Holistic Healing With Functional Nutrition: What To Do When Nothing Works

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'll be speaking with Andrea Nakayama, functional medicine nutritionist and educator, host of the 15-Minute Matrix podcast, and the founder of Functional Nutrition Alliance. She's led thousands of clients and now teaches even more coaches and clinicians around the world in a revolution reclaiming ownership of both their own and their clients' health. But before our conversation, if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebooklet, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now onto the show. Welcome to the show, Andrea.

Thank you so much. Thank you so much. I'm excited to be here with you.

I'm excited to have you.

So can you tell me about your history and what got you into the field of functional medicine?

Yes, I'd be happy to. So I, I was in a completely different career in my life. I worked in book publishing for over a decade, and in April of 2000, my late husband was diagnosed with a very aggressive brain tumor. It's called a glioblastoma multiforme, and it's a stage 4 cancer. He was given about 6 months to live. He was in his early 30s. I was just 7 weeks pregnant at the time. And I was also a foodie. I was definitely experimenting with food for my own health, noticing little things, but that catapulted our reality into a whole different realm of care. So first and foremost, we entered into the medical system and I had never been in the medical system. Sure, I'd been to the doctor for a broken wrist or arm, for a sinus infection, but had never been in the system in this way. And that experience kind of woke me up to some of the gaps in our medical system. And the two gaps that I noticed at that time were that everybody is treated like their diagnosis. And everybody with the same diagnosis is treated the same. So if you have a glioblastoma, the 32-year-old man, my late husband, is treated the same as the 80-year-old man. It is a protocol for that condition. And so while we were in this reality, this new, grave new world that we were in, I was looking to see anything and everything we could do to shift the outcome in any way we could. So I was bringing him forward information about diet and lifestyle. How does sugar impact inflammation and tumor growth? And ultimately it was his decision to make, but we made major dietary changes. He ultimately lived past his prognosis. He lived 2 and a half years, so he died when our son was 19 months old. This is back in 2002, and that really changed my perspective on healthcare, quote unquote, food is medicine, and what's possible to help a person navigate through the system. And slowly but surely after his passing, I realized that this was my calling and that led me forward to trainings and exposure to functional medicine, which really spoke to me. And on from there, which I can talk about as we have time.

Yeah. Well, first of all, I'm so sorry for your loss and, and how tragic to, to be cut off so early.

Yes. Thank you.

So you said in our pre-interview call that your practice's sweet spot is the client or patient who has not had success anywhere else and maybe is hopping from practitioner to practitioner. And I know I've seen a few of those and they maybe are having trouble taking most supplements or eating most foods. So can you explain your philosophy around helping those types of people and how you proceed with them?

Yeah, so most of what I do now— I started my practice back in 2009. I started training other practitioners in 2012. So at this point, most of what I do is train other practitioners, health coaches, dietitians, a lot of nurses around the world who really want to understand the principles and philosophies of functional nutrition. And I've really established a systems-based approach that speaks into what you're talking about. So the first thing I really want to understand is who it is that I'm talking to. I have the entire functional nutrition matrix, which is modeled after the Institute for Functional Medicine's matrix, but it's a little bit more easy to use and think through and talk to a patient through. And that's divided into categories that I would call the story, the soup, and the skill. The soup is the system's biology. It's all the areas where the gut's connected to the brain. All the things are happening inside the body and we recognize that they're connected. The story is what I really want to understand in relation to what you're talking about. What are your— in functional medicine, we call them ATMs, your antecedents, your triggers, your mediators. Tell me about where you came from, What's happened through your life and what have you noticed helps you feel better and makes you feel worse? And the soup is our systems biology. The story is our unique journey, and the skills are all the things— sleep and relaxation, exercise and movement, nutrition and hydration. Oftentimes what I see when somebody has been there and done that, they've tried everything, is that they're doing all the practices, but they're not really focused on the internal healing at a pace that's appropriate for their body. So they're chasing fixes, but the internal healing that allows their body to accept the foods, accept the supplements, work with that next intervention are impaired. And that's the work that hasn't happened. Oftentimes we have to slow it down to speed it up, and people are very fixated on going on a protocol or following the next principle or tracking or finding the quick fix or the next supplement, or I can't sleep, should I take this herb or these hormones or whatever it might be? And oftentimes for a sensitive body, it's too much, too fast, and the body doesn't have the time to heal. So all that to say, I'm going to do a really, really thorough assessment of an individual to understand what's actually happening. What have you tried? What have you learned? And then let's get really systematic to allowing the body to heal and receive healing as opposed to chasing the next thing.

Can you give me an example of someone who maybe was in that situation and what the body needed to be able to start accepting the healing?

Yeah.

I mean, a lot of times, I'm not thinking of a case, I'll be honest. I'm not personally working with that many cases right now, so I have to dig back and one might come to me. But what I often see see is that the body's in a sympathetic dominant state. So that chasing, that questing, when we think about sympathetic dominance, that's our fight or flight mechanism. And I'm often seeing people who are questing the next fix, the next solution. How do I do this? So what I will hear, if I think about my case study group where I was working for people for my book that have been there and done that, worked with all the top functional medicine doctors, done the tests, taken all the supplements, eaten the quote unquote perfect diet at the, with the perfect timing, and they weren't feeling better. And they feel angry, they feel jilted because the things that are promised to us just don't work. I think we think those protocols are very sexy and they're gonna be the answer and they get us further fixated and sick. Stuck in that fight or flight. Where's the next thing? How do I fix my broken self perspective?

Yeah. I've definitely seen people who've been through the wringer with some of these top names, functional medicine, and they've said, oh, I spent $20,000. I spent $50,000 or whatever.

Correct.

And they just stuck them on a set protocol. Like, like they literally take everybody they see and they go, okay, these are what you're going to do. Everybody does the same thing. And it just, I'm, I'm, I'm shocked honestly that that's the way they're practicing, that I just sort of assumed the top names in functional medicine would be a little more individualized.

Yeah. I mean, unfortunately I think that the road that functional medicine has gone on has veered away from the three primary tenets of a truly functional practice. And those three primary tenets, we have Willow here with me, my cat's here with me, but the three primary tenets are a therapeutic partnership, meaning we are equal. Equal in this relationship and your understanding of yourself is as important as my expertise. Looking for the root causes, which means we know how to ask why is this happening, not just what do I do about it. And a systems-based approach which embraces systems biology. Those are the three tenets of a functional practice as designated in the origins of the Institute for Functional Medicine. And unfortunately, it's become very conventional-based in that it's another pill for an ill. The pill might be different, or it might be a bucketload of pills. They think that diet is a handout. Dietary change is not a handout. There is a lot that goes into making change, understanding a person's relationship to change and what their body can tolerate and not tolerate. So I think there's a lot of mistakes happening in a lot of functional practices today that really are going too fast for the needs of the individual.

So you talked about sympathetic dominance, and I'm thinking about something I heard on a podcast recently, which was they had looked at children who had abuse and, you know, ACEs, that type of thing. And they when they checked their cortisol and right before bed, all of their cortisol was elevated such that it was impacting their sleep.

Yes.

And that this is something that like persists through adulthood.

Yeah.

How do you undo that kind of stuff?

Yeah. So I think that when we're looking at adverse childhood experiences, when we're looking at trauma, whether it's childhood trauma or adult trauma, like I received with my late husband's diagnosis and illness and death. That we have to recognize where and when it is our job to address that with a client or patient and where it is our job to hold space for it. So my job is making the connections visible for people. So that matrix, that story, the soup, the skill, helping people to understand that everything is connected. We are all unique and all things matter. In my practice, one of the things that I'm teaching others is what I call the 3 tiers to nutrition mastery. Tier 1 are the non-negotiables. Now, non-negotiables are vast, but the non-negotiable trifecta that is true for all of us is sleep, poop, and blood sugar balance. If those aren't there, then it's going to be hard to heal. So if I see somebody who has elevated cortisol or is having disregulation around sleep, I'm gonna really dive into that one thing, not with, hey, go sleep, take some melatonin, or hey, your cortisol's elevated, take these herbs. I'm gonna really look at how do we unpack that, bring to awareness some of the triggers that might have us in that sympathetic dominant state, that fight or flight state. Look at all our practices around sleep. Start to recognize what makes us feel better, what makes us feel worse, which are our mediators, and really start to see if we can make a slow but steady difference in small practices that lead to more sustainable results. And this is a very long-winded way of saying, when I give that person a supplement for their sleep, I'm bypassing the opportunity for that person to learn in a long-form fashion what actually helps them to be more empowered with the decisions they're making. And I'm making them more reliant on me for their solution. That's not what I want. I want to empower people to have that deeper awareness about what is happening with their own body. So a child who's carrying that lack of safety into their nighttime routine, that awareness is something I'm gonna ask them to bring to the fore, potentially with a therapist who can hold that space for them. And meanwhile, we're gonna work on how do we make your bed and your bedroom and your sleep time ritual as safe as it can possibly be for you. And what kind of language do we need to use to bring you into that parasympathetic, that rest and digest? And sure, are there ways we can manage your blood sugar, help with your mineral support, like all the things that are going to help there, but it's not a one and done. That's mine to fix, I guess, is the thing. It's mine to recognize the connections and help illuminate them while bringing the foundations into place. That really help to support that person in moving forward. I just thought of a case, Lindsey, in that, okay, like somebody was asking me to look at their lab. I look at people's labs like a, I'm a, I'm a geek when it comes to serum labs and I can make all sorts of connections. But just looking at, this is the husband of my cousin who is also a functional nutrition counselor, and I was looking at his labs with him and he was trying to control his sleep and his anxiety with herbs. And he was constantly getting to what I would call is a later stage intervention. When I look at his labs and he's a teacher, I was like, are you hydrating? And he is like, well, I drink like one Nalgene a day. And I'm like, how much do you weigh? So I could see in his labs that he's dehydrated. Dehydration can lead to anxiety and fatigue because the blood isn't pumping as fluidly as it needs to, to the heart and the brain. And so my ability to understand the simplicity on the other side of complexity is then what helps me make connections and help him to slow down, look at, let's trial that for 2 weeks. And then let's look how sleep is, make sure your hydration is earlier in the day. So you're not having to go to the bathroom, but just things that we often overlook in favor of the fancy newfangled supplement or protocol when we're not creating the foundations of health.

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So what markers were off on his bloods that you—

all his red blood cell markers. So in his CBC with differential, all the red blood cell markers are your, you know, your RBC, your hemoglobin, your hematocrit, your MCV, your MCHC, like like all of his red blood cell markers were indicators to me to ask the question, are you hydrating?

Were they high or low?

They were high.

Okay.

Interesting. So given we're on a gut health podcast, what are the factors that people might not be thinking about that could be affecting the health of their gut microbiome?

Yeah. So when it comes to the gut microbiome, there are many factors that I like to think about that influence um, the entire digestive tract. So I like to think about it as one of the three roots. Any sign, symptom, or diagnosis is a branch in my book, and the three roots are our genes, digestion, and inflammation. And that's like a Venn diagram for me. So that's why I'm putting my hands like this. The digestive root, the circle of influence, or the soil, is the mechanical, the chemical, the structural, and the microbial. So before I rush to microbial issues, I wanna make sure we're chewing. We've got the hydrochloric acid and the enzymes that we need, and I don't mean supplementally, I just mean we are able to produce and break down the foods that we're bringing in. We have structural integrity, which comes back to the microbiome, but really making sure that the inflammation is down and the gut structure is not hyperpermeable or leaky. And the microbiome is going to be key, but we forget that sleep feeds the microbiome, that exercise feeds the microbiome, that vitamin D feeds the microbiome. We often rush to what we're gonna take to feed the microbiome. Now, if we are feeding the microbiome with food, I'm gonna think of classes of foods, and those include our ferments, of course, our polyphenols, and our resistant starches. So those are the ways that first and foremost, I'm going to make sure that we're feeding the microbiome in a daily way, in addition to supporting that with, um, with probiotics and prebiotics that we might take in in different ways. I am not a fan of specialty testing for the microbiome unless I find I need to. That's usually later on down the line, if at all. I'd prefer an organic acids test over a GI MAP or anything like that, but I rarely would have our— us in our clinic do those because we can assume that the people who are coming to us likely have gut dysfunction even though they are, or if they are not experiencing gut issues. So, mm-hmm. Again, one of the three roots, if you have chronic signs, symptoms, or diagnosis, diagnoses that aren't getting better, digestion has to be focused on and the microbiome's gonna be a part of that.

Okay. So you mentioned sufficient hydrochloric acid to break down your proteins, of course. And I have read that one sign of insufficient hydrochloric acid is— stomach acid is nails that are cracking and breaking. And this has been my 20-year quest to fix this problem. And I have autoimmune IBS, so I have elevated vinculin antibodies and recurrent SIBO that I have to kind of keep under wraps. Yes. Am I missing something? I mean, I've, I've tested the zinc, I've tested the, I mean, I am deficient and taking it, but the, but the nails are getting worse. Yeah.

And the, I think this is where we can get stuck on thinking X leads to Y. So deficient hydrochloric acid could lead to a number of symptoms, but so could different nutrient deficiencies that might be excluded from the from a specialty diet. So I always like to put the but in the column of the specialty diets because when we reduce our food intake, sometimes we're missing certain nutrients. A common one for those of us with autoimmunity are our B vitamins, which are tricky to take for a lot of different reasons. But when we reduce certain foods from our diets, particularly grains, we might actually be missing some of the B vitamins that also help with our hair, skin, and nails. So it's hard to say that it's just because of one thing. So if you have worked on your hydrochloric acid and you've supported that and you're not seeing results, give it a checkbox and know that you still don't know the why of that thing, right?

Like on the multi, on the B complex. Yes. Zinc.

Yes, exactly. So there's different reasons that may not be evident yet. And with all you know, Lindsey, and all you've looked at, it's one of those things that's like, okay, I don't know the answer to this. How much is it bothering me? Is it bothering me because it hurts or it's painful, or is it bothering me because I should know the answer and I don't?

Entirely cosmetic.

Exactly. Exactly. And that's where I think like, coming into that parasympathetic, like I'm doing all the things I need to do and all the things I know to do. I'm still having this issue. So I'm just gonna hold space for that.

Perhaps that's the one, one idea that hadn't occurred to me. It's just accepting it.

Just accept that for now. Something will reveal itself.

Yeah. What bothers me about it though, is that I feel like it's telling me that there's there's something not working right and that it's sign that it's somewhere else. There's something more serious going on that I'm not seeing. That's what bothers me about it.

And I think if you're looking at everything, if you've looked under the hood, I think this is where we can get hyperfixated on some notion of right or healthy. And this is where like we then start questing when in fact, like you're thriving. Your brain's working, your body's working, you've done all the looking and you're taking really good care of yourself. How can we just celebrate that and put down the thing that we feel like is trying to tell us something, but you know, maybe it's not to be heard right now.

Okay. I will accept my bad nails.

They're not bad.

They're just— my slightly imperfect nails. Okay. For now, you mentioned your three roots, many branches philosophy. Can you apply that to autoimmunity and, and tell us a little bit more about that?

Yeah.

Yeah.

That's exactly what I created it for. So if we think of any autoimmune condition, it is a branch and all the associated signs and symptoms with that autoimmune condition. So. If we can envision a tree with leaves or branches that don't look as healthy as we want them to, your nails, then we can think that's a symptom, that's a branch. And if we focus on the branch, let's say we go up to a tree in a forest and we wanna help this tree thrive, but its branches are turning brown and fall, the bark is falling off. Do we wanna pick off those branches? Do we wanna saw them off?

No.

We wanna think, how do I get deeper to the trunk? How do I get deeper still to the roots? And how do I nourish the soil that those roots live in? So autoimmunity is a branch. It is a result of many things, multifactorial. Aspects that are happening internally. There is not one root. And I just wanna say, this is another mistake I see a lot of practitioners, um, putting out there that there is one root, that histamine intolerance or mold or SIBO is the root. There is never one root. There are always three roots, the genes, digestion, and inflammation give us a broader perspective. And then each of those has soil, or what I call the circle of influence, that allows us to think, where do I need to focus my attention there? So genes, just as an example, we can't change our genes, but we can change the expression of our genes. That's epigenetics. And the factors there are food, movement, environment, and mindset. And so we've been talking inadvertently about this notion of mindset, you know, how does mindset around sleep and safety around what the signs are that our body is telling us, how does that put us into that questing state? And can we actually heal in a questing state? I'm not sure we can. The inflammation, the circle of influence is clear, calm, enhance, and modulate. We may need to clear a microbial infection. We may need to clear a food that isn't serving us. We may need to clear an environmental factor that our body can't process, but we may also need to clear negative thoughts that are keeping us from being in our thriving selves.

Yeah. I have started recommending some people to who, who have in particular these tough cases where it seems like they are, you try literally everything on them and just nothing is working, referring them to other programs like the Gupta program or hypnotherapy or, you know, something that's going to intervene on the mental side because as a gut health coach, I don't quite have the time to work on those types of things. If they were doing once a week health coaching, 12-week program, maybe, but I don't see a lot of clients in that type of setting anymore.

Yes.

So, so nervous system. Yeah, exactly. It's, it's all connected. Everything matters. It's all connected. And so that's a brilliant move where you recognize somebody, I think you said it really beautifully, like needs kind of an intervention between that mindset piece that's keeping them in that questing, frightened, parasympathetic or sympathetic dominant, lack of parasympathetic dominant state that the body cannot heal in. And we have to learn to catch ourselves in those states. I have a really stressful work situation because of how large the organization is at this point. And I have to have a number of practices that buffer my day to be able to cope with the stress in the middle of my day.

Yeah, I have this Ring Air and it's, uh, it tells me, it tells me about my stress and I find it interesting. It'll say like, what are the different categories? Well, one says sympathetic activation, one says stressed, and the one is just, I can't remember, it's like a mid-level. Activated or something.

Yeah.

And that slight tune in. So if I think about my stress levels and I think about, I'm somebody who can tolerate drinking coffee, but if I drink it on the weekend, I'm fine. If I drink it during the week when I'm already in a stressful situation and I'm already in go, go, go, go, I can notice what it does to my heart rate. Whereas if I'm in my let things go weekend mode, that's all balanced. And so that ability to tune in and give myself some allowances, to me, that's what health is, where we don't have to be so straight and narrow, or it isn't so restricted, but we're kind of navigating life and living with all that we know. Yeah.

I just had a client who, who said she, before she even started working with me, she had stopped drinking nightly and drinking coffee. And she's like, I already feel so much better that, you know, she still was bloated every day, but you know, she was like, I feel so much better just from those two changes that I can't even believe like how far I've come just from that. And I've never been a coffee drinker, so I, or, or a, a daily alcohol drinker. So, so I've never noticed anything huge in, in, modifying those, but I thought that was a, a good testimony to the basics.

Absolutely. Absolutely. Making those changes, we often bypass them while looking for all these other things. And, you know, drinking alcohol at night can be a huge detriment to sleep in a number of factors and to mindset and our mood. And I don't think we realize those things when we're in it, just living our daily life. We also have to recognize that healing may look different than idealing, right? So when we're living in an ideal state that has a little bit more wiggle room, that is where we get to live into it like I'm talking about. When we're on a healing journey, we might need to get a little bit more strict with the recognition that it is so that the wounds can heal. And that's when we then move forward. I think my biggest concern, going back to one of the earlier questions you asked, is that a lot of people are making the dietary and supplemental changes, but they're not allowing or supporting the body to do its healing. So the wound is still there while the restrictions get more and more and more narrow, and then that leads to frustration.

Yeah. So with, back to the whole question of the rings, So I, I see, and, and it's shocking, honestly, because I'll, from the waking up and I, and I, the thing is you don't sense that you're stressed out. Totally. Like, that's the thing that's shocking. When I look at it, I'm like, oh, okay. At that moment where I had to make this transition and I was getting up and going and making breakfast or where I was then interacting with this person or like each of those transition points seems to send me into stress mode. And I don't have a sense that I'm stressed out. I think it was a pretty relaxed day. And then I look and I'm like, oh, or when I'm working, I'm just like yesterday, I had a super quiet day sitting at work, just sitting on my computer, didn't talk to another human being. That would be for me a really low stress thing because the more you interact with other people, the more, you know, it requires a different level of activation, shall we say. And I was sympathetically activated all through the morning. Just getting on my computer and answering emails and following up with clients.

Yeah, I think it's that feedback loop where we're getting it from internally or externally is really interesting. So if you don't feel it internally, is there some aspect that is a natural level of when your cortisol is naturally raised, which should happen in the morning, which is then being interpreted as stress. Like, again, where do we outsource our feedback loops to the data on the scale, on the test, on the ring, to the nails? Like, where are we outsourcing what we actually feel? And is there a way to trust what you're actually feeling? So I use my Oura ring to kind of track my activity. Through the day and to, um, or at the end of the day, and to look at my sleep as a reflection. Like, what little things can I do to shift some of these markers with my sleep so that I'm getting better sleep? And does that impact my heart rate variability, which is ultimately helping with my, my resilience to the stress in my life, but I don't use it as a directional. I use it as a clue to kind of give me some feedback to support how I'm feeling or what I could be doing. And I think again, there's a tendency, not on your part, but culturally there's a tendency to biohack, to outsource to all these different tests and data measures, what our body actually is telling us something. And I'd be curious, like, are you stressed or are you jazzed about what you're doing? Like, what's actually happening there that would help you interpret that data from a different lens?

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Yeah, I think I need to know more about how they designate the levels and that's the part I haven't learned. So then maybe I'd have a better understanding. But yeah, I, I do recognize that you have, yeah, the cortisol waking pattern and that it's falling during the day. So I'm not quite sure how they're, I assume they're measuring it on the basis of things like heartbeat and temperature. I don't know what else they, what else do they gather? So, but exactly on the, on the drinking question. So I have noticed something though about drinking and sleep, which is if I drink the next night or the night of drinking, I get more deep sleep. And I've been thinking this isn't because drinking is a good thing for me and it's giving me more deep sleep. It's because my body needs more time to detoxify the alcohol.

Could very well be. So not the night you sleep, but the night after. So you drink the night I sleep the night, the night you sleep, you drink, you, yeah. I mean, it's a depressant too. So, you know, you're coming down. I think some people are gonna have blood, more blood sugar swings because of the alcohol. So they're not gonna have that deeper sleep. They're gonna wake up more often to go to the bathroom depending on blood sugar levels. You're probably, you know, somebody who tends to your blood sugar, so that's not an issue, but it is a depressant. And so ultimately your body's coming down and yes, nighttime is our sleep, is our number one form of detoxification. So your liver's going to work for you.

So I'm not sure if you mentioned 'em already because you seem to have a lot of different sort of groupings of ideas, but Did you already talk about the 3 tiers to Nutrition Mastery?

I mentioned them. So just to put it into context, there's 3 systems that I'm thinking through all the time. System 1 is the matrix. That's how I map a person, you know, the story, the soup, the scale. Everything is connected. We're all unique. All things matter. Then I mentioned 3 roots, many branches. So those 3 roots being the genes, digestion, and inflammation with the branches If you're listening and you can list a sign, a symptom, or a diagnosis that has been chronic, that is a branch. And if you're focusing there, then we have to take our attention down deeper. So that leads us to the 3 tiers. And I mentioned the non-negotiables and the non-negotiable trifecta. So let me just say the 3 tiers. Tier number 1 is the non-negotiables. Tier 2 is deficiency to sufficiency. On the other side of that is toxicity. And tier 3 is dismantling the dysfunction. So dismantling the dysfunction is like going for the branches. It's that top level. It's what medicine does. This is wrong. Let's fix it. In functional nutrition, what we should be doing is taking a different way into the same problem. It's that root and soil approach. And that's what leads me to the tier 1 and the tier 2. So tier 1, Non-negotiables. Like I said, I have the non-negotiable trifecta: sleep, poop, blood sugar balance. Those all have to be in place and worked with, otherwise it's hard to move forward. So I wanna make sure we're really diving in and understanding that. But then each individual has their own non-negotiables. So Lindsey Parsons, if I asked you what makes you feel better and what makes you feel worse, You have a list of those things, as do I. Some people don't, and that becomes what we really start to unravel with them because in functional medicine, those are our mediators. When I go to sleep by 10 o'clock, I feel better. If I stay up past 10 o'clock, it's gonna mess with my sleep pattern. That then messes with my blood sugar the next day.

There.

I know that a 10 o'clock bedtime is a non-negotiable for me. Not eating certain foods. I don't drink, I don't eat refined sugar. I personally don't eat cow dairy or gluten. Those are my non-negotiables. Mine. I'm not saying they're true for everybody. So sleep, poop, and blood sugar balance is the— we all need to. But then for each of us listening, get into learning about your non-negotiables. What do you know makes you feel better? What makes you feel worse? And then you're in a risk-reward situation with yourself every single day. When I drink coffee during the week, I notice my heart rate's a little bit more elevated. I'm a little more aggressive at work. I get to make that decision. Do I wanna be that person or do I wanna have my green tea that day? Like, which person do I wanna be? My decision so that I'm not following a protocol. I'm in a state of awareness. Deficiency to sufficiency, that tier 2. Sure, that can be a deficiency in zinc or vitamin D or B vitamins. There are many nutrient deficiencies. Could be a deficiency in enzymes or hydrochloric acid. It could also be a deficiency in love or joy or play or laughter or sleep or sex. You know, there's so many things that when we think more broadly, we have a much bigger toolbox for healing.

Right. So just so that people can take some very actionable nuggets out of this, One of your non-negotiables is pooping. For a person who is not pooping regularly, what would you recommend?

Yeah. So first of all, I wanna see what that means, right? So before I say take some magnesium or do XYZ, I wanna see what does not pooping regularly mean? So does that mean you're going once a day? Does it mean you're going once a week? I wanna also micro timeline that. When did this start? Have you always had an issue? Is there any oscillation between the elimination? Does anything you've tried in the past make it better for you or make it worse for you? I want the whole story. And then I'm gonna start with my 3 principles in terms of diet before I bring in different changes. So there's 3 principles. I'm gonna go to principle number 2, which is eat the rainbow. Do we have enough fiber in the diet and can your body tolerate fiber? So a lot of people, as I'm sure you know, being a gut health coach, can't tolerate fiber. And so I'm looking at that. I'm trialing different things. I might have to do some more internal gut remediation so that we can bring in more fiber, but that's my first opportunity versus forcing elimination to occur. It's a sign that there's some more I need to work on. So the Eat the Rainbow also leads back to principle number 1 with food, which is fat, fiber, and protein. So I'm going to document with somebody through a food, mood, poop journal, mood being any sign or symptom, including Constipation, bloating, any of it. So it's not mental mood, it's any mood the body's having. But I'm gonna look at what's true for you before I make any recommendations regarding what to do. But I'm starting first and foremost after the inquiry and the assessment. My first recommendation is gonna be what can we do dietarily to kind of 2.0 what it is that you're currently doing.

So it sounds like this is— this method that you've developed is very intensive. Like, it seems like it would be very time-consuming. So I'm curious, like, when somebody signs up with somebody who's trained under you, like, how many appointments do they typically have to sign up for, or, or how does that work?

Yeah, I mean, different people work it differently. I'm gonna talk about how we work it in our clinic. So the people who trained under me who actually work at the Functional Nutrition Alliance We have an initial session that really is deep in its assessment. So that initial session is actually 3 parts. It's a strategy session and then it's a premier case review that has 2 parts. The first part is after the intake where we're going to do motivational interviewing and learn a lot more and create a functional nutrition timeline. So we want to see who you are, When did this start? Like I said, with the micro-timelining around the constipation, I wanna know when did you first know? And people will say, I've always been constipated. When was the first time you actually noticed you were constipated or recognized it was constipation? Are there times where it's gotten better or worse? I wanna understand who you are. That's the assessment. Then the second part of our premier case review is where we will do nutrition counseling. We'll have the functional nutrition matrix. Completed from the prior sessions and be able to make some initial recommendations. In our practice, we then have 3 and 6-month, um, packages. Some people might go beyond that and continue to work with us for years or come back at intermittent times, maybe when they're more independent but want us to look at their labs twice a year or whatever it might be. It's very dependent on the individual, what they're working with, as is our cadence of visits. So with some people, we may meet with them for a half hour once a week, whereas with other people, we might meet with them for an hour once a month. It really depends on where they are, what they need, how acute their chronic issues are. So like, what's the intensity they're dealing with at this moment to get through some of the pain that they're experiencing. In my prior years of practicing, I worked with people for years, but the intensity of our work went from, you know, very intense to more spread out, check in, learn new things as you need them.

Yeah. So that initial intake, it sounds like that we could last Multiple hours.

The initial intake is gonna take time for the practitioner as well as for the practitioner and the patient. So the patient is doing some pieces like filling out a lengthy intake, right? And then there's the motivational interviewing where we're creating a timeline. There's work for the practitioner before the timeline. There's work for the practitioner after the timeline, right? So it is a, process. I call it the ART of the practice: Assess, Recommend, Track, Repeat. So we are constantly in an inquiry and assessment phase without making recommendations just based on a sign, symptom, or diagnosis.

Got it. So I'm, I'm curious, like, did you develop this whole system after starting out on the, within the traditional functional medicine world and then seeing the flaws and then you were like, something needs to change. So you kind of developed a system. How did it come about?

Yeah. So there were ways that I was working, not coming from a healthcare background that were kind of more of a story arc. And I didn't realize I was doing something that was different than any other health coach or nutritionist. Like I had no clue. And then when I started to show up in health coach spaces, I was recognizing that I was having a lot more success in practice and people were asking me to teach them what I was doing. So I kind of had to unpack the way my brain worked in order to teach it to others, which is where these systems thinking come about because we have a way to talk about it. I then found my way to functional medicine, was like, holy moly, this is what I do in the realm of nutrition. So that's functional medicine. I'm actually thinking similarly, but it's in the realm of nutrition. So I started to develop the sister ways of thinking about what I was doing to what was happening in functional medicine. And with their approval at the Institute for Functional Medicine, adapted some of the principles and practices for a different scope of practice. So I'm trained as a functional medicine nutritionist, but what I'm teaching is functional nutrition and functional nutrition counseling, and what we're offering is functional nutrition. So it is not medical, it is not meant to be medical. We don't diagnose, we don't prescribe. I think this is a mistake. Mistake a lot of people make. We don't treat, we assess, we recommend, we track. It's a different process, but it's very adjacent to functional medicine. So it kind of happened in an organic way over time.

Interesting.

Yeah.

Well, this has been a really interesting perspective, sort of at a higher level maybe than often I dig down into the details being a detail-oriented person. And I think you have a good big picture thinking. Which helps to pull out and look a little bigger sometimes.

Yeah.

So thank you for bringing that perspective.

Yes, my pleasure. And it's something I'm often doing with our students. I had one of our Power Hours today. It's a 2-hour Q&A, and it's an often reminder to get out of the weeds and think like, what are we missing? What happens when we bring our weedy bias to our own care or the care of others? Sometimes there's things we might be overlooking. So When we broaden our perspective, there's a lot that might live there.

Yeah. So tell me where people can find you.

Yeah, so lots of places. Andrea Nakayama in all the places. So andrea nakayama.com, on all the socials, LinkedIn, it's Andrea Nakayama. And then at the website, andrea nakayama.com, it'll lead you back to the Functional Nutrition Alliance where I train practitioners, so there's different information. The more patient-focused information and not me as a practitioner, but me speaking more generally, like I'll be doing in my book, is over at andreanakayama.com. And the practitioner stuff is at Functional Nutrition Alliance.

Okay. And then the practice that you are associated with is located where?

Functional Nutrition Alliance is where we have our practice as well.

Okay.

Then it's virtual or in person. Oh, okay. Great.

Okay.

All virtual.

Wonderful.

Yeah.

Well, thank you so much for sharing your knowledge with us today.

Yeah.

Thanks for having me. It was really fun.

This was a good perspective for me because as a detail-oriented person, I can get lost in the details.

So it takes a big picture thinker to help me zoom out a bit. If you'd like to support the podcast, you can buy supplements at a discount from my Fullscript dispensary, order tests at a discount from my Rupa Health Lab store, or use my affiliate links to iHerb. Which is available worldwide, or Amazon. And just a note that you can use my Amazon link to buy anything, not just supplements, and support the podcast. So I'd love it and really appreciate it if you'd bookmark my link and use it for regular Amazon purchases. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, as well as follow me on X, Instagram, TikTok, and Pinterest. Links for those are in the show notes. Thanks for for joining me today. Here's wishing you all the perfect stool.