Conventional GI Workup vs Functional Gut Health Program | Podcast #297
If you’ve ever wondered how functional medicine differs from everyday conventional medicine, this is the podcast for you. Dr. J sets out to explore conventional medicine GI workup vs. functional medicine gut-health workup. It’s a compare and contrast while looking at what chronic conditions may be missed by conventional medicine. Check out for more info.
Dr. Justin Marchegiani
In this episode, they cover:
0:29 Gut Issues, H. Pylori
7:49 How Are These Detected?
24:16 Compare and Contrast of Treatments
32:10 Saliva Secretions
Dr. Justin Marchegiani: Hey guys, it’s Dr. Justin Marchegiani here really excited today we’re going to be having a phenomenal podcast on the topic of conventional medicine, gi workup versus a functional medicine gi workup. We want to just kind of give you guys a little compare and contrast and talk about where others shine and where others may be better, especially for most people who have chronic health challenges that may be missed by your conventional medical workup. Before we dive in, Evan, how are we doing today, man?
Evan Brand: Doing really well, this podcast started with a story. quick story. The best man in my wedding. He called me last night and Hey, how you doing? Everything’s good. Okay, awesome. And then hey, I need some help with my wife. She’s been having a lot of gut issues for the past several months. She went into conventional doctor then went to a I’m assuming she went to some type of a specialist. Gi probably I told them about her issues which were bloating, major abdominal cramping, cramping, and pain, floating stools, possibly some changes with mood, but I don’t know if that was brought up to the doctor. So just conventional gi stuff and some pain that was radiating to the back. So pain in the front that was in radiating to the back. And her protocol was no testing. I don’t even think they did palpation they didn’t do physical exam. I think it they just listened. And then they said, okay, buy this probiotic. This probiotic was something that you and I looked up. It was one strain of bacteria in the bifido family, and it was loaded with fillers. And it was what’s considered a consumer grade product, meaning you don’t have to be a practitioner to get it. And it was just loaded with garbage fillers and sugar and other stuff. It had sucrose like why do you have sucrose so that was it. So that was it. And so then When you and I called this morning, I just said, Look, we’ve got to cover this because she got nowhere. And she spent all this time sitting in a doctor’s office waiting. And now she’s no better off. So I talked with her for a little bit. And we made a protocol for her that I think is going to be far, far better.
Dr. Justin Marchegiani: That’s great. Yeah. So really excellent. And when we see patients on the functional medicine side, most have already gone through a pretty thorough, conventional workup. So, you know, my perspective on a lot of this, not that I’m a trained gastroenterologist, not we’re functional medicine practitioners. But I see lots of patients who have already been through the gamut. And so I really try to understand what’s already been looked at what’s been tested, and you see a pattern, you know, when you see a couple hundred patients kind of go through these intense workups you see a pattern of what’s already been done, and you can kind of see what’s been missed, or kind of what their perspective is. So, most conventional gi doctors, you know that these are ones that are not functional medicine and nutritionally change right 90% are going to be in the conventional Category right there just following the typical internal medicine gastroenterologist, kind of best practices workup. So most are coming in they’re doing a history, they may do a physical exam some kind of a palpation to see where inflammation may be in the intestinal tract right certain areas may lead them to think certain things right, upper left quadrant, right my left that could be stomach kind of things maybe pancreas things, upper right. Could be more on the gallbladder liver area, you know, bottom, like mid left could be more spleen, bottom right mid right could be more intestines, and then lower right lower left could be either appendix on the right could be colon ascending on the right, descending on the left sigmoid colon on the left so that you kind of get a decent area. If you just know the general anatomy of what the inflammation could be Now, the next step is going to be depending upon you know, how invasive that things need to go right. They may recommend a capsule or endoscopy just to get a window. What kind of inflammation is in the intestine and then almost always though, they may need to go deeper into an actual endoscopy which is scoped down the mouth. Alright, colonoscopy is going to be scoped up the rectum to look in the colon area right you have your sigmoidoscopy, which is the last part of the colon before, stool goes into the toilet. And then you have all the way up the different intestinal tracts in the colon, right you have your descending your transverse or ascending and then on the upper side, you have your tummy. You have your tummy on the endoscopy, and then you have the first part of that small intestine. So obviously on the colon they may be looking for if you’re older, maybe polyps, which could be precancerous, they may be looking at inflamed tissue. It could be inflamed tissue from a ulcerative colitis when maybe there’s bleeding. It could be inflamed tissue from Crohn’s disease, which may manifest a little bit differently higher up usually, and usually there’s some level of skip lesions we’re all sort of colitis may not have that on the upper side. There could be ulcers in the stomach, right? Those are all possible things. And then there may be other tests to look at the levels of blood there may be things done like a fecal occult blood, where they’re testing microscopic levels of blood in the stool, maybe looking at calprotectin, which are inflammation markers in the intestines, maybe doing a barium swallow to look for any fistulas or blockages or even bleeding. On a barium swallow those are all like conventional things, they may pull out a ultrasound to look deeper at pancreas or gallbladder or liver, if some of that area comes back and flame or to even monitor monitor some of the krones type of inflammation. Some of the more progressive gastroenterologist are starting to do more of the breath testing, the lactulose breath testing, which may look at hydrogen and methane gases. Some may even do a glucose type of breath testing, it looks at more of the bacterial imbalances in the stomach. These are all other more progressive, forward thinking kinds of functional medicine, functional GIS, maybe doing that. Not a lot do that though. Then after that you have your conventional blood tests which could look for inflammation or immune cells or calprotectin. Or actually no calprotectin has to be in the stool but you could look at C reactive protein, you could look at immune markers, right. You could also look at the blood, you could just look at red blood cells, hemoglobin, hematocrit, iron, because if you’re losing blood, you may see it on a panel like that as well. And then some may also do stool testing. Now they may do more of your conventional stool testing that is less accurate, less specific, maybe not the more cutting edge DNA testing that’s looking for microbes that are more sensitive level parasites, H. pylori virulence factors Candida sibo bacterial overgrowth, right elastase deatta krijgt elastase is an enzyme markers, the adequate amount of digested fat marker. So these are things that they they’re typically not going to look at that we’re going to really dive in deeper because we’re doing a real functional assessment for what’s happening in the gut conventional medicines more looking at a pathological assessment, where we’re looking at PE, here’s optimal digestion what’s functionally not working compared to optimal, because there’s a big spread between, you know, being functionally optimum, and being disease and pathological is a big spread. So the problem is a lot of people are in between, this is where a diagnosis happens. This is where optimal is maybe somewhere in between that area and they’re just not going to get picked up. They’re not going to get assessed or found. And that’s where most 90% are going to be in no man’s land. In regards to their assessment or diagnosis, now we can go into treatment next, but I’m going to just pause there and give you a chance to comment.
Evan Brand: Sure, yeah. Good. Good overview and H. pylori breath testing is sometimes done.
Dr. Justin Marchegiani: I forgot H. Pylori. I’m sorry. Yes. H. Pylori as well.
Evan Brand: Yeah. So that’s something where, you know, if we, typically what Justin and I are doing when we work with someone is we’re going to have them send us any labs that they’ve done. Maybe the last six months, maybe a year. If We think it’s still relevant. And we’ll take a look at it. So each problem our breath testing will see those. But the truth is that there can in with all these conventional, less accurate tests, there can be an issue with false negatives. So that’s even more frustrating for the client or the patient because they come to us. They’ve got five or six things they’ve done with the GI people, and they still don’t have any answers. And of course, they don’t have any action plan or protocol. So for me, before I figured out that I had h pylori and parasite issues I did the barium swallow, you drink barium, which is terrible. It’s like drinking chalk. And then you go and you get an X ray. I was having a ton of gi burning upper gi burning so that’s where they did the you swallow it and then you basically lay back they then X ray you and try to see what was going on. And, of course, I wish I didn’t have that done because it wasn’t functional. And it gave me no answers. And all they said was Yeah, you may have some inflammation, they just call it idiopathic gastritis and then they send you on your way. No, yeah, meaning Idiot gastritis we don’t have a clue. And then they gave me the recommended acid blocker and the anti spasmodic and sent me on my way. And I said, I’m not taking them, don’t even give me the prescription pad, I’m not going to take it. And then Luckily, I was able to do functional testing, which then confirm the bugs that I had. So, so I’ve been there, I’ve been there, done that, and you made a great point, I just want to kind of restate it in a different way just to make people make sure people are clear with it, which is this this huge, wide, like you call it a spectrum, the spectrum of all the way over on one side is death disease, celiac krones, just like some sort of like you said, a pathological diagnosis. And then on the other end is like optimal gut health. And you could be so far down this hole, very, very close to pathological level of tissue destruction in the gut, but still not enough to technically be celiac or be krones or be this or that. So until you get to that level, to the conventional world, you’re fine. You just got to keep that Go and keep going, keep going until you get to the level of tissue destruction where you could say you are celiac or Crohn’s or pain, colitis or whatever. Now we can prescribe you this drug. And that’s it. And I’ve actually had doctors tell some of my clients during their workups Hey, sorry, you’re not there yet. You’re not bad enough yet. You’re not sick enough yet. We can’t do anything until you get to this point, like with thyroid, you know, your thyroid is not destroyed enough where we’re gonna put you on this drug or we’re going to cut your thyroid out. So just keep living as if you’re living now, once you’re bad enough, then call us back and we’ll cut your thyroid out or we’ll cut out your colon. If it’s diverticulitis. We’re going to wait until you’re in really bad shape. We’ll go ahead and do surgery. Let’s cut a foot of your intestines out. Yay. No, that’s not the answer.
Dr. Justin Marchegiani: Exactly. And then just to kind of echo on it because we see a lot of H. pylori, and conventional medicine may do a endoscopy for that where they’re taking a sample in the upper intestinal tract view the scope, they may do a stool And that may or may not pick it up. And then they’ll typically do the breath testing and like there’s different kinds of breath testing, as I already alluded, right you have your lactulose, which is going to be more your cebo breath tests, it’ll look at hydrogen and methane. You have your glucose, which may look at upper intestinal, upper gut, stomach type of bacterial overgrowth, right lactose takes about two hours to work through the full stomach, the small intestine, so anything after two hours is usually a pretty good window into the colon, because that’s where lactose starts to get absorbed by the bigger, bigger bacteria in the colon. But glucose tends to get absorbed a lot faster in that first, you know, 20 to 40 minutes so it gives you a better window of the stomach. And then you have your h pylori breath test where they’re giving you like it’s a urea breath test, they’re giving you like a urea tablet or a urea solution. And basically, the H pylori in your stomach will take their urea, right because typically how h pylori works, that makes an enzyme called urease. And that method analyzes the urea and the protein into ammonia and co2. So when you give that urea, the H pylori will convert a lot of it into co2 and ammonia. Ammonia has a pH of 11. So it’s very alkaline so that throws off your stomach digestion and lowers your stomach acid, but it also spits off a lot more co2 than in their mess. They’re they’re measuring high amounts of co2 to get a window if you’re positive for H. pylori on that conventional H. pylori breath test. So they’re looking at three things. Typically, they’re looking at breath, maybe a stool antigen, which is the stool under a microscope, they’re looking at maybe an endoscopy, if it’s more serious to rule out gastritis or ulcers, and then maybe a blood test with a look at like an IGG, IGM, or IGA. And it G’s more of a long term marker, so you really want to request an IGM IGA to see if it’s more active and acute. So those are the big things that they’re going to be looking at on the H. pylori side and I just say that because h pylori is a big thing. We find a lot and can be a problem in a large percent of the population after 30 to 50%. And then I would say things like Candida or a fungal overgrowth are very rarely looked at or assessed and will typically look for that in the stool. And we’ll also look for that in the urine via a functional DRAM and a tough test. So we’ll look at things with a good functional stool assessment. We’ll also maybe do that cebo breath test that lactulose SIBO breath test. Now most conventional gi Doc’s don’t do it. There are some like for thinking conventional MDS that are gastro docs, like Dr. Pimentel at a cedar Sinai, he started making more of the breath testing more mainstream on the conventional side, which is good, which is excellent. But still, a lot of conventional Doc’s aren’t even doing it. So we’ll do that. We’ll look at it we’ll run the more progressive sensitive DNA stool tests. And that will also look at the urine test which can look at bacteria in the urine and it can also So look at fungus in the urine, the [inaudible] or I can look at the hippo rate and the indicator which is a marker for bacterial overgrowth, as well as protein putrefaction not breaking down your protein. So benzoates another big one. [inaudible] in a tick is the fungus. And those are HIPAA raised another big one, there’s a couple of 2 phenylacetic acids. Another big one is about 10 markers that we’ll look at for bacterial overgrowth on an organic acid.
Evan Brand: And none of the stuff that we’re going to do is going to be invasive at all we’re going to get into kind of the, you know, compare and contrast some of the treatment options to we have regarding the testing the stool that we’re going to do, it’s an at home stool test, it’s going to be way more accurate. I’d like to put a number on it and say 100 times more accurate and sensitive but I don’t know the exact number. I would just say that. We’ve had hundreds and hundreds of people who’ve done conventional testing through their practitioners, they show up with nothing, even like doctors data has missed in fact For example, but there’s DNA stuff that will run will find or fill in the gaps where the other testing failed or lacked. So that’s going to be the at home stool testing, and then the organic acids testing. That’s amazing. I mean, that even find stuff that the stool test doesn’t find like the yeast overgrowth, and it’s all done at your house. It’s amazing. Nice.
Dr. Justin Marchegiani: Yeah, it’s very, very nice. It’s non invasive. I’ll tell you the problem with a lot of conventional medical assessment, if they’re doing a breath test, fine. If they’re, you know, obviously a good pal patient is really nice, especially when it’s acute, conventional medicines really good at finding Irritable Bowel Disease, like you know, krones ulcerative colitis, or something more like an ulceration. If you’re older that can be helpful at like precancerous polyps, but even that they don’t address why those polyps grow. That’s another conversation. So they’re really good at finding those kinds of things. But the question is, how do we get there is that underlying cause being addressed a lot of times it’s not, and then a lot of times it’s being managed with ppis proton pump inhibitor. Maybe a corticosteroids, some kind of like they have like natural coating products that kind of coat the gut but still don’t fix the underlying issue. May maybe Imodium or some kind of antispasmodic, or anti nausea medication, especially when IBS is a diagnosis because a lot of IBS type of diagnoses or diagnosis of exclusion, meaning they’ve ruled everything out, therefore, they give you this diagnosis, which means, hey, you have some symptoms, but we have no idea why it’s cost or what the causes so they give you this diagnosis, you feel comfortable that you got a label, but that diagnosis is a diagnosis of exclusion. It’s you rule these things out, therefore it has to be this that tells you nothing about the underlying cause. And you’re still recommended just certain medications that control the symptoms, and may create more problems over time. Like if you’re on chronic acid blockers, you’re going to have issues with minerals, and digesting protein and digesting fats and over time, you can have some serious nutrient deficiencies for sure.
Evan Brand: And then you can have mood issues, you’re gonna have sleep issues, because now you’re not making neurotransmitters from the amino acids. So now you’re irritable, you’re anxious, you’re depressed, you can’t sleep at night, and your guts still a wreck. And that was me. And I got the diagnosis of IBS and it was nothing but drugs. And back to my friend’s wife. So they recommended that we talk about that probiotic. It was just one strain, and it had a bunch of garbage fillers in it. They also, of course, told her to eat more fiber. And this is a woman who’s basically pescatarian and she’s eating cooked organic vegetables for almost every meal, I’m like, wow. So they told you eat more fiber? Did they even ask you about your diet? No, of course they didn’t. They didn’t ask you what you’re eating. I mean, vets are better at helping with gut issues. And dogs then gi dogs aren’t helping with gi issues in humans. Why? Well, because the first thing you do when you go into the vet, what’s the vet gonna say? Oh, what kind of food are you feeding him? You go and you take your puppy and oh, my puppies, you know got diarrhea. Oh, what are you feeding your puppy? But that’s not the first question that gi doc asked. Now It’s not the first question we asked either right boy definitely in our it’s definitely in our workup.
Dr. Justin Marchegiani: Oh it’s something that’s going to be going to be asked on day one is one of the most important things for sure. But kind of getting back to the conventional Sykes I really want to give conventional medicine it’s Do you know hat tip where it’s good, it’s really good at a lot of these conventional, you know, irritable bowel diseases or extreme ulceration, they’re just still not good at getting to the underlying issue. So let’s say you have an Irritable Bowel Disease, right? They may give you something like a lialda or mesalamine or a corticosteroid or a biologic or an immunosuppressant or some type of antispasmodic or Imodium just something to manage those symptoms. If it’s bad enough, they may give you chemotherapy like a methotrexate, something like that. They may do deeper testing like a CT scan, if they’re looking at things or a MRI, which doesn’t have the radiation CT has the radiation they made. They made a deeper testing for that. A lot of times they’re still going to want to go inside Do that colonoscopy or endoscopy for sure, which has its own host of issues because you typically have to be under anesthesia for those, okay? And anesthesia has a major negative impact on your gut flora. And sometimes they may even want you to be on antibiotics post treatment sometimes. So it just depends upon the doctor and kind of your situation. But the anesthesia could have some negative impacts on it. And there’s some data it’s more controversial now, but I’ll put it out there. But there’s some data talking about the fact that the equipment that is used to do a colonoscopy, the cameras or endoscopy cannot fully get sanitized due to the sensitivity of the equipment. It can’t fully get sanitized. Therefore, there could be some potential fecal debris on there. from a previous patient. It’s possible right? It’s more controversial.
Evan Brand: No, I don’t think it’s controversial. I’ve seen it for years man, they call them HAI- hospital acquired infection. It’s huge. It’s one of the leading causes of death in hospital setting is an infection that you pick up by getting a routine procedure done. I actually had a woman who had this happen, and she developed major, major major c diff infection. So she had issues before. You know, she was having a lot of stomach pain, a lot of burning. She went in, went to the gastro, they did the endoscopic, the endoscopy, and let’s go. And after she got home, she had endless, endless, almost to the point where it killed her diarrhea. And I was like, oh, that doesn’t sound good. And guess what she had Clostridium difficile, also known as C diff. So then what happened? She gets the conventional GI Doc’s to prescribe her antibiotics, very, very strong antibiotics. However, C diff is just one of the major bacterial infections that’s become resistant to the antibiotics. The CDC has been warning this about this for years. They now call what we’re in now is the post antibiotic era. Just look up CDC post antibiotic era, you can read about it. And so this woman still had seed if she did the antibiotics, she killed off any remaining good bacteria. And she was still miserable. We ran the testing on her confirmed the C. diff was there via urine and stool. And then we used anti microbial herbs. And guess what, we got the woman better. We got the C. diff gone, and she was fine. So I’m glad that you pointed out they are good at finding stuff. That’s pathological. But yeah, and then they’re not going to tell you why you have Crohn’s and they’re not going to put you on an autoimmune Paleo Diet like we are.
Dr. Justin Marchegiani: Exactly, they’re not going to do that. Now, just to kind of highlight a couple things here. We talked about the hospital acquired infection, there’s also a chance of, you know, rupture, or, you know, poking the hole with with the cameras that are going into your, into your throat or into your rectum as well. It’s always a possibility. So the nice thing about some of these, the assessment and testing that we do, there’s no chance of any side effects, which is excellent and there’s no chance of disrupting your floor either with anesthesia or swallowing radioactive solution, right? So it’s nice to have an assessment that doesn’t really have a chance of causing any more problems. And it gives you that full spectrum because remember, on the conventional medicine side unless there’s this much inflammation on the scale, here’s optimal. Here’s a diagnose visible condition. There’s a large gap here. And if you’re somewhere in this gray area, this is the gray area where the doctor says, Hey, we can’t help you. Hey, it’s all in your head, hey, you’re just getting older. Here’s a prescription for an antidepressant. Like literally, these are things that happen after the fact and there are some doctors that are saying, Oh, well, here’s a probiotic, like you mentioned with your friend that called you and they recommended a crappy antibiotic right now. Hey, that’s better than jumping on the anti depressant, right? That’s at least a good step in the right direction. I appreciate the thought right A for effort, but outcome Not quite. And so the people are starting to wake up a little bit and I think people are under doctors are understanding that patients are going above and beyond and they’re reaching out the doctors like so some not a lot are striking. Trying to get through games stepped up for sure.
Evan Brand: Yeah. And the other story I had in my head, I may have mentioned this for but a male client of mine, he went in and got an endoscopy. And I don’t know exactly what part what material, what piece of the equipment, but anyway, he has a piece of equipment stuck in his body. And he has to go, he has to go in for surgery now to get that piece of equipment removed. And he just went in for a routine scan into scope. And now he’s got something stuck inside of him. And now they got to cut them open and get it out versus we’re having you wake up and pee in a cup at your house and mail it to a lab and we’re getting hundreds of biomarkers from that. And we’re having you poop into a tray and you scoop that into the collection to and you’re also doing that at home. And you’re sending that into the lab. So I mean, just in terms of ease, and you know, I’ve we’ve talked with quite a lot of few people who they’re worried about their immune system, so they don’t want to go around the hospital anyway, where there may be people that they could get exposed to COVID Yeah, so We’re saying, Look, don’t worry, you’ve never had to go anywhere. And with our practice, you still don’t have to go anywhere. And we’ll still mail you everything. You don’t even have to go to a pharmacy yet to pick it up. We’re going to mail you what you need to your door. So that’s fun, more convenient for sure.
Dr. Justin Marchegiani: Love it. But we did a pretty good job. Now we’ll just kind of compare and contrast a lot of the treatments, right? Because I have my six our protocol on how we work on digests or work on supporting someone’s health. So of course, gastroenterologist are typically going to make zero recommendations on food. Now some of the more progressive ones may say, hey, cut out gluten dairy, refined sugar, that that could be common that a lot of times, that’s not going to be enough, or they’ll recommend a conventional low fodmap diet, which could still have other grains and other inflammatory foods in it. So that still may not be great. So we have kind of our own special kinds of diets that we use, whether it’s a specific carbohydrate diet, cutting out females, salicylates, whether it’s not immune diet, which is kind of paleo plus, right, paleo. No grains legumes dairy right on the immunes no nuts seeds nightshades eggs we may do a keto we may do a carnivore we may look at cutting out histamines and a lot of different dietary templates that we have used thousands of times and we kind of know where the best ones to apply are, that’s important because nine times out of 10 your conventional doc won’t even touch that. Okay, next up is we’re going to recommend digestive support. Now your conventional Doc’s more likely to prescribe an acid blocker than anything to help improve digestion. Now, an acid blocker may be reasonable if there’s an ulcer or an acute ulcer. Now, a lot of times also like pain can improve with digestive support. So there’s also like pain we make ask to try a tiny bit of acid, the tiniest amount, maybe a teaspoon, or an eighth of a teaspoon of ACV or lemon juice. If that causes any irritation. We can all assets we just lean on enzymes. We just lean on maybe some bile salts and then we work on adding in extra healing and soothing nutrients to help support the gut lining conventional Medicine are not going to recommend any healing soothing nutrients, they’re not going to recommend glutamine, aloe, dgl, zinc, rising carnosine, they’re not going to recommend any of these high quality nutrients to help support the Go on.
Evan Brand: Let me point out to if you’re putting anything with acid on the shelf, it’s on the shelf temporarily, we’re likely going to bring that in at a future date where, you know, I got into the debate with the GI doc back in the day, and I asked her, Well, why do I feel better when I do extra acid and extra enzyme? She goes, No, that’s not possible. I’m like, I take more stomach acid, the more stomach acid I take, I feel better. I have less bloating. I have less gut pain. Nope, that’s not possible.
Dr. Justin Marchegiani: Okay, that’s someone that does not have an understanding of physiology, right? Because physiology tells us the more stressed and inflamed we get, the more our sympathetic nervous system is activated. Where does that jump blood to? arms, fingers, feet, why run, fight flee. So all that goes away from the intestine so we have a decrease in our digestive juices and we have a decrease in acidity because that’s part of the juices that are produces and then the acidity triggers enzymes to be produced. So if you have any type of acid irritation, unless we’re coughing up blood, or we have an active Oh sir, I always recommend adding a very tiny bit because sometimes, least half the time, it can make it better. Sometimes the mucosa is so raw that it can’t handle it. So if that’s the case, if we can’t handle it, we lean more on enzymes and healing soothing nutrients. If we can’t handle it, then we just gently taper it up. And again, we’re typically recommending a stool test that’s going to look at old cold blood. So we’re going to get a really good window if there’s blood in the stool or run a conventional blood test that will look at red blood cell hemoglobin hematocrit and particular sites, okay, particular sites or young, immature red blood cells over losing a lot of blood. Guess what goes up particular site. So if we see a lot of particular sites that could be a sign of blood loss. Now, women could have that because they bleed a lot men straight Why’s and have a lot of estrogen dominance? So you have to understand the context of what you’re testing. And when.
Evan Brand: Yeah, good point, good point, the calprotectin we are going to be looking at so that is one marker that does have good overlap from conventional to the functional side. We love looking at calprotectin that’ll kind of give us a clue on just how inflamed is the gut? And is it possible that we could throw in a little bit of acid right away, and I’ve had people that they have had high calprotectin. And we were able to still do a low dose, maybe two to 400 milligrams of patane. And that was enough to really calm things down and improve their digestion so much that we then infer that the malabsorption was creating the inflammation in the first place. And all we did is help them break down their foods better and then the inflammation always drops. It’s so fun to see that I’m sure you get the same high from it that I do where you see high calprotectin you’re like well look at this number. It’s scary. We don’t like it. Yeah, protocol, retest boom, look at the levels drop. It’s so satisfying.
Dr. Justin Marchegiani: Yeah, I would also say a lot of the inflammation and the irritation that is in the inside. decimal track can be from poor digestion. So the food purifies it ferments, it runs cinephiles, it basically rots inside your intestines, and that creates his own host of acids that can be irritating. And sometimes taking a little bit of a digestive acid can decrease the rotting acids from the food. So that kind of thought process is a little bit of acid can decrease the production of more acids from the rotting of the food. And big big clinical pro write this down. I always recommend taking acid with food already in the stomach. People can have false positive ulceration symptoms with HCL by not taking their HCL with food and that’s protein and fat. So I always like protein and fat on the bottom of the tummy kind of coating it and then we’ll typically come in if we’re on the fence with a 16th to an eighth of a teaspoon of ACV or lemon juice, tiny bit and some water just a tiny bit and then that’s a good first step because if you can handle that, then usually you can work your way up. If you can get to a teaspoon to a tablespoon, then usually we can start to add in supplemental HCL and go from there. But worst case, if we can’t, or we’re just being more conservative, we just lean more on enzymes. We go to the gut healing nutrients, and the third are repair right repairing the hormones and the gut healing nutrients where we support a lot of the adrenals. and stuff as well. We need testing for that. The fourth RS where we come in and knock out infections. Most people on the conventional side the antibiotic is prescribed first, not fourth. So we set the table so we can go in there and deal with infections better. And then we’re using herbs that have more of a broad spectrum, but I’m more selective for the bad critters versus the good guys, which don’t create as much of a rebound overgrowth, and then we deal with repopulate rynok good bacteria and we’re not doing just to defeat along them with a whole bunch of additives. We’re doing professional strength professional grade, high potency antibiotics that have you know, that the amount of probiotics on our labels is where that would be at expiration. Not at manufacturing. So when you get a product from us, you’re probably getting double the amount that’s actually on the bottle. And then six RS retesting, and we understand that siblings and their spouses may pass infections back and forth. That’s really important to keep that in mind when we have a chronic issue.
Evan Brand: Yeah, and that’s not that’s not going to get brought up ever. I mean, I actually had a actually had a medical doc send me an email, and they were mad at me because I blamed the husband’s H. pylori infection on the wife. And so the wife was working with this doc and was saying, this practitioner, this guy on the internet, is saying that I’m the reason that my husband got reinfected with h pylori. So the medical Doc’s like that’s not possible. That’s not true. I’m like, Look, man, I could send you hundreds of cases I’ve got before and afters here where we tested someone. We then made a protocol we got rid of the infection two to three months later the infection comes back within test the spouse, boom, the spouse is positive, then we put both Have them on a protocol, boom. Now both of them are clear and both of them stay clear. So, I mean, why that would be controversial? I don’t know. But it was it was a funny email.
Dr. Justin Marchegiani: Yeah, I mean, I have one study right here in front of me it’s called saliva secretions in the efficacy of H. pylori. They’re talking about H. pylori was detected in dental plaque and oral lesions and in the saliva.
Evan Brand: When was the year of that study? Just curious.
Dr. Justin Marchegiani: Yeah, I’ll pull it up here right now. So you can see it may put it right up on the screen-
Evan Brand: Because maybe, you know, maybe this was a guy who maybe he hasn’t looked at a journal in 20 years and he doesn’t know that this is possible or true. And while you’re doing that, too, I want to say something about the-
Dr. Justin Marchegiani: 2011 but there’s a lot of studies on this stuff. So there is going to be some h pylori in the saliva for sure.
Evan Brand: Yeah, and I want to talk about the the herbs in such too. So the cool thing is with the anti microbial herbs, those alone can help reduce them. inflammation and we made out of the gate, as opposed to saying, Hey, here’s an acid blocker out of the gate. If we’re waiting on testing, you know, if someone’s really miserable, it may be 2 3 4 weeks turnaround time. We could throw something in right out of the gate that’s going to address and calm things down, which is very, very good. We talked about a guy had that was a teenager with panchal itis we talked about him a few podcasts ago. But anyway, we got him started on a really potent aloe extract right away. And by the time we got his lab results, Two, Three weeks later, he was already significantly better in less pain, less misery. So that’s the cool thing is there are some quote like, I don’t want to call him urgent care, but for lack of a better term, there are some quick fixes that we can implement right away before we get testing.
Dr. Justin Marchegiani: Totally. And then right here, salivary secretions, the Journal of dental think this is out of two round salivary secretions and advocacy of H. pylori eradication. So basically, they see that hey, the oral cavity may be affected, right. And they see that there could be saliva. saliva could contain H pylori secretions and then the conclusion is they find that h pylori eradication from the stomach may reduce the may reduce the salivary secretion of H. pylori. So we see that in some of the studies and this has been around for a while, so, it’s good to know that and that just kind of supports our theory that we’ve seen clinically with spouses passing things back and forth. And, again, you know, it doesn’t have to be a sexual thing, just sharing drinks and maybe silverware and just living in a house where those kind of things happen easier, right? That increases the chance.
Evan Brand: Oh, yeah, we’ve seen it in kids where it’s like, oh, hey, honey tribe, I did this organic dairy free ice cream, and mom’s got h pylori here. She has given her two three year old the spoon and then you and I’ve seen you know, countless children 2 3 4 5 6 year old kids with H. pylori, and my daughter had it my oldest summer she had h polarized so we tested her gut she had parasites first we eradicated those then on the retest H. pylori showed up and then luckily we were able to get rid of that. So you know, we clinically and personally deal with these things all day, every day, so we have a lot of, we have a lot of sympathy and empathy when it comes to the gut work here. And I just feel for all those people like me that they go to the doctor’s, you have so much hope you’re so anxious about the appointment. I remember feeling comforted. I remember I was in so much pain. I remember being in that office waiting for the doctor to come in. And I just felt comforted back then being in that environment. I’m waiting in the office. I’m like, Yes, she’s going to come in here he or she’s going to come in here. They’re going to give me the answer. They’re going to help me they’re going to get me solved. And then my bubble just got burst. I remember walking out of that place just so disappointed. I thought, oh my god, I remember the beginning of my appointment here. I was so thrilled and happy. I’m going to get to the bottom of this thing. And then here I am, you know, X amount of time later so disappointed and had to keep searching. So we feel for you, we’ve been there.
Dr. Justin Marchegiani: 100% and then again, just because someone has h pylori. The healthier you are, the stronger your immune system, the better levels of IGA you used to create which is going to be in the saliva. mucosa mucosal membrane barriers that’s gonna fight these infections. So it’s just because you get exposed to it in the saliva doesn’t mean you’re necessarily going to get an infection. But the more immuno compromised, you are stressed, weaker adrenals gut barrier integrity issues, poor digestion, the greater chance that h pylori that’s in the saliva could gain a foothold in your body. It’s very possible.
Evan Brand: Yeah, good point. I’m glad you pointed that out. Because there’s going to be a couple haters. Eventually, they’re going to hear this and go, Oh, that’s bullcrap. You know, 50% of the population has H. pylori, you’re painting it to be the bad guy dead. Well, in the modern world, people are so toxic, so stressed, so immunocompromised that I don’t think we can coexist the way we used to, because our buckets are so full. So these things do tend to take on a more pathogenic pro inflammatory state than maybe previously where people stress bucket and toxin bucket was less full. So yeah, I’m glad you made that point.
Dr. Justin Marchegiani: Yeah, and again, not everyone will get exposed to it, because their immune system will just knock it out via their IGA and some may get it but they’re going to be able to be Ace symptomatic, and they’re okay. And then they’re just like, hey, this isn’t a problem. And then they project their their good health and their asymptomatic status to Hey, you know this, this can’t be the problem, because I had the same thing, but everyone has a different constitution. And because of that constitution difference, it could affect you differently. For sure.
Evan Brand: Yeah. Well said, Well, I think we did a good job. We covered the testing piece, kind of the conventional colonoscopy and endoscopy, barium X ray scans, MRIs, CAT scans, CT swallowing, radioactive tracers, compared to the at home, organic acids and genetic DNA based stool testing that we’re doing at home with people. We compared the drugs, the antibiotics, the acid blocking medications, the antispasmodics, the immune suppressant or immune modifiers, like you mentioned, possibly an extreme case a chemo drug, versus we’re going to be going for more inflammatory herbs, natural antimicrobial herbs, anti parasitic antifungals, possibly some extra acid and enzymes, maybe some zinc carnosine and other things to heal up the gut later. Maybe some additional mushrooms and adaptogenic herbs to strengthen the immune system, possibly using these things throughout the family with spouses or children to help protect them as well. And then of course, the diet piece possibly, like my dad when he was suffering. When I was a young kid and he was suffering with diverticulitis, he was told to eat more fiber and that was his diet protocol. And it was take you know, GMO Metamucil psyllium husk or whatever it was with natural with it probably wasn’t even natural flavoring back then it was probably artificial flavoring. And that was the protocol versus you mentioned the templates so possibly, low fodmap low histamine, paleo autoimmune carnivore. There’s different things that we’re going to do based on our educated guesses plus, with the labs, the information and then people’s food journals, how are they feeling basically-
Dr. Justin Marchegiani: Even cooking, cooking, a lot of times just cooking those foods up better, avoiding raw foods and that can help a lot right the cooking is pre digestion and if your tummy has a heart digesting the food The more we can pre digest that food within reason you know steamed sauteed even stews or soups instapot crockpot pressure cooker that can really help with helping the tummy access those nutrients better.
Evan Brand: I brought out the Instant Pot The other day you know it’s summertime it’s hot so it’s not very attractive to bring out the Instant Pot but man, we threw some organic purple sweet potatoes in that instant pot, 10 minutes. It’s awesome. Oh my god, they were so good.
Dr. Justin Marchegiani: Oh, yeah. Like like my carb cheat on the weekend is going to be potatoes because why? Cuz they’re grain free. They’re starchy. I can handle them on the autoimmune side. Some may not be able to but it’s just it’s a really good healthy safe starts and it gives you that mouthfeel that you’d miss from like, you know, breads or grains. That’s my big cheat and I do 10 minutes on the instapot on that it’s wonderful or, you know, at a nice Steakhouse is pretty good too.
Evan Brand: It was hard to believe I could I mean, it was a pretty good sized potato and I thought 10 minutes there’s no way this thing’s going to be done. It was done. We put some butter on that bad boy, some garlic salt. Delicious.
Dr. Justin Marchegiani: It takes 45 minutes to do Boiling or steaming in real life. I mean, the instapot is pretty amazing how fast they can cook stuff.
Evan Brand: This episode is brought to you by Instant pot.
Dr. Justin Marchegian: I know right? Awesome well if you guys are enjoying this content and you wanna share with your family and friends, or you wanna dive in and get support from myself, Dr J or Evan, EvanBrand.com, reach out for Evan. JustInHealth.com reach out to myself, Dr. J. If you guys enjoy the content we’re available, click down below, whatever you’re source, we have links down below to get access. Make sure you give us a comment. Let us know what you think, what you like, what parts resonate with you, give us a comment, like, share, hit the bell for notifications and we appreciate you guys sharing this with your family and friends, so they can become empowered about their health. You guys have a phenomenal day. Take care ya’ll.
Evan Brand: Bye now.
Dr. Justin Marchegian: Bye.
The Harmful Effects of H. Pylori
How Functional Medicine and the Paleo Diet Can Address H. Pylori
A majority of world’s population have H. Pylori bacteria living in their stomach. This damaging bacterium has been revealed to be the main source of fatigue and other common health complaints. H. Pylori invades and damages the stomach’s protective mucus layer, thereby leaving your stomach susceptible to ulcers.
The Harmful Effects of H. Pylori
H. Pylori is commonly transferred by sharing food and drinks with other people, and multiplies very quickly through the saliva. Those with a weak immune system and other health issues are particularly susceptible to contamination.
H. Pylori is the primary cause of poor digestion and stomach ulcers. This bacterium impedes on the stomach’s capability to manufacture mucus, and irritates the inner lining of the stomach. The irritation turns out to be so severe that it leads to the pathogenesis of stomach ulcers. More than 80% of gastric ulcers are due to H. Pylori. This bacterium, if left untreated, can lead to stomach cancer.
H. Pylori Causes Fatigue
H. Pylori can cause fatigue by blocking your ability to absorb vitamin B12 and iron. As we know, the two common causes of anemia are a vitamin B12 or an iron deficiency. This means that if you’re taking B12 and iron for anemia but still aren’t seeing results, you might have an H. Pylori infection.
Role of Functional Medicine
The gut walls possess more than 70% of the cells that build up your immune
Role of Paleo Diet
The Paleo diet focuses on eating natural food that is extensively available. If you’re suffering from H. Pylori infection, here are some great foods to incorporate into your diet:
- Quality meats – Such as grass-fed beef and lamb, and wild sockeye salmon.
- Eggs – Pastured eggs, the yolks will be a deep, rich yellow-orange color.
- Fresh Organic Vegetables and Berries
- Natural oils –Avocado and Coconut oil are some of the best.
If you’re suffering from any digestive issues or fatigue, addressing the health of your gut with the help of a functional medicine practitioner should be your first course of action.
By treating any gut infections and optimizing your diet, you can reduce your symptoms by addressing the root issues.
What Causes H. Pylori Infection…The Most Insidious Infection Around?
By Dr. Justin Marchegiani
What causes H. pylori infection? Did you know that over 50% of the population has an H. pylori infection (1)? Dr. Marshall, the scientist who discovered H. pylori, won the Nobel Prize in medicine in 2005 for his discovery. His initial research was done on himself, as he infected himself to prove the bacteria’s causal connection with gastritis (inflammation of the stomach).
H. pylori is an opportunistic infection that spreads more rapidly in people that have a compromised immune system. This is why there are higher rates of all parasite infections in Third World countries. In the United States, we are seeing an increase in chronic stress and poor eating habits, which compromises our immune function and makes us open for an attack.
How Do You Get an H. pylori Infection?
H. pylori, unlike other parasitic infections, can be spread very easily via saliva and doesn’t require sexual intimacy per se. This is why it’s very common to see an entire family test positive for an H. pylori infection. Things like sharing a drink or silverware can be enough to spread the infection in a compromised individual.
What does H. pylori do to our body?
One of the biggest problems with H. pylori is its production of a specific enzyme called urease, which essentially neutralizes hydrochloric acid due to its increased production of ammonia. Hydrochloric acid is needed to help digest protein, ionize minerals, and create an acidic environment in the guts to stimulate bile release from the gallbladder, which aids in fat digestion in the small intestine.
If we can’t ionize our minerals properly, this will lead to a whole host of issues, including osteoporosis, immune problems, thyroid problems, and anemia. Lack of hydrochloric acid will also lead to indigestion, malabsorption, gas, bloating, and a catabolic physiology (your body breaking down faster than it can build up).
A large percentage of H. pylori infected patients will not present with any symptoms, so it’s possible you could be feeling great and still have an infection. This is also why my recommendation for anyone with an H. pylori infection is to supplement with hydrochloric acid and enzymes to ensure optimal digestion, even if no digestive symptoms are present.
It’s important to note that the enzymes and hydrochloric acid by themselves will not be enough to eradicate the infection. A proper assessment should be made by your functional-medicine doctor regarding your primary physical, chemical, and emotional stressors to ensure long-term eradication of the infection.
H. pylori also irritates the stomach lining, hence its connections with gastric ulcers. This essentially creates silent inflammation, and now your adrenal glands have to come to the rescue to put out the smoldering fire in your gut. Your body uses cortisol from the adrenal glands to help put out the fire. But as your adrenals become more fatigued, cortisol will lose its capability of keeping the fire under control. This is the point where you will start to see the exacerbation of your symptoms. Many people can have this infection for a long period of time and not necessarily have any symptoms until their adrenals drop into stage III adrenal fatigue.
What Makes H. pylori Different?
H. pylori is a gram-negative bacteria. What this means is that H. pylori has two cell walls while most bacteria (gram positive) only have one cell wall (see picture below). When there are two cell walls, it makes it harder for antimicrobial medicines and herbs to eradicate the infection. This is analogous to a castle with stone walls for protection also being surrounded by a moat, which makes it more difficult for any intruders to invade.
Efflux Pumps and Antibiotics
In between the first and second cell wall, there is something known as efflux pumps. These pumps have the ability to disperse the antibiotic medicines that were given to the patient back outside into the gastrointestinal tract. These efflux pumps are believed to significantly contribute to antibiotic resistance, which is so prolific today (2).
When the antibiotics are pumped back into the gastrointestinal tract, patients can experience more die-off reactions. These reactions can include fatigue, nausea, bloating, flu-like symptoms, and diarrhea. H. pylori has obviously adapted in a way that has made it more resistant to antibiotics. This is one of the main reasons why I’m such a fan of herbal medicines, as they can be used for longer periods of time and don’t seem to have the same side effects as antibiotics.
The other major issue with gram-negative bacteria is that the outside of the bacteria is toxic. This toxin is known as lipopolysaccharide (LPS), or endotoxin, which is actually toxic to the liver. The more H. pylori becomes eradicated from your body, the more your detoxification pathways become stressed from the toxic debris! This is why I find removing the infection over a longer period of time and using additional herbs to help with drainage and detoxification can be beneficial in reducing those die-off reactions.
The most common or conventional symptoms of H. pylori infection:
- Abdominal pain
- Bloating and fullness
- Dyspepsia or indigestion
- Feeling very hungry one to three hours after eating
- Mild nausea (may be relieved by vomiting)
Less common symptoms of H. pylori infection:
- Neurological pain
- Anemia (B12 or iron)
- Leaky gut (gastrointestinal permeability)
- Depression and anxiety: All of the neurotransmitters in our body are made from proteins and amino acids.
- Constipation and diarrhea: Inflammation can disrupt motility in the GI tract.
- Crohn’s, ulcerative colitis, or any other digestive disorder
- Explainable weight gain.
- Fatigue or thyroid disorder: H. pylori is linked to autoimmune thyroid disease (6).
- Blood tests: These tests are indirect and assess the specific immune responses to the H. pylori infection. The immune responses that are measured are H. pylori and IgA, IgG, and IgM antibodies. If you test positive for IgA or IgM, you can be confident that you have an active H. pylori infection. Research has shown that test results in patients that are positive for IgG antibodies tend to drop within six months of H. pylori removal (5).
- H. pylori breath test: This test measures increased levels of CO2, which is the by-product of urease and nitrogen. H. pylori breath tests tend to only show acute infections.
- Stool test: H. pylori stool tests are the gold standard and are the only tests that look for the actual particles of the H. pylori bacteria.
- Endoscopy: This test is the most invasive and tends to be the least reliable, especially if you have no overt symptoms. This test can be good at assessing cancer as well as damage to the stomach, duodenum, and esophagus. For most individuals this test is unnecessary and is only recommended for high-risk patients.
Conventional Treatment Options and the Prevpac
Patients who have H. pylori and also have an ulcer are most likely to benefit from being treated. The treatment does not work in all patients.
Treatment must be taken for 10 to 14 days. Medications may include the Prevpac, which is a combination of three antibiotics.
- Clarithromycin (Biaxin)
- Amoxicillin, tetracycline, or metronidazole (Flagyl)
- Proton-pump inhibitors, such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium)
- Optional: Bismuth subsalicylate (Pepto-Bismol), in some cases
Natural Treatment Options
- Mastica (3)
- Burberines (4)
- Oil of oregano
- Olive leaf
- Black walnut hulls
- Probiotics (4)
- Vitamin C (4)
It’s very important the right combination of herbs as well as the right dosage of herbs are used. I strongly recommend a customized program by a functional-medicine doctor specific to your needs. This will give you the best chance of removing the infection the first time without terrible die-off reactions. If you have any of the symptoms mentioned in this article, click here to schedule a complimentary consult.