Functional Nutrition101 by Andrea Nakayama

functional
101
nutrition
Andrea 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
contents
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
Functional Nutrition Lab is the practitioner training division of the Functional Nutrition Alliance LLC.
introduction
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 flavor 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 find. 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 fingerprints 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
confidence (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 difference 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.
functional nutrition 101 3 www.functionalnutritionlab.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!

been there, done that
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 specific 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 difference in each of these clients’
lives?
I’d like to teach you to seize that opportunity and that moment for
both your benefit and that of the client or patient seeking your advice.
Put the fear that you don’t know where to go first 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 fingertips.
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-fits-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 different 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 inflammatory in

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.

3 PRINCIPLES TO POWERFULLY
POSITION YOUR PRACTICE
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.

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
101
nutrition
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

find 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 Matrix
3) the FxNA Functional Timeline

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.

what is “functional” anyway?
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 influence. Before we go any further, I want to define
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 Dictionaries

functional
Syllabification: func·tion·al
Pronunciation: /’fəNG(k)SH(ə)n(ə)l
ADJECTIVE
1 Of or having a special activity, purpose, or task; relating to the
way in which something works or operates: there are important
functional diﬀerences 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) affecting 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

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.

can you see it, too?
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 confidence 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 find 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 confidence. 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 effective with your clients?
Can you see yourself attracting more clients?
Can you see yourself taking a bigger stance in your field (our field)
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.

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!

the first step to knowing enough
is knowing what to ask
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 effectively draw answers and

conclusions from your clients’ Health History, Intake Forms, and
strategy sessions?
Are you feeling ready to position yourself differently 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 field and started seeing clients?
Are you, like me, consistently striving to make a bigger difference

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 first 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 find 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 first 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

have 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.functionalnutritionlab.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,

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
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.”

there are keys in the chronology
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 effective, practitioners. Note that when
we get to it, I’m going to put a different 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
different, 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 first visit had to be that
of an investigative journalist. While I didn’t want to probe her, I did
want to open the field 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

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.

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.

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

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?

may the force be with you
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 affected 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 affects
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
effective 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.”

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

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.

get dynamic!
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 first 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 first 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 figured 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.

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.

when to ask what
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 first question is our when question: “When did you

first 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.

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.

wrapping it all up
I’D LIKE TO leave you with one final question.

We covered:
1) When did you first 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 final 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.

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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FU N CTIONA L N UT R I T I O N MAS T ERY AT-A -GL A N C E by Functional Nutritionist Andrea Nakayama
POWER YOUR PRACTICE WITH
FRAMEWORKS
One of the most troubling beliefs (for practitioners
and patients) is that we can move from A to B in a STORY VS
straight line—that ailment x has a quick or basic
solution (y). Healthcare would be simple if this were
STATISTICS
Your client is a unique individual with a unique story. They
the case! But it’s not. In order to treat the chronically
are not their blood count or their estrogen levels or their
ill, we need to look beyond the quick fix and begin diagnosis. There was a unique path that their body took in
to think differently. In order to solve the unsolvable response to many factors to express itself as it is, right now.
cases, we need to take a functional approach. This 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
requires letting go of the one-size-fits-all fantasy that you already know. There are others that will need to be
and moving into a new paradigm where we look at uncovered. There might even be things that they are hiding
each person as a unique individual. from themselves. Ask and let the story unfold.
PROCESS VS FRAMEWORK
PRESCRIPTION VS FORMULA
Prescription = Do X to cure Y. The more complex the health It can be challenging to embrace the reality that there is no
issue, the less likely this is the case. In fact, working like this is formula for clinical success. The diet that works for you may
a violation of the whole (person) and bypasses the importance not work for me. But frameworks provide systems and struc-
of bioindividuality. To truly help the chronically ill, we need to tures that enable you to think into the unknown. Frameworks
move away from one-size-fits-all prescriptions, and learn to acknowledge that each person is different and they help you
ask questions that will reveal the unique healing path for each to capture information that is true about the person’s history
client. By doing so, we honor that the restoration of health is a and their physiology and organize what matters so you know
process that will look different for each person. what to do next. The first framework we use at Replenish is our
customized intake form and tools to capture the key details.
PERSONAL EVIDENCE DYNAMIC

VS STUDY EVIDENCE VS STATIC
Study evidence can give us a place to start. It’s what happened Stasis implies that health lives in one particular, static place—
in a narrow, controlled environment. Your body and your situa- that there’s a single number (for everything from your iron level
tion is necessarily different than what any study will show. Even to your weight) that we’re all aiming for. Once we reach that
if all the studies show that coconut oil is healthy and easy to place we want to stay there. The truth is, health is dynamic. Your
digest, if a client shows symptoms every time they eat coconut body is always responding, minute by minute, to what’s going
oil, then you need to pay heed. Recognize more than what has on in your life. Your external environment, your emotions, what
been shown to work for certain folks, and look at what works you had for lunch, how much you slept last night, hormonal
(and what doesn’t) for each particular body. changes as you age . . . this is what in functional medicine we
call homeodynamics. Allow for these fluctuations.
PARTNERSHIPS
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
1 YOU+CLIENT
One thing we’ve lost in modern medicine is connection.
Doctors have little time with each patient, and your clients
way to uplevel your practice. Yet you might not real- are likely not used to being fully seen or heard. Your ability to
ize that there are several other partnerships that are connect with your clients, to truly be with them in their pain,
sets you apart. The partnership you create with your client is
also key players in a successful practice. Take time
one of mutual trust, respect, and commitment to a common
daily to consider how you can power your practice goal. This connection leads to compliance, retention, and
with each of these partnerships for optimal results. root-cause resolution.
2 YOU+CLIENT’S
LIFESTYLE
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
3 CLIENT+SELF
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
recommendations with their truth. Working with a 12-year old clients in creating a relationship with themselves. I like to call
girl with Crohn’s will look different than working with a 52-year this “non-violent communication with self”—where they are able
old man with the same diagnosis. You can dispel resistance to listen to the subtle signs and symptoms that are begging
and rebellion when you take the time to fully appreciate the for attention. Clients can then examine why they are hurting,
nuances of your client’s way of life and ensure that your guid- what might have led to their troubles, what exacerbates their
ance takes them where you know they need to go, at a pace symptoms, and more. This empowers the client to become the
that suits their style. hero of his own healthcare team.
4 YOU+OTHER
CLINICIANS
The term Integrative Medicine has been described as: “the prac-
5 YOU+DOCTORS
Partnerships between nutrition professionals and doctors
tice of medicine that reaffirms the importance of the relationship can be powerful . . . for both practitioners! Even when doctors
between practitioner and patient, focuses on the whole per- know that nutrition and lifestyle modification matter, they don’t
son, and makes use of all appropriate therapeutic approaches, have the time or expertise to work into the nuances of dietary
healthcare professionals and disciplines to achieve optimal changes like you do. Let’s face it, making dietary changes isn’t
health and healing.” When you work within your scope of prac- easy! You have the ability to work deep into a client’s everyday
tice, and can easily refer out to other types of practitioners and bring your unique lens back to the MD. You bring a lot to the
that you believe will support your client’s healing journey, you table! Step forward with confidence and assurance in support
become the trusted resource for your client and create referral of a shared end goal: the patient’s well-being.
partnerships that work both ways.

ROOT-CAUSE RESOLUTION
In Functional Medicine and Functional Nutrition we
aim to get to the underlying cause of the presen-
tation as opposed to just suppressing symptoms.
1 “BACK IT UP”
In the Functional Nutrition Lab community, “back it up” is our
mantra. It acts as a reminder to step back and look at the
This is what’s called “root-cause resolution.” It’s the whole individual, as opposed to a symptom or diagnosis. It
difference between turning off the stove and just also reminds us to always consider digestive function when
putting a lid on a boiling pot. In order to practice working with “food as medicine.” One person’s food is another
person’s poison and our ability to utilize the nutrients we take in
root-cause resolution, there are key physiological is determined by the health of the GI tract, from top to bottom.
steps we can take to determine what needs our You are not what you eat, but what your body can do with what
attention next. you eat.
BALANCE
BLOOD SUGAR
Blood sugar swings don’t just affect those with diabetes. They
affect us all. Blood sugar swings impact our hormones, our
3 “CLEAR THE
MUDDY WATERS”
In my clinical practice, we honor the process of “clearing the
muddy waters” before we determine next steps of care. This
weight, our moods and leave us more susceptible to chronic includes cleaning up the diet and lifestyle habits of each in-
diseases like heart disease and cancer, and autoimmune con- dividual—starting with a basic anti-inflammatory protocol and
ditions like psoriasis, Hashimoto’s and more. As practitioners, attention to core basics like hydration, sleep, relaxation and
neglecting to address blood sugar balance—which goes supportive community—before we address next steps of care.
beyond mitigating sugar intake and can be more of a physio- This practice reveals clues to deeper issues and often clears
logical imbalance (right down to the function of the cells)—is signs and symptoms in the process.
an oversight that thwarts root-cause resolution.
TRACK IT!
Oh how we love our tracking tools! Our F/M/P (food/mood/
5 BIOINDIVIDUALITY
RULES
Genes. Microbiome. Toxic exposures. These are just some of
poop) journal allows us to step into our client’s everyday hab- the ways in which our bodies differ from one another. These
its, patterns and behaviors. After seeing thousands of clients are also reasons why what worked for you and your healing
I’m still surprised to find that what a client thinks they’re doing journey may not work for all your clients. Understanding the
is not always the same as it looks on paper. Asking them to true precepts of bioindividuality rules in practice. We don’t want
capture F/M/P details for 3–5 days, in a purely objective way, those differences to paralyze us, but instead to help inform each
allows you to go in with your detective hat and determine where stage of care. The #1 rule in a functional practice, aimed toward
there’s room for daily improvement that could make a significant root-cause resolution, is to honor the individual.
impact.
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.
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 © 2018 FUNCTIONAL NUTRITION ALLIANCE, FORMERLY REPLENISH PDX PAGE 1 OF 18
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 □□ fast food

□□ diet soda □□ gluten (wheat, rye, barley)
□□ refined sugar □□ dairy (milk, cheese, yogurt)
□□ alcohol □□ coffee
24. Are you currently on a special diet?
□□ autoimmune paleo (AIP) □□ paleo

□□ SCD/GAPS □□ blood type
□□ dairy restricted or dairy-free □□ raw
□□ vegetarian □□ refined sugar-free
□□ vegan □□ gluten-free
□□ Other (please describe)
25. What percentage of your meals are home-cooked?
□□ 10 □□ 30 □□ 50 □□ 70 □□ 90
□□ 20 □□ 40 □□ 60 □□ 80 □□ 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 □□ thin, long or narrow

□□ often float □□ small and hard
□□ difficult to pass □□ loose but not watery
□□ diarrhea □□ alternating between hard and loose
29. Bowel Movement Color
□□ medium brown □□ variable

□□ very dark or black □□ yellow, light brown
□□ greenish □□ chalky colored
□□ blood is visible □□ 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 identify any current or past conditions and add a date for when the condition appeared. In
the space below each list, please briefly describe your symptoms, chosen treatment(s), and dates.
Gastrointestinal
past now date past now date
□ □ ________ Irritable Bowel □ □ ________ Gut infections
Syndrome □ □ ________ Dysbiosis
□ □ ________ Crohn’s □ □ ________ Leaky gut
□ □ ________ Ulcertative Colitis □ □ ________ Food allergies, intolerances
□ □ ________ Gastritis or Peptic Ulcer or reactions
Disease □ □ ________ Gallstones
□ □ ________ GERD (reflux or heartburn) □ □ ________ Known absorption or
□ □ ________ Celiac Disease assimilation issues
□ □ ________ SIBO □ □ ________ Other
Please briefly describe your symptoms, chosen treatment(s) and dates:
Cardiovascular
□ □ ________ Heart attack □ □ ________ Hypertension (high blood
□ □ ________ Heart Disease pressure)
□ □ ________ Stroke □ □ ________ Rheumatic Fever
□ □ ________ Elevated cholesterol □ □ ________ Mitral Valve Prolapse
□ □ ________ Arrhythmia (irregular □ □ ________ Other

heartbeat)
Hormones/Metabolic
□ □ ________ Type 1 Diabetes (autoimmune hyperthyroid)
□ □ ________ Type 2 Diabetes □ □ ________ Endocrine problems
□ □ ________ Hypoglycemia □ □ ________ Polycystic Ovarian
□ □ ________ Metabolic Syndrome Syndrome (PCOS)
□ □ ________ Insulin Resistance or Pre- □ □ ________ Infertility

Diabetes □ □ ________ Weight gain
□ □ ________ Hypothyroidism (low □ □ ________ Weight loss
thyroid) □ □ ________ Frequent weight
□ □ ________ Hyperthyroidism fluctuations
(overactive thyroid) □ □ ________ Eating disorder
□ □ ________ Hashimoto’s (autoimmune □ □ ________ Menopause difficulties
hypothyroid)
□ □ ________ Hair loss
□ □ ________ Grave’s Disease
□ □ ________ Other
Cancer
□ □ ________ Lung Cancer □ □ ________ Prostate Cancer
□ □ ________ Breast Cancer □ □ ________ Skin Cancer (Melanoma)
□ □ ________ Colon Cancer □ □ ________ Skin Cancer (Squamous,
□ □ ________ Ovarian Cancer Basal)
□ □ ________ Other
Genital & Urinary Systems

□ □ ________ Kidney Stones □ □ ________ Interstitial Cystitis
□ □ ________ Gout □ □ ________ Frequent urinary tract
infections □ □ ________ Frequent Yeast Infections
□ □ ________ Erectile Dysfunction or □ □ ________ Other
Sexual Dysfunction
Musculoskeletal/Pain
□ □ ________ Osteoarthritis □ □ ________ Sore muscles or joints,
□ □ ________ Fibromyalgia undiagnosed
□ □ ________ Chronic Pain □ □ ________ Other
Immune/Inflammatory
□ □ ________ Chronic Fatigue □ □ ________ Environmental allergies
Syndrome □ □ ________ Multiple chemical
□ □ ________ Rheumatoid Arthritis sensitivities
□ □ ________ Lupus SLE □ □ ________ Latex allergy
□ □ ________ Raynaud’s □ □ ________ Hepatitis
□ □ ________ Psoriasis □ □ ________ Lyme (and co-infections)
□ □ ________ Mixed Connetive Tissue □ □ ________ Chronic Infections
Disease (MCTD) (Epstein-Barr, Cytomegalo
□ □ ________ Poor immune function virus, Herpes, etc.)
(frequent infections) □ □ ________ Other
□ □ ________ Food allergies
Respiratory Conditions
□ □ ________ Asthma □ □ ________ Pneumonia
□ □ ________ Chronic Sinusitis □ □ ________ Sleep Apnea
□ □ ________ Bronchitis □ □ ________ Frequent or recurrent
□ □ ________ Emphysema Colds/Flus
□ □ ________ Other
Skin Conditions
□ □ ________ Eczema □ □ ________ Acne
□ □ ________ Psoriasis □ □ ________ Skin Cancer (Melanoma)
□ □ ________ Dermatitis □ □ ________ Skin Cancer (Squamous,
□ □ ________ Hives Basal)
□ □ ________ Rash, undiagnosed □ □ ________ Other
Neurologic/Mood
□ □ ________ Depression □ □ ________ Mild Cognitive Impairment
□ □ ________ Anxiety □ □ ________ Memory problems
□ □ ________ Bipolar Disorder □ □ ________ Parkinson’s Disease
□ □ ________ Schizophrenia □ □ ________ Multiple Sclerosis
□ □ ________ Headaches □ □ ________ ALS
□ □ ________ Migraines □ □ ________ Seizures
□ □ ________ ADD/ADHD □ □ ________ Alzheimer’s
□ □ ________ Autism □ □ ________ Other
Miscellaneous
□ □ ________ Anemia □ □ ________ Sleep Apnea
□ □ ________ Chicken Pox □ □ ________ Whooping Cough
□ □ ________ German Measles □ □ ________ Tuberculosis
□ □ ________ Measles □ □ ________ Known genetic variants
□ □ ________ Mononucleosis (SNPs, polymorphisms, etc)
□ □ ________ Mumps □ □ ________ Other
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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functional

Andrea Nakayama, fnlp, msn, cnc, cne, chhc

HOW TO USE THE GUIDING PRINCIPLES OF

THREE PRINCIPLES TO POWERFULLY POSITION YOUR PRACTICE 10

Functional Nutrition 101 15

THE EMPATHY EXAM 27

There Are Keys in the Chronology 28

REFRAME NUTRITION COUPON 50

These key principles help us to fully comprehend the magnitude of our

Embracing the concepts in Functional Nutrition 101 is an invitation

functional nutrition 101 3 www.functionalnutritionlab.com

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

It was heart-breaking. Crushing. Devastating. Unbelievable. No matter

Several months later, I started to experience what I call “post-traumatic

No more would a 32-year-old man with a brain tumor, like my husband,

No more will we ignore the depression, anxiety, and fearful thoughts

functional nutrition 101 4 www.functionalnutritionlab.com

Functional Nutrition Lab is the culmination of those years and

Functional Nutrition Lab is also an education and an opportunity that

Positively changing the way we do healthcare is my life’s work and

functional nutrition 101 5 www.functionalnutritionlab.com

This is not about a formula.

The book is not written.

P.S. You’ll notice that I refer to all of us practitioners as “health coaches”

Several years ago I was attending a functional and integrative medicine

functional nutrition 101 6 www.functionalnutritionlab.com

SEVERAL WEEKS AGO I received an email from a holistic

functional nutrition 101 7 www.functionalnutritionlab.com

functional nutrition 101 8 www.functionalnutritionlab.com

functional nutrition 101 9 www.functionalnutritionlab.com

ARE YOU READY to advance your practice, have eager clients

It’s true. As holistic health professionals, we do know everything we

What we don’t know is what’s going on in there. That’s why we need to

functional nutrition 101 10 www.functionalnutritionlab.com

After some probing, tracking, and investigation, we were able to

There’s actually a book called “What’s Going On In There?” by

functional nutrition 101 11 www.functionalnutritionlab.com

In order to practice the principles of bioindividuality, you really need

I have a client named Pamela who has SIBO, or small intestinal

functional nutrition 101 12 www.functionalnutritionlab.com

functional nutrition 101 13 www.functionalnutritionlab.com

HOW TO USE THE GUIDING PRINCIPLES OF

1) the FxNA in-depth Intake Form and Intake Process (You’ll

functional nutrition 101 15 www.functionalnutritionlab.com

Remember, we’re looking at both a paradigm shift of what this realm of

Knowledge → Practice → Mastery

By now, many of us hold the realm of Functional Medicine in high

functional nutrition 101 16 www.functionalnutritionlab.com

WHILE YOU AND I likely know what “Functional Medicine”

from the Oxford Dictionaries

First, the goal is to address the underlying cause of any sign,

functional nutrition 101 17 www.functionalnutritionlab.com

Second, the practitioner engages in a system-based approach,

And third, and this may be my favorite as a nutritionist: the patient

functional nutrition 101 18 www.functionalnutritionlab.com

functional nutrition 101 19 www.functionalnutritionlab.com

I’D LIKE TO BACK UP just a bit and move toward that

Feel it in your body.

It’s a competence and confidence. It’s a success of touching people’s