How to Investigate The Root Cause of Your Gut Issues | Podcast #366

In functional medicine, it has long been familiar that gut health is paramount to the rest of the body. We didn’t fully understand why for years, although we knew the gut was the seat of the chronic inflammation and immune system. With the gut microbiome renaissance, we also need to understand how integral gut bacteria are to our health.

Dr. J and Evan discuss that screening for more serious underlying issues is essential. These may include gastric ulcers from an h.pylori infection, leaky gut, and other digestive system problems. Finding out whether these conditions are an issue also impacts how you manage gut health.

Dr. Justin Marchegiani

In this episode, we cover:

0:00 – Introduction
3:34 – The Signs and symptoms of digestive disorders
7:35 – What tests are effective to find the root cause of gut issues
13:58 – The downside of ordering lab tests on your own
26:21 – Food template modifications that will fit for your gut health

Dr. Justin Marchegiani:  Here, Dr. J, with Evan Brand. Really excited to have an excellent podcast today. We’re gonna be chatting about how to investigate the root cause of your gut issues. We see lots of patients come in and they’ve gone to see the SIBO doc or the Candida doc or the parasite doc or the thyroid doc and whatever the symptoms that they’re dealing with, magically that issue, that doc only focuses on is the problem, how coincidental right? And so, we want to talk today about having a holistic mindset not being necessarily attached to what the diagnosis or what we think is the root issue but really be focused on the outcome and the different tools we use and have to investigate and support healing. Evan, how you doing man?  

Evan Brand: Doing good. And not to mention too, the conventional approaches, right, maybe they get to the SIBO guy or to the parasite guy or to the worm guy, maybe they went to the endocrinologist first for their hormone symptoms and then they got referred to the gastro doc and then the gastro doc did an endoscopy or a colonoscopy or a barium x-ray scan like you did to me and then they say oh you’ve got gastritis and that’s the only thing they can pull out of you is hey there’s some inflammation and then it ends there so whether you’re coming, listening from the conventional approach whether you have tried to go more natural holistic approach. As you and I’ve talked many times, people over-specialize and that’s the problem. You and I are what I would consider very good specialists but we also have a generalist undertone to us, meaning, we’re not gonna get caught up in just the SIBO, we’re not gonna get caught up in just the parasite, it’s rarely that simple. 

Dr. Justin Marchegiani: Absolutely. It’s like, imagine, like you hired a handyman to come over and fix something in your home and the handyman just takes this Phillips flat head screwdriver and it’s like, or, I’m sorry, not, but let’s say a regular Philipps screwdriver and just say hey I’m gonna use this Philipps screwdriver even if it requires a nail, even if it requires a wrench or a drill, I’m married or attached to this Philipps head screwdriver and we don’t want to be attached to the tool, we want to go in, know that we have a myriad of tools in our tool belt and pick the right tool for the right job. There’s a nail, I’m going to pick a hammer. Hey, there’s a, you know, a wrench, you know, we’re gonna use something that is good for a wrench etc. So, we’re picking the right tool for the job and we are focused on the outcome, getting the results and we’re not focused on how we get that outcome, right? The vegan diet people, they’re gonna make it so everything is solved by a vegan diet and that’s it, right? And so, we are independent of the tools that we use to get the success that we need. 

Evan Brand: Yeah. Yeah. That’s a great point and a lot of this comes from just experience but also our own personal journey too, I mean, you know, my story, you helped me through my story of having digestive issues and skin issues for decades of my life and we looked at the H. pylori, worked on that then it was parasites then it was bacterial overgrowth then it was Candida then it was mold, I mean, so, I went through the ringer personally and I think personal suffering but of course clinical experience really gives you the non-biased approach and I think that’s what you need because if you’re trying to just sell book or you’re just trying to just get clients in from a book you wrote on SIBO, as you said, everything’s gonna be SIBO and if somebody is not in that box, you’re gonna still give them the same treatment, you’re not gonna get them better and then they’re gonna move on and the average person who comes to us has already been to 5, sometimes 10 or 15 practitioners, so it’s not surprising when we look what they’ve done and they’ve still missed some of the pieces. So, why don’t we talk now about some of the pieces, like when we’re looking at someone with gut issues, what are the pieces we’re trying to lay out on the table in front of us to gather enough information to find what’s truly going on and then of course how to fix it.    

Dr. Justin Marchegiani: 100%. So, the first thing that I think is essential is you got to do a good history, you have to understand how everything unwound, right? And so, when you look at most people’s history, a lot of times there’s poor diet, there’s usually some stress issues, a lot of inflammation compounded by junky fats, um, poor digestion, in general, not being able to break down proteins and fats, lots of refined sugar usually processed grains, excess omega-6 or trans fats and these things just continue to put the body in a pro-inflammatory state and what that means is, when you become overall inflamed at a higher level, your body starts to break down faster than it can heal and so the goal of being anti-inflammatory, right, is restricting a lot of the foods that drive inflammation, so your body can heal faster than you break down. So, there’s always this net buildup versus net breakdown and so when you’re breaking down over time what starts to happen is just as you know from a joint standpoint, you’re starting to feel a little bit inflamed, stiff from a mood standpoint, you may have anxiety, depression, obviously fatigue starting to creep in. Because, the more inflamed you are, your body’s having to deal and allocate adrenal resources to deal with the inflammation, to deal with the stress where normally those adrenal resources would help with energy and good mood and good circadian rhythm and so of course then that starts putting stress on the thyroid then you start having mood issues, temperature, hair loose and then of course the more stressed you are, the more that starts to suppress your body’s ability to digest optimally. So, HCl levels, enzymes levels, maybe bile salt levels start dropping. You start to have a harder time breaking down protein, breaking down fat. You may start getting burpee or gassy or more flatulence, now, your motility starts to go south typically more on the constipated side but you can still have more diarrhea too. And then, your absorption starts to go south and when that starts to go south, now you start to have, um, a bottleneck and all the nutrients, whether it’s B vitamins, flat soluble vitamins like A, D, E, K, whether it’s minerals or amino acids to help your brain chemicals or cholesterol to help your hormones. Those building blocks start dropping and then those pathways start getting shorted and they don’t have the resources to run optimally. And, when we don’t have the resources, more symptoms start to happen. And of course, this kind of compound in this whole journey is the immune system starts to drop and then when the immune system starts to get weaker, now, bugs start coming into the situation, whether it’s parasites or yeast overgrowth or SIBO or bacterial overgrowth or H. pylori. And again, we don’t have to be married to which one or which system is the one, right? But we have to look at things objectively and, um, I think it was Dr. Kaler said this to me over a decade ago, it was kind of a good line, he said, ‘patients have the right to have more than one issue, more than one infection, more than one hormonal imbalance going on at the same time, so don’t get married to one thing because you have the right to have lots of things going on.

Evan Brand: Yeah. Yeah. And you illustrated beautifully, just the constellation of symptoms that can happen. So, if someone is coming in with gut symptoms that’s usually the tip of the iceberg. Underneath that iceberg, just like your poster, you got right there. If we put the tip of the iceberg is gut under the water there, it could be the anxiety, the depression, the fatigue, the low sex drive, the cold hands the cold feet, the brain fog, the concentration issues, the memory problems, the skin issues. And so, once you do a good history, you’re also gonna be talking about pharmaceuticals too, what kind of like proton pump inhibitors were you on. That’s a big thing, like were you on acid blocking medications, were you on other things disrupting your gut. So, of course, figuring out, if you’re still on those medications, you’re not fully gonna get better, if you have a ton of drugs that are causing these side effects and then you get into the testing. Now, this is where you and I differ from other people. Some people, they’re married to the SIBO test and I don’t want to speak for you, I’ll ask you about this but me personally, I think a SIBO test is a waste of time because when we look at a GI map stool test, we’re gonna see a more detailed breakdown of specific pathogens like Strep and Staph and Pseudomonas. And the way I look at it is your mouth to your but is one long tube, so, if there’s dysbiosis in there identified on the stool or the urine organic acids, we can assume it’s probably in the small intestine but the protocol, the herbs that you’re gonna use, are gonna treat the whole thing. So, to me, I want to hear your thoughts on this too, but to me, if I see positive hydrogen or methane, all I’m going to go and do and say is gonna to be, ‘yep that makes sense’, but beyond that those breath tests are not really that helpful.     

Dr. Justin Marchegiani: Yeah. I mean, a SIBO breath test is just looking, it’s an indirect measurement, looking at the gas created by the bugs, so methane or hydrogen gases that are created. So, if we can find bugs that typically produce those gases or an imbalance in but bugs that shouldn’t be there, then we know more than likely, there’s something going on in that SIBO realm. It doesn’t change the treatment that much because a lot of the herbs we use to knock down those bugs that they’re gonna be similar if not the same on the SIBO side. Now, my philosophy may be a tiny bit different than yours but I find anyone with these type of bug issues we’re running a comprehensive stool test and usually an organic acid test and on one or two of these tests, we’re gonna see either the bugs, the bacteria imbalances, whether it’s Citrobacter, Prevotella, Morganella, Pseudomonas, Klebsiella, or H. pylori or parasites. We’ll see these bugs elevated if we don’t almost always, we catch it on the organic acid side when we’re looking at 2,3 phenol acetate or benzoate or Hippurate or D’arabinitol for yeast, usually we’ll catch it there. If I don’t catch it on any of those tests on the stool test or the organic acid test then I’ll pull out a lactulose breath test but I’d say 99% of the time we never have to go that far.  

Evan Brand: Okay. Okay. Good point. Maybe it’s a 1% of the time test for you and I guess what I would do if let’s say we missed it, we felt like we missed it on stool and urine, I might just come in or if sometimes if someone just has no budget to do anything, we may just look at symptoms scan history and just come in with some herbs and see how they do. And, a lot times, a lot of these antimicrobials, antifungals, anti-parasitic herbs, a lot of times it clears up the issue anyway so we don’t like to come in blind but in a few rare cases we have come in blind and we’ve still had good benefits. A lady just chimed in on the live chat here, my gut is not happy, chronic constipation after using pain meds for pain and recovery from five back surgeries. Yeah, that’s a common issue with the opiates, right? Because that’s gonna slow everything down so yeah, I guess the answer is eventually this person’s gonna have to try to get off those opiates, right? But there are some, maybe some brain-gut motility activators we can use, right?  

Dr. Justin Marchegiani: Of course, you know, if you’re on those opiates, you probably had some surgeries and surgeries man, meaning typically anesthesia, maybe a lot of antibiotics along the way so that’s probably really screwed up the gut microflora. So, first off, you have to get to the root cause of the pain. Second thing is you have to have a good, uh, doctor to work with to taper you off those medications while providing anti-inflammatory support because you need whether it’s systemic enzymes or anti-inflammatory herbs plus that brain takes time to get rewired from the opiates because you’re processing pain totally differently. Remember, opiates don’t have an anti-inflammatory mechanism, they just block pain at the brain level which isn’t good because pain is a good indication like if I have pain in my ankle and it’s there then I can know okay I shouldn’t walk on it because I’m causing more damage, right? So, even if I were to take Ibuprofen and my pain went away, I would still want to be very careful, I don’t do too much on it because I’m gonna cause damage, right? So, most people that are chronically inflamed by these opiates, they’re just causing more and more damage because just because they can’t perceive the pain, they’re still causing this inflammatory breakdown.  

Evan Brand: Yep. That’s true. Someone else has chimed in, my gut has been destroyed by many rounds of antibiotics. And, that’s super common, I mean how many times have you and I see that where someone comes in after a round of antibiotics, I mean that’s probably one of the top five things we see, right?  

Dr. Justin Marchegiani: 100%

Evan Brand: They said they’re dealing with IBS-D so that would be diarrhea and eating a limited vegan diet. So, my first thought is, uh, oh vegan diet, raw leafy greens, if you’re dealing with diarrhea, vegetables are gonna irritate the gut, I would push you more towards getting some good animal proteins in even if you could only handle like a carnivore collagen like a beef peptide protein powder or you know collagen shake maybe with some organic berries that’ll be my first thought. How would you think about this one? 

Dr. Justin Marchegiani: Yeah. I mean, you could definitely look at reducing some of the fermentable carbohydrates and really look at cooking and steaming a lot of those things so it’s easier to break down but you really got to reach out to a good functional medicine doctor that can kind of help navigate you through it because if you don’t have all the digestive enzymes and acids there, it may be hard to break these things down. Also, someone chimed in, what about Vagus nerve issues. So, this is kind of a classic area in functional medicine where people try to talk about things differently in a nuanced way and they’re just talking about the same thing in a different way but people think it’s a new thing, right? So, when we talked about like inflammation and adrenal stress, when the more stressed you are and the more you activate the sympathetic and the more inflamed you are, right? Guess what happens when inflammation goes up and the sympathetic nervous system goes up, the vagus nerve or the parasympathetic nervous system always goes down, does that make sense? So, when we talk about these things it’s implied that the vagus nerve or the parasympathetic branch of the nervous system that would helps with healing and recovery is always going to be impaired and so people talk about things kind of as a way to nuance themselves make them seem different kind of market themselves in a different way which is fine but, you know, the average person may get a little confused about it and so just know that, that’s kind of under same umbrella that we’re talking about. We talk about the vagus nerve or the parasympathetic, it’s being factored into this whole adrenal stress inflammation umbrella, I think, yeah, inflammation is the bigger umbrella then you can put adrenals and parasympathetic and sympathetic all under that umbrella. 

Evan Brand: Yeah. Very true. Very well said. Teri chimed in, I’ve been experiencing constant belching, a new symptom for me. So, once again, you got to get the labs run, I want to look at your organic acid, see what’s going on there. Get a GI map stool test run. Are you on proton pump inhibitors? Are you taking supplemental acids and enzymes? How old are you? If you’re above the age 40, you probably have low acid, low enzymes, maybe gut infections too. So, with stool, urine sample and good workup, you could probably resolve belching. I mean, that’s a pretty easy one.  

Dr. Justin Marchegiani: And, I strongly recommend, do not get these labs on your own because, just because you get a lab, you’re not gonna have any ability to know what to do next and that’s everything, right? You gotta know what the plan is next, uh, and then typically you wanna look at like when I order a lab, it’s in conjunction with we’ve done a b c d e f and then not the lab is gonna plug in at g. Does that make sense? So, it’s never just this is a or this is it. There’s a whole bunch of, sequence of things that we’re doing before we get to all the data from the lab. And so, when you work with someone, most people are gonna have that plug in at some level in the clinical chain downstream. So, most people think, oh this is just it, this is a, this is the whole piece of the puzzle and it’s not. So, just kind of keep that in the back of your head. I know that can be a little bit confusing when you’re a lay person coming in there but it’s important information. I think, just start off with a lot of the foundational things first, just kind of wrap your head around it. Don’t get kind of myopic in this tunnel vision. Oh, it has to be Candida, it has to be this, be very open minded that it could be many different stressors and just have that really good differential kind of diagnosis list of all the things that we’re gonna go and hit and not get overly focused on one thing. 

Evan Brand: Yeah. Good point. I’ll also say too, I’m not saying go to your doctor who’s failed here for the last 10 years and try to ask them for organic acids test or stool test because even if they were able to run it which most of the time, they don’t have accounts set-up with the lab so they’re not going to. But even if they were able to and they run it, they’re not gonna know how to interpret it, they’re not gonna know how to make a protocol based on it. So, this is a shameless plug for you and I and what we do as functional medicine practitioners, we work clinically around the world with people. So, uh, Teri’s asking where she can get the labs from. It depends, uh, we use a couple different companies. It depends on where you live and what you got.

Dr. Justin Marchegiani: We’ll do this, we’ll put some links on the videos below so for you and on your site and mine. So, if you want to get it from us, I recommend getting it from us and then work with Evan or work with myself. We’re here to help you. We’ll put the links below or you can go to evanbrand.com for Evan or Dr. J here, justinhealth.com for me. And then, just to kind of highlight what you’re saying, I see so many people that have some of these tests sometimes and the first question is walk me through what your doctor ordered this test, said about it. Did they give you a real thorough review? How much time, oh, hey they just spent a minute, they just said x y z and it really was, I’m like wow, you know, you have all this information here and yet it really isn’t thoroughly addressed, I would say 90 plus percent of the time. So, it’s really important when you get these tests ordered. You really want to come through it thoroughly, so you can extract as much actionable information as possible. And, if your doctor doesn’t have that level of, uh, skill set of information on it, that’s fine, just find someone else. 

Evan Brand: Yeah. You make a great point. I mean, so many times, I know, you and I have a section on our intake form where you can, like attach previous labs. I’ll see 5, 10, 15, 20 labs and I’ll be from a medical doctor or a chiropractic or some other type of practitioner. I’m like wow, they did a really good work-up on you. Like, how did this go, why are you coming to me, what was the protocol? Oh, they didn’t have a protocol. Like, well, why’d they run the labs? ‘Because I wanted them to’. Okay, then what did they say about the labs? ‘Oh, well, that was not bad but I could use a little improvement and so they gave me an enzyme’. And it’s like, they give you an enzyme, you’ve got 20 pathogens, you’ve got parasites, you’ve got H. pylori, you’ve got major gut inflammation and the sequencing of this is important too. So, even if they read a cookie cutter protocol where it says like take oregano oil, you might not be a good candidate for that if you’ve got a bunch of inflammation. Your gut’s irritated, you go throw a, you know, a nuclear bomb in there, you’re gonna irritate your gut more. So, the sequencing is important. So, I guess, just to highlight here what we’re talking about, it’s the sequencing. As you mentioned, when does the lab come in? That’s not just the end all BL tool, there’s other strategies you’ve implemented up until that point. And then, when you work in the killers, is it right out of the gate? Do you got to settle the gut first? 

Dr. Justin Marchegiani: Yeah. It’s never. The problem is people have done, the patients come in and they’ve done a lot of different things. So, like maybe, they’ve tweaked their diet and so they think, okay I’ve made these diet changes, right, whether it’s enough or not is besides the point but they think, okay I’ve done these diet changes, check. Diet isn’t part of the equation, so in their mind they kind of check that off. So, when they see another practitioner, they kind of have this list of things in their mind they’ve checked off. And then, they’re like okay, I’ve already worked on the diet stuff. Yep, I’ve already done some digestive support. So when I lay out my plan, there’s kind of like, we’ll I’m not gonna do this because I’ve already done some of this or I’m not gonna do that. No. it’s like, if I give you a safe and the combination is 6 or 7 numbers. You don’t say we’ll spin number 33 on my other state therefore I don’t have to do it this time around. The combination has to be done in sequence together. The other analogy is cooking. If you want to crack the eggs after you bake the flour, well that cake’s gonna be pretty nasty, okay. So, it’s kind of the same thing as a sequence and just because someone has done something before in the past. One, it may not have been all the way there but we still have to plug that sequence back into the overall flow of things. Does that make sense?    

Evan Brand: Yeah. It does. And I know

Dr. Justin Marchegiani: You’re smiling, so it sounds like that’s something that you deal with and hear a lot. 

Evan Brand: Oh yeah. Yeah. Well, it’s just, you know, once 

Dr. Justin Marchegiani: It’s so much easier dealing with patients that have done nothing that have no, um, no predisposition to like what’s next, they’re like a blank state because then you can kind of come in and there’s zero resistance and you can work through your flow. When people have done a lot of things and they think they've done everything in that area, it’s always hard, you kind of have to convince them to redo these things over again. That could be tough. 

Evan Brand: Now, well, I’m just smiling because of the safe analogy, you know, you always kill it with the analogies and I’m also smiling because I don’t know if it was your kids or my kids screaming, I’m like, I’m pulling my headphone out like is that my kids is that Justin’s kids. And, one of the things that I hope you guys love and appreciate about us is that we’re dads, we’re family men at the end of the day. And so, we’re working, we’re hustling, we’re grinding with our clients but we’re implementing this stuff into our family we’re helping kids, our own personal kids, we’re working with kids clinically. I’ve got kids that are 1 year old, 6 months old, 3 years old that are clinically working with us to get help. And so, we’re practicing what we’re preaching with our family too and I just want to highlight that because there’s so many people out there, so many practitioners that they were so focused on medical school or their practice that they never have the chance to even start a family, you’ve got these mid 40s late 40s upper 50s practitioners out there. They have no family experience and I think that’s where you and I are different because we know when you’re working on a gut protocol. Let’s talk about that for a minute. When you’re working on a gut protocol with a kid and you’re like okay, we’ve got terrible tasting tinctures that we can try, we’ve got some capsules that maybe mom or dad can open up and put into apple sauce. You know, you and I have personally and clinically dealt with the logistics of implementing this stuff so even if you’re gonna get this perfect gut protocol put together, the logistics of following it and getting your kids to take it, 3-year-old Johnny who doesn’t want to take the Artemisia, you know, it’s like, well how do you get that in. That’s the important thing because the proper labs is a step, the proper nutrition is a proper step, the protocol is a step, but the implementation of it and then what do you do after step one and then you if they react to that herb, how do you go to step 2, this is where the hand-holding is necessary. So, you know, when we talk about labs, I think, it kind of devalues the art of medicine a little bit because you and I have so much artist, you know, artistry to what we do and it’s hard to translate that just with a lab test because, you know, anybody could start running labs and like you said we’ve seen 5, 10, 15 labs come in from previous practitioners but they did nothing with it. So, the real art is when you take the protocol, you take it with, you and I are injecting confidence and we’re injecting motivation. I talked with the client this morning who said that she came to me because she was so afraid of her gut symptoms and she came out of fear but now we have basically transformed that fear into empowerment and education and the labs were a tool to help change that. So, don’t put all your eggs in this lab basket, they’re still amazing, you and I still run them on everyone but there’s other stuff that’s injected into that lab that really makes the magic happen.    

Dr. Justin Marchegiani: Yeah. 100%. I think, the hardest part too is you work on dealing with the stressors, with patients. You fix their stress. You get your digestion better. You fix a lot of the microbiome. You knock down a lot of the bugs. Again, in the realm of Candida or dysbiotic bacteria, it’s still going to be there. You’re never ever gonna knock it out 100%. So, there’ll always be a small residual bit, maybe lingering in the background, way beneath threshold but if the stress starts to come back or if people start to add too much of food that’s questionable into their diet, sometimes these things can come back and the amount of flexibility, some kind of can follow the 80-20 principle. If they’re right 80% of the time on things 20% they have a little bit of flexibility. Some got to do 95.5 or some got to be 100 but just really try to make sure if they cheat, they still keep grain free anti-inflammatory etc., like last night, I went to True Food Kitchen for my birthday, and I had some of the, um, their chocolate cookies which inside the cookie, it’s like cassava and banana based. So, that’s great. If I’m gonna cheat, I’m gonna try to do it in a way that’s not gonna cause me to get bloated or gassy or have any skin issues or you know, digestive problems. 

Evan Brand: Uh, a lady commented and Dr. J seems super energetic today. Yeah. He’s a birthday boy. That’s why he’s feeling better.

Dr. Justin Marchegiani: Oh, yeah. No problem there. 

Evan Brand: So that’s good. Another comment here, I wonder which lab test should I run, uh. 

Dr. Justin Marchegiani: I would say just here, out of the gates, regarding labs, I don’t wanna name specific companies on these videos because if we change it in the future and someone just watches the video, um, that they may just go to the old one. So, we’ll put links down below. That way, if we decide to change things in the future then you could just go look at the links down below and so my staff typically will update this in the next 12 hours or so. Just check back at the end of the day or tomorrow, we’ll have everything in there so just keep an eye on that. In that way, if something changes, um, it’ll be reflected in the description below. 

Evan Brand: But here’s what we can say, we’re still gonna run a stool sample, now, maybe that type or whatever. 

Dr. Justin Marchegiani: Cutting edges, some kind of stool testing is gonna be great, right? Organic acid is gonna be excellent. I love that because of the, I mean, every now and then I’ll get a stool test coming back and the gut issues look pretty good like not too bad nothing crazy but then you’ll see a lot of yeast because sometimes you miss the yeast on the stool test, that’s common or you’ll see 3 or 4 markers like Hippurate, benzoate or 2,3-phenylacetate right or D-lactate really hides. Okay, good, I’m glad I had this extra net to catch it because the stool test missed it. 

Evan Brand: I had that last week actually. You know, I had a lady and I kind of got freaked out at first, you know, I was looking at the stool and I’m like, oh my God, this lady has every gut symptom in the book and normally on page 3, page 4 you’ll start to see some crazy stuff going on. In this lady, it was clean, oh man, like, is she crazy, I didn’t really think that but you know partly it is like, uh-oh, where’s it coming from, is this really her stool test. Then we get to the organic acids and holy smokes, as you mentioned, oxoglutarate, D-arabinose, tartaric acid, tricarbolic acid, everything was off the charts and I go, oh, thank you Jesus we have the answers on the organic acid. So, that’s why we love to run both urine and stool because certain things get missed and it’s the synergy of the information from the labs. You may find a parasite on stool and then you may find the Candida on urine then you really go, oh holy crap, that’s where it’s coming from. So, um, let’s hit this other one here. There was a person

Dr. Justin Marchegiani: I want to hit one of the questions. Anthony wrote to me there, thanks Anthony for the great feedback, and again guys, we’re trying to interact with you guys live and I want to answer questions live, so this is like I call it, uh, functional medicine improv, right? You know, you get your comedy shows, this is our functional medicine show so I appreciate that. Thanks for the feedback Anthony. Isabella writes in waking up distended, right in the morning. So, with that, a lot of times, you got to calm down a lot of the fermentables in the diet. If you’re waking up distended in the morning, almost always there’s a lot of fermentation happening in the gut and these gases are being produced. Now, there’s a couple of variables that you can do to help that. One, you starve it out by reducing all the foods that feed that. Two, you have to be able to break down your food because even if it’s good food, if you’re not breaking it down well, it’s gonna essentially have the ability to rot and rancidify and putrefy. So, you got to make sure enzymes, acids, and potential bile salts are addressed because HCl, hydrochloric acid, and bile salts, if you have low levels of that, those things in and off themselves are actually antimicrobial. They have a mild antimicrobial effect, not like oil of Oregano, but they have a mild antimicrobial effect. So, if you have, like, digestive distress and you have poor levels of these things, guess what, these bugs are more likely to grow and of course we have to come in there and do some killing, you know, making assumptions that like if you have a lot of distention like there’s no fiber, there’s no raw vegetables even though you read all these things have this big salad, you know, you could steam some of these things, you may want to look at low fermentable things that’s great. You may want to make sure your stress is good and you’re chewing your food up really well and you’re you know avoiding hydrating outside of an ounce or two of, you know, water to swallow and some supplements so that’s kind of your starting point. And if you wanna reach out, Isabella, you feel free to use the link down below, you can reach to Evan and I. 

Evan Brand: Let’s read the rest of her comment here because I think it’s helpful for people. So, she said that she tested negative for SIBO, I’m guessing that might have been a breath test and she said she’s 21 years old and it affects her daily life. So, when I hear 21-year-old female, a lot of bloating as you mentioned, I think the veggies, I think cutting out leafy greens, no salads, maybe or 

Dr. Justin Marchegiani: If you do it, keep them low FODMAP and steam it or sauté it like I’m pretty sure Bok Choy and Kale. That’s low FODMAP, if you sauteed that in some coconut oil or some ghee or some kind of good animal fat, you’d probably be okay but test it, right. I’m all about testing not guessing. 

Evan Brand: True. True. So, I think about hormones, I think okay, she’s 21, right? This is a healthy fertility age. Is there some sort of issue with hormone imbalances? Are there estrogen dominance type issues as well? What about breast tenderness? What about PMS, irritability? Are there mood issues as well or is it just an extremely distended belly? 

Dr. Justin Marchegiani: Now, in the history that’s gonna come out with a good history because you’re gonna see it cyclically happen typically premenstrual or typically ovulation. So, a good history will fret that out. Let’s assume it’s every day, hormones are probably not the root cause but of course we know we’ve already talked about it, chronic digestive issues will eventually cause hormone problems because of the inability to digest the nutrients to make the hormones overtime. 

Evan Brand: Good point. And, the bacterial overgrowth which will crank up beta glucuronidase. That creates the recirculation of toxins. So maybe that. What about birth control too? Is that in the equation? I start thinking about that so 

Dr. Justin Marchegiani: Birth control pill will, it definitely has an effect on, um, alkalizing some of that tissue in the intestinal tract and the vaginal tract. That’s why one of the big effects that you see with, like birth control pills is yeast infections, right? Because it’s shifting the pH. It’s also creating a lot of nutrient deficiencies. So, if you have birth control pill issues, they can definitely put you in that microbiome, um, area where it kind of goes the wrong way there. 

Evan Brand: Yeah. So, hopefully that helps and as you mentioned if you wanna reach out, you can. Dr. J at justinhealth.com and me at evanbrand.com. With a stool and a urine and a good workout, we could probably get to the bottom of that. I would say that digestive issues are something you and I have the most experience of out of anybody that I know because all the people that have failed others then they come to us. 

Dr. Justin Marchegiani: Absolutely. The hardest part too is once you kind of get on that straight and narrow, finding out how much latitude you have, right? Some people, they may not be able to do dairy afterwards. Some may still have to be grain free, they can’t even do rice or, um, oatmeal, right? So, some people they got to be a little bit tighter on their diet. Some can be a little bit looser. And it’s hard. The hardest thing I think is with kids because kids, I mean, I have two, a two- and four-year-old boys, right? And most kids in their age eat like crap. It is just like absolutely mortifying to see how most kids eat. And, normal and typical are two different things, right? So, people say, I wanna be a normal kid, I wanna eat like a normal kid. It’s like no, you wanna eat like a typical kid, like normal 60 years ago was a totally different diet than normal today, right? 60 years ago, everything was mostly organic. Kids ate relatively, you know, whole foods and there wasn’t all the GMOs and all the crap and all the excess omega-6 fats and trans fats and people were eating good proteins in every meal and we had actually home-cooked meals and home-cooked dinners. That’s totally different today, right? And so, typical and normal are two different things. 

Evan Brand: Yeah. Not many seed oils or non-existent seed oils or go back a little further, go back 5000, 15-20000 years in United States, even just a few hundred, you read the native American stories, I mean those kids were eating Bison, breakfast, lunch, dinner, you know, what were having, they were having Bison. If it was a time where they maybe didn’t get a kill, they had pemmican which is gonna be like a dried meat product, maybe some tribes, they would integrate berries into it. But if your food has a brand to it, now there are some exceptions like there are some really good companies that make Bison meat and all that but in general

Dr. Justin Marchegiani: The jerky, yeah, there’s some good stuff, there’s some decent paleo granola. If you can handle nuts and seeds then that stuff’s okay as well. 

Evan Brand: But in general, my point is if your food has a brand to it, it probably has some level of processed. Now, if you say a farm, like a farm name, I don’t consider that a brand. I’m talking about, like Kellogg, that’s a brand. If your food has a brand to it, it’s probably not something good. I’m not looking at the brand of my wild blueberries, I guess technically they have a name or a store but they’re blueberries. So, you just got to think simply and as you mentioned long term, there may be dietary changes but overall, I think a lot of people can get back to foods that they previously avoided or were previously afraid of, not to mention, people that are afraid of meat, so many people are afraid of red meat. We interview people all the time and they say, oh, I eat red meat a couple times a month, I eat red meat every day, like why, and oh well you know, my cholesterol or my heart or my doctor said this and so there’s still so much programming. I think you and I forget, now, I know you have TVs and you probably have some exposure to this but in general I don’t have any exposure to pharmaceutical ads and so I forget just how much indoctrination and programming of dietary information people have and so part of the art of what we’re doing too is just removing any of the historical programming, they’ve had about certain foods. I think some people freak themselves out so much, they’ve been told a certain food is so bad for them, they go into it, thinking if I eat this steak, I’m gonna have problems and they literally will put so much stress and emotion into the worry of food. That then drives further symptoms.  

Dr. Justin Marchegiani: Yeah. I always start with you gotta have a framework on how you analyze any data or any concept, right? So, my first framework that I look at anything with is old foods don’t cause new diseases, right? When you look at most of the diseases we have today, the regular there routinely Neolithic, right? They weren’t at the same level that we saw a hundred years ago, right? Obviously, we had different problems back then because we didn’t have the same level of water sanitation, indoor plumbing, antibiotics which you know for like, you get a major cut, you had an infection, you don’t have antibiotics, you could die, right? So, we have that, that’s different. So, Neolithic foods cause most diseases. And so, when you look at good proteins and animal fats and these kinds of things, they have been eaten for as long as you can go back. So, those typically aren’t going to be the problem, right? It’s mostly gonna be the processed foods, the excess omega-6. And also, you know, the whole vegan bent that’s something that’s not really supported by anthropological data. You look at the works of western price so you look at people that studied indigenous societies, almost always meat was consumed when it was available. The only societies that typically didn’t consume meat were societies that didn’t have access to it. And if you look at the works of Western price when meat was accessible, it was typically consumed. It wasn’t like, oh let’s just not consume it. It’s typically, they didn’t have access to it and when they did eat it. And so, people that tend to do really good on a non-vegan diet are your ectomorphs, these are people that can handle lots of carbohydrates. It’s impossible to do a vegan vegetarian diet for the most part and not be very, very high carbohydrate and also, typically, you also got to plug in a lot of protein powders to do it well, whether it’s free form amino acids, whether it’s collagen or pea protein or rice protein or hemp protein, mostly having to plug in a lot of amino acids to get enough especially if they’re trying to put on muscle and be, you know, on the fit side.  

Evan Brand: It’s hard to be Vegan, it’s easy to be an animal-based person, I’ll tell you that. There’s just a lot of hacking, have to do. So, Isabella chimed back in, she was a little bit behind on the live stream so she chimed in here. So, here we go, we got some more evidence guys. I hope you’re having as much fun as we are because this is like a, you know, on the fly functional medicine, uh, workup here. So, she said, loss of period for six months as well, mood issues like anxiety and racing heart upon waking irritability which is what I was thinking some kind of hormone stuff. I’m a bit behind wanted to input that so.  

Dr. Justin Marchegiani: The problem with a lot of those symptoms, it requires me having to ask a very important question, I won’t ask that question but we’ll just say the meat of that question begins with a letter v and we’ll just let people linger on that and Isabelle, if you want to reach out feel free. I think we chatted in the part, so feel free to reach out, I’m happy to help you.    

Evan Brand: Yeah. Yeah. That’s a very, very good point and would make perfect sense especially with the timeline here. I would be wanting to look at some blood work. You know, actually, I had a woman last week, 33 years old, loss of period, other issues, we ran her blood, elevated D-dimer that indicates breakdown of clotting so we’ll leave it at that for today but mid-30s women should not be having elevated D-dimer. 

Dr. Justin Marchegiani: Yeah, and we’re speaking kind of like we are in a very, uh, discrete type of manner because we want to keep this information flowing to you, okay, so people out there hopefully you most, you mostly get that and you want to continue to see us on the air. That’s our goal. 

Evan Brand: Here’s another question then you and I can wrap this up here in a minute. So, can gut health issues cause high resting pulse and arrhythmias. Let me tell you my personal experience and maybe we could chime in on the clinical side too but when I had gut issues when I had H. pylori, I was anxious, I had issues with my blood pressure. I had heart palpitations. I had panic attacks. I had all sorts of mood issues. I had heart issues. I had sleep issues. I had skin issues. So, 100%, gut issues can cause this.  

Dr. Justin Marchegiani: Yeah. The bugs in and of themselves definitely can cause anxiety so you can go type in their scientific studies, type SIBO or H. pylori and anxiety, there’s definitely mental health association, connection with the two. Also, if you have digestive issues, you tend to have hydrochloric acid issues. When you have hydrochloric acid issues, you tend to not ionize minerals and absorb minerals optimally. The two big minerals that are intimately connected with your heart and heart rate and heart rhythm are potassium and magnesium and a lot of times people aren't getting sodium and chloride as well. So, the electrolytes have to be looked at and potassium and magnesium have to be looked at and most don’t get enough, you need 4 7 00 of potassium a day, most get half that and so I have a product called potassium synergy that does about 13 00 per 150 in magnesium or so side by side. It’s really hard to get enough. Most supplements for potassium stink, they’re like 50 or 100 milligram capsules so you got to take like 15 or 20 capsules a day so sometimes, you need to plug in a supplement if you’re having issues, I mean you can go look at the most potassium-rich foods, salmon, avocadoes, sweet potato. Those are really good options of course, um, some animal products as well, are going to be right up there as well. And again, avocados have twice the amount of potassium as bananas, I know we’re kind of o a carb-centric society. If I say potassium, you’re gonna say bananas, right? But avocados have twice the amount.  

Evan Brand: Yep. Good call. Good call. So, long story short, gut issues definitely cause other issues, mood issues are very common. Fatigue is also very common and so that’s gonna affect neurotransmitters so we would be looking at all that. We’d be looking at neurotransmitters, gut inflammation, um, secretory IgA. You can look at fecal fat. There’s a lot of stuff that goes into that, that may affect the high resting pulse. Also, seeing a lot of things right now with viruses and high resting pulse rate. So, if there was a current infection, previous infection, pulse rate could be there. You mentioned potassium. 

Dr. Justin Marchegiani: Hydration, sodium chloride and then your potassium, magnesium. Those are gonna be your big ones out of the gates. And then also, blood sugar, you know, some people, they really get into a stressed-out state if they wait more than an hour or so to eat. And if you have digestions, a little wonky, you may want to start with something really simple like some gentle ginger tea or some collagen amino acids or something really light and simple in the morning and some electrolytes even before that. 

Evan Brand: Yeah. Yeah. Good call. Sometimes, you know, herbals, I might come in with like motherwort or passion flower, valerian, some kind of like calming ginger.   

Dr. Justin Marchegiani: Yeah. I was looking at the nutrients first because the nutrients could be actually root cause and the herbals will never be root cause but they are a palliative supporting mechanism, right? You know, it’s like, you can do passion flower or lemon balm or you can do a benzo on the pharmaceutical side. It’s like obviously the herbs are better and then even before the herbs the actual nutrients that may be deficient that are driving it. 

Evan Brand: Very good at all. I’m ready to wrap this up, if you are

Dr. Justin Marchegiani: Herbs aren’t going to have the, you know, the side effects so I’m always down with supporting something palliatively if they aren't going to have the side effects or you know any of the negative consequences like some of the meds may. 

Evan Brand: Yeah. Well said. Are you ready to wrap this up? 

Dr. Justin Marchegiani: Yeah. Great chat with everyone here today. I’m glad everyone’s on the chat interacting. We really appreciate it. Functional medicine improv is our flow here, uh, you guys wanna reach out to evanbrand.com for Evan, Dr. J here, myself at justinhealth.com. We’ll put links down below. If you’re seeing it on youtube, you know, great, excellent. If you’re listening to this on itunes or any of the podcast places, there will be a video link below. If you wanna see us interacting as well, there’s that as well. And phenomenal chatting. Anything else, Evan? 

Evan Brand: Yeah. If people wanna chime in and they want to watch, if you guys are listening or if they’re on my podcast because we’ll upload these on my show as well. If you want to check us out here on video, give or take somewhere around 11 to 12 eastern on Mondays on Dr. J, justinhealth YouTube channel. So, if you wanna look for us, join the party. Look up Justin on YouTube justinhealth, Justin Marchegiani, Dr. J something like that. You’ll find him on there and, uh, we’ll put the link in the show notes too. So, if you wanna join the YouTube community, you can. There’s what 60 something thousand on there. So, that’s pretty

Dr. Justin Marchegiani: Also on Rumble, also on Betshoot, also on a couple other places. So, we’ll put the links on the websites so you can get the banners, get the links but Rumble’s our new one that we’re going to just get more exposure, people. 

Evan Brand: And you’re reuploading the YouTube videos too there, right?

Dr. Justin Marchegiani: Yep. You got it. 

Evan Brand: No live function on there or anything yet? 

Dr. Justin Marchegiani: Not yet. Not yet. 

Evan Brand: Okay. Okay. All right, well, you guys take it easy, we look forward to helping you get your gut health back, just stay patient and don’t give up. And so, we’ll see you next week. 

Dr. Justin Marchegiani: Take care of you all. Bye now.