Enzymes and digestive support – Dr. J and Evan Live Podcast #127

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Dr. Justin Marchegiani and Evan Brand discuss about enzyme, its uses to the body, as well as its impact on digestion and overall health. Listen to them as they go into the enzyme mechanism related to gut issues such as infections and heartburn.

Know about the acidity levels that may have positive or negative effects to one’s digestion. Gain valuable insights regarding the different topics asked by the listeners which include hiatal hernia, PPIs, and antibiotics. And learn more as these functional medicine experts share their knowledge about diet and supplements that have huge effects on enzyme production and stimulation.


In this episode, we cover:

2:13       Enzyme Production

6:10       Gut issues and heart burn

12:30     Symptoms involved with enzyme and acid issues

24:05     Hydrochloric Acid (HCl)

30:05     Types of enzymes

35:48     Antibiotics and gut health

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Dr. Justin Marchegiani: Hey there! It’s Dr. J and Evan today. We got an awesome podcast. It’s a great Friday. We are live, too. So anyone’s that tuning in and wants to get some questions asked and/or answered, we are stoked to be able to do that. Today’s topic is gonna be on enzymes and how they can be used therapeutically to help with digestion and to overall improve your health. Evan, what’s going on, man? Happy Friday.

Evan Brand: Happy Friday! It’s beautiful here, the trees are blooming. It is freezing, though. We went from 70° to like 30° so – uhm, hopefully spring is coming because I’m ready to get outside again as soon as possible and go for an extended distance hike.

Dr. Justin Marchegiani: Got it. And people on Facebook here, if you’re not hearing Evan , do your best to head over to the YouTube channel. YouTube.com/justinhealth and click on the live view so that you can see Evan’s beautiful mug staring back at you and get your questions answered. I’ll try to be able to answer questions on Facebook as well as YouTube. So feel free and ask.

Evan Brand: Perfect. So enzymes – where should we start? I mean this is the importance of health; this is the – this is important for longevity; this is important for preventing or reversing disease because you’ve got to build a breakdown of foods with enzymes to be able to actually absorb the nutrients. Time and time again, you and I run organic acids panels on people where we look at amino acid metabolites and we look at these other biomarkers where we find that people are just not digesting their food and they’re not absorbing or assimilating any of their nutrients despite them spending hundreds of dollars a month on food, and organic food. Or they are on AIP diet, and they’re buying grass-fed beef and organic veggies but yet, they’ve got all these symptoms because they have low enzymes. So they could have hormonal imbalances; they could have fatigue; they can have excessive hunger; they could have sugar cravings and carb cravings all which could be tied into this enzyme deficiency because they’re just not breaking down their food; they’re stressed; they’re not chewing their food well. We’re kinda break all this down today.

Dr. Justin Marchegiani: Absolutely. I love that. So off the bat, let’s talk about how your body can actually make an active enzymes first. I think that’s a really important first step. So enzymes are primarily gonna be stimulated through the digestive processes and primarily the parasympathetic nervous system. So the more your nervous system is parasympathetic, right? That’s the – the rest in digest. The more you’re gonna have a nice low pH in your stomach. You’re gonna have gastrin stimulated. All these gastric juices uhm – coming about. That’s gonna lower the pH coz a lot of enzymes are actually pH driven. So if we don’t hit that first domino of parasympathetic nervous system stimulate the nice low pH and the nice low pH is from hydrochloric acid. Hydrochloric acid kinda also has the sterilising effects. So if you get some bad, kinda junkie food in there, it’s gonna have like an effective taking maybe you some bleach and putting it on a public pit. It’s gonna help clean it up. So it’s gonna be more sterile environment. So think of hydrochloric acid as like a bleach in your tummy. And also activates the proteolytic enzymes. It starts with pepsin, it takes pesinogen to pepsin. So it gets the digestive enzymes going. And that nice, low pH, all that food gets mixed up with the hydrochloric acid and eventually goes down in your small intestine at least as chyme. And then it stimulates the pancreas to produce more enzymes in the gallbladder to produce more bile which will help with fat. So that’s kinda first domino reaction and it starts with the parasympathetic nervous system response, and it starts with having good hydrochloric acid levels. Now, one thing to talk about here, “How can we stimulate our own juices?” Number one, chewing your food well is gonna be super important. Making sure you really chew, one chew per tooth is a pretty good rule of thumb. Number two is making sure you’re in parasympathetic state – not eating and not being on the go or eating when you’re in the car. Have a good relaxation kind of state. Number three, making sure you’re hydrated coz a lot of the digestive juices come from the liquids that you eat. And then number four, not consuming water for the sake of hydrating while you are eating.   The more you consume water while you’re eating, think about it- water has got a pH of 7. 7 is going to take the pH in your gut at 2 and bring it up close to the 7. So these enzymes are pH driven. So the lower the pH, the more the enzymes are activated the more water you drink in the meal, the more you dilute the enzymes that are already there, the more you raise the pH and you deactivate future enzymes from being produced. What do you think, Evan?

Evan Brand: Yeah. So people wanna know the number about the stomach. It is very, very acidic. 1.5 sometimes 1.2 to 3 is the range of the pH. I mean this is so intensely acidic that if you opened up that HCl out of your stomach and put it on your shoe, it would melt your shoe into piece.

Dr. Justin Marchegiani: Absolutely.

Evan Brand:  You’ve gotta have that. And I wanna just repeat that because you said it well, but in order to activate pepsin in your other enzymes to break down the protein, you’ve got have an acidic enough stomach. You’ve gotta have enough HCl production.

Dr. Justin Marchegiani: Absolutely.

Evan Brand: And so you’ve got have parietal cells in there that are making the HCl. But if you’re in sympathetic fight or flight mode because your body thinks you’re running from a bear even though it’s just running from email, or you’ve got a bad boss, or you’ve just got some bad news, or you’re eating during a meeting, or you’re eating at your work desk. You know these are all things that are not going to trigger that –

Dr. Justin Marchegiani: Totally.

Evan Brand: You’ll be setting yourself up for you know, tummy trouble. And we can talk about some of the implications of what happens if you have this hypocholorydia state which is a low stomach acid state that basically set you up for infections and things like that which we’ll get into.

Dr. Justin Marchegiani: And again, we got questions coming Facebook and I apologize. People on Facebook are only seeing one side of the conversation here. But – Hey, Steve, how you doing? Off the bat with the gastric ulcer situation. If people have an ulceration or have gut lining issues in the stomach, one of the first things we do off the bat, if we know that history is present, we’re gonna use gut healing and soothing nutrients first. We’re gonna use bone broth, we’re gonna use aloes, slippery elm,  deglycyrrhized liquorice, L-glutamine and we’ll kinda coat that stomach there. We’ll make sure the food is well broken down. We may even focus more on the GAPS kind of approach. And add more liquid soups that are really easy and palatable. And we may focus more on enzymes first. Now depending on how someone is doing, how sensitive the gut is can be a good measure of how the gut’s healing. That’s a good sign. So you can start with like a 6 to an 8 to a quarter of the teaspoon of apple cider vinegar with food. Now if you’re gonna add any acids in, you can start with light acid such as Apple cider vinegar, and/or uhm – just plain old organic lemon juice and do it with food because if the stomach is empty, it’s like someone touching your raw sunburnt skin. It is gonna be more sensitive. Put a little food in there, do a nice gentle, very low dose of acetic acid, whether it’ in uhm – apple cider vinegar or citric acid in the lemon. That is a really good step. Quarter of the teaspoon and upwards and gradually work your way up. If that’s good, once you get a full tablespoon and have no problem with food, we can transition you to an actual hydrochloric acid tablet with pepsin. But in the interim, healing, soothing nutrients, and then we taper. We focus more on the enzymes in the HCl because they are less abrasive.

Evan Brand: Let’s back up a bit. Let’s talk about symptoms people may be experiencing if they need enzymes or if they are in this hypochlorydia, low stomach acid state. So I would say, any type of burping or gas after eating, that tells us you’re not breaking foods down.

Dr. Justin Marchegiani: Huge.

Evan Brand: If you’re a vegetarian or a vegan in the past, a lot of times people go vegetarian or vegan because they say they’ve lost the taste for meat. But in many cases, that just because they don’t have enough stomach acid to digest meat.

Dr. Justin Marchegiani: Exactly.

Evan Brand: And so meat is bad for you, but it’s not. Heartburn – a lot of times people have heartburn but it’s actually too low stomach acid not too much. You’ve got that valve at the bottom of the stomach and it’s kinda regulator. And if your food is not broken down, your body’s smart, it doesn’t want undigested food in the intestines, so if it can’t go down, it’s gonna leak in one place which is up. What about the uh – lower esophageal sphincter? Can you talk about that maybe from like a chiropractic perspective? About how that valve can get stuck open. I mean, can adjustments and massages or stuff help that? Or is that more internal work has to be done?

Dr. Justin Marchegiani: Yeah. I mean you have different issues with the various sphincters that go from the esophagus into the stomach. And then obviously, the stomach into – hold on, one sec. I’ve got a little _ right here. I apologize for that. Okay, so regarding that – you have different sphincters that go from the stomach to the small intestine,  from the small intestine to the uh – large intestine. And obviously from the esophagus into the stomach. So the key elements here is we have to make sure the first domino is gonna be the esophagus to the stomach, right? If we don’t have enough acidity, what happens is that esophageal sphincter is they open. So this is one of the major reasons why stomach acid actually helps a lot of people with heartburn. It helps two ways. The esophageal sphincter gets tighten when there is enough acidity. And then number two, food will rot and putrefy and ferments and organic acids will rise up from the food. So if there’s not enough acidity, initially, that esophageal sphincter may stay open, food will rot and then those acids will rise and burn the esophagus. So 2 mechanisms: tightening of the sphincter and the breaking down of the food. If we don’t do that, it rots. So that’s step number one. Step number two, food goes from the stomach to the small intestine. If we don’t have enough acidity, then we’re not gonna trigger the bicarb release from the pancreas when it goes from the stomach to the small intestine. We’re not gonna trigger the gallbladder and we’re not gonna trigger the uhm – the bile salts. Number three, it goes from the small intestine to the large intestine. If we have dysbiosis and low stomach acid and low enzyme environments, we can have ileocecal valve patency where this  is kinda the first mechanism of SIBO or the bacteria from the colon will start migrating its way back up to the small intestine and then we start getting all kinds of extra methane and hydrogen gas is increasing. And that’s gonna create more malabsorption, more diarrhea, more constipation, more of those IBS kinda sequela. And then –

Evan Brand: I wanted to ask you one thing. I know we’re – we’re a bit biased because of the people that are coming to us typically they’ve been to 5, or 10, or 20 different practitioners –

Dr. Justin Marchegiani: Yeah.

Evan Brand: Before they get to us which is mind blowing and it’s an honor. What percent of people have a low enzyme state, low stomach acid state, therefore potentially SIBO state? I mean, you and I see bacterial infections. I’d almost say it’s 9/10. But I wanted to see what your number is.

Dr. Justin Marchegiani: Yeah. So how many people 9/10 here or out of 10 here do we have bacterial infections? I would say at least half of some type of digestive issue minimum. Uhm – I would say out of the general public, I would say the people that see us I would say a 100% have some level of a gut issue. Even if someone doesn’t know it because – people come, let’s say they don’t have a gut issue, let’s say it’s hormonally driven. If it’s a female, it’s gonna be PMS or mood issues or fog. If it’s a male, it’s gonna be uhm – energy, focus, endurance, exercise, muscle mass, low libido. Again, those issues can be affected by the gut and a couple different mechanisms. And kinda tying it back to enzymes, we always go on our diets here. But if you have enough enzymes and digestive capacity, all the nutrients that make up all the brain chemicals which help us focus and think and deal with stress, also the nutrients that help become our hormones. So the cholesterol and the essential fatty acids they’re gonna become the precursors to our cortisol and our sex steroids. So if we have any digestive issues, any of that could be thwarted by low stomach acid and enzymes. We’re not gonna have the building blocks that we need to – to build a healthy chemicals to help us feel good, deal with stress and inflammation, help rebuild our body.

Evan Brand: Yeah. Just to zoom back out, this cascade, this domino effect you’ re discussing could all happen from you scrolling on Facebook while you’re sitting down to eat your lunch.

Dr. Justin Marchegiani: Totally.

Evan Brand: And that’s the important part. So I wanna go back and just mention a few more symptoms of people that you have a need for enzymes and/or increased stomach acid. If you got undigested food in your stool, that’s an easy one. If your stool is floating, that’s an easy one because we know therefore, that the bile is likely not getting secreted potentially due to a low fat or too low-fat diet. So therefore, you’re gonna have that issue. Uh – also fingernails. So Justin and I, we talk a lot about fingernails. So if you’ve got chipping, peeling, very brittle fingernails, you’ve got ridges on the nails, that tells us that digestion is not good. You’re not getting these trace minerals from your food. Uhm – and then last one, we could just say anemia, right? Because if somebody’s got low iron or ferritin levels, we know that they’re eating grass-fed beef or bison or elk and all these delicious foods, but you’re not  rice and help knowledge delicious foods but you’re not cleaving off the iron and so you gotta have a lot of acid to do that.

Dr. Justin Marchegiani: 100%. Couple of just to kinda piggy back on that, you have the fingernail issue, if you run your finger across the other finger, across the arch of it, if you have that’s relatively, you may see some tiny, tiny lines but when you run on your finger, it should be smooth. You shouldn’t see any white spots or little speckles on the finger. That’s a sign of zinc deficiency. Your nail should be relatively strong. If you push it straight down on an axial low position, it shouldn’t really bend. It should stay pretty straight, pretty strong. People that have issues with this, their nails will start to peel. Those are to be more brittle and weak. You’ll start to see vertical ridge and white spots. That’s gonna be your first kind of sign that you’re not quite digesting protein, fat  and obviously ionising your minerals especially zinc. That’s number one.  Number two, in females, it’s super common, it’s called uhm – keratosis pilaris. So if you look on the females, back in their arm, the tricep here, like this are of the tricep, you’re gonna see this like little dots, like this reddish kinda spots. And this is called uh – Keratosis Pilaris, typically from essential fatty acid deficiencies. And a lot of times if you don’t have enough hydrochloric acid and enzymes, that will show up. So you – you know, you walk through airports or see lots of people, you’re gonna see that commonly on a lot of females’ arms, especially birth control pills can exacerbate it more.

Evan Brand: Why?

Dr. Justin Marchegiani: Uh – because it affects digestion.

Evan Brand: Oh – yeah. And my wife for example –

Dr. Justin Marchegiani: And it affects nutrient deficiencies, too. B vitamins, minerals and such.

Evan Brand: So I’ve got two personal anecdotes to what you’re talking about. So when you first looked at me, you say, “Evan, you’ve got a parasite.”

Dr. Justin Marchegiani: Uh-hmm.

Evan Brand: And you said I had two parasites and my nails were terrible. Now they start to get much better because I’ve cleared the infections and now I’m supplementing with enzymes like – you know, it’s water. I love them. I’d take them with every meal. Uh – but also, my wife, when she was on birth control pill as a teenager, she had major Keratosis Pilaris on the back of her arm.

Dr. Justin Marchegiani: Huge.

Evan Brand: It was crazy. I mean –  massive amount. And she thought that, “Oh, my mom had it, so I should have it.” No, that’s not the case. And so now, with the fish oil –high potency fish oil, the enzymes and then making sure the gut’s healthy, it’s gone and it’s amazing.

Dr. Justin Marchegiani: Yeah. Typically, the birth control pills gonna affect the pH uh –in the – in the intestines primarily the urinary track. That’s one the big things you see with females on the birth control pill. You see increase in yeast infection. They’re gonna affect pH and that vaginal kind of environment. and obviously it can have an effect in the gut, too. So the more you uhm – negative competing opportunistic microbes to kinda  invade in there, they’re gonna the shift the environment to be more favourable to them. And that’s gonna take away from the digestion capacity. And the more your digestion is down, harder  to breakdown those proteins and fats and ionised minerals. And then you can start getting those deficiencies. That’s why B vitamins, and minerals, and essential fats one of the first deficiency you’ll see on birth-control pill. So tying it back in here, enzymes are super important. Couple of questions from uh – YouTube, pH – like the whole idea pH, I mentioned, people say you wanna be alkaline, the question is where? Where do you wanna be alkaline, right?  With the stomach, you wanna be very acidic. In the stomach or in the small intestine, you wanna start becoming alkaline again. As you go back on the colon, you’ll start to be a little more acidic. The urine typically is gonna be a little bit more acidic coz you’re putting more acidic waste out through it. Uhm – you’re gonna have bicarbonate that’s gonna bind with uhm – CO2 in the blood to help rid of the CO2. So you’re breathing out acid via the CO2 and making bicarbonate in the blood. So a lot of pH regulatory systems that are happening. The biggest thing that’s gonna affect pH is inflammation. Inflammation is gonna have an effect on pH a hundred to a thousand times greater than your diet. Uhm – you’ll see –

Evan Brand: Say that again.

Dr. Justin Marchegiani: Yeah. Your pH is gonna have about a 100 to a 1000 times more of an effect because of inflammation due to your body, not because of your diet. Now you’re diet – you can have inflammatory things in your diet such as grains, excess sugar and trans fat, but again, meat – people meats are acidic, right? About 5 or so on them. 5- 5 ½  on the pH scale which is logarithmic. But grains are 10 times more acidic than, let’s say meat. And if you listen to my podcast it will be coming in a few weeks with Doctor Robert Rakowski part 2. He talks about that apect. That it’s the inflammatory things in our environment that are creating far more acidity than our diet. But again, healthy green, organic vegetables in every meal, you should be totally fine from the pH perspective and then getting some good extra minerals in your multi-support whether it’s magnesium, potassium, calcium. Those extra buffering mineral should – you should be buying.

Evan Brand: Let’s also bring up alkaline water and how big of a scam and ridiculousness it is to do alkaline water if your goal is to have optimal digestion especially people drinking alkaline water. They buy these expensive machines were they’re pumping of 9 or 10 on the pH scale of water.

Dr. Justin Marchegiani: Yeah.

Evan Brand: You’re drinking with the meal. I mean, you’re setting yourself up for failure. Now, could there be some type of therapeutic benefit of alkaline water by itself? I don’t really know maybe you’ve got some advice on that. But for me, I’m gonna go with a good spring water or a good reverse osmosis water with trace minerals back in like you do. I mean, for me, the alkaline water, it’s just been debunked so many different places and it’s not worth even talking much more about.

Dr. Justin Marchegiani: Yeah. I’m not a huge fan of alkaline water. The question is anytime  someone sells me an alkaline water, I’d say, “What are the buffering minerals that you use to make it alkaline?” And typically, they’re like, “What?” Coz if you got just a really good clean water, I mean, just adding some good-quality electrolytes or a little pinch of high-quality sea salt with the spectrum of minerals, you’re probably gonna be pretty good and that may raise the pH up a little bit. But I’m not concerned about getting up – you know, having super, super alkaline water. I’m fine with drinking water that’s clean  and filtered. Infuse some minerals back and I will have a little electrolyte solution. I’d put my reverse osmosis water filter, so I’ll put a little bit of minerals in there first thing in the morning. Or I’ll just – I have a little salt shaker there, too. And I’ll get some extra minerals. And that way,  1 to 2 glasses in the morning, one to two big glasses in the afternoon with infused minerals and just salt my with – with good Celtic or like typically like real salt better just for flavour variety. But that’s a good way to get the minerals. Not a huge fan of you know, these crazy expensive water machines that are alkaline. I think the really high-quality filters are better. And uhm – I  like things like Pellegrino and natural sparkling water too because of the extra sulphates that are in there which is so good for detoxification, too.

Evan Brand: Yeah. So, I wanna ask you, chicken or egg question and then we can probably hit some of these YouTube questions about the hiatal hernias and HCL supplementation, all that.

Dr. Justin Marchegiani: Yeah.

Evan Brand: It’s hard to say, did someone get a low enzyme, low HCL state, which then led to undigested food particles, which then were to intestinal permeability or leaky gut, which then set them up for SIBO or parasite infections? Or did the infection come first? Like I told you about yesterday. I had a little four-year old girl that had her stool test back and she  had two parasites. And it’s like – being that young, we would assume that HCL and enzyme production would be pretty good, being a tiny little kid. But, she had tons of rounds of antibiotics. So it’s like chicken or egg. Was it the HCL and enzymes that got low that did set her up? Or was it just the decimation of the flora via about antibiotics that didn’t set her up for infections? Which one do you think it is?

Dr. Justin Marchegiani: Yes. When it comes to infections, there’s a couple of  scenarios how that happens. Number one is your stress. Your immune system is compromised and you get exposed to some infectious debris. And your IgA, your enzymes and hydrochloric acid levels are low and you can’t – you can’t quite – uh, you know, uh – knock it out. It’s just kinda like you leave the drawbridge down in the castle, you’re flying around the Star Trek ship and the force fields are down. So invader can come in, the Klingons can attack, right? Those are my analogies. Now that’s scenario number one. Now scenario number two is you’re relatively healthy and you just get exposed to a large bolus of infectious debris, right? You’re hanging out and you’re drinking some water in Mexico. You’re on the beach in Bali, you’re out in uh – Lake Austin, like I do and maybe someone water comes in your mouth, and you get some GERD, right? So those are the two major scenarios. And it’s – number three is uhm – I would just say food vector, the compromised immune vector.Those are gonna be the two biggest ones. There’s a couple of out there – ones and that’s gonna be the animal vector. You’re just getting exposed or you’re letting your animal lick your face all day, and you’re just not even – you’re not connecting the fact that your cat may have crypto and now you got the crypto infection. Or I’ve seen it with dogs and GERD is super, super common.

Evan Brand: What about this question here about, “Can a hernia cause hypochlorhydria?” What’s your experience from a chiropractic perspective on hiatal hernias? Can you fix those chiropractically? And will that cause low stomach acid?

Dr. Justin Marchegiani: So regarding hiatal hernias, and I just posted a link online for people on YouTube or Facebook that wanna see the full, kinda dual side of it. We only kinda do my side with the technology that we have here. But regarding hiatal hernia, in my opinion, if you’re only fixing a symptom of the hiatal hernia, if you’re doing a chiropractic adjusment for it. Now I think that’s fine because it palliative, it’s natural. You know, what’s the risk to reward? Very little risk, only reward. We just wanna fix the root cause. And typically that’s gonna be getting the inflammation vector away from the intestines.  Once the inflammation is better, the nerves that go to those muscles won’t be sending the inflammatory response that’s creating that tightening. It’s called the viscera somatic reflex. Visceral is organ; somatic is muscle. So the organs and muscles  are on a two-lane nerve highway and the more those nerves are stimulated, it’s like the more you do bicep curl, the bigger your bicep gets, the tighter, tighter it gets, right? The more stimulation that goes to that area that’s like pain, the more it can pull that stomach up above the diaphragm which is based the hiatal hernia.

Evan Brand: Wow.

Dr. Justin Marchegiani:  You pull it down, but then you wanna make sure you get to the root cause. Inflammatory soothing nutrients, fix the infection, fix the ability to digest the food.

Evan Brand: Okay, good. You answer the question. So you can help with physical adjustments of hiatal hernias but you also gotta be working back to the root cause to make sure it doesn’t just pop back.

Dr. Justin Marchegiani: Exactly. That’s the key thing.

Evan Brand: Okay. Here’s another question then. Uhm – “When can you start minimising HCL?”  He’s been taking them for three months. So I guess the question is – is there ever a time where you stop taking them? And I’ll just go ahead and give my two cents first, which is not really. There’s never really an expiration date of when you should uh – minimise HCL. Because if you look at Dr. Jonathan Wright’s book, “Why stomach acid is good for you?”, we look at age. With the Heidelberg test, we see that HCl just drops and drops every year that you get old. Uh – any age past twenty, actually you start reducing HCl. So for me, I consider it the foundation. But what about you?

Dr. Justin Marchegiani: So couple different theories on that. I think hydrocholoric acid is the most under rated supplements in the toolbox for any functional medicine doctor and patient. I think it’s absolutely essential because if you buy a really awesome, organic diet, healthy meat, healthy proteins, healthy fats, and you’re not quite breaking it down fully, well you’re really not gonna be accessing all the nutrients that are in those food. So I think that – from that perspective, it’s a great insurance policy to access your nutrients from your expensive diet already.  Number two, I think it’s something is you get help that you don’t need it all the time but like for instance, I’m heading down to lunch here over at Paris down in Austin. So it’s like I’m doing like let’s say, Friday lunch. I’m really excited about it. I’m gonna bring some hydrochloric acid and some enzymes. Its gonna be some nice little pork chop I’m gonna have there. So we’re gonna up the HCl and enzymes big time. That’s number one. Uh –number two,  if people don’t want to be on it all the time, there are things they can do if they need a little support such as Swedish bitters whether its gentian, or chamomile, or little bit of ginger, can very easily just stimulate your hydrochloric acid levels. Or even just a tablespoon of apple cider vinegar or a little bit of lemon juice can be really stimulatory for the hydrochloric acid. There are ways you can stimulate it naturally. And also, there are studies looking at gastrin. Gastrin is the compound that’s produced in the stomach that actually feeds back to produce hydrochloric acid. And that compound –  that chemical does not decrease as you take hydrochloric acid. So it doesn’t have a negative feedback loop. So negative feedback loop is you take steroids, right? Testicle shrink, right? The feedback is more of the steroids cause the testosterone in the internal production to go down. Now taking that analogy to the stomach, as gastrin – as hydrochloric acid goes up artificially, gastrin levels don’t drop. You don’t have this atrophy happening. So it’s good to take it if you wanna give your digestive system a break or you’re eating a bigger meal and you just wanna make sure you can break it down better so you don’t have indigestion afterwards. Totally fine. Uh – ideally, you shouldn’t need it all the time. And number three is you can artificially or just uh – naturally stimulate it with the bitters, gentian, the chamomile, the ginger, etc.

Evan Brand: Well I kinda use the three S, too. Soup, salad, or smoothie. If you’re doing any of those three, you could probably opt out of the enzymes and be okay.

Dr. Justin Marchegiani: 100%. Unless you have a lot of digestive symptoms, that’s the key thing.

Evan Brand: Yeah. See, there’s another question here. Dale asked, “Can we share a quick functional medicine perspective on vaccinations?” That – we’d have to save that for another show, Dale.

Dr. Justin Marchegiani: I went into this with Dr. Robert Rakowski last week. So I would say, Dale, check out that podcast coming up very soon. We go into that a little bit.

Evan Brand: Here’s Betty. She’s got a question, too. What’s the logic behind any acids and PPIs? Profits don’t count as logic. Ahh. Okay.

Dr. Justin Marchegiani: So I talked about this a lot. So PPI is like if you’re – if you’re trying to create the perfect drug that works but creates so many other issues that will create more pharmaceutical dependency down the road, it’s the perfect drug. Let me walk you through it.  So you have acid issues because you’re not digesting your food, right? You have you know, the esophageal sphincter ‘s open, the food is not digesting. It’s rotting in your gut, the acids are rising up and hitting the top part of your throat. You start having symptoms. The first thing you may reach for is the over-the-counter Tums, right? Calcium carbonate lowers the acidity, it works. You feel better. Eventually you need to reach for a Nexium or Omeprozole or some kinda Prilosec, a proton pump inhibitor that prevents the hydrogen binding to the chloride molecules that makes the hydrochloric acid. So then you start having less as acid reflux symptoms. It works. You feel better. Now the problem is the more you shut down those proton pumps,  the less stomach acid, typically the less enzymes – one of things that starts happening is you become dependent on it because the gut lining becomes so irritated, inflamed. You’re not digesting your foods. So then what happens is you don’t break down the neurotransmitters, you don’t break down the fat and the protein that become the neurotransmitters and the hormones. So you start having mood issues. So now your chance of antidepressants go up, your – your chance of having more anxiety – because you don’t have the L theanine and a lot of the GABA coming in. So your chance benzodiazepines goes up. You’re not breaking down the cholesterol, so your chance of needing Viagra goes up because you have erectile dysfunction coz you can’t make your sex hormones. Uhm – you become more inflamed, typically. So then your chance of needing a cholesterol medication goes up because inflammation will increase your cholesterol. And the more you can’t break down certain minerals like magnesium, your chance of Lisinopril Hydrochlorothiazide, ACE inhibitors, blood pressure medications goes up. So you can see what happens. You’re on this medication and all these other medications are needed to help manage all the symptoms that come from it. It’s crazy.

Evan Brand: Yeah. I was gonna mention some of the research, too. I mean there’s research that links PPIs to kidney disease, dementia, heart attacks, bacterial overgrowth, infections, bone fractures, and also the fastest growing type of esophageal cancer. So there is a lot safer ways of dealing with heartburn than the PPI.

Dr. Justin Marchegiani: Yeah.  And HCL and enzymes are totally safe if you’re pregnant, too. I’ve had no problems with that uhm – with my pregnant patients – not an issue.

Evan Brand: Should we go to other questions?

Dr. Justin Marchegiani: Yeah.

Evan Brand: Or was there other stuff you wanted to mention first?

Dr. Justin Marchegiani: I think there’s one other element about enzymes – that’s taking specific enzymes on an empty stomach away from food can be excellent for cellular detox, cleaning up scar tissue, and even treating cancer. Dr Nicholas Gonzales, before he passed, was doing that successfully for many years. And you know, taking high-dose enzymes on an empty stomach, for me, that’s a first-line therapy for anyone with cancer. Those enzymes get into the bloodstream and they’re gonna be able to digest any bad cancer cells that weren’t tagged by the immune system for apoptosis.

Evan Brand: And can you mention briefly just the types of enzymes? Coz I think people may think enzymes are just one thing, but we’ve got digestive enzymes we’ve got proteolytic enzymes, we’ve got systemic enzymes which you were teaching me about last night. Uh – uh – talk – talk people through just the different categories. Just that way, we know  what we’re covering here.

Dr. Justin Marchegiani: Yeah. You’re gonna have enzymes like amylase and such which are gonna be more your carbohydrate enzymes, okay? You’re gonna have various proteases that help digest protein and those will have different names like trypsin or chymotrypsin, right? Protease, etc, etc. And then you’ll have various enzymes, lipases. And these will be more for digesting and breaking down fat. And also, you’ll have bile salts that kinda work synergistically with that. So those are your major categories. Carbohydrate, protein and fat. And like you said, the biggest people that tend to move away from me are ones that have low hydrochloric acid and enzymes, so they move away towards vegetables which actually have more natural occurring enzyme. So they – people that go vegetarian, right? They’re thinking, “Oh, you know, I just feel better on vegetables and not so much on meat.” If the meat’s inherently bad, it’s like, “No, the meat is exposing a weak link in your digestive track.” That’s what’s happening.

Evan Brand: Yup. Yeah. I wanna give a brief anecdote about my use of proteolytic enzyme specifically bromelain. After I got my wisdom teeth surgery, I was taking tons of bromelain and my gums healed in rapid time and the surgeon on the one-week follow-up was like, “Evan, I never seen anybody heal this quickly. What have you been doing?” And I say, “Well, I’ve been popping arnica like it’s candy and also doing tons of proteolytic enzymes.” And he was like, “Wow, this is – this is cool!” So, it worked.

Dr. Justin Marchegiani: I love it. And when you do these kind of enzymes for systemic use,  you want – there’s a couple out there. They’re a lot more expensive coz you’re using more serrapeptidase enzymes which come from the silkworm. Silkworm if you will look at kinda look at the thread that comes from their spinning or however – whatever they produce from a byproduct. The thread that they make their nest with and such is incredibly strong. The tensile strength is unreal. So they are actually extracting the enzymes the silk worms make uhm – make their net out of and they’re using in systemic enzyme formulas. And they put these enzymes in terracotta capsules coz you don’t want to use digestive enzymes for systemic enzyme purposes coz they won’t outlast the stomach. They won’t get to the stomach intact.  So you want something that’s enterically coated that gets into the small intestine, and then gets into the bloodstream without breaking down food. You don’t want any food to be there. You want it to be in a full empty stomach. And we use high-dose arm serrapeptidase enzymes enterically coated. And again, they’re gonna be a lot more expensive than your typical digestive enzymes.

Evan Brand: And when are those cases? I mean what – what’s like top few situations where S__  would wanna be on that?

Dr. Justin Marchegiani: Oh, yes. So we’re gonna do that with any type of cardiovascular issues – issues with uh –history of blockages, cardiovascular-wise. Uh women are trying to dissolve endometriosis and fibroids that can be helpful. Uhm – people that have cancer issues that are trying to just knock down some cancer cells. And then also just for uhm – scar tissue in the joints or just  the general cellular cleanse that help cleanse out debris in the body. But again, none of these treat or diagnose, right? These are all therapeutic things to help support whatever health issues that are already there. We just have to say that as our disclaimer.

Evan Brand: Agreed. Yeah. So I wanna just mention briefly about infections. So once someone’s got an infection, regardless of how they acquired, whether it was chicken or the egg which happened first, once you’ve got parasites, you’ve got this SIBO situations, etc, you’re set up for lower and lower enzymes and lower and lower HCL. So it really is uh – a long process that we take people through where you’ve got to remove infections, you’ve got to restore the gut, you’ve got to restore the enzymes, you’ve got to heal up the gut lining that are totally damaged. It’s a long process. Uh – Samuel asked – oh no, it was Cory here. He asked what would be the best HCL supplement for somebody with SIBO. And should you take both HCL and enzymes at the same time? You wanna hit on that one?

Dr. Justin Marchegiani: Yeah. Take HCL and enzymes at the same time? Absolutely. Because –

Evan Brand: You have to –

Dr. Justin Marchegiani: I mean enzymes – the only time I give them by themselves if someone’s gut is really raw and they can’t handle it. But again hydrochloric acid will help your body make its own enzymes by activating via pH – via low pH.

Evan Brand: Well – And I wanted to mention too, you know, you and I both got professional enzyme formulas, but the dosing is pretty conservative for that reason.

Dr. Justin Marchegiani: Uhm.

Evan Brand: So you may only get 200 mg of HCL per one capsule of enzymes and that’s so low that unless you’re just terribly inflamed, you should be able to tolerate  such a low dose of HCL like that.

Dr. Justin Marchegiani: Yeah. In my line, I have two formulas with HCL. I might digest energy that has lower hydrochloric acid levels that are meant for people that are already  have pretty good digestion, but just need a little bit extra support. And then they’ll have some enzymes in there, too. And then I have my two that I break up for more – for people that have more digestive issues. We’re trying to get more of a therapeutic dose. And some can’t handle that much HCL but need a lot more enzymes. So we don’t want the fact that they are in the same capsule to limit how much we can give. So we can go lower HCL, more enzymes, or vice versa. And we’ll kinda throw in some HCL tolerance test 1-4, 1-5 capsules on the HC – HCL. Any warmness, we back off by 1. Enzymes will typically go up between 1 to 4. If we feel a lightening, or better digestion, or improved bloating, or gas, or any symptomatic relief, or just a feeling of better digestion, then we’ll keep it at that those. If not, a standard 1 to 2 capsules per meal is typically okay.

Evan Brand: Here’s another question. “My doctor put me on Ornidozole and Levofloxacin.” Oh, man. “I have hunger pains, fatigue, constipation, felt better for a week and then hit a wall. How effective are these? And side-effects?” So, those are two antibiotics and –

Dr. Justin Marchegiani: Well, anytime you take an antibiotic, one of the big side-effect is gonna be a rebound fungal overgrowth, alright? Lots of females have noticed they take antibiotic, they get a reoccurring yeast infection weeks later. And a lot of conventional physicians are actually growing wiser that their patients – their female patients a lot of time, like a Diflucan  or Fluconazole after antibiotic. Now again, you’re much better off giving them a probiotic. You can do it even during just away from the dose. And then do a probiotics after a month or two afterwards just to prevent that rebound overgrowth. And a rebound overgrowth is let’s say you have a lot of good and bad bacteria in your gut, you give antibiotic, what happens is you lower all of it. Now, the good bacteria provides a nice environment so the bad stuff can’t grow. So as soon as the good stuff is low, then the bad stuff naturally proliferates. It’s the whole idea of once you clean out your garden, the tomatoes don’t just automatically, the weeds do. You actually have to go in there and plant the tomato seeds or whatever you’re growing. You have to plant those seeds, you have to aerate, you have to put the fertilizer down to create the environment so the vegetables grow.

Evan Brand: Good analogy.

Dr. Justin Marchegiani: You don’t have to do that with the weeds. The weeds are automatically there on auto dial, so to speak.

Evan Brand: That is such a good analogy. Yeah. And it’s amazing. How about unless it’s a life-threatening situation, try not to go with antibiotics, anyway. Figure what the root cause is. There’s so many natural antimicrobials that you and I use in they’re so effective. They have no side-effects, no lasting – anything. They’re in and out.

Dr. Justin Marchegiani: Absolutely.

Evan Brand: And then we don’t need stuff like Diflucan which is also terrible, which in many cases you’re gonna just basically piss of the candida. And yeah, you’re gonna get rid of it  but then the candida’s gonna come back with a vengeance. And we test your urine, we’re gonna see massive arabinose –

Dr. Justin Marchegiani: Yeah.

Evan Brand:  Or tartaric acid.

Dr. Justin Marchegiani: Yup, yup.

Evan Brand: Back with a vengeance you’ll say, “Oh, I just finish a round of Diflucan.” And it’s like, “Whoa! Maybe it worked for a day, but candida is back and she’s mad.”

Dr. Justin Marchegiani: Exactly. Alright. So let’s summarize everything we chatted about here, Evan So like, let’s say you’re just tuning in now or you just get really overwhelmed and your eyes got a little gloss over. What’s the Reader’s Digest version? I’ll let you go first.

Evan Brand: Yeah. So to me, reader’s digest version – enzymes and HCL are crucial. They are one of the most important foundations you should have if you want to be a healthy human that lives a long life, plain and simple. And then the caveats to that are well, do have things in your body that you need to work with a functional medicine practitioner and get tested for, such as infections like parasites and bacterial overgrowth like SIBO and candida. Now, if you get the testing piece done, you find out that your free of infections, which is pretty rare, then awesome. Maybe you’re just at a lower dose of HCL and enzymes, and maybe if you do soup, salad and smoothies, you don’t use enzymes but otherwise, you’re kinda cycling on. And you’ve got a cute little glass jar like I do that I shove in my wife’s purse. It’s got may enzymes and HCL in there. I take it if we go to restaurants and I always have it on the dinner table because if its out of sight, it’s out of mind.

Dr. Justin Marchegiani: Totally.

Evan Brand: So when I sit down at the dinner table, the enzymes are right there. Uhm – as you get older, we know with the works of uh – Steven Wright. HCL is gonna drop, so to me, it’s not an optional supplement if you want to be healthy. Mother nature just doesn’t care about your optimal digestion once you’re 40, or 50, or 60 because you’re pass the hunter gatherer reproductive age which was like 16 to 20 years old. So mother nature doesn’t want to kill you but she just doesn’t care if you digest your grass-fed beef when your age 40 to 50. So enzymes become a must. You wanna mimic the stomach acid levels of when you were younger and you had an “iron stomach” You wanna try to macht that with supplements.

Dr. Justin Marchegiani: Absolutely. And then in the future, what I’m gonna do is, anyone on Facebook, I’m gonna put the link in for the live YouTube side just so we can have people that uhm – want to see the full thing, they can go to YouTube and check out the whole thing. I wish we could make a go live on both sides here but right now the technology doesn’t quite do that. So we’ll shoot over the YouTube link in the future and just to add one last thing. Get the parasympathetic nervous system response going. Make sure you’re in a stress free, kinda relaxed environment; make sure you’re chewing your food enough times, uhm – get the saliva going to help start the digestion in the mouth. Then last but not the least, if you are really gluten sensitive, and you may be getting exposed somewhere like you’re going out to eat, and there maybe some contamination that you’re unaware of, enzymes that have dipeptyl peptidase for DPP4 enzymes can be helpful because that will help break down any bits of gluten. And the more the gluten can be broken down into smaller constituents, the better the body has a chance of dealing with it better. So keep that as a little side note, DPP4 enzymes can be hepful.

Evan Brand: What – When is the right and wrong time to use those?

Dr. Justin Marchegiani: Well, the wrong time is I’m gonna have a birthday cake, but it’s okay because I’m taking my DPP4 enzymes. It’s not necessarily for that, but if you are gonna have it though, it will lessen out the blow. But we don’t wanna give someone a crutch to be able to make a whole bunch of bad decisions. But if, let’s say I’m ordering some food at the restaurant and maybe there’s something in there, having it be handled by someone that just have their gloves on that handles someone’s breaded item. So you will do it more for incidental exposure just to prevent that so your body can deal with the gluten of – from that perspective.

Evan Brand: Love it. That’s great advice. So that should in your suitcase then if you’re travelling. We should do an episode on that. I think we did a travel hack episode.

Dr. Justin Marchegiani: We did.

Evan Brand: We should do a – on the go. Like if you’re not travelling but you’re just going out and about in the city and you may stop somewhere to get some food. What should you have, just in case.

Dr. Justin Marchegiani: Totally. That makes sense.

Evan Brand: So much fun.

Dr. Justin Marchegiani: And I’m gonna do maybe another Q&A. If I have time, I’ll make you another quick Q&A taken today. We have a couple of people here that are asking questions. They’re a little bit off-topic which is fine. But we’re only gonna answer the ones that are more on-topic. And I’ll try to have more Q&A conversations wherein we can take of everyone else’s questions.

Evan Brand: Also, last thing. If you have it, you should sign up for SpeakPipe. That way, people can send us audio questions and then we can play the audio clips and put them in for our podcasts.

Dr. Justin Marchegiani: Love it. Great idea, man. Any last thoughts, Evan?

Evan Brand: No. If people need help, reach out. justinhealth.com   notjustpaleo.com We’re available and this is the stuff we work on everyday.

Dr. Justin Marchegiani: Love it, man. Well you have a- awesome Friday, man and we’ll talk really soon.

Evan Brand: Take Care. Bye.

Dr. Justin Marchegiani: Bye.

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