The Interplay of Functional Nutrition & Narrative Medicine with Andrea Nakayama

00:00 - Dr. Andrea Moore (Host)
Hello, hello welcome. Welcome, andrea, I'm so excited to have you here today. How are you doing? 

00:05 - Andrea Nakayama (Guest)
I'm good and I'm thrilled to be here with you, thank you. 

00:09 - Dr. Andrea Moore (Host)
Well, why don't you start with telling everybody a little bit about yourself and how you got to where you are? 

00:16 - Andrea Nakayama (Guest)
Wow, quite a journey there. 

00:18
Well, I'm Andrea Nakayama. 

00:20
I'm a functional medicine nutritionist, I'm founder of the Functional Nutrition Alliance, where we train thousands of practitioners around the globe in the science and art of functional nutrition, and I'm also a practitioner of narrative medicine, and I'm loving the intersection of the functional medicine and narrative medicine worlds these days. 

00:44
And this all came into being for me way back when, over 20 years ago now, in April of 2000, when my late husband was diagnosed with a very aggressive brain tumor, I took what was an interest in food and in trying to regulate things about my own body that I didn't understand at the time and apply it to everything we were going through with his brain tumor treatment and the condition itself. So that is where it all started. At the time he was diagnosed, I was seven weeks pregnant with our first and only child, so it was a time of real reckoning and recognizing where our medical system sometimes falls short. It does a lot, but it also falls short when there is a chronic condition. So there's certainly a lot I can talk into there, but that's the origin story of becoming the practitioner and the educator that I am today. 

01:50 - Dr. Andrea Moore (Host)
Yeah, and what a journey. And yeah, I just want to speak to just the power that you stepped into in that moment. I'm sure there was a ton of other emotions and things happening as well that I feel like never quite gets the attention or we forget that that's all happening as well. But I think for so many listening who are experiencing chronic pain, chronic illness, it's sometimes hard to remember that there can be this goodness that comes out of it or something else. It's not like we want it to happen or that it had to happen. You know what I mean. I feel like some of those can really fall flat, but it's like it happened and there can be this positive shift that comes out of it and I think that's just so powerful what you did with your circumstances. I just really want to speak to that because that, thank you. 

02:52 - Andrea Nakayama (Guest)
Yeah, I think it like it can become like toxic positivity, right. 

02:56 - Dr. Andrea Moore (Host)
Yes. 

02:57 - Andrea Nakayama (Guest)
Silver lining, but I refer to it as post-traumatic growth. 

03:02
As post-traumatic growth, it's that recognizing the reality of the trauma and also recognizing what needs to come forth from that trauma as well. 

03:14
And so for me, it was a real recognition of the gaps in our medical system, and I always like to remind people that I am not here to give fault to our medical system, and I always like to remind people that I am not here to give fault to our medical system. 

03:28
It just isn't all the things, that it needs to be for all the people, especially because it's focused on acute care, but also that there were so many blessings that came from the everyday experience two and a half years that he lived, which was two years past his prognosis that we had together, that we had with our young son, who will be 24 a week from today as we're recording, and that I wanted to pay forth, that I wanted to really do something with what I had seen and learned and experienced, and so that post-traumatic growth wasn't just a silver lining, it was an impetus, a passion, a purpose that really came about because of that experience. So I think it can happen and what you're saying is so important, andrea, and that it's a reminder that our pain can give way to possibility. 

04:33 - Dr. Andrea Moore (Host)
Yes, yes, yes, and I love what you said. There's like it's not about toxic positivity. We're not about toxic positivity here. It's a full acceptance of the reality we're presented with, full acceptance of the reality we're presented with. 

04:45
Sometimes that reality is really harsh, it's really brutal and unfair and unjust and our options end up I mean, I, to me, the first, the first thing is always to feel and express what needs to be felt and expressed and then from there to take that next step, and that can be a step into growth, I mean, or it can be a step into despair, and I always tell, even if you step into despair, you can still always then feel the despair and then take the next step into growth. You know it's like gets to be on your own pace, but it's yeah. I just want to recognize your ability to do that because it's it's hard, that's really really hard. Thank you, yeah, and so something. 

05:27
It's funny because I was we were talking about this a little bit before we started, but I felt like getting the invite from you to be on here felt like this full circle moment because, unbeknownst to the person who was connecting us, I knew Andrea and because I had actually taken her digestive intensive, which I don't know if that exists anymore, but it was, like I don't know, eight years ago, 10 years ago, I can't even remember. It's been around for a while. 

05:52 - Andrea Nakayama (Guest)
Yeah. 

05:54 - Dr. Andrea Moore (Host)
Because I'm a nutritional therapy practitioner. 

05:56
I don't talk about it like a ton on this podcast, but it was amazing and one of the reasons I stepped out of the nutritional therapy world was because I felt like it was. 

06:08
It became obsessed with perfectionism, yeah, and I feel like there are pieces from that course that really shaped the way I think and still think, and really just drove me more into my passion, whereas meeting people where they are and really honing on the basics, and so why don't you speak a little bit to that? Because I know one of the big things that I, not so much in the nutritional therapy program but all the continuing it afterwards. It felt like it was so like you have to have this lab test and this lab test, and I was getting clients who were like literally like had spent $10,000 on lab testing and they're like I'm not feeling any better. So I felt like the universe was sending me a message of like this is not where I want to go, and I felt like your program very much spoke to my instincts as it was. It was nice to have that confirmed as a very new practitioner back then. Yeah, there's so much I have to say about that. 

07:05 - Andrea Nakayama (Guest)
And I think, like I'm just going to put the lab conversation aside for a moment, which we can go back to, because I can get on a big soapbox about the way labs are used today, especially for people who are experiencing chronic health challenges. But I really am a stand, even more so than eight years ago, for a framework versus a protocol, and we've become a very protocol fixated culture. We want the quick fix for everything, even when what we're experiencing will not be addressed by a quick fix. And by a quick fix I mean a protocol, a diet, a supplement regime, a test that's going to tell us what's going on. So the frameworks that I've created help us to reframe how we think about our health conditions, bringing us back to those core basics, or the foundation, or the terrain, the soil that's going to need to be supported in order for us to heal. So one framework that's evolved since you've gone through the course is what I call three roots, many branches. Now, any sign, symptom or diagnosis that we can identify is a branch, we can identify is a branch and if we envision a tree with branches on it, any sign, symptom or diagnosis, chronic pain, the conditions that are leading to the chronic pain branch and we are so often fixated on fix the branch. That's what our medical system does. It's very targeted therapy towards the branch. 

08:45
As a functional medicine nutritionist, and I believe nutrition isn't just about food, it's about growth, metabolism and repair, which really is a broader realm, brings us back to not just the trunk and not just the roots, but the soil, and so I always say if there's any chronic condition, there are always three roots, and those three roots are our genes, our digestion, which is where food meets physiology and inflammation, that sort of a Venn diagram. But each of those roots also exists and is nourished by soil, and the soil is where, when we as patients put our attention there, we have more opportunity to help ourselves. Unfortunately, we're all focused on the branches, we're all focused on the dysfunction, and there's different ways to reverse that dysfunction or support what it is that we're experiencing, that we've lost touch with. So I'm a stand for how do we bring it back to that broader realm that gives us all the opportunity to help ourselves, as opposed to playing doctor, looking for the one route, all the things that this quick fix testing culture guides us towards. 

10:09 - Dr. Andrea Moore (Host)
Yes, yes, yes. And as a physical therapist too, it's so funny how applicable this is, cause it's like I work with people on many different realms chronic pain but I also see people who might have an acute condition. So I just have to share the story, because I literally came from the physical therapy clinic and it was just such. A great example is I have a woman right now with like literally the most pinpoint. It is like a button size spot of pain on her foot. That only recently happened, about a month ago, and so it's not even that chronic of a condition or anything like that. And this was the second time I've seen her. But from the first time I was already like, yeah, this isn't a pinpoint, like yes, it's pinpoint, but we just there was enough to rule out as this is something up the chain. 

10:56
And I ended up giving her a breath exercise in child's pose, and she was like why am I doing this? And I explained it to her. But the point was I won't go into the explanation because it's not useful right now but she got up and she was like oh my god, my foot feels better. She's like how good breathing. And I was like, because everything's connected, that's my mantra. You just needed to bring the breath back into your you know whatever into your low back and that moved her hips, helped her hips move better and therefore she was walking better. And you know, there's other things that we're going to do. 

11:33
But she kept giving me, feeding me in the evaluation, these words of like, if I just slow down and pay attention to how I'm walking and walk through my whole foot, I feel a little bit better. And she kept saying, if I just slow down, and I was like, yeah, right, it was like all the clue I need. So I was like how often do you feel like other other areas in life where you feel like you need to slow down? And she just laughed she's like everywhere. And I was like, okay, right, like it's like we. It's amazing how much our words, or our patients or clients' words tell us so much. But she would have never picked it up on her own. Yes, sometimes you need that third party to say it back to us. And she's like, okay, I get it. Okay, I'm going to work on slowing down. 

12:16 - Andrea Nakayama (Guest)
Yeah, and the phrase I often use is slow it down to speed it up, yes, and I think when we're looking for quick fixes, we want the speedy solution. 

12:26
But the speedy solution only leads us to, like you were saying earlier, with the tests it's, first of all, not a solution or a resolution, maybe bringing some temporary relief, but not that sustainable relief. And it costs a lot of money and we put the time into it and then we just gather more and more frustration about what's not working. And that's who I really see you know personally and in the evolution of my work are people who have been there and done that. They've seen all the top practitioners, they've paid for all the things and they are angry, and that anger is also not conducive to healing. They're angry because they have invested all of this money. And I'm not saying there's anything bad about those protocols or those methodologies. They may just be too much, too soon, not the right thing for that individual. You as an individual may overlook aspects of who you are and what you need, and this is where those quick fixes aren't individualized and that means they're not functional even though they say they are, they're not. 

13:41 - Dr. Andrea Moore (Host)
Yeah, absolutely, and I'm so with you too on the protocols of it. It's like the wrong place, wrong time or wrong person, wrong time it's. There's so much of that. It's like it's not, like it's inherently bad. It makes actually a lot of them make a lot of sense, but trying to, I mean, even heal your gut with all these fancy things and detoxes, but you can't poop properly. You're going to run into issues Like you can't start trying to strip your body of things? 

14:12
if you can't, then or you can't try to detox things if you can't get it out in the first place. 

14:14 - Andrea Nakayama (Guest)
It's, like you know, actually make things worse. Exactly, yeah, I say the non-negotiable trifecta. The place to focus first is sleep, poop and blood sugar balance, and if those things aren't in order for you and you're trying to do next steps, whatever those might be, you're building on quicksand and you're not going to see the results you're after, and those aren't commands. Sleep and poop and blood sugar balance are very individualized for each of us for a number of reasons? 

14:46 - Dr. Andrea Moore (Host)
Oh, absolutely. I mean, well, before I go to, let me ask you how then, do you go about with someone finding that individualized piece? Because I think this is the hardest part is that people are trying to find it through themselves. They're trying to, you know, piece together random things that they saw on Instagram or random things that they read, and it's like it's so amazing that we have so much access to information, but in weird ways, it's made things a lot harder. 

15:15
I've I mean, I'm sure you I'm curious to hear if you've noticed a huge difference. But, like, even in the short, you know I've been doing this work for 12 years now, with chronic pain, but I will say there really is a shift in who I see or how they're coming in. And, yeah, there's almost a lot more layers to now work through, because it's almost like an undoing of all this information that I'm like it's not. I mean, there's some, there's some information that's that's just wrong. But, like most of the time, it's not that it's inherently wrong, it's that it's not for you. 

15:45
It's correct. You're trying to read information that might work for somebody who's a diabetic, for instance, but you're not a diabetic, or vice versa. It's just misplaced and then to undo the mindset pieces around like that's the part I mean I love working with it. It's like undoing kind of all this misinformation that doesn't work for your body, like even someone who you know slowing down is such an important thing. But I've also worked with people who actually have almost been stagnant in their lives because of their chronic pain. 

16:20
So actually slowing down and resting isn't what you need. You actually get up and move and push yourself, but it's like no pain, no gain. 

16:27 - Andrea Nakayama (Guest)
Yeah, yes, but slowly, of course. 

16:29 - Dr. Andrea Moore (Host)
Yes, yes 100%, but it's like, it's okay, you're not a fragile flower, you actually are. You're safe to actually get out and move, whereas other people you're like, okay, you need to chill out. It's like. So you mentioned the narrative piece. I would love you to speak more, sarah. So you mentioned the narrative piece. I would love you to speak more, sarah. Say the name of it again, because I haven't heard that Narrative medicine. 

16:47 - Andrea Nakayama (Guest)
Yeah, Can you speak more about that? The mantra to everything I do is everything is connected, we are all unique, which you're speaking to, and all things matter. So everything comes under that mantra Everything's connected, we're all unique, all things matter. As I was moving further and further into the field and really, you know, at the forefront of the field of functional nutrition I was recognizing that we were paying more attention. I have a cat visiting us, so I love it. 

17:21
It's amazing. I was recognizing that we were getting more and more attuned to that. Everything is connected. This is systems biology, and I do think there's more attention to systems biology. We know the gut's connected to the brain. We know that hormones are connected to the detoxification pathways or at least we could know that we should know that which are connected to the gut, so we have a better understanding of systems biology. Everything's connected. 

17:50
We also get very fixated on the final piece. All things matter. So we think like our diet matters, our sleep matters, our tracking of all the things matters, right. So we've gotten very fixated on those to-dos. But I realized that what was missing so much was that we are all unique and how we honor that for ourselves. And that's the story. That's the story that we bring as patients to our healthcare situation. So I went on this quest to understand like where is the story honored in a clinical practice? Where does that matter? Because it does. It's a huge piece of it. In functional medicine and functional nutrition. We have the timeline and I really teach into how we understand and do motivational interviewing about that individual. It's a step a lot of people just want to pass right over, but for us. It's really a huge part of the equation. 

18:52
But this all led me to finding the practice of narrative medicine. It's a newer practice, it's only in its 20s. It comes out of Columbia University, but it is now practiced more widely across the globe and it's a very pedagogical and academic practice. I've written an article what Narrative Medicine Means to Me on my personal website, but it allowed me to understand how do we sink into the patient's story and what's the science behind the patient's story in clinical outcomes. Is there a connection there and what is it and how do we cultivate it as practitioners? 

19:39
But also, I'm interested in how do we give those same tools that we practice in narrative medicine as clinicians to patients to be able to listen in to themselves instead of seeking everything outside? What does my ring say? What does the scale say? What does the tracker say? What are all the things really slowing down and feeling what this means to us? What is my body trying to tell me? And so the practice of narrative medicine again, it's very academic, it's very pedagogical, but it's really about close listening and really honing in on how we pay attention to the nuances, like you did, andrea, with that patient who was telling you and writing when I slow down. When I slow down and your ability to not just rush ahead and bypass. That is the practice of close listening. So that's what narrative medicine is in a nutshell it's a practice of close listening, close reading, paying attention. We typically do it as a practice with art because art is human, it's messy, it's not a linear like. 

20:55
here's the story this happened and this happened. It really is like an expression that if we spend time with it, there's a lot to uncover, and exercising that muscle helps us spend time with the nuances of the human experience. 

21:14 - Dr. Andrea Moore (Host)
Oh, I love that so much. That's so beautiful. Yes, yes, yes To the spending the time to listen and being able to hear, and I think this is one of the hardest parts for people who have chronic illness or chronic pain, and I speak about this a lot, in that our body starts to feel like the very threat and so it feels unsafe to listen. It's like, oh, I just, but I don't want, right. It's like this is my. I mean, that's my absolute favorite thing to work with, is the person who's like, but I don't want to listen because it's so uncomfortable to go in. 

21:48 - Andrea Nakayama (Guest)
Yes. 

21:49 - Dr. Andrea Moore (Host)
And I always give the metaphor. It's like can you imagine if you were going in for a surgery and the surgeon's like okay, but I don't? 

21:56 - Andrea Nakayama (Guest)
want to look at that, because it's really like ugly. 

21:57 - Dr. Andrea Moore (Host)
So I'm just going to like fix it while not looking. 

21:59 - Andrea Nakayama (Guest)
You know what I mean. 

22:05 - Dr. Andrea Moore (Host)
It's almost like what we're trying to do, versus like, in order to really like know, for the surgeon to know what's going on, it's like you have to be able to like look into the wound and look into the messiness and all the like guts and the blood and like really take your time to be with it and sort it out and have that capacity to be with that discomfort and then, like, step by step, you can start to heal things. 

22:24 - Andrea Nakayama (Guest)
Yes, and sometimes I think you know, one of the things I'm trying to do on my personal website, andreanakayamacom, is offer free narrative medicine workshops once a quarter so people can experience this. 

22:37
But also every blog I write there's a narrative medicine prompt, and sometimes it's about allowing ourselves to just experience, respond to a prompt or a question, as opposed to having to look at the big, scary thing. 

22:55
Yes, it might just get us in touch with it by noticing smaller moments. So I just am in the process of writing an article about what it means to be moved and what being moved means for healing. And so how is it that just coming into the oxytocin and the parasympathetic response and the neuroplasticity that can happen when we recognize, even from like a silly commercial or watching your child perform that feeling of being moved and holding that and recognizing why did that move me? And spending time with that as opposed to or in addition to, having to look at the thing that maybe feels really, really scary? So we're touching that element and we're regaining that instinct to know ourselves versus always looking outside. Again, the ring, the scale, the test, like all of that information, is outside of us and we've become so accustomed to measuring ourselves based on that, as opposed to looking inward. 

24:21 - Dr. Andrea Moore (Host)
Yes, yes, yes, I love that and I think it's so true that we are so reliant either and even people who don't use those external devices. It's like something to just tune into is, how much do you look to, whether it's a coach or a physical therapist or someone to tell you almost how you're feeling, like a lot of patients, sometimes you come in, is it moving better and it's like I don't know. Is it? What's your sense of it? I mean, I can tell you what I feel, but like what's you know what I mean it's? It's funny to, it's funny to hear. 

24:58 - Andrea Nakayama (Guest)
Calibrate right Like it's a calibration. 

25:01 - Dr. Andrea Moore (Host)
Yeah, and then there's people who are attuned to any of every little thing that it's like, okay, sometimes we almost need to pay a little less attention to certain things. Right Again, the, the individuality to it and it's knowing yourself, am I someone who hyper-focuses, am I someone who just can't even feel? And it's really counterintuitive. But a lot of people who can't feel still hyper-focus on areas because we're not concentrating on the whole piece, where it's almost a way of distraction from something else in many senses. But yeah, and. 

25:29 - Andrea Nakayama (Guest)
I think that's where narrative medicine for me brings us out of the hyper vigilance or the ignoring that we're talking about here, because it's less about that pain. That body like it brings you into your stories in a different way your experience. One story I love to tell which illustrates this is I was working with a woman in her 70s who had struggled with sleep her whole life, according to her, and you know, was still struggling and had some other health issues that were related. She had autoimmune conditions that were kind of well managed, but the sleep was not. And she would constantly say well, I've struggled with sleep my whole life. And I said can you tell me the first time you remember it as a struggle with sleep? Because if you're saying I've struggled with sleep my whole life, what does that mean? Like when did you know it was a struggle? What is that actually like? 

26:32
And she told me this whole incredible story. She sent me a photograph of her childhood home. She talked about where the windows were, what would happen when she was trying to fall asleep, because there was no curtain on the window between her house and the neighbor's house. Nothing ever happened, but it didn't allow her to feel safe and go into that parasympathetic rest and digest. That gave us a whole different insight into where to focus our attention on that like ability to rest and trust. And as we were talking about it, she was able to say actually that's the same feeling I have in the passenger seat of a car because she doesn't have control over something. And so, wow, different problem to solve than magnesium or melatonin for her sleep and just a different conversation. So it takes the fixation off of I can't sleep. I've always had problems sleeping. That's my narrative. Always this has been my problem, or that hypervigilance and into a different angle around that experience. 

27:49 - Dr. Andrea Moore (Host)
Yes, yes, absolutely Wow. What a cool story and what an amazing thing to uncover. And so I am curious in terms of this kind of going or switching topics a bit, but I feel like there's so much more. Like you said earlier, it's like there's so much more awareness on how everything's connected and I feel like there's a lot more education and and whatnot. But yet I'm getting curious what your stance is on this or what your viewpoint is on this. I feel like the availability of good food and somehow what's being provided is only getting worse. Yeah, and as a parent to a seven-year-old, I'm just noticing that more and more of how, what is up with this? Like, what is your sense that is up with this gap? Like we have so many more people who are aware of good food and yet our ability to access it is only it's getting, I don't know. It feels like it's getting harder. Maybe it's not. 

28:44 - Andrea Nakayama (Guest)
Yeah, yeah, I mean I feel like too. There's so much information and yet people are getting sicker all the time. 

28:56
So, like there's a lot of divides, there are divisions between, and I know you've been like sitting in the political world but, I feel like access and reality are really up right now in a lot of arenas in terms of what it means to be able to have access, to even be able to think about making changes to the way you eat, whether it's access to whole or real food, or whether it's access to be able to think about those things because of your own experience in your body or with your body. 

29:35
And so I feel like we've really narrowed. I almost feel like nutrition has become a dirty word with body positivity and with the anti-diet culture, which I think are really important, and I think nutrition has a place in those conversations but they've become polarized, as if one is bad because it is about the exclusion, the diet, the limiting, as opposed to something that's about healing. And so I feel like I'm a real stand for what I call the democratization of functional nutrition, which means that we should all have access and it doesn't have rules around it, like you have to shop at Whole Foods or the farmer's market or only eat organic. There are ways to think about these connections and influences on our body that aren't about privilege and access alone, but it's become that way. So we have more processed foods as we have more awareness, and they're at odds with each other. 

30:44
Just recently there was a whole blow up about processed foods not being bad and being okay in the media and in a lot of mainstream media, and so now there's a division between ultra processed foods, processed foods and whole foods. Like it just keeps getting driven by different industry standards is how I'm going to say it. 

31:08 - Dr. Andrea Moore (Host)
Yeah, yeah, it's. Yeah, I think you spoke to something that's so huge is this polarization and this division, these divisions that are happening, and I feel like there's so many things politics and life but let's talk about it. Keep it with food right now of that. Things feel like they're contradictory to another, but they're, they're not. You can love your body at any size and choose really beautiful, nutritious foods for it, because I think sometimes body love is a really hard concept for people. So I just talk about it from a place of body respect, because you can respect someone you don't even like. It's just we can be respectful. 

31:47
And so I talk about respecting our bodies. And if our bodies are having trouble digesting something, or we eat something that doesn't feel good or we leave this feeling cruddy the next morning, then how can we eat foods that feel nourishing, whatever that happens to be for that person? And the reality is, for most people, processed foods don't leave them feeling good. It's tough for your body to digest, it's harder on them. It doesn't mean you can't you know, I was just on vacation. It doesn't mean like, okay, we're stuck here and I'm going to pull something out of my backpack and give it to my kid Cause it's easy and I'm not going to buy the $15 or whatever at SeaWorld or you know what I mean Like here take the prepackaged item. 

32:57 - Andrea Nakayama (Guest)
But yeah, it is, but it's not something that we're, I'm going to say, fortunate enough not to have extreme situations occur like somebody with celiac disease is just having to make a removal of a food category. 

33:11
Somebody who else, who might feel sluggish or not feel great, is making a risk reward decision. My son, you know, didn't grow up eating gluten. At a certain time in life decided to reintroduce gluten into his life. He doesn't. He knows if he eats certain kinds of food it's going to make him feel kind of sluggish and tired, but he doesn't exclude them. It's a risk reward decision that he's making for himself. So if he can get a gluten free bun on the burger, that's his choice to go for. But if he's out and about and there's some really good asian restaurant and they have noodles that he wants to eat, he's gonna do that and that's a decision. Because he's lucky enough I'll knock on wood, yeah not to have major symptoms from consuming that food. So I think there's also a spectrum and once we're aware of what something does to us, I can't eat gluten and have that same like. I will not feel good and so risk. 

34:22
Reward for me is the risk is higher than the reward of the flavor. Yeah, that's a decision I make, but not one that I'm gonna demand other people make for themselves yeah, well, we're on the topic of gluten. 

34:39 - Dr. Andrea Moore (Host)
I'd love to hear your kind of stance because it is something. So my son, he has ADHD and you know we have tried so hard to do gluten-free. You know we have tried so hard to do gluten-free, and it is especially since I went into parenting, being like I'm going to, you know, feed my child perfectly, which obviously hasn't happened. But you know, even I have the ability to pack his lunch every day. You know what I mean. Like I have complete control over his food and yet somehow it's amazing how challenging it is. 

35:12
Yeah, and so one of the things that I'm personally like currently struggling with and I'm sure there's a lot of other people because they've heard things where it's like, with gluten, with certain things, it really does take being completely gluten free for a period of time to notice, hey, is this impacting my symptoms or not? Yes, time to notice hey, is this impacting my symptoms or not? Yes, and you know we might make it like two weeks, and then it's like we go to school and they're like oh, so-and-so, whatever, you know whatever. Or he just found something and and ate it, or you know, there's always, there's like there's always something that we can't seem to make it more than like a week or two without, or grandparents feeding things, because they don't as much as I have tried to educate them, and they'll like buy gluten-free bread. 

35:56
They'll do all this thing and then they'll just give them something that's like blatantly gluten, because they just like don't understand. You know what I mean. I guess the question is is like how do you know if something's making a difference? Like when is it worth really like nailing down and being like I am going, I am restricting, and how intense do people need to be about that restriction to notice, to like give it a fair chance, I guess, cause I'm like I'm not sure if we've given it a fair chance or not. 

36:23 - Andrea Nakayama (Guest)
Yeah, I mean, I think it depends on how big the problem is and what kind of driver it's going to be and what kind of impact it has on the individual and the family, so I've certainly worked with teens that would benefit from a gluten-free diet, and I'm not about to impose that on them and. I've worked with teens who I will impose a gluten-free diet because of the extreme nature of what they're experiencing, and you know I'll make sure they have the skills to do it and can follow through and the family support and the ability to talk about it. 

37:00
But I think we have to be really careful about who is this, what is the impact on the family and the people around them, and is the impact of the exclusion or addition worth what we think can be the benefit? And I think with something that is probably fairly managed ADHD it's hard to go all in Like I'm saying, if it was celiac disease. Or my son's apartment mate now, who's one of his closest friends from college, is has an anaphylactic dairy allergy, so she will be in the hospital. 

37:43
Yeah for sure, dairy, it's not about like. Well, I exclude it because. 

37:48 - Dr. Andrea Moore (Host)
I get constipated. 

37:49 - Andrea Nakayama (Guest)
It's like she will. She doesn't eat out. She has to ask tons of questions. If he has dairy in the house, he has to be really careful about the. You know what surfaces he's using, what utensils he's using, and that's a different situation. So I feel like it really is situational in terms of how far am I going to go and what's the cost to me. Again, risk and reward. If you're experiencing chronic pain, just as an example, and we know it's inflammatory in some way, we can see the. You can feel the inflammation. We can see serum lab results that show inflammation. It's not neurological, like a fibromyalgia situation would be. It's worth trying to see if it reduces the. It's worth trying eliminations of inflammatory foods to see if it gives you some results and then you can take it from there and start to learn about what works for your body. But I think it's so individual in terms of how much is this impacting me and what am I willing to do for it. That doesn't feel like I'm sacrificing my life because we have to live. 

39:20 - Dr. Andrea Moore (Host)
So I don't know if that makes sense as an answer, but like it makes so individual it's so funny because what you're saying, I'm like, oh, this is exactly what I tell my patients about clients, about other things. Right, I believe that, like, especially with chronic pain, is there's certain things that my clients will have where we get it to the point where it's managed and it's always like, okay, could I make this better? And I'm like, probably, but is it like the amount of effort, especially in certain cases when there's, you know, certain damage that's been done to a joint or something, or where there's been an injury, it's kind of like I mean there's a point where I mean, yeah, I guess you could keep going, but is it worth it? Like, if all you have to do to manage this is two minutes of exercises every morning? Like is it worth going down this giant rabbit hole of I'm like to me? 

40:08
No, like I always come back to how do you live your life more and how do you expand your life out again, and anything that feels starts to feel like it's constricting. Yes, I'm always cautious. I think there's sometimes there are times where we got to be a little constrictive so we can open, right, it's almost like the cocoon so you can bloom, um concept. But it's like, as long as we're aware that that's what we're doing, then yes, yeah, so no, I agree. 

40:35 - Andrea Nakayama (Guest)
Yeah, I think it's so necessary, just to know, also like what can live in our gray area. So I call it, like the path, the poison ivy and because I live in Portland, oregon, the bike lane. But some people might think of it as the shoulder of the road. There might be things that, like we just know. 

40:58
I don't need that, it doesn't make me feel good and there might be things like well, if there's a little bit of that in something once in a while, I'm okay. It can be in that gray zone and we all need to find that area for ourselves. But I'm more about inclusion before exclusion. So, what is it we can do? That is, like you said, broadening, widening before we have to exclude or eliminate, so we have more available to us and it doesn't feel so restrictive. 

41:36 - Dr. Andrea Moore (Host)
Yeah, and when it comes to food, one of the reasons I started working with a nervous system and the way I do is because I would get these women who had had every lab test done. I would look at their food journals and I'm like I couldn't even eat this well, like I couldn't. I couldn't make a better food journal, like they would be perfect, totally. 

41:58
And the common theme was there was so much anxiety around and fear around food, and so I mean they were just eating in the most sympathetic state which, yes, and I'm sure you can speak to what that does to your digestion um, that in just helping them breathe and touch in and chew their food, all of a sudden they could eat a whole lot more foods. 

42:21
And that was all we did was like let's work on bringing the nervous system down and with that, I haven't talked about it a lot in this podcast and I'm sure you could say it so much more beautifully than I could. Why does being in the parasympathetic state or the sympathetic state versus the parasympathetic state, or the sympathetic state versus the parasympathetic state, impact our digestion so much? 

42:39 - Andrea Nakayama (Guest)
Yeah, I mean, it's right there in the name behind it and that sympathetic is the fight or flight. I always think of it as, like you know, leaning forward, and a lot of that is in that conditioned food hypersensitivity, that obsession about things, but also that seeking that you and I see a lot of people go through like where's the next thing, what should I be taking? Where's the next test? What's going to tell me what's wrong with me? That's a sympathetic dominant state. That's putting your body into fight or flight. 

43:10
The body not only can't digest in that fight or flight response, it can't heal in that fight or flight response. So the hormones, the neuro hormones, everything that's activated in that sympathetic dominant state doesn't allow for the body to rest and digest. And so digestion is the rest and digest is how we call parasympathetic state. And a parasympathetic dominant state allows us to rest and digest. It allows for the calming and the healing. It is the countermeasure to that fight or flight. And so many women who are in a sympathetic dominant state do not go back to that rest and digest. They're in a chronic fight or flight response. So again, to digest, for the body to do what it needs to do, it needs the hormones to be calm and in a state that allows for the breakdown of food and isn't prioritizing other hormones that are about safety. 

44:20 - Dr. Andrea Moore (Host)
Yes, yeah, and I always like to add on it, especially with the parasympathetic state where people are like, well, I am, I rest a lot and really they're resting is scrolling on their phone or making a to-do list. Well, it's like. It's like I think sometimes that fight or flight gives people the idea that fight or flight means you're like up and moving, which we have. People who also are like compulsively can't just sit still. But I noticed that I this, this is me, because I fell into this I'm like, oh, what are you talking? I'm so chill. I thought I was a chill person. It turns out I was not. I just didn't know any better. But it was like, oh, compulsively scrolling on your phone or even thinking thoughts over and over and making the mental to-do list or running through this scenario in your head of how you wish you said something different or all of that, even if we're completely still and appearing to be restful, our body's in that fight or flight. 

45:18 - Andrea Nakayama (Guest)
Totally. I mean even like shame and guilt, and all the emotions and the mindset factors that can really feed our sympathetic dominant state, all the triggers that we might experience, all of the ways that we respond to what's happening around us. We can feel like I can feel, even coming back to work on Monday after the holiday. Boom, boom, boom, boom, boom boom. 

45:50
And that ability to feel that response and just go, okay, that's what's happening, allows me to bring recognition to what that's doing to my entire nervous system, and so sometimes I think it's just that awareness, kind of like the flip side that I was talking about with what moves us side that I was talking about with what moves us, like when we allow ourselves to sit in a moment and go, oh, that's what that is. It's allows for a different sense of awareness that helps with self-regulation. 

46:26 - Dr. Andrea Moore (Host)
Yeah, and I just even want to re-highlight how you said that is. It's it's a recognition, it's an awareness, it's not a demonization that is happening. It's not like because I think that's what I see happening as people are learning about nervous system regulation. Oh my God, my nervous system is ramping up and then we're just ramping it up even more. It's just like, oh, I'm so noticing how my nervous system totally ramped up about that Fascinating, like okay, and it's just even that right there brings in the regulation of just an allowing, allowing it to happen and recognizing it. It's like that's the regulation. Then you can do anything else if you need to, but yeah, exactly. 

47:09 - Andrea Nakayama (Guest)
It's really just sitting with that awareness and allowing that awareness to be something you're curious about, to sit in curiosity. And I feel like that brings us back to the practice of narrative medicine. It's about close listening. It's not about judgment, it's not about an expectation as a prac from the practitioner lens. I am not putting judgment on anything I'm hearing. I'm just holding space. I'm not sitting there with what I'm going to do next or what I'm going to say, which is the hardest thing for me to teach my students who are other practitioners. Like you don't know the answer, I, you haven't met this person. Like I don't care what they have, you don't know who they are. And then, as patients ourselves, all of us really sitting with that same curiosity and unknowing, like what is that? Why am I feeling that? What is it that I'm feeling? And is there some way I can hold space for that, that, even if I don't have the words? 

48:17 - Dr. Andrea Moore (Host)
for it. Yes, oh, that's so beautiful. I could ask you a million more questions, but I want to be respectful of your time because you notice we're coming to the end here. And one I want you to first let people know where you, they can find you and how to work with you or learn more from you, because I know you have a lot of amazing courses and I will say I have taken so many courses and so much of what information I just integrated now is so it's so hard for me to be like I'm like I don't know where I got half the stuff from, but I'm like I remember yours and it was so beautiful and I still remember certain. I'm like. I'm like I could say certain. I'm like I'm like I could say certain things I'm like, but I don't know if I've just made them my own words at this point, but I know so many of the concepts. What's that? That's the intent. 

49:04
Yeah exactly Like so much. I just know so much of the concepts that I got were so driven by that and I only took your tiny tiny little. It was just the. It was like the baby course and I love I feel like you really shaped a lot of the way I think about it with like the storyline and everything. So just thank you so much for that, cause you really have such a beautiful way of speaking and and teaching. So, yeah, tell people a little bit more about where they can find you it just makes me. 

49:26 - Andrea Nakayama (Guest)
so you know it's. It means everything to me that somebody like you can take a little bit of the work even and like, move it into your own world, Like. That's so meaningful to me. So thank you for the work that you're doing. Over on my personal website, andreanakayamacom, people can find access to the writing, the free workshops, and that will always lead you back to the work at Functional Nutrition Alliance. So Andrea Nakayama is more patient focused, but you know, everything I'm offering is just available. It's not like there's any course or any yet. Who knows, one day maybe, but it's all there just to explore and it'll lead you back to the Functional Nutrition Alliance, which is the larger part of my work where I'm training providers. We do have a virtual clinic. There's a lot going on there, but if you go to andreanakayamacom, it'll lead you to all the different places. 

50:23 - Dr. Andrea Moore (Host)
Amazing, thank you for that. And two questions to end with. One's a tough one, so feel free to talk about it, I'm curious. So also one if you could leave people on an individual level with one thing, what would it be? And then two, if you had a policy change that you could make, which is very different from individual recommendations, I find, because you can't make a policy about listen to your body right like like what would it be? 

50:56 - Andrea Nakayama (Guest)
my gosh. A policy change? Um, yeah, I mean I, that's a big one, andrea good question. 

51:07
I need to think about that. I mean, I definitely feel like we've lost touch with culture, our culture. I wish there was something that helped us honor our pasts, our elderly, the wisdom that comes. I feel like we're such a new, evolving, always changing culture. So which is good in some ways, but in the process we leave some things behind that I think have deep meaning. So I'm not sure what the policy would be, but it would definitely recognize that there's wisdom in where we personally have come from, our lineage, our cultures. So let me think what that policy would be yeah, no, I love. 

52:03 - Dr. Andrea Moore (Host)
I mean, I love that so interesting that you even went there because I was like so different. I like, yes, yes, yes to that though I. 

52:09 - Andrea Nakayama (Guest)
So much wisdom, so much wisdom yeah, that could like overarchingly inform so many of the things we do business, policies, politics, all of it, um. And then you know one thing I want to just ask people to play with, like I feel like nutrition isn't about um, isn't about uh, rules, but there are some principles that I think are really simple that I'm just going to share, because there are principles I would say apply to anyone and can be adapted in any way. And the first one is fat, fiber, protein at every meal. That's going to help with our blood sugar. 

52:51
The second one is eat the rainbow, and that's super fun, especially if you have kids. Just lay, what colors did I eat today. And the third one is to start to get familiar with your yes, no, maybe, list. What's true for you. So I feel like if I could ask everybody, put down the diets, put down should it be keto, intermittent, fasting, working for this person, that book, that influencer, that TikToker, whatever it is put it all down and just embrace these principles. That, I think, is the one thing I would ask everybody in relation to what they put into their body. 

53:33 - Dr. Andrea Moore (Host)
Yes, so beautiful and so well said, Awesome. Thank you so so much for being here. I've so appreciated having you. I've loved this conversation so much fun. Thank you, Andrea.