What it takes to be a good functional medicine patient and get great results – Podcast #53

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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.

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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