In this episode, Dr. J and Evan Brand dive deep into upper GI problems like bloating, nausea, swallowing issues, and persistent stomach pain — shifting the focus away from symptom-based medications and toward true root-cause healing. They also explore how infections, inflammation, and even environmental exposures can trigger chronic digestive problems.
00:00 – Introduction to upper GI issues: reflux, gastroparesis, bloating, and nausea
05:30 – How Lyme and co-infections may contribute to trouble swallowing or throat tightness
12:00 – Why PPIs, balloon dilation, and conventional GI treatments often fall short
20:15 – The powerful role of diet changes and food-sensitivity triggers
30:00 – Mold, environmental toxins, and their connection to chronic gut dysfunction
35:45 – Long-term PPI risks: kidneys, nutrient deficiencies, and microbiome disruption
45:00 – Why functional lab testing is essential for seeing the full picture
Root Cause First
Medications often mask symptoms without fixing what’s driving the issue. Identifying infections, inflammation, and lifestyle triggers leads to longer-lasting improvements.
Diet Matters
Food sensitivities and inflammatory foods can worsen reflux, nausea, and bloating. An elimination diet can be a powerful tool for calming the upper GI tract.
Chronic Inflammation is a Major Player
Conditions like eosinophilic esophagitis stem from ongoing immune activation, making anti-inflammatory nutrition and lifestyle strategies critical.
Don’t Overlook Infections
H. pylori and other gut pathogens can significantly aggravate upper GI symptoms. Proper testing and targeted treatment can make a major difference.
PPIs Carry Risks
Long-term proton pump inhibitor use is tied to kidney issues, nutrient depletion, gut infections, and bone health concerns — alternatives should be explored.
Environment Affects Digestion
Mold exposure and airborne allergens can inflame the gut and worsen symptoms. Environmental cleanup is often part of the healing process.
Holistic Healing Works Best
Combining diet changes, targeted supplements, environmental support, and functional testing creates the most complete and sustainable healing plan.
Dr. Justin Marchegiani: [00:00:00] Hey guys, it's Dr. Justin Marjani. Welcome to the Beyond Wellness Radio podcast. Feel free and head over to justinhealth.com. We have all of our podcast transcriptions there, as well as video series on different health topics ranging from thyroid to hormones, ketogenic diets, and gluten. While you're there, you can also schedule a consult with myself, Dr.
J, and or our colleagues and staff to help dive into any pressing health issues you really wanna get to the root cause on. Again, if you enjoy the podcast, feel free and share the information with friends or family. And enjoy the show. And we are live. It's Dr. Jian, the House with Evan Brand. Today we're gonna be talking about all issues, upper gut, esophageal, um, gastroparesis, acid reflux.
We're gonna be dialing into that area today and really focusing Evan, my friend. How we doing today, man? Hey, I'm doing
Evan Brand: good. And a lot of people have issues in upper gi more so than lower GI, potentially. Mm-hmm. I mean, you've got a lot of people out there on acid blocking medications and other proton pump inhibitors.
You've got people on antis, [00:01:00] spasmatic medication, and you know what's crazy? I was looking into this for myself and. Lyme disease is actually a potential issue. This is in PubMed, they call it dysphagia. This is this, or dysphagia. Maybe you pronounce it a little different. Yeah. But it's this issue where you could have issues with trouble swallowing or this globus sensation in the throat.
And turns out in PubMed there's some case reports about it. And what they say in the paper is that, I'll, I'll pull it up here, is that Lyme is probably affecting. Some cranial nerves, and that's the mechanism of it. But here it is right here. Dysphagia. Dysphagia. How do you say that? You say dysphagia. Lyme.
I said dysphagia. Dysphagia, yep. So due to Lyme case report, so November, 2024, yada yada, talks about Lyme. And then down here it's talking about how it's rare, but that it's associated with a lower motor neuron syndrome. Brainstem, encephalitis. So [00:02:00] I think this is a. This is a piece of the puzzle. I know some of it is more infection load, so we could talk about h pylori and some of these other infections.
But for me, with my history with Lyme, I'm thinking, man, like did that affect me? Did that affect my throat, my swallowing? And so I'm always trying to optimize and make sure I'm clearing issues like that that could give you issues long-term. 'cause I've seen people in their fifties and sixties having these choking issues where they're afraid to eat and, and that's not a way to live
Dr. Justin Marchegiani: either.
I see this a lot and many people, they go in, they'll do these balloon dilations or the first thing is they'll be on acid reflux medication or they'll be on gavascon or these, these suc fate, these coating agents. None of these things fix the underlying cause. And my issue is I'm not anti-medicine. I'm pro root cause.
And when you go to a conventional doctor. And they make a recommendation and you see that, okay, the underlying cause is not gonna be addressed, so therefore you're probably gonna be on this medication forever as you manage the symptoms. That's where I kind of put my foot [00:03:00] down, because if you're going to use a medicine.
That's fine, palliatively use it while you get to the root cause. But that mindset is not used. And conventional doctors are fooling patients by acting like we're actually fixing the underlying root cause.
Evan Brand: Yeah, I've heard about that expansion of the esophagus. You're saying it's a balloon that they're using to just like dilate the esophagus?
Dr. Justin Marchegiani: Correct.
Evan Brand: And so
Dr. Justin Marchegiani: they'll just dilate it. They'll stretch it out, but the reason why they're stretching it out in the first place is because inflamed tissue gets tighter. Right. Anyone knows you're sprain, your ankle, what happens? It gets tighter, you hurt your back, everything gets tighter, right? So chronic inflammation causes tissue to get tighter and not move well.
And then of course you see all these signs of inflammation. You may see gastritis. If you got an endoscopy. You may even see chronic Barrett's esophagus where the, the tissue in the esophagus goes from that thin squamous to the thicker columnar you may see. Eosinophilic esophagitis, which is just more eosinophils, a type of white blood cell coming in because [00:04:00] of the inflammation, the white blood cells are aggregating there to go after the inflammation, and then of course you may have that globus sensation, that feeling that your throat, something's in your throat because of the inflammation, because of the stuckness, because that tissue is so tight, things may not move through it well, and so you may feel that.
And you know, typically we're not really getting to the underlying cause. And then the next step tends to be PPIs. It tends to be Harper medication. Either histamine blockers like Pepcid, ac, or your proton pump inhibitors, like your Nexium or your Prilosec. And then maybe we're gonna go after coding agents, right?
And then God forbid you have other inflammatory issues going on. Well now you may be on NSAIDs and that makes the problem worse. It rips up that gut lining even more. Check
Evan Brand: this out too. This is out there. 'cause I'm wondering like, why are we all of a sudden hearing about EOE or in this case they're calling it I guess EOG, esinophilic gastroenteritis after this thing, so, [00:05:00] yes, exactly.
That's interesting. Exactly. So it's out there. Exactly, because man, I, I was not hearing anything about EEO e maybe even five years ago. And then now all of a sudden, EOE
Dr. Justin Marchegiani: is eosinophilic esophagitis. That's the immune cells coming in.
Evan Brand: Yeah. And, and now all of a sudden there's people coming in, they're like, Hey, this is what I was diagnosed with after endoscopy.
I'm like, what the heck? Is it just that we're, we're identifying more cases of it? Or are these new variables all of a sudden triggering people?
Dr. Justin Marchegiani: Yeah, and a lot of these diagnosis and symptoms, they're just inflammation in certain areas of the body. Inflammation ha hits the esophagus or lower throat that creates a certain set of symptoms.
Inflammation goes deeper into the intestinal tract or into the colon. You get more symptoms if there's an autoimmune response. Now there's more symptoms that happen. That's where IBD diagnoses come in. That's where Crohn's ulcerative colitis that fit under that IBD umbrella. Now we're recommending more severe medications.
Medications. Now we're recommending [00:06:00] Enbrel Humira. Now we're recommending bio biologics, lialda mesalamine. Right, which are just immune suppressants, right? So conventional medicines approaches turn off the immune system on one side. That's where it's more severe. Here's an anti-inflammatory, but it may rip up your gut lining in your heart and your blood vessels.
That's the other one. And then, hey, we're gonna just suppress your body's ability to digest and break things down so you don't get irritated by your body's own acid. Or let's just kind of provide a coating agent in there as well, or an antihistamine to shut down the acid too. That's conventional medicine's approach to this.
And when you understand. The mechanism that they're doing. 'cause like when they recommend a drug, like they're not really saying, Hey, this is what the drug does. A lot of times they're not really telling you the mechanism. When you understand the mechanism, you're like, but how is that helping my physiology to function better?
It's not. It's suppressing it. So the symptoms go away. We're trying to up, figure out the root cause and then upregulate what's not working. So that's how we draw a line between conventional and functional.
Evan Brand: [00:07:00] Yeah, and well said. And you know, you and I have a decade plus of holistic nutrition implementation on our own and then in the practice, and there's a lot of food sensitivities and food triggers.
Mm-hmm. For these upper GI issues. I would say if you want an easy approach. Closer to a IP is gonna be the best. Getting rid of gluten. Yeah. Getting rid of dairy eggs. I would say all tree nuts. And then there's this other sort of comorbidity, if you will, called OAS Oral allergy syndrome. Okay. Yeah. And we should pull that up because, yeah.
This is something that I, that I think I was dealing with years ago and it basically, what happens is there's different families, like you've got ragweed family. Mm-hmm. You've got the mug wart family. I've got a graphic here. Let me. Lemme try to bring this up. It's not the greatest graphic, it's, it's too small and too grainy, but it's showing pollen, uh, cross reactivity.
And so for example, in the Birch family, you've got [00:08:00] apples, you've got peaches, plums, pears, cherries, almonds. So everybody doing almond milk. Almond flour. Almond flour. Ste cookies. Almond flour, Ste tortillas, right? People are doing almond by the pound. That could be a potential issue for this what's called oral allergy syndrome, which is a cross reactivity of these type of pollens.
So my advice is just go a IP and see if you can calm this thing down. I know for me personally, if I get carried away doing too much dairy, even if it's raw, organic dairy, I can feel the difference. Then you've got mug wort, broccoli on here, garlic, onion. So this is interesting. And then Timothy, I've never even heard of Timothy.
I feel like I know a lot of plants, Timothy, they're saying, wow, never heard of that. They're saying orange is, is there? So, and, and you and I were talking pre-show about histamine too, so let's try to connect histamine to all this. Also, just to highlight
Dr. Justin Marchegiani: one thing, I a hundred percent agree. The nuts and seeds can be a big deal, and for most people they're totally fine.
That's why we recommend autoimmune out of the gate. 'cause it just guts gets some of those more healthy foods that maybe, hey, this is good, this is healthy, but it may be a [00:09:00] problem for you. So it gets some of those foods to pay more attention to that. And then also too, talking about like some of the connection with these like weeds and things like that.
I find mold or allergens from the environment can sometimes come in and really impact the gut. And that's a weird one, and people can miss that. So that's why anytime we see chronic gut issues, if we're making changes with the food and we're not getting all the results, we're looking at the environment, we're running plate test inside, and then we're also gonna compare it to outside.
A big thing is you should have a drastic improvement outside plates versus inside. If you don't, then we need to really get the environment better.
Evan Brand: Yeah. And yeah, and I've, I've been through hell and back with mold. I wouldn't wish it upon anyone. Yeah. Especially when you get the, the brain impacts the dizziness.
So if you're having weird symptoms that cannot be explained, maybe some of this upper GI stuff resonates with you, but you're also having neurological symptoms like dizziness. You're having tingling, you're having headaches, maybe even full blown vertigo. Uh, ringing in the ears. You know, this is something that we wanna investigate and Dr.
J and I can run [00:10:00] these labs on you, and we order urine and stool testing primarily to look for not only the upper GI infections, we can look for h pylori, which is a big driver of this faulty sphincter. Here we've got. Issues like parasites and bacteria, that could be a driver as well. So I know we're throwing a lot at you here in this short amount of time, but this is how we think about these cases.
This is how we build out this, this visual framework of, of how to fix it. It's, is it the oral allergy stuff? Are you doing apples every day? And that's a trigger for you? Are you doing too much almonds? Are you doing eggs every day for breakfast? Are you doing nuts and seeds in excess? Are you doing dairy?
'cause you heard raw milk is good for you and now you're drinking raw milk every day. And then you do raw cheese on your burger at night. Are you doing sourdough, which is still wheat? Are you doing sourdough bread? Right? So you see quickly how this can get outta control. If you're just following like the crunchy mamas online, you're doing your sourdough, and then you do your raw milk, and then you do your cheese, and then you do your almond this, and before you know it, you've got four or five potential triggers.
So if you're [00:11:00] upper GI is not right. Meat and berries are probably gonna be safe. Rice is probably gonna be okay. Potatoes, plantains, those are probably all gonna be safe. Um, but I do wanna connect histamine if we can. So I, I do think histamine is a piece of the puzzle if you've already got preexisting mold or some other driver of histamine or mast cell problems, and so therefore you might have to cut down on your grass fed hotdogs, even though they're delicious, you might have to focus on not doing leftovers.
I know for me, if I do like two day leftovers, I can feel a difference. And so the issue there is that if protein is sitting after it's been cooked, it's gonna accumulate more histamine. So if you've got ground beef, which is higher histamine on its own compared to a steak, and that ground beef is sitting in your fridge for a couple of days, a after you've cooked it.
That's gonna be higher histamine than freshly cooked. So try to freeze things. If you know that you want to revisit that food. Don't just leave food sitting in the fridge cooked for days and days and then eat it a hundred percent.
Dr. Justin Marchegiani: Now let's talk about a couple other mechanisms here. So, [00:12:00] number one, leaky gut plays a big role because with the more permeable our gut mining is, the more the enterocytes become permeable.
That allows. The outside world, right? Food particles, um, lipopolysaccharides, toxins from the environment, allergens in the environment that allows it to get into the bloodstream, which then now the immune system sees it because 80% of your immune cells are in the intestinal tract. They're in the gault, which is the gastric associated lymphoid tissue and the malt mucosal associated lymphoid tissue.
And so that allows the immune system, and again. People don't get this, but in your gut, in your intestine, it's actually still considered outside your body, right? Because it's in your intestine. And then when it goes inside the micro vli into the bloodstream, now it's actually inside your body. So it goes from outside to inside and it's getting exposed to the immune system.
So when we start to have inflammatory. Cytokine release due to the inflammation in your gut that starts to tell your body to reduce [00:13:00] stomach acid production because it's trying to say stop damaging the gut lining. It starts to impact the parietal cells that are in the stomach that produce hydrochloric acid, and then you have this gastro that's produced in the stomach that then increases the acid production.
But when you have lots of histamine, that can actually lower the gastro and then you can have lower stomach acid and then the inflammation lowers it. And then these same parietal cells that produce hydrochloric acid, guess what? They're the same cells that produce intrinsic factor that bind to B12 in your stomach.
So then you can reabsorb it at the end of your ileum. And so that can create B vitamin problems and that's how you start to have energy issues as well. So this a kind of a, a deep. Domino rally and how things can start to become worse over time. And then also without enough acid that starts to impact our lower esophageal sphincter.
'cause we need acidity to tighten, right? Gastrin helps tighten that lower esophageal sphincter. And so now acid can climb its way up and that can create more inflammation in the lower esophagus. That's where you get [00:14:00] more of the Es eosinophilic esophagitis, and then it can even make its way up to the upper.
Esophageal sphincter, that's where the LPR Laryngeal Ferrin reflux or silent reflux comes in as well. So it's this domino rally of destruction. Essentially,
Evan Brand: yeah, it's wild. Bring this up again. This is crazy. I don't wanna freak people out too much about Lyme, but you know, after me personally having Lyme, growing up in Kentucky, this is a contrast enhanced MRI showing that there was some left facial nerve issues.
And then down here, uh, just like you were talking about, they're talking about here this upper esophageal sphincter dysfunction and this guy was having aspiration on both puree and liquid textures. And then they go down here and they show. The aspiration. Correct. And this is, this is from Lyme. This is hard to believe, but Lyme is affecting some sort of cranial nerve and it's affecting.
Your throat and potential to swallow. So that's wild. So, I mean, this is why you really, you don't wanna leave Lyme untreated, and you and I use a DNA urine test for [00:15:00] that, which we like better than the antibody testing because mm-hmm. If your immune system is suppressed due to mold or something else, your antibody test may show clear and you get a false sense of security.
And then if it's a chronic Lyme, you know, the, the plan's a little different than acute Lyme. So once again, if you've got weird stuff, weird symptoms, swallowing involved, throat's involved, your throat feels weird. It's potentially lime. So we should look, we should look at the mold. We should look at the histamine diet.
We should make sure we clean up the eggs, the wheat, the dairy. Let's look for h pylori. Correct. Let's look for, uh, parietal cell dysfunction. Let's add in extra acid and enzymes. Let's get soothing nutrients. Let's get the marshmallow, the slippery elm, the chamomile. Let's get all those gi track soothing herbs in there to heal this bad boy
Dr. Justin Marchegiani: up and some people.
Evan Brand: If
Dr. Justin Marchegiani: the inflammation's gone on long enough, they may not be able to tolerate the acid. And that's where you really gotta see a functional medicine provider, because that's where the tissue has been damaged. At a level where you're gonna need more nuanced functional medicine approach. And just throwing a hydrochloric acid with [00:16:00] Pepsi's not gonna be enough.
Right? And so what happens is that pH in the stomach gets altered, and as that pH is no longer able to handle that nice load two to two and a half level, or you've altered it by taking a lot of. Acid blocking medications for a while. That starts to allow more bacteria to migrate upward from the small intestine.
And so now that bacteria is in there, it's created more inflammation, it's creating more fermentation, more bloating, more burping. It's then keeping that esophageal sphincter open. It's allowing more stuff to migrate up to the throat. Maybe we have h pylori in there too. It's also created more.
Deficiencies of nutrients because now that stomach acid that we need to ionize our minerals, it's too high. And then now zinc, iron, calcium, magnesium. Now we're not gonna absorb those and then maybe we're not able to break down our protein. So now our tryptophans not being broken down into serotonin and melatonin.
Our phenol and tyrosine's not being broken down to dopamine. So now it starts to affect our mood, our focus, our cognitive function, our [00:17:00] sleep, our relaxation. We're not breaking down our amino acids to make gaba. So, I mean, it's overwhelming, right? Because there's a lot of things that start to happen and we start to have these spirals in different directions and it makes it harder and longer to recover.
And you can see that just throwing an acid blocker, just throwing sate, just throwing an anti-inflammatory does not fix the underlying issue. And so. We're not anti-medication, we're pro root. Cause if you use medication, that's fine. Talk to your doctor about what's the root cause, how are we gonna get to the root cause?
So we're not gonna have to be stuck on the medication forever. Ask that question so you can get better answers. And then if you're not happy with the answer, that's fine. Use the medication acutely and then find a functional medicine provider that you can work with while you work with your conventional doctor to taper off these things.
Evan Brand: Yeah, well said. And this beautiful illustration there mentally for people. Hopefully you can rewind that. Listen to it again, but this idea that, okay, yeah, we're talking upper GI today. We're talking digestion, we're talking burping, bloating, that sort of thing. [00:18:00] But then this does spiral into anxiety, depression, chronic fatigue in insomnia, hormone imbalances, nutrient deficiencies, skin problems, hair loss, hair thinning, right?
Because all this stuff is dysfunctioning. So. Conventional medicine is gonna just zoom in. Here's the steroid, here's the balloon. We're gonna blow up your esophagus so you can eat and not choke, but. Uh, sorry for the anxiety, go to the psychiatrist. Okay, here's your benzo. Okay. Sleep doctor, here's your Ambien.
Okay. I mean, it's just crazy how quickly it spirals outta control. So we say this not to, like you said, it can be overwhelming, but with just a couple of labs, you can really investigate a lot of this stuff and see what's actually wrong. So I encourage all of you to test and not guess with your health. Dr.
J and I are able to get worldwide distribution on these test kits, so get a note test. Get a GI test with us. Let us help you to see what's going on under the hood. And then once we do a consult, we'll be able to look at each piece of this puzzle and we'll be able to optimize this bug here, bring [00:19:00] this up here, bring this down.
And it's a series of levers and gears and buttons that we're changing and pushing and twisting all at the same time to create. Harmony, and that's the goal. And this is how you get into your sixties, seventies, and eighties, and you feel good. You don't end up with neurodegenerative disease because you've been on PPIs for 20 years.
New, new study came out on PPIs and dementia. Look it up on PubMed. It's legit. And so it's important to catch this stuff. Now, if you're in your twenties, thirties, forties, and you're just like, oh, it's fine. I'm on the acid blocker. It's managing my symptoms. No, we don't want you with dementia in 20, 30, 40 years.
And so this is important to address now. Not in 10, 20 years when you start having cognitive decline.
Dr. Justin Marchegiani: Yes. Uh, and also one other thing, I wanna highlight this too. There's another big side effect that's been known about PPIs just in the last year or two. Is it bones? Lemme know when you can see it. Can you see there?
Yeah, I see it. Uhhuh. Okay. So it's talking about the impact of proton pump inhibitors on kidney function and chronic kidney disease. Oh, perfect. Here we go. So it's [00:20:00] talking about, um, the findings of the systemic review highlight the need for a thorough evaluation and the benefits of PPI use particularly in patients with pre-existing kidney issues, um, as they're finding it being a major stressor on the kidneys.
Yep. Yep. So very important that we wanna be on top of that, right? Basically a link between PPI use and different kidney issues. And so again, it may be more of a problem when you have kidney issues, but we know it's not good. We know it's impacting the nutrients, so you wanna be on care, you wanna be careful.
Evan Brand: Yeah. We've read about
Dr. Justin Marchegiani: medications, bone loss. Mm-hmm. Yeah, we know that. And also. We wanna be pro root cause we don't wanna be on medications that have these side effects, especially long term.
Evan Brand: Yeah. Well, uh, we gotta wrap this up, but if you need help, let us help you. Dr. J is available@justinhealth.com. You can get functional lab testing worldwide, me@evanbrand.com.
So dr. J justin health.com, me@evanbrand.com. Let us help you get a couple things done. You're not gonna spend a ton to do this. It's worth every [00:21:00] single penny to see these answers. I know just an average trip to the ER is three to 30 grand depending on what happens if you stay overnight, what kind of screens they do.
And they're not gonna show you the stuff we're gonna show you. So let us, let us show you something different. Let us be that second, third, or 20th opinion for you to help you get to the bottom of this stuff.
Dr. Justin Marchegiani: And even on the functional medicine side, there could be multiple underlying root causes that are, that are working in parallel.
So we're still not gonna say, Hey, it's just, it's just your low end stomach acid. That's it. It could be stomach acid, food, allergens, environmental stuff on the outside. Plus maybe you have SIBO and h pylori, right? There could be four or five parallel things going, and maybe there's some nutrient deficiencies because of it, right?
And so. We don't have a dog in the race. We just wanna get the patient better. We wanna get to the root cause so we, we will line everything up and address everything in tandem. We're not gonna just focus on just one thing. Yep. Yep. Well, very good. Uh, so head over to evan brand.com. Evan sees patients worldwide on the functional medicine side.
Dial a test, mail 'em wherever you're at, [00:22:00] even if you're outside of the United States. We work with patients there. And then myself, Dr. J, just in health.com. You can reach out, schedule there. Also, my new book. The thyroid reboot, thyroid reboot.com. We'll redirect over to Amazon. Uh, you can get the book there and we talk about the thyroid gut connection, which connects to all these issues too.
Evan Brand: Yeah, man. And congrats on the book. It looks like you're in the top five right now in the chiropractic section. It looks like, I think you're, you're in fifth place
Dr. Justin Marchegiani: for books. Nice. I hit number one for preventative medicine and for endocrinology. So. Appreciate that you guys want to see a great book and my life's work.
It took a while to get that done. A lot of good images too. I appreciate the support.
Evan Brand: Awesome, awesome. Yeah, put the link in the show notes for folks and uh, get a copy, support the mission and, uh, yeah, let's make this thing a bestseller. Thank you guys so much for being here. We'll catch up with you soon.
Excellent. Take care, Evan. Bye now. Bye.
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