Explore the profound link between your gut health and mood in our latest episode on Functional Medicine's take on the gut-mood connection. We delve into the science behind the ‘second brain' and how imbalances in our gut microbiota can significantly influence our emotional and psychological health. Featuring leading Functional Medicine experts, we'll break down the complex relationship between our gut, brain and the role of inflammation.
Unearth practical tips on dietary changes, lifestyle modifications, and effective therapies to optimize your gut health and enhance your mood. Join us in understanding this critical and often overlooked aspect of our health and well-being. Remember to like, share, and subscribe for more videos on Functional Medicine's innovative approaches to holistic health.
In this episode, we cover:
00:12 – Anxiety and Mood Medications
02:50 – Hormonal Imbalances and Issues
06:44 – Protein and Neurotransmitters
10:10 – Patients with Diet Protocols
13:48 – Tools to Fix the Root Cause
17:13 – Functional Medicine Approach
19:22 – Health Anxiety and Conventional Approach
22:19 – Takeaways
Dr. Justin Marchegiani: Hey guys, Dr. Justin Marchegiani here. We have Evan Brand in the house. Evan, man, it's been a while. What's going on, dude?
Evan Brand: Oh, doing really well, man. We're gonna talk about gut and mood issues, specifically anxiety. I mean, there are so many people on antidepressants, anti-anxiety meds, and really, if they fix their gut, they might not have to be on those. So I'm not saying stop your Pharmaceuticals, let's be clear, but the truth is, most people that we see that have mood issues, there's a gut component.
So that's what you and I are going to unpack today. We'll talk about testing strategy, supplement strategy, how do you fix this thing? Because unfortunately, your psychiatrist, they're probably not going to run a stool test on you.
Dr. Justin Marchegiani: 110%! I mean, when you look at most issues with mood, and that kind of is a broad umbrella, we could put irritability, we could put depression, we could put anxiety, it's mostly going to be handled in a couple of ways. Anxiety, things you're going to be throwing benzos, for the most part, right? Benzodiazepines, Xanax, Lorazepam, those type of benzo type of medications, Ativan.
And then you have your SSRIs, which are going to be your antidepressants, whether it's Lexapro, then you're going to have, I'm pretty sure, your SNRI medications that work more on the reuptake and impacts of dopamine. I think Wellbutrin's in that camp as well. I don't have the exact medication names because they, it's always new ones and there are generics.
But you have your SSRIs, selective serotonin reuptake inhibitors, your SNRIs which are NRI, norepinephrine, and dopamine are kind of connected, and then you have your GABA type of medications which are your benzos, and those are your big ones. You have the old antidepressants from the '80s, the tricyclics, you have those. Is there anything else you want to highlight on the mood side?
Evan Brand: Yeah, the Effexor, that's the one you're thinking, the SNRI. That's the popular one, Effexor, that's Venlafaxine. Amazing how they come up with all these names, and none of these are root cause, and unfortunately, people generally go as far as doing the medication. Maybe they try to hit the gym, and they notice, hey, when I exercise, there's definitely a mood-exercise connection.
So I do want to give some free credit to the free exercise piece of helping your mood, but overall, that's as far as it goes for people, and they don't have a clue that the dysbiosis, the reflux, the diarrhea, the constipation, the gut pain, the skin issues, the eczema, The Athlete's Foot, the toenail fungus, the UTIs, the vaginal yeast problems, they don't make the connection that those things are giving us clues.
That's a window. These other symptoms are a window into what's happening up in the brain. So if we hear someone that says, “Hey, I have these gut complaints, intestinal cramping, diarrhea, I also have toenail fungus, I have sugar cravings, I have thrush on my tongue, and by the way, I have anxiety!”, We're gonna go, “Oh, smokes. Well, this is all totally connected.”
Dr. Justin Marchegiani: 100%. Gotta get to the root issue.” And then we can also throw birth control pills in there as well because if you have a lot of hormonal issues, and those hormones are impacting your mood and focus, especially if you can kind of link it up to PMDD stuff, which is like hormonal kind of mood symptoms to the extreme, extreme mood, extreme fluctuation, extreme depression, those kind of issues, then of course, antidepressants would also be recommended.
I'm sorry, birth control pills would also be recommended to kind of shut down the cycle and to regulate some of these huge hormonal swings. So that's definitely something to keep in mind too.
Evan Brand: Well, how about doing both? Then you're on Lexapro, you're on birth control. Sounds like a perfect nasty combo to not feel well.
Dr. Justin Marchegiani: Yeah, and then you may also be on a PPI because you have poor digestion, and then that forever alters your ability to break down protein and good fats optimally, and these are the building blocks to make a lot of your neurotransmitters. People forget that serotonin and dopamine and norepinephrine, epinephrine, these all come from amino acids.
And so if you don't have good protein digestion, these amino acids and building blocks are going to impair the actual raw material and the making of these neurochemicals. And then also hormones have moods, or I'm sorry, hormones have a major impact on your mood. So you have neurotransmitters up top, that's more in the brain.
These neurotransmitters then help you with FSH and LH and cortisol and a lot of downstream signaling with cortisol with DHEA with progesterone with estrogen, and we know progesterone is a natural GABA chloride channel opener, kind of how GABA, kind of how benzos work. So progesterone has very calming and relaxing effects. We know that most people today are more estrogen-dominant, that progesterone is skewed downward because progesterone can pinch-hit for cortisol.
So the more stressed and inflamed you are, you're going to take that progesterone downstream. So now your natural benzo, right, your natural Xanax, if you will, is now dropping. So now you're more stressed, and then at those progesterone drops out soon in your cycle, you may have a lot of extreme PMDD, mood, of course, PMS, heavy bleeding, breast tenderness, back pain, cramping, right, the list goes on.
So you have to look at the neurotransmitters upstream. They help with your HPA, HPT, HPG axis, that's talking to your adrenals, your thyroid, your gonads, that signaling helps with the LH, FSH, and that's how your hormones produce hormones. Well, you need that good signaling upstream.
Evan Brand: Yeah, and this gets worse by the time you're age 35, 40, 45, 50, and you've been chronically stressed and imbalanced for 20, 30 years, this is going to compound. So women may be thinking, “Well, why was I fine when I was 18? Now I'm 46, and I'm anxious all the time, I'm stressed all the time.”
Well, you likely did some of that progesterone steal that you're describing to deal with the cortisol of raising children and managing a household and keeping up with the dishes. You did that for 20 years, and now you've essentially, for lack of a better word, you've kind of burned yourself out.
And so where do we start with these people? Well, you mentioned hormones, so we can look at that via saliva, you can do urine, but then the gut piece is where I really want to focus because I've seen cases where people are so depressed and anxious. All we do is get them on a gut protocol. We're not even giving any mood support, so to speak. And all of a sudden, they're like, “I'm not depressed anymore.” Like, wait a second. What do you mean you're not depressed? Like, at first, it was shocking. It was like, really? Because I look back, I'm like, “Well, surely I put in some amino acids. Maybe we did tyrosine, we did phenylalanine, we did 5-HTP.” And I look, and I'm like, “No, we actually didn't do any mood support. This is crazy.”
And then I started seeing it over and over again, and you and I have poked through the research on this, so we won't bore people right now with it. But the specific probiotic strains that we use, those help too. So not only are we trying to address this bacterial imbalance, this dysbiosis equation that's making toxins, but now if we're putting probiotics in, it's like we're getting a two-for-one. We're fixing the gut bugs and reseeding with good ones, and now the anxiety just plummets.
Dr. Justin Marchegiani: There's a lot of things that we can do. We talked about proteins and how that impacts the raw material in the building blocks for our neurotransmitters. Neurotransmitters are help make that chemical signal from neuron to neuron, so we need the neurochemicals there, the building blocks of protein, the raw material of our brain. Guess what? Cholesterol and fat.
So if you're low fat, low protein, vegan, vegetarian, you're going to have mood issues. You're going to have depression issues. Okay, also we have to break all those things down. So just like you said, we have the gut absorption. We have hydrochloric acid, enzymes, and bile salts that help break all those things down. And then we have to absorb it. So what you just said regarding the gut, if we have microbes that are impeding absorption. We've got bugs, H. pylori, dysbiosis, SIBO, parasites, that's going to impact the absorption.
And then what you just said, you kind of highlighted probiotics. Probiotics have a major influence on the immune system on gut permeability and inflammation. And a lot of the newer antidepressants and mood drugs that are in the pipeline, instead of working on like reuptake and hit inhibition like SNRIs or SSRIs, they're working on reducing inflammation in the brain.
So we know that inflammation plays a major role because that activates microglial cells. These are the immune cells in the brain. And when they are activated, you start activating them up, and more of them start getting activated, and that can cause brain fog and mood issues because when you have inflammation in the brain, your cells don't work optimally.
Evan Brand: Amazing. So the future drugs may be more root cause in a way. They may be more anti-inflammatory. But still, there's got to be some negative effects with that so…
Dr. Justin Marchegiani: Well, yeah. The problem is almost all drugs, when you look at the mechanism, they kind of either block some kind of enzyme or inhibit some kind of pathway from occurring. So if you go look at PPIs, proton pump inhibitors, or SSRIs, right, SSRIs, you look at ACE inhibitors, right? So if you look at the medication themes, are they do not upregulate physiology.
And the problem is you go back to certain drugs, let's say in the early 2000s, let's say Vioxx, for instance. Those medications were COX-2 inhibitors. So COX stands for cyclooxygenase two. Well, that enzyme was a really important enzyme that increased inflammation, but that enzyme was also needed for heart and gut lining rebuilding.
And so when you block that, yeah, the drug worked, but it caused 60,000 deaths due to ulcers and cardiovascular incidence because that enzyme was shown important for rebuilding that tissue. So this is why drugs, you've got to be very, very careful with them because of the side effects. Because when you block and inhibit a pathway over here, something can happen over there.
Evan Brand: Yeah, amazing.
Dr. Justin Marchegiani: And one-third of all FDA-approved drugs end up getting pulled after the fact. So just guess, you got FDA approval. Guess what Vioxx did? And it killed almost a hundred thousand. I think it was Merck, struggling. I think they paid billions of dollars in fines for that. That's just, you know, that's just true facts right there.
So you got to know that because what they approved may not be the thing. So we'd like to do tried and true methods that really work on reducing inflammation, of course, diet number one. We can use curcumin slash turmeric. We can use boswellia, white willow bark. We can use systemic enzymes like nattokinase and serrapeptidase and lumbrokinase and bromelain. So there's a lot of natural higher dose fish oil, keeping really good omega-3 fats in there, getting more meat that's grass-fed and pastured and less linoleic omega-6 fats. These are a lot of good things that we can look at.
Evan Brand: Yeah, so the diet piece is critical. Most people that come to us truthfully, they're already doing that. They've already explored diet. Most of them have some experience with cleaning up their diet. So usually, we're not wasting too much of our breath on the whole gluten and dairy thing. But some people…
Dr. Justin Marchegiani: Well, I had a patient last week though. I had a patient last week. I said, “Hey, I just want to do this thing over here with this protocol, but I don't want to tell my diet.” And I'm like, “Okay, that's like you want an addition put on your second floor to your house, but your foundation's cracked.” (Yeah) Oh yeah? That may actually cause the foundation of the house to tip over, right? So you have to really build that foundation. And of course, if you're adding on to your house, you even more have to make sure that foundation is solid.
Evan Brand: Yeah, agreed, agreed. And then on the gut piece, you can look at urine for organic acids. We can measure distance there. We could do stool testing at home and this is more accurate than what you're going to get at a hospital. So for example, if you came back from Mexico, you had food poisoning, you end up in the ER, they run some stool test on you, if you can get them to do that, there may be the tropical disease specialist who comes in and takes a look at you.
Truthfully, their testing is outdated and not as sensitive as what you and I are using. (exactly, 100%) So, you know, these people are frustrated when they get to us because they said, “Well, I've already been tested by the gastro.” They ruled everything out, and I'm like, “Well, they ruled everything out according to their testing, but with these more advanced sensitive tests, we find things that supposedly aren't there. And then with that data, we don't have to guess. Now we can actually make a specific protocol we've done thousands of times to address these bugs.”
So get the data, get the data, get the data. If that's one thing you take from today, if you have mood issues, get your testing done. You can reach out to Dr. J and do it, you can. You can reach out to me. We can run these labs, get the results in a couple of weeks, and provide more answers than you've seen by visiting 20 different conventional medical practitioners.
Even Mayo Clinic, they're not actually doing that good of a job. I've seen the protocols that they're doing. They're helping people rule stuff out, like I had a lady who got an MRI; they were worried about something in her brain, and they said, ‘Nope, nothing there, and nothing we can do.' I said, ‘Did they talk to you about diet?' ‘No.' ‘Did they talk about your gut?' ‘No.' ‘Do they talk about supplements?' ‘No.' Like, what'd they do? They just said, ‘We'll just keep an eye on you.' I'm like, ‘Okay, great.'
Dr. Justin Marchegiani: Yeah, a lot of these people you think, ‘Oh, I'm gonna go to Mayo Clinic or Cleveland Clinic.' I mean, a lot of times, they're good at ruling out kind of weird genetic or pathological issues, even genetic stuff. I tell patients if it's genetic, if it truly is genetic, it would be caught at birth. It'd be Tay-Sachs or Trisomy 21; it'd be Huntington's disease. It'd be something typically caught at birth.
But when you're finding things out 30, 40, 50 years of age, it's more epigenetic, meaning you have genetic triggers that are in effect – stressors, diet, lifestyle, inflammation – and these are then activating genes. So it's not that you have a genetic code that is active right away and you can't change it. It's more epigenetic. And if it's epigenetic, that's the light switch going on and off.
So think of the DNA as like the electrical wiring that's already there. Think of the epigenetics as the actual switch that you can flip. Hardwiring is there; we can't change that. But we can change if the switch is on or off. And so most times, people say, ‘Oh, it's genetic at 40 or 50 years old.' It's really epigenetic, and we have control over that. And so then what's the steps that control the epigenetics? And that's where functional medicine works amazing, and that's where conventional medicine drops the ball.
Evan Brand: Yeah, well said. And you can come in with tools like we can do GABA, we can do taurine, inositol, we can do things like magnesium 3 and 8 to calm the system…
Dr. Justin Marchegiani: L-Theanine, L-Theanine, (Here's the thing though…) Epsom Salt foot baths
Evan Brand: What if you stop there, though, see, the naturopathic approach is going to stop you there. (A lot of times) They're going to say, ‘Okay, take your theanine, take your GABA, hope you feel better.'
Dr. Justin Marchegiani: And again, the difference is you have supplements and nutrients and amino acids and herbs. And if you don't have the right philosophy, that could still be allopathic in a way because you're still not fixing the underlying issue.
Now, I like this at least better because you're not killing 60,000 people a year like Vioxx did, or you're not getting people hooked on benzos where it's very difficult to get them off once they've been on for years and years and years. So I do like it from that standpoint. But now if we start looking at their diet and we look at dysglycemia and blood sugar issues, we look at sleep, we look at their gut, we look at their hormones, we look at toxicity and mold, now we're really having a holistic approach. And now we can plug these tools into a holistic approach that actually gets to the root underlying issue.
Evan Brand: Cost-wise, this doesn't have to be insane. People may hear all this and think this sounds crazy, and you know you're not able to do it, but I've seen people on five and ten thousand dollar programs from naturopathic practitioners, and I look at the program, and there's nothing to it. It's just some enzymes and maybe some ginger, like you said, turmeric. I'm like, that program was five grand, that's all it was. Like, where's the root cause? What is your goal?'
And they're like, ‘Well, we didn't really have a goal; it was just try to get the anxiety down.' I'm like, ‘Well, you are not gonna like – you could take this protocol here for 20 years and not fix the issues.' I tell people that all the time, like it could be vitamin D, K, E, magnesium, enzymes. I'm like, ‘Okay, great, but like, you've got mold off the charts, that's why you're anxious, like bingo! You're not gonna fix it with this protocol.'
Dr. Justin Marchegiani: Yeah, I tell patients for me, it's the SSS approach, the last S in the three is symptoms. And most people, they just stay there and they spot-treat symptoms with drugs, ‘Oh, pain and said, Oh, depression SSRI, Oh, digestive issues proton pump inhibitor,' right? Or you could plug in, ‘Oh man, I just give you some HCL, I'm gonna just give you some turmeric,' right? You can still do that there a little bit.
Now you go Upstream to the body systems, so that now we're starting to get more holistic and functional medicine. The body systems are going to be digestive, immune, right, detoxification, hormone, lymphatic, right? So now we can look at the systems, and we can run tests to see how the function of these systems are, and then we go one step up the first S, which is going to be stressors. We're going to look at those physical, chemical, emotional stressors.
Tell me about where you live; is there any mold or environmental toxins? Do you have an issue with gluten, blood sugar issues? So now we're going to look at emotional stress, and now we're going to look at the physical, chemical, emotional stressors. We're going to see how that impacted your body's systems, right? And then, of course, we'll also work on support down here. But we'll make sure the above two things, stressors and systems, are supported.
Evan Brand: And this works. I mean, you and I are doing well. I mean, we've got stress load with dealing with our kids and trying to be good fathers and good practitioners. And we're practicing what we preach, and the stuff we do clinically, we do personally. And so that's what's allowed us to do this now, for you know, combined over 20 years between us both, this is helping lots of people.
And I don't see you or I slowing down because this is addicting and fun. Its' truly… And I hope that it's going to be something on the street corner that people are talking about. I think people are waking up. They don't want to be on these meds for anxiety. They don't want to be on the meds for depression. They know that it's digging themselves deeper into a hole. But still, the stuff we talk about is still not like grocery store checkout line conversation yet
Dr. Justin Marchegiani: Yep. So on the gut side, we have probiotics which can be helpful. But if you have SIBO or probiotic intolerance, like you get bloated or gassy or foggy with fermented foods or probiotics, then we really have to work on cleaning up the gut. Some of these things we mentioned that could help may also make you worse too. And that's where you have to have that functional medicine kind of detective hat to kind of dig in deeper.
You have to look at the gut, you have to look at the absorption. You have to look at all your digestive nutrients to break things down. Look at the dysglycemia. Blood sugar issues going up and down can cause energy and mood issues. And then, of course, you have to look at the female hormones. And like Evan said, you know, are you living in a moldy apartment? Do you have a history of heavy metal exposure? All these things can matter.
So you want to create that audit list because what we're really good at is, someone comes to you and they have a whole list of potential issues. Well, how do you address that? So I always use Okum's razor, like what's the most likely, what's the most likely situation, right? A patient comes to me one time and she's like, “Oh, I got a headache, so this weekend I went to get an MRI because I thought I had a brain tumor.”
It's like, “No, that's not how any of this works.” Like, the first thing I would say is, “Were you hydrated? Were you getting electrolytes? Did you skip any meals? Are you eating protein and fat at each meal?” And, of course, when I asked a couple of those things, she's like, “Oh yeah, I didn't hydrate that much. I had some alcohol the night before, I didn't need any protein.”
So it's like, “Of course, right?” So we go to the most likely and the least invasive to the less likely into the most invasive. So we always do it in that order. That way the patient gets better fastest and the least expense and the least level of invasiveness.
Evan Brand: Yeah, those are those are always interesting cases. It's always the female with the anxiety who goes headache – brain tumor. Oh my God, so…
Dr. Justin Marchegiani: Yeah. Or someone that has a tummy issue, “I have a tumor, I have an ulcer.” It's like, “Well, you could just have some gastritis, could just have some general inflammation, could just have some indigestion.” And you know, look at the history, and it's nice to have tests like the GI map where we can look at blood in the stool, we can see eosinophilic protein, we can look at capitect, and so we can see how good or bad the gut is doing from an inflammatory or immune standpoint. So we have tools to assess that.
Evan Brand: Yeah. So if you have health anxiety, the best thing you can do is to get data, get some of this clinical data, not necessarily an MRI. I did have one female client in her 70s. She had breast cancer many years ago. She ended up having brain cancer. Like this was a new case, got an email a couple of weeks ago, “Hey, cancer's back, brain tumor this time.” I'm like, “Oh, this is terrible.” So in her case, MRI came through, but she had a massive, terrible health history.
So like you're saying, we don't want people to just be having some baseline headache anxiety and go straight to brain tumor. Like, get the data with us first and we'll let you know if something's not right and you need to investigate further. I mean, I know you and I both have seen cases on the stool where we're going to see massive amounts of inflammation and bleeding, and we go, hey, look, maybe you do need to get that colonoscopy. But to run off right away for that sometimes is unnecessary based on us looking at five to thirty different biomarkers that indicate intestinal health. We're going to look at that first.
Dr. Justin Marchegiani: Yeah. Most people that I have seen, and you probably have a similar experience, especially if they have some chronic health issues, they've probably already seen a lot of conventional allopathic doctors. And they probably haven't gotten the results they want. They've probably already been failed by them in their eyes, like, “Hey, I couldn't get better. I've been doing this for years. They're putting me on this drug, this drug, this drug. These are my options with them.” And I'm just like, “I want something different.”
So most people, they've already kind of been ruled out to that level of degree. And you know, I see patients with blood in their stool, and they go to their gastro, and they're like, “Yeah, you have some IBD and Crohn's.” And they're not overly worried besides, “Hey, let's give you maybe lialda, a salamine, or a biologic, and let's try to get the inflammation down.” But that's it.
And it's like, well, what about upregulating physiology and microbiome and bacteria and infections and low hydrochloric acid, enzymes and bile and leaky gut and zonulin? Like those things don't even enter the equation. They're all over their head.
Evan Brand: I know. Isn't that shocking still in 2023? It's still like 1980s or I don't even know what decade it would be.
Dr. Justin Marchegiani: Well, I mean, it's the whole insurance industry, basically. When you have five or six minutes to work with the patient, I mean, you can't even ask enough questions just to hammer down: “Is their environment moldy?” in five or six minutes. Let alone get their whole work up in. (True, true) you know?
Evan Brand: The system is not…
Dr. Justin Marchegiani: You know, true, And then you're like “Hey, you know? Do you have any history of water leaks? You know, what's the humidity in your basement like? Do you have any foundation?” The time you figure that, “Oh, time to go!”
Evan Brand: “I'm late for my next one. (I know!) I got 20 others in the waiting room today.”
(I know) Oh yeah. So I mean, you know, you and I are, we're, we're zooming in more because that's what's truly helping get people better. So I encourage you, get the data, if you need help, reach out. We're gonna do this again next week too, we can go deeper into gut or anxiety. If you all have questions or topics you'd like us to cover.
You could always go, I know Dr. J publishes these on his Justin Health YouTube channel, so if you go on there and you add some comments, things you want to hear about, questions, we had a couple of questions come in about keto and anxiety, also what to do with blasto diverticulitis, so we could definitely cover those.
Dr. Justin Marchegiani: Those are great. Absolutely, and if you guys are listening and you've been on antidepressants, benzodiazepines, SSRIs, please do not just come off them, you know. If you've just been prescribed them and you want to come off, talk to your doctor that just prescribed them and see if they can taper you off. If you've only been on a very short period of time, you could probably get off pretty fast, as long as it's not something that was prescribed because you were suicidal or something overtly serious.
But always go back to that prescriber so they can manage that taper. If you've been on for years, most prescribers still pull patients off too fast, especially with benzos, you may need a six-month to a year taper, and I always tell patients, get the foundation right with your diet, lifestyle, supplementation, gut, and then go back to your prescriber and then say, “Hey, just slowly taper that off, usually over six months to a year, know what the side effects are and then watch them and just go really slow with that, okay?
But always go back to that prescriber, never just do it willy-nilly, and always do it with a foundation underneath you and then taper versus like, “My blood sugar is terrible, my gut's off, well, I'm gonna just come off.” No, don't do that, just be responsible in how you do it
Evan Brand: Agree. (Let the prescriber know.) Amen to that. If you need help clinically, you can reach out, we work with people around the world, justinhealth.com. That's for Dr. J. Consult lab testing is available worldwide. We're experts at this, domestic, international, the logistics don't matter. We always figure it out to help you guys, even in the nooks and crannies of the earth. (Yes) And if you want to reach out to me, it's Evan, evanbrand.com. You can reach out, we're happy to help you guys
Dr. Justin Marchegiani: Excellent, yes, very good. And then we didn't touch upon any of the emotional stuff, so like EFT or NLP or EMDR. So today's podcast really wasn't going into that aspect, we were more looking at the physiological things regarding gut and hormones and such, so just there's a whole other layer on top of that, though, but we'll save that for our second podcast
Evan Brand: Yeah, part two tips and tricks, (Part 2) Yeah, let's do it!
Dr. Justin Marchegiani: Excellent. All right, Evan, great chatting with you, man, you have a good one. (You too, take care) Take care, everyone, take care, bye, y'all.
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