278. How to Better Understand Stress with Andrea Nakayama, Functional Medicine Nutritionist and Educator

Stress. We experience it so much in our lives today, yet do we truly understand it? We bring stress to our healing, to our eating, to our health challenges, but how often do we pause to take in the whole picture of what's really going on? How can we begin to tune into ourselves among all the noise out there? How can we start moving through stress more effectively? In this conversation with Functional Medicine Nutritionist and educator, Andrea Nakayama, we go deep on all things stress and how to "separate the problem from the solution" for a more holistic understanding of what's really going on.

Among the Questions Explored:

• How can we develop a deeper understanding of stress?
• How can being self-aware be self-care?
• Why do quick fixes and endless data often do more harm than good?
• How can working within a group on food and other stressful issues be life changing? 
• How has functional medicine gone off the rails?

Guest: Over two decades ago, Andrea Nakayama's husband was diagnosed with a brain tumor and given 6 months to live while she was pregnant with their first and only child. In response, she doubled down on an area she was passionate about—nutrition—in an attempt to extend his lifespan beyond his 30s. They made it over two years, and in the wake of his death, she discovered that she had developed Hashimoto’s. The transition from caregiver to patient challenged her to advocate for herself and others within a healthcare system that routinely pushes cases like hers and her late husband’s to the margins. As the host of the 15-Minute Matrix Podcast and the founder of Functional Nutrition Alliance, Andrea is leading thousands of students and practitioners around the globe in a revolution to offer better solutions to the growing chronic illness epidemic.

Connect with Andrea Nakayama: 

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• Website

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Transcript

Ali Shapiro [00:00:08]:
Hello, everybody. I'm just taking a deep exhale. It has been a week here in America. I think this episode, which is gonna be all about stress, couldn't come in a better time. We experienced stress so much today, and I think we have a real lack of recovery from it, from it's not even a 24 hour news cycle anymore. It's like a 2 minute news cycle, and we bring stress to our healing, to our eating challenges, to our health. And so I really want us to unpack, like what is stress and how can we move through it better? Especially because the phrase says that I think it was first attributed to Joan Rivers, life doesn't get easier, we get better. Right? And that's something that not only do we have to deal with that, reality and we are in a time of immense change.

Ali Shapiro [00:01:05]:
So there's gonna be more stress coming faster. So I wanna really tackle this, topic today in hopes to help you have a better handle on it. Before we get there, I do want to talk about 3, things. First of all, part of the insane news cycle is that Richard Simmons, who, many of you probably are familiar with, passed away this past weekend. And I was really upset about it. Some of you may have known him through the deal a meal diet that he did, which was basically I tried it. Of course, you would get these cards and kinda like a card deck, deal them to like in this kind of flexible way to lose weight. But he was also the promoter of a lot of, it was called Sweatin' to the Oldies and different exercise things.

Ali Shapiro [00:02:03]:
And he was one of the leading people who really made exercise, I think, accessible to everyone regardless of your body size, or regardless of if you were a professional athlete or not. If we look at through the history of exercise, right, exercise for everyday people is a relatively new concept. And for a while, it was really just geared towards people who were already super thin or wanting to be thin or just athletes. That's why else would you focus on your physical fitness. And I think Richard Simmons was someone who really pioneered this more inclusive, expansive, approach. And you could tell he just like loved people and really brought the humanity forward and us trying to feel good in our body. So just wanna acknowledge him. He, there was a podcast about him for a while, because he became a real recluse, you know, in his later years.

Ali Shapiro [00:03:01]:
But I just want to acknowledge his passing, and for all of those who he held a special place in our heart. My one friend and I, Lindsey, who we used to do step aerobics together at Valley's in high school, And there was a guy who taught our classes called Roger. And and Roger was, like, our local Richard Simmons in Pittsburgh, in the Pittsburgh suburbs. And she texted me being like, Roger and Richard Simmons were the goats. And I was like, I know. I know. So, I know he really impacted a lot of people. So, I just wanted to, acknowledge his passing.

Ali Shapiro [00:03:40]:
The second thing is remembering to leave reviews for insatiable. I have a goal to get to 200 by the end of summer. We'll do this the Equinox summer, September 21st. We started at 175 and we're up to 190. I can't thank all of you enough who have really rallied. We have 10 left to go. It really takes less than 2 minutes. It's a free way to help the show and I'll leave a link in the show notes of how you can do that on Apple Podcasts and or Spotify.

Ali Shapiro [00:04:11]:
You can review in 2 places. I'm going to read 3 of the recent reviews. This is from Sylvia Ann R. She said, Oh, yeah. So interesting. I had kind of forgotten about macros, pushing that info to the back. I am on it now. I'm going back listening to your older podcast.

Ali Shapiro [00:04:30]:
Aniad 23, I hope I'm pronouncing that right, said, I discovered Ali's podcast Insatiable about a year ago and so glad I did. I always look forward listening to the episodes now. It is one of my go to podcasts on nutrition and health. The episodes have given me so many insights and ahas, great information, and I always get a ton of value. Keep them coming, Ally. You are making a difference. And then lastly, well, one of the newer ones, not the last one. But, we have Blue in a Red City Road Insatiable.

Ali Shapiro [00:05:03]:
I absolutely love Ali and her show. I feel like her take on food is something I can apply to everything in my life. She is so smart, but also so easy to understand. Her podcast has significantly contributed to my healing journey. Love, love, love her show. Thank you, Allie. So thank you everyone, who is taking the time to leave the review. It really, really helps this independent, business owner out.

Ali Shapiro [00:05:29]:
And then the last thing I wanted to say is stress is also on my mind because we address the roots of stress and emotional eating in my upcoming program, Why Am I Eating This Now live, which will launch and be open for registration in September. That is in less than 3 months. Can you believe it? I always kinda gas my breath at the passage of time. But in the show notes, I'll link an I'll include a link to the wait list. We have a lot of people on it. I'm so excited. We're totally revamping the program to incorporate some of the new research. So this is gonna be amazing for people who really wanna get to the roots of their emotional hungers and why they fall off track with food without having to white knuckle it.

Ali Shapiro [00:06:17]:
So, check that out. And lastly, now we are getting into our episode with Andrea Nakayama. We share the funny story of how we met, but I have known Andrea for, oh my god, maybe 15, 16 years now. She is one of the people I admire the most, in the space as a peer, as a colleague. And I really wanted to have this conversation with her because when we think about stress, I find that a lot of the people that I'm working with now are more stressed than ever about their healing, about their health. People are increasingly having more diagnoses. Obviously, I'm getting older. So, there's more stuff that happens as we age.

Ali Shapiro [00:07:04]:
But I also think the space of functional medicine, of healing, personal development is getting noisier and noisier and it's really kinda jumped the shark. So Andrea is gonna bring us back to earth. She's gonna help us clear a lot of the confusion and really speak to the power of what a true functional approach, including a whole body person approach, how that moves the needle, how that enables you to not stress, and actually address your stress, which is probably contributing to the problem. It's not just if you're eating gluten or sugar or not. So I'm so excited to bring this conversation to you today, to hopefully clear the air, get you feel settled in to, what you actually need to do to heal your body, heal your relationship with food, and your relationship to yourself. So a brief summary, we'll get into her story, which is so powerful, at the top of the episode. But 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 Minute Matrix podcast and 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.

Ali Shapiro [00:08:43]:
Without further jitter jabber from me, here is this episode. Enjoy. And I hope afterwards, you feel your stress go down by at least 5 notches. Take care. Andrea, thank you so much for being here today. I have wanted to have this conversation around stress for so long, and yet I didn't know who to have it with. And so, I'm so grateful that you're here because you are the perfect person I would want to have this conversation with. So, thank you so much for for being here.

Andrea Nakayama [00:09:16]:
Oh my gosh, Ali. I'm always excited to spend time with you, and, we have such a magical story, and I love that we keep coming back together and finding our ways into these deep conversations.

Ali Shapiro [00:09:30]:
Yeah. I was trying to think of when we first met, and I remember it was in a hotel lobby, I believe in New York City, And my brain is I'm still coming out of menopause brain. It was in New York City, but I can't remember what conference it was.

Andrea Nakayama [00:09:44]:
It was a integrative health symposium, and you actually were not attending the conference. I think you were waiting for a friend in the lobby, and I came out, like, for a little break from the conference, and we started talking, and we just, like, clicked and gelled and ended up just circling around each other years later. I think that was I don't think you were attending the conference. You were doing some research.

Ali Shapiro [00:10:12]:
You were

Ali Shapiro [00:10:13]:
right, my friend. Yes, yes, that's right. And you're right, my friend who was a client term friend was actually there. So that is an amazing memory. And yeah, it's we've been in each other's circles for We've been in this field and has really grown up with it, I think of functional nutrition, holistic nutrition. But, I feel like in some ways, functional medicine has jumped the shark and you're bringing us back and you're in a more holistic keeping true to, the origins of functional medicine, which is a systems approach. So I just so appreciate the work that you're doing in the world. So, can you tell people a little bit about your story and how you became so devoted to this systems approach, to the body and nutrition.

Andrea Nakayama [00:11:09]:
Yeah. So thank you for saying what you just said. I really appreciate that. And I do feel like functional medicine and functional nutrition have gone off the rails, and it's actually creating a lot more stress for people that we'll talk about. For me, the change in my own career came in, the early 2000s when my late husband, Isamu, was diagnosed with a very aggressive brain tumor, and I was just 7 weeks pregnant with our 1st and only child. So talk about stress. As you know, and as you talk about pregnancy is a stress in and of itself, but then at the same time, my husband was diagnosed, we're looking at likely what he was given. His prognosis was about 6 months to live.

Andrea Nakayama [00:11:54]:
So here I am going through stress upon stress upon stress, physiological stress, psychological stress, there's a lot happening there. And, while he was given 6 months to live, he lived about two and a half years. So he did get to live to have an imprint on our son. He died when our son was 19 months old. At the time of this recording, our son is 23 years old. So that was a long time ago now. But it really woke me up to some of the major gaps in our medical system. And those two biggest gaps that I first encountered, and I think these are important for all of us to recognize for ourselves, is that people in our current medical system are treated like their diagnosis.

Andrea Nakayama [00:12:42]:
So you are your diagnosis, and then everybody with the same diagnosis is treated the same because there is a protocol for that diagnosis or sign or symptom whatever it may be. So those gaps are what really led me after Isamu passed to recognize that there was something to fill, that there was something that needed to be addressed so that patients could have more agency over their health and realize what other things we could do to improve or alter our health outcomes. So that's my story at in a nutshell at the beginning, and it has really changed over time given what I've been exposed to in the industry as well.

Ali Shapiro [00:13:34]:
That story is so powerful on so many levels because I think what you just said is like Usama was treated like his diagnosis and not the whole person. Right? And to your point, you were able to fill in gaps that that diagnosis couldn't, I think. And for him to be able to meet Gilbert and Gilbert to meet him, like, that is such a profound difference. Right? Those 19 months, like, I have chills. Like, that is Totally. Yes.

Andrea Nakayama [00:14:08]:
I mean, Gilbert does not remember his father, but that imprinting and the love that he knows from the story and from having that initial time together is really critical. I mean, an interesting story to think about here is that, Gilbert was born at home in San Francisco where we lived at the time, but I had to transfer to

Ali Shapiro [00:14:32]:
the hospital to deliver the placenta.

Andrea Nakayama [00:14:32]:
So the midwives didn't want Gilbert to go to the hospital because they would admit him as a newborn if we arrived there. So I actually left the premises of the birth, and the 2 of them had time with 1 of the midwives there to support to really have a deep bonding experience that was without me there that I think, like, in some ways was by design that they could have that those hours together. Ultimately, Isamu couldn't handle the worry about me, and the 3 of them got in a car. So Gilbert got in a car in his first hours of life, and they came to the hospital, and he suddenly hit him. But they did have an hour or 2 of, like, deep, deep bonding without me even there.

Ali Shapiro [00:15:28]:
Well, yeah. And even your use of the word imprint because so much of us, we think, oh, well, we don't remember our early experiences. And yet, there is a felt sense that often, you know, that can't be articulated, but it's there. Right? And so I think that's why I love that you use the word imprint. It's there. It's there. Even if you can't psychologically remember it, there's a physiological felt sense of attachment, I guess, that comes out. Yes.

Ali Shapiro [00:15:57]:
One of the things also that I know about your story is that after all of that caretaking and all of that stress of pregnancy, birth, filling in the gaps, to extend your late husband's life, you developed Hashimoto's. Can you share a little bit about that as well?

Andrea Nakayama [00:16:18]:
Yeah. That was an interesting journey that also led me

Ali Shapiro [00:16:22]:
to understand more of the gaps in medicine.

Andrea Nakayama [00:16:22]:
And I just wanna say when I talk about the understand more of the gaps in medicine. And I just wanna say when I talk about the gaps in medicine, it isn't to elicit any disdain for what our medical system is. Our medical system has limitations, and it's really important that we recognize those limitations. Otherwise, we cause ourselves more stress because we're looking for one person to be the be all end all, or we're looking for somebody or something to serve all needs. And I really do believe that we need new kinds of practitioners, that we need other support than we get from the system or the doctor. The doctor is not the god. They are a guide, and we might need other guides. So I just wanna say when I talk about the medical system, it's not about disdain.

Andrea Nakayama [00:17:08]:
It's about recognizing limitations and also scope. Right? So, with my own Hashimoto's, it came after actually uncovering my mom's Hashimoto's because she was experiencing thyroid issues that weren't resolved by the medication, and I started digging. This is very early in my career. I I wasn't in nutrition yet. I was still in school studying and learning, but I started to look around and the information that we have available to us today, I can call it information or I can call it noise. The noise that's available to us today was not available when Isamu was sick, when I was looking for, what was going on with my mom. So it was a lot of digging to understand, wait, how can we look at this differently if she supposedly has this diagnosis, she's given the pill for the diagnosis, and she's not seeing results. What does that mean? Is it a dosing issue? Like, what's going on? And that's where I started to see the physiological system more comprehensively and ask a different set of questions that led us to the appropriate diagnosis which was Hashimoto's not hypothyroidism.

Andrea Nakayama [00:18:29]:
So Hashimoto's is an autoimmune condition that happens to manifest as, hypothyroidism, but it's a different issue at its roots and needs to be addressed differently. And then when I started to experience the same things without medication, I started to wonder, wait a minute, what's going on here? Was able to label it for myself, but I'm not in the position to diagnose that's outside of my scope. I can make the assessment and take it to a doctor who could then give me the diagnosis that I already knew I had. But it was a lot of that stress, which is an underlying factor to autoimmunity that was at the roots, not one root, but the roots to my own Hashimoto's, evolution and diagnosis.

Ali Shapiro [00:19:26]:
That's such a I think I love that you said roots because sometimes the noise will say nothing's genetic, and it's, like, well, okay, maybe environment and triggers, you know, genetics load the gun, environment triggers, you know, pull it as they say. And though there if you have a genetic component, it's important to know that, to know that this may be a weakness that you want to account for. So, if your mom had it, you had it, it's like, okay, genetically, we need to be aware of this and the stress, you know, contributed to that being activated or whatnot. So, I love that you said roots. So, that's really important. Okay. So, stress. I want to start off with, I feel like we all know we're stressed.

Ali Shapiro [00:20:15]:
We use this term, I'm stressed, I stress eat, I mean, the world is stressful, but it's still a vague concept, I think. So, how do you define stress? Like, how do you how do you define it?

Andrea Nakayama [00:20:29]:
Yeah. And I just wanna back up a little bit and talk about those roots for a second. So I always say that there are 3 roots and many branches and the branches are any sign, symptom, or diagnosis that we have. Including the hospitals, including the menopause, including all the symptoms that we might experience. Those are branches. And if we keep trying to address the branches, we miss the opportunity for sustainable results, and we stay in a stress cycle. We stay in a sympathetic dominant stress cycle where we are chasing. We're in fight or flight, which is, you know, to answer your question, that definition of a stress response where we are in that sympathetic dominant fight or flight response.

Andrea Nakayama [00:21:13]:
And when we are only focused on the branches, that's where we remain. The roots in the models that I've developed are the genes, which you were speaking about, digestion and inflammation. And so if I look at those three roots, the genes, we cannot change our genes, but we can change the expression of our genes. And so those are epigenetic factors, and stress becomes becomes one of those epigenetic factors that's really creating more of the, challenges that we might be experiencing with our genes. Digestion, we can come back to, but I will say, like, if anybody's talking to you about food or nutrition without talking about digestion, they're missing the point because the 2 meet someplace. The digestive system is where food meets physiology. And if the digestive system isn't functional, it's not working to the best of its ability, it you could be eating the quote, unquote best diet ever, however you define that, which is, you know, its own set of challenges, and there will be issues there. And then with inflammation, stress is a major factor.

Andrea Nakayama [00:22:22]:
So I think of the 3 roots, again, genes, digestion, and inflammation, and each of those roots lives in soil that I'm helping people understand so they broaden their perspective to health instead of that targeted branched approach to health. So when we say stress is a sympathetic dominant fight or flight response, There are different ways that we experience stress that I will identify as psychological, physical, and physiological. And we have to recognize that they're all contributing to each other. And so it's not just, oh, I'm stressed. The world is stressful. If our body is experiencing more stress because of a physical or structural issue. We've been, you know, we're misaligned. We've been in an accident.

Andrea Nakayama [00:23:19]:
We have, things that are we're experiencing at a physical level or physiologically, which is often the case as we are aging, as we go through more insults in our lives and our bodies, that's going to impair our abilities to actually manage the external or psychological or emotional stressors. So our ability to see more broadly and give ourselves the grace of not doing it right because we can't do the one thing and step into the rest and digest, I think is how we start to have more of that resilience that counters the multitude of stresses that we're experiencing.

Ali Shapiro [00:24:09]:
I love that. It makes me think of the the good news and the bad news is it's all connected. It's still having this ripple effect on other systems. A 100%. So it's the good news and the bad news. Yeah.

Andrea Nakayama [00:24:28]:
I mean, I try to make it broader for folks because we get so targeted and so hard on ourselves, and my mantra, to your point, is everything is connected. We are all unique, and all things matter, so recognizing everything's connected, that stress over here and this, like, yeah, I am under a lot of stress, and if I get a good night's sleep, if I drink my water, like, all those things matter. I get a kudos. I get a good gold star, so it is, you know, a recognition that we are, when we play target practice with our health issues, we're actually causing ourselves more stress because we're looking for that answer instead of embracing the beautiful complexity of life. We started this conversation with stories that are part of what make us who we are, and that recognition is where I would love patients to focus more instead of trying to ignore who they are and adopt this problem that we're seeing in medicine, which is a protocol based. This is the problem. This is how I fix it. We're doing that to ourselves, and I would like to say, wait a minute.

Andrea Nakayama [00:25:51]:
Let's think about this differently for ourselves. Recognize that that isn't working for me in the medical system, why would it work for me in my own self care?

Ali Shapiro [00:26:03]:
Yeah. I think one of the things that I just got off with my, one of my group programs, we were kind of reflecting, and I think one of the people were saying, it was almost like I didn't realize I was holding so much until I didn't have to hold it. And I think that's one of the challenges with, especially psychological stress that then wears and tears the more that you go through menopause, the more you age, but we beat ourselves. We end up beating ourselves up for not being able to handle everything instead of saying like, Why does this make sense? Right? Like maybe you're not supposed to be on and going nonstop for 18 hours a day, so that we can look at this. I love these buck I'm calling them buckets that you said, like, physiological, physical, even, like, I think, like, sitting in a desk all day. Totally. Yeah. And then psychological.

Ali Shapiro [00:26:56]:
Yeah. Those buckets, that that give some people something to ground into to just almost like, you know I mean, Carlos always jokes with me, like, I do this tag. I'm like, if I have, like, a headache, I'm like, did I get enough water? Have I been sitting too long on my desk? You know, it's like Yes. It's like you start to realize you can go through different buckets instead of I can't handle this. You know? I think that's looking at that whole person approach as you call it.

Andrea Nakayama [00:27:21]:
Yeah. I think

Ali Shapiro [00:27:22]:
It's so important.

Andrea Nakayama [00:27:23]:
One of the things that I've really seen is a tendency to look outside of ourselves for more and more information, whether it's some kind of tracker that we're wearing or using, some guru that we wanna I call it pill protocol or or practitioner shopping. We are looking outside of ourselves, and it's very similar to how historically people use to scale. I don't know how I feel about myself until I step on the scale. Right? Like, that same thinking is where we are caught in looking for our internal barometers. And part of where my work is turning, embracing narrative medicine as a part of functional nutrition, is looking at where we look inward. What are the clues that tell us where our boundaries are? What does and doesn't work? When you were talking about stress and menopause, I can think about when I had hot flashes and how I started to recognize that if I went to bed, either with stress high for some reason or another or past a certain time, then I would have the hot flashes that would wake me up and affect my sleep and then cascade from there. So my ability to recognize hunk, this day, I did have a hot flash. This night, I didn't have a hot flash.

Andrea Nakayama [00:28:57]:
What's the difference? And like you're saying, not overanalyzing, but just recognizing, wow. I went to bed at 9 last night, and I slept all the way through the night. What does that tell me? Is there is there something instead of just looking to what the negative feedback loop is, where is there a positive feedback loop Where I start to identify what in functional medicine we call our mediators, the things that make me feel better, the things that make me feel worse. The more of those I know, the more I have agency over how I feel. And it seems simple, but when we actually can engage with tuning in instead of tuning out, there's a lot of good information there.

Ali Shapiro [00:29:45]:
Yes. Well, I love that because And I love that your work's turning there because that is what my work is rooted in. So, 100% is, realizing that developmentally, we had to think that there was experts out there, our caretakers, our doctors, like you don't wanna come out of your 20s with no moral code, no sort of, you know, sense of right and wrong. But I think the task of adult development and adulthood and maturity is to say, Oh, those people didn't know everything. Right?

Andrea Nakayama [00:30:19]:
Totally. And

Ali Shapiro [00:30:20]:
so, And I live with my body 24 hours a day. So, I need to start to like even at the beginning, it feels confusing, like I need to start there. So, I would love to make this really practical and kind of do a case run through with you of a client of mine who gave me permission to use her example. Yeah, I know. I was like, I think Andrei will love this. So we're gonna call her Jane. That's obviously not her real name, but she is a 44 year old single mother who has Hashimoto's as well, so I'm glad you defined what that was earlier. And just again, for listeners who don't know, it's a chronic disorder where the immune system attacks the thyroid and has symptoms that range from fatigue, to weight gain, to joint and muscle pain, there can be fertility challenges, it can be very different based on the person.

Ali Shapiro [00:31:16]:
Jane is also struggling with some lingering effects from having had COVID for a third time. And she's a really hard worker, ultra responsible. She has a huge job. And she's oh, yeah. I said single mother. She's like a really incredible person. And a few years before working with me, she went to a respected functional medicine doctor, some would say famous, and this doctor put her on the autoimmune protocol diet, which for short is known as AIP. And it worked for some time, but she couldn't sustain it.

Ali Shapiro [00:31:52]:
And here's what she texted me when I asked her if I could, use her her example. And she said, sure. She said the AIP diet was helpful, but near unmanageable and absolutely not sustainable at all. And I think too large of a calorie deficit too. And I felt like I had to master this AIP program, right? Like, she was exceptional to everything else, she's going to bring this to her life, and it isn't possible. And so, I felt like a failure. And then back at square 1 for feeling so defeated, and if it was expensive, and it was so expensive. And she said, Had I done Truth with Food First, I never would have considered the AIP diet.

Ali Shapiro [00:32:34]:
Looking back, it's too much of an isolated approach. That was interesting.

Ali Shapiro [00:32:39]:
But then

Ali Shapiro [00:32:39]:
you're desperate. Yeah, you're desperate because regular medicine has no answers. And so, we hope we have so much hope with everything we try. So I think the big thing that listeners will identify as she felt like a failure and guilty, right? Like, Oh,

Ali Shapiro [00:32:55]:
I felt better for a short period

Ali Shapiro [00:32:56]:
of time. So, let's imagine we're collaborating together

Andrea Nakayama [00:33:00]:
to support her.

Ali Shapiro [00:33:01]:
How would you begin to approach someone like Jane?

Andrea Nakayama [00:33:05]:
Yeah. I mean, first of all, I see you, Jane. So many people, unfortunately, have been down this road where, again, they're given a diet as if it's a handout, really not understanding the person's history, what there's how sustainable it is, whether they can afford the diet, what their social life is. There's so much more to consider when we're thinking about nutrition. The other thing I wanna say is that when I talk about a holistic approach, I'm not talking about the interventions being holistic. I'm talking about the entire approach being holistic, meaning that I need to know Jane that holistically to actually make a recommendation. In my teaching, I call it the art of the practice, assess, recommend, and track, and repeat, and that assessment's very deep. We do not make a recommendation based on a diagnosis, based on a 15 minute visit.

Andrea Nakayama [00:34:12]:
We are really going deep into who are you, Jane, so that I can understand the appropriate movements forward. So I have 3 key systems that we use to think through a case, and I'm just gonna highlight those because they'll help us figure out where we need to focus even though it's Hashimoto's, even though we know there's a history of COVID, even though we know that Jane is so hardworking and has a lot on her plate and has tried so many things before. So those three systems are what I call the 3 tiers, the 3 roots, and the matrix, the functional nutrition matrix. So from a assessment perspective, I'm gonna really step back and understand all of Jane's history. I wanna know how Jane was born, what birth order it was, what her childhood was like, what life was like when she got the Hashimoto's diagnosis, when those symptoms started, when are they worse, when are they better, What has she noticed works positively? What works negatively? With AIP, I'd put a plus and a minus with that because she felt some positives, but there were also some negatives. I wanna understand Jane's story really deeply. I also wanna understand Jane's soup, and by the soup, I mean the system's biology. I wanna understand, yes, you received a Hashimoto's diagnosis, but what else have you experienced? Are you experiencing any digestive symptoms? What happened with the long COVID? How did you know or the COVID 3rd time? What are the lingering effects? I wanna map that so I can see all that Jane is experiencing or has experienced instead of just focusing on the diagnosis or what's happening in this moment.

Andrea Nakayama [00:36:09]:
Because her hormones are gonna be connected to her digestion, which is connected to environmental inputs, which is connected to that. I wanna see the whole picture. And then I wanna know Jane's skills right now. What do sleep and relaxation look like? What do exercise and movement look like? What do nutrition and hydration look like? Right now, no judgment. I just wanna see the picture of Jane, and that's what the functional nutrition matrix allows me to do. And the way I think about it is separating the problem from the solution. So, yes, the problem may be I have Hashimoto's or I'm in menopause, but when I understand that problem more fully, I can see more clearly what our next steps are. So that's system number 1 is all about the individual.

Andrea Nakayama [00:37:05]:
It allows me to truly see Jane for Jane. Of course, there's gonna be more I'm gonna learn about Jane as we move forward, but I can really step back and see more and map more of the whole and understand Jane's goals as well so that anything I'm recommending is making sense to her, and we make sure it's a sustainable solution. So instead of walking out of a visit with, like, 30 supplements, I would look at a deficiency and make sure that we know how we're addressing that deficiency. Is the way we're addressing the deficiency appropriate? Knowing the physiological mechanisms that are in operation with something like Hashimoto's, I'm thinking through the entire picture. Even looking at her labs, Allie, I'm seeing where the break points are instead of just looking at the branch, Hashimoto's. I'm seeing, wait. This is communicating with this. The brain's communicating with the thyroid, but for some reason, the thyroid's not producing what it needs to do, or it's not converting what it needs to.

Andrea Nakayama [00:38:15]:
So when I'm looking at the labs, I'm seeing a picture that helps me to help that individual slowly but surely and make sure that it is a sustainable thing for them. If it's a diet, which I'm hardly recommending ever, but sometimes we need to clear something out of the diet. I'm making sure we're replacing, We know what to bring in before we take anything out, and AIP is a lot of restriction. Deficiencies, So, I would say Jane won in stopping a highly restrictive diet because it means that the diet wasn't the only issue in the picture. Does that make sense? We shouldn't stay on these restricted diets too long. They lead to deficiencies that lead to other signs and symptoms.

Ali Shapiro [00:39:18]:
I oh, my god. You just first of all, I'm struck by the care that goes into your approach because, my work is a lot about, in this case, I would approach the emotional stress. And I think going to a practitioner and I think part of the reason I get great I mean, I focus more on a lot of the emotional stuff. I don't go you know, you have kind of like the deep physiological. But I think part of the reason my work is effective, my group is effective, and what you're saying is so effective, what you do is so effective is the care. You're giving someone a relational place they can rest, they can share. And I bet when you're asking them because you said no judgment. How many times do you go to a nutritionist? I mean, and I hear the stories, and it's like people are bracing for the judgment, right? They're bracing for the metaphorical, You've gained £2, you're wrong.

Ali Shapiro [00:40:19]:
That's the baggage that's coming in

Andrea Nakayama [00:40:20]:
with them.

Ali Shapiro [00:40:21]:
And so then they don't share everything. And so you're giving them Again, I'm looking at this through the lens of belonging, secure belonging. Totally. And enables them to start to eat. Safety. Yeah. I yeah. I mean, thank you.

Ali Shapiro [00:40:35]:
That's the word

Ali Shapiro [00:40:36]:
I use, but it alluded to.

Ali Shapiro [00:40:39]:
But you're giving them the space for I think maybe for themselves for the first time to see themselves as a whole person instead of this collection of where you've got you know, I remember when I was short, IBS, you've got allergies, you've got asthma, and you just start to feel like this broken totally bits rather than making some of these connections.

Andrea Nakayama [00:41:01]:
Totally, Allie. That's so smart. And I I wanna even back us up out of this different systems and just say the 3 primary tenants of a truly functional practice. If we go back to our earlier conversation about what's really functional, the 3 primary tenants are a therapeutic partnership, looking for the root causes, which means we ask why is this happening, not just what do I do about it, and a systems based approach, which embraces systems biology. I like to think it also embraces systems thinking, so, you know, these mental models that I've set up. But if it's not a therapeutic partnership, if they're not asking why is this happening instead of what do I do about it, and if it isn't embracing you as a whole, it is not functional. I'm sorry. Like, functional has gone off the rails into functional testing, functional supplements, functional biohacks.

Andrea Nakayama [00:41:55]:
It is not functional if it doesn't embrace those three tenants, and that therapeutic partnership is so key. And it's really it struck me how much that's missing, that that's really where I've focused more of my future work and the writing that I'm now doing for a patient audience, which is in the narrative medicine arena, which is a whole other weirdo, like, area of thing. I mean, nobody knows what functional is, like, let alone narrative medicine. But this idea that we are human beings that come to the table as whole people that can see ourselves as whole, that can understand ourselves better. There's so much opportunity in there that I feel like we've just lost in health care, and that's what you're speaking to. When in clinic and in clinical practice, we start asking questions through motivational interviewing, people start going, wait. Why are you asking what happened in my life when this symptom occurred? And we can say everything is connected. They come back with stories.

Andrea Nakayama [00:43:13]:
Oh, I forgot to tell you that when I what because they start making connections. That's a win for me from the get go when people realize that things in life impact the body and the body's not existing in a vacuum.

Ali Shapiro [00:43:33]:
Yes. Yes. It's almost like we have to retrain ourselves to know what data matters. Right? Like, oh, I forgot to tell you when I got this Hashimoto's diagnosis, this also happened. It's like, Oh, okay. That was a stress. And what now coping strategies because like if Because this client, Jane, obviously came to me to work more on the emotion. I mean, you work on blood sugar and gut health on a basic level intrusive food, but I was looking at the systems like she was like I had this I would fall off track with this when I was, I felt like I deserved food after working hard all day, and what we Totally.

Ali Shapiro [00:44:14]:
In my YMYding, the SNAP program, we focus on the 4 emotional stresses, which are tired, anxious, inadequate, and loneliness. And for her, the tired trigger, it was like the diet itself was so exhausting. She's already tired. And to make time for that and to make time for other things, it's like, I feel like I'm not being productive. And I bet if she were to work with you or one of your

Ali Shapiro [00:44:42]:
the practitioners you train, it would be like, Oh, this like drive to work secure my goodness or

Andrea Nakayama [00:44:52]:
Yes.

Ali Shapiro [00:44:52]:
And so, now, I'm trying to be so good and work so hard at my healing, but it might be counter it might be backfiring because you gotta pace yourself. And to your point, you wanna be in rest and digest, not fight or flight when you're healing.

Andrea Nakayama [00:45:09]:
Exactly. I mean, we cannot heal in fight or flight. So the soil that I have around the root of inflammation is clear, calm, enhance, and modulate. If the body's not in a calm state, we will not experience healing. And so if we're constantly in that fight or flight, that's not where we're gonna experience what we're looking for, which is ironic given how much people are questing for a fix. And I think to your point, when we start to make those connections and also recognizing our history. So understanding somebody's history with their body, with food, with dieting, like, even though I would say go to Ali for the deeper work to consider that, I need to know that that exists. So, you know, I can think of somebody in my case study group for the book I'm writing that also has Hashimoto's diagnosis, that did all the AIP and went to the functional medicine doctors, but has a history of, dieting as a young child because her mom didn't want her her mom was worried about her own body, but also worried about her daughter's body.

Andrea Nakayama [00:46:25]:
And this woman is, biracial, so in a different body than her mother is due to her genetics and constantly, you know, judged for the body that she was in. And so those relationships that we have with food are also driven by patterns that we've come up with that are patterns and triggers throughout our lifetime. So before I would ever, ever make any dietary recommendation, even to keep a food mood poop journal so I could see what somebody's eating, I have to understand what's the terrain I'm entering here so I'm not just talking through the realm of nutrition, which has a bad rap these days because of all the noise out there, when nutrition can be really beneficial if, offered in a very therapeutic and safe way. But when we go too fast or we make it a handout or we put perfectionism around it, some ideal of perfectionism, I don't know whose, but that's another question, then that's actually not health. I think health is when we know our bodies better. We can respond to it. We know how to take care of ourselves, not when we follow a certain diet or do what our Oura ring tells us to do. So I think that, you know, this idea that we unpack the entire story alleviates a lot of the stress and also the stress of having to hold it all on your own.

Ali Shapiro [00:48:07]:
Yes. Yes. Well, even you I was also struck when you were explaining how truly functional you are is it sounds like you're meeting people where they are, which is the only place you can really start from. And I think a lot of functional, a lot of I even see with emotional eating stuff, they're starting where people might need to end up. Often it is Yes. Is it where you actually need to end up? But it's like, okay, but what are the bread crumbs? Like gluten free if you're Hashimoto's, of course. But what are the bread crumbs that people need to work up to that so that they're getting momentum versus stressing out? Because I also work on helping clients get out of all or nothing. So, like, having a plan, like Jane said that, Oh, I can be exceptional and perfect at, it's like unconscious catnip of like, I'm going to approach this how I approach everything else in my life.

Ali Shapiro [00:49:00]:
And it's like, so how do you I'm curious how because I love it's clear that you help clients make these, like, connections. How do you help people make those connections versus them fall back on these default narratives of, well, I fell off track because I'm weak or because I just love food so much, rather than, to your point, maybe now by doing AIP, you have other deficiencies. Yes. And so, you're tired. Yes. So, you don't have the energy to put into this. So, how do you I'm curious how you help help people make those connections.

Andrea Nakayama [00:49:36]:
Yeah. I think it is a lot about simplifying how we're thinking about the road there. So if we're talking about a gluten free diet for some reason that we think is beneficial, Right? I personally eat a gluten free diet. I think that for an autoimmune condition, a gluten free diet is important. That's not the recommendation I'm making. I have to really understand, does this person have the skill set to understand, to feel making that change, and how do we get them there? And somebody could be very advanced in what they're doing from a dietary perspective and say, I'm a 100% gluten free. That's not an issue. Or somebody can say, I still crave x, y, z, and that's where we need to sit, like, really sit where we are, not go into some ideals.

Andrea Nakayama [00:50:26]:
So this is gonna bring me to the 3rd, one of the 3 systems that I was talking about. So the 3 tiers to mastery. Tier number 1 are the non negotiables. Tier number 2 is deficiency to sufficiency, and tier number 3 is dismantling the dysfunction. What medicine does and what we do when we embrace a dietary theory that's supposed to work for the Hashimoto's or the SIBO or whatever it is, is we are going to tier 3. And I want us to come back to tier 1 and tier 2 because that's actually how we address tier 3. There's not one way to get to addressing tier 3, which is you being symptom free or as close as your body can be to symptom free. When we focus on the soil or the terrain, we also address the branches.

Andrea Nakayama [00:51:15]:
But what we're doing is tier 3, addressing the branches, diagnosing the symptom. And so tier 1, nonnegotiables. First thing I wanna say is everybody listening right now, you and I, Ali, we have our own nonnegotiables recognizing this is what makes me feel better. This is what makes me feel worse. I love I have to I've gotta dance. I've gotta see my friends. I've gotta be able to go out, and they're drinking wine. I want to know, and I want each of us to know these are my nonnegotiables.

Andrea Nakayama [00:51:51]:
These are the ones I've learned over time, and these are the ones that are really important to me. If we start there, we have a basis of self care right away because we're knowing ourselves. In addition to that, I would say that the nonnegotiable tri fecta is sleep, poop, and blood sugar balance like you are working on. So if we think about sleep, that is not a command. I can't tell you, Ali, sleep. I can't just give you that directive. We need to actually look at what's happening with your sleep. What time are you going to bed? What's the environment like? What could your body do to support? Again, if we all know how sleep is important, people then wanna take melatonin or take magnesium or go for the fix.

Andrea Nakayama [00:52:44]:
I wanna uncover what's the reality of your sleep situation. Do a deep discovery on sleep. Our sleep and good quality sleep is going to help us have more resilience for the stress. It's going to help us manage our blood sugar better. It's going to feed our microbiome, which is going to help our immune function, right, and our digestive function. So sleep, poop, and blood sugar balance are my nonnegotiable trifecta that I'm bringing to the therapeutic partnership to work on, And I'm bringing that awareness to each of those areas so that we start to focus our attention on the clearer things that are happening versus some ideal of what we're supposed to be taking, doing, measuring x, y, z. Blood sugar balance, as an example, everybody's obsessed with continuous glucose monitors right now. I am not against a continuous glucose monitor if needed, right, but the way I'm gonna look at blood sugar balance in addition to sleep and poop is fat fiber protein.

Andrea Nakayama [00:53:58]:
Let's just play with fat fiber protein at every meal. Do you have the skills to be thinking about which fat, which fiber, which protein, and how do we start to play with that? So I'm going into what I'm gonna say is the simplicity with an eye towards the complexity. I understand the physiology. You don't need to. I need you to understand you because there's 2 experts in the room. I'll be the expert in how your body works. You, Ali, you, Jane, I need you to be the expert, and you bring that to our partnership, and that's how I'm going to continue to help you better.

Ali Shapiro [00:54:41]:
Well and I love that because my master's degree is in about is a lot about how adults change and learn. And adults, and I would argue argue 4 year olds, hate their agency. Like, they hate being told what to do. So you're giving people again, meaning like, here, what? Let's help you develop the skills. What are your non negotiables? And here are my non negotiables. How do we meet in the middle? How can I actually work with you to empower you instead of giving you a worksheet and saying, You are under my command? It's just the outcomes are gonna be so different. I mean, I know listeners can feel that listening to this. Yeah.

Ali Shapiro [00:55:19]:
And you make me think about I love that you brought up the CGM because I feel like that's jumped the shark too. But you're like, do you even have the skills to understand why the CGM is going up or down? Like, that's the more important piece that we're looking at in terms of protein, fat, and fiber. Because I think sometimes and this brings up a question I wanted to ask you.

Andrea Nakayama [00:55:42]:
Yes.

Ali Shapiro [00:55:43]:
And is there's so many things you can test. There's so much data now. So, if like Jane comes in with her functional medicine testing or someone comes in with their Oura ring or their CGM. And I know working with clients, they've often asked, Should I get this test? Should I get that test? So, how do you frame the utility of all this testing and data for clients? Because again, I think sometimes we're missing the mark, but how do you think about this stuff? I know you mentioned the CGM, but even a kind of big picture view of all this data that is great that in some ways, it sends a signal, Hey, I have some agency over my health. I don't just have to wait till the doctor test my a one c once a year. But how do you use this data effectively without becoming overwhelmed or even being headed in the wrong direction? How do

Andrea Nakayama [00:56:34]:
you approach that? Climb on my soapbox. My soapbox about testing. So I've written a lot on my personal Put it down. Get on that soapbox. Yeah. I've written quite a lot about biohacking and qualitative data versus quantitative data. I think we're very stuck in what quantitative data we can gather, which doesn't give us qualitative information. So we are not like you said, yeah, we we're getting data.

Andrea Nakayama [00:57:05]:
We're getting numbers, but we don't know what that numbers those numbers mean for us. Yes.

Ali Shapiro [00:57:10]:
Yeah. Will you define qualitative versus quantitative for people just so they understand the difference?

Andrea Nakayama [00:57:15]:
Yeah. Yeah. So the quantitative data is the statistic, the number, and and I have a 2 part article about this on my personal website. That quantitative data is the number we can grab from something. The scale, the test, it doesn't actually tell us qualitatively what to do about it. So you talked about people wanting tests. This has gone rampant these days that people, like, wanna test for leaky gut or wanna stools test or they want a genomic test. That doesn't tell anybody clinically what to do with the information.

Andrea Nakayama [00:57:51]:
There is no x for y based on these supposed functional tests, which have a lot of questions behind them anyway. I am a fan of testing when we need extra information. Do we actually need extra information at this point? Which information do I need that's going to help me with my clinical recommendations? None of that functional testing, including a CGM, tells you what you need to do. The problem is we're taking that information that is quantitative, my blood sugar went up, and

Ali Shapiro [00:58:27]:
we're assigning

Andrea Nakayama [00:58:29]:
qualitative, thinking to it. My blood sugar went up, it's because I can't eat bananas. We're not thinking about everything is connected. I ate that banana on an empty stomach when I was rushing out the door with my kids to school, I did have a cup a sip of my husband's coffee. And we're not doing that. We're then assigning negativity to the banana as opposed to understanding the complexity of the situation. So we're taking quantitative data, and we're assigning qualitative meaning to it. The qualitative is really where we understand the picture.

Andrea Nakayama [00:59:09]:
Same with hormone testing. I love hormone testing. I love Dutch testing. We're looking at it. Most people are looking at it incorrectly depending on their scope. It does not tell us what to do. It tells us, if you're looking at it correctly, how your body functions. And when we support the body's function, we change the way the hormones express instead of coming in.

Andrea Nakayama [00:59:37]:
Here's what this says. You have no estrogen. You need to take estrogen. And you know what? When you need to take estrogen, you also need to take progesterone, so now you're taking estrogen and progesterone. And you know what? Let's add some DHEA to like, that is not the solution. The solution is how does your body metabolize hormones? Are you pooping? Are you sleeping? Blood sugar is the base to hormones. So again, it's understanding the full picture. So when people are looking for testing, I want to know what information are you looking for from that testing, and what are you looking to do with that information? And I might say, if it's somebody was my client, okay.

Andrea Nakayama [01:00:18]:
Great. We've got this information. We still have a lot to do. That's likely gonna be a waste of money right now because we still have some other things to do before we need that added information. And so I'm not opposed to any of these models. It's just what are we getting from it, and what is it informing? And I think we've got lost in this thinking that this data tells us what to do. It doesn't. It doesn't.

Andrea Nakayama [01:00:50]:
If you get a SIBO test, do you get a stool analysis, an oats test? Like, it doesn't tell you what the protocol is. It gives you context if you know how to look at it.

Ali Shapiro [01:01:02]:
If you know how to look at it. Yeah. Yeah. I was thinking about, yeah, I just had I brought my I had hired a sleep coach when I had insomnia who's a functionally trained

Ali Shapiro [01:01:10]:
practitioner, but she came into Truth With Food, and she was

Ali Shapiro [01:01:10]:
talking about wearing, you know, practitioner, but she came in to Truth With Food and she was talking about wearing she wore a continuing glucose monitor just for a couple weeks to kind of get most of But she said it was shocking to see like after she would get off the phone with her mom, her blood sugar like spiked, right? And so, it's like to your point with the banana, like, is it the banana or is it the rushing out the door or is it like the fight you just had with your partner? Like, what you're we need to be able to asking

Ali Shapiro [01:01:38]:
better questions with this data rather

Ali Shapiro [01:01:38]:
than it's the food. And there's people probably know who it is, but she shows the blood glucose graph, you know, and it's like now And again, that can be that visual can be striking, but it's like you do want your blood sugar to increase.

Andrea Nakayama [01:01:59]:
Me too.

Ali Shapiro [01:02:00]:
What what this is this one person's body, what else was going on in the background that we're not lingering? That can be really hard. And I think what I love what you're saying about testing because in my I'm working with people who are still trying to do what I call the foundational stuff, like sleep well, eat well consistently. So, I'm always like, is this going to actually change your behavior or is it going to make you more stressed out? Totally. Now, you know this, and you can't implement. And what you need to be doing, and I love what I heard for you is like this sequence over strategy. Okay. Maybe we need that test, but is this the timing for that? Correct. Let's get this other stuff based on what we've agreed are your non negotiables, my non negotiables.

Ali Shapiro [01:02:49]:
Maybe that testing comes in, but right now, the sequence of events is something else. So I just love that you brought that in because if the nuance is sometimes that testing can help, but if you're not doing some of these more foundational things, it's just gonna add more to your plate when you haven't learned the skills yet

Andrea Nakayama [01:03:08]:
Exactly. Gotta

Ali Shapiro [01:03:09]:
do the other thing.

Andrea Nakayama [01:03:10]:
Exactly. And a lot of the functional docs are doing a lot of that testing up front, like, there's so much we can do that you have more agency over that will impact what we see on those tests before we get them all at once and have to do this entire protocol. The testing I do like as a clinician from the get go is regular old serum blood levels. My my, list may be more extensive than some doctors, but I know a lot of people get angry at their doctors because they're hearing from influencers which labs you need, and then their doctor won't run it. I do wanna say a doctor will not run something they don't know how to read or they don't know what to do about it, and that is a good thing. We can't tell our doctors what to do, and there's plenty we can do with the information that we get from them just to understand what is actually functional. So you said this earlier, Ali, in terms of, like, feeling like we're broken. One of the things that I like to have people set up is a lab chart for themselves where they're tracking over time, and I love to show them what's actually functionally in range because the truth is, Jane, you, me, we are all more functional.

Andrea Nakayama [01:04:34]:
Our bodies are more functional than they are not. And when we remember that our body is actually working for us, we really shift our perspective on how we are listening to it, loving it, caring for it, as opposed to constantly feeling like we're broken and we can't do what we're supposed to do to fix it. We are more functional. We wouldn't be sitting here right now if we weren't more functional than we are not. There's little things that need tweaks, and there's little ways we can do that that are actually easier than we think. The simplicity on the other side of complexity is the key. And I think, you know, my takeaway message in all of this is get obsessed with yourself in the beautiful nuanced ways. I'm just gonna tell 2 quick stories related to blood sugar.

Andrea Nakayama [01:05:30]:
One is my own related to sleep and, what happens with my sleep if I work out late at night. So if I work out in the evening, it impacts my heart rate variability, impacts my sleep and my resilience, except if I go to a dance class. If I go to a dance class, I have so much joy that actually the entire picture changes. And I could tell that through my Oura ring, but it just gives me a feedback loop as opposed to telling me what to do. The other story I want to tell is about my assistant who happens to also be a somatic therapist, and luckily is my personal assistant. But she has, type 2 diabetes, and she works through that with all the ways she's, trained in nutrition. But she notices that if she goes outside and sits with the sun as it's rising and sits with the sun as it's setting every night, that that impacts her blood sugar. So we have to remember that it's not just about the banana.

Andrea Nakayama [01:06:38]:
It's not just about the gluten or the grains or what we think we're eating, that all of those factors exist within a broader network that influences our physiological systems. And when we can tune in at this lovely listening level like we would do with our child, not this, like, obsessing, you know, overarching, what can I do to change this, we start to get signals from ourselves that are really helpful and help us be better partners in for our bodies and in our therapeutic partnerships?

Ali Shapiro [01:07:19]:
I love that because I'm thinking about how, you know, in talking about stress, it's like the how of how are we healing. You're talking about being more curious and more assuming that this feedback loop is making sense versus being like, I gotta go on this diet and restrict, right? It's like, it's such a, just a different approach. And, you know, and everyone has probably heard this, like if you were trying to work on your relationship to food and your body, it's like you can't hate yourself into a loving relationship with yourself, but you can't stress your way into healing. It's like Correct. Would be the map or the track for this conversation. So true. I love those examples that you've given because I think that speaks to your growing interest in narrative medicine of like meaning making. Like for you, dance is so joyful.

Ali Shapiro [01:08:11]:
Right? And so it's like, Oh my God, it just doesn't have the same effect as something that may still be getting your heart rate up, like, oh, I'm thinking of running. I hate running.

Ali Shapiro [01:08:23]:
I hate running. I hate to. Something that is just like, the surplus dread.

Ali Shapiro [01:08:28]:
It's so different. But I think as you're talking, I wanted to ask you about the stress of quick fixes because I'm starting to think in our conversation that sometimes the data feels like a quick fix to our panic, right? Yes. Oh, I'm not sleeping. I'm not this or that, or I'm gaining weight and I don't know why, or I'm thinking of my panic around my insomnia. I mean, it was just like, Over time, it became, Why am I not sleeping? I'm desperate. You know? And so, you talk about how the latest quick fix diet, which even maybe an AIP diet, even though it's supposed to be a short term, it can be a quick fix to not asking these deeper questions or something like, Okay, my CGM tells me it's the banana, bananas are out. Right? And then over time, every you're like, I can't eat anything. And really, it's, you know, oh my God.

Ali Shapiro [01:09:22]:
I was joking with Jane. I was like, Yeah, maybe you needed to go off gluten, but we've discovered you need to shift how you're working. Right? Like Yes.

Andrea Nakayama [01:09:28]:
Maybe it's really about the

Ali Shapiro [01:09:30]:
job, not No. Exactly. Eliminating dairy. But so can you talk about the stress and waste in time and money of these quick fixes that kind of address the leaves in your metaphor, but not the the branches, let alone the roots.

Andrea Nakayama [01:09:48]:
Correct. So the roots are the soil. Yeah. I think it does keep us in that, again, sympathetic dominant we're questing. So I think the pause there when we wanna click on that Instagram post that's telling us to buy this supplement. I mean, I can't tell you how many friends and family members I will get texts from that are like, should I be taking x y z? And I'm like, why do you want to take that? And they'll pair it to me what the ad is saying, And I'm like, but you're already doing x y z. Like, they don't understand. They they there's so much noise, and we're so led to believe that that is the thing that's going to save the day.

Andrea Nakayama [01:10:34]:
And I think what if we realize that it's not if let me just back up here. If it were that easy, you would have already found it. You would have already found it. What works for somebody else doesn't work for you. Just be in your journey because it's actually adding to the stress on your finances, on your hope, because you think like, oh, that's gonna be it, and then it's not. And so it leads to more of this disdain that I think really does it erodes the trust we have in our body, the trust we have in those that are trying to guide us, the trust we have in making change because we've made a lot of change, And so it's actually doing more harm than good in a number of ways. And so I would just ask people when you find yourself wanting a quick fix to ask yourself, whether it's through a test or a pill or whatever diet, what am I looking for? And sit with that. What am I actually looking for? Is that the only way to get that? And so I think we have to recognize the ways in which all of that questing is doing a number on our bodies.

Ali Shapiro [01:11:58]:
Well and this brings me I actually just told my Truth With Food Group this quote of yours, and I was like, I'm interviewing Andrea next, and this because my why am I doing this now work is intrusive, is all about this. But you have this quote that says, my best self care came from being self aware. And I was like, mic drop, this has been my experience. It's my client's experience as well. And so, again, with Jane, I was she realized her tiredness was from this need to believe she had to work hard at everything and be productive, and we worked on ways of replenishing her energy. But how do you think people can start to use this powerful quote that you use? Self awareness is my self care, to collect that kind of qualitative data or make those sort of connections that you were talking about with your own dancing. And and and so, I just I love that quote of yours. It needs you need to tattoo it.

Ali Shapiro [01:12:59]:
It's so interesting. It's on this prescription pad.

Andrea Nakayama [01:13:02]:
I know, and it's hard to teach. And this is, to me, just if I can talk about the practice of narrative medicine a little bit, and I am offering free workshops once, once a quarter right now. I mean, I'd love to do more. But when we interact with the humanities, whether that's through art or a movie or poetry or even a commercial, like, the moments we are where we are moved, I think there's something really important for us to listen to. So the next time that you are hearing a song or watching a movie or even again a commercial and you find you're moved to tears, to laughter, just taking that pause to go, what what was that? What's my response to that? What was I feeling? Is to me the prescription for how we start to develop the skill set of that self awareness. I will tell you I had an incredibly stressful moment at work at my, you know, company on Monday. I was, like, pacing outside my mom's house where I am. Like, I was furious.

Andrea Nakayama [01:14:23]:
I actually let that out to somebody senior to me, but then I take the time to go, Why am I triggered? Why is this triggering? What's happening for me in this moment that's making me so excited, And how can I put some meaning to that so I can articulate it better instead of staying in the heat of the emotional response? The emotional response has so many clues for us If we can take the pause, and this is in your area more than it is mine. I'm just looking at it more through a narrative medicine perspective. The humanities, allowing ourselves to be human helps us to develop self awareness, whether it's the humanness we experience inside or that's triggered inside from something happening external to us. So in the workshops, I'm using poetry as a moment. We might read I might read a poem, I'll have a volunteer read a poem. Then we'll listen to the author read the poem and what we feel and respond to and then write to a prompt about our own life for a prompt that I give. Like, that feeling is there's so much information in there that can really help us to understand ourselves better, to develop self awareness, and it sounds I I think I fear that we would so desperately want the fixes that we're forgetting how to feel the joy in the dance. Be in that moment that you were telling me about before we hit record where you were feeling the emotion about your son talking about growing up? Like, what's in there that really moves us to chills, tears, laughter.

Andrea Nakayama [01:16:24]:
Oh, that's me. That's me. That's what I want to find out more about.

Ali Shapiro [01:16:34]:
Yeah. I love that. And and I think this actually becomes full circle where we kicked off of how you create so much safety and thus allowing for their narration, the pieces of someone's story to come through. Because I think having a practitioner like you or I know in my group programs like, again, this group program where people are like, being with this group was life changing. And I was like, well, we created a safe space to then make it feel safe for you internally to kind of be with that emotion. Right? Part of, attachment and belonging is about being able to rest in our vulnerability. And I think if we're coming to our healing, like, this is wrong, we can't even create that attachment within ourself or the belonging within ourself to say, right, we just think I'm triggered versus having the safety. And so, I think that's why you and the practitioners you're training.

Ali Shapiro [01:17:36]:
Like, I want everyone to know about them because it's like, there's another way where because you need this model before you can often do it for yourself. Right?

Andrea Nakayama [01:17:44]:
Yes. Because a lot of our providers are trying to fix us too. So it's not just us. We're in a system that is perpetuating the fact that we're broken, wrong, doing it wrong, something needs to be fixed, and that's the message we get perpetually. And so we don't get to show up for ourselves or in any therapeutic partnerships, save for the spaces like you're creating, that allow for people to be fully present with themselves.

Ali Shapiro [01:18:16]:
Yeah.

Ali Shapiro [01:18:16]:
I know. I said, you know, everyone's sad the group's leaving, and I said, well, I I said, disbanding because the program's ending. And I said, I hope though that this serves as a model of what you should be allowed to share. You know, not should, but, like, where can you find spaces and cultivate the type of relationships? And it does start with ourselves though, right? This is why I wanted to have you on because you're one of the few practitioners that I know has the expertise, but also the personal experience to really understand how to hold that space for people so they can make these connect these dots, and you have the great insight to realize like, oh, at the end of the day, a lot of this makes sense. And if it makes sense, I can trust myself to move forward in a different way rather than I'm so broken, I'm this test, I'm this at a range, I'm because ultimately, the story we have about ourselves is how we're gonna make meaning of the data. Right? And if we have the story of I'm wrong, then it's just that's gonna put us in fix it mode rather than curiosity mode. So I just the work you're doing is is like holistic on so many levels, I just think. And the practitioners you're training and and all of that stuff.

Ali Shapiro [01:19:28]:
And we will definitely link to your, narrative medicine workshop and all of the functional nutrition alliance and all of that, because I hope everyone, if they wanna take a functional approach, starts there instead of, you know, celebrity, you know Tasks. Type of

Andrea Nakayama [01:19:47]:
I'm good. We're so much too. But yes. Yes. Yes.

Ali Shapiro [01:19:54]:
But I mean, you know what I'm saying? Like, because I think when you were also talking, this is kind of derailing, and then I want to ask if you have anything that I didn't ask you. But I think sometimes, and I'd be curious of like I joked with Carlos at my gym that I started going to after having a baby. They start you with like the InBody, right? So, you get your weight, your fat analysis and all that stuff. And I'm like, I almost and I love my gym. It's like, Oh, this almost gives you like, Wow, this is shocking. And I wonder if some of the functional medicine testing, yes, they need an analysis, but is this a marketing thing of like, Oh, my God, you have all of this wrong, and then it confirms that you're helpless and powerlessness, and then, oh, here's the solution. I don't know. I mean, that's maybe that's a podcast for a different I I think it's a good

Andrea Nakayama [01:20:41]:
really good point. Yeah. And I think that then people anchor on that as part of their identity too. But I have, but I am. This is what I see with, like, mold and mycotoxins. Like, there's so much overidentification with these problems that people say, like, oh, when I addressed that, like, everything was better for me. It actually is a branch. 2 people could be exposed to the same stress, the same toxin, the same whatever, and they're going to respond differently, and that's because of the terrain.

Andrea Nakayama [01:21:18]:
So, yes, I totally think that's a really good point that it keeps us locked in this brokenness that is unnecessary.

Ali Shapiro [01:21:29]:
Yeah. Andrea, is there any question that you wish I had asked during this interview or anything you'd like our listeners like to leave our listeners with?

Andrea Nakayama [01:21:41]:
We covered a lot of ground, and I I just wanna invite folks to maybe even listen more than once because sometimes I feel like it could seem like we're talking in tongues when we talk in systems and, like, you know, because we're so hyper focused on the sexiness of the promise and the fix. And so I just wanna invite everybody to slow down in what they're considering as a next step, to tune into what you're doing, and really just allow yourself to separate the problem from the solution. When I say that, that is a term that isn't mine. It comes from learning from the people who have made the best and the hardest decisions throughout history. I study, like, how do we address complex problems? And one of them is separate the problem from the solution. A lot of us today go to meetings at work where we're identifying the problem for 5 minutes and then focused on the solution for the next 50 minutes. And we actually haven't identified fully what is the problem we're trying to solve for so we don't get the results we need. And I think that's really true in health care.

Andrea Nakayama [01:23:06]:
So I guess that's my little nugget is separate the problem from the solution. If you find yourself solution oriented, just take a pause, meditate on it, whatever that means for you. If it's a dance class, washing the dishes, taking walking your dog, actually sitting in meditation, whatever that means for you, just take a pause before you take action.

Ali Shapiro [01:23:31]:
I love that you say that. I used to lead with this quote, that and there's different numbers in it, but it's from Albert Einstein. And he said, if I had an hour to save the world, I'd spend 55 minutes defining the problem and then 5 minutes solving. And there's, again, 50 minutes. There's different but I think that illustrates the heft of and the importance of really separating the problem from the solution. And I love that you use the word terrain. I think that's really helpful for people to think of, of like instead of what, you know, Andrea is saying the leaves and the branches, so the symptoms or whatever, what are some of those 3 buckets that lead the terrain of physical, psychological, physiological? So, that will help people start to suss that out. Thank you so much for being here.

Ali Shapiro [01:24:23]:
I'm gonna have to have you back if that's okay.

Andrea Nakayama [01:24:25]:
There's so much fun. I yeah. I love speaking with you, and I love your approach and your mind. So thank you for all you do, Ali. It's so much fun to be with you.

Ali Shapiro [01:24:37]:
You too. And where can people find more of you? I mean, we will link to everything in the show notes, but where where's the best place for people to find your brilliance?

Andrea Nakayama [01:24:45]:
If you head over to Andrea Nakayama or Andrea Nakayama on all the places, although I am not posting a lot on social media because it does feel really noisy to me right now, but andrianaakayama.com has all links to all the places to back to the Functional Nutrition Alliance, to the writing and the newsletter and the narrative medicine workshop, to all the different things can be found at andreannakayama.com.

Ali Shapiro [01:25:12]:
Wonderful. Thank you so much, Andrea. You have made such a ripple effect, And I just I can't wait to see what you come up with next in narrative medicine.

Andrea Nakayama [01:25:24]:
Thank you. Thank you so much,