The Top 5 Reasons Why Your Estrogen Levels are High – Men & Women!
Let’s talk about the top 5 reasons why your estrogen levels are high. We’re going to break them down today.
WHAT ARE ESTROGENS?
First, let’s look at the 3 major kinds of estrogens: E1 or estrone, E2 or estradiol, and E3 or estriol. In a woman’s regular cycle, it’s usually estradiol we’re talking about. When you start shifting to more menopausal and the ovary stops working, you start getting more estriol. The adrenals help in kick in a lot of DHEA and you make more estriol. Estradiol is more of the growth factor type of estrogen and estriol is a weaker estrogen.
WHERE CAN WE FIND ESTROGENS?
- PLASTICS. You’ll get it when the plastic is warm like in a microwave or out of a plastic water bottle especially if it’s in the car and the sun is hitting it or it’s outside. That’s why you want a good stainless steel or glass water bottle if you’re going to go outside or leaving it in the sun. The microwave heat and the radiation is going to cause a big release of plastic chemicals there, the xenoestrogens. One of the big ones are the phthalates but also BPA. There are other types of BPAs that are new which are supposedly safe but there are still estrogen-like compounds there as well. These plastics can affect women and men as well. Men are actually going to be more affected by them because men aren’t used to having estrogen in their environment and getting a whole bunch is going to be a problem.
- PESTICIDES. These tend to have an estrogenic quality to them and if you’re eating foods that are not organic, you’re definitely going to be getting organochlorines and various pesticides in your environment.
- PHYTOESTROGENS. These are found in soy. For example, I had a vegan-vegetarian patient. We ran a Dutch sex hormone panel on her and her estradiol was through the roof and really high. Phytoestrogens can be a big one, so soy may be a problem. With vegan-vegetarian, there’s a lot of phony protein consumption like fake meat kind of stuff such as the Beyond burger where there are a lot of soy and estrogen-like compounds in there. There are also hormones in meat. You have to make sure you get antibiotic-free, hormone-free, and ideally organic and pasture-fed or if you’re on the Whole Foods scale, step 4 or step 5 is ideal. Step 2 is at least pretty good. Organic means no pesticides, no hormones, and also the food they’re eating has no pesticides or hormones, too.
- HIGH LEVELS OF INSULIN. Too much carbs drive high levels of insulin because insulin responds to a high level of blood sugar. The blood sugars in your bloodstream go up and your pancreas comes in. The beta cells make a bunch of insulin to bring it down and bring it into the cellar and converted to fat. So, high levels of insulin upregulate an enzyme in men called aromatase that converts testosterone, the male hormones, to estrogen which becomes a problem. Now, in women, a similar thing happens but it’s the exact opposite or the big switch. Their estrogen is converted to testosterone. So, women can actually get more androgen-like issues which results in weight gain, acne, hair growth, and sometimes you can see some libido enhancements on that. So, that’s the difference between men and women.
- POOR GUT HEALTH. In the gut, we make healthy good bacteria in our gut that help us absorb a lot of nutrients. A good healthy gut function helps us break down protein for good HDL levels and good enzyme levels. We need these to break down protein into amino acids which are really important for helping us to detoxify. So, detoxification helps us to excrete estrogens that we’re getting exposed to in our environments such as the pesticides, plastic, or something that you don’t even know you’re getting exposed to. Good healthy detoxification will help your body eliminate that, so that’s a good backup plan.Also, if we have a lot of dysbiosis, SIBO and bacterial overgrowth, we can make a lot of what’s called beta-glucuronidase. This is an enzyme that’s made by bad bacteria and it makes it harder to detoxify estrogen. The beta-glucuronidase takes conjugated estrogens and binds it to a protein that helps us excrete it out the body. It takes that protein and it pulls it apart. It takes the handcuffs off that protein, so that allows that estrogen that’s been deconjugated to go back into the body in the general circulation. So, if we have gut issues, that could be a major concern.
HOW DO WE ADDRESS THE PROBLEM?
We need things like cysteine, glycine, glutamine, sulfur amino acids, and things that help us methylate like B12, B6, and folate. So, these nutrients we have to get them in our diet via a good diet. We need to be able to break down and absorb those nutrients, so we need good digestion to get those things in there.
So, in general, we’ve got to make sure we have a good gut bacteria balance. Even fungal overgrowth can cause problems and H. pylori that can lower stomach acid and make it harder to break down nutrition on one side and then it can create this bacterial overgrowth enzyme that makes it hard to detoxify estrogen. These are really important components. If you have any issues with estrogen, you’ve got to look there.
Now, we may want to do things to help detoxify like make lifestyle changes, food changes, pesticide changes, make the changes in regards to plastics, and make in in regards to your diet, your glycemic load, and your gut. That’s a good first step to get to the bottom. There are also different things we may do to help upregulate detoxification to help get that estrogen. It may be activated charcoal or various soluble fibers. It could be things like bentonite clay. We could use things like DIM or Calcium D-Glucarate or glutathione, sulfur amino acids, and vitamin C. They’re all helpful in different situations. We would recommend them based on what’s happening but at least make the diet and lifestyle changes out of the gates.
The Top 5 Causes of Chronic Headaches
Today we are going to be talking about the top underlying reasons why you may be having a chronic headache. I had a patient come in today who had headaches for 25 years, monthly and chronically, and we were able to get to the root cause and there are many different root causes for every person. Let me lay out the common ones that I find to be a major vector of my patients.
So we have headaches and head pain or migraines where you kind of have that aura and sound sensitivity. There are a couple of different major reasons why headaches may happen.
1. Food Allergens
Most common food allergy is gluten and dairy. There are some studies on gluten affecting blood flow up to the brain. We have these garden hoses on the side of our neck called our carotid arteries. When we have inflammation especially caused by gluten that can decrease blood flow and blood profusion to the frontal cortex, and when you have less blood, you’re going to have decreased performance of the brain. You can see that manifesting in a headache. People don’t know but headaches are actually an issue with vasodilation in the brain. Caffeine can help as caffeine actually causes constriction and brain’s typical headache signal is caused by vasodilation.
2. Food Additives.
These could be things like MSG, aspartame, Splenda or various artificial colors and dyes.
3. Blood Sugar Fluctuation.
We want to have healthy proteins and healthy fats with every meal. If we skip meals or we eat foods that are too high in carbohydrates and refined “crapohydrates” and sugar, and not enough fats and proteins, our blood sugar can go up and then drop. This is called reactive hypoglycemia. We react by putting a whole bunch of sugar in our bloodstream because all of these carbohydrate sources break down into sugar — processed sugar, grains, flours and acellular carbohydrates. These type of flours and refined processed carbs get converted to glucose in our bloodstream. When glucose goes up, our pancreas goes, “Holy smokes! We got a lot of glucose there. We got to pull it into the cell.” It spits out a whole bunch of insulin and pulls that glucose right down, and we have his blood sugar going up with a lot of insulin driving that blood sugar back down. When that blood sugar goes back down, this is where we have cravings. This is where we have addictions, mood issues, energy issues, jitteriness, and cognitive issues. Our body makes adrenaline and cortisol to bring that blood sugar back up. Most people literally live on this high insulin where they are making fat, storing fat and engaging in lipogenesis which makes us tired. Then blood sugar crashes which makes people jittery, anxious, and moody. Most people live on this reactive hypoglycemia rollercoaster and that can drive headaches.
4. Gut Infections.
Patients with a lot of gut inflammation, gut permeability, and infections whether it’s H. pylori, SIBO (small intestinal, bacterial overgrowth) or fungal overgrowth have gut stressors can create inflammation in the gut. When we have inflammation in the gut, we have gut permeability. So our tight junctions in our intestines start to open up and undigested bacteria, lipopolysaccharides, food particles can slip through and create an immune response. You can see histamine along with that immune response and histamine can create headache issues.
5. Hormonal Issue.
A woman’s cycle is about 28 days and in the middle is ovulation. Some women have it during ovulation and most have it right at the end just before they menstruate. This is called premenstrual syndrome that is right before menstruation. A lot of women may also have it during menstruation, too. What happens is progesterone can drop out early and that drop in progesterone can actually cause headache manifestations and also the aberrations in estrogen can also cause headaches as well. We may also see it with excessive bleeding too. So if you’re bleeding a lot or too much, what may happen is you may lose iron and that low iron may cause oxygenation issues. That low level of oxygen may also cause some headache issues as well. Because if you can’t carry oxygen, that is going to be a stressed-out situation for your mitochondria and your metabolism. For menopausal women who have chronically low hormones and they’re not in an optimal place, that can create issues. Progesterone and estrogen can be very anti-inflammatory. So if there is inflammation in the brain, progesterone is a powerful anti-inflammatory and that can really help a lot of inflammation in the brain.
Top 5 Causes of Bloating – Functional Medicine Solutions & Mold Bloating Connection | Podcast #282
Hello, everyone! In today’s podcast, Dr. J talks about bloating and its connections with mold, low stomach acid, bacterial overgrowth, h. pylori, fungal overgrowth/candida and parasite infections. Mold and mycotoxins may also play a role in causing sympathetic and adrenal stress that could affect digestion. Food allergens and too much-processed carbohydrates may also feed bad bacteria that could contribute to bloating and gas. The cause of your bloating might not be what you think it is. And how does mold fit in this puzzle? Dr. Justin Marchegiani is drawing a line between the root cause and palliative solutions. We’re also looking at more natural solutions to help treat and relieve your bloating. Of course, very important is the root cause and checking back to that so everything connects and encourages better digestion and less bloating. We’re talking about the tests we conduct to help get down to the root of your bloating, chronic vs. acute bloat, and the next steps. Let’s ditch the discomfort of bloating!
Dr. Justin Marchegiani
In this episode, we cover:
01:06 Lab Testing, Root Cause and Palliative Solutions
9:55 Mold Exposure
15:33 Digestive Support, Infections, and Fungal Overgrowth
17:21 H. pylori and Mold Connection
25:19 Working with Functional Medicine Practitioners
28:02 Best Practices’ List
Dr. Justin Marchegiani: Hey, guys. It’s Dr. Justin Marchegiani here with Evan Brand. Today, we are gonna be chatting about functional medicine solutions for bloating. Really excited to get to the root cause. Evan, how was your weekend, man? What’s going on?
Evan Brand: Oh, not too much. It was very good. I’m excited to dive in to this topic. I figured we would divert from the coronavirus. We’ve done, I don’t know, hours and hours and hours and hours of content on that and what we’re still seeing clinically is that people still have issues outside of that, being concerned with that, and one issue that’s popping up pretty much every single day and that could be because we focus so much on helping improve gut health in people is the issue of bloating, and people will come in with the sort of preconceived ideas of what’s going on. They’ll say, “Oh, I have bacterial overgrowth or I have this or I have that. I have parasites.” And that’s what they think is going on but in a lot of cases, and this is why you and I focus so much on doing advanced lab testing, in many cases the people wrong. What they thought was wrong with them is not what’s wrong with them and then we find a different solution. So why don’t we dive straight in to the testing? Maybe talk about some of the tools that we use to investigate these issues and then we could dive in to maybe the specific things that we are seeing that are these triggers or root causes.
Dr. Justin Marchegiani: Absolutely! So when we look at root cause, we always want to draw a line between root cause and then palliative solutions that may help symptomatically. We always want to draw a line, right? And of course, there’s palliative solutions that are more conventional-based, right? Whether it’s like bloating, whether Gas-X or some type of drug to address, Imodium or something else on the tummy side that’s gonna just manage symptoms on the drug side, right? And then there are even more natural things that do the same like activated charcoal, right? And then there are some things that are more palliative but may connect into the root cause like digestive support, like enzymes and acids. As part of a lot of bloating issues, there tends to be some kind of a gut infection or gut stressor followed by low stomach acid, low enzymes, low bile salts. So there are some palliative things we may throw into the mix that may help support and allow us to feel better but they are also part of the root cause. So we—we want to always plug in solutions but also make sure we are checking back to the root cause so we’re not—we’re making sure that everything connects. Palliative, root cause, and they all want to connect and ideally, we’re choosing root cause stuff that’s gonna be more—more natural that’s in alignment with what your body needs for good digestion to begin with.
Evan Brand: Well said and there could be a lot of overlap between the palliative stuff and the root cause stuff like the enzymes, great example. So testing-wise, what are we looking at? How are we identifying the root causes of bloating? Number one is stool test. We do a DNA stool test on pretty much every single person. Unless they’ve already had something run and it was very good or recent testing from a previous practitioner or doctor, then we may use that but in most cases, we’re looking at a DNA sample to try to figure out what’s going on and not only what’s going on, but what specific species of bacteria, what specific pathogens like worms, what specific parasites, what’s the gut inflammation look like, what’s the gut barrier look like, what about H. pylori, is that going on? Because if enzymes make you feel better or enzymes making you feel better because you have an H. pylori infection that’s—
Dr. Justin Marchegiani: Uh-hmm.
Evan Brand: Suppressing stomach acid, so I would say stool test is probably the best but not always the best place to start testing-wise. What would you say?
Dr. Justin Marchegiani: Absolutely! So I mean, there’s just—we look at underlying physiology, right? You can tell a lot by underlying physiology with symptoms. The difference is a good functional medicine doctor is gonna look at the symptoms and go upstream to the body systems that may not be functioning optimally. So if I’m seeing indigestion, I’m thinking okay, maybe we don’t quite have enough enzymes and acidity to activate our digestive support, right? Because we need nice low acidity, right? Low acidity is like a pH of like 1-1/2, 2-1/2, that helps activate enzymes and the acidity also helps then trigger bile release once that chyme goes into the small intestine, and it also triggers more pancreatic enzyme release whether it’s lipase or protease. These are enzymes that break down protein or fat, so we need that acidity. Also, acidity makes it harder for bacteria to grow. So think of acidity as like the—it’s like the Clorox bleach on the dirty picnic table, right? It just really kinda cleans things up and makes it really hard for a lot of the not so nice guys to grow. So we know that’s kind of a foundational tenet and that’s always good to look at that. Now, we have other outside things like emotional stressors and any type of emotional stressor or any type of stressor plays into the adrenals. Because when we activate the adrenals, we’re either surging cortisol or adrenaline, right? One is from the outside of the adrenal gland, right? The cortex, that’s cortisol. One is from the medulla, the inner part of the adrenal gland. Either the inner half or inner third and that’s gonna be surging a lot more adrenaline, right? Both are intimately connected, right? Adrenaline gets to the scene first. Cortisol follows by about 20 minutes, okay? And these are gonna activate a fight or flight sympathetic nervous system response and that nervous system response will take blood flow and shunt it away from the intestines and bring it to the arms, hands, and feet, so we can run, fight, and flee. So if we have emotional stress and it’s unresolved, or we are putting our body in stress from food allergens or from eating on the go or not chewing our food up well enough, we’re just consuming a lot of toxins in our food, whether it’s mold or pesticides or chemicals, that could be activating that fight or flight response. So that’s why looking at the adrenals can be helpful because if we have this chronic digestive stress, that could be stressing out the adrenals and a lot of people that focus on digestion in the functional medicine world, they don’t ever bridge the gap between digestion and hormones, and they really come full circle.
Evan Brand: Yup, so that’s your answer. Your answer is what will the next test—my question was what was the next test you would say is important for investigating bloating? So your answer would be adrenals.
Dr. Justin Marchegiani: The adrenals would be a really important part because the fight or flight, the sympathetic nervous system is helpful. Now again, this is gonna be more on the chronic element. This is like a chronic issue, right? If this is more of an acute problem, the adrenals may be at play but they may not be a big piece in that person’s healing recovery. But it’s always good to look at because the problem with stress, people associate stress like when you say emotional stress or stress, you’re thinking like family, kids, finances, work, right? The problem is if you have an underlying Giardia infection or H. pylori infection, even though you are on beach totally relaxing, you know, drinking Mai Tais, you are still gonna have stress in your body that could be activating a little mini sympathetic nervous system response because of the infections. So that’s why the gut stuff, if it’s chronic it can be under the surface and you may not even be perceptible what’s happening.
Evan Brand: Yup, and that was my case. I mean, I had Giardia and other infections, my adrenal test looked terrible.
Dr. Justin Marchegiani: You had three amigos, right? You had three amigos, right?
Evan Brand: Yeah, it was the H. pylori, the Giardia, the Crypto and when I ran an adrenal profile, I didn’t feel stressed, right? I was taking a lot of adaptogenic herbs, so maybe that was helping but if somebody said, “Are you stressed?” I’m like, “Nah, not really.” But when you looked at my adrenal profile, my system was clearly stressed. I’m glad you pointed that out that even though you don’t “feel stressed” or you think your life is fine or “Oh, my kids are great. My husband’s wonderful.” It’s like, okay, cool but that doesn’t matter actually. You could have plenty of co-adrenal stress and have nothing going wrong in your life at all but that—let’s take this a step further. So you mentioned the cortisol release and all of that, so what is that actually doing to affect the gut? Well, the cortisol, it’s catabolic. It eats things away, so you know, you’ll read or hear about people who go run a marathon and then they’ll have diarrhea. That cortisol just tears apart the gut barrier. So I’m sure there’s other mechanisms involved but to me that’s one that comes to mind.
Dr. Justin Marchegiani: Yeah, also you can look at post-marathon and then look at immune system deficiency. You’ll see chronically low or at least, you know, for a few days to a few weeks on the low IgA side, from long-distance aerobic exercise. So you could be over-exercising or just doing too much aerobic, and that could be really compromising your immune system, right? So that could be playing a big role as well. So like you mentioned, chronic cortisol can rip up that gut lining and then the more that gut lining is ripped up, greater chance of food allergens. So then now if you’re consuming, you know, questionable foods, there’s a greater chance that you may start reacting to those foods as well.
Evan Brand: Here’s the funny thing. I’m thinking out loud. So in terms of like Buzzwork–Buzzfeed type titles, you know, I kinda brought this up to you before he hit record. I’m like, hey, let’s do something on like top 5 causes of bloating. But the funny thing is when you’re a practitioner, it’s really tough to just go, number one, number two, because as you see, you and I are—we’re connecting all of these dots. So we could end up coming up with more of like 20 different mechanisms leading to the bloating whereas people, when they go to click on an article or something, they want it to just be one, two, three, four, five. But when you really do functional medicine and you see this stuff clinically, it just does not work like a one, two, three, four, five. It’s not like car where it’s like—okay, it’s a bad carburetor. Remove the carburetor. No, it’s like, okay, you got the adrenal stress from the gut bug you picked up and then that’s affecting the gut barrier and then you’re training Crossfit four days a week. That’s affecting it. So it’s really difficult to just go bang, bang, bang. So we’re hoping to zoom in but also help you wrap your head around the whole picture of this.
Dr. Justin Marchegiani: Yeah, it’s really tough, right? Like let’s go look at your situation, Evan, if you don’t mind. So—
Evan Brand: Sure.
Dr. Justin Marchegiani: You know, you had some blood sugar issues, right? You also had three major gut infections—Giardia, Crypto, H. pylori—three amigos. You also had some potential tick bite stuff, right? And then we also had some chronic mold exposure. So it’s like—like if you just went and saw the mold specialist, you’d still be sick. You know what I mean?
Evan Brand: Uh-hmm.
Dr. Justin Marchegiani: Because it’s like it’s not just about grabbing the mold. Now, the mold was important but you know, we also worked on blood sugar and made sure you were getting enough food, made sure you were digesting your food, you started gaining weight, you supported the adrenals, cleared out the infections. Then we saw there’s all those chronic molds. Let’s work on the mold stuff. You also, in between there, you know, address some of the cavitation stress that may or may not had been a big issue. By the way, do you think the cavitations were a big underlying issue with your health issue? Do you think it was just kind of a side thing for everything?
Evan Brand: It’s tough to say because the heart palpitations that I had for years, I mean when I was living down in Austin, I was 20 lbs lighter than I am now. So—
Dr. Justin Marchegiani: I know. You were really skinny.
Evan Brand: Yeah. So I put a lot of weight back on, thank the Lord, and my wife did, too. Here’s the interesting thing. We thought that she was skinny due to breastfeeding, you know, because she had been lower weight than she was when she was in high school and we thought that it was just breastfeeding all the time but no, it was probably the mold exposure because when we got her on binders, her weight restored back to normal. So to answer the question about the cavitations, I mean, you know, I was having heart palpitations almost every single evening. I’d sit down on the couch and then, oh my God, you know, the heart palp and then as soon as I got—that night of the cavitation procedure when they cleaned everything out, that was the first night I didn’t have heart palpitations for I don’t know, at least a year. So it stopped that immediately. My blood pressure—
Dr. Justin Marchegiani: The question becomes like well because you were already in pretty good shape before that, what if—what if the mold was addressed before that? Would the heart palpitations even be an issue? Would the cavitations even been able to cause a heart issue? Does that make sense?
Evan Brand: I don’t know. Well, it’s hard to say. Yeah—
Dr. Justin Marchegiani: And the reason why I’m bringing this up is because I have a lot of patients come in and no one has, you know, very little people have unlimited resources, so like, where do we start? And when you have like big picture, when people say like mold or like cavitations or heavy metals, like they’re thinking a lot of money is gonna be thrown out those resources, so our job is to be like, well, how do we prioritize that? How do we get the best results, you know, for the least amount of money.
Evan Brand: Yeah.
Dr. Justin Marchegiani: That’s really the tricky thing because when you go to like myopic practitioners that are the cavitation person or the mold person or the Lyme person, it’s very hard to get a—or the gut person, it’s very hard to get a holistic perspective because you know what they’re gonna be doing. You’re seeing that person. That’s what they’re gonna do. That’s their stick.
Evan Brand: Yeah, and the truth is that my blood pressure issues, I have having these weird blood pressure spikes, those mostly resolved but the mold exposure—another re-exposure to mold didn’t happen for a couple of years after that and then the blood pressure issues came back. So, did it temporarily fix some sort of orthostatic hypertension-type stuff and some hypoglycemia stuff? Maybe but you know, it was—you have to travel, so the expensive travel plus $5,000 for the procedure. So, you could have bought a lot of binders for $5000 bucks. That’s a lot of charcoal.
Dr. Justin Marchegiani: Or, you know, home remediation stuff but you know, just kind of setting the tone for people that are listening. Being a patient myself, right? And helping to fix myself and you as well, and working together, it’s really overwhelming. But I just want listeners to know that if they wanna find someone like you or like me who had been through this and have the mind’s eye and focus on prioritizing and really figuring out what are the first steps and doing things in an order of operation, I think that makes it less overwhelming and that also plays into the whole stress because if you’re doing a treatment plan that’s gonna be so expensive or so segmented like, oh, we’re gonna do this and then that, then it becomes a little bit convoluted and hard to jump on board because you feel like it’s gonna take so much out of you to get going.
Evan Brand: True. True. Yeah, I’m glad you brought that up and I would say that every step along the way that you’ve had in your health journey, every step along the way I have had in my health journey taught us a lesson. Maybe it wasn’t the secret sauce, right? But let’s say it got me 10% better. That 10% better was what I needed to regain the weight that I lost from my parasite infections and then getting the exposure and then using detox solutions, you know, that got me maybe 50% better and then using immune-supportive herbs and antimicrobial herbs, that gave me 10%, 15%. So, I think what you’re saying in so many words is that many people come in kinda thinking that they have a need for silver bullet if you will and it’s kinda like, “Hey, Dr. J or Evan, I think I have got this parasite and that’s wrecking me.” And then we do all the labs and we see there’s no parasite. We see it’s actually a huge candida problem or it’s a huge nutrient deficiency or major gut inflammation or something that. And so we focus on that and then they’re 80% better. Then we kinda go back and we’re like, “Hey, remember how you thought it was parasites? Well, look, the 80% progress you’ve made by pursuing this and that instead. So, back to the bloating conversation, when we’re looking at somebody that comes in and it’s like the major complaint like bloating, what is really interesting is when you unpack all of it. There’s actually more coming along with it. So, it could be like, yeah, bloating is the uncomfortable part but then you look at the bowel habits and then you look at the disturbed sleep and the teeth grinding and then you look at the skin rashes.
Dr. Justin Marchegiani: Yes.
Evan Brand: And then you look at the dark circles under the eyes and then you look at the 20 lbs of weight gain with doing nothing, and then you start looking at thyroid labs and then as mentioned, adrenals. So, I guess my point here is that, it’s okay and good to have a one primary complaint, but it’s very rare for it to exist like that.
Dr. Justin Marchegiani: Yeah, exactly. Yup, 100%. So, we wanna prioritize everything. So we look at digestive support. We may look at infections. We may also wanna look at fungal overgrowth. Now, a lot of times fungal overgrowth may come with the stool testing but sometimes that can be missed. So we’re gonna look at clinical symptoms like fungal toenails or tinea versicolor rash or chronic yeast issues or chronic jock itch, or those kinda things, right? Maybe chronic dandruff. We’ll look at that. We may also run organic acid testing that will look at D-arabinitol or oxalic acid. Things that may give us a window of fungal metabolites in the urine, and then we may also run a breath test, too, to get a little bit more of a window of what’s happening with other dysbiotic bacteria and we may even see imbalances and commensal bacteria which is normal gut bacteria. So, a lot of times that always come at the end because if you have imbalances with infections that will always or could drive commensal bacteria, normal flora out of balance. So, we also want to prioritize things on that note and of course, the diet is gonna be a foundation. So coming off, we may typically lean more on the Paleo side. We may cook more of the fibers down. We may lean more on the lower FODMAPS, lower fermentable carbohydrates especially if there’s more bloating or gas because those fermentable sugars even in healthy vegetables like garlic and onions could drive a lot of these problems, and people tend to like lean into the fact that like, “Oh, I have SIBO. I have this infection.” But sometimes, like in Evan’s situation. Evan had three major parasites and so it’s really good to have you kind of your mind’s eye wrapped around it because if you only thought he had H. pylori and then address H. pylori, and the problem still persisted, you’ll be like going insane. You’ll be thinking like, “What’s going on?” So, it’s good to really have that holistic perspective and address everything systematically. It just gives you the better chance that you’re gonna fix things, you know, a lot sooner than later.
Evan Brand: Yeah, and you and I haven’t talked about this but I’ve kinda come up with this theory that H. pylori is—and some of these infections are really like a secondary infection due to like a primary mold exposure. So, I remember being a kid playing in my grandmother’s basement that had flooded on many occasions, they—all they did was turn on a couple of box fans and it took several weeks to dry out. I guarantee I had H. pylori and parasite issues for many, many years. You know, I had gut issues as long as I could back into my childhood. I just wonder because you and I have talked about this idea of like commensal bacteria and there’s this argument, right? That H. pylori could—you could co-exist with H. pylori and that it shouldn’t cause any problems, but why is it getting so out of control, so out of balance? Now, granting my diet was terrible as a kid and all of that, but what if the immune-suppressive aspects of mold toxin weaken the immunity so that I wasn’t able to fight off candida? I wasn’t able to fight off H. pylori and that’s what allowed those infections to thrive and take over.
Dr. Justin Marchegiani: Exactly, and I think a lot of the argument is more at the level, like maybe there can be a tiny bit of H. pylori present but when it hits a certain threshold, right? Then there’s a greater chance that it can cause a problem, right? And then of course, the more food allergies you’re consuming that are gonna inflame the gut, now that maybe makes it cause a problem, and then if you have enough decrease in stomach acid and enzymes from the H. pylori, that can cause a problem, too. I mean, we know Dr. Marshall who got the Nobel prize for discovering H. pylori, I mean, he thought it was crazy. He had to give himself H. pylori to see that it caused ulcers and infections or it can, right? So, we know there’s a connection with it. So, kinda my issue is let’s lower the infections, fix everything else, and a lot of times people get better and get better much faster. Now, the problem with a lot of people in a lot of medical approaches to an infection is the antibiotics just a drop a bomb down there and they may not get the infection and they may create rebound fungal overgrowth and disrupt the immune response, so a lot of times you can get sicker from antibiotics with some of these chronic gut issues. So, you really have to be addressing the problem holistically.
Evan Brand: Yeah, well said. So, I mean, if you go to a conventional doctor and you do get diagnosed with H. pylori, the first problem is the testing is really bad in the conventional world and so a lot of times, they’ll miss the infection but if they did find the H. pylori, they’ll do triple or quadruple therapy, 3 or 4 antibiotics at the same time, often multiple rounds of that due to the antibiotic resistance.
Dr. Justin Marchegiani: Correct.
Evan Brand: And then as you mentioned, now you’ve got even more–let’s say you came in with bloating as we talked about but you went the conventional rabbit hole, and then now you’ve got the yeast problem and then you feel got even more bloating there. So, you know, I would never do this study but it would be very interesting to see, to test this theory if you take 10 people that have high H. pylori that also have high mold toxin that we know is suppressing the immune system in various ways, what would happen if you just focused on a mold detox protocol? Would the immune system gain the upper hand on the H. pylori to get it back in balance? I would never test that, right? We’re always gonna do both at the same time, use antimicrobials and use detox support at the same time, but it’d be interesting to test this theory of it being an “opportunistic bacteria” that in theory—
Dr. Justin Marchegiani: Yeah.
Evan Brand: You could shut it down if the immune system was strong enough.
Dr. Justin Marchegiani: Yeah, and then kinda my theory, if I am gonna address any mold toxins initially while doing other foundational stuff, I mean, my general theory is don’t push, don’t dump too many toxins right away. If I’m gonna do anything I may just gently nudge in some binders or some gentle lymph support but I’d probably spend more of my time and effort fixing the home if there’s an acute exposure on where those infections, where the mold may be coming from. What’s your take on that and how your peer does that?
Evan Brand: The home is always part of the investigation. So if you see that there’s like high levels that show up, and people are like, “Why—why are you going a tangent about this?” Well, it is a huge gut issue. If you just look up Dr. Ritchie Shoemaker, he is the guy who has been working on these issues for 25 years, tons of people manifest only as gut symptoms. So that’s just the disclaimer but if we see that something shows up on the urine, then we’re gonna go the house to try to match up the species and see, okay, because you’re growing Aspergillus in your gut, you know, you can see it on the organic acids now, at least on Great Plains they’ve got on the first page, they have certain markers that are tied in to Aspergillus. So you can kinda see, hey, you’ve got mold colonization and then we’ll try to look and see if it matches up to the house at all and in some cases, it doesn’t at all. It’s like the house has Fusarium but the gut has Aspergillus, so yeah, the house could be a problem but it looks like it’s more you internally. You’re more of a factory or manufacturing plant, so then we’ll just throw in some silver or something else to try to knock that internal colonization down, and then still working on the other stuff. It’s rarely a number one priority as you mentioned. It’s like, hey, here’s a little binders. Here’s some antifungals that also will happen to kill the candida overgrowth that you have and plus these other herbs that we mix it with are antimicrobials, so that’ll knock down some of the bacterial stuff you have. So it ends up being like a 3 in 1 combo and assuming the constitution of the person is strong enough, but maybe we need extra liver or adrenal support, they usually do fine.
Dr. Justin Marchegiani: Yeah, I always pause going after mold right away. I just find that well, if there’s a lot of symptoms or we have a lot of house symptoms, right? Any visible mold, tell-tale sign, any chronic humidity in the home, tell-tale sign. If we see things tend a little bit moist on the wall, right? We can get a moisture meter. We can detect some of that stuff. History of leaks, those kinda things, then we’ll definitely just do a simple house test. Because the thing about a house test is, if you got 5 people in the house, then all 5 benefit from that test, so it’s kinda like a 5 in 1. So, I definitely like the house testing because it definitely gives you your best bang for your buck, number one and then we’ll typically remediate or address some of those things or if we don’t see any big red flags, we’ll just maybe get a higher quality air filter. So, we’ll do a lot of the Austin Air stuff which is a great one because of the zeolite and the activated charcoal and so either for Austin Air or Justinhealth.com/shop. Evan has his site as well—evanbrand.com, store button. If you guys wanna get a high-quality air filter that we personally use with patients and ourselves, that’s a great option. And then for me, I tend to always pause that stuff because I can see major benefits a lot of times without that but we’ll kinda put it on that treatment plan on that path. I like to get gut stuff fixed first because a lot of times the body will dump a lot of mold via the hepatobiliary system. Hence, Shoemaker and a lot of these protocols binding up stuff that comes from the liver and gallbladder, right? So that’s kinda my approach to it and that dovetails with bloating because if we have digestive issues, you really wanna make sure. People don’t think their digestion could be affecting detox, right? They kinda think of those as compartmentalized things but if we have digestive issues, it could easily be impacting detoxification, so whether it’s metals or mold or just general pesticides from conventional food, all those could play a role and your digestive issues could be affecting that.
Evan Brand: Yeah and here’s the funny thing. You know, you and I had thousand plus cases under our belts before we even became educated about mold. So it does pop up into our conversation a lot and a lot of people come to us and ask us these questions and we’ve done some really great interviews about this but the funny thing is we were getting people better before you and I knew anything about it. So, I do want to focus on or at least point that out. Now, I think it’s just helping us to add an extra puzzle piece to the puzzle. Because there are certain cases where resolving the gut issues, like the parasites and the bacterial stuff, you’ll look at the gut report, right? We’ll have side by side. Oh, great! We cleared out the infections but we still have these symptoms—the brain fog, the dizziness, the sleep issues, right? So now we know, hey, that other puzzle piece could be this because we did clear out the gut infections. But I would agree with you and argue maybe what 80%, 90% of the time, you could resolve those type of symptoms—the bloating and such, just from the gut issues, the liver, the gallbladder support alone.
Dr. Justin Marchegiani: I get scared for my patients or any patient that comes in and is going to see just a Lyme practitioner or just a mold practitioner. I get really scared if they have not done the foundation because with practitioners like that that are so myopically focused, anytime they’re treating the Lyme or treating the mold and they have a negative issue, it’s that it has to be die off and that means we’re on the right track. So it becomes this kind of vicious cycle where their—by them feeling worse, it supports them continuing to do that thing which them feeling worse may mean it’s the wrong thing or it’s too fast or it’s not in the right order, and a lot of times those protocols can be very expensive especially if you see a Lyme practitioner that does antibiotics and you are on antibiotics for years. That can be scary or if you are looking at a home remediation and you don’t know how to do it the right way, and you’re looking at tens of thousands of dollars on a home remediation. That could be scary, tool. So you really wanna be able to hit things in the most sequential way possible and the biggest knowledge understated that I have dealt with the last year or two with you and me on our mold side is really how to fix some of these mold issues with our homes as cost-effective as possible.
Evan Brand: Yeah, I wish I have my $10,000 back. I was just desperate.
Dr. Justin Marchegiani: –therapy.
Evan Brand: Yeah, for the enzymes.
Dr. Justin Marchegiani: Yeah.
Evan Brand: You know, I was sick. I was symptomatic. I didn’t feel well. My daughter had stomachaches. My wife wasn’t sleeping well. You know, and we were looking up holistic solutions. We didn’t have time to fully do the research and figure out what we know now and here we go dropping 10 grand, and my situation was no better and even in some cases, it was a little worse and so, I don’t wanna turn this into the mold podcast but just pointing out the fact—
Dr. Justin Marchegiani: Yeah, it’s connected for sure.
Evan Brand: That yeah, yeah, it is. But the fact that you could pursue rabbit holes like that and be no better off, right? Symptomatically, I was just as sick as before and that 10 grand could have used for several years worth of adrenal support and liver support and gallbladders and binders and all the stuff I really needed but I was desperate to fix the house because to me that was kind of the blame but I also had some internal gut digestive stuff going as well. So, I guess the point really here is that you wanna make sure you have all the puzzle pieces and try to work with the practitioner who can be zoom in and zoom out, and that’s what we try to be really good at. We try to be really good at making sure that if we do need to hyperfocus we’ve got the skills and tools to do that. We’re gonna use this specific protocol, this many times a day for this many weeks to address this infection. However, we may also need to zoom out and get your house in better shape and get your spouse in better shape in case they are re-infecting you and we’re also gonna help with those pieces, too.
Dr. Justin Marchegiani: Exactly. So, just kinda recapping for people listening. When I work with a patient, when Evan works with a patient, we kinda have like our best practices’ list and we really make sure we hit things. So, of course, we are removing the bad foods, we’re dialing in the diet, and of course, that could be more nuance that just a really good whole food Paleo template. There can be other foods like we mentioned FODMAPS on other sides, chewing our foods, cooking foods, those things. Number two is replace. Replacing enzymes and acids, maybe bile salts. That’s important. Sometimes other things need to be addressed like prokinetics and such. Third R is repairing the adrenals, repairing the hormones, repairing the gut lining, partly because of the sympathetic stress that may be driven by the hormones and how that can affect digestion and gut lining. Fourth R, removing the infections and this could be parasitic. This could be H. pylori. It could be bacterial overgrowth. It could be SIFO or small intestinal fungal overgrowth. There could be even, we could throw mold toxins in with that as well. And then the fifth R will be repopulate, reinoculate good bacteria. Sixth R, re-test and sometimes you’d come back with a new infection, that can happen, and that’s frustrating. So there’s a kinda an order of operations and again, there may be a certain deviation and certain ways we go deeper based on our experience, but that’s just a general framework at how we’ll dive in deep, so we don’t miss anything.
Evan Brand: Yeah, it took my daughter three rounds. You know, we’ve done—
Dr. Justin Marchegiani: Right.
Evan Brand: Like five stool tests on her and she’s not even 4 years old yet. You know, she showed up with one bug, knocked it out, re-test it. New bug, got rid of it then H. pylori showed up and then candida, knocked those down. I mean, it’s crazy so it can be a little bit of whack-a-mole and that just comes with the territory. It took me several rounds, too. You know, we kinda joke about the gut being like an onion having different layers of infections.
Dr. Justin Marchegiani: Yup.
Evan Brand: But it does appear that they do kinda come out in layers. It’s, you know, is it possible that H. pylori with that little tail structure you see in the microscopic images?
Dr. Justin Marchegiani: Yeah.
Evan Brand: Is it possible it’s burrowed deeper in the intestinal wall and it comes out later? I don’t know. It’s tough but we just—
Dr. Justin Marchegiani: It’s hard to say. It’s hard because with kids, too, you can’t quite hit it as hard either, you know.
Evan Brand: Yup.
Dr. Justin Marchegiani: But yeah, that’s why—and again, that situation is pretty rare to go that many times. I mean, that’s more in the extreme but it happens, you know. We always wanna be upfront with people.
Evan Brand: Kids are barefoot. They’re out playing in the creek, playing in the dirt, you know. So it’s kinda like—
Dr. Justin Marchegiani: Yeah.
Evan Brand: How your kids are.
Dr. Justin Marchegiani: Kids are a little magnet for critters, right? I mean, we kinda know that. They—
Evan Brand: Yup.
Dr. Justin Marchegiani: Fall down. They have no problem picking up dirt, putting it in their mouth, the whole nine yards. So yeah, I get that. Is there anything else, Evan, you wanna leave the audience with today?
Evan Brand: I would just say get a good—get a good workup on yourself. Could you just go to Whole Foods and go buy a bottle of oregano oil off the shelf because you read some blog that said that oregano oil kills fungus and that may be the cause of your bloating? That might work, but is it the full piece? Is it the full picture? Are you gonna take it forever and then you kill the good bacteria and then you’ve got a more imbalanced gut than you did before? Maybe. So, my advice would just be get a good workup. Try to have a practitioner on your side that’s gonna be able to look at all the pieces, not just zoom in on one tiny piece of the puzzle—
Dr. Justin Marchegiani: Correct.
Evan Brand: And convince you that’s everything and if you do want to reach out to us, we are those people. I mean, we do look at the full picture. So, Justin’s website is justinhealth.com. He is available worldwide for consults via phone, Facetime, Skype, Zoom, whatever you gotta do to connect, and my website is evanbrand. Same thing. We both work across the world. So we are very blessed, very grateful to be in the opportunity to help you, so thanks for tuning in.
Dr. Justin Marchegiani: And then if you’re listening here, 99% of the people we don’t get the chance to even see in person or you know, over the phone or such. So if you feel like you could benefit or your family could benefit, you know, share this information. At least it’s gonna get people moving in the right direction, taking a couple of good action steps, and then put your comments below. We really wanna know what your experience is, what has helped with you, etc. What were some of the missing lynchpins to help your care and also a thumbs up and a share. We would really appreciate it. Alright, Evan. It was a phenomenal chat, man. You take care.
Evan Brand: You take care. Buh-bye.
Dr. Justin Marchegiani: Bye.
Healthy Gut Function Can Boost Your Immune System
By Dr. Justin Marchegiani
Healthy gut function can help improve and boost your immune system. It is your gut that helps to improve your body’s ability to fight infections. Our localized immune system is where 80% of your immune system is.
GALT – Gut-associated lymphoid tissue
Your gut is interacting with food every day and you do not get want to get weak in regards to your body and your immune system. Don’t make your immune system go after bad foods. Eat whole foods and following a paleo template is a good approach. You don’t want your immune system stressing out because of certain foods that are coming into play whether it is gluten, refined whole dairy, lots of refined sugar, and bad things like that. We have similar stuff happening with the small intestine where we have a lot of microvilli which are kind of like little vacuum cleaners that will like suck up a lot of the nutrients and vitamins that we take.
MALT – Mucosa-associated lymphoid tissue
These are where your immune cells live. If we have infections, that is going to create stress on the microvilli. Celiac disease wear down microvilli and that affects your body’s ability to absorb nutrition as well as affects your immune system, too. I find that a lot of people have a weak immune system because of their gut. It is not so much that their gut is weak but it’s that their gut is so preoccupied fighting things it should not be having to fight.
In the small intestine we have other nutrients that are vital for our immune system. We have a couple of things that are being produced:
- We have different kinds of B vitamins — B1 or thiamine, B2 or riboflavin, B3 or niacin, B9 or folate, and B12 or methylated B12. These are really important. We also have butyric acid. Butyrate is the same kind of fat we see in butter but butyric acid is going to make it harder for a lot of the bad bacteria to grow. So infections, bacteria and viruses tend to not like in acidic environments as it makes it harder for those critters to grow and our immune cells love that. It keeps the immune system strong. Good fatty acids are our immune system’s friend.
- We also have things like Vitamin C which you’re not going to get as much of that but you need healthy absorption of these nutrients. If you have good vitamin C in there or if you are consuming vitamin D, you need to absorb it. So we need to have good gut function to absorb.
- We also have Vitamin K1 and K2 which are very important.
- Zinc and a lot of minerals that we need good hydrochloric acid levels from.
How the localized immune system works
When you create an antibody and you tag a protein. Let’s say you have this virus. What happens is we tag it with an antibody. So have you ever gone to like a big city like San Francisco? I used to live there. You park your car, right? And the parking attendants would come by and they put a piece of chalk and they put a mark across the back tire and what we used to do, we used to come back and erase that mark, but that mark was there to tag, the tag use and then when they come back an hour later if you were still there they knew you were there and they wrote you a ticket. We used to like erase that but your immune system is doing something similar. It is tagging that virus and then that allows other immune cells, other T cells or natural killer cells to kind of come in there and be able to attack it later. So your immune system tags stuff very similarly and with a healthy gut function, because so much of your antibodies are here in the GALT and the MALT, it really, really helps your immune response.
Autoimmunity starts in the gut and it starts in the gut via leaky gut. We have gut permeability and again, leaky gut is the same thing as gut permeability. Those tight junctions open up and it allows undigested food particles to get into the bloodstream which stresses out the immune system. Alessio Fasano, a gastroenterologist at Harvard, says that almost all autoimmunity starts in the gut and if you have an increased autoimmune response, you are going to have a weakened immune system.
SIBO Can Cause Histamine Intolerance, Here’s How. | Podcast #268
For today’s podcast, we’re focusing on SIBO, gut infections and more histamine issues, and how SIBO can cause histamine intolerance. Last podcast about histamine went well last week, so today we’re going deeper into these topics. Check out this podcast with Evan Brand.
Dr. Justin Marchegiani
In this episode, we cover:
1:43 Histamine, symptoms and solutions
8:21 Diet recommendations
15:20 Fat Consumption
17:07 Gallbladder issues
Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house with Evan brand, Evan, how you doing today, man?
Evan Brand: Hey, man, Happy Monday. I’m doing really well.
Dr. Justin Marchegiani: Happy Monday to you as well. I know we chatted, kind of in our pregame interview, we chatted about what we’re going to talk about and we kind of chatted about histamine, histamine went really good last week, we see a lot of patients with potential histamine sensitivity. And the histamine a lot of times may not be– a little reverb there. histamine may not be a root cause of the issue. It may just be a symptom of other issues going on in the gut. We always kind of keep that in mind. A lot of people. You know, if you don’t have a lot of experience, clinically, it’s easy to think that histamine is the root cause. And then you feel like you have all these food restrictions and you’re not sure what next steps to do and that’s tough. So we’re going to be focusing on SIBO we can even expand that to gut infections, and histamine issues. So I’m really excited for today’s topic.
Evan Brand: Yeah, you made a great point right from the gate which is people that are focusing on The nutrition piece too much or focusing on maybe some of the supplemental things correct. Many people discuss DAO, which is something I’m experimenting with just to play with it and see how it works. DAO is the enzyme in your body that naturally helps to grade histamine. But as you have infections and stress and toxins, you are either unable to produce less, I mean, we’re not 100% confident with the mechanism, you may produce less or maybe is less effective. So people will do a DAO supplement say, Oh, well, I feel better. I’m not having these food reactions, and they’ll just stop there. But this is where we’re starting now at the end of that rope, and then we’re taking you to the whole next level, because if you stop there, you’re just you haven’t addressed what’s actually going on.
Dr. Justin Marchegiani: Exactly. So in general, histamine is a neurotransmitter made from histidine. It’s designed to help with the inflammatory response. It’s designed to vaser dilate open up the blood flow of the blood vessels so you have better blood flow, which helps with an inflammatory response. So you bumpy your elbow, right, you bump your head there’s a histamine response that helps vaser dilate helps migrate a lot of those white blood cells into that area kind of helps promote healing. The problem is acute acutely and acute situation not that big of a deal because it happens and then your body recovers. We’re more talking about a chronic kind of low grade inflammation or low grade histamine issue where you’re chronically swollen, you’re chronically inflamed. You may have a lot of chronic histamine symptoms, this could be headaches, it could be flushing, right, that chronic red and flushing symptoms. It could be nausea, it could be hives, right, those kind of wheels are you to carry a hives and the skin could be fatigue, it could be brain fog could be just kind of chronic low grade swelling could be allergic shiners under the eyes with a lot of lymphatic pooling in the face. So it’s good to keep an eye on these symptoms as they could be part of what’s going on. And then of course, there’s a lot of medication that are typically treating these things, whether it’s Xurtak or [inaudible] or Pepcid AC, different medications. The problem with a lot of the medications, they tend to have more side effects, whether it’s fatigue or brain fog. And a lot of people, they just get knocked out when they take a lot of these medications. So they’re kind of stuck because their performance and ability to function at work, if they’re doing hard work are dealing with their kids, they’re going to be pretty much a zombie or zonked out for a lot of them. So we want to really get to the root cause of why these symptoms are present. And a lot of times the guts going to be a big role because a lot of chronic inflammation is going to be at the gut level, whether it’s inflammation from food that you’re dealing with, whether it’s gluten or dairy, and or other histamine foods, right fermented foods or age meats or citrus or avocados, or it could be from a deeper infection that sets you up to be more sensitive, right. If you have SIBO or bacterial overgrowth, or other infections, it’s going to potentially make it harder for you to digest food, the harder it is for you to digest food, the greater chance that you’re going to develop food allergens. And also the more inflammation in your gut, the greater chance that you’re going to have gut permeability. So the more permeable your gut is, the more these foods have a way of getting into the bloodstream, the more your immune system sees them and an undigested state increases the chance that we’re going to make antibodies for those foods. And then also just the fact that we have other bacteria that may be slipping into the bloodstream. These compounds are lippo polysaccharides these can also go and create histamine issues. They can also go to the up to the brain hit and hit a lot of brain fog and mood issues. So there’s a lot of like dominoes they get hit. His to me maybe one of those dominoes, but there’s a lot of dominoes that get me hit. And then you have a lot of symptoms happening from it. And then the question is you have to kind of corral all these symptoms in to a root cause of like, what’s the next step but it gets very, really overwhelming.
Evan Brand: Yeah, I want to go back to the symptoms real quick. Something that’s really interesting is the fact that you could have issues with your sleep, you know, trouble falling asleep or even dizziness. You know, I noticed when I went low histamine with my diet, some of this Kind of disequilibrium, dizziness stuff that I was having that I thought was mold exposure, or possibly co infections I bartonella. I noticed when I went lower histamine, it got better, like my head got more clear and then I was able to go to sleep better. So this is kind of why you mentioned some people do the anti histamines and then they get knocked out. You know, I think part of the reason that some people’s nervous systems are so revved up is excess histamine, but here they are taking melatonin. Now, that may help or passionflower or, you know, we’d like to use like, Mother Ward or Valerian or Thean or Skullcap there’s a ton of good sleep options, but you may be missing the boat so those herbs are fine. Those are much safer than a sleep drug which are extremely hard to get people off of. But this the the sleep herbs may not be the root cause it may be histamine. So you could try going with a lower histamine diet during the meantime, that’s something we may recommend you do is go lower histamine while we’re working on labs are waiting on labs. And then if we find that just by lowering histamine in the diet, All the sudden, you have less blood pressure problems, you fall asleep easier, you’re not flushing, you’re not having the nasal congestion, you’ve got rid of headaches, maybe your energy’s better, well, then that’s a great clue that we’re onto something. But we don’t want to get you stuck on low histamine forever. I just don’t think that’s a way to live. So that’s when we’re going to go into these gut infections. So you mentioned bacterial overgrowth, and how we’re going to be looking at that as with stool and urine. So, Justin, I run honor, no problem between us both probably thousands of labs per year. And I would say, Now, granted, we’re a little bit biased, right? Because people that come to us have already been to many practitioners, and so they often are going to have real problems. But I would say 90% of people we look at are going to have some sort of a bacterial overgrowth problem that’s leading to these issues.
Dr. Justin Marchegiani: 100%. So histamine, it’s an important first step to look at and kind of know the histamine foods. We’ve already talked about some of the foods last time And we I think there’s a handout up there from last time as well from last week. So take a look at last week’s podcast. Try to put some of those links down below so you can access them but more common histamine foods are going to be ones that are rich in probiotics fermented foods. And that’s tough because people are following the Paleo template or following Weston a price or understand the benefits of probiotics and fermented foods. That’s kind of a curveball. And a lot of people kind of walk into this and they’re like, wait a minute, that’s supposed to be good for you. Yeah, it should be good for you. But for some people, it may be a problem with histamine and if they have SIBO it could be a problem as well. I call it probiotic intolerance. And that’s very possible. That’s what’s happening. Next are going to be your citrus foods, your age meats. Of course, a lot of paleo foods are going to be on that list. So if you’re just going paleo you cut about half of them out anyway, just by default.
Evan Brand: You know what got me in trouble though? coconut aminos I love-
Dr. Justin Marchegiani: Yeah, and amino acids are pretty high.
Evan Brand: Super high. And I was for I was, you know, there’s basically fermented coconut blossom nectars what it is, but of course The longer things ferment the higher the histamine so I was making my steaks and marinated steak and then maybe even add a little extra coconut aminos during the cooking process. Yes. And I was going too crazy with it. So I’m taking a break from coconut aminos that’s something that gets heavily used and abused and healthy foods because people are trying to ditch soy sauce for example.
Dr. Justin Marchegiani: Exactly. And that’s a good first step. And if you don’t have a histamine issue, that’s a really good first step. But if you do and you have some symptoms, like we mentioned earlier, then you know what, where to look. But in general, regarding histamine, we want to keep those foods down. So I mentioned some of the avocados, the tomatoes, the egg plan. So if you’re cutting out night shades, you may get that out. By default, avocados are kind of a curveball, right? Because that’s a really good fat. We also have the age meat, so try not to let meat sit around longer than a day or two, or even meats that tend to be preserved, whether it’s jerky or, or bacon are those kind of things. And then of course we have your probiotic foods and then our citrus So those can be curveballs. And then obviously teas and coffee, and britisher teas are the big one teas and energy drinks. That’s a DAO inhibitor. So they’re not really high in histamine, but they inhibit that enzyme DAO that helps break down histamine. So, you know, keep that in the back of our mind. So in general, the more information we– go ahead, yeah.
Evan Brand: I was just gonna say one thing about drinks. I’ve had some people that go on to like a CVO like these natural stevia sodas, where you’re doing carbonated water and a lot of time there’s added citric acid to those. And so there’s a lot of citric acid added to some of those drinks and I’ve had people drink those and then all sudden they flush out and so just cutting the drink out with the citric acid that could be something that kind of created some type of either a mast cell response or a histamine response. So that’s just one other one other potential cause and it’s tough because if you’re eating like if you’re drinking a carbonated drink and you’re doing a steak with coconut aminos, and then you’ve got your sauerkraut or kimchi on your plate with your whole grass fed dairy, it’s tough to know what you’re actually responding to. So sometimes you really have to just keep a food journal and go really simple where you just drink that carbonated drink for 15 minutes and then wait, see if you get a response and then move on to the next food item and the next food item. Hopefully, the average person it’s not that tricky, but for some it can be.
Dr. Justin Marchegiani: 100%. And of course, we already mentioned the kombucha, there’s some higher sugar ones, there’s some lower sugar ones. If you’re probiotic intolerant, that’d probably be something you want to pull out for at least a couple of weeks to a month and see kind of where you sit after after the fact. It’s got to make sure that we’re fixing digestion. We have enough HCl and hydrochloric acid and enzymes and good digestive support. Foods not being digested appropriately are going to create stress and inflammation in the gut. And then we got to look deeper at you know, making sure the common food allergens are out because a lot of times regular food allergens like you get from grains or dairy, or lentils or the goons, those can create similar symptoms of histamine and the question is welcome Is there a histamine response to these foods from an inflammatory perspective as possible, right? Because the more you create inflammation, we know that histamine is a part of the inflammatory response. It’s it. It’s part responsible for the vaser dilation that happens. So it’s possible that inflammation from other foods that aren’t necessarily histamine sensitive foods could potentially drive histamine symptoms, we have to keep that in the back of our mind. And this is why it’s so hard because you’re like, wait a minute, this foods not a high histamine food, yet I’m having high histamine symptoms, how do I connect the dots and that’s how it’s all from inflammation. inflammation is the first domino and there’s many different Domino pastor trails that could take based on inflammation being present. Now, the hidden sources of inflammation are things that we don’t really see or we’re not aware of like low stomach acid low enzymes are not necessarily aware of that we may be aware of the fact Hey, I take hydrochloric acid, I feel better, I have less bloating and less gas and more regular or I do a SIBO test, I treat my SIBO and my motility My histamine symptoms improve after the fact that’s also another thing that can create awareness, but you may not be aware of it unless someone helps guide you in the process and does some testing as well.
Evan Brand: Yeah, and I’m not going to say that all the time it happens to older people, we’re talking 40 50 60 70 80. But in general, I think it’s going to be more common for someone who is older because they’re going to make less stomach acid just due to age. Now we have seen kids and teenagers that have a lot of skin issues and gut issues, and I was one of those teenagers. And that’s because my diet was terrible, right? So you’ll still get younger, younger people that have these histamine intolerance issues, mainly because their guts been wrecked by antibiotics or they just had a bad diet to begin with. But if we’re just saying, as you mentioned, some of these dominoes that fall, one of the dominoes that falls with age is just HCl, so you become at a higher risk of getting bacterial overgrowth because now you don’t have enough acid to neutralize what you get exposed to from your foods.
Dr. Justin Marchegiani: 100% And again, I think part of it As you get older, there’s a natural drop in hydrochloric acid and enzymes as you get older. So there’s that. So I think age does play a role because of stomach acid dropping. And we need stomach acid to activate our enzymes and we need stomach acid to activate our bile salts. And we know bile has natural antibacterial effects. So the less bile you have, the more easy it is for bad bacteria to grow. So if we have good stomach acid, that’s going to provide an anti microbial environment meaning harder for bad critters to grow. And then with good HCl we also produce better bile salts. bile salts have that good acid byproduct that keeps bacteria down as well. That’s why you see a lot of people that have SIBO they’re also typically taking bile salts to help with one the environment but also to being able to break down fats really, really important.
Evan Brand: So how about people with had a gallbladder it sounds like they would be brain risk for this problem, then?
Dr. Justin Marchegiani: Well, they have to be on bile support for life now. Because what’s happened is that don’t really have a gallbladder anymore. They’re common hepatic bile doc and the liver is now the gallbladder. And so it doesn’t hold bile. Like the gallbladder concentrates bile like 15 to 20 x. And then it contracts and punctuates to release a bile at the right time, ie you have a fatty meal. Do you have a hormone that’s produced or a neurotransmitter kind of peptide called coli sista kinda, and that triggers the gallbladder to contract, it releases all this stored bile that’s been concentrated. And that bile can now come in and hit that fat and digest it and emulsify it. The problem is, you don’t have that punctuated release, because the gallbladder is gone. So it just kind of drips, it just drips drip strips, like a leaky faucet all day long. And then you don’t have the concentration of it. So it’s kind of a little bit more watered down. It’s a little bit weaker, and you don’t have the concentrated release at time of that fat being ingested. So that’s the problem.
Evan Brand: Yeah, well, you know, conventional doctors don’t educate people on this when they go into a potential gallbladder removal surgery. They’ll just say, Yeah, you’re Liver still is going to make some bio for you, but they don’t talk about that concentration factor and how it’s literally, you know, that’s like taking a, you know, a little fairy dust of some HCl and throwing it in and hoping it works. It’s not a therapeutic amount that’s going to come without that gallbladder, I mean, no still going to survive, right? I mean, there’s tons of people living but it’s just they’re not thriving.
Dr. Justin Marchegiani: Well, what tends to happen after that is to cover up a lot of those symptoms. conventional medicine says, Well, you have to be careful of your fat consumption. Well, yeah, you do because you don’t have the same level of bio output, but you need good fat, you need fat soluble vitamins A, D, and K, your long chain omega three fatty acids are really important for your health. So you’re not getting good fats. That’s a bad thing. I mean, we’ve seen with the obesity epidemic over the last hundred years, the last 30 or so years, fat consumption has dropped significantly and weights gone up. So it’s not really a fat issue based on the correlation. It’s really a carbohydrate issue. Maybe a trans fat issue, maybe an excess refined junkie vegetable oil issue but good healthy fats are not part of the play. And if we now affect our digestion when we can’t absorb those things, well every membrane in our body has good fats in them. So we need healthy fats to make our cell membranes. We need vitamin A, which is a fat soluble vitamin for our thyroid receptor sites. We need fish oil for inflammation. That’s our long chain omega threes. We need cholesterol which tends to come trapped in with animal fat for our hormones for our brain mass. So all this stuff is so important for healthy hormones. healthy body healthy brain
Evan Brand: Yep, absolutely. And there’s no education on that. It’s just Yep, you gotta gallbladders gotta come out and then that’s it. And then they don’t have here’s the interesting thing that the surgeon and then the doctors and such they don’t deal with the collateral damage. They just kind of got it out and move on. So then they end up coming to us. Hey, look, here’s this list of 20 symptoms I developed after gallbladder removal surgery. not to get too distracted from our from our topic, but this is all related because it could have been connecting a histamine problem could have been what led up to this and then it could have, you know, continued after the removal.
Dr. Justin Marchegiani: And I’ve done some articles and podcasts on gallbladder issues in the past and there are some common paleo foods that could be a gallbladder issue as well. Porks one of them, especially Bacon is also a histamine overlap there. So is I think sauerkraut as well, onions. There’s a bunch of paleo foods that like, you know, on the surface, you’re like, wait a man, these are pretty healthy foods. But if you have a gallbladder issue, it could be a driving factor and yes, some of these foods overlap with histamines. So take a look at just go to my site JustinHealth.com just type in gallbladder and you’ll find those articles and videos there for y’all.
Evan Brand: Perfect. So we hit on the the SIBO, we often discuss that SIFO small intestinal fungal overgrowth is very commonly occurring at the same time. And so that’s where once we get the proper lab testing, looking at stool and urine primarily, we’re going to be finding the answers that We need to start resolving this. As we mentioned, you may be using extra enzymes and acids. Maybe you’re using histamine degrading enzyme supplementally to try do yeah, you’re using that as a band aid knowing that you’re working backwards. And then once we come in with herbs to address, which is the, the opposite of the conventional neomycin, die flu can Neistat and kind of protocol, we’re going to come in with herbs instead, and then eventually retest and then of course watch symptom improvement at the same time. But with retesting labs, with watching symptom improvement, may be doing those band aids you can reverse this issue.
Dr. Justin Marchegiani: Yeah, we need to calm down the inflammation in the gut because those mast cells are what’s making a lot of histamine right. So your basal fills are in your blood when those basal fills go into the tissue goes into the gut lining there, they’re all become mast cells. And mass cells are what produces histamine and imagine this, you know, this mass cells sitting here, the longer we’re not exposing ourselves to inflammatory food, that mass cells like swelling up because it’s used to having a reserve Now that reserves is kind of like, kind of in gorging itself bigger and bigger and then now you eat some food that’s kind of off your food recommendation, then you get this massive flood of histamine. And when you feel like even worse, and this is what happened with someone’s on a good diet for a while, and then they go off the wagon. They’re like, Holy smokes, I got hit by a bus. What happened? I thought I was doing really good. Why have I not become more adaptable at these foods? Well, it takes some time. And then a lot of times these mast cells are just sitting there in the short run, filling up with histamine waiting for you to just go off your diet.
Evan Brand: Yeah, what about alcohol? Do you have anything to say about that? Because I had a woman who’d been off alcohol for a long time. We kind of discussed Hey, you probably shouldn’t do it. your gut barriers toast and she went to some work party and had two drinks and then she emailed me the next day Oh my god, I’m so miserable. Alcohol has never done this to me before. Granted, she was on a protocol. So some of the herbs mixing with alcohol is not smart, but just from a avoid leaky gut perspective and then going back to it, she seemed like she got worse than alcohol used to make her feel. Do you have any insight on that?
Dr. Justin Marchegiani: Yeah, so I always tell patients like don’t add any alcohol and until we have a level of clarity, a level of improvement. So then if we add an alcohol and we go backwards, we know that the alcohol brought us backwards that way. We’re not feeling crappy. And then we’re putting alcohol in there. And maybe the alcohol is what’s holding us back from getting better. And we don’t know it, right, because we always felt crappy to begin with. Yeah, so kind of get clean first. So then when you get dirty again, you know, okay, I know what clean feels like. There’s something that changed here. So regarding alcohol, there’s different quality of alcohol. So you could have like a mixed drink with a whole bunch of sugar in it, you know, that’s going to cause a whole bunch of problems just because of the sugar and the crap that’s in there. And obviously, there’s like different wines that may have pesticides or sulfates or potential gluten in there. A lot of wines are contaminated because there’s a lot of flour that lines the barrel the wines. So hard alcohol is going to be your cleanest and keeping the sugar content if you do a mixed drink, and then also like a champagne or a dry white wine will kind of be your next step up, right, the dry or whites or the dryer kind of champagne is going to have less sugar, it’s going to have less potential irritants. So you kind of start with the fruit, the kinds of alcohol that will have the less additives and inflammation compounds, and then kind of work your way back. And that wave, it just gives you the chance to have in the least issues now there are some cultures where they just have less da o to hang out with in your in their in their guts in their bloodstream. So they’re going to react to alcohol, they’ll get like a facial flush. You see this in a lot of Asian cultures because they don’t quite make as much do. So they’ll take that Pepsi they see a lot of times and that blocks that histamine response. So a lot of cultures may just have less histamine issues. You see it with Asians and alcohol, they get very flush, so you just got to know where you’re at, and then just try to choose an alcohol that’s gonna have the least possible chance of a reaction. And then you can always do some activated charcoal. In between to kind of help with that, too.
Evan Brand: Yep, that’s good advice. Anything else you think we should say about testing or herbs or things we’re doing to work on this issue?
Dr. Justin Marchegiani: Well, there’s different herbs that we’re going to recommend depending on if we’re methane dominant SIBO or hydrogen dominant SIBO, and a lot of times people have the right to have more than one issue going on at once. So, you could have SIBO and a parasite infection, you could have SIBO and H. pylori, you could have SIBO and SIFO and SIFO is nothing more than a fungal overgrowth. It could be Candida, various different yeast, mainly the main ones, Candida, but you could have all of these things going on together. It may not just be SIBO, you have the right to have more than one issue. People get fixated. They’re like, I know it’s Candida. I know it’s a worm. I know it’s this and it may be but it may be that and a whole bunch of other things. So keep your mind open to all the different stressors that could be going on at the same time.
Evan Brand: Well, the funny thing is to maybe the person’s right and they did have a parasite or they did have Candida, but we may find something even higher up on the priority list and that like if I see, you know, okra toxin levels we know okra toxin and other mold toxins we know those damage that go if I see those things off the chart and I look at dizziness and they can’t sleep and they got heart palpitations and all these other symptoms that don’t sound like SIBO. We might go after that first and SIBO and histamine and all that may be secondary and tertiary problems. So that’s another fun and important reason that we do multiple tests on people is because if you come in and you’re like, hey, Dr. J, I know it’s SIBO just run the SIBO test. He’s gonna say, No, I really think we need to also look at this and this and that. And that’s not just because we like to run labs. It’s because we like to have data so that when our puzzle pieces are on the table, we can make a more complete picture, as opposed to trying to identify your problem and make a protocol based on one little piece if we don’t, I mean, if we’re using the just one little puzzle piece, it’s just not you know, your success rate may be hindered.
Dr. Justin Marchegiani: 100 & 10%, and I think it’s, it’s really important to kind of keep that in the back of your mind. That could be a lot of different things happening. And like you mentioned earlier, an important component is the history. Hey, do you live in a house where there was recent water damage? When you’re in your home, and you leave for a period of time? Do you feel better? Have you rectified the water damage? How did you do it? Is there any visible mold in your home? So these are really important questions to know. And sometimes I’ll see in my history, I’ll see patients Yeah, there’s water damage, and they didn’t really do much to address it. And they really feel foggy in the home. They feel better when they’re outside, getting fresh air. These are important signs and symptoms. A lot of times you’ll see more neurological things like you mentioned, Evan, whether it’s brain fog, or just spaceyness or headaches. And again, we’re looking for that timing in regards to a flood or there could be even a chronic issue where there’s just high humidity in the home. And that’s where doing some of the mold testing for the home is ideal. The multitasking for the home is great because if you have you know, five people in the house We get a positive Mold Test. Well, we know that that could be affecting all five people. So it’s good to know that.
Evan Brand: Yeah, absolutely. I had a building I went into when I was in Florida. And I literally got flushed. After entering the building. I had like a reaction to the building. I started to feel off, I was just like, Whoa, this is not a good building. And I look up at the ceiling and there’s water spots, water stains, all over the ceiling. I was like, Oh my god, and this is not. Oh, Evan, you’re crazy. This is placebo. You looked at the ceiling, and then you convince yourself you felt bad. No, I felt bad before I even saw the ceiling. This was on the way, walking out of the building, I look up and see all the water stain. So most people are not that sensitive, and most know are not that in tune to their situation to know, hey, I’ve been in this building for an hour and every time I am in this particular building, for example, like college students, they’ll say when I go to this one classroom, I can’t focus I get brain fog. I get really tired. Maybe the subject is boring and they don’t like the teacher but it could be the building, particularly Making them bad. So I’ve had some college students I work with where I’ll just tell them, hey, try to sit in a different part of that room. Or if it’s a big auditorium, move to a different corner where maybe you’re closer to a door where you get fresh air and see if you feel better. And yeah, obviously, this is a more like, nuanced small percentage of the population, but it does happen. And I want people to know, they’re not crazy. This is a real phenomenon you may be experiencing.
Dr. Justin Marchegiani: Yeah, and the nice thing about it is you should be able to figure out some correlation from this, because you’re in that building, you’re out, you’re in your home, you’re out, maybe you’re walking around all day. So hopefully, you can notice a correlation there. Like you mentioned earlier, everyone’s not going to be that level of sensitive, right? There’s different genetic variation, obviously, depending on how long you’ve been exposed to something and how much is it already in your cells in your fat in your body already can make you more sensitive. So with some of your mycotoxin testing, which will do a lot of urinary testing for mold, will see some of these things and we if we do a urinary test for mold, we have to also challenge it. So we’re going to be using glutathione for at least a couple of days ahead of time. Just because if your detoxification pathways are a little bit weak, or let’s say the molds overwhelm your system, you may have lower glutathione. Anyway, so it may be harder to push the mold out to begin with. So you have to keep that in the back of your head. That’s why we test the home first. Because if we have a high level of mold in the home, we don’t see a lot coming out in the urine. Well, it’s really important that we provoke that and just give you enough detoxification support to at least get a window and how much is coming out in your year and that way, we have a baseline. So as we treat over 369 months, we can come back and see if those levels are dropping.
Evan Brand: Yeah, infrared sauna is great too. For that you can measure a lot of higher increased levels after sauna so somebody can’t tolerate glutathione and for some reason you could do a sauna, and also fasting which is pretty interesting. That’s why a lot of the samples we do in the first thing in the morning because fasting can help excrete some of these toxins too. So we could obviously dive more into that on another show. My mood levels are almost gone. I had okra toxin level of 195 you want it below four.
Dr. Justin Marchegiani: Fasting, though, with fasting, you only can do that really acutely, though. That’s like a short term thing. It’s not a long term strategy, right?
Evan Brand: Yeah, yeah, I’m just talking overnight fasting, but maybe, you know, like intermittent fasting. Maybe in between those meals, you are exceeding a little more and flushing a little more toxin out.
Dr. Justin Marchegiani: God. Okay, so you were saying okra toxin. Go ahead.
Evan Brand: Sorry. Yeah, yeah, that’s okay. I think the reference range was below four is optimal. And I started out at a 195. And here we are talking almost exactly one year later, and my levels are down to a 15. So-
Dr. Justin Marchegiani: 195 to 15. So it’s like, 98% 95% reduction.
Evan Brand: Yeah, it’s a lot but it took a year and that’s hardcore work. That’s conventional and prescription binders that sauna, that’s extreme avoidance. That’s liver lymphatics. I mean, that’s a lot of work. So I just want to end this by putting a realistic timeframe in people’s heads, you know, when they have a reaction They take a Benadryl and they feel better in half an hour. You know, they’re really happy about that, or when they have a headache and they take an Advil, they feel better in 30 minutes, that’s great. But with these issues here, we’re talking reversing potentially 10 20 30 40 50 years of toxins and damaged gut barriers and overgrowth and antibiotic usage and all that crap. So, you know, when we tell somebody, hey, six months to a year timeline, I think that’s extremely short when you factor all that in.
Dr. Justin Marchegiani: 110%. Man, I like it. I think you’re on the right track. with that. I think we’re on the right track with today’s chat, trying to connect the SIBO component, trying to also connect the different gut components that connect the SIBO. And then also I think the mole and we need to do our own little show on mold and histamine. Maybe next week, we’ll come back and do more than his mean, it gets really important. I think it’s a big issue. And the problem is a lot of people have multiple issues at the same time, and this is where it’s really hard. We want to glom onto one thing we want this one, hey, we want to have this one label. This is my issue, it’s kind of easy to wrap your head around that. But it could be a lot of different issues. So everyone that’s listening, keep your mind open to their being lost at problems at the same time. And also, if you’re overwhelmed, this is where it’s good to reach out to a practitioner like Evan. EvanBrand.com, or myself Dr. J. JustinHealth.com if you want to dive in deeper, kind of get your arms wrapped around it with some objective lab testing. So we actually know what is happening underneath the hood, so to speak. Yeah. And anything else you want to add today, man?
Evan Brand: No, I just want to give people a little bit of boost of hope and encouragement. Just say hey, look, as you mentioned, there may be layers to this, but you can peel back the layers you can you can get better, no matter how long you’ve suffered. You can you can you can keep that in mind.
Dr. Justin Marchegiani: Yeah, and your story is great with the mold because you really had some pretty debilitating symptoms. And mold one of those things. It’s like if you don’t know what’s there, man, it’s like, you’re just in it in an environment where there’s just toxins all around you and you don’t even see it and it’s a slow creep and the time symptoms start really in their head, it’s been going on for years. That’s the problem.
Evan Brand: Yeah, I got to give a shout out to our mutual friend, Dr. Jack Wolfson, for telling me that it was mold. I didn’t want to believe it. But I was talking to him and said, Hey, I was waking up dizzy. This is weird blood pressures going all over the place. And he writes back in all caps, one word mold. And that started at all.
Dr. Justin Marchegiani: Yeah, and the thing is, I mean, I’ll give credit to Jack. I think that’s us right on there. The problem is, there are a lot of let’s just say, mold, myopic doctors, where everything’s mold, right? Everything’s mold. And that’s a problem too, because it may not be so the differences with you, you got this feedback from Dr. Jack you tested your home, guess what? Really high mold, you tested your urine, you provoked it really high mold. So we had some objective data to kind of support us. So we weren’t kind of flying blind. So I think you did the right thing. And for people that are listening to this and think it’s mold, get that testing done first so you can be more confident. And then more importantly, because you’ve gone through the whole mediation process that’s even more overwhelming. And that’s where you want to work with an expert because You can feel like you have to spend six figures to get your home remediated. And that’s not the case. You can do it for way, way cheaper. And it can be, let’s just say a process that isn’t as bad as it thinks. Or if you feel like it is based on what you see online and everything.
Evan Brand: Yeah. And into Jack’s defense, you know, he is he works on hearts. You know, he’s not a mold doctor, but his wife was really sick. Yes, last few years from mold. So luckily, he had had first hand experience. So he thought, hey, this sounds kind of weird, and at least had enough in the trenches experience with his own wife to know, hey, that might be it. So very interesting how it all turns out, I think it’s one of the biggest hidden epidemics going on.
Dr. Justin Marchegiani: Yep. I see the whole mole thing and the Lyme thing as well. Anytime there’s some kind of a weird neurological symptom. people throw that out there. And it could be right but get the whole thing worked up. I mean, the thing with Evan Evan had three different other infections to begin with. So you had I think giardhia blast on h pylori.
Evan Brand: Crypto. Yeah.
Dr. Justin Marchegiani: Crypto, Giardhia, H pylori, right. So now just kind of for everyone listening so they can have insight, Evan had already addressed those issues ahead of time. And he gotten a little bit better, but there was still something holding him back. So if Evan just myopically focused on the mold and didn’t get rid of those infections, he may not have the same level of improvement. So there’s kind of an order of operations and how we want to hit this. And because you had three series, I mean, each one of those infections individually is kind of a big deal. The fact that you had all three going on at the same time, I call it the three amigos. It’s definitely going to be a major stressor on your body, and then you throw in the mold and the adrenal stress and then potentially blood sugar issues. Yeah. So you had a whole host of things that we were able to kind of sequence up and have it all makes sense.
Evan Brand: Yeah. And we’re talking we’re talking over a four to five year period, you know, those gun reactions were cleared out almost five years before the mold protocol. And that’s not due to that that’s not the way that necessarily I wanted it or that that we wanted it to happen. It’s just the way it happened. That was you The exposures came later. And so not everything could be perfectly sequenced and care but it’s just a matter of peeling back the layers you can to get some level of improvement. And that quality of life hopefully will continue to motivate you and allow you to pursue other layers of healing.
Dr. Justin Marchegiani: Well, the nice thing with us is we’re getting better because we’re also treating ourselves and thousands of patients so because of that, it’s not just like you know, textbook information, it’s real world actual results kind of driving treatment, driving protocols, driving kind of our perspective on what the next steps are for patient so it allows your treatment allowed me to get better at this and allow you to get other patients better so we just continue to grow like that which is excellent.
Evan Brand: Yeah, it’s a very, very, very cool place to operate.
Dr. Justin Marchegiani: Anything else you want to add Evan?
Evan Brand: That’s it. mentioned the links again, you can reach out to Justin, Dr. J, at JustinHealth.com my website’s EvanBrand.com. We both offer intro console where you can book 15 20 minutes, you can chat about your symptoms and goals. See if you’re good Fit for care if so, we’d love to help you. We’re very grateful to be in this position. So we honor it and we’ll be back next week.
Dr. Justin Marchegiani: Excellent. You guys have a phenomenal day. Look forward to checking in soon. Take care y’all. Bye now. See ya.
IBS Might Be Connected To Your SIBO (Small Intestinal Bacterial Overgrowth) | Podcast #257
Today’s podcast is all about IBS, a common disorder that affects the large intestine. We are going to dive in deeper on how is SIBO connected to IBS, symptoms, the root cause and a lot more. Read up more about Dr. Justin’s podcast with Evan Brand.
Dr. Justin Marchegiani
In this episode, we cover:
1:12 What is IBS
9:47 Fodmap diet, histamine IBS connection
24:01 Hydro Colon Therapy
Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house. Hope everyone is doing phenomenal. today’s podcast is going to be on the SIBO IBS connection we’re going to dive in to IBS and is it connected to SIBO lot of symptoms there will try to look upstream inside out and get to the root cause of this. Evan, how are you doing today, man?
Evan Brand: I’m doing wonderful. I was diagnosed with IBS. And can you remember what year it was several years ago by a conventional doctor who did nothing but look at me and palpate my stomach and prescribed me an acid blocking medication and then said, Yep, you’ve got IBS and that was it. So it’s just crazy. How many people get diagnosed with IBS? I should try to pull up some numbers on this and see, but I would say most people are undiagnosed because they’re suffering, right? They’re having diarrhea or constipation or bloating or gas and they just don’t go to the doctor, they just take an over the counter this or that and move on with themselves.
Dr. Justin Marchegiani: Exactly, exactly. And IBS is a, a disease a diagnosis of exclusion, meaning you rule out a lot of the more Inflammatory Bowel issues, Crohn’s, ulcerative colitis, a lot of those symptoms being like extreme weight loss. you rule out all of the inflammation markers, like high amounts of calprotectin blood in the stool, whether it’s from inflammation in your colon, small intestine, or ulcerations in the stomach, right. So you’re ruling out all of the big, big, big, big issues, okay, rectal bleeding, extreme weight loss, extreme vomiting, extreme abdominal pain, those kind of things are going to be the big things that we’re going to be ruling out. And then of course, we have you know, more of the in between symptoms where we have Yeah, we have constipation. We have some loose stool and diarrhea. We have some nausea, but there’s not a lot of inflammation present. There’s not a lot of us no calprotectin we may run like a colonoscopy or sigmoidoscopy, we’re looking at the end of the colon and seeing no real signs of inflammation, or bleeding, a run a CT or an X scan an X ray scan and see what’s going on there. But we’re ruling out like the strong pathological issues, but we still may have a lot of symptoms that I mentioned earlier. And so once we’ve done that, then you kind of fit the criteria of IBS. Now, the question is, what’s the root cause? And I’ve seen many, many times we have one study right here, saying that IBS, is connected to seabone can be caused by SIBO between one and 40% of the time. This isn’t a study by the journal gutten liver in March 2017. We’ll put the link below on that. So we know there’s a strong association up to 40%. And so we know there’s a strong association when we have IBS. There’s two major kinds of IBS. Keep it bluntly, we have IBS D which is diarrhea, IBS. IBS C which is going to be IBS for this digestive issues. But there’s more on the constipation the slow motility side. And the faster high motility side.
Evan Brand: Here’s the interesting thing, the route of, I guess the diagnosis of exclusion, you mentioned, a lot of people don’t even get to go that route because the doctor throws them the drug and sends them on their way. I mean, you talked about the optimal scenario where you get all the proper scans, you get your calprotectin looked at, you can measure your Secretory IgA and look at your gut barrier. But that often doesn’t get done. Often. It takes multiple complaints, it takes multiple visits. Sometimes, emergency room visits are required because people are in they have to be in so much pain and misery for the conventional doctor to listen enough to then give them the proper referral. So I just want to point out what you said is that all these things are great, but a lot of times it doesn’t happen that way in the conventional we always do that in the functional world. Looking into the testing but that’s not the first step for most people. And that’s just the sad truth. And I don’t know if it’s a cost saving measure. I don’t know if it’s the insurance companies don’t want to go straight to send you over to a gastro doc for deeper analysis. I don’t know why. But I never got referred over until I had major complaints. And even when I got referred over the gastro doc didn’t even do a full workup. It was just a quick seven minute visit.
Dr. Justin Marchegiani: Exactly. So when they’re looking at these things, they’re just trying to rule out the more serious Irritable Bowel Disease type of symptoms. Right. Once that’s been ruled out, you can still have a whole bunch of nausea and spasms and diarrhea and constipation, then obviously, headaches and fatigue and mood issues can resolve, especially if you’re not digesting and absorbing a lot of your nutrition. You may have a lot more symptoms, and you’re going to be typically left with just a few medication choices. So the big ones are going to be things that help with the diarrhea, various anti diarrheal or antispasmodic medications, okay, and then you’ll have laxatives to help with the constipation to slowly side of the stool moving. That could be various laxatives that could be Metamucil or fiber supplements. And then of course with some of the diarrhea things antispasmodic medications tend to be used and then also a lot of times, antidepressants because we know serotonin plays a huge role in the gut on motility. So conventional medicines using a lot of antidepressants, whether they’re tricep like antidepressants, the older ones from the 80s or SSRIs are also use. And then of course, there’s the pain, right? It could be a pain in the intestine, then pains are going to be used, whether it’s like gabapentin or something else like that. They’re giving medications on the pain side. So these are the big ones that are going to be used. It’s kind of cookbook, right? It’s okay fast tools, slow stools, pain, right? pain medications, and then sometimes they’ll give pro kinetics for you know, your food setting in there so long. And then of course, the antidepressants. Those are the big for families and medication. So walk me through how does any of that fix the root cause it doesn’t, right, the mindset is we’re going to just manage the symptoms and hope that things don’t get worse over time. And we know that with entropy and inertia, things always tend to go downhill over time. Not better if we don’t get to the root cause if we ignore the root cause.
Evan Brand: Did you mention acid blocking drugs? Those are often thrown a lot.
Dr. Justin Marchegiani: Yeah. Yeah, I mean, if that’s symptoms present, I mean, those are typical symptoms for IBS in general, but if we have IBS, and GERD combined, yeah, acid blockers would definitely be used. Pro kinetics, along with that to pro kinetics are just things that help with the motility and the migrating motor complex to keep food moving through the intestine. So yeah, you may see that as well. Yeah, there’s a lot of different scenarios where other let’s say diagnoses or symptom presentations could overlap for sure.
Evan Brand: Okay, so I just want to briefly dive into some of the other symptoms or things that could be happening outside of the gut. So like the mood issues that can happen we’ve done stuff on this before and we’ll continue to talk about the gut bacteria and the the the mindset so anxiety issues, depression issues, insomnia, irritability, there’s a lot of other emotional things that people may not even recognize are from the gut. I mean, and this is coming from somebody who I suffered with depression for a long time of my life. And once I cleared up my gut, it was if the clouds over my head lifted, so I just want to point that out that, hey, if you’re suffering, emotionally, it may also be your gut. So you have to start in my opinion, you have to start they’re going to the mental health counselor may be necessary to but for me, the game changer was getting my gut cleared out my energy, my mood just went insanely, insanely good after that.
Dr. Justin Marchegiani: Exactly. And then what’s happening there physiologically or biochemically what’s happening is when we have unresolved emotional stress, and it could be subconscious stuff where we may need to use techniques that help address things subconsciously, it could be just conscious stress, what we need to just have kind of write out the big issues and and create some kind of an action plan that we could execute to get to the problem on it. Whatever it is, if it’s work or relationship or financial stuff, whatever it is, that’s going to activate our fight or flight and sympathetic nervous system and the sympathetic nervous system interplays with the adrenal and that makes stress hormones to help us deal with that stress, whether it’s adrenaline or cortisol, and cortisol and adrenaline long term is very catabolic, so it’s going to help, it’s going to actually break down our neurotransmitters so we’ll have less neurotransmitters that can then affect motility. We know that antidepressants are used for motility. So we know if we actually deplete our own natural antidepressants that we make naturally serotonin don’t mean we may have less of it to help with motility number one, the more fight or flight we get into the more we can actually break down our gut barrier. High levels of cortisol can break down IGA. I did a video that’s out this morning, you can take a look at it on histamine intolerance, and in that study, there was an article talking about cortisol impacting IGA and the immune response and can cause more histamine when you’re stressed. So you could have high amounts of histamine, which a lot of histamine symptoms overlap with IBS. So it could be skin stuff. It could be headaches, it could be fatigue, brain fog stuff, you know, and a lot of the histamine issues overlap because when you have inflammation in the gut, and you have a lot of cortisol stress, you may be making more histamine and the gut bacteria has a huge impact on the kind of histamine you have. And we know that dysbiotic bacteria and or SIBO, which is bad bacteria from the colon migrating up into the small intestine can have a major impact on histamine. And on all the other symptoms. We just talked about mood, nausea, depression, anxiety, and then of course, your typical IBS symptoms, constipation, diarrhea, stomach pain, etc.
Evan Brand: Yeah, well said. So you may come in with the diet, right? We may use the diet as a modifying tool, you know, something like a low fodmap diet may help, right because you’re trying to reduce the things that are fermenting in the gut, and possibly feeding the bad guys, but that’s where a lot of people stop is they end up with some diet protocol like a SIBO diet or an IBS diet. And and that’s it and they don’t go any further. So they may be able to manage it. But that’s still not the full root cause what would you say about the diet piece? And the involvement?
Dr. Justin Marchegiani: Yeah, so a lot of people they come in, they may already be on a standard American diet, and then they’re like, oh, okay, I’m going to make some diet changes. And they may still have issues and and the problem is a lot of fodmaps are fermentable carbohydrates or healthy foods. So why do people start scratching their head because they’re like, wait a minute, I’m already cutting a lot of crap out but I still don’t feel good. Or hey, like, I’m following this Weston a price thing where they’re telling me to eat lots of fermented foods. Why do I feel worse, and this can happen because a lot of those foods are very fermentable. So the bacteria in your gut feeds on a lot of the carbohydrates in those foods. Those carbohydrates being from fructose oligo, die in moto and poly, all these different kinds of carbohydrates or sugars that are naturally in these foods, healthy foods, but the bacteria will feed off of them.
Evan Brand: Let’s talk fugit just so people like okay, what is he talking about? like apples, pears, those are common fruits that are five.
Dr. Justin Marchegiani: Yes, right. Yeah, yeah, those will have. So there’s a really good handout that you can look at, I’ll post my handout underneath. But these are different carbohydrates. So frictions are going to be high and fruits only go and die in mono and poly sat and poly, poly alcohol. These are going to be in different types of vegetables and foods. Now there’s an app that you can get on your phone called fodmap, A to Z and it will tell you exactly which one of those fo de ma ma p ma PS in there, the different types of carbohydrates are in each food. I have a generalized handout that I’ll put below that has all the different ones in there. And so you know, but the big thing is you just want to cut them out. And the goal is that you’re starving out some of these critters by not giving them the fermentable fertilizer so they can grow. You can starve them out. And that can be a good first step that makes sense.
Evan Brand: Yeah, kombucha has an issue too I remember I had a woman who she had extremely high levels of [inaudible] her organic acids test indicating she had a ton of Candida overgrowth, she had toenail fungus. She had even fungus on her on her skin like a fungal infection on the skin. This lady was drinking five kombuchas a day. Now, granted, that’s an extreme case, most of you listening are probably not drinking five kombuchas a day. But that just goes to show you can have too much of a good thing in the fermentable food category. And some people get crazy with it. They’re eating sauerkraut every day, I just don’t think that’s necessary.
Dr. Justin Marchegiani: Exactly. So a little bit goes a long way. But if we if we have what I call probiotic intolerance, meaning foods that have good natural probiotics, and it caused problems, there’s probably SIBO going on, and there may even be an overlap with histamine issues. Because fermentable foods also have a high amount of histamine. So so many different conditions overlap, and it’s really, really confusing because you have to have a root cause perspective, because when you go to the root cause and you’re up here, lots of things emanate down below various symptoms, various others diagnoses and all a diagnosis is it’s just a way of taking a whole bunch of symptoms and throwing them in one bucket. The problem is different buckets have overlap as well total, whether you have like a mass cell issue, that’s one bucket, but then that may overlap with IBS. And then a lot of IBS symptoms, of course, overlap with Crohn’s or ulcerative colitis or microscopic lattice, but they don’t quite have as many of the inflammation signs. So there’s a lot of different characteristics and you have to, if you can go upstream is only a few root causes up here. So you get much less overwhelmed when you go up, right? You go essentially inside out, above, below, above, below, inside out. So you always go in to fix the outward manifestations and symptoms.
Evan Brand: Yeah, well said about the histamine IBS connection. I don’t think most people pick up on that they, they go on like a low histamine diet, but they’re doing it for what they think are histamine problems, but really, that’s the same thing as IBS problems. So the diarrhea could be a histamine thing. It could be a SIBO thing. So you really have to tease apart all these things. So how do you how do you tease this apart? You know, how do you approach these different buckets and then go up to the top what’s at the top.
Dr. Justin Marchegiani: You need a good functional medicine provider that can help guide you because it’s really confusing. And unless you’ve walked that path before, it’s easy to get to glom onto one thing, and then get overwhelmed. That’s number one, and it happens all the time. And then number two, you can go down the path where you’re kind of stuck on a whole bunch of medications that are managing issues, but then you’re like, you know, you’re just trying to like, you’re crumbling and you’re trying to hold everything up with duct tape, and it’s, it’s stressful. So the first thing is you got to get the diet component under control. So we have to look at cutting out fodmaps maybe cutting out autoimmune foods, we have to really pre digest and cook everything very well so we can digest it better. Right? Think of cooking as pre digestion. So kind of wrap your head Okay, cooking is precious, and a lot of people will think oh raw, so good. While raw may be okay for some people that have great digestion, but if you don’t have good digestion, so a lot of fiber in there that could be hard on your gut, it could be a lot more fermentable fiber in there. Also, the fact that you just tell me has to work harder and if you have less hydrochloric acid less enzymes, which we know according to many studies show that SIBO patients have less acid. They’re [inaudible] low stomach acid. We know stomach acids, an important trigger to make enzymes as well. So if we have low stomach acid, we have low enzyme issues. And then of course, if we’re eating when we’re stressed, or we’re not chewing our food up well enough, we’re just going to not break those foods down. And then those foods are sitting in our guts, and it’s a stress to break it down. So number one is choose good foods. But number two is pre digest them with really good cooking methods and in mastication just chewing it up.
Evan Brand: Well, yeah, when I had gut bugs, I was trying to eat salad and it was a waste of time. I was not digesting leafy greens at all. So I just gave up on eating salad and that’s why a lot of people end up going with a more meat based diet and I’ve seen so many people, there’s a lot of like famous YouTubers and other people who were raw vegans. And they end up getting off of that because they’re just like, hey, it destroyed me. I couldn’t digest anything. I was malnourished.
Dr. Justin Marchegiani: And some people they go to the extreme of going full carnivore, which is definitely low fodmap to, which does great, but some don’t have to go to that extreme. And some people they actually feel worse too, because protein and fats are also hard to digest as well. So sometimes there’s less anti nutrients and there’s less fiber, there’s less fermentation, and that’s enough to allow them to feel better and heal others they can handle some of those foods, they just have to be more autoimmune or moral low fodmap. And they really have to be working on the cooking methods and of course, the next step is going to be supplementation. So we may work on adding natural prokinetics, things to help with motility. We may add in hydrochloric acid and enzymes, you may add an anti inflammatory support for the gut lining, whether it’s dgl or like in my line, we use gi restore which is a healing nutrient for the gut lining. You have different things as well and your line as well. But we may we may come up with a plan based on how the person is presenting and things that have already helped or haven’t helped.
Evan Brand: Yeah, so it could be some herbal antihistamines to you kind of hit on the IBS histamine connection. So part of what we do is teasing apart when to do what? So if we’re trying to get someone’s got dialed in, they may be so miserable that we first have to use herbal antihistamines to try to calm things down. Let’s use the example of somebody who every single food they eat, they have a food reaction there. They say I have food sensitivities, and we say to what they say to everything, and we say, okay, and that’s where we can come in with maybe herbal antihistamines that you can take during the day to try to help regulate that massell reaction. You can look at the acid and enzymes, possibly possibly probiotics, but usually that’s like phase two. Usually phase one is more of us trying to manage the symptoms, get the proper information via the lab testing that we could talk about, and then make the game plan and usually the game plan is going to have to involve some combination of anti parasitic antifungal and or antimicrobial herbs and often we combine those together.
Dr. Justin Marchegiani: Exactly and then pre digesting the food by cooking it well is going to be helpful. We can do a crock pot, which is great for pre digesting foods and making more soup and stew like foods. The only problem with the crockpot is foods can accumulate more histamine there so if you’re not feeling good with crock pot foods, we may need to progress more to an Insta pot or pressure cooker. And a pressure cooker is great because it cooks the food faster so there’s less time for histamine to develop and of course an Insta pots even better because that’s going to be a hybrid pressure cooker and a crockpot combined. You just have to make sure with a with a crock pot with an Insta pot you’re very present when you cook it so you have to make sure you release that steam valve before you open it up and you’ll have an explosion so I always recommend like you put it way away from the shelf. Make sure kids don’t touch it. Make sure everyone knows like you do not touch it. Have one person deal with it. Someone comes in and wants to grab a snack bite of something, you’re going to have an explosion. So just make sure you’re very aware of that. And you have one person managing it, put it away, make sure the kids are out of the room and make sure that the vent is vented and that little little kitaen in the middle drops all the way down. So you know that that thing is cool when you’re when you’re opening it up. And I even recommend get like a fireproof blanket, put it over it and then turn it. Those things are-
Evan Brand: Yeah, they’re insanely hot. Good point about the-
Dr. Justin Marchegiani: Just gotta be careful because some women or even myself and I’m in the kitchen, you’re just like you’re doing 10 things at once and you may just go right to it and not think so you just really got to be very present when you’re using an Instapot. Okay, this is how you gotta do it. And you got to be very, very careful.
Evan Brand: Yeah, they’re incredibly hot and powerful for sure. I’m so glad you brought up the the histamine issue with the crock pot because you know bone broth is all the rage everybody’s drinking bone broth. We measure their gut barrier, guess what their gut barrier still toast drinking a gallon of bone broth a day did nothing for you and a lot of these people if they’re missing making their own bone broth because they don’t want to pay the price of somebody else to make it for them. People are saying that they’re letting it in the crock pot for 12 hours or 15 or 20 or 25 hours. That is a ton of time for histamine to build up. So I’m not saying stop doing bone broth, but I’m kinda saying that because I’ve had people that were actually having histamine reactions. They didn’t know it was linked to the bone broth. They get these weird rashes on their face or on their skin. They get a headache. They have no clue why. And I’d say well, when you get a headache Oh, it’s always in the morning. Oh, well, what do you do for breakfast? Oh, I drink a cup of bone broth in the morning. Ah, take out the bone broth, no more headache.
Dr. Justin Marchegiani: And again, my rep my opinion on this is bone broth for most people will probably be fine. So if you have negative symptoms, after taking it, like Evan said, then you probably want to pull it out for a period of time and really look at getting the histamine out just for a period of time and just I just call it being histamine conscious, right? Look at the high histamine food list and really pull out all the ones that you are consuming the most and just kind of watch and wait, but if you’re consuming has to mean are you you’re consuming bone broth and you feel relatively good with it. Continue doing it. I have no problem with that.
Evan Brand: Yeah, sorry, I’m not trying to, to label a small population as the whole population, because you’re right. That’s not that’s not everyone. But there are some super sensitive people listening that may hear that little nugget and apply and be like, Oh, yeah, I wasn’t so different. I didn’t know it. But hopefully you’re not in that category. Hopefully, you’re in, you can do as much bone broth as you want.
Dr. Justin Marchegiani: And this is the hard part because there’s so many caveats, right? There’s so many exceptions, you know, if and, but, and that’s why you really need a good provider to work with that can help you navigate because there’s so many exceptions to the rule, and we can’t be absolute in our generalizations here. So take everything with a grain of salt for sure. And if you’re working with someone that’s individualizing approach, there may be an exception to it. So that’s really good to note. So outside of that, I think the food components really big I mean, I’ve have my six our approach, which you kind of follow something similar as well, where we’re removing the bad foods or replacing the enzymes second or repairing the gut lining under the hormones. The hormones are the X Factor. People forget about this. I already highlighted how cortisol and stress and the sympathetic nervous system can affect digestion, but it also affects histamine. It affects the gut barrier. It affects the immune response. So the hormones are a big component. People come in there. There’s a lot of, let’s say, guts, functional medicine, doctors online, and they’re so myopic to the gut. They just everything else blows away and I can’t tell you how many people I’ve seen that they’re menopausal women that have ridiculously low hormones that are affecting their gut as well. They have low thyroid, which are that affects their motility, hey, that’s a sign of SIBO and IBS, right. Also people that have poor adrenal function, they don’t have enough cortisol to deal with the inflammation in their gut either. So you got to look at the hormones that gets overlooked all the time. And then I’ve personally then of course, removing the infections which there can be different kinds of infections and you you got to know that it may not just be SIBO, your SIBO they also have an H pylori connection which may also have a fungal overgrowth. SIBO and SIFO, there may be like you said, everyone we had I think that the three amigos, right, I think we had blasto giardi and H. pylori. So it was a-
Evan Brand: Crypto always you always mix up the blasto in crypto currency.
Dr. Justin Marchegiani: So, so crypto giardi and H pylori.
Evan Brand: Equal equally terrible.
Dr. Justin Marchegiani: Yeah, crypto grd. which is which is worse? I mean, crypto is probably worse than x file, then blasto.
Evan Brand: Yeah, my gut was a mess. I was not I was not healthy man. I was malnourished for sure.
Dr. Justin Marchegiani: Hundred percent, one hundred percent, or anything else you want to add to that list?
Evan Brand: The testing aspect, you kind of hit upon what we’re doing, but not in too much detail. So we’ll just kind of briefly cover that is primarily stool testing is going to give us a lot of the answers, of course, but as you mentioned here, you’ve got to get the other puzzle pieces. So you may need to run that cortisol panel, you may need to run that thyroid panel. So we may have to send you out to blood to get blood work because, as you mentioned, you could have someone with a gut motility problem that is not gut related. And how crazy is that? That it could be a thyroid problem causing your gut problem. Most people find that connection.
Dr. Justin Marchegiani: It can it definitely can for sure. And I have a couple of questions that popped in in regards to doing hydro colon therapy is that helpful? My opinion about hydro colon therapy, it’s an extreme way to move the bowels. So if there’s an extreme constipation, that may be a good way to start to kind of get things moving. But in general is a lot of things that happen in the colon, where we reabsorb electrolytes and things like that. So I don’t really want to disrupt a lot of that day in day out. So I much rather use natural things to kind of move the bowels if we have to do colon hydrotherapy acutely fine, but long term, we want more natural strategies that fix it and of course, fixing the bacterial or the infection stressor that could be screwing up motility is obviously root cause so there’s a lot of natural things that I consider to be non root cause like that, not root cause, but it’s palliative, and it may support it may be better than a lot of the medications or surgeries but we still have to have our eye towards the root cause and more sustainable everyday Things that are less invasive.
Evan Brand: Yep. Well said if I may mention the whole vitamin D connection we wanted to hit on this a bit.
Dr. Justin Marchegiani: Oh, yes.
Evan Brand: So there is a paper that had come out. Just a couple of weeks ago, October 2019, which was a study on ultraviolet B UVB light, which you get from sunlight exposure, and you could buy like UVB lamps, I’m sure. And the paper looked at the implications of low vitamin D. And at the end of it here, it just talks about how seasonal fluctuations in the composition of the gut microbiome are found and this is due to the different levels of UVB light. So basically summertime, a lot of people say they feel better during summertime. Part of the reason is if you’re getting more sunlight, you’re actually helping to regulate your gut bacteria and they found that the IBD flare ups were super common and linked to vitamin D deficiency. It says here, due to the gut dysbiosis associated with low vitamin D they go on and on. But that’s the sparknotes is that low vitamin D equals gut dysbiosis equals irritable bowel.
Dr. Justin Marchegiani: Yep vitamin D can have a big implication I think also vitamin D has a big connection with the serotonin receptor sites and we know serotonin has a big connection with what motility so I think it’s all connected right i think vitamin D then connects to serotonin. serotonin connects to motility. And if we’re not moving our bowels adequately, then you know you can start to have bacteria accumulating right because low and slow motility can definitely cause bacterial overgrowth, right that food sitting in your gut fermenting longer. So, when we look at SIBO, we primarily have hydrogen dominancy about or methane dominant SIBO, and those symptoms tend to correlate methane, constipation, hydrogen diarrhea, and sometimes we can have a combination of two. That’s the general correlation. So, the testing that we would do with that as a lactulose breath test, and that’s going to look more at small intestine overgrowth. We also have glucose breath test which you can look more at the upper stomach, there’s the urea blood, the urea breath, which is more of a newer test kind of an experimental phases. But essentially you’re blowing into a tube baseline, slamming down a 50, to 75 gram thing of lactulose, which is a large sugar molecule that does not get digested and absorbed, but gets fed to the bacteria. And when the bacteria starts to eat it, it starts spitting off gases. And the sooner in that three hours, so you get baseline below, slam down some lactulose below every 20 minutes for three hours. So the rule of thumb is, it should take the lactulose about two hours to get into the colon. So typically, at two hours, you’ll see this double peak accumulate. And that’s a sign that that the lactulose is hit the bacteria in the colon. So the mindset is, if we start seeing spikes in gases, right, methane greater than three are definitely great of intense concern hydrogen greater than 15 combined greater than 20 definitely concern, we start seeing spikes in these methane and hydrogen gases, then we know the bacteria, especially if it happens before two hours. We know the bacteria are gobbling it up. And there’s more bacteria because more bacteria equals more gases. So lower gases, lower bacteria, more bacteria, more gases, of course, hydrogen based bacteria, more hydrogen, but no bacteria, more methane. And on the GI map, we can actually they’re testing now various methane bacteria, so you can see some of that on the GI map.
Evan Brand: I like that. Yeah, I was gonna ask you now that that’s on there. How do you how do you correlate that? Or do you do a breath test and you’re going to run stool? Is it just in certain situations, or can you infer from the stool Now that may cause you not to run the the breath?
Dr. Justin Marchegiani: So we know a lot of the bacteria that we test on the GI map? We know if it’s connected to SIBO. So, we already know like things like Pseudomonas and klebsiella and citrobacter Prevotella and Morgenella are already connected to SIBO. Now, do we know without a doubt that this bacteria is in your small intestine? No, I mean, it’s like, it’s like you have a toothpaste tube. And then you have a little bit of toothpaste in the middle, and then you squeeze it all out and then you try to infer after you squeeze it all out where in the toothpaste thing it was, it’s hard to know that right? You need a biopsy where you go in there and you either grab it in that part of the testing, or you do the breath test where you can infer based on the time where it’s at. Outside of that. I just say that you’re you’re making a diagnosis, a functional assessment of, hey, you have a general dysbiosis. And based on the research, we know that this the bacteria that’s high in your test is associated with SIBO. And then we can also try cutting out some foods and seeing what happens. Number two is a strong history or a lot of symptoms. We may run a breath test alongside of it, it just depends. I typically don’t recommend a ton of testing. If we can do functional assessments and we see improvements and we see functional assessments approving it, then that gives us enough ammo to say this is an issue. The patient is already getting better. That’s the most important thing.
Evan Brand: Yeah. Well said Because see, a lot of people get caught up on that, like, What? Where are the bacteria? What’s the location? Do I have SIBO or not? And it’s like, well, you’ve got Pseudomonas Aeruginosa over growing. It’s probably in your small intestine based on your symptoms. let’s address the Pseudomonas. And if your symptoms get better, it was probably in the small intestine. That’s kind of how I approach it. I don’t often run breath testing.
Dr. Justin Marchegiani: And you can also make some diet changes, too. And so yeah, cutting out the fodmaps, like I mentioned, or those kind of things, they can give you a pretty good window into it.
Evan Brand: Yep. So So yeah, we try to only do things that we see are going to help us create a clinical outcome. And in a lot of cases, my opinion, you tell me if yours is different, my opinion, the SIBO breath test doesn’t add too much more to the picture. If we get a really, really good stool analysis.
Dr. Justin Marchegiani: If we get a good soil analysis, and we already make changes on the diet and the lifestyle and supplement side and we already see things that they give us a clinical indication of what direction we’re heading in for sure I hundred percent agree with that. Yeah. Okay.
Evan Brand: Well, I think that’s all I needed to say that I don’t have anything else on this topic at the time, but I hope it’s been helpful for people.
Dr. Justin Marchegiani: I think it’s been really, really good and of course, antibiotics can be helpful, but more specific ones that are using the SIBO are going to be the Neomycin and or the Rifaximin or Sifaxon, those are antibiotics tend to stay more in the gut and don’t go systemic. Of course, our natural bias is towards the antimicrobials. There have been studies that compared the effectiveness of the antibiotics with antimicrobials and the the natural ademma chrome os have come up better in some situations. That being said, Every now and then someone does better with antibiotics, but clinically, I found most people do very good with herbs. And they tend to do really well because of the E flux pumps, the natural antimicrobials inhibit the flux pumps, which is essentially let’s just say you’re you’re in a canoe and what you start taking on water okay, the flux pumps are essentially you in the canoe bailing the water back into the into the lake, right? That’s the flux pumps. So think about it. If we have a bacteria we want to kill, we want that water to accumulate in that canoe and sink the person or sink the bacteria. So the flux pumps prevent that canoe from sinking. So the herbs tenant act like someone coming in and taking away that person’s bucket and then they can’t bail out the water and then the canoe or the bacteria takes on water faster and sinks. So you have some really good benefits with the herbals with the flux pumps and then also the biofilms are another component so the biofilms are like protective shields that the bacteria use from being killed so things like ginger or silver and or graphics or systemic enzymes can be very helpful for essentially taking away that the Spartans shield so to speak and making them more vulnerable to the herbals.
Evan Brand: Yeah, Serapeptidase did a wonder for me as soon as I started on that I had a massive massive sinus drainage and I wasn’t even someone who felt like I had any sinus issues at all, but once I started doing that, and combining with antimicrobial antifungal herbs, I mean it was literally me achieve he was literally me peeling back the onion and hitting a new layer of infections, which is why sometimes on the retest, we’ll see new bugs show up and people say well, why wasn’t this on the first test? We did? Well, probably because it was hiding and we pulled it out of hiding.
Dr. Justin Marchegiani: Exactly any patients that are listening you know, they always see my ginger tea recipe or me talking about using ginger tea. Why? Well wonder ginger tea helps with inflammation. It helps with motility but also it helps with biofilms. So I like to use things that have multifactorial benefit and it’s cheap right helps them the digestive side helps in the motility side and helps on the biofilm side beautiful in reducing inflammation too.
Evan Brand: Beautiful. We could do a whole show on biofilm, I think but yeah, it’s definitely definitely part of this puzzle.
Dr. Justin Marchegiani: 100% I did a video on biofilms. We’ll put that we’ll put that in the reference below that a few years back, so that’ll be a good reference for y’all. Silver is also a great biofilm Buster as well. So my line, we use GI Clear three, which is a nano silver. And then of course, we just make the homemade ginger tea. And I have a video on that too well, so we got a lot of stuff with the references. And if you want to add anything for your video, and we’ll add stuff there too. That’s perfect. Cool. All right. Any other questions from the listeners feel free to chime in? Again, we’re one of the only podcasts out there where we try to really talk about real life experience with patients. You know, we’ve had experiences over the last decade with thousands of patients. And then we take questions live because we don’t need to prep for this stuff where this is things that we do every day. So you don’t prep for the for the book that you read to your kid at night because because you you know the language so well. We know the functional medicine language and we’re happy to be able to engage with y’all on that. Let me see what we have for questions here. All right. How do you treat patients from a distance so we have labs that we can order anywhere in the country. Or even the world. And then number two, we can always engage face to face via FaceTime or Skype or zoom. And then of course, we can make diet changes. We have a lot of handouts and video support, we just engage via phone or Skype or video works great. IBS constipation and frequent urination and a tingling sensation to my testicles and anus and the doctor didn’t know what it was any ideas, hard to say. I mean, there could be some aggravation of your your lower single nerves if you’re knowing that pudendal area is irritated, there could be a disc issue potentially that could be a sciatic potential issue with that s one s two s three nerve root could be affected. So it’s hard to say what’s going on there. I mean, people that ride bikes or things like that that area can be a compressed people that have sciatic issues or sit too much could be compressed. So I need to have a little bit more info but of course, if there’s digestion issues, fixing that would also be helpful using all the things we talked about today. Evan?
Evan Brand: Gosh that was great. I have nothing else to say except, you know, you could run some testing but that doesn’t sound like a parasitic type issue. I agree with you. It sounds more nerve related.
Dr. Justin Marchegiani: Exactly. And how to get rid of colon pain that’s caused by chia seeds. Well, first thing if you’re having a lot of colon or digestive pain, let’s cut out the chia seeds. Let’s cut it out for a period of time, see how we do. Excellent. And then another question here that’s on topic is the SIBO always come with pain. No. And this is weird. A lot of times SIBO may not even come with digestive issues. It may come with brain fog, it may come with fatigue, it may come with depression. And they come with symptoms not associated with digestion. And this is the hard part where people that go to their conventional medical doctor, or even a lot of functional med doctors there, hey, if you don’t have these gut symptoms, we’re not going to run these gut tests, right? People become very symptom oriented in regards to what testing they’re recommending. And that can be a big mistake, and people can fall through the cracks.
Evan Brand: Oh, yeah. Well said anxiety too I’ve had a lot of people with anxiety, and they don’t have gut symptoms, and then we get their stool test back. I’m like, are you sure you don’t have any gut symptoms? Like how do you have this many infections and you have no gut symptoms. It’s always amazing. I don’t know if it’s just a disconnect. If it’s a, they’re used to it. They don’t know what their gut should feel like, you know, they’re used to their stomach being bloated all the time. And then we do a protocol and it’s flat and like, Oh, I guess I was bloated. I didn’t know that. Yeah, that’s a great point.
Dr. Justin Marchegiani: Yeah. And then a patient writes in what if you have gas when you’re taking sulfur based amino acid. So if you’re having a lot of gas, when you’re taking sulfur based amino acids, you just back off the dose and just gently taper it up. And I’d probably take it with food. So it mixes in with the sulfur amino acids of my animal products, animal products, and just kind of taper it up from there and go slow and get to a level where you feel comfortable. It’s great that we had all the major questions here so far. Anything else you want to add, Evan?
Evan Brand: No I’m glad we have some questions, it’s helpful to dive into the real life experience. So if people have questions ahead of time or in the future, you know, feel free to reach out to us on our websites, you know Justin Health Wellness Clinic on Facebook, Instagram as well, you know, look us up, follow us connect with us that way too because a lot of what we do is kind of a thankless job you know, we’re connecting with, you know, hundreds of thousands of people per year but rarely do we have people actually reach out and give us an actual like, hey, I want you to cover this or this or this topic, y’all kind of just sit there and wait which is fine, but we would like the interaction to so feel free to reach out and ask us questions will answer them.
Dr. Justin Marchegiani: We appreciate it. Also, someone wrote in Yeah, our intestines are our essentially our GI tract is our first brain for sure. there’s what’s called the enteric nervous system and there’s just as many nerves in our in our gut and our GI tract as there are in our brain, right and our brain is essentially our central nervous system that’s brain the spinal cord. Peripheral nervous system is the spinal cord out to the extremities. And then of course, we have the enteric nervous system, just as many neurons in the gut, as in the spine and brain, so that’s really important. So of course, having digestive issues can affect your mood just as having issues in your brain can affect your mood. Your second brain, which is your gut, is so important. And of course, that’s where all the building blocks from your gut go to your brain anyway, so all the nutrients and amino acids that make your brain chemicals come from your gut so of course, you have your own enteric nervous system there but you have all the building blocks that come from there too. So really, really important.
Evan Brand: Yeah, just treating your brain is not the answer.
Dr. Justin Marchegiani: It could be part of it and some people it may be all of it but most people it’s going to be a combination of the two. Yeah, yeah. And this is where you need that skilled experience so feel free and you want to reach out to Evan, EvanBrand.com, Evan works with thousands of patients all over the world and then myself at JustInHealth.com and we appreciate you guys clicking below and write us a review as well as go into iTunes. Justinhealth.com/iTunes, Evanbrand.com/iTunes. Appreciate it y’all. You guys have a phenomenal day. Take care.
Evan Brand: Take care. Bye bye
Dr. Justin Marchegiani: Bye.
Functional medicine solutions for SIBO (Small Intestinal Bacterial Overgrowth) – Podcast #98
Dr. Justin Marchegiani and Evan Brand dig into a lot of the things that you need to know about SIBO — the causes, lab tests and treatments available for small intestinal bacterial overgrowth.
Learn to differentiate SIBO from other digestive issues and/or infections when you listen to this podcast interview. Get to know about symptoms and lab tests to confirm SIBO as well as the functional medicine approach that will pave the way to gut healing. Find out the root cause of your gut problems and not just focus on the issue of SIBO so you can get effective treatment immediately.
In this episode, topics include:
3:57 What is SIBO?
6:59 Testing for SIBO
10:27 Causes of SIBO
12:13 Autoimmune Paleo Diet/Specific Carbohydrate Diet/Low FODMAP
26:10 Treatment with supplements
Dr. Justin Marchegiani: Evan Brand, it’s Dr. Justin here, man! Happy little Monday! What’s going on for you?
Evan Brand: Hey, thank you! Well, this baby is coming apparently. That’s what’s coming.
Dr. Justin Marchegiani: It’s exciting. I know we talked about it on Friday. You were getting close, still not quite there yet but you’re almost coming down the hill on this one.
Evan Brand: By the time this show goes out, the baby will be here.
Dr. Justin Marchegiani: Super exciting!
Evan Brand: Yup.
Dr. Justin Marchegiani: And this is gonna be a Paleo baby, right?
Evan Brand: Yes, absolutely.
Dr. Justin Marchegiani: Nice. So do you have a Paleo baby name set up yet?
Evan Brand: Su—Summer.
Dr. Justin Marchegiani: Oh, is that the name?
Evan Brand: Yeah.
Dr. Justin Marchegiani: Oh, awesome! That’s great!
Evan Brand: Yeah.
Dr. Justin Marchegiani: Very cool. I know, if it was like a—a last minute kinda judgment call. That’s cool.
Evan Brand: Thanks, man.
Dr. Justin Marchegiani: Perfect and it—it’s almost, it’s not quite officially summer yet, June 21st, right?
Evan Brand: By the time this show goes out, it probably will be June 21st.
Dr. Justin Marchegiani: It probably will be. Yeah, actually it will be past that. I guess it’ll probably come out in late June. So that’s great. Awesome timing. Good to hear.
Evan Brand: Yup.
Dr. Justin Marchegiani: Any other updates on your end here?
Evan Brand: Everything’s great. Just seemed to be plucking away at any road blocks that have been in my health journey and—and other’s journeys. So I think every week you and I chatting about a new topic is really empowering people. I’m continuing to get good feedbacks, some new 5 star reviews on this show for iTunes, so everybody seems to be liking the direction that we’ve gone with these—with these episodes. So it’s always good to have the feedback.
Dr. Justin Marchegiani: Love it. Love it. Any good treatment cases last week that you wanna share?
Evan Brand: Last week, let’s see. I’ll look at the calendar and that will help me to refresh my brain. Yeah, actually I do have a good one. So a guy is actually a rocket engineer. He builds rockets for shooting up satellites and spaceships–
Dr. Justin Marchegiani: Yup. Uh-hmm.
Evan Brand: Into outer space and his brain is not working as well as it should be.
Dr. Justin Marchegiani: Uh-hmm.
Evan Brand: So immediately upon starting to work with him, I got the Neuro Synergy product to him, which is several different brain vitamins and I got an email this morning and that said that his brain is starting to work better. So within less than a week, changes in cognitive function, that’s pretty insane. So the huperzine and some of the other brain-boosting nutrients that I’m using with him is very effective. So I think sometimes we don’t have to wait for people to have their lab test results. We can just immediately throw some nutrients their way that we know they’’ll benefit from that might help them and can’t hurt them, so to give them that motivation because you and I like to get people at least 5-10% better each month and if we can get you started on some nutrients while you’re waiting for your labs, then that’s gonna be great.
Dr. Justin Marchegiani: 100%! Same here with me. I mean, we have lots of autoimmune patients that come in every single week. We make simple dietary changes like transitioning to an autoimmune and/or throwing in a low FODMAP eating plan and we see remarkable changes and then we just add just simple things, like getting extra nutrients in through a good high-quality multivitamin. Getting better digestive support on board there, helping to support the hormones and the adrenals or diagnosing any underlying thyroid imbalances and getting rid of infection. It’s amazing just what type of healing capacity the body has when you just remove those roadblocks.
Evan Brand: Absolutely! My sleep’s been better than it has in probably 5 or 10 years. So who knows how long I had my gut issues going on? Like seriously. Every day I wake up, I’m like, “Wow! I was sleeping deep.” It’s just mind-blowing.
Dr. Justin Marchegiani: Well, you’re gonna need that sleep with this new girl on the way here so–
Evan Brand: Tell me about it!
Dr. Justin Marchegiani: You’re gonna need efficient sleep.
Evan Brand: I know.
Dr. Justin Marchegiani: Great. Well, we talked pre-show that we were gonna address some topics of SIBO today, and then we’ve kinda interlaced or intermingled SIBO in other topics that we’ve addressed on parasite infections and probiotics and other types of digestive issues, but today this is gonna be a podcast just focused on SIBO and—and what SIBO is essentially and just to kind of give the abbreviation here, SIBO stands for small intestinal bacterial overgrowth and to keep it really simple is that we have a lot of the bacteria from the large intestine kinda creeping its way back into the small intestine. In a nutshell, that is what SIBO is. It’s basically bacteria from the colon kinda being in the wrong spot in the intestinal tract typically making its way back towards the small intestine. I’ve done a lot of videos on this. I know you have done some stuff, too. So go to justinhealth.com or notjustpaleo.com and Google just SIBO and you get a lot more info on this. But essentially we have that ileocecal valve that kind of is the capacitor that restricts entry from the small intestine to the large and it starts to open up and we start to have this bacteria creeping back into the small intestinal tract.
Evan Brand: Yeah, so looking at some of the research, the latest statistic I found here is that in terms of like irritable bowel syndrome, you know, SIBO is one of the most common causes of IBS, so it certainly could have been a factor for me with my IBS struggle. It says here up to 84% of IBS cases have been linked to SIBO. So if you’ve been told by the conventional doctor, if you go in and you have some of the constipation, diarrhea, bloating, abdominal pain, all the other symptoms that can happen. You go to the gastroenterologist that you probably get referred to, they’ll just say you have IBS. It might be SIBO and that’s certainly what I’ve seen and definitely you’ve talked about it all the time. You see it every single week how many people are dealing with this. So it’s—what would you say? 6/10, 7/10 people that are presenting with gut symptoms actually have SIBO?
Dr. Justin Marchegiani: Yeah, I mean a lot of people that are coming in with digestive issues more than likely have SIBO. The question is, is SIBO the root issue? So we know a lot of the SIBO symptoms are abdominal pain, discomfort, bloating, diarrhea, constipation, gas bloating, etc. And a lot of people that have gluten issue or other infections like H. pylori or parasitic infections or fungal overgrowths which may not be considered SIBO per se, but they tend to mimic a lot of those small intestinal bacterial overgrowth symptoms, so we wanna rule those out because I consider the deeper infections upstream issues and I can consider the lot of the SIBO stuff downstream. Now it’s not to say that SIBO isn’t a contributing factor. It’s not to say that we don’t have to address the SIBO because a lot of the herbs that we use to knock out the higher up infections can be sensitive to a lot of the SIBO type of overgrowth that we see anyway. So in other words, SIBO is important. Most of the people we always wanna rule out the upstream stuff first. I typically don’t ever go to your typical SIBO breath test to evaluate SIBO until we’ve ruled out the deeper infections because if we have H. pylori, if we have a parasitic infection like Giardia, Crypto or Blasto, it makes sense that the collateral damage of SIBO, that bacterial overgrowth will be there.
Evan Brand: So you’re saying it’s not even worth it technically if you just go straight to the typical hydrogen-methane test at this point. We need to really look at running the comprehensive stool panels first with people presenting with these symptoms because that’s gonna give us the most bang for our buck in terms of identifying underlying causes and if you go in and treat SIBO but you haven’t removed the infections and people will still struggle, right?
Dr. Justin Marchegiani: I see that a lot. I’ve seen a lot of patients that have come from other functional medicine doctors that just specialize in SIBO–
Evan Brand: Yeah.
Dr. Justin Marchegiani: And have only had their SIBO treated per se and they may use the—the conventional SIBO antibiotics which are like rifaximin or neomycin, a 10- to 14-day kind of dose of that, typically 500 to 1000mg b.i.d., it depends on what the doctor prescribes on that. So I’ve seen that and then they still come in with symptoms and then we’ll test and then they have Blasto—Crypto or Blasto, and H. pylori. So I think SIBO is important to assess and we’ll talk about how we can assess that but we wanna rule out the upstream. I always upstream to downstream.
Evan Brand: Yeah.
Dr. Justin Marchegiani: What could cause the most collateral damage to the least, that’s kind of how I assess things. It’s pretty conservative that way we’re not doing 100 tests at once. You know, we can start with 1 or 2 tests, focus on the gut, cross those off our list and then go downstream to a SIBO assessment. Now there’s typically 2 for the most part. There’s the more invasive sample where they’re going into the intestinal tract via endoscopy, right? Through the mouth down the esophagus and doing some kind of a sample to look at that—get a—a sample of that bacterial issue, that’s one way. That’s like the most, like the gold standard, because then you know, okay, I’m getting this sample of this bacterial overgrowth sample and it’s coming from the small intestine and we know and we can confirm that shouldn’t be there. It’s an overgrowth. That’s like sample #1 or measure #1 but it’s pretty invasive.
Evan Brand: Yeah.
Dr. Justin Marchegiani: Typically don’t do that unless someone’s very, very sick and it’s typically done by the conventional doctor ahead of time. In a less invasive way, it’s what’s called a small intestinal bacterial overgrowth breath test, where they give a sample of lactulose or sometimes if we’re looking at the upper small intestine, the upper stomach I should say, they’ll—they’ll give a sample of glucose, but typically lactulose because it takes about 100-120 minutes, about 2 hours or so to get down into that lower small intestinal tract, you know, by that duodenum and ileum area, that part of the intestine, and then we can see elevation in certain gases, whether it’s elevation in methane, whether it’s an elevation in hydrogen or we’re looking at a—a combination of methane and hydrogen together, and that’s typically what we’re looking at and we’ll see things, a greater than increase in methane above 3, some will say is an issue and could be indicative or SIBO, some say above 15–
Evan Brand: Uh-hmm.
Dr. Justin Marchegiani: Typically if we’re looking at a combination of methane and hydrogen, somewhere between 15-20 is gonna be positive. Again, some of the test will have these ranges on it like if you look at the National College of Naturopathic Medicine, they’ll have their ranges. Commonwealth Labs will have some ranges, too. I think there’s another lab called ARO Labs, their another one that has–
Evan Brand: I don’t know–
Dr. Justin Marchegiani: SIBO as well.
Evan Brand: I don’t know if you saw BioHealth doing SIBO now. They just released it.
Dr. Justin Marchegiani: Oh, I didn’t see that one.
Evan Brand: Last week.
Dr. Justin Marchegiani: Oh, that’s great!
Evan Brand: Yeah.
Dr. Justin Marchegiani: And it’s breath testing?
Evan Brand: Yup.
Dr. Justin Marchegiani: Oh, that’s great. I’ll have to–
Evan Brand: Yeah, I’ll–
Dr. Justin Marchegiani: Subscribe to that test.
Evan Brand: Yeah, I’ll send you—I’ll send you the clinician sheet about it here. And let’s talk about some of the other causes, too. So you talked about parasitic infections, like if there is an infection in the gut, that could definitely cause SIBO because of the damage that’s gonna be done and you talked about the diet a little bit, too, you know, in terms of like patients doing a lot better with a low FODMAP diet. So if we see like a lot of carbs, sugars, fructose, that’s gonna be an issue. If they were on PPIs before. What are those—what are the common brand names of the PPIs? Is it like a Prevacix, what is it called?
Dr. Justin Marchegiani: Yeah, you have Prevacid. You have omniprazole.
Evan Brand: Prevacid.
Dr. Justin Marchegiani: With the generic.
Evan Brand: Yeah.
Dr. Justin Marchegiani: You have Nexium. You have Prilosec.
Evan Brand: Which are all over-the-counter at this point? They almost all used to be prescription. I guess now the patents are up so people can do and destroy their gut with these things by just jumping on a strong PPI like that. Candida, a lot of times if you have candida, you’ll have SIBO at the same time.
Dr. Justin Marchegiani: Uh-hmm.
Evan Brand: If you went through antibiotics. Let’s say that you’ve got like bronchitis or you got some type of sickness and the doctor threw you on a round of antibiotics. That can really be a good—a good trigger for SIBO and I’ll see that a lot and that’s one of my intake questions is, have you gone through a round of antibiotics recently? And a lot of people say, “Yes.” And so we don’t necessarily have to go straight into the SIBO test like you say. If we get the stool panel run or the organic acids, so we can see like infections and candida overgrowth, a lot of times the treatment for that is gonna overlap and start working at getting rid of the SIBO in a way, right? If we’re using some of these natural antimicrobials and herbs and say oregano, garlic, things like that, we may knock out the SIBO just as a by-product of getting rid of a parasite or bacterial infection.
Dr. Justin Marchegiani: Exactly. So when we look at that, the fore of the first dietary changes we’ll do is that I always typically start with an autoimmune diet because a lot of the symptoms of inflammation can be a lot of SIBO symptoms. So cutting out things like nuts and seeds, and—and nightshade vegetables and even eggs, just off the bat, get them to a baseline autoimmune kind of diet is—is a good place to start. And then from there what we typically do is we assess. We’ll reevaluate a few weeks later to see how we’re doing. We’ll probably add some hydrochloric acid and enzymes in because a lot of patients that have these issues, they’ll have—they’ll have a history of being on PPIs like I mentioned, these acid-blocking medications. These acid-blocking medications create further deficiencies in nutrients, such as various minerals like magnesium, selenium, zinc, and we need some of these nutrients for healthy thyroid, adrenal relaxation, and even to make hydrochloric acid. So you can see once you have one of these underlying issues, they can tend to compound the problem and make it worse and worse over time. So then people continue to get worse over time and they tend to go back and lean on those medications that cause a problem in the first place. So then you got this rabbit chasing its tail around, and the problem gets worse and worse over time.
Evan Brand: Yup. That makes perfect sense. So just in terms of the diet piece, I often hear of like this Specific Carbohydrate Diet which in a way I would say the autoimmune Paleo diet’s pretty close to the SCD, wouldn’t you?
Dr. Justin Marchegiani: Autoimmune Paleo Diet is pretty close to the SCD, yeah. So the SCD, when we look at the SCD, there’s one out there by Allison Siebecker that’s an SCD and a—a SIBO one, a low FODMAP when that’s combined. So in my member’s area, my patients have access to this where we’ll sometimes give the SCD in conjunction with the low FODMAP so the—the SCD is called the Specific Carbohydrate Diet. And what’s different about the SCD is it’s various phases of introducing foods. Typically foods start off, they’re really simple. It’s just meats and maybe some carrots off the bat. Everything’s peeled and even cooked pretty well or even mashed so there’s no outer coating. It’s low in salicylates, low in phenols. So you have your meats. You have basically your carrots and then the next phase you may start to add in a couple more vegetables and maybe a little bit of apple or pear sauce and then you go up to—to level 2 and level 3 and level 4 and you gradually introduce more and more foods. Now if you’re following a straight SCD or Specific Carbohydrate Diet, that may still have some FODMAPs in it. So we gotta be careful. So we may put a combination of an Autoimmune/SCD and low FODMAP together. It really just depends on what the person’s history is. If they have a—an underlying ulcerative colitis or Crohn’s issue. We typically go autoimmune in conjunction with low FODMAP, in conjunction with kind of a low salicylate, low phenol, SCD approach. Because some foods like potatoes are technically low in FODMAPs.
Evan Brand: Right.
Dr. Justin Marchegiani: Same with tomatoes as well, right? Same with eggs. But people that have autoimmune stuff, they may be sensitive to those things. Even nuts are supposedly okay on a low FODMAP, right? Sometimes, alright, if you look at Allison Siebecker’s they’re considered to be okay, but if you look at other low FODMAP diets, nuts are not acceptable and also nuts are not acceptable if you are on an Autoimmune Diet. So we get a little bit more strict on how we approach things, just because I have, you know, hundreds of data points of patients doing well on this approach. So it’s really tough off a bat. It’s not meant for a forever thing, but it’s meant to just kind of cross our T’s, dot our I’s, find out what foods we’re sensitive to, cut out some of the inflammation and significantly reduce a lot of the bloating and gas and a lot of those constipation and diarrhea, SIBO symptoms as we get the person better.
Evan Brand: Yeah, and lot of people if they’ve suffered long enough, they’re open to that and they’re willing to do that but if—if some people they haven’t gone strict with the—the diet, it may feel like we’re taking a lot of good stuff away from you, but this is gonna help to speed up your process of you getting better because if we’re relying just on one treatment whether it’s the herbs or some of the other botanicals, you can get better but it may take longer. So like Justin’s saying here, if we’re improving the diet and stacking that on top of the good lifestyle, getting the good sleep, all the other factors still are important, that’s just gonna make sure that you get better faster, and that’s the question that we often ask is how quickly do you wanna get better? And that will determine, you know, how deep or how intense we can go with stacking all of these on top of one another, and maintaining a normal life that’s pretty free of symptoms overall.
Dr. Justin Marchegiani: Exactly. Yup, exactly, 100%. So regarding some of the testing I mentioned, the glucose testing, to look more in the upper small intestine—on the upper stomach tract. Lactulose is typically, you know, the—the best one so to speak because of the slow breakdown of the lactulose. Again, if we have some type of gastroparesis or some type of significant motility issue, it may take longer for that lactulose to get down there and that we may see an issue with that being delayed on the breath test. Like if we’re only doing a two-hour breath test, right? Like the Genova one, but it takes 3 hours to get down there, we may miss that infection, right’? So some people will actually have them wait an extra hour than start the test at the first hour in and then we can get a good window of that, so and it’s also if faster motility, then it may go too fast, so you gotta have to kinda weigh those, weight the odds of—of both of those different testing there. And then also I did a whole video on how to do some of these tests, alright, like what the data says and what we’re looking at but I kinda mentioned some of the things, greater than 3 on the methane and 15-20 is—tends to the point that we wanna look at for hydrogen and/or methane. Typically 20 or above combined hydrogen-methane is positive, 15 or above for hydrogen, and again that can change from test to test, so I did a deeper video on that and how to interpret it.
Evan Brand: Great. Yeah, and so it looks like—looks like BioHealth is gonna be a better solution than the Genova, looks like there’s 3—it’s a 3-hour test here with 10 breath samples. So I think this might be the new gold standard for us.
Dr. Justin Marchegiani: Oh, I like that. That’s great. I’m gonna have to order one and get access to that ASAP. Yeah, I see, May 23rd. It just came out. That’s phenomenal.
Evan Brand: Yeah.
Dr. Justin Marchegiani: Very cool. So regarding testing we already talked about kinda my philosophy looking at the upstream infections, that’s important. And there’s a lot of people out there, a few people out there I can think of off the bat that are—are not in favor of adrenal testing. Now I understand where these people are coming from, these clinicians. I don’t necessarily agree, because I think people have significant inflammation on their backs and on their bodies, and they have a very difficult time regulating it. And when we see someone that has decent adrenals but has gut symptoms, that matters versus someone that has very impaired adrenals, and what I mean by impaired, let’s say a flat adrenal rhythm, or let’s say a reverse cortisol rhythm and/or very low depleted sex hormones. Now some of these clinicians are basing these off of symptoms but I can tell you many times that I get surprised every now and then and now that I’m doing the 201 by BioHealth and the newer Dutch testing, you’d be surprised how often you get surprised with some of these people’s clinical presentations. And sometimes when I see that, then I got to the thyroid and it’s really the thyroid that’s really the—the weak link in the chain. So I’m a big fan of looking at the adrenals because it gives me the ability to look at what that patient’s capacity for regulating inflammation and stresses and also gives me a window into their sex hormone outputs so how fast they can heal and also how dysregulated is their cortisol rhythm. Alright, the Whitehall study found that the closer that morning cortisol is to that night time cortisol, an increased risk of cancer even greater than cigarette smoking. So cortisol rhythm to me is important and it also gives patients when they come in with a real crappy rhythm or a very low sex hormones, it gives them a bull’s eye to shoot for. So it really creates a significant level of compliance because that patient knows they got a test in 6 months that they’re studying for so to speak, and by studying I mean going all the diet and lifestyle things and being compliant with the treatment because then we can follow-up and see how we’re doing and then we can have a real specific treatment. So to a lot of those doctors out there, I think they’re—they’re missing the boat a little bit and I think they would get better patient compliance and I think they’d be surprised that some patients are probably slipping through the cracks because their adrenals are terrible and that would allow them to provide a better prognosis on where they’re going based on their patient’s inability to regulate stress and inflammation.
Evan Brand: Absolutely. Yeah, that’s a great point and that ties into the gut. People may think, well, why are you talking about adrenals? But this whole adrenal cascade, this is going to affect the gut, so—which we may have talked about briefly in another episode, if you’re unable to regulate your inflammation because you do have adrenal issues then that’s gonna leave you more susceptible to the gut. So if you’re only focusing on the gut and what a lot of practitioners do, I—I mainly think for marketing purposes is to kind of pigeon-hole themselves into being say a SIBO specialist or a gut specialist but you honestly can’t get people better 100% if you are a specialist. Is that a safe statement to make because if you’re only focusing on SIBO and you’re just killing off all of these bacteria but yet they have wrecked adrenals a leaky gut situation is still there because they have say high cortisol all day, you can’t get someone ultimately better. That seems like they’ll just spin their wheels.
Dr. Justin Marchegiani: Yeah, I think it’s great to be able to market to the public as you specialize in this area, but I think it’s important that you still, you know, flex your holistic muscles that yeah, even though I specialize in here, I still connect in the adrenals. I still connect in the gut.
Evan Brand: Right.
Dr. Justin Marchegiani: I still connect in the detoxification issues along with it, so even though we’re really focused on this one issue, we are not myopically focused where everything else becomes non-existent in our periphery.
Evan Brand: Exactly.
Dr. Justin Marchegiani: So I think–
Evan Brand: That’s well-said.
Dr. Justin Marchegiani: I think that’s really important because that’s where conventional medicine’s kinda gone wrong, where the cardiologist only knows about the heart and doesn’t know about the hormones and vice-versa for the endocrinologist and the gastrointestinal doctor, right? But we know how important all of those things are connected.
Evan Brand: Yup, absolutely. I had another thought and I think I lost it. It was about—oh, just in—in terms of SIBO, you know, I’ve already kind of said this so I may be repeating myself but basically if someone is just throwing themselves on the antibiotics or the herbal antibiotics, you may spin your wheels and you were talking about how the—the importance of adrenal testing even for gut issues. Last week, I had a female in her 60s, I—if I would have guessed, I know you and I kind of put things in our head, “Oh I think this person’s gonna show up like this.” I would have guessed that she was flat-lined with her cortisol, however, she had a sum of over 60. Her cortisol sum was insanely high and her cortisol rhythm was insanely high, yet she had tons of fatigue yet had some anxiety in the evening. So I thought, “Oh, maybe we’d see an elevation in the evening.” No, her cortisol was just off the charts, the highest I’ve ever seen ever. And now I found that out and I wouldn’t have been able to start working on the fatigue if I would have thrown her on something stimulating like licorice, I would have created a disaster for that woman. She would have felt worse. So without that piece, it’s really scary to—to jump on a program.
Dr. Justin Marchegiani: Exactly and the big thing we’re trying to do in functional medicine is we’re trying to use objective lab testing to really drive compliance because patients have been told already that have come and seen us that it’s all on their head and they need something to show, “Hey, this is a window under the hood of what’s happening with your physiology, your hormones, and your biochemistry. It’s real.” And then now from that, we’re gonna re-test in a certain amount of time, so the pressure’s on you to be compliant so then they know “Hey, we’re gonna be making these changes and we’re gonna be re-testing,” so they’re gotta do their part. And then also and make sure that we are—we aren’t guessing, we are assessing. Because I get surprised every now and then. So I think some people are missing the boat on that from a clinical standpoint. I understand why they do it because they’re hyperfocused on—on cost and such. And I get it, if someone, you know, has significant financial issues and they don’t wanna do a certain test, but my issue is you wait 2 or 3 months and they’re not quite feeling where they want to, almost everyone regrets not running that test 2 or 3 months ago, right?
Evan Brand: Yeah.
Dr. Justin Marchegiani: It’s never—I mean maybe you may start getting better and you’re like great, it worked out, but if you don’t feel better in that couple of months, then you’re gonna really wish you did that test because then you have a little more confidence in what direction you’re moving forward with regarding your treatment for your SIBO issues.
Evan Brand: Yeah, and that’s sort of like if you’re buying something really cheaply, like say you just buy a little piece that may fit the job for a tool that you needed at home, but then that screwdriver breaks, now you have to go buy another screwdriver and then that one breaks, and then eventually you’re like, “You know what, I’m gonna buy a screwdriver with a lifetime warranty.” It’s just gonna last you a lot better, but yet you’ve spent double or triple because you’ve been trying to only use an incomplete puzzle I guess is what I’m saying.
Dr. Justin Marchegiani: Yup.
Evan Brand: Like if we try to focus on, “Oh, let’s just look at adrenals,” then that’s what—what I did in the beginning because I was just trying to just prioritize things for people and now I’ve come to the conclusion and you have a long time ago, this conclusion, we really don’t want to just look at this one piece. We really have to try to get this full puzzle upfront with someone because then we’re delaying the success that they get and then they blame us but it’s—we don’t have the data, so we can’t work without the data.
Dr. Justin Marchegiani: Exactly. So I always tell patients, the longer you’ve been sick, the more sick you are and the faster you wanna get better, it’s better to pull a couple more labs out so we have a—a more complete picture. The shorter you’ve been sick, the better you feel, and the less motivated you are to get better, then we can start with just like something like one test.
Evan Brand: Right.
Dr. Justin Marchegiani: But I always tell patients, it’s better to do something over nothing because then we can start moving forward versus you know, sliding backwards.
Evan Brand: Right.
Dr. Justin Marchegiani: So a couple more things on the SIBO, a couple of the herbs that—that I formulated and use. I use a couple in my practice. One is called GI Clear One and one is called GI Clear Six. They each have some various herbs I use that have some high amounts of berberines or Artemisia compounds in there, cloves, Java Brucea, wild indigo, just various herbs that had shown to be very sensitive to killing some of the gut bacterial overgrowth, okay? That’s number one. There is some other ones out. There’s been studies looking at the antibiotics, the Neomycin or the—the rifaximin and rifaximin is the same thing as Xifaxan, FYI. And then the combination of the—the neomycin with the—the herbs. So looking at just the antibiotics and then looking at just the herbs, there’s been some studies showing that herbs actually work better. Now when in doubt, if you’re gonna just say, “Well, I wanna go the antibiotics,” still go with the herbs because the herbs have a really good effect at knocking out biofilms, too, and some of the antibiotics won’t touch the biofilms, that’s number one. And then number two, people need a longer dose of these antibiotics and people that do long-dose antibiotics can wipe out a lot of their beneficial flora so combining it if they are with the anti—with the herbs are gonna be beneficial because herbs are shown to be just better clinically taking it over the long period, safer, less side effects than a lot of the antibiotics would. And you have couple 10,000-year history with these herbs being used by various tribes and cultures to help with infections and parasite stuff and like wormwood and with malaria, and like mastika on the island of Chios in Greece for all kinds of different issues with the H. pylori and other issues. So it’s nice to use the herbs. I’m biased towards the herbs because of their safety, because of their long-term history and because of our ability to use it long-term and the ability to affect things like efflux pumps, which are kind of the bacterial way of bailing water out of sinking ship. So imagine antibiotics coming in and the—the ship bailing, and those antibiotics back into the intestinal tract creating more bacterial overgrowth because it’s knocking out a lot of the good stuff. So those efflux pumps get affected more by the—the herbs and they also affect some of the biofilm, which are like the protective shields that these infections use to protect themselves from getting killed.
Evan Brand: Yeah, I’ve seen a few studies about enteric-coated peppermint oil as well.
Dr. Justin Marchegiani: Yup.
Evan Brand: And I used that when I suffering a lot with IBS. I wasn’t into the herbs, so I didn’t know enough about the herbs at that point. So I was using the peppermint oil and I had great success and that’s something I’ve given to my dad, too. He’s had a lot of issues with his gut and it has been incredibly helpful. It’s hard to find a clear piece of research that says whether you would be able to use the enteric-coated peppermint oil specifically for treatment of SIBO, like if you can knock it out by itself, what do you think? Maybe in a—in a low overgrowth situation, it could give you some antimicrobial benefit but I think you’re probably gonna need a bit more of a well-rounded approach by adding in the herbs on top of that.
Dr. Justin Marchegiani: Yeah, I mean, typically I would never rely just on one herb by itself.
Evan Brand: Yeah.
Dr. Justin Marchegiani: I would do a combination of a couple. If you look at my GI Clear One and GI Clear Six, we do that in those products. In my GI Clear Five, that’s the pure emulsified oil of oregano; we’ll hit that up really hard as well and then we’ll even use my GI Clear Three which is silver and that’s a really good biofilm buster, and then we always like to throw in ginger because there’s a lot of research on ginger busting out biofilms, too. So we do a combination of different things and we’ll even interject the low FODMAP diet and sometimes we’ll even start eating a little bit of FODMAPs while we’re doing the killing because it’s kinda like putting cheese on a mousetrap for the so-called mouse, i.e. the bacteria to come out of hiding. When it comes out—BOOM! We’ll use those herbs and really knock them down to size.
Evan Brand: That’s great! That’s really interesting concept there.
Dr. Justin Marchegiani: And look at your situation, right? You would have what I would consider to have a—be a lot of SIBO symptoms. Like if you went to one of these SIBO docs that are out there, the first thing they would have had you done was SIBO testing–
Evan Brand: Yeah.
Dr. Justin Marchegiani: Without a doubt. But look, what came back on a stool culture, right? We’re talking an actual, you know, under the microscope, you know, stain/culture diagnosis. You came back with Giardia and Crypto, correct?
Evan Brand: Correct.
Dr. Justin Marchegiani: Yup. If you did a breath test, you would have came back and they would have been just all 100% myopically focused on the gases. “Oh, those methane and hydrogen are high, we gotta knock them down.” But if you looked upstream, you’d see you’ve had 2 major infections that would have been missed.
Evan Brand: Yup, I know. And I—I would have suffered. Maybe depending on how heavy hitting the treatment would have been for the SIBO. If it was a very heavy hitting treatment, tons of garlic, tons of the oregano, the berberine–
Dr. Justin Marchegiani: They have may have got it by accident, right?
Evan Brand: Exactly. But I wouldn’t have known and what if I—let’s just say, what if I did the SIBO treatment for a shorter duration than necessary to get rid of the parasites then my symptoms would have come back and then I would have been well, that didn’t work, why not?
Dr. Justin Marchegiani: Right?
Evan Brand: So–
Dr. Justin Marchegiani: Especially a lot of these SIBO infections aren’t known to be as contagious like these parasite infections. These parasite infections can be fecal-oral, can be spread by intimacy wherein not quite as much as with the—the general SIBO stuff, right?
Evan Brand: Yup.
Dr. Justin Marchegiani: Because the SIBO really is a whole bunch of different bacteria that are just overgrown so to speak. So–
Evan Brand: Right.
Dr. Justin Marchegiani: We—we wouldn’t think of that as being like a—a contamination or potential, you know, thing that can be vectored per se, but when we deal with infections, H. pylori, to—kind of be added in there, we have a different perspective on the—you know, the spouses and the partners that could be affected in there and contaminated with.
Evan Brand: Yup. And so I think that’s a pretty good overview. We talked about the testing, getting the full panel run, making sure you’re getting some stool testing run with your practitioner, making sure you’re getting some adrenal testing to see how much is this cortisol issue—how much is that contributing to your leaky gut, making you more susceptible to pick up bacterial and yeast overgrowths and parasite infections. And then we talked about some of the herbs and then combining those for the synergy. We talked about the diet in terms of watching out for the FODMAPs potentially doing like an SCD or an Autoimmune Paleo Diet for the time being then re-introducing things, seeing how you feel. Is that—is that the 4 pillars? Is there any other missing piece?
Dr. Justin Marchegiani: Yeah, for the most part. Let me just go through it at my head. We have the 5R’s. So we’re removing all the bad foods, right? This could be but not limited to autoimmune foods–
Evan Brand: Yeah.
Dr. Justin Marchegiani: SCD, low—low, cutting out the higher phenols and salicylates. Cutting out the FODMAPs and potentially even cutting out histamines. The more messed up someone’s gut is, the more they have to be diligent and vigilant on their diet in the beginning. So some of these things may have to be removed. Next R would be the replacing. Replacing enzymes and acids to really help with the breakdown of these foods. Third R would be repair. Repairing the gut lining and/or adding in, repairing nutrients to reduce inflammation. So we may add in some specific strands of probiotics to help with the inflammation and the repair side. And also the adrenal piece, right? Helping to regulate inflammation better so we can put out the fire in our gut and we also know the adrenals are important for IgA production. Very low cortisol will affect IgA. So the repair involves potential probiotics, potential anti-inflammatory nutrients, and potential adrenal support. Fourth R is removing the infections, anywhere from the parasite to the—to the bacterial issue, to the fungal overgrowth to the SIBO, and the fifth R is gonna be reinoculation where we really focus on the probiotics even through it’s not a forever kind of thing. It still has an effect of receding at least for a month at a time and then the last piece after those 5 R’s are completed are retesting, making sure there’s no lingering infections that come to the surface.
Evan Brand: Nice.
Dr. Justin Marchegiani: That’s–
Evan Brand: Well said.
Dr. Justin Marchegiani: Yeah, that’s the overview.
Evan Brand: And—and I like how you painted out—you painted out the order of operations there and you did not say probiotics first. I think you and I discussed the female patient I had where she went to the naturopath, threw her on like a heavy—heavy dose of the soil-based probiotics and she blew up like a balloon, felt awful, tons of symptoms. Wrong order, wrong treatment.
Dr. Justin Marchegiani: Yeah and also if we’re gonna do specific kind of probiotics, I’m a bigger fan with my sensitive gut patients to use the one called Megaspore.
Evan Brand: Yeah.
Dr. Justin Marchegiani: It’s typically a Bacillus clausii, subtilis, coagulans bacillus kind of spore-like strain. It tends to be more sensitive to people that are what I call probiotic-intolerant. They get a lot of gassiness and bloating and digestive symptoms from probiotics.
Evan Brand: Yeah, she—she felt horrible and I was so glad to finally see in the flesh just because treatment sounds good, you just talked about the 5 R’s, you can’t just go straight to number 5. You have to do 1, 2, 3, 4, 5.
Dr. Justin Marchegiani: Most people wanna go to number 5 or number 4 because it’s sexy, right? Oh, probiotics and this!
Evan Brand: It is.
Dr. Justin Marchegiani: It’s just sexy.
Evan Brand: Yeah.
Dr. Justin Marchegiani: But number 1 off the bat, before they even, we have the 5 R’s, is gonna be get some testing done, right? Ideally, once you’ve—let’s say you tried cutting the FODMAPs out and you’re done AIP, great! If you’re getting results, good. I strongly encourage you at some point to dig in and get some testing done, right? That’s where looking at the body systems would be super helpful, organic acids testing and/or adrenal and/or gut testing will be helpful. The more symptoms, we may dig in to thyroid stuff. That way we get a complete picture. Now the worse thing you wanna be dong is guessing and then having all these things happening where you’re starting to get worse over time and you don’t know and you get—start getting scared and you’re like, “Well, what do I do next?“ Having the testing is super helpful and having a clinician that’s been there a couple thousand times really gives you a lot of confidence because, you know, if I’m climbing Mt. Everest and something happens, I wanna have a—a Sherpa or someone with me that’s—that’s been up that mountain dozens of times that knows the ins and outs.
Evan Brand: Absolutely, yeah. That’s a great point.
Dr. Justin Marchegiani: Any other comments on that? So we have the testing. We talked about the SIBO testing. We talked about the breath testing and just to kinda correlate symptoms, increase in methane gas can typically mean constipation, increase in hydrogen typically means diarrhea. We can have both. We can be alternating. So it’s to be able to coin some of those symptoms, right? Either diarrhea or constipation or some of the gases. It may hold true, it may not. And then we talked about the—the different testing, either the endoscopy sample. We talked about the breath testing. We talked about the actual gut testing as well, looking for the parasites. And then we talked about the periphery testing, either the adrenals or deeper organic acids testing to look downstream.
Evan Brand: Yeah, but say the only thing I would add to that is don’t be alarmed necessarily. This is a good conversation to have with your specific practitioner, but don’t be alarmed if things do get a little bit worse before they get better, especially if there’s like a parasite like I was dealing with. Things got a little bit worse before they got better. So don’t assume that it’s just gonna be–
Dr. Justin Marchegiani: Yes.
Evan Brand: A—a miracle solution. There may be this readjustment period that you’re gonna have to work through, a couple of speed bumps along the way but that can be normal to have an exacerbation of symptoms before they get better. And that’s—and that may be okay–
Dr. Justin Marchegiani: Yeah.
Evan Brand: But you need to talk with your practitioner to make sure.
Dr. Justin Marchegiani: Yeah and a good—some good references on the mainstream for this article here or this podcast would be Dr Pimentel out of the Cedars-Sinai over—over at California, Los Angeles there. Also Allison Siebecker and Dr Sandberg-Lewis out of NCNM, over at National College of Naturopathic Medicine. Those are some good resources and references on the whole SIBO thing here outside of you wanna kind of dig in to nitty-gritty, those are some good places to look.
Evan Brand: Good stuff.
Dr. Justin Marchegiani: Any other questions, Evan? Or comments or concerns?
Evan Brand: Not—not for today.
Dr. Justin Marchegiani: Like it, man! Well, go out and get sick people well and I’ll do the same.
Evan Brand: Amen!
Dr. Justin Marchegiani: Have a good one and best of luck with Summer coming into the world.
Evan Brand: Oh, thank you.
Dr. Justin Marchegiani: Take care, Evan.
Evan Brand: Take care.
Dr. Justin Marchegiani: Bye.
Evan Brand: Bye.
Paleo 101 Part 2: Top 3 Roadblocks When Going Paleo
By Dr. Justin Marchegiani
Welcome to Part 2 of our Paleo Diet series, where we are looking at lab markers to help you transition successfully to a healthy diet and the roadblocks that can get in your way. In part 1 of our Paleo Diet series. We discussed inflammation, blood sugar, and lipid lab markers and what to look for on these tests as you begin a Paleo diet, or template. Briefly, we want to see your lipids improve, whether it’s triglyceride to HDL ratio of cholesterol to HDL ratio, and we want to see improvement in inflammation and blood sugar. These would be the nice benefits of an anti-inflammatory, nutrient-dense, low-toxin eating plan.
So let’s say you’re one to two months in, and you’re seeing some improvement. It’s going well, and you’re on the right track; but now, you’re hitting some roadblocks. Maybe you’re fatigued or have energy issues, your fingernail quality doesn’t look good, you still have some digestive issues (bloating, gas, constipation, or diarrhea). And maybe they have gotten even worse since you you’ve increased your protein content.
Anti-inflammatory, nutrient‑dense, low-toxin food should not make you feel worse unless your digestive system is impaired in some way or another. So now, it’s time to dig in a bit deeper and get those roadblocks out of the way.
What Are the Paleo Roadblocks?
The three main roadblocks we’re going to address are anemia, infections, and thyroid issues. We’ll also cover the lab markers we would look at when considering each.
In people whose hydrochloric acid (HCl, stomach acid) levels are low, anemia can be an issue. Interestingly, this happens in people who eat a lot of easy-to-digest food. Because of anemia, their stomach acid and their digestive secretions weaken because they aren’t staying tuned up with the proper proteins.
This is seen in people who have a strictly vegetarian or vegan diet. There may even be some gastrointestinal inflammation preventing us from binding minerals. And the low HCL may be preventing us from ionizing so the minerals, such as iron, calcium, selenium and magnesium can get into our bloodstream.
Lab Tests for Anemia
When we see anemia issues, the first pattern we’ll look for is a decrease in red blood cells, hematocrit, and hemoglobin. It may not necessarily be low, but it may just be in that bottom 20% of the range. This will tell us if there’s a broad-spectrum anemia.
The next anemia pattern we’ll look for is through the iron panel. TIBC and UIBC are different iron-binding proteins, and they actually tend to go high when iron is low. So the more binding proteins we have, the more iron our body needs. We will also typically see iron saturation and ferritin levels drop. If we see these markers in our anemia patterns, then we know we probably have an iron-based anemia.
We’ll also look for anemia patterns through B vitamin markers. We’ll look at MCHC, MCV, and MCH. These markers just tell us how big the red blood cells/hemoglobin are. The bigger our red blood cells are, the more immature they are. Red blood cells get smaller as they mature. So this will be an indicator of two kinds of anemia—B vitamin and iron.
A chronic infection, such as a parasite infection, bacterial infection, viral infection, or even a fungal infection, may be present. These infections will affect our immune system. About 70–80% of our immune system lives in the gastric associated lymphoid tissue (GALT) of our stomach and in the mucosal associated lymphoid tissue (MALT) of our intestinal tract. So with so much of our immune system living in our stomach and intestinal tract, it’s clear to see why an infection could be affecting our ability to properly absorb nutrients.
When we have digestive immune stress, it fires the sympathetic nervous system (i.e., our fight-or-flight system). We have two branches to our nervous system. Our sympathetic nervous system is our flight-or-flight nervous system, and our parasympathetic nervous system is our rest-and-digest system.
When our sympathetic nervous system is fired up, it’s going to drive more of our fight-or-flight response. It will decrease hydrochloric acid and enzymes, and it will increase blood flow to the extremities—arms, hands, and feet—to allow us to fight and flee. This is one of the major issues when we’re under chronic stress, and those stressors could come from infections.
Lab Tests for Infections
One lab test we would look at for infections would be a stool panel, and not just the conventional hospital or Lab Corps tests—I run many of those and they sometimes miss the infection. We would run a specialty test, especially the DNA, PCR-based testing. We have a higher level of sensitivity and specificity on them. Also, we can draw conclusions from a CBC with differential panel. This looks at our white blood cells—our neutrophils, lymphocytes, monocytes, eosinophils, and basophils (an easy way to remember these: Never Let Monkeys Eat Bananas). We might consider the following based on an increase in these cells:
- Neutrophils—If we see neutrophils high, we’ll consider a bacterial infection. Particularly high neutrophils, above 60, and we’re automatically going to gravitate toward pylori issues.
- Lymphocytes—If we see lymphocytes low, we automatically think a chronic viral issue; if we see them high, we think acute viral issue. When we see lymphocytes low, however, along with neutrophils high, this is a common pattern for an pylori bacterial infection.
- Monocytes—If we see monocytes high, it typically means our immune system is fighting an infection.
- Eosinophils—If we see eosinophils above three, we almost always think parasites. At this point, we would run those specialty stool tests because they will help us determine exactly what type of infection we are dealing with.
- Basophils—If we see basophils go out of range, typically above one or two, we start to think tissue inflammation and potential allergies.
Next we have thyroid issues. Cold hands, cold feet, constipation, mood issues, and energy issues are all signs the thyroid is not functioning appropriately. So we’ll want to run a complete thyroid panel.
Lab Tests for the Thyroid
We typically run our TSH, which is a brain hormone. This gives us a peek inside the window to what’s happening with our brain and how it’s communicating with our thyroid. We’ll also look at thyroid hormones: free T4 and T3, total T4 and T3. T4 tells us what is coming out of the thyroid tissue, and T3 gets converted by the liver and intestines, by healthy stress levels, and at the thyroid (about 20% gets converted at the thyroid).
We’ll also run our antibodies, too, which are basically looking at our immune system. Our immune system could actually be attacking our thyroid gland and making various antibodies called TPO, TB antibodies, thyro-binding globulin antibodies, and even TSH receptor site antibodies. This would tell us if we are dealing with an autoimmune thyroid condition, such as Hashimoto’s thyroiditis.
It takes time when transitioning to an anti-inflammatory, nutrient-dense, low-toxin diet. The Paleo template will get you on the right road, but you will likely encounter a few roadblocks along the way. Don’t let them dissuade you—address them one by one, and before you know it, those roadblocks will be far behind you.
The SIBO Solution—Getting to the Root Cause of Small Intestinal Bacterial Overgrowth
By Dr. Justin Marchegiani
Have you been diagnosed with and treated for small intestinal bacterial overgrowth (SIBO), and you still don’t feel any better? I see this over and over again—patients coming in after traditional treatments for SIBO, but they still feel terrible. Why is this, and what can you do to successfully tackle your SIBO? I’m going to break this down in three steps. I will address the fact that SIBO can be connected with other infections or dysfunctions, making it particularly difficult to treat.
What Is SIBO?
Small intestinal bacterial overgrowth (SIBO) occurs when various bacteria living in our large intestine migrate back up into our small intestine. Our intestinal tract is about 21–22 feet long. Our stomach contents empty into our small intestine. It undergoes a series of biological processes before eventually emptying into our large intestine where a variety of bacteria, good and bad, live.
Once the bacteria from the large intestine invade the small intestine, these bacteria spit off various hydrogen or methane gases. When we do a lactulose breath test, this is what we are measuring, the hydrogen or the methane generated by the bacteria.
Hydrogen gas, for instance, is known to be associated with diarrhea, and methane gases are known to be associated with constipation. A lot of people who have SIBO may have a combination of hydrogen and methane, thus creating an alternation between constipation and diarrhea; this is very common.
The simple fact that these bacteria are now where they aren’t supposed to be, in the small intestine, disrupts digestion by affecting peristalsis (the contractions of the intestines that allow the contents to move through at a normal pace) and makes the gut very uncomfortable. When peristalsis is moving the contents too fast, we can have malabsorption where there’s not enough time to properly absorb the nutrients from our food. When peristalsis is moving the contents too slow, this can cause autointoxication where we absorb fecal toxins.
Once we have SIBO, there are some steps we can take to eliminate it.
Step One: Treat SIBO
Step one is to treat SIBO by starving the bacteria of the foods they thrive on:
- complex carbohydrates: oatmeal, potatoes, and other natural sources of carbs,
- simple carbohydrates: sugars, breads, sodas, and other processed carbs.
Starving the bacteria is like not filling your car up with fuel: eventually, it’s going to die. Starving the bacteria doesn’t mean you starve yourself. You just change the foods you are consuming. I recommend removing or lowering FODMAPs or changing to an autoimmune Paleo diet because there could be other food allergens, like eggs, beef, nuts, or seeds. That may not be high in FODMAPs but still may be disrupting and creating inflammation in the gut.
Step Two: Attack SIBO with a Functional Approach
Step two is to attack SIBO with a functional approach toward killing it. There are a couple of different approaches.
- conventional approach, which typically uses a combination of the drugs rifaximin and neomycin in a 500 mg twice-a-day cocktail over a two-week period.
- functional approach, there are a few antimicrobials we may rotate and use: allicin (the compound in garlic that makes it most active), neem, berberines, goldenseal, barberry, Oregon grape, oil of oregano, cinnamon, biofilm busting enzymes, and these are just to name a few. There’s some research showing the antimicrobial herbs tend to be a little better with less side effects. My bias is toward the natural antimicrobials because I’m a functional medicine physician who focuses on natural treatments.
If someone just has a SIBO infection, we can use that antimicrobial approach to knock it out of the park. But the challenge with either approach (the antibiotics and the antimicrobials) is that a lot of times people have a bigger underlying problem—an H. pylori infection, an amoeba, a protozoa, a worm, a parasitic infections, and so on—that really forms the hierarchy of the SIBO. The SIBO antibiotics and antimicrobials may not touch the underlying infections.
I saw a patient who tested positive, a year or two earlier, for an Entamoeba histolytica infection. That’s one of the mothers of all parasites, and it kills hundreds of thousands of people a year in third-world countries because it dehydrates them, causing diarrhea. She was treated four or five times with Rifaximin and Neomycin by leading conventional experts in SIBO in this country. At first, it reduced her symptoms, but those symptoms started coming back because while those antibiotics might tackle SIBO, they won’t touch an E. histolytica infection; they aren’t strong enough for that specific kind of amoeba.
So there may be a more supreme infection at the root cause of your SIBO, and that infection may be why the bacterial overgrowth is there in the first place. In order to kill SIBO, the root-cause infection must also be treated, and there are functional ways to treat these infections as well. So the goal is to determine if there is an bigger underlying infection, and if so, that needs to be knocked out before attacking SIBO with the functional approach.
Step Three: Crowd Out the Bacteria
Step three, we crowd out the bad bacteria with the good. Good bacteria includes Lactobacillus casei, Lactobacillus plantarum, various Bifidobacterium, and even soil-based probiotics.
So imagine the various good bacteria—we’ll call them GB—come in and gain a foothold. They take up a lot of the space that had been inhabited by the old infectious material. It’s like at the Grammys when a celebrity leaves his or her seat; a seat-holder (someone paid to sit in the seats so the theatre doesn’t look empty on TV) sits in the seat until the celebrity returns. But in our case, the GB, the good bacteria, have no intention of leaving their seat when the bad bacteria try to return. That’s what the probiotics have a really beneficial effect in doing—crowding out the bad bacteria.
Probiotics also affect the pH, and that can improve B vitamins and various nutrients, like vitamin K, as well. So there’s more than just the crowding-out aspect. There’s also a nutrient and an environmental aspect.
The Importance of Supporting Organ Dysfunction
This is the foundational piece that a lot of doctors miss: supporting organ dysfunction. Let me explain. A patient comes in and has SIBO, iron-based anemia, adrenal fatigue, and Hashimoto’s (an autoimmune thyroid condition). If we just treated this person’s SIBO—let’s say we cut the FODMAPs and treated, attacked, and crowded out the SIBO—how would that patient do?
Depending on how good or bad the patient’s thyroid, adrenals, and anemia are, he or she would probably still feel terrible. So the rule of thumb is to support the dysfunctioning organ.
If we have an anemia, we have to get that fixed; if we have indigestion, we have to get the enzymes and the hydrochloric acid (HCl) functioning. We have to support the adrenals first and the thyroid second or at the same time, depending on how bad the thyroid is (the worse it is, the sooner we treat it). From there, we want to support the sex (male or female) hormones. So we really want to support the body’s ability to regulate energy.
Hormones are either a carpenter or a fireman. We have natural “fireman” hormones, like cortisol, that are like water putting out the fires of inflammation. And we have “carpenter” hormones, like DHEA, progesterone, estrogen, and testosterone, that are anabolic and help build us up. If the body is under chronic stress, chronically inflamed, it’s going to deplete its level of carpenters. The carpenter’s ability to rebuild, its firefighters, or its ability to put out the fire are affected. So we always need to support the organ dysfunction.
In summary, we support the following:
- adrenal’s ability to maintain a healthy cortisol rhythm, as well as the amount of cortisol that may be needed
- thyroid function. Whether its natural desiccated thyroid or nutrients for thyroid conversion.
- digestive system, like HCl and enzymes to maintain protein and fat, and even bile salts support to maintain gallbladder production.
- detoxification pathways
- extra amino acids
It’s important to not just knock out the SIBO and its underlying infections but also to make sure all the organs are functioning optimally and the body is in balance because you’ll feel better faster.
If you have SIBO or digestive symptoms and you want dig deeper into what the underlying cause may be, you may want to try the SIBO Solution—starve it, attack and kill it, crowd it out, and support the organ dysfunction. It’s important as well to choose the right natural supports to address the underlying infection.
How to Heal Your Gut Steve Wright Podcast #16
Dr. Justin and Dr. Baris interviewed health coach Steve Wright, co-founder of the SCD Lifestyle which is a community of health experts dedicated to help people heal their guts and take responsibility for their health and body.
In this podcast, discover what SCD or Specific Carbohydrate Diet and how to use it to help restore one’s gut health. Learn the healthier way of dealing with constipation without using Psyllium husk. Understand why the functional medicine approach to treating patients is much more effective and beneficial than the insurance based approach to treatment. Also find out about the common gut infections and key lab testings to accurately detect them.
In this episode we cover:
05:44 SCD versus GAPS Diet
14:07 Psyllium Husk and Constipation
31:20 Functional Medicine Model vs. Insurance Model
35:50 Key and Foundational Lab Testings
45:16 Other Clinical Markers for Infections
Baris Harvey: Welcome to another awesome episode of Beyond Wellness Radio. In today’s episode we are interviewing Steve Wright of scdlifestyle.com. Steve is a health practitioner. He is also known as a poop specialist in our space.
Dr. Justin Marchegiani: Laughs
Baris Harvey: He struggled with severe IBS and digestive problems and now helps other people fix their guts. So, how is it going today, Steve?
Steve Wright: Great man. Thanks for having me on.
Baris Harvey: Yes, it is awesome to have you. How is it going today, Dr. Justin?
Dr. Justin Marchegiani: It is going great Baris. I am really excited for today’s podcast.
Baris Harvey: Yes definitely. So Steve, I gave a little quick introduction but for the people out there who do not know about you. Could you give us a little background about your story? I know one thing that I like, we actually just did an interview with Garrett and he had a different, like an engineering background and you also did some electrical engineering in the past. Can you tell me about your background and how you got led into this health space?
Steve Wright: Yes, definitely. And that is actually what I tend to call myself, as a digestive engineer or a health engineer. I have in the past few years worked with people one-on-one but I have recently stopped doing that. So I guess I am no longer officially any sort of practitioner. It is sort of everybody’s story of how you ended up in the space. I had an issue and no one in the modern medicine system was giving me any relief at all. Not even a small amount. And so my background from college was electrical engineering and I think what engineering in college does teach you is, it teaches you to be okay with really complex problems and problems that has unknown parts of them. And so once I really realized that food was a big thing in my digestive issues. I had a really, really bad IBS with gas and bloating that was like so bad it would make me want to cry. But then when I farted I would feel so good but it would smell so bad.
Dr. Justin Marchegiani: Laughs
Baris Harvey: Laughs
Steve Wright: It was like those kinds of farts that nobody wants to claim, like you are afraid that something died in you.
Dr. Justin Marchegiani: Laughs
Steve Wright: (Laughs) So, it was a very diabolical problem everything I had to eat. I had all kinds of other symptoms that was just my big pain. I had cystic acne. I was 30 pounds overweight, used to be 60 pounds overweight and all these different issues. And one of my good friend Jordan, my business partner now, he was celiac and he was getting help from gluten-free and a practitioner put him on a Specific Carbohydrate Diet and he stated getting better. And so in a moment of fury and just tears and “upset-ness” I called him one day and he convinced me to give it a shot. And in 3 days into changing my diet my gas and bloating was gone. And so at that point it was when I felt empowered. And suddenly I had started to take a little bit of responsibility for my own health and not outsource it to cure everything. And so between kind of being angry and really sick that kind of led me to like sort of own my training and as far as problem solving goes and take responsibility. And so it has been a 5-6 year process now of, “Okay well, that feels better but how much more energy could I have? Can I have clearer skin? You know, could I go from a very strict diet that works very well to a diverse diet that is like 80-20? You know, can I do a sprint triathlon? Can I go backpacking for multiple days up in the Rocky Mountains? And just kind of every layer to sort of getting my health back to levels I never thought existed. And then each time I find something that works I try to turn around and educate the public about it or create some sort of program to allow people to do it cheaper, better and faster.
Baris Harvey: Definitely, that sounds good. That is a good overall view of what happened. And I like the fact that you had to go on a strict diet because of how much healing you needed in the past but also where now you probably can be a little bit more lenient and not so strict on your diet. Do you still have to be pretty precise? Do you notice like a definite change when you eat like maybe the wrong foods? Or is your body a little bit more shall I say resilient to that now?
Steve Wright: I definitely have a much more resilient health perspective at this point or health level at this point. I mean I can eat gluten for like a meal or two. Anything more than that my skin will like instantly begin to breakout and I will feel some fogginess in my brain sometimes as well. So I still have sensitivity to some types of foods. And in general, I eat all whole foods, typically. If I do go out, I am going out to the best restaurants eating very much it is like Paleo with some Weston A. Price sort of mixed in. So I will eat legumes like once a week properly prepared. Obviously, I would eat high quality dairies from time to time. But in general, 85-90% of my template diet is meats, fruits, vegetables and healthy fats. You know, that type of thing.
Dr. Justin Marchegiani: That is awesome. That is awesome. So Steve, this is Justin here. A couple of questions for you on the SCD diet. I have used that diet with my patients quite frequently especially the ones that have colitis or Crohn’s disease, etc. And I also use the GAPS diet or the into phase diet for GAPS. And I am just curious, when you are working with patients, how would you apply the SCD versus GAPS and when would you choose one over the other?
Steve Wright: Great question. So essentially, what we use at SCD lifestyle and what I would use with people is basically the best of both worlds. So in my opinion, the Specific Carbohydrate Diet as it was written by Dr. Sidney Hass or as it was written by Elaine Gottschall in her very popular book “Breaking the Vicious Cycle” is incomplete. And the work of Dr. Natasha Campbell McBride has done with the GAPS diet again, all of these people are amazing and they helped saved my life. So this is not a sort of walking on them. We need to continue to further the ability to help people. And so both diets by themselves and silos have disadvantages. And they do not seem to produce consistent results for the majority of people who tried them. They seem to maybe only serve 60% or 70% or something like that.
Baris Harvey: Steve, real quick, I think some listeners might not know kind of the overall, what is, before you kind of go into what you do with clients, could you go to a quick brief overview of what the SCD lifestyle or the SCD diet kind of consist of? And also what the general basis of a GAPS diet is?
Steve Wright: Sure. Sure, yes. And that is a great point. We should probably define what we are talking about.
Baris Harvey: Yes definitely.
Steve Wright: Great, great point Baris. Yes, so the Specific Carbohydrate Diet started in the literature in the 1920’s. Essentially the diet as it was written through those various evolutions I just mentioned, is a diet that is processed food free, additive free, grain free and polysaccharide or disaccharide free even though that is a little bit of a debate right now if you get into the minutiae. But essentially, what is allowed on Specific Carbohydrate Diet are properly prepared legumes, some fermented dairies such as cheese or homemade yogurts. Meat, fruits, vegetables, nuts all of those types of things. And there are specific, for instance, Elaine Gottschall chose to not include seaweed and multiple other specific parts of fruits that have polysaccharides. And the basis for that is just that when your gut is really messed up, you cannot breakdown those carbohydrates chains and actually absorbs them and end up feeding bacteria or feeding the gut dysbiosis that might have already be going on. So, Dr. Natasha Campbell McBride saw the golden SCD and took that and made it as the underlying foundation of GAPS. And what she did was she essentially innovated on top of it to really help her autistic son. And so she removed dairy from it because a lot of people have dairy allergies and totally understand that. She also added in juicing. She added in like some specific probiotic recommendations. She did come up with like a lengthy Intro Diet whereas SCD has sort of an initial phase diet like 3 or 5 days whereas the GAPS intro phase can be much longer. And so both of them have a lot of merit and they help a lot of people. And I think Dr. Natasha Campbell McBride totally hit on something that we also abide by at SCD lifestyle which is that dairy is very reactive. And we personally tell everyone no dairy for 30 days. You know, always be testing it. And then if you do happen to be okay with dairy, I think it is a really powerful food group that you should not completely exclude. And so that is one of my sort of beefs with the GAPS diet. As far as like how do we use either one? It is a great question. So, essentially, it comes down to I think creating your own custom diet. And both diets could get you there. Might be for GAPS really is that the juicing can be overtaxing if you are already learning how to cook and how to shop again, how to clean up. And so if you want to add on top of that another layer of juicing, those are more skills and more money where the bang for the buck only seems to be there for a certain set of people who have really bad detoxification issues. And for other people who have like SIBO, that is small intestinal bacterial overgrowth or other really bad gut dysbiosis the apple juicing can really affect them. And if you have someone who switches diets in the first week or two and all they do is feel worse they are not going to stick with it. And so once again I am not against juicing. I just think it is something that you add later as you begin to jump into this lifestyle. So basically my overall thing is start with meat, fruits, and vegetables. Cook everything. And we have like phasing charts over at scdlifestyle.com but I am kind of staying away from actually like the cruciferous family in the beginning because those can be hard to breakdown because it has a little bit more complex molecules and fibers in those. And really just starting from a cooking standpoint. The GAPS intro can be like no fruits and vegetables. And I think that works for some people but in general from a satiety standpoint and from the ability to stick to a diet, I think there needs to be some sort of compromise there. And so that is kind of what we are trying to do at SCD Lifestyle. It was like we saw these people failing in multiple ways and we are like, “Okay, let us just take the best practices and sort of begin to coach people through that.”
Dr. Justin Marchegiani: Awesome. Those are some great points, Steve. So looking at the SCD and looking at GAPS, one thing I noticed on the GAPS side is the big emphasis in bone broths. I do not quite see that on the SCD side. So I just wanted to kind of figure out how you apply, how you use bone broths. And just one layer on top of that is I kind of want you to go into FODMAPS. Because I know even in the GAPS intro they still talk about adding in broccoli and cauliflower and even onions at some points. And I see in the intro diet they even mention apple cider and things like that in one and two and then avocado I think in phase two or three. So I want to get your take just to rehash that on when you apply broths and do you ever take FODMAPS 100% out of the equation? And you probably even want to go into what FODMAPS are, too.
Steve Wright: Yes, yes that is a lot of stuff to unpack there but great questions, Justin. So let us start with the bone broth. Yes, bone broth can be like this amazing human food and I do think it should be very much a part of a healthy person’s or a person who can digest it very much a part of their life. You know, hopefully having it on a weekly basis if not a more often basis. Now you know some people love it every day. And I think it is a great food for that. So I love the fact that the GAPS diet really elevates bone broths and talked about it a lot because it does seem to be like a needle mover for a lot of people. And so I think we have to always keep our eyes on the different needle movers because you know something like maybe supplement x is really good for your health but it is maybe not going to like really cause massive change in a month or something like that whereas bone broth could have a potential to do that. So my thoughts are we typically add it in a little bit later after the first 30 days or so and always looking out for fat malabsorption. Because there are a lot of IBD people for instance or people who are still misdiagnosed or undiagnosed who have just a really wrecked gut and bone broth for them is like death soup. Like drinking it just makes them want to cry. So I think it is worthwhile to let people know that if you cannot tolerate a lot of fatty foods or anything like that, where you have like some really bad gut dysbiosis, sometimes it is better to wait four to eight weeks before you begin to slowly introduce bone broths. And then the same thing could be said for probiotic foods. You know GAPS is really, really big on probiotic foods and I love that as well. But again there are the really, really sick people who need to have a gradual introduction into all of these things. Like for instance, my business partner Jordan, he had to start with the one strain of sauerkraut per day for like months. It took him like two or three months to get up to like two or three spoonful or forkfuls of it. And so that is where I think that first three days is really key for just keeping it really simple and trying to keep the diversity a little high with fruits and vegetables. But also as you mentioned you know watching out for FODMAPS. So FODMAPS you know, is a fascinating diet out of Australia. And I think it is a really cool new take on foods and how they impact us and how the gut flora is impacted from them. In general, I think a 30,000 foot view, my experience with FODMAPS is that the more intolerant you are to FODMAPS foods the more damaged and the more destroyed your gut is. And so removing them if you are intolerant to them in the beginning can be sort of like a life changer. Like your quality of life can immediately go way up. However, I do not think there are classes of foods that you want to keep out forever. Like you mentioned, onions and broccoli and cauliflower, these are very powerful great foods.
Dr. Justin Marchegiani: Yes. Right.
Steve Wright: That we should use later on in a very healthy diet. But I think sometimes for those people, they will just have to heal their gut a little bit longer before they can reintroduce those.
Dr. Justin Marchegiani: Excellent points.
Baris Harvey: Yes. That makes a lot of sense. So it is basically a certain level of making sure that you are healthy enough or you take like a more therapeutic approach where maybe you have to kind of babysit, be kind of delicate on what foods you introduced until that gut is kind of cleaned up and now you can actually take some of the nutrients out of these other foods that might be harder to digest.
Steve Wright: Yes, I mean let’s face it. The diet that you should be following is like for me is the Steve diet, it’s the Baris diet, it’s the Justin diet. And your gut flora, my gut flora, our epigenetics, all these things are different. And they are also different depending on where you are in your health in your life. So in the beginning, you might have to get a very restrictive diet. But do not label food just good or bad. Just label them good for me right now or not good for me right now and based on whether you can digest them or not digest them.
Baris Harvey: Uh-hmm. Definitely that sounds good. So you are just talking about how some people have a problem digesting fats. And it is funny because we also talked about how people can have problems with breaking down the carbohydrates and often times when people are backed up and have constipation. I know a lot of people they really like to bulk up with like psyllium husk or just pack a bunch of fiber in order to get things moving along. But I like how you have a little bit of a different perspective. Could you for the listeners out there who might have some constipation issues and they are just trying to stack up on psyllium husk, can you give some other advice on how they can maybe helped with their constipation issues?
Steve Wright: Yes, so I guess my counter perspective is that fiber from whole foods is really the kind of fiber you want. And supplementing with psyllium husk is basically you would try to do the same thing if this analogy makes sense to you this is what you would be doing with psyllium husk. So let us say, since we are talking about poop, you take a big dump and you clog your toilet. And you go to flush and yet nothing happens. Would you pour out more toilet paper and start shoving it in the toilet to make that…
Baris Harvey: Yes, it would make everything worse.
Steve Wright: Right, right. So that is sort of the same thing with psyllium husk. It is sort of like a plugged toilet in a way. Would you dump a bunch more of poop basically into your system hoping that it is just going to unclog it? With some people it works in the short run. Myself, when how much you will actually experience it is that it is either going to make a bunch of bloating and really hurt or it might work for a week or so. And then also you will notice you need more, and more and more. And through this process you might actually be damaging your colon just because you are creating so much feces. So my take on that is it is not an amount of poop problem that constipated people have, it is the inability to get rid of it. So there is an evacuation problem going on and not a lack of poop to get rid of.
Baris Harvey: Uh-hmm.
Steve Wright: There are lots of ways that we could do this without using psyllium husk and some of the herbal laxatives and enemas and things like that. And that is through substances that either help with peristalsis which are the waves that actually move the food through your stomach and then obviously get rid of your stool. And then there are also substances like vitamin C and magnesium which are nutrients that your body could absorb and could help you in that regard. But when you overdose on them or begin to sort of micro-overdose on them they will actually draw some water into your digestive tract and sort of begin to help move things along or soften the stool and kind of get it along. So, I really prefer the sort of short term interventions with vitamin C and magnesium and typically magnesium glycinate or citrate. And then long term thinking about what is going on in here? Why is peristalsis not happening? Do you need more probiotics or more fiber from whole foods and begin to try to get to the root cause of why you are constipated in the first place.
Dr. Justin Marchegiani: Excellent points. Great points, Steve. Now I work with a lot of patients and I find gut infections are strongly at play. Lots of different parasites issues, whether bacterial issues, H. pylori, chronic, fungal overgrowth, SIBO. And a lot of these infections they produced toxins, right? So we know endotoxins or lipopolysaccharides. These are produced from a lot of the gram negative bacteria and these can disrupt a lot of those peristaltic waves or kind of like if you would get the last bit of your toothpaste out of your toothpaste you kind of roll it up. That is kind of how your intestine works. So can you talk about how kind of in your role working with patients being a clinician, how these infections really kind of muck things up, if you will?
Steve Wright: So just to clarify, I do not have a medical license or anything. So I was just a health coach.
Dr. Justin Marchegiani: Uh-hmm.
Steve Wright: Yes GI infections are extremely prevalent. And people are not getting this message or are not hearing this message. If you sort of poll the community and I am not sure what percentage you saw, Justin but like Dr. Tom O’Bryan sees 70 to 80% of every person who walks into his clinic whether they are complaining about GI issues or not have a gut infection. I have heard Dr. Lauren Noel talked about around 80% as well.
Dr. Justin Marchegiani: I agree.
Steve Wright: Okay cool. Yes.
Dr. Justin Marchegiani: Totally agree.
Steve Wright: And that is what we pretty much saw, too. It is 80-90% for the people that we are working with. So it is a really high percentage. And so, yes exactly those infections do a lot of damage. Number one, they could shut down the peristalsis waves. Number two, all those toxins are definitely causing inflammation and probably leading to leaky gut. And it is really the root cause especially constipation. Like constipation to me is like a huge massive red flag that there is probably some sort of infection that you want to go and get tested for.
Dr. Justin Marchegiani: Yes. That is great. And I also have a site called fixyourthyroid.com and I talk a lot about thyroid issues. And I see on your blog here today, you did a blog on, “Is your thyroid destroying your gut function?” Could you touch base on the thyroid gut connection, Steve?
Steve Wright: Yes sure. I am sure you have mentioned this before but every cell in your body needs thyroid hormones. They need at least T3 to function. And so the thyroid is extremely important. And if you look in the research, there is a high prevalence of thyroid disorders and inflammatory bowel disease, celiac disease and thyroid disorders are very high. And so it is kind of fascinating to think that there is a gut issue that is diagnosed and then typically or at least you have a much more increased risk of ending up with some sort of thyroid autoimmune disease as well. And I think a lot of what is going on here is you have a couple of things. Number one, is that if there is not enough thyroid hormone ending up in your gut cells the peristalsis waves, this is shown in research, the peristalsis waves will be either slowed down or the strength of them, their ability to sort of squeeze out like what you are talking about the toothpaste, will be diminished as well. And that is just because the cells are not getting enough of the hormone signals to do the job that they are supposed to do. Now if you are hyperthyroid instead of hypothyroid then you could be causing like diarrhea or something like that. And you know that the really cool research that is coming out that I am really pumped about now that I would be writing more about in the coming weeks, is that they are now showing that maybe up to 20%. And this is really new stuff. But all we really know is that the gut flora plays a big role in the conversion from T4 to T3. I know this is not perfect science but I think it is easiest to remember T4 is sort of the inactive form or thyroid hormone, more of storage part of the thyroid hormone.
Dr. Justin Marchegiani: Right.
Steve Wright: And T3 is the one that everybody wants majority of the time. And so the gut flora helps with not only the conversion of the T4 to T3 but they also store some of the T3. So if you have a disrupted gut flora you might have, you know, poor conversion. And then that is going to feed the signal back to begin to make more thyroid hormone and it can continue this bad feedback loops and really begin to cause a bunch of issues. And conversely, maybe you are eating an SCD diet or a GAPS diet. You have gotten rid of your gut infection but you are still having to rely on magnesium or vitamin C to have bowel movements when it could be just that you needed some sort of thyroid support or some work up there to actually begin to restore full function to the gut. Does that make sense? I do not know if I was talking all around that article.
Dr. Justin Marchegiani: Yes absolutely.
Baris Harvey: Yes, I know that sounds awesome. I mean like a simple way to think about it and it is so awesome how complex yet amazing our bodies are. When you see something like hypothyroidism and then slowing down the intestines. And we know like our thyroid is like our master metabolism kind of gland. And then we see like, “Oh, if you have hyperthyroid you might have diarrhea.” And it is kind of like your body telling you like things are hypermobile, it is speeding up. There is something going wrong. Or if the inverse is happening through your body and it is kind of obviously telling you something. And often times it is just so common that we kind of ignore those signals.
Steve Wright: I mean, I think that is just part of like every system in the body. Like functional medicine, like everything is just connected to everything. And so it could be that the gut is messing up in the HPA axis where the thyroid adjusts itself or it could be the other way. And so I think what you said there is perfect. Really a lot of this is about becoming aware of our bodies again. And I know one of the ways in which I got sick was essentially and it is no fault of anybody’s but sounds like humans we get like a manual that says this is how you should relate to your body. And this is what a perfect poop is. And this is what a perfect thyroid is, right? We do not get that. And typically the process of getting that is through getting back into our bodies and realizing what we are putting in, what we are consuming and then talking to other people who have like a very robust, resilient health: how did they feel? Like what did they do? And if you can’t do what they do then you are like, “Oh, interesting. I wonder why that is?”
Baris Harvey: Yeah definitely. So I want to slightly transition. I was actually on a call. Somebody called and they are talking about a client going to their doctor after you know they tested these gut panels. And it is funny because we talked about the infections and parasites and usually people think like unless you are swimming in some dirty water in Thailand, we do not get parasites or infections or things like that in America. But they also had leaky gut and they went to their doctors and their doctors said well it is not real, right? It is not a real thing. I am not going to treat anything like that. Could you answer this question? For us, we kind of know this but is leaky gut real? And how have you seen that in your practice?
Steve Wright: Yes, this is such a profoundly simple question. What is real is what is real to us individually. So in that doctor’s point of view, leaky gut is not real to him. I do not know what his basis of medicine is or how he functions in this world. I am not here to judge him. But let us say for instance, you just went to PubMed which is, and for people to know, that is a big search engine for all the research that is going on in the medical community. If you type in intestinal permeability which is the medical term for leaky gut; leaky is kind of like the slang term. You will find well over 10,000 research papers that reference it. So I do not know, maybe things become real for that doctor at 100,000 references or 12,000, I am not sure. But what is true is that since the 1980’s, papers have been published since we realized how the gut actually begins to function is through cells that become more permeable depending on the conditions that are present in the body and outside of the body. And so this is a known fact now that there is such a thing as a permeable gut and that is actually how the gut cells function. The problem is that this is just beginning to be taught in medical schools and as most people know your average family practitioner and even most gastroenterologists and people like these, they got into school a long time ago. And to be honest they are not interested in learning new ideas. They are just interested in going through a yearly conference or two and brushing up on the paradigm that they bought and paid for and work really hard to get. So I think at this point, the patients out there have to decide whether or not they believe it is real. If they believe it is real then it is time to fire your doctor and find someone who believes the same thing you believe. I mean if you believe that you should pay your taxes and your accountant says do not pay your taxes you will probably fire that accountant and go to one that believe what you believe.
Dr. Justin Marchegiani: Right.
Steve Wright: So the same thing applies to medicine. Doctors are there to serve you. And that is not how it always had been portrayed but that is really how the world works. When you buy a consultant they are there to help you. So if your consultant is not acting in a way you wish they would it is time to fire them.
Baris Harvey: Awesome.
Dr. Justin Marchegiani: Awesome points, yes. And Steve just so you know, 10, 842 for intestinal permeability on PubMed right now as we speak.
Steve Wright: That is so awesome. It is creeping up.
Dr. Justin Marchegiani: I know.
Steve Wright: It is going to get to 11,000 real soon.
Dr. Justin Marchegiani: (Laughs) I know. Right. So, you kind of touching back on the doctor’s paradigm and being a physician myself and working with lots of patients you come to the resolution that what you are learning in school and what you are learning in textbooks is about 20 to 30 years old. So to be on top of things and to really help your patients, you have to be studying what is clinically working now. Talking to other doctors, going to cutting edge conferences where you are learning the application of what is happening now. What are the best tests? What are the best things we can use supplementally? Diet wise, lifestyle wise to fix these things. And also we have to step outside the insurance model because a 5-minute doctor’s visit is not going to be enough to get the information to teach our patients. So you can talk about kind of the functional medicine model versus the insurance model?
Steve Wright: Yes. Sure. So, I love analogies, right? So I think this is how the insurance model works. It is much like the public school system. So if people can think about the public schools system. They probably thought about that more than the insurance model. But the teacher and the doctor are the same role. So in the public school model, the teacher is told exactly what they must teach. They have exams that their students are measured on. If they do not get their students through that certain grade then they could be fired. They get specific kinds of pencils. They get specific textbooks regardless of what they want to teach. They are told how they have to teach and what exactly the takeaways are. Well, that is the exact same thing that is happening in the medicine world. So I really do not fault the doctors. I do think that obviously, like you Justin, like you decided that you are going to do something different. And you have decided to take more responsibility, more investment into your profession. And there are teachers; they are stand up teachers who do the exact same thing. They buy their own markers. They buy their own stuff. But that takes a really special person. And so if you want to subsist inside either system you have to realize the standard of care that is practiced there. And so in the insurance model, the insurance companies dictate exactly how these doctors have to function. And if they do not follow what the insurance companies said with step one it can go so far as the medical review board could remove their license.
Dr. Justin Marchegiani: Wow!
Steve Wright: So their license is what they paid hundreds of thousands of dollars and eight to ten years of their life to get. So they are stuck in a really, really rock and a hard place position here. And so that is where you almost have to step outside of the system and go over to this non-insurance based model where a lot of the functional medicine practitioners practice. And I think there is another distinction there that we should make which is that, I think the insurance model is really built around symptoms care. It is about solving the immediate pain but no time is spent on why are you in pain or how did you get here. Whereas in the functional medicine model, which is typically outside of this insurance model so that physicians like yourself can actually spend 30 minutes, an hour, more time than that. You actually have time in your day to probably research the tough cases and figure out the newest and best models or reach out to world class practitioners who are doing something different that no one has heard of yet to help these people. And that model is really about why is this happening in your body. Because you might have acne and depression and a little bit of constipation and you knee might hurt a little bit. But in the insurance based model you are probably going to have a physician for each one of those things. You are going to have a dermatologist. You are going to have a neurologist. You are going to have a gastroenterologist and you probably will have some sort of an orthopedic surgeon or something on your team. And none of these people talk to each other. And then in the functional medicine model, you can go and see someone and they will be like, “Oh, actually all that stuff is related back to… Oh, looks like your gut and your hormones are off.”
Dr. Justin Marchegiani: Laughs
Baris Harvey: Uh-hmm.
Steve Wright: And so if we fix both of those all that stuff will go away. And so I think that is also a big distinction between those two models. One model is silo and specialty focused and the other model is like wait, everything is related. It is all of the system. And so if I treat something over here it is going to affect something else over here.
Dr. Justin Marchegiani: Absolutely. And I am constantly learning and I found the SCD Lifestyle phasing chart through you guys, through your site and I have been using that for my patients for the last year. And that is where they worked wonders. I appreciate that. You know, that contribution you made.
Steve Wright: Oh, thank you so much. Yes. Really and this is probably both of you guys just kind of thought, I just want to create this stuff, you know. I am in this for myself as well as for everybody else. But I really want to create tools and blog posts that I wish I would have had 7 years ago. Because it is inexcusable that more people do not know about these stuff. So that is kind of like a rule that I have about what products and what things you put on the market. What blog posts we publish. If this would not serve me 7 years ago we are not going to do it.
Dr. Justin Marchegiani: Love it, I love it. And right now, there are a lot of people out there that are trying to get answers, right? They are trying the diet stuff and they are also curious about functional medicine lab testing. So I know there are a lot of ways that you can spend a lot of money on lab testing and maybe not accomplish a whole bunch. So there are certain tests out there that may not get you the underlying cause of what’s driving things. So, what would you think are the key foundational lab testings that you would recommend? And again there are exceptions to every rule. Like a lot of times people think that food allergy testing is a waste but for some people it may be beneficial. What tests do you think are key and foundational to addressing maybe chronic gut and/or fatigue issues?
Steve Wright: Yes, yes that is great. And you are right. Everything that we talked about in the world there is an outlier. So from my point of view, again kind of like if you take sort of my engineering mindset, how do we get the most bang for our buck? And what are the biggest needle movers regarding diet? And we can apply this for test, too. And so when it comes to test, I think the first thing is getting a good handle on a salivary adrenal panel, like adrenal stress index is what they are called, for your hormones. Because we talked about thyroid earlier in this podcast but with a lot of people who are just learning or do not know about it yet, is that as long as you do not have an autoimmune condition with the thyroid a lot of it could be handled just through fixing your adrenal glands. And then a lot of sort of other sex hormone issues can be taken cared of if you really get those guys working properly and the feedback loop is working properly. So I think number one, you know working with a physician who can screen you for autoimmune markers. That is really a needle mover test. And some people do that through like Cyrex Labs. Other people can do that through blood testing. I think those are really big needle mover test because if you find that that is huge in this whole grand scheme of things and what you are going to eat and what you should go after. I think the salivary index BioHealth is the trusted lab that I like. I tried a lot of labs out there and I have run panels. Do you agree?
Dr. Justin Marchegiani: I agree. Like a 100% agree.
Baris Harvey: Uh-hmm.
Steve Wright: Okay great. I have run panels and I am not going to name any other labs but almost every other big labs you have ever heard of I run side by side panels and BioHealth always seems to line up with symptomology for people and so that is what I trust for the salivary or hormone stuff. And then the next big thing is the GI infections test or two. So here is a fascinating nugget that is not only fascinating but extremely frustrating. We did over 400 case studies where we have people doing a BioHealth 41H which is a stool test for infections versus other labs stool test. So we just essentially said this is the model of what we do. If you want to work with us because of what we have seen you have to do these two tests. And that means basically double the money. And we found somewhere around 70% of the time roughly, you know give or take 10% they were off. And there was one test that caught some bugs, that made sense and the BioHealth did not or the BioHealth caught them and the other test did not. And so that is a really frustrating but it is a very interesting point which is that you want a practitioner who not only uses sort of the same base testing but also sees a lot of these tests because tests are not perfect. There is nothing about any medical testing out there that is perfect. Even cholesterol testing is very imperfect. And so you need a practitioner that understands the subtleties and the limitations of testing. So when it comes down to needle mover test, I would definitely go with a BioHealth salivary panel at least the 41H from BioHealth and then combine that with maybe another one out there Genova or Doctor’s Data or something like that or another trusted lab. And then however your doctor prefers to screen for autoimmunity.
Baris Harvey: Awesome. I know you mentioned the false negatives with kind of the GI testing. I know you might not treat in a specific way if you do not find anything. But are you still going to kind of go about it the same if somebody is having a lot of symptoms of infection and you are not finding anything. Or you still might do some kind of protocol that is still geared that way just in case it was a false negative?
Steve Wright: Yes, yes definitely. I definitely talked to people about that in the past. And I know a lot of high, really respected coach or medicine practitioners do the same thing. And the issue with that is that you do not know. You have to then use a sort of like a broad protocol. You cannot target a specific type of bug for instance if it was H. pylori versus SIBO those are two different programs. Every one of those infections has a specific protocol that works really well for it. If you get a false negative but you still think that there is an infection there I think it is still worthwhile at that point to use some sort of broad spectrum based protocol and then follow-up with testing again. So just because you have one false negative, here’s a crazy story for you guys. So I have low stomach acids since I started this whole journey. It was one of the first things that I have figured out and nobody was talking about. And I am like, “Oh, my gosh! If I take Betaine HCl like I would start to have these amazing poops. I don’t burp anymore. And I do not have indigestion anymore. It was just an amazing thing. And so ever since and that was like 7 years ago, I am like Googling and trying to figure out like what causes low stomach acids to be low or to be suppressed. And you know there are a lot of different things but the main one out there is typically is H. pylori. And so for years, I am like, “I have H. pylori I know I have it.” But I have like two and a half years’ worth of tests that are negative, negative, negative. No H. pylori. And so we have never treated it because there was never anything there. And we are talking about all kinds of different labs, all kinds of different ways of testing. But as I got healthier and healthier, I did another stool test and then eventually I did get a positive for H. pylori. And treated it and now I do not need any sort of stomach acid boosting support unless I am under a really bad stressful situation. So the moral of the story here is number one, tests in and of themselves just done once are almost worthless. You need to continue to do testing overtime. And there are conditions such as crypt hyperplasia which may have been happening in my case or there is maybe this idea in my head, this theory that as you begin to solve a root problem, as I began to increase my immune system through fixing hormone dysregulation all of a sudden that infection became active enough to actually finding it on the test. And so I really think it is a fallacy to think that you can test once and figure this all out.
Justin Marchegiani: Yes. That is a great point. And I recommend lab testing just for preventative medicine maintenance just once a year. At least a gut test even if you are healthy. I know when I met my fiancée for instance, she had 15 years of IBS issues going to the ER, being scoped many times. And when I first treated her she had a blastocystis hominis infection. We removed that infection half of the pain gone. Then we tested again H. pylori, then it is cryptosporidium, then it was a worm infection, then it was Giardia. It was 7 or 8 infections layered in the crypt. So if all of our listeners can just open the palm of their hand, think of the fingers as like the villi and then where the finger gaps meet the palm of the hand, that is like where the crypts are. And these infections get burrowed up in there. So based on your experience Steve, what do you think are the most common and most virulent strong infections that you see out there are?
Steve Wright: Well, I just want to echo exactly the advice that you just gave, Justin. I do the exact same thing. I actually just ordered a $2500 worth of preventative testing.
Dr. Justin Marchegiani: Nice.
Steve Wright: I do it every year. And that is part of my budget. That is part of how I look at health care and taking responsibility for my health these days. I have a catastrophic health insurance policy. But then I also have that deductible covered in savings. But every year, I budget two to three thousand dollars’ worth of preventative testing just to make sure I am on the right track. Because if I can catch this stuff I will never even use that deductible unless it’s some sort of an acute problem that happens through sports or accident or something like that.
Dr. Justin Marchegiani: Love it.
Steve Wright: So I could not echo that enough.
Dr. Justin Marchegiani: Love it.
Steve Wright: So back to common infections. So I would say like out of the 600 or so case examples I can poll from blastocystis hominis as a huge one. See what else, H. pylori was another really, really common one. Entamoeba coli is another really common. I would say those three are probably the most common that I saw on a regular basis along with SIBO. Excuse me, I should definitely throw small intestinal bacterial overgrowth in there because that is super common.
Dr. Justin Marchegiani: Yes, yes. And then when you are looking at patients because I have the same thing where sometimes the lab work does not come out positive, you know, like what are you going to do? What are the clinical markers and signs that you may look to say, “Well, there are still something wrong.” Maybe they have cut out FODMAPS and they have an improvement. What are the other clinical markers would you look at outside of just lab testing?
Steve Wright: Yes, I would look at number one, any gas or bloating at all is an indication to me that there is likely low stomach acid plus some sort of overgrowth. Those are really big red flags for either or both conditions because they sort of feed each other. I would guess like, okay so if you are using supplements that physically alter the way in which the intestines work that would be things like digestive enzymes, Betaine HCl, ox bile, vitamin C, magnesium if you want. So like the first three are more about like stopping diarrhea or helping constipation. And magnesium, vitamin C, laxatives things that improve constipation. If you are not having perfect poops on a really healthy diet like a whole foods diet or like any of the diets we have talked so far you are still having loose stools or constipated tools that is all we really need right there. The other thing is if there are any autoimmune markers at all I am automatically thinking GI infection and yes I would say any autoimmunity, any sort of GI distress at all. And then lastly like, if things just seem complex, like you have been sick for a really long time, then typically I am assuming you have multiple areas of your body that have been down regulated overtime and part of that is just going to be the gut. So maybe it was not always the gut. Maybe it started with some thyroid and adrenal stress and then you have lost your immunity and then you just picked up a gut infection. So now you are presenting as chronic fatigue or multiple chemical sensitivity or fibromyalgia. And you know, for instance, fibromyalgia. Essentially 70% of people with fibromyalgia have SIBO. So any of these sort of complex syndromes and undiagnosed problems like IBS immediately I am thinking this person has a high, high chance of having a gut infection of some type.
Dr. Justin Marchegiani: Uh-hmm.
Baris Harvey: Yes definitely. That makes a lot of sense. And real briefly, I know we are coming close to the end of our episode but if you can go over because I know SIBO is really a big issue that is starting to pop up a lot more now. For those of our listeners who are not too familiar with it. I know Dr. Justin you recently did a video on SIBO.
Dr. Justin Marchegiani: Uh-hmm.
Baris Harvey: Could you go a little bit more into SIBO and just talk about how you might get this overgrowth and kind of like what is a little bit behind the mechanisms and maybe some ideas on how you get rid of it as well?
Steve Wright: Yes sure. So small intestinal bacterial overgrowth is essentially you are having too much bacteria in the small intestine. It could be beneficial strains bacteria, could be just neutral bacteria or even bad bacteria that have overgrown. Essentially what has happened is most of your bacterial growth should be in the large intestines not in the small and somehow you now have a colony in the small intestine that is essentially producing a lot of gas. They are just being bacteria. Bacteria very, very simple. I mean they eat and they give up a by-product. But the symptoms that it causes are very intense and can be very debilitating depending on the level of the overgrowth and the length of time. So the ways in which you get it are almost too numerous for us to even go into on the show. It is a wonder that your average sick person in America has not gotten it. A lot of people do have it. But essentially, once you combine stress with one bout of gastroenteritis or just like food poisoning or something like that your chances of having SIBO go through the roof. And some of the new research is starting to talk about the fact that just one round of gastroenteritis something like that, every time you have one of those, your chances of SIBO go through the roof. But there are lots of other things you can have. Valve malfunctions in your intestines; low stomach acid really feeds into it. Essentially, how are you going to beat it is that those bacteria need a food source. So it is just like if you dropped a spoonful of peanut butter on a side walk, the ants and the animals are going to come running. And so that is essentially what is happening with the small intestines. There is a food source and biology is just taking over. Like there is going to be something that is going to step up and fill that role in the community. And so reducing the food source through diets like the Specific Carbohydrate Diet, through the GAPS Diet is one way to begin to lower the community. But a lot of people would need either an antibiotic protocol with typically Rifaximin, maybe some other add‑ons or maybe an herbal protocol to really get rid of it. And from my personal opinion, and as I guess one of the leaders behind the Specific Carbohydrate Diet at this point in time, I do not believe that you can starve out SIBO. I have been working on it with myself, and working with people for over 6 years now and this idea that you can starve out SIBO thing or candida thing infection I think it is just a giant myth.
Dr. Justin Marchegiani: I totally agree with that. I see that all the time with my patients. We have to use a combination of herbal medicines whether higher dose or the oregano or berberine and Goldenseal or higher dose Artemisia, I 100% agree with that.
Steve Wright: Awesome. And I want to say that if people who are listening to us are like, “Man, I did that, too and it came back.” The first thing I am thinking is your immune system is suppressed and it is probably your hormones. So I think a lot of the recurrent candida people or the recurrent SIBO people out there if your functional medicine practitioner has not been focusing on your hormones and your immune system I think that is why a lot of the reinfections are or the colony just overgrows again.
Baris Harvey: Uh-hmm. Definitely. I like the analogy made earlier with the you know, you dropped something on the floor and all the bugs and the ants are going to eat it. It is kind of like if your body is unable to breakdown what you have then something else will and then so yes and it is hard to say, “Oh, we’ll starve it out.” While they are still there you still have to find a way to get rid of them. So definitely, I have looked and have researched and I have seen the same thing.
Steve Wright: Yes, I would totally encourage people to check out Dr. Allison Siebecker over at siboinfo.com. She has proven that these bacteria can live on fats. They can live on proteins. They can live on the mucus that we generate. So this idea of starving them out is not a reality based on the new science.
Dr. Justin Marchegiani: Uh-hmm. Well, his name is Steve Wright. You can find him at scdlifestyle.com. As a physician myself, I highly recommend everyone to go and download Steve’s free quick start guide. I use it with my patients. I recommend it to all my patients. So everyone go out there and get that right away. Steve, are there any other ways our listeners and viewers can find out more about what you do?
Steve Wright: Yes, I mean if you are looking at starting the SCD or GAPS or something like that or having a lot of that stuff I think the quick start guide is great. If you are someone who is beyond that at this point and you have already tried these types of diets and you are looking for the next level of information, we recently created a new site called solvingleakygut.com and on it you can go there and you can take a free quiz. Sort of taking your risk factors into account to see what your chances of having a leaky gut are. And at the end of the quiz you will answer a question about what is your number one complaint right now. Is it digestive related? Is it hormones? Is it energy? Skin? That type of thing. And when you take the quiz you will get the results for free but you also will get a 60-minute interview on whatever your top health complaint is. I would say that what we trying to do is kind of create two different sites. One site for the people who are sort of just getting started with this more of the beginner stuff for free. And then solving leaky gut is more for the advanced people who are on the train of autoimmunity and have had gut issues for a long time.
Dr. Justin Marchegiani: Thanks so much, Steve. We appreciate it.
Steve Wright: Thank you so much for having me on the podcast. It has been a great discussion.
Dr. Justin Marchegiani: You are welcome. We will have you back very soon.