#73: Justin Marchegiani, DC- SIBO, Gut Bugs, Herbs and Leaky Gut

by Mike Mutzel




About Justin Marchegiani, DC

Dr. Justin’s Functional Medicine and Chiropractic practice is an outgrowth of the increasing need for natural healthcare solutions which is evident in the San-Francisco Bay Area, Austin Texas and beyond. Female hormone imbalances, hypothyroidism, chronic pain and fatigue are on the rise along with many other countless chronic degenerative conditions.

Contact Dr. Marchegiani



Show Notes

02:07 Dr. Marchegiani’s Journey: He wanted to be an orthopedic surgeon. During his undergrad, he worked in the surgery field for 4 years. In surgery, he would hold the limbs of diabetic patients as they were being amputated.  He decided that he wanted to get in front of the illness. During this time Dr. Marchegiani had an autoimmune thyroid condition, chronic fatigue, adrenal fatigue, and brain fog. He began to study successful early functional medicine pioneers.

03:57 Hashimoto’s: About 20% of all women will have Hashimoto’s.  It is common to receive a false negative test. He always treats as though there is an autoimmune condition, cutting out foods, providing extra nutrients, and eradicating infections that drive autoimmunity.

05:29 The Importance of Selenium: It is a precursor for glutathione. Our thyroid produces thyroid hormone via iodination, binding iodine to molecules of tyrosine. One of the byproducts is hydrogen peroxide. Selenium neutralizes the hydrogen peroxide into water and oxygen, rendering it benign. Many of us are selenium deficient.  Hydrogen peroxide stimulates our humeral immune system to start attacking.  With his autoimmune thyroid patients, Dr. Marchegiani works on the adrenals, inflammation, diet and selenium. Two hundred micrograms of selenium over 6 months will reduce thyroid antibodies 50%.  If taking iodine, be sure the take selenium. Brazil nuts contain selenium, however the amount varies. Start at 200 to 400 micrograms.  Over a gram of selenium starts to become toxic.

08:36 Helicobacter Pylori: H. pylori reside in the stomach and first parts of the small intestine. It can spread easily via saliva. Often family members are infected as well. It produces an enzyme called urease, which interacts with urea and produces ammonia and CO2. The H. pylori breath test calculates CO2 levels. Ammonia has a pH of 11. Our gut is typically a 1.5 to 2 pH.  A result can be mineral malabsorption of zinc, selenium, and magnesium which are important for thyroid function. He also sees inflammation from H. pylori.

12:15 Stomach Acid and Medications: A study found that patients with hypothyroidism who were taking proton pump inhibitors had a greater need for thyroid hormone. Proton pump inhibitors do not reverse malabsorption. They cover up the symptoms. Low stomach acid means low enzyme activity, which means low absorption, which will drive leaky gut. It also affects leptin and insulin signaling.

13:28 H. Pylori Testing: Dr. Marchegiani has his patients who present with possible H. pylori do a stool antigen test that looks for a piece of H. pylori in the stool. An IgA, IgG, IgM blood test is done. IgA and IgM measure the acute immune response. A breath test shows elevations in CO2. A PCR DNA test looking at DNA pieces of H. pylori in the stool. The BioHealth 41H’s H. pylori portion of the stool test seems to be the most accurate at detecting H. pylori and all major bugs.

17:26 Treating H. Pylori: Mastic gum and berberines like goldenseal, barberry, Chinese coptis, or Oregon grape, are effective treatments. Berberines block the efflux pumps, a mechanism where bacteria try to pump away antibiotics or antifungals. Berberines help the infection take on antimicrobial medicines faster.

20:41 Treating Infections Before Treating SIBO: You need to address infections before treatment for SIBO. Often, eradicating infections can allow the body to heal itself of SIBO.  Sometimes infections do not show up on tests because the infection may not always be shedding. Dr. Marchegiani often staggers testing for this reason.  SIBO is an overgrowth of bacteria from the colon into the small intestine.  Wormwood and Artemisia (not to be confused with artemisinin) are powerful. Be sure to work with a practitioner.

25:55 The 5 R Approach: Remove inflammatory foods with AIP (autoimmune paleo), FODMAP or paleo, or a rotation of them.  Replace the hydrochloric acid, enzymes, and bile salts. Repair could be implementing an adrenal program at the same time to balance cortisol and provide healing nutrients like L-glutamine, licorice root, slippery elm, aloe, ginger and certain probiotics and certain nutrients to help rebuild the gut lining. Remove the infections, pulling the weeds. Probiotics, perhaps soil-based, is putting down the seeds.

28:48 The Recommended Diet: The recommended diet includes healthy pastured organic meat, shellfish, and fish, but no eggs for the first month. Vegetables may be low FODMAP.  Consume fats like ghee, tallow, beef, olive oil, MCT, and coconut. The sicker people are and the more chronic, the more extreme the diet and a rotation may be necessary.  Those of us with leaky guts can quickly develop food sensitivities as specific foods consistently leak from the gut. Our immune system will attack anything that we have eaten more than a few days in a row.

30:10 Detecting Yeast: Detecting yeast in stool testing is challenging, but it may be seen in the GI Effects or BioHealth tests. D arabinitol is indicative of high levels of yeast. This is found in an organic acids test. Dr. Marchegiani looks for clinical signs like a history of jock itch, athlete’s foot, dandruff, itchy blotchy red marks, history yeast infections and antibiotic use.

31:43 Organic Acids Testing: It is a window into nutrient deviancies and into how certain body systems are functioning, like fatty acid metabolism, carbohydrate, energy production, B complex, methylation, and indirect neurotransmitter metabolism markers for serotonin and dopamine.

33:38 Bidirectional Gut Inflammation: Systemic inflammation, for example from Epstein Barr or stress, inflammation outside of the gut can cause inflammation inside the gut. Gut inflammation produces biotoxins that travel outside of our gut and affects our mood and create inflammation.

35:02 Systemic Inflammatory Microbes: For Epstein Barr, cytomegalovirus, or Lyme coinfections, Dr. Marchegiani uses tests from Medical Diagnostics Laboratories which will determine if the virus has reactivated.  Early antigen IgG or IgM is a sign of a reactivation of Epstein Barr. Epstein Barr is linked to chronic fatigue. These are treated with foundational strategies: diet, lifestyle, blood sugar stability, sleep, and removing inflammatory foods. Herbs and propolis, silver, reishi, cat’s claw, olive leaf, monolaurin can be used. The one or ones used depends upon the patient. As a resource, Dr. Nicholas Hedberg has a course called the Infection Connection at infectionconnection.net.  For IV nutrition, check out Lauren Noel, ND at drnoel.fixyournutrition.com.

39:40 Dr. Marchegiani’s Favorite Herb: Eleuthero is his favorite herb for adrenal support. It helps to boost immune function and DHEA, a precursor for many anabolic hormones. Ashwaganda is a very close second favorite. It is great for immune and stress balancing.

40:32 One Health Tip for America: Swap grains for greens, assuming healthy fats and proteins are already there.