Frequently Asked Questions

I get asked a lot of questions when people start implementing change into their lives, it is completely understandable. In my mind there is no poor question. However, in an attempt to save all of us time I have made a list of the most common questions I receive. If your question is not on this list – fire away. I will always do my best to get back to you in 24 to 48 business hours.

 

  1. Where do I put this Adrenacalm lotion stuff?

Adrenalcalm is applied to vascular areas. I like the inner elbows and the back of the knees. You can also put any excess on the back of your neck.

 

  1. How do I dose digestive enzymes and HCl?

I use multiple digestive support products. You likely have something from APEX, Pure, or Designs for Health. They are similar and we follow the same dosing strategy for all of them. We titrate up AKA you start with one pill before or after the meal. If you do not feel a warming sensation at anytime up until the next meal move to 2 and so on until you do feel a warming sensation. Then back off one and that is your dose. For example, if you feel a warming sensation at 3 your regular dose would be 2. Then after a while you may feel a warming sensation with 2, so back off to 1. I also do not take digestive support with shakes. I do like to fake chew them though to kick start the digestive process.

 

  1. How do I dose Magnesium?

There are many different forms of Magnesium that are used for different needs. I mostly use Mag Citrate or Glycinate. But baths and topical formulations can be even better, however adherence tends to be more difficult with these strategies. Nevertheless, the top end dose tends to be 5 times your body weight in pounds, but some clinicians will even go over this in some circumstances. Thus, if you are 200lbs that would be 1000mg. Most folks get up into this range and Magnesium is one of those supplements that can really be a godsend for folks struggling with energy levels or constipation. When you start taking Magnesium, titrate up slowly, perhaps 100-150mg each day. If you get loose stool in the morning back off. You have reached GI tolerance for the present moment.

 

  1. How do I organize all these supplements so I don’t miss anything?

I love this geriatric pill organizer. It’s cheap and I load it up once a week and then don’t have to think about it again. The liquids can be a bit tougher. I always have them around a meal and for vitamin D and fish oil if you miss one day you can just go double the next as they are fat soluble not water soluble.

 

  1. Which supplements do I need to refrigerate?

Most anything that is a liquid keep in the refrigerator, specifically Resvero, Turmero, Coq10 Active, Fish Oil, and Ultra D 5000. Also, any probiotics should be refrigerated. Better to be safe than sorry.

 

  1. I am confused about this glucometer protocol, what do I do and what do I buy?

Yes, I am asking you to bloodsport yourself for a few days. But if you have diabetes this is kind of your life so it is a good reminder about how you don’t want to have to exogenously take over your blood sugar control. Here is a link to an article about re-using lancets and the protocol is below.

Glucometer protocol

Take measurements at the following times for three to five consecutive days with at least one workout day.

Upon Waking

Pre-Meal

1 Hour after each Meal

2 Hours after each Meal

3 Hours after each Meal when possible

Then create a spread sheet of what you eat when you workout and what your values are so we can get a really good picture of your day. (I have a great example of this that I include in your follow-up)

I like the True Result glucometer – cheap and accurate. You will need more striped which you can purchase here.

 

  1. How much should I work out?

This is a superb and loaded question and one with the most individualized of answers. If you know me, you know that I get very grumpy when it comes to the training recommendations handed out by Functional Medicine practitioners. They tend to use very generalized recommendations, that could be great for some and flat out dangerous for others.

My favorite way to think about your training load is using a methodology contrived by Dr. Mike T Nelson. Dr. Nelson breaks all stressors into either eustress or distress. Distress workouts leave you in a puddle of sweat staring at the ceiling fan for half an hour. Eustress workouts leave you energized and feeling better than when you came in the gym. Dr. Nelson likes to judge facial expressions, in distress workout you will be grimacing and showing the pain on your face. In Eustress workouts you will likely be smiling, maybe even outside, and the reps won’t ever get to excruciating.

This is all individual. A eustress workout for Ethan Grossman would likely leave me dead. A eustress workout for me may kill you. It is all about matching the intensity with the person and making sure quality and adaptation are what we are chasing.

Here are my three rules for the majority of your training. 1) You cannot be flat out exhausted after the workout. 2) You cannot be exhausted later in the day around 7 or 8pm. 3) You have to make sure you are actually improving.

If you have the financial capacity, hire a coach. Please! I have a coach and I recommend all athletes and coaches have a coach. All of us are generally very poor at taking an objective view of what we need to do and how we move.

Here are a list of just a few of my favorite coaches who understand and respect physiology and the Functional Medicine Process.

Aaron Davis – Austin, Texas – Works Remotely

Patrick Estes – Austin, Texas

Logan Schwartz – Austin, Texas

Paul Monje – Austin, Texas

Patrick Massey – Austin, Texas

Jayci Cormier – Austin, Texas

Teo Ledesma – Austin, Texas

Dave Rascoe – San Marcos, Texas – Works Remotely

Jack Wheeler – San Marcos, Texas

Michael Wright – San Marcos, Texas

Phil Janzen and Daniel Martinez – San Antonio, Texas

Dr. Mike T Nelson – Twin Cities, Minnesota – Works Remotely

Joe Giangrasso – NYC – Works Remotely

Dr. Pat Davidson and Ethan Grossman – NYC

Gerard Friedman – Brooklyn, New York

Jim Laird – Lexington, Kentucky

iFAST – Indianapolis, Indiana

Endeavor Sports Performance – Philadelphia, Pennsylvania

 

  1. What if I don’t feel good when I eat foods on the AutoImmune Paleo or Elimination Diet?

Don’t eat them. These type of diet protocols are best guesses, in that they are protocols that exclude the most common food allergens and immunoreactivities i.e. gluten, grains, nuts, shellfish, night shades, eggs, coffee, dairy, soy, etc. But that does not mean that you don’t have reactions to other “healthy” foods that you eat more often. The ultimate goal of these programs is to make you cognizant of how food makes you feel, but also not hyper aware and OCD about it either. Take an objective view of the process and take the reintroduction protocol very seriously as that is where we get to reintroduce and see how you react to certain items with a clean slate.

 

  1. I am through this elimination diet stuff, what do I do next? I want pizza!?

Ok, put down the pizza. If you eat that and react, was it the gluten? Cheese? Tomato? Peppers? Mushrooms? Who knows! We have to be more scientific than Papa Johns.

When we reintroduce food items we only want to reintroduce items one at a time over a three day period. Maybe, the first food you want to reintroduce is eggs. So you have some eggs one morning and then pay attention for the next few days on how you feel. If you feel bad you wait for all symptoms to clear and then give yourself a three day grace period of keeping it the same and then you try try again. At the thirty day mark I always shoot out a full write up about how to take on this process. Elimination protocols are the gold standard in research and it is important to acknowledge that there may be some placebo effects going on here. I know it is tough, but you have got through the initial protocol and likely feel pretty great. Enjoy the process, don’t fall off the wagon now!

 

  1. Before I started this elimination diet I could eat all the cupcakes and ice cream I wanted, but now when I eat those things I feel horrible! What did you do to me!?

For many people they have been fighting a war in their guts for a long time. Imagine Braveheart or Vikings when everyone is dead or rolling around on the ground moaning with spears in their thighs after a battle. Then there a couple guys walking around cleaning things up. This is what many people’s immune system is like in the GI tract. They are not reactive because the war has been going on for so long and they cannot mount any kind of substantial attack. Then we put you on an elimination protocol and you give the battle a break. You recoup your forces, sharpen your weapons, and train new recruits. Then after the protocol is over you go to war again and you get symptoms, sometimes horrendous symptoms because now your body can actually attack something.

“The body ignores constant stimuli.”

-Dr. Bob Rakowski

We can test for food immunoreactivities but the only testing worth anything is Cyrex IgG and IgA testing and even that is far from bullet proof. You can still be intolerant to foods and not immunoreactive. This is a discussion that we always have after someone has gone through this testing. Figuring out what food you thrive on is a journey, but I can gaurantee you that is likely not made up of consistent cupcakes and ice cream. Sorry.

 

  1. Can I have coffee? How much should I have?

Coffee is the over protective boyfriend of foods. People clutch the mug of luscious black or brown liquid with a death grip. I think this has to do with the fact that it is a drug, but also because we enjoy everything surrounding coffee. It symbolizes slowing down or getting lots of work done. It has an earthy smooth taste that many of us love. It has an aroma that fills the house as the sun rises. I want some right now! If you can eliminate caffeine effectively the research shows that it is very healthy and coffee is extremely high in anti-oxidants. Caffeine even has the ability to up-regulate detoxification enzymes that clear environmental estrogens.

However, some people can’t take it or at least need a break. It is estimated that somewhere around 10% of the population should avoid caffeine entirely because they don’t clear it well. However, you can also have poor clearance time of norepinephrine and epinephrine which would also indicate that you should not consume copious amounts of caffeine. We can test all this with genetic testing (23andme.com) that you do not need me to order. Also, if your HPA axis is highly dysregulated you are going to want to take a hiatus from caffeine to give your body a chance to heal.

This is a very individual question and I always try to help people find individual answers. I drink almost exclusively decaf and some green tea now and then. My energy levels are great and my sleep is terrific. I also never consume any caffeine in the afternoon or evening.

At its root we have to treat coffee as a tool, not a crutch. We have to examine whether our coffee consumption is a positive or negative on our health and we must understand that this may change with time.

 

  1. What water filter should I buy?

I like the brand ProPur for both counter-top gravity filters and shower filters. But there are many other brands who have quality products. Just make sure that it has solid testing behind it and for the love of Zeus don’t drink tap or bottled water.

 

  1. Where do I get bone broth!?

If you are in Austin Picnik sells a good one. If you make it yourself there are many recipes out there, just make sure that your bones are from organic, grass-fed, grass-finished happy animals.

Here are some recipes from the Primal Jar creator himself Dave Rascoe. Keep it within the community.

 

  1. What should I store my food in?

Glass. After reading this I want you to discard of all your plastic cups and Tupperware. This will likely cost you less than 100 dollars to replace your current set up with Pyrex containers and Mason Jars.

 

15. What personal care products can I use?

This is something I don’t generally have time to discuss in consults but it is incredibly important. I think of this very simply, if you wouldn’t eat it don’t put it on your lips, skin, or hair. I used to spike my Mohawk every day with this fancy glue gobbity guck. Then I plugged the ingredients into the environmental working group’s skin deep website and it was full of allergens and endocrine disrupting chemicals. Eeeeek! Now I only gel up my hair for important events, like one date a month with my wife. I have also checked my soap, shampoo, and deodorant and they all come back very clean. I recommend you do the same with all of your personal care products and clean out your bathroom and head to Whole Foods for cleaner healthier products.

 

If you have any further questions email away to drhouse@functionalmedicinecostarica.com!