In this episode of The Dr. Hedberg Show, I interviewed Andrea Nakayama in a discussion about strategies for healing Hashimoto's disease.  We talked about her "3 Tiers to Epigenetic Mastery" and how they relate to Hashimoto's disease and thyroid health.  Within the 3 tiers we discussed stress, gut health, infections, micronutrient deficiencies, adverse childhood experiences, SIBO, reproductive hormones, goitrogens, iodine, and all the various diets that people are following these days.

Andrea is a clinician but also a Hashimoto's patient so it was a real pleasure to get her insight and expertise on healing Hashimoto's disease.

Dr. Hedberg: Well, welcome everyone to "The Dr. Hedberg Show." This is Dr. Hedberg and I'm really looking forward to my conversation today with Andrea Nakayama. And she actually had me on her show, "The 15-minute Matrix," talking about infections and Hashimoto's disease. And she's extremely knowledgeable. She knows a lot about thyroid issues and Hashimoto's, which we're gonna get into today. So Andrea, welcome to the show.

Andrea: Thank you so much, Dr. Hedberg. I'm so pleased to be here.

Dr. Hedberg: So for the people who don't know that much about you, why don't you just give everyone a little bit about your background and what you're working on these days in functional medicine?

Andrea: Yeah, thanks for asking. I'm a functional-medicine nutritionist, and I've created a curriculum for practitioners where I train into the theories of a functional-nutrition approach, both the science and the art of working in what I consider to be the gap in functional-medicine or holistic-medicine approaches. So I have a school called Functional Nutrition Lab. We have about 4,000 graduates in over 65 countries at this point. And we also have a virtual clinic where we work with patients directly and serve, again, the underserved population. I think of the people we serve as the big bigs. They have big health issues and they've already made a big effort, sometimes working with the top doctors around the country. So that's the work that I do that I feel really passionate about. And I myself, I'm a patient. I have Hashimoto's. I have had quite a life journey that led me to uncovering my own autoimmune disease. And I manage it so that I can live the best life possible.

Dr. Hedberg: Let's jump into the what you call the three tiers of epigenetic mastery. And so, this is a kind of a system or approach to healing and functional medicine. So can you walk everyone through this approach that you've created?

Andrea: Yeah, absolutely. I definitely see, like I said, that there is a gap in functional medicine. And I am completely in service to the functional medicine model. I really believe that we have to see the person as a whole. We have to look at the roots. We have to work in therapeutic partnership. And we have to see through systems, a systems-based approach, both biological systems and understanding the web of interconnections, but also a systematic approach that allows us to work with those who are sick and not getting better. So if we honor the truth of bio individuality and see every single individual as unique in their own way, not just a diagnosis like Hashimoto's or like I experienced with my husband having a brain tumor, you know, he was treated like a brain tumor, if we're to see each individual and each patient as unique, we still need a systematic approach. Otherwise, we're constantly in the dark looking for solutions.

And that's why I created the three tiers to epigenetic mastery. I saw it as a way to teach into honoring the individuality of each patient. So the three tiers are, tier one, what I call the non-negotiables. Tier two, deficiency to sufficiency. And tier three, dismantling the dysfunction. And what I see in functional medicine is that we often go to the tier three approach. We often want to skip to the sexy infection or the thing that's happening in the body that may be one of the roots. And yet, there is so much terrain surrounding that root. There's the soil that we also need to address. So these are those three tiers. And we could look at them, in particular to Hashimoto's, and think through that lens. I also just wanna say that the three tiers are not necessarily linear. They are things that need to be addressed all at the same time. So it might not be that we're bypassing one to just look at one of the others.

Dr. Hedberg: Yeah, you bring up a good point about going after what might be on the surface. When I launched "The Infection Connection" in around 2010, 2011, I've gotten so many emails from practitioners who, you know, went through the training and learned how to treat infections like Epstein-Barr virus. And I'll get an email saying, you know, "I've been treating the Epstein-Barr and, you know, it's still positive and they're still not doing well." And then, I asked them, "Well, you know, what else are you really working on?" Because, I mean, you can go in and you can attack the virus and suppress it but if you're not really addressing the reasons why it's active in the first place, then you're not really going to get anywhere.

Andrea: Exactly, exactly. And we have to think about these three tiers again as the soil in which that root exists. And I think one of the mistakes that we're making in functional medicine is that there's so much focus on the root cause that patients are now seeing it as the quick fix. "If I get this test done, if I find the root and address that root, everything will be better." And they're not necessarily seeing that in a state of chronic stress or with certain deficiencies at stake, that it is very difficult to address that root, that it might not work. It might not actually be a quick fix. And I think that, again, is one of the mistakes that we're making.

Dr. Hedberg: Yes, let's build on that a little bit. I'm glad you're here to talk about this. And I had Chris Kresser on the show a few months ago and we talked a little bit about this as well because I have concerns about functional medicine. Sometimes it feels kind of like the Wild West. And, you know, you and I both train clinicians in functional medicine. And one of the issues is that you can take a patient with, say, Hashimoto's disease, and they can go to...let's just say you send them to 10 completely different functional medicine practitioners, you know. They could be people who are highly-seasoned, you know, well-trained, and you're still going to get variation in how the patient is approached. Even within functional medicine, there's gonna be preferences on certain labs that don't really make sense other than the practitioner just says, "Well, this is what I feel the most comfortable with." Or, you know, the supplements are gonna be highly variable and the types and the doses and the frequency. The diet will be variable.

I mean, you know, the patient with Hashimoto's, they could go to 10 practitioners and there's not going to be 10 identical diets for that particular patient. You know, one practitioner might be, you know, on the keto train or autoimmune paleo, or vegan. I mean, we have difficulty with some kind of standardization and I can see why conventional medicine can be very skeptical of what we do. So how do you see that whole issue and how do we move forward in the right way with developing some kind of consistency across practitioners?

Andrea: Yeah. I mean, I think scope is very very important. And I like to say I train the allied functional medicine practitioner. And the truth is that there isn't one diet for any individual no matter what their condition. Let's say, we're talking about brain tumors and we know the research shows that a ketogenic diet can be beneficial in this situation. If that brain tumor patient is in the midst of going through treatment, chemotherapy, radiation, surgical intervention, it might not be the right time for a ketogenic diet. We cannot just look at situations in relation to a diet. And this is, again, where I think the allied functional medicine practitioner comes in to really assess who is this patient, where are they. And diet is not just a handout. We really need to understand what is this person capable of in their life and what is the necessary intervention right now, and where is it tiered.

So somebody getting a handout or being sent to a blog post or a Pinterest page with autoimmune paleo may not be appropriate for them given the other stressors in their life. And this is, again, where I see the need for a practitioner who can work with the reality that that individual is in, and not just say, "This is the right diet. This is the right test." I like to say all information that we gather from the patient is true but partial. And that's why, in our practices, we do very very deep assessment. And that assessment includes what I like to call the story where we look at the antecedents, triggers, and mediators. The soup, where we look at the biological function, and the skill, where is this patient right now and what are the necessary next steps that will take them on this journey towards healing as opposed to saying that there is a quick fix.

So we need to, through a tier-one approach, those non-negotiables, those are gonna be individualized. And I think that is how we honor the practice of functional medicine. We say that we are looking at the whole person and that it's an individualized approach and all information is true but partial. And the best partner on the case is the patient. And it's our job to educate the patient to be their best partner as opposed to us sitting in the seat that we're the god or the goddess with all the answers.

Dr. Hedberg: Right, right. So, as you said in the beginning, you're a patient as well and you have Hashimoto's. So why don't we dig into that a little bit because a lot of the listeners have Hashimoto's. And so, where,