Digesting fat is so important for one’s hormone growth and for healthy cell membranes as every single cell has a lipid bilayer. If one wants to be a good fat burner on a ketogenic template, it is really important to have great gallbladder function.
In today’s podcast, Evan Brand and Dr. Justin Marchegiani talk about utilizing functional medicine principles and assessment to figure out how one’s gallbladder is doing. Listen as they talk about what can one do about it, the common gallbladder symptoms, root cause solutions, and how can one get better from these symptoms. Stay tuned for more!
In this episode, we cover:
00:35 What is Gallbladder?
04:47 Consistency of Chewing Foods
08:16 Bile Surgeries
14:18 Autoimmune Issues that Affect Gallbladder
17:28 The 3 F's of Gallbladder Issues
20:26 Some Advises if Your Gallbladder was Removed
26:32 Comprehensive Stool Test
Dr. Justin Marchegiani: Hey there, it's Dr. Justin Marchegiani, welcome to today's podcast. We're gonna be talking about utilizing functional medicine principles and assessment to figure out how your gallbladder is doing. Also talking about what we can do about it, what are the gut- what are the common gallbladder symptoms, what are root cause solutions, and how we can get you better. We know, digesting fat is so important for your hormone growth, for healthy cell membranes. Every single cell has a lipid bilayer. And also, if you wanna be a good fat burner on a ketogenic template, it's a really important we have great gallbladder function. So Evan, welcome to today's podcast, man!
Evan Brand: Hey man, thanks for having me.
Dr. Justin Marchegiani: Awesome. Well, let's dive in brother. I'm excited to- to dive in. So, first off, let's just first dive in just to kinda physiology 101: what is the gallbladder? Why is it even so important? So, off the bat, gallbladder is kinda in this upper right quadrant here just beneath the rib cage, ‘kay? If it's tender in that area like they'll do a- a palpation that's called Murphy sign, uhm, in that area where they'll look for tender type of gallbladder issue where the gallbladder's inflamed. But the gallbladder, it- it basically concentrates bile at about a 15 times above than the common hepatic bile duct in the liver wood. So when you're having your gallbladder removed, that common hepatic bile duct up in the liver just drips bile all the time, it's not specific, it's not during a fatty meal, just kinda hits, and you can definitely have some bile acid diarrhea issues. When you have a gallbladder it concentrates that bile 15 times and then allows it to come out and time it, it- it squeezes, it contracts, and s- puts up that bile especially during a fatty meal 'cause you have these hormones in your stomach when that food- when that uhm, kind, that mixed up food in your stomach gets released into the small intestine. Uh, the nice acidity of that stimulates this uhm- neuropeptide called cholecystokinin or CCK for short. And that cause the- the gallbladder to contract and stimulate all these bile release which helps with fat digestion. If we don't have a gallbladder, we're not gonna be able to breakdown fat optimally through biliary concentration.
Evan Brand: Yup. So, you're in to that fast, I'm just gonna repeat it so it gets into some people's heads.
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: So, you say, when your- you put food down the hatch, especially fat, it enters the digestive tract, the body says “Okay, boom. There's fat in here now, I'm gonna start making CCK”, and that comes from your duodenal, and I believe the jejunal as well, and then- it- to respond to the CCK, then the gallbladder goes “Oop, CCK is in the neighborhood, now I'm gonna release my stored bile because we've got fats to take care of”. So then the bile, or they call gall, will start working on these fats and then turning those fats into usable fuel.
Dr. Justin Marchegiani: Yeah, think of emulsification is like you have a greasy pan, and you put a drop of like soap, right, like some- some dish soap like dawn dish soap, and it kinda breaks it up, it emulsifies it. Think of that's what's happening if you got this greasy pan in your stomach, which is all the fat in your stomach going into your small intestine, that emulsifies it and allows your body to break it down and absorb it. It goes in these little things that form uhm- a- uh- a- a- a micelle, and that allow it to get into your body and be able to utilize it. Now, going up one kind of marker is hydrochloric acid levels. This is even important, this is more important because hydrochloric acid stimulates, it lowers the pH, and a nice low pH triggers cholecystokinin. So, we also need good pH function, good hydrochloric acid function and then that then, in the small intestine really gets the bile going, and then we also have some enzymes in the pancreas called lipolytic enzymes, lipase enzymes that also help with the pacre- with the- with the gallbladder in the- in the bile digestive process.
Evan Brand: Well, you make a good point, 'cause when we jump into this conversation, if we'll look at the whole digestive cascade, as a big row of dominos, when you get to CCK and you get to the gallbladder, you're really talking 3 or 4 dominos down the list but it's good that you went upstream first to the mouth, where that's where you're chewing your food – hopefully you're chewing your food, you're not rushing through your meal. That's why I don't like things like chipotle, I enjoy the food itself, but it's all soft, it's mushy, meat and rice and guacamole, and you can just shove it down the hatch and you really have to chew the stuff. So, if I eat a soft meal, I still try to be very condescend about chewing, chewing, chewing, chewing, tellin' the digestive system, “Hey, something's coming down the hit- down the hatch”, but, you make the point about HCL. It's why it's so important when we- uh, talking about gallbladder symptoms which we're getting to in a minute, to look for, and to treat if you have them, H-Pylori, and other infections 'cause, if H-Pylori is reducing your HCL levels, well, you can't go straight to the gallbladder. I mean, you- you can, you can take bile salts to help it, but you didn't fix the root cause, it was H-Pylori.
Dr. Justin Marchegiani: Exactly. So, kinda highlighting, we went from the gallbladder. What's happening at the gallbladder, upstream to HCL, and that- that also activates other enzymes in the stomach called pepsin, and also gets the pancreas producing lipolytic fat breaking down enzymes, and then proteolytic protein breaking down fat enzyme, it's- it's very rare that you just have fat by itself, typically fat, protein and cholesterol tend to come together. And then, up one stream above is the chewing part. We wanna make sure we're chewing our food at least 32 times, that's about one chew per tooth, right, you have 32 teeth, so think of 32 chews, 32 teeth. And in general, getting your food's to like an oatmeal like consistency, like- if you're having a food that's kind of more predigested like a chipotle meal, you gotta just make sure you at least chew to that good oatmeal-like consistency, and try to be in a relatively stress-free environment because the parasympathetic nervous system is really important for HCL secretion, thus enzyme secretion, and thus, uhm- bile secretion because we need that nice acidity, we need the enzymes, we need the digestive secretion. And for a sympathetic state, all that blood flow is going out extremities, our arms and our feet to run, fight and flee. So, it's very important that we have good parasympathetic, so good breathing, gratitude, being in a quiet kind of relaxed setting to start our digestive processes.
Evan Brand: You know, I was trying to find some research on this, I am just gonna guess based on the mechanisms we discussed, that people on acid blocking medications probably have more issues with gallbladder. Would that make sense, 'cause let's say you don't have H-Pylori infection but you're on an acid-blocking drug, isn't that gonna just down-regulate this whole process we're talking about?
Dr. Justin Marchegiani: Yeah, we need good acidity to trigger that CCK. So, that totally makes sense, right? And then we need- to be able to break down god fats. What are good fats? Well, we have our mono unsaturated fats are gonna be things like olive oil, avocado oil, and then maybe even some nuts and seeds. We have more saturated fats which are gonna be animal products, right? Grass-fed beef, uhm- any of our like, you know, fish, chicken, beef stuff, you're gonna have omega-3 fats which are on the polyunsaturated category. Omega-3 is more polyunsaturated, and then you also have your saturated coconut oil which I think is your only plant fat that's saturated, maybe that and palm I think are the only 2 big saturated ones that are plant-based. So, we have our saturated fats, right? Coconut, plant-based fat- coconut, and animal-based fats. We have our mono-unsaturated which typically are gonna be uh- a lot of the olive oil, potentially avocado oil, we have our polyunsaturated, a lot of times which are fish, and then maybe some of the nuts and seeds kind of fit into that monounsaturated category omega-6 kind of category as well. And then we have our uhm- Vitamins-A, D, E and K, “ADEK”, these our fat-soluble vitamins. So if we don't have good bile-support, we're not gonna be able to break fat down by the minute which is really good for our uhm thyroid function, it's good for our skin, right? Higher dose Vitamin-A is great for skin that's why they use uhm- Accutane which is- is a Vitamin-A analog to shrink the oil cells on the skin, also great for our eyes. Vitamin-D obviously great for our immune system, we make it too from the sun. Vitamin-E is great for our heart, it's a natural antioxidizing, great for inflammation. Vitamin-K is really good is found in butter fat. It helps get calcium into our bone, right? Vitamin-K2, consider activated- a- activated X by western price, really important nutrients. So, these fat-soluble vitamins, we really need good gallbladder function to absorb them.
Evan Brand: Yeah, and if you don't have a gallbladder, we'll get into that in a minute, you know, I was just looking up, uh- reading the bile, the surgeries that people get. When you get into the gallbladder world, gallbladder surgery is just such a huge, huge money maker and it's done often times in cases where it didn't have to be done. And I told you we need to get a lady on whose uh, got a specific website about protocols for people with gallstones to try to help give them relief and to save their gallbladder. But another surgery which is crazy to me is called fundo- fundoplication, and it's what they do to relieve chronic acid reflux. The surgeon tries to recreate your lower esophageal sphincter, by taking the upper portion of your stomach and wrapping it around the lower part of your esophagus and sewing it into place.
Dr. Justin Marchegiani: Wow.
Evan Brand: That just seems insane to me, they call it anti reflux surgery. How many of those people, just have H-Pylori infections that were put on acid blockers, therefore that LAS, that lower esophageal sphincter wasn't working properly, or maybe they had a mineral deficient or maybe it was a ___[09:18] issue and structurally, that could get adjusted, but instead, they go get their stomach wrapped around their esophagus and sewing together. That's insane!
Dr. Justin Marchegiani: It really is, and that's kinda what conventional medicine does. They can go to some extremes to fix things that in my opinion are much more foundational and much more simple. And most of the time I would say 99% of the time, the surgeries aren't root cause, right?
Evan Brand: Yeah.
Dr. Justin Marchegiani: So if we look at the conventional side, we have things like a HIDA scan which is like a nuclear image, they swallow s- solution that's nuclear, and uhm- they kind see kind of biliary function, right? You want typically a 33 to 40 percent kind of dejection fraction that's normal, on the gallbladder. So, you can look at that with the HIDA scan, you can even look at, an ultrasound, uhm, to give you a window of the inflammation in the gallbladder. It's not gonna give you how much uh, bile is flowing to the duct but at least give you- okay it- it- is there- is it stagnant, or just stuffed in there, is it inflamed. You can kind of get that sense as well. A lot of times they'll do some conventional testing, 'cause if your gallbladder is inflamed, and there's an immune response, you may see white blood cells uh- on the higher side, right? Uhm, you may also see certain liver enzymes, ALT is a common liver enzyme, AST is another enzyme that can be effective in the skeletal muscle, you can see GGT, think of the “G” in gallbladder, GGT is a big gallbladder enzyme. Bilirubin is a byproduct of red blood cell metabolism that comes out in the gallbladder. With high bilirubin, we may have some- some backed up gallbladder bile issues. And then a- also, I think alkaline phosphatase is another big one that we may see on the higher side. So, we're gonna see bilirubin on the higher side, alkaline phosphatase on the higher side, and then we're also gonna see potential HIDA scan issues, that can- those are- HIDA scans more like pathological.
Evan Brand: Yep.
Dr. Justin Marchegiani: There are a lot of people that are in between that may be okay on the ultrasound or maybe okay on the HIDA scan and we can use some of this functional test as well. Uhm, but really important we gotta dig to the root, underlying issue on what's going on there. And again, AST is more skeletal muscle but there's some crossover with the liver, ALT is more liver. Think of the “L” in ALT as liver and then the alkaline phosphatate is a big gallbladder one, also a big one for zinc. Alanine transferase or ALT, asphotate transferase, and then alkaline phosphatase for ALP.
Evan Brand: Well, the good thing is, a lot of the blood markers you just mentioned are pretty standard. So, even if you're not working with the functional medicine practitioner like one of us, you may be able to get your doctor to just run these labs, refer back to this podcast and look and see if you have an elevation. Now, the only problem is, the conventional reference range for blood testing is very bad. So, you may be quote, “normal” by your doctored standards but our reference ranges maybe tighter. So if we start to seal your ALT or your AST enzymes go up, it may not be up enough to flagged. So, that's why it takes a trained eye to look at these numbers and see, and we've seen it time and time again, we get somebody on gallbladder supplements their AST and ALT go down. So, it's amazing to see, we gave this nutrient, “boom” look at the blood changing just based on this nutrients, it's really cool. Let's talk about symptoms now, I think we've given a good-
Dr. Justin Marchegiani: Yeah, just to highlight one thing, you just wanna get that CBC done at- which is a complete blood count, and then also a CMP – Comprehensive Metabloc Panel profile, and it's important, you need to work with a good functional doc because you may be okay in a lot of these areas and you still may have issues, so now what, right? So you don't wanna just rule it out 'cause some of these testing are good, you wanna look at subjective symptoms, connected to the anatomy, connected to how your stools look, right? If we have fatty stools, blond stools, excessive amount of wipes to clean out your- you know, to clean yourself after going number 2 or just, you get skin marks on the toilet seat, we're probably not breaking down fat. And again, if you have too much MCT oil in the morning, that can also do a tube instead as a laxative effect. So, you gotta look at it the trend in general, clinical symptoms, subjective symptoms, and then lab symptoms to really make a complete picture of what's going on.
Evan Brand: That's a good point 'cause my AST and my ALT on my blood looked perfectly fine. But when I had parasite infections, I had that low right side pain under my rib cage where my gallbladder and liver are. Your gallbladder is kinda tucked in with your liver under there, so if you look down at yourself on your right side up where that rib cage, if you're having pain there, when I had parasites, I had ton of pain there, my blood looked perfectly fine. So I don't want, like you said, you don't wanna give a- a false sense of hope just 'cause your blood looks okay. There may be other functional problems that you'll find by looking at stool testing for example. But let's hit- let's hit-
Dr. Justin Marchegiani: Yes.
Evan Brand: -on these symptoms, because you mentioned some but we needed just go through symptoms here and tell people, “okay, what would you be experiencing?”.
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: So, you mentioned, fatty, greasy stools-
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: You mentioned it takes a lot of wipes to clean your butt, you mentioned the skid marks in the toilet which if everybody is going on a high-fed diet these days, sure, that may be okay but if you've got gallbladder problems to start and then you try to go on to ketogenic diet and you don't feel well or you don't lose weight and you're complaining to your doctor, that may be the part of the problem is gallbladder.
Dr. Justin Marchegiani: 100%. Also, autoimmune issues can affect the gallbladder as well. Gluten's a big one, it creates those condition called primary biliary- what's that last?
Evan Brand: I think you call it cholangitis.
Dr. Justin Marchegiani: Yeah, primary biliary cholangitis. I mean, typically just “PBC” for short. But basically you can have some scla- scarring of this uhm- on the- the kind of biliary tubes that go out of the gallbladder, and as well as the- you know, the gut- the liver goes to the gallbladder, the gallbladder kind of comes out together with the pancreas and comes out the sphincter of oddi, or the hepato biliary kind of ampulla, and that- that can kind of scar and it can sclerose, it can kind of have uhm narrowing of the- of that vasculature. Of course, it can back up, and if that backs up, and those enzymes can't get out you can have pancreatitis as well. But that's an autoimmune condition where your body is attacking a lot of that tubing that goes up to the gallbladder and maybe even can help with the pancreas, and that can narrow and prevent a lot of that stuff from coming out. So of course, gluten is a big component because that can really activate a lot of au- autoimmunity and you can also have a leaky gut, you can also have a leaky gallbladder which does aggravates more autoimmune attack because things that shouldn't be out in the bloodstream are out and that exacerbates the immune system going after it.
Evan Brand: Yeah, so let me just read a few sentences on these whole PBC thing 'cause I think this is critical. We know, even just this is just standard you know, medical textbook stuff that says “it's the most common among women”. And we know that Hashimoto's is more common in women and men. So it says here, “the cause is not clear but we know it's more common in people with…” guess what, “…hashimoto's thyroiditis”.
Dr. Justin Marchegiani: Yes.
Evan Brand: So, it says here, “An autoimmune cause is- is thought possible because more than 95% of people with PBC have certain abnormal antibodies in their blood. These antibodies attack mitochondria. What triggers these attack is unknown…”, of course they say that but it may be exposure to a virus or toxic substance A.K.A. ‘gluten', maybe dairy, I mean, you and I talk so much auto about- about autoimmunity so I'm glad that your brought this up because, you know, these people may have these symptoms, and they're not gonna know what's autoimmune in nature, they may just get the- the knife and say, “Hey, we've gotta pull this gallbladder out”. Not necessarily, what if we can shut down this autoimmune attack?
Dr. Justin Marchegiani: 100%. Also, here’s the bigger issue too. Okay, great, the gallbladder is removed, your digestion is now forever altered. I've yet to meet a conventional patient of a gallbladder procedure, whether surgeons that “oh, by the way, you're gonna have to add in HCl, pro- or- lipolytic enzymes and bile salts for the rest of your life”. I've never really heard that, at least bile salts seem to be added in. I would say HCl and enzymes too, but I've never heard someone do that. Now, your digestion is forever altered, do you think there's a connection with now you're not being to breakdown cholesterol optimally 'cause that's gonna be in the bile, right? The bile is 97% water, then you have some cholesterol, and cholesterol salts as well, and you also have some toxins coming out, that's why if you have uhm- poor, you know, gallbladder-emptying, then you're not getting rid of potential toxins that are in there too. So, we gotta be emptying that gallbladder. If we're not breaking down Vitamin A, D, E, and K, if we're not breaking down our fat-soluble vitamins, which I just mentioned, if we're not breaking down cholesterol which is the building block for all of our hormones, do you think we're gonna have problems ladies, uh- as you get into your 40's and 50's, with menopausal issues, perimenopausal issues, PMS, and we know the main connection, it's kind of a slang but, I've heard many uhm- let's just say general surgeons say it, it's the 3 ‘F's' of gallbladder issues: fat, female and forty. And that's the time to- late 40's, early 50's where hormonal transitions happen, and if you can't breakdown those nutrients, you are setup for a menopause uh- of “hell”, so to speak.
Evan Brand: Yeah, in terms of side-effects, possible side effects of gallbladder remover- removal, it could be anything from pancreatitis, to increased risk of choline cancer to increased digestive sy- symptoms like heartburn, could be constipation. So, we've seen people that- they don't feel well, after they get the gallbladder removed. And uh, like you said, there's no surgeon out there saying, “Hey, I'm gonna put you on this comprehensive digestive support protocol, after we remove it”, no, they're gonna you out with anesthesia, cut that bad boy out, and send you home in a day or 2. Uh, there's a- a whole lists symptoms here I'm looking at now, symptoms of- uh- symptoms after gallbladder removal. I've had women have gallbladder attacks, but they don't have a gallbladder. You know, it's like, “well, how the heck does that happen?”. So, you know, the- the- the removal is not the “cure all”. Anything from nausea to gas and bloating, distension, burping, belching, feelings of fullness, heartburn, barrett esophagus, diarrhea, dumping syndrome, weight gain. There's a whole article here all about post gallbladder removal weight gain happening.
Dr. Justin Marchegiani: And part of the reason why women get targeted so much – I hate to say it – is the estrogen. The estrogen kind of makes things sluggish and slow, it kinda takes- it kinda makes it turn into molasses. So, things really are very sluggish, very viscous, and of course, that can affect gallbladder and bile flow. Women that are on, you know, uh, birth control pills, that's gonna- in- obviously increase estrogen levels, obviously just being stressed, right? You're gonna take your progesterone, you're gonna shoot it downstream to cortisol, and that's gonna basically cause estrogen dominance there because you’re already starting to lower progesterone in relationship to estrogen. You're getting estrogen in the environment from the conventional meat products, uh, water, plastics, chemicals, hormones in the meats as well, and then you're also gonna be just getting it, just from uhm- being a woman, having 10 times more estrogen than a man. So, you're- you're already predisposed, and then when you add stress to it, it's going to exacerbate it uh, big times. So, you really wanna make sure that you're fixing the- like if you're having- if you know you have a gallbladder issue, you also need to be going after the- the hormonal issues as well. And then we can dive deeper into the food allergies stuff too, so you gotta go after the hormones, gotta make sure you fixed the estrogen dominance, you gotta make sure you fix the digestive aspects, and then we can go into foods later.
Evan Brand: Well, I'm sure there's gonna be a ton of people that are just yelling at us right now through they're podcast app or YouTube or wherever they're listening to us, and they're saying, “Well, this is not fair, I already have my gallbladder removed, so what the heck do I do now?”. So, do you wanna address that now or should we talk about that later?
Dr. Justin Marchegiani: Yeah, so, off the bat, the underlying mechanism that was driving that inflammation in the body's still there. Just the end target, the end uh manifestation of it is removed, but now other tissues may start to, uh, have issues, then also if you don't fix the underlying uhm, digestive im- impediment which is, your fat-soluble vitamins, your cholesterol, your hormone building blocks are now gonna be thwarted in their digestive processes. So, you have to fix that to prevent compounding hormonal issues, 10, 20, 30 years later, number 1. Uhm, and then so obviously this- so- err- if you're- if you still have your gallbladder, we wanna keep it by doing a lot of the preventative things. But on the food side, I outlined this in a couple of my gallbladder videos are down in the past. But there's some common foods that are even uhm- let's just say paleo-approved, but should probably be looked at- look at removing. So, of course we have the refined sugar in the guts. That's kind of a no-brainer right here. But, uhm, in order of kind of like uhm, the most likely offender are gonna be eggs.
Evan Brand: Yes.
Dr. Justin Marchegiani: So definitely autoimmune template, cut out the eggs, pork, onions, chicken turkey, milk, coffee, corns, beans, nuts, apples, tomatoes, peas, cabbage, spices, peanuts, fish, rye. I'm gonna link my article that goes into this. So, everyone's probably like, “Say it again!”, no, I'll put the link below, don't worry, take a look at the article, alright? But, I have them in most likely to offend to least. So, if you're overwhelmed after hearing that like, “What the hell am I gonna eat?”. Just start with the biggest 3 or 5, or look at that list and say, “What are the biggest 3 or 5 that I eat on a daily or weekly basis” and just pull that out. Once we get the inflammation under control, we support HCl, we support enzymes, we support bile salt production, we look at the gut 'cause sometimes there can be infections like H-Pylori and giardia, and of course SIBO in and around that ___[22:31] that can exacerbate everything too. So, we get the infections clear, if we get the acidity and the enzymes dialed in, if we cut out some of the common offending foods, we may be able to start adding some of these foods in overtime. But I find pork's a big one, eggs are a big one, those are like my- my 2 biggest right there off the bat, and they're kind of paleo-friendly too.
Evan Brand: Yeah, eggs are huge and people over-eat them and, if you have gallbladder issues, uh- when I interviewed Ann Louise Gittleman, she said the same thing, she said eggs are the biggest offender. I'm like, “Wow, I thought that was just me”, no, it's- it's a real thing, and then also onion. I think she said onion are ready-
Dr. Justin Marchegiani: Yes.
Evan Brand: But that was- that was a problem for me when I had parasites and I would try to do like stir or fry and throw some onion in there, I'd end up with that lower right side stomach pain, I'm like, “What the heck is it”, or if it was I had parasite infections but, the other- the other part of it was the onion. So, yeah, I at least temporarily, like you said going on an autoimmune protocol while you're working with your practitioner to fix the other underlying causes, you're gonna be in good shape if you do that.
Dr. Justin Marchegiani: Onions are also a ___[23:28] too. So there could be some underlying SIBO or small intestinal bacterial overgrowth going on as well. So, you gotta look deeper at everything. So, kinda like piggy-backing everything, alright? Women are gonna be the- more bigger offenders 'cause of the hormones, because of the- you know, the pregnancy prevention with the birth-control pill, so you have that, right? So we gotta fix the hormones, fix the hormones, number 2, cut out the foods, at least paleo to autoimmune paleo with those additional 3 to 5 to 8 foods I just mentioned. Get enzymes dialed in, get acids dialed in, and definitely bile salts added in, and if you already had your gallbladder removed, definitely do all 3, and those that up and watch your stools and make sure your stools go floating to sinking, right? Oil and water mix, so if you had the stool, with the whole bunch of undigested fat, and oil and water mix, the stools stay on top of the water, they don't sink. So, you wanna see the stools sink, and ideally you wanna be able to clean yourself, you know, 3 to 5 wipes on average, and you wanna make sure when you flush, you're not seeing big skid marks all the time. If you're doing some MCT oil in your coffee there may be some issues there, too much of that can cause some undigested MCT, so be mindful of that. So, foods, acid, enzyme, bile salts, get the infections cleared, and if you're a woman, get the estrogen dominance fixed, get the hormones balanced.
Evan Brand: Yup, and, how can you do that from a testing perspective, we mentioned the blood, but I'll just throw a few other components of this in. Number 1 is the stool test, so we're always gonna be running a PCR stool panel, or gonna be looking for all this. As you mentioned, we're gonna look at H-Pylori, we're gonna look for giardia, we're gonna look for cryptosporidium, blastocystis hominis, there's a ton of different bugs, there's worms, there's parasites, there's bacterial overgrowth we look at, there's candida that we look at, that's all done with the combination of stool and urine testing. And on the stool, there's a couple markers that we can track, obviously, you looking in the toilet is gonna be the best way to track. Well, we like numbers, you know, Justin and I like data. So, when we look at steatocrit, which is a fecal fat marker that usually is expressed as a percentage. I like to see it, you know, 10% or below, we'll see some clients, they're 30, 35, 40 percent steatocrit, that means they're not digesting their fats at all, and they while I'm doing a ketogenic diet and I feel like crap, it's 'cause they're not digesting anything.
Dr. Justin Marchegiani: That's it.
Evan Brand: So, we gotta get that steatocrit down, and how you do that, well, one, clear the bugs too, supplement, and then, what was the other part of my brain? The blood, we talked about the blood, we talked about the stool, oh, the beta glucuronidase. So, beta glucuronidase at enzyme on the stool test we look at, that enzyme gets messed up due to bacterial overgrowth. When we see the enzyme is high, that's when the estrogen dominance probably becomes more problem- problematic because now, they're re-circulating the hormones. So, we do some like a calcium d-glucarate or a DIM, or something else, maybe a broccoli seed extract to try to get, or could be probiotics, could just be clearing bugs, taking care of the SIBO, the glucuronidase goes back down, and now all these quote, “estrogen-dominance symptoms” just disappear, and it's really fun to see that.
Dr. Justin Marchegiani: 100%. So, kinda highlighting the test again, look at your symptoms, if you have pain in the upper right quadrant, under the rib cage, if you have problems breaking down fat, if you're seeing a lot of your fat, your stool sinking or floating on top, not sinking. If we run a ho- comprehensive stool test and we see a lot of uhm, steatocrit, undigested stool, we see that greater than 10 or 15, whatever that lab marker is right in that area, we got problems, and then we gotta dig in deeper, and this could be the reason why you have hormonal issues too so we have to highlight that. Is there anything else in this topic Evan that you wanna go into that we haven't gone in deep enough?
Evan Brand: I don't think so, I would just tell people that if you feel discouraged, or, you know, you're facing surgical removal of your gallbladder, I'm not saying the gallbladder can always be saved. I have a friend of mine, she's in her late 50's, maybe early 60's at this point, and she was having major, major gallbladder pain, and I told her about taking digestive enzymes, but the pain just continue to grow. So, you know, I said hey, you might have to, you know, go to a doctor and get this checked out. This is very recent, so she did. And her gallbladder function was basically nothing, and she went in and she had to get surgical removal and because of with so much inflamed tissue around her gallbladder they couldn't do the- the- the uh, laparoscopy, where they just give you a small- a small uh surgical side, they had to really cut her open like 6 to 8 inches, they hadn't take out the gallbladder, and the surgeon told her, that her gallbladder was so heavy, full of stones that it felt like a concrete block. He said there was no way you were gonna save this gallbladder. So, I think there is a point of no return, where surgical removal does happen, we're not shaming anybody or making fun of anybody if you got your gallbladder removed, that sucks, like she had to get it out, there was no turning back. And now, you know, she's got tubes coming out of her stomach to drain her bile until she recovers from the surgery. So, obviously, that's an extreme case but man, uh, you know, it can- it can get to a point where surgery is the only option but we're just trying to help you before you get to that point.
Dr. Justin Marchegiani: Yeah, so if we don't have enough, if you don't eat good fats, then we don't have good gallbladder flow, then, what happens is, it's like not changing the oil. A lot of that bile uhm, and that cholesterol can crystalize. And then overtime those crystals can- can produce more and more crystals. And then imagine these little crystals that are like- a little mini or- miniature-like porcupines. And imagine that gallbladder contracting, it's like giving a- a big porcupine a nice hug, right? Probably not the best thing. So, that can create a lot of inflammation, and the more little porcupine you're having your gallbladder, the bigger issue every time you have fat that contracts. And then also, we can have potential pancreatitis because of it 'cause those gallstones can eventually produce, can block the bile flow, and that can stop pancreatic enzymes from flowing into the small intestines. So, that can create more inflammation. So, the more this thing, err- there's more of this issue, the underlying cause goes unaddressed, the more the inflammation accumulates, accumulates, accumulates, accumulates, there may be a drastic solution of cutting out the gallbladder. Now, I would say, the vast majority of the time, it can be saved. We have to make the food changes, uhm, we also do a lot of gallbladder bile support, we'll also use things like phosphatidylcholine, we'll do beet root powder, we'll do taurine, we'll do dandelion, we'll do artichoke, French trees, or herbs that're designed to help to help one thin out bile flow, they can smooth out the little crystals, so imagine like kinda coming in there and smoothing out all the little porcupine barbs. Uh, that way they aren't as sharp, and then we can be very careful with our fat consumption, maybe we do the tiniest amount possible. A lot of the coconut fats are easier to process and digest. So, maybe we'll do more coconut fat, we'll just do- just the- the largest amount of fat we can handle without issues, we up the enzymes, we up the bile salts, and then we give a lot of those herbs to smooth out the bile flow, thin out the bile, and smooth down the crystals. We'll even do some- some like extra phosphorus drops to even thin out the bile uhm stones as well.
Evan Brand: Yeah, I do beet powder every day. You know, part of that for my circulation issues dues to all the mold in my body, so- so the beet powder's been really helping. But, you know, back to my friend, you know, she was, she's a woman, she's over age 40, she does have excess weight, you know, she is overweight, she is very sedentary, uh, she did have some familiar health issues as well, you know, any- any family history of uhm- diabetes, other type issues like that can- can increase the risk of gallstones which then increase the risk of these problems, so, if you were to take all of the things you don't wanna be sedentary, you know, overweight, uh, etc., poor diet, she had all those things against her. So, I'm not gonna- I'm not saying that everyone's gonna end up like that with her case which is extreme but, you know, I just wanted to point out, hey, sometimes there may need to be a surgical removal. But, we just- we wanna try to prevent that. Statistics I found say there is about uh- 3 quarters of a million surgeries every year for gallbladders.
Dr. Justin Marchegiani: Exactly. Then we kinda talked about, our women- right- our- our fat, 40 and female. The big issue is, estrogen is a big uhm cause of kind of making the- the gall uhm, making the bile more sludgy, so is insulin. So, insulin is also another stimulating factor, this is part about I think where the fat comes in there, because the more weight you have typically is more insulin-resistance, insulin’s that hormone that sticks sugar into the cell, converts it to fat, so if you have more insulin, that's a greater likelihood of making the bile flow more sludgy. So, if you have high levels of insulin, that's gonna slow up the bile flow, and then if we have uhm, high levels of estrogen or just estrogen dominance, that's gonna sludge up the bile flow as well.
Evan Brand: Yup. I'm sure we could keep going on this topic all day but, we should probably wrap it up. Reach out if you do need help, you can go to justinhealth.com, and Justin's summit is coming up very-very darn soon. So, I don't know when you're listening to this, if you listen to it in the future, and you already missed out, well, you can purchase his summit, but if you're listening to it ahead of time, his summit is going live very soon, in two weeks at the first week of March. So, go to thyroidresetsummit.com. Go register for Justin's event, it's gonna be awesome, I interviewed him, which I thought was probably one of the best interviews possible, and interviewed me, and I talked about some other stuff that he hadn't talked about. So make sure-
Dr. Justin Marchegiani: [Crosstalk] …interviews too.
Evan Brand: Thank you, thank you [crosstalk].
Dr. Justin Marchegiani: …for sure.
Evan Brand: So, so go register, uh, it's- it's gonna be probably one of the biggest events of the year called Thyroid Reset Summit. So, thyroidresetsummit.com, go check it out and to run through health talks which is like the apple of summits, they do a great job of putting things on, and there's, I don't know what, 30 other experts on there. So-
Dr. Justin Marchegiani: 30 great experts. And also, I'm giving way the first uh- 3 to 4 chapters of my new book coming out, the thyroid reset. That book will be coming out in the next uh, few months here, so, get your free intro copy and then I really appreciate you guys picking up the book as well. Get me up there on the Amazon ranking so we can help more people, I appreciate it. And also, just to finish with this uh, article, here, the uhm conclusion, very important here for gallbladder issues, just to tight home, repeat yourselves a lot because repetitions some other skill, here's the conclusion, insulin resistance is a risk factor for the incidence of gallbladder sludge and stones during pregnancy and after. And then it says insulin resistance may represent a causal link between obesity, overweight and gallstones. So our big mechanisms here, just kind of- f- coming in full summaries, if you missed the whole entire podcast, if you get this one thing, you got it. High levels of insulin, increased gallbladder sludge. High levels of estrogen, or estrogen-dominance, increased gallbladder sludge. Inflammatory foods, right, that drive insulin and inflammatory foods that are paleo friendly like, pork, like onions, like eggs, like coffee, maybe an issue, and then of course the low HCl levels, uhm, the low-fat diet, uh, all of those things and eating in the stressed out environment, those are gonna be your big 3 or 4, then also infections, giardia, gluten-sensitivity, SIBO, all of those things are gonna drive, probably the big 5 factors. Infections, insulin, estrogen dominance, low HCl enzymes, and then hidden food allergens. Those are your big 5 factors of this gallbladder issue here.
Evan Brand: Yeah, well said. And I love my friend to death but my wife and I were driving in the parking lot the other day, and she's- and- and then we see our friend who just got her gallbladder taken out, and she's sitting in the Taco Bell Drive Thru, and I'm just like, “No, that's exactly what got you in this problem in the first place”. So, the diet is so critical, you can't skip it.
Dr. Justin Marchegiani: Hundred percent, excellent. And for anyone enjoying this, I'm gonna do another live Q&A here tonight, this at- you know, the very end of the day, probably around 5, 6 o'clock here central time. Make sure you subscribe to the YouTube channel, we do a lot of live Q&A. So, go to justinhealth.com/YouTube. If you're listening to the channel now, make sure you hit that bell, that gives you the notification. So, if you're on your phone, it'll pop-up as it ___[35:35] doing a live chat. Even if you're not around for it, just your little- little question in. So, we do a live Q&A, it's op-in question, if there's a topic, keep your question to that topic, if it's a podcast, we may or may not get to questions 'cause we kinda get in our flow state and uhm, we may just be really focused on our conversation.
Evan Brand: Take care.
Dr. Justin Marchegiani: Hey Evan, you have a good one, take care.
Evan Brand: You too, bye.
Dr. Justin Marchegiani: Bye everyone.