15:46], wash out from all the VOCs in your home, but, you don’t wanna do it all the time. A friend of mine, a mutual friend of our’s, Daniel Vitalessi, who lives up in Maine, it’s so moist up there. Uh, I can’t, I don’t remember the full details but I remember him saying about having a mold problem on his previous houses, and it might consider at the podcast, he left his windows open all the time. ‘Cause he like to live in the woods, and he love the sounds of nature and all that so he had his windows open all the time. But I mean all that moisture was just forming on his window sills and so you gotta, you gotta think about the building materials that we’re using. Like our ancestors they were outside all the time, you know, but they had like a buffalo hide, they had bison hide, you know, they didn’t have dry wall, and uh, you know, treated wood and all those sort of stuff. They didn’t have the same building materials that we used today. So, try to compare, “Oh my grandma she lived in the summer and she have air conditioning and her windows are open all the time,” yeah, but her house wasn’t probably made with modern dry wall. So those materials could withstand moisture, our modern day materials are more moisture sensitive.


Dr. Justin Marchegiani: Exactly. Yup, hundred-


Evan Brand: It’s a bit of a tangible. Let’s go back to the testing. So, we didn’t talk about adrenal testing for anxiety, I mean that was one of my problems too is, uh, I would feel pretty good during the day but then at night I would feel anxious before I would go to bed, and I have that night time spike of cortisol that we often see.


Dr. Justin Marchegiani: Yeah, so what we do is we look at the cortisol rhythm throughout the day and then the cortisol rhythm gives you a window to how your cortisol, how the outer part of your adrenal glands are doing. So we look at this high to low to lower to lowest type of taper. These tapers are important because it’s set by our HPA access. So we start to see these regulations lower by the morning or higher at night or it’s kind of bouncing around like we call the pinball effect. It’s pinballing that could create mood issues number one. Number two, we also look at the inner part of the adrenal glands called the medulla which make a lot of adrenaline. Adrenaline or no adrenaline, same thing as epinephrine and norepinephrine, medicine uses a lot of words to say the same thing. So, we’d also wanna look at that, ‘cause if we’re really stimulating a lot of adrenaline or no adrenaline that’s helpful to know so we’d wanna run a good cortisol rhythm test to look at free and total cortisol which is great. We’d also wanna look at some of the uh, amino acid metabolizer or some of these neurotransmitters. Like, we’d look at vanilmandelate  to get a window at adrenaline metabolism. We’d look at homovanillate to get a window to dopamine metabolism. And also you’d wanna get a window into B6 because B6, especially at folate and B12 are really important for methylation. And a lot of these brain chemicals like epinephrine and adrenaline, ___[18:28] they need to get methylated. So we, we need these carbon hydrogens to bind it to methylated, to activate it and that requires sulphur amino acids so if we’re excessively stressed or really methylating our brain chemicals ‘sause we’re making a lot of adrenaline, we’re gonna be burying under a lot of sulphur amino acids as well. And we need sulphur amino acids also to detoxify, we may not have a lot of extra sulphur left over to run ___[18:58] we may not have enough of these sulphur compounds to run these other accessory pathways which are really important for what? Detoxifying us from mold, heavy metals, various organic chlorine, pesticides, or stressors in the environment so that’s why it’s really important to look at these other accessory nutrients that are involved in the stress handling response. 


Evan Brand: Yeah, let’s take what you said. Let’s dig further. So now you’re deficient in sulphur, you’re not detoxifying properly. You do get exposed to pesticides, go out to a restaurant with your family on a weekend and have a good dinner knowingly eating pesticide and that’s gonna kill off good bacteria in your gut. Those good bacteria are supposed to make your brain chemicals so now we go back all the way to anxiety again. So it is this kinda self-repeating cycle. So this why you can’t just focus on one aspect of your body. You can’t just put all your eggs on the gut basket, all your eggs on the adrenal basket. This is why Justin and I don’t really say, you know, you know, word expert at adrenals, word expert at gut, or word expert at this or that, because if you go in with the microscope and you’re just looking with this one problem, like you could see the thyroid, and see that there’s a problem with the thyroid, that could cause anxiety too, right? Like if you have Hashimoto’s you’ve got antibodies that attack the thyroid and you get a little bit of hormone into the bloodstream that could cause anxiety for sure.


Dr. Justin Marchegiani: (Cross-talking.) Yeah.


Evan Brand: I mean we didn’t talk about that extensively. However, if we just focus on thyroid, okay we’ll gonna give you ___[20:24] or something else to calm the thyroid, did we fix the problem why the thyroid is auto immune in the first place. We fixed the immune system attacking the thyroid by looking at adrenals, and gut and chemicals, all that. Or we just give someone herb to calm the thyroid and that was all we did.



Dr. Justin Marchegiani: (Cross-talking.) Right.


Evan Brand: Because if we did just that, then we fail.


Dr. Justin Marchegiani: Correct, and I’m seeing this more and more with various functional medicine doctors that are out there. What I’m seeing there are people, just the thyroid functional person, just the gut functional person. There’s nothing wrong with that marketing stampone, and like I’m gonna market to those people but I’m gonna look at everything once they’re in there, I get that. That’s kinda where my focus is. You wanna reach out the people so they ___[21:06] with you but you’re still looking at the whole thing. I’m seeing people, I’m seeing people only focusing on just the thyroid. Or only focused on just the gut. And then I’m looking at their labs, I’m seeing these people coming to me as patients and I’m like, oh its’-it’s really too bad because had an anemia and anemia was missed because this person was only focused on the thyroid or hey, this person had an adrenal issue or other issues going on and they were only focused on the gut, they didn’t fix those other things. Does that make sense?


Evan Brand: (Cross-talking.) It does.


Dr. Justin Marchegiani: So just be careful. A lot of people out there are focused on, you know they’re focused on, they’re reaching to functional medicine practitioners that are marketing one thing and another for their anxiety but they may be missing in the treatment a whole body system that’s so important. So, when people are out there looking for functional medicine doctors, you know, if you find someone that you like that’s great, just make sure when you interview them, when you talk to them make sure they’re gonna be looking at all the underlying systems, not just focused on one system like the gut or one system like just the adrenals. Make sure you’re looking at the whole thing.


Evan Brand: Yeah, I think over the next five to ten years this is gonna be a bigger problem just because of the Internet. The Internet allows us do what we do, and we are very grateful for the opportunity. But that also allows other people to go pick up some high profile credential and then market a specific flavour of functional medicine. Like, I’m gonna be the hormone girl, and I had a woman last week and she went to this hormone functional medicine specialist and the lady’s loosing hair, in clumps and clumps and clumps every time she takes a shower, and we look at her blood work, and she’s never been – she goes to this hormone lady, I don’t know how, a hormone functional medicine never tested her, never tested her blood, didn’t look at her ferritin, ferritin level was a six. The lady can hardly catch her breath, she’s got major anxiety, she’s losing tons of hair. Like, look at your ferritin, like, if you don’t fix that, you’re not gonna get your hair back no matter what this lady tells you about your bio identical hormone plant. So, it’s just that, it’s – I think it just comes with the territory of this because as you say people are trying to market, but you gotta make sure that they’re turning over all the rocks.


Dr. Justin Marchegiani: (Cross-talking.) Yes.


Evan Brand:  ‘Cause last thing you wanted to do is go spink like two to three thousand dollars and then now you gotta start all over because you didn’t address the other stuff.


Dr. Justin Marchegiani: You want the complete picture. Let’s connect this with some other things. Obviously we have female hormone issues like progesterone, low oestrogen or oestrogen dominance if you’re a cycling female. Obviously we have the menopausal kinda side where the hormones could just be low across the board, and we’re starting to have a lot of menopausal symptoms, from low progesterone, low oestrogen, because now our follicles, our ovarian follicles are used up. And then we have obviously on the cycling side, where we’re having a lot of PMS, a lot oestrogen dominance and we have lower progesterone, and that could be another component because progesterone is a GABA Chloride channel opener. So it opens those GABA Chloride channel in the brain, and allows us to relax. A lot of people could have a lower progesterone, oestrogen dominance, or just lower hormones across the board if you’re on the menopausal side. And the crazy thing is, we can also have similar symptoms if our thyroid is also low. This is why it’s so important to why you cannot just, just create a market and for one thing but it’s really important that you look at the whole component to make sure, other patients were hey, thyroid was the missing key to their anxiety, some it was low progesterone, some it was a combination of the two. And unless you’re treating and looking at it, and also treating it, then you know, you’ll know from you know, from experience what levers is moving what.


Evan Brand: Yeah, and I briefly hit on the Hashimoto’s, I think we should talk about it for a second because this is such a common issue. We’re seeing women with all sorts of different levels of thyroid antibodies. From the tens to the hundreds to the thousands. When the immune system is going after the thyroid, the first thought is, well, we’ve gotta calm down the immune system, we’d better try to stop this attack on the thyroid, but really, it’s fine at the first thought, but really what we’re seeing is we have to be addressing the other causes, if you give someone like a thyroid multivitamin, like it’s got your Selenium, and your Chronium, and  and ___[25:18] and all those stuff. That’s good on a theory but you could stay on a thyroid multivitamin for five years and still never get to the root cause.


Dr. Justin Marchegiani: Absolutely. All the thing that I would think is at the low hanging fruit perspective ___[25:30]. So of course gluten sensitivity can create GAD antiobodies and GAD is glutamate, uh, glutamate decarboxylase enzyme which is the enzyme that helps make, uh, uh, helps make GABA in the brain and GABA is that nice inhibitory relaxation chemical, so GABA’s important, gluten’s a strong component in that ___[25:50] response. But also gluten can drive, uhm, Hashimoto’s and that you will see increase in thyroid peroxidase and thyroglobulin antibodies. And these antibodies are gonna stimulate attack on the thyroid, attack the thyroid, and you may spill out hormone and as that hormone spills out to rev up the metabolism create swings of anxiety there as well.  


Evan Brand: Have you ever experienced that, I mean you talked about your story with Hashimoto’s. have you ever had a day or a week or a time in your life where maybe a stress or, you know, uh, when you first had your son you’ve had like high in stress  did you ever feel like “Oh my God” like “My Hashimoto’s is kicking in”  did you feel that or-


Dr. Justin Marchegiani: I definitely had episodes where I felt like blood sugar fluctuations and that cortisol adrenaline blood sugar swing ___[26:39] issues in the past and I feel that potentially previous gluten exposures have potentially revved up the thyroid and had created some of those symptoms as well. Yeah I have in the past for sure. I tried to medicate that as soona s possible-


Evan Brand: Yeah, but it’s not fun the blood sugar piece you implied you hit them. Let’s, let’s – I know we hit that kind on Anxiety Part One, but with the blood sugar, you know in terms of testing, right? We talked about hormones; we talked about gut, organic acids, etcetera… Blood sugar testing, how simple and easy is that? If you’re feeling anxious, I mean I had a time where I had impending doom. I thought my god, the world’s gonna end, something bad is about to happen. I don’t know what it is, I checked my blood sugar, it was a fifty nine.


Dr. Justin Marchegiani: (Cross talking.) Yeah, yeah.


Evan Brand: I mean, whoa.


Dr. Justin Marchegiani: I know, I know. That’s gonna be an issue because low blood sugar will drive a lot of cortisol adrenaline to pick it up. Now again if you’re fully ___[27:30] adapted that’s better because you have a lot more ketones there but I still think, uhm, even when you’re blood sugar’s that low could definitely create some issues for sure.


Evan Brand: Yeah, so if you have anxiety, I mean, don’t automatically think oh it’s Hashimoto’s, it may might not be. It could be something simple like low blood sugar or high blood pressure. You know when I was having some blood pressure swings, I noticed when the pressure was high, a side effect of that increased blood pressure, was anxiety. So do you take anti-anxiety herbs or do you think blood pressure herbs? For me, it was a combination of both. I took, like, inhibitory things to support GABA, you know ___[28:09] etcetera and I also did some hawthorn berry and  some folate and some other things to help blood pressure. I kinda worked on both. That’s why really, people, you know, email us and say “Oh doctor J can you just give me a protocol for my Hashimoto’s?” It’s like, do you see how bad of a question that is? It’s like we have no idea what the heck is going on. Or can you just give me “Doctor J give me a parasite protocol” We have no idea what’s going on. Like, give me an anxiety protocol. You can’t do that because what’s the mechanism? What is the mechanism behind it? So, you know, in the long run you’re gonna spend so much more money knowing the whole foods or in Amazon buying this anxiety supplement bust, you know, stress busting supplement. Like, might help, probably won’t hurt, but, get the testing done. Get the data, get the rocks turned over. I can’t tell you how much time I wasted just taking this random herb for energy, random herb for sleep. And I had no idea what I was up against.


Dr. Justin Marchegiani: Hundred percent. Well, excellent thoughts here today. I think we laid some, some good references for various mechanisms. How we can go down this path and of course how the gut is intimately connected. And I talked about the auto immune mechanism a minute ago, just kinda gonna dovetail on that because today’s podcast is on gut health and anxiety. A lot of that mechanism happens and works because of gut prebio ability. So with leaky gut and gut prebio ability have that mechanism where we have that undigested, whether it’s yeast or bacteria or foods include in our casein compounds get into that bloodstream through the gut lining right. We have our tight junctions, they open up especially with exposure to gluten and casein and potentially other endo toxins and fungus metabolites. They’re gonna open up these things get into our bloodstream and then our immune system is now exposed to it or these things now exposed to our immune system and can really heighten that auto immune system response now. And then that’s part of what’s going on here. So auto immunity is a big issue especially if someone’s anxiety is connected to a thyroid issue, there’s a good chance that thyroid issue is auto immunity nature, and then acts the part of it.


Evan Brand: Yeah. How simple of a thought. Like your, your dinner at the pasta restaurant could be driving your anxiety in your auto immune condition. Well it’s very well possible.


Dr. Justin Marchegiani: Well, excellent. Today’s a phenomenal podcast. To everyone listening if you wanna dive deeper with Evan head over you can schedule a consult with Evan. If you wanna dive deeper with myself click the arrow we can schedule a consult and dive in deeper. Yeah some of the labs we talked about today we’ll put links down beneath the podcast. You can access some of these labs, uhm, some of the gut tests are really important. Some of the adrenal tests, some of the neurotransmitter metabolite tests we’ll make sure we have links down below as well. Evan, any other questions, comments or concerns?


Evan Brand: I would just say don’t give up if you do need some type of anti-anxiety medication or something prescribed temporarily while you’re working on the root cause. I’m not judging you for that, neither is Doctor J. The point is we want you to get to the root of this and we see so many people that they wanna get off their pharmaceutical medications and they don’t know how. This is your road map to do so keep your head up, keep focusing on “What else have I not done yet? What other rock do I need to turn over My blood test, and my doctor said I’m fine.” Well there blood test probably sucked, get a better blood test, figure out what the heck is going on.  


Dr. Justin Marchegiani: Exactly. You guys liked the show here put some comments down below. I love to hear what you think, like to get suggestions on future episodes. Give us a thumbs up or might share as well. Really appreciate it. Evan, today was great man, we’ll be in touch and we’ll talk this week. Take care everyone here. Bye bye.


Evan Brand: Bye bye. 



Thyroid Testing and the Importance of TSH | Podcast #214

There are different symptoms of thyroid issues that need to be considered in thyroid testing. These are symptoms that are subclinical, the less talked about and the typical. A bit overrated? Find out more and learn from Dr. J’s interactive and live podcast!

Today’s podcast talks about thyroid tests and the importance of TSH. Learn about the symptoms of thyroid issues, the physical assessment of thyroid gland or palpation, addressing different TSH issues and all other factors that may affect thyroid functions. Stay tuned for more!

Dr. Justin Marchegiani

In this episode, we cover:

00:42    Thyroid-Stimulating Hormone

02:38    The Less Talked About Symptoms of Thyroid Issues

03:57    Physical Assessment of the Thyroid Gland

04:36    Poly Autoimmune Conditions

05:40    Indicators used by Endocrinologists to Assess Thyroid Hormones

07:42    Optimal Thyroxine Conversion

08:47    Addressing High TSH Volume

12:32    Other Factors that Affect Thyroid Functions


Dr. Justin Marchegiani: Hey there it’s Dr. Justin Marchegiani. Today, we are doing a live podcast. We’re gonna be talking about thyroid labs and TSH. Why is it important? Why is it- maybe a little bit overrated. We’re gonna go into this. And again, make sure you hit the thumbs up, give me a uhm- subscribe, hit the bell as well so you get notifications. I’m one of the only health professionals that sees patients and does lot of these live, interactive podcast, slash Q&A hybrids. I really wanna get lots of uh- interactive involvement, and I wanna get your feedback, I wanna get your thoughts and I wanna interact in the podcast live information so we can make it even better. Alright, so, let’s dig in.

So, when we’re sessing thyroid function, you know, one of the big obvious things that we’re gonna do is- is blood testing, to look at your thyroid. Now, even before that, you may have thyroid symptoms, you may have cold hands or cold feet, you may have hair loss, outer third of the eye eyebrow issue, you may have mood issues like brain fog, mood issues, depression, constipation, those are more of a subclinical, meaning, let’s say- a typical, like they aren’t typically- they are what comes to mind if you go see your medical doctor when it comes to thyroid. The typical ones are gonna be cold hands, cold feet, hair loss, for sure. The depression, the anxiety, the mood issues, uhm- the constipation, low or slow bowel motility are typically gonna be less talked about, just FYI.

So, we’re gonna- maybe do a palpation. They’re gonna look for thyroid swelling. They’re gonna look for thyroid inflammation. Why would that thyroid be swollen? It could be because TSH is elevated. TSH is the whipping thyroid hormone. Its the- it’s the person that sits on the horse-carriage that whips the horse to make the horse go faster. Think of the conductor whipping that- the harder, and the more he whips that, that’s like TSH going up, tryin’ and get that thyroid to make some thyroid hormone, typically T-4 – tetraiodothyronine. T-4, tetra means 4, ‘kay? And then iodothyronine, so that’s 4 molecules of iodine bound to typically uh- thyroxine molecule that makes your T-4, your active thyroid hormone. That gets converted and activated down the road with the 5-deiodinase enzyme that’s selenium-based, so we need selenium. And we need other nutrients like vitamin-A, copper, zinc, magnesium, uhm- ye- yeah, Vi- Vitamin-C, uh- typically some glutathione, maybe some superoxide dismutase, a lot of good compounds there that are really designed to help with that conversion. Also, cortisol imbalances, too high or too low, same with insulin, too high or too low can also thwart that thyroid conversion.

So your conventional docs’ gonna- number 1, kinda do an audit of your symptoms. Number 2, they’re gonna do some palpation to look at the swelling, could be high TSH, could be an elevation in thyroid antibodies, TPO, thyroid peroxidase , or thyroglobulin antibody. And that could be whipping the thyroid- not quite the same as the TSH but more like someone putting daggers or stabbing your thyroid, your antibodies actually attacking. So TSH is different ’cause that’s your pituitary talking to your thyroid but raising the volume, and that can cause swelling if the TSH goes too high, then we have the thyroid antibodies which are your immune system coming in for the attack. And that’s really trying to attack the thyroid, that’s a little bit different ’cause that can actually cause a lot of long-term damage as well, and a lot of that functional thyroid tissue that makes thyroid hormone can really be impacted and produce less hormone overall, and you may need to actually be on thyroid hormone for a longer period time, if not, your whole life, depending on how long an autoimmune attack’s been going on. For most people that I see, there’s been an autoimmune attack to some degree for at least a decade, typically, before I see them. So, tends to be happening at a very subclinical level for many years, before people even notice any symptoms. That’s kind of a scary thing about it that can be going on for such a long period of time.

Alright, so we talked about kind of the physical assessment, right? They may have you swallow some water, they may palpate just above and below the Adam’s apple while you swallow. So here’s your Adam’s apple, they’ll go and just- maybe just a centimeter or so outside. And they’re feeling, if there’s any nodules, right? Typically, you’ll just feel like a little bump, it’s a nodule, they’ll feel if it’s swollen, where- it’s just- it’s a little puffy, it’s sticking out more the normal. Of course, you need a- a baseline to know what normal feels like. But when it feels a little bit more puffy and kinda sticks out a little bit, once you feel a couple of normal, once you can get an-  a sense of what that feels like, and looks like.

Now it’s a poly autoimmune, TPO thyroglobulin. It could also be potentially Grave’s, but that’s usually a- a minority percent of the cases, usually 1 or 2%, 90, 95%+ are gonna be hashimotos in origin. Now, hashimoto’s is an autoimmune attack that involves TPO and thyroglobulin, and it tends to fatigue the thyroid out overtime, but you can’t hyper off the bat, and then, the Grave’s tends to affect the receptor sites or the stimulating imm- immunoglobulin that causing the thyroid to make more thyroid hormone. Hashimotos can feel like Grave’s in the beginning, so it’s really tough to know the difference. Typically you’re gonna be looking at TSI and thyroid receptor site antibodies to differentiate the two. Again, hyperthyroid symptom with hashimoto’s isn’t that big of a deal. With Grave’s it could be a bigger deal because it can cause potential stroke, because you can really ratchet up those uh- thyroid numbers very-very high, much higher than you could with let’s just say hashimoto’s type of an attack, but, always good to get both of that asses.

Now, most people that are going to see their doctor, they- they’re kinda in this “no man’s land” where the first thing that’s really being looked at, to assess what’s going on is TSH. Now, I mentioned earlier, TSH is like the whipping hormone, right? That’s the con-  that’s the person in the- in the carriage whipping the horse, right? So, they’re looking for that- that whipping to start going up a little bit above. Now, according to the American Clinical Association Endocrinologists, AACE for short. AACE, anything above two and a half, may be a problem. So, we start looking at things a little bit more closely, once the TSH goes above two and a half… me, about 3. Once it’s going above 3, I’m a little bit perked up and I’m paying very close attention. Now, conventional endocrinologists typically won’t care until it goes above 4 and a half, to 5 and half. I always tell patients, “The easy way to cure your hypothyroidism, if you’re diagnosed ‘conventionally’, is if you have a high TSH on the west coast”. Remember, the TSH on the west coast is a 4 and a half. You go to the east coast, its 5 and half. You have a 4.75 on the west coast, think of ship from L.A. to Boston and now you’re cured overnight. I wish it was that simple though, that, seriously, you’ll see in the lab-reference range that changes that easily. So, 4 and a half to 5 and a half I think is a little bit late when it comes to assessing thyroid hormones. Some don’t even care ’till it goes even 10 or even above. So, we like to use that TSH of an indication of 3- 3 or so. But we also wanna look downstream, you wanna look at T-4, 3 and T-4 total. We wanna look at how much hormone that the thyroid actually making. ‘Cause sometimes we see TSH high, right? And then we see T-4 is adequate. Meaning, okay, the thyroid is compensating by making enough thyroid hormone, but it’s having the whipped at horse a lot. Meaning, “Hey, that horse is going that normal speed, but having a whip it a little bit more than we should”, meaning, we’re eventually gonna fatigue that horse out, over time if we have to maintain that level of whipping. So that goes, okay, good- so the horse is able to do its thing, but, over time it’s not a good thing if we whip it that much.

And then we have some areas where we see T-4 starting to drop. And that’s a concern ’cause that tells me that, alright, we’re overstimulating, we’re over-whipping, and the thyroid is still not motivated enough even with that stimulation to make more thyroid hormone, that’s a concern. We also have to look at the conversion downstream ’cause some people, we see, okay, that T-4, that horse is going a good speed, but the conversion to T-3, the active thyroid hormone, doesn’t really fit into the horse analogy, but that active T-3, T-4 is relatively inactive, 300% more inactive than T-3. That T-3 has to convert, and has to- you go from typically like uhm- a T-4-free, and like, let’s say around 1 to 1.5, that has to convert downstream to T-3 and about 3 to 3.5 . And if it starts dropping below that where we have a good level of T-4 around 1 to 1.5, and that T-3 drops into the low 2’s, we got a problem, ’cause that’s a relatively active thyroid hormone being that T-3. So we have to make sure it’s converting optimally, that’s number 1.

Number 2, we have to also address the TSH. We hope- we won’t want the volume of that TSH to be so high. We wanna get that under control as well, and we also wanna make sure the T-4 is good and the thyroid conversions’ good. So, we’re looking at TSH, we’re looking at T-4, number 2, we’re looking at T-4 to T-3, number 3, and then number 4, we’re looking at thyroid antibodies, is that TSH being attacked, or is that TSH compensating because that thyroid that’s being attacked in the hormone is not quite optimum. And then number 5, the 5th variable is gonna be reversed T-3. Are we converting some of that T-4 to reverse T-3? So, we have TSH is the first domino, T-4 is the second domino, T-3 is the third… this is where the T-4 to T-3 co- conversion happens. Zinc, selenium, magnesium, healthy CoQ10, uhm, of course glutathione’s gonna be involved, superoxide dismutase, uh- co- uh- cortisol and insulin. This conversion happens here, we have the sub-conversion which is reversed T-3, and this is the blanks in the metabolic gun. So when we see T-4 going to reverse T-3, that reversed T-3 congest and blocks up that thyroid receptor site and prevents active T-3 from going in there. This is vitally important if we have thyroid issues.

So, most conventional medical docs are looking at TSH, that’s it. Maybe they look at T-4, but, they’re not really looking at it in depth, they’re not running T-4, 3 or total, they’re not looking at the conversion downstream and give very rarely have thyroid antibodies looked at because, well, thyroid autoimmunity doesn’t matter, we’re not gonna do anything from a conventional standpoint, we’re not gonna give immunosuppressant drugs, we’re not gonna give corticosteroids typically ’cause the side-effects are worse than the actual disease. So they’ve kinda made- let’s just say an analysis that we’re gonna save those from more serious autoimmune conditions like crohn’s or also the colitis, those kind of things, ’cause the medications aren’t warranted for the symptoms. But, the problem is, if we see autoimmunity which we know about 50 to 90% have an autoimmune mechanism involved, that means a lot to us functional medicine docs. Why? ‘Cause we’re gonna look at leaky gut, A.K.A. gastrointestinal permeability. We’re gonna look at infections, we’re gonna look at gluten sensitivity, we’re gonna look at certain nut- certain nutrient-deficiencies that are really important for autoimmunity such as low zinc, low selenium, low CoQ10, really important nutrients to run our thyroids. And also CoQ10 is gonna get blocked if we’re taking a statin. So of course if you’re taking any statin medications, you’re gonna have some problems with your thyroid as well, ’cause you’re not gonna make your own internal CoQ10.

So, kinda recapping, right? Conventional analysis, alright: analyze symptoms, palpation. Palpation’s only gonna be good if there’s an extreme autoimmune attack, and then of course, uhm- they’re gonna assess, maybe run TSH, T-4, if you have a better doctor whose assessing the autoimmune stuff, they may run a thyroid ultrasound. Okay, great. So now, we get in assessment of inflammation, typically, not too much will be done with that because the drugs typically are worse than the actual symptoms of the autoimmune thyroid. Next step is how does that hormone cascade look? TSH, T-4, 3, and total. T-3 for you and total, reversed T-3, thyroid antibodies only can even look at T-3 uptake as well. We wanna look at the whole kit and kaboodle. Now, if you wanna dive deeper I’d refer you to other podcast where we can look at adrenal halve ’cause cortisol plays a huge impact. We also know as a female, right? Estrogen-dominance, alright, A.K.A. higher estrogen, lower progesterone relatively speaking.

Progesterone has a big impact on thyroid function as well. And then we add in the elements of insulin-resistance, excess carbohydrate, insulin resistance or reactive hypoglycemia, can exacerbate autoimmunity, affect thyroid conversion as well, and obviously deplete a lot of nutrients just through having a run more glycolysis for our fuel. We tend to burn up a lot more B-Vitamins and magnesium and really important minerals. And then if we add in the extra vector of hypochlorhydria, those stomach acid from gut infections, then it makes it even more apparent, that we don’t have enough acidity to ionize our minerals, get ’em into the blood and be able to breakdown, absorb and digest our fatty acids, cholesterol and amino acids, so it’s quite the cascade. So, most people need to get the full thyroid workup, ge- go to your conventional doc, fine, get at least the big things ruled out. But then once your- once your to- hey, it’s all in your head, you really wanna go see, or they don’t give you much of an option, or maybe they just say, here’s some centroid, the other option with that is a lot of people, when we talk about that T-4 to T-3 conversion, my clinical experience is about 80% don’t make that conversion optimally because of all the other important nutrients that are involved in that conversion. So that’s why you gotta look at the full, complete picture. And most people, centroid won’t get the job done and may make your TSH look pretty, meaning get it back below- get it back to about a 1, but it may not help the rest of that hormone cascade because the conversion is not there, it’s just T-4, and many people don’t have all the other nutrients to make that conversion downstream.

Alright, so I’m live here, I’m gonna open it up to some questions in the topic of thyroid, thyroid health and anything that we can tangentially connect back to thyroid and thyroid lab testing. So, let’s go dig in to what the listeners have to say here, will be got y’all.

Neem writes in, “Low TSH, insulin, bile and cholesterol due to chronic infection, any recommendations?”, yeah. So if TSH is low, that means your hypothyroid, your- your- I mean your pituitary is going basically low, right? You- almost the hypopituitary issue, and if you’re not taking too much thyroid hormone, it’s probably just because of stress and cortisol and inflammation so you have to get the diet right, get the adrenals right, and get the gut right. So, 6 hours on the gut, remove the bad foods, replace the enzymes and acids, repair the gut lining and the hormones, all of it, thyroid, female hormones and adrenals, and then eventually deal with body system too and getting rid of the gut infections.

Hey Ahmet, hope you’re enjoying today’s show. Uhm, Soupper writes in, “Hashimoto’s, high cortisol, please the Vitamin-C”. So, yeah, Vitamin-C’s helpful, I have no problem with that, it’s gonna help with inflammation, no problem there.

Justin G writes in, “Hi Dr J. I am 64 Male, low to normal T-4 and T-3, 6.4 TSH. No swelling, no symptoms other than anxiety. No meds taken. Some evidence of autoimmune antibody. Doc says monitor without meds”. So if you’re having some thyroid symptoms, personally, with low normal T-4 and T-3, I’d wanna know is there any antibodies at all? You mentioned some evidence of autoimmune antibodies, so I wanna know what those levels look like, and I would definitely add in a little bit of bioidentical thyroid hormones to knock that TSH down. I didn’t go into this but I think it’s important. A lot of doctors get freaked out over TSH going too low. I had a patient just before I jumped on today’s uh- live podcast, whose doctor was concerned about TSH that was too low. And this is the problem when were you- actually using thyroid supports, sometimes that TSH can go too low because we’re supporting the thyroid, that the brain saying, “Hey, we can lower our volume because the thyroid’s getting extra support, so let’s lower the volume”. Now, when that TSH go so low, let’s say below .3, a lot of doctors get concerned of grave disease. Remember, we talked earlier, grave’s is uh- autoimmune attack where it affects TSI, thyroid stimulating immunoglobulins, or TSH receptor antibodies where it stimulates the thyroid to make more thyroid hormone. So when they see TSH low, they’re thinking that maybe a grave’s attack that’s hyper stimulating the thyroid. But, really, it’s just we’re giving a little bit of thyroid hormone and we’re- we’re focusing on the thyroid hormone being in the therapeutic range and not necessarily worried about the TSH being in the right range. The problem is, TSH, when we give exogenous thyroid support or hormones, the TSH tends to be more receptive to these exogenous hormone than the actual tissue is. So, what does that mean? My analogy, my famous analogy is, go outside and try to figure out on the hot- in the hot day, what the temperature is by touching the sidewalk. Well, the sidewalk conducts heat, more or better than the air temperature does. So, a hundred degree outside in Austin, is gonna be like a hundred and seventy degrees or- like a hundred and fifty degrees sidewalk. So, your pituitary is like the sidewalk in this analogy, it’s more sensitive and picks it up so, you tend to see a lower TSH when we give thyroid support. Now, problem is, if we base everything off a TSH, we tend to be under supporting the thyroid hormone levels. Meaning, if we’re shooting 50% to 25% of the reference range, right? So if we have a range of let’s say T-3, T-3 is like between 3 and 4 and a half. Let’s say we’re shooting for 3 and a half to 3.75, we may undershoot it if we’re trying to just hit the TSH. So, essentially, you wanna look at the thyroid hormone, you wanna look at the TSH too. Ideally if we can have the TSH not go below .3, maybe ideally have it settle around 1, that’s great. But sometimes, my patients that, their TSH is at 1, but they still have low thyroid symptoms, we go up another grain with their thyroid support and it’s like boom, the symptoms are gone. So, what should we do? Should we make the TSH in the lab look pretty? Or should we focus on the patient’s clinical outcome, their symptoms, and their actual thyroid hormone levels. Meaning, let’s say they’re in the top 25% of the range, that’s where their symptoms go away, but at the top 25% of the range for T-3, 3, that may cause your TSH to go a little bit low. But if we go let’s say, 50% of the range for T-3, their TSH looks perfect but some symptoms creep up. So you got to gotta weigh out all the options. A lot of doctors, even some natural ones, prioritize TSH over the patient’s symptoms and thyroid values. I weigh both of them up. Sometimes we can do both, sometimes we can’t. So we have to look at all of the issues. Are we addressing the adrenal issues, check. Are we addressing the thyroid issues, check. Are we addressing any female or male hormone issues, check. Are we fixing the gut, check, are we supporting the nutrients that help the thyroid get better? Are we supporting blood sugar and insulin resistance. If we have to look at the whole, entire picture, if you just look at the thyroid and your whole treatment plan off a TSH and these numbers and that’s it, maybe missing the forest for the trees, so to speak. So, we gotta have a complete perspective we have to take, the TSH and the T-4 and the T-3, all in context ’cause most people on the conventional side, they prioritize the TSH, partly because that is the main thing they are looking at to analyze grave’s, and I think because conventional medical doctors are conce- overly concerned about grave’s ’cause it can mean stroke or heart attack, so they are v- you know, are thyroid storm essentially, so they are hyper focused on the TSH where in- in functional medicine land, we look at the the full thyroid hormones typically, so if there is grave’s we’re gonna see it down the road with T-3 being excessively high, and our T-4 being excessively high, and then we’re rule it out by ordering additional thyroid stimulating immunoglobulin and TSH receptor antibodies as well. We won’t just ever take it for granted.

Okay, let me keep on rolling guys. I went into a pretty in depth on that one, but hopefully it was helpful. Uh, “T-4 to T-3 conversion issues?”, yeah, that’s gonna be nutrients. Uhm, the 5-deiodinase enzyme is gonna be an important enzyme, it’s selenium-based. It comes from the liver. So liver stress, liver issues, toxic livers, low selenium, low glutathione, uhm- magnesium, zinc, important digestive nutrients and minerals, Vitamin-A, cortisol higher or low, insulin too high or too low. And this is probably why lower carb can sometimes cause low thyroid symptoms, we had a little bit of starching, boom, low thyroid goes away, or the other way around. We see high blood sugar, we get the blood sugar under control, we go on a keto-paleo template, and then boom, magically, insulin gets better and thyroid gets better too. So we gotta look at everything is connected, alright?

Uhm- pa-pa-pa, Ahmet writes in,”Hypoglycemia, autoimmune relation…”, yeah, so when you have reactive hypoglycemic, blood sugar swings, this is when you make- consume too much carbohydrate, alright? Not enough proteins or fat, or you’re just going too long between meals and then you’re eating a bunch of carbs, blood sugar goes up, and then your body over secretes insulin and it crashes. And the crash is the reactive part, meaning, you’re going, you’re reacting into low blood sugar because the pancreas made extra insulin. And that drop creates lots of cortisol, lots of uhm- adrenaline to bring that blood sugar back up. So, what you’re seeing is lots of cortisol and blood sugar, cortisol and adrenaline surges to bring back up that blood sugar if you will.

“Would very high TSH and normal T-3 and T-4 in postmenopausal women mean adrenal issue due to estrogen dominance?”, “Would very high TSH and normal T-3 and T-4…”, potentially, I mean, it’s one thing that would be on our checklist that we’d wanna cross often. Make sure it’s not a vector. So, yeah, it’s potential but it could be autoimmune, it could be other things with the adrenals too.

Uh, “Best grave’s treatments?”. So, I mean, we treat grave’s the same way as we treat hashimoto’s in general. Of course, if thyroid hormone’s really high, we may recommend PTU or methimazole which is a- the conventional drugs that actually block iodine uptake, or we may use more natural things like carnitine, or lithium lithium orotate, uhm, or blue flag, various herbal compounds. Again, it just depends on how severe, how bad the symptoms are, and we wanna look at the numbers. Make sure they’re not too high. Typically, refer out to an MD just to get stabilized while we work on all the other underlying things, gluten as well is a big one. But you wanna have a good conventional MD as well as a functional MD. The problem is, a lot of conventional MD’s can over-freak out, and sometimes I had some patients get recommended to get their thyroid removed right away, which is a terrible move, right? You kinda- you gotta understand what’s going on here and try to give the body a chance to get back in the balance as long as the levels, let’s just say aren’t excessive, and we’re having cardiovascular issues, worst case, we use a medication to stabilize while we go deeper.

Uhm, Sherry write in, “Do I still have grave’s disease if my thyroid has been completely removed; it’s been 2 yrs and my levels are all over the place”. So, number 1, you never actually get your thyroid all the way removed. Getting your thyroid removed is like ripping up gum on your shoe. And it’s probably always gonna be some, and some of it can grow back, not all the way but you may have some grow back. And then number 2, the underlying autoimmune stress is still there. So you have to get the autoimmune mechanism whether it’s leaky gut, or other nutrient issues or gut permeability or infections or foods, you have to slow, get the underlying mechanism removed, right? Why there’s grave’s or hashimoto’s, or an autoimmune thyroid, a- happen. Well, what happens, ’cause the conditions are just right. If I remove my thyroid, does that change the conditions being just right? No, it doesn’t.

Lisa writes in, “What are appropriate levels for reverse T-3?”. Ideally between 10 and 20. 12 and 20-ish.

Yoli writes in, “Dr. J., my lymph node on my neck is swollen and it’s uncomfortable and painful what can i do if anything, uhm, to help… and can I continue doing my sinus rinse?”. Yeah, continue doing your sinus rinse. Obviously there’s swollen lymph nodes in this area, so there’s obviously bacteria or your lymph system and your macrophage are trying to gobble up stress in the throat area. So, adding ginger, add natural things are gonna help with flushing out the lymph. You could do lymphatic massage right here by the back angular of your jaw, and you can just do kind of clo- kinda clockwise turning and massaging, like this, and then you can just drain one side right into the- thoracic cavity, and just drain it all down, that’s helpful. You could also add in some burdock tea which is great for the lymph, and or ginger tea, and you can even throw in some red roots or red clover is great for the lymph. But something is going on with your immune system it’s attacking stuff, and it could just be bacteria and junk that’s making you sick so continue with the sinus rinse because any mucus here can go down the Eustachian tube and then- and then go to your ear and create an ear rakes, so you wanna keep your sinuses flushed out with Xlear and Neomed, that’s fine. And also make sure you’re doing the ginger and/or some immune support or you can even do some Reishi mushroom to make sure you are fully supported.

Emmah writes in,”Graves’, pins and needles on my feet. and extreme discomfort. Hair loss and eyebrows. On neurontin, not as effective anymore”. So, yeah, you gotta go see a conventional MD. More than likely Emmah, all the issues that we talked about in today’s podcast are happening to you, and you need to get a full workout to see which one’s are the top priorities.

Roshan writes in,”Outside of hashimoto’s, what are the hardest to cure thyroid issues? Are most thyroid issues completely curable?”. Uhm, it just depends. The more severe the autoimmune attack is, obviously the harder, especially if- it’s because of infections and leaky gut, and there’s lot of other autoimmune conditions like let’s say you have, uhm hashimoto’s but you also have rheumatoid arthritis, or crohn’s, right? It’s something called PGAS, polyglandular autoimmune syndrome. If you have one autoimmune condition, there’s a- a 76% chance that you have a second autoimmune condition. And if you’re a female, it’s even higher. Uhm, females have issues because of the fact that they have more estrogen than guys, right? Part of the reason why they’re fertile and the women, in general, that higher amounts of estrogen can throw off the CDH, CD4 cell balance and make them more prone to autoimmunity. So, that estrogen can really have an effect in the- and the more the estrogen dominance goes into effect, the higher risk of autoimmunity, ’cause that CDH, CD4 ratio. CDH being the natural killer cells, the T- uh- the CD4 being the natural- or the helper cells. When that balance goes out of whack, increased autoimmunity, that’s why estrogen dominance is such a big deal and needs to be addressed. And again, that also includes environmental estrogens, right? Pesticides, round-up, uh herb- herbicides, rodenticides, uh- fluoride in the water and junk in the water, birth control pills in the water, hormones in the meat, all of that stuff, hormones in the milk, all of it.

Rhonda writes in, “Is it bad to have any TPO antibodies? My levels are 9”. No, that’s okay. It’s natural to have some antibodies because there’s a natural recycling process that happens, we just don’t want it to be excessive. So, like LabCorp uses a range of I think 34 or higher as positive. I think Quest uses 9, so I typically say keep it below 15-ish, and that’s pretty good.

Roshan writes in, ” How do fungal or bacterial infections drive hypothyroid?”. Well, I mean, bacterial and fungal issues can increase leaky gut, of course, bacteria contains lipopolysaccharides, fungus consain- contains acid aldehyde and mycotoxins that are put stress in the liver, uh, more leaky gut, and of course they can eat and uhm, that cause malabsorption of nutrients as well.

Paul writes in, “Could Hashimoto’s cause Crohn’s? Or other way around?”. Well, no, basically, hashimoto’s and crohn’s are the effect. None of that’s the cause, right? These are the effect, crohn’s, hashimoto’s, rheumatoid arthritis. The underlying cause can be a combination of genetic predisposition, which is then triggered by gluten sensitivity, by cortisol fluctuations, by insulin resistance, by inflammation in your diet, by high amount of Omega-6 to Omega-3, nutritional deficiencies, gut infections, poor sleep, right? So, of course, genetic predisposition, is what loads the gun, what pulls the trigger is gonna be the stressors that I just mentioned and then the effects are hashimoto’s, crohn’s, RA. Now, the difference is, you may just have that gun ready to go and that hammer already backed, right? So, you’re more predisposed. Or others, let’s say that can actually put the bullet in, cock the hammer back and pull the trigger, meaning, a lot more things going on for a lot longer for that effect to happen. But either way, we have control if we pull the trigger or not, whether your guns are already loaded, we still have control over- over you pulling the trigger.

Yoli you are totally welcome there. Uh, Paul writes in, “How does low thyroid give cold hands and cold feet?”. Well, because thyroid hormone controls metabolism, and that’s basically the sum of all chemical reactions in the body. So, of course, uh- the more chemical reactions you have which is controlled by your thyroid hormone, which increases metabolism, the byproduct of your meta- having a healthy metabolism is heat. It’s kinda like, you know, do you get enough heat to keep you warm from a small fire or a large fire? Well, a large fire, why? Because there’s more reaction with the oxygen and the fire and the wood, right? And that gives off heat as the byproduct, of course. So, of course, you need more fuel, you need more metabolic reaction happening, more metabolic reaction with the air, and the combustion of the- of the wood gives you more heat. It’s the same thing with what’s happening in your body. And then of course we need thyroid hormone to be able to break down cholesterol and breakdown our hormone metabolites and hormone building blocks so we can make more female, or male, or adrenal hormones too. So, when you have low thyroid it can affect a lot of your other hormonal systems as well.

Rhonda writes in, “Are all thyroid hormone tests reliable (ZRT, Everlywell)?”. Well, great question. I mean, when it comes to some of the ones like ZRT or- they have some good spot tests. I- I’ve use ZRT, I use their spot test only if someone does not have a conventional lab to get an actual draw on. My concern is, I used to run some of the Theranos test like couple of years ago before they went out of- out of business, uhm and I found, I would compare ’em to like LabCorp, Quest and they were very inaccurate. So, the spot technology, meaning like it’s a little finger spot, hmmm- it- it’s getting better but it may still be off a little bit so I only use ZRT or the spot ones if someone does not have a lab test within 3 hours. If not, we run a- a Quest or LabCorp, which is pretty standardized. You need more blood to run those so it’s hard to do it with the spot. Meaning, just a little finger print one like you went on a blood sugar meter. Uhm, but the technology is getting better but if I can run a Quest or LabCorp and actual, you know, vial or 2 is run, and that is always better.

Let me jump on to Facebook here and give here and give you some Facebook love. Sorry you guys, I did not given you the attention here. Alright, Annie writes in, “So, a whole bunch of…”, let’s see here, “…I was 17 years old. Ever since recent illness resulting in gall bladder removal, my body has been out of whack – gut issues, anxiety, never had that before”. Yeah, I mean, here’s the deal. If you don’t have a gallbladder, it probably means you have hypochlorhydria, it definitely means you don’t have enough bile salts to break down fat. You’re gonna have a hard time probably breaking down protein and fat because of the- the low stomach acid and the low bile. And that puts you in the position to have a lot of nutrient i- issues, so you really have to work with a good functional medicine doc to get the diet better, to get the digestion better, and to get your hormones better. Lot of issues going on there.

And Lara writes in, yeah, gluten is huge, I totally agree, it’s a big issue. It’s a one of the major drivers of leaky gut. So here… “Without giving synthroid can we cure better hypothyroid situations?”. Well, I mean, yeah, if there’s an autoimmune attack, as long as we’re getting the autoimmune attack under control, synthroid will help bring that TSH down which helps prevent whipping of that thyroid, right? Remember, TSH, the whipping of TSH is not the same as an autoimmune thyroid attack. Not the same but still, it’s still stimulating the thyroid. So, by giving a little bit hormone that does bring that TSH which is good. Lots people were concerned about, you know, excessive bone loss, or thyroid nodules with TSH going too low. Uhm, but again, err- from my s- situation here, as long as it’s not excessively too low from grave’s, you’re more than likely okay. Just make sure your doctor’s monitoring your thyroid levels.

Megan writes in, “Can excessive sweating in warm weather be your thyroid?”. Hard to say, I mean, it’s pretty normal to sweat in the warm weather. Uhm, I would just run a basal body temperature test and- and make sure you’re utilizing your, you know, regular indoor room temperature. That way you’re not using any extreme high, low, to assess your metabolism. So, we wanna be between 97-8 and 98-2 for an axillary temp, armpit, and 98 to- to 98-6 for your oral temp. Do it first thing in the morning before you move around and eat.

Paul writes in, ” When is last time your hashimoto’s gave you issues Dr. J?”. I- I’ve been able to keep it under control. I mean, my levels, my TSH stays below beneath 2, my T-3 stays above 3, my T-4 stays between 1 to 1.5, my antibodies stay right in the border, been able to keep in control.

Donna writes in, “Is intermittent fasting ok with hashimoto’s?”. Only if it’s in control. Only if it’s stabilized and in control. If it’s not, do not do it. Make sure you’re having your hormones stable first.

“What nutrient support the pancreas?”. Well, I mean, of course, for you to give enzymes- for you to give more enzymes to prevent the pancreas to have to make extra enzymes, we’d give a stomach acid to help. Those are gonna be the big things is, you know, the exocrine function of the pancreas which are gonna be enzymes and lipase, enzymes, pancreatic, proteolytic, or cer- essentially these are- they’re pancreatic enzymes and they have proteolytic function, meaning, protein, and then lipolytic functions, meaning, fat digestion. So we’d to give a lot of those things to take stress off the adre- uhm, the pancreas, and we give more acidity as well to the stomach which is an important trigger of pancreatic enzyme sec- secretion.

Ahmet writes in, “Hypothyroid situations. Some doctor recommends low fat, low calorie diet. Is it true?”. I mean, would some doctors recommend it? Yeah, it’s terrible. Go into PubMed, type in “hypocaloric diet”, and “hypothyroidism”, low calorie causes low thyroid. It make sense because if the sum of all your chemical reactions, essentially your metabolism, right, is controlled by your thyroid and you stop giving fuel into your thyroid, or meaning, you sta- you start giving low calorie I- A.K.A., low nutrition, low fuel, you are not gonna have enough nutrients to run your thyroid, and that’s gonna cause low thyroid hormone functioning. The same thing, if I put less gasoline in the tank of your car, eventually you run empty. It’s the exact same thing.

Rhonda writes in, ” If my basal temperature is in the lower 97 degrees, is that thyroid problem?”. May- maybe not, it really depends on your symptoms, and it depends on what your thyroid test says as well. I don’t ever go all one- all in on the- the basal temp, because that can be other issues, and sometimes that can just be a broken thermometer too, so we wanna look at your symptoms, and we want to look at your hormone levels.

Alright, jumpin’ over to Facebook, “Hypothyroidism and diabe…” uhm- “Hypothyroid and diabetic, have beginning of gastroparesis and concerned of the meds prescribed… Armour, might not be metabolized if it sits in my stomach too long”. So, yeah, so- if we have digestive issues Kathi, I definitely recommend absorbing your thyroid hormone in your mouth sublingually to bypass a lot of that, then swallow after 1 to 2 minutes. But you wanna work with the good functional medicine doc as well.

Uhm, Rejjiie writes in, “Been suffering from autoimmune thyroid condition for the past few years. My throat was enlarged, but after taking some herbs mixed with garlic, pau de arco, oregano leaf, zinc and Vitamin-C, it has gone back down”. Yeah, a lot of those herbs are also anti-microbial, so I wouldn’t be surprised if there’s some gut issues, bacteria, yeast or fungal that could be part of what’s stressing out the body, it’s very possible.

Alright guys, I think we answered a lot good questions here. Just make sure you guys sign up for the thyroid reset summit. We’re gonna go into all these things. I have 30 experts that I’ve heard, interviewed, amazing interviews where we go into depth in all these different topics. So, totally free to sign up,, you’ll be able to see my own personal interview, Evan’s interview, and a bunch of other amazing expert’s interview. You guys are gonna love it, and it helps support the channel, and it helps support more content coming to you. So, appreciate you guys signing up, and I will be back tomorrow for a live Q&A. I’m trying to get better at giving you guys heads up, so sometimes I’m like, “Oh, a patient”, like, you know, is “mister console”, I jump in, or at the end of the day, and I put my sun down for bed, I have a half hour free, let me jump on. So, I’m gonna try to get better like giving you guys, what, maybe 24-hour heads up. Let me know how much time you want, put your questions down below, I’ll answer it later. And uhm, let me know future topics, future live podcast topics you guys would love to hear about. I love being on the fly and dynamic so we can make the show interactive ang get your questions answered. So, I appreciate it, you guys have a phenomenal day, and I will be back tomorrow. Take care, bye. 


Xlear Sinus Rinse Kit

Hashimoto’s Triggers – Autoimmune Thyroid – Podcast #143

Hashimoto’s Disease - Autoimmune Thyroid

Dr. Justin Marchegiani and Evan Brand talk about the different causes and triggers of Hashimoto’s disease. Find out how it is connected to one’s immune system, diet and gut health and learn why women are more susceptible to having it.

The thyroid, adrenals and gut health are important factors to consider in addressing Hashimoto’s disease. Listen to this podcast and learn about the natural solutions and beneficial supplements to support them.

In this episode, we will cover:

01:29   Hashimoto’s Disease

09:24   Socialized Medicine

13:40   Use of Secretory IGA in Measuring the Immune System

15:39   Women and Stress-sensitivity

18:24   Ketogenic Diet, Insulin Resistance and Hashimoto’s







Dr. Justin Marchegiani: And we’re back! Evan, it’s Dr. J. How are we doing, man?

Evan Brand: Pretty good. How are you doing?

Dr. Justin Marchegiani: Good. I’m loving the ambience. My new plantation shutters in the background; just loving that there. Just nice. Ready for an excellent day. Got a little lunch break here. I’m seeing patients all morning. Ready to drop some knowledge bombs, and then get back to patients in the afternoon. How are you doing, on your afternoon?

Evan Brand: Yes. Likewise, same story. I had a female client this morning, who I was telling you over air. We had run her blood work before…

Dr. Justin Marchegiani: Uhhmm–

Evan Brand: …previously. And it was basically just a checkup. I said, “Hey, why don’t we check your thyroids?” She didn’t really have hyper or hypo symptoms, and she showed up with thyroglobulin antibodies, which is one of the type of antibodies you and I test our clients for on blood. And she showed up with a level of 50. And we should see that, as minimal as possible. I mean, hopefully less than 1, but she’s had a 50. And she said, “What’s triggering this?” And, we can go into that today, but I was hoping you and I could really outline a lot of different causes and triggers of Hashimoto’s because it’s so common in our females, we see it every single week. It’s like – well, there different triggers for different people. So, hopefully, we can try to go into a couple of different arenas here, and talk about the big puzzle pieces.

Dr. Justin Marchegiani: I like that. And then people on Facebook, we also got Evan’s audio on the background, too. So, if you’re listening on Facebook, go over, jump on YouTube, justinhealth.– or and vice versa with YouTube. Get on the Facebook page so you can get this live feed. We’d like to them and do our Q&A’s too. So this is great. So, a hundred percent. Hashimoto’s the big issue, vex about 30– or thyroid issues, about 30 million people in this country, uh – I’d say, at least, hmmn– I’d say a quarter of probably undiagnosed, or at least undertreated or undersupported because they’re given synthetic thyroid medication. That’s– is T4, right? T4 in origin. And then you have these various enzymes called D2 and D3, that help convert and activate thyroid hormone. And the problem is those enzymes, if you have Hashimoto’s, there’s a good chance that D2, D3 and even D1 enzymes are not working optimally, so then that conversion of T4 to T3 – that inactive thyroid hormone to active T3, about 400 percent increase in the metabolic activity of T3 versus T4, those enzymes aren’t there for the conversion. So that’s a big issue, right? [crosstalk] And not to mention, when you take a thyroid hormone, you’re getting a T4, right? But you’re also getting T3, right? Triiodothyronine, which is your active thyroid hormone, you’re getting T2, which isn’t even tested, right? T2, uh– Diiodothyronine, is a metabolically active hormone, only measure in the research settings, and not even really talked about in conventional medicine, T1, T0, Calciton, which is very helpful for Calcium metabolism. So, again, we’re not getting that in our conventional thyroid medication. The big thing is those D2, D3 enzymes that you’re missing, that T4 to T3 conversion with. So lots of people are being medicated with thyroid hormone, right? Synthroid, Levoxyl, Levothyroxine. Though TSH comes back in the normal range, so they look good on their conventional doctors uh– thyroid test, but they still have all these thyroid symptoms, right there. The thinning hair, the outer third of the eyebrows, swelling of the hands and feet, anxiety, mood issues, constipation, depression, and they’re not getting better.

Evan Brand: So, why? What’s up with these enzymes? What’s happening to them?

Dr. Justin Marchegiani: Well, I mean, there’s the underlying physiology, typically, inflammation, right? Inflammation is what drives people into that disease, or pathological state, right? And that pathological state means more symptoms, right. All the things I just mentioned, the moods, the digestive stuff, uhhmm– the hair loss stuff, the energy, the weight gain, all those things are gonna be affected. Now, a big component we talked about it, ‘cause a lot of these issues, right, thyroid-based things are gonna be autoimmune in nature, so autoimmune means your immune system is actually attacking your thyroid gland, so you have these antibodies, like TPO or Thyroperoxidase, you have antithyroglobulin antibodies, and these are primarily with Hashimoto’s, for instance, and they come and they attack your thyroid gland. And that’s about 90 percent– let’s say 50 to 90 percent are autoimmune in nature, so you and your conventional medical doctor or your endocrinologist says, “Oh, here’s – here’s the conventional thyroid pill.” They’re not actually getting to the underlying immune– immune imbalance, right? They’re not fixing the underlying things, like gluten, right. Grains and gluten, and that molecular mimicry that happens where your immune system can be exacerbated ‘cause of Gluten. That’s the one, one really big component. Couple of others will be gut – the gut issues. So, small intestinal bacterial overgrowth, gut bacterial imbalances, infections, H.pylori, Blastocystis hominis, uh– Lyme or Borrelia burgdorferi, uhm – Yersinia enterocolitica. So those are just a lot of gut infections that can significantly affect your GI. And again, that sulphatase enzyme in the gut made by healthy bacteria, really helps to activate, that thyroid hormone really helps to upregulate those D2, D3 enzymes to get your T4 to T3. So, all that technical jargon, what the heck does it mean? We’re trying to get your– your active thyroid hormone up higher; that’s the goal. Your T3 levels, get them up higher because, just doing it on the conventional side, and say, “Hey, let’s give you uh– a synthetic thyroid hormone.” That may not be enough to actually get the end stage thyroid hormones better. It may make the upstage TSH look better but not the downstream T4 and T3.

Evan Brand: Conventional, like the National Institute of Health, though, say that the Hashimoto’s affects one to two percent of people in the United States. Do you agree? One to two percent or do you think it’s much greater?

Dr. Justin Marchegiani: So you’re saying– repeat that question, one more time for me.

Evan Brand: National Institute of Health– is it – do you heard– are you hearing echoes? Is that messing you up?

Dr. Justin Marchegiani: No. No problem. I just got a comment here. Someone’s saying they’re not hearing the audio on the YouTube site. [crosstalk] You guys are hearing the audio, give me a thumbs-up here, but I think we’re looking good.

Evan Brand: Okay. So, National Institute of Health, they say, “Hashimoto’s affects one to two percent of people in the United States.” I think it’s much, much higher. Izabella Wentz, I think she gave a number that was much, much higher too. What’s your take on this percentage here?

Dr. Justin Marchegiani: Yeah, I think it could be much higher, for sure. I think it could be much higher, and the big issue is that most doctors they aren’t testing for thyroid antibodies. That’s the major issue. Uh– we talked about a patient this morning over in Canada, whose doctors aren’t uhm– they aren’t even testing for thyroid antibodies. And the big reason why is because, think about it, right? If the solution is a synthetic thyroid hormone, like Levoxyl, or Synthroid, or Levothyroid, right, if that’s the ultimate end game, and that doesn’t change whether there’s autoimmunity or gluten issues, or infections, then it stays the same. Why change that, right? Why change that variable up because they’re not gonna do anything different if something else comes back, right? Does that makes sense?

Evan Brand:  Yes, it does.

Dr. Justin Marchegiani:  Even though 90 percent are autoimmune in nature, right? Even though 90 percent of thyroid issue’s autoimmune, they’re not gonna do anything different anyway, so why even look for it? Because then, it just creates more questions the doctors have to answer, and they don’t like to answer questions they’re not prepared to uhm– to answer. Most people…

Evan Brand: And they’re not trained, because if antibodies do come back, they’ve got nothing. They’ve got no way to talk about Klebsiella and Citrobacter bacteria that need to be treated. Uh– yeah, and so uh – just to give a little bit more back story on the Canada, so– you know, Justin and I both have clients in Canada.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And they’ll say, “Hey, we’ve got health insurance over here. It’s free.” But there’s a catch to that. It’s not that good. All they’re gonna do is they’re gonna run, like, a one-marker, like maybe TSH, and then based on that they may give you a prescription drug. But if you don’t have your free T3, the reverse T3, the TPO, the TG antibodies we talked about, may not always using Algin, maybe you tell me there’s a better analogy, but mine is: if you just have TSH and you’re trying to treat thyroid, it’s like touching the sidewalk and estimating the forecast.

Dr. Justin Marchegiani: Yeah. That analogy sounds really, really familiar. I don’t know why.

Evan Brand: There’s no way you came up with that. I’m pretty sure…

Dr. Justin Marchegiani: I came up – I came up with that one. That’s been around for, like, six or seven years, ‘cause that’s how I teach my patients about TSH– TSH. The receptor sites in the pituitary are hypersensitive. The thyroid hormone, therefore, uhm – TSH will drop– will drop more precipitously because the brain is sensing thyroid hormone being a lot higher then what it is. So, peripherally, the thyroid hormones never get high enough and the periphery in the actual tissues but it’s– it’s high enough in the brain ‘cause the brain’s more sensitive to thyroid hormones. So, TSH will always drop faster than what the peripheral tissues need uh– in the periphery there for thyroid hormone. That’s why you don’t want to base your dosing or your support of the TSH 100 percent, ‘cause the TSH is so sensitive. Touch the sidewalk outside when it’s a hundred degrees out, it’s gonna be able to fry an egg on it, right. But again, the air temperature will always be a lot cooler. The peripheral tissues will always be less saturated with thyroid hormone uh– than the latter. Make sense?

Evan Brand: I’ll give it– I’ll give you a credit. It must have rubbed off of me then, if you had that one before. [laughs]

Dr. Justin Marchegiani: It did. I do– that’s mine. That’s uh– that’s a Dr. J-ism. But I’m– getting back on your thing, man, yeah. Socialized medicine for the most parts thinks– Okay, I’ve seen patients from all over the world. All over the world, Europe, Canada– Socialized Medicine’s great if you only need it for acute traumatic issues, right? You sprain your ankle, right? You have to go to the ER, ‘cause of some reason. But outside of that, if you getting stuck on that chronic conventional model, all you have for options are conventional drugs, right? And then number two the waits are like, three to six months to get in. Again, this is what happens. I have hundreds of patients where I’ve had this story, literally had this story they literally told me over and over again. And then because everything is socialized, the government says we’re not gonna reimburse. Reimburse then guess what happens. There’s not a market place for it, right? There’s less people going underground. Now, I do have people over in Canada that are functional medicine doctors and they’re doing– they’re thriving even in a socio uh– even in a uhm– sociological medicine society there, right? Even with a socialized medicine society because, people aren’t getting better even though the medicine’s free they’re still going in paying a lot of functional medicine doctors. And again, we start today. Why am I hampering on this is because, that doctor wasn’t running TPO or any of the thyroid antibodies. So, the socialized medicine said, “Nope. We are not gonna test your thyroid antibodies. We deemed that not appropriate, and this person needs to know they have Hashimoto’s so they can make changes with their immune system, with their gluten, with the gut, with a lot of the converting nutrients to help T$ and T3.

Evan Brand: So let’s– let’s go through a list. I know, we could kind of jump around but, maybe we could do like a top five [crosstalk] or maybe even like a top ten.

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

Evan Brand: So, number one– in no particular order, but number one, you already mentioned gluten. So, this would include any grains, right? ‘Cause even like our Amaranths, our Buckwheat, our Kiwa. That Kiwa could still be cross-reactive and trigger the antibodies, right?

Dr. Justin Marchegiani: Correct. I would still stay away from all grains. Grains probably being number one trigger becau– partly because of the amino acid sequence in the grains, I very similar to the surface proteins of the thyroid. That’s number one. So [inaudible]…

Evan Brand: What about now? Are you seeing issues with him?

Dr. Justin Marchegiani: Well, I mean, that’s a cross-reactive thing so, if gluten is like, you know – if gluten is like the brother and sister, you know, Hamp’s kind of like, maybe the cousin, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: The second cousin once removed, so to speak. S, again uhm– it may be something that needs to be pulled out with someone on an autoimmune kind of elimination provocation diet for at least a month or two. So, the grains component’s really important. Got to get that out. But not just the molecular mimicry thing. There’s uh– some research looking at Non-Celiac Gluten sensitivity, where they talked about gluten. Even in people that aren’t really Celiac or aren’t even a gluten, like, sensitive person, so to speak. Where just taking that gluten in, they still get gastrointestinal permeability. The guts gets a little bit leaky even with uhm – the fact that they aren’t really gluten-sensitive, so to speak. They aren’t gluten-sensitive but that’s the gut permeability that’s driven by the gluten. And prior, what’s happening is, we’re getting this protein called Zonulin increased. And Zonulin basically unzips, so it’s like an unbuttoning my shirt. That’s Zonulin, right? Unbuttoned zip, right? Opens that gut lining up, and then all these digestive proteins you get right through there.

Evan Brand: So, Zonulin goes up in the presence of grains. We had a question in the live chat about Brown rice. Absolutely, Brown rice would still be in a category of grains that you would want to remove.

Dr. Justin Marchegiani: Yeah.

Evan Brand: If you want to avoid Hashimoto’s. I tried to justify with you for a long time, “Oh, I love my white rice.” You know like, man, it’s just not worth it. And now uh– saw this stew– sweet potato now, and…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …my skin. My skin’s actually gotten better, too. You know, Even though I’ve pulled out – I’ve pulled out the rice.

Dr. Justin Marchegiani: Yeah, man. You go back to your old uh– YouTube videos, you had some– some stuff going on there, [crosstalk] and you like’s porcelain skin.

Evan Brand: I tried gut bugs, too.

Dr. Justin Marchegiani: Yeah. Use some gut bugs, man. You’re almost up to a runway model status, Evan.

Evan Brand: I don’t know about that but I appreciate it.

Dr. Justin Marchegiani: You’re getting there. Good.

Evan Brand: Oh, so gluten, [crosstalk] so gluten grain…

Dr. Justin Marchegiani: Gluten and the Zonulin – gluten, the Zonulin stuff and then also other grains still may have some gut irritating compounds, right? The Lectins, some of the Phytates, some of the Oxalates, some of those things, which can be irritating on the gut. So, really, it comes down to like, getting the immune system in the molecular mimicry going. But then it also has some impact on the Zonulin and the leaky gut.

Evan Brand: Okay, so you already said the immune system. Let’s hit on that piece. Let’s make that like our number two or number three. Uhm – we can measure the immune system with the secretory IGA on the Stool Test that we’re running on people.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Uhm – can we go on that number and just use secretory IGA as our immune system, kind of our first line of defense?

Dr. Justin Marchegiani: Yeah.

Evan Brand: And if we see IGA’s low, can we say, “Okay, you’re more susceptible or…”

Dr. Justin Marchegiani: A hundred percent.

Evan Brand: …this will trigger?

Dr. Justin Marchegiani: Yeah. We’ll see low IGA levels. IGA is that mucosal membrane barrier. It’s that first line of defense that lines the gastrointestinal tract, all your mucus membranes, your mouth, you know, our anal cavities, flatulent tract, urinary canal, everything. Every little surface there, even your eyes have IGA in the surface there. Your first line of immune defense. So, when that gets weakened, typically, it will go up and there’s an acute infection. You’ll see it there. We run Stool Test while measuring the stool, and then we’ll actually see it drop down for Chronic Stress. So IGA’s really important, ‘cause that’s a good measurement that your immune system is under stress.

Evan Brand: Right. So, a lot of times, more often than not, you and I are gonna see chronically low IGA, indicating that someone’s been dealing with these issues for a long time. So, Chronic Stress, overwork, maybe they’re not sleeping as well as…

Dr. Justin Marchegiani: Yeah.

Evan Brand: Maybe they have gut infections that are damaging that IGA because people may say, “Well, if I’ve got Hashimoto’s, how did I get a low immune system in the first place?” Well, chicken or egg, all of it– I mean, you could have had adrenal stress, which then weaken the gut. Then you picked up gut bugs, or vice versa.

Dr. Justin Marchegiani: Yeah, absolutely.

Evan Brand: Okay, what’s– what’s next?

Dr. Justin Marchegiani: Yeah, typically it’s a combination of emotional stress that tends to set people up. That tends to be it. So, there’s, you know, you choose with whatever’s happening with your life: work stress, financial stress, family stress, kid’s stress. Whatever’s happening there, that tends to set things up, and that will weaken the immune system.

Evan Brand: I had a female client did uh– that I talked with earlier. She’s a teacher, so she’s on summer break, right now. She’s feeling much, much better. But when she’s back in school, she’s done. She wants to get out of the field of teaching. Everything kind of gets worst, symptom-wise.

Dr. Justin Marchegiani: Yeah.

Evan Brand: So that’s a good example of work stress…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …right there.

Dr. Justin Marchegiani: Yeah, absolutely. And then, women are a little bit more prone to it, because there’s actually a research on this, where their immune system can go out of balance. Like, one emotional, like, you have an emotional argument with the woman, their IO6, their Intergluten-6 can go out of balance for up to two days after a fight. For some of the men, they can go out of balance for like a few hours, but then it’s back in. So I always– this is part of the mechanism why women are more prone to autoimmune conditions. Their immune system probably just a little bit more, I should say, a little more sensitive. And there’s also the Estrogen issue, right, because, Estrogen can affect the CD4 to CD8 balance. And they can skew that balance. So, the more women are Estrogen dominant. That can throw off their immune system. Their CD8, CD4, their natural killer cell, to help her cell ratio. CDH’s your natural killer. Your CD4’s your helper cell. And they could skew that ratio uh – up.

Evan Brand: So, I’m guessing the– like the ancestral view of why woman’s immune system would be more sensitive. Would you say just because of uh– uh– having children, where the immune’s got to be able to modulate itself not to attack and kill the fetus, for example. So, their immune system’s a little bit more variable than a man. Or what do you think is the ancestral lenses?

Dr. Justin Marchegiani: Yeah. I think, it probably has to do with uhm– I think it probably has to do with just raising children in that extra level of empathy, being able to take on other people’s feelings, and kind of be able to uuuh– what’s your need, right? You got, like, you know, you’re raising a child. You have to be to really sense what’s going on. I think that may play into it. I’ve zero evidence outside. That’s just my opinion; just observation. But there’s research and studies on that. Also, blood sugar can throw people’s immune system off to. So like skipping meals, and not giving enough nutrition, and just going long periods of time. So, that’s a big thing, right. That’s a big thing, so, I just, you know, I tell people just make sure you get your communication and your relationships kind of dialed-in. If you’re having issues with the spouse, get the communication down. Try to get, like, try to create a really good environment, where you can communicate, and you’re not gonna get flooded and drive people’s immune systems off.

Evan Brand: Right.

Dr. Justin Marchegiani: You know, that’s kind of, that’s number one. Number two, so let’s get meals, right. Now, when you’re healthier, you can play around with intermittent fasting, okay. That’s a good tool, but you got to get it dialed-in with your hormones good first, and you feeling good first. I may get that dialed-in later on.

Evan Brand: Oh, how about Ketosis too. Like, I tried it with Dr. Mercola, and he’s like– he’s like concerned that a lot of people are going into a ketogenic diet but they’re doing it for too long. So, he’s kind of a proponent of, like, five days on and then two days off. Or hold his go and eat potatoes, and things like that. And really kind of carb-griefy. So, how much of this thyroid epidemic, Hashimoto’s even kid of in the Health Space where you and I are working. These women come into us. They have triggered Hashimoto’s, do you think Ketogenic diet could be a trigger, potentially?

Dr. Justin Marchegiani: Well, I think, Ketogenic diet has actually helped a lot of people with Hashimoto’s, especially ones that are insulin-resistant, because insulin-resistance can actually block thyroid conversion. So, that’s my issue– is if your insulin-resistant, you may do really well with the Ketogenic diet for a while, but then you may hit the wall.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, then the question. When you hit the wall, that’s where you may start gradually increasing your carbs up. Maybe 10 grams a week, and maybe do a couple of low carb days, like Keto days, and then come out for one or two days in the higher carb side. But, I think, if you’re coming into this, being overweight, with uh– hips circum– you know, waist circumference greater than 35 for a female, 40 for a male. There’s probably some level of insulin-resistance that a Ketogenic diet will help reverse. But then you may have to refine or retune your carbohydrate thresholds afterwards.

Evan Brand: Okay, and that will always be based on adrenal health, and that would be based on, maybe, Vitamin D status or gut infections, depressants, of those. There’s always more, more things, so when people find, “Oh! Ketogenic diet,” It’s like there’s so many different variables out there and these other pieces of the puzzle.

Dr. Justin Marchegiani: Yeah, yeah. I mean, Atkins was sniffing around the right area when he started talking about Ketogenic diets in the 70’s. the problem with Atkins is, he didn’t put enough qualifiers on it. I mean, okay, great. So I eat a whole bunch of meat now, is that gonna be hormone antibiotic, free, you know, laden meat, or is it gonna be organic grass-fed. Oh, Atkins says soy protein’s okay. Eeh! Aspartame’s splendid, okay. Eeh! Right, not good. So, protein quality’s really important. So, if you’re gonna do protein powders, you know, Collagen peptides, you know, P protein, like maybe– maybe some really good grass-fed wheat protein, right. Choose really good protein sources if it’s powder. Or choose really healthy meat souces, or really fat sources. Lots of toxins are stored in the fat, so if you’re eating diseased animals, you’re not gonna get high quality of uh– of a meat product passed down to you from a nutrient perspective.

Evan Brand: Yep, well said. Okay, so we hit the secretory IGA, we hit the Zonulin, we hit the gluten.

Dr. Justin Marchegiani: Also, we talked about thyroid nodules too, right. Someone on uhm– Facebook here, had commented here. So, thyroid nodules are just like these little abnormal tissue spots in the thyroid, but typically gonna be driven by autoimmunity, right. So, Hashimoto’s gonna be the major thing. Hashimoto’s, typically, is an autoimmunity that is involving TPO antibodies, and antithyroglobulin antibodies. Now, again, all autoimmunity, for the most part, will end in low thyroid. The difference is grave disease has a couple of antibodies that can jack up thyroid functioning. Keep it up to the point where you may stroke or you may have an issue if left untreated. So, we that with TSI or Thyroid Stimulating Immunoglobulin and also TSH Receptor antibodies, so, which you want to make sure under control. Why? It helped saved many thyroid uhm – from going into uh – graves or a thyroid storm state by using specific nutrients to help it. and also…

Evan Brand: What happened with uh– with thyroid nodules? Let’s say, someone…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …has antibodies at that point. Maybe we suggest they go get a thyroid ultrasound. They say– Okay, hey. Can you palpate? Like, would you suggest an ultrasound, or can you palpate and figure out whether you have nodules?

Dr. Justin Marchegiani: Oh, great. Let’s go into that. So, try to palpate the thyroid is – Find the Adam’s apple, so like, mine’s right here.

Evan Brand: Get a little closer to the mic, so people can hear good.

Dr. Justin Marchegiani: Yeah. This is your Adam’s apple right here. Right. So, I feel here. I go down, about one centimeter, and then out a centimeter. And, you know, I would do it by standing behind myself, who I can step out of my body. About be here. I touched each side and I press it into the other. And I would have myself swallow water. And I would feel, just for any irregularities in the surface. It will be almost impossible to do it to yourself just as I demonstrated with the angle. But you would stand from behind someone, and you have just nice flat palms, and you just go through the surface, and you touched, you pushed, and you want to feel it come out in the other side. And basically, you want to just feel a smooth surface, and you want to not feel it as an inflamed puffy. You have to feel a couple normal ones to know but, that will give you a pretty good idea.

Evan Brand: The ultrasound sounds easier though. I mean, let’s just say, that you come back with nodules, what happens? Do you just – do you just play the waiting game? You just watch him or how do you approach it?

Dr. Justin Marchegiani: Yeah, I mean, it depends where you’re at, right? There’s always that increase chance of potential thyroid cancer, right. So, it’s good to get that screened, ‘cause of the increased risk. But it’s not the first thing I worry about. Because if you just do all the things that we tell you, I can’t tell you how many patients whose nodules have just significantly reduced. Significantly reduced.

Evan Brand: Yep.

Dr. Justin Marchegiani: Though, I’ve seen that happen so many times, so, hey, you know, just run it by your endo. See what they say. And then just let them know that you’re gonna do some things on the functional medicine side. And, come back and monitor it. you just want to make sure it’s moving in the right direction. Now, some nodules can be caused by low Iodine, too. Again, w tend to get enough Iodine, a couple hundred MIC’s really odd. You need like 200 MIC’s is like they already– hey, you may need a little bit more, but you got to be careful with supplementing Iodine because the Iodination process that happens, so– Iodination is nothing more than the Iodine bonding to the Thyroxine molecules to make your thyroid hormone, right? Like T4 is your Thyroxine, your 4 molecules, your Thyroxine bound to four molecules of Iodine. That process of binding it and pulling out the sticking glue getting stuck there. That’s called Iodination. That process spits of a lot of Hydrogen peroxide which can be inflammatory. And that can drive a lot of B cell infiltration. Your immune cells into your thyroid and exacerbate that autoimmune attack. So you got to be careful off the bat when giving any Iodine. So I always like to get in the Selenium in there first, get the diet dialed-in, get the lifestyle stuffed-out then, and then really lower the information first before I go after it. And if we go after it, we’ll titrate that slowly. We won’t go at it hard. There’s a lot of docs out there that go really high in the Iodine I don’t recommend going high of the bat. I think it’s better off going slower, and work on the foundational stuff first.

Evan Brand: Yeah. Love it. Uh – I was gonna ask you a question about Iodine. I forgot what it was. Tsk. Darn. I lost my point. Alright. Let’s keep moving on. What else comes to mind for triggers.

Dr. Justin Marchegiani: Yeah. So we talked about the food stuff. We talked about blood sugar, we talked about emotional stress. That’s still a big one, okay. Because, emotional stress taps in to your sympathetic nervous system and your sympathetic nervous system wires right down to the adrenals. And that’s umping out Cortisol. Pumping out Adrenaline. And your body will always sacrifice sex hormones for stress hormones. It’s just the hardwired adaptation. Right? If you don’t survive today, you’re not gonna have to worry about reproducing tomorrow, right?

Evan Brand: Yep.

Dr. Justin Marchegiani: So, gut component– the gut component’s very important. We talked about gut bacteria, and how the healthy bacteria’s really helpful with the Sulphatase. Also, that’s where we absorb nutrients, right/ that’s where we absorb a lot of our B Vitamins, a lot of our minerals, a lot of our amino acids, right. Thyroxines and amino acids, that’s part of making thyroid hormone. Also, 70 to 80 percent of your immune system is located in your gut, right? So, you want to jack up your immune system, you know, just get your gut in bad shape by not digesting food, putting a lot of inflammatory things in there. [crosstalk] And uh – throwing off your gut bacteria and uh – whole bunch of steroids from the foods, antibiotics from the foods, anantibiotics in your uh – medicines for maybe, reasons that, maybe be unwanted, so to speak.

Evan Brand: Right. Yeah, the gut’s huge. I mean…

Dr. Justin Marchegiani: Yeah.

Evan Brand: I don’t really like the term SIBO because it’s so generic, but you and I, we see so many different species of bacteria. We can assume that most of them are going to be growing up from the colon to the small intestine.

Dr. Justin Marchegiani: Yeah.

Evan Brand: So if you’ve never been diagnosed to SIBO, or any type of bacterial overgrowth, like specifically, Justin and I are gonna  be looking for, like, a Citrobacter or Klebsiella, or there’s two species of Proteus. Those are all autoimmune trigger bacteria. That’s in the literature too. So, if you’ve got bacterial overgrowth, bacterial infections, parasites, Yeast, or like we see many times a combination. So it could be a Citrobacter, plus Blastocystis hominis, a parasite, plus Candida. That’s uh – that a – that’s a triple whammy there.

Dr. Justin Marchegiani: Yeah.

Evan Brand: That could definitely cause the antibodies to go up. The good thing is this is reversible, right. Now, would you say– I know for us, you know, we’re not medical doctors so we can’t use the term uh– cure. Uh– but is it possible for a cure for Hashimoto’s or when you get your antibodies down, let’s say, you were at a 50 on your TG antibodies, and we do all the good work with you. We get the antibodies back down, let’s say, below a five. Are you cured or can you always just rebound quicker than the average person back up to that bad state of Hashimoto’s again?

Dr. Justin Marchegiani: Yeah. I mean, you can always ramp back up, but it’s all about adaptation, right? The healthier you are, the greater ability you have  to adapt to stress. So, when you have the susceptibility for a certain disease. So, someone posted on Facebook, I have anti-NaN antibodies, that’s kind of a very broad sense, but your predisposed to certain conditions, certain diseases. Maybe Rheumatoid arthritis, maybe Lupus, maybe Scleroderma, maybe CREST, right. So a lot of autoimmune conditions you may now predispose for. But that just means you have the genetic triggers, those genetic switches, are kind of right in the middle, and if those stressors flick it down, right, that stress could flip that gene on and they could activate. So we managed all the things that we talked about, right? Blood sugar, nutrient density, stress, grains, gut health, uhm – being infection-free, ideally, healthy probiotics, healthy gut bacteria, and then making sure that if there’s thyroid damage already, we support that, making sure we support thyroid activation, right. Zinc, Magnesium, CoQ10, Selenium, maybe the right Iodine, use your functional doctors resource, making all those nutrients and things are dialed-in. That’s gonna significantly help improve your resiliency, so if you do have a disease, you may be able to– your body may be able to keep it in check enough, were the symptoms aren’t even visible. But some they say you’re cured, but legally we can’t say you’re cured.

Evan Brand: Right, exactly. What about the liver? What’s the role of the liver?

Dr. Justin Marchegiani: Yeah. Yeah. So the liver’s really important ‘cause a lot of those deionized enzymes. They come from the liver, right. So, the liver’s really stressed and taxed dealing with the whole bunch of fructose coming in there, ‘cause your Insulin-resistant or toxins, and round-up and pesticides, and a whole bunch of junk. It may not be able to do its job, activating and converting thyroid hormones, so we want to make sure, number one, that we are uhm – keeping the stress off it. ‘Cause a lot of liver stuff is more about to stop adding crap to the system, right?

Evan Brand: Exactly.

Dr. Justin Marchegiani: And then number two, I know, Izabella Wentz talks about it in her book, the Hashimoto Protocol. She starts a lot of her patients on a liver cleanse that first month, which can be helpful. So, Liver Support Phase 1, Phase 2, detox support. In my line, it’s uh– Phase 1 is either uhm– Antioxidant Supreme or Liver Supreme, and then Phase 2 is gonna be Detox Aminos. That supports all the Phase 1 and Phase 2 pathways that run your liver. The fat-soluble, the water-soluble, and the water-soluble to excretion in Phase 2. That’s really important.

Evan Brand: So, list of some ingredients. So this is like your Methionines, your Taurines, your milk fissles, [crosstalk] your Vitamins A, you Beet powder, your Artichoke extract.

Dr. Justin Marchegiani: Artichoke, yeah. And then your Phase 2 is gonna be  more of your amino acids. That’s like an acetylation, methylation, uh– glutathione conjugation. All that stuff. So cysteine, glutamine, glycine, uh – taurine’s in there, methionine, uh– We throw Calcium-D-Glucarate in there. Those are really good compounds.

Evan Brand: Cool, cool. Uhm–

Dr. Justin Marchegiani: So I think we hit some good triggers. We talked about some things to help about things to help with thyroid conversion too. We talked about the liver, we talked about the infections and the leaky gut, and then yeah. The whole thing about gluten– oh by the way.– uh– I’ll tell you off the air.

Evan Brand: Alright. Alright.

Dr. Justin Marchegiani: But I’m–

Evan Brand: Hey. Let me tell you something that– before you – I want to –  I want to mention two things. I believe we hit it already, but the adrenal piece, uh– with Cortisol stress, with adrenal problems. You can also pack the conversion of T4 to T3 hormone there. So you got to get your adrenals checklist.

Dr. Justin Marchegiani: Yes. Oh yeah. We got to hit that, man.

Evan Brand: Yeah. So…

Dr. Justin Marchegiani: Yeah.

Evan Brand: So, if you’re working on your thyroid, but you’re not working on your gut, and your adrenals, your results are likely going to not be very good, because adrenal stress is gonna reduce the conversion rate. And then, you can go back to it. But let me say one other thing. I had a client this morning. She was trying to justify uh– eating gluten, and grains, and crackers and stuf like that, because of her food-sensitivity test.

Dr. Justin Marchegiani: Exactly where I was going, man. You’ve read my mind.

Evan Brand: Alright. Her food-sensitivity test said, “I’m not sensitive to gluten.”

Dr. Justin Marchegiani: Yeah.

Evan Brand: And so, she’s still doing gluten. I said, throw your food-sensitivity test away.

Dr. Justin Marchegiani: yeah. I mean the big issue, right. Some of the non-celiac gluten sensitivity research. People that weren’t even gluten-sensitive, they have increased gut permeability.

Evan Brand: Say that again. Just to make sure that it’s like super clear for people.

Dr. Justin Marchegiani: Yeah. People that weren’t gluten-sensitive, right, they weren’t like celiac, they weren’t like having any gluten issues, based on conventional standards, when they got exposed to gluten, they noticed some level of leaky gut, some level of permeability in the gut. Based on the study’s objective criteria diagnosis for it. So that means, more leaky gut, means more immunogenic compounds, undigested foods, LPS, Casein, right – all these things. Dysbiotic bacteria may get into that bloodstream, may start to cause some immune system kind of pissed off, right? Then it may go out looking for that thyroid tissue, or maybe even uhm– the pancreas, or other tissues, or other autoimmune tissues.

Evan Brand: Or even if it doesn’t go straight to that, the gluten could still cause a leaky gut situation, which then sets you up. So, when you go to Sushi Night, you could go pick up Blasto, or some other parasite, which then causes even more damage…

Dr. Justin Marchegiani: Yeah

Evan Brand: …which then leads to the antibodies. SO, one way or another, you’re setting yourself up. There’s really just no justification for gluten in the diet.

Dr. Justin Marchegiani: Yeah, exactly. I won’t give any press to the book. It’s out there right now. We’ve talked about it before.

Evan Brand: [inaudible]

Dr. Justin Marchegiani: Yeah. People say, “Oh. Gluten this and that, maybe okay.” Not necessarily okay. I don’t think it’s uhm– something that people should be consuming. Some people may be able to handle it. Again, if you’re gonna consume gluten, you better off doing it and uhm– sourdough form, if you’re gonna do it. Or, you know, if  you are healthier, right, and you’re on the right track. Every now and then you wanna do a little bit of white rice, as a treat. As long as you’re doing good, as long as you’re on point, right, then I think that’s okay.

Evan Brand: Yep. Yeah, for sure. Alright now, uhm– there was something else. I interrupted you. I hit the Adrenal piece, and I had to talk about the food-sensitivity testing and the lady trying to justify gluten.

Dr. Justin Marchegiani: Yeah, that was it. I think we hit it, and I think just the– the adrenal imbalance, whether high Cortisol or low. So, Chronic stress, low cortisol, with the reverse Cortisol rhythm, or acute stress, really high Cortisol, both can affect your thyroid conversion and activation.

Evan Brand: Yep, yep. Got it. So, I mean, yes. You can take adaptogenic herbs. We love, we promote those, but that’s still not addressing the root cause. So if you hate your job, we can give you all the Ashwagandha, Rhodiola, uh– Siberian Ginseng in the world, and we’re gonna help you adapt to the stress, but you still got to remove the stress. It’s like I know you see the analogy of the engine life, putting the tape over the uh – the check engine light in the car. I like the analogy of like a doorbell too. Like if you keep pushing the doorbell. Uh– your still gonna have issues. You can try to like disable a doorbell, but it’s still being pressed. Like, you hate your job, or you’ve got a turbo relationship. I had a woman, who she told me. She said straight up, “Evan, until I divorce my husband, I will not get better.” And I said, “Well, I fully support you in that decision.” And now, she’s going through the divorce. She’s already starting to lose weight, just based on the reduction of the emotional stress. So I think that’s just amazing, and unfortunately, that happens. But, if you wanna be healthy, you got to make some tough decisions, sometimes.

Dr. Justin Marchegiani: I agree. I appreciate you’d actually given me credit for that analogy. I thought you were gonna pawn that one off of yourself.

Evan Brand: [laughs] No, definitely not.

Dr. Justin Marchegiani: Good, ‘cause I wasn’t gonna give you, like, two Paleo demerits for that, but I’ll hold those back.

Evan Brand: Appreciate it. 

Dr. Justin Marchegiani: Good. You got a credit in a bank of Dr. J here. Excellent. So, I think we hit everything: the Cortisol stuff, we hit the gut stuff. Someone over here, I’ll try him in. So, someone talked about this is functional medicine on demand, can Candida hang around in the thyroid? Candida can create things known as acetaldehyde. Acetaldehyde can be inflammatory, right. Like, it’s one of the products of alcohol. So that can be inflammatory and really affect things. Candida can also get the immune system wrap up. Uhm –  Candida or acetaldehyde in the gut can convert in the Salsolinol. Salsolinol’s known to increase uhm– antibodies to uhm– receptors for dopamine in the substantia nigra midbrain. So, that can create other issues with autoimmunity, so yeah. Candida is not a good thing either. And that’s, you know, that’s according to conventional medicine, not really to exist at all. But we see it all the time.

Evan Brand: Oh, yeah. I mean, Honestly, and I think I may have mentioned this. I told you this or I told people on the air already, uh– sorry if I’ve repeated myself. I’m sure we do that all the time.

Dr. Justin Marchegiani: Yeah.

Evan Brand: But, when I first started learning about Candida and yeast, I thought, “Oh, candida, Yeast.” You know, I kind of put it on like the bottom of the totem pole, below bacteria and below parasites, in terms of the effect on the body. But I’ve seen all kinds of crazy stuff with Candida alone, where it’s like, whether it’s brain fog, depression, fatigue, cravings, I mean, something that sounds so benign. “Oh, Candida,” “I’m gonna do a Candida Cleanse.” It’s like, a lot of people promote it, kind of like– almost like it doesn’t exist, or almost like, it’s a trendy topic, and you can just do some type of, like, “Candida Cleanse smoothie”, “go buy my online candida program and you’re gonna get better”. It doesn’t work that way. But, candida can affect almost everybody’s system, whether it’s adrenals, whether it’s gut, whether it’s Lewd…

Dr. Justin Marchegiani: Totally.

Evan Brand: …depression, anxiety, etc., It can all stem just from a Yeast overgrowth. And I would say, you tell me if your stats are different on your side of clients, but for me, I’ve seen about, nine out of every ten people, shows up with Yeast.

Dr. Justin Marchegiani: Yeah, and the big issue with Candida and Yeast is that, some people have it but, it’s just the tip of the Iceberg. The other infections that may trumpet, so to speak in the hierarchy. So, Candida may be an issue in some people, it can be a main issue. Right? Like, we’ll run a Stool Test, and we’ll see it like, “Oh. We have some Candida there.” And then we’ll look at another test. Nothing else comes back. And then on uh– Organic Acids. We’ll see the Arabinose, or the Arabinitol, really high, so we’ll, “Okay. This really maybe a Candida issue.” And then we’d see some clinical symptoms, like uhm– Seborrheic dermatitis or Cradle cap, or just you know, dandruff. You may see some yellow-discolored fingernails, maybe some white coating in the mouth, maybe some tinea versicolor rash. Right? We may see some of those things that may say, “Hey. This may be a primary Candida issue and we hit it hard.”

Evan Brand: You said that a bit quick. The tinea– what’s that? Yeah. It’s like little blotches on the skin.

Dr. Justin Marchegiani: Okay. They just look like little blotches, and it’s uhm– it’s pretty smooth to the skin. It’s not really itchy. It doesn’t really spread but you want to kind of gross yourself out. Just put it in the Google images, and you’ll see the umpteenth degree of it. But it’s just gentle blotches on the skin. They tend to be a little [inaudible]and scarred.

Evan Brand: I know sometimes people may think it’s that but it could be like Keratosis pilaris instead.

Dr. Justin Marchegiani: Keratosis pilaris tends to be a little bit more flaky, and uhm– that tends to hit the back of the arms. [inaudible]…

Evan Brand: Yeah. Such like on your triceps he’s pointing to.

Dr. Justin Marchegiani: …like little back here. Right? That tends to be essential fatty acid stuff. So again, if you’re having issues digesting fats, someone in our live chat, so they don’t break down fat well. Hope you get the gut work done, ‘cause that’s a big, big component. ’Cause if you’re not breaking down fat well, you’re probably not breaking down protein well, either.

Evan Brand: So that would mean, if you’re spinning your heart and money on a good quality fish oil, then you could be potentially wasting your money even if it’s triglyceride form, if digestion’s compromised.

Dr. Justin Marchegiani: Yeah. I mean, most underrated supplements out there, if you were to start on two things: enzymes and HCl. That’s it. Enzymes and HCl get the diet. [clears throat] Excuse me; frog at me. Get the diet a hundred percent dialed-in so, you can actually break down that food. Put the money on the food quality. Get the food quality up.

Evan Brand: Yep. I had a lady tell me, she’s like, “I feel so much better by doing Apple cider vinegar. I don’t notice taking enzymes and HCl.” And I was like, “Okay. You can try it. But I– I’ve still think HCl and enzymes do better than just …

Dr. Justin Marchegiani: Oh.

Evan Brand: …apple cider vinegar but– so…

Dr. Justin Marchegiani: Yeah. Apple cider vinegar’s a great starting point if someone’s like, “Ooh. I don’t know. I’d had some bad reactions to HCl.” Okay. Great let’s just start with the teaspoon of apple cider, but, we’re gonna go with food in your belly first. And then they’ll do good, alright, let’s go to a tablespoon. [crosstalk] Okay, let’s go to–

Evan Brand: You know what I’d do? I make a little tonic. I’ll do like uh– apple cider vinegar. I recently got uh–

Dr. Justin Marchegiani: Yeah.

Evan Brand: …a lime, or like a citrus, squeezer. So, I’ll do like uh– a lime or lemon and uh– apple cider vinegar in there. And then, sometimes, I’ll add like some Vitamin C, or I’ll add that adrenal tincture I told you about. I’ll add that tincture to it. And it’s like a great little tonic.

Dr. Justin Marchegiani: Yeah. I think that’s great, and then, typically, then we do a little graduation ceremony when we go from that apple cider vinegar to the HCl. That’s the next step.

Evan Brand: Yep.

Dr. Justin Marchegiani: Any of the comments said? What do you think, man?

Evan Brand: I think we should wrap it up. I think we’d hit a lot of different triggers here. And if people want to learn more, you’ve done plenty of videos on Hashimoto’s. We’ve done more podcasts on this, so there’s hours of more content, I’m sure, that we’ve created on this. So, just go on You can search Hashimoto’s or search thyroid. You could check out my site too, Evan Brand, and make sure you’re subscribed. So, if you want to join in on the conversation, we can answer your questions on the fly. And, of course, if you want to work with Justin, visit his site too, You can schedule. If you want to schedule with me, same thing, And, we’re available. We deal with this stuff all the time, and don’t take no for an answer. Somebody says, “No, I’m not gonna run these antibodies, then you leave.” You fire them because, if you want to get on the root cause of your issue. You have to have the biomarkers. If you’re guessing and checking, you’re building up your supplement graveyard, you’re not gonna get better that way. You really got to get these number on a piece of paper first, because you got to be able to track them and we have to be able to see. “Okay, look. Once we did this, we fix your gut. We got the adrenal support.” And look at the antibodies, drop, drop, drop, drop. And then eventually, “Hey. Maybe you don’t have a thyroid problem anymore.” And it’s totally possible we do it all the time.

Dr. Justin Marchegiani: Awesome. So, here’s the sequence. Ready? Instead of buying crap food, you increase the food quality, and you choose the right kinds of food. That’s number one. That will start to get– that will start to lower inflammation, and give you more energy. As you start having more energy, you can start cutting the emotional stress out of your life. Get used to it with your spouse. Work on it with your spouse. Get a book on communication. Get it– things fixed with your kids. Do your best to fix things at work. Whatever other stressors, all dealing with emotional stress takes energy. So most people that have a lot of emotional stress, typically they don’t have the energy to deal with it. So, get the energy up by just getting the food right. Then you can start to deal with the emotional stress. And then, once that’s kind of dialed-in, you can start adding in some supplements to fast-track it. first set iss gonna be digestive support, and after that, you really want to work with the functional medicine doc to get everything else dialed-in. But work on the foundational stuff first, and then make sure while you’re doing all that, you’re not causing yourself to spin around in a rabbit wheel. While you’re doing excessive exercise, too much CrossFit, just so you’re getting drained with that. And then if you can combine in the good sleep and the good hydration, now you’re set. So, now, when you go see a functional medicine doc, it’s like, “Boom!” You hit the ground running.

Evan Brand: Oh, man. We could– we could have done a whole podcast just on CrossFit and thyroid issues, so maybe for a future day. But yeah, over exercise – I have a lady last week. She said, she exercises CrossFit six or seven times a week. She’s doing CrossFit, and like, “Gosh!” way too much.

Dr. Justin Marchegiani: Yeah. And a CrossFit may be great if you’re – if you’re already healthy, if you’re diet’s spot on, if  you’re resting hard, if you’re doing some good things, post-workouts and pre-workouts to recover. But if you’re not there, it’s not gonna be the best thing for you to start off. Unless, you’re a gym’s got a really good On-Ramp Program, and they get the Arm Wrap style in, where they’re not doing some, you know– they have some great timing with their Arm Wraps, then it’s probably okay. But you got to go somewhere where there’s a good Arm Wrap Program.

Evan Brand: But even then, even if you were optimally healthy like you were talking about, would you still tell somebody, “Go do seven days a week in CrossFit?”

Dr. Justin Marchegiani: No. No,– the only– I mean, professional athletes do that if they want, but they’re taking naps, and that’s their job during the day. But, the average person, typically, I would say, maxes four times a week.

Evan Brand: Working, living a life, being a parent or uh– spouse, I mean, it’s tough.

Dr. Justin Marchegiani: And, ideally, spread it out. Right? Monday, Tuesday– Monday, Wednesday, Friday gig, you know. During the week, trying to keep a day off in between.

Evan Brand: Yep, yep. Well said. You said something else in your, in your small rant. I forgot what it was. I was gonna– I was gonna ping off of it. But I guess we should wrap this thing up.

Dr. Justin Marchegiani: Yeah, I mean, it’s funny, like, you ping me at lunch time, “Let’s do a podcast, alright.” And then we’re like “Only fifteen minutes. Only. That’s it.” Then, it’s all like, an hour later, “Damn it!”

Evan Brand: I know. 

Dr. Justin Marchegiani: “What happened?”

Evan Brand: I know.

Dr. Justin Marchegiani: We tried to be disciplined. 

Evan Brand: I know.

Dr. Justin Marchegiani: Alright. Well, I think we hit all the good stuff on the foundatinal side. Is there anything you wanted to add to the foundational piece?

Evan Brand: That’s exactly what it was. Blood sugar balance, make sure that that’s keep.

Dr. Justin Marchegiani: Yeah.

Evan Brand: That was exactly a blood sugar balance, hydration, you’re getting your good minerals, using your good salts, uh – using trace minerals if you have to, trace mineral supplements if needed.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Uh– we talked about the fatty acids with the fish oil. Optimizing HCl and enzymes, supporting the liver, gull bladder, supporting detox pathways, supporting methylation if you have to, uh– and looking for the root cause, getting the testing. Without the [crosstalk] testing, you’re guessing.

Dr. Justin Marchegiani: Love it. [crosstalk] Love it. Excellent. Alright. Evan, I’m gonna go hang up here on YouTube. I’ll go say goodbye on my Facebook peeps, and we’ll talk real soon, my man.

Evan Brand: Take care.

Dr. Justin Marchegiani: Take care.

Evan Brand: Bye.

Evan Brand: Bye.



“Hashimoto’s Protocol” by Izabella Wentz



10 Essential Nutrients To Heal Your Thyroid

10 Essential Nutrients To Heal Your Thyroid

By Dr. Justin Marchegiani


The thyroid is a bowtie type of gland that sits just below the Adam’s apple. It regulates your metabolism and weight, and thyroid hormones are required for almost every physiological process in your body.

The thyroid secretes a hormone called T4 that gets converted into an active thyroid hormone called T3 which is needed for all cells of the body to be metabolically active.

T4 is inactive, while T3 is active. 20% of this important conversion happens at the thyroid gland. The other 80% happens peripherally. Out of the 80% that happens peripherally, 60% is converted in the liver, 20% is in the healthy gut bacteria, and the other 20% is via healthy adrenal function and stress regulation


Signs and symptoms of a potential thyroid issue include:

Unexplained weight gain

Fatigue and tiredness/energy issues

Numb or tingling fingers/toes

Muscle soreness

Menstrual and fertility problems, PMS,

Thinning of outer third of eyebrows


Dry, flakey skin

Poor concentration and memory

Temperature intolerance


*Thyroid vs. Adrenals*

It’s important to note that adrenal fatigue is often found alongside thyroid disease, and many of the symptoms of the two overlap, so it is important to look at the thyroid and the adrenals side-by-side. Remember, 20% of the T3 conversion process relies on healthy adrenal function and stress response. One huge step you can take to support both the adrenals and the thyroid is by paying attention to your iron levels. Low iron is linked to low cortisol, a hormone produced by the adrenals which is necessary for proper thyroid function.





We want to look at the body as a whole in dealing with thyroid issues: hormones, diet, lifestyle and nutrition. To avoid supplement overload, the first thing we want to do is to clear out all the dietary and lifestyle sources of stress on the liver. This means cutting out aspartame, junk food loaded with additives, gluten, and anything else the liver has to work extra hard to detox. As we learned earlier, 60% of T4→T3 conversion happens in the liver. Because our liver is always giving detoxification support, we want to take off excess stress (and stop giving our liver stress to detox in the first place), then use supplements such as Liver Supreme.


Selenium: The thyroid is our organ with the highest selenium content and is necessary for production of T3. It can reduce autoimmune issues, as well as decreasing anti-thyroid antibody levels. Besides supplementation, whole foods sources of selenium include grass-fed beef, beef liver, eggs, chicken, spinach, brazil nuts, and yellowfin tuna.

B Vitamins: Thiamine and vitamin B12 help balance hormones, and aid in combatting chronic fatigue. Vegans and vegetarians need to pay special attention as they are much more likely to be deficient in these essential nutrients. Beef liver, sardines, grass-fed beef, eggs, lamb, raw milk and cheese, and salmon are great sources of these vitamins.

Probiotics: Healthy gut bacteria balance is vital for a healthy self. Thyroid conditions have been linked to leaky gut (when proteins such as gluten can leak through the gut and get into the bloodstream, which causes inflammation throughout the body, including the thyroid). 20% of T4→T3 conversion happens in the gut. Probiotic-rich foods include sauerkraut, kombucha, kvass, kefir, and natto.

Iodine: Iodine deficiency is often linked to hypothyroidism. Iodine can be found in whole foods such as fish, sea vegetables, eggs, raw dairy, and seaweed. For 10% of people, iodine can resolve thyroid disfunction, though those with Hashimoto’s should avoid higher dose iodine supplementation, as it can potentially aggravate the autoimmune condition especially in the environment of low iodine.


Tyrosine: In a process called iodination, iodine, tyrosine and thyroglobulin bind together in making your T4 molecule. Tyrosine is found in protein-rich foods such as chicken, turkey, almonds, avocados, beef, and eggs.

Zinc: Zinc is required for T4 to convert to T3, and is also required for T3 to function properly. Zinc impacts many areas of your health, including digestion, skin and eyes, the immune system, omega-3 fatty acid metabolism, and thyroid function. Zinc is found in red meat, pork, oysters, and chicken.

Fat-soluble vitamins: Many essential vitamins and nutrients required fat to be properly absorbed and used by the body. For example, high cortisol levels are associated with low vitamin D levels. But if you are on a low fat diet, you are not going to be absorbing as much vitamin D as you might expect. It is important to have quality sources of fat, such as grass-fed butter, in order to get the full benefits of your supplements.

Vitamin C: The adrenal gland contains the highest concentration of vitamin C in the body, and as we know, there is correlation between adrenal function and thyroid function.

Omega-3 Fatty Acids: Can help “decrease inflammation and help with immunity” for thyroid support. Research shows that omega-3 fatty acids can increase thyroid hormone uptake.

Iron: Research shows correlation between low iron and low cortisol, and cortisol is necessary to convert and activate T4 to T3.

Glandular supplements like Thyro Balance can be beneficial for individuals not getting adequate daily nutrients, particularly those that support the adrenal and thyroid glands. Another supplement that helps provide extra nutrients for thyroid hormones synthesis and T4 to T3 conversion is Thyro Replete.


Conventional medicine generally takes one of three routes in dealing with thyroid issues.

If a patient is labeled as having Hashimoto’s or hypothyroidism, they are prescribed Synthroid.  Most people that are given Synthroid, synthetic T4, don’t convert it to T3, leaving them with tons of thyroid symptoms.

If they’re diagnosed with Graves’, doctors typically just want to perform a thyroidectomy- meaning they pull the thyroid out!

Thirdly, they might want to use radioactive iodine, and shut the thyroid gland down.

The majority of people have hypothyroidism/Hashimoto’s, meaning there are underlying issues affecting thyroid T4-T3 conversion outside of their control, and the mainstream medicine routes aren’t going to tackle the real root of the problem.


While supplementation is valuable and always available for extra support, a balanced life and a healthy diet are the necessary foundation pieces for proper thyroid function.

If you are looking for supplementation to help your thyroid, we offer thyroid support in our store.

To listen to Dr. Justin’s podcast with Evan Brand on the thyroid, check out podcast #54.


Thyroid and Nutrient Deficiencies Q & A – Podcast #125

Dr. Justin Marchegiani and Evan Brand dive into an exciting discussion all about thyroid. Listen carefully as they engage in a dynamic conversation with the listeners and share some valuable information regarding their functional medicine approach on issues relating to thyroid; its connection to adrenal health, gut health, nutrition, and infections.

Learn about the hyper- and hypo- symptoms related to thyroid issues. Find out how other conditions like leaky gut and other infections are linked to thyroid health. Gain valuable information on different tests used to assess thyroid health and rule out other conditions contributing to thyroid issues. Increase your awareness about the different sources, like foods, supplements, and metals which all impacts thyroid function.

In this episode, we cover:

04:19   Thyroid and its connection to adrenals and leaky gut

12:50   Testing for Autoimmunity

16:42   Infections and Thyroid Health Connection

21:35   Cortisol Lab Test for Adrenal Issue

28:36   Thyroid Symptoms and Assessment

32:23   Iron

37:20   Gluten and its connection to leaky gut

54:23   Mercury

58:25   Iodine







Dr. Justin Marchegiani: YouTube as well. Any questions, feel free to type them in. Today’s podcast will be on thyroid. Evan, can you hear me okay?

Evan Brand: I sure can. You sound good.

Dr. Justin Marchegiani: Awesome, man. We are live. What’s going on, man?

Evan Brand: Oh, not too much. Like I told you, somebody in France has had a fun weekend with my business credit card. So uh – besides that, everything is good.

Dr. Justin Marchegiani: Very cool, man. Yeah. Well, at least you got a capital one card, so you’re pretty well protected, right?

Evan Brand: Yup.

Dr. Justin Marchegiani: That’s awesome. So we’re live on Facebook and YouTube. Again, better to be on YouTube, my opinion coz you get to see Evan and myself. If you’re watching me on Facebook right now, we’re a little compromised. We only got my feedback. You’re not gonna hear Evan’s side of it. So feel free and check out to be able to see Evan’s pretty face and be able to get some questions there. But we will answer questions on Facebook Live, too.

Evan Brand: Cool. So today we wanted to talk about thyroid. There is many lab test out there that you can get. Still, conventional doctors are not running the lab tests that are important, though, some of these antibody markers, some of the reverse T3 markers. Maybe you should briefly chat about that just since people maybe on Facebook. Talk people through why is this happening? Why are these conventional doctors not running these other important thyroid markers? Why is it just TSH and some of the other boring stuff?

Dr. Justin Marchegiani: Great question. And again, today we’re talking about thyroid and we talked about this topic a lot, done a lot of videos on it. I have a book coming out on this very shortly as well. So I’m just kinda do a brief overview. Feel free and check out Evan’s page not just and his podcast from more info as well as mine. We’ll give you more info here today. Hopefully we’ll be able to have a live interaction. But Evan’s question is for the Facebook live listeners. “Can we get podcast live on YouTube, too?” is the question about conventional thyroid issues versus functional thyroid issues. And this is a big difference, and most people they go and get help from their conventional physicians on matters of thyroid issues. They think that their conventional doctor is ruling them out for thyroid issues and they may, if it’s an extreme thyroid issue. You know, very, very high TSH, extreme thyroid swelling, uhm – maybe while hyper-symptoms if their grades are on the hyper side, or if they have a lot of thyroid destruction, or goiter things. They may get picked up by conventional testing, but many patients they aren’t getting picked up on conventional testing because they’re kinda in no man’s land. Conventional medicine looks at things like an on and off switch. You’re either healthy, right? The light’s on. Or you’re unhealthy, the light’s off. And we know in functional medicine world, that light switch is more of the dimmer switch, right? The light may be on halfway, right? You’re halfway healthy; or another way to look at it, you’re halfway to not being healthy. But it may not be all the way off. Maybe just flickering a little bit. And unless you’re all the way off, what’s gonna happen is they’re not gonna see anything wrong with your health issues regarding your thyroid. And they’re not gonna make any recommendations for interventions. And that’s the biggest problem. With thyroid issues, looking from the conventional to the functional medicine realm. And also, you have to look at the tools that they have right there. One tool – most part two, you’re gonna have some kinda surgical intervention or you gonna have some kind of uhm – pharmaceutical intervention. None of which typically fixes the root cause of what’s going on. Especially when we understand that thyroid issues are 90% autoimmune in nature. I’d say at least 50-90%. So we know if it’s autoimmune, and we don’t fix the underlying cause of why the autoimmunity is there, right? Then the underlying mechanism of the antibody is in the immune system attacking the thyroid tissue is still happening in the background.

Evan Brand: That’s terrible. I mean we’ve got thousands of people at this point who we work with, where they’re on thyroid drugs, and they still feel terrible. And I’ll go back and say, “Hey Doc, look, give up my Synthroid or other pharmaceutical, I still feel terrible.” And they’re just gonna up the drug more and more and more. So it’s like you’re jamming this gas pedal down, but you are not figuring out what’s the issue in the first place. And so for us, we’ll always gonna be looking at the gut; looking for infection; seeing what could be going on; why is there some type of attack going on. And then also looking at adrenals, too. And figure out what’s the adrenal thyroid connection. Maybe you could brief people on that a little bit? How someone with adrenal issues could have thyroid issues and vice versa.

Dr. Justin Marchegiani: Yeah. So Evan, your question was looking at adrenals thyroid issues, we also have a listener question as well, talking about thyroid and gluten sensitivity. I’ll try to intertwine with the two answers. But again, adrenals are really important because you have cortisol production coming from the adrenals, which is important for managing stress and inflammation. Also, generally energy via blood sugar. Also, cortisol – is they differ healthy thyroid conversion. So if we have two high cortisol, or if your stress response is too high, we’re kinda in a Stage I adrenal issue that can block thyroid conversion. So we have this T4 thyroid hormone that gets converted down to the T3. And T4 is relatively inactive compared to T3.  So we have to make this conversion. There’s a lot of things that are needed for that, whether it’s selenium, or zinc, or vitamin A, or other nutrients to help make that conversion. But cortisol, from a hormonal perspective, is also needed. So if we’re too low on our response, right? We have this HPA axis, this regulation, the brain, the agent P, the hypothalamus and pituitary are hypo functioning. They’re dysregulated like a broken thermostat in your house – doesn’t turn on the heat, or turn on the air conditioning. That same thing is needed to help make that conversion from T4 to T3. So we have depleted adrenals that can strongly, strongly be an inhibiting factor of thyroid conversion. And also, if we have too much stress, one of the mechanisms the body does to regulate the stress response, is to make more reverse T3, which is essentially like taking uhm – the clip by the – your gun and putting blanks in there. So they kinda – they fit into the – into the magazine. They fit into the cartridge, right? But they fire, but that then you don’t get the same metabolic effect. You don’t get the increase in energy; don’t get all of the hormonal benefits; you don’t have the warmness and the increased blood circulation; and you don’t have the degradation of cholesterol and other hormonal byproducts. So you can see that the adrenals are intimately connected. Now answering the person’s question here on gluten. Gluten is really important because that’s a big strong – That’s a big stimulator of leaky gut. So gluten exposure can drive leaky gut. What it does is it increases zonulin, which unzips the tight junctions in a lot of patients, even people that are necessarily having a response to gluten. It shows that there is still uh – intestinal permeability that’s happening. And the more food particles that get into the bloodstream, the more LPS is in the gut, the more that can unzip the gut, the more – allow more food particles in there, and create more immune stimulation. And it’s also inflammatory in the gut, too. And also can create this concept known as molecular mimicry, where the immune system sees the surface proteins, and it can mistakenly identified it is the thyroid, and it starts attacking the thyroid tissue, creating more inflammation. And that can cause these thyroid follicles. So still, that hormone is creating unbalanced levels.

Evan Brand: And this could all come from gluten exposure, you’re saying?

Dr. Justin Marchegiani: It can all come from gluten exposure. Gluten is one strongest stimulators of leaky gut, along with distress, along with LPS, which is a compound produced from bacterial overgrowth, right? So the worse stomach acid, the more stress we have, the more essentially we’re not breaking down our food, the more we’re gonna have bad bacterial overgrowth that’s gonna increase LPS, that’s gonna unzip those tight junctions even faster, which is gonna create more immune issues, more food allergy issues. Because think about it, right? The immune system shouldn’t be getting revved up to deal with food; shouldn’t be getting revved up to deal with the digestion. So the more that’s happening- well what that means is that your immune system is going in overdrive. One of the major reason why people are when they’re sick – think about it. Because their immune system sucks up so much energy. So the more you’re revving up your immune system by just consuming food, you’re gonna be constantly tired. And that’s just gonna drain your adrenals, and drain your thyroid, and increase that thyroid autoimmune attack.

Evan Brand: Yup. Well said. So I mean, we got the zonulin. What’s the link there between the zonulin and LPS? So are these connected at all? Or are these going up and down in relationship to each other?

Dr. Justin Marchegiani:  Yes. So the more zonulin you have, typically the more leaky gut you’re gonna have, right? So vitamin D is actually a zonulin inhibitor. So the more zonulin you have, the more leaky gut. So LPS will increase zonulin. Infections will increase zonulin. Gluten will increase zonulin. And that basically, if this is like Parker jacket, you’re wearing that’s kinda like unzipping those tight junctions and then basically food particles can get in there.LPS particles can get in there. When LPS flows to the brain and makes it way up to the brain, leaky gut, leaky brain that LPS can create inflammation in the brain which feels like brain fog, which feels like mood issues, which feels like depression, which feels like anxiety. And this is really hard for a lot of people. Getting back to Evan’s question on gluten and the brain, is people may have a gluten issue. Think that well gluten has to cause digestive problems diarrhea, bloating, gas, reflux constipation, diarrhea. But it may not – It may be causing depression, anxiety brain fog, poor memory, poor uh – just word recall. And you may have a gluten issue, but it may not be even because by – you know, you may not see it because it’s not those conventional symptoms. And again, that same thing is gonna create thyroid issues, too. Coz that same mechanism that opens up the lining of the blood-brain barrier and the brain, also affect the gut, which then creates that more autoimmune thyroid attack.

Evan Brand: Well said. And there’s a lot of people that justify eating gluten to us. Whether it’s like organic wheat, or they’re doing some type of like sprouted wheat, or something like that. But gluten is gluten, and even if you’re not celiac – now there is research that shows that celiacs are gonna have30 times higher zonulin levels than a non-celiac. So massive, massive leaky gut in the celiac person in comparison.

Dr. Justin Marchegiani: Right.

Evan Brand: But still, we could even talk about the study. It’s Scandinavian Journal of Gastroenterology. It showed that gliadin, which is a gluten protein can affect zonulin even in people without the gene for celiac.

Dr. Justin Marchegiani: Yes.

Evan Brand: And so basically they said, “All gliadin, regardless of what – whether you are celiac or not, it’s still going to activate zonulin, therefore leaky gut, therefore this LPS, these endotoxins are gonna get in there.”

Dr. Justin Marchegiani: Totally.

Evan Brand: Which is crazy. And – and I love that. I love that the science because then you and I aren’t the bad guys when we’re telling people to get rid of gluten. It’s like, “Look, here is the research.” Yeah, maybe you don’t get a – acne from gluten, but you still causing leaky gut, regardless. I love that we can actually prove that and it’s not just up for – it’s not just our opinion coz we’re the nutrition guys.
Dr. Justin Marchegiani: That’s the key thing that you mention there, Evan. The zonulin and the gluten can trigger the leaky gut and you may not necessarily have an autoimmunity, and the question is the more stressed you become, the more compromised you become, the more your toxic burden, your stress burden, the more  your – the physical, chemical, emotional stress buckets get full. That’s where your body’s ability to adapt to stress really becomes inhibited. And again, the biggest mechanism really is, leaky gut. Even if you’re not necessarily gluten sensitive, you may be getting a leaky gut, which is adding stress to that stress bucket, right? It’s decreasing stomach acid; it’s decreasing enzymes; it’s increasing the ability to have food allergens; it’s increasing transfer infections and SIBO.Because the more your immune system is weakening the gut, the more that force field, that IgA gets lower, and the more critters can come in. So, yeah, 100%. And again a lot of people – I’m not a big fan of gluten because its, one: it’s hard to break down, it’s heavily pesticide, it’s low in nutrient density. A lot of the anthropological data shows that it’s been consumed only about 10,000 years ago, and the people that are consuming it typically have lower bodies – body stature, smaller in uhm – skeletal structure and increased risk for osteoporosis. Again, hunter gatherers tend to be more forgers uhm – starchy tubers, berries. Those kind of things, and obviously, meat and bone marrow. You study how the brain evolved. Really, it was the hand axe that allowed us to carve into bones and access bone marrow, and then creates spears to kill animals, and access that nutrients to grow our brains massively. Omega-3 is fat from the fish. So all of those things were huge in evolving our brain. Now, getting back to thyroid-We got a couple questions over here from the listener’s here on YouTube. So I’m gonna list a couple of. Couple is “how do you test autoimmunity?”Number one: kinda tying it back thyroid. We would look at TPO, or Thyroid Peroxidase antibodies or anti thyroid globulin antibodies; we’ll look for immune attack on the thyroid tissue. Also, we can look at TSI, immunoglubin, which is a marker for Graves’ disease, which is also a thyroid condition; or TSH receptor antibodies for the hyper- TSH receptor antibodies for the hyper; TSI for the hyper; and then TPO and thyroglobulin antibodies for the hypo. Now again, you can have the hypo antibodies, though, and have hyper symptoms initially. So you can kinda be on both stages at one point. So just kinda keep that in mind.

Evan Brand: And then more time, just so people are clear to that. Seems a bit confusing.

Dr. Justin Marchegiani: A lot of people that start out with hyperthyroid – or sorry – hypothyroid antibodies, low thyroid function antibodies, the TPO and thyroglobulin bodies, even though those are markers for a hypo-, Hashimoto’s, they can progress into hyper- symptoms initially because your thyroid follicle have about four months of thyroid hormone stored in it. So what that means is, you can spill out that thyroid hormone many, many months before, even up to a year or so, before you actually get depleted and go low. And that’s where the TSH gets really high. TSH will go high as the thyroid gets depleted, but in the initial attacks, in the first year or so, you may feel more hyper- symptoms even though it is a hypo– Hashimoto thyroid mechanism that’s happening.

Evan Brand: Uh, got it.  Well said. Okay. So, people may self-diagnose themselves with hyperthyroidism, your saying that it could actually be a hypo-caused by Hashimoto situation that’s going on. They just don’t feel the full effects yet coz it’s a new – it’s a new attack. Is that correct?

Dr. Justin Marchegiani: Totally. So the symptoms they may have is irritability, anxiety, mood issues, difficulty sleeping, heart palpitations, uhm – they may have like tired but wired kinda feeling. Those are the big things that they’re gonna have. I would say, yeah, the anxiety is gonna be a big one. Difficulty sleeping is gonna be a big one. Where the hypo- symptoms star to come in, again you may still have anxiety; you may still depression. The big differences is you’re gonna start to see the hair thinning because thyroid hormones are needed for hair follicle growth. So the outer thirds of the eyebrows go; the hair starts to thin on top; cold hands and cold feet it starts to happen. You may start to see constipation issue, too. You may start to see your triglycerides and your cholesterol go up. Again, infections can cause constipation, too. Uh – increase insulin can also cause increase cholesterol and triglyceride, too. So there’s other things. But that’s a general indication, is the cold hands, cold feet, the fatigue, the hair loss, the constipation and the increase in lipids you’re gonna see. That’s why you wanna test full thyroid panel, which is gonna consist of TSH, brain hormone, T4,inactive thyroid hormone (free and total), T3, which is converted peripherally 20%, and 80% throughout the body (free and total) and obviously you T3 uptake. You can look at thyroid binding globulin, which can go up or down if you have PCOS or on birth control. And then also reverse T3 and all the antibodies I mentioned.

Evan Brand: Yes. So I’ve also16:19read about another one that I’ve not seen used very much called TRAB, thyroid stimulating hormone receptor antibody, but it says that the antibodies are only ordered when someone is hyper- . And a positive result for that usually means great. So I’m not seeing that one that often, though.

Dr. Justin Marchegiani: It’s just a different name for I think the TSH receptor antibodies. Like TPO also has a like a name called,microsomal antibodies. So again, typically it’s the same names. So TSH receptor antibodies that’s probably another name for that, just like the microsomal is the same name for TPO.

Evan Brand: Uhh. Okay, got it. Now should we talk about – Is this is the time we should talk about the link between infections and thyroid health? Because people that were looking at, we’re not just gonna look at thyroid, we’re gonna look at the gut, too. And the average between us is about 1 in 3 of having infections. You know, every third person is gonna show up with infection. Sometimes even – you know those weak. Sometimes it’s 9 out of every 10 people has a parasite or other infection.

Dr. Justin Marchegiani: Totally. So we have a few questions coming on the uhm – YouTube Live board here that we’ll kinda tie in. But yes, so the big infections that can affect thyroid and can increase that thyroid autoimmunity: H. Pylori, okay, Yersinia, Enterocolitica, blasto, E. histo. Those are gonna be the big ones that are really gonna affect the thyroid. Even Lyme has a specific amino acid pattern that can create autoimmunity to the thyroid. So for sure, those are the big ones. You know, there’s been study showing that when you eradicate H. Pylori – It’s Italian study out there, that thyroid antibodies significantly drop. I have a video on blasto, right? Blasto infections are resolved, antibodies drop. Same with Yersinia, infections drop. As you attack Lyme, antibodies drop. So that can be a big stimulator and drive more leaky gut, more zonulin, more immune stress, which then creates more stomach acid and enzyme environments, which creates more adrenal stress, more thyroid stressed, and more nutrient deficiencies which perpetuate everything. So you can see, if don’t get to the root cause in this, that’s fine. You can go see your conventional medical doctor to make sure your TSH isn’t elevated, right? But in the end, you’re still gonna be suffering. And that’s why I have so many patients then I know you do as well that have all these symptoms. And I’ve seen a doctor for over a decade and are just tired of it. Alright, you know, this can’t just be my thyroid and all that we done is on 50 mics or 100 mics of Synthroid and that’s it. We can’t do anything else. They know there’s something more and that’s why they are reaching for people like you and myself, Evan.

Evan Brand: Yeah. Well in toolbox, it’s just not there, right. I mean, it’s not their fault. They’re just doing all that they’ve got. That’s the only tool in the – in the shed. The surgery or wait till you have some type of disease, or some big nodule, or a goiter or something crazy. And now, okay, now we have to do surgery.

Dr. Justin Marchegiani: Yeah. And a lot of people are talking about, “Well, what if you don’t have antibodies coming back on your thyroid?” My personal take on that is, above 40% comeback false negative. So it’s negative, but it could be positive. So what does that mean? Well, typically I’ll run the antibodies on someone at least three or four times before I say that they probably don’t have – they probably don’t have an autoimmune issue – at least 3 or 4 times. Now, the gold standard is a biopsy. Still going with a needle aspiration, and they poke it into the thyroid, they’ll if the tissues have any lymphocyte infiltration. So there’s an immune response going into the thyroid. So you can also have – you know your conventional physician palpate it. They’ll typically reach around your neck. So here’s my Adam’s apple, so it’s down just maybe a centimeter, and then out 1 or 2 cm. So it’s right here. And then you can typically run your finger right across it, then you can touch and push from one side to the other, and just feel the surface. See if it’s smooth, and then you can swallow, and feel that structure. And you can feel like a little nodule or a little bump and that’s possible. A nodule can typically mean autoimmunity or can mean an iodine deficiency. You can go to your conventional physician for that. I talked about the needle aspir –aspiration, but I don’t recommend unless you have – must you really want to know a hundred percent. The next more conservative approach would be a thyroid ultrasound to see if there is any swelling at all. Yeah. And that will be – those will be – My first line of defense would be, “Alright, let’s do your antibodies.” Second line would be ultrasound. I typically wouldn’t recommend the needle biopsy unless you are more worried about the cancer side of it, right? If I’m more worried about cancer then we may do that, or we may do a thyroid scan. But again, those are more invasive. I really only want to see those if we’re trying to rule out cancer. Coz typically the ultrasound and the antibodies will be the best. And we know, uncontrolled Hashimoto’s can lead to cancer, right? It increases your risk of cancer. So everything we’re doing is actually decreasing someone’s thyroid from progressing to a mandibular, papillary, follicular cancer. That’s – that’s the goal. So regarding that piece, everything we’re doing is gonna work either way because we’re mitigating the gluten in the food; or reducing the infection load; or upping the nutrients to help lower antibodies and help the thyroid convert; or making all diet and lifestyle changes and getting rid of the infection, which are gonna help improve the thyroid conversion, activation, and  the upstream signaling downstream.

Evan Brand: Early on in the chat, someone asked, “How should one read the cortisol lab test for adrenal fatigue?” “What numbers indicate the issue?” That’s gonna depend on the lab. Justin and I really like Biohealth, especially because they’ve got a brand-new test that were using now, which is six-point cortisol test. So any practitioners that are using a four-point cortisol test on you-

Dr. Justin Marchegiani: Uh-hmm. Yup.

Evan Brand: They’re outdated. They need to get with the –the times. With the 2017, six point is the new one. And how can you read the numbers? Well, typically there’s gonna be like a high patient line, a low patient line and then you would wannabe right in between those sandwich. And it’s gonna depend. So other labs are gonna have different – you know, different markers, different reference ranges. So for us to read a reference ranges to you, will be really boring. Uh – but basically long story short, you wanna be perfectly sandwiched in between those two lines. And it’s very rare that we see somebody in that. Most of the time we’re gonna see a low cortisol picture. And this is a low-free cortisol.

Dr. Justin Marchegiani: Yeah. Exactly.

Evan Brand: They’re gonna be low pretty much all day. And this is for most people. And so, then we have to keep digging deeper.

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand: We don’t just throw them a bunch of adrenal support and say, “goodluck” We gotta figure out what – why is this happening?  Is there a lot of emotional stresses, or chemical stresses, or thyroid issues, or parasites? And these are the other pieces of the puzzle.

Dr. Justin Marchegiani: Exactly. So you made some really good points there. So with the adrenal, the car test, the adrenal, the uhm – the cortisol-adrenal response, especially in the morning. Cortisol starts off low in that first initial bit of waking up, and really pops up in the first half-hour to one hour after waking. So Evan and I are looking more at those types of test to see how that cortisol awakening response is happening in the morning. Coz cortisol is so important for thyroid activation to prevent T3 pooling, which is T3 not getting into the cells, as well as to prevent reverse T3 up-regulation, right? Reverse T3 is the uh – the blanks. The blank bullets that fit into the magazine that prevent the real bullets from getting fired. The real thyroid hormone being the real bullets, upregulating your metabolism. So those are the things that we’re looking at. And I agree, cortisol, and low cortisol, and low thyroid can intimately feel the same, right? We have patients sometimes that will feel like, “hmm, do they have a thyroid issue or adrenal issue?” We’ll run both test and we’ll see their TSH is, let’s say: 1, 1.5; T3 is at 3, 3.2; and their conversion is okay. But we’ll see, “Oh, yeah” their cortisol awakening response is terrible. Their cortisol is low; their DHEA is depleted. If they’re female patient, their hormones are off, right? So we’ll see. We’ll be able to  differentiate the two. And if you’re just going based of a symptoms, and trying to self-treat yourself, it’s gonna be really hard. You start going in one direction over the other. You may not get better. And a lot of patients, they instantaneously wanna go get their thyroid supported and treated first. The problem with that is, you increase thyroid hormone levels, and you already have lower cortisol. You can actually lower your cortisol even more, right? Just go google uhm – Addison’s disease, which is cortisol failure, right? – Addison’s disease, contraindications – And one of the contraindications you’ll see on their thyroid hormone because thyroid hormone can actually lower cortisol more. Coz think about it, right? Thyroid increases metabolism. The more your metabolism is increased, the more you metabolize through your hormones as well. So if we lower our hormones, and you are already at super low cortisol to begin with, you can actually feel worse as well. A lot of people feel worse when they just go after their thyroid and it can really create more problems.

Evan Brand: Wow. Now that you say that, I’m picturing a woman last week who, she was on Levothyroxine for a very long time. Her cortisol levels were like the lowest I’ve ever seen. So I wonder if it’s that drug that’s contributed to her cortisol being even lower than it would have been without the drug. What do you think?

Dr. Justin Marchegiani: Yeah. Absolutely. Absolutely. You can see patients that they go on their thyroid support, and they start feeling worse. And it’s just – it’s really difficult because if they’re seeing a functional medicine practitioner, they may lose faith in that person, right? And – and just say, “Hey, I’m just gonna keep on doing what I’m doing. I’m just gonna go back on the Synthroid.” So you have that aspect there, right? And then uhm – also have the fact that you know, what’s primary? A lot of people have in – the adrenal issue is the more primary issue. And if we start treating that first, then we may get the patient feeling better, which then creates more compliance. The more compliance, the more – the more the patient’s gonna follow through on diet, on lifestyle, on addressing infections. And that gives us a better chance to leverage the patients to do the right thing to heal.

Evan Brand: Well said. And plus, if the adrenals get back online, then we know that that conversion from T4 to T3 active is gonna be better. So they may not even need to go to the “thyroid support” if all these other root causes were the biggest thing. I mean it’s a parasite and an adrenal problem. If you fix those two things, is it possible you can get away with never going into, “Hey this is your thyroid program now. We just have to fix the other pieces.”

Dr. Justin Marchegiani: Yeah. Absolutely. So uhm – looking at that piece, you’re hundred percent right. I see so many patients, we’ll measure their thyroid temperature like their basal temperature. And again, for basal temps: 97.8 to 98.2 °F is gonna be where you wanna be for your armpit axillary temperature; and then98.2 to 98.6 °F is oral temperature. And typically do that in the morning before you get out of bed. And also do it sometime in the afternoon before you have lunch, and kinda do a general average. And again, a lot of people will be relatively low, and they’ll start to see their temperatures start going up uhm – as we treat the adrenals. One of the big things we see with the adrenals is we see an erratic temperature. The temperature is kinda bouncing around. Anything greater than .3°F can be – can lead to be a sign of a potential adrenal issue via a temp.

Evan Brand: Let me ask this. Let me ask this with you. So you’re saying, .3 difference. So that would mean if you woke up one day and you tested your armpit temperature, let’s say you were 98° flat in your armpit before you got out of bed, then the next day, you’re at 98.3. To you, that’s gonna signify thyroid and adrenal issues. Is that right?

Dr. Justin Marchegiani: So we went from 98 to 98.3?

Evan Brand: Yeah.

Dr. Justin Marchegiani: Yeah. So it’d be greater than .3 So if you’re 98-98.4 and we’re consistently seeing this back-and-forth oscillation, so we’re seeing 98, 98.4 or 97.9 and it’s constantly bouncing back and forth greater than .3 that could potentially mean an adrenal issue, right? And because it’s erratic, but at a good level of temperature 97.8 or higher. So we typically mean of an adrenal issue. If we see it low and erratic, let’s say, 97, 97.4, 96.9 to 97.5, then that would potentially be an adrenal and a thyroid issue. And again, temperatures aren’t perfect, right? Like when we assess thyroid, there’s three indicators we use. We use subjective, which in my opinion is the most important. How do you feel? Do you have a lot more hyper- or hypo- symptoms, right? Hyper- symptoms being anxiety, palpitations, mood issues, tired but wired.

Evan Brand: What about sweating? Increased sweating?

Dr. Justin Marchegiani: – sweating, irritability, difficult sleeping. Where the hypo- symptoms, again, you can still have the mood stuff; you can still have the anxiety and mood stuff; you can still have some tired and wired – some tired and wired

feeling but typically more tired, though. And then the big thing is the cold hands, the cold feet, the thinning hair, the thinning eyebrows, the constipation. Those are gonna be the big differences. And obviously what trumps any of it, is an increase in TSH or thyroid antibodies are gonna be the biggest distinguishing factor, if it’s TPO or TSH receptor antibodies.

Evan Brand: And I just wanna mention one thing, too. In a lot of cases, the people we’re working with are gonna have both hypo- and hyperthyroid symptoms which can be equally confusing.

Dr. Justin Marchegiani: Totally. Yup. Equally confusing. I mean we look at like the test that we give our patients to assess that uhm – right? The other big one’s losing weight. Losing weight uhm – even though you’re – or unintentionally gaining weight if you’re on the hypo- side or unintentionally losing weight if you’re hyper- side, right? That’s gonna be another, another big one. Elevated cholesterol – another, another big one. So those are a couple of the other ones that I mention there where the anxiety, the excessively sweating, uhm – again, hands shaking, difficulty sleeping, uhm – feeling more warm on the hyper- side. Those are gonna be the other big ones. And obviously having a family history. If your mom, or your aunt, or uncle, or your sibling has a thyroid issue, right? That’s gonna be a big – just, you know, big factor. One of the big questions I do in all my intakes is, are there celiac disease or any autoimmunity that runs in your family? Whether it’s thyroid, or Parkinson’s or MS, or ulcerative colitis, or Chron’s or anything autoimmune related, type I diabetes. And if there is, that really gets me to hone in there. But testing for autoimmunity, conventional medicine typically does it like ANA, or HLA-B27, or an RA Latex like – these are like the conventional, like broad markers for like scleroderma, or like – or celiac, right? Or see, rheumatoid arthritis, or lupus. They’re very non-specific a lot of times. And again uhm – and they typically are late stage markers. It takes a while for them to pop-up.  And again, a lot of people they may be asymptomatic and still have them. So it’s not a real motivating factor for a lot of people. Where some of the things we look at it with the thyroid antibodies, well even just a little bit above like the normal range. So like LabCorp, it’s 33 or 36 for the TPO. Where I think the thyro – the thyroglobulin antibody is anything greater than 1 is positive. So if we’re like at 1.5 or 2, you know – we will look at that and we’re gonna really push for autoimmune changes and autoimmune protocols. We see TPO going above 20, we’ll start to say, “Hey, you know, you wanna be careful with this.” And we’ll keep an eye on that. And then we have the – you know, people are on the thousands on the antibody levels. And we’ve made this change and I’ve seen 70, 80% drops. We take a patient from 2300 down to like 3 to 400, which is a massive drop.

Evan Brand: And so that’s diet, that’s lifestyle, removing infections, supporting adrenals. All those pieces, right?

Dr. Justin Marchegiani: Yeah. Absolutely. And I got a question here on FacebookLive. I’ll try to connect it in here. And again, I apologize for Facebook Live listeners here. If you’re watching us there, check out the YouTube so you can actually see Evan. I’m gonna try to reiterate the questions so that you can hear it. Uhm – but that will be the best way to get the full conversation. Regarding uhm – question on Facebook Live, he’s talking about iron. Now, iron is really important coz it’s a really important building block for thyroid hormone. And we also need triiron for thyroid activation from T4 and T3, and we need it for just generally carrying oxygen to ourselves, which is really important for cellular metabolism. So if we have low iron levels that could be an issue. Now I did a full video this for people to get back to the iron video to get like the specifics on that. But again, typically we’ll recommend, like in my line, we use an Iron Supreme. It’s a Ferrous Bisglycinate. And we’ll do about 25 milligrams of iron, anywhere between 2 to 4 times a day to help support that. But also, we’ll figure out the root cause. Coz a lot of females, it’s excessive menstruation or hemorrhage. It could be vegetarian and vegan diets, or it could be the x factor of malabsorption from gut inflammation, to low stomach acid and enzymes and not being able to ionize minerals to an infection that’s stealing your minerals.

Evan Brand: Yeah. I’m so glad you brought that up because here I am thinking about myself, and the whole time, I had two parasite infections.

Dr. Justin Marchegiani: Totally.

Evan Brand: I guarantee I have low stomach acid. I guarantee I had issues with iron absorption. And people, let’s say, even if you’re eating the best organic grass-fed beef, if you got an infection that is causing stress on the gut, therefore reducing stomach acid; therefore reducing the ability for you to cleave off those amino acids and iron from them – from the meat, you can still have trouble. And what about – what about ferritin, too? Because the iron storage protein, that’s what we’re gonna test. For many times, you’re gonna see, especially women have very, very low ferritin levels where – and you’ve got a woman with ferritin levels you know – in between say 20 and 40. You may be experiencing something like breathlessness, for example. You could definitely have hair loss falling out. Sometimes I’ll hear women say when their ferritin is about 20, let’s say their hair is falling out in clumps. So you wanna get ferritin, which is the iron storage protein. You gotta get that levels tested, too. And we like people to get up, you know, 60, 70, 80 with ferritin just to ensure that – that iron storage protein is actually working. Now – and this is something that I haven’t looked at very often, but I’m curious if you know Justin, if you’ve got low ferritin, are you always going to have low iron as well? Or is it possible that with low ferritin, your iron could still check out okay?

Dr. Justin Marchegiani: So with lower ferritin, iron serum can pop up, and it can pop up because – imagine like ferritin is like the gasoline that’s in the gas tank, right? And then think of like iron serum is like the iron is actually in the carbonator and then the piston’s ready to be – ready to be combusted, right? So one’s like – iron is like, what’s ready to go that’s in the actual engine and carbonator; and ferritin is like, what’s in the gas tank, right? So obviously the more important one is gonna be what’s in the gas tank coz that gives you the bigger picture, right? You don’t care, you know how much – how much engines – how much fuel’s in the carbonator. It will only take you maybe a couple of hundred meters, maybe a mile. I don’t know, I’m not a big car guy, so – But keep that in the back of your mind. Now the difference is your body has a little bit more of an interplay with other systems. So inflammation can increase iron serum. So that’s why we look at ferritin, but then we’ll also look at it with iron saturation, too. We see iron saturation low, below 25, when we see TIBC or UIBC on the higher side, that means your binding proteins are growing more and more fingers –  to have more iron. And if we see iron serum up, then we’ll be like, “hmm, maybe there’s some inflammation” We may wanna look at C-reactive protein, right? We may want to look at some of those inflammatory markers. Uhm – if we’re running a gut test, you may look at lactoferrin or calprotectin and see it – inflammation is occurring in the gut. So it really depends on what else is happening in the body. Does that make sense?

Evan Brand: Yeah. It does – it does. So, if you had to pick one or the other. Let’s say, somebody only gave you the option to run some of the specific iron markers or ferritin, what would you pick? For me, I think – I feel like I’ pick ferritin, if I could only pick one.

Dr. Justin Marchegiani: Yeah. I mean, ferritin for sure. But an iron panel is like 30 bucks. There’s no reason –there’s no reason why anyone should nickel-and-dime on that because you don’t wanna compromise $30 getting a complete picture. So I think we run it. We keep doing it for 30 bucks and that’s everything.

Evan Brand: Yeah.

Dr. Justin Marchegiani: And that gives you the ferritin, the iron serum, and that gives you the UIBC, the TIBC, the iron stat. So then you have a real complete picture of what’s happening. And then you know, even just looking at someone’s CBC can be helpful coz you can look at red blood cells, hemoglobin, hematocrit and if that’s starting to go low, then we can look at MCH, MCB, MCHC, which is basically markers to see how big your red blood cells are, right? Smaller red blood cells typically mean iron issues; bigger red blood cells typically mean B12, folate and B6 issues.

Evan Brand: Wow. There’s another question. Actually there’s a comment up here by Tonya. She was talking about how she was able to eat gluten and dairy now after she had infections. And I guess she treated those, and now she’s able to eat gluten and dairy. I feel like that depends on the person. Me, personally even if I could get away with it, I still wouldn’t do it because you’re still gonna increase zonulin and leaky gut. Potentially set yourself up for future infections.

Dr. Justin Marchegiani:  Yeah. That’s the problem, right? Disaster doesn’t occur in –a day or a week, right? And we know that leaky gut can still happen even without the symptoms, right? We – there’s just been studies where they’ve given people pieces of gluten and they measured symptoms, they didn’t see necessarily an increase in symptoms or negative side-effects. But they saw this increase in zonulin and leaky gut because of it. Now we know that when that happens, you increase your risk of having other issues. So I know there are people right now, we get the same conversation. We’ll be talking to people that have been able to smoke cigarettes and not get lung cancer. Okay, great. Now, does that mean that you’re gonna go out and recommend smoking cigarettes to anyone? No. It’s still not gonna be beneficial. It’s still gonna be inflammatory. It still increases your risk. You don’t know who the people are that are gonna have the negative effects to begin with, right? It’s all like you have that looking glass that you can see in know. And also uh – you don’t know down the road when stress comes on and other things happen. Coz usually it’s not just one thing. It’s like, “great, now this person who’s talking – their stress bucket, they’re already filling it halfway.” So they’re going into with a half-full of stress bucket thinking that they’re okay, right? Alright. So, I got a half full of stress bucket. So now when other things come into their life, they’re gonna overflow faster.

Evan Brand: Agreed.

Dr. Justin Marchegiani: And then also – and also other people, that may overfill their stress bucket right away. And so that’s why you have to make sure that you know that some people may be the exception to the rule. They aren’t the rule. And this is where it’s –We have the advantage, Evan, because we see so many thousands of people that we can make correlations and can actually even see causation because we make changes and we see direct changes in the person’s physiology and their symptoms are getting better. So we can’t make – we can’t create all these protocols for the exception to the rule coz there are so many exceptions. There are people that smoke and don’t get cancer, alright? We know that. People that may consume gluten and may be okay, but the majority may have issues. Or they may set themselves up in increased stress bucket, right? Meaning increase their ability to handle less stress, so that when more stress comes on, boom, now they’re laid up.

Evan Brand: Exactly. Yeah. Tonya we had to put you on the chopping block there because for you commenting about saying gluten and dairy and you can get away with it now. You’re speaking for thousands of people that listen and do the same thing. And Justin and I will look at the symptoms of someone, and if there are still health complaints that haven’t been resolved, then let’s say we get the retest on GI-MAP stool test, and we look at antigliadin and antibodies, and I caught the lie detector test. I don’t know if you do, Justin. But it’s uh – when you get the antigliadin antibodies, it’s like, okay, one of three things happen. Either you’ve got gluten, you ate gluten, or you’ve got cross reactivity going on. And so, even if your symptoms are not supposedly there, your body is still fighting internally. There is still this internal battle going on, which is not what we want because then those antibodies can get confused and start attacking other tissues, which we don’t want.

Dr. Justin Marchegiani: Yeah. And it’s tough because there are people that we see eat a diet that is you know – highly processed with a lot of carbs. And their blood sugar is relatively okay. And that maybe because they’re naturally more insulin sensitive, or they exercise more. And we see some people that eat the same diet, and they’re diabetic. So what do you do? Like I can’t sit there, and say, “well this person who eats this way isn’t diabetic” that means that diets is fine. No, it’s not. You have to look at the greater picture. You also have to look at what – does that diet now, is it nutrient dense? Is it anti-inflammatory? Is it low in toxins? And no, it’s not. But again, don’t get me wrong. Like dairies are open-ended topic, right? Ghee may be perfectly great. Butter maybe perfectly great.  Raw milk may be perfectly great for some people. But then we go to the pasteurized dairy, we go into more of the yogurts, which could be great, but it may not be. So do – we have to kind of uhm – can have a criteria for all those different compounds, right? Because some dairy may be okay, some may not be okay. And sometimes bread, too. Some people may do okay with bread over in Europe. Or they’ll do fine with sourdough bread coz it’s fermented and has less gluten in it versus, let’s say, wheat bread here that’s conventional. So you got to look at it, too. Some of those things may be okay and may have to be more specifically talked about.

Evan Brand: Yup. She commented back. She says, we’re missing the point. If parasite is the cause, you can go back to the way you were, prior to eating – oh the way you were prior, like eating gluten. We as people, ate gluten for a millennia and now it is the cause of all ills. I’ll comment on it first, and then I’ll let you say something about it. In the modern world, we have a lot more toxins. We have a lot more things that we’re up against, and so gluten, where maybe only would have change someone’s health 2 or 3% 5000 years ago, now,  has the ability to modify someone, tell 50 or 75, or even80% in some cases. We’ll see 80% of symptoms get better without it. So for me, comparing millennia to the modern world, we’ve never had a world like today. So it’s just not really a valid argument.

Dr. Justin Marchegiani: Yeah. And the grains aren’t even like– If you look at the biblical grains, they talked about in the diet, and Dr. William Davies totally debunks this. If you look at the grains 2,000 years ago, reference in the bible, these are 12 chromosome uh – grain products versus the ones that they have right now, they’re hybridized and genetically modified, they’re up to 50 chromosomes. The gluten content is much higher and is also the extra stress of potential GMO nutrients, poor soils, as well as pesticide exposure. So it’s not quite the same way. Plus, people have to look at it from this perspective, if you drive around on your car, and you get a flat tire on your car, right? And you change the tire and you put the little – let’s forget that. Let’s just say you’re driving around on that flat tire for like a year, okay? So the flat tire is the cause of what’s happening here. But you drive around the flat tire for a year. That’s like ignoring the stressors of your health. It could be gluten. It could be parasite. But the longer you drive around on the flat tire, the more you front angles out of alignment; the more your suspension goes out of whack; the more your whole shock system in the car becomes stressed. And even if you decide, let’s say a year later, I’m gonna change that tire and put on a nice, fresh tire, which is like cutting out the gluten, managing stress, managing sleep, your car has been compromised where just changing the tire won’t fix it. You’re gonna have to go in for a full frontal alignment. You may have to get your tires rotated; you may need new shocks; your brake pads may have worn unevenly. There’s so many other issues that may happen with the car that where collateral damage from that flat tire being ignored. So just because you, let’s say, it was a parasite issue, and the parasites are now gone; or it’s a gluten issue, and the gluten’s now gone, doesn’t mean you now have nutritional deficiencies; doesn’t mean your enzymes and HCL are now effective; doesn’t mean your thyroid and your adrenals hormone system are now stressed; doesn’t mean your detoxification systems are now stressed, right? So this is what is happening. And other analogy is you’re in debt for 5 years. Great. You stop – you curtail your spending habits but you don’t get out of the hut – but you don’t get 100 grand out of debt by just changing your spending habits today. You need a bailout, or you need a lot more time just to start saving and get that money back up. Does that make sense, Evan?

Evan Brand: Yeah. Or the analogy of the spider web.

Dr. Justin Marchegiani: Yes.

Evan Brand: Where there’s other pit of the web that’s affected, too. So for example, we can use me as an example. You look at me when uh – first time I came to your house. You’re like, “Evan, man, you look like you get a parasite.” You just- you just saw it. And I was like, “okay” It’s been a year plus since I’ve eradicated those infections, but I still am using enzymes and HCL because I was in such hypochloridic state that I still need to use supplemental HCL and supplemental enzymes. And I don’t really have an end date in mind where I’m not going to use enzymes because if I’m busy, or If I feel like I’m just not chewing my food as much as I should, to me, I like that nutritional insurance policy in place.

Uhm – there’s another question too that Chris asked earlier. He said, “not to be the dead horse, but isn’t there another marker to show autoimmunity of failsafe?” I guess since he’s asking because a lot of times –

Dr. Justin Marchegiani: I already answered that one with the ANA and the conventional ones.

Evan Brand: Oh, okay.

Dr. Justin Marchegiani: And then the TPO. And also the gliadin antibodies be the stool testing we do. And then there’s uh – a test by Cyrex Lab that looks at leaky gut, which could give you a predisposing marker, where it looks at zonulin and occludin toxins which can open up the tight junctions. So that one will be another one when I look at.

Evan Brand: It’s pricey. Have you run that one often? The Cyrex, I mean, it’s like 600 bucks.

Dr. Justin Marchegiani: Yeah. I’m not a big fan of that because it doesn’t tell me any of the cause. So if people have infections and their diet is not good, and they have – we’re seeing a low stomach acid and low enzyme environments, it’s not worth it. We just kinda work on treating the cause and then a lot of times, the clinical picture changes. Peoples bloating in gas and all these symptoms improved, which we know that means their digestion is getting better, their absorbing more nutrients. That means there has to be a leaky gut mechanism happening. I’m a bigger fan of looking at causal test versus the effect test. The effect tests are only good if you’re trying to convince someone or that people are skeptical. But once – people that are coming to see us are very intelligent because they’ve already educated themselves. They listen a lot to podcast. They read lots of blogs. They watch a lot of videos. They already get it. They don’t need to be convinced. They just wanna be fixed. So it’s a different mindset with those people.

Evan Brand: Agreed. Well said. And we don’t have people that need to be convinced they have leaky gut. Most of the time, they’ve already self-diagnosed themselves. In many cases, you don’t need to spend – I’d say99.9% of the cases, you don’t need to spend the money on a blood test that’s gonna say you have leaky gut. We could just list off symptoms – boom boom boom. Yeah, you probably got leaky gut. Cyrex, for their food sensitivity test, that is – that is cool one, but even then I feel like it’s a unnecessary in most cases because if you and I are gonna put somebody on like a AIP approach, let’s say thyroid disease did show up, some Hashimoto’s. We’ll have to go AIP and maybe we could try to reintroduce things. But they’re gonna be able to be a better barometer of Austin than the test in most cases. Like, “Oh when I added dark chocolate back in” or “when I added dairy back in” and this is what happen. I feel like that’s more valuable than a blood test.

Dr. Justin Marchegiani: Totally.

Evan Brand: Totally.

Dr. Justin Marchegiani: We’ll do a full autoimmune elimination protocols and it’s gonna be very valuable for 90% of people. We’ll go an autoimmune diet, cutting out nuts, seeds, nightshade, eggs, obviously grains, legumes, dairy. And again, for people that are like the gluten fans that are on the message board here, they still aren’t nutrient dense food. If you look at the nutrients, if you look at the other compounds that aren’t gluten-related, right? Let’s look at the fact that some people are intolerant. They just can’t break it down because they’re missing the enzymes to do that. And that any time the food is not broken down, it can create stress in the body just like people that can’t break down lactose. They’re lactose intolerant and then they have diarrhea and bloating. So, some people just may be intolerant to breaking down the protein. Some people may be increasing inflammation because of the lectins and the phytic acid and then the oxalates that are just shutting mineral absorption. Other people may be having the autoimmune issue. So it’s still not a nutrient dense anti-inflammatory low toxin food. It’s not like there’s this missing nutrient that you can get out of gluten or out of these grains that you can’t get in some really awesome nutrient rich vegetables or healthy fruits with –or healthy starchy tubers. Does that make sense?

Evan Brand: Yeah. It does. Now – this is off-topic. But –

Dr. Justin Marchegiani: It’s not a missing link. That’s my thing. If people had to say that – we – could show me a nutrient density chart and say, “But Dr. J, you get these nutrients, or the zinc and this is amazing or this, B vitamins”. I’d say, “Okay, but there’s not that evidence that it’s there.

Evan Brand: Right.

Dr. Justin Marchegiani: Now a great – a great talk on this uhm – what’s his name, out of Harvard there – Matt Lalonde did a great talk at the Ancestral Health Symposium at 2012 on nutrient density. I highly recommend anyone watching that. But when you look at the nutrient density that you’re gonna get in meats, especially organ meats, it’s insane. It just destroys grains. And grains are the lowest out of all those foods.

Evan Brand:  Yeah. Now, we’re – we’re off-topic from the thyroid, but that’s fine because I love that’s it’s a dynamic conversation.

Dr. Justin Marchegiani: It connects in, right? Because-

Evan Brand: It does.

Dr. Justin Marchegiani: -nutrients help in thyroid conversion, they help with thyroid activation, they help with the adrenal, which helps the thyroid cells. Even though we’re off-topic, we’re gonna do our best to kind of meander our way back to the thyroid.

Evan Brand: Yeah. Now, what I was gonna say was a bit off- topic, which is – well all you’re saying is totally on topic but what I’m gonna say is it’s funny how even some of these professional healthcare companies are now designing supplements, which I’m not gonna even give them the credit of naming these products. But there are gluten supplements out there, where it’s like, “here, go eat gluten, but then here is this enzyme or here’s this XYZ supplement to where you can still try to eat gluten, but you just take these pills with them instead.” It’s like, that’s ridiculous. That’s like covering up the engine light in your car. The light’s still there, but here’s this magic tape that’s gonna hide it. I just don’t think supplements that enable you to eat gluten is a good idea.

Dr. Justin Marchegiani: Now, here’s the deal, right? If you have thyroid antibodies, if you know – if you have objective measures of autoimmune issues, or your heightenly celiac sensitive, another word is – almost like – almost like if you have gluten, like you’re laid up, like you’re just – you’re junk for days on it, I don’t ever recommend cheating with gluten. If you can manage, if you’re really healthy, and you don’t have severe thyroid or antibody markers popping up, then you could try going gluten-free you know, right? It maybe rice, or corn may be okay. If you do that, I typically recommend the enzymes, like the DPP-4 enzymes and we’ll take it with charcoal. But it’s a cheat, and we’re just trying to mitigate it. And we wouldn’t wanna ever do that as a staple to allow ourselves to eat gluten. Now, like myself, like maybe once year, like if I’m in Boston and I’m in the north end, I may have like a cannoli, but I found an alternative uh –modern bakery and get some gluten-free ones that are white flour-based. But if I go, I mean I’ll up the DPP-4 enzymes, increase the charcoal, and the vitamin C in the knack. And that will help me deal with it. Uhm – but again, that’s like – if you look at it, the 2000 meals I have a year, you know – maybe one or two have that in there, right? Not a lot. We’re talking .001% But people who are really, really sensitive or having gut over their health issues, initially you really wanna be puritanical. And then – I’ll kinda dovetail this with Johnny’s question here. Some of the testing that I will do to fine tune, if like patients are on the autoimmune, they kinda reintroduce things back in and they’re still having issues, and not quite sure what works, there will be some testing we’ll do like an MRT is a pretty good test. I’m liking the ELISA / ACT test as well coz it’s not just antibodies, it’s looking at various lymphocytes, too. And I do a combination of the ELISA and I’m – I’m kinda testing the MRT as well. And I’ll actually be doing some blind testing and sending some uh – different vials in with different people with actually my blood on with different names. I’m doing some blind testing on that. So hopefully I’ll do a video on that.

Evan Brand: You ought to try the, if you have it already, I believe it’s the Array 2. And there’s a couple of other Arrays form Cyrex, too. I’m a bigger fan of that than the MRT.

Dr. Justin Marchegiani: Well the problem with Cyrex, though, it’s only looking at Ig or IgA – that’s the issue. So with the ELISA, it’s also looking at T-cell lymphocyte response and you’re not gonna get that picked up on Cyrex. That’s the big issue. And if you’re not exposed to gluten, let’s say we’re doing this test, and “yeah, I haven’t eaten gluten in a month or a couple of months” Well, if the immune system isn’t responding to it coz it’s not being exposed to it, it won’t come up in the test.

Evan Brand: Uhhh.

Dr. Justin Marchegiani: And people will be like, “Oh, look, I’m fine.” But may not be the case. So you have to look at it in a complete spectrum.

Evan Brand: That makes sense. So the ELISA / ACT.

Dr. Justin Marchegiani: Uh- hmm.

Evan Brand: And that’s blood.

Dr. Justin Marchegiani: That’s blood. Exactly.

Evan Brand: Cool. That sounds great. Well, I feel like we should probably wrap this up. I know this has been a lot of information uhm – if people are interested in your book, then they need to sign up for your email list. I mean – you’re so passionate about thyroid health, it’s definitely infectious. And do we have a date on that? Of this thyroid book? What’s up with that?

Dr. Justin Marchegiani: It’s done, man. I’m shooting it up to the editor. So we can buff it out and – and you know, I read all – every thyroid book on the market, I pretty much read. And my biggest issue is, you can summarize every thyroid book in like 5 pages.

Evan Brand: I know.

Dr. Justin Marchegiani: So I want a book that’s shorter. It’s more condensed. I want every page to be neat. I want every page to be __I want every page to have like action items. People can walk away and really improve their health and then throughout – in a standstill, they can reach out to people like myself and you, to kinda like get to the next level. So that’s where I’m at right now – to fine tune and boil it down. I want to touch just one question. Dale mentioned it earlier, he talked about mercury. And mercury is an important aspect coz mercury can pinch it and affect the thyroid. There’s this study showing that lowering mercury can decrease thyroid antibodies. I have one patient that had thyroglobulin antibodies over 2000 and we saw the antibodies drop below 100. So we saw a 99% drop in antibodies by removing mercury. So we’ll test that. We’ll do challenge test via urine and we’ll use various provocation agents like DMPS, which is 2, 3 dimer propanoic acid, or we’ll do uh – 2, 3 dimer succinic acid, which is DMSA. Or we can even do EDT as well. But I typically do the DMPS challenge and we’ll be able to provoke that and see what’s coming out from the mercury. That can be a big, big uh – kind of underlying revealer of another aspect of what could be driving an autoimmunity, which is the mercury. And again, I know you’ve done the shade testing which looks at urine unprovoked, hair, and blood. Not a big fan of hair and because they don’t tell you an active or chronic uhm – a chronic level. Doesn’t give you a tissue burden. And also, there’s study showing that people that push more mercury out on the hair actually have better detox pathways, and they measure people who push less mercury on the hair, and they actually found that they had more provoked mercury in the urine even though they push less out in the hair, partly because their detox pathway is impaired.

Evan Brand: Wow. I’m gonna try yours coz it sounds like it sounds like I could be getting some numbers that are not what they actually are. I wonder what other heavy metals are impacting this, too? I wonder if cadmium, for example, or aluminum is also gonna impact thyroid. It seems like all heavy metals potentially could. Or do you think it’s specific to mercury. Mercury’s gonna be the biggest?

Dr. Justin Marchegiani: Well mercury is definitely gonna be the biggest coz it’s one of the second or third most toxic compounds in the world. It’s really bad. So that one. Obviously lead is gonna be really bad, too. Because lead and mercury interplay, right? If you look at the lethal dose of one – if you take uhm – the dose, you get hundred rats lined up, and you figure out, you keep on titrating the mercury dose up. So the first rat dies out of a hundred. So you titrate the mercury up, the first rat dies, right? That’s called the – the lethal dose of one, right? The 1, the 1% that kills – the dose of 1% of that kills. And you do that for mercury and lead, so you have the hundred rats, right? One dies of mercury, right? You increase the lead up here or one dies of lead. And you now combine the mercury and lead those together to all 100 rats, they all die. Did you get that?

Evan Brand: Yeah, I sure did.

Dr. Justin Marchegiani: So what they’re saying is even though it only kills one of here over a hundred and the lead over here kills one out of a hundred, but when you combine it together, and gives it all to 100, all of them die. Meaning that, these metals are synergistically connected and can have exponential effects when added. So if you see mercury and lead together, typically the compounds that we’re using, are gonna be specific to mercury and lead for sure. So you don’t have give a special one for mercury and a special one for lead, right? So you give it and it would globally affect mercury and lead and typically cadmium, as well. And we’d also wanna give extra binders. Crochet talks about this like MC but MCT like modified citrus pectin, MCP actually. Uh – we’d also give maybe charcoal or bentine clays. We’d also use things like chlorella, especially for mercury. And we’d also use things to support detoxification. So in my line, we use heavy metal clear and then we also use DMPS and we use a lot of sulfur amino acid support to run phase 2 detoxification, as well.

Evan Brand: And still eat your broccoli, folks.

Dr. Justin Marchegiani: Oh, yeah. Your cruciferous are gonna be really important for your DIM and Indole-3-Carbinol which all help run phase 2 detoxification.

Evan Brand: Awesome.

Dr. Justin Marchegiani:  Well, anything else here? Any other questions we wanted to run to? Uh – on the YouTube live here, anything else we can answer?

Evan Brand: I think that was everything.

Dr. Justin Marchegiani: I think we hit it all up pretty well. Oh, I didn’t touch upon this. Let me just hit it real quick. Iodine. Iodine is a really important nutrient for the Iodination process to make thyroid hormone, right? If you look at the T, the T typically stands for- some people say thyroid or tyrosine. And then the 4 number is the Iodine. So you have the Iodination process and then you have the 5 prime, the iodinase that comes in there and it grabs and pulls off an iodine, and activates it and makes it T3. Well, that enzyme that activates thyroid hormone is selenium dependent and comes from the liver. So healthy liver function is really important. But having adequate iron uhm – adequate iron level as well is important, but having adequate iodine is also important. RDA is about 150 to 200 µg a day to at least prevent goiter. Now some people may need more than that. Now you have people like Brown Steen and other doctors that are going super, super high, 2550 mg a day. I’m very, very cautious of doing any high-dose iodine. I have seen too many patients uhm – like literally just lose their hair. Like just like gaps, like handfuls come out and their thyroid has gotten worst. Number one, like if we give iodine and they have autoimmunity, it’s typically months later after we’ve stabilized the gluten, stabilized the adrenals, supporting thyroid, supporting nutrients, supporting the gut, get their diet in shape, get their digestion better and then we’ll start very low and we’ll gradually work them up. But we’ll be checking in, we’ll be monitoring it and we’ll be doing very low doses and then gradually tapering it up or also making sure there’s enough selenium there, enough B vitamins, enough minerals, enough vitamin C. So we’ll make sure there’s a lot of other cofactors coz when you give iodine, it can spit out hydrogen peroxide, which can increase D cell lymphocyte infiltration into the thyroid. So it can exacerbate autoimmunity. So if we do it, we’re doing it responsible. We’re doing a lower RDA doses as a starting point and then gradually working our way up from there.

Evan Brand: So what about working with foods at the same time? So I’ve heard some people, anti-kelp people out there. And I don’t know why there’s some anti-kelp people.

Dr. Justin Marchegiani: Well, I think you just gotta be careful with kelp just because just coz where it’s coming from, the whole Fukushima disaster two years back.

Evan Brand: Yeah.

Dr. Justin Marchegiani: -radiation. So just gotta be careful. There are some really good sources out there. You gotta make sure it’s not coming from one of those places and number two, there’s a whole list of foods that you can give. Typically, like in my multi- there’s gonna be at least the RDA there, which is great.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Egg yolks are gonna have some iodine as well. Uhm- obviously seaweeds have some good iodine sources. You just have to make sure that it’s not gonna be the Fukushima kind. I’ll get a list right here. I’ll read out a couple of foods that are really high in iodine in just one second.

Evan Brand: I’ve heard strawberries, too, which is interesting. And then I also wonder – it’s hard to get a composition sheet for a Himalayan pink salt. I wonder if you’re gonna get any iodine from pink salt or not?

Dr. Justin Marchegiani: Yeah. I mean there’s some maybe some trace amounts there. I know iodized salt; 1 gram will have about 77 µg. There are some research showing that increased iodize salt consumption did increase autoimmunity. And it could just be that these are the general public. They’re just taking it, they already have a poor diet, and they don’t have the selenium, and the B’s, and the minerals, and the vitamin C in the background. And maybe that’s why that happened. So it’s hard to say. So there are studies on that showing there could be an issue. But things like cod, right? Things like shrimp, uh – things like turkey. Even some navy beans, even some tuna, even some eggs are gonna have some good iodine. I mean one egg is gonna have 12 to 15 µg iodine. So if you do 4 eggs a day, that’s about 60. You got a good multi- that will be 150. Uhm – you have some fish, you got some other food, now you’re like at 3, 400µg. Now you may need to go higher, but you had to work with physician or functional medicine practitioner to be monitoring the antibodies and make sure you have all ducks in a row first, before you go there.

Evan Brand: Yeah. I mean there’s people that will just start covering themselves in iodine. And so that could be a bad idea, you’re saying, coz you could actually increase antibodies, right?

Dr. Justin Marchegiani: Totally can increase antibodies. Uhm- you gotta be careful with that.

Evan Brand: I’m not – for some reason iodine, one of those things and kind of the eggs will call the natural health community that is – it’s been portrayed as very benign. And I remember even in some of the – the classes I was taking down in Austin, I remember a girl in class, she like paints everyday, she was painting her arm with iodine. And she was like, “it’s the greatest nutrient ever.” I was like, “Oh, my Lord. This is out of control.”

Dr. Justin Marchegiani: Well painting on your skin for the most part, 80% of it evaporates.

Evan Brand: Uh-huh.

Dr. Justin Marchegiani: The only time I recommend painting it on your skin is if you have fibrocystic breast disease uh – you have a lot of cyst and painful breast tissue. Painting it on the breast tissue can be great coz you’re driving the iodine right into the localized spot, where there’s the cyst, which could help. But outside of that, I mean, if you have –if you need iodine systemically for your body and for your thyroid function, you wanna take it in – in your body. And typically do a liquid potassium iodide.

Evan Brand: So she wasn’t – She probably wasn’t making herself toxic then. She was just turning herself uh – brown.

Dr. Justin Marchegiani: Yeah. 80% of it – you know, the iodine pass test, like the faster it evaporates, meaning the more your body absorb it; the slower it evaporates the more iodine you have. It’s very crude measurement, right? The better test is gonna be like Hakala or I think doctor stated, there’s an iodine loading test. I think it’s 25 to 50 mg of iodine then you test uhm – your urine and see how much GPL. So the goal is, if you pee 90% or more, it means your iodine levels are saturated; if you pee less than 90%, right? You pee less than 90% that means your body grab more of that iodine. So it’s – you’re essentially low. That’s the theory on that. 90% and more, you’re okay; less than 90, you’re low.

Evan Brand: Uhh. That’s interesting.

Dr. Justin Marchegiani: But again, regarding iodine, you gotta do it responsible – responsibly. If you’re – think of iodine gasoline on the fire.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Gasoline is not bad when you put it in your car. But if your car is on fire, and you start putting gasoline in your car, you can create problems, obviously, right? That’s what’s kinda happening in your thyroid. You wanna look at everything holistically. And you want the body system approach that Evan and I use, the key three, looking at the hormones, ATF( adrenals, thyroid, female hormones); ATM (adrenals, thyroid, male hormones), gut and infections, putting nutrients, digestion, better food, allergies, and then looking at detox and nutrients, as well.

Evan Brand: Yup. Well said. Go to to schedule consultation with Justin. Check out the thyroid videos series. He’s got hormone videos series, too. You’ve got the supplement line there. And then, you could check out my stuff, too, or you could just google either of us. Justin, or Dr. Dr. Justin Marchegiani. Evan Brand. You’ll find us both. And stay tune because this is really fun. And I don’t know about you, but I’m loving this. I think maybe 3 to 5 times more than just doing an off-air podcast coz people are asking questions. And it’s like shaping and structuring this.

Dr. Justin Marchegiani: Yeah.

Evan Brand: This little organic podcast ball.

Dr. Justin Marchegiani: Yeah. I love it. We love the questions. We like just having this little kinda dialogue back and forth and “ooh, someone responds over here, let’s see what they said” and we kinda see if we can interject it into the conversation. That’s great. Totally m__we’re on the fly.

Evan Brand: Love it.

Dr. Justin Marchegiani: Like impromptu, right? It’s like we’re on the stage, doing a little impromptu podcast.

Evan Brand: There’s no cuts; there’s no edits; there’s no –

Dr. Justin Marchegiani: Overall man, this is it.

Evan Brand: This is – this is the real deal. This isn’t – there’s not a makeup person coming in and touching you up here. I mean this is the real deal.

Dr. Justin Marchegiani: I know. If you guys are liking this, we’re gonna do it a lot more. We just need thumbs up; we need likes; we need shares; show us the love. Go like Evan’s channel. Share the podcast. And then we’re gonna do more of this, and get everyone’s questions answered, and just provide more value. Like how could we provide more value to our listeners and improve your health.

Evan Brand: Yeah. And I think I mentioned it already. But if you wanna schedule a consult with Justin, just go to the website, you could schedule the consults there.  And same thing for me, and we’ll chat with you all next week. And let’s do something next week, maybe – maybe on like clinical success stories we’re having in the practice.

Evan Brand: Well that means they’re coming in –

Dr. Justin Marchegiani: And just like, maybe go over our top 3 stories of the week. Coz we see – you know, so many patients. We can pick out 3 easily.

Evan Brand: Well, yeah. I thought of something, too. Uh- actually, a woman who was struggling with fertility is now pregnant. And I figured, getting her on and talking about her story with parasites and how her fertility was compromised due to the infections. Getting her on the air, maybe asking them– we have to make it fun for them, too. 

Dr. Justin Marchegiani: Yeah.

Evan Brand: For them to take time out of it, get them to share their story and just kinda talk them through what we did. I think that’s- that’s the most remarkable part of all this, is getting to hear the feedback, which a lot of people, they’re not getting to hear the stories. And this is what keeps us motivated and keeps us going.

Dr. Justin Marchegiani:  I love it, Evan. That sounds awesome, man. Well, let’s connect real soon, brother.

Evan Brand: Take care.

Dr. Justin Marchegiani: You take care. Bye now.

Evan Brand: Bye.


Natural solutions to optimize the brain, thyroid and adrenal connection

Natural solutions to optimize the brain, thyroid and adrenal connectionBy Dr. Justin Marchegiani

Today’s talk will address how important nutrients and nutrition are for healthy thyroid, adrenal and brain function. I’ll do a brief overview of how the thyroid works just so you’ll have some foundational information. And then I’ll cover what you need or what you may be missing that’s preventing your thyroid from functioning optimally on the nutritional side. So let’s dig in.

Overview of Thyroid Hormone Production

Let’s outline how the thyroid hormonal cascade or domino rally works. The first step we have is really the brain signalling down to the thyroid. This pathway is known as our thyroid stimulating hormone (TSH). Our TSH is coming from the brain, particularly the pituitary, and it’s telling the thyroid to make thyroid hormone.

From there, our thyroid spits out some T4, and about 20% of that T4 actually gets converted to T3 at the thyroid, and we’ll review some of the nutrients that we need to help that conversion. So 20% actually happens in the thyroid gland. The other 80% actually happens peripherally, and 60% of that 80% actually happens in the liver.

Factors to consider in thyroid hormone production

Factors to consider in thyroid hormone production


A healthy liver function is very important. If we’re getting toxins, chemicals, and various plastics in our food, then we’re not getting enough sulfur-based amino acids or antioxidants in our diet to run those pathways. Our liver may be burdened and that may affect our body’s ability to convert and activate thyroid hormone.

One of the enzymes that’s responsible for thyroid conversion, the 5-deiodinase enzyme—you break it down 5-deiodinase. De-i is taking an iodine off. So the T and the number 4 stands for how many Iodines there are. The 4 stands for the number of iodines. So de-iodinate means pulling an Iodine off, and that’s why it goes from T4 to T3, because we’re pulling 1 iodine molecule off it, and we’re doing it with that liver-based enzyme known as the 5-deiodinase enzyme, which is selenium-based.

So things like egg yolk, seafood, nuts, seeds—things like that are going to be very rich in Selenium, which we’re going to need for that liver enzyme to work. Selenium is also a strong precursor to glutathione. So selenium also helps with our detoxification, also supports the liver. Liver is very important for thyroid hormone conversion.

Gut Bacteria

Next we see gut bacteria. We need good, healthy gut bacteria because about 20% of conversion happens in and around the gut with acetic acid or the various sulfatase enzymes, and these enzymes are important at taking inactivated T3 and activating it. So if you have dysbiosis or imbalances in gut bacteria from various infections, pathogens, or even small intestinal bacterial overgrowth (SIBO), that can throw off the balance of your gut bacteria, and that can decrease your gut’s ability to activate thyroid hormone.

Adrenal Glands

The adrenals are profound and very important for activation of thyroid hormone, mainly because of the fact that if we’re under adrenal stress, that can increase our reverse-T3 levels. I count the adrenals as being a 20% contributor of activating thyroid hormone. They do it a couple of ways. If the body’s under too much stress, cortisol is too high. If we have high cortisol, we’ll have more reverse T3s.  And reverse T3 is inactive T3.

How this happens is that the reverse T3 molecule gets in the receptor site in the cell. It doesn’t have the same metabolic effect of the T3. The T3 can’t make its way into the receptor site because the receptor site is blocked. So that’s kind of how reverse T3 works. It’s like taking a gun and putting blanks in the magazine. When you fire that gun, the effect that you’re looking for is for that bullet to come out, but all you hear is the noise. And you don’t get the actual end result, same thing. Metabolically, we see a hormone in that receptor site, but it’s a hormone that doesn’t have the same type of stimulation that thyroid hormone does at the nuclear-receptor-site level.

Are you worried about your thyroid condition? Click here to get help.


So on that note, we need healthy levels of cortisol for thyroid conversion to happen. So the adrenals are also affected because high levels of cortisol, stress, etc.—these can actually affect TSH. TSH levels can go off with an extreme amount of stress via cortisol, and if we’re depleted, if our adrenals are so dysfunctional that our cortisol levels are now low like at a stage-3 adrenal fatigue level (cortisol levels <23), then we’re not going to have enough cortisol to make that conversion happen. We need cortisol to really activate that thyroid hormone.

When we do thyroid temperature testing, we’ll see chronically low temperatures with low thyroid function. When we see adrenal stress, we’ll see aberrations in temperature greater than 0.3 degrees Fahrenheit. So what we’ll see when we have adrenal and thyroid issues is if this is the threshold we want to be at temperature-wise, we’ll have a low temperature but we’ll have aberrations in that low temperature. If it’s just a straight low temperature, that’s a thyroid dysfunction. If it’s low and aberrant, that’s thyroid and adrenals. And if it’s normal and aberrant, that’s just adrenal function. So that’s a great way that you can use temperature to assess whether you have a thyroid issue, adrenal issue, or both.

Nutrients and Thyroid Hormone Activation

3 Nutrients and Thyroid Hormone Activation

Now that you have a good background of how the thyroid gland converts a lot of the T4 and T3 into active hormones, let’s talk about some of the nutrients that are involved for activating thyroid hormone.


Our TSH is the signaler. So TSH is an inverse hormone. It goes high when thyroid hormone is low, and it goes low when thyroid hormone is high essentially. So if I’m yelling at someone and I’m not getting their attention, I’ll have to raise my voice louder until I get that person’s attention. Think of that as what TSH is doing: the brain is yelling down to the thyroid to make hormone, and if it’s not high enough, it will increase the amount of TSH. TSH is a very bad indicator to use for thyroid dysfunction because it’s so late-stage. It comes on so late in the game, 5 to 10 years down the road.


We really need to be looking at the actual active hormone downstream, the T3. This is much more important and much more indicative of an early-stage thyroid issue. A lot of times people may have healthy levels of TSH because T4 feeds back into the brain better than T3. We could have normal levels of T4 but have low levels of T3, and it may not even be reflected in the TSH. I see that all the time in my patients. That’s why we have to be very careful. We actually have to look at TSH, T4 free and total, T3 free and total, and maybe even look at reverse T3 and the thyroid antibodies.

We talked about the nutrition—vitamin A, zinc, various B vitamins, and protein—for healthy thyroid-hormone function knocking that first domino over, which is TSH. And, again, if we have a gut issue, you can see that nutrition isn’t just a given. If we take in nutrient-rich foods, but we have a gut issue, malabsorption, low stomach acid, dysbiosis, and infection, you can see how that may impede the absorption of these nutrients, thus causing deficiency even though we have a really good diet. So keep that in mind: we always need to look deeper at the gut, deeper at the liver, and deeper at the adrenals. We can’t ignore these three body systems.


Iodine is an important nutrient for thyroid-hormone creation. The process known as iodination involves iodine and tyrosine being cleaved together. The T in T4 and T3 stands for tyrosine (an amino acid), and the 4 and the 3 stand for the number of iodines. We don’t need too much iodine to have this healthy conversion and activation.

Iodine  Dosage

There’s a lot of debate out there that we need more iodine, into the high milligram range. Some say we only need the recommended daily allowance (RDA), 250 or so micrograms, to make our thyroid hormone. We have to be careful because iodine can be a strong stimulator of autoimmunity, and there’s a great deal of research showing that excess iodine can actually stimulate Hashimoto’s. It activates TPO or thyroglobulin antibody that can increase thyroid destruction.

Iodine and Autoimmune Conditions

A lot of people say that the reason iodine’s a contributing issue with autoimmune conditions is because people also are very low in selenium, and when iodine is being fused to thyroid hormone via this process known as iodination, a result is that hydrogen peroxide gets kicked out. This hydrogen peroxide can be very inflammatory and can cause our B cells to come up and infiltrate. It also starts attacking the thyroid tissue. That’s why if you’re getting any amount of iodine, you want make sure there are adequate levels of selenium. This is because selenium actually neutralizes the hydrogen peroxide. It pulls an oxygen off it and makes it H20, which is water, which is very benign.

Getting iodine and not having selenium there by its side can definitely be a recipe for destruction. So with iodine, be very careful. Make sure you’re working with a functional medicine doctor. Make sure you’re not autoimmune or have any autoimmune symptoms before you give iodine at higher levels. About 200 micrograms will probably be okay, but double-check with your functional medicine doctor.


This is really important. If you have a microcytic, hypochromic anemia, that’s going to be a major issue. Low iron—we need iron to make thyroid hormone. But we also need iron to help carry oxygen throughout our body.

B vitamins

B6 is super important because B6 helps with dopamine activation, and if we look at the hypothalamus, which is the top part of the brain, we actually need dopamine from the hypodopamine production to actually stimulate the hypothalamus to make thyrotropin-releasing hormone (TRH). TRH is important at stimulating TSH. So dopamine is essential, and a lot of people may have neurotransmitter issues that need to be fretted out doing an in-depth organic acid test.


So Iodine, Tyrosine, Iron, and your B vitamins are really important for energy, for making the Krebs cycle go around. Vitamin C is a really important antioxidant and helps the adrenals as well. Vitamin D is really important for immune function. A lot of people with Hashimoto’s and hypothyroid autoimmune issues tend to have a vitamin D polymorphism at the receptor site of the vitamin D receptor. And they need higher levels of vitamin D, 70 to 100. So be very mindful if you have an autoimmune thyroid. Make sure your vitamin D levels are up at 70 to 100, just to make sure you have that therapeutic immune balancing effect.

We already talked about the nutrients needed for our T4 to T3 and that Selenium is essential also for the autoimmune effects of helping to neutralize the hydrogen peroxide into water.

Zinc is also very important for thyroid conversion. Zinc is also essential for sex hormone production, making testosterone essentially, and then also it’s an important building block for making Hydrochloric acid. If our Hydrochloric acid levels aren’t adequate enough, we won’t keep a nice, low pH in the stomach. If we don’t have that nice, low pH, we won’t be able to break down protein and fat adequately and we’ll have a harder time ionizing minerals. We need to ionize minerals and hit them with Hydrochloric acid, so we can then take them into our blood so they’re not like rocks floating in our bloodstream. We actually need to ionize them so they’re absorbable. If we have issues with these nutrients, we may see other problems in the thyroid hormone chain that could be happening as well.

Woman holding neck suffering from thyroid issues

Have your thyroid checked and get it tested now! Click here to schedule a functional medicine consult.

Thyroid Testing

Thyroid autoimmunity is a big issue—40% of people that test for thyroid autoimmunity actually are a false negative. This means they come back negative, but they may still have a positive thyroid autoimmune condition. So make sure you get your thyroid looked at either by palpation and/or by ultrasound. Just to make sure there are no nodules or inflammation in the thyroid that could be caused by Hashimoto’s.

So outside of that, if you have a thyroid issue, nutritional issue or neurotransmitter issue that could be affecting your thyroid, and you’re not quite sure of the next step to take, click here to schedule a consult with me to dig deeper or get my Thyroid Hormone Balancing Series for more information on how you can get your thyroid back into balance.

Hashimoto’s and Hypothyroidism – Foundational Info to Heal Your Thyroid – Podcast #54

Dr. Justin Marchegiani and Evan Brand talk all about thyroid issues in this podcast.  Listen as they share their recommendations on the first steps that patients with thyroid issues need to take in order to be successful along with helping them to push their thyroid to heal in the right direction. 

Find out what the potential signs and symptoms of a thyroid issue are and distinguish between adrenal and thyroid issues as well as the difference in dealing with thyroid issues from a conventional medicine approach versus from a functional medicine perspective. They also differentiate adrenal failure versus adrenal fatigue. Have you ever wondered what role does progesterone have that affects the thyroid function? Discover more about it and the other hormones affecting thyroid issues in this interview.

In this episode, topics include:

1:18   Thyroid 101

2:35   Thyroid physiology

6:20   Adrenal physiology

11:29   Conventional medicine approach versus functional medicine perspective

21.30   Adrenal failure versus adrenal fatigue








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Dr. Justin Marchegiani:  Hey, it’s Dr. J here with Evan Brand and today we’re gonna be talking about thyroid issues.  We got lots of patients coming in to our offices and they’re like, “Hey, doc, I got a thyroid issues, what do I do?”  And we haven’t even talked about what we’re gonna say yet, but we’re just gonna have a dynamic conversation about what we recommend any of our patients that are coming in that think they have a thyroid issue, what the first steps they need to take are to be successful and to start helping to push their thyroid to heal in the right direction?  Evan, what’s up today, man?

Evan Brand:  Hey!  Not much.  I’m fired up.  Let’s do this thing.

Dr. Justin Marchegiani:  Dude, I’m–I’m ready to go, man.  My thyroid’s feeling great today, so let’s do this.

Evan Brand:  Sounds good.

Dr. Justin Marchegiani:  Before you go in, what did you have for breakfast?

Evan Brand:  What did I have?  I can’t even remember.  I woke up.  Did I eat anything yet?  I may even be fasted honestly, what did I eat?  I have no clue.  If I re–if I remember, I’ll let you know.

Dr. Justin Marchegiani:  Nice.  So you didn’t eat any leprechauns or gnomes today?

Evan Brand:  No.

Dr. Justin Marchegiani:  Nothing like that?

Evan Brand:  No.

Dr. Justin Marchegiani:  Gotta love those grass-fed leprechauns, man.  They’re awesome.

Evan Brand:  Yup, yup.

Dr. Justin Marchegiani:  Especially if you get some Kerrygold butter, you know, it’s like perfect.

Evan Brand:  A little pinch of Himalayan salt.

Dr. Justin Marchegiani:  That’s it, that’s it.  Alright, so thyroid issues.  Thyroid 101.  So first off, anyone’s that potentially having hair loss, energy issues, fatigue, the outer third of those eyebrows that are thinning, potential constipation, vertical ridging on those fingers, low temperature, you know, tingling, numbness in the fingers and toes, these are all potential signs and symptoms of a thyroid issue.  But the problem with the thyroid is that a lot of the symptoms–it’s like a Venn diagram where there’s a massive overlap between thyroid issues and adrenal issues.  So all of my patients no matter if they have a diagnosed thyroid issue or not, we wanna look at the thyroid and the adrenals side by side.

Evan Brand:  Yeah, I remember what I had for breakfast.  It was organic pork sausage that my wife made for me.  That’s why I didn’t remember because I didn’t prepare it.

Dr. Justin Marchegiani:  Nice, awesome.

Evan Brand:  Yes, so you’ve already alluded to–to–we were gonna talk about, you know, what is the first step to do when it comes to thyroid issues, and for me, my answer which I didn’t know your answer–my answer was gonna be to look at the adrenals because if the adrenals are taxed, then it’s gonna be pretty hard to us to keep the thyroid in a good, healthy, functioning manner if the adrenals are taxed.

Dr. Justin Marchegiani:  Yeah, so let’s just break down thyroid physiology for the listeners.  So your thyroid gland is this little bow–bowtie type of gland that sits just below the Adam’s apple.  So if you just kinda run your hand or down your chin here where your chin and your platysma, that skin underneath your chin hits your throat, that your little bump there that’s your Adam’s apple, if you go about a couple–about a centimeter down and a centimeter out, that’s your thyroid gland and that gland secretes a hormone called T4 that is–that gets converted into an active thyroid hormone, T3.  So that gland right there, bowtie-shaped, that thyroid hormone is needed for all cells of the body to be metabolically active, right?  To control metabolism and that T4 about 20% of it happens at the thyroid gland.  So the conversion of T4 to T3, right?  T4 inactive, T3 active, 20% of that conversion happens at the thyroid gland.  The other 80% happens peripherally.  So now out of that 80% that happens peripherally, 60% is the liver, 20% is in the healthy gut bacteria and the other 20% is via healthy adrenal function and stress regulation.  So there’s a lot of like percentages in there, I go back to the anchorman quote, 60% of the time, it works every time, a 100% of the time.  So it’s a little confusing, so just quick little recap on it.  20% of the thyroid conversion at the thyroid, T4, T3 done, right here.  The other 80% happens peripherally, 60 liver, 20 gut–healthy gut bacteria and gut function, 20% by healthy stress and adrenal management.

Evan Brand:  That’s cool, yeah, and so you mentioned the liver, that is a place where I actually would have not started with the–with the thyroid but I didn’t realize the–the huge percentage there.  I always look at the adrenal stress pictures so maybe I’m looking at the smaller piece of the pie when I should be looking at the bigger one.

Dr. Justin Marchegiani:  Yeah, I mean, the enzyme. 5-deiodinase enzyme–so deiodinase what it means is it’s de-i–it’s deiodinating meaning it’s pulling off an iodine molecule.  So when you see like T4, with the T4, the T stands for tyrosine which is an amino acid and the 4 stands for 4 molecules of iodine.  So when you’re deiodinating something you’re pulling off 1 iodine molecule.   So you’re pulling off 1 molecule off the T4, which then makes it the T3, and the enzyme that does that, that 5-deiodinase enzyme is selenium-based.  And a lot of that conversion happens in the liver.  That’s where that enzyme is most metabolically active.

Evan Brand:  And a lot of people are deficient in selenium.

Dr. Justin Marchegiani:  Absolutely, I mean, 2 to 400 mcg a day is gonna be a pretty good amount, and if you’re sitting there thinking well, I just gotta have 3 Brazil nuts, *beep*, the selenium content in Brazil nuts can range between ten-fold.  So you could have 3 Brazil nuts hoping to get 200 micrograms of selenium or maybe you’re getting 20 micrograms of selenium depending upon the soil it’s grown in.  So there’s quite a lot of variations, so really important that you’re on a good multivitamin that’s got 200 mcg of selenium in it just off the gecko.  And all of my patients are on a high quality, highly absorbable multi with 200 mcg of selenomethionine as our thyroid insurance policy.

Evan Brand:  That’s great, yeah.  I should probably switch mine.  I’ve been using just a standalone, because I’m not using a multi right now personally.  I’ve just been using a 200 mcg of selenium by itself.

Dr. Justin Marchegiani:  Nothing wrong with that, too.  So we talked about the thyroid, right?  Let’s talk about adrenal physiology, just so everyone kinda can wrap their head around it.  I wanna take these complicated concepts, break it down, and have people walk away with an action point.  So the adrenals, they sit right on top of our kidneys and they help manage stress.  And again, stress isn’t just emotional stress, it’s physical stress.  It’s also chemical which could be blood sugar, it could be infections, it could be inflammation.  And our adrenal physiology is we’re pumping out cortisol and that cortisol fluctuates throughout the day in a diurnal rhythm, meaning higher in the morning, lower at night, and that cortisol is there to help give us energy.  It’s there to help put out the fire of inflammation but our adrenals also put out significant amount of sex hormone, too, called DHEA sulfate.  And that sulfate is really important for healing, it’s really important for sex hormone output for female so a lot of PMS symptoms are gonna be caused by adrenal fatigue and we need healthy levels of cortisol to be able to help assist in thyroid conversion.  So that cortisol, if it’s too high, that cortisol will actually block thyroid conversion and increase TSH which is this brain hormone called thyroid-stimulating hormone.  So too much cortisol, we block that T4 to T3 conversion, and we have TSH go up.  And if we don’t have enough cortisol, then we’re tired already because cortisol gives us energy and it regulates blood sugar, if we don’t have enough cortisol for thyroid conversion.  And then typically in those patients, TSH will even look normal on a lab test but T3 will be low.  And you’ll go to your doctor every time, you go to your endo, and then they’ll tell you your thyroid’s fine when it’s not.

Evan Brand:  Yeah, actually, I just got a lab result back from a female patient yesterday.  She’s in her mid-30s.  She loves high intensity interval training.  She’s got everything pointing at adrenal issues, so we finally get the–the salivary results back.  Her cortisol is so low, man.  She’s in the 0-5 range in the morning and she’s just like 2-3 units per day.  The only thing that was in range was her nighttime level because she–just completely tanked at that point.

Dr. Justin Marchegiani:  Yeah, absolutely, I see that all the time.  So things that we’re trying to get across to anyone listening is so you get some thyroid symptoms.  Take a step back.  We gotta look at the thyroid, right?  Individually.  We gotta look at the adrenals individually.  So the test you want for the adrenals is gonna be a #201 by BioHealth, that’s a cortisol rhythm test.  And if people are having a hard time getting access to this test, they can reach out to you, they can reach out to me, and we can get access to these tests for them and evaluate it.  That’s step one.  The next test is a full thyroid panel.  That’s gonna be your TSH.  That’s gonna be your T4 free, your T4 total, your T3 free, your T3 total.   Ideally, a T3 uptake and reverse T3.  And thyroid antibodies because a significant percent of these patients, they’re autoimmune.

Evan Brand:  I think that’s awesome that you mentioned that and you’re never gonna get told to run that by your conventional doctor.  So once again we’re looking at this from a functional perspective, not the “Oh, your TSH is low or whatever, here’s some Synthroid.”

Dr. Justin Marchegiani:  That’s it.  That’s it and most patients because they’re autoimmune–what autoimmune is it means self attacking self, that your immune system is ramped up to the degree where it’s attacking the thyroid tissue and breaking it down and the problem with that is is people that have this autoimmune type of sequelae of symptoms, they’re in the middle of hyper to hypo because as the glands being attacked or stabbed if you will, the–the thyroid hormone is dripping out, creating hypersecretion because there’s a lot more dripping out if you will.  It’s kinda like to use the gruesome of like let’s say you–you stab someone, right?  A whole bunch of blood comes out in the beginning, but in the end the person’s empty and there’s no more blood left.  Think of thyroid as like that.  I know it’s kind of a gruesome analogy, but honestly you will never forget it and you’ll be able to wrap your head around, “Oh, I’m having a hyper-like symptom, oh, wait, now I’m hypo,” and you kinda go back and forth, you’re gonna think of those thyroid as like you’re basically your immune system is putting little knives into it and it’s dripping the hormone out, and you only got about 3-4 months of thyroid hormone stored in those follicles.  So once those follicles has been bursted for a long enough time, they’re eventually gonna run dry and you’re gonna start having more hypo-like symptoms.

Evan Brand:  Yeah, and if people had access to the video feed here, they would be laughing out loud at your–your–your hand demonstrations, it’s just an–a great–great analogy.

Dr. Justin Marchegiani:  I know, I’m like pretending I have a knife in my hand and like trying to s–and like motioning like I’m stabbing my thyroid gland, oh man, and just so everyone knows I do have Hashimoto’s so I can speak from experience.  I’ve had to make myself an expert on thyroid health because of necessity because conventional medicine typically offers nothing for it.  So–

Evan Brand:  Yup, you’re a wounded warrior, man.  Those are the best ones to see.

Dr. Justin Marchegiani:  Absolutely and I can tell–I can say with confidence that anyone watching this or listening to the show is gonna walk out of it knowing more than their conventional trained endocrinologist on–on thyroid issues from a functional perspective.  They’re gonna know more of the disease stuff of course, like you know, thyroid nodules and–and Graves’ and things like that, but the thing is, conventional medicine’s approach is pretty much 3 options, okay?  If it’s Hashimoto’s or hypo, it’s Synthroid.  Most people that are given Synthroid, that’s synthetic T4, they don’t convert it to T3, so they still have tons of thyroid symptoms.  Number two, if they’re Graves’, they’re typically gonna just want a thyroidectomy, pull the darn thyroid out, done, right?  Number 3, radioactive iodine, shut the thyroid gland down.  I mean, those are the 3 major options, or they’ll give like methimazole or propylthiouracil to help knock down the thyroid hormone levels, you know,  they’ll–they’ll get PT or something like that.  So those are like the 3-4 options that are in the cookbook of your conventional endocrinologist for thyroid.  There may be a rare thing left out there, you know, thyroid cancer, thyroidectomy as well, but that’s your general kind of gist, and the majority of people, 90% of people are gonna be in the hypo-Hashimoto camp and there’s gonna be underlying issues that are affecting the thyroid conversion outside of their control.  It’s not gonna be pathological, it’s gonna be functional and that’s where we come in to really get to the bottom of it.

Evan Brand:  Yup, so we alluded to the adrenal distress picture but I mean, what’s the other important picture, I mean would you look at something like adding in some liver support, I mean some milk thistle, if you’re gonna be helping take some of the load off of the toxin filtration process that the liver’s doing, is that gonna free up more energy so to speak, more fuel for the liver to do its job in thyroid conversion?  Am I–Am I thinking right there?

Dr. Justin Marchegiani:  Absolutely.  So a lot of times we’ll start out and we’ll run an organic acid test and we’ll be able to run various organic acid markers that will look at liver function like hippurate, glucarate, there’s about 6 or 7 of them, sulfate for instance, pyroglutamate for B12. so we’ll be able to run these different markers that look at methylation, that look at an–acetylation, that look at our detoxification pathways from a phase 1 to phase 2 perspective, so we can really get a window on how it’s functioning.  But typically off the bat because I don’t wanna get into supplement overload with patients, the first thing we’re doing is just clearing out all the liver stress from a diet and lifestyle perspective, alright, aspartame, all the junkie food additive, gluten, all of the crap that’s just in your diet, that has to go first, right?  Because our liver is always detoxifying, you know, giving detoxification support, you’re not, you know, turning on detoxification systems, you–your buffering it, you’re taking the stress off which can be helpful, but we always wanna make sure we’re stopping the stress from going in first, and then–then it’s probably better supplementing later.  So for me, I have a 3 body system approach where it’s hormones first and then part of that foundational layer, below that is diet, lifestyle and nutrition.  So that’s the first step that we’re looking at before we go deeper and there’s exceptions to every rule but that’s in general, the first step.

Evan Brand:  Yeah, I always like to geek out and go beyond because sometimes I assume that people have the diet and lifestyle picture figured out but a lot of people are still struggling with that.

Dr. Justin Marchegiani:  Yeah, I mean, I see so many of my thyroid patients, they’re just–their adrenals are shot and they are just so myopically focused on the thyroid gland that the forget about the adrenals and they forget about their female hormones, right?  We can’t forget progesterone, a female hormone is responsible or highly involved in TPO production, okay?  So TPO is thyroid peroxidase.  That’s an enzyme that actually helps build or make thyroid hormone.  It binds the iodine and the–and the tyrosine together and if we have super low progesterone, that’s gonna lower thyroid peroxidase activity.  So we’re gonna be making less thyroid hormone just by having lower progesterone.  And again, why do we have lower progesterone?  Well, because progesterone goes downstream to make cortisol if we’re under a lot of progesterone and that low progesterone in the second half of the cycle, right before during that week before you bleed, that’s your PMS time, well, that’s where PMS happens typically due to that progesterone falling out early.

Evan Brand:  And the reason that happens you’re saying is because you have elevated cortisol from excess stress, is that what you’re saying?

Dr. Justin Marchegiani:  Yeah, elevated cortisol in the acute phase and then chronically low in the–you know, lower in the chronic phase.

Evan Brand:  Uh-hmm.  So–

Dr. Justin Marchegiani:  Meaning the longer that stress has been going on, that cortisol bottoms out.

Evan Brand:  So when that cortisol bottoms out, what happens to progesterone then compared to when cortisol’s high.

Dr. Justin Marchegiani:  Well, progesterone’s a building block for cortisol.  So if we look at the adrenal hormone cascade, we see cholesterol as the first domino, like all hormones are made from cholesterol.  So don’t go on a low fat diet, vegan diet.  You will destroy your hormones.  I’ve seen it hundreds of times.  Again, some people do better on it than others and a lot of people feel better on a vegan diet because they’re coming from it–with a crappy standard American diet, so they see improvement and they think well, it’s the vegan diet, but no, it’s all the other crap they cut out.  That’s another podcast for another time.  But cholesterol first, conversion to pregnenolone.  Pregnenolone then gets converted to progesterone on the other side of the cascade and then progesterone gets converted to cortisol.  So you can see what happens is if we’re under more stress, this progesterone escape, this cortisol escape where that progesterone leaks down because it’s needing to deal with the cortisol stress.  The cortisol needs to be there to manage the stress and inflammation.  So I always tell patients, your body is hardwired to deal with the stress of today versus the healing of tomorrow, right?  Progesterone’s there for healing, it’s there for healthy brain and–and brain function and relaxation.  It’s also there for pregnancy, right?   Progestation, progesterone.  So all those are really important but if our bod–body is so stuck in the stress in the moment, tomorrow never happens because you’re always in this stressed out state.

Evan Brand:  And that’s a miserable place to be by the way.

Dr. Justin Marchegiani:  Oh, my gosh, absolutely.  So almost all my female patients, they come in with some degree of thyroid issue, some degree of adrenal fatigue, and then because all of these are connected, right?  These hormones function and dysfunction together, there’s a level of PMS and/or female hormone dysfunction along with it.

Evan Brand:  Uh-hmm.  Yeah, and then you were kinda alluding to the pregnenolone steal, if people wanna geek out and read about that, it’s an amazing–just to look at the chart of the hormones getting stolen and sex hormones are messed up and now your libido’s gone, and I mean, it’s just–everything goes haywire.

Dr. Justin Marchegiani:  Oh, my gosh, absolutely.  Did you wanna comment on that a little more?

Evan Brand:  Well, I was just a–I just think you’re doing a really good job of taking a pretty complex topic and breaking it down.  I mean, this is intimidating for some people to try to take this knowledge into their lives and apply it and you know, if they try to go back to their doctor with this information, you know, they’ll probably be just laughed at or maybe even, they’ll get their eyes rolled at.  “Oh, I heard this functional medicine doctor and this functional nutrition guy talking about this and just silly.”

Dr. Justin Marchegiani:  Exactly and just remember, right?  If you’re going to your doctor and you’re trying to get functional medicine help in the conventional medical model, you’re like banging your head against the wall.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  Alright?  It’s–it’s gonna be very, very difficult, right?  It’s trying to get your surgeon to not operate.  I mean, your surgeons are typically there to operate.  That’s what they’re there for.  That’s what they’re trained for.  And same thing with conventional physicians.  Conventional physicians are there to–most of the time just prescribe drugs unless they’ve been taking training outside the conventional medical paradigm.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So if you go there, you’re gonna find yourself having to educate your doctor more about this and again, why do you wanna sit there and educate your doctor about this when you can find people that are already educated?

Evan Brand:  I agree.

Dr. Justin Marchegiani:  I have patients all the time and they’re like, “Well, can you call my conventional doctor and–and talk to them about that?”  I’m like, “That is an act of futility.”  I mean, they can listen to this podcast but you’re much better off just finding people that are already in sync because then you don’t have to waste time.  So with that, the typical downfalls I see–most patients go to their doctor, they about adrenal issues.  Let’s say the topic of adrenal issues are brought out, right?  Conventional doctor, the first thing they go to is Addison’s or Cushing’s disease.  So Addison’s is an adrenal failure state, cortisol is almost non-existent.  And then Cushing’s is a hyper, hyper cortisol state, right?  Where you typically have elevations of blood sugar, you have the moon shape face, you have the buffalo hump in the back, you know lots of adiposity and that’s it.  So we have the two extremes, right?  So basically, you go to your doctor, it’s the one extreme on the high and the one extreme on the low, and the idea that everything in between is normal, that’s the idea.  That’s what it is and in the functional realm we realize that there are two extremes and there’s a functional spectrum in between there.  And the farther away you reach the high or low end, the more symptoms you have.  But the problem with that philosophy is that you may never each, you know, the high or the low end.  And what that means is that you’re stuck.  You’re never gonna get help.  You’re gonna be told it’s all in your head and there’s gonna be no solutions for you.

Evan Brand:  Right.

Dr. Justin Marchegiani:  That’s the problem.

Evan Brand:  Yeah, or here’s an anti-depressant, it’s just–that’s–that’s what we’re gonna do.  Yeah, so–

Dr. Justin Marchegiani:  And they’re just gonna just say, it doesn’t exist, so we wanna just differentiate adrenal failure versus adrenal fatigue, right?  Adrenal fatigue is more of the functional imbalance that may or may not progress into a disease state.  90% of people that have adrenal fatigue are never gonna progress into an Addison’s or Cushing’s state, it’s just not gonna happen.

Evan Brand:  I was gonna say–

Dr. Justin Marchegiani:  Those conditions are rare.

Evan Brand:  I was gonna say, I–I’ve personally never seen adrenal failure.  I’ve only dealt with the fatigue side of things luckily.  I mean, I don’t even know if–I don’t know.  I’m sure there’s people out there that are–that are in that, but I haven’t–I haven’t dealt with any.

Dr. Justin Marchegiani:  Yeah, so if you’re going to your conventional doctor and you’re having this conversation, just know that there’s gonna be a massive amount of backlash and there’s why, right?  Because of the–the differences in fatigue versus failure, right?  Adrenal fatigue is more of an HPA, right?  Brain talking to adrenal issue and also a stress feedback loop issue, right?  That’s number one and then on the thyroid side, well, most doctors are gonna run a TSH, which is a thyroid-stimulating hormone test which is nothing more than a brain test.  It’s looking at your pituitary.  So for instance, if we wanted to test something, it makes sense to actually test the hormone that the gland produces.  So for instance, if we wanna test your hormone function for your, let’s say your testosterone, right?  We would test testosterone, right?  We wouldn’t test LH per se, we would test testosterone.  That makes the most sense because testosterone is the actual hormone we’re looking at.  But LH, that’s the pituitary hormone that tells the gonads to make testosterone.  So why would we just look at LH when we can go look at the actual hormones being made.  Same thing, take that analogy now and throw it into the thyroid.  Why are we using brain hormones to look–to look at and assess the thyroid when we can actually test the T4 and T3 hormones individually?  Well, it’s just because it’s an antiquated way.  It’s what we were able to test first and it’s kind of the whole model of drug-prescribing is based off of that.  So it’s a very end-stage approach.  We’re look at the disease pathology, the high and low versus the functional imbalances that happen in between.  So we wanna live on the in between side, you know, all of the functional imbalances in between not on the high and low side.  Most patients that come to see us, they’ve–if they’re on the high or low, they already know it and they’ve been prescribed and typically many of them still don’t feel better and they still need answers.

Evan Brand:  Yup, and we do.  We do get them back into that functional range and it’s amazing how much you can feel better.  Even something like optimizing vitamin D levels has been huge for–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Like my grandpa.  He was having a lot of chronic low back pain issues.  I found a couple of studies linking the two and we upped his vitamin D, re-tested and now, you know, he’s better.  He’s got some other inflammatory issues going on, but I mean, just getting back in the functional range of everything one at a time is just–it’s the way to health and healthy people do exist and it is possible for you to get better out there.

Dr. Justin Marchegiani:  Yeah, and a lot of people for instance aren’t getting the help they need from a functional perspective in the thyroid community, in the conventional community, because most thyroid issues are autoimmune in nature.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So because they’re autoimmune, giving a thyroid hormone does not fix the immune system destroying the thyroid tissue and then the inflammation that’s then created by that then affects conversion of T4 to T3, it then affects receptor site uptake, so it affects the hormone from binding into the receptor site so a hormone has to go into this receptor site to have a metabolic effect, kinda like your key is useless it goes into the lock and turns.  It’s kinda the same thing and autoimmunity is affected by things like gluten and potentially dairy and infections and selenium levels and nutrient levels and leaky gut, and all of these things that are functional medicine issues and they will never ever be touched upon in the conventional medicine community.

Evan Brand:  Yup.  So just a quick question, I know we gotta wrap things up here–people that are listening, they may just feel like, “Wow!  This Synthroid is killing me.”  Going cold turkey on Synthroid, what are the–what are the complications or issues there?

Dr. Justin Marchegiani:  Well, again, if you’re prescribed a thyroid hormone by your conventional medical doctor, most of the time, 99% of the time you need it because they’re using TSH as a established range to dose thyroid hormone.  The problem with that is is that TSH takes about 5-10 years to go high.  So most of the time, your thyroid issues have been going on for almost a decade.  So you don’t ever wanna come off thyroid hormone if you were prescribed it but you wanna find in someone like us.  Now typically what I do off the bat is I don’t ever take them off their thyroid hormone but we may change and put them on a full spectrum thyroid hormone, where they’re getting T4.  The same T4 levels, not that touching that at all, but also adding in some T3 as well, and then also looking at the adrenal side of the fence.  And most people that are dose thyroid hormone based on TSH, they aren’t given enough thyroid hormone.  So if the gland has been destroyed for a couple decades or a decade or so, they may need thyroid hormone because the B cells, alright, the immune cells have infiltrated that thyroid, they’ve destroyed, they–now the tissue has gone fibrotic, it’s now scar tissue, and it’s no longer functional.  Again, we may be able to get recovery back, but if we don’t have recovery, we gotta make sure we’re getting enough thyroid hormone for healthy function.  So we always wanna make sure we’re getting enough thyroid hormone but we don’t wanna base it off a TSH per se, we actually wanna use our T3 free and T3 total to look at how much active hormone we’re actually making.  That’s gonna be the best way to do it.  Don’t look at TSH.  Your brain is much more sensitive to thyroid hormone than the peripheral tissue.  So what happens is, the thyroid hormone, the TSH will actually go lower in response to the thyroid hormone.  So your thyroid hormone may not be quite where it needs to be for optimal function in that T3 reference range, but your TSH may go low because your TSH and your thyroid or inverse, right?  TSH goes high when thyroid’s low.  TSH goes low when thyroid’s high.  So if we see the TSH drop, most doctors go, “Oh no!  We’re giving you too much thyroid hormone.  You’re overdosing.  You have Graves’.”  But just look at the T3.  Most of the time we’ll see the T3 in the top half to the top 25% of the range.  It’s not even high but most docs will just jump to that conclusion, you’re given too much without actually looking at the hormones individually, which drives me nuts because it’s like they’ve–if we can look at the direct temperatu–if we can look at the direct measurement of the hormone, let’s do it.  And the analogy I give my patients is, using a TSH as a gauge for thyroid hormone levels is like going outside and feeling the sidewalk to detect what the temperature is, right?  So the sidewalk’s always gonna be way hotter than what it is, right?  So we have this extra sensitivity thing going on.  And why the hell touch the sidewalk when you–when you can just look at the thermometer or pull up your weather app on your phone, right?  We have much more sensitive ways.  So don’t go outside touching the sidewalk, go and look at your app for the temperature.  Same thing with your thyroid.

Evan Brand:  That’s awesome.  I was waiting for the analogy, man, and I’m pumped.  That’s a great way to wrap this thing up.

Dr. Justin Marchegiani:  That analogy like hit me 2 weeks ago and I was like, “Eureka!”

Evan Brand:  That was incredible.  I was thinking the whole time we were going through this I was listening but I was trying to visualize an analogy and I was drawing a blank.  So you really killed it with that one.

Dr. Justin Marchegiani:  Yeah, ex–yeah, thank you.  And I just want everyone that’s in the conventional model and trying to get help, I know how it feels.  It’s ridiculously frustrating.  I have so much empathy.  Don’t bang your head against the wall.  I want you to have compassion for your medical doctor and to understand where they’re coming from.  They’re just coming from a different place, okay?  So if you need the functional medicine support to heal which the majority of people do, then we need a different and your MD may not be the best person to get that approach.  Get all the pathology stuff ruled out first.  We wanna make sure nothing’s being missed from a global pathological standpoint, like a cancer or something, maybe an over, you know, hypothyroid issue like TSH through the roof or something.  But once that’s been addressed, they gotta reach out to people like you and people like me to get this stuff under wraps.

Evan Brand:  Definitely.

Dr. Justin Marchegiani:  So I know, I–you know, went into like professor mode today.  We’re gonna have this stuff all transcribed, so go back, take a look at it.  Read it a few times.  We’ll do more podcasts on it.  People who have more questions, let us know.  We’re gonna be happy to break this down.  I want everyone to walk away with an action item.  So action item is get a full thyroid test, get a full adrenal test if you’re on the fence.  That’s your first two things to do and then from there, we can talk about options about what the next steps are.  But those are your first 2 options and if they need it, they can get it from me or from you.

Evan Brand:  Yup, sounds great.

Dr. Justin Marchegiani:  Evan, do you want to add some stuff?  I feel like I was just an absolutely ball hog today.  I’m so sorry.

Evan Brand:  Oh, no.  No, perfectly fine.  I’m sitting here loving it, man.  It’s been great.  No, I just want to say that, you know, the main thing is that you’re–you’re taking baby steps in the right direction.  So maybe you’re on the fence about this, you’re looking into the testing, that doesn’t mean that you should wait until you get testing and you actually get a piece of paper that says you need help.  It’s okay to go ahead and start helping yourself right now.  Removing the gluten if you’re still eating that.  Removing the excess stimulants if you’re doing that.  If you’re speeding 30 miles over the speed limit today on the highway, reducing that, you know, all of these lifestyle things that we’re going to recommend you anyway, go ahead and get started on some of those now.  If you’re speedometer or your RPM in your car is red lining right now, you have the power to turn that down and get yourself out of the red line.  Take a hot Epsom salt bath or something this evening, you know.  Get that red line down, start calming yourself down and getting yourself ready for the therapy that we’re gonna put you on anyway and you’re really gonna help accelerate your results.  You’re gonna get better faster and at the end of the day, that’s what we want.  We wanna help you get well as fast as possible, but in an ethical and you know, an intelligent way.  We don’t just wanna come in with huge jackhammer.  So just slowly work yourself there and–and start–start swimming now and we’ll meet you at the other side.

Dr. Justin Marchegiani:  Absolutely.  And you forgot to mention how important consuming the grass-fed leprechauns are.

Evan Brand:  Grass-fed leprechauns, yup.

Dr. Justin Marchegiani:  Alright, everyone, hope you enjoyed the show.  Check out the transcription,,  Thanks everyone and have a great day!




Thyroid Imbalances and What You Need To Do About It!

Thyroid Imbalances

By Dr. Justin Marchegiani

Thyroid Imbalances

Did you know that there are almost 30 million people (mostly women) that have an diagnosed thyroid disorder? Synthroid or levothyroxine (synthetic thyroid medication) is the 4th best selling drug on the market, yet with more thyroid medication being prescribed the problem doesn’t seem to be getting better.  Here’s why!

Thyroid Symptoms

Difficulty Losing Weight
Body Aches
Low Libido
Cold all the Time
Water Retention
Dry Skin
Chronic Fatigue Syndrome
Diffuse Hair Loss or dry hair
Cold extremities
Poor memory
Poor concentration
Pale skin
Shortness of breath
Heavy menstrual flow
Muscle or joint aches
Poor motivation

 thyroid symptoms

If you have 2 or more of the above symptoms and your Doctor is telling you you’re fine, then this article is for you!

Why running your TSH isn’t enough!

The typical thyroid test your Doctor is running is not a good indicator of  your thyroid function. Most of the time the conventional thyroid tests are only looking at TSH (A Pituitary Hormone) and T4 (Inactive Thyroid Hormone).  TSH, time and time again is shown to be a poor measure of overall thyroid function.

“TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure” (1).

Yet nearly every Doctor relies on this marker to treat their patients.  So if you TSH comes back normal but intuitively you know something isn’t right, what’s your next step?  Your next step is to get a comprehensive thyroid assessment so you can see exactly where your imbalances are occurring.  Your thyroid can dysfunction in many different ways, below a picture depicting all of the different things that can effect thyroid function all the way from the brain to the gut.


thyroid flow chart

If you are struggling with a thyroid imbalance and or need help looking over you lab tests feel free and reach out to by clicking here. 

The problem with typical thyroid testing is the majority of treatment is dictated around TSH levels.  Your TSH is a pituitary hormone, not a thyroid hormone.  Research has shown that essentially the brain is more sensitive to thyroxine (T4) then the rest of the peripheral tissues so it’s possible that TSH can drop to a normal level and at the same time the surrounding tissues have not received their proper fill of T4 yet.

“The serum concentration of thyroid stimulation hormone is unsatisfactory as the thyrotrophs in the anterior pituitary are more sensitive to changes in the concentration of thyroxine in the circulation than other tissues…It is clear that serum thyroid hormone and thyroid stimulating hormone concentrations cannot be used with any degree of confidence to classify patients as receiving satisfactory, insufficient, or excessive amounts of thyroxine replacement” (2).

The questions begs to be asked, “Are we treating a lab test or the patient?”  The more we use a series of lab tests with other subjective and objective markers into the care plan, it’s my belief the patient will start getting better faster.

Below are a series of lab tests that are essential to run to properly evaluate thyroid function.

I also recommend running T4 total and free, T3 total and free, thyroglobulin, reverse T3, and T3 uptake. It’s important to assess the body’s ability to convert T4 (inactive thyroid hormone) to T3 (active thyroid hormone). Any time we see a normal level of T4 followed by a low level of T3 we know there is a conversion issue. On a conventional thyroid test, T3 would never be assessed and you would probably slip through the cracks of the medical system with an undiagnosed hypothyroid.

It is important to assess the levels of free fractions of thyroid hormones because those are the only hormones available to the receptor sites.  Only 2% of hormones are free, meaning that they are bound to a protein carrier, therefore are free to bind to a receptor site and create a metabolic response. About 98% of thyroid hormone is protein bound so running both free and total thyroid hormone gives you a better perspective into the glands overall strength, the ability to convert T4 to T3 as well as the ability for thyroid hormone to bind to receptor sites.

Euthyroid patients receiving thyroxine (T4) replacement have higher serum thyroxine and free thyroxine concentrations than normal euthyroid subjects. This is not so for serum triiodothyronine and free triiodothyronine (T3) concentrations (2).

As you can see above, even patients that are given thyroid hormone replacement are not guarenteed to convert T4 thyroid hormone (Inactive) to T3  thyroid hormone (Active). Having adequate levels of T4 can make your TSH levels drop but it may not be enough to ensure your metabolically active thyroid hormone (T3) is adequate.

thyroid conversion

Did you know that 90% of all thyroid conditions stem from an underlying cause of auto-immunity (3)? Essentially the immune system is producing various antibodies that attack the thyroid tissue. Thyroid Peroxidase Ab (TPO), and Thyroglobulin Ab (TG) are produced in Hashimotos Thyroiditis which is an auto-immune condition that causes hypothyroid function over time.

Thyroid Stimulating Immunglobin Ab (TSI) or thyrotropin receptor antibodies are produced in Graves Disease, an auto-immune condition that causes hyperthyroid function.

At a minimum it’s important to at least ask your doctor to run TPO and TG antibodies to see if your thyroid condition is auto-immune in nature. Most medical doctors resist running these antibodies because it doesn’t change conventional protocol.

From a functional medicine paradigm it’s important to know if you are auto-immune because it changes the overall approach to how the thyroid is treated. Any time any auto-immune condition is present the focus needs to more on the immune system and the gut and less on the thyroid or injured gland.

Most Important Lab Tests

TSH: Pituitary hormones that signals the thyroid to make T4, a poor marker of thyroid status unless elevated.
Total T4: 98% of T4 thyroid hormone that is inactive and protein bound.
Free T4: 2% of  T4 thyroid hormone that is active and freely bound.
Total T3: 98% of T3 thyroid hormone that is inactive and protein bound.
Free T3: 2% of T3  thyroid hormone that is active and freely bound.
Reverse T3: Sign of a stressed physiology and a slower metabolism.
Thyroglobulin:  Increases with BCP’s (birth control pills) and higher levels of estrogen, decreases with elevation in testosterone like in PCOS.
T3 Uptake: How much active thyroid hormone is taken up by the receptor site. Elevated upate can be a sign of higher levels of testosterone commonly cause by PCOS (Poly Cystic Ovarian Syndrome) in females. Low uptake can be caused by elevations in estrogen primarily seen by BCP’s.
TPO Antibody: 70% of auto-immune patients are positive for TPO.
TBG Antibody: Less likely positive but should still be tested to rule out auto-immunity.
TSI Antibody/Thyrotropin receptor antibodies: Auto-immune condition that causes hyperthyroidism or Graves Disease.

To get access to affordable thyroid blood testing click here!

There are some excellent calculated ratios that you can perform that can provide additional data points to assess your overall thyroid function.

Most Important Calculated Ratios (4)
TT3/RT3 Ratio: 10-14
RT3/Free T3: Ratio 20-30

Check out this awesome calculator then can help you figure out your thyroid ratio!

“The T3/rT3 ratio is the most useful marker for tissue hypothyroidism and as a marker of diminished cel­lular functioning.” (4)

If you would like to schedule a brief complimentary consultation to review your options and order the above lab tests; appointments can be made online by clicking here.


1. British Medical Journal PMC143526.

2. British Medical Journal PMC1341585

3. Baillière’s Clinical Endocrinology and Metabolism 

4.  The Journal of Clinical Endocrinology & Metabolism 2005; 90(12):6403–6409

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.