Gallbladder Attacks| Podcast #228

Gallbladder seems like a small pouch that is located just under our liver and is responsible for storing the extra bile the liver makes. Pretty easy, right? No. The gallbladder plays a very important role especially in digesting fatty foods.

In today’s podcast, Dr. Justin Marchegiani and Evan Brand talk about the importance, and how to take care and address problems when it comes to our gallbladder. Stay tuned!

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

02:52 Gallbladder’s Function

07:43 Risks of Taking Out a Gallbladder

12:45 Mechanisms Behind The Damage

14:58 Hormones

19:26 Gallbladder Damaging Foods

22:32 Parasites

23:53 Hormones and Birth Control Pills

25:50 Keeping It Safe

31:25 Fiber and Sugar

34:15 Tests



Dr. Justin Marchegiani: Hey guys it’s Dr. Justin Marchegiani here, I was out of the office last week. I’m so excited to be back in action. We get Evan brand here in the house and we’re gonna be doing a talk on gallbladder attacks what you can do to treat, prevent and what the physiological cause of this is. Again do we have to rely on conventional medicine to get your gallbladder out. Can we do more natural means to get to the root cause. So, Evan how we doing man?

Evan Brand: Hey man pretty good, yeah. This is timely because as I told you before my mother-in-law she ended up having a bunch of pain last night and goes into the ER and they say after doing an ultrasound, which is one of the diagnostic tools that conventional medicine is really useful for, they said, yep you’ve got gall stones, you got to get your gallbladder taken out and they’re gonna say, hey you got to go right into surgery and get it out and I’m trying not to let that happen but I may lose this battle, it’s hard to say right now.

Dr. Justin Marchegiani: Oh, before we dive in man you had a baby in the last week. Congratulations!

Evan Brand: Good, thank you. I can’t show her off, she’s gone. Mom took her out somewhere, but yeah she’s, she’s healthy. She was 8 pounds 1 ounce. No complications during birth at all. Everything went absolutely amazing and, right yeah, yeah my wife had her in a big old bathtub that we bought and got set up just for that so.

Dr. Justin Marchegiani: Her name is Jenna Rose B.rand

Evan Brand: Yep, that’s it.

Dr. Justin Marchegiani: That’s awesome JRB, I love it man.

Evan Brand: Yeah, yeah.

Dr. Justin Marchegiani: So she’s drunk right there, right.

Evan Brand: There man, mom’s good, mom’s recovering and we’re figuring out our sleep schedule. Still the baby’s sleeping pretty good, she’s breastfeeding pretty good. So far so we can’t complain, I’m still in kind of that like oxytocin overload so I don’t have much to complain about right now.

Dr. Justin Marchegiani: Yeah, a little hazy. It’s always a little tougher when you have another kid because you got to still manage the other kid while this new babies into the world and then maybe it is a jealousy thing going on so you got to manage that so it’s definitely tightrope walking. I’ll be there in like 3 months so it’s like crazy that I’m just, you know, you’re like a sneak preview of what’s to come 3 months ahead of time here.

Evan Brand: I know all I can say is enjoy it with one kid because you don’t realize how easy it is to have one until you have two, and then it’s like wow this is more than twice as complicated as one it doesn’t just double it’s an exponential work scale.

Dr. Justin Marchegiani: I know that’s first six months of the hardest wood getting the sleep on track everything is possible with good sleep. When sleep is not there, everything becomes so much harder across. You got a good sleeper.

Evan Brand: Yep.

Dr. Justin Marchegiani: And of course you’ll do all the right stuff so much of baby sleep has to do with you know early on it’s tough because the baby just doesn’t have the blood sugar stability aspect but having good quality breast milk and good proteins and fats in Hannah’s diet will be huge with providing sustenance for the baby, so, fingers crossed that you guys are on the right track there.

Evan Brand: Yeah, thank you man I appreciate it.

Dr. Justin Marchegiani: Well let’s dive in the gallbladder issue, so physiology 101. What is your gallbladder? So, it sits right below your liver so your livers on your right side, here so in this quadrant here and the gallbladder kind of tucks up underneath and it’s there to primarily concentrate bile salts and bile is designed to help emulsify fat. So think of emulsification is when like greasy pan soap it’s the pan it starts to kind of like suds and break down that’s emulsification in the ability the reason why we want to emulsify it so we can absorb if not if you just try to wash a let’s say a greasy baking dish with just like water use a big sheen right and that essentially what happens in your stool you’ll see that kind of a sheen in your stool and you may even see your stool float if we can’t break down fat adequately, so we need that emulsification so we can break down that fat. And it’s important because there’s actually nutrients in fat like vitamin A, D, E and K these are fat soluble nutrients vitamin A is great for your skin for your thyroid for your immune system D is obviously great for your immune system you make it from the sun as well vitamin E is a powerful antioxidant and great for cardiovascular health and stress and then vitamin K is amazing for your bones it’s also a very important nutrient for your immune ___[04:04], your immune function and healthy vascular system so vitamin A, D, and K really important and you will not be able to optimally break those down within adequate bile salt production so if your gall bladder is not working and that can be a problem. Now, your gallbladder provides a benefit because it concentrates violet and the 15 acts some people report you and higher compared to what your liver could do so your gallbladder sits there. It’s just little pouch and then it concentrates that bile. And then when you eat food by protein and fat primarily it’s gonna be fat but typically protein is batter together that’ll go into your stomach you’re gonna make a whole bunch of stomach acid that lowers the pH. That nice low pH causes activation of proteolytic enzymes. That nice low pH then goes into your small intestine. That nice low pH then triggers bicarbonate from your pancreas which helps bring that acidity back to neutral about,   but that nice low acidity triggers a hormone a hormone peptide called CCK, or cholecystokinin for short, and cholecystokinin causes that gallbladder to contract and release that bile salts and that good acidity also causes the pancreas to produce light pace in proteolytic enzymes lipase means fat digestive enzymes proteolytic, means protein digesting enzymes so we need that nice low pH, and that triggers our gallbladder to work and if we don’t have a good gallbladder, that bile from the most part your liver becomes your gallbladder. So you’ve become and hepatic bile duct expands and that gallbladder just kind of drips and it doesn’t really get to that nice concentrated fashion and work as well, so you’re not gonna have good fat digestive capacities.

Evan Brand: Man, I didn’t even know this there’s so cholecystokinin can also be its officially called pancreozymin,  did you know that?

Dr. Justin Marchegiani: No, I didn’t know that was, uh, another name for it.

Evan Brand: I guess that’s another name for it. But yeah, so it’s made right there in the first sect ion of your small intestine. That’s pretty cool. I never knew that name before. Yeah, this is interesting because you, you gave a really good visual about the whole bacon grease on a pan thing because it’s fat soluble when I picture that and, and I, and I use your visualization. I’m seeing all these nutrients that are almost hidden or protected by the layer of fat and if you can’t bust apart that fat and emulsify it, it’s like those nutrients just go to waste you could be eating those nutrients but if you’re not emulsifying the facts those nutrients are not really getting absorbed and I think this is why so many people you even who take vitamin D supplements, maybe they’re deficient because they’re not maybe one they don’t have a gallbladder or two they’re just not eating it with fat or three they just don’t have the emulsification process working.

Dr. Justin Marchegiani: 100%, and again like if you’re eating really good foods fats and proteins and that’s not digesting properly a lot of times, you’re gonna feel nausea. You’re gonna have indigestion because a lot of these proteins and fats they’re gonna go rancid. They’re gonna rancidification and  then they’re gonna get putrified right so rotting proteins Beautification rotting fats rancidification fermentations the carbs and that can create a lot of bloating and gas and digest the de-stress, so and that can even create more nausea. Yhen what tends to happen is a lot of these kind of people are, are ones that tend to go more vegan, vegetarian plant-based because they’re really just having a hard time with these harder. Let’s say energy intensive foods to break down and then their diet starts to shift so we got to get to the root cause and say what’s going on with our digestive system and figure it out.

Evan Brand: Well, you know, what I just found out too is kind of a risk of getting out the gallbladder is the increase of colorectal cancer goes up quite significantly. When you get the gallbladder removed, if you just Google gallbladder or they call it a cola how do you even pronounce this, is a sola, coalescedectomy-

Dr. Justin Marchegiani: (Cross-talking.) Yep.

Evan Brand: Coalescedectomy, anyway, remove the gallbladder alright it’s quite significant, I’m trying to find the exact percentage here but I would just say that there is a big increase in different types of cancers after you get the gallbladder removed and I would say probably just because the gallbladder does have some function to help with detoxification, because you’ve got this connection between your liver and your gallbladder and your bile so that whole system gets disrupted if gallbladder is removed.

Dr. Justin Marchegiani: Yeah 100 % yep, so in general we have like two major ducts right we have like this common, this common bile duct right, and then we have this pancreatic duct because you have bile coming out so you have liver, gall bladder, common bile duct ,or the common duct and then you have the pancreas hanging over here, and you have a successive pancreatic duct. So what happens is these kind of conjoined and then they eventually go to this hepato pancreatic ampule er there’s a couple names for it, it’s the same thing it’s basically just where the liver and the gallbladder duct meet the pancreas dock and then they go into the small intestine. You can have stones that go right after, they, here they go a little bit lower. You can have some stones join now when those stones are there it can create a blockage and it can create a backup of enzymes in the pancreas, and they can create a backup of gall bladder or the bile or essentially you can create more pressure where those stones are up in the gall bladders and then you can create pancreatitis issues on the pancreas side right because it tees to the right and then we’re at each to the left. You can create inflammation in the gall bladder right and these are both issues so typically they lean more on pulling out the gall bladder than they would the pancreas just because the pancreas has a lot of other exocrine functions like insulin and glucagon and other types of hormones so they typically go right to the gallbladder and remove it. Now we can talk a little bit about should you remove itn should you not. It just depends on how acute it is and how long it’s been going on. But I’ve had great experience saving people’s gall bladders by doing some of the things that we’re going to talk about in a bit so you really have to sit down and talk with your doctor see how your immune system is doing. See how inflamed jar but you really if you’re gonna let’s say try some of the more natural things to save your gall bladder, you really want to be monitoring it especially if you’re on the pancreatitis side because that can definitely be dangerous. Any thoughts on that Evan?

Evan Brand: Yeah, I wonder if looking at the pancreas, if that would be something they would look at via blood or if that would just be the ultrasound maybe they would look to see if the pancreas is inflamed, I mean how would you judge the pancreatitis so you would know?

Dr. Justin Marchegiani: That’s a great question. I’m not sure the exact what they — I imagine the ultrasounds and to be a big component in it they’re probably gonna also look at your immune markers as well to see how jacked up your immune system is from what’s going on and like you probably also look at some various pancreatic enzymes as well.

Evan Brand: Okay here’s the National pancreas Foundation testing would be yes ultrasound so this would look for acute pancreatitis there’s an endoscopy basically endoscopy type of ultrasound that they can do them RCP which is basically like a special type of MRI and then a CT scan.

Dr. Justin Marchegiani: Yeah and they’re gonna look at also the pancreatic enzymes like we talked about the amylase and the light base.

Evan Brand: Okay.

Dr. Justin Marchegiani: Exactly, so yeah when you understand physiology, it’s not that complicated because you only can test them look at, so many things so you have your physical exam where they’re just gonna touch and and poke in that area and see where that pain is and just assess how it feels on the outside. They’re gonna look a little deeper with an ultrasound. They’re gonna look a little deeper with immune testing to see how much your immune system is stimulated and also look at the enzyme see how bad the enzymes are and that’s normal.

Evan Brand: I mean if you had a gallbladder attack, it’s normal to have some back up and for that pancreas to be dysfunctioning a bit. It doesn’t mean, you know, just if you do have maybe some pancreatitis, I don’t think that necessarily makes a situation any more detrimental like if you avoid surgery. I don’t think that means you can’t avoid surgery if your pancreas is inflamed bit.

Dr. Justin Marchegiani: Yeah. My biggest thing, because this is a podcast and we’re not seeing people individually. So make sure you check with your doctor just know that every conventional doctor or surgeon is going to be prone to pulling your gallbladder out because that’s what they do. They don’t understand nutrition or the root cause of what’s happening so you have to understand that to begin with ,but my goal is at least to get your doctor’s blessing you at least try some of these things and then you can come back and monitor and see how you do, but we’ve had great success. So let’s talk about some mechanisms that drive these problems, so the first thing I would say is just poor digestion to begin with, right. We don’t have enough stomach acid, we don’t have enough stomach gas so we missed the stimulation for the pancreas pancreatic output. If we miss the stimulation for the pancreatic out, but we probably have missed stimulation for the gallbladder to contract and the more we have bile that sits in our gob line or longer we can get crystals to form and when these crystals form at some point your gallbladder will start to contract, and that’s like going and petting a porcupine. Like giving a porcupine a big hug right because these crystals are forming and then they’re inside this gallbladder now the gallbladder contracts over time and it’s like given that pork you find a big hug and then you get a lot of inflammation then they go and they’re gonna test your gallbladder via ultrasound then it’s, yeah, it’s inflamed we got to pull it out but it’s not getting to the root cause of why it needs to be pulled out or why it’s inflamed to begin with so we want to. Just keep that in mind.

Evan Brand: Yeah well said well also we’ve had some people that they’ll go from like a really low fat or a nonfat diet – paleo and then they have pain in that area. Kind of that low right side under the ribcage there, and I think your analogy works perfect for that which is that their gallbladder really probably hasn’t been being worked it hasn’t been being squeezed and pumped like it would if they were eating good fat so that’s why some people will go on paleo or keto or something similar and they’ll complain of issues.

Dr. Justin Marchegiani: Yeah, I think a lot of women have been brainwashed. You know, from the 80s or 90s where you’re kind of going lower fat and then when you’ve gone lower fat for a while and that gallbladder is not having to contract. It’s like the equivalent I’m not changing the oil in your car for a while that oil in your oil tank gets sludgy it gets really sludgy it’s not moving well and then it’s possible that you could have a blockage or a stone could form and then you start eating paleo and you’re eating all these really good healthy fats your gallbladder is contracting you’re hugging that porcupine or that that backup occurs maybe to your pancreas, and back to your gallbladder and then you get a whole bunch of inflammation but and then you’re told hey we got to get your gallbladder removed, so we got to understand the mechanisms here another major mechanism is estrogen dominance so if you’re a woman or even guys – because guys are getting exposed to lots of estrogens in the food the water and through plastics and pesticides and glyphosate, that this can cause the bile to get more sludgy. It can turn it into molasses, so you have kind of let’s just say more weakened or decrease bile flow and this can create issues as well so sludgy bile can be a big concern in the hormones have a major impact on that.

Evan Brand: Well now that you say that, the natural question becomes what about all the women that are on bio identical hormones and they’re getting put on progesterone and estrogen creams and all that I mean that’s got to be playing a factor in this.

Dr. Justin Marchegiani: Yeah, I mean if you’re on hormonal support make sure it’s bio-data   and make sure you’re being monitored. Make sure it’s really being monitored so you know that you’re not in an estrogen dominant state. You want to make sure you have a good ratio of estrogen to progesterone, so typically on average is about 22 to 23, to one progesterone over estrogen right because progesterone should be more dominance but a lot of women just natural they’re more estrogen dominant and a lot of people if they’re supplementing hormones a lot of times they may not provide that good progesterone with it or if they’re cycling females, they do it at the wrong time may just do progesterone throughout the month which is not what you do for a cycling woman because they have a follicular phase which is the first half and they have a luteal phase which is the last half first l, and luteal for last and that last half is where progesterone really predominates and I’ve seen a lot of doctors recently where women they’re cycling they’re still in their cycling age their follicles are still active and they just kid progesterone flat line throughout the whole month that’s not how you treat a cycling female.

Evan Brand: (Cross-talking.) Yeah, well-said.

Dr. Justin Marchegiani: So getting back to that we talked about the hormonal imbalance and then of course if we start having sludgy or dodgy bile flow that’s going to start to impair really good fats, and fats are great because they make up our cell membranes they all. We also tend to have fat and cholesterol together a lot of times and cholesterol is a really important hormonal building block so when you start to have poor bile flow and poor fat digestion then you start to have more bloating and gas issues because things are rancid if I and putrifying in our guts right and then we need these important nutrients to make our hormone so then we start to have digestive issues and now we start to have more hormone issues because these building blocks aren’t being absorbed and we know vitamin K vitamin A is really important for the thyroid and then we start having thyroid issues. And we also know vitamin A is really important for skin too and then you start to have skin issues so you can see with some of these cascades you can start off with poor digestion got symptoms hormonal imbalances skin issues and then when you start affecting more hormones, you can affect mood cognitive so you can see how that gallbladder domino can fall and then so many other cascades of symptoms can occur after the fact.

Evan Brand: Yeah, well thyroid too I mean we could go on and on we if we unpack this thing fully this could take us all day, but we know that low thyroid, so hypothyroidism and especially Hashimoto’s. you know that’s gonna be a link to with gallbladder function if your thyroids under functioning that’s gonna affect things to the stomach acid you already hit on that so i always think of H pylori soon as you stay low stomach acid, i think of all these women with H pylori infections or women that are on the anti-acids or PPIs that’s a contributor to.

Dr. Justin Marchegiani: Big-time, so being on PPI is also antibiotics because antibiotics really mess up our gut bacterial balance and then that can really have some negative effects of – some studies showing that antibiotic exposure can significantly increase cholestasis so stasis this means like the flow is impeded so the flow starts to get more dodgy and kind of more like molasses versus water so to speak so that can start to create issues with bile flow and then of course we talked about the stomach acid and enzymes the next big when I say it would be food allergens

Evan Brand: Yeah this is huge. You gave me a good article on this it was about Dr. Jonathan Right, who you and I both love and look up to his book Why Stomach Acid is good for you. Its amazing, if you don’t own that book it’s like bucks on Amazon totally favorite books of all time and he talked a lot, yeah, I mean we’re talking I was telling you I think he’s in his mid to late 80s now I mean he was talking in the 1960s about food allergies in this article food allergies and what and in the contributing factor to took all bladder issues and he was saying that eggs was number one the number one offender for these people   90 almost 93 percent of people that they were studying had an issue with eggs that’s gigantic and then.

Dr. Justin Marchegiani: Also number two is pork aka bacon. So this is big because if you’re in the paleo community and you’re on a paleo template you’re probably eating a lot of eggs and bacon so one of the first things that we see with patients is if we have any gallbladder issues we pull out eggs and bacon and I’ve seen it work phenomenal now after that there’s I’ve done a video on this a few years back so we’ll try to put that the gallbladder video in the references, if you just put my name and gallbladder you’ll probably find the article in the video but we have eggs and bacon number 1 and   2, onions number 3, chicken and turkey 4 and 5 and then milk coffee and then we have some citrus oranges and then corns beans nuts apples tomatoes peas cabbages spices peanuts fish and rye to follow so I gave you a long list and you may be overwhelmed the, the biggest thing I’d focus on is the first yeah focus on eggs. I focus on the baking component. I focus on the coffee and I’d focus on maybe chicken or turkey but at least do those first out of the eggs and bacon maybe some coffee because those are pretty common and see how we do from there now of course the gluten and the refined sugar in the trans fats the junkie or standard American foods are like first so if you got someone that’s on a standard American template well first thing is just try to get them to go paleo first that may be a good first step but go paleo but cut out eggs and bacon as a starting point and maybe coffee just to see how we do to start.

Evan Brand: Yeah I don’t do eggs that often. I mean I had a lot of digestive problems with them in the past when I had parasite infections. I couldn’t tolerate eggs they send me straight to the bathroom so I don’t know if that was related to gall bladder if that was just due to my infections but now I’m ok with eggs I just don’t really care for them I only eat them maybe, maybe once a week I’ll do a few eggs.

Dr. Justin Marchegiani: I mean eggs are a super food there. They got a whole bunch of really good fat soluble nutrients in the yolk really good protein source. I think eggs are phenomenal but not everyone can do it and if you can’t do it just make sure you, if you love it, rotate it, if you love it, rotate it. So, we have those common foods of course we’re going to add in extra enzymes and hydrochloric acid so we can break the foods down right those would be the next steps and I would say a couple of other things here for poor digestion is you kind of already alluded to it with H pylori but other types of infections whether it’s SIBO bacterial overgrowth whether it’s other types of parasites blastocyst is hominis Giardia Giardia is also known to hang out in bile ducts in the out ladder so Giardia can definitely be a gallbladder a stressor for sure I don’t remember if.

Evan Brand: I told you that I mean this was coming up on four or five years ago, now I’m pretty confident I had a gallbladder attack due to Giardia, I mean I was doubled over in pain and it was in that low right quadrant of my abdomen and that was when I got my stool test back that said Giardia is, so if you just type in Giardia bile duct you can read about it they’ve known about this since like the s that Giardia can hang out around that area and cause sort of a phantom gallbladder attack I mean it’s real the pain is real but it’s not actually a gallstone or anything it was the Giardia doing it which is hard to believe because it’s such a tiny organism it make you think how could it do that.

Dr. Justin Marchegiani: Yeah exactly, and also healthy bile flow is really important because bile acids which is what they are vile acids help provide a really good environment for good gut bacteria and keep the bad stuff down in the gut, so when you start having poor bile flow and you’re not producing good bile guess what happens you have less bile acids in the intestines so then you start to have more gut bacterial imbalances so we just have imbalances and the bad bacteria higher amounts of bad verses lower amounts of good and then this starts to wear away or create leaky gut because now we have this dysbiosis. Bad bacteria tends to produce something called lipopolysaccharides or endotoxins that’s the outer coating of the bad bacteria and it can be stressful on the gut lining and actually can create leaky gut so another mechanism is this poor bile flow can, can create imbalances and bad bacteria and that bad bacteria can also start to affect leaky gut now also one other thing we talked about hormones right but also birth control pills are in a similar category especially most of them are going to be estrogen base and they’re gonna be very high levels faster than      to times typically more estrogen than normal and that can start to sludge up gallbladder and bile flow so you can start to see right birth control pills prescribed decrease bile flow decrease bile acids and the intestines more despotic bacteria less good bacteria leaky gut more food allergens food allergens then cause markov ladder is so you can see how that vicious loop kind of plays out ,and then also you can add in while your immune system gets compromised more infections come in that feeds back to more gallbladder stress that you can see the vicious cycles here and you can see how okay just cutting out my gallbladder doesn’t really fix that that mechanism is still in effect.

Evan Brand: Yeah. Well that’s why people report having a lot of pain and post gallbladder issues and they say well I’ve got my gallbladder remove and I’m still having all these symptoms. So some of the sites that we had referenced about symptoms after gallbladder removal could be guess what gallbladder attacks, nausea, vomiting, discomfort, gas and bloating, burping, and belching, heartburn new or worse Barrett’s esophagus, constipation, diarrhea, weight gain that’s all after the gallbladder is gone so it’s really not a miracle cure as it’s promoted unfortunately.

Dr. Justin Marchegiani: Exactly so if we can avoid gall bladder removal, that’s ideal. If it’s incredibly late stage it may be tough but if we can get to it early enough we can definitely keep your gob wider now. So we have the foods, we have the gluten we have the refined sugar, right we have the big things on the Paleo side which are eggs and bacon now when your gallbladder is kind of inflamed we may have to go a little bit lower on the fat in the meantime just because we don’t want to be hugging that porcupine so to speak meaning gallbladder stones contracting on those stones could create more inflammation. we may have to go lower fat or at least rely more on coconut oil for our fat because that does not require as much bile basically bile flow to be able to emulsify coconut oil and then we want to cut out some of those bigger foods we talked about the bacon and the eggs and we’d probably do some leaner proteins good healthy vegetables and lower sugar fruits maybe a little bit of safer starches and keep it all cooked really easy to digest use enzymes use acids and we also want to use supplemental bile salts to break down the small amount of fats that we are eating but we would want to keep the fats down just because you wouldn’t want to be causing that gallbladder to contract around those stones and pet that porcupine so to speak, yeah.

Evan Brand: And if the if the media were trying to sabotage you, they would take that clip that you just said, you may need to go lower – fat and use it against you just to be clear, that is the only time you’re ever going to hear him say go lower fat that’s in this context don’t know the context of-

Dr. Justin Marchegiani: It’s a transitionary period to allow the inflammation to drop to bring and support some extra digestive nutrients so your body can actually handle the fat that you’re taking in and then as the inflammation and the gallbladder symptoms in the pain improves then we can start to taper it up but this advice that I’m giving you really want to be working with a functional medicine doctor you do not want to be doing this on your own absolutely not.

Evan Brand: And I just wanted to point out that because some people may be driving or listening or something and they hear oh I need to be lower fat that’s in the context of this.

Dr. Justin Marchegiani: It’s a season for a reason and it’s designed to help take stress off those systems so they can heal better. Now there’s certain things that will add in as well like we have certain supplements in our line that are have ox bile in it or we’ll use phospholipids like phosphatidylcholine or phosphoric acid which can help dissolve the stones and help decrease the nausea. We may do things like dandelion or fringe tree or artichoke which help thin out bile flow and help support and nourish the gall bladder we may do extra things like beetroot which thin out the bile salt as well we may do things like taurine that help with bile flow, as well so we may do these different things to support and nourish the gall bladder. In the meantime we may do extra stomach acid and enzymes and of course we’re gonna look deeper at the gut and then got bacteria we’re gonna look at some of the lifestyle causes whether it’s medication or hormones that may have driven the issue to begin with and we’re also gonna dive in and look deeper at what the if there’s leaky gut what the potential causes of leaky gut are do you have also some infections that are happening so we got to hit this thing you know 360 degrees it’s really important.

Evan Brand: Yeah, well said. I’m glad you gave all the notes about. Okay, here’s what you do in the situation but then you always have to work backwards because if you just take a digestive enzyme that hasn’t addressed the root cause, yeah, I’m gonna call it and you guys credit the root cause because maybe your age above and you have low stomach acid because you’re aging but you still go to work backwards and fix the other stuff too.

Dr. Justin Marchegiani: Exactly. Now couple of tests that we’re gonna see here or you know first thing is pain that’s gonna be there. Second will be ultrasound to look and see the inflammation in this area and then third, are gonna be the blood markers for the gall bladder you’re gonna see alt or ast for the liver which can be affected by the gallbladder Gigi T’s more specific to the gallbladder and then of course you have, um, you have a LP alkaline phosphatase. They’ll be another one and then you have LDH which are various enzymes in that area of pancreatic enzymes that you can see increase as well and then also the amylase and the lipase are gonna be other ones that may go up if the pancreas is affected. As well so those are the big tests there and then on the functional medicine side we want to dive in deeper to some of the root cause tests which will be gut function just good clinical work up because a lot of people can see low stomach acid can be a really important root cause and then also to make sure we’re infection free cuz infections can be a big part of what’s going on and of course if, like for instance your mother-in-law, I mean if she’s had impairments with, you know, good fat soluble vitamins for the last ten years there’s probably other hormonal systems that have been impaired because of it.

Evan Brand: Oh I guarantee it I’ve got her on enzymes. Luckily she’s been on enzymes and acids for a while but yet you know she’s still sedentary you know.

Dr. Justin Marchegiani: I had a study pulled up right here over sixty thousand women regular exercise reduced gallbladder surgery risk by      % she said in Terry she did have a family history of gall stones her mother had her gallbladder removed so there, there is a somewhat of a you know family history which plays a part of part of the battle and then fiber too, you know, she does quite a bit of dairy so I know that’s one of the big no nos to is staying away from, like, your creams and cheeses and ice creams and yogurts and all that and then fiber. I definitely know she’s not getting enough fiber so I didn’t know this until just now so I’m just reading this that I knew fibers’ good, you always hear well fiber is good. Well, why? Well here’s the mechanism. So fiber reduces the absorption of the deoxycholic acid so this greatly lessens the cholesterol solubility in the bowel and promotes its excretion so that’s the mechanism fiber reduces absorption of deoxycholic acid which lessens cholesterol solubility in the bile promotes its excretion rather than the cholesterol forming a stone it.

Evan Brand: Sounds like, yeah, so it basically helps that cholesterol kind of move its way out of the body that way it’s not hanging around too long and forming crystals and stones that makes sense yes. Okay.

Dr. Justin Marchegiani: That’s cool, so, so fiber is key blood sugar keeping your, keeping your out your, blood sugar stable which she doesn’t eat a bunch of good fat so I’m sure her blood sugar’s all over the place.

Evan Brand: That’s probably where exercise has a play into. It’s like what’s the mechanism why would exercise help your gall bladder. I think it has to do with the insulin resistance and the better you know the more insulin sensitive you are the more you can handle extra carbohydrates and of course extra carbohydrates if your insulin resistant that can start screwing up your hormone so as a woman you know you can create more estrogen dominance and higher levels of testosterone when your insulin resistant. And as a guy, you up regulate an enzyme called the aromatase which can increase estrogen formation and that can also dug up and slow up your bile flow which can promote more crystallization and thus blockages and inflammation so all this makes sense so we’re trying to lay out these various mechanisms so people listening can wrap their heads around it from a root-cause perspective, yeah, I always love to read like well.

Dr. Justin Marchegiani: This study says this, but if you don’t have the mechanism behind it, to me it’s kind of useless so here’s, here’s one more and then we’ll wrap up maintain a normal weight so obesity which she’s definitely overweight I don’t know if I’d obese but definitely overweight obesity increases cholesterol synthesis which leads to more cholesterol secreted in the bile and when you lose weight that will that will reduce your risk as well so I mean really it’s the perfect storm we talked about it it’s the dairy it’s the gluten over age     not enough fiber sedentary eating conventional fats not probably doing enough enzymes and acids until I came into the picture and through supplements at her and she took some of it history of birth control I mean it makes sense why this is such a common issue and why there’s billions of dollars being spent year to remove these i found one estimate here that’s around the guy was Doctor. right it’s article you gave me here where’d it go yeah here we go every year in the U.S. four hundred thirty thousand gallbladders, four hundred thirty thousand gall bladders are removed. Average cost is thirty thousand dollars this gets up to an annual grand total of twelve point nine billion, is in with a be twelve point nine billion dollars. Wow unbelievable, that’s a lot of money is that, I mean there’s got to be a money component is that why is it the combination of the money and that the doctors are not trained on this stuff.

Evan Brand: Yeah, I mean if you don’t understand root cause and all you understand is you know as typically its general surgeons doing these surgeries. If all you understand is how to cut then that’s gonna be your solution and again he may not go away cuz you know you have other areas that can be inflamed besides just the gallbladder.

Dr. Justin Marchegiani: That’s right.

Right, and you mentioned that earlier yeah what a trip.

Evan Brand: Well, I’m ready to wrap it up, if you are you talked about the testing so you know from a functional perspective getting the stool looked at we can measure your fecal fat for one that can be a good indicator just to see hey look we have high static rib not digesting facts you mentioned the infection piece looking at H pylori and parasites and bacterial overgrowth and Candida organic acids testing. We’ll look at other types of bacterial overgrowth that can be throwing things off nutritional markers we’ve got a whole ton of nutritional status markers we can look at via blood and urine and then getting your foundational supplements in order on top of your diet, I mean, that’s really the secret sauce right there yeah I think so.

Dr. Justin Marchegiani: I think we hit it all. So if anyone has any gallbladder issues or digestive issues please feel free and reach out to Evan at or me at and we can get you in and schedule for a consult to look deeper at what is going on because we really want to get to the root cause of what’s happening, I mean, the root cause really is. Where you want to be and you want to have someone that can connect all the dots because it’s not just a hormone issue or a gut issue or a leaky gut issue or an infection issue or a medication issue, it’s a combination of a lot of things. Some people that maybe more than others so you really want to look at everything     d and connect the dots. Yep, if we’re doing, you know, put your comments below we really appreciate your comments. Make sure you’re sharing it to friends and family that could benefit we’re trying to just put so much information for people because a lot of let’s just say other people that are out they maybe aren’t as transparent or reachable right they’re hard to get ahold of or they’re just more blogging and you can’t really connect with them via video like this so this is a great medium take advantage put your comments below and give us a thumbs up as well and a share we really appreciate it and then you can head over to iTunes as well Evan / iTunes Justin / iTunes write us or review we really appreciate it.

Evan Brand: Yep good, good, good, good, for all the plugs. The only other thing I would say is take the two minutes to write us a review because when you do that what it does is I’ll actually pull us up in the iTunes charts so when your average Joe Schmo with gallbladder pain goes in the health and nutrition category on podcast will be at the top of the charts and then they click there and they get to hear this verses who knows what else.

Dr. Justin Marchegiani: Exactly. Well, everyone thank you so much. Hope you guys have a phenomenal week I’ll be back for some live Q&A; so stay tuned subscribe to my channel hit the subscribe they subscribe button hit the bell as well to get notifications. Evan, congrats on the new baby, will talk soon man

Evan Brand: Thanks, take care.

Dr. Justin Marchegiani: Take care, bye.



Heavy Metals and the Gut Connections – Podcast #175

In today’s podcast, Dr. Justin Marchegiani and Evan Brand discuss the link between heavy metals and the gut connections. Listen as they talk about how heavy metals affect the gallbladder functions and the outline of things that affect these functions. Also, know the different tests that can detect heavy metals.

Learn how to treat and prevent leaky gut and other gut problems from occurring. Find out the best natural treatments these two will share. Keep watching!

Dr. Justin Marchegiani

In this episode, we cover:

01:22   The Heavy Metals and Gut Connection

06:40   Factors Affecting Gallbladder Function

11:20   Heavy Metals Disrupts Detoxification in the Gut Microbiota

12:46   Herbs that Supports the Liver

14:33   Cholesterol’s an Important Building Block for Hormones


Dr. Justin Marchegiani: Hey, guys. It’s Dr. J here in the house. Evan, how are we doing man?

Evan Brand: Happy Monday to you. Life is good. The sky is blue. I can’t complain.

Dr. Justin Marchegiani: Love it, man.Well, today, we’re gonna chat about heavy metals and the gut connection. I think a lot of people— they get myopically focused on heavy metals and they— One of the first things that people want to do is they want to do this crazy detox when patients first come into care. You have all these docs that want to do that. And again, I think there’s a time and a place for heavy metal uhm— testing. There’s the time and a place for heavy metal detox. One of the biggest things that, you know, we want to chat about today is, “healthy gut function actually helps detoxify heavy metals. Getting rid of parasites can also help de— decrease heavy metals. Also, bringing in healthy gut bacteria, the Lactobacillus rhamnosus species has been shown to actually decrease certain heavy metals as well. So, gut function— Again, good hepatobiliary function, meaning, your liver and your gallbladder dumping bile. Bile helps break down fat. And again, biles also gonna have a whole bunch of potential toxins. And if it may go out via the stool as well. So, healthy gut function, healthy liver and bile function is really important for fat digestion as well as heavy metal reduction. So, let’s kind of just talk about heavy metals and how it connects to the gut.

Evan Brand: Yeah. So, the first thing is, if you’ve got a leaky gut, that’s a problem. So, you’ve  eventually got to fix leaky gut. And of course, as you mentioned, people are typically doing it in the wrong order. They want to go straight to a heavy metal detox as the first step to their protocol. But, if you’ve got a leaky gut, we know that you’ve likely gut a— a leaky brain. Now, I haven’t looked too much into the brain. I don’t even know how you would do this with a test. I guess it would have to be postmortem, like, how— How could you even test heavy metals in the brain. Like, we know that with a leaky  brain that’s possible, but how would you even test that to prove what we’re saying? I feel like it’d be hard. It’s like, what do you do? You cut a piece of the brain out and test it for metals? Like how would you even do that?

Dr. Justin Marchegiani: Well, regarding the heavy metals, I mean, it’d be hard that you’d have to do Tissue Burden Test. So, like, you’d have to use like a chelation agent, like a DMPS or a DMSA. Uh— I like DMPS ‘cause they shown that that can kind of like scrape the surface of the blood-brain barrier. Dr. Rashid Buttar talks about, like— if here’s your blood-brain barrier, there’s some metals right on the periphery. The DMPS just kind of comes by and just— just sloughs off that surface heavy metal uh— amount that’s hanging out there. So, that’s kind of the benefit that you get from the DMPS. It just kind of comes by the surface and just kind of scrapes off what’s hanging out there versus going in there, and uhm— you know, throw on a rock in a beehives, right? [crosstalk] That’s the big issue with metals is— I— I know a chiropractor colleague of mine that did a heavy metal chelation off the bat. He did like an IV thing and he did just kind of whim into that first, and he literally got paralyzed from it. He had parts of his body that were paralyzed and almost like, you know, with that— with the hand, uh— hyperflexion like that, right? That kind of thing, like a stroke, but he still has it to this day from doing an excessive amount of heavy metal uh— liberation off the bat. And Dr. Kharrazian’s talked about, you know, when he first got in the functional medicine doing some IV heavy metal chelations, people getting incredibly sick. So, I really want to put our focus to patients that are listening to this, and like, “Oh, I’m myopically focused on heavy metals,” think about as we get the gut better, as we get digestion better, or actually getting heavy metals reduced.

Evan Brand:  Yeah. So like, let’s talk about— You mentioned the bile already, but let’s go back to that for a second. We know that when we get your stool test back, if we look at your elevated fecal fat, to stay out of crit marker, we can know. Okay. You’re not digesting fats well. You’re probably not making enough bile. If you’ve got s— a sluggish liver, sluggish gallbladder function. To me that seems like one of the— the pinch points, if you will, of the metals.Could you speak on that a bit? Like me— the gallbladder and the metal connection?

Dr. Justin Marchegiani: Yeah. A lot of the metals are dumped out via the hepatobiliary system, right? This is kind of like the big issue with a lot of people and potential, like, vaccination issues. Like, there’s some Aluminum ins— in a lot of the vaccines now, and a lot of the people are concerned, because in that first year to a life that hapalic— that hepatobiliary function isn’t quite dialed in yet. So, if you’re getting exposed to some metals, it may be we don’t have quite the mechanisms to get rid of those metals, right? That’s some of the people on the Aluminum side uhm— there’s still a little bit of thimerosal in the flu vaccine still, which is a— Ethyl mercury compound. So, having healthy hepatobiliary function, meaning— hepato means liver, biliary means bile and bile ducts. So, you have liver, and then that kind of like, you have the— the bile production that happens in the liver, and then it goes down to the gallbladder, and the gallbladder holds it and concentrates it. And then, when you have fat in your diet, that produces a hormone called CCK, Cholecystokinin, which then causes the gallbladder to contract, and it produces bile salt, which then help emulsify and break down the fat. So, imagine like a big fatty, like, you know— Let’s say you cooked a bacon in the pan, right? And, you feel that the bacon coating after is kind of uh— dried, so to speak. Well, that’s like— it’s just like stuck there, right? Imagine you get some nice Dawn soap, and you break it up. It emulsifies. It breaks down that fatty coating. And that’s kind of what’s bile salts do. It’s like that Dawn dish soap. It breaks it down, so your body can absorb a lot of those fat-soluble nutrients— Vitamin A, Vitamin D, Vitamin E, Vitamin K, the EPA fats in fish oil, the DHA fats in fish oil, the healthy saturated fats as well. So, makes sense.

Evan Brand: Yeah, it does. So, what’s happening with the low-fat diet then, if you’re not getting that gallbladder to fire, and therefore secrete bile. To me, since like, you’ve got a problem on your hands.

Dr. Justin Marchegiani: So, not having enough fat in your diet is like not changing the oil in your car, right? Everyone has the experience if you gone too long without changing the oil, what happens? It starts getting sludgy, right? And you don’t have that lubricant there for your engine, but it starts getting sludgy. And, in our gallbladder analogy, it starts actually crystallizing and forming stones. That’s part of the reason why people can have gallbladder stone issues— gallstone issues uh— is because these stones crystallize because they’re not moving. So, it’s like a river— It’s like a fast-flowing river when it gets cold. If the river’s not moving, it can freeze, right? If it’s moving really well, it’s hard for a moving river to at least freeze, especially when it gets colder. It may still freeze but it’s gonna be harder for it to freeze. So, think of the bile that’s moving. It’s just not gonna form and— and crystallize and get the stones going because it’s got too much inertia behind it.

Evan Brand: And then maybe we can chat about stress a bit. I mean, heavy metals are definitely a stress but, what about adrenals and emotional stress, and— Let’s say, you’re eating too fast, or you’re not chewing food well. No. I want to try to outline a few different things that would affect gallbladder function. Let’s say, you are eating a whole foods diet. You’re getting good fats in. You could still have gallbladder problems. Just ‘cause you eat high-fat or higher fat, doesn’t mean that you’re not po— It’s not possible for you to still have gallbladder issues and therefore, fat digestion problems.

Dr. Justin Marchegiani: So, can you repeat your question?

Evan Brand: The question is, “What are all the factors that would— that would affect gallbladder function or suppress gallbladder function, even if you had fat in the diet, too? You heard that part about…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …low fat [crosstalk] being bad? [crosstalk] Well, I eat— I eat a lot of fat. So, what other things could affect the gallbladder?

Dr. Justin Marchegiani: Well, number one, toxins can be more fat-soluble, so we want to choose healthy fat-soluble sources or, you know, healthy— you know, fats. Right? Not with the whole bunch of pesticides and chemicals that tend to be a more magnet for kep— for— for— for chemicals, right? Toxins. So, metals are toxin as well. So, if we are, you know— If we are having metals, right? They’re gonna be in the bile. They’re gonna be in the fat. And ideally, the body’s gonna sequester those and pull those out. If we have additional metals, we can give binders like charcoal or clays, or modified citrus pectin or chlorella, which kind of help bind those things up, and help us kind of escort out of the body better. Now, when we have excess adrenal stress, that activates the sympathetic fight or flight nervous system. And when the fight or flight nervous system is activated, it’s gonna make it harder for us to increase stomach acid levels with decreased stomach acid levels. It’s also gonna decrease enzyme levels. So, -when we have lower stomach acid, we need high stomach acid to activate our Cholecystokinin, that’s CCK. And then, CCK’s what stimulates the gallbladder from emptying so, if we have good stomach acid levels, high stomach acid levels, we’re gonna have good enzyme levels. We’re gonna be able to break down the fats better. We’re gonna be able to, then, increase the CCK. And then, that’s gonna stimulate the gallbladder, which will empty, and that’s gonna have potential toxins in the— in the bile as well. So, that bile’s gonna potentially have the ability to break down fat, but there also will be some toxins that will be dumped out. So, we have to have healthy stress levels ‘cause if we have really slow motility, we could potentially reabsorb a lot of those toxin that’s in our bile. That’s why we want good motility. Low thyroid function can create low motility. SIBO and— and dysbiosis, and infections can create low motility. They can also create fast motility, which again, the problem with that is then we create a malabsorption environment. And then we talked about stress in the adrenals in that sympathetic nervous system, decreasing stomach acid, decreasing enzymes, decreasing CCK. which then decreases bile flow. Decreased bile flow is gonna prevent those metals being removed via hepatobiliary, liver to gallbladder, gallbladder back into the intestines, then intestines into the stool, and stool into the toilet.

Evan Brand: Yep, well said. So, the whole cascade can really just fall apart at the top of the food chain, as usual, with digestion. So, if you’re eating while you’re stressed out, you’re not chewing your food, your rushing through a meal, maybe your playing on your phone, or reading a newspaper while your eating— just anything that’s generally taking you away from the present moment, which is the parasympathetic process of digestion. If you’re in sympathetic, you will not digest. So, you’ve got to chill out. You’ve got to relax. I tell people if you’ve got five minutes before and after meal just to breathe and just relax— you know, even my wife, I’ll get on her sometimes. She’ll be eating the last bite of food, and then she’s scraping the plate into the garbage.l It’s like, “No. No. No. Slow down. Sit at the table for a few minutes. Chill out.” Because if you can start that first cascade, “Okay. I have food in my belly,” your in a good place. Now, you brought up infections, so let’s go a little deeper there. We’ve chatted about H. pylori lots of times but I think it’s worth mentioning here with heavy metals because if you have H. pylori that bacterial infection is gonna shut down HCL. So, if you’re low on Hydrochloric acid, now the gallbladder’s basically not gonna get this message to secrete, and therefore, you’re not gonna have the ability to push metals out. The fecal fat’s gonna go up, and it could all happen just from H. pylori alone.

Dr. Justin Marchegiani: A hundred percent. I have one study here. I want to just kind of read the abstract here a little bit. Uhm— so, off the bat, they talked about the gastrointestinal epithelium having several functions. Number one, being a physical barrier ensuring mucosal immune response and excluding or detoxifying harmful intestinal content. So, healthy gut bacteria has a major effect on detoxifying healthy content. So, heavy metals can also disrupt the gut microbiota, but low and poor microbiota, poor healthy gut bacteria can also have an effect on detoxification. So, this is why eating really good foods that don’t contain xenobiotics or foreign antibiotic sources, meat that’s not, you know, conventional, so we’re not getting exposure to antibiotics. Just not getting exposure to antibiotics in our overall life, in general, will have a big help on that. Not eating excess sugar— all of these things can affect our microbiome. Having infections like you mentioned earlier, Evan, with the H. pylori can also affect the microbiome. And then, with poor microbiota balance that can potentially affect our body’s ability to rid itself of these toxins.

Evan Brand: Yep. So, let’s go into some of the— the binder conversation a bit. You hit on clay. You hit on— What was the other one you mentioned? Could—

Dr. Justin Marchegiani: Activated [crosstalk] charcoal is good. Uh— modified citrus pectin is really good. Chlorella— different types of Chlorella is excellent to bind up Mercury in the gut. Chlorella is not great at pulling out Mercury in the body but it’s really good by pulling it out in the gut.

Evan Brand: Okay.

Dr. Justin Marchegiani: Uhm— The modified citrus pectin is really great ‘cause that’s been shown to reduce Lead. They’ve done studies in— in retirement homes where they’ve seen that significantly reduced Lead. And I like that because it’s not like a liberator. It’s not like maybe a chelation compound that may liberate and— and you know, throw a rock in the beehives, so to speak. It’s more just cleaning up what’s hanging out.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, it’s a little bit different than like a DMSA or a DMPS— those kind of compounds.

Evan Brand: Let’s chat about herbs a bit, too. I mean, we use a lot of things that can help support the liver.

Dr. Justin Marchegiani: Cilantro’s great, right?

Evan Brand: What about like a burdock? We’ve got Milk thistle. We’ve got uh— Vitamin A we use a lot. Beetroot powder is good. Goldenrod can be good, too.

Dr. Justin Marchegiani: Those are all really good for bioflow. Like a lot of those herbs are very tonifying and supporting to oxidative stress in the liver, like Milk thistle or Silymarin, like the Burdock, or the Dandelion root, or the Fringe tree root for fringe reactant. These are really good for liver and gallbladder flow. So, they allow things to flow better. Better flow, things go out into the uh— intestines, where they should go, and that’s gonna then help a fat breakdown. It’s also gonna with toxin elimination. And again, we can also increase the fiber, right, which is basically what modified Citrus pectin is ‘cause that finder wil— uh— bu— uh— fiber will prevent the bile from being recycled. And why is that helpful? Well, if the bile has maybe more heavy metals in it. It may not be the kind of bile that we want to recycle. We may want to get rid of it. So, like I mentioned, when you dumped out the bile, it’s gonna serve for fatty acid digestion. But it’s also may have some toxins in it, as well. So, our body likes to recycle a lot of that uhm— bile, uhm— that’s why like the Cholestyramines, which are like the older statin— They’re not really a statin but they’re cholesterol-lowering drugs, and they were basically, bile sueuestory agents— Bile salt sequestering, that means it would bind to the bile, and pull it out. Now, guys like Ritchie Shoemaker are doing that as a way to eliminate mycotoxins. Did I say a lot of mycotoxins are in the bile as well. So, they’re trying to remove the mycotoxins in mold by giving bile salt sequestering agents. We can deal with different fibers as well, and that prevents that bile from being reabsorbed. But— Again, bile’s primarily Cholesterol. What’s cholesterol, guys? Cholesterol’s a building block for a lot of your hormones. If you look at the hormonal cascade, we have cholesterol. We have pregnenolone, and then pregnenolone shoots out in the progesterone, shoots out in the estrogen, shoots out in the mineralocorticoids, like aldosterone that help with mineral regulation. And then, we have cortisol and the stress hormones on the other side. So, cholesterol’s really important. It’s not that it’s bad and you want to get rid of it, it’s that it also could have a— uh— be a magnet in the form of bile salts towards metals. And if we have metal issues, we may want to use some kind of a natural fiber to knock it out. To—

Evan Brand: Uh— So— So, if cholesterol is too low, like with the statin medication, or if cholesterol is— let’s say, in the 400’s, I guess— is there an issue being too high or too low?

Dr. Justin Marchegiani: Well, it definitely can be. I mean, it can be. So, if cholesterol’s too high, it can mean there’s low thyroid function, potentially. Uhm— Cholesterol’s like a band-aid, so think about it as if you’ve walked into a thorn bush. You’re gonna need more band-aids that there are less band-aids, right? A lot more because of the inflammation from the thorn. So, cholesterol could be laying down more internal band-aids in the arteries in the area that’s inflamed because of stress and inflammation. So, that’s also possible, too. You could be hypocholesterolemia. Again, this is gonna be something that will be chronic throughout your whole life because the enzyme uhm— that stimulates cholesterol, the HMG-CoA reductase enzyme is overactive, so, that’s gonna stimulate more cholesterol production. And then also, regarding uhm— you know, cholesterol, I think some of the research in the— I think it was the Framingham Heart Study showed like 320 or higher is where the risk factor of cholesterol could be bad for your heart. Right. That’s where it can kind of increase. So, that 320 point, we like to look at the ratio between HdL and total cholesterol. We like it— you know, below 4 ½ to 4, and that’s a pretty good way to look at it. So, if you’re HDL’s around 80 or 90, and your— let’s say, four times 90 is 360; 360 may not be bad for cholesterol if your HDL is within that four (4) to 4 ½ level. I— I may be okay with that, but we have to look at the thyroid. We have to look at the systemic inflammation. Uhm— We have to kind of take the whole entire body in— in perspective of what’s happening.

Evan Brand: Yeah, ‘cause you can’t just take somebody and say, “Everyone has to be below 200 with total cholesterol.” This doesn’t makes sense.

Dr. Justin Marchegiani: Yeah. And again, the reason why I like doing like bile salts sequestering compounds, whether it’s natural stuff, like citrus pectins, or whether it’s like a cholestyramine. The reason why it’s not as bad as astatine is because, number one, Astatine’s blocking the enzyme that makes cholesterol. The problem is, that enzyme is also active for the— the Mevalonic acid pathway— that same pathway that makes internal CoQ10. So, the problem with the statin is your blocking the enzyme that also makes CoQ10, and CoQ10’s really important for your mitochondria and your Krebs cycle generating ATP and energy. And that’s a problem, because if you look at antibiotics and a lot of the pharmaceutical drugs, just type in any drug, or any antibiotic, and type in the word mitochondrial dysfunction that these medications have some negative effects on the mitochondria. So, if you’re doing that, you’re taking Astatine, which automatically lowers ther— the— the building blocks that run that mitochondria, CoQ10 Ubiquinone, right? That’s gonna affect everything. That’s gonna make your mitochondria really sluggish, and maybe decrease your ability to generate energy. Maybe, increase your chance for chronic fatigue, another adrenal and thyroid issues. And, CoQ10’s also really important for autoimmune thyroid. It really helps with thyroid inflammation, so you’re really more prone to other inflammatory conditions ‘cause those anti-inflammatory nutrients aren’t there. Plus, if you’re decreasing your cholesterol levels uhm— artificially, with Astatine, you’re also gonna have less building blocks for your hormones. And the, cholesterol levels below— Let’s see here. It’s on my Dry-erase board. Cholesterol levels below 160 increases your chance of psychotic illness, Alzheimer’s, Dementia.

Evan Brand: Yup.

Dr. Justin Marchegiani: You’ll see a video about that later on today. So, low cholesterol— And that’s actually NIH study, right there. Off the bat—

Evan Brand: I’ve seen that with depression, too. There’s— There’s…

Dr. Justin Marchegiani: Hmhmn—

Evan Brand: …other literature out there about depression with cholesterol being too low, too. So—

Dr. Justin Marchegiani: Exactly, a hundred percent. [crosstalk] No doubt, man.

Evan Brand: That’s a trip. Well, well said about that. Uh— regarding the— the instage for people with heavy metals, the timeline is key here. So, remember, this is a— a marathon. This is a long-term thing. I don’t think heavy metals are something where you could just come in, do a couple months, or maybe even three— six months, and then just say, I’m done with metals. ‘Cause it just doesn’t work like that. The environment is just too toxic with metals. So, this is really something that I don’t know how you want to frame it, Justin, but to me, it’s something that should be daily.

Dr. Justin Marchegiani: Yeah, man. I think it’s gonna be a long-term thing. I think the big exposure for heavy metals for most people is gonna be Mercury filli— fillings. Uhm— Most people call them Silver fillings, but they’re greater than 50 percent Mercury, so— you know, we call them what they are. They’re Mercury Amalgam fillings. Uhm— Some people talk about fish being a big source of Mercury. I think it depends. Uh— A natural chelator of Mercury is Selenium, and Selenium— If you eat fish that are higher in Selenium in relationship to Mercury, that’s gonna— You’re automatically gonna have more of a chelator that will help with the reduction of Mercury. So, like Skipjack tuna is really high in Selenium to Mercury, while the Alaskan Sockeye Salmon uhm— Cod Haddock— So, my in site— I— if— We’ll put it up there. A good Selenium to Mercury ratio type of fish, so you can see where the Mercury’s much higher than Selenium. And again, if you want to consume some of these fish, and you’re a little bit, you know, on the edge about it, you’ll— say, you’re pregnant, or you’re just want to be careful, you can always take a little bit of Chlorella with some fish or some activated charcoal. I’m okay with that, too. But, just know that Selenium is gonna be a natural chelator for it. And also, Selenium’s really important for thyroid inflammation and thyroid conversion. It’s a building block for Glutathione, so, it’s a cofactor with Glutathione production, and it’s also gonna be uhm— tsp— the enzyme 5-deiodinase enzyme that activates T4 to T3. Your inactive to active thyroid hormone will come from Selenium as well.

Evan Brand: Yeah. You got to have at least what, 200 mics. And then sometimes, with autoimmunity, we may even bump it up closer to like a 400 hundred microgram daily of Selenium.

Dr. Justin Marchegiani: Yeah. Yeah, 400 microgram may be a really good spot, supplementally. You know, anywhere between 400, supplementally, to maybe an additional 400 in your diet,a s well.

Evan Brand: And, what do you do for fish? How often? What are you doing for fish?

Dr. Justin Marchegiani: I do one to two times a week, at least. I do Skipjack tuna, a lot of times. That’s got a very high Selenium to Mercury ratio. I also consume it with, maybe some extra really good fats and a lot of the good vegetables along with it. Uh— if I go out and do Sushi, I will typically uhm— bring some activated charcoal along with me, just to be on the safe side.

Evan Brand: I’m wonder— I mean, with the charcoal, it’s like if you’re eating that around the meal time, are you sabotaging yourself in terms of absorbing other nutrients from that meal?

Dr. Justin Marchegiani: I mean, I don’t think a hundred percent. I mean, definitely less, but you kind of have to factor in. You know, if you’re more worried about some of the potential toxins that are in there, then, I would always air on the side of taking some activated charcoal. It’s not gonna soak everything up, but—

Evan Brand: Right. So, [crosstalk] you got to choose your battles.

Dr. Justin Marchegiani: Yeah. I mean, it’s an adsorbing compound, so it— it’s like a magnet. So, it doesn’t just like bind the stuff, like indiscriminately. It has a— an— a magnetic-like attraction to pull these toxins in.

Evan Brand: Yep. Yeah, that make’s sense.

Dr. Justin Marchegiani: It’s an adsorbent, not an absorbent. Right. Absorb is like— Think of a sponge absorbing a whole bunch of fluid on— on a countertop. ANd, adsorbent is like— remember back in like, grade school, you see the thing with the— with the Iron fillings, and then you put a magnet over it and all the Iron fillings jump towards the magnet. It’s kind of like that.

Evan Brand: Yep, well said. That’s cool. That makes a lot more sense to visualize it.

Dr. Justin Marchegiani: Hmhmn—

Evan Brand:  Let’s look at some of these questions to see if any of these are pertinent to the— to the equation here.

Dr. Justin Marchegiani: Let’s do it.

Evan Brand: Uh— We had one from Tessa. She said, “If you have low Iron, does this indicate possible heavy metal toxicity?”

Dr. Justin Marchegiani: If you have low Iron, hard to say. I mean, I would look at it as, you know, “Are you a Vegan vegetarian?” If you’re a female, “Are you— are you having excessive menstruation?” I would look at those first, number one. number two, there could be malabsorption in the gut. So, I would look at that first. I wouldn’t look at— I wouldn’t jump to the heavy metals with low Iron levels.

Evan Brand: Yeah. I would say, look at infections, too.

Dr. Justin Marchegiani: Mn—

Evan Brand: ‘Cause Justin and I are seeing a lot of [crosstalk] parasites.

Dr. Justin Marchegiani: —sorption.

Evan Brand: Also, we’re seeing uh— worms. And a lot of these worms, like Hookworm, they can also cause Anemia and steal your Iron. So, definitely get a stool test run. Look for all these big bugs and see if you can find it.

Dr. Justin Marchegiani: Hundred percent.

Evan Brand: Uh— Here’s one from Addy. She experiences Chronic Fatigue intermittently. She has a doctor’s visit tomorrow. What kind of labs should she ask for? Uh— Addy, if you’re going to a conventional doctor, even if you’ve request a lab, which I would recommend, and Justin would probably say the same, is an Organic Acids Test, so you can look into mitochondrial function, as well as liver detox function, Glutathione, amino acids. Conventional docs is  not gonna have a clue what you’re talking about. You could try, but that’s what I would look at if I were looking at Chronic Fatigue. And then also, you could try getting a salivary adrenal test run, because if you have Cortisol that’s too high or Cortisol that’s too low— If you’re not in the Goldilocks zone, you could be Chronically Fatigued that way. I know I was when I had adrenal problems. So, I would say those two tests. Justin, what do you say?

Dr. Justin Marchegiani: Yeah. I mean— So, you said the adrenals, right? And you said [crosstalk] thyroid?

Evan Brand: I said the Oat…

Dr. Justin Marchegiani: Oh, yes.

Evan Brand: …and adrenals.

Dr. Justin Marchegiani: Oh, and adrenal, yeah. I would add probably thyroid to that as well, because you get off three factors of the energy system, right? You have the mitochondrium nutrients, which usually picked up in the Oat. You have the adrenal, which will affect the Cortisol— The Cortisol, the Glucocorticoid steroid— Gluco meaning blood sugar and energy, and then thyroid’s gonna be your— your metabolic thermostat. So, those are gonna be the big three. But just know, like, you’re conventional med— If you’re trying to get functional medicine care in a conventional medical model, alright, i— i— it’s like gym and a square peg in a circle hole. It’s just not gonna work. They’re not gonna work. They’re gonna run TSH. They’re gonna look at you about mitochondria and be like, “Yeah. I don’t know what you’re talking about there.” And then, Cortisol-wise, they’ll say, “Well. I don’t think you have Cushing’s or Addison’s because you don’t have any of the symptoms. And then, the— ma— They may say, “Okay. Let’s run an ACTH Stim Test.” Maybe, “Let’s run a Cortisol Serum.” If they— If they placate you, right? But that’s not gonna give you the data you need ‘cause a lot of what we’re talking about are functional imbalances, not pathological diseases.

Evan Brand: `Agreed. Yeah. Well said. I— I would say her only— her only shot or her best shot would be using the conventional doctor to get the bloodwork done. But, you’ve really got to pound them that you want more than the TSH. You would want to make sure that you get also the free T3, the free T4, the reverse T3, if you can, the TPO antibody, which is your thyroid peroxidase antibody, and then your TG, which is your thyroglobulin antibodies. I’d also give Vitamin D, get your B12 levels checked. That would be great too. Maybe red blood cell Magnesium— That’s what you could use a conventional doc for. If the— If you’re lucky, they’ll run those extra markers. But if they just do TSH, you’re wasting your time. So, make sure. Make sure. Make sure. Triple make sure, they do the antibodies for you— TPO and TG.

Dr. Justin Marchegiani: Love it. Hundred percent, makes sense. What do you think next for questions here, Evan?

Evan Brand: Uh— Let’s see here. Most of these are off-topic, so I don’t want to divert us. Too bad. Uh—

Dr. Justin Marchegiani: Yeah. If you guys are asking questions, we love the questions. Try to keep it as much on topic as possible. And again, if you’re liking the show, give us a thumbs up, give us a share. We love the exposure. We want to help more people. That’s our mission. And again, the more exposure we get, the more we can help more people. Plus, we want to answer your questions as well.

Evan Brand: Yup. Here’s one. So, Tessa asked here, how do you increase your stomach acid? Take digestive enzymes, just eat certain foods, or both? Uh— First, you got to figure out if your stomach acid’s low, why would your stomach acid be low? We hit on H. pylori being a big cause of low stomach acid. Also…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …eating while you’re stressed, eating in a rush, not chewing your food, just any lifestyle stressors that can impact stomach acid levels. What else would you add, Justin?

Dr. Justin Marchegiani: Yeah. So, She’s got the cart before the horse. It’s the— the HCl causes the low enzyme levels to the most part, because the HCl’s a trigger for activating Pepsin, Pepsinogen to Pepsin. That’s an enzyme. And, it’s also the trigger for activating a lot of uh— enzyme released from the pancreas. So, we need to increase acidity. So, the first thing you can do is work on the stress. Like you mentioned, chewing your food up helps increase the surface area. And then, if you want, you could add in some digestive stimulators, like a little bit of lemon juice or a little bit of Apple cider vinegar right before your meal. And you could even work your way up to some supplemental HCl. In my line, we use HCl Supreme. And we may also add in some supplemental enzymes, and we— we do them separately with people that have a lot of digestive issues because of Atrophic Gastritis, meaning their gut lining’s so thin they may be only able to handle a small amount of HCl but a larger amount of enzymes. And if we give HCl and enzymes together, we have to increase it in that ratio versus we can stop where the HCl starts to irritate, and go back a little bit. And then, we can continue to up the enzymes accordingly, so that’s why we do it that way. But, of course, we’re always focused on root cause, first: stress, chewing, not hydrating with food, uhm— you know— getting rid of the H. pylori, getting rid of the dysbiosis. But then, using the supplements to help support your gut, kind of like you would— you know— be on crutches if you broke your ankles. Kind of the same philosophy.

Evan Brand: Yup. Well said. And— and wer— we’re going a little bit more conservative with our dose of HCl, so if you look at something like a now food super enzyme, they’re gonna have a bunch of enzymes but they’ve got like 700 or 800 milligram, nearly, of Betaine Hydrochloric acid. That could be too much for a lot of our clients because if they have gut bugs or other infections that’s irritating, creating that Gastritis you mentioned. That’s too much. So, if you look at our formulas, we go a bit more conservative. Like [crosstalk] 200 hundred milligram would be a starting place. Two hundred milligram Betaine— You may want to start there, just because if you’ve got issues, you may throw 6— 7— 800 in and you might do— do more harm than good, and we don’t want that.

Dr. Justin Marchegiani: Again, the people that are more sensitive, they’re gonna know. And if you don’t know, just start with the— a tablespoon of Apple cider vinegar. If you do okay there, then you could probably start a little bit higher and work your way up.

Evan Brand: Dilute it or— You’re saying dilute it with a little bit of water, or—

Dr. Justin Marchegiani: I think you could just shoot it down straight.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Yeah. I mean, for me, I just rather shoot it down straight and get it done with ‘cause it’s so terrible. [laughs]

Evan Brand: Oh, yeah. [laughs]

Dr. Justin Marchegiani: You could always do a shot of lemon juice, as well.

Evan Brand: Yeah.

Dr. Justin Marchegiani: ‘Cause that gets the digestive support done.

Evan Brand: Yup. Are you saying just for the test or just regularly you would do a shot ACV? I don’t know if that would affect the teeth or not if it’s— if it’s touching your teeth.

Dr. Justin Marchegiani: Uh— I— I’d be okay with it. It’s not gonna— It’s n9ot bathing in it, right? You know—

Evan Brand: Right.

Dr. Justin Marchegiani: The acid that in your mouth that sits around your teeth, primarily is from sugar, right? The staph mutan, the bacteria in the mouth, eats a lot of the— the sugar in carbohydrate and then spits off all these acids. So, it’s more of the sugar consumption that creat— creates the acid via the gut— via the bacteria in the mouth.

Evan Brand: True. True. That’s true. Well said.

Dr. Justin Marchegiani: I would think maybe that ACV may even kill some of that bacteria as well.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Acetic acid— you know, a lot of these critters don’t— they don’t like a uhm— you know, acids like that.

Evan Brand: Yup. Yup. I think there’s one more question here that was on topic— kind of on topic from Neem here. He asked, uh— “How do you go about reintroducing foods after Candida, SIBO, or other infections?

Dr. Justin Marchegiani: One at a time. One food at a time, every three to four days. Lower those and then increment it up. Any negative symptoms— ANy negative symptoms pull that food out.

Evan Brand: How— How do you approach it? I know there are certain people that say, “Oh, there’s uh— AIP reintroduction. You’ve got to start with like egg yolk, and then egg white, and then nuts.” Have you seen a big difference in the order of operation…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …[crosstalk] or is it really just whatever food?

Dr. Justin Marchegiani: I do. I have an autoimmune handout, Autoimmune Reintroduction Diet handout…

Evan Brand: Yeah.

Dr. Justin Marchegiani: …on my blog post. Take a look at that. We’ll try to have it posted in the show notes. But, I try to always start with like egg yolks over the egg, because some people can handle the egg yolk but not the egg and the egg whites. Right? I always like soft poached like sof the yolk is runny versus fully-cooked because of the deoxidation and the rancidification of the cooking process. So, soft yolks before going to a solid yolk. You know, uhm— and then egg whites whole eggs seconds. Right? And then next would be Ghee before butter, and then one nut at a time, one seed at a time, one nightshade at a time. That’s kind of a good general order to do it, because some people can handle the— the egg yolk soft and not cooked, or they just can’t handle the egg white at all. Some can handle Ghee, but they can’t handle the butter. So, there’s an incremental way in why we do it.

Evan Brand: And then other foods, I mean, people freak out a lot about fruit in Candida. I haven’t seen a big issue with berries. If we’re doing organic berries [crosstalk]… a serving—

Dr. Justin Marchegiani: —or two a day is fine. I’m not worried about that.

Evan Brand: There’s so— those people that are like, “Oh my God! You have to do this Candida diet. If you eat one piece of fruit, you’re gonna feed the Candida, and you’re protocol’s not gonna work.” It’s just not true.

Dr. Justin Marchegiani: We may even up the Carbohydrates during killing, that act like cheese in the mouse trap. To bait them out.

Evan Brand: Uh— that’s interesting. So, timing— I mean, we always like to talk about carbs with dinner, like maybe a sweet potato—

Dr. Justin Marchegiani: I think carbs with dinner is better. I mean, the way I look at it is I want to stack the fasting period from sleep. I want to stack that period with keeping the carbs superlow the first two meals of the day, ‘cause then I can take eight or ten hours without eating. And then, do another six to eight hours without having really any carbs, maybe outside of veggies, so I can stack that ketogenic timeframe of getting, you know, 16 hours in without really much carbohydrate. I like that stacking period.

Evan Brand: Well, your brain works better, too. So—

Dr. Justin Marchegiani: Uh-hm—

Evan Brand: [crosstalk] Another benefit.

Dr. Justin Marchegiani: You can up the carbohydrates, you know, post-workout or you can even do it at night before you go to bed, or around dinner time is fine. You can add in a serving or two of fruit. You can add in a serving of, you know, healthy safe starch grain-free versions. That’s all great.

Evan Brand: Awesome. I think that was all the questions. So, if you want to wrap it up, we sure can.

Dr. Justin Marchegiani: Yeah, I think it’s great. Someone asked about uhm— lymphatic support. A Red Root or Red Clover is great. Uh— ginger’s also great. Rebounding or Whole Body Vibration’s also phenomenal. Uh— there’s some really good lymphatic support homeopathic by a company called Heal. Heal is some really good lymphatic detox support. Those are great. I like that all significantly. Well, guys, give us a like. Give us a thumbs up. Uh— hit the bell as well. That will actually tell you when we’re going live. We’ll try to go live on Fridays and Monday mornings here. I may go live once during the week, ‘cause I’m just— I’m getting so stoked with all these people listening and watching and great questions. So, hit that bell. Give me a thumbs up. Give me a share right now. We want to help people. Anyone in your life that’s having health issues, have them tune on-board. We’l— We’ll get their questions answered. And Evan, what a great show today, man. You look phenomenal today, brother.

Evan Brand: A lot of fun, you too. If you guys need to reach out, schedule a call. Look up Justin’s site. It’s You can schedule a consult there. Also, uh— you’ll check at other things, too that aren’t here on the videos. So, there’s other articles and things. There’s full transcriptions. You don’t mention that but I think it’s worth if people—

Dr. Justin Marchegiani: Full transcriptions.

Evan Brand: If people need to go back and read some of these, that’s on Justin’s site. So, go view that. And then, if you want to reach out, schedule a consult with me. You could do the same thing at my site, So we look forward to helping you out.

Dr. Justin Marchegiani: Evan, hey man. You look phenomenal today. You take care.

Evan Brand: You too. See you.

Dr. Justin Marchegiani: Take care. Bye.

Evan Brand: Buh-bye.


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The entire contents of this website are based upon the opinions of Dr. Justin Marchegiani unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Justin and his community. Dr. Justin encourages you to make your own health care decisions based upon your research and in partnership with a qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Dr. Marchegiani’s products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using any products.