Leaky Gut and Autoimmunity – Dr. J. Podcast #161

Dr. Justin Marchegiani and Evan Brand dive into a discussion about the link between gut infections and autoimmunity. Gain knowledge about leaky gut, how it occurs in the body and it’s connection to Hashimoto’s.

Explore the different stressors which affect gut health and contribute to a weakened immune system. Learn about Dr. Justin’s 6-hour template, which includes his expert recommendation regarding healing, nutrient and supplements.

In this episode, we cover:Leaky gut and autoimmunity

00:34   Leaky Gut and Autoimmunity Connection

04:05   GABA and the Blood Brain Barrier

06:48   Hashimoto’s and Gut Health

12:23   6-hour Template

22:40   Thyroid Health: T3, T4




Dr. Justin Marchegiani: Hello, ladies and germs! Dr. J in the house. Evan, how we doing, man? How was your Holidays? How’s your Thanksgiving?

Evan Brand: Holidays were great. Let’s dive in. I know we’ve got a short limited of time. But we’re doing this on the fly because this conversation of gut health and gut infections and autoimmunity is huge and hardly anyone is talking about this. Conventional doctors don’t have a clue about the link between gut infections and autoimmunity, so dude, let’s dive right in.

Dr. Justin Marchegiani: That sounds phenomenal. So we talked about in the show, kinda chatting about leaky gut and autoimmunity, which is really important because leaky gut is kind of like one of the primary mechanisms of autoimmunity kinda starting, which is kind of gastrointestinal permeability cells in the gut called the tight junctions. They start to unzip, kinda like you unzip your coat on a hot day and undigested food particles can get in there in this kind of creates this uhm— cascade of reactions call molecular mimicry, where certain food proteins— the surface proteins on these foods are similar to surface proteins of the thyroid or the brain or the pancreas, the beta—the beta cells of the pancreas, whatever. So you have this kind of immune system getting primed to similar proteins in foods which then prime the immune reaction for the immune system. It starts attacking these tissues in the body. So that’s kinda one of the first defenses is this autoimmunity leaky gut, molecular mimicry and that while they gut’s leaky, you have undigested bacterial compounds also getting in there, too. And then kinda just perpetuate and windup that immune system. And then also make it prime to—for other infections that kind of slip in there because the immune system now has weaken. Other infections can slip in. And typically, we’re gonna have a lower stomach acid environment so you’re gonna have less sterility in the stomach coz that low pH really prevents a lot of bacterial and critters from growing. But now that pH is like, you know, it’s like walking over to the dirty picnic tables and normally you spray it down with maybe some bleach. Or let’s say in a healthy version, maybe a really good antimicrobial essential oil. But now, we don’t have that because of the stress from the gut.

Evan Brand: Yup. Well said. Now, Hashimoto’s for example, is probably most common autoimmune condition that we’re going to see and deal with and that probably you guys listening are aware of. Leaky gut has to take place for Hashimoto’s to happen. That’s one of the dominoes that happens. So you’ve got the leaky gut situation. You possibly got the gluten in the diet. You got the immune stress, which could be internal or external. So bad boss, bad spouse, bad relationships, bad job— those are kind of the big dominoes we see. And when you all those up together, that’s how you get autoimmune disease. It’s really just that simple.

Dr. Justin Marchegiani: Totally. And then we have people on the live chat here. And again, this is a great reason why you should subscribe to our YouTube channel—justinhealth. Uhm because we have these podcast going live as well and we’ve also incorporated other technology in the background to get a higher quality audio versions. So if you want better audio, you can subscribe to Youtube, but also check out our podcast uhm—Evan Brand, notjustpaleo and then beyond wellness radio myself. So just keep that in the back of your head. And then your question was—I just missed it. We talked about—Oh, yeah! Leaky brain. Leaky brain is connected as well coz we have these live questions coming in. And so we are multitasking like it’s no tomorrow. So leaky brain’s important because we have these called astrocytes or the brain blood or the blood brain barrier which is kind of the interplay between systemic blood and then the passing over to the brain. And we have the cells called astrocytes. And again, same thing, when we have gut lining integrity, it tends to affect integrity of the lungs, integrity of the sinuses, integrity of you know, vaginal wall area, urinary tract. So you have people that have gut issues—gut integrity issues. It almost always can cause sinus issues, brain fog, brain issues, UTI issues, bladder issues, right? So you have all of that mucous membrane barrier, it’s gonna be compromised throughout the body not just the gut. But the guts kind of that first major domino that falls and then everything else tends to follow along with it.

Evan Brand: What you think about the GABA test for the blood brain barrier, where you take like a 500 mg GABA and if it works and you get relaxed, that says you have a leaky brain. Do you agree with that?

Dr. Justin Marchegiani: I’m not sure I buy that because I’ve seen people that do—that are really healthy and that do well with GABA.

Evan Brand: Yeah.

Dr. Justin Marchegiani: And they, you know, symptomatically, they’re doing pretty good. They’re eating well. Again, certain supplement companies have kinda put that out where they have a GABA challenge. They say, “Hey, GABA is this really big amino acid compound and it shouldn’t go through that blood brain barrier; therefore if it does, that means your major blood brain barrier is permeable.” I’m not sure I buy that. I think it’s something to keep in mind, something to try. I have a lot of patient that have gut issues and they’re sick and that use GABA or will only give them GABA and they don’t notice much benefit either.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, you know, how do you sparse that? That’s hard.

Evan Brand: I know. Who knows, man. That’s a good question.

Dr. Justin Marchegiani: Everyone tries to be a little bit trendy and nuance in this functional medicine field.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Because they wanna make a name for themselves.

Evan Brand: Yeah.

Dr. Justin Marchegiani: And I get that from a marketing perspective, but just looking at the clinical application, I’m not sure there’s ton.  But, heck, if you have GABA and you want to try it and you get uh—benefits, that’s great. I notice a little bit of improvement with GABA. Like when I take it, I feel little but relax. I also do that with Ashwagandha as well. I feel it with magnesium. Someone chimed in and asked if magnesium can be taken with Ashwagandha. Yeah, sure. I’ve no problem with that.

Evan Brand: Works great.

Dr. Justin Marchegiani: Hope everyone’s listening had a great Thanksgiving, too.

Evan Brand: Yeah. Tesa wants to know, “Have you reversed your Hashimoto’s, Dr. J, by healing the gut?”

Dr. Justin Marchegiani: Well, so we have to be careful when we say reversed, right? So have we decrease the inflammation? Have we address underlying issues that made people susceptible to having autoimmune attack? And we—can we lessen those and decrease them to the point where we are no longer symptomatic because we have the inflammation down or quench enough? Yes. I’m just very careful because you know, eyes in the skies and people listening in they’re— they’re looking for that the cure the cure-all word, right? We just got to be careful. We don’t cure anything. We support the body’s ability to—we support the underlying stressors that cause the issue to begin with. And we support the underlying systems that weren’t functioning well. And then the body can start to get these symptoms under control because the symptoms are just a manifestation of the symptoms— the systems not working. Symptoms occur because systems aren’t working. Systems breakdown because of underlying stressors. As functional medicine doctors, we come in, we fixed the underlying stressors, we support the systems that aren’t working and then the body starts to heal itself, right? The body’s on autopilot. We just got to get the stressors in the systems work. If the system’s working, then get the stressors out of the way.

Evan Brand: Yup. Well said. So you had some— you had some gut bugs and things going on, do you care to talk about your story for a minute with the – Hashimoto’s?

Dr. Justin Marchegiani: Yeah. I have—I have a low level of Hashimoto’s kinda in the background, I had elevation antibodies TPO and thyroglobulin antibodies and you know, I had some adrenal stress going on. And I just really worked on fixing the gut issues, which I had a handful parasites—Blasto, uhm— yeast, significant yeast overgrowth and H. pylori. Addressing those, fixing nutrient issues to help with the antibodies, fixing the digestion, fixing gut bacteria balance is of course working on stress reduction, sleep, all those important diet and lifestyle things. And again, the antibodies for me are just still slightly elevated, but there they’re in a range where you know, functionally my thyroid is not beaten up to the point where I need any thyroid hormone. My TSH is in a pretty good place and my T3 levels are pretty good. I actually have to go on for test real soon. So, yeah, I mean it’s possible to—to address the stressors and the system dysfunction to the point where you may not— you can call yourself cure. We just won’t call you cure for me, a functional medicine perspective.

Evan Brand: Yeah. Agreed. I need to get my thyroid panel run to. You’ve been pushing me to do it.

Dr. Justin Marchegiani: Yeah. You should.

Evan Brand: I need to do it. I mean you and I both have had these infections. I had H. pylori as well. I had a Crypto, Giardia and yeast and Pseudomonas Aeruginosa.  So, you know, that’s a fun thing about Justin and I. We both had all the things that we deal with in the clinic. So when you guys are looking to work with somebody, it’s— to me it’s a lot more honorable if you’ve had somebody that’s been in the trenches themselves, where we had to fix us to keep going to help other people. I think that’s always pretty cool. Uhm— what else I know we would have limited time, but what else should we mention here about kinda this autoimmunity piece, the gut piece. We mentioned the leaky gut, we mentioned some of the triggers just in a roundabout way. So Candida, bacterial infections, parasites, H. pylori, low stomach acid, gluten in the diet, dairy, possibly eggs, other food sensitivities. These could all contribute to that permeation of the gut barrier; therefore, causing the situation.

Dr. Justin Marchegiani: Hundred Percent. So, let me just kind of answer some of the things that you’re talking about while injecting some of the live questions we get. That’s the reason why the show is so unique compared to other shows coz we are off-the-cuff. This is the real deal here. So some patients are talking about having a lot of mucusy stools, right? And uhm— wanting to know where they should go for help, right? Of course, I recommend coming to see either myself or Evan, but typically one, we want to make sure food allergens aren’t driving this, right? Number two, we want to make sure we have enough digestive support on board to help those foods be broken down enough. So if there’s fat maldigestion issues, of course, adding in more bile salts or more lipolytic enzyme, right? Lipase— things like that. Uh— protease—proteolytic enzymes, right? These are all really important. And then, of course, once we can have the deck kinda dialed in, if foods are still a problem even with that, we may make them more palatable. We may go with more crockpot kinda GAP specific carbohydrate kind of eating template, where the foods are just easy—more processed via cooking, they aren’t raw, they are peeled or mashed. We’re decreasing salicylates and phenols and potential gut irritants so those foods can be consumed better. And then, of course, we’re gonna look deeper at the hormones because hormones have a major effect on inflammation and energy. And a lot of people that have gut issues, their guts are inflamed, we have to support the inflammation of the gut lining. And then, the big one is getting rid of the infections.

Evan Brand: Yup.

Dr. Justin Marchegiani: And that’s where you know, we’re probably go next.

Evan Brand: (laughs) Yes. You’re right. So uh—Cent50 here, who asked the question. Yeah, the loose, mushy stools, I mean that was me. I had Cryptosporidium, I had Giardia, I had H. Pylori, I had bacterial overgrowth. Until my gut issues were addressed, just FYI, I had IBS for 10 or 15 years of my life and conventional doctors had no solutions for my—my stools. And it wasn’t until actually cleared out the infections that my bowels and my stools became normal again. And so, yeah, you got to get yourself tested. Justin and I run several different companies. Uh—stool testing just depending on you know what—what we’re looking at. But, yeah, get a comprehensive stool test. Your conventional doctor may be able to order through your insurance, if you tell them you want diagnostic solutions Lab, it’s unlikely. You probably have a functional medicine guy like us to run it for you. But either way, once you get the diagnostic tool, you can fix this pretty quick.

Dr. Justin Marchegiani: There’s a lot of healing nutrients. So like, when we work with the patient, we kinda follow that 6-hour template— template that I’ve created over the last decade or so. There’s a lot of ones that are out there— three hours, four hours. In my opinion, a lot of them stink and they’re the wrong order. So the six that I’ve created and began to follow as well, in my opinion, is the exact clinical order which I follow things. So the first hour is removing the bad foods. And again, it’s not cookie-cutter because that maybe just getting someone from a standard American diet to a Paleo template. That may be taking someone from a Paleo template to an autoimmune template. Maybe someone on an autoimmune template and the Paleo template taking them to a GAPs or specific carbohydrate diet or low FODMAP template. I had patient last week who’s been Paleo for three or four years—chronic pain, chronic issues, chronic mood issues, chronic sleep issues. We took him from a Paleo template to an autoimmune-Paleo template and all of the symptoms went away in one week.

Evan Brand: That’s it.

Dr. Justin Marchegiani: This is someone that’s like already been on point for a long time and we just pulled out a few foods. So we have those— that kind of progression because you’d be surprised, the smallest things that we do have a huge effect. And it’s like, whoa! you would’ve thought I would have created the awesomeness protocol ever and found a you know, this hidden infection that everyone missed and got rid of it for that kind of improvement to happen. But sometimes it happens, we’re just removing some food. So, first, I remove the foods, second, I replace enzymes, acids, digestive support, bile salts, too. Third hour is gonna be repairing the gut lining. It could be also repairing the thyroid and adrenals and sex hormones, too. Fourth hour is removing infections. That’s where we go after— bacteria, parasites, uhm—fungal overgrowth. Those kinda things. We may even go after co-infections future podcast on that soon enough. Fifth hour, repopulating or reinoculating probotics. Some of these nice and beneficial bacteria. They’re transient. They only hang out for a month or so and pass on. So, getting some of that it in there periodically is helpful. Sixth hour is retest. We want to make sure infections are gone. And maybe even address family members too to make sure they are not being passed back and forth you know, playing hot potato.

Evan Brand: Yup. Well said. Riley asked a question about—he said, “Evan is your IBS completely healed now after addressing anything?” Uhmm—kind of a confusing question about addressing anything. Yeah, I don’t have IBS anymore. I’m infection free, no more H. pylori, no more parasites, no more bacterial overgrowth, no more yeast overgrowth and I feel good and feel completely normal, which was an amazing thing because after so long, you know, it took me to be so long to get here.

Dr. Justin Marchegiani: Totally. And with your situation, right? Like if you start eating bad foods again and your immune system got compromised, you may have another critter or two that pops back. You may have some inflammation from the food and such. And then those symptoms, they start coming back, right? So it’s not like a cure, like, “Hey, you have scurvy. Here’s vitamin C.” And then as long as the vitamin C is there, you’re good forever, right? It’s like, “Hey, there may be other stressors that may cause the systems to weaken again and those IBS symptoms start to occur, right?”

Evan Brand: Oh, Totally! Yeah. I mean I could go— I could go out to a restaurant and get some type of contaminated food and all the sudden creates a leaky gut situation. Maybe I pick up a gut bug, maybe I was eating while stressed during a week and I didn’t chew my food good. And then I picked up a parasite and have to start all over again. So, yeah, definitely, you know, you could always backtrack. You’re—you’re never permanently in a good place.

Dr. Justin Marchegiani: Totally. And again, one thing I see out there on Facebook, and I see it marketed, and it’s–  I have to call—I’m not  gonna call anyone out directly—

Evan Brand: No, come on. Do it.

Dr. Justin Marchegiani: I’ll call out the concept. But lots of people, they’re like, “You gotta heal leaky gut. Here’s a gut healing program.”

Evan Brand: Yeah.

Dr. Justin Marchegiani: And if you look at it, a lot of times, you know, it’s bone broth or just a lot of healing nutrients and a lot of probiotics, right? And maybe a little diet change. But if we go look at the six hours, what are they really doing? They’re doing the third hour, maybe a little bit of the first, maybe a little bit of the second, maybe a little bit of the fifth, right? They’re kinda skipping around. They don’t have a system and how it’s being integrated a lot of times. And I would say 99% of the time, it ignores going after and getting the infections fixed. Totally ignores it. Because you know, these people are recommending a general program to like thousand people at once in a huge kind of a webinar kind of style, right? Well, how do you get all the types of testing and customize everything in that format? You can’t. So it’s a very general kinda overview approach. And in my opinion, it’s going help some people, which I think is great. It’s admirable. But it’s also gonna  a miss a lot of people and those people that don’t get help may lose faith in functional medicine or say, “This is not for me.” So I’m just kinda calling that out because think about it, right? If the root cause of what’s going on is an infection component and you’re doing let’s say the first, second, third, fifth alright but you’re not getting rid of the infection. Well that’s like me giving you this healing aloe, right? You get a sunburn, you come back from the beach, I give you this aloe, right? The underlying cause of the sunburn is the— is the sun. And then you go back out the next day and you get sunburned again and I just give you more aloe. That’s the equivalent of what a lot of these people are doing. Well, just have some more bone broth, have some more of glutamine, have some more of this healing compound for your gut lining. So we got to get to the root cause. A lot of people are just being very general out there. And you know, the listeners of our show will get it and say, “Hey, I see that the missing piece there.” And that’s why we have those six hours that way coz then you can look at it and you can say, “Hey, this is a really specific way we go about addressing things here.”

Evan Brand: Yeah. Well said, man. And that’s the food is medicine, people. And we love the food as medicine people, but that’s why you know, we pursued functional medicine because the food is just the first step, right? It’s just one pillar of the house. It’s not gonna hold the house by itself as a single column. And also, I want to mention the order—the order of operations. If somebody just go straight to bone broth and probiotics and L-glutamine, that’s the wrong order. And sometimes people get worse. They’ll come to us and say, “Oh, Justin and Evan—“

Dr. Justin Marchegiani: Yup.

Evan Brand: “I took XYZ probiotics coz I heard it on a podcast or a blog and I felt terrible and I had a flare up of my condition. Can you explain what happened?” Yes, if things are just terrible in the gut,. sometimes you have to hit the reset button. You can’t immediately just add in all these probiotics and expect it to work. Sometimes we have to fix the balance first and eradicate the bad guys before the good guys can come back in.  So that’s why the order of operation is just a second when Justin said it’s so important. And this may explain why you’re spinning your wheels even though you’re all—you’re doing everything about the Paleo gurus are saying to do.

Dr. Justin Marchegiani: Yeah. We just want to make sure everyone’s educated. I mean, we have some people out here, they’re chiming about, “Hey, I really want a functional medicine doctor but I don’t have the—the money for it.” Well, guess what? The best thing that you can do right now is be listening to our podcast coz all this information is free.

Evan Brand: Yup.

Dr. Justin Marchegiani: We’re providing tens and thousands of dollars for free information off of people and I get messages all the time. “Hey, made a couple of these changes or recommendations and my autoimmune condition for 10 years is gone.” Right? I didn’t cure him.  I promise. I didn’t cure him, right? The body just heals itself, right? We got to say that as our disclaimer. But that’s you know, what’s that worth. When someone is you know, seeing a rheumatologist for 20 years on lots of expensive medication that’s tearing up their gut and their body and creating more symptoms than they’re actually helping. What’s that worth? So just utilize the pickup as much of the free intel as much as possible. And then you know, allocate some savings or HSA or flex spending. So if you want to dig in deeper, that’s an option. But utilize as much of the free stuff as possible because the diet is the foundation.

Evan Brand: Yup.

Dr. Justin Marchegiani: 50% is gonna be the diet so work on that first. Once you max that out, and you’re seeing some decent results, then you’d want to go in deeper. You can reach out, for sure.

Evan Brand: Yeah. And you can contact likely so. You can contact your conventional doc and try to get some stuff run through insurance. But it’s likely that they don’t have accounts with these functional labs and they likely just aren’t going to do it. Fut if you’re really lucky, you’ve got a really good M.D., you may be able to push push push push at least get the lab so you have the data. Now what you do with the data? Well then maybe that’s where you come to a functional medicine guy that can help in terms of creating a protocol. But getting the data should not be impossible.

Dr. Justin Marchegiani: Totally. And a lot of functional medicine docs that do a podcast or websites, I find that they take information, they wrap it up and they try to make people feel so confused where they walk away from the podcast or the video, being like, “What the hell just happened? What I do now ?” And they walk away feeling less certain. I want to make sure no one walks away from any podcast or video I do, gaining more certainty. And at least walking away with one action item that they can add into the repertoire of whether it’s a lifestyle or a supplement or just a different perspective on the6 hoir healing so they get better and they feel more confident.

Evan Brand: Yeah. I watch a couple of functional medicine videos like over the weekend and they were like hour-long videos I made it through 10 minutes. And I thought, “This is not gonna help me at all.” So I decided to turn it off. So let’s do it, let’s do our action steps and summary here.

Dr. Justin Marchegiani: So of course, we have our six hours, right? So everyone listening kind of our general feedback is gonna be a Paleo autoimmune template to start. And again, depending on where you’re at, that maybe really a lot of— really overwhelming for you, cutting out grains, legumes, dairy and primarily having healthy fats, proteins, uhm more veggies and fruit instead of starch. And having healthy fats like you know, if we’re doing a Paleo, maybe a little butter or ghee. If we’re going fully AIP, no nuts, no seeds, no dairy. Just coconut, Olive oil, may be avocado oil, some healthy animal fats. And that will be a good starting point for people. And then again, an AIP or an SCD or autoimmune diet, again, I’m just kinda laying out the Paleo template to start coz that’s probably the easiest buy in without pre qualifying anyone. I would say that after that, at least getting some digestive support going there. And again, you know, the ones that we formulated, we recommend the most coz we’ve put our stamp of approval. High-quality HCl or enzymes. In my line, it’s HCl supreme or enzyme synergy or I’ll add in the liver supreme for extra bile support for digest energy. And Evans line—Evan has a similar products as well. Uhm— so that’s a good starting point there. And then seeing where you’re at, I think is the next step coz there may be infections, there may be other testing that has to go in deeper. So I think if you can get that, that’s number one. And then I think if you can just make sure the hydration component and the sleep component is dialed in next, that’s a good second step. And that gives most people of really good you know, path to go down and if people are listening, they’ve already done that and they’re like, “what’s next?” well, that’s where I think you’d want to reach out and do a little bit more testing because that’s what I think the infection component and/or the hormone component and/or the nutriend malabsorption component from the infection could be the next vector we’d really have to put up in our sites, so to speak.

Evan Brand: I’m gonna address one comment here and then I’ll bring up a question then we could uh—we could wrap it up. Leslie mentioned the diet’s the foundation which kinda sucks no more pigging out in the middle of the night. The good thing is that could be related to infections. I mean for me, for example, when I had parasites, I would get these food cravings that just didn’t make sense and it wasn’t me. It’s these bugs. They are stealing your nutrients, they want food so they’re cannibalizing your muscle tissue and when you’re eating, they’re messing up your ability to digest especially coz I had H. pylori. My stomach acid levels were lower. I was basically hungry all the time and I was losing weight. Getting to like a scary point of weight loss. So really, the diet is not too hard once you just address your gut bugs, that— the whole like binging type thing on food, it really doesn’t happen once your gut is healed, once your adrenals and your thyroid are helped out and your blood sugar’s more stable. It’s not an issue. I mean you could fasted for a long time and feel stable. You shouldn’t have to get hungry or go on a crisis stage. Justin, a question for you. Uh—some doctors say T3 doesn’t matter; they don’t test it on Thyroid labs. The person’s taking T3 now slowly increasing. Would you be lowering T4 when adding this?

Dr. Justin Marchegiani: Well, I would typically be adding more than likely a T4, T3 put together so there’s gonna be a combination of both. Most doctors don’t care about uhm—T3 because the major pharmaceutical companies, Abbott’s the big one, that has a patent on Synthroid is a synthetic T4. It’s easier to monitor uhm— giving a T4 the half-life’s five days, so it’s really easy. It’s not like a T3, which could potentially have more side effects. Uhm—and it’s patentable, right? It’s the basically tetraiodothyronine with the sodium salt on it. So that’s how they get the patent to it. Uhm—again, they don’t m__ it because that’s just not what they do. They give you the T4, they get the TSH back in range. All your thyroid symptoms could still be present. Cold hands, cold feet, anxiety, mood issues, hair thinning, you know, gut here fitting things you know, gut stuff, constipation all could still be there, but if the TSH is in range, they’re happy. They checked off the list, you’re gone. So that’s where you got a dig in deeper. You got a look at the T4, T3 conversion. You got to look at the autoimmunity. You got a look at the nutrients. You gotta look at the adrenal conversion, the gut conversion connection and the liver detox conversion connection, too.

Evan Brand: Yup. Yup. Should you ignore TSH? No. It’s definitely worth factoring TSH in. You just don’t want to use that as the end-all be-all only marker. But you— but when you have the free T3 and the reverse T3, the TPO, the TG antibodies kinda all the stuff we run, the TSH makes a lot more sense when you got a full picture.

Dr. Justin Marchegiani: Yeah. We like to keep TSH in the equation and look at sometimes people come in with the TSH that’s perfect, but their T4 T3 conversion sucks. And then what do you do? You know when you’re treating the TSH or are you treating the actual patient? So we’ll try to increase thyroid hormones, see if symptoms change and we’ll try to support HPT access communication with specific herbs. And of course, stress modulation and getting infections— getting rid of infections coz that can really mess up the HPT access, the Hypothalamus Pituitary Thyroid connection.

Evan Brand: Yup. For sure. Uh—Leslie and a couple other comments about you know, where to go next? Well, I mean, you know, if people may say, “Oh, we’re biased.” But the answer is get tested. Our philosophy is “Test, don’t guess.” So if you’re confused, you’ve got symptoms that don’t make sense, get tested. That’s the first step. You can look at adrenals, thyroid, gut, get all the puzzle pieces laid on the table. That way you’re not just buying random supplements that you might not actually need. We’ve seen so many people with 20 and 30 supplements that they’re taking and they still feel terrible. And we cut that down to five supplements because it’s based on labs and all of a sudden people get better. So you know, save up your money for that. Maybe you don’t go buy the next newest supplement you hear about. Maybe you— you focus on investing into some testing first.

Dr. Justin Marchegiani: Exactly.

Evan Brand: And you can check it out on Justin’s site. It’s Justinhealth.com You can look at the supplements, the labs on there. Same thing on my site, Evanbrand.com and we’re happy to help. So, feel free to reach out.

Dr. Justin Marchegiani: Totally. And also, couple of people asked about Dr. Gundry’s The Low Lectin Protocol. I think it’s the plant paradox. Again, my thing is if you’re just going to a Paleo template, you’re gonna cut a lot of those lectins out. If you actually cook some of the plants, some of the starches,  some of the vegetables and lower the lectins even more, if you still have a lot of gut issues, upgrading it to an autoimmune protocol, you decrease lectins more. If we still have issues and we can move to a specific carbohydrate or GAPS protocol and we decrease lectins even more. So it just depends on where you’re at cooking knocks a great chunk of that out and just going to a Paleo template, where we’re cutting out grains, legumes, dairy and focusing more on non-starchy veg, uhm— lower glycemic, low sugar fruits and safe starches that aren’t grain-based, you’re gonna have a huge effect and grains, where most of the lectins and irritants come from. So again, that— my opinion matches people making things a little bit more complicated than they have to be.

Evan Brand: Marketing.

Dr. Justin Marchegiani: Uh-hmm.

Evan Brand: I mean, he’s done a good job that book is spread.

Dr. Justin Marchegiani: Yeah. It has gone viral. Everyone asked me about it all the time. I can’t get a go of a— one day without a patient asking me about it. So I have to follow it. I think I found it on fast reads on Amazon. So I got a—like uhm—abridged version of it that I’m siphoning through.

Evan Brand: Nice.

Dr. Justin Marchegiani: I’ve got a couple of services where they do these summaries. And it’a great.  I mean I get 90% of the information.

Evan Brand: Exactly.

Dr. Justin Marchegiani: Suck it up in a half hour and I’m like, “Oop, got it!” That’s it. On to the next one. Well, any other questions you wanted to answer here, Evan?

Evan Brand: I think that’s everything. I think that’s all we can—we can chat on today and we’re gonna do a podcast soon on co-infections. We’re gonna talk about Lyme, Bartonella and Babesia Uh—Justin and I, I mean, we’ve literally got the books like right here that we’re—we’re diving into.  We wanna make sure we’re the most educated and current up-to-date with our information before we broadcast to you guys. So make sure you hit subscribe on Justin’s YouTube channel while you’re at, hit subscribe. And uh—we’ll be back again soon.

Dr. Justin Marchegiani: Totally. And one last thing. Patient asked here—person asked here on the chat list, uhm—“How do you—how do you choose your functional medicine doctor? How do you trust them?” He said, “I can’t trust them. How do I choose them?” Well, number one, I think they should have some kind of content out there whether its video, audio and/or blog post where you resonate with their information. Like their philosophy, their information, you should resonate. I find most patients are the biggest reason why they don’t get better is because, number one, compliance, and number two, they’ve been burnt and the past or they failed in the past and therefore they’re kind of priming their subconscious to fail again. So they don’t follow through and they’re off to the next one other, you know, they’re making a 180 move in can’t see someone else because some little thing happened. They’re not following through enough. So I think keeping—one, making sure you choose someone based on their philosophy and the information and making sure you resonate at an emotional level and just a logical level. Here’s the plan, generally speaking, right? And then number two, making sure you’ve given enough time and then follow through uh—for it to work.

Evan Brand: Yup. Well said. I’ll address— address this last question, then we’ll roll here. Uh—Is it common to have to go through a few rounds of infection killing protocols? Yes.

Dr. Justin Marchegiani: It can.

Evan Brand: You can. It took me a couple of rounds to go through, some herbs to knockout things coz I have multiple infections. When you’re trying to kill five or six or seven things at once, yeah. I can’t take multiple rounds. Why is that? Depends on the person’s immune system health or stress levels, how long they’ve had infections, the amount of damage that’s there, how much inflammation is there, are they sleeping well, do they have a good diet. You know, there’s million factors to answer why that— why that could be. Hope that helps.

Dr. Justin Marchegiani: That’s great.

Evan Brand: Andrea is asking a question about his father’s prostate cancer. PSA levels are rising rapidly. Can we cast opinions or advice?

Evan Brand: I can’t. Justin?

Dr. Justin Marchegiani: That’s about thyroid, it’s about uhm— prostate issues?

Evan Brand: Yeah. Prostate. Prostate cancer this drug—Enzalutamide had been recommended for father’s prostate cancer PSA levels are rising rapidly. Can you cast opinions or advice?

Dr. Justin Marchegiani: Well, let me describe– I have one formula here that’s been helpful. Yeah. I have one compound here that I’ve been using here, just I had a couple of supplement companies reach out and I’m using it. It’s the pomegranate extract, and the flower pollen extract and its cranberry extract. So cranberry, pomegranate and flower pollen. This is an excellent support. Lot of research behind those extracts as well. Lycopene is phenomenal, getting adequate levels of selenium 200 mics a day is phenomenal, enough zinc as well is phenomenal saw palmetto’s great. These are excellent compounds that help. Lycopene is phenomenal as well. Again, the diet has to be in place. You want to get the lifestyle things going and again, these things don’t grow overnight. They probably taken decades to kind of move. So coffee and Coffee enemas may also be helpful to kind of early push detox in a faster more acute kind of way. But some  couple of compounds that I mentioned are phenomenal and wouldn’t hurt getting them on board in the meantime.

Evan Brand: Yeah. And look at my podcast I did with the lady named Dr. Nasha Winters.

Dr. Justin Marchegiani: Uh-hmm.

Evan Brand: She did a book that’s called, “The Metabolic Approach to Cancer” She— she had cancer herself and she’s been holistically supporting people with cancer for about 20 years. So uh— look up Nasha Winters and uh look up her book and you could implement some strategies there hopefully.

Dr. Justin Marchegiani: Also, get the insulin levels under control. Make sure fasting insulin is five or below at least. That’s important because insulin is gonna cause a lot of cells to grow and then also making sure xenoestrogen exposure is mitigated, right? Don’t drink out of plastic bottles, avoid pesticides and GMO’s and glyphosate and Roundup. These are chemicals that you’re gonna get from conventional foods. Obviously, eat organic, right? Pasteur-fed meats. Again, these things— I shouldn’t have to repeat them, but I just can’t assume that everyone knows these stuff.

Evan Brand: They don’t. Not everyone does. So, yeah, keep repeating it and keep preaching. And I think that’s all the questions. So we did— we did really good. That was fun.

Dr. Justin Marchegiani: I heard a quote back. It’s a quote from the 1940s, where Joe DiMaggio was interviewed and they said that Joe said, “We noticed that you sprint on and off the field every single time at full speed no matter what.” And he said, “Well, there may be someone coming out to see me for the first time ever that seeing me play the way I’m playing and I wanna play at 100% every time.” And then maybe some people that are coming out for the first time seeing us play here, and we want to make sure that they get that information that we may assume that other people uh— may have, right? The equivalent will be like us jogging on the field, so to speak, if we just assume that.

Evan Brand: Yup.  Well said. Well, reach out if you need help. Justinhealth.com You can schedule with Justin. Evanbrand.com if you’d like to schedule consults with us. We should have some availability in the next 3 to 6 weeks or so. So just take a look and  we’re happy to help you soon as we can.

Dr. Justin Marchegiani: Oh, by the way, I’m adding in the Mimosa Pudica as well. So I’ll be reporting back on that in the next couple weeks. I think you as well Evan. So we’ll chat about that.  Again, I just got that in stock. That’s the Para-1 in my store. I think you have it in your store as well. So, we’ll put that in the show links, too. So that’s a cool new herb that we’re working on. We have a couple other herbal compounds in the mix that we’re using for different types of co-infections that we’re researching uhm—in the background, too.

Evan Brand: Awesome.

Dr. Justin Marchegiani: Hey, Evan, great chatting with you, man. You have an awesome day. We’ll chat soon.

Evan Brand: You too. Take care

Dr. Justin Marchegiani: Bye.

Evan Brand: Bye.








Lab Testing to Assess Malabsorption and Leaky Gut

Lab testing and Malabsorption Assessment
By Dr. Justin Marchegiani

Today is going to be a video where we actually go over a real live patient’s lab test and we’re going to be looking for malabsorption. Again, a lot of people that come to see me, there tend to be some kind of chronic stress issue where eventually that stress has affected their gut; and essentially, they’re no longer able to maximize the absorption of a lot of the nutrients coming into their body.

So we’re going to look at a few different lab tests here, some cutting-edge stool test looking at specific DNA technology, as well as some organic acid testing. We’ll look at these various organic acids which are metabolites from protein that have various companion nutrients that give us a window into how other nutrients in the body are doing; and we can see malabsorption and stress based on that pattern.


The GI Map

So we’re already on this first test here. This is called the GI-MAP. Now in this test, it’s a PCR which stands for Polymerase Chain Reaction DNA test and it’s going to look at various infections, whether it’s pathogen, bacteria, various parasitics, various viral infections H. pylori. It will look at bacterial overgrowth.

Low Beneficial Bacteria

You can see that this patient, this person has actually low beneficial bacteria. So you can see lactobacillus is a beneficial flora along with bifidobacter. It is also a beneficial probiotic. You can already see the person has low beneficial bacteria. That’s automatically starting to make me feel like there is a dysbiosis. Dys– meaning out of balance, –biosis meaning bacteria.  This out of balance regarding bacteria, typically more bad stuff than good. We already know the bacteria that’s good is low.


Find out more about testing for malabsorption from a functional medicine doctor by clicking HERE!

Bacterial Overgrowth

So let’s go to the next page.  Looking at potential autoimmune bacteria, we look pretty clean, but look up here. We already some dysbiotic flora showing up. So we have Pseudomonas species and Staphylococcus species. Now off the bat, that theory on page one regarding the dysbiosis, we already know is present because we can see it here based on the Pseudomonas and the Staphylococcus.

Go down a little bit further.We got the trifecta: Blasto, Dientamoeba fragilis and Endolimax nana. Then we go a little lower, there’s also candida. So we got a bacterial overgrowth. We have 3 parasitic infections, not one, but two, but three—Blasto, Dientamoeba fragilis and Endolimax nana. We have candida albicans and we have low beneficial bacteria, and if we don’t add any more insult to injury, we also see low levels of enzymes. This is important.

The more stressed your gut is, the more stressed your adrenals and your blood sugar and sleep is, the more put your body into a fight or flight; and the more that shuns your body from being able to adequately produce enzymes as you can see it right here.

Low Elastase

Looking at the various compound, Elastase, which gives us a pretty good marker of what’s coming out of the pancreas. So Elastase is low, low pancreatic output, and we also see low SigA, which is the localized immune system in the gut, and that kind of makes sense. How’s your immune system going to be when 70-80% of it is in the GALT and MALT, which is in the stomach and the small intestine, when you got 3 infections—3 major parasitic infections, a candida overgrowth, low beneficial flora, and 2 dysbiotic bacterial overgrowths. And then we also can’t break down our food well, so you see this sets us up for the perfect storm in functional medicine world. That’s why we look at the gut because most people they would be passed and they wouldn’t have this deep assessment to figure out what’s happening under the hood.

Summary Page

So again, we saw low beneficial flora there; and then we saw very high amounts of dysbiotic bacteria here; and then we saw Blasto infection, Dientamoeba fragilis, Endolimax nana, high levels of Candida. These tests aren’t the best for picking up candida and the best clinical indicators like jock itch or fungal nails or thrush, coated white tongue or itchy rectum or itchy anus, dandruff—those types of things are telltale signs of fungus and we actually have it on the test, too. It also includes low localized immune system and the low levels of enzyme.


The Organic Acid Test

The organic acid test

So let’s switch gears and go to the organic acid test. This will give us a window into other companion nutrients that’s going on in the body. So down the list we go, so this is the summary page.

So real quickly about organic acids, organic acids can go high or go low. High organic acids, my analogy is it’s like making a million dollars a year but spending two. You’re still a million bucks in debt. It’s a lot of debt, versus someone on the low side—a lower organic acids, that’s like making 10 thousand a year, but you’re spending 20. So you have a lot less in the supply side which is kind of important. Typically, lower organic acids mean it’s a longer type of chronic issue; where higher means it’s more of an acute issue in this typically a little bit more resiliency there. And so high and low, both are signs of deficiency. Don’t let the high fool you. High still means there’s essentially a functional deficiency based on the high demand. The sweet spot’s kind of in the middle.

Organic acids are metabolites from protein. So what that means is the proteins are metabolized to various organic acids and these organic acids have various companion nutrients that they essentially are symbolic of. Various things like suberate may be symbolic of carnitine or homovanillate; vanilmandelate may be symbolic of adrenaline or dopamine level. Various organic acids have their companion nutrients.

So high or low, we would look to that companion nutrient as a source of solution.

The big five are always going to be:

  1. Diet
  2. Malabsorption, digestion or food allergens—gut issues basically.
  3. Emotional stress and/or sleep.
  4. Toxicity.
  5. Genetics like MTHFR, genetic individuality with certain nutrients, MTR, COMT, vitamin D receptor issues.

So all those things are going to be at step number five with the genetic factor. So going back in here real briefly. This person, what do we see? They already had this test over here with all of the infections. What do I think when I see infections? I always think potential malabsorption.

Let’s go look at that now. Low free form amino acids, low amino acids. Going to the neurotransmitter section, more low amino acids, very low, that means this is a long-term type of situation happening here. Low serotonin, low dopamine, low amino acids, low amino acids, and we keep on scrolling down here. So you can see, the moral of the story here is malabsorption.

And if we go to each section, look at carnitine, fatty acid, everything is low. Look at the energy production. Everything skewed into that first quintile. Look at the L-lactate, low amino acids, look at the B vitamins. Everything’s low. Look at methylation, low. Look at neurotransmitters, everything’s low. Not bad with the oxidative stress. Detox low-high. Bacteria wasn’t that bad. So this organic acids test missed the bacteria even though we had a whole bunch pop up here. That’s why we always want to do multiple tests to help have a safety net in case we missed something.


Treating Malabsorption with Functional Medicine

How to treat malabsorption with natural medicine

The take home is with functional medicine assessments that are holistic and broad spectrum with a clinician that has a knowledge base, we can pick up infections that drive dysfunction in the body. Now when we see things like low amino acids like that, what does that mean to me? What does that mean to the person at home watching this video? It means we’re in a catabolic state of physiology. Our body is breaking down faster than we are building up. Our body has to take in nutrients and has to be able to digest it, assimilate it, utilize it and get it into the bloodstream then actually use it. And that’s what’s happening here, but we have a malabsorption. We have lower amino acids because gut stress creates malabsorption. So we got to fix the root cause from a diet perspective, a stress perspective, we have to support the adrenals, but also fix the underlying gut issue that’s driving that malabsorption.

Fix malabsorption by getting to the root cause. Ask a functional medicine doctor HERE!

Now with this person here, we may have to do a couple of rounds of gut killing to really get things cleaned up because there’s a lot of different things happening with these infections.

So if you have a chronic issue, we got to look deeper at the gut, got to look at the malabsorption and the nutrients under the hood. If you feel like you have an issue that kind of resembles this, and you want to look deeper under the hood at what could be the potential cause, we need a holistic approach. So click and subscribe. Click on screen and reach out, and schedule a consult with myself.

The top 5 causes of leaky gut and how to fix it – Podcast #70

Today’s podcast features Dr. Justin Marchegiani and Evan Brand breaking down the 5 causes of leaky gut and how to fix it. Listen to this discussion if you want to get a full understanding of what a leaky gut is. Dr. Justin explains all about digestion thoroughly in this interview. They also talk about the importance of chewing your food when you eat for the digestive process.

causes of leaky gutLearn about the connection of leaky gut to stress and cortisol. Discover an effective way to deal with leaky gut with the Dr. Justin’s 5R Approach — a combination of removing bad foods, adding in digestive support, adding in healing nutrients and adrenal support, removing any infections, and bringing back and trying to repopulate with a lot of good bacteria.

In this episode, topics include:

2:44   Digestion 101

7:45   Causes and culprits of leaky gut

11:43   Stress and cortisol

14:45   5R Approach

26:51   On testing for leaky gut










Podcast: Play in New Window|Download

Dr. Justin Marchegiani:  Evan, Dr. J here. What’s cooking, man?  It’s Friday.

Evan Brand:  Hey, it is Friday.  I didn’t cook anything for breakfast today.  I just did a couple of slices of some organic simmer sauce chicken that I found that is really delicious and then I had my all-time favorite Love Crunch organic nut bar.  It’s got some organic cashews, a little bit of dark chocolate, some hemp seeds, a little bit of pink salt I believe or sea salt in there, so I’m feeling macro-nutrient balanced to start my podcast here with you.

Dr. Justin Marchegiani:  That’s great.  I’m actually doing a little bit of intermittent fasting this morning, just did actually a little bit of Bulletproof coffee here and I’ll probably have some collagen here in a few hours, but doing a little IF this morning and I’m feeling pretty good.  I’m not seeing patients ‘til this afternoon so I’m–I’m rocking it.

Evan Brand:  That sounds good.

Dr. Justin Marchegiani:  Very good.  Well, anything else on your radar screen?

Evan Brand:  Well, I’m definitely–off-topic–but I’m definitely interested in cars now.  You know, I’ve been spending time off air talking about cars this morning so that’s always fun.

Dr. Justin Marchegiani:  Always fun stuff, like it.  Well, today we talked about digging in to leaky gut.  We’ve done some videos on digestion and infections and hydrochloric acid which all play a role into leaky gut, but I think we need to do a really, you know, a good job just kinda tying everything together to really what is a leaky gut.

Evan Brand:  Sure, that sounds good.  For me, you know, everybody pretty comes in the door and they diagnose themselves with leaky gut.  It’s like, “I have leaky gut and that’s why I’m coming to get help.”  And a lot of people do have it, but I guess I wouldn’t always jump to conclusions about that, so maybe should we break down kind of like the gut a little bit?  I mean, you want some level of permeability, like you have a certain level of intestinal permeability, but it’s when you’re exposed to gluten and these other things that you’re gonna increase that permeability and now toxins that should not be able to get through and infections and stuff that shouldn’t be able to get through this lining, now they can and they break through the tight junction and then now you have whether it’s an autoimmune disease or you have other physical symptoms that hurt you and then you’re troubled and then now you have to try to work on sealing that back up.

Dr. Justin Marchegiani:  Yeah, absolutely.  So our gut–inside of our intestinal tract is actually considered outside of our body, just kind of a weird thing to wrap your head around, so when you’re eating something, it’s technically considered outside of your body in the intestinal tract and basically we have to bring it in via the tight junctions and that gastrointestinal kind of barrier system.  So we take food in, it goes into our stomach.  Just kind of Digestion 101 here.  We take foods into our stomach and the first level of digestion actually happens with the teeth, right?  We’re breaking things down.  We’re chewing–the technical term is mastication–medicine loves making big words that make no sense, so we’re masticating our food, we’re breaking it down.  That starts the digestive juices being secreted.  It enters our stomach and it’s starting to get churned up and the hydrochloric acid comes out which has almost like a sterilization effect with the food but also activates a lot of our proteolytic enzymes in our stomach, one known as pepsin which helps start breaking down protein.  And then all that food gets mixed up into this kind of soupy mixture called chyme.  And that chyme is the–should have a nice low pH and that low pH and that chyme is actually going to be released from our stomach into the small intestine and once it’s released, our pancreas spits out a whole bunch of bicarbonate to kind of bring the pH back up so we don’t have an ulcer in our small intestine, but that nice low pH initially triggers our pancreas to make a whole bunch of enzymes like trypsin and chymotrypsin and lipase, these are fat enzymes and protein enzymes that will help break down protein and fat, and it will also trigger out gallbladder to contract and spit out a whole bunch of bile salts which will start helping to emulsify fat.  So the first domino is good healthy mastication in the–in the mouth by chewing that increases surface area.  The stomach does its job with the–the nice pH and having a sterilization effect and also activating proteolytic enzymes, small intestines now triggered where bicar–bicarbonate comes out and then also enzymes from the pancreas and bile salts from the gallbladder.  So that’s kind of where we’re at.  Any questions there, Evan?

Evan Brand:  No, that’s good.  I mean, a lot of people, they don’t actually chew their food that well and then they wash it down with a soda or other type of drink. They’ll just put a bite in their mouth and then they’re just chugging something down and goes to the gut and you’re creating a lot more stress for the stomach.  It’s gotta work harder than it should have to, so that kinda wears you out, too.

Dr. Justin Marchegiani:  Yeah, I remember back in the day, this was like maybe 10 years ago when I was a personal trainer, and I was thinking that, you know, eating the conventional way was healthy and I was sitting there and I’m eating a Subway sandwich thinking that this is such a great thing, right?  Because, you know, Jared from Subway lost all this weight.  I’m gonna do the same thing.  So I’m eating that sandwich and the roommate–my roommate next to me went and said, “You just chewed that thing 7 times before you swallowed it.”  And I was like, “Whoa!”  And it kinda hit me, like the first part of digestion with that stomach–with your, you know, getting the food in your stomach, chewing is so important.  I think that’s a really important thing, you know, a good rule of thumb is you chew your food for every tooth that you have.  So on average that should be like 32 chews or 33 chews, if I remember my dental anatomy correctly, probably 32 because it’s even.  Again, if you’re unhealthy and you have no teeth, that doesn’t give you the excuse to just swallow your food whole but I think you get the idea.  Chewing is super important for the digestive process.

Evan Brand:  Yeah, definitely.

Dr. Justin Marchegiani:  So we chew our food up, right?  We get the protein digestion in the stomach.  We get the fat and protein in the small intestine via the pancreas and the gallbladder.  Now that food has to get broken down, ideally even more into its individual constituents, meaning protein is like the pearl necklace.  Each individual pearl is like the amino acids, right?  So we wanna take that pearl necklace, we wanna break it open so all those individual pearls are–are laid out so our body can then absorb the amino acids and protein digestion is very energy intensive, so if people are under a lot of stress, it can take energy-digesting proteins.  So sometimes if we are in a catabolic state, our body is breaking down a lot of tissue and we’re already having digestive problems, getting free form amino acids in your digestive system that are already broken down can take a lot of stress off the gut because it can just absorb those individual pearls because they’re already broken off the necklace if you will.

Evan Brand:  Yeah, so do you do capsules or do you do liquids when you are gonna do some amino acids?  What do you like?

Dr. Justin Marchegiani:  Typically, a combo of the two.  Typically, a really good high quality protein powder in the morning, like a pea or a beef protein powder.  People who are less sensitive, maybe a grass-fed whey, and then individual amino acids that are free form, because even pea and whey and beef they aren’t free form.  There’s still a little bit of digestion that’s involved but, you know, not even close to the same as food.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  But when we have people that are showing either low amino acids on their blood work or on their organic acid test, we’ll give them additional capsule versions of free form aminos, so they bought–so they can absorb a lot of those things to help make their neurotransmitters and their–their lean tissue as well.

Evan Brand:  Yeah, so unless you have a different direction to go with this thing, we should probably talk about some of the causes and culprits of leaky gut.  So for me, huge–a lot of people that I talk with, who are doing CrossFit and other intense exercise and they’re depending on Advil and ibuprofen and Tylenol, and all of these other NSAIDs that are just not good for the gut lining at all, and I find that a lot of these people, once they start using these products for their pain to cope with their exercise routine, now they’re joints are hurting worse than ever before.

Dr. Justin Marchegiani:  Yeah, it’s like, “Huh.”

Evan Brand:  And then we start to make the connection with, “Man, that gut is getting destroyed and now other things are getting through that barrier that should not be.

Dr. Justin Marchegiani:  Uh-hmm.  Exactly.  So medication is definitely gonna be a stressor because it can wear down that gut lining for sure, and again, I was really stressing the digestive component because if we’re not digesting our foods down fully, what starts to happen is these proteins that are incompletely digested, they start getting into the bloodstream not in their free form, not in their essentially fatty acid form but, you know, impartially broken down or partially broken down or partially emulsified, or partially digested, right?  And that’s a problem because then the immune system can freak out.  It starts to say, “What’s this here?  This shouldn’t be here.  What’s going on?”  And those surface proteins on some of those foods can resemble other body tissue.  So if you look at like a–a surface protein amino acid sequence of gluten, it may resemble things like the myelin tissue that coats the nerves or it may resemble the thyroid tissue or it may resemble joint tissue.  Or if you’re looking at dairy, it may resemble tissue on the pancreas for type 1 diabetics.  So the foods being incompletely digested is a big component.  So everyone kinda, while they’re sitting here, just put your hands together like you’re saying a prayer, right?  But then you’re looking inward on the inside of your hands, so you can see the fingers interlace and you can see really tight, but you can see a nice little seam there.  That’s kinda like you’re gut lining and where those fingers interlay, that’s called our tight junctions.  That’s like the epithelial tissue in our gut lining and if we just pull our tissue or pull our hands apart just enough to create a little bit of daylight, that starts to hap–that’s what’s happening when we start to have a leaky gut, and again the leaky gut could be one, from eating bad foods, right?  Eating foods like gluten or dairy, like dairy maybe being higher casein dairy like cheese or–or milk, or could be eating things that–higher sugar foods.  They could be from infections like fungal overgrowth or parasites, or it could even be people that are sensitive like phenols and salicylates or mycotoxins that are in the food.  It could even be from lack of nutrients like zinc.  It could also be from you not chewing your food well or you eating while you’re having a whole bunch of stress so you’re not digesting food, so you’re not having enough enzymes or hydrochloric acid.  So there’s a whole bunch of things, right?  Medications you also mentioned.  So all of these things.  If you’re having your hands tied together, it’s like pulling them apart just a little bit and it’s allowing those undigested, unbroken down foods in those pearl necklaces that should be broken down to go into the bloodstream and then our immune system is looking for the APB, right?  All posted bulletin, right?  We got a–a person driving a black Lexus, it’s stolen, but then hey, the guy maybe driving the black BMW gets pulled over instead, right?  It’s that case of mistaken identity and other tissues get caught up in the collateral damage and that’s what happens with leaky gut and other parts of the body.  It’s that these parts of the immune system are revved up because the amino acids on these foods look similar to other tissues.

Evan Brand:  That’s mind-blowing, isn’t it?

Dr. Justin Marchegiani:  It is, isn’t it?  I’m gonna take a breath right now and let you break some stuff down.

Evan Brand:  Yeah, for sure.  Well, I wanted to talk about cortisol a little bit, too, because stress is a huge part that can contribute to leaky gut and, you know, if you go back far enough in a–in a client’s history and you find that they did start doing like a CrossFit exercise or they had a significant job change or they went through a divorce or something like that, some type of huge stressor whether it’s emotional, chemical, physical, they seem to derail themselves.

Dr. Justin Marchegiani:  Yes.  Uh-hmm.

Evan Brand:  So now, there’s that–the link between the cortisol and the leaky gut.  So if you have all these other things that you’re putting in your mouth and alcohol is another big one, too.  You’re putting all these things in your–your mouth that are causing you issues and you have all the stress on top of it is really when the Jenga game starts too fall.  You pulled out one too many pieces of the puzzle and now the whole thing has collapsed and then you have more issues, so stress for me was a huge part of my recovery process after the diet picture was–was dialed in.

Dr. Justin Marchegiani:  Yeah, and we have this kinda like this nice little balance with cortisol.  It’s kinda like the Goldilocks effect, not too hot, not too cold, not too high, not too low.  Cortisol goes too high, we actually burn through a lot of our gut lining.  That’s stress, right?  You’re under a lot of stress.  That increases cortisol.  You’re burning down that gut lining.  You’re IgA, that’s the mucosal membrane barrier that lines the gut starts to weaken.  The mucus layer on the intestinal tract or on the stomach starts to think out and then you don’t have the protection from the stomach acid and you need–too much acid will–will break down that gut lining so then when foods come in, it’s like–boom–now they can easily pass through or there could be impaired digestion.  But if our cortisol’s too low, we actually need some level of cortisol to build up our gut lining, to create out gut lining and we need some level of cortisol to deal with inflammation.  So little fires will maybe be ignited in our gut and if we can’t put those fires out with the cortisol, that’s gonna be a problem.  And then also we need cortisol to build up that gut lining, too.

Evan Brand:  So let’s go a little deeper with that and try to apply this to the stuff that we see all the time.  Most people we see are low in cortisol because they’ve gone through so much stress that now they’re more like a stage 2, stage 3 adrenal fatigue.  So what you’re saying here is you go high cortisol at first, so you’re stage 1.  You’re burning the candle at both ends.

Dr. Justin Marchegiani:  Yes.

Evan Brand:  So you’re destroying the gut, right?  So then they wear out the adrenals and the pancreas and the liver, all the–the whole system here and now they’re low cortisol.  So now you’re saying once you hit that point, you don’t even have enough stress hormone to build these processes back up which is why you have to get the adrenals going.  You have to get the digestive system going.  You have to get the detox going.  You’re saying, because if you don’t have enough fuel, because your stress bucket’s empty, you can’t even build this gut healing process back up anyway.  Am I–am I–

Dr. Justin Marchegiani:  Correct.

Evan Brand:  Saying that right?

Dr. Justin Marchegiani:  Correct.  So once you get into this place where the gut’s starting to become leaky.  You really have to then follow a 5R approach, which we’ll talk about in a bit to get the gut healed again.  And that’s a combination of removing bad foods, adding in digestive support, adding in healing nutrients and adrenal support, removing any infections, and then also bringing back and trying to repopulate with a lot of good bacteria.

Evan Brand:  Uh-hmm.  It’s funny, I always hear, like you’ll–you’ll–sometimes the functional medicine thing, you’ll hear 4Rs and then you hear 5Rs, and then sometimes you hear 6Rs, it’s like how many are there?

Dr. Justin Marchegiani:  I know right?  I made up my own and the reason why I did it is because I found a lot of the order was messed up, meaning a lot of people will say remove, but they’ll say remove the foods and they’ll put the infections in the same place, and the problem with that is people–or I should say–functional medicine practitioners and doctors really screw this up because they take a sick patient who can’t regulate inflammation, they can’t digest foods, they’re already inflamed, and they go after a massive infection.  There’s a whole bunch of die-off or Herxheimer’s reaction, which is the body becoming overwhelmed of the dead debris, having to process the dead debris from the in–of the–the infection killing program.  It has to push it out to the limb for the detox or the kidneys or–and then the immune system has to deal with all of the–the biotoxins of the infection and the person has a healing crisis.  They just feel like crap and then they fall out of the program and then there’s a patient that thinks functional medicine isn’t gonna be able to help them.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So my goal is the removal of the infection is one of the last things that we do because we have to get the person digesting.  We have to cut the crappy foods out.  We gotta start shifting their body into an anti-inflammatory state.  I gotta give their body the extra nutrients.  We also have to work on giving the extra repairing nutrients so I focus at least one to two months on that before we knock out the infection, that’s why there–we have remove twice.  It’s removing the beginning with the foods and then remove at the end in the fourth R with the infection and then also my third R where we do repair.  Repair typically with most doctors is just healing nutrients and those healing nutrients are like the aloe, the deglycerides, licorice, the L-glutamine, a lot of these healing mucilaginous and nutritive-based amino acids, that’s the repair part.  But with me, I also add in the adrenals because cortisol’s important for gut-healing and like you said Evan, most of our patients are stage 3, their cortisol’s beneath that 23 nanomils per liter on the cortisol rhythm test for their cortisol sum for the day, so they don’t have enough cortisol to even deal with the inflammation in their gut.  So with us, it’s really the 5Rs and it’s–it’s that way because of thousands of patients that I’ve treated and I found this is the magic sequence that tends to work the best in most people.

Evan Brand:  Well, it makes so much more sense.  I mean, how could you come in with this big sledgehammer and this gut-killing protocol?  I just had–actually had a–a call the other day with a girl where she’s got Hashimoto’s which is so common and she started working with another lady on top of me because she’s local, so she’s able to go see her in person.

Dr. Justin Marchegiani:  Too many cooks in the kitchen.

Evan Brand:  That’s what’s happening, man.  So here I am trying to work on the adrenals with this lady and next thing I know, she says, “Hey, Evan.  I’m taking like 10 or 15 new supplements,” and she’s on this huge gut-killing protocol now because this other lady–

Dr. Justin Marchegiani:  Oh, man!

Evan Brand:  Is doing it the–I almost call that like the standard functional medicine way so now, you know, she doesn’t know who to go to for all these new symptoms that are coming up because she’s taking all of these gut-killing stuff.  I mean, the oregano oil, the GIX micro whatever, I mean, she’s–she’s going deep in the rabbit hole and my explanation, I try to keep it as simple as possible, as like, “How are you gonna put the windows in your house if you don’t even have the walls up yet?”

Dr. Justin Marchegiani:  Oh, my gosh!  You know, I totally hear you and this is the biggest mistake most functional medicine doctors and practitioners make.  So anyone that’s looking for a functional medicine doctor, make sure you interview them regarding this process, because I think if they don’t have this down, then there’s probably another–you know, other pieces to the puzzle that are probably missing.

Evan Brand:  Well, what–what’s happening now is that she is getting stagnant, so I mean we–we looked at the adrenal picture again and we went over some of the symptoms just on a questionnaire and it’s like, “Okay, we’re clearly reducing some of these adrenal things,” where she’s not waking up in the middle of the night anymore and things like that, but now all of a sudden with this Herx’s reaction, now the joints hurt.  Now she feels like she has the flu all the time and it’s significantly reducing her confidence to continue on because she’s this early in the game with this lady and now all of a sudden everything’s getting worse, so–

Dr. Justin Marchegiani:  Right.

Evan Brand:  I guess, my point is here that I mean, I’m just seconding what you’re saying, it’s gotta be done in something a little bit more common sense than just coming in and killing everything just because you’ve identified something.  I mean, yeah, we definitely wanna identify and that’s what we do, is identify what’s going on but we’re not gonna come in and chase after that stuff if you’re not ready for it.

Dr. Justin Marchegiani:  Exactly.  Exactly.  So looking at the 5Rs that I’ve–you know, applied in my clinic and practice, there are a couple of exceptions.  I’m gonna walk you through the exceptions.  So the number one, the first exception is while we’re doing the killing, some people may need some detox or binder support.  So we may add in some extra clean, you know, soluble fibers to help with binding that can have apple, pectin, or celery root or carrot root and try to do a lot of plant-based fibers that are soluble and try to avoid a lot of that–the grain-based non-soluble fibers just because of gut irritation.  So that’s one extra piece to the puzzle.  The next piece to the puzzle is some people do better with some probiotics during the whole program and we have a couple of different strains that we use in the office that are very helpful but we talk about the reinoculation kind of being that fifth R, that fifth phase, and that’s important and most of people will be able to do it that way, no problem.  Some may need a little bit of probiotic during the program because it will help some of their gut inflammation, right?  There’s been studies showing that probiotics taking can actually decrease cortisol levels in the gut and if under a lot more stress, that may be beneficial.  It can also help with digestion.  It can also help easing stomach inflammation and irritation, and if you’re–maybe have constipation or diarrhea, it could make a–a benefit, have a beneficial effect on some of those gut symptoms that may already be present.  So depending on where that person is at, we may add some probiotics, some specific-strains whether it’s a soil-based or some specific others that we use like in the bacillus family that really help modulate any of the gut symptoms that may be present.

Evan Brand:  That’s beautiful.  I love how that works.  I mean, it’s almost like an adaptogen, probiotics in a way.  It’s like if you’re–if you’re having diarrhea, it can help balance that out.  If you’re having constipation, it can help get things moving.  I love the–the effect.  I’m gonna put probiotics in the adaptogen category now.

Dr. Justin Marchegiani:  I know right?  So looking back here with the leaky gut, right?  We pull apart our hands or our fingers and where they’re interlaced there, that’s where the leaky gut starts.  That’s the tight junctions.  Now what facilitates that is a protein called zonulin.  So everything we’re doing is trying to reduce stimulation or production of zonulin because zonulin’s kind of that–the energy that pulls that gut junction apart.  So gluten is the–one of the biggest stimulators of zonulin.  Also endotoxin which is a toxin secreted by bacteria.  The outer layer of the bacteria that has these little kind of like fla–flagella-like projections if you will–I’m making these little hand motion on the Skype, too bad everyone can’t see me on that–but these little flagella-like projections that sit off of it and now those are actually LPS, and if you google LPS, it’s another word for endotoxin.  And you break endo–endo means internal, right?  Toxin is toxin, right?  So medicine again using big confusing words, so it’s an internal toxin produced by the bacteria that has–has to go and get filtered up by the liver, so it’s toxic.  So that can actually create an increased zonulin proteins.  Also things in the food, casein could be a stimulator, phenols and salicylates which is what’s kinda taken out of the GAPS diet or the SCD diet.  So those can be a big thing as well and then mycotoxin and mold and even dysbiotic bacteria where your gut bacteria is really out of–out of whack and even SIBO or small intestinal bacterial overgrowth, which is another form of dysbiosis specifically in the small intestine.

Evan Brand:  So you got me thinking here–

Dr. Justin Marchegiani:  Go ahead.  Yeah.

Evan Brand:  Let me–let me interrupt you here, so, you know, talking about this endotoxin here and you’re talking about the liver’s job to get that stuff out.  Let’s say someone had been taking a lot of pharmaceuticals or they have had a bad skincare regimen, where they’re getting a lot of chemicals and their diet there, maybe they are eating chemicals and other fungicides and pesticides from non-organic produce, things like that, and they’re increasing that liver burden, that could technically make the leaky gut problem worse because now you’re not able to get rid of that endotoxin as well because the liver’s focused on these other chemicals.  Is that accurate?

Dr. Justin Marchegiani:  Exactly.

Evan Brand:  That’s scary.

Dr. Justin Marchegiani:  Exactly. Uh-hmm.

Evan Brand:  I mean, that’s why the foundations of this removing as many chemicals from your life is gonna be important for people listening.

Dr. Justin Marchegiani:  Yeah, any stressor is–that you add to your intestinal tract is gonna be an issue because everything that goes into your gut has to go to the hepatic portal vein which then goes to the liver, and then goes filtered out and then goes systemically.  So the more stress in your gut, it eventually goes to the liver as well.  So the cleaner–the cleaner food that you put in your intestinal tract, the less hard–I should say–the more, I should say, what’s the better word here?  The liver is not as stressed as much during the filtration process.

Evan Brand:  Yeah, right.  Just taking the load off.

Dr. Justin Marchegiani:  Just taking the load off, that’s it and that’s important because our liver really has to work hard with all the toxins in our day and age.  And I heard this at a conference recently–I’ll put it out there–I’m not sure how accurate it is but from what I understood is a healthy liver functions at 99.9%, you know, upwards of 99 in change.  I heard a cirrhotic liver, a liver that’s not functioning well, it’s really only a 10% difference in its function.  It’s functioning basically at 90%.  And I could be wrong on that, I heard it the doctor–the doctor lectured on that topic but from what I understand, it’s only a 10% difference in filtration that makes the difference of a diseased liver and a healthy liver.

Evan Brand:  Geez.  So if you’re 1 or 2% off, holy crap.

Dr. Justin Marchegiani:  I know, that could be a pretty big deal and that could create a lot of symptoms, too.

Evan Brand:  Yeah, so it means–something that’s kinda like the overwhelming idea of this whole thing is that it’s not one thing, you know, everybody’s always looking for that one thing that’s gone wrong that’s caused their health issues, it’s not one thing.  It’s a combination of things.  Like I told you, I had a cankersore that popped up in my mouth, you’re like, “Dude, you probably got gluten somewhere and from a sauce or something like that that I came across and it caused me to have some type of symptom.  So obviously that’s a huge cause that we always stay away from as much as possible, staying away from, you know, wheat protein, gluten.  But there’s this–this whole list, I mean, that we could make a thousand–a thousand pages long of these other things.  So if you’re getting frustrated and you’re thinking it’s that one piece of your life that’s causing you issues, maybe.  But it could that we need to just focus in on several different pieces of your life at the same time and just take a few baby steps in the right direction to get your better.

Dr. Justin Marchegiani:  Exactly.  100% agree.  Now a lot of people are all about, “Well, how do I know I have leaky gut?”  Well, there are some tests out there.  I personally don’t do any of these tests because I think anyone that has digestive issues or has chronic health issues, they’re gonna have a leaky gut because there’s a common pattern in any of these patients.  There’s inflammation.  There’s maybe some food allergens.  There’s poor digestion.  There’s lack of stomach acid.  A lot of times there’s an infection.  There are maybe some toxicity overwhelm or overload.  It may be some nutritional deficiencies.   I mean, all of those together are gonna be like a perfect storm.  So Cyrex through a lab, I think out in the west coast, that looks at some leaky gut markers like actomyosin, occludin, or zonulin and they look at lipopolysaccharide.  That’s the endotoxins and look at the various antibodies and they’re kinda looking at the fact that these antibodies are gonna be a strong stimulating factor of leaky gut, especially if we know zonulin’s there, right?  That’s the protein that kinda unzips that gut lining.  So these are some more objective ways to quantify leaky gut.  I don’t think you have to go that way.  Most people don’t need that.  They can just start with the general 5R plan and they’re gonna already start getting better and feeling better off the bat because with the whole leaky gut test, it doesn’t change anything in treatment.  We’re not gonna go about doing anything differently because we see some of these markers pop up.  So if it doesn’t change treatment for me, why do it? The only time–

Evan Brand:  I love it.

Dr. Justin Marchegiani:  Yeah, the only time I would do it is if someone’s kind of a biohacker and really wants objective data or someone’s just very skeptical and is like, “Well, I wanna see it.  I wanna look at it.  I wanna–I wanna touch and feel it and know that it’s actually there.”

Evan Brand: That–that’s so smart.  I’m so glad you said that.  Because like some of the other stuff, like a stool test, you can’t opt out of that.  An adrenal test, you can’t opt out of that.

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  Organic acids, you can’t opt out of that.

Dr. Justin Marchegiani:  Right.

Evan Brand:  This one, you can pretty assume.  I mean, what would say?  Would say 9.9 out of 10 people that are having the symptoms we’re seeing are leaky gut people?

Dr. Justin Marchegiani:  Absolutely and then it–it comes down to what degree as well, right?  And that may be different from day-to-day and to, you know, what food exposure and what stress you’ve had and sleep and all that, so there’s a lot of variables.  Another variable, another test that I think you can bypass on is food allergy testing.  I don’t think food allergy testing is bad and for some people it may be a good idea especially if you’re dealing with someone that’s very resistant to cutting out foods and need to see it in black and white, like I mentioned with leaky gut.  That can be helpful, but most people they’re gonna need an elimination diet with some level of rotation to it.  Let’s think about it, right?  If you get back a test that says you’re allergic to beef and chicken and a whole bunch of vegetables and fruit that you’re already eating and then you start eating, “Well, I’m gonna more fish and I’m gonna eat more–more turkey, and then I’m gonna eat these vegetables and these fruit.”  And then you re-do the test, well, if the gut’s leaky, guess what happens?  You tell me, Evan.

Evan Brand:  I don’t–I–

Dr. Justin Marchegiani:  In the spot.

Evan Brand:  I honestly zoned out.  I was so entranced with the tone of your voice that I got lost.  Say it again?

Dr. Justin Marchegiani:  Evan, that is 10 Paleo demerits.  Alright, I want 25 push-ups right now.  So basically, anytime you switch to the foods you’re eating especially early on with the gut still being inflamed, you’re gonna eventually develop antibodies and an immune response to the new foods you’re eating as well.  So if you’re allergic to beef and you cut beef out and now you’re eating turkey every day, well, then it’s just a matter of time before turkey’s on that immune list.

Evan Brand:  Right, was there a question involved in that?

Dr. Justin Marchegiani:  So the whole idea is well, what do you do with the diet?  Because if, you know, I’m not getting this food allergy test, well, how do I figure out what to eat?  Well, typically a good elimination diet that involves an autoimmune Paleo aspect is usually a good starting place for most people and I always tell patients, “rotate their meat families,” so a good way to go is turkey–or I should say–your poultry, your fish, your beef, and your pork.  Kinda rotate those proteins, pick one per day and rotate them and then eat different colors of vegetables.  Different colors and you can even break it down to taxonomy of the vegetable family.  I have a handout on my website that does that but for most people that aren’t terribly sick, just eating different colors and rotating the types typically is enough.  The fats tend to be more benign because it’s the–the immune component in the body is more protein-based so having just fats tend to be okay.  Again, butter has a little bit of casein, right?  So butter may be an issue but pure coconut and pure olive oil tend to be fine.  So moral of that story is an elimination diet with an autoimmune element that has some rotation pieces to it tends to be a better replacement for any food allergy testing.

Evan Brand:  Yeah, just imagine if the whole world went on an autoimmune Paleo diet, how much money would be saved in the healthcare system overnight?

Dr. Justin Marchegiani:  Oh, my God.  I mean, just diabetes alone, it’s gonna bankrupt the healthcare system.

Evan Brand:  Oh!

Dr. Justin Marchegiani:  People don’t know it but the average life span of someone that’s diagnosed diabetic is like $2 million.  You know, their–their life span of costs when frankly, I mean, this stuff can be fixed relatively easily with just some diet and some lifestyle and exercise pieces and maybe some–some supplementation as well.  Like, I mean, a couple of thousand dollars gone.

Evan Brand:  Yeah, I know.  It–it’s just amazing to me.  I mean, I’m kinda zooming out here in my head about all the different problems that we see and the different manifestations of where someone that’s just starting with this condition of leaky gut, how they start with this, but they could end up with an autoimmune disease and now they’re on Humera and these other immunomodulating drugs and they have the medical bills and then they have the side effects and they have the side effect of the side effect and it’s just amazing to think that there’s so many people going down the rabbit hole when just with this podcast here, I say this is probably one of the most important podcasts we’ve ever done because–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  If you start here with this foundation of getting this gut lining and this tight junction in order–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  You’re gonna save yourself potentially thousands of dollars and maybe even millions over your lifetime and the quality of life, I mean, that’s priceless.  There’s no dollar–dollar sign that you can put next to that, so–

Dr. Justin Marchegiani:  Absolutely, and just remember anyone who has an autoimmune condition, autoimmunity starts in the gut.  Alessio Fasano, researcher out of University of Maryland now over at Harvard, he’s the one that kinda coined the term or did a lot of the research on gastrointestinal permeability and he was kind of, you know, almost a pariah in the field so to speak.  I mean, Harvard’s now picked him up and he’s done a lot of great research but he got a lot of crap.  I saw him speak at an autism conference a few years back and he was just lecturing to all the people saying, “Guys, you have no idea how much crap I’ve gone through just to bring this information to the forefront.”  And I couldn’t believe it, because, you know, now leaky gut is even becoming more mainstream but this guy went through a lot of slings and arrows to bring this information up there and he’s even gone as far to say that this mechanism, leaky gut, gastrointestinal permeability has to be present in almost all autoimmune conditions for them to even happen to begin with.  So that means your Parkinson’s and your MS may be driving–may be driven from a gut issue to begin with.

Evan Brand:  Oh, man!  That’s–that’s mind-blowing right there.

Dr. Justin Marchegiani:  Wrap your head around that like something that’s not even GI-related is coming from the gut and this is where medicine, conventional medicine drops the ball because you are already alluded to it earlier, it’s like everything has like one, like a cure of symptoms–a cure of symptom and it’s just one thing.  But you can’t cure something that has multiple causes.  And there could be literally just 10 causes happening at once.  Let’s say each cause has a 10%, you know, it’s 10% attributed to the underlying condition, well, it’s not just one thing to point at, you may have to treat each of those 10 things and knock each down from 10 to 0 for that person to get better.  A drug can’t do that because it’s only focused on one enzyme system or one biochemical pathway that is blocking or inhibiting and it’s not fixing or upregulating any of the systems and it’s only focused on one at a time.

Evan Brand:  Yup, yup.  Well, that–that doctor that you were talking about, I mean, it’s a lot like what happened with Galileo.  I mean, here he is discovering that the Earth is spinning around the sun, I mean, I don’t know this stuff full story but I’m pretty sure he was–I don’t know if he was imprisoned or at least highly, highly stigmatized for this discovery and everybody is like, “Yeah, right.  You’re an idiot.”  You know?  The Earth does not spin around the sun.  Something so revolutionary and he–it takes some, however, many years.  I mean, he probably died before it actually comes out that that was true.  I mean, when–you know, Newton and Coppernicus and all these other guys come around and they were like, “Yeah, he was right.”  So it’s–it’s basically what’s happening now but it’s just in medicine.  It’s this whole idea that we have to just–we have to invent the drug, right?  It’s like we’re gonna find the cure.  The cure is never going to come into–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  One pill.  It’s not gonna happen.

Dr. Justin Marchegiani:  Uh-hmm.  No, it won’t.  And then the same thing with Dr. Semmelweis who figured out that, you know, going from the autopsy lab where he was doing, you know, pathological dissections keeping the blood on his hands and not washing it and go and deliver babies upstairs was causing all kinds of, you know, illnesses with these newborns and causing death.  And it’s like, my God, he came up with the idea, let’s change our gloves and wash our hands, and he was like exiled.  It’s like, “You’ve gotta be kidding me.”  Like if you were to–if you would go today and say, “Well, yeah, washing your hands is bad.”  You’d be like, “What?  Of course.  You need to wash your hands especially in surgery.”  And this guy was thought to be like a heretic, you know, just a little over a hundred years ago washing your hands was considered to be, you know, insane, which is just nuts in itself.

Evan Brand:  So we’re living in the future right now.  Like this podcast is ahead of its time.  I mean, this stuff, not to toot our own horns too much here but I mean, it could take another–give–I mean, give me a timeline, I mean, you’ve been doing this stuff longer than me.  How long is this gonna take to become mainstream where the doctor on every corner is talking about this stuff we’re talking about?

Dr. Justin Marchegiani:  I don’t think it will happen from a top-down approach.  It won’t happen with the drug companies or the conventional mainstream doctors because there’s–they’re too entrenched with the pharmaceutical model and too funded by it.  With their education and their treatment modalities are 100% focused on symptom drugs.  It’s allopathic.  It’s great for acute medicine because the isolated cause of acute issues, they’re acute.  They happen once.  That’s the whole reason why they’re acute.  The car accident patient who broke their leg.  The car accident happened.  It’s done.  It’s over with.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  But the people that have the issues that we have, they’re having little micro car accidents every single day 24/7, and it’s not being fixed by the Celebrex that was prescribed or by the anti-depressants.  So the medical model will never–it won’t–it won’t change top-down, meaning it’s not gonna be the government and the doctors and the drug companies that do it.  It will just change based on a free market approach or people saying, “I’m gonna go look for a functional medicine doctor to fix my condition because my conventional doctor is just throwing anti-depressants and Prilosec and Nexium and corticosteroids at me and immune-suppressive drugs and it doesn’t look too good and the side effect’s staying and it’s not fixing any of the issues.”  So we’re getting information out there and we’re just trying to create another option, so now instead of only having option A, which is drugs and surgery and–and trying to manage symptoms as they get worse where eventually the side effects become worse than the actual disease to begin with, we’re having a second option that’s more free market where you can actually get the underlying issue fixed and part of that issue is always gonna be the diet and the lifestyle and the nutritional piece which frankly isn’t even present at any medical schools.

Evan Brand:  Not at all.  Yeah.  So the bottom-up approach, I mean this grassroots thing is happening now is just going to become an even bigger and bigger presence until it’s actually–whether it’s accepted or not, we don’t’ really care, I don’t care at least–so that bottom-up approach is just gonna get so big that it reveals itself because of the success rate that it has.

Dr. Justin Marchegiani:  Yeah, it’s gonna be just natural inclination of people searching online, blogging, listening to podcasts, and getting tired of the options that are thrown at them from the medical establishment.  I mean, the functional medicine community doesn’t have billions of dollars of marketing.  What they really have are individual doctors and practitioners like myself that go out on the Internet and blog and do podcasts and do videos.  That’s it.  I don’t have a billion-dollar payroll to–to market this stuff.  So for me, it’s just me putting free information out there, trying to give people hope and connect with them and give them solution.  That’s it.  That’s my marketing plan and lots of free information.  That’s it.  Now conventional medicine it’s a different–different story.  You open up the–the TV, your–your paper, right?  I mean or any magazine.  Like drug commercials they’re just littered out through it and you’re not gonna see that in functional medicine.

Evan Brand:  That’s very true.

Dr. Justin Marchegiani:  Yup.  So and they got functional medicine in the Cleveland Clinic now and now I’m already predicting that it will kinda be a watered down version of functional medicine.  It will be functional medicine light or diet functional medicine, and I don’t think it will be, you know, what functional medicine could or–could be because well, I mean, frankly, if you got a massive multimillion-dollar hospital that makes a whole bunch of money, because they have cancer wards and heart disease wards and they treat diabetic patients, and you got this one department called functional medicine, that’s sucking all the other departments dry–dry, I mean, it–they’re a business that have to stay in.  And if one part of it is losing money for the whole hospital, how could you stay in business?  It’s not a viable model.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Right?  If it’s by itself and it’s fully an entity onto its own like–like me and you are, it’s different.  But when you are a hospital that makes hundreds and millions of dollars and you got one sector of that hospital causing every other sector to–to lose money, it becomes pretty tough.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  So wrapping up here, Evan, is there anything else you wanna say before we give all the listeners kind of a–a Reader’s Digest summary here?

Evan Brand:  I think this was good.  I mean, this was definitely longer than some of the other episodes but this was well-needed and I think we covered a lot–a lot of ground here.

Dr. Justin Marchegiani:  Yeah, so I think off the bat, we’re already ones coming in.  The first thing you can do is try to eat your food in a non–at a non-stressful, stress-free environment, chew your food, one chew per tooth, right now I think that’s 32 chews if memory serves me right.  Make sure you’re not drinking a whole bunch of water with your meals and avoid all the inflammatory things that are gonna be driving that zonulin stimulation.  The gluten is gonna be the first.  Any of the dairy outside of, you know, butter may be okay.  All of the extra irritants and chemicals and pesticides, so go organic.  And then if we’re having digestive issues, we wanna look deeper at infections.  We wanna look deeper at SIBO and dysbiosis and H. pylori and low stomach acid and low enzymes and then if we are still having issues from there, the next step will be to really go through a 5R program with a–a good quality functional medicine doctor that really gets to the root of these issues and helps heal that gut and get your digestion optimal.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Anything else, Evan?

Evan Brand:  That’s it.  I mean, I’m sure I could rant some more but I think we’ve–I think we killed it today, my man.

Dr. Justin Marchegiani:  Alright, man.  You have a good weekend.

Evan Brand:  You, too.

Dr. Justin Marchegiani:  Bye.

Evan Brand:  Bye.


A Six Step Strategy for Healing a Leaky Gut

By Dr. Justin Marchegiani

We are hearing the term leaky gut a lot these days, but what exactly is it and how do we heal it?

When we hear the word “leaky” associated with anything, we know that can’t be good, and a leaky gut is no exception. Just as a pipe gets holes and leaks water, causing damage to everything around it, the gut can get holes and leak toxic intestinal contents, causing damage to other parts of the body.

This article provides a five step strategy for healing a leaky gut and preventing a leak gut in the future.

What Exactly Is a Leaky Gut?

To understand how to heal it, we first have to understand what a leaky gut is.


leaky gut

The intestinal lining contains layers of cells connected by tight junctions. The intestinal lining is supposed to only allow the appropriate nutrients to pass through and into the bloodstream. When the tight junctions become inflamed due to gluten or other irritating foods or even infection, they can open up, and food particles can slip through, introducing toxic materials, such as yeast, bacteria, and parasites, into the bloodstream.

The bloodstream carries these toxins throughout our body where they are absorbed in a variety of locations, creating inflammation. As we continue to feed our bodies offending foods, the leaky-gut cycle continues, keeping our bodies in a constant state of inflammation.

The Impact of a Leaky Gut

Leaky gut can present itself in a variety of ways and can lead to chronic conditions. Some people may have irritable bowel syndrome (IBS), Crohn’s disease, or other pathological conditions. Others may have skin issues, bloating and gas, or gastroesophageal reflux disease (GERD). Still others may fall somewhere in the middle.

All of these conditions have a common etiology: leaky gut. So we have to get the gut healed.

Click here if you are wondering if your chronic health issues might be due to a leaky gut.

Strategies for Healing a Leaky Gut

leaky gut

1. Remove Hyperallergenic Foods

The first step is to remove irritating foods causing the leaky gut. Physical, chemical, and emotional stressors can lead to inflammation, and inflammation tends to cause our bodies to break down faster. Irritating, hyperallergenic foods introduce physical and chemical stressors to the body.

Stressors cause the immunoglobulin A (IgA) in the mucosal barrier in our gut lining to break down. When this happens, we may see sinus infections, gut issues, irritation, fungal infections, or even urinary tract infections. Removing irritating foods can help remove this stress to the gut.

infection cycle

What foods to remove varies by individual. Common irritating foods include, but are not limited to, the following:

  • Grains
  • Sugar
  • Dairy
  • GMO foods
  • Processed foods

If there is an autoimmune issue as well, we may need to add a rotation component to the diet and also eliminate foods that include the following:

  • Nuts
  • Seeds
  • Tomatoes
  • Potatoes
  • Eggplants
  • Peppers

Again, there’s not a one-size-fits-all plan here. Each person has to find his or her offending food and eliminate it.

Since 70% to 80% of our immune system is located in our gut, removing allergenic foods is very important to keeping the body healthy.

2. Replace Enzymes, Acids and bile salts

When our body is under the control of the sympathetic nervous system (SNS), it’s in a fight-or-flight state. As we get more stressed, our blood rushes toward the extremities so we can fight or flight. As blood leaves our digestive system, we are not able to produce the enzymes, hydrochloric acid (HCl), and bile salts we need for proper digestion. This makes the environment more susceptible to dysbiosis, small intestinal bacterial overgrowth (SIBO), and chronic infections.

Our parasympathetic nervous system (PNS) is our “rest and digest” state. The PNS actually brings the blood inward toward the gut, and this allows for proper enzyme, HCl, and bile salt production. So getting our bodies back under the control of the PNS is important.

3. Repair with Healing Nutrients and Adrenal Support

There are specific healing nutrients that will help repair the gut. What nutrients, how much, and whether or not they are needed will depend on the specific gut issue, how long it has existed, and if there is inflammation. L-glutamine, slippery elm, marshmallow root extract, aloe vera, and licorice are soothing and will assist with healing the gut.

Having healthy adrenal glands also is very important for healing the gut.

The adrenals produce cortisol, which helps neutralize inflammation and maintain a healthy gut lining. If we have too much cortisol—if we’re too inflamed, and our body’s inflammatory response is too high—we’ll actually break down our gut lining. If our cortisol function is too low, we won’t have enough of it to build our gut back up.

So having an appropriate stress response, having healthy adrenal function is important to creating the right hormonal response, to having healthy levels of cortisol. Cortisol is also there to help deal with inflammation, so if we have inflammatory compounds in the gut, cortisol can also put out that flame before it grows into a five-alarm fire.

4. Remove Infections

Removing infections is imperative, and this step is often missed in traditional medicine. Infections can drive a leaky gut, keeping us in a stressed-out state, which keeps the SNS activated, preventing digestion.

Blood work or a comprehensive stool analysis needs to be done to determine if there is an infection (SIBO, dysbiosis, bacteria, virus, etc.) and what infection we are dealing with.

There is a reason removing infections is near the bottom our list of strategies: it can actually be stressful to your detoxification system and immune system to remove an infection. Also, in some people the hormonal system (adrenals, thyroid, and male or female hormones) must be addressed first to decrease the risk of side effects and other issues.

5. Reinoculate with Probiotics

Imagine you have a backyard garden full of weeds. You can’t plant new seeds in that weedy garden. There’s not enough room for those seeds to grow. You’re going to have to pull out the weeds and prepare the soil before you can plant your new seeds.

In our first four strategies, we removed all the weeds (the bad stuff) and prepared the soil (our gut). Now we can reseed (reinoculate)—put the good bacteria back in.

cross section of colonMany people have issues with adding in probiotics. These issues occur when they are trying to plant seeds in a garden that’s full of weeds. Get the first four strategies in check first, and then introduce probiotics into your properly prepared gut.

6. Retesting to ensure infections are clear

It’s important to ensure infection are cleared after treatment. Some patient may have other new infections that would burrowed deeper into the gut lining that will be exposed on retest. Some patient may need a few rounds of clearing herbs to clear them. Some patient may also get reinfected from a spouse or partner who maybe carrying an infection symptomatically (like in h. pylori).


Following the five strategies presented here may not be simple, but leaky gut is not a simple condition. Taking the challenge and putting forth the time and effort to heal your gut will be worth it when you see the drastic improvements in your overall health.

If you have questions on the five strategies and how to get your gut healthy, click here to get help!


“4 Steps to Heal Leaky Gut and Autoimmune Disease.” Dr. Axe Food Is Medicine. http://draxe.com/4-steps-to-heal-leaky-gut-and-autoimmune-disease/: accessed 6/12/15.

Reasoner, Jordan. “Leaky Gut Syndrome in Plain English-and How to Fix It.” SCD Lifestyle. http://scdlifestyle.com/2010/03/the-scd-diet-and-leaky-gut-syndrome/: accessed 6/12/15.

Leaky Gut image from www.leakygutcure.com.

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.