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. 

The Top 5 Causes of Bloating | Podcast #364

Abdominal bloating occurs when the gastrointestinal (GI) tract is filled with air or gas. Most people describe bloating as feeling full, tight, or swollen abdomen. Your abdomen may also be swollen (distended), hard, and painful.

Dr. J and Evan describe that gas is the most common cause of bloating, especially after eating. Gas builds up in the digestive tract when undigested food gets broken down or when you swallow air. Everyone swallows air when they eat or drink.

On the other hand, they also talk about different components of why you may be having to bloat that you may not notice. Plus, available testing and lifestyle modifications you need.

Dr. Justin Marchegiani

In this episode, we cover:

1:57  – The role of acid-pH level in the digestive system
5:01  – The link of depression and anxiety to bloating
10:02 – The benefits of probiotics and effects of stress to digestive health
18:17 – Functional medicine strategies and testing to find the root cause of bloating

Dr. Justin Marchegiani: Really excited to have a podcast today. We’re gonna be diving into a couple of different topics. The big one here is gonna be bloating – one of the big root causes of bloating. We’re gonna talk about it from a biochemical functional medicine perspective. Evan, how are you doing man? What’s going on brother? 

Evan Brand: Doing pretty well, excited to dive in and talk about gut infections. I think that’s probably the first place to start because you and I have run thousands of urinary organic acids and genetic stool tests over the years. And years ago, you know, we used to use a three-day stool test. Now, with technology improvements, we could do a one-day one sample stool test and we can uncover so much. So, I’ll just kind of riff on things. I know we like to title things just for marketing purposes and call it top five but we may go into 15 by the time we’re done because just right off the top of my head here, high gut inflammation like how calprotectin may be an issue, low pancreatic enzyme function, bacterial overgrowth, where we’re gonna measure the dysbiosis, H. pylori infections, parasites, worms, specifically Clostridia and Candida can cause a lot of issues with bloating. So, in general, I would just say any gut infection but we can break that down as much as you want to. It could be a huge cause of bloating. And, the problem is this, when you go to a conventional medical doctor or a gastroenterologist and you get some sort of bloating remedy or some sort of digestive aid, maybe an acid blocker, antispasmodic medication. Obviously, these are not addressing these infections. You could take acid blockers for the rest of your life and never clear the H. pylori that’s driving the low stomach acid which then drives the fermentation in the gut which then drives the bloating. So, I just want people to have in their heads a clear mindset of what are you taking, is it actually fixing the problem, are you just masking your symptoms. And in the case of an acid blocker, you’re actually putting yourself deeper in the hole because you’re taking low stomach acid that’s driving heartburn or an infection and you’re making it worse. 

Dr. Justin Marchegiani: 100%. So, you know, the first catalyst for good digestion is a nice low pH. That good acid pH, we need good hydrochloric acid to make that happen. So, we need essentially hydrogen ions to bind to chloride in our gut and so we need chloride from minerals. So, we need good minerals, good quality sea salt that helps make stomach acid on our own. Now, if we’re under a lot of stress and our adrenal glands are in stress overdrive, it could be cortisol high or low imbalances, as well as adrenaline issues, right? It could be high or low cortisol stress issues that could put us in a fight or flight state and that sympathetic nervous system stimulus is gonna negatively impact our body’s ability to start with making stomach acid and digestive secretions and of course that stomach acid is almost like an antimicrobial. Think of like using lemon or apple cider vinegar is a natural cleaner right. They recommend these online. You can make natural cleaners usually some kind of acid as the foundation of the formula because acids are antimicrobial and so think of acids in your intestinal tract as being antimicrobial. They also, some kind of help tighten the sphincter, the esophageal sphincter from the stomach into the esophagus. It gets tightened with good acidity and so part of the reason why we get bloating and a lot of these gases rise up to the esophagus is inadequate levels of acidity and that keeps the esophagus open and then what happens when that esophagus is open over time, the fermentation acids that occur can actually, eventually irritate the bottom of the esophagus because we didn’t have enough acids to trigger that good closure in the beginning. 

Evan Brand: Yeah. Yeah. So, then you’ll get these, what are called silent reflux issues sometimes it’s called GERD. And once again, prescription drugs are what’s the common remedy but once again it’s not the root cause. It may reduce the symptoms because if you have that backwash it’s gonna help slow the backwash down but it’s not gonna fix the sphincter so we might come in with extra betaine hydrochloric acid or if you’re extremely inflamed which is that someone can’t tolerate a low dose of it but then we could do something like apple cider vinegar with a meal sometimes bitters. I personally don’t do bitters, I just do HCl and enzymes. 

Dr. Justin Marchegiani: Yeah. We can always test it with ginger. We can always test it with an acid like lemon, lime, or apple cider vinegar, start with a teaspoon of that and mix in a couple ounces of water and then kind of work our way up from there. So, acidity is a really important first step. Of course, if we have inefficient, um, inefficient acidity levels we can almost guarantee, we’re probably gonna have poor enzyme levels and probably gonna have poor bile acid levels, right? Bile acids are important because they help break down fat and bile acids are also slightly acidic, right, in the name of bile acid and it’s also antimicrobial. So, just like we talked about the acids having an antimicrobial benefit on the HCl side, also, bile acids have an antimicrobial benefit. We see in SIBO, a hallmark of SIBO is bile aids insufficiency and so with SIBO we don’t have enough acids there on the bile side so then we have a hard time breaking down fat and then a lot of times that fat will create indigestion, petrification because it’s not being broken down. Now, when we run certain stool tests, we’ll see increases in a metabolite called steatocrit, which is a breakdown of the fat that means it’s not being broken down in the stomach. It’s coming out at higher levels which means we’re not breaking it down. So, steatocrit is a big deal because steatocrit, if we don’t have good fat digestion, we probably have some protein digestion issues, we probably have some enzyme and acid issues and we probably have, um, some gas issues, bloating issues because these things require good digestion and if they’re not being broken down well, we’re probably getting some methane or hydrogen gases kind of rising up from that.

Evan Brand: And you know, we’re taking on the subject of bloating but it’s very common that someone with these issues you’re describing, they’re also gonna have issues with energy and probably mood like anxiety and depression because you’re mentioning this issue with fat digestion, protein digestion. Now, you’re not gonna get the aminos that you need to fuel your neurotransmitter so it’s very rare that somebody’s gonna come to us and say, hey I’m just bloated and I have nothing else. Usually, along with that bloating, you’re gonna have these tangential symptoms too like anxiety, depression, fatigue, and so I encourage people, you can focus on one smoking gun like bloating as your big thing you’re coming in for but you gonna make sure you understand there’s a bigger, deeper connection to your mood issues too. So, this is the person who’s on break, uh, someone just commented about severe brain fog. We could hit that too, uh, but somebody might come in and say, hey I’m bloated and then you tease apart their case and you go, oh so you’re actually anxious too. You’re on antidepressant and an acid blocker and this happens every day, all day. So, just to clarify, number one, we hit a low stomach or we hit infections first. Number 2, low stomach acidity, you mentioned low bile in the gallbladder. Also, let’s give a shout out to people that don’t have a gallbladder, what about these poor people, they’re gonna need a lot of supplemental help for the rest of their life. And so, unfortunately, this is a very very common procedure done in the U.S., where the gallbladders are removed and so these people are gonna need some purified bile salts forever in my opinion. Well, what’s your…?

Dr. Justin Marchegiani: Absolutely! They’re definitely gonna need bile salts and some extra enzymes like lipase but again, you gotta get to the reason why that gallbladder issue even happened. Now, most people, it’s women in their 40s who have an overweight issue and so what tends to be driving, that is usually food allergens whether it’s grains or inflammatory foods but also estrogen dominance. So, if you have an imbalance in estrogen, estrogen is gonna help promote more fat storage so you obviously have more estrogen more fat storage. A lot of times you’re gonna have PMS issues too so you may be moody, irritable, um, sleep issues, uh, you could have fibrocystic issues, uh, tenderness, a lot of pain around PMS time. So, you gotta get to the root cause of that as well. So, we started out with just bloating but you can see how then this estrogen issue can affect bile levels and good bile flow because estrogen causes everything to get really stagnant and not flow well and then you’ll start having mood issues and PMS issues and maybe even fertility issues. So, you can see how you start at one point which is bloating, which is the topic of the video but then it can spiral down this other kind of tangential pathway.   

Evan Brand: Yeah. Not to mention two, let’s just say it started out with heartburn, I just want people to kind of visualize this. So, let’s say it starts out with heartburn. You go to the target and you buy Prilosec, which is over the counter acid blocker medication, you reduce your stomach acid even more but you feel some relief from the heartburn and let’s say your spouse had H. pylori, you guys pass that between each other, so now you’ve got even more reduction of stomach acid levels, you’re on the acid blocking medication. Now, you’re anxious, you’re starting to get depressed, you’re getting a bit of fatigue. As you mentioned, now, you’re getting some hormonal issues, some hormonal issues like breast tenderness or PMS or ill ability, you’ve got this dysbiosis growing in your gut so you have this bacterial infection. It could be multiple things, Strep, Staph, Klebsiella, Pseudomonas, Bordetella. And now, you’ve got beta-glucuronidase issues. Now, you’re recirculating all this estrogen. You’re creating more problems with the gallbladder. Maybe, you get the gallbladder removed. Now, you’re in really big trouble then that leads to the diet so then you read some guy on the internet who says, you need to be doing 70 – 80% vegetables. So now, you’re doing all these veggies and you’re even more bloated and you’re even more gassy and you don’t know why. So, you’re eating broccoli, you’re trying to force all these leafy greens down, a lot of vegetables. Maybe, you’re doing a lot of avocados, these higher FODMAP foods that are fermenting in the gut. This is the case where you’ve got a really, to me, the best, most beneficial thing I’ve seen for these cases, get the diet very simple, focus on good quality animal proteins and for a time being minimize your vegetables so that you can let the gut rest. 

Dr. Justin Marchegiani: Yeah. Absolutely. From a solution standpoint, yeah, good proteins, good fats and then if we’re gonna do vegetables, make sure they’re cooked steamed, sauteed, maybe use an instant pot and try to make sure they’re on the lower fermentable side. Now, that being said, next, what’s another driving factor of bloating? increase in fermentable vegetables. Now, people are hearing all kinds of things about probiotics being helpful. Well, they are. There’s a lot of good benefits to probiotics and the microbiome and the endogenous nutrients they produce. They, um, whether it’s vitamin K2, whether it’s different B vitamins, really helpful. It also produces acidity which helps keep a lot of bugs and bacteria from growing in the gut, totally helpful. Now, if you already have a lot of bacterial overgrowth and bad bugs growing, sometimes, these extra good bacteria can actually cause more bloating, more gas. And then, of course, because they’re fermentable they can also create histamine too. So, the histamine may create more brain fog or headaches, more destruction there. So, you may have more histamine symptoms, you may have motility issues because they’re producing hydrogen methane gases maybe and that may cause either diarrhea on one side or maybe more constipation on the other side, definitely possible. 

Evan Brand: Yeah. Yeah. Good call on the histamine. And so, some of these bacteria on your gut, they’re gonna be releasing histamine too. So, if you’re combining high histamine foods, you’re doing leftovers, let’s say, last night, you made a steak, you’re cooking that leftover protein. That’s gonna be higher in histamine. Combined with the histamine being produced from this bacterial overgrowth problem, yeah, you mentioned brain fog, skin flushing, rashes. So, once again, here we are talking about bloating but we’re trying to elucidate this big spider web of other symptoms that may be going on.   

Dr. Justin Marchegiani: Correct.

Evan Brand: Um, also, what about a stress component meaning someone just simply not chewing enough, they’re rushing through their meals. I think this from a mechanical perspective. If you look at your average person, I mean I saw somebody on the highway the other day, I don’t know if it was a donut, a piece of pizza, it was some kind of junk. I couldn’t tell exactly what it was but either way there’s still people trying to do makeup, scrolling on their smartphone, eating a piece of pizza, all while driving on the highway at the same time and we wonder why they have digestive problems. So, maybe we talk about the impact of not being settled when you are eating and this sort of like, this parasympathetic process that digestion is supposed to be our ancestors, they didn’t have that level of stimulation while they were trying to eat. I mean, maybe there was a wolf trying to come, get their bison killed but beyond that there wasn’t this big sympathetic stress underneath all of our meal times.   

Dr. Justin Marchegiani: Yeah. We kind of started out the video talking about the parasympathetic-sympathetic balance and how important that is because the parasympathetic is part of that rest and digest that gets the digestive secretion going. It stimulates all the blood flow into the organs, the intestines. So, of course, setting really good boundaries for your meal, you know, I recommend kind of kind of go into a meal five times or ten minutes, just kind of relax, do some deep breathing, have some appreciate, appreciation about your day, the food in front of you, you know, just whatever blessings you have in your life, just try to really get to that parasympathetic state with just good breathing in the nose, right, four to five nasal breaths in and out. Focus on whatever’s good in your life, appreciation. Whatever you have to do, whatever kind of resonating prayer to put you in that state when you just feel better and then go into that meal keep it quiet or if you want to listen to something that kind of allows you to feel good and feel rested or relaxed, that’s fine. And then, go into that meal and make sure you chew your food really well. Try to avoid a lot of hydration with the food, you know, a couple of ounces of water for swallowing some pills or digestive support is fine but try to get into that meal, like, I just had to have a good routine. Get some good hydration ahead of time, try to go into some kind of meditation or prayer for five or ten minutes ahead of time to really get that parasympathetics going and then go into your meal and really just try to chew things up pretty well too, you know, about 30 chews per bite of food on the average, kind of get your food chewed up to about an oatmeal like consistency so it’s really broken down well that’s allow the enzymes and the acids to work a lot better too. 

Evan Brand: Yeah. You know, what’s interesting is a lot of people are kind of pressure into these business meetings like with their boss or with their co-workers, there’s this like work-meeting-lunch deal where people are going out with people they probably wouldn’t associate with outside of the workplace and they’re going and eating with those people. And so, I would just tell you, if you don’t like it and that’s not your vibe, don’t do it. If you feel more comfortable, more relaxed eating by yourself, don’t do it. I mean, I remember, l had some stressful conversations over lunch and dinner tables before with people over the years and I leave feeling like I didn’t eat anything and that my mind was so focused on even if it wasn’t a negative conversation. If it was on some sort of business deal or the state of the world or something and then I’m eating. I would get up from the table. I’m like, oh crap, did I eat and I didn’t process that and it would sound maybe like unnecessary advice but I think a lot of people need to be picky of what they talk about it at the dinner table.

Dr. Justin Marchegiani: Yeah. I think anything that’s gonna keep you in that parasympathetic state is great, you know, save the more stressful things before or after and I think, also, just have good boundaries. Try to make sure you get at least 20 minutes for a meal, um, to yourself, you know, I mean, if you don’t have 20, if you can’t put 20 minutes in your schedule for you to consume some good food and put yourself in that parasympathetic state then you got some boundary issues and you got to really work on roping in your schedule and getting some control over it, at least so you have that 15-20 minute to yourself and you can really process that food well. And again, I’m not saying there won’t be some exceptions or some stressful days here or there but on average try to make sure 80 to 90% of the time, you really have control over your schedule to that degree. 

Evan Brand: One of my favorite things to do even in the wintertime here, if I’ve got blue skies. I’m taking my shirt off, I’m going to sit on my front porch where I’ve got a nice comfy front porch patio chair and that chai is warmed up by the sun so I just take my shirt off sit there barefoot and in the chair and eat my bison burger for lunch and the sunlight is a mast cell stabilizer so I noticed the sun helps me if I have any kind of food reactions, the sun will stabilize that, obviously there’s nitric oxide benefits. There’s likely some nervous system benefits circadian rhythm benefits. So, for me, if you can get fresh air on your lunch that’s great and what the heck does sunshine have to do with bloating, well, I mean there’s even some studies on sunlight improving the diversity of your gut and we’re outside all the time now. So, if you just type in like sunlight microbiome, you can read the papers on this, it’s in a microbiology journal about how exposure to the UV rays can improve the gut diversity so it’s no surprise that all these people in offices buildings all day, they got poor diversity. Obviously from other things but lack of sunshine is a negative factor for your gut health. 

Dr. Justin Marchegiani: Yep. Yeah. Absolutely. I mean, also, there’s other bugs that are out there I think we already kind of talked about H. pylori because that can affect the stomach and that can decrease, um, acid production and thus when acid production is down, we know enzyme production is also down and then that can also affect biliary function, biofunction, so we know H. pylori is a big thing. Other bugs can be problematic, right? We already mentioned SIBO, which could be a whole bunch of different bacteria that are overgrown in the small intestine that could be Citrobacter, Prevotella, Klebsiella, Pseudomonas, Morganella, right? It doesn’t really matter the actual bugs but if there’s an overgrowth there, they can definitely disrupt digestion creating different gases on the methane and hydrogen side and that can create obviously more bloat. Other parasites can cause problems too. So, we see things like Blasto, Blastocystis hominis, right? E. histo, D. fragilis, Giardia, Cryptosporidia, these are all other bugs that could be problematic. Then even things like fungal overgrowth like Candida overgrowth, whether it’s a Rhodotorula species, Albican species, these types of imbalances can cause problems. So, it’s good to test and really make sure that we look at the whole microbiome and see what’s out of balance or not and then from there food wise, I mean, of course, general refined sugar, refined grains, right? These processed foods, excess fiber, lots of raw vegetables, uh, fermentable carbohydrates, right? These things are gonna be on the list, as well. And so, we’ll kind of add those. There are a lot of different things that we have to look at so I kind of gave you the top five or six on this list. Anything else, um, Evan, you wanna add to it?

Evan Brand: Well, I would just say that if you’re coming into this conversation, you’re listening, maybe you don’t have much background and listening to people like you and I talk about functional medicine strategy. Some of this may just go right over your head. You may just tune out because you’re hearing these things which sound exotic and they sound rare, like H. pylori. I don’t have that. Giardia, what the heck is that? Blasto, though I don’t have that. You know, I just have bloating. The reality is these are very common things. The problem is the testing that’s used in the conventional gastroenterology world is very outdated and very insensitive, meaning there’s a lot of infections that go missed and even if these infections are tested for, it’s not likely that you’re gonna find an accurate result. And so, what we’re talking about, these are not rare situations, you and I, between us both, we’ve seen several thousand clients and patients across the world over the last decade and we can tell you that these issues are something we see every day, all day. So much so that in fact when I see a whole big list of infections on the stool test, I don’t get shocked by it. Yep. Uh-huh. That’s it. That’s what we’ve got. So, if you’re listening to this, you’re like, ‘man, that’s not me. I’m just bloated and tired.’ Well, there’s a reason for that. And so, I highly recommend you get tested, figure out what the heck you got, going on because if you’re not testing, you’re guessing and if you’re going and taking probiotics or random enzymes and you don’t feel better or you’re confused about what you should actually taking and not taking and you’re building up a supplement graveyard. It’s time for you to get tested and figure out what the heck you’re up against. And so, if you need help, you can reach out clinically, Dr. J is at justinhealth.com. you can reach out and do consults worldwide. So, we jump on a video call just like we’re doing here, Zoom, facetime, skype, we can look at your labs that you run at home and we can figure out what’s going on and make you – a game plan to get better. And if you need help for me, it’s Evan, evanbrand.com and either one of us, Dr. J, justinhealth.com, evanbrand.com, we’re here to help you and the cool thing is you can reverse these issues and you can get to a point where you don’t even recognize your gut health. I mean, if I look back at myself even 10 years ago, I had such severe IBS. I did every diet under the sun and I made some progress but it wasn’t until I looked at my gut that I really made the magic happen. 

Dr. Justin Marchegiani: 100%. And so, just to kind of highlight a couple of things out of the gates, um, we’ll put some links below as well to some of the lab tests that we recommend, whether it’s the stool testing, whether it’s the organic acid testing which does look at bacterial and yeast metabolites. I love the organic acid because it’s very good at picking up Candida and yeast overgrowth, where a lot of times those tool testing will miss that and of course the, um, breath test will not touch any yeast overgrowth. So, it’s nice to have whether it’s stool test, whether it’s the GI map, whether it’s an organic acid, whether it’s a conventional lactulose, breath test, these are all good tests. We’ll put links down below. So, if you guys want to look at getting some of those to start out at the gates, you feel free, you can. Also, I like to compare and contrast like what we do versus the conventional gastroenterologist. So, most gastro docs, they’re just trying to rule out significant pathology, significant disease and so they may cross off the list by doing some kind of an endoscopy, which is camera down the mouth to look at inflammation in the stomach or esophagus and if they see esophagitis or gastritis, you know, what they’re going to do, they’re gonna recommend some type of PPI or Gaviscon or some type of a coding agent to kind of help reduce the inflammation but they’re not gonna really fix the root cause. Most of the time, they pull you off acids, which may be helpful in the short run but it’s forever altering your ability to break down protein or fat and it also can shift your bugs in a negative direction because now you don’t have the good acidity to keep the microbes down. You need the acidity to activate enzymes, you need the acidity to activate your bile salts. So, someone’s jumping in on the questions here saying that hey they feel better on keto but now they’re feeling more constipated. Yeah, super common because what’s happening is you’re cutting out a lot of the foods that are causing problems but you haven’t fixed your digestion, you don’t have enough acidity, enzymes, bile, there may be some bugs that are still impacting digestion and this is why being on good proteins and fats can be helpful but they also reveal weak links in your digestive chain if you’re not breaking down food well. So, just kind of getting back on the gastro doc kind of bandwagon, they’re gonna be looking at pathology inflammation in the stomach, you know, ruling out the big things like blood, um, in the ulceration in the stomach, you know, usually you’re gonna know that because you’re coughing it up but you’re seeing it in your stool. If you have irritable bowel disease symptoms like Crohn’s or ulcerative colitis, usually, you’re gonna have significant inflammation in the stomach, usually significant diarrhea, blood in the stool, they’re gonna rule that out and then what and then for the most part, once the big pathology things, ulcerations, cancer, massive amounts of inflammation are ruled out, they’re gonna typically give you like IBS diagnosis, whether it’s IBS-D for diarrhea or IBS-C for constipation and they’re gonna just manage whatever symptoms whether those symptoms are with different drugs. So, if it’s constipation, they’ll use laxatives. If it’s diarrhea, they’ll use things like Imodium or Pepto Bismol or anti-inflammatories. They’ll just modulate the symptoms with drugs and that’s it and they’re not gonna really get to the root cause. They’re gonna just try to spot the treat and then that’s where people come to us because overtime, those drugs will become less and less effective, you have more and more side effects, you’re not fixing digestion, you’re creating more nutritional deficiencies, maybe more gut permeability issues, maybe more autoimmune stuff and so these patients then come to us because they’re just tired of putting band-aids over band-aids. 

Evan Brand: Yeah. Well said. I forgot to mention the endoscopic procedure that is super common, uh, they wanted to do that on me, years ago, when I had IBS and I denied that because I even back then I had read about these infections that people were acquiring from getting scoped meaning the last person that they put the tube down, they didn’t properly clean or sanitize that so then they stick it down your throat and then you leave the hospital just to investigate and as you said, the only thing that’s gonna come out to that is they may say gastritis which is super generic. It doesn’t tell you anything about these infections and they’re not gonna give you an herbal protocol to address the infection causing the gastritis. But now, you’ve left the hospital with Clostridia or some other possibly antibiotic resistant infection that’s involved to evade the sterilizing and cleaning procedures. So, I’m all about non-invasive, accurate, functional medicine testing and that’s why we love what we do because there’s a very rare, maybe one every five years, yeah, is there a case where I’m like yeah, you need an endoscopy because there’s something crazy here.  

Dr. Justin Marchegiani: Yeah. Usually, with an endoscopy or colonoscopy which is gonna be going up the rectum to look in the colon. Usually, there’s gonna be blood in the stool, some type of significant inflammation, whether it’s excessive diarrhea, excessive inflammation, excessive blood in the stool, excessive weight loss. It has to be at the extreme ends for that to make sense. Most people just have inflammation and a lot of times the tests won’t kind of tell you enough about the root cause, they’re just gonna put you on medications to manage the symptoms and that’s where you’re kind of stuck in between. Now, a lot of my ulcerative colitis, IBD patients, they’ve already done that. Yeah, so then, it’s like all right, they’ve kind of already crossed that off their list any weird cancers, ulcers, it’s already done, they know, they’re just being managed with Lialda, Prednisone, a biologic and then it’s like, now what, right? And so, we still have to get to the root cause of that and get the immune system chilled out and figure out what stressors are there so we can get on top of that too.     

Evan Brand: Yeah. I mean, I know you and I have seen countless emails being sent to us with pictures of colons and you know different things from these scopes like hey there’s my scope results, you know, what do you have to say about it and the answer is always the same. Okay, there’s something there, let’s work on the infections. And so, uh, yeah, someone in the chat, uh, shelly said, yes that they all recommended me, every time, I go to the doctor. So, yeah, that, I mean that’s all they’ve got, they don’t have the stuff that we’re using maybe in 20 years from now you can go right down the street and get done what we’re talking about but for now you’ve got to seek out somebody like us that’s gonna be able to help you, uh, there’s one person in the chat too asking about a viral impact on the gut, it’s real. I did a whole section of that in my better belly course about that virus in the gut and so it’s definitely a big factor.   

Dr. Justin Marchegiani: Yeah, and just to kind of, uh, speak, kind of on the line here, so, um, we can, we don’t get censored, there’s certain viruses that are out there, right? There’s an ACE2 receptor site that gets impacted in these different viruses and the ACE2 receptor site, there are a lot of them in the gut and these receptor sites are really important for absorbing amino acids and so if you have any of these maybe chronic viral issues, one of the good things that you can do is actually extra free form amino acids to allow these receptor sites to absorb these amino acids easier, right? I think the free-form amino acids are already broken down. So, if you have this chronic immune stress and you’re having a hard time recovering from the immune stress adding in some additional free form amino acids can be very, very helpful on the healing side.  

Evan Brand: Yeah. I’ve seen a lot and there’s papers on this too but I’ve seen it clinically too. People post viruses that will look at their stool, there’s gut inflammation, there’s low secretory IgA, so we can see there’s been some damage and so we have been able to resolve it. So, yeah, we’ll wrap this thing up but if you al need help, please reach out clinically, we mention the websites one more time, Dr. J, that’s justinhealth.com, me evanbrand.com and we’re here to help you guys, so you can reach out and we’ll get to the bottom of this. 

Dr. Justin Marchegiani: And sometimes, we’ll even use some kind of an elemental diet with people that have chronic digestive issues just  because it can be hard, breaking protein and fat down and these are really good, important nutrients but sometimes we just got to break it down for them and using some kind of an elemental or a modified elemental, where maybe you make the first four to six hours of the day, really easy to process in some kind of smoothie or shake that has most of the amino acids in free form, maybe the fats more easy to process like in an MCT oil or something like that and then we use a lot of the vitamins and minerals all broken down. That could be very helpful and give the digestive system a chance to rest and some people they notice this because they just feel really good when they fast and so if you fast and you feel really good that’s excellent but you’re still not fixing the problem of getting nutrients in the system so that’s where using some kind of an elemental type of shake can be really helpful. 

Evan Brand: Yeah. Well said. Well, I’m done. I feel like we’ve covered a lot of good stuff here. 

Dr. Justin Marchegiani: Excellent. Yeah. I mean someone asked one question about flour substitutes. It just depends on where someone’s at, so flour, it’s a processed food so out of the gates, if someone wants, um, like a starch, um, I recommend maybe a greener banana, maybe yucca, cassava, maybe a Kabocha, spaghetti squash. Just look at some of the fibers, uh, non-starch, I should say, more starchy carbohydrates that are gonna be grain-free, see how you do with that. And then, if you want an actual flour, you can look at it like an arrowroot or you can look at it like a cassava is pretty good because it’s still grain-free but it’s still gonna be on the processed side. So, ideally, try to keep it grain-free so you don’t have extra gluten sensitivity connection with those.   

Evan Brand: Yeah. Definitely. That’s what I was gonna say too. Potatoes, rice, a lot of these things can still create problems for people. I’ve had many people feel like crap on some of these gluten-free breads. So, yeah, it’s still processed garbage in my opinion. 

Dr. Justin Marchegiani: Yeah. And then, someone wrote in about the, um, the onions there. Onions are very high in FODMAPs and that can be a problem and so if you head, your gut feeling a lot better and you can come back in and you’re noticing FODMAPs are creeping into your diet and causing a lot more bleeding definitely kind of, you know, rain that back in and see how much that back in and see how much that kind of brings you back to homeostasis. 

Evan Brand: Yeah. This person told, uh, they said that they’ve had similar issues with cabbage, brussels sprouts, and other similar veggies. So, yeah, I mean I would go more animal-based. See how you feel with just some meat and some berries for a little while. Maybe if you tolerate a little bit of some organic pecans, if you want to do a little bit of nuts but do like a bison burger and a handful of blueberries for lunch and see if you feel better. I suspect you will. 

Dr. Justin Marchegiani: Yeah. At least, just try, you know, cutting out the higher FODMAP foods because when you address microbes, right? You starve it on one side with restricting certain foods that can feed it, you can kill it with certain herbals and then you crowd it out with probiotics. And so, sometimes, we have to go back to the killing side and kill the microbes out a little bit more but I always just see how much the starving kind of works. Get the starving going again and then if you have to kind of return to a protocol, where we knock down the microbes with herbs, we can always do that too. 

Evan Brand: Yeah, and we’ve made these protocols a lot. It’s really fun to combine and mix and match and get the synergistic effect of this herb plus that herb. I mean, that’s where the magic really happens and there is an art to this too like you said when to cycle things on when to cycle them off, so there’s not just this one cookie cutter thing that you have to do. You really got to just work with the person. Certain herbs are used for certain parasites, certain ones we use for bacteria, certain ones we use for fungus. It depends on what you got, most of the time it’s a combination of all these bugs. 

Dr. Justin Marchegiani: Awesome. Hey, Evan, great podcast today. Hope everyone at home listening enjoyed it. Feel free to share with friends or family. Put your comments down below. Let me know what things that you guys have tried at home that have worked well or haven’t. Really appreciate the conversation. Evan, have an awesome day man. 

Evan Brand: You too, take it easy. 

Dr. Justin Marchegiani: Take care. Bye. 

Evan Brand: See you. Bye-bye. 

References:

https://justinhealth.com/

https://www.evanbrand.com/

Audio Podcast:

https://justinhealth.libsyn.com/the-top-5-causes-of-bloating-podcast-364

Recommended Products:

Enzyme Synergy

Probio Flora

Genova ION Profile

Genova Organix Dysbiosis

Genova SIBO Breath Test

Genova Organix® Comprehensive Profile

International DSL GI MAP Genetic Stool Test

DSL GI-MAP Genetic Stool Test

Natural Way to Increase Blood Flow And Decrease Inflammation | Podcast #343

For starters, blood flow is why your body can get what nutrients it needs and how it can eliminate what it doesn’t. If you have reduced blood flow, your body will take longer to heal and recover. Reduced blood flow can often result in inflammation, pain, muscle cramps, fatigue, numbness or coldness in the hands and feet, digestive issues, and slower recovery time.

According to Dr. J and Evan, there are three primary concerns to address when looking at improving circulation by reducing inflammation, blood viscosity (blood’s stickiness or thickness), and supporting healthy arterial function (ensure the arteries can contract or dilate needed).

So, how can food help us to do that? While the healthy foods we eat can benefit our blood flow and circulation, some foods are to be aware of as part of a healthy diet. Often, the additives we add to our food through sugars, trans fats, and salt can be tasty but with a few adverse side effects.

Dr. Justin Marchegiani

In this episode, we cover:

1:57:     Inflammation and ways to reduce it

4:46:     Signs and symptoms of hypercoagulability

11:07:   Natural Herbs to improve blood circulation

16:47:   Tips to improve blood circulation and reduce inflammation

20:06:   Food template, tests, and supplements

Dr. Justin Marchegiani: And we are are live! It’s Dr. Justine Marchegiani here in the house with Evan Brand. Today we’re going to chat about blood flow. How do we increase blood flow, decrease coagulation, decrease inflammation. All the natural strategies to get to the root cause. Blood flow is really important. We need blood flow to carry oxygen. We need to carry nutrition to our organs and our body systems. And if we have stress in our body, whether it’s infection, inflammation, diet issues, lifestyle issues, hormonal imbalances that affect circulation, that’s to impair our body’s ability to generate energy, generate heat; right healthy metabolism, feel good, feel energized. And we’re going to dive in on that topic today. Evan, how are we doing today man?

Evan Brand: Doing really well. You know, I had a few friends actually suggest that I had a hyper coagulation problem due to batonella and babesia, and mold toxin, and some other crap I’ve dealt with. And so I ran a coagulation panel. There’s some of these coagulation panels online that you can order and I went and run the blood on myself and my, my panels turned out perfectly. Even according to some of the functional ranges. Now, I don’t have a baseline. You know, several years ago, when I first got exposed to mold to compare to. But I will tell you just in terms of symptoms; my great coagulation blood work results correlates with my symptoms. Meaning, my hands and feet are perfectly warm these days. I told you years ago, my arms and feet are chronically cold . I mean, as long as I can even remember, even as a child, I remember my feet being freezing and having to use a little electric space heater in my grandma’s basement to keep my feet war. I remember that from years ago. So I’m just really happy that the blood showed fine and some of the strategies which we’re going to dive into today that those worked and those actually helped me because, on paper I look great and symptomatically doing much much better in the blood flow department.

Dr. Justin Marchegiani: Excellent. Yeah, I love that. Makes a lot of sense. So of course, one of the first things that we look at when we’re trying to improve blood flow is reducing inflammation. So when you have lots of cytokines or in interleukines or inflammatory messengers, right? They’re there to kind of say, “hey we have inflammation”. And what is inflammation? Let’s define that. Everyone talks about it but, what is it? So, inflammation is essentially we have this increase in cytokines, interleukines, due to the fact that our body is breaking down faster than it is repairing, okay. There’s natural inflammation that is good. Like think of having a good workout, right? You naturally get a little sore afterwards and then a day or two later, you get stringer and your muscles get more, I don’t know, adaptable. And then you develop more strength, more tensile strength, more power, more output; because your muscles adapted to that inflammation. So there’s a little bit of inflammation but in the end, your body adapted to it and it built up just a little bit more than it broke down on average, right? That’s healthy inflammation. And so, inflammation that we’re talking about is inflammation out of balance. Were let’s say you work out a little bit too hard. And now that soreness is prolonging days later, and now you’re almost a little bit weaker than when you started because the breakdown is now greater than the build up. And so healthy inflammation is the build up is a little bit greater than the breakdown that’s healthy inflammation. Unhealthy inflammation is the breakdown’s a little bit higher than the build up, and that’s what we’re talking about today. And so, of course, too much exercise, too much inflammatory foods, especially in the way of foods that are nutrient poor, foods that are too high in refined vegetable oils, good healthy fats; they become your cell membranes. Every cell has a lipid bilayer in the body. The brain’s you know, 70 fat and cholesterol. So if you are eating junky fats, that’s going to cause your cell membranes to turn over to being very unhealthy. It’s also going to cause your brain to turn over to be very unhealthy and there’s some data showing that you’re going to have those cell membranes hung up to six years with the junky fats that you’re eating. So you’re really want to look at the fat. So, vegetable oil fats not good because they have to be processed in a way that damages those fats in the extraction process. And so you have a lot of oxidation happening, a lot of hydrogenated oils due to either oxidation or the trans fat process that occur. And again, you, why are fats made in the trans fats because they have a longer shelf life, right? And so, we want fats if they’re on the plant side, they’re not going to be denatured, so avocado oil may be okay, olive oil of cold press, and extra virgin and good quality and good brand’s okay. Of course our saturated fats are the best because they’re the most heat stable. So coconut animal fats, maybe some palm, of course like any of your tallows are really good, especially if the animals are healthy and pastured raised. These are going to be your best fat, so at least 50 percent of our trans fats, we want to be saturated, high quality, because it guarantees them not being oxidized and we’re acidified.

Evan Brand: Yep! Well said. And so when you define hypercoagulability, this is a term that’s thrown around a lot now, or you could just call it increased coagulation. What they’re really talking about is some sort of a build up. Like, you know, you mentioned whether it’s inflammatory cytokines, or what’s cal fibrin things that are affecting the capillaries which as far as my research goes, it’s pretty interesting stuff. Capillaries, they’re so small but the red blood cells have to go in single file line to get to get through the capillaries. So if you have a build up of fibrin from some sort of inflammatory reaction, whether it’s to a mold, a virus, or some other pathogen that can affect those capillaries, which then creates some of the cold hands, cold feet. So let me just riff on symptoms for a minute and then we can go there. So, uh, symptoms wise, let’s say cold hands, cold feet, let’s say cold nose, I would say erectile dysfunction, could be a big one too for men. A lot of coagulation issues with men you see, uh, reduced blood flow and of course, side effects-erection. I would say brain fog would be big too. You mentioned, you got to have blood flow to get to the brain. So I would say, brain fog, maybe memory issues, fatigue, I would say muscle fatigue as well. So if you’re noticing that you’re having trouble lifting  weights or you’re having a lot of post-exertional malaise, it could be mitochondrial related. We’ve talked about that before but, I think the coagulation could be part be part of it too. So I’m a big fan of lumbrokinase which I think is one of the big remedies that’s really helped me. Lumrokinase is way stronger that nattokinase which is which is commonly sold. Lumbrokinase is like the big daddy, the big brother above natto. And I tell you, it’s been an absolute game changer. If I take that, not only does my brain work better but my hands and feet are warm. So just in terms of like, solutions, you know, you could run a coagulation panel, and I think it’s easiest, rather than trying to run through all the markers, like d-dimers and all that. Instead of running through all that. I think it’d be easier. We could just like, put a link in the show notes for like a coagulation panel app, like you could run through lab corp request, and if people want to dive into it, they can but, I think those…

Dr. Justin Marchegiani: So on some of those markers, what would some of the markers that you’d look at on the coagulation side?

Evan Brand: Yeah, I wish I had my lab in front of me. I could pull it up.

Dr. Justin Machegiani: I’ll give you c couple that. I give you a couple that. So we talked about inflammation; we talked about interleukinesand cytokines. Why does that matter? Because the more inflammation you have in your bloodstream, the more sticky cells get, okay. Cause think about it, right? From inflammation standpoint, why would your cells get more sticky from an inflammation standpoint, right. Let’s kind of look at what’s, you know. What are the, um, the intentional, like what’s the intention of our creator and making us and why would that happen, right? Because we have to look at the fact there’s an innate intelligence as to why our body does things. It doesn’t do it by accident. And I would say that most of our stress that we experience as we evolve as a species is through a cut, and injury, a fall, something very acute. So our body is trying to stick things, glue things back together, prevent us from bleeding out, right? Allow scar tissue to form to help heal and recover, whatever that damage area is, right? That kind of make sense now. The problem is, we have less acute damage like, falls, crashes, and these things. But we have this chronic, degenerative inflammation that’s happening. So, yeah. Starting to create many bits of scar tissue which again, that is going to be making cells, stick together, so you’re looking at things such as fibrin, increased platelet aggregation. Meaning, platelets are the little cells that flow through your bloodstream that help you create clots, right? Platelets then create fibrin so it creates these clots . And so then you’re having deceased blood flow because of clots, because cells are more sticky because of inflammation. And that’s there to help, help your body do better when it comes to stress or something acute; but we’re having this chronic degenerative stress and of course, high levels of blood sugar, high levels of insulin are going to make your cells more sticky, right? This is why we see in diabetes, right, when Evan talks about a lot of the capillaries when they go a single file, we see that a lot in the eyes, and so we see a lot of eye aneurysm stuff, a lot of eye issues in diabetics, a lot of limb issues because really poor blood flow in the capillaries going on to the finger and the hands. And so high levels of insulin from high levels of blood sugar that also creates the advanced glycation end products which are essentially the sugar coated proteins that are oxidized because the high blood sugar, and that oxidation depletes things like vitamin C and vitamin A, and vitamin E, And so we have less of these nutrients to help our eyes, to help our skin, to help our collagen, to help wound healing, and then you start to have very poor blood flow, decrease immune cells. Getting to the extremities, the hands, and feet; and then you develop a gangrenous lesion on your foot with all this inflammation and poor blood flow, and then you have have it chopped off because it starts to create and infection. So you can see how all these things start to spiral out of control and of course, blood sugar inflammation, um is kind of the hallmark of how all this starts. We’ll go more into things  that you can do. So Evan mentioned like the lumbrokinase. Excellent! Seropeptidase, the enzyme from that silkworm, excellent. Right? These are systemic enzymes taken away from food. Those enzymes come in kind of like a rato-rooter or a liquid plumber would for like, a clogged hair in your drain, in your toilet, right? So it breaks it down, okay? Now we have to make sure that we’re getting to the root cause but, in general, that’s helpful because it’s not going to be as inflammatory, it’ll break down scar tissue; it has a lot of anti-cancer immune benefits because when it hits all these cytokines, it kind of dissolves them and breaks them down so it does help reduce inflammation which is great.

Evan Brand: Yeah, you made a great point too about diabetics suffering from this issue quite a lot in the blood sugar component. That’s huge! And then, also, one thing to note too when you do start to dissolve some of the fibrin, you may, if it’s due to the infection, you may have some sort of a die off or like herxheimer reaction. So just keep that in mind, and obviously if you’re working with one of us, we’re going to coach you through that process but, if you have a practitioner that’s maybe not aware of that, then they may not know why your symptoms are flaring up if you start to dissolve some of this fibrin. So for example, when I first started ramping up lumbrokinase, I was also doing some biofilm busting nutrients, and some may argue that you’re busting biofilm with things like this and so I had a reaction. You know, I got some headaches, I got some anxiety, I had some heart palpitations and some other symptoms, indicating I was probably releasing something that was hiding within that fibrin. And so, if you have a reaction, you feel worse on something like the, uh, like you said, seropeptidase or maybe, nattokinase, or lumbrokinase. You could be on to something, and as you mentioned too, you don’t want to just live on this enzymes and not get to the root cause. So for me, I really do think babesia has been a big one for me because, when I’m taking herbs to address babesia, I find that the circulation is much better. For some people, it could be bartonella. They call it small vessel disease. If you look into pubmed, you could look up small vessel disease bartonella. This is an infection that can come from ticks but it can very very easily come from cats. Many many cats, like 90 percent of cats have bartonella and if they scratch you, you can get bartonella from your cat, you can get it from fleas, so there are other vectors that can transmit this. So some people say like, “ oh I never had a tick bite”, doesn’t matter. I’ve seen many many people with bertonella and likely from their cats. And so, you may want to come in with herbs and knock out bartonella while you’re working on the fibrin. And I know you and I use a product that’s a mixture serapeptadase, and ginger and boswella, and turmeric. So we kind of working on the inflammation piece and the fiber piece at the same time, and it’s a great one-two punch.

Dr. Justin Marchegiani: Yeah, any of my patients listening know that I’m always using ginger tea, right? I’ve kind of taken the ginger tea recipe which Is I think it’s pretty famous in the gaps protocol and I’ve used that, and I’ve added in a lot of the, um. Manuka honey because it’s very soothing on the gut, and it has some mild antibacterial properties and anti-inflammatory for the gut. So I do that with a lot of my patients because it sues the tummy, it is an anti-biofilm, so it allows any of the herbs that I’m using with my patients to knock any bugs down. It helps make the herbs stronger, and it’s anti-inflammatory, um, which me, and it’s also an anticoagulant. So the anti-inflammatory, anticoagulant, just allows one better blood flow, better flow allows those herbs to kind of work better and be transported throughout the body, and then it also prevents the lymph from being congested. So it just allows things to be kind of move around and excreted from the body. So you have to move things through the liver, through the kidneys, to the guts. So we need to have that good movement to allow things to work appropriately. So that’s, that’s really really important out of the gates; and also on working with a lot of lyme patients or co-infections; all that plays a major role. I would say other herbs you can use are things like bacopa, uh, gingko is also amazing, you can do things that have, um, uh, nitric oxide support in there like beetroot. These are all beets are excellent You can get beetroot powder, that’s very helpful at supporting blood flow. Things like resveretrol are also very good, right; antimicrobial but also really help with good blood flow, so um, that’s excellent as well. Uh, cat’s claw can be really good as well, because anytime it has antimicrobial, antioxidants, and then it reduces inflammation. That naturally tends to improve blood flow. So better blood flow is good. So we can one have good circulation to the hands and feet, we’re carrying nutrition better.; we’re carrying more of the herbs to help whatever the microbial imbalance is, and then we’re supporting lymphatic flow of all the dead debris out. Has to move out to the body, get circulated to the lymph, go back to the kidneys, and the, and the digestive tract to be excreted out. So those are some really good herbs that we’ll also use, skull caps also really good as well. Um, you mentioned turmeric  which is really good, and then outside of that, adaptogens can be really powerful too. Because, if we have lots of cortesol from inflammation and stress, cortisol is also going to cause things to not move as well because, it’s there; it’s responding to inflammation but it’s also going to slow down a lot of blood flow. So if we can, and this is kind of more in a chronic um, scenario, right, not talking acute, talking more chronic. Because acute, there is acute blood flow to an injury, because that’s how the body is trying to heal stuff. Let’s try to drive level that’s why when you bump your elbow, it gets swollen right, there’s increased blood flow. We’re talking about more cortisol chronically, and so we’ll use things like adaptogens, whether it’s thodiola or ashwagandha to really calm down that chronic stress response and really get it kind of modulated to help improve cortisol which then helps with blood flow long term.

Evan Brand: Yeah, you made a great point like the bacopa, the gingko. I mean, there’s a reason all all these herbs that we’re talking about are inside of brain formulas. Look at any professional companies, whether it’s ours or any other companies that are using nutrients to support the brain health, guess what? Gingko is always in there so it’s cool because it helps systemically and that of course, improves the brain function. There’s a lot of cool studies about gingko with micro-circulation in the brain. I love gingko. I take it, I take phosphatidylserine, I do choline, acetylcholine, I do acetol cermitine, I do like a blend of all these things and I tell you, it really makes a difference. Do you want to hit on a couple more of the foods you mentioned? The beets…

Dr. Justin Marchegiani: Yes, that’s important.

Evan Brand: Okay. I love beats. Like, I’ll do beet powder and I mix it with my vitamin C powder. It’s so delicious that combo, and I’m not joking like, 10 minutes after I drink a scoop of beet powder with vitamin C, my hands are so warm, like they’re alsmost flushed because there’s so much blood flow there. I mean, I feel it instantly. And then, that really helps in the sauna too. So if you’re having issues with sweating, that could be due to poor blood flow, poor nitrate oxide. So my personal advice because I’m historically not a good sweater, I will do beet powder and then do a few minutes of a rebounder, and then  I’ll jump the rebounder most folks know what that is kind like a mini trampoline. I’ll jump into the sauna after that, and with the beet powder rebounder combo, I sweat like 50 % faster.

Dr. Justin Marchegiani: Interesting. Very cool. Yeah, yeah, I like that. I mean, I’d say like from a foundation of people listening like, we’re throwing a lot of stuff out there, right? So what’s the order of operations and how you try things. So the first thing is, get your diet under control. So the first thing is, control dysglycemia, control blood sugar swings, high levels of blood sugar, high levels of insulin are going to cause things to get really sticky when they flow. The second thing is really improve the nutrient density; lot of good antioxidants, so a lot of good green vegetables, uh cutting out food allergens from dairy and from gluten and of course, refined sugar and inflammatory junk foods, really improve the nutrient density in the vegetables if you’re going to choose fruit, choose nutrient-dense fruits are not overly high for what you can handle metabolically of course, really good healthy fats; remember omega-3 fatty acids are natural blood thinner. Quite before surgery, they’ll say like you know, no fish oil or systemic enzymes taken away from you know, taken within the couple of days of surgery because, they don’t want you to bleed out, right. So especially high quality, god healthy, you know, local like maybe while the last guy kind of frozens you know, salmon or a really good clean tuna, just try to choose wild farm type of fish; these are going to have excellent omega-3 fatty acids, and then of course, choosing grass-fed meat, excellent. Because you’re going to get a lot of GLA fat, you’re going to get a lot of good clean fats from the cow eating grass which is super helpful. So fats are really important, they’re natural anticoagulants and then they help make a good healthy cell membrane so your cells can communicate and function optimally.

Evan Brand: Let me make one note about the lumbrokinse because, you see that warning label and you and I kind of heed that warning but, I saw a podcast interview that Dr. Jill Carnahan did with a lady named Dr. Ann Courson. She’s been kind of the bog voice about coagulation and talking about lumbrokines. She said it’s really non-issue and while she still may, and this not verbatim but, while she may pull these things out temporarily, she’s had people that like went into emergency on high-dose fish oil and high-dose lumbrokinase and they had no bleeding issues at all. So this is not heparin or crazy intense blood thinners from pharmaceutical industry. These natural blood thinners even though they may be potent, she said, she’s never seen a single case of anyone bleeding out so that there’s probably too much warning and too much fear about the fish-oil and these enzymes thinning the blood. She’s never seen it cause any major problem.

Dr. Justin Marchegiani: Yeah, heparin, warfarin, they have anew one the plavix one, right? These are different blood thinners that are  out there. Yeah, I mean you definitely want to talk to your anesthesiologist last surgeon follow their instructions on these things. I think it’s safe just to be off it, uh, during a procedure and let your doctor know about it.

Evan Brand: And I’m saying just, and by the way, I’m saying just the natural stuff, the drugs, I have no clue about them, I’m not a pharmacist, but like fish oil. Should you take a few days off? Yeah. You probably should but, just foe anybody’s fearing but for anybody that’s afraid like oh my God, I had to go to ER and I had to get this emergency surgery, am I going to bleed to death because I’m on fish oil, the answer looking at her perspective was no, not at all.

Dr. Justin Marchegiani: Yeah, yeah. Probably not. I mean, I am far more worried about someone going into surgery being totally inflamed and developing clots, um, or having a polmunary embolism or a stroke or something like that. The bleeing out, right? You know but, in general, don’t be on high doses of blood thinners that we’re talking about. The natural ones, if you know you have a plan surgery just in general. In general, I mean, consuming fish, eating fish, I don’t see a problem with a lot of these things. And outside of that you know, what other markers we can look at. So of course, we mentioned, um, fibrin or fibrinogen which is a marker. So fibrinogen is the inactive form of fibrin, and so high levels of fibrinogen mean you have a lot of clotting building blocks. Higher levels of platelets could be something to look at. I would say, elevations and inflammatory compounds like homocysteine, ESR-Erythrocyte Sedimentation Rate. CRP C-Rective Protein. These are all inflammatory markers that tell us, okay, inflammation is present, the more chances their inflammation is up, cells are going to stick together, the more cells stick together, it’s like trying to walk out double doors, three or four people side by side. It’s just gonna clog up the flow, right? And so that’s gonna help give you an indication that some things are not flowing well, and then you can try different strategies, the ones we’re talking about go back and retest those markers, and that’s helpful. I would say the one marker that’s a little bit different, the homocycteine, that’s going to happen typically due to inactive or not enough high quality methylated B vitamins. Usually folate, usually B6,  B12 – these are important vitamins. If you don’t get them, in methylated or more active forms, this metabolite of homocysteine can accumulate and these B vitamins decrease homocysteine. So how it works is, it goes methionine, a dental homocysteine, homocysteine, to cycteine. This is kind of metabolism, a breakdown of methionine into cysteine, and cysteine goes into glutathione. This healthy metabolism requires these B vitamins, right? Folate, methylated B12, right? Um, B6, right. These are important nutrients need to be there so we can take that homocysteine and brign it through all the way down to cysteine and metabolize optimally. If not, it can be inflammatory and affect the arteries and the area where the blood’s flowing and create inflammation and plaquing.

Evan Brand: Yeah. And just to take it a step further just so people are like what the heck is he saying? So when you’re looking at this one blood, you’re saying when you see the elevated homocysteine, or we can even look at some of these metabolism markers on the organics acids. When you see this elevated, you know that there’s usually a B vitamin deficiency, correct? That’s what you’re saying, elevated homocysteine on the blood.

Dr. Justin Marchegiani: Yeah. I mean, D vitamin deficiency or you’re just getting a lot of crappy B vitamins right? You’re getting a lot of folic acid, you’re getting a lot of B12 that you may not be methylated. You’re getting a lot of B6 that may not be activated. So we want to make sure you’re getting lots of activated B vitamins, high quality. In my line we use one called B vitamin synergy, we’ll put the link for that below. Of course like your best natural source for these type of vitamins are going to be green leafy vegetables, and high quality grass-fed organic meats right? So sometimes people have an mthfr issue and they need more of those B vitamins and so that’s want to make sure the supplements are great. And if you’re consuming a lot of like processed crappy orange juices and grains, you may get a lot of folic acid and crappy B vitamins there. That’s the case you want to cut those out. You want to get lots of good natural B vitamins from the source I just mentioned. And you want to take a really goof clean B vitamin supplement that’s going to have those in methylated activated forms, and if we’re doing testing on like a um, mthfr blood test. We would look at those phenotypes and see what’s present but organic acids are wonderful too because, we can look at markers like kind of urinate, xantharinate to look at B6. We can look at markers like fig glue or four amino glutamate to look at folate. We can look at markers like methylmalonic acid to look at B12. So there’s different markers. We can look at betahydroxy isovalerate, right? These are all good markers for B vitamins to look at. So we can see if these things are, if we have metabolic demand issues, we can go and tweak those accordingly.

Evan Brand: And most people are depleted and have issues. I mean, obviously we’re a little bit biased because we’re working with  people that don’t feel well but, we know that even the people that work with us, they’re doing a hell of a lot better than the average American in terms of diet and lifestyle, and stress, and sleep, and hopefully all of those factors. And so if we see they’re deficient the way we see often, then we know the average American’s deficient too because, you’re burning up these bees when you’re stressed. That’s a whole other  podcast but, you did a great job on, on hitting on the markers. There’s a couple more like new ones. Like ther was like anti-thrombin that was on this panel.

Dr. Justin Marchegiani: Yep. That’s another one. That’s kind of like fibrin. It’s another type of clothing factor.

Evan Brand: You had the d-dimer which is really tough to get a doctor to actually run d-dimer. That’s why you and I luckily, we run our own blood work but, if you just went to your regular doctor and said I want a d-dimer. Unless they think you’ve got an active blood clot, they’re probably not going to run this for investigative purposes. I don’t know why but even vitamin D, some clients have to beg just get vitamin D so…

Dr. Justin Marchegiani: Yeah. With d-dimer, that’s typically run if someone’s on a blood thinner. I don’t think plavix requires it now but, if you’re on like, one of the older blood thinners that requires you to make sure d-dime are stable. They’ll run that because they’re worried about like, oh my god you eat more green vegetables that is vitamin K, vitamin k increases clotting factors. They’ll want you to want to adjust your d-dimer accordingly. Or they want to adjust your dosage of your medication according to the dimer. So my whole thing is if you’re not eating a whole bunch of green vegetables because, your doctor is worried about it, well I would just say eat some green vegetables, tell them you want to have good, green vegetables but then have them run a d-dimer and adjust your clotting, your medication according to you eating a good, healthy diet. I see people that are scared of green vegetables because their doctors are too lazy to re-test their d-dimer and adjust their medications.

Evan Brand: Oh wow. Yeah. I understand that but yeah. That was most of it, that was most of the stuff there. So you did a good job hitting on it and like you mentioned a lot. We’re throwing a lot at you here supplements and foods, and beets, and talked about nitric oxide. I mean, really I think you’ve hit the messages. Getting the inflammation out of the diet and then looking into the testing because, some of the functional medicine testing we run outside of blood work can provide data on what’s going on. And then obviously, mycotoxins are huge. So for me, when I get exposed to mold, if I stay in the moldy hotel for a weekend, guess what? My hands and feet go cold. I mean it’s almost a direct impact. So I’m not saying that’s everyone’s smoking gun but, it’s a big factor that’s not really talked about.

Dr. Justin Marchegiani: Right, right. So I always try to boil things down to a process, right? What’s the concept, what’s the process? A process is something we can consistently repeat. It’s kind of like in fourth grade, you learn pemdas, right? Remember pemdas? It’s the way you do a math problem. That there’s addition, subtraction, division, all these different things in one line. What’s the process, pemdas right? Well today, what’s the process here? The first thing is one, make sure the food you eat is anti-inflammatory nutrient dense low toxin. That’s the first thing. Second thing is get your blood sugar under control because yes, you can eat really good foods but, your glycemia, your blood sugar can be out of control and that can increase insulin, coagulation, clotting, right? So first thing is nutrient density anti-inflammatory diet. Second thing is get your macronutrients under control. Third thing is get lifestyle strategies under control. Don’t exercise too much. Exercise enough, start making sure sleep is under control. Sight? Start making sure you’re drinking good clean, filtered water with extra minerals. Make sure there’s enough minerals in there. If you can add in different strategies like, rebounding or whole body vibration, or sauna therapy, excellent. Then maybe at that next level, we can start going into, um, supplements, right? What are the easiest supplements to add in? Well, good healthy fats, good healthy fish oils. Maybe some some extra ginger, maybe some systemic enzymes right? You don’t have to start with everything. There’s a lot of things we put out there. It’s like a poople platter. We don’t got to do it all. Just try to start with one or two things but, start with that order of operations. Follow the process; don’t get overwhelmed by everything; just follow the process. And the next thing after that is you know, if you have inflammatory conditions, autoimmune issues, thyroid issues, crohn’s, ulcerative colitis, colitis, uh, lime, co-infections, autoimmune issues, and you have chronic inflammation chronically cold hands, cold feet blood flow issues, you have to look at thyroid, you have to look at your hormones, you have to look at the gut; and this is where it’s good to bring on a good functional medicine practitioner like us. So if you want to reach out to Evan, evanbrand.com or myself, Dr. J – justinehealth.com. That’s kind of where your next step to kind of go a little bit deeper, to kind of you know, hire that trail guys that’s been to the top of mount Everest hundreds of times. So you can have the confidence that we’re going the right way and not taking a shortcut off a cliff so to speak.

Evan Brand: Yeah. It’s great. Well said. It’s just so great to be able to reverse some of these stuff. I mean, I just assumed that was me. I just had cold hands, cold feet, and I thought, okay. That’s just me for some reason, I just don’t have good blood flow here, and I just kind of like owned it, and I think a lot of people are listening. They own these symptoms and they get used to their way of life, and like nope that’s just the way I am. I’m just a depressed person. It’s like no, there’s a reason for that. I do believe that we truly have a baseline of being healthy and optimal, and good blood flow, and good brain function, and good sex drive, and good sleep. If you look at like tribal societies, they don’t have these type of issues. They don’t have these chronic issues with blood pressure and mood issues. Some of these like ancestral people, they don’t even have a word for depression. It’s not even in their language. So I just encourage you if you’re listening, and you’re just owning your symptoms, and you’re like that’s just me, don’t own it anymore. Just know that that’s okay that something’s wrong, there’s a dysfunction going on. There’s likely a cause of it and we’re investigators at heart. I mean, we love this stuff so like you mentioned, if you want to reach out, justinhealth.com for Dr. J, evanbrand.com for me. We’d love to help you, and help you get to the next level of health. It’s totally possible.

Dr. Justin Marchegiani: Yeah, I would say don’t own it form the perspective of like, hey this is just me, this is how it it is but, own the process. Like you know, one of the root things that I can be working on to get these things under wraps. I think that’s a really important kind of uh, step to be looking at, okay? Anything else guys, feel free and let us know, comments down below. We’re really happy to help you and kind of get to the next step with you all. Feel free, evanbrand.com, justinhealth.com and we’re happy to help. Anything else you want to add Evan?

Evan Brand: No, that’s it. Just keep moving forward. That’s the goal. There’s not a finish line so just keep, getting to the next level, you know, It’s not like, my life’s going to be perfect when I get cold hands and cold feet resolved. No, you could do that and still be miserable. So you gotta just chipping away, okay? Don’t give up.

Dr. Justin Marchegiani: yeah. And then also, kind of one thing. People in the comments asking about couple different questions here. Um, just want everyone to know in our climate today, there’s some off-limit topics that you know, we’re not touching, and people kind of read between the lines on this, and we’ve made a decision that there’s a lot of other information that is so important to um, put out there to everyone. So we’re staying away from some health topics not for the goal of censorship but because, we want to be able to put other health topics like we’re talking about today out there so everyone can take action. So just know uh, you know we’re making kind of a strategic decision to really put more focus on functional medicine. Areas and nutrition people can take action on versus other things that are out in the zeitgeist to the world today.

Evan Brand: I think there’s a time and a place for it and there may be a better place for it. But a lot of those places right now are super dicey in terms of service and stuff. I mean, who knows what can happen to you. So yeah, we’re we’re investigating options though.

Dr. Justin Marchegiani: Yeah. So anyone listening, we’re putting really our focus on all of the functional medicine; all the things that people can take form an actionable standpoint. And so, just that’s kind of the direction because we feel like we can help more at that area. And um, that’s kind of it on that. Any comments, feel free to let us know below and we’re here to help you all.

Evan Brand: Alright. Take it easy.

Dr. Justin Marchegiani: Take care, guys! Bye now.

Evan Brand: Bye-bye.

References:

https://justinhealth.com/

https://www.evanbrand.com/

Audio Podcast:

https://justinhealth.libsyn.com/natural-way-to-increase-blood-flow-and-decrease-inflammation-podcast-343

Recommended products:

Organic Grass Fed Meat

B-Vitamin Synergy

Antioxidant Supreme

Genova Organix® Comprehensive Profile

Genova NutrEval® FMV

Why is My Digestion Broken – Lab Test Interpretation of GI MAP with Lisa Pomeroy | Podcast #335

The digestive system is a winding and extensive part of the body. It ranges from the mouth to the rectum. The digestive system assists your body in absorbing vital nutrients and is responsible for getting rid of waste.

Because there are so many types of digestion issues, you might mistakenly dismiss them. Dr. J and Lisa emphasize that it’s essential to understand the root cause of digestion issues — as well as emergencies — so you know when to talk to a functional doctor and have yourself tested.

Dr. Justin Marchegiani

In this episode, we cover:

0:00 – Introduction

3:31 – GI MAP Interpretation from a sample patient

Dr. Justin Marchegiani: Hey guys it’s Dr. Justin Marchegiani here. I am with Lisa Pomeroy. Really excited to have her on today’s podcast. We’re gonna be chatting about different kinds of lab tests. Everything labs really. Our goal today is to show, we’re gonna be really diving into the gut tests, really looking at gut function. One of the big tests we’ll look at is the GI map and how to interpret that and some of the big take-homes as we go through that to you know pull out action items as we address patient concerns. And the next one we’ll go into is the ion panel where we’ll get a really good window into mitochondrial function, neurotransmitter function, overall nutrient absorption, gut function, etc. So, really excited to have Lisa on the show today. Lisa, how you doing? 

Lisa Pomeroy: Doing good! How about yourself?

Dr. Justin Marchegiani: Hey,doing wonderful. Really excited to, uh, chat with you, very good. 

Lisa Pomeroy: Yeah.

Dr. Justin Marchegiani: Awesome. So, why don’t you let people know a little bit more about yourself me, you’re a clinician as well. 

Lisa Pomeroy: I am yeah. I am a traditional naturopath. Um, I’ve done a bunch of differential functional medicine training programs. So, you know like, you I’m a graduate of Dan Kalish’s, uh, Kalish spectatorship. So, I love learning and a lot of the learning was something I had to do to try to get myself healthy.  Because when we talk about gut issues, I had major gut issues. I mean, as young as seventh grade, I was having ulcer-like pain and unfortunately, no one I went to, knew about H. pylori, knew about testing for H. pylori, treating H. pylori, so I had to suffer in silence for another 20 years with severe stomach pain before I run the test on myself, found I had H. pylori and got rid of it.

Dr. Justin Marchegiani: Wow! That is crazy. What a story.

Lisa Pomeroy: Yeah, I come home from school and drink cabbage juice. I mean, I was that devoted because it’s the only thing that would help. 

Dr. Justin Marchegiani: Yeah, intuitively you knew the vitamin you in there was helping. 

Lisa Pomeroy: Exactly!

Dr. Justin Marchegiani: Yeah, so you really had to wait a long time, so that’s crazy because you must have so much appreciation for what we all do today. You have a lot of empathy for your patients. That’s great! It’s important to have that. 

Lisa Pomeroy:  Yeah, I talk to people and we’ll talk about like a five-year-old child or something and I just, you know, I’m just so grateful because it’s like I’m so glad that they have that the parents know enough to be getting this child help so they don’t have to suffer like I did for another 20-30 years with severe gut pain. You know, we find out that they have a nasty parasite in their gut and we get rid of it and they’re not gonna be nutritionally deficient and have all these gut symptoms for decades. 

Dr. Justin Marchegiani: Oh, totally. Yeah. And it’s important, I mean obviously out of the gate, the labs are important to give us a lot of information that’s clinically actionable but you know diet and lifestyle, foundational things, a lot of these, you know, we probably don’t need a lab test per se. I mean, it’s good to have it right? I t’s nice to know, like okay, maybe there’s some gluten sensitivity, maybe there’s some inflammation, maybe there’s some immune activation and we should kind of start some diet changes and there’s some foundational things that you tend to find that just generally help most people out of the gates, you know, maybe sugar or gluten. What things you specifically utilize?

Lisa Pomeroy: Yeah, exactly! I mean, we look at the top pro-inflammatory foods in the diet. Most people say gluten, dairy, white refined sugar and ultra-processed foods. You know, those are gonna be some of your top things, where a lot of people will notice a difference, where you can pull it out, you know, you can do a trial where you, you know, you eat whole unprocessed foods, your whole fruits and veggies, roots and tubers, you know, that sort of things. You cut out the dairy you see how you do, so yes, testing can be helpful with that, but some of it can just be, you know, take it out and see how you feel.

Dr. Justin Marchegiani: See how you feel

Lisa Pomeroy: Exactly!

Dr. Justin Marchegiani: That makes sense. Oh cool. Why don’t we dive into some of the GI map testing out of the gates. I got a sample patient here, we’ll pull it up on screen. 

Lisa Pomeroy: Okay.

Dr. Justin Marchegiani: We’ll kind of whip through it and we’ll try to keep it actionable. I mean, unlike a lot of shows, you know, you’re a clinician, I’m a clinician, you interact with patients and doctors throughout the week and so we’re trying to get people, real actionable information here. 

Lisa Pomeroy: Yeah, great!

Dr. Justin Marchegiani: Can you see the screen here? 

Lisa Pomeroy: I can. Yeah. It’s coming through nice and clear. 

Dr. Justin Marchegiani: Okay, cool. So, we’ll just kind of start off, um right off the bat here, page one. So, we’re looking at a lot of bacterial pathogens, some parasite pathogens and viral stuff. I’ll let you, kind of take it away with the first part. 

Lisa Pomeroy: Sure. So, basically what I want to see on this first page is nothing. You know, these are things that really don’t belong there. So, I want to see that less than DL which stands for below the detectable limit for all the things down the page. Now, some of these, we don’t necessarily need to interfere with, like that E. coli 0157, uh, that one is something it’s an acute pathogen. It’s actually, uh, like a foodborne pathogen and we’ve been seeing a lot of these pathogenic E. coli lately. They tend to peak in the late summer months, so July, August, September, we see a lot of them, just because they’re on the fresh produce, you know, the leafy greens, served lettuce, your basil, your berries. So, you pick them up and so we’re looking for symptoms. Now, this case, this is a very teeny tiny little level E0. So, that is something they either just picked up a very small amount or is mostly on its way out. And that’s where an E. coli like 0157, you know, is something that’s considered transient, self-limiting, it’ll go away on its own. Now, it may or may not give you symptoms. If you did get symptoms, they probably last for less than a week, probably get some diarrhea, some cramping, fever, nausea, that sort of thing. So, sometimes we’ll see these on the report and we go, okay, well, that explains why you had diarrhea two weeks ago, you know, you got a hold of this bug, but, you know, it may not be something we actually need to do something about. 

Dr. Justin Marchegiani: But every now and then, you see the 01h57, I mean, you see, that with spinach a lot, these people will die every year with it. So, if it can be serious to people are, have a compromised immune system or gut function, right? 

Lisa Pomeroy: Exactly! And that’s what especially the elderly, the young children, they are the greater risk of more severe types of infections and that’s where a lot of times people, you know, and a lot of times they know that were, you know, the time say they got some diarrhea, they run the test, they’re waiting for the results to come back. Usually, those symptoms are going to peak, before the results came back, so they know I’m having severe things are coming out both ends basically. I’m puking, bloody diarrhea. They should know they need to go to seek emergency medical care. And that’s something where, you know, usually by the time, we’re seeing people. Now, most people don’t get that severe, but if they would, they would have sought medical attention. So, usually, we’re seeing the side more like, oh yeah, I had loose stools for two days, I just my gut was a little off, you know. So, we may not to intervene, although, I always look for there’s deeper bigger issues because, really, you know, the body is meant to protect us from these infections, so if you were susceptible to picking up the E.coli on your spinach or your lettuce, you know, where was the stomach acid, shouldn’t that come in and killed what, you know, you ate and went through your stomach or what about secretory IgA, this is marker later on the test that tells you about gut immunity. You know, secretory IgA. Yep, there it is, yep. So, that one, if that’s low, you know, that’s a problem because that can actually engulf pathogens, so they can’t attach to the bowel wall, can take them so the immune system knows that’s a bad guy, we got to get rid of it. So, if you have a good stomach acid, good bile, those are antimicrobials to kill things, if you have a good secretory IgA, that’s your gut immunity, that’s gonna protect you, it’s our first line of defense. So, again, if I see an E. coli, I may not need to do some protocol to get rid of it, it may just go away on its own. But I’m looking for the deeper issues. You know, if you don’t have good stomach acid, you’re probably gonna pick up E. coli again next summer or whenever you again eat something that has it on it. 

Dr. Justin Marchegiani: That totally makes sense. I’ll scroll back here to page one, so we can go in order, uh, and then obviously we have some other food poisoning types of bacteria here Campylobacter, uh, Salmonella, we may see in chicken. Do this change anything for you if someone still has something lingering and some gutted gut issues, I mean, you’re still going to try to address it with some herbals when it’s appropriate. 

Lisa Pomeroy: Exactly! Yeah. Some of these and there is, you know, research keeps coming out where we’re thinking something like Campylobacter, you know, we think it’s something that just temporarily stays in the gut and then it’s gone. It’s kind of like a hit and run, where it does its damage and then it leaves the gut repairs. But, in some people, they’ve actually done some duodenal aspirates and find that, you know, they can actually find it still in the gut and the person hasn’t had that recent food poisoning incident. So, there is a little bit of a question with some of these, could they actually stick around a little bit longer and that’s definitely a problem too. So, if they show up on a single report, you know, say Campylobacter, shows up, my initial assumption is yeah, you probably ate some chicken or something lately that had it, but if I’m seeing repeated tests, maybe it’s a chronic colonizer or maybe you keep getting food poisoning, maybe you’re eating at some local fast food chicken place that maybe doesn’t have the best quality chicken or again, you have low stomach acid. It takes very few organisms to infect you if you have low stomach acid, so again, we need to look at, is this a chronic issue for repeatedly seeing it. Is this low stomach acid, low gut immunity, something’s wrong.

Dr. Justin Marchegiani: Exactly. And then same thing here, we have different types of sugar toxins which are, these are toxins actually produced by the E. coli, is that correct?

Lisa Pomeroy: Yeah, E. coli was kind of unique in that there’s, they’re all pathogenic E. coli. You can kind of lump them all together that, but they have different mechanisms of actions, different toxins they produce and so they kind of each got their own special name even though you can all just lump them all together, they’re just food borne pathogenic E. colis.

Dr. Justin Marchegiani: That are gonna produce different toxins that would create inflammation. 

Lisa Pomeroy: Uhum, yeah. 

Dr. Justin Marchegiani: So, either way, you’re gonna be, you know, trying to clean out the diet and use some kind of herbal to kind of knock it down so to speak. 

Lisa Pomeroy: Yep, and I look at food quality, I also, you know, because something like, you know, again, chicken could be a source of Salmonella, Campylobacter. If you’re eating conventional chicken versus organic chicken. They found, you know, when they’ve actually done research studies on this the non-organic ones are more highly contaminated with these bugs than the organic plus they tend to be more antibiotic resistance. So, say, if you do get Campylobacter, Salmonella, chances are it’s going to be a very nasty type that’s not going to respond to treatment, if you did need treatment. Um, and then certain, techniques too like, you know, personally I get organic pastured air chilled chicken because there’s again how is the chicken processed, they can put it in a chlorine bath which is just essentially like a fecal soup, they have all of these chicken carcasses just in this big tub of chlorinated water. And so, if you have one contaminated chicken carcass in this big pool, it can contaminate other ones. Versus air chilled, they’re kind of, you know, just single hanging on their own, so again, they’ve done the research where air chilled is less contaminated with these microbes. So again, whether you’re susceptible or not, I mean, I still don’t wanna, you know, I do my best cleaning my produce, you know, buying good quality food. So, we’re looking at food hygiene, food quality, but you know, you do things the little things that you can do, when purchasing these things to prevent your exposure. 

Dr. Justin Marchegiani: Okay, cool. We also skipped, I think C. diff out of the gate so C. diff is a bacterial infection, it can, it’s common in hospitals. High levels of antibiotics can mess up your gut and create an imbalance there, um, obviously toxins A and B together tend to be more synergistic and worse than just one. Do you want to add to that at all? Comments to that?

Lisa Pomeroy: Yeah, so a lot of people see this test and they panic when C. diff comes up because we know that C. diff can be a nasty infection. However, we have to keep in mind what this test is measuring, is the bacteria not the toxins. So, what this tells you is that, there’s C. diff bacteria in the gut that carries the gene that would allow it to produce toxin A and or toxin B. Whether it’s actually doing that at the moment is the question. So, what’s defined as C. diff infection is the bacteria are there actively producing the toxins and the toxins are whether damaging the gut causing the diarrhea, the classic C. diff presentation. 

Dr. Justin Marchegiani: What is that?

Lisa Pomeroy: Now, a lot of people are actually colonized with C. diff, where the bacteria is there but maybe you have some good guys that are keeping it in balance preventing it from turning on those genes and producing the toxins and so that’s where it’s important to have the good bacteria there to not wipe them out by antibiotics or other things. So, we can’t differentiate between infection or colonization here, you know, this is just telling us, C. diff bacteria is there and you know, we don’t really want it there. Now, if someone does have symptoms that indicate a possible infection, you know, we certainly could do further testing and actually test those toxins to confirm. But a lot of people, if they say, well, I’m constipated, you know, probably not a C. diff infection, you know it’s, if they don’t  present like those classic symptoms, it’s probably more colonization which is far more common but I still don’t want it there because it’s essentially lying in wait, waiting for the opportunity, you get a UTI, you take around antibiotics, now again, you killed the organisms protecting against this, so now, you do turn on the gene, get the toxins,  get the C. diff infection. 

Dr. Justin Marchegiani: So, we have the bacteria that has potential to make this toxin but it’s not necessarily show that the same toxin, they are b is present. It’s more the potential of it based on the bacteria.

Lisa Pomeroy: Exactly! This tells us about the bacteria and not whether toxins are actually being produced. 

Dr. Justin Marchegiani: And this Clostridium, isn’t the same as on page two. This one is a little bit different but this is a kind of more the overall class where this is more of the specific type of Clostridium within that class. Is that correct?

Lisa Pomeroy: Exactly! So, C. difficile is a pathogenic organism that’s part of that large group. 

Dr. Justin Marchegiani: That family. 

Lisa Pomeroy: Yeah, but Clostridia actually has a lot of beneficial butyrate producers. So, this is just picking up, there’s a very small subgroup of maybe more pathogenic potentially harmful ones within the group. 

Dr. Justin Marchegiani: Okay. Very good! Excellent! Anything you want to see down here? I mean we have you mentioned a kind of Salmonella, more connected to chicken and eggs, things like that, uh, cholera more waterborne. Anything else you want to say about Cholera or Yersinia?

Lisa Pomeroy: Yeah, so, Vibrio in the U.S. the most common source is actually seafood. So that’s what I’m checking to see if it’s like, okay Vibrio comes up, which doesn’t all that often but once in a while it will. I just check, you know, did you eat seafood recently and it’s always, oh yeah, I had some shrimp and you know, again, may or may not had those acute symptoms but you know often there’s recent seafood consumption. Now, in other countries, it’s more through the water, through, you know, just dirty water that has fecal contamination, here it’s usually seafood. 

Dr. Justin Marchegiani: Okay, very good! And then, um, Yersinia, you said, is that seafood as well? That was just the vibrio?

Lisa Pomeroy: That’s just a vibrio. Yeah.

Dr. Justin Marchegiani: How about Yersinia?

Lisa Pomeroy: Yeah, that one can come through many different sources, um, sometimes it could be, you know, even raw dairy products, could be pork, you know, many different sources for food, uh, but this one actually can be a trigger for Hashimoto’s. So, it doesn’t show up. 

Dr. Justin Marchegiani: It can. 

Lisa Pomeroy: It can, yeah. So, it doesn’t show up all that often but if it does, I’m looking at the thyroid antibodies and other testing or seeing if there’s already a diagnosis of Hashimoto’s. 

Dr. Justin Marchegiani: Very good! And then parasite wise, we have Crypto, E. histo, and Giardia, which definitely are the big three, right, um, Crypto primarily found in water, E. histo is going to be nasty little amoebic that people don’t know it’s in the top three to five causes of death in third world countries. It’s a nasty little bugger. 

Lisa Pomeroy: It is!

Dr. Justin Marchegiani: And then Giardia, as well, which loves to hide in the gallbladder. I’m gonna let you kind of go into those one by one. Quick question, why do they have these parasites here and then on page four, a separate section for parasites? Why don’t they put them all in one spot? 

Lisa Pomeroy: Yeah. My thought is that, you know, within the medical community, certain pathogens now are widely accepted as disease causing. So, like, pretty much, I mean a conventional doctor, a functional medicine doctor, they’re all going to say, you know, Crypto, Giradia, E. histo are bad. You know, we don’t wanna see those. Now, Blastocystis hominis, you know, most functional medicine practitioners will say that, that has a lot of potential to cause harm, linked it with Hashimoto’s and you know, hives and IBS. But from the conventional standpoint, they’re not entirely convinced because some people can have Blasto and not have symptoms. So, the ones on page four, there is research supporting that all of them have pathogenic potential but they’re not as widely accepted as a 100% pathogenic unlike the ones on page one. 

Dr. Justin Marchegiani: Makes sense. I know a lot of people like Mayo clinic are starting to say, hey if you have Blasto and have some level of symptoms, well, you probably should address it, you know, most people that we see the problem is. Well, what constitutes a symptom from Blasto for instance we know a lot of gut issues can cause extra-intestinal symptoms like fatigue, brain fog, mood issues, sleep issues. So then, how do you really connect the dots? Obviously, we have diarrhea, constipation, acid reflux, bloating, right? But sometimes you get these extra intestinal ones which are a little weird. 

Lisa Pomeroy: Exactly! Like Blasto, people say, oh well I have no gut pain, and then I start asking more about their symptoms like, oh well, I do have chronic hives, and I have joint pain and I have, you know, these other symptoms, it’s like. Well, I can show you research study that’s linked that to Blasto. Yes, it’s not a gut related system symptom, but it’s been linked to blasto.

Dr. Justin Marchegiani: 100% Yeah, very good. 

Lisa Pomeroy: Yeah. Yeah. So, going over the page one pathogen, so yeah, Cryptosporidium, Giardia, those are actually both small intestinal infections, whereas the E. histo is a large intestine infection. Um, but Crypto and Giardia, often can be from the water, so we do have to look at drinking water and for Giardia, recreational water can be a big source too. So, again, a lot of these pathogens have their seasons. So Giardia, we can see more prevalent in the summer months because people are going in and swimming in lakes and streams and rivers and swimming pools and you know, or going water rafting or you know doing things recreational water parks and you just get a mouthful of water and chlorine doesn’t consistently kill it unfortunately. So, you still could get it or it could be your well water so I was always look to if we see Giardia, what are you drinking, you know, are you drinking well water, is it filtered, you know, are you, do you swim in lakes and streams, ponds, you have a swimming pool, so we always want to look at that because sometimes if there is, if it is well water and it has Giardia and you can often test your water for these bugs too, you know, we wanna make sure we’re getting rid of that source. Um, but yeah, I mean that could be, these can be nasty again. You can pick them up on the food. All of these have what they call the fecal oral route. So basically, if you know, again, it could be animal poop and stuff that just gets on your leafy greens because your cattle farm is next to your lettuce farm. There’s a little runoff and yeah, it’s hard to wash your produce. I mean, I still recommend soaking fresh produce in water with a little vinegar or hydrogen peroxide in it to try to kill those bugs. But even still, I mean, lettuce has so many little nooks and crannies, it’s hard to get it all killed.

Dr. Justin Marchegiani: Absolutely! And we probably want to make sure every patient that we see, the clinician that we see is recommending a good quality water at least a carbon-based one or ideally even at reverse osmosis just really make sure we filter out all those potential parasitic cysts plus water’s got a whole bunch of nasty things in it, like chlorine, like potential fluoride and pharmaceuticals that you want to filter out as well. 

Lisa Pomeroy: Exactly! Clean water is a must whether it’s the bugs or the toxins.

Dr. Justin Marchegiani: Exactly! Any other comments on the viral pathogens here? 

Lisa Pomeroy: Yeah again, those you know, again, tend to acute rather than chronic colonizers. Although, again, Norovirus, there is some evidence, it could be a chronic. But you know, these will feel often like a stomach flu. So again, you usually pick it up more your food like poisoning. But, some of these, you could pick up, like Norovirus, say you go to a public restroom, you touch the faucet handle and then you eat your lunch without washing your hands. You know, if you touch something with the virus, you put your hands in your mouth, you could pick up something like Norovirus from touching objects too. But, usually feels like a stomach flu. 

Dr. Justin Marchegiani: Okay cool. Well, let’s drive into H. pylori here next, um, and also just a little reference range, um, tidbit for a lot of folks here. If you’re trying to figure out the reference range, you see, I don’t know, let’s say. Let’s go on to see where’s a good example. 

Lisa Pomeroy: Well, H. pylori, it’s a big one too. 

Dr. Justin Marchegiani: Yeah, but if you look at E. coli, you’re trying to figure out where this fits in the reference range. If the exponent is below the reference range, then you got to move to the left. So, this really is .00860 and then if its above, like this, this is e to the five, right, then you have to move to the right to make it just to make it equal, um, the exponents kind of throw a lot of patients off that I, I find when we go through them all. 

Lisa Pomeroy: Yeah. Exactly. Yep.  And it’s just, it’s in scientific nomenclature, yeah, it’s just otherwise, you have a ton of zeros. Yeah. It just cleans up the report. 

Dr. Justin Marchegiani: Exactly!

Lisa Pomeroy: And there’s nice, like these are powers of ten, so you can get like powers at tens chart like e3 is a thousand. So, you can go, oh, that’s e3 is a thousand, take the 2.9 multiply it, that’s 2900 cells. 

Dr. Justin Marchegiani: Exactly! Exactly! And then really quick here with the H. pylori. I haven’t seen the last year so a ton of virulence factors come back on my patients. Have you seen that as the lab kind of tone down the sensitivity with that? Have you noticed?

Lisa Pomeroy: It depends. Fortunately, we don’t see them often, which I mean the problem with virulence factors is they’ve been associated in the literature with higher risk of gastric cancer, gastric ulcers, cardiovascular disease. So, if you have H. pylori that has these attached to it, it has more potential to cause harm and disease. Now, I just saw one yesterday, where she has a history of H. pylori and unfortunately, she got it back again and she had it pretty much looked like this one. It had like four or five virulence factors, which is what she was dealing with before too. So, we do still pick them up, you know, again, fortunately, it’s not as often because this is the really nasty type of H. pylori, you don’t want to see. 

Dr. Justin Marchegiani: Exactly! And then, regarding the reference range, this is above one. If someone is borderline or a little bit below, would you typically want to treat them or let’s say if they had symptoms, would you still want to treat them? 

Lisa Pomeroy: Yeah. So, it becomes more of a clinical decision if it’s below that of a thousand cell threshold. But we have had people have like, this is a 2.9 e3. We’ve had people like a 2.6 e2, which is just 260 cells. They’ve had endoscopies and have been told that their stomach was covered in H. pylori and highly inflamed. So, sometimes, this can be the tip of the iceberg. We have to remember where is this infection located. This is a stomach infection. So, something in the stomach, you know it depends on how much is being shed into the GI tract that day. It’s got to travel 20, 22 feet through the intestinal tract to come out the other end. So sometimes, this is going to be heavily diluted from what we started out with. So, this could, yeah, so this could be a glimpse of what’s there. So that’s where there I, you know, it comes down to the clinical decision, does this fit. If someone comes in and they have gas and bloating and GERD and reflux and stomach pain and I see a borderline level, a moderate positive, I’m probably gonna do a protocol because it fits. Now, if this was a very low level and they had absolutely no symptoms and I looked through the rest of the report, their microbiome looks good, their enzymes look good, their gut immunity looks good, maybe it’s okay. Maybe they have good Lactobacillus and things keeping it in check. But I wanna see signs that it’s not causing any harm so that’s where I look at the symptoms, the history, the rest of the report. 

Dr. Justin Marchegiani: That makes sense. And then with these cytotoxic proteins, are these more genetic type of risk factors because of the, because of the genes or are they specifically connected to the H. pylori and if you knock down the H. pylori, will knock down these cytotoxic proteins? 

Lisa Pomeroy: Exactly! So, these are genes attached to bacteria. They’re not related to the person. So, as you kill the bacteria, the virulence factors go with the bacteria. 

Dr. Justin Marchegiani: Got it! You can clear them as the bacteria gets knocked down. You can, you can knock down the bacteria that has those genes attached to it.  

Lisa Pomeroy: Exactly! Like, if you have babA that just allows the H. pylori to stick to the stomach a little bit better. So, we have to, we might bring a little cranberry juice because that has an anti-adhesive property to it. So, we just try to undo that little trick that the H. pylori has which here, the babA allows it to stick so we’re going to do something so it can’t stick. 

Dr. Justin Marchegiani: Oh, would that be a good recommendation if you had H. pylori without the babA?

Lisa Pomeroy: You could actually because there is research that shows that cranberry juice seems to kill H. pylori and just prevent it from ticking to the stomach wall. So, with babA, I definitely would include it but I also often include it just with H. pylori. 

Dr. Justin Marchegiani: And then, if you address someone like round one and there’s still some H. pylori left or you didn’t move it a ton, are you gonna try a second round with different herbs and just kind of mixed them up? How do you address patients where you don’t quite get the result you want the first round? 

Lisa Pomeroy: Yeah, and this is when we’re using herbs, especially the herbs we traditionally use things like mastic gum, DGL, Licorice, they don’t have the major impact on the beneficial flora. So, it’s not like we’re going in there with some really super strong herbs a lot of times that will just knock out everything and so we can often use repeated rounds of some of those herbs safely without disrupting everything else. But I have had people were, especially skin conditions where until we get that H. pylori less than DL, their skin won’t clear up. So, for me, I looked to see now if they’re feeling great if we knocked it down and there’s a little bit again, it’s always a judgement call but I’ve seen people with acne, with eczema, where until it hits a less than DL, they have the symptoms, the second they hit less than DL they’re gone.

Dr. Justin Marchegiani: So, are there any other herbs that you’ll pivot off the mastika or that you use synergistically with it or that you’ll rotate in if first round didn’t work that you’ll pivot on the second or third round with? 

Lisa Pomeroy: Uhm. Yeah. So, a lot of times other organisms can actually promote the colonization of H. pylori like yeast is a big one I look for because there’s, yep yeah, and there’s actually research that yeast and H. pylori have what researchers call an intimate relationship. So basically, if there’s yeast and H. pylori together in the mouth or the stomach, the H. pylori can go and hide inside of the yeast and kind of seek refuge inside of it and then later come out when the coast is clear. So, if I see a bunch of yeast on the next page, I may need to bring in some antifungals at the same time trying kill H. pylori or it’s just gonna hide out and just come out later. So, that can be something we miss, you know, H. pylori can produce biofilms and hide inside a yeast. Some bacteria can produce hydrogen and that hydrogen also can fuel the growth of H. pylori. So, that’s where sometimes I do look at. Okay, let’s bring in some Berberine, some Oregano, some Neem, some Pau D’Arco silver, something that’s gonna also address the bacteria or the yeast or some biofilm disruptors like NAC, and acetyl cysteine, can break down H. pylori biofilms. So, I’m thinking about all of those things because those could be what we’re running into a wall. 

Dr. Justin Marchegiani: Makes a lot of sense. Very good. Any of the comments on the H. pylori and then also like what are the big virulence factors to look out for, like a top three?

Lisa Pomeroy: Yeah, I mean, some of the nastier ones we’re thinking more like gastric ulcers, gastric cancers, cagA is one of those big nasty ones. Um, dupA, the dup is duodenal, so that one’s a little more duodenal ulcer. VacA, that again, is another one, where ulcers, cancer. So, I’d say, the three worst one, the cagA, dupA, the vacA. I mean, yes, babA is not a good thing but it’s more allowing it to stick to the stomach a little bit more, it’s gonna be a little bit invasive, a little more inflammatory. But, you know, those other three are just especially nasty. 

Dr. Justin Marchegiani: Got it. The cag, the dup, and the vac?

Lisa Pomeroy: yeah

Dr. Justin Marchegiani: Okay. Very cool. And now we go into the normal bacteria. These are commensal flora, normal flora in the gut but we can kind of gain a little bit of insight what’s happening in the gut based on these imbalances. I mean, out of the gates we have, you know, just out of the gates, we have Lactobacillus, which is a beneficial flora that’s low so we’re certain starting to see low levels of beneficial bacteria. Anything you want to say kind of from this section down?

Lisa Pomeroy: Yeah. And again, we can tie this with other sections too like Lactobacillus actually lives in the stomach and it’s very antagonistic towards H. pylori. So, if I’m looking at this and going well, we have a nasty H. pylori and infection, we have low levels Lactobacillus, I’m gonna get, get a lactobacillus probiotic in here, to try to help not only get more Lactobacillus in the system because it’s clearly lacking but it’s gonna help push out some of that H. pylori from the stomach. Now, in general, I look at, you know, do we have highs, do we have lows, because even though these are good guys, too much of a good thing is a bad thing. So, I still don;t wanna see highs or lows. Now, lot of times, when things are low, it’s often something killed them. So, I look for a history, did you take antibiotics recently or things like artificial sweeteners, like you know, splenda, sucralose, it’s a chlorinated sugar, chlorine kills bugs including the good bugs, so we need to be looking at agian the diet. Are you doing something that’s killing these, do you eat GMO foods, food sprayed with glyphosate? Glyphosate is patented as an antibiotic, again it’s gonna kill your good bugs. So, are you doing something that’s killing them or are you starving them, you gotta feed your bugs, they like fiber, so if you’re restricting fiber in your diet, if you’re not eating lots of whole fruits and vegetables and beans and nuts and seeds and you know maybe some gluten-free grains. I mean all of these things have the fibers that these guys love. 

Dr. Justin Marchegiani: 100% and so a lot of fibers, a lot of fruits, a lot of vegetables. If someone were to go carnivore, would you see a lot of these commensal flora drop typically?

Lisa Pomeroy: You do, unfortunately. Yeah. Unfortunately, we have seen some reports for people who are doing carnivore and especially if there’s low stomach acid, especially if there’s H. pylori, you’ll see, a lot of the ones, the opportunistic ones on the following page go really sky high and you’ll see lots of low levels here because these guys like their fiber. Now we don’t test some of the bile loving bugs here but you know if you were testing those, we would expect to see some of the protein degrading, you know bile loving ones, those are the ones that are gonna go up but they’re also ones that produce things like hydrogen sulfide which can be very pro-inflammatory in excess. So, while it may relieve some symptoms, I’d rather look at why can’t you digest your foods and vegetables and carbs and that kind of stuff. You know, there’s probably an infection like H. pylori or some dysbiosis instead of restricting your diet so severely and starving your good bugs, let’s get rid of these bigger issues, get you digesting better so you can have those foods again.

Dr. Justin Marchegiani: Very good. And so, out of the gates there, any specific changes that you’re gonna see, you’re gonna make outside of those recommended diet or lifestyles? Things for like Faecalibacterium prausnitzii, Akkermansia, any specific changes there?

Lisa Pomeroy: Uhum, yeah. So, Faecalibacterium prausnitzii is the major butyrate producer, so butyrates are very anti-inflammatory in your gut but it also has an effect in the brain. Butyrate produced in your gut will cross your blood brain barrier and have an anti-inflammatory effect in your brain, stimulates BDNF – Brain derived neurotropic factor, can help with anxiety. So again, we’re not just looking a gut impact here, we may see this is low with skin conditions and anxiety and all these other issues. But this loves fiber, loves resistant starch, so I might suggest, you know, let’s eats some, you know, rice that’s been cooked and cooled or some potatoes or roots and tubers that have been cooked and cooled because if you cook these foods and then you cool them it creates resistant starch. So, like something, like potato salad would, you know, Faecalibacterium prausnitzii would really happy with some potato salad. But also your fibers, you know, fruits and veggies, roots and tubers, all of that stuff but it wants fiber. 

Dr. Justin Marchegiani: Very good. And what if some of those foods cause people to get more bloated or gassy like let’s say they have issues with nuts or have issues with legumes or lentils, would you suggest they continue to eat that even if they feel bad or listen to their body in that?

Lisa Pomeroy: Yeah. We always want to listen to the body, you know, some foods are just harder to digest than others so some people especially if your gut is very damaged and inflamed, maybe you can’t handle the beans, legumes, lentils right off the bat. So, we find different foods, you know, other fiber-rich foods that don’t cause that discomfort and sometimes it’s about portions too, so something like an apple. Maybe you can’t have a whole apple because it has a lot of fermentable carbs but you can have two apple slices or you can’t have a whole plate of asparagus but you can have two spears of asparagus and a stir fry. So, we’ll always look at those things but I also look at enzymes. You know, if you don’t have enzymes to break down these foods, you’re probably gonna feel too good with them. So, I’m always looking at elastase, one again later in the report if that’s low. I’m bringing in a pancreatic enzyme supplement because that not only helps with your gas and bloating and you know all those digestive symptoms but also helps of the dysbiosis because if you’re not digesting your food, your bugs will, so you’re giving them all you can eat buffet if you don’t digest your food. So, enzymes are really key and they’ve actually done some really cool studies finding that, that low elastase one is actually a more influential on your microbiome than your diet and all these other factors. You know, having poor digestion will highly influence what’s growing and not growing.

Dr. Justin Marchegiani: Very cool. Anything else you want to say about, um, the different families of bacteria so the conventional thinking is Bacteroides is very helpful very important to have in your tummy in good amounts, uh, Firmicutes the high levels of this one tends to so that you know the B for Bacteroides, B for beautiful, very beneficial. Firmicutes, one of these ones where high levels increase calorie extraction which potentially some correlation with weight gain in the literature. Any comments on these?

Lisa Pomeroy: Yeah, so again, it’s all about balance. So Firmicutes is actually where a lot of those butyrate producers are. They’re in this category. So, both, you know, we can’t say that either one is good, one is bad but good guys and bad guys in both categories so it’s just all about having that balance there. And yes Firmicutes, they can, you know, make you retain more calories from your food so you could gain weight, if they’re abundant but I’m looking at if your Firmicutes is getting too high it’s probably you’re eating too many carbohydrates or you’re not digesting them. So again, if I see this high and your enzymes are low, I’m getting those enzymes in there and we’ll often see this balance out. 

Dr. Justin Marchegiani: Yeah. And then, you may want to address either fermentable, FODMAPs or even go lower carb as well?

Lisa Pomeroy: Yeah, depending on it again, I look at symptoms, I mean I don’t want to starve the colonic bacteria, so I’m just, you know, a lot of times just finding which fibers are triggering symptoms, can we get some enzymes in there. There’re actually enzymes now that are specific for digesting high FODMAP foods and so I’ll bring in something like that where you know they’ll say, we’ll I love onions, but you know I just get such terrible gut pain afterwards. You take this enzyme, you can eat onions. So, your microbiome, loves onions, you know. Yes, they are highly fermentable they can cause more symptoms but if you get the proper enzymes in there, a lot times you’re fine and your gut microbiome will thrive on those foods. So, I’m very careful about what I take out, because you know, I don’t want to trigger symptoms but I also don’t want to starve bacteria.

Dr. Justin Marchegiani: Um, very good. And then what about increasing Bacteroidetes, is anything specific to help with that? 

Lisa Pomeroy: Yeah, so maybe again, it’s something you know, if they’re low we think about, you know, fiber again the whole like more plant-focused foods but something too we know about Bacteroidetes, they don’t like excessive fermentation, so that’s where again, I look and connect the dots here. H. pylori showed up, H. pylori in most people causes low stomach acid. If your acids low, you’re probably excessively fermenting your food. Bacteroidetes don’t like the pH shift that occurs as a result of that, so they’re just not going to do well. You know a lot of these bugs what’s growing is going to be determined by pH and oxygen levels. So, chances are, you know, if you get some plenty of fiber in the diet get rid of that H. pylori that’s suppressing the acid causing excessive fermentation, these again could just balance out. 

Dr. Justin Marchegiani: Very good. Excellent. And anything else? Let’s hit the dysbiotic bacteria section. So, these are quite frequently going to be found in general dysbiosis or SIBO right? Um, Bacillus is kind of this beneficial spore like probiotic that you get in megaspore or thrive or lot of these newer probiotics that are out. Why don’t you take it from there so with this one there’s a certain threshold that you like to see it stay below but if it’s a little bit high, is that okay? 

Lisa Pomeroy: Yeah. So, bacillus actually, a healthy gut should have some Bacillus in it so this is one we actually see a number next to that Bacillus species on every single report. So, an e4 e5 is actually pretty typical. With this one, I’m actually more concerned if I see a less than DL. To me, that’s more of a deficiency of this. So, you know, if it’s low, I mean, again we think about the diet and all those things we can supplement since we do have them available in probiotic form. Now, if it’s high there’s been a link between poor digestion and excessive levels. So, if it’s going high, I tend to think, okay what’s going on with stomach acid with enzymes with all of those things. So, that’s what I’m usually supporting if it’s getting high. 

Dr. Justin Marchegiani: Very good. Excellent. Probiotic, enzymes if it’s getting high. Anything else with restriction of carbohydrate or FODMAPs at all?

Lisa Pomeroy:  With that one, I don’t usually do too so much. It’s more just uh focusing on if something’s causing low stomach acid like H. pylori. We need to deal with that bigger issue but it’s often more just poor digestion, digestive dysfunction.

Dr. Justin Marchegiani: Very cool! Anything you want to say about the general dysbiotic bacteria below? We can start with the despotic section. I mean, is there any rhyme or reason of why one may proliferate in someone’s gut over another or is it just kind of the dumb luck of you know, too much sugar, too much carbs, antibiotic exposure, not cough beneficial flora to compete? How does like, why would one proliferate over another?

Lisa Pomeroy: Yeah, so there’s definitely certain conditions that will promote some over others. Like we see, Klebsiella there in that bottom section. It not only causes inflammation but it loves inflammation. If your gut becomes inflamed, it’s going to bloom. So, with this one if your gut is inflamed because you have a, you know, crappy diet because eating a bunch of food additives and proinflammatory foods. You’re lacking those good butyrate producers. You know, all of these things have changed in your gut to make it inflamed that’s gonna make your Klebsiella very happy and it’s gonna become overly abundant like this or things like, you know, certain things have been tied in the research with low stomach acid. So Streptococcus, you know, one of the top things, you’re going to see with low stomach acid again this individual is dealing with H. pylori. So, we’re probably going to see some high Streptococcus, which we do. Besides Streptococcus, Staphylococcus tends to show up with low stomach acid. Again, right above that there it is and Enterococcus. Now, Enterococcus here was more a moderate overgrowth but still it is showing up a little bit which it’s fitting with this pattern. The more things that you have showing up that fit that pattern the stronger it is. So, I’d say, the enterococcus, the Staph, the Strep, Klebsiella will see more with low stomach acid and even Pseudomonas. Pseudomonas thrives when there’s a lot of undigested protein around. So that’s another one where, this page to me looks like a classic consequence of having low stomach acid. So again, we have to think upstream what’s causing them, that correct that but we also may bring in some antimicrobial herbs because this has gotten to such a state where we may not be able to just get rid of these by dealing with those bigger upstream issues like H. pylori and low enzymes at this point.

Dr. Justin Marchegiani: So, the Enterococcus, Staph, Strep, and Klebsiella, when you see them elevated, there’s going to be more of a connection with low stomach acid and probably low enzymes too because those are connected as well right?

Lisa Pomeroy: Exactly! We often call this the digestive dysfunction pattern.

Dr. Justin Marchegiani: Okay. How do artificial sweeteners impact this or even things like pesticides will they have a kind of negative impact like an antibiotic. How does that work? 

Lisa Pomeroy: Yeah, they can. That’s what they find a lot of the artificial sweeteners they find that they tend to kill things like Lactobacillus and Bifidobacterium, and yet they promote a lot of times it’s this one other phylum which is called Proteobacteria, so Klebsiella is a member of Proteobacteria. Pseudomonas is a member of Proteobacteria. But they’re really virulent, more proinflammatory organisms that will tend to bloom again with more inflamed conditions higher oxygen and they also tend to go up when we have food additives and chemicals and pesticides and all of that. So, you see a lot of the research, it’s kind of like the, the bad dysbiosis pattern you’ll see is these high Proteobacteria, like again, high Klebsiella, high Pseudomonas, with low butyrate producers like for Firmicutes, low Clostridia, low Faecalibacterium prausnitzii. So too many proinflammatory bugs not enough anti-inflammatory bugs. 

 Dr. Justin Marchegiani: Got it. And so lower butyrate, uh, not enough anti-inflammatory bugs and that’s more with what Provatella, Proteus, Fusobacterium, was the big ones there?

Lisa Pomeroy: Those are gonna be your more proinflammatory ones again. Yeah. Anything in your potential odder will trigger susception. 

Dr. Justin Marchegiani: with low butyrate

Lisa Pomeroy: With low butyrate, yeah. Because that’s going to change the environment that will promote their growth. 

Dr. Justin Marchegiani: And so, when you are working on producing butyrate, can things just like butter which is butyric acid, can that have an influence? Are you trying to also add in potential resistant starch or probiotic fibers or adding just actual Butyrate in there? What are, what are your thoughts on each one of those and what do you do to try to impact butyrate?

Lisa Pomeroy:  Sure, yeah. I mean, butter or ghee it does have some butyric acid or butyrate. It’s just, it’s so small, it’d be hard to get therapeutic amounts plus a lot of people are dairy sensitive especially when their gut is damaged and leaky. 

Dr. Justin Marchegiani: Can be for sure

Lisa Pomeroy: Yeah. So, if I’m going to supplement or try to get more butyrate in, I look at, I mean, we could use a tributyrin supplement, you know that can be really great like if I see, if all the butyrate producers are low and their calprotectin is high which is telling me their gut is inflamed and they have a lot of GI discomfort and they also have a lot of food sensitivities. Getting that butyrate in there directly can often calm things down or diarrhea. Butyrate can be terrific for diarrhea. We’ve seen chronic diarrhea that’s been going on for years or decades. Stop within a week of giving some tributyrin. So, sometimes I do give butyrate directly or IBD I’ll often use some butyrate directly because the gut is so inflamed that can be really helpful. But a lot of times, you know, people don’t necessarily want another supplement. You know if I’m not seeing those major signs where I definitely want to add it in, I may just be let’s feed the butyrate producers. Yes, we can give the end product but you’re still not feeding them, you know, I always think of like the butyrate is more like giving you healthy soil that’s going to promote their growth but you still got to feed them. They’re not gonna grow if you don’t feed them. So, you got to get the fiber in there, so I look at, you know, you can feed them with the fiber, you could get the butyrate in there and maybe you want to do both. They find that actually giving the butyrate and the fiber which is promoting the environment and giving the fertilizer to feed them, you get an even stronger impact. So many different options what we may do, any combination of those.

Dr. Justin Marchegiani: So, if it’s only those bacteria are in the lower sides. If they’re higher, would you also still want to do that?

Lisa Pomeroy: Depends what we’re seeing, I mean, again, if the gut is highly inflamed, I may bring it in or there’s terrible diarrhea, I may do it more for symptomatic relief. But, you know, if those bacteria are in good shape, you know, we don’t necessarily need to do that to encourage them to grow by shaping the environment but there’s still other reasons, we might use butyrate. 

Dr. Justin Marchegiani: Is it more of a concern when they’re higher or lower?

Lisa Pomeroy:  It’s low that it’s more there’s usually a deficit of the short chain fatty acid butyrate if they’re low because if there’s low population, they’re not making enough butyrate 

Dr. Justin Marchegiani: That’s less than DL you’re looking at, right less than DL

Lisa Pomeroy: Yes, these aren’t the butyrate, those are on the previous page, um.

Dr. Justin Marchegiani: You’re talking about the commensal stuff here.

Lisa Pomeroy: Yep. Yeah. So, the three markers that represent them are the Firmicutes phyla, at the very bottom. Yup, the Clostridium class and then Faecalibacterium prausnitzii. 

Dr. Justin Marchegiani: Okay, got it. These are the big three, Clostridium, Faecalibacterium and Firmicutes, these are the big butyrate producers. 

Lisa Pomeroy: So, there’s low, if they’re low you just could try feeding them or if the guts really inflamed again, they don’t like an inflamed environment so you may bring the butyrate in to try to take down some of the inflammation and then give them the fiber and now they’re really gonna grow. 

Dr. Justin Marchegiani: Got it. Okay. Very cool. Anything else you want to say about the like Citrobacter or these despotic bacteria individually, I mean, a lot of these are gonna be commonly found in SIBO right, but because it’s a stool test and all of it, it’s moving through the intestines, we wouldn’t necessarily say this SIBO unless we had like a breath test but we could say that’s a kind of a generalized dysbiosis.

Lisa Pomeroy: Yeah. And some of these bacteria we look at like Klebsiella, Pseudomonas, they just live in the small intestine that’s just their area that they hang out but it’s not necessarily SIBO, you know, yes, they’re in the small intestine but SIBO is when there’s too many overall bacteria in the small intestine, sometimes you just have a dysbiosis. You know, it may just there’s not, overall, it’s just Klebsiella and Pseudomnas are too high. 

Dr. Justin Marchegiani: And so, you’re gonna utilize like a breath test, a lactulose, where you’re looking at hydrogen and methane gases and see if they’re really elevated to really know that. 

Lisa Pomeroy: Yeah. If you wanted to see more of that SIBO picture, is there too many bacteria in the small intestine because maybe you had food poisoning incident before and your migrating motor complex that kind of that street sweeper isn’t working well to push the bacteria out. But if I’m looking at these, yes, these are in the small intestine, they’re overgrowing you know, maybe there’s other things overgrowing in the small intestine with them but you know to me it’s something, I’m looking at, you know, low stomach acid, low enzymes, is a huge factor with bacteria in the small intestine. So many cases, we can work on digestion, H. pylori, get some antimicrobials in there and often takes care of those whether even though, they’re in the small intestine versus a colon.

Dr. Justin Marchegiani: Cool. Anything else you wanna say about these individual dysbiotic critters?

 Lisa Pomeroy: Yeah. Well, Klebsiella, since this one shows up, these are, you know, besides being very proinflammatory, they are putting, you know, putting you at increased risk of perhaps developing autoimmune condition. So, like Klebsiella is something that’s been linked with rheumatoid arthritis, ankylosing spondylitis, IBD. So, if you had that perfect storm, if you have the bacteria which is your trigger, you have a leaky gut and you have the genetics that make you predisposed to getting say rheumatoid arthritis. It could lead to that down growth. So that’s we’re seeing signs, you know, maybe you don’t have rheumatoid arthritis now, but 10 years, 20 years, 30 years from now, if you don’t do anything about Klebsiella, it could turn into that. So that’s where again we look from a functional medicine perspective, you know, we wanna try to head off a lot of these symptoms too and that’s where we can get a glimpse into that now, with the stool testing to try to get rid of this. Now, so it doesn’t become a future problem. 

Dr. Justin Marchegiani: Very cool. Anything else you wanna say on these down below the Proteus or the Fusobacterium?

Lisa Pomeroy: Uhm. Yeah. Now, some of these actually live in the mouth, so Klebsiella lives in the mouth, Provatella lives in the mouth, Fusobacterium lives in the mouth. So, we can’t forget other microbiomes too. So, they’re part of the oral microbiome. And there’s actually a lot of overlap. I think it’s like 45% of the microbes are similar between the two. So, we always have to look at oral health, dental health, if someone has issues in their mouth maybe they need to get their teeth cleaned, get an infection dealt with. Because if you’re swallowing these bacteria every day in your saliva. Now, if you have low stomach acid, you don’t kill them very well as they pass through the stomach so you could get too many in your intestinal tract because there’s low stomach acid but you could also too many in your intestinal tract because there’s too many in your mouth. So, we have to be always looking at the health of the mouth too and what’s coming above the GI tract. 

Dr. Justin Marchegiani: I’m a big fan of flexing either with colloidal silver or hydrogen peroxide and if you’re sensitive you can always dilute at 3%, that’s very helpful at knocking down some of those bugs, do you agree? 

Lisa Pomeroy: Exactly. Yeah. Exactly. A lot of people like water picks and they’ll do different things and mix and sometimes they’ll alternate too and yep and even the nasal, I mean you have to figure, you know, what’s you know, is being swallowed there from the nasal passages. 

Dr. Justin Marchegiani: Post nasal drip stuff

Lisa Pomeroy: Yep, we’ll squirt some silver or something up to the nose too to try to kill something that’s in there, that’s being swallowed and getting down in the gut.

Dr. Justin Marchegiani: Very good. Let’s dive into yeast. I typically don’t see a lot of yeast come back on these labs. When I do it’s usually beneath the reference range sometimes it’s positive but a lot of times I tell patients, if I see it here and it’s not DL then it’s probably a concern. I mean on the organic acid testing which we can talk about at a later point we’ll see things like D-arabinitol or D-arabinose, which is a really good yeast, uh, marker which does, I do find that tends to come up a little bit more frequently than, uh, this test. What’s your take here?

Lisa Pomeroy: Yeah. So, yeast again, we have to keep in mind, it can grow lots of places. You know, it can grow in the mouth, in the stomach, in the small intestine, in the large intestine

Dr. Justin Marchegiani: Skin, Fingernails

Lisa Pomeroy: The skin, yeah. So, I mean of course, anything outside of the GI tract is not gonna show up in the stool. If you have a toenail and fun-fungal infection a scalp fungal infection. It’s not gonna come out in your poop unless it’s also in your gut. So, we always have to keep in mind people say oh I have a yeast problem at my toenail, why didn’t it show up. It’s like probably localized to your toenail. Now, of course, again, we have the dilution factor. If you have thrush, if it’s more in your mouth and not so much in your colon, we may not see a hug amount in the stool or even in the stomach because it’s gonna be diluted out as it travels, so this is really good at looking at like especially the lower bowel because it’s right there ready to exit. The higher up in the GI tract you get, the more dilution is going to play a role into it. Where sometimes maybe you will see it more in organic acids in a urine test than in the stool. If it is a little more upper GI. although, I mean we do pick up DNA that’s coming down from the mouth, the stomach as H. pylori shows up small intestine. But this is something where if it’s detected at all to me that’s a problem because yeast overgrowth tends to cause a lot of symptoms especially hits the gut and the brain. So, a lot of people will say yeah, I have the gas the bloating, you know, the constipation, the diarrhea but it’s also the brain fog, the memory loss, I can’t remember where I put my keys, it’s no cognac, I just, my brain doesn’t work like it used to. 

Dr. Justin Marchegiani: The acetaldehyde produced from Candida right?

Lisa Pomeroy: Exactly. Candida produces so many toxins, a lot of those affect the brain or they have the, the sugar cravings so it’s like, I want to get healthy and I want to stop eating all these carbs and candy bars and everything but I just can’t, you know, It’s the Candida calling out for. So, you gotta knock out the Candida. 

Dr. Justin Marchegiani: On the extreme side, you could have auto brewery system, um, syndrome, when you’re actually creating your own fermentation with it. The story of this is true, a gentleman got pulled over and he was tested being drunk on the breathalyzer but it was actually yeast in his gut that like made their own little brewery in there and created alcohol from that metabolism that got him drunk and a lot of cognitive people that feel drunk, feel brain fog, it could be from that yeast and all that fermentation happening 

Lisa Pomeroy: Yeah, and other organisms can do that too, Klebsiella, another one that could do that too. 

Dr. Justin Marchegiani: Ah, interesting. Good, very cool. And then, does it matter, I mean obviously Candida tends to be the bigger yeast most people know about that and you have some subspecies here. Any difference is it, does it matter, are you treating them the same way? Do they differentiate in symptoms at all?

Lisa Pomeroy: Yeah. It’s hard to say in symptoms I mean a lot of the yeast behave the same, a lot of times we’re doing similar protocols anti-fungal, you know, fatty acids like caprylic acid, undecylenic acid, herbs like Pau D’Arco, berberine, oregano, so we’re typically addressing them the same. Now, these are all can be normal inhabitants of the gut like Candida, it’s, you should have Candida in your gut. You know, it has a purpose, the whole thing is it’s all about balance. You get too much of it creates all these toxins and excess you can get symptoms. So same thing with these and some of them are actually in your environment like Rhodotorula is something that we sometimes see a little bit of that showing up and certain areas of the country seem to have it more just in the environment. It’s kind like a pink colored fungi. So, I tell people like do you have like a pink colored ring around your toilet or your tub something like that in your bathroom, it could be Rhodotorula. 

Dr. Justin Marchegiani: Interesting. Anything else in this?

Lisa Pomeroy: That’s the main thing with the yeast there. Yeah. 

Dr. Justin Marchegiani: How about the viruses?

Lisa Pomeroy: Yeah. So, the main reason, the viruses are on the panel is when these viruses are reactivated in the colon, they’ve been linked with IBD. So, we’re looking for that association there with you know colonic viral reactivation.  Now of course we know that these viruses can live in many organs and tissues like Epstein-barr virus and the thyroid gland. So, it doesn’t mean if these don’t show up that you don’t have the virus somewhere else in your thyroid, liver but this is looking more of the IBD colonic link. 

Dr. Justin Marchegiani: Very cool and we have different parasites as well, we kind of already chatted about Blasto earlier, but can you give us kind of the reader’s digest from on the critters here, on the bugs. 

Lisa Pomeroy: Yeah, so again, all of these can cause symptoms in some cases very severe now these the ones I’d say tend to cause the worst symptoms, would be the Blastocystis hominis and Dientamoeba fragilis. Especially in kids, we can see, you know, kids with just terrible tummy aches and pain and issues maybe failure to thrive they’re just a little underweight for their age and you know, just a lot of behavioral issues. We see Dientamoeba fragilis come out a lot. Both the Blasto and D. fragilis have been linked with IBS and studies. So, we do often see some quite significant symptoms with them. Uh, now some of the oddball things, extra intestinal you may see, you know, with like joint pain, I think, Blasto and Endolimax nana is another one. I’ve had a lot of people where it’s like I think I have Lyme disease and so we’ve run a lot of good because Lyme disease, you need a good test because it’s hard to find. But if you do a good Lyme disease test, you know, when it comes up negative, you know, we’ve had people do that and it’s like, we’ll it’s negative what do I have, I mean, this joint pain is awful and it’s Endolimax nana, so it has affinity for collagen related tissues, so you can see some pretty nasty joint muscle tendon, ligament issues with that one.

Dr. Justin Marchegiani: This is more collagen based huh?

Lisa Pomeroy: That’s the Endolimax nana.  

Dr. Justin Marchegiani: Oh yeah. 

Lisa Pomeroy: Yeah, yeah so that’s what I look for with that one well I’ll, you know, if I see it show up and they’ll say well I have no gut symptoms. It’s like, well when you work out at the gym, do you see an injury prone where it’s like oh I was lifting weights and now I twisted my shoulder and oh, now it’s trying to run and now my ankle hurts and you know or they just go I’m you know 29 and I work out, I go for a run and I’m so sore and stiff in the morning. I don’t think I should feel like this for 29 years old. 

Dr. Justin Marchegiani: Exactly. 

Lisa Pomeroy: Yep. 

Dr. Justin Marchegiani: Very cool. Anything else on these Pentatrichomonas at all? 

Lisa Pomeroy: Yeah, I mean again, some of these just vague, just general gut related symptoms. You know, any of these really could cause gas bloating, abdominal pain, discomfort, constipation or diarrhea. So you know, just general like IBS type symptoms. 

Dr. Justin Marchegiani: Very cool.  Anything about the worms? I don’t see the worms come back as much. I really don’t. Do you?

Lisa Pomeroy: Well, we don’t see a lot of worms, you know, fortunately because they are a little trickier, you know, we often do recommend deworming medications because it is very difficult to kill them with natural means. But yeah, worms can be quite nasty, um, you know, some of these are, you know, small intestine too, and things like the you know, Ascaris is a roundworm, you know, it doesn’t, you know, some of these worms like the, the hookworms and things, they actually attach to the bowel wall, so they kind of stay in place, I mean, they could, you know, suck your blood and stuff, you know, get the nutrients from the blood. But Ascaris is kind of free-floating there and the problems is because it’s free-floating, it’s not attached, it sometimes gets into places where we really don’t want it and so they found it migrating into things like your gallbladder and you know, your lungs and other places so that one, I mean the big issue with these worms are they can create blockages in some cases with those big worms, you know, sometimes, there can be blood loss, nutritional deficiencies too because if they’re you know sucking your blood and damaging your gut, you could have impaired nutritional absorption. Now, in the U.S., we typically, don’t see these massive infections where there’s like a big ball of worms but you could have a couple worms and they could be causing a lot of issues. Yeah. 

Dr. Justin Marchegiani: Interesting. Very good. And then anything else with the, I think, the Trichuris, that’s the whipworm, right? Um, Nicator, is that a hook I think, not sure hook or whip but either way. Different, different, other different worms there, which we’re gonna treat either with, you know, typical medication like Mebendazole, Albendazole, Vermox, or higher dose wormwood or Artemisinin, also tends to be very helpful with some of these too. 

Lisa Pomeroy: Yeah. And again, some of these, they all have different ways you can get infected, like some of them it could be walking barefoot on a sandy beach, you know, others it could be. Yeah. some of those worms

Dr. Justin Marchegiani: Trichuris

Lisa Pomeroy: Yeah. And in others you could be, you know, you’re exposed to it through like there’s pork tapeworms and you know beef tapeworms and stuff so again it’s looking at food quality and making sure that it’s cooked thoroughly. You don’t want to go to a restaurant and get the rare hamburger or be eating, you know, a rare

Dr. Justin Marchegiani: Make sure, its good restaurant, make sure the quality is good. 

Lisa Pomeroy: Exactly.

Dr. Justin Marchegiani: Make sure it’s like Wagyu from like a five-star restaurant at least. Yeah, for sure. 

Lisa Pomeroy: Yeah. 

Dr. Justin Marchegiani: Cool. And then down below, we have a couple of markers here out of the gates. The steatocrit right, which is the marker for maldigested fat, so if we see a lot of fat in the stool we’re thinking of potentially either gallbladder flow issues, maybe stones that are affecting the flow maybe we don’t have enough acids because acid is really important for the gallbladder to trigger and contract make CCK, elastase and another marker for the pancreas and enzyme production and again if you have low enzymes, um, HCl or acids is an important stimulator for making and activating enzymes. Any comments on those?

Lisa Pomeroy: Yeah. So exactly.  Yeah. so steatocrit has to do with fat malabsorption. Now ideally, I’d like to see a less than DL here. So, I really don’t want to see malabsorbed fat showing up in the stool. Like this one. Isn’t terrible at six so six percent of the stool was some undigested fat but it’s still it’s not ideal, I’m looking for signs why might that be, is there a bile issue, is there a lipase issue. Those are the major things that are digesting your fat, your bile from them you know, produced by the liver, secreted by the gallbladder or lipase is a pancreatic enzyme so for me then you know, if I see this, I look at the elastase one to go, okey what’s the lipase looking like. Elastase, one healthy control usually above 500. So, this individual, I’d say okay, Lipase is probably a little low because were only 388, so chances are if we get a good pancreatic enzyme in here with a nice amount of lipase, will clear up this fat malabsorption too. 

Dr. Justin Marchegiani: Very cool. And then any feedback on the Beta glucuronidase, well that’s a, I mean, we’ll just like talk about it out of the, out of the bat. This one has a major effect from dysbiotic bacteria producing it right and so but it also can affect hormone metabolism so you have these bad bugs maybe it’s Klebsiella or gram-negative bacteria like Proteus or Citrobacter. It’s gonna make this enzyme that is going to take conjugated estrogen and it’s gonna deconjugate it and allow the estrogen to go back into the circulation. Comments there?

Lisa Pomeroy: Yeah. Yeah. Exactly. We look at sources. Now, bacteria is the number one thing I look for. Do we have those species over growing that produce it so then I go flip back to page two and three and go, do we have E. coli, do we have high Bacteroidetes or Bacteroides fragilis, uh, do we have 

Dr. Justin Marchegiani: So you may look here, so you may look at Bacteroides, you may look at E. coli or what else? Anything else? 

Lisa Pomeroy: Uh, the Bacteroides fragilis, Bacteroides fragilis at the top there. Um, Clostridium class and Firmicutes phylum some species, I mean those are large groups but there’s some in there, if those are high it may also be coming from there. 

Dr. Justin Marchegiani: Now, this person doesn’t have a lot of those either and they still have it. 

Lisa Pomeroy: They don’t, yeah. 

Dr. Justin Marchegiani: Again, it’s a sample but

Lisa Pomeroy: Yep. Now the next page do they have Staphylococcus. Uh, they do and really high, yeah, we have Staphylococcus species. Staphylococcus can also produce it. So, this person, I’d be going, okay maybe the Staphylococcus is the where it’s coming from so if we get the staff down, we could bring this down. Yeah, the problem is especially we look at you know say this is a you know a menstruating female. You know, she’s producing a lot of estrogen and she can’t get rid of that estrogen so they say beta glucuronidase kind of comes around like a pair of scissors so say you know your toxin your estrogen goes to the liver goes through glucuronidation which is a detox pathway and the body kind of packages it up nice and neat for elimination so it puts the estrogen in a box puts the lid on the box ties and nice little bow around the box. Well, your beta glucuronidase comes around like a pair of scissors snips of ribbon, lifts the lid, let’s the estrogen out so now estrogen gets to get reabsorbed recirculate and now you get estrogen dominance so now you have PMS and menstrual cramps and breast tenderness and all of those types of symptoms. So, yep. 

Dr. Justin Marchegiani: Very good. And then occult blood, we could see this potentially from blood in the stool, ulcerations, could be ulcerations in the stomach working its way down a lot of times I find It could be from hemorrhoids. It’s a common one too. The outer veins and the rectum area. They’re just, they’re dripping a little bit or the women out there on their menses too that could potentially drive that you’d be back there 

Lisa Pomeroy: Exactly, yeah so ideally, I like to see under five that would be considered negative. 5-9 that’s where we often think oh, did you collect during your period, are you constipated, do you have hemorrhoids, no, that’s a typical range, anal fissures, maybe a constipated there’s a little tear or something. Above a 10 that’s our red flag because above a 10 we have to consider that you know this could be IBD, colorectal cancer, polyps and we just don’t want to miss any kind of pathology here. So, this is where we look to see is there something that makes sense or a diagnosis that makes sense say I see an occult blood of 35 well the person has ulcerative colitis. Okay now, we know why there may be blood it makes sense. But if it’s a 35 and there’s no known reason for this to be then we may need to repeat it, you know some of the acute pathogens again. If we go back to page one that E. coli, you know, uh, the 0157. That one can cause bloody stool. So, say that they got this nasty E. coli from a hamburger. Yep. And the, the EHEC, the enterohemorrhagic E. coli. Yeah. So, they could cause bloody stool so maybe, if there was a little bit of blood it was from an E. coli or something just passing through. So, if it’s above a 10 we often start by just repeating the occult blood to see was it some fluky thing where it was an acute pathogen or something but if you get two positive occult bloods it’s often referring out to see, you maybe need a colonoscopy because again we just don’t want to miss, we’ve caught early-stage colon cancer by catching some of these, you know, occult blood levels that are creeping up. 

Dr. Justin Marchegiani: uhum, absolutely. And then we have IgA which is gonna be an immune marker that’s you, your kind of your mucosal membrane that kind of hits all the mucuses, so mouth, intestinal tract, vaginal canal, urinary canal, so if we see something high, that could be some kind of an immune stress. Your immune system is fighting and going after, if it’s low it could be just chronic stress that’s depleted that immune system that made you more vulnerable. Any thoughts on that?

Lisa Pomeroy: Yeah, exactly. I mean for me, low is a much bigger problem than high. High means the immune system’s working. 

Dr. Justin Marchegiani: Working, yeah. It’s good. 

Lisa Pomeroy: yeah. It’s attacking some microbe or some food but I mean that’s what it’s supposed to do, if something’s threatening it, it should go up, it should try to resolve it. Low means that it’s just it’s burnt out from wear and tear that constant assault and it just can’t mount a response and when it’s low you’re going to be more vulnerable to the E. coli and the Yersinias and the H. Pylori and the parasites because this is our first line defense, you know, we got to have this nice and robust. 

Dr. Justin Marchegiani: Absolutely and then gluten antibodies, how often do you see this positive and I find it’s gonna drop if someone’s on a healthy diet they could still be gluten sensitive but it will go down so it may not be the best indication of hey, you’re gluten sensitive, um, and you may get a false security because you kept your guten out and then you’re thinking, you’re okay and you can add it back in but it’s gonna be kind of exposure based, right?

Lisa Pomeroy: Exactly, yep. In order for the body to produce antibodies to something, it has to have that current exposure. Now, gluten antibodies can last three to six months in the system from a single exposure, so if they’ve had gluten in the last three to six months it could still be elevated from that but if someone if say they come in and they say I’ve been gluten free for five years, I shouldn’t be seeing elevated antibodies. If I am, there is a problem, it’s sneaking in somehow and we do often see this. I saw, I think two people earlier today who were diagnosed celiacs and it was high. That’s not good. That means that they’re still having that exposure so we’ve got to figure out where it’s coming from that is not a good thing and they’re telling you, really have to

Dr. Justin Marchegiani: Yeah, and what do you do when people are like, no I really haven’t been getting exposed. I tend to say well, is there cross contamination, is it potentially going high because maybe there’s an egg allergy or they’re eating some rice that’s technically gluten-free but could still react or is it still dairy thing what other foods could trigger that?

Lisa Pomeroy: Yeah, so first I look for actual gluten cross contamination because most cases it’s actually gluten, they didn’t realize that the oats, oats will be contaminated with gluten unless they’re certified gluten-free so it could be they’re eating their regular old quaker oats, you know, they’re gonna have gluten, so we gonna look for those or they’re sprouted bread. Yeah, it’s Ezekiel bread. It may have less gluten but still has gluten so we gotta look for that or oh my boyfriend eats gluten and I kiss him right after I, you know, after he eats the hamburger. That’s gonna be a step. 

Dr. Justin Marchegiani: That’s possible.  

Lisa Pomeroy: Or they kissed their dog, they feed their dog, regular gluten kibble and they kiss their dog. So, I looked at all of those, um, and they found that you know, eating out in restaurants. They did this great study a couple years back and they said about a third of all restaurant meals that you’re being told are gluten-free tested positive when they’re actually tested and that went up to 50% for gluten-free pizza and gluten-free pasta. So basically, if you go out to a restaurant, you order the gluten-free pizza or pasta, it’s a 50 50 shot whether you’re actually getting gluten or not. 

Dr. Justin Marchegiani: Yeah. It tends to be, usually if you’re going out, if you’re getting like a steak or some steamed vegetables, usually you’re okay tends to be more in the sauces, the thickeners or even a spice and so worst case you just, you season it yourself with your own sea salt at the table or something just to make sure it’s its clean. 

Lisa Pomeroy: And some things too, I mean I actually you know because I am gluten sensitive, you know, gluten triggers Hashimoto’s for me. So, I went gluten-free like 14 years ago and my antibodies dropped and never come back because I’ve stayed gluten free. 

Dr. Justin Marchegiani: That’s great.

Lisa Pomeroy: But I do test. I have this little testing device and you could put a pea sized portion of the food in the device, it takes about three minutes and it’ll tell you if it had gluten or not. So, I will test if I buy some new food, especially if it says manufactured in the same warehouse with wheat, dairy and all that kind of stuff or if I don’t know say if I want to eat, I can put the food in the device and know if its gluten-free or not. So 

Dr. Justin Marchegiani: Wow, so what’s this device called?

Lisa Pomeroy: It’s called Nima. It’s N-I-M-A. So, it’s a Nima, Nima Partners Company, you can buy it through. It’s cool little device, you have to buy these capsules that are one-time use but you put the food in the device, so anytime I buy anything new any packaged food, even supplements, I run it through my Nima. Because, I was being glutened by a cinnamon powder like I run one of these tests on myself and my anti-gliadin was a little high and I thought was a test wrong that this is impossible I’ve, I’ve been gluten free for over a decade this got to be wrong so I bought a Nima then this a few years back and tested everything I was eating and an organic cinnamon powder the company grinds fresh in their facility tested positive and I was eating this almost every day. I stopped eating it, seven months later retested, antibodies gone. 

Dr. Justin Marchegiani: Wow, okay. We’ll put a link up on screen put it on the show notes that’s uh, that’s crazy, very cool. 

Lisa Pomeroy: If I’ve ruled out that, that’s the first thing I look for because the majority of people, it is just gluten contamination. Now if we’ve ruled that out then I looked at okay there’s about six foods that are cross-reacted with gluten, there’s dairy, there’s yeast, there’s corn, there’s millet. So, then we start to look at 

Dr. Justin Marchegiani: other things

Lisa Pomeroy: Yep. Other things that you know if you’re continuing to eat dairy then maybe there’s an issue there. Yeah, it’s, they recently changed the website, I think it’s Nimapartners.com

Dr. Justin Marchegiani: Okay cool. I’ll put it below in the show notes. Anyone’s listening back and you’ll get that. That’s great. 

Lisa Pomeroy: So sometimes we have to remove cross-reactive foods so there can be other factors but you know, the problem is once you’ve lost oral tolerance to gluten, you can’t get it back. It’s the only food we know of that your body creates memory B cells to so, it is something like for me being gluten-free for like 14 years I shouldn’t have antibodies but if I start eating gluten again, I will have antibodies because I’ve lost oral tolerance. 

Dr. Justin Marchegiani: That’s why I like the genetic test because you don’t have to necessarily challenge it or know you, if you have the HLA DQ2 or eight or you know one alpha, one beta, one or three then it’s a good chance that you have that those gluten sensitivities and you should probably stay away from it. 

Lisa Pomeroy: Um, yeah. 

Dr. Justin Marchegiani: Any feedback on the genetic testing for the gluten. 

Lisa Pomeroy: Yeah, I think it’s helpful, I like all these tests, I mean they always give you a little different piece of information so I think it’s helpful, you know a lot of times correlating the genetics with what we’re seeing here. So, I mean the genetics don’t tell you, you are having a problem versus this tells you are having a current problem. So, I like both and sometimes people need the information from both because just seeing the genetics, you know, they go, well I could have a problem but is that enough you know, a motivational factor to keep me from eating gluten versus I see this and it’s high then I know, okay, my body is really not happy right now because of the gluten I’m eating. I definitely need to go gluten-free. So, it depends what motivates someone and again if they haven’t eating gluten for a while, I don’t want them challenging it, you know, they could certainly again run this as is like myself eating the cinnamon, I though, I was gluten free but I was being glutened so it showed up. So, I tell people run the test as is look at your genetics and I’d rather you do that than reintroducing gluten and now starting that inflammatory cascade that’s going to last for three to six months. 

Dr. Justin Marchegiani: Very cool. Well let’s just wrap this up, your last couple of markers and by the way, I know we chatted about, uh, probably a little bit ambitious wanting to go into the, uh, the ion panel but I’d love to have you back soon, Lisa and really dive into the ion panel. Would you be open to that?

Lisa Pomeroy: I would, I love talking lab test interpretation. 

Dr. Justin Marchegiani: Very cool, so out of the gate here, calprotectin, really good tests for inflammation produced by the white blood cells in the intestinal tract, it’s a protein and of course, Zonulin is that protein, that’s a sign that those tight junctions are being unzipped in the intestinal tract and potential gut permeability. Comments on that?

Lisa Pomeroy: Yeah. So, calprotectin is a kind of a general marker for intestinal inflammation. Now with IBD, we can see this exceptionally high. Usually, yeah, the two things that are going to cause your highest levels are acute pathogens so again something like that nasty food poisoning E. coli or something like your IBD type thing. You could see upper hundreds or even thousands with that. 

Dr. Justin Marchegiani: Yeah 

Lisa Pomeroy: Ideally, I wanna see under 50. So, a lot of people will see things like an 87 or a 120 where I go that’s higher than I’d like, so again, we start looking at, okay, what’s causing this colonic inflammation, again, are you lacking butyrate producers, do you have too many of these proinflammatory bugs, do you have a parasite like Blasto hanging out in your colon. So, we’re looking at all those other factors that could be causing inflammation. Or again, some of the food additives, you know, maybe you like to go your grocery store and get rotisserie chicken. A lot of rotisserie chickens have Carrageenan in them. Carrageenan is a known proinflammatory food additive. So, there’s little things we can sometimes do to bring down our gut inflammation but yeah, so that one’s gonna tell you about if your gut is inflamed or not, Zonulin tells you if your gut is leaky. Now Zonulin will, you know, go up, you know, it’s triggered by things like gluten and gram-negative bacteria. They have an endotoxin, LPS in them. So, gluten and LPS are the top two triggers for Zonulin, so again I’m looking for is antigliadin high, do you have a lot of these bacteria that are overgrowing or again do you eat GMO foods like glyphosate is another trigger for Zonulin. So, if this is high, we need to look for, what’s triggering it and then we’re probably gonna need to do some gut repair, you know, maybe we want an L-glutamine based powder, you know, because we want to make sure that the gut damage is being healed up the tight junctions are restored, the integrity of the gut barrier is restored. 

Dr. Justin Marchegiani: Very cool. And then Lisa, you’ve given us so much information here. This is excellent. I’m going to recommend this to my patients here to get a kind of a little bit more of a deeper dive, if they want more intel. This is excellent. Um, if people wanna find out more about you, where’s the best place to go? 

Lisa Pomeroy: Yeah. So, I have a couple different websites, I work with practitioners and right now I’m, you know my practice is closed to taking in new clients but, you know, may open up in the future, so my more client website is my last name Pomeroy, so pomeroynaturalhealth.com. Now, if there are practitioners who want more, you know, help on lab interpretation for their patients or if they’re interested in the different training courses I created, that website for practitioners is pomeroyinstitute.com

Dr. Justin Marchegiani: pomeroynaturalhealth.com for patients. pomeroyinstitute.com for practitioners. We’ll put the links below here, so people can get to that faster. Anything else you want to leave listeners today with, Lisa?

Lisa Pomeroy: Um, I guess, just you know, they say all health begins in the gut and I’m a believer of that because I had so many issues, I mean, you almost name a pathogen on this report I’ve had it. Everything from roundworms to just about every Protozoa to H. pylori. You know, I’ve had it all and I know how much, you know, it just wreaked havoc on my gut for decades so starting very young. You know, my parents would always think she’s coming down with a stomach flu because she just puked out of the blue. You know, it was just the H. pylori and everything else, my low enzymes. So, I had just terrible terrible gut and so I mean for me was the functional lab testing that found these issues. I mean, that found the H. pylori, the parasites, the low enzymes, everything else and I just think you know for me it’s just so important on why I get so passionate about this. For me, it was giving me the answers that I needed to restore my health. So 

Dr. Justin Marchegiani: Excellent. Well, you have a great story at least, you did an excellent job for sending me information and I think uh, people that are watching are getting a lot of information out of it. So really appreciate it, look forward to have you back on the show real soon.  

References:

https://pomeroyinstitute.com/

https://pomeroynaturalhealth.com/

Audio Podcast:

https://justinhealth.libsyn.com/why-is-my-digestion-broken-lab-test-interpretation-of-gi-map-with-lisa-pomeroy-podcast-335

Recommended products:

DSL GI-MAP Genetic Stool Test

International DSL GI MAP Genetic Stool Test

What are the Natural Anti-Inflammatory Agents for Pain Relief

In general, we have our COX pathways. Now, Arachidonic acid can feed those pathways. A lot of excess, junky, refined Omega-6 from animal products can definitely feed those pathways. That sets the table like gas in the kitchen where a little spark can take it off.

Click here to consult with a functional medicine doctor for recommendations on natural pain relievers.

Where to find anti-inflammatory agents:

1. Natural herbs like ginger can help with COX-1.

   

2. Fish oil is excellent for COX-2 at high doses. If you do high doses of fish oil, you can increase what’s called lipid peroxidation because fish oil is a polyunsaturated fatty acid. It’s more unstable. It’s got more double bonds in it. Omega-3 means three double bonds. The more double bonds that are they are, the more unstable the fatty acid is to heat things like that and the more, let’s say it can be oxidized. So, having extra vitamin C or extra vitamin D on board when you’re taking extra fish oil just to make sure you don’t have oxidation is great, and we already talked about things like systemic enzymes.

   

3. There is also curcumin but liposomal curcumin is better due to the absorption or something with black pepper in it helps with absorption, too.

   

4. Frankincense or Boswellia.

   

5. White willow bark which is kind of how aspirin is naturally made though aspirin works more on COX-1. So, aspirin can be your other natural source and you can do white willow bark which is the natural form of aspirin.

   

6. There are things like Tylenol but Tylenol works more on the central nervous system perception. So, it decreases the nervous systems’ perception of pain. Note: We have to be careful of Tylenol as it can actually chronically reduce glutathione. So, if you’re taking Tylenol longer-term, you definitely want to take it with NAC and/or some glutathione, just to be on the safe side.

   

7. At the extreme example, we have opiates which block pain receptors in the brain, the opiate perception of the brain. It’s not the best thing because you’re just decreasing perception of pain. Obviously, the opiates are way more addictive.

   

8. We can block some of these natural pain perceptions with CBD oil. So, CBD is another great way to reduce the perception of pain.

   

In general, we want you to try to do more of the herbals and more of the natural stuff out of the gates because that really, really, really can help reduce inflammation.

If you have osteoarthritis, rheumatoid arthritis, sports injury, or you’re just trying to heal maybe postoperation, these things may be something to implement and then obviously work in all the other root causes, too. You are not just what you eat. You are what you digest from what you eat.

So, if you’re doing all these good nutrients, but you’ve got some type of malabsorption issue in the gut, you’ve got ridges on your fingernails, you’ve got thinning hair or falling out here, you may need to look deeper at the gut and try to find some of these more root cause issues that led you to that amount of inflammation or slow recovery in the first place.

If you need to reach out to talk about your pain and inflammation issues, click this link to schedule a chat with me!

Collagen Diet: Collagen-Rich Foods for Healthy Joints, and Skin

We know collagen is going to help with the joints because we know half of your bones are protein. We need good building blocks for our cartilaginous tissue and ligamentous tissue. Frankly, most people get most of their protein from muscle meats. That’s a problem because they’re not getting the knuckles, the bones, and the cartilage, as we would from old-fashioned soups. So, if you’re doing a lot of soups and bone broth soups, that’s great. If not, we really want to add extra collagen.

Click here to consult with a functional medicine doctor for more information on a good collagen diet and supplements.

I do 20 g of collagen in my coffee every morning. I think it’s amazing. I do my true collagen with some MCT oil and grass-fed butter. I love it. I think it’s excellent for skin, hair, nails, and just for overall prevention of bone loss and cartilage loss. We know the wear and tear that most people experience in their joints throughout the year, especially if they do a lot of long-distance cardio. You really need more building blocks to help prevent and mitigate the wear and tear, so you don’t have knee and joint replacements later in life. Collagen can really help decrease some of that wear and tear.

How do you take collagen?

I like adding collagen in my coffee in the morning because it has a nice little kind of creamer-like effect. It gives that little bit of frothiness which is wonderful. I also do it before bed. Sometimes I’ll do a little bit of collagen (glycine), magnesium, and vitamin C because vitamin C is a really important building block for making collagen. I find magnesium has some very good calming effects as well where there are plugs in the GABA or it’s just a natural beta-blocker as well. It can calm the heart and bring the heart rate down a little bit. I think magnesium does work on some of those GABA pathways as well and, of course, magnesium helps with blood sugar. You’ll get deeper sleep and better REM sleep when you have good magnesium. So, I love combining collagen and magnesium at night.

Where can you get collagen from?

You can get collagen from food via bone broth. Chicken skin is super rich in glycine, roughly 3.3 g for 3-1/2 oz. If you make chicken soup, throw the whole chicken in there. Get a rotisserie chicken from Whole Foods and or get the fattier cuts of the chicken at least with the bone and the skin, so that way you get the best of both worlds if you’re going to do it from a whole food source. Regarding seafood, wild salmon is going to be the best source of glycine.

If you want to learn more about the collagen diet and other good sources of collagen, click this link to schedule a chat with me!

Natural Herbs and Foods to Help Fight Stress

When you’re stressed, what are the important things? Blood sugar stability is really important because most people get on a roller coaster when they get stressed, meaning they’re overly gravitating towards alcohol and towards refined sugar. Their blood sugar goes up and then it crashes down, and then it creates more nervous system stimulation via adrenaline, epinephrine, and cortisol being stimulated to bring the blood sugar back up.

Click here to consult with a functional medicine doctor for guidance on which foods to eat for stress relief.

So, I find just keeping it really simple and really easy with your meals. You may be more nauseous when you’re overly stressed because stress hormone does cause you to feel nauseous. So, this is where you may want to do a soup or a simple smoothie, something really easy where there’s not a lot of digestion but you’re still getting some proteins and fat in there, whether it’s some collagen and some coconut milk or just sipping on some bone broth. Something like that’s going to have some good fat and good protein, and it won’t be hard to digest. So, if you feel nauseous, just still know you should probably be eating but just try to make it something very easy on your tummy.

Then think what are some of the nutrients your nervous system is going to need when you’re more stressed. So, the low hanging fruit, B vitamins. B complex is going to be very essential. Magnesium is going to be excellent. GABA and L-theanine are good things that are going to help you relax and wind down. Valerian root or passionflower, which are all connected to GABA and that inhibitory neurotransmitter that helps you just relax a little bit. It kind of puts the clutching gear and disengages the gearbox, so you can downshift so to speak.

I always go to nutrients first and then I go to my favorite adaptogenic herbs second. So, Ashwagandha is one of my favorites. Rhodiola is excellent and there’s holy basil, which are my favorite very relaxing and tonifying herbs.

If you want to learn more about herbs for stress relief, click this link to schedule a chat with me!

The Top 5 Reasons Why Your Estrogen Levels are High – Men & Women!

Let’s talk about the top 5 reasons why your estrogen levels are high. We’re going to break them down today.

WHAT ARE ESTROGENS?

First, let’s look at the 3 major kinds of estrogens: E1 or estrone, E2 or estradiol, and E3 or estriol. In a woman’s regular cycle, it’s usually estradiol we’re talking about. When you start shifting to more menopausal and the ovary stops working, you start getting more estriol. The adrenals help in kick in a lot of DHEA and you make more estriol. Estradiol is more of the growth factor type of estrogen and estriol is a weaker estrogen.

Click here if you need to consult with a functional medicine doctor to learn more about estrogen and your hormones.

WHERE CAN WE FIND ESTROGENS?

1. PLASTICS. You’ll get it when the plastic is warm like in a microwave or out of a plastic water bottle especially if it’s in the car and the sun is hitting it or it’s outside. That’s why you want a good stainless steel or glass water bottle if you’re going to go outside or leaving it in the sun. The microwave heat and the radiation is going to cause a big release of plastic chemicals there, the xenoestrogens. One of the big ones are the phthalates but also BPA. There are other types of BPAs that are new which are supposedly safe but there are still estrogen-like compounds there as well. These plastics can affect women and men as well. Men are actually going to be more affected by them because men aren’t used to having estrogen in their environment and getting a whole bunch is going to be a problem.
2. PESTICIDES. These tend to have an estrogenic quality to them and if you’re eating foods that are not organic, you’re definitely going to be getting organochlorines and various pesticides in your environment.
3. PHYTOESTROGENS. These are found in soy. For example, I had a vegan-vegetarian patient. We ran a Dutch sex hormone panel on her and her estradiol was through the roof and really high. Phytoestrogens can be a big one, so soy may be a problem. With vegan-vegetarian, there’s a lot of phony protein consumption like fake meat kind of stuff such as the Beyond burger where there are a lot of soy and estrogen-like compounds in there. There are also hormones in meat. You have to make sure you get antibiotic-free, hormone-free, and ideally organic and pasture-fed or if you’re on the Whole Foods scale, step 4 or step 5 is ideal. Step 2 is at least pretty good. Organic means no pesticides, no hormones, and also the food they’re eating has no pesticides or hormones, too.
4. HIGH LEVELS OF INSULIN. Too much carbs drive high levels of insulin because insulin responds to a high level of blood sugar. The blood sugars in your bloodstream go up and your pancreas comes in. The beta cells make a bunch of insulin to bring it down and bring it into the cellar and converted to fat. So, high levels of insulin upregulate an enzyme in men called aromatase that converts testosterone, the male hormones, to estrogen which becomes a problem. Now, in women, a similar thing happens but it’s the exact opposite or the big switch. Their estrogen is converted to testosterone. So, women can actually get more androgen-like issues which results in weight gain, acne, hair growth, and sometimes you can see some libido enhancements on that. So, that’s the difference between men and women.
5. POOR GUT HEALTH. In the gut, we make healthy good bacteria in our gut that help us absorb a lot of nutrients. A good healthy gut function helps us break down protein for good HDL levels and good enzyme levels. We need these to break down protein into amino acids which are really important for helping us to detoxify. So, detoxification helps us to excrete estrogens that we’re getting exposed to in our environments such as the pesticides, plastic, or something that you don’t even know you’re getting exposed to. Good healthy detoxification will help your body eliminate that, so that’s a good backup plan.Also, if we have a lot of dysbiosis, SIBO and bacterial overgrowth, we can make a lot of what’s called beta-glucuronidase. This is an enzyme that’s made by bad bacteria and it makes it harder to detoxify estrogen. The beta-glucuronidase takes conjugated estrogens and binds it to a protein that helps us excrete it out the body. It takes that protein and it pulls it apart. It takes the handcuffs off that protein, so that allows that estrogen that’s been deconjugated to go back into the body in the general circulation. So, if we have gut issues, that could be a major concern.

HOW DO WE ADDRESS THE PROBLEM?

We need things like cysteine, glycine, glutamine, sulfur amino acids, and things that help us methylate like B12, B6, and folate. So, these nutrients we have to get them in our diet via a good diet. We need to be able to break down and absorb those nutrients, so we need good digestion to get those things in there.

So, in general, we’ve got to make sure we have a good gut bacteria balance. Even fungal overgrowth can cause problems and H. pylori that can lower stomach acid and make it harder to break down nutrition on one side and then it can create this bacterial overgrowth enzyme that makes it hard to detoxify estrogen. These are really important components. If you have any issues with estrogen, you’ve got to look there.

Now, we may want to do things to help detoxify like make lifestyle changes, food changes, pesticide changes, make the changes in regards to plastics, and make in in regards to your diet, your glycemic load, and your gut. That’s a good first step to get to the bottom. There are also different things we may do to help upregulate detoxification to help get that estrogen. It may be activated charcoal or various soluble fibers. It could be things like bentonite clay. We could use things like DIM or Calcium D-Glucarate or glutathione, sulfur amino acids, and vitamin C. They’re all helpful in different situations. We would recommend them based on what’s happening but at least make the diet and lifestyle changes out of the gates.

If you want to find out the root cause of what’s happening, click this link where you can schedule a chat with me!

Top 5 Warning Signs of Hormonal Imbalance

Let’s talk about hormones. I’m going to dive into a couple of clinical pearls that I see in my practice from working with hundreds of female patients and male patients which have a major effect on modulating and supporting hormonal balance.

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These are my top 5 hormonal balancing strategies:

1. One of the first things in regards to hormones that’s very important, and this may be common sense but I try to give a lot of knowledge guided by experience, is nutritional building blocks for your hormones. Healthy cholesterol from animal products are very essential. Fat soluble vitamins like A, D, K are very important. Lots of good protein are also very important. We have steroid-based hormones that are going to be more cholesterol-based and we have peptide-based hormones that will also be protein-based. So, a lot of these protein, fat-soluble vitamins, and cholesterol especially healthy animal cholesterol are very helpful for hormonal building blocks. If you have a vegan-vegetarian diet or if it’s very nutritionally poor or there’s a lot of processed food, that may set you up with a deficit out of the gates for just hormonal issues. Remember: Make sure the food is nutritionally dense, anti-inflammatory, and low in toxins. That’s vital.

2. Now, if you’re having a lot of good nutrition in there, the next thing is we have to make sure we’re able to digest it and break it down. So, if we have a lot of chronic acid reflux, poor digestion, constipation, or bloating, we know we’re not quite breaking down our food and our nutritional building blocks. That could tell us that we may have hormonal issues because we’re not breaking that down. Therefore, those nutrients can’t get into our body or get in our bloodstream and be taken throughout the body to be used as building blocks. So, if we have a bottleneck in the nutritional side, that could be a big factor.

3. Stress, whether it’s emotional or chemical stress. If we’re eating foods that are inflammatory or we’re nutritionally deficient and we have a lot of emotional stress, what tends to happen is our hormones kind of go on two sides. We have an anabolic side which are the growth hormones — testosterone, estrogen, and progesterone — that kind of help deal with growing. Then we have anti-inflammatory hormones which would be cortisol and are catabolic. I always put progesterone in that category because progesterone can be used to make more cortisol. So, we have our anti-inflammatory and then our anabolic. In some, they kind of cross over. Insulin, growth hormones, and testosterone are anabolic. The more inflamed we get, we could have high amounts of testosterone because of PCOS and because of inflammation. So, some of these hormones kind of interact and cross over. With men for instance, the more inflamed men get and the more stressed they get, that can actually cause an upregulation of aromatase and could increase their estrogen. So, see how these things kind of cross react. Your hormones are going to be either pro-building or anti-inflammatory to reduce stress. So, for chronically and stressed out state, cortisol is going to rip up your protein and kind of decrease your muscle mass. As a woman, you’ll see your progesterone level start to drop and that will start putting you into an estrogen-dominant state because if we normally got 20 to 25 times estrogen than progesterone, that ratio starts to drop. Even if you still have more progesterone than estrogen, that ratios is going to throw you off and that can create breast tenderness, cramping, mood issues, excessive bleeding/menorrhagia, infertility, a lot of mood issues, back pain, and fluid retention. All those are possible situations.

4. Xenoestrogens from the environment and foreign estrogens. They can come from plastic components, pesticides, herbicides or rodenticides, mold toxins, and heavy metals. They are going to disrupt our hormones. The easiest thing is eat organic, avoid plastics, and avoid a lot of the chemicals in the water because a lot of times you can get pesticide runoff or hormone runoff in the water. So, clean water and clean food, and then make sure it’s organic avoid the plastics as well. That’s a big, big thing. Plastics are probably okay if they are in a refrigerator or in a cold environment but ideally if you’re heating stuff up or it’s going to get exposed to light, you want some kind of a Pyrex or a glass container. It’s much better and really important.

5. Last but not the least would be just making sure our detoxification pathways are running well. So, if we have good hormonal balance but we can’t detoxify it, then a lot of times we can reabsorb it. So, if we don’t have good sulfur, good glutathione precursors, good B vitamins, good methylation, N-acetylation and glucuronidation, we may have a hard time eliminating. Hence, we are re-absorbing a lot of our hormones. So, being able to break down your proteins, break down your amino acid and your B vitamins is going to help with your body’s ability to eliminate a lot of these toxins.

Summary:

Blood sugar, digestion, stress, xenoestrogens, and toxicity are really big. Those are the big 5 across the board. Try to apply at least one of these things.

If you’re struggling with hormonal issues and you want to dive in deeper, feel free to schedule a consult with myself.

Methods To Encourage Good Bowel Movement

You see women on Instagram. They’re all done up with their hair and makeup, and they’re marketing #ad #detox #tea. They have these ridiculous products that they’re remarketing and they’re not talking about poop. The best way to detox is getting poop out. I’m not going to buy detox tea. I’ll get a bit of dandelion or some milk thistle blended in and that’s part of it but unfortunately, detox is co-opted by the marketing industry. Most people don’t even focus on that. They’ll poop once a week but then they take a detox tea and they think they’re doing it correctly.

Click here for a consultation with a functional medicine doctor if you want to learn how to detox properly!

My whole take on detoxification out of the gates is very simple.

1. 1. Get enough good clean water in your system.
   2. 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. We need good B vitamins, good antioxidants, and good sulfur amino acids. For breaking down those nutrients well, there’s not a bottleneck with ACL levels or enzyme levels. We’re getting enough to clean water.
   3. Not overly stressing our sympathetic nervous system.
      Remember: The more we overly stress the adrenals, the sympathetic nervous system decreases that migrating motor complex which are the wavelike contractions that move stool through your intestinal tract, just like you roll up the toothpaste roll at night to get that toothpaste moving through to get your toothpaste out to brush your teeth. Your intestines are the same things.

   If you can do those top three things right, you’re on the right track. There may be extra things where we need extra sulfur or extra antioxidants or compounds or binders to help with mold or heavy metal. That’s true and that would be addressed down the road but a lot of 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.

   

   
   Supplement Suggestion:

   Use one for liver support that has some gallbladder nutrients built into it. That can be really helpful because with sluggish bowels because a lot of times there’s also sluggish bile production. So, just helping thin the bile whether it’s using supplemental ox bile or methionine, taurine, B powder, whatever else we can do to increase bile flow. That’s going to be helping.

   

   Detox and Diet

   This is a low-hanging fruit that your average American is still really, really blowing it on which is just the fact that they’re not doing enough good meats, good fats, and good veggies. Your average American might wake up and do a piece of toast and maybe in 2020 or 2021, it’s an avocado toast but still that’s not the optimal thing for good poop.

   Inflammation in the diet can easily mess up the intestinal tract and can easily create inflammation in the gut. That could either move the body more to diarrhea or more to constipation. If we start moving more to constipation, that’s not good. Of course, these foods can stress out the intestinal tract and then when we start creating inflammation in the intestinal tract, then we already have indigestion meaning we don’t have adequate enzymes and acids. So, we’re burping a lot after our meals, food sits longer in our tummy, and a lot of gases are produced because the foods are not being broken down properly. That’s a problem.

   We’ve got to really make sure we’re masticating and chewing our food very, very, very well. We’ve got to make sure to increase the surface area for enzymes and acids to work. We also have to make sure 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 help with swallowing pills. Don’t do it for hydration purposes. Because water has a pH of 7 and your intestinal tract has a pH of 1.5 to 2. So, if you start adding a whole bunch of pH 7 to up to a pH of 2, you’re going to move that pH more in the alkaline direction away from the acid direction. We need good acidity to help activate her enzymes in our acid levels. That’s very important.

   If you have any issues with detoxification, please reach out to a functional medicine doctor.

   Remember:

   1. 1. 1. Chew your food up well.
         2. Make sure you’re not overly hydrating with the food. Do all your hydration 2 minutes before.