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
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
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 EvanBrand.com and I'm going to make the link MAP. So EvanBrand.com/map, 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 EvanBrand.com you can reach out to Dr. J at JustInHealth.com. 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.
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