Putting together the optimal functional medicine program – Podcast #116

Dr. Justin Marchegiani and Evan Brand discuss about effective functional medicine programs and how they create and follow protocols. This interview goes in-depth about the world of functional medicine practice.

functional medicine programsFind out why you shouldn’t wait for something to happen before doing anything about it health-wise. Discover the differences between Body System One and Two and how optimal health can be attained. Learn about the various tests you can take and the right tools that are available to further achieve better and more effective results with functional medicine.

In this episode, topics include:

01:26   Get help as early as possible

07:00   Body System One

10:19   Diet and lifestyle

17:16   Body System Two

38:22   Tests







Dr. Justin Marchegiani:  Hey, Evan, it’s Dr. J in the flesh. How we doin’ this Monday?

Evan Brand:  Hey, man! I’m doing great. How are you?

Dr. Justin Marchegiani:  I’m doing great. Can’t complain. It’s a little rainy Monday here in Austin. The grass is getting plenty of water which is great. I got the fireplace on behind me, so it’s got that wintery Christmas feel a little bit.

Evan Brand:  Nice. Excellent.

Dr. Justin Marchegiani:  Can’t complain. How about you?

Evan Brand:  Doing well, man. Hey, we were trying to record this thing, and then we had choppy audio so I wanna repeat what my little rant was because I thought that was important. I’m always curious about what is the catalyst for someone to work with yourself or myself, and I had a lady this morning who had been listening to us for six months and she knew that she had problems. She had a lot of gut issues going on but she continued to just listen to try to fix herself, and then she got the diagnosis of alopecia and now she’s lost over half the hair on her head, and now she’s figured out that that’s the time to come and get help. And I just want that to be a fire under people’s butts listening that you shouldn’t wait until things are so bad that you’re at rock bottom before you get help and unfortunately, that’s the conventional system that we’ve all been brainwashed to do which is we wait until we’re really bad, we absolutely need a doctor or practitioner and then we go get help. And my advice, get help now. If you have symptoms and things are off, and this is something you’ve—you’ve trained me on so much. It’s like, “Evan, look, these issues are not gonna resolve themselves. You have to resolve issues now. They’re not just gonna magically disappear.” Did you wanna speak on that a little bit about people just waiting too long or people just not having enough reason so they think to get help?

Dr. Justin Marchegiani:  Yeah, well, there was an interesting scenario just the recently. There was a plumber in my house a few months back and he was doing some work, and there was just like a leak on the faucet, and for some reason the leak went away the next day. So there were two plumbers there and he goes down and looks, and he couldn’t find the leak. And he goes, “Well, maybe it just went away,” and then his partner, the plumber next to him spoke up and said, “You know what? Leaks never go away on their own. If there’s a leak, it’s gonna get worse.” So he went down there and he looked, and he said, “Okay, well, we just need more flow and if you had more flow coming, it would start to leak.” And he looked a little deeper back and he found the leak and just the environment wasn’t quite right enough for the leak to be expressing itself but the whole idea was that these problems don’t ever tend to go away by themselves. So that was kind of the moral of the story and connecting it to your patient, let’s say if you have these symptoms, they’re gonna get worse and the question is, how long do you wanna wait until those symptoms, right? Pain, pay attention inside now—that’s what symptoms are—whether it’s aesthetic, whether it’s inflammatory, whether it’s mood or energy. How bad do they have to get before you start getting a—a fire under your butt so to speak.

Evan Brand:  Right. Well, and my grandparents, their old house, you know, they had issues with their plumbing and they had to wait until their entire basement was flooded and thousands and thousands of dollars’ worth of carpet and furniture was ruined due to the flood before they came in and got the issue. So maybe they saved, you know, a couple hundred bucks in the beginning, but then it cost them likely $10,000 or more in the long run because they waited until things just hit an absolute worst-case scenario. So you know, I know there’s a lot of people out there listening that are trying to fix themselves and you and I certainly applaud that. I mean that’s what this is all about, right? Taking your health into your own hands and us teaching you how to fish, but at a certain level, you really just have to reach out and—and don’t be afraid to get better and—and don’t be afraid. You know, we’re real people. We don’t bite and we’re here for you. That’s what this is for. The show is to inspire you and to help you, but there’s nothing that’s gonna replace a one-on-one, you know, with one of us because there’s so many courses and online things, and things that you can look into, but it’s not specialized and I’m against specialization if you only look at one person. But you know, something we’re gonna talk about today is functional medicine is a specialty but we’re breaking that down. We’re—we’re looking at someone. We’re casting a net wide enough to look at every body system, so that we’re gonna figure out what in the world going on with somebody.

Dr. Justin Marchegiani:  100%. And so the template for how we treat patients is pretty unique for—for us as functional medicine clinicians, right? There a lot of nutritionists out there that will primarily just focus on the diet piece. There are a lot of medical doctors out there that I find that will a lot of time skip the diet, maybe focus on more of the hormones and ignore the gut. You have other people that will only work on infections, whether it’s Lyme or a gut doctor. They’re only focused on the infections. So the question is, how do we become the general or the ultimate general practitioner, where we can pull the key issues from the infections, from the hormones, from the diet, from the lifestyle, from the digestive system, and combine them together and mesh it? So we put it all together in a way that is holistic, that represents the underlying cause from each person, because that underlying cause percentage-wise may be different for each, meaning one person that may be 60% diet, 30% infections, and 10% hormones, and others it may be 30% diet, 50% hormones, 20% gut. So you gotta look at it from the perspective of what piece may be the bigger player, and it may not be the same for each person. So we may not know, but if we hit them all in the order that we consider to be the order of priority, that’s gonna give us the highest chance of hitting all of those key issues and not missing them.

Evan Brand:  Right, and during the free calls, you and I block out just a few hours each month for free calls, which we’re always booked up for those and it’s a true honor to be able to offer that to people.

Dr. Justin Marchegiani:  Absolutely.

Evan Brand:  A lot of people ask us, “Hey, Justin or hey, Evan, you know, can you just tell me right now what tests we’re gonna need to run.” And we can’t because that involves a case review, that involves looking at your history, looking at the fork in the road when did things get bad, how long have things gotten bad, what else was going on at that time in your life in terms of stress and travel and relationships and moving. You know, so there really is no one-size-fits-all program. Now there are similar tests that we run on nearly everyone, but at the end of the day, it’s so case-by-case and I know people wanna just get put into a box because it makes them feel comfortable. I mean, think of like Weight Watchers, right? You know, it’s a point system and you can buy their little hundred-calorie snack packs of pretzels. But that’s a horrible box to be in and you don’t wanna be confined there. So it—it’s a box of functional medicine but it’s a box without boundaries, too, because we never know what toolbox or toolkit we’re gonna need to reach into to pull something out specifically based on—on your symptoms.

Dr. Justin Marchegiani:  100%. So we wanted kinda get things dialed in, and we have like the pallet of our tests that we may choose from for body system one. That’s like the hormonal system and we break that up into ATF and ATM, adrenals, thyroid and female hormones for our female patients and then our ATM, adrenals, thyroid and male hormones. And depending on how deep we go is depending upon what kind of symptoms present themselves and how long the patient’s been sick. Typically, the longer someone’s been sick, it may be better to get more data so we can fine tune the plan better, more specific to what’s going on. If someone’s been maybe not feeling good for just a little bit of time, maybe only a few years or a few months, we may run less off the bat because we don’t need as much data. Typically, the low hanging fruit tend to work on people that aren’t as chronic. So that’s kind of a good rule of thumb. So our body system one test are gonna typically include high-quality adrenal tests. Well, and that depends. I know we’re going back and forth and testing, you know, the new Biohealth saliva test that’ll be out soon. We’ve been using the Dutch for a bit of time. We have been using the old Biohealth 201. I have lots of patients that come in with other subpar salivary hormone testing that—that come in. We also look at the DHEA sulfate, which is an adrenal marker of sex hormone precursors from the adrenals, DHEA sulfate. And then we’ll also add on female and male hormones to those tests, whether it’s female hormones, progesterone, estrogen, estrogen metabolites, the different kinds of estrogens, estradiol, estrone, estriol, whether we are looking at the DHEA metabolites like androstenedione or etiocholanolone. Those also get factored in, maybe even melatonin as well. So we’ll look at all these different metabolites on the hormone side and then depending on if they’re showing with thyroid symptoms, we may even run a thyroid blood test or we’re looking at all of the thyroid markers, TSH, T4 Free and Total, T3 Free and Total, reverse T3, T3 uptake, and thyroid antibodies. So those are kind of all of the hormonal tests that we may run. And we even have some different. We may even time it up on day 20 of a female cycle if they’re—if they’re menstruating to get a window into where their hormones are tapping out. We may even look at a full month long panel, testing hormones every other day for a full month, so we can get a window of ovulation and the ebb and flow of the hormones throughout the month, just to make sure it’s optimal for fertility.

Evan Brand:  Yup, well said. So body system one. I mean, this is the foundation, you know. You talk about these people that just focus on the gut and we’ve dealt with that. I mean a lot of times and I know you hear this just as much as me if not more, “Oh, I’ve already been to 10 specialists or 20 specialists or 20 doctors. They all think I’m crazy or they said it was just the gut. They gave me antibiotics.” If you don’t get the hormones aligned and checked out, you’re kinda wasting your time really because if you have cortisol issues, you’re likely gonna have leaky gut issues which is gonna leave you susceptible to infections. So it’s like if we come in and just hit the gut, which we’ll talk about in a minute, body system two, it’s not really worth it, right? Because if you get the infection gone, but the leaky gut’s still there due to the cortisol issues, I mean, that’s kind of a bigger top of the food chain issue, right?

Dr. Justin Marchegiani:  100% and just backing up one bit, everything sits on a foundation. So the introductory foundation for everything is diet and lifestyle.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And we’ve talked about this before, but just to make sure we don’t miss it, the foundation is gonna be what you eat, when you eat, the quality of food that you eat, how you sleep, how you move, how you deal with stress, and hydration. So that’s gonna be a really important piece of the puzzle. Making sure we’re eating nutrient-dense, anti-inflammatory, low toxin foods. Making sure the diet is dialed in for you. Now what does that mean for you? Well, if you’re just a little bit sick, maybe you’re kinda in the middle, it’s not too bad, a Paleo template may be good to start with. Alright, no grains, no legumes, no dairy. If we’ve been sick for longer, maybe we have a history of autoimmunity in the family, or there may be known autoimmunity in yourself or known autoimmune symptoms, well, the next step may be an Autoimmune Paleo template where we go to the next step which is cutting out nuts, nightshades, and eggs. And then from there if there’s excessive gut issues, we may look at specific carbohydrate diet where we cut out salicylates and phenols and peel our vegetables and—and make sure everything’s well cooked and mash our foods. We may even look at a GAPS approach where we focus more on bone broth and soups and—and the same type SCD stuff, more in a liquid, palatable—a liquid, more palatable type of form. And we may even go to a low FODMAP diet where we cut out the fermentable carbohydrates–fermentable oligo-di-po—let’s see, fermentable oligo-di-mono and polysaccharides. So it’s your—your fermentable carbohydrates, your fermentable sugars. So we may add that piece onto it just to make sure that we’re taking as much stress off the body. We’re stabilizing blood sugar. We’re not adding toxins from the pesticides and chemicals and GMO and Roundup and—and the glyphosate and we’re stabilizing blood sugar. We’re not skipping meals and we’re making sure that we’re sleeping good at night and we’re hydrating appropriately in between meals or 10 minutes before, so we’re not diluting digestive enzymes and hydrochloric acid.

Evan Brand:  Well said and there’s a ton of overlap in all of those, too. I mean–

Dr. Justin Marchegiani:  A ton.

Evan Brand:  You’re going to be omitting gluten. You’re gonna be omitting–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Many of the dairy components, the inflammatory component, then you’re going to stay away from pesticides and chemicals. I had a guy the other day. He asked me. He said, “Well, I’m not sensitive to gluten. So do I still have to avoid it?” I said, “Absolutely.” There’s no deficiency of gluten ever and just because you don’t think you’re sensitive to it, some of your skin rashes and all that is probably caused from some type of food intolerance. You know, you don’t have to be doubled over in pain from eating a bagel to—to necess—you know, to necessarily have to stay away from it, right? You don’t have to be falling over, needing a morphine shot due to the pain from gluten if you—if you have anything, any symptom, headaches. I mean I had a lady who had migraines for 20 years and it was amazing how simple it was just to get the diet and the gut cleaned up and the migraines went way. So I think people expect massive, massive symptom sometimes to be caused from gluten and otherwise, they don’t wanna get rid of it but you should just get rid of it.

Dr. Justin Marchegiani:  Yeah, my thing with grains and gluten is if you’re gonna cheat and you’re gonna do grains, number one, the safest grain for most people tend to be white rice. So that’s tends to be an okay alternative if you’re gonna do a grain, if you’re gonna cheat. White rice tends to be okay. Even better, try doing the safer starch. You know, yucca, plantains, sweet potatoes, let’s see—I said plantains, yucca, sweet potatoes,  squash—those type of safer starches tend to be a better alternative for most. Go ahead.

Evan Brand:  Yeah, I was gonna say taro, too. Some people talk about that.

Dr. Justin Marchegiani:  Taro, arrowroot, yeah, and then also if you’re gonna—like let’s say you’re like, “I’m gonna do bread.” Well, sourdough bread has actually shown to have less gluten because of the fermentation process that gliadin protein tend to be more dissolved in the fermentation process. So if you’re gonna go get all glutened out, take a look at the good, better, best side of it, right? Good or best would be abstaining and doing zero grains. Good may be doing like white rice or better—sorry, better maybe doing like white rice or something that’s fully gluten-free. And then third would be, alright, fine. You’re gonna do a gluten bread, well, it’s gonna at least be fermented, i.e. sourdough bread. It’s fermented, so the gluten and the compounds in there that may be more allergenic are decreased. But the other things–

Evan Brand:  Right.

Dr. Justin Marchegiani:  That Evan and I still wanna touch upon are the lectins, are the phytates and the oxalates, the mineral disruptors, the protein disruptors, and the high amount of pesticide and Roundup that are on some of these products. So you can at least reduce it by going organic and by going the sourdough method so it’s at least fermented and soaked, so the grains are gonna be more palatable and not have the mineral and enzyme disruptors. But again, better, right? Good, better, best. Best is gonna be at least keeping the grains out. Good or better part is gonna be in between, going like a rice protein and then like, you know, good would be doing the fermented sourdough bread option like I just mentioned.

Evan Brand:  Yeah, and put it this way, it helps me sometimes to understand kind of the ancestral or the planetary perspective on this. These plants and these grains, they don’t want to get eaten–

Dr. Justin Marchegiani:  Oh, yeah.

Evan Brand:  And digested, right? I mean, they want to pass seed on through an animal and then it come out fully digest—or un—you know, undigested, fully undigested, so that that seed can go back into the ground and grow more grass or grain. I mean, that’s the goal with birds and humans, too, if it goes through and it’s not getting digested, the goal is for that seed to be intact enough to grow more plants, and they don’t wanna get eaten.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So that—that’s enough reason there that—that makes sense and really help me. But like, “Oh, man. Wow. Okay.”

Dr. Justin Marchegiani:  And it’s pretty simple, right? You know, from evolution standpoints our role, I mean, it sounds crude is just to be able to pass on our—our seed to our offspring, right? That’s pretty much it. You know, be able to survive enough so you can procreate and pass on your DNA to your offspring. That’s pretty much it. Now there’s two ways of doing it. There’s having claws and weapons and tools and teeth, so you can prevent getting attacked on or preyed on, right? That’s like the wolf or the fox, or maybe us with our weapons as humans. And then there’s the, “Okay, I’m gonna get eaten, right?” Berries, grains, but there’s gonna be seeds and things that are gonna keep the seed and the DNA intact, so eventually maybe it will go back and be able to grow again and pass on its offspring so it can live again, right? So there’s two methods. It’s either you’re gonna fight now or you’re gonna basically submit but live the fight another day by passing itself back into the soil again so it can grow.

Evan Brand:  Yup, yup. Should we move on to body system two?

Dr. Justin Marchegiani:  Yeah, and then last piece that is the foundation with the diet, I’d say is also the emotions. So if there’s a lot of emotional stress, like there’s an active serious relationship issue. You know, not just like hey, you know, you had a fight here or there but you have active relationship problems. Maybe there’s an active divorce issue. Maybe you’re real problem with the child or a family member or maybe a death of a loved one or serious work stress, or stress at your church or where you go to—to have a spiritual connection, or you excessively exercise a ton, right? Those kind of things need to be looked at because they can provide a lot of stress underlying. So we wanna make sure there’s not an active emotional issue because it affects the timeline in which we expect healing to occur. If you’re actively going through a divorce or you’re having serious work issues, we may say hey, our goal is gonna be just to dig out feet in and prevent us from sliding downhill, and we may not be able to gain a whole bunch of ground going uphill.

Evan Brand:  Well said, yeah, and I’ll also mention the electromagnetic fields which I’ve done–

Dr. Justin Marchegiani:  Oh, yes.

Evan Brand:  Countless podcasts on. I had a lady the other day. She heard a podcast about EMF that—that was on the show and she bought a meter online and anything above 1 milligauss, a measure of magnetic field is bad, right? And this lady had 50 milligauss in her bedroom. And so she lives in San Francisco. She didn’t believe it. She called the power company as I told her to do and they came out and they measured, and sure enough, it was about 25 or 30 milligauss. So her meter was pretty inaccurate, but it was accurate enough to detect a problem that warranted further investigation. And even the power company was like, “Well, this is insanely high.” I mean, you’ll see some people that say anything above 3 milligauss of magnetic fields which comes from power lines is—is bad, but either way, 20, 50, that’s insane and so she’s moving immediately and she said she hadn’t slept well for months and kinda like my story that you and I chatted about when I had to move. I was measuring 7 milligauss in my office and I feel like I didn’t sleep. So I mean, that’s another cause of adrenal hormone issues that you and I are discussing and talking about with people because it’s—it’s an invisible smoke, right? If you had glasses that you could wear and see this stuff, everybody would freak out. But it’s invisible. And like my friend Eric Windheim says, “It’s like fighting a ghost.” So you have to measure this stuff and—and mitigate it, and there’s more. We won’t go into more detail today, but just check out EMF in the search bar on the website, and you’ll be able to find, you know, more episodes.

Dr. Justin Marchegiani:  Absolutely. So we addressed the foundational pieces, diet, lifestyle, emotional stress, meal timing, nutrient density–

Evan Brand:  Environmental.

Dr. Justin Marchegiani:  Toxins from the chemical. Toxins are essentially—the electromagnetic toxins, right? That’s kinda in that toxin realm.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  We hit that. We talked about the hormones, ATM, ATF. And then next step is gut function/gut infections. Now typically when we start out with the diet piece, depending on what’s happening symptomatically, if we see a lot of reflux, a lot of bloating, let’s say we have a history of vertical ridging in the nails or we see a lot of undigested food particulate or the stool looks grayer or the stool floats or we have poor hair quality or very dry skin, these are all symptoms that we’re not digesting our food optimally. So to support the diet piece, we may bring some of the digestive support up forward, and bring it into intro phase. What I mean is we may bring in some of the hydrochloric acid, some of the enzymes, some of the bitters, some of the digestive support to help stimulate digestion because we see that as supporting the intro phase. We’re working on digesting foods and making sure that piece is dialed in. So that may have to be brought up forward because it’s—it supports the foundation. That’s number one. Number two is we have to knock out the infections. So as we look at body system two, we really break it down into 5 steps. So number one is remove the bad foods. Number two is replace the enzymes and acids like I mentioned. So that’s the digestive support to make the intro diet piece work better. Number three is repair and repair means repairing the adrenals because we have to make sure that piece is there. because we don’t wanna work on really healing the gut, until we have the hormonal environment dialed in to help reduce inflammation and help heal the gut lining and help improve IgA levels, which is the localized immune system in the digestive tract. We also wanna make sure healing nutrients are present for people that have extra gut inflammation or extra gut irritation. Things like L-glutamine and the healing nutrients, the licorice root, deglycerized licorice root, maybe slippery elm, maybe cat’s claw, maybe some gentle amino acids like L-glutamine, and Jerusalem artichoke, etc. These are healing nutrients that help that gut lining. Number four is the removing of the infections and we’re able to remove the infections most adequately because of the 3 phases before it. Because of the removing the foods, the replacing the enzymes and acids, the repair in the gut lining and the adrenals, now we can come in and we can start working on removing the infections, and the infections are gonna be specific to the stool test we recommend to pick up the infection. So the H. pylori comes back or fungus comes back or various multiple parasites come back, those all need to be specifically addressed with unique protocols for each. And then number five is going to be the re-inoculation with robotics, really receding all of the good seeds after the weeding’s been done. And then number six is gonna be the retesting to make sure one, infections are cleared and two, there are no new infections as last podcast talked about, making sure there are no resistant infections that were burrowed in deeper that are showing their ugly head, and the only exception will be adding probiotics in the repair phase. Because sometimes probiotics can have an anti-inflammatory effect, and depending on how bad the gut is, we may add some probiotics in the ref—the repair phase as well as the reinoculation phase to help support gut healing and inflammation.

Evan Brand:  Well said. I wanna speak just for a minute and see if you wanna add anything to it about the topic of antibiotic use and infections. There’s a lot of hate on the Internet about herbal remedies for infections, you know, whether it’s an M.D. or a naturopath or someone. You know, getting in an argument about saying, “Oh, herbs don’t work. You have to use triple therapy or this antibiotic or this antifungal prescription.” And there’s very, very, very, very few cases where it takes us more than one or two rounds to get rid of an infection using just herbs, no prescription. So could you add something to that conversation, too? I would 95% of patients can address their gut function and their got infections with herbs alone. 5% of the time we may have resistant bugs that we’ve treated, re-test, still there. Treated, retest, still there. Treated, retest, still there. And it’s 2-3 times and we’re not able to knock it out. But I’ve had people go and on the third time, we knock it out. So the antibiotics may be an option for some people. The conventional antibiotics that are typically run like the metronidazole, the Flagyl, which are the most commonly prescribed ones for these infections tend to miss the infection about two-thirds of the time. And then a lot of times the antibiotics prescribed for your typical triple therapy for H. pylori like clarithromycin, amoxicillin, and/or omeprazole like Prilosec, acid-blocking medications, tend to do the same kind of thing. They’ll miss the infections a third half the time.

Evan Brand:  Well, what about this, too? What about creating more resistant strains due to the antibiotics that have been so overused? Which then makes our job a little bit tougher because people have gone through rounds and rounds of this crap and it’s done nothing.

Dr. Justin Marchegiani:  Exactly. That’s the problem is you run the risk of having these antibiotics not work in the time where maybe you really need them, like you get in a car accident or you step on a—a rusty nail or some, some kind of infection that’s more acute and more severe based on the exposure of the microbes. So I’m always about conservative to invasive, right? What’s the most conservative type of care off the bat? It’s always gonna be diet. It’s always gonna be lifestyle. It’s always gonna be using antimicrobial herbal medicines that have been around for literally thousands of years to have a strong safety profile, to have the ability to use them long-term without resistance–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And also aren’t gonna wipe out a—as many other microbes, any other beneficial microbes the may be present that are helpful for your gut. We won’t wipe those out and create more problems. I can’t tell you how many patients I’ve seen that have been on antibiotics and had devastating side effects, and now we’re treating them from the damage caused by the antibiotics in the beginning. I’ve seen it so many times. Don’t see it with herbs though.

Evan Brand:  I know.

Dr. Justin Marchegiani:  But I see all the time with antibiotics so I’m always very conservative and we go up in—in gradations on what step one is. Herbs. Step two. Herbs. Step three. Maybe herbs. And then if we’re still having issues, then we go and we lean towards the antibiotics, typically on step three most of the time.

Evan Brand:  Yup, yup. Well said. And just the fact that this has been used, the herbs that we’re talking about. They’re been used for thousands of years before antibiotics were invented. To me that says something about the success rate and the safety. So when people read concerns about herbs. A lot of times the concerns are unwarranted unless you’re talking about mixing herbs with pharmaceuticals, like you know, 5HTP and SSRIs and stuff like that. Yeah, you can get into trouble. But generally, there’s really nothing to be concerned about compared to the tens and if not hundreds of thousands of people dying due to medical error. That’s now the third leading cause of death. Did you know that? Medical error.

Dr. Justin Marchegiani:  Wow.

Evan Brand:  So—so this—this is real. This isn’t something were just saying on our—on our high horse. You know, this is for real. Look at CDC death or medical top causes of death. You’ll see medical error and this is from the proper, you know, or this is the prescribed rather is what I meant to say, the prescribed dose of a medication is still causing third leading cause of death, is medical error.

Dr. Justin Marchegiani:  Yeah, I know. I know Barbara Starfield has her prized article in the Journal of the American Medical Association 2000, all on how much medications and surgical procedures done correctly, right? Hey, the surgery was a success but the patient died. Hey, the prescription was—was perfect according to what the patient’s symptomatology was, but the patient had an ulcer and died, right? Just like that happens with ibuprofen 19,000 times a year according to the New England Journal of Medicine. So we know there’s a risk with conventional treatments. So we wanna be as conservative as possible, so we don’t have to go to those type of higher risk procedures.

Evan Brand:  Agreed, agreed. Well said. So yeah, the infections are huge. I mean, Justin and I, we have more podcasts on that talking about our own history with infections. So not only are we in the trenches helping others remove them, but we’re doing it on ourselves, too. So this is—this is a huge piece and has been instrumental for me to get my—my weight back when I’ve lost, you know, 20 pounds of muscle from infections. So this is a real big deal in something that has to be addressed.

Dr. Justin Marchegiani:  Correct, and I think the key thing, too, is we’re not anti-medication.

Evan Brand:  Right.

Dr. Justin Marchegiani:  We’re all about using the correct tool at the right time, but also weighing the pros and cons. Like if we’re, you know, we got our tool bag on or our toolbelt on, right? And we have all these different tools in our tool bag, alright? And we look at this screw and it’s the flathead groove in it, so we know I gotta pull my Phillips head out, right? I’m not gonna look at that screw and be like, “Screw this, my dog must not gonna allow me to use this flathead, throw it away and then try to pull it—the Phillips in there and try to work it.” So let’s say it’s a—a flathead groove, I’m not gonna look at flathead screwdriver and throw it away, and say, “I’m gonna try using a Phillips, right?” I’m gonna go and say, “Well, this is the right tool for it. So I’m gonna put it in and I’m gonna use the correct tool based on what’s presenting itself.” That’s like if you get in a car accident, we’re not gonna look at the patient and say, “Great! Let’s just throw you on some turmeric right now and call it a day.”

Evan Brand:  Right.

Dr. Justin Marchegiani:  No. We’re gonna say, “Go to the ER. Get the correct test to make sure there are no fractures, no bleeds, no hemorrhaging.” You may even want to be on some higher dose pain meds. You may want to avoid the opiate ones, right? Because of the addiction, but maybe some higher those pain meds acutely just because you’re in severe trauma and pain. And then we’ll get you stabilized and then we’ll get you on a really good routine after. So we look at the right routine. If we see that flathead groove, we’re reaching for the flathead screwdriver. We’re not reaching for the Phillips.

Evan Brand:  Yeah, absolutely. And if you break your arm, yeah, you don’t go take a dose of turmeric and fish oil. I mean, you need to get that checked out and make sure there’s no internal bleeding, etc., etc. So there’s no trophy for—for trying to be a hero and dismissing the acute, incredible trauma medicine that—that is offered. You know, it’s just the things we’re dealing with, their 1, 5, 10, 20, 30-year chronic issues and that’s where functional medicine tends to have far superior success rates. You know, 90+ percent success rates that you and I both have.

Dr. Justin Marchegiani:  Exactly, and some of the things that are talked about regarding antibiotics, and I’ll put some of the research in the show notes, but antibiotics can create oxidative stress and mitochondrial dysfunction. That’s a big issue, so the mitochondria is gonna be the powerhouse of the cell which is gonna help generate ATP which is like the fuel currency for energy, and also creates oxidative stress which is just a way of breaking down your body, right? Oxidation, you leave a rusty nail in the rain, it gets all rust or you leave a nail out in the rain, it gets rusty because of that oxidation process. We have internal rusting. Doesn’t quite show itself like that, a brownish rust, but it happens—it happens internally and that creates a depletion of a lot of your antioxidant reserves. So your body has to use up more vitamin C, use up more vitamin E, use up more nutrients that would typically be used for other healthy functions. So oxidative stress and mitochondrial dysfunction are a side effect of some of these antibiotics use. So we really want to make sure if we’re using them—excuse my frog on my throat—we wanna make sure they are used appropriately for the right situation.

Evan Brand:  Well said. Yeah, and I’ll briefly mention, typically for body system two, we’re gonna be looking at comprehensive stool testing. We’ve discussed that. So whether PCR-based testing or otherwise, and then also the organic acids testing. So you hear us talking, maybe it sounds fancy, mitochondrial issues, amino acid metabolite problems, etc. but we can see and I see it all the time. Vitamin C levels, very, very, very low across the board most time on organic acids which is a urine test that you do at home and then you send that back to the lab and then we go over the results and then stool testing, you’re gonna be able to find infections. You’re gonna go through the protocol and then you’re gonna retest and the infections are gonna be gone. So that’s—that’s it for body system two. Let’s go on to body system three, Justin. So detox, methylation, making sure that people are able to actually do things at the end of the line. Once everything has happened, once a good digestion has happened, you’ve absorbed your minerals, your colon’s helping to produce vitamins for energy, your probiotics are doing the things they should be doing, now it’s time to get the stuff out of the body. We’re hoping the liver is gonna be able to do what it can do. We’re hoping you’re pooping, right? I mean, people buy all these fancy detox powders and teas, but it’s like if you’re not pooping but once a week, that’s a huge issue. That’s a great way to detox, poop and pee. How simple and revolutionary is that?

Dr. Justin Marchegiani:  100%. Poop, pee, breathing, and sweating. It’s like un—unreal. So looking at a lot of the detox things, certain nutrients are required to detox. So you can see why number three, why detox is put number three. Let’s just break that down so everyone can get the—understand the concept. Again in this show, we’re really committed to being able to teach concepts because if you get the concept, there’s zero memorization involved in it. Once you get the concept, it’s like riding a bike. You get back on—Boom! You never have to go to that learning curve of falling. So what’s the concept? So number one, if we’re poor foods and eating toxic foods, and foods that are nutritionally poor, what happens to detox? Automatically impaired.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Right? So why are we gonna work on detox off the bat? Because if we just get that first phase done, we’re starting to work on detox even though we’re not working on it directly, because it’s body system three, we already worked on it in the intro phase. Number one. Number two, we actually start breaking down the foods. That means we start breaking down the proteins into their smaller amino acid constituents and we know how important the sulfur based amino acids for operating phase 2 detoxification. Phase 2 is like the n-acetylation, hydroxylation, the glutathione production, the methylation, and we need methionine and we need cysteine and glutamine and glycine and taurine, and all these really important sulfur aminos, and if we can’t break down our protein constituents into those smaller products, you know? Ripping off the pearl necklace and pulling off the individual pearls, that’s what it’s akin to. If we can’t do that, we’re not gonna be able to run phase 2 and then frankly we need lots of antioxidants and B vitamins to run phase 1. So if we have SIBO or dysbiosis, well, our probiotic production internally from our gut bacteria is automatically forwarded or downregulated because we know good bacteria in our gut produces a lot of those nutrients for us, right? Good bacteria eats poop and poops nutrition, B vitamins, antioxidants, nutrients. Bad bacteria eats nutrition and poops poop. Bad bacteria makes you more toxic. So what is the more toxicity from the bad bacteria due to body system three? It decreases its function. So you can see how we lead up to diet and lifestyle. We lead up to digesting food. We lead up to healthy gut bacteria, knocking out infection, addressing the flora, because all of that sets the stage for body system three, so we can come in there and really support the nutrients that are missing, the pathways that aren’t working properly, and we can potentially even knockout specific heavy metals if we see heavy metals are in there with other types of chelators and compounds that pull the metals out. And some of the test we do—well, I’ll take a breath there, Evan. Any comments?

Evan Brand:  Yeah, I mean, well said. I wanted to mention this comes at the end because we want to make sure that everything else has been addressed upstream. I mean we’re not going to go straight to detox if we know that you have infections and we know that you’re still getting, let’s say artificial sweeteners in your diet which can be placing a burden on the liver, right? So we want to see the liver and your detoxification abilities, methylation, this includes anybody with like MTHFR genetic defects. This includes you, too. All that other stuff’s gotta be taken care of first because we want to see what the actual baseline is. Not the baseline when you are doing so much sugar and alcohol and bad fats and artificial sweeteners and all of that that’s got the burden on the liver. So once we get all that stuff out of the way, then we take a look at body system three. It’s the, “Oh, okay, so this is the true baseline,” and then yeah we can look for heavy metals, from dental fillings, amalgams, you know, bad food, bad water, too much tuna fish, other environmental exposures, and then we can start helping to get the detox system working better because if you’re not pooping well and you have an overburdened liver, you’re just gonna be recirculating all these toxins. So then you’re gonna get the joint pain and the allergies and the asthma, and the skin problems, the headaches, the brain fog, alcohol intolerance, I mean, we could go on and on but you gotta get all that other stuff taken care first, so if you go straight to detox or somebody tries to sell you on some detox protocol first when you don’t even know if you have leaky gut or not, I would be cautious and maybe you have more to say about that, but I don’t like the idea of pushing stuff out of people’s body if they don’t even have enough trash men to come gather all of the trash at the end of the road.

Dr. Justin Marchegiani:  Yeah, 100%. So we have everything lead up to it and I think you emphasized the whole leaky gut part right because the leaky gut as you mentioned is really the consequence of all of the inflammation, the inability to break down food, the compromised immune system, and then the infections. All of that will lead to leaky gut. So leaky gut isn’t necessarily a result. It’s more of an effect of all of the inflammation and the damage.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Right? The gluten, the bad foods, all of the inflammation. So that’s kind of the end product that you get there is leaky gut. So looking at everything that you mentioned. How do we quantify it? Because you put some really good points out there. How do we actually know what’s going on from the detoxification side? Well, we’ll look at an organic acid test. Typically as a good starting point because we’ll get a window into various detoxification pathways, whether it’s pyroglutamate or other types of organic acids, sulfate—these are organic acids that will give us a window into how those sulfur aminos are doing. If the demand for them is higher or if they’re depleted. And we’ll also get a window into B vitamin status. We’ll get a window into methylation and we’ll also get a window into oxidative stress by looking at the 8-hydroxy 2-deoxyguanosine for instance. Again, these are all like jeopardy words but these are organic acids that give us a window into all these systems, whether it’s simply xanthorrhoea for B6, whether it’s the amino acids for the brain with vanilmandelate or homovanilate or 5-hydroxyindoleacetate or whether it’s markers for gut bacteria like hippurate or benzoate. So these—these markers give us a big window into what’s happening and the organics can really help tell us what’s happening there from some of those detox nutrients, and we may even look at like a SpectraCell or a NutrEval as well. Again, I lean more towards the organics because that’s my baby.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  The NutrEval combines the organics with another blood test for nutrients, too. So that’s a—another side option which at least does contain the organics and that gives us a good window into what’s happening but we always go back to intro, body system one, hormones, ATF, ATM; body system two, the ability to digest, removing food allergens, healing the leaky gut, repairing the gut lining, removing infections, adding in probiotics, and retesting because we gotta make sure new infections aren’t there and the old ones are gone. Number—body system three is gonna be detox nutrients and that’s typically where we follow suit, and we reserve the right to kinda move some things in. Like if I know someone has a ton of oxidative stress, I may throw some extra vitamin C that we may discover on an organics test, I may throw it in with the adrenal protocol. So we do things and we mix-and-match outside of that box a bit, so if any patients are listening, they may think, “Well, Dr. J gave me some detox support in body system one,” and that’s gonna be dependent upon how that person’s presenting, how sensitive they are, and how bad their detox is. We may add some small things in with body system one, because maybe the adrenal support is too much for their liver, and we need to give their liver just a little bit of support so they don’t have a lot of those hormone side effects.

Evan Brand:  Totally, well said. I’m gonna mention two things and then we can wrap it up.

Dr. Justin Marchegiani:  Cool.

Evan Brand:  One for me on the organics, which I just love is the quinolinic 5-HIAA ratio–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Looking at inflammation because you could go on and on and sound fancy, but when someone sees inflammation and you’re like, “Look, here it is.” It’s like, “Oh, crap.” Because inflammation, you know, even a conventional physician is gonna talk about inflammation as a cause of disease, right? And so when we can actually prove that to a client or a patient, it’s incredible and it’s very profound to be able to do that and then whether it’s 3, 4, 6 months later when the retest comes, and you can see that that number’s gone down, it’s very, very rewarding for both of us, and lastly, the toxin piece, too, something that Justin and I have been talking about a lot and—and I’m running on—I’m running this test on nearly everyone I possibly can–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Including myself is the GPL-TOX so I can look at the toxic load because I bought a sauna based on my toxic load of insecticides, and this is not a challenge or a push test so even the sickest people, we don’t have to worry about doing any type of chelation which may push some stuff out. You just urinate in—in the morning in a cup and you send it off. And the cool thing is you can run it side-by-side with the organics, so it’s literally the same urine sample. All you have to do is spend a little bit extra investment to get both test run organics and GPL-TOX at the same time, and I had insecticide levels in my body that are known carcinogens that were higher than they should be. And so for me, this is a huge, huge, huge new realm of opening up this. Look, we know there’s detox problems. Let’s fix it, but what are we actually fixing. You know, that had always been the question, right? Ooh, there’s detox problems. Man, you got headaches. You got chemical sensitivity. You can’t handle perfumes, gas fumes. Look, here’s why. And oh, man, is there anything more fun in the world than this? I mean, I—I don’t think so.

Dr. Justin Marchegiani:  Yeah, I agree. I mean, it’s like we’re CSI detectives without all the—the murder and blood, right?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  We’re trying to put together the—the puzzle piece that’s really getting people’s quality of life back. So just summarizing those tests. We run the organics test. We run maybe the OAT, which is the—the Great Plains Lab organics. We run the GPL-TOX. We may run the NutrEval, the SpectraCell and then we have the heavy metal challenge test where we challenge, with a chelation compound, like DMPS or DMSA or EDTA to get a window into the toxic burden of metals because metals don’t want to stay in systemic circulation. They don’t wanna stay in the blood. They only go on the blood acutely in that first 24 to 48 hours, then they go into the tissue.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Whether it’s the brain or the individual tissues or even bones when it comes to lead. So we gotta get a window into it so we have to do a challenge, a provocation agent that can go in into the tissues and really kinda pull things out. It’s like, “Hey, you go outside. You look for bees. There may not bees swarming around, but if there’s a beehive there, well provocation agent’s throw rock into the beehive, right?” You know those bees are in that beehive when those—when that rock hits it and those bees come out, that’s the provocation agents. So we use that same kind of methodology with the heavy metal test. The rock is like the chelation compound that we use to see what’s coming out in the urine and a lot of times we see aluminum, we see arsenic, we see cadmium, and we see a whole bunch of mercury and lead, and it’s different for each person.

Evan Brand:  Yup, absolutely, and then you got blood metals, too. Quicksilver’s Blood Metals is cool.

Dr. Justin Marchegiani:  Yup.

Evan Brand: There’s the Mercury Tri Test, too, for hair, blood, urine. There’s so many different things out there. A lot of them are good. A couple of them are bad, but you know, we’ll help you to make the distinction what is right for you and this is case-by-case. Some people they may not need to investigate metals. Other people they’ll come to us and they’ll say, “Evan or Justin, man, I got metal problems.” And they just have a gut feeling and in those cases, I say, “Okay, cool. Let’s get you checked out.“ It’s not gonna hurt. It can only help you to investigate. So if you have a gut feeling and that gut feeling can be disrupted obviously if you have got problems, right? Because the inflammation in the gut, you might be getting mixed signals, but if you have a gut feeling, ask us, and let us help you to investigative. If it’s something we didn’t bring up yet or maybe it’s early in the game and we wanted to do it later, just bring it up because you never know. You could be onto something that we just haven’t got to yet and that may save us, you know, a month or two of—of time.

Dr. Justin Marchegiani:  Absolutely. And again, we’ll the show notes for everything, the full transcription, again in my new Thyroid Book that will be coming out very soon, just putting the finishing touches on it, we’re gonna have a chapter in the book all on this type of discussion, putting it all together because I feel like this is probably one of the key pieces that most functional medicine practitioners and doctors really, it—it’s very esoteric. It’s kind of in the ether. Like how does it all look?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Like what does the whole plan look like? And it just kinda like, you feel like almost like they’re making it up as they go and I think is really important if you’re gonna hou—you know, you’re gonna hike Mt. Everest so to speak, I wanna see that map. I want to know how we’re gonna go up there. I wanna know how we’re navigate that crevice and—and get across that—that ledge or that cliff. I wanna kinda feel like it makes sense when we get directions. So I think that’s a really important piece that we’re adding, is that clarity and that, you know, what’s our fu—future pacing vision? How are we getting to the top?

Evan Brand:  Yup, amen.

Dr. Justin Marchegiani:  Anything you wanna add there, Evan?

Evan Brand:  I don’t think so. I think this was great and fun as always, real honor. If people want to schedule, go to justinhealth, J-U-S-T-I-N, Justinhealth.com to schedule with Justin. If you want to schedule with myself, go to notjustpaleo.com and like I said, we both block out a few hours, so you know, if there’s a spot available, you wanna grab it for the 15-minute free call. See if we’re a good fit, you know, discuss your options together. Justin and I are happy to do that and we look forward to helping you all out. You know, listening to this is one thing. Getting in the trenches with us is another, and I mean without functional medicine, I would likely still be dealing with depression and irritable bowel syndrome and skin issues and fatigue and insomnia and adrenal problems. I mean, every aspect, everything that could’ve gone wrong was wrong in my body systems and just one by one, plucking these things off the list, and there’s never a finish line, right? I mean it’s always a continual journey. So you’re just always pushing to the next step ahead and this is your time. You know, you don’t have to suffer.

Dr. Justin Marchegiani:  Love it. I appreciate the hope and the inspiration, Evan.

Evan Brand:  Yes, sir.

Dr. Justin Marchegiani:  Great chat. Great chat. Look forward to chatting with you very soon.

Evan Brand:  You, too. Take care.

Dr. Justin Marchegiani:  Have an awesome day!

Evan Brand:  You, too. Bye.

Dr. Justin Marchegiani:  Bye.

The right path for treatment in your functional medicine program – Podcast #89

Dr. Justin Marchegiani and Evan Brand talk about their sequence of care in today’s podcast. Find out why they do things in the order in which they do them and discover the specific reasons why. What is the underlying philosophy behind it and why is it important to do them that way? 

functional medicine programOnce again they put an emphasis on getting diet right to begin with, followed by sleep and lifestyle. They also discuss in depth about how body systems work. Dr. Justin also describes his 5R approach in this interview. Listen and get some valuable insights on how detox programs really work and why some people may have undesirable experiences.

In this episode, topics include:

01:02   Functional medicine practitioners

03:20   Emphasis on the diet piece

07:33   Body system one

16:16   Body system two

21:32   Body system three









Dr. Justin Marchegiani:  Evan Brand, it’s a beautiful day in Austin, Texas. How is it out in Louisville?

Evan Brand:  It’s great today. My wife’s like, “We have to get outside. All the dandelions are popping up. It’s like 65 and blue skies,” so for this time of year, I can’t complain.

Dr. Justin Marchegiani:  That’s great. I was over in Lake Austin yesterday, water skiing for about 3 hours and I’m really sore today. Water skiing is like the ultimate full body support—or—full body support. I was in a wet suit yesterday, but I just was thinking back because I was out there in January without a wet suit.

Evan Brand:  Geez.

Dr. Justin Marchegiani:  Talk about cold thermogenesis. I mean, amazing though. It feels so good.

Evan Brand:  That’s great.

Dr. Justin Marchegiani:  Well, what do you wanna talk about today? I think we—we have a couple ideas here, but one of the things that our patients have been asking about and we used to kind of talk about it as well is the sequence of care. Why we do things in the order in which we do them and why—like what’s the underlying philosophy behind it and why is it important to do it that way?

Evan Brand:  Exactly, yeah. So a lot of different practitioners. There’s so many these days. The holistic health field is growing, which makes you and I happy because we know that more people are gonna get helped. But at the same time on top of that, people are coming in with these different treatment modalities and they may all be great, you know, like acupuncture’s great, acupressure’s great, you know, homeopathy may be awesome for you, you know, who knows? But a lot of times, we’re sharing people that are going to these different practitioners and they’re just getting some type of approach that may not work and there’s many reasons why it may not work. Maybe it’s not backed around as much science as some like the salivary testing where there’s like 12,000 studies on that you and I use, or maybe they’re getting the treatments in the wrong order which is something that you and I wanted to talk about today. I think you and I already discussed this story before but what kinda led us in to having this discussion today is a female patient of mine who’s 24 years old. She went to a naturopath for her stomach issues. She had already been the conventional route with the gastroenterologist, and no help. They did the endoscopy and everything, no help. So she went to a—a naturopath and she got thrown on a probiotic and her symptoms got worse. So her stomach was even more distended and her bloating was worse. Her abdominal pain and cramping was worse and she got thrown on this probiotic and she just continued to—to fall apart. And so I asked, “Well, was there any type of lab work done? Was there any investigative tools used on? You didn’t check for SIBO or other sorts of issues?” No, nothing. And so we run a couple of tests and finds out she’s got some major overgrowth in the gut and so we pulled out the probiotic and then start with the treatment and then she’s better and then we’re gonna revisit the probiotic but it’s gotta be in the right order and she’s feeling much better and she’s been struggling for 7 years. And you tell me this all the time, there’s people—we’re basically the end of the rope, for most people. We’re the end of the line.

Dr. Justin Marchegiani:  Absolutely. Most people don’t realize that there needs to be a certain order in which we do things. And one of the things that I think separates us from most functional medicine providers, especially the medical functional medicine, like the medical—MD functional medicine doctors is that we have a really strong background in nutrition and lifestyle. So one of the things we emphasize is get your diet right. And that’s gotta be the first thing. Now most people that I think comes, yes, because you’re the Not Just Paleo guy is you got a lot of people that have already gone Paleo which is great. That means they’ve enhanced they’re macronutrient ratios. They’re increased their macronutrient quality, meaning they’re buying higher quality protein, grass-fed meat, organic. They’re eating, you know, low mycotoxin foods. They’re avoiding the grains and the refine sugar. So we have that piece dialed in which is great and then we also have some of the lifestyle principles which you did a couple of books on. You did your—your REM Rehab book and then your Stress Solution all on these diet and lifestyle things, like the—the forest bathing, like the sleep hygiene, like all these really important things that need to be there to help everything work, because they have a really great effect on reducing inflammation. So if we get the inflammation reducer button hit on the lifestyle piece and we get the inflammation button hit on the diet piece, that sets us up to how we deal with the patient in the functional medicine realm. So why don’t we just touch upon the diet and lifestyle piece before we go into the functional medicine and our—the body system approach?

Evan Brand:  Sure. So that’s always gonna be the first step and like you alluded to already. Most people that are coming to—to you or I, they already have some type of diet in place, so whether it’s Paleo, whether it’s—maybe it’s because of us, I don’t know—Autoimmune Paleo is–

Dr. Justin Marchegiani:  Yes.

Evan Brand:  Very common. A lot of people are already on that diet, but yet they’re still struggling. So I would say about 95% of people that I work with are people that already have been on a Paleo or some type of whole foods diet, Bulletproof diet, something similar for a period of time, you know, some people 6 months, some people 6 days, some people 6 years, and they’re still struggling. So that’s why I look at it and it’s important to have that in place. You gotta have the nutrients. You gotta have your good fatty acid balance, your minerals, your hydration’s key, making sure you’re getting your Omegas, all of that, and that can all be counteracted by a bad lifestyle though.

Dr. Justin Marchegiani:  Right.

Evan Brand:  So if you’re eating Paleo but you sit in Los Angeles traffic for 4 hours a day and you just—you white knuckle it every time you’re on the highway–

Dr. Justin Marchegiani:  Right.

Evan Brand:  That’s gonna counteract it. So for me, the diet I look at it, and to me, I don’t really—I know this sounds weird—I don’t really get that excited when I see someone has the perfect diet anymore, because a lot of people have what I will consider a really good diet, but they’re still struggling. So it’s like, “Okay, good. That’s there, but you’re still not healthy. You’re still not—something’s not right.”

Dr. Justin Marchegiani:  And I think one of the things that’s helped me out in my practice and I think you would agree is doing the podcasts and doing the blog post and the YouTube videos, we’re kind of educating patients by osmosis to begin with. So they have this foundation that’s so deep and the bigger their foundation, it’s like, you know, versus giving them a shot glass to pour information in versus this big bucket. So now they have this bucket so we can start dumping information whether it’s lab test or supplements, we’re going deeper into special kinds of diets where most patients they come in to your regular run-of-the-mill natural practitioner, they got a shot glass, they’re still eating the standard American diet and you just talked to them about cutting out sugar a little bit and it’s like, their cup is already, you know, overflowing if you will.

Evan Brand:  Yeah, that’s a great point. I didn’t think about that. A lot of people do say—I’m sure you get this every week, too—yeah, I heard the latest podcast on this, and it’s like, that’s so exciting. In between consults, we’re already working on you but you’re still wanting to dig deeper, you’re still wanting to gather more information, and maybe it is information overload at a certain level, but either way, I’d rather you have too much information than not enough because that’s gonna prevent you from struggling.

Dr. Justin Marchegiani:  Right, so we kinda already touched upon the diet piece. A good Paleo template, where we’re cutting out the pesti—the pesticides, the GMOs, we’re avoiding the grains, the refined sugar, and the common food allergens like what you see in an autoimmune Paleo ultimately start, right? The grains, the conventional dairy, the soy, the legumes, maybe even the nuts and the seeds and the nightshade veggies and the eggs for certain people, and then we kinda introduce them back in. That’s kinda there and then we have the sleep piece where getting to bed before 11 to 10:30, getting good quality sleep and if you want more on the sleep hygiene, you can see previous podcast or checkout Evan’s book, REM Rehab.

Evan Brand:  Yup, thank you for that.

Dr. Justin Marchegiani:  Little plug there for you.

Evan Brand:  Thank you, sir.

Dr. Justin Marchegiani:  Let’s transition into the body systems now—now, one of our mentors is Dr. Dan Kalish, great guy, amazing clinician. Most people out there that talk about functional medicine, it’s sad to say that they aren’t actually in the trenches seeing patients. Got a great relationship with Dr. Dan and he has been seeing patient for 20-25 years, over 10,000 patients so he has a perspective that is very unique. It’s not theoretical—it’s a theoretical with a clinical application of hey, does it work or does it not? So we like that, and I know you’ve—you’re creeping up over a thousand patients in your lifetime, I’m over—I’m into a couple thousands so far so we have a lot of patient experience which is great. Now we find that one of the most important things, once the diet and the lifestyle piece is there, what’s the next piece? And we find the hormone—the hormone system tends to be best. Now that’s ATM, not the place where you get your money, but adrenals, thyroid, male hormones for the men. And then ATF, not alcohol, tobacco, and firearms, but adrenals, thyroid, and female hormones for the women. So that’s kind of our body system one approach. Now some people the thyroid and the female hormones are more important than the adrenals and vice-versa on the adrenals for the others, that’s where the functional medicine testing is amazing because we can line them up side by side, and see, “Hey, where’s your thyroid at? Do we have low body temp? Is your Free T3 below 3? Is your T3 total below 100? Or do you have low DHEA below 2? And with a cortisol sum low beneath 23? Or does your progesterone around 18-21 go below 200 pg/ml?” Right? So we can look at all these things and hold them up side by side and compare them. Any comments on that?

Evan Brand:  Yeah, well, it’s just amazing to me, this—this not that complex really. Once it’s dialed in and once we’ve created this system to it, it’s really not that complex but it’s so often ignored and the adrenal test for example, just looking at these hormones, it’s such a revolutionary thing because you and I both speak with people who’ve been to every specialist doctor in the country but yet they’ve never had an adrenal profile run for example. And then it blows my mind because then they get put on these different drugs or hormone creams or different therapies, but if they just looked at the body system and saw that they needed to be put on an adrenal program, they could have avoided all the side-effects and symptoms and things that now we’re trying to clean up the mess from.

Dr. Justin Marchegiani:  And it goes that way with the gut, too, just like you connected with the adrenals. I just did a YouTube video last Friday on a patient that just came in—all kinds of gut issues, ran just a conventional blood test, but we saw a whole bunch of immune markers off. To me, interpreting it from a functional medicine perspective, we’re like, “Hey, there’s some infections here.” Doctor said, “Nope.” You’re fine. We run our test and she hid the Three Amigos which is my slang term for Blastocystis hominis, Giardia and H. pylori.

Evan Brand:  Oh, man.

Dr. Justin Marchegiani:  Three major infections and there was a subclinical anemia as well because of malabsorption and because of excessive bleeding around menstruation. So go figure, but in the conventional medical world, she was fine and what we see when patients come down that path, it’s once they’re told their fine, it’s just a little bit while longer before they tell you it’s all in your head and they either recommend an anti-depressant or they put you on a birth control pill and/or an acid-blocking medication to stop the symptoms. I mean, that’s typically how it is. Me and you have seen it with hundreds of different patients and they get that same kind of response.

Evan Brand:  Oh, yeah. And that was actually the discussion I have with a male in his 50s this morning. Just turned out he has Klebsiella as well as H. pylori, but yet he’d been seeing this psychiatrist for—I don’t know—5, 10 years and he was diagnosed with depression, but he says, “Evan, I can track it to when I went to China and I got food poisoning.”

Dr. Justin Marchegiani:  Bingo.

Evan Brand:  And I was sick for multiple weeks. I lost 20 lbs from all the diarrhea and he just like brought that up and I was like, “Oh, my God.” I said, “We need to get a stool test run on. I can’t believe that we haven’t got there yet.” You know, and so there’s the answer. It’s just—if that’s ignored, you’re gonna get a drug and it’s not gonna fix—I mean the depression is not gonna be fixed with, I don’t even know, what do they use? Lexapro? I can’t even think of the names of them now.

Dr. Justin Marchegiani:  Yeah, it would be like an SSRI.

Evan Brand:  Like a Paxil.

Dr. Justin Marchegiani:  Yeah, or an SNRE or it would be like an old tricyclic anti-depressant. Those are the typical mechanisms. Basically what they do in a nutshell is they allow the serotonin or dopamine to accumulate between the pre and post synaptic neuron, between where the neurons meet, because it’s the neurotransmitters that act like the bridge that connect the action-potential neural impulse from pre to post, and it just allows it to accumulate more between that synapse. The problem is, the more it accumulates, the more the enzymes are upregulated to break it down, thus creating a deficiency in the long run, and guess what happens to that dosage of those medic—medicines over the long term?

Evan Brand:  Yeah, they got–

Dr. Justin Marchegiani:  Do they go up or down?

Evan Brand:  Gotta keep going up.

Dr. Justin Marchegiani:  They gotta keep going up and when the medications go up, what do you think happens to side-effects?

Evan Brand:  Definitely increases.

Dr. Justin Marchegiani:  That’s—that’s why the world needs functional medicine.

Evan Brand:  I agree. It’s scary. It really is when you think about that, because you look at the timeline here and the dosages do go up. You know, it’s whether a 5 to 10 to 10 to 20 and you’re just chasing the dragon there for a bigger hit and it doesn’t work. So now thank the Lord we found this.

Dr. Justin Marchegiani:  Yes.

Evan Brand:  And now we’re gonna fix it, and he’s gonna feel better. I told him, you know, I legally can’t say that you can stop these anti-depressants but if it becomes a side-effect that you’re just so healthy that your brain works again, you know, that’s a conversation to have with the psychiatrist that you’re feeling better, so–

Dr. Justin Marchegiani:  And when we fix these things, we’re always working in conjunction with the prescribing physician, either letting them know that the patient’s gonna be reducing and the patient has to make that call themselves and/or with the doctor and we just let them know what’s going on and the doctors working with the patient, we never wanna do it without the prescribing physician knowing. We just wanna mitigate the side-effects. We wanna make sure there’s a support system present so if we have a side-effect—boom—the doctor who’s prescribing it, who knows that drug the best or the most can curtail the dosage to make it last, because when we have side-effects, it’s typically because the person’s getting healthier, there’s more substrate in the brain to relocate, right? Because if we have more building blocks that can be told where to go, then we could hit that saturation point and have side-effects. So typically those side-effects are just mitigated by tapering down the dose, and that’s where it’s great to have a good prescribing physician in your corner so they can take responsibility of that piece and dial it down.

Evan Brand:  Right, and that’s a good distinction to make. It’s not that we come across this, you know, anti-MD. You know, neither of us are MDs, but we do still respect and use them for when we need them, but they’re just not the ones that are gonna help get to the root cause. They’re just there to help kinda keep an eye on the situation and monitor things, and a lot of times, it’s sort of well, I don’t know what you’re doing with those crazy silly amino acids, but keep doing what you’re doing because it’s working, you know?

Dr. Justin Marchegiani:  Exactly, exactly. So we kinda outline what we’re doing with body system one, which is ATF or ATM. The diet’s already lined up. The lifestyle’s already lined up. Now we talked about some of the gut stuff, so the gut’s the next piece because we know if there’s a leaky gut, our immune system’s gonna be in—in overdrive, that’s number one. Because undigested food and/or bacteria or biotoxin particles from the infection will get into the blood stream and that can cause molecular mimicry where your immune systems are attacking other tissues that look similar, number one. Number two, it’s gonna create immune stress. It’s gonna make your liver have to work harder to filter out these antigens. Antigens meaning foreign proteins or foreign compounds in the body, and then number three, we’re gonna have malabsorption, right? Because we’re not gonna be able to break down and ionize our minerals, our iron, our calcium, our magnesium, our selenium, our zinc, these important compounds that help our mood and digestion and hormones. And then eventually we’re gonna have macronutrient issues where we’re not gonna be able to absorb protein and fats and then there goes being able to make healthy hormones to help reconstitute our lipid bilayers and which is—lines every single cell, help raw material for our brain health, and then we create inflammation and then inflammation drives brain fog and mood issues and more hormone issues, so you understand now, the sequence is the body system one, the hormones, then the gut second. And now we can deviate from time to time, and I don’t think it’s worth going into the exact reasons why we deviate because it maybe is we call like a one-percenter or five-percenter, so 90-95 to 99% are gonna follow into that 1, 2 to 3 approach just because of how people predictively break down as they get sick and inflamed.

Evan Brand:  Yup, so are we still on body system two?

Dr. Justin Marchegiani:  Yeah, two.

Evan Brand:  Ok—okay. So it finally made sense for—for myself and this guy after he heard our podcast with my—about my parasites, he looked at his fingernails and he sent me an email with a picture of his fingernails. He had super intense vertical ridging across his nails and so we knew there was some type of dysbiosis going on there. So, you know, in his case, you know, it was caused from these bacteria but you all listening, too, you know, it could be yeast, too. It could be some candida stuff. It could be parasites. All of these things are going to tie into the same body system. So just because you hear that and you think, well, I don’t have a bacterial infection, that’s okay. There could be a parasitic infection. There could be a yeast overgrowth, too. You could have blood sugar issues on top of that, meaning that you’re basically going to have cortisol spikes and crashes, which are gonna further contribute to leaky gut, and so it doesn’t really matter what your struggling with generally this net that we’re casting for body system two is gonna be able to catch whatever type of dysfunction is there and how that actually manifests, there’s a lot of things that can go wrong but generally they’re gonna show up all in the same place as we investigate number—body system number two.

Dr. Justin Marchegiani:  Right, and one of the things that I say that really irritates some of my patients is they come in, they go, “I think that it’s the yeast that’s causing the problem” or “I think it’s adrenal fatigue,” and I say, “You know, Sir or Ma’am, you have the right to have more than one problem.” So a lot of times it can just be one issue that we resolve that one issue and it’s like—boom—you know, life breaks on marble head if you will, or it’s 10% here, 20% there, 15% there, or maybe 30% there. The gluten, the sleep, oh, there’s infection, there’s dysbiosis, there’s yeast, there’s detox issue, there’s nutrient issue. And then it’s like, boom, they all combine up and then it’s like, you know, we say have this great clinical outcome where the patient gets better over a 3, 6, 9, 12 or even maybe a—a 2-year type of sequence depending on how sick and how long they were sick to begin with.

Evan Brand:  Yup, that’s a great way to put it. There’s never one—the way I always say it is there’s never one thing that’s gonna make you or break you. It’s gonna be a combination of about a thousand different factors. So if you think, “Oh, it’s this one cookie.” That one cookie is maybe not gonna kill you, if it’s a gluten-free cookie, but if you’re eating those every night, that’s gonna take 5% away from your energy because your blood sugar’s gonna crash while you’re sleeping, and then the 5% of you doing too much coffee and skipping breakfast, because you know, everything is factored in. So every bite or every decision is sort of going to swing the pendulum or swing the teeter-totter or however you wanna look at it.

Dr. Justin Marchegiani:  Right, right. So we kinda talked about the gut stuff, right? And all the different elements, the leaky gut, the food allergens, the extra toxicity stress, the immune stress, also 70-80% of your immune system’s in the gut. So as soon as we start having immune stress, well, it’s really close to home, right? So where there’s fire—you know, where there’s smoke, there’s fire and where there’s stress close to home, it’s going to affect your immune system.

Evan Brand: Yup, so the whole microbiome in there you’re referring to is very common for people to talk about it now. It’s very common for people to just jump on probiotics or jump on other sort—some sort of bacterial support, but there is an order to the—to the method.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And if you just jump on it because you heard on some podcast that it’s good to take something, you may wanna make sure you’re doing it the right order.

Dr. Justin Marchegiani:  Yeah, and our—our sequence that we use for gut infections, something that I—I kinda tweaked over my—my tenure here, but it’s the 5R approach and we’ve talked about it in my other podcasts but one, first R is remove the bad foods. Second R is replace enzymes, acids and bile salts so we can break down the food. Three is help repair which is healing nutrients, adrenal support, and/or potentially probiotics because probiotics can have an anti-inflammatory healing, repairing effect. We don’t do it all the time in the repair phase, but sometimes we do. The fourth R is remove the infections, that’s the second remove. Notice why it’s not the first. Most doctors do it in the first, big, you know, clinical mistake there, well—we’ll give you a Paleo demerit on that one. And then the fifth R is the reinoculate, but again like we said, we may do some of that in the repair phase but 90% of the time, it’s gonna be in the reinoculation—reinoculation phase. So remove, replace, repair, remove #2, reinoculate.

Evan Brand:  I just wanna hit and repeat on what you said because that’s really profound. Most people, they’re going to find something. So let’s say you do go to someone that does run similar testing and they do find an infection, what Justin is saying is, we’re not necessarily going to come after that right out of the gate because you may not be ready for it. You may—you may not be strong or stable enough, so he’s saying let’s get you healthy first. Let’s remove all the things that are making you sick in the first place. Now that you’re ready and you’re toughen up and your defenses are prepared and you know, you’re flexing your muscles and you’re strong, now we’ll come in and address it. But if it’s in the wrong order there, that’s why you may be ridden with symptoms and so we try to keep the side-effects to a non-existent or extremely low level and that’s the way to do it, is just do it in the right order, make sure you’re ready for it.

Dr. Justin Marchegiani:  Exactly. And then that kinda transitions to body system three, where that’s our—our detox and/or nutrient type of programs, our detox and—and our brain programs tend to happen there. We also may add in probiotics there, too, because typically once we hit the fifth R, we’re done with a lot of the gut killing and then we graduate the patient as long as you’re doing good to that body system three where we use a lot of detox support and a lot of time it’s geared based on the Organix test that we run. A lot of time we’re adding in extra nutrients that we may find on the Organix test. We may add in extra nutrients with the adrenals or with the gut, and we kind of add them in as a means to support the adrenals and to support the energy systems in body system one, but there may be some nutrients we wait and we hold off, and add it in in body system three to help support detox, to help support reinoculation, to help support the brain and/or neurotransmitters. So we kind of—this is where the clinical art comes in where we have these body systems one, two and three that are very linear, but then you know, what stuff do we wait and hold off on, and what stuff do we add in to support one or support system two or we wait til the end to support three, but the nice thing is we have the date for each system and then we can look at the clinical outcomes of you know, the thousands of patients we’ve seen in the past and then we can interject it, what will be best for the patient and then we can outline options of hey, how fast do you wanna get better or how slow do you wanna get better? And then we can hit the gas pedal of success accordingly.

Evan Brand:  Yup, so body system three, once again, not selling a broken record but this is where most people start. They’ll put you on some detox tea or a detox shake, or a detox program and you’re just coming from maybe a conventional diet, maybe not, maybe you have everything dialed in, and you just skip over hormones, you skip over adrenals, you skip over the whole GI system, and now you’re on some detox cleanse and you’re feeling awful. You feel like you have the flu and you have no clue why. Well, here’s your answer. We haven’t revved up the other systems to make you able to do this so you know, if you’ve had bad digestion for such a long time and you’re filling up your body with free radicals, you got a toxic load in there and you’re not ready to just dump all a whole bunch of supplements in to help you detox because you can’t handle it. So maybe somebody, you lived in a toxic house, you can’t just go straight into detox, you gotta check everything else, too, because there’s an order. So–

Dr. Justin Marchegiani:  There is. Now it’s one of the other pieces we gotta be very careful of is the heavy metals because a lot of doctors wanna jump on heavy metal programs right off the gecko and this is a big, big mistake. Even when we do detox programs, we’re typically doing either in conjunction with detox program or doing it after a, you know, our chemical-based phase 1 or phase 2 detox because one of the main mechanisms of detoxifications is the gut, the hepatobiliary system. That’s the liver shooting out toxicity and bile salts to the gallbladder and then spitting it out into the gut an then having good transit time to eliminate that stool. So if we don’t—if we have any gut issues still lingering and they haven’t been dialed and addressed yet, we’re screwed because now we’re gonna have what’s called autointoxication where we reabsorb a lot of these compounds. So we gotta make sure the gut is so dialed in, the diet’s dialed in and this is—I would say at least 99% of the time. There may be a scenario where you get some type of acute environmental toxicity, you break a thermometer crap, you know, or you know, mercury one, or you get exposed to something really bad environmentally. You see your kid chewing on some lead paint or something, then you may wanna go in and start doing a chemical detox right away because it’s acute. But most people, it’s a chronic issue, so for the chronic issue, you really wanna lay out the 1, 2, 3 approach and then wait deeper into the body system three phase before we bring out some of the—the more powerful chelators to help pull down some of those toxic metal loads.

Evan Brand:  That’s a great point. So I’m gonna paint a little picture or a story and correct me along the way if I’m wrong.

Dr. Justin Marchegiani:  I just wanna—I just wanna make you’re not eating that paint.

Evan Brand:  No, I’m not eating the paint.

Dr. Justin Marchegiani:  It’s gonna be lead paint that you’re painting.

Evan Brand:  No, it’s gonna be zero VOC paint.

Dr. Justin Marchegiani:  Just checking.

Evan Brand:  Alright, so let’s bring—we’ll Sally into the picture. She’s 45. She’s busy working. She’s looking towards retirement but she’s got all these symptoms so she knows she’s gotta keep working away and make the money and buy all our good food and all of this. So she’s stressed out so she’s dumping magnesium from her body. She’s burning through it like jet fuel, so now she’s dependent on a couple cups of coffee per day and she just doesn’t feel right. She’s got this fatigue. Four o’clock hits, her brain’s not working. She’s tired. She’s exhausted. She’s got some excess belly fat she wants to get rid off. So she’s gone through all these programs out there, here’s the detox stuff, here’s et cetera, et cetera, but we look at the next system. She’s constipated, you know, she’s not even going poop once a day, not even that often which is not good, and then she goes and she does the detox shake and she feels awful, like you mentioned, if you have all these little chinks in the armor across the systems, your—your results are gonna be limited. So if she’s constipated, like you mentioned, you’re not gonna be able to flush out those toxins. So here you are releasing toxins. You’re opening up these pathways, right? In the liver, but yet there’s nowhere for them to go, so you get worse. But let’s say we look at her adrenals, get them dialed in, adjust the rhythm as needed, get her pooping normally so she can get the toxins out, heal up the leaky gut, get rid of the parasites, get rid of the infections if they’re there, then move into detox and getting the brain turned back on, making sure the neurotransmitters are working the way they should and that she’s methylating and she’s getting all of her B vitamins and her antioxidants and all of that.

Dr. Justin Marchegiani:  Bingo.

Evan Brand:  So–

Dr. Justin Marchegiani:  Bingo and I wanna say one more thing, too, with that is that when we talk about detox program or detox support, I wanna just make sure people aren’t under the—the misnomer that you aren’t doc—you aren’t detoxifying outside of the program. You’re always detoxifying. It’s just the question to what degree are you detoxifying and then we know that stress burns through nutrients and a lot of the nutrients needed to detoxify are gonna be sulfur-based amino acids, antioxidants, B vitamins and a lot of nutrients and these things get burnt up under stress and they get burnt up with malabsorption and gut stress and dysbiosis. So we’re talking about enhancing detoxification naturally via indirection mechanisms by style, sleep, diet, digestion, gut and then in body system three when we talk about detox, we’re talking more about a punctuated upregulation of these pathways via specific supplements to upregulate the antioxidants, the sulfur aminos, the extra Bs, the methylation like you talked about, Evan, and all the extra nutrients that may be missing you will know on lab test.

Evan Brand:  I love that, yeah. It just doesn’t sound as sexy as like a skinny tea–

Dr. Justin Marchegiani:  Right.

Evan Brand:  That you’ll see promoted online. But our skinny tea, detox tea, no. An upregulation, I mean, you’re detoxing every day. Hopefully, you and I are slightly detoxing right now from our breakfast or lunch today, you know, that’s the goal.

Dr. Justin Marchegiani:  The best thing you can do to detoxify is eat protein, alright, make sure you’re digesting that protein—high quality protein, right? Grass-fed meat, if you can handle whey protein, that’s an amazing source of sulfur amino acids, if not pea protein; if not, other high quality grass-fed or pasture-fed meat. Drinking enough water. My friend and colleague Dr. Robert Rakowski, the solution to pollution is dilution, say that ten times fast, and then get sleep. These are simple things. Now after that, this is where we kinda like, you know, we’d roll up our sleeves and we get all functional medicine fancy on you and we break out some of these more specific programs but foundation first, because no matter—the higher you wanna build meaning the more intricate you wanna get, the deeper that foundation has to be. Just like building a hotel. They go so deep down for the foundation so we wanna have that foundation so deep, so we can pile right high on top of it.

Evan Brand:  I think of a tree rather than a hotel, big root system. I was in the woods yesterday. This tree had fallen over I guess from all the storms that we’ve had.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Its root system was literally, I mean, so the tree was on its side and the roots and the dirt were all popping up, it had to be 12-foot tall. That, I mean, I was—I was reached all the way up and I could not touch the top of the root ball and it was a massive tree. And so you think, “Man, that’s what it takes to hold something that big up.” So–

Dr. Justin Marchegiani:  I love that, and let’s just stay on that analogy with the tree, because this is one of the things that I hit my patients over is the tree analogy, is that most people, they’re in the leaves, right? The leaves are all the different symptoms, okay?

Evan Brand:  Okay.

Dr. Justin Marchegiani:  Where it’s pain or fatigue or mood, and then a lot of conventional or I should say, not so good nutritionists or not so good functional medicine doctors, they’re in the leaves treating the leaf. “Oh, well, this is a zinc issue, or we’re—we’re gonna do this herb for that and we’re gonna give this for that,” which is okay, as long as we have the right perspective that it’s palliative, not root cause. So as long as we can differentiate that’s fine, but then now where the—the really good nutritionists and functional medicine doctors go is they trace the leaves back to the branch. Great, we start making sure that branch is being addressed and then the even better ones go to the limb and the limbs being all the things that we mentioned—the systems, the diet, the lifestyle, and then we go right back to the tree trunk, the base, that’s where the core things that we’ve already mentioned in our foundation analogy have to be there. So we have the trunk, we have the limbs, then the limbs branch out into branches and then the branches branch out into leaves. Hope that makes sense.

Evan Brand:  Yeah, it does. So I’m gonna read just a little piece of the definition of palliative care just because I didn’t fully understand the full definition, so it focuses on providing patients with relief from the symptoms, pain, and physical stress and mental stress, whatever the diagnosis. So basically, it’s “Oh, you’re back hurts? Here’s 800mg of ibuprofen,” which is what I got prescribed when I hurt my back when I used to work at UPS to pay for my college. I never got told, “Hey, dude, maybe you shouldn’t lift 125-lb packages by yourself and work third shift and you’re up at 3AM. Maybe that’s your issue and your—your body can’t regulate your hormones properly so you’re not rebuilding and you’re in a catabolic state, you know.

Dr. Justin Marchegiani:  Right.

Evan Brand:  So–

Dr. Justin Marchegiani:  Right.

Evan Brand:  There we go.

Dr. Justin Marchegiani:  Now we’re kinda like just digging into that analogy, it’s gonna be always better for the natural doctor to go in and say, “Okay, well, here’s some fish oil and some curcumin and maybe some Boswellia for the—the pain in the back.” That’s great because at least we know it’s not gonna cause the ulcer or the liver stress, because we know according to the Journal of Medicine 1998, et al. 19,000 people die a year taking ibuprofen properly, so we automatically know you’re in a better place just doing that. Now the better doctor who’s practicing functional medicine, root cause medicine would say, “Okay, great, let’s send you to a really good applied kinesiology chiropractor. Let’s start adding some specific exercises from foundation training or some functional movement patterns and then let’s make sure your diet’s better so you have the nutrients for the back and the ligament. Let’s add in some collagen. Let’s make sure the sleep’s dialed in.” Like that’s how we go deeper. So I’m not saying adding palliative support is bad, it’s gonna great especially if it’s natural without the side-effects, okay? And then as long as we add in the other pieces, then we set a really good foundation to build on.

Evan Brand:  Yeah, you and I both like fixing symptoms so people can feel better and stay motivated for the program but as we’re removing the symptoms kind of side-effect, maybe supplement in our case, we’re still trying to work backwards to get rid of what’s causing it in the first place so maybe one day you won’t need that Boswellia or et cetera.

Dr. Justin Marchegiani:  We deal with a lot of executives that have a really stressful job that frankly, they may not be able to curtail as much of their stress at work but we can at least add in B vitamins and adaptogens and nutrient and glandular support and adrenal support that will help while we can cohorts them into getting a little more sleep, taking 5 or 10 minutes out to mediate or go walk in the woods and get some fresh air, or do some forest bathing, things like that. So we try to interject little pieces there and what I say is we help them we’re they’re at, you know.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  If—if they’re at this place, if we can just take one step forward that’s better, but for someone else, that may be too much. So we wanna help them where they’re at.

Evan Brand:  Yup, my lawyer clients and entrepreneur or business guys or businesswomen, they’re always the ones that have the most need for what you’re talking about, some of the adrenal support. Do you have any particular patient that comes to mind in terms of profession, in in terms of the typically having the lowest adrenal function or the worse adrenal function?

Dr. Justin Marchegiani:  Yeah, anyone with a type A personality and that could be—a lot of times that’s gonna be your lawyer, it’s gonna be your entrepreneur a lot of times. They’re—they’re burning the candle at both ends, and you know, I definitely fall into that category sometimes so I make I take my adaptogens. I make sure I get the right sleep. I make sure I try to get the mediation in or a—a walking kinda gratitude session in during the day and get the vitamin D. So I try to practice what I preach 100% and I need to because it keeps me real for my patients, you know, we’re just—we’re—we’re busy here keeping it real, Evan, right?

Evan Brand:  Yeah, we have to. I mean, that’s the only way to do it.

Dr. Justin Marchegiani:  That’s it. Well, anything else that you wanna touch upon that you think is important that you want your listeners and your patients to hear?

Evan Brand:  Not really. Just make sure that you’re playing an active role in this, too. So I just had a female client of mine email me this morning and she said, “I think I figured it out.” She said, “I need to change the timing of the vitamin C.” And she goes, “It makes me feel a little bit weird if I take it too early. So I’m gonna try later in the day or I may just try cutting it out for a few days.” I’m like, “Okay, awesome.” So we may not know every single little piece of the puzzle that’s going on, you know, in your household with your stress level with trying to get your kids to work in the morning and trying to check up on your emails and all that, so we fit everything in in terms of like your program according to the best timing that we can give you based on what we see, but if there’s other stuff behind the scenes that we don’t see like you’re running around crazy like a madman or a madwoman in the morning, then maybe they—taking those morning supplements dosage, maybe that won’t work. Maybe you have to shift it a little bit later. So always play the proactive approach and don’t just kind of like put your hands out and want everything to fall back into place without you having to do the work. It’s still work but it’s fun work and it’s very rewarding for you to play a proactive role in your health.

Dr. Justin Marchegiani:  I agree. And then one thing I just want to kind of leave here, to kind of echo for everyone is if you’re having an issue where you’re not getting that 5-10% improvement going through body system one to two, et cetera, there’s probably something deeper. It could be a deeper infection, number one. It could be your mitochondria’s really burnt out and you need additional mitochondrial support during the process or number three, there could be some serious detox impediments and we may need some extra detox support to help kind of help your body process everything because if we give these supplements it may even be too much stress on the body to handle. We may have to really kind of backtrack it to the detox and do body system three first and give enough time for three to work before we even go to one or two.

Evan Brand:  Right.

Dr. Justin Marchegiani:  So–

Evan Brand:  Yeah, the last thing—the last thing I was gonna say, the guy I was talking about earlier with the malabsorption issues and the Klebsiella and the H. pylori, you know we always frame it around, “Well, how quickly do you wanna get better?” And he was like, “Well, I wanna have more energy, better sleep ASAP.” So we just started investigating body system one and we were treating based on, you know, stage 3 adrenal fatigue but we hadn’t made it to body system two yet. Just because we were so caught up in working there, so if you have an incomplete picture, now if you’re listened to this, you’re gonna know whether your picture’s complete. If it’s not complete, make sure you do start to complete it, because now we’re starting to complete the puzzle for this guy and we’re only going to accelerate the results because now we found two infections that we didn’t know about for the last 3 or 4 months.

Dr. Justin Marchegiani:  That’s it. And I think if something does go wrong, if doesn’t go as planned I should say, that’s probably a better phrase—something that doesn’t go as planned, it means something. Write it down and then meet with your functional medicine practitioner and have a solu—have a solution-based mindset, not a “Hey, this is where I’m at. I’m mad. I’m sad,” and you know, just throw a tantrum. Say, hey, back up, what does this mean and how can we then move forward with a solution-based approach to fix it? Because again, 90-95% of the patients get better with these proven approaches, so if you’re not in that 90-95%, and you’re in that 5-10%, I know it stinks. I empathize, it doesn’t feel fun or right, but then the question is how do we switch gears into that solution mode and get to the root issue that needs to be tweaked for you to help kinda unleash your success potential?

Evan Brand:  That’s great.

Dr. Justin Marchegiani:  Awesome, Evan, anything else?

Evan Brand:  That’s it.

Dr. Justin Marchegiani:  Hey, great talk today as always. You enjoy this great Monday!

Evan Brand:  You, too.

Dr. Justin Marchegiani:  Take care, bye!

Evan Brand:  Bye!

What It Takes To Be A Good Functional Medicine Patient And Get Great Results – Podcast #53

Dr. Justin Marchegiani and Evan Brand engage in a conversation about how to be a great functional medicine patient and how to get the best results on your functional medicine program.  Find out why being more compliant as patients can help you achieve better results by listening to this podcast.
functional medicine patient

Discover why check-ins and follow-ups are important to be successful in reaching your health destination and goals in addition to avoiding a waste of time to heal. With functional medicine, it’s like entering a journey of working together and a partnership to heal your health. What is the ideal timeframe to commit to a program? How long should you do it? Answers can be found during this discussion.

In this episode, topics include:

2:15   Staring with a dietary approach

16:56   Importance of check-ins and follow-ups

22:11   Functional/biohacker group mindset

25:48   Advice on buying supplements

27:10   Summary








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Dr. Justin Marchegiani:  Hey there, it’s Dr. Justin here with Beyond Wellness Radio.  Again we got Evan Brand, our guest co-host on today and we’re gonna be talking about how to get the best results on your functional medicine program, how to be a great functional medicine patient.  Again, Evan and I were talking about this topic before the show and we’re really excited to chat about it.  But Evan, how are you doing today, man?

Evan Brand:  Hey, I’m great.  Just before we jumped on here I was outside.  I had my shoes off, I had my shirt off, I was doing some very slow push-ups.  I read a–an article Mercola put out today and he said quit doing fast push-ups so I did some really slow ones and some kettlebell stuff so I’m feeling good.

Dr. Justin Marchegiani:  That’s good.  Yeah, on the Skype cam, you’re looking a little extra pumped today.

Evan Brand:  Thanks, man.

Dr. Justin Marchegiani:  That’s probably why.  Here we go.  Awesome.  We’ll have to start doing videos on–we’ll have to start doing our podcast on video so you can–you can flex for the camera.

Evan Brand:  Sure thing.  Once I get a–a new HD webcam.

Dr. Justin Marchegiani:  Love it!  Awesome.  You’ll be able to see all the ripples.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Cool.  So I really wanted to put out some content today and we talked about it as well so we can help our patients get the best results possible because a lot of it is like we’re putting out information, we’re being teachers, we’re being clinicians but on the other end of the fence there takes a compliance element.  And the more compliant and the better our patients can be, at being good patients, the better results we can help facilitate.

Evan Brand:  Oh yeah, I–I mean, this is–when you brought this topic up, I mean, my stomach just got butterflies of happiness because it’s been such an issue for me lately to get people to stick on their–their protocols and they don’t understand why they’re not getting better.  So they come back at me but everything’s been laid out, but it’s an issue of compliance or they just don’t wanna do something and that’s where the problem is but it’s hard to get them to see that and I think we’ll be able to break down today what things you can do right to actually prevent yourself from being one of those people that come back to us and say, “Why am I not getting better, you know?”  So that’s my thought.

Dr. Justin Marchegiani:  Absolutely.  So I think starting off a good place would be just diet.  When I have patients coming in depending on how sick they are or how long or how chronic their illness has been, we’re starting with diet.  And depending if they’ve been sicker longer, we may start with a more drastic type of dietary approach so we can accelerate healing, reduce inflammation, and reduce maybe all of the–the nasty foods that are keeping the gut leaky and the person inflamed.  So off the bat, I always try to make–try to get my patients to buy into the most drastic change off the bat because they see the best results.  But again, some patients, it’s too much too soon, so one side of the fence, we’re trying to make the most drastic change so we can get the results the fastest but some people, it’s like well, let’s just kinda take a baby step there.  So I always try to lay it out here, we have option A that gets us there faster, option B is gonna be slower but you may not see the results that you want as fast, we may have to baby step towards that AIP or that gap so that SCD or that low FODMAP Paleo approach over the next month. So instead of getting there in 1 month, it may take you 2 months to see those dietary changes.  So I try to give my patients options on how we can get there.

Evan Brand:  Yeah, and that kinda depends on where they’re coming from, right?

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I mean, because some people that come to me are already doing somewhat of a Paleo diet and then there’s other people that are just drinking tons of Coke and they’re eating Subway.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So it’s kinda interesting, you know, it depends on where the person is coming from, what protocol we can put them on.  Is that the same thing for you?

Dr. Justin Marchegiani:  Yeah, I mean, I see a lot of patients that are already Paleo and they’re coming to me because Paleo isn’t working.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So I’m already in that place with a lot of my patients but I really try to hold my patients accountable and I put a lot of responsibility on them with the food diary.  So food diary is a great way so we can get a window into what their life’s like.  And for me, a food diary isn’t just about what they’re putting in their mouth, it’s also when they’re putting it in their mouth.  Are they drinking a whole bunch of water with their food?  Are they consuming their protein and fat in the morning in that first 30-45 minutes of waking up?  Are they going too long between meals?  Are they exercising 2 hours and they have stage 3 adrenal fatigue?  Are they going to bed past midnight?  So I look at–I have a lot of those elements kinda lined up on my food diary list that are important to get a window into what’s happening on.

Evan Brand:  Yeah, and the–the when you eat I think that’s a very important part of dietary compliance that’s ignored because I’ll send some recommendations over and say, “Hey, you know, here’s 3-4 days’ worth of eating.  You know, here’s 3 different breakfast, lunch, and dinner options.”  And then I’ll follow up and say, “Hey, I haven’t actually followed up,” and say, “Hey, fill out a new journal lately.  I probably should be doing that.”  But just getting people, “Give me an update on the diet.”  “Well, I’ve just been so busy, I just keep skipping meals.”  And then we go off their symptom graph and their blood sugar stuff’s off the chart, so they’re never gonna get better no matter if they’re eating that grass-fed beef once a day, the other 10 hours they’re starving.  It’s just not gonna cut it.

Dr. Justin Marchegiani:  Exactly.  So I tell patients, number one, if they want the most effective results is let’s try to get the maximum buy-in off the bat, and if we’re having trouble with the buy-in, then we gotta do a food diary so we can see where we’re at, what we’re doing right, and then we gotta follow up and we gotta see where we’re at.  I always tell patients if we’re really having a hard time with–with the 100% buy-in, we gotta have a negotiation.  We gotta sit down and negotiate and see what foods can’t you do, what foods are you having a hard time with, and let’s see if we can find an interim.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So for instance, I got a vegetarian patient who’s 100% vegetarian vegan, we have a buy-in–we’re like, “Alright, here’s what we’re gonna do.  We’re gonna do high quality unsweetened unflavored pea protein just to give you some extra aminos.  We’re gonna give you some extra free form amino acids.”  This person I have a strong suspicion that has an H. pylori infection, so we’re giving some extra enzymes and hydrochloric acid support and we’re allowing them to have some lentils, alright?  Because out of all the legumes, the lentils tend to be the least problematic and then we’re trying to get them to do a little bit of egg yolks and some wild Alaskan sockeye salmon, just a couple of ounces a day.  So I kinda had that little buy-in where, hey, they’re not like full Paleo, but they’re just cutting, they’re adding in a little bit of foods that may have higher quality protein, higher quality fat, and you’re not getting all the carbs that you typically get in your standard vegetarian diet.

Evan Brand:  Yeah and you’re not getting the soy and other garbage.

Dr. Justin Marchegiani:  Yeah, I mean, most vegetarians don’t realize it, you try to combine your vegetarian proteins, right?  Outside of a protein powder, right?  Because that’s the exception.  You do rice and beans, right?  And you get 15 grams of protein when you combine them but then you get 80 grams of carbohydrate.  That’s a lot.

Evan Brand:  Yeah and that can really stall fat loss if you’re above that carbohydrate curve and that curve obviously is dependent on–on people.  So I guess that’s where we come in is to determine what that right curve is for you but maybe that kinda ties into what I was thinking too about being a, you know, a good patient and getting the–the most result is that you just have to follow what’s outlined.  I mean, it sounds simple but, you know, I just had a lady who had to take a trip for work and she was around the convention food.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And I told her, I gave her an entire shopping list, and I said, “Hey, here’s a shopping list of portable meals, you know, some grass-fed jerky, some organic nuts and things like that.  I want you to take these because I don’t want you to get derailed when you’re at this convention eating work food, and then a few days later, I get the email, ‘Oh, potatoes! Potatoes! Potatoes!’”  And now she’s flared up and she’s feeling like crap, so–.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  So I don’t know where I’m going with that thought but I just wanted to mention that story.

Dr. Justin Marchegiani:  Yeah, I mean, you’re giving your patients options and, you know, they made a bad choice, and I think Dr. Mercola said this recently, “You can ignore–you can ignore reality, but you can’t ignore the consequences of reality.”  Right?  You can ignore reality, “Oh, I can eat potatoes or I can eat gluten.”  But you can’t ignore the consequences now that you feel crappy, your skin’s inflamed, your gut’s inflamed, you don’t feel good.  You can’t ignore those consequences.  So my goal when I’m dealing with patients is just to let them know that, hey, you know, we can outline what their plan is but based on our experience working with thousands of patients, we know that there’s certain consequences to the reality and we wanna let them know, “If you do this, you’re more than likely not gonna get better in that timeframe or those symptoms will get worse again.”  So we’re trying to create a plan that has their goals in mind, number one.  Now if they can’t do it, we gotta have a negotiation.  We gotta readjust the timeframe of getting better.

Evan Brand:  Right, yeah, and I would like to say that the process is a straight line from point A to point B coming in and then the healing phase, but it is a bit of a–it is a bit of a rollercoaster and kind of a windy river so to speak, but most of the time, we’re not creating rivers that flow backwards.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  You know, that’s more of where someone is–is not following something properly and they’re gonna make their own path backwards and then we have to circle that river back again.

Dr. Justin Marchegiani:  Yeah, and I always make it clear with patients is we don’t wanna reintroduce any new foods until we okay it with the doctor or the nutritionist.  We wanna make sure that we stay on that clean diet and then we set up a plan to reintroduce foods because how we reintroduce it is important.  I see a lot of patients, they come off 10-15 foods and they add them all back and at once, and they’re like, “Oh my gosh, I feel like crap,” and it’s like, “Exactly.”  Major antigenic, allergenic load, we have to do it one at a time every one 3 or 4 days to take into account that there may be a delayed reaction happening.

Evan Brand:  Interesting, yeah.  And I’ve done that, too, with gluten cross-reactive foods, I mean, because I’ve pulled rice and potato and hemp out.  I thought for a long time that I was allergic to hemp and I actually had one of these bars the other day, it’s incredible.  You gotta try them out.  It’s called a Love Crunch bar and it’s an or–

Dr. Justin Marchegiani:  Nice.

Evan Brand:  It’s an organic–it does have peanuts which kinda sucks but it does–but it does have organic cashews in there and some hemp seed–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  And some organic dark chocolate and things like that.  And I thought for the longest time that I was completely allergic to hemp and I pulled it out for so long and I recently just added it back in with that bar and I was fine, so it is possible that you may start out being very limited in some of the recommendations that we’re allowed to give you, but eventually you may be able to expand your variety again and do completely fine.

Dr. Justin Marchegiani:  Exactly and people don’t understand, too, is if you’re doing a whole bunch of carbs, too, all carbs, you know, especially if it’s high sugar fruits or grains or starch, all those convert to sugar.  So we also have to look into the fact that you may be eating anti-inflammatory food but if you’re getting 300 carbs a day, where you may have adrenal fatigue and some metabolic syndrome, even though they may be on that Paleo list, we have to also take into account the sugar breakdown as well.

Evan Brand:  Right.  Yeah, I typically for myself I’d say I’m probably maybe 150 to 200 grams per day.  I never count anything but I mean, if I’m starting to get back into working out something like that then I’ll do maybe a–I think my wife and I will split either a half cup or a cup of organic white rice and we’ll eat that for dinner with some, you know, with some steak and some broccoli and I feel good.  So it’s–it’s ultimately a balancing act and that’s kind of the beauty of it is that it–it takes time to figure out what that perfect–that perfect range for you is.

Dr. Justin Marchegiani:  Yeah, and with myself because my patients, a lot of them are autoimmune, I’m even staying away from the grains even the rice which if you’re gonna do any grain that would be your safest one to start but I’m even favoring more of the side of plantains, sweet potatoes, squash, yuca, things like that to starch because they don’t have any ties to that grain family so to speak.

Evan Brand:  That’s true, that’s true, yeah, and you know, I guess pulling out the spices and things like that, too, maybe with the reintroduction of spices not using, I mean, there’s tons of organic blends out there but adding those back in could be sketchy, too, because you may be throwing in all sorts of cayennes and chili peppers and other nightshades for autoimmune people.  So that is something that–that I’m careful about but the rice, I don’t know, it’s a–it’s all–it will always be controversial.

Dr. Justin Marchegiani:  It’s an individual basis.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  It’s an individual basis again I always–I always air on the side of causing the least problem because that way, you know, you just caused the least problem but again there are people that will be the exception to the rule, and you probably can handle rice.  I can probably even handle a little bit of white rice every now and then, but you know, if we have carbohydrate–because in the end, there’s really no nutritive value in the white rice.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  You’re just getting the glucose, right?  So if we can get that glucose from another source that may give us 20% or 30% chance of having cross-reactive gluten issue, I’m all for it.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  But you’re right, it’s a 100% individual, I agree.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  So on that note, like with patients for instance, one of the things that I find is that when we start cutting foods out or start cutting a lot of the bad foods out, it’s instantaneously analysis leads to paralysis where if 50% of their calories were now–were crap before, meaning a whole bunch of glutinous or sugar grains, then maybe only 30% of those calories are substituted.  So there’s a 20% gap, meaning they just cut their calories down 20% and they’re complaining of being hungry.  So I always tell my patients off the bat, if you’re–can’t go 4-5 hours between meals or if you are hungry it’s because you did not substitute enough of the calories that you pulled out of your diet with the healthy anti-inflammatory non-toxic calories.

Evan Brand:  Yeah, and you know, if you’re–if you are going to be most of these plans that we’re putting people on, they just are naturally a lower carbohydrate plan and if you’re not properly balancing out your macros there and adding in some more fat in replacement of those carbs, you’re gonna have the irritability, you’re gonna have maybe even the sugar craving where at the end of the meal, you just wanna go up and eat a piece of dark chocolate or something like that.  Those are signs that you may need to tweak that ratio and fill in the gap with some fat there.  That’s kinda my go-to–my–

Dr. Justin Marchegiani:  yup.

Evan Brand:  Go-to macro.

Dr. Justin Marchegiani:  Yeah, I agree.  And I always see patients if they go too long between meals, that’s where those cravings will happen.  Let’s say they have dinner or lunch at 12, dinner at 6, well, there’s a 6-hour gap there that may have caused a, you know, a low glycemic spike, and then now it’s–it’s your brain is–is craving sugar to get that blood sugar back up and it–and it’s just causing a lot of sweet cravings.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And then something I wanted to mention in terms of what makes, you know, a good client, someone that’s going to do the program long enough, because what happens with me and actually it’s funny now because the people have come back to get reevaluated, but people have come in the door and maybe this is–this is my fault for not saying, “Hey, we need to make this a 3- to 6-month minimum commitment together–

Dr. Justin Marchegiani:  Minimum.

Evan Brand:  Now I’m sorting–yeah, now I’m starting to do that but before, you know, last year when I was taking some people on, they would just schedule a few consults.  I don’t know if it was maybe financial-related, they were just too busy, or maybe they just thought, “Hey, I’m gonna come in.  I’m gonna get this program designed.  I’m gonna get my supplements, get my lab tests and everything’s gonna fall into place.”  And then they don’t have regular check-ups, they’re not adjusting things with me as needed, and then you reevaluate them and you run the–the symptom questionnaire and they’re almost back to where they started.  So I’m sure you have plenty to say about that.

Dr. Justin Marchegiani:  Yeah, I 100% agree.  I don’t take on any patient that’s not willing to commit 3 to 6 months.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  That’s–I mean, think about like a–a major like, you know, cruise line ship for instance, right?  It takes so much energy and time for that thing to actually turn when it’s at full speed, right?  Like an airplane takes probably dozens of miles to actually make that 180-degree turn if it’s at 700 miles per hour, right?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  I mean, it’s–it’s basically going, I think, it’s a mile a second, right?  So if it takes a minute or two to turn, that could be 60 miles I think, if my Math’s right.

Evan Brand:  Yeah, that’s close.

Dr. Justin Marchegiani:  Yeah, I think it’s a mile a minute, maybe a mile a minute there, no, 60 miles per hour is a mile a minute so yeah, you’re looking at a mile a second.  So that totally makes sense to me.  So we’re dealing with patients–where was I going with that?  We really wanna make sure that we have enough time to change the direction of where their physiology is going, number one.  And two, we gotta have check-ins.  Every now and then we get patients that may cancel or follow-up and that’s super important to have it because if we’re off like for instance, an airplane’s off by 1-2 degrees throughout the whole entire trip, but they’re like they’re 1-2 degrees to the left, 1-2 to their right, so they’re constantly balancing out.  Now dealing with patients, if they’re off by 1-2 degrees and they just continue with that 1- to 2-degree, you know, maldirection for 8 weeks, then now, they’re just–they’re off way–they’re not even close to the right direction.  So if they’re flying from Austin, Texas to Boston, well, they’re now heading in the direction of North Carolina.  They’re not even close to where their end destination was, so having those follow-ups every month or every 4 weeks or maybe even if they’re new to this type of diet change altogether and they’re overwhelmed, maybe even every 2 weeks to 1 week until we can get some solidarity and some–and some confidence in the direction that we’re heading in.

Evan Brand:  Yeah, and I’m too–I’m too busy to continue doing that but what I was doing was having basically like an unlimited coaching plan for people where just anytime they wanted to–to hit me up on Skype, they could do that.  But now it’s gotten, it’s–it’s too crazy to try to keep up with that, so I’ve gone to the more 3- to 6-week check-up thing and it’s incredibly what you’ll hear.  There are so many things that they may have had pre-programmed into their mind that we may not have covered yet because we only covered, you know, what we could see being the most immediate issue.  So I’m looking with a pretty scope but maybe my scope’s not big enough sometimes and then they come in and they say, “Oh, well, I thought I could just drink tons of vitamin water or something.”  Just–

Dr. Justin Marchegiani:  Right.

Evan Brand:  Something–something small has been slipping through our protocol that I didn’t know about–

Dr. Justin Marchegiani:  Exactly.

Evan Brand:  And then we find it during that follow-up and then now we re-align the sails and now we’re gonna hit the island.

Dr. Justin Marchegiani:  Exactly.  Or we’ll have patients sometimes that will may have a slight reaction to a supplement on day 1 or 2 and just stop it, and then we miss the follow-up and then we don’t talk for 2 months and they’ve been off their supplement for 2 months, essentially wasting, you know, time to heal.  So it’s really important, you know, as the doctor that we kinda set expectation here’s where we’re at, here’s the protocol, here’s the program, here’s the diet.  We wanna check in.  The check-in is designed to kinda have a little feedback so I can tell you where you’re at and make sure you’re not making any mistakes, but also to give you a pat on the back and to confirm that we’re heading in the right direction, and to see what changes are occurring, too.  How’s the physiology changing?  How’s energy?  How’s sleep?  How’s libido?  How’s our mood?  How’s our skin?  How’s digestion?  We wanna see and make sure we’re monitoring so we can be confident we’re heading, you know, north in that direction of healing versus northeast or northwest.

Evan Brand:  Yeah, and I think it’s just a little bit of a mindset re-frame, you know, maybe people have been used to the conventional model before and they haven’t gone to this functional model where they go in and they get a check-up once a year or–

Dr. Justin Marchegiani:  Yes.

Evan Brand:  Once every few years at the doctor.  It’s a 10-minute visit, they come in, they may or may not get some general blood work that shows little to nothing about their–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Overall health in a functional perspective and then they’re out the door, so I think a little, you know, a little bit of this whole process is understanding that when you are coming into one of our doors is that you’re entering a journey of working together.  This is not we’re going to just give you the pass-go, free pass, or whatever that’s called from Monopoly and–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  See you later.  We’re gonna collect the money.  Thanks a lot.  Goodbye.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Good luck!  This is more of creating a partnership to heal your health.

Dr. Justin Marchegiani:  Yeah, I totally agree.  That makes 100% sense to me and you know, I always tell patients that we–you’re coming from a place where you’ve probably been having health issues brewing.  If the symptoms are relatively new, the underlying cause has probably been brewing for years.  If not decades depending on how old you are, before you even came to see me.

Evan Brand:   Uh-hmm.

Dr. Justin Marchegiani:  So for the most past, everything you’ve done up to this point hasn’t worked or you wouldn’t be in my office, that’s step 1 and number 2, more or the same equals more or the same.  I had a plumber in my–in my house a couple weeks ago and my faucet was leaking, and it just stopped leaking and he goes, “Oh, maybe it fixed itself.”  And I’m sitting there, I go, “Really?”  I’m like, “It just fixed itself?”  And he goes, “Wait a minute.  Actually, problems never fix themselves unless we actually address the underlying cause.”  So he was kinda saying, “Hey, things just don’t fix themselves.  Let me take a look at it.  Oh no!  It just stopped because, you know, it just happened to, but it may come back in a week or two.”  And I–I kinda viewed that as people’s symptoms.  They go through a low where they’re–they’re feeling bad and they’re feeling good and just kinda like the plumber kinda reminded me.  The leak in the faucet’s probably not just going to fix itself.  That very rarely happens and then the problem down the road will probably get more expensive and it will take more parts, more labor, more of my money because it will cost me more to fix, but it will also cost me more quality of life.

Evan Brand:  That’s–

Dr. Justin Marchegiani:  And having more symptoms.

Evan Brand:  I–I have to add it.  You just sparked some inspiration.  Here’s something that people may be listening and they may say, “Well, I–I’m not a client.  I’m not a patient.  I don’t need to be a client.  I don’t need to be a patient.  I’m pretty okay.  That’s kind of the wrong mindset and that’s not to say every single person out there right now needs to schedule an appointment with us and get help but I think also there’s this weird mindset where people only need to come get help if they are sick, they broke their leg, they’re throwing up and they have diarrhea 20 times a day.  “Okay, now I need to come get seen.”  And that doesn’t have to be model and that’s definitely the functional model and a lot of people that you and I work with are people that are really healthy and they just wanna push that boundary, the biohacker group.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  The–the functional group.  They just wanna hit that next level of performance.  So if you’re hearing this and you’re thinking, “Well, I’m not sick.  I’m pretty okay overall.”  That doesn’t mean that you don’t need to get seen because there’s so many different things that you could be optimizing like optimizing your digestion for example, making sure that you’re actually gonna be breaking down and assimilating your amino acids and nutrients that are gonna help you perform when you’re doing your–your CrossFit workout for example.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So you don’t have to listen to this and think, “Well, I’m not one of those people because I’m not basically bleeding out of my gut, so I don’t need–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  To be seen.”

Dr. Justin Marchegiani:  Yeah, I agree.  And myself, I’m getting ready to order over a thousand dollars of lab work and I’m gonna run a whole bunch of tests on myself.  I’m gonna create a whole program and protocol just as if I’m a patient.  I mean, I–I do the diet and lifestyle stuff money because I can’t look at myself in the mirror.  If I don’t do it, at least 90-95% because I know I’m telling patients 12 hours a day to do it, so I gotta be authentic and I gotta own it because when patients talk to me, they know that I’ve been there literally thousands of times and I own the situation.  Oh, this happens to this.  Oh, this happens to that.  I know that you gotta do this.  So I own the diet and lifestyle part but I do, getting ready to do over a thousand dollars of lab work.  I’m gonna draw myself out a full supplement program and I’m gonna have, let’s say Dr. Kalish or Dr. Peter Osborne review that program with mea and make sure there’s nothing else that I’ve missed that I can be doing to perform better or function better at my optimal health.

Evan Brand:  Right.  I- but I just had to distinction there because I find myself listening back to what we’re saying and–and people may be picturing this crippled, broken person and that’s not typically the image of people that you and I are seeing.  I mean those people are there but there’s plenty that on the outside they look perfectly fine.  You just don’t know that they can’t focus and they’re sitting at work staring at their computer trying to do something and they have so much brain fog, they can’t figure out how to do their–their day job, you know.  So that’s kinda where we try to come in and fix that stuff.

Dr. Justin Marchegiani:  Yeah, me and you are always trying to, you know, function at optimal level.  I’m having conversations.  You’re having conversation with me about stuff that you can do to perform better so we’re all doing it, and I guess the only difference between ourselves and our patients is we really dedicate our life to this 100% where it’s our living and we just have thousands of data points to go through.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Right.  It’s like the lawyer going to court, they’ve been there thousands of times.  So when they go to court, it’s not a big deal.  But your first time in there, you’re kind of, you know, maybe a little uneasy.  You don’t know the, you know, the language.  You don’t know the rhetoric, you know, you don’t know the accord.  So it’s much easier for people like us that have done it to be able to provide the insight and also, I mean, it’s even more important when it comes to what labs do you order.  What supplements do we order?  How do we periodize the program?  Because that’s just 100% experience.

Evan Brand:  Yeah, I know–

Dr. Justin Marchegiani:  Right?

Evan Brand:  We’re running out of time but you made a point that I wanna hit on.  Don’t just go and jump on Amazon and see that something’s a bestselling supplement and order it.  One, quality control.  Number two, you may or may not need that and people come in and one of the things on my intake form is list any herb supplements or medications you’re taking and you would be ama–well, you wouldn’t, but the listeners would be–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Amazed–

Dr. Justin Marchegiani:  Oh, yeah.

Evan Brand:  At how much stuff is on there and it’s like, “Why are you taking 500 mg of, you know, say magnesium every single day or why are you taking coQ10?  Have you ever found that you need that?  Why are you taking blank?  Why are you taking this quality?  “Oh well, I just heard about it on Dr. Oz or–or whatever.”  And that’s not saying that you’re wrong or that you’re stupid or something, but I don’t want you to be creating expensive urine and, you know, other things that could go wrong if you’re taking something that you don’t need.  So–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  At a certain point, it’s great you–you’ve found this podcast, you’re on the goal to empower your own health, but at a certain you just have to let go of the reins and let somebody else help you and guide you into direction as opposed to you taking–“I’m –I’m a biohacker, I’m gonna do this thing on my own.”  And you and I have both done that and I’ve hit the wall and been a wounded warrior myself.  That’s what brought–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Me to this whole thing.  So–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I just wanted to make that little rant there.

Dr. Justin Marchegiani:  I think that’s great and I just kinda wanna summarize for everyone here.  On the diet perspective, really try to do–try to buy in at the highest level to what you can regarding what your doctor’s telling you and again, doing a food diary can be super helpful so we can monitor and assess and try not to reintroduce any foods until we kinda give the thumbs up because we wanna do it in the right way to look at any potential delayed food allergies.  And then regarding appointments, making sure we follow up if you’re really new or green to this type of eating, maybe weekly or twice a month or minimum every 4 weeks to every month just to make sure that we’re on track and even if we’re on track just to confirm that we’re on track, number two.  And then when we sit down and talk about labs and talk about supplement programs, we wanna make sure we create a program that makes sense.  I find doing everything at once can be overwhelming so in my clinic, we create phases, right?  Phase one, we’re looking more at the hormones, adrenals, thyroid, male or female hormones.  Phase two, we’re looking at gut infections, digestion.  Phase three, we’re looking at nutrient deficiency, detoxification, neurotransmitter.  So we try to phase it out so we don’t get overwhelmed because if not, you’re that person walking into the doctor’s office on 50 supplements with a whole bag of products and that can be overwhelming.  And then number four, communicate.  If you’re feeling overwhelmed, if you feel like things aren’t working, communicate.  If you’re having a reaction to supplements, communicate.  Schedule that troubleshoot consult.  Have a quick email.  If we need further dialogue, come in sooner before your appointment so we can follow up and we can tailor things.  If you want and save it, a month or two months later, we waste all that time to heal.

Evan Brand:  Yeah, totally.  I’ve seen that.  You come to the appointment, we jump on Skype, and they say, “Oh, I’ve had diarrhea for the last 3 weeks straight.”  Why didn’t you tell me?

Dr. Justin Marchegiani:  Right.

Evan Brand:  “Well, I just–I thought we need–you know, I–I would just tell you on the appointment.”  There’s email for a reason.  It’s very convenient.

Dr. Justin Marchegiani:  Yup.  Yeah.  And then also what’s helpful is have a quick little summary of like the 5 or 10 questions that are on your mind, maybe with a 24 or 48-hour food diary ahead of time sent in because then when I have patients that do that, we can just roll through that list.  We can look at their food diary.  We can confirm and we can make so much better use of their appointment time as fast as possible.

Evan Brand:  That’s a good idea.  I don’t know if you have that but I’m thinking we should create like a little universal troubleshooting form that–

Dr. Justin Marchegiani:  That’s what we’re gonna do.

Evan Brand:  You can have on hand in between and say, “Hey, fill this out if something happens and you need me in between our appointments.”

Dr. Justin Marchegiani:  Well, this podcast will be recommended, required material for all my patients and I hope for yours as well and we’ll have the transcription up and I’ll have this put into a nice PDF handout little checklist where patients can through and check off all the things and make sure they’re on track.  So again, we always wanna make sure we’re doing our job.  That’s our goal.  That’s our given.  That’s gotta be a must.  But at the same standpoint, we want good patients and we have to make sure they’re doing their job.  It’s kinda like that Jerry McGuire movie with Tom Cruise, right?  Help me to help you, right?  Help me to help you.  So we wanna make sure we can hold our patients accountable and then kinda give them a scorecard or a little checklist so we know and we can give them assurance that they’re doing everything they possibly can do.

Evan Brand:  Yup.  Amen.

Dr. Justin Marchegiani:  Awesome.  Anything you wanna add, Evan?

Evan Brand:  Not much, just keep–keep moving forward.  Keep hope.  Stay positive.  There’s always help out there for you.  Baby steps in the right direction every day or what help you.  It’s easy to get overwhelmed when you’re trying to take your health into your own hands but we’ve both found out that this is the best way to do it that this is the real way to achieve health and that the surgery and the drug model is–is not fixing anyone and it’s making a lot of money for certain industries and certain people and that’s not what we’re about.  We’re about getting to get you to be able to go for that hike that you’ve been putting on hold or get you to go on that fishing trip with your grandkids or whatever it is that thing that, you know, our goal is not to keep you in this little cycle.  Our goal is to get you back out into the world so that you can be an optimally functioning human to keep our society going and to keep us productive, you know, as a species.  So that’s kinda where my heart’s at and where my head is today.

Dr. Justin Marchegiani:  Yeah.  When you get healthier, every part of your life gets affected by it.  You’re a better mother, you’re a better husband, a better wife, a better girlfriend, a better lover, a better mom, better dad, a better parent, a better teacher, a better employee, a better business owner, a better entrepreneur.  Everything gets affected when you get healthier and if people are kinda like well, what’s the next step here?  Again, a good first step because you’re listening to this show, there’s probably a resonance with us off the bat, feel free and reach out to NotJustPaleo.com for you Evan or JustInHealth.com for me if you need further guidance on the functional medicine or nutritional path to get better.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  Alright, Evan, man, have a great day!

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Anything you wanna add?

Evan Brand:  No, that’s it.  You, too.

Dr. Justin Marchegiani:  Alright, take care.

Evan Brand:  Alright, buh-bye.

Dr. Justin Marchegiani:  Bye!


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