In this episode, Dr. Justin Marchegiani speaks with Dr. Jeff Moss about selenium, mercury exposure from fish, iodine, potassium, electrolytes, and acid-alkaline balance from a functional medicine perspective. They discuss why seafood may be unfairly blamed for mercury issues when the selenium-to-mercury ratio may be the more important factor.
From a functional medicine perspective, this conversation highlights how nutrients like selenium, iodine, potassium, magnesium, and electrolytes affect thyroid function, antioxidant pathways, brain health, detoxification, and overall metabolism.
They also emphasize the importance of looking at the basics first, including diet quality, protein intake, hydration, electrolytes, sleep, exercise, and patient symptoms instead of only chasing lab numbers.
Selenium deficiency occurs when the body does not have enough selenium to support thyroid function, glutathione peroxidase activity, antioxidant defense, and mercury binding. Selenium is especially important because mercury can bind selenium tightly, reducing its availability for the brain, thyroid, and detoxification pathways.
• Selenium may help buffer mercury exposure from seafood.
• Fish may provide cognitive benefits due to DHA, EPA, protein, iodine, and selenium.
• Mercury toxicity may depend more on selenium status than on mercury alone.
• Iodine dosing should be individualized, especially with Hashimoto’s or Graves’ disease.
• Potassium is an overlooked electrolyte that supports cardiovascular and metabolic health.
• Urine pH can be a simple tool for evaluating low-grade metabolic acidity.
• Dr. Moss emphasizes treating the patient, not just the lab numbers.
Dr. Moss explains that mercury binds strongly to selenium. When selenium is available, it may reduce mercury’s ability to bind sulfur-containing compounds like glutathione and other important proteins.
The discussion challenges the idea that fish should be broadly avoided because of mercury. Seafood that contains selenium, DHA, EPA, iodine, and quality protein may offer cognitive and overall health benefits.
Before focusing on exotic lab markers or genetic concerns, Dr. Moss emphasizes fundamentals such as food quality, protein intake, carbohydrates, hydration, electrolytes, sleep, and exercise.
Dr. Justin Marchegiani: [00:00:00] Hey, guys. It's Dr. Justin Marchegiani. Welcome to the Beyond Wellness Radio podcast. Feel free and head over to justinhealth.com. We have all of our podcast transcriptions there, as well as video series on different health topics ranging from thyroid to hormones, ketogenic diets, and gluten. While you're there, you can also schedule a consult with myself, Dr.
J, and/or our colleagues and staff to help dive into any pressing health issues you really wanna get to the root cause on. Again, if you enjoy the podcast,
Dr. Jeff Moss: feel free and share the information with friends or family, and enjoy the show.
Dr. Justin Marchegiani: Hey there, Dr. Justin Marchegiani here. Today, I got Dr. Jeff Moss from Moss Nutrition here in the house.
Today, we're gonna be talking about all things from mercury in fish to iodine to acid/alkaline balance, so really excited to have Dr. Jeff Moss on today's podcast. Dr. Moss, how we doing today?
Dr. Jeff Moss: Good. Thank you so much for having me. Excellent. Look forward to talking to your patients-
Dr. Justin Marchegiani: Yeah … and the
Dr. Jeff Moss: people you serve.
Dr. Justin Marchegiani: Absolutely. Excited to have you here. So we were talking in the pre-interview about mercury in fish and the [00:01:00] selenium-to-mercury ratio, and should fish be something that we eat or avoid? So you were really diving into the literature on that, some of the benefits, some of the pros and cons. I wanna just kinda let you go into this topic here for a few.
Dr. Jeff Moss: Yeah. The central issue which I really started looking at about two, three months ago was, are, is sea… And I emphasize seafood, as opposed to freshwater. Separate discussion I'll get into shortly. Are fish getting a bad rap? We all know the central dogma that has been going on probably for two or three decades now, that ingestion of fish due to the mercury issue is questionable, and for pregnancy, it's a non-starter.
You basically, you're condemning your baby to some type of decre- a significant decrement in brain dysfunction. And so I really was [00:02:00] curious. I must admit, okay, everybody's saying it. I hear it all the time. My peers say it. The, quote-unquote, “functional medicine experts” are all saying it. So they know much more than me.
Okay. Accept it. Then two things happened. Actually, I remembered something I read and wrote about, and it's been long ago. I forgot about it, quite frankly. It's 20 years ago. And at that time, I started reading the work of two authors, two researchers Raymond and Ralston, and they're still publishing papers.
And they started writing about this issue probably in the '90s, and basically saying that fish are getting a bad rap. And their position being is that fish have a significant amount of selenium, and the chemistry of that i- [00:03:00] is very simple, quite frankly. First of all, why does mercury make you sick? All this all this hype we hear about how horrible it is, it's actually quite simple.
And really all it does is it binds two things. Number one, it binds sulfur, and that's… It's a pretty big deal because you bind sulfur, that takes your glutathione out, and of course proteins, all kinds of things involve sulfur as a molecule. Okay, detoxification pathways. All right. But it also binds selenium.
Okay, so what? It's very interesting that over the years i- in creating our company, I've liked to focus on the nutrients that kind of fall through the cracks. Like any other industry, the nutrition industry is an industry of fads, [00:04:00] and marketing, no different. For example it's finally starting to settle down, but about five, 10 years ago, vitamin D cures everything.
That is the answer to all your problems, vitamin D. Not minimizing the impri- importance of vitamin D, very important, but even now the Endocrine Society is saying, “Do you have to test everybody on vitamin D every year?” Probably not. Okay, so things come and go. Selenium, for whatever reason, is falling through the cracks.
Getting back to the work of Raymond and Ralston, what they said is that the primary harm from mercury primarily is it binds up sulfur. Secondarily, it binds up selenium, and there's an important difference there. The [00:05:00] bond between selenium and mercury is much tighter, much stronger than the bond between mercury, sulfur and mercury.
So if you have selenium, enough selenium in the system, it'll preferentially take up the mercury and keep it from binding to sulfur- … the glutathione, et cetera. Now, there is controversy in terms of what happens to that selenium-mercury complex. Raymond and Ralston said in their initial papers that it basically just sits, does nothing.
Completely inert. It'll just sit in your body until you die. I've read some literature that says it is actively excreted as a mercury-selenium complex. Either way- It's inert. It- it's not harmful to h- health at all, except for one fact, important factor, and that is the fact that [00:06:00] when the mercury binds up selenium, glass half full is the mercury's gone.
It won't harm you at all. Glass half empty, now you don't have the selenium, which is important not just for, important for an- an antioxidant, glutathione peroxidase, thyroid function. And so when the mercury binds up selenium, you have less selenium available for these other important functions.
Solution, of course, is simple. You just eat foods that are high in selenium or, God forbid, you take a selenium supplement. Oh my God, we're gonna recommend a supplement. And this is what they pointed out. But by virtue of the fact that selenium takes out mercury, generally speaking, even though, yes, there is a decrement to health in terms of losing the selenium, the overall effect is uniformly positive.[00:07:00]
And they quoted a very fascinating set of studies which seem to be replicated subsequently. This paper I'm talking about was written about maybe twen- 20 years ago, and they looked at a study of two populations. Both were… one was in the Seychelles Islands, which is off of East Africa, and then the Faroe Islands, which I believe is in nor- North Atlantic.
And both had very high fish-eating populations. Both demonstrated in their children and pregnant women very high levels of mercury. The ones from the Faroe Islands, the mercury, as you… was most people would expect, showed a correlation between decrement and brain function, particularly in children.
Seychelles Island, just the [00:08:00] opposite. Significant levels of mercury in the children. In fact, even higher- Wow … than in the Faroe Islands. But eating fish was uniformly correlated by improvement in cognitive performance. They said, “Why is that?” In the Faroe Islands, they were eating pilot whales.
Dr. Justin Marchegiani: Much higher in mercury, right?
Dr. Jeff Moss: Very low, high mercury, but very low in selenium.
Dr. Justin Marchegiani: Yes.
Dr. Jeff Moss: Seychelles Islands, they're eating typical predator fish, tuna, blah, blah, blah, salmon, et cetera. Predator fish, which are very high in selenium in addition to mercury- And significant correlations with positive outcomes. Their conclusion was, is that for all of the hand-wringing and brow-beating about mercury, their position, and it has not changed in subsequent papers, that we do not have a mercury problem [00:09:00] in our society.
We have a selenium deficiency problem in our society. Now, what is the one downside is, as I mentioned, that mercury binding… selenium-binding mercury, glass half full. Mercury's not available. Glass half empty, selenium's not available for thyroid glutathione peroxidase solution. Just take a selenium supplement, 200 micrograms a day.
This research I did start some checking, and going fast-forward now to February of 2024. Quite frankly, I talked about these s- Ra-Raymond and Ralston papers, wrote about it, talked about them at Bridgeport, eh, just kinda nobody really seemed to care. “Jeff, you're just an outlier. We all know mercury is from fish is bad.
What do you know? What do they know?” I just kinda filed it away. And then I [00:10:00] read this paper in the American Journal of Clinical Nutrition in February of two… of this year, and they showed a study done on elderly populations where looking at fish intake as it correlates to cognitive function.
And they found in almost every measurement of cognitive function that fish correlated with positive outcomes in terms of cognitive performance. So the authors ask, “Why is this?” And these are populations ranging from the 60s, I think, into the 80s, so several different populations. Positive correlation. So number one, of course, they looked at the fish oil, EPA, DHA.
Correlation. But they made a point that we cannot s- explain the results entirely on fish oil. All right, what might it be? Could be the protein. All right. But they said the missing link [00:11:00] here to explain the positive correlation is the selenium. So this really cau- gee, I haven't looked at this issue in a while.
Maybe it's time to reinvestigate, look at more current research. Number one, I started to really look and fi- try to find negative studies on fish and cognitive performance in relationship to mercury content on younger populations, children, pregnancy, older populations I really had trouble finding even one that indicated, and I'm saying now well done, published, peer-reviewed studies, not something I looked up on Google.
I'm talking about well-done studies, reputable journals. I had a hard time finding even one study that really showed a negative impact. [00:12:00] And then… But I found it interesting that this… The bad rap on fish persists. I wrote about… It was an interesting article in New York Times. Got a lot of publicity. You probably saw it.
I'm sure many people saw it. And it was an article about the cognitive issues of one of the candidates for president, Robert F. Kennedy
Dr. Justin Marchegiani: Jr. Oh,
Dr. Jeff Moss: yeah. And he was having some cognitive dysfunction, and of course what got a lot of attention- Worms, right? Yes, he had brain worms. And actually, y- at first you think, “Oh, here we go.”
And there was some legitimacy to that. He may have picked up when he's traveling or whatever. Yep. But then… But no, that's not the real reason. The real reason according to the experts quoted in The New York Times article, none of whom actually examined Kennedy, it's obviously the fish. Exactly.
Dr. Justin Marchegiani: [00:13:00] Yep.
Dr. Jeff Moss: It's all those tuna fish sandwiches I ate. That's my problem. And then I started reading further on in the article. He's far from benign in terms of his health issues. He was a drug user. He had hepatitis C, high stress. And then towards the end of the article, a little throwaway statement caught my attention, that he had some type of a spasmodic disease of the larynx, I believe, vocal cords.
And he got an implant, a titanium implant. And I thought to myself maybe I should look up titanium implants and the impact on brain health.” Sure enough, there was a study on it. A significant decrement in brain health related to titanium implants. The experts quoted in the article were unanimous.[00:14:00]
The most important factor is the tuna fish sandwiches. Gotta avoid fish. That was the theme of the article by all the experts. And quite frankly, from what I can tell, it's just not supported by the research. And really to me that's the moral of the tale, that fish have gotten a bad rap. Now, one other caveat I emphasize and it's and Raymond Ralston and several other researchers say the same thing. This is true for seafood, which is uniformly high usual predator fish, I should say. Again, tuna, et cetera.
Dr. Justin Marchegiani: Correct. Yeah.
Dr. Jeff Moss: Uniformly high in selenium. The same can't be said for freshwater fish, where the content of selenium will be highly variable.
China, for example, is well known to have very low selenium levels in their soils, which reflects out [00:15:00] into the fresh water. Higher mercury too, right? ‘Cause of some of the excess coal that's being there without being filtered out. True. But again the central issue appears to be, in all these studies, the most important issue in determining mercury impact, adverse impact on brain health, is not the amount of the mercury, it's the amount of selenium.
That is the overall message. So the position is, we have to get off of this more mercury, the worse you are thinking that has been so prevalent to the point of only becoming dogma. Correct. And leading to needless avoidance of certain valuable food sources, and sometimes obsessive compulsive behavior recommended by many, quote-unquote, “experts” in our field and the more allopathic field [00:16:00] about basically living your life around mercury avoidance.
And-
Dr. Justin Marchegiani: So a couple of questions there. You made a lot of good points. I wanna just make sure I break it down. So- Okay … selenium, natural chelator for mercury. Also, it does… It's an important cofactor for glutathione as well, correct?
Dr. Jeff Moss: Glutathione- Selenium is a cofactor for glutathione peroxidase, one of the major antioxidant enzymes.
Dr. Justin Marchegiani: Which recycles glutathione, right? Helps recycle it. Correct.
Dr. Jeff Moss: That is correct.
Dr. Justin Marchegiani: And you also talked about sulfur as well, because sulfur… when you say sulfur, are you referring to like cysteine, L-cysteine, N-acetylcysteine kind of compound? Yeah.
Dr. Jeff Moss: I'm speaking about- Combining … all those are…
You're speaking about amino acid molecules, all of which contain sulfur.
Dr. Justin Marchegiani: And a lot of-
Dr. Jeff Moss: So I'm speaking ex- really collectively, expansively about compounds that contain the element sulfur.
Dr. Justin Marchegiani: That makes sense. And glutathione is a tripeptide consisting of, glutamine, glycine, cysteine, which are- That's right
Many sulfur-rich amino acids. So if we have the glutathione there, then the [00:17:00] mercury isn't a big deal. But also the DHA, EPA fats in those fish provide far more benefit than you would get from avoiding the mercury in the fish, as long as the selenium is there to buffer it, essentially. Is that kind
Dr. Jeff Moss: of the- Yeah.
Research consistently shows that to be true, that avoiding fish due to mercury content- Will be a net negative in terms of overall mental cognitive performance
Dr. Justin Marchegiani: And how many IQ points? ‘Cause we see in the literature going incredibly low with iodine for fetal brain formation lowers IQ. We see excess fluoride in the water in IQ.
We see the DHA fats lower IQ. How many points are we talking about? Five, 10?
Dr. Jeff Moss: Your point's well made. The iodine discussion is a whole separate issue.
Dr. Justin Marchegiani: Yep.
Dr. Jeff Moss: I really looked into this in detail. Number one, there's no controversy in terms of iodine being essential. No argument there. We all know that. The controversy which rages to this day is how much do you [00:18:00] need, and there are camps that vary in how much do you need and how much is excessive, how much is toxic.
Correct. And it's far from settled. You have on the extreme one end that anything above the RDA, 150 micrograms a day, is a risk to health. On the other end, the other extreme, is that it's safe at virtually any amount. And there seems to be, unfortunately, in these, both of these camps, a strong, to me, a strong need to be right.
In other words, that I know best for everybody. And what I have seen is the research… you're a clinician.
I'm a clinician. What's the reality is that no generalization is worth a damn, [00:19:00] including this one. That's the reality. Everybody's different. We cannot generalize in terms of what need is.
The real issue, of course, is risk to thyroid health. The point I have seen in the research is that the thyroid is amazingly resilient to variations in iodine levels. And the reason is explained from a paleolithic viewpoint, is that the hunter gatherer had tremendous variation in terms of exposure to iodine from seasonality or lo- locale.
The goiter belt, the old goiter belt in the Midwest United States. Some populations were eating fish, which is high in iodine in certain times of the year, and then other times of the year, they would have to rely more on plant foods or [00:20:00] land-based foods. So there was a tremendous variation in levels of iodine over time.
And so from an evolutionary point of view, it was suggested That the thyroid has a amazing capability to cope with extreme levels of iodine either going on the low end, it can adjust to that. On the high end, it can adjust to that. But here's the problem. We're talking about healthy thyroids, which in our country sometimes are f- hard to find.
And as the thyroid becomes exposed, particularly to chemical toxins the thyroid seems to be especially susceptible, for example, to some of the chemicals in cigarette smoke, and will lose its abi- its adaptability, if you will, and will become more sensitive to extremes or extreme variations [00:21:00] in iodine levels.
How can you predict with reasonable certainty what level of iodine is right for any one individual? As I've mentioned before, we have the extreme camps that wanna convince that no, nobody should take more than 150 micrograms a day. The other camp, everybody should be taking 12, 14, 30, 50, 100 milligrams a day, and we have conclusive proof.
As a clinician, from a clinician's point of view, what I have found, and the clinicians I've talked to in the trenches, who know a lot more than me, have said it's very difficult to really predict with any degree of accuracy. Doing iodine testing can be helpful. A spot test for iodine is really not useful because the levels vary throughout the [00:22:00] day.
24-hour urine is better. Problem with 24-hour urine is trying to get a patient to collect urine for a whole day. N-not easy.
Dr. Justin Marchegiani: And when you do the urine, are you challenging it? Are you giving a certain amount to see what's excreted versus what's taken in?
Dr. Jeff Moss: Depends on who you talk to.
Dr. Justin Marchegiani: Yeah.
Dr. Jeff Moss: I'm familiar with the urine the chall- the iodine challenge test, and that the other side, the extreme people on one side.
The classic the classically accepted lab test is no, it's not a challenge test, it's just you're doing 24-hour urine to s- check out the status. Like I said, somewhat impractical. So the people I've talked to that, to me, the most practical sense is you have somebody who needs iodine, don't make any assumptions.
Start out with a product that can be titrated a- as little as possible. That's why I personally like the liquids, where you can titrate-
Dr. Justin Marchegiani: I agree
Dr. Jeff Moss: So [00:23:00] start as low as an RDA level, a drop or maybe a drop or a drop every other day at 150 micrograms. See how the patient does. See if they have any thyroid related, excess iodine related symptomatology, agitation, anxiety, et cetera, rapid heartbeat.
If the patient seems to be doing fine from a thyroid standpoint, you stop there. But if you feel they do more or need more, you keep on titrating up very gradually until you find out that sweet spot where the patient seems to be seems to be doing well. The only one exception I saw to that was the work on fibrocystic breasts.
Iodine, five to six milligrams a day seemed to be reasonably helpful with very little downside. But other than that, in terms of a consensus I really could not find a consensus. I looked for research that I want to [00:24:00] find the level at which nobody has ever demonstrated side effects, ever. The only thing I could find that was 100% was 150 micrograms a day, the RDA.
And then there was some, which I thought was misleading publications that talked about that we need to replicate Japanese intake.
Yep. And the quote out there was the Japanese taking 12 milligrams a day. Yes. The healthiest people on earth. There is a well-known publisher or a researcher, clinician, Ellen Gabay- Yes
who really looked in this in detail and his articles are available. I think they were published in Townsend Letter a few years ago, where he found that the way they came up with this 12 milligrams a day in the Japanese was based on some flawed mathematics. And there was papers published, [00:25:00] actual pub- papers published by the Japanese about 10, 15 years ago.
The actual intake of the Japanese was about, I think, one and a half milligrams a day. Yes. And with that, was reported in the Japanese literature that the Japanese, yes, many do have a high iodine intake due to their intake of seafood. They have a significant hyperthyroid Graves' disease problem in Japan due to high intake of seaweed.
And so the idea that the Japanese taking 12 milligrams a day and everybody lives happily ever after is just not supported by the Japanese research.
Dr. Justin Marchegiani: Correct. I'm gonna provide a little bit of insight on that too on my side. I have a book coming out this summer called “The Thyroid Reboot.” So I looked at your iodine series from 10 to 15 years ago, which I recommend every clinician go back and look at that 'cause you really did an exhaustive review on the iodine literature [00:26:00] and the physiology.
So you have this sodium-iodine symporter, and if you overwhelm that with too much iodine, the body won't be able to shut it in, and you can also have this effect called the Wolf-Chaikoff effect, where you can actually go hypothyroid. Precisely. And when you look at iodination, which is the process of binding tyrosine, the amino acid, which is where you get the T, T4 from, right?
To the iodine molecules, that process actually requires hydrogen peroxide as a, as an exhaust byproduct. Hydrogen peroxide can aggravate B cells, which can promote an autoimmune response. And so I always say, “Do we have autoimmune issues? If we do, we have to be very careful of adding additional iodine above the RDA, at least initially.
We should try to get those antibodies down with an autoimmune type of diet.” And guess what? Selenium is such an important cofactor that pulls that extra iodine that extra oxygen off the H2O2, which is hydrogen peroxide, and turns it into water. So my sentiment is, “Hey, get on a autoimmune diet, get enough selenium, maybe 200 into [00:27:00] 400 micrograms of selenomethionine in there.
Get your blood sugar stable, get your other cofactors, your magnesium, your zinc, your CoQ10, and then maybe down the road you can work on titrating that up, like you say, gradually. But monitor your levels and monitor your antibodies.” What's your take on that?
Dr. Jeff Moss: Yeah, I think your point is extremely well made, and we all– we, both of us know, many people know that this problem of autoimmune thyroiditis, either from a Hashimoto's low, Graves' high, is becoming more and more common.
And because of this i- inflammatory assault, which from chemicals certain gut pathogens can have an impact on creating a mon- an autoimmune thyroiditis. It really loses its ability, as I talked to, talked about, to re- respond effectively to high var- variability of iodine levels. And you run into the risk, as you said, and again, I think your point is well made, [00:28:00] iodine does not operate in isolation.
It's a closed system. We need all the nutrients, including the selenium we've been talking about, but there's other factors that certainly certainly come into play. But that– the concern here is that, again, these generalizations I've heard some very sad case reports, and this is not only from a clinical standpoint, from a medical legal standpoint.
These are people I know personally who were convinced of the safety of across the board, without any real assessment- Without any real titration across the board, complete safety, go for it. And I remember one case in particular. Very nice MD, a young girl, and came in, had some s- thyroid issue, and put [00:29:00] on high-dose iodine.
Didn't hear anything for a while. Then hears back from the mother, and mother says that “We went to our endocrinologist. My daughter's not doing well.” And ran an iodine test, and extremely high, and the MD says, “What have you been doing?” “Oh, my, my healthcare practitioner put me on this high-dose iodine.”
“Oh, really?” Was not a pleasant experience, because whatever we think, practitioners think, the extremes think, how wonderful it is, how right it is, how accurate it is, how well-supported it is, from a medical-legal standpoint, you do not have a leg to stand on. You will lose. [00:30:00] So that's something else to keep in mind.
Yes, if you're a certain high-profile, I won't name names, a certain high-profile person who basically is considered to be an expert and has certain types of licensure and degrees where you cannot be questioned okay, go ahead. But for some many of us who operate on the fringes from a medical standpoint for us to go out there and recommend with no abandon, with just high doses of iodine based on a seminar we took, for us normal practitioners who do not have no-questions-asked licensure, you are at significant medical-legal risk.
Dr. Justin Marchegiani: I know for a while back, I think it was Dr. David Brady maybe back in 2010, [00:31:00] I heard a talk him speak at, and he was talking about the number one reason why practitioners lose their license was due to thyroid malpractice, just not addressing the thyroid issue-
Dr. Jeff Moss: Exactly …
Dr. Justin Marchegiani: according to the standard of care, or giving iodine that creates an autoimmune flare, or- Yep
allowing TSH to stay too high and too long without, getting that addressed.
Dr. Jeff Moss: Said. Yeah. I know David personally, and yes, he… We're on the same boat on that one.
Dr. Justin Marchegiani: Yeah. So in general, it sounds like you have that happy medium approach. I felt like a lot of the higher iodine proponents, those people, those practitioners, Brownstein, et al.,
a lot of that… Or Abrams, right? A lot of times that o- or Abraham, those original kind of postulates of giving excessive or high amounts of iodine came from these original Japanese studies, and then when there was a pullback in that, said, “Hey, maybe we're off by a factor of 10X,” I didn't really see a lot of these practitioners maybe revising their original estimates based on that new data.
Did you notice that at all?
Dr. Jeff Moss: Yes. And first of all, I wanna be clear, from according to Gabbe, there was no original [00:32:00] Japanese research. What it was a distillation of basically looking at… I'm not sure I'm gonna get this correct. It's been a while. Number one, looking at the overall intake of seaweed in Japan versus the overall content of iodine in seaweed in Japan.
And what Gabbe pointed out was that there was a mathematical a significant and serious oversight. One study was looking at dry weight of a seaweed. The other study was looking at wet weight-
Dr. Justin Marchegiani: Ah …
Dr. Jeff Moss: of the seaweed. Their math was off, and that's how they came up with the 12 milligrams.
Dr. Justin Marchegiani: And I'm guessing what, the wet was probably…
The dry was probably more concentrated, right?
Dr. Jeff Moss: Yeah, I… And I don't remember- Less water … the specifics. I did write about that. But again, Gabbe went into this in detail in his writings [00:33:00] about the flawed mathematics in coming up with that number. Again I go back to research, which I did write about, actual research done by Japanese, and the actual intake is, again, about one and a half milligrams a day.
Dr. Justin Marchegiani: Makes sense. Totally makes sense. Excellent. Anything else you kinda wanna round off the iodine topic on? And I think, what about the types, right? ‘Cause we have iodide, which is I2-, right? But iodide gets broken up into two molecules of iodine. So do you have any preference of giving a combination of iodide versus iodine-
Dr. Jeff Moss: Yeah
in
Dr. Justin Marchegiani: your
Dr. Jeff Moss: clinical practice? The thyroid primarily relies on iodide
Dr. Justin Marchegiani: now.
Dr. Jeff Moss: There is molecular iodine, that's what you're mentioning. That seems to be more helpful from a non-thyroid standpoint. In terms-
Dr. Justin Marchegiani: Prostate, breast tissue.
Dr. Jeff Moss: Yes. Breast in particular. Okay. Yes. Now, there has been some talk about prostate.
Almost all of what I saw was animal studies. In terms of breast, the good human [00:34:00] studies were on fibrocystic breast disease. There is some very suggestive literature from animal studies on breast cancer. As far as I know, although I haven't looked in a while, it has not been replicated in human populations.
And that's molecular iodine- … not iodide, which is thyroid Personally, yes. I like a product that is a combination of the two. But again I'm more on the conservative side, starting low and going by patient response, mainly in terms am I going to see efficacy on one hand, and any suggestion of thyroid malfunction on the other.
Dr. Justin Marchegiani: 100% makes sense. Very good. And then doesn't the body break down iodide into iodine, though? ‘Cause it's just, it's two iodine molecules fused- Yeah … that make iodide, right? So you
Dr. Jeff Moss: can- there's a metabolic aspect to it, sure.
Dr. Justin Marchegiani: Okay.
Dr. Jeff Moss: That's very true. All
Dr. Justin Marchegiani: right. So we hit the iodine aspect, I think really important, and I think there's validity on both sides.
But, the literature does show too much [00:35:00] iodine can increase Hashimoto's, and you talked about the Japanese association with Grave and Hashimoto's being a thing. But we also have on the other side, the goiter belt and low iodine can create a supply deficiency issue and can create goiter on that side.
How prolific do you see just populations not getting at least that 150 or maybe 350 micrograms of iodine in a day to c- put them in that goiter state? How common is that?
Dr. Jeff Moss: In the United States, very uncommon since the iodization of salt.
And of course, we all know about there's no deficiency of salt intake in the United States in the average population.
But it was at one time, we're talking about before iodization, which I think oc- occurred in the mid-20th century. And then of course, nowadays, fresh seafood it's easy to get. It can be shipped anywhere overnight. And of course, going back when I was a kid in the '50s, the idea of getting fresh fish particularly in the wintertime, it, it was [00:36:00] unheard of.
When I was a kid, I thought fish came in these little sticks, silver- Exactly. Yeah, fish
Dr. Justin Marchegiani: sticks,
Dr. Jeff Moss: right? Yeah … I never even saw a real fish. Yeah, fortunately now, because of the readily availability of fresh seafood, you can go to almost any Whole Foods in the country or other fish markets and get good quality fresh fish, and of course, iodization of salt.
Iodine-related thyroid d- deficiency issues is quite rare in the United States, although there certainly is studies on other countries where it still is a significant issue.
Dr. Justin Marchegiani: Very good. Excellent. So essentially, like with patients, I'll use Cronometer a lot, which will look at… it's MyFitnessPal-like.
Yep … but it looks at nutrients as well. But then you have just the overall stress can increase burning of these nutrients, or there could be- … some genetic issues that could require increased demand. So like you're saying, you try to look at the diet and try to get a window just clinically what's right in front of you, and then this may give you an extra window to provide more fine-tuning of support.
Dr. Jeff Moss: Yeah. Now, I'm a [00:37:00] clinician. I'm in business because I give the people what they want. And I've never had anybody come to me and say, “You know why I'm here? I wanna optimize my hippuric
Dr. Justin Marchegiani: acid.”
Dr. Jeff Moss: Never had it happen. They come to me I don't feel good and I wanna feel better.” That's always… And I never forget that, never for a minute.
I tell– I've told my students for years, “Treat the patient, don't treat the lab test. The lab test is helpful, but treat the patient.” “Don't treat the numbers.”
Dr. Justin Marchegiani: So
Dr. Jeff Moss: take the lab test, see how it correlates with symptomatology and clinical presentation based on the combination of the in, in– of the data, of the information, then make an appropriate recommendation.
And I have reports from clinicians “I did a follow-up test. Boy, the numbers aren't changing.” Oh, okay. How's the patient doing? “
Dr. Justin Marchegiani: Oh, they're great. They never felt [00:38:00] better.”
Dr. Jeff Moss: Oh, okay. You're done. Don't fix what ain't broken. We live in a world… We live in a dirty world. If you think your goal is to create perfect biochemistry, no, you've gotta be on another planet.
It ain't happening here. Our goal and my viewpoint is to basically help the patient deal with their chief complaints, feel better, quality of life, they can do what they want in the face of a dirty world that's not gonna get any cleaner. If anything, it's gonna get dirtier. This is the reality of the world we live in, so I focus on chief complaints.
That's my number one criteria. And so with that in mind I use the numbers as a guideline, and if the patient improves, I'll say to the patient, “All right, the numbers aren't perfect, but you're doing great. Let's just set it aside, watch and wait. If [00:39:00] necessary, we'll do follow-up, but I'm not gonna keep on r- cramming you full of supplements to get perfect numbers.”
Dr. Justin Marchegiani: Totally makes sense. Anything else you wanna add on that? So I like a couple of the organic acids that really look at a lot of gut metabolites- Yeah … for bacteria and for yeast. I think that's an extra helpful window for running gut testing, and maybe they come back clear for dysbiosis. And I find it's– tends to be a little bit more useful and a little more direct than maybe a SIBO breath test 'cause I get more data, I get more window into C.
diff metabolites. Candida can be a little bit tough to come up with on some of these more comprehensive stool tests. What's your take on the gut bacteria, dysbiosis, fungus kind of information?
Dr. Jeff Moss: I used to be the same. I have the same line of thinking as you. This was before the DNA, new generation of DNA stool tests.
Dr. Justin Marchegiani: I run both, yes. The GI MAP.
Dr. Jeff Moss: Yeah.
Dr. Justin Marchegiani: Yeah.
Dr. Jeff Moss: Sure. The GI MAP. There's others out there, but the GI MAP is the one that I use the most [00:40:00] often. I think the technology's improved. I can generally get all the information I need based on history, diet, looking at the GI map, maybe a SIBO test occasionally.
Dr. Justin Marchegiani: And what other nutrient tests do you like to get a window into nutrients outside of just looking at someone's diet history, getting a window into that?
Dr. Jeff Moss: But that aside, and I also say that most of the people I've seen, I call them nutritional virgins. I can't remember the last time I ever had a person who's never taken a supplement in their life.
Dr. Justin Marchegiani: By the
Dr. Jeff Moss: time they get to me, they got vitamins and minerals- Yes … coming out of their ears.
Dr. Justin Marchegiani: Yeah.
Dr. Jeff Moss: What I see most often in terms of nutrient issues, nutrition issues, is not micronutrients, it's macronutrients. Yes. Protein intake is suboptimal. Poor quality protein. Issues of protein-carbohydrate imbalances.[00:41:00]
Occasionally too too little protein, too much carbohydrate. But unfortunately, in my mind, more often than not we now have a kind of fad, the carbs are evil fad. That, “Oh my God, no starches.” It's not just gluten anymore. It's all carbs. Evil. What's the perfect diet?
Ketogenic.
High protein, high fat. We don't want any of those grains. We don't want any of those beans. We don't want any of those starches. All bad. And so this is something I s- I'm seeing is that last I saw, carbohydrates are still necessary for health and according to the literature that I've looked at.
And so that number o- is certainly a big issue looking at a ca- protein-carbohydrate balance, which can go in either direction. I do see an issue also of two things. Number one… Three things. Number one is something that [00:42:00] we think is out of fashion in our functional medicine world, but it still matters, is calories.
Calories- … do count. And yes, I'll see very often excessive caloric intake, but more often than not the kind of people I see, they're not eating enough food.
Dr. Justin Marchegiani: I see the same thing too. When I make diet recommendations, and if you go back and look at Christopher Gardner's study, the A to Z study back in '08, '09 at Stanford, his hypothesis were the Atkins people were gonna eat the most and lose or gain the most weight, and it was ac- the exact opposite.
The Atkins people, the, on the higher moderate protein, higher fat, lower carb diet actually ate less. And the theory was that fats and proteins are very satiating from a neuropeptide standpoint. Peptide YY, cholecystokinin- Adiponectin. These tell your brain you're full. It's when you're eating a lot of the processed flours and grains and sugars and processed fats that are in processed flours and bake- bakery goods, that's what starts to get the appetite out of kilter and starts to [00:43:00] create maybe this excess caloric issue.
Your take on that?
Dr. Jeff Moss: Yeah, you're very right. The qualitative aspect is certainly cannot be under- underappreciated. But yeah, eating poor quality macronutrients is a big factor for many reasons. It really upsets the apple cart in terms of appetite centers, satiety. And it's interesting you mentioned Atkins.
There's a many anecdotal reports that have pointed out that people start out with Atkins and they do wonderfully initially. Losing weight, “I feel better than I ever felt in my life.” Then a month or so later, the weight loss plateaus and I'm starting to get a little tired and energy issues.
And you can always know why. They didn't read to the end of the book because even Atkins said eventually you gotta start eating carbs again. Yes. It's not forever. [00:44:00] Yes. So I always found that you could always tell the people who read the whole book.
Dr. Justin Marchegiani: It was amazing to me because Atkins talked about, he called it OWL, ongoing weight loss.
Each week, once you plateau, you increase 10 to 15 carbs per week.
Dr. Jeff Moss: Yeah.
Dr. Justin Marchegiani: And that was… And it's just amazing how people took that and they never added that last part to it. And I'm like, my gosh. It's come on. We need to have the whole picture here.
Dr. Jeff Moss: Yeah, exactly. Other issues that I've seen are the simple things that people…
Again, it's boring, out of fashion, not sexy. What do you drink? You have a few, “Oh, I have this wonderful diet. I have my baked potato and I have my broccoli and I have my salmon.” Yeah … “What do you drink?” “Oh I have let's see. I have tea and, “how about water?” “Oh, yeah, that.” I always… So very often they're drinking things that have water [00:45:00] as a base.
But I learned from my mentors tea is not water.
Dr. Justin Marchegiani: Diuretic.
Dr. Jeff Moss: Soda is not water.
Carbonated water is not water. Water is water. They're not the same. So I certainly look at that. And then another area as you mentioned too, I I mentioned I really been the foundation of what I've been doing for the years is electrolytes.
Fluid and electrolytes really go hand-in-hand.
Dr. Justin Marchegiani: And you have an excellent potassium electrolyte product in a powder. And most electrolyte products, I have one as well, they don't have enough potassium. They don't. It's a major deficit. We need 4,700 milligrams a day- And there's a common one out there that everyone knows that's got 200 milligrams a serving.
It's just not enough. Your thoughts?
Dr. Jeff Moss: There was so much misinformation on potassium. I really started getting inter- interested in this. I was looking at the work of an urologist she's on the West Coast. I think she's still working Linda Frizeto. And her partner was researcher Sebastian, was his last name.[00:46:00]
And they started looking at… Wrote a whole series of papers looking at potassium intake from a hunter-gatherer Paleolithic point of view. And what they found out Frizeto really expanded on this, was that the hunter-gatherer had a very high potassium intake. As you indicated, the RDA is about 4,700 milligrams, 4.7 grams.
What she pointed out, the hunter-gatherer was sometimes eating 10 to 15 grams a day.
Dr. Justin Marchegiani: Yeah.
Dr. Jeff Moss: And mainly because they're eating mainly green leafy vegetables, plant food type of things. Yes, they were eating animals when they could get them, but sometimes not easy for the hunter-gatherer, so their diet was primarily plant-based, very high levels of potassium, and there was no evidence of any significant downside.
The [00:47:00] sodium intake, on the other hand, was quite low in that population. And what Frizeto and Sebastian pointed out is because of this disparity in sodium and potassium levels in the food supply of the hunter-gatherer over time we developed mechanisms to retain sodium because it was so rare in the food in the food supply.
On the other hand, we developed mechanisms that it's easy to absorb potassium, it's easy to excrete potassium. And why is that good, this scenario? Is if your sodium is rare, 'cause you're gonna retain it, potassium is common, so you're gonna take it in readily and get rid of it readily. You can pee it out very easily.
It's, a lot of it's ex- most of it's e- excreted in the urine. Now of course we have the exact opp- exact opposite. [00:48:00] We have high sodium, low potassium diets. And so what we're running into, of course, the body wants to retain the sodium. That causes a problem. And the body wants to easily get rid of the potassium, which is a problem because you're taking so little to begin with, and of course, all types of negative adverse health associations.
And their central issue, of course, is that- The real issue with sodium, again, getting back to the mercury selenium analogy, the real issue, like I said, the real issue with mercury and selenium is not too much mercury, it's not enough selenium. They're positioned the exact same thing on potassium and sodium.
The real issue is not too much sodium, it's too little potassium. In several studies looking at particularly urine- urinary sodium potassium ratio studies, they found that the key issue in terms of health is too little potassium in [00:49:00] relationship to sodium. Doesn't mean we shouldn't decrease excess intake, particularly from processed food, but the most important thing is to make sure we have optimal potassium intake.
As you mentioned, RDA, RDI is about four and a half grams a day. Most current literature I've seen on this indicates the average American is getting about three grams a day, so about two-thirds of the amount. Now, one other important issue in terms of potassium supplements. If the RDI is so high, four and a half grams, why are potassium supplements so low?
And I don't know where this came from. It's an urban legend that the supplement industry just has accepted as fact. There's no research on it that says anything above 99 milligrams per capsule, per tablet is not only toxic, but against the law, disallowed by the FDA.
Dr. Justin Marchegiani: I wonder… My, my theory is if you go look at how [00:50:00] the lethal injection works in most states, it's an overdose of potassium.
So I wonder if there's just a negative stigma due to potassium being used for the lethal injection as it's being connotated towards supplements as being lethal as well.
Dr. Jeff Moss: Said. And I decided to check into this a few years ago in terms of looking into where did this come from? So I called my FDA attorney and I says, “Can you tell me where this FDA FDA restriction on supplemental potassium came from?”
He calls his contact the FDA and is told there is none. There is no regulation- … that limits the amount of potassium in an oral supplement. What is regulated is what you said. Injectable potassium, which is very dangerous. Why? As Frizetta and Sebastian pointed out, the body has all kinds of overlapping mechanisms to deal [00:51:00] with practically any level of oral potassium.
It's absorbed very readily, it's metabolized very readily, it's used very readily, and it's excreted very readily. On the other hand, when you inject it, the body doesn't know what to do with it. Exactly It's a really, it becomes, again, we are designed to get our nutrients by mouth, not by injection
Dr. Justin Marchegiani: 100%. Just like too much magnesium, you just get loose stools, very similar to potassium.
And I've seen patients that have been bradycardic and that their doctors were gonna put them on a pacemaker. We just get their potassium up and it's like the lights go back on. Yeah. It's amazing.
Dr. Jeff Moss: So this is a really a very much underappreciated issue, and I've been on the, my soapbox campaigning on this for several years.
And based on the symposiums that I go to, functional medicine symposiums I do not hear many symposiums where a major [00:52:00] speaker is speaking on potassium. They talk about magnesium all the time. I'm still not hearing much about potassium.
Dr. Justin Marchegiani: I agree. And then if, s- if someone's really sensitive, I'll use like a Redmond's Real Salt or a sea salt that's gonna have a broad spectrum bit of electrolytes- Yeah
and we'll combine a little bit with it, 'cause sometimes people are sensitive with potassium, they can drop their sodium, or if they do sodium, they can drop potassium. So you can always just have a little bit there as a backbone so you don't throw it off. I find that to be helpful. Thoughts on that?
Dr. Jeff Moss: Yeah.
Certainly there are some patients there are gonna be some special circumstances. If there are renal issues, that changes the whole game.
Dr. Justin Marchegiani: So when… So how much electrolytes do you add in if someone does have kidney issues, stage two, stage three kidney issues, but their electrolytes are still low, so they need something.
Is it just a smaller dose? How do you dovetail that?
Dr. Jeff Moss: Given the high degree of variability with renal dysfunction and renal disease, the presence of medication, it's really going to be patient specific. You can't generalize. You have to measure, do a do the serum [00:53:00] potassium. There are certain guidelines that you start out, similar to the iodine situation, you start low, see how the patient is doing remeasure, and then go from there.
I can't- You're only shooting
Dr. Justin Marchegiani: for the middle of the reference range though on the potassium?
Dr. Jeff Moss: Yeah. Generally speaking, what I've seen in terms of overall health, cardiac health, the range 3.5 to 5.5, right in the middle, right around 4.5- Yeah. I'd
Dr. Justin Marchegiani: say that … is
Dr. Jeff Moss: considered to be optimal on that. That's part of the problem also is there's a gross misunderstanding, not only in the allopathic community, but in the heil- the med- alternative medicine community, is that the pathologic norms of 3.5 to 5.5 is good enough.
So you're at 3.6, you're fine. Okay? The research I've seen, no. You want it in the middle. When you start getting… 'cause it tends to be, the impact tends to be logaritm- log- logarithmic.
Dr. Justin Marchegiani: Bingo.
Dr. Jeff Moss: So you get down even to 4.2, 4.1, you're in a [00:54:00] yellow zone here in terms of- … of health outcomes. By the time you're in the high threes, you got a problem.
Bingo. When you get out s- below 3.5, you're in trouble No question about it. But, it's standard thinking, “Oh, I'm at 3.6, no problem.” No. So we really want it to be… The literature seems to be very clear that you want it in the middle. In fact, some are advocating anywhere from 4.5 to 5.0.
The renal issues, of course, is a major consideration. The other major consideration is hypertensive drugs. If your patient is on a potassium-sparing diuretic, of course, you have to be very careful with potassium supplementation, and those are still very common.
Dr. Justin Marchegiani: That makes sense. I wanna wrap up here.
You've just been a, just a breath of fresh air with all the knowledge that you're putting out here, so I appreciate that. Thank you. You did many articles maybe a decade ago about acid/alkaline balance and the body is highly specific at keeping blood pH at a good 7.3-ish because [00:55:00] if not, then enzymes in the body won't be active and you can easily go into a coma.
But I remember a while back you were doing a lot of urinary measuring to see where that pH was, and I think you were a big fan of doing a potassium bicarbonate and a magnesium glycinate to help bring the pH up if it was overly acidic. What are your thoughts on that now? And do you feel like you were just using the acid balance as another gauge to look at your electrolyte levels and seeing if there was sufficiency or deficiency?
What's your take on that now?
Dr. Jeff Moss: Yeah, you bring up an interesting point, and I've written on this for years, but about a… I think about a year or so ago, and I did write about this, a wonderful paper came out, which I reviewed, and that talked about a lot of misunderstandings. Number one, there is met- metabolic acidosis and then metabolic acidemia.
Emia meaning the blood. We rarely will see metabolic [00:56:00] acidemia. Ah. The blood is very stable.
Dr. Justin Marchegiani: Very, yeah.
Dr. Jeff Moss: Almost impossible to change. If you do have someone who has a true metabolic acidemia, low blood pH, there should be… If they aren't, they should be in the hospital. That's a very serious condition.
What we see is what is termed chronic low-grade metabolic acidosis, which is basically more of a tissue-based phenomenon where there is an imbalance often caused by poor diet, too high in refined carbs- Yes … protein, et cetera, et cetera. And the urine pH is a good tool. It's not perfect, but it's a good tool in terms of getting some idea where the patient is at from a this metabolic, low-grade chronic metabolic acidosis standpoint.
Does urine pH, first morning urine pH, have any direct correlation with blood [00:57:00] pH? No, does not. You have to measure the blood. Does it give you some information in terms of metabolic acidosis? No, it's not a direct measurement. Can we reasonably extrapolate based on overall history-taking, dietary history?
Can we use first morning urine pH as a reasonable tool to basically determine that the patient is ingesting a diet too high in acid-forming factors, and will need some alkaline mineral support, either in terms of fresh green leafy vegetables or a potassium magnesium supplement of some type? Yeah.
It's a good gross tool not only to determine need, but also the patient, it's easy, inexpensive. A roll of pH paper, like 10 bucks, lasts you for months. And they can just titrate themselves over time. What I'll typically do is advise the patient, “Here, [00:58:00] check your pH.” According to the paper, what we want to see on first morning urine pH, the sweet spot is somewhere between 6.4 and 7.2.
There is some variation in terms of, for the experts what the range is, but there seems to be a, an agreement that you want it at least 6.4. It should be 7, 7.2, 6.8. Variation in the papers.
Dr. Justin Marchegiani: And I actually talked to someone who ran a cancer clinic, and he would say a lot of his cancer patients, they were actually too alkaline-
Dr. Jeff Moss: Yes
Dr. Justin Marchegiani: In their urine. And the whole idea was that, we excrete inflammation and such via acidic waste products, and so being too alkaline may mean that we're not excreting these compounds, too.
Dr. Jeff Moss: Yeah, you bring up a good point. Now you're talking about very serious metabolic imbalances. You're getting…
Cancer patients, they're a whole different world. It requires a whole degree of expertise and knowledge of how to address their needs. They're By the time they've gotten cancer, particularly metastatic [00:59:00] cancer, they are so metabolically imbalanced for years, that's a whole different world.
But generally speaking, what we're gonna see in our world of the chronic illness, overweight, tired, fatigued patient is going to be a first morning urine pH below 6.4, and giving them some type of supplementation, change in diet. We can easily get the numbers above there. And then over time, they can determine I've been doing okay, but then I went on vacation.
I ate and drank what I shouldn't eat. Now I did my pH, it's a little too low, so I'll take some more potassium and go on my healthy diet at home again.” So it's a good at-home tool they can use. Inexpensive, easy, and of course, the supplementation itself is usually very reasonably priced.
Dr. Justin Marchegiani: And you were trying to get it up to what?
7.3, 7.5? What was the goal pH-wise by adding more magnesium and potassium?
Dr. Jeff Moss: Yeah. What I saw, the literature I saw was no higher than 7. Really, above 6.4 is the key
Dr. Justin Marchegiani: Good. So get above 6.4. So obviously if your diet's, [01:00:00] inflammatory, a bunch of sugar, just cutting that out can help. But if you wanna- Could
Dr. Jeff Moss: be yeah, it might be just a dietary change, more exercise, that type of thing. But yes, should it… As you mentioned before, when you start getting into above 7.2, there's a reason to suspect maybe a UTI some type of infectious process- Yep … can be increasing a 2I, and that is a concern.
Generally speaking, we have other tools at our disposal. We can determine if there's something going on from a renal standpoint, kidney stones, U- UTI that type of thing. We can easily determine if the urinary pH is reliable for us. But if you got a patient who's comes back the pH is like six, 5.5…
I had a patient call me up once, and the paper, as comes yellow and will turn more green or blue as your pH goes up. It didn't change color, so she calls me up and says, “Your pH paper-” Wow “… is broken.”
Dr. Justin Marchegiani: Ah. Too acidic. [01:01:00] Wow.
Dr. Jeff Moss: Yeah. So no, the pH paper's not broken. You just need some support.
Dr. Justin Marchegiani: Wow. Dr. Moss you've put a really, ton of good information here. We really appreciate it. We'll make sure this gets out to the listeners, and we'll do a- Great … full transcription, so if people wanna go and listen to it or read it, that's gonna be available. Is there anything else you wanna leave the listeners with here that's important that you wanna highlight?
Dr. Jeff Moss: Usually what is causing your problem, and you may not wanna hear it, is the things you do every day you never think about. So before you get into, “I know I have some exotic enzyme defect. My problem is I'm homozygous for MTHFR. That's my problem,” that's one of the hot ones, right? That's…
Dr. Justin Marchegiani: Yep.
Dr. Jeff Moss: Before you go there that's the cause of all your problems, just take a look at basics.
Basic diet, protein, cal- caloric intake, protein carbohydrate ratio, fluid, electrolytes, [01:02:00] exercise, sleep. Go to the basics.
Dr. Justin Marchegiani: I agree. Excellent, Dr. Moss. We appreciate everything. Dr. Jeff Moss here, mossnutrition.com. Sign up, get access to the newsletter. If you're a practitioner, definitely sign up. If you're a patient, you can still access the newsletter, and there's a lot of good relevant information that's, I think, very practical.
Dr. Moss, thanks for being on the show. Really appreciate it. Thank
Dr. Jeff Moss: you so much for having me. I really appreciate it.
Dr. Justin Marchegiani: Thank you, sir.
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