#278 Dr. Justin and Evan on Clostridia, ADHD, and Dopamine Toxicity

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Dr. Justin Marchegiani and Evan Brand discuss the link between Clostridium difficile and Leaky Gut. Clostridium difficile is a bacteria found almost everywhere and can cause symptoms like diarrhea, fever, and abdominal pain.

Listen as the two functional medicine experts share their thoughts on how this bacteria can affect your health and what you can do about it. 

In this episode, we cover:

01:50   Biggest Risk Factor of CDI: Accumulative Antibiotic Exposure

05:32   Mood Issues Equals Gut Issues

07:47   The 6R Protocol

15:23   Fecal Transplant is an Experimental and a Palliative Therapy

21:10   Top Symptoms of Clostridium difficile

Dr. Justin Marchegiani: Hey, guys. It’s Dr. Justin Marchegiani here with Evan Brand. Evan, how are we doing today, man? Happy Monday.

Evan Brand: Happy Monday to you, the best day of the week. Uh– We’ve got a short limited time but we wanted to dive in and chat about gut infections and how this can affect mental health. We test everyone’s gut. We run a stool test on everyone, organic acids testing on everyone, or nearly everyone as much as possible, because there’s a lot of different markers that conventional doctors are never going to test. Therefore, you’re never gonna know what’s going on unless you can get these specific functional medicine testing run. And, one thing that we see a lot of is Clostridia. And- So, you and I we’re reviewing a little bit of the literature before we jumped on here, that the Clostridia bacteria, oftentimes people are gonna know about C. diff. You’ll hear about Clostridium difficile or C. diff. very commonly spread in like nursing homes and hospitals. A lot of times, it’s causing diarrhea. And there’s actually people dying of this because it’s actually become antibiotic-resistant. So, if you get Con– if you get a conventional doctor to diagnose and treat you for C. diff., it’s gonna be antibiotics. But the problem is, these antibiotics are working very very minimally. You know, they’re working– I don’t have the statistics but it’s not often that– that they work. And then, they come in a second, or a third, or a fourth round of antibiotic, and they still can’t get rid of it. And the things that we use, whether it’s Silver or Oregano, or garlic, or berberines, and barberries and berberries– there’s so many different natural antibiotics out there that we can use, and people don’t talk about this. So, that’s why we’re here to talk about it.

Dr. Justin Marchegiani: In one of the biggest things that predisposes people for C. diff., Clostridium difficile, is antibiotic exposure. I mean, I have one uh– journal article, basically talking about the cumulative antibiotic exposure is the biggest risk factor for Clostridium difficile infection, CDI. So, again, we know antibiotics are used kind of like candy in the conventional medical community. So, you know, the big thing that we’re trying to do is like, (1) let’s always try to do natural herbal botanicals first because, number one, they have a lot of antioxidants to them. Number two, they tend to have effects that inhibit the reflux, or the efflux pumps. And these efflux pumps are– Imagine a canoe with a hole in it and imagine you’re sitting in the canoe. You’re bailing out water, right? As water comes in to the hole, you’re bailing out water back out into the ocean. That’s kind of what efflux pumps do. The hole in the canoe is the antimicrobial or the antibiotics coming in, and then, the efflux pumps are bailing that water out. So, the benefit that we have with the efflux pumps, or the benefit that we have with the natural antimicrobials is we don’t have that– that pail, bailing out the water. We don’t have the critters bailing up the water, so it can take on water faster and we can essentially s– uh– sink the canoe so to speak.

Evan Brand: That’s crazy. Well, let’s chat about the brain a bit. So, there’s a lot of complicated uh– neurochemistry involved and we’ll keep it as simple as possible. If you just Google for yourself, Clostridia brain chemistry or Clostridia HPHPA, this is something that you can find– this picture. And what happens is normally, your neurotransmitters, like Tyrosine, are supposed to get converted into Dopa then into Dopamine. But what happens is, when we pull up your stool test and your organic acids, if we see that you’ve got elevated HPHPA– That’s organic acid that will show high on an OAT Test, a urine test. If you have this bacterial infection, what happens is, your Tyrosine doesn’t get converted into the Dopamine like it’s supposed to because there’s an enzyme. And Justin, maybe you can clear this up too, if I’m– if I’m interpreting this wrong. But these Clostridia species, they create an enzyme, and it’s called Dopamine beta-hydroxylase that causes the Dopamine not to break down properly. So then, all the sudden, you‘ve got aggression and rage and irritability and Schizophrenia and Autism, and all these other things that show up, because this enzyme is cranked up due to the bacterial infec– due to the bacterial infection. Then, you have excess Dopamine. Then, you go crazy. Is that how you interpret that whole cycle?

Dr. Justin Marchegiani: Well, yeah. I mean, if you look at the– uhm– the cycle right– So, we have Phenylalanine, which comes from Tyrosine, and then Phenylalanine can go down into these various Clostridium difficile metabolites. And then, from thee, that Dopamine hydrox– Dopamine beta-hydroxylase enzyme helps convert it downstream. And then, from there, it can also go into Norepinephrine, as well. So again, that’s important because any type of gut [inaudible] affect enzymes in the body, which can affect neurotransmitter conversion. But, number two, Clostridium difficile also causes a lot of digestive issues, especially Diarrhea. So, we know that if there’s Diarrhea happening, that is a good chance that we’re not gonna be able to break down, assimilate, utilize and absorb a lot of the nutrients that we’re taking in our uh– body through our diet and supplementation. So, that may also create more issues, ‘cause then we have less building blocks. So, I definitely see being a two-way street, some of these enzymes may affect optimal conversion of Dopamine in the brain. Remember, Dopamine can’t cross the blood-brain barrier, right? A lot of these amino acids do. And then, these amino acids get converted locally in the brain. And then, we also have the absorption component as well, which is really important.

Evan Brand: Yep. So, if you’ve got mood issues, a lot of times, you’re gonna have gut issues at the same time. When I had parasites, I had H.pylori, I had bacterial overgrowth. I didn’t have C. diff., luckily, but I had other species. My moods were– were not good. And even though, I’d done the Paleo diet for a long time, 80 percent of symptoms were better, but I didn’t get that final 20 percent symptom improvement until I fixed the gut. And Clostridia’s just one one of those things that show up. You mentioned other bacterial overgrowth. A lot of times, we’re not gonna see Clostridium in vacuum. We may see Candida, we may see mold, we may see fungus or fungal toxins, we may see parasites, we may see H. pylori, which is another type of bacterial infection that suppresses stomach acid. And this thing can get out of control. So, if you do have gut symptoms or you do have mood symptoms, whether it’s like aggression, irritability– you feel like your fuse is shorter than it should be, of course, there’s a factor in adrenals. There’s a– a liver component to this. There’s a thyroid component. We could probably chat about. But really, the– the take home messages, you’ve got to get tested for this. And uh– I’ve seen a lot of false negatives too– and maybe you can speak on this. That a conventional testing that is not as sensitive as what we’re using can miss these infections. Can you speak on that?

Dr. Justin Marchegiani: Well, again, the GI Map Testing that we use, we also look at C. diff., the toxin A and the toxin B. These are various toxins produced by these critters, and if you have both of them, A and B, the– You know, that’s gonna be– means you have uh–   a more virulent infection. You need to get treatment A.S.A.P. for that. But you may just have one toxin over the other, A versus B, or B versus A. So, that can give us a pretty good window what’s happening. And, you know, we have the Clostridium difficile species or other species of Clostridium as well. So, on these tests, we’ll see other species that are there but we really want to look for the various toxins that are present as well, ‘cause that’s gonna really cost a lot of the issues. And in conventional medicine, they’re typically using like Vancomycin to treat it. In the natural medicine world, you know, we can use berberines. We can use antimicrobial botanicals, right? There’s also specific probiotics we can use, like Saccharomyces boulardii and specific Lactobacillus species, like the Lactobacillus rhamnosus species. Now, in the the probiotics that we use, like in my Probio Flora, right. We have the rhamnosus in the Lactobacillus all in there together. And we’ll, typically, also hit it with very high dose Saccharomyces boulardii as well. But even before that, Even before we get to step five in that Six R protocol. First R, remove bad foods. Second R, replace enzymes, acids. Third R is gonna be repair the gut lining and the hormones. Fourth R’s removing the infection. So, we work on the fourth R, using a lot of the herbal botanicals to help remove the infection. Fifth R, we work on repopulation. So, again, we hit it in a lot of different steps to make sure we can knock it out fully. We don’t just rely on one antibiotic, because we do know that one of the biggest riks– risk factors for Clostridium difficile infection is cumulative antibiotic exposure according to literature, right?

Evan Brand: Yep. Yep. Well said. Let’s chat about protection a little bit. I mean, let’s say that you have to go visit a friend or a family member in a nursing home or a hospital, what could you do to maybe prevent yourself from picking this up? Because this Clostridia can be airborne.I mean, are you talkin– like, I’ve heard some people spraying Silver, like around their nose, their ears, their mouth, just trying to have like a general barrier. I mean, putting on a facemask, like, what do you do? How do you prevent yourself from picking this infection up, or at least, how do you reduce your risk?

Dr. Justin Marchegiani: Well, number one, uhm– a lot lof it’s gonna be spread in the– in th– in the bathroom, right? Because people have a bowel movement that’s particulate. Maybe they don’t flush, and they can aerosolized out of the toilet seat.

Evan Brand: Oh, gross.

Dr. Justin Marchegiani: …of course, keeping the toilet seat close– Those kind of things. Ideally, you know, trying to avoid a lot of public restrooms. When you have to– to utilize a bowel movement. Or at least just make sure uhm– you know, it’s fully flushed, right? Fully flushed– all that stuff. And uhm– you do your best with that. But that’s how…

Evan Brand: You know what’s crazy?

Dr. Justin Marchegiani: …I–

Evan Brand: The most of the public bathrooms, they don’t have lids on their toilet seats. So you just think of all these hundreds of people going in a public bathroom. There’s usually not a toilet seat. They flush it. That stuff’s going everywhere. Have you seen those studies where they’ve used like– I don’t know if it was a thermal imaging camera or like a UV Camera or a blacklight, and they can see like a the fecal matter is like 10 feet away from the toilet? Have you seen those videos?

Dr. Justin Marchegiani: [sigh] I’ve not seen that. I think it’s got to be getting better today, because a lot of the uhm– toilets kind of flush automatically.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, there is that benefit, right? As soon as someone gets off the seat, it flushes within a few seconds.

Evan Brand: True.

Dr. Justin Marchegiani: That– That’s better than someone just letting it sit there for a long period of time. Of course, you know, physical contamination is gonna be the big one. So, just touching stuff and not washing your hands– I think it’s good to have one of those uhm– I think it’s EO. EO makes one, but you can get them at Whole Foods. They’re kind of like a– alcohol, herbal…

Evan Brand: Yeah.

Dr. Justin Marchegiani: essential oil kind of rub you can get to spray or the gel. So I think it’s good like, once you’re out, like just kind of do that. You know, use a little bit of that gel or that spray as well. Just because, now you’re out. You haven’t touch anything, and that gives you a good chance of knocking that stuff down. So, I’ve no problem with that. That’s gonna help significantly.

Evan Brand: Yeah.

Dr. Justin Marchegiani: …wants that component dialed in.

Evan Brand: Yeah. Good advice. ‘Cause if you’ve got it on your hands and maybe you scratch your nose or you touch your face or something, and then you’ve get it into the bloodstream.

Dr. Justin Marchegiani: Exactly. And of course, just having a stronger immune system, right? A lot of these things happen when your immunocompromised. So, when you have poor diet, when you’ve poor– that’s when you’ve poor sleep, when you already have a compromised gut issue, these things can happen. So, they very rarely happen just out of isolation. Uhm– you may have other infections and then the C. diff– an issue. You may have other infections that came about because of chronic antibiotic use ‘cause antibiotics can cause rebound overgrowth as well. Or, if you’re using antibiotic– I don’t know, like an H. pylori infection. You’re doing triple therapy, right? A lot of the other uhm– things that are also used outside of Achromycin are gonna be Proton Pump Inhibitors, right? But what does that create? Low stomach acid environment. That’s gonna set you up to not breakdown proteins, be able to break down fats and ionize minerals. So that creates more problems down the road, right?

Evan Brand: Yeah. Well said. So, if you’re on an acid blocker, this conversation should perk your ears up a little bit. Pay attention ‘cause you’re at a higher risk for these infections. We see it every single week between us both. We’ve seen thousands and thousands of gut bugs. So, uh– acid blockers or uh– also birth control pills, too. We know that can affect the gut microbiome a bit. And also, uhm– yeast infections, too. So, if women have had yeast infections, they’re gonna get put on like a Diflucan or a Nystatin, or some other pharmaceutical. That could also change the microbial balance, and you get Clostridia that way. So, basically, any intervention that’s knocked out the good guys is gonna put you at risk, you’re saying.

Dr. Justin Marchegiani: One hundred percent, and just stay out of hospitals. Really, just stay out of, you know, conventional hospitals. I mean, if you have family member who really get sick, and you have to go, totally get it, right? But if you have the ability to wait ‘til someone’s out of the hospital, wait ‘til they’re out.

Evan Brand: Yeah. I mean, my wife uhm– her mom was in the hospital uh– what was it?– maybe a month ago. She had a lung nodule. They couldn’t figure out if it was cancerous or not, so they just took her in anyway and did like a long nodule surgery. And my wife wanted to go into the hospital, but I was like, “With the baby? We just can’t chance it.” So, she told her mom, “Hey, look. We’re just gonna wait it out.” And, it only took an extra day or two for her to get home. Nobody’s feelings were hurt, and she still got to visit her outside of the hospital environment. I mean, the last thing we wanted was, my wife bringing home some type of bug and get the baby sick, you know. So, we just didn’t take the chance.

Dr. Justin Marchegiani: Oh, totally. And, if someone’s in the hospital ‘cause of some, you know, severe reasons, right? Of course, you want to go, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: But if it’s like a severe life and death kind of thing, you know, try to utilize Face– FaceTime or Skype in your smartphone. That’s a good way of connecting ‘cause that– The biggest thing is being in hospitals and getting an antibiotic exposure. And guess what– yes, to the people that get the most antibiotic exposure are who? Right? They’re in hospitals.

Evan Brand: Oh, yeah. Yeah, rational.

Dr. Justin Marchegiani: These are people that are sick and they’re coming in to the ER. They’re coming in, right? ‘Cause the more chronically they’re comin in, typically, more antibiotics are prescribed. Because well that’s really the biggest thing that, you know, conventional medicine has with people that are sick.

Evan Brand: I know, IV is, too. [crosstalk] IV antibiotics. I mean, that’s just. I can’t believe how often that’s dispensed and distributed. It’s kind of scary.

Dr. Justin Marchegiani: A hundred percent. So, in general, like, we look at this from a functional medicine perspective. We can kind of like, zoom in on one type of thing here, which is C. diff., but when we were looking at things, we’re looking at the whole picture. So, C. diff. may be a part of your clinical picture if you have diarrhea or digestive issues or have leaky gut. So, maybe saying is C. diff an issue? It may be. But it may also be a combination of C. diff., H. pylori, and Blastocystis hominis. So, you– everyone has the right to have more than one issue going on at the same time.

Evan Brand: Great.

Dr. Justin Marchegiani: So, they’re just gonna keep that, you know, in the back of your head. A lot of these issues aren’t binary. They’re aren’t on-off. You know, one or the other. You can have multiple different things happening. And of course, the longer these gut issues are present, the more there’s a– an absorption or a bottleneck of nutrients getting into your system. That’s gonna affect your neurotransmitters. That’s gonna affect your adrenals. Also, potentially affect your thyroid, if your not maximally absorbing Selenium or Iodine, or Copper. And then, we know what the whole uhm– what the whole neurotransmitter thing in Dopamine, right? We look at the HPHPA. B6 is very important for Dopamine metabolism. And if we have dysbiotic bacterial overgrowth, that internal production, the B vitamins are gonna be down. And we may not quite be able to absorb the B vitamins in our diet, partly because of the increased transit time, right?

Evan Brand: Yep.

Dr. Justin Marchegiani: And, there’s toxicity and inflammation in the gut, your colon and your intestine’s soaked up a lot of water. Why? It’s doing it to dilute the– the infectious debris so it can flush it out. It’s diluting it and then flushing it out. But, what also is diluted and flushed out is also gonna be all of these micronutrients that are in your intestines that may not have enough time to assimilate, as– absorb and be utilized yet.

Evan Brand: Yep. well said. And then, we’ll give a mention here to fecal transplant. I mean, this is still kind of an ex– uh– e– e– I would say, experiment/ex– uh– I can’t even say the word, Justin. What is it? Experimental therapy?

Dr. Justin Marchegiani: Yeah. Uhmhm–

Evan Brand: Because I’m seeing people that are getting fecal transplants, and there is cool literature that after one, if not two, maybe three of the most fecal transplants, where you’re taking stool from a donor hat does not have C. diff. You’re transplanting that with a capsule of, usually have very, very deep-frozen stool– very, very cold frozen stool, in a capsule form. The C. diff. infected patients swallows that. Theen, within one, two, or at the most, three fecal transplants, the success rate is over 95 percent of curing C. diff. The only thing is, I’m having people that are saying they are getting personality changes, and that they’re starting to have a different preference for music. And if they’re craving fast food when they never craved fast food, and that they’ve gained weight or they’ve lost weight, because we’re finding out these gut bacteria are very unique. And you can take somebody’s gut bacteria from an obese person that doesn’t have C. diff., put it into your– you who’s a skinny person and also, you get obese. And, it’s because you took someone else’s microbiome and out it into your gut. So, I think it’s a– absolute last resort and a lot of the antimicrobials and protocols that you and I use for parasites and other bugs, we’re gonna kill C.diff. in the process of that. So, if that were unsuccessful, maybe, fecal transplant is necessary. But, man, I don’t really want to change my personality, or become obese because I took my bacteria from someone that, that had a– a personality that I didn’t like, or something. I mean, that just sounds– that sounds crazy to me.

Dr. Justin Marchegiani: Yeah. And again, when you do a fecal implant, you know, it– it’s gonna have effects that aren’t gonna be, potentially forever. Because z– when you put bacteria in your gut, it tends to be more transient and pass through.

Evan Brand: Okay.

Dr. Justin Marchegiani: You know, that kind of a microbiome that you have in the beginning is kind of what you have. You can influence it and nodge it in a direction, and a lot of these things tend to be more transient. That’s why, you know, you can’t just take a probiotic once and then get the benefit forever. You’re taking it but then also, may be getting fermented foods in your diet. Those kind of things to alter it. Maybe you’re taking some probiotics, a bottle of it, every quarter or so, once you’re doing really well and you’re getting fermented food in daily. But, again, I look at, like a fecal implant is kind of like a palliative thing.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, if I’m seeing an improvement with symptoms, and we’re able to knock the infection down without having to do a whole bunch of antibiotics, I think it’s beneficial. My thing is, if you have C. diff. and a whole bunch of other infections, and you’re still eating poorly, or you have other food allergens in there that are causing leaky gut, I see the fecal transplant is kind of like rearranging the deck chairs on the Titanic, so to speak.

Evan Brand: So– [crosstalk] yeah.

Dr. Justin Marchegiani: It’s not quite fixing the root cause better than antibiotics, in my opinion. So, we’ll have to just keep an eye in, and see how these things are– are looking in the literature. It’s the same thing with a lot of these docs that are using the helminth or worm therapy. Right? Uhm– They’re using and stuff to kind of modulate the immune system. I see a lot of that as being palliative, right? If not, we’d see people in third world countries that have lots of parasitic infections and worms, you know, have super robust health, right? Obviously, there are also malnourished and have really poor water supply. But I can imagine an infection driving and improving someone’s health. I ju–

Evan Brand: Agree.

Dr. Justin Marchegiani: I just that– For me, I just have a hard time wrapping my head around it. I think it can push the immune system in one way or the other. And because, let’s say, you’re immune system was on this side, maybe more TH2. And now, you push it, more TH1, by giving a helminth or a worm. Then that can shift the immune system more to equilibrium, and you feel better. I don’t think it’s still the root cause, but I, my mind, I always like kind of look at things, “Okay. We have palliative therapies that just fix symptoms, and then palliative therapies that are more natural with less side ef– side effects, right?” Like so– Like, think of a headache, right? Palliative for headache, what’s that.

Evan Brand: Advil.

Dr. Justin Marchegiani: Magnesium, curcumin, right? Well, palliative that’s natural [crosstalk] side effects.

Evan Brand: O-kay.

Dr. Justin Marchegiani: Curcumiin, uh– Magnesium, B6, right– the various– you know, rosemary, ginger, right? Natural palliative things, without side effects. And then the other side, we have Ibuprofen that kills 20,000 people a year, taken properly.

Evan Brand: Yep.

Dr. Justin Marchegiani: So, I look at like palliative and then what’s the risk reward on those palliative things. So, I kind of put the fecal transplant more on the safer side versus like some of these other medications that kill many people, taken properly. So, we got a palliative– safe palliative, unsafe risk-reward, and then also what’s the root cause. So, in functional medicine, we always delineate all three of those.

Evan Brand: Yep. Well said. Well said. Uh– I think we could probably make this conversation longer, but since we’re out of time today, I think that was efficient. You’ve got to get the diet dialed-in. When we’re talking to you guys, we’re always assuming you’re following something like a Paleo template, organic pasture-raised  meats, organic veggies, high-quality berries, maybe some nuts and seeds, if you’re not on an AIP diet and you can tolerate those, you’re getting to bed on time, you’re getting out with the Sun, you’re getting exercise, adequate hydration, no sodas, no– you know– fake fructose in the diet, you’re not skipping meals, you’re getting your adrenals checked out, you’re thyroid, and then you’re jumping into this conversation. So, that’s all the prerequisites required to– to have on-board before you really start diving in to a gut protocol. So, uh– if you want to learn more, we’ve got hundreds of hours of content on this. Keep looking around. Go on Justin’s site, his personal site and blog, where you can also sign up for functional medicine consults. That’s justinhealth.com. And if you’d like to reach out and schedule a consult with me, you could do the same thing at evanbrand.com. And make sure you hit Subscribe on Justin’s channel here. Keep the tribe growing, and hit the bell. You’ll get the notifications. We’re gonna be back with you guys next Monday, around the same time. So, stay tuned for more.

Dr. Justin Marchegiani: Absolutely. And just remember, top symptoms for a C. diff. are gonna be watery diarrhea, fever, loss of appetite, uh– belly pain, nausea– these are all symptoms of other kind of infections, too. So, you know, it’s easy for people to– to read about one thing and say, this is me, right? You see it a lot with Lyme– Ly– Lyme disease– those kinds of things. So, you keep that in the back of your mind. Uh– washing with hands and soap, [clears throat] tends to be more effective than just using alcohol. Keep that in the back of your mind. If you’re visiting someone in the hospital, you know, wear the full gown get-up. You know, that same kind of gown that they’d wear. People that had MRSA wear that get-up as well.  So, if you’re gonna see someone, you know, that’s an extra wha– extra, well uh– protection as well, on top of that. Anything else you want to add there, Evan?

Evan Brand: I think that’s it. Get yourself tested. Like I said, reach out to one of us. If you need to get some functional medicine stool testing or organic acids testing done, we look for this. We see it thousands of times a year, but there are natural solutions. So, keep digging. Don’t give up and we’ll talk wiith you guys next week.

Dr. Justin Marchegiani: Absolutely. And then, anyone that’s asking questions here, try to keep it on topic. If you’re going off the deep and talking about things that we’re not chatting about, save that for my daily FAQs, uhm– that way, I can answer you there. I may do one today, so look. I’ll try to put it up in the YouTube queue, so you guys can be aware of it. And someone writes in about Eosinophilic gastroenteritis that can either be from severe food allergies or from other parasites. Allergies and parasites can increase Eosinophils. So, keep that in the back of your mind. Hey, Evan, phenomenal chat today. We’ll be right back here. I’m gonna do a video in a bit. I’ll post it up on YouTube later on today, and I’ll mail you back later on for a live FAQ, so stay tuned. If not, Friday mornings are gonna be when I do that. But look later on today. Evan, phenomenal chat, man. We’ll talk real soon.

Evan Brand: Take care. Bye.

Dr. Justin Marchegiani: Have a great Monday. Bye.