The Top 5 Causes of Bloating | Podcast #364


Abdominal bloating occurs when the gastrointestinal (GI) tract is filled with air or gas. Most people describe bloating as feeling full, tight, or swollen abdomen. Your abdomen may also be swollen (distended), hard, and painful.

Dr. J and Evan describe that gas is the most common cause of bloating, especially after eating. Gas builds up in the digestive tract when undigested food gets broken down or when you swallow air. Everyone swallows air when they eat or drink.

On the other hand, they also talk about different components of why you may be having to bloat that you may not notice. Plus, available testing and lifestyle modifications you need.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:57  – The role of acid-pH level in the digestive system
5:01  – The link of depression and anxiety to bloating
10:02 – The benefits of probiotics and effects of stress to digestive health
18:17 – Functional medicine strategies and testing to find the root cause of bloating

Dr. Justin Marchegiani: Really excited to have a podcast today. We’re gonna be diving into a couple of different topics. The big one here is gonna be bloating – one of the big root causes of bloating. We’re gonna talk about it from a biochemical functional medicine perspective. Evan, how are you doing man? What’s going on brother? 

Evan Brand: Doing pretty well, excited to dive in and talk about gut infections. I think that’s probably the first place to start because you and I have run thousands of urinary organic acids and genetic stool tests over the years. And years ago, you know, we used to use a three-day stool test. Now, with technology improvements, we could do a one-day one sample stool test and we can uncover so much. So, I’ll just kind of riff on things. I know we like to title things just for marketing purposes and call it top five but we may go into 15 by the time we’re done because just right off the top of my head here, high gut inflammation like how calprotectin may be an issue, low pancreatic enzyme function, bacterial overgrowth, where we’re gonna measure the dysbiosis, H. pylori infections, parasites, worms, specifically Clostridia and Candida can cause a lot of issues with bloating. So, in general, I would just say any gut infection but we can break that down as much as you want to. It could be a huge cause of bloating. And, the problem is this, when you go to a conventional medical doctor or a gastroenterologist and you get some sort of bloating remedy or some sort of digestive aid, maybe an acid blocker, antispasmodic medication. Obviously, these are not addressing these infections. You could take acid blockers for the rest of your life and never clear the H. pylori that’s driving the low stomach acid which then drives the fermentation in the gut which then drives the bloating. So, I just want people to have in their heads a clear mindset of what are you taking, is it actually fixing the problem, are you just masking your symptoms. And in the case of an acid blocker, you’re actually putting yourself deeper in the hole because you’re taking low stomach acid that’s driving heartburn or an infection and you’re making it worse. 

Dr. Justin Marchegiani: 100%. So, you know, the first catalyst for good digestion is a nice low pH. That good acid pH, we need good hydrochloric acid to make that happen. So, we need essentially hydrogen ions to bind to chloride in our gut and so we need chloride from minerals. So, we need good minerals, good quality sea salt that helps make stomach acid on our own. Now, if we’re under a lot of stress and our adrenal glands are in stress overdrive, it could be cortisol high or low imbalances, as well as adrenaline issues, right? It could be high or low cortisol stress issues that could put us in a fight or flight state and that sympathetic nervous system stimulus is gonna negatively impact our body’s ability to start with making stomach acid and digestive secretions and of course that stomach acid is almost like an antimicrobial. Think of like using lemon or apple cider vinegar is a natural cleaner right. They recommend these online. You can make natural cleaners usually some kind of acid as the foundation of the formula because acids are antimicrobial and so think of acids in your intestinal tract as being antimicrobial. They also, some kind of help tighten the sphincter, the esophageal sphincter from the stomach into the esophagus. It gets tightened with good acidity and so part of the reason why we get bloating and a lot of these gases rise up to the esophagus is inadequate levels of acidity and that keeps the esophagus open and then what happens when that esophagus is open over time, the fermentation acids that occur can actually, eventually irritate the bottom of the esophagus because we didn’t have enough acids to trigger that good closure in the beginning. 

Evan Brand: Yeah. Yeah. So, then you’ll get these, what are called silent reflux issues sometimes it’s called GERD. And once again, prescription drugs are what’s the common remedy but once again it’s not the root cause. It may reduce the symptoms because if you have that backwash it’s gonna help slow the backwash down but it’s not gonna fix the sphincter so we might come in with extra betaine hydrochloric acid or if you’re extremely inflamed which is that someone can’t tolerate a low dose of it but then we could do something like apple cider vinegar with a meal sometimes bitters. I personally don’t do bitters, I just do HCl and enzymes. 

Dr. Justin Marchegiani: Yeah. We can always test it with ginger. We can always test it with an acid like lemon, lime, or apple cider vinegar, start with a teaspoon of that and mix in a couple ounces of water and then kind of work our way up from there. So, acidity is a really important first step. Of course, if we have inefficient, um, inefficient acidity levels we can almost guarantee, we’re probably gonna have poor enzyme levels and probably gonna have poor bile acid levels, right? Bile acids are important because they help break down fat and bile acids are also slightly acidic, right, in the name of bile acid and it’s also antimicrobial. So, just like we talked about the acids having an antimicrobial benefit on the HCl side, also, bile acids have an antimicrobial benefit. We see in SIBO, a hallmark of SIBO is bile aids insufficiency and so with SIBO we don’t have enough acids there on the bile side so then we have a hard time breaking down fat and then a lot of times that fat will create indigestion, petrification because it’s not being broken down. Now, when we run certain stool tests, we’ll see increases in a metabolite called steatocrit, which is a breakdown of the fat that means it’s not being broken down in the stomach. It’s coming out at higher levels which means we’re not breaking it down. So, steatocrit is a big deal because steatocrit, if we don’t have good fat digestion, we probably have some protein digestion issues, we probably have some enzyme and acid issues and we probably have, um, some gas issues, bloating issues because these things require good digestion and if they’re not being broken down well, we’re probably getting some methane or hydrogen gases kind of rising up from that.

Evan Brand: And you know, we’re taking on the subject of bloating but it’s very common that someone with these issues you’re describing, they’re also gonna have issues with energy and probably mood like anxiety and depression because you’re mentioning this issue with fat digestion, protein digestion. Now, you’re not gonna get the aminos that you need to fuel your neurotransmitter so it’s very rare that somebody’s gonna come to us and say, hey I’m just bloated and I have nothing else. Usually, along with that bloating, you’re gonna have these tangential symptoms too like anxiety, depression, fatigue, and so I encourage people, you can focus on one smoking gun like bloating as your big thing you’re coming in for but you gonna make sure you understand there’s a bigger, deeper connection to your mood issues too. So, this is the person who’s on break, uh, someone just commented about severe brain fog. We could hit that too, uh, but somebody might come in and say, hey I’m bloated and then you tease apart their case and you go, oh so you’re actually anxious too. You’re on antidepressant and an acid blocker and this happens every day, all day. So, just to clarify, number one, we hit a low stomach or we hit infections first. Number 2, low stomach acidity, you mentioned low bile in the gallbladder. Also, let’s give a shout out to people that don’t have a gallbladder, what about these poor people, they’re gonna need a lot of supplemental help for the rest of their life. And so, unfortunately, this is a very very common procedure done in the U.S., where the gallbladders are removed and so these people are gonna need some purified bile salts forever in my opinion. Well, what’s your…?

Dr. Justin Marchegiani: Absolutely! They’re definitely gonna need bile salts and some extra enzymes like lipase but again, you gotta get to the reason why that gallbladder issue even happened. Now, most people, it’s women in their 40s who have an overweight issue and so what tends to be driving, that is usually food allergens whether it’s grains or inflammatory foods but also estrogen dominance. So, if you have an imbalance in estrogen, estrogen is gonna help promote more fat storage so you obviously have more estrogen more fat storage. A lot of times you’re gonna have PMS issues too so you may be moody, irritable, um, sleep issues, uh, you could have fibrocystic issues, uh, tenderness, a lot of pain around PMS time. So, you gotta get to the root cause of that as well. So, we started out with just bloating but you can see how then this estrogen issue can affect bile levels and good bile flow because estrogen causes everything to get really stagnant and not flow well and then you’ll start having mood issues and PMS issues and maybe even fertility issues. So, you can see how you start at one point which is bloating, which is the topic of the video but then it can spiral down this other kind of tangential pathway.   

Evan Brand: Yeah. Not to mention two, let’s just say it started out with heartburn, I just want people to kind of visualize this. So, let’s say it starts out with heartburn. You go to the target and you buy Prilosec, which is over the counter acid blocker medication, you reduce your stomach acid even more but you feel some relief from the heartburn and let’s say your spouse had H. pylori, you guys pass that between each other, so now you’ve got even more reduction of stomach acid levels, you’re on the acid blocking medication. Now, you’re anxious, you’re starting to get depressed, you’re getting a bit of fatigue. As you mentioned, now, you’re getting some hormonal issues, some hormonal issues like breast tenderness or PMS or ill ability, you’ve got this dysbiosis growing in your gut so you have this bacterial infection. It could be multiple things, Strep, Staph, Klebsiella, Pseudomonas, Bordetella. And now, you’ve got beta-glucuronidase issues. Now, you’re recirculating all this estrogen. You’re creating more problems with the gallbladder. Maybe, you get the gallbladder removed. Now, you’re in really big trouble then that leads to the diet so then you read some guy on the internet who says, you need to be doing 70 – 80% vegetables. So now, you’re doing all these veggies and you’re even more bloated and you’re even more gassy and you don’t know why. So, you’re eating broccoli, you’re trying to force all these leafy greens down, a lot of vegetables. Maybe, you’re doing a lot of avocados, these higher FODMAP foods that are fermenting in the gut. This is the case where you’ve got a really, to me, the best, most beneficial thing I’ve seen for these cases, get the diet very simple, focus on good quality animal proteins and for a time being minimize your vegetables so that you can let the gut rest. 

Dr. Justin Marchegiani: Yeah. Absolutely. From a solution standpoint, yeah, good proteins, good fats and then if we’re gonna do vegetables, make sure they’re cooked steamed, sauteed, maybe use an instant pot and try to make sure they’re on the lower fermentable side. Now, that being said, next, what’s another driving factor of bloating? increase in fermentable vegetables. Now, people are hearing all kinds of things about probiotics being helpful. Well, they are. There’s a lot of good benefits to probiotics and the microbiome and the endogenous nutrients they produce. They, um, whether it’s vitamin K2, whether it’s different B vitamins, really helpful. It also produces acidity which helps keep a lot of bugs and bacteria from growing in the gut, totally helpful. Now, if you already have a lot of bacterial overgrowth and bad bugs growing, sometimes, these extra good bacteria can actually cause more bloating, more gas. And then, of course, because they’re fermentable they can also create histamine too. So, the histamine may create more brain fog or headaches, more destruction there. So, you may have more histamine symptoms, you may have motility issues because they’re producing hydrogen methane gases maybe and that may cause either diarrhea on one side or maybe more constipation on the other side, definitely possible. 

Evan Brand: Yeah. Yeah. Good call on the histamine. And so, some of these bacteria on your gut, they’re gonna be releasing histamine too. So, if you’re combining high histamine foods, you’re doing leftovers, let’s say, last night, you made a steak, you’re cooking that leftover protein. That’s gonna be higher in histamine. Combined with the histamine being produced from this bacterial overgrowth problem, yeah, you mentioned brain fog, skin flushing, rashes. So, once again, here we are talking about bloating but we’re trying to elucidate this big spider web of other symptoms that may be going on.   

Dr. Justin Marchegiani: Correct.

Evan Brand: Um, also, what about a stress component meaning someone just simply not chewing enough, they’re rushing through their meals. I think this from a mechanical perspective. If you look at your average person, I mean I saw somebody on the highway the other day, I don’t know if it was a donut, a piece of pizza, it was some kind of junk. I couldn’t tell exactly what it was but either way there’s still people trying to do makeup, scrolling on their smartphone, eating a piece of pizza, all while driving on the highway at the same time and we wonder why they have digestive problems. So, maybe we talk about the impact of not being settled when you are eating and this sort of like, this parasympathetic process that digestion is supposed to be our ancestors, they didn’t have that level of stimulation while they were trying to eat. I mean, maybe there was a wolf trying to come, get their bison killed but beyond that there wasn’t this big sympathetic stress underneath all of our meal times.   

Dr. Justin Marchegiani: Yeah. We kind of started out the video talking about the parasympathetic-sympathetic balance and how important that is because the parasympathetic is part of that rest and digest that gets the digestive secretion going. It stimulates all the blood flow into the organs, the intestines. So, of course, setting really good boundaries for your meal, you know, I recommend kind of kind of go into a meal five times or ten minutes, just kind of relax, do some deep breathing, have some appreciate, appreciation about your day, the food in front of you, you know, just whatever blessings you have in your life, just try to really get to that parasympathetic state with just good breathing in the nose, right, four to five nasal breaths in and out. Focus on whatever’s good in your life, appreciation. Whatever you have to do, whatever kind of resonating prayer to put you in that state when you just feel better and then go into that meal keep it quiet or if you want to listen to something that kind of allows you to feel good and feel rested or relaxed, that’s fine. And then, go into that meal and make sure you chew your food really well. Try to avoid a lot of hydration with the food, you know, a couple of ounces of water for swallowing some pills or digestive support is fine but try to get into that meal, like, I just had to have a good routine. Get some good hydration ahead of time, try to go into some kind of meditation or prayer for five or ten minutes ahead of time to really get that parasympathetics going and then go into your meal and really just try to chew things up pretty well too, you know, about 30 chews per bite of food on the average, kind of get your food chewed up to about an oatmeal like consistency so it’s really broken down well that’s allow the enzymes and the acids to work a lot better too. 

Evan Brand: Yeah. You know, what’s interesting is a lot of people are kind of pressure into these business meetings like with their boss or with their co-workers, there’s this like work-meeting-lunch deal where people are going out with people they probably wouldn’t associate with outside of the workplace and they’re going and eating with those people. And so, I would just tell you, if you don’t like it and that’s not your vibe, don’t do it. If you feel more comfortable, more relaxed eating by yourself, don’t do it. I mean, I remember, l had some stressful conversations over lunch and dinner tables before with people over the years and I leave feeling like I didn’t eat anything and that my mind was so focused on even if it wasn’t a negative conversation. If it was on some sort of business deal or the state of the world or something and then I’m eating. I would get up from the table. I’m like, oh crap, did I eat and I didn’t process that and it would sound maybe like unnecessary advice but I think a lot of people need to be picky of what they talk about it at the dinner table.

Dr. Justin Marchegiani: Yeah. I think anything that’s gonna keep you in that parasympathetic state is great, you know, save the more stressful things before or after and I think, also, just have good boundaries. Try to make sure you get at least 20 minutes for a meal, um, to yourself, you know, I mean, if you don’t have 20, if you can’t put 20 minutes in your schedule for you to consume some good food and put yourself in that parasympathetic state then you got some boundary issues and you got to really work on roping in your schedule and getting some control over it, at least so you have that 15-20 minute to yourself and you can really process that food well. And again, I’m not saying there won’t be some exceptions or some stressful days here or there but on average try to make sure 80 to 90% of the time, you really have control over your schedule to that degree. 

Evan Brand: One of my favorite things to do even in the wintertime here, if I’ve got blue skies. I’m taking my shirt off, I’m going to sit on my front porch where I’ve got a nice comfy front porch patio chair and that chai is warmed up by the sun so I just take my shirt off sit there barefoot and in the chair and eat my bison burger for lunch and the sunlight is a mast cell stabilizer so I noticed the sun helps me if I have any kind of food reactions, the sun will stabilize that, obviously there’s nitric oxide benefits. There’s likely some nervous system benefits circadian rhythm benefits. So, for me, if you can get fresh air on your lunch that’s great and what the heck does sunshine have to do with bloating, well, I mean there’s even some studies on sunlight improving the diversity of your gut and we’re outside all the time now. So, if you just type in like sunlight microbiome, you can read the papers on this, it’s in a microbiology journal about how exposure to the UV rays can improve the gut diversity so it’s no surprise that all these people in offices buildings all day, they got poor diversity. Obviously from other things but lack of sunshine is a negative factor for your gut health. 

Dr. Justin Marchegiani: Yep. Yeah. Absolutely. I mean, also, there’s other bugs that are out there I think we already kind of talked about H. pylori because that can affect the stomach and that can decrease, um, acid production and thus when acid production is down, we know enzyme production is also down and then that can also affect biliary function, biofunction, so we know H. pylori is a big thing. Other bugs can be problematic, right? We already mentioned SIBO, which could be a whole bunch of different bacteria that are overgrown in the small intestine that could be Citrobacter, Prevotella, Klebsiella, Pseudomonas, Morganella, right? It doesn’t really matter the actual bugs but if there’s an overgrowth there, they can definitely disrupt digestion creating different gases on the methane and hydrogen side and that can create obviously more bloat. Other parasites can cause problems too. So, we see things like Blasto, Blastocystis hominis, right? E. histo, D. fragilis, Giardia, Cryptosporidia, these are all other bugs that could be problematic. Then even things like fungal overgrowth like Candida overgrowth, whether it’s a Rhodotorula species, Albican species, these types of imbalances can cause problems. So, it’s good to test and really make sure that we look at the whole microbiome and see what’s out of balance or not and then from there food wise, I mean, of course, general refined sugar, refined grains, right? These processed foods, excess fiber, lots of raw vegetables, uh, fermentable carbohydrates, right? These things are gonna be on the list, as well. And so, we’ll kind of add those. There are a lot of different things that we have to look at so I kind of gave you the top five or six on this list. Anything else, um, Evan, you wanna add to it?

Evan Brand: Well, I would just say that if you’re coming into this conversation, you’re listening, maybe you don’t have much background and listening to people like you and I talk about functional medicine strategy. Some of this may just go right over your head. You may just tune out because you’re hearing these things which sound exotic and they sound rare, like H. pylori. I don’t have that. Giardia, what the heck is that? Blasto, though I don’t have that. You know, I just have bloating. The reality is these are very common things. The problem is the testing that’s used in the conventional gastroenterology world is very outdated and very insensitive, meaning there’s a lot of infections that go missed and even if these infections are tested for, it’s not likely that you’re gonna find an accurate result. And so, what we’re talking about, these are not rare situations, you and I, between us both, we’ve seen several thousand clients and patients across the world over the last decade and we can tell you that these issues are something we see every day, all day. So much so that in fact when I see a whole big list of infections on the stool test, I don’t get shocked by it. Yep. Uh-huh. That’s it. That’s what we’ve got. So, if you’re listening to this, you’re like, ‘man, that’s not me. I’m just bloated and tired.’ Well, there’s a reason for that. And so, I highly recommend you get tested, figure out what the heck you got, going on because if you’re not testing, you’re guessing and if you’re going and taking probiotics or random enzymes and you don’t feel better or you’re confused about what you should actually taking and not taking and you’re building up a supplement graveyard. It’s time for you to get tested and figure out what the heck you’re up against. And so, if you need help, you can reach out clinically, Dr. J is at justinhealth.com. you can reach out and do consults worldwide. So, we jump on a video call just like we’re doing here, Zoom, facetime, skype, we can look at your labs that you run at home and we can figure out what’s going on and make you – a game plan to get better. And if you need help for me, it’s Evan, evanbrand.com and either one of us, Dr. J, justinhealth.com, evanbrand.com, we’re here to help you and the cool thing is you can reverse these issues and you can get to a point where you don’t even recognize your gut health. I mean, if I look back at myself even 10 years ago, I had such severe IBS. I did every diet under the sun and I made some progress but it wasn’t until I looked at my gut that I really made the magic happen. 

Dr. Justin Marchegiani: 100%. And so, just to kind of highlight a couple of things out of the gates, um, we’ll put some links below as well to some of the lab tests that we recommend, whether it’s the stool testing, whether it’s the organic acid testing which does look at bacterial and yeast metabolites. I love the organic acid because it’s very good at picking up Candida and yeast overgrowth, where a lot of times those tool testing will miss that and of course the, um, breath test will not touch any yeast overgrowth. So, it’s nice to have whether it’s stool test, whether it’s the GI map, whether it’s an organic acid, whether it’s a conventional lactulose, breath test, these are all good tests. We’ll put links down below. So, if you guys want to look at getting some of those to start out at the gates, you feel free, you can. Also, I like to compare and contrast like what we do versus the conventional gastroenterologist. So, most gastro docs, they’re just trying to rule out significant pathology, significant disease and so they may cross off the list by doing some kind of an endoscopy, which is camera down the mouth to look at inflammation in the stomach or esophagus and if they see esophagitis or gastritis, you know, what they’re going to do, they’re gonna recommend some type of PPI or Gaviscon or some type of a coding agent to kind of help reduce the inflammation but they’re not gonna really fix the root cause. Most of the time, they pull you off acids, which may be helpful in the short run but it’s forever altering your ability to break down protein or fat and it also can shift your bugs in a negative direction because now you don’t have the good acidity to keep the microbes down. You need the acidity to activate enzymes, you need the acidity to activate your bile salts. So, someone’s jumping in on the questions here saying that hey they feel better on keto but now they’re feeling more constipated. Yeah, super common because what’s happening is you’re cutting out a lot of the foods that are causing problems but you haven’t fixed your digestion, you don’t have enough acidity, enzymes, bile, there may be some bugs that are still impacting digestion and this is why being on good proteins and fats can be helpful but they also reveal weak links in your digestive chain if you’re not breaking down food well. So, just kind of getting back on the gastro doc kind of bandwagon, they’re gonna be looking at pathology inflammation in the stomach, you know, ruling out the big things like blood, um, in the ulceration in the stomach, you know, usually you’re gonna know that because you’re coughing it up but you’re seeing it in your stool. If you have irritable bowel disease symptoms like Crohn’s or ulcerative colitis, usually, you’re gonna have significant inflammation in the stomach, usually significant diarrhea, blood in the stool, they’re gonna rule that out and then what and then for the most part, once the big pathology things, ulcerations, cancer, massive amounts of inflammation are ruled out, they’re gonna typically give you like IBS diagnosis, whether it’s IBS-D for diarrhea or IBS-C for constipation and they’re gonna just manage whatever symptoms whether those symptoms are with different drugs. So, if it’s constipation, they’ll use laxatives. If it’s diarrhea, they’ll use things like Imodium or Pepto Bismol or anti-inflammatories. They’ll just modulate the symptoms with drugs and that’s it and they’re not gonna really get to the root cause. They’re gonna just try to spot the treat and then that’s where people come to us because overtime, those drugs will become less and less effective, you have more and more side effects, you’re not fixing digestion, you’re creating more nutritional deficiencies, maybe more gut permeability issues, maybe more autoimmune stuff and so these patients then come to us because they’re just tired of putting band-aids over band-aids. 

Evan Brand: Yeah. Well said. I forgot to mention the endoscopic procedure that is super common, uh, they wanted to do that on me, years ago, when I had IBS and I denied that because I even back then I had read about these infections that people were acquiring from getting scoped meaning the last person that they put the tube down, they didn’t properly clean or sanitize that so then they stick it down your throat and then you leave the hospital just to investigate and as you said, the only thing that’s gonna come out to that is they may say gastritis which is super generic. It doesn’t tell you anything about these infections and they’re not gonna give you an herbal protocol to address the infection causing the gastritis. But now, you’ve left the hospital with Clostridia or some other possibly antibiotic resistant infection that’s involved to evade the sterilizing and cleaning procedures. So, I’m all about non-invasive, accurate, functional medicine testing and that’s why we love what we do because there’s a very rare, maybe one every five years, yeah, is there a case where I’m like yeah, you need an endoscopy because there’s something crazy here.  

Dr. Justin Marchegiani: Yeah. Usually, with an endoscopy or colonoscopy which is gonna be going up the rectum to look in the colon. Usually, there’s gonna be blood in the stool, some type of significant inflammation, whether it’s excessive diarrhea, excessive inflammation, excessive blood in the stool, excessive weight loss. It has to be at the extreme ends for that to make sense. Most people just have inflammation and a lot of times the tests won’t kind of tell you enough about the root cause, they’re just gonna put you on medications to manage the symptoms and that’s where you’re kind of stuck in between. Now, a lot of my ulcerative colitis, IBD patients, they’ve already done that. Yeah, so then, it’s like all right, they’ve kind of already crossed that off their list any weird cancers, ulcers, it’s already done, they know, they’re just being managed with Lialda, Prednisone, a biologic and then it’s like, now what, right? And so, we still have to get to the root cause of that and get the immune system chilled out and figure out what stressors are there so we can get on top of that too.     

Evan Brand: Yeah. I mean, I know you and I have seen countless emails being sent to us with pictures of colons and you know different things from these scopes like hey there’s my scope results, you know, what do you have to say about it and the answer is always the same. Okay, there’s something there, let’s work on the infections. And so, uh, yeah, someone in the chat, uh, shelly said, yes that they all recommended me, every time, I go to the doctor. So, yeah, that, I mean that’s all they’ve got, they don’t have the stuff that we’re using maybe in 20 years from now you can go right down the street and get done what we’re talking about but for now you’ve got to seek out somebody like us that’s gonna be able to help you, uh, there’s one person in the chat too asking about a viral impact on the gut, it’s real. I did a whole section of that in my better belly course about that virus in the gut and so it’s definitely a big factor.   

Dr. Justin Marchegiani: Yeah, and just to kind of, uh, speak, kind of on the line here, so, um, we can, we don’t get censored, there’s certain viruses that are out there, right? There’s an ACE2 receptor site that gets impacted in these different viruses and the ACE2 receptor site, there are a lot of them in the gut and these receptor sites are really important for absorbing amino acids and so if you have any of these maybe chronic viral issues, one of the good things that you can do is actually extra free form amino acids to allow these receptor sites to absorb these amino acids easier, right? I think the free-form amino acids are already broken down. So, if you have this chronic immune stress and you’re having a hard time recovering from the immune stress adding in some additional free form amino acids can be very, very helpful on the healing side.  

Evan Brand: Yeah. I’ve seen a lot and there’s papers on this too but I’ve seen it clinically too. People post viruses that will look at their stool, there’s gut inflammation, there’s low secretory IgA, so we can see there’s been some damage and so we have been able to resolve it. So, yeah, we’ll wrap this thing up but if you al need help, please reach out clinically, we mention the websites one more time, Dr. J, that’s justinhealth.com, me evanbrand.com and we’re here to help you guys, so you can reach out and we’ll get to the bottom of this. 

Dr. Justin Marchegiani: And sometimes, we’ll even use some kind of an elemental diet with people that have chronic digestive issues just  because it can be hard, breaking protein and fat down and these are really good, important nutrients but sometimes we just got to break it down for them and using some kind of an elemental or a modified elemental, where maybe you make the first four to six hours of the day, really easy to process in some kind of smoothie or shake that has most of the amino acids in free form, maybe the fats more easy to process like in an MCT oil or something like that and then we use a lot of the vitamins and minerals all broken down. That could be very helpful and give the digestive system a chance to rest and some people they notice this because they just feel really good when they fast and so if you fast and you feel really good that’s excellent but you’re still not fixing the problem of getting nutrients in the system so that’s where using some kind of an elemental type of shake can be really helpful. 

Evan Brand: Yeah. Well said. Well, I’m done. I feel like we’ve covered a lot of good stuff here. 

Dr. Justin Marchegiani: Excellent. Yeah. I mean someone asked one question about flour substitutes. It just depends on where someone’s at, so flour, it’s a processed food so out of the gates, if someone wants, um, like a starch, um, I recommend maybe a greener banana, maybe yucca, cassava, maybe a Kabocha, spaghetti squash. Just look at some of the fibers, uh, non-starch, I should say, more starchy carbohydrates that are gonna be grain-free, see how you do with that. And then, if you want an actual flour, you can look at it like an arrowroot or you can look at it like a cassava is pretty good because it’s still grain-free but it’s still gonna be on the processed side. So, ideally, try to keep it grain-free so you don’t have extra gluten sensitivity connection with those.   

Evan Brand: Yeah. Definitely. That’s what I was gonna say too. Potatoes, rice, a lot of these things can still create problems for people. I’ve had many people feel like crap on some of these gluten-free breads. So, yeah, it’s still processed garbage in my opinion. 

Dr. Justin Marchegiani: Yeah. And then, someone wrote in about the, um, the onions there. Onions are very high in FODMAPs and that can be a problem and so if you head, your gut feeling a lot better and you can come back in and you’re noticing FODMAPs are creeping into your diet and causing a lot more bleeding definitely kind of, you know, rain that back in and see how much that back in and see how much that kind of brings you back to homeostasis. 

Evan Brand: Yeah. This person told, uh, they said that they’ve had similar issues with cabbage, brussels sprouts, and other similar veggies. So, yeah, I mean I would go more animal-based. See how you feel with just some meat and some berries for a little while. Maybe if you tolerate a little bit of some organic pecans, if you want to do a little bit of nuts but do like a bison burger and a handful of blueberries for lunch and see if you feel better. I suspect you will. 

Dr. Justin Marchegiani: Yeah. At least, just try, you know, cutting out the higher FODMAP foods because when you address microbes, right? You starve it on one side with restricting certain foods that can feed it, you can kill it with certain herbals and then you crowd it out with probiotics. And so, sometimes, we have to go back to the killing side and kill the microbes out a little bit more but I always just see how much the starving kind of works. Get the starving going again and then if you have to kind of return to a protocol, where we knock down the microbes with herbs, we can always do that too. 

Evan Brand: Yeah, and we’ve made these protocols a lot. It’s really fun to combine and mix and match and get the synergistic effect of this herb plus that herb. I mean, that’s where the magic really happens and there is an art to this too like you said when to cycle things on when to cycle them off, so there’s not just this one cookie cutter thing that you have to do. You really got to just work with the person. Certain herbs are used for certain parasites, certain ones we use for bacteria, certain ones we use for fungus. It depends on what you got, most of the time it’s a combination of all these bugs. 

Dr. Justin Marchegiani: Awesome. Hey, Evan, great podcast today. Hope everyone at home listening enjoyed it. Feel free to share with friends or family. Put your comments down below. Let me know what things that you guys have tried at home that have worked well or haven’t. Really appreciate the conversation. Evan, have an awesome day man. 

Evan Brand: You too, take it easy. 

Dr. Justin Marchegiani: Take care. Bye. 

Evan Brand: See you. Bye-bye. 



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