The Importance of GI Testing and the GI Map | Podcast #259

Today our topic is on the importance of gut testing. This kind of testing is kind of what we use in our functional medicine processes. It can pinpoint the precise and accurate levels of different types of microbes in your gut. Know the pros and cons of gut testing and why it is very important. Check this podcast we have with Evan Brand.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

2:36 Contributing factors to Gut Inflammation

11:30 H. Pylori

14:31 Overgrowth category

26:13 Immune System Health

36:34 Antibiotics


Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house with Evan Brand hope everyone is doing fabulous here today, we are going to be talking about the importance of gut testing. Super, super important is a couple of modalities that we use kind of at our functional medicine tool belt. And gut testing is super important. We’re going to kind of go in the ins and outs of gut testing why it’s important. We’re going to break down some of the GI map actual testing as well. And we’re going to go through what a typical test looks like. What we’re actually assessing what we’re looking for infections, functional analysis, other intestinal health markers, like inflammation IGA levels, beta glucuronidase, steatocrit, elastase we’re going to break it all down. We’re trying to bring everyone actionable information that you know a lot of doctors, a lot of people you see online, they’re not releasing things So a lot of the stuff they talk about, it’s kind of theoretical, and it’s not really applied. So everything that we’re talking about today has actually been applied with thousands of patients so hoping everyone enjoys. So while we’re on the topic, Evan, how are you doing today, man? 

Evan Brand: I’m doing pretty good. I’m trying to look for a stool test. It’s like really bad because it’s more fun right when you see ones that just have tons of infections on there, and I’ve got it I’ve got a good one here that we can dive into. I was just trying to find one with a high beta glucuronidase because that was one key point that I wanted to talk about with you is that many people are sick because of having high Beta glucuronidase which is an enzyme that goes high due to bacterial overgrowth in the gut. And so many people talk about, Well, you’ve got to take calcium gluconate right? People discuss calcium gluconate as a supplement to help lower high basically granted days now this is like your average person at the grocery store is not gonna have that This conversation but we’re talking in the functional medicine world, if you’re working with a practitioner, they may look at you. And if they know what they’re doing, they may say, hey, yeah, you should probably do calcium gluconate. But that’s not the root cause the root cause is figuring out. Why does this person have high beta glucuronidase in the first place? Yeah, we can take nutrients to lower this and we can take nutrients to lower inflammation. We always have to work backwards. So why don’t we talk about the backwards piece? What what are the contributing factors to the gut inflammation? We’re seeing what are the contributing factors to the Secretory IgA being low? Why does this happen?

Dr. Justin Marchegiani: So first thing first is we have to do an adequate history. How did we get here? That’s like the first question that everyone needs to be asking themselves, and their functional medicine doctor needs to be kind of reviewing with them. So a lot of people, there’s usually a history, that portion that reveals this. So when I come in and I do a history, I do a timeline history. I try to figure out how the person got here. So there’s two scenarios, there’s either the person got to this position where they’re sick and not feeling well, acutely. I was in Mexico, I ate some bad food. Now I’m sick, or most of the time, there’s a chronic insidious bit to it, where there’s been some stress, emotional stress, physical stress, chemical stress, bad food, poor digestion. And then the kind of stress has been going in a downward pattern health symptoms have been getting worse over time, and then boom, they get sick, acutely, but it’s not really acutely, there’s been a downhill kind of spiral the whole time. So number one, there is totally acute, feeling great. And now they’re not number two, it’s this chronic downward decline, boom, they get sick. And that’s a number three is it’s just chronic, and there’s no timeline. There’s no event at all. It’s just a gentle downward slope. So three ways that kind of health symptoms unfold, one very acute to a downward decline followed by an acute Episode and it could be a couple of acute episodes by the way may not be may not be one. And a lot of times there could be an autoimmune flare involved in there. And number three is it’s just a gentle downward decline with no acute episode. So those are the big three scenarios. So we have to really look at Hey, when was the last time you remember yourself feeling good? Walk me through the timeline over the last 1015 years? When did things start to go sideways? Was it when you were eating some bad foods and gluten? Was it when your diet was poor? Was it when stress or sleep was poor? Was it when you started going through menopause or having some hormonal issues? Was it when you had a thyroid flare? What was going on when all this stuff happened? And those are the important questions because we have to connect the dots to the root cause. So when we ask questions about symptoms that are downstream, we’re actually looking upstream to the root cause that cause the symptoms to manifest. So there’s a different mindset. Most clinicians and doctors are looking at, hey, what medication can we do to cover up that symptom or even what supplement or nutrient or herb can we use? used to cover up that symptom, but we’re actually we may be looking at that too, but we’re also looking upstream as well.

Evan Brand: Yeah, a couple other triggering factors. Divorce is huge. So any issues with marriage whether someone just had a bad marriage and needs to divorce but they haven’t yet they did get a divorce. Like I had a woman last week who developed Hashimoto, she developed thyroid antibodies after her divorce, she had blood work done before she had no antibody, she went through crazy stressful divorce fighting over who gets the kids and all that, and then boom, you look at the labs, and then there’s the antibodies that showed up as sort of a response to the major stress.

Dr. Justin Marchegiani: Yeah, of course. And ideally, when you deal with marital stress, ideally, you’re on top of it and you seeing a counselor to help and it’s always easier to mend it than to walk away some situations you can some you can’t but we always recommend getting some kind of counseling there to help to help on that side of the fence. And then of course, you know, death of a loved one is going to be a big one. Even things like moving and a lot of times moving may be tied to a promotion. Or a good thing. But believe me, it’s very stressful. We look at what’s called the social adjustment questionnaire, moving death of a loved one death of a child’s even more. You know, affairs, divorce anything on the relationship size really big. So those are going to be important things you want to look at from an emotional stress standpoint, because those can be a big thing. And they put stress on the adrenal glands. So hey, we just want to make sure that we’re addressing it, we’re processing it, we’re seeing a counselor, we’re seeing a therapist, someone to work on it. Maybe there’s subconscious stress, maybe we’re working on EFT or NLP or EMDR techniques to deal with PTSD from that trauma. So we have things like that, right. And then, of course, like in your timeline history, we’re also going to be looking at was there a leak in your house? Was there any mold exposure, things like that? Because that’s a big environmental poll. Hey, do you feel better when you leave your house for a week? You know, barring the fact that you may be on vacation and stress is lower. If you just leave your house for a week you feel better. So we like to have Those kinds of timelines, because that can. So I digress. But that can set you up for a whole bunch of gut issues. So when we talk about gut testing, it’s never just the gut myopically. We’re trying to connect the gut to underlying stressors that have been accumulating for years, if not decades, that got you to this position to begin with.

Evan Brand: Yep. Well said Well said, Yeah, the mold piece is huge, you know, because people move so you have the stress of moving, but then you’re moving into a house. It’s moldy. So you and I mean, countless times now we’ve seen people where it’s like, Okay, what happened in the last few years your health went downhill. Well, I moved two years ago. Oh, okay. When you moved into that house, did you get worse? Yes, I did. Okay, let’s test it. Boom, there’s a big smoking gun. And now we know, just with the help of some of these laboratories that look at mycotoxins, they’ll tell you straight up. The papers look at mycophenolic acid, a major mycotoxins it damages the gut barrier. So this is a new cause of leaky gut beyond infections. Also, it promotes the growth of Candida which disrupts your gut and your brain function and efficient moats the growth of Clostridium bacteria, which we often see. So now we have the root cause of the root cause meaning, okay, these people keep treating Candida maybe with the natural path where they do herbs to kill Candida, and then it keeps coming back. Why is it coming back? Well, now I know mycotoxins are one of the big triggers. But let me share my screen. Let’s go into this. I’ve got two different. I’ve got two different ones here that I want to that I want to talk through with you. Let’s do and so two different situations, both of the people had similar symptoms just in terms of mood issues, depression, anxiety, but the one on the right here on my right here, this is the one that’s moving. This one is– 

Dr. Justin Marchegiani: I just want to highlight I want to just highlight one thing here for people. So this first page here, a lot of the path is on the first section bacterial pathogens. These are typically food poisoning type of pathogens, C diff toxin A and B. When you have both is more serious. You can get these from antibiotics, hospital setting primarily Campylobacter and then a lot of the E. coli Whether it’s the endotoxin genic hemorrhagic Coli, or the O 157, or the various Shigella toxins, which are part of the E. coli spectrum, salmonella, cholera, your stinney is kind of like a parasitic bacteria, these are usually going to be food poisoning situations with the exception of C diff more hospital setting, or antibiotic setting. And then, of course, the parasite section is others on page four on this test, but these are some significantly big ones, crypto, and to me, but his political histo for short giardia. And then, of course, some of the viral issues with it, the viral issues with tend to be more self limiting, but the biggest here are going to be parasites and more of the food poisoning or hospital based infections above. All right, go ahead.

Evan Brand: Yeah, and I’m going to make a pretty link which is a link that will redirect you because if you’re listening on audio, this is not going to be as exciting. So if you’re, if you’re listening to my podcast, you can just type in and I’m going to make the link MAP. So, that’s going to take you to Justin’s YouTube channel where you You can view this if you want to kind of follow along. But yeah, so on this on these two particular cases, nothing showed up on on page one. Everything’s below detectable limits. A lot of times we’ll see crypto and Giardia. Though if we’ve got somebody that’s got weight loss or weight gain issues, we’ve got stomach cramping, we’ve got diarrhea. And the interesting thing is to this time of the year when we’re talking towards the end of November, we’ll have a lot of people that will come to us with more acute issues. And when we look at the acute issues, a lot of times the noroviruses will show up and we can give some support but a lot of times those things just have to run their course.

Dr. Justin Marchegiani: Yeah, a lot of times are self limiting. We can do things like high dose silver, so my line will do GI clear tree which is a silver compound or nano silver. We can also do monell Lauren as well to kind of help knock those things down. We can even just do high dose oil of oregano so my lines Yeah, clear fives in emulsified oil of oregano very high dose that can be helpful shakhter threes and nano silver. So a good nano silver a cool little silver can be helpful and a good mana lard which is an extract Coconut, all had great antiviral benefits too.

Evan Brand: Yep, so here’s page two. Now as I mentioned the one on the right here, this person is more sick symptomatically. And we already see one reason why you see the H. pylori at the top of page two here. And this is like an exponential scale. So goes he 345, whereas the person on page two, they’ve just got a lot of stuff going on with their normal Flora being too low, you’ve got some that are showing up too high. But obviously page two here the H pylori is going to be the biggest smoking gun for this person on the right.

Dr. Justin Marchegiani: So let’s kind of hit it one by one. So we have the H. pylori section. So one thing to highlight is the standard deviation, I have a lot of patients that freak out that don’t quite get it. So, you know, unless you take in a stats class or a physics class. It’s weird, right? I wish the lab didn’t use the standard deviation, meaning either the five either the four, whatever. So when you see the reference range, the reference range is either the three. So the average person will look at this and say, Oh, well, the range is greater than one. This is 1.2. That’s only a little bit It not not necessarily, because this is either the three over here to the right, and this is either the five, so to equal it out, you have to move the decimal place to the right three times. So when you move it to the right once now becomes 12, either the four, and then when you move it again now becomes 120, either the three. So now when you look at it, it’s actually 120 times above the normal limit. So that’s important because if it’s 120 verses, only one time above, that tells us the infections probably a lot more serious from an overall load standpoint. Does that makes sense? It does. And people confuse that. And it’s okay. It’s not normal, right? Unless you take in those classes, you know, you’re not going to know it. So if people look at it first time around, it’s just confusing. The lab could do a better job at that, but that’s where we’re at. And then if you look at the virulence factors below, these are cytotoxic proteins that are produced by the infection. So you can see this person on the right and people listening will have The link for these labs so if you want to click on the link and follow along and look at the lab with us, we also have video format. So if you want to see the video version, it walks us walk you through it that way. So you see these virulence factors. So one of the bigger ones is going to be the VAC gay, the gay and the CAG. The most, most research on those two, but these are cytotoxic proteins that are being produced by the infection that give it greater chance of inflammation, ulceration, cancer, etc. So it just it tells us the infection stronger That’s all it is. It’s like oh, this infection has a little bit more muscle or meat behind it so to speak. So you could still have problems without the virulence factors being present. But if we see virulence factors in a strong amount of H. pylori, well then we know that this infections probably a lot more serious, we have to handle it, you know sufficiently But either way, if we see even a borderline number on the H pylori, then we’re still going to address it and make sure we knock it down any comments there.

Evan Brand: I’ve seen multiple people that have had a history of stomach ulcers. And those people with a history of stomach ulcers do tend to show up with some of the virulence factors. And there are some papers on that we’ve got a white paper on this where we can look at the different virulence and see what they’re associated with some is long term inflammation, some is long term infection, some is increased risk of stomach cancers, and the Safageo cancers and all that. So these are very helpful. And if we do see them positive, we always put a huge emphasis on him.

Dr. Justin Marchegiani: 100% Next we have the normal bacteria. And so this is normal, good flora. You know, I should say normal beneficial Flora in the gut. So like when I say that there are two that are probiotic species like you know, well, the ones you think of as probiotics those are going to be your lactobacillus and bifidobacterium species. And there’s a lot of different lactobacillus there’s lactobacillus para kci, acidophilus rotary right. Lot of different kinds of bifidobacteria, long gum, etc. So there’s many different species, bifidobacteria, the lactobacillus kind of lumped all those into one. These are what we consider our probiotics. And everything in this section is a normal bacteria. So when you see achra mantium, you send affiliate high, okay, that’s on the higher side. Is that an infection? Is it a despotic bacteria? Not necessarily. We’re not going to worry about it too much. These things kind of take care of itself. And I’ll go into that. You can see this person has a lactobacillus is low, right. So that’s a beneficial bacteria. So I’m already leaning into the fact this person probably has a dysbiosis, meaning higher amount of bad bacteria in relationship that good bacteria. And so you can see here below, this is the types of bacteria and then the phyla. Think of phyla as family. And there’s two general families of bacteria. There’s the bacteroides family, think bacteroides beautiful, and then from mek kinase think of for mek kinase as fat Now what does that mean? from mek kinase bacteria tend to have the ability to over absorb calories. So when we see higher amounts of mek kinase over absorption of calories, and again, some of the studies on this or week or more MySpace studies, higher levels are for mekinese increase weight gain in mice due to calorie absorption. Think of bacteroides is beautiful, helps, it does the opposite of gaining weight keeps you leaner and healthier, right. So, we don’t judge a lot on these markers, because these could be off if we have a lot of bad bacteria or infections. And I can already see below a little bit, you can see the despotic bacteria section, there are some bacteria that are already off. So because we know that a lot of that normal bacteria may be off so we don’t really worry about it. It’s more of an effect, not necessarily a cause. So we keep it in mind. And as we clean things out and we add prebiotic fibers and we change the diet. A lot of times that stuff by itself will kind of come back into balance itself. We don’t really get too myopic on that.

Evan Brand: Any comments on this overgrowth category as we? Yeah, so let’s move on to the overgrowth category. We talked about how this person on the right is definitely more sick and symptomatic, as the person on the left says my internet connection is unstable. I don’t know if I got choppy on you for a minute. It should be fine now. Good. Okay, so you see the Pseudomonas over here on the right Pseudomonas SBP, Pseudomonas Aeruginosa, you see the staff, little caucus different species of that. You see streptococcus is real high. So even just looking at a numbers perspective, looking at the number of different species of overgrowth bacteria, you could see the one on the right is obviously a bigger problem.

Dr. Justin Marchegiani: Exactly 100%. And then the big thing I like to look at is, look at the standard deviation, I see which ones have the same standard deviation that are positive. So off the bat, you can see the staff is 1.08, but it’s got one standard deviation above so it’s 10 x higher so that’s like an 11. So fives the reference range elevens not bad. Next thing I look Look at this step six are greater than one. So nothing’s like jumping out super high, Bacillus 7.5, either the five, one point and so nothing’s really super high. Now I go over to the patient on the right. Um, let me see if I can what jumps out at me here. So you can look at this was Yeah, Pseudomonas, for instance. Right? That’s 3.468 of the five, the reference range 1.08 of the four. So what’s that? Really? That’s really 34.6? Well, so the Pseudomonas is really high, that’s 34 times above, that’s a big deal, right? So I try to look at and say which ones are are mildly elevated in which ones are significantly elevated, what does significantly mean 10 X or above 10 extra above I considered to be significantly elevated. Now we’re not going to do anything specific to target one bacteria of an over another. We have specific herbal blends that will use to work on knocking these bacteria down. And again, these bacteria can produce methane and hydrogen gases. That can disrupt motility can cause constipation, cause diarrhea. So you want to keep these in mind. Now, a lot of people are like, Well, can this Tell me if I have SIBO? This is a common question. Yes and no. So we know that certain bacteria like Pseudomonas or strep or citro, bakkar, or Prevotella are associated with SIBO. We know that according to the literature, but we can’t specifically say because we don’t know exactly where the bacteria came from, right? So imagine you squeeze some toothpaste out of the toothpaste tube, and you want to know, hey, well, what part of that toothpaste tube was exactly in the middle portion of a two? Well, it’s hard to know once it all came out, right. So, with a SIBO breath test, you can know because when you swallow lactulose, you know, and you blow in the tube every 20 minutes, you know, based on the time it takes for that lactulose to enter the the large intestine, you know, kind of where it is. So it takes about 120 minutes to get into the colon or the large intestine. And once that lactulose breath test is done, so you kind of know if it’s within that hundred and 20 minutes that it’s probably in the small intestine. So we need a breath test to really confirm SIBO overgrowth in general to be exact. Can we say that it’s probably a SIBO overgrowth when we see certain bacteria? Hi, yes. So we tend to use terminology like hey, you have a just a generalized dysbiosis. And we can treat it and address it and retest. We can also do SIBO breath testing so we can be more accurate with lactulose. And know exactly potentially where it could be based on that timing scheme that I mentioned. So with lactulose, you’re blowing into a tube, and then you’re so you’re blowing into a tube, you get a baseline, then you swallow some lactulose and then you’re breathing into every 20 minutes. So you’re going to be able to get about, you know, about six to eight readings before you know it’s in that colon. Does that make sense?

Evan Brand: It does, and we just did a whole show on that. So go look back just a couple episodes ago, we did a whole podcast on SIBO bacterial overgrowth parasite, so check that one out. Now. Here’s what section I want to point out here, which is the fun guy yeast category. You see here that both of these people tested negative or supposedly negative for Candida SBP Alba cans, geo tricon micro spurt, and these are different fun guy. Micro spurious technically considered a parasite, but it’s, it’s confusing. So it’s in the fun guy category. Now, here’s the interesting thing. I don’t have these right in front of me to show you know, these false negative for candy candy is really tough to find in the store. We’d like to measure the organic acids like tartaric acid, and [INAUDIBLE] at all on the urine. So these are false negatives. So people ask about what’s the accuracy? Well, this test is very good, but it does have the issue of missing Candida quite a bit. And I can tell you because I remember these cases, both of these people had major candida overgrowth, it just didn’t show up. So you can’t This is why a lot of people they’ll try to save pennies and only do one test when they’re looking into their functional medicine history. But you can’t you gotta have all the puzzle pieces because all Otherwise, we may only be using antimicrobial herbs and not antifungal herbs and in this case, that would be what would happen we would have only used the bat the antimicrobials and not antifungals. But I can tell you, after looking at the urine of these people, they needed the antifungals. So we got them because we had all the picture. The picture was complete with the urine and stool, not just the stool

Dr. Justin Marchegiani: 100% so just kind of looking above real quick. The gi map can tell us generalize dysbiosis it can give us a pretty good guess that there could be small intestinal bacterial overgrowth SIBO based on the bacteria we see, but it can’t 100% confirm SIBO. So just trying to get people to wrap their head around that. That’s a common question I get. So I’m going to refer my patients to listen to this podcast for more Intel, but to be exact on the SIBO we need that protest. The next is a biopsy. Most people are not going to do a biopsy when there’s less invasive testing like a breath test available. And now adding to your point about the fungal overgrowth. The first thing we look at to assess fungal is clinical symptoms. Do we have any fungal toenails or fingernails? Do we have any dandruff issues in the hair? Do we have any tinea versicolor rashes on the skin? Do we have any history of athlete’s foot or jackets those kind of things. And of course that tells us there could be the gives us a higher chance that there could be fungus in the gut. That’s number one. Number two, we’re going to want to address that either way with specific herbs and obviously we want to hit it topically because sometimes fungus on the body or hair or scalp or skin or growing area or anywhere else still may be a problem and we may have to hit it topically that’s really important to note. And then we also have the [inaudible] which is going to look at fungus from the organic acid perspective and the organic acids a urinary test and that gives us a little bit more of a systemic window into either gut bacteria or yeast. And so that’s another test that we tend to combine with this because I’ve seen a lot of people come back clean on the yeast or fungus the very elevated, that’s important to keep an eye on.

Evan Brand: Yep, all the time. So we’ve seen much, much worse than this page 4 here, there’s a lot of other cases we could have pilfer through but just these are just the to be pulled up today. And according to this, you see that the only thing on the parasite and worm category was the person on the right here had some didn’t to me but fragile list which, according to the lab, they would say this isn’t a normal range. Now, we’ll probably end up killing this just as a byproduct of using the herbs to knock out the other bad guy. So this will probably disappear on a retest. But a lot of times we do see stuff pop up on these pages here blasto and cyclospora and [inaudible] there’s some other bad guys on here that can help drive up these inflammation markers. Now, if you go down to the bottom section here, I told you in the beginning, the person on the right had way more way more symptoms, they were way more sick and look here at the calprotectin level, the inflammation level, you know, we’re well above 400 here. So this is super, super inflamed gut and I’m surprised at that. IGA was as good as it was here the IGA expected to be lower, but it wasn’t. So either way this person needs help major.

Dr. Justin Marchegiani: Exactly. So just recapping, we have the parasites, these are all significant. So please have a parasite that’s close to being positive. So this one, this person here with the D fragilis, at 2.51, either the, either the third, versus the range being 1.08 of the five, I’m not worried about that, because this is essentially, let’s move it over to the left twice. So we’re looking at point o two, five, and then that’s one or greater, so not really worried about that, even though comes back positive, not worried about it, but it’s far below the reference range. If it was maybe 50% below the reference range or greater, you know, 50%, or up meaning point five and up even five same as the reference range, then you know, we’re going to work on treating that for sure. And so we have all these parasites here we of course, we have worms and we have different protocols for worms or for parasites, and we different protocols. If someone has A worm, a parasite, fungus, and bacterial overgrowth together and we may sequence things differently. So there’s a lot of different combinations and how we may hit things depending on what else is coming back. You know, any comments there Evan? 

Evan Brand: No, this is all good. And then what do you want to say about the immune system health here?

Dr. Justin Marchegiani: Yeah, so let’s kind of hit one by one. So sciatica it’s very important if we can’t break down fat that tells me that we have poor biliary output. If we have poor biliary output, there could be stones or sludge in there that could be from estrogen dominance. It could just be from inflammation in the gallbladder. It could be from poor stomach acid levels from gut stress and from CBOE and from infection, so we have to follow the six hours we remove the bad foods we replace the enzymes acids and maybe bile salts, if we have increased levels of sciatica because we have to be able to break down fat. Remember, bile is anti bacterial, right? So if we don’t have enough bile, and we’ve had chronically low bile sciatica will be higher and if sciatica tire that means Biles lower long term Biles antimicrobial So with lower levels of bile for long term that can actually drive bacterial overgrowth, so we want to make sure it’s the adequate adequate. We want to make sure elastase is good if we have low enzyme output, it automatically go to the fact that we probably have low hydrochloric acid too. And we’re going to stop them at HCl and enzyme separately. If we see sciatic right there, we’re going to add an extra biliary support in ox bile as well to help with fat Breakdown.

Evan Brand: Let me mention here what with the H. pylori infection, I’m kind of surprised have two things on this one on the right here that the secret is below detectable limits, because a lot of times we see H. pylori, and hi stay out of crit on the same panel, and then the IGA I’m surprised the IGA is not lower, meaning the gut barrier is less than tech. So maybe that means that the person was doing really good with diet, but I don’t think so with the calprotectin being so high. I don’t know, maybe it’s a relatively new infection. The IGA is better than the physical fast, not there. I don’t know. We don’t have to know every detail of why things show up the way they do. But it was just surprising to see that.

Dr. Justin Marchegiani: Exactly. So I mean, it’s important. So when we see you could have digestive issues and some of these markers couldn’t look, okay. So we have is that there’s an art and a science to what we do. So it’s not just Well, the test says there’s therefore, you know, we’re not going to give you support because we’re not treating a piece of paper, we’re treating a real life human being. So we have to look at the total picture, we have to look at the labs, we have to look at clinical markers, clinical indicators, hair quality, nail quality skin color, we have to look at the whole picture, right? If we see poor nail and skin and hair quality, well, we’re thinking this probably some digestive issues, especially with breaking down fats and protein, even if this test says we’re okay. Yeah, so next thing is we look at beta blocker on a day that tells me there’s probably some bacterial overgrowth, which made it look around and this gets made by bad bacteria. So we like to look at that as well as the other markers for bacterial overgrowth like the actual bacteria themselves. And then of course, that’s going to screw up estrogen metabolism. So we may, if it’s a female or a male, when they were having high amounts of estrogen symptoms, we may give things like calcium to glue great. But a lot of times just fixing the digestion and getting extra sulfur nutrients in there can help a lot of that so we can start breaking down and escorting out those re metabolized hormones, those research questions, we may give extra fiber a vitamin C as well. It just depends but when I seek beta glucuronidase high I’m thinking hormonal issues and I’m thinking also bacterial overgrowth issues too.

Evan Brand: Yeah, just general toxicity because you’re really circulating toxin. So when we see mycotoxins high, if we look at chemical toxins high, we know that person is really circulating all their toxicity. So we really have to prioritize that when we see it high.

Dr. Justin Marchegiani: Exactly. And then the next thing is ocula. Of course, if we see an H pylori infection, you know, we’re thinking Oh, hey, is there an ulcer? Is there any blood in the stool is already redness in the stool? Most of the time, we see That’s going to be in the stool. We’re thinking, hey, maybe there’s just hemorrhoids, right? Those hemorrhoids veins in the in the anus, they get inflamed, but people chronically bearing down. And sometimes a little bit of blood can come out through those veins. And that’s not necessarily as big of a deal as let’s say, an ulcer in the upper gut track, or something in the small intestine like a dwan ulcer So we have to kind of draw a line between ulcerations in the intestinal tract, and maybe a little bit of blood coming out from the hemorrhoids. So of course, if we see any blood, we asked, Is there a history of hemorrhoids? And most of the time, there’s Yes. If we’re not sure, then, you know, we’ll look at Hey, is there any anemic patterns, they’ll be 12, low iron, run a full iron panel as well run it run a full CBC with indices, so we can get a window to make sure it’s not affecting the overall blood and iron levels and hemoglobin levels. Okay, any comments there?

Evan Brand: We’ve seen a really high and these cases it was zero, but we’ve seen it high and it’s a great, very helpful piece of the puzzle.

Dr. Justin Marchegiani: Exactly. And the next thing I would say is the ga levels and again IGA, it’s good to look at we don’t go all in an IGA. If we see extreme high, we’re thinking maybe there’s an active infection and the immune system is going after it. If we see low, we think maybe there’s some chronic stress and that immune mucosal barrier has been weakened due to inflammation from food infections, poor digestion, emotional stress, etc. We don’t go all in though. So it’s not like, Hey, this is low, we have to, you know, go all in and target that. It that’s a, I call these peripheral markers, meaning they’re an effect, not a cause. So the IGA is going to go up because of other things, that’s not going to be a problem in and of itself, we have to look upstream to get to the root issue. So we keep it in mind, but it’s not going to be something we get so myopically focused on.

Evan Brand: Yeah, and it’ll often it’ll often self regulate. So if it’s, if it’s too high, and you fix the bugs, it’ll go back to normal. If it’s too low, and you remove the infections, damaging the mucosal barrier, then it can come back up on its own, and sometimes it does need special care, but a lot of times it does self regulate.

Dr. Justin Marchegiani: Exactly. Exactly. And then again, we have the gluten antibodies. That’s a big deal because if we are gluten sensitive, and we’re consuming foods that are making us weak and jacking up our immune response or weakening our immune response, that’s a problem. So of course, the gluten markers are a big deal and we gotta keep that in mind. And it may not just be cutting out gluten, and you know, avoiding wheat, barley and rye, right, which are gluten grains. Really, that’s basically adding, maybe cutting out all grains because glutens just like brothers and sisters in a family, they may look similar to their aunts, their uncles and their cousins, right, there’s a family resemblance and so our immune system still sees that family resemblance to other types of gluten grains, like rice or oats or corn, or even pseudo grains like quinoa. So we may have to cut out all grains and go 100% grain free. And then of course, the other X Factor is going to restaurants that could be grains or flowers or thickeners and sauces. So if you’re going out to eat and you’re trying to be 100% green Free, you know, stick with steaks stick with things that don’t have sauces on it unless you know exactly what that sauces.

Evan Brand: Yep, well said the calprotectin look at the huge difference here. I mean, despite both of them having bacterial overgrowth, we see calprotectin here at a three, no issue. And then over here we see 400, which is really high. We’ve seen higher but I mean, that’s, that’s a significant problem. And I would say this is more of a, an effect as well, right? I mean, you’re not going to say, Hey, we’re going to submit specifically go after calprotectin however, I often do, I often will throw in, I’ve got one I called gic with two, which is just a straight aloe extract, I often will if it’s this high throw in just a little bit of some aloe or something else to try to hurry up and give down even while we’re working on the bad guys. Yeah.

Dr. Justin Marchegiani: calprotectin is basically c reactive protein, which is a systemic inflammation marker for the blood. It’s a systemic inflammation marker for the gut. calprotectin is produced by the white blood cells in the guts and in and around inflammation. Here’s the thing you You can still have inflammation in your gut in your tummy, and not have high levels of calprotectin. So it’s not a catch all. It’s not perfect. But if we see calprotectin is there we know we keep that in mind, there can be some false positives regarding calprotectin. And of course, there can be false negatives, meaning not that calprotectin is high, but it came back negative, but more like you still have inflammation in your guts. It’s just not coming up coming back with calprotectin. So it’s not the be all end all but if we see it high, it can lead us that there could be some Irritable Bowel Disease like Crohn’s or ulcerative colitis, or microscopic colitis, which is important to know people that have Irritable Bowel Disease, right. Those types of conditions that I just mentioned, they have to be more strict and they have to be more extreme with the diet and like Evan said, we’re going to be adding in more healing and soothing compounds aloe ggl l glutamine. We’re going to be adding a bone broth, things that are soothing for that gut lining to calm down the inflammation of course. That’s that’s an effect not a cause. So we’re still going upstream to all of the things we just talked about earlier.

Evan Brand: Yeah, like that you mentioned here, so this person, you, you’re not going to necessarily get them off the hook just because they’re calprotectin was low as if they’re reporting gut inflammation symptoms, there’s like major bloating or there’s burning, or there’s just stomach pain, we may still use gut healing nutrients, and now with this person, even though they didn’t show up, hi. So I like the point you make that it is kind of an art and a science, because there’s a lot of people that they expect to look at the number and then have a game plan just based on the number but it actually goes deeper than that.

Dr. Justin Marchegiani: Exactly. And I see a lot of people that are doing these tests on their own, and they’re trying to self treat. And it’s a big, big mistake, because you have to look at the clinical picture. I have people that want to reach out to me and just want me to review the test. And I’m like, No, I need to know the whole clinical picture. I need to know everything about that patient, their history where they’re at, and then I connected to the results. So you have to look at everything, and people really make a big mistake. And that’s why you You want to have a good functional medicine doctor that can connect the history to the labs super important.

Evan Brand: Let’s talk about the antibiotic resistance just for a couple minutes and then I gotta run but on the right here, let’s talk about this one because this is the person who did show up with the H. pylori. How would you approach this page if let’s just say that everything we’re positive and they’re going to go to their gastro doc and they’re going to say, hey, gastro, Doc, I’ve got h pylori, but now I’m showing up they don’t but let’s say in this case, because we’ve seen it a lot. amoxicillin shows positive Clarithromycin fluoroquinolones also positive positive positive then what?

Dr. Justin Marchegiani: Yeah, so when we look at when we look at some of the markers here, for instance, these are different families of antibiotics. So for H pylori, there’s what’s called triple therapy that’s come Amoxicillin Clarithromycin Omeprazole, right, amoxicillin, Clarithromycin or antibiotics. So they’re looking at resistance of the H pylori to the antibiotics so obviously nothing came back there. Then you have the floor Quinn alone family which is sometimes us that’s going to be you know, this is has a lot Side effects in the literature with mitochondrial damage. fluoroquinolones are also known to destroy ligaments and tendons, lot of Achilles tendon ruptures associated with these we really want to avoid fluoroquinolones at all costs. So fluoroquinolones will be it will have a Quinn lucquin Cipro, those kind of things got to be careful with those tetracycline as well. It’s not going to be not gonna have the same side effects as the fluoroquinolones and then we have different families of antibiotics, right. So b lactamase is going to be things like they’re going to be penicillin derivatives, that’s going to be cephalosporin etc, typically, penicillin derivatives. So if we see, be lactamase positive, you know, then we want to probably want to avoid if we’re going to go down the antibiotic route, the penicillin derivative antibiotics again, for us, it’s not a big deal because we’re not using antibiotics like a conventional medical doctor would. So it doesn’t really help us a ton, but if people have gotten out of In the past, and we say, Hey, you know, you haven’t gotten better, it’s nice to connect the fact that hey, there may be some genetic resistance.

Evan Brand: So you know, yeah, because we’ll have people that say, hey, look, Dr. J already did triple therapy and then they come to us and guess what they showed positive for all the ones that they did in the triple therapy. So it’s at least nice for us to be able to explain to them why they failed in the past and sometimes that alone just makes people feel better.

Dr. Justin Marchegiani: Exactly. And then we have the macro lives down here, which essentially Clarithromycin up top is a macro slide. So, these are different families, they use these at the top because these are the most common, they call it triple therapy or prep pack is what you said about us, but clarity myosins in the macro lives family, so you have like zero Max Azithromycin, Erythromycin, you have Clarithromycin by x and these are different macro lies and then you have vancomycin by itself. So, these are different anabolic families that are going to be used to address the infection, but we’re not using that but it’s nice To know if there’s resistance and connect it back to the history, or anything else you want to add there, Evan,

Evan Brand: I would just say, the point that you already said, but I’ll say it again is that you can’t just look at this lab and expect someone to review this lab for you and make a protocol. And if they do offer that service, I would be skeptical that service because that’s not how it works. You can’t just look at this and have a full picture. And then hey, I’m going to make a protocol based on these numbers and get you better if you’re just in a vacuum you’ve got you’ve got no history, you’ve got no no information on sleep and diet and stress and relationships and you’ve got no clue what they’ve done that’s helped and no clue of what they’ve done. That hasn’t helped. I mean, I just don’t want people to focus on that by itself. You got to have the full case history you got to have the full review because you just won’t get better if you don’t,

Dr. Justin Marchegiani: history is half labs or the other half. And really important is anyone listening to wants to take the next step. Feel free to reach out to Evan brand at you can reach out to Dr. J at We’re available for consultation worldwide if you want to dive in. And if people aren’t ready to take the next step just use this information. It’s totally free get your health better if you have family or friends that could utilize it as well just give us a share Sharing is caring. We appreciate it. Put your comments down below if you’re enjoying it. Let us know what you think. I know Evans gotta run to a patient I do as well. So Evan, wish you the best. It’s Thanksgiving day week. So you have a great Thanksgiving Day with your family and everyone listening have a phenomenal Thanksgiving as well. Everyone, you guys take care. 

Evan Brand: You too. See you later. Bye. 

Dr. Justin Marchegiani: All right. Bye.


Audio Podcast:

Improving Gallbladder Function with Functional Medicine | Podcast #216

Digesting fat is so important for one’s hormone growth and for healthy cell membranes as every single cell has a lipid bilayer. If one wants to be a good fat burner on a ketogenic template, it is really important to have great gallbladder function.

In today’s podcast, Evan Brand and Dr. Justin Marchegiani talk about utilizing functional medicine principles and assessment to figure out how one’s gallbladder is doing. Listen as they talk about what can one do about it, the common gallbladder symptoms, root cause solutions, and how can one get better from these symptoms. Stay tuned for more!Evan Brand

Evan Brand

In this episode, we cover:

00:35    What is Gallbladder?

04:47    Consistency of Chewing Foods

08:16    Bile Surgeries

14:18    Autoimmune Issues that Affect Gallbladder

17:28    The 3 F’s of Gallbladder Issues

20:26    Some Advises if Your Gallbladder was Removed

26:32    Comprehensive Stool Test


Dr. Justin Marchegiani: Hey there, it’s Dr. Justin Marchegiani, welcome to today’s podcast. We’re gonna be talking about utilizing functional medicine principles and assessment to figure out how your gallbladder is doing. Also talking about what we can do about it, what are the gut- what are the common gallbladder symptoms, what are root cause solutions, and how we can get you better. We know, digesting fat is so important for your hormone growth, for healthy cell membranes. Every single cell has a lipid bilayer. And also, if you wanna be a good fat burner on a ketogenic template, it’s a really important we have great gallbladder function. So Evan, welcome to today’s podcast, man!

Evan Brand: Hey man, thanks for having me.

Dr. Justin Marchegiani: Awesome. Well, let’s dive in brother. I’m excited to- to dive in. So, first off, let’s just first dive in just to kinda physiology 101: what is the gallbladder? Why is it even so important? So, off the bat, gallbladder is kinda in this upper right quadrant here just beneath the rib cage, ‘kay? If it’s tender in that area like they’ll do a- a palpation that’s called Murphy sign, uhm, in that area where they’ll look for tender type of gallbladder issue where the gallbladder’s inflamed. But the gallbladder, it- it basically concentrates bile at about a 15 times above than the common hepatic bile duct in the liver wood. So when you’re having your gallbladder removed, that common hepatic bile duct up in the liver just drips bile all the time, it’s not specific, it’s not during a fatty meal, just kinda hits, and you can definitely have some bile acid diarrhea issues. When you have a gallbladder it concentrates that bile 15 times and then allows it to come out and time it, it- it squeezes, it contracts, and s- puts up that bile especially during a fatty meal ’cause you have these hormones in your stomach when that food- when that uhm, kind, that mixed up food in your stomach gets released into the small intestine. Uh, the nice acidity of that stimulates this uhm- neuropeptide called cholecystokinin or CCK for short. And that cause the- the gallbladder to contract and stimulate all these bile release which helps with fat digestion. If we don’t have a gallbladder, we’re not gonna be able to breakdown fat optimally through biliary concentration.

Evan Brand: Yup. So, you’re in to that fast, I’m just gonna repeat it so it gets into some people’s heads.

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: So, you say, when your- you put food down the hatch, especially fat, it enters the digestive tract, the body says “Okay, boom. There’s fat in here now, I’m gonna start making CCK”, and that comes from your duodenal, and I believe the jejunal as well, and then- it- to respond to the CCK, then the gallbladder goes “Oop, CCK is in the neighborhood, now I’m gonna release my stored bile because we’ve got fats to take care of”. So then the bile, or they call gall, will start working on these fats and then turning those fats into usable fuel.

Dr. Justin Marchegiani: Yeah, think of emulsification is like you have a greasy pan, and you put a drop of like soap, right, like some- some dish soap like dawn dish soap, and it kinda breaks it up, it emulsifies it. Think of that’s what’s happening if you got this greasy pan in your stomach, which is all the fat in your stomach going into your small intestine, that emulsifies it and allows your body to break it down and absorb it. It goes in these little things that form uhm- a- uh- a- a- a micelle, and that allow it to get into your body and be able to utilize it. Now, going up one kind of marker is hydrochloric acid levels. This is even important, this is more important because hydrochloric acid stimulates, it lowers the pH, and a nice low pH triggers cholecystokinin. So, we also need good pH function, good hydrochloric acid function and then that then, in the small intestine really gets the bile going, and then we also have some enzymes in the pancreas called lipolytic enzymes, lipase enzymes that also help with the pacre- with the- with the gallbladder in the- in the bile digestive process.

Evan Brand: Well, you make a good point, ’cause when we jump into this conversation, if we’ll look at the whole digestive cascade, as a big row of dominos, when you get to CCK and you get to the gallbladder, you’re really talking 3 or 4 dominos down the list but it’s good that you went upstream first to the mouth, where that’s where you’re chewing your food – hopefully you’re chewing your food, you’re not rushing through your meal. That’s why I don’t like things like chipotle, I enjoy the food itself, but it’s all soft, it’s mushy, meat and rice and guacamole, and you can just shove it down the hatch and you really have to chew the stuff. So, if I eat a soft meal, I still try to be very condescend about chewing, chewing, chewing, chewing, tellin’ the digestive system, “Hey, something’s coming down the hit- down the hatch”, but, you make the point about HCL. It’s why it’s so important when we- uh, talking about gallbladder symptoms which we’re getting to in a minute, to look for, and to treat if you have them, H-Pylori, and other infections ’cause, if H-Pylori is reducing your HCL levels, well, you can’t go straight to the gallbladder. I mean, you- you can, you can take bile salts to help it, but you didn’t fix the root cause, it was H-Pylori.

Dr. Justin Marchegiani: Exactly. So, kinda highlighting, we went from the gallbladder. What’s happening at the gallbladder, upstream to HCL, and that- that also activates other enzymes in the stomach called pepsin, and also gets the pancreas producing lipolytic fat breaking down enzymes, and then proteolytic protein breaking down fat enzyme, it’s- it’s very rare that you just have fat by itself, typically fat, protein and cholesterol tend to come together. And then, up one stream above is the chewing part. We wanna make sure we’re chewing our food at least 32 times, that’s about one chew per tooth, right, you have 32 teeth, so think of 32 chews, 32 teeth. And in general, getting your food’s to like an oatmeal like consistency, like- if you’re having a food that’s kind of more predigested like a chipotle meal, you gotta just make sure you at least chew to that good oatmeal-like consistency, and try to be in a relatively stress-free environment because the parasympathetic nervous system is really important for HCL secretion, thus enzyme secretion, and thus, uhm- bile secretion because we need that nice acidity, we need the enzymes, we need the digestive secretion. And for a sympathetic state, all that blood flow is going out extremities, our arms and our feet to run, fight and flee. So, it’s very important that we have good parasympathetic, so good breathing, gratitude, being in a quiet kind of relaxed setting to start our digestive processes.

Evan Brand: You know, I was trying to find some research on this, I am just gonna guess based on the mechanisms we discussed, that people on acid blocking medications probably have more issues with gallbladder. Would that make sense, ’cause let’s say you don’t have H-Pylori infection but you’re on an acid-blocking drug, isn’t that gonna just down-regulate this whole process we’re talking about?

Dr. Justin Marchegiani: Yeah, we need good acidity to trigger that CCK. So, that totally makes sense, right? And then we need- to be able to break down god fats. What are good fats? Well, we have our mono unsaturated fats are gonna be things like olive oil, avocado oil, and then maybe even some nuts and seeds. We have more saturated fats which are gonna be animal products, right? Grass-fed beef, uhm- any of our like, you know, fish, chicken, beef stuff, you’re gonna have omega-3 fats which are on the polyunsaturated category. Omega-3 is more polyunsaturated, and then you also have your saturated coconut oil which I think is your only plant fat that’s saturated, maybe that and palm I think are the only 2 big saturated ones that are plant-based. So, we have our saturated fats, right? Coconut, plant-based fat- coconut, and animal-based fats. We have our mono-unsaturated which typically are gonna be uh- a lot of the olive oil, potentially avocado oil, we have our polyunsaturated, a lot of times which are fish, and then maybe some of the nuts and seeds kind of fit into that monounsaturated category omega-6 kind of category as well. And then we have our uhm- Vitamins-A, D, E and K, “ADEK”, these our fat-soluble vitamins. So if we don’t have good bile-support, we’re not gonna be able to break fat down by the minute which is really good for our uhm thyroid function, it’s good for our skin, right? Higher dose Vitamin-A is great for skin that’s why they use uhm- Accutane which is- is a Vitamin-A analog to shrink the oil cells on the skin, also great for our eyes. Vitamin-D obviously great for our immune system, we make it too from the sun. Vitamin-E is great for our heart, it’s a natural antioxidizing, great for inflammation. Vitamin-K is really good is found in butter fat. It helps get calcium into our bone, right? Vitamin-K2, consider activated- a- activated X by western price, really important nutrients. So, these fat-soluble vitamins, we really need good gallbladder function to absorb them.

Evan Brand: Yeah, and if you don’t have a gallbladder, we’ll get into that in a minute, you know, I was just looking up, uh- reading the bile, the surgeries that people get. When you get into the gallbladder world, gallbladder surgery is just such a huge, huge money maker and it’s done often times in cases where it didn’t have to be done. And I told you we need to get a lady on whose uh, got a specific website about protocols for people with gallstones to try to help give them relief and to save their gallbladder. But another surgery which is crazy to me is called fundo- fundoplication, and it’s what they do to relieve chronic acid reflux. The surgeon tries to recreate your lower esophageal sphincter, by taking the upper portion of your stomach and wrapping it around the lower part of your esophagus and sewing it into place.

Dr. Justin Marchegiani: Wow.

Evan Brand: That just seems insane to me, they call it anti reflux surgery. How many of those people, just have H-Pylori infections that were put on acid blockers, therefore that LAS, that lower esophageal sphincter wasn’t working properly, or maybe they had a mineral deficient or maybe it was a ___[09:18] issue and structurally, that could get adjusted, but instead, they go get their stomach wrapped around their esophagus and sewing together. That’s insane!

Dr. Justin Marchegiani: It really is, and that’s kinda what conventional medicine does. They can go to some extremes to fix things that in my opinion are much more foundational and much more simple. And most of the time I would say 99% of the time, the surgeries aren’t root cause, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: So if we look at the conventional side, we have things like a HIDA scan which is like a nuclear image, they swallow s- solution that’s nuclear, and uhm- they kind see kind of biliary function, right? You want typically a 33 to 40 percent kind of dejection fraction that’s normal, on the gallbladder. So, you can look at that with the HIDA scan, you can even look at, an ultrasound, uhm, to give you a window of the inflammation in the gallbladder. It’s not gonna give you how much uh, bile is flowing to the duct but at least give you- okay it- it- is there- is it stagnant, or just stuffed in there, is it inflamed. You can kind of get that sense as well. A lot of times they’ll do some conventional testing, ’cause if your gallbladder is inflamed, and there’s an immune response, you may see white blood cells uh- on the higher side, right? Uhm, you may also see certain liver enzymes, ALT is a common liver enzyme, AST is another enzyme that can be effective in the skeletal muscle, you can see GGT, think of the “G” in gallbladder, GGT is a big gallbladder enzyme. Bilirubin is a byproduct of red blood cell metabolism that comes out in the gallbladder. With high bilirubin, we may have some- some backed up gallbladder bile issues. And then a- also, I think alkaline phosphatase is another big one that we may see on the higher side. So, we’re gonna see bilirubin on the higher side, alkaline phosphatase on the higher side, and then we’re also gonna see potential HIDA scan issues, that can- those are- HIDA scans more like pathological.

Evan Brand: Yep.

Dr. Justin Marchegiani: There are a lot of people that are in between that may be okay on the ultrasound or maybe okay on the HIDA scan and we can use some of this functional test as well. Uhm, but really important we gotta dig to the root, underlying issue on what’s going on there. And again, AST is more skeletal muscle but there’s some crossover with the liver, ALT is more liver. Think of the “L” in ALT as liver and then the alkaline phosphatate is a big gallbladder one, also a big one for zinc. Alanine transferase or ALT, asphotate transferase, and then alkaline phosphatase for ALP.

Evan Brand: Well, the good thing is, a lot of the blood markers you just mentioned are pretty standard. So, even if you’re not working with the functional medicine practitioner like one of us, you may be able to get your doctor to just run these labs, refer back to this podcast and look and see if you have an elevation. Now, the only problem is, the conventional reference range for blood testing is very bad. So, you may be quote, “normal” by your doctored standards but our reference ranges maybe tighter. So if we start to seal your ALT or your AST enzymes go up, it may not be up enough to flagged. So, that’s why it takes a trained eye to look at these numbers and see, and we’ve seen it time and time again, we get somebody on gallbladder supplements their AST and ALT go down. So, it’s amazing to see, we gave this nutrient, “boom” look at the blood changing just based on this nutrients, it’s really cool. Let’s talk about symptoms now, I think we’ve given a good-

Dr. Justin Marchegiani: Yeah, just to highlight one thing, you just wanna get that CBC done at- which is a complete blood count, and then also a CMP – Comprehensive Metabloc Panel profile, and it’s important, you need to work with a good functional doc because you may be okay in a lot of these areas and you still may have issues, so now what, right? So you don’t wanna just rule it out ’cause some of these testing are good, you wanna look at subjective symptoms, connected to the anatomy, connected to how your stools look, right? If we have fatty stools, blond stools, excessive amount of wipes to clean out your- you know, to clean yourself after going number 2 or just, you get skin marks on the toilet seat, we’re probably not breaking down fat. And again, if you have too much MCT oil in the morning, that can also do a tube instead as a laxative effect. So, you gotta look at it the trend in general, clinical symptoms, subjective symptoms, and then lab symptoms to really make a complete picture of what’s going on.

Evan Brand: That’s a good point ’cause my AST and my ALT on my blood looked perfectly fine. But when I had parasite infections, I had that low right side pain under my rib cage where my gallbladder and liver are. Your gallbladder is kinda tucked in with your liver under there, so if you look down at yourself on your right side up where that rib cage, if you’re having pain there, when I had parasites, I had ton of pain there, my blood looked perfectly fine. So I don’t want, like you said, you don’t wanna give a- a false sense of hope just ’cause your blood looks okay. There may be other functional problems that you’ll find by looking at stool testing for example. But let’s hit- let’s hit-

Dr. Justin Marchegiani: Yes.

Evan Brand: -on these symptoms, because you mentioned some but we needed just go through symptoms here and tell people, “okay, what would you be experiencing?”.

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: So, you mentioned, fatty, greasy stools-

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: You mentioned it takes a lot of wipes to clean your butt, you mentioned the skid marks in the toilet which if everybody is going on a high-fed diet these days, sure, that may be okay but if you’ve got gallbladder problems to start and then you try to go on to ketogenic diet and you don’t feel well or you don’t lose weight and you’re complaining to your doctor, that may be the part of the problem is gallbladder.

Dr. Justin Marchegiani: 100%. Also, autoimmune issues can affect the gallbladder as well. Gluten’s a big one, it creates those condition called primary biliary- what’s that last?

Evan Brand: I think you call it cholangitis.

Dr. Justin Marchegiani: Yeah, primary biliary cholangitis. I mean, typically just “PBC” for short. But basically you can have some scla- scarring of this uhm- on the- the kind of biliary tubes that go out of the gallbladder, and as well as the- you know, the gut- the liver goes to the gallbladder, the gallbladder kind of comes out together with the pancreas and comes out the sphincter of oddi, or the hepato biliary kind of ampulla, and that- that can kind of scar and it can sclerose, it can kind of have uhm narrowing of the- of that vasculature. Of course, it can back up, and if that backs up, and those enzymes can’t get out you can have pancreatitis as well. But that’s an autoimmune condition where your body is attacking a lot of that tubing that goes up to the gallbladder and maybe even can help with the pancreas, and that can narrow and prevent a lot of that stuff from coming out. So of course, gluten is a big component because that can really activate a lot of au- autoimmunity and you can also have a leaky gut, you can also have a leaky gallbladder which does aggravates more autoimmune attack because things that shouldn’t be out in the bloodstream are out and that exacerbates the immune system going after it.

Evan Brand: Yeah, so let me just read a few sentences on these whole PBC thing ’cause I think this is critical. We know, even just this is just standard you know, medical textbook stuff that says “it’s the most common among women”. And we know that Hashimoto’s is more common in women and men. So it says here, “the cause is not clear but we know it’s more common in people with…” guess what, “…hashimoto’s thyroiditis”.

Dr. Justin Marchegiani: Yes.

Evan Brand: So, it says here, “An autoimmune cause is- is thought possible because more than 95% of people with PBC have certain abnormal antibodies in their blood. These antibodies attack mitochondria. What triggers these attack is unknown…”, of course they say that but it may be exposure to a virus or toxic substance A.K.A. ‘gluten’, maybe dairy, I mean, you and I talk so much auto about- about autoimmunity so I’m glad that your brought this up because, you know, these people may have these symptoms, and they’re not gonna know what’s autoimmune in nature, they may just get the- the knife and say, “Hey, we’ve gotta pull this gallbladder out”. Not necessarily, what if we can shut down this autoimmune attack?

Dr. Justin Marchegiani: 100%. Also, here’s the bigger issue too. Okay, great, the gallbladder is removed, your digestion is now forever altered. I’ve yet to meet a conventional patient of a gallbladder procedure, whether surgeons that “oh, by the way, you’re gonna have to add in HCl, pro- or- lipolytic enzymes and bile salts for the rest of your life”. I’ve never really heard that, at least bile salts seem to be added in. I would say HCl and enzymes too, but I’ve never heard someone do that. Now, your digestion is forever altered, do you think there’s a connection with now you’re not being to breakdown cholesterol optimally ’cause that’s gonna be in the bile, right? The bile is 97% water, then you have some cholesterol, and cholesterol salts as well, and you also have some toxins coming out, that’s why if you have uhm- poor, you know, gallbladder-emptying, then you’re not getting rid of potential toxins that are in there too. So, we gotta be emptying that gallbladder. If we’re not breaking down Vitamin A, D, E, and K, if we’re not breaking down our fat-soluble vitamins, which I just mentioned, if we’re not breaking down cholesterol which is the building block for all of our hormones, do you think we’re gonna have problems ladies, uh- as you get into your 40’s and 50’s, with menopausal issues, perimenopausal issues, PMS, and we know the main connection, it’s kind of a slang but, I’ve heard many uhm- let’s just say general surgeons say it, it’s the 3 ‘F’s’ of gallbladder issues: fat, female and forty. And that’s the time to- late 40’s, early 50’s where hormonal transitions happen, and if you can’t breakdown those nutrients, you are setup for a menopause uh- of “hell”, so to speak.

Evan Brand: Yeah, in terms of side-effects, possible side effects of gallbladder remover- removal, it could be anything from pancreatitis, to increased risk of choline cancer to increased digestive sy- symptoms like heartburn, could be constipation. So, we’ve seen people that- they don’t feel well, after they get the gallbladder removed. And uh, like you said, there’s no surgeon out there saying, “Hey, I’m gonna put you on this comprehensive digestive support protocol, after we remove it”, no, they’re gonna you out with anesthesia, cut that bad boy out, and send you home in a day or 2. Uh, there’s a- a whole lists symptoms here I’m looking at now, symptoms of- uh- symptoms after gallbladder removal. I’ve had women have gallbladder attacks, but they don’t have a gallbladder. You know, it’s like, “well, how the heck does that happen?”. So, you know, the- the- the removal is not the “cure all”. Anything from nausea to gas and bloating, distension, burping, belching, feelings of fullness, heartburn, barrett esophagus, diarrhea, dumping syndrome, weight gain. There’s a whole article here all about post gallbladder removal weight gain happening.

Dr. Justin Marchegiani: And part of the reason why women get targeted so much – I hate to say it – is the estrogen. The estrogen kind of makes things sluggish and slow, it kinda takes- it kinda makes it turn into molasses. So, things really are very sluggish, very viscous, and of course, that can affect gallbladder and bile flow. Women that are on, you know, uh, birth control pills, that’s gonna- in- obviously increase estrogen levels, obviously just being stressed, right? You’re gonna take your progesterone, you’re gonna shoot it downstream to cortisol, and that’s gonna basically cause estrogen dominance there because you’re already starting to lower progesterone in relationship to estrogen. You’re getting estrogen in the environment from the conventional meat products, uh, water, plastics, chemicals, hormones in the meats as well, and then you’re also gonna be just getting it, just from uhm- being a woman, having 10 times more estrogen than a man. So, you’re- you’re already predisposed, and then when you add stress to it, it’s going to exacerbate it uh, big times. So, you really wanna make sure that you’re fixing the- like if you’re having- if you know you have a gallbladder issue, you also need to be going after the- the hormonal issues as well. And then we can dive deeper into the food allergies stuff too, so you gotta go after the hormones, gotta make sure you fixed the estrogen dominance, you gotta make sure you fix the digestive aspects, and then we can go into foods later.

Evan Brand: Well, I’m sure there’s gonna be a ton of people that are just yelling at us right now through they’re podcast app or YouTube or wherever they’re listening to us, and they’re saying, “Well, this is not fair, I already have my gallbladder removed, so what the heck do I do now?”. So, do you wanna address that now or should we talk about that later?

Dr. Justin Marchegiani: Yeah, so, off the bat, the underlying mechanism that was driving that inflammation in the body’s still there. Just the end target, the end uh manifestation of it is removed, but now other tissues may start to, uh, have issues, then also if you don’t fix the underlying uhm, digestive im- impediment which is, your fat-soluble vitamins, your cholesterol, your hormone building blocks are now gonna be thwarted in their digestive processes. So, you have to fix that to prevent compounding hormonal issues, 10, 20, 30 years later, number 1. Uhm, and then so obviously this- so- err- if you’re- if you still have your gallbladder, we wanna keep it by doing a lot of the preventative things. But on the food side, I outlined this in a couple of my gallbladder videos are down in the past. But there’s some common foods that are even uhm- let’s just say paleo-approved, but should probably be looked at- look at removing. So, of course we have the refined sugar in the guts. That’s kind of a no-brainer right here. But, uhm, in order of kind of like uhm, the most likely offender are gonna be eggs.

Evan Brand: Yes.

Dr. Justin Marchegiani: So definitely autoimmune template, cut out the eggs, pork, onions, chicken turkey, milk, coffee, corns, beans, nuts, apples, tomatoes, peas, cabbage, spices, peanuts, fish, rye. I’m gonna link my article that goes into this. So, everyone’s probably like, “Say it again!”, no, I’ll put the link below, don’t worry, take a look at the article, alright? But, I have them in most likely to offend to least. So, if you’re overwhelmed after hearing that like, “What the hell am I gonna eat?”. Just start with the biggest 3 or 5, or look at that list and say, “What are the biggest 3 or 5 that I eat on a daily or weekly basis” and just pull that out. Once we get the inflammation under control, we support HCl, we support enzymes, we support bile salt production, we look at the gut ’cause sometimes there can be infections like H-Pylori and giardia, and of course SIBO in and around that ___[22:31] that can exacerbate everything too. So, we get the infections clear, if we get the acidity and the enzymes dialed in, if we cut out some of the common offending foods, we may be able to start adding some of these foods in overtime. But I find pork’s a big one, eggs are a big one, those are like my- my 2 biggest right there off the bat, and they’re kind of paleo-friendly too.

Evan Brand: Yeah, eggs are huge and people over-eat them and, if you have gallbladder issues, uh- when I interviewed Ann Louise Gittleman, she said the same thing, she said eggs are the biggest offender. I’m like, “Wow, I thought that was just me”, no, it’s- it’s a real thing, and then also onion. I think she said onion are ready-

Dr. Justin Marchegiani: Yes.

Evan Brand: But that was- that was a problem for me when I  had parasites and I would try to do like stir or fry and throw some onion in there, I’d end up with that lower right side stomach pain, I’m like, “What the heck is it”, or if it was I had parasite infections but, the other- the other part of it was the onion. So, yeah, I at least temporarily, like you said going on an autoimmune protocol while you’re working with your practitioner to fix the other underlying causes, you’re gonna be in good shape if you do that.

Dr. Justin Marchegiani: Onions are also a ___[23:28] too. So there could be some underlying SIBO or small intestinal bacterial overgrowth going on as well. So, you gotta look deeper at everything. So, kinda like piggy-backing everything, alright? Women are gonna be the- more bigger offenders ’cause of the hormones, because of the- you know, the pregnancy prevention with the birth-control pill, so you have that, right? So we gotta fix the hormones, fix the hormones, number 2, cut out the foods, at least paleo to autoimmune paleo with those additional 3 to 5 to 8 foods I just mentioned. Get enzymes dialed in, get acids dialed in, and definitely bile salts added in, and if you already had your gallbladder removed, definitely do all 3, and those that up and watch your stools and make sure your stools go floating to sinking, right? Oil and water mix, so if you had the stool, with the whole bunch of undigested fat, and oil and water mix, the stools stay on top of the water, they don’t sink. So, you wanna see the stools sink, and ideally you wanna be able to clean yourself, you know, 3 to 5 wipes on average, and you wanna make sure when you flush, you’re not seeing big skid marks all the time. If you’re doing some MCT oil in your coffee there may be some issues there, too much of that can cause some undigested MCT, so be mindful of that. So, foods, acid, enzyme, bile salts, get the infections cleared, and if you’re a woman, get the estrogen dominance fixed, get the hormones balanced.

Evan Brand: Yup, and, how can you do that from a testing perspective, we mentioned the blood, but I’ll just throw a few other components of this in. Number 1 is the stool test, so we’re always gonna be running a PCR stool panel, or gonna be looking for all this. As you mentioned, we’re gonna look at H-Pylori, we’re gonna look for giardia, we’re gonna look for cryptosporidium, blastocystis hominis, there’s a ton of different bugs, there’s worms, there’s parasites, there’s bacterial overgrowth we look at, there’s candida that we look at, that’s all done with the combination of  stool and urine testing. And on the stool, there’s a couple markers that we can track, obviously, you looking in the toilet is gonna be the best way to track. Well, we like numbers, you know, Justin and I like data. So, when we look at steatocrit, which is a fecal fat marker that usually is expressed as a percentage. I like to see it, you know, 10% or below, we’ll see some clients, they’re 30, 35, 40 percent steatocrit, that means they’re not digesting their fats at all, and they while I’m doing a ketogenic diet and I feel like crap, it’s ’cause they’re not digesting anything.

Dr. Justin Marchegiani: That’s it.

Evan Brand: So, we gotta get that steatocrit down, and how you do that, well, one, clear the bugs too, supplement, and then, what was the other part of my brain? The blood, we talked about the blood, we talked about the stool, oh, the beta glucuronidase. So, beta glucuronidase at enzyme on the stool test we look at, that enzyme gets messed up due to bacterial overgrowth. When we see the enzyme is high, that’s when the estrogen dominance probably becomes more problem- problematic because now, they’re re-circulating the hormones. So, we do some like a calcium d-glucarate or a DIM, or something else, maybe a broccoli seed extract to try to get, or could be probiotics, could just be clearing bugs, taking care of the SIBO, the glucuronidase goes back down, and now all these quote, “estrogen-dominance symptoms” just disappear, and it’s really fun to see that.

Dr. Justin Marchegiani: 100%. So, kinda highlighting the test again, look at your symptoms, if you have pain in the upper right quadrant, under the rib cage, if you have problems breaking down fat, if you’re seeing a lot of your fat, your stool sinking or floating on top, not sinking. If we run a ho- comprehensive stool test and we see a lot of uhm, steatocrit, undigested stool, we see that greater than 10 or 15, whatever that lab marker is right in that area, we got problems, and then we gotta dig in deeper, and this could be the reason why you have hormonal issues too so we have to highlight that. Is there anything else in this topic Evan that you wanna go into that we haven’t gone in deep enough?

Evan Brand: I don’t think so, I would just tell people that if you feel discouraged, or, you know, you’re facing surgical removal of your gallbladder, I’m not saying the gallbladder can always be saved. I have a friend of mine, she’s in her late 50’s, maybe early 60’s at this point, and she was having major, major gallbladder pain, and I told her about taking digestive enzymes, but the pain just continue to grow. So, you know, I said hey, you might have to, you know, go to a doctor and get this checked out. This is very recent, so she did. And her gallbladder function was basically nothing, and she went in and she had to get surgical removal and because of with so much inflamed tissue around her gallbladder they couldn’t do the- the- the uh, laparoscopy, where they just give you a small- a small uh surgical side, they had to really cut her open like 6 to 8 inches, they hadn’t take out the gallbladder, and the surgeon told her, that her gallbladder was so heavy, full of stones that it felt like a concrete block. He said there was no way you were gonna save this gallbladder. So, I think there is a point of no return, where surgical removal does happen, we’re not shaming anybody or making fun of anybody if you got your gallbladder removed, that sucks, like she had to get it out, there was no turning back. And now, you know, she’s got tubes coming out of her stomach to drain her bile until she recovers from the surgery. So, obviously, that’s an extreme case but man, uh, you know, it can- it can get to a point where surgery is the only option but we’re just trying to help you before you get to that point.

Dr. Justin Marchegiani: Yeah, so if we don’t have enough, if you don’t eat good fats, then we don’t have good gallbladder flow, then, what happens is, it’s like not changing the oil. A lot of that bile uhm, and that cholesterol can crystalize. And then overtime those crystals can- can produce more and more crystals. And then imagine these little crystals that are like- a little mini or- miniature-like porcupines. And imagine that gallbladder contracting, it’s like giving a- a big porcupine a nice hug, right? Probably not the best thing. So, that can create a lot of inflammation, and the more little porcupine you’re having your gallbladder, the bigger issue every time you have fat that contracts. And then also, we can have potential pancreatitis because of it ’cause those gallstones can eventually produce, can block the bile flow, and that can stop pancreatic enzymes from flowing into the small intestines. So, that can create more inflammation. So, the more this thing, err- there’s more of this issue, the underlying cause goes unaddressed, the more the inflammation accumulates, accumulates, accumulates, accumulates, there may be a drastic solution of cutting out the gallbladder. Now, I would say, the vast majority of the time, it can be saved. We have to make the food changes, uhm, we also do a lot of gallbladder bile support, we’ll also use things like phosphatidylcholine, we’ll do beet root powder, we’ll do taurine, we’ll do dandelion, we’ll do artichoke, French trees, or herbs that’re designed to help to help one thin out bile flow, they can smooth out the little crystals, so imagine like kinda coming in there and smoothing out all the little porcupine barbs. Uh, that way they aren’t as sharp, and then we can be very careful with our fat consumption, maybe we do the tiniest amount possible. A lot of the coconut fats are easier to process and digest. So, maybe we’ll do more coconut fat, we’ll just do- just the- the largest amount of fat we can handle without issues, we up the enzymes, we up the bile salts, and then we give a lot of those herbs to smooth out the bile flow, thin out the bile, and smooth down the crystals. We’ll even do some- some like extra phosphorus drops to even thin out the bile uhm stones as well.

Evan Brand: Yeah, I do beet powder every day. You know, part of that for my circulation issues dues to all the mold in my body, so- so the beet powder’s been really helping. But, you know, back to my friend, you know, she was, she’s a woman, she’s over age 40, she does have excess weight, you know, she is overweight, she is very sedentary, uh, she did have some familiar health issues as well, you know, any- any family history of uhm- diabetes, other type issues like that can- can increase the risk of gallstones which then increase the risk of these problems, so, if you were to take all of the things you don’t wanna be sedentary, you know, overweight, uh, etc., poor diet, she had all those things against her. So, I’m not gonna- I’m not saying that everyone’s gonna end up like that with her case which is extreme but, you know, I just wanted to point out, hey, sometimes there may need to be a surgical removal. But, we just- we wanna try to prevent that. Statistics I found say there is about uh- 3 quarters of a million surgeries every year for gallbladders.

Dr. Justin Marchegiani: Exactly. Then we kinda talked about, our women- right- our- our fat, 40 and female. The big issue is, estrogen is a big uhm cause of kind of making the- the gall uhm, making the bile more sludgy, so is insulin. So, insulin is also another stimulating factor, this is part about I think where the fat comes in there, because the more weight you have typically is more insulin-resistance, insulin’s that hormone that sticks sugar into the cell, converts it to fat, so if you have more insulin, that’s a greater likelihood of making the bile flow more sludgy. So, if you have high levels of insulin, that’s gonna slow up the bile flow, and then if we have uhm, high levels of estrogen or just estrogen dominance, that’s gonna sludge up the bile flow as well.

Evan Brand: Yup. I’m sure we could keep going on this topic all day but, we should probably wrap it up. Reach out if you do need help, you can go to, and Justin’s summit is coming up very-very darn soon. So, I don’t know when you’re listening to this, if you listen to it in the future, and you already missed out, well, you can purchase his summit, but if you’re listening to it ahead of time, his summit is going live very soon, in two weeks at the first week of March. So, go to Go register for Justin’s event, it’s gonna be awesome, I interviewed him, which I thought was probably one of the best interviews possible, and interviewed me, and I talked about some other stuff that he hadn’t talked about. So make sure-

Dr. Justin Marchegiani: [Crosstalk] …interviews too.

Evan Brand: Thank you, thank you [crosstalk].

Dr. Justin Marchegiani: …for sure.

Evan Brand: So, so go register, uh, it’s- it’s gonna be probably one of the biggest events of the year called Thyroid Reset Summit. So,, go check it out and to run through health talks which is like the apple of summits, they do a great job of putting things on, and there’s, I don’t know what, 30 other experts on there. So-

Dr. Justin Marchegiani: 30 great experts. And also, I’m giving way the first uh- 3 to 4 chapters of my new book coming out, the thyroid reset. That book will be coming out in the next uh, few months here, so, get your free intro copy and then I really appreciate you guys picking up the book as well. Get me up there on the Amazon ranking so we can help more people, I appreciate it. And also, just to finish with this uh, article, here, the uhm conclusion, very important here for gallbladder issues, just to tight home, repeat yourselves a lot because repetitions some other skill, here’s the conclusion, insulin resistance is a risk factor for the incidence of gallbladder sludge and stones during pregnancy and after. And then it says insulin resistance may represent a causal link between obesity, overweight and gallstones. So our big mechanisms here, just kind of- f- coming in full summaries, if you missed the whole entire podcast, if you get this one thing, you got it. High levels of insulin, increased gallbladder sludge. High levels of estrogen, or estrogen-dominance, increased gallbladder sludge. Inflammatory foods, right, that drive insulin and inflammatory foods that are paleo friendly like, pork, like onions, like eggs, like coffee, maybe an issue, and then of course the low HCl levels, uhm, the low-fat diet, uh, all of those things and eating in the stressed out environment, those are gonna be your big 3 or 4, then also infections, giardia, gluten-sensitivity, SIBO, all of those things are gonna drive, probably the big 5 factors. Infections, insulin, estrogen dominance, low HCl enzymes, and then hidden food allergens. Those are your big 5 factors of this gallbladder issue here.

Evan Brand: Yeah, well said. And I love my friend to death but my wife and I were driving in the parking lot the other day, and she’s- and- and then we see our friend who just got her gallbladder taken out, and she’s sitting in the Taco Bell Drive Thru, and I’m just like, “No, that’s exactly what got you in this problem in the first place”. So, the diet is so critical, you can’t skip it.

Dr. Justin Marchegiani: Hundred percent, excellent. And for anyone enjoying this, I’m gonna do another live Q&A here tonight, this at- you know, the very end of the day, probably around 5, 6 o’clock here central time. Make sure you subscribe to the YouTube channel, we do a lot of live Q&A. So, go to If you’re listening to the channel now, make sure you hit that bell, that gives you the notification. So, if you’re on your phone, it’ll pop-up as it ___[35:35] doing a live chat. Even if you’re not around for it, just your little- little question in. So, we do a live Q&A, it’s op-in question, if there’s a topic, keep your question to that topic, if it’s a podcast, we may or may not get to questions ’cause we kinda get in our flow state and uhm, we may just be really focused on our conversation.

Evan Brand: Take care.

Dr. Justin Marchegiani: Hey Evan, you have a good one, take care.

Evan Brand: You too, bye.

Dr. Justin Marchegiani: Bye everyone.




Improving Your Kids Gut Health | Podcast #204

In today’s podcast, Dr. J. and Evan Brand discuss different ways to improve your kids gut health. Watch as they tackle about unconventional methods in dealing with gut bugs, why your kids’ behavior at school might be related to their gut health, or learn the importance of having a stool test to address the root cause of various gut issues.

Stay tuned for more and don’t forget to share. Sharing is caring!

Dr. Justin Marchegiani

In this episode, we cover:

01:57    Herbal tinctures

08:33    Chewable probiotics

10:16    Dealing with bacterial issues in the gut

14:19    Paleo templates, the 6-R process

24:02    Substituting vs. removing


Dr. Justin Marchegiani: Hey guys, it’s Dr. Justin Marchegiani back in the house. I am back from vacation– feeling uh– rested and recharged. A little cold on vacation, my son got a little sick. He’s– he’s f– first to second cold, it kind of blended together. We had some herbs and such with him– uh— with us. We packed uh– in advanced just to make sure we’re on the– on— you know, had all our protective stuff there. Had activated charcoal probiotics, had a couple of herbal tinctures, uhm— which worked great. And I brought some stuff for myself so, it able to knock it out and get on top of it fast. So, feeling pretty good. How we doing today Evan?

Evan Brand: I’m doing pretty well. How did uh– TSA and all that did it? That go well, do they bug you about your supplements?

Dr. Justin Marchegiani: Uh– I got global entry, and TSA-free. And I got it for my son as well. So, it’s pretty easy for my wife and I to do all the travel ’cause we got that and then– that was nice. Pretty–

Evan Brand: Sweet.

Dr. Justin Marchegiani: A good deal.

Evan Brand: Ohh.. Well life is good for me. Uh– we just got my s– my daughter’s stool test back. This is her third stool test in 2 and a half years.

Dr. Justin Marchegiani: Uh huh.

Evan Brand: And– we– showed up with some bugs, and you and I were just looking at that. Her stools have been loose for– at least a few weeks. And we did all the diet stuff, tweaking diet as much as we can. Thinking that it could just be something like eggs for example, which is a really common allergens for kids that she loves– you know, it wasn’t eggs though. It was these bugs. And so, it’s very important, if you have a kid, doesn’t matter whether your kid’s one year old, or– a hundred years old, your kid could still have gut bugs. And this is something that a pediatrician is not going to know about. And– I know this and Justin knows this as well because we have parents reach out to us all the time.

Dr. Justin Marchegiani: Right.

Evan Brand: And we don’t– we don’t really market ourselves as like, “Pediatric functional medicine practitioners” but we’d have to become that because these pediatricians are telling these people that the only option are antibiotics, or– other type of pharmaceutical drugs. And that’s not necessary because we can fix these issues with herbs.

Dr. Justin Marchegiani: 100%. So, like, when I was in Mexico for instance, we brought down some tinctures. Uh– couple of the ones that I love is Goldenseal. That’s an exce— excellent herbal tincture. Uhm– that– that works phenomenal, along with higher dose Berberines like Berberine HCL, Oregon Grape, uh– Barbarithes are great. So these are the one of the things that I was using while I was out at Mexico. I was also using a lot of like burdock, uhm— also using a lot of uh– grapefruit seed extract. These are really helpful. And also a lot of silver as well. And silver is great because– silver is actually a biofilm buster. So a lot of research on– silver helping knock down bacterial biofilms. And biofilms are like, these protective shields the bacteria will use to– prevent them from being attacked by the herbs or antibiotics. So, the silver’s really helpful for reducing biofilms, and– ’cause they got a l— a mini cold for my son, you know, having the– putting down in such, you know, use really enclosed quarters and then flying, you know, you’re breathing in recycled air at the– I think– my biggest stressor anytime I gets ticket typically has uh– component of flying, that’s ’cause you’re in distant– in a tube in the middle– middle of the air– uhm— breathing recycled air the whole time. And you got heap of coughing and then that gets recycled throughout the whole, entire cabin. So in general, uhm— silver, Goldenseal, uh– lot of Berberines, these are very-very powerful and then that my second biofilm buster is also ginger. So I’m gonna jump on instant carb. I’m gonna order some fresh ginger from my local whole foods, and I’m gonna juice it up, run it through a French press, filet it out, add a little bit of honey and. That’s gonna make an amazing ginger tea that I use for a lot of my patients for dial if it’s great for any other im–immune issues. Now at the resort I was staying at, they were making me ginger tea as well, and it’s very helpful.

Evan Brand: Go to the– go through the logistics and making that again. You take your ginger. You–

Dr. Justin Marchegiani: Yeah.

Evan Brand: –cut it up. You said you wouldn’t need a blender–

Dr. Justin Marchegiani: –[crosstalk] two different pieces of it, so– couple ways you can do it, I mean, you can if you have to. You can cut it up real, real, real thin, and then add 12 ounces of hot water, and then run it through a French press or coffee filter.The best way is either gonna be– you can grate it too. The best way is to juice it– either juice it or run through a Vta Mixer or Ninja, and then add the water– the 12 ounces of hot water. You know, want about 16 ounces total. So fill like my– clean canteen mug if you will.

Evan Brand: I’ve never juiced it before. I literally just take chunks and then put it in the bottom of the mug. And then when I get to the bottom of the cup, I just leave the chunks there.

Dr. Justin Marchegiani: Yeah, you’ll not gonna be able to get all of the active constituents that are trapped in the fiber though. That’s the big issue. So– you– you– you blend it up or you juice it as ideal. You can grate it too but that’s a pain in the butt. Then once you get to the end you’re kinda like saw and your finger’s off–

Evan Brand: [laughs]

Dr. Justin Marchegiani: –so I recommend using it or uhm— running it through a blender, like a high-power blender. Add your hot water to it, and then a little bit of your– your honey. And you could do Manuka honey which is really good anti-bacterial like a wild Clover honey’s fine. And then a little bit of lime, and then– your client’s optional. And then, you can put that– I recommend putting that in a French press. If you don’t have a French press you can just put it in some kind of a coffee pot, let it stew for 5, 10 minutes or so. And then you can either pour it and run it through a, uhm— a coffee filter. Sit cup filter into it like a pour over. That way it takes all the fiber and the particulate out. So you’re only taking in the active constituent. Or the easiest is a French press. Then you just press all the particulate out, and then you only pour the juice out.

Evan Brand: Oh, you know what I could’ve done too which I haven’t, would be to get– I have one of those little stainless steel tea– balls where you put the loose leaf tea in. I can just put the– the bits of ginger and one of those little stainless steel balls and– like steep in a cup of hot water.

Dr. Justin Marchegiani: You could that, uhm— you just gotta make sure that– you blend it up really well though–

Evan Brand: Oh.

Dr. Justin Marchegiani: –So you wanna put all the active constituents in there.

Evan Brand: I may get like one of the— a little– a small blender. I’ve got a big blender. I mean if I put two or three little chunks of– ginger in there, that blender– it’s not even gonna hit it.

Dr. Justin Marchegiani: It– it depends how powerful it is like my Vitamix, no problem.

Evan Brand: Even if it’s just a couple pieces.

Dr. Justin Marchegiani: That’s it– yeah no problem– the Vitamix– the– that thing, you put your arm in there it would– it would freakin’ liquify.

Evan Brand: [laughs]

Dr. Justin Marchegiani: You know what I mean.

Evan Brand: Yeah.

Dr. Justin Marchegiani: –that thing is– I think it’s got– a 4 horsepower.

Evan Brand: It is.

Dr. Justin Marchegiani: Don’t wanna mess around with it, right? So Vitamix or a Ninja or a Magic Bullet. I don’t know with a Bullet, yours– it’s still really good too.

Evan Brand: Okay, I might get one–

Dr. Justin Marchegiani: So cheaper option, just a Bullet.

Evan Brand: Okay. So how we got on this subject was because what we were looking at on my daughter’s GI-Map, she showed up with some prevotella, which is interesting ’cause we find that a lot in clients–

Dr. Justin Marchegiani: Uh-huh.

Evan Brand: –and have a joint pain. We know 75% of people with RA actually have prevotella infection. So if you fix the prevotella sometimes the joint pain goes away. Now obviously, you know, she’s so little– she’s not gonna understand, or be able to probably discuss joint pain to us, but it is there. And then also she showed up a small amount of H-Pylori, which some would argue as normal. But because of the– virulence factors that we see–

Dr. Justin Marchegiani: Right.

Evan Brand: Those are not good. But her inflammation was still low, which is good because a lot of times we see the inflammation goes high when you see virulence factors.

Dr. Justin Marchegiani: Yeah, you’re referring to like the calprotectin that came back on your test?

Evan Brand: Yup. It was fine. It was like a 27, so it’s a little bit–

Dr. Justin Marchegiani: I mean, I still like that in single digits personally, so I don’t wanna knock that down. And again, this– if you– get everything else down it’ll probably fix itself. And then the ginger tea would also help ’cause that’s really, powerful– a– anti-inflammatory as well.

Evan Brand: Yup. So we were talking about some uh– If– if you pro– hear sounds in the background, if like, “What the heck is goin’ on?”. Uh– people are working at Justin’s house, so if you’re hearing that, that’s what’s going on. Uhm– but we were lookin’ at— we were looking at her stool test result, we’re comin’ up with a game plan. Now– kind of a couple options with the kid, this is the– I guess this is the finesse of using herbs is that– you know, we were discussing using some kid’s strength formulas where they’re kind of a weaker dilution of certain herbs. Or you go with a higher strength, but is a lower amount. Now just because kids, they’re so light, you know. She’s 25 pounds so we don’t know exactly how she’s gonna deal with a full strength heavy hitting anti-microbial protocols. So what we’ve done so far is we were just started on some kid’s formula at the appropriate dosing. Generally speaking, you’re doing like a quarter of a dose for kids, or maybe a third of a dose for kids. And then we’re just gonna try to graduate her up and see what happens. Now, what I noticed is, and what a lot of parents tell me is the same thing that I noticed is that, when you do start killing off infections in kids, you may see some symptoms that adults might not have. So for example grinding of the teeth. I noticed she was grinding her teeth last night. But that was it. We haven’t had any other issues in terms of like, anger, or ___[08:29] ’cause lot of times mood issues happen–

Dr. Justin Marchegiani: Uh-huh.

Evan Brand: –when you start killing bugs too.

Dr. Justin Marchegiani: Exactly. Now with kids, one of the things we’ll also do is some chewable probiotics. I mean, that can be phenomenal. There’s a couple of brands that I use that work great.  So chewable probiotics can help especially ones that are higher in a saccharomyces boulardii, can also help knock down some of the H-Pylori. Also higher dose of lactobacillus and deferribacter strains can also help as well. They can also  help reduce inflammation– [crosstalk] beneficial things.

Evan Brand: I wanna probe you on this and I’m sure people wanna hear this too– you know, you’ve been doing probiotics for your son, I’ve been doing probiotics for my daughter but yet on the normal bacteria category all these beneficial bacteria, she still showed up low. Now you’re thinking that’s just due to competition or what else could be going on?

Dr. Justin Marchegiani: Well number one, I mean, if you weren’t giving it to her, the question is how much lower would it be, right? That’s number one

Evan Brand: Right.

Dr. Justin Marchegiani: Uhm– number two, there’s some other not so nice bacteria there, that could be ___[09:23] and out, so– knocking– and she’s also doing some antimicrobials so– you know, I think knocking down some of the not so good bacteria would be helpful. Getting the stool more solid and solidified again would be helpful. And then really focus on reinoculation, repopulation. And again, these bacteria are forever kind of thing, right? But they’ll, kind of come in there and be transient within about a month’s period.

Evan Brand: Yup.

Dr. Justin Marchegiani: And then tryna add back in some fermented foods after it. I think would be great, you know, slip in a little bit of kombucha if she can. Or uhm— sauerkraut or some fermented food I think would be great.

Evan Brand: Yeah, her face I– I gave her a sip of kombucha, the gingerade one? [laughs] Her face when she drank it was hilarious.

Dr. Justin Marchegiani: Yeah, you could try–

Evan Brand: [crosstalk]

Dr. Justin Marchegiani: You could try the kevita one. Uh– the kevita one is– is a little bit of Stevia sweetened in it.

Evan Brand: Okay.

Dr. Justin Marchegiani: And it’s still relatively lower sugar but it tastes a little sweeter because it’s Stevia sweetened. So that could be that option too.

Evan Brand: Aah– okay– okay. Good advice. Yeah, so we kind of jump ahead and started talking about infections and herbs. Now we’ll back up a little bit. Let’s talk about children and some of the signs and symptoms that your children may have an issue. We talked a little about the cognitive stuff. So all these kind of repeat some of that just in case. Now we’re talking thing that the parents may not notice that the teachers do notice at school. So this could be any like focus or concentration problems. This could be ___[10:39], the kid could be angry, the kid could have o– outburst– emotional outburst, they may have trouble controlling their emotions. You know, I’ve had– I had one woman who had two 5-year old twin boys. They were about to get kicked out of school ’cause their behaviour was so bad. And it turned out that they had a clostridia infection. And Justin and I did a whole show on this about clostridia and how it affects the brain. But these kids had to build up a dopamine. Their dopamine was off the charts; they’re 5-years old. So all we did, we fixed the gut, the dopamine came back down on the retest and the mom said, “What the heck did you do to my children?”. I said, “What do you mean?”. She said, “Well they’re a different kid. Now they can actually sit still in their chair”. And that was ’cause we fixed the gut.

Dr. Justin Marchegiani: And that dopamine going high, was that from clostridium, like what was– was that just from a– a stress response for the dopamine going high? What was the rationale behind that mechanism?

Evan Brand: I mean– I mean, probably both, right? It’s probably a combination of all of it but we would point the biggest finger at the– HPHPA marker that goes up. I believe on The– Great Plains O-Test, it’s number 16. That’s a clostridia mark we looked for. And you and I did a show on this but it’s messing up that enzyme. Dopamine beta-hydroxylase, it makes you sound smart when you say it. Uh– that enzyme gets messed up due to clostridia. Clostridia inhibits the function of the enzyme, therefore dopamine gets built up.

Dr. Justin Marchegiani: So that’s pre– yeah, so the–the burning, ’cause that’s not like a marker of dopamine but the– the burning of dopamine goes up really high, and it’s affected by the not so good bacteria, uh– in the gut, or that clostridium bacteria. And so what you’re saying is, uhm— by getting the clostridium down, you can have a major impact on dopamine metabolism and that can affect mood and behavior too, right?

Evan Brand: Oh, it’s huge. So, like I said, the– the lady emailed me, you know, and she’s like, “What did you do to my kid?”. And then I go to read the rest of– the email, and she’s like, “Hey, this kid actually sits still, the teacher’s so happy that the kid can focus now.” So, you know, before you go and you take your kid to a doctor that’s gonna put ’em ritalin and or some other pharmaceutical drug to quote, “Calm them down”, you definitely wanna recommend getting a stool test on. And this is something the pediatrician honestly might not know. Honestly 98% of them aren’t gonna know how to run a GI map, they’re not gonna know how to interpret it, and they’re not gonna know how to make an herbal protocol to treat these issues. The only option for, you know, conventionally, is gonna be– I mean, what would they do, I don’t even know, do they refer them to a gastro doc? Or do they just prescribe the antibiotics themselves. What do you think?

Dr. Justin Marchegiani: Well, it depends. Uhm– i— if they have a lot of bacterial issues, uhm— some of the more cutting edge one’s well, right a SIBO breath test. And if positive, they may recommend rifaximin or rcifax which is the same thing, and the omicin

Evan Brand: Yeah.

Dr. Justin Marchegiani: Uh– some may just diagnose you’re with IBS-D.

Evan Brand: Aaah.

Dr. Justin Marchegiani: And then just give her on some, maybe some imodium or some other, you know ___[13:18] or I think, to slow down uh– the BM, and give it more solidity. So it just depends. Not all doctors are created equal on the conventional level. Uhm– so you really wanna go on the functional side. Now, with your daughter’s situation, I would also look at ruling out food allergens. I know, you’re also feeding her, I think a little bit rice. Uhm– and I would also look at potentially cutting out nuts and things like that. So I would tighten up the diet as like, you know, means of addressing the low-hanging fruit.

Evan Brand: Yeah.

Dr. Justin Marchegiani: ‘Cause you don’t wanna be going through all these stuff and– you know, they’re kind of be like– and on the fence kind of primal paleo food there that maybe we could pull out and see what happens.

Evan Brand: Yeah, you’re right. So we did, we did pull up the rice. We were giving her some organic white rice made it in the pressure cooker, which in theory help reduce lectin contents. So we did that once a week but we pulled it out. Also, almond butters, she loves almond butter. We pulled it out completely just because we thought, “Hey, maybe this is a factor”. Still no positive improvement after removing those, so hopefully once we start knocking out these bugs, we’re gonna see some stuff happen, but it’s not overnight.

Dr. Justin Marchegiani: Exactly. So, what else could we do for the kiddos? So, and then of course, uhm— a paleo templates’ gonna be a great starting point. A lot of the good fibers and the good uhm— carbohydrates in there are gonna be helpful for the gut microbiome. Cutting out the inflammation will be very helpful to the microbiome. We could also add in some fermentable carbohydrates, uhm— afterwards, like the fructooligosaccharides kind of carbohydrates to help fetal out of the beneficial bacteria, whether it’s a rribonolactone, larch tree, uhm— inulin, chicory root, some of these are really helpful, they help feed some of the beneficial flora. And again if you get a lot of bloat— really bloat because of it. I mean, really have to go work to that for a ____[14:57], right? First I remove the bad food, second I’ll replace the enzymes acids stir it up, repair the gut lining, support the adrenals hormones. 4th R is remove the infections, 5th R is repopulate, reinoculate probiotics. So we gotta do it in that order. If you start doing a lot of the– the fertilizer, before you do the weeding, you gotta pull the weeds, before you drop down the seeds. And then you gotta drop down the seeds before you fertilize. So I think that the fertilizer is lot of the prebiotic fibers that help the seeds grow. We weed, we seed we fertilize. And the fertilizer is those prebiotic fibers. Some make sense?

Evan Brand: Yeah, it does. I’m gonna take that statement a little further ’cause this is why parents are confused. You know, they go the whole foods, they’re trying to do the right thing for their kid, they go and they buy probiotics, or they buy this and that formula for kids, and they don’t see the results they’re getting. And that’s exactly what you’re seeing. you’ve gotta do it in this order. You can go to Whole Foods, or any place right now and buy consumer grade probiotics which are not as good as the professional grade stuff we provide for our clients. Just gotta note that. Quality is a huge issue. So, you could go and buy something that says, “Probiotics for kids”, and maybe it’s not good enough, maybe there’s extra fillers, maybe there’s maltodextrin and gellan gum and guar gum and a bunch of other crap. They’re stressing the child’s digestive system, also reducing the availability and absorption of that product, so– that’s why you wanna go really-really clean, with the nutrients. But also, it’s not gonna fix it. If you just put in probiotics, that alone is not gonna get rid of parasites. She had a–

Dr. Justin Marchegiani: Yeah.

Evan Brand: –my daughter showed up with a little bit of ___[16:30] on there too. You can’t get rid of that with just probiotics.

Dr. Justin Marchegiani: Yeah, that level wasn’t too bad. Now again with parenting, in dealing with kids, you know, I have a– 15– almost 15 months– year old son. And, you know, we have– it’s like a non-negotiable to– to eat bad food, right? It’s this kind of like, you don’t negotiate with your kid to put on a seatbelt in the car. You don’t negotiate with your kid to put on a helmet when they ride their bike, right? I kinda look at food as the same thing. Now, there may be some ne— negotiables within that paleo template the ___[16:57]. So, for instance, on the vacation, my son was, you know, a little bit sick, not doing good. So we compromised a little bit with peanut butter.  Now, if I was at home, in my own house I would use almond butter instead. So that was a compromise. We compromised doing a little bit more easier fruits, so a little bit more water melon and berries. This appetite with salt a little bit which happens when you get sick. We tend to have like chicken soup and bone broth, so we– you know, we use some collagen peptides, we eat some simple– uh– fruits, we did some simpler uhm— easier to process kind of meats and such. So we did our best uhm— to handle that. We brought some green juice, I brought some collagen peptides, made a little smoothie for him, to make it easier on his tummy. When you get sick, a lot of times you get nauseous. And that nausea is designed to– to decrease your– your food intake. Uhm– There’s some benefits with fasting, helping to regenerate and increase your– white blood cell and your immune cell population. So, part of that nausea and that feeling is just– it’s– setting you up to fast a bit, to help increase the immune system. Now, last night, we found my son he ate a whole bunch of, you know, really good food to get his appetite back. So we had to compromise a little bit but we did our best within that template. Then we get– we didn’t wanna feed him any refined sugar at least. We didn’t wanna feed him any grains. We did a pretty good job at that. So, you gotta just work with what you have. Always tryna, you know, good– good, bad or best. And always try to find the healthier substitute if you have to switch.

Evan Brand: Yeah, good point about the refined sugars and– and the grains ’cause, all kids snacks, like if you go to like the “kid’s section” at the grocery, it’s all grain. Even if it’s organic it’s still all rice, and wheat, and barley, and quinoa, and hemp, and amaranth. And– it’s not to say that those things have to be removed forever. Like maybe a little bit of hemp protein could provide some value. But generally speaking, we find that a lot of kids, especially– you know, uh– your son being as young as he is, his immune system and gut probably not fully developed yet. So you don’t wanna put a bunch of grain in there.

Dr. Justin Marchegiani: Exactly. And– and we eat peas like for dinner last night, and we were able to do a cauliflower pizza crust, with a little bit of dial almond cheese. And that worked out great. And that’s really good protein, uh– very– very much in the lower carb side. And good proteins in there. I think there may be a tiny bit of rice, within that pizza crust, it’s mostly cauliflower and egg. Uhm– but, you know, within our chit, that’s a pretty darn good chit if we’re gonna have pizza–

Evan Brand: Yeah.

Dr. Justin Marchegiani: So that’s, kind of like our way of– of substitute and things in there that could be much worse.

Evan Brand: You know what’s funny is a lot of these uh– conventional pizza places that actually have all gluten free stuff now, like pizza hut Papa Johns– everybody’s going gluten free, so that means education is working.

Dr. Justin Marchegiani: Yeah, and yeah. I don’t– I don’t wanna consume a whole bunch of carbohydrate either, right? I wanna still keep my carbohydrate in check. Especially if I’m like exercising as much. I really gonna be more careful with the carbs when you’re more sedentary.

Evan Brand: Yeah. Uh– let’s go to some of the– the questions or comments on here. There’s one on here from a person that said, everyone researched the product for storing, google doctor Zach Bush, will be a God-sent for digestion issues. I had a client and–  this is not the first. I’ve had probably half a dozen or more of clients who’ve been taking that product for a year. And this is supposed to seal off the tight junctions in the gut and fix leaky gut issues as a silver bullet. However, I’ve had female clients with their IGA so low, that we know their gut barrier is not intact at all. And they were on that formula religiously for year

Dr. Justin Marchegiani: Uh-huh.

Evan Brand: –and it didn’t worked.

Dr. Justin Marchegiani: Yeah, I mean, that’s the 3rd– a 3rd R, right? The third R is, repairing the gut lining, repairing the adrenals and the hormones, and– if you don’t go to the full 6-R process, right, remove the bad foods – 1st R. 2nd R, replace enzymes acids and your bile salts. 3rd R, repair the gut lining and the adrenals or hormones. 4th R, remove the infections. 5th R, repopulate. 6th R, retest to make sure infections are gone. Sometimes on retest we see new infections that were buried in deeper. So you gotta work to that process. And that’s why it makes sense that some peop—  I’m not saying products’ bad, I think it’s a good product. It’s a mineral, kind of amino acid peptide that helps with the gut lining. But it may not be root cause well because it’s not being plugged in to a comprehensive program. Part of the reason why functional medicine works, and good practitioners get results more frequently the most is because they’re working with any a– a– a clinical framework. Well there’s a whole journey here, we’re not spotting and adding certain things in there to do patch jobs. We’re working through it in entire framework that’s a root cause based and system based if you will. Does that make sense?

Evan Brand: Yeah. Well, this is the same thing as if somebody’s talked about some miracle probiotic, right? That would be skipping to l– let’s see– let’s call it step 5. Or R-5, right? As opposed to– this one we’re talking about restoring the gut lining or just skipping to step three. So– so yes. There’s– there’s a lot of stuff in every step of the way that could be a great silver bullet, but none of it works in isolation. So, the order of operations– the whole product, that’s a whole– you gotta have all of it. Uhm– let’s see what else there was here on– on questions. Uh– there’s some stuff but not really on the topic of gut, more stuff about hormones. Here’s one from Gabe. Uh– he was asking uh– his kids crying to his teeth in the middle of the night, thoughts? Yeah, I would say get your— get your kid a stool test. I mean it’s very probable there’s parasites or other issues going on. Also stress, and that could be like EMF stress. You know, WiFi in the house, it’s not turned off at night. It could be other stuff, but kids grinding their teeth– I’ve noticed like if we’d had a stressful day where we run my daughter around, we’re real busy running air and just tryin’ to keep up with family. You know, she may grind her teeth on those nights. So, it could be a stress component.

Dr. Justin Marchegiani: Absolutely. Uh– Simple thing you can do to help improve parasympathetic function is uh– put the– the mouth tape on. Put the mouth tape on, that forces you to breathe through your nose which can increase the parasympathetic uh– nervous system response which is the rest and digest. So that’s a really easy one off the bat. And then of course looking deeper at the gut uhm— for infections and parasites, obviously some be really helpful. There’s a– a technical term for grinding your teeth, I’m not sure.

Evan Brand: Bruxism?

Dr. Justin Marchegiani: Yeah– yeah– bruxism. Exactly. And that’s associated with parasites. We know that–

Evan Brand: It is.

Dr. Justin Marchegiani: ___[22:56] even says that.

Evan Brand: Yup.

Dr. Justin Marchegiani: ___[22:57]. Yup.

Evan Brand: We see all the time. And he also added here. Gabe had another comment. His kid has a lot of sugar cravings lately and very bad stool. So there is your answer. I guarantee there’s a candida overgrowth as well–

Dr. Justin Marchegiani: Or some yeast issues, and you gotta– cycle down drop the carbohydrates down or– and– and– and or at least shift to more whole food based carbs, at least uhm— there were sugar fruit, maybe a little bit of say for, starch in there. Just depends on how good or bad the diet is. Uh– if– if they’re a younger kid and they’re pretty active, I just sub out the carbs for whole food carbs. [crosstalk]

Evan Brand: I would in terms of supplements I would be doing some liver support, some adrenal support for kids can even be done like some eleuthero or some– some–

Dr. Justin Marchegiani: Yeah.

Evan Brand: –Siberian ginseng,

Dr. Justin Marchegiani: Yeah.

Evan Brand: –and then also get the stool test ’cause there’s probably candida and or parasites.

Dr. Justin Marchegiani: Yup, that makes sense to me. Well anything else here Evan you wanna address today?

Evan Brand: Yeah, uh– one other– one other comment here, someone said, they have to wear a night guard every night due to the damage they’ve done in their teeth from grinding– grinding and clenching so badly. Get your gut looked at. I used to grind my teeth, my wife told me about it all the time. Said, “You grinded your teeth all night last night.” And I’ve ran the stool test, and look, there is the infections. Now I– now I no longer do that.

Dr. Justin Marchegiani: Now, still if you have that issue, feel free to use– feel free and use a mouth guard just so you don’t grind that teeth away, right? But, make sure you get to the root cause, right? Obviously the mouth guard is not gonna be root cause but use it in the meantime ’cause it’s not gonna have much side effects. It’s sound like a medication that’s gonna– have a lot of negative uh– effects, so continue to use that while you investigate and get to the root cause and work to those full 6-Rs. Uhm– but, regarding the kiddos, uhm— we’re gonna use a ginger tea, we’re gonna use some herbal formulas that are gonna be dosed according to their way, and ideally they’re gonna be reasonably palatable against swallow pills. We’re gonna add in the right probiotics. Uhm– we’re gonna add in some biofilm busters, and we’re gonna make changes in the diet. We’re gonna work within, you know, what the parents can do. But we wanna make sure, right? I wanna get kind of parent’s head wrapped around this, your kid eating bad— your kids eating bad, it– it’s– you’re not gonna negotiate your kid with the seatbelts, or a helmet riding their bike, right? Most parents will probably say no. Same thing with food. And we may find a healthier substitute that gives your kid what they want but doesn’t put them in the position to feel like crap or– let’s just say get a lot of poor nutrition in like– let’s say pasta, right? You see a lot of pasta. Well, you can go to something like zucchini noodles, you can go to something like miracle noodles as well and then just use a– a really good fat based cream on there to give it a lot of taste like you do some ___[25:22] or some coconut cream stuff as it’s some really good things out there. So, there’s always a substitute for whatever your kid is addicted to. And try to ease them over to that, and of course, the solution is, just don’t ever open up pandora’s box, right? If your kids never know it— it’s there, it’s always easier but, you know, most people I see, they’ve already opened up pandora’s box. We just wanna find that healthier substitute, we don’t wanna go to removal mode, we wanna go to substitute mode. People always feel better when they’re substituting versus removing.

Evan Brand: Here’s a funny story, and then we gotta go. Uh– we took my daughter to the zoo, uh– they had a little halloween event, not too long ago. And– you– you mentioned the whole pandora’s box thing. So, you go around to these little booths, right? And they– give out little candy or snacks, or treats, or pencils or whatever for kids, right. You take your little halloween bucket, running around. Every single booth we went to, you know, we took– most the time we just said, “No, no thanks, no thanks. Keep it. But couple times we let ’em throw like a bag of skittles or– or– or like a– a Twix bar or something. And the– and the halloween basket, my daughter didn’t even know what it was, she wasn’t even interested at all. And then we get to the point where they give us like an Annie’s organic granola bar. And she knew exactly what it was. And she says, “Bar, bar, bar”. That’s the only thing she was interested in. The rest of the candy, she didn’t even look at. It didn’t even exist to her.

Dr. Justin Marchegiani: That’s funny. Yeah, when we went trick or treating, we didn’t do too much. Uhm– because my son’s not quite walking yet. But, I mean, we already have– the plan already dialed in. We have some high quality darker chocolate things. Uh– the Justin’s darker chocolate peanut butter cups or some higher dark– dark chocolate kind of things that are organic. And hey, here’s the– the halloween candy, that’s gonna go to the ___[27:02] shelter. And we’re gonna just swap out bags. And then you can pick, you know, one or two things a night out of the– the healthier bag with lower sugar and more antioxidants and– and not all the GMO high fructose corn syrup. ‘Cause remember, most of that candies that have high fructose corn syrup, it’s gonna come from GMO corn which is gonna have a whole bunch of roundup residue which is not gonna be good for their gut lining. Part of the reason why uhm— gluten sensitivity is so prolific in today’s environment. Uh– I think a lot of people are postulating I think Stephanie Seneff out of MIT has also said the stew is at the gut microbiome as being altered negatively by the roundup glyphosate pesticide, and that’s having an impact increasing gluten sensitivity.

Evan Brand: Yup. And uh– go check out that podcast. I did a podcast with her. You should interview her too Justin if you haven’t. Yeah, and just type ’em like Evan Brand-Stephanie, or Evan Brand-Stephanie GMO. We did a good podcast on that. Why, she believes we’re seeing such a very-very sharp increase in autism too. So, uh– we’ll wrap this thing up. But if you wanna reach out to Justin, or myself, our websites are, and you could go schedule a consult. Justin works with kids all the time, I do too. My website’s, and we would love to help you. When share this information, spread it, give it to your pediatrician, you know, let them know that there’s an alternative option. And the antibiotics are not the first thing that we wanna go to. We now know, researchers proving, there’s permanent DNA damage and permanent changes, and methylation changes after using antibiotics. So, if we can prevent these kids, that– you know, before age 5 or 6, so many of these kids are getting put on antibiotics. I’d love to prevent that and get them on herbs instead. ‘Cause we’ve seen it before and after we’ve got the lab results to prove it. You can successfully eradicate these problems with using natural medicines. So this is not alternative medicine, this is what existed before the drugs did.

Dr. Justin Marchegiani: Totally. And then my summary, was Stephanie– Stephanie Seneff said– sound right?

Evan Brand: It did, yeah, yeah. The– the– yeah, that the increase in the round up is damaging the gut barrier which is changing how we react to the food. Yeah, so it was perfectly clear–

Dr. Justin Marchegiani: Perfect.

Evan Brand: And that’s just the tip of the iceberg. So, like I said, there’s a– there’s more to that story if people wanna hear it. And then you should probably interview her ’cause she’s– she’s– cool lady to talk to.

Dr. Justin Marchegiani: Yeah, now that my summit’s done, people head over to thyroid reset summit. My summit will be coming out this– uhm— winter– end of the winter, early spring, so really excited for that. So I’ll have more live interviews on my podcast. Give us the share, give us the thumbs up, head over to You need more support or help, uh– feel free and follow the links there. Also head over to for more support and help. We get reinvigorated guys by your sharing, by your comments, uhm— and– it makes us wanna work harder to work to get more info to help improve all you all’s lives. So thank you so much, give us the thumbs up, subscribe, alert. Anything else Evan you wanna add?

Evan Brand: No, that’s it. Hope you’re all well, we’ll talk to you next week.

Dr. Justin Marchegiani: Alright then, you take care. Bye now.

Evan Brand: Take care, see you later.

Dr. Justin Marchegiani: Bye y’all. Bye.


Great Plains Organic Acid Test

My Lab Tests Are Normal But I Still Have Symptoms

By Dr. Justin Marchegiani

I see patients all the time in my practice that tell me they don’t feel right, yet their medical doctor tells them their lab tests are normal. The typical response from the average medical doctor will be something like this: “It’s all in your head. You may benefit from taking an antidepressant.” Or if you’re a woman, it may be blamed on female hormone issues, and the next solution may be to go on a birth control pill to help normalize your cycle.

Intuitively, people know something’s wrong even if their lab tests aren’t totally in the red. The most common response I hear in my practice—

“My lab tests are normal, but I still don’t feel well!”

Blood Test Normal Range

The problem with this scenario is there are physiological, biochemical, and hormonal explanations for why patients feel the way they do. Conventional medicine typically gives these patients no answers and worst of all, can sometimes make them feel as if they’re making it up.

In the world of functional medicine, we tend to look at things differently than your conventional medical doctor. Most lab tests have originated to include 95% of the population into the normal values. So if your medical doctor tells you your labs look fine, that just means you fit into that 95% category, or two standard deviations away from the mean if you are into statistics.

Anyone that has walked around an airport for just a little bit of time will be able to tell you 95% of the population doesn’t fit into the healthy category. Conventional medicine makes a massive assumption that the absence of disease is health. This is like saying the absence of being poor on the street means you’re rich! I hope my analogies help drive the point home that these assumptions are absurd!

Why the Answers to Symptoms Get Missed by Conventional Lab Testing

As society gets sicker and sicker and sicker, we know the reference ranges get wider, and wider, and wider. So if you are someone that may have been healthy to begin with, and then have a sudden drop in your health, you may still fall within that normal reference range. Thus, being told nothing is wrong.

It’s really not your medical doctor’s fault. Conventional medicine trains physicians to look for pathologies or disease, and this is a good thing. Where this paradigm falls short is when you aren’t sick enough to fall into the category of being diagnosed with a disease. So what do you do next?

Essentially, conventional medicine is saying, “Go home, continue doing what you’re doing, get sicker, and then maybe we’ll be able to diagnose you with something in a few years.” Intuitively, that doesn’t sound right to me. We need to look at things in a more sensitive way so we can pick up this slow and steady breakdown before it becomes a major problem.

Your body is designed to adapt to stress. Maladaptation is the number-one sign that your health is starting to decline. If your body loses the ability to adapt to the various stressors in your life, you will eventually come down with some type of disease. The goal of functional medicine is to figure out where the underlying stressors are coming from. Using specific lab markers that are sensitive, we can chart your overall health function on a spectrum so as we start incorporating treatments, we have objective and subjective markers of improvement.

Functional medicine can look at the exact same labs and potentially pick up subtle things that conventional medicine may not. Click here to get your labs assessed.

Thyroid Lab Testing and the Inadequate TSH Test

Most people have low thyroid symptoms even though their thyroid lab tests are normal! The standard panels that are looked at are typically a TSH test (a brain hormone) and T4 test (a storage thyroid hormone). It always bothers me that conventional doctors very rarely look at the active thyroid hormone (T3) to assess a thyroid problem. Especially since the research over time has shown that TSH testing isn’t the best to assess thyroid function. If TSH is elevated, it’s a surefire sign of thyroid dysfunction, but it’s a marker that tends to elevate late in the game.


functional thyroid range

Above are the markers that I commonly run on my patients to assess which pattern of thyroid dysfunction they have. Thyroid antibodies are also looked at to assess if there is an autoimmune disease at play. Most conventional physicians totally ignore thyroid antibody testing completely because it doesn’t change the conventional treatment; Synthroid will be given either way. Knowing whether or not a patient has an autoimmune thyroid disease (Hashimoto’s thyroiditis) can make all the difference in the world.

When we are dealing with Hashimoto’s, it’s the immune system that is out of balance. It is destroying the thyroid gland. It doesn’t make sense to put all of our focus on the thyroid gland if the immune system is attacking it daily. Some people with Hashimoto’s (hypothyroidism) may need thyroid hormone depending on how bad the damages is. I always recommend getting a full assessment like the one above before it is recommended. Hashimoto’s patients will typically respond better on a combination of T3 and T4, like in Nature-Throid, or a bioidentical thyroid glandular instead of a synthetic T4 medication.

Adrenal Testing

Assessing the glands that help control and regulate stress is very important to your health. Your body is designed to be healthy, and part of being healthy means adapting to stress. Your adrenals are instrumental at producing hormones throughout the day that are designed to do just that.


adrenal fatigue

Cortisol is secreted in a pulsatile fashion, higher in the morning and then tapering off throughout the day. Cortisol is designed to help stabilize blood sugar and help deal with stress and inflammation. The more dysfunctional our adrenals become, we start progressing into deeper stages of adrenal fatigue. This is where our brain (the master controller) isn’t able to communicate with our adrenals properly and we develop HPA axis dysfunction. This is nothing more than communication breakdown that can be fixed with proper diet, lifestyle, stress management, and a properly prescribed adrenal program (specific to your pattern of adrenal fatigue).

Blood Test Markers for Health

Looking at blood test markers from a CBC, CMP, or lipid panel can provide a pretty good idea of how the body’s systems are functioning.


When we see digestive markers, like albumin, globulin, creatinine, BUN, or serum protein, out of balance, it can tip us off that we may be dealing with some digestive inflammation, low stomach acid, leaky gut, and/or malabsorption.

Energy systems

We can look at markers like RBC, Hgb, Hct, MCV, MCH, MCHC, and ferritin, which are markers for an anemia. An anemia typically deals with deficiencies in certain B vitamins, like folate or B12 and/or iron. Most conventional doctors tend to miss these subtle imbalances. And they can contribute to a person’s inability to transport oxygen, create energy, and convert T4 (inactive thyroid hormone) to T3 (active thyroid hormone).


When we see blood sugar markers, like fasting blood sugar, hemoglobin A1C, or insulin, out of balance, it is a good sign there is inflammation. There are more specific markers that can be looked at, like C-reactive protein, ESR (erythrocyte sedimentation rate), fibrinogen, and a triglyceride-to-HDL ratio greater than 2.


When we assess white blood cell (WBC) function, long-term low WBC can be indicative of a chronic infection, while elevated WBC can be a sign of an acute infection. This rule is the same for the WBC’s constituents as well. Below is a list of the specific components of WBCs. We are looking at the markers below in a more sensitive range than the standard lab range, so we can pick up more subtle infections.

  • Neutrophils: Potential bacterial infection including H.pylori
  • Lymphocytes: Potential viral infection
  • Monocytes: Potential parasitic infection and recovering from an infection
  • Eosinophils: More specific for a potential parasite infection
  • Basophils: Can increase due to allergies, inflammation, or parasites.
  • Alkaline phosphatase: When low, a sign of zinc deficiency, which is a key immune-system nutrient

Blood Test Normal Range

Stool Testing

Most people who are tired and moody and have weight gain and hormone imbalances tend to have an infection! I have tested hundreds of patients, and I would say, based on my experience, over 70% have a parasite, bacteria, or fungal infection.

Yet in First World countries, it still isn’t accepted, by and large, that these infections can cause a problem. But having worked with many patients with these infections and having helped to remove the infections, I can tell you I’ve seen significant changes, and my patients will tell you the same.


GI Pathogen Screen

These infections can cause classic GI symptoms, like bloating, gas, constipation, diarrhea, and acid reflux. These infections, at the same time, can cause symptoms that are more nuanced, like depression, hormone imbalances, fatigue, neurological issues, skin issues, and weight gain. It’s hard to connect the dots when these infections aren’t causing the typical symptoms you would see in Third World countries (distended bellies and such).

Click here to receive more great information like this!

So What Do I Do Next?

If you are told that your lab tests are normal but you know something deeper is wrong, you are probably correct. Most of these problems if left alone only get worse and take more time and money to fix later on.

If you need help getting to the bottom of your health challenges, click here!

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