Recently I interviewed Andrea Nakayama, and we talked about the functional nutrition and tying this into thyroid autoimmunity. If you would prefer to listen the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
I am very excited to chat with today’s guest, Andrea Nakayama. We are going to be chatting about functional nutrition and tying this into thyroid autoimmunity. Andrea is a functional medicine nutritionist and educator who has 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.
As the host of The 15-MinuteMatrixpodcastand the founder and former CEO of Functional Nutrition Alliance, Andrea draws on systems biology, mental models, root cause methodology, and the therapeutic partnership to offer long-awaited solutions for the rapidly growing chronic illness epidemic.
After losing her young husband to a brain tumor in 2002, she discovered a passion for using food as personalized medicine and is now regularly consulted as a nutrition expert for the toughest clinical cases and the practices of many world-renowned doctors. She trains nearly 4,000 practitioners each year in her methodology, so they can, too, be the last stop for their clients and patients as well as a trusted referral partner for doctors in their area. Andrea, thank you so much for joining us.
Andrea Nakayama:
I am so excited to have this conversation with you.
Dr. Eric:
Let’s go ahead and dive into your background. I know that you have a history of Hashimoto’s. If you could talk a little bit about that, and how you started getting into functional nutrition, which I gave a little bit of that during your bio. If you could expand on that?
Andrea:
As you said in the bio, my husband was diagnosed with a brain tumor when I was seven weeks pregnant back in April 2000. That really catapulted an awareness of what was happening in the medical space. Prior to that, in our early 30s, we hadn’t really ever been in the medical system. Maybe we had gone to a doctor for a thing or two, but we hadn’t been in the system. That really became a wake-up call for me in terms of where the system excels and where there are some gaps in the system, and what we can do to fill those gaps.
I think of that time with my late husband, Isamu, as my boot camp in nutrition and in all integrative practices. It wasn’t until many years after he died that I decided to change my own career, put myself back through school, many years of training, and then really create a practice, and a practice that was actually doing so well that other practitioners were asking me what I was doing. I realized how I had to take off the model that I was practicing and be able to teach it to others.
During that time, as you said, I myself realized I had autoimmune thyroid issues. I had Hashimoto’s. It took along time to get that diagnosis. In retrospect, with all I know now, it’s no surprise because there was a lot of stress for me going on during one of the biggest triggers for an autoimmune condition, which is pregnancy. I wasn’t only pregnant, but I was pregnant with a lot of stress, given my husband’s diagnosis and illness. That was quite a journey that both led to my own health issues and discovery simultaneous to reshaping my own career and aiming to fill these gaps that I had identified in the medical system.
Dr. Eric:
You were diagnosed with Hashimoto’s during your pregnancy or after?
Andrea:
Years after the pregnancy. While I was pregnant, we changed our diet for the brain tumor, so I was in my “skinny jeans” two weeks after I gave birth because there was a lot, I was doing to support my body. I also look back and can see the underpinnings of an autoimmune condition brewing, not just during that time, but prior to that. It took years for things to manifest in a more obvious way and even more years to actually get the diagnosis that I already knew was true.
Dr. Eric:
Unfortunately, that’s pretty typical with autoimmune conditions, especially Hashimoto’s. It will be underlying for quite a long time. Even when someone experiences symptoms, a lot of times, they will just look at TSH, which might be within the lab range, so a doctor will dismiss it. Again, that’s why you’re doing what you’re doing now, helping other practitioners as well. Based on the unfortunate experience that you had with your husband. You’ve turned that into helping thousands of practitioners.
Can you talk about functional nutrition, what exactly that is? People listening to this are likely familiar with functional medicine. There are different terms out there. If you can compare the different terms, even the difference between functional nutrition and functional medicine.
Andrea:
I’d love to. It’s a word that’s gotten away from us in a lot of ways, so I will bring us back to the foundations. You mentioned some of them in the bio as well.
The three primary tenets of a functional practice are a therapeutic partnership; looking for the root causes, which means we ask why, not what; and a systems-based approach, which embraces systems biology. I always like to say as well as a systematic way of working. How do we work in systems, so we know how to approach each person as an individual?
Those three tenets are at the basis of what was designed as functional medicine back in the ‘90s with Dr. Jeffrey Bland and many others understanding the basis of systems biology. When I say that, I mean as we know now, the gut’s connected to the brain, and the gut’s connected to the liver, which is connected to detoxification, which is connected to our hormones. Understanding that internal terrain, I like to say everything is connected. Understanding that is the premise at the core of a functional practice.
If we look at the differences between functional medicine and functional nutrition, it’s really about what the tools in our toolbox are. With functional medicine, doctors are still prescribing, which is within their scope of practice, and there is an awareness of diet and lifestyle modification, but I think it’s run away from itself a little bit in terms of scope of practice.
What we do in functional nutrition is we double click on the realities of diet and lifestyle modification. I like to say that nutrition is about growth, metabolism, and repair. It’s not just about the food we eat or don’t eat. It’s also about sleep and relaxation, exercise and movement, hydration as well as nutrition, stress and resilience, relationships and networks. All of those things feed our growth, metabolism, and repair, and impact what we can or can’t do with the food we eat.
For me, the nutrition piece is a double click, meaning we are opening that Pandora’s box of what it actually means to make this kind of change. I always like to say that nutrition isn’t a handout. Dietary change isn’t a handout, especially when we’re talking about women, especially when we’re talking about this time in history with anti-diet culture and body positivity. There is an intersection of where we have to look at the role that diet plays and what’s going on with your health and your health outcomes that takes a level of counseling, which is the role of a functional nutrition counselor.
I want to say, which should be the role of a functional nutrition counselor because I’m seeing the word “functional” thrown out a lot to mean testing. To me, that’s not what functional nutrition is. I’m not anti-testing, but there is a lot of other work that we can be doing that makes the practice of functional nutrition much more accessible to every and all individuals as opposed to a concierge, high cost practice, where we get lots of tests, treat to a test, take lots of supplements, and shop at Whole Foods. That’s not what functional nutrition is to me.
I hope that explains the difference between functional medicine and functional nutrition. I think there is a real need for more functional nutrition counselors who can think in these ways.
Dr. Eric:
It sounds like ideally, functional nutrition should fall under that functional medicine paradigm, but many practitioners overdo it with the testing and diagnoses. They focus more on that and don’t dive deeper into the health history and diet and lifestyle, as they should be. Am I understanding that correctly?
Andrea:
Yes, really understanding what does it mean to get to the root? What are the roots? What are our influencers with those roots? As opposed to looking for the root in a test. That’s not where the root lives. The root lives in the history, like you’re saying, into the timeline, into the matrix. Who are you? You are an expert in you. I’m going to learn way more about you by spending time with you than by looking at a piece of paper or any other scale or measure of who you are. They both might be needed, but we’re bypassing the most important evidence in the room.
Dr. Eric:
I admit I do testing in my practice, but I really consider myself to be more on the conservative side. There are some practitioners who will recommend a few thousand dollars’ worth of testing to pretty much every one of their patients. I know some practitioners say if they don’t go through all the testing, they can’t become a patient. With me, even if a person can’t afford the conservative testing, I would never say the person can’t become a patient. I also want to look at the health history and dive into diet and lifestyle, too. That’s great that you’re saying that. I appreciate that honesty. It’s great that you’re teaching your practitioners for so many years as well.
We met at an IFM conference. IFM, Institute for Functional Medicine. They talk about antecedents, triggers, and mediators. I wanted you to dive into those and maybe tie that into thyroid autoimmunity. I know you had your history of Hashimoto’s. Also, a lot of people who listen to this have Graves’. Of course, those apply to any chronic condition, not just thyroid autoimmunity, or regular autoimmunity for that matter.
Andrea:
Absolutely. I just want to say to your last point about the labs. I also love labs. I love them when I need more information. A lot of times, we have enough information to work with before we need that added information. That’s where I think there is a mistake. I also use and love labs. I think it’s just how they’re being used and where we’re bypassing the regular labs we can get from our doctors.
What’s coming in there? There is a lot of information there that sometimes point out to the instance of hydration and where we could be focusing on hydration. Change everything else just by changing how much water somebody consumes. All those other test results are going to change. I just wanted to point out, yes to the labs, when we need more information. At least from a functional nutrition perspective.
Back to our ATMs or antecedents, triggers, and mediators. What I’m going to talk about is two models that I think into. When I think about a case, I’m always looking through three different tools that I’ve created that are based on IFM tools to begin with.
One is the functional nutrition matrix. It’s an offshoot of the functional medicine matrix. In that matrix, there is three sections. They relate to everything is connected. We are all unique. All things matter. Everything is connected is that systems biology. We are all unique are those ATMs. That’s related to who we are and what’s individual about us.
Our antecedents are our genes, yes, but we don’t need to get genetic testing. We can talk about our family history. We can talk about who we are, where we’ve come from. It’s also when we were born, where we were born, how we were born, what order we were born in. There is a lot of good information in those antecedents that tell us where did you come from? What did you not affect in your life? It was just a part of what came with you. That’s what we’re gathering with our antecedents. It could be your genes. It could be your polymorphisms. We could capture that, but it doesn’t necessarily have to be those types of genes that people are looking for right now. It could be just what you know about your genes.
Our triggers are things that have happened throughout our life, positive and negative, that have impacted where we are today. For me, the ATMs are really about our timeline. There is gold in a patient’s timeline. If somebody says to you, “I’ve always had trouble sleeping,” my question to them is, “Tell me about your first memory of having trouble sleeping.” I’m not just making them a recommendation or putting them in a sleep study because actual information and triggers that we can identify from their childhood could be a part of the story. Our triggers are things that have happened in our life. It could be food poisoning, or traveling out of the country, or a virus, or taking antibiotics. It’s what we can look at and say, “I think there was a before and an after this point.”
When you were asking me my story, I told you that pregnancy is often a trigger for autoimmunity, such as Hashimoto’s or Graves’. It’s because of the shifts that are happening in our immune system during that time. I had other triggers, huge stressors on top of that trigger. Those for me are part of my story and my triggers.
Our mediators are my favorite part of the matrix. They are related to what I call the skills. They’re what we know what makes us feel better and what makes us feel worse. We get to put a plus or a minus next to the things that we know about ourselves.
My goal as a functional nutritionist is to help people know more of their mediators. Once we know more of our mediators, we have more agency over our own health because we’re making a risk/reward decision each and every day with each and every choice that we make as opposed to being in the big unknown and relying on a provider to tell us what we should or shouldn’t do.
ATMs are the antecedents, triggers, and mediators. I love spending time there. In fact, all my work going forward in the book I’m writing, it’s about the ATMs. The ATMs are our story. I really love the opportunity to bring people into that story. It’s a little corny, but I like to think of it as the “Oh me” instead of the “Why me?” which is a lot of the place we tend to be in with autoimmunity because it’s so confusing.
Dr. Eric:
You mentioned in some cases—obviously not in all cases—as far as pregnancy being a trigger. Would you agree that the antecedents could be the reason why in some cases it could be a trigger? Not only the genetics, but if someone is born via C-section, and they weren’t breast-fed as a baby, had a history in childhood of antibiotics, accumulation led to the point where it wasn’t in a way not the pregnancy itself, but everything leading up to the pregnancy that caused that to be the trigger.
Andrea:
Correct. There is never one trigger, just like there is never one root. The model I’ve created is what I call Three Roots, Many Branches (TRMB). This is based on the work of Dr. Alessio Fasano, who created the three-legged stool of autoimmunity.
My TRMB allows patients to think into any sign, symptom, or diagnosis as a branch. If we can visualize a tree, we can think of any sign, symptom, or diagnosis: Hashimoto’s, Graves’, bloating, migraines, restless leg, whatever it is. That’s a branch on our tree. We can address that branch, and that’s often what we’re going to our medical doctors for. In functional nutrition, we’re not only going deeper into the trunk and deep down to the roots. We’re focusing on the soil that the roots exist in or live in.
For me, the three roots for any chronic condition, which encompasses all autoimmune conditions, are the genes or the genetic predisposition; digestion; and inflammation. Those are the roots. If we have an autoimmune condition, I’m going to tell everybody we have to look at all three roots. But we can’t do anything about the roots.
What I’ve done is create a circle of influence that surrounds each of those roots that gives us a little bit more agency. Around the genes, there is a circle of influence, which are epigenetic factors. Around the digestion, there is a circle of influence. Around inflammation, there is a circle of influence. That gives us a little bit more of an idea of where do I go? What do I do?
To your point, Eric, yes, it’s never one trigger. You are never to blame. It’s again understanding, “Oh, this is what set me up for this. This is just the tipping point” versus “I did that, and therefore, it’s my fault.”
Dr. Eric:
I agree. There is usually, if not always, multiple factors, multiple triggers. Getting back to functional nutrition, how big of a role does that play in your opinion, when it comes to, I don’t know if you use the word “reverse” autoimmunity, or have someone regain their health? Obviously, it plays a big role. To reword it another way, can just nutrition alone help to alter the course of Hashimoto’s, Graves’, all these other chronic conditions?
Andrea:
I’m going to give you the answer I give most of my students, and then I’ll talk into it. When I say to my students, “What’s my favorite answer?” they will answer, “It depends.” Of course, because I’m a functional medicine nutritionist, I believe in the powers of food. Yet from a functional nutrition perspective, food is this object outside of our bodies. Coffee is coffee. Wine is wine. Bread is bread. It’s the intersection or the symbiosis of where food meets physiology when it comes to functional nutrition. I’m looking at how does this food or the elimination of this food impact your body and your brain?
For instance, we can talk about specific foods. Is it ideal for the healing of the internal system to eliminate a food? Yes. If that elimination causes a tremendous amount of stress, is that stress also detrimental to your health? Yes. I’m looking at the whole picture, but I always believe that there is a place for dietary interventions in addition to the powers of internal healing.
Dr. Eric:
That’s a good response. I’m glad you said it depends because I see it all the time, too. There are people where all they’ll do is eliminate gluten, and that seems like that’s enough to get into remission and to feel great again. Then there are people who follow whatever type of diet, whether it’s paleo or AIP, and they’ll still feel lousy. Maybe that’s not the right diet for them since there isn’t a perfect diet that fits everyone. But there could also be other factors, whether it’s the chronic stress they’re dealing with or infections. I’m glad you mentioned that.
I wanted to ask you: Do you have a favorite diet? Speaking of paleo, there is ketogenic, carnivore, AIP. Do you have one that you recommend to most people with autoimmunity? Does it really depend on the person, as far as what you’re going to recommend?
Andrea:
For me, it really depends. What I do for myself is not what I recommend to others. I don’t think dietary intervention is a prescription. I’ll tell you my principles for what we could be looking at, but my goal is for people to eat the most diverse diet that is possible for them at any one point in time. All of those factors are going to change over time, if we’re really looking at nutrition.
When I think about those areas of influence, that soil I was talking about that surrounds the roots, if we look at the root of genes and our epigenetic factors, the influence, the expression of our genes, that includes food, movement, environment, and mindset. Each of those, I can look at their circle of influence.
For food, I’m going to think about quality, quantity, diversity, and timing. All of those are going to be different depending on the individual. If I were to say, “Intermittent fasting, it’s the bomb,” but I’m talking to somebody who has blood sugar issues and dysregulation and is up in the night, intermittent fasting is going to be problematic. If we say, “Ketogenic diets are the way to lose weight,” and everybody is going on ketogenic diets, but they have problems digesting fats, or they don’t have a gallbladder, we are causing more issues based on these theories versus looking at the individual. That is not functional to me.
The principles that I’d rather invite people into around how they eat are three. I always talk in three’s if you haven’t noticed. Lots of three’s, sometimes four’s. Every meal should include fat, fiber, and protein. Of course, there is deeper conversations around what that means. How does that feel? But that will help with our balancing of our blood sugar, our metabolism. We have to start at least playing like that, bringing to awareness not how am I eating in accordance to a theory or a prescription, because that’s a diet. Nobody will stick to it, or barely anybody will stick to it. If we start to bring awareness to, “Wait, I’m actually choosing this not because it was listed on a piece of paper of what I should be eating and buying, but because I’m bringing awareness to what I’m eating.” Fat, fiber, protein.
The second one is to eat the rainbow. This is just something to have fun with. How many colors did I get in my day? I don’t care if it’s three blueberries, and it goes in blue or purple. Just start to have fun with your food. That will crowd out some of the other foods as you start to play around with that.
The third principle is to have your yes, no, maybe list. This relates to those mediators we were talking about, but it also brings people into awareness of what they know works for them, what they know doesn’t work for them, because I guarantee they know some of those things. Start to ask questions. “Every time I eat broccoli, it feels different. Sometimes, it feels like this. Sometimes, it feels like that. I don’t know. Should I be eliminating broccoli?” Put it on your maybe list. Focus where you do know for a minute, and then you start to experiment.
What I’m trying to introduce is more of an ownership and a relationship versus a set of principles that put people in a healing diet protocol, many of which should not be done for long periods of time but are because people don’t know how else to live.
Dr. Eric:
I agree as far as diversity, definitely important. It also sounds like certain foods you recommend avoiding, like things that can be mediators such as gluten. I imagine you advise people with Hashimoto’s and other autoimmune conditions to avoid it. Are you saying that just by introducing all the other healthy foods, it will push out those common allergens, without saying specifically “avoid gluten or dairy?”
Andrea:
I’ll tell you how it works. As you and I both know, and I’m sure our audience knows, there are certain foods, like gluten and others, that have the potential to act as molecular mimics in the body that can exacerbate our immune system.
For me, it’s a non-negotiable personally to eliminate gluten. What I’ve done in the last few years is work with more populations of people who have chronic illness but also have really troubled relationships with histories of diets and dieting or body or dysmorphia. I’ve worked with a group of transgender practitioners. I’ve worked with military practitioners who don’t have options to make changes that we would think of as ideal. That’s really informed the way I talk about diet.
If you and I were talking as practitioners, and if I have the opportunity to educate about gluten, yes, there is an entire class in my digestive intensive about the interactions of gluten in the body. I want people to understand those connections, so they’re in that risk/reward relationship.
However, I am cautious about starting with dietary eliminations for people who may have more complicated relationships with food, dieting, and their bodies. I’ve certainly worked with people with Hashimoto’s and Graves’ where the conversation about diet or food tracking is off the table for a little bit, and we have to think about other ways to enter while we warm up to the situation of talking about gluten.
I like to think of this as the ideal versus the heal. Ideally, with Graves’ or Hashimoto’s or any autoimmune condition, because of those three roots, we are not eating gluten because gluten can impact our gut lining and our ability to receive things in our bloodstream that we don’t need that impact our immune system.
Yes, yes, yes, and there are certain ways in which food elimination is so triggering for people, I have learned. A lot of people who have Hashimoto’s because they have been on extreme diets that make me really want to rewrite the story about how we usher into conversations that are about being able to take agency for our own health. I know that it’s complicated.
Yes to the elimination of gluten for Hashimoto’s and Graves’ ideally. And these are complicated conversations. I just want to note that because there is so much anchoring on these quick diet changes these days that I think are putting a lot of pressure and shame on too many people who also have these conditions.
Dr. Eric:
I agree. I think it makes sense. Ideally, gluten should be a non-negotiable, but depends on the person. If someone is used to eating gluten all the time, depending on how the health history and conversation goes, you still might encourage them to avoid gluten. If they’re in a position where that is stressing them out, you might take it slow and gradually, even with the gluten, and try to work on incorporating healthier foods rather than focusing on elimination.
I think it sounds like also, there is less non-negotiables, like for example, AIP, not to pick on it because I like it, but eggs are not allowed for AIP. It sounds like you wouldn’t tell every autoimmune patient that they can’t have eggs because even though it’s not part of AIP for certain reasons, it’s not the same as gluten, whereas gluten arguably causes an increase in intestinal permeability and inflammation in everybody. But eggs are nutrient-dense, and a lot of people do really well on eggs. I think I understand where you’re going. It makes sense.
You’re right in that really strict diets do tend to stress out a good number of people. That defeats the purpose of the diet in the first place, if they are going to follow a strict diet but really stressing every day on “When am I going to introduce the next food?” or “I can’t do this more than a week or two.”
Andrea:
I was going to add two things and one actual case study because it’s often helpful to think through that lens. I’m working with a case study group from the book I’m writing, which is focused on the timeline. I’m not their clinician because that’s not a book. I can’t be one-on-one.
We’re working through some more principles. There is one person who has Hashimoto’s. There is more than one person with Hashimoto’s in this group, but this one particular person has been to all the doctors. In fact, all of them have been to all the doctors and on all the protocols, and they are still not better. That leads me to what I love about the work. What’s happening that that’s the case? What’s going on? Where is there a lack of understanding? How do we get out of “I know what to do, but I’m not doing it” to the reality that if you knew what to do, and you really knew it, you would do it? There is something missing in the education or in the implementation.
For this one person in particular, she had been on an AIP diet. It had felt better, but it had triggered all of her disordered eating and her control of every single thing she had to include. Even when I was saying “we’re going to food track,” she couldn’t track her food. When I was saying “eat the rainbow,” she would go to eight cups a day. She couldn’t be in the in-between, in the small steps because every step was a big step, a huge step. That allowed her to be either in the all or nothing arena.
That all or nothing, neither were working for her, and neither were helping her get to her full expression of health because one helped her feel better physiologically but was a lot of stress psychologically, and the other one was maybe psychologically feeling a little bit better but was not physiologically working for her.
She had to have a rock bottom moment, and I had to allow her to have a rock bottom moment, where she was actually on the floor, vomiting, coming out both ends. Her husband, up and worried. Her daughter, up and worried. For her to say something has to shift. She kept saying to me, “Gluten doesn’t impact me. I don’t have any digestive issues.”
She wrote me a week off of gluten and said, “I don’t know what I was thinking, that gluten wasn’t impacting me. I can finally put my wedding ring back on my finger, and I haven’t been able to in three years.” That had to be her journey of ownership, so that she is not feeling shame or guilt around what she was doing and not doing. She was having a deeper sense of awareness. That is a more interesting, sustainable path for me for people forward than what is essentially becoming a diet.
The other thing I want to say with some of these healing diets, whether they’re low histamine or AIP or low oxalate or low lectin, these usually point to the fact that there is more healing that needs to be done internally so that the body can tolerate more foods. None of those diets are meant to be done for long-term. Once we do those diets for long-term, you are usually introducing other nutrient deficiencies by what we are not including in the diet that can manifest as signs, symptoms, and even diagnoses.
Eliminating gluten isn’t going to lead to any nutrient deficiencies. That’s the difference between a sustainable way of living versus some of these very restrictive diets, which are not designed for long-term living. People are getting narrower and narrower. In our clinic, we work with people who are eating three foods for three years when they come in. They just don’t know what’s going on, and they haven’t done the internal healing.
You can tell I’m passionate about this. I think we’re doing nutrition all wrong. I feel like there is a lot more we could be doing to move in with each individual to their reality, their story around food, and their body, and around making change to make it a sustainable change.
Dr. Eric:
I agree. There is actually some research now. With ketogenic, I think there’s one, if not multiple, studies on the long-term effects on the gut microbiome since you are not eating a diverse diet. I can imagine it’s the same with some of these other diets, not to pick on any specific diet. With ketogenic, it’s in the research, so I can pick on that, even though I’m not anti-ketogenic.
With these diets, if you’re going to do them, they’re not meant to be permanent diets or even really long-term diets. You make a good point.
Getting back to the gluten, you’re not going to have any nutrient deficiencies with giving up gluten or unhealthy oils or some other foods or categories of foods, whereas if you start restricting too many things, then you fall into that trap. Like you said, the psychological effects that it has on the person, we can’t overlook.
Andrea:
Those psychological effects have a physiological impact. That is the truth of functional practice. I always say I’m not a therapist. I’m into physiology. For me, it’s what’s going on in the body, and how there are so many things that can happen that impact what’s going on in our body. Our gut isn’t just impacted by our food and probiotics; it’s impacted by our sleep and our stress and our hydration and so many other things. I just worry that we’re missing those realities of the truth of systems biology when it comes to food and diet.
Dr. Eric:
Hydration, as you mentioned, that’s big as well. A lot of people don’t drink enough water, so they might focus on avoiding gluten, avoiding other common allergens, doing what they feel is everything right from a dietary standpoint, but maybe not drinking enough water.
One time was actually yesterday in a patient consultation, where I asked someone, “Are you drinking enough water?” They were honest and said, “No, I’m pretty sure I’m not drinking enough water.” A lot of people say they are not staying well hydrated.
Andrea:
Even before I might know that, this is a place where I love serum labs. We can look at people’s red blood function and see if they’re potentially dehydrated and point that out and make the connection. I’ll have a lot of people who are complaining to me about fatigue. If you look at a red blood cell function that is not functional, and they’re not hydrated, we’re not pumping enough blood, and we’re going to feel our energy depleted.
Making those simple connections for people, I like tothink of itas the simplicity on the other side of complexity. We think that the conversation about hydration or sleep, maybe that’s a little too basic. I talk about the complex stuff, but I can talk to you about your hydration in relation to your energy and your oxidative stress. I can talk to you about your sleep and your microbiome. It’s understanding the complexity of systems biology and yet understanding the realities of the core basics, which for me are on the right side of the matrix, which is why I keep using my hands. Those ATMs and those core basics.
Dr. Eric:
That’s a great point about what’s considered to be basic testing, like a CBC with differential or comprehensive metabolic panel. Unfortunately, a lot of doctors spend a few seconds looking and seeing if everything is in the lab range. When it comes to the RBC, they’re concerned if it’s low. If someone has anemia, the low hemoglobin, the low hematocrit. If it’s elevated or on the higher side, they may not pay attention to that, which as you could suggest, means someone has problems with hydration. I definitely recommend all those basic tests.
Here’s a question when it comes to the non-negotiables. I’ll put you on the spot as far as dairy. Would you consider dairy to be a non-negotiable when it comes to autoimmunity?
Andrea:
I’ll tell you my non-negotiables because I have three tiers of nutrition mastery. Tier one is your non-negotiables, which are sleep, poop, and blood sugar balance. If dairy is impacting something, then we have to look at dairy as a non-negotiable, your yes/no/maybe list.
I do think people have different tolerances for dairy. I have some Hashi sisters, one which we were talking about earlier, who can’t tolerate dairy at all. I can tolerate minimal dairy, and it feels fine. I didn’t tolerate dairy at all times. I’m careful about what I choose. I don’t eat cow dairy. I will eat goat and sheep dairy. I choose to ideally eat raw goat or sheep dairy. I can’t eat it regularly; I can put it in what I call my bike lane, for those of you on the east coast, that’s the shoulder. I’m on the west coast, so it’s a bike lane. We have our path. We have our poison ivy. There’s a place where we need a little wiggle room, so that we’re living.
For me, it depends where we are in our healing journey. It depends who we are, and it depends what we’re able to track and determine as working for us, like you said with eggs. I’m about the same with eggs as I am with dairy. It’s not an everyday. It’s on occasion. I’m selective about my source or quality that I’m using when I do consume that food. I’m pretty tight about how I eat, but it allows me the wiggle room to at least take a whole food and make it an include in moderation as opposed to some notion of can’t.
Dr. Eric:
Just to repeat your non-negotiables: sleeping, pooping, and balancing blood sugar. Dairy, depends on the person. Gluten, obviously falls in that non-negotiable, as you mentioned. Definitely want to get sleep. That’s another big problem.
As far as regular bowel movements, what do you consider? Two per day, three per day?
Andrea:
So many of us with autoimmunity are perfectionists. We’re type A. I don’t want anybody worrying about the perfect poop now. Yes, I like to think about form, function, and frequency when it comes to poop. 1-3 times a day is nice. Well formed, easy to pass, no straining but not urgent, brownish in color, not too light, not too dark. That’s our best diagnostic test for a person. Look in the bowl. What do you got? How does it feel?
Then how can you begin to see what makes a difference? If I eat more protein, does that impact my poop? If I eat more fiber, does it impact my poop? If I eat more fiber and increase my hydration, does that impact my poop? This is how we develop true sustainable relationships with our food and our dietary plan. Just paying attention. I think poop is our best diagnostic tool, but not through stool testing, through what’s in the bowl.
Dr. Eric:
Observe your poop.
Andrea:
Heavily.
Dr. Eric:
Not to say there is not a time and place for a comprehensive stool panel. Again, before you do that, make sure to observe your poop. It’s a good point. There is a lot you can tell by observing not just the poop, but looking at your tongue. Paying close attention.
There are people who say, “Should I do testing for candida?” I’m not saying I never do that, but do you have strong sugar cravings? Do you have a thick white coating on the tongue? Other symptoms that might suggest that? You might be able to find out without doing the testing.
Andrea:
Exactly.
Dr. Eric:
Glad we’re having this conversation. One of the questions I wanted to ask you since I know you work with a lot of practitioners is some of the more important functional nutrition tips that you give to practitioners. I don’t know if what we already covered would be some of those tips, or if there is anything else for any practitioners who might be listening to this that we didn’t cover yet.
Andrea:
I want to highlight the understanding of what’s going on in the body. I train thousands of practitioners, and they may be surprised that I’m teaching physiology. I’m just teaching it through the lens of where food and lifestyle meet physiology. Even our nurses and doctors and chiropractors who come through my training will ask, “Is this going to be a repeat of what I already know?” They come in and are like, “I knew the physiology, but I never thought of it like this.”
The biggest thing I’m teaching people is what I call “What’s going on in there?” When we understand how the body should function, we can see the clues to where we might need to move to make our recommendations.
Then the top tools I’m going to use are the functional nutrition matrix, which again, remind us everything is connected, we are all unique, and all things matter; the TRMB, to help us think through, where do I go now; and what I call the three tiers to nutrition mastery, which starts with tier one, the non-negotiables. It goes to tier two, deficiency to sufficiency, and then tier three is dismantling the diagnosis. That tends to be where we want to go. If we work on tiers one and two, that soil, we actually influence tier three without having to play target practice.
Dr. Eric:
All right. You covered a lot. You gave a lot of wonderful information. Is there anything I didn’t ask you that I should have asked you? If not, perhaps you could summarize what steps people should take if they are interested in taking that functional nutrition approach.
Andrea:
I think we had a great conversation, so I feel like we did covera lot of basics. I do want to say that oftentimes, we’re overcomplicating the situation. For patients listening, I just want to remind patients that you actually have influence in the decisions that you make every day. If you’re struggling with a decision, that’s where you can seek help.
I invite you to think about your non-negotiables, and they may be not eating gluten or saying, “Oh, she said sleep, poop, and blood sugar balance. I don’t know how to do those, so that’s what I’m going to get help with as opposed to my diagnosis because I know this impacts the expression of my diagnosis.”
Also, I invite people to think about what are your personal non-negotiables that you know? For me, it’s reading, spending time with my partner and my son, being out in nature, being in awe. I went to Iceland last summer, and I’m going again this summer because wow, the healing power of awe was just astounding to me.
I invite people to think about their personal non-negotiables. Might be playing music or having more laughter or being with family more often. There is a lot of healing in that that we’re bypassing as we’re stuck in this sympathetic dominant state, seeking the answer, when in fact it’s multi-factorial. It’s all the things. There’s stuff you can do while you’re on that quest.
Dr. Eric:
Well said. Where can people find out more about you, Andrea?
Andrea:
You can head over to AndreaNakayama.com. Lots of A’s. That will lead you to all the places, to the Functional Nutritional Alliance, where I teach practitioners; to any writing and opportunities I have now; and to The 15-Minute Matrix podcast and other podcasts like this one.
Dr. Eric:
Thank you so much, Andrea. Appreciate your time and sharing all your wonderful knowledge when it comes to functional nutrition.
Andrea:
Thank you so much.