#531 Conventional Medicine vs Functional Medicine: Detox and Going back to Health Basics

with Andrea Nakayama

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Andrea Nakayama

Our movement, our environment, and our mindset enhance and modulate. We may need to clear a metal; we may need to clear an infection; we may need to clear a negative mindset; we may need to clear an allergen. It allows us to think a little bit more broadly versus this targeted approach that I think we’re taking too often. And what I like to remind patients is that there are always two experts in the room, and one of those experts is you, the patient. And you can’t be an expert if you don’t do your inquiry, if you’re handing over all your agency to another individual.

 

Dr. Wendy Myers  

Hello, everyone. I’m Dr. Wendy Myers. Welcome to the Myers Detox Podcast. Today, we’ve got a great show for you. We have Andrea Nakayama, she is a functional nutritionist. She’s the host of the 15-Minute Matrix Podcast and founder of the Functional Nutrition Alliance. She’s going to talk to us today about functional medicine and using a systems approach to address the underlying root cause of your health issues. We’re going to discuss nutrition to optimize detoxification, how to optimize sleep, and we’ll also delve into hormones. What you need to prepare before you start taking bioidentical hormones is a really interesting conversation because I think so many people think that just taking hormones and hormone replacement is the answer that’s going to solve all of their symptoms and help them lose weight and whatnot. And it doesn’t always work out that way. We’re going to tell you why on the show today. Andrea has led thousands of students and practitioners around the globe in a revolution to offer better solutions to the growing chronic illness epidemic. By highlighting the importance of systems biology, root cause methodology, and therapeutic partnerships, she is helping historically underserved individuals reclaim ownership of their health. As the founder of the Functional Nutrition Alliance, where you can get a certification that Andrea offers, you can learn more about Andrea’s school and certifications at www.FXNutrition.com and more about Andrea at www.AndreaNakayama.com.

 

Andrea, thank you so much for coming on the show. 

 

Andrea Nakayama

I am so excited to be with you, Wendy.. 

 

Dr. Wendy Myers  

Yeah, so why don’t you tell us a little bit about your background and how you got interested in functional medicine? You have a really compelling story.

 

Andrea Nakayama

Thank you, I’ll try to compress it into a story that we can all digest quickly. So, I’m a functional medicine nutritionist and the founder of the Functional Nutrition Alliance, where I primarily train practitioners. I’ve now trained about 8,000 practitioners in over 68 countries, and I feel very fortunate to be able to do this work. But this was not my original career. I did not start in healthcare, medicine, or nutrition. I did have a really big passion for food as medicine for my own body, I think, because of what was happening with underlying autoimmune issues before they were diagnosed. But in April of 2000, my late husband was diagnosed with a very aggressive brain tumor called a glioblastoma multiforme when I was just seven weeks pregnant. So, this is April of 2000, a long time ago. Before we hit record, I told you my son’s 23, so a long time ago now. But my late husband was given about six months to live. Isamu lived two and a half years. We did a lot, everything and anything we could do to support his longevity, so he had a little bit of time to imprint on our son. But that really woke me up to a lot of the gaps in our healthcare system. And I say that not to condemn the system but just to say it can’t be our be-all and end-all, as you and your audience know all too well. That really woke me up to where some of those gaps were and how I could start to fill them and help others to fill them as well, so that people who are sick and not getting better get more of the help that they need.

 

Dr. Wendy Myers  

Yes, yes. And I mean, conventional medicine is amazing for diagnostics and for emergency medical care. If I get in a car accident, I don’t want to go to my acupuncturist; I want to go to a hospital. But there are a lot of issues in the management of chronic health conditions, and there’s pretty much a total absence of heavy metal testing, for the most part, and also really nothing about anti-aging or prevention at all. So, let’s talk a little about that. I want to talk a little bit about optimal nutrition for detoxification. But also, I want to talk about some of your anti-aging tips and things that you can recommend to people to maximize their life and have the best quality of life that they can.

 

Andrea Nakayama

 

Wendy, I’m wondering if it’s okay if I back up a little bit, because a lot of the work I do is to back us up and bring us through a different way of thinking about things that really complements the work you do and the questions that you’re asking. So, we’ll get there. But I’m going to ask us to put on our beginner’s mind for a moment because I really pay heed to the three primary tenets of a functional practice. And that means a therapeutic partnership, looking for the roots, which means we’re asking, “Why is this happening?” and not “What do we do about it?” just yet, and really understanding a systems-based approach, which means we honor systems biology. And what I see in the patient population is that we are very quick to rush to the fixes because that’s what conventional medicine tells us, that’s what the system really tells us that we need a fix for something. So, I just want to establish that we are not broken, that our job is to help our body to be as functional as we can possibly be. So, I’m a real believer, not just in systems biology, which helps us understand that everything is connected, but also in a systems-based approach. And I have several systems that I like to train practitioners and patients to use when thinking about their health. So, I’d love to bring us into two of those systems. I’d love to bring us into three, but if we could look at two of them in relation to detoxification and anti-aging, I think that’ll be helpful because it helps us see what we might be missing under the surface of where we’re paying our attention.

 

Dr. Wendy Myers  

Yes, people need guidance, like what do I do outside of my conventional medical doctor? How do I go about this?

 

Andrea Nakayama

Exactly. So, the first thing I’m going to start us out with is a model that I call “Three Roots, Many Branches.” This model helps us understand that any sign, symptom, or diagnosis we’re experiencing is a branch. I love to bring people into this by saying, imagine you’re in a field, encountering this gorgeous tree, let’s say it’s springtime, we’re in the field of wildflowers in the Pacific Northwest where I live. You walk up to this tree and recognize that, although it’s spring, some of the leaves are not returning, and some of the branches don’t look healthy. So, what do we want to do about that? Do we want to get a ladder and pick off leaves? Do we want to get a ladder and a saw and saw off branches? Probably, we want to rethink our approach and realize that’s not going to get us to the solution for this tree to be in its utter magnificence. We want to go deeper to the trunk, and deeper still to the roots, and deeper still to the soil.

 

Any sign, symptom, or diagnosis we are experiencing, whether it’s related to detoxification, some kind of infection, a heavy metal, seeing lines around our eyes, experiencing estrogen dominance, low estrogen, or having PCOS, are branches from this model. I’m not saying they don’t need to be addressed head-on. But what we can also do as patients, and we all are, is go deeper into the roots and deeper still into the soil. The three roots that I’ve always identified for any chronic issue not easily resolved are the genes, digestion, and inflammation. Those are the three roots, but what’s the soil? The soil is what I call the “Circle of Influence.” This is borrowed from Stephen Covey, who talked about the habits of the most successful people. Instead of focusing on our area of control, which would be the root, or our area of concern,  I have no idea what to do. I’m a sympathetic dominant, what do I do, take this, do that,  test this, we get to go into our circle of influence and all those other things can help. I’m not saying they’re not necessary, but where we can also focus is on our circle of influence around those roots for our genes, that includes our food, our movement, our environment, and our mindset. These are epigenetic factors that influence our genes. For our digestion, that includes the mechanical, the chemical, the structural, and the microbial. These are all things that impact not just our digestion but our metabolism and nutrition. And then for inflammation, it’s clear, calm, enhanced, and modulated. We may need to clear a metal, clear an infection, clear a negative mindset, clear an allergen. It allows us to think a bit more broadly versus this targeted approach that I think we’re taking too often, leaving us scrambling and forgetting some of what I’ll talk about in our next model, which are the non-negotiables. Let’s take a pause there and see how that fits with what you think and how your audience might resonate or what questions might come up.

 

Dr. Wendy Myers  

Yeah, no, no, go on to the next thing. Yeah. Because I do resonate with what you’re saying about not wanting to just cut the tree branch off, cut out your gallbladder, or just pull that tooth, whatever the case may be. I think people really need to listen to their intuition when working with any practitioner and see what’s right for them, what kind of resonates with them. Maybe they should get a second opinion. But, you know, when it comes to anything, and not leave your health, or your organs, like cutting out your gallbladder, as just an example, leaving those decisions to just one person or one type of practitioner can really have big consequences in doing that. So, just for me, when I was having health issues, I went to the doctor, and they sort of had hormone levels of a menopausal woman and just said, “Hey, just take all these hormones for the rest of your life.” And that didn’t resonate with me. So, I sought other answers. And I think it’s important for people to do that when they’re working with any type of health practitioner.

 

Andrea Nakayama

Yes, absolutely. And that can be hard to do. So, I just want to acknowledge that what I’m asking is for us to come into a parasympathetic dominant place, which is a place from which we can heal, and recognize that we may need to do sometime-lining, we may need to map. So, when somebody says to me, “I’ve never been able to poop,” or “I’ve had issues with belly fat,” what I want to ask is, go back in time, when was the first time you noticed that? What happens that makes it better or worse? Like, where do we get into a level of self-inquiry that helps us with that first tenet of a functional practice that I mentioned, which is the therapeutic partnership. And what I like to remind patients is that there are always two experts in the room. And one of those experts is you. And you can’t be an expert if you don’t do your inquiry, if you’re handing over all your agency to another individual. And I’m not saying you have to have the answers to what to do, but you get to have the answers to who I am. And this is very cliché, but I like to say that the goal is to take people from the “Why me?” to the “Oh, me. That’s what happened. Oh my gosh, that’s what happened in my life. That’s really interesting. That’s the first time that happened; it got worse when I was going through graduate school,” then like to be able to tell that story is really beneficial.

 

Another tip that I’ll just throw in here is being able to separate our signs or symptoms, and our diagnosis is really helpful when speaking to a conventional medical practitioner. So understanding that a symptom is something we experience that can’t be measured, and a sign is something they can measure or tell. So you can be unconscious, and your signs are still there, you still have a fever, you still have a rash, you still have distension. But being able to speak in relation to those distinctions really helps us to communicate in a way that isn’t clouding that conventional practitioner’s mind about what they can measure and what they can’t, what they don’t understand. Fatigue, that’s a symptom, can’t be measured, but we can speak into it, “I have fatigue, it happens when…” I notice it gets better if… That story is what we can bring to all of our relationships, our therapeutic relationships.

 

The other model I wanted to introduce us to in terms of detoxification and anti-aging is what I call the Three Tiers to Nutrition Mastery, and it actually is really the Three Tiers of Epigenetic Mastery, but it’s the Non-Negotiables, Deficiency to Sufficiency, and Dismantling Dysfunction. And just like cutting off those tree branches, we often go to Tier Three, and conventional medicine focuses on Tier Three, “Dismantle the dysfunction. What’s wrong? Fix it.” And what I’m asking us to do is get into those roots in that soil, which is in the Non-Negotiables, and in Deficiency to Sufficiency. So deficiency, yes, it could be in a vitamin D or a vitamin B that’s helping us detoxify. But it could also be in joy, or love, or sleep, or poop, which become part of our non-negotiables. So our non-negotiables are unique to all of us. However, I do have a Non-Negotiable Trifecta, which includes sleep, poop, and blood sugar balance, and I will say those are three keys to detoxification and to anti-aging. Because if we are not sleeping, not pooping, and our blood sugar is not in balance, we have other factors that are going on that impact our abilities to eliminate, excrete, do what we’re supposed to do with any toxins, endogenous or exogenous. And that’s going to contribute to advancing the aging process in a number of ways, from our brain health to our metabolism to our hormone health.

 

So for me, I like to think of it, Wendy, as the simplicity on the other side of complexity. I understand systems biology really well. And you know what? It still brings me back to the fact that most people are not focused or tuning in to their sleep, their poop, or their blood sugar balance, while they’re looking for bioidentical hormones, a detoxification protocol, or some anti-aging cream. We’re forgetting that that is actually the pillar, those are the pillars on which both of those things, which are hugely interrelated, as you know, really rely.

 

Dr. Wendy Myers  

Yes, absolutely. I mean, if you’re not sleeping, you primarily detox when you’re asleep. You have your glymphatic system open up and detox your brain. Your liver is going to work detoxing you. If it’s not working, you’re kind of waking up at 2-3 a.m. That time If it’s congested. There are problems in that department. And just lots of sleep deprivation over the years, over decades, that catches up with you in a big way. So, that’s my suggestion for people whose primary focus is troubleshooting that. Let’s talk about that a little bit. It can be very challenging to figure out why you’re not sleeping. I definitely battled with this. And I mean, there’s 14 different areas that interfere with sleep. So, you really do have to have a systematic approach when it comes to that, to go through each of those 14 lines to try different things to figure out what the problem is, and then how to address that.

 

Andrea Nakayama

Yeah and I think like you said, it’s so important to recognize that sleep deprivation leads to factors that accelerate aging and hinder the body’s ability to detoxify oxidative stress, inflammation, a weakened immune system, and all of those things you listed, the liver’s function, the glymphatic system, so the brain health, all of those things are really important. So, I feel like when we talk about sleep, we’re looking for a remedy for sleep. And so, the first thing I like to do is lead people through a very detailed questionnaire and actually have four articles on sleep on the Functional Nutrition Alliance site that we can link to, or people can go search for. But then, that has our sleep questionnaire on there. But what do we need? Like, what time are you going to sleep? What’s happening when you sleep? Do you go to sleep at the same time every night? Do you wake up every night? Do you wake up at the same time every night? What happens when you wake up? Like, there’s a next level of questions before I go into solutions that helped me to figure out which of those things we need to be considering as we’re putting the pieces of the puzzle together. So, let me just give you one example. New research came out recently about menopausal women and intermittent fasting, and it is not necessarily working for the needs of women who are very postmenopausal. And this for me is a heal versus ideal situation. So, I believe in all the research, and there’s less than we think there is about intermittent fasting, but about allowing the body to go into its rest and digest state. If we are not ready for that to happen in those longer periods of time and we force that, we’re putting extra stress on the body’s systems, and we’re causing more hormone issues and more sleep issues because we haven’t addressed the heal before going to the ideal, which is the 12-14-16, whatever the belief system is that you’re subscribing to. So, as an example, are we not sleeping because we’re having blood sugar dysregulation through the night? So, that becomes the set of questions where I’m listening to somebody, and they’re saying, well, I’ve been trying intermittent fasting. They’re not putting those pieces together. Everything is connected. My mantra is, everything’s connected, we are all unique, all things matter. So, understanding that there are all aspects of your life that are affecting your sleep. But we first might have to ask, what does not sleeping or what do sleep problems mean to you, and dive in deeper to what’s happening, and then we start to try things. And I always start with food first when I can, unless I’m recognizing that there is a really clear deficiency because that CO2 deficiency to sufficiency is really important. On the other side of that is toxicity. So, just really upholding that balance and making sure we’re asking the right set of questions.

 

Dr. Wendy Myers  

Yeah, so I know you guys are listening, you’re watching your Instagram, an hour or two before you go to bed, and you end up sacrificing an hour to sleep, and get the blue light going, and it can be very hard to be disciplined to set yourself up for sleep success. I mean, there are a lot of tempting distractions out there. 

 

Andrea Nakayama

That is true. And I think we often overlook those tempting distractions, and what we are engaging with may also get our systems upregulated instead of the downregulation that we need. Also, practices that include things like intermittent fasting may have people eating later. And so their body is in a full rest and digest state. So again, recognizing that a number of things are likely connected, and we can start asking a set of questions before bringing in resolutions.

 

Dr. Wendy Myers  

Yeah, I know, for me personally, if I eat after 7 p.m., I usually try to be in bed by 10-10:30. But if I eat after seven, without fail, I don’t sleep as well. I’ll wake up in the middle of the night, I’ll wake up in the morning hungry. And because, you know, your blood sugar’s kind of all over the place, digestion is disrupting sleep. And that’s just one of the biggest, the easiest things you can do, and biggest factors in getting a good night’s sleep as don’t eat after seven or at least three hours before you go to bed. And so let’s talk about nutrition. Let’s talk about functional nutrition for detox. Unless you wanted to add anything else to your systems approach. But yeah, let’s talk about what are some of the nutrients and supplements that are optimal for detoxification? 

 

Andrea Nakayama

Yeah, and again, as a functional medicine nutritionist, I’m just going to state that personally, my preference, because I’m so focused on bio-individual needs. I do not talk about supplements outside of a therapeutic partnership, because I feel like a lot of people can end up taking things that are inappropriate for their body because they think it does something. So, I prefer a general food-first approach when we’re speaking in forums like this. That said, if I’m teaching somebody or I’m working with somebody individually, there are going to be specifics that we need to get into for that individual. So, with that caveat said, I’m always thinking through the realm of dietary principles versus a diet, especially with the amount of anti-diet culture that we have now, and a lot of pushback that is happening around diets. I don’t believe diets are a handout because we have complex relationships with food and our bodies. And I prefer to think about what is in the diet before we think about what I am removing so that we’re crowding in as we crowd out. So, three dietary principles, and these will support detoxification: fat, fiber, protein at every meal. And of course, when we talk about fats, we’re talking about not processed fats, so whole food. All of these things are going to help with that sleep, poop, and blood sugar balance. So, that non-negotiable trifecta is going to be supported by fat, fiber, and protein. And I know Wendy, I’m saying like simple stuff, this seems like this is too basic, but I’m telling you, I see the people who have worked with the top experts, done all the things, taken all the supplements, followed all the diets, and they’re just off because they’re not better. And sometimes they’re saying to me, “Wait, my fatigue is connected to my hydration? What does that mean? Nobody told me that.” or “I can go to sleep a half hour earlier. And that might make a difference.” And I’m just thinking, where did we miss talking about these things that seem simple because they actually have huge, complicated physiological impacts. So, Fat, fiber protein, every single meal. fat, fiber, protein, or snack, just do a little checklist with yourself. The second principle is to eat the rainbow. This is where we get all our antioxidants, which are going to help us with our oxidative stress, they’re going to help us with our fiber intake, we’re going to get lots of nutrients to deal with that deficiency to sufficiency that helped us do a number of different functions. And so, just get super playful, track your colors of the rainbow that you ate in a day, don’t need to count calories, don’t need to have this or that, see what you’re eating, it’ll get rid of a lot of the other stuff that we don’t want to be eating when we’re playing with our food in that way. And the third principle is your yes, no, maybe list. And this is where it becomes really functional. Because each of us has things that we know work for us or don’t work for us, or we’re just not sure. And that’s in functional medicine, what we call our mediators. My job as a functional medicine nutritionist, I see it as helping each individual to understand more of their mediators. Again, what makes you feel better, what makes you feel worse, the old me of the equation. So, your yes, no, maybe list is, what do you know doesn’t work for you? I can tell you all day long that the magnesium that you’re going to get from your nuts and seeds is brilliant for your detoxification and your elimination and your hormone balance and your sleep. And if you don’t feel good when you eat nuts and seeds, and you know, and you can tell me, “I feel nauseous when I eat them” or “they make me burp”, or “I get hives”. That’s a no. And that’s not in our perfect diet list. Because that’s your personal no. I have my personal no’s, I do not eat gluten, I do not eat cow dairy. But I do eat other dairy and I don’t eat refined sugar. And there used to be a time where I would say I don’t eat grains. But I always say now, I don’t eat grains unless I do. Because I like to have a little wiggle room and not be on this straight and narrow path where it’s hard to live because we’ve got to live, part of aging gracefully is actually living not always seeking for a solution to fix ourselves because we’re broken. So, again, food, simple, just going to leave it there and might need to go into very specific healing protocols with an individual, but for all of us, it would behoove us to think through the lens of fat, fiber, protein at every meal, eat the rainbow, and our yes, no, maybe list, and the number of people that I’ve seen be able to take their healing to the next level by bringing it back to that simplicity is phenomenal. And I don’t know how it’s being overlooked, but it is.

 

Dr. Wendy Myers  

Yeah, I am a huge proponent of that, just getting back to basics. Because just the hydration, a healthy diet, 30 minutes of exercise, you don’t have to go to the gym for an hour and a half. Just go for a walk and just get something in every day, just very, very simple things, and getting hydration right. Because that can be challenging as well. But just some of these basic things, getting minerals, these few things can have huge dividends and reduce a lot of symptoms that people have. It doesn’t have to be this super complex protocol. Just do the basics and see what’s leftover. And also, I think a big variety in your diet is also related to…

 

Andrea Nakayama

 and rainbow comes in right like it just brings us that variety right away.

 

Dr. Wendy Myers  

Yes, because I think there are some people out there eating healthy but they’re eating chicken, rice, and broccoli every single night. Are they just, there are some people like Victoria Beckham who eats chicken and vegetables or something like that, fish and broccoli, every night for like 25 years, just something crazy, just because she doesn’t want to waver from the calories or whatever that is. But I know a lot of people who are in that rut, but they’re technically eating healthy. So, that variety is really key.

 

Andrea Nakayama

Yeah, I mean, the two areas that I see here are either people have eliminated, eliminated, eliminated, like you’re talking about, where it’s almost conditioned food hypersensitivity because they haven’t done the internal work to heal. And so they’re looking to the food to be the solution. The ideal for me is to eat the diet that’s as vast as that individual can eat at that point in time. That’s the ideal diet. Like I want it to be as diverse, like you said, as possible for that moment in time. But people do tend to think that food is going to be the controlling factor. And so they eliminate, eliminate, eliminate. In my clinic, we often see people coming in eating real foods, and they don’t realize that they haven’t done the internal healing to be able to introduce more foods. And then they’re hypersensitive, either physiologically or mentally, to everything that they’re eating. That’s not going to heal us because we need the diversification of nutrients for all cellular functions, including detoxification and anti-aging. The other situation is people are eating according to a prescribed diet, but they’re eating the newfangled foods that may have been designed to appeal to that diet that aren’t serving them. So, let’s say they’re eating an autoimmune paleo diet, but they’re eating one of these new cereals that is still a whole bunch of carbohydrates but no grains. And they’re eating that with some kind of non-dairy milk, but they’re not getting fat, fiber, or protein in that meal; they’re maybe getting some fiber, maybe. But they’re mostly getting carbohydrates, but it fits in the rules section of a paleo or autoimmune paleo diet. And so they don’t realize that there are ways to diversify and support that healing process from that point forward.

 

Dr. Wendy Myers  

On that note, the beef that I have is with some of the people on vegan diets. I’m not a huge proponent of that diet. But I have seen a handful of people do okay on it. More proponent of vegetarianism, as it’s just not as strict. But, you know, people go and eat these industrial seed oil butters, and the fake cheeses, and all these things that have these really inflammatory oils in them, and they are so unhealthy, but they’re following their prescribed diet. But I think that we need to take a look at that and avoid these industrial seed oils, like canola and the grape seed, which is the canola, and just all these other oils, or corn oil, soybean oil, or whatnot.

 

Andrea Nakayama

All the seed oils that are processed, so any of the processed oils and fats for sure. So really coming back to, what do we mean by fats? What do we mean by unprocessed fats? And how does that work for us? I even say skim milk,it’s surprising, but it’s still hard to talk to people about the fact that skim milk or 2% milk is a processed food, because we processed it to remove the fats that were supportive of digesting that whole food. So, I think it’s really coming back to whole foods first and getting out of a mindset that the solution is outside somewhere in some very complicated protocol, when in fact, we can come back internally. And I’ve listened to many of the podcasts, Wendy, and I love how you talk about hormones and different factors that are implicated by our abilities to detoxify. Like poop and estrogen. It’s huge, but people are focused on poop; they’re focused on estrogen. And that’s just a good example of where we think, “Oh, I can get this supplement or this bioidentical externally,” but we still got to be able to process whatever we’re doing. And that’s when it comes back to what our body does internally.

 

Dr. Wendy Myers  

Yeah, and that’s where I was too, at 37 I was told I had the hormone levels of a menopausal woman. And rather than just jump at the suggestion of my functional medical doctor, although that may have been the right thing for me, I wanted to know, why isn’t my body producing the hormones that it should be at this age? And so I looked at my stress, and I looked at my diet, and I looked at what is involved in my body in producing and metabolizing hormones. That’s the liver, digestion, not being able to poop, and things like that. And that’s how I learned about toxins and how toxins are interfering with your hormones. And that’s why we’re talking today, is me asking those questions and looking at the underlying root causes of why my body wasn’t able to produce the hormones that it should have been. So let’s talk about hormones, because so many women that are listening are concerned about hormones, low hormones, unbalanced hormones, perimenopause, menopause, or just maybe reproductive issues. And certainly, hormones are key in anti-aging. So, what is your take on hormones? And how do we optimize them? Like in the functional way, to promote anti-aging and health in general?

 

Andrea Nakayama

Yeah, it’s such a good question. And the way I look at it brings us back to one of the non-negotiables, all of them, actually. But I think of your hormones in a pyramid, and at the base of that pyramid is blood sugar balance, then insulin, then cortisol, then thyroid, then sex hormones. When we’re trying to balance our sex hormones without having addressed everything that leads to that tipping point, we actually have more issues, or we have unresolved issues. I don’t know about you and your practice, Wendy, but what I see is that people think that taking the bioidenticals these days, there was a point where bioidenticals were off the table or hormone replacement therapy was on the table, then off the table, then back on the table. But now people think, “Oh, I’m gaining weight because I’m perimenopausal. I’ll just take bioidenticals, and that will help.” And what I see so often is that dialing in our hormones is a process that we have to be down for. It includes, on our part, being able to do that baseline work, and in the practitioner we’re working with, going back and forth until we get it right, and what feels right in our body. So I’ve heard you say, “I wish I had tested in my 40s.” And I love that, Wendy, because I wish people tested their hormones in their 20s. Because we don’t have a baseline to know what is true for each of us. And there is a difference in each of us; there isn’t a range. But there isn’t a way that is necessarily what’s going to feel our best.

 

I know you don’t think I’m revealing anything because you talk about it, but you feel good about bioidenticals. I actually take my bioidenticals because I have to. And I really limit them because I feel better off of my bioidenticals. So I take them because I’m supporting my bones, because I’m supporting my heart health. And so I need a little bit of estrogen, which means I need progesterone. Because those two have to be balanced. We should never be taking estrogens without understanding our progesterone levels and making sure they’re both dialed in. But more important for me than our hormone levels is our hormone detoxification and our hormone metabolism patients. So, when I’m looking as a functional medicine nutritionist who does not prescribe hormones, when I’m looking at somebody’s hormone testing, the testing I prefer is a Dutch test, a dry urine testing for comprehensive hormones, because the pieces I can have an impact on from my scope of practice are the metabolism and the detoxification, which comes back to all the other principles.

 

So, if we just look at the hormone levels and address those, we’ve forgotten that hormones exist in the terrain, in soil. And that soil comes back to those pieces which are going to be individual for a lot of people. And I know we were looking at what foods help with these things. It comes back to the rainbow, to the fibers, we can look at our broccoli and our sulforaphane-rich foods, there’s so many things we can look at. But I like to keep it broad with the fat, fiber—fiber being a key hitter, protein, and those rainbow foods that help with the metabolism and the detoxification. But again, bring it back to your blood sugar balance. And if you’re like, “Oh my gosh, I need a continuous glucose monitor,” maybe start with that fiber, protein, see how you feel. Start with your sleep. What’s happening for you before you go looking for more resolution externally, because I like to bring in those resolutions at the right time for that individual.

 

Dr. Wendy Myers  

Yes, I found that out very pointedly when I started. I hit menopause about three years ago, and I started having hot flashes. And I thought, “Oh, this is fun.” And mine weren’t even that bad, but they’re very annoying. And I realized that I needed to eat more protein, balance my blood sugar. And then I finally correlated that when I eat something I’m not supposed to be eating, and my blood sugar goes up, that’s when I start doing the hot flash. I just didn’t correlate those two. I just wasn’t making that connection. And when I figured that out, I don’t get hot flashes anymore. 

Andrea Nakayama

Exactly, that same thing happened for me, Wendy, and I’m 57, so you know, postmenopausal. But for me, it was my stress level and my ability to manage my stress levels, especially before bedtime, because I was having flashes at night. So if I didn’t really honor my sleep non-negotiable, which means going to bed by 9:30, 10 o’clock, then I was already on an upswing in my system that was causing me to have more adrenal-related issues, which was causing me to have more hot flashes. When I was able to manage my bedtime, and especially my stress levels at nighttime, I didn’t have hot flashes. So, like you, when we start to realize, again, I’m going to bring the mantra: everything is connected, we are all unique, all things matter. Sleep matters. Food matters; blood sugar matters, lunch matters, relationships matter, sex matters, it all matters in whatever way we can bring in that way of thinking to our own ecosystem.

 

Dr. Wendy Myers  

Yeah, and I like that point you bring up about that you can take other bioidenticals to supplement what your body’s not producing anymore. But you still need to optimize your body’s ability to metabolize them. So like the estrogen, you can take it, you know, bioidentical, but then that can metabolize into toxic forms of estrogen if your liver isn’t functioning well, if your liver is unable to detox properly, or you’re not pooping. Yeah. So, can you talk a little about that? 

 

Andrea Nakayama

Yeah, absolutely. This is one of the ways that I really like to train the practitioners that I teach to look at hormones, because it is not within my scope to diagnose or prescribe, contrary to what my mother believes, and how I compare to the doctor she sees, right. But that’s not in my scope. So it is in that context. So, I’m always looking for how we get the body to eliminate and detoxify what it doesn’t need. Those are those endogenous toxins, and excesses in estrogens or testosterone or anything. But particularly, we see it with estrogens and testosterones. When we’re not processing those through our liver, our urine, and our poop, that’s when we have more potential for those to become dirty hormones that we’re reusing and recycling that lead to more of the branches, the signs, symptoms, and diagnoses that we’re experiencing.

 

So, being able to take that dual effect of here’s the thing I should be doing to address this sign, symptom, or diagnosis. But wait, here’s the thing I could be doing for myself or at home. So, that metabolization is how we utilize those hormones. And that also, I will say, is where I will help somebody determine whether hormone replacement therapy is right for them. Again, not mine to prescribe. But I’m always recommending it based on their metabolism. Let’s see if we can shift your ability to utilize estrogens before you bring in more estrogens, or let’s start really, really slow, one hormone at a time, over a longer period of time so that we’re titrating. And we know what the shifts are related to. And that way, we find the right prescription for you. So, even though I’m not the prescriber, I’m working with people to help them mitigate extra problems that they could have based on how they metabolize, break down, and utilize or detoxify, excrete the hormones that they don’t need. And that’s just a slow process. And I think it’s very indicative of the relationship we have to be in with our bodies.

 

But really, that hormone process is one I think is getting a lot more people tripped up because they don’t realize it’s probably titration. It’s a start low, go slow. It’s a shift here, not there. It’s a try this, pivot here. And it’s iterative, to find the right dosing for our bodies based on a number of factors. And a lot of people are recommending hormones without even doing that testing.

 

Dr. Wendy Myers  

I love what you said. This is the first time on this show, of over 500 shows (Episode), that anyone has said, “Why don’t we prepare your body and get you pooping and the liver working before you start considering hormones? Optimize your body’s ability to metabolize those hormones.” They don’t want to hear that concept. Yeah, and then, most medical doctors are not going to be using a Dutch test. They don’t know what that is, it’s not covered by insurance. So they’re not able to see what your hormones are metabolizing into if you’re making a lot of toxic estrogens that can lead to cancers and things like that. 

 

Andrea Nakayama

Correct! Yes, and a lot of the symptoms that we experience, we might be thinking, “Well, I’m doing the thing, but I’m feeling worse, or now I have this problem,” and we don’t understand why. So, for me, there’s a lot of opportunity in that functional, physiological optimization, as well as what I think of as the qualitative, in addition to the quantitative information. The quantitative information is on that test; it’s on that Oura ring; it’s all the information we want to collect these days out of our tests and our trackers, which I love. But we need to put that into context, and that comes with the qualitative information of asking ourselves those questions, like we talked about with sleep, or like we talked about with recognizing, “Wow, I have hot flashes when I eat X, or I have hot flashes when I go to bed by Y.” That becomes the qualitative information that helps us to have more agency in our longevity, in our aging, and in our detoxification.

 

Dr. Wendy Myers  

Yeah, and that takes a lot of observation and writing this stuff down. It’s just work that your doctor just doesn’t have time to look into. Or maybe they’re not even asking these questions; it’s really up to you to get in and empower yourself. And I’ve seen so many people just get into trouble just going to the doctor, just doing what they’re saying. I mean, spending years, just even with a bladder infection, spending nine months with the doctor, and functionally just can’t figure out what it is or what’s causing it, or their health condition that they’re trying to address. And so, you really do have to take matters into your own hands. And there’s a lot to it. So that’s why I do the show, to educate you guys on how to do that.

 

But yeah, when I was doing hormones, like I started with testosterone, and just felt amazing on that, but you can get way too much testosterone. You know, you need to slowly start titrating that up, or you don’t want to start getting a really deep voice or getting too muscular, or there are side effects. I had some chest acne, I was like, “Oh, what is that?” And I had some hair fall out, you know, and those are side effects of testosterone. But it only happened for a week. And so I had the right dose. And man, am I happy!

 

Andrea Nakayama
That’s so great. And like, for me, Wendy, I love that we can honestly talk about our personal experiences. I already know that I make a lot of testosterone and I process it well. So it doesn’t mean that I’m growing chest hair or having a mustache. I am pretty driven, very on task. And when I took more testosterone, it did feel good, but it made me feel more of that energy that had already been too much in a lot of situations. So I joke about this with coffee too—my body metabolizes coffee just fine. I don’t know if the people around me metabolize how I drink coffee. And the testosterone felt like that to me, in that I was like, “You know what, I don’t think my body needs this because I already make enough testosterone.” Even though it’s gone down over time, I’m fine. But the recommendation came from like, “Everybody feels good on testosterone, women feel great.” And there’s so, I think we really have to do that tuning in. And the minimal that we can take of anything to help us come into that feeling great is where I like it to be.

 

Dr. Wendy Myers  

Yeah, and I think progesterone is so key for so many women. My sleep being more calm, less stressed from taking progesterone and the right amount of it. I was doing a cream at first; it’s like 5 milligrams, I needed 200 milligrams of progesterone. Okay. And in the mix, it makes GABA; I’m just knocked out all night. And I absolutely love it. And I think that’s one of the simplest things that people can start with that has very few side effects. And so many women need it, especially beginning in their 30s.

 

Andrea Nakayama

Yeah, and form is really key for whatever your symptoms are and how you metabolize progesterone as well. So that might be a process of determining: Is it a cream? Is it a pill? What’s the right dosage? And I’ve just watched so many women go through the dance of trying to find the right thing and the right place of application. Is it in the vagina? Is it on the breast? Is it on the inner arm? Is it orally? You know, there’s a lot of different ways to take these things. And I think when I say this, it’s just to remind women, get ready for a process, a journey. It’s not a one-and-done. It’s not a quick fix. And meanwhile, while you’re on that journey, continue to optimize your sleep, your poop, your blood sugar balance, get your body ready, as you said, for this journey, not just of aging, but of anything you’re doing to help your body as it ages. And that’s where we have the most success.

 

Dr. Wendy Myers  

Yes, I mean, when I started with progesterone, I started with a wild yam cream that’s bioidentical in nature. I start with a five-milligram dollop of cream. I was doing it for a while thinking it’s not really working, maybe progesterone is not the issue, but I just wasn’t taking enough of it. So, I think people have to be aware of that. Also, you might need to use the whole jar, bathe in a jar a day. That’s what you’re going to need. Or I’m doing the prescription right now, and that’s what’s working for me, but I’m still researching it and still looking at options. There are homeopathic ones, Dr. Theresa Dale homeopathic. Those are amazing. I have a machine right here; I can do hormones, right? There are all kinds of choices. There are all kinds of things you can do. Try different things, see what works. But yeah, why don’t you tell us more about your school and more about the work that you’re doing? And how people can kind of do a deep dive into learning more about how you do things?

 

Andrea Nakayama

Yeah, thanks for asking. So, there are two places to go. If you head over to www.andreanakayama.com, that’s where I’m doing more of the patient-focused writing, writing a lot about qualitative and quantitative issues with biohacking when we want to get into a more functional approach. That’s work that I’m doing towards my book writing. But you can link to all my other work there as well, at the Functional Nutrition Alliance, which is the company I founded back in 2009. That’s where I have the school, Full Body Systems. It’s a 10-month training in the science and art of functional nutrition practice. So, we go through seven major body systems, and the art of all these systems that I’m talking about and why we might need to focus on them in clinical practice. So, that’s the grounds for clinicians to check out over at FXnutrition.com and www.andreanakayama.com and hopefully, both serve you in some way or another

 

Dr. Wendy Myers  

Yeah, fantastic. Because you are a wealth of information, I have a lot of practitioners that listen to this show. So, definitely encourage them to go check out your work and maybe to sign up for your functional practitioner modules and course and whatnot. Well, Andrea, thanks so much for coming on the show. Really appreciate the insights and your time. 

 

And everyone, thanks so much for tuning in to the Myers Detox Podcast, where I feel so privileged to talk every week to world experts on health, to help give you those insights that you need, those little pieces of the puzzle to help you feel good because you deserve to feel good. So, thanks for tuning in, and I’ll talk to you next week.

 

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