The Top 7 Causes of Why You Are Bloated | Podcast #344

Stomach bloating happens when the GI tract is full of air or gas. Most people describe bloating as feeling full, tight, or swollen in the abdomen. Your abdomen may also swell (distended), be firm, and have pain. Bloating is often accompanied by pain, flatulence, constant burping, and abdominal rumbling.

In this video, however, Dr. J and Evan talk about the other causes of bloating that may be due to medical conditions. These include irritable bowel syndrome and disease, bacterial overgrowth, altered gut motility, aging and stress, and many more.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:41:  Bugs and gut infections

2:58:  Low Enzymes, acids, and bile salts

3:45:  Aging and stress

5:29:  Adrenal stress and food allergens

8:43:  Mold toxins

10:29: Low thyroid hormones

12:55:  Gut autoimmune disease

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Dr. Justin Marchegiani: And we are live! It’s Dr. J here in the house with Evan Brand. Evan, how are you doing today, my man?

Evan Brand: I’m doing well. We’re ready to talk about like, the mainstream topic. Like, sometimes, you and I, and we go into some of these nuances, that unless you’re into functional medicine or natural medicine, you may just be like, what the heck are you talking about? But  every single human being, man, woman, baby, they can already relate to bloating. So, let’s dive in. You came up with the magic number of seven. So we’re going to riff on who knows, could be 7 or 17 different causes that we see clinically from bloating. Let me start off with number one. Gut infections which if open that can of worms, we can do five to twenty infections, and then get to that magic seven number right away. But I’m just gonna go ahead and say…

Dr. Justin Marchegiani: 100 percent.

Evan Brand: Bacteria and Candida-those are probably like, two of my biggest smoking guns. I, I know parasites cause a lot of gut damage but I’ll say personally, when I had parasite infections, I don’t think I had much bloating. I think it was more of my dysbiosis, my candida problem driving the bloating than the parasites.

Dr. Justin Marchegiani: You know, when people have parasites, there’s a lot of issues happening so it’s really hard to know like, is the parasites alone the root cause why you’re having these issues. And it’s hard to know that. I mean, parasites can definitely do it because they can affect you body’s ability to generate stomach acid, and enzymes, the bile support. Obviously, they can eat a lot of these foods and they can be fermenting, and creating gases being released from them, you know, they’re pooping in their, you know, um, farting inside your intestines and creating gases and things, and obviously, they’re creating  information which then can affect digestion so parasites, we can just kind of lump bugs all the same bucket if you will. So we could say bugs, parasites, H.Pylori, fungal overgrowth-we can say small intestinal, bacterial overgrowth, or SIBO, or candida overgrowth, or fungal overgrowth. All those things kind of go in the bucket worms kind of goes in that parasite bucket as well. Anything else you want to highlight there before we go number two?

Evan Brand: Yeah, how about, uh, you can call it SIFO too. We haven’t hit that term but, just, just in case people aren’t clear on it so when we talk about fungal overgrowth. You can literally have what’s called SIFO. So this means you can have SIBO but, you can also have SIFO, and as you mentioned, it’s rare to see these things in isolation. So we’re often going to be using broad spectrum herbs, or antimicrobials, anti-fungals, antiparasitics all at once to try to knock all these down.

Dr. Justin Marchegiani: 100 percent. So regarding, um, bugs, SIBO, SIFO, and fungal overgrowth, or candida that are kind of all in the same bucket there. Uh, I would also say, diff kind of isn’t that bucket too, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: Um, you know. You can almost put some of the mold, um, the colonized mold, uh, fungal critters in there as well. Some of the aspergillus and things like that potentially, they may have different root cause of why they’re there but, that’s something that should be looked at. Next thing, is um, low enzymes, low acid, low bile salts. And again, some of these things are caught like they’re connected. So like yeah, HCL, enzymes, low bile salts if we are, aren’t able to break down those foods adequately, they can ferment, they can acidify, they can create gases; and of course, those bugs on step on can also create low stomach acid, low enzyme and bile salts. So everything is kind of connected in this web here. So I would say, the digestive secretions I think would be there. I’d also throw in, maybe some lifestyle things like not chewing your food enough, and maybe drinking too much water which shifts the pH in the stomach from a two-ish to closer to a seven which water is, and those would be the things I want to highlight. What do you think?

Evan Brand: Yeah, good call. And I’ll also point out just age and stress, not chewing some of this lifestyle measures you mentioned. That could be enough to create the bloating. As we know, the infections are going to drive some of this too. So kind of like, chicken or the egg, and it is possible that just age alone by the time you’re 40, 50, 60 beyond, you’re going to be making less stomach acid and Dr. Wright’s book. He had an amazing graph in their age and stomach acid levels. So if you’re one of the lucky few that are 40, 50, 60 with no gut infections, you simply just have an aged-induced low stomach acid. Well, that’s cool but, the low stomach acid will eventually drive some sort of infection, right? Now you’ve got this fermentation and purification of the food. So even if you’re like, somehow magically clear on stool or urine, and you just have low stomach acid, it won’t be that way forever. Eventually, stuff will pop up.

Dr. Justin Marchegiani: 110 percent. Now, everything’s connected right? So of course, if we have fungal overgrowth and bacterial overgrowth, well that can affect stomach acid but, now that also can affect motility, and so if we have slower motility, right? On the faster motility side, like diarrhea and such. You know, that can really cause a little bit of bloating but tends to be more on the slower stool side because, the stool is just sitting in your intestines longer, and maybe getting compacted. Maybe it’s taking you two to three days to kind of move that stool out. That may give you a sense that you’re feeling more bloated more as well. So I would say now that the slower motility, potentially caused by the bugs, caused by the HCL, could now start to increase that feeling of bloat.

Evan Brand: Yeah. So you’re saying like, you’re literally just full of poop as opposed to the infections or releasing gases which make you feel full but that’s a different type of bloat. So that’s a good, that’s kind of a good distinction there.

Dr. Justin Marchegiani: Yeah. It could just be a combination of everything, you got a little food baby inside of you, you know.

Evan Brand: Yeah.

Dr. Justin Marchegiani: That’s possible. Next, I would say adrenal stress. And so adrenal stress, the adrenals are part of the stress handling system that helps your body manage stress. Whether it’s through making adrenaline to help your body like, get the spider senses going so you can deal with that stress, uh, it could be just chronic low-grade stress where you’re making a lot of cortisol, and or you’re chronically inflamed from foods and emotional, and maybe even physical stressors, where the adrenals are just really over romped up and that’s activating the sympathetic nervous system, and so you have that see-saw, right? And sympathetic is the fight-or-flight, that’s the go-go-go, that’s the gas pedal. The break is the parasympathetic, they’re on a see-saw. So it’s hard to like, double clutch you know, and have a hit the gas and the break at the same time, so usually the sympathetics are up, the para are down. If the parasympathetic’s up, the sympathetics down, and the parasympathetic is to rest and digest. That’s the vagus nerve, right? People are like, “Oh! Gargles, sing”, right? Well, those maybe palliative things but, how about just fix the stress in your food, in your emotional life, in your physical life, work on that first. Uh, that’s going to make a huge difference and of course, gluten and processed sugar, and inflammatory foods, and foods that are nutritionally deficient can drive that kind of stress as well.

Evan Brand: Oh, yeah. Let me piggyback off that then. So you got the food-adrenal connection but how about just food connection in general? I mean, if you’ve got dairy in the system, you’ve got gluten in the system, you’re going to effect the tight junctions in the gut, so you’re going to maybe contribute to leaky gut but, also you may have some bloating from that. Now, there are enzymes, I know you and I, we manufacture some custom enzymes that things that can contain, what’s called dpp4, which is an enzyme that can help break down gluten. There’s also some allergy enzyme type formulas that we use where we can break down the occasional instance of all these types of proteins, dairy protein, and soy protein if people are getting exposed to it but, food allergies are big one, so I know you and I talk a lot about good quality meats, good quality fats, organic vegies and such but, if you haven’t got your diet boring before, I think I would go boring. I mean, look at me, I’ll do like a grass fed steak and a handful of blueberries for breakfast and I feel great. So, for me I would just recommend really, simplifying, trying to get your foods in isolation where you know, what you’re reacting to. For example, let me use my wife as a story. So, we were doing swapples which are awesome! It’s like a healthy waffle-it’s yuca, yuca-based, and she thought those were affecting her stomach but, she was also doing organic coffee, and she was doing eggs, and she was doing pastured sausage or bacon. I’m like okay, well, you got too many foods in here. We don’t know what it is. So we got down to elimination and then boom! We figured out it was the coffee affecting the gut. It wasn’t the food after all. Even the eggs which are common trigger were no problems. So I think you got to dial the food allergies, the food sensitivities, and just try to eat you food in isolation. Maybe do a food journal. Even on your phone, you could do an app, like I use Day Book a lot to take notes and you can just make a note like, :Hey! Eggs hurt my tummy today, or eggs got me bloated”, and then you can figure out what it is.

Dr. Justin Marchegiani: Absolutely! So the food component, just the inflammatory nature of that food. I think is also going to be a big one. Um, like you mentioned, I would say next, mold toxins. I know mold, uh, can do different things, whether it’s, you know, we kind of talked about it as kind of being a bug thing, which I guess it could be connected but, the problem is you may live in a moldy home. You may have things in your environment, whether maybe it’s too humid, right? And there may be a different solution for that than fixing out your bugs, clearing out the bugs in your tummy, so we may have to go about that a different way. So I guess, the mold kind of connects with the bugs but, there’s also a different solution to it. So we’ll put mold as a separate entity on that list, and that could be just too humid of a home. It could a leak in the home that was never fully remediated properly, um, it could be lack of good quality air filtration. All of those things could play out and of course, mold also is a sympathetic nervous system stressors as well.

Evan Brand: Definitely and they’re two different categories because, you can have two different situations you can be colonized for mold, meaning you’re growing in your gut and sinuses. Or you could just be a mycotoxin reservoir and some people are lucky enough to where maybe, their immune system was able to not allow the colonization or maybe the exposure of the mold was not too long-term, therefore, they’re just reservoir of mycotoxins but they’re not growing it. That’s a better situation. It makes out job easier if that is a situation, and yeah for sure, I mean, mycotoxins for me definitely affected my gut, my brain, my stool, consistency, so binders really help. So if you are having bloating but you’re having more IBS type symptoms, you know, of course bringing in the binders; we’ve done podcast on that is going to be the next step. Let’s go back to hormones per minute because yeah, I would consider you one of the best experts in hormones, and you’ve taught me over the years about hormones, and I know that PMS for a lot of women. PMS is a big deal, not only is it mood changes but, it’s bloating. So can you full us in there? What’s the hormone connection outside of cortisol to bloating.

Dr. Justin Marchegiani: Yeah. So I would say out of the gates, um, low thyroid has a string connection with affecting motility. So one of the side effects of low-thyroid hormone. Obviously, can be the conventional hair loss, cold hands, cold feet, eyebrow thinning of the outer third, maybe mood issues, maybe irritability, and obviously some of that overlaps with adrenal and female hormones and male hormones. But low-thyroid also affects motility, and so low thyroid hormone could easily affect motility. And if we slow down motility, that could easily allow more time for those foods, the ferment kind of create that food baby if you will. Just put more bulk in your tummy just make you feel a little bit more bloated and distended so it’s very possible could be playing a role in the whole situation.

Evan Brand: Okay. Well, we talked about thyroid and 90% of hypothyroid cases are hashimoto’s, so I mean, we could just say hanshimoto’s could be a cause. It’s a roundabout way. It’s a long, it’s along route to get from hanshimoto’s to bloating but, it does make sense.

Dr. Justin Marchegiani: Yep! Exactly. Um, so yeah, at this stage of the game, female hormones can plug in. Like if you have estrogen dominance, right? Lower progesterone, higher estrogen. Um, relatively speaking and just lower hormones. That can create potential things that could affect motility via stress, via sleep, and then if those things are compounded, that can create more adrenal stress. So you can kind of like, you know, it’s kind of like, it’s six degrees of bloating, right? It may not be a direct, direct indication but, it can easily, kind of dovetail two or three you know, weighs in and hit a couple of these different factors, that makes sense. So I would say some of the female hormones, um, obviously, some of the cortisol, and adrenaline, and of course the big one that we’re hitting now is the thyroid, the low-thyroid hormone. Evan Brand: Yep! Yeah.

Dr. Justin Marchegiani: Is that number five or six?

Evan Brand: Two… I don’t know. I don’t know. I think we got, we got more of those. So how about just bowel obstruction? I mean, this is not going to be a common situation but, you know, if somebody hasn’t poop in a week, and they’re listening to this podcast, I mean, you have to consider the possibility of bowel obstruction. Unfortunately, this is pretty rare but it does happen.

Dr. Justin Marchegiani: Yep! Yep. 100 percent. Um, so that can definitely happen. An again, all these things that we’re taking about would be contributing factors of that,right? So that makes a big difference on that front. Um, so we hit the enzymes, we hit the food allergens, we hit the bugs, we hit mold,

Evan Brand: That’s five.

Dr. Justin Marchegiani: We hit adrenal stress,

Evan Brand: That’s six.

Dr. Justin Marchegiani: We hit thyroid stress. That’s seven! I think we hit them all.

Evan Brand: All right.

Dr. Justin Marchegiani: Is there anything else you want to add as a bonus or value add for the listeners?

Evan Brand: Uh, yeah. So any kind of autoimmune gut stuff. So celiac, crohn’s, ulcerative colitis. Even diverticulitis in some cases could cause any and all of these issues we talked about in terms of bloating, and stomach pain, and all of that. So if you are seeing more than just bloating, you’re seeing blood in the stool, or you’re seeing  floating stool, maybe there’s fat malabsorption issue. We could go into gallbladder potential issues there as well; where we need to use some extra bile salts. So I would just say any kind autoimmune gut stuff is going to be a big one.

Dr. Justin Marchegiani: Yeah, a hundred percent. Autoimmune is gonna just create more inflammation. It’s gonna inflame the tissue to make it more raw, the more inflammation in the tissue, and the more sensitive the intestines are, the more your adrenals, and you cortisol, and your fight or flight system will totally get activated. I think it’s a really good step out of the gates here. I think we really hit a lot of good things here. So, we have food, we have low enzyme, we have low acid, we have bugs, we have mold, we have adrenal stress, right? We talked about thyroid and then the last thing we talked about is just the bowel obstruction and or the autoimmune um, gut stuff. So I think we hit seven to eight there. So a little, a little extra. So guys, if you’re listening.. go ahead.

Evan Brand: Let me, let me do the outro for you today. So today’s shorter and we want your feedback because we’ve done, I, I, lost track, I know my podcast is over 400 episodes. I know you and I have done hundreds together. So we want feedback on this. Is, is this is coming up on 15 minutes. How do you enjoy a 15 minute podcast? Is this all you need? Do you enjoy the 30-45? What do you like, because I mean, we could always go deeper but, eventually It becomes um, maybe rants or tangents. Today is just like, boom boom boom. So please, uh, go on Justin. Look up maybe his Instagram page, just in health or Justine Marchegiani. Look him up there and look up me Evan Brand and send us a message, and let us know. ‘Cause sometimes, we forget to check the reviews but yeah, send us a message maybe on Instagram. That probably the best place. We don’t use the Facebook too much because of some of the censorship going on but anyway, check us out, send us a message. Let us know what you think! Is it shorter, and sweet, and boom boom boom episode, is that good enough for you or do you want deeper dive? Let us know, and if you need help clinically, you can reach out. Justin works around the world with tons of people, thousands of people over the years, and he can run all sorts of labs to investigate these issues. So to reach out to Dr. J, and for me Evan Brand, We would love to help you, we offer intro calls too. So you can book a quick call to discuss your symptoms, your goals, see if you’re a good fit, and we can help you anywhere. So the beauty of these type of symptoms, there are root causes, it’s not a deficiency of some sort of gas x or other thing you’re going to get ate walgreens, you know, there are root causes here that you can investigate and you can reverse these symptoms.

Dr. Justin Marchegiani: 100 percent. And then in regards to the solutions here, the solutions are addressing those root cause. We can go, we can do another podcast in the top six palliative kind of solutions, but out of the gates you know, fixing the bugs, fixing the stomach acid, look at what those adrenal stressors are, getting the food right. I think those would be the big kind of the root cause foundational things today. We’re not going to go too granular into extra protocols but, just kind of more big picture stuff and we’ll do another podcast in the future where we get more into the nitty-gritty in this.

Evan Brand: Sounds good.

Dr. Justin Marchegiani: Awesome! And guys, if you want to leave us a review, or We’ll put the review link below. We really appreciate that review, really appreciate your comments below. You guys have an awesome day. We’ll talk soon.

Evan Brand: Take care now.

Dr. Justin Marchegiani: Bye!


Audio Podcast:

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The Root Cause and Solution of Your Stomach Burning and Upper Left Quadrant Pain | Podcast #355

Pain in your upper left (UL) abdomen under your ribs can have a variety of causes. Several vital organs exist in this area, including the spleen, kidney, pancreas, stomach, colon, and lung. One of the most common origins of these issues is due to digestive problems. Heartburn typically happens when acid comes back up from the stomach into the esophagus. It can result in discomfort and a burning sensation in your chest. The pain can feel burning, sharp, or cause a tightening sensation.

Additionally, Gastroesophageal Bowel Disease, commonly called acid reflux, is a condition that occurs when you experience heartburn more than two times each week. Irritable Bowel Syndrome is also a chronic condition that involves a group of intestinal symptoms that usually occur together. The symptoms can differ in severity and duration from person to person. Inflammatory Bowel Disease (IBD) also includes any disorder that can cause inflammation in your gut; the most common of these conditions is Crohn’s disease and ulcerative colitis. Dr. J and Evan emphasized that having your daily food and environment checked. Possible modification is a basic essential thing to do to avoid gut issues that can compromise overall health.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:32    Stomach Burning and Irritation

8:48   Causes of Stomach Cancer, General Inflammation

14:27  Herbs

19:26  Bacterial Overgrowth causing Stomach Problems

27:41  Mood, Stress, Depression and Anxiety Conditions

Dr. Justin Marchegiani: We are live. It’s Dr. J here in the house with Evan brand. Evan, how are we doing today, my friend? 

Evan Brand: I’m doing great. You ready to dive in and talk about heartburn? One of the most common issues one of the trending issues that’s always trending because us as a modern society, we have a lot of issues with hypochlorhydria, which is the technical term for low stomach acid. And so you and I are going to break down some of the reasons some of the root causes some of the triggers, and then some of the solutions. So where do you want to start? 

Dr. Justin Marchegiani: It’s a great question. So out of the gates here, we’re chatting about what h pylori stomach burning stomach irritation, so there’s a lot of root causes here. I would say out of the gates here, let’s hit H. pylori first. 

Evan Brand: Let’s do it. So I had H. pylori. So I’ll tell you from personal experience, and you and I clinically have seen many, many, many cases of H. pylori, let’s start with a conventional approach to it. So first of all, the testing for H pylori is not very good in the conventional world. And there’s an issue with false negatives. Luckily, the DNA stool test that we use is very effective, and we can find it very accurately. And conventional treatment is going to be what’s called triple therapy, or sometimes quadruple therapy, which is three or four antibiotics at the same time to try to kill this helicobacter infection, which if you look at the microscopic photo of it, it kind of looks like a jellyfish, it’s got this creepy little look to it with a creepy little tail. It’s not a pretty little bugger, but man, it causes damage to those parietal cells which secrete stomach acid. And this is something that was very controversial for many times until the researcher actually infected himself with H. pylori and gave himself an ulcer. Right? You and I talked about that story before. 

Dr. Justin Marchegiani: Yeah, that was Dr. Marshall. I think in the in the mid 80s. He couldn’t get funding for his research. So he’s like, hell, let me be the subject. And so he just infected himself with it. And h pylori, like you mentioned, is that he had a co shaped helix shaped kind of bacteria that kind of burrows into the gut lining. This it’s controversial because, well, I shouldn’t say it’s controversial, we know that it can cause ulcers and stomach inflammation, we know that it can affect acid secretion. Now, a lot of people complain that it’s an increase your acid levels, H. pylori tends to actually decrease acid levels. It creates an enzyme called urease, which takes the metabolite from urea protein metabolism, it turns it into co2, and then also ammonia and ammonia is got a pH of 11. So in the typical urea breath test for H pylori, they give you a bunch of urea. And the whole thought process is if you have h pylori, you’re going to have more of that urease. And that urease is going to convert that urea into ammonia and co2, then thus a positive co2 level is going to be give you the H pylori indicative for a breath test. Now that ammonia has got a pH of 11. So it will start to neutralize and start to move your stomach pH in the more alkaline direction. So kind of one to six is going to be your acidic scale, okay? One is going to be 10 times more acidic than two, two times 210 times more acidic than three, and then you get to seven, which is going to be neutral, that’s your water. And then everything above that base are alkaline, right? And so ammonia is that 11. So you’re taking that pH in your stomach that should be around one and a half to two and a half and you’re moving it more neutral. And so of course, that can affect a whole bunch of problems in your stomach from indigestion, dyspepsia, you’re not breaking down your proteins, you’re not activating your enzymes. And also H. pylori can thin out that gut lining. So part of the reason why people feel like it creates more acidity is because your gut lining gets thinner, your gut lining gets thinner that’s making you more sensitive to acid in your stomach. It’s kind of like if I got a sunburn, right? If I got a sunburn, and I went out the next day in the sun, did the sun get hotter? Well, it feels harder when I’m in the sun with a sunburn, right? Did the sun get hotter? No, it is your skin’s more sensitive. That’s when you’re out in the sun. It feels like it’s 150 degrees out but it’s not. It’s the same thing with your intestine you got a sunburn got that feels more irritated. Thus that acidity the acid that you’re putting in there may cause some irritation just like going out with a sunburn. 

Evan Brand: Yeah, that’s great analogy check your microphone to it sounds like it may switch to your headset, make sure it’s on your USB and I’m going to riff on h pylori for a minute because my personal experience with it was not fun. I lost a lot of weight and I was kind of freaking out honestly like I lost so much weight and I couldn’t stop it and no was no shortage of calories. I was eating plenty of good meats and good fats and I just kept losing weight and I think h pylori is really one of those big stepping stones or maybe the better analogy is the domino effect. And once the age polarize there, as you mentioned, it kind of in activates your enzymatic process. So your pancreatic enzyme function, the release of the stored bile from the gallbladder is going to slow down or be reduced. So this is what I think leads to a lot of the SIBO or the bacterial overgrowth dysbiosis problems that you and I see clinically because when we find h pylori, we go down to page three of the stool tests and then boom, now we see Prevotella and klebsiella and Pseudomonas And all these other bacteria that are thriving so many people have heard of SIBO because it’s trendy, and they’ll come in and they’ll do SIBO protocols. But if they don’t get rid of the H pylori, I’m convinced that’s one of the smoking guns that allows the dysbiosis to take place. So, long story short, if you’re someone listening, if you’ve treated your gut before using antimicrobial herbs, or possibly even antibiotic therapy, and you didn’t get better, or maybe you got better and you relapsed, consider that you’ve missed one of two things mold toxin, which is weakening the immune system or number two h pylori, and it could be coming from your spouse. So if your spouse is not being treated, they could have reinfected you and that’s why you’re on the merry go round and you can’t get off.

Dr. Justin Marchegiani: 100%. So h pylori is one of the first things now, people say, well, a large percent of the population has h pylori, and that that is true. And so the question is, are you immunocompromised with that h pylori is an issue we’re not. There are a lot of people that can survive on four or five hours a night sleep. But once you become stressed, and your adrenals become dysfunctional, and your diets been poor for a while, that four or five hours of sleep may not be enough. So you have to look at the context of the person for sure. 

Evan Brand: Yeah. It sounds decent. It could just be the bitrate or something I do believe you have it on your USB now. It just sounds like it’s a little grainy, but it I know on our local and it will be just fine. So it’s, it’s plenty good enough for today. 

Dr. Justin Marchegiani: Okay, excellent. All right. So out of the gates here, just kind of hitting all the right things that we’re chatting about. So we talked about the susceptibility for H. pylori, right. h pylori is going to be one of these things that may be a problem in people that have symptoms. So if you have symptoms, if you have issues, we want to look at that and the gates for sure. I think that’s gonna be a top priority. Anything else you want to highlight regarding other infections? I know SIBO was another one that could potentially affect digestibility and your stomach cebo is going to hit more of your small intestine, but some of that bacteria overgrowth can move its way and migrate to the stomach as well for the gastric area. 

Evan Brand: Yeah, well, I think H pylori is probably the biggest smoking gun but like you’re not talked about many times, you can have permission to have multiple things wrong with you. Right? You said that so it’s funny because we’ll see Candida will see bacteria will see H Pylori, which is bacteria will see parasites will see worms. So the cool thing is when we come in with the testing, we’re often using full spectrum herbs. And what I mean by that is we’re going to try to knock out Candida bacterial overgrowth, the H pylori, the parasites, often we can do it in one fell swoop. And it’s really fun to do this in children or young adults, because they tend to get better faster. Like if I see a five to 15 year old kid and we’re working with them. It’s amazing how much faster they get better than like a 70 year old adult, for example. It’s something that I think shows the immune system being weak long term, this can be a bigger problem. So when you hear about stomach cancer, and the ulcers and esophageal problems, and GERD and some of these more scary diagnosis, these, these are likely more long term infections, or it could be the virulence factors, which are something that we test for if you look into the research, H. pylori by itself is not going to cause a ton of problem in the short term. But when it has these virulence factors that essentially strengthens the disease, the way I think about it is like the little whale shark, or actually, whale sharks are huge, but the whale shark with the little fish that kind of swim under its fins, to me, those are the virulence factors, they kind of strengthen the main host there, they’re allowing the H pylori to thrive, they’re allowing that shark to do what he needs to do, they’re helping to maybe eat parasites off of the shark, so they’re kind of helping him hang around. That’s how I think of these virulence factors. It doesn’t change the protocol much, but when we see a ton of inflammation or when we see a ton of gut damage, it’s good to be able to link that back to a stool test.

Dr. Justin Marchegiani: 100% here, the virulence factors are going to look at those cytotoxic proteins and it’s a genetic susceptibility of this H. pylori is going to produce more toxins that are going to increase your chance of ulceration increase your chance of stomach cancer, increase your chance of just overall general inflammation. So it’s nice to look at the virulence factors. Now we have a couple we have like Virdi,  VagA, iSay, these different virulence factors, these are cytotoxic proteins. And so it’s good to look at that. Now one of the things we’ll also look at in regards to intestinal inflammation to kind of make correlations is we’ll look at calprotectin. Calprotectin is another systemic marker that’s excellent to look at, because it plays a major role with inflammation in the gut as well. And so that’s a really good one. So it’s like a C reactive protein for your gut. CRP is a basically an inflammatory marker for the body. C reactive protein. calprotectin is a protein produced by the white blood cells in the intestine. So when there’s more inflammation, more cytokines, more interleukins, nuclear factor, Kappa beta, all these inflammatory presence, it’s going to give you more of a window that that’s happening now. It doesn’t tell you what the cause of it is. So you need to do detective work and get to the bottom it’s going to be usually one to four or five things. Something of infection, some type of food allergy, some type of immune stressor, whether it’s exposure to mold or heavy metals, okay? It can also be gut permeability where things are getting into the bloodstream and you’re having this, I mean, a logical reaction, those would probably be the big four out of the gates. And then I think, also just if you’re eating a lot of junky inflammatory foods, omega six grains, a lot of pro inflammatory foods, those could also drive it too. 

Evan Brand: Yeah, I would say there’s probably an autoimmune component to right if you’ve got Crohn’s or ulcerative colitis or something like that, that may elevate that. And I know some of the stuff we talked about, if you try to take our conversation and put it in front of your GI doctor, they may not follow us on some of this stuff. But they will follow us on the calprotectin. I mean, that’s a pretty common marker that it’s going to be tested in conventional gastroenterology. So if you’re trying to like educate your doctor, if they’re willing, enable cool, you know, send them this podcast, hopefully, they’re open to integrating some of these things into their practice. But often, we’ve had many people that have been the GI doctors, 5 10 15 doctors before they come to somebody like us. And unfortunately, they’ve had very poor testing, and they’ve had very poor treatment. That’s why they’re still needing help. And we’re usually at the end of the rope, which you would think puts a ton of pressure on us, but I think you and I are used to and I actually enjoy it. Because in contrast, what we do makes the other people look silly, and our success rate is so good that it’s really it’s a blessing to be able to have some of these tools on hand. And it’s really fun and inspiring to be able to give people hope. And some of these chronic gi issues like heartburn or reflux or GERD, or some of these esophageal problems like what they call like issues with the LES to lower esophageal sphincter that can become very traumatic. And people think that surgery or drug is the answer. But we don’t have to go there in the majority of cases. 

Dr. Justin Marchegiani: Yeah. And also, when you start to have you know, a lot of dyspepsia, that’s like the bloating, that’s the nausea, the burping the belching, when you start to have that, right, that lack of acidity in the intestines, if you have a lack of acidity, you also have a lack of enzymes more than likely because acidity is an important trigger for enzyme activation, right, because a lot of our enzymes are pH sensitive. So if you don’t have a nice low pH, they’re not going to activate and also that bacterial overgrowth, and you can look at bacterial overgrowth in the stomach usually be a glucose breath test. Now, the conventional breath test that we use for like SIBO is we’ll use a lactulose blood test, or lactulose breath test where you swallow a lactose solution. And then you’re gonna, you’re going to blow into a bag, and you’re going to get a baseline and then you’re going to swallow the lactose solution, and you’re going to blow every 20 minutes. And you can sometimes see an increase in gas that first 20 to 40 minutes, usually being reflective of the stomach area, usually in that first 120 minutes gives you more of the small intestine. And if you do a glucose breath test, that’s going to give you more of a window into what’s happening in the stomach. Now, typically, what we do is i’m doing more of a store test and I’m getting a global look at bacterial overgrowth in the intestinal tract as a whole. Obviously, when we’re testing stool, it’s all moving through the intestine. So you can’t say Oh, that bacteria is in that part of the intestine or that part of the colon or that part of the stomach, you can’t really do that because it’s all moving its way out and getting mixed up, right. So a breath test could be helpful for that. Now, for me, it doesn’t necessarily change a lot what I’m going to do, because if I see him does a lot of klebsiella or citrobacter, or I see some h pylori or I see a lot of organic acids showing him parade or fenzbenzoate right are two three phenolacetate, right different markers indican. And that tells me we got some problem especially indicate indicates one of those bacterial overgrowth markers that also has to do with more increased putrefy protein. So that’s going to be a good indication that there’s some stomach issue going on and dyspepsia issue going on. So if I see that that’s going to gear me in that direction to be focused on addressing the stomach. And when we do herbs, guess what you can’t just target one part of the intestine, when you give these herbs is going to move its way through. Some of these herbs are going to target things more specific to h pylori like mastic gum or bismuth. But obviously, some of those are still going to have general antimicrobial benefits that will move down the entire intestinal tract. And some even have anti parasitic benefits too. So it’s hard to just target things we do know there’s a history of herbs that tend to be more selective to certain things in the intestinal tract. 

Evan Brand: Yeah, great, great, great segue to into the herbs. So let’s go into that now. And we’ll be providing some links, we’ll put them in the show notes. We’ll put them in your podcast app. So if you’re listening on your iPhone, you should be able to check if you’re on Justin’s podcast listening, you should see some links for his products. If you’re on mine, you should see mine we have custom formulas that we’ve created in partnership with professional healthcare company so we don’t use any kind of consumer manufacturing. Most supplement companies, they gather products from around the world and they just label them up in a warehouse and ship them out. But they’re not professional. So there’s typically not as much tests. If any testing at all purity potency, those kind of things are not well tracked, we’re very anal about what we do, because we have to get results clinically. And if we don’t, then people don’t get better, and they don’t come to us. So we have a legitimate reason we have to be of the utmost quality. This is stuff that you can’t get through consumer, like Whole Foods, places, or Amazon, these are professional so that that’s, you know, just a little bit about quality. But in terms of the stuff we’re using, as you mentioned, we have different blends. So sometimes we’re going to go with more of like a mastic gum, clove berberine, Wild Indigo blend, these are things that can be both anti inflammatory, anti microbial, anti antifungal, anti parasitic, and then we have some where we’ve got a little bit of gut healing nutrients, like we might throw in a little bit of some dgl into the blends. So now we’re doing two things at once, which is great, we’re killing but we’re also soothing the gut lining, which is probably so irritated, as you mentioned, this thing is thinned out from the infection itself. And then we go into more of the antifungals, too. So we may stack. If we see on the organic acids, you’ve got an anti fungal need, then we’ll throw that into on top of the anti microbial need. And that’s where the magic really happens. There’s a synergistic effect. So rarely Are we going to come in with just oregano oil or just garlic, we’re likely going to use a combination of possibly 510 or even more herbs. And then if you want to comment on that, and then let’s get into the the question of like, where do probiotics fit into this equation? What about digestive enzymes and increasing stomach acid? Where does that fit into this equation? So if you want to hit on the herbs at all, then let’s transition. 

Dr. Justin Marchegiani: Okay, so first off, I think people come in with stomach issues saying, Hey, I have an H. pylori issue. And that’s it. So I think, one you have the right to have more than one infection or gut imbalances happening at the same time. So it’s really important don’t get myopically focused on one infection, there’s probably multiple issues. You could have h pylori, you could have some level of bacterial overgrowth that involve other types of infections, like klebsiella, or Pseudomonas or citrobacter. You could have a fungal overgrowth, you could have a parasite infection, as well. So all those things can be present. And also, you’re probably going to have a lot of dyspepsia where you’re having bloating, nausea, indigestion because you’re not breaking down your foods adequately. So you’re going to need to follow my six R’s right and moving the bad foods and again, that could be different for everyone. Some people that could be a paleo template, others it could be an autoimmune, it could be a low fodmap template as well could be a low histamine could be a gassers SCD template. So there’s different templates we’re going to plug in, depending on how sick or how chronic this issue is. And then number two, we’re working on enzymes and acids to really work on digesting things better. And again, acids tend to be anti microbial. Also, bile acids, which are produced by your gallbladder are also anti microbial. So if you have biliary insufficiency, you’re not breaking down your fats, inadequate levels of bile salts will create a a more hospitable environment for bad bugs to grow. So that’s the second are placed enzymes, acids, bile salts, third are repairing the gut lining and supporting the adrenals and the hormones because the adrenals help really provide a good anti inflammatory environment. So if you have imbalances in your cortisol function, you may have a lot of inflammation that’s not being managed by your adrenals. And then of course, on the repair side, you kind of hit it earlier. Some of the repair nutrients that we’re going to use maybe glycine could be L glutamine, it could be zinc. Zinc is very helpful. A lot of studies showing that to be very helpful with gut permeability. I would say DGL licorice, aloe okra, vitamin A. These are really important nutrients that come down the gut lining early I also like ginger and manuka honey. Manuka is used in hospitals in burn units, because it’s very anti inflammatory. So I like a little bit of manuka honey, and my ginger juice tea recipe is wonderful. Any comments on that? 

Evan Brand: Yeah, that’s delicious. I’m a huge fan, too. And the good news is, depending on what’s going on, you could start soothing the gut a bit early. So as you mentioned, there is kind of an order of operations. But depending on the case, if someone’s in real bad shape, we may come in with some of those soothing nutrients early. Let’s talk about probiotics, too, because this is a confusing one for a lot of people. They just hear online, a podcast, a blog, a website, they’ll hear probiotics, probiotics, I think it’s time to just throw it in. And a lot of people have a bad reaction to that. I think we actually did a whole podcast on this, like when and why probiotics may make you feel worse, but why don’t you give us just some sparknotes on that, when and why and how do we integrate probiotics entities. 

Dr. Justin Marchegiani: So people tend to have stomach issues in general because they have this bacterial overgrowth in the gut, that’s going to affect the esophageal sphincter from closing. They also have a lack of enzymes and acids. So the food’s rotting, it’s putrifying, and transfer defying and creating lots of different gases as a result. Now, people tend to have a lot of bad bacteria in their gut, they tend to be very sensitive to fodmaps fermentable carbohydrates, fructose, oligo, disaccharide, mono and polyols. And again, probiotics tend to have fodmaps in it because probiotics are inherently fermentable right fermentation breeds bacteria, good bacteria growth, they can also breathe bad bacteria growth, right? And so if you’re consuming a lot of probiotics and you have a lot of bad bugs, it can really create a feeding frenzy just like throwing chum in the water. When there’s sharks around. It creates a feeding frenzy. If you go to your local Lake, I go down to Lake Austin and start chumming the water, right? Well, there’s no sharks down there. So you’re not gonna see any sharks come in, right. And so think of probiotics and a lot of fermented bowls. They may be reasonably good and healthy for you. But if you have sharks in that water, and you chum the water, you just create a feeding frenzy. 

Evan Brand: Wow. And that you’re saying, with probiotics, you’re not necessarily even talking about prebiotics?

Dr. Justin Marchegiani: Correct. Again, people that have more extreme fodmap and SIBO sensitivity. That’s where probiotics start to become more of an issue. You can still have some SIBO and fodmap sensitivity, and you may not get rise to the level where probiotics are problem, right? So people that are out there and having problems with their kombucha or their sauerkraut, you know, it could also be a histamine issue, because probiotics and fermentable are also high in histamine so they could dovetail and be a couple of different things happening at the same time. Either way, if that’s the case, we still have to work on fodmap restriction, because when we deal with gut bacterial issues, we starve on one side with diet changes. We kill on the other side with specific antimicrobials, and then we crowd out and overpopulate on the last component so we we starve kill and crowd. 

Evan Brand: Yeah, that’s great. And then the saccharomyces comes into the equation too, right? Which is kind of marketed and sold as a probiotic, but technically is a beneficial yeast, I love saccharomyces it’s something- 

Dr. Justin Marchegiani: It crowds out it crowds out so it has beneficial effects of crowding out and also is shown to be very anti cdiff. Anti h pylori, anti blasto and it has immunomodulating benefits increasing IGA levels too. 

Evan Brand: Yeah, we love saccharomyces it helps them mycotoxins too. I’ve seen it in a lot of people. And when I talk with Dr. Nathan, who is a guy who treats a lot of mold patients, he talked about saccharomyces being great for specifically, I think it’s actually metabolizing, or changing the structure of the mycotoxins to make them more water soluble, but there may be sort of a crowding out effect with the mole too. So it’s just a great overall thing. So if you’re working on a gut healing protocol, and you haven’t used saccharomyces, that may be something to chat with your practitioner about, it may be something great to add in. 

Dr. Justin Marchegiani: Yep, I like it, that makes a lot of sense to me. So when we have that upper left quadrant pain, right, your stomach for the most part is going to be just right in usually this area here. So this is kind of your, this point right here is your HCl point. And this points more of your enzyme point. So like pancreas, small intestine is like really right here, stomach’s usually going to be right in this area here. And then you have the esophagus, going up here, obviously, right, and then this esophageal sphincter can stay open. When we don’t have enough acidity and we have bacterial overgrowth, then you can have a lot of that regurge of that reflux happening when we have inadequate levels of assets. So one thing if you kind of take your hand right here, and you follow the sternum down, right, we’re kind of tucks into the left, if you rub it a little bit, and it’s a little bit sensitive. That points normally sensitive anyway, but if it’s really heightened, is a chance there’s inadequate levels of HCl in the stomach. So that’s a good little kind of pressure point there.

Evan Brand: Yeah, and people listening that can’t see he’s showing this down right there at the sternum, and then you can follow the rib line down to the left, or you could follow it down to the right, and you could check both sides. That’s a really cool thing that you can do in person when you’re working with the practitioners, you can palpate these points. And I remember when I was in one of my schooling lessons, we were with the teacher, and we had a lady who lay down on the table and everybody was coming up and palpating and man, this lady about jumped off the table when we hit that HCl point. So of course, we didn’t have a stool test on her but man, I bet she had some infection going on. 

Dr. Justin Marchegiani: Yeah, and it’s good to rub that and then you can kind of rub a couple other spots to see if it really is heightened and then you can also start start treatment. Right, make diet changes, add in support, right? start addressing microbials down the road and see if that changes but again, the biggest thing I really want to highlight for people listening, we live in this antibiotic culture today, right you have an infection, antibiotics, antibiotics, antibiotics, and so what tends to happen as people are in kind of my six are step right the fourth are is moving the bugs right? replace the net or remove the bad foods replace the enzymes and acids and bile salts, repair the gut lining and the hormones remove the infections, repopulate good bacteria, pre probiotics, retest that fourth Rs a movie infections, people go to this first. We live in this like, antibiotic generation people are programmed Kill, kill, kill, kill, kill, it’s the biggest mistake you can make. Some people can get away with it. If you’re really healthy and you don’t have an overabundance of inflammation, you can get away with it. Most can’t. And they end up creating a whole bunch of problems. And I tell my patients the first rule of functional medicine right the first rule of Fight Club is don’t make yourself more sick. It’s really important So that’s why that fourth R where that remove that second remove right the first removes the food. Right. The fourth R the second remove is removing the infections, we do it in that order, because we’re trying to calm down the immune system, trying to support our anti inflammatory system so they can deal with inflammation and stress better. We’re working on digesting and breaking down our food or working on motility that allows us set the table so we can come in there and wipe out the bad bucks. 

Evan Brand: Yeah, he kind of alluded to it. But just to make it clear, you’re actually improving your immune system by clearing out these infections. And some of these herbs we’re using may have immune supportive benefits too. So that’s just the real joy of what we do is you’re boosting the immune system, you’re letting the gut heal by removing the infections. It’s just amazing. And when you get the spouse involved too, like if you’re seeing a rebound case where husband feels great and then the wife sick and back and forth, you know, they may be passing the H pylori between each other even children who I mean I was sharing water bottles with summer my daughter when she was two, I tested her when she was two she had real high H. pylori. So I’m convinced I may have given it to her, I don’t know. But luckily, we did herbs and she’s in good shape now. And when we retested her the H pylori is gone. So I’m glad that we’re able to get it resolved. But this is a problem that affects kids. So like when someone hears heartburn, they automatically picture old Betty sitting in the wheelchair with the gray hair and she’s got indigestion she’s got her santech in her hand. No, it’s not just her. I mean, this could be two years old, this could be 10 15 20 30 40 years old. So don’t discriminate. This bacteria does not care what you look like and how big or small your or anything. This is a bacteria that affects all people across the population. So if you have these issues, get tested, don’t guess. And if you need help clinically reach out we work on this issue all the time, it’s one of my favorite things to do is work on these gut infections. So if you need help clinically, we work around the world with people we send testing to your home, you do the labs, we get them back to the lab for reporting. And we jump on a call like we’re doing now and we talk about it and we help you make a protocol help you fix your issues once and for all. So if you want to reach out to Justin, you can have his website, If you want to reach out to me, and like I mentioned, we’ve got some links, we’ve got some gut healing products and some things that we’re okay with you guessing on, there are a couple of things you could do out of the gate. But ultimately, you need to know what you’re up against. Because as we alluded to, you may not have just h pylori, you may have other infections. So coming in with the glutamine, the zinc carnosine, that lm that kind of stuff that kameel, the ginger, the Manuka, it’s awesome. But that may not be the right order of operations, it may help you by some time, but you got to clear the bugs.

Dr. Justin Marchegiani: 100% and there’s a lot of studies out there looking at H. pylori, for instance, with a lot of mood and stress and depression and anxiety related conditions. And they find that when a lot of the H pylori is addressed, some of these changes occur as well with these issues improve or they talk about antidepressant drugs working better now. Now, why is that happening? Now, I believe the reason why it’s happening is because when you address some of these bacterial overgrowth, you’re absorbing your nutrients better, you’re absorbing your protein, you’re absorbing your fat, and in some cases, probably absorbing their drugs better, so they work better because they’re in their system. Now, I personally believe if you’re not breaking down your proteins and your fats, these are functional building blocks for your neurotransmitters, that you’re going to have some issues in regards to your mood and your cognitive function and potentially energy because a lot of the nutrients and minerals and B vitamins have to get absorbed that way too. So if you have issues with your gut, don’t just think hey, this is just a gut issue. Therefore my only symptoms are dyspepsia bloating, gas, nausea, constipation, depression, diarrhea, you could have fatigue, you could have cognitive issues, you could have mood issues, depression, anxiety, sleep, right. So we have to get kind of outside of the we have to go into the extra intestinal world meaning symptoms outside of just your gut related symptoms. And so it’s possible if you’ve h pylori, you may only have fatigue and mood issues, and sleep and it’s very possible. So you don’t want to just get hung up on the digestive symptoms thinking I’m okay. You could have things outside of the gut area. 

Evan Brand: Yeah, and you don’t even recognize it. And the psychiatrist is certainly not going to suggest that our anxiety and depression is an H pylori infection. And that was it for me. I mean, I had panic attacks and anxiety. I mean, I was a wreck when I had gut infections. I will tell you personally, and clinically, I’ve seen the link between mood issues and gut issues. And I had a lady that I had maybe the last two months, I did not give her any anti depressant herbs at all. All we did is work on her gut and within six weeks, she said her depression was 90% better. And she just said it kind of nonchalantly and I’m like you said you were depressed for 20 years during our initial call or you’re not realizing what we’ve done in six weeks just by working on your gut. We’ve as you self reported a 90% reduction in depression which you’ve had for 20 years. That is insane. That should be on the Billboard. That’s Beyond the headline news, but I think there’s just some ignorance about the link between gut and mood issues. So hopefully the psychiatric world and the gastroenterology world can start to get more integrated because right now they’re still very, very separate which is no good for the population. 

Dr. Justin Marchegiani: Yeah, here’s an article in the get the Journal of gastroenterology research and practice. It’s called the rule of H. pylori, and regulating hormones and functional dyspepsia. So if you get right to it, it says H. pylori strains have been shown to affect the secretion of several hormones including five five hyphen ht or five HTP. That’s the serotonin melatonin precursor ghrelin which affects mood and appetite, dopamine gastrin, which affects HDL levels. So and then has, it might be the cause of psychological disorders of functional dyspepsia. So, essentially, there’s a strong connection with H. pylori hormones, and a lot of the neurotransmitters and appetite regulating compounds so really important, right, H. pylori, we have to go above and beyond just thinking this is a digestive issue. It can affect mood, energy, sleep, and of course, hormones as well. 

Evan Brand: You and I talked about this kind of like we’re just like tying our shoes and cooking some breakfast. Would you have for breakfast today? Oh, I had some pastured eggs and bacon and sausage. What about you? Oh, yeah, handful of some avocado because, like we talked about it, like it’s just so nonchalant. But I mean, if this were to be the headline news, like you and I, this podcast we just ate if this were to be like, the trending thing of the week and 300 million people heard this. I mean, we could put a huge dent in the world, I think we’re doing a great job. We’ve got good numbers, but my God, if this was like the trending interview of the week, I mean, just imagine people would have so much more hope for their mental health, their physical health, their heartburn. This is empowering stuff here.

Dr. Justin Marchegiani: Yep. And don’t expect your conventional medical doctor to know about this stuff unless they’ve gone through more integrative kind of nutritional, natural, functional type of continuing education. Most dermatologists don’t even understand that your skin has a direct connection with your diet, right? They still have pamphlets in the dermatologists office saying what you eat has nothing to do with your skin. Most people that have eaten crappy and change their diet to be much more healthy, they can tell you one of the benefits you see is your skin, right? We know inflammation, and oil secretions all have a major effect with inflammation, grains and six junky carbs. While Same thing with our gut, there’s that same level of disconnect all throughout medicine, because each, let’s say medical specialty only knows their thing. And you know, when you’re working 60 to 80 hours a week, you’re not going to have the time to really keep up with the literature and what’s happening. And, you know, if you’re relying on your medical school training, well, typically that information has to be around for 20 or 30 years before it gets into a medical school curriculum. So what you’re getting in medical schools, and they’ll be 20 to 30 years behind probably at least 20 years behind time. So don’t expect your doctor to be in the loop on this thing. So you got to really go outside of the box and, and educate. 

Evan Brand: Yeah, I mean, I’ve got a very close family member who has a nanny for a well respected neurologist, and the neurologist home is filled with frickin mold. And no wonder the kid has a lot of issues and no wonder the mom has gut issues and the dad has brain fog and everyone’s exhausted and they don’t sleep good and they have skin issues. It’s like your neurologist, those are mycotoxins. Those are killing your brain. Do you not know it? Nope. She doesn’t know. It’s crazy, man. So hopefully we can continue to do good work like we’re doing and spread this word because man. Yeah, we’re still in the stone age’s and a lot of aspects. 

Dr. Justin Marchegiani: Yeah, no, I think we’re on top of it. Well, if you guys enjoy today’s podcast, we really appreciate it, head over to or You can subscribe to our email list. You can become a patient we work with patients all over the world happy to help you. Especially in the day and age the last year how things have gotten more virtual. It’s great to have access to good clinicians and doctors, virtually so we can provide that for you. And if you enjoyed today’s podcast, write us a review. Click Below the link you’ll see a link for a review, write us a review. And also share this with friends and family. We appreciate it Sharing is caring. If you enjoyed it today, apply one thing, share it with one person that you love that could help them. Evan anything else? 

Evan Brand: No, that’s it. You did a great job and we’ll be in touch next week. So take it easy and have a good one. 

Dr. Justin Marchegiani: Have a good one y’all. Bye now. 

Evan Brand: Bye bye.


Audio Podcast:

Recommended products:

DSL GI-MAP Genetic Stool Test

International DSL GI MAP Genetic Stool Test

Genova Organix® Dysbiosis Profile

GI Restore


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:

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

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






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. 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. 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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