How to Address Acute Tummy or Stomach Upset – Podcast #347

There are several things worse than having an upset stomach and diarrhea. This situation may completely throw off your day, limiting the foods and drinks you can enjoy and keeping you tied to your toilet. Understanding the root causes of these symptoms and how to manage them effectively can automatically cut down the effort and time you spend dealing with them.

Most of the time, tummy issues are treatable at home. As soon as you feel sick, begin regulating your diet to clear liquids in small amounts and frequents. Make sure to drink enough water to keep your urine clear or a pale yellow, and don’t hesitate to seek medical attention when things are getting worse after first aid treatments.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1: 53:   Natural Strategies to get things under control

4:13:    What’s the possible root cause?

10:49:  This you can do with diarrhea

14:56:   Natural strategies and Testing

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Dr. Justin Marchegiani: We’re really excited today. We live on a bunch of different social media platforms at the same time. So excited to interact with a lot of different people; not just from youtube but, facebook, instagram, linkedin, a bunch of other still periscope as well. So really excited. Evan, how are you doing today my man.  What’s cooking?

Evan Brand: Well not too much i was dealing with little vomiting this morning with some kids. So I thought, well, why don’t we do an acute to me upset video and hopefully that will help some people. You know a lot of people at first, you need to have… Anytime, anybody’s sick now i mean,  everybody’s like COVID until proven innocent right? Whether you have sinus issues or smell issues, tastes issues, tummy issues, people freak out you know. Luckily, there are some really good at home rapid test that you can do with a 15-minute result now. It may be difficult to find those. You may have to order order them online but, Abbottt makes a good one so if people are at home and they’re worried, they get sick like, “What do i do?”  you know. A lot of people, they are just stuck In this fear response like, “Oh my god.” I’m going to die as soon as anything’s wrong. So you can get these rapid tests and have them at home. So i think that’s a good strategy just out of the gate for people. If you get into acute issues whether it’s vomiting, diarrhea, shortness of breath whatever you think is going on. For me, before you feel like you got to run out and go to the hospital, i think it would be good to do an at-home and mess before you could always go to a local clinic where you can get a rapid test. Supposedly, a little bit more maybe a few percentage points more accurate than at home.

Dr. Justin Marchegiani: Yeah i think those are good things out of the gates. Now one of the things we are heating today is because your daughter had a little bit of tummy upset over the weekend into today, and you know, there’s a– we’re parents, we have kids you know. Obviously, we see patients all over the world and we deal with some of these acute tummy upsets. Weather it’s vomiting or acute diarrhea, and what are some natural strategies to fix that? What’s the root cause? What are some natural strategies to atleast get it under control? So first off Evan um well, how did you handle your daughter? What happened with her over the weekend? What did you do that helped?

Evan Brand: Yeah she had sinus issues first where she just had really really tough time breathing out of her nose. So i tried to get her to do some sinus spray with a five-year-old. hey really don’t want stuff squirted up their nose so that wasn’t too successful. We were able to get some argentin in which is a professional silver hydrosol. So we did a little bit of that early and then with hit some antimicrobial drops. So we did some liquid antimicrobial, it depends on what you got going on. For us we did kind of a broad-spectrum formula but, there’s different ones that you can use. So olive leaf is a good option. There’s some that are full spectrum like microbes layer used called uh poseidon drops can be helpful too. So a few options we’re just kind of rotating through some of these, and then We are doing binders so just because you don’t know what’s going on If it’s bacteria or some sort of pathogen, it’s going to be pooping out these lipopolysaccharide endotoxin some kind of garbage. So we do Some binder within a half capsule of some binders Before bed with applesauce that seemed to calm things down but then, with the vomiting, we were talking about this before we hit record, You know what the coolest thing was in the most effective so so far was homeopathic so we did two of them; we did cinecom album and then did nux n-u-x vomica. So those two homeopathics, i would say really really changed the progression and helped her go down the fork in the road where it stopped the vomiting. Now, is it possible that she just got it out everything out of of her system and it was good on its own? Or Is it possible these homeopathics really you know, stop it? I’ve had a lot of success personally and clinically with homeopathics. It’s something that i didn’t know a ton about until i started experimenting but, these are very very good, safe things that can be tried and worst case scenario it’s not hurt. It can only help. So arsenical is going to be more For vomiting and nux is going to be more for nausea. There’s actually like if you look on the label either one of these could be used for food poisoning but, i’m finding that nux is better for the symptom nausea whereas arsenical is better for the actual symptom of vomiting.

Dr. Justin Marchegiani: Very good. Excellent. So out of the gates here you know, what’s the root cause? You know, most of the time i find when you have a root kind tummy upset, it’s usually going to be some kind of food poisoning thing out of the gate.  So of course I think some kind of e coli or some kind of toxigenic e coli or maybe a salmonella, or campylobacter. Some kind of like food poisoning bacteria out of the gate. It could also be a parasite too! I find food poisoning tends to be a little bit more acute and that’s kind of how you know at the moment. You may not be clear enough but out of the gates like you mentioned a couple different things, silver can be helpful, higher dose probiotics – probiotics can be very helpful because especially the bifidobacter and lactobacillus because one they are anti-inflammatory so they bring the inflammation down in the gut. Probiotics are shown to help with gut permeability issues so with the acute food poisoning or acute tummy stress there could be a lot of gut permeability which then increases the immune Response because then you have all these toxins leaking into the bloodstream potentially creating gut stress in immune stress. And then i would say after that, um, they’re going to help crowd out a lot of bad bugs so if you had a big whack of e coli or a big whack of campylobacter or salmonella something like that, listeria it’s gonna help crowd some of it out and so probiotics i think out of the gates for it’s calming effects and i think you can look deeper in run a stool test if some of these issues or more chronic. Parasitic issues maybe more chronic and then of course my good old favorite ginger tea is wonderful because ginger is anti-inflammatory, has some mild antimicrobial benefits as well and especially bacteria and also has some anti-biofilm benefits. So you can combined ginger with probiotics you can combine ginger with some antimicrobials as well, Two kind of help those herbs to be more Let’s just say virulent because you essentially are taking the shields out of these bacterias, you know, arms right. Biofilms are the protective shields the bacteria use and when you take the shields out, the bacteria are more vulnerable and then the herbs work much better, and they help kill them much better. So those are a couple of strategies out of the gates anything else Evan that you’re doing?

Evan Brand: We tried to go for the ginger tea her tummy was just so upset she couldn’t Keep liquids down so we just said ok to intense right now. We’re just going to just let it rest so luckily with a palette homeopathy she was just able to just put it under her tongue. Therefore she didn’t have to take in any new liquid so we tried to do just some other liquid tinctures. There were a couple mils but It was just too much so luckily, without It, we just gave the tummy a break. No more liquids hit the homeopathic and then boom! The gut’s calm for now, so we’re still in the middle of it at the time this is recording but, she has not vomited since we did those homeopathy remedies. So hopefully she’s, she’s over the hump now.

Dr. Justin Marchegiani: Yeah homeopathy is interesting i don’t see A lot of it as being like root causal like it’s not Fixing like lexi your daughter ate some food or Head of food allergen exposure or eat it, was eating while stressed, not enough stomach acid or got a bug It may not fix that but It’s going to help control sum of the symptoms, modulate the inflammation kind of help bump physiology back into the normal direction. Which kind of buys you time to fix whatever is going on. So i like that, so i think that’s a pretty good strategy out of the gates. I think also too is…

Evand Brand: The microphone depend on it.

Dr. Justin Marchegiani: Yeah i think also modifying…

Evan Brand: I’m just gonna say I’m not gonna depend on it. I wasn’t gonna depend on solely but, if i can buy your time like you said, and then If you see in a week there’s still an issue when boom! We’re going to run urine or we’re going to run stool.

Dr. Justin Marchegiani: Exactly yep and i like the idea of you want either fasting out of the gates. If it’s really a bad infection and there is really a lot of nausea, you could also do things like bone broth. Just where you get a lot of nutrition but it’s pre digested, so there’s not much digestion that has to happen to grab that glycine or grab those fatty acids because it’s pretty well digested. So some kind of bone broth is wonderful, some type of a ginger tea is great, some type of collagen amino acids is great. I think all those are you know, really good strategies out of the gate just to kind of help provide nutrition but not what a lot of stress on your tummy to be able to digest it and access it because when the gut’s really inflamed, It can be stressful absorbing those nutrients.

Evan Brand: Yeah good point she was complaining of stomach pain too. So as soon as her tummy settles down i think she can handle liquid. What were going to do, we’ve got a couple different formulas i know. You and i, we manufacture some but, there’s also some other good professional competitor brands. There is one from Innate response that i like it’s a GI like soothing formula That’s got like some raspberry flavor into it. It’s got some glutamine some larch tree extract. I believe it’s got some mutant chamomile aloe, those type of blends. So kind of a leaky gut permeability support those are good  in this situations too. When did make sure like you said you don’t know what it’s from It could be bacteria, virus, parasite; whatever this to me, honestly, at this point It doesn’t matter. I’m just in the acute phase, i’m trying to calm her tummy down. So if i can get her to do over the period of today a couple grams of glutamine, need some of these extracts that’s going to calm the gut down too. You and I have seen clinically beneficial like ulcerative colitis, crohn’s, any type of diverticulitis, any type of these flare-ups  or autoimmune flares. We’ll use Use some of these licky gut remedies, so i would then use that as a crossover right. I would use it in the same in the same situation.

Dr. Justin Marchegiani: Yeah, exactly. Now, out of the gates when deal a lot of these situation we always want to understand the root cause. Now, the nice thing about acute traumatic situation, like in your situation here, is the root cause is usually is a one off right. It’s going to be a food poisoning episode. It becomes more Of an issue if it’s an acute parasite and it lingers. And most of the time it’s a one off, and as long as someone’s diets reasonable, and they have decent health, you don’t really have to go super upstream and, and look at all of the underlying systems. You can find out just do triage with natural medicine which is kind of cool, Command bear with some of the different nutrients and herbs that we talked about, support some of the lymphatic system with ginger, or burdock root right. Slippery elms wonderful for the lymph, wonderful for calming the gut lining. L-glutamine is also wonderful for calming, Aloe’s also wonderful for gut lining. So there’s a lot of great things That we can do to calm the gut lining. Support barrier integrity get the inflammation under control. We don’t really have to worry about getting the root because usually, that root is an isolated situation especially when someone’s relatively healthy and then they have an acute episode.

Evan Brand: Right and then your system is going to get back to baseline on its own. We’re just kind of helping it. So like you said it might not need much more attention then just a couple of days which would be great.

Dr. Justin Marchegiani: Yeah, absolutely. So that’s pretty cool out of the gates. So we talked about diarrhea, a couple of things. We can do with diarrhea is a lot of times, you have to understand why the body is doing what it’s doing. So the body is usually getting exposed to some kind of bacteria, parasite, some type of toxin that is very irritating on the gut lining. And the body is thinking hmm, how can we dilute it, Dilute whatever that compound is and flush It out of the body as fast as possible. So what the body is typically doing and say, “Ok. Let’s bring a whole bunch of fluid and water into this system here.” Let’s flush it out, let’s increase motility time. Now what it’s going to do is it’s going to screw up your electrolytes a lot of times, It’s going to screw up your hydration status. And it’s also going to make it hard to absorb nutrients. So what’s the first thing we do? First thing is we can put some binders in so we can bind of those toxins so they are less irritating, less inflammatory. So are different binders could be activated charcoal, bentonite clay, different zeolites, different pectins. These fibers are great because they will bind up that toxin, and it will make it less mobile, less inflammatory. Kind of put straight jackets or handcuffs on it right. The next thing we’re going to do is make sure we are hydrating because the solution to pollution is dilution. We want to make sure there is enough water there. So we can dilute and not get dehydrated. And the next thing is make sure there’s enough electrolytes. Electrolytes are a big deal because, if we are low in sodium, and potassium, and magnesium, when you start having a lot of these bugs, what you start to notice is you may start getting dizzy, vertigo , or heart palpitations , or just feel totally off, and a lot of that can be from a lot of electrolyte issues due to the infection. And so we get the electrolytes right The hydration right, and then we also provide some good binders there that can prevent these toxins one from being as mobile, and being an inflammatory and um, and that can create make a better environment for the body to move the bowels out slower without losing all the nutrients as well.

Evan Brand: Yeah good point and this is kind of an Art right this is where the art comes in Ab medicine when your Trying to integrate these things at the right time That someone can tolerate so right now If i try to give her a big cup of electrolytes She might not be able to because she had trouble keeping down The mcqueen so you kind of have to know when Like you might hear this and go oh my god i’m going to do all the Things because i want to get better but there can be an o order of options. I think get Your got come down first if you can go on an hour or two if you’re in an active vomiting situation. If you can go an hour or two without vomiting, that might be the cost might be clear enough for you to try to work some of the other stuff, and whether its a liquid tinctures to kill or if you are doing something like a bio site or other antimicrobial drops, We use the dosage is usually so small, that i think you can keep it down because you’re not going to have to do a ton of drops right. If you could just do like five drops, That’s tiny your body is barely going to recognize that. And if it’s the tongue, i don’t think that’s going to create more vomiting but that’s kind of where the art comes in paying attention to what’s going on.

Dr. Justin Marchegiani: I agree doing some of the liquid drops are wonderful. Because if you can’t do a full capsule, hopefully you can right. But if you can’t you know getting some liquid drops in near epsom herbals can be super helpful, maybe some silver. Also, like you mentioned if you really have a hard time keeping things down, that’s very good iv iv fluids, iv electrolytes, iv nutrients maybe a good Idea because that bypasses the whole digestive system. So then it gets right into your bloodstream and does what it has to do so you can find some liquid iv services come to your house or find a facility near you where you can pop in, get it done. Ideally, if it’s acute Probably better off paying the money and having someone come to your house. Probably feel a lot better and i think it’s better than going to an ER. Unless you’re you know, really in rough shape. Then go to an Er but if not,   but if you’re better off doing it at home because there’s less um, infectious material You know at home than in the hospital right. So i think that’s good strategy out of the gates for sure.

Evan Brand: Yeah, well. And to take it a step further not only that but, if you do these mobile services, like i did this last summer you’re able to customize what you want. So the hospital is not going to put glutathione in IV like they did no i’m not going to give you 10 Grams of vitamin c like i requested. So you’re going to get a much much better menu if you will of nutrients if you were to go to th e hospital.

Dr. Justin Marchegiani: Yep! I agree. I 100% agree. So first thing out of the gates i would say is, Try to do liquid or even just fast and then if you really having a hard time with the with the nutrition try to do liquid whether it’s an elemental diet, or some collagen and amino acids, or someBone bro that’s great , and if you can’t eat the food down ideally try to get some kind of an I be going on there i think that’s a good strategy out of the gates. I think the next thing that would probably happen it would be like IV antibiotics if you absolutely had to but ideally, we don’t want to go there unless unless all the other natural strategies aren’t working. So we want to Really try the low-hanging fruit That’s going to have the best bang for the buck, The least amount of side effects, the least amount Collateral damage, And kind of go up from there so of course, try to look at what cost the problem. Did you eat some bad mayo, Did you eat some crazy seafood , what happened, try to isolate the cause If there’s a lot of vomiting or diarrhea. And um, vomiting is going to be harder because it’s not moving Through the intestinal tract it’s staying in the stomach essentially and the intestine upper small intestine and moving out right. So you’ve got to do things to calm yourself down. So i think the big things like you mentioned the homeopathic i think are great. I think the probiotics are great too. I think ginger can be great um, for the vomiting components but, Everything else i think the diarrhea stuff you know, The binders , the hydration , getting all that stuff going to calm down, the ginger. All that stuff’s wonderful. Anything else you did besides the homeopathics for the vomiting, Evan?

Evan Brand: No so far that was all she could get it down. But luckily it’s been good enough.

Dr. Justin Marchegiani: Cool. Yeah, that’s really cool. I like that. Alright! So Out of this out of the gates here um, We’re kind of hitting things like on an acute level right. So patients are coming in, they have these acute symptoms that are the kind of some of the strategies we would look at. Of course it’s easy for some of these people to move into the crowd. I’ve heard a lot of patients that are like, oh yeah. Like three years ago, i went To this place and i eat this food and i felt realistic for a week or two and then i started getting better but I didn’t get all the way better and now this stuff is lingering. And of course for some people this type of acute scenario, you may get over it but you may not all the way recover. And why is that? You can get another kind parasyte infection, you can get h pylori, There could be some food poisoning which we see on some of the testing we do. We’ll see some of the Shiga toxin some of the toxigenic e coli, What is it What is it truethe 0Oh157h right. This is the food poisoning type of e coli that you See in the spinach once a year and such so Lucy song on these things on testing. And some of these things can cross the acute Level into the chronic sphere. And People have had these experiences. Then they may not recover all the way and then, that’s where we think start to have to start integrating more tool testing to look at and see what’s happening.

Evan Brand: Yeah, well said. I mean there’s so many people that say they have Bali belly right. Name go to Bali, or they go Mexico or they go somewhere; they come back and then they are never the same. And it’s an interesting phenomenon because a lot of times We’re just trying to find them at the acute phase like ok, binders whatever but, then If they don’t fully recover, or sometimes they will reach out to us, we never got to help them in the acute phase. They’re just coming to us in the chronic like hey i’ve been sick for three years after this Mexico poisoning event. When that’s where we come in with a testings uh, you mentioned infections. We will see salmonella, we’ll see giardia, we’ll see crypto. If there was like a lake trip we’re maybe, got some fresh water contamination, or a backpacking trip where they got some parasites. Ee will find that on stool test pretty accurately, gut information we can measure. That’s where we might do a test for you know, just because i do it a couple of times a year but, If she get over this. Then I might rush to do it right away so it depends on the person right.

Dr. Justin Marchegiani: Yeah i mean i have a lot of Australian patients and it’s funny In that culture, um, it’s because they’re so close to Bali, a lot of them will take trips over there. Ang of course, the the I mean it’s like one out of every two of every two of my Australian patients they got sick in Bali and it is actually a cultural thing. I look it up we’re a lot of them would do this This raspberry cordial cordial drink it was a big thing and they would bring it with them to Bali, and we would drink it prevent totally while they are in Bali to mitigate the Bali berry uh  belly,  and i did a little research on it. Some of the berries that we’re used To make that drink actually have some antiparasitic antibacterial effects so they are kind of taken. Even though it is a sugary kind of not so great drink there is still some therapeutic benefits of some of those berries being antimicrobial. And so even people in australia kind of know, okay. We’ll take this raspberry cordial drink and bring it with us to Bali to sip it over for the next couple of weeks to prevent a tummy infection.

Evan Brand: That’s cool. Well, you and i talked to about That before i think we did whole podcasts on like travel supplements but, i mean that’s yeah enzymes, oregano oil, silver. Those kind of things, binders would come in handy.

Dr. Justin Marchegiani: Yeah i did a food poisoning podcast i think about two years ago. I was in a friend’s wedding and i remember i was In the north end and i had a nice rib eye steak In the north and right. Anyone that knows the Boston area north end’s a big Italian area, big restaurant Italian area. What a nice rib eye steak and i eat it and it was Just like it was like someone punched me in the stomach. It was like woah oh my gosh like i felt totally just incredibly a lot of nausea. And then i brought my GI Clear 4 with me. I hit that i remember I had like two, i had my GI Clear 1 and some oil of oregano and a hit that hard. It didn’t quite do it and the next day i hit the GI Clear 4 and within 30 minutes, It went away. I couldn’t believe it, it was like someone flipped a switch. It’s crazy! So sometimes you need synergistic herbs sometimes you know, the goldenseal and the high dose berberines, and some of the burdock root. It can’t really really calm down the gut lining.

Evan Brand: You know when people see my pantry or my cupboard full of different supplements, they’ll look and be like. “Oh my God. This is crazy! You’ve got like 50 60 bottles of stuff.” and i tell them look, I I don’t go to the doctor. I mean, if i’m dying, I’m gonna go but otherwise I’m gonna be working on myself, and i think it’s a very empowering thing to get experience and learn some of these herbs, learn some of these protocols. I just want people to not be fearful sickness you know, i think a lot of times even my why i told her i was like, “honey, you’re like freezing up” because you know, here’s my daughter vomiting and i’m running over there sprinting I want on the other side of the house but i’m sprinting over there with the trash can to give it to her because my wife was just kind of froze up and i was like, no you got You gotta get yourself out of this freeze response, don’t be afraid of this, we going to help her through it. I just want people listening to know that there so many good options and things that we’ve done for thousands of years period. We’re not talking crazy stuff here; these are not new inventions that we’re discussing. These are things that have been used traditionally in India and China, and other countries for forever. So these are things that are so powerful that i would say in the majority of cases, you are not going to need to hit as you mentioned like IV antibiotics. That’s on the extreme end of treatment. I think in most cases, these type of situations We are talking about will lead to that level of intervention.

Dr. Justin Marchegiani: 100%. So people Listening here, hopefully you have some strategies regarding acute situations of vomiting and diarrhea. Now why does one vomit over diarrhea? That’s a great question. I mean i would say the inflammation has to be stomach area upper intestinal tract, for vomiting to occur, and probably Information has to be more lower intestinal tract because once things have gone so far right. You just have natural gravities and two things downhill versus uphill. So i think a lot of that may depend upon where What inflammation is and how uh where all this toxic burden in the intestinal tract higher of i think on the vomiting side, Lower up in the diarrhea side. So either way i think you’re going to have similar root causes of why it is Happening and hopefully will give you a couple of ideas to kind of triage that.

Evan Brand: Yeah, I would say certain infections just attack certain parts of the body. More certain infections are going to go more for the stomach, like each pylori you know you’re going Do you have more heartburn in digestion type symptoms. You are not going to have so much diarrhea necessarily Web h pylori wear something like giardia or crypto.  Those are to me,  going to be more intestinal based you are going to. Because those are intestinal parasites so you have More diarrhea so i think it depends on what you are dealing when too. And that’s why we will use some of the testing To if this becomes more chronic we will use the testing to kind of, guide us on what to do because if it is more tummy upset. We made you this set of blend but if it’s more colin we might go this set . So there’s kind of that’s that’s the reason we have a toolbox that’s the reason we have testing.

Dr. Justin Marchegiani: I like it.  well if you guys are listening and you want to reach out Deeper you need some acute health or you want to You know get a long-term strategy 66 song on face chronic issues In your health see you free head over to, Evan’s available worldwide for consultation support, and again I’m Dr. J Is my site feel free there will be a little button, click in schedule we are available worldwide. Again we’ve been doing this for many many years many thousands of patients, of feedback, and support so kind of have learned over the years. I tell you, In school you develop a really good foundation. But then, In practice that is really where it gets you good because you see so many people, and you figure out what works and you develop the common themes and you can just rinse and repeat that over and over again.

Evan Brand: Yeah, getting your hands dirty, getting in the trenches. I mean it’s been a blessing for us you know, You and I learned so much from the people we work with. I mean More than probably any book or any course I mean it’s A real blessing to have like you said. Once you see the trend of people, it’s fun. It’s really fun to help people. It’s addicting. We love it.

Dr. Justin Marchagiani: 100%. Ok guys feel free to give us a share, thumbs up, like, put your comments down below. Let us know what you think and we’ll be back. Have a great day. Take care y’all. Evan Brand: Take care now bye bye.


Audio Podcast:

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

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. for Justin. My website is 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.


Audio Podcast:

The Harmful Effects of H. Pylori

How Functional Medicine and the Paleo Diet Can Address H. Pylori

A majority of world’s population have H. Pylori bacteria living in their stomach. This damaging bacterium has been revealed to be the main source of fatigue and other common health complaints. H. Pylori invades and damages the stomach’s protective mucus layer, thereby leaving your stomach susceptible to ulcers.

The Harmful Effects of H. Pylori

H. Pylori is commonly transferred by sharing food and drinks with other people, and multiplies very quickly through the saliva. Those with a weak immune system and other health issues are particularly susceptible to contamination.

H. Pylori is the primary cause of poor digestion and stomach ulcers. This bacterium impedes on the stomach’s capability to manufacture mucus, and irritates the inner lining of the stomach. The irritation turns out to be so severe that it leads to the pathogenesis of stomach ulcers. More than 80% of gastric ulcers are due to H. Pylori. This bacterium, if left untreated, can lead to stomach cancer.

H. Pylori Causes Fatigue

H. Pylori can cause fatigue by blocking your ability to absorb vitamin B12 and iron. As we know, the two common causes of anemia are a vitamin B12 or an iron deficiency. This means that if you’re taking B12 and iron for anemia but still aren’t seeing results, you might have an H. Pylori infection.

Role of Functional Medicine

The gut walls possess more than 70% of the cells that build up your immune system, and a whole host of bacteria. When you think about gut bacteria, you might be thinking of the symptoms that are manifested by gut imbalances. It’s true that a gut imbalance can negatively affect your ability to digest important nutrients. However, by making conscious diet choices, you can help overthrow the bad bacteria and promote the proliferation of the good guys!

Role of Paleo Diet

The Paleo diet focuses on eating natural food that is extensively available. If you’re suffering from H. Pylori infection, here are some great foods to incorporate into your diet:

  • Quality meats – Such as grass-fed beef and lamb,  and wild sockeye salmon.
  • Eggs – Pastured eggs, the yolks will be a deep, rich yellow-orange color.
  • Fresh Organic Vegetables and Berries
  • Natural oils –Avocado and Coconut oil are some of the best.

If you’re suffering from any digestive issues or fatigue, addressing the health of your gut with the help of a functional medicine practitioner should be your first course of action.

By treating any gut infections and optimizing your diet, you can reduce your symptoms by addressing the root issues.

5 Signs You May Have Low Stomach Acid

5 Signs You May Have Low Stomach Acid

By Dr. Justin Marchegiani

Do you suffer from any of the following?

Suffering from Indigestion, heartburn, constipation, gas, nutrient insufficiency

  1. Indigestion: Food doesn’t sit well after you eat.
  2. Heartburn: You have GERD (gastro esophageal reflux disorder).
  3. Constipation: You don’t pass at least 12 inches of stool per day.
  4. Gas: This is primarily in the form of belching or flatulence.
  5. Nutrient Deficiency: You have a past history of anemia or are low in certain micronutrients.

What is stomach acid, and why is it important?

Your body produces hydrochloric acid (HCl) for these primary purposes:

  • It activates pepsin, a specific proteolytic enzyme found in the stomach.
  • Pepsin’s primary job is to break down protein.
  • It provides an acidic pH in the stomach. This helps to decrease the chance of outside infections from proliferating like parasites, bacteria, and fungus.
  • It produces acidic chyme (the mixture of food in the stomach). When chyme is released from the stomach into the small intestine, the acidity stimulates the gallbladder to release bile and the pancreas to produce enzymes (lipase and chymotrypsin, to name a few).
  • It ionizes minerals so they can be broken down and absorbed by the body.
  • It stimulates gastrin, which helps protect the stomach and improve digestion.

Digestion and HCl

HCl is really, really important to start the domino cascade of healthy digestion. If that first digestive domino isn’t knocked over, it’s safe to say you are at a higher risk of digestive symptoms.

As mentioned above, HCl activates enzymes in the stomach, small intestine, and pancreas to start breaking down carbohydrate, protein, and fat. If HCl secretion isn’t initiated in the stomach, you will start to see a putrification, or rotting, of the proteins; fermentation of carbohydrates; and a rancidification of fats (1).

Digestion And HCL

Indigestion Creates Gas and Burning!

When the enzymes that are needed to break down these foods aren’t present, we start to see malabsorptions occur. These malabsorptions cause an increased intra-abdominal pressure, which can cause a weakening of the esophageal sphincter. When the esophageal sphincter loosens, this allows the organic acids from the rotting foods to rise up (reflux or GERD) and burn the esophageal tissue (2). Remember, esophageal tissue doesn’t have the protection (mucus) from an acidic environment like the stomach does.

Essentially, low stomach acid provides the environment for bacterial overgrowth in the stomach/small intestine to occur, which then creates malabsorption. You are now set up for a vicious cycle of poor digestion that almost never improves on its own unless the underlying cause is addressed (3) .

When food isn’t broken down completely, gas in the form of belching or flatulence is common. A dependency on pharmaceutical medications, like acid blockers, is now created that doesn’t address the underlying problem and only creates even bigger problems down the road, like B12 or iron anemias to name only a few (6).  In my clinical experience, HCl helps reverse these conditions and improve digestion; therefore, decreasing stomach acid in the long run with drugs isn’t a good idea most of the time.

Stomach Acid Protects Your Stomach and Your Esophagus…Huh?

Yep, you heard it here first! Most people associate stomach acid as a problem. Yet stomach acid is needed for the stimulation of mucus from pyloric glands. This mucus acts as a shield against the stomach acid and protects the gastric mucosa.

The pyloric glands secrete mainly mucus for protection of the pyloric mucosa from the stomach acid. They also secrete the hormone gastrin.

~Guyton’s Text Book of Medical Physiology, 11th edition.

The more your digestive track loses the ability to break down protein, fats, and carbohydrates, the greater the chance for a bacterial overgrowth to occur. As the balance of bacteria becomes more dysbiotic (more bad bacteria in relation to good), this can weaken your esophageal sphincter as mentioned above and allow burning in the esophagus to occur.

Why Am I Constipated?

Why Am I Constipated

As the ratio of good bacteria and bad bacteria becomes flipped in favor of bad bacteria, all kinds of bad things occur. We start to see incomplete digestion, which has an effect on motility. The excess of bad microbes in the GI tract can produce chemicals that slow down peristalsis, or the wavelike contractions that move food through your intestines. If you have more bad bugs in your gut, your transit times get slower (4).

Most people I see with digestive symptoms have some sort of gut infection, either H. pylori or a myriad of other parasites that are notorious for causing these types of issues. Unless these infections are addressed, these digestive symptoms tend to linger. To learn more about how you can address these issues, click here! 

Chronic constipation can also be connected to hypothyroidism as well. I strongly recommend ruling out any potential thyroid imbalances as well.

Stomach Acid Helps You Absorb Nutrients

HCl is needed to ionize minerals so they can be absorbed, assimilated, and utilized. There have been studies showing nutrient deficiencies in calcium, iron, and B12 when low stomach acid is present. Low stomach acid can even increase your chance of osteoporosis as well (5,6).

One of the most underutilized supplements is HCl, especially if you are already spending a good deal of money on organic food; you want to make sure you are absorbing and assimilating it properly. The old adage “you are what you eat” isn’t true. “You are what you eat, digest, assimilate, absorb, and utilize!”


If you have serious gastrointestinal irritation or a history of ulcers, you should not add any HCl into your supplement regimen without the guidance and support of a skilled functional medicine doctor. Some patients need more enzymes and gut healing herbs and nutrients before any HCl is introduced. This is on a case-by-case basis.

If you are having problems with you digestion, click here to schedule a complimentary consult to figure out the best solutions for you. 

Physiology References:

Guyton’s Text Book of Medical Physiology, 11th edition.

The entire contents of this website are based upon the opinions of Dr. Justin Marchegiani unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Justin and his community. Dr. Justin encourages you to make your own health care decisions based upon your research and in partnership with a qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Dr. Marchegiani’s products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using any products.