I’ve been reading fiction about old ladies lately.

Not by accident.

I made a deliberate decision to sit in proximity to full lives—lives lived in all their glory and suffering—before I get there myself. To accustom myself to the territory, the way you’d prepare for a climate you’re about to move into, or a mountain you’re readying to climb. To recognize myself in these women. And to remember my privilege: most of them lived through harrowing times with far less than I’ve had.

The books I’ve chosen have old women at their center. Or women who become old women by the final page. Or women whose stories end there entirely, and inevitably.

I have a whole lineup.

The pull is stronger than my explanation for it. But this isn’t the first time I’ve read my way toward something I didn’t yet have words for.

The Year We Ran Out of Narrative

From early 2025 through February 2026, I led The Long View—a longevity book club I designed around a single animating question: what does it actually mean to age well? Twenty books. Twenty-three sessions. A community of women reading and exploring together for a full year.

The research showed up. The biology, the epigenetics, the evidence. The data on sleep and movement and what connection does to mortality. Balance and bacteria. Muscles and memory. Germs and gums. The cells and the supplements, the science and the sales—all vying for our anti-aging attention and obsession.

But somewhere around session seven, many of us stopped asking: How do we extend life?

And started asking: What are we extending life toward?

The books shifted. The conversation shifted with them.

Joseph Coughlin, who directs the MIT AgeLab and was one of our authors that year, put it plainly: after about age sixty-five, we run out of narrative.

The world is built for a default adult—younger, faster, more legible to the systems that made it. Older adults, especially older women, find themselves living inside a story that was never written for them. It’s not because they’ve stopped mattering, but because nobody thought to picture the future with them in it. That’s Coughlin’s thesis, and it landed hard for me.

We are not building the future we want to age into.

We haven’t designed it, funded it, or legislated it.

But the more uncomfortable truth—the one that keeps working on me—is that we haven’t imagined it.

We don’t have the stories to spark our imaginations. And without the stories, we don’t know what to build, what to tend, or how to care.

The scholar Margaret Morganroth Gullette calls this being aged by culture. The body changes, sure. But so does the script the culture is willing to write for the body that changes. The script for older women has been thin for a long time. We’ve polished the rearview mirror to find the unwrinkled skin, the body we should have appreciated when we had it, the flux of hormones that kept us supple and agreeable and still bleeding. The road ahead, we have not looked at.

A Thousand Miles Away

The longevity economy—the anti-aging creams, the supplement stacks, the age reversal protocols, the tests that measure your decline to the decimal—has a clear strategy.

It keeps us facing backward—lamenting the food we ate in our twenties, the habits we should have started earlier, the damage we might still reverse—because a woman mourning the body she used to have is a far better customer than one curious about the body she’s becoming. There are few products for the future. What does exist—the walker, the alert button—arrive wrapped in apology, or get sold as the punchline. There’s an entire industry built on grief for the past, and almost nothing that meets the future without flinching. As it’s sold, optimization is a project aimed at the life we’ve already lived—not the one we’re actively aging into.

My husband Isamu died at thirty-four. July 2002. He didn’t get to become old. He didn’t get the decades that are the subject of my current fascination—the accumulation, the gravity, the long view. The future was taken from him in a way that was not optional and was not fair.

I am now aging for two.

That’s not a burden I carry with the same grief I once did. It’s more like a clarifying weight. A reason to take seriously the years I’ve been given that he was not. Ikigai, as they say in Japanese—a reason to get out of bed in the morning, a reason for being. A reason to look forward rather than back. To ask not just how long, but toward what and why—and whether the world I’m aging into is one I’ve helped to nurture, or one that I’ve simply inherited and accepted as unappealing and inconsequential.

My mother is living those decades. She’s eighty-seven. She lives in San Diego. I live in Portland. The distance between us is a thousand miles up or down the coast, depending on your vantage point, and a phone call.

My year in The Long View changed how I pay attention to her. Not in the logistics-of-care sense—though that’s always quietly calculated as I listen to her aches and pains, review her lab work, and help her weigh next steps—but in a different register entirely. I started watching more carefully. Listening for what her life is actually like from the inside. What she has access to. What has become harder without becoming impossible. Where the world fits or meets her and where it doesn’t. Which stories bubble up and which fade to the background. And where my own mindset about aging—and about being an aging adult with an aging parent—needs to shift.

She is living the future I’m aging into, largely without a map. Because the map was never drawn—and the only people who could draw it are the ones already out there. The travelers. We keep building the conversation about age without asking the aged.

Back to the Books

Which brings me back to the books.

The Correspondent by Virginia Evans. Honey in the Wound by Jiyoung Han. The Red Address Book by Sofia Lundberg. Violetta by Isabel Allende.

Each one different. Each one asking me to sit with a life I haven’t lived and find something familiar in it anyway. None of them offer protocols. What they offer is more rare: the texture of a full life, seen from inside it. The accumulation of decades. The gravity of grief and stubbornness and grace that arrives in a woman who has been paying attention for eighty or so years.

This isn’t about doing more, or doing it better. We’ve been handed a version of aging that treats the body as a problem to manage—something to monitor, correct, amend against its own unfolding. But attention isn’t the same as intervention. Caring for ourselves doesn’t have to mean living in constant critique of the body’s own changing.

The pull is to look back—to fixate on the stages already trodden, to grasp for what once was. But more and more I find I want to look ahead. I have more books on my list to help me do that.

So here’s what I’m wondering: is anyone else reading this way? Choosing stories that put you in proximity to the lives you’re aging toward rather than the ones you’ve already lived?

I’m not announcing a book club. I’ve done that—a whole year of it—and I may do it again someday. But first I’m curious. I’m planting a seed and watching what grows.

If you’re reading something that fits—an old woman at the center, a full life on the page, an ending that doesn’t look away—tell me in the comments. I’m building the list, and I’d rather build it with you. And if part of you wants more than a list—to read some of these alongside each other and talk about what they stir up—please do say so. I’m listening for whether the appetite is there.

Because what I’m really after is this: to read and write my way into a future that’s richer, stranger, and more fully human than the one we’re being handed.

That’s the book I’m looking for. Maybe you’re looking for it too.

Further reading:

Joseph Coughlin’s The Longevity Economy: Inside the World’s Fastest Growing, Most Misunderstood Market (PublicAffairs, 2017) is the book we read in The Long View. He directs the MIT AgeLab.

Margaret Morganroth Gullette’s Aged by Culture (University of Chicago Press, 2004) is the foundational work; her more recent Ending Ageism, or How Not to Shoot Old People (Rutgers University Press, 2017) extends the position.

The novels referenced in this piece:

Virginia Evans, The Correspondent.

Jiyoung Han, Honey in the Wound.

Sofia Lundberg, The Red Address Book.

Isabel Allende, Violetta.

For two decades, I trained practitioners in functional nutrition. Thousands of them, across dozens of countries, learning to work with patients that the conventional system couldn’t fully see. And the question that kept surfacing—from them, from their patients, from anyone trying to make sense of what this kind of care actually was—came down to the same thing.

What makes what you do different?

It’s a harder question than it sounds. The labels available to us—functional, integrative, holistic, lifestyle, root-cause—each point at something real, and each falls short in a different way. I spent years watching practitioners reach for one term or another and feel the gap between the word and what they were actually doing with the person in front of them. Or the gap between the word and what their audience understood.

And I watched something else happen too, something harder to name. Some of those same practitioners—trained explicitly to hold complexity, to resist the reduction of the single-cause explanation, to stay with the person rather than the protocol—slipped, over time, back toward the answer economy. Not out of bad faith. Under pressure, even if they didn’t always recognize it as pressure. The people they were serving had been shaped by the same marketplace we’re all swimming in, and those people wanted answers. Wanted clarity. Wanted the one thing. And the practitioners who gave it to them—who packaged their nuance into a protocol, who translated their complexity into a supplement stack—tended to grow faster, reach further, earn more.

The market rewards resolution. It always does. What it cannot reward is the harder, slower work that actually delivers it.

My own answer to what makes this work different, refined over time, comes down to a single word. What we are practicing—when we resist the pull of the answer economy—is pluralism.

And I mean something specific by that word—something older than the contemporary vocabulary may suggest, and something that language has largely obscured.

Before we go further, I want to explain my use of the word pluralism. And I want to say first that while I’ve spent two decades inside clinical practice and education, this piece isn’t for practitioners. It’s for the people practitioners serve—you, me, the woman who has seen four providers and left each appointment with a different answer. The one who is scrolling at midnight, trying to make sense of what her body is doing. The one who suspects that the problem isn’t actually her, and isn’t any individual practitioner, but something larger, more insidious, and more difficult to identify. If that’s you, this is what I’ve been wanting to say: the mismatch you’re feeling between what you’re looking for and what you keep finding isn’t a personal failure. It’s an institutional one. It has a history. And once you can see the history, you can start asking different questions—of the system, of your practitioners, and of yourself.

Today, some would call what I’m pointing at integrative medicine. Andrew Weil and others have done meaningful work to bring that term into the mainstream conversation. But integrative medicine, as it has developed institutionally, has tended to mean biomedicine selectively adding complementary modalities to its repertoire. Acupuncture in the cancer center. Mindfulness in the cardiology practice. Nutrition counseling alongside the pharmacology.

That’s real progress. I applaud it. But it’s not quite what I mean.

When I say pluralism, I mean the clinical methodology of holding multiple legitimate frameworks for understanding a body simultaneously—biological, biographical, social, spiritual—without collapsing them into a single explanation. Medical anthropologists have documented this as the actual empirical reality of how most of the world’s people have engaged with healing across most of human history. It’s what was displaced from American medicine in the consolidation I’m about to describe. It’s what generations of women practitioners had been doing without needing a contemporary brand name to market or validate it. And it’s what I’ve spent the last two decades training practitioners to relearn.

The clearest way I know to show you what pluralism is, what its displacement cost, and why it matters now, is through a single night, in a single life.

What the Chart Couldn’t Hold

I was thirty-three years old, seven weeks pregnant, holding a plastic bag with my thirty-one-year-old husband Isamu’s shoes in it, at three o’clock in the morning.

Within hours of arriving at UCSF’s emergency room, medicine had done what medicine does well. It found a mass in Isamu’s brain. Within weeks, brain mapping, a craniotomy, and a pathology had named it—glioblastoma multiforme, a grade IV primary brain tumor, as aggressive as brain cancer gets. It assembled the team: neurosurgery, neuro-oncology, radiation. It outlined the protocol and followed it. When we arrived in that emergency room on that Saturday night, what we needed was what we got—a scan, some immediate relief for the headache that led us there, and a next-step plan.

The chart told one story. Other important things—our life, the pregnancy, the man inside the diagnosis, the wife being sent home alone with her husband’s shoes in the middle of the night, the lives being reconfigured in real time—had no category in the chart. Medicine wasn’t being careless. It was doing precisely what it was built to do, with the acuity the moment required. But what I began to realize, standing in that corridor, was that the medical frame had edges. That what lived beyond those edges was real. And that no one in that building had a form for it, because that was never the form they were given.

I’ve spent the decades since asking why. Why did medicine leave so much behind? How did we get here? And how is it shaping what’s happening to us now—to me, to other patients, to the woman reading this who is making yet another midnight decision about her body without quite knowing who to trust?

What I’ve come to understand is that the absence wasn’t accidental. It was structural. And it began nearly a century before that Saturday night in 2000.

What the Frame Was Built For

In 1910, the educator Abraham Flexner published a report on American medical education that would reshape who got to call themselves a doctor in this country—and, by extension, who got to be cared for, and how. With Carnegie Foundation backing, it closed the schools that didn’t meet his standard, elevated laboratory-based, disease-focused, mechanistic training as the singular model for what a doctor should be, and drew a hard line between what it called scientific medicine and everything else.

Flexner did real work. He also did costly work—costly to a particular set of practitioners who had been doing the everyday tending of bodies in this country for a long time, and who were now on the wrong side of an accreditation line. For most of the prior century, most Americans had received their everyday care from a wide range of healers—homeopaths, herbalists, midwives, eclectics, naturopaths, osteopaths—each with their own training, their own reasoning, their own relationship to the body in front of them. In much of rural America, in immigrant communities, in Black communities, and in the ordinary lives of women caring for women, the midwife or the herbalist wasn’t an alternative to conventional medicine. She was the only care available.

The displacement that followed didn’t happen by accident. It had specific mechanisms, specific targets, and specific consequences that are still shaping the care you receive—and don’t receive—today.

The full piece traces that history—who was displaced, what was lost, why it matters to the woman navigating the healthcare landscape right now, and what pluralism actually looks like as a practice rather than a wellness buzzword. All sources and references are there.

Continue reading here: https://www.andreanakayama.com/resources/the-answer-economy-a-pause-before-you-accept-the-next-solution-served

I know this is complicated territory.

Whatever brought you here—curiosity, concern, your own complicated relationship with what medicine recommends and what you’ve learned to question—I won’t ask you to set that aside. I’ve spent twenty years in functional medicine learning to take seriously what people carry into the room. That includes the history that makes a recommendation feel different depending on who’s making it, when, and why.

So I’ll tell you where I’m standing before I tell you what I’ve been researching.

I got the first dose of the Shingrix vaccine on a Friday just a few weeks ago. By Saturday I had a pulsing headache behind my right eye, intense enough that I stood in a parking lot and wondered whether I’d be able to drive home. I spent the rest of the day in bed. My Oura ring showed elevated autonomic stress for days. It wasn’t the kind of stress that comes from a debate or a deadline, but the behind-the-scenes kind that registers in your heart rate variability when your body is doing significant work without telling you about it.

I was hungrier than usual. Tired in a way that wasn’t explained by my schedule.

I knew what was happening. I’d done the research. I understand the work of the immune system. And I had a specific reason for finally making the decision that led me to the Safeway pharmacy for the shot that bruised my left arm.

My 87-year-old mother reminded me of the rest of it just this week.

What My Mother Told Me

I was just three years old. My sister Lori had gotten chickenpox first—mildly, the way some children do, the way the textbooks describe it, the way my son endured it twenty years ago. I caught it from Lori. But what happened next was something else entirely.

The blisters weren’t just on the surface of my skin. My parents were told there were blisters on my internal organs. My fever spiked. My eyes swelled. I lay in my orange and yellow bedroom—the one with the paper dolls and the books I couldn’t read because my eyes were too swollen—burning from the inside. My parents were beside themselves with worry. The doctor, a man named Dr. Borovsky whom I came to know like he was my uncle, went to light candles at a church with the nurses that worked in his office. They prayed for me while my parents drove me from New Jersey across state lines to Columbia Presbyterian in New York to see a specialist. There were tests. There was fear of Reye Syndrome, a rare disorder that damages many parts of the body, especially the brain and the liver. There was a baby aspirin given for the fever—later found to be contraindicated in exactly this situation.

I remember none of it.

Lori had chickenpox mildly and moved on. I had it severely and did not.

Chickenpox occupies an interesting place in the cultural memory of those of us born before about 1990. For a generation, it was a normal childhood rite of passage—chickenpox parties, deliberate exposure, the assumption that getting it once and being done was the right strategy. The varicella vaccine arrived in 1995, and the social narrative around chickenpox shifted within a generation. Children born after about 1998 mostly do not get it. Their parents (like me) did.

My mother, when I called her this week, kept returning to the same phrase. The chickenpox, she said, was the beginning of it all. Meaning my sickness. Meaning the body that would become difficult to understand, that would require a decade of investigation, repeat hospitalizations, fear, and my parents’ decision not to have more children. It would, eventually, make my career in functional medicine make sense—because, for reasons including but not limited to this childhood experience, I needed to understand what conventional medicine often fails to explain.

My mother has been holding that sentence for nearly sixty years. The beginning of it all. As if the body sends up a flare at the moments worth remembering—and then keeps the record quietly, whether we do or not.

It turns out she may have been right in ways she didn’t have language for.

What the Virus Doesn’t Do

Here is what the research is now making clear about the varicella zoster virus (VZV)—the virus that causes chickenpox.

It doesn’t leave.

After the rash clears and the fever breaks and the child recovers enough to go back to school, the virus retreats into the sensory neurons alongside the spinal cord and the cranial nerves. It establishes what we now understand as latency. It’s held there, silently, by VZV-specific T-cell immunity—the immune surveillance that runs continuously, without your awareness, for the rest of your life.

For most people, this works. The virus stays dormant. Decades pass.

But as we age, that T-cell mediated immunity naturally declines. The virus doesn’t disappear. It just faces weaker opposition. And the people contending with the steepest decline relative to their viral burden are those of us born before the 1995 vaccine—the ones carrying wild-type VZV from a childhood chickenpox infection.

Here’s something most people don’t know: before childhood vaccination became widespread, adults who’d already had chickenpox were regularly re-exposed to it. At school pickup. At family gatherings. From a neighbor’s kid with spots. That re-exposure didn’t usually give us chickenpox again—our immune systems recognized the virus and neutralized it. But in doing so, they quietly refreshed our VZV-specific T-cell immunity. We were getting passive immune top-ups throughout our adult lives without knowing it, and those top-ups kept the latent virus in our nervous systems more thoroughly suppressed.

When childhood vaccination arrived and chickenpox largely disappeared from circulation, that ambient boosting disappeared too. Adults who carry the wild-type virus stopped receiving those regular immune reminders. The latent virus faces progressively weaker opposition. This may be part of why shingles rates have risen in the decades since childhood vaccination became standard—a relationship known as the exogenous boosting hypothesis, still debated in the scientific literature. The vaccine that protected a generation of children may have quietly removed a protection the previous generation didn’t know they’d been receiving.

This dynamic was documented well enough that it delayed childhood chickenpox vaccination policy in the United Kingdom and several other countries, where public health bodies weighed the benefit to children against the cost to adults losing their natural immune reinforcement. It’s not a fringe concern, it’s a significant population-level trade-off that plays out quietly, over decades, inside individual nervous systems.

At some point—for about one in three people—the balance tips. The virus reactivates. It travels down the nerve to the skin and produces shingles: the rash, the burning, the nerve pain that can last for months or years after the blisters clear. In some cases the virus reactivates not in the skin but in the facial nerve—a condition called Ramsay Hunt syndrome, which can cause facial paralysis, vertigo, and hearing loss, and is frequently misdiagnosed as Bell’s palsy because it’s rare enough that many clinicians don’t immediately recognize it.

That much, most people know.

And when you bring up shingles, almost everyone has a story. Their own, or a partner’s, a friend’s, a parent’s—the shingles episode that wasn’t just a rash. The pain that didn’t end when the blisters did. The months of postherpetic neuralgia. The friend who hasn’t slept right in two years. For me, the story that lingers involves my maternal grandmother—my Grandma Betty. The grandma that gave me hope, confidence, and frozen chocolate chip cookies. Her shingles kept coming back. The last episode landed her in the hospital, where she had the stroke that took her life.

I was eighteen. I was just starting college. I lost the person who believed in me most. And it was the first death I can remember registering as grief and loss and longing.

What the research about shingles published in the last eighteen months has added is a bit hard to absorb. I spent the past year reading over twenty books on longevity and following the evidence as it emerged. The shingles vaccine kept showing up. It isn’t necessarily a longevity headline, but it is a finding that crosses disciplines. Cardiologists are noting it. Neurologists are noting it. The biological aging researchers are noting it. By the time I sat down to write this piece, I had read enough to know it wasn’t a single signal in a single dataset.

Here’s some of what I found:

• A 2025 analysis of health records from over 100 million Americans found a consistent relationship between VZV reactivation and dementia—across nearly 400 measured variables.

• Recurrent shingles episodes carried higher dementia risk than a single episode, suggesting the cumulative burden of the virus’s activity matters, not just its visible announcements.

• A January 2026 study examined shingles vaccination across seven domains of biological aging—inflammation, immune function, cardiovascular health, neurodegeneration, epigenetic aging—and found that vaccinated individuals showed measurably slower aging across multiple domains, with effects persisting four or more years post-vaccination.

• Four independent meta-analyses, the largest pooling data from 21 studies and over 104 million participants, have found approximately a 24% reduced risk of any dementia and a 47% reduced risk of Alzheimer’s specifically among those vaccinated against shingles.

The most methodologically rigorous study used a natural experiment in Wales, where the shingles vaccine was offered free through the NHS—but only to those born on or after September 2, 1933. Those born even days before that date were ineligible for life. The program wasn’t mandatory, but because eligibility was determined by exact date of birth rather than personal choice, the people just old enough to qualify and the people just too old to qualify were, in every meaningful way for these purposes, identical—same health histories, same socioeconomic circumstances, same proximity to care.

The only difference between them was an accident of birthdate.

Because of that, the standard objection to vaccine research largely dissolves. That objection is reasonable and has followed the field for decades: people who choose to vaccinate may have different viewpoints on health, better access to care, more regular contact with their doctors—or diverge from non-vaccinators in the many smaller ways that accumulate into any health decision. Any of those differences, not the vaccine itself, could explain better outcomes. But when eligibility is an accident of birthdate, those differences disappear. The person born one week after the cutoff and the person born one week before it are not different kinds of people. They simply live on opposite sides of a line drawn by a policy date. That’s about as close to proof as population-level vaccine research gets.

The result showed a roughly 20% reduction in new dementia diagnoses over seven years among those who were eligible.

And the results are not limited to that one study. They’ve been replicated in Wales, as well as in England, Australia, New Zealand, Canada, and multiple US health record databases, by independent research groups, using different methods. And it keeps pointing in the same direction: that vaccinating against shingles appears to reduce the risk of dementia, and possibly the broader trajectory of biological aging, in ways that the field is still working to fully explain.

What this means, practically, is that the virus my three-year-old body received from my sister in that New Jersey suburban house—the virus that drove my parents to Columbia Presbyterian, that led to candle lighting in a church, that my mother has described for nearly sixty years as the beginning of it all—has been in my nervous system ever since. It’s been held there by immune surveillance that has kept it dormant, mostly, while also, possibly, doing things we are only beginning to measure. And the evidence now suggests that what I do about that virus—at fifty-nine, with an active clinical frame of mind and decades of research capacity and an Oura ring—has potential implications for what happens to my brain and my biology over the next thirty years.

What Moves a Decision Like This

I want to recognize something candidly before I go further: Shingrix produces real side effects.

First, a note on what Shingrix actually is: It’s the second-generation shingles vaccine, approved by the FDA in 2017. It replaced an older vaccine called Zostavax that has now been discontinued in the US. Shingrix is non-live and uses an adjuvant called AS01B to drive a stronger T-cell response—the same arm of immunity that holds the virus dormant. That stronger response is why it appears to work better than its predecessor. It’s also why people feel it.

In clinical trials, 17% of recipients had at least one Grade 3 reaction—severe enough to prevent normal everyday activity. For people with autoimmune conditions—rheumatoid arthritis, MS, Crohn’s, or Hashimoto’s, like myself—there are legitimate questions the clinical trials have not fully answered, because those populations were largely excluded from the studies. There is a small but documented increased risk of Guillain-Barré Syndrome (another autoimmune condition affecting the peripheral nerves and muscles) in adults sixty-five and older within 42 days post-vaccination, acknowledged on the vaccine manufacturer’s label. Women tend to report stronger reactions than men. (Though who knows if that’s due to biological reaction or to women being more likely to report what they feel.)

For me, these aren’t reasons to dismiss the vaccine. They are reasons to make an informed decision with someone who knows your full picture, and not to hand that decision to an algorithm or a blanket prescription of what should or should not be done.

Shingles is also not communicable in the way most diseases we vaccinate against are. You cannot give shingles to anyone. A person with active shingles can, through direct contact with the rash, transmit the virus to someone who has never had chickenpox or been vaccinated against it—in which case that person develops chickenpox, not shingles—but the reactivation that becomes shingles in your nervous system stays your reactivation. The virus that has been latent in your dorsal root ganglia since childhood, waking up now, is your virus.

Unlike the childhood varicella vaccine, whose use shifts patterns of exposure across the population, the biological risk Shingrix reduces lands on the person who takes it. The potential benefit lands on the same person. The side effects, the same. That makes the Shingrix decision different from decisions about vaccines where my choice has implications for the people around me—where what one person does affects what another person catches.

The immediate biological calculus is mostly interior. The risk it reduces is mine. The benefit, mine. The side effects, mine. Which is exactly the kind of decision that belongs to the person inside the body, made by or with the help of someone who knows it well.

But interior doesn’t mean uninfluenced.

The selective vaccinator among us is not making a decision like this on biomedical evidence alone. We’re making it inside a cultural moment that has its own complicated history, where institutional trust has been fractured in ways that are sometimes justified and sometimes not, where the line between skepticism and misinformation has become genuinely difficult to locate. I would never suggest that your hesitation is uninformed. But I do want to share what I found when I went looking, and what it meant against the backdrop of my own body’s long relationship with this particular virus, so that the thinking, when and if you do it, is your own—and richer for the company.

The research on Shingrix is, by the standards of preventive medicine, unusually strong. The Wales natural experiment is the kind of evidence we rarely get. The replication in Canada makes it harder to dismiss. Four meta-analyses across more than 100 million people pointing in the same direction is not a signal to ignore because it comes from a cultural moment we’ve learned to distrust.

But evidence alone is not what moves people. What moves people is understanding what’s at stake in their specific body. Mine has been carrying this virus since I was three years old, since the blisters went internal, since my parents drove me to New York in fear and my sister was already fine.

My mother called it the beginning of it all.

My grandmother’s shingles was closer to the end.

I am trying, at fifty-nine, to keep it from claiming the middle.

It is making me wonder, though.

My mother held that one sentence about my childhood for nearly sixty years, and the body that received it has been holding the virus for just as long. The term for what was happening inside me—viral latency—did not exist in the room when I was three. Not quite. A British general practitioner named Robert Hope-Simpson was formulating it in 1965, working from sixteen years of careful observation of 3,500 patients in a rural practice in England. He proposed that following chickenpox, the virus becomes latent in the sensory ganglia, where it can be reactivated from time to time.

I was born in 1966—a year after Hope-Simpson published his hypothesis. I got sick in 1969.

The concept of viral latency as it applies to VZV was being written into the medical record in essentially the same moment my body was writing the virus into its memory. Neither my mother nor Dr. Borovsky, lighting candles at a church while my parents drove me to Columbia Presbyterian, had access to it yet. The confirmation that Hope-Simpson’s hypothesis of viral latency was correct didn’t arrive until 1983. We now know that T-cell immunity is what holds the virus dormant—the immune system’s long memory, the quiet surveillance that keeps the latent virus from stirring. That particular understanding developed through the 1980s and 1990s, the decade in which we lost my grandmother. The dementia connection is only from the last eighteen months.

The keep thinking about what else I have filed away as resolved.

Not as a wound, or as trauma. Just as: that happened, and then it ended, and then we moved on. The cystic acne that appeared in moments of extreme change and pressure. The car accidents I walked away from. The pregnancy that didn’t continue. The grief that I metabolized, I told myself, in the appropriate amount of time.

My mother said it was the beginning of it all and meant my sickness. And she was right about that.

But I’m starting to think that she was expressing more than she realized. That what we name as beginnings are sometimes just the moments where the body started keeping a record nobody asked it to keep and that didn’t make it into the chart. But the body has been keeping every record of every one of those moments ever since, faithfully, without request or permission, waiting for someone to finally pay attention.

What in your body is still holding what you decided was over?

Sources and further reading

On VZV latency and the therapeutic vaccine framing Laing et al., “Immunobiology of Varicella-Zoster Virus Infection,” critical appraisal of Shingrix mechanism, PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC5557227/ Shingrix as therapeutic (not prophylactic) vaccine, Human Vaccines & Immunotherapeutics. https://pmc.ncbi.nlm.nih.gov/articles/PMC11959904/

On the lost natural booster (exogenous boosting) On the exogenous boosting hypothesis and shingles incidence, Vaccine. https://www.sciencedirect.com/science/article/abs/pii/S0264410X14013760 Declining VZV circulation after 1995 and immune control, Journal of Infectious Diseases. https://academic.oup.com/jid/article/226/Supplement_4/S470/6764830

On VZV reactivation, dementia, and biological aging Polisky et al., 100-million-record analysis of VZV reactivation and dementia, Nature Medicine, October 2025. https://www.nature.com/articles/s41591-025-03972-5 Ogunjimi et al., review of VZV reactivation, stroke, and cardiovascular risk, Nature Reviews Microbiology, February 2026. https://www.nature.com/articles/s41579-026-01289-9 Kim & Crimmins, shingles vaccination and biological aging across seven domains, Journals of Gerontology Series A, January 2026. https://academic.oup.com/biomedgerontology/article/81/3/glag008/8430804

The Wales natural experiment and Canadian replication Wales date-of-birth eligibility study, Nature, October 2025. https://www.nature.com/articles/s41586-025-08800-x Canadian replication, Lancet Neurology, 2026. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00455-7/fulltext

Meta-analyses on shingles vaccination and dementia 21-study meta-analysis, 104 million participants, October 2025. https://pubmed.ncbi.nlm.nih.gov/41269248/ Marra et al. (UBC), Human Vaccines & Immunotherapeutics, August 2025. https://www.tandfonline.com/doi/full/10.1080/21645515.2025.2546741 Yin et al. (Peking University), Journal of Alzheimer’s Disease, June 2025. https://pubmed.ncbi.nlm.nih.gov/40551502/ Earlier meta-analysis, Neurology, April 2024. https://www.neurology.org/doi/10.1212/WNL.0000000000206308

On Shingrix side effects, autoimmune exclusions, and Guillain-Barré Syndrome CDC, About Shingrix. https://www.cdc.gov/shingles/vaccines/about-the-vaccine.html CDC, Shingles Vaccine Recommendations for clinicians. https://www.cdc.gov/shingles/hcp/vaccine-considerations/index.html

Further reading on selective vaccination and the cultural moment Heidi Larson, Stuck: How Vaccine Rumors Start — and Why They Don’t Go Away (Oxford University Press, 2020), on hesitation as a question of trust rather than information.

Belonging is a deeply human need. It’s more than being surrounded by others or part of a crowd. It’s about feeling seen, accepted, and understood for who we truly are. And it doesn’t always require big gestures—sometimes it’s just an unspoken understanding, care without question, a connection that quietly binds us.

For much of my life, I’ve felt like an outsider. But it wasn’t until I became a widow at 36, left to navigate life with a 19-month-old son, that I truly understood what the absence of belonging feels like—and how powerfully its presence can heal.

When Care Comes Without Asking

Within the first year after my husband Isamu’s passing, my toddler son and I drove to Seattle to spend a weekend with my cousins. They were celebrating a friend’s graduation from acupuncture school. Still in survival mode—juggling solo parenting responsibilities and not knowing how to ask for help—I arrived without expectations.

What I found surprised me: asking was unnecessary. Without words or requests, each cousin stepped in. One scooped my boy into his arms, another threw the diaper bag over his shoulder, yet another lifted the stroller. They relieved me of my usual burdens, allowing me the rare pleasure to just enjoy the moment.

My needs were anticipated before I could even articulate them. In that small, unspoken act of care, I felt deep kinship—a reminder that even in my brokenness, I was supported and loved. Included.

That moment reminded me that belonging doesn’t require grand statements—it’s in the unspoken understanding, the care without question, and the connection that binds us.

The Biology of Connection

Before exploring how belonging affects health, it’s worth noting that contemporary social psychologists are rethinking where belonging fits in our hierarchy of needs. Increasing evidence suggests belonging may be more central than originally thought—perhaps as foundational as safety itself.

Research in psychoneuroimmunology shows that emotional stress from disconnection directly impacts our physical health. When we experience isolation or exclusion, our stress response activates, leading to higher cortisol levels. This chronic activation affects digestive health, sleep, immune function, and even skin conditions.

But the science goes deeper. Steve Cole’s pioneering research in social genomics demonstrates that lack of social connection activates gene expression related to inflammation. Social isolation triggers stress-related genes, leading to increased inflammation that contributes to cardiovascular disease, diabetes, autoimmune disorders, and most chronic health conditions.

On the flip side, belonging has the opposite effect. Cole’s work shows that social connection helps regulate the body’s stress response, reducing inflammation and promoting better health. Strong social bonds reduce the activity of inflammation-related genes, helping the immune system function more effectively.

The Loneliness Epidemic

Research by social psychologist Dr. Julianne Holt-Lunstad reveals that lack of social connection is as significant a risk factor for early death as smoking 15 cigarettes a day. The absence of connection is associated with increased inflammation, lower immune function, and even shortened telomeres—protective caps on chromosomes that play a role in aging.

A 2016 study in PNAS found that social isolation increases inflammation risk to the same extent as physical inactivity during adolescence, and in older age, its effect on hypertension exceeds the impact of diabetes.

This isn’t just about having people around—it’s about the quality of connection and whether it fosters that deep sense of being seen and accepted for who we are.

Finding Belonging in Unexpected Places

More recently, I found belonging in an unexpected place: dance class. After decades away from dance, I wasn’t looking for competition or perfection. I wanted a space where I could just be, where my body could move freely without judgment.

Without saying a word, where nobody knew my name, belonging was immediately recognizable. Every session starts with a cheer for first-time attendees and a reminder to just have fun. The crowded room includes people of all shapes, sizes, colors, and identities. Collectively, we move to choreography—individual yet unified. It’s belonging without rules of initiation other than showing up.

Connection Across Differences

My friend Claire finds her deepest belonging not with people, but in the ocean:

“The first time I truly felt like I belonged, there were no people around. I was alone in the deep ocean, held by saltwater, surrounded by a pod of spinner dolphins. Far from the debilitating physical pains that kept me grounded on land, I was free. These creatures made me feel at home, alive, and welcome. None cared what I was wearing, how successful I was, or whether I was clever. I didn’t have to do anything at all. I was enough simply as I was.”

Whether through intimate friendships, creative communities, nature, or solitude—belonging takes many forms. The key is finding spaces where we can show up as ourselves without fear of judgment.

An Essential Nutrient

From a health perspective, belonging functions as an essential nutrient. When we experience genuine connection, our bodies produce lower cortisol levels, release oxytocin (the bonding hormone), and activate dopamine and endorphin production. These aren’t just feel-good responses—they support immune function, heart health, and cognitive resilience.

The Blue Zones research, despite recent debates about data accuracy, confirms one undeniable factor: deep community ties contribute to longevity. In these cultures, elders aren’t seen as burdens but as active contributors whose wisdom is valued. This sense of belonging—where people are respected and actively included—contributes to both lifespan and healthspan.

Creating Space for Connection

True healing goes beyond addressing physical dysfunction. It’s about understanding the stories we carry and the connections we make with ourselves and others. When we create space for our narratives—whether of loss, triumph, or transformation—we not only connect more deeply with others but strengthen our relationship with ourselves.

Belonging is a bridge between various realms of healing, reminding us that we don’t just survive in community—we thrive in it.

The complete exploration of belonging as medicine, including the full science behind social genomics and psychoneuroimmunology, frameworks for cultivating connection in chronic illness, and practical tools for building authentic community, is in my comprehensive essay: Read: “The Medicine in Belonging”

Some moments in life take our breath away—not because of shock or fear, but because they strike a deep chord within us. Maybe it’s the swell of music that leaves you wiping tears from your eyes, or a stranger’s act of kindness that momentarily restores your faith in humanity. Perhaps it’s seeing someone you love embraced for exactly who they are, or a faded photograph that brings a rush of memories.

As we age, these moments take on new significance. They become markers of meaning, reminders of the stories we carry and the connections that sustain us. And science tells us that these emotions are not abstract—they are embodied experiences with measurable effects on our health.

When Worry Transforms to Wonder

I recently found myself moved in an unexpected way. I was driving home from my evening dance class in the rain when my phone buzzed with an emergency notification:

Emergency SOS. Gilbert called emergency services from this approximate location. You are receiving this message because Gilbert has listed you as an emergency contact.

My heart skipped a beat. Gilbert is my 24-year-old son, living independently in New York City. My mind raced through possibilities—had there been an accident? Something worse?

I called his phone. No answer.

After reaching out to his roommate, I learned Gilbert was safely at a restaurant with friends and their visiting family. His waterlogged phone had malfunctioned, triggering the false alarm.

But as I sat in my car, relief washing over me, something profound happened. My initial worry transformed into unexpected gratitude—not just that Gilbert was safe, but for the life he’s building. He wasn’t just dining with friends; he was welcomed by a family that had chosen to embrace him as one of them.

In that moment, I felt the depth of what it means to be moved. The contrast of emotions—fear, relief, gratitude, pride—anchored me in the present moment, reminding me of the rich complexity of love and connection as our roles evolve.

More Than Just Feelings

Being moved isn’t merely a sentimental experience. It’s a robust biological process with measurable effects on our bodies and minds. When we experience emotional resonance, several powerful physiological responses occur:

Oxytocin release: Known as the “bonding hormone,” oxytocin floods our system during moments of emotional connection. It reduces cortisol levels, lowers blood pressure, and promotes relaxation. This isn’t just about feeling good—it’s about measurable health benefits that support longevity and resilience.

Parasympathetic activation: When we’re moved, our bodies shift into “rest-and-digest” mode, the biological equivalent of a deep exhale after tension. Unlike structured practices that require time and effort—like a 30-minute meditation—being moved can activate this healing state instantly.

Brain engagement: The limbic system activates during these experiences, strengthening neural pathways related to empathy and memory. These moments don’t just feel profound—they literally rewire our brains for greater connection and cognitive resilience.

Redefining Aging for Modern Women

At 58, I find myself witnessing the realities of my generation—women who are creatives, innovators, and game changers. We’ve built careers while carrying relentless demands, contributing to what I see as new crises in health: chronic stress, burnout, and skyrocketing autoimmune conditions.

This has fueled the biggest boom in the “longevity movement,” with women seeking solutions in bioidentical hormones, specialized diets, and supplements promising to balance cortisol or supercharge mitochondrial function. While these tools have their place, they often overshadow deeper work.

The question isn’t just “What can I take to live longer?” but “What can I do to live better?”

The lessons from Blue Zones—regions where people live longer, healthier lives—show us that purpose is as vital as diet or exercise. The Japanese call this ikigai, the reason to get up in the morning. In Costa Rica’s Nicoya Peninsula, plan de vida emphasizes having a life plan that provides meaning and connection.

We find ourselves most profoundly moved in moments of alignment—when purpose and connection meet. And it’s here, in the quiet resonance of meaning, that true healing begins.

The Health Benefits Are Real

Research reveals that being moved impacts multiple aspects of health:

Physical: Emotional resonance lowers cortisol, reduces blood pressure, and supports immune function. These shifts help prevent disease and even slow cellular aging by reducing chronic inflammation.

Mental: These experiences decrease anxiety and depression while building resilience, especially during times of uncertainty or change.

Social: Being moved strengthens relationships and reminds us that our stories are part of a greater, interwoven narrative of humanity.

These benefits become as important as managing blood sugar or supporting mitochondrial function. They invite us to redefine vitality—shifting focus from just maintaining physical health to nurturing our emotional, mental, and social landscapes.

Creating Space for Wonder

Being moved isn’t something we can force, but we can create space for it:

• Engage with art and nature: Watch a sunset, listen to music that stirs your soul, explore beauty around you

• Reflect on meaningful moments: Consider what experiences have touched you deeply and what they reveal about your values

• Foster connection: Spend time with people who inspire you and seek shared experiences

• Practice presence: Tune into the present moment and appreciate life’s small, meaningful joys

Living Truer, Not Longer

In our focus on extending life, we sometimes forget to deepen it. Being moved reminds us that vitality comes not only from what we consume or do, but from what we feel and experience at our core.

As you move through your day, consider: When were you last truly moved? What did it teach you about yourself? How might you create space for more of these moments?

This is how we step into aging with grace and purpose—not by chasing youth at all costs, but by living fully in each stage of life.

The complete exploration of emotional resonance as medicine, including the full science behind oxytocin and parasympathetic healing, plus frameworks for aging with meaning rather than just longevity, is in my comprehensive essay: Read: "The Healing Power of Being Moved: Stories, Science, and the Art of Aging"

When managing your health becomes a full-time job, it’s easy to feel disheartened. You may have tried the latest diet trends and supplements, hoping that each new approach will bring lasting relief. But instead, it feels like the same place, the same symptoms, like you’re balancing on a tightrope that could give way at any moment.

The restrictions are untenable. The cost is unsustainable. The uncertainty is unbearable. The exhaustion has become unrelenting.

In the search for health and healing, it’s tempting to turn towards protocols—rigid, step-by-step approaches that promise results. They’re everywhere: in social media posts, wellness blogs, handouts from well-intentioned providers, and books that guarantee the latest “how-to” guide for easing what hurts.

They offer clear instructions, promising a direct path to a better place. Just follow the yellow brick road.

But what if protocols are part of the problem?

The Seductive Promise

Protocols pledge relief but often provide only temporary fixes, addressing symptoms without tackling deeper issues. By focusing on surface-level relief, they create the illusion of progress without sustained improvement. When the sure-fire results don’t come—or we find it impossible to adhere to the plan—it can be unnerving, leaving us more frustrated than before.

Health isn’t one-size-fits-all. Protocols rarely account for individual physiology, genetics, lifestyle, or personal history. A diet that works wonders for one person may worsen symptoms for someone with a different digestive profile, hormone metabolism, or history with food access. A supplement protocol to boost energy might trigger headaches or digestive discomfort when not aligned with your body’s unique needs.

The Protocol That Hooked Me

Back in the day, the protocol that seduced me was a raw vegan diet. Finding meal ideas felt like a treasure hunt, with long hours spent flipping through obscure cookbooks. It was a corner of the web rich with community, connection, and cause. I loved the meticulous food prep, the art of combining flavors from only the freshest ingredients.

For a while, it felt incredible. At first, my body detoxed, and though it produced an unfamiliar scent, I embraced it as a sign that I was “purifying” myself. My frame slimmed down in ways that pleased me externally, yet inside, I began to feel a kind of tenderness that was hard to explain.

But then things shifted. I started gaining weight—not normal weight gain, but a layer of puffiness, an inflammation that sat like a film over my skin. That initial sensitivity grew into discomfort. When my young son hugged me, I would flinch from the pain in my breasts. Sometimes, I would lie on the couch, just trying to calm my digestive distress.

Looking back, I realize I had already been eating a whole-food pesca-vegan diet, carefully crafted for sustainable health. But with raw veganism, I’d taken things too far for my body. I was pushing my body to an extreme it didn’t need or want. That period marked a tipping point. My body was already primed for autoimmune activity, and this experiment seemed to initiate it. Eventually, years later, I received a diagnosis—Hashimoto’s.

Frameworks vs Protocols

Instead of protocols, you need frameworks—adaptable guides that respect the complexity of your health journey. A framework doesn’t tell you exactly what to do. Instead, it helps you ask the right questions, see connections, and make informed decisions.

Think of a framework as a map rather than a set of directions.

Where protocols offer rigid instructions, frameworks invite you into an ongoing, personalized conversation with yourself. They recognize that everything in your body is connected—your gut, hormones, immune system, mental health, stress levels. They acknowledge that you are unique.

A framework is tailored to you. A protocol is like a uniform that just doesn’t fit.

Consider some examples where protocols miss the mark:

Keto might help regulate blood sugar for some, but it won’t address underlying factors like stress, gut health, or inflammation. If you struggle with fat digestion or have sensitivities to eggs or dairy, keto could worsen health challenges rather than resolve them.

Turmeric might temporarily reduce inflammation, but if the underlying cause is chronic stress or immune dysfunction, no amount of turmeric will resolve those deeper issues. For some, high doses may cause digestive upset, adding complications rather than relief.

Questions Worth Asking

In Functional Nutrition, we recognize that the problem isn’t always where the symptom appears. Instead of jumping to quick fixes, we ask fundamental questions like “What would have to be true for this problem not to exist in the first place?” These questions help us avoid chasing solutions that only bring temporary relief at best, more problems at worst.

Frameworks offer agency, while protocols can lead to dependency. Frameworks foster independence, allowing you to understand your body’s unique needs and signals. By embracing frameworks instead of protocols, we build a model of health that is adaptable, holistic, and empowering.

Starting With Foundations

Sometimes, the answer isn’t in the latest health trend but in revisiting the basics—the steady, foundational practices that quietly build the body’s resilience over time.

If you’re looking for an immediate guide, consider beginning with what I call the Non-Negotiable Trifecta: sleep, poop, and blood sugar balance. These three areas form the backbone of physical well-being. For an even simpler daily practice, focus on Fat, Fiber, and Protein in each meal. Small, consistent actions like these are the bedrock of sustainable health.

Healing doesn’t have to be a chase for the next big thing. Instead, let it be a practice—a return to the basics that truly matter.

The complete guide to frameworks vs protocols, including the full Core Basics system, step-by-step approach to sustainable healing, and how to break free from the protocol dependency cycle, is in my comprehensive essay: Read: “When You’re Not Getting Better (And Why Protocols are Part of the Problem)”

In my journey through providing and receiving care, I’ve reached a resounding revelation: The patient narrative—their story—is missing from healthcare assessments and treatments.

This absence struck me profoundly as I continued to ponder the gaps that exist in care for those suffering chronic health challenges. I hear repeatedly of consultations where symptoms are addressed with tests and subsequent supplements and prescriptions, but the stories behind those symptoms were just shadows in the room.

Simultaneously, there’s a growing trend to seek answers outside of ourselves in our personal health quest. We scour the internet and chase the latest diets, vitamins, and fitness fads with a constant peripheral gaze. Something must exist somewhere over the horizon. This external pursuit leads us away from tuning into the narratives written by our bodies and experiences.

We’ve become so intent on finding information outside ourselves—in Google or a guru—that we’ve neglected the rich, contextual stories our bodies tell us. Stories that are critical in guiding our decisions and next steps.

When Stories Become Medicine

How can storytelling constitute medicine or support medical care? Stories transcend mere anecdotes. They are gateways to better comprehending complex health scenarios, enabling patients and healthcare providers to navigate them more effectively.

During a narrative medicine exercise, Melinda, a client managing type 2 diabetes and Hashimoto’s disease, shared memories related to controlled food access in her childhood. Her mother’s focus on maintaining a specific body size—for herself and Melinda—drove the control. This environment fostered a complex emotional relationship with food and body image.

Any notion of “food as medicine” felt more toxic than supportive to Melinda. Eliminating inflammatory foods, as might be prescribed for her conditions, triggered fear and alarm. Experts in physiology recognize that such stress responses are counterproductive, hindering the body’s ability to manage immune responses and blood sugar balance effectively.

Acknowledging the impact of psychological factors and early life experiences on Melinda’s eating behaviors was crucial to making any progress. My awareness of this background allowed me to customize my nutrition counseling approaches, holistically considering her triggers alongside her physical health needs.

This revised approach was considered, caring, collaborative, and customized. It led to more meaningful and sustainable health changes because we respected her experiences and fostered a healthier relationship with food.

The Missing Narrative

Your stories are not just background noise. They are vital chapters in your ongoing health narrative, deserving of attention and respect. Your held stories are as much a part of you as your muscles and mitochondria.

Let me share a personal example. During a narrative medicine workshop, I was prompted to think of a song whose music enhances the power of the words. This simple exercise unlocked a profound memory.

My late husband was obsessed with music. We’d walk down the hills of San Francisco to boutique record shops, their CD cases clicking as he flipped through them. Archer Prewitt was one artist he discovered, and whenever a particular song came on, it struck a chord of sadness and longing within me.

In his last week of life, when he could no longer speak due to a brain tumor, I asked if he knew which song always made me cry. He raised his pointer finger—our sign for ‘yes’—and gave me an ironic smirk: Yes, I know. But of course I cannot tell you.

After Isamu died, I found the song in his alphabetized CDs: “I’ll Be Waiting.” This personal reflection underscored how narrative medicine connects individual experiences to broader insights about healing and loss.

Beyond Symptoms

Healthcare today often focuses on “curing”—eliminating evidence of disease. But healing means becoming whole. Your health journey isn’t just about managing symptoms; it’s about navigating another aspect of your life’s journey.

In examining disease, we gain wisdom about anatomy, physiology, and biology. But in examining the person with disease, we gain wisdom about life. This approach moves beyond symptom management to explore the unique stories underlying chronic health challenges.

We must redefine what it means to be a patient—becoming active stakeholders in our health journey, bringing what nobody else can to the table. As patients, we possess invaluable insights that can inform and enrich the care we receive.

The Tools Are Simple

The tools of narrative medicine are accessible no matter where you are in your health journey: active listening, reflection, and prompted writing. That’s it.

If you say something like “I have always had trouble sleeping” or “I’ve always been constipated,” I invite you to go back in time. When was the first time you remember experiencing these challenges? Where were you? What did it feel like? What do you remember about that first time you can put memory around the sensation?

Listen to the messages from your body—both the whispers and shouts—as they can guide you on your health journey.

This represents a paradigm shift in understanding and managing health by placing your story at the center of healthcare. The complete guide to narrative medicine practices, including specific writing prompts, interactive exercises, and frameworks for reading your body’s story, is in my full exploration: Read: “Exploring Narrative Medicine: A Personal Perspective”

If you’ve traveled the landscape of modern medicine in search of answers to your chronic health challenges, you’ve likely encountered the profound influence of Evidence-Based Medicine (EBM). It’s an approach revered for its rigorous scientific style, and that esteem is understandable. We want evidence to support claims, especially when our health is at stake.

But here’s what might surprise you: EBM might not mean what you think it does. Or what you want it to.

The “evidence” in guideline-driven EBM is like following a precise recipe for baking a cake—one determined to be the “best chocolate cake for an eight-year-old’s birthday party.” In the controlled environment that confirmed this designation, the climate is always the same. You have one type of oven, identical pans, and every ingredient measured to the exact gram from the same source, with no substitutions allowed.

But if you’ve ever tried to bake a cake, you know what happens when you bake at high altitude, with a different oven, or with slight variations in ingredients. Even the type of flour can yield vastly different results. The strict recipe—while proven in one controlled setting—might not yield the same perfect cake in every kitchen.

You Are Not an Average

The story in healthcare is more complex than guideline-driven EBM suggests, especially for those living with chronic illness. EBM protocols are derived from averages and standard deviations. But you are not an average. You live a life full of color and complexity that extends far beyond what can be encapsulated by statistical data.

Here’s what’s concerning: the clinical trials that led to many accepted guidelines have predominantly included specific demographics—mostly white and male, between ages 18 and 65, within certain body composition ranges. This lack of diversity has profound implications. It means the “average” identified for prescribing your treatment might not represent the response of other racial groups, genders, ages, or body types.

That average may not include you.

Imagine Sarah, a 42-year-old graphic designer living with rheumatoid arthritis. She runs her own business from home, is married with two children, and navigates her passions for rowing and skiing alongside managing her condition. While EBM guidelines suggest a standard medication regimen for RA, Sarah’s journey is anything but standard.

Despite following these guidelines, Sarah continued struggling with flares during times of stress, seasonal changes, and forest fires. These flares weren’t adequately addressed by the “average” treatment plan, leaving Sarah disappointed with the limitations of evidence alone.

Personal Evidence: The Other Side of the Coin

In my years of clinical practice, I’ve learned that what I call personal evidence can be equally valuable to evidence derived from clinical trials. What may be statistically significant in a study can be personally insignificant—or even inappropriate—for you.

Consider Alex, a college student diagnosed with ADHD who started taking Adderall. Initially, she noticed significant improvement in concentration and academic performance. But over time, she experienced increased anxiety, sleep disturbances, appetite loss, and body image concerns that began to overshadow the benefits. These changes affected her participation in college sports, which was particularly concerning given her swimming scholarship requirements.

When Alex came to me, we shifted the conversation from what generally works to what would work for her. Her late nights, missed meals, and midnight snacking weren’t conducive to focus and attention. She struggled with bloating and asthma, and her frequent swimming exposed her to high chlorine levels. By addressing these aspects in a targeted, sustainable manner suited to her dorm lifestyle, we explored root causes, identified triggers, and initiated gradual changes.

This approach led to durable habits, significant health improvements, and heightened self-awareness—all essential for her academic and athletic commitments while setting her up for future success.

The Healing vs. Curing Distinction

Dr. Lissa Rankin speaks beautifully to this distinction: “While I believe you can cure yourself, one gigantic lesson I learned is that healing is not the same as curing. You can cure without healing, and you can heal without curing... curing means ‘eliminating all evidence of disease,’ while healing means ‘becoming whole.’”

In the EBM paradigm, guidelines focus on attempting to “cure.” The role of healing is beyond its scope. But chronic care requires something different from the predominantly evidence-based acute care model. Your sustained struggles require a personalized approach that accounts for your history, narrative, and personal evidence.

Beyond the Confines

The limitations of strict EBM adherence include time constraints that delay simple lifestyle interventions, cost considerations that limit access, potential for bias affecting diverse populations, conflicts of interest from industry funding, lack of diversity in clinical trials, and resistance to adopting innovative solutions.

When you recognize the actual constraints of the scientific “rigor” promised by EBM, you open the door to a broader, more inclusive understanding of your health. You welcome a spectrum of evidence—from the empirical to the personal. You can blend the precision of EBM with the subjective truths of your own experience, crafting a healthcare journey that is uniquely yours.

This approach promotes a care model that truly caters to you, the person—not just you, the patient.

The complete exploration of personal evidence, including frameworks for reading your own narrative and bridging the gap between population data and individual experience, plus detailed case studies and practical applications, is in my full essay: Read: “Beyond the Evidence of Evidence-Based Medicine”

Your sleep score is red again. Your glucose spiked after that “healthy” meal. Your heart rate variability is lower than yesterday. Now what?

If you’re like most people navigating chronic health challenges with the help of wearable technology, you’re probably reaching for a supplement, adjusting your protocol, or googling “how to fix [insert metric here].”

But what if that narrow lens provided by your biohacked result is actually leading you astray?

The Missing Context

Someone using a continuous glucose monitor might notice a spike in blood sugar after consuming a particular food. Instead of examining the broader context—what they ate before or after, their stress levels, their physical activity prior to eating—they quickly attribute the spike solely to that specific food. They miss the intricate interplay of various factors in a blood sugar response.

This is how wearables can inadvertently promote a contemporary version of applying a Band-Aid to an assumed issue, without grasping underlying causes and frequently neglecting more straightforward solutions.

Think about it: if the data tells you your glucose spiked after eating an apple, you might eliminate apples. But what if the real culprit was the stressful work call you took while eating, the fact that you skipped breakfast, or that you ate the apple at 9 PM when your circadian rhythm expects rest, not digestion?

When Quick Fixes Create New Problems

Here’s what happens in the tunnel-vision state that stems from chronic symptoms and frustration: we seek anything that promises to alleviate discomfort and uncertainty, even if it costs us our savings, our pleasures, or both.

But what if that melatonin you chose to help your REM sleep introduces digestive distress or daytime drowsiness? What if it negatively interacts with another part of your healthcare protocol? What if you trial a sleep supplement with several agents and can’t tell where the rash that suddenly appeared came from?

As a Functional Medicine Nutritionist who’s witnessed this cycle in both patients and practitioners for over two decades, I’ve seen how the frenzied pursuit of relief leads people to even more hacks—tests, techniques, pills, protocols—in pursuit of a breakthrough.

The Real Root Causes

Many individuals find themselves endlessly chasing solutions, spending countless resources, and facing confusing guidance from numerous advisors, all while enduring persistent symptoms. The search for solutions, fueled by enticing wearables and experts promoting various cure-all methods—cryotherapy, saunas, nootropics, dietary theories—often sends people down a convoluted path of costly experimental interventions.

But here’s what I’ve learned: the root causes aren’t your methylation, mitochondria, or mold. They aren’t your anxiety, autoimmune condition, or asthma. The root causes are deeply intertwined with lifestyle, emotional health, and the broader context of our lives.

The data from your wearable represents just one narrow slice of a much larger picture. It cannot capture your stress response to that difficult conversation with your teenager. It doesn’t know about the grief you’re processing or the career transition keeping you awake. It has no context for the decades of pushing through red flags or the cultural messaging about your worth being tied to your productivity.

Beyond the Numbers

What if health isn’t merely about chasing numbers and quick fixes, but about uncovering the deeper meanings behind our life experiences? What if every illness truly is a narrative, as writer Anatole Broyard suggested—a story waiting to be told?

The distinction between quantitative data (your sleep score, glucose reading, step count) and qualitative data (your energy patterns, emotional landscape, life transitions) isn’t just academic. It’s the difference between managing symptoms and understanding systems. Between quieting alarms and addressing what’s generating them.

This goes much deeper than wearable technology—it’s about how we’ve been taught to relate to our bodies and what we’ve been conditioned to trust. The complete exploration of qualitative vs. quantitative health data, including practical frameworks for reading your body’s actual signals, is in the full essay: Read: “You Can’t Hack Your Health” - Part 2

You can’t hack your health.

At least, not if you’re struggling with chronic symptoms that refuse to resolve despite your best optimization efforts. If you don’t have a chronic health concern and you use biohacking techniques to optimize your physical performance, you may be among the lucky few who can successfully hack a thing or two. But if you struggle with an unresolved health issue—whether it’s related to pain, fatigue, digestion, immune function, focus, or your ever-changing hormones—then the hacks you seek may do more harm than good.

Here’s the paradox that keeps me up at night: In the age of the biohacking boom, why do rates of chronic health challenges continue to rise?

We live in an era where information flows freely at our fingertips, where sleek wearables promise to quantify our health by measuring heart rate, step counts, and nightly sleep scores. The realm of biohacking encompasses everything from microdosing psilocybin to 3-minute cold plunges to wearing blue light glasses. Yet despite this fervor for personalized health insights, millions still find themselves endlessly chasing elusive solutions, spending countless resources, and facing confusing guidance—all while enduring persistent symptoms.

When Data Leads Us Astray

Let me give you a personal example. My Oura ring repeatedly tells me that my REM sleep score is low. My phone app displays a red line for REM while other sleep markers show blue with “good” or “optimal” notations. I know that REM sleep benefits cognitive, immune, and cardiovascular function, plus hormone and metabolic health. I want that REM.

The repeated “bad” score and longing for better sleep could lead me to search for quick solutions: magnesium to melatonin, GABA to ginkgo, cannabis to chamomile. While I’m not opposed to any of these in the right circumstances, some may be more supportive than others for my particular body. Some could introduce imbalances if not needed or inappropriately used.

Meanwhile, there are highly effective lifestyle shifts that could better address my quest for more REM: sleep schedule, bedtime routine, screen time, caffeine and alcohol intake, meal timing, exercise timing and intensity, stress management. When I neglect these essential lifestyle factors in favor of a cure-all informed by my wearable, I miss key factors that impact not just my REM sleep, but other seemingly unrelated health objectives.

The Wrong Kind of Data

This highlights a prevailing trend—the pursuit of quick-fix solutions based on quantitative metrics. The data from wearables may tell us something about our health, but it can also lead to impulsive actions that fail to address underlying issues. Sometimes these knee-jerk interventions unintentionally introduce additional imbalances that become part of the terrain contributing to the very symptoms we’re eager to resolve.

As the supply of insights, findings, and formulas increases, shouldn’t we see a corresponding decline in chronic health challenges? Wouldn’t the abundance of data and relentless pursuit of symptom resolution lead to a noticeable reduction in chronic diseases?

As a clinician who’s seen many people try—and then try even harder—to find answers, I’ve come to recognize this as a mystery that demands exploration. Is there one hack, pill, powder, or test we’ve missed? Or are we overlooking something altogether different amidst the sea of data and high-tech therapeutics?

I believe it’s the latter. We’ve collectively ventured away from a path that has the potential to provide profound insights into the real root causes of our unresolved ailments. The root causes aren’t your methylation, mitochondria, or mold. They aren’t your anxiety, autoimmune condition, or asthma. The root causes are deeply intertwined with our lifestyle, emotional health, and the broader context of our lives.

What if we’re chasing the wrong kind of data altogether?

This touches on something deeper about how we approach our bodies—the difference between quantitative and qualitative data, and why health isn’t merely about chasing numbers and quick fixes, but about uncovering the deeper meanings behind our life experiences. I explore the complete framework, including what qualitative data actually looks like and how to apply it, in the full essay on my blog: Read: “You Can’t Hack Your Health” - Part 1

If this seems impossible from where you're sitting, I beg you to read on. 

Acute and Chronic, what's the difference (and why does it matter)?

First, we need to define two key terms that have as little to do with Kahneman's principles as healthcare does. Stick with me here, as these definitions will help us find our way into this economically sound reframe that'll help you step back into the driver's seat of your own care. The two terms we're exploring are acute and chronic.

Acute: 

1. very serious or severe

• There is an acute shortage of water.

• acute pain

• the world's acute environmental problems

• acute competition for jobs

2. an acute illness is one that has quickly become severe and dangerous 

• acute appendicitis

Chronic: 

1. (especially of a disease) lasting for a long time; difficult to cure or get rid of

• chronic bronchitis/arthritis/asthma

• the country's chronic unemployment problem

• a chronic shortage of housing in rural areas

2. having had a disease for a long time

(source: Oxford's online Learner's Dictionary)

While I'm guessing these definitions are nothing new to you, we've lost sight of their potency when thinking about healthcare. And when I say "we," I don't just mean you and me. I also mean the systemic structure in which we are delivering care. Part of the issue is that we, as patients, are looking for resolutions to our chronic health challenges in a paradigm that is expertly designed to address acute health concerns. In addition, those that serve the current structure (meaning most healthcare practitioners) are so well trained in delivering solutions for acute issues that they've largely lost the skill of thinking differently and addressing a chronic challenge or condition. 

Seeking help for chronic health concerns in traditional or allopathic care is a tragic mismatch. And there's no wonder that frustrations with our medical system run rampant. 

Let's step back and identify what an acute health challenge might be…

• a broken bone

• an asthma attack

• a heart attack

• a burn

• pneumonia

• the flu (or a virus)

• a respiratory infection

• food poisoning

• strep throat

• a burst appendix

You get the picture. An acute illness or injury occurs suddenly, with rapid onset. Depending on its severity, it usually goes away on its own or with some targeted health or medical interventions. And, as is the case with a heart attack, it could be life-threatening without the appropriate medical care. When you call your doctor after hours, the message will likely say: "If you believe that you are experiencing a medical emergency, please hang up and call 911 immediately or proceed to the nearest emergency room or after-hours medical facility." This is because acute issues need what Kahneman calls "fast thinking."

Can we just take a moment to celebrate the fast-thinking put into action in our emergency rooms, by paramedics, during surgical processes, and so many modern-day medical personnel and procedures? The construct leading to the grievances saves lives, predominantly when attending to those acute concerns it's designed to address.

Thank you, modern medicine!

But, how about a chronic health concern? Let's take a look at some examples of these…

• high blood pressure (not induced by "white coat syndrome")

• diabetes

• arthritis

• depression

• osteoporosis

• cancer

• heart disease

• Alzheimer's

• autoimmunity 

• PASC (post-acute sequelae of SARS-CoV — i.e. "long-haul")

The list can go on and on, of course. But that last bullet point says it all! This chronic condition is "post-acute." And this can be true of all acute conditions: they can lead to more chronic health challenges if not properly or fully addressed or resolved at the time of their relative onset — becoming post-acute. 

A chronic condition typically has a slow progression that builds over some time. While there may have been one trigger (like one of those acute conditions listed above), that one trigger likely occurred in a field where other underlying factors allowed that isolated insult to provoke a long-lasting problem. Most acute stimuli do not become chronic without a permissive biological landscape.

Epstein-Barr Virus… when the acute becomes chronic

An example of the potential for the acute to become chronic (or "post-acute") is the virus called infectious mononucleosis (IM). Upwards of 90% of adults in America are said to have been infected with IM by the time we are 35 years old, with primary infection usually occurring in our childhood, young teens, or early 20s. IM manifests with signs of fever and swollen lymph nodes and symptoms of fatigue and sore throat. The incubation period is between 3-6 weeks, making exposure challenging to pinpoint. While several viruses can lead to IM, the most prevalent is the Epstein-Barr virus (EBV), which makes up about 90% of IM cases.

Even once the symptoms of the infection go away, EBV stays in the body in its inactive form in perpetuity. Its ability to cause symptoms is controlled by complex mechanisms of our highly adaptive immune system. Yet EBV can reactivate without us even knowing it, enabling us to transmit it to others, unbeknownst to us (or them). It can also get chronically stimulated for those of us who cannot control the reactivation of the virus. This can happen when our immune system is triggered or compromised for one reason or another. Common triggers for EBV reactivation include heightened stress, toxins (such as mold exposure), other infections, hormone imbalances, or immunosuppressant agents. 

When this happens, we may be facing what's called chronic EBV. There's been a slow progression of the viral activation in a terrain (including any combination of stress, toxins, infections, hormone imbalances, etc.) that enables a virus to proliferate and an immune system to struggle beyond its one-and-done acute function. And the signs and symptoms of that biological burden, from extreme fatigue to nerve impairment, rob you of your everyday ability to do what you are meant to do. 

The problem: We're still looking to the "fast thinking" model for what requires an alternate approach! And this is where Kahneman's principles of "slow thinking" deserve our attention, especially when it comes to our self-health care.

Acute health problems demand "fast thinking," but chronic health challenges require "slow thinking"

In Kahneman's book Thinking, Fast and Slow, he defines two ways we think through problems. System 1 thinking is quick, automatic, and often impulsive. System 2 thinking is analytical and deliberate. System 1 thinking is fast and necessary for so many everyday activities, and urgent, on-the-spot, and acute situations. Yet bringing System 1 thinking to System 2 problems that demand a different thought process is sloppy. And when we do try to use System 1 thinking for System 2 issues, we often recruit cognitive biases to legitimize our approach. Whether our choices are right or wrong, we’ll find ways to favor our opinion and justify our actions. 

Confirmation bias is one heuristic we may experience with our healthcare providers when they employ System 1 thinking. This can occur when they see your case only through the lens of a particular diagnosis or test result. Instead of embracing the whole, they selectively focus on specific data points in your health history or labs to confirm their belief while ignoring or overlooking other vital elements of your story and experiences.

And we, as patients, may often fall prey to what Kahneman calls the planning fallacy. This is a bias where we underestimate the amount of time needed to address a chronic condition. Because we are thinking with an acute care mindset (or caught in what I often call the "quick-fix trap"), we expect more immediate results than is realistic. If it took a long time to get here, it might also take more than a minute to reverse.

Get your handout here!

How to apply "slow thinking" to your chronic health challenges

If you're along for the ride, know that we’re about to go slow. As Shakespeare said, “Wisely, and slow. They stumble that run fast.” We’ll smell the roses and stop to pick daisies. None of that can be done going 80 miles an hour. 

Step 1:

Download the My Digestive Signs & Symptoms Survey

Step 2:

Complete the Survey to the best of your ability.

Step 3:

Go back through and highlight the signs or symptoms that you've been struggling with for a year or longer.

Step 4:

Pick one or two from that list of more chronic signs or symptoms and think back over your history experiencing them. Has anything helped that symptom to feel better or made it feel worse? If so, make a note right on the sheet or somewhere else you keep notes for yourself.

Step 5:

If you identified something (or things) in Step 4 that fell into either the “better” or “worse” category, consider what you might shift that allows you to bring some of Kahneman's "slow thinking" to your health challenge.

Step 6:

Let me know! Is there a place that System 2 thinking (i.e. “slow thinking”) has worked in your health or your life? Is there a place that you’d like to apply it? And if you need help figuring out how to apply slow thinking to a chronic digestive issue, let me know that too!

Leave a comment

My passion is an assortment of interests that have manifested in “nutrition”. 

But my passion is not “nutrition” per se, even though you likely know me as a nutritionist who is very passionate about the work I do. 

My passions are actually art and design. The perceptual and the sensual. The way things come together and intersect. Growth and the elegance (and sometimes messiness) of feedback loops. Context! I love context. I can’t really think or solve a problem without understanding the terrain in which a concern or obstacle exists. 

Any other route to resolution seems flat, shallow, and depreciated. A mistake. 

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Ultimately, these passions took shape within my life’s purpose – a purpose that stemmed from the disillusion of witnessing my late husband navigate a healthcare system that displayed herculean methods of intervention alongside disregard for the humanity of the patient. Isamu was not just his diagnosis. He was not a case. He was so much more. And to me, he was everything.

Experiencing the disjointed mechanisms of medicine at such close proximity established my intent. No more should people suffer as he did – or be unseen like he was. Although it took time to discover, that conviction prescribed my life’s purpose. 

Life’s purpose as an antidote

Passion and purpose are two focal points in the 5-P model that I developed and teach to practitioners at Functional Nutrition Alliance – practitioners who are working to overcome self-imposed obstacles to pursue their ambitions to help those in need. I also believe these same 5-P theories support our personal health and health outcomes. The 5-Ps include: 

Passion

Permission

Purpose

Persistence

Perseverance

It may feel challenging, or even like a big waste of time, to sit down and consider the questions: “what am I passionate about?” and “what gives my life purpose?” – as opposed to the quest for those other provocative Ps in healthcare, the pills, the protocols, and that all-knowing practitioner. But research shows that we may be missing some important pieces to the healing puzzle. 

A recent review and meta-analysis in Science Direct reveals that purpose in life is associated with a reduced risk of dementia. 

Got brain fog? Read on.

According to the review, purpose is considered a positive psychological construct (PPC). The study aims to synthesize evidence between those PPCs and later risk of mild cognitive impairment (MCI) and dementia. There is accumulating evidence associating negative psychological conditions such as depression, anxiety, pessimism, and hopelessness with increased risks of compromised brain function. But there is less research into the PPCs and the balance they may provide in the realm of prevention.

As I’ve been diving into the frustrations that so many of us feel with our unresolved symptoms as well as with the medical model when struggling with chronic health challenges, I’m struck by the quagmire in our current healthcare system. What aims to support may actually make you sicker (in more ways than one). The system itself may be thwarting valiant efforts toward prevention or slowing the progression of an underlying disease state. And this dilemma is multiplied for those standing at the margins of medical understanding, or those with histories of discrimination and distrust. 

How many are experiencing anxiety, pessimism and hopelessness related to their symptoms or medical care? I fear it’s more than we’re willing to admit. If the evidence shows that these mental states are correlated with cognitive decline, what are we doing to counteract those adverse influences? And how do passion and purpose play a part?

“Significant findings for purpose/meaning remained stable across analyses, suggesting that higher purpose/meaning in life is associated with a reduced rate of clinically significant cognitive impairment by nearly 20%.” – from the meta-analysis

The analysis concludes that PPCs such as life purpose and optimism are a “promising area for future research which may have important implications for dementia prevention.” Yet these topics remain uncharted in the prescriptions or protocols we seek (or receive) for countering the symptoms that, ironically, polarize us from our passions and purpose. 

Permission for your passions to drive your purpose

It’s important to recognize that purpose isn’t something that comes with the snap of our fingers. Knowing your purpose may seem as elusive as the resolution to your memory loss, confusion, brain fog, or any other symptom that just won’t go away. And a discussion of your life’s purpose may feel as hopeless as the many dietary interventions or supplement regimes you’ve tried to no avail. 

I didn’t know my purpose until I felt it rumbling through my core. And my lived-life delivered it to me – meaning there wasn’t a thread I could trace back to my childhood, (that’s where passion comes in).

The shape, texture and flavor of my purpose was not apparent for many years. And it’s not static either. It evolves. At times it can feel like walking through a dense forest in the dark, barely seeing my way. Direction only comes from putting one foot in front of the next while following the illumination of the north star in the sky above. My north star is to address the injustices experienced by those suffering with chronic health challenges while working alongside that selectively significant yet flawed system of care we’ve all come to rely upon. 

It also took me time and permission (along with persistence and perseverance) to think outside the box. I could have told myself “the system is broken, so I’ll become a doctor and be different than so many others.” But had I done that, I would not have been appreciating what psychologist Mihaly Csikszentmihalyi calls “flow”. 

“A joyful life is an individual creation that cannot be copied from a recipe.”

― Mihaly Csikszentmihalyi   

I discovered that my passion for context was a key ingredient in living my life with purpose. I had to grant myself permission for that passion to inform my purpose. It was not only knowing that context is how I make sense of the world, but understanding that I had to pay attention to it so that it could become an integral part of my inner wisdom and practical application. Knowledge is from my learnings. Application is my practice. Wisdom is the whole.

If finding your purpose is a daunting proposition, let it go. Start with your passions.

When I was completing my BFA, I encountered two kinds of art history professors. One made us discuss paintings from the Medieval and Renaissance periods and, during our final exam, identify the artist and relative date of a painting we had never seen. The other talked about the cultural and sociological challenges of the time – the circumstances and context that informed the art, and the habitat the artist lived in. The former elicited a stress response that caused me to freeze like a deer in the headlights, save for the tears quietly streaming down my face during an exam I knew I, an otherwise good student, would fail. The latter enlivened my curiosity and desire to engage in discussion. One made me insecure, the other confident. And yet both courses were in art history. 

The lesson was not about labeling myself or one of the instructors bad or good, dumb or smart. Both professors were published and well-respected in their field. Instead, the lesson was about decoding what makes me tick, what spurs my interests and excitement. This gave me permission to layer that understanding onto my purpose and come up with my own operating system, even if my operating system looked different than the standard perception of the field. Or even the word: Nutrition. 

Reframing “nutrition” (and my purpose)

This brings me back to the subjects you might expect me to write about. Food. Recipes. You may assume you’ll see photos of me at the farmer’s market or in my kitchen whipping up an enviable meal. But I found those pursuits and depictions never actually explained what I do. And yet diet and lifestyle modifications were some of the places we experienced gaps in my late husband’s care. They were the areas I saw were necessary to address, in tandem with all the other interventions he was receiving. 

Since the prognosis was grave for his type of brain tumor (a glioblastoma multiforme or GBM), we had to borrow our approaches for TAKING care from other areas of health and science (Note: This was over 20 years ago). Breast cancer patients and survivors had mobilized around the benefits of adjunct care. Integrative doctors were speaking out about the influences of complementary therapies. Functional Medicine was present, but not known to us. And Precision Medicine practices were just making their way onto the cancer scene in the ways we now understand them (Head over to this post to learn more about these terms). What was offered to us were the standards of medically revolutionary care – craniotomies, targeted radiation therapies, chemotherapeutic agents in clinical trials, new uses of antiangiogenics. We were the lucky ones – with insurance and access to the best medicine had to offer. And yet what was not being discussed was the terrain (and context) in which the tumor was growing. OR what we could do about it. 

While my passion for nutrition started with a desire for some control in an otherwise out-of-control situation, that passion is now only partially related to food. Yes, no. Right, wrong. Macros. Phytochemicals. Ratios on the plate. Meh. I don’t really care what you eat. I’m not invested in a prescription, a diet plan, or a protocol. Keto, intermittent fasting, macrobiotic, plant-based. Nutrition just doesn’t work like that. Literally… it doesn’t work. At least not for any good length of time, or without other core work upon which sustainable results depend. Part of that core work is understanding the context into which the food goes… the context of your body. In other words, I care more about you than your food. You, and your health outcomes are my purpose.

Nutrition, by definition, is about growth, metabolism, and repair. Food alone isn’t going to support those biological functions. Instead, it’s about the chemistry of where two (or more) contributing factors intersect. The PPCs – those positive psychological constructs – could be among those factors. And there’s a plethora of others to consider as well.

Where is my passion?

Though the research is showing that purpose may be a part of the prescription, if you don’t know it, don’t fret. Worry can lead to one of those negative psychological constructs that works against us. Your formula for using purpose as a path to preventing or reducing cognitive decline starts with your passions. They may pop into your head as a thing you love to do (play music, take photos, walk in nature), or, like me, a way you like to do those things (through research, writing, contextual understanding – zooming in to zoom out and zooming out to zoom in). 

Or you may find that your passions are not clear to you, either. That can happen too!

Either way, take a moment to wind back the clock. Whether that’s back to a moment in your childhood or young adulthood where you developed an understanding of yourself and found your flow, identify something that made (or makes) you tick. Release the need to put a label or meaning to it, or to carry the weight that it is your savior. Instead consider how it manifests in your life, or how it can manifest as part of a new daily practice. It may be in a coloring book or in a deep connection with a friend. It may be in brainstorming your vote on the next ballot with your neighbors as a way to make a difference. Or perhaps it’s in brewing a cup of tea or a pot of broth for a sick child. Watch. Listen. Practice. And let your passion guide your path to purpose and brain power.

“It is not the hearing that improves life, but the listening.”

― Mihaly Csikszentmihalyi   

References:

Bell, Georgia, et al. “Positive Psychological Constructs and Association with Reduced Risk of Mild Cognitive Impairment and Dementia in Older Adults: A Systematic Review and Meta-Analysis.” Ageing Research Reviews, vol. 77, 2022, p. 101594., https://doi.org/10.1016/j.arr.2022.101594.

Csikszentmihalyi, Mihaly. Flow: The Psychology of Optimal Experience. Harper and Row, 2009.

Korthauer, Laura E, et al. “Negative Affect Is Associated with Higher Risk of Incident Cognitive Impairment in Nondepressed Postmenopausal Women.” The Journals of Gerontology: Series A, vol. 73, no. 4, 2017, pp. 506–512., https://doi.org/10.1093/gerona/glx175.

Sutin, Angelina R., et al. “Sense of Purpose in Life Is Associated with Lower Risk of Incident Dementia: A Meta-Analysis.” Journal of Alzheimer's Disease, vol. 83, no. 1, 2021, pp. 249–258., https://doi.org/10.3233/jad-210364. 

I was interviewed on the Life (Un)Closeted podcast with Rick Clemons to discuss my interests in expanding the reaches of Functional Medicine and Functional Nutrition to meet the unique needs of transgender patients. Rick is a coming out, sexuality, and authenticity expert. He inspires gay and bisexual men to live their lives without apologies. So, as you can imagine, he was the perfect host for me to speak with about my passions for serving trans folx more fully, (and in aspects of their lives that may not currently be receiving what’s considered gender-affirming care).

The World Health Organization defines gender-affirming care as encompassing a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity.” And while it is not my job as a Functional Medicine Nutritionist to directly address the social, psychological, behavioral or medical interventions a person may receive, it is my job to ensure that those factors are taken into consideration when that same person is receiving care for a chronic or underlying condition. It’s also my role to support anyone going through a therapeutic treatment, whether that be antibiotic therapies or chemotherapy, as well as surgery and hormone therapies. 

It is in this arena of physiological care and reinforcement that I see some major GAPs in gender-affirming care that Functional practitioners can fill. 

I’ll link to the podcast in its entirety below, but wanted to share an excerpt with you on these pages. Whether this topic is of interest to you or not (and I hope it is), the principles I share are ones that help us see the powers of Functional Nutrition in action – embracing the realities that everything is connected, we are all unique, and all things matter. Once you’ve given this a read (or the podcast a listen), please share your feedback and comments below. How we get to the changes we need in healthcare is not a prescription, but a dialogue. My dialogue with you is a part of the necessary evolution. 

Excerpt from Life (Un)Closeted podcast with Rick Clemons:

Andrea Nakayama:

…That really leads me to what my interest was in working with transgender practitioners and seeing how there can be more Functional Medicine and Functional Nutrition practitioners helping LGBTQIA+ folx because I don't think there is enough. I do not think this is a conversation that's happening enough in the Functional Medicine and Functional Nutrition spaces. I do feel like I need to say, I am a cis-gendered, straight, white, middle-aged able-bodied woman. I'm also a widow of 20 years. I'm a single mom, and I founded a successful women-owned business. 

I like to think of myself as a disciple of the human condition: What are all the factors that bring you to where you are seeking help today?

In gender-affirming care, we tend to think about that term in relation to the psychological and the surgical interventions related to transition. The studies and the research (regarding gender-affirming care) are primarily around those two areas – the psychological and the surgical interventions. 

And yet there are so many other health conditions that transgender folks are struggling with as well… heart disease, diabetes, there's autoimmune conditions like Hashimoto's and rheumatoid arthritis, and lupus… None of us are exempt from these health struggles and the research into gender-affirming care in primary care is very minimal. And in Functional Medicine and Functional Nutrition, like I said, I just don't hear it spoken about enough… 

We have to recognize that the people coming to us have likely experienced discrimination in their healthcare and may or may not have had access to healthcare throughout their life, depending on their family of origin, their experience, other marginalization that they experienced in their life. That really piqued my curiosity and led me to consider four different factors that make me feel like we're doing care for this population all wrong…

Something you and I share, Rick, is that passion for the story. For me, that whole story is loaded with triggers, big-T triggers, little-T triggers, as with traumas, big-T traumas, little-T traumas. And that's what helps us to really help somebody untie the knots that got them to that particular place in their health, in their behavior, in their thinking, and all of it…

The four areas that got me thinking about gender-affirming care in Functional Medicine

For me, the things that really got me interested in working with trans communities and trans folx was less about where we get in the “self-care”, and more about how we manage the medical interventions. My passion is working with people with chronic illness. That's my passion – really diving into where things just aren't working as we would like them to work. So the four areas that really started to get me to think more about diving in (to this work) were:

1. the biology

2. the surgery

3. the hormones

4. the trauma

BIOLOGY

…When we look at the biology of how we are formed in utero, there's a change. We start the same for seven or eight weeks. Then there are shifts in hormones and hormone suppressants that actually turn the fetus into what we then term a “girl” or a “boy”. There’s a lot that could happen in utero in relation to hormonal exposure from mom and from our environment that can shift the expression of what we think of as gender norms. Gender is a continuum. It is not polar and so that understanding for me, once I understood the physiology was like, wait a minute, this is why transgender folx have existed throughout history. It's something that happens throughout the lifespan of an embryo and a fetus. 

SURGERY

When I think about surgery – and I'm going to use a term here, and I'm all for gender-affirming surgery, so I want to say that – but surgery is an “insult”. I say that in (air) quotes, not because I think getting surgery is an insult. Getting surgery (may be) necessary. However, it's a mechanical trauma. When we have surgery, there is tissue injury, there's tissue inflammation. Surgery induces a cascade of physiological stresses in different phases. There's oxidative stress, enzymatic stress, energy stress… 

Surgery is #2 in the four that got me thinking about this. (And) it's my desire to help people through it. YES, you are having surgery:

• What's being measured before you have surgery? 

• How are you healing from that surgery? 

• How do we help your body to transition post-surgery? 

• And get ready pre-surgery? 

So (we’re) recognizing surgery is a physiological “insult” and I'm putting that in (air) quotes, that it is a mechanical trauma. I mean, if I'm going to the dentist and having anything done… I'm helping my body prepare for and recover from surgery. So YES, to gender-affirming surgery AND I believe people deserve help to prepare and recover from that surgery because it will induce other underlying or silent inflammation. We have to remember what we are doing to the body to support it through the transitions.

And I know I told you before we went live, Rick, I feel like this is my ‘coming out’ show because these are hard things to talk about because we want to just be the YES for gender-affirming care in its psychological and surgical and hormonal forms. And I am a YES for that, but I'm a YES, AND in an ideal setting, and I do feel like we have to get this kind of care, this adjunct care to more folx who may be going through it. Not all transgender people decide to have surgery or hormones. So there's different decisions and opportunities based on a number of factors. I just want to say, how can we help? How can we help you? 

From a Functional Nutrition perspective, we are embracing trauma-informed care, which is another piece of the puzzle… As I was coming to my own desires to do this work, when I got to the point of “how can I help?,” it looked very different (than I thought it would). Getting to these areas that I was concerned about, which I'm sharing now – the biology, the surgery, the hormones, and the trauma – was not even the conversation I was able to have at the beginning. Sometimes actually helping is a whole different thing than what we think it is (or is going to be).

HORMONES

What we know about hormone replacement therapy (HRT) and its history is that it started in the 1960s. It was popularized in the 1990s. The first clinical trials were in the 90’S and the World Health Institute released its findings in 2002, showing that hormone replacement was more detrimental than beneficial in its effects. Now a lot has changed and we are able to deliver (safe) bioidentical hormone replacement therapy (BHRT) for menopausal women. But I don't see that we're applying what we’ve learned about hormone replacement to trans folx choosing hormone therapy through gender-affirming care. So again, it's the YES, AND. YES, we need those hormones, AND…

• Who's measuring your hormones? 

• Are those hormones working for you? 

• Are you detoxing the hormones you don't need so you don't have the ill effects of estrogen dominance, which (can be) estrogen dominant cancers? 

Who's looking at it more holistically, more functionally so that we can say YES to the hormones and YES to your health and your long-term life? I know it's a big ask. I think we're far from being able to deliver this kind of care, but it's part of what really drove my passions (to dive into gender-affirming care in Functional Nutrition)...

I'm concerned that we've created a box for gender-affirming care that focuses on the gender-affirmation surgery alone. I know people who are doing great work in gender-affirming care and psychology but it doesn't look at the rest of the human body, and the history of that human body, and what other conditions might be at play in that body… We've created another box. And it's an important box. It's a critical box. But how do we widen the walls of that box?

TRAUMA

That brings me right to the fourth point that really concerns me…I always say, there's no protocol. There's a framework. There's a framework for how we think into the case, but there's no protocol… Two people with the same diagnosis got there for different reasons. So the reversal or management is going to look different and the fourth point that I was going to talk about… The fourth point is trauma. 

We talked about biology, surgery, hormones, and (now) trauma. There's a lot of research around trauma-informed care now and it tends to take place in the psychological realm as opposed to the physiological realm. It’s moving there, but we know the research shows us that people who have experienced adverse childhood experiences (ACEs) of any sort are also then more prone, more at risk, to experiencing chronic conditions, usually related to autoimmunity and pain-related conditions. So how do we embrace that for the trans folx that are looking for care? How do we recognize that they may or may not (to different extents), have a history that is informed by some kind of trauma, and how do we hold that?... I know that when people are receiving the surgical and therapeutic parts or psychological parts of gender-affirming care, they are receiving trauma-informed care.

But if we widen the box or open the closet, how do we bring that into all of our (healthcare) practices, whether our practices are geared towards (current standards of) gender-affirming care or not? How does it all become gender-affirming care so that trans folx feel safe and welcome in our practices – exploring their diabetes, their BMI that might be keeping them from surgery, their autoimmune condition? How do we all become more trauma-informed and gender-affirming? That's really the final point that kind of led me to raise my hand and have a scholarship group where I could put it to the test.

Trans teens are at a far greater risk of experiencing disordered eating

I do have to mention that trans teens are at a far greater risk of experiencing disordered eating, probably four times greater. There's certainly gender dysphoria that can lead to body dissatisfaction and there's social oppression and oppression-based trauma that lead to the need to really carefully address “self-care”. So self-care is less about the ‘shoulds’ and what we ‘could’ be doing, and more about creating that space of safety for looking at the connections between how we talk about food, or when it's (even) appropriate to talk about food. Maybe we have to talk about sleep for six months before we can even touch the food, right? Because there's a lot there in terms of disordered eating patterns because of that body dissatisfaction, which is tough. 

I’d like to shift the conversation from self-care to self-health care. 

To listen to the interview that these excerpts came from in its entirety, please be sure to head over to the Life (Un)Closted website, or you can find the podcast on iTunes, Google Podcasts, Spotify, Radio Public, Podchaser, or TuneIn.

How do you respond when your doctor says that what you eat doesn’t matter (for your Hashimoto’s, Crohn’s, PCOS, chronic Lyme, PASC or long haul, or any other chronic pain or condition)?

🤐

That’s right. You say NOTHING!

It’s not our job to convince, educate, or even believe them on this particular matter (as opposed to other concerns that fall within their area of expertise). 

And it’s not their job (unless they’re the rare combination of nutrition expert and medical doc) to be intimately familiar with a set of tools not in their toolbox. 

On average, doctors receive about 19 hours of nutrition training

To put this into perspective, that’s about 19 out of the estimated 46,000 hours of study required to obtain a medical degree.

“Today, most medical schools in the United States teach less than 25 hours of nutrition over four years. The fact that less than 20 percent of medical schools have a single required course in nutrition, it’s a scandal. It’s outrageous. It’s obscene.” – Dr. David Eisenberg, adjunct associate professor of nutrition at the Harvard T. H. Chan School of Public Health

Fortunately, more doctors are aware of the impacts of food on the body. Yet few know how to talk to you about it, guide you through change, or be your advocate. So they answer with what they either believe or believe they have time to effect (with their restrictions on both their time and their clinical understanding of making dietary changes). If we expect anything different, that’s on us. I’m not here to rally against the doctors or change the medical curriculum. I believe in specialists, not generalists. And, in this case, that specialist is you. 

You only need to specialize in you

If we are to safely make dietary changes, it’ll require more than can be crammed into 19 hours of academic (vs. clinical) study. It’s more than a handout, a blog post, or a 30-minute YouTube video. Sound and sustainable dietary changes deserve careful consideration on a case-by-case basis. It necessitates a physiological and psychological understanding of the body and brain, along with compassionate care surrounding issues of access to food and safety, personal and ancestral relationships with foods, and trauma-informed care (because, let’s face it, many of us are reckoning that we have pretty f’d up relationships with food, let alone “diet!”).

If we allow ourselves to take a step back, to shake the idea that some diet or dietary theory is going to deliver the quick-fix that solves all our woes, and focus instead on tuning in to our body’s patterns and responses, then we become the partner and the specialist that we’re seeking. You become the expert in you. I become the expert in me. We stop looking for validation and approval outside of ourselves and, instead, acknowledge what our signs and symptoms are trying to tell us. 

You likely know more about nutrition than your doctor does 

You likely know more about nutrition than your doctor does, and that’s OK. You don’t need to look for their approval to TAKE care!

Whether you’re pumping your fist in the air and screaming “YES,” or dubiously shaking your head “NO,” I want to take a moment and recognize that this road is not easy (or well understood). Unresolved signs and symptoms can leave you or someone you love standing at the edges of medical know-how, with the disappointing realization that medical intervention alone is just not enough. And tuning in can be hard work. Yet it’s the most empowering and revolutionary work we can do. 

There’s a fine line between listening and obsessing

Listening to our body’s responses requires a pause. What’s consequential? What’s inconsequential? What requires immediate action? And where is more time needed to separate the problem from the solution? 

Listening to your body is the work of becoming intuitive. Of silencing the many voices that want to crowd our mind and point to the answer. It’s a creative pursuit that requires honing the muscles of curiosity and trust. Curiosity about yourself. Trust in yourself and your innate healing powers (even when they need a helping hand from a change, an elimination, an addition, or a guide). 

A horse whisperer needs to spend time with the animal, learn their body language, senses, and instinctual behaviors. A bee whisperer (or beekeeper) is often curious and fascinated by interconnectedness. A baby whisperer approaches their job with keen observation and respect for the individuality of the small being they are looking to support. If you have a “green thumb” (which I do not), you know how to test and read the messages of the soil and the leaves, and respond accordingly. And if you have chronic and unresolved signs and symptoms, your body is calling you to become its whisperer – to hear its proclamations and reply in kind and in care.

Note: I am still accepting applications for my small Case Study Groups.

Learn more here!

References:

Adams, Kelly M, et al. “Status of Nutrition Education in Medical Schools.” The American Journal of Clinical Nutrition, vol. 83, no. 4, 2006, https://doi.org/10.1093/ajcn/83.4.941s. 

Crowley, Jennifer, et al. “Nutrition in Medical Education: A Systematic Review.” The Lancet Planetary Health, vol. 3, no. 9, 2019, https://doi.org/10.1016/s2542-5196(19)30171-8. 

Winick, Myron. “Nutrition Education in Medical Schools and Residency Training.” Childhood Nutrition, 2020, pp. 251–254., https://doi.org/10.1201/9781003067856-20. 

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It’s not unlikely that you or someone you know suffers from chronic and medically unexplained signs or symptoms. Before I talk about what a medically unexplained sign or symptom even means (and more importantly, what it means for you), let’s identify the difference between a sign and a symptom. 

A sign vs. a symptom

Your signs and symptoms may be related to an existing diagnosis or unknown factors. While a sign can be measured in a health or medical examination (even if you are unconscious or cannot communicate), a symptom is noted only by you, the patient. For your healthcare team, a sign is objective. A symptom is subjective. But both signs and symptoms are out of your norm and relevant to your potential condition, treatment and resolution. Since only you know your symptoms, they must be communicated verbally or through your movements or actions. Otherwise, they risk going undocumented in your medical records. 

Check out some of the distinctions between signs and symptoms in this chart:

I appreciate that these distinctions can be confusing. But knowing the difference between signs and symptoms helps you to better advocate for yourself when receiving care. “I have a fever, a runny nose, and these skin outbreaks on my chest” (listing your signs). “And I’m also experiencing congestion and unusual fatigue” (noting your symptoms).

Separating these experiences allows your medical provider to quickly categorize and direct their attention to documentation, further inquiry, and care. It also helps build the bridge between your language and theirs. This is part of how a therapeutic partnership is formed.

Medically unexplained signs and symptoms

In 2017, a paper entitled “Medically Unexplained” demonstrated that physiological pain or dysfunction doesn’t always correspond to a disease or diagnosis (read more in my previous post about the allure of the diagnosis). The presentation of persistent problems can be labeled with the umbrella term “MUS” (medically unexplained symptoms) or “MUPS” (medically unexplained physical symptoms). The mismatch between a series of signs and symptoms and a plausible pronouncement based on our current diagnostic criteria has left too many of us without a name for our hardship.

A 2021 paper on MUS recognized that these “symptoms are common, real and are associated with significant distress, loss of functioning and high healthcare costs.”

As time marches on, the many who hurt or can’t function (or operate at 75% or less), have become many more. 

You may recognize yourself standing under that umbrella, thinking you’re alone in the storm. Or you may realize that you’ve dismissed someone in your circle as a complainer or hypochondriac. Or maybe, if you’re a clinician like me, you’ve found yourself trying to save the day and be the hero who will “fix” it all. 

If that’s you, seeking answers for yourself and reading this now, I see you. You are not alone. You can’t get out of bed or want to climb back under the covers after the kids leave for school. Your weight won’t regulate like it used to with what (in retrospect) was just a little bit of effort. That pain in your breast or the ache in your hip or the itch in your ear just won’t stop. And the symptoms, some just niggling and others more pronounced, are compounding. You live on a revolving spectrum between annoyance and acceptance, hope and humility. Sometimes you don’t even know which symptoms are worth bringing up when you see your health or medical provider.

What I’ve seen in my 10+ years of practice is that folks with these chronic symptoms are left on an exhaustive and endless quest. And these aren’t people with rare disorders that deserve a sub-plot on House-MD or a chapter in a textbook of medical anomalies. They’re your sister, best friend, aunt, me, and perhaps you. 

Unfortunately, as advanced as our medical assessments have become, we just don’t have the appropriate diagnostic criteria for a new wave of conditions resulting from myriad insults—lifestyle, environment, and even evolution. But we do have some tools to help us captain this new terrain. 

"Some stories don’t have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next. Delicious ambiguity."  — Gilda Radner

Tracking is action

So what do we do in those circumstances where even our best diagnostic criteria fail to reveal answers? When the diagnosis is still elusive or when it just isn’t enough? How do we get out of feeling stuck on either side of the diagnosis divide (before or after)? And even when testing has led to this or that conclusion, then what? 

The answer to that question is, unfortunately, not always clear. 

This is where TRACKING comes in. In fact, I wish it came in earlier. And always. 

Please don’t roll your eyes. What I’m about to share with you is cheap and easy, yet effective.

I’m a fan of all sorts of tracking—sleep tracking, symptom tracking, poop tracking, and even food tracking (when your safety and situation allows). I like tracking at different times, for different reasons. It can help us embrace the pause, step out of the weeds, and collect the data that helps us to see our next move more clearly. 

Call me crazy, but I like to think of the tracking process as “strategic.” It’s our personal way of engaging in the scientific method.

Shane Parrish, one of my favorite thinkers on both the art of decision making and the power of mental models (two of my top subjects to explore), says: “The time used to correct poor thinking comes from the time that could be used for good thinking. Good thinkers understand a simple truth: you can’t make good decisions without good thinking and good thinking requires time. Good thinking is expensive but poor thinking costs a fortune.”

↑ Read that quote one more time. Let it sink in. 

A test result is one piece of data. That’s it. 

How large or small a piece depends on the test, the situation, the data itself. The rest of the data comes from you. You actually already have it. It’s your signs. Your symptoms. When they occur. When they feel most challenging. And tracking them doesn’t cost a penny. 

But not tracking that data may cost you a fortune.

In my next post I’ll share my new Sign & Symptom Survey for you to complete for yourself. Together we’ll explore what to do with the data you collect.

If you’re struggling with a chronic illness, I’m now accepting applications for small Case Study Groups for my upcoming book. You can learn more and apply here. 

References:

Husain, Mujtaba, and Trudie Chalder. “Medically Unexplained Symptoms: Assessment and Management.” Clinical Medicine, vol. 21, no. 1, 2021, pp. 13–18., https://doi.org/10.7861/clinmed.2020-0947. 

Rosendal, Marianne, et al. “‘Medically Unexplained’ Symptoms and Symptom Disorders in Primary Care: Prognosis-Based Recognition and Classification.” BMC Family Practice, vol. 18, no. 1, 2017, https://doi.org/10.1186/s12875-017-0592-6.

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Elusive symptoms. No clear diagnosis. You can’t get the right lab tests run (or the right person to read them). You’re frustrated. 

But you can’t just abandon your doctor. Time. Resources. It’s just not an option. 

It can be maddening. And I get it. It’s why I’ve spent the last 10+ years educating an army of Functional Nutrition Counselors to help fill the gaps in healthcare at a more affordable cost and for a wider breadth of patients.

But let’s pause for a moment to discuss the allure of that diagnosis…

The author, Meghan O’Rourke says, “diagnosis isn’t the end point when you’re dealing with a chronic illness.” 

(You can listen to my 15-Minute Matrix podcast episode with Meghan mapping Chronic Illness here. And be sure to pick up her newest book, “The Invisible Kingdom: Reimagining Chronic Illness.”)

For chronic illnesses – those symptoms that just won’t go away (whether from an infection like Lyme, Epstein-Barr Virus [EBV] or many others; an autoimmune condition; fibromyalgia; or long-haul) – that diagnosis may be just a piece of the puzzle. True, but partial. I realize the diagnosis seems like it can resolve our concerns and lead us to the best next steps. For some, it does. But, unfortunately, not all (I see you).

Yet the allure of the diagnosis is BIG. And it certainly can help, even if it isn’t a fix-all solution. Believe it or not, the big picture healing may happen, in part, before you receive a diagnosis. And still, much of it may remain in your hands after you are diagnosed.

Here’s the Cycle of Chronic Illness that I’ve created based on patterns I’ve seen in 100s of patients:

1. Rationalize 

2. Retreat 

3. Recognition 

4. Relief 

5. Realize 

6. Resent

7. Reclaim

Kübler-Ross’ Cycle of Grief, introduced in her book, “On Death and Dying”, helped us identify our stages of mourning, both for self-acceptance and to receive appropriate support while experiencing significant loss. She also stressed that the stages were not linear. The time that each of us lingers in a stage of grief differs. And while some will experience all stages, others will only weather a few. Mostly, the cycle helped to describe what can be messy and hard to articulate, not just for ourselves but for those we love or counsel. Much like a diagnosis, the stages of the grief cycle were clues, not determinants. Again: true but partial (and open to interpretation). 

Let’s look at each of those 7 stages of the Cycle of Chronic Illness to determine if you’ve ever been in one (as I have) or are in one now:

RATIONALIZE: This is the stage where you attribute signs or symptoms to life events or a known condition. It might be “my age,” “my long hours,” “my depression,” “my IBS.” Too much of this or that, or some other correlation. There’s likely a relationship between your symptoms and the culprit you’ve identified, but it may not be the whole truth. Nonetheless, you tell yourself it is. It must be.

RETREAT: In this stage, you pull away. You may feel guilt, regret or shame for talking about your signs or symptoms. You might even be embarrassed when they reveal themselves. Rashes. Lost patches of hair. Running to the bathroom (and sometimes not making it). You retreat from family and friends. You tell yourself that “nobody understands.” Perhaps you search for online groups where others “get” you. You comfort yourself in your retreat with assurances that you’re tired anyway. Why go out!

RECOGNITION: You’ve finally found a healthcare specialist that validates your experiences. They perform a test or assessment that assigns a name or provides some reasoning for what you’re experiencing. At last! A diagnosis or interpretation that you can latch on to. Finally there’s someone who doesn’t think that what you’re describing is “all in your head.”  

RELIEF: Now that you (and this provider) know what it is, it can be fixed! You have X and they will do Y. You feel better knowing what to google, where to direct your attention, and having someone on your side who’s identified and can address the issue. Then life can return to “normal” (or so you believe).

REALIZATION: In the classic Hero’s Journey, this stage marks another moment of crisis. It’s the moment when you begin to understand that addressing this thing isn’t a one-and-done. Even knowing what it is (or could be) does not lead to all the answers. You still don’t feel 100%. Shit. What are you supposed to do now? 

RESENTMENT: In this stage, you recognize that there are limitations to clinical insight, diagnostics, and interventions. You join the ranks of millions of others who stand at the edge of medical knowledge and understanding. There is no Quick-Fix. There is no easy understanding. There is no one and done. You may have displeasure, or even bitterness, for the systems that have failed you. That may be the health and medical systems that lead you on a wild goose chase. Unfortunately, it may also be your own body systems. Why can’t anyone (or anything) just get it right?!

RECLAMATION: Welcome home! This is the stage you will return to again and again. And hopefully, you will find a way to live here for longer periods of time. In the Cycle of Chronic Illness, this is where you find acceptance, awareness, discovery, and self-health care. It’s the phase where you learn how to speak to your family, friends, and medical team as a self-health advocate. You are not rationalizing or retreating, and you do not feel resentment. And the recognition comes from within. You are a rebel with a cause. The cause is you (and your life!)

If you too struggle with a chronic illness, as you read through these stages of the Chronic Illness Cycle, is there one that resonates with where you are right now? Can you take a moment and write down some thoughts about those feelings and that state? 

And what does the 7th stage, reclamation, sound like to you? Is it a place that you welcome or a place that you fear? Does it seem like sovereignty or settling? 

If you’re struggling with a chronic illness, I’m now accepting applications for small Case Study Groups for my upcoming book. You can learn more and apply here. 

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Learn more and apply here!

This application is for small Case Study Groups who will put my methodologies to the test for themselves (and for an upcoming book I’m writing), without the dedicated support of a Functional Nutrition Counselor. I believe we all deserve to feel better, and stepping back and appreciating all that brought us to this moment in time is part of the process of getting there. I want to help you and others feel your best, no matter the signs, symptoms or diagnoses, or the means to access private Functional Nutrition counseling. 

These Case Study Groups are for you if…

+ You have been feeling sick, tired or in pain, and you’re just not getting better 

+ You have an autoimmune condition like Hashimoto’s, Lupus, Sarcopenia, Crohn’s or one of the other 100+ autoimmune diagnoses that are not easily resolved 

+ You have fibromyalgia or another chronic pain syndrome 

+ You experience unresolved depression, anxiety or PTSD related to your life (or even to medical experiences)

If one of those rings true for you, I encourage you to apply here. 

Equal Care Provided to All

And please note that I am on your side! I’m committed to providing equal care to all participants, regardless of age, race, ethnicity, physical ability or attributes, body size or weight, religion, sexual orientation, gender identity or gender expression. 

In addition, your privacy will be respected throughout, and I'll be sure to provide all the details once you're accepted. For now, dive into the application! It'll only take about 10-15 minutes of your time, and I’m so looking forward to learning more about you and supporting your next steps of Functional SELF-health care.

Oh, and if you don’t know what Functional Medicine or Functional Nutrition is, please don’t worry about it! What’s most important is that you’re ready to embrace your self-health, understand what brought you to the current struggles you’re experiencing, and become the best advocate you can be both for yourself and with your health and medical provider or team.

Please Spread the Word!

If you know of anyone else who you think would benefit from this opportunity, please do forward this along. And more details can easily be found on the application page here.

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STEP 1: FORGIVE YOURSELF (you didn’t know any better)

STEP 2: EXAMINE YOUR OPTIONS (agreements vs. expectations)

STEP 3: TAKE Care (actually take it!)

I also promised that I’d drop some “swipe copy” to use when communicating with your doctor. “Swipe copy,” if you’re unfamiliar with the term, are words you can cut and paste to articulate your needs with professionalism and know-how. In other words, I’ll do the leg work for you. Consider me your doctor whisperer or your private ghostwriter!

As I discussed in my last post, Step 2 includes establishing agreements with your physician. Communicating your needs can help you determine if the relationship is worth saving and what you can get out of it. That understanding will help you to show up to your appointments with more clarity. This is critical while you are considering what your options might be if you cannot change course, choose another doctor, and ghost the practitioner who treated you with disrespect or disregard. In that same post – and this is important to remember – we also considered the clinician may not know any better. They may not know something you know from your research if it’s outside their expertise or standards of care. And if what you’re asking is beyond their scope of understanding, they’re likely not going to do, order, or recommend something just because you asked them to. That’s both the reality of the situation and well within their integrity (as frustrating as it may be).

For today’s swipe copy, I’ll use the context of a patient wanting to see a FULL THYROID PANEL when their doctor won’t order more than a TSH (thyroid stimulating hormone). This is a simple case I’ve heard hundreds of times in my practice. You can use this same simple swipe copy to ask for other markers you’d like to see. 

Global notes for communicating with your doctor:

1. Keep your letter short

2. Don’t try to educate – stay in your zone of genius (which is YOU… YOU are your zone of genius!)

3. Mention a few key signs or symptoms that are still unresolved

4. Take a moment to capture this cadence in the swipe copy: 

   APPRECIATION, SYMPTOMS, REQUEST

5. Don’t forget: No matter how great your note, a doctor will not do something they don’t understand. When it comes to labs, that means they likely won’t run a marker if they don’t know what to do with the results

SWIPE COPY:

Dear Dr. __,

Thank you for your support as I try to navigate my [list diagnosis or short list of signs/symptoms]. I’m still struggling with [short list of one or two signs/symptoms] and would love your help. Now that we’ve tried [X, Y, Z already explored], what are your thoughts on running a Free T4, Free T3, Reverse T3, TPO and TgAB along with the TSH to give us a broader picture? Are there other tests you’d recommend at this time given my ongoing symptoms?

Thanks again and I look forward to hearing back from you,

[name]

Note: If you have a doctor situation that you’d like me to SWIPE for you, write it below or send me a DM on IG @andreanakayama

To review, our 3 steps are:

STEP 1: FORGIVE YOURSELF 

STEP 2: EXAMINE YOUR OPTIONS 

STEP 3: TAKE Care 

STEP 1: FORGIVE YOURSELF (HOW-TO)

You had NO CLUE it was going to happen. 

You walked into that office expecting healthCARE and had ideas about what that meant. You vulnerably shared your signs, symptoms, and concerns, hoping to be heard and supported. Or maybe you arrived with armor from the get-go, already considering the medical staff untrustworthy due to medical racism, sexism, anti-fat bias, and many other cognitive biases. Those prejudices now encompass a growing number of people who suffer chronic illnesses that don’t respond to current tried-and-true diagnosis or treatment methods. And that’s more of us than you might expect!

STOP & READ: I recognize that this experience may not apply to everyone. You may have had the opportunity to walk out the doctor’s office door and move on to meet that amazing provider that swooped in and saved the day, your life, and found your answers. But I’m guessing that if you did, the celebrated practitioner didn’t do it alone. We never do. YOUR work and efforts were a huge part of the equation, so stick with me as we applaud your superpowers too. YOU are the hero here. 

We cannot collectively address the solutions to a system that works for some conditions (and people) and not for others without taking a good hard look at reality and all its nuances. If you know me and my approach to addressing individualized health, you get how detailed and contextualized it can (and should) be. It’s all connected, right? It all matters. 

Every social insult is a physiological injury.

That’s why it’s so important that you forgive yourself. 

Forgive yourself for not knowing what you didn’t know before you learned it. 

— Maya Angelou

It wasn’t your fault! Not in the least. It’s a systematic problem. And it’s deeply rooted. 

So while we cannot change history or even the structures that lead us here, we can change ourselves. We can shift how these experiences impact our inner terrain. Our collective and self recognition is foundational. Forgiveness is key. Self-forgiveness is paramount.

Self-forgiveness is your ultimate act of resistance!

Studies show that forgiveness can improve sleep and reduce anxiety, depression and stress. Its power to alter health outcomes increases as we age. Not forgiving yourself can impact heart health, blood pressure and immune modulation.

Forgiveness is choosing to love. It is the first skill of self-giving love. 

– Mahatma Gandhi

If you have a story of medical gaslighting to tell, go ahead and speak it. Aloud or to yourself. With a pen or crayon, a poem or a song. In the comments below or in the pages of your journal. And forgive yourself for what you didn’t know. 

STEP 2: EXAMINE YOUR OPTIONS (HOW-TO x 2)

You’ve experienced the sting of being gaslit. You were told you were too sensitive. Too much. Overreacting. Reading too much into it. Dismissed for your perception of reality or even your own body.

And it would be easy for me to say, “just find another doctor.” It’s what I did with the two micro-stories I shared in previous posts (here and here). But finding a new doctor isn’t always an option. (You may have more choice than you think. I’ll share one of those stories below for inspiration.) 

So if not another doctor, if we can’t actually walk out the door and never come back, what options do we have? Fortunately, there’s a powerful one. Are you ready? (Note: It may not be the answer you want to hear.)

Shift your expectations of the relationship.

“Find free­dom in the con­text you inherit.”

– Lee Mar­a­cle (Stó:lō)

At Functional Nutrition Alliance, I teach practitioners about the difference between agreements and expectations. I love this conversation because agreements are something we create. That creation allows for co-agency. In contrast, expectations are something we usually “have” (and don’t actively choose). They can lead to disappointment, resentment, and polarity. 

With agreements, we consider what’s actually possible in the given context. With expectations, we can get anxious, even defensive (by “we,” I mean both parties – the patient and the practitioner. And I’ve been both). Nobody likes living up to someone else’s expectations. Your doctor (or past doctor) is no exception!

An expectation is a belief you hold in your own head about an anticipated outcome. It’s usually singular. And we can feel betrayed when those expectations are breached (when in reality, we didn’t clearly voice our wants or needs). Expectations allow us to shift blame onto someone else. In this case, it may be the doctor who mishandled your care, leading you to feel unseen and belittled. And while that’s not OK, it’s interesting to consider how we shift the power without a power play. 

Agreements may be the answer.

In contrast, an agreement is between two people (in this case, you and your doctor). It’s anything you each claim that you will or won’t do. Agreements must be clear – who is going to do what by when?

Anything else is careless. And not an (or in) agreement.

Toward this end, it’s important to remember that when you walk into your healthcare appointment, no agreements have yet been made. How to articulate what you want and come to an agreement is another story. As you ponder the difference between expectations and agreements, are there any interactions you can rewrite in your mind?

In considering the distinction, I’d be remiss if I didn’t point out where certain expectations are fundamental for healthy primary relationships. We all deserve to have certain expectations met so we can show up in those more challenging situations advocating for ourselves. These essential expectations help us keep a good measure of when something falls off the path of acceptance, and when we may need to articulate something more clearly that’s important to us (this is where agreements come into play).

While I’m far from a relationship counselor – except when it comes to the relationship we each have with our body, our symptoms, and our healthcare team – here are some Non-Negotiable expectations I believe we each deserve in our primary relationships. (Please feel free to add to the list and put those in the comments as we co-create!)
✓ compassion

✓ respect

✓ consideration

✓ time

✓ interest

Note: The compassion, respect (and so on) that we expect from various types of relationships differ. We don’t expect the babysitter to assess our elbow rash, or the tax accountant to discuss our anxiety. We don’t think to ask the heart surgeon to look at our toenail fungus. Yet somehow, we’ve fallen into the idea that many of our other doctors – no matter their specialties, whether they be GPs or OB/GYNs or Endos or Gastros – know everything. This may include the tests we want them to run or the nutraceutical solution to a sign or symptom that replaces the standard pharmaceutical prescription. It’s important to consider and respect that they might not know what you know for a variety of reasons.

If you’ve ever worked for anybody else and had to “manage up” (i.e. manage your boss or supervisor to best navigate your on-the-job situation), think of it like that. Or if you’ve parented a teen and need to carefully avoid landmines while expressing your care, concern, and advice… yeah, that. The stakes may feel different (it’s your health and body, after all), but the approach is similar.

Head back here next week so that I can provide you with some swipe copy (ie. copy you can cut and paste to send to your own doctor) for how to communicate and create agreements.

And while you are examining your options, ponder where you may have had expectations that you can reframe as agreements the next time you see that provider. Meanwhile, consider if there is a way to find another provider and start with those agreements from the outset. 

You may have more choice than you think!

Just because I have my standards they think I'm a bitch.  

– Diana Ross

I’d like to share a personal story about finding an option I didn’t know existed when it came to choosing a doctor. It’s the kind of option that can make you feel like a burden, a bother, and any other B-word Diana Ross might pull out of her knee-high boot.

This story goes way back to the summer of 2000, after my husband Isamu was diagnosed with his brain tumor. Following his first marathon resection (16 hours of surgery to remove as much of the mass as possible for pathology and prognosis), he was assigned one of the neuro-oncologists at the UCSF brain tumor center who worked with his tumor type. She came to his hospital room to deliver the news about the pathological assessment. I’ll never forget her. Or that moment. (I just visited the center’s website to see if she still works there and got chills. She does.)

As we know in retrospect, the news was not good. Nor was her delivery. I don’t know that I could do any better, so I don’t blame her, but I wish she had left her pity at the door. Ultimately it was a personality mismatch between Isamu and the assigned Neuro-Oncologist. 

When she told us that 5% of patients make it to the one year mark post diagnosis, Isamu was determined to be among that 5%. When she added that only 5% of those 5% live to 5 years, he made his intentions clear. 

Her pragmatism was melancholic. 

His pragmatism was tenacious. 

This was over twenty years ago. We didn’t know what we now know about the role of genes and the potential of Precision Medicine for improving cancer outcomes. I certainly didn’t know what I now know about the terrain in which cancer can grow. This was all a jolt of a wake up.

One lesson we learned was that we could ask to change doctors at the brain tumor center. It took some encouragement because 1) we’d never been assigned a doctor before, especially not for something so grave; and 2) there were only three doctors to choose from for his particular care. 

Reality check: we’d most certainly run into the doc we were dumping in the hallways!

Would that be awkward? What would she think of us for ditching her care? 

The answer: Who cares! 

In order to TAKE care, you sometimes have to find the care that works for you. And sometimes the littlest shift – in our case, from Dr. C to Dr. P, right in the same practice – can make a world of difference, where tenacity and candor meet their match. 

Don’t be afraid of what anybody will think if it will ultimately serve you. 

STEP 3: TAKE CARE (HOW-TO)

This third step in our 3 Steps for Moving On After Medical Gaslighting is what the pages of this blog are all about. This step allows us to nest in a place of optimal self-health while exploring our needs, wants, desires, and beliefs (!!) around health and healthcare. 

TAKING care is a place we get to live, not just visit.

Many of us are really good at taking care of so many things: our partners, our kids, our parents, our communities, our work. And I’m not here to remind you to “secure your own mask before assisting others” (We hear that enough!).

Instead I want to encourage you to actually TAKE it. 

This isn’t about prioritization. We’ve got to move beyond that. You are your #1 priority. Let’s assume that’s a given. This is about ownership and agency. And while freedom and possibility and resources of all sorts will look different for each and every one of us, I’m guessing there’s still a place for you to TAKE some of what you actually need.

If that looks like TAKING a bite of cake because you’re tired of the world telling you that you can’t, and that’s what you define as part of your healing… TAKE it!

Or if it looks like TAKING a food or beverage off the menu because it doesn’t make you feel good, despite the social, familial, or medical pressures you feel to fit in or “go with the flow”... TAKE it (out, in this case)!

Your TAKE care is going to be different from mine. 

And it may be different today than it was last year, or that it will be in five. And while we’ll continue to explore this, remember that what you’re TAKING is seriously (and solely) for you. Your blood and bones. Your flesh and feelings. Your genes and glands. All of you. 

If you think it’s self-health to do something in reaction to (for, or against) some pressure or force outside of you, remember that in doing so, you are not actually TAKING care (of you). Sometimes TAKING care looks like saying “yes.” And sometimes it means “no.” But it’s always a radical act of self-transformation. 

Medical gaslighting can make you feel minimized, unheard, misunderstood, dismissed. Maybe you start second-guessing yourself. That sucks. Yet it’s even worse when your provider is unable to recognize the needs of those who occupy bodies different than their own – whether the differences are due to gender (or gender norms), sexuality, race, class, culture, body size, identity, or situational circumstances. 

“If any female feels she need anything beyond herself to legitimate and validate her existence, she is already giving away her power to be self-defining, her agency.” 

- Bell Hooks

All bodies can suffer from discomfort, dysfunction, and dis-ease. Kidney failure, cancer, and Hashimotos don’t discriminate. Nor does any other illness.

It’s crushing to know that health and medical providers can help, but sometimes do not. And so I find myself awkwardly fumbling my way out of the exclusivity of the field I love and the modalities I believe in (Functional Medicine, Functional Nutrition) to explore access. I trust the Functional approach. We all deserve this kind of care. Yet I’m tired of seeing it restricted to those with the means to know it exists or those who can afford concierge services and a battery of tests (that may or may not be necessary).

Nutrition need not be a dirty word

I don’t believe that Functional Nutrition needs to be expensive (or offensive – as “nutrition” seems to have become – in an age where we ditch the diet and reclaim our bodies and desires). I do not believe in conducting all the testing before it’s clinically time to do so. I do believe in the democratization of Functional Nutrition – in exploring how we all find the Functional Nutritionist in our own back pocket. And this is where I stumble and trip, learning what it means to be an advocate for care, especially for those who are sick and not getting better. It requires patience, humility, empathy, and a good ear. It takes caution, vulnerability and compassionate leadership to offer what I know about the body and its healing potential, even when these discussions are complex, nuanced, and sometimes political.

As I think through my tips for moving beyond gaslighting, I consider: are these tips only relevant for those who were gaslighted and then had the resources to find the provider who would become their savior? (If that’s you, you are very fortunate!) Or can I design them for those for whom gaslighting is expected and baked into their personal or familial history? I know the answer. And I admit that I may not know all the answers. I cannot know all of your experiences. But I do ask you to try these steps on for size, as I discuss them this month, and to speak up and let me know if I missed something that is true for you.

So what’s next after those incidents that leave us feeling like we need to legitimize and validate? How do we move beyond the anger and frustration of not being able to trust a healthcare provider to do what we thought they would/should/could do? And more importantly, how do you overcome the possible disappointment in yourself for not trusting your gut as quickly as you wish you had?

I have a lot of feelings about how we’re looking to medicine and certain medical professionals for the wrong things, but before I go there, let’s talk about us… the patients. Because let’s be real, nobody will take care of you like you.

As you consider those steps, which I promise I’ll explore in more detail, we need to acknowledge that stories of medical gaslighting sit on a spectrum. The experience I shared last week was little ‘g’ gaslighting, but it woke me up. Unlike intimate gaslighting, which often stems from narcissism and abusive intentions, medical gaslighting is usually more naive. It comes from

• lack of knowledge

• limited understanding of the contributing factors of illness beyond what can be “fixed”

• insufficient time (or other resources) for empathy, or

• potential distrust of the patient experience

In other words… it’s not about you. 

Until it is.

Adrenal Fatigue was not the answer

Once again, it was about me when I went to the naturopathic doctor asking what was happening in my body several years after my husband died. This was way back when the diagnosis du jour was “adrenal fatigue”. In my 15+ years in the healthcare space, I’ve seen this zeitgeist shift plenty of times. Parasites. SIBO. Candida. Mold Toxicity. Heavy Metals. Heck, people used to claim their MTHFR was the root of their problems and point to their SNPs as a diagnosis. I’m not saying those things don’t exist or that they don’t play a role in health outcomes. They do! Yet I have issues with clinicians who get hooked on these conditions, diagnosing all patient problems through that lens alone. Like the parable of the three blind men touching the elephant, this can become a quest to confirm bias. (Isn’t one sign of a good scientist to prove yourself wrong, not right?).

The well-meaning ND that I saw heard my story: the loss of my husband, raising a small child, putting myself back through school, and a full-time job. From this she determined (without testing in a circumstance where I would have welcomed it) that I had adrenal issues. She prescribed a supplement regime based on the supposed diagnosis. 

The results were bad. I could not get out of bed while on the prescribed nutraceutical plan. Her response: “this is what you have to go through in order to improve.”

That right there is a form of medical gaslighting. I shared my experience and it was dismissed. In fact, the truth of my situation (my adrenals were fine and I had the onset of autoimmune thyroiditis), was never properly assessed until much later. I was seen as a young “widow”, a single mother, a driven woman, and treated for that. My history was heard, but not placed in the context of my concerns for long enough to establish an appropriate diagnosis. Again, I want to recognize that there are a spectrum of medical gaslighting situations that escalate all the way up to a capital MG, many of which I’ve witnessed firsthand in my years in practice. But I want to consider how we shift the power and truly start to get our health needs met. 

You too? 

Tune-in

I invite you to sit with the three steps listed above. If you have a moment in your own personal history that you can define as medical gaslighting, tune in to where it sits in your body. How does it impact your relationship with medicine, health care, or even yourself? 

Next week we’ll kick off by exploring how to move through the steps so that we can all do a little spring cleaning of these toxic experiences.

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