Essential Blood Tests to Analyze Your Health | Podcast #305

Regular blood testing is one of the most important ways to keep track of your overall physical well-being. Getting tested at routine intervals can allow you to see how your body changes over time and empower you to make informed decisions about your health. Here’s Dr. J and Evan talking about the areas to check aside from the usual blood tests we know. 

A conventional medical doctor will typically recommend that you get routine blood work, but this is the bare minimum. There are several significant reasons you may want to get blood tests more often than that. Either you want to optimize your health or to reduce the risk of disease and health complications. 

What are some routine tests and others that you should ask or know? Aside from CBCs (Complete Blood Count), Dr. J and Dr. Even pointed out enzyme markers, cholesterol tests, blood sugar tests, liver markers, thyroid panel, and so on. It will help your doctors make a differential diagnosis and dive into the root cause of your present health status. To know more, check out this podcast.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

3:12       Conventional Side of Blood Works

12:14     Thyroid Panels

17:56     Blood Glucose

23:50     Adrenal Issues

29:33     Lipid Panels

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Dr. Justin Marchegiani: We are live. It’s Dr. J here in the house with Evan brand. Today, we’re gonna be chatting about blood tests that we use to help assess our health and help us get better. So we’re gonna be chatting a little bit about kind of intro blood tests, what the best tests are kind of what our perspective on that is, Evan, how are we doing today, man? 

Evan Brand: Doing really well excited to dive into this topic, I went, got my blood work. And I got my wife’s blood work done on Friday. And I just want to give a brief little note on how you and I run blood work as clinicians because it’s very easy. And it’s so convenient, because we don’t have to go and beg a GP or an MD and say, Hey, please, please, doctor. I mean, you and I’ve heard countless stories. Yeah, I asked my doctor to run this, they wouldn’t run it, I asked my endocrinologist to run this, they wouldn’t run it. With us, the accounts that we have with our credentials, were able to order and create customized lab panels. So you and I both have created customized blood panels that with a click of a button, we can go boom, order it for anyone, whether it’s ourselves, or our clients or patients, and then we get an instant requisition form. We go straight into labcorp request, you check in, you sit down, they call your name, you hand them the paper, you get the blood draw, you go home, it is so amazing. Every time I get my bloodwork done, I’m like, wow. And I didn’t have to get anyone’s permission to do that. But my own. 

Dr. Justin Marchegiani: Isn’t that nice? Yeah, it totally is nice. Also, there’s the big insurance scam, right. So because we have accounts directly with the lab companies, we can order tests, and typically we get, you know, an 80 to 90%. You know, discount in price compared to what the insurance would bill. So like my typical thyroid panel, full thyroid panel that I charge my patients probably around $120. And the insurance would typically charge a patient for that well over $1,000. So then patients, most patients don’t get 100% coverage, right, especially if you’re not in network, and then the doctors can’t ever retest, but once every six months, so then you’re you’re stuck not being able to ever retest. But they think, Oh, I’m gonna get coverage for this. And then they get 90% coverage, and they end up paying more money. For the for the 90% coverage, even though they paid 100% cash, it had been cheaper. So that’s kind of the insurance scam. And then the problem with that is they can’t retest but once every six months, so they’re kind of stuck. So yeah, it’s really nice to be able to order what the patient needs and to be able to reorder and reassess. Based on a time that is good for us. Not good for the insurance companies. That’s kind of nice, right? 

Yeah. And you’re kind of we’re kind of circumnavigating that conventional system where you’re waiting two, three months, and then you get a bill in the mail and you’re like, oh, medical bill, What’s this about? And then it’s like, oh, you owe 700. with us. It’s all transparent. It’s up front, you pay, boom, boom, boom, you’re done. I’ve already paid for it. I know that I’m not spending another penny. And the turnaround time is insanely quick to like one or two days, typically on some of these panels are running. So let’s go into some of the details. Now, let’s quickly compare and contrast. I think you and I have a lot of fun. Like where we did our conventional functional medicine vers conventional medicine, gut workup. Let’s talk about the same with bloodwork. So if you go to your doctor, and you have them say, hey, Johnny, we’re going to run your blood. What is that going to look like?

So conventional medical doctor, they’re typically going to do a CBC, they’re going to do a metabolic panel, they’ll probably do a lipid panel that’s usually going to be at maybe a year analysis, that’s kind of it. So like on the CMP they’re kind of looking at liver enzymes. They will look at some electrolytes on the liver on the CMP as well. Those liver enzymes electrolytes, maybe some protein markers there, they’ll probably look at glomerular filtration kind of some baseline kidney function with creatine and and bond. The kit the liver markers are going to be a lt and as to the liver enzyme markers, the gallbladder is ggt but probably look at some bilirubin your electrolytes are going to be sodium chloride, potassium magnesium, all serum not not intercellular which is a difference Okay. And then on the red blood cells are going to look at red blood cells RBC some adequate hemoglobin that’s part of the CBC right complete blood count which is going to help be helpful for anemic patterns right low iron right, although also run indices which are MC VMC, HMCHC right me corpuscular volume me corpuscular hemoglobin me corpuscular hemoglobin concentration. When those markers go high, that tends to mean that we’re dealing with B vitamin issues like b 12, full eight issues, and we call that megaloblastic anemia. So we have two kinds of anemia. As we look at big cell anemia is right we tend to be more B vitamins stuff. And then small anemias. We tend to be more on the red blood cell hemoglobin hematocrit, low iron side, and then we have immune markers, whether it’s neutrophils, lymphocytes, eosinophils, monocytes, and basophils, which could be from bacterial issues, parasite issues, gut inflammation issues, viral issues. And then I would say on top of the CBC, that’s pretty much it and then your limits. So total cholesterol, triglycerides and then of course, your LD vldl pattern, and then there’s some add ons that we may talk about whether it’s c reactive protein for inflammation, fibrinogen, for inflammation, homocysteine for inflammation, methylation, vitamin D. and we can kind of go into each one of those in regards to what we think is important on the functional side. But you know, the whole lipid thing is, it’s kind of overplayed, right people think that lipids are a really important issue now once you start going over 200 or so on the total cholesterol, and that may not be. And we’ll talk about the ratios and the perspective that we add to when we look at it.

Evan Brand: Yeah, so the way you talk, it sounds pretty good. It’s like, oh, wow, that’s a lot of stuff. But truthfully, there are rarely issues that show up on just standard bloodwork. Now, if you have more of the functional training that you and I’ve had regarding blood chemistry, you can kind of, I guess you would just say pick through the CBC with a fine tooth comb, and you can really look and maybe find some functional issues, like for me, I know that I you know, for a very long time, my hematic crit, you know, I’ve always had the hematocrit be a little bit high, which, based on some of the training you and I’ve had, it would indicate that there’s probably a dehydration issue. And that’s tough. You know, it’s, it’s, it’s tough to stay hydrated. And so even if I mean, I’m sipping on water all day, but you know, I’ve heard there’s a big influence on anti diuretic hormone, and all of that when you’re exposed to mold toxin, that’s a conversation for another day. But anyway, unless you’re really looking with a with a fine tooth comb, conventional bloodwork doesn’t reveal much. And you may see a little bit of this a little bit of that, but it’s not, I’m not making too many protocol decisions based on a CBC I would say. 

Dr. Justin Marchegiani: So when I look at blood, it can give me a good area of where to where to look next, or where to dive in deeper, which is helpful. And then if we look at it, using the optimal reference range, or a functional reference range, we can definitely glean better information. So the problem with most conventional medical doctors, they’re looking at blood through a pathological range, they’re trying to pick up like major disease patterns or pathological patterns. And so how it works is you have to show you have all people kind of fit in what’s called the bell curve. And the typical range is going to be two standard deviations to the left and right, this is represents about 95% of the population fit into the so called normal. So you have two and a half on the high two and a half on the low that are on the high or low side, pathologically, right. And so the problem with that range is it as people get more unhealthy and sicker. And as those sick people tend to test more, what happens to the lab reference range over time, it gets wider. And so it becomes more encompassing, it’s like having a bad field goal kicker and you make the field goal every year wider and wider and wider and closer and closer to compensate for the lack of, you know, good kickers out there. So it’s kind of like that. And so what we do is we kind of narrow up that range a little bit, and that narrower range helps us pick things out before it becomes a problem. So let’s kind of go over a couple of things. So with women or people that are vegan vegetarians, women, because they bleed more when they’re when they’re at menstrual age, right, typically 50 or below 48 or below, they can be more anemic. So we may look at things like lower red blood cells, right, red blood cells, you know, below 4.2 or so we may look at hemoglobin below 12, we may look at him at a crit, you know, in the mid to low 30s as a sign that there could be some low iron issues brewing, we may also run an iron panel, it’s not typically run, but we may run things like ferritin, or iron binding capacity. Or we may look at things like iron saturation to get a window of low iron, for instance. And that’s commonly missed, because what most conventional Doc’s do is, their threshold for low iron is really low. And there’s a lot of women I see in vegetarians in general that could be on that lower side could be a little bit anemic, and then they’re not going to be able to carry oxygen throughout their body adequately, which makes a huge difference in energy and stress and and mitochondrial function and thyroid function because you need to be able to carry oxygen to have good energy. 

Evan Brand: Yeah, let’s go into some of the more let’s let’s, let’s break some of the stuff down. But before we break it down more, let’s hit on what are the things that that we’re going to run and so I’ve got my panel pulled up that I ran. And so I’ll kind of run through some of these things. But as you mentioned, ferritin that’s typically not going to get run I’ve rarely rarely seen fair to run by anyone. The iron saturation as you mentioned the iron binding capacity. That’s really wrong. That’s right to be ti BC. Often on your bloodwork, the vitamin D. I mean, my God, it’s so important, but yet vitamin D to this day is still not commonly run. Nope. And if they run it, they may run the wrong one. I’ve seen people where they don’t run the 25 o hydroxy. tryptophan, they’re going to run like the even the beat the D two. They’re going to run the What is it? Ergo? 

Dr. Justin Marchegiani: Yeah, the vitamin D too. Yep, Ergocalciferol.

Evan Brand: Yep, yeah. Ergocalciferol? Yeah. So you have a vitamin D, they may run the D two and you’re like crap I needed to d3.

Dr. Justin Marchegiani: Yeah, the [inaudible]. The animal base kind of the d3 is the more active form. The D two is the more plant synthetic form, typically made from lanolin. A lot of times, that’s the D two, that’s the ergocalciferol. Ah, so vitamin D is really important. And then the range on that is pathological as well. They want above 20. Why? Because they’re looking for rickets, right, the bone bending disease, right, because d3 helps absorb calcium and helps a calcium get into the bone. So we want 50 to 70 or maybe 70 to 100 if we’re autoimmune or cancer risk. So vitamin D is a big one, I would say also on the CBC, we may be looking at immune cells, if I see low white blood cells, you know, below four and a half. There could be some you know, deficiency issues if there’s high white blood cells, you know, greater than seven and a half there could be some immune stress. Now we look at the, the immune cells, how do we look at those never let monkeys eat bananas, that’s the mnemonic device and doctor at school we learned so neutrophils we want to see, you know, below 60 lymphocytes, we want to see mid reference range when we see high neutrophils or low neutrophils and elevated lymphocytes. That’s a common h pylori or bacterial infection pattern. If we see elevations in eosinophils, greater than four, we’re thinking potential parasites or chronic environmental allergies by sea monocytes, greater than 10. I’m thinking some kind of intestinal inflammation. So we there’s different, you know, patterns you may look at, when we look at some of these immune cells. That’s very important. But unless it’s very high, they’re typically not going to say much. And if it’s very low, they typically don’t say much either there. 

Evan Brand: Yep, so also more advanced thyroid markers. It’s very, very sad how many people go to even an endocrinologist and they may only end up with a free T for possibly a free t three, but even that’s not guaranteed. Maybe a total T for you may get Of course, TSH is going to be on there. But you and I are definitely going to be running like thyroid globulin, I mean obat antibodies, we’re going to be running t TPO, thyroid paradoxus antibodies, maybe TSI, sometimes if we think there could be something else going on next. And then you’ve got the uptake of T three, what else you got? You got reverse t three that we’re going to be looking at. That’s an awesome marker. And that’s never run. 

Dr. Justin Marchegiani: Yeah. So when it comes to a thyroid panel, you already mentioned it, most conventional endocrinologist and primary care are going to run TSH because that’s the major screening brain hormone, not a thyroid hormone majrooh. It’s not a thyroid hormone, but it’s a major brain hormone that talks to the thyroid and you’d be lucky to get a T for total after that. But we know downstream is a lot of conversion issues and even patients that have normal TSH, guess what, especially if they’re on Synthroid, which is a synthetic thyroid medication that’s just T for many of them can’t make that conversion. And that’s a problem too. And so you can have adequate T for good TSH and low t three. And you may have a lot of thyroid symptoms. So it’s really important that we look at things complete. And don’t even get me started on thyroid antibodies, because that’s almost never run and thyroid antibodies are the major mechanism why most people sideway glands aren’t functioning properly because their immune systems have beaten the crap out of their thyroid for a very long time. 

Evan Brand: And we’re talking what I mean, you’d say probably over half of cases of hypothyroid are probably autoimmune based on what I’ve seen, what would your guess be? 

Dr. Justin Marchegiani: Yeah, I would say that and some may not even come back on the lab test, but it’s very helpful to be able to look at those we run TPO antibodies and thyroid globulin antibodies. And so my full thyroid panel nevitt, some kind of a TSH, T for free and total t three free and total TPO antibody, federal globulin antibody, and we may run a reverse d3 or an uptake. Those are all okay markers to add to. So that’s kind of your complete thyroid panel. Let me just piggyback to the CVC. Is there anything else on the CDC? I think we hit it all there. We can go to the metabolic profile now if you want. 

Evan Brand: Yeah, well, you mentioned like earlier, like CBR active protein c reactive protein, I guess it kinda depends. I mean, sometimes that standard, but a lot of times that’s not an hscrp is, you know, going to be the same same section of the inflammation panel on your blood. So hopefully you get those two run together. 

Dr. Justin Marchegiani: Yeah, usually CRP and cardio CRP is basically the same thing CRP, they’re just, they’re breaking the number down typically below two, I think the cardio CRP, they typically don’t do it less than two or so. So when they you do a highly sensitive CRP, they’re just breaking it down into a smaller number. Let’s go we want to see that below one that’s great as a good marker of systemic inflammation. And fibrinogen is great. We have for highly inflamed, we may see a lot of clotting happen. And fibrinogen looks at clotting factors, which is helpful. So if we don’t have good fatty acids, good omega three omega six ratio or a lot of inflammation, a lot of trans fat, high blood sugar cells tend to agglutinate they get very sticky. And so it’s nice to see where that stickiness that stickiness level is. And homocysteine is also another measure of blood inflammation because it’s homocysteine is an inflammatory metabolite. That typically happens when there’s not enough B vitamins B six and four And B 12. In their active form, that can be a big inflammatory issue there too.

Evan Brand: Yeah, that was a problem for me. Actually, I did have elevated homocysteine couple years ago and started hitting some more Foley and it fixed it. So it was fun to see how the blood correlated to that. 

Dr. Justin Marchegiani: Yeah, you know, we’re going to try to get as much of that which we can do leafy greens and high quality, you know, essential fats and meats, right, but that’s good. And so metabolic profile, we may look at liver enzymes that could be helpful patients that have a lot of insulin resistance and inflammation, you may see an elevation in liver enzymes. What does that mean? That could be a non alcoholic, fatty liver, non alcoholic steatohepatitis, that’s Nash or non alcoholic fatty liver, meaning your liver has stressed not from alcohol, but from typically too much fructose and junky carbs. So the liver is a people think the liver is just a big filter for toxins. No, it also has a major effect at regulating blood sugar, and is also a storage site for sugar, especially fructose. So when you over consume fructose from high fructose corn syrup, or, you know, just too much carbohydrate, in general, the liver really gets stored up. And then when that liver fully gets saturated, overly saturated with fructose, for instance, you start having all these up regulations of inflammatory enzymes called the the junk enzymes, the J, the J and K one enzymes, and you see a lot of inflammation and a fatty liver there, and you see it an ultrasound. And so that’s a common marker seen those elevated liver enzymes, and it’s good to be able to look at that. 

Evan Brand: Yeah, I don’t know if you’ve tested bloodwork much with people like in the middle of a protocol. But I’ve had a couple interesting cases where, while using binders, we’ve seen liver enzymes go up. And it could have been also parasite protocols and things like that, that were kind of interwoven with detox protocols. But I’ve seen liver enzymes temporarily go up during that. So I don’t know if you pay much attention to that. But I’ve seen it and they always go down as soon as it protocols over so.

Dr. Justin Marchegiani: Even with some killing herbs, like worm woods, a common one that we may see a little bit of elevation and liver enzymes, people that are sensitive, some of the killing herbs, it could be a little bit of stress, is it just the herbs? Or is it the dead debris that is now mobilized from the killing of those microbes, it could be both. That’s where adding things like binders can be very helpful just to kind of put handcuffs on those critters and escorted out of the body versus kind of having it go back into general circulation. also adding an extra glutathione support can be helpful too. Just to really support and tone if I deliver those are very important too. 

Evan Brand: Yeah, well. And it’s common for you and I to use some sort of a liver gallbladder support too. So we may be throwing in like some extra taurine or Mathionine or beet powder artichoke. And there’s many, many things that I say milk thistle already NAC. So there’s a lot of stuff we can do. But yeah, I just figured I mentioned it. Because if someone’s listening and you happen to do blood work in the middle of a protocol, it’s possible that the levels may you may look at him and go, Oh, my God, my liver enzymes, but it will go back to normal relatively quick after killing protocols over. 

Dr. Justin Marchegiani: Exactly. Also, we may look at glucose, blood glucose is going to be on a metabolic profile as well. CMP panel, I don’t love it as much, because most people that are going to get a blood test and they’re getting pricked in the arm of the big needle, or they kind of stressed. Yeah, and so that the cortisol from that can really increase their blood glucose. So I like getting a really good blood sugar kit like this. And then you can measure your blood glucose during the day. So here’s my little kit here. And so I have I use the keto Mojo now because it measures ketones, so I’m a little meter, I have my little pricker here from my finger, and then I have the blood glucose and the ketones. So this one right here is the blood sugar. And this one here in the lighter blue, this is my ketones. So it’s kind of nice to have those. So I can test my blood sugar before I eat. And then I can do a one two hour three hour and play around with my blood sugar. The whole goal is the more you keep your blood sugar down after a meal and bring it back to baseline within two or three hours, the less insulin you’re making, the higher it goes up and the longer it takes to come back down, the more insulin you’re making. So it gives you kind of a good window how you’re responding to food. 

Evan Brand: Yeah, what I wanted to point out is that you’re doing more functional analysis of glucose versus if you just go into your doctor once every six months, you get a morning fasted glucose, that’s just not enough information.

Dr. Justin Marchegiani: It’s not because the whole goal while you’re just checking morning glucose is because you’re thinking your food, so out of whack, that your glucose is now elevated as a result. Now the problem is most people haven’t eaten in 12 hours. So for your glucose is still be out of whack. 12 hours later, the problem has to be pretty severe number one, and then number two, a lot of times it can be elevated not because of food, but because of stress hormones in the morning. And so the stress hormones, people say oh, I’m at 105. Yeah, but it just could be a good cortisol response in the morning called the dawn phenomenon that’s raising that glucose. That’s why you want to check it against your foods during the day. If you have a blood glucose issue. You’re going to see one and two hours later, it’s chronically elevated, and it’s taken a bit of time to come down. So that’s a better marker. Make sure you’re handling glucose okay.

Evan Brand: Yep. How about hemoglobin A1C, this is something that for diabetics, obviously, this is hopefully going to be regularly checked. But for your average person that maybe has some issues, A1C is probably not going to be on your standard blood panel. 

Dr. Justin Marchegiani: I don’t love A1C, I used to like it. I don’t love it as much, I find that when people’s blood cells live longer, because they’re more healthier, they have more time to accumulate blood glucose. So the A1C it’s a part of the hemoglobin and they’re looking at the coding, the coding of glucose on the outside of the hemoglobin, right? So imagine, like, you know, when you, you know, you go up into your car during allergy season, you can see like a big fixed swath of like pollen on the car, they’re kind of looking at the swath of glucose on the outer part of the human lobe. And now the problem is, the longer your red blood cells are hanging around, the more time they have to accumulate that blood sugar. So it can be helpful to look at something. But if you’re, if you’re a little bit on the higher side, or like, let’s say 5.5 or so, let’s say under six, but 5.5. And up, it may just because your red blood cells are a little bit more healthier. So like, for instance, with my anemic women who may have a ton of blood sugar, right, a lot of carbs, because maybe they’re vegetarian or vegan. Guess what? When you’re anemic, your red blood cells die faster. So all my anemic women have A1C super low, like in the forest. And so it’s not going to be a great marker when your red blood cells don’t live that long, and we see it with our anemic patients.

Evan Brand: That’s a good point. Good point.

Dr. Justin Marchegiani: If I see someone six or higher, yeah, it’s helpful, you know, but when you’re kind of in that subclinical zone, you’re going to typically have to go back to one, a meter like this, to really look at it. And then also look at your fasting insulin, which is a better marker, because that’s going to give you a better window, how much insulin you’re making frequently. 

Evan Brand: Yep, good point, that analogy is perfect. The pollen on the car. So good job there.

Dr. Justin Marchegiani: Right. And if you leave your car out there a lot longer, you’re gonna get a lot more pollen. It’s kind of like that, right? 

Evan Brand: I’m always under five though, no matter what with a one C, I’m always right. 4.9. Somewhere in there. 

Dr. Justin Marchegiani: Yeah, I’m pretty low, too. I’m always like, right in the low fives. 5’1 5’2. But I’ve seen a lot of patients in my career that have that have really good diets that have tested their blood sugar, have good insulin, and they’ll still have a little bit higher on the a one C and I’m just like, yeah, it’s just it’s missing some people. That’s all. It makes sense. The question is, what’s the mechanism? And that’s what it is. 

Evan Brand: Yep. Makes sense. You hit the you hit the dawn phenomenon. So you know, cortisol that may be run via blood, although we don’t really like blood cortisol too much. We really like more functional analysis of cortisol, like with urine or possibly saliva? 

Dr. Justin Marchegiani: Oh, yeah. And part of the reason why we don’t we don’t like it, is it because when you’re measuring a stress hormone, while creating a stress response, ie putting a needle in my arm, you may influence that a little bit, right? And so that’s kind of the reason why we don’t love that. And even if you’re like, Well, you know, do the adrenals make cortisol fast enough after the needle happens to show in the blood? Well, it’s not just that it’s the fact that you’re anticipating it happening. Therefore, you’re replaying that stress in your mind all the way up to the doctor’s office to go and then the elevator getting into the you’re already making that stress hormone while you’re anticipating what’s going to happen. 

Evan Brand: Yeah, you go in the friggin lab with the scientific fluorescent lights above your head. It’s all awkward the quiet they got some like drug commercials on in the waiting room, Justin, and they call your name come on back. Yeah. So and, you know, also Not to mention, too, that that’s just a snapshot, right? I mean, that doesn’t tell us anything about what’s happening at two or 3pm when you’re complaining of that midday crash. So I really am not too interested about what happened at 8am. I’m really want to know what what’s going on at 2pm when you’re saying you need that third cup of coffee. 

Dr. Justin Marchegiani: Exactly, yep. 100%. So it’s, it’s really important that you’re kind of on top of that. So I think we hit some good blood glucose stuff, we hit some liver enzymes we hit. I’m thinking here, we hit some of the electrolytes. electrolytes are good, too. So sodium and chloride are really good ones. Now when I see patients that have adrenal issues, you could easily have low sodium and high potassium, or you can just kind of have lower minerals all together. Now the serum is not going to be the best marker for testing minerals. So when you see your minerals out of balance, you know, it’s a big issue, but you could still have mineral issues. And the serum be okay, because it really matters what’s in the cell. Not necessarily what’s floating around in the blood. So think of interesting Imagine you’re in a pool, okay? The pool is serum. Okay, you’re in the little floaty. You’re in the little inner tube, right? So it’s you in the inner tube, right? You and the inner tube and the water in the inner tube that’s intercellular. The water outside of the inner tube is extracellular serum. So that’s kind of how you think of it. So when we test some of these nutrients, it’s better to get a sample of the water in the inner tube with you that’s intercellular versus the water outside of the inner tube. That’s serum.

Evan Brand: Yeah, and how do people get that? What is look like?

Dr. Justin Marchegiani: Well, you can like we can add like a red blood cell serum or a potassium serum on some of these panels, we may run like a spectracell, or a Nutri eval or an ion panel that looks at more intercellular nutrients, we may look at different tests that allow us to do that. But there’s not too many add ons for conventional testing like quest or labcorp. Outside of I seen a blood cell magnesium is good. You can do a potassium if you wanted. So there are a couple that you can do to get a window into that. 

Evan Brand: Yeah, I was gonna say I looked through all the options for the conventional labs, RBC magnesium, I think that was about it. I think that’s all I could find. 

Dr. Justin Marchegiani: So yeah, not too much. But it’s something you know, because magnesium is a big one, right? And with magnesium RBC, we want to see a greater than five on that one, red blood cell magnesium greater than five. So that’s helpful. And then, of course, we mentioned magnesium surround, we want that greater than two. And then your minerals, you want them somewhat mid reference range, once we start going under 100 or so I think like sodium, it’s like 104 is kind of mid range. If you’re under 104, it could be a problem, potassium, I forget the exact ranges in it, but I want them all about mid range. In regards to the reference range. 

Evan Brand: What do you feel about using conventional bloodwork to do like omega three omega six fatty acid panels, I know, there’s some Doc’s that are just so obsessed with all these ratios. But, you know, truthfully, if you’re doing the things that we’re discussing with our clients and patients for nutrition, you’re going to pretty much be optimized anyway. I don’t know what that would tell you. Besides, hey, maybe you need to do a little more this or that? 

Dr. Justin Marchegiani: Yeah, it’s a great question, I think, look at the person’s food. Like someone could have really good diet, but let’s say the meat and the eggs aren’t pasture fed. Well, that could easily be the reason why your omega six to three is off a little bit. Or it could be that you know, you’re just doing too much plant fats, and those plants or from coming from, you know, omega six bass plants soy or canola or safflower. So if you’re doing good fats, like coconut oil, and olive oil and avocado stuff, which are monosaccharides are Yeah, so those are, yeah, those are MonEl fatty acids versus like, vs. poly, which is like a fish oil, right. And then so the fish oils, you have omega threes, right, which are going to be like, the ones that are we talking about that are going to be more on the anti inflammatory side, right? These are the Polly’s. And then of course, the Omega sixes are going to be more on the vegetable side. These are going to be also Polly’s but they’re going to have six bonds, these are going to be your safflower canola, these are going to be your soybean oil, all of your plant based fats, most in the most of your plant bait fast, to extract the fats from them with the olive oil or maybe an avocado, you tend to have to damage the fats, they tend to be more damaged, they tend to be more on the Omega six side. And when you get when you eat plants by themselves, you’re not getting that concentration of fats. And so you tend to not have that high omega six to omega three, when you’re doing just vegetables by themselves. Okay. And so we can just look at how much fish you haven’t per week, how much pasture fed eggs you have in a week, how much steak or meat that is grass fed, you haven’t per week, and then you can kind of look at it relative to what’s high on the Omega sixes like the knots and the seas and the refined vegetable oils. And you can kind of get a pretty good assessment of where you’re at, which is like kind of for one or less. So four times omega six to one is pretty, it’s pretty. Okay. And you can always run that omega three to six tests on the blood too. Does that make sense? 

Evan Brand: It does. Yeah, I just find that it’s not a huge needle mover. So I don’t run it too often. I mean, I think it’s cool to check in you could call it kind of a lie detector test as somebody says they’re doing everything that’s dialed in, but then you find out that Oh, they’ve been coconut grass fed steak, but it’s been in this healthy heart oil blend that they found on the shelf and it was a safflower canola combo. You’re like, Oh crap, then we missed it. And you got to get off of that stuff. So yeah, I mean, I was just gonna say so it’s not really a standard thing. For me at least you know, I’m not running into often with people but- 

Dr. Justin Marchegiani: But it’s there it’s an option and then it’s something if someone wants to run we’ll run it and so we have the polyunsaturated which is the fish oil or on the omega three side, right. And then we also have things like flaxseed oil, but it has to get converted to the to the higher up fatty acid so you know, omega three fish, and then you get to get some mega three from cows that are grass fed as well. 

Evan Brand: What about particle size on a lipid panel? So we talked about that briefly. It’s just a good add on that most people don’t do and our friend jack Wolfson, he discusses particle size and I think it’s something that more people are asking questions to their doctor about but it’s still very uncommon to run. 

Dr. Justin Marchegiani: People that have a cardiovascular history. Just want to run it to begin with. I think it’s okay. I can almost always tell you what your particle sizes if you’re eating good health saturated fatty acids like coconut oil and grass fed butter. And you’re getting meats that are like good quality fish, good quality grass fed beef, egg yolks, you’re keeping a lot of your junky fats down a lot of the refined sugar down and a lot of the trans fats down, you’re going to have a large, you’re going to have a particle size A, which means large and buoyant and fluffy, right? Think of a like you want an ad on your test. And then you have the small dense atherosclerotic particle size B, think B for bad, and the B for bad, more trans fats, more inflammatory, processed vegetable oils, more refined sugar. And so with patients, I almost always can look at their diet. And guess what that will be to begin with. So if I do a dietary check and do a diet recall, what’s what’s the average day look like? And I look at that and I get a window, it’s pretty easy to predict that. And so we’ll run it for patients that have a cardiovascular history, and they just want to know, but for the most part, it’s not hard to predict it. 

Evan Brand: Yeah. And when you see it, are you just tweaking dial? Like, if you see a bunch of small dense particles, or are you coming in? Are you using any kind of like plant sterols or anything like that, to help with it are you just tweaking diet, and then it fixes itself? 

Dr. Justin Marchegiani: It depends how acute the patient is. But if it’s if it’s not acute, meaning the patient’s not dealing with a heart issue right away, then we’re going to just tweak the diet, and that’s going to take care of it, we’re going to add an extra omega three fatty acids from fish oil, we’re tweaking the diet, we’re getting the carbs down, we may be adding extra nutrients to manage blood sugar and manage inflammation. And then usually within a month or so you’re gonna see a big change. After we retest. Awesome, yeah, usually once you get about 100 good meals, then you’re going to see a big shift. A good average person is doing about 21 meals a week, right? So three a day times 721. So four to five weeks, once you get 100 meals in, if you can get them close to in a row. Your body has a huge shift in physiology. 

Evan Brand: It’s amazing how quick you can change stuff I knew. I mean, sometimes we get impatient because like what the detox piece like that takes longer. I mean, I’m here I am a couple years in detox and mycotoxins. I’ve still got some going on. So, you know, with that, it’s like, oh, man, you get impatient. But luckily, with the blood, it’s a quicker turnaround time sounds like. 

Dr. Justin Marchegiani: Oh, totally, man. It’s really important. So I think we hit some of the big markers today. I would say one other one for lipids. You know, I don’t really care if cholesterol is a little bit on the higher side, just I try to make sure the cholesterol to HDL ratio is ideally you know, four. So if the if your Triggs are sorry if your total cholesterol is 200, and your HDL is 60, or what’s that ratio to the math, put my calculator 200 divided by 60, that’s 3.3. That’s pretty darn good. Usually, when you’re under three and a half, that’s half the average risk factor. Okay? When you let’s say you’re at 242 40 divided by 60. On the HDL, now you’re at four. And so I like to look at the total cholesterol to HDL because HDL is what recycles cholesterol. Okay? So if you have good recycling lipoproteins, ie HDL, that’s a good sign. And then I’m also going to look at my trigger to HDL ratio, we want that under two. But if we can have a closer to one, that’s wonderful, what does that mean? Take your trig number, let’s say your trig numbers at 60. Let’s say your HDL is at 50. Well, what’s that? What’s that number? Well, we do 60 divided by 50. We’re at like, 1.2. That’s good. So we want to under two but closer to one’s ideal. That’s a really good marker. That’s my insulin resistance inflammation marker for my limits. So I’ll look at trade over HDL. That’s a really good marker. 

Evan Brand: Yeah, you know, I talked to jack one time about the, the blood and I said, When do you start getting freaked out regarding total cholesterol, because if you talk to a conventional cardiologist, they’re they’re brainwashed on that 200 number. And he says that he’s got people up in the 450s, that he’s not worried about 1%, like total cholesterol being 450. And it’s not an issue. So he just talks about, like he said, ratios, inflammation associated with it, you know, then you get into more trouble. But I mean, the total number, I mean, he acts like it’s just minimally important.

Dr. Justin Marchegiani: Yeah, on its own, I would be a little bit concerned once you start getting in the mid 300. Just because that’s that could be more hypercholesterolemia. And that’s not necessarily a diet thing, that’s more of a genetic thing where you’re making a lot more cholesterol. So I personally would get a little bit more concerned with that and I’d be monitoring that. But it’s hard to really jack up your cholesterol when you’re keeping inflammation down. Like I just did a blood test for my lipids last month, and my cholesterol my total cholesterol and you know what I eat man? I good fats, good proteins, good eggs, good fatty acids. And my total cholesterol was at 165.

Evan Brand: Whoa, yeah, I was like a 202.

Dr. Justin Marchegiani: Yeah, 165 my my trades were at 60. And my HDL is we’re at 50. So I had like a 1.1 1.2 ratio for trigger over HDL, which is great. And so most of the cholesterol, you’re gonna Ahead is gonna be made by your body. So when it starts getting too jacked up and your diets good, you know, we want to look at thyroid hormone, maybe that could be a big thing. And there could be a hypercholesterolemia genetic issue, and we can always run a genetic test for that to see what’s going on. And if that’s the case, what are natural things you can do to get your cholesterol down, you can do higher dose berberine to make sure your thyroids check, you can also do some potential plant sterols as well. But get that check. So my philosophy if it goes a little too high, I’m curious, I’m worried about the hypercholesterolemia piece. 

Evan Brand: Yeah, and I don’t mention that 400 number just to get people off the hook. I just thought it was interesting that that’s what he was saying. And he’s probably talking like, you’re in big trouble if you get to that point. But But anyway, so that’s rare, though. 

Dr. Justin Marchegiani: That’s super like these are very, very rare situations, you know, sub 1% of the population are going to be there. My never seen it ever. I have two patients with that. But most people already know about it, because someone in their family already had been picked up previously. Yes. So most people already know what especially today, you know, maybe 3040 years ago, not as much, but people that have had those issues have already been picked up. They already know genetically, if it’s in their family, and then once you know genetically, if it’s in their family attend to get tested for it. 

Evan Brand: Yep. Right? Well, let’s wrap this thing up. So as we mentioned, bloodwork is a piece of the puzzle. If you go to a practitioner, and they’re like I’m going to analyze your blood and tell you everything you need, they’re wrong, because you mentioned some of the clues into the immune section about parasite infections and all that. However, I will speak for you and say that you’re not going to depend on that bloodwork solely to identify parasites, you’re still going to be running comprehensive genetic DNA based school panels, you’re going to be running organic acid panels to look and deeper. So yes, you may look at those things. And I think it’s awesome that you gave us some insight into that, however, I’m not going to go to a guy who’s going to look at the blood and say, Yep, you’ve got parasites, let’s put this protocol together, I’m going to want more data. So blood is just part of that data. And it can be helpful, especially when you’re working with autoimmune people, because you and I like to look at these antibodies, and it’s very fun and satisfying. And it makes you look better when you could have a a woman come in with a TPO of 1000. And all you do is fix her gut and our TPO antibodies go down to sub 200. That’s exciting. 

Dr. Justin Marchegiani: Totally, that’s huge. So I think today is very great, great podcast, because we’re talking about actual things. We want people to kind of like say, Hey, you know, what’s it like to be inside Dr. J, and Evans head, and this is kind of it. And everything that we look at, we’re kind of like a detective, we’re putting like checkmarks in the column over here that support us going in this direction, or going in that direction. So we add up all of our checkmarks, right, and we’re kind of create what that differential diagnosis is, and what tests we’re going to do to dive in deeper in in whatever those avenues where those check marks are adding up. So that’s kind of inside of our head, we’re walking through you through our thinking. And if you want to dive in and reach deeper, you know, into work with a practitioner, like Evan or myself, you can head over to, you can schedule a consult with Evan or myself at And you can schedule we are available worldwide to help y’all with your functional medicine and natural health care needs. And if you want to get to the root cause we’re going to be the best person to to look at anything else you want to highlight here today. 

Evan Brand: Maybe just one frequently asked question, Well, I’m not where you live. Does that matter? Well, in the US, it doesn’t matter at all. We can run like a blood comprehensive blood panel, we can run that anywhere now. We’ll try to help people internationally in regards to providing maybe some codes or things like that to help people. But at least for the us know, you location does not matter. We haven’t had any issue with that. I think New Jersey for a while was getting a little more strict. But beyond that, no. I mean, nationwide, it’s a piece of cake. So as we talked about the beginning, create a panel, send a requisition form to your email, print it go get your labs drawn, you’re done. It’s awesome. percent was in New York, or was in New York or New Jersey was one of them. 

Dr. Justin Marchegiani: Yeah, both. 

Evan Brand: They’re both difficult. But was it for blood? Or was it for some of the functional or was it- 

Dr. Justin Marchegiani: For blood, but there are some still some Malin fingerprick tests that we have accessible to deal with patients like that. So we still have options for them. Maybe not quite as much. And then if they’re near the Connecticut border or the Pennsylvania border, we have also options there too, but we still have some mail and stuff. That’s helpful. 

Evan Brand: Cool, cool. All right. Well check out the sites We’ll be back next week. Take care.

Dr. Justin Marchegiani: Excellent. Have a good one, y’all. Take care. Bye.


Audio Podcast:

Testing and tracking your thyroid health – Podcast #111

Dr. Justin Marchegiani welcomes Dave Korsunsky of Heads Up Health back to the show to talk about assessing the thyroid. Listen to this podcast to learn more about the complete thyroid panel and how you can organize your lab test data. 

thyroid testingFind out exactly what you can do about all the information that you get from your thyroid tests in terms of keeping track and charting your own data to look at patterns. Learn how these can be very useful when compared to other variables such as sleep, blood sugar or even the steps you’ve done in a day. Discover why you should get a full thyroid panel and how or where you can get it.

In this episode, topics include:

02:29   The role of the thyroid and hormones

05:26   Components of a full thyroid panel

09:48   Supplementing the thyroid

21:22   Thyroid antibodies

26:10   How or where to get full thyroid panel









Dr. Justin Marchegiani:  Hey, there, it’s Dr. J. I’ve got my good friend here, Dave Korsunsky. We’re gonna be chatting about how to measure—how to assess your thyroid. Dave’s got some great technology called Heads Up Health, We use this software a lot for—to help patients kind of chart their lab data so they can follow it, create graphs, compare it to other variables like sleep or blood sugar or how many steps you’ve done in a day. So we’re gonna really dig into how to look at and how to assess your thyroid and what numbers and lab values we look at. Dave, how are we doing, man?

Dave Korsunsky: Doin’ great, doc. Thanks for having me. I can see on Skype here that you’re sitting in your home office and I remembered that just a few months ago I was over at your place and we did a—we did a show on testing ketones which went great and happy to be back and actually talking about something that I see coming up all the time. Heads Up Health is pretty active online in a lot of the different Facebook groups and different communities on Ketogenic Diets and Paleo Diets and this—this question of the full thyroid panel comes up all the time. So I’m glad we can dive into it. It’s also something that was personally relevant for me and you may recall when I was your patient, that was one of the things you helped me fix. So I can throw in some of my own personal experience here as well.

Dr. Justin Marchegiani:  Absolutely, that’s great. I was going to do a nice live on-screen recording here of a—with my ketones but my battery is dead. Damn it. I hate wasting these strips. They’re so expensive.

Dave Korsunsky:  Where do you get yours from? It’s 4 bucks a strip here in the US. I know there’s cheaper sources out there.

Dr. Justin Marchegiani:  Well, I got it from the person that you told me to get it from over in New Zealand.

Dave Korsunsky:  That’s right.

Dr. Justin Marchegiani:  On eBay.

Dave Korsunsky:  Actually, it was Australia.

Dr. Justin Marchegiani: Australia.

Dave Korsunsky:  Yeah, it was Australia.

Dr. Justin Marchegiani:  Australia. Yeah, that’s it–.

Dave Korsunsky:  But they’re clamping down on that now. They—I think it’s illegal for them to ship to the United States now. So they’re getting harder to find on eBay.

Dr. Justin Marchegiani:  Yeah, I hear you. There’s still there a little bit though, but today for lunch I had—I had a collagen bar. I had tuna with a little bit of like Mark’s Primal Mayo so like egg yo—like you know, egg, olive oil or egg avocado oil.

Dave Korsunsky:  Yup, I’ve seen that product. Yup, it’s great stuff.

Dr. Justin Marchegiani:  And then like some shreds of carrot in there and like a little bit of cut up spinach, so it’s pretty high fat, very little carbohydrate. So my ketones will probably be around 0.6 mmol right now.

Dave Korsunsky:  Yeah.

Dr. Justin Marchegiani:  Now–

Dave Korsunsky:  Well, as I mentioned to you I don’t have my meter with me, otherwise we could nerd out and do some ketone testing like we did last time.

Dr. Justin Marchegiani:  Absolutely.

Dave Korsunsky:  Another time.

Dr. Justin Marchegiani:  Another time. Absolutely. Well, today we were gonna talk about thyroid and just really put the focus on thyroid and thyroid’s important, right? Thyroid’s that gland that sits kinda right where that bow tie in the neck would, just below and outside of the Adam’s apple and it produces a metabolic hormone called thyroid hormone and that hormone gets produced and it gets converted and activated in the body and there’s a lot of things that are responsible for making thyroid hormone and activating thyroid hormone. Like we’ve talked a lot in the past about ketosis and insulin resistance and having too much or too little insulin can really have an effect on how thyroid hormone gets activated which is really interesting. So with the software that you created over at, anyone listening can go head over there and get a free account, but you can plug in your thyroid lab values and–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Let’s kinda just start—well, let’s just start with an anecdote kind of your personal story of us working together with your thyroid and then we’ll dig in to the meat of the matter here.

Dave Korsunsky:  Yeah, so this was back in I think in 2011-2012 when you were still working out of the Cupertino office.

Dr. Justin Marchegiani:  Uh-hmm, yeah.

Dave Korsunsky:  And you may recall you and I met at Asprey’s 1st ever conference.

Dr. Justin Marchegiani:  Yup.

Dave Korsunsky:  In San Francisco and you were hustling there. You had your—your adjustment table out–

Dr. Justin Marchegiani:   Yeah.

Dave Korsunsky:  And you were just—I’m like this guy is awesome.

Dr. Justin Marchegiani:  Mmm.

Dave Korsunsky:  So the first time I started working with you, I—I just brought in all my labs from my conventional doctor and—and I had them in a—a horrendous spreadsheet at the time.

Dr. Justin Marchegiani:  Right, right.

Dave Korsunsky:  I’m sure there’s a lot of people listening who have those horrendous spreadsheets, but as we started going through my numbers and you started looking at stuff, you noticed that the only test I’d ever had one was TSH, and I maybe had 2 or 3 of those done over the course of a lifetime. Maybe this was standard physical, etc., and so that was one of the first things you ordered for me, was—was a full thyroid panel and I guess maybe I think it’s important to talk about the components about the full thyroid panel, also important to address why maybe a lot of conventional doctors only ordered TSH but in any event that was my situation. So as soon we ran the full panel, there were a few things that—that you noticed and that you immediately picked up on. The first is you noticed that TSH actually looked good. It was great actually in range, perfect. But when we looked under the covers a little bit, we noticed, first of all T4, also excellent and—and you were educating me on all these numbers.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  I had no idea what any of this stuff meant as a patient and—and you sat down with me and took me through this whole panel.

Dr. Justin Marchegiani:  Right.

Dave Korsunsky:  And you said, “Hey, T4 is the start of the whole cascade.”

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  That never looks good but then you noticed my T4—my T3 was incredibly low, out of range low.

Dr. Justin Marchegiani:  Right.

Dave Korsunsky:  And my reverse T3 was out of range high.

Dr. Justin Marchegiani:  Yes.

Dave Korsunsky:  And everything else was fine. So that was my situation and then we started working on it and—and we can talk about the treatment protocol later but maybe you can just get into a little bit more about—first of all what are components of the full thyroid panel?

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Why it’s more important to get that, besides just TSH, and even how people can get that if—if their doctor won’t do it for them.

Dr. Justin Marchegiani:  Right, exactly. So you can use Heads Up Health and just kinda plug your data in there to help keep track of it. Anyone that’s really doing their thyroid testing, they can use that as a technology to help track it and then compare it to sleep or maybe their carbohydrate levels, right? You could plug it up to MyFitnessPal, one of these apps, and then see how your carbohydrates and/or your insulin chart with your thyroid hormone.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  But starting off here, we kinda have the domino rally of our thyroid hormone cascade, meaning the first block that falls over is TSH. Now TSH is a brain hormone so a lot of people really get wrapped up in TSH being too high or too low, but it’s a brain hormone. It’s—it’s not quite like measuring your thyroid hormone. It’s very indirect. So TSH is looking at how the brain is yelling or talking to the thyroid. The whole analogy is if the thyroid’s not producing enough thyroid hormone, it’s like someone across the room that can’t hear you, you instinctively raise the volume of your voice, which is because the thyroid is on the lower side, right? Lower thyroid function, if someone can’t hear you, you raise the volume, the thyroid raises the volume of TSH and just like if you were in a library and—and it’s really quiet and they’re really close to you whisper and you lower the volume because it can—it’s where the thyroid or the person is very receptive to your voice. So think of your thyroid, kinda in those analogies. So TSH too high or too low can mean issues. The problem is if you’re waiting for the thyroid to be assessed and you’re looking at the TSH, it can take a very long time. Some even say 8-10 years to assess the thyroid properly by looking at the TSH because it’s a late stage indicator. It’s not the thyroid, it’s the brain. So if you’re looking and waiting for the thyroid to get assessed, it may take a while, and not to mention it’s—it—either the cut-offs for the reference range are pretty high. I mean, typically in the East Coast it’s gonna be about 5-1/2 on the TSH. In the West Coast, it’s gonna be a 4-1/2 on the TSH, where once it gets to that height, we call that hypothyroidism because the brain’s having to yell so loud that the thyroid is—we’re assuming is not responding well. I’ll just kinda take a breath there.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Any comments on that, Dave?

Dave Korsunsky:  No, I think it makes sense. I mean especially if—if you’re waiting on changes that have to happen in the brain. So help me understand that. That—that’s presumably stuff that takes a lot longer to settle in, and—and it may mean eliminating stress in your life.

Dr. Justin Marchegiani:  Yeah, sleep.

Dave Korsunsky:  It may mean dietary change. It may mean–

Dr. Justin Marchegiani:  Uh-hmm.

Dave Korsunsky:  Also the things–

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  That—that first have to show up at a—at a brain level, like at a neurotransmitter level or at some level in the brain. So that has to happen first before you see change in thyroid. Is that right?

Dr. Justin Marchegiani: Yeah, so when we look at TSH, it can be a really good indicator if something’s really high of diagnosing or picking up hypothyroidism.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani:  Now, the conventional range 4-1/2 on the West Coast, 5-1/2 East Coast, I like it to be around 1,

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Definitely 2-1/2, 1 to 2-1/2 is a pretty good, what I call functional range for the thyroid. That’s a good starting. Again the—where it gets fuzzy is when you start supporting someone’s thyroid because they need thyroid with thyroid glandular or hormone, most docs are basing the treatment off of the TSH.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Not a good way to do it because the brain is very sensitive. It’s more sensitive to thyroid hormone than the actual peripheral receptor sites. So my analogy for the patients is, go outside on a hot day and figure out the temperature by touching the sidewalk. Well, the sidewalk conducts heat much higher than the air, so it’s gonna be a lot hotter.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  I.e., the TSH may respond more sensitively because of the receptor sites, just like the sidewalk would be hotter or be more sensitive to heat than the air. So that’s step 1. Step 2 is then looking at the T4 hormone which is what’s made by the thyroid. So TSH comes down, talks to the thyroid, the thyroid goes through this process called deiode— deiodination where it’s adding and building thyroid and tyrosine and thyroglobulin molecule to build this thyroid hormone, alright? Vitamin A, copper, zinc, magnesium, selenium are also involved in those processes. Vitamin A as well. And–

Dave Korsunsky:  So that’s why you got me on a selenium. Part—part of your treatment then was—was adding some of these supplements in at some point.

Dr. Justin Marchegiani:  Uh-hmm.

Dave Korsunsky:  is that right?

Dr. Justin Marchegiani:  Yeah, exactly. Iodine can be really important, too. You just gotta be very careful with iodine because a lot of people that have thyroid issues, it’s autoimmune in nature. It’s the immune system attacking the thyroid gland. So you gotta be careful because more iodine can be like throwing gasoline on the fire.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So you gotta be careful in the beginning. I always favor giving selenium in the beginning over giving—over giving iodine as well just because of that inflammatory mechanism. So–

Dave Korsunsky:  Yeah, that’s where you started me off. You started me with selenium and then we added the iodine then later.

Dr. Justin Marchegiani:  Yeah, exactly. So we have our T4, right? We make that through this whole iodination process. Then we convert it or we activate T4 to T3. So when we look at T4, we like our T4 Total being around 6-10, that’s a pretty good range for T4 Total, and T4 Free about 1-1.5 is a pretty good range. Again, go over Heads Up Health to get all these ranges more in depth.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  We then cleave off, right? This is part of the deiode—the—this is the 5-prime deiodinase enzyme, that’s selenium-based, that now cleaves off the iodine process. So it’s iodination is what makes the thyroid hormone then de iodinate, we pull an iodine, we—we grab an iodine off. So instead of being T4, now it’s T3. There’s 3 iodines now and we activate T3 which is the active thyroid hormone. So that’s what’s really having the whole metabolic reaction in the body, increasing our temperature, increasing metabolism, energy, heat, temperature and the selenium enzyme’s really important into that. And when you go on Heads Up, you’ll see T3 Free, we like above 3, you know, above 3-3.8, 3.4, you know, 3.8, 3.4 is fine, pretty good, right in that top 25%, top third of the reference range is great. 3.0 to about 4 is fine and that’s for T3 Free. And T3 Total, we like above 100, 100-130 is fine, and again we fine tune that with objective temperature testing, making sure the temperature is looking well. So typically 97.8 to 98.2 if we’re looking at the armpit or 98.2 to 98.6 if we’re looking at the mouth is a pretty good way to assess that.

Dave Korsunsky: Uh-hmm.

Dr. Justin Marchegiani:  And we’ll do that in the morning before we get up and we’ll do it in the afternoon before lunch, because if we increase metabolism, we’re thinking that that’s gonna spill over into objective symptoms like energy but we’ll also see it as heat in the temperature.

Dave Korsunsky:  Yup. So I remember when we’re working on Heads Up, you said, “Dave, you need to have a place to track basal temperature as well.”

Dr. Justin Marchegiani:  Yes. Yes.

Dave Korsunsky:  And that’s part of what you’re doing. Do you use that to diagnose or to zero in on—on thyroid health?

Dr. Justin Marchegiani:  it’s a good indicator to look at side by side. The problem is a lot of people have broken thermometers, and I’m just—I see people coming back with 95 on their temperature and it’s just like they have no—you know, they’re feeling better. Their temperature’s up and then when you tell them to get a new thermometer, and it’s better. So you know, I don’t put too much stock in it, but it’s nice to see it–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  When it starts to change and move in the right direction and it correlates with symptoms and it does that a lot.

Dave Korsunsky:  I know that when you were helping me along those lines, it was specifically recommended to use a mercury-based thermometer, and in that one time you had those on your website and they are—they’re getting increasingly harder to get, so is that still something you sell on your site?

Dr. Justin Marchegiani:  Yeah, I have a couple right here. I’m gonna throw them up on screen. I actually have 4 right here.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  I used to recommend more of the mercury. The problem was I actually dropped a couple and I was just like, “Damn, it’s too dangerous.”

Dave Korsunsky:  I did, too.

Dr. Justin Marchegiani:  And so it’s just—I just said, “You know what, even though it’s —it’s accurate, nice. It’s just not worth the potential of dropping it and having the toxicity of having to clean it up.” So I went away from it just because I’ve met some accidents.

Dave Korsunsky:  Sure.

Dr. Justin Marchegiani:  So what I typically use now is just the highest ranked fertility digital thermometer on Amazon. That’s measured to a 100.

Dave Korsunsky: Cool, yeah, it’d be good—yeah, it’d be good to get that model if you have it. I know, I’m going to get another one.

Dr. Justin Marchegiani:  Yeah, I—I have it in my store over at It just links to Amazon and–

Dave Korsunsky:  Got it. Yup.

Dr. Justin Marchegiani:  And in JustInHealth approved products and then my thermometer’s there. But it’s just the highest ranked fertility digital. Not just the digital but a fertility one because fertility has to be more accurate than—than not because of the nature of hormone testing in temperature.

Dave Korsunsky:  Yup, good.

Dr. Justin Marchegiani:  So that’s where I’m at now. So I do like temperature. It’s nice for patients to see it, to feel it. Also with the temperature testing that’s pretty cool is you can get a window into how the adrenals are functioning, too, because if your temperatures are varying greater than 0.3°F per day can be a really big sign that the adrenals are overtaxed.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  So one of the things we see as people’s thyroid and adrenals get healthier and better, their temperatures get warmer and they’re more consistent. Warmer and more consistent means healthier thyroid and healthier adrenals.

Dave Korsunsky:   Yup, okay, that’s all good. So what’s on the rest the panel? I know there’s a bunch of other stuff that’s included in—in the full thyroid panel where—we’re slowly working our way through it here.

Dr. Justin Marchegiani:  So TSH, we already mentioned.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani:  The T4 Free and Total. Again, the Free represents about 2-5% of the hormone level.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  The Total represents the balance.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  T3 Free and Total.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  T3 uptake. What’s being absorbed and taken up by the receptor sites.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  We like above, you know, upper 20s, 28 to lower 30s, 32, 33, 34 is fine.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  We also like to look at reverse T3. Now this is important because this was something that came up on your test.

Dave Korsunsky:  Right.

Dr. Justin Marchegiani:  You had good levels of T4 but then you weren’t converting downstream to T3, right? We had this high level–

Dave Korsunsky:  Exactly.

Dr. Justin Marchegiani:  Of reverse T3 and just, you know, a sub-clinical low level of T3 but it was me—really going downstream to RT3 or reverse T3.

Dave Korsunsky:  Exactly. Yup.

Dr. Justin Marchegiani:  And reverse T3, it’s like putting—it’s like putting blanks in your gun. You fire the gun off, you hear the noise but no bullet comes out. You got this blank that’s sitting in that thyroid receptor site. It’s supposed be like T3 but it doesn’t quite have that metabolic property so to speak.

Dave Korsunsky:  So do you—do you see that a lot, Doc? Where there’s—where that conversion is just not happening, right? And—and what are the first things you think of when you see that the T4 to T3 conversion is just not uprating right?

Dr. Justin Marchegiani: Great question. So the first scenario, if T4 to T3 is not converting well but we see reverse T3 going high–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  You know, we always think selenium and we always think stress.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So then when we look at stress, we’re making sure the diet’s good, sleep’s good. We’re looking more at the adrenal to make sure the adrenal function is good as well, and you know, making sure practices of meditation, the right amount of exercise are good, not overexercising or underexercising, keeping all the bad foods out, and then we’ll even use things like selenium to help lower reverse T3 and even things like milk thistle to lower it as well to help clear it out because a lot of that reverse T3 is made by the liver so we can clear it out but we gotta fix the underlying reason why it was getting converted there to begin with. That’s the key.

Dave Korsunsky:  Yup, makes sense. And I think in my case, it was just a combination of things exactly like you described. It was really a stressful time for me personally. You introduced the selenium supplement. I also at that time started moving over to a much cleaner diet, more of a Paleo based diet, coming off of just a standard diet. So I think all of those things helped and then what we were doing was we were—were running the thyroid panel. You’d—you’d give me my treatment protocol in my Word document. I’d—I’d get the intervention. We’d run the thyroid panel 3 months later and we’d—we’d track the numbers and I could get engaged in that process and one of the things—one of the reasons I build Heads Up was because I genuinely believe that when the patient can get engaged with their numbers and understand what they mean, it helps. It just gets—you get better results and so we saw it, right? We’d—we’d run the test every 3-6 months and we’d look at the new numbers together and I just love that.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  It was really, really effective.

Dr. Justin Marchegiani:  Yeah, and I think we also did—we did some milk thistle as well to help. If I remember correctly you were doing those Insanity workouts, an hour–

Dave Korsunsky:  Yeah, I just crushed—I had crushed my adrenals.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Like just—I was overtraining. I was in a stressful situation work-wise. You know, my diet wasn’t great. You know, having too much fun on the weekends.

Dr. Justin Marchegiani:  Yeah, you were doing that.

Dave Korsunsky:  Yeah. All—all of the ingredients were there for a—for a disaster but luckily we were able to intervene and—and get things course corrected.

Dr. Justin Marchegiani:  Yeah, I remember you definitely made some changes with your diet. You were getting more—more quality fats, better quality fats in there as well that was helping out a lot.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  And then we got you on the adrenal support, too, which I think made a big difference. And I know we also had some gut issues that came up–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Down the road, too, that I think as we addressed those we had improvements there, too. I think maybe a Klebsiella or some kinda bacterial overgrowth.

Dave Korsunsky:  Yeah, these were all important pieces that we had to work on.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Actually, another—another big one for me was actually just racking my sleep. I know it—it sounds silly but even just getting some basic metrics from like a wrist worn device, a FitBit. In my case, I’m wearing one on my wrist now. Just having some data about when I was going to bed and when I was getting up, and how much sleep I was getting on a regular basis. Until you see the numbers, I didn’t realize that I was maybe 6 hours not getting enough and when you’re overtraining and not getting enough sleep and—and you start to see all of that, and you start to see the information that I’m getting from you that are—that are suggesting lifestyle-related stressors, having that that sleep information was—was really, really helpful and it brought a whole new awareness to my sleeping patterns and help me try to move to a—a more natural sleep-wake cycle instead of midnight or one. For example, going bed at 10 and it takes some time to get your body back on a—on a more normal cycle but there’s so much data we were collecting that was helpful along the process and it’s just part of what we wanted to do in Heads Up is give people a place to track it all, but sleep was really important in addition to all of the things that—that you mentioned that we fixed as well.

Dr. Justin Marchegiani: Yeah, absolutely. So kinda just coming back in line here. We talked about the thyroid conversion piece. Sleep really helps because sleep can help curtail cortisol levels, can also help maximizing growth hormone levels which are important for being anabolic and repairing tissue.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  And also can help with recycling neurotransmitters, right?

Dave Korsunsky:  Yup, and—and there was al–

Dr. Justin Marchegiani:  Yeah, go ahead.

Dave Korsunsky:  There was also some antibodies on that thyroid panel–

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  That you always look at as well.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  You were always looking for autoimmunity.

Dr. Justin Marchegiani:  Uh-hmm. Yes.

Dave Korsunsky:  So maybe what—we could talk about that for a bit.

Dr. Justin Marchegiani:  One step ahead of me.

Dave Korsunsky:  Okay.

Dr. Justin Marchegiani:  Let me just—let me just come full circle on the thyroid conversion piece.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Almost there. So the sleep piece is really important.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  The selenium is really important for all the nutrient levels in helping to convert that downstream.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Also insulin resistance, a lot of people that have high levels of insulin, they may have this hard time converting thyroid hormone or activating it T4 to T3. If they have high levels of stress hormone that may help as well or hurt the conversion. If they’re really have—almost low levels of cortisol because of HPA axis dysfunction.

Dave Korsunsky:  Yup. That–

Dr. Justin Marchegiani:  Where the brain is numb talking to the thyroid that can really help decrease that conversion, prevent the T4 from going to T3. Certain nutrients like copper and selenium and zinc. Also high levels of mercury can also be a big factor. So those are kinda just some—some good generalizations there. Now getting to your next question that you asked—perfect timing was was the thyroid antibodies. So, so many of the thyroid—so many thyroid conditions are actually brought upon by autoimmunity, meaning your immune system is making specific antibodies that are attacking the thyroid gland.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  One is known as TPO or thyroid peroxidase enzyme. It’s an enzyme that puts thyroid hormone together and then the other one is the thyroglobulin antibody which is the surface protein of the thyroid. And if you’re making antibodies and you’re tagging the thyroid then you’re gonna be attacking it and breaking it down and these B cells and B lymphocytes are gonna be getting in there and attacking it.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  And that’s not good because as it’s being attacked, it’s like stag—stabbing a knife into it and thyroid hormone drips out.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So your TSH and thyroid hormone levels can be off for a long time. You could have hot flashes and anxiety, and tachycardia and be sweating a lot and that’s a really good sign that you’re starting this whole autoimmune progression and again, conventional medicine will not get to the root cause. They ignore the immune mechanism, i.e., the antibodies. They forget what’s driving it and they just say, “Here’s Synthroid,” and they just wanna get that thyroid TSH back nice and low again but we’re not getting with—with the simple things like the gluten and the grains and the inflammation and the insulin resistance and the infections that are so commonly addressing it.

Dave Korsunsky:  Yup. I know there’s a lot of people really close to me that are dealing with autoimmune conditions and so that’s something that—that comes up all the time. You—you’ve worked with many of those people directly.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  And have helped them–

Dr. Justin Marchegiani:  Yup.

Dave Korsunsky:  Make the changes necessary to—to work on those antibody numbers specifically.

Dr. Justin Marchegiani:  And I think that’s why you did really well off the bat, too, because one of the big changes you made, because you were like just starting to get into Dave’s Bulletproof Diet and you were–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Cutting out grains and really cutting out mycotoxins.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  And you were eating more fat so you were stabilizing your blood sugar and getting your insulin better. I think that really helped with calming down any potential autoimmunity that may have been present.

Dave Korsunsky:  Yeah, and if I think back to some of the things that were going on at that time, it was—it was definitely going on to the Bulletproof Diet at that time that helped a lot. That helped with a lot of the blood sugar stabilization.

Dr. Justin Marchegiani:  Big time.

Dave Korsunsky:  And you mentioned that that’s one of the reasons there—there may be T4 to T3. working on stress, getting the GI stuff fixed up. You ran the tests to do that. You also ran the adrenal test which I think just are more indicative that there’s–

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  A stress—a stressor in the system whether it’s physical or mental, so we worked on that and then some—some supplements to help. Selenium being the—the most obvious one, and all of those things worked and then we re-ran the numbers and it was—you know, it took a while. Maybe this was a 12-month process, 18-month process where we worked everything out, but it was great. And there’s that—that functional medicine type process where you’re doing what we just described. I mean, how common is that in—in your practice with patients you’re seeing?

Dr. Justin Marchegiani:  Well, it’s really common especially the autoimmune piece because people are stressed. They’re not eating good—good meals. They’re insulin resistant because of the suppressed immune system of all the things I’ve mentioned, opportunistic infections kinda take hold as well. So that’s a multi-layer kind of system that we’re looking at so you really gotta wade through it systematically so we can get to all of the key lynch pins.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  If you’re just doing one thing to systematically or symptomatically make you feel better, may not be what kinda unlocks the healing long-term.

Dave Korsunsky:  Yup, makes sense. And so just going back to the—to the thyroid panel, I mean, when we first started working together, you—you didn’t see that in any of my previous lab testing so it’s something you ordered right away.

Dr. Justin Marchegiani:  Yes.

Dave Korsunsky:  Is—is that something you like to do upfront with—with all patients? It’s just to see where those numbers are or is it case by case?

Dr. Justin Marchegiani:  It’s case by case. It depends what symptoms are present off the bat. If we’re going to the person’s history and there’s lots of energy issues and lots of mood issues like let’s say hair loss, outer third eyebrows, let’s say cold fingers, cold hands, tingling, numbness, things like that. We will definitely order a thyroid. If we don’t have a lot of the hair loss and the cold hands and cold feet-

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Stuff off the bat, we typically stick to the adrenals first, see how good or bad the adrenals are and then I have them do temperature testing over the next month and we monitor through there.

Dave Korsunsky:  Cool.

Dr. Justin Marchegiani:  And if symptoms are improving on the adrenal protocol and their temperatures look decent, we won’t necessarily jump to the thyroid off the bat. If we’re not quite getting the improvement we’re looking at and temperatures are low, then we’ll go and we’ll dig in to that thyroid.

Dave Korsunsky:  Yup, that makes sense. And I’ve, you know, personally for the last 8 months I’ve been on a–on a Ketogenic Diet and have been doing really well with it but I’d love to run another panel to see how my numbers stack up and that kinda leads into my next question which is a lot of people when they go the doctor, they—they may not be able to get the full panel ordered for—for various reasons. There has to be a diagnostic code of something like that.

Dr. Justin Marchegiani:  Oh yeah.

Dave Korsunsky:  So, I know you have the panel available. Is that one of the panels people can get from you and just go to Lab Corp and get it? I realize you gotta pay out of pocket, but sometimes that’s just the most—the quickest and easiest way instead of having to negotiate with—with your doctor.

Dr. Justin Marchegiani:  Oh, yeah. The panel that we have online, the complete thyroid panel in the store, so, click on the Healthy Living Store, you’ll see the lab test button. Click it and look for the complete thyroid panel. And that panel I think it’s about $150 and that’s a complete–

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  You can’t run anything for the most part.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  On your thyroid.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  It’s got all of the thyroid markers you need. Typically if that panel is not covered by insurance, right? That’s over a $1000.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So by just paying cash, you kinda cap—you cap your losses so to speak and that’ll give you everything you need. That’s a really good first line for anyone with thyroid issues. That’ll give you everything you need to—to get a complete picture of what’s going on.

Dave Korsunsky:  Yeah, and I see—I see a lot of people who we communicate with and just a lot of people who are asking questions and stuff who—who may not be making progress as they move to—they make the nutritional changes. They go Paleo. They make the dietary changes. They’ve adopted Keto or some of those principles and they’re not seeing any changes in body composition and so it’s—that’s often something that I think of and are those correlated? Would you start to look at—at thyroid and metabolic if you’re not seeing changes once you make the—the nutritional interventions?

Dr. Justin Marchegiani:  Absolutely. The thyroid can control metabolism, heat and energy, so it’s definitely a place that you wanna look at for sure. When people have their thyroid working better, they tend to be able to have a higher metabolism, burn more calories, burn more systemic body fat which is a really good thing.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  But not all the time. Some people—it’s just, we get their thyroid working better they’re no longer depressed and constipated and their hair starts growing back.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So I see the thyroid kinda being a different—having different priorities, you know, they may not be the priorities that you want so to speak, fair enough. But it’s—it’s amazing we see different things happen and I can’t tell you how much depression and mood changes with better thyroid.

Dave Korsunsky:  Yeah, and—and a lot of the people, a lot of our users who are on Keto actually, it’s a—it’s a small percentage but they do start to report hair loss in some cases and can you talk about when it may be for example a nutrient deficiency vs a thyroid for example? Is it hard to tell? Any thoughts on that?

Dr. Justin Marchegiani:  So you’re talking about looking at the lab work? How can you tell it’s a nutrient issue?

Dave Korsunsky:  Well, let’s say you were dealing with hair loss for example and you mentioned that thyroid could be one option, could it also be jus due to dietary issues, for example?

Dr. Justin Marchegiani:  Absolutely, absolutely. I mean we need protein. They tend to be all connected because if we have a protein issue, well, if we are having a protein malabsorption where it’s affecting the hair, it’s probably affecting the thyroid because we need certain amino acids that would be in those foods to help make thyroid hormone like tyrosine for instance. So if it’s showing up on the gut level, it’s probably gonna eventually make its way to the thyroid level, too. So–

Dave Korsunsky:  So protein specifically in the diet is what—

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  What we’d be looking for?

Dr. Justin Marchegiani:  Yeah, I mean high quality protein. I mean if we have people with gut issues, we’ll use like various collagen peptides and/or free form amino acid products to deliver the protein in a way where there’s no digestion required to really process it.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  That way it gives the digestion some time to relax while we work on fixing it.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  But I never just isolate variables. If I see the thyroid and I see protein and gut issues, we’re gonna fix everything, you know?

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  As we go through body system 1, 2, and 3 and if it’s something we tr—address in body system 1 with the thyroid, meaning where we’d look at ATF or ATM—adrenal, thyroid and male hormones or adrenal, thyroid, female hormones—and we start to see the hair start coming back with thyroid hormone, that’s a great sign.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  And then it may come back as we start repleting nutrients in body system 2 with the gut.

Dave Korsunsky:  Uh-hmm. Makes sense.

Dr. Justin Marchegiani:  So I mean we’ll trace it back afterwards and kinda use this retrospective look at it and say, “Hey, when we did this, that happened more and when we did this, this happened more.” Sometimes you can’t tell because there’s a delay.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  So we try to do our best and just fix what we find.

Dave Korsunsky:  Yup, makes sense.

Dr. Justin Marchegiani:  But–

Dave Korsunsky:  Well, I know I’m due for a full set of labs.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Thyroid panel included and—and you’ll be the first to take a look at them once they’re ready, so yeah, I’ve to get working on that and part of—part of what you were helping me with was—was building Heads Up Health to help people track all of this information.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Particularly when you’re working with health experts outside of the conventional system, just having everything in one place and being able to share it with any doctor you want, so you and I will be working on that together in the near future.

Dr. Justin Marchegiani:  Absolutely and I wanted to touch upon one last thing because I know you’re—we’re really getting out there to the Keto community which I think is great. One situation that I’m seeing is most thyroid conditions, I’d say 99% off the bat, they’re gonna do so much better off the bat especially if they’re coming from a standard American diet going Keto–

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Because that’s gonna help insulin resistance. It’s gonna help this–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Kinda numbness to this insulin receptor where–

Dave Korsunsky:  For sure.

Dr. Justin Marchegiani:  You know, we’re not getting the insulin low enough because these receptors are so numb to get sugar into the cell.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Right?

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Insulin’s the—insulin’s the key. The receptor is the lock and basically the receptor site’s not accepting the key so we have to put—put—essentially push more keys into the hole to get that key out, to get that essentially door open to let the sugar in. So we get this insulin resistance where more keys getting into the cell. So that’s not a good thing because insulin when it’s too high can cause lots and lots of hormonal issues. One of them being thyroid conversion or T4 to T3 thyroid hormone activation. So getting on a Ketogenic Diet is gonna be essential because it’s gonna really get that insulin level down. The only thing is I find sometimes when people are long-term Keto, sometimes we may be get a little bit—we may go a little too low on the insulin and if we add just a small amount of carbs even just 10-20g, it can be enough to get your insulin levels a little bit higher and we see an aid in thyroid conversion. We’ll see T3 go up on the lab work. We’ll see hair—hair improved or maybe even temperature improved but that tends to be when people are Keto chronically or long-term. Everyone’s gonna–

Dave Korsunsky: Yup.

Dr. Justin Marchegiani:  Benefit on off the bat and get a really big benefit. It’s long-term afterwards. We wanna fine tune it and I’m totally non-dogmatic about it. If you can keep at a Keto level or—that’s great. If not, we just up it 10-20g to see how we do. I had a patient just yesterday we upped it about—we add about a quarter of sweet potato at night and a lot of her low thyroid symptoms went away.

Dave Korsunsky:  Makes sense. Yeah, well, I mean this is all good stuff, Doc. I think there’s so many people that need the—the full thyroid panel. Maybe have never had it before or maybe they‘re stuck just where they are in terms of their health transformation. I know it was a huge step for me, just seeing these numbers, figuring out how we address them. I know you make the panel available to people who can’t get it from their doctor which is awesome. Heads Up Health has got the software to help people track all of this stuff especially if they’re getting data from different labs and they wanna manage it all in one place. So hopefully there’s some people who can use the information here, get their own panel run and it may be an important diagnostic piece for them as they work on their own health goals.

Dr. Justin Marchegiani:  Absolutely. I’m gonna put the complete thyroid panel in the link below so if you’re interested in it, feel free and click on it. That’ll be a great way to access that panel.

Dave Korsunsky:  Yup, and I can include some information for people who want to start getting all of their health records organized using Heads Up Health. There’s a couple videos we put out there that just showed how to integrate all the medical records, basal temperature, macro nutrients so I can send that along as well.

Dr. Justin Marchegiani:  Great. Any other questions, comments or concerns, Dave?

Dave Korsunsky:  No, this was great. I see this topic come up all the time. So I’m glad we were able to address it and—and provide some information on what the full thyroid panel is and—and what the markers are and some of the things you can start doing to—to fix it.

Dr. Justin Marchegiani:  So anyone listening to this and kinda, you know, has all these labs in front of them and not quite sure you know what to do with it, get over to Heads Up Health. Get it integrated in there so you can start seeing patterns and then it’ll be really fun as you go forward tracking your labs. You’ll be able to see trends that you may have not seen otherwise.

Dave Korsunsky:  Yup, sounds great.

Dr. Justin Marchegiani:  Alright, Dave. Great talk! You have an awesome day.

Dave Korsunsky:  Yup, likewise. Thanks, Doc. Take it easy.

Dr. Justin Marchegiani:  Thanks, bye!


Thyroid Test:
Heads Up Health:

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