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The Root Causes of Constipation & Slow Motility | Podcast #331

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Wouldn’t it be easy if you could blame your constipation on one thing? While that typically isn’t the case, your irregularity could be pointing to either one or multiple causes. Let’s watch and listen to Dr. J and Evan here, helping you learn what your gut may be trying to tell you, and what you can do about it. 

Dr. J and Evan emphasized to make a few changes to your lifestyle and see if they result in any positive bowel changes. Such as more high-fiber foods in your meals: fruits, vegetables, whole grains.  These steps will help you observe health changes – what works and what’s not via tests results as well.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:56       Slow Motility, Bowel Motility

8:06       Detoxification

15:57     Food for Detox

22:00     Vegan Honeymoon

27:40     System Approach, Solutions

30:51     Conventional Side

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Dr. Justin Marchegiani: We are live. It’s Dr. J here in the house with Evan Brand. Today we are going to be having a podcast all about constipation and bowel motility issues. This is a topic that we deal with all the time with our patients, especially when we’re dealing with and addressing potential infections. This can be a common side effects. So we’re going to dive into the underlying mechanisms and what you can do what we do about it with patients. Evan, what’s going on, man? How we doing?

Evan Brand: Doing really well. If someone listening is still embarrassed to talk about their poop, then I would encourage you to shed that shit shed the shame or embarrassment. We talk about poop all day. We love it, we enjoy it. This is part of being a human number one being a healthy human number two, because if you’re not pooping, you’re reabsorbing toxins, whether that’s xeno estrogens from environmental exposure or pesticide and herbicide or mold toxins, I mean, how we get rid of our toxic waste and chemicals and things we’re making internally and that we’re exposed to is peeing and pooping. And so when you look at someone who feels bad, they have dark circles under their eyes, they have skin issues, they’re irritable, they’re fatigued, they have headaches, a lot of times constipation is one of the underlying issues with those people. And if we can just get them pooping properly good amount in good shape, good size, good consistency, good frequency, we can really increase their productivity, their energy, their mental cognition, we can get rid of sugar cravings. I mean, there’s a lot that can happen when you just regulate the bowels. So we’re going to dive in today on some of the big root causes root triggers, I’m going to go straight to number one for me, which is going to be gut infections. Now, you and I were just talking before we hit record about different gut bugs and how some people with IBS, they’ll end up IBS constipation, others end up IBS D diarrhea. And so depending on what type of infections you have, your bowels may become dysregulated.

Dr. Justin Marchegiani: 100%. And so, when you have different gut stressors, slow motility can easily be a result. So you can easily see on the on the fast side, motility is too fast. Our body doesn’t have the ability to reabsorb water and electrolytes in time, because usually electrolytes and water kind of follow each other. So as the colon kind of pulls out the electrolytes, usually the water comes out with it. And so when we have slower bowel movements, right, they’re usually harder, more compact kind of stools. So if we look at like, for instance, the Bristol stool chart, I’ll pull that up on screen. So anyone that’s watching the podcast can take a look at it. The Bristol stool chart, the chart that’s used by gastroenterologist and such, but it’s just a way of kind of assessing where you’re still fit. So the typical number four is like the poopy policeman. And that’s like just a really good solid looking snake, like not overly hard not overly soft stool. That’s number one. If you go to the actual number one on the Bristol stool chart that’s like kind of the rabbit poop, right, the rabbit pellets really hard, hard to move. And then number seven is just pure liquid. So four is kind of right in the middle, and in between. So let me just show you what I’m talking about here. So you guys can visualize if you’re watching the podcast video along with it. So here is the Bristol stool charts that you guys can see. Okay, so number one, right separate heart clubs, nuts hard to pass. This is like the rabbit poop, right? That’s type one. And then it gently progresses back to two and three, right? where it starts to get more sausage shaped like it says except it gets more smoother, and that as it goes to three. And then step type four is the perfect poopy policeman kind of more of a sausage like more smooth, not overly cracked or not overly soft. And then you can see as you go to five and six, it becomes more liquid and then seven and just entirely liquid watery, no solid. And so that gives us a pretty good window. And so we usually when we have when the guts really inflamed, and we have usually a lot of toxicity in the gut, we can usually see it go to number seven where it’s pure liquid. And that’s because the body is just trying to flush things out. And when things go a little bit slower, you could still have inflammation and have type one right so you could have h pylori, that’s lowering stomach acid, you could have a lot of cebo that is meth that’s producing a lot of methane based back gases. And how do you know it’s methane is you have a lot of foul smelling gas or flatulence that’s a sign that there’s a lot of methane present. And methane can easily screw up that migrating motor complex and make the bowels go more on the slow side. But you can have the same level of infections like h pylori, or maybe histo or Giardia. And that could also cause it to go on the diarrhea side. So it just kind of depends. Everyone’s a little bit different. But we always you could have cebo you could have h pylori, you could have low enzyme and low acid levels that can easily be causing type one. But for someone else, those same infections could easily be driving steps type seven, right where it’s pure liquid. So you got to look at everyone as an individual on that. And really, you know, come up with the right plan.

Evan Brand: Yeah, and it can Alternate to write. I mean, that was my situation when I first had gut issues and I was losing weight uncontrollably when I had H. pylori and parasites and bacterial overgrowth and Candida the whole nine yards. You know, there’d be some days the gut was good. And most days the gut was not good. Luckily, I’m over that now. But man, I’ll tell you, I have a lot of empathy for people that, you know, you never know what you’re going to get, you kind of wake up and it’s like, Is today a good day or not a good day. And now that I’ve learned so much, you and I, both over the past few years about mold toxicity, that’s a big trigger for gut issues, too. So I’m get constipated, but a lot of diarrhea. And I think that’s the body’s way of trying to get rid of the toxin, but also the gut is so irritated. And you can have leaky gut from mycotoxin exposure, that that can be a factor too. So eventually, we’ll get into the gut healing phase of our conversation. I think that’s critical to healing constipation.

Dr. Justin Marchegiani: 100%. And so on the constipation side, there could be issues with obviously, the bowel motility has to be slow. So what’s constipation. So if you’re not having a BM, you’re not passing about 12 inches of stool in about a 24 hour period. That’s typically constipation. And there are millions of people in this country that aren’t able to have a BM every day. Now, once you start going 2 3 4 5 6 7, I see some patients that go up to seven days about a BM, that’s a problem because half of your stool is going to be bacteria. The other half is going to be you know, fiber and such. And within that stool, some of that bacteria and toxins needs to leave your body. If you’re not having that pass through your intestinal tract into the toilet, your chance of reabsorbing a lot of those toxins goes up really high. That’s definitely not good. Because those toxins get reabsorbed into your body. There could be xeno estrogens, there could be mold toxins, there could be a whole bunch of junk in there that you could be reabsorbing, and that could be really stressing out your body. So the first thing we talked about with detoxification is people talk about Detox Detox Detox, right? Well, if you’re not pooping every day, and that’s because of a gut infection or not chewing your food well enough or having insufficient hydrochloric acid or enzyme levels, or having some kind of a h pylori or SIBO issue. All of those things can easily affect your detoxification people are really focused on detox. Just by getting your digestion and your motility better. That makes a huge difference on your liver, and all your detoxification pathways, your lymphatics, your immune everything.

Evan Brand: Yeah, it’s funny, you’ll see women on Instagram, they’re all done up their hair and their makeup and their lipstick, and they’re like marketing, hashtag add hashtag detox hashtag tea. And they’ve got these like, I don’t know, you know how it is like, these ridiculous products that they’re marketing and they’re not talking about poop. To me, that’s the best way to detox is get poop out. I’m not going to buy detox tea, maybe like a little bit of dandelion or some who knows milk thistle, blend it in. Yeah, I mean that that’s part of it. But unfortunately, detox has kind of gotten co opted by the marketing industry. And so most people don’t even focus on that, though. You know, they’ll poop once a week, but then they take a detox tea and they think they’re doing it correctly.

Dr. Justin Marchegiani: Yeah, I mean, my whole take on detoxification out of the gates is very simple. Okay, first, get enough good clean water in your system, to make sure you’re digesting your amino acids and all your nutrients. Well, remember, sulfur based amino acids run the majority of your detoxification pathways, along with B vitamins, right. So we need good B vitamins, good antioxidants, good sulfur amino acids. So if we’re breaking down those nutrients, well, there’s not a bottleneck with HDL levels or enzyme levels. We’re getting enough good clean water. And we’re not overly stressing our sympathetic nervous system because remember, the more we overly overly stress the adrenals the sympathetic nervous system decreases that migrating motor complex, which are the wave like contractions that move stool through your intestinal tract just like you kind of roll up the to pace roll at night, I get that toupees moving through to get your toothpaste out to brush your teeth. your intestines do the same thing. So if you can do those top three things, right, you’re on the right track. Now there may be extra things where we need extra sulfur or extra antioxidants or compounds or binders to help with mold or heavy metals. That’s true and that that would be addressed down the road but a lot of toxic patients detoxification happens hepatobiliary liver gallbladder back into the intestines and then out the intestinal tract. So we need to have really good motility and really good absorption of nutrients and a lot of good clean water to help fuel that.

Evan Brand: Yeah, good point. Good point. Yeah, so we both manufacture our own custom blends of supplements that are professional grade, and we both have a liver support that has some gallbladder nutrients built into it. That can be really helpful because, as you mentioned, with sluggish bowels, a lot of times there’s also sluggish bile production. So just helping to thin the bile, whether it’s using supplemental ox bile or muthoni, taurine, beet powder, whatever else we could do to increase bile flow that’s going to be helping and then why don’t we hit on the diet piece. I mean, I think this is the low hanging fruit that you’re having. American is still really really blowing it on, which is just the fact that they’re not doing enough good meats, good fats, good veggies, you know, your average, American might wake up and I don’t know, do a piece of toast and maybe in 2020, or 2021, it’s an avocado toast. But still, you know, that’s not the optimal thing for good poops.

Dr. Justin Marchegiani: Yes, so inflammation in the diet can easily mess up the intestinal tract, inflammation in the diet can easily create inflammation in the gut. And that could either move the body more to diarrhea or more constipation. Now, for the sake of this podcast, if we start moving more to constipation, not good. And of course, you know, these foods can stress out the intestinal tract. And then when we start creating inflammation in the intestinal tract, and then we already have indigestion, and we don’t have adequate enzymes and acids, so we’re kind of burping a lot after our meals, food sits longer in our tummy, right, and we’re not in a lot of gases are produced because the foods are not being broken down properly, that’s a problem. So we got to really make sure we’re masticating and chewing our food very, very, very well, we got to make sure that increases surface area for enzymes and acids to work, we also have to make sure we’re not overly hydrating with our meals. So hydrate 10 minutes or more before meal. And then if you’re consuming a little bit of liquid with a meal, just do it to kind of help with swallowing pills, don’t do it for hydration purposes. Because water has got a pH of seven, your intestinal tracts a pH of 1.5, or two. So if you start adding a whole bunch of seven, Ph to a to a pH of two, you’re going to move that pH more in the alkaline direction away from the acid at direction. And we need good acidity to help activate our enzymes and our acid levels very important. So that’s low hanging fruit is chew your food up well. Second, is make sure you’re not overly hydrating with the food do all your hydration two minutes before.

Evan Brand: I’ve got my grandfather so many times till this drink liquid with almost every bite of his food, held his Drink, drink drink, like take a bite of food and wash it down with liquid. I’m like no, like you’re literally just pouring water on your digestive fire don’t do that. So yeah, it’s it’s easy. And it actually does make a difference. I mean, you know, I’ve probably talked about that before. But it does make a difference. Like if I, I’ve got a mason jar here, my goal, if I sit at the dinner table, I will try to not have it more than like two ounces of liquid. You know, if I have a full cup, I’m more I’m liable to drink it. If I’ve just got a little bit I know, hey, this is the only liquid I have if I need a little help with the meal. Otherwise it just food, no liquid with the meal. 

Dr. Justin Marchegiani: Yeah, for me, as soon as I know, like a meal is coming, I’m gonna go just maybe take two mason jars, add some sea salt to it, I’m going to down them and then I’m good. And then you know, 510 minutes later, I can start the eating process and I chew my food out very well. So then that gets the digestive juices rolling as well. So on top of that another low hanging fruit is let’s say you eat good quality proteins or fats, and that makes you constipated. That’s almost a surefire sign. You’re not making enough enzymes or acids. So some people they really do poor with enzymes, and acids, and it reveals itself through animal products. Now, a lot of people when that happens, guess what their natural tendency is, unfortunately, either going to go vegetarian or yeah, oh, it’s the meat that’s so bad for my gods, the meat that’s in my intestinal tract for days and days. It’s rotting in there, you know, yeah, documentaries, I have to cut out the animal products. Well, it’s just a sign that your enzymes and your acids are really poor. And the meat is revealing that now what’s the solution? Now in the meantime, you may want to drop down some of the meat that you’re doing, or some of the protein or fat you’re doing, just to kind of lessen some of the stress off the intestinal tract. But the first thing we’ll do before that is we’ll add in some HCl and some enzymes, maybe even some bile salts, we’ll see how much that starts to correct it. And then if we need then we can drop the animal protein and fat down a little bit if we need. Now, if your intestinal tracts really messed up, you may have to do an elemental or a bone broth faster, or something more liquid based to make it easier on your intestine. So everyone’s a little bit different. And we have a lot of clinical experience about being able to meet someone where they’re at so we can get optimal results.

Evan Brand: Yeah, and it’s sad that the meat gets the blame, you know, and like you said, all these documentaries that will pop up on Netflix, they’re all like, majority, you know, anti meat vegetarian vegan documentaries, and then you kind of have to help clients because sometimes we’ll get clients that have not listened to enough of us where the we haven’t convinced them to get back on me actually had a vegan or ex vegan client come to me last week. She said she was vegan for six years. And she got back on me with the help of listening to our podcasts. And she says she feels better than she ever has, which is amazing. She was able to transition back onto me without necessarily a bunch of supplemental enzymes, but in most cases, yeah, we’re going to come in due to and people may say why why do I need the supplement? Well, we don’t live in a world where you’re sitting on the edge of a cliff overlooking a river valley with no stress. And you know, hunter gatherer average work 18 hours a week. We’re not doing that anymore. We’re working 40 60 hour work weeks. We’ve got kids, we’ve got technology we’ve got Got smartphones taking our attention away, we’re scrolling in Bowling at chipotle looking at our phone while we’re eating, or we’re stressed from bills and mortgages and obligations and whatever and age, by the time you’re age 40 50 60, you’re not making hardly any enzymes and acids compared to when you were younger. So all those factors add up that is the answer of why why do you need enzymes to support you? And how do enzymes help you poop? Well, because when that food is digesting better, your body’s going to be able to get rid of what it doesn’t need. And if you have a lot of malabsorption problems, you know, you may see on digested food in the stool. And over time, I’ve noticed people just adding in a handful of berries a day was all we needed to really clear up their their issues. Once we got all the gut infections enzymes in, you know, infections resolved, enzymes put in if they still needed help, we’ll go into a couple other things you want to get into. But handful of blueberries, I mean, that does a lot.

Dr. Justin Marchegiani: So it just kind of going back to some of the the vegan stuff. So I always tell my patients will in general, ie more non starchy vegetables, most paleo people eat more non starchy vegetables than vegans do. Most vegans I find have lots of processed carbohydrate, they have lots of grains, lots of lentils, or legumes and they don’t typically eat tons of non starchy vegetables, it’s it’s difficult. On the vegan side, most don’t do it right now, if you’re going to be a vegan, you need to do lots of good fats from avocado and coconuts. And you probably need some kind of an amino acid supplement from rice or pea protein or some kind of some kind of an algae kind of protein source because most aren’t doing it right if you’re going to do it that way. But number two is sometimes the vegetables can jack you up to especially if they’re raw, because a lot of that fiber or if the vegetables are higher in fermentable, carbohydrates, some can be like garlic and onions and, and broccoli and asparagus, they can be higher and fodmaps. And fodmaps can be fertilizer for a lot of the SIBO base bacteria. So if you have a lot of bad bacteria that’s producing maybe more methane, and some of those vegetables start to feed some of that methane producing bacteria that may make you more constipated too. So I’ve seen some patients do better more with the meats than with a lot of the plants. So I’ve seen it go both ways. And you know, it’s hard because if you’re let’s say you’re one person, and you had an experience where you went vegan, and you felt great, well guess what, you only have your experience, I see patients that have gone carnivore and felt great. And so because we have this perspective, where we’ve seen dozens of people do great from different things, that allows us to form a unbiased clinical recommendation on what we think is best for the patient, because we’ve seen successes work from both sides. And the question is, we don’t have a dogmatic belief in Oh, well, this is what does it well, this is why it would do it for this person. And this is maybe why it doesn’t for you. And we’re going to we’re going to move the levers around because the goal isn’t to do this thing is to get you the result. So it’s really important that if you’re working with someone, you know, kind of talking to patients that are out there, you want someone you want to work with someone that’s results driven, not process driven, meaning, hey, this, you have to do this diet, this is the most important thing, this should get you the results versus Hey, no, I want to get you these results, we’re going to try pulling some of these levers and see what happens as a result. And then we’ll we’ll go backwards from there. So just really important. You want to make sure you’re working with someone that’s results driven, not necessarily, you know, dogma driven, if you will.

Evan Brand: That’s another great soundbite. You’re just rolling out these things. I love it. This is exactly the point that we needed to hit on. Because in this day and age, unfortunately, everything is kind of a soundbite. So you go to the lectin guy, you’re going to get the lectin diet, you go to the carnivore guy, you get the carnivore diet, you go to the vegan guy, you get the vegan, and you and I don’t really have any labels for us, we’d like you said we were results driven. And so we’re able to be more flexible. I love that we’re not in a box, like these people, because once you write the carnivore book or the lectin book, you’re kind of that guy, and then you’re stuck in that box. And it’s like, oh, wait a second, I’ve got all these other people doing really good with some cooked lightly steamed veggies and blueberries over here. But you told me I need to be carnivore. So what the heck, and then it just blows your credibility. So I yeah, I don’t want to be in a box.

Dr. Justin Marchegiani: Now I tend to lean more on the Paleo template, but I use the word template, not diet, so I can have flexibility. And there’s some patients that I’ve seen that haven’t been able to tolerate any meat, we’ve had to just lean on free form amino acids, with some good vegetables or starches that are easy to handle. And I’ve had to go to that extreme with some patients. And if my dogma was no, you must eat animal products all the time. While I may not have been able to help that Paris person so we try to have the levers that we work with. We kind of have like a foundational bias, but it’s a bias that is flexible and that we can adjust according to the patient.

Evan Brand: Yeah. And eventually I would argue that that person you’re referring to could probably get back in and they may have been able to get back here forever later.

Dr. Justin Marchegiani: Not the case, not a forever thing. It’s kind of a starting point where, hey, you break your ankle, you probably may have to be in a wheelchair out of the gates. And then we progress you to, you know, some crutches and they put you on a boot and then you just maybe Walk slowly, you don’t run and now you start jogging and majesty, right, there’s a progression and how you how certain things heal? Well, it’s the same thing, the four year digestive system that’s not quite as outward, it’s inward, right and how it looks and performs. But you can feel it just the same as an outward injury to your foot or hand.

Evan Brand: Yeah, I’m gonna keep this thing going a little more philosophical than action based for a minute, just to to further this conversation, which is that let’s say someone goes to the bookstore. It’s funny, everything’s changing with society, isn’t it now it’s the Amazon bookstore, the Kindle bookstore, it used to be the real physical brick and mortar, there’s still a need that exists out there. I know there are some. So you go into the store, right, and you go to the diet section, and then someone picks up like, the, like I said, the Paleo book, The lectin book, The carnivore book, they do that, and then they get different or weird results. And then they kind of just give up, and that’s why they get so opposed to the word diet, or they get so opposed to the idea of changing the way they eat to change their symptoms. But the problem is, all these people writing these books are missing all the other root causes. So just because Jane didn’t do well, with a lot of meats, she might give up on meats, like you said, or she saw the documentary and give up on meats, but she never worked with somebody like us. So when we have these clinical tools that we have, where we’re going to be measuring the stool measuring the urine and looking at different infections. If we could just resolve those for Jane, get some of the enzymes back in clear the infections, guess what now she does great with the meat. So it’s sad, because there’s so many people that may have tried stuff like this, but they got so turned off with the non amazing results that they thought it was the diet to blame. But it wasn’t it was just the root causes. And like you said, the indicator is it sort of for us, it’s a clue Oh, that happens when you do meets, that doesn’t mean give it up. That means let’s figure out why. And the H Pylori could be the big one.

Dr. Justin Marchegiani: It’s true. And I call it the vegetarian or vegan honeymoon. A lot of people that do go vegan, they can feel great their first year, it all depends where they’ve come from if they ate a lot of processed food or crappy food. And they’re eating lots of organic vegetables, and maybe some good healthy or plant fats like olives, or avocado or coconut oil. And they’re just getting a lot of organic food in their system, they may feel a lot better now over time is essential fatty acids and amino acids start moving more in the deficient side. And a lot of those fat soluble vitamins like a d k start moving downward, they’ll start having more problems over time. And that’s kind of I call it the vegan honeymoon where they’re kind of chasing that honeymoon. They’re like, I don’t feel as good as I did last year. And they kind of get stuck. And usually it’s a protein, fatty acid kind of issue, or maybe even a carbohydrate issue too much carbs. And then you got to look deeper. So getting back to the constipation part right, we have the six hours that I used to work with my patients. And we kind of start with that as a framework, removing the bad foods, or placing the enzymes and acids to the first two hours. And we adjust the diet accordingly. So it could be cutting out cutting down a lot of the fiber or a lot more cooking or going lower fodmap. or cutting out salicylates or females or going on to a moon, it could be a combination of all of that could be an elemental diet, of course, adding in enzymes and acids. And bio, especially if the stools are floating more, that’s a sign that we’re not breaking down fat, so we may adjust those first two hours. And if we’re having bowel movement issues, I may add in things like ginger, or bitters or D lime any, we may have to even add in some natural things like trifle or magnesium to really get the bowels moving. It just depends. I don’t like to add in bow movers unless I really can’t move the bowels with those first two hours, right. If I can’t move the bowels with those first two hours changing the diet and changing enzymes, acids and bile support, then we may lean on things to kind of get the ball moving. But I always want to see how the body responds before we have to add those things in first.

Evan Brand: Well, you make a great point. And even clinically, the things you would recommend to be used directly for moving the bowels those things are still a hell of a lot safer and more effective than some of the conventional stuff you’re going to get. So I mean, if you go to your conventional doc and they refer you to the GI doc and you’re diagnosed with let’s say IBS, C constipation, IBS type issue, there’s going to be some type of a pharmaceutical involved and there’s likely going to be side effects with that. And once again, it’s not the root cause so in your case like you mentioned clinically, you may not go straight to the magnesium hydroxide to help move the bowels by adding water to the bowels However, there’s so many people deficient in magnesium anyway that you could be actually fixing simultaneously fixing an underlying mineral deficiency plus helping to move the bowels. So the cool thing about what we do, is there a positive side effect so we can kill multiple birds with the same stone?

Dr. Justin Marchegiani: Yes, I’d much rather use a nutrient than like an abrasive herb like Cena or Cascara Sagrada, right? No one has a deficiency of that, but they may have some deficiencies in some of these magnesium so that can be helpful. Now if I get bowels moving out of the gates, usually one or two months in, I’m going to try pulling back on some of these compounds to see if the bowels can move on its own. So it just depends, right? We’re getting the body hydrated, we’re chewing better. We’re working on eating and a non stressful environment, we’re getting enzymes and acids better. We’re cutting out the inflammation. And we may be changing some of the format, the building and the food. So all of those things are moving so many levers. So when I work with patients, patients are like, want to know like, what’s the solution for this? What’s the solution for that? It’s like, I don’t know, I’m going to just give you what I’ve seen to work. And we’re going to do eight or nine or 10 things out of the gates. And we’re going to see what works. But in general, to know exactly which one it is, it’s really hard because you’d have to like make one change, wait a couple of weeks, make one change, wait a couple of weeks. And it would take patients years to get better versus weeks and months. And so we make a whole bunch of changes at once. And then we monitor and we check in on those changes.

Evan Brand: Yeah, good point. So just to give a little more clarity, somebody who’s listening, like what does that even mean? Eight or nine changes. Oh, my God, that’s overwhelming. No, I mean, it could be Hey, look, we’re going to give a little more enzymes and acids, we’re going to pull this food out, we’re going to get you to do a little bit more water and a cleaner water source, we may throw in a little bit of this extra mineral, or maybe a little extra vitamin C, you’re going to do a handful extra of some blueberries, you’re going to make sure you’re getting enough adequate movement because you’re a sedentary job. So we’re going to get you a standing desk. And now you can stand up and move around, we’re going to get you to do a 10 minute walk a day, we’re going to get you to you know, take a couple deep breaths, we’re going to get you to chew your food better, we’re going to make sure that you’re not sitting in, I don’t know a crazy loud restaurant with like, you know, speakers blasting, you know, techno music in the background, we want you to just settle down, we want you to go to bed on time. I mean, yeah, those things give you 5 10 15%. And then by the time you add it all up, you’ve got really good success.

Dr. Justin Marchegiani: Yeah, you’re not chewing your food. I’m sorry, you’re not hydrating when you’re eating right? All these things matter. And maybe getting a little bit more sunlight, right? All these things matter. And so that’s why it’s so hard to be like, well, what’s the solution? for this? It’s like, well, there’s a lot of things that can be a contributing factor, it could be 10%, for this 5% for that 20%. For that it’s very rare that this one thing is at 90 100%. Sometimes you get big, like you just make one simple change. And you the next week you check in with the patient. They’re like, well, I’m 80 or 90% better, it’s like whoa, that’s a home run, that can happen too. But we don’t count on it. And that’s why we do things kind of in a systematic fashion of what’s going to be the low hanging fruit and then we kind of move up from there, right? You got to build up the foundation of the house once the foundation solid, now you can you can build up, the foundation is not solid, then you have a whole bunch of problems that have happened with with the building of the house as you start going up.

Evan Brand: Good point. Good point. And this is the whole reason that we do a workup and we run people through a sort of a system. You call it a system approach. Because if you come in and you go to the doc, hey, I’ve got constipation. Pharmaceutical laxative, see you later. If you come to us constipation, it’s like, Huh, Interesting. Interesting. Okay, let’s figure out why. And if you ask why enough and you do the proper testing, you’re going to get to that why. So I just want to make sure we’re always comparing and contrasting because you ask, you know, Bobby, who hasn’t pooped all week what he’s going to do for his constipation, he might go to Walgreens, he’s going to go to the laxative section. Oh, I found this laxative. This one looks good. Let me drink some of this stuff. Oh, yeah, I poked Problem solved. It’s like, huh, yeah, you solve the constipation problem, but you didn’t solve why that’s happening in the first place. So I just, it shouldn’t have to be revolutionary to think root cause, but it still is not the mainstream. So until it’s the mainstream, our job is not done.

Dr. Justin Marchegiani: Yeah. And so when for most conventional, like gastro people, for instance, they’re just like, hey, motility support, here you go laxative support, here you go. It’s very rare, you may get one that say, hey, let’s do a Siebel breath test, maybe that, and then what after that, maybe they’re gonna just recommend, hey, you know, do this quick little diet thing, because a lot of the conventional fodmap diet still have a lot of grains and other crap in there. So you may not change the inflammation. And they may throw some Rifaximin or neomycin at you, boom. And then now maybe you have a fungal overgrowth or something on the backside, because they don’t do or address the gut bacteria, right? And then that can create other rebound overgrowth down the road. So let’s say you have a very progressive kind of forward thinking gastro Doc, maybe that’s what happens that I just mentioned, but most that’s going to be hey, here’s your motility enhancer. And you know, you got to just learn to relax and meditate and hey, maybe taking antidepressant a lot of time. That’s it. So you’re kind of stuck. And that’s just the insurance space model. When you have three to five minutes with a doc, that’s typically all they’re going to recommend for you. They don’t have enough time to really dive in deeper. And that model doesn’t give them the ability to dive in deeper. So you really need to see a functional medicine doctor to really have the ability to go deeper and get to the root cause.

Evan Brand: Yeah, I get so frustrated with that term, integrative it just makes me angry because I’ve had so many people and I know you have to hundreds and hundreds and hundreds of clients and patients that have said I’ve worked with this angle. Right of guy, Mike Oh, integrative What did he do? And you know, they kind of market it as it’s like so forward thinking, but like you said, it may be the Rifaximin at most. And then guess what a lot of these people they have antibiotic resistant infection. So we’ll test them and guess what the SIBO situation is still going on. Maybe they have parasites or like you said, there’s a fungal overgrowth component to it as well, their guts leaky, their guts inflamed. Now they’ve got all sorts of other problems as a side effect of hitting this Rifaximin. In some cases, it can help maybe play whack a mole a little, it may knock some things down, but they still have enough problem when they come to us that we need further work. So I get frustrated with this integrative idea. Because and I know there’s good intention behind it. But as you mentioned, with that model, the way the model exists, it doesn’t doesn’t allow enough time and there’s not enough advanced testing, like we’re doing to to fully get to the bottom of it

Dr. Justin Marchegiani: Correct. And once you kind of talk to your conventional medical doctor, and you say, hey, walk me through your thinking on what you think the root cause of this could be. Usually it kind of reveals their that they really don’t know. Because if you’re just providing a drug to treat the symptoms, well, obviously, they’re not worried about the root cause because it’s Band Aid down below, right? So we kind of look at everything in my line, kind of as the SSS approach, right? You have the underlying stressors here, could be physical stress, chemical stress, emotional stress, food allergies, bacterial overgrowth, sibo, right, all of these stressors, increase our stress bucket, and then the body systems start to dysfunction, hormones, digestion, immune detoxification, as the system starts to dysfunction, then you have all this, the symptoms happen down below. And so conventional medicine just band aids, these symptoms down below, they don’t ever go upstream. So you got to have conversations with your doctors that talk more about the upstream issues. And so we try to nullify all of the underlying stressors, make sure foods good chewings, good, hydrations. Good. And then we’re going to do tests that look at the function of the systems. So it’s a lot different of approach. So if you’re working with someone, you know, you want to be able to ask the right questions, what do you think the underlying root causes are, and as a patient, make sure you walk into it with an open mind that there’s probably not one underlying issue, it’s probably a bunch of things that are spread out, that are part of the underlying cause, from a stress standpoint, and the body system standpoint that are emanating the symptoms downstream?

Evan Brand: Yeah, well said Well said, that’s a great, great visualization, and you have permission to have 4 5 6 7 8 9 10 things going on.

Dr. Justin Marchegiani: That’s the key, that’s that that’s the missing assumption, you could have a lot of different things. And then as you walk through with the clinician, and you’re making changes, you need to not go into it as Oh, I made this diet change and the supplement, I don’t feel better yet. It’s okay. There’s always a plan B, a Plan C, a plan D, a plan E. And if the answers down here, and E and F and you, you quit and get discouraged that B and C, then you never get a chance to kind of go deeper. So just as patients are listening here, always make sure you have that ability to kind of just like, have a good attitude and keep on progressing down the line.

Evan Brand: Yeah, and you can’t blame them on me. This is the way that people have been conditioned over decades and decades of conventional medicine, but it still does frustrate me when someone will approach us whether it’s a friend or a family member or something and they’ll say, Hey, you know, I’ve got autoimmune. I’ve got sjogrens or I’ve got alopecia or I’ve got, you know, diabetes type two. What’s wrong with me? Like, why did this happen? Where did this come from? It’s like, Where do I even start? You stay up till 1am? You posted a picture the other day on your Facebook page? Have you eating an ice cream Sunday? Yeah, never get exercise. I know what you do. You sit all day, you don’t get outside and you’ve never had a tan in your life. So you’re afraid of the sun. If you do go outside, you lather yourself in sunscreen chemicals. You don’t eat organic, you’re super stressed. I mean, you know, so when people ask, well, what’s wrong? Why is this happening? It’s almost like, Oh, are you ready for this? Because I’m about to open up Pandora’s box here. And I’m going to tell you 20 things of what’s happening, I’m gonna tell you 30 things of why this has happened to you. So it’s just a reeducation really, of telling people look, it’s there’s not a one smoking gun, rarely to you and I find one smoking gun.

Dr. Justin Marchegiani: Yep, I 100% agree. It’s nice every now and then where you kind of get a home run and functional medicine, when you kind of make a couple of changes. And it’s like boom, and you blast it out of the park. It’s always a good luck little ego check. Because you know, you work with a lot of difficult patients over over time. And so it’s nice to get a couple of home runs every now and then. But if you work with a good clinician that has the right algorithm and kind of goes through the things goes to the options that give you the greatest chance of success out of the gates, and then work to the things that give you the less success at the end, then you have the greatest chance of success as a patient early on. And you set the foundation for greater healing over time. So I think that’s really the most important mindset is clinically go with the high percenter options.

Evan Brand: Yeah, and I’m not being a bully here. And I’m not making First of these people, I’m just saying, we really need to re education. You know, you you people eventually come out of the woodwork at at you when you and I do what we do and they’re not ready for the red pill. They’re not you know, they’ll ask what’s wrong me? Why do I have diabetes? Or why do I have this headache? It’s like, ah, are you ready? Are you ready? Because there’s there’s a lot to uncover. There’s a lot to unpack.

Dr. Justin Marchegiani: Yeah, I think most people once they’ve kind of gone through the conventional medicine model, and they’ve kind of said, Hey, all right, well, I just don’t want to be relying on laxatives or enemas my whole life. What’s next? Usually, once there’s, they kind of have this level of like, okay, these are the only options I have from conventional medicine. There’s a level of openness that occurs from that, where they’re like, Alright, what’s next? What’s next? I’d see functional medicine and nutrition is helping people all the time, what’s next outside of this because they just kind of have this yearning that there’s got to be something more. And I think that’s creates a level of openness and readiness to. 

Evan Brand: Good point. Good point. Yeah. I often say people have to hit rock bottom or they have to be miserable enough to listen, I mean, you and I’ve heard countless stories of husbands and wives that are stubborn and they want to eat the pizza while the other spouse has to eat the grass fed steak and sweet potato that grass fed steak sweet potato tastes better anyway. So I don’t know what they’re doing. But But anyway, they’ve got to have their own issue right? And then finally, once the other person once they get miserable enough, then finally they’re they’re willing and you don’t have to drag them into this whole thing as much.

Dr. Justin Marchegiani: No, I totally agree. Well, if you guys are listening, and you enjoy the podcast here, put your comments down below. Really appreciate the thumbs up and a share. We also reviews are great JustinHealth.com/iTunes, EvanBrand.com/iTunes. It’s great. If you feel free to head over to EvanBrand.com you can schedule an appointment with Evan anywhere in the world. Vice versa with myself Dr. J at JustinHealth.com. We’re here to help y’all. And I appreciate you guys listening and just feel free to share this content with some friends or family that can benefit. Again, we’re clinicians that have had 10s of thousands of patients experience kind of combined, and we want to provide actionable information with y’all so you can take action and get your health back in your hands. So we really appreciate you guys being listeners and attending. 

Evan Brand: Take great care yourself. We’ll be back next week. 

Dr. Justin Marchegiani: Thanks.


References:

https://www.evanbrand.com/

https://justinhealth.com/

Audio Podcast:

https://justinhealth.libsyn.com/the-root-causes-of-constipation-slow-motility-podcast-331

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