The truth about coffee and its impact on your health – Podcast #75

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Dr. Justin Marchegiani and Evan Brand begin the interview with how you can stick to your goals then proceed with a talk regarding the truth about coffee and its impact on your health. Learn all about coffee, its benefits and all the good stuff you can get from it. Find out how coffee can stimulate you and the amount of coffee that you should be drinking. 

truth_about_coffeeDiscover what kind of coffee you should go for and what’s the best time to drink coffee. Also in this interview, you can learn about what nutrients can be found in coffee. Did you know you can take a magic carpet caffeine ride? There are also some things you can add to your coffee to make it better, so listen to this podcast to find out what they are.

In this episode, topics include:

3:24 About coffee

6:00 Different kinds of coffee

7:24 Nutrients in coffee

8:45 When to drink coffee

15:00 Benefits of drinking coffee

 

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Dr. Justin Marchegiani:  Evan, what’s up?  It’s Dr. J.

Evan Brand:  Not too much.  We’re moving along and this week, it’s a great week for both of us.  The new year is off to a great start.  People are surprisingly motivated and inspired and we’re hoping to create some lasting New Year’s Resolutions.  I say I’m a big fan of 30- or 90-day resolutions, not a year, because you’re gonna be a different person in a year.  But hopefully we can still hinge on that momentum that people have programmed into their brains today.

Dr. Justin Marchegiani:  Yeah, I mean only 8% of people actually reach their New Year’s Resolution.  So I’m a big fan of just keeping week-long resolutions.  Like if your goal is to lose 10 pounds or improve your health in way, shape or form, well, figure out the actions that need to be done on a week-to-week and then make your week the goal.  Because what happens is people get so far behind that they just eventually quit because they’re just like, “Hey, I can’t–I can’t reach that goal,” right?  I’m already 3 weeks, 4 weeks behind.  There’s no way–there’s no catching up.  But if you have a week-to-week goal–hey, my goal is to go to the gym is 2 times this week.  My goal is to eat 90%, you know, Paleo, cutting out grains and refined sugar, outside of maybe a couple of these little treats here, then it’s easy.  “Oh, I failed last week, well, I have this week in front of me.”  So you kinda chop it up into these small goals that are incredibly measurable, but then you can always just redeem yourself the next week.

Evan Brand:   Yes, something that–that also I’ve noticed is, people get into that catastrophic thinking where if they eat one brownie or one treat, they deem everything they’ve done a failure, and so they’re just like, “Well, I’m gonna go completely off track now and have nothing dialed in because I ate some–some gluten, and now everything’s ruined, so I might as well just give up completely.”  And that type of thinking gets you into trouble pretty quick.

Dr. Justin Marchegiani:   Totally agree.  That’s why I like the short-term goals, and also set yourself up for success.  If you have a health goal, figure out how many meals you have to eat good.  Hey, I’m eating 3 meals a day, let’s say 3-4 meals a day, that’s 21 to 28 meals a week.  So let’s say 20 meals a week, you’re gonna be spot on.  They’re gonna have, you know, vegetables in it.  They’re gonna have good healthy fats.  They’re gonna be nutrient-dense, low toxins, and anti-inflammatory.  They maybe 1 or 2, I’m gonna incorporate like a little bit of a Paleo treat meal.  I’m not gonna have gluten.  I’m not gonna have a whole bunch of refined sugar and fructose and artificial sweeteners but maybe I’ll have, you know, a Paleo treat like a Hail Mary tart like 2 nights a week or I’ll have some–some dark chocolate a couple nights a week that’s very low in sugar and organic and gluten-free and all that good stuff.  So you can kinda plan in how many meals do I have to have to be really on track and then from there you can place in treats that are far better because having some dark chocolate, my gosh, 90% that’s like not even bad, but if you’re having 50% chocolate, that’s like 3 or 4 times the amount of sugar, and a whole bunch of milk and dairy, and if it’s not organic, pesticides, too.  You’re gonna be significantly derailing yourself where just doing a healthier version of that may actually give you some health benefits.

Evan Brand:   Good point.

Dr. Justin Marchegiani:   Yeah.  So today we chatted about kinda pre-show that we wanted to talk about coffee a little bit.

Evan Brand:   It’s very common.  I haven’t seen–I guess I’ll put it this way, 90% of people are drinking coffee that I’m seeing–I don’t know what your ratio is.  It’s rare to see someone that does not drink coffee.

Dr. Justin Marchegiani:   So let’s talk about coffee a bit.  Coffee is–is a stimulant.  So it can stimulate cortisol and/or adrenaline or catecholamine production from the adrenal glands.  So the adrenalin glands are these glands that sit on top your kidneys.  They’re your stress-handling glands.  People don’t realize this but they also produce a significant amount of your sex hormones as well.  So when you’re stressed and you’re broken down and you’re trying to heal, sex hormones are really important for building blocks of yourself, not just for having–having kiddos.  So on that note, coffee’s gonna stimulate those adrenal glands and will make some adrenaline, again norepinephrine or epinephrine, these are all interchangeable words, right?  Medicine loves to create lots of other words for the–that say the same thing.  So adrenal–adrenaline and catecholamine, epinephrine, norepinephrine–they’re all the same thing, and then cortisol is that hormone that stabilizes blood sugar and also puts out inflammation.  So when people drink coffee, that’s one of the big things and that’s gonna stimulate your sympathetic nervous system and give you a whole bunch of energy.  Now, depending on how you’re using coffee, it can be good or bad.  So the first aspect of coffee I wanna focus on is coffee quality.  Coffee is typically heavily sprayed with pesticides so pesticide exposure is gonna be not good for your liver, not good for your body and your brain, so automatically going to organic coffee is gonna be a big step in the right direction.  That’s number one.  Number two, if you’re doing like a Central American coffee or, you know, a single source coffee that is gonna be of higher quality.  It’s gonna have less mold or mycotoxins like ochratox–ochratoxin and such.  These are various fungus or molds that are on coffee that can definitely create inflammation in your brain and definitely decrease your mental performance.

Evan Brand:   Yeah, I don’t drink too much coffee personally but when I do, I try to make it a good quality, and I’ll feel the difference.  Sometimes, I’ll drink a cup, if I ever do, I’ll drink one and I’ll feel brain fogged and then others, I feel super clean, so if you’re noticing that every morning, you’re drinking your cup of Joe and you feel different, then the previous when you drink it, then you may wanna check out that quality and see if it’s up to par.  You may be getting a blend.  That’s something I see that is a problem for people is they’ll go with a breakfast blend or something like that, which basically is just a fancy marketing term to trick you into thinking it’s good, but they’re just taking several different varieties of coffee and mixing them together and at that point, you’re adding almost like too many cooks to the kitchen, now it’s gonna be much harder for you to track what the quality of that is because you have 3 or 4 different strains of beans in that–in that same bag.

Dr. Justin Marchegiani:   Yeah, absolutely.  So there are, you know, different brands of coffee out there.  There’s Dave Asprey’s upgraded coffee which is a really good coffee.  There’s a–I think it’s Bluebell, they’re up in Bay Area, Bluebell I think or Blue Fog.  I think it’s Blue Fog Coffee.  They have a really good coffee.  Premier Research has a great coffee as well.  We use that coffee.  I’ll drink it as well and also it in my patients that are doing enemas which can be great.  So really just try to find a single source, typically higher altitude coffee, Central American coffee is gonna be better.  Single source is gonna be better and just try to buy from places that are more reputable.  And yes, it will cost you more money to have a good cup of coffee.  So spend a little bit more money.  Get the single source.  Get Central American or higher altitude-based coffee and buy coffee from people that have a reputable, you know, sourcing process.  That’s really important.  Then I always basically brew my coffee, you can do it either drip or I like mine French pressed because I feel like the coffee bathes in the water just longer and it has more time for all the aromatic compounds and constituents in the bean to encompass themselves in the water.  It makes a much stronger coffee.

Evan Brand:   Now stronger in effect, too, like you’re gonna feel a more buzz from it?

Dr. Justin Marchegiani:   Well, I’m just basing it off of taste so imagine if the taste is there, there’s gonna be more active constituents there as well.

Evan Brand:   Uh-hmm.

Dr. Justin Marchegiani:   So when we look at some of those active constituents, coffee actually has a lot of nutrients.  They have various alkaloids in them that are antioxidants.  They have B vitamins like riboflavin, that’s B2.  Pantothenic acid which is B5, which is actually–is a important nutrient for the adrenal glands.  Manganese, potassium, magnesium, niacin, there is some decent nutrients in coffee, a lot of antioxidants as well.  The thing is because it’s a stimulator, people that have adrenal issues can easily go to town on coffee to kind of make up for their lack of adrenal potency.  So we wanna always make sure that coffee isn’t being used in replacement of poor adrenal health.

Evan Brand:   And I’d say that’s so common but 90% of the population doesn’t know that they’re actually doing that.  If you told the average person on the street with their 24-ounce Starbucks with whipped cream and all that on top and you’d tell them, “Look, you’re trying to offset your low adrenal output.”  They’re gonna be like, “What?”  They have no idea but that’s typically what’s happening.

Dr. Justin Marchegiani:   Yeah, most people need to be more honest with themselves.  When they go to Starbucks and they say, “Can I have a coffee?”  Just stop that and say, “Can I have dessert?”  Because that’s not coffee, it is dessert.  I mean, like all these different shots and all these different whipped cream with sugar in it and stuff, it’s just–it’s just absolute–it’s like dessert.  People feel like they’re having coffee, but it’s really just dessert in a cup.  So with coffee, there’s a couple things you can do.  So, number one.  I always have patients do coffee after they eat, because sometimes if there’s gut issues, coffee can be abrasive on the gut.  I’ve seen it too many times in my patients.  So if you have gut issues, try doing a little bit of coffee after you eat.  That’s number one.  Try putting some high quality fat in your coffee.  What fat does to your coffee, it binds to the caffeine and actually creates a time-release effect.  So get this magic carpet caffeine ride versus this rollercoaster caffeine ride.  The rollercoaster caffeine ride, everyone knows what that is.  You have it, it’s like–boom–you’re jittering.  You’re bouncing off the walls and then crash.  Where the magic carpet caffeine ride is this gentle, you know, rise and you go up there and then you feel sustained and you can keep–keep your energy going at the highest level.  I always get–when I say it I always have that theme song for Aladdin going in there–going on in the background.  Any comments, Evan?

Evan Brand:   Well, theanine’s cool, too.  The amino acid theanine.  If I were to drink coffee, which literally is probably 2 cups a year at this rate, I will take some L-theanine which is found in green tea.  I love to take that because that’s gonna help to balance out that caffeine.  I’ve got the 23andMe test done on my genes and sure enough it–it told me what I already figured out, was that I’m a slow metabolizer of caffeine and I just feel weird and–and crazy off the wall if I–I drink too much of it, and so I’ll take about 1 or 2 hundred milligrams of theanine with the caffeine and it just totally balances you out and you have that calm, smooth clarity.  Combining that with fat, I’ve never done combining with fat and theanine at the same time, but that sounds like a trifecta.

Dr. Justin Marchegiani:   Oh, absolutely.  So the–the fats is gonna time-release that caffeine and make that magic carpet caffeine ride–cue the music–and then also people that have that fat metabolizing–excuse me–that caffeine metabolizing issue, that’s the CYP1A2 gene, that gene is gonna make it more difficult for you to metabolize that coffee and people that have that, they’re gonna know.  They’re gonna feel the jitters.  They’re not gonna feel too good after coffee.  They may have a real hard time sleeping after coffee as well.  So people are gonna know that and you can always get that genetic test.  Was that 23andMe?

Evan Brand:   Yeah, that was 23andMe.

Dr. Justin Marchegiani:   So 23andMe for that test.  Most people are already gonna know.  Not a huge fan of genetic test because they are not functional.  They’re static.

Evan Brand:   Yup.

Dr. Justin Marchegiani:   So I like tests that can look at epigenetics, meaning the expression of how you’re functioning now and not static genes.  So that’s one piece.  Now we talked about the slow metabolizers.  People that are fast metabolizers, they also know it, too, because they tend to do pretty well with caffeine.  It doesn’t tend to hit them that much.  I would say I’m somewhere in the middle.  I don’t need coffee.  I love the warm goodness, like having that coffee in the morning with the butter and also, I forgot to add, the MCTs.  We wanna have grass-fed butter because grass-fed butter has butyrate in it, which is a short chain fatty acid that binds to the caffeine and creates that time-release effect.  We also have the MCT, which is the medium chain triglyceride.  It’s a fatty acid that’s typically a combination of 6, 8, 10, and 12 carbons long.  So we have 6, 8, 10, and 12 which is capric, caproic, and caprylic and then we have C12 which is lauric acid which is the primary fat in breastmilk, that’s antimicrobial, antifungal as well.  So these are really good fats.  So you have your MCT oil.  Now Dave Asprey has one that I think is typically C6.  I think it’s just capric and that’s like, I think 8 times more MCT in it.  That’s a good one, too.  I like that one.  I’ll also use other MCTs, too.  So MCT is great.  Butter is great.  Now if you’re autoimmune and you think you’re sensitive to like the Kerrygold grass-fed butter, you can always throw in some keifer–not, I’m sorry–ghee.  Ghee is what you’d wanna do.  You can do the clarified ghee from, I think it’s Pure India or Purity Farms.  It’s the one in Whole Foods with the cow and the blue label.  Ghee is gonna have no lactose in it, relatively speaking, and it’s gonna have no casein either.  Now butter may have a small amount of lactose and a small amount of casein.  Now for most people, lactose is the sugar that’s in dairy that people don’t have the enzyme for, and they’re called lactose intolerant.  And then casein is that inflammatory protein in dairy.  So if you do ghee, you’re gonna have less casein and less lactose.  Now most people with grass-fed butter, they’re not gonna have a problem, but if you are having a problem, go to the ghee.  That can be your–your next best step.

Evan Brand:   Ghee is tasty to cook with, too.

Dr. Justin Marchegiani:   Oh, it’s awesome.  I love ghee.  So on that note, we make our coffee better by just time-releasing the fat.  We do it after a meal.  Now I typically recommend doing like 1 to 2 cups.  Like keep it at 1-2 cups and I don’t recommend any coffee after noon time.  After the noon time.  But coffee has a lot of great benefits because it’s gonna be very neurologically stimulating.  It does this because there’s an inhibitory neurotransmitter in your brain called adenosine and it’s inhibitory.  So it’s shutting–it’s shutting things down.  It’s slowing things down.  So think it as–think of inhibitory neurotransmitters as like the–the brake pedal and think of stimulatory neurotransmitters as like the gas pedal.  So again, coffee blocks this inhibitory neurotransmitter called adenosine.  Now at the same time, it stimulates things like dopamine which is a more excitatory, more a reward center-focused neurotransmitter and then also dopamine precursors like neurotransmitters norepinephrine and adrenaline.  Alright, norepinephrine and epinephrine are adrenaline and they actually come from dopamine.  So adrenaline is actually a building block that comes from dopamine.  So the coffee will up the dopamine and up those adrenaline levels which will help focus and also the reward centers in your brain fire better, too.  Comments, Evan.

Evan Brand:   I froze there for a little bit on your end.

Dr. Justin Marchegiani:   I’m gonna say–I’m gonna say we have to get you some–some coffee right now.

Evan Brand:   No, it’s too late.  It’s–it’s 3:30 my time.  I’d be up awake if I drink some at this point.

Dr. Justin Marchegiani:   Yeah, so on that note, coffee–the benefits are gonna be neurological for focus.  So really excellent way to study or focus or get extra work you have to get done, that can be a really great source.  It could be great especially if you’re mixing in the fats.  It can be great to increase ketones because coffee, the–the caffeine in that will increase fatty acid stimulation.  So it will increase the fatty acid synthesis, so you’ll make more fatty acids.  You’ll stimulate more fatty acid production release in your body, so you’ll be able to burn those fats for energy and that’s gonna keep your blood sugar more stable.  It will also stimulate ketones if you consume it with the fats, like the butter and the MCT.  You’ll get more ketones and ketones are another fat precursors that your body can burn for energy and it’s like throwing these big logs on the fire.  So when those big logs are on the fire, your blood sugar is gonna be more stable and ketones will also suppress your appetite so you’ll feel hungry longer.

Evan Brand:   Yeah, and obviously a lot of people listening want health but admittedly, a lot of them are gonna want weight loss, too.  And they’ll talk about, “Oh, I have that 5, 10 pounds around the belly area I wanna get rid of.”  This method that we’re talking about can be an effective way for weight loss and obviously it’s a side effect of making yourself healthy because you’re getting in these high quality and high potency fats, but I’ve heard of many people and you and I heard it all day every day at the conference, people losing significant amounts of weight by doing, you know, a butter coffee or an MCT oil and things like that in their–their routine.

Dr. Justin Marchegiani:   You just gotta be careful because there’s so much good fatty acids being stimulated from your body and then you’ll also have the ketones from the MCT and potentially the butter, it could shut down your appetite.  And when your appetite shut down, let’s face it, you’re just not gonna eat other good foods.  And you’re getting nutrients in the coffee, you’re getting nutrients in the butter and fat, but I mean, there’s not gonna be much outside of that.  So you have to make sure you’re not shutting your appetite down so much where you’re robbing Peter to pay Paul, so now you’re not gonna get the nutrients on the other side of the fence from having a healthy lunch, a healthy dinner.  So I see a lot of patients, especially my patients that do Bulletproof Coffee, it can be a great tool but a lot of people are using it to the excess and it’s shutting down their appetite so much they’re not getting other nutrients they need from their other meals that should be throughout the day.  Remember when we eat food, it’s not about calories, it’s about nutrients.  Your body runs on nutrients.  All nutrients contain calories.  Not all calories contain nutrients.  A whole bunch of calories and a whole bunch of fructose corn syrup, but there’s not much nutrients there.  So if we’re eating nutrient-dense foods, healthy veggies, organic meats, healthy fats, maybe some low sugar fruit, we’re gonna be getting a lot of vitamins and minerals and nutrients along with it.  So we don’t wanna shut out appetite down to the point where in–where we are no longer having the desire to eat nutrient-dense foods.

Evan Brand:   Yeah, great point.  Yeah, I mean, I’ve seen that dozens of times where people are just not even eating a lunch because they will do that coffee and here it is, 2-3 p.m.  They’ve had no solid food at that point and then at that point, I–I start to get a little bit concerned about blood sugar because I know you may have the good fats and the coffee but at a certain level, your body still wants those solid food over a liquid food that may have fat in it.

Dr. Justin Marchegiani:   Yeah.

Evan Brand:   I don’t have any–

Dr. Justin Marchegiani:   Uh-hmm.

Evan Brand:   Research to prove, say drinking your fat versus chewing your fat, but to me, it’s always good to have solid food when possible for those fats.

Dr. Justin Marchegiani:   Absolutely and not to mention, just the fact that we don’t wanna be relying on the coffee just to whip the adrenal glands more.

Evan Brand:   Yeah.

Dr. Justin Marchegiani:   That’s really easy and I see a lot of people, they’re just not eating enough throughout the day.  Not getting enough nutrients throughout the day.  They’re killing their appetite with the ketones which can be good if you are consuming too many calories but if we’re eating real nutrient-dense food, those calories and those nutrients are detected by our brain and our brain shuts down our appetite appropriately when we’re getting enough nutrients.  So we wanna keep that regulation system going by eating real food throughout the day.  So how I do it is this.  I’ll have a little bit of coffee in the morning, maybe 1-2 cups of coffee.  I’ll do it after my breakfast.  So this morning, I did 4 poached eggs, okay.  Did my coffee mixed with butter and MCT, blended that up for about 30 seconds, had that after my eggs, and I was ready to go.  So when I ate lunch at 1 o’clock, 5–5-1/2 hours in, I wasn’t even craving it.  But it felt good.  My blood sugar is stable.  I got some nutrients in my–my system, which is good, and I get enough calories in the system, too.  So that’s important.  And then for most patients that have adrenalin issues, I wouldn’t go more than 1 or 2.  And I also do the chest–the–the test here which is basically have no coffee for a morning.  See how you do.  Do you get by?  For me, it’s just that warm blanket.  That’s what it is for me.  I did no coffee yesterday or I’ll even mix it with decaf every now and then and it doesn’t change for me.  People that may be coffee sensitive, they could do like a–a matcha potentially or a chai tea.  Have you tried it with matcha, Evan?

Evan Brand:   Oh, I love matcha.  Yeah, absolutely.

Dr. Justin Marchegiani:   Do you do it with the–do you do it with the MCT and butter?

Evan Brand:   I’ve–I’ve never done MCT.  I have done butter and it was a little weird just because it was a super buttery flavor tea–

Dr. Justin Marchegiani:   Yeah.

Evan Brand:   So it kinda threw me off a little bit but it’s still–it’s still made me feel amazing.

Dr. Justin Marchegiani:   Yeah, I know chai that’s pretty well.  So people are trying to get that extra fat in your body and you can’t do the coffee because of stimulation or because of just potentially you’re afraid of autoimmunity from the coffee beans.  Well, you can easily do the chai tea.  I always try decaf, too, and give that a whirl and see how it goes.  Also, one thing to add, coffee especially high quality coffee beans–studies show that there’s more antioxidants in coffee than both fruits and vegetables combined.  So people gotta remember, a lot of antioxidants in coffee, a lot of benefits, just make sure it’s high quality.  Make sure it’s organic.  You’re not getting a whole bunch of pesticides.  Make sure you can tolerate it.  If you have an autoimmune condition, well, try a–a chai tea instead or even try going off it a 100%.  Add some high quality fat to it so you create that magic carpet caffeine ride and create that nice time-release effect.  Do it after you eat and make sure you only have 1-2 servings a day and make sure you’re not using it as a crutch to just keep your appetite suppressed and avoid getting enough nutrients in other places throughout the day.

Evan Brand:   Yup.

Dr. Justin Marchegiani:   Any comments, Evan?

Evan Brand:   No, I think that’s a great overview.  I mean, definitely just zoom out a little bit and be honest with yourself about your caffeine usage.  I know for my wife now that she is pregnant, she’s gone cold turkey on coffee, and some people say, “Oh, maybe you could have a cup or–or two or whatever,” but she’s pulled–she was a daily coffee drinker and now she’s totally fine.  So maybe would she be cool to drink it?  Probably, but she’s not and she feels good and–and it’s kind of a good reset, I suppose.  And so maybe if you’re questioning your habit a little bit, it might be good to just take–take a day off or take everyday’s off and switch to tea or something else, or maybe just do no diuretics and do some lemon water instead.  That is one piece that I guess I would add to finish out here, is that coffee is a diuretic and teas are diuretics as well, and so just because you are drinking maybe 40 or 50 ounces of water per day, which, you know, that may not be enough anyway if you’re adding in that coffee then that doesn’t count as your water intake so make sure you replenish what you’re drinking in terms of ounces for your cups.

Dr. Justin Marchegiani:   Yeah, if any of my patients are listening and we talk about drinking half your body weight in ounces, coffee does not count towards it.  So you just gotta make sure you–if you’re like–for me I’m 200 pounds, I need 100 ounces of water a day with minerals added and that does not include any coffee or teas that I have.

Evan Brand:   Yup, so do the Math.

Dr. Justin Marchegiani:   Well, I’m just making this podcast primarily for a lot of my patients that come on do and Bulletproof Coffee.  I endorse it–Bulletproof–I think it’s great.  I think it’s a great tool for focus and for blood sugar stability and getting lots of good fats in but it can be easily abused and it can be a crutch of people not getting enough food and they just don’t wanna eat throughout the day and it can really sabotage their adrenals if you do too much or do it too much in the long run.  So if you’re gonna do Bulletproof just in the morning, I recommend doing some collagen, like 20 grams of collagen in the morning, so you’ll at least get some good protein and amino acids in your system that will help with just overall nutrients.  So if you’re in a stressed out state, your body won’t be pulling protein from your muscles, it at least has amino acids in the bloodstream it can take from and then make sure you have it afterwards and then have a lunch scheduled at around 1 or 2 o’clock.  And then if you wanna add in an intermittent fast day, let’s say you just do some intermittent fasting and don’t eat solid food until 2 or 3 o’clock that’s fine, but make sure you’re healthy first.  Make sure you don’t have any health complaints and try it on a weekend day where there’s less stress.  If you’re an executive or a busy person, and you’re not having nutrients, well, again if you’re not putting nutrients in the tank, your body has to get them from somewhere.  Okay?  It doesn’t just like manifest them out of thin air.  So it’s gonna come from somewhere and that’s gonna cause you to burn up some of your minerals and more of your B vitamins and shred out more of your protein if there isn’t nutrients there in the tank to burn.  So remember that.  Put nutrients in the tank.  Don’t think about calories.  Think about nutrients and then make sure you do some of the tips that I mentioned to prevent yourself from getting derailed by caffeine and coffee.

Evan Brand:  Yup, great points.

Dr. Justin Marchegiani:   Alright, Evan.  It’s been real.  I got a patient.  We’ll talk soon.

Evan Brand:   See ya!  Bye!

Dr. Justin Marchegiani:   Take care!

 

 

 

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