Why Do You Have Diarrhea? Functional Medicine Can Help | Podcast #266

New episode is up! Today’s topic with Evan Brand is all about Diarrhea and how functional medicine can help with it. Let’s know more about trending digestive issues, the root cause and solutions. Find out more about it here.

Dr. Justin Marchegiani: And we are live. It's Dr. J here in the house with Evan Brand. Evan, what's going on man? How's your Monday going?

Evan Brand: It's going pretty good. We were looking at some trending digestive issues and apparently diarrhea is beating out constipation as a trending gut issue. It's funny because when I think about all the clients we work with, I feel like constipation is extremely common, but at least according to the internet, more people are suffering with diarrhea. And the interesting thing is, they don't know what to do besides go to the pharmacy and get some over the counter anti diarrheal medication. And those young people live on that they'll live on. Oh yeah, Imodium ad. anti diarrheal medication and just think that that's normal and just oh my just take my medication or even if you get a prescription, anti diarrhea medication, like, that's just my medicine, it's like, no, you're missing the boat

Dr. Justin Marchegiani: 100% I mean, the question becomes, well, why do we have diarrhea? What's going on? So typically diarrhea, there's a hallmark of some level of inflammation in the intestinal tract, and your body is trying to flush out whatever that inflammation is from. That inflammation can be from food, allergens, gluten, dairy, processed sugar, it can be from sugar feeding bacteria, or a yeast overgrowth, and then that yeast overgrowth can cause diarrhea or that bacterial overgrowth can cause diarrhea. We see it very frequently in hydrogen dominant SIBO. We have a lot of bacteria that are bad that are in our intestinal tract, and they're making a lot of hydrogen gases. Those hydrogen gases can accelerate motility cause things to flush out faster essentially diarrhea. So, the interesting thing is though, I see sometimes inflammation from Candida like the mycotoxins that are produced or even the methane produced from bad bacteria as well, sometimes it can slow people up so I see people go from you know, the faster you know, the the diarrhea side to the constipation side. Usually when things are more acute, usually diarrhea is tends to be what manifests when things are more chronic. A lot of times you can see more constipation, but especially when people have more inflammation in the intestinal tract, we will see more diarrhea, especially if there's any Irritable Bowel Disease, whether it's all sort of colitis or Crohn's or some kind of microscopic colitis will see it of course, and hydrogen dominant SIBO will see it. People that have very severe food allergens will see it of course, like the extreme level of gluten sensitivity, where we have celiac disease will definitely see it because there's a lot of inflammation and those microfi lie in the intestines are getting worn down. So it's really a mixed bag. I'll see it on both sides of the fence. The question is, number one, why is it there? inflammation? Where's the inflammation coming from? Now we have to become an inflammation detective. We talked earlier that mold but could potentially cause diarrhea as well. So we got to look at all vectors, not just one thing. Number two, we have to say, Well, what foods do we have to adjust so we can slow down the bowels, because if the bowels continue to move fast, well, we're going to not be able to reabsorb our electrolytes and we're not going to be able to digest and assimilate our fatty acids, amino acids in our vitamins and minerals, which create more problems like thyroid and adrenal and mood and cognitive issues. So it becomes a vicious cycle where diarrhea can spiral into all kinds of other issues, including weight loss, too. So if you have Irritable Bowel Disease and your weight loss, we have to get the diarrhea under control.

Evan Brand: Yeah, well said about the other points because I'm thinking here, your your average person is focusing just on the main symptom. It's like okay, I've got loose stools I don't know why I'm going to go take my anti diarrheal medication. And I'll just live on that. And but they're missing the fact that if you're not absorbing your nutrition, if everything's moving too fast, even if you're eating a good template, good fats, good veggies, whatever you're eating, it's not going to matter. Those amino acids will never be used to make your brain chemicals to make your hormones. So now you've got hormonal problems. So then you go on a medication for that, and then you're depressed and anxious. So you go on a medication for both of those issues. I was looking at drugs.com the other day, because I was doing some research. I'm building out this course on the gut, and I was wanting to talk about what are the best selling drugs. And the number one best selling drug right now in the world is an antipsychotic medication. And I thought, Okay, wow. And then you go down the list of number two, number three and number four drugs. And it's all related to mood and or autoimmunity, like number one drug in the world, Abilify. How many people that Taking this antipsychotic drug have gut issues that they don't even realize they're causing their mood issues and then the doctor never brings it up and they put them on this drug. And then you got number two. So let me go a little further with this drug conversation. Number two, you've got Nexium, Nexium being your conventional medication to treat GERD to create a lower stomach acid issue. So that's number two drug and then number three drug best selling drugs in the world is you've got humera which is treating ulcerative colitis, psoriatic arthritis, rheumatoid arthritis, psoriasis, and they even use it in Crohn's disease. So our guts as a society are pretty screwed. And you can just look at these drug numbers to confirm it. 100%

Dr. Justin Marchegiani: Yep, I totally agree. Now, let's just kind of go over symptoms, right. So diarrhea, we're going to see loose and watery stools. We're going to see a cramping we made blood in the stool. So if we're having diarrhea and we have Irritable Bowel Disease where there's Crohn's or ulcerative colitis or we have hemorrhoids or anal fissure, or maybe even alterations in the stomach from H. pylori we may see blood in the stool may see mucus in the stool and the mucus is going to be from the inflammation in the intestines. Of course, it made him realize, you-

Evan Brand: Yeah, you could be you could always have hemorrhoids two gentlemen, I mentioned that

Dr. Justin Marchegiani: I mentioned hemorrhoids anal fissure. Yep. all sort of colitis, Crohn's, also, ulcers from H. pylori in the stomach. Yep. All those things are potentially concerning. And again, the big concern with diarrhea is going to be dehydration and the mineral loss. This is how people die from diarrhea and third world countries where there's, you know, really poor sanitation, they get sick, they get an infection, and they just lose all their electrolytes. They go into heart failure because they're just losing all their electrolytes. Now, in the US, not a big deal. We just get an IV in the meantime, which will prevent anything really bad from happening or people We'll do something like Pedialyte, which we can do natural forms of electrolytes, but we have to fix the diarrhea. So there's things like the BRAT diet which can be helpful which is banana, rice, apples toast and our line we don't like the, the toast because it's gluten and that can potentially create more issues. Or we don't like the rice either because a lot of times gluten sensitivity that can be a problem, but the bananas or apples sauce or kind of an intro gaps or cooking food up really well. making it easy on the intestines can be great. We may even throw some activated charcoal to bind up whatever those irritants are as long as we get to the root cause of the irritants meaning if it's food, we fix that. If it's an infection, you may not be able to fix it right away. But we'll at least get to that. If there's a bacterial issue. We may look at adding calming nutrients, or specific gut bacteria, probiotics to kind of calm things and chill things down which can really help with a lot of that increased intestinal motility and that hypersensitivity. So the bifida and lactobacillus species that want to studies proven on those to be very helpful at decreasing a lot of the bad bacteria and calming down that hyper motility in the intestinal tract.

Evan Brand: We like aloe too will use some aloe extracts. A lot of people will just go to a local grocery store and buy like aloe juice, but a lot of times those have added sugar and added sugars can create a problem with your gut. But when we say aloe we're talking. I don't want to use the term pharmaceutical grade because pharmaceuticals are garbage. They have a lot of binders and corn and gluten and others Yeah, so let's just say professional grade will use professional grade aloe clinically and this is going to be typically extract meaning you may take 200 pounds of aloe converted to one pound of extract and then you encapsulate that. And we've seen crazy things on lab results. I remember one girl who had blood the stool, we got her stool test back and she had a calprotectin level of over 1000 which is just absolutely astronomically high inflammation in the gut. And I was like okay, well We've got some answers the worst infections present. But in the meantime, we just wanted to hurry up and get inflammation down while working on the bugs. And so we did some aloe extract. And then after six weeks we did a retest, because the inflammation was so scary high we've retested sooner than average. And then we had already got it down to below 100. So aloe is just super, super amazing for these gut issues. Even if you don't know what's going on. It can be a good band aid and I would say far better than the conventional band aids of like Imodium AD and those kind of things.

Dr. Justin Marchegiani: Absolutely yet 100% and we always want to look at, you know what the root causes. All right, that's really really, really important. And so the food stuffs very important. The inflammation stuff very important. The bacteria good bacteria is helpful. Why? Well clinically, when we add in certain high dose Lactobacillus bifidobacterium bifidobacteria species, the research shows that that can actually help decrease Clostridium decrease ecola decrease salmonella or Shigella, or Pseudomonas, and a lot of those bacteria can drive a lot of the diarrhea to begin with, especially things like Shigella or ecoli could easily be from food poisoning, right? And that we know a lot of these good bacteria can also be anti inflammatory. So if our intestines are really inflamed, they can really modulating, calm down that inflammation, maybe decrease that immune response or decrease the calprotectin, which is a result of the inflammation in the gut, which is helpful. And so that's really, really awesome. Now, fecal transplants had been used. I've seen it just the question is, where are you getting the fecal transplants from? Do does the other person have an infection that you may be adding into your intestinal tract? I've seen people get better from fecal transplants and also some get very, very sick. So it all depends upon who the donor is how that spun out how it's cleaned up, and all that stuff matters. You know, if you're just doing it for a random friend, and then you're not having them tested, you don't know where they're at you they may be giving you an infection.

Evan Brand: I don't Think it's necessary. You think you and I've talked about this before. I'm pretty sure I grew up better on a podcast, but maybe not. But there have been cases of people that have significant personality changes after they get a fecal transplant. Like there was a story of a woman who all of a sudden after her fecal transplant, it cured her c diff. But then all the sudden, she had very, very strong cravings for French fries. And then all of a sudden, she started to just want to listen to nothing but jazz music. It sounds like I'm making this up, but I promise I'm not and then she found out it was an older guy and African American donor. And he love french fries and jazz music. And this lady wanted to listen to jazz music and eat french fries. Just weird, weird. personality changes. If you just do research on like, you know, personality or mood shift fecal transplant, you know, you'll have people that will start to get fat, because there's a belief that some of these I guess you would just say we'll just call them communication pathways inside of these microbes could change it to where a fat person could get skinny and a skinny person could get fat by transplanting someone else's fecal matter.

Dr. Justin Marchegiani: So I think there's a second brain there's the second brain, right? The enteric nervous system, which is a the same amount of neurons that are in your spinal cord and your central nervous system, the brain and spinal cord, same amount of neurons are in your guts in that enteric nervous system. So there's a reason why, you know, Michael gursha gastroenterologist at Columbia, wrote the book, the second brain so it makes sense that the microbes in your gut may play a role in your nervous system and change different things about you for sure. That's why the more we reduce inflammation naturally, the healthier you're going to be, the healthier you're going to be able to think your nervous system perceives threat it takes input in, it allows your body to now create output. So the better we have that input to output, with our nervous system being cleaner, the better we're going to be able to respond and adapt different situations and especially when it comes to the intestines. Well that's where we absorb all nutrition in our in our in our body needs these nutrients to run metabolically. So it's vitally important. So I think we hit a lot of the core stuff so well food allergens are going to be a big one gluten refined sugar or junky omega six fatty acids from refined processed vegetable oils are not going to be the best. Of course, casein and dairy can be an issue. Some people can tolerate butter though, which is pretty low casein low lactose. ghee may be a better option, or even none if you're really autoimmune sensitive. Nuts and seeds may be fine people on a paleo template but we may need to cut those out. Right, you know least that initially if we have a lot of diarrhea, maybe nightshades as well because of the alpha solonian component there. And we may need to really cut out a lot of the fiber or at least decrease a lot of the fiber by cooking, whether it's cutting down the fermentable carbohydrates, the fodmaps because that may be driving up a lot of the hydrogen gases going more low fodmap carbohydrate It could also be cooking those before Who's a lot better steaming them saute and I'm using an Instant pot. Definitely peeling them. mashing them really helps. Because if our guts more inflamed, we're giving more harder to digest carbohydrates in there, that could be an issue.

Evan Brand: Artificial sweeteners, let's throw those into because we've had some people where their diets dialed in, but somehow, artificial sweeteners have crept into their life in the form of like chewing gum, or even meant, you know, like breath fresheners. A lot of times people just think, Oh, this is like my favorite gum and they don't even pay attention to the label. You've got sort of a tall, you've got mandatory, you've got aspartame, of course, some of these sweeteners can cause gut issues and so very, very, very easy, but some people just don't think about it. You're like have 100% organic diet and here you are eating Trident, which is loaded with just garbage sweeteners.

Dr. Justin Marchegiani: We also know that things like I think it's Splenda. That's like the glucose molecule with three molecules of chloride attached to it. We know those have an effect on the gut bacteria, right. And we know if we negatively impact the gut bacteria we can see an increase in motility or we could see a decrease. So if you're on artificial sweeteners, that's going to be one of the first things like taking that Splenda. ilanics going to be really important

Evan Brand: to the infections. I mean, because this is, I think, where most of the stuff happens, you covered the low hanging fruit, like potentially low fodmap, more autoimmune approach, cooking things getting away from your raw vegetables. I haven't eaten a salad and I don't know how long I just don't feel very good with leafy greens. It doesn't tear my gut up like it used to. But there was a point where if I would eat leafy greens, it would just trigger boom, trigger might have you saute

Dr. Justin Marchegiani: it though, or break it down and some fat or cook it up. How do you do? Do you better with it? I do. Perfect. Yeah, so cooking. It's really helpful. People. It's important people to remember that cooking is pre digestion, right? You know, a lot of people in the vegan rock community they're like, Oh, well if you cook it, you're destroying the nutrition not really because a lot of times the accessibility to The nutrients is decreased with all that fiber. Now, if you can tolerate a salad here, they're great. But if you can't, you know, we know that steaming at least steaming those foods is actually going to increase a lot of the bioavailability. If you go look on like, you know the thing, it's my food data.com that the food pyramid people, the government, they have data on raw broccoli versus steamed broccoli and steamed broccoli actually has more nutrients because we're making it more bioavailable, because we're decreasing some of that fiber, making it easier to handle and digest and break down. Now you also add some fat on there, too, right? We know there's studies looking at Olive oil on top of your salad that you actually increase the bioavailability of the nutrients in the salad when you add fat because that fat helps kind of pull in those fat soluble nutrients better. And so having fat on your steamed veggies actually is very helpful for the absorption.

Evan Brand: Yeah, it's and who I mean, honestly, who likes to sit down at the table and just eat raw broccoli. I mean, it just doesn't even It's not even appetizing. I think from just an intuitive eating standpoint, you would know steamed broccoli with some good butter and some pink salt on top is definitely more palatable and there's more nutrition in there so of course it's going to be more palatable.

Dr. Justin Marchegiani: exactly I had a conversation with Jimmy Moore a few years back he's like I just look at my vegetables as a vesicle to get extra fat in my body. I'm like yeah, that's it. That's a good way to look at it. Absolutely. All right. Most kids hate best most kids hate vegetables man because they were just brought up with one either having them vegetables cooked to death, or there wasn't a good you know bit of sea salt or or high quality fat on there. So you want your kids to get vegetables just kind of start off with things that are maybe some green beans, put some butter on there some sea salt start with something like that. Get the salt good quality salt with full spectrum minerals like ribbons or Himalayan pink salt, and then add some good quality fats and if your kids sensitive you can go to ghee and if they're still sensitive after that, you can go to coconut oil or some kind of beef tallow that works great.

Evan Brand: Yep. All right. Let's get into the bugs though because I think this is like once you get Beyond Diet once you get rid of the artificial sweeteners once you get rid of antibiotics once you get rid of all drugs damaging your gut, you know yeah, we could do a whole hour on medication side effects and diarrhea being a side effect of some type of pharmaceutical but let's focus on the bugs. You mentioned H. pylori earlier. This is huge. Can you talk about the mechanism? Why would H. pylori I set this cascade to end up causing diarrhea?

Dr. Justin Marchegiani: Yeah, I've seen that cause diarrhea and constipation but number one, it's creates inflammation we know especially if we have extra virulence factors like [inaudible]. There's different virulence factors which are a sign of cytotoxic proteins are being produced by the H. pylori means more inflammation, more chance of gut inflammation, you know, clinically, a stomach cancer, those kind of things, but we see lots of H. pylori, they're not going to develop into that per se, but we just know with those virulence factors there there's more inflammation. We know H. pylori will also mess up the digestive cascade will decrease stomach acid, it will decrease stomach acid in the gut making your gut more alkaline making it harder to break down protein, making it harder to get the acid going to kind of start that Domino cascade for good digestion. So, without enough stomach acid, it's harder to ionize minerals, it's hard to get our bile being produced in our pancreas being produced because hydrochloric acid and acids are that kind of the first domino to get our digestion rolling. So that can make a big impact on breaking down fats, ionising minerals. And then of course, we need minerals to make more hydrochloric acid, we need our sodium chloride or zinc. We need those minerals to make more acid so then it's like a vicious cycle because then you don't have the minerals to make the acids and then then you have less acid as a result. And then you're more stressed than the more your sympathetic nervous systems on fight or flight, the harder it is to produce our digestive juices so then the problem gets worse and worse over time. That's the issue.

Evan Brand: Well, let's, that's all well said. Let's add this on top of The next two is when you have the low HCL. Now you're not actually going to be killing off the things you're getting exposed to. So let's say you were infection free before. Now you're sexually active with a partner or even just kissing, sharing cups sharing spoons. I mean, it's quite easy to pass H. pylori between each other. This is why Justin and I often end up working with the entire family because, you know, the husband may pass it to the wife and the wife shares the cup with the kids or feeds her the spoon and then the kid gets the H. pylori. But now, when you get exposed to viruses, you get exposed to bacteria, different parasites, other infections can be piled on. So H. pylori just basically reduced your defensive shields so to speak. Now your shields are down and these bacteria and parasites that normally would get killed off in a low pH, super acidic environment. Now the stomach is, let's say closer to a four in pH. It's headed towards more alkaline. Now all of a sudden, these pathogens are like hey, look at this guy. Got perfect place to live not enough acid to kill me, I'm going to stay right here. And then those infections start feeding on the undigested food and the food was digested because of the H. pylori, reducing the digestive fire. So then you see how throwing the infection piece on top of it, you really really spin out of control. And that's what led to me losing 25 pounds. And it took me a while to recover from that.

Dr. Justin Marchegiani: Exactly. So we kind of have to have like a working philosophy and how to deal with the diarrhea. So we gotta look at the food. First, we got to look at the nervous system because if we're perceiving lots of stress, that can have a big impact. So we have to, you know, eat in a more environment that's going to favor parasympathetic nervous system output. We can meditate before a meal hypnosis we can do things to kind of relax our nervous system EFT tapping, we can listen to some by neural beats, things are just kind of relax. our nervous system is going to be really helpful. Of course taking you know following my six hours, taking the Getting the bad foods out the foods that we're eating, we're going to work on cooking them better, we're going to add an enzymes we're going to add in acids. If our stools are floating right, we may add in bile salts to help with the breakdown on the fats. We may if we have a lot of diarrhea, we may want to give some activated charcoal away from food to kind of slow down the motility and to kind of calm things down. We may want to give some natural ginger or some aloe or some slippery elm or some l glutamine. depending on what's happening, how bad things are, we may want to do an elemental diet, we may even want to look at fasting if foods really driving the issue. Fasting may be a beneficial kind of modality, we may not want to play and one last thing we may want to add in probiotics sooner instead of maybe that fifth, we may want to add it sooner and put it in with a third or because probiotics can help with the inflammation and and kind of calming down the gut. So this is really important because there's a lot of art in here and it's not like a set protocol. So this is where bringing it clinicians very important. If the low hanging fruits not really working well, this is where reaching out to myself or Evan maybe really important if you're already having a hard time or you're not the typical case.

Evan Brand: Yeah, so I just wanted to play devil's advocate for a minute and be the person who's saying, Oh my god, are you serious? You're telling me I have to meditate. I have to, you know, calm my nervous system down before I eat, like, do you know how busy I am? And that's just ridiculous. Why should I have to meditate? Well think about so so that's the devil, the devil's advocate. And then I'm going to answer my own devil's advocate, which is, yeah, of course you need to meditate or do something to calm the nervous system because think about the last time you were out camping. Hopefully, everyone listening has been camping before you're out sitting in the woods by a campfire. You've got your friends and family with you. All you hear is the sound of the birds and maybe if you're by a creek, you hear the sound of a creek, it's relaxing. It's calming. Hopefully people aren't just playing on their phones in the woods. You're sitting there, you're by the fire you're cooking. That is a very, very parasympathetic inducing, setting, right? You're calming the nervous system. And that would have been the everyday life of our ancestors. It wouldn't have been some special outing where you could throw the sleeping bag in the trunk and you head out to the campground No, that would have just been daily life just sitting by the fire talking, socializing, eating. Now, instead of the socializing at the at the lunch table, you know, if you're an employee, you might just be sitting by yourself in some lunch room and you're like scrolling on your phone, I call it the scrolling bowl. Like if my wife ever and I go to Chipotle, we call it we say, Oh, we got a scroll and bowler. This is your person who they have their bowl of meat and rice and they're just you know, force feeding them while they're scrolling on their phone. It's like that is the worst habit ever. Here you are looking at I don't know bad emails or social media or somebody else's new car, new house, and you're expecting to tell your nervous system. Hey, it's time to digest. It just doesn't work.

Dr. Justin Marchegiani: Yeah, try it. Find some music or maybe say meditation or prayer, whatever you got to do to kind of relax your brain, maybe it's listening to our podcast, you know, we can, we can kind of induce some parasympathetic nervous system response with some of our, our conversation, whatever that takes to kind of get you in that place. That's awesome. Getting some digestive enzymes and acids or bile could be really helpful. And just kind of starting off like that. Just make sure you're not eating while you're in the car. And you're not eating really fast in between meetings, try to really make sure you have that time scheduled. So when someone's like, Oh, well, can I speak to this time when I got a meeting, right? Because if you're not going to sacrifice that time off, you're off your meal, you know, that's really important that we create that good environment.

Evan Brand: Can we talk about other infections so H. pylori is huge, we talked about how that can lead to other infections because it's reducing the digestive fire. Now all these parasites can thrive. So let's go into parasites a little bit diarrhea because I suffered tremendously with Cryptosporidium, which is a waterborne parasite. The CDC actually did a big news article this summer about oh my god. Watch out for the swimming pools crypto is there. And then of course GRT as the other common waterborne parasite, and those both will just wreck you in terms of diarrhea.

Dr. Justin Marchegiani: Yeah. So the more stress we are, the more our immune system or the more like our defense system, right? Think of it as that immune mucosal barrier like the old Star Trek episodes, they put the force fields up and then the laser beams would bounce off of it, right. Think of IGA is that protective barrier that's going to bounce back the parasites and the infectious critters right. And then things like Campylobacter, our food poisoning kind of bacteria Campylobacter Shigella E. coli, salmonella, these things kid create diarrhea, especially acutely could last long term. infections like you mentioned H. pylori, which soon as we start decreasing our stomach acid and the more we increase our sympathetic nervous system response, our adrenal is going to overdrive, the more chance that things that expose that are exposed in our in our body, whether it's food or water, whatever that They could gain a foothold, whether it's crypto or blasto, or Jiajia, or enemy the histological or a D fragilis, whatever or worms, right, whatever that infection is could gain a foothold and could start creating inflammation. And then it's that downward cycle because the more inflammation the more the digestion gets poor, the more the digestion gets poor, the more the nutrients are harder to digest, the more the nutrients become depleted, the more our stress handling system gets depleted, the more stress and then it just keeps on feeding. It's a positive feedback loop of destruction.

Evan Brand: Well, let's point this out. Diarrhea could be good if you got exposed to some type of pathogen actually body's trying to get rid of it but the problem is, I don't really find many cases I don't know if it's just due to people being on technology and the nervous systems are so wreck like you mentioned, it's it's it's everything right? It's always a question of why is this happening? But I don't really find many cases where someone says hey, I went to such and such restaurant and got sick and immediately got over it. A lot of times these issues are becoming chronic now is it? Now? Are there people getting acute diarrhea? And then they just don't reach out to us clinically? And they're fine. Yeah, maybe so but a lot of times we're seeing people that they went to this trip or this country or wherever, and then they've stayed sick. And then the question becomes, well, why? And I think it's all of it. It's the stress. It's the nervous system piece. It's pesticides, herbicides damaging the good bacteria. So now there's not as much reserve of good bacteria. There's the What about if the person doesn't have a gallbladder and now they don't have as much of that concentrated bile to digest fat. So they're just always in a state of malabsorption. What about if they got the repinned Excel, you know, there's some talk now of the appendix being a reservoir for beneficial bacteria and the diarrhea that the appendix can go boom and release the stored beneficial microbes to help calm it down and You got so many people that have had their appendix removed already. So I think it's just, it's five or six big factors that are causing people to not just have these acute episodes anymore. It's becoming chronic

Dr. Justin Marchegiani: 100% yet 100% is a lot of variables along with it. So I think it's really important. Anything else you want to address regarding food or diet or lifestyle or anything else something that was

Evan Brand: and I microbials can be key, you may have to do it in reverse order. You talked about glutamine and slippery elm and marshmallow and we hit a lot of the calming herbs and, and this is you mentioned, it's an art and this is kind of where that art can come into play. Because depending on the case, we may have to do some of those calming, soothing herbs just in the beginning to get things calm enough to where we can even proceed with doing antimicrobials like your berberine which has been shown to be very, very helpful in these IBS type situations. You could kind of call it CFO, CFO, IBS diarrhea. I mean, it's all in the same mess of a gut problem.

Dr. Justin Marchegiani: Yep, exactly. So there's different herbs that we use, we have different lines of products berberine, or golden seal, or high dose oil of oregano or clove or artemia, or most of pudica, various herbs, obviously, binders at higher doses could be helpful. And then, of course, probiotics, whether it's bifida or lactobacillus, or Saccharomyces boulardii, or various spore biotics, there's different ones that we may use depending on what's going on. So lots of different things we have to line up. So get the food right, get the digestion, right, kind of get the gut more stable. If it's not stable, then we may have to reach out to someone to kind of get those next steps lined up. And if it's not going away after a few days, we definitely have to get some testing to look at what kind of infection could be hanging out.

Evan Brand: Yep, so stool and urine are going to be the most common that we're going to look at blood testing I mean could sometimes play a role in this if we're trying to look at like HSC RP like systemic inflammation, markers, things like that. liver enzymes if we think something's not right from a detox perspective, but yet stool and urine are probably top one and top two things we're going to run on, you know, just to be clear, these are going to be far above the standard of care. This is not just like your stool sample from your doctor's office, those are typically outdated. There's a lot of false negatives, the reference ranges are not good. So we're doing much, much more advanced testing. And once we get the data, then we know what to do. Because Could you just go and take aloe and probiotics and you're fine, maybe, can you just go straight to oregano and try to kill whatever you think you picked up? Maybe. But there's a lot of tools out there. And you're great at analogy, so I'll try to mimic your skill had analogies. You're not just going to go out into the garage to start some type of project on your car and just grab a random wrench and think okay, this wrench may be the one to take these lug nuts off the wheels. It could be this one over here. It could be that tool over there, but I'm just going to grab This one and see if it works. That's the same thing as going and trying to pick whether you're going to do aloe or oregano or probiotics or enzymes or charcoal. It's like there's so many things out there, but you shouldn't just grab for one and hope it sticks. You really want to have a plan? And how do you get that plan as you get the data? And that's either clinical information, laboratory information or both.

Dr. Justin Marchegiani: Yep. 100% I totally agree. You want to look at what needs to be addressed? And then use the appropriate tool, right versus grab the tool and see what you can do with it right? Is the tail wagging the dog or is the dog wagging the tail right caused an effect not affecting costs. Mm hmm. And that's very important. Alright, so anyone that's diving in deep if you're appreciating this content, put our comments down below, give us the thumbs up, make sure you subscribe and hit that bell button. So we get you get notifications of our great content coming your way. And if anyone wants to dive in deeper and reach out to Evan, EvanBrand.com and well as Justin, myself, Dr. J, JustInHealth.com. They'll be a little schedule link. You can click that Down below, and some of the lab tests that we're talking about or like the GI map, or the organics or a Siebel breath tests, these are some of the common tools that we'll look at, and feel free. And we'll put those links down below if you want to dive in deeper with them, but it's really important. You want to get this information and then be able to apply it clinically. So you may order these things and it may not make sense to you. So that's where the clinical experience comes in next step. Anything else you want to say here at Evan?

Evan Brand: I just forgot to mention viruses. Maybe we'll do a whole another hour one day on just viruses but you know, your virus is a big one. Yeah, a dino virus, you've got the rodent virus. I mean, there's there's a lot of stuff that can trigger these things. So once again, that's something you can look at, we actually can identify certain viruses on the stool, which is really cool to see because if you catch somebody in an acute episode, you can look and say, boom, here's the virus, we think that's triggering it. And even if there's not a change in protocol, it's great to be able to prove it.

Dr. Justin Marchegiani: Yeah, it's cool and some of the antiviral things will do is hide those mana Lauren or Hydros olive leaf either We're giving some binders to kind of soak things up can also be helpful. hope everyone enjoyed today and if you did, click below to get more Intel and Evan great chatting with you, man. You have a great day you take care. Hey, we'll talk soon. Take care right.

Evan Brand: Bye bye.

References:

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Audio Podcast:  

http://justinhealth.libsyn.com/why-do-you-have-diarrhea-functional-medicine-can-help-podcast-266

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