Functional Medicine Approach for Urinary Tract Infections (UTI) | Podcast #356
One of the most common human infections is one that people rarely speak about. Urinary tract infections (UTI), also known as bladder infections, impact 10-20% of women at least once a year, and the specific treatment intervention is prescription antibiotics. Middle-aged women with chronic conditions like autoimmunity, dysbiosis, and hormone dysfunction are regular patients in functional medicine, so regular taking of antibiotics could pose a problem.
Dr. J and Evan talk about that when optimizing microbiome health, hormone production, and immune tolerance, it is crucial that bacteria are allowed to thrive, and antibiotic use poses a warning to that opportunity. With that said, if urinary tract infections (UTI) are among the most common conditions physicians see, and we are attempting to avoid circumvent antibiotic use, what functional medicine approaches do we have?
Dr. Justin Marchegiani
In this episode, we cover:
0:00 – Introduction
6:31 – N-Acetylcysteine in protecting the urinary bladder
11:17 – Foundational strategies in keeping the urinary tract healthy
17:10 – Antibiosis versus the association of N-Acetylcysteine, D-mannose, and Morinda Citrifolia fruit against UTI
19:11 – Men’s role in preventing UTI
Dr. Justin Marchegiani: Dr. Justin Marchegiani here with Evan brand. And today we are excited to talk about functional medicine approaches to address UTI or urinary tract infections. My immune system is just a little bit under the weather, so I’ll be channeling my inner Barry White today. Really excited for that. Evan, how you doing man?
Evan Brand: Hey, pretty good. Yeah. I hope you feel better and get back to kicking butt, which you’re still kicking butt but most people would call it in but I’m glad your brain is working enough and we’re gonna get this thing done. So,
Dr. Justin Marchegiani: I haven’t had a sick day over a decade. I don’t, I don’t plan to have a sick day ever.
Evan Brand: Good. Good. Good. Alright. So, now, uh, with UTI, I mean this is something that’s extremely common. We see it a lot in young children because their poop gets in to their urinary tract whether they’re wiping the wrong way or whether this is a young child that’s still using diapers, so I’ve seen it with our children, we’ve worked on our kids. I’ve seen it with a lot with the kids I worked with clinically. And then adults we see this a lot, where a lot of it is due to sexual transmission. I mean we’ve seen many cases where if we support the female, the male is the vector and the woman start to get almost resentful towards their husband because they know every time, they have sex they’re gonna end up with UTI. So then, that really affects their sexual health and their relationship. And so, today’s podcast hopefully will encourage people to take this seriously and we’ll have some strategies you can implement to get both you and your spouse if that’s what’s happening and better shaped where this is a non-issue.
Dr. Justin Marchegiani: Do we have any data on the semen quality, the semen quality affecting, uh, urinary tract infection of females?
Evan Brand: I’m gonna look it up but I know clinically and I know you’ve seen the same thing that we hear that story all the time of where everything is fine and then boom they have sex and then all of a sudden it’s they have a UTI.
Dr. Justin Marchegiani: Yeah. I know in, um, in men
Evan Brand: So, here’s the study right here, semen culture and the assessment of genitourinary tract infections in the male. It says here is, uh, contributes approximately 50% of the cases.
Dr. Justin Marchegiani: Yeah. I wouldn’t be surprised if nutrient deficiency has a lot to do with it because I know zinc is very high in semen, right? Um, very important for the health of the sperm and I know zinc also has anti-bacterial, anti-viral qualities to it. So, I wouldn’t be surprised if someone’s more nutritionally deficient they’re gonna have less zinc in the semen and that less zinc will make it harder, make it easier for bacteria and other critters to grow. So, just a thought, again, you know, we try to, you know, high level thinking, you know what’s the mechanism, look at all the downstream signals that could be one component though.
Evan Brand: Yeah. It’s talking about these different types of bacteria in this male study talking about how it plays a role in genital tract infections and some of these are natural inhabitants of the male urethra which can contaminate semen during ejaculation. So, there’s your answer.
Dr. Justin Marchegiani: So, it’s almost like men could have a subclinical kind of UTI.
Evan Brand: Exactly.
Dr. Justin Marchegiani: That could be affecting it. So, if you’re a female having chronic UTI issues, you have to have your partner looked at or addressed. And we’ll talked abour natural strategies of course keeping sugar down is going to be one of the big ones because one of the biggest bacteria involved in UTI is gonna be E. coli. E. coli you’ll see high in bacterial imbalances in the gut, you can also see some, I think some Pseudomonas in some as well as some Klebsiella but it’s mostly gonna be E. coli.
Evan Brand: They were talking about E. coli and even Mycoplasma in that study, which kind of interesting.
Dr. Justin Marchegiani: Yeah. Exactly. I know, um, yep, that’s a big one for sure.
Evan Brand: Some part, you know, some families or couples, they’ll end up just going to using condoms because obviously that’s gonna work and that’s gonna prevent the critical transfer but really the better thing is to get the health of your spouse improved and so, if you’re a female who’s done some of the conventional strategies, let’s kind of go into that now. Some of the conventional stuff that’s being done and we’ll compare it to the functional strategies but if you’ve done some of this stuff and you’re still struggling that’s when it’s time to get your spouse on board. And I know, you and I, we really like to work with couples and we like to get the whole family healthier together because we find that if we just focus on the female that her results are not as good and you know, this actually kind of carries over into H. pylori and all the work, you and I do with gut infections because we see cases where a female will use herbs successfully to eradicate certain infections in the gut. She’ll then get reinfected from the spouse even not into sharing cup, spoons, drinks, kissing and then they’ll get infected. So, as much as I can, I’m trying to bring the husband on board into these health protocols.
Dr. Justin Marchegiani: Yeah. So, a couple of things out off the gates that men can do to help support the women is cut the sugar out of their diet or at least drop it down to the point where you’re not growing some of the microbes in the urinary tract. That’s helpful. You can also add some things in. Like ginger is actually very helpful so maybe some ginger kombucha can be good or some really strong ginger tea is wonderful. You can also add a little bit of Manuka honey because there’s a lot of data on Manuka actually decreasing E. coli and Staph in the urinary tract. So, these are some simple kinds of easy things. You can even take some raw cranberry juice. Raw cranberry juice is very high in D-mannose, which is a large sugar molecule. The body does not digest but it creates like, uh, magnet-like effect. It’s like dragging a magnet across a surface and grabbing iron filings and pulling them out. Think of the iron filings is the E. coli and so it kind of pulls them out. So, those are some easy simple strategies for some men out of the gates is ginger, cranberry. I would say just make sure you’re hydrated enough, right solution to pollution is dilution, Manuka, and keeping the sugar down. Those are excellent strategies out of the gates.
Evan Brand: Yeah. And NAC, so we wanted to talked about NAC because NAC has been pulled from Amazon and this nutrient is getting harder to access as just a regular consumer. Fortunately, we work with professional companies, so we still have access, we still do manufacture NAC-Glutathione combos but there was a paper that we have here on NAC and the cool thing is I know you’re taking NAC right now.
Dr. Justin Marchegiani: Yep. I’m taking up to four grams a day to help biofilms if in the sinuses, it also, um helps with decreasing virus replication in case I have any viral stuff going on. I think I have personally just a little, uh, rhinovirus. That’s what I personally think and then outside of that, um, increasing glutathione, antioxidant support, biofilms, helps with mucus, so it keeps the mucus kind of flowing from. So, it’s, so it doesn’t, um, impair oxygenation and blood flow.
Evan Brand: See, if you can pull up or highlight that paper, I just shared on the screen there. You know, for folks listening you’re just missing out on this part of it, but that’s okay, we’re just trying to just show you at least maybe a couple of studies a week. That kind of
Dr. Justin Marchegiani: Yeah. If you’re listening, yeah and if you’re listening here, we’ll put the video link below, so don’t worry about it, just come and check about it later and we’ll put the link down below.
Evan Brand: All right. So, this is titled, N-Acetylcysteine Protects Cells from Bacterial Invasion, I like how they call it an invasion, and Displays Anti-Biofilm Activity against Urinary Tract Bacterial Pathogens. So, long story short, they discuss using antibiotics, which were really, we can dive into that. But really that is the conventional approach with this stuff, and the problem with antibiotic resistance problems and so you’ll have women that’ll do these formulas whether it’s in this study they’re talking about cipro which is dangerous stuff. I don’t like the sound of cipro at all, for many of the potential permanent tendon issues and other side effects associated with it.
Dr. Justin Marchegiani: Yeah. Cipro’s in the fluoroquinolone family which can negatively impact mitochondria and connective tissue so if you’re gonna use antibiotic, try to use one, not in the fluoroquinolone family. Maybe amoxicillin, a tetracycline, just talk to your MD if you’re gonna go that route, to avoid that antibiotic at least.
Evan Brand: Yeah. But here’s the conclusion, NAC is a non-toxic, antibiofilm agent and can prevent cell invasion and formation by uropathogens. So, once again, NAC for the win. This stuff is incredible.
Dr. Justin Marchegiani: Yep. And again, with antibiotic is like I’m always about, let’s do the more natural things first and kind of go, least invasive to more invasive, right? And antibiotics to be the top part of the more invasive side.
Evan Brand: This is interesting, I guess this was an Australian researcher, doctor who put this study together. They’re saying here that in Australia, you know, there’s an estimated 150 million infections and this is 12% of hospitalizations.
Dr. Justin Marchegiani: UTIs are?
Evan Brand: For UTIs
Dr. Justin Marchegiani: Wow. Holy smokes.
Evan Brand: And 30% of all women have a recurrent episode of UTI and then of course the problem with the UTI, right, UTI kind of sounds like, oh it’s not too bad. But I mean this stuff gets up and infects your bladder that gets really bad and then it can even farther ascend and then infect your kidneys and then that’s when you get into a really big trouble and that’s where they talk about sepsis and some of these other literally and potentially fatal infections from UTI. So, when UTI is kind of one of those, it sounds like, it’s just like this easy, not a big deal, but it can turn into a big deal.
Dr. Justin Marchegiani: Yeah. So, just kind of like out of the gates, like what are the symptoms of UTIs, right obviously, like pain, pain during urination, you can see a lot of cloudiness in the urine, right? Potentially, even blood in the urine. It can have a really strong smell as well. It can even create pelvic pain in that area that pelvic or pubic area for sure. It can also move up so women have a very short urethra unlike men, that urinary tract can go to the bladder very very easy just because the distance is really short, so once it goes to the bladder, right, you’ll see pelvic pressure, you may see blood in the urine, frequent painful urination, lower abdominal discomfort and then it can continue going up from there into the kidneys. That’s where’s you’ll start noticing a lot of back pain, flank pain, um, you may notice starting to get chills and fever and maybe nausea and vomiting. And usually, once it starts to get into bladder into the kidneys, you know, you may want to look at seeing conventional medicine for the antibiotic at that point, definitely in the kidney. But, I mean, I think if people can be educated about this and be on top of it, I think you can avoid a lot of that upstage, um, conventional need for medications.
Evan Brand: Well, like many other things that we’ve talked about. Early treatment is key. So, if you can come in and hit some of this stuff hard with D-mannose, your N-acetylcysteine, we use these cranberry extracts very effectively. You and I have also used some professional formulas that contain hibiscus and parsley and horsetail. So, the goal really, I think is to try to break down into like three main categories. So, you go the biofilms, breaking components like your NAC for example or you could add in like natto, Cerezyme or some sort of other proteolytic systemic type enzymes maybe even lumbrokinase would help. So, that’s your number one is your biofilm busting. Number two, you’ve got your antimicrobials that you and I use like bearberry, barberry maybe even clove or oregano might be helpful. Silver, I think, is worth to mention. And then, I would say the third mechanism of action is the anti-adhesive properties so you’re really trying to help flush things out. So, that’s where just hydration comes in.
Dr. Justin Marchegiani: Yeah. Mannose.
Evan Brand: And some of these herbs,
Dr. Justin Marchegiani: Mannose too.
Evan Brand: Yeah.
Dr. Justin Marchegiani: Because that’s gonna pull, that’s gonna help pull the E. coli off like iron filings, right, like I gave that under the gates. So, just couple of foundational things. We’re kinda, we’re kind of hitting some of the meat here, I want to just kind of make sure we set a good foundation. So, out of the gates, women are gonna be more prone because of a couple of reasons. Okay. Number one, we talked about the intercourse and the injection of semen that may either have bugs in it or it may just essentially expose a weaker urinary tract so of course the first thing is hydration if you’re a female and getting up after the sex, getting vertical and going to the bathroom. Get that urinary tract moving, get’s some hydration in you. That’s a really good first strategy our of the gates and of course if you’re prone to having UTIs, you may wanna have a powder of D-mannose like we mentioned or some of the formulas that Evan mentioned, some D-mannose, Uva Ursi, um, parsley is excellent maybe a little bit of silver but you can just start a little bit of D-mannose, a little bit of cranberry extract and a little water and drink that before bed or you know, after a, um, interaction like that. The next thing is, if you can look at the hormones, right, hormones can play a big role so you have the high, you have the low. So, women that have very high levels of estrogen especially women that are on birth control pills that’s gonna shift the urinary tract pH based on the high levels of hormones, that can make it easier for the E. coli to grow because E. coli does not like an acidic environment. And when you started to make the environment more alkaline, right, you usually hear alkalize or die well not necessarily. The urinary tract if it’s alkaline can actually grow bugs, so birth control pills can actually cause the bug to grow to the alkalinity. You can also see the opposite, right, the goldilocks effect. When women go into menopause and their hormones drop, low hormones can also have an impact on the immune system in the urinary tract and that can cause, it can be more, you can be more prone to have UTIs if you’re menopausal with low progesterone, low estrogen because that plays a role in the environment and the immune system and the IgA levels in the urinary tract and so not too hot, not too cold, right? Not too much hormones, not too low hormones, so birth control pill on one side too much, menopausal issues, low hormones on the other side. You really need to work with a good functional medicine person to get the hormones dialed in it, may not be a simple, hey take to something that you may have to fix the hormones too.
Evan Brand: Yeah. Good call, good point, bringing that up. And that’s more of like a longer-term thing. That’s like if you’re trying to get well and stay well, that’s stuff we’re gonna be looking at. So, is it possible to come in and use some calcium D-glucarate or something like that to help that pathway and get rid of the excess estrogen? I think it could help but is it going to like acutely get you out of the UTI maybe not so I think it’s good you’re mentioning to have a plan meaning like a long-term health functional medicine health plan that then prevents you from having to do some of these acute strategies we’re talking about.
Dr. Justin Marchegiani: Yeah, I mean there’s a palliative kind of, um, non-root cause support that we have but we try to always package in the palliative stuff with lifestyle changes that make it more holistic and make it more root-cause and then we also dive into the hormonal aspect and also, I would even say gut aspect. I’ve seen imbalances in the gut bacteria, shift and influences the urinary tract microbial balance too. So microbial imbalance in the gut has a way of shifting microbial imbalance in the urinary tract and it could be just 80% of the immune systems in the gut and that’s having a major effect. It could just be some of this stuff’s working its way down there through moving the intestinal tract. It has a way of shifting or migrating or moving in some way, you know, those kinds of things. But either way look at the gut, that’s where a lot of the immune system is. Look at the hormones, look at medications that could be influencing these things. Look at hydration, those kinds of the root, I think starting situations, you really wanna have your head wrapped around.
Evan Brand: Yeah. In regards to testing you can do this at home. They have companies that make at home UTI test strips that you can do, where you just urinate on the strip and you’re gonna be able to test your leukocytes and they have a little reference range that you can look at and basically the dark on most of these it’s purple, the darker the purple, the more severe the infection is. And we had incredible results with our daughter using some of the D-mannose, we some chewable versions, we did some of these herbs mixed in some apple sauce and we retested using these little pee strips and I want to say, I’d have to ask my wife to confirm, it was either two or three days, we completely got it from a deep dark purple indicating a very intense UTI to nothing. It was completely white. So, the brain is called azo, A-Z-O. And they also make other things, I think they make like ovulation strips and that kind of stuff for more like female health. But this urinary test strip, you’re looking at maybe ten bucks for a pack of these. So, if you do have suspicion or if you’ve had chronic UTIs, this is something that I would recommend you at home because so many times you and I hear a story of a woman having to schedule an appointment, get into the doctor. Yep, I have a UTI. It’s like you could have done that and figured it out at home in two minutes for 10 bucks. The accuracy is very very good.
Dr. Justin Marchegiani: Absolutely. 100% And of course, um, there’s some tests if you do like a uroscopic or a microscopic urinalysis, you know, we’ll be looking at leukocytes, we’ll be looking at protein in the urine. We’ll be looking at pH, we’ll be looking at potentially bacteria. E. coli, looking at the actual microbes in the urine, that’s helpful and then obviously just from a diet, just for me a lifestyle strategy. This is obviously going to pertain more to kids, right? Just teaching your kids how to wipe the right way, right? Females, front to back, kind of common sense, but kids obviously develop blood habits and that could be a simple, easy lifestyle methodology. They can, they can fix that problem and just getting more water, more hydration, if, um, kids have a compromised immune system due to the too much sweets, um, obviously artificial sweeteners like aspartame, Splenda, those can impact the microbes as well. Those things can compromise the immune system and shift the micro, the micro, um, kind of balance, microbiota balance in the gut and in the urinary tract.
Evan Brand: Yeah. Let me show this one more thing. Do you mind bringing this, highlighting this paper?
Dr. Justin Marchegiani: Yeah. Absolutely.
Evan Brand: There’s one more that we wanted to show people, this was just titled, Prospective study to compare they said antibiosis, they’re talking about antibiotics versus NAC, D-mannose and Morinda fruit and the conclusion of the study at the bottom here, D-mannose and NAC resulted in similar to antibiotic therapy. So, even if somebody wants to nitpick and argue, well antibiotics are like
Dr. Justin Marchegiani: Better.
Evan Brand: They’re not. They’re not. Now, I’m not saying that in a severe situation where your kidneys are affected and you’re going septic, I’m not saying, I’m going to try to do this, but I’d be doing all of it, I’d be doing the mannose, the NAC maybe the antibiotic if I had to, but I mean, based on the stuff you and I’ve seen clinically based on more than what we’ve looked at in these papers alone. I mean, the cool thing about PubMed too, is you’ll be able to have related articles pull up like you could go into this one. D-mannose and Hibiscus and Lactobacillus probiotics. You know.
Dr. Justin Marchegiani: Yeah. Probiotics are gonna have a major influence as well due to the acidification of that area. I mean, you can depend, depending on where you’re at, you could potentially even do intervaginal probiotic, you know, you could put the capsule in let it dissolves or you can mix it in, uh, with little, a little bit of aloe or shea butter or coconut oil, something that’s gonna dissolve and um, you could essentially mix it in, you know freeze the cube or refrigerate the cube so it’s solid and then insert intravaginally and that will kind of dissolve and then it will contain some of those nutrients to help support the vaginal canal and depending on where you’re at for some yeast you could even do that same thing with boric acid too. I recommend some kind of a carrier though, just so, it’s uh, just so, it’s not as abrasive if that canal or that tissue is really sore or irritated it just provides some moisture to that area as well and won’t irritate it. And if you’re unsure test the, test the moisturizer whether it’s aloe or shea butter or coconut oil, test it before you put any of the extra stuff in it, so you know, if that’s a problem at all.
Evan Brand: You know, what I’ve also seen to be beneficial, I’ve seen some homeopathic vaginal suppositories for UTIs. I don’t know much about them, but I’ve had women try them and they have worked, when everything else failed, so I think you should be open to it. And the probiotics are game changer too, as you mentioned, you could do intravaginal with the capsule it’ll just dissolve or just oral probiotics has been helpful so as you mentioned the gut, you know, that’s something we’re gonna look at. So, if we see a female who suffer with UTIs and we see she’s got a lot of issues on her stool test, you know, we can’t say directly, hey this is why you have UTIs. But if we fix the stuff in the gut, chances are high that they’re gonna suffer less and less frequently from UTIs. It’s really, really important as you mentioned you got this vaginal microbiome, you’ve got the oral, you’ve got the gut, you’ve got the skin microbiome, so, I mean if anywhere there’s dysfunction or dysbiosis going on, I think they can affect the whole system.
Dr. Justin Marchegiani: Absolutely. And then, men play a part of the role, you know, in this whole thing. So, get your sugar consumption down, better hydration, could always throw in a little bit of ginger or cranberry kombucha that’s a really easy simple thing. Just to add in as a routine. Sometimes, it’s easier to add things to a routine than pull things out.
Evan Brand: Well, think about how many men, you and I have seen and work with over the years with gut issues so, I mean getting their gut straightened out too is gonna be my goal because I’m sure that’s gonna affect what’s we’re seeing in these paper zone like semen quality, and they’re not passing these microbes, you know, via sperm. So, man, you gotta get on board. Women just I, you know, I feel bad for them because they take a lot of the blame, they take it upon themselves like there’s something wrong with them and in many cases, there definitely are issues with the dysbiosis and the female but in the men they kinda get off the hook so, we’re calling all the men out here, you gotta get involved too, you gotta get your health involved. If you’re over there, eating pizza while your wife is sitting here cooking a paleo meal, you gotta get on board because, you know, this is a team sport here.
Dr. Justin Marchegiani: Yeah. And you can always use a barrier method if not, right, that’s an easy way at least in the interim and then also just getting the hydration up and avoiding the sugar can make just a huge difference. Sometimes, it’s not even 100%, just an 80 20 can make a huge difference on that.
Evan Brand: I know how men are, being a man, so if the wife says, uh, honey you’re gonna have to use condoms for the rest of our, uh, sex life, I think that’ll be a, easy quick motivator to get them on board and they’re natural.
Dr. Justin Marchegiani: Totally. Yeah. I find like kind of in the men sphere, there’s like two kinds of men. There’s like the men that are like biohackers that are like always into like optimal performance trying to improve and get everything kind of optimized in their health and their life and their come some guys that they kind of just, they’re a little bit more slow to the punch and they’re motivated by what the rest of their family is doing, their wife’s doing, and then their wives kind of get them on board, there’s like kind of two classes like that, I think me and you tend to be more in the biohacker class and we see a lot of biohackers that are in, right, you know, that are really motivated and they’re all about performance, performance and then some their wives are more on that side of the fence and the wives kind of get them motivated but most of the time though, once someone can see their life improve and usually if you get healthier, you don’t just improve in the urinary tract, you improve in cognitive, mood, libido, energy, digestion, so women, if you can get your husbands on board, they’re gonna see a lot of buy and hopefully other areas and hopefully you’ll be able to get them a long-lasting buy in which is really important for energy and just, you know, people being, um healthier which is important.
Evan Brand: Yeah. Well said. We can mention this comment here that came in the live chat and then we can wrap it up. We’ve kind of hinted at this but we didn’t say it directly, when we talked about UTIs, I mean a lot of times, we are referring to the bacteria but in many cases there’s a yeast component too, so there’s a fungal component, here’s the cool thing though, you and I are always using blends and these blends are not only antimicrobials but also anti-fungal, anti-yeast. So, someone in the comments here wrote that they kept getting UTIs even after getting treated until they started yeast treatment and that’s a cool thing. Think about if you come in with antibiotics, so let’s just quickly compare the conventional and functional approach. You come in and do the antibiotics, those are not anti-fungals, but if we’re using something like bearberry, barberry, berberine, cloves, silver, Saccharomyces boulardii probiotics, we’re creating an antifungal, anti-microbial, anti-parasitic protocol all in one, which is awesome because sometimes we’re killing multiple birds with the same stones and that’s why we love what we do.
Dr. Justin Marchegiani: 100% and of course, you know, a good history will kind of figure this out, based on you know, if you have a new sexual partner or not, STDs always can be a thing, so we’re looking at Chlamydia, maybe Gonorrhea, right? And so, these types of infections, I think we could probably see some improvement with some of the natural things especially if we add in silver and such but these types of things, if you’re not having results, they may require a special kind of antibiotic, if that’s at play. And so, obviously, you know, it’s gonna be history dependent, if you’re in the steady relationship then that may not be a thing or if you’re not sexually active that probably isn’t gonna be a thing but it’s always good to kinda keep that in the back of your differential list of things that you kind of work up through from least likely to most likely.
Evan Brand: Yeah. Good call. So, on that NAC paper, it actually did talk about Chlamydia and it talked about the mycoplasma and there was a couple others in there and it was talking about the anti-adhesive, anti-biofilm properties of the NAC. So, even if it were STD, I think NAC is something you’d still wanna implement.
Dr. Justin Marchegiani: Yeah, I mean, usually you’ll gonna see some level of discharge too with some of the STD stuff but worst case, you know, you can just tested try some of the simple things out of the gates. A lot of times the history will tell you, especially if you know, if you’re, um, had intercourse in the next day, you know with your husband or partner and the next day you’re starting to feel some issues, then it’s probably gonna be on the E. coli side of the fence which is 90% of the time, so you know, if you have 90% odds with something, we’re gonna go with that out of the gates for sure.
Evan Brand: Yeah. Okay. So, testing strategies just to summarize, you could do the at-home test strips for this, we think a good stool test would be, in order to figure out what’s going on with you’re gut and how’s that affecting your microbes down south same with your partner, if we can get them on board, get your stool looked at, a urine test is helpful too because we’re gonna be able to look to Candida overgrowth and other types of fungal colonization. So, we like the organic acid, so an oat, a stool and some of the at home test strips, I think that would be a great starting place because you could do other things, blood work, and as you mentioned like the urinalysis and like in the conventional lab, you could do that too. But you might not, if you do these top three.
Dr. Justin Marchegiani: Absolutely, and then the big symptoms that would differentiate an STD over UTI are gonna be like more systemic symptoms, so like nausea, fever, swollen joints, sore throat, symptoms that are kind of gone more systemic and of course there can be some localized symptoms that can be more severe like extreme discharge, severe rash in that area, blisters in the genital area, but look for more systemic type of symptoms that could be driving that.
Evan Brand: Okay. You’re saying more systemic symptoms would be what?
Dr. Justin Marchegiani: The ones I just mentioned, so pelvic
Evan Brand: No, would be a UTI?
Dr. Justin Marchegiani: No, that’s gonna be more of an STD, so think of STDs are more severe therefore the symptoms are more severe. They’re more systemic. So think of systemic symptoms are things that are more severe, localized symptoms, right, that means the microbes haven’t spread as much and they’re less severe, so more severe think of the STDs.
Evan Brand: Got it. And then you mentioned in the beginning if the UTI is more severe that’s were the back gets involved in the case of the kidneys, you know, there are people that, they perish due to UTIs if they go septic so obviously, you would have a lot more issues than you would know by then. You’d be in real bad pain.
Dr. Justin Marchegiani: Absolutely. Yep. 100%. And again, like you know, UTI, on a desk, can go to the bladder and then the kidneys and then, you could have a fever, you could have these things, so as a UTI gets more severe that could definitely drive the symptoms up as well. But usually, what people can see it because it’s just following that urinary tract, it’s going from the urinary tract to the bladder, to the ureters and then up to the kidneys. So yeah, usually you can see that and feel it, the pain starts to move up. Well, anything else, you wanna add?
Evan Brand: No. I’m just gonna say, we work with this issue all the time. We’re really happy to help people and to provide solutions to what have been a major issue. A pain, an issue and like I said with people’s sex life and with just people’s personal health. I mean this is something that’s a big burden for a lot of people especially women. So, we’re really happy and fortunate to have outside of the box tools that we use with great success and we don’t only back it up with clinical experience, we backed it up with some of the research we’ve dove into and the professional formulas we use are tried and true. So, if you need help, please reach out, we’d love to help if you wanna reach out to Dr. J you can at justinhealth.com justinhealth. If you wanna reach out me Evan Brand, you can do so at evanbrand.com and we both work worldwide via facetime, phones, skype and we send products to your door, so if you need to get any of these labs done, investigate you, it doesn’t matter if you’re in California or Oregon or Michigan or Florida or New Mexico or Australia or Canada or Europe, we can do it, we can help and we work with people around the world, we have for decades so it’s just a true, true pleasure to get the hands-on experience with this issue because I think the most empowering thing is to know that you’re not a victim meaning you’re not just going to have to go on antibiotics. That’s just the foghorn of the conventional approach, and it’s just so empowering and inspiring to know, there’s other ways, other tools, there’s other approaches that are very, very successful.
Dr. Justin Marchegiani: 100% Yeah and if you guys enjoyed it evanbrand.com, justinhealth.com. There’ll be links right there to work with us. Hit that thumbs up, helps the search algorithm improve so more people can see our information and give us a share, give us a comment, write us a review, we’ll put links below to do that. Thanks, y’all, you guys have a great day, we’ll talk soon.
Evan Brand: Take care.
Dr. Justin Marchegiani: Bye Evan.
Evan Brand: Bye. Bye.
Solutions to Small Intestinal Bacterial Overgrowth (SIBO)
By Dr. Justin Marchegiani
I see patients every day walking to my clinic with small intestinal bacterial overgrowth (SIBO) symptoms. Have you ever felt your stomach pooch out after eating certain foods? Do you ever feel like you can’t quite digest your food all the way? Small intestinal bacterial overgrowth can also contribute to leaky gut syndrome!
There are millions of people with SIBO-like symptoms covering them up with medications that don’t fix the underlying problem. SIBO can affect our immune system and compromise our body’s ability to break down food and absorb nutrition.
Below are 5 signs you may have SIBO:
1. Burping or belching
3. Indigestion/low nutrient absorption (low B12, proteins, and fats)
4. Diarrhea or constipation
5. Abdominal pain
What Causes SIBO?
When we have low stomach acid, or achlorhydria, our body lacks the ability to activate protein-digesting enzymes in our stomach, called pepsin. We need a low pH (acidic), right around 2, to ensure our body’s optimal digestive capabilities. This is why people on proton-pump inhibitors (drugs that block stomach acid) are at an increased risk for SIBO.
A low pH also provides an inhospitable environment for bad bacteria to grow. When bad bacteria overpopulate the stomach, it’s easy to see the increase in intra-abdominal pressure. This increase in intra-abdominal pressure can open up the esophageal sphincter and allow acids from the stomach to rise up and create irritation or burn the esophageal tissue. Without adequate levels of stomach acid, SIBO is almost certain!
Without adequate enzyme production, our body has a difficult time digesting proteins and fats. When our body doesn’t break down these proteins and fats fully, they putrefy, rancidify, and ferment in our intestinal track. This is not good!
HCl is the first important step for enzyme production. Without an acidic pH, the foods that are released from our stomach into our small intestine will not provide enough stimulation to trigger the gallbladder to release bile acids and pancreas to produce protein (trypsin and lipase) and fat-digesting enzymes. Without the crucial release of these enzymes, our body is at an increased risk for small intestinal bacterial overgrowth, or SIBO.
Many infections are opportunistic and are able to take hold of the person’s body because of an accumulation of physical, chemical, and emotional stress. When this happens, we tend to have a decrease in immunoglobulin A (IgA). IgA is a protective mucous membrane barrier that lines our intestinal tract and plays an important role at preventing SIBO. Because 70 to 80% of our immune system is located in the lymphoid tissue in our intestinal tract, this has the ability to throw our immune system out of balance.
Chronic infections can lower stomach acid and decrease our body’s ability to break food down. With low IgA and a lack of stomach acid, our body is a sitting duck for an infection. Bacterial and parasitic infections are known to produce toxins (endotoxin and lithocolic acid) that can actually suppress our immune system. If you’re having chronic SIBO-like symptoms, feel free to click here to see if an infection connection is possible.
There are many other risk factors for SIBO, including fibromyalgia and IBS. These other conditions have common threads along with the main causes of SIBO that are above.
When our immune system is compromised by various infections, we have an inability to break down, absorb, and assimilate food due to an increase in physical, chemical, and emotional stress. This accumulation of stress eventually breaks the weak link in your chain. Because the gut is so central to the immune system, so many different conditions have a common link with small intestinal bacterial overgrowth. I would go as far to say that it is impossible to have a chronic disease without some type of gut dysfunction!
What Is SIBO?
SIBO is typically caused by a migration of bacteria from the large intestine making its way back upstream into the small intestine.
“SIBO may be accompanied by both maldigestion and malabsorption. Bacteria in SIBO might significantly interfere with enzymatic, absorptive and metabolic actions of a macro-organism.”
When our digestive system becomes stressed, our ileocecal valve can become loose. The slack in the ileocecal valve makes it easier for bacteria to migrate up the gastrointestinal tract. If more bacteria starts making its way up the GI tract, it makes it harder for the healthy gut bacteria in our small intestine to produce important nutrients, like vitamin K, vitamin D, iron, and various B vitamins.
What Type of Bacteria Is Found in SIBO?
How Do You Test for SIBO?
1. Hydrogen or methane breath test
A solution of glucose or lactulose is consumed. Hydrogen or methane levels are measured after the test, and if hydrogen or methane is found in amounts greater than or equal to 20 ppm, it is considered a positive test for SIBO. Ammonia is a common by-product from the intestinal bacteria. Ammonia has a pH of 11, so it’s easy to see how bacteria can affect intestinal pH!
2. Comprehensive stool test
The pathogenic bacteria mentioned above can be found in the stool by a comprehensive stool analysis. All lab companies are not created equal when it comes to this type of specialized testing. I recommend only using the best companies to ensure that you are getting accurate results. My three favorite lab companies for stool testing are Biohealth Diagnostics, Genova Diagnostics, and Doctors Data. If you are trying to get assessed for SIBO or any other infection, feel free to click here!
3. Organic acid test: This test can look for metabolic by-products of SIBO, including benzoate, hippurate, phenylacetate, phenylpropionate, p-hydroxybenzoate, p-hydroxyphenylacetate, indican, tricarballylate.
How do you treat SIBO?
Conventional Treatment Options
Conventional treatments typically consist of taking specific antibiotics, such as metronidazole and rifaximin. Antibiotics are powerful medicines, and I typically recommend a natural herbal approach first. The herbs tend to be more gentle on the body and don’t have all of the side effects.
Natural Treatment Options
There are many herbal medicines that can help eradicate SIBO. One of my favorites is oil of oregano. Other great herbs include berberine, artemisia, cat’s claw, colloidal silver, and ginger.
Sometimes it’s more than just SIBO causing the problem. If you are having any of the above symptoms, it’s good to get checked by a functional-medicine doctor to make sure there are no other infections driving the problem.
Some of these bacteria use biofilms as a means to protect themselves from the antimicrobials. It can get a little more nuanced when addressing the stubborn infections. Feel free to click here if you need help!
I find many patients do better at making diet and lifestyle changes first and addressing the adrenals and hormonal system second before addressing the gastrointestinal system. When patients go right to the GI system, the side effects tend to be much higher!
FODMAPs: Removing fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) from the diet is also important. These FODMAP sugars can fuel the pathogenic bacteria in the gut, which then leads to more toxic metabolic by-products. Many people notice great improvements in stomach distention, gas, and flatulence after removing these foods from the diet. I personally find a combination of diet, lifestyle, and herbal medicines tend to be the trick to addressing the underlying cause of the problem.
Resistant starch: Adding resistant starch type 2 or 3 into your diet can also help feed the beneficial bacteria in the gut. The beneficial bacteria in the gut produce a short-chain fatty acid called butyrate. Butyrate helps keep the pH in the gut lower, tightens the ileocecal valve, and provides fuel for the cells of the colon. Watch the above video for more information on how resistant starch can help improve your SIBO.
My Favorite Resistant Starch
- Type 2 resistant starch—unripened banana flour by Wedo.
- Type 3 resistant starch—potato flour by Bob’s Red Mill.
Instructions: If you have significant SIBO, start with just 1 tsp of resistant starch and work up to 2 tbs. If you have any significant gas or bloating after taking the resistant starch, half the dose the next day. When in doubt start slow. Gas and bloating are surefire signs that you have SIBO.
I can take 2 tbs of resistant starch two times per day without any symptoms. Some people may have to use herbal medicines to significantly knock down the SIBO before the resistant starch can be tolerated. Make sure you work with your functional-medicine practitioner to support you in the process.
On a low-carbohydrate diet, the E.rectale and the Roseburia bacteria can significantly decline. Adding in resistant starch can help prevent this decline in beneficial bacteria while maintaining a low-carbohydrate eating plan. Some people are carbohydrate sensitive and need to keep their carbohydrates down, and this provides an excellent option to get the best of both worlds.