How to find a good functional medicine practitioner – Podcast #52

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Dr. Justin Marchegiani and Evan Brand in this podcast talk about how to find the ideal healthcare provider, holistic functional medicine doctor or functional nutritionist, as well as the qualities, traits, and skill sets that a practitioner needs in order to help you. 

This interview stressed the importance of having a systematic approach that lays down diet and lifestyle as the foundations then find out where stress is coming from and do some labs to  figure out what those underlying chemical stressors are. The next step will be focusing on the hormones then moving on to the gut killing and infections.

In this episode, topics include:

4:33 About nutrition and diet

9:25 Seeing the picture as a whole and lifestyle

23:59 Free information

26:10 Looking and prioritizing labs

28:05 Supplement recommendations

 

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Dr. Justin Marchegiani:  Hey there, it’s Dr. Justin Marchegiani.  Welcome to Beyond Wellness Radio.  Feel free and head over to BeyondWellnessRadio.com where you can access our full podcast transcriptions.  While you’re there, you can also sign up for our Thyroid and Female Hormone video series.  This series goes into the root causes of why your hormones are out of balance.  While you’re there, you can also schedule a functional medicine consult with Dr. Justin, myself, where we’ll dig deeper into the root cause of your health challenges.  Feel free and think of sharing this podcast with at least one person.  This podcast grows by people sharing it.  Sharing is caring.  If you think of one person that can benefit from this information, please feel free and share it.  If you’re enjoying the podcast, click below the video or podcast where you’ll see the iTunes review button and leave us a review on iTunes.  You can also sign up for the newsletter at BeyondWellnessRadio.com where you can get updates before anyone else.  Thank you so much and enjoy the show.

Hey, it’s Dr. Justin Marchegiani with Beyond Wellness Radio, again my guest co-host, Evan Brand, will be with us today and we’re gonna be talking about how to find the ideal healthcare provider.  How to find your holistic functional medicine doctor or functional nutritionist, what qualities, what traits, what skill sets do you need in your practitioner to find someone that can help you.  So first off, Evan, what’s going on, man?  How we doin’?

Evan Brand:  Hey, what’s up?  I’m doin’ great.  I just avoided a tornado.  I thought I was gonna get blown away and not be able to make this call, but I’m super thrilled to be here and still be alive luckily.

Dr. Justin Marchegiani:  That’s good, awesome, and if we get cut off during the show, we will know why.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So what did you have for breakfast this morning?

Evan Brand:  I just had a shake today.  So I did some organic almond milk, a handful of blueberries from the local farmer at the farmer’s market.  I did 2 scoops of grass-fed whey so probably about 30-35 grams of protein there, and then 1 fat spoonful of coconut oil.  I feel like I said I did that last time but that’s kinda my go-to shake.

Dr. Justin Marchegiani:  That’s good.  Awesome.  And for all the listeners I am upgrading the command center’s bandwidth so we’re gonna be going from 20 megabytes per second to 200 megabytes so the quality will get better.  We apologize for last show having a couple of crackles in there but that’s gonna get better, so just hang in there.  We’ll continue to deliver the high quality.  So for me today, I did beef protein, grass or grass-fed beef protein with just water.  I did a whole scoop of greens, organic green powder in there, and some coffee, MCT and butter.  So I had about 40 grams of protein, got about a scoop of collagen in there, about 4 servings of vegetables and the organic green powder and then some good fats and proteins combined, so I’m–I’m ready to go.

Evan Brand:  Yeah, sounds like a good way to start the day and you’ll be hungry for a real solid food lunch.  That’s why I like doing shakes because when you actually eat a real steak again, it’s amazing.

Dr. Justin Marchegiani:  Yeah, and it’s just nice in the morning to just get those aminos in your body fast.  I’ll do like half my breakfasts will be shake-based just because it’s easy, it’s nutrient-dense, I’m getting a whole bunch of greens in there, too, and I can just make sure it’s highly absorbed really.

Evan Brand:   Yup. Yup, that’s nice.

Dr. Justin Marchegiani:  Cool, man.  So today we talked about kinda in our pre-interview that we wanna to kinda lay out for all of our listeners what kind of qualities that, you know, you should be looking for in your practitioners and you know, obviously a little plug for us, I think we both exhibit a lot of those qualities so if anyone’s needing a healthcare functional medicine doctor or a functional medicine nutritionist in yourself to feel free and check out JustInHealth.com or NotJustPaleo.com if you wanna get more information.  But outside of that, because I know I’m booked out almost 2 months in my clinic.  I know you’re booked out a bit in your clinic, so we’re really busy so we’re not gonna be able to help everyone.  So we wanna make sure anyone that needs help and can’t get to us, they at least will be able to interview their provider and look for the skills that are needed to be successful.

Evan Brand:  Right.  Yup, I agree.  Where do you think we should start?

Dr. Justin Marchegiani:  I think the nutrition part.

Evan Brand:   Yeah.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Well, so for me, I’ve had people that have gone to holistic nutritionist because there’s so many different schools of thought out there now and there’s so many different nutrition certifications that nearly everyone could be considered a nutrition expert and unfortunately, some of those people are training clients to become complete vegans and raw food vegans–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  And things like that and I’m sure you have some stories as well and I’ve definitely had to help people recover.  I mean their hormones have been destroyed.  They’ve become very fragile, low energy after about 6 months.  They feel good at first and they just get sicker and sicker.  So that’s kind have been my experience so it’s not to say that our way is the only way, but that you should be eating some animal–you gotta be eating animal products preferably organic, pasture-raised animals whenever possible, because those amino acids that you’re gonna be hopefully digesting and breaking down from those animals will–are going to be converting into neurotrasmitters and making you feel good so it–it’s no surprise that, you know, veganism routes of–of nutrition and depression go hand in hand.

Dr. Justin Marchegiani:  I totally agree and I don’t like the term diet when I’m talking to my patients.  I like the term template and I do believe a Paleo template is best and I believe a Paleo template really is non-dogmatic because within that template you can be high carb, you can be low carb, you can utilize more of a specific carbohydrate diet approach for patients that have more gut or diarrhea or constipation issues.  You can use gap-side approach or you can use a low histamine approach, a low FODMAP approach.  So there’s a lot of flexibility that you have within that Paleo template.  You can use an autoimmune diet approach.  Again I work with so many vegans and vegetarians and we may just be choosing like, “Hey, we’re gonna get some egg yolks in your diet this week, and then everything will be vegan minus the grains and the legumes.”  So we can have someone who’s eating 95% vegan but getting some animal protein and animal product in there and they–they’re still doing 95% of what they were doing as a vegan but they’re not getting all the other crapohydrate and inflammatory foods and we may give them some extra free-form amino acid and some extra protein powder to maximize the aminos that they may not be getting in let’s say a vegetarian or vegan diet.

Evan Brand:  Right, yeah.  And then if–if it’s not quality soy that we can start pulling that off and weaning people on to real products and opposed to tofurkey and things like that.

Dr. Justin Marchegiani:  Yeah, they aren’t real foods, and I think also you need to have like a non-dogmatic approach or a non-dogmatic filter in which why you choose the foods you choose, so if I’m choosing a Paleo template, why are we choosing those foods?  My filter is, well, they’re anti-inflammatory, they’re nutrient-dense and they’re low in toxins.  It’s that simple.  You go through a vegetarian, you’ll pick out all the phytates and oxalates and the lectins, wheat germ agglutinins, and potential food allergens.  I mean, I just had a vegan last week, great vegan, but she has osteoporosis in early 30s and her teeth are already getting brittle and having extra cavities because of a lack of mineralization.  So why is that?  Because there’s all kinds of other irritants and toxins that are in our food that are affecting absorption.

Evan Brand:  That’s incredible, yeah.  And I’ve had similar stories and I’ve gone, you know, the kind of on the, I guess on the application side, I’ve also added in like some sublingual B12 and things like that just to help them because they’re–they’re so exhausted.

Dr. Justin Marchegiani:  Yup.  Yeah, exactly.  And I find that a lot of like, let’s say, I’m getting someone to transition over from a vegan-vegetarian diet from–on a functional medicine perspective because they’re low on these aminos, they’re–let’s say, there’s fat-soluble nutrients, right?  A, D, E, and K you can’t get in plant foods and again, beta-carotene ain’t vitamin A, so a lot of people can’t make that transition of beta-carotene to vitamin A especially if you’re hypothyroid, especially take a look at your palms, if you see a slight orange tinge to your palms, you’re not converting that beta-carotene to vitamin A.  So on that note, regarding the vegan solution there–where was I going with that?  Oh yeah, there’s a lot of people that are vegan-vegetarian and they’ll start eating a little bit of meat, and they’ll feel like crap.  They’ll be like, “Look, it’s not good.”  And I’m just like, “No.”  Your digestive system is shutdown.  You are not used to making stomach acid.  You don’t have the physiological equipment turned on to even process that kind of protein and fat, so we gotta add in the enzymes and hydrochloric acid and that makes a massive difference when we’re switching someone over onto a diet.  The enzymes and the acids may be a game changer.

Evan Brand:  Yup, so I think you kind of already alluded to what I was gonna bring up in terms of another trait that you want from your practitioner and that’s someone who sees the picture as a whole.  Now, you know, specialization is good in certain aspects but if you have that, if you’re using a magnifying glass or even a microscope in some cases to zoom in on a patient’s health issues, you’re going to miss the point.  You’re gonna miss what you just mentioned.  You’re gonna miss the fact that they may be low on stomach acid, so you don’t–you’re not able to start north to south if you didn’t see that process.  So do you wanna kinda hit on that string a little bit?

Dr. Justin Marchegiani:  Yeah, so once we have the diet in place, we kinda wanna figure out where within that Paleo template, if you will, they’re gonna do best.  So I had 2 vegans this week, “Hey, we’re just trying to get a little bit of egg yolk in and we’re gonna get some pea protein and some additional free-form amino acids.”  So once we have that, because we have such a non-dogmatic approach, we’re gonna be a ble to work with these people.  Now the next thing to layer on top of that is we gotta look at lifestyle, right?  Like forget labs, that’s–that’s gonan be the next thing but where’s the lifestyle?  Like are you chewing your food up?  Are you chewing your food properly?  Are you drinking enough water?  Are you eating within that first 30-45 minutes of getting up if you’re adrenally fatigued?  Are you going 4 or 5 hours without eating?  Are you skipping breakfast?  Are you trying to do intermittent fasting?  Are you doing too much CrossFit and that’s screwing up your adrenals?  Are you going to bed too late, right?  Are you getting cross-contaminated with rice and corn thinking that you’re still gluten-free, right?  These are all other things that need to be factored in to the diet and lifestyle thing and you gotta have a really good nutritional and lifestyle filters and not to bash on the medical doctors, but I find the MDs tend to be ones that miss this because they didn’t have a strong nutritional background in medical school because they don’t have nutrition at medical school for the most part.  I’ve talked to Stanford MDs, they had like a one hour, one credit hour nutritional course that was online, and basically if you just pass the test, you passed the course, and it’s all having to do with like nutritional disease like, you know, beriberi–what’s that?  Oh, that’s a B1 deficiency.  Scurvy–what’s that?  Vitamin C.  So it’s more from a disease perspective, not a functional optimal health perspective.

Evan Brand:  I’m not surprised to hear that, yeah, and Ricketts I’m sure was in there, too.

Dr. Justin Marchegiani:  Oh yeah.

Evan Brand:   Which is–

Dr. Justin Marchegiani:  Vitamin D, yeah.

Evan Brand:  You’re not gonna experience them most of the time.

Dr. Justin Marchegiani:  Right.  So we gotta have the diet perspective and the lifestyle perspective.  So the first thing before any supplements, any labs, any fancy schmancy protocols, is you gotta have the diet and the lifestyle, and you gotta say, “How are we gonna customize this diet for me and where I’m at?”  I think that’s super important and we gotta have a general template but I mean, patients that come in, we’ll, you know, we’ll do an SCD approach, maybe with an autoimmune filter on top of it that have a lot of gut issues.  Patients that are more healthy, we may just use a general Paleo template and we may up the carbs if they’re doing a lot more CrossFit and such.  So we–we figure out where they fall on that spectrum and customize.  So that’s kind of the–the foundational layer, the diet and lifestyle layer that any functional nutritionist or functional medicine doctor needs to have.  And that should be a key thing that you interview them on.

Evan Brand:  I like that and just to kinda harp on that a little bit more.  You’ll see the programs out there that are very cookie-cutter and there’s a lot of–

Dr. Justin Marchegiani:  Yes.

Evan Brand:  A lot of marketing involved in these programs within–within the health space and–and people think that this is a solution because they saw the before and after pictures of someone and hopefully, you know, today we’ve reframed that a little bit and make the distinction that there’s so many unique things going on with your environment, how many toxins you’re exposed to, all of these things that it’s–it’s not in your health decision to go for a cookie-cutter program like that.  So there always needs to be, you know, your specific life factored in to your protocols.

Dr. Justin Marchegiani:  Yeah, exactly.  So what step next should we talk about regarding a practitioner?

Evan Brand:  Well, I think just someone who is actually going to speak to you on the same level.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And you know, that’s what I like about you as well is you have a lot more training and clinic experience and hours than I do but yet we’re still able to connect on the same level.

Dr. Justin Marchegiani:  Right.

Evan Brand:  And that’s a huge off-putting thing when a–a patient’s going to a practitioner and they’re getting maybe not belittled but they’re feeling like they’re, you know, a couple inches tall and that they’re not smart and that they need to just bow down and listen as opposed to a good practitioner approach would be to sit down with this person and they should give you a warm good gut feeling and honestly–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I think you’ll know as soon as the, you know, as soon as the doc comes in or as soon as you just on the phone if you’re doing a, you know, an online consult with one of us, that you’ll know immediately if you’re gonna click or not and based on how you’re treated ultimately I think that’s–it’s a huge thing, man.  Personality is a big deal.

Dr. Justin Marchegiani:  Yeah, I agree.  I always say is you need a plan, right?  When I talk to my patients the big thing that I’m addressing is “When did everything, you know, go south for you?  When did all your symptoms start occurring?  When did that happen?  What was going in your life?  What was–what was the stressors like?”  I wanna know how the broke down because I wanna make sure that we’re incorporating diet and lifestyle strategies that make sure those stressors are neutralized if you will.  But even if they are neutralized, right?  Let’s say the original stress is hitting a nail while you’re driving your car and you get a flat tire.  But if I just drive around in that flat tire for a couple of months, there’s gonna be a lot of collateral damage that happens to my car outside of the original injury.  So let’s say the original injury is stress from work, poor eating, sleep, well, now we changed all that but basically you’ve done the equivalent of driving around on a car with a flat tire for 6 months.  So now you have axle issues, front and alignment issues, everything’s screwed up.  So now we actually have to go in and fix other parts of the car that weren’t even originally damaged in the beginning.  So I kinda see that as how functional medicine works.  The diet and lifestyle strategies fix kind of the environment that set the person up to fail but with functional medicine we’re now digging to the hormonal system damage, right?  Adrenals, thyroid, female hormones or ATM–adrenals, thyroid, and male hormones if it’s a male.  We’re digging into the gut issues, right?  The inflammation, the infections, and the malabsorption.  And then we’re digging into the–the detoxification backup, right?  What’s happening with detox?  So body system one hormones, body system two gut, body system three detoxification.  And I find when the body’s chronically stressed, almost all of my patients who have been sick for at least longer than a year, there’s some kind of infection because their gut has been worn down because of stress, and that infection has come in and is basically preventing them from healing.

Evan Brand:  Yeah, man, you know something that was brilliant you just alluded to without saying it directly is that the healing process is gonna take time and I think that’s another distinction of how to judge your practitioner.  You know, if you go in the conventional model, you go in and, you know, like I–I told you for example, we were thinking that my wife may have had Lyme.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So we go in and you get the quick fix recommendation, you get the pill for the antibiotics and you run out and that’s it and you won’t see them again until 3-5 years later down the road when something happens and you go back in, and so what I’m getting at here is that you should get a realistic approach to your health journey from your practitioner.  If you go and you meet once and they’re telling you all you gotta do is just buy this, this, and this and this magic pill, and then see you later, then you’re not gonna get better that way.

Dr. Justin Marchegiani:  No.

Evan Brand:   You need to find someone that’s–that’s down to join you on this journey and you guys are gonna do this thing together for 6 months and even longer.

Dr. Justin Marchegiani:  Exactly, like most people for instance, if they ever had to go to court, they get a lawyer.  Most people that, you know, are doing a lot, let’s say in business, they get an accountant or someone to help file their taxes, right?  People–higher people that have done something a lot of times, so they can have the ability to know it’s done right and the efficiency.  So it’s the same thing.  The most important thing we have is our health because our health is which–is the vehicle in which we experience everything, right?  Fun, life, our family, friends, our work, so that vehicle is a clunker if you will.  Everything else is gonna be bad.  So we wanna have an expert, like you’ve dealt–you’ve dealt with hundreds if not thousands of patients.  I dealt with thousands of patients a year.  You want that experience because we’re able to connect the dots and see, “Okay, you’re here.  Alright, here’s the next step.  Here’s the next–”  We can put the dots together where if you just have one person who is on there and equals one journey, everything’s new, everything’s foreign, everything’s different, and it’s hard to have confidence to know one, what to do, but also the order in which to do it.

Evan Brand:  Right.  So–so what would be the wrong order?  I guess, maybe we should–we’ve talked some of the rights, so let’s talk about the wrongs of how someone can really derail themselves if they’re trying to do this on their own, like say they just go jump on an adrenal support or an adrenal glandular because they’ve heard that that’s good for them.

Dr. Justin Marchegiani:  Well, the big thing I see number one is people find out they have an infection, they freak out and treat the infection and they get worse.  They haven’t made any of their changes.  So the big thing is jumping towards treating an infection when you don’t have any other foundation before it.  Number two is their fatigued, they just take a whole bunch of adrenal support which just like throwing gasoline on the fire if you don’t make any other changes.  So there needs to be a systematic approach in my system which is similar to your system.  It’s diet and lifestyle as the foundation, right?  We do an audit of where the physical, chemical, and emotional stress is coming from and we collect some data.  We do some labs to figure out what those underlying chemical stressors are, because a lot of time we may have no idea what they are, right?  If you’re fatigued or brain fog or have anxiety because you have a parasite infection, well, how the heck are you gonna know you have a parasite infection?  You may just think your anxiety is caused by Xanax deficiency or Wellbutrin deficiency.  You may not know that there’s a chemical stressor there.  So we gotta get information to dig in deeper.  So once we dig in the information we gotta ensure that the diet’s good, the lifestyle’s good, the sleep’s good, because we wanna make sure those foundational things are there.  Also on top of that, are you breaking down your food?  Are you having a bowel movement once a day?  How does your food look?  Are you breaking it down?  Do you need enzymes and acids to help break down your food?  Because if you can’t break down your food, even if you’re eating a great diet like an autoimmune diet but you can’t break it down, forget it.  And then once we’ve done that, then we’re moving into the phase 1 where we’re really focusing on the hormones, adrenals, thyroid, and/or female or male hormones, and we–we’d like to do it in a sequence.  Adrenal hormones should always be addressed first, followed by male or female hormones second, and then thyroid typically last.  Typically in that order.  It may reverse based on certain situations but that’s a good general order.  Typically thyroid’s either second of third depending on what’s going, and we hit it in that order.  And once we’ve kinda stabilized the hormonal system, then we go to the gut killing.  Then we go to the infections because dealing with an infection can be stressful on the body.  Your body has to deal with the biotoxins and the lithocholic acid and the endotoxins and the mycotoxins, basically all of the dead soldiers if you will from the infection, and we have to process those–those skeletons in you will.

Evan Brand:  Right and yeah.  I–I wanna get better at analogies because I love yours so much.  But–

Dr. Justin Marchegiani:  It’s taken me years to get these things up because doctors create this language that’s like meant to make patients feel disempowered, and I wanna just take that language and say, “Screw it.”  We’re gonna use words and analogies and stories that actually connect with what’s happening because if you–if you understand a concept you never have to memorize it, right?  If the concept–if you understand the concept, it’s there.  You can never forget it, like concept I just said with the, you know, the–the so-called dead soldiers and the debris and like you don’t have to memorize that, you got the concept.  I don’t have to talk about Herxheimer’s reaction and all these things, that’s what it is.  But what the heck’s a Herxheimer?  If I give you the concept and the analogy, you got it.  You never have to memorize it, it’s there.

Evan Brand:   Totally, yeah.  In analogy, I was picturing when you were talking about that kind of why you need to get these support systems in place first is, I mean, that’s basically a flood is coming and all you’re doing is putting up a few sandbags, that’s all you have.

Dr. Justin Marchegiani:  Right.

Evan Brand:  You don’t have a good foundation–

Dr. Justin Marchegiani:  Right.

Evan Brand:  You’re gonna get wiped out and the flood is–is gonna take over.  So–

Dr. Justin Marchegiani:  Exactly.  So and I think that would be another thing is, your doctor needs to tell you what’s going on, where are you now, what’s your vision next month, what’s your vision 3-6 months from now, what’s the plan?  And like with my patients, I graduate them from phase 1 to phase 2 because I need compliance from my patients.  I need to make sure they’re doing what–they’re doing their part, right?  Doctor is latin for teacher.  So I’m doing a lot of teaching.  I’m also doing a lot of coaching and motivation because I need to make sure they’re doing what they’re doing.  I need to hold them accountable.  Sometimes patients need a pat in the back when they’re doing good and sometimes a–a kick in the butt when they’re–when they’re doing bad.

Evan Brand:  Yup.  Yeah, I like that.  Yeah, docēre to teach, yeah, and–and that is part of the process and you’re doing it together.  You didn’t say reprimand or you didn’t say gawk at or–or talk down.  You’re teaching.  It’s a–it’s a–it should be a fun, enjoyable, you know, process for people and so if you’re miserable with your practitioner, maybe this is another good key here, is don’t be afraid to fire the practitioner.

Dr. Justin Marchegiani:  Yeah, yup.  Ab–absolutely and sometimes you know, the practitioner–I’ve had to fire patients.  Because, you know, I put my reputation out there with every patient I work with and some patients, every now and then you get really difficult patients and there’s a lack of compliance and it’s really hard because you wanna be able to help someone but you need a certain level, a baseline of compliance and if that compliance isn’t there, it’s hard.

Evan Brand:   Yup.  So I’m trying to think if I had–I had one more in my brain and I lost it, so I didn’t know if you had any other good qualities for a practitioner.

Dr. Justin Marchegiani:  I think, you know, just kinda tooting our horns is free information.  I mean, you have 300 or hundreds of different podcasts.  I have 160 podcasts and over 200 YouTube videos and almost 100 blog articles, lots of free information that shows people what our brand is about, what our system is about because you need–there’s too much stuff out there to go over in a consult, so you need lots of stuff that can be gone over in a podcast or a YouTube video or, you know, on the weekend by checking out a free blog or something.  So lots of good information to support everything in the consult, I think, is important.  It’s a–it’s a value-added that I make sure all my patients have access to and I know you do the same as well.

Evan Brand:  Yeah, right.  It’s–it’s not like we just popped on and “Here we are, we’re gonna help you.”  I mean, there’s thousands– probably thousands of hours that you can spend reviewing all of the trench work, I guess–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I would call it that you and I have both posted for people.  So all of that stuff’s there if you’re not ready to actually get committed.  This will be kind of the stuff to maybe inspire you to think, “Huh, maybe this isn’t normal for me and feel exhausted but when I try to lay down on the pillow at night, I’m wide awake, and this video here explains why.  Huh, maybe it is time for me to get tested.”  So, you know, that’s kind of a good–just a good way to get familiar with the concepts if you’re just new to this whole space and you’ve been led down the conventional route and it has failed you or made you sicker than, you know, always have hope.  I think that’s maybe my last good quality is you wanna find a practitioner that is going to encourage you and that has hope for you because if you just feel like you’re number 62375, then that’s all you are and that’s how you’re gonna feel, and you’re not going to leave empowered from your consultation.

Dr. Justin Marchegiani:  Yes, I agree.  I think also when the doctor is sitting there and talking with you about the labs they’re recommending, you always wanna ask yourself, “How is this addressing the root cause?  How is this getting to the root cause?”  That’s always a question that needs to be in the back of the patient’s mind and I always stress it with the patient pro-actively, but the patient needs to be asking the doctor, “How is this getting to the root cause?”  And also looking and prioritizing what labs.  So when I sit down with my patients and recommend labs, they’re always on a priority scale.  We’ll recommend between 1 in 5 labs or 1 in 4 labs with each patient depending on how sick they are and how fast they wanna get better, and we prioritize it from 1, 2, 3, 4, and 5.  And I always prioritize them and there’s some labs out there depending on, you know, how much extra income a patient wants to put on labs, I’m not a huge fan of food allergy testing.  I’m not because anyone with a leaky gut, anything they consistently eat, they’re gonna develop a food allergenic response to it.  So I’m not a big fan with food allergy testing, yet sometimes I will use it for patients that are uncompliant.  I’ll use it for autistic children who are eating terrible diets and their parents don’t wanna cut out their food.  And I’ll also use it for patients that are just allergic to everything across the board and maybe we can gleam a little bit of extra info but for the most part, there’s always a relative rotation element to the diet where we’re getting variety in it and we’re rotating what we love so we’re not developing food intolerances based on that food slipping through the tight junctions of that leaky gut because our gut’s inflamed.  So that’s–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  One thing that’s really important.  You wanna comment on that, Evan?

Evan Brand:  Well, no, I was just gonna say that I’ve–I’ve had great experience rotating my diet as well–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Because I’ve loved things like coconut so much that I’ve overdone it.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Things like leafy greens, I’ve loved them so much that I do have to cycle on and off of these different nutrients so that’s something to keep in mind.

Dr. Justin Marchegiani:  Probably eggs and bacon, too, right?

Evan Brand:  Oh, totally eggs, yeah, and bacon.

Dr. Justin Marchegiani:  I mean, Paul Chek, he said something early on in my career that resonated with me.  He said, “If you love it, rotate it.  If you love it, rotate it.”  So if you really love what you’re eating, get a–an element of rotation there.  And again, how fastidious do you have to be?  Again, the more sick you are, the more fastidious you have to be.  Okay?

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And the next thing is supplement recommendations.  So supplements are powerful tools.  So number one, you wanna make sure your doctor is recommending the highest quality supplements.  Not a big fan of MLM products, not a big fan of that stuff.  There are some decent things out there but I’m a fan of dealing with the highest quality supplement companies out there.  Tier 1 companies.  Companies that are independently tested, that use the highest raw materials, and you know, will probably cost more than your products at Whole Foods in general or at Costco.  So a good product will cost you a little bit of money, but again I always tell patients the most expensive supplement is the one that doesn’t work or the one that contains fillers or additives or a whole bunch of junk in it.

Evan Brand:  Totally, yeah, and I–I think a good rule of thumb is if it’s a product that’s available on a shelf or this–not always the case, but if it’s on Amazon and it’s not exclusively sold to practitioners then there may be a chance to raise some eyebrows and I’ve kinda switched away from some of the companies I used to use before becoming–becoming a practitioner and I’ve kinda strayed away from those and really upgraded the quality and I’ve noticed the difference in how it works and when you look at some of the articles on ingredient quality, something could say rhodiola but if it’s not extracted to, you know, the 3% rosavins that you actually need–

Dr. Justin Marchegiani:  Right.

Evan Brand:  Or it’s extracted only 1% or you know, et cetera, then, yeah, it’s expensive.

Dr. Justin Marchegiani:  It is.  It is.  And also I’m very leery of patients buying their supplements on Amazon or eBay.  I have multiple supplement reps from the companies that I work with directly so I purchase directly from the manufacturer so there’s no middlemen, and I have seen these major supplement companies that do their quality assurance, they will actually buy their products on Amazon from some of these third-party distributors and they will buy the product and they will actually send it back to the lab and test it, and they’re finding literally like rice flour.  Like just innocuous supplements, innocuous compounds in the supplements.  And if I get someone who’s taking rice flour and then they’re gluten-sensitive and inflamed, they aren’t gonna get better.  Or if they’re getting a product, you know, that’s counterfeit, they’re just not gonna get better and it’s–it’s really difficult, you know, to help a patient when, you know, they’re trying to say 10% on a product but then they’re getting something that’s totally crap, they end losing 100% in order to save that 10% so it’s gets difficult especially when you wanna make sure you’re delivering the highest quality that can happen and it does happen and the New York Attorney General did a whole raid on GNC and all these different stores and found that majority of their products didn’t even contain what was on the label.

Evan Brand:  Yeah, Walgreen’s I believe.  CVS, too.  I don’t wanna–

Dr. Justin Marchegiani:  GNC.

Evan Brand:  Throw everybody under the bus without knowing.

Dr. Justin Marchegiani:  Yeah.  And not to mention like they found like for instance, I think it was last year, they found 10 mcg of lead in the female multivitamin at the vitamin shop.  So you get–you gotta–you gotta be careful, so I know the people that I work with, the people that you work with, they’re doing third-party independent-tested lab assessments and they’re also buying the highest quality raw material, right?  If you see fish oil, let’s say, Kirkland’s Costco fish oil like 300 caps for $10 and then you see like a higher quality fish oil for $30, there’s a reason why.  And part of the reason why is that fish oil, most of the cost actually goes into the filtration process not the fish oil.  So when you buy a crappy fish oil for cheap, you’re getting what you pay for.

Evan Brand:  Yeah, so here’s the–here’s the official story, I wanted to make sure we were accurate here.  So it was New York State Attor–State Attorney General and he instructed Target, GNC, Walgreen’s and Walmart to immediately cease selling a number of scam herbal supplements, they–4 out–4 out of 5 products did not even contain the herbs and their ingredients listed that contain like you said powdered rice, house plants, and asparagus.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Fraudulent projects–products included Echinacea, ginseng, St. John’s Wort, garlic, gingko biloba, and saw palmetto.

Dr. Justin Marchegiani:  God, that’s terrible.

Evan Brand:  And I use those–I use those specific ingredients and I’m sure you do, too.  So if we were just sending people, “Yeah, just go down to Target and go buy it.”  I mean, that would be not–that’s not a good practitioner quality, there.

Dr. Justin Marchegiani:  No, no, and you really do get what you pay for.  And that’s why I’m working on creating a private label line so I have even more–my own quality, my own custom label line, so I can ensure a higher quality than before, because I–I mean for me, it’s everything.  I want to make sure my patients get the best results.  So if they’re not getting enough of this B vitamin, this B6 or this herb to wipe out an infection, we may not get them better as fast, and I–I need to be able to be confident that what they’re getting is exactly on the label.  So like for instance, with one of the probiotic companies that I use, they put on there for their CFUs, the colony forming units, the put on there how much will be in the probiotic 2 years after it expires.  So when you say–when you see a hundred billion units per serving that’s what’s in there 2 years after it expires.  So they literally put double or triple the amount in there to ensure you’re gonna get what’s on the label 2 years from now.  That’s what you get when you’re using a higher quality company.

Evan Brand:  That’s great.

Dr. Justin Marchegiani:  So Evan, I think the next question after that is how many supplements is right for you?  So dealing with patients, when we create an adrenal program for instance, we’ll start with anywhere between 2-6 products, and we try to work on what the patient needs, where they’re at, how sick they are and how fast they wanna get better, and also what’s their emotional tolerance, can they handle a whole bunch of pills or not?  So we have to have that conversation and some patients that are sicker and wanna get better faster, we need more nutrients, we need–we need extra support especially if they’re life’s stressful, their nutrition isn’t perfect, they’re maybe not sleeping the best, we may have to give a few extra products.  So I think that conversion needs to be had with the doctor and with me, it’s a sliding scale of how much I recommend and I customize that with the patient.  And sometimes if we’re–have an adrenal program lined up with a good multi, a fish oil, and some adrenal support, and let’s say we have a–a gut-killing program lined up and a person has a couple of different gut infections, it may be a fair amount of products.  So you have to sit there and talk with your doctor and figure out what you’re on, why you’re on it, figure out if it’s in your comfort zone and also find the timeframe of how you’re on–how long you’re gonna be on things and when you can consolidate.  Some patients are under so much stress they just–they need that, and that’s just how it is and they feel better and perform better with it.  So there has to be that conversation and it can’t be like, “Oh, you’re on 10 things, your doctor’s, you know, ripping you off,” it needs to be “Why,” like, “Did you have a conversation with your doctor about that?  Does it make sense?  Do you know why you’re on everything?  Is your doctor making sure your diet’s good?  Is the lifestyle and the sleep good?”  You gotta have that conversation.  It’s gotta be individualized.

Evan Brand:  Yeah, I–I’ve find a lot of people that come in and they fill out the–the little form.  What are you taking?  Supplements, herbs, medications, if I do prime them about those, “Why are you taking those?”  “Oh, I don’t know.  I just–I read it was good.”  And so there may be some imbalance created, I mean, especially with things like zinc.  I mean, throwing off the zinc and copper balance for example.

Dr. Justin Marchegiani:  Right.

Evan Brand:  I’ve seen tons of people.  “Oh well, I read zinc is good for testosterone so I just started taking 50 mg of it because I’ve read it on a bodybuilding article.”  That’s not the wisest idea and you–you’re coming in the door with, you know, tons of supplements–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  That you actually may get helped by removing those supplements and then just completely starting from ground zero again.  So–so always being open, I guess would be a–I don’t know–a good–a good way to come into the door because you never know what’s gonna need to be adjusted.

Dr. Justin Marchegiani:  Yeah, I totally agree.  And there’s a site I use called the HealthAliciousNess.  HealthAliciousNess.com and it’s a great site looking at all of the various nutrients in foods.  So like when we have a person that, let’s say, on a test comes back with low in zinc, we’ll look up the top 10 zinc foods and we’ll make sure those foods are in their diet.  Or if they’re low in calcium or-or potassium, we’ll look at those foods and we’ll see if those foods are in their diet, and again, this is part of the reason why we kinda have a Paleo template is because those top 10 foods almost all of the time are staples in a Paleo template, go figure, right?

Evan Brand:  Yup.

Dr. Justin Marchegiani:  So the diet and the supplement part, it needs to be customized and I do with some patients sometimes that are sick and not feeling good but they don’t wanna take a lot of supplements and that’s okay, we just have to make sure the diet’s lined up and perfect and you’re managing stress and your life isn’t too much stressful and you’re sleeping good, and we also have to kinda gauge your expectations of healing.

Evan Brand:  Right, yeah­­–

Dr. Justin Marchegiani:  If you have maj–

Evan Brand:  Yeah.  I was gonna say–

Dr. Justin Marchegiani:  If you have a major infection and you don’t wanna take maybe 1 product, you may not get that infection cleared out.

Evan Brand:  Yeah, or if you’re a teacher and you have the summers off and you have the time that you’re gonna be relaxed enough to actually be more compliant then maybe you can skip out on a couple but if you’re high flying day by night person then you’re gonna need a little bit more support there.

Dr. Justin Marchegiani:  Yeah, and I do adrenal test pre-imposed and it takes a long time to heal the adrenals, just doing lifestyle and diet alone.  Typically it takes like a couple of months of vacation time with perfect diet and lifestyle and the way I look at it is “Well, why don’t you do that and take the supplements and super charge the healing even faster?”

Evan Brand:  Totally, yeah, I mean even if someone’s still working 40-hour work weeks, I mean, sometimes I try to estimate a year even–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Depending on the person.  What would you say?

Dr. Justin Marchegiani:  Yeah, we look at their adrenals test and based on their adrenals whether they’re normal, stage 1, stage 2, or stage 3 and that’s basically an indicator looking at how little cortisol or how much cortisol they’re making in conjunction with the rhythm of their cortisol and in conjunction with DHEA or sex hormone levels, we can base a good timeframe of healing.  So stage 1 is 3-6 months, stage 2 is 6-9, and stage 3 is 9-12 months.  And anyone that’s chronically ill with multiple infections 1-2 years minimum.

Evan Brand:  And that’s actually really fast if you’ve been sick for 20 years.

Dr. Justin Marchegiani:  It’s really fast.  I mean, yeah, especially when conventional medicine will probably just throw you some anti-inflammatory COX2 or NSAID drugs, maybe some prednisone, and maybe some anti-depressants.  I mean, that’s not ever gonna fix the problem and will probably make things worse down the road.

Evan Brand: Uh-hmm.

Dr. Justin Marchegiani:  So I think we went over some really good stuff.  I mean, I think the summary would be make sure your doctor has a approach that addresses and looks at diet and understand why they recommend their diet and make sure there’s customization within that diet, number one.  Number two, make sure there’s lifestyles being looked at, meal timing, stress, meditation, exercise, sleep, blood sugar; make sure that’s being look at.  Number three is what’s the approach, right?  What labs are we gonna order to get to the root cause, right?  And are we addressing the other stressors that were in our life that caused the problem to begin with and then also, how are we gonna recommend the supplements?  How do–how do we prescribe them?  What are the phases of care?  How I do get to the next phase?  What are our markers of success, objective and subjective?

Evan Brand:  Yup.  I think you covered it.

Dr. Justin Marchegiani:  I think it’s a really good place.  Do you want to add anything to that, Evan?

Evan Brand:  No, that–I mean, that was killer, man.  That was more concise that I could have made it.

Dr. Justin Marchegiani:  Alright, good.  And again, I’m available over at JustInHealth.com and you can take a look at the free Thyroid video series and Female Hormone video series, and again my most successful patients–my most–the patients that I’m able to help the best and the fastest, they are the most educated, so anyone whether you’re gonna work with myself, Evan or another great doctor out there, get educated.  The education process is a huge part in healing because it creates compliance and it’s gonna allow you to not self-sabotage yourself because you’re already gonna have the good subconscious gems of what you gotta do to heal.

Evan Brand:  I love it, yeah.  And it saves us a lot of time not explaining why that piece of bread is not gonna help you.

Dr. Justin Marchegiani:  Oh, my gosh.  I fight with so many patients on things that we could just be putting more of that time towards actionable items versus fighting on the old.  So the more you get educated outside of the doctor’s office in call, the better it is and the more money you’ll save yourself, too.

Evan Brand:  Amen.

Dr. Justin Marchegiani:  Alright, Evan.  Hey, great talking to you, man.  We’ll talk very soon.

Evan Brand:  Likewise.

 

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