Dr. Justin Marchegiani and Evan Brand go in depth and reveal the truth about PPIs or proton pump inhibitors when taken especially over long periods of time. Discover what they do for your body, how it affects digestion, and what other issues they can possibly lead to.
Find out about the roles of hydrochloric acid and enzymes. Listen to this podcast to understand how proton pump inhibitors could be affecting organic acid markers and your body’s ability to generate ATP and energy. Learn how you can get off these medications and do away without taking proton pump inhibitors and then deal with your symptoms in a much better way starting with diet and lifestyle changes and getting in touch with a functional medicine expert to help you and then you can also proceed with any testing needed.
In this episode, topics include:
1:36 Proton pump inhibitors
6:50 The risks of taking PPIs
10:49 PPI and hydrochloric acid levels
17:40 Nutrient deficiency
19:30 Summary and take aways
Dr. Justin Marchegiani: Evan Brand, it’s Dr. J. How we doin’ today, man?
Evan Brand: Hey, I’m doin’ great and fired up about drugs. So let’s talk about some drugs today.
Dr. Justin Marchegiani: Nice. Oh, by the way, this is your podcast after your newborn.
Evan Brand: I guess it is. I didn’t realize that. Yeah, she–
Dr. Justin Marchegiani: Yeah.
Evan Brand: One of our friends actually made us a Not Just Paleo branded onesie.
Dr. Justin Marchegiani: Onesie, nice,
Evan Brand: And she’s wearing that today, so I have to put a picture up on my social media if people wanna stalk me, they can.
Dr. Justin Marchegiani: Awesome. And your daughter’s name is summer, right?
Evan Brand: That’s right.
Dr. Justin Marchegiani: Love it. Excellent! Very cool.
Evan Brand: Yup.
Dr. Justin Marchegiani: And I actually in between I got a dog and my new dog’s name is Butter.
Evan Brand: Nice.
Dr. Justin Marchegiani: Which I love because she melts in my lap. She sits on my lap almost all day, even while on the calls of my patients. It’s really cool.
Evan Brand: What is she? She looks like a shih tzu kinda but not really.
Dr. Justin Marchegiani: Yeah, she’s kinda like a Jack Russell and a Yorkie, just about 10 pounds. She’s a little Paleo doggie. She gets all grain-free, biologically appropriate, raw, good quality foods, grass-fed meat, you know, because dogs are pretty much obligated carnivores, you know, mainly meat and such. So yeah, she does really good. She’s pretty healthy.
Evan Brand: Good to hear.
Dr. Justin Marchegiani: Love it. Cool, man! Well, we both got some major changes in our life, probably a lot more for you than for me.
Evan Brand: Yeah.
Dr. Justin Marchegiani: With the—with the child here and then me got my nice little dog, so love it! And I got two—two cats and a dog and you’re just on—what, you got one dog and a–
Evan Brand: One dog and one baby.
Dr. Justin Marchegiani: And a—and a daughter.
Evan Brand: Yup.
Dr. Justin Marchegiani: Nice. Great! Very cool. Well, let’s riff on here the proton pump inhibitor topic. A whole bunch of different drugs out there and that family, a couple of common names are Nexium, Prilosec or—or omeprazole. There’s also the purple pill, Nexium. Let’s see—Pepto—no, Pepto-Bismo. Prilosec, omeprazole, Nexium, any others that you—you can come by. There’s like about 8 of them, 10 of them out there.
Evan Brand: They have so many different names.
Dr. Justin Marchegiani: Yeah, so many.
Evan Brand: It’s honestly hard to keep up.
Dr. Justin Marchegiani: Yeah, pantoprazole, esomeprazole, yeah, I mean anything that ends in a -prazole is basically gonna be your proton pump inhibitor. You have the purple pill which is Nexium, your Prilosec, omeprazole is the over-the-counter version of Prilosec. And again, all these drugs they just block hydrochloric acid. So they’re proton pump inhibitors. What’s a proton? That’s basically hydrogen. So it’s preventing hydrogen, which is a positive charged atom from binding to chloride and forming hydrochloric acid. So that’s how it’s working. It’s mechanism of action is—is preventing those hydrochloric acids from being secreted in the stomach and binding into chloride and performing that nice acidic pH which is really important we know from activating proteolytic enzymes, enzymes that help break down protein.
Evan Brand: Absolutely and if you look at Dr Wright’s Why Stomach Acid is Good For You, we see he tracked several different people. I believe he used—can’t remember the name of it, but the capsule that was actually like inserted, the—the piece of technology they inserted into the stomach to measure–
Dr. Justin Marchegiani: Yeah, it’s called–
Evan Brand: The acid level.
Dr. Justin Marchegiani: It’s called the Heidelberg test.
Evan Brand: Yeah, I believe he did the Heidelberg test on all these patients or people in his studies and he showed after age 20, your hydrochloric acid production begins to steadily drop until you die basically and so we’re taking people that already have low stomach acid if they’re 40-45 years old and starting to get heartburn, indigestion, bloating and these other symptoms and they’re lowering that HCl level even more which I just had a note here from Healthline that was talking about PPIs, several studies now link to PPIs to a high risk of pneumonia and an infection of bacteria which is C diff., the Clostridium difficile that you and I see often on organic acids results. So this is not just your gut that’s affected here. There’s other places in the body that can really start to dysfunction if you have low stomach acid and, therefore, you’re not breaking down your food and absorbing your nutrients anymore.
Dr. Justin Marchegiani: Right, and then again, where these proton pump inhibitors work is they work on the stomach in particularly the parietal cells, and the parietal cells these cells also produce intrinsic factor which is like this binding compound that helps bind to B12. So B12 in your diet then hits the intrinsic factor made by the parietal. It then gets reabsorbed at the end of your small intestine in an area called the ileum. So binds the B12 in the stomach and then it reabsorbs it in the ileum. So when we have issues with the parietal cells, we can also—we also may have issues with intrinsic factor. There are things called pernicious anemia. So the more we have gut dysfunction, greater chance we’re gonna have stomach breakdown issues, and then we typically go on proton pump inhibitors and there’s a greater chance that there we may have B12 or anemia issues that are B-vitamin based after the fact.
Evan Brand: Great, so I mean in terms of PPIs, I remember not long ago they were all prescription drug commercials. Now things like Nexium are available over-the-counter, isn’t that right?
Dr. Justin Marchegiani: Yeah, well, I’m pretty sure omeprazole is over-the-counter now for sure and that was basically Prilosec. That was, you know, a big, big multibillion-dollar drug. I think these drugs we mentioned before the show, they’re like in—always in the top 4 or top 5 money-making drugs. And the problem is when you—when you take a proton pump inhibitor, right? I mentioned the proton something like hydrogen, and it works with your hydrogen potassium pump system in the body, which we mentioned affects hydrogen being produced via the parietal cells in the stomach, forming hydrochloric acid but there’s other areas of the body where these hydrogen potassium pumps are being interfered with and that can affect ATP production, thus your mitochondria. So we see lots of people come back on their organic acids testing with weakened mitochondrial dysfunction. We’ll see the organic acids super low or super high. We’ll see things like cis-aconitate or aconitate. We’ll see different markers like lactate and amino acid markers low for CoQ10, various B vitamins, and it’s possible that a proton pump inhibitors could be affecting some of those organic acid markers, thus affecting your body’s ability to generate ATP and energy.
Evan Brand: Ah, so let me probe you a little bit further on that. So you’re saying here the cascade of problems that happens is we have this PPI. We’re lowering the stomach acid, so now we’re spending our hard-earned money on grass-fed beef but we’re not actually cleaving the iron and the vitamins and the amino acids from that protein, right? So we’ll show up with very low amino acids on the organics, is that what you’re saying?
Dr. Justin Marchegiani: Correct and there’s even research showing that people that take thyroid hormone and are on PPIs have to actually increase their thyroid hormone dosage. So it doesn’t only just affect that, it can even affect medication that are natural in origin. So being on this PPIs, I call it like it’s the first domino of—of your health destruction. Because anytime you impair digestion, you impair all the nutrients that are needed to run your body’s energy systems, hormone systems, detox systems, neurotransmitters and mood systems. So once you start shorting those systems out, any type of short means increase in symptoms. It means depression. It means anxiety. It means PMS. It means fatigue. And so basically our ATP is part of how our body generates energy aerobically and the more our body is forced to generate energy anaerobically, it’s gonna lead to more fatigue.
Evan Brand: Right, so now–
Dr. Justin Marchegiani: It’s gonna lead to more fatigue. Go ahead.
Evan Brand: And I was just gonna say now if you stack someone who already has mitochondrial issues, they’re not producing enough ATP and then you take that and combine it with a toxic load, say there’s still getting exposed to glyphosate, which a new piece of research came out and said 93% of people have glyphosate, the pesticide used in non-organic food, that is going to increase the toxic load, the mitochondria can’t do their work even more, so things like organic diet become even more important than before especially if you have this compromised gut issue. The number—number 2 drug in all US pharmaceuticals is Nexium and you and I were looking at the stats–
Dr. Justin Marchegiani: And that’s the purple pill–
Evan Brand: Yeah, so it looks like less than 10 million but well, on the way to 10 million dollars’ worth of this drug is being sold per year.
Dr. Justin Marchegiani: Right, now here’s the triad, right? People come in or they first get their medication for a Prilosec or a proton pump inhibitor, right? Then the next thing that’s gonna happen is they may start to have mood issues. Now they’re gonna be on antidepressant. Okay, so now they have acid-blocking meds. Now they have a mood issue. And now they start having fatigue, right? And then with fatigue comes like ADD. So now they’re on like an upper. They’re on like a methamphetamine, Strattera–
Evan Brand: Like a Vyvanse.
Dr. Justin Marchegiani: Like a Strattera, a Vyvanse or an Adderall. So now they’re on an upper. They’re on a proton pump inhibitor and they’re also on a mood medication for the depression. Now they’re anxious all the time because they’re on a mem—methamphetamine half the day, right? So now they’re on Xanax or some kind of benzodiazepine. So all these things start to happen. If they’re a guy, they’ll probably start to have low libido because a lot of the side effects of antidepressants are low libido. So now the libido starts going down. They can’t get it up in the bed. Now they’re on Viagra an d now because they’re so inflamed, their cholesterol is going high because their body is ridiculously inflamed so you can see, right? The domino of destruction is acid-blocking medication followed by mood drug, followed by stimulant, followed by anti-anxiety, followed by anti-libido, followed by statin.
Evan Brand: Ugh!
Dr. Justin Marchegiani: And it’s a—it’s a common—it’s a common, common pattern. And not to mention people that tend to have all those types of problems, also gonna be inflamed, and when they’re inflamed, they’re also on what else? Pain medication, right? So then it’s gabapentin, then it’s the Enbrel, then it’s an ibuprofen, NSAID, the older meds would have like the Celebrex or a Vioxx and those killed a lot of people, too. So again these medications aren’t—be on, the more problems, the more mitochondrial dysfunction, the more energy, and then as soon as you get on an ibuprofen even though it’s over-the-counter, I mean Wolf et al, 1999 American Journal of Medicine, 20,000 people die a year taking it properly.
Evan Brand: Yup.
Dr. Justin Marchegiani: These aren’t meds you wanna be on as a lifestyle medication.
Evan Brand: Right, right. And then you already alluded to it a little bit, it’s the leaky gut situation going on, the liver burden there, potential autoimmune disease from all of this because now you’re set up for bacterial overgrowths and candida problems and parasitic infections and it gets scary pretty quick, doesn’t it?
Dr. Justin Marchegiani: It does and I didn’t even touch upon the SIBO part.
Evan Brand: Yeah.
Dr. Justin Marchegiani: Because you mentioned it earlier, right? When you lower—I should say, when you lower the hydrochloric acid levels, you essentially raise the pH, right? Because we need hydrochloric acid levels to be high for the pH to be low. So essentially when we—when we decrease hydrochloric acid levels, that pH goes high, we have impaired digestion, and that increases chance for opportunistic pathogens—your Staph, your Strep, your Clostridia like you mentioned, your Campylobacter. All those different pathogens start overgrowing that increases chance of leaky gut. We talked about these pathogens having these dangerous metabolites such as lithocholic acid or endotoxin or LPS which can go and create leaky gut and then cross the blood-brain barrier and create mood issues, but it also can drive more SIBO, right? Because SIBO is gonna be essentially bad bacteria moving its way up and we know SIBO symptoms cause IBS so then it’s more medications, right? You’ll be on mesalamine or some type of prokinetic or antidiarrheal medication. I know you were diagnosed with IBS and they put you on a whole litany of meds and this could all potentially stem from proton pump inhibitors.
Evan Brand: Yeah, they tried to. I never filled the prescriptions. Thanks God. I denied them all. And you and I were looking at some other research which I just sent you the link to that we can put in the show notes is 73,000 people that were 75 years of age or older and free of dementia were analyzed and they found that people had—people that were receiving regular PPI medication, 77% of them had a significant increased risk of dementia compared to patients that were not receiving PPI. So we look at all of these places. I just saw a new giant complex got built right down the street like an assisted senior care facility primarily targeted towards Alzheimer’s and dementia. Think of how many of those people are put on PPIs. I know we have parents and grandparents listening, that’s—that’s a big deal and we’re always seeing these campaigns of Fight for the Cure, Run for the Cure—how about just avoidance? And that was the conclusion of this research here, the avoidance of PPI medication may prevent the development of dementia. So this literally, you’ve done a great job of elaborating this. This literally spreads out like a spider web into every aspect of our civilization.
Dr. Justin Marchegiani: Yeah, absolutely and by the way, any type—anyone that tells you they have a cure for something, run for the hills. And the reason why—even when it comes to cancer. When it comes to any type of disease, the reason why there can’t be a cure it’s because when there is multiple causes, there can never be a cure, right? Because think about it, for there to be drug, a drug has to work on—it works on a mechanistic level. So for instance, proton pump inhibitors, what’s the mechanism? It re—it inhibits proton pump—it inhibits the proton pumps. It inhibits the hydro—hydrogen crossing that, you know, potassium membrane and creating hydrochloric acid. That’s how it works. But what if your acid burn was from drinking too much water while you ate or eating too much gluten or having a lot of emotional stress and eating while you’re driving. So you see how there could be multiple different causes or it could just be old age because Dr. Jonathan Wright show that as you grow older hydrochloric acid levels drop. It could be a gut infection. So how can we have a cure that fixes all of those different causes? We can’t. Now what may happen, let’s say I just got you meditating and got you eating in a more quiet environment, that may help a lot of people but it will never be the cure for everyone. It’ll never be the catch all. But it’ll probably help everyone else. But in conjunction, we can never say it’s a cure because only drugs can essentially cure someone, right? According to FDA rules. But what we are trying to do and what our focus is on is getting the underlying causes addressed and someone may have the same diagnosis, disease or set of symptoms that are caused by different set of underlying causes, so we kinda focus on the big 5 or 10 underlying causes for each issue and that gives the greatest chance of helping that person’s symptoms resolving.
Evan Brand: Absolutely, well said. If that segment, that 2 to 3-minute segment were aired on national news, it would be the most viral piece of health nuggets that the—the mainstream population has ever heard.
Dr. Justin Marchegiani: Right. I mean how can you have a cure for cancer when maybe that woman’s cause of breast cancer was because of her pesticide exposure everyday where the other person over here is because she’s eating too much sugar, and this guy down the street because he’s getting exposed to round-up on a daily basis and then maybe the person that came from, you know, Japan near the—the nuclear spill 3 years ago got exposed to something there, right? But maybe–
Evan Brand: Or—or just the person who goes and gets the yearly annual recommended mammograms which we’ve seen–
Dr. Justin Marchegiani: Right.
Evan Brand: Bad research about those now.
Dr. Justin Marchegiani: Yeah, increases your chance of cancer I think 1% every year. So if you start getting them at age 30, and the time your 60, you got 30% increase there.
Evan Brand: Right.
Dr. Justin Marchegiani: So how can we create a drug that actually will fix all those underlying causes? You can’t. You can’t. So we just gotta make sure we understand that, that there is no such thing as a catch all, even in functional medicine, we focus on body systems that typically get affected when people present with certain symptoms and for the most part, if there’s any catch all that you could—I would let you air on the side of, typically the gut’s a pretty big catch all for everything.
Evan Brand: Yeah.
Dr. Justin Marchegiani: Now it may be the gut and the adrenals and the gut and something else, but typically the gut is almost always gonna be a piece of the puzzle, but it may not be the whole puzzle.
Evan Brand: Right. So you would say, I mean, in most cases, it’s at least half of the battle is getting the gut straightened out because that is going to affect the ability to produce hormones like you mentioned, the ability to uptake thyroid hormones and have all these other systems working properly so it’s not necessarily our starting place but it’s a big piece of the pie.
Dr. Justin Marchegiani: Yeah, and a lot times we can’t start there per se because people’s energy systems, their adrenals, their thyroid are so flogged, they can’t generate the energy and if we went after infections, they would feel like crap.
Evan Brand: Oh yeah.
Dr. Justin Marchegiani: So one of the first places we do work on is cutting the foods out, the bad foods, and adding the good foods. And then number two, right next to that, is adding the digestive secretions so our patients can break down their foods. Remember good food can be toxic to the body if it’s sitting there rotting. Who wants to go eat the organic spinach that’s sitting on your counter for a week versus, you know, in the fridge for a day or two and then eaten later, right? You wouldn’t wanna eat that. And then also we just touched upon the nutrient deficiency. We talked about B12, right? B12’s important for creating healthy, mature red blood cells. We also need iron for energy and oxygen carrying capacity. We need iron to make thyroid hormone. So if someone’ got a thyroid issue, we gotta look at hydrochloric acid. We gotta make sure PPIs aren’t part of the mix. What about osteoporosis? We need calcium and magnesium digestion. Well, if we got—if we’re on Boniva or if we’re on Osteo—whatever the other medications are out there—Boniva’s the big one, then you know, you’re not getting to the root cause if you’re also on a proton pump inhibitor and not digesting your minerals or ionizing your minerals, too.
Evan Brand: Right.
Dr. Justin Marchegiani: Lots of studies on that.
Evan Brand: So you literally—you literally fall apart in every aspect.
Dr. Justin Marchegiani: Oh, my gosh! I know! And then also there’s some studies on that talking about basically PPIs having a higher risk of heart attack and—and what could be the potential mechanism? Well, I think it’s partly some of the minerals. Alright, we need magnesium. It’s a natural beta blocker to keep our heart in check. Healthy minerals help conduct nervous system impulse. We also need it to break proteins which typically have antioxidants in them and healthy cholesterol which is an important antioxidant, building block for our hormones. Also things like CoQ10 and L-carnitine.
Evan Brand: Yup.
Dr. Justin Marchegiani: To help our heart have the energy and generate the ATP for our heart to pump. So that kinda make sense, right? We got increased cardiovascular, increased nutrient absorption. We altered the gut with the SIBO and with the malabsorption. So a lot of different things come and you also mentioned the cognitive things, too. So you can see how everything gets affected here.
Evan Brand: Yeah. So where should we go? Where should we go from this? We’ve outlined and everybody’s like, “Holy smokes! Now what?”
Dr. Justin Marchegiani: Alright, so you’re listening to this podcast, great. You’re just listening to it for the—for the brain candy, awesome! Grab some popcorn or maybe some chocolate avocado pudding, right? To keep it more Autoimmune Paleo and just enjoy the show but if you’re like listening to it with a perspective of like, “Yeah, I got some of those symptoms.” Well, what’s your first step? Well, obviously we always talk about diet piece. So I would start with a good autoimmune diet. That’s a good important thing. So that’s no grains, no legumes, no dairy, that the auto—that’s the Paleo filter. The second filter on top of that is the autoimmune one, that’s where we cut out the nuts, the seeds, the nightshades, and the eggs. Patients do that for a minimum of 4 weeks, but if they’re continuing to get benefits at 4 weeks, don’t stop until you plateau. Patients go like, “Oh, 4 weeks in, even though I’m so much better in this area and that area, I’m gonna go back on nuts and eggs.” It’s like, “Well, hold on!” if you’re getting great results, don’t—don’t, you know, mess with the good thing. If it ain't broken, don’t fix it. So I always say don’t go on the old foods again—autoimmune foods until you plateau. Number two, once you do that, making sure your digesting your foods is essential. Adding in a good enzyme product. I mean, I have my enzyme synergy product, probably like you have one as well. A good enzyme would be great. Now if you have acid, over acid symptoms, start with an enzyme without hydrochloric acid because people that do have digestive issues, their gut lining is so thin, even something like hydrochloric acid may be too much. Something that’s just an all enzyme would be helpful and then tinker around with a shot of lemon juice or a teaspoon to a tablespoon of apple cider vinegar. If you can tolerate that then you can start to taper in hydrochloric acid down the road. When you have been on a medication like this long-term, you really wanna work with a functional medicine professional. I always recommend letting the prescribing doctor know what you’re doing, say, “I wanna go off it.” And make sure they’re okay with it. If you have an ulcer and they’re like don’t go off it yet, let’s give it time for the ulcer to heal, you wanna heed that recommendation. So let your prescribing doctor know what’s going on. Make sure they’re okay with it and then do all the diet and lifestyle things. You can always add in enzymes while you’re on the proton pump inhibitor and then you can always make the diet changes and then work with a good functional medicine provided that can help dial in the hydrochloric acid and then go to the 5Rs because what’s inevitable is an infection’s probably present that needs to be addressed next.
Evan Brand: Yeah, so the mainstream practice is not always bad in the case of ulcers like you mentioned. You may need a PPI for a short-time so that you can let that thing heal, but generally speaking, there’s something going on that led to that in the first place so if you’re there, then you may have to dig yourself out of that first before you can jump on it but—but yeah, that’s great advice. So then it sounds like the next step once we get the foundations in order is looking into testing. So let’s rule things in—bacterial problems, yeast problems, parasitic infections.
Dr. Justin Marchegiani: So SIBO testing, yeast, fungal testing, parasite testing. Also just know that your conventional medical doctor, it’s not in their scope to get you off these meds for the most part.
Evan Brand: Right.
Dr. Justin Marchegiani: If that’s prescribed, then you’re typically gonna be on for a very, very long time. I’ve had many patients that have been on these meds for years. Now most of the time, the underlying cause is never addressed. Therefore, they need it. They have to be on it. So the medical doctor really isn’t motivated, because when the patient misses it, they’re like, “Oops, that hurt. I got that burning.” So it kinda motivates the patient to stay on it and not really look to the—the root cause. But in functional medicine land, we look deeper and we’re able to help a lot of people get off these medications with their doctors help and, you know, and backing essentially so we do it the right way.
Evan Brand: Exactly. That’s well said. So stool testing–
Dr. Justin Marchegiani: But also the next–so yeah, stool–go ahead.
Evan Brand: I was just gonna outline that, so stool testing–
Dr. Justin Marchegiani: Yeah.
Evan Brand: Maybe some SIBO breath testing. Just getting the baseline, ruling things in, ruling things out, and then what were you gonna say next?
Dr. Justin Marchegiani: Well, when we’re on acid blocking medications, especially if our gut lining’s thin, it almost always means we have weak IgA levels and weak adrenals. So we always wanna look at the adrenals because the adrenals help reduce inflammation if we’re inflamed. We wanna make sure our adrenals, our natural anti-inflammatory, our natural ibuprofen’s working to help reduce inflammation, okay? That’s gonna help build up our gut lining, too. We need healthy cortisol levels to build our IgA up. And then also number three, we gotta have good energy, right? So if our adrenals aren’t working properly because they are too busy putting out the fire in your gut. Well, you’re gonna feel fatigued and you’re probably gonna even have brain fog, too. So the adrenals are important and then if you’re having thyroid symptoms, right? Cold hands, cold feet, constipation, mood issues, depression, outer third of the eyebrow thinning, hair loss, right? Any of those symptoms you wanna look at the thyroid, too, because that may be affected as well.
Evan Brand: Yup. I was gonna say also making sure that you—you outlined it already, but the order of things, too. And like there’s a lot of gut-healing supplements that people may do like I’ve seen just over the past week a lot of people just taking things kind of willy-nilly just because they read about it like slippery elm and marshmallow and all of these gut-soothing herbs, aloe vera, but you may not need to jump straight to that if they infection has not been identified and removed yet. Those things may help and likely can’t hurt, but you’re gonna just be kinda be spinning your wheels and wasting your money at some level.
Dr. Justin Marchegiani: Yeah, if you’re doing that, like in my line I have a product called GI Restore we use. I know in your line you have one as well, we’ll use those but we’re always using them in conjunction with getting to the root cause, if not now or in the next month or so. A lot of people use those just to control symptoms. It’s like, alright, instead of an acid-blocking med, here are some enzymes and hydrochloric acid and some soothing herbs and nutrients and L-glutamine. A lot better. A lot of the underlying causes are addressed there but if we’re not causing the lifestyle causes or the food causes, you know, that’s strike 1. If you’re not addressing the infections, that’s strike 2, and if you’re missing the adrenal piece, that’s strike 3, right? So we wanna really have a comprehensive approach that looks at everything. So let’s say we forget everything up to this point, right? Number one, change your diet. Paleo/Paleo-Autoimmune, that’s step one. Step two, get on some enzymes at least. This is where you wanna start working with a functional medicine professional before you go deeper. Step three would t hen be doing the testing to assess the gut and if you have deeper symptoms, address the adrenals and thyroid and then even deeper, maybe the organic acids especially because of the mitochondrial dysfunction that can happen with these medications long-term.
Evan Brand: Well-said.
Dr. Justin Marchegiani: Any other clinical anecdotes you wanna give about patients that you’ve seen on PPIs, Evan?
Evan Brand: Yeah, well, one thing that was interesting last week is a female who her adrenals actually showed up fine, which I was surprised because she had so much fatigue going on but then she showed with Clostridia bacterial overgrowth and she actually had a history of a PPI. I don’t believe she’s on one currently. I think she had a history of one for 10 years, and so she showed with Clostridia bacteria. It didn’t show up on the stool panel but it showed up on the organics and then all the–
Dr. Justin Marchegiani: Ah.
Evan Brand: All the mitochondria markers were very high, succinic acid and others were very high and then the amino acid portion, it was so low that it hardly registered. And I was like–
Dr. Justin Marchegiani: Right.
Evan Brand: Oh my—oh my God. I said, “Do you feel—like how do you feel after you get done with a meal?” She was like, “I feel like I don’t absorb anything.” I’m like, “Well, we can clearly see it here. Your amino acids are flat lined.”
Dr. Justin Marchegiani: Right.
Evan Brand: And so it was just really interesting to me because you and I talk so much about adrenals and we work with so many people with adrenal issues that to find someone that has decent adrenals was shocking.
Dr. Justin Marchegiani: Yeah.
Evan Brand: And then I was like, “Okay,” and then you have to wait a few days, you know, to get the other labs and it’s like, “Oh, now the light bulb went off. Here’s why.” It’s a whole another system that’s dysfunctioning that you’re never gonna get that measured by going to the clinic down the street and getting your standard of care yearly check-in. It’s just never gonna happen.
Dr. Justin Marchegiani: Absolutely and also I’m gonna leave everyone here with a couple of clinical pearls. Because the big benefit of this show really is you’re working with two clinicians that are in the trenches working with patients. We aren’t just doing research all week long and making theoretical statements. We’re understanding the big picture. We’re working with people and we’re taking our clinical information and sharing it. Quick clinical pearl number one, separate your enzymes and your hydrochloric acid. A lot of people are taking like an enzyme HCl product, like maybe Super Enzymes is a common one. Good product. But if you were on a proton pump inhibitor and have gut issues, you wanna separate your enzymes from your hydrochloric acid. Why? Because your gut lining may be so thin that you may not be able to handle more than a couple hundred milligrams of hydrochloric acid and now if your enzymes are bound up with that, now your enzymes are limited to whatever amount of hydrochloric acid you can take because there it’s a packaged deal. Where if you get them on separately, let’s say you can only handle a quarter of a capsule of hydrochloric acid, but you can still ramp up the enzymes to 2, 3, 4 caps where before you’ll be stuck with maybe an eighth of a dose.
Evan Brand: Yup.
Dr. Justin Marchegiani: Number one is that. Number two is don’t go on hydrochloric acid off the bat. Focus on enzymes. Add in a—a tablespoon of apple cider vinegar, see if you can tolerate it. See if it makes your symptoms better. Take it with food. Some people with mess up the hydrochloric acid stuff by taking it at the end of their meal and it stacks on top of their food and burns their esophagus. So we really wanna emphasize that and last thing, I didn’t really go under the main mechanism, I missed it, I say it so many times with my patients, but I forgot it today. One of the main causes of hydrochloric acid issues, one of the main mechanisms is actually low levels of hydrochloric acid, right? Because GERD and acid reflux happen because of low levels of hydrochloric acid. The food rots, rancidifies, putrefies. Organic acids from that food rotting rise up and then burn the esophagus—the top part where that cardiac sphincter comes in and tightens up and basically closes down the stomach environment from the esophagus environment, and most people with low levels of hydrochloric acid, they don’t get that tightening of the esophageal sphincter, that cardiac sphincter, number one and number two, the get their food rotting and then the get the organic acids rising up. Where if the hydrochloric acid levels were high enough off the bat, they probably would have broke down those foods without any problems.
Evan Brand: And it would have killed off the potential pathogens in that food as well.
Dr. Justin Marchegiani: Absolutely.
Evan Brand: Undercooked—undercooked food, mishandled food, sushi, etc. Like I had a female that she went to India, showed up clean stool test, went to India—I think, I don’t know if I had her on enzymes at that time or not—it’s been about a month or so, came back, symptoms and infection. And I was like I wonder what would have happened if the high dose of enzymes and HCl would have been in her travel kit, maybe we could have prevented that situation from happening.
Dr. Justin Marchegiani: Big time. I got a whole video coming out on what to do when traveling, supplement-wise, and then also some people gotta go a little deeper. They gotta do some GAPS stuff or FODMAP or SCD, specific carbohydrate diet stuff because their guts is really messed up. This is where people like me and you are great resources, so again everyone listening, grab whatever you can from this info here. Listen to it twice. Check out the transcripts. Give us a review. If you’re really liking it, go over to iTunes, BeyondWellnessRadio.com/iTunes, NotJustPaleo.com—what’s your little end link after that?
Evan Brand: I’ll make it iTunes.
Dr. Justin Marchegiani: Okay.
Evan Brand: It’ll be NotJustPaleo/iTunes.
Dr. Justin Marchegiani: ITunes, yeah, give us some reviews, guys. We’d love hearing back from you. We wanna provide great information. Our goal is to be able to touch over a million people. I know Evan has. I have, too. Let’s say 10 million people so we can really help change the world and get them off the—the addiction to the conventional medical treatment pathway so to speak.
Evan Brand: Yup, yup, amen. I know when people hear, “Oh, leave us a review.” It’s so easy for this podcast to end and then you just put your phone away or your laptop, but I know it takes a little bit of effort. You actually have to go into BeyondWellness, go into NotJustPaleo on iTunes and you have to literally click Write a Review button on your iPhone or your computer, PC or Mac, in the iTunes app. And then you have to click some stars, whatever stars you think we deserve, and then you actually have to type.
Dr. Justin Marchegiani: That’s it.
Evan Brand: Type the review. Submit. That’s how you do it. I’ve gotten over 200 5-star reviews worldwide but we should get that number to a thousand, 5 thousand, 10 thousand, however many it needs to take so that we continue to beat out Jillian Michaels in her podcast.
Dr. Justin Marchegiani: I know, my gosh. I just can’t stand the eat less, exercise more mindset. It’s so much more nuisance than that, and also everyone knows someone on these medications. Shoot this podcast over to them. Have them listen to it. It could change their life.
Evan Brand: Amen.
Dr. Justin Marchegiani: Evan, it’s been awesome. Make sure you hi to your wife and Summer for me.
Evan Brand: I sure will.
Dr. Justin Marchegiani: Oh, and then by the way, I got Butter here. She says hi, too.
Evan Brand: Hey, Butter.
Dr. Justin Marchegiani: Take care. She’s unsalted by the way.
Evan Brand: Cool!
Dr. Justin Marchegiani: Take care.
Evan Brand: See ya!
Dr. Justin Marchegiani: Bye.
Evan Brand: Bye.
References: http://www.altmedrev.com/publications/16/2/116.pdf
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