How a Functional Medicine Nutritionist Balances Empathy and Expertise

Recently, I heard Andrea mention (with a chuckle) that her boyfriend eats marshmallows. And, like you, I thought WHAT? 

How can this world-renowned Functional Nutritionist and thought leader in Functional and Integrative Medicine be so accepting of marshmallows as a part of her boyfriend’s diet? After all, most of us likely know that refined sugar is an inflammatory food and the first ingredient in marshmallows is: sugar! In Full Body Systems, we learn that addressing sugar consumption (and blood sugar balance) is key for many people that suffer from signs and symptoms related to inflammation. So… out with the sugar for all, right?!

This is the exact type of thinking that Andrea and her Nutrition Team speak about in the program, and it’s a TRAP! Specifically, it’s the Empathy TRAP. As coaches and clinicians, we want to help, “fix”, and serve the people we care about most. We want to end their suffering (or our perception of their suffering), help them achieve their desired health outcomes. We also (and all too often) want to bring them over to “our side” of thinking. But this is the trap, and we mistakenly fall out of our scope of practice when we place ourselves in the position of the guide without the invitation to be one.

What does tea have to do with Functional Nutrition Counseling?

I sat down with Andrea to get her Functional perspective on this boyfriend/marshmallow scenario. She shared a fantastic analogy as she’s known for doing in her teachings (it’s also one of the many aspects that make learning from her so easy). It was a reference to a video about tea that she also speaks about in this blog post on the “R” in the ART of Counseling. 

To briefly summarize the analogy, it goes like this: If a thirsty person wants tea, you can invite that person over for tea. If they accept, it’s a mutually acceptable and pleasant exchange. However, after the person drinks their cup of tea and you offer them more, you don’t continue to pour tea for them if they refuse that second cup. They don’t want any more tea. To pour them more would be rude and disrespectful of their needs.

I absolutely love this comparison. It applies to myriad situations.

Honoring the individual

Andrea shared with me that students in Full Body Systems sometimes show up wanting to change the diet of everyone around them. They’re eager, gung ho, and so excited to pull out the soap box and step right on top of it. They further assume that Andrea’s own mother, sister, son, and, of course, boyfriend do all things that we determine to be the healthiest. After all, they have access to Andrea Nakayama at their fingertips!

But, as we know in theory, there is no one-size-fits-all diet or lifestyle.

Furthermore, as Andrea reminded me with the tea analogy, our clinical services must be solicited. And then, they’re most serving when properly executed with careful assessment strategies. Are we a daughter, son, partner, girlfriend, uncle? Or are we their clinician? Sure, we can be both, but only with mutual consent. Just like the pouring of tea scenario.

And, as Andrea emphasized during our interview about her boyfriend eating marshmallows, one of the most important questions to ask when we have this desire to “fix” our loved ones is: what (or who) are we trying to serve? Egos are fragile. When we learn a new skill or trade or hold strong beliefs, it can be natural to want accolades or validation for our knowledge, especially from those that we admire or whose approval we seek, even when it’s cloaked in our desire to “help”. When I step back and think about it, I fall into this trap all the time!

Balancing the relationship between client and loved one

For Andrea’s boyfriend, as she explained, marshmallows serve a particular bio-individual need. (And it’s not just his sweet tooth!) He is a long-time athlete and hiker. When fueling endurance, he’s learned that he does best with fast fuel at specific intervals because, bio-individually, he utilizes and depletes nutrients so quickly. Marshmallows help him with carb load energy on his mountain ascents. He’s found it to be the perfect combo of fast fuel and bulk (that doesn’t leave him feeling depleted or hungry.) Andrea points out that he actually wouldn’t need to eat a lot of fiber on a hike, which would slow the digestion and absorption processes, as would proteins and fats. Whereas those other nutrients would be ideal on a regular day and for a typical meal, his endurance needs call for a different formula. 

Andrea relayed how much she respects that he’s figured out the recipe to keep himself going. In fact, as she pointed out, he eats marshmallows, but he’s doing so Functionally! Now that’s an interesting reframe!

The elimination trap

A frequent situation that people find themselves in when seeking out a Functional Nutrition Counselor is the elimination of food categories or groups. It might be processed or inflammatory foods or it might be food chemicals, like oxalates or lectins. I hear Andrea speaking on this topic a lot and what I love about her teachings in Full Body Systems is that she doesn’t default to one specific elimination diet. Instead, the goal is to return someone to a fully Functional state. She focuses on working slowly to address the Non-Negotiables and to move from Deficiency (or Toxicity) to Sufficiency in a bio-individualized manner.

And part of honoring a therapeutic relationship is accepting an invitation for assistance or guidance, dynamically monitoring the person’s needs, and staying within the “scope” of the relationship. For example, at the beginning stages of Andrea’s connection with her marshmallow eating boyfriend, he commented on what he could and couldn’t eat. He shared that he wished he could eat a whole bowl of greens like what she had in front of her. He said she’d be a queen if she could help him get to a place where he could eat a whole bowl of broccoli. Invitation (or perhaps it was a challenge!) accepted. 

At this point, Andrea revealed that she took a step back, honored the relationship, and determined how they were going to go about it. As she learned more, as he casually shared specifics about his taboo foods, she recognized that a lot of it seemed to come down to foods high on the FODMAP list. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. That’s a mouthful! But as I understand it, these are short-chain carbohydrates (or sugars) that can be poorly absorbed in the small intestine, causing some people to experience digestive distress after eating them. That said, Andrea wasn’t going to put him on a low FODMAP diet and manage his meals and food intake. She didn’t want this new relationship to turn into a therapeutic one, and she knew there was another way to address the problem.

She was mindful of the gut-healing work that had to be done and determined that instead of removing more foods from his already limited diet, she’d support the internal terrain.

Paving the way to gut health

You can imagine I was curious. “What did you do?!” Andrea’s response: “A lot of gut healing.” She said she added what she calls “magic sprinkles” to support healthier gut function to some of the meals he was already, comfortably, eating. She made a few recommendations to swap certain foods he ate for others, knowing he wouldn’t follow-through if he didn’t like the taste of it, or if it didn’t make him feel good. She suggested a mid-morning smoothie with some key nutrients added for addressing imbalances. 

And now, well, you can imagine that Andrea not only accepted the challenge, but she’s also, not surprisingly, the queen. While her boyfriend eats marshmallows on the trail, his morning oatmeal with brown sugar and skim milk initially transitioned to gluten-free oatmeal with raw honey and collagen. That’s now replaced by a hemp, chia, walnut no-oatmeal soaked in almond milk with raw honey and collagen. For lunch he eats that big bowl of greens he could previously only dream of, along with his protein. And his evening meal includes a big salad, filled with vegetables that were previously off the menu. His diet is now filled with the fiber-rich foods that he once feared, and that further fuel his sustainable gut health

What was the most important ingredient to healing the gut? 

His acceptance and feeling fine about making change was the single most important part of the journey. Andrea maintained a hands-off approach. She wasn’t (and isn’t) in a therapeutic relationship with her boyfriend. She does not want to track and monitor his food, his mood, or his poop! She thoroughly assessed his signs and symptoms and made recommendations based on his request, leaving the follow-through to him.

It was a great lesson for me to hear that someone can go from compromised digestion, where they struggle with eating a diverse diet, to being able to eat the way he does now, without having to go the elimination diet route to get him there. And you may find yourself wondering, like I did, can this approach work for everybody? 

Andrea answered: “It really depends. Again, he had some gut issues. He doesn’t have other major health issues that we were trying to address or workaround. He’s a scientist and engineer in the way he approaches his health, so he knew what wasn’t working and had eliminated those foods on his own. This is also a trap that many people fall into when they don’t have guidance. They eliminate, eliminate, eliminate. And this can be concerning for long-term health based on how little nutrition is achieved. We had to clean up the terrain and help fortify his system in ways that were going to be easy for him to implement without feeling like an impediment to his lifestyle. There are parts of that equation that are true for everyone, but what needs to be removed or added or addressed is going to be unique for each individual.”  

Confidence as a practicing Functional Nutrition Counselor

I was able to glean so much insight from this conversation with Andrea and I’m grateful to share her words of wisdom with other coaches and clinicians that are ready to help people move out of discomfort and into sustainable solutions like I am. My key takeaway: Ask yourself what the nature of the relationship is and how to honor what’s right for the situation.

I can appreciate that the confidence of not needing the validation of the people we love only comes with practice and time. Even if they are your parent, spouse, child, or friend, the client or patient is the master of their own life. Unfortunately, we’re only going to get ourselves in trouble when we try to propose something contrary to their beliefs without their blessing.

While I went into the interview wondering “how does Andrea feel about her boyfriend eating marshmallows?” I came away with the reminder not to pour tea for people who aren’t thirsty.

Read more from the Functional Nutrition Alliance

What’s Functional and what’s not Part 1

What’s Functional and what’s not Part 2

What’s Functional and what’s not Part 3

By: Functional Nutrition Alliance

Founded by Andrea Nakayama, we help coaches, clinicians, and health care practitioners across the globe transform healthcare with Functional Nutrition. We offer cutting-edge nutrition training programs, clinical guidance, and Functional Medicine thought leadership.