Weird question: what does amputating limbs teach you about health?
That’s how my guest this week started his career… in the surgical ward assisting with amputation after amputation.
He knew there had to be a better way.
Now a practitioner of holistic medicine, Dr. Justin Marchegiani treats the root cause (not just symptoms).
On this show with Dr. Justin, you’ll learn:
- How bad bacteria in the gut can cause depression and fatigue
- How to boost testosterone without drugs
- When you need to fine-tune your carbs
- Why we can control aging
- What Tom Brady eats for performance
- How to heal your thyroid
- And much more…
Justin Marchegiani: Treat The Root Cause
Abel: Dr. Justin Marchegiani is a functional medicine practitioner who treats patients using real food, biohacking, and quantification right here in Austin, Texas!
What’s cookin’, man?
So great to be on the show. I met you way back in the day at Dave Asprey’s first Bulletproof Conference in 2013. So glad we could get in touch again.
Abel: Likewise. Let’s talk about how your approach is a bit different from a typical doctor’s office.
I started in a surgical unit at UMass. I would help the surgeon hold the limbs as the doctor would amputate. You hold this limb and you can literally feel the blood pulsing through it, and then it’s amputated, and you take it down to the morgue. Literally hundreds of limbs passed through my hands. I remember going into the changing area and talking to the surgeon, and asking him how we could get in front of it and fix it. I didn’t think he was interested, because he’d go out to the butt hut and smoke his cigarette afterward.
There’s a big disconnect between conventional and natural medicine—getting to the root cause.
I looked at the diet piece, got it down. I looked at exercise piece, got that down. Then I looked at functional medicine docs and nutritionists to plug in the other pieces, because you really need a comprehensive system. Diet, lifestyle… and then you need to look at blood sugar, hormones, the gut, and detoxing to plug it all in.
Diet and lifestyle can be a really effective starting point, and conventional medicine misses that.
If I have acute trauma, great. I get in a car accident, bring me to the hospital. But if I have diabetes, I probably want to look deeper under the metabolic hood.
PEOPLE ARE DIFFERENT, BUT KIND OF THE SAME
Abel: What can you do to get people on board before they’re sick?
It’s tough. I see a lot of patients that have banged their heads against the conventional medical establishment wall. I see more people now because of shows like yours, which are showing people they have options. People are coming in saying they have fatigue, mood issues, depression—what can I do to get ahead of that?
There’s so much good information that a lot of patients are coming in on a Paleo template. They’re getting the toxins out, the grains out, the food quality up, and really driving up nutrient density. They’re subbing greens for grains, cutting out refined sugar, eating high-quality meats, high-quality fats. They’re getting the inflammation down and they’re feeling better, but what’s leftover is where the functional medicine doctor comes in and fine-tunes things.
A lot of people feel great on a low-carb diet; they feel great because they’ve got insulin resistance going on, and then they plateau. What’s next? Dial carbs up? We have three macronutrient dials here: carbs, fats, and proteins. We have good quality, organic, nutrient-dense, and anti-inflammatory. Now it’s time to fine-tune that.
Diet is always the first place to start, and then we can follow up with lab testing later.
Abel: What are you looking at when nutrition is concerned? Why would you dial the carbs up or down, for example?
Most people are already a little overweight. A BMI of 25 to 30 is overweight to obese. For a male, their waist might be 40 inches or above, and 35 inches for women. They might also have higher blood pressure, or any inflammatory marker—C-reactive protein, sed rates—these are markers of inflammation, so we want to default to a low-carb diet and get the cells more sensitive to glucose or sugar.
So that typically looks like around 10 to 15 percent carbs—less than 15 to 20 grams of carbs a day; fats between 40 and 65 percent, and protein between 15 and 25 percent. I never give those numbers, though. I say, show me the palm of your hand. Eat that much meat. And eat the bone-in, fattier cuts of meat. Then, if you want more fat, put an avocado on it.
As for carbs, make 80 percent of those vegetables, and that last 20 percent a bite of sweet potato or a handful of berries. People may plateau and experience symptoms like fatigue, and cold hands or feet—then we might dial them up a bit.
I live at about 70 carbs a day if I’m not working out.
Abel: I’ve hit that wall a number of times. You kind of have to figure out where you should be. How do you describe that wall?
If you’re doing Crossfit and you’re keeping that keto approach, you might feel really tired after workouts and not be able to recover. The next day you’re super sore, even with good sleep and diet. That’s a good indicator. We do body temperature testing and see if temps are below 97.8 degrees for the armpit area in the morning or afternoon—that’s a good sign to up the carbs.
Another way is to just try bumping it up to see how you feel. A lot of people find that low-carb approach works for them, and then they say everyone needs to be on it. It doesn’t always work well for everyone, but that’s where we always start, and then we dial up or down from there. If someone is overweight, we go there to get them all clean, and get their cells more sensitive to sugar.
Abel: A few years ago, sweet potatoes might have made me fat—now they make me feel great.
I didn’t realize you were literally holding amputated limbs, and I can’t imagine what that might feel like. But it’s important to raise the stakes. How do you get average people to make their health a priority?
It’s like The Matrix: You have the blue pill and the red pill. I think it’s the red pill that gives you the ability to see and you never come back. How can I use and leverage the Internet to get podcasts and videos and great content out there? You get people out there that are desperate, and they’re trying to get information that resonates with them.
I’m trying to put information out there that is logical and connects with people.
A lot of doctors speak too much over people’s heads. I was taught by a mentor at a young age: If you can’t break information down and connect with the average layperson, you don’t understand the content well enough.
Abel: I had to re-learn how to speak simply after my Ivy League education. For the doctors listening, what would you recommend to help the message land?
People don’t care what you say. They hear or feel what you say. You want to make sure they feel it.
You have to practice what you preach on the diet and lifestyle side. If you’re recommending particular lab tests and programs, go through that first yourself. Own it.
Growing up I had fatigue, blood sugar issues, major gut issues, Hashimoto’s thyroid. These are conditions in the medical world where it’s like, “Okay you have autoimmune thyroid; we’ll give you prescriptions of synthroid, you’ll be on it forever. No diet and lifestyle changes, and maybe someday we’ll take out your thyroid.”
There’s something more than that.
Everyone stands on the giants of people who came before them. Success leaves footprints. Follow the footprints of other people who have walked before you.
Abel: My mom is a nurse practitioner, and right now she’s specializing in genetic testing and how genetics affect your assimilation of nutrients.
How do you see the health world evolving in the next few years?
The functional medicine world is market-driven. People are coming in spending their own money, and there’s a lot of value in that. Copay-driven conventional medicine is a short, one-minute visit with not a lot of time to go over diet and lifestyle. I’m seeing more patients that want and demand more time: Look at my food diary. Let’s look at these lab tests. Any functional markers we can glean from these lab tests?
Because patients are more educated, they know the cop-out of “It’s all in your head” or “You’re just getting older” is BS. Because of your show and Dave Asprey’s show and others like it, they know people are getting help and they’re reaching for it with their dollars.
WHY DOES EVERYONE HAVE A THYROID PROBLEM?
Abel: What’s happening with the thyroid? We’re hearing about thyroid dysfunction more and more these days.
Conventional medicine have always treated thyroid issues on the hypo side. They treated them all the same. Write them a prescription and send them home. Basically, what we know is that 50 to 90 percent of thyroid issues are autoimmune in nature. It’s not just the thyroid malfunctioning from a nutrient standpoint, but it’s the immune system attacking the thyroid tissue.
When you have one autoimmune condition, you have a 76 percent chance of having multiple autoimmune issues. So if you have a thyroid issue, you may also have subclinical gluten sensitivity, or type 1 diabetes, or MS, or leaky gut—one of the driving factors of autoimmune conditions.
You may have a thyroid issue with no digestive problems, but part of that mechanism is coming from the gut. How does that happen? No diarrhea, bloating, gas, or acid reflux.
We are digging in deeper. Getting the grains out, getting rid of the autoimmune trigger foods. Maybe going on an autoimmune Paleo shtick for some time. Maybe we’re supporting glands that aren’t the thyroid, like the adrenals. Or we are looking at the gut or the mitochondria—because of the leaky gut, you have malabsorption of B vitamins and the mitochondrial nutrients aren’t there.
Often we are treating a condition that is not the root cause; often it’s the immune system and the gut that’s driving it.
Abel: What are people suffering from that they might not realize?
A lot of people are on medications like SSRIs or mood-stabilizing drugs, but many of the mood issues are gut-related. We have lipopolysaccharide (endotoxin, or LPS, for short) that’s from bad bacteria in the gut that can actually pass through the gut lining.
Foods like gluten, and inflammatory fats and bacteria in the diet unzip it a little and allow particles like LPS into the bloodstream, which then passes into the brain and can cause mood issues, depression, and drive fatigue, because it poisons the mitochondria, which is like the powerhouse of the cell.
People are so connected to energy problems as a caffeine deficiency, or needing more stimulation, or in the more conventional medical world, they may throw Adderall or other methamphetamines at it.
Abel: Speed is a weight-loss therapy for a shocking amount of people.
Back in the day it was phentermine injections, until they found it was causing heart issues.
Abel: What about someone who is just dipping their toes in citizen science, individualized health, biohacking—what should you pay attention to first?
I learn so much from my patients. Research is helpful, but the problem with true science is you have to control one variable. Let’s say you have someone not sleeping well, eating inflammatory grains and sugar; they have mood issues, are not handling stress well, and are not hydrating enough. That’s like six variables I just mentioned.
So are you going to change one a month for nine months, or are you going to change them all now and see how that lands?
We are changing so many variables: nutrition and supplements, getting inflammatory compounds down, getting toxins out, boosting nutrient-dense food and high-quality fat, and fixing the gut and the hormones. There are so many variables that using conventional medicine would take forever.
Start with the foundation principles: sleep, hydration, a Paleo dietary template. Make sure that it’s non-dogmatic, so you can switch the dials later. Finally, keep the toxins out of your body. You can fine-tune all the rest later.
Abel: As someone who has treated a lot of patients, would you say everyone is the same, or are we wildly different?
There’s a predictable way in which people break down:
- Stress-handling glands break down first.
- Your ability to deal with blood sugar goes down.
- Inflammation goes up.
- Gut integrity starts to go down.
- Ability to break down foods goes down.
Once we have malabsorption, that affects mitochondria, detox pathways, and neurotransmitters, because that all comes from protein and nutrients in the gut.
Once you have those functional imbalances, the symptoms that happen are unique to each person. The functional imbalances, or body systems that start to malfunction are typically the same—someone can have autoimmune thyroid, and others adrenals—but the symptoms that present themselves tend to be more on the unique side.
HOW TO SLOW AGING (YES, YOU REALLY CAN)
Abel: What about aging? Do we have any control over it?
We can control aging—when we age, stomach acid goes down, so we maybe have an impairment to break down good foods. So if we have twenty years of not breaking down good foods and we’re already eating bad foods, that’s obviously going to accelerate that aging process.
These three things accelerate the process: not getting enough vitamin D, sleep issues, and mental mindset.
The aging process is just a magnification of mistakes that are made right here, right now.
We know this because we see people like Jack LaLanne, who kick butt into their late nineties, and some who die in their forties and fifties and have terrible quality of life.
Abel: I’ve been thinking about the idea of someone like the Rock, who earlier in his career had no neck and a big puffy face; he’s doing things differently now. There are people who are in great shape their entire lives and that serves them well. Then you have the elite athletes who trashed themselves, or something went horribly wrong, and it seems like because they were training that hard, they are now in poor health or died early.
As it pertains to health and athleticism, what’s the breakdown? Are you doing yourself a service by being athletic your whole life, or are you wearing yourself out by putting more mileage on your body?
I’m a big Patriots fan. I’m from the North Andover area in Boston. Tom Brady isn’t the best “athlete.” If you looked at him in college, even in his first draft year, Tom talks in 2007–2008 when he got his ACL injury. He talked to some functional medicine practitioners, and functional nutritionists, and he says his performance got better after that year.
If you look at someone who’s been in the NFL for sixteen years, he’s gotten better each and every year, and has accelerated by eating high-quality organic foods, seeing functional medicine practitioners and chiropractors, and he’s getting eleven hours of sleep a night.
If you look at people next to him, they’re not quite the same. I’ve worked on a lot of NFL athletes. They’ve excelled their whole lives and kicked butt in spite of their bad habits. They have ten or fifteen years of bad habits, and they’re in the NFL or pro sports and get injured; they lose a step or two and they’re gone.
Then you see someone like Tom Brady or Julio Franco; in the ’90s he had a twenty-five-year career and was notorious for bringing his own organic food because he knew the nutrition part was so helpful. At that level, you’re dealing with an equal level of talent… but what happens when you get injured?
Abel: From what I’ve read, Tom Brady follows a Paleo-ish autoimmune diet—about 70 to 80 percent plant foods. He’s not eating nightshades to keep inflammation down.
He eats about 20 percent meat. His chef is a vegan chef, but his vegan chef makes him Paleo foods. High-quality fats, beef, fish, no grains, no refined sugar. I did a whole podcast on this.
Someone like him gets hurt and gains a step—gets faster and better. He gets ten hours of sleep a night. That’s amazing!
Abel: Kobe, LeBron, a lot of people at the high level later in their careers are doing this because they see it can turn back the clock. Even if you look at my biomarkers now compared to ten years ago, I am ten years younger now! Your longevity, the way you think, everything is tied up in this. What are some before-and-afters that you’ve seen?
I’ve seen people with thyroid issues who have antibodies in the 1,000 to 2,000 range, which is very high if you’re familiar with TPO antibodies for Hashimoto’s, get down into the low hundreds, if not negative.
I’ve seen people with tons of gut issues that are totally resolved. We’re not curing anything; we’re just fixing underlying imbalances in the diet and biochemistry.
The thyroid, energy, fatigue, chronic infections—a lot of people who have these stressors find it affects their digestion and decreases their ability to make this protective membrane called IGA mucosal membrane barrier… and critters can come set up shop. Chronic infections wear on the anti-inflammatory pathway, your adrenals and cortisol, and affect malabsorption and set you up for bacterial imbalance.
Abel: Autoimmune can be a life sentence for a lot of different problems that get serious fast. So if someone’s listening and they do have a hint of autoimmune issues (maybe psoriasis or gut), how can you turn that around? Some have been told they don’t have hope.
The food trigger is a big one. Autoimmune Paleo is the first step. It’s slightly different from your program because it’s cutting out nuts, seeds, nightshades, tomatoes, potatoes, eggplant, peppers, and eggs. You cut those out for about one month and then slowly reintroduce them.
Second, if you’re not breaking down healthy foods, that’s a problem. Good food that sits on your counter will rot. Same thing happens in your gut when you’re not making enough hydrochloric acid and digestive enzymes.
Third is infection. If you already have an infection in the gut, your bacterial balance is skewed. That’s where 70 to 80 percent of your immune system lives.
Good bacteria eats poop and poops nutrition. Bad bacteria eats nutrition and poops poop. Bad bacteria actually adds more toxins to your gut, but good bacteria adds more nutrition to your gut.
Abel: Most people don’t think about their gut and body as an ecosystem. The answer is in honoring nature, not fighting it.
If you want your leg amputated, Western medicine is there for you. But if you don’t want your leg amputated, there might be a better way of going about this, and the science in preventative and functional medicine is getting so much better recently.
What’s really feeding the sheer magnitude of sickness we are seeing today? It does seem unprecedented, obesity, autism—is it toxins, food, everything?
For the diet piece, check out Gary Taubes’s book Good Calories, Bad Calories. It started back when they basically created the food pyramid out of bad science.
Today we eat 150 to 160 pounds of sugar a year. I eat none. So someone out there is eating more to make up for me.
We need to look at refined sugar. If we’re eating more sugar and carbs, what are we missing out on? Good fats.
Then we need to look at the 2 billion pounds of pesticides dumped on us per year. These are organochlorine compounds that kill insects by destroying their nervous systems and affecting their reproduction. What are they doing to us?
If you watch the documentary The Disappearing Male, you’ll see that this whole case of estrogen dominance and all the estrogens in our environment is driving fibroids and PMS and infertility in women, and affecting men with gynocomastia (manboobs).
Also, the overdose of antibiotics has knocked out a lot of our good flora.
Our guts are a breeding ground of toxins, refined sugar, and antibiotics that are used out of “necessity.”
Abel: One question that comes in a lot is about low testosterone. What do you do to reverse that?
When you take in more female-based hormones like estrogen through the water, plastics, and pesticides, that inhibits the compound in the brain called LH, which tells your gonads to make testosterone. You’ve disrupted that communication feedback loop.
A lot of people are stressed, and a good deal of sex hormones comes from the adrenal glands. Because of blood sugar and other stuff in the gut, your adrenals are constantly dealing with stress and lose their ability to produce DHEA—a precursor to the sex hormones responsible for providing some of the anabolic sex hormone building blocks, which basically help build you up, keep you lean, and help you put on muscle.
Abel: What about day-to-day lifestyle changes?
Keep cortisol down. Cortisol and growth hormone are intertwined.
Hormonally intelligent exercise. Again, why do you exercise? You do it to create insulin sensitivity to help keep insulin on a good level, because high levels of insulin shoot fuel to your fat cells rather than your mitochondria. It also stimulates growth hormone and testosterone. Resistance training movements, compound movements—front lunges, deadlifts, lunges, step-ups, sprints.
We have the foundation—Paleo diet template, sleep, water—then we can look at supplements to help with adrenal glands: DHA, pregnenolone, eleuthero or siberian ginseng. Getting nutrients up like zinc is so important for sex hormones, along with selenium. Plus adrenal support, if you’re under the guidance of a good functional medicine doctor.
Abel: How do we find a good doctor? What do you recommend?
Find someone on YouTube, a blog, a website, or a podcast that resonates with you. You want to make sure the information feels good. There are a lot of great people with good sites and great info. I am available virtually worldwide. I am booked out quite a ways with patients, but I’m always willing to help.
Abel: It’s proactive health. What we all can take away is “Be easier, track our stuff.” You can get a Fitbit to track your sleep. It will surprise you when you see what you’ve been eating, how you’re sleeping—we’ve unlocked so many insights about our lives.
Me, for example, I’m a light sleeper; even if I’m in bed for nine hours, I might only get seven hours of sleep.
IS ALCOHOL OKAY?
What about with alcohol? Do you sleep lighter with alcohol?
Abel: If it’s a small amount of clean alcohol, one or two, it’s very different from six. I’ll wake up in the morning and I can tell. Even if it’s one or two, usually. I get that question a lot—there’s a huge difference between having two drinks every night (fourteen drinks a week) and having two drinks one night a week.
What are some other quick tips for real life?
When it comes to alcohol, if you can handle it, have some clean alcohol. I like my version of a Moscow Mule: Tito’s vodka, ginger kombucha, half an organic lime. Dry prosecco or champagne are good choices. Or Robb Wolf’s NorCal Margarita: half a lime, a shot of tequila, and carbonated water.
If you’re getting exposed to toxins, activated charcoal and vitamin C are a great combo. If you’re going to indulge, that’s a great way to buffer some of that.
WHERE TO FIND JUSTIN MARCHEGIANI
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BEFORE YOU GO…
We just wrapped up our Sugar Detox Challenge in our online community, the Fat-Burning Tribe. Congrats to all of you—we’re stoked to help you get the sugar monkey off your back. Sugar is a nasty beast.
I’m on day 22 and still going strong. I’m on a roll! I’m down another inch in my waist and in my hips, too! 5 more pounds down. What a lovely benefit.
It amazes me how I’ve changed. A few months ago I would never have managed this. I now realize that sugar or sweeteners is a major trigger for me and I need to just stay away from them all—at least for a while. Thanks for challenging me.
Rick from the Tribe wrote in to say:
Even though I’m new to the Tribe, I’ve been following The Wild Diet for about a month. I’ve lost 22 pounds and most of my pants are starting to fall off. I had to buy new pants and tighten my belt. I look forward to getting in great shape and continuing to eat healthy. I made the Baked Spaghetti and Meatballs tonight and it tastes great!
Congrats, Rick! As much as we dudes loathe shopping for clothes, it’s a lovely problem to have. Glad you dig the spaghetti and meatballs, man!
We’ll be kicking off a new challenge in the Tribe very soon, so be sure to join us!
My wife, Alyson, and I have been tinkering in the kitchen for years to make real food taste great.
And we have brand new Wild recipes for our members. We’re talkin’ Slow-Roasted Ribs, Persian Kebabs, Chicken Tikka Masala, the delectable Wild Pumpkin Bread, and tons more.
If you want all these recipes and done-for-you Wild Meal Plans to help you burn stubborn fat, listen up. You can get all of these goodies and more for a limited time when you join The Fat-Burning Tribe.
If you want to level-up your health, get back to your high school weight, and eat some of the best food you’ve ever tasted, we’re waiting for you in the Tribe.
What did you think of this interview with Dr. Justin? Leave a comment below to let us know!