Skin Issues from Die-Off and Food Reactions | Podcast #249
Dr. Justin Marchegiani: And we are getting
ready to go live here in just one second.
And we are live. It’s Dr. J. Here in the house.
Evan, how are we doing, man? Do you have a
Evan Brand: I am doing wonderful. We finally
got some rain. We’ve been in a drought for
like a month. The trees, instead of turning
like yellow and orange, they’re just going
from green to dead. So we finally got like
tons of rain last night. I was in fresh water
in my pond. So everything is good.
Dr. Justin Marchegiani: That’s great, man.
Excellent. I know we chatted pre show that
we were going to talk about food reactions
and or die-off reactions affecting the skin.
I think this is really important to see a
lot of patients that may have skin issues,
whether it’s some food, whether it’s from
got bacterial imbalances and whether it’s
from addressing or knocking down gut bacterial
imbalances. So usually everything interplays.
I have an interesting study I printed off
over the weekend and it’s all about the food
and food inflammation affecting the gut microbiome.
And we know that food has a major impact on
the microbiome. We know the microbiome has
a major effect on the skin, because the more
we put stress in our gut, our body will use
our major means of detoxification to deal
with that stress and inflammation, whether
it’s to the kidneys and out the urine, whether
it’s out the gut, whether it’s from the guts,
from liver, gallbladder into the stool and
out the gut that way or through the liver.
So we have three major pathways. And then,
of course, the fourth one is going to be skin
skins. And to be the fourth one with exception
of breath, you know, breath breathing, you’ll
have some there, but the skin will be the
next one. And the more other means of a toxic
location are stressed, the skin isn’t to be
leaned upon more. So the first thing is to
work on other systems that detoxification
less that lessen the stress load of things
going in. So we have input and output skin
is primarily use on the output side of the
equation. So the first thing we can do is
do things to support the output, but no one
root cause is decrease. All the things coming
in on the input and we’ll kind of break what
that equation looks like. Input output down.
Evan Brand: Yep. So in other words, the skin
should not get involved with detox, but it
can pinch hit, if you will. If it has to.
If the other systems are so compromised and
then you see a skin issue, you know that you’ve
got some work to do.
Dr. Justin Marchegiani: Exactly. So I would
say the first thing is inflammatory foods
are going to have the biggest effect on the
skin and some of it’s not even detoxification.
Some of it just can be autoimmune. And just
through general inflammation in the skin,
cells can be affected. So we can have reactions,
dermatitis, various dermatitis, which just
means skin inflammation. It’s hilarious. People
go to the dermatologist and they’re like,
oh, you have a dermatitis as well. I know
that. That just means my skin’s inflamed.
Of course, it’s red. It’s puffy. I know it’s
inflamed. I don’t need you to just give me
the Latin version of that same description.
Right. It’s crazy. So, yeah. So you have various
dermatitis is awful like colitis, which is
the follicle is inflamed. Right. And then
the next thing would be various autoimmune
things which could be rosacea, which now is
an autoimmune component, eczema, autoimmune
component, psoriasis, autoimmune component.
And then you have different rashes that could
be fungal or bacterial in Batigo or ringworm
could be bacterial and various tinnie versus
color or in the scalp you may see separate
dermatitis or cradle cap or dandruff. These
all have potential fungal bacterial implications.
And psoriasis and eczema and rosacea. I had
significant rosacea as a child. And then in
school, I mean, I’ve notarization now, but
that was strongly tied to gluten for me. So
food can have reactions from an autoimmune
standpoint and then just from driving inflammation.
And then the next thing foods and do is like
the scientific article that I talked about
earlier and has a major impact on the gut
microbiome and that has a major impact on
gut permeability. And the more permeable the
gut is, the greater chance of more autoimmunity.
But the greater chance that food will have
more inflammation in the body. Because now
that undigested food particles are actually
getting into the bloodstream and creating
more inflammation. And let’s not forget, I
want to highlight one thing. When you actually
swallow food, it’s in your tummy. It’s actually
still considered outside of your body. So
then when you start having more gut permeability
and then undigested food particles get into
the bloodstream. Now there’s a greater chance
of more inflammation in the body. Go ahead.
Evan Brand: Yeah. So we should probably mention
histamine as part of this. Now, we’ve done
a whole show. We did a whole podcast on this,
which I think was really good all about histamine
intolerance. But I just want to briefly mentioned
that part of this whole cascade of problems
that you’re talking us through histamine could
be a variable or a factor. So if you’ve got
this eczema rosacea piece that could be worsened
and if you have a histamine intolerance, which
histamine intolerance, once again, kind of
like the dermatitis issue that you discussed,
that is a byproduct of something. Histamine
intolerance doesn’t just exist in a vacuum.
It’s happening because of something, so you’ve
got to work backwards and figure out why are
you having this reaction in the first place?
It’s not just go on a low histamine diet.
That may be part of the solution, but why
do you have to do that?
Dr. Justin Marchegiani: Exactly. I’m going
to go pull up here just a couple of pictures
that y’all can see. And again, if you’re using
Google image to, let’s say, kind of follow
some of these skin reactions, just make sure
you type in like mild or whatever, because
Google image tends to show you the most pathological
extreme version of most of these conditions.
F.Y.I So you can see here is just some you
take care of some hives, you can see kind
of these raised little circles here. These
are your typical hives, so you can see that.
And then of course, your tenia tinnie aversive
color. I’ll just type in mild so we don’t
get the crazy extremes. So typically you see
almost a little bit of hyperpigmentation happen.
So this is your skin, it’s actually lightening
up. That’s tenia. It looks very similar almost
to vitiligo. So vitiligo goes in autoimmune
condition. That’s what Michael Jackson had
that destroys the pigment. So vitiligo mild.
Let’s go look at that real quick. That basically
destroys the melanin, the skin that’s autoimmune.
But if you look at vitiligo, that’s actually
very similar. So you can see kind of some
of that hypo pigmentation, right?
Evan Brand: It’s a lot more common, man. You
never see anybody with vitiligo. Now, almost
every time I go out in public, I see somebody
like, oh, that just tells you the world’s
become more toxic. There’s more compromised
Dr. Justin Marchegiani: Yeah. And then you
can see here, you know, various tenia here
where it kind of is a little bit of hypo pigmentation.
That’s pit psoriasis versus color similar.
Again, we’re just kind of going over the common
things. We have the various infectious rashes.
And then, of course, we have eczema and dermatitis,
which are going to be eczema verse, I should
say, psoriasis, which are similar to autoimmunity.
So you could see typically here we go right
here. So you can see psoriasis a little bit
more raised and flaky eczema is a little bit
more flat to the skin, but they look very,
very similar. You need a good dermatologist
to kind of help diagnose that. But the nice
thing is because it’s autoimmune. You know,
we’re gonna be doing similar similar things
to fix it.
Evan Brand: There’s a good versus right there.
Right there. What’s it say? Go look right
there. There’s like a little. That one. Yeah,
Dr. Justin Marchegiani: I’ll do that next.
So you can see psoriasis a little bit more
flaky and white eczema a little bit more red.
Evan Brand: Here’s our friend, Dr. Jackers
pop up in Google Images. Good. Good job, Dr.
Doctors. All right. Here. Yeah. Image that
that red one that you’re on right now.
Dr. Justin Marchegiani: That’s this one here.
Oh, good. Oh, yeah. Yeah. Great. Yeah, that’s
good. Awesome. Chronic. Lifelong common adult.
Autoimmune. The thick. Silvery scales. So
it’s really that the silvery ness and then
the Eczema’s a little bit more red. All right.
And then if they had any actions, can cause
that as well. I know with with your wife as
well as mine, eggs were a big reaction from
my kiddos down the breast milk side. So keeping
that in mind is really helpful. Sometimes
autoimmune, even when a mom’s breastfeeding
can make a big difference with any other skin
issues you wanted to look at while we’re here.
Evan Brand: I think those are the most common
Dr. Justin Marchegiani: I’ll say one more
thing. It can’t those is not your is interesting
because a lot of skin stuff that we’ll talk
about in a minute on those too mild so we
don’t get the crazy stuff. As you’ll see it,
a lot of times you’ll see it. It’s very common
in African-American women. But yeah, and I
think it’s because they’re just more sensitive.
Carbohydrate wise is a lot more like insulin
resistance issues in the African-American
community. But obviously it’s everywhere now.
But you’ll see it a lot. It’s just a pigmentation
issue around the back of the neck or like
you’ll see it in the armpit area right in
here. Here. That’s from hyper insulin. That’s
from hyper insulin. So too much carbohydrates
are going to see a lot of that. Why is that
important? Because if you’re consuming too
much insulin. Insulin is actually going to
drive up your body’s sebaceous glance and
it’s gonna cause you to make more sebum and
that sebum is actually had impacts on your
oil in your skin and that oil is going to
feed the bacteria and that bacteria can cause
cyst and acne and skin issues. So it’s really
important when we look at food, we keep one,
the insulin levels down or at least within
what you need. OK. If you’re more insulin
resistant, that means you have to keep the
carbohydrates lower. More vegetables, less
fruit and starch. The next one is looking
at the inflammation component of the food,
keeping the inflammation down. Could that
be being autoimmune? Yeah. If you have autoimmune
genetics and you’re seeing skin issues popping
up that have an autoimmune connection like
the ones we just talked about. Yes, some people
paleo is enough because paleo, which is cutting
out just grains, legumes and dairy, maybe
allow some butter. It’s focusing on Whole
Foods, meats, vegetables, maybe some fruits,
maybe some safe starches, some good fats,
except the junky refined process to make a
success. That’s usually enough for most people,
but some have to go to that paleo template
to point out that auto immune template to
get that next inflammation buffer.
Evan Brand: Yeah. Like nightshade for were
an issue for me for a while, surprisingly
with my skin because I would do some of these
sauces, you know, just combos of like Jalapeno
peppers and tomatoes and all that. And I would
have mild rashes that would pop up on my face
when I had gut infections. I couldn’t do salsa
for quite a while. So I was also probably
eating it with organic blue corn chips at
the time. So it could have been corn as well.
Dr. Justin Marchegiani: Could have been corn.
That’s why you got some better brands out.
Now, the CSA brand makes a good yuga cassava
based flower, which are the same things that
can be excellent and it’s a safe tuber and
it’s gonna be grain free. So you have options
like that. So we always start with the diet.
Number one, we may do the autoimmune 2.0 next.
We also have to look at the gut because gut
permeability through either inflammation in
the food, poor digestion or despotic bacteria.
H. Pylori, various parasites. All those things
can make a big difference. Knocking those
down and depending on what comes back, we’re
gonna create a protocol to address those different
things. So of course, we’re not going to go
into each things with other podcasts to deal
with that. So feel free and take a look at
any of our gut bug or Cibo or parasite podcasts.
More info. We’ll try to put maybe some links
in the references, but keep that in the back
of your head. Any any thoughts on that?
Evan Brand: Yeah. We’ll think about when you
and I first became friends. About five years
ago, my skin was a mess and I had gut bucks.
So I. Yeah, like you said, we’re not going
to go super into detail, but my diet was good.
I was paleo for 3 to 4 years. My skin was
still messed up and it was because of my gut
Dr. Justin Marchegiani: It had three different
infections in your gut that were big. Yep.
Yep. You have three different big infections.
Next thing I wanted to highlight on top of
that, what you mentioned, histamine now histamine,
the you to carry your stuff, the more inflammation
in your gut. Remember 80 percent of your immune
systems in your gut and your gut than your
mouth gastric. Associated lymphoid tissue
and in the stomach. And then mucosal associate
olympe with tissue in the small intestine.
The more those immune cells are revved up,
it’s gonna be the Basia fills the basia fills
when they go outside of your thinking, outside
of when they go outside of your blood, into
the tissue they create. Matt, they turn into
mass cells essentially, and those mast cells
produce histamine. So the more your immune
system is aggravated and revved up, the more
those base officials will move into and migrate
over to mass cells and produce histamine.
So think of histamine as a natural byproduct
Evan Brand: Makes sense. Yeah.
Dr. Justin Marchegiani: And histamines vasodilators,
it opens things up think about it, right.
If you bump your eye or bump your head. What
happens? Things swell. And why is that happening?
It’s happening because the swelling visodilates
allows the immune cells to aggravate and calm
down the inflammation. The problem is, if
it’s not an acute response, meaning I bought
my elbow, it’s isolated if it starts to become
a systemic issue. Well, now you have systemic
histamine issues and now that may manifest
as you carry a hives on your skin. It could
manifest as tonight’s headaches, right? My
migraines, dizziness, those kind of typical
Hy-Vee kind of symptoms. And so you really
have to get everything under control and maybe
even look at cutting out histamine on top
of everything else. But we don’t go there
unless we’ve already done everything else.
And the clinical presentation lead us in that
Evan Brand: Yeah. Like you mentioned, a lot
of times, we don’t have to go there because
we’re addressing root causes and mold is a
big trigger, too. I learned that firsthand
with histamine. I was having tons of Marcel
slash histamine reactions, just weird things,
weird symptoms I’d never had before. Now that
I’ve started to detox mold, I’m having less
and less what I would consider histamine reactions.
And I’m also doing some herbal antihistamines
that I continue on a regular basis that really,
really helped calm things down. So I’m glad
you made the distinction between histamine
is a good thing, but when it becomes systemic
histamine, that’s not a good thing.
Dr. Justin Marchegiani: Yeah. Typically anything
acute is OK because it’s designed for a reason.
It’s the chronic out of control reactions.
We want to really kind of attenuate and calm
down because those are the things that are
going to be driven by, you know, diet and
lifestyle and chronic stressors. So the chronic
stressors, we want to make sure they’re on
our radar so we can neutralize them.
Evan Brand: Yep. And testing is key. So if
you’ve been to your as you mentioned in the
beginning, just like my wife, we took her
to a dermatologist and they said, oh, yeah,
you know, this is this or this is just a generic,
you know, fancy term and didn’t have any root
cause measures, didn’t talk about changing
personal care products, didn’t talk about
the diet and talk about food allergies. None
of it. It was just, yep, your skin sucks.
Here’s some steroids topically. Same thing
with the gut. So if you go to a gut doctor
and they say you have gastritis. You’re no
closer to the answer than you were when you
Dr. Justin Marchegiani: Exactly. It’s hilarious.
People go in, they just get the Latin terminology
like, OK. Like, I go to the orthopod. My knees
hurting. You have arthritis in your knee?
Well, of course, that’s his joint inflammation
of the knee. Right. The root cause is not
talked about. So regarding skin, sort of,
especially with people that have diets to
be the first thing to get. And you have to
really be 100 percent on the diet to see how
much improvement you’re going to get. Now,
there is more nuanced stuff. Sometimes you’re
going to have issues where eggs or nightshade
or nuts could be a problem. And that’s where
if you’re not getting the benefit of Paleo
1.0 or just the regular paleo template, this
is where an autoimmune template would be utilized
next. So first level is paleo. Second level
is auto immune.
Evan Brand: Gm because of the chocolate to
the chocolates kind of in that same category
with chocolate or.
Dr. Justin Marchegiani: Coffee or coffee too,
with histamine. Most don’t have to go to that
level to get the benefit. So people that are
listening, you don’t have to do autoimmune
first. If you know you have an autoimmune
issue already diagnosed, then jump on the
autoimmune as a shortcut.
Evan Brand: Yep.
Dr. Justin Marchegiani: Number two, make sure
you’re digesting and breaking down your food
and your chewing your food up good enough.
Make sure you’re chewing your food off. You’re
not hydrating with food, with meals. I mean,
you can have a couple ounces of water as well
as some pills. That’s fine. But you should
not be hydrating and trying to actually consume
water during those meals to hydrate. Do that
10 minutes or so before two hours after and
then make sure you’re really dialing your
enzymes and acids so we can better break down
those foods. A lot of people in a lot of gut
bacterial issues, they create stress in the
gut that stress and inflammation in the gut
activates the sympathetic nervous system response
which will decrease your own internal enzyme,
acid and gastric secretions because of the
internal stressors. You could be on a beach
totally in a Zen like state, but your microbes
may be stressed.
Evan Brand: Yeah. Let’s talk about the environment
of when and where you’re eating. If you’re
driving a car trying to eat a chipotle, a
burrito, that’s a terrible idea. If you’re
in for me and I think other people experience
the negative effects, but maybe they’re just
not cognizant of how it’s affecting them.
Noisy restaurants. If you go out to a nice
steakhouse. But they got freakin a million
people there and they got music cranked up
so loud. You have to yell to talk to the person
across the table from you. That’s a sympathetic
stressor. I don’t care how nice the steak
is. You’re probably not going to digest it
optimally. Think of our ancestors when they
were eating a zebra. They’re sitting on the
edge of a cliff. You don’t hear friggin anything
except the birds. So it’s just not natural
to be in a closed building with so much noise
where your body is like, alert, alert, alert.
Dr. Justin Marchegiani: Yes.
Evan Brand: You’re turning off enzymes and
Dr. Justin Marchegiani: And there are things
you could do. I mean, you could put you could
put on some meditation, music or some some
by neural beads, something like that. You
can work on your breathing and you could kind
of like kind of control everything coming
at you input wise. That would help. You could
focus on gratitude. All these things activate
the sympathetic s deep breaths in all breathing
to the nose to activate the parasympathetic.
But yeah, one hundred percent control the
environment. Number two, you don’t have that
much control over the environment than you
do extra things regarding the music. What
you’re focusing on, the breathing, the breathing
is the biggest thing. Anytime you get into
a stressful situation, program your body to
just breathe deep and breathe through the
nose, because the first thing that happens
when stress occurs is shallow breathing coming
from the mouth and chest. So if you know that
and you can just control the breathing and
make it come to the nose and keep the belly
moving and still do those four to five seconds
in and out, then you’re gonna be set. You’re
going to have a big control on your sympathetic
Evan Brand: That’s good advice. Yeah. I think
I forget that sometimes, you know, I hear
like the super loud environment. I’m like,
oh, god, it’s so loud in here. And I probably
jump into sympathetic. I can probably try
to counteract it better, but I’d still rather
sit in the middle of the woods and eat a sandwich,
Dr. Justin Marchegiani: Hundred percent. Hundred
percent. First thing that happens. Is anyone
listening? Just focus on the breath. Breathing
in through the nose. And then you can go up
to the nose to where, out to the mouth. That’s
fine. The most important thing is into the
nose. That’s the most important thing in about
four seconds in hold for a second. Four seconds
out. Hold for a second. That’s perfect. That’s
great. Now, enzymes, acids, controlling the
environment, parasympathetic versus sympathetic
nervous system response, right? Parasympathetic.
So the break and the relaxation, sympathetic
side, the gas, the acceleration that go, go,
go, go, go. So we gotta make sure that’s under
control. Got to be 100 percent in the diet.
Start on paleo. One point I’ll go to auto
immune 2.0 and then I would say look at what’s
going on with the gut as you address that,
make sure we have detox support in place.
If we’re having reactions, detox support could
be just adding the IRBs in very slowly so
we don’t kill things off too fast. The more
debris we kill off, it’s like the equivalent
of putting imagine your detoxification or
your immune or your lymphatic system is really
poor or not doing well. That’s like me taking
my coffee cup and like saying, hey, this is
your trash can like put your trash from your
house and that this is your trash can. So
we know if you do that, this is gonna be overflowing
before the morning’s over. Right. So that
overflowing is gonna be symptoms, skin issues,
headaches, joint pain, all of those things.
So number one is we can take the cup up and
change, you know, take the garbage out. A
lot of times to make sure it doesn’t overflow.
And we would do that through lymphatic support.
We would do that through titrating the herbs.
And very slowly we would do that and through
binding support. We may do that through sulphur,
amino acids and or glutathione or extra antioxidants
to support phase one or extra for Amano’s
for phase two. It would depend on each patient
so we can taper it up so we don’t put too
much garbage in. Number two, we can support
the lymph, which essentially allows things
to move better and then support that detoxification.
And as that gets better and we support those
systems, it’s like we’re kind of bringing
in a new garbage pail instead of the cob.
Now we have the bigger mug and then we have
the small garbage pail and the bigger one.
And so we kind of upgrade each time as we
titrate things up and support the limb, support
the detox, support the binding support and
Evan Brand: Yeah. And it’s always a little
bit of a seesaw, right. Like when you say
it like that, it sounds so easy. It’s like
take lymph. Take Lemp support. IRBs take liver
support. IRBs take glutathione and you’ll
be in good shape. But the truth is, when we’re
working with people, it’s highly individualized
because depending on how long you’ve been
sick, depending on how many layers you have
to your illness or your symptoms, you may
not be able to handle it. For example, if
I do too much glutathione, I feel bad. But
if I do none, I feel bad. So I think of it
like it’s like a tightrope is kind of my analogy.
So it’s like if you do nothing, you fall off
the tightrope to the left and you’re symptomatic.
If you have it dialed in perfectly for you,
you’re walking the tightrope to the finish
line. But if you do too much, you fall off
the other side. And so like as people get
better when we’re doing follow up calls, we
may be tweaking the dose. Whereas before they
could only handle 2 capsules of a liver support
complex with milk thistle and beet powder
and artichoke and all that. But now they can
handle four capsules. And so it’s not where
we want you to just like go to Whole Foods,
buy a liver supplement and expect it to make
all your problems go away with your skin.
You’ve really got to have a coordinated plan.
And as you get better or as you get worse
or new stressors come in, you’ve got to back
the dosing down. So like for me, when I was
going through gut work, if I was really stressed,
I couldn’t handle the full dose of anti parasitic
IRBs. I had to cut it in half. And then when
I was less stressed, like you and I talk about
this idea of like do things on a weekend when
you’re not a stress and try supplements, it’s
the same concept with this other of the detox
Dr. Justin Marchegiani: One hundred percent.
So it’s pushing catch, right. Push, meaning
we’re stressing potentially stressing out
already talk system through various killing
and then catching is we’re eliminate we’re
supporting our lymph ah detox, our phase one,
our phase two to and making sure we’re actually
having regular bowel movements. We’re making
sure all these things are happening so we
can eliminate things. And when we talk about
binders, binders aren’t perfect. Imagine you
have a whole bunch of iron filings on the
table and I just take a magnet and I just
kind of pull it through. Will the magnet grab
every single iron filing there? No, there’s
going to be some stragglers. Right. But it’s
going to grab a good chunk. So think of that
as like charcoal or bentonite clay or activated
charcoal or zehle light or citrus, packed
ends or corella, whatever binder we use for
whatever that iron filing is, there’s got
to be some debris left behind. That’s why
we want to do multiple doses the day and we
want to taper up. So we’re not overwhelming
our system with too many iron filings, so
to speak. The iron filings be being reminiscent
of the debris that’s left behind.
Evan Brand: Yeah. So just to say it the other
way, you can make yourself worse by doing
too much. Binder’s right. It sounds really
sexy. Let’s bind to the toxin. I mean, it’s
going to take tons of charcoal. Mm hmm. I
made myself worse. I was doing like six caps.
A child. You couldn’t hold more things out.
You could pull more things, that’s why we
taper into everything. Yeah, I did like six
capsules of charcoal for a while and I felt
amazing. I was like a new man. And then I
went up more like eight or 10 capsules a day
and it was too much.
Dr. Justin Marchegiani: I got to remember,
you call me that night. You’re like, man,
I’m feeling really dizzy. And.
Evan Brand: I think that might have been the
day I did a double dose of glutathione.
Dr. Justin Marchegiani: That was good. And
you’re right. I think I talk all about maybe
doing more charcoal to counteract that. Yeah.
I remember the charcoal.
Evan Brand: Same thing, though. I like in
that situation, charcoal was the remedy. But
before charcoal was the was the provocation,
if you will. It was the bad guy because I
did too much in my analogy of that. One is
like you have a bad girlfriend and you’re
kicking her out of the house. And so she’s
like taken the pictures off the wall and throwing
them down the hallway like there’s this collateral
damage of you kicking her out. Same thing
with the toxin when you’re dragging the toxin
out, especially if you have a permeable gut
barrier. I think if it is like these toxins
reabsorbed back into the bloodstream, like
the goal is pull them through the intestinal
tract. But if the intestinal tract is compromised,
you’re gonna have re absorption. So I can’t
prove this 100 percent. But my theory and
thought on this is that if your gut barrier
is in better shape, we measure the secretory
IGA. The gut is less leaky or not leaky, hopefully.
And theoretically Binder’s would be more tolerated
versus someone where we see a super leaky
gut. Binder’s may make them worse. They may
need to titrate very slowly. What do you think?
What’s your thoughts on that?
Dr. Justin Marchegiani: I think you’re 100
percent right. Everything you have to ease
into it. And that’s why we always start with
diet and hydration digestion first, because
that’s where most people’s stressors are coming
from. And we want that foundation kind of
just dial them, because if they’re able to
digest and break down their food better, then
they’re extracting the antioxidants and the
B vitamins and the sulfur amino acid from
their food. And if we’re breaking it down,
then they’re getting those nutrients in. There’s
less stress that the food kind of fermenting
and rotting behind. And then we’re making
sure that they’re having regular bowel movements.
So we’re eliminating toxins and then we’re
making sure we’re getting enough hydration.
The solution to pollution is dilution. And
then if we’re also more sensitive, we can
lean more on the talks vacation from sweating.
We could do infrared near infrared sauna.
We could even do just some gentle red light
therapy, which can help with skin issues,
too. On the outside, it can really help reduce
the inflammation of the active skin lesions.
These are really good ways to kind of start
things out. We can progress from Paleo 1.0
to autoimmune 2.0 if we need, and that’s probably
one of the first good steps. Any any feedback
on the foundation steps, Evan?
Evan Brand:The part about pooping regularly.
You briefly mentioned it, but that could be
literally the biggest piece of the puzzle
is simply just addressing chronic constipation
in someone. If they’ve been doing diuretics
like coffee and teas and they’re not getting
enough water, I can’t tell you how many times
you and I’ve seen people’s skin improve just
by getting them to go poop two to three times
a day versus they used to poop every other
day or some people once a week, which is just
scary. It’s like what you’re eating three
times a day for seven days and only one poop
comes out per week. That is terrible. No wonder
he got bad skin.
Dr. Justin Marchegiani: Oh, I know. There’s
a famous gastroenterologist named Match knock-off
mecs knock-offs quoted his famous quote, As
life and death starts in the colon. And part
of that it is just being able to have regular
BMR and move your stools at least 12 inches
a stool a day. If not, you are gonna have
what’s called auto intoxication, right? Auto
meaning self intoxication, self poisoning
from not pushing the debris out of your body.
That’s like not taking out your garbage for
a couple of weeks and the flies and maggots
start to come home. The rest of the speech
speak and that’s not good. So we have to make
sure those foundational things are done. I
can’t underestimate water, right. The solution
to pollution is dilution so that 10 times
fast. The solution, right. The solution to
pollution to toxins is dilution. So you deluded
down. Right. So more water helps make everything
go round. Right. That’s really important.
Let’s talk about lymph. Some a big fan of
making sure the lymph is supported. So there’s
various tinctures that we use professionally,
different lines that we use. There are some
individual IRBs that we can do. low-hanging
fruit is going gonna be ginger. Ginger is
really, really excellent with lymph. So is
red roots and so was burdock. Those are my
two or three favorite kind of limp supports
the kind of keep things moving outside of
various tinctures that we use.
Dr. Justin Marchegiani: I’ve got limb support
right here on my desk. So one that I didn’t
even know about maybe a year ago was Cleaver’s.
And so my lymph blend is, yes, red root, which
is also great for the spleen. We love using
Red Root for Lyme and co-infection. Eckard
Neisha would also create a sedative. Yep.
And then we’ve got the Cleaver’s. And then
this other one that I didn’t know about is
Baptista like like you’re getting a baptism
by your root. And so. Here’s a funny story
real quick. I think stories are helpful because
like we get an educating mode, then I think
people like story time. OK, so, you know,
I had tested for some bartonella antibodies
and for Busia and so I was playing around
with some of these Bartonela and bebesia herbs.
And within about half an hour of doing that,
I got a super bad headache. And I thought,
you know what? I wonder if this is lymphatic
related. Maybe I’m killing off these pathogens
and my lymphatic system is overwhelmed. So
what did I do? I took three shots of lymphatic
blend of verbs. And guess what? The headache
magically went away. I didn’t do anything
else. I didn’t drink a ton of water. I didn’t
take charcoal. All I did was go from taking
the Basis Bartonella killers to take an extra
lymphatic support. And the headache disappeared.
And I was like, oh my God, this is a miracle.
Like the lymphatic system is super underrated.
And I think it’s the missing component to
a lot of people’s detox protocols.
Evan Brand Doing that I got a super bad headache
and I thought you know what. I wonder if this
is lymphatic related. Maybe I’m killing off
these pathogens and my lymphatic system is
overwhelmed. So what did I do. I took three
shots of lymphatic blend verbs and guess what
the headache magically went away. I didn’t
do anything else. I didn’t drink a ton of
water I didn’t take charcoal. All I did was
go from taking the BCA Barton fellow killers
to take an extra lymphatic support and the
headache disappeared and I was like Oh my
God this is a miracle like the lymphatic system
is super underrated. And I think it’s the
missing component to a lot of people’s detox
Dr. Justin Marchegiani: Interesting I 100
percent agree. By the way the Baptisia herb
is the same thing as wild Indigo my g i clear
too which is my H pylori killer I have wild
Indigo or Baptista in there and then also
my g clear for which is my bigger bug killer.
I did formulate that with burdock root. Burdock
root is very very very good and then some
of the female hormone herbal supports will
actually have red root in it because red fruit
is excellent for limp so women premenstrual
t into menstruation may get a little bit more
swelling little retention red you can be helpful
and the next one that’s really good is poke
root poke root is really good especially for
mastitis poke root is excellent.
Evan Brand So here’s some here’s something
interesting when you start to up regulate
these detox pathways and you up regulate lymphatic
drainage your pee smells way different I don’t
know how much you’ve played with lymphatic
support but when I start bumping up limp support
and liver support the urine will just smell
way different especially red root because
I believe red root specifically is one of
the ERs that helps to drain the excess ammonia
and a lot of these bacterial pathogens you
and I are talking about we can measure the
robotic acid on the organic acids panel and
that’ll show ammonia at all. So when you drain
this stuff out you can smell the change like
if you’re human pee smells like Cappie to
me you know you’re on the right track of draining
that excess ammonia out of your system.
Dr. Justin Marchegiani H pylori will also
convert some of the protein metabolism into
ammonia as well and ammonia is very alkaline
too so it actually will disrupt digestion.
That’s part of the reason why or how H pylori
makes you gut less acidic because part of
their urea metabolism from urea to urea right
H pylori makes this enzyme called Ureae. You
know it’s an enzyme because of the ASC at
the end and ureae hits the urea which is from
protein metabolism and spits off CO2 and ammonia
that ammonia is got a p h of eleven so that
decreases your stomach acid levels makes it
less acidic so digestion goes downhill and
then you have higher CO2 levels hence the
the CO2 Urea breath test will come back positive
for H pylori so yeah one hundred percent and
typically I’m not a big person that has a
lot of die off my big die off symptom will
be a little bit of fatigue and a little bit
of skin stop but some people have significant
die off issues and the more your health is
kind of gone downhill the more you may have
die off symptoms and he’s gonna have to be
aware of that.
Evan Brand What do you say the longer you’ve
been sick too. I think the timeline of time
is a big role.
Dr. Justin Marchegiani Yes because I think
it takes time to get your immune system hyper
reactive like that takes time. Yep absolutely.
Anything else you wanted to work on addressing
now. Before we go into some questions.
Evan Brand Well why don’t we just mentioned
the testing then that we would be using to
investigate these issues. There’s not like
there’s not a lymphatic test to measure your
lymphatic system. You know you can really
just look at symptoms you can look at any
potential edema as you can have people do
like self lymphatic massage and if they get
better or worse from it you know lymph is
a factor you’ve got swollen lymph nodes you
can look at some of the clinical signs but
there’s not like a test where you go and pee
in a cup and it says your lymphatic are not
working we’re primarily going to be looking
at other markers to indicate the system as
a whole select organic acids testing is always
part of our workup genetic stool testing is
always part of the workup blood testing can
be helpful because you mentioned some of the
specialized white blood cells we may look
at those to gauge the immune system overall
but without the data you’re really just guessing
and checking. So that’s why I say don’t just
buy a liver support figure out what the heck
is going on first. Are you recycle leading
toxins like are you. Are you bringing toxins
through an open loop where you’re getting
them out or is it a closed loop like [inaudible]
issues that are too high due to bacterial
overgrowth that’s a big issue the big mechanism
Dr. Justin Marchegiani Yeah. So input is going
to be decrease all the toxins coming in. Organic
food whole food making sure you’re digesting
your food enough water decreasing all you
know having high quality food decreases the
antibiotics decreases pharmaceutical load
in the food because animals or plants were
sprayed with them if not organic and then
also enough water right solution to pollution
is dilution so that’s kind of our first starting
point and we can also look at our hygiene
products right skincare soaps deodorants make
sure we’re not rubbing a whole bunch of toxins
on it make sure we’re pooping regularly at
least 12 inch of the stool really good solid
poopy policeman number four in the Bristol
a days ideal and then we can kind of work
on pushing things out whether it’s cleaning
out the guts supporting phase one or phase
two detoxification phase ones to be more B
vitamins and antioxidants Phase 2s and to
be more sulfur amino acids including my own
and then our various binders that we may use
depending on what’s happening and then various
lymphatic support and then of course we’re
going to work with patients and dial that
in 100 percent and the diet’s got to be really
really really solid.
Evan Brand Yeah. Please don’t wear scented
products. It destroys me but it destroys you
too. So. Your laundry detergent. Think about
it you’re wearing those clothes all day and
your skin is absorbing that. So if you’re
wearing you know Tide detergent it’s garbage.
Get rid of that crap go free and clear. Even
if you’re not going with more of the quote
like organic brands even your conventional
mainstream laundry detergent brands now make
free and clear. Like all is a very cheap brand.
They have four in clear words not synthetic
fragrance. Stop using dryer sheets. Use wool
balls if you have to. They last forever.
Dr. Justin Marchegiani That’s what I have.
I have the wool balls.
Evan Brand I’m sure that those won’t be staticky.
So you and I were kind of chatting about it
off air. The chemicals that people wear on
their clothes. Ninety nine out of 100 people
in my experience have a smell to them. So
whether it’s a cologne a perfume a dryer sheet
a laundry detergent. It’s toxic stuff going
into your skin so you could just have your
diet dialed in. But what are you doing everyday
you’re spraying your neck and your wrist with
this perfume that you think other people want
to smell. That goes into your bloodstream.
Those are toxic chemicals. I’ve had clients
that are in the perfume industry and they
can hide thousands and thousands of chemicals
under that quote fragrance term. So there’s
actually a documentary about fragrances. I
think it was called stinky but it was just
about how dirty the industry is of chemicals
and none of this stuff is tested on humans
long term. It’s just it might smell quote
good but you don’t know what the heck it is.
Dr. Justin Marchegiani Absolutely and I had
a patient who had some skin issues this last
week and a lot of her gut symptoms got a lot
better and she was improving in other ways
but her skin was still lagging behind. She
did a little bit of research and she found
that she actually had a skin parasite and
this could be. Let’s say I call it put it
on the X Factor category where if you’re doing
a lot of the foundational things and maybe
a lot of the first level gut stuff and you’re
still not seeing any improvement in the skin.
This would be a good area to look. This is
a parasite is called Demo decks and it can
create inflammation in the follicle and there
are some various ointments or topical things
you can put on your skin actually help some
of these things.
Evan Brand Ask Is this something that you
would fix from the inside out with into microbial.
Dr. Justin Marchegiani Well you do it on the
inside but these things live on the follicle
of the skin so you have to topically apply
things to get these things under control.
There are some formulas that have some herbs
in them like a stragglers in such them oriental
medicine type of herbs but it’s going to be
Evan Brand And what’s the conventional medical
model say about this. What are they doing.
Dr. Justin Marchegiani You know what. I don’t
even know what the conventional medical model
is because it’s so undiagnosed it tends to
Evan Brand I’ve seen tiny mite. I’ve seen
this on people violations.
Dr. Justin Marchegiani They go on the eyelashes.
But again the key thing is that these things
tend to hit people that are gonna be immunocompromised.
Evan Brand Yeah go into that pub med right
there. Let’s see with that in 2014. Yeah.
Yeah. Let’s see what it says. This is interesting.
Dr. Justin Marchegiani So this is a potential
vector. I kind of put in the X Factor category
so you people are on top of it so it’s a various
might and they can live and they can create
inflammation. So look it’s a tiny parasitic
mites that live near hair follicles but they
can affect the skin as well, they say.
Evan Brand They say like quick treatment but
it didn’t say anything about treatment.
Dr. Justin Marchegiani Let’s let’s see what
kind of let’s say we got here for treatment.
Yeah. So here you go. Another useful feature
is the composite the the scale but mine. Yeah.
Escape aside lindane or lindane. Oh I think
lindane is pretty darn toxic now.
Evan Brand I’ve heard of lindane and I don’t
know whether to lend lindane as well.
Dr. Justin Marchegiani And lindane I’m pretty
sure. So you can see they get on their skin
as well. So they have it here as well so there’s
a little mites in here but I’m pretty sure
lindane is pretty darn toxic. I mean you see
it is that any other treatment options. Yep.
So there’s there’s various methods but I’m
pretty sure lindane is pretty darn toxic.
So you gotta be careful though. But in general
there are options there and there are some
natural ones as well.
Evan Brand Oh yeah. There you go. Yeah right
there on right go up on Wikipedia. There it
is. When lindane agricultural insecticide.
Dr. Justin Marchegiani Yeah. So you’re putting
an insecticide on your on your skin.
Evan Brand When it absorbs. You know it’s
going to absorb and.
Dr. Justin Marchegiani Absorb and go through
your body through your liver. For sure. Yep.
But there are some herbs that are out there
that are in Oriental kind of soft type of
form that you can topically apply as well.
Evan Brand And then you think approaching
antimicrobials in the gut would probably help
Dr. Justin Marchegiani I think you should
still go through everything and then potentially
try a good topical thing on the backsides
Evan Brand I hate to go on lindane. I mean
I guess if you’re miserable, you’ve got to
do what you gotta do.
Dr. Justin Marchegiani Well I would do the
topical things first that are gonna be more
on the healthy side. I’ll see if I can pull
it up here in a minute. There’s some good
topical ones that are out there that may be
good options. I’ll have that.
Evan Brand I actually had a client that brought
that it brought that to me. She said I have
a think she said it was scabies I guess that
was the same thing scabies and one of the
same family on her on her eyelashes. And nobody
had any answers so I just suggested coconut
oil because I figured coconut oil was a sort
of an antimicrobial antiviral and I just had
to rub coconut oil right here on the top of
the eyelid. And she did get somewhat better
it wasn’t complete resolution from that alone
Dr. Justin Marchegiani Interesting. Interesting.
I’ll pull up a couple of things here that
people can do.
Evan Brand We didn’t talk about coconut oil
but I think that would be a good first line
of defense. Topical solution. I mean we use
that for my daughters our first daughters
cradle cap because coconut is sort of an antifungal
in time microbial the carpet like acid in
the model Lauren in there. Those are both
really good. Really good topical but also
internal. So eating coconut oil could help
Dr. Justin Marchegiani Yes exactly. And yet
the medication that this person tried and
didn’t have to get success with it was basically
just a sulfa a sulfur and zinc oxide cream.
Evan Brand Interesting. And it worked. Yep.
Dr. Justin Marchegiani Exactly. Worked very
well. So it was a sulfur kind of and zinc
oxide cream. It’s exactly what it was.
Evan Brand That seems easy enough.
Dr. Justin Marchegiani Yeah. I put up a couple
of the the visual people can see it. So they
can have some good options.
Evan Brand Was that like a prescribed thing
or is it something you could just get over
Dr. Justin Marchegiani This was an over-the-counter
Evan Brand Wonder how sulfur would do that.
Maybe it just kills it. Maybe the thing can’t
breathe in sulfur.
Dr. Justin Marchegiani Yes sulfur has a natural
antimicrobial effect. Let me go pull up my
Evan Brand All right.
Dr. Justin Marchegiani So here’s one for the
demo decks. Can you see my screen yet. Yep.
I see it it’s got some crazy Chinese letters
on zinc oxide sulfur supplement. And again
this website is demodex so it’s demodex.co.uk
And it has a lot of good options for topical
demodex and this was shared to me by my patient.
That’s right. So it’s good. I want to put
it out there. It’s an X factor it’s not though
it’s not gonna be the first thing you go to.
Evan Brand Go up go down just a hair. I like
it said something in the description go down
just a little bit.
Dr. Justin Marchegiani Oh I’m sorry. Yep.
It’s going to be zinc oxide and sulfur.
Evan Brand OK so it says here. I mean they’re
talking a lot of stuff microbial fungal demodex
they’re talking it can soften epidermis. It
can’t be in the treatment of acne as well
steroid induced rosacea.
Dr. Justin Marchegiani Yeah I mean topical
zinc isn’t the be great. The nice thing about
these things you can do it for a lot of other
things so it be worth giving it a try. Here’s
another one as well. And I asked me endemic
X cream. I mean you could see this thing has
a couple of herbs in here as well. We try
to find the ingredients.
Evan Brand We learn so much from working with
people clinically. Yes so so great.
Dr. Justin Marchegiani Simone roots. Moneri
seeds Bristol Chinese carnations. A couple
of different things and I sensed experiments
aren’t the best but I mean hey you know this
is designed to be the cute type of treatment.
So hopefully that gives some people a couple
of ideas here. Demodex.co.uk Is a good option.
Evan Brand Very cool. This is the stuff we
learn by working with people. You’re not going
to find this at your dermatologist’s office.
Dr. Justin Marchegiani No is great my patient
was able to share that with me and we were
able to get it out there and it’s not going
to be the first thing that people who have
skin issues should go to. But if you tried
a lot of things. Hey put it in your back pocket.
Give it a try. This thing is we’re all results
driven. There’s no there’s no dogma here right.
It’s all about getting results.
Evan Brand Yep I think that’s all we need
to cover. I hit the testing I don’t know if
you wanted to say anything about testing that
you do there is like patch testing and stuff
like that but you know we’re not dermatologists
so we’re not running patch testing.
Dr. Justin Marchegiani Get the gut dialed
in. Feel free and go see a good dermatologist
to just get things ruled out. If they kind
of give you the diagnosis the diagnoses that
we’ve already talked about fine you know that
makes sense isn’t to be things like Perry
oral that can be caused by other issues whether
rubbing too much experimental stuff on your
skin or as a female. Birth control pills can
cause Perioral dermatitis. That’s a unique
situation because more topical things like
coconut oil can actually make it worse. So
just keep an eye on that it’s always good
to at least get a diagnosis to know what you’re
dealing with and that way you can make sure
the root cause is under control.
Evan Brand I just wish dermatologists were
more root cause.
Dr. Justin Marchegiani They aren’t at least
if you get the diagnosis though then you can
listen to this podcast and try to connect
to the root cause.
Evan Brand But if you’re listening if you’re
listening and you’re a paleo dermatologist
please reach out to us. We would love to speak
Dr. Justin Marchegiani We’d love to speak
with you. Love a good referral base for these
kind of things. Excellent. Any questions Evan
you want to dive into.
Evan Brand I don’t haven’t pulled up. So why
don’t you tell me if there’s any good ones.
Dr. Justin Marchegiani Yeah there’s a lot
of things we kind of already addressed.I keep
on having boils under my arm every time I
shave usually resolves on its own. Is there
an underlying issue I should worry about.
I mean it just depends. Obviously there’s
a follicle inflammation issue that’s happening.
If it’s only happening with shaving I mean
these are some kind of lubricant that you
could put in maybe use a coconut oil or shea
butter or just some kind of a natural soap
lather that will provide a little bit more
support from the friction. If it’s only happening
from that so hard to say there Sebastian writes
in. Thanks for all the awesome information.
Always this is goal I’ve gone through a lot
of what you guys are mentioning awesome and
know how it all unfolds and the causes. Thanks
so much Sebastian and then Sean Rice and I
had a reoccurring sub dermatitis in the beard
area past four years sent in Genova dis biopsies
and suspect it’s Candida. Yeah so there’s
some really good antimicrobial shampoos that
you can do topically but you want to hit on
the inside and out. And again I have them
on my site just in health outcomes. I shop
on recommended products I have some Amazon
links to some of those creams and soaps there.
Evan Brand I would love to see you grow a
beard I’ve never seen you grow a beard.
Dr. Justin Marchegiani It’s been a while man.
It’s been a while. I think it’s been about
six years. But yeah I may pull it off this
winter we’ll see.
Evan Brand When I when I tried to grow a beard.
I notice I always touch my face more and I
think back and contribute to what this guy
was mentioning with his skin. Anytime I got
a lot of hair I’m always touching my face
and who knows what’s on your skin oils and
bacteria and other things.
Dr. Justin Marchegiani That’s totally true.
Sean writes in very clean LCD based whole
food diet but I think I need to eradicate
with antimicrobials. Yep that’s the next step
Sean Ashley writes in can candida die off
make you dizzy and weak. Yes it can. It totally
can. New dive systems come and go like last
couple hours then go away and come back. Yeah
I mean they can definitely oscillate for sure.
Evan you agree.
Evan Brand Oh absolutely and if you’re you
know if you can go you know drink more water
as you said dilute and then go pee and take
lymphatic support maybe some kidney support.
You have a global movement. Maybe that will
help lessen the die off but also when I feel
bad I’ll do just a little bit of charcoal.
Dr. Justin Marchegiani 100 percent which can
cause dry big flaky patches in the hairline
that’s gonna be your substrate dermatitis
which tends to be more fungal based. Can Diop
be exacerbated by passing hard and dry stools.
I seen people that do pass stools either they
have an issue meaning intensive intensification
or they actually feel better so it can definitely
the passing of things can definitely shift
what’s happening in your gut as well. Dennis
writes It is their first but it’s bad for
your health. Yeah they are basically it’s
an aluminum molecule that’s dehydrated that
that then expands and clogs the poor and makes
it impossible for you to sweat these welds
there. So definitely not good. You rather
have something that allows you to sweat but
has natural anti-microbial qualities that
kills the bacteria that produces the not so
nice smell. You know you can do that with
shea butter or coconut oil or very very much
very certain parts of the coconut oil like
a public acid tends to be more anti-microbial.
Sean says that high morning cortisol and very
high DHEA some sort of got dysbiosis as well
will sort of dressing will be the connection.
Well inflammation in the gut causes inflammation
in the body and in your stress handling system
tries to deal with that. Aaron writes in Is
there a relation between skin disorders and
chronic Lyme. Definitely can be lyme is a
stressor on the body and that’s the stressor
on the liver and detoxification and that can
easily affect the gut as well. Anytime you
have inflammation in the body it’s a major
stress ball in your stress bucket and when
you’re stressed buckets full systems in your
body don’t function optimally. And people
that have Lyme can have other co infections
like Evan knows about like the busier about
Evan Brand Yeah and you know those are all
immune suppressants. Right. And so when your
immune system is depressed bacteria viruses
fungi those can all take the forefront and
take you down. So part of resolving that would
have to be supporting the immune system while
trying to remove the microbes or at least
get the microbes back in balance. There’s
this debate about whether you can fully kill
Lyme. I don’t know.
Dr. Justin Marchegiani Yeah we can definitely
least knock it down so it’s not as big of
an issue on the immune system for sure. And
then regarding dry.. Barb writes in What About
dry issues with skin like water lesions so
first thing is make sure we have enough collagen
and good building blocks to have healthy skin
right cultured amino acids are great. And
then if we’re having like some kind of skin
tag type of things one make sure the insulin
is under control because more insulin will
cause those contacts. And the number two you
can always get like a little cotton ball and
sop it up with apple cider vinegar and then
like that kind of like get a Band-Aid or like
a wrap and wrap it up against that lesion
and a lot of times it will fall off. You can
also make like an apple cider vinegar tumor
type of like pull this and then put it on
a Band-Aid or end a cotton swab and then tape
it to your skin that can help those lesions
just kind of fall away.
Evan Brand Maybe a little bit of tea tree
mixed in with that would be good.
Dr. Justin Marchegiani A little bit of Melaleuca
or a tea tree. Yep that’s great too two thoughts
on CBD pretty talks. I mean it’s not going
to be what I would use for detoxification
but has other good immune benefits mood benefits
anti inflammatory benefits but it would be
my first thought. For detoxification.
Evan Brand CBD is like the new raspberry ketone
remember I like five years ago there was raspberries
Dr. Justin Marchegiani Yeah yeah yeah. More
the the green coffee extract right. That was
the big one. Things get really trendy right.
Sean writes in do you treat patients outside
of Texas via phone and email. Yes I do. Evan
does as well. So see Evan. EvanBrand.com.
We see patients all over the world and for
myself JustInHealth.com see patients in Texas
and all over the world. You are welcome Sean.
Evan anything else you want to add today.
Evan Brand I think I said we can wrap it up.
Dr. Justin Marchegiani And they just a little
thing we always put it out there every time
if you guys are enjoying this podcast give
me a thumbs up. We’d like to know in the comments
that you guys have done that haven’t been
successful. I read those comments and I take
that information and I incorporate it into
my kind of mental tool bank so to speak and
apply it as necessary. So let me know your
comments or what’s helped you. What makes
you feel better and if you enjoy it share
with one person that you know in your life
that could benefit ninety nine point nine
percent of people we help. We do it without
even seeing them. And that’s the power of
internet. We appreciate you guys spreading
the good word.
Evan Brand Yep. Take care. We’ll see you all
Dr. Justin Marchegiani Have a phenomenal week
y’all. Take care. Bye now.
Evan Brand Bye bye.
Dr. Justin Marchegiani Bye.