Dr. Joe Tatta: Welcome back to the Healing Pain Summit. I am your host, Dr. Joe Tatta. Today, we are talking about the link between thyroid disease and chronic persistent pain. Our special guest today is Andrea Nakayama. She’s a functional nutritionist and educator who is leading thousands of clients and practitioners in a global health revolution through Replenish PDX. She helps chronically ill people chart their path toward health. She also has a school called holistic nutrition lab where she teaches health professionals a science and art of functional nutrition practice. She’s the co-producer of the Hashimoto’s Institute and is a recipient of the 2015 impact award from the national association of nutrition professionals. And you have welcome to the healing pain summit. Thank you so much. I’m so excited to be here. Great for you to be here. So excited to kind of tweeze out the link or the underlying root cause between thyroid and persistent pain. But tell us first, you know, you were not always in healthcare. Tell us how you kind of started your path toward being a healthcare practitioner.
A. Nakayama: Yeah, absolutely. I think for a lot of us, the, the road to becoming a healthcare practitioner or to being really invested in health starts with a personal or a personal family health crisis. And for me that was in April of 2000 when my husband Isamu was diagnosed with a really aggressive brain tumor at the time I was seven weeks pregnant and it was quite a journey. He was given about six months to live, not expected to see our son born and he lived about two and a half years. So we really kicked into action and I’m sure a lot of people can relate to that. When you’re faced with something like that you really kick into action, you learn everything you can. I think about it as my bootcamp in really learning about health and medicine and alternative treatments. So that was the beginning of my journey. I had a completely different career and it took some time to really realize that this was what I was supposed to be doing. And in about, uh, I don’t even know what year it was. Now I’m going to say 2010, 2011. I myself was self diagnosed with Hashimoto’s. So I have a real passion for this connection between thyroid function and chronic pain.
Dr. Joe Tatta: Excellent. So obviously as practitioners we know we learn a lot about the kind of foundation, the theory, but obviously living through something in your own body or someone who’s close to you is always a great way to learn more about, um, you know, disease and health in general. Um, so today you put years of study in and you’re already functional nutritionist. Tell us what is a functional nutritionist? Cause we hear about, you know, registered dieticians, we hear about um, nutrition professionals. What is a functional nutritionist?
A. Nakayama: Yes, absolutely. So I love this question because I think it’s really important to tease apart and we can all practice functionally no matter what our degree is. And I’m really a stand for that type of practice. So we may be familiar with the terms or the concepts of functional medicine where in theory these doctors are looking for the root cause, really addressing a whole person and uh, looking for a real partnership. One of my favorite tenants of functional medicine is that its goal is to create a therapeutic partnership between the practitioner and the patient. So I see my job in the realm of nutrition and personal lifestyle, health and medicine as really elevating the patient’s ability to be that partner. And that comes through understanding the systems approach that any sign or symptom, whether it’s anxiety or depression or bloating or pain, does not exist in a vacuum.
A. Nakayama: And we’ve become a culture that really looks to address just that symptom instead of seeing the environment, both internal, physiologically and external, that that sign or symptom exists within. So I’m really a stand for how we understand the environment in which those signs and symptoms exist, understand their interconnection, really look for the root cause. And as a nutritionist, as a functional nutritionist, I will be addressing those root causes with the nutrients, with diet, with lifestyle, and in partnership with the client or patient and perhaps their medical team. So it really is looking at things functionally and using all the tools and resources we have to make the changes that are going to have an impact.
Dr. Joe Tatta: Excellent. That’s a great description for everyone on the summit. Um, so I invited you on as the expert because you are the expert in, in thyroid and you run the Hashimoto’s Institute. You had lots of experience both in your nutrition practice as well as coaching professionals, but start to talk to us about kind of the link between thyroid problems and persistent pain that someone may experience.
A. Nakayama: Yeah, so we have to really, again, going back to this environmental, uh, con perspective, we have to really see that any symptom doesn’t exist in that vacuum. And I like to say that whenever there is a situation that is related to chronic illness and for the time being, I’m going to talk about chronic illness as related to autoimmunity. So we’re seeing more and more a bigger increase of autoimmune conditions, um, around the globe. And I like to think of those as rooted in three different places. And I call that the three legged stool. And that three legged stool is related to our genetics, which as we all know, can be turned on or off. So we may have a genetic blueprint. And then what does it mean when certain genes are expressed? And then also our gut function. So that three legged stool is our genetics, the permeability of our gut.
A. Nakayama: So everything we’ve heard about leaky gut, what is happening and how well are we digesting and absorbing our nutrients and able to utilize them at a cellular level. And then also what bacteria, what is the microbiome or bike road Bayada as they say, what’s going on in there at that level. So this is where I see the roots of more and more autoimmune chronic issues, which we’re seeing a lot of and that really sets an environment up for a lot of things to go awry. So I’ll go into that a little bit more. But to first make connections between the thyroid and chronic pain, there are more and more connections being made between, uh, the occurrence of fibromyalgia in those who have thyroid disorder. And those who have by roid disorders are about, uh, over 30% more likely to be diagnosed with fibromyalgia. So we have to look at those statistics that are coming out more and more in the research and take a look at why. But I definitely see a lot of people, in fact, my mom who has Hashimoto’s is experiencing a lot of back pain right now. So I see this a lot in the clients and customers we serve at replenish and um, just in the population in general, those who have thyroid disorders.
Dr. Joe Tatta: Hmm. Excellent. I want to thank you for that framework of the three-legged stool. I think it’s really powerful and I want to go back to that just for a quick second and not dive in too deep, but give us a, just a, you know, kind of glaze over regarding genetics because you know, we have clinicians as well as patients on the summit, um, for those who are seeking kind of their health transformation. People think that, well, I’m born with my genetics and I really can’t influence that. There’s no way I can influence that. It’s kinda in my cells. It’s kind of, you know, coded already. Talk to us about the truth behind that.
A. Nakayama: I love this topic because I think it really speaks to where we have a lot more control than we think. So even though there’s a lot lately, people are running to get their genetic coding, whether there’s a lot of, um, people want to know about their MTHFR and their COMT and they’re getting 23andme reports. And I think those are amazing. And they give us next step information when we’re at that deeper level of digging, what they’re telling us is that code and they don’t tell us whether everything is expressed or not. So we actually have the power to turn genes on or off. These are what are termed our epigenetics. It’s what’s overlying the genetics that causes them to express or not express. And our diet and our lifestyle factors have the biggest impact on this. That is what the is, uh, the epigenome is, it’s what helps these genes flick on or off. So we actually have all the power in our hands to determine what is going to express. And some of it may have come with us and already be turned on and we have the opportunity to mitigate it. And some things, even if we see them in a 23 and me, doesn’t mean they’re expressed. It doesn’t mean they’re turned on. So we don’t want to be fearful of what we find there. We want to use it as additional information to clean up our environment.
Dr. Joe Tatta: Excellent. That’s a great explanation. I think, you know, obviously like you said, people are running to get their genes tested so to speak, or their DNA tested, but really the power is in their hands as to exactly what their health can be and what their recovery can be like. So I think it’s really powerful. Thanks for sharing that. Absolutely. Let’s, let’s, you know, get back to the topic at hand, which is thyroid. What do you see as the root cause or the root link between thyroid disease and chronic pain? So I just do have to stipulate that the majority of thyroid disease is autoimmune immune.
A. Nakayama: So the percentages, people are gonna argue over this, but it’s anywhere between 95 and 98% of a hypothyroidism is Hashimoto’s, which is autoimmune hypothyroidism, which means we have the presence of antibodies which are attacking the South. So we really have to understand first and foremost what is happening with the thyroid. And I think that’s really key. And this is a lot of what we do in the Hashimoto’s Institute. And I do in my training and girl’s guide to Hashimoto’s, we need to understand, people need to know what is going on with my thyroid because that will determine or help shape the treatment. So if it is autoimmune, we go back to that three legged stool. So we have to think about the fact that genes can be turned on in a certain environment and an environment that’s inflammatory in any way as part of that environment and what’s happening with the gut.
A. Nakayama: So what is happening in terms of how we actually break down and process the foods we eat actually even beyond the food, how are we processing things at the digestive level, at the liver level. So this is where we really can look at this scope of the interconnection. And the two places where I see a deep connection between thyroid disorder and pain are in a situation where there’s inflammation and we can talk a little bit more about that. And in situations where there are metabolic issues, so when there are thyroid issues, there are metabolic issues, but we are likely looking at other endocrine imbalances in the face of that thyroid imbalance as well. So understanding what’s going on with blood sugar and the adrenals and the sex hormones. So it really is looking at different environments. Uh, at replenish, we look at these as like different arms or pedals because we look at them in a whole context with each other. So we can begin to address the whole, and maybe we want to back up and talk a little bit more about inflammation as a, I’m sure you’re talking a lot about inflammation in the summit, but that’s really where we want to start thinking about the connection between the pain and the thyroid.
Dr. Joe Tatta: Excellent. So let’s, let’s talk about inflammation. But before we do that, in addition to pain, what are the most common symptoms that someone with thyroid disease will begin to experience? Cause obviously pain is, you know, pain is, it can occupy your mind. So that becomes kind of like the first thing. Just get me out of pain. I have a life to lead, you know, I want to start moving. I’ve got kids getting out of pain. But what are the other symptoms?
A. Nakayama: Yeah, we’re definitely looking at brain fog, weight gain, um, fatigue. Those are huge ones. Anxiety, there’s a lot because of the inflammation is affecting multiple systems in the body. It can affect your brain function, it can affect your weight gain. So that’s going to really be where people are feeling the most, uh, the most acute symptoms that are disturbing them. For me, it was really subtle, so I noticed I was eating really, really well. It was after my husband had died, but you know, I had gone through quite a lot of stress while my hormones were changing and stresses a huge instigator of inflammation. So of course I was in a stressful environment managing it. Like I do. I’m somebody who can balance a lot, but it had taken a toll on my body. So it took years and I couldn’t understand why my pants were getting tighter on my body.
A. Nakayama: It was pretty subtle. If I went to anybody, they wouldn’t have said there was an issue, but I knew there was something niggling going on that wasn’t getting better. And this is often true for people with thyroid disorder. It may not be that their labs show that there’s something wrong, but they know there’s something wrong. They’re seeking and searching for an answer. And so that becomes a preoccupation. And I would say a symptom as well, like trust, trying to trust yourself in the face of everybody telling you it all looks fine, whether it’s because of the labs or because things aren’t getting that bad or be with your symptoms that they can see or because they’re looking at you and saying, you know, Oh, it’s just because you’re aging. You know, it’s just because you’re getting older. So I would also include in the symptoms that niggling that something just isn’t right with everybody telling you otherwise.
Dr. Joe Tatta: Excellent. So always be on the search. So there’s always a way you can find a practitioner who can help support you in your path toward health basically. Absolutely.
A. Nakayama: And trust your gut, you know, if it’s telling you something and you need to have some answers and at least work with somebody. Again, going back to those partnerships that you can trust is helping you get to the roots or uncover if there is anything going on. So you really need to create a therapeutic partnership and you have the right to at the same time, I like to advise that people try to really work on a relationship instead of practitioner shopping. Um, so you know, find the people and Joe, you’re doing a great job of introducing everybody to different practitioners so that you can find the people who are going to support you the most.
Dr. Joe Tatta: Excellent. Thank you for that. So let’s get to the root cause of inflammation and thyroid. Talk to us about some strategies people can take to quiet the inflammation in their body.
A. Nakayama: Absolutely. So you know, we’ve, when we think about that, all those pedals and those interconnections, we do need to think about what are the root cause of those myopathies. So any disease of the skeletal muscle, and that again is going to come back primarily when the thyroid is concerned to inflammation and to metabolic disorders. And when we’re talking about inflammation, especially with thyroid and Hashimoto’s, we’re looking at a situation where the white blood cells are essentially attacking self with Hashimoto’s. They’re attacking the thyroid. Autoimmune conditions don’t typically exist in a vacuum. And when the immune system is overactive, it is likely attacking other tissue in your body as well. So it may be attacking that skeletal muscle tissue. It may be attacking nerve tissue that sending signals to your brain that are, uh, exciting the pain or exacerbating your sensation of the pain. So we need to then go inside and say, why is there inflammation?
A. Nakayama: So for me, that always starts with what I call clearing the muddy waters, which means taking out the foods that are most inflammatory. And there are some foods that are just going to be inflammatory that we know are inflammatory. I’m going to list the top three, gluten, dairy and sugar, refined sugar, those are inflammatory. So we start there and then there are next step foods that may be inflammatory for you. You in particular. So we do a little bit of digging to figure out what is your immune system having a response to. And that response is a cleanup response. Inflammation is actually a thing that your body is doing to get rid of something that looks like a foreigner in your bloodstream, in your system. So for some reason something that is good out in the world may be appearing as bad in your, your particular body and the way that your immune system has been trained. So we start there and simultaneously we do inner repair. So I like to really look at repairing the entire digestive system. We say from top to bottom. So we’re looking at everything from how we think about food and how it’s processed mechanically and chemically all the way down to what we leave behind in the toilet bowl. So we can really start to assess how do we create a better relationship between our food and our physiology. And that’s really a first step in taming the overexcited immune system.
Dr. Joe Tatta: Wonderful. So three great take-homes. So take out gluten, take out sugar and take dairy out of your diet and see if it decreases your pain and inflammation. So three powerful take-homes that people can apply right now to their life. So let’s talk about one food that may be or may not be inflammatory and a little bit controversial with thyroid, which is soy. So where do you sit on the M team? As far as soil goes, I
A. Nakayama: am a stand for bio individuality. So I don’t, there are certain things that I am going to take off the table. Gluten, refined sugar. There’s enough studies that show that they’re inflammatory. When it comes to soy, I’m going to be discriminatory, so I like soy that’s less processed if we’re going to eat it. So any fermented soy like Tempe or miso, I’ll draw the line at tofu and anything like soy milk or anything that’s more processed because it is getting, it’s getting more processed and as soon as we get into processing our foods, we’re into a whole other ball game in terms of how we process our foods internally. It just confuses the whole system and you know GMO soy, there’s issues there. So as long as we’re working with organic, non GMO, GMO, uh TemPay and NISO and tamari, which is gluten free, even non GMO soy lecithin, which is very high and Coleen very important for brain health. Those I am in favor of as long as the individual doesn’t have a soy allergy or sensitivity. If they do, then I’m not including those for myself. Those that I just mentioned are foods that I can eat periodically with success, but that’s not true of everybody. In fact, I mentioned my mom, she cannot tolerate soy, she has all sort of colitis, she will have immediate symptoms with soy. It’s out of the picture. So again, I think that we have to get really particular you need to find what works for you.
Dr. Joe Tatta: Right. And you mentioned frequency, you know the frequency of what we’re eating actually. So for instance, if you are vegan or vegetarian, you may be eating soy three times a day. That may be reacting different than if just have a story, let’s say once a week,
A. Nakayama: right? Once a week. I don’t even have it that often. You know for me, if it comes in like once a month, fine, I can get other forms of miso, I may use tamari or you know, coconut aminos is something different that I can use there to, to vary it up. But yes, I think frequency is a huge issue because if it does have a little bit of excitability in the immune system and we eat it on occasion, the immune system can calm down and not be in a constant inflamed state. And this is where, I’ll just give a quick example, Joe. For me, if I eat eggs every day, which you know, I think are a beautiful food, eggs are a perfect food. If I eat them, I start to experience joint pain. I can feel it in my hands and in my wrist and I’m typing a lot and at my computer writing and I start to feel something that’s not okay.
A. Nakayama: If I eat an egg in something, you know, on occasion my body can handle it and I have to decide what other factors are causing inflammation and do I want to add the egg into the picture if I’m traveling, which is stressful for me. If I’m during a launch, I’m not going to eat that food even on occasion that is a little bit more inflammatory because it’s like a bucket and my bucket is near full. So I have to manage that. If I’m in a more relaxed time, then I can play around a little bit.
Dr. Joe Tatta: Excellent. Thank you for sharing your personal, um, food sensitivities with us. Um, so as a functional medicine practitioner, you obviously talk a lot about nutrition, but obviously exercise and movement is part of one of the tools that you talk to your clients about. So it can be really tough. I mean, upwards of 75% of Americans don’t have any kind of regular exercise program. How do you start to talk about exercise and movement with your clients and you know, patients healing from thyroid?
A. Nakayama: Well, I really like to look at the, what I call the, you know, the kind of the core of what we need to be doing. So our core strategies and one of the top ones, they’re core basics basically is what I call them. And one is exercise and movement. And we have to match that to the individual. So again, a lot of times people think they should be doing a certain kind of exercise. We see a lot of people with metabolic disorders, adrenal issues, thyroid issues that are trying to do CrossFit because it worked for them before or because it worked for their friend or their cousin or their sister to lose weight. And in fact they’re actually exacerbating the problem. So I think we have to look at where somebody is, what they’re doing and where they’re coming. You know, what they’re coming to us for, and then try to match the exercise that we’re recommending to what their goal is usually in their journey to healing. So it’s part of the conversation. It’s definitely one of the core basics and we have to think about what’s relaxing, what’s therapeutic and what’s also giving them what they need in the process.
Dr. Joe Tatta: Hmm. That’s powerful because I think as we know that, you know, nutrition can be prescriptive, movements should be prescriptive as well, depending on where you are with your current health state. Um, so tell us, you’ve overcome thyroid disease. What is your weekly movement?
A. Nakayama: Uh, this is like one of my dirty little secrets. No, you’re asking me, like I told about my food. I actually Jazzercise perfect. And the reason I Jazzercise is cause I used to dance quite a bit and I don’t get to go to dance classes like I used to there in the evening. And um, I have now a 14 year old. I want to be home with him. So I, I find something that works for me. And just like you’re saying in terms of the therapeutics, I also think we have to find something to do that we love to do. That’s where exercise really comes into play. So I love to walk and I love to dance. So for me I always have to confess that I Jazzercise. Excellent.
Dr. Joe Tatta: I’m glad it brings you some joy. Cause sometimes people look at exercise as a chore, but when you find something that not only keeps you healthy but you enjoy doing it, that’s kind of the secret sauce. Yeah. Let’s get back to the nutrition for a couple of minutes. Talk to us about the nutrients that someone may be lacking or may need in their diet. Who is overcoming thyroid issues? And I know there can be a lot of them, but maybe the top one or two.
A. Nakayama: Yeah, we definitely want to think about, um, selenium is key for how we utilize and transform our thyroid hormones and zinc. Those are going to be the two that I’m going to, if I can just pick two. But I do have a gift and a handout that shows where the different nutrients are necessary in the process of thyroid hormone conversion so that everybody can take a look at that. But selenium and zinc and we can get those from food sources. And if you do get this handout, I will be sharing with you as well what foods you can look to to obtain those key nutrients that we need. As Joe said, there are a lot of them, but selenium and zinc are really important through different areas of the chemical process.
Dr. Joe Tatta: Excellent. So I’ve been talking with Andrea and Nakiyama. She’s a functional nutritionist. Her practice is, we plan is Replenish PDX. Um, she also has an online training program for clinicians called holistic nutrition. So please tell us what you’re up to in the near future where people can find you.
A. Nakayama: Yeah. So I’d love for you to get that little handout. It’s our thyroid diagram and you can go to replenish pdx.com forward slash healing to get that diagram. And I actually have a Hashimoto’s program coming up in the near future. If you get that diagram, you will be notified of that program. This is really sharing the tools that I use so that you can start to manage your Hashimoto’s or your thyroid disorders and understand what the roots are and where the connections come from and what it really means to get back into the driver’s seat and work with the team of practitioners. You have to make a difference in your life.
Dr. Joe Tatta: Excellent. So just share this one more time, that website so they can go to it and check it out.
A. Nakayama: Yeah. If you go to replenish pdx.com forward slash healing, you’ll get my thyroid diagram and I promise I’ll let you know more about the nutrients that are related to those or the foods that are related to those nutrients and tell you all about the girl’s guide to Hashimoto’s program.
Dr. Tatta: Excellent. So I want to thank Andrea Nakayama for being with some healing pain summit and connecting the dots between thyroid disease and chronic persistent pain. Check her website out, and we will see you on the next episode of the Healing Pain Summit.
