how to use the guiding principles of … · nutrition 101 andrea nakayama, fnlp, msn, cnc, ... to...

functional nutrition 101Andrea Nakayama, fnlp, msn, cnc, cne, chhc

HOW TO USE THE GUIDING PRINCIPLES OF FUNCTIONAL MEDICINE TO CAPTIVATE AND ENROLL CLIENTS — WHILE GIVING YOU THE TOP TOOLS TO HELP THEM

Introduction 3

Been There, Done That 7

THREE PRINCIPLES TO POWERFULLY POSITION YOUR PRACTICE 10

Functional Nutrition 101 15

What is “Functional” Anyway? 17

Can You See It, Too? 20

The First Step to Knowing Enough is Knowing What to Ask 23

THE EMPATHY EXAM 27

There Are Keys in the Chronology 28

Let “How” Be Your Guide on How to Help! 33

May The Force Be With You 35

Get Dynamic! 39

When To Ask What 42

Wrapping It All Up 46

ACTION STEPS 49

REFRAME NUTRITION COUPON 50

FUNCTIONAL NUTRITION MASTERY AT-A-GLANCE TIP SHEETS 51

FUNCTIONAL NUTRITION ALLIANCE CLIENT INTAKE FORM 54

contents

Functional Nutrition Lab is the practitioner training division of the Functional Nutrition Alliance LLC.

functional nutrition 101 3 www.functionalnutritionlab.com

MY PASSION for the food we eat started more than two decades ago, yet it wasn’t until April of 2000 when this culinary curiosity became a full-blown obsession. It happened when I discovered that health and fl avor have a primary and vital partner: physiology.

When food meets physiology magic happens! It’s the place where you can get transformed into the steward of knowledge and the seeker of truth that your clients have been waiting to fi nd. In Functional Nutrition Lab, I teach unspoken insights and untaught skills that are needed to see each person as the unique individual that he or she is, despite their diagnosis.

These key principles help us to fully comprehend the magnitude of our originality as people. You’re as unique as your fi ngerprints and that includes your singular talents as well — the ways you do what you do best, like nobody else.

Embracing the concepts in Functional Nutrition 101 is an invitation to operate at your personal and professional best. It will give you the confi dence (and the chops) to be an essential player on your clients’ or patients’ health and medical team.

Many of you aim for this kind of clinical success, and rightfully so! I’m honored to reveal this high-level wisdom to those who are hungry to make a diff erence in service to others. Clearly, we’re on a mission together.

• • •My journey to nutrition and wellness started with a health crisis, a moment unique to me, and yet I know we all come to the healing professions with a story of our own. This is my story: When I was 36 years old, I sat at the side of my husband’s in-house hospital bed that was located in the sunroom of the house we had bought together only one year earlier.

introduction

http://www.fxnutritionlab.com


As he took his last gasping breaths, I held one hand on his slow-beating heart and another around his cold fingers. In that moment, I did the hardest thing I’ve ever done: I told him it was OK to go.

One more breath. One more. Then, no more.

No more breath for my beloved, Isamu. No more life for the father of my 19-month-old son. I lost the love of my life, my biggest fan, and best friend.

It was heart-breaking. Crushing. Devastating. Unbelievable. No matter how many days I had leading up to that moment — days that others assumed we were planning for his death when, in our reality, we were fighting for his life.

Several months later, I started to experience what I call “post-traumatic growth.” That’s when my vocational and life purpose started to take shape.

No more would a 32-year-old man with a brain tumor, like my husband, walk into a doctor’s office and be treated like a dead man when he was given six months to LIVE. Isamu was not a glioblastoma multiforme; he was not his diagnosis. He was my husband, a father, a brother, a son, a lover – and he lived two years past his prognosis, by the way.

No more will we ignore the depression, anxiety, and fearful thoughts that are norms in society without questioning the functionality of the “second brain” -- the area below our belly button, beneath our abdomen, and in our gut. This seat of digestion is at the root of all health issues and demands to be addressed.

No more will we get confused by diets and dietary theory, putting aside or overriding that a single food may affect us each differently. The garlic that’s helpful for your digestion may irritate my gut lining. The raw kale that I put in my daily smoothie may make you feel sick. The coconut oil one client eats by the spoonful may cause another to break out in a rash.

No more.No more suffering.No more blatant unknowns.No more cookie-cutter solutions. No more patients, sitting in the mystery of their health, feeling like their own bodies have become impossible riddles to solve.



It’s time to reclaim our physiology and fully understand how our bodies are impacted by our personal histories and methods of self-care. It’s time to connect the dots and recover a system of healthcare that honors the individual AND the whole person who is seeking health and remedy.

• • •Functional Nutrition Lab was born simultaneous of this fierce purpose and at the requests of many health coaches and holistic professionals. They wanted to know the tools I was using to support the healing of my nutrition counseling clients. They wanted to be privy to information that isn’t largely discussed or taught in nutrition school.

With a two-month waitlist for new clients, I knew it was time to build a virtual clinic with a team of hand-picked and hand-trained nutritionists. That was a milestone for me and also for those who could now operate with support.

Since I’ve never learned directly in any one program or from any one teacher, my signature approach has been self-labeled, “The Science and Art of the Functional Nutrition Practice.” It came from years of training in holistic nutrition and functional medicine, combined with the opportunity to have worked with hundreds of one-on-one clients and thousands of course participants. Their beauty, complexity, and diversity have been my greatest teachers and most challenging puzzles. And it’s their physiological distress, along with their unique histories and personalities, that dictate their care.

Functional Nutrition Lab is the culmination of those years and teachings. One student noted that

Not only did you pour your own heart + soul (and all your past training) into the course, but you shined a spotlight on other speakers and perspectives. You left the functional medicine door ajar for us to peek in and learn.

Functional Nutrition Lab is also an education and an opportunity that I hold very close to my heart. It’s a curriculum that had been in fruition for over a year before it opened for registration in 2012.

Positively changing the way we do healthcare is my life’s work and purpose. It cannot be done alone and that’s also why Functional Nutrition Lab came to be. It allowed me to be devoted to you, your success, and your life’s work, as well as my own.



Through this functional understanding of health and nutrition, and by recognizing that we are all unique physiological beings, I firmly believe our collective experience with healthcare can and will improve. By investigating, comprehending, and ACTING on what’s unique to each individual, we can help one person at a time to heal, function, and thrive like never before.

This is not about a formula.

The book is not written.

Each client or patient is like a new language. I’m going to teach you how to be an interpreter.

P.S. You’ll notice that I refer to all of us practitioners as “health coaches” throughout Functional Nutrition 101. When I use that term, I’m referring to every single one of us, no matter our scope of practice or designation. Let me tell you a quick story that will explain this…

Several years ago I was attending a functional and integrative medicine conference. At that conference, one of the leaders of the Institute of Functional Medicine got up to speak. She asked each type of practitioner in the room to stand up and receive applause. MDs. NDs. DOs. LaCs. RDs. NPs. PAs. Nutritionists. Etc. Then she asked everyone who is a health coach in the room to stand up. The whole room got on their feet and the whole room clapped! It was a powerful moment.

No matter your designation, we are all a stand for ‘health’, and we’re all responsible for some level of ‘coaching’ our patients or clients to achieve their goals. So when I use that term, ‘health coach,’ I’m speaking to every single one of us. That includes you—no matter your scope of practice!



SEVERAL WEEKS AGO I received an email from a holistic health coach asking for my advice. It was not unlike the emails or panicked phone calls I’ve received in the past from a good number of practitioners. In this case, the coach had two specifi c questions for me: What could be done with a client of hers who has Candida but has already eliminated all sugar, gluten, and alcohol? And how could she approach a young client who has gastroparesis (a digestive disorder of the stomach) and has already done a complete dietary overhaul?

These are two perfect examples of when the “what’s going on in there game” comes in handy. This is when the work becomes fun. That’s right – FUN! The game begins and instead of feeling paralyzed with that “uh oh, what now?” pit in your own stomach, what if this was the moment when you could feel mobilized, inspired, excited? What if you knew that you had the ability to really make a diff erence in each of these clients’ lives?

I’d like to teach you to seize that opportunity and that moment for both your benefi t and that of the client or patient seeking your advice. Put the fear that you don’t know where to go fi rst or what to do next for these advanced cases aside and rest assured that you can, and will, have the keys to the kingdom of support right at your fi ngertips.

Am I about to reveal the cure for Candida overgrowth or the three top tips for addressing gastroparesis? No, I’m not. What I’m inviting you into is not a one-size-fi ts-all approach to every health challenge that you might encounter. And what you’ll begin to understand as you meet more people with the same diagnosis is that such a set protocol doesn’t exist.

As one of my mentors along the way taught me many years ago, even if you’re working with two diff erent women, both 44 years-old, both diagnosed with breast cancer, both the same weight and same height, the roots to one of these women’s diagnoses could be infl ammatory in

been there, done that



nature while the other one is hormonal. How you comprehend those key distinctions, without feeling like you have to go back to medical school, is what’s going to transform your success rates.

And get ready. There are also going to be many health challenges that you may have never heard of — bizarre ones, complicated ones, even if you’re an RD, ND, NP, or other therapeutically trained health professional. Yet these people with a variety of health concerns beyond the mundane also need our help. And there are more of them than you can imagine! They’re bound to come knocking on your door, as they do ours, almost daily.

Instead of a cure-all for every condition under the sun, what I’m inviting you into is a paradigm shift in both your thinking and the ways in which we address people’s health complaints. While I will definitely share some clear, actionable steps and tools you can put into motion with your very next client or patient, I also invite you to sit and contemplate what’s possible in our collective practice of healthcare. This is where we really start to shift the system that many of us have come to believe is broken or lacking. This is where we’re mobilized to break the silence of the suffering that we’ve seen our friends, family, clients, and patients experience, and that maybe we have been burdened with ourselves. It’s with this revamped prototype for potential that we, collectively, reinstate hope in a population that is sick, suffering, and has all but surrendered. This may not be the population you dream of serving, but they will come to you hidden behind symptoms like brain fog, weight loss resistance, allergies and more. Your ability to help them no matter how deep the roots of their pain will determine your own realization of your desire to affect more people’s lives. The good news is that it’s not as hard to unravel as you may think.

What if the six-month protocol you’ve been handed doesn’t work or it’s already been executed by the person seeking your help? Who can you be for them then?

I’ve learned many lessons along the way. I now know that I’m not the right teacher or mentor for the person who just wants to be told what to eat. In my opinion, that’s not an effective or sustainable approach. At FxNA, I teach my clients and customers to understand themselves better and to be in dialogue with their body’s signs and symptoms. I’ve come to call it “non-violent communication with self.”

These tactics can enable them to progress forward no matter how grim the diagnosis or how debilitating the signs and symptoms. I’m aiming



for their success beyond the cleanse, beyond the detox, or beyond the one-on-one counseling sessions. I’m aiming for them to be independent and less reliant on me for their every move because they understand. You can liken this mind shift I’m talking about to parenting. We want our children to grow up to think clearly and independently, not to be rushing back to us to answer every question and to fail when they’re outside of our immediate fold.

What this means for them is inviting the opportunity to think for themselves. And this is not only true of my approach with my clients and course participants in FxNA (or with my parenting tactics!), but also with my Functional Nutrition Lab posse. What I teach my students is the art of the dynamic dance that we need to be in with each and every client or patient. This is the paradigm shift. This is where you come into what’s possible — for them and for YOU. This is where you move out of a one-size-fits-all approach into the true reverence for bioindividuality.



ARE YOU READY to advance your practice, have eager clients knocking on your door, and elevate your role in your clients’ healthcare team? Do you want to be the most important person they rely on for key information? I’m not talking about your sales, or marketing, or the best webpage to get the word out. What I’m talking about is being the true expert that you’d really like to be in your field and for your clients and patients.

There are 3 principles that I’d like to introduce you to that can help you to position yourself in that important place.

PRINCIPLE #1: YOU ALREADY KNOW EVERYTHING YOU NEED TO KNOW TO HELP PEOPLE WITH THEIR DIET.

It’s true. As holistic health professionals, we do know everything we need to know to clean up peoples’ diets. We typically know how to remove the sugar; we know how to identify gluten in the stores and in their cupboards; and we know how to teach our clients to bring in the greens and focus on whole foods. We are the bridge between what’s going on with the doctor and what’s going on at home with their food, diet, and personal lifestyle practices. I call us Allied Functional Medicine Practitioners. We can teach them how to shop at the farmer’s market, what to grow in their garden (even if it’s on their urban windowsill), and how to cook one-pot meals on the stove to feed the family in a hurry.

What we don’t know is what’s going on in there. That’s why we need to play the game, What’s Going On In There?

Let me tell you a story. I had a client, a little girl named Elise, who was just under two when her parents brought her to see me. Elise could not sleep. She had eczema all over her body and severe constipation. Her mom was reduced to giving her an enema about every four days because she didn’t poop on her own. By the time Elise and her parents walked in my door, the entire family was in complete distress.

3 PRINCIPLES TO POWERFULLY POSITION YOUR PRACTICE



This family had explored many dietary theories over the previous year. They had gone off gluten, sugar, dairy, and they were eating a whole foods diet. In fact, they were eating what you might consider to be the perfect diet for her condition — a condition, by the way, that had yet to be diagnosed despite the many physicians they had seen. In the year prior, Elise’s family had adopted the specific carbohydrate diet (SCD) by removing all grains, and then they had started to follow the GAPS diet, the gut and psychology diet designed by Dr. Natasha Campbell-McBride. As you might already know, Dr. Natasha Campbell-McBride is brilliant. I love the GAPS diet, and I’ve learned so much from her about the connection between the gut and the brain, but this diet wasn’t working for this little girl. My job in that situation was to figure out why, to determine What’s Going On In There?, and to find out why this diet — which may have seemed like the most healing diet — wasn’t working for her.

After some probing, tracking, and investigation, we were able to determine that her unique digestive system was unable to digest certain chain lengths of fat. The only way I was able to figure that out was to get very intensely involved with her family and her diet; it was the only way to see what she was eating and how she was responding, and to know really intricate information about her digestive system’s function, including the liver and gallbladder and her ability, or in this case inability, to digest those otherwise-healing fats.

There’s actually a book called “What’s Going On In There?” by neurologist Lise Eliot. That book is about learning what’s going on in your baby’s brain as he or she is responding and growing each day, month, and year. So, I like to take that concept of What’s Going On In There?, and say that, as people, just like as babies, there’s the stimulus that’s going on around us, and then there’s something that’s happening within our bodies.

So, what we need to do with our clients is understand that the food is part of the stimulus, but how that stimulus responds inside their body is something we need to learn and understand. And that’s where being a detective and playing the What’s Going On In There? game are really critical. So, this is where, yes, we know all we need to know as holistic health counselors to clean up peoples’ diets, but that’s step one. We need to take it a step further. I know you’re often in situations where you want to take things a step further and know more about how you can help a client. What I’m going to teach you in Functional Nutrition Lab is that ability to understand what’s going on in there for each individual client.



PRINCIPLE #2: THE CORE TO HEALING IS UNDERSTANDING BIOINDIVIDUALITY.

We’ve all heard the term bioindividuality. Yet I’d like to take our understanding of it a step further and talk about biophysiology. How is it that each of us are really different? How is it that what’s worked for one client doesn’t work for another client?

In order to practice the principles of bioindividuality, you really need to understand this concept of what’s going on in there so that you can take what you know about food and bring it to the individual who’s consuming the food. What happens when you’ve cleaned up the diet, you’ve brought in all the good foods, you’ve added kale and quinoa, you’ve got them making green smoothies, you’ve even introduced the superfoods and select supplements — you’re working with goji berries, and flaxseeds, and chlorella tablets, and turmeric, and green tea, but your tried-and-true practices don’t work for a client for a specific reason? How do you begin to decipher that if you don’t fully understand What’s Going On In There?

I have a client named Pamela who has SIBO, or small intestinal bacterial overgrowth. What’s happened is that the bad bacteria that were populating her colon, her large intestine, have moved into her small intestine and are disrupting her digestion, her brain function, and her immune and hormonal health as a result. Pamela is in a situation where she cannot digest fibers without blowing up to look like she’s five or six months pregnant. Yet fiber is something we think of as positive. It’s something we’re trying to bring in to our clients’ diets, perhaps with flax, hemp, chia, more greens, and lots of fibrous veggies. None of that works for Pamela.

There was only one way that I could figure that out and find out how to help her, and that was by understanding What’s Going On In There?. Being able to understand that internal biophysiology allowed me to be the detective and not prescribe to a set protocol, bringing her the kind of healing that I know you want to deliver to your clients with more confidence and more know-how.

PRINCIPLE #3: ELEVATE YOUR ROLE IN YOUR CLIENTS’ HEALTHCARE TEAMS.

It’s important that you know that as a holistic health coach or as the nutritionist or Allied Functional Medicine Practitioner, you do not need to be at the bottom of the tier with the doctors and acupuncturists and



naturopaths that are also on your clients’ teams. You can be a part of that team. You can be equal. And you can even be sitting in the driver’s seat.

You do not need to feel like you do not know enough to help your client or to help her entire team figure out what’s going on for her. What I’m proposing here is that your understanding of what’s going on in there and playing the What’s Going On In There? game enables you to elevate your role and the ways in which your client looks to you, relies on you, favors you, and turns to you for advice, recommendations, and information. You become the trusted resource, and you get their referrals and their applause for what you’re doing to help them figure out what’s going on in their body — sometimes things that nobody else has been able to decipher.

• • •To play the What’s Going On In There? game, to honor the beauty of bioindividuality and biophysiology, and to elevate your status on your clients’ healthcare team, continue to follow the practices outlined in Functional Nutrition 101 and be sure to show up for the opportunity to take knowledge to practice. (Practice doesn’t make perfect, by the way, but it does allow for a level of mastery that I just know you’re going to love!)

www.functionalnutritionlab.com



functional nutrition 101

HOW TO USE THE GUIDING PRINCIPLES OF FUNCTIONAL MEDICINE TO CAPTIVATE AND ENROLL CLIENTS — WHILE GIVING YOU THE TOP TOOLS TO HELP THEM


IN THIS EBOOK we’re going to focus on what I like to call Functional Nutrition 101. This is how we, as nutrition professionals, can use some of the guiding principles of Functional Medicine to captivate and enroll clients, while at the same time giving us the top tools to help them on their unique journeys to wellness. These principles of Functional Medicine, which are simpler than you might think, will enable you to determine clients’ underlying issues, get them feeling better faster, and ultimately help you to become the hero on their healthcare team.

I want to show you how you can begin to immediately delve deeper into uncovering the underlying causes for your clients’ health woes. Does that mean you have to go back to medical school and understand how to diagnose and prescribe? No. It means that you have to know how to dig, decipher, and readily enter into a dynamic dance of discovery that is particular to the person sitting in front of you. Your client or patient deserves this, and so do you! Let me show you what I mean.

I’d like to reveal, right now, some of my best clinical secrets. Are you ready? We at FxNA utilize three key tools with each and every client who comes into our fold. These are strategic tools that I’ve adapted from Functional Medicine practices to meet our needs as nutrition professionals. These tools include:

1) the FxNA in-depth Intake Form and Intake Process (You’ll fi nd a copy of our comprehensive Intake Form at the back of this book and you can download a free copy here: www.functionalnutritionlab.com/intake. Feel free to use parts of that form or the entire thing to construct your own Intake Form and tailor it to your particular needs and niche.)

2) the FxNA Functional Matrix3) the FxNA Functional Timeline

http://www.fxnutritionlab.com/intake

http://www.fxnutritionlab.com/intake



The second and third tools — the Matrix and Timeline — are ones I share in my Reframe Nutrition audio course (that’s your next step to become a Functional Nutrition master, and there’s a coupon for you on page 50 of this book!). I refer to all three of these tools throughout Functional Nutrition Lab, and we use them every day in my clinic. They’re that important. I’ve even adapted some of them for the customer to utilize for themselves!

It’s the first tool, the in-depth Intake Form and the Intake Process itself, that I want us to explore together in these pages.

Remember, we’re looking at both a paradigm shift of what this realm of a holistic health practice can really be and starting to explore one of the top tools to begin the process of delivering expertise and excellence. I am committed to excellence in each and every thing that we do at FxNA. And both the mind shifts and the practical tools are equally important to your success — just as they are in our relationship to our food or diet. Please do not discount the relevance of either: bypassing the mindset for the tools or sitting in the mindset of possibility without taking action are both missing an important nugget of opportunity.

Knowledge → Practice → Mastery

You took the initiative to follow a dream you had, to gain more knowledge about food, diet, lifestyle and more. Now let’s take that initiative forward — into your own life, your practice, the health of others, and, yes, the changeable face of our currently lacking healthcare system. Let’s make you a master.

By now, many of us hold the realm of Functional Medicine in high regard. It’s been noted as a “trend to watch” and we certainly follow along with interest as these self-identified doctors work on the front lines of our medical system to transform what practitioners can be and what they can provide to the patient population. We, as nutrition professionals, may be behind the scenes, working hands-on in the trenches with the client or patient to adjust what is commonplace and everyday, transcending their relationship to their food and diet. But ultimately, for any of us, it all comes back to what it means to practice in a functional way — no matter what your degree, no matter your scope of practice.

http://www.reframenutrition.com



WHILE YOU AND I likely know what “Functional Medicine” means, not everybody does. Or maybe we know that Mark Hyman does it, that David Perlmutter does it, and yet they seem very distant and other, honored and acclaimed. But, like I said, you can work within the functional framework too, gaining recognition for your services within your own sphere of infl uence. Before we go any further, I want to defi ne what I mean by “functional” and introduce you to some critical precepts of a functional practice to ensure that we’re both on the same page when we use this core terminology.

from the Oxford DictionariesfunctionalSyllabifi cation: func·tion·alPronunciation: /’fəNG(k)SH(ə)n(ə)l

ADJECTIVE1 Of or having a special activity, purpose, or task; relating to the

way in which something works or operates: there are important functional diff erences between left and right brain

1.1 Designed to be practical and useful, rather than attractive: she had assumed the apartment would be functional and simple

1.2 Working or operating: the museum will be fully functional from the opening of the festival

1.3 (Of a disease) aff ecting the operation, rather than the structure, of an organ: functional diarrhea

1.4 (Of a mental illness) having no discernible organic cause: functional psychosis

I actually love the word “functional.” It means useful and whole. It’s as medicine should be. And according to the Institute of Functional Medicine, there are some foundational conditions of a functional practice.

First, the goal is to address the underlying cause of any sign, symptom or disease state — aiming to get to the root of what is not

what is “functional” anyway?



functioning and preventing a person from feeling his or her best.

Second, the practitioner engages in a system-based approach, always understanding that one physiological system in the body affects others and that it is a network with constant crosstalk and the sharing of common pathways. (The body is dynamic and the practitioner must be too!)

And third, and this may be my favorite as a nutritionist: the patient and practitioner are ultimately to engage in the most therapeutic partnership. I not only see this partnership as key in my own relationships with my clients, but my hope is always to help my clients to become the most viable partner in their relationships with their doctors, and for me to be in the most viable, productive and “functional” partnership with any other healthcare provider on my clients’ teams.

There are guidelines or precepts that we can follow that are part of the functional practice, no matter what our field of expertise. The first of these precepts — again, a guiding principle of Functional Medicine — boils down to a number of questions that you can pose to your clients to help map out your next steps based on their unique history. That’s right, all those functional doctors out there, from Mark Hyman to Jeffrey Bland to Amy Meyers, they’re not skipping this step in favor of doing a bunch of lab testing. Their Intake process and the questions they pose during that session are key to their success with each and every patient.

I’m not saying that these practitioners I’ve mentioned don’t ultimately go the distance — testing blood, saliva and stool (and clinically I might go there, too), yet they know where to first direct their attention in their care of the person in front of them. Even knowing which labs to order, and when, is contingent on a set number of questions in their Intake Process and what their patients’ answers reveal.

I’m going to say this again, because one of the biggest inquiries I get from holistic health practitioners is about lab testing. Everybody wants to know about lab testing as if it’s our only tool to uncover the root of health issues. Now I love labs, but the person sitting in front of me — her signs, her symptoms, her history, her relationship to the story of her life — those are brilliant diagnostic tools too! And believe it or not, those diagnostic tools, along with an understanding of the physiological ramifications of those signs, symptoms and history, are far more revealing than a set of numbers on a sheet of paper. Ultimately, it’s the former — what the client reports in response to your



targeted questions and Intake — that will allow the lab numbers to make more sense and become just another piece of the puzzle down the line.

Using what you can gather from your client or patient with a set of five questions that I’m going to outline for you here is, without a doubt, one of the key principles of Functional Medicine. The doctors don’t skip it, so why should we?

I’m going to share with you what I have found to be the most important diagnostically significant questions and how to use them to start to recognize What’s Going On In There? with your very next patient or client.

If you consider just one of the questions that I’m going to reveal today, and you implement that question or technique into either your Health History or Intake Form, your initial strategy session or Intake protocol, you’ll find that there will likely be a little tunnel leading toward that needle in the haystack. You will be one step closer to knowing how to approach the physiological breakthroughs that your client needs.

Like I said, I’m sharing my approach with you because so many of you asked for it, but I’m also sharing because I know what can happen for you when you have new keys and new pieces to the puzzle. You feel more empowered and more knowledgeable, and you’re ultimately more successful in the work you do. This is how we return healthcare to the individual, where it belongs. This is where we move away from dogma and embrace the true dharma of distinguished healthcare. This is where you get to really make the difference you are meant to in people’s lives.

Who would have thought that some of our success could boil down to a set of QUESTIONS?! Well, it can, and it will. Keep reading and you’ll see how.

While I know I don’t have the cure for cancer to share with you in these pages, if I can help arrest or inhibit some of the symptoms that I see people encounter by upgrading your game — symptoms like I watched my husband suffer — then I’m determined to do so. I know we can do this together.



I’D LIKE TO BACK UP just a bit and move toward that psychological shift into possibility and potential, so you can sit in the seat of confi dence when asking the questions we’re about to explore.

Take a moment, right now, to envision what could be true for you if you had more fundamental and foundational knowledge in your existing practice, if even though you didn’t know it all (we never do), you still felt like you had the tools to fi nd what you needed as new challenges arose, even in the most complex client cases. What would that look like?

See it.

Feel it in your body.

It’s a competence and confi dence. It’s a success of touching people’s lives and how that in turn touches you and yours.

What would it mean to have more of the keys to unlock the foundations of health or to be handed more pieces of the puzzles in the conditions that seem most perplexing? When you think about that, what are you able to foresee for yourself?

Can you see yourself being more eff ective with your clients?

Can you see yourself attracting more clients?

Can you see yourself taking a bigger stance in your fi eld (our fi eld) overall?

Can you see yourself stepping into more of a role of leadership, either within your town, your niche, or the entire realm of holistic nutrition?

Can you see yourself bringing your unique gifts to the world?

Take a deep breath into the possibilities you just envisioned for yourself. I can see all of that for you. I can see that for us! And I’m devoted to us realizing our potential.

can you see it, too?



It’s awesome, truly awesome, because we have a place in reversing not just disease states, like diabetes and heart disease, with food and nutrition, but also what the entire system of healthcare is and has become.

In the Introduction, I relayed a bit about my history and what led to the development of FxNA. I told you about my husband Isamu’s brain tumor diagnosis, his illness and his death, which happened two years later and was the biggest catalyst and inspiration for all that I do in my work today. I also shared the course of study that led me to essentially hang my shingle and open the doors of FxNA.

I can tell you that I invest in my education, in my mentors, and in the trainings that I trust will best move the dial in my own work and my clients’ successes. With the addition of our lead nutrition team, we at FxNA have been able to see over 700 one-on-one clients and lead more than 5,000 people through various detox or cleanse protocols that have been the jump-start to catapult a healthier and more conscious lifestyle. I have thousands more people on my mailing list who are staying engaged in the conversation of health and wellness through our regular mailings. Even these people, who have never met or worked with me in counseling or in programs, write to me to thank me for the opportunity to stay tapped into the deeper conversation of health. I feel blessed.

I never could have imagined that I’d be doing the work I’m doing right now, or that my work would touch so many people’s lives. I’m honored, and I’m inspired. I’ve learned so much through the work itself, the experiences, and most particularly, through each and every individual. Bioindividuality really starts to take on a different meaning when you encounter that many different bioindividuals!

I want to be clear that I don’t share all this with you to brag. I share it with you because this is possible for you, too. You invest in yourself. You invest in your future and your knowledge and know-how. You explore your tools, your education and, yes, your mindset (that mindset piece might be my biggest personal secret weapon, to be honest). You see the results. Once again, this is true of our efforts in our relationship to food, and it’s equally true in our relationship to our practice and our dreams.

Going back to your vision for yourself, what would it mean to touch as many people’s lives as you could? What would that number look like for you? What do you want to change in the realm of health and



healthcare? And do you know, somewhere deep inside of you, that you CAN?

Over the last couple of years, as I’ve stepped more deeply into the realm of Functional Medicine and having a truly functional practice, I’ve been working to refine and improve the Health History and Intake Form that our private clients receive. It has been, and continues to be, an evolutionary process that I consider with great care as I distinguish the most critical questions to ask to get the information I need to best help them. Again, the objective is to use the Intake Process as a diagnostic tool — perhaps more revealing than the most extensive set of lab work. Some people see that first session as an opportunity to sell their services — not so at FxNA. That session, like I said, is one of your best opportunities for problem solving. That in itself could be a huge mindset shift for you!

http://www.holisticnutritionlab.com


AT THIS POINT you may be wondering if this book is for you, if you’re going to get what you need from this conversation about Intakes and questions to truly take your practice to the next level. Let me ask you some questions, and you take a moment to think through the answers for yourself:

Do you wish you could more eff ectively draw answers and conclusions from your clients’ Health History, Intake Forms, and strategy sessions?

Are you feeling ready to position yourself diff erently with your clients and on their healthcare team, becoming able to speak to both skeptical family members and medical professionals?

Did you love your holistic health training but also feel it left you a little lacking in practical and clinical knowledge when you entered the fi eld and started seeing clients?

Are you, like me, consistently striving to make a bigger diff erence in people’s lives and in the world?

If you answered “yes” to any one of those questions, this is the book for you. So let’s get out of our heads and our dreams and into reality — actionable reality.

Let’s look at that fi rst tool I mentioned — what I’m going to call the “A” in the ABCs of functional methods — the Health History and Intake Form. At the back of this book, you will fi nd the most recent iteration of our Intake Form. (Note: I update the FN101 ebook each year when I update our Intake Form. I’ll be sure to let you know when that happens!) We use this as our very fi rst tool, as I’ve learned in my Functional Nutrition and Medicine Trainings, to help us to determine What’s Going On In There? with each and every client.

I want you to have the fruits of our labors — our testing, our tactics, and the questions we like to ask our clients to sit with. I want you to have

the fi rst step to knowing enough is knowing what to ask


our Intake Form, so you can pick and choose which questions work for you. In addition to the version at the back of this book, you can also find the form at www.holisticnutritionlab.com/intake. It’s a Done4You form that you can draw from and incorporate into your own Health History form as you choose.

Ultimately, what this form and this exploration of the impact of inquiry mean for you is that you will get further clarity about how to investigate underlying issues that might be bugging your clients. You will be able to seek solutions to help them feel better faster, leaving more opportunity for more clients to come your way. What this also means for you is you get the tools to start playing the What’s Going On In There? game right away, with your very next client or potential client.

I wanted to start with these questions because they are the keys into the kingdom of knowledge. Like I said, with these strategies you can get started playing the What’s Going On In There? game immediately. Yet there are most certainly more pieces to the complex puzzle that each person presents. As I mentioned earlier, there’s that client who has Candida and comes to you having done everything you already know how to do. Or how about the client who has gone through your weight loss program that’s worked for everyone else except her? What’s Going On In There?

For now, let’s delve into the nitty-gritty. I’d like for you to pretend for a moment that you’re an investigative journalist — a detective. That’s right — as nutrition professionals we wear many hats, and the one I’m asking you to put on right now is that of Sherlock Holmes.

Take a moment and put on that hat. Are you Joan Didion, Barbara Ehrenreich, Nora Ephron, Walter Cronkite, Susan Sontag, Barbara Walters or, one of my favorites, Truman Capote? Think about these outstanding investigators. Their success hung on their ability to ask the right questions and elicit answers that imparted truths otherwise untold, weaving together a story that was riveting and revealing.

As a holistic health coach, you are now a person who’s seeking to get answers, to find clues, to allow a story to unfold. You are an investigator. You are not pretending to know the answers (that would not be a “functional” approach); instead, you are working to unearth them. Each client you see has, and actually is, a unique story to be told and to behold. She’s waiting to be heard, yes, but she’s also waiting to be understood. The health concerns that she has, the ones that brought her to see you — whether they are weight related, digestive,


http://www.holisticnutritionlab.com/intake


autoimmune, self-image, or in the realm of mental health — deserve your understanding.

I have to point out that, by understanding, I don’t mean answers or even compassion. By understanding, I mean the ability to journey with her through the trajectory that led her to this place and forward, no matter what that takes. Every single day, we hear clients who go through our Intake Process say what a blessing it is to be understood in this way. The one I received yesterday read:

You must know how gratifying it is to be so heard and to engender the hope that someone will be able either to “see the whole picture” of what is going on with me, or to ferret it out somehow.

That response is from our Intake Process alone. The purpose of that first session together, and the questions that follow, is to get you the same kind of response.

From a journalist’s perspective, imagine the holes in the story being presented to you. Those holes are the great, unanswered questions. And YOU are the one to ask the great questions. As Allied Functional Medicine Practitioners, we tend to focus on the how. How will I approach bringing a deeper level of healing and health to this person, group, or community? How will I organize the strategies I employ? Will I talk about water before greens or the other way around? How will I make this formula that was presented to me in nutrition school a mode of therapy of my own?

But again, from a journalist’s perspective, how is only one piece of the equation, one piece of the puzzle. We’re missing those important other questions. Do you remember the classical journalistic questions? They’re the what? who? where? when? and why? This sampling of questions, along with how, may be a journalistic cliché, but there’s a reason that when combined they allow a story to unfold.

As holistic health professionals, we’ve come to boil our approach down to the simple and sometimes formulaic pattern of “X simple tips on how to do Y.” You’ve seen that before, right? An example of that would be Five Simple Tips on Boosting Your Energy. Or Three Simple Steps to Kick Your Sugar Cravings. There’s nothing wrong with that approach. It’s popular. It sells. And most of the time, it works! I know I use it as an entry point to the work that I do in group programs as well.

The hole in this approach is that it only addresses the how.

Are you following me here? The remaining five questions have been



left out of the equation. And because of this, I would posit that the bioindividuality has been left out, too. So for those with whom the “X simple tips on how to do Y” does NOT work, the client is left feeling unmet and misunderstood, and you, the coach, may be left feeling similarly.

I don’t know if you’ve ever experienced anything like that feeling: a situation when you felt you left a client hanging, when you didn’t know how or where to take the next steps to help her. In this situation, the foolproof method that has worked for you, your cousin, your best friend, and perhaps the majority of other people you’ve counseled, just isn’t working. And while it’s true that we can’t help everyone — none of us can — the feeling that comes in that moment is one of failure. Even if it’s one person in 100. I know too many health coaches who have questioned their prowess because they felt like they didn’t know enough. I’d like to hypothesize that one thing they didn’t know was the set of questions to ask that might have helped to reveal some answers — answers that would have shifted their clients’ failures to successes, as well as their own.

We’re going to change that. Today.

The first step to knowing enough is knowing what to ask.



THE EMPATHY EXAM is a book of essays written by Leslie Jamison. Jamison is a “medical actor,” meaning she gets paid to play sick for medical students, who guess her maladies and get graded on their care.

The book caught my attention because it documents the training of the student doctor in interacting with a fictitious patient. I’d like to share some quotes from that book that I hope will ignite some curiosity within you about the power that the questions we’re discussing can have.

From the perspective of the “patient”:

“Humility means they ask questions, and questions mean they get answers, and answers mean they get points on the checklist.”

“Empathy isn’t just remembering to say that must be really hard — it’s figuring out how to bring difficulty into the light so it can be seen by all. Empathy isn’t just about listening. It’s asking the questions whose answers need to be listened to. Empathy requires knowing you know nothing. Empathy means acknowledging a horizon of context that extends perpetually beyond what you see.”

“Empathy means realizing no trauma has discrete edges. Trauma bleeds. Out of wounds and across boundaries.”

“Empathy comes from the Greek empatheia—em (into) and pathos (feeling)—a penetration, a kind of travel. It suggests you enter another person’s pain as you’d enter another country, through immigration and customs, border crossings by way of query: What grows where you are? What are the laws? What animals graze there? ”

“Empathy isn’t just something that happens to us — a meteor shower of synapses firing across the brain — it’s also a choice we make: to pay attention, to extend ourselves.”

THE EMPATHY EXAM



LET’S RETURN to the who, what, why, when, and where of the process without eliminating the how in order to become more empathic, and therefore more eff ective, practitioners. Note that when we get to it, I’m going to put a diff erent spin on how. I’m also going to scramble up the order of those journalistic questions to show you how I might use them in a clinical setting to yield the best results.

I want to target some of the most critical questions my team asks of all new clients. You’ll see that they might be simple questions, but the answers — if you put on your empathetic journalist hat — can be quite telling. I’ll tell you about a client I saw just a couple of months ago. She’s a 17-year-old girl whose parents discovered she was binging and purging. I’ll call her “Grace.” I squeezed Grace into my schedule after hours because I felt compelled to help her. With similar circumstances, I’m sure you would too.

Grace is smart and creative and athletic. She’s conscious of her food choices. She drinks green smoothies before she runs, eats healthy full-fat plain yogurt, and makes her own raw desserts. Her family eats well, buying sustainable pesticide-free produce and hormone-free meats. They eat dinner together — both parents and all three kids — unless one of the kids has a game. If given the choice between candy and vegetables, Grace told me she’d pick the veggies every time.

Yet she still found herself caught in a loop.

Grace isn’t the most communicative teenager I’ve met. In fact, I met with a girl the same age earlier in the same week and had a completely diff erent, chatty experience. Grace was embarrassed about her condition, and she’d seen a host of healthcare providers before sitting down with me. My approach with her in that fi rst visit had to be that of an investigative journalist. While I didn’t want to probe her, I did want to open the fi eld for exploration into the reasons that led her (her in particular, not every other teenage girl with bulimia) into the behavioral pattern in which she found herself. I didn’t need to lecture

there are keys in the chronology


her to try to solve her problem. And I didn’t need to treat her like the condition she had come to me for: bulimia. I needed to open up possibilities for healing with Grace.

Once we established some connection through conversation, I started with my key “when” question. . . .

When did you first experience this?

What you can start to gather from the answer to this question is a timeline. (Oooh, remember I said the FxNA Functional Timeline was one of the other two tools we use when inviting clients into our counseling fold? It all starts with the first when question!) You can begin to create your own functional timeline through a series of questions that stem from that when question: When did you first experience X?

Now let’s get back into journalist mode. Remember, you’re not trying to solve the client’s problem or, in this case, treat the bulimia. You’re with Grace. When you discover the when, you want to take several factors into account. These factors are:

• her unique story, and how she relays it to you,• the lifestyle factors surrounding that first occurrence — that first

when,• and the possible imbalances that have resulted due to that

experience, based on what you might know physiologically and psychologically about Grace.

What you’re looking for each time you pose the when question is a chronological portrayal that captures the client’s story. Within that chronology, you can begin to look for triggers, mediators, and symptoms. We dive deep into each of these terms, and how to work with them, in Reframe Nutrition. For now, we’ll define triggers as the conditions and situations around Grace that led to that first occurrence: a breakup with a partner, parents fighting, not getting the position she wanted on a team, et cetera. The mediators are the things (conditions, thoughts, emotions) that instigate the behaviors, making a difference between when she takes action to binge and purge and when she doesn’t: feeling too large, feeling out of control, feeling like she doesn’t fit in. The symptoms are the things she began to feel as a result of that first occurrence: heartburn, sour stomach, and cravings she had never felt before — both for foods and for more of the same activity, an activity that helped certain feel-good brain chemistry to fire.


http://holisticnutritionlab.com/reframe/?utm_campaign=reframe&utm_medium=link&utm_source=fn101-ebook&utm_content=link-only-no-coupon-mention&utm_term=fn101-owners


I want to be clear here that I’m not suggesting you diagnose or presume to know any answers with your clients. One of my favorite Mark Hyman quotes from a live presentation I saw him deliver at an Integrative Medicine Conference was, “Hey, I don’t know what I’m doing!” Remember, just like Dr. Hyman, you’re playing an investigative journalist. And in so doing, you begin to reveal some important keys or portals into the most healing and helpful approach for that client. So the question, “When did you first experience X?” allows you to begin to unravel the story; the story that is unique to Grace.

In Grace’s case, you can clearly see that I’m not treating bulimia with a Five-Step Approach or Signature System. I don’t have the Top Ten Tips for Treating Bulimia. Instead, I’m helping Grace by giving her the opportunity to express her story and also by understanding the broader context in which the symptom, binging and purging, occurred, as well as what physiological side-effects she might be experiencing that could use our attention. In response to her answers, I’m helping her to make connections that become anchors for her own self behavior modification, as well as educating her about the physiological underpinnings of the unwanted symptoms she’s now experiencing.

We’re making associations together and, instead of me asking her to look more closely at her diet, I’m actually asking her to look at herself.

We’ve become so far removed from understanding ourselves as physiological beings — impacting and impacted by our psychology. One of the biggest gifts I feel I give my clients is a better comprehension for themselves of What’s Going On In There?!

Think about the power of this when question and all it can do for you. Think about its ability to invite a personal biography to unfold. Think about how you might shift that when question or where you might use it in your initial strategy session with a client. And think about what associations your client might begin to make — seeing connections that were previously elusive. This is so simple and yet such an important nugget.

With Grace, the when question enabled me to discover that she’d been engaging in the binge and purge behavior since 8th grade, so that’s three years. It enabled me to track when she was compelled to do it and how it changed or escalated over time, ultimately becoming its worst when her parents found out. It tended to occur when she got too hungry after school and after track practice. She would then come home and either eat more than she felt was good for her or eat foods that she



clearly knew weren’t good for her. That would make her feel bad about herself, and then the purging would ensue.

It was telling to learn through the when questioning and the unfolding timeline that it worsened when Grace’s parents found out. Did you catch that? Additionally, her feelings about the behavior were of embarrassment — around her family and as she relayed it to me. So the bad feeling about herself was a major trigger for the behavior. Now this isn’t surprising since the act of purging can release that host of feel-good chemicals in the brain that I mentioned earlier, chemicals that would help to alleviate those bad feelings, but only temporarily — an up-and-down pattern that would keep her coming back for more.

The information I was able to gather from Grace by asking the when question and developing a timeline with her help enabled me to understand her triggers and begin to comprehend what was going on inside her body and brain. It also allowed me to draw information from a person who was not otherwise as forthcoming about telling her story. Speaking to someone about a chronological history can be more effective and more revealing than asking them how they feel, why they’ve come in to see you, or what’s “new and good” today.

For many of our clients, this open-ended line of questioning can either lead to a litany of aches and pains or a shrug of the shoulder. It’s much better to know the plan for your questions. Why are you asking them and what do you want out of them?

I had another client recently who was coming to me for a number of mental health concerns, including depression and anxiety, but who also experienced cystic acne. When I asked her the when question — When do you first remember experiencing cystic acne? — she revealed that it began when she was around 12 years old. My next question was to ask her what else was happening around that time. The answer? Her parents started to fight and ultimately divorced. That connection gives us a lot to work with!

This is all so telling. Let’s think about it. . . At 12 years old, she’s just budding into her own hormonal response; she would just be getting ready to stretch out, to push away a bit, to claim some of her own space in the world. But her natural instincts are thwarted by disturbing and disruptive occurrences around her, causing a red-hot and angry, yet unreleased, response within her at a physiological level. Cystic acne is a bacterial overload that the immune system cannot remedy quickly enough — it’s inflammation!



With that deeper knowledge obtained about the case from the when question, I first tell the story back to my client, so I can ask for more information to build both rapport and understanding. I can then figure out some clear ways to begin to help her, at least initially.

With Grace, if we look at the story she shared, can you see some obvious functional challenges? I’ll bet you can:

• There are some apparent blood sugar issues, revealed by her eating more or different foods than she’d like at the end of a long day of school or practice.

• There are some brain chemistry concerns (which from my lens links right back to gut health), evidenced by the addictive cycle she’s found herself in, seeking the release of a storm of “happy” chemicals to relieve the negative emotions.

• And there are clearly self-esteem issues and repatterning of coping mechanisms around food and food choices.

But if I were treating the symptom alone (vomiting after eating), or the diagnosis, which is bulimia, and not asking the when question to help me develop that timeline, I likely would not have been able to discern the complexities of how to get into her particular life patterns and some of the simplicity of where to go next. I would be addressing this as a psychological problem alone and not helping to address the underlying physiological imbalances that trigger that psychological state. We can’t remove the psychological from the physiological or vice versa — something we’ll explore in depth in Functional Nutrition Lab’s Digestive Intensive.

Another important lesson in all this is what we call “backing it up.” We can get so caught up in how overwhelming it is to address a certain health condition or set of symptoms with food and nutrition therapies. But if we “back it up,” looking more clearly for the root causes, as we do when practicing “functionally,” we sit in a much stronger seat of expertise. “Backing it up” allows us to meet the person and begin to uncover and address the underlying factors of his or her signs and symptoms.



THE NEXT TOP QUESTION I want to invite you to think about in the who? what? when? where? why? how? schematic is the how question. But this is not the “how do I fi x it as the professional” question. This is another question for the client. The question is:

How have you dealt with this concern in the past?

What your client tells you in response to this question is going to reveal a lot about his history, his approach, and his personal follow-through, so that you can tailor your next steps accordingly.

Again, I realize these can seem like simple questions. But what I want you to understand is what I’m revealing are top tools within the Functional Medicine model that have allowed me, and the practitioners who are adopting this functional approach, to go more deeply than what my prospective client might put on paper or relay in a conversation that is just about food, diet, or incoming complaints. I’m asking questions that will reveal the keys to allow me to better help the client, and your ability to do the same will help you more than you can imagine until you actually put it to practice.

Most often people are coming to me because they want to feel better. I’m guessing this is true of you, too. But how to get them to feel better, to achieve their goals, and to address their nutrient defi ciencies will likely take an investigative approach that allows the real person to truly come out and be seen, not just emotionally, but physiologically. . . functionally. “How have you dealt with this concern in the past?” is a question that can lead to some interesting information for you!

In the fall, I lead a focus group for women who consider themselves to be experiencing “resistant weight loss.” Weight loss isn’t something I usually approach straight-on in my practice, but resistant weight loss is of interest to me because there are likely underlying or causative physiological factors at play. (These are those root causes I discussed, begging for us to “back it up” to uncover why symptoms, like resistant

let “how” be your guide on how to help!


weight loss, are manifest.) Uncovering those factors is where the game of What’s Going On In There? begins.

What is resistant weight loss? In order for me to know that these women have actually “tried everything,” as I know many women have likely told you, too, I needed to know what “everything” was for each person I was polling in this group.

“How have you dealt with trying to lose weight in the past?” is a question — THE how question — whose answer tells me a lot about a client and what I need to know to change the course of her success. It will report what she’s tried: Weight Watchers, calorie counting, low-fat, high-fat, Atkins, gluten-free, sugar-free, et cetera. I can then ask, “How did that work for you?” after each of the techniques she relays. In this way, I start to build an arsenal of systems that are effective for each individual and why. I then get to reincorporate aspects of what worked for her into our more functional protocol, so she can fall into step with a methodology that already retains some sense of success for her, both emotionally and physiologically.

Am I going to put her on one of those prescriptive protocols, Weight Watchers or Jenny Craig? No, I’m not. But I might borrow a thing or two that I now know worked for her from that tactic of questioning — whether that be the relationship to having parameters to follow or the elimination of certain food groups that worked successfully but ultimately “didn’t feel sustainable.” Similarly, I might glean some information from what didn’t work. An example of this might be how calorie counting didn’t work because she felt cut off from pleasure and enjoyment of temporary indulgence. Good information, right?



THE NEXT QUESTION I like to keep in my arsenal of potent queries is the who question.

Who in your family or on your team will be most supportive of you making dietary change?

As many of us were taught, there are primary foods and secondary foods. While I agree with this premise, I hold a strong belief that our food and how our bodies can digest, absorb, and utilize the nutrients from that food is at the core of the expression of all the primary foods. In my perspective, the model is switched. What I mean by that is our relationships, our spirituality, our career path, and our exercise are and can all be deeply aff ected by both our choices in food and our bodies’ functional health status. They’re each contingent on the other. You cannot separate them; they are not primary and secondary but reciprocal, correspondent and integrative.

(Remember that the second foundational condition of a functional practice is that the practitioner engages in a system-based approach, always understanding that one physiological system in the body aff ects others and that it is a network, with constant crosstalk and the sharing of common pathways. That applies in the interrelationship between the primary and secondary foods. There is no hierarchy here!)

I’d like to share with you my biggest belief around this work that we do. It’s my core belief and the place I move from in all the work I do. It’s the reason why I’m not just a technical clinician, someone who reads labs and addresses health from a set of numbers and symptoms (though I’m able to do that clinical piece as well). It’s why I trust that I’m also an eff ective practitioner, one clients can turn to and rely on.

I believe food and nutrition are keys to unlock our full physiological potential. You may have heard me refer to this as the key-and-lock approach if you’re familiar with my teachings or you’ve seen my Tedx Talk, “Action Potential.”

may the force be with you

http://www.holisticnutritionlab.com/video/sf-talk/

http://www.holisticnutritionlab.com/video/sf-talk/


But it doesn’t end there. The food and nutrition come together to act as the first key, the one to unlock our unique physiological potential. This potential is reliant on our genetics and our environment, but is freed by the lifestyle choices we make, inclusive of our food. The second key is that unique physiological potential itself, the health of our internal ecosystem. I believe that this physiological potential is a key to unlock the powers of both the heart and the mind. More clarity within creates more fullness of the expression.

But it doesn’t end there, either! Food and nutrition act as the first key, unlocking the powers of the body. The powers of the body in full function act as the second key to unlock the powers of the heart to feel, love, and express, and of the mind to focus and produce, dream and innovate. Then the fullness of the expression of the heart and the mind become the third key to allow us to tap into our BIG purpose — what we are here to do and how we can fully actualize that potential.

In this way, the body, in its fullest expression and function, becomes, in essence, a vessel through which pleasure, purpose, and wisdom move. And in this way, when I’m recommending a specific diet or reading in between the lines of someone’s labs, I’m not just looking to remedy a supposed health condition; I’m working toward her ability to recognize and realize her true self. It’s a lofty belief, I know, and yet I see it happening time and time again. I see transformation occur when people begin to pick up and recognize the keys.

What would it feel like for you to witness this transformation in the people’s lives you touch with your clinical care?

How might that transform your life?

This brings us back to the who question. The people who love and support us the most are often the people who can also see us in our most true or realized selves. There’s a part of us they “get,” and they’re rooting for us. This who question, in conversation with your client, is a gentle way of inviting a commentary on the support he or she will or will not receive during your counseling. Can you see how the question, “Who in your family or on your team will be most supportive of you making dietary change?” can invite an opening of discussion? And that discussion can reveal quite a lot that will bring you deeper into the tenor of the healing environment.

I’ve been in situations where one parent comes to me wanting and believing that a dietary change will help a child, and the other parent is completely skeptical. So while you’ve got mom making sprouted



buckwheat granola in the morning with homemade nut milk, dad’s squirting chocolate sauce with sugar in it into the kids’ mouths at night.

Have you been there, too?

The challenge isn’t just relegated to the health of a child. Oftentimes husband and wife teams will be in differing camps about the role of dietary change. This is important to know. This might change the conversation around, “Let me check with my husband,” in response to your invitation to how you advise working with a prospective client, if you know that hubby doesn’t think nutrition makes a difference. At least the disconnect is illuminated and on the table, and you can enlist the support of the person who is most supportive of change.

In many, if not most, cases, when it comes to kids, I’m able to help the other parent make a turn. And I must confess that it’s the science behind what we’re doing that usually does the trick. Sit down with mom and dad and an anatomy book and clear explanations, and there’s really no denying physiology. But asking that question and allowing the complexity of the home, social and relational life to unfold is what enables me to understand my way IN with the family. My goal in a situation like this is not to be a therapist or even a coach. I’m a nutritionist. My goal is to help a child heal. And if that’s my mission, then one key is getting both parents on board. How I do that might take some strategizing and educating.

Here’s a good example. I saw a client last week who I’ve seen somewhat regularly for several months. He actually feels fine. He’s a successful entrepreneur who wants to feel his best, have more energy, and be able to perform better in his athletic pursuits. He’s not my usual client. They typically have more extreme health conditions, but somehow he got on my schedule and continues to return for periodic visits. His blood work looks fine; he has nothing to really complain about, but he wants something more. I can relate to this. I’m always seeking to feel and perform my best. You too?

Let’s call this guy “Fred.” Fred came to me last week with his Food/Mood/Poop journal, a document we use regularly to generate deeper understanding and conversation of daily habits and patterns, and we were reviewing it for optimization. Something he’s doing regularly is eating store-bought energy bars. Now there are a few bars I approve of for regular consumption, and fortunately that list is growing as the marketplace catches on to our initiative, but there are not many, and they do not include the ones he was eating. It’s not all that difficult to whip up a batch of energy, granola, or protein bars, and I’ll happily


https://s3-us-west-2.amazonaws.com/fxna/client-services/pdf/fmp-journal-5-day-fillable.pdf

https://s3-us-west-2.amazonaws.com/fxna/client-services/pdf/fmp-journal-5-day-fillable.pdf


provide clients with those recipes. Now here is Fred, wanting to optimize his best performance in all aspects of his life, but he’s not willing to spend ten minutes whipping up some homemade bars. So I challenged him on this. I talked to him about the continuum of health and that there must be some level of acceptance with what IS if you’re not willing to go the extra effort for the extra mile. Fred got it. He’s smart like that.

I also know, from our previous conversations, that Fred’s wife is not fully on board with the dietary changes he wants to make for himself. Her thinking, according to Fred, is, “if it ain’t broke, don’t fix it.” Now that’s all well and good, except Fred keeps coming back. He wants something more. He’s seeking an upgrade from his diet, and he wants something more out of his life. And yet, in his family, he’s like a lone island. There’s no allegiance and no support. So last week, when I spoke to Fred and confronted him about going the extra mile for himself, I also discussed ways in which he could invite his wife into the process with him. I suggested opportunities that might allow for the two of them to engage in a transformation together.

You see, the answer to the who question for Fred was, sadly, nobody. Or it was me. But at this point, given his goals and his existing eating patterns, which besides the store-bought bars are near perfect for a middle-aged family man without any obvious health challenges, Fred doesn’t really need to see me, especially when I have a long wait-list of people who do (people with unaddressed autoimmune conditions, SIBO, multiple chemical sensitivities, rare cancers and more!). What Fred needs is to find an anchor outside of me to join him in the pursuit of his dietary goals and aspirations. He needs support. And that’s understandable. We all do!

Asking the who question helped me to determine what Fred’s needs really were in our sessions together and to help him to seek ways to resolve his problem — to find potential ways to meet his needs and, as a result, further his dietary and health status — ones that were potentially less expensive than maintaining a relationship with me. Perhaps that would be a key to even more successes realized in his life.



ALL THESE QUESTIONS are great tactics to get inside of your client’s history and patterns of behavior. They invite revealing discussions that enable you to break down the action steps, as we did for Grace. Addressing blood sugar is much easier than addressing bulimia, right?

These questions are the fi rst tools to discovering What’s Going On In There? What’s going on may be physiological. It may be behavioral. It may be social. It’s likely all of the above from our systems-based perspective. They’re all interrelated, and this is the functional approach. But the RIGHT questions get you the right clues. They help you to make informed recommendations and decisions about how to proceed. No matter what you know right now about health and nutrition, asking these questions will help to take you a step further in understanding your client and developing rapport. That fi rst session with a client can be so much more for you and for her!

My son, Gilbert, and I are big fans of the public radio show Radiolab. Do you know it? One program that really caught our attention was called “Talking to Machines.” It was super interesting, yet also kind of freaky. The initial story was about a man who had gone on an online dating service after divorcing. He struck up a relationship with someone he thought to be a woman; in fact, she wasn’t a woman at all but instead was a robotic program. The program responded to his correspondence with an answer that would goad him on to continue the conversation. And this man developed a relationship, at least in his mind, with this supposed woman, until the questions he was asking and the answers that she gave no longer made sense. He started to get suspicious, and it was shortly afterward that he fi gured it out. He realized this machine did not truly understand him.

Another story on the show revealed a test program that was a robotic therapist. The planned questions the machine asked truly convinced the client to open up and have moments of self-discovery.

get dynamic!


Does this work? Yes, it does. It’s wildly successful — to a point. While it’s great to ask the questions, to invite self-discovery for your client, I also want to encourage you to be on your own path of inquisitive discovery at the same time. You are not to be a robot inviting just her a-ha’s, but also your own. What you’re doing in those sessions with your client is not just inviting her to have revelatory moments because of something she shared. You’re cultivating your own ability to have realizations based on her answers. That a-ha that you have is the one that will naturally lead you to the next step in that client’s care. You are the detective. What’s the next step for HER that will make a difference in her ability to realize more healing potential? The detective’s job is to solve the mystery. But it takes work.

This is where a deeper comprehension of the body and of what’s going on in there will become critical. When you ask the questions, the when, the how, and the who questions we’ve already explored, you can then realize what your client needs to get to a deeper level of healing, a level of healing that goes above and beyond dietary cleanup.

Let me give you an example: Let’s say the next thing you invite your client to do is drink green smoothies each morning. You give her some awesome and tasty recipes — the ones your whole family enjoys. Some contain coconut milk, others chia seeds. There’s a mocha version with a gluten-free grain coffee and raw cacao. There are a variety of high-antioxidant fruits, such as pomegranate and blueberries, and one with papaya for the great digestive enzymes it contains. All, of course, have some greens mixed in. You’re super proud of your yummy smoothie recipes, and you’re excited to share these with your client.

Within just a few days, your client reports that the elimination of morning oatmeal and the substitution of the green smoothies (which taste yummy, by the way) are leading to a lot of gas. Each day, 30 or so minutes after she has her smoothie, she’s so bloated she can’t even button her pants. She’s taken to wearing yoga pants with tunics over them every day this week.

What’s Going On In There? Do you have any idea?

When did this first happen? “Well, the first day I had the smoothie.”

How have you dealt with gas and bloating in the past? “I’ve never actually experienced it like this!”

So this is where we get clinical. This is where we need to understand the physiology and start to make some connections that will lead to



resolutions of this new problem. Don’t panic. It’s not your fault. But you do need to address it without running in embarrassment in the other direction, because the suggestion you made didn’t lead to the expected results. In fact, there are some NEW symptoms. And these symptoms are brilliant CLUES! (Clue #1: Gas and bloating started with the introduction of the delicious and nutritious smoothies. Clue #2: Gas and bloating is not something your client usually experiences. More questions: Are there any ingredients in the smoothie that are new to you? Are there any similarities in category or chemical structure to those new foods? Can you try a process of elimination with the new foods to see if the symptoms persist? What do the foods and the symptoms tell you about her digestive capabilities? Symptoms are clues too!)

Like I said, the when, how, and what questions are critical, and yet they’re just the beginning. What comes next is what you DO with the answers and the clues. This is the fun part. And I’m going to show you how to make it fun. In Holistic Nutrition Lab, I translate the anatomy and physiology I’ve learned and continue to learn in my trainings and my practice into terms that are meaningful to your life as a holistic health professional looking to have a more dynamic relationship with your client or patient and truly gain a better understanding of where food meets physiology (and why that might be different for each of us). I have an inside view into what will enable you to better meet your clients’ needs.



KNOWLEDGE → PRACTICE → MASTERY

It’s time for you to practice. And me too! Whenever I can. But remember, practice doesn’t make perfect, instead it creates the opportunity for a level of mastery.

But before you start practicing, I want to bring our attention back to the who, what, and why in our client intake and strategy sessions. We’re not done there yet! I want you to have some tactics to put into action with your very next client.

To review, we’ve already covered the following key questions:

1) The fi rst question is our when question: “When did you fi rst experience this?” (“This” is the symptom or problem or challenge or health condition.)

The answer allows you to start to draw a timeline. Within that functional timeline unfolds a story that magically releases some keys to the solution or course of treatment.

2) The second question is: “How have you dealt with this problem in the past?”

And remember, the answer speaks to you about her compliance, her successes, and what works and doesn’t work for her. Remember, too, that what works and doesn’t work for her could be a physiological cue, a behavioral cue, or a patterned cue.

3) And the third question we explored is: “Who in your family or on your team will be most supportive of dietary change?”

The answer here indicates where she may need more help to follow through with your suggestions and where you can help her to cultivate an environment that supports the results she’s aiming to achieve.

when to ask what


So we’ve covered a when, a how (or maybe two), and a who.

Next I’d like to bring your attention to an oddly-positioned question on my Intake Form. It asks:

What are your health goals and aspirations?

Before I talk about why this is one of my top five questions and what it means, I want to point out why it’s here on the form, at the end instead of at the beginning. I like to ask this question at the end, after clients have considered all the other questions, because at this point they may be more acutely in tune with their goals and aspirations. Earlier in the process of completing a form or when just sitting down to speak with you, they may not be so open or in depth about their wants and needs, and it may be harder to articulate what’s possible.

But even when I’m meeting with someone for the first time, I often find it helpful, depending on the context of the conversation, to ask this question again, out loud — “What are your health goals and aspirations?” — after we’ve created an empathetic environment.

A really good example of using this big what question at the end of the session or Intake Form is a client I have who I’ll call “Melissa.” Melissa came to me in a bit of perplexed desperation. She’s a hard-working designer at a top athletic company. Melissa had suffered a surprising breakup that left her confused and lonely. She had no energy, yet she got herself to work every day. She ran every day. She ate what we might consider a healthy, standard American diet (SAD). Melissa didn’t really care much for food, so cooking wasn’t top on her list.

Melissa had lost a lot of weight. She was thin and somewhat absent from her own life — as absent as her physical self was becoming. When she came in, she sort of shrugged her shoulders about why she was there. She said she just wanted to “feel better.” But after we talked and I led her through some deeper questions, like the ones I’ve shared with you, she was able to see by the end that something might actually be going on with her. Instead of just wanting to “feel better” (a somewhat nebulous statement), she was actually able to articulate that something didn’t feel right within her.

Approaching the situation first from the correlation between the gut and the brain and what appeared to be some depression, I started by cleaning up Melissa’s diet. We removed gluten and dairy, and I did an IgG food sensitivity panel to uncover any hidden food triggers that were affecting her energy and her outlook.



We found some other underlying factors there, and slowly but surely we removed those foods, finding convenient and easy food options for Melissa to incorporate into her day. We went from the organic Oatios to a green smoothie that was packed with marine phytoplankton, fish oil, and easily absorbable proteins. We brought in targeted snacks with coconut oil and flax seeds to balance her blood sugar and support her adrenals. I started her on probiotic therapy, building the good bacteria in her gut to help not only with her sensitivities, but also with her brain and immune health. And we started a full-spectrum B-complex to support her mental health and liver detoxification. While this occurred over several sessions, I still felt that something was unanswered. I had suspicions about her thyroid health because of the way in which she had lost weight and because of the display of her symptoms.

I then sent Melissa to an integrative naturopath with whom I work here in Portland, and we ran more tests — tests that I requested on her thyroid, her adrenals and her sex hormones, as well as a comprehensive blood panel. And there it was — Melissa had Hashimoto’s, or autoimmune hypothyroidism, that was in a state of hyper behavior (causing the fast and significant weight loss). Melissa’s adrenal reserves were also depleted, and it was a wonder she was actually functioning at work. I recommended she take a leave of absence (LOA). I coordinated this with her doctor, and Melissa was able to take six full weeks off from her job to initiate the process of recovery. She slept during most of it, and she needed to! She was basically incapable of doing much else.

But remember when Melissa walked in my door, she was somewhat flippant or passive about the fact that she had even come. It took a discussion, a thread into a deeper line of questioning, and some pointed questions to lead her to an answer that had more potential, more meaning, and more clues for me to act upon, and for her to begin to address some deeper physiological imbalances. You see, it wasn’t just about the Oatios or about her big breakup. We could have just focused there, but these were intricately related to, and perhaps major triggers, for her entire physiological self.

Melissa, by the way, has remained a client for years now. Her condition is one of the most complex I’ve seen, with multiple underlying infections including Epstein-Barr Virus (EBV), polyautoimmunity (including antibodies to her brain), and Superior Canal Dehiscence in both ears — a broken vestibular system causing extreme vertigo. For Melissa’s ongoing care, I work in tandem with her naturopathic physician, her functional neurologist, and even coordinated with her



ear and skull surgeon to orchestrate IV nutrient therapy, including vitamin B, vitamin C, and glutathione post-surgery to help her to more quickly detoxify the anesthesia and narcotics needed for the procedure due to her impaired liver detoxification system due to an MTHFR and other genetic polymorphisms.



I’D LIKE TO leave you with one fi nal question.

We covered:

1) When did you fi rst experience this?2) How have you dealt with this problem in the past?3) Who in your family or on your team will be most supportive of

dietary change?4) And the delayed: What are your health goals and aspirations?

The fi nal question is one that I preface with a disclaimer: I know it might seem odd, but please consider why you might want to achieve these health goals and aspirations.

Now get ready. Some clients might scoff at this question. Some might take the time to contemplate. But asking this question, here on the Intake or when you’re with them in person, allows you to explore the motivation behind their goals and aspirations.

Perhaps you were able to see how the when question led to another when question that allowed you to create a timeline. The how question led to another how question that allowed for the formation of historical context. The why question here, enables you to continue to ask why . . .

Something really important that I want to point out here is that this line of questions allows you to continue to engage in conversation with your client. It allows you to demonstrate that you are the trusted expert for him. You are the one who knows how to ask, how to unravel more information. Again, this is so he can have a-ha’s, but also so you can have tiny epiphanies during your client session that enable you to think on your toes, be the dynamic practitioner that you can be, and know your next step, the step that’s going to lead him closer and closer to his designated goals and aspirations, while holding them with the same importance that he does.

wrapping it all up


I’d like to leave you today considering the “X simple ways to solve Y” scenarios, the simple-sounding, ready-made answers. They do work, sometimes. And they will help you build your practice and your business, for sure. But there’s also a way to elevate their status, to allow those simple steps to have even more meaning. And when what you need is something different, something more in tune, informed and educated, take the time to consider the situation fully and ask the thoughtful questions to help you do so. Don’t be afraid to go back to the questions again and again to dive more deeply into the roots of the presenting health concerns. That’s what a functional approach is — a deep dive into the roots.

Spend sufficient time deciding what you need to accomplish with each bioindividual client and why it matters. This doesn’t mean you don’t have a set toolbox or a signature system, but the entry point or strategy for success may well differ for some. Be prepared for that. Be on your toes. Know how to play the What’s Going On In There? game to determine when something doesn’t follow the same set patterns or flow that worked for you, your best friend, or even the majority of your clients.

With more information and more body understanding in your arsenal, there will be opportunity enough to work on the seductive “how?”, because your clients, your class participants, and your detoxers will stick around! They’ll understand that you have what it takes to be the clever leader on their team.

I know that some people liken health issues to a battle. Well there’s an old war saying that goes, “Time spent in reconnaissance is seldom wasted.” That’s the exploration, the surveillance, the investigation. I’d like to add that it’s especially true if you want to come out on the winning side.

I’ll leave you with one last story, a success story, in fact. “Mary” came to me blown up like a balloon. She had been in the hospital with an infection and put on antibiotics and steroids. She was literally twice her size when she came to see me, showing me a picture from just a couple of months earlier, before she got sick. She could no longer recognize herself in the mirror. She could barely walk. And she was desperate.

Mary’s cousin had recommended that she come to see me. I had worked with her cousin’s 12-year-old daughter, “Allison,” to take her from her Crohn’s diagnosis (for which the doctor had prescribed surgery and life-long steroids), to complete avoidance of both the surgery and the steroids and a thriving (finally), growing, and pain-free tween whose



blood work knocked the socks off the doctors in just three months’ time. (There have been a good number of these teens with Crohn’s in our practice as of late! It’s a growing population that needs our help).

So Mary came to me with high hopes. The doctors were diagnosing a rare autoimmune liver disease. A few months later, Mary sent me her most recent labs. And WOW! Her hemoglobin A1c (long-term blood sugar marker) was nearly normal after being severely elevated; her liver enzymes (which I like to see around 15-26 but had gotten as high as 237) were fully in range, and she looked like herself again.

What did I do with Allison and Mary? I promise to share both of their stories in the Functional Nutrition Lab Digestive Intensive, where we take practice to a whole other level, using the skills we’ve outlined in Functional Nutrition 101 in tandem with a deeper understanding of physiology and nutrition therapy to manifest full body, functional, healing potential.

Now go practice! Become your own kind of master. And together let’s see how we can create a deeper and more profound movement of health, healing, and change.



ACTION STEPS

ONE (IF NOT SEVERAL) of my mentors says “education is meaningless without action.”

Start using these materials and concepts now!

1. Look over the Intake Form at the back of this book or at www.functionalnutritionlab.com/intake and start to consider which questions, perhaps with ones of your own, might produce the most thorough Intake Form for you.

2. Write the five key questions out for yourself on a piece of paper and try them out on your very next client or patient, seeing what unfolds. (Remember, it takes practice, so if it feels awkward the first, third, or fifth time, keep at it. The results will come and you’ll start to feel more confident in those conversations and be able to draw out more important information to help you help them!)

3. Tell me what works for you! Email me at [email protected] and include “Functional Nutrition 101” in the subject line.

4. Come visit me on Facebook (www.facebook.com/functionalnutritionlab) and Twitter @AndreaNakayama and LinkedIn. I always like to connect a face with a name and the Functional Nutrition Lab community of practitioners is very important to me. I love running into students at conferences and really meeting face to face!

5. Go to www.functionalnutritionlab.com to hear from Holistic Nutrition Lab graduates about how Full Body Systems has elevated their practice and changed their life.

6. Give yourself a big High Five for making the investment in yourself and your dreams. I’d love to help you take that even further.

7. Ready for your next step? Join me and the Functional Nutrition Lab community for the Reframe Nutrition Workshop series. You can learn more at www.reframenutrition.com and don’t forget to use your special discount coupon on the following page!




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It can be challenging to embrace the reality that there is no formula for clinical success. The diet that works for you may not work for me. But frameworks provide systems and struc-tures that enable you to think into the unknown. Frameworks acknowledge that each person is different and they help you to capture information that is true about the person’s history and their physiology and organize what matters so you know what to do next. The first framework we use at Replenish is our customized intake form and tools to capture the key details.

Study evidence can give us a place to start. It’s what happened in a narrow, controlled environment. Your body and your situa-tion is necessarily different than what any study will show. Even if all the studies show that coconut oil is healthy and easy to digest, if a client shows symptoms every time they eat coconut oil, then you need to pay heed. Recognize more than what has been shown to work for certain folks, and look at what works (and what doesn’t) for each particular body.

One of the most troubling beliefs (for practitioners and patients) is that we can move from A to B in a straight line—that ailment x has a quick or basic solution (y). Healthcare would be simple if this were the case! But it’s not. In order to treat the chronically ill, we need to look beyond the quick fix and begin to think differently. In order to solve the unsolvable cases, we need to take a functional approach. This requires letting go of the one-size-fits-all fantasy and moving into a new paradigm where we look at each person as a unique individual.

PERSONAL EVIDENCE VS STUDY EVIDENCE

Your client is a unique individual with a unique story. They are not their blood count or their estrogen levels or their diagnosis. There was a unique path that their body took in response to many factors to express itself as it is, right now. It’s by uncovering that path that you will help them to find their particular road to wellness. There are likely parts of the puzzle that you already know. There are others that will need to be uncovered. There might even be things that they are hiding from themselves. Ask and let the story unfold.

STORY VS STATISTICS

DYNAMIC VS STATIC

PROCESS VS PRESCRIPTION

Stasis implies that health lives in one particular, static place—that there’s a single number (for everything from your iron level to your weight) that we’re all aiming for. Once we reach that place we want to stay there. The truth is, health is dynamic. Your body is always responding, minute by minute, to what’s going on in your life. Your external environment, your emotions, what you had for lunch, how much you slept last night, hormonal changes as you age . . . this is what in functional medicine we call homeodynamics. Allow for these fluctuations.

Prescription = Do X to cure Y. The more complex the health issue, the less likely this is the case. In fact, working like this is a violation of the whole (person) and bypasses the importance of bioindividuality. To truly help the chronically ill, we need to move away from one-size-fits-all prescriptions, and learn to ask questions that will reveal the unique healing path for each client. By doing so, we honor that the restoration of health is a process that will look different for each person.

FRAMEWORK VS FORMULA

FUNCTIONAL NUTRITION MASTERY AT-A-GLANCE by Functional Nutritionist Andrea Nakayama

POWER YOUR PRACTICE WITH

FRAMEWORKS

This partnership isn’t with you directly, but it’s one that you foster. In order for true healing to occur we need to assist our clients in creating a relationship with themselves. I like to call this “non-violent communication with self”—where they are able to listen to the subtle signs and symptoms that are begging for attention. Clients can then examine why they are hurting, what might have led to their troubles, what exacerbates their symptoms, and more. This empowers the client to become the hero of his own healthcare team.

The term Integrative Medicine has been described as: “the prac-tice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole per-son, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.” When you work within your scope of prac-tice, and can easily refer out to other types of practitioners that you believe will support your client’s healing journey, you become the trusted resource for your client and create referral partnerships that work both ways.

One of the most frequently asked questions I get from healthcare practitioners is, “How can I partner with doctors?” Partnering with doctors is a fantastic way to uplevel your practice. Yet you might not real-ize that there are several other partnerships that are also key players in a successful practice. Take time daily to consider how you can power your practice with each of these partnerships for optimal results.

YOU+OTHER CLINICIANS

One thing we’ve lost in modern medicine is connection. Doctors have little time with each patient, and your clients are likely not used to being fully seen or heard. Your ability to connect with your clients, to truly be with them in their pain, sets you apart. The partnership you create with your client is one of mutual trust, respect, and commitment to a common goal. This connection leads to compliance, retention, and root-cause resolution.

YOU+CLIENT

YOU+DOCTORS

YOU+CLIENT’S LIFESTYLE

Partnerships between nutrition professionals and doctors can be powerful . . . for both practitioners! Even when doctors know that nutrition and lifestyle modification matter, they don’t have the time or expertise to work into the nuances of dietary changes like you do. Let’s face it, making dietary changes isn’t easy! You have the ability to work deep into a client’s everyday and bring your unique lens back to the MD. You bring a lot to the table! Step forward with confidence and assurance in support of a shared end goal: the patient’s well-being.

While it seems to go without saying, we need to pay heed to the reality of our client’s life and lifestyle in order to match our recommendations with their truth. Working with a 12-year old girl with Crohn’s will look different than working with a 52-year old man with the same diagnosis. You can dispel resistance and rebellion when you take the time to fully appreciate the nuances of your client’s way of life and ensure that your guid-ance takes them where you know they need to go, at a pace that suits their style.

CLIENT+SELF2 3

54

1



PARTNERSHIPS

In my clinical practice, we honor the process of “clearing the muddy waters” before we determine next steps of care. This includes cleaning up the diet and lifestyle habits of each in-dividual—starting with a basic anti-inflammatory protocol and attention to core basics like hydration, sleep, relaxation and supportive community—before we address next steps of care. This practice reveals clues to deeper issues and often clears signs and symptoms in the process.

Oh how we love our tracking tools! Our F/M/P (food/mood/poop) journal allows us to step into our client’s everyday hab-its, patterns and behaviors. After seeing thousands of clients I’m still surprised to find that what a client thinks they’re doing is not always the same as it looks on paper. Asking them to capture F/M/P details for 3–5 days, in a purely objective way, allows you to go in with your detective hat and determine where there’s room for daily improvement that could make a significant impact.

In Functional Medicine and Functional Nutrition we aim to get to the underlying cause of the presen-tation as opposed to just suppressing symptoms. This is what’s called “root-cause resolution.” It’s the difference between turning off the stove and just putting a lid on a boiling pot. In order to practice root-cause resolution, there are key physiological steps we can take to determine what needs our attention next.

3

5TRACK IT!

In the Functional Nutrition Lab community, “back it up” is our mantra. It acts as a reminder to step back and look at the whole individual, as opposed to a symptom or diagnosis. It also reminds us to always consider digestive function when working with “food as medicine.” One person’s food is another person’s poison and our ability to utilize the nutrients we take in is determined by the health of the GI tract, from top to bottom.You are not what you eat, but what your body can do with what you eat.

“BACK IT UP”

BIOINDIVIDUALITY RULES

BALANCE BLOOD SUGAR

Genes. Microbiome. Toxic exposures. These are just some of the ways in which our bodies differ from one another. These are also reasons why what worked for you and your healing journey may not work for all your clients. Understanding the true precepts of bioindividuality rules in practice. We don’t want those differ ences to paralyze us, but instead to help inform each stage of care. The #1 rule in a functional practice, aimed toward root-cause resolution, is to honor the individual.

Blood sugar swings don’t just affect those with diabetes. They affect us all. Blood sugar swings impact our hormones, our weight, our moods and leave us more susceptible to chronic diseases like heart disease and cancer, and autoimmune con-ditions like psoriasis, Hashimoto’s and more. As practitioners, neglecting to address blood sugar balance—which goes beyond mitigating sugar intake and can be more of a physio-logical imbalance (right down to the function of the cells)—is an oversight that thwarts root-cause resolution.

“CLEAR THE MUDDY WATERS”

1



ROOT-CAUSE RESOLUTION

client intake form © 2017 functional nutrition alliance, formerly replenish pDX page 1 of 14

Client Information

Name _______________________________________________________________________

Address _____________________________________________________________________

City ________________________________________________________________________

State _____________________________________________ Zip Code __________________

Phone (day) __________________________________________________________________

Phone (cell) __________________________________________________________________

Phone (night) ________________________________________________________________

Email _______________________________________________________________________

Referred by __________________________________________________________________

Statistics

Age ________________________________________________________________________

Birth Date ___________________________________________________________________

Gender _____________________________________________________________________

Height _____________________________________________________________________

Blood Type __________________________________________________________________

Current Weight ______________________________________________________________

Ideal Weight _________________________________________________________________

Weight One Year Ago _________________________________________________________

Client intake Form

Thank you for taking the time to fill out this form and provide us with details of your health, goals and medical history. Feel free to save this form to your computer and type in your answers at your convenience. The boxes where you type your responses will expand to accommodate your text, so you will have as much space as you need.


Birth Weight (if known) _______________________________________________________

Birth Order (please list ages of biological siblings): __________________________________

Family/Living Situation: _______________________________________________________

___________________________________________________________________________

Children: ___________________________________________________________________

___________________________________________________________________________

Occupation: _________________________________________________________________

___________________________________________________________________________

Exercise/Recreation: __________________________________________________________

___________________________________________________________________________

History

1. Have you lived or traveled outside of the United States? If so, when and where?:

2. Have you or your family recently experienced any major life changes? If so, please comment:

3. Have you experienced any major losses in life? If so, please comment:

4. How much time have you had to take off from work or school in the last year?

□ 0 to 2 days

□ 3 to 14 days

□ more than 15 days


Health Concerns

5. What are your main health concerns? (Describe in detail, including the severity of the symptoms):

6. When did you first experience these concerns?

7. How have you dealt with these concerns in the past?

□ doctors

□ self-care

8. Have you experienced any success with these approaches?

9. What other health practitioners are you currently seeing? List name, specialty and phone # below.

10. Please list the date and description of any surgical procedures you have had (including breast reduction or augmentation).


11. How often did you take antibiotics in infancy/childhood?

12. How often have you taken antibiotics as a teen?

13. How often have you taken antibiotics as an adult?

14. List any medicine you are currently taking:

15. List all vitamins, minerals, herbs and nutritional supplements you are now taking:

16. Have any other family members had similar problems (describe)?


Nutritional Status

17. Are there any foods that you avoid because of the way they make you feel? If yes, please name the food and the symptom:

18. Do you have symptoms immediately after eating like bloating, gas, sneezing or hives? If so, please explain:

19. Are you aware of any delayed symptoms after eating certain foods such as fatigue, muscle aches, sinus congestion, etc? If so, please explain:

20. Are there foods that you crave? If so, please explain:

21. Describe your diet at the onset of your health concerns:

22. Do you have any known food allergies or sensitivities?


23. Which of the following foods do you consume regularly?

□ soda

□ diet soda

□ refined sugar

□ alcohol

□ fast food

□ gluten (wheat, rye, barley)

□ dairy (milk, cheese, yogurt)

□ coffee

24. Are you currently on a special diet?

□ autoimmune paleo (AIP)

□ SCD/GAPS

□ dairy restricted or dairy-free

□ vegetarian

□ vegan

□ paleo

□ blood type

□ raw

□ refined sugar-free

□ gluten-free

□ Other (please describe)

25. What percentage of your meals are home-cooked?

□ 10

□ 20

□ 30

□ 40

□ 50

□ 60

□ 70

□ 80

□ 90

□ 100

26. Is there anything else we should know about your current diet, history or relationship to food?

Intestinal Status

27. Bowel Movement Frequency

□ 1–3 times per day

□ more than 3 times per day

□ not regularly every day


28. Bowel Movement Consistency

□ soft & well formed

□ often float

□ difficult to pass

□ diarrhea

□ thin, long or narrow

□ small and hard

□ loose but not watery

□ alternating between hard and loose

29. Bowel Movement Color

□ medium brown

□ very dark or black

□ greenish

□ blood is visible

□ variable

□ yellow, light brown

□ chalky colored

□ greasy, shiny

30. Do you experience intestinal gas? If so, please explain if it is excessive, occasional, odorous, etc:

31. Have you ever had food poisoning? If yes, please describe in detail, including 1) Where were you 2) What did you treat it with and 3) If you feel like you fully recovered from it:


Medical Status

32. Please check any of the following conditions that apply to your history and briefly describe your symptoms, chosen treatment(s), and dates.

□ Cancer

□ Heart Disease

□ Hepatitis

□ Venereal Disease

□ Diabetes

□ High Blood Pressure

□ High Cholesterol

□ Kidney Disease

□ Thyroid Disease

□ Depression

□ Asthma

□ Allergies

□ Anemia

□ Chronic Yeast Infections

□ Concussions or head injuries (major or minor)

□ Other

Please briefly describe your symptoms, chosen treatment(s) and dates of the above checked conditions:

33. Please check frequency of the following:

Short term memory impairment □ yes □ no □ sometimes

Shortened focus of attention and ability to concentrate □ yes □ no □ sometimes

Coordination and balance problems □ yes □ no □ sometimes

Problems with lack of inhibition □ yes □ no □ sometimes

Poor organization abilities □ yes □ no □ sometimes

Problems with time management (late or forget appts) □ yes □ no □ sometimes

Mood instability □ yes □ no □ sometimes

Difficulty understanding speech and word finding □ yes □ no □ sometimes

Brain fog, brain fatigue □ yes □ no □ sometimes

Lower effectiveness at work, home or school □ yes □ no □ sometimes

Judgment problems like leaving the stove on, etc □ yes □ no □ sometimes


Health Hazards

34. Have you been exposed to any chemicals or toxic metals (lead, mercury, arsenic, aluminum)?

35. Do odors affect you?

36. Are you or have you been exposed to second-hand smoke?

Oral Health History

37. How long since you last visited the dentist? What was the reason for that visit?

38. In the past 12 months has a dentist or hygienist talked to you about your oral health, blood sugar or other health concerns? (Explain.)

39. What is your current oral and dental regimen? (Please note whether this regimen is once or twice daily or occasionally and what kind of toothpaste you use.)


40. Do you have any mercury amalgams? (If no, were they removed? If so, how?)

41. Do you have any concerns about your oral or dental health?

42. Is there anything else about your current oral or dental health or health history that you’d like us to know?

Lifestyle History

43. Have you had periods of eating junk food, binge eating or dieting? List any known diet that you have been on for a significant amount of time.

44. Have you used or abused alcohol, drugs, meds, tobacco or caffeine? Do you still?

45. How do you handle stress?


Sleep History

46. Are you satisfied with your sleep?

47. Do you stay awake all day without dozing?

48. Are you asleep (or trying to sleep) between 2:00 a.m. and 4:00 a.m.?

49. Do you fall asleep in less than 30 minutes?

50. Do you sleep between 6 and 8 hours per night?

For Women Only

51. How old were you when you first got your period?


52. How are/were your menses? Do/did you have PMS? Painful periods? If so, explain.

53. In the second half of your cycle do you experience any symptoms of breast tenderness, water retention or irritability?

54. Have you experienced any yeast infections or urinary tract infections? Are they regular?

55. Have you/do you still take birth control pills: If so, please list length of time and type.

56. Have you had any problems with conception or pregnancy?

57. Are you taking any hormone replacement therapy or hormonal supportive herbs? If so, please list again here.


Sexual History

58. Do you have any concerns or issues with your sexual functioning that you’d like to share with us (pain with intercourse, dryness, libido issues, erectile dysfunction)?

59. In the past year, have your sexual partners been men, women, or both? And how many partners have you had in the past year?

Mental Health Status

60. How are your moods in general? Do you experience more anxiety, depression or anger than you would like?

61. On a scale of 1-10, one being the worst and 10 being the best, describe your usual level of energy.

62. At what point in your life did you feel best? Why?


Other

63. Do you think family and friends will be supportive of you making health and lifestyle changes to improve your quality of life? Explain, if no.

64. Who in you family or on your health care team will be most supportive of you making dietary change?

65. Please describe any other information you think would be useful in helping to address your health concern(s):

66. What are your health goals and aspirations?

67. Though it may seem odd, please consider why you might want to achieve that for yourself:

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