Different Types of Abdominal Pain & What It Could Mean | Podcast #248

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Abdominal pain is another health problem that is caused by various conditions. Abdominal pain, also known as stomach pain, can be crampy, achy, dull, intermittent or sharp.  Some of these include infections, abnormal growths, inflammation, obstruction, intestinal disorders and a lot more. 

Listen through this podcast as Dr. J and Evan Brand gets to the meaning of different kinds of abdominal pain, the functional medicine perspective, what to do, and the kind of look deeper to the underlying root cause.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

01:47 Physiology review, top parts on stomach or abdominal pain

10:08 Midline parts of Stomach

21:05 Gut issues, diastasis

25:57 Lab testing

33:11 Hospital Acquired Infections


Dr. Justin Marchegiani: And we are live. It's Dr. J here in the house. We have Evan Brand here as well. Today we're going to be talking about abdominal pain, different types of abdominal pain and what it could mean. And we're going to give you the functional medicine kind of clinical perspective as well and give you some action items of what could be the root kind of deeper underlying cause of it all. Most people on the conventional medicine side. We'll just look at surgery and drugs and acid blockers or pain medication as your alternative. And we're going to be looking a little bit deeper. Evan, how are we doing today?

Evan Brand: I'm doing wonderful. It's crazy to think about all the different possibilities of stomach pain. You know, we hear this from our clients all the time. Hey, I've got stomach pain. That's one of my complaints. That's why I'm coming to you guys. Please help. And then the question that we always ask right back to them is, well, where is the stomach pain? Because you could say stomach pain and it's like, OK, is this the lower white? Is this the lower left? Is this the the top like right below the rib cage is is under the right side of your rib cage. And depending on the location, that could mean a huge different range of problems. It could be something very simple, like you have low stomach acid and maybe you've got some heartburn, too. You've got diverticulitis or you've got some type of bowel disease or you've got appendicitis. So where should we start? You want to start at the very top of the gut and work our way down?

Dr. Justin Marchegiani: Yeah. Let's start at the top and work our way down. So let's kind of give people a physiology review. And then where there are, let's say, inconsistencies in the physiology, that's where symptoms start to happen. So remember, everything emanates from physiological imbalances and those imbalances, symptoms increase and progress and then eventually pathology may progress. Some people it takes years depending on how acute or how traumatic the injury occurred. Right. So the upper area off the bat on the left side to center, isn't it be more of our stomach type of symptoms. So on the left, we could have you know, on the further left here, we could have more pancreatitis symptoms. Now, pancreatitis, most of the time is going to happen with a strong history of being an alcoholic. You can also have potential gallbladder stones that work their way out. And that as they work their way out, there's a place where the gallbladder and the pancreas kind of connect. And if that stone happens just below, it's possible it could back up the pancreas. So your big issues with pancreas are going to be a potential gallbladder stone or being an alcoholic. There's also other types of rare infections that could drive it. But those are the big two on the pancreatitis. Now, on the left side, it's greater likelihood that that's going to be a stomach issue than it is if pancreas issue. But it's good to keep that in the back of your head as you go midline. It starts to mean that it's probably more of a stomach issue. Dyspepsia, that means indigestion. It could be inadequate stomach acid. That's driving a lot of it. Meaning you're not having enough stomach acid. You're not breaking down your food dyspepsia, which means poor digestion. And then, of course, from that we can have heartburn. We don't have enough stomach acid or esophageal sphincter will not close. Food may rise up from the rodding acids in our tummy and that can create heartburn, that can create inflammation in the stomach. And then, of course, the more inflamed our stomach is the nerves that go to the stomach area on a two lane highway to other muscles. And one of the other biggest muscles is going to be the cure of the diaphragms that cure the diaphragm can rise up or I should say the stomach could actually rise up and pop above the diaphragm. So here's our diaphragm. Here's our stomach. It could pop up and go above it. And that's called a hire, a hiatal hernia. And that can affect digestion, too. So I'll just kind of lay out those couple of things and I'll let you comment. Go ahead.

Evan Brand: Yeah, I had a hiatal hernia and I had an H. Pylori infection. So for my knee, the top center of my gut, right below the sternum, that's where when I did have stomach pain, I would say this is a common area. I'm going to say at least 50 percent of the people we work with, if they're going to complain, we're talking to the patient population that's complaining of stomach pain. I'd say half of them are talking about this midline right of the sternum. It could be H Pylori, the whole heartburn piece. And then potentially the Hiatal hernia. I felt it. It was bad. But luckily, I had a chiropractor who was able to do the visceral manipulation on it, kind of pull it back down. It was not fun, but it was almost instant relief.

Dr. Justin Marchegiani: Yeah, the manipulation, super helpful, you can do it as well by swallowing some water, lifting your hands up, going up on your tippy toes and then dropping down to your heels and dropping your hand down, and that can help, too. Basically, if you use your diaphragm and here's your stomach. You're creating you're lifting this up, which essentially lifts everything up. And then you're then you're dropping it. So you're trying to create momentum to kind of pull that stomach back down in the visceral manipulation way, as is the more specific way. But that's just a good side thought. So kind of highlighting things. We have basically inflammation in the stomach. And remember, inflammation in different ways is where the diagnosis gets labeled, right. Hiatal hernia. It's more specific to the stomach raising up heartburn. And dyspepsia tend to be intimately connected. You have poor digestion. Eventually there's gonna to be some some level of heartburn and then gastritis is just inflammation of the stomach. So if you have poor digestion, if you have a Hiatal hernia, if you have dyspepsia, that could definitely emanate. And then you have the extreme where you have an ulceration, which is essentially a cut inside of your stomach. And typically that gastric mucosa has been worn away because of poor digestion, stress from food, stress from H. Pylori or Sebo or C.F.O. And all those things. You know, fungal overgrowth can emanate in the stomach as well as the small intestines, too. And all those things can be kind of at the root. And then as you move more to the right, this tends to be more where the liver and the gallbladder are. So your liver is in to be your liver is going to be like this right here where-

Evan Brand: He's saying the right is just for people listening. When he says the right person-

Dr. Justin Marchegiani: it's your right. So not the part, not readers. Right. Not you looking at someone. And you're right as you're looking. But the actual person's right.

Evan Brand: Yeah. You look down at yourself down to your right. There's your-

Dr. Justin Marchegiani: Yeah. So if you write with your right hand. Right. That's gonna be your right side and your liver is gonna be right in this area like this. It's gonna be basically like this shape or it's think this shape. Here, right here, like this, like a triangle, almost kind of shape and right tucked in underneath the liver will be the gallbladder. So typically you have the gallbladder right underneath it. So most people when their pain and their liver, it's going to be a gallbladder pain most of the time unless there's a lot of cirrhosis happening from alcoholism or you can have a lot of non-alcoholic alcoholic steatotic hepatitis Nash or non-alcoholic fatty liver. And that's typically going to be from excess fructose. Fructose is gonna be excess fructose, which is a sugar. It's a fruit sugar. It's typically have for half glucose and sucrose. But I'm saying I have glucose and sucrose. But with today's modern fructose, it's a little bit more a little more fructose and fructose preferentially gets metabolized in the liver. And once your liver is kind of stored up of fructose over time, you have a lot of inflammation, enzymes that can up regulate like the JNK one enzymes. And those enzymes can create a lot more inflammation in the liver, typically from fructose. It's also various like hepatitis markers like hepatitis A and B, like a food poisoning one. Hepatitis B is more like an STD one. Hepatitis C used to be more like they like needles and stuff like that. So yeah, hepatitis infections can also be partly at play too. But you're more your more likelihood is going to be alcohol and the most likelihood now is going to be a non-alcoholic fatty liver and that can be reversed. We monitor liver enzymes like ALT or AST or GDT. for the gallbladder. Give us a good look at what's happening in the liver from a conventional mainstream look. And then we can also do ultrasounds to dive in deeper. If we're concerned, that could be a problem.

Evan Brand: People may think you're just making stuff up. I feel like your Diet Coke or your. Well, I guess Diet Coke wouldn't have sugar to have aspartame. Let's just say Coke. Your Coca-Cola is hurting your liver. People are. Oh, now give me a break. How's that hurting my liver? Well, there you go. It's the non-alcoholic fatty liver disease due to the fructose in there. So it's good that you write down the connection, because if you talk to your average person standing on a street corner and say, hey, do you know that your coke is causing liver damage, they're going to like, no way. There's no way.

Dr. Justin Marchegiani: I know. It's really sad. And, you know, the end stage liver enzyme markers there, their end stage, they kind of come up a little bit late in the game. You know, we like to look at a lot of organic acid markers that can look at the to thighbone and can look at a lot of these for amino acids involves Bob and phase two detoxification or a lot of these antioxidants involved in phase one. So we kind of get a window into these things before there's a problem. But we understand the foundational physiology and we understand the imbalances and fructose is going to be a big one. All right. Fructose is gonna be a big one. So just keep that in the back of your head when listening. I saw two patients last week with fatty liver. So, you know, we're monitoring your insulin levels. We're keeping the fructose out. Just keeping it did not starchy vegetables. And we'll look at those liver enzyme markers and make sure we get them under control.

Evan Brand: And you can reverse it. I mean, we can absolutely different herbs that we use that are specifically for this whole hepatic system. And we've seen the markers turn around and people feel better and then they no longer have that diagnosis. So that's a good thing, is if you give the body the right nutrients and yes, you can you can heal it.

Dr. Justin Marchegiani: Oh, yeah. One hundred percent. I mean, it takes a little bit of a commitment, but you can definitely do it.

Evan Brand: All right. Let's move on. So we talked about all the top stuff. Let's go like midline area, like I guess you want called midline. You'd call it center of the tummy belly button area all around in there. Each side of the belly button.

Dr. Justin Marchegiani: Yeah. So let's go into that next. That's right.

Evan Brand: There's actually something I want to say. Let me look it up. Was it called Murphy's sign. Yeah.

Dr. Justin Marchegiani: With Murphy sign, that's going to be your gallbladder sign. OK. So like typically you kind of gum like this in school, they teach you come at it here with your fingers and you kind of go into the rib cage. So it's. So here's eye rotates you I'm pressing underneath and basically I'm breathing in. And as I breathe out. I'm working my fingers up there. And if it's if it's a gallbladder issue, you know, you're gonna season some pain into and tender feelings there. I mean, no one's going to use that as a full on diagnosis of a gallbladder issue. They're going to refer you out for an ultrasound. They're gonna run a metabolic panel and look at liver enzymes and gallbladder enzymes. And they will also maybe even do a high dose scan when they look at, you know, biliary flow as well.

Evan Brand: I like those old school tests. I mean, the history of that. Dr. Murphy, I mean, we're talking this was invented that Murphy sign was like the 1880s is when.

Dr. Justin Marchegiani: Yeah. I mean, if you look at old school doctors, old school doctors were much better clinicians than today's doctors because today's doctors, they just rely a lot more on lab testing and functional diagnostic screening like ultrasound or MRI or a CAT scan or X-ray. So there was a lot more functional tests.

Evan Brand: I mean, more hands on.

Dr. Justin Marchegiani: Yeah, a lot more hands on functional tests. I mean, how about the best one, man? How about the one? I mean, this is the one I think you should bring back for your clinic is when they were looking at for type 2 diabetes. Right. They would actually have the person pee in a cup and the doctor within taste it to see if there was any sweetness in the urine. Because diabetes mellitus had mellitus meant something like sweet tasting urine. So the clinician would actually taste the patient's urine to see if has any sweetness to it. How about that?

Evan Brand: That's a trip. I'll let you take that one. I'm going about the outside.

Dr. Justin Marchegiani: I'm going to start doing videos for you and get patients in, Evan will diagnose your diabetes lab test free.

Evan Brand: Oh, goodness, that's crazy. Now, there was another test. It wasn't Murphy's. Maybe you could remember this. I want to say it started with a C, as in Charlie around. You know, I took a course on some functional hands on Pål patients and it was around the belly button. Like there were different how patients you would do around the belly button. There was one of these other old school doctors. I want to say it was with a C, but I can't remember.

Dr. Justin Marchegiani: Right. Yeah, there's a couple. So there's like these points right here so I can apply kinesiology. On the left side was the hydrochloric acid point and on the right side was the enzyme. And how I remember it as HCL the L in HCL I think of left. So left then the enzyme one is the right. So could be one of those points. So if you kind of rub here and it's really tender, that can mean an HDL issue or you rub on the right side and it's tender. That could mean an enzyme issue. And again, I'm always giving hydrochloric acid and enzymes together anyway, but just food for thought. It's something to think about.

Evan Brand: Yep. Yeah. I don't have any in my mind. The school references with me, but it was pretty cool at least in person because you could correlate these different pain areas there on a on a palpation with a type of issue. So some of the students about oh yeah, I do have bacterial overgrowth and then you get that point. Oh yeah. You sure do. You're sensitive.

Dr. Justin Marchegiani: Exactly. Now if we go to the middle area, right, we have the upper quadrant right left was kind of a little bit more pancreatitis, some stomach gastritis, middle was more hernia, but still stomach and ulcers and then. Right. Was more kidney gallbladder area. Well, now we go middle row, the middle outside areas that could potentially be our kidneys. Now our kidneys are deeper. So a lot of times that that pain, that flank pain will emanate deeper in the back. So usually kidney pain will be more in the back. But on the front, you're gonna see potential any level of inflammation in the intestines. You're gonna see emanate at this level. All right. So if you had any issues here in the midline, this could still be pancreatitis issues. This could still be any type of bowel inflammation, Crohn's those to any type of bowel or such. Sorry. Any type of intestinal inflammation. Bowel typically refers to the colon. Any type of intestinal inflammation. You're going to see more midline in the belly button belly button just lower than belly button area. Once you go on the outside, this could easily be ascending and descending colon. So essentially the colon leaves on the left. So this is gonna be your descending colon leaves left and then your ace then in colon is the right, you have a transverse colon. But that's a little bit you know, that's a little bit deeper. And then as you go lower, you're gonna have protect your pelvic issues. So on the lower right hand side. This is gonna be where your appendix is. And then on the midline to left side, this can easily be deeper colon issue. So any type of ulcerative colitis issues, sometimes Crohn's, can affect the colon more. It's a small intestine, but sometimes it can stagger both and then you can have all this various colon pain, colon inflammation, diverticulitis, any type of gut inflammation that's colon base is going to be in this area. And then for some women, midline, there could be an Endometriosis in these areas, too. You're gonna see that tend to act up more around your cycle, though. So you have to look for timing of that. Acting up around your cycle. You could have and dimitrios issues, guys, that won't be an issue. But any type of IBS or irritable bowel or colon inflammation stuff like [inaudible] colitis or bottom right hand quadrant will be your Elio siecle valve and. Your appendicitis symptoms?

Evan Brand: Yeah, I mean, when I was a kid, my dad would be in severe pain and he always had his hand over on his left side over there and he ended up having to have some of his colon cut out. You know, he had really, really bad diverticulitis when I was a kid and ended up in surgery. They cut out like a foot, you know. So it just it sucked to see how much he suffered. His diet was just terrible.

Dr. Justin Marchegiani: Yeah. I mean, with diverticulitis, that's basically the little diverticulitis, literally little herniation out pouches where things can get stuck in their various foods. It tends to not be an issue until the bacteria goes out of balance in your gut and food becomes more inflammatory now it becomes more of a problem where like things like seeds or nuts can stick in it. And such tends to not be caused by those issues. But the more inflamed your gut gets from other diet and lifestyle factors, then those foods can cause a problem for sure. And obviously not not good enough healthy fiber can create colon motility issues. And if you can have stool impaction where that your your bowels aren't moving and then the stool gets backed up and can create pain and gas bubbles that way too.

Evan Brand: Yep. And if people hear a little tiger in the background, that's Dr. J's cat.

Dr. Justin Marchegiani: That's Dexter. I know. Hey, Dex.

Evan Brand: All right. So let's go to the low area now. So like low right side pain. I mean, I could have sworn I was having appendicitis one time. I mean, it was such a severe pain in my low. Right. I thought, OK, I'm going to die. It's appendicitis. Luckily, no, it was probably just my illegal sequel. Valot Because after I did some stool testing, I had some bacterial overgrowth problems. I also had some parasites at that time. So maybe we should talk about that kind of infection connection here. We talked about H pylori up at the top. Yes, infections could also be I mean really anywhere, but we're trying to be specific, but the low right area that to me is like a parasite area as well.

Dr. Justin Marchegiani: Yeah. Illegal siecle valves, a big one because that's where the small intestine meets the colon. So you have duodenum to [inaudible] Ilium. Those are your three parts of your small intestine. Duodenum is the top two genomes, the middle ilium the bottom. And then the ilium then goes to the colon on the right side. And that's the Ilium Siecle valve. Right. So it's it's cecum on the colon. Then it goes up to ascending transverse descending and sigmoid comes down and deep in the middle. Now in the middle, at the very bottom, this is where it could be a prostate issue, too. It could be a bladder issue as well. It could be a deeper ovary, ovarian cysts, endometriosis issue, as you know, if you're a female. So you gotta keep those different things in there. And, of course, like Evan was alluding to is anytime you have a parasite infection, these things can emanate in different parts of the intestinal tract and create inflammation. And there's no kind of, hey, this is the area where parasites go. They kind of have free reign. So just keep that in the back of your head. A parasite, if you could create pain in any of these areas and it's totally up for grabs.

Evan Brand: Yeah, we do know that giardia can affect the gallbladder. So I would just say as a general rule, if you're looking down on your right side. So under that rib cage on the right side, working down towards the appendix, that's where I had pain and I had giardia. So if you have infections, if you've had bad water, bad food, or you just most of your pain is localized to the right. I'm not going to say 100 percent, because that's not what this podcast is for. But that would say, hey, that's enough symptoms for you to justify getting some functional testing done, potentially an ultrasound as well. But in some cases, you may just need a really, really good DNA based stool test. We can look at these infections, come up with a protocol to address them and dialing in the diet and then that pain magically might just go away.

Dr. Justin Marchegiani: One hundred percent. Yeah. Always good to keep an eye on all those things. And that's why it's good that you work with a good functional medicine doctor, because food allergies can cause a lot of these problems, too. You're going to see more food allergies kind of emanate in the in the upper to middle quadrant areas. But sometimes you can see lower quadrant. I had a patient say without allergies. We're talking, what, gluten sensitivity, inflammation from gluten, inflammation from foods. But the most common ones are going to be grains, of course. And then you can see even dairy create problems. And then you have more of the autoimmune food allergies, which are going to be eggs and nuts and seeds. And those can create problems, too. And you're going to see them more in the upper and middle quadrants. But sometimes they can work their way down to the colon as well. It's possible. I've seen it. And like you mentioned, different parasites can work their way down there, too. And typically, just having bad digestion, you start to see that in the in the middle to upper quadrants, because usually it starts with poor hydrochloric acid and.

Evan Brand: The minus someone to tomatoes, peppers-.

Dr. Justin Marchegiani: Tomatoes, peppers, you know, all those kind of problems with digestion. You tend to see the first domino tends to not fall correctly in that first domino is not enough acidity and then not enough enzyme starting in the gastric tummy area and into the upper small intestine. So you start to see it here. It's very rare to have good digestion starting off and then it goes bad downhill. It tends to be how we start the domino rally correctly and then all the other dominoes kind of fall in place, so to speak.

Evan Brand: That's a good point Yeah. So just to say it in another way, the dysfunction will probably be evident at the very most north starting place. It's not you're not likely to have just a, you know, southern gut issued by going to start up here and down there. You may have problems as well.

Dr. Justin Marchegiani: Yeah. Where you see more Southern got issues. It typically is going to be going gonna be like a diverticulitis thing. A lot of times could be a parasite, could be an appendicitis thing. I've seen it happen, but just kind of a generalized rule of thumb. What I see on average.

Evan Brand: All right. Here's here's one thing that we forgot to mention, because there's probably a couple moms listening, screaming at us saying, oh, my God, you're not talking about diastasis recti. Oh, yeah, yeah. That's if you've had babies. Yes. You could have some scar tissue up there. Justins, somebody who educated me all about meile factual issues. And so there could be some meile facile slash scar tissue in that area as well.

Dr. Justin Marchegiani: Yeah. It's all about history. So if someone's just had a baby, that's different. Some of you know, the more cutting edge surgeons, they'll even put a couple sutures. And when they're taking the baby out afterwards or if it's a C-section, if they're going in for a C-section and they're already in there, they'll put a couple of sutures in. You know, in that midline just to kind of keep that muscle together a little bit, sort of and separate, basically, you know, imagine the Six-Packs, so to speak, the midline of the six-pack' kind of separates. And you can have a little bit of bulging there. And that's almost always gonna have a pregnancy history with it. For the most.

Evan Brand: I didn't have any babies, but I had that pain because I got-

Dr. Justin Marchegiani: Yeah, you didn't have the full separation where there was bulging out.

Evan Brand: No, I never had a bulging, but I just had a lot of midline pain that I felt could be related to hernia. But after I got an abdominal ultrasound, they said that I did tear the abdominal wall. And as I was using improper form, I was lifting super heavy kettlebells like 90 pound kettlebell as I was lifting those out of a crate to pack those up when I was working down in Texas. Yeah, just dum dum dum lifting heavy stuff in proper form. And I really did a number two to the abdominal wall.

Dr. Justin Marchegiani: Yeah, exactly. And then for someone like for you you're working on with a good mile fashion release or an active released person kind of breaking down that scar tissue and then you know, then you're working on better form with good abdominal bracing to activate that TBA kind of ahead of time. That's good.

Evan Brand: Yeah. So heavy lifting, people listening if you're into CrossFit or whatever else, you're lifting heavy rocks or crazy stuff, you know, make sure that you're doing it with proper form. I'll tell you, after having an abdominal wall injury, it man, it really limits what you can do. You don't realize how much you use your abdominals until you injure them.

Dr. Justin Marchegiani: One hundred percent. Anything else you want to highlight so far in regards to the abdominal area so far?

Evan Brand: I think you did good mentioning the bladder stuff. You mentioned the ovarian says as a possibility. What about fibroids, too? Would not also be kind of same area.

Dr. Justin Marchegiani: Yeah. So we have endometriosis is going to be basically endometrial tissue growth outside of the uterus. So you're going to see that could be on the outside of the uterus while it could be. Are the outside of the uterus. It could be on the bladder area. It could hit some of the intestinal area. So that could hit and some of that lower quadrant. And you're going to see that more flare up around pre-menstrual and menstruation time. So you're going to see a timing there. Obvious that's an apple, women only and then fibroids as well. That's going to be more in the uterine area. That's got to be right in that pubic bone area, midline. And because the fibroids can contract a little bit and if they're intramural fibroids, meaning they're kind of sandwiched in between the muscle, then you feel it a little bit more if they're subserosal. So what's in the uterus? If there are [inaudible] they're gonna be at the top. If there is one more time when they're on the outside, I think it's. Yeah, well, it's on the outside, so you'll just feel it a little bit more lateral, so to speak. OK. When you'll see it happen and you'll see it happen more around premenstrual leading up to bleeding too, during bleeding.

Evan Brand: Ok. That's important. A lot of women listen or so the inguinal hernia. I mean, yes, like I said when I thought I had a hernia, that was the area. They said, yep, you could definitely have a hernia around here. But luckily I didn't. But it's it's super common. So, I mean, tons of people are getting those mesh surgeries and then they're having tons of complications from those. So I'm not an expert at hernias or surgeries, but my limited knowledge of it says to do the mesh free if you're in the situation of a hernia in that area, a mesh free surgery. Sounds like there's less complications as doing the mesh.

Dr. Justin Marchegiani: with fibroids, it's a sub mucosal. Is that mucus lining inside the uterus? The sub rosell is more superficial, more on the outside just for any of the clinicians listening. Sweet. All right, cool. So we hit all the female stuff. Of course, ovarian cysts could be a big one. That'll be a little bit more lateral. All right. A little bit more outside. It'll be more right with the ovaries are ovaries are going to be a little bit lateral to the uterus. And that same thing will be timed up more on pre-menstrual and or menstrual. And you're going to only ovulate from one ovary. So it's typically going to be bilat. It's going to be typically unilateral. One side or the other won't be both sides at the same time.

Evan Brand: That's a good thing. Good point. Good distinction. OK. How about if you're ready? Why don't we talk about testing some of the things that we would do from a functional perspective? We mentioned the conventional already, like the ultrasound, abdominal ultrasound. Correct. You've got like a barium x ray scan where you drink a disgusting drink and they do an x ray to look for different issues in the upper stomach, like correct ulcers, which I had done at one point. But the functional testing, I think can help us and a lot of cases to look at the inflammatory markers, the gut barrier function, bacterial overgrowth. We could test for parasites and candida overgrowth. These things are key.

Dr. Justin Marchegiani: Yeah. I mean, you're going to have like your barium swallow radioactive drink looking at the esophagus and making sure everything's moving down that pathway correctly. You have a higher scan where they're putting something intravenous into your body that's radioactive and taking pictures and making sure everything flowing out the the bile docks and the gallbladder and all in that intestinal area is flowing properly. So it just giving you a window into that type of that part of the anatomy to make sure everything is moving appropriately. You're looking for obstructions, fistulas, just things that would prevent generalized flow. Maybe a tumor is blocking something. So they're trying to get a window into big picture of pathological things, maybe got maybe a gallbladder stone. Right. It could be causing the pancreas flow back up issues like I mentioned earlier. So you're trying to get a window into ruling out big picture physiological issues. And then, of course, we have things like the ultrasound, which can be used to look at the gallbladder area and the liver area to pick up stones or potential, you know, non-alcoholic fatty liver. You can even look at the kidneys a little bit, too, or even the prostate. It's gonna be a different kind of ultrasound, but yet you'll be able to look at those two. That's good ways to visualize it. Then, of course, you do have your generalized blood markers so we can look at glomerular filtration rate or bond or creatinine to get a window up. Is it kidney issue? If we're potentially concerned that could be UTI or a bladder infection spreading to the kidney. We can always run a urinary test like a microscopic urinalysis to look at various bacteria or white blood cells or things that could be affecting the urinary tract, bladder, kidney area. So those are all very helpful, too. And then gallbladder or boorish, prostate inflammation. There's your your favorite digital exam, right. Finger up the butt feeling for any inflammation or swelling. And then we can always do a PSA which may be nonspecific and then even do an ultrasound, too.

Evan Brand: Yeah. And then you may have to go further. You know, something like, yes, you're not test that we run, but like your C.T. scans-

Dr. Justin Marchegiani: Your MRI to look at these are going to be more to look at bigger picture growth, bigger picture stuff. And a lot of docs may just start off with that just because they want to rule out the bigger picture stuff right away. So you have a CAT scan and your MRI. What you're going to be big picture.

Evan Brand: And hopefully it doesn't go that far. But if you end up getting those things, sometimes you find bad things that you don't want to find tumors in different issues. So, yeah, I'm on the show.

Dr. Justin Marchegiani: And then we shouldn't forget about, you know, the generalized Kalinowski before endoscopy and ask to be camera down the mouth, colonoscopy, camera up the rectum to look for masses bleeding ulcerations and or just general and generalized inflammation. The problem with it is it doesn't tell you root cause, hey, you have gas. You have gastritis. Hey, you have inflammation in the intestines. What's the cause? Right. So the problem with a lot of these testing is unless it's acute like an ulceration or a big tumor, that's important to know right away. So it could be addressed. But most people it's an in-between kind of thing. And the root cause is address. And usually there's some kind of an acid blocker or pain medication or anti spasmodic or anti diarrhoeal or laxative. It's typically recommended to fix the problem, not mix it, fix it. Really, it's to manage it. Right. Most gastro docs are just once they've ruled out big picture disease stuff. They're primarily just managing symptoms for the patient. And then you got to deal with. Well, do you really want to have your diarrhea manage for the rest of your life or do you want to actually get to the root cause? You know, you have to weigh those things out. Most people want to fix the root cause.

Evan Brand: Yeah. They just that it's it's a revolutionary idea which it shouldn't be to find the root cause. 

Dr. Justin Marchegiani: Yeah I mean it's it's kind of like you got a flat tire do you want to manage it by riding on your spare the rest of your life or do you actually want to get a new tire and fix it happening. 

Evan Brand: Kind of. Yeah. I find mechanics are far more root cause than doctors. Isn't that interesting. And veterinarians same thing first question what kind of cat food or are they eating what kind of dog food are they eating that's like the first question. 

Dr. Justin Marchegiani: Yeah. The interesting thing someone said was that there was a mechanic and a doctor. I don't know. Well the mechanic actually gets to turn the car off. The doctor can't. The car's running all the time. You know as the clinician. Right. So you get a big advantage when you get the turn the car off.

 Evan Brand: Yes it's true. All right. So speaking of heartburn drugs then I want to make a comment about the endoscopy. So CBS over the weekend pulls Zahn tech and similar heart bug heartburn drugs because of the cancer concern. So time and time again I mean over the last year you and I've kind of watched this thing unfold with all of these H2 blockers these PPIs continually getting recalled and pulled off the shelves due to cancer links and so they're saying Oh well a study said you know there's no markedly increased risk of cancer. Basically they don't have a clue. They don't know. There's some studies they're saying Yep cancer from people die. Some are saying maybe some are saying we don't know we haven't had a long enough trial. So once again though it's not root cause. So rather than debate whether or not acid blockers cause cancer or not figure out why the heck do you need an acid blocker in the first place what's causing you such bad gastritis in the first place. Maybe it's an H pylori infection. If you fix that you won't have to worry about am I taking an acid blocker that causes cancer or is this a safe acid blocker. So that's my comment.

Dr. Justin Marchegiani: And then and I'm not against acid blockers in general for for real acute stuff. It can be very helpful. But I only want to use it very acutely as we get to the root cause and put out the fire. You know I'm OK if it's a quick stopgap measure. But the problem is once you're on it and you're not getting to the root cause and that tissue stays raw it's hard to get people off it. So you just gotta keep that in mind. We want to have a root cost perspective but we don't want to be so anti-drug where you know maybe these medications could be helpful for a day or two or three to get you through to the next step. But most people aren't using it as a stopgap. They're using it as a a lifetime crutch. So it's kind of have the right mindset when you go into these things. I don't think you have to be totally puritanical. Although if I have a heartburn episode which I typically don't I'm using enzymes first and then I'm using more natural kind of soothing things seconds but if I needed you know if I needed to do a little bit of baking soda the chill things out I would and I could if it was affecting me from sleeping but I have my first line therapies that are more root causal that address the issue first. So we got to keep those in mind.

Evan Brand: Yeah the problem is when you get on those prescriptions there's really not an end game it's not like Hey just PPI for a week it's kind of like OK here's your PPI I'll see you in six months and there's no discussion of when are we going to get off of this. How are we going to get off of this. Is that a weaning protocol as we reduce PPIs or are we going to increase HCL. None of that's discussed. And then my comment on the endoscopy is that there is a big problem with these scopes not being cleaned properly.

Dr. Justin Marchegiani: Yes that's a big issue. Yes. Dr. McCall had a guy on this topic. Yes go ahead. 

Evan Brand: Yes. So the problem is you go in to get a routine procedure like an endoscopy and then you leave the hospital with some type of a clot. They call it an H A I , a hospital acquired infection. Yep. And that's crazy. So it's like OK I'm going to go in and just get the scope done. This sounds fun. And then you leave and then now you've got some major infection that could really affect your health. So I'm not against the endoscopy I think there's tons of things that have been helped by using those but man it's not going to be my first thing. 

Dr. Justin Marchegiani: One hundred percent. So we've got to keep that in mind. And also one more thing I wanted to mention there. We talked about endoscopy. We talked about coitus. Oh yeah. One more thing. So a lot of people that have got issues meaning middle to upper quadrant pain especially midline or to the left a lot of times are some high level of inflammation in the gastric area or the gut the stomach right now that inflammation a lot of times gets better with some level of stomach acid hydrochloric acid but you have to be very careful because some people their gut lining is worn so thin they may need stomach acid but they can't handle stomach acid. In other words any of my patients listening. Give us an analogy all the time. Imagine you have back pain but you went out and laid on the beach two too long that day and got a sunburn. So now you need a massage. You need a good adjustment but the superficial pain on your skin from sunburn is making the therapy much more uncomfortable to bear the massage or the adjustment. So some people need to calm things down in the gut before they can actually get that good acid support. So you have to figure out you that person with back pain in the sunburn and we have to handle things a little bit differently so most people may hear this and just jump on the hydrochloric acid bandwagon and they may have negative symptoms so be very careful. I strongly recommend that you're doing this under the guise of a good functional medicine doc. And if you have a conventional medicine doc make sure you just keep them in the loop. They know what's going on.

Evan Brand: Yeah. Well said so there is a right place and a right time for specific nutrients for example the HCL you mentioned also like probiotics people may say oh I've got gotten got bloated and gassy. Yeah I'm going to go get probiotics and then they have a bad reaction and they come to us and say Hey why did probiotics make me feel like crap in our answer as well. Because there's a right place at the right time and based on your particular picture that we've identified using functional testing like organic acids and GI map stool testing and other functional tests. This is not the right time or the right place. So we'll paint that timeline of like OK. Yeah HCL is good. But first we're gonna do a month of healing support then go to HCL then use antimicrobial herbs then possibly bring in probiotics. But if you mess with that order or if you just hear the buzz word or the what you call like click bait. Probiotics are good HCL is good. You try to self medicate and you feel worse and then you don't know why.

Dr. Justin Marchegiani: Because I'm the king of analogies I'll jump another analogy I love analogies because it just it hits you. You never forget it. You're trying to you're out in the garden right. You're throwing down seeds before you did weeding. All right. Hey you tried to get your car wax before you got it washed right. There's an order in which you have to do things. So you try to put in add more beneficial bacteria to your gut and you've got a whole bunch of bad stuff already there. So there's a sequence that involves cleaning and getting things under control before you go to that next step. And how do you know it's because you tend to get bloating your gassy or brain foggy and don't feel good with probiotics and if you're that person then you know how and why.

Evan Brand: Yep. I was one of those guys I'd try to take probiotics and I failed miserably and I had tons of stuff wrong with my gut. So I had to go backwards and oh I did a wrong order and this is just experimentation. You know I've experimented with plenty of different things and people send us stuff to try and no not the right time. So I had to clear out my gut bugs first and then do probiotics and I was fine. 

Dr. Justin Marchegiani: Correct. Yep. Hundred percent man.

 Evan Brand: I think that's I think that's all that we need to talk about I didn't mention the functional test. I don't know if you wanted to say anything else about potentially doing like breath testing for SIBO or H Pylori.

Dr. Justin Marchegiani: Oh yeah his great great question. So let's kind of work down so we have our generalized breath test. The glucose breath tests will be more for the stomach and the upper intestinal tract the lack jello so be more for the entire small intestines. Those are your your big breath tests as are your rear breath test that's more experimental. But we have the glucose in the lab to those that are primarily on the breast side right now. Then we have a really good stool test different companies out there bio health makes up for when H Doctor's Data. There's a three day sample with an H Pylori. We like a lot of the diagnostic solution laboratory ones the G.I. map stool task We'll put links below in case you guys want to grab one of those. So we like those will also potentially run some blood markers for antibodies for H pylori will may even run at specific H pylori urea breath test that looks at CO2 in response to H Pylori. We may also look at organic acid tests that look indirectly at urinary yeast [inaudible]. Or we may look at bacterial markers in the urine like two three fennel acetate hip Ray indicating various urinary markers of dysbiosis. So we have those for the gut which are really helpful. And then I would say is there anything else you wanted to add. I hit it all. 

Evan Brand:  I think that was it. You mentioned the stool testing like I alluded to earlier. We're primarily looking for infections on there so the bacteria rack growth. Sometimes we find certain infections on organic acids testing that we don't find on the stool and vice versa sometimes like for example the stool testing is not very good for finding Candida but the urine is very good for finding better for candida for sure. Yeah. And then with the stool that's where you're going to find more infections like bacterial problems sometimes the urine tests miss it and then I already mentioned like the mucosal barrier. We'll look at measuring gut function gut inflammation on the stool. So really with urine and stool we can do a lot. But there may be a point where we do have to say hey you've got to get an ultrasound. You know there is a purpose and a point to the conventional diagnostics. I'm not against them but-.

Dr. Justin Marchegiani: I typically recommend all people that have any acute issue you know get your conventional M.D. to kind of sign your first. It's always good because then you kind of know care. You know the big picture stuff we're not missing it we're on the right track and then we can go see Dr. J or Evan to dive in deeper at more cost stuff. Also I wanted to highlight one more thing you were just mentioning there. You were just talking about the ultrasound you're talking about. Oh yeah. One more thing. So I see a couple of patients that have a lot of Candida issues and sometimes I'll even order a full spectrum Candida antibody so I'll run IGG IGM IGA .. I found a person with elevated IGA antibodies for candida. So it's good to have those looked at because then you can get a window into the systemic immune activation of the immune system going after Candida. It's good to know that.

Evan Brand: Oh man we didn't even talk about mold yet. I can't tell you specifically where the pain would be in your stomach. But Dr. Richard Shoemaker one of the guys has been treating mold illness for like twenty five years. One of his symptoms that he's come up with is abdominal pain. And so J.W. who's been on the podcast from immunolytics he's spoken many times to me about his daughter his his daughter and when she would go into a moldy building her and her mother both would have abdominal pain and that was their cue to leave. Oh it will be like bending over in pain when they leave the building. Their pain goes away. So that's another like unique symptom and then we forgot to talk about the spleen a little bit. 

Dr. Justin Marchegiani [00:11:21] Spleen that to be in that upper left hand corner too but don't like.

Evan Brand: Lyme and co infections though if someone has Lyme disease or co infections it can affect the spleen. And so if you had like a slightly enlarged spleen that could cause pain. So we may be looking at doing some blood or urine testing for Lyme and co infections as well because that's one other thing that most practitioners are going to miss. But I've seen be very very helpful.

Dr. Justin Marchegiani: Yeah I mean you'll see a lot of spleen stress with like Epstein Barr so knowing if you have any Epstein Barr issues increased chance of spleen rupture and then of course you know you're going to see potential lower immune markers lower red blood cells where you can't figure out why you know it could be a spleen issue going on there a bone marrow actually where you're not making enough of these good cells of course just traumatic issues right hits and stuff car accident spleen ruptured spleen is really important. That's going to be the recycling cavern for a lot of your red blood cells. That's good in a lot of immune cells are made there. Excellent.

Evan Brand: I think that's it. That was the only missing piece I believe.

 Dr. Justin Marchegiani: Yes everyone's list. If everyone's listening here and I'm really enjoying it then something resonated with you. Put your comments down below what did you like. What experience have you had with specific abdominal pain what helped it. What was the root cause for you. And if you're enjoying the podcast give us a share and a thumbs up boost up that YouTube algorithm and allows more people to get access to the information and share it with one person you know that could benefit if anyone wants to dive in deeper and they're like yeah I'm a little bit confused. Hey that next step will be. Click below and schedule a consult with myself or Evan and we'll be there to help you and guide you in the process and you Evan. A major issue. Get it rolled up by your conventional M.D. first and then reach out and we're happy to dive in deeper at the root cause level.

Evan Brand: Well said. So check out the website. JustInHealth.com for Justin. My website is EvanBrand.com. And we'll talk with you all very soon.

Dr. Justin Marchegiani: Excellent you guys have a phenomenal day. Take care. 

Evan Brand: I'll see you later. 

Dr. Justin Marchegiani: Bye.

Evan Brand: Bye.




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