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Low Dose Naltrexone and More | Podcast #185

November 5, 2019

Dr. Justin Marchegiani: Hey there! It’s
Dr. Justin Marchegiani in the house. Welcome back to Beyond Wellness Radio. We have Dr.
Sajad uh— Zalzala, Dr. Z for short. Dr. Z, welcome to the show! Dr. Sajad Zalzala: Thanks for having me, Justin. Dr. Justin Marchegiani: Well, let’s dig
in today. So, you’re a family medicine practitioner. You’re a medical doctor and you kind of
made your journey over to the functional medicine world. And, it’s always interesting because
when you go from the medical doctor realm, you put so much time, so much work into understanding
the allopathic side of medicine. Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: And, to come over
on to [stutters] Let’s call it the— the uh— the— the good side, right? Dr. Sajad Zalzala: Uhuh— Uhuh— Dr. Justin Marchegiani: Walk me through that
journey. How did that happen? Did you get disenchanted with conventional medicine? What
happened in your life to then cause you to come over unto the uh— to the light, so
to speak? Dr. Sajad Zalzala: Sure. Actually, for me,
it happened early on, uhm— right— right in medical school. So, actually, started out
my uh— my career after high school uh— as Computer Science major. I— I— First,
I don’t want to do anything with medicine uh— but I changed my mind, uhm— you know—
a few years into my studies. That’s Computer Science, actually gravitated more towards
a customer service helping people rather than, you know, technology. Dr. Justin Marchegiani: Uhmhm— Dr. Sajad Zalzala: So, I— I decided, you
know, I’m wasting my time with computers and I decided I wanted to go. I— I wanted
to be a doctor instead. Uh— So, I kind of switched gears and uh— you know— applied
for medical school. I was fortunate to get in. I almost dropped out after the— after
the first year of medical school. Uhm— Me— Studying was a lot harder than I thought it’d
be, you know. I didn’t have the skills that I— that I needed uh— to uh— you know,
to make it through. And, I almost dropped out actually. Uhm— But, what saved me was
actually, in my introduction, is Integrated Medicine.or Holistic Medicine. At the time,
it wasn’t you know— Functional Medicine is still one of those terms that wasn’t
quite used yet, uhm— but I think, at that time, Integrated medicine was— was the term
that was mostly used. Uhm— But the reason I almost dropped out of medical school is
because there I was a bit disconnected by what we are learning from the biochemical
pathway physiological perspective of what we were learning from the therapeutics perspective.
Uhm— You know, it just— it just— It seems like our class— our class is completely
ignored. Everything you could do from a diet, nutritional, you know, lifestyle perspective
uhm— to— to help— to help a patient and focus specifically on drugs and surgery,
and that was pretty much it. Uhm— Dr. Justin Marchegiani: Totally. And— And
again, I kind of little tongue-in-cheek, put a little jab at the… Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani: …allopathic uh— Dr. Sajad Zalzala: [laughs] Dr. Justin Marchegiani: …medicine community.
But, Allopathic Medicine is phenomenal at Acute Traumatic Care… Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: …where the underlying
cause isn’t an issue, right? You got in a car accident…. Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: …the underlying
cause is already isolated. It was the car accident ot the trip and fall, right? Dr. Sajad Zalzala: Hmm— Dr. Justin Marchegiani: Chronic Medicine or
Chronic Degenerative conditions, there’s an underlying cause that’s— that’s still
not addressed that if you just… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …use medications,
we’re not covering it up. We— We’re covering it up. We’re not getting to the
root cause. So— Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: You had this mindset
where it was allopathic and then you shifted over because in family medicine, you’re
just constantly prescribing drugs for symptoms… Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: …and not getting
to the root cause, correct? Dr. Sajad Zalzala: Exactly. Exactly. I mean,
I think— I think, conventional medicine and all kind of [incomprehensible] medicine
is kind of a victim of its own success. BUt, a hundred years ago, I mean, uh— you know,
Penicillin was a big thing. You know, surgeries, surgical techniques were a big thing. And
so, they were curi— you know— Allopathic practitioners are curing diseases and kneeling
patients uhm— for things that were thought to be incurable. But— But in our— in our
day and age, where most people are not dying of infections, where people are not dying
of, you know, uh— you know, slivers in their feet and things like that, uh— you know,
it— [stutters] they’re trying to take that— the success from a hundred years ago,
and trying to— and trying to put it into our— our modern uhm— maladies, and it—
it just— it just fails, terribly, because it completely ignores so many things in our
biochemical and [stutters] uh— and uh— physiology. Dr. Justin Marchegiani: Yeah. We’ve come
a long way because water is cleaner, right? WE have good water purification process. Maybe
we still leave some Fluoride and Chlorine in there but that’s another podcast. Dr. Sajad Zalzala: [makes a sound] Dr. Justin Marchegiani: We have, you know,
clean— We have food storage systems like refrigerator so we can keep food fresher and
such. Uh— Obviously, we do have the pesticide component. We do have indoor plumbing. These
kind of things have decreased a lot of the infections, but then now we have all these
Chronic Degenerative uh— things that are occuring, like heart disease… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …and Cancer at much
higher rates. Was there a personal kind of impact with— Did you have a health challenge
that kind of pulled you over from conventional medicine into functional medicine? Dr. Sajad Zalzala: Not until later. I mean,
I was a big fan of uh— Integrated Medicine, right? Kind of right from the start that I
heard about it. Uhm— But later on I uh— you know— So, I’ve always had a challenge
with my weight. I— I was a— I was a big kid back when there weren’t really many
big kids. Dr. Justin Marchegiani: [laughs] Right. Right. Dr. Sajad Zalzala: Uh— [laughs] So learning
about Integrated Medicine function has allowed me to kind of help me control that, and I
still struggle with it. Uh— You know, if anybody’s— If anybody’s struggle with
their weight, they kind of know what their doctor… Dr. Justin Marchegiani: Uhmhm— Dr. Sajad Zalzala: …you know, what I’m
talking about. Uhm— But uh— you know, I uh— I learned to clean up my diet. You
know, I learned that the uh— food pyramid was completely uh— bogus. Uh— And— And—
And— And that— You know, I— I went Gluten-free back in 2011. And even though I’m not a
strict as I want to be but uh— but I— I— I still think it’s a big component
of— of— of where I’m at today in terms of my health. Uh— [crosstalk] And it—
And it shows— Yeah. It shows just the power uh— of— of— of— of just simple things
like that. Dr. Justin Marchegiani: [breathes in] Dr. Sajad Zalzala: Uhm— That— That just
means your medicine’s fully ignores, or they actually try to— try to convince you
otherwise. Uh— Like, there was a story and uh— uhm— how people who are Gluten-free
are at high risk of having Arsenic poisoning. Uhm— We got to kind of read between the
lines and say, “Well, it’s not— It’s not because you’re Gluten-free. It’s because
you’re eating so much rice.” [laughs] Dr. Justin Marchegiani: Exactly. You’re
into [incomprehensible] but like— Dr. Sajad Zalzala: And it has lights saying,
“Gluten-free you know— Gluten-free uh— diets are linked to Arsenic toxicity, you
know.” So, there’s still be this big war being waged between— you know, between the—
the— the natural health community and the— and the conventional allopathic community. Dr. Justin Marchegiani: A hundred percent,
and that’s the problem. A lot of conventional medicine has a lot of confounding variables
that aren’t really laid out there. That’s great that you’re able to break that down.
And I’m just curious too because I found with a lot of medical doctors there’s like—
There’s a sense of arrogance that like, “You know what, I’m in medical school.
I’m a medical doctor. Ther— The medical school’s only gonna teach me what is important,
and if I didn’t learn it in medical school, it must not be important.” How were you
able to turn that part of your brain off and realize you weren’t getting the whole story,
this wasn’t it? Dr. Sajad Zalzala: Well, I guess that for
me, because I was fortunate enough to learn about Integrated Medicine early on. Actually,
learning about it, functionally, they’re medicine. Listen to Dr. Jeffrey Bland. [crosstalk]
I listened to… Dr. Justin Marchegiani: [crosstalk] Uh—
Yeah. Got it. Dr. Sajad Zalzala: …his— his clinical
updates. You know, attending the uh— the— some of the IFM and the Integrated Medicine
Conference. It actually helped me learn the allopathic part a lot— a lot more uh—
effectively, uh— because— It’s ‘cause it opened— o— opened m— my eyes a lot
more. So— So when I learn the allopathic stuff uh— you know, always in the back of
my mind’s like, “This is not how it actually treat a patient.” You know, I had a Hypertensive
patient. I would not actually actually start them on antihypertensives, you know. I fix
their lifestyle first. But— Dr. Justin Marchegiani: Right! Dr. Sajad Zalzala: But… Dr. Justin Marchegiani: Right! Dr. Sajad Zalzala: …I know the mechanism
is action for the medications and I know that the test is asking for this therapy. So—
So I always l had a kind of [stutters] I had to act almost like a split personality in
some ways where I needed to know what I need to— to think like the allopathic people
wanted me to think like they have allopathic educators wanted me to think like. They also
had this thing where I knew there was a different way to do it. Uhm— So— So I would— It
was never a sense of betrayal as the only real sense of— of betrayal is was the fact
that they— that they really didn’t teach any of these other therapies in medical school.
Uh— And every time I ask my professor uh— about it like— like— like you’ve learn
about a pathway or something like that. What— What couldn’t you— Couldn’t you change
that pathway using, for example, you know, Turmeric to— to reduce inflammation rather
than some drug or something like that. Or— Or— Or something like that, and then—
and then the professor would kind of stare at me. It was like, “Whoah! Hah! Maybe you
could? But we don’t have any large randomized controlled trials… Dr. Justin Marchegiani: Hah! Dr. Sajad Zalzala: …to prove that. Uh—
So, you know, with this kind of like, you know, move along. You just— just— just—
just learn what we want to learn. Dr. Justin Marchegiani: It’s like, “Of
course, you’re not, because you can’t patent some herb— you know, that the mother
nature created.” And then, if any drug company spent billion dollars getting it through Phase
III Clinical trials, uhm— they wouldn’t have unlimited rights to it… Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani: …so they would never
recoup their money. So, of course, that’s never gonna happen, right? Dr. Sajad Zalzala: Yeah. Wha— I mean, Functional
Medicine is gaining steam uhm— into the mainstream. I mean, you have the Cleveland
Clinic. They have a Functional Medicine department. Uhm— You know, you have— you have other
major universities and hospital systems kind of down… Dr. Justin Marchegiani: Yeah. Dr. Sajad Zalzala: …board. Uhm— I don’t
know if— if the— these programs will ever be as effective as we need them to be ‘cause
a lot of times they’re kind of padded with uh— “fluff” for lack of better term.
Uhm— Dr. Justin Marchegiani: Totally. Dr. Sajad Zalzala: But like for example, I
mean, not to knock on any hospital systems but, you know, a lot of times it’s, “Oh!
Come check out our uh— Holistic Medicine department,” and basically, just Yoga classes.
Not the… Dr. Justin Marchegiani: That’s it. Dr. Sajad Zalzala: …knot kind Yoga. Yeah.
Not the knot kind of Yoga. I mean, Yoga’s a great therapy but— but— but to think
that— to think that— that— that, you know, by sprinkle in a little Yoga in a—
in a hospital that you call it now Holistic Hospital. You know, I— I think— I think
those just uh— uh— uh— whitewashing— whitewashing the whole thing. Dr. Justin Marchegiani: Oh! I— I totally
agree. And I’ve said— I’ve got it on records a few times, I don’t think you’re
gonna see— and I could be all wrong. I don’t think you’re gonna see the Functional Medicine
at Cleveland Clinical really, truly be what it needs to be. I think it will be water down
to some degree… Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani: …and the reason
why I say it is because you’re gonna have tens of millions of dollars invested into
a Cancer Wing at Cleveland Clinical Clinic. You’re gonna have tens of millions of dollars
invested into a— into a Heart Disease Wing. Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: If you bring Functional
Medicine treatment and care into that hospital, that sucks profit and revenue… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …out of those other
wings. Dr. Sajad Zalzala: Mm— Dr. Justin Marchegiani: I mean, they’re
CEOs. Just look at the— you know, the bottom dollar Dr. Sajad Zalzala: Dr. Justin Marchegiani: , and they’re gonna
be like, “Hey! You know, this one thing is doing okay but, you know, it’s stealing
a whole…” Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani: …”bunch of revenue
from what keeps the clinic afloat.” And, there’s a lot of money in Cancer and Heart
Disease and Chronic Disease like Diabetes. And, don’t get me wrong, a just— There’s
not gonna be the ROI on dr— on supplementation and lifestyle counseling because these aren’t
patentable things. Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: That’s the [inaudible]— Dr. Sajad Zalzala: Yeah, exactly and absolutely.
And then, unfortunately, I think until the healthcare bubble bursts and people realize
that— you know, that [stutters] those insane to pay for, you know, 50,000 dollars a year
for a therapy that just covers up the symptoms. Until that happens. Uh— Yeah. I think—
I think we’re kind of stuck with it, unless— unless patients take— take control of their
own health and try to kind of seek out their own therapy. Dr. Justin Marchegiani: Oh! Totally. Like— Dr. Sajad Zalzala: Mm— Dr. Justin Marchegiani: I mean, for instance,
uhm— my wife and I had a child at the end of the last summer, and he’s doing phenomenal.
But, like a lot of children, as you know, as a family uh— practitioner, is had a—
a slight like heart murmur, which a lot of times in— in the child and I— and I think
can be totally normal. So, we were just like, “Alright. So, well let’s just get it evaluated.”
Uhm— Kind of fast forward to the end, his heart was totally fine… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …but we get the
bill back… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …and it was like
3,000 dollars… Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani: …for an hour of
the doctor’s time. I mean, they… Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: …did like a little
uhm— They did a little, I want to say, a ultrasound test. Dr. Sajad Zalzala: Yeah, Echocardiogram. Yeah. Dr. Justin Marchegiani: And uh— And then,
one other type of test. But those 2,500 dollars, the insurance ended up paying everything but
three hundred bucks. But, I’m… Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: …like, “Wait a
minute! Lie, if I just went to the— to the Cardiovascular doctor and was like… Dr. Sajad Zalzala: Uhuh— Dr. Justin Marchegiani: …out here, 300 bucks.
Just— Just give me what I need from the service perspective… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …we could have just
cut out all that whole insurance industry. Dr. Sajad Zalzala: Right. Right. Right. I
know, absolutely. Absolutely. Absolutely. Yeah, I mean— I mean, uh— the direct—
direct care and— and self-pay is becoming much more uh— popular as— as copays and
deductibles go up. Uh— I mean, I have an incredibly high, you know, deductible on my—
on my family’s plan. And I do everything I can to try to stay out of the— of of the
healthcare system. You know, I’m fortunate that I have access to the healthcare system
uh— you know in the— in ways that I learn other people don’t but— but— but you
know, people are smart about it. I think they can also kind of— you know, uh— work with
their doctor, their— the- work with their health provider to kind of uh— keep people
much more affordable. Uh— And [crosstalk] then— Then, when— Then, when you’re
dealing with the insurance and everything’s inside it like uh— Dr. Justin Marchegiani: One hundred percent,
and that’s the issue— is that I’m paying a whole bunch of money for like a high-deductible
insurance, where, in the end, I could had just paid that person cash. You know, I think… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …having an insurance
is great for high-deductible stuff. You get in the car accident. [crosstalk] Something
really— Dr. Sajad Zalzala: [incomprehensible] Yeah. Dr. Justin Marchegiani: Something really expensive
that’s gonna happen and you may need care… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …or hospitalization,
that’s where I think it’s good. But I think everything else, having an HSA or Flex
Spending… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …and then, going
with the doctor— ‘Cause with me— I’m not sure how it is in your practice but it’s
just me. I have a couple of people that help on the administrative side. I don’t spend
all this money on billers and staff and overhead. So, number one, I get more of what I g—
what I charge… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …and I could charge
less than most people because of the situation, right? Dr. Sajad Zalzala: Yeah, absolutely. [crosstalk]
Absolutely. Yeah. That’s why I started this. I w— You know, I’m— In the pre— pre-recorded
session, I was speak— talking to you more about why I started this online clinic. Uh—
It’s— It’s because by— by doing online, by a long-gauged access, a patient— you
know, a— a practitioner directly— It brings down the costs. Dr. Justin Marchegiani: Huge. Dr. Sajad Zalzala: There’s also convenient
factors as well. I mean, uhm— you know— Dr. Justin Marchegiani: Don’t commute? Dr. Sajad Zalzala: You don’t commute, right?
You don’t— Dr. Justin Marchegiani: Wait in the office? Dr. Sajad Zalzala: Yeah. You don’t have
to take a half a day off of your work schedule to go— you know— to go— to go sit—
to go sit in a waiting room. And you know you just— you necessarily have to uh—
uh— you know [stutters] You could potentially uh— book— book outside of the uh— you
know, regular business hours. Uh— Because, usually, practitioners on the other end are,
you know— they have a little more flexibility as well. So, it’s— it’s better for the
practitioner and— and for the patient. Dr. Justin Marchegiani: That’s great. And,
Dr. Z, what’s your website? So, people listening, if they want to reach out to you and get support,
how can they uh— Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …can hold you? Dr. Sajad Zalzala: Yeah. So— So, the uh—
The online clinic I run is called the Uhm— Dr. Justin Marchegiani: Love that name. Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani:
We’ll put the uhm— the link right below so if you guys are listening to it and you’re
driving and doing something and you can’t access it. Just click below in the description
and you’ll find that in there. Dr. Sajad Zalzala: Sure. Sure. I mean, uh—
[stutters] my goal for that clinic is to just try to help as many patients as possible by—
by allowing them access to a uh— functional medicine glider. Uhm— One of a— One of
the challenges with— with uh— a non-medical functional provider is— you know, the some—
some of them faces as— Some— Sometimes, patients need medication uh— uh— to try
to, you know, to try to get rid of certain… Dr. Justin Marchegiani: Stabilize Dr. Sajad Zalzala: …issues. Exactly. For
example, if somebody has like a— has like heavily Yeast infected because of a Yeast
Overgrowth— you know, sometimes, you need some kind of solinized standards. Herbs don’t
always work as well as it should. Uh— We’re taking probiotics, so that’s kind of a—
a situation where, you know, you— you need a medical doctor kind of in the background
there to kind of order that. Order blood tests. You know, a lot— a lot of tests and things
like that are not— I mean, you’re not able to access directly. Uh— So, I work
together with these— with these uh— health coaches or these, well— uh— they’re—
they’re functional medicine providers, I call them… Dr. Justin Marchegiani: Yeah. [crosstalk]
It could be a practitioner or another… Dr. Sajad Zalzala: A practitioner, exactly. Dr. Justin Marchegiani: …non-prescribing
physician like myself. Dr. Sajad Zalzala: Exactly. So, I kind of
collaborate with these— with these non— with these non- uh— prescribing uhm— a
non-medical— non-MV uh— uh— p— practitioners. They kind of get the best of both— get the
best of both worlds to the patient. I mean, they— they have… Dr. Justin Marchegiani: Okay. Dr. Sajad Zalzala: …fantastic educations
and experience in functional medicine. And then, when I need that support and supervision
from a medical doctor, I’m licensed in 35 states, uhm— So, that allows me kind of
broad access to— to pretty much, you know, 90% of the audience that’s listening to
you in the United States. Uh— So— So that— That’s kind of my vision for that. YOu know,
it’s still fairly recent in terms of its uh— launch. Uhm— You know, we’re still
accepting patients. Uh— And— And— And we hope to— We hope that it’ll grow as
time goes on if people know more about it. Dr. Justin Marchegiani: Awesome, Dr. Z. So
let’s dig in a little bit deeper here. So, number one, we have like— you know, you
talked about like the biochemistry and the mechanisms when you were in medical school.
You would dive in, you would understand what the mechanism is. You would try to get kind
of your head wrapped around how the drug works for that mechanism. But then, you would say,
“Okay. Well, how can we plug in a natural intervention to help support that?” Is that
correct? Dr. Sajad Zalzala: Exactly. Exactly. Again,
that’s kind of where— where I listened to Jeff Bland and other— uh— other people
like him; really made a big difference in my education. Dr. Justin Marchegiani: Okay. Well, I’m
gonna lay one thing out and then, let’s kind of play a game and just go back and forth
here. That way, I think people can— can understand both mindsets. So, we have High
Blood Pressure, right? Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: Those are the— I
mean, we have the big medications for it. Are gonna be like Hydrochlorothiazide… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …like a water pill.
We have Angiotensin-converting enzyme… Dr. Sajad Zalzala: Uuh— Dr. Justin Marchegiani: …drowse [inaudible]
blockers, right? Dr. Sajad Zalzala: Right. Right Dr. Justin Marchegiani: So— So, I look at
it as, “Okay. Well, number one, we can help water retention by… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …just helping with
Insulin resistance ‘cause Insulin… Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: …process water retention. Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: We have— We have
uhm— the Angiotensin-converting enzyme medications, where we can just support the adrenal function. Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: We can get inflammation
in the body down… Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: …which will help
decrease vessel constriction. Dr. Sajad Zalzala: Mm— Dr. Justin Marchegiani: Things like Curcumin
or— or Ginger or Fish oil will help relax kind of the— the inflammation there. Then
also, things like Magnesium, which… Dr. Sajad Zalzala: Magnesium… Dr. Justin Marchegiani: …[crosstalk] helps
in natural beta-blocker for the heart too. Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: So, that’s kind
of— That’s like… Dr. Sajad Zalzala: Ome— Omega-3 is so kind
of the— the— the flexibility in the arteries and in our— in our blood as well. Uhm—
You know, just staying away from inflammatory foods. I mean— I mean a lot of times uh—
the— the Circulatory System is so inflamed because of the junk that we feed ourselves.
[laughs] Uhm— you know, uh— Yeah, you— you could bring down the blood pressure fairly—
fairly quickly by just going on a— you know, super clean— super clean diet. And, I’ve
seen that happen uh— you know, quite often. Dr. Justin Marchegiani: That’s great. I
want to see. Do you have another uh— another drug? Can you cut another mechanism that you
can lay out and then just kind of compare and contrast the allopathic versus the functional
med uh— mindset like I just did? Dr. Sajad Zalzala: Uh, well, you know, uhm—
Diabetes, for example, that’s a big one. Uhm— Dr. Justin Marchegiani: Excellent. Dr. Sajad Zalzala: So— Yeah. Yeah. So, I
mean, the number one— the number one prescribed drug is Metformin, and actually, I like that
drug. I don’t want to knock it. Uh— And uh— the reason I think it works so well
‘cause it’s actually an extract with uh— I believe it’s the French Lilac or the German
Lilac. French lilac… Dr. Justin Marchegiani: Yep. Dr. Sajad Zalzala: …I believe. Dr. Justin Marchegiani: Okay. Dr. Sajad Zalzala: I think that’s why it’s
so powerful. You know, in fact— in fact, every since I started prescribing it just
for its anti-aging properties. Uhm— But if you want to go— you know, if you’re
purest, and you want to go like completely, you know, natural with that, even though—
even though Metformin’s pretty close to that, uh— Berberine is another uh— way
you could do it. Uhm— So— So Metformin for those who may not know. Uh— Is this—
It works really well because it uhm— uhm— it helps the Insulin receptors work better,
uhm— and then also, blocks excess uh— accumulation of sugar storage in the liver.
Uhm— So uh— you know— excess creation of sugar in the liver as well. So— So, it
really works really well. Uhm— But of course, you know, any— any supplement or medication
or anything that should you take externally is only gonna work so far— you know, uh—
if— if— if you don’t— You have to make changes to your lifestyle and diet. I
mean, I tell patients I’m a big fan of what’s called the Paleo Diet, uhm— you know, like
a modified Paleo diet. You know— Dr. Justin Marchegiani: [crosstalk] Paleo,
like Paleo template. Yeah Dr. Sajad Zalzala: Yeah, exactly. What people
try to eat as closely as their ancestors do. Dr. Justin Marchegiani: Love it. Dr. Sajad Zalzala: Uhm— [stutters] And that
seems to work the best for a wide variety of people. Uhm— You know, they were the
largest variety of people. I mean— I mean, there’s some individuality. I mean— I
mean, people from Europe may be different from people from Asia and there might be little
bit of uh— that kind of tweaking that you need to be there, but I just like the concept
that when I think— I think got to be with that Yeast. So— So, anybody— anybody who
comes in my office at sessions comes from Diabetes. First thing I do is I make sure
that they get on a Pa— Low-carb— Low Starch Paleo Diet. Uh— And then, Metformin’s
usually I’ll start with Like, if they want to go uh— they want to go [inaudible] I’ll
be with a Berberine. Uhm— But then, from there, I mean, if— if you’re talking about
the Insulin sensitivity, you put them on things like Chromium uhm— because, you know—
Because Chromium’s important for the uh— for the receptors, Insulin receptors. Dr. Justin Marchegiani: Yeah. Dr. Sajad Zalzala: Uhm— You got to put in
mind something— s— a good quality B Complex because all those— you know, all the B vitamins
are— are— are needed to help process the Carbohydrates. And a lot of people are deficient
on those just— just because of the process foods. Uhm— Dr. Justin Marchegiani: Yup. Dr. Sajad Zalzala: The Magnesium’s another
thing uh— [stutters] that a patient’s on. Uhm— You know, uh— anything with bitter,
like bitter Melon, Dandelion— anything that tastes bitter, they said they have substances
in that help kind of control a blood sugar as well. Uh— I mean, there’s so many things
you can do. Uhm— One medication I do not use for d— Diabetics is a Glyburide or the
Sulfonylurea medication. Dr. Justin Marchegiani: Yeah. Dr. Sajad Zalzala: Uh— I stay. I stay away
far those as possible. Dr. Justin Marchegiani: Why is that? Dr. Sajad Zalzala: The reason because uhm—
if I— I find it actually helps accelerate Diabetes because what it’s— It kind of
forces the pancreas to release more Insulin. Dr. Justin Marchegiani: Stimulates more Insulin. Dr. Sajad Zalzala: Exactly. Exactly. And the
last thing you want as a Type II Diabetic is more Insulin, uhm— because it burns the
pancreas out faster and it’s kind of a faster path down that cliff to you after [incomprehensible]
eating Insulin injections. Uhm— Dr. Justin Marchegiani: Exactly. Dr. Sajad Zalzala: So— Dr. Justin Marchegiani: That makes sense.
[crosstalk] So, I just want to break that down for the listeners, right? What you’re
saying is we have this pathway of Insulin resistance that happens. We have this drug
Metformin, which is the— the French Lilac you mentioned, which decreases some Glucose
absorption in the— in the gut. It decreases some of the Gluconeogenesis, which means producing
sugar from the liver. Also, I think— I mean, you didn’t highlight, but I just want to
see. Do you also give some extra B12 to prevent any uh— Anemia issues from the Metformin
and Low B12 connection? Dr. Sajad Zalzala: Oh, yeah! Anybody I’m
informing, I always have their B12 level periodically, and— and I encourage them. B12, well that’s
part of the B Complex that I tell my Diabetics to take. Dr. Justin Marchegiani: Got it. So, that’s
there. And again, conventional medicine, they’re not touching the diet. They’re typically
recommending the food pyramid, which has… Dr. Sajad Zalzala: Yes. Dr. Justin Marchegiani: …more grains, more
inflammation, higher blood sugar via Cortisol and just Carbohydrates that they’re consuming.
And then, you know, typically, it’s the Sulfonylurea medications and then, eventually,
they’re on to full on Insulin. Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: And I know, just giving
more Insulin to cover up all that sugar. So, you’re actually trying to get to the root
issue… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …which is the diet
and the lifestyle change. You may use a medication, which I do think Metformin is— is a better
medication. And again, I think a lot of the anti-aging benefit just come from the fact
that we’re getting Insulin down… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …too, right? Dr. Sajad Zalzala: Right. Well, there are
other— There are other uh— anti-aging properties in that formulated system. Dr. Justin Marchegiani: let’s hear it. I’m
curious. Dr. Sajad Zalzala: Yeah. yeah. So— So there’s
three anti-aging pathways. There’s a kind of.. Dr. Justin Marchegiani: Cool. Dr. Sajad Zalzala: [incomprehensible] Sirtuin
gene. Three major ones that we know about and there i— there may be more. So, you’ve
got these Sirtuin genes. Uh— Dr. Justin Marchegiani: Yeah. Dr. Sajad Zalzala: let’s talk about that.
So, you’ve got the uh— the AMPK, uh— A-M-P-K… Dr. Justin Marchegiani: Yep. Dr. Sajad Zalzala: …and you’ve got the
MTOR. Uhm— Dr. Justin Marchegiani: Yes. Dr. Sajad Zalzala: You know, if anybody’s
read anything about red wine and Resveratrol, they’ll know about the Sirtuin genes, originally
discovered by a— you know, a guy— a brilliant uh— scientist out of a Harvard Medical School
back about— about 20 years ago. He discovered that the— that— that from Yeast on up,
we have these genes called the Sirtuin genes. Uhm— And— And he found that— that in—
that in uh— many organisms, we can actually stimulate the Sirtuin genes by taking the
Resveratrol. Now, they spent millions of dollars trying to find Resveratrol derivatives to
work in humans. Unfortunately, it never panned out. Uhm— Now, Dr.— His name is Dr. David
Sinclair. He’s back in the lab and he’ looking at a substance called NAD or NADH.
It’s a derivative of— of uhm— Niacin. Uhm— Uh— Don’t ask me what NAD or NADH
is for it’s really long. Dr. Justin Marchegiani: Yeah. Dr. Sajad Zalzala: You can look it up. But—
But we’ve ignored NAD for a long time. You know, remember from your high school Biology
class, uhm— N— you know, NAD was just kind of one of those things that’s just
part of the Krebs cycle. We took it for— We took it for granted. You know, we always
thought that the end goal is ATP, and we need ATP. But you need N— NAD to make it. We’re
also… Dr. Justin Marchegiani: [crosstalk] It’s
a reducing agent, right? NAD’s main job is to— is to grab electrons. Dr. Sajad Zalzala: Exactly. Exactly. And—
And uh— You know, you need a certain number. I can’t remember if I’m at how many but
you need a certain number of NAD to make a certain amount of ATP. But as you get older,
the— the number of ATP— the number of NAD available to us is— is— is less and
less. In fact, there’s this a— well, a study show that at a time you’re 50, you’re
down about half as many as much— as much NAD uh— production as— as— as a young
healthy adult does. Uh— And that’s— that’s the part of— that’s the problem
why the Resveratrol in humans doesn’t seem to work. It’s because of that lack of NAD.
Once you get the NAD levels up, then everything works better. And there are— There are some
research on some substances that help to help do that. Uhm— Dr. Justin Marchegiani: So, let’s break
that down. So, what pathway was that again that you just mentioned that the— the Resveratrol
was with? Dr. Sajad Zalzala: The Sirtuin. The humans
have a— seven— Dr. Justin Marchegiani: Sirtuin? Dr. Sajad Zalzala: …seven Sirtuins. Yes— Dr. Justin Marchegiani: Is that similar to
the— to the nerve pathways? Dr. Sajad Zalzala: Uh— nerve— nerve—
uh— Dr. Justin Marchegiani: Cell Resveratrol does
a lot with the nerve pathways. Resveratrol, Green tre— Green tea— those kind of things. Dr. Sajad Zalzala: I believe they are [crosstalk]
related. I believe they are related. I have to… Dr. Justin Marchegiani: It must be. Dr. Sajad Zalzala: …go back to my biochemistry
books to— to see how they’re related. Uhm— Dr. Justin Marchegiani: [crosstalk] So, the
first one’s the Sir path. Go ahead. Yes. Dr. Sajad Zalzala: The Sir path, or the Sirtuin… Dr. Justin Marchegiani: Uhmhm— Dr. Sajad Zalzala: …Fluid path, but you
need enough NAD in order— in order to— to actually put those certain pathways to—
to be activated. And uh— there’s a lot of sc— there’s a lot of research going
on in subs— substances to help boost NAD levels. Uhm— The one that’s available
right now as a supplement form is called Nicotinamide Riboside or NR. Uhm— It’s kind of costly,
but it’s— It’s well— well worth it. Uhm— Uhm— The uh— I find if used in
combination with other uhm— Mitochondrial Support uh— supplements that actually works
a lot better than by itself, uhm— Dr. Justin Marchegiani: And then, additional
B vitamins would also help with the NAD as well? Dr. Sajad Zalzala: Uh— Yeah. B— Again,
because you got to remember that Krebs cycle. Dr. Justin Marchegiani: Z— Yeah. Dr. Sajad Zalzala: With B vitamins involved… Dr. Justin Marchegiani: Nicotine. Dr. Sajad Zalzala: …and all that— Exactly.
All in that— Well, maybe… Dr. Justin Marchegiani: FAD as well. Dr. Sajad Zalzala: …if NAD is— NAD is—
is derived from— made from uh— a Niacin or B3 vitamin. Dr. Justin Marchegiani: Yes. Dr. Sajad Zalzala: Uhm— So— So, if I don’t
have enough NAD, the Sirtuin genes don’t work. So— So, you need— you need both,
like Resveratrol to sti— help stimulate the uh— the— the Sirtuin. But you need
in that, you know, NAD boosters to help boost it to kind of work more. So kind of fuel,
the fuel for the certain uh— proteins. The other two pathways, the uhm— the MTOR and
the AMPK— those can be stimulated by things like Intermittent Fasting or fasting. Dr. Justin Marchegiani: MTOR. Dr. Sajad Zalzala: Yeah, exactly. Exactly.
But also— Dr. Justin Marchegiani: Also, coffee too,
right? Dr. Sajad Zalzala: Uh— Dr. Justin Marchegiani: Can coffee help with
the MTOR? Dr. Sajad Zalzala: The— There’s a lot
of things that we’re learning about that can help… Dr. Justin Marchegiani: Yes. Dr. Sajad Zalzala: …that can now boost MTOR.
I’m not— I don’t— I don’t know as much about the studies for coffee but I—
I wouldn’t be surprised. I mean— I mean, coffee’s got a lot of things in it, uh—
Polyphenols and things like that. Uhm— But— But like I say, it can stimulate those pathways
by uh— fasting— fasting, uh— Metformin. Also— Also stimulates those— those pathways
well. Uhm— Dr. Justin Marchegiani: Now, is it primarily
doing it through the Insulin sensitivity. Is that how it’s doing it? Or is there another
[crosstalk] pathway? Dr. Sajad Zalzala: No, I think— I think
there’s something else to it. I think there’s… Dr. Justin Marchegiani: Okay. Dr. Sajad Zalzala: …something else to it.
Uh— I don’t exactly how it’s stimulating it, uh— but uh— but you know, when you
do— you know, gene arrays and things like that, uh— you know, working analysis, it
seems to be uh— uh— you know, stimulating those two pathways uh— for— for the positive.
Uh— And that’s why there s— there seem to be more and more traction in getting Metformin.
People who are not even Diabetic, you know, Pre-Diabetics, or eve people who just you
know, who— who— who just had a little extra trouble losing weight, it seems to be
very effective. Uhm— [stutters] And when you add it to a Paleo Type Diet. It just kind
of adds that one more layer of— Dr. Justin Marchegiani: Uhmhm— Dr. Sajad Zalzala: …of benefit to it. Uhm—
So— So, I— I commonly prescribe Intermittent Fasting for my patients. Uhm— And basically,
what that is, is you know, you stop eating at like 6:00 o’clock at night. And then,
you kind of skip breakfast. You know, I know that’s kind of blasphemy for a lot of nutrition
stuff but yeah. You skip breakfast and then you don’t need until you know as— as long
as you can go. So, usually it’s about, you know, 10:00 o’clock, noon, so that gives
you a good uh— you know, 12-16 hours, where— where your kind of uh— kind of fasting for
that period and you’re letting your Digestive tract uh— rest. And your turning on these—
these house— housekeeping genes. Dr. Justin Marchegiani: Yeah. And there’s
a 16 by 8 where it’s your having that 16-hour fast [crosstalk] and 8-hour eat window, or
an 18 by 6. And if anyone has adrenal issues or blood sugar issues, one thing you can even
just think about doing is even a 12 by 12. Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani: What you may stop
eating at 7:00 PM, and then— or let’s say 8:00 PM but then you’re up at 7:30 the
next day and you don’t have breakfast ‘til 8:00. And… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …that can give you
12-hour window too. Dr. Sajad Zalzala: Right. Right. Read… Dr. Justin Marchegiani: If you’re having
between. Dr. Sajad Zalzala: The longer you can go without
food, the— the more likely you are to turn on these housekeeping genes. Uhm— The effect
is at the M— the MTOR, the AMPK, uh— some of the other— some of the other genes as
well. Uh— And— And— And, you know, there’s also a way to do it is called a calorie restriction,
but uhm— [stutters] the people who are brave enough to do the TruCalorie restriction. Uh—
I— I’ve heard— I’ve heard— I’ve heard that they’re miserable because they
just don’t have enough vitality to, you know, they don’t have calor— enough calories
in the diet to sustain vitality. Uh— Dr. Justin Marchegiani: A hundred percent. Dr. Sajad Zalzala: Again, they— they—
they may end up living a little bit longer than the rest of us but, you know, I— you
know, I think there are— there ae so many other ways to kind of accomplish that same
goal without— without— without that uh— hit to your vitality. Dr. Justin Marchegiani: Yeah. The problem
is I’ll— i— if we’re talking— You know, people talk about nutrition and then
use calories a lot, but calorie’s just a form of energy. Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: It’s a measurement
of heat. Really, calories in our world are gonna be attached to nutrients. Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: So, if we’re talking
low calorie, we’re also talking a low nutrient diet, and our— our metabolic system to need
nutrients. Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: So, it’s not good
to shorten the nutrients… Dr. Sajad Zalzala: All right. Right. Dr. Justin Marchegiani: …but if you can
get the nutrients in but use the fasting window… Dr. Sajad Zalzala: Uhmhm— Uhmhm— Dr. Justin Marchegiani: …to still turn on
some of that biochemistry that— that has that effect, then you get the best of both
worlds. Dr. Sajad Zalzala: Sure. Sure. Well, what
I was referring to is this fad that I think [stutters] that uhm— that came about maybe
20 year ago— 20 years ago, around the same time the discovery of Sirtuin genes, where
they— where they took monkeys, for example, and I put them. You know, they did— they
didn’t calorie restrict it. Uhm— And yeah. I mean, the monkey was calorie restricted.
You know, he was lean. He lived longer without diseases but i— people said he looked miserable.
Uhm— They— I think, they— they start losing fertility in things like that just
because your body just can’t— you can’t— the body just can’t function on— on such
a reduced calorie. And by reduced, I mean, take— take your basal calorie requirement
so for me, it would be somewhere around, you know, 2,000 or 2,200 calories, and cut that
by 30 percent. And sustain that. That’s really hard to do. Uhm— the people who do
it— I don’t know if there’s anybody left [laughs] that was still doing it. Uhm—
But— But the p— But there was a society, the Calorie Restriction Society, back like
10-15 years ago. Uh— I don’t know if anybody’s still part of that or not. But, people who
do it— I mean, you got to be really strict about it. Uh— And then, you have to be really
careful talking about the nutrients. You have to be really careful to get all your nutrients
in and that condensed in that lower calorie. I’m not a proponent of calorie restriction.
I think there are other ways to do it. I think the Intermittent Fasting will get you most
of the benefits. Uhm— Intermittent— Intermittent Fasting— well, you don’t do it everyday.
You may.. Dr. Justin Marchegiani: Yes. Dr. Sajad Zalzala: …do Intermittent Fasting
maybe four days out of the week. Uhm— And then that— that’s what I— that’s what
I… Dr. Justin Marchegiani: Yeah. Dr. Sajad Zalzala: … currently do.And, if
there’s a better way— you know, If somebody comes on and mention there’s a better way
to do it. You know, I looked at research. I looked at some data behind it [stutters]
and I adopt uhm— and I kind of adopt that posture and try it out with myself and see. Dr. Justin Marchegiani: I think that’s great.
I think there’s some really good benefits there. So, really interesting. You broke down
those pathways and how uh— Metformin and maybe [stutters] functional medicine practitioner
looks at Diabetes or Insulin Resistance. Let’s look at pain. Let’s look at like the enzyme… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …pathways. There
was the enzyme that kind of works on those sick low oxygenates… Dr. Sajad Zalzala: Uhmhm— Uhmhm— Dr. Justin Marchegiani: …pathways. Let’s
break that down. What’s the mindset, allopathic versus on the functional medicine there? Dr. Sajad Zalzala: Yeah. So, I mean, uhm—
you know— Pain— Pain is actually a very good topic because, you know, ev— everyday
we’re hearing about, “We’re kind of in Opioid crisis. People are over— overdoing
Opioid.” But just— just— just a little aside on that— I mean— I mean, I think
an addiction, in general, was on the wise. Not just a medication addiction, I think—
I think people using pain medication, because— because addiction is just such a big thing
now, and a lot of it has to do with the but— you know, the— the— you know, the neurotransmitters
and brain being s— so out of whack for— for all sorts of reason. Uh— You know, depleted
nutrients, uh— Uhuh— Dr. Justin Marchegiani: Uhmhm— Dr. Sajad Zalzala: Just— Just the Chronic
stress. Uh— Now, you have cell phones— you know, and the cell phone kind of teaches
you how to— how to— how to be addicted. You know, every little minute you’re looking
at it, and you know, you’re like that little monkey who— who— who oppress the— who
oppress the Dopamine stimulation until they die. Uhm— [clears throat] And so— So,
I think, you know, pain is a big thing but we also have to kind of look at— have to
look at the addiction uhm— all part of it as well. But, to answer your question, uh—
yes. So— So, you know, in the conventional allopathic, if somebody comes to you with
some kind of Tendonitis or inflammation somewhere, you know, the first thing you reach for is
Ibuprofen, you know, Naproxen, uhm— you know, uh— Celecox— Celecoxib— things
like that. Uh— And those— Those uh— uh— blocks the action of the COX-2, uhm—
but not without— but not without side effects. Uhm— You know, stomach— stomach issues
is big. Uhm— You know, if you’re using the occasional Advil— you know, it’s Ibuprofen.
It’s— It’s probably okay but— but, you know, people who are around it all the
time, it seems to set them up for things like leaky gut, uhm— dysbiosis, uh— and those
can really set you up for even— ironically, for even more inflammation down the line.
Uhm— Dr. Justin Marchegiani: So, basically, the
enzymes that those medications block, those enzymes are really important for Hepato—
b— basically, repairing the liver, repairing the gut lining… Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani: …helping the heart
to be healthy. So, you’re blocking one enzyme… Dr. Sajad Zalzala: Uhmhm— Uhmhm— Dr. Justin Marchegiani: …that creates this
inflammatory compound called Prostaglandin 2, right? Dr. Sajad Zalzala: Uhmhm— Exactly. Dr. Justin Marchegiani: But then, on the other
side of the fence, it’s decreasing the repair of the heart, the gut and the liver, right? Dr. Sajad Zalzala: Exactly. Exactly. I mean,
there— there are much more effective ways and much less an— much, much less dangerous
ways of doing it. Uh— You know, something simple as Turmeric and I… Dr. Justin Marchegiani: Uhmhm— Dr. Sajad Zalzala: …believe there’s enough
Turmeric now, but there’s so many other uh— alternatives out there, but you know
Boswellia, uh— Devil’s Claw uhm— you know— you know, Ginger, Celery seed. There’s—
There’s [stutters] There’s very— There’s very nice combinations out there as well.
I kind of combine all those and kind of in proper ratios. And they have almost none of
the side effects you’ll get and the inflammatories uhm— uhm— but again, I mean— I mean,
they— they may work you know, if you’re in a pinch, but— but I wo— I— Again,
I always recommend trying to figure out why. That— That’s what functional medicine
is all about. Why? Why doesn’t the inflammation [inaudible] Why do they have pain? Pain is
a symptom. The— There’s something wrong, uhm— and— and you have to try keep—
keep— keep peeling the onion, so to speak. You got— you got to keep— keep going to
the next layer until— until you figure out why and what therapeutic you need to kind
of get in there and fix that pathway. That’s done right. Dr. Justin Marchegiani: And, you know, those
medications, those NSAIDs, they work really good. And they do [crosstalk] really do have,
I think acutely, you know, a day or two… Dr. Sajad Zalzala: Yeah, exactly. Dr. Justin Marchegiani: …or let’s say
you broke uh— you broke a bone or you had a surgery or something. I think they w—
they work great, or maybe, you know… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …worst case if it
doesn’t happen too often, maybe you drank too much the night before, right? But, we
want those longer term— Wha— Wha— One, we want diet and lifestyle strategy [crosstalk]
to that keep the inflammation down. But, number two, we want natural strategies that we can
use more frequently… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …and not have to
rely on the big guns, right? Dr. Sajad Zalzala: Exactly. Exactly. I mean—
I mean, I’m not— I’m all— I’m all for, you know, taking an Aspirin or an Advil
when you— you know, you got [stutters] you did something you shouldn’t have and [laughs]
now you’re gonna pay. You reach one that’s fine, but a long-term use, no. I mean, like
you mentioned heart— heart issues uh— you know, raises your blood pressure. Uh—
you know, it’s really hard on the kidneys and the liver. Uh— So— So, there’s really
no— there’s no good reason. Now, unfortunately, the alternative out there has been the Opioids. Dr. Justin Marchegiani: Yes. That’s the
big hit. Big deal. Dr. Sajad Zalzala: Yeah. And— And then,
that’s— you know, that’s been devastating people in so many different ways. Uhm— You
know, uh— the— the chronic activation of the Opioid receptors. Uhm— So— So,
first of all Opioid receptors are seem to be everywhere in Nevada. And— And this is
a good segue into LDN Low-Dose Naltrexone. Uh— Dr. Justin Marchegiani: Yes. Perfect. Dr. Sajad Zalzala: L— LD— Yeah. Opiate
Receptors are almost everywhere in your body. You know, when we— when you reach for Tylenol
3 or Percocet or Vicodin, you know, that’s stimulating the Opiate receptors in the brain
and the spinal cord to try to reduce the pain. Uhm— But, it’s also blocking the Opiate
receptors in our Immune System, in our Pituitary gland, and all [stutters] the Gluteal cells
in our brain. You know, they’re— they’re everywhere and— and we’re learning more
and more about how important these are. And, that’s why you’ll often see people who
are in chronic pain medication, uh— chronic Opioid medications. Uhm— The testosterone’s
in the tank. If they’re female, their hormones are all in a whack. Uhm— Uh— You know,
[stutters] it just kind of seems to decimate the uh— decimate the uh— the— the Endocrine
System body, uh— and in the end will all sorts of— well, long-term— long-term effects.
And to make things worse, they stop working after. Uh— And that— And that’s why
you get tolerance, and tolerance eventually leads to addiction, where you need more and
more and more of it, to get the same effect. Uhm— ‘Cause— ‘Cause eventually, the
body starts to downregulate the Opiate receptors. They’re stimulated way— stimulated way
too much. The body downregulates to them uh— them and— and— and you just— you just
don’t have any Opiate receptors left now. Dr. Justin Marchegiani: So, it’s basically
like Insulin resistance but with your OPR receptors? Dr. Sajad Zalzala: Yes. you can think of it
like— Dr. Justin Marchegiani: Yeah. Dr. Sajad Zalzala: …just like that. I mean,
it’s— it’s probably slightly different but yeah. Exactly. So if— So, I— I think—
I mean, I don’t— I don’t have any data to prove this but I think the same reasons
why all of us are becoming Insulin resistance is the same reason why we’re all becoming
Opiate resistance. Now by the way, we make our own Opioids. They’re called Endorphins.
You know, uh— they ru— they runner’s high [stutters] and that high that they get
when they— when they— when they, you know, exercise. That’s because of release of Endorphins.
Uhm— And so— And so, by becoming like Endorphin or Opiate Resistant, we’re actually
blunting that— that natural response we get to— to uh— to let go natural Endorphins.
And the— And that— And that can have a lot of consequences as well. Dr. Justin Marchegiani: One hundred percent.
And that again, it’s like when you come up and your resistant and then you come back
down, I mean, the side effects of coming off Opioids are… Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani: …tremendous. Dr. Sajad Zalzala: Right. Dr. Justin Marchegiani: And, my big concern
is chronic inflammation— You go from NSAIDs, unaddressed, you go to Opioids… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …and the problem
is, the more stressed you are and the more inflamed you are— I’ve never found a stressed,
a chronically stressed or inflamed person that didn’t have a bad diet, and they didn’t
have also a bad gut. And the problem is… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …you mentioned it
earlier, beta-Endorphins are natural pain-relieving compound… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …but beta-Endorphin
is a 19— uh— I mean, 19 the— 19 amino acids to make beta-Endorphins. So, if we have
bad digestion… Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: …we’re not gonna
be able to break down those proteins and make our natural… Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: …beta-Endorphins
as well. Dr. Sajad Zalzala: Right. Right. So you have—
So you have a production issue but also a receptor issue. Dr. Justin Marchegiani: Yes. Dr. Sajad Zalzala: Uh— One way— Now—
Now I mentioned that the Opiate receptors are on Immune System as well. Dr. Justin Marchegiani: Uhmhm— Dr. Sajad Zalzala: Uh— And— And— And
we’re learning more about— more and more about— about the importance of them. We
haven’t fully fleshed out the exact amounts, but it seems like people who have Immune System
issues, like Rheumatoid arthritis, uh— Fibromyalgia, uhm— you know, Gout, uh— Sorry, not Gout,
Psoriasis— things like that, uhm— they— they seem to have a uh— they seem to have
a lack of these— was— of these Opioid receptors. And, uhm— uh— And that’s
kind of where the— the idea of using Naltrexone comes in play. Uhm— So, Naltrexone, for
those who don’t know uh— was originally uh— uhm— approved back in the— in the
80’s or 90’s for— for alcoholism uhm— but at— at the 50-milligram dose, and it’s
still used. There’s a lot of— There’s a lot of addiction centers that use uh—
Naltrexone uh— to help— to help alcoho— alcoholics stay away from alcohol. Uhm—
However, there’s a doctor— I think his name was Dr. Bihari. He— He— He found
out, kind of by accident, that- that people who are taking Naltrexone, uhm— they seem—
they seem to have a positive effect on the Immune System. Uhm— And so, you know, they
play around the dose to try to hear out what the— the optimal dose was, and it turned
out the lower the dose the better, up to— up to a point, obviously. Dr. Justin Marchegiani: So, we’re talking
like 2-4 milligram-ish? Dr. Sajad Zalzala: Yeah. Yes. So, 2 – 4½
— 4½, initially the highest that I’d go. So, the reason it’s called Low-Dose
Naltrexone because we’re not using it at pharmacological 15 milligrams. We’re using
it more of the physiological, maybe homeopathic— uh— you know, 2 milligram to— to 4 ½
milligrams. Uhm— In fact, I think it’s such a powerful therapy. You know, obviously
it doesn’t work by itself. I need to kind of address the other issues, but sometimes,
you know, it— it— by itself, I’ve— I’ve seen it work— wonder drug. So, I
uh— I have this— I have this web service that everyone— It’s called the,
uhm— uh— where uh— you know, a lot of people doing a lot of reading on, and on the
end it’s got a lot of— it’s got a lot of uh— you know, coverage on Facebook pages
and other news groups, and things like that. Uhm— And— And, if you want to know where
they can go to— to get a prescription, a lot of times, the last evac and the family
doctor, and the Doc kind of specializes ahead and say, “Well, you’re not alcoholic,
why do you need Nal— Naltrexone?” Uh- It’s because, you know, most allopathic
doctors have no idea that you can use Naltrexone this way. Uhm— So, I created this website
called, where patients can request the uh— descriptive directed consultation,
and I evaluate them for prescription for the LDN. It has to be from compounding pharmacy,
and there’s several good ones around the country. Uhm— So, that— that’s kind
of another site service that I offer as well, uhm— becau— because— because it’s
such— I think it’s such a powerful therapy. Uh— The number one reason that I prescribe
it is for Fibromyalgia. Uhm— The number two reason is autoimmune conditions of all
sorts: MS, Rheumatoid arthritis, Psoriasis— things like that. Uhm— But there’s been
more and more a— uh— research on it for— for psychiatric conditions as well. Again,
going back to those Opioid receptors and Glial cell which can help— help control the information
in the brain, we think that Anxiety depressionism is inflammation in the brain, so if you can
do— do anything to reduce that inflammation, uh— it— it seems to help uhm— So, uh—
uh— so— so— The way it works, uhm— The mechanism of action for the low-dose Naltrexone,
is that you— you— you temporarily block the opioid receptors. Dr. Justin Marchegiani: Receptors, right? Dr. Sajad Zalzala: Exactly. And then, uh—
but only for a short time and only for a small amount. And so, over time, you actually end
up with more Opioid receptor. And it— And it changes gene expressions and things like
that to positive, and that help balances the Immune System. It doesn’t activate— It
doesn’t overactivate the Immune System. It doesn’t suppress the Immune System either,
but it brings it back into a balance. And that’s why it’s also used for things like
uhm— uh— infections. In fact— In fact, some of the early work on— on LDL was for
HIV, uhm— but a lot of times— you know, people— what people requested for to help
fight off uh— you know, uh— Lyme disease, uh— Chronic Epstein Barr Virus infection,
uh— thing— things of that nature. Dr. Justin Marchegiani: That’s great. So,
basically, what’s happening is, we have a mild blocking of that… Dr. Sajad Zalzala: Hmhm— Dr. Justin Marchegiani: …Opiate receptor
site, and then, there’s some compounds that are produced to help modulate the Immune System
help that, the T-regulatory cells, to kind of balance out that… Dr. Sajad Zalzala: Exactly. Dr. Justin Marchegiani: …ones. But of course,
you’re looking at is, “Okay. Here’s like a palliative thing we can do to just
kind of help with the Immune System. Dr. Sajad Zalzala: Uhmhm— Dr. Justin Marchegiani: You may also be working
on the Insulin Resistance, the inflammation. Dr. Sajad Zalzala: Right. Right. Dr. Justin Marchegiani: Maybe, Vitamin D is
profound as well. So, you may be looking at a bunch of other things, but then, plugging
that in as an additional palliative support. Dr. Sajad Zalzala: Sure. Dr. Justin Marchegiani: Is that correct? Dr. Sajad Zalzala: Exactly. Exactly. And,
I have uh— about— about half of patients that asked me for— for the prescription
are already working with a holistic practitioner and greater practitioners such as yourself,
uh— but, you know, who may not have prescribing powers. And it is uh— it is a “prescription
only” medication protocol. Uh— Dr. Justin Marchegiani: I think it’s important
because I think a lot of Docs, they— they may say, “Hey. Here’s this natural thing.
They prescribe it but they don’t do all the other things that I consider… Dr. Sajad Zalzala: Right. Exactly. Dr. Justin Marchegiani: …follow-up upstreams.
So, I think it’s important that you’re setting the table upstream, but then you’re
also working downstream, too. Dr. Sajad Zalzala: Exactly. So, anybody that
I do a consultation on for the LDN— uh— LDN prescription, I make sure they’re—
they’re working with somebody or I put them in touch with somebody before I create. Uh— Dr. Justin Marchegiani: Oh, that’s great. Dr. Sajad Zalzala: Yeah. Dr. Justin Marchegiani: So, I’m just curious.
If someone like is addicted to— to— to Fentanyl or Oxycodone or whatever too, can
you just list out the— these uhm— these Opiate medications? Dr. Sajad Zalzala: Yeah. So— Dr. Justin Marchegiani: Fentanyl, [crosstalk]
we have Oxycodone, Percocet— Dr. Sajad Zalzala: [incomprehensible] found
in patches. Oxycodone is found in Percocet. Percocet is a mix… Dr. Justin Marchegiani: Yeah Dr. Sajad Zalzala: …of Oxycodone and Acetaminophen
[inaudible]. Yeah. You’ve got the Vicodin, which is Hydro— Hydrocodone mixed with Tylenol.
Uh— We have Norco. It’s very similar— It’s similar. We have Codeine, which is
very weak uh— uhm— uh— Opioid medication. It— It’s converted to Morphine. Uh—
Morphine is the— is the original. I mean, that’s what they— that’s what they extract
from the Opium, uh— the Opium uh— Dr. Justin Marchegiani: Right. Dr. Sajad Zalzala: …poppy plant. Uhm—
And uh— uuh— And so— Dr. Justin Marchegiani: And— And then, with
Heroin— Heroin’s also a derivative of that too, right? Dr. Sajad Zalzala: E— Exactly. Exactly.
Uh— The another derivative that is Dilaudid or Hydromorphone. Dr. Justin Marchegiani: Yeah. Dr. Sajad Zalzala: It’s about four or five
times stronger than uhm— [stutters] than Morphine. Uhm— And so, when we— when we
look at these medications, how much somebody’s on, we always look at what’s called a Mor—
Morphine equivalent dose. Dr. Justin Marchegiani: Hmhm— Dr. Sajad Zalzala: Because like— It’s
like at a Morphine the original molecule and all these other Opioids are kind of uh—
derivatives. Uhm— Now, outside of these consen— you know, hard Opioids, there are
some synthetic Opioids. Uh— Tramadol is one of them. Dr. Justin Marchegiani: Yup. Dr. Sajad Zalzala: Uhm— And one of the newer
ones on the market is called Nucynta. Uhm— And— And they— They work by [stutters]
they activate the Opioid receptor, but not as strongly as Morphine and their derivatives.
But, they also have other— other effect to them. Uhm— Patients tend not to tolerate
them as well as— [stutters] as a pure Opioid medications because they have like uh— effects
on uhm— uuh— the— the effects on Serotonin and Dopamine and things like that the patient
just can’t tolerate sometimes. Dr. Justin Marchegiani: A couple of quick
questions. Is Oxycodone and Oxycontin the same thing? Dr. Sajad Zalzala: Uh— Oxycodone is kind
of a generic. Oxycontin, it would be as a brand name. Uh— Dr. Justin Marchegiani: Brand name. Dr. Sajad Zalzala: Yeah. And Oxycontin is—
is supposed to be an extended-release but uuhm— uh— but that’s actually been replaced
by Oxymill, uhm— uh— because too many people were just kind of breaking the tablets,
and you know sniffi— I don’t want to give… Dr. Justin Marchegiani: Right. Dr. Sajad Zalzala: …anybody ideas [crosstalk]
for sniffing. Dr. Justin Marchegiani: Right. No. Dr. Sajad Zalzala: That’s a— [laughs] Dr. Justin Marchegiani: It’s already out
there. Dr. Sajad Zalzala: [laughs] Yeah, exactly.
Chewing them, uh— you know— thing— things like that they’re doing just to get that
high. Because, again— you know, [stutters] once you get a little bit of that high, you’re
always for a next time. You just have to take higher and higher doses to get that high.
Uh— Dr. Justin Marchegiani: So, with Oxy and Hydrocodone,
which one’s stronger? Dr. Sajad Zalzala: Uh— I believe the Ox— Dr. Justin Marchegiani: The Oxy? Dr. Sajad Zalzala: Yeah. The Oxycodone, I
believe is— is slightly stronger than the Hydrocodone, uh— which is about on par.
Uhm— But— But because these are kind of all derivatives of Morphine, I mean, different
ones have different— have different uh— reactions uh— in patients. UHm— Like for
example, some people say that uh— Oxycodone uhm— doesn’t— doesn’t cause constipation
as much as Morphine. Uhm— uh— you know, I— [stutters] I pre— prescribe in my clinic
but— but I— I am— I try as much as possible to get patients off of them as much as possible.
Actually, I— I don’t prescribe them myself. I have a lot of patients who come to me in
my— my practice in Ontario, uh— who— who were on them. And— And it’s just a
lot of work uh— to think— to get patients off— off of these Opioids. Uhm— Dr. Justin Marchegiani: And, do you have a
taper? Like, do you have a protocol in which you— you’re tapering off a certain percent
over a certain time or is it just totally customized? Dr. Sajad Zalzala: Uhm— It’s kind of customized
depending on— you know— how long the patient is on it. Uh— I mean, the guidelines say,
I think uh— no— no more than ten to 20 percent for a month. Uhm— I find that actually
quite aggressive. Sometimes, you have to bring it down just a smidge each— [crosstalk]
each month. Dr. Justin Marchegiani: So, maybe like—
maybe like five percent a month is— is reasonable? Dr. Sajad Zalzala: Yeah. Yeah. And that [stutters]
the challenge is that the dose— the dosing seems to be uhm— tsp— is not— is not
uhh— l— like, for example, uh— Oxy— Oxycodone comes in, you know, fives and tens.
Uh-huh— say… Dr. Justin Marchegiani: Right. Dr. Sajad Zalzala: ..gonna create it. Uh—
You know [stutters] and kind of find uh— in between. Uhm— There’s also, you know,
co— There’s also the uh— the ant— the agonist— antagonists like uh— Methadone
and Suboxone. Uh— Those are a lot more… Dr. Justin Marchegiani: Right. Dr. Sajad Zalzala: …popular uhm— but—
but— you know, they have some of the same properties as— as your Opioid medications.
But— But if you take too much, it kind of blunts the high. Uhm— Dr. Justin Marchegiani: Do you have any experience
with the herb Kratom to help people get off the Oxys? Dr. Sajad Zalzala: I’ve heard a lot about
that. [laughs] Uhm— But I had not— I don’t have any person— I’ve had— I’ve had
several patients ask me one, uh— but I haven’t— I— I— I don’t— I don’t know any
reliable sources uh— or safe sources so I don’t — I don’t recommend it. Uhm—
I’d have to do more— more reading research and I should get— get more feedback from
patient before I can make any recommendation. However… Dr. Justin Marchegiani: [crosstalk] Yeah.
For good things to be better. Dr. Sajad Zalzala: Yeah. However, to— to
kind of segue to another topic we’re about— w— w— we’re talking about on the pre-recording—
How— How much time do we have by the way? Dr. Justin Marchegiani: Uhm— We have—
We have about f— five or ten minutes left. Dr. Sajad Zalzala: Oh, okay. Dr. Justin Marchegiani: How much do you need? Dr. Sajad Zalzala: Yes. So, just real quick.
So, I was completely against, you know, uh— Cannabis. You know, probably… Dr. Justin Marchegiani: Oh, yeah. Dr. Sajad Zalzala: …for five years. Oh,
yeah. So, I’m completely against it. You know, when— when I had patients come up
to me about Cannabis— medical Cannabis, ‘cause— cause it’s legal here in Ontario
and several other states. I was like, “You know, okay. The— These— you know, these
patients are just kind of find uh— a legal way to get high.” But then, uh— you know—
But then I had a medical student with me rotating one day and he’s like, “Doc, you got to—
you got to check out the OCBD.” You know, and then— and— and you know, which is
a— which is a component of Cannabis. Uhm— It’s Cannabidiol. It’s so— It’s so—
so Cannabis, the plant. I mean— I mean, we— we’ve taken it from nature and we’ve
kind of hybridized it, and things like that, that [stutters] a lot— a lot of times the
recreational one is much higher THC than what we find in nature. Uhm— And so— so a lot
of people who— who were looking for— uh— Cannabis as a recreation, will look for the
high THC. Uhm— And— ANd THC has some psychoactive properties. It— It can have some therapeu— Dr. Justin Marchegiani: It will get you high,
basically. Dr. Sajad Zalzala: Exactly. Exactly. But it
can help with people with… Dr. Justin Marchegiani: In the munchies. Dr. Sajad Zalzala: Exactly. Exactly. It can
help in to a limited extent people who have like Anxiety issues, PTSD— things like this.
So, there is a place for a little bit of THC. Dr. Justin Marchegiani: Yeah. Dr. Sajad Zalzala: Uhm— However, one of
the components that I’ve been impressed with the CBD Cannabidiol. Dr. Justin Marchegiani: Mm— Dr. Sajad Zalzala: And that— that seems
to have a lot of anti-inflammatory effects. In fact, there seems to be specific Endocannabinoid
receptors in our— in our— in our selves, in our bodies. Uh— We’re not— We’re
not quite sure what they’re there for. Uh— because we haven’t, I don’t— T— To
date, I mean, I haven’t— I haven’t seen the news and greatest research of date. There’s
nothing in our body that— that stimulates these Endocannabinoid receptors. It’s just
but— but these Cannibal [stutters] these uh— these Cannabis extracts do. Uhm— And—
And they have a lot of a pos— positive effects on our— on our inflammation on Immune System.
Uhm— When I— When I prescribed a CBD Oil, I almost always prescribe it with the highest
CBD concentration available. Somewhere… Dr. Justin Marchegiani: 2 THC Dr. Sajad Zalzala: …about 20 percent. Exactly.
THC— I try to keep THC to a minimum. Uhm— Uh— And— [stutters] And I’ve have patients
who h— who have milder, the— they seem to get better on it. I’ve had a co— a
couple patients with seizure disorder. Uh— It doesn’t work for everybody with seizures
but— but it does seem to— it does seem to help in a couple patients I have.. Dr. Justin Marchegiani: And is that working
with the Opiate receptor site? Would you do that in conjunction with LDN or you’re choosing
one path or the other to start? Dr. Sajad Zalzala: Well, they’re separate
paths. Dr. Justin Marchegiani: Okay. Dr. Sajad Zalzala: So— So, you— Dr. Justin Marchegiani: But the CBD, it’s
still hitting the Opiate receptor though, a little bit, isn’t it? Dr. Sajad Zalzala: Uuhm— Not— I could
say, the— the— the making reaction seems to be this— this uh— uh— uh— Endocannabinoid
receptors Dr. Justin Marchegiani: Okay. Dr. Sajad Zalzala: Uhm— And— And it’s—
And it’s separate. I mean, there are— there are people— Uh— There— There may
be some cross— cross-reactivity there, but I think— I think it’s uh— fairly minimal
from— for what I know. Uh— And so, there are people routinely on CBD and LDN, and it
doesn’t seem to be any reaction. Uhm— Now, if somebody’s on CBD and they want
to try LDN, I usually just add precaution and start them on a lower dose than they normally
would. Uhm— And then— And then teper them up more slowly. Dr. Justin Marchegiani: Mm— Dr. Sajad Zalzala: But— But you know, I’ve
had a lot of people using successfully the other, and I see they’re kind of synergistic.
Uhm— So, I’ve come around the last couple years on Cannabis. I mean, I— I still think
it shouldn’t be used recreationally. Uhm— And I don’t think it’s worth it. I—
I think there are just too many— too many problems with using it frequently. But—
But if you can get the me— medicinal aspects out of it, uhm— then— then I think—
I think it actually [stutters] has the potential of being a— a great uh— adjunct thera—
therapeutic to— to all the others that we talked about. Dr. Justin Marchegiani: So, with the CBD,
you’re not getting maybe the slower reaction time, or the munchies or maybe any of the
maybe the lower motivation or uhm— memory issues. It’s— It’s more just helping
modulate, has some anti-Anxiety stuff to it. It has to be Endocannanib— the Endocannabinoid
receptor activation which helps with the Immune System. THC though— I— I do hear it does
has some really good pain benefits and some… Dr. Sajad Zalzala: It does. Dr. Justin Marchegiani: …anti-nausea stuff,
if there’s maybe some chronic pain or some Cancer stuff happening. Is that true too? Dr. Sajad Zalzala: It does, absolutely. Absolutely.
I mean, because I’m not a pain doctor, uh— when— when somebody requests uh— Cannabis,
medical Cannabis for pain, there is a Cannabis Pain Medical Clinic here— here in town that
I refer them to. Uhm— But— But my gu— But I’m— Uh— I’m much more comfortable
prescribing them the low THC because, you get— you get into a lot less legal trouble
that way. [laughs] When you start dealing with, you know, THC products then, you know,
there’s— there’s uhm— special courses the doctors are expected to go through, and
I just haven’t had— I just haven’t had the time t— to do those yet. So, I don’t
feel comfortable playing around with THC so much. But CBD I, you know, I haven’t seen
any problems with it so far. It certainly doesn’t seem to affect the— the— the
cognition, right? Dr. Justin Marchegiani: And if someone does
CBD— If someone does use the CBD, can they— can they work while they do it? Can they drive
while they do it? Dr. Sajad Zalzala: Yes. As far as I know.
I mean, as far as I know, I hadn’t seen any way [incomprehensible] with it. Uhm—
In fact, a lot of the products in the states now uhm— the— they kind of get around—
get around the whole legality should by using Hemp— Hemp-derived CBD. And— And uh—
there are farmers that uh— that— that grow uh— uhm— uh— specifically, bred
Hemp products that had almost no THC and high CBD. They don’t— Technically , Hemp is
still legal in the U.S. It’s not grown in the U.S. It’s grown in Canada. [laughs]
Uuh— Dr. Justin Marchegiani: Mm— Dr. Sajad Zalzala: But— But— But, you
know, Hemp— Hemp— Hemp products. I mean, you can buy Hemp seeds. You can buy uh—
uh— you know, cereal with Hemp in it if you like. You can buy Hemp oil. Uhm— But—
But— But like I kind of get to get around the— the legality of uh— using Cannabis
uh in Marijuana. Uh— A lo— A lot of— A lot of the CBD products over-the-counter,
on the market or [inaudible]. Yeah. And [stutters] I don’t think that’s any problem. Uhm—
uh— I— You know, the— they seem to work— they seem to work just as well, whether you
get it from Hemp or from— from the regular, you know, uh— Cannabis. Dr. Justin Marchegiani: Amazing. Really great
information, and Doc— Dr. Z is licensed in over 35 states here in United States as
well. He’s also uh— in Canada too. So, if you’re on both sides of the fence there,
feel free and reach out to him. Dr. Sajad Zalzala: Yeah, Dr. Justin Marchegiani: rootcauses— plural— So, feel free… Dr. Sajad Zalzala: Yes. Dr. Justin Marchegiani: …and reach out to
Dr. Z. He may really help provide that extra buffer between the conventional medicine and
functional medicine bridge that a lot of people need. Dr. Z, thank you so much Is there anything
else you wanted to share with the listeners today? Dr. Sajad Zalzala: Well, the only, I think,
was that LDN Direct if anybody want to be uh— you know— want where is just in a
minute. If they’re working with practitioner but they want to try the LDN, uhm— you know,
I’d— I’d be more than happy to try to help them. Uh— So, it’s LDNdirectcom.
Uh— And— And uh— And then, a lo— a lot of times people don’t have a practitioner
to work with, and I refer them to my Root Causes Clinic or to a local practitioner such
as yourself. Dr. Justin Marchegiani: Dr. Z, thank you so
much for the information. It’s refreshing getting both sides of the fence there. Have
a phenomenal day. We’ll talk soon. Dr. Sajad Zalzala: Thank you. Dr. Justin Marchegiani: Thank you.


  • Reply mario frias April 26, 2018 at 5:33 am

    can you guys talk about suboxone and low trt and if safe to go on it while on trt

  • Reply twor May 25, 2018 at 7:57 pm

    doctor, i have a question, can we do a water fast and take ldn?

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