Understanding Digestive vs. Hormonal Bloat: Symptoms, Causes, and Relief Strategies with Evan Brand | Podcast #421

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The video discusses the difference between digestive and hormonal bloat, the root causes, and relief strategies. It emphasizes the importance of testing and personalized treatment plans for optimal results.

Key Insights

– 🌪️ Hormonal imbalances, such as estrogen dominance, can contribute to fluid retention and bloating, especially during the menstrual cycle. Addressing hormonal balance is crucial for reducing bloating symptoms.
– 🍽️ Dietary factors, such as consuming fermentable foods and anti-nutrients, can contribute to digestive bloat, and improving diet and digestive support can help alleviate symptoms.
– 💉 Comprehensive testing, including hormone panels and gut testing, is essential for identifying the root causes of bloating, such as SIBO, H. pylori, and mold issues. This allows for targeted and personalized treatment plans.
– 🏋️ Strengthening the pelvic floor muscles through exercises like squats and lunges can support digestion, especially during hormonal changes like perimenopause and menopause.
– 🩺 Balancing estrogen and progesterone levels is crucial for reducing bloating. Herbal support and bioidentical hormones may be used while considering individual needs and preferences.
– 🧪 Mold issues can impact estrogen levels and contribute to bloating. Evaluating both gut and environmental factors is necessary for effective treatment.
– ⏰ Personalized treatment plans, based on thorough testing and understanding of individual symptoms and needs, are essential for the successful management of bloating and hormonal imbalances.



Dr. Justin Marchegiani: 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.

Dr. Justin Marchegiani: J, and or our colleagues and staff to help dive into any pressing health issues you really want to get to the root cause on. Again, if you enjoy the podcast, feel free and share the information with friends or family. Hey guys, Dr. Justin Marchegiani here. Welcome back to the podcast with Evan Brand. Evan, my friend.

Dr. Justin Marchegiani: How are we doing, brother? Evan Brand Oh, doing good. Good to see you, man. Dr. Justin Marchegiani Good to see you as well. I'm really excited to dive in today's topic. We're gonna be talking about digestive bloat versus hormone bloat. What's the difference? What's the root cause? How can you distinguish it?

Dr. Justin Marchegiani: What to look for, right? We wanna really dive into the root cause that we have so many patients that come in that have hormonal imbalances, whether it's. PMS issues, whether it's perimenopause, menopause, a lot of times, there's just overarching digestive issues in the background, whether it's SIBO or H.

Dr. Justin Marchegiani: pylori or fungal overgrowth. Maybe there's some chronic mold issues as well, some colonized mold issues in the gut. So, there's a lot of overlap and it's like, patient gets really inundated with all the symptoms and it's hard to parse through what should our next step be. We're gonna kind of dive into this topic a little bit deeper than I think most people do.

Dr. Justin Marchegiani: So, really excited to dive into that today, man.

Evan Brand: Oh, yeah. You know, so many women, they report to us. We'll have on the intake form. What's your current weight? What's your desired weight? And it's always desired 20 pounds less than the current weight. A lot of these women say, look, I feel and look six months pregnant.

Evan Brand: This bloating hits. I'm not sure what it is. Some women say, Hey, I even get bloated when I drink water. Some say they find it's related to way or or some sort of a nut allergy or sensitivity. Some say it might be related to gluten or other types of dairy products. Maybe it's certain grains like rice or corn.

Evan Brand: So I think there definitely is like a dietary food intolerance aspect to it, but I have so many people that are eating a great diet and they're still having bloating issues and it's usually something deeper. So most of the time you and I see people, they've already been eating better, quote better. You know, it's different for different people, but.

Evan Brand: On average, people have already started to eat more whole foods diets and they still have this problem. Dr. Justin Marchegiani

Dr. Justin Marchegiani: Absolutely. So if we look at like the typical month long menstrual cycle, we start out the first half of the cycle is the follicular phase, typically days 1 through 12, 1 through 13.

Dr. Justin Marchegiani: This is where you're gonna start to see a Let's say FSH starts to increase at the pituitary level, that then starts to grow a follicle. FSH stands for follicle stimulating hormone. That follicle is gonna then start to produce and stimulate estrogen. So estrogen is gonna start to go up and peak around day 10 of the cycle.

Dr. Justin Marchegiani: So estrogen is peaking like this, and then as estrogen is peaked up, this is where your likelihood of having the largest amount of symptoms is the highest, because you have a high amount of estrogen and you have a low amount of progesterone. And estrogen will, you know. It will hold, it will cause flow retention, especially if progesterone is low.

Dr. Justin Marchegiani: Progesterone tends to drop water. Estrogen tends to hold on to water. So, in that first 12 days, that's when you're really at this prone, very prone level. And when ovulation starts, typically, progesterone is gonna be at a high point, excuse me estrogen will be at a high point around day 12. And then progesterone starts to go up around day 12 or 13 and is peaked out around day 15.

Dr. Justin Marchegiani: So, you have this, this kind of like, you know, Estrogen's high, progesterone's coming up. Now, this is around day 15. And so, where estrogen and progesterone cross, this is where ovulation tends to happen. And so then, you have your hormones at the highest level for each right around that time frame. And then as you go into the luteal phase, this is where progesterone's gonna go really high, and then estrogen should be lower.

Dr. Justin Marchegiani: Now, A lot of women, they have a luteal phase defect. They have very low progesterone. They don't have a nice peak progesterone surge, partly because of cortisol and adrenal stress, because progesterone can pinch hit for cortisol. So the more chronically inflamed or stressed woman is, that progesterone will be lower and then that will create a lower progesterone imbalance and that's going to also throw off fluid retention as well.

Dr. Justin Marchegiani: It's why it's very common. premenstrually to have this breast tenderness or just feel swollen or have back pain because that progesterone is lower and that's progesterone is really important for muscle relaxation and also helping to flush flush water out. And so we have this estrogen progesterone kind of balance there out of the gate.

Evan Brand: Yeah. So do you think this explains why, I mean, when you look around in society, men as well, that everyone just, you got all this bigness, all this fluid, I mean, the obesity rate in this country is massive. I mean, even since you and I started recording content a decade ago, you know, people are just large people.

Evan Brand: They're just larger. How many of these men out there do you think walking around with an excess estrogen problem that's driving this water retention and bloating?

Dr. Justin Marchegiani: It's a great question. I mean, I think when you look at women, it's different because it's going to have a cyclical correlation with it. And of course, like, we live in a very estrogen dominant world with GMOs or pesticides or organochlorine pesticides or plastics all having kind of an estrogen backbone to it, BPA or BPS, which is, you know, hey, this bottle is BPA free, right?

Dr. Justin Marchegiani: It's really just BPS, which is even worse than BPA. People are like, oh, great. I'm doing a good job. No, not really. I mean, sub it for a stainless steel or a glass one, and then you're in a better, better place. And then also, yeah, so there's this double edged sword of like, okay, now you start to gain more fat.

Dr. Justin Marchegiani: And then fat actually is an extricant hormone in itself. Extricant, extricant gland where it'll actually produce estrogen in and of itself. And then if you add an insulin resistance, insulin will increase and that will cause more sodium retention and then water follows sodium. So as insulin goes up, sodium goes up, water goes up and then you hold on to that water.

Dr. Justin Marchegiani: That's why I like it. You see someone on an Atkins diet, you know, for every one gram of glucose you drop, you're going to drop three parts of water. And so when you drop carbs, you drop insulin, you drop sodium and you drop water. And so if you're insulin resistant and you're eating inflammatory foods like processed gluten, flour grains, maybe processed dairy.

Dr. Justin Marchegiani: Now, You have more inflammation. Inflammation is driving more cortisol. Cortisol is driving more glucose. Glucose is driving more insulin. Insulin is driving more sodium. Sodium is driving more water. And then you're also producing more fat. Fat produces more estrogen. And thus, the cycle continues perpetually.

Dr. Justin Marchegiani: I know it's a little confusing, but when you connect the dots, you're like, Oh, that makes sense.

Evan Brand: Yeah. It's a runaway train. So people hearing this are like, okay, I hear what you're saying. There's a hormone problem here. Maybe a dietary problem as well. Where do I start from the testing perspective? Is this something that we can just investigate via blood?

Evan Brand: Is it necessary to run more functional labs like the urine or the saliva to look at a cortisol or a hormonal rhythm in that way? Where do we approach the testing? Great

Dr. Justin Marchegiani: questions. Let me just go over a couple more scenarios and then we can talk about testing because the testing will be more specific to the different scenarios.

Dr. Justin Marchegiani: So, first one is we have our typical cycling woman, right? Cycling age, right? Less than 48. Typical monthly cycle, 28, you know, 26 to 30 days. Maybe there's some PMS right before menstruation and or right during menstruation. but it's a typical relatively stable cycle. You know, they're going to see more fluid retention in that maybe first day one through 12.

Dr. Justin Marchegiani: Maybe they're going to have some PMS things that involve some fluid retention swollen breast tissue, back pain, right? There's some different, you know, things that we can do for that. And there's women getting to their forties. I'm gonna be more perimenopause happening where estrogen is actually starting to drop.

Dr. Justin Marchegiani: They may actually experience some hot flashes during their cycle. They may actually experience some menopausal symptoms during their cycle, but they're still having a cycle. But they're just starting to feel more like menopause is setting in partly because estrogen Estrogen levels are dropping. Now this is important 'cause as estrogen levels drop, this can also weaken pelvic floor muscles and that weaker pelvic floor muscle could cause more digestive issues 'cause it's gonna exacerbate, motility, it's gonna exacerbate just bloating.

Dr. Justin Marchegiani: 'cause those intestinal muscles are important for moving the food that you're eating in your intestinal tract out. And so that drop in estrogen could be weakening the pelvic floor and they can be exacerbating bloating and digestive issues just 'cause the muscles are not as strong as they should be.

Dr. Justin Marchegiani: So that's important to think about out of the gate. And then of course, as you go full on menopausal, now you're not having a cycle. It's been a one year, right? Now you're kind of menopause to post menopause, right? Menopause is like that first, like one year of not having a cycle. And then once you no longer have a cycle, now you're kind of post menopausal, but post menopausal is, it's a little bit.

Dr. Justin Marchegiani: Dishonest because you can still have a lot of menopausal symptoms even though your site's been one year since you've not had a cycle. So, you can still have hot flashes, mood issues, and skin issues, and libido issues, and vaginal dryness, and and collagen elasticity issues. You can still have a lot of other problems even though you're technically, you know, post menopausal.

Dr. Justin Marchegiani: And then we can also throw PCOS in there when we have,

Dr. Justin Marchegiani: And that's causing more androgen growth and that's causing maybe more acne, maybe more hair loss. It may be causing other types of issues, maybe increasing prolactin and throwing off the cycle. The number one cause of PCOS is gonna be prolactin. So the number one contributing factor of PCOS is going to be infertility.

Dr. Justin Marchegiani: So PCS will, PCOS will drive infertility in 25 to 50 percent of cases. And so anytime someone's complaining about infertility issues, always look at PCOS. And then of course we can look at fibroids or endometriosis which are typically going to be driven through excess hormonal, you know, imbalances, typically on the higher levels on the estrogen side.

Dr. Justin Marchegiani: But those can also drive infertility. digestive issues, bloating, diarrhea, and constipation. And then, obviously, that can throw off some of the hormonal and fluid imbalances issues. As your estrogen drop, that also can throw off fluids and electrolyte issues, and that can also cause fluid retention, too.

Dr. Justin Marchegiani: Evan Brand

Evan Brand: Yeah, there was one paper here that looked at women with endometriosis. They call it Endo belly, 96 percent of women with endometriosis had belly bloating. So this is a big deal of building up a lot of tissue and creating inflammation in the abdomen. So that could be swelling, water retention, bloating, the endometrial like tissue that can cover or grow into the ovaries and then trapped blood can then form cyst.

Evan Brand: So now you've got a cyst problem as well. And then there's also some literature here saying that those with endometriosis are more prone to SIBO. So So, there you go. So, if you're trying to tease this thing apart, you can see why just a short visit in the OBGYN office may not be very helpful because you might get this birth control recommendation, which you and I have heard this story thousand times, they send them home with birth control, and this is not gonna address any of the dysbiosis or other digestive problems internally.

Dr. Justin Marchegiani: Now, when you're seeing hormonal symptoms, symptoms that are driving digestive issues, you're typically going to see it more cyclically kind of correlate with the cycle and you'll see other usually hormonal related symptoms kind of correlate with it. Whether it's mood, whether it's libido, whether it's skin, hair, right?

Dr. Justin Marchegiani: And so, usually with digestive issues, it's going to be more connected to the daily rhythm of your meals during the day. And so, We can definitely do stool testing to look and see, is there SIBO, is there fungal overgrowth, candida, is there H. pylori, is there a parasite issue? We can also work on adding in digestive support, adding in and getting, getting the diet better and cleaner and see if that helps.

Dr. Justin Marchegiani: A lot of times if we get the diet better and cleaner, and we start to have better digestive support there, that can give us even better results. It's feedback if it's digestive or hormonal. Typically hormonal issues take a little bit longer to kind of move the needle on because there's a lot of inertia and momentum you have to move.

Dr. Justin Marchegiani: We're usually, if it's from digestion, we can start to see that improve a little bit sooner. And so that can tell me a little bit clinically about what's happening when I start to add interventions in and what starts to move the needle, that can tell me about what the root cause potentially

Evan Brand: is. Yeah, well said.

Evan Brand: I mean, maybe within what, a week or two, if it's more digestive food intolerance related. I mean, let's just say, let's just say

Dr. Justin Marchegiani: someone has low stomach acid, like we're getting the stomach acid up and a low enzymes that could help too.

Evan Brand: Well, how about take the woman who is doing salad for her lunch. And she's doing beans or peas or lentils or something for her dinner.

Evan Brand: I mean, you take that woman off of those things. I would expect to see a reduction in symptoms. I mean, within a couple of days.

Dr. Justin Marchegiani: Yep. Definitely. Especially if they're having a high amount of fermentable foods, high amount of FODMAP foods, especially a lot of raw foods. vegan, vegetarian kind of things, think they're helping their digestion with more raw stuff because there's more enzymes, right?

Dr. Justin Marchegiani: Well, there's a lot of more fermentable fiber, so if the gut bacteria is off, that could be the fertilizer fueling some of that too, right? And a lot of those foods could be very inflammatory if we're looking at like oxalates or salicylates or phenols, a lot of, we call them anti nutrients, if you will.

Dr. Justin Marchegiani: There could be a high amount of those that could be really disrupting digestion too.

Evan Brand: Evan Brand I mean, some of the best looking women, if you can find, whether it's celebrities or internet. Influencers, and if you see a woman who's like a fitness influencer discussing diet, most of those women, the ones that look the best, that have the least bloating, the flattest looking tummies, they're pretty much animal based.

Evan Brand: They're definitely more meat heavy and less vegetable heavy. They're not just posting a daily salad photo.

Dr. Justin Marchegiani: Yeah, and almost any people like that that are going in and doing some kind of a picture or video shoot, they're probably going to be going into that with a two or three day fast. And that fast alone is going to decrease inflammation from their diet.

Dr. Justin Marchegiani: It's going to decrease insulin. It's going to decrease their, their electrolytes too, potentially, and they may have less fluid on them. And so they may look a lot leaner too. And so fasting can be helpful, but I always tell patients the fast, the fasting benefits usually come from what you're not eating.

Dr. Justin Marchegiani: Versus the fast itself, you're not eating the inflammatory foods, or it's really helping you to get your insulin back in check, and then the lower insulin is causing less sodium, less sodium, less water, and then also you're not eating the inflammatory foods, so the inflammation and the cortisol starts to go down, and so, fasting has some benefits, but you know, it can also be a stressor if you don't have good electrolytes, good hormones, good blood sugar, and so, you know, just, you always take things with a grain of salt, if you will.

Evan Brand: Yeah, for sure. Okay. What about the labs? You ready to talk about those? How do we look into this thing and how do we approach it? Because in most cases, it's not just one thing. It's likely a potential I'll like to role play with you real quick. So, so, so here, here's the way I would see it is let's say we run the GI map and then you get down to page four.

Evan Brand: And you see because there's massive dysbiosis, you see there's elevated beta glucuronidase issues. Therefore, that's affecting the conjugation and the excretion of excess hormones. So now we know just this glucuronidation problem could be driving the hormonal problem, therefore driving the bloating, but that was all stemming from a gut infection that screwed up that enzyme.

Evan Brand: Dr. Justin Marchegiani

Dr. Justin Marchegiani: Yeah. And so, when we look at beta glucuronidase, that enzyme gets high and that makes it harder to detoxify our estrogen. So, we may wanna add in some binders to kinda help bind up estrogen better. We may add in things like calcium to glucurate or DIMM and NAC and glutathione to help us detoxify and help lower the beta glucuronidase, but you have to also get to the root cause of why that beta glucuronidase is there, which is you have to knock down some of that dysbiotic bacteria.

Dr. Justin Marchegiani: You have to make some of those diet changes, get your enzymes and acids better, and again, you may wanna do some testing because there could be a lot of different things. Things overlapping. You could have h pylori, there could be just your classic small intestinal bacterial overgrowth kind of milieu, which could be Citra, bacter, Proteus, Klebsiella, Morgan Ella staff strap.

Dr. Justin Marchegiani: It could be all those kind of, all the above, if you will. That could be out of balance. You could have some candida issues. There could even be. E. coli like toxin, E. coli like toxin, sugar toxin, it could be Clostridium difficile. It could be a bunch of things. So, it's good to get looked at and get tested.

Dr. Justin Marchegiani: You know, you see it a lot in some of your patients that have mold. There could be a lot of colonized mold hanging out whether it's Fusobacterium or Aspergillus. So, it's good to rule some of those things out so we don't miss anything.

Evan Brand: Yeah. And this is not just for your bloating. Okay. I mean, if you type in like glucuronidation cancer, you'll find that liver and colon cancers go significantly up if there's issues with this pathway in the body.

Evan Brand: So I know sometimes we might be focusing on what may be perceived to the average person as like a vanity problem. Like, Oh, I'm bloated. But really, these deeper dives cluing you into things that could potentially be potentially be trying to stop cancer before it occurs. I mean, I've seen women that have had cancer and on paper, unfortunately, we see some of the same things in other women that just don't have a cancer diagnosis yet.

Evan Brand: So we could take Sally over here, who's got major glucuronidase problems and she's got bloating. And then you've got Jenny over here who she actually has cancer and she looks the same on paper. So, I know there's other factors, there's chemicals, etc. But it is interesting to see that. Dr. Justin Marchegiani Yeah.

Dr. Justin Marchegiani: I mean, so one of the first things we're gonna look at is just where are we at with estrogens in the environment. We're gonna look at that. Do we have a history of being on birth control pills? Are we on birth control pills now? With just a lot of the extra fluid retention, usually Sodium goes up. And if Sodium goes up, a lot of times Potassium can go low.

Dr. Justin Marchegiani: Because Sodium and Potassium have this natural relationship. And the DRI, the daily recommended intake for Potassium is around 4, 700 mg. Most people don't get that. Dr. Justin Marchegiani. Head over to chronometer. com. Just, it's like a MyFitnessPal, but it will look at nutrients. Run a sample there. Run a sample breakfast, lunch, and dinner.

Dr. Justin Marchegiani: You'll find most people don't even get to half the level of potassium they need, just 4700 mg. Now, I mean, you get about 1 gram per avocado you get. So avocado is a fast track way to get it. You can get it with some sweet potato. You can get it with some high quality fish or beef. People think banana, but bananas are much more carby, but it's got half the amount of potassium as an avocado.

Dr. Justin Marchegiani: Avocado is much better, much more blood sugar stabilizing too. Good healthy mono and saturated fat. So you gotta really look at, you know, your nutrients, your macros, and get things dialed in. So we can get the potassium up, which is helpful. So my line, we use a powder potassium just because most potassium capsules are like a hundred milligrams a cap.

Dr. Justin Marchegiani: So you're taking 10, 20 caps a day, which can be a little bit annoying. So we'll do a powder capsule and mix it with some sea salt together. Okay. A lot of people, they'll also do things like, that have a natural diuretic like dandelion root. Dandelion root's also really good at gallbladder flow and gallbladder support, so it helps with fat digestion.

Dr. Justin Marchegiani: Well, if you're estrogen dominant, guess what happens to your bioflow? Right? Get stagnant a little bit. And so then it can be harder for you to break down fat. And so then this is where you start to get the the gallbladder crystals starting to show up, right? And this wasn't said by me. This was said by a surgeon.

Dr. Justin Marchegiani: I remember I was assisting in a procedure where they were taking out a woman's gallbladder. And the doctor turned to me, yep, she has all the risk factors. I'm like, what's that? She's like, he goes, the three Fs. I go, what's that? He goes, female, fat, and 40. 40 plus. I'm like, Oh, so if you're overweight, makes sense because you're insulin resistant.

Dr. Justin Marchegiani: Now, most people who are overweight, this is back like 20 years ago, the low fat diet was all the rage. And so if you're overweight, you're doing low fat. Well, the problem is if you're low fat, what macronutrient tends to go up when you're low fat, more carb, right? So that if you're low fat, then you don't empty your gallbladder efficiently.

Dr. Justin Marchegiani: And if you don't empty your gallbladder efficiently, those crystals are more likely to, to form. And so got to keep. So, if you keep the fats low, and the carbs go up, and then you have estrogen issues, whether it's estrogen dominance, which you could have low pro you could have low estrogen and still heavy estrogen dominant, because that progesterone has skewed much lower than the estrogen has.

Dr. Justin Marchegiani: So, keep that in the back of your head. And that can throw off bile flow. So, things like dandelion root can be helpful. Now, we may be adding hydrochloric acid, because hydrochloric acid it's it's it's it's stimulates cholecystokinin, which causes our gallbladders to contract, which is important. So, just getting your HCL up, you can actually help your gallbladder.

Dr. Justin Marchegiani: But we could add in dandelion. We could add in beetroot powder, which I know you use some for some of your mold patients. So, you could be helping people's gallbladder just by helping them detoxify mold indirectly. And then you could add in phosphatidylcholine, taurine actually ox bile in and of itself, extra lipase enzymes and your proteolytic enzyme support.

Dr. Justin Marchegiani: Those are all good options out of the gates.

Evan Brand: Oh, yeah, so get the stool. We could do hormones so we could do blood We could do urine also like we could run a dutch panel and look at all the different types of estrogen You will get some neurotransmitter stuff on there as well. So a lot of times these women are not just bloated They could be anxious.

Evan Brand: They could be depressed. They could have chronic fatigue as well So we're gonna help you with the mood issues, too. It's just for Marketing purposes, we're titling this thing about bloating, but I hear you, and I know that more than just bloating, you have XYZ symptom, which could be the low libido, which is tied into all this.

Evan Brand: Maybe you just don't feel sexy because you're so damn bloated, right? It could be like a literal vanity thing, or it could be, hey, this bloating is a clue that hormones are really off, and that's why you have no libido. So, we hear you about the Tangential symptoms that are related to this whole bloating.

Evan Brand: The bloating is just the thing for us to point and go, Oh yeah, that's a problem, and then we're gonna help you fill in the blanks of why. So, you know, we can run labs anywhere in the world and help you all out. So, if you need help, if you're sick of getting a five minute appointment and being recommended birth control.

Evan Brand: I mean, I've heard women in their fifties being put on birth control. I'm sure you've heard this too. It's kind of crazy to help their symptoms. It's like, yep, just take birth control and that's it for the appointment. I don't like that, so if you want something better, you know, we can help you. Dr.

Dr. Justin Marchegiani: Justin Marchegiani Now, like, I always, people say, Oh, do dandelion, do this, do birth control pills.

Dr. Justin Marchegiani: It's like, well, what's the mechanism they're trying to, to, to push to then control the symptom downstream? Because if you understand what mechanism they're trying to push, then we can say, Is there a better mechanism that can gain control over that without these synthetic hormones? And so usually with birth control pills, they're trying to increase estrogen.

Dr. Justin Marchegiani: It's usually an ethanol estradiol, kind of one of those, you know, low, low estrogen type of products that's going to increase your estrogen that will then dust decrease your FSH. And a lot of times that FSH, for instance, can cause this phase of dilation and add into the hot flashes. Now, So they're trying to bring the FSH down by giving more hormone, which then can help with the estrogen symptoms like the, the hot flashes and such.

Dr. Justin Marchegiani: Now, we may use maca, we may use black cock black cohosh if you will. So these are different like estrogen modulating herbs. I like the herbs that modulate because they can fit in that receptor site and they can kind of tune it up or tune it down. And then we may also add in progesterone along with that because a lot of times there's this estrogen progesterone imbalance in almost anything synthetic that conventional medicine adds unless it's It's like a, like a Marina or a Skylar.

Dr. Justin Marchegiani: These are different. Or Kylena. These are different like synthetic progesterone IUDs. The problem with those IUDs is they're just leaching progesterone like all the time for literally years at end. And you're not cycling progesterone like it should, right? And so you're not getting that nice luteal phase increase and then drop.

Dr. Justin Marchegiani: You're getting this like low, low trickle, which doesn't really mimic what nature does. And so we may use adaptogenic herbs. We may use progesterone. We also have to be very aware that when you add progesterone in for the first time, it can sensitize estrogen receptor sites so you could feel bloated and flow retention.

Dr. Justin Marchegiani: That's why I always add these things low and slow and steady. We do sublingual and we may also add in NAC or DIM or support to help with clearance. If we see like two methoxy, two hydroxy estrogens off or if we see pyroglutamate or some organic acid markers for detoxification are off, we may throw in additional binders.

Dr. Justin Marchegiani: Or additional support on the estrogen detoxification site

Evan Brand: too. Heck yeah, man. We can do this with urine too. So this is a really fun process if you don't hear the passion in our voices, you know, this is a, a true fun, enjoyable process to get yourself regulated to where you could feel good. You could look good.

Evan Brand: You can sleep good. Your mood can be well. So yeah. This is a sustainable goal. So I hope that women, if you're listening, you know, maybe get your husbands on board. Maybe they're skeptical and they haven't supported you in this journey of seeking different solutions. Maybe the conventional model has let you down.

Evan Brand: You need a functional medicine strategy, a plan in place. We're happy to help you do that. So if you have anything else, let us know and then let's wrap this thing up.

Dr. Justin Marchegiani: So just to kind of give like a mind map overview, because I know this is like overwhelming and like my brain always. compartmentalized stuff.

Dr. Justin Marchegiani: And I create like a little mind map so I can follow it. So the first thing out of the gate with any kind of bloating, the first thing is getting inflammation down in your diet, get better digestion. That's going to be the first thing. Cause if we have insulin issues, that's going to cause flow retention.

Dr. Justin Marchegiani: If we're eating inflammation, that's going to cause cortisol. That's going to cause. insulin. That's going to cause excess sodium and it's going to cause all kinds of problems. Now, obviously, the more you're inflamed, the more the hormones go off, the more you can skew progesterone down. You can have estrogen be a little bit higher relatively if you're more of a cycling woman.

Dr. Justin Marchegiani: And then as you go perimenopause, that estrogen is dropping, menopausal dropping, dropping, dropping. This is where we have to add in more interventions regarding estrogen progesterone. And this is where we start to have a lot of this lower this kind of lower What was the word? Like the core, the lower part of the core, right?

Dr. Justin Marchegiani: That lower core area starts to become very weak, right? Yeah. The pelvic floor is the better word. Yeah. That lower core floor starts to become weaker. And this is where doing squats or lunges or single leg step ups. Like doing strong, functional movements can be great. I did a podcast with a woman. She has this ball that you sit on and you squeeze your butt muscles too.

Dr. Justin Marchegiani: That can be helpful. But she always, she said in that podcast, doing step ups and lunges, so doing those good single leg movements where you really activate your core on the, on the front, and then. that will also help activate the core from below that pelvic floor part of your core. Because really the, the, the core is you have the front muscles here.

Dr. Justin Marchegiani: This is your rectus abdominis and then your external and internal obliques. Then you have the back muscles which are going to be your multifidi. And then you have the pelvic floor on the bottom and then your diaphragm on the top. So you get this box happening right here. Look at this box happening. Oh, you put a thing on screen.

Evan Brand: Evan Brand Yeah. I found, I found a little graph on this just to help women kind of look and plot where they could be in terms of age. So on the horizontal axis here, you've got your age. And then over here on the vertical axis, you have your average hormone production. So, I mean, on average, you're peaking maybe mid to late thirties with your estrogens.

Evan Brand: And then by the time you're 50, you know, you've had a massive, massive decline on average. There's way geekier graphs out there, but I think this is just a simple way to look. And if you look back at your life and where you felt good compared to where you are now with your age and your symptoms, I hope this would help explain a little bit of it.

Evan Brand: Dr. Justin Marchegiani

Dr. Justin Marchegiani: 100 percent and it's good to look at the root underlying cause of why you're here. First thing I recommend is find a good practitioner because you're going to want to get testing, especially if these issues are more chronic or you're going in to perimenopause or these issues have been going on for quite a while and you've gone to your conventional medical doctor and they said, Hey, first control pill, antidepressant, or as you get older, they're maybe recommending an IUD or maybe they're recommending super high dose of bioidenticals and you want to do something more natural.

Dr. Justin Marchegiani: bioidenticals can be great. You just got to look at the dose and dial things up. I mean, with women, I'll recommend 25 to 50 milligrams starting out with progesterone. I'll see some more natural minded obese go up to 300 milligrams, maybe a little bit high, right? Especially if you fix the adrenals, fix the gut, and all the inflammation gets better, you may not need as much of that.

Dr. Justin Marchegiani: So, it's good to look kind of deep in that. Evan

Evan Brand: Brand Check this graph out, too. This is pretty interesting here. This is just looking at women, you know, 35 and beyond really starts this decline. On average here, 75 percent reduction in progesterone from ages 35 to 50, my Lord. And then estrogen on average, 35 percent reduction from age 35 to 50.

Evan Brand: Dr. Justin Marchegiani

Dr. Justin Marchegiani: Yeah, absolutely. And then at some point, estrogen may need to be added in. I typically do not recommend adding estrogen in until the ovaries. are kind of no longer functioning, if you will. We're in that kind of menopausal time frame. Then it may make sense, you know, it's been a year or so since you've had a period, we may use more herbal support to modulate estrogen.

Dr. Justin Marchegiani: And then once it's been a year, we may start to add in some bits of bioidentical estrogen based on. lab testing tend to more favor more of the estriol support because it tends to be a little bit more cancer protective as well.

Evan Brand: Yeah, I'm glad you brought that up because that is a controversial subject.

Evan Brand: We should do a whole part two, three on that. But then I do like here how on this graph it's showing the big gap here between estrogen and progesterone around age 50 and how this is really why you see so many women not very happy and not very horny at age 50.

Dr. Justin Marchegiani: Yeah. And that's where the progesterone is really important for water.

Dr. Justin Marchegiani: Decrease too, right? It can help with water decrease and know for more estrogen dominant, right? Progesterone is lower in this gap here. This is where we're going to have some problems. So, you know, I think it's a really great point. And then just to highlight that too, when we talk about hormones, a lot of times conventional medicine misses the adrenals because the adrenals are the backup generator as you go into menopause.

Dr. Justin Marchegiani: And if you go into menopause, then your backup generators on empty. right? Let's do now. Let's switch to the backup generator in your house. If it's on empty, you don't have the propane to support it. The storm comes now doesn't work. And so now you need more hormones, more support because the adrenals aren't there to pick up the slack.

Dr. Justin Marchegiani: And part of how I think we get better results than most other hormone specialists is we really look at the adrenals too, because those are what's responding to your day in, day out stress. And that's what produces your cortisol rhythm, which is daily, not just your menstrual cycle, which is monthly.

Evan Brand: Evan Brand Yeah, well said.

Evan Brand: Well, if people want to reach out, they can get help from you directly. That's Dr. J, Dr. Justin Marchegiani. That is at the website, justinhealth. com, justinhealth. com, consults anywhere worldwide. And me, Evan Brand at evanbrand. com. We're happy to help you all. We'd love the opportunity to be able to run some of these labs and investigate this with you and hold your hand through this process.

Evan Brand: You know, it can be very, I don't want to say scary, but we'll just say this. A lot of women, they try to fix themselves, and then they listen to a webinar, and a podcast, and a blog, and they buy this supplement, and they buy this probiotic, and they buy this enzyme, and now they're 22 and a half supplements into this thing, and they don't know what the hell they're doing, and they don't know how to get better.

Evan Brand: We end up saving them money and time by simplifying, but also targeting. the protocol to their issues. There's a hundred things you could take that might help and can't hurt. But really, is that what you need or do you need a smaller targeted plan? And that's really our goal.

Dr. Justin Marchegiani: Dr. Justin Marchegiani 100%. And I know you deal with a lot of mold issues and mold can impact estrogen too.

Dr. Justin Marchegiani: And so we see that a lot. too. So it's very important to get your gut looked at, potential mold looked at, and you may have colonized mold going on in the gut, and that's an important thing. And if you have mold in the gut, then where do you look next? You gotta look in the environment. When you go down the rabbit hole of mold, it can get very overwhelming.

Dr. Justin Marchegiani: It can get very costly unless you have people to help you navigate it and kind of do it the most cost efficient ways possible. So just when you guys are thinking about this, don't get overwhelmed. We're here to help assess, not guess. So evanbrand. com for For Evan, and then justinhealth. com. For me, we're here to help.

Dr. Justin Marchegiani: And put your comments down below. We'll be responding to those. Evan, any last words, my friend? Evan Brand Well, it sounds like we're gonna have to do part two. Mold, bloating, estrogen. So, let's

Evan Brand: plan that. Dr. Justin Marchegiani Let's do it, brother. Alright, man. You have a good day. Alright, take care. Alright, peace.

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