Why Can’t I Tolerate Probiotics – Probiotic Intolerance | Podcast #293

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Today’s episode talks about Probiotics. Probiotics is a live bacteria that is good for our body, especially in our digestive system. Probiotics are called good or healthy bacteria because it helps in keeping our gut healthy. Dr. Justin, together with Evan Brand talks about probiotic intolerance, how to tolerate them and how and when to take them correctly. Check out this link to know more.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:10   Probiotics

5:59   When Probiotics Go Wrong

8:33   How Do We Tolerate Fermented Foods

26:11  Dairy Infused Probiotics

31:22  Best Time for Probiotics

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Dr. Justin Marchegiani: All right. And we are live. It's Dr. J here in the house with Evan Brand. Today we're going to be chatting about probiotic intolerances. Why can't I tolerate my probiotics? Let's dive in. Evan, how you doing, man? 

Evan Brand: Doing really well excited to dive into this topic. Probiotics are one of those. What do you call them? Maybe low hanging fruit things that will pop up on a news article or on mainstream news, or maybe a TV commercial even. So your average person compared to something like using activated charcoal and berberine and those kind of more nuanced functional medicine, medicine things. Your average Joe Schmo probably is at least heard of probiotics. And the problem with when things become mainstream, is they lose all the disclaimers and they lose all the caveats to when these things are good. So you'll hear somebody probiotic yogurt or probiotic this and it's like okay, great. Probiotics must be good for you. I'm going to go take one and then I take it and then I run down The bathroom with diarrhea and I almost crapped my pants on the way to the bathroom. I've heard that story Why? And I'm like, Okay, well let's unpack it. So that's what today's podcast is about.

Dr. Justin Marchegiani: 100% So, probiotics, right? What are they beneficial bacteria primarily in the family of lactobacillus bifida bachter, there are some other kind of pseudo probiotics like Saccharomyces boulardii, which is more of a beneficial yeast that can help potentially grow with the probiotics are beneficial bacteria and can help outcompete bad guys like fungus and yeast and other bad bacteria. We also have spore based probiotics, which are a little bit different tend to be more either soil based or spore base in the family of the bacillus family right, bacillus Clos Ei bacillus, subtlest Bacillus coagulants, like conformist, etc. And these are different types of bacteria. So typically when we talk probiotics, we're typically talking more on the befo lactobacillus species side of the fence now, anthropologically, evolutionarily, we got exposed to a lot of good bacteria urea whether it was from just the soil right, not quite cleaning our vegetables, but having some having some soil on that and you get some of the bacteria in the soil on our food. Hence the the role for soil or spore based probiotics supplementally primarily you get through fermentation with whether it's pickles or kimchi or sauerkraut or some kind of a fermented tea that we see more in modern day kombucha. These are typical ways that we get exposed to beneficial bacteria in our diets. And this is healthy, and today we've therapeutically, you know, gone one step above by dialing in probiotics from an oral pill, whether it's VSL, three, or are different higher dose bifida or lactobacillus species, different kinds, whether it's lactobacillus acidophilus or para kci or infantis or bifidobacterium, long GM, etc. all these different species that we see that have a lot of anti inflammatory effects according to the literature, they can help reduce back to infections, food poisoning, diarrhea, some cases they can help improve constipation. And again, these are things that we've seen clinically, right? When you do a study, Evan and I were talking about this pre show, you have to control a lot of variables. And let's say someone's eating, probiotics or fermented foods, but their diet stinks or their sleeps crappy as other variables in their life that could affect things. So clinically, we've seen amazing results with probiotics. It's a powerful low hanging fruit. But the question really, today is what happens when probiotics go bad? Why is that occurring? Meaning what happens when probiotics cause negative symptoms or side effects?

Evan Brand: Yep, you did a great, great job to talking about the kind of the prehistoric aspect of this because, you know, the the average skeptical person who doesn't want to buy supplements and thinks it's snake oil or whatever. They may say, Well, why why all the sudden Do we need probiotics? My grandparents didn't take probiotics and they lived till they were 96. And you answered it, you know, even if we don't go as far back as the hunter gatherer tribalism It even just great parents, you know, great grandparents. They're living off the land. Like my grandpa's grandpa had 350 acres. They were eating chicken right out of the backyard. They were in the soil all day, he had a horse to help him till the dirt. I'm sure he was getting his hands dirty all day. And he had a great long, healthy life. So today, we're removed from that you've got the conventional even in the organic industry, you've got things that are happening, like potentially the chickens being exposed to chlorine, or just even in tap water. You know, there's all sorts of different products, chemicals, drugs, pharmaceuticals in tap water. So if you're getting this conventional organically or organically raised chicken, and it's at Whole Foods, is it better than like the factory farm stuff? Yeah, but now I'm even seeing there's these organic factory farms that a lot of Whole Foods is using where they're basically just big warehouses in their organic feed, but they have nothing to do with being pastured and that reduces the nutrient density of Animals. Of course, if you go out to a restaurant and go get chicken fajitas if it's not labeled or classified as being free of antibiotics or getting a dose of antibiotics that's killing the good bacteria in your gut. So there was a guy I believe his name is Jared. I believe his last name is leech. I think it's Jared Leach, maybe Jeffrey leech. I have to look it up. But anyway, it's a guy who went to East Africa and Tanzania and was looking at the guts, his whole Microbiome Project that he's running. And he just looked at the diversity of people's gut. And he compared typical American people versus these hostile people who were basically eating zebra meat and tubers, and honey, and the diversity of the bacteria was off the charts, and these people, so so I know, this is a long story and rant and I'm rambling but the point was, we don't have diversity in our guts anymore. So probiotics are our attempt to help increase the diversity and increase the number of strains and the amount of strains of good guys that we have.

Dr. Justin Marchegiani: 100% so let's kind of dive in to the aspect of when probiotics go wrong or when and probiotics create negative symptoms. So one of the first things if we have a lot of bad bacteria in our gut, right dysbiotic bacteria, right? This could come up on a stool test, we may run a breath test and see various gases at higher levels like methane or hydrogen. These gases can disrupt motility, right, more methane gas can create constipation, more hydrogen gas can create diarrhea, sometimes there's just alternating between between the two. And when we have a higher amount of bad bacteria, like what's bad bacteria, so we could have overgrowth of E. coli or central factor or klebsiella, or Proteus, or a bunch of other ones out there, Pseudomonas Mirabilis, right, different species of bad bacteria, these critters when exposed to probiotics, because probiotics are essentially a fermentable compound, right? So they're kind of in that fodmap family, right. Fodmap stands for fermentable oligo disaccharide mono and polyols. Polyols being like xylitol, all right? So they're kind of in that fermentable aspect of fodmap. So a lot of people with SIBO or generalized dysbiosis right, generalized dysbiosis just means there's a bad bacterial overgrowth. SIBO says specifically were that bad bacterial overgrowth is ie the small intestine. When you consume these beneficial bacteria that can be a war in your tummy, where those beneficial bacteria ferment and feed some of that dysbiotic bacteria and can create more gases and those gases can then disrupt motility either create tummy aches, nausea, can throw off motility and either increase constipation or increased diarrhea.

Evan Brand: And it sounds a little bit cliche because we've said it so many times. But we talked about the order of operations with fixing the gut. And we talked about how you don't want to fertilize the garden before you pull the weeds. And that's essentially what you're saying because if we come in, let's say we have Jane Doe who comes in the door. She has gut complaints, maybe it's gas, bloating, burping, constipation, etc. And she's been on probiotics, she went to Whole Foods and bought some and she felt bad. She doesn't know why we're going to run a comprehensive stool test on her. We're going to run an organic acid urine test on her, we're going to look at it. And if we see that there's all these major overgrowth, you're talking about Pseudomonas and Morganella and Streptococcus and staff and whatever else, we're typically going to pull them off the probiotics immediately, and then we're going to come in with what probably some kind of an antimicrobial antifungal or combo.

Dr. Justin Marchegiani: 100%. Now one of the things that I see at my new patient consult and I'm dealing with patients for the first time, we're typically dealing with patients that have already making a lot of diet changes. One of the first questions I ask is, how do you tolerate fermentable foods? Like when you have kimchi or sauerkraut or some kombucha? How do you deal with it? And they either tell me they do great or they have a lot of negative symptoms. Anytime someone tells me they have negative symptoms, I automatically know there's more than one A bad bacterial overgrowth there. And it's to the point where that small amount of beneficial bacteria from the fermentation process is feeding that bad bacteria and you're getting a feeding frenzy. Right? Your child would that mean now sharks are there? 

Evan Brand: What would that mean when you say? Yes, Dr. J, I do kombucha and I feel bad. What are you expecting these people to report from that?

Dr. Justin Marchegiani: They're talking about typically some level of bloating or gas, or some type of motility issue slow or fast motility, diarrhea, constipation, and then of course, you may even get belching, bloating, those kind of things on top of it. So those are the biggies. And then when we see that happening, it's usually the bacteria is just feeding off of the fermentable carbohydrate, and is then now spitting out excess methane or hydrogen gas that's creating those symptoms. And it could even be throwing off motel throwing off digestion too, because when you're when you're really gassy, and you're really blody it's possible that there's not a lot of stomach Acid there. And that could create more stress in the intestinal tract, thus decreasing enzymes and acid production. So it's very possible that now we have poor digestion and then we eat our next meal, and maybe even harder to break down. So all those things are very possible when we have this level of bacterial overgrowth and probiotics come into the mix. So first checkmark is Hey, how do you feel when you consume fermentable foods? Do you feel neutral? Better? worse? We're yet with that the first lecture last?

Evan Brand: Let's throw in the brain to because-

Dr. Justin Marchegiani: I'm sorry, the brain fog is one of the another big one. But we could talk about why that is to the whole mechanism.

Evan Brand: Okay, yeah. But that's what I was going to mention because somebody's listening to what you just said they're going to go Okay, great. He said this, this, this and that. I don't have any of those gut symptoms. I just get so brain fog. I can't even find where I put my phone or my keys after I drink kombucha. What the heck does that mean?

Dr. Justin Marchegiani: So we're just talking about kind of the the SIBO gas kind of mechanism. The other mechanism that we may see could be coming from histamine or various biological a means that are produced from the probiotics, right? So we could have a histamine release from the probiotics, right? or biological aiming stimulation, which is then going to, you know, the common histamine side effects or symptoms come into play. This could be headaches, this could be brain fog are cognitive issues. So, yeah, that's a really good call on that, that kind of goes outside of just the the SIBO methane hydrogen kind of gas thing. That's, that's more of a histamine kind of response.

Evan Brand: Yeah, because that was me. I mean, I didn't have that many gut symptoms. I remember being down in Austin, there's like, it's like the kombucha capital down there. And we were trying a bunch of different ones. We'd go out to like a grass fed burger joint, get kombucha on tap, and I would drink it and it was like I was drunk. And I was like, Whoa, I had major cognitive issues. So I think there probably was a histamine component, but I believe that whole acetal aldehyde issue is probably part of it as well, you and I've talked about this idea of Candida overgrowth producing this a pseudo aldehyde or other toxins and it's similar to an alcohol molecule where people are basically getting drunk on their own internal alcohol production. And so that can for me, I think that can be a sign that something's going on as well.

Dr. Justin Marchegiani: Yeah, I mean, with probiotics that they can, you know, you can have a little bit of alcohol production as a byproduct of fermentation, right. That's how alcohol is made. So there's a tiny bit there. All right, that that is also possible. Number two is histamine dilates blood vessels, right? And it brings immune cells to the area. That's part of how the immune system works. Like if you go bump your elbow, it starts to swell up. Why is it swell up, that's histamine was a swelling, it's swelling, because the immune system is trying to open up blood vessels to help with the inflammation. So that's kind of like the whole idea is you don't want the immune response to go over too much. And that's why you ice it down to keep it from getting to swelling. But as a combination, you want some of that there, but when you're eating histamine and that immune reactions happening, and let's say those blood cells, those white blood cells are going into your brain Well, we know the more immune activity activity in the brain can cause more brain fog, or we know the micro glial cells in the brain, when overly activated can create brain fog. And so if you're noticing, you know, more swelling or redness, more itchiness, more cognitive issues, more headaches, that could be a big issue. Now, you could always just try consuming more da o enzyme with the hiss with the probiotics with the fermented foods. You could also look at doing oral probiotics that are lower in histamine species, like the lactobacillus para kci is one that's a higher histamine one as well. The lactobacillus Helvetica is another one lactobacillus hell guardi and thermophilus and buck Neary are going to be lactobacillus species that are higher in histamine. So there are some species that will be lower. You can also try even consuming more soil or spore based probiotics, which can be helpful too. And or just consuming some extra da Oh, while taking the probiotics. See if that neutralizes as well. So a couple little experiments you can do to see if that moves the needle in the right direction.

Evan Brand: So let's talk about the fact that when you address the gut, that your tolerance is going to improve of probiotics, right? Even if you, let's say, you come in and let's say you've got a bunch of parasites and bacterial overgrowth going on, if you come in and bring herbs in, just at the end of that protocol to eradicate or reduce those infections, you should, in theory, tolerate probiotics better Is this true?

Dr. Justin Marchegiani: So repeat that one more time, want to make sure I grabbed all that.

Evan Brand: Just knocking down the bugs alone, you're going to tolerate probiotics more.

Dr. Justin Marchegiani: So a couple things. It just depends. So patients come in, they're telling me Hey, I have problems with fermented foods. So one of the first things that we're going to do is we're going to go on a lower fodmap diet, and we're going to starve out some of these critters. So the first mechanism is we're starving. So lower fodmap kind of template, cutting out the fermentable oligo, disaccharide, mono and poly all foods that creates a starvation like effect and that can beat down the critters Without having to kill them just by cutting down their fuel source. It's kind of like yeast and sugar, right? You go lower sugar, lower carb, you can starve out some of the Candida, that the one of the first things and then we work on digesting as well because if we have a lot of bacterial overgrowth, we know low stomach acid is a common issue with bacterial overgrowth. So we work on good enzymes good acid production, we make sure that we're digesting our food well and we have good motility if we're going into the bathroom every two three days, while we're making ourselves toxic through our toxins in our in our stool. So we so there's the six hour approach that I've done for a decade here, and it goes with every patient and now what there's different aspects of each hour that we'll talk about that we can implement. So the first art is removing the bad foods. Now for some patients that could be a paleo template for some that's a paleo autoimmune low fodmap. Some it's carnivore, some it's a low salicylates low low fodmap kind of sad template. There's there's different ways and different levers that we can move within that First, remove our The second error is to replace and enzyme replace acid, maybe bile salts, maybe maybe bitters. It depends on how good or bad someone's guts guts that for that. The third hour is going to be repairing the digestive tract or in and or repairing the hormones because hormones are specially adrenal, they play a huge role in reducing inflammation, and people that have a lot of gut issues. their immune system is overstressed. They're usually inflamed, and they're also pretty tired. So getting good hormone support can decrease inflammation, help with energy up with mood. The fourth hour is going to be removing the infections when we go after things in order of operations. So there's different h pylori, there's yeast, there's parasites, there's bacterial overgrowth, there's an order of how we hit those for best success. And this is where the killing of a lot of this stuff comes into play. So the first major component that allows us to be able to potentially let's say, get exposed to fodmaps or probiotics in the future and be able to tolerate it is first Start things out. The second thing is kill things. And the third thing is going to be crowded out. And then once we've done that fourth are the remover then we use specific botanicals to help knock these herbs down or knock these critters down, which then allow us to handle probiotics, or fermentable foods is now repopulating reenact collating with probiotics. And we may choose different species depending on what you can or can't handle. So typically, I'll come in there and I'll challenge and see if our probiotic intolerance has changed. And we may add in different lactobacillus species or we may go to more spore based species or saccharomyces species or low histamine species. So I'll kind of test it in between and we'll see what works and then we retest, want to make sure that infections are gone and no new infections have come back sometimes a infection that wasn't there originally could come back like h pylori or a parasite. So you have to test it on both sides to ensure that we're knocking it out. 

Evan Brand: It does, are you going to retest before or after probiotic Like let's say you do a round of herbs, knock bugs down, then you come in probiotics, are you going to test after that? Are you going to kill test, see what the results are then maybe kill again, then do probiotics.

Dr. Justin Marchegiani: I typically retest about one month into probiotics. And the reason why I do is because probiotics can help reduce inflammation. Right. So if someone's guts inflamed, you're going to see a major improvement, inflammation wise post probiotics, or at least, you know, given enough runway for them to work, I find that a month is usually pretty darn good. And then number two, the immune system can improve with probiotics. So we can see improvements in IGA and we know probiotics can help with digestion to and I would say the third thing after that is probiotics have been shown to help improve gut permeability partly through I think inflammation partly through crowding bugs out they can help with gut permeability, hence autoimmune stuff. And so those are the big reasons why immune digestion and gut permeability significantly can improve and inflammation right now. can improve post probiotics. So I give it about a month or so that I find patients got settle? Much better.

Evan Brand: Yeah, yeah. Good call.

Dr. Justin Marchegiani: What do you notice clinically?

Evan Brand: Well, I mean, it depends because if you come in let's say you take Joe who's got all these gut symptoms, he showed up with three parasites H. pylori, he's done triple therapy. So he's already been on antibiotics, you know, his guts a mess. He's got calprotectin through the roof, we might come in and do six to eight weeks of herbs. And then I'll let him just kind of rest not even probiotics yet, depending on how he's feeling, maybe some gut soothing herbs just sprinkled in for a couple of weeks just to see how he feels when he gets off the end of microbials. And then if he's off for a week or two, then we'll kind of debate Okay, based on the progress or do we go into gut healing probiotics yet? Well, you know what, I'm still having major in consistencies with my bow some days it's loose some days it's good some days I'm really tired some days I'm really bloated. Okay, sounds like there's an issue. She's still going. So sometimes I'll come in and just go ahead and run a second round of verbs to knock bugs down, then go into either gut healing probiotics and then a retest. So it depends on the person like every answer we talked about.

Dr. Justin Marchegiani: Yeah, some people do really great with probiotics afterwards, some can get a little bit of a loose stool. So I always try to ease it in there. But I find most people are going to do much better. Can I my analogy is this right? You go to the garden you don't go throw down seeds. When there's a whole bunch of weeds in the garden you kind of get the weeds pulled up why that creates space for the seeds to grow, right? weeds will outcompete the seeds. And when the seeds start to grow any anyone that's good in lawncare will tell you once you have a really good foundation for good grass growing, the good healthy grass will actually crowd out weeds from growing. So I kind of use that philosophy cleaned it up, really get some good seeds down really work on that good healthy gut microbiome through through healthy diet and through you know, good you know, decreased consumption of sugar refined processed crap maybe add in a little bit of carbohydrate that may help feed gut bacteria very, very gently and that allows that the grass to grow which then outcompetes a lot of the bad critter so we d weed or D weed first and then throw it on the seat second, right? You go to the carwash you get the car wash. If you go to the automatic carwash, right. You go in what's the first thing that happens? It washes your car first soap it, wash it, rinse it and then it waxes it right then it puts the wax or the rain acts on afterwards. You never put the wax on a dirty car. You got to clean the car off first before you get the wax on Think of the wax as the probiotics in this nature.

Evan Brand: Yep. And we're not coming in with antibiotics ever because we don't prescribe that stuff. When when somebody comes in. I had a woman last week Unfortunately, she had double whammy, C diff and H pylori. And she had already been through the triple therapy. So the doctors gave her all sorts of very, very powerful antibiotics. She did it for months and months and months we retest her stool. She's Still has CDF she still has H. pylori. So we're coming in with now botanicals instead. And luckily the success rate is very good. And the bacteria in general haven't developed any sort of resistance to the herbs. So if you're someone listening and you're saying, Well, why is your all's method better? Well, because the antibiotics there's this antibiotic resistance phenomenon going on And the same thing is happening with fungus. Now the CDC is freaking out about Candida, believe it or not, they've got this huge bulletin about Candida. Oh my god, they antifungal drugs aren't working anymore. Well, luckily, the antifungal herbs we use still work great and far better and safer than the drugs.

Dr. Justin Marchegiani: Well problem with with the antibiotics is the antibiotics don't really address the efflux pumps that despotic or, you know, bad bacteria use so efflux pumps, essentially think of like you're in a canoe, right? And the canoes got a hole in it and you start taking on water, right. Ideally, if you're in that canoe and you don't do anything would happen. into the canal,

Evan Brand: You're going to sink.

Dr. Justin Marchegiani: Sinks, right? So think of efflux pumps has given someone a bucket and allowing them to bail that water out of the canoe. If you're bailing water out of the canoe at the same speed that it's coming in, you can stay afloat theoretically, right? Yeah, that makes sense. So think of the efflux pumps is giving that bad bacteria a bucket to bail that antibiotic back out into the intercellular space. And so essentially, these efflux pumps are like this bucket bailing the antibiotic back into the intercellular space. So some of these herbs actually have a flux pump inhibitor aspects to it. So it's like ripping away that bucket from that person on the canoe so they can't bail water. Now the canoe is doomed to sink now that bacteria is doomed to take on that antimicrobial compound and sink or be eradicated faster. Does that make sense?

Evan Brand: It does, and we've talked about that before I think. I think we talked about berberine and efflux pumps, didn't we, maybe-

Dr. Justin Marchegiani: Berberine and Artemisha have really good success together. And a lot of these herbs work very good synergistically.

Evan Brand: That's the other hard part we were talking about before we hit record on talking about studies, you know, you'll look at this one strain or this one herb isolated. But we never do that. I mean, we may use 510 15 herbs in combination, and No, that doesn't mean we're going to sell you 15 bottles. That means we have formulas that we have where we've got five to 10 herbs in one formula. So if you take one capsule, you're getting a broad spectrum of all sorts of antifungal, antimicrobial, anti parasitic together, and how in the world can you ever quantify the synergistic effects of herbs? I just don't know of a way to do it.

Dr. Justin Marchegiani: Also, the amount the potency, right, you know, very, very high levels. So we can have a therapeutic effect, like we talked about the whole Pixie dusting effect. A lot of people that sell some of these compounds online and it looks pretty looking at the back to the ingredients but you need the potency. So when we have we have our patients taking it that microbials I mean the doses Pretty strong to ensure that we're going to have a therapeutic effect.

Evan Brand: Yeah, I did a little plug before one of my podcast episodes the other day. So I'm going to just say kind of what I said in that plug, which was that you and I are working with people clinically, we're in the trenches. We're not just reading like a PubMed article than doing a podcast and trying to show that like, we're the boss. We're the experts here. We learn from the studies and papers, sure, but the most we learn is from clinically working with thousands of people and implementing things and figuring out what works and what doesn't, and then tweaking the game plan according to that. And so, when it comes to supplements and herbs and nutrients we're using, they're all top top top tier, you can only access these herbs and nutrients and even get available products to put it in a bottle if you're a practitioner. So we're not doing consumer manufacturing, contract manufacturing, or you're just grabbing random herbs in a warehouse throwing a label on it and putting it on Amazon. No, we have practitioners sort of over our heads that are helping to monitor the quality The purity, the potency, they're testing for mold and mycotoxins and heavy metals and all that. So if you ever buy anything from us, whether your client patient or not, just know that you're getting some legit good stuff.

Dr. Justin Marchegiani: Absolutely. Also a couple other components I wanted to highlight is some probiotics. They're grown in the base of dairy. So if you're getting probiotics that could have some dairy in it, whether it's the casein in the dairy, that's the protein, or whether it's lactose that could potentially create a side issue. So a lot of times the probiotics that we're using, and that we create, they're going to typically be dairy free. So if there's any dairy sensitivity issues, we can kind of pull that variable out. So my line I use one called pro bio flora, it's got 12 to 13, lactobacillus and bifidobacterium species that are that work phenomenal, very potent, and they're also going to be dairy free as well. So that's one that I've used pro bio flora, I'll put the link down below. Also a high quality, saccharomyces polarity, which does work excellent. You can have really good immune benefits and anti Candida benefits too. And then I'll also have have specific spore based probiotics. So one of the ones that I've been using for a while is megaspore. biotic, which I do, like, I think it works really, really good. I like that. And these probiotics can hang around a lot longer, they can potentially eat a lot of the growth of other bacteria so they can help some of the other good bacteria grow. Probiotics don't last forever. So like the whole idea that like I'm just I'm putting bacteria in my tummy and they're gonna be there forever. Pulling up the case you lose about a four week kind of transients cycle. That's why getting exposed to good probiotics, whether it's from supplement or from fermented foods kind of more on a regular basis is good. I always tell patients, you know, get a bottle of probiotics in your system probably every quarter. If you know as they're so good rule of thumb, even if you are not consuming even if you're consuming fermentable carbohydrates and you can tolerate them IE kombucha, kimchi, sauerkraut, get a bottle of probiotics and once a quarter or number two, if you can't tolerate any fermented foods at all, then you should be taking probiotics, you know at least one or two capsules daily. You know, in my line we're typically doing, you know, 40 to 80 billion probiotics therapeutically. If you go too much higher than that probiotics can have a cathartic like effect, they can really crowd out ecological niches of bad bacteria. So you have to be careful, I always recommend starting a little bit low. And usually people are packaging about maybe five to 20 billion per capsule or so. And then you can kind of start with, you know, one to four, maybe up to six caps a max on that and see how you do and again, when we manufacture our probiotics, you'll see on the outer label Cfu, which stands for colony forming units, and we'll say how many colony forming units are in there. When we say how many CFCs are in there, we're stating how much is there at expiration? Not at manufacturer manufacturing, there's actually far more to compensate for the loss just have he and transportation so we always overpack it. So what you see as Cfu is at expiration, and a lot of the cheaper probiotics, you see, it's the opposite. They say, what's in there at manufacturing, and what's in there and expiration ends up being far less. And that's a little trick the supplement industry puts out, it's a little bit deceiving. That's why you want to spend good money on good probiotics that are going to label it more accurately.

Evan Brand: Yeah, great point. And that's just another reason that we get five star reviews clinically, and on the podcast, too. So thanks for reviewing the podcast, but the clinical things, you know, the most important to us because at the end of the day, if we give you something and sell it to you, and we don't get the result, you're not going to be happy. You're not going to tell your friends, your family, you're not going to get them on board. So we have to perform we kind of have this performance pressure on us. And so yeah, we can't play around and I've had too many people go to Trader Joe's and I bought the probiotic at Trader Joe's and it did nothing. It's like oh my god, let's open that can of worms. It's not apples to apples.

Dr. Justin Marchegiani: Yeah. When you are facing the people that are buying the products you recommend And you need to, you need to perform therapeutically. You can't cut corners on quality and potency and purity, you just can't do it because you develop a reputation through getting people better. And it's like if I'm a painter and I'm painting your house, I'm not going to just use the cheapest paint and then in three or four years you're pissed off because you have to paint the house 10 years early, you choose the highest quality paint so you have the best result right? Same thing in the supplement industry. You can get the cheapest stuff or you can buy the more expensive stuff you can buy meat that's McDonald's quality, you can buy meat that's from the grass fed, organic farmer down the street, right so we want to choose the highest quality which probiotics are in your lineup and I know mine's the pro bio Flora I have sacro Flora I do a megaspore that I special order that I carry that one at my store. I love those. What do you use?

Evan Brand: Nice my two Well, I guess I have three bestsellers the pro bio might see same thing freeze dried Saccharomyces Boulardii, Profile my C's, It's amazing. The Pro Biosphere like these little balls with the with the delayed release technology and Oh, that's nice. And then the Probiotic Pro like professional, that's the one that's the dairy free. So that's the one with the fog in there the prebiotic fibers in the probiotic and that one is it's killer for IBS and UTI. It's hard to believe that you can put something in the gut and positively improve you t eyes, but it works like a charm for that.

Dr. Justin Marchegiani: Exactly. And now people always ask probiotics, if you do it with food or empty stomach, I kind of default to an empty stomach. Just because some of these probiotics these bacteria can be, let's just say killed with acid. Now the spore based probiotics tend to be able to be acid resistant so you can use with food. There's some beneficial effects of taking probiotics with food, though, from a digestive standpoint. So probiotics can actually help improve digestion on one side. But on the other side, though, if you're trying to have more of a repopulation recalculation effect, I recommend it empty stomach, but some people see an improvement with digestion taking fermented foods. probiotics with it. That's why some people they feel really good having their kombucha after their meal. They just feel like oh I feel really good on my digestion side that's because of the acidity and and some of the, the various acids that are in become which can really help stimulate digestive acids I think especially if it's ginger then you have some bitters in there that can stimulate more digestive juices as well. So I think that's a component but I typically default to an empty stomach. Your thoughts?

Evan Brand: Yeah, I think I agree. I mean, I think it's case by case before bed could be good too. Like if your guts really irritated and it's affecting your sleep. I've had some people with IBS where they're up in the middle of the night with cramping and such. You know, we'll do like some of my gi sooth to which is an aloe extract. We'll do that with probiotics before bed and people report Hey, I slept through the night because I was in less pain with my gut. So

Dr. Justin Marchegiani: Yeah, some patients that really have a hard time with probiotics. As we introduce them back in on an empty stomach. I'll start with a little bit with the food. Just as a as a way to start getting an egg. Sometimes they can tolerate with food, but not quite. on an empty stomach, so I'll kind of inch in that way too. So it just depends, like you said, case by case basis.

Evan Brand: Yeah, yeah, it's hard, right? We're trying to take 1000 different ways that it's happened before and distill it into one podcast to refer to it's like, well, tricky. 

Dr. Justin Marchegiani: Exactly. Anything else you want to highlight today? I mean, we've been going pretty good for a while we're on a good clip here. Anything else you want to highlight?

Evan Brand: Just one one real quick study here. That was regarding anxiety and bacteria. There's many studies out there if you just type in probiotic anxiety in PubMed, you can look at it but there was a mental health center in Shanghai. And they reviewed 21 studies that looked at 1500 people. Long story short, the probiotics versus the placebo group, the anxiety in these people was significantly reduced. So like the we know, the ram gnosis in particular is very beneficial, but there's others as well. So, depression, same thing. You You could find studies on bipolar and depression and all sorts of mood issues and DHA. You and I talked about this, but we'll say it again before we wrap up. A lot of the neurotransmitters a lot of the brain chemistry is happening first in the gut. So serotonins happening in the gut, the gut bacteria are producing toxins affecting neurotransmitters. So you've got to fix the gut to fix the brain in many, many cases with mental health. So if you're depressed, if you're anxious, if you're angry, if you're irritable, consider the gut.

Dr. Justin Marchegiani: Love it. Excellent. Excellent, excellent. Well, let's wrap it up here today was a really great chat if you guys enjoy it, put your comments down below. Let us know your experience with probiotics beneficial bacteria, let us know the good and bad and kind of what's giving you all the best results and if you guys want to dive in you can work with Evan, EvanBrand.com, you will meet Dr. J at JustinHealth.com and we are available worldwide to help patients out during this time. So feel free and reach out and we'll put probiotics linked down below so you can see the actual ones that we recommend and if you want to support us, we always appreciate it. We're trying to provide the highest quality products that we can do anything else, Evan.

Evan Brand: That's it. Have a great day. Take care. 

Dr. Justin Marchegiani: Take care y'all. Bye now.



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