Severe physical episodes after meals and upon waking (no mental anxiety, normal labs) - #10590

Age: [to fill] Sex: [to fill] Height/Weight: [optional] Medications: [to specify] Main issue: I experience intense physical episodes that occur: 1–3 hours after meals In the morning upon waking (fasted state) These episodes feel like a strong physical stress response, without significant mental anxiety. Symptoms during episodes: Strong internal tension Feeling of physical unease or stress Increased heart rate (moderate) Altered breathing Digestive discomfort in the stomach and intestines Occasional brain fog or mild dissociation ➡️ Mentally, I remain relatively calm. I feel like a spectator of a physical reaction. Timing details: Meal at ~12:30–13:00 Symptoms begin ~14:00–14:30 Peak around ~15:30 Morning: Symptoms present upon waking (fasted) Improve gradually after getting up Medical context: Gastritis found on endoscopy, negative for H. pylori Chronic digestive discomfort affecting both the stomach and intestines Local inflammation in the stomach and intestines has been documented on medical testing/examinations Symptoms seem linked to digestion Benzodiazepines have limited effect Antacids and proton pump inhibitors (PPIs) have been ineffective Laboratory and investigations: CRP (including high-sensitivity): normal TNF-alpha, IL-6, IL-8: normal Ferritin, iron: normal ESR: normal Fasting glucose: normal TSH: normal Creatinine: normal Stool analysis: normal Liver: ALT persistently ~2x upper normal limit (only abnormal finding) Liver ultrasound: normal Fibroscan: normal Biliary tract CT scan: normal Questions: What mechanisms could explain this pattern (fasted morning symptoms + delayed post-meal episodes)? Could this be related to glycemic fluctuations even with normal fasting glucose? Could this reflect an autonomic nervous system imbalance? What could explain documented local inflammation in the stomach and intestines despite largely normal blood tests and poor response to antacids/PPIs? Could there be a digestive inflammatory process that is not showing up on standard systemic markers? What tests would be most useful (e.g., CGM, tilt-table test, others)?