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?
Once 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!
Functional Medicine Patient and Its Great Results
By Dr. Justin Marchegiani
Functional Medicine, is a medical practice or treatments that focus on optimal functioning of the body and its organs, usually involving systems of holistic or alternative medicine.
Why are check-ins and follow-ups important to success in reaching your health and healing goals? Why is a committed and collaborative mind-set necessary to health and healing? In functional medicine, it’s a journey of working together, a partnership that leads to your health. Being compliant as a patient will help you achieve better results. This article lists ways you can assure you are, or will be, a compliant patient.
Start with a Dietary Approach
- Follow your practitioner’s dietary plan, individually customized for you, to accelerate healing and reduce inflammation.
- Keep a food diary, recording what you eat, when you eat, and lifestyle issues (exercise type, time, and duration; sleep times and patterns; etc.) that may be impacting your diet.
- Don’t cheat, skip meals, or vary from the dietary plan.
- Plan ahead. When there will be a change in routine that could lead to food temptations or conveniences (vacations, parties, holidays, etc.). Take along healthy portable meals or snacks.
- Communicate with your practitioner if you are having any challenges with the dietary plan or the approved foods. Most of the time, appropriate adjustments can be made.
- Don’t introduce new foods (or beverages) without your practitioner’s OK. Even the smallest change can disrupt the entire protocol.
- Don’t get hungry! If you’re getting hungry between meals, talk to your practitioner.
- Be prepared to commit 3–6 months to your dietary plan in order to learn habits and skills that can lead to lifelong dietary success.
Show Up (Physically and Mentally) for Check-Ins and Follow-Ups
- Make check-ins and follow-ups a top priority on your calendar, and don’t skip them.
- Be committed to weekly, biweekly, monthly, or bimonthly check-ins or follow-ups, depending on what your plan requires. This isn’t your conventional-medicine yearly doctor visit.
- Be fully transparent with your practitioner about not only your successes, but also your failures since your last meeting. This is a good time to share your detailed food diary.
- Answer your practitioner’s questions fully and honestly. This is so he or she will have the best opportunity to help you succeed.
Develop a Functional/Biohacker Group Mind-Set
- Understand that more of the same equals more of the same. The way you’ve always done it has no place in healing your health.
- Commit to changing your mind-set if you wish to succeed.
- Realize that problems don’t fix themselves—the underlying cause must be addressed.
- Don’t stop the program because you feel good one week in. Feeling good one day does not equate to problem solved. You must follow the full protocol to achieve lasting results.
- Optimizing your health should be a personal goal even if you don’t feel you need “healing.” The functional model encompasses all levels of health, even biohackers who just want to push the boundaries of performance.
- Read, learn, and listen to everything your functional medicine practitioner recommends. Read Dr. Justin’s blogs, listen to his podcasts, and watch his video series.
Buy the Right Supplements
- Determine the right supplements for you by working with your practitioner who knows your individual needs.
- Purchase high-quality supplements.
- Don’t take a supplement just because a Facebook friend or ad says it’s the best. Or just because a celebrity doctor endorses it. You’re only creating expensive urine, or worse, if you don’t need it.
The goal is for you to own your diet and lifestyle! When you get healthier, you’re a better mother, a better father, a better husband, a better wife, a better girlfriend, a better boyfriend, a better lover, a better teacher, a better employee, a better business owner, a better entrepreneur. Everything improves when your health improves.
Please reach out if you need further guidance on the functional-medicine or nutritional path to getting healthy.
Listen to the full Just In Health podcast “What It Takes to Be a Good Functional Medicine Patient and Get Great Results—Podcast #53” below: