Beyond Calorie and Carb Counting: Functional Nutrition for PCOS [Podcast]
“We are not what we eat. We are what our bodies can do with what we eat.” – Andrea Nakayama
Every person has unique biology and must be treated as such. Andrea Nakayama is a rock star in the field of functional nutrition. She teaches thousands of practitioners and patients a year how to use the principles of functional nutrition to personalize diet and healthcare and heal with sustainable results. In this podcast, Andrea explains functional nutrition, its benefits, and how you can get started.
Mentioned in this podcast: Functional Nutrition Alliance’s Matrix
All PCOS Diva podcasts are available on
Andrea Nakayama is a functional nutritionist and educator leading thousands of clients, students, and practitioners around the world in a revolution reclaiming ownership over one’s own health. In the curriculum of Functional Nutrition Lab, her online school for practitioners, Andrea teaches the science and art of the functional nutrition practice through the lens of where food meets physiology.
Within her own clinic, Andrea and her team of nutritionists work with the chronic ailments most providers pass over, and she is regularly consulted as the nutrition expert for the toughest clinical cases in the practices of world-renowned doctors.
Amy: So, I always talk about how knowledge is power when it comes to PCOS and women with PCOS really need to be Divas and to advocate for themselves. But we often really need to have that background information in order to do so. So, today, we’re going to talk, delve into the world of functional nutrition. I know many of you may have visited a dietitian before and the dietitian has you counting carbohydrates and calories and that’s really the approach to managing your diet with PCOS.
Well, if you’ve never explored the world of functional nutrition, you are in for a real treat because that really takes the dietitian approach and just blows it out tenfold. It’s really a fascinating way to approach your health. I am thrilled to have the rock star functional nutritionist in the world, Andrea Nakayama. She’s a superstar in the world of functional medicine. She’s a functional nutritionist who helps chronically ill people get better when no one else can.
Her clinical skills have won her the attention of many world renowned doctors who consult with her on their own difficult cases. More than that, Andrea trains thousands of practitioners every year in how to have the clinical success that she’s had. She is the CEO and founder of Functional Nutritional Alliance and Functional Nutrition Lab and she’s training an army of change makers in the field of healthcare. So, I’m so thrilled that you could join us, Andrea.
Andrea Nakayama: Thank you so much, Amy. I’m really touched to hear you speak about my work. Thank you.
Amy: Gosh. Well, I’ve been following you for a long, long time. Ever since you had a feature in Whole Living Magazine, which I don’t even think is around anymore. Maybe you could share with our listeners how you came into this field of functional nutrition. I know you have a really personal story behind it.
Andrea Nakayama: Yeah. Thanks for asking that too. I think we all have really personal stories that lead us to our quests to become Divas, as you like to say. So, for me, it really dates back to April of 2000 when my husband, Isamu, was diagnosed with a very aggressive brain tumor. At the time, I was just seven weeks pregnant. So, we were actually telling family and friends that we had a brain tumor before we were telling them that we were pregnant. That started the course of a drastic change, as you can imagine, in my life.
He was given six months to live. He wasn’t expected to see our baby born. He actually lived two and a half years. So, he died when our son was 19 months old. That son is now 17 years old. So, it was a huge change for me. I already was a foodie, very interested in my own health, but we recognized that we had to do everything, to look under every rock to think about his cancer differently than the standard model was thinking about it and that started me on a journey to redefine my own self after he passed away.
Amy: I can’t even imagine going through that. I have three kids and being a mom without my husband, gosh, I don’t know how you did it. But from that place of looking under every rock, I would imagine that looking at the health illness differently from this functional medicine, getting to the root cause of illness. I’m sure that really shaped what you do with Functional Nutrition Lab.
Andrea Nakayama: Absolutely. I didn’t have a name for it at the time. What I was experiencing was very emotional. I was experiencing my soulmate being given a death sentence and treated like a dead man walking. So, he was treated like his diagnosis. So, the kind of, he had a grade 4 aggressive brain tumor. You walk into any office and even when we would go to the hospital midwives, they’d be whispering in the hall because it’s like the worst case scenario in terms of cancer. Most people don’t live past six months.
So, I watched this man who was my rock being treated like a dead man, like he was already gone. That didn’t work for me. So, I didn’t know what it was called at the time and I didn’t know what we were doing. But I was an emotional response where I was basically saying what’s being offered to us doesn’t work and this isn’t okay. No more. No more should people be treated like their diagnosis because everybody’s different.
Amy: Yeah. I think that women with PCOS, although we don’t have cancer, it’s not an acutely life threatening illness or syndrome, but I can definitely resonate with that feeling that the mainstream medical doesn’t have all that much to offer us except giving us a pill, Metformin, or the birth control pill and telling us to go on a low carb diet.
I think what’s so refreshing about your approach is you’re looking at the entire person, really mind, body, spirit, as well as what’s going on in your body from a biochemical point of view as well. Before we dive into your protocol, I would love it if we could back up a little bit and you could explain to those who have never really heard the term functional nutrition or functional medicine and explain that to us.
Andrea Nakayama: Yeah. I would love to. What you just said is so important because we actually don’t work with people with cancer all that much in our clinic. We’re working with people with chronic health conditions. I myself have Hashimoto’s. So, I get it. Whether it’s a cancer diagnosis or some chronic condition or syndrome that we’re suffering from, we still do not deserve to be treated like our diagnosis. No two people are alike for reasons that we’ll explore.
Since my husband’s diagnosis, the whole realm of precision medicine has really come into play where we’re recognizing that just because a cancer exists in an area of the body doesn’t mean it reacts the same in everybody. So, two people with breast cancers may have different genes that make those cancers react differently. That is true for all of us in the chronic arena as well. So, when we’re looking at the realm of functional medicine, there are three tenets that I think are really important to understand.
One is that the patient and the practitioner are working in a therapeutic partnership. When we hear that, we often celebrate the doctor stepping forward and being a partner. What you do so beautifully, Amy, is you actually elevate the standing of the patient to be that partner. So, being a Diva doesn’t mean walking in with your hands on your hips and being resentful of what the doctor has to offer you. It means standing up and acting for yourself. So, for me, that therapeutic partnership is key.
Another tenet, the second tenet is that we work in systems. So, we have a systems based approach that’s both considering biological systems, so how is the gut connected to the brain, connected to your hormones, connected to your liver? How do we understand what’s going on in the individual’s body and how we have an approach that leads us through the process of getting there, because there won’t be a quick fix. There will be no pill or protocol that does the same thing for everybody.
The third tenet is that we look for the roots, meaning we’re understanding why. Why did this syndrome, why did these signs and symptoms develop instead of just masking the signs and the symptoms? So, we’re looking for sustainable results.
So, those are tenets of functional medicine that I think are really key and yet we are still placing too much pressure on the doctor to know all the answers. The truth is we need to be Divas. We need to own our own everyday processes and what it is that we do to support ourselves and how we educate ourselves. That is the role of functional nutrition where we’re looking at diet and lifestyle modification through those tenets. We’re understanding the physiology. We’re doing what I call backing it up to look at those roots. Why did this happen for you?
So, it’s the work you do on your own. But a lot of people need another practitioner to look through a different clinical lens to help understand what is this diet? What is this practice? What is your lack of sleep? What is your constipation? What is that stress at your job? How is that impacting your physiological function, meaning your biology, that’s manifesting in those signs, the symptoms, or the diagnosis?
So, I like to, if we visualize this, think of a pyramid where the functional medicine doc may be at the tip, at the very top of the pyramid or triangle and they know that diet and lifestyle modification matters. The patient, all of us, is at the bottom in the weeds trying to navigate, “My doctor told me to eat low carb. I’m supposed to take this supplement. That supplement actually makes me dizzy. This is actually putting stress on me, to weigh my calories.”
The functional nutritionist exists in that middle place to say, “Wait a minute. This isn’t working for you because,” and really educate the patient and sometimes, as in our case in our clinic, work in conjunction with the physician on the case to bring things forward that the doctor can’t possibly see because they’re not in your everyday, they’re not in your diet and lifestyle, and we really can’t ask them to be. It’s out of scope.
Amy: Yeah, and I think too doctors have such a short amount of time with you in the office, 10, 20 minutes, that they can’t possibly even get to the tip of the iceberg on a subject like this to coaching you on lifestyle and dietary changes. That’s where functional nutritionists, health coach really comes into play.
Andrea Nakayama: Absolutely. It’s so important and oftentimes, the doctors can’t see the nitty gritty, they can’t be in it, and let’s face it. As you and I know, Amy, diet and lifestyle modification is more than a handout. We all have a lot of issues around our diet, around our lifestyle changes, things we’re attached to. That takes some work and some massaging and understanding what’s unique to you that’s actually going to move the dial forward.
So, it’s a hidden world, functional nutrition. It’s so important, and yet I feel like we’re often just looking for the doctor who’s going to be the one that’s going to give us all the answers and fix it all. That’s a condition of our culture where we’ve come to rely on the quick fix all too often.
Amy: Yeah. I often say that for PCOS, there really is no magic pill. In fact, you are the magic pill.
Andrea Nakayama: Yes.
Amy: It’s the work that you do on yourself and I’m really excited for you to share some more information, especially about your functional nutrition matrix because I think this gives you the tools for your toolbox in order to be the magic pill.
Andrea Nakayama: Yes. Yeah. So, let’s talk about the matrix. The matrix I’ve designed, and everybody can take a look at what I’m talking about with the functional nutrition matrix by going to fxnutrition.com/matrix. M-A-T-R-I-X. So, it’s fx, which is often the shortcut for functional, nutrition.com/matrix. There you’ll see the functional nutrition matrix, which I’ve modeled after the functional medicine matrix designed by the Institute of Functional Medicine.
So, I like this matrix because it allows us to break down the information in a way that we as patients and as clinicians can understand. It’s divided, as you can see, into three areas: the area in the left column, the central area, and the area in the right column. The way I talk about those is the left column is the story, the center area where you see the starburst is the soup, and the right column is the skill. So, story, soup, and skill. When you’re going to different doctors, they tend to focus in either one of these.
In psychology, they may look at the story. In the medical profession, they may look at the soup, which I’ll define. In health coaching, they may look at the skill. In functional nutrition, what we’re having to do is put them all together. Go ahead, Amy.
Amy: Oh, yeah, I was just going to say I think we find that doctors and healthcare professionals with PCOS treat all of these symptoms. Just looking at this, you might have IBS and so you go to a gastroenterologist or you’re having immune issues like Hashimoto’s or you’re dealing with stress and anxiety and depression. You’re going to all these different practitioners that are just treating these symptoms. This allows you to see the big picture.
Andrea Nakayama: Exactly. So, instead of thinking through the ology lens, gastroenterology, psychology, immunology, we’re putting it all together and saying how are all these things connected to each other? So, we spend a lot of time in the story arena and that actually has a whole other area that we go into called the functional nutrition timeline. You can see there are words there that might not make sense to you. But I’m going to break them down for you.
So, antecedents are basically your genes or your history and as you shared with me, Amy, most women with PCOS have a mother who also had PCOS. So, that means it’s in your genes. That’s like what did your mother experience? Was there diabetes in your family? Do you have an MTHFR polymorphism or some other polymorphism like a COMT or something that impairs your blood sugar management? So, what are your antecedents, just meaning what came before you?
Your antecedents are also how were you born, what was that birth like, what was your time in utero? What was going on? If we think back to my story, I could think about my son’s antecedents being the fact that I was seven weeks pregnant with him when my husband was diagnosed with a brain tumor. That’s going to be an antecedent for him. Hasn’t played out, knock on wood, in any negative way to date, but it’s an antecedent.
A trigger are the things in your life, and I invite you to think about this and maybe even write them down, print out this matrix, are the big things that happened in your life, the big stressors. So, those stressors could be a divorce. They could be your parents’ divorce. They could be going to grad school and having to work at the same time. They could be food poisoning. They’re the things that really pop out for you in your life that were big occurrences that are all stressors. A car accident. What were those things? Again, we have a whole timeline where we map this all out and spend a lot of time there with patients.
Then your mediators are the things that you know help you feel better or worse. The mediators are your gold. This is where you become a Diva. This is where you really are knowing for yourself what works and what doesn’t and where do I need help figuring that out? So, for me, getting to bed by 10:00, that’s a positive mediator. If I push that, I’m going to be risking how I feel every day. I cannot eat certain foods like gluten or cow dairy or eggs. I know what the symptoms are.
What are the negative mediators? Where does stress fit into my life? So, mediators are where you start to take ownership. So, again, antecedents are your genetics, triggers are the things that happened in your life that are unique to you. The person sitting next to you with PCOS had different triggers in her life. The mediators are also unique to you and those are the things that you need to help you feel better or that you recognize make you feel worse. The mediators go right over to that skills area on the other side of the page so that you start to identify what are the things that help me to feel better? Not that I’m being told to do, but that are for me? So, that’s the story and that’s a huge piece that’s missing in allopathic care.
Amy: Yeah, and I want to stress what you said about these are empowered choices that you’re making for yourself. It’s not because somebody told you to do it. I think that is such a key shift. When you start realizing that, say, gluten and dairy make you feel logy and brain fog and you can make that empowered choice and that becomes a mediator for you, it’s very different from somebody telling you you can’t have X, Y, or Z food.
Andrea Nakayama: Yeah. It’s empowering and it’s also, there’s a whole different ownership involved there. I remember when my husband was sick and my son was still just a little baby and my parents were flying into watch him every so often while we were going back and forth to treatments. My dad came to me and said, Gilbert, my son, really wants this food because I told him he can’t have it and he got upset. I’m like, “Because you told him he can’t have it. If you just said we don’t eat that, he would be fine with it.”
It’s all in the story you tell yourself too of you own your mediators and say if I drink that glass of wine, this is the risk reward I’m taking. This is what it means for me. That’s a different ownership. You are making a decision. The reward of drinking the wine is this. The risk is this. What am I willing to do? What’s the risk reward for me vs. I can’t have that? Which, I don’t know, if you tell me I can’t do something, I’m going to put my hands on my hips and tell you I can.
So, all in the way we frame it and identifying mediators for me is the most empowering thing we can do. But it’s about understanding them for you based on your story, your soup, and the skills that you uniquely are able to put in place for yourself. It’s not dictated. It’s what’s your reality? How much are you traveling? All those things come into play.
Amy: It’s so eye-opening, I think, to have this all on one sheet of paper. So, I really encourage people to download it and maybe even start filling it out. I think my experience, now I’m 46 years old. As you get older, I think you get a little wiser. I do think that sometimes we overthink getting from point A to point B. If you’re feeling so ill, struggling with PCOS symptoms, how am I ever going to feel better again? But it’s making those constant, consistent positive changes. So, I don’t know how you’d frame that, like following your mediators. I’m not sure, but yeah.
Andrea Nakayama: Yeah. I call it keep moving.
Amy: Keep moving. Yeah.
Andrea Nakayama: So, I always say that the road from A to B is never a straight line. So, if you draw on a piece of paper right now and A on the left side and a B on the right side and a dotted line between the two, it’s never going to look like that straight line. It’s going to go up and down and up and down and we’re going to see that certain things work for us and certain things don’t. They may not work because the condition isn’t ripe to receive them. They may not work because it’s not the right nutrient or dietary approach for you. That’s all the work that has to be done unfortunately. That’s all the work that we have to do for ourselves.
It’s really interesting to me that we have a challenge in our society doing the work that leads to optimal health when we recognize practices of yoga or enlightenment or finding the right brand of jeans that fit your body. We go and we try things on and we go, “Well, that doesn’t work. Well, that’s too tight around the waist. Well, that’s too high waisted. Well, I can’t wear that low rise.” We do that process, we try things on.
But when it comes to our health, we just want to walk into the store and have the jeans fit beautifully and make sure that they’re the perfect ones and walk out and it really only took trying on that one pair and man. I’m fine. I look hot. Right? So, there’s a process involved in health and healing and giving you a system and an approach allows you the confidence that you are continuing to move forward. I do know this now for myself. This works, this doesn’t.
Amy: So, I’d love for you to talk about the mind, spirit, emotions, community part. That’s something that I talk a lot about. Being a PCOS Diva, you really need to nurture that spirit, mind, body, spirit connection and really pay attention to your emotions. I love seeing that here. But in your practice in working with clients and patients, how does that move the needle for, I’m going to say women.
Andrea Nakayama: Yeah. Yeah. So, I think if we look at that center part, that starburst part of the matrix that I call the soup, the reason it’s a soup is because all the ingredients need to be there for everything to come together and work to function, which is why we’re calling it functional, right? We want the body to function. Each node in there is related. It’s a web of interactions. So, the GI function, the gastrointestinal function is going to impact the immune. It’s going to impact detoxification. It’s going to impact the hormones.
The mind, spirit, emotions, and community piece is a piece, that’s an ingredient in this soup. So, if we are not tending to that part of ourselves, if we feel isolated, if we feel wronged, whatever it is that we’re going through, unseen, not heard, it is going to impact all those other parts of our biology and all those signs and symptoms we have are going to be impacted. So, for me, it’s a key component, as key as detoxification or the recognition that we have insulin issues or the immune and inflammatory. It’s a key component, but it doesn’t stand alone.
So, when we’re looking at the matrix, the way I train practitioners to look at this is your bucketing, for you as a patient, you could bucket any of your symptoms that might go in any of these areas. Structural integrity, if you’ve ever had an accident or fallen, you note that down there. GI function, anything you’ve had that’s gastrointestinal, anything you’ve had that’s a symptom of constipation or diarrhea or bloating or indigestion, right?
As you move through and around in all the nodes in that central arena, you do take some time to look at the ones that are either overpopulated or underpopulated. So, when we look at a matrix and we see, wow, I have a lot in the gastrointestinal, immune, and hormone arenas, but I don’t have anything listed in mind, spirit, emotions, and community, that’s someplace we have to stop, take a breath, and go, “Am I being fed? Am I getting the nutrients I need in this part of my life?”
Amy: So, how would one prioritize? So, looking at your matrix, I’m sure women can almost check off everything. I have gastrointestinal issues, I’ve got hormone, I know I need to detox. Where do you start?
Andrea Nakayama: From a nutrition perspective, I always start in the gastrointestinal arena because we are not what we eat. We are what our bodies can do with what we eat, which is why the approach we were talking about earlier, Amy, with a dietician and just saying eat low carb, it really doesn’t matter what the dietary theory is. It matters what your body can do with those nutrients you’re putting in. So, we see people who are eating what looks like the best diet ever, but they’re actually still malnourished and that’s because their body can’t actually utilize the nutrients.
So, we have to focus on GI function and this is where the role of a functional nutritionist would really come into play because it’s going to be hard for an individual to figure out on their own, not just am I eating the right diet, but wait a minute, am I getting all that where I’m buying organic, I’m eating all this good food, but am I actually utilizing those nutrients that are going to help me heal? That’s a clinical perspective that the doctor might not tend to and that might be hard to see on your own. Does that make sense?
Amy: Yeah, absolutely. I think that’s where the individual comes into play too. I think what’s so frustrating, I think, for so many women is they’re on PCOS Facebook groups or message boards and women are talking about the success they’re having on the keto diet. So, they try the keto diet and they gain weight and they’re thinking, “What’s wrong with me? Why is this not working for me when it’s working for everybody else?” Or then they try to become a vegan because on someone else’s board, they say this is the answer for women with PCOS.
Andrea Nakayama: Yeah, and this is the culture right now. It’s very much focused on dietary theory.
Amy: Mm-hmm (affirmative).
Andrea Nakayama: So, this is the culture right now. We’re very much focused on dietary theory because it too looks like the quick fix. We’re saying, “Okay, that one pill didn’t work alone. Let me now try this diet that’s working for everybody or that’s in the most popular book. How about bone broth? Everybody’s talking about bone broth. Let me just get on whatever wagon is right.” But there’s actually conditions in the body that, if we look at the soup from a clinical lens, don’t do well with high fat diets, with the collagen in bone broth. But how do you know that when the prescription that’s out there is this diet works?
Again, like you said, that’s where bio-individuality really comes into play because those things don’t always work. They don’t work for everybody and the reason they don’t work for everybody has to do with your internal biology, what’s going on in your body. If we don’t take time to focus on that, we miss the opportunity for healing.
Amy: So, if somebody wants to really dial into this, how do they go about finding somebody to work with?
Andrea Nakayama: Well, the first thing I want to posit, and I do have a gift for everybody, which is basically how to master your genes. It’s the three tier approach of how to master your genes. That will give people our protocol, which has three tiers to it that include the non-negotiables, deficiency to sufficiency, and dismantling the dysfunction. Before I go on, Amy, I just want to say that when we talk about the mind, body, spirit, that can be a deficiency, a true deficiency as much as protein can be a deficiency or folate or vitamin D or these other things that we might learn about.
Tending to your mind and your spirit and community, that can be a deficiency that does have an impact as much as those other things. So, when we think about non-negotiables and deficiencies, which is where I really see the role of functional nutrition, we have to think about it from every area. So, I just wanted to posit that. But once people get that asset, you can learn about our clinic at the Functional Nutrition Alliance.
I’ll make sure you know about that once you get that download, which you can get at fxnutrition.com/pcos. Then we also train practitioners. So, if you want to see someone in person, because we’re a virtual clinic, you can always reach out to us and we can see if we can help you find somebody in your area as well.
Amy: Yeah. Your website is a really great resource too for wonderful blog articles and information if people want to dive deeper. You also have some really great recipes.
Andrea Nakayama: Thank you.
Amy: So, just a lot of information at your website and we will post that in the show notes, as well as the matrix and the free resource that you just mentioned too, Andrea. I have been asking my podcast guests in the past, and I need to get back to this, about leaving us with a message of hope for women listening with PCOS. I was wondering, I don’t meant to put you on the spot, Andrea, but would you mind giving us a little message of hope?
Andrea Nakayama: Yes. I think when we sit with what’s coming up for us, even if it’s grief, and we can sit in that place of grief, grief because of a diagnosis or a way we have to change our life or give up a food or change the way we do things, when we can sit with that and honor it and really feel it and transcend through it, that’s where we become empowered. That’s where we become the Divas. I get it. I’ve had to do a lot of this work in my life. But sitting and learning the lessons that life is bringing to us, as painful as it could be, is such a huge gift and does blossom into the hope we need to see our way forward.
Amy: Yeah. I love that. In my own personal story, really, my PCOS diagnosis was a wake-up call. Then it really became this springboard for growth, personal growth, for sure. So, I love that insight and thank you for sharing that with us and all of your fantastic information about functional nutrition.
Andrea Nakayama: Thank you so much, Amy. I’m so pleased to be here with you and your community. I’m such a fan of your work and the message of really being a Diva in your own healthcare. It’s a powerful one. So, thank you.
Amy: Oh, gosh. I’m so happy you joined us, Andrea, and I thank everybody for taking the time to listen today.
I love what I do Erika! It blesses me too 🙂