Episode 96 | 20 June 2023

On this episode of the Alix Turoff Nutrition podcast, Alix sits down with Anya Rosen, MS, RD, CPT, IFNCP.

Anya is the founder of Birchwell, a virtual functional medicine consulting clinic based in New York City. Anya specializes in digestion (including SIBO, reflux and IBS), hormonal concerns (such as PCOS, PMS/PMDD and menopause), anxiety and depression, brain fog and fatigue, thyroid disorders, metabolism (blood sugar management and weight loss), autoimmune conditions, and joint pain. At Birchwell, Anya uses advanced lab testing and comprehensive assessments to identify the root cause of health concerns, which she addresses using food, supplement and lifestyle strategies.  

Some of the topics we covered in this episode include:

• What is functional medicine and functional nutrition?

• How functional medicine tests can be used in conjunction with nutrition and lifestyle strategies to improve conditions such as PCOS, insulin resistance, IBS, and other hormonal issues

• Hormone replacement therapy for women in menopause

• Hormone coaches on social media

• Functional medicine “factories”

• ….And more!

To learn more about Anya:

• Connect with her on instagram (@birchwell.clinic)

• Learn more about her services at birchwell.clinic

Alix (00:04):

Hi, everyone. Welcome back to the podcast. Today I’m joined by Anya Rosen Anya is a registered dietitian, and the founder of Birchwell, which is a virtual functional medicine consulting clinic based in New York City. But she is available to you no matter where you are, and we’ll get into that in just a few minutes. Anya specializes in a whole host of things that many of you listening may have experienced. So listen up if this is you. Digestion, which might include SIBO, acid reflux, IBS, hormonal concerns (PCOS, PMS, PMDD, menopause), anxiety and depression, brain fog and fatigue, thyroid disorders, metabolism issues such as blood sugar management and how that relates to weight loss, autoimmune conditions, and joint pain. Lots of the things that people come to us as nutritionists for that we don’t always have answers to. So I’m very excited to dive in today with Anya. She’s going to tell us a little bit about the lab testing that she does in her practice, the assessments that she has available to her that allow her to identify the root cause of health concerns, which she then addresses using foods, supplements, and lifestyle strategies. So with that, Anya, welcome to the podcast.

Anya (01:24):

Hi. Thank you so much for having me on.

Alix (01:27):

Thanks for being here. I don’t believe that we’ve covered functional medicine and nutrition in much detail on the podcast, so I have so many questions for you today, but I  like to start, as we always do with our guests, to just hear more about what got you to this place, working in nutrition, and specifically working with the population that you work with now.

Anya (01:50):

Yeah. So, you know, I’ve dealt with endocrine, gastrointestinal, anxiety issues throughout my life all of which contributed to my growing interest in health and wellness. And really the catalyst for me was a bone fracture that led to me discovering that I have low bone density when I was in my early twenties. And this led me to question everything that I thought I knew about nutrition and exercise, which I got mostly from the media <laugh>, and ultimately inspired me to go back to school and get my master’s in nutrition and become a registered dietitian. So along the way, I began offering coaching while I was still finishing my graduate degree in my dietetic internship. And during that time, I myself was struggling to get my menstrual cycle regular after coming off of hormonal birth control, which I was on for 10 plus years. Meanwhile, I kept seeing that a significant number of my own coaching clients were struggling with health issues that their doctors couldn’t resolve and I wasn’t able to improve with the basic nutrition advice that I was able to provide.

(02:57):

So during that time, I ended up also working for another integrative health provider and then completed some additional functional nutrition training and got this new toolkit that I began employing with my clients and with myself, and started seeing progress. And that really just snowballed. I realized that this was my calling and it was filling in this gap in the healthcare model. And since then that has been my focus mostly working with women, but also some men usually ages 20 to 50 sometimes younger, sometimes older, but who really understand a great deal about nutrition and have a relatively “healthy” lifestyle, but are having health concerns that they can’t really resolve.

Alix (03:47):

Amazing. And I think a lot of people fall into the category of someone who has gone to the doctor with various symptoms that are not the norm for them, and have left without any answers. And so what sometimes happens is you take to the internet if they’re not lucky enough to find someone like you because there aren’t that many people out there, or maybe there are, but they don’t seem to be as front facing as some of the louder voices on social media, and it can take them down many rabbit holes. And so there’s this big umbrella of “functional medicine”, which I think some people listening to this might be familiar w
ith, but some aren’t. How would you define functional medicine and functional nutrition?

Anya (04:37):

I think first it’s important to understand the conventional medicine model. With the current standard healthcare system, you go to the doctor, they take a quick inventory of your signs and symptoms, and from there they can offer you either a prescription, a procedure or send you home with nothing at all. Conventional medicine waits until you present with some sort of textbook diagnosis before they can really take your health concerns seriously. And in terms of nutrition, advice is usually very simple and generalized. Doctors notoriously receive very little nutrition education and they tend to be the ones that end up providing it the most, unfortunately. Personally, I believe that functional medicine involves a comprehensive assessment of your signs and symptoms alongside your entire health history and strives to understand how everything is connected to identify the underlying reason for your issues. I make sure that I’m using comprehensive labs proactively to prevent some sort of imbalance or dysfunction from escalating to a disease or illness. And also using more advanced nutrition supplements and lifestyle strategies to help people feel better without some of the potential negative side effects that you might get from medications.

Alix (06:07):

So some of these symptoms that people present with might not be life-threatening, let’s say, fatigue, although, some could argue that could be… let’s say  you’re driving and you get a car accident, but there are things that people could say, “okay, just sleep more. We’re all tired, we’re all stressed. everyone’s hair is falling out.” So okay, there’s no cancer there, but these are clearly making your life uncomfortable. And why are they happening is really the question. So when you have someone who presents to you with various symptoms, what is the first place that you start? How far back are you digging?

Anya (06:49):

The way I begin is we always do a comprehensive health questionnaire. So I have them go through this quiz online before we even meet that takes about an hour for them to complete. And that’s walking through their entire health history, all of their current symptoms and struggles involving all systems in the body, anything that they’ve tried, anything that has helped everything going on also outside of their diet and lifestyle. So I’m already trying to piece together this puzzle. And then from there, we meet and I might do a little bit more digging, ask more questions, probe a little bit more. And then from there, we always do comprehensive testing. And this varies from person to person as far as exactly what we’re doing, but almost always we do blood work.

(07:42):

And this goes beyond anything that you’re going to receive from your conventional physician, especially your PCP which usually is the one that’s running annual blood work. They tend to just do a CBC, CMP, they’ll maybe check cholesterol or vitamin D whereas we’re going way beyond that. So for all my clients, we’re doing a full comprehensive thyroid panel. We’re doing a full hormonal panel. We’re looking at different markers of blood sugar management, we’re looking at inflammation markers, we’re looking at other micronutrient markers, screening for autoimmunity. And usually adding some additional markers depending on that person’s concern. Then sometimes we will tack on some additional functional medicine testing if I think that it’s merited and that the person is really going to benefit from it. And we can go more into this later, but as much as I love functional labs, there are limitations, and we always need to take that with a grain of salt. So I don’t always use them. But we use the labs, we do some digging and from there, once we have all this information, we can create that person’s health story we can find, or at least identify potential root causes, and then come up with a plan involving food, supplements, and lifestyle to address that.

Alix (09:02):

Okay, great. So where this differs from a conventional medicine approach is the amount of time that you really have to go and dig into someone’s history because usually you go to the doctor and they’re asking you, about what’s happening right now? And you might be say “I’m bloated”, and maybe they’re asking when it started, but they’re not going as far back as… “did you have any disordered eating in high school?” So I think that’s really a big difference because what I’ll say as when I look at these conversations online, there’s some voices in the nutrition space that will say these labs are bogus or that these are fake diagnoses and functional practitioners are  just trying to take your money and give you all these supplements.

(09:59):

And there are people in the functional space doing that and that’s really harmful. But what’s so interesting about what you do as well is that you are a registered dietitian, so the nutrition piece is a very big part of it, whereas you’re not just necessarily sending someone off, you’re able to guide them with a nutrition plan to go along with it. And I think that’s a big difference. How common is it that people have come to you after having gone to other practices that do functional medicine, maybe already being on some sort of regimen, whether it’s supplements or lifestyle plan, and it’s just not coming together.

Anya (10:45):

Very, very common. And this goes back to what you just brought up, which is that time element that the practitioner spends with the patient is so essential to the functional medicine process. I’m spending time both with and without that patient thinking through literally everything. I’m walking them through their day from the moment they wake up to the moment that they go to bed, I’m asking all the details of their bowel re
gimen, I’m asking all of these questions that a doctor’s not going to be able to ask in 15 minutes. Or a large scale functional medicine clinic is also probably not asking because the time the practitioner needs to spend with that patient is nearly impossible to scale. So when you start to scale it which is happening more and more, what happens is you’re creating these, these funnels that you’re sending people on.

(11:42):

They have X symptoms, you run these tests, depending on which markers are elevated, you prescribe these supplements and by doing so, you’re taking the labs without the context and with a huge grain of salt that they need to be taken with. They always need to be combined with the patient’s presentation, and if you’re not applying any clinical judgment that’s going to churn out a regimen of 20 plus supplements with no end. And that unfortunately is what a lot of people are getting put on. So I am seeing this unfortunately more and more and with supplements, even if they’re natural, that doesn’t mean they’re completely innocuous. They, they still can have negative effects, especially when taken long-term or not as directed

Alix (12:31):

Yeah. And who knows what the combination of these things with other medications and vitamins and minerals is. And with supplements, not only can they have various effects, but the quality of supplements is also very variable across the board. 

Anya (12:53):

Of course, supplements are so poorly regulated. You need to make sure that even if you are buying high quality supplements from a professional-grade dispensary, there’s always a slight risk. So you should only be taking supplements if there’s a good reason for you to do

Alix (13:11):

I’d love to start with IBS or digestion issues, because that seems to be a big reason why people are seeking out help. Maybe they go to a gastroenterologist, they might do a colonoscopy, an endoscopy, and then if there’s nothing there, maybe they’ll test for Celiac. I know for sure that I’ve had clients ask to be tested for SIBO and have been turned down by their gastroenterologist. So outside of those main tests, what are the things that you can do to dig into the reason why someone might have digestive issues, which might vary from gas and bloating to constipation, diarrhea, and then upper GI stuff?

Anya (14:06):

First I think I just wanna highlight that IBS is ultimately a diagnosis of exclusion. It’s your doctor’s way of saying there’s something wrong with your digestion, but I don’t know why, and I don’t really have the time or the tools it takes to figure out anything more. And so patients that get this diagnosis, they’re usually told either their symptoms are in their head or they’re given some medications like laxatives, antidiarrheals, sometimes antidepressants all of which can worsen symptoms down the road and lead to more problems. So in terms of the way that I approach IBS is first and foremost, I make sure that the lowest hanging fruit has been addressed. Sometimes it can be as simple as implementing a certain diet or lifestyle adjustment, for example, increasing or decreasing insoluble or soluble fiber, or implementing things like bowel training which are two simple but impactful changes that I can do with my clients if I think it’s warranted.

Alix (15:02):

What is bowel training? 

Anya:

Bowel training is kind of exactly what it sounds like. It’s teaching your body to use the bathroomat a certain time of day or in a certain setting. And so it’s  very helpful for a lot of people that are struggling with constipation or even going too frequently. So first I can do this thorough assessment and I can see there’s definitely some things with the way that they’re eating or living that we can tweak. Now let’s say we make those tweaks and that person is still not feeling better, or there are no tweaks that I could even see that should or could be made…

(15:46):

Then we might do some additional testing. The two top tests that I do for GI issues are stool tests and breath tests. The stool test that I do is called GI Map by Diagnostic Solutions. It’s definitely not perfect. It uses DNA PCR technology to identify any sort of bacteria, fungus, parasites, and also looks at different intestinal health markers. Like pancreatic function, inflammation digestive immune response.I prefer it for the intestinal health markers. In terms of identifying bacteria, fungi, parasites, I need to combine that with that person’s presentation. I do tend to see more false positives. So let’s say we find a parasite. I do want to do a retest and confirm especially if it is a parasite, that’s something that we’re concerned about.

(16:45):

But, let’s say we find something like candida overgrowth and that person presents with all of the symptoms of candida overgrowth… they have really bad brain fog, really bad sugar cravings, frequent yeast infections. Then it’s good confirmation that that is the problem, and then we can address it. So I’m using this test as a tool, but it’s not the end all be all, and I’m not just churning out a protocol from it. Breath tests for SIBO also have their issues. And that actually tends to be more false negatives. So again, I’m combining that with their symptoms, with their presentation. Usually with SIBO we’re going to see strange micronutrient depletions on labs. So that’s a good telltale sign and also cross-referenci
ng it with symptoms. What is their bloating like? Are they having normal bowel movements? What is their health history like? Do they have any sort of risk factors that would make them more likely to have SIBO? Then maybe I’ll do a SIBO test using the breath.

Alix (17:50):

Would you say that SIBO is overdiagnosed? It seems like everyone comes to me with SIBO or having had SIBO.

Anya (18:01):

I think in the functional space it’s probably overdiagnosed, and in the conventional space it’s probably underdiagnosed, but the problem to me is less so the diagnosis. It’s more so the approach. The approach in the functional space, but also in the conventional is typically just kill the bacteria. But then the problem is that everyone is relapsing. And that’s because no one is addressing the reason why SIBO is presenting in the first place. It doesn’t just happen out of thin air. It almost always is related to a motility issue. So there’s an issue with the speed at which food is moving through the digestive tract which is leading to overgrowth. And that could be an issue with the vagus nerve. That could be a structural issue. I see a lot of postpartum women who have had a C-section or anyone that has had any sort of abdominal surgery and has scar tissue or adhesions can be a huge risk factor. Eating disorders are a huge risk factor. Undereating or even hypothyroidism. Anything that’s going to down your system are all our big risk factors. So if those risk factors are not addressed, that person will relapse.

Alix (19:16):

Super interesting! And a perfect example of both of us as registered dietitians and I even have my own GI issues, I have ulcerative colitis which is so different because there’s a clear test and treatment and generally if you take the medication, you’re fine. But with SIBO, it feels like “maybe they do have it, maybe they don’t”.  But I do see a lot of times that it keeps coming back and they’re not sure why or if that’s normal. So… the breath test is usually the gold standard, but you said there are even more false negatives than false positives on that test?

Anya (20:07):

Yeah. Also it’s a very tricky test to perform. You have to go on a very specific diet 24 hours before. 

Alix (20:17):

Right like, chicken and rice? Super plain? And then there’s also the component of having someone like you as sort of a patient advocate, whether it is them going to their doctor and reporting back, or looking at these tests or saying, “Hey, I think that we should retest”, or “we should double check these results because it’s not lining up with their clinical presentation”. And how would someone even know to ask those things or question that?

Anya (20:50):

Exactly. Unless you’re a professional in this space it’s really hard to know. And that’s why people end up turning to Google and they get down these rabbit holes. And ultimately, I do end up often interfacing with my patients’ doctors and acting as that advocate, or at least explaining to them what they need to say to that doctor. And it’s a bummer that there needs to be that third party involved

Alix (21:21):

I know. Now, another condition that seems to be either undiagnosed, misdiagnosed and just all over the place is PCOS. For some people, you’ll ask when they were diagnosed and they won’t even really know. They’ll say some doctors told them they have it. Some say they don’t. It seems to be all over the place but I often work with women who have a PCOS diagnosis. What are the symptoms that they’re presenting with and what is the experience that people are coming to you with?

Anya (21:55):

I feel like, especially in this past six months, everyone, both in my professional and personal life thinks they might have PCOS or their doctor just kind of throws that out in conversation. I don’t think that should just be thrown around like candy. But usually it’s a combination of a few different presentations. Usually it’s either the ultrasound that reveals polycystic ovaries, cycles are irregular, androgens or those male hormones like testosterone are elevated. You don’t need all three of those above. There’s actually four different phenotypes. And they are different combinations of those three. But those are the three main criteria.

(22:49):

But, the thing is that regardless, there’s always a driver of  PC S and additional testing can give us a little bit more information about that. And the approach to PCOS should be addressing that driver. So, for example, most often we see some sort of insulin resistance going on in cases of  PCOS. And that doesn’t mean that you necessarily have to be overweight in order to have insulin resistance or have something funky going on with your insulin. But we do usually see that go hand in hand with PCOS. However, sometimes PCOS can be triggered by coming off of hormonal birth control which is post pill PCOS. And that’s because there’s an androgen rebound that happens for some women.

(23:35):

So that’s why some women will go off of hormonal birth control and suddenly they’re having acne and their hair is falling out. It’s usually that androgen surge. And if that’s case, usually things will normalize on its own and not really need too much of an intervention. At least not longer term. But, you know, PCOS can also be driven by things like inflammation or even can be stress induced. And if those are the root drivers, then that’s what you need to address. So as you can see, PCOS, really can look and present very differently in different women. And it needs to be approached depending on the reason why it’s happening.

Alix (24:15):

Yes. Because at least from the people that come to me with PCOS related concerns, it’s always “you have to go on a low carn diet.” Or “ I have extra hair, my eyebrows grow back quickly, I must have PCOS” or “I was overweight as a kid and my periods were irregular, so they just told me I have PCOS” and there’s no further understanding of it. And so that brings me to the hormone experts that we see… “experts”, that we see online. And PCOS is one that they love to go after, but you’ll see generally things like, “I can help you balance your hormones” or just that phrase “balancing hormones” is a big buzzword right now. And you obviously work with people who have various hormone issues, whether they’re out of balance and issues related to that. So what are people getting at when they say that? And what are some of the red flags that people can look out for when identifying someone who probably doesn’t really know what they’re talking about

Anya (25:37):

So it’ because there’s two different camps, right? One camp is like “you don’t need to balance your hormones”. Which is silly. And then there’s the other one that’s like, “everyone has estrogen dominance” or high or low testosterone and you need to go on like a hundred supplements to address it. The reality is,it’s somewhere in between. I do see a lot of women with  things like estrogen dominance, which a lot of people used to roll their eyes at. But nowthere’s more and more solid research and evidence showing that it’s real. It’s not just a made-up buzzword, but really that means high estrogen in relation to progesterone. 

Alix (26:22):

And is that something you would test for? Because you see these thinks like “Oh my G*d, I use plastic water bottles. Am I going have too much estrogen?” What kinds of symptoms are people experiencing when they do have that? 

Anya (26:36):

Usually one of the first telltale signs is anything reflected in your menstrual cycle…. really heavy periods, really bad cramps, really awful PMs or even PMDD, really bad insomnia around your period. These are all potential signs that there is an estrogen-progesterone imbalance. But again, it could also be so many other things which is why I do like to test for that. And that is where I do use a specific functional test called the DUTCH test. And again, just like the GI map, it’s not a perfect test. Not everyone needs it. It’s a very expensive test.

Alix (27:18):

And these generally are not covered by insurance?

Anya (27:21):

Rarely. Rarely.

Alix (27:22):

Right,  A whole other issue.

Anya (27:25):

Yeah. But for the right person it can be really great. So that’s a good way to confirm at least if someone does have estrogen dominance.

Alix (27:34):

And then what would be the interventions for that?

Anya (27:39):

First we have to see if is it that the estrogen too high or is the progesterone too low? Is it a combination of both? High estrogen can be related to things like inflammation or blood sugar dysregulation. But sometimes it could be something else. For example, you mentioned the plastic water bottles… toxin exposure can contribute to estrogen, but it’s rarely just that that causes the estrogen to be high. It’s more like, your pool is already full and then this might just tip it over a tiny bit more. YWhereas low progesterone I see a lot related to undereating, especially not eating enough fat. A lot of stress I see related to it.

(28:30):

 Sometimes it goes hand in hand with things like PCOS. Or there are a lot of micronutrient deficiencies too. There’s so many different potential reasons, which is why I also always say that hormonal imbalances are not the root cause they are a manifestation of some other issue going on. So the
whole idea of going on a hormone balancing plan or protocol doesn’t really make sense because it’s almost always that your hormones are off because of something related more upstream that you need to address that sometimes is just like, blood sugar regulation or something that is just diet related.

Alix (29:20):

Right. Because otherwise it’s like, okay, so we’ll just give more progesterone, but why was that low in the first place? That’s really the root cause. And that’ a very common phrase that you’ll hear with functional medicine is “we get to the root cause” and that conventional medicine doesn’t care about the root cause. And it’s just a big argument. And then people who actually need help gets lost in that shuffle. \I love the way that you explain it because it’s really clear and helpful. 

So, speaking of hormones… let’s talk about thyroid issues. And thyroid hormone is the one that everyone runs to when they talk about weight specifically. When someone is struggling lose weight they jump to “maybe it’s a thyroid issue”. And there’s also autoimmune thyroid issues and there tends to be really only a couple markers tested when you go to the doctor. Like TSH, T3, T4?

Anya (30:30):

Maybe.

Alix (30:31):

So how do you go about wigging into what’s going on with the thyroid and can you speak a little bit about autoimmune thyroid issues like Hashimotos?

Anya (30:46):

Honestly, I’m so passionate about this having struggled with my own thyroid issues throughout my life and seeing it with so many different clients too. So like you mentioned if you go to the doctor, an endocrinologist even, and you say “I’m tired all the time, I’m gaining weight, my hair is falling out, my skin is dry, I think I have a thyroid issue.” They will test TSH and maybe they will test T4. Rarely will they do a full thyroid panel. Just checking TSH with or without T4 is not enough. Because free or total T4 could be totally normal and then free T3 can be low. And if free T3 is really low, then your thyroid function is Im impaired.

(31:36):

Your metabolism is slowed. And just to back track, to give a quick thyroid 101, your thyroid is the butterfly shaped gland. It produces T4, which is the inactive thyroid hormone. T4 needs to be converted to T3, which is the active thyroid hormone and that T3 needs to get into the cell. But T4 can also be converted to reverse T3, which is also inactive. And reverse T3 can compete for absorption in the cell with that active T3 hormone. So we need our thyroid to produce adequate T4, convert that T4 to T3 where it needs to be converted and then get that T3 into the cell. So there are a lot of different things that can go wrong along the way, which is why we need to test all along the way because someone can also have, normal TSH, normal T4, but have cellular hypothyroidism where that T3 isn’t really getting into that cell or they’re over converting to reverse T3 and now reverse T3 is kicking that T3 out of the cell. So that’s why I always test free T3, reverse T3, also test thyroid antibodies. And sometimes with the antibodies being elevated that also can contribute to thyroid damage. And that is when we see Hashimotos or an autoimmune hypothyroidism.

Alix (32:55):

Right. So are those the TPO antibodies?

Anya (33:00):

Yeah. And TgAb.

Alix (33:01):

And so that has also been something that I know doctors don’t often test. And I’m not sure what it is, I think there might be that feeling like, “Don’t question me, I know what I’m doing.” There’s also the insurance question of what will insurance cover and will I be able to get this lab work reimbursed for a patient? And then also just a lack of understanding of how to interpret these tests and how to use them. 

Anya (33:37):

Yeah. And listen, I think that doctor’s deserve more credit sometimes than the functional medicine world gives to them. Doctors are incredible. They save lives and without them we would not be functioning as a society, but just like anyone, they have certain tools in their toolkit and this is what they were taught. The training that they got is to check TSH, maybe T4 and go off of that and they’re just restricted in their ability to help you both by time and insurance. And that also is a huge factor, right? So they only have 10 or 15 minutes with you. They’re seeing 50 patients a day and they’re only really going to order tests that they know can get covered by insurance because they don’t want to end up in a situation where you have a few hundred dollars bill and you are mad at the practice. So there are a lot of reasons why they approach testing the way that they do. But my hope is that with, with younger, newer generations of doctors that they will start to, to change that

Alix (34:44):

Yeah. I have a ton of respect for doctor’s, my husband’s a doctor. But I
also see there’s no possible way he would be able to perform surgery if he was also reading about thyroid antibodies every day.

Alix (35:01):

There are different jobs for a reason. Just like I can’t come and set up a wifi router from scratch because I didn’t learn that skill. Everyone needs to work together for the healthcare experience to be as good as possible. The problem is, for dietitians and I think in the functional medicine space specifically, we’re fighting with insurance coverage and being able to earn a living as a dietitian unfortunately is very difficult if you take insurance and for doctors it’s the same thing. And I think there’s a lot of private equity interest in functional medicine…. It seems like there’s a lot of startups that are popping up. There are a few really big ones that you might hear advertised on podcasts. And I feel like some of the big names the self-help sphere are involved and it seems like there’s some weird pipeline going on there. 

(35:57):

And again, the bigger it gets, we come back to the same issue that we need to spend more time with people, we need to get to the root cause. But they’re walking out with this list of 2,500 supplements and no explanation or follow up plan. What is the patient experience at some of these bigger practices, are they actually meeting with a registered dietitian or getting any follow up?

Anya (36:37):

From my understanding, it’s different at different ones, but my understanding is that usually the model is they do an initial meeting with the doctor. That’s maybe about 30-45 minutes and that doctor orders the tests. And from there they meet with health coaches and the health coaches oversee their care after, but the doctor is still the one that recommends the supplements, I’m pretty sure. So there’s a lot of handoff that happens. And again, when you do that sort of handoff, when you lose that connection with the patient, things get lost along the way. 

Alix (37:18):

That makes sense. So maybe they’re getting some support, but how are they going to cover whatever you spoke about in your 75 minute session to translate that to the doctor, translate that back and then how do we know what the education is like for these help coaches. I know they may be able to help you implement certain lifestyle changes, but are they aware of things like…I think before you said the vagus nerve…I would never even think of that. It seems like quality control might be a little bit of an issue.

Anya (37:50):

Yeah. And I’m happy that functional medicine is becoming more mainstream and that these tests are being talked about more, but I also am worried that it’s like it’s almost just watered down

Alix (38:03):

Yeah. And then you have the doctors and dietitians who hate to speak about anything about functional medicine, they feel they’re all just grifters trying to take your money and it’s just one big fight and the people who are actually struggling getting lost in the middle, which is awful. 

So, food sensitivity tests…obviously you believe in a lot of different tests that you use in your practice, but these are not something that you use. Can you speak to why these tests  are not something that you use and what you would use instead?

Anya (38:52):

Yeah, I mean, I would love it if there was a perfect food sensitivity test. It’d be amazing if you could just pee or take your blood and know exactly what foods you should or shouldn’t be eating. But unfortunately, it’s not that simple.  So popular food sensitivity testing measures your IgG response to foods. So first of all, there is no evidence that supports its use in diagnosing food sensitivities. But I do believe sometimes that the evidence might be a little delayed. Beyond that, just thinking about the physiology behind it, IgG antibodies are produced as a normal response from your body to the food you’re eating. That’s why usually the food that’s flagged tends to be foods that you are eating the most frequently because your body is just responding to them.

(39:51):

And as a result, these tests can lead to a lot of unnecessary diet restrictions and food fears which is hugely problematic. And even moreso, it’s not addressing or even attempting to address the underlying reason why your food sensitivities are manifesting in the first place. So in general, my approach to nutrition is that I really believe that the best diet is the one that is the most broad and varied as an individual can healthfully consume. So I’m always trying to broaden the diet of the people that I’m working with. Some people do have to restrict certain foods for health reasons, but if they don’t have to, I’d rather them not. So instead if a client comes to me believing they have a food sensitivity, which is different than a food allergy or food intolerance, but if they believe they have a food sensitivity instead of saying let’s cut that food out maybe we will temporarily cut it out short term, do some testing, do some digging together to see why they may be having a sensitivity to that food, addressing that, and then reintroducing that food if we decide to cut it out.

Alix (41:04):

Right
. There’s just so many factors that could be involved with stomach issues. And so like you said first you look for the lowest hanging fruit…if someone’s not sleeping, if they’re not getting enough fiber or getting too much, not drinking water. Then those things really do have to be addressed.

Anya (41:29):

Yeah. I mean, sometimes it really is so simple. Sometimes, someone’s like, “I’m sensitive to to kale” and I walk through their diet and they’re having a giant kale salad every night. That is going to make anyone feel bloated. Kale is gas producing. But sometimes maybe they’re sensitive to kale, they’re having it in small normal amounts, it’s well cooked. Maybe it’s because they have bacterial overgrowth and that is pushing them over the edge and that’s why they’re feeling that way. So there are nuances and for some people, it really is as simple as let’s just modify your diet a little bit. Other people not so much.

Alix (42:15):

And so, the last sort of person or patient profile that I’m curious about is someone who comes to you with weight loss resistance. Maybe they’ve tried everything to lose weight and they just feel like they can’t. Is that something that you are able to address?

Anya (42:33):

Yeah, and I’ll be honest that that tends to be one of the hardest people to work with because there are so many factors to it and I’m sure you see this all of the time, probably the number one reason why I see this isn’t even thyroid or hormones, it’s because they have been yo-yo dieting their whole life and that really tends to be the most common reason why I see this. And it’s not fun to tell them that but sometimes we just need to do some metabolism repair. We need to reverse diet a little bit. We need to get your intake up because you’re eating so little, you’re not losing weight and your metabolism has compensated and adapted to that. So that tends to be one of the most common causes.

(43:18):

But then again, sometimes there are other things like you mentioned…undiagnosed hypothyroidism or subclinical hypothyroidism which can contribute to weight loss resistance. I do see also people that conflate weight gain or feeling bloated or heavy with things like water retention or excess gas. So sometimes just reducing inflammation, improving digestive function can help people feel like they’re losing weight, but really they’re just losing water or they’re just de-bloating. Sometimes it is a micronutrient deficiency that also can contribute. I see a lot of things like low vitamin D, poor iron storage, methylation issues with B vitamins that can affect metabolism can all contribute to that. But I’d say four out of five times it’s yo-yo dieting that’s the issue. And that person just really needs to work on that first.

Alix (44:22):

Yeah. And other than weight gain, for women in menopause, I’m sure they’re coming to you with other things such as sleep disturbances, issues with libido, skin issues. How can you address that?Hormone replacement? Lifestyle? Supplements? Where do you start?

Anya (44:45):

So I’m always going to start with diet first and foremost that I find I’m repeating over and over with postmenopausal women is getting their protein intake up. It’s essential for so many reasons. Then from there, in terms of lifestyle… strength training is something I’m a huge fan of at all stages of life but especially around menopause. Supplements… there are several that I do use in my practice that can be very helpful. One of my favorites is black cohosh and there are many others depending on the person. DHEA is a hormone but is over the counter and I use that a lot with pre and post menopausal women but always according to labs. And I’m a fan of hormone replacement therapy especially at this point in life.

(45:44):

 And I do often refer out if I feel like someone is a good fit for it. So if their symptoms are really debilitating then I might suggest that. I think Hormone Replacement Therapy has gotten a bad rep in the past, but now it’s being revisited. And there’s been a lot of criticism around giving things like estrogen. And luckily I think that now we’ve come to realize  it could be more way more beneficial than harmful. 

Alix (46:17):

Yeah. I’m very interested in that too because I remember years ago even hearing about it was very controversial and now it seems that very trustworthy sources and professionals are saying, “oh, not so fast…this is something we need to revisit.”

Anya (46:36):

I know, and of course, women’s health has just been notoriously an afterthought, right? So this one study came out, people freaked out about it, they said HRT is bad, women are going to suffer. And there was no reason for that. It wasn’t merited. So I’m very, very happy that it’s now being used more and women are able to feel so much better throughout their life.

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