Dr. Justin Marchegiani and Evan Brand break down the root causes of gut dysfunction and why so many people suffer from symptoms like brain fog, fatigue, anxiety, and low libido without ever realizing their gut is the underlying driver. Drawing from thousands of combined patient cases, they explain how functional lab testing reveals infections, dysbiosis, and digestive breakdown that standard blood work consistently misses. The conversation covers digestive physiology, immune function, H. pylori transmission, natural botanical protocols, and why the conventional medical approach of acid blockers and antibiotics falls short long term.
Dr. Justin Marchegiani: And we are live here, Dr. J in the house with Evan Brand. Today we are going to be talking about how to support and get your gut healthier in 2026. So excited to dive into this topic. We will talk about some of the root cause modalities that we use to help support your body's ability to work on healing itself. Evan, how are we doing, man?
Evan Brand: Hey, I am doing good. You know, we have seen some of these studies come out in the last couple of years about younger people in their twenties and the colon issues that are popping up. It is really affecting a lot of younger people, and I think it creates fear for them because they do not know what to do. They think it is some unlucky dice roll or some unlucky deck of cards they were dealt, that they are going to end up that way.
But the reality is, with the labs that you and I have been doing for over a decade now, we have seen thousands of cases of all ages, and there are things that show up way sooner on these functional labs that we run, way sooner than the conventional pathology level of issue.
So I just want to encourage you right out of the gate here. If you feel like something is not right, and that could be a mood issue, anxiety, depression, fatigue, joint pain, skin problems, or it could be all your typical IBS symptoms that I was diagnosed with many years ago, check this stuff out now. Do not expect your standard blood work to show this stuff. We are going to unpack a little bit about how you can look deeper, and you do not even have to leave your house, which is quite convenient.
Dr. Justin Marchegiani: Yes, and when we work on supporting the gut, here is the common misconception. Gut issues or gut dysfunction, meaning problems in your gut physiology, do not have to manifest as bloating, gas, or diarrhea. And do not get me wrong, they can, and that is pretty common. But you are just as likely to have what we call extraintestinal symptoms. The brain fog, the fatigue, the anxiety, the mood issues, the cognitive challenges, the low libido.
And it makes sense because the gut is the area where all of your nutrients get absorbed, utilized, and assimilated. They go on to feed the thyroid gland, they feed the mitochondria, they feed the synthesis of your hormones, including estrogen, progesterone, and your male hormones. And obviously if you are inflamed, insulin resistance and cortisol can be impacted as well, which creates further downstream problems.
The gut is also where 80% of the immune system lives. People forget that when you have weak gut function, you are going to have weakened immune function, and that increases your risk for a wide range of health issues, including getting sick more frequently and being more immunocompromised overall.
Evan Brand: It is interesting how prominent the immune health section is at Amazon or Whole Foods. It is always right in your face. Immune health, immune health, immune health. But it is really just your generic stuff like elderberry or zinc. People think the idea of immunity is just bumping up your zinc or your elderberry. When the reality is, if you improve your gut health, you should rarely get sick.
I am not saying getting sick is inherently a bad thing. Some would argue getting sick is a normal part of having a flexible immune system. But overall, after clearing parasites from my gut, after clearing bacteria, yeast, and working on mold for many years, there is a whole new level to your immune function that you did not even know existed.
A few weeks ago my kids got completely wiped out from the flu that was running around at school. My wife got hit, the kids got hit, and I did not get it. I credit putting in a decade of work on my gut that allowed me to completely bypass that issue.
Dr. Justin Marchegiani: Yes, we went to Mexico two weeks ago and my wife got hit pretty hard. Now I brought some Liposomal rescue and I focus on supporting my immune health through the respiratory channel, specifically getting my sinuses cleaned out with saline. Using a little bit of Liposomal support can be amazingly helpful because a lot of bugs and viruses enter your body through the sinus cavity. So if you can decrease that viral load and make it harder for those infections to enter through those inlets, it makes it harder to get sick.
When you look at how immune-supporting herbs work, there are three major mechanisms. Number one, they are going to upregulate your natural killer cells, your CD8 cells. Think of these like the Navy SEALs or Delta Force of your immune system. They go in fast and they handle threats quickly. Number two, they work on antibody production, improving your IgG, IgA, and IgM levels. This is more like the infantry that comes down the road, typically delayed unless you have had previous exposure. And number three, certain compounds actually work on killing the infection directly.
For example, Goldenseal works on killing microbes directly. Reishi mushroom works more on improving natural killer cell function. Berberine may work on knocking down microbial load. Monolaurin may work on disrupting the viral envelope. So there are different herbs and compounds that can either go after the infection directly, support the natural killer cell side, or increase antibody production. And having healthy gut function makes both of those immune arms more robust.
Evan Brand: And you may hear all of this and think, okay, so how do I plug this in? When, where, how, what dose? And the answer is that it is all based on your labs. Our whole philosophy is test, do not guess with your health. Sure, you could go to the immune health category and buy a lot of different things and maybe feel better. But if you do not have the data, you are really missing the boat.
Because if you have a parasitic infection, if you have H. pylori suppressing your stomach acid, if you have some level of bacterial overgrowth robbing you of your nutrients, no amount of guessing is going to fix that properly. I had a patient yesterday in South Africa. He was proud of eating from the land. They are homesteaders, they live on the farm, eating all their own meats and produce. But on paper his nutrient deficiencies were significant because he had very high levels of dysbiosis.
I told him, look, I am proud of you for your diet, but you cannot eat your way out of this. You are what you digest, not just what you eat. It goes deeper than that. So if you are listening to this and wondering where to start, step one is to get your gut looked at. Let Dr. J and I help you. We can get a GI panel done, a urine panel done, and you will have results in a couple of weeks that show you exactly what you are up against.
Dr. Justin Marchegiani: 110%. The data is essential. And when you are chronically stressed, most people are dealing with some level of inflammation and sympathetic nervous system overdrive. You have the parasympathetic, which is rest and digest, healing and recovery. Then you have the sympathetic, which is your go, go, go response. When the sympathetic is overdone, you are going to see a reduction in hydrochloric acid production, which then decreases your digestive enzymes and decreases your bile output.
The first domino to fall in digestive physiology is stomach acid. A low pH, meaning more acid, activates pepsinogen and pepsin, your proteolytic enzymes. It makes it harder for microbes to survive in your gut because the acidity knocks down microbial load. It also triggers the closure of the esophageal sphincter via the secretin pathway.
That well-acidified food, called chyme, then gets released from the stomach into the small intestine, which triggers cholecystokinin to be released. That causes the gallbladder to contract and release bile to emulsify fat. It also causes the pancreas to produce lipase to break down fat, and trypsin and chymotrypsin, which are proteolytic enzymes. The pancreas also produces bicarbonate to bring the pH back to neutral so we do not develop a peptic ulcer.
That entire physiology is critical. When it breaks down starting in the stomach, we begin to see burping, belching, gastroparesis, GERD, gastritis, and over time thinning of the gut lining. If left unaddressed, you can develop Barrett's esophagus as the acid rises and the tissue at the base of the esophagus begins to change from squamous to columnar. We have to look at all of this holistically.
Evan Brand: And it is a beautiful symphony when it works. But when you have the level of infection that we see on a daily basis, it breaks down fast. I would say 8 out of every 10 people we test, and granted we are biased because people are reaching out with health concerns, but we do have some people who come in feeling pretty good and just want to optimize. Eight out of 10 people I test, I am seeing some level of dysbiosis, bacteria, yeast, fungal issues, or parasitic issues.
Over time this disrupts the entire digestive process. So watching someone's vlog about what they eat in a day and thinking you are going to fix everything by eating like them, I promise you it is not that simple. Dr. J and I have had our diets dialed in for decades, and we still fine tune our gut health regularly.
This also shifts based on who you are around. You can pass bugs between partners. I talked yesterday with a woman in her twenties, new partner, and suddenly she had new issues, yeast problems, dysbiosis, sugar cravings, brain fog. We checked the partner and they had issues too. So we have to consider whether something transmissible was passed between them.
Even with your kids. I am convinced my oldest got H. pylori from me when she was two, just from sharing a water bottle. It can be passed that easily. So do an inventory of your whole household. If you are a family, you cannot look at yourself in a vacuum. Consider your partner, your kids, anyone else in the home, even an elderly parent who lives with you. Bugs can be transmitted throughout the entire household.
Dr. Justin Marchegiani: Absolutely. And on the topic of H. pylori transmission, I have patients gargle with 3% hydrogen peroxide twice a day. That can really knock down the microbial load in the mouth and reduce salivary transmission. You can dilute it to 1.5% if your gums or tissue are sensitive. And I also recommend soaking your toothbrush head in hydrogen peroxide for about five minutes a couple of times a week, because you can actually reinfect yourself from your own toothbrush. This is a lesser known point but it is clinically relevant. Just keep a small mason jar or shot glass with a bit of hydrogen peroxide and rotate your toothbrush heads regularly.
For further reading on oral transmission and H. pylori reinfection: pmc.ncbi.nlm.nih.gov/articles/PMC7179623
Evan Brand: Yes, that is great practical advice. I also like clove and wintergreen-based natural mouthwashes. There are some good options out there. I have also switched to a boar bristle toothbrush, so no plastic, fully natural. You will see bamboo toothbrushes but a lot of them still use polyester bristles even if the handle is bamboo. Worth looking into if you want to go fully natural there.
Now in terms of our approach to treating these gut infections, we do not prescribe antibiotics. We do not use pharmaceuticals. I have had tremendous success personally and clinically with natural botanicals. When you hear us talk about these bugs, the conventional answer is often an acid blocker, an antispasmodic, or triple antibiotic therapy for H. pylori. We have seen people go through that approach and in some cases it reduces inflammation or symptoms in the short term, but it does not fix the root issue.
We come in on the botanical side. We use herbs that have antibiotic-like mechanisms to suppress bad bugs, but they preserve the beneficial bacteria far better. They do not damage the mitochondria. They do not further reduce stomach acid. There are two sides to this. There is the conventional approach and then there is the functional approach. Long term, five to ten year outcomes are very different. Look at the research on PPIs and dementia. If you are currently on a bandaid like a PPI or considering one, let us help you find a different path, because long term the consequences are significant.
Dr. Justin Marchegiani: 110%. And retesting is important because sometimes deeper layers of infection reveal themselves as we address the surface layers. As we clean up the microbiome and get to the brush border and the deeper crypts of the intestinal lining, there can be other infections or microbes hiding there. So that is always something to keep in mind.
We also want to make sure we are getting probiotics reestablished, which create the short-chain fatty acids like butyrate that feed the colonocytes and make the gut lining healthier. And sometimes we see a patient whose labs still show some infection or mild inflammation, but their symptoms have improved 70 to 80%. That is actually very common.
You have to look at health from the big picture. Infectious load, probiotic levels, prebiotic levels, stomach acid and enzyme production, sleep, anabolic metabolism, nutrient repletion, and reducing inflammatory inputs through diet. All of these things matter together.
I have seen cases where inflammation markers rose slightly after beginning treatment, but the patient felt significantly better. The snapshot we get from labs is just one piece of a much larger puzzle. We are not capturing every interleukin, every cytokine, every immune compound. What we are doing is having broad, meaningful impact throughout the system.
And this is why we love this work. You could plug your lab results into an AI tool and it is not going to see the clinical nuance that we bring. If your labs are shifting and you are still confused, let us walk you through it. We see thousands of cases a year. If you need help, reach out to us and let us show you what is under the hood.
Evan Brand: It is so empowering to see the data. When you have symptoms but no explanation, the fear can start to build. You get a significant gut flare and end up in the ER with a $5,000 bill and they tell you they could not find anything and hand you an anti-anxiety prescription. We hear these stories all the time.
If you have even a little bit of health anxiety, if you feel like something is not right, let us take a look. You can reach out to Dr. J at justinhealth.com and to me at evanbrand.com. We help people worldwide. This should be a fun process. Healthcare should not be scary or miserable. You should leave these conversations feeling like you finally have a grip on what is going on.
Dr. Justin Marchegiani: 100%. And just to be clear for everyone listening, we are not treating disease. We are not treating conditions. We are working to support your physiology. Your body has a vitalistic drive to heal itself at all times. Our goal is to identify and address the underlying physical, chemical, and emotional stressors that are acting as barriers to that healing and recovery. Functional medicine is about supporting your body's ability to heal and upregulating your physiology. We are not diagnosing or treating conditions or diseases. I just want to make that distinction clearly.
Evan Brand: Said another way, we are removing the roadblocks to optimal health. You can see the path to where you want to be. But along the way there are spike strips, and those spike strips are the infections, the nutrient deficiencies, the amino acid imbalances, the brain chemistry issues. Those are the roadblocks. We help you clear them so you can get where you are going.
Dr. Justin Marchegiani: 100%. And if you believe you have a treatable disease, please see your medical doctor first, and then reach out to us. We are here to support the underlying physiology. Alright everyone, have an awesome day. Take care.
Evan Brand: Take care. Bye everyone.
Disclaimer: This content is for educational purposes only and does not constitute medical advice. We are not diagnosing or treating any disease or condition. Please consult your licensed healthcare provider before making any changes to your health regimen.
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