“Most functional medicine practices out there, they’re still treating a problem, treating disease. My focus is really very precisely narrowed down to the optimization, to human performance. How can I improve really four things: better energy, better brain, better body, and better sex? Those are the four things that guys are looking for on a regular basis.”
– Dr. Tracy Gapin
Dr. Tracy Gapin is a board-certified urologist, a world-renowned men’s health & performance expert, and the founder of the Gapin Institute, the global leader in High-Performance Medicine. He’s an Aggie from Texas A&M, went to medical school at UT Southwestern in Dallas, and he completed his general surgery and urology training at the University of Florida. He spent almost 20 years in a busy urology practice in Sarasota, FL where he specialized in robotic surgery, and minimally invasive treatment for prostate cancer and men’s health before launching the Gapin Institute. Dr. Gapin is also a Fellow of the American College of Surgeons, and a member of the American Academy of Anti-Aging, Age Management Medical Group, and International Peptide Society.
Dr. Gapin is a thought leader, a professional speaker, and the author of the best-selling books Male 2.0 and Codes of Longevity. Recognizing our broken healthcare system only treats illness rather than promoting health, performance and longevity, he created the High Performance Living brand, including his proprietary N1 Performance Health program. He has over 20 years of experience focused on providing executives, entrepreneurs, and athletes with a personalized path to optimize their health and fulfill their highest potential. Last year, Dr. Gapin stepped away from his urology practice to focus on functional medicine full time and here, he shares his wisdom.
Functional medicine is really looking at the root cause of a person’s health, and Dr. Gapin dives into everything from the importance of gut health to how genetic testing allows him to create custom healthcare plans for his patients. We also discuss nutrition and optimal diet and how different individuals may have different dietary and exercise needs. Dr. Gapin shares detailed information about his offerings at the Gapin Institute and how other physicians can incorporate functional medicine into their own practices.
- How understanding functional medicine completely changed Dr. Gapin’s approach to helping his patients
- The importance of the gut biome and the impact genetics have on individual health optimizations.
- How a customized diet and exercise plan helped one of Dr. Gapin’s patients achieve his health goals.
- What to do if you’re interested in incorporating functional medicine into your own practice.
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Dr. Gapin: Most functional medicine practices out there, they’re still treating a problem, treating disease. My focus is really very precisely narrowed down to optimization, to human performance. How can I improve really four things: better energy, better brain, better body, and better sex? Those are the four things that guys are looking for on a regular basis.
Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna, a practicing physician and co-host of the podcast where we talk about physicians lives outside of work and ways to crush burnout, stories of achieving success on personal terms based on what success means to each of us as individuals. Physicians are not responsible for the broken parts of our health care system, but there are skills we can learn to put ourselves into the driver’s seat of our own lives, and we can benefit from coaching to accelerate that professional and personal growth. That’s what we’re here to talk about, physicians and their real lives, and we thank you for joining us. I do have a question for you, our listeners today. Is the Great Resignation real? Are you feeling it in your day to day in any way? I had someone call and ask me this earlier this week and I certainly am feeling it in my practice, and I’m curious what you’re seeing out there. Please feel free to message me at [email protected] and tell me what’s happening where you are. And if you enjoy the podcast, please take a moment to leave us a five-star review wherever you get your podcasts. That makes a huge difference to let others know about us. I’m thrilled to have with me Dr. Tracy Gapin, a board-certified urologist, men’s health expert, and owner of the Gapin Institute for High Performance Health. I’m excited to learn about Dr. Gapin’s story, how that has led him toward preventive medicine with a personalized approach, because our biology for each of us is unique. So why not treat your health and prevention of illness with a personalized approach? And I’m also interested in talking with Dr. Gapin about how this has affected his practice of medicine and ways that he would recommend for us to potentially add pieces of this to our own practices and hopefully improve the quality of care that we can give to our patients. Dr. Tracy Gapin, welcome to DocWorking: The Whole Physician Podcast.
Dr. Gapin: Oh, thanks so much. Glad to be here with you all this morning.
Jen: Really appreciate you joining us. Our audience is mostly physicians and we’re interested in hearing your story. It’s always helpful to hear the stories of fellow physicians, especially when you’ve done something, I think, that’s off the beaten path. So I’d love to hear how you, as a practicing urologist, have come to where you are now through the more traditional practice of medicine for years and then deciding to do something a bit different.
Dr. Gapin: I’m excited to share this story because this is really a passion of mine, is helping physicians learn how to do what I’ve done over the last couple of years because it’s been really transformative for me, my health, my life and really my family as well. I am a recovering urologist, I like to jokingly say, after 20 plus years in urology, I stepped away last year. That path started about eight or ten years ago when I was very unhealthy. Like most of us physicians, I was so focused on my career that I was neglecting my own health. I woke up one day and suddenly I was 30 plus pounds overweight, felt like crap, had no energy, stressed out, wasn’t eating well, wasn’t exercising, was doing all the wrong things. And as a quote “men’s health expert”, you would think that I would have the answers and know what to do, but I really didn’t, because as we all know, our health care system is really all about treating disease. And if you don’t have an ICD-10 code, there’s not much out there for you. So I went to a colleague of mine here in town, a concierge medical doctor, and he did a bunch of bloodwork and found that my lipids were sky high, my creatine was elevated, I was again 30 plus pounds overweight. And I have a family history of cardiovascular disease as well. And so he gave me a very scary picture in terms of my cardiovascular risk and told me I need to lose weight, exercise more, and I might need a statin if things don’t look better, if my cholesterol numbers don’t improve. And that was really it. Nothing else in terms of what do I do? What do I eat? How do I incorporate these lifestyle practices? What supplementation might I need? And so on. So I started studying on my own and I studied epigenetics, which was this amazing emerging field at the time. Now it’s become very popular learning about precision medicine, which is using genetics to really individualize health and how we can use our snips, single nucleotide polymorphisms, to understand what we should eat, what we should not eat, what’s right for our body, how do we improve, sleep, detox, what exercise is right for our bodies, etc.. And then I started learning about peptides and I started learning about hormone optimization. And this is crazy, but through my entire urology training, we never learn about hormones. We never learn how to properly optimize hormones. I learned about functional medicine, which I used to think was crazy. Now it’s amazing. I recognize how powerful it is when we can understand how our bodies are working, understand physiology, understand what’s underlying the issues at hand, whether it’s low energy, brain fog, weight gain, all these things that traditional medicine doesn’t teach us. So I applied all these concepts on myself, transformed my own health, lost all the weight, felt better, became a new person. And it hit me that this was a real passion. I was suddenly studying again and going to courses and going to meetings and getting certified on these new areas of health and wellness. And I started applying it on my patients, and I created a program for my urology patients, a purely cash based program, where I can provide these higher-level services within my existing insurance based urology practice. Well, that grew to the point that it became so popular, and I was devoting so much of my time and energy to it that I realized that I had really found my purpose and my passion in life. And I made the very bold decision to step away from urology so that I can really pursue that full time. And so two years ago, I gave my partners notice that I was leaving a very lucrative practice. And a year ago, July one, I stepped away and I launched The Gapin Institute for High Performance Health. And my emphasis now is high performance health. It’s all about health optimization and human performance and longevity. And I tell you what, I haven’t looked back. People ask me, do you miss the robotic surgery? Do you miss the big open cases? Do you miss the procedures? And I got to tell you, I love what I do and my family sees a different me as well. And it changed my life. And I feel like I’m having a much bigger impact than I ever could have before as well.
Jen: Wow, there’s so much to talk about here. I love your story and I love how you’re addressing a huge gap in our health care system, really, which is that we as physicians are not trained to look at the entire individual and find preventive ways to help them prevent illness. We’re really trained to address illness specifically. I’m wondering if you can even just go back and define some terms for us, for those of us who are trying to understand these new fields that are opening up and that are so critical. Functional medicine versus integrative medicine.
Dr. Gapin: Yeah. So functional medicine is really looking at quote “root cause”. So functional medicine looks at trauma. It looks at underlying physiology. Looks at gut health. Looks at things like cortisol. Looks up micronutrient levels, looks at organic acid. We learned in medical school about glycolysis and the citric acid cycle and the electron transport chain. And you figure you were done with that, that you pass that test. But in fact, now I use that stuff every day because understanding metabolomics, which is understanding how energy production occurs, how ATP energy is created, NAD levels, all these intricate facets of our physiology, functional medicine is really the foundation of all that. And so functional medicine is simplistically a root cause medicine that is looking at what is the underlying cause of your issues. Now my exception to functional medicine is that it’s still somewhat disease focused. So most functional medicine practices out there are focused on treating Lyme, autoimmune, thyroid disorders, various issues like that, PCOS and infertility. They’re still treating a problem, treating disease. My focus is really very precisely narrowed down to optimization, to human performance. How can I improve really four things: better energy, better brain, better body and better sex. And those are the four things that, you know, as a men’s health expert, and my passion is men’s health, those are the four things that guys are looking for on a regular basis. So functional medicine is root cause to answer your question, and then integrative medicine is, I like the phrase, but technically it really implies that you’re integrating it more with the soul, with more of the spirituality part of medicine. And I’m personally just not very involved in that aspect of medicine. So it can be somewhat confusing to practitioners, what is integrative versus functional. Regenerative medicine now is another term that’s using more at how do we help the body repair itself, how do we help it recover? And so this is where we use things like PRP and I use exosomes and this is stem cell therapy and biologic materials. Peptides, for example, would be a regenerative approach to health as well. PRP is platelet rich plasma, so it’s where we can simply draw blood, spin it down in a high-speed centrifuge, separate out the buffy coat, which is the layer, which is the platelets, which are full of growth factors and cytokines and chemokines that enable us to stimulate and promote repair and recovery and angiogenesis and healthy remodeling. And so that’s all regenerative medicine. And then the final phrase that practitioners may not be familiar with is precision medicine. And that’s where we use genetics, patients’ polymorphisms to understand what’s right for them and how can we tailor health specifically like what I was talking about earlier to them as well. So my approach when I talk about high performance health at The Gapin Institute, what do I do? It’s really combining all those facets of traditional medicine with regenerative medicine, precision medicine, functional medicine, and how do we integrate all those together to achieve the niche that I’m looking to serve?
Jen: How has epigenetics progressed? Where are we currently with that in terms of how it can actually be applied?
Dr. Gapin: I think the best way to explain this would be giving an example because I like stories. So one of the early clients that I had who came to see me, Tommy, he was a local chiropractor, friend of mine in town here. He told me how he could not burn belly fat. He was running on a treadmill hour and a half a day. 90 minutes every morning. He was eating ridiculously clean. He was eating keto and he was not seeing any results. He could not burn those last 5 to 10 pounds of belly fat, no matter what he did. Well, when I ran his genetics, we found that his carbohydrate genes showed that he actually was able to burn fat with higher complex carbs. He was eating the wrong foods, he was eating the wrong diet. He was eating you know keto is very low carb or no carb. He was eating the wrong diet for his body. Now you go out there and the Twitter world will tell you that you need to be doing keto and that’s how you’re going to get the results you’re looking for. Great example of how genetics, precision medicine helped me tailor that nutrition plan for him so that he’s eating foods that will actually help him accomplish that goal. For him, it was the completely wrong diet. Same thing with workouts. He is not designed for endurance training and his genetics show that he did much better with interval or burst style training and so we completely shifted his training program and you know months later he’s finally able to achieve his goals. Now he also needed some hormone tweaking and some micronutrients as well. But those are two key lifestyle changes that we’re able to affect purely based on genetics.
Jen: I can’t resist the opportunity to talk for a minute about nutrition because there has been a huge shift in what we understand in nutrition. I think all of us as physicians should not be at all surprised and probably have been predicting for 50 years that sugar is the next big enemy and that right now our Western diet is completely infiltrated with it in every which way. And it seems to be, I would say personally, it seems to be quite addictive, but I think that it is the biggest enemy that we should all be aware of. I’m curious how nutrition, whole food, plant based, for example, eating versus keto diet, which we do hear so much about how these types of prominent choices that are out there versus the traditional Western diet, what you’re seeing and what you’re recommending. Outside of just the individualized treatment.
Dr. Gapin: I wholeheartedly agree with you that it’s definitely evolving. There’s so much noise out there and there’s so much emotion behind it all where people are very opinionated, whether it’s carnivore, whether it’s plant based, whether it’s whole food, whether it’s Paleo, Mediterranean, you know, whatever diet, you know, whatever flag you plant in the ground, you’re going to live and die by it. The answer is there are some generic recommendations I give everyone, and that includes you mentioned sugar. Obviously, sugar is one of the biggest evils in our diet. We’re aware of the massive effect it has on energy production, on fat storage, on mitochondrial health and oxidative stress and all chronic inflammation or, you know, all the incredibly negative effects. The other one that I’ll point out that doesn’t get any attention are the seed oils. So by seed oils, we’re talking about the omega six polyunsaturated fats. And so by this I mean canola, sunflower, safflower, peanut, cottonseed, oils. Basically, any packaged product you get, if you look at the ingredients, you’ll find that in there. Great example, my wife and I were at Target last summer and I’m going to get almonds. Big bag of almonds. One bag says, I always recommend looking at the ingredients. One bag says almonds, awesome. The bag right next to it, dry roasted almonds, sounds pretty good. You look at the ingredients, very first ingredient, sunflower oil. Almonds, salt, sea salt. Those oils are pro-inflammatory. Those oils, the intake of those all are linearly associated with the increase in cardiovascular disease we’ve seen over the last 50 years. Like it’s like a direct linear correlation with increase in these polyunsaturated omega six fats as that’s really the biggest thing that I would say beyond the sugar is eliminating the seed oils. When you go to a restaurant, they’re cooking in those oils. So that’s really a big source of this pro-inflammatory poison that we’re being exposed to. In terms of general recommendations, again, as limiting sugar is limiting the omega six oils, focusing on the healthy oils, healthy fats, you know, that monounsaturated and the omega three polyunsaturated that are very healthy fats, things like salmon, olive oil, almonds, macadamia nuts, avocado. Those are fantastic sources of fat. I don’t really ever push for a low fat diet. It’s more healthy fats and it’s all about macronutrients. And so, you know, we look at carbs, fat, protein, what’s the balance of those three? And that’s so often a problem where sometimes it’s what you’re eating, you’re eating the wrong foods, but a lot of times is the balance of it as well. So we tend to eat too many carbs, too much fat, and not nearly enough protein. And so a general recommendation for everybody is you need to be eating more protein. Yes, genetics helps us tailor that. But in general, most people don’t eat enough protein, especially in comparison to the carbs and fats that they’re eating.
Jen: And of course, the next question that makes me think of is about the biome itself and the gut biome and how we’ve advanced. And we, of course, it’s a really a huge frontier, but we are making advances in understanding how significant that is in terms of well-being and nutrition, longevity. And how does that factor into your practice?
Dr. Gapin: What a great question. I do so much microbiome testing now that I would have never believed it previously, and I do that because it’s impactful for nearly every patient I work with. So microbiome testing, it’s simply done with a stool test. At home, patients collect stool sample, little bottle, jar or bottle and mail it off to the lab and within a week we get the results back. What we get from that is we get healthy bacteria. Disbiotic were bad bacteria. You know, there’s this balance between good and bad bacteria in the gut, as we all know. But so often you get an imbalance where too much of the disbiotic or bad or unhealthy bacteria, if you will, predominate and over take the good bacteria. That creates issues with systemic inflammation and oxidative stress that raises cortisol. And what that will do is that can damage the gut lining. So other things that we get in our microbiome testing are tests looking for the integrity of the gut lining. So things such as secretory IgA, which is the protected mucosal layer of your gut, we’ve never heard about this in medical school. This is stuff that is totally foreign to us as medical doctors. But it’s so important because when you start to break down that gut wall, then you allow pro-inflammatory antigens to stimulate autoimmune response. So many patients are having brain fog or acne or weight gain or headaches or all these various symptoms that are originating in their gut. Recurrent UTIs, I used to treat them with ten different course of antibiotics to find the right one. Now I recognize I’m like, suddenly I had this awakening. It’s all coming from the gut and the imbalance of the microbiome is the source of all of that. So microbiome testing should be part of anyone’s clinical practice.
Jen: And for someone who’s listening, who may be interested in incorporating that into their clinical practice, what would you recommend? What are the steps to be able to do that?
Dr. Gapin: I’m currently working on a physician certification program, actually, so I run a high level program is now called G1 Program for High Performance Health. G comes from the Gapin Institute. That program incorporates medical management, traditional medicine, integrative, these functional tests such as microbiome testing, food sensitivity, metabolomics, cortisol, Dutch urine based hormone testing, genetics, and then combining that with coaching. Everyone needs a coach and health coaching is really important for a lot of the executives I work with. So my program incorporates coaching and lifestyle, nutrition and fitness training as well. And so to answer your question it’s not easy. There are programs out there, you can go through A4M, you go through IFM, there are a number of other places you can get trained in reading microbiome testing. I’m trying to put together the entire package because I know medical doctors that I talk to, they’re excited about doing something better for their patients. How can I provide innovative care? But they don’t know how to start and so my goal is to try to put all that together into a physician program. So if anyone is interested, reach out to me and we could talk about the details of that.
Jen: To your point about coaching and everyone benefiting from having a coach, what we see in ourselves as well as our colleagues and everyone really in the entire world is this knowing-doing gap, but especially among people who are high performers and who are understanding concepts but somehow not able to put those into action and coaching can really help to accelerate that. So I love that you have that as part of your program and certainly something that we definitely agree about that as well. Where can people reach you if they’re interested in learning more?
Dr. Gapin: Any docs who are interested in reaching out to me personally. My email is [email protected]. I’ll also show you a little different angle here as well. If you were a patient or a potential lead potential client source, you can text the word “health” to 26786. Get to see what I’ve designed on the business side of it as well because a lot of questions I get is well, how do you integrate a cash-based practice into what I’m doing right now? What does that look like and what are the pieces? And so you could see just the initial steps of what does that look like as a patient coming in? And you’ll see some of the freebies I give away. You’ll see how you can book a call with my team to understand it on that side. But if you want to reach out to me personally again, my email is Doc Tracy, that’s [email protected].
Jen: Terrific. Thank you so much for coming and joining us, Dr. Tracy Gapin of The Gapin Institute for High Performance Health. Thank you again, and we look forward to continuing this conversation with you.
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