A Functional Medicine Approach

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A Functional Medicine Approach with Rich Jacobs
Aug 8, 2016

Rich Jacobs is a functional medicine practitioner who is committed to helping women overcome health issues such as fatigue, insomnia, and low libido. He became passionate about helping others holistically through his own health issues that doctors couldn’t resolve.

Rich comes on the show to talk more about functional medicine and how this holistic approach helped him take back his health and decrease certain concerns that he was having.  Rich also addresses why weight gain may not be from overeating and ways stress affects hormonal imbalances.


  • What is functional medicine?
  • Just what makes Rich so passionate about functional medicine?
  • The effect that stress has on our body
  • How our gut is tied to health
  • Your weight gain may not just be overeating.
  • What is DRESS? And why Rich takes this approach



Dr. Meaghan: Hello everybody and welcome to Podcast 158. Today I welcome Rich Jacobs to the show. Rich Jacobs is a functional medicine practitioner who works with individuals to help them to reach their goals through a functional medicine model. He is sharing so much information with us today about exercise, diet, and what role it plays in health and wellness, a great conversation that everybody should listen to. I thank Rich for coming on the show and sharing all of his expertise.


Hello everybody, and welcome to Beyond the Basics Health Academy Podcast. I am your host Dr. Meaghan Kirschling. Today, I’m joined by functional medicine practitioner Rich Jacobs. Hello, Rich. How are you?


Rich: Good, Dr. Meaghan. How are you?


Dr. Meaghan: I am doing really well, and I appreciate you coming on. I’m going to tell the people a little bit about you first. You love to work with women, especially the age range 25 to 45. You help them to overcome common health issues, such as fatigue, insomnia, and low libido. That’s something that a lot of individuals can obviously relate to. As a former collegiate strength and conditioning coach, you understand the spectrum of health from athlete to non-athlete. You really work with everyone in that spectrum. Also, you are passionate about helping others holistically through their own health issues that doctors can’t resolve. You do this through functional medicine and the health detective skills to really find the cause of common health issues.


We’re going to talk a lot about that and your approach. We’ll also discuss why you think that there are so many people that are falling through some of those loop holes in medicine, and how you can help them with their health issues. Thanks so much for coming on the show.


Rich: You’re welcome, and thank you very much for having me.


Dr. Meaghan: I would love for you to start out by talking a little bit about functional medicine. Let us know why you’re so passionate about it.


Rich: Great. I am so passionate about it because I actually had a lot of those health issues that you mentioned myself. As a former college strength coach, I was obviously very athletic and kept myself in shape. Then suddenly, in my mid-30s I had low libido, sleep issues, unexplained weight gain, and bloating. I had everything going on. I went to see several doctors, like most people do. They took the blood draws and the lab work, which they all do. And they all came back normal. Of course I wasn’t feeling normal, but the best they could do was give me a couple of pills to treat the symptoms.


Inherently I just knew that there was more going on than that. That’s when I did more research on holistic ways to heal the body. That’s when I found functional diagnostic nutrition.  It’s actually one of the main teaching programs out there in functional medicine. I took that course to teach other people, but also to heal myself. I became very passionate about helping others and showing others that there is a way to feel better. Even if nobody believes you that you have these symptoms, you really want to find that root cause and treat it.


Dr. Meaghan: I think it’s important, because I think a lot of people are going to relate to this. What it sounds like is you were in your 30s, what anybody would look at and say, “You’re a healthy individual,” because you had always worked out and taken care of yourself. I’m assuming you went from doctor to doctor, and they were telling you that there was nothing wrong.


Rich: Yeah, that’s exactly it. Obviously that’s very frustrating.


Dr. Meaghan: I think that that’s one of functional medicine’s strengths. There can be this dysfunction that doesn’t have to be a disease. So many people like yourself are falling through the cracks because aren’t necessarily diagnosed with a disease. They can’t say, “This fits into a perfect little diagnosis,” but there was definitely dysfunction.


Rich: Yeah. The challenging part about chronic diseases is that there are many different ways that they actually manifest. It’s hard to figure out where and even when these symptoms occurred. It all starts with the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. It can stem off into many different directions from there.


Dr. Meaghan: Stress is also one of the things that you look at. How the stress affects everything, but especially things like hormone balance and sleep cycles, etc. You really do work a lot with the stress response and how it affects different parts of the body.


Rich: Yeah. I don’t just look at external stressors. We all have them, of course, it’s just how we deal with them. I also look at the internal stressors. For instance, what else is going on inside the body, particularly in the gut or digestive tract, areas that most of us don’t think about checking.


Dr. Meaghan: I think that’s one of the big things too. A lot of times where the problem stems from, or the stress that is causing our bodies to not function at that optimal level, might not even be something that we’re tuned into. We might be having headaches, but they could be coming from the gut.


Rich: Oh, yeah. It’s funny because many years back I became lactose intolerant. Of course the Internet was fairly new at that point, and I didn’t really know what was going on. I just knew that all of a sudden I couldn’t drink milk without having some issues. Of course now, years down the road, I know that that was my first warning sign that things were changing. I did have a lot of stressors in my life. When I hit that tipping point that you’re talking about, it tipped me over into the cascade of symptoms and illnesses and kind of knocked me out.


Dr. Meaghan: When that happens, it affects every part of your life. I’m sure you were noticing you were no longer sleeping right, working out right, feeling right. Yet everybody was telling you that it was normal, that you were normal. You were healthy.


Rich: Yeah. Of course, later I learned that normal is a relative term. There are a lot of common things out there, but not normal. Obviously through the research, training and practice, I see that there’s a lot of common and not a lot of normal out there.


Dr. Meaghan: There are so many people walking around not feeling optimal. Whether it’s through eating something that they shouldn’tt, inflammation, or oxidative stress, etc., our bodies can sort of get used to things changing. But it’s not optimal. I think that’s where functional medicine is really strong. You’re saying, “Let’s get it so that it’s optimal.”


Rich: Yeah, absolutely. The body is really good at adapting. If you do have a stressor, or you do deal with bloating, for instance, eventually you get used to it and you just deal with it. A more common one, of course, is PMS for females. It’s not common to go through, but how many women out there say, “No, I don’t have any symptoms?” In America, I would say it would be tough to find even a few.


Dr. Meaghan: I think that’s a really important thing. Whether it’s PMS, chronic fatigue syndrome, fibromyalgia, some of our autoimmune diseases, are a sub-optimal function that we need to address. It’s not a deficiency of a drug that we’re missing, but the fact that one of our pathways is no longer working optimally.


Rich: Yeah, absolutely. The funny thing that a lot of us forget is that the body is made to repair itself. It actually does know how to heal itself and be optimal on its own. We just need to allow that pathway to occur so that it can actually heal and then move on.


Dr. Meaghan: Yeah, I think that that is so important. I know you work with a lot of athletes and Crossfitters, and others across the board. One of the things that people are really tuned into is weight gain. I know one of the things that you talk about is that weight gain may not just be overeating.There are other things that go into weight gain. I would like to touch on that, because I think that it’s such an important topic for so many people.


Rich: Absolutely. I know there’re so many people out there who work their butts off at the gym or in Crossfit or running, etc., even eating healthy, and they’re not getting the results that they want. Because of my background, I enjoy working with that type of person. Is your audience familiar with some science behind this? I’d love to teach a little bit. It’s kind of like that light bulb that goes off.


Dr. Meaghan: I love education and teaching, so I would say start from the basics and teach away.


Rich: If you’re looking at the whole system, cortisol plays a huge role. It controls not only circadian rhythms, stress response, and energy production, but glucose regulation, which is sugar. The brain basically works on glucose. When you get dysregulated, you have cortisol and insulin-producing a lot of inflammation. On top of this, now you have visceral fat. Visceral fat is that fun fat around the organs. It’s created by too much cortisol and insulin over a long period of time. The thing about visceral fat is that now it’s creating its own inflammatory markers. This starts that vicious cycle.


Going back to the HPA axis that we talked about earlier, hypothalamic-pituitary-adrenal axis, half of that is in the brain, and glucose is the primary source of fuel. With the hypothalamus being in the brain, it’s going to be very sensitive to the glucose level changes. For example, waiting too long to eat between meals, or having too many carbs, makes blood sugar go up and down, up and down. Hypoglycemia is common because people decide to skip breakfast in the morning. This affects the HPA axis and throws everything out of balance. Your body has to compensate for that.


Looking beyond glucose regulation, the HPA axis is involved in energy balance, insulin sensitivity, metabolic function, food selection, and satiety. It’s no surprise that increased stress is going to increase the amount of comfort foods that people eat. The high fat, high sugar, high salt foods. These have all been shown by research to alter the stress hormone response in the brain. It makes people crave more of these foods when they’re under a lot of stress, because it’s almost a physiological therapy. That’s actually a big sign, when I start working with people. I start by asking, “Do you have these cravings for sugar and salt?” If they say, “Oh yeah, I love putting salt over everything,” it’s the first sign that we have to go a little deeper.


Looking at these facts, it’s apparent that the stress cycle disrupts hormone function and hormone signaling. I’m getting to the point of weight gain. You have stress, which can lead to weight gain. Then you have obesity, or if you start to put on too much weight, it now leads to more inflammation. Once you get into the cycle, you have stress, which leads to inflammation, which leads to weight gain. But now you have this weight gain which causes more inflammation. It’s this vicious cycle that it’s hard for people to get out of.


Dr. Meaghan: I think that’s a really important part to drive home. Once there is that weight gain and these changes in hormones, it causes more inflammation. It’s sort of like that inertia, where you’ve got that small snowball that’s rolling down a hill and gaining speed along with more snow as it goes down.


Rich: It’s brutal. These poor … I always say women. It happens to men too, but I work a lot with women. These poor women who are doing everything right, are just having trouble getting out of that cycle. Now you apply the principle to our weightloss-aholics, or our crazy Crossfitters trying to lose weight. Now they’re under eating, because the theory is still out there that, hey, if you eat less calories you’ll lose weight. I can’t wait for that to die.


Dr. Meaghan: Me too. I think we’re in this one for the long haul though. I too can’t wait for that one to be buried finally.


Rich: Yeah. That’s stressful, because of hypoglycemia and blood sugar levels if you’re not taking in food. Then you’re overworking at the workouts, and that’s putting even more stress on the body. Here you are trying to under eat and overwork, thinking that you’re going to lose weight, and really the reverse is happening. You’re causing more inflammation with this. Part of what I do with people is actually tell them, “You need to eat more and work out less.” That just blows their mind. Nobody wants to hear that, because it doesn’t make sense to them. Ultimately we have to start somewhere, and usually people are overworking and under eating.


Dr. Meaghan: I would love to know what you recommend because once you get into that fallacy it’s hard for people to let go of. They’re getting this from all different angles, that the less you eat the more you’ll lose weight. And it’s just not true when you’re in these metabolic situations. I’d love to talk about fat also because the other thing is a lot of these people live in fear of fat. They don’t want to eat fat because they also believe that it’s going to make them fat, when really it helps the stress response and the glycemic responses, etc.


Rich: Absolutely, and the right kind of fats. These are fats from nut butter and from animal meat if you’re not vegan, olive oil, coconut oil, etc. People who I put on high-fat diets actually eat fewer calories than people who are on low-fat diets. It happens for a couple of reasons.


The obvious reason is that fat is more satisfying, satiating. It’s very dense and it makes you feel full. It stays in the stomach for a long time, because it takes longer to digest and to break down and to move on. Less apparent, carbohydrates activate hormones in the brain. I don’t have to get too scientificbut this makes you more hungry. You keep eating carbs, and your brain is like, “Oh yeah, this is good. Let’s keep eating,” if you’re not combining that with a protein.


Most importantly, because you’ve got to look at insulin and glucose, carbs are going to go through the stomach very quickly. They’re going to raise blood sugar very quickly, which means now everything has to respond to lowering that blood sugar. Conversly, a hig -fat diet doesn’t have a large effect on insulin response, so it can really keep your blood sugar more stable. We can go deeper. I don’t know how deep you want to go with this, into ketogenic diets, and how those can be effective.


Dr. Meaghan: I think more people are learning about ketogenic diets, and talking about their effects on brain support, glycemic support, and decreasing visceral fat.


Rich: Going on a ketogenic diet is basically keeping the blood sugar at a stable level. You’re not introducing carbohydrates into the bloodstream for at least 14 days. That’s kind of the magic number that the research has shown to be effective. That allows the body to use more of a ketone as energy, which is derived from fat. Tthe brain actually works well on ketones. I know I’m summarizing a lot here. When you’re working with ketones, the body actually functions better. People find that they are more clear, instead of the brain fog that might happen when you have the fluctuation in blood sugar.


In fact, I have a lot of athletes who I’ve put on ketogenic diets, especially endurance runners. I know that’s crazy, because you see a lot of endurance runners pounding Gatorade and Goo and all these fun sugars. However, the body can actually sustain the energy longer on a ketogenic or high-fat diet. I know you mentioned the belief that eating fat could cause you to gain fat. The opposite is true. In fact, having a high-fat diet can help lower your blood lipid numbers. You’re now teaching your body not to store the fat, and to use it as an energy source instead.


When you do that, you don’t have those cravings for carbohydrates. It all comes down to hormones and blood sugar regulation. When your hormones and blood sugar are regulated, you don’t have those intense sugar cravings. You no longer have ups and downs of energy.


Dr. Meaghan: That’s something so important that a lot of people don’t realize. First of all our body actually utilizes fat in a ketogenic diet not only better but also more effectively and efficiently, and we don’t see all the side effects that we do with carbs.


Rich: Yeah, absolutely. Not that carbs are bad, but they need to earn their place in your diet. In other words, if you’re at a desk all day, which I know many of us are when working, you don’t need carbohydrates to sustain that energy. If you’re working out, doing Crossfit, or triathlons, there’s a place for carbohydrates depending on your body composition. The leaner you are, the more carbs you actually need to help your body through some of those high intensity activities.


Crossfit is high-intensity training, when you’re going very hard and then taking a rest. That’s going to tap more into what’s called the ATP energy system, and that’s a quick energy source. Carbohydrates are needed in part to help feed that source when you’re very lean. When I say lean, I’m talking about men under 10% body fat, and women under 15% body fat. We’re talking fairly lean, like the men and women you see during the Crossfit competitions.


Dr. Meaghan: How do you recommend that they take in carbs? Do you recommend that they take them in throughout the day, before working out?


Rich: You mean if you’re already leaner?


Dr. Meaghan: If you’re already leaner.


Rich: If you’re already leaner, it’s more effective to take them in after workouts to help glycogen recovery in the liver. You don’t need them as much before that workout. However, with some of the bodybuilders and intense athletes, it can be more effective to start taking carbohydrates about halfway through the workout in liquid form.


Dr. Meaghan: Okay, that would make sense. Liquid form, do you recommend the goos? What are you recommending in liquid form?


Rich: In liquid form … no, I don’t like the goos.


Dr. Meaghan: I figured you didn’t.


Rich: Is this a loaded question? I think they’re too simple of a sugar, and I think they can spike too much, which will lead into a crash. Instead, I would actually combine let’s say dextrin or maltodextrin, depending on which one you prefer, with a protein or an amino acid. What I personally like doing is some dextrose, a little bit of glutamine, and branch chain amino acids about halfway through the workout.


Dr. Meaghan: Okay. You combine them then with some good amino acids and get the benefits of both.


Rich: I do. Because protein or amino acids, which are the simpler form of protein, help to slow down the digestion of carbohydrates so I don’t get a quick sugar spike. I’m still getting it in, but I don’t want to have that quick sugar spike, which will result in a drop later.


Dr. Meaghan: Perfect. For both men and women that are going through this, what kind of activity and exercise do you recommend?


Rich: Somebody who is already in dysfunction?


Dr. Meaghan: Yeah, in the dysfunction. Someone who has cortisol and visceral fat and is looking to improve those cortisol and stress hormones.


Rich: In my practice, I definitely use a handful of labs to find out what’s going on and where that client is at in that point in time before making recommendations. However, my overall recommendation is working on diet first. The diet that I really like to use is between the elimination diet, which I have through the Institute for Functional Medicine, or the Mediterranean diet. The Mediterranean diet is really good because it’s widely accepted by most people, and has actually been studied and proven to be a good intervention when dealing with dysfunction. It is proven to balance glucose and blood sugar levels.


That would be number one, working on diet before working out. More often than not, people who are in this situation usually aren’t eating the way they should be. It’s kind of like a risk/reward ratio. Don’t put them at risk to get hurt or to fail at the working out part. Start getting the good energy you need first, and then get out there and start moving.


If you’re going from somebody who sits at a desk all day and doesn’t work out very much right now, I would suggest just starting to walk around and maybe going on the treadmill or finding a partner to do some hiking. There are some Crossfit gyms who work with beginners. I’d be really cautious about that and do your homework. You can look into that, personal training. In other words, in the beginning, I highly recommend getting some structure. I definitely would recommend somebody helping you out, so that you know how to do it properly.


Dr. Meaghan: Perfect. I know obviously with these systems going off, and getting the hormones back into place, you might not see any changes or weight loss right away. Can you speak to individuals about what to expect for gains with this?


Rich: Yeah. Some of you are going to not like hearing this, but as you’re releasing those toxins, after you get on a good supplement plan, nutrition plan, and you start to detox all those bad chemicals out, the inflammation and the visceral fat, you might actually gain weight in the first couple of weeks before you start losing that weight. The release of all the toxins in the body could cause some more inflammation as your body is trying to deal with it and get it out, which is why I do recommend at least a multi vitamin, a good one, at the very least, to help assist in detoxifying the body.


Then after that, it really depends on the individual and where you’re starting. I’ve seen people lose four to five pounds a week, safely. I know that’s way above the range of what you normally hear of the one to three pounds. That’s mainly because a lot of that weight was inflammation, and once you start bringing that inflammation down, the body starts to relax and let it go. I wouldn’t necessarily say it’s unhealthy if that starts happening, as long as you’re eating well and working out smart and you’re doing all the things properly.


Dr. Meaghan: I think that’s important, because I’ve seen that clinically too, where people gained weight. They’ll say, “Of course I went on this and gained weight,” but it lets you know exactly how toxic your body was and how much stress your body was under, and after your body gets reset. A lot of times then that weight will come off.


I like the fact that you talked about sometimes when you get first into that de-inflammation state and start to lose the weight, you will lose significant weight each week. I also like to tell people during that time, “Just realize this is your body is going through the process of taking away the inflammation,” because then you might after that go down to one or two pounds, and then people are like, “Oh, this isn’t working anymore. I’m only losing a pound a week.” I think it’s good to touch on those concepts.


Rich: Yeah. That’s where the art in coaching comes in and managing expectations and reminding people that all this didn’t happen in two months. Although it might come off quickly, you’re not going to get rid of everything in two months. It’s going to take time.


Dr. Meaghan: I definitely think that that is a great thing for people to understand, because we’re geared to think that if we’re not going in the right direction or if it’s not happening fast enough then it’s not working. The most important thing is making these lifestyle changes, to make it so that these are things you’re incorporating into your life.


Rich: Yeah. That’s where I have the DRESS approach. This is all about lifestyle. You need all five of these things to work. DRESS is diet, rest, exercise, stress reduction, and supplements. Really work on diet and nutrition, really work with people on sleep and getting sleep, whether it’s a temporary relief with a sleep supplement or figuring out how we can change nutrition to sleep better. If you’re not getting sleep, you’re not going to get the results you want. That is when your body repairs itself, and you really need to get it.


Dr. Meaghan: I have a question about sleep, but you can go on to exercise. Get through the DRESS part so everybody understands it.


Rich: Exercise, we discuss the best route for that. I guess I’m a little different than other practitioners because I was a strength coach for most of my career, so I have a strong background in that area and how to direct people in that area. Some people just need yoga. I just read a research study today about Bikram yoga and how it’s been proven to decrease the stress response in the body. Quite honestly, I thought it was the opposite because of the heat, and how hot it was, but the research shows that it actually can be helpful in helping stress reduction. Sometimes I start people out with yoga.


Then that goes to the first “S” which is stress reduction. When I talk about that, that’s external and internal. I think I touched on that earlier in the show. That internal stress, that could be pathogens in the gut, that can be small intestinal bacterial overgrowth, that can be a lot of things going on that, unfortunately, doctors who are well trained in treating severe stuff aren’t looking for when you go to them. I touch on those areas, and that’s where the labs come in, to make sure that we can rule everything out and not miss anything.


Then the last “S” is supplementation. Unfortunately, because of our environment and our food sources, we need a little bit of supplementation, and you want to make sure that you get the proper kind. What I mean by that is that the air is more toxic than it used to be, so we need to deal with that. Food is not as nutritious as it used to be. I know all these topics can be a whole other podcast. We need to replace those areas. Even if you’re on a vegetarian diet, you still need to replace it. You’re not getting the same level of nutrients that we were even 50 years ago.


Dr. Meaghan: I do think that that’s one of the things that’s really important. People must realize that our environment and lifestyles lead to us really needing to be advocates for ourselves and make sure that we are taking a proper approach to health and wellness.


What I wanted to ask you about sleep is that sometimes your diet is what keeps you up at night and interferes with sleep. I’d like to touch on that briefly if we can.


Rich: Sure. It depends on the individual and what’s going on in their life. Over training, I often see that. I did another show where they asked me about over training, and I actually don’t believe in over training but more so under eating. In other words, if you’re not eating enough to support the energy that you’re spending, then your body is going to react in a negative way. A lot of times people aren’t eating enough, or at night people like to have a nice dessert. It’s the summertime, so people like to have ice cream at night or wine at night, and all these things can be very disruptive to sleep patterns.


A lot of times clients call me up and say, “Hey, I usually wake up at 2:00 in the morning, I’m sweating and hot, and I don’t know what’s going on.” Of course, we talk about nutrition, and a lot of times they’re having alcohol or high sugars at night, and that disrupts the flow of cortisol.  Again, cortisol helps manage blood sugar. If we have a spike, we’re going to have a drop. Oftentimes that drop occurs between 1:00 and 3:00 in the morning when the liver is healing. We have to discuss these scenarios and correct nutrition.


Dr. Meaghan: Something that people don’t realize is that when you look at the body and you look at sleeping, that we’re supposed to go through specific cycles and rejuvenate and restore. A lot of times what we’re doing right before we sleep is interfering with those cycles being in the correct order and going through the correct pathways during sleep.


Rich: Right. The typical American now is stressed out at work, they come home, they probably didn’t eat enough all day, so then they have a big shot of food at home at dinner with their spouse, and maybe a dessert and a glass of wine afterward. That’s the typical cycle that goes on and on and on, and so we don’t actually get good sleep, which means we actually don’t repair or regenerate.


Dr. Meaghan: That does make a lot of sense, and I think it’s something that people don’t think about a lot. Can you tell us a little bit more about how they can find out more from you? Where you are in social media, the Internet, all of those things, so that people can find out more about you and your comprehensive approach to health and wellness.


Rich: Thanks. My website is MyHealthDetective.com, or RichJacobsfdn.com. When you get there, you can actually get my free sleep report, and that will give you some of the information that we talked about today in more detail. My Facebook page is My Coach Rich. That’s about all I use right now.


Dr. Meaghan: That’s perfect. We will include all of those in the podcast notes so that people can find you, follow you, and get the information that you have out there, because I love your comprehensive approach to health and wellness and all the different things that you work with, with both men and women. I really appreciate you coming on the show.


Rich: Thanks, Dr. Meaghan, I really appreciate it as well.


Dr. Meaghan: For all of our listeners, I remind you to be kind to others, take care of yourself, and make good choices. Thanks for listening, and thanks Rich, for sharing all of your information and knowledge with us today.


Rich: You’re welcome, thank you.



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