Welcome to the Data Driven Health Podcast, where we discuss thyroid health and lab testing with Dave Korsunsky, founder of Heads Up Health. In this episode, we explore the importance of thyroid function, key lab tests, and factors affecting thyroid health. Dave shares insights on personalized treatment plans and the role of data-driven decision-making in managing thyroid disorders. We also dive into the Heads Up Health platform, which integrates health data for optimized thyroid health management.
Discover emerging trends and advancements in thyroid testing, as well as the future of data-driven thyroid health management. Learn tips for improving your thyroid health through collaboration with healthcare professionals and empowering yourself with data and technology. Don't miss this enlightening conversation on the intersection of health and technology for thyroid health management. Subscribe to the Data Driven Health Podcast for more episodes like this!
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In this episode, we cover:
00:51 – Dr. J Brief Background
05:44 – Thyroid Health by Dr. J
11:24 – The Thyroid Book Sneak Peak
20:24 – Emotional Stress Impact on Overall Health
30:07 – Temperature Testing
35:54 – Top 3 Metrics of Dr. J
39:49 – Takeaways
Dave Korsunsky: Today, is an old friend and colleague, a guy who's been in the game just as long as I have. Actually, a guy who's responsible for a lot of getting me into Health Optimization and fixing my health. So, I'm pleased to welcome, Dr. Justin Marchegiani to the show! He's going to share some of his expertise on specifically thyroid, but he can go deep in all kinds of different areas on Functional Health. Doc, welcome to the show!
Dr. Justin Marchegiani: Hey, Dave, thanks so much! I mean, I remember years ago, you're like “Hey, I'm thinking about doing this podcast thing. How should I do it?”, and here you are man. You're making it all happen, so love it. Love what you're doing here. This is great! And excited to to drop some serious knowledge bombs on today's podcast. This is good.
Dave Korsunsky: Yeah, there's just a ton to unpack with respect to Thyroid Health especially what are some of the more functional interventions for thyroid health. I really want to go deep on that topic today but before that, for everyone who's listening, if you've been listening to this show for quite some time, just a little bit of history with Dr. Justin and I. Dr. Justin and I first met at the one of Dave Asprey's very, very first conferences ever. (Yes) So, this was I believe 2012, and it was the very first biohacking conference data Asprey ever had. Now it's thousands of people and it's in Beverly Hills, and Florida, and it's just gone insane.
But the first one Asprey ever had was in the San Francisco tenderloin, in the basement of a hotel, (Yes) and there was about 20 biohackers there, and Dr. Justin was there. And he had his adjustment table out, (YES!) and he was just, after the conference, he was just hustling. He was doing adjustments, he was like just on it. And then, doc you were you were practicing in Cupertino, at that time. (Yes, that's correct.) And I was living in San Francisco, and I started coming to your office in Cupertino, and I started working on my health with you. You were really the first functional doctor I'd ever worked with.
And what was amazing about working with Dr Justin was, he was the first person who could actually go and find all those subclinical things that needed to be addressed, that every other healthcare professional I'd worked with had missed. So, for example Justin, you identified some issues with um thyroid that we're going to talk about here today. I had very high levels of reverse T3 and we're going to get into what that means. Now, why does that matter? Well, nobody I'd ever worked with medically had run a full thyroid panel. They just ran some half-assed TSH panels. So, that was the first thing.
And then you started looking at more of the functional testing. You started looking at the microbiome and you were the first to identify that I had a gram-negative bacteria in my microbiome which is not bad we all have it. (Right) But what happens is, in some people, it gets out of balance relative to the other parts of the microbiome. And you were the first one I was able to test that and we worked on it. And all through this process, I was keeping all the lab test information you were running for me in a spreadsheet. And then what I did was I'm like “Hey this is pretty interesting!” I went back to all my old doctors and I got all my old blood work and I added them to the spreadsheet.
So now, I had the data from when I was working with you, but then I also had 10 or 15 years more into the future from past doctors. And that's honestly where I had the Aha! moment for Heads Up, which is “Wow! I actually have more insight into my health than any doctor will ever have because all I did was put this data in a spreadsheet.” (Yes!) pardon my French. (Yep!) And it's like “Why is the system now able to do this?” And I could see trends that had been going in a certain direction for 10 years and there is zero chance that any medical professional would ever be able to see that. Not because they don't they're not looking it's because the system is so fragmented.
I had four patient portals to log into: Quest Lab, ofcourse Stanford, UCSF, St Mary's to try to cobble this data together. So before we dive into the thyroid topic, I just thought it'd be fun to reminisce a bit doc about like, how we first met. We were, we've been doing this biohacking thing since 2012. So we're kind of like the OGs and just how you, actually working with you (Exactly!) and then, you might remember we started even designing screens together for the app.I'm like “Hey Justin what do you think about this screen for like tracking ketones?”
And you're like “Well you also need a, you also need to add a tag for this.” And actually the one for blood glucose you're like “Well you need these little pieces of information and change it this way.” So, we started actually like work on some of the early user interface designs together. So it's fun. It's been like, I don't know man, gosh 10 or 11 years now we've been working together.
Dr. Justin Marchegiani: I love it man. it's great! Time flies, this is awesome. And we're gonna kind of reminisce a little bit and try to coalesce some good information to help the listeners out so that's phenomenal, I love it.
Dave Korsunsky: Yeah, so you know, also Justin, I've seen you speak at a number of conferences. I've seen you speak at paleo FX, among other things and you have an incredible amount of expertise on thyroid. And I thought we could spend some time discussing that today because Hashimoto's, Graves, low energy, weight gain, metabolic dysfunction, blood sugar dysregulation, there's so many things really that, that are all correlated and tied to Optimal Thyroid Function, autoimmune conditions, autoimmune thyroid, and even if you're listening and you've never even run a full thyroid panel on yourself, and you're working on a lot of these things.
It's an area that Justin has a tremendous amount of expertise on. So, doc maybe we could just start by having you give us a basic overview on the thyroid gland itself. What it does? What is that cascade of hormones that starts like right from the pituitary? That whole cycle if you can break it down for us and then let's get into like the full thyroid panel. Why it's different from just looking at TSH? And what tests have to be on the full thyroid panel to get a full picture of what's going on?
Dr. Justin Marchegiani: Yeah, awesome man, great question.
Dave Korsunsky: Hey, I hit you hard there doc with a couple of big ones right out of the gate.
Dr. Justin Marchegiani: No that's good, that's good. I'm excited to dive in. So I mean first off, I got a book on Thyroid Health coming out called The Thyroid Reboot. So, my first chapter I give that away free. So if you go to justinhealth.com. You can get access to it. I have a lot of the the lab ranges and everything there, so some of this stuff will be there. So it's kind of like, think of it as like a clip note, so someone wants to get access – justinhealth.com
Dave Korsunsky: Yeah we'll link to it here as well. (Yeah) And we'll link to that chapter and then the book.
Dr. Justin Marchegiani: Perfect, that's awesome. So I mean, out of the gate, like thyroid health is a major issue just today in general. I think it's one out of five, women have it. There's an autoimmune implication that tends to get skirted over by conventional medicine because you know, the medications to treat autoimmune conditions, a lot of times are worse than the actual issue. And we still have a very antiquated way of looking at thyroid health, right?
Conventional medicine looks at things from a disease-based state. They're like, “All right, let's just fix the pathology so the labs don't represent a disease pathology.” But that doesn't necessarily mean you feel good, you're healthier, your energy is better, your mood's better, your hair is better. Doesn't necessarily mean that we can get that TSH back into range, but are you really feeling better? Is that correlating with the clinical outcome? And a lot of times, no. And so, that's one of the big things and also the indication, the late stage indicators like TSH, you could have a problem for five, ten years before that even pops out of range, where your doctor would even say, “Hey maybe there's an issue here.”
And so, we have one, just a philosophical disconnect, right? Function and performance over pathology and disease. And then number two is we have late stage indicators, how are we even testing this? What sort of indicators are we doing to even assess function and that can pick things up before they become a problem? And then number three I would say is, your hormones just don't dysfunction in isolation, right? Everything kind of happens together. It's like a spider's web, right? You touch one part of it, it reverberates.
And so when you have thyroid issues, there's a good chance there could be autoimmune, there's a good chance there could be gut, there's a good chance there could be adrenal health, nutrient deficiencies, toxicity. Of course maybe the thyroid is the weakest link out of all of them or maybe you have three or four equal weak links. So you have to look at everything with an open mind saying, “Hey, what else is going on here even though I resonate with all these thyroid symptoms? Cold hands, cold feet, hair loss, eyebrow thinning, constipation.
There could be other things also coalescing and driving that as well. And so we want to keep that open mind so we can really get to the root of what's happening.
Dave Korsunsky: Yeah, there's a couple things that came up for you just to relate that back to some of my own experience about that may be helpful for those listening. When I was working with you, I didn't necessarily have a lot of those symptoms. The hair loss, cold hands. I was working on just some body composition, weight loss. But I remember when you started looking at my full thyroid panel, you did indeed also find that my adrenal cortisol curve was not good.
Which means when you tested the saliva-cortisol at different points in the day, a normal curve. You wake up and your cortisol level starts going up, and then towards the evening time it starts winding down. So, you ran the thyroid panel and the adrenal cortisol panel. You were the first one to do that. It turns out my cortisol curve was out of range, which indicates there was adrenal issue there which you mentioned. And then you also ran the microbiome tests, and you were able to find that there were things in the microbiome that may have been causing the issue.
There was a stressor in my microbiome that may have actually been the cause of the adrenal fatigue, and also the cause of like subclinical thyroid. So that's just based on my own experience. And then you also mentioned something else which was kind of like the early check engine light. You know oftentimes, in a conventional diagnosis, by the time the TSH lab is out of range, you know, you've already been trending in the wrong direction for five or ten years. We do a lot in metabolic health.
It reminds me a lot, Dr. J of testing hemoglobin A1c, or actually starting to test fasting insulin. Which can actually give you an indicator, potentially years or decades before you get a diagnosis. So, is that a similar type of relationship insulin to hbac, and then like some of the advanced thyroid markers to identify thyroid issues early.
Dr. Justin Marchegiani: 100% Yeah, that's a big one. I mean, you can go right now into Google. You could type in T3 and insulin resistance or T3 and just you can look at diabetes. That'll give you the extreme but you're going to see all kinds of impairments because when you look at thyroid conversion, there's a lot of factors that are involved in that. Insulin resistance, cortisol inflammation, all play a major role. (Yeah) You asked me a question last time about some of the lab markers, let me just kind of dive back into that. I'll actually pull up my book on screen here, give you guys a little sneak peek before it goes to the editor here. (All right yes) Are you able to see it?
Dave Korsunsky: Oh hang on, let me just enable the screen share here. Yeah we got it doc.
Dr. Justin Marchegiani: Perfect, awesome! All right, so let's dive in. Here's the comments-
Dave Korsunsky: So if you're listening, we'll link to this. If you're watching on the screen, Justin is scrolling through some of the information that he presents on his website, in his book. So take us through a double.
Dr. Justin Marchegiani: This will be the new book here that comes out. So chapter one's gonna be the first one because we talk about some of the thyroid lab testing here. So let me just kind of dive into that. There's a couple-
Dave Korsunsky: Yeah, and please mention doc, the difference between TSH and the full panel because I think that's really the pearl here of making sure you run the full thyroid antibodies, T3, T4, reverse T3, like a lot of my friends and family in Canada, they can't even get a reverse T3 run. They just won't run, (Yeah) period.
Dr. Justin Marchegiani: Yeah, exactly! It's crazy! So, when we look at the kind of physiology of the thyroid, right? We have brain, the brain communicating with the thyroid to actually make T4, right? So, typically conventional medicine, they're only looking at this brain hormone called TSH. So they're like, “Oh, I'm going to test my thyroid.” Well, are you really testing your thyroid when you go to your conventional doctor? Or are you testing a brain hormone? You're actually testing a pituitary hormone. Now that pituitary hormone is a signaling hormone. It talks to your thyroid to make T4, here's T4 right here. It's relatively inactive. It's about three to four hundred percent less active than T3.
And so T4 is good to look at because if you have low T4, you're probably going to have low T3. So it's nice to see at least that component. Most are only going to run TSH, maybe you run T4. And then we have this conversion here, and this T4 goes either to active T3, or to inactive reverse T3, okay? And so, if we go back to some of your situation, you had this low level or this high level of reverse T3, this lower level of T3, and this is an important thing to look at. This can be very- (I had a conversion issue) Yup, exactly! Now there's another infographic down here that I made. Let me see if I can grab it.
Dave Korsunsky: So I hadnormal TSH, just for everyone listening. (Yeah) So, if you just tested TSH, I would have come back in range. I had normal T4, so that looked good. But then, when you looked at the level of T3, I was low, and when you looked at the amount of reverse T3, I was high. So my my T4 to T3, that step in the chain was broken. Did I get that right doc?
Dr. Justin Marchegiani: That’s correct. Yep, that's correct.
Dave Korsunsky: And then the question that you worked on with me is why. Why is that conversion not optimal? And that's kind of where you and I really started our thyroid work.
Dr. Justin Marchegiani: Yep! And here's a good infographic I made that kind of looks at a lot of the things that can impact this conversion. So we have different stressors, right? That have a major effect on thyroid activation. Cortisol, high or low. So this cortisol is a stress hormone, so if we're acutely stressed, it's good that cortisol goes up, right? That's a good thing. The question is, we don't want it to stay up where we're anxious, tired but wired, can't sleep, excessively sweaty, our sympathetic nervous system, our limbic systems and overdrive. So cortisol is a big one.
There's different nutrients, if we have selenium issues or anemia, anemia could be low iron, low B12. Because we're maybe, we have gut issues, dysfunction, maybe we're vegan or vegetarian, maybe we have low selenium, right? Maybe we're not breaking down and ionizing our selenium. We could have insulin resistance, we could have gut issues, inflammation, we could have gut bugs or gut permeability.
Maybe we're not eating enough protein. I mean, the backbone of the thyroid hormone is actually tyrosine, which is a protein. So, all of these things, you know, heavy metals, you could throw mold in there, with females low progesterone is a big deal as well.
So. all these are factors that can impact you know, thyroid conversion. So, when you go to your conventional doctor and they're like “Yeah, your TSH is okay.” Well is that enough? More than likely it's not enough. And then the question is, even if you run a full panel you still have to look at it with the mindset of like, “All right, which one of these things could be active? What do we have to dive into next?” Does that make sense?
Dave Korsunsky: That's exactly what I was hoping to get into. That kind of maps back to my own experience as well. I had to start looking at a lot of those things. I wasn't supplementing at all with B-complex. Turns out I needed to because of a methylation issue. That was I figured out later. Selenium, that's something that you had me add to my supplement stack. I still take it today. Iodine, I do take a little bit of that in in the stack. Insulin resistance, when I was working with you Justin at that time, I had no idea what it meant to check my blood sugar.
I had always been young and healthy and fit. And I'm like check my blood sugar. Even like stick my finger and get a drop of blood, and like, but actually that is probably one of the most profound things I've learned on the journey, because understanding which foods send your blood sugar off to the stratosphere, and which foods actually keep your blood sugar in check. That is a massive game changer, not only for thyroid health, but just for sleep and weight loss. So, insulin resistance, I had some early signs of that just from being ignorant to it, quite honestly.
And then gut, we already mentioned, I had some issues there. Make sure I'm getting enough protein, (Yeah) that's just really, really easy to overlook. So, I guess once you figure out that some of these lab ranges are not right, that's where the functional expertise comes in, and you start the diagnostic process. It's probably one or more of these things that all need to be addressed.
And the thing with the functional approach is, when you're working on these things like insulin resistance and micronutrient deficiency, they don't just fix. You know, the day after you start taking the supplement. Unlike a pharmaceutical which can have very, very fast acting effects, these types of things, they can take months, sometimes years to fix. Is that accurate?
Dr. Justin Marchegiani: 100% Yeah. I mean, these things you know, didn't happen in a day. A lot of times these problems have been going on, probably for a decade, before you even noticed it. And so, here's a graphic I just put down to the book here now. I have some of these images pulled out because when you're doing book editing, it's a pain in the butt to put color images. It just makes your book go up like three times in cost and everything. And so I'm trying to get a lot of these things converted to black and white. But I just pasted this in here, I think it's helpful. So just kind of looking at things, right?
We have brain signaling, is the starting the first Domino. Imagine like a Domino Rally, right? So, the first Domino is our brain, TSH. It talks to our thyroid and so things that can impact your brain, that things that can impact or get in the way of that first Domino, inflammation. So autoimmunity, toxicity, exposure to pesticides, heavy metals, right? Mold toxins, stress, cortisol, these things can impact that signaling and we can have what's called HPT-axis dysfunction. That just means hypothalamus-pituitary-thyroid dysfunction.
Think of it as you go to your thermostat, it's hot as heck out. You're trying to turn the thermostat down and get the AC on, but imagine the heat kicks on, right? So, you kind of have the signals of the wires are crossed, so the HVAC into the furnace. That's what's happening here. Next, we have our thyroid, it does a couple of things here. It actually can make T4, that T4 can be converted to T3 at that thyroid. That's your active thyroid hormone about 20%, and then we have issues in the liver.
And so, the liver is really important because the liver makes the 5-De-iodinase enzyme, that's selenium-based to help with the conversion of T4 to T3. That enzyme is a De-iodinase enzyme. What does De-iodinase mean? It means it takes off one iodine so you have T4, that just means tyrosine and four iodines. It pulls off one of those iodines now it's T3, so the the T4 and the T3 it corresponds to how many numbers of iodine are there. This starts the activation process. And so when you talked about having reverse T3 issues or a lot of stress, right? That's a big component is the liver. Because that helps that enzyme to activate your thyroid hormone.
Dave Korsunsky: Yeah, that makes total sense and I didn't, I was, again I was working for a huge tech company. I had a really fast-paced career. I was going out on the weekends with my friends, partying hard and I didn't have a good handle on healthy diet. I didn't, again this was before I'd started my journey. I didn't know what it meant to eat in ways that were healthy on blood sugar. I definitely was in what I would call a very high stress state just in the job that I was in. It was extremely stressful and I started, that's when I first even started learning how to practice meditation.
And I remember when I started practicing meditation, I would just sit for like 15 minutes at home before bed.And it was just it was profound change actually and that's that's when I started learning, learn how to down-regulate my own stress. And that's when I learned, how to not just with meditation, but other things that were really helpful for stress just like being outdoors more, spending time with friends and family. I started practicing Hot Yoga, which is intense but it was actually very, it helped with a lot of the, just the physical tension in my body, the muscle tension.
Because I was lifting heavy weights and being super physically active, so getting into the whole stress management part of it is another thing that's been hugely important for me. When you're working with client stock and you suspect that there's an emotional stressor, work, life, family, how do you make recommendations there? It's obviously different than a environmental or a chemical stressor. Any recommendations on that part of it?
Dr. Justin Marchegiani: Yeah, so when I always do my intake with patients, I always like to get a surveillance of what's happening emotional stress-wise. And so the big ones are going to be, is there work stress? Is there financial stress? Is there marital stress? Is there issues with the kids or just kind of the family unit? Or just kind of satisfaction or purpose in your life? I just try to get kind of a surveillance of you know, survey the landscape and see what's an issue what's not.
Everyone's going to have stress, the question is are you managing it? And so patients are like “Yeah, you know, there's some issues here or there but we're on top of it. We're functional. we're doing good. Nothing, I'm not sweeping any dirt underneath the carpet, I feel good.” If there is issues going on, someone's in the middle of a divorce, maybe there's lots of you know crippling debts, maybe they hate their job. Well, it's like all right, we just have to get really clear on what our goals are, right? And we have to make sure that we at least are doing one to two different things to fix the problem.
Our brains are- (It’s a good way to look at it.) They will, it's like you know, it was tax week. I think earlier in the week right, April 15th, right? Tax day, right? If I ignored filing my taxes and paying my taxes, my brain would chip away at me and keep me up at night because of the stress and the consequence that could happen. And so your brain's not going to stop until you start doing stuff. “Hey, reach out to your bookkeeper, reach out to your CPA.” It's trying to get you to take action and it will create anxiety and stress until you are motivated to do it.
And so just make sure that you're taking some action to neutralize these issues and so I just say “Write down the big three to five issues. Make sure you write down one to two steps that you are actively pursuing to neutralize that.” That gets the limbic system off your back and then you start to feel like you're getting momentum on that. And then, of course, you can do extra you know, stress management things whether it's you know, meditation prayer gratitude, you know, EFT-
Dave Korsunsky: Go to the spa, you know, like just even self-care fellows out there. Just go to the spa, they got like hot tub, cold plunge, infrared sauna, you know just take a couple hours there. And it's important doc, (And I’d tell patients- Yeah go ahead) I want to emphasize emotional stress as a potential impact on thyroid function. I don't think enough people make the connection between something like work stress and how that can affect your body's own chemistry. So that's just like the one connection point I want to make here is understanding that just purely stress can dysregulate this whole chemical process that Dr. Justin is explaining here.
Dr. Justin Marchegiani: Yep, 100% And I always tell patients the healthier you are, the more resistant to stress you are. And so, yeah you can have stressors but the healthier you are, the more you'll be able to deal with it and adapt to it. It's just the the stress that's high level and it's unresolved, and it's things you are not taking action on, that's where it gets a little bit concerning. So as long as you're taking action, or if you're in the middle of a divorce, hey our expectations are going to be down-regulated because stress is really high.
Dave Korsunsky: Totally and so okay in that stressful period for the next three months, all right. Yeah fine, let's deal with it. I'll make sure I put all my support structure in place. But then, when that stress ends, your body should be able to bounce back to where it was before.
Dr. Justin Marchegiani: Yep there you go, but the healthier you are, the more you're going to be able to adapt to what's happening. (Love it) And so just kind of looking at this last part here, I didn't quite go into it. But the reason why we have all these conversion issues, cortisol imbalances, guess what? That's going to be a big component of stress because what's happening when you're stressed, lots of cortisol, lots of adrenaline, it can deplete neurotransmitters, it can deplete a lot of nutrients.
You can open up guidance physiology textbook, right? And you'll see when you're stressed you're dumping lots of B vitamins and potassium out your kidneys. That's part of what's happening during stress, like you lose nutrients during stress. So the more stressed you are, the more you have to have your diet and nutrition and supplementation on because you're just, you have an expensive transaction fee so to speak.
Dave Korsunsky: Hey, you know, that reminds me Doc, there was another lab test I ran when I was working with you it was called homocysteine. And that's another one of these labs that it's very hard to get your conventional medicine doctor to run. Anecdotally, I remember that I got my, one of my integrative doctors to run it and I went to LabCorp and ran it. And LabCorp sent me a bill for 350 dollars for a homocysteine test. And then I went on the LabCorp website and I could buy the same test for seventy dollars, and my insurance company billed me 350. I'm like “Hey, shouldn't the rate that my insurance company gets be lower than what you get off the street?” That's when you realize how up the system is. Anyhow-
Dr. Justin Marchegiani: Homocysteine totally jacked up, yep.
Dave Korsunsky: It was out of range high for me and you said, “Hey Dave, this is probably related to B vitamin deficiency.” (Yep!) And so I, you gave me a couple different B vitamin complexes to try. Ultimately it took a combination of a couple of the right B vitamin supplements, right? Now, just for those listening, I use the Quicksilver methylfolate. It's a sublingual, and then I use another one that's in a pill format, from Designs For Health. And that combination gets my homocysteine down in range. So, that's I think I saw in my own physiology, the B12 deficiency. It showed up in a elevated homocysteine value among other things.
Dr. Justin Marchegiani: And then, conventional medicine, when they look at that here's they look at it. “Oh, you have a B vitamin potential issue. Let's just run a serum B12.” Well, that's probably not going to show up anything until you have, you know, unless you're extremely vegan vegetarian, or have a lot of gut issues, irritable bowel disease, those kind of things. So, you have serum B12 on one side, and then you have things like homocysteine, methylmalonic acid or trans-hollow cobalamin, that are much better markers, (Yep, we ran both of those) that are more sensitive things up. Yeah, and then, you could even put fig loo into that same camp, formula glutamate.
So, we can run some of these markers that will pick some of these things up even ahead of time. Now I just wanted to hit real quick here just some of the markers that we were talking about. You asked me some of the lab markers so I'll put this on screen again.
Dave Korsunsky: Yeah, what's the full thyroid panel? That's I think what we should get into. What's on it? There's like 12 or 14, if I'm not mistaken, that are on the full panel.
Dr. Justin Marchegiani: Yeah, I'll give you that. Approve me to add that to your thing, do you see it there? (Oh yeah, I see it doc, okay hold on) Yeah, I'm gonna add it back in here. (There you go) Okay, so first thing here, TSH right? That's the brain hormone, (Yep, that one’s standard) standard ranges about 0.5, right? I do about 0.5 to 2.5, that's a more sensitive marker. The American Clinical Endocrinology Society says anything above 2.5 starts to become a little bit problematic. So TSH, that's the brain hormone, that's here.
Okay, now we go to T4. Now free is always the most important. For a first timer, you can come in and run T4 free in total, that's totally fine. Total is going to look at the overall output, so my range is 6 to 10 on that mg to DL. Conventional medicine it's a little bit wider and so that's good to look at, at least 6, all right? Now, on the free, I like to be at 1 to 1.5 mg per DLs ideal, okay that's good. This is your relatively, inactive thyroid hormone. T4 still has roles in the body for brain health and bone but 1 to 1.5, but we're really T3 is going to be the thing, the next most important one.
We have some indirect markers here like FTI, not really important. Get the first chapter of the book you can see it. T3, same kind of thing. We have T3 total, this is going to be our overall kind of glandular output. This is about 100% of what's produced and then we have, guess what? T3 free, that's going to be the more active. Two to five percent of your hormones actually free. The other 95% to 98% are protein bound. So again, ideal healthy range is about 3 to 4.2, standard range is a little bit wider, 2 to 4.4. So, we want to be in that middle quintile to upper 25% quintile is a good place to be.
And on the T3 total about 100 to 160 is pretty good to be, that's excellent. Now, looking down below, there's T3 uptake. Again I don't typically worry about this if your T3 free is pretty good, it's good nice to have. We have reverse T3, it's another good marker. I, T3, reverse T3 can be important to look at especially when T3 free is is low, so reverse T3 when T3 free is low, I'm like “All right, why is it low? Do we have a reverse T3 issue? Do we just have a conversion issue? We're not really converting much T4 to T3 in general. Forget reverse T3.” (Yep, that was me).
When you have conversion issues, it's good to know, when this is high, it tells me a potential stress response is going on. And that reverse T3-
Dave Korsunsky: I was pushing it too hard. Training too hard in the gym, too much stress at work, going out on the weekends, you know, it was just like, it was all compounding.
Dr. Justin Marchegiani: Yeah, and so kind of right here, it talks about it reverse T3 binds into the thyroid receptor site just like T3 without the same metabolic response. So, it's like putting a blank in a real gun, you pull the trigger there's a loud noise but there's no bullet. It's taking the the place of the real metabolically active hormone. And then we have our antibodies, antibodies, thyroglobulin antibody, and then we have TPO, antibody down here below. These are the most common ones to look at Hashimoto's. So, anything above 15 or so or above 0.9 or so, on the thyroglobulin antibody, could be problematic.
We have thyroid binding globulin, this is a little bit, this is a lot of times going to be looked at when, when there I think is, see here this thyroglobulin, this is going to be looked at more for like cancer and things like that. And then thyroid binding globulin, that can go up when there's binding issues, so when there's a lot of hormones, you see it in women with birth control pills, or extra exogenous hormones, those can significantly impact those things or even you know PCOS and such.
So those are the big markers that kind of they are out of the gate. And now, functionally I'll run temperature testing along with that to see how the physiology. Because we know the thyroid plays a major role with the metabolism and so it's nice to correlate that with body temperature. Because metabolism and body temperature are equally connected. So, it's nice to look at one, what the patient's symptoms and presentations are, hair loss, cold hands, cold feet, fatigue. Two, look at the actual lab markers and then, three try to find some subjective, objective middle ground marker of their physiology, which will be body temperature.
Dave Korsunsky: Yeah, I remember you talking about basal body temperature which is very different from just checking your temperature. For example, when you're get the thermometer out of the medicine cabinet and check it. Basal means you check it, well you can explain it doc. Can you explain the difference between basal and a regular? Just middle of the day temperature check.
Dr. Justin Marchegiani: Yeah, ideally you're going to do it before you get up. Before you start getting active. (Right in bed, before you can get out of it) Right in bed! Yeah, and I just use a digital fertility thermometer. I used to use some of the mercury thermometers, those were great, but then you get every now and then a patient drops it, spills the mercury everywhere.(I did that. I spilled the mercury everywhere.) I know, so that's why I'm like “All right.” Just go to, like the certified digital fertility ones that'll go to the tenth of a point-
Dave Korsunsky: Do you have a link doc you can share with one that you recommend?
Dr. Justin Marchegiani: Yes, I do, I do.
Dave Korsunsky: All right, all right. We'll put that in here as well.
Dr. Justin Marchegiani: Yeah, I think it's justinhealth.com thermometer, justinhealth.com thermometer. I'll put the link-
Dave Korsunsky: Yeah, so you just get the thermometer before you get out of bed. You do take a couple minute reading and that's your basal temperature before you've actually gotten out of bed to do anything.
Dr. Justin Marchegiani: Yep, that's the one that I like right there. Digital thermometer reading, I'll put it in the chat here. But that's just a good one that I like as well-
Dave Korsunsky: Yeah I’ll throw it in the chat, I'll put it in the show notes.
Dr. Justin Marchegiani: Yeah, that's perfect, yep, that's a good one. I like it but anything that goes to the 100th degree, super you know, precision. You know, accurate like that. Now, with women, you got to be a little bit careful on it because you know, the first five to six days of your cycle are going to be the best time to test it. Once a woman starts getting in the middle part of their cycle, there's going to be about a 0.3 degree bump due to ovulation.
So two to six is going to be the best but once they hit the ovulation to the second half of their cycle, there will be a big temperature bump, and so if you're testing there you could get a false high reading saying you're okay. So, just in females that first week of the cycle is going to be the most accurate on that front.
Dave Korsunsky: Awesome (Okay? So, I hope that makes sense in that one.) It does, now let's try to round it out here, doc. So, (Yeah) if you're listening and you've never had a full thyroid panel, even if you're generally healthy, I think it's good to get a full thyroid panel just so you have baseline data. You know, there may be nothing wrong but you know, three, five, ten years from now you've got baseline data on all of the tests that Dr. Justin mentioned. For those in the United States, it's actually pretty easy to order your own labs now.
So, if you have a medical doctor that won't run the full panel for you, you can just go online and pay cash for it. I think even Quest and Labcorp, Ulta Labs is another one we use. Get a full thyroid panel get your baseline data and then if you're working on any type of some of the symptoms, Dr. Justin mentioned hair loss, cold hands, you know fatigue, weight gain, fingernails, or just you want to you're a biohacker and you want to fully optimize every shred of performance, full thyroid panel be the way to go. Doc, when is your book going to drop because you're the master? I've seen a lot of presentations on this. You break it down better than anybody. So, when when can we get access to your resource?
Dr. Justin Marchegiani: Yeah, absolutely. The book will be coming out sometime this summer or fall. I'm just going through the last little bit to editing. The problem with writing a book, it's never good enough. You go through it you're like “Okay, not anymore-”
Dave Korsunsky: It's the same building your own software, doc by the way.
Dr. Justin Marchegiani: Oh, it's just, it's just crazy because it's just like it's never good enough, never good enough. And I probably will never go and like write it myself again. I will just hire someone to do it for me so I can just like totally be to dettached to it.
Dave Korsunsky: You get too attached to it. You gotta be (It's like a little baby.), you gotta put your baby out there at some point (Exactly!) and say it might be ugly. And you know what? Then you iterate it again. So, it's different with the book, you know with software like with Heads Up, we can put it out. “Okay, that user experience sucks!” And we can go back and quickly iterate it. Not so with a book, so I can understand the need to want to get it just perfect.
Dr. Justin Marchegiani: Exactly! So I'll put here a couple things here. I got some options here for people to get thyroid tests done. I'll put some links here I have my abridge thyroid test which I do for patients that already kind of know where they're at, that doesn't have the total thyroid hormones and then I might complete one. I'll put the link here for you guys here. They'll be in the back of the book. I kind of saw how Tim Ferriss did it, where he had like recommended links at the end of foreword body. I'm like “I'm gonna do it like that, so there's good resources there.” So, people wanna get just-
Dave Korsunsky: Yeah, and doctor Justin you can also, people can consult with you as well. Justin Health, if you want to get a full breakdown, Dr. J can help you there. And of course, if you need the best app on the market to help you track all your lab tests over weeks, months, years, decades, measure basal body temperature, track sleep quality, blood sugar, that's Heads Up Health. So Doc, I think what I'm creating at Heads Up is really a good compliment to what you're creating.
People can have all of their blood tests, not just the ones from the doctor they're working with today. Once you actually take the time to get your labs organized, you'll be able to see trends and things that most doctors will never see just because they don't have all the data.
So Heads Up and Dr. Justin's thyroid protocol, match made in heaven. (Love it!) Hey Doc, in closing here, I want to ask you a question that we often ask some of our guests here. And that question would be, in Dr. Justin's opinion, what are the top three health metrics that you pay attention to?
Dr. Justin Marchegiani: Yeah, I think the number one thing is your functional glucose tolerance test. That's probably one of the best things you can look at because it shows how your body is dealing with your actual food, your meal. Like what does that look like? You know, you before you go to meal, how's your blood sugar? Maybe you have a fast, your Insulin?
Dave Korsunsky: So you test before you go to eat. I remember you told me this, you said “Dave, go eat your favorite breakfast. I don't care what it is. (Yep) Bacon and eggs, Denny's, I don't care. Test your blood sugar before. (Yep) One, two and three hours after, is that right?
Dr. Justin Marchegiani: Yep,that's correct and then you want to see how your body responds to that meal. So, you kind of come into it, you get a fasting, maybe hopefully you're below 100 at your fasting reading. You do a one hour, two hour, three hour ideally we don't want to be above 140. There's some data in the literature that you have glycation and oxidative damage at the organ level above 140.
We know above 170, you start to pee it out in the kidneys. So, that's a major kidney stress. That's the reason why 80 percent of kidney transplants and kidney disease happens to diabetics because blood sugar is really, really hard on the kidneys when it gets high.
Two, we want to be below 120, maybe even below 100 an hour or two, right? And definitely below 100 in hour three. And we can get a simple glucose monitor, I have one right here. Keto Mojo is a great one because it looks at ketones as well and you have an integration for ketones on the app.
Dave Korsunsky: Before you go with one of these, I got the CGM.
Dr. Justin Marchegiani: Yep, right here and the next one here. I raise your Freestyle Libre Three. And again I’m not- (Haha, Always on the point there, Doc) Yeah and you got it. I'm not sure I'm trying to figure out where I want to put it on. I feel like it's better on the outside of the bicep versus on the back. I don't know do you have any opinion?
Dave Korsunsky: I like it on the back because you can look cool (Yeah!) and you can do a little tricep flex. (Yeah! Little tricep yeah!) Yeah, just it's a low key flex when you're showing people your tachometer. (Yes, that's awesome! I love that!) Okay, functional glucose tolerance test that's one.
Dr. Justin Marchegiani: Yep, yep I think that's number one and then number two I would say, add the insulin in there. Add just your general inflammation markers and so with inflammation markers, I would be looking at CRP, HSCRP. regular CRP won't test below two, two or three sometimes so I like HSCRP so you can see exactly your number 0.5. I want a below one. I would say in today's day and age with inflammation, I would also want to throw on their homocysteine. I kind of put that in the inflammatory camp. Homocysteine is a metabolite that will increase when you have inadequate levels of B vitamins. And then you get this metabolite homocysteine which is very inflammatory.
Also, if you have MTHFR issues and you're getting folate, folic acid from junky refined foods, processed sodas and drinks, and breads, that's a problem. I would say next, I want to look at fibrinogen, I wanna look at-
Dave Korsunsky: You only get three, Doc. Yeah you got it, narrow it down. So you got functional glucose tolerance, you got CRP, you get one more.
Dr. Justin Marchegiani: So, I would put like my inflammation bucket. So, in the inflammation bucket I'd put CRP, homocysteine, D-dimer?
Dave Korsunsky: Are you get cheating but you’re allowed. We’ll allow it. We’ll allow it, okay.
Dr. Justin Marchegiani: I got a big bucket. (I didn't say-) It's a big ten here!
Dave Korsunsky: All right, we'll allow it, continue. So, you got functional glucose tolerance, you've got an inflammation bucket, and inside the bucket you mentioned, (Yeah) HSCRP-
Dr. Justin Marchegiani: HSCRP, homocysteine and D-dimer. I wanna make sure blood flow, clotting, all these things are dialed in because that's a big concern. I'm seeing a lot more clotting issues today and a lot more inflammation on that side. So, I want to make sure that's fully dialed and rectified as well.
Dave Korsunsky: Okay, third bucket.
Dr. Justin Marchegiani: Third bucket I think gut is really important. Lots of people have gut issues, whether it's absorption, whether it's inflammation due to bacterial overgrowth, sibo, gut bugs, fungal overgrowth, parasites, H. Pylori and I want to make sure gut function is optimal. One that's where you absorb all your nutrients, so if you're eating a really great diet, what are you getting those nutrients absorbed?
And number two, eighty percent of your immune system is there. And so if you have immune stressors and your guts jacked up, well one of the first things you can do to have a healthier immune system. That means stronger immune system with colds and flus and viruses. But also allergies, not having an overreactive immune system is getting your gut looked at and fully dialed in.
Dave Korsunsky: Awesome man. Well, Dr. Justin is the functional thyroid master and we're very grateful for him coming here to share his expertise. Doc, we've got links to all of the lab tests products, the new book coming out. Congrats on that! When it hits I know it will be awesome. And I know that you at Justin Health, you just, you pump out tons of amazing content. So you can check out Justin on YouTube and all the platforms out there. He's constantly putting out just like super high quality information. He's one of the best I've worked with just in terms of his breadth of expertise.
So doc, I know we've been working together for 10 or 11 years. (Yes!) Hopefully in another 10 or 11 years, we'll be on another podcast, maybe with a few more gray hairs? (Yes!) But we'll still be gone.
Dr. Justin Marchegiani: Yeah! Absolutely! And by the way, chapter nine, putting it all together, I have you there Heads Up Health. And the links there to help manage a lot of the labs and kind of track everything, and keep track of it. So that's in my book, you made chapter nine man.
Dave Korsunsky: Hey, you know one other shout out to Dr. Justin. When I was in the early days of building Heads Up Health and I was broke, he let me, he'd let me crash at his place, a pair ot thugs (Ha ha) in Austin.
Dr. Justin Marchegiani: Yes, excellent man! Good times brother! Very good! (Yeah) Well, thanks for putting this information out. Hopefully, it coalesces with everyone well. And then justinhealth.com, you can access the first chapter. Also if you want to dive in, I have a podcast and a YouTube channel, do a lot of live stuff and see patients kind of worldwide on the telemedicine, functional medicine side. So if you want to reach out there's links there where you can do so.
Dave Korsunsky: Awesome Doc, have a great day brother.
Dr. Justin Marchegiani: Thanks for having me, I appreciate it.
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