There has never been more information available about what to eat, which supplements to take, or which labs to run when you have Hashimoto’s. And yet so many women feel like they are doing all the things and still haven’t arrived where they hoped they would be. This episode is about the layer underneath all of it, the one that makes everything else you’re already doing land differently.
Inna is joined by Andrea Nakayama, a functional medicine nutritionist who has spent more than twenty years in this work, trained over nine thousand clinicians, and lived with Hashimoto’s herself. What makes this conversation different is that it doesn’t start with a protocol. It starts with a story. And in Andrea’s hands, that story becomes a completely different way of understanding your own healing, one where the answers you’ve been searching for out there turn out to be much closer than you thought.
The Triggering Event Behind Andrea’s Hashimoto’s
Andrea’s path with Hashimoto’s began against the backdrop of one of the hardest things a person can live through. In April of 2000, when she was seven weeks pregnant, her late husband Isamu was diagnosed with a brain tumor and given six months to live. He outlived that prognosis and passed away when their son was nineteen months old.
The hormonal shifts of pregnancy, layered on top of that kind of sustained, life-altering stress, created exactly the conditions in which autoimmunity takes hold. What’s striking is that Andrea didn’t even know she had Hashimoto’s at the time. It was years later, while putting herself through school as a single mother and building a new career, that she recognized the autoimmune pattern in her own mother’s thyroid, and only then connected the dots to herself. It’s a reminder of how long these things can be quietly building beneath the surface before anyone names them, and how often the trigger is not one single thing but a life that became hard to carry.
Sitting in the Synapse: The Pause Between a Symptom and a Fix
One of the most original ideas Andrea shares is what she calls sitting in the synapse. A synapse is the small space between one thing firing and the next. And she uses it to describe the space we’ve almost entirely lost: the pause between feeling a symptom and reaching for a fix.
We’ve been trained out of that pause. We can see an ad and buy on it in seconds. We can hear on a podcast that we should be taking something and order it before the episode ends. Andrea’s invitation is not to stop taking care of yourself, it’s to let a little space exist first, so you can ask what’s actually happening and what your body is really asking for. That pause is where the useful information lives, and it’s the thing most of us skip on the way to the next solution.
Why Tuning In Matters More Than Outsourcing to Another App or Test
Andrea describes a culture where we’ve handed over our most basic self-knowledge to devices and products. Someone asks how you slept and you answer with your ring score. Someone asks if you’re hydrating and you name your electrolyte brand. These are things we used to simply feel, and now we outsource them.
Her point isn’t that the data is useless, it’s that we’ve stopped checking in with ourselves first. She uses electrolytes as an example. They’re genuinely important, but a single packaged formula gives everyone the same four minerals in the same ratios, when what each person needs is individual, and often the real question underneath is simpler: am I actually drinking enough water? She talks about seeing bloodwork from people faithfully taking electrolyte powders whose labs clearly show they’re dehydrated. Sometimes the most advanced thing you can do is return to the basics and pay attention.
This is also where Andrea makes a case for not overlooking standard serum labs in the rush toward functional testing. Basic bloodwork, read carefully and in context, tells a rich story, and something as simple as hydrating before a blood draw changes what those labs can show you. Functional testing has real value, and so do foundational labs. It’s not either/or, it’s about not skipping the ground floor on the way upstairs.
The Story, the Soup, and the Skill
One of Andrea’s most useful frameworks is the story, the soup, and the skill.
Early functional medicine, she explains, was almost entirely focused on the skill, meaning what to do, what to take, how to fix it. Then the focus swung hard toward the soup, the internal terrain of mitochondria, histamine, gut bacteria, everything that could be going wrong inside. What got lost in both phases was the story.
The story is your history. It’s the family patterns you inherited, the triggering events across your life, and what Andrea calls the mediators, the things that reliably make you feel better or worse. Knowing that a 9:30 bedtime leaves you feeling like a different person than a 10:30 bedtime, or that a glass of wine with friends costs you a full day of energy, is information no lab can hand you. She calls those mediators your personal superpower, and reclaiming them is a huge part of what shifted her own health.
Three Roots, Many Branches: A Different Way to Look at Autoimmunity
The symptoms of Hashimoto’s, whether it’s hair loss, fatigue, breast tenderness, brain fog, or changes on the scale, are the branches of the tree. Chasing individual symptoms, Andrea says, is like sawing off a branch. It doesn’t help the tree actually thrive.
The three roots she identifies in autoimmunity are genes, digestion, and inflammation. All three are always in play, and all three need tending. The things we love to blame, like mold or histamine, aren’t roots at all, they’re part of the soil that influences the roots.
Digestion is where this got especially real. Inna and Andrea dig into how often people reach for a new digestive enzyme, feel great for a few days, then feel nothing, when the bigger conversation is the one no one wants to have: are you actually chewing? As Inna puts it, if you swallow a piece of lettuce whole, there isn’t a bottle of enzymes on earth that will finish the job. Andrea agrees, chewing is what activates the body’s own chemical secretions in the first place. Enzymes and stomach acid support absolutely have their place, and they work far better when the mechanical foundation of thorough chewing is there to begin with.
You Cannot Heal in Fight or Flight
Andrea says it plainly: the body cannot heal in a sympathetic dominant, fight or flight state. And that state, the be-all-things-to-all-people, always-doing mode, is extraordinarily common among women with Hashimoto’s.
This is where healing stops being about a supplement and starts being about permission. Andrea dances four times a week, in a room full of people of every age and shape, where someone else calls the moves and she simply gets to be in her body. There’s growing research, she notes, that joy, connection, and movement are as anti-inflammatory as the fish oil or the turmeric, and yet these are the exact things we cut first when life gets full.
Inna gets honest here too, sharing how even with a husband who actively encourages her to go, take the trip, see her girlfriends, the guilt still shows up and can rob her of the very joy that would help her. It’s something she’s worked on for years and still practices. Naming that guilt when it appears, rather than letting it run the show, is part of the work, and it’s a place so many listeners will see themselves.
What a Week in Tokyo Revealed About Real Health
Andrea recently spent time in Tokyo visiting her son, and came home describing it as a parallel universe. Health there isn’t packaged into a supplement or a protein bar. Older people move through the city, up and down subway stairs, without being remarkable for it. Convenience stores sell freshly made rice, fish, miso, and pickled vegetables. Her son starts every morning with the same nourishing seven-dollar breakfast and can’t imagine beginning his day any other way.
What she felt there was closer to the ancient idea of eudaimonia, a word that points not to happiness as a passing emotion but to flourishing as a way of being. Health woven into ordinary life through food, movement, community, and a gentler relationship with time. She describes a café where you’re handed a postcard and a poem and write a note to yourself that they mail back to you a year later, a small, tender act of caring for your future self. None of it requires a plane ticket. What it requires, she says, is permission to slow down.
A Final Note for Anyone Who Is Still Searching
If you’ve tried a lot of things and still don’t feel like yourself, Andrea’s invitation is gentle and a little countercultural: take one step back instead of one step forward. Pick a single area, your sleep, your hydration, the way you chew, the guilt that follows you when you do something kind for yourself, and just get curious about it. Not to diagnose it. Not to fix it. Just to notice.
That noticing isn’t a detour from the real work. It is the real work, the ground everything else you’re doing gets to stand on. And it’s where healing finally has room to begin.
Connect with Andrea Nakayama
Substack: AndreaNakayama.substack.com
You can also find Andrea by name across the major platforms.
Full Episode Transcript
Inna Topiler CNS MS (00:01.623)
Andrea Nakayama, I am so excited to have you. Welcome, welcome to Thyrid Mystery Self, Toshimoto’s and Hypo-Thyroidism Reveals.
Andrea Nakayama (00:11.156)
I am thrilled to be here with you, Ina. So excited to chat.
Inna Topiler CNS MS (00:15.449)
Yes. Andrea, you have had Hashimoto’s. Before it was cool to have Hashimoto’s. Before people knew about Hashimoto’s. And since then you have such a story. so many things. And I think that your story and everything that you’ve been through in your overcoming of adversity and how that shaped your diagnosis and subsequently.
How you were able to bring that to your mission, how you were able to feel better and do all of the things that you do and accomplish all of the things that you have, I think is so inspiring. It’s just, it’s really inspirational. And so I don’t typically start with people’s stories, but I think in your case, this is different. And I think that my listener is going to resonate so much, and it’s going to be so helpful for them to understand how it all fits together. So
Can you start by just telling us a little bit more when were you diagnosed and what happened?
Andrea Nakayama (01:15.628)
Yeah, I’m gonna go back a little further because as we know, there’s typically a big triggering event. The situation is ripe for the Hashimoto’s, but there’s an event that happens or something that shifts our biological function. And for me, I’m gonna go back to April of 2000 when my late husband Isamu was diagnosed with a brain tumor when I was seven weeks pregnant.
So, you know, I’m gonna ground that I am a functional medicine nutritionist and I can see through this lens. At that point, I wasn’t in the field. I was just a woman in my 30s, going through a lot of hormonal changes, as we do in pregnancy. Pregnancy itself can be a trigger for autoimmune conditions. But then I’m going through a lot of stress on top of that.
Isamu, my late husband, was given six months to live. I’m seven weeks pregnant, so he wasn’t expected to live to see our child born. So that’s tremendous flurry of stress, not the everyday stress, though there’s that too, but like this extreme situation. So at this point, I will say I didn’t know I had Hashimoto’s.
Prior to his diagnosis, something wasn’t right. That story that we can all relate to. This is way before Dr. Therese Tatis Karazian was writing about your labs are normal, but you don’t feel normal. None of that was in the domain of thinking about health. I mean, I’m going back to a time when really all there was in nutrition was Andrew Weill. You know, there wasn’t online searches.
So Isamu was diagnosed. We went through that period of time. Our son was born. And Isamu lived two and a half years. So he outlived his prognosis. He died when our son was 19 months old in July of 2002. And it wasn’t for several years that I realized I had Hashimoto’s. And the way I realized was because of my mom’s thyroid.
Andrea Nakayama (03:35.191)
Issue. So I was starting to get into the field, put myself back through school, and I was identifying that something wasn’t right with her thyroid. And I could see that it was autoimmune. And then that helped me realize that mine was autoimmune as well. So that probably was, you know, 2006, 7.
So back in the day when everything was seen through only you know, hypothyroidism lens, no autoimmune in the thinking.
Inna Topiler CNS MS (04:15.215)
Yeah. Yeah. Wow. I mean, it’s I’ve, you know, heard the story, but you know, every time listening to it, like just my heart. Like, I can’t even imagine. I can’t even imagine that. Honestly, like I don’t even know what to say. and of course, like you were saying, that triggering event. And it’s hard to know, right? Like how long things have been brewing, but we know with autoimmunity.
Andrea Nakayama (04:37.912)
Yes.
Inna Topiler CNS MS (04:39.931)
We have our genetic predisposition, we have a lot of other things in nutritional deficiencies and toxins and all this stuff, but then it’s usually the one thing that’s gonna bring it into up to the surface. So at that point, now you weren’t in nutrition still then, right? When did you get your training? Yeah.
Andrea Nakayama (04:41.868)
Exactly.
Yes.
Andrea Nakayama (04:52.428)
Yes.
Andrea Nakayama (05:00.148)
Yeah, so the training was long because I was thinking I was going to go to become an RD. So I did all my post back, pre-med, pre-rex, which took me years because I was working full time and a single mother. So I was going back to school for years. My undergraduate degree is a Bachelor of Fine Arts, which has come through in my work. I think people can see the art and the design and kind of the
Held experience in the work that I created. But it took then many years to go back, put myself through school, amass many certifications because I decided not to go to the program that I got into, the only dietitian program I would have considered, ultimately get my master’s of science in human nutrition and functional medicine, just lots of years of training. But as you are pointing to, the Hashimoto’s diagnosis came.
Early in that journey. So I was already starting to understand what autoimmunity meant. What does that mean for my body? I certainly didn’t have the systems that I then taught to other patients and ultimately to other practitioners to understand how to work with autoimmunity, but I started to see how there was a
broader perspective I had to take as you speak about so beautifully not just addressing the thyroid, but understanding that the thyroid is existing in a terrain or a milieu that I had to tend to. Meanwhile, having a highly stressful life, which so many of us do. I mean, my triggers were my triggers, but so many of us have lives that are hard to
digest when we hear them when we hear somebody’s lived through what they’ve lived through.
Inna Topiler CNS MS (06:59.097)
So what did you do next? Like once you realized that it was autoimmune and then eventually, you know, more testing came, but what were some of the first thing they s that you did and what did you really think or feel that moved the needle for you?
Andrea Nakayama (07:14.752)
Yes, I think that understanding for me, context has always been queen. And so understanding how the immune system works and that my immune system was overreactive. So it’s not about immune boosting, it’s about management and where do I need to calm and cool in addition to supporting it to do its job.
And how do I understand what an antibody is? Like that has always been my approach and how I taught other clinicians too. And you know, ultimately I’ve I’ve trained over 9,000 clinicians. Almost half of them were nurses. And even though they had learned anatomy and physiology, they didn’t understand it in relation to dietary and lifestyle. Like, what do we do?
when the immune system is overreactive, other than give it a suppressor, right? Like an immune suppressor, which is what we typically do medically or conventionally for an autoimmune disease. We suppress the immune system. But that can lead to other downstream effects. So
I just started to really think differently about my nutrition. How could I make sure I was getting the nutrients I needed? How could I make sure that my sleep was sufficient? And that really came to light during perimenopause. And there’s such a connection between the thyroid and the sex hormones, which, you know, as you age with Hashimoto’s, you really experience in a different way. But I really started to look more
Broadly, sleep and relaxation, exercise and movement, nutrition and hydration, where were these things? Stress and resilience, relationships and networks, those are the core basics in a functional, a truly functional medicine approach, and tending to them with everything I had without getting into little fixes, but really nourishing the environment.
Andrea Nakayama (09:27.638)
As an example to answer your question, recognizing that my bedtime needed to be secure and I needed to really hold it, even though I was starting a new business, growing a business quickly, a single parent. Of course, my best work might happen at 11, but that didn’t serve me. Having a drink with girlfriends, going out on a Friday or Saturday night, fun and connected.
But the next day, feeling kind of my whole energy depleted and paying attention and going, risk reward, risk reward. Can I still go out and connect with the girlfriends, but not have the drink? And still feel the connection, the good part, but not have the next day’s, I don’t want to call it a hangover because I wasn’t getting drunk, but I could feel as a person who doesn’t tend towards.
Mental depression, my body just feeling more depleted. And I couldn’t afford that as a single mom, putting myself back through school, trying to build a business. You know, I needed the energy I needed. So I think the answer to your question was paying attention without constantly looking for a quick fix.
Inna Topiler CNS MS (10:50.927)
I love that so much. And we were just chatting about this before we hit record. And I think this is just something that right now, especially with all that we have, with social media and YouTube and just information. there’s information everywhere, right? And most of the things, especially if you look at some of the things on social media that go sort of quote unquote viral, right? They’re typically like,
If you’re not doing this, you’re gonna have that. So do XYZ. Or, you know, here’s the 10 things that you absolutely need to have in order to get rid of, you know, whatever it is. And a lot of those things, you know, not to say that they’re wrong. I mean, of course they have merit, but we’re all different. And so I think for so many of us, I love what you’re saying that it’s like, I feel off. Okay, well, what vitamin can I take? And obviously, this is coming from me.
Andrea Nakayama (11:28.355)
Yes.
Inna Topiler CNS MS (11:44.23)
Who is a formulator of nutrients? So I love nutrients, and I am in no way saying nutrients are bad, right? But it’s what you’re saying. It’s this really balanced approach. It’s sitting in, okay, well, what am I feeling? And also going back to, okay, well, where what caused that? Versus like, let me try to fix it. And I think this is one of those things, and especially with Hashimoto’s, though I think as women, this happens to us where we
Andrea Nakayama (11:49.048)
Same.
Inna Topiler CNS MS (12:14.031)
Don’t like to feel uncomfortable, which I totally understand. No one doesn’t. I’m not saying that we should feel uncomfortable. Like if we have a headache, we want to do something about it. But I think when we have an emotion, right? Which is our energy that’s in motion and it doesn’t feel good so often, right? Like we’re blocking out, we’re like, I don’t like this. So how do I numb it? How do I replace it? How do I, you know, and I think even just with positive affirmations, which
Andrea Nakayama (12:16.344)
Yes. Yes.
Andrea Nakayama (12:40.994)
Yes.
Inna Topiler CNS MS (12:41.137)
You know, we’re all told like, you feel bad. Think positive. Think this. And not to say there’s room you know, there’s no room for that, but how do we just feel what we feel, even for a short period of time, to stay with that?
Andrea Nakayama (12:51.874)
Yes, yes. Yeah, it’s I think of what you’re talking about as sitting in the synapse, right? And a synapse is a space between one thing firing and another thing firing. And what you’re talking about is the feeling of the the feeling, the sensation or the symptom or the sign and the doing. And we forget the synapse and everything, if you think of serotonin or dopamine, they have to move between receptors.
And stay in that synapse for a little bit of time. And we’ve forgotten the pause. And we do, it’s so easy to do. We can see an Instagram ad and buy right on it. We can be told in a podcast or some other thing that we should be doing or taking. And it’s universal. It’s told to us as if it’s universal. I will say going years back, because I’ve been in the industry now for 20 years.
I used to talk about it as the epigenetics of the online telesummit to my peers, to Isabelle Wentz and Sean Croxton, and the people that were at the early stages of the health and wellness mafia, as I like to call it. That when there were a lot of summits that were happening online.
Inna Topiler CNS MS (14:03.547)
Yeah, it’s
Andrea Nakayama (14:10.68)
We, the experts, were coming on, and a lot of people were giving advice. If this is happening, it could be this diagnosis, and here’s the nutrients to take. That is not individualized care. People are then, us as patients, are left in the position of self-diagnosing and self-treating. And you and I were talking about this earlier as well.
We don’t know if that’s the right thing for our bodies. And the reason I’m calling it epigenetic is because all the things we do in life impact our physiological function. Those are the things that influence our genes. And we could have the wrong things coming in and influencing that genetic expression as well as the things that positively influence. And the wrong things aren’t necessarily just, you know.
Alcohol or ultra-processed food or whatever we want to blame, they’re also taking the wrong thing for our particular needs and our particular body. And I see this happening even at the most basic level, like with electrolytes, right? Electrolytes, yeah, yeah.
Inna Topiler CNS MS (15:22.223)
Yeah, tell talk to us about that because everyone loves electrolytes.
Andrea Nakayama (15:27.116)
We need our electrolytes. Our electrolytes are our four minerals that keep us in balance at the cellular level. But when we take an electrolyte supplement, that is all four nutrients, including two we don’t often need because we get them from our food, and two that we might need in different ratios individually, and they come packaged with lots of fillers and potentially you know, chemicals and sweeteners. We’re not
Actually, doing our body good. We have to think on a more individual basis. And the first step is: Am I hydrating enough? Yes, we may need more electrolyte support, but we need to trial and error. What happens if I add a little bit more salt? How’s my magnesium ritual at night? As opposed to taking a you know pat packaged.
supplement or powder that we’re told is good for all of us.
Inna Topiler CNS MS (16:32.145)
Right. Yeah, absolutely.
Andrea Nakayama (16:33.802)
I see people’s blood work all the time who are taking electrolyte powders and I can clearly tell they’re dehydrated. And it’s because they could I can s in yeah. So in I really love to look at serum labs. So baseline labs I feel like get overlooked too often in favor of the functional labs. So
Inna Topiler CNS MS (16:42.523)
How do you see that on Bloodwork? Tell us more.
Inna Topiler CNS MS (16:57.413)
Hundred percent.
Andrea Nakayama (17:00.888)
I’m not against the functional labs, although I think there’s some that are not necessary and leading people astray. I also think people are doing too much at once, but I think we’re bypassing the gross information. Again, as a functional medicine nutritionist, I wanna look at the soil, the terrain, what does this all live in? And when we need information, more information.
Inna Topiler CNS MS (17:08.186)
Agreed.
Andrea Nakayama (17:27.608)
Go get more information because it’s gonna help us clinically. A lot of times those functional tests aren’t helping us clinically because they’re giving us information too far down the line or that we know is gonna be off and gonna lead us right back to what we would have done without spending that money. I’d rather somebody spend their money on a massage or acupuncture or something where they can just go into a
Inna Topiler CNS MS (17:40.689)
Exactly.
Andrea Nakayama (17:51.383)
parasympathetic rest be taking care of state as opposed to doing self-diagnosing or telling themselves they’re wrong. So serum lapse. I can see through somebody’s CBC with their differential and their red blood function if they are likely to be dehydrated. And that might just be you didn’t drink water before your lab draw.
Which is an important thing to do, even if you’re taking a fasting lab, you want to be hydrated before that lab. The blood will flow easier for the draw, but it’ll also give us a clearer sense of how your blood is functioning. but I can see.
Inna Topiler CNS MS (18:34.799)
And it’s amazing how so many providers will say, No, no, no water, nothing and I was telling people, No, no, water is okay. It’s considered fasting. But like a lot of the staff at most doctors’ office, if you call, they’ll say, No water, nothing. And then people wonder why they can’t like find our vein and why the blood’s not coming out.
Andrea Nakayama (18:39.072)
Right. Water. Yes.
Andrea Nakayama (18:47.032)
Yeah, please hydrate.
Andrea Nakayama (18:51.308)
Yes. It hurts. Yes. Yeah. Please hydrate. That is our like golden ticket for people. Like hydrate before your lab draw because it does offset what we’re seeing in the labs too. And then we might be incorrectly diagnosing or recommending based on what we see. so yeah, that’s so I can even see, even talking to my sister yesterday, she sent me her labs and I’m like, you need to hydrate. And she’s like, I
take my I won’t name the name, but that’s how people answer these days. Like we say, how’d you sleep? And we talk about our ring score. We say, are you hydrating? And we talk about which electrolyte we take. Those are basic functions that we don’t need to pay for. We need to tune in. How did I sleep? I feel like I slept pretty well, but I did get up once, you know, it’s
It’s really tuning in versus outsourcing always to somebody else’s expertise.
Inna Topiler CNS MS (19:59.274)
So many different angles, right? From the medical providers we see, which again, we absolutely need them and we need to get that personalized care. But how we feel, you know, whether whatever our labs show, right, or don’t show how we feel and tuning in is so important. But also, I love what you’re saying about the apps. I think there’s so many apps, and gosh, I mean, they do make our life easier. And there’s a lot of data that we could never have known 10 years ago, 20 years ago, right? That we know now.
But then it’s also the question of like, but is that data first of all, how useful is that data, right? Because are do we have something that we can do about each and every single one of those data points versus just collecting it? But I think even more so you hit the point is that we rely so much on the data that we forget to tune in. And that’s so important.
Andrea Nakayama (20:32.078)
Right.
Andrea Nakayama (20:35.405)
Right.
Andrea Nakayama (20:44.546)
Yes, yeah. And I will say, like, you know, through my career, I really developed the tools to help us think in this way. Like, how do we get what’s in our head out on paper? And one of those tools was the functional nutrition matrix. And I’m bringing this up for a reason based on what you just said, because we forget the data that comes from our history. And
What happened to me in years in functional medicine is I saw first and foremost we were very focused on the skill. What do I do? What do I take? How do I fix? My hair is falling out. I feel fatigued. What do I need to do? Should I eat sulforophane or not eat sulforophane for my thyroid, your broccoli? Do I
Take the selenium or not, take the selenium. Do I eat a Brazil nut? Should I eat eggs or dairy? It was all about the skill. And then as time went on, we got very obsessed with the what I call the soup or the body, everything that’s going on inside. It’s my mitochondria, it’s my histamine, all the things that we wanted to blame. And I want to just remind everybody: everything’s connected. It’s all connected. But what I’ve realized, there are things.
Three parts of a functional matrix. And this is the Institute for Functional Medicines matrix and my functional nutrition matrix. Those three parts, if I’m to label them, are the story, the soup, and the skill. So at first in health, we were obsessed with the skill. What do I do? Then we became obsessed with the soup. What’s going on? How do I fix it? What’s wrong with me? And I went on a quest to say, like, where’d the story go?
And there’s story around data, there’s story around why the data is coming out that way, there’s story around how we got here, who are we, what are those triggers, not so we can fix them, but so we can hold space for ourselves and if we’re clinicians, hold space for others based on the reality of their lives.
Andrea Nakayama (23:00.652)
And I want to say in the story, in a functional medicine context, it’s the antecedents, what’s my hist my family history, the triggers, which are the things that have happened through my life, like for me, the illness and death of my husband, could be graduate school or loss of a job or parent. And then there’s the mediators. And the mediators are what make me feel better and what make me feel worse.
And I think that this is our superpower. And it goes back to the question you asked me. What did you do? And what I had to do was tune in enough to realize what makes me feel better and what makes me feel worse. And how do I pay attention enough to know if that’s just one day or over a period of time? Our mediators are our personal superpower.
We are wonder women when we know for ourselves when I go to sleep at 9 30, I feel so much better the next day. If I stay up till 10 30, have a harder time falling asleep and a harder time getting a good night quality sleep. I just have an unlock to feeling better that nobody could teach me but me by trial and error. So
Story is what led me to narrative medicine. It what it’s what led me to see that there’s a bigger picture to our health history than the biological fix.
Inna Topiler CNS MS (24:36.982)
Yeah. Yeah. So it it did. And I think to everyone listening, sometimes you know, on the show we talk about every angle when it comes to thyroid and autoimmunity. And we talk about the importance of dealing with some of the triggers that are happening, not dealing with, but understanding and supporting, right? And we talk about sleep, we talk about stress. And I think that
Andrea Nakayama (24:37.932)
I hope that all made sense. That was
Andrea Nakayama (24:48.918)
Yes, of course.
Andrea Nakayama (25:02.029)
Yes.
Inna Topiler CNS MS (25:05.751)
Sometimes, and may I even say oftentimes, you know, people even when I talk to my one-on-one clients, they’re like, Yeah, I know, I know. And I said, Hold on, I know you know, but wait. And it’s exactly what you were saying. Hey, I feel better when I go to sleep at 9 30 versus 10 30. Most people be Yeah, I should get to bed earlier, right? But what does that mean for you? And I think that so often when there’s things that seem like common knowledge, if you will, right? But
Andrea Nakayama (25:15.138)
Yep. Yep.
Andrea Nakayama (25:25.624)
Yes.
Andrea Nakayama (25:33.89)
Yes. Yes.
Inna Topiler CNS MS (25:34.502)
We don’t take it as that. And so like, yeah, yeah, I hear, I heard it, I heard it, yeah, I should. But we take those things for granted. And listen, I’m all for a good biohack. I’m not saying that’s not important, but I think we give so much more power to, there’s this peptide. And again, there’s so much research, amazing things with peptides, then there’s a time and place, right? Because we then do this peptide, but then maybe it gives you a side effect. So then we do another peptide. So we almost treat some of these things the way we do with medications. And
Andrea Nakayama (25:44.429)
Yeah.
Andrea Nakayama (26:04.088)
Exactly.
Inna Topiler CNS MS (26:04.101)
For people who listen to the show, obviously, of course, we all understand how important thyroid medicine is. But I think for a lot of people, you know, they they think, okay, well, I don’t want to be on too many medicines. So let me fix whatever is not fixed, but I guess fix slash support, right? Whatever else is going on. Instead of going, you know, and getting diabetes, like I’m gonna change my diet. And instead of this, you know, I may need to alter certain other things. So I don’t need all of these medicines. So I’m not on the soup. And I think people understand that part.
Andrea Nakayama (26:09.592)
Yes.
Andrea Nakayama (26:18.54)
Yeah. Yeah.
Inna Topiler CNS MS (26:34.671)
But then they treat it with a whole, you know, thirty supplements in a bag plus five peptides plus, you know, whatever else, which has its time and it has its place, but it’s
Andrea Nakayama (26:38.818)
Yes. Yes.
Andrea Nakayama (26:48.6)
There’s a time and a place, and I like you, I take my supplements and I care about my food. You know, like there’s it I’m not saying either or.
you are saying we do that same thing and really what deep health in the way that historically it existed. If we I just wrote a piece for Substack, it’s not published yet on how did we get to the word wellness and where did it come from? And there used to be words like eudaimonia or even shalom, which doesn’t mean peace, it means
wholeness, right? Like it means connection. And it was never done in isolation. Those things were done in community, social context was understood, and we realized that it wasn’t just about eating this or not eating this or taking this and not taking this. And the wellness industry unfortunately has is a bigger industry, I will say, monetarily than the pharmaceutical industry. It’s larger.
monetarily than the pharmaceutical industry. So when we think about that, we have to recognize that we’re being sold to in the ways that we have put a, you know, a stop up against and said, like, I don’t want that. And it’s not that it’s necessarily wrong. It’s that, is it right for right now? And am I doing the baseline work to see whether or not I need that?
Extra step, that extra test, that extra app, that extra nutrient. And some of it’s scaffolding for a period of time, and some of it may not be necessary. And sometimes we think we’re getting a fix that has long-term deleterious effects. And that comes into being even with thyroid medication.
Andrea Nakayama (29:01.282)
And what happens with our sex hormones later on. And there’s a relationship between all of our hormones. And so what we think is a fix for now may have something that we want to think about in a longer term way.
Inna Topiler CNS MS (29:16.581)
Yeah. Yeah. Absolutely. Now, for you personally, you’re going to graduate school, you’re starting a business, and this is where you started to really put the framework together for yourself. So, what did you notice in terms of your symptoms? The symptoms you had, if you could tell us a little about that, and then how they shifted when you started paying attention to these things. And then obviously you went on to have an even bigger bigger business and a bigger business and trained thousands and thousands of people, which is very rewarding and exciting, but also a lot of stress. So
Andrea Nakayama (29:45.666)
Yes.
Inna Topiler CNS MS (29:46.29)
How did some of your symptoms and possibly maybe your thyroid antibodies get affected? Tell us more about that because I think it’s so helpful for people to just see other people’s experiences so they know they’re not alone.
Andrea Nakayama (29:51.192)
Yeah.
Andrea Nakayama (29:59.509)
Yeah, and I’m happy to share a model too that helps us think into this, but my symptoms were clearly inflammatory. Like I felt waking, but almost like a film that was around me. And I’ve heard this from other autoimmune patients too. Like you go into the doctor and they’re like, You’re not, there’s nothing wrong with your weight. And you’re like, I know, but it doesn’t feel right. And it
Becomes difficult to have anybody pay attention because it doesn’t look like the problem they equate with it. and it felt like there was a layer of film that I was moving through, and my I had tenderness in my breast that was so extreme that my then young son, like I couldn’t have him hug me. Like it was so painful. So there was a lot of inflammation and slowly but surely bringing new.
Nutrients in. I was already eating a really healthy diet because when my husband was ill, we changed our diet. So while I was pregnant, we really shifted to a pesca vegan Mediterranean diet for his health. I’m pregnant during this time.
So literally after giving birth to an eight and a half pound baby, I was like in my quote unquote skinny clothes. Like I had actually brought my body into some level of balance during pregnancy because we were eating so healthy. So I also just want to say I wasn’t starting my Hashimoto’s journey from a standard diet. I was starting from a nutritionist perspective, having
led somebody through a detailed diet, but there was still inflammation. And so that’s really where I needed to focus on clearing and calming. And it was really, I would say, primarily diet and nutrient. The testing that we have now wasn’t available. So I was doing a lot of gut work, but not with any microbiome testing or that just wasn’t available in the same way. So I was just
Andrea Nakayama (32:12.278)
doing probiotic therapy and gut healing. So it really was a three-root approach, which is part of the model that I’ve built for autoimmunity. So it was many tiered is what I want to say, but mostly based on food and nutrients that I was really focused on, baseline nutrients.
Inna Topiler CNS MS (32:37.861)
Yeah. And those nutrients you were mentioning that there weren’t as many functional medicine tests. So you were doing them based on how you felt or based on some basic blood work?
Andrea Nakayama (32:46.978)
Yeah, I was doing I understood that there was a gut piece connected to autoimmunity. So the model I ultimately designed is what I call three roots many branches. All the symptoms, the tender breasts, the hair loss, the fatigue, the puffy eyes, all of the symptoms are branches. And if we think about a tree in a field and the branches are in healthy.
Or the leaves on the branches aren’t healthy, we can pick them off, we can saw off the branches, but we know we’re not actually helping that tree to thrive. And so we have to go down to the trunk, down deeper to the roots. And what I identified also with like, you know, previous work of like Alessio Fasano and people who had looked at autoimmunity is.
Through the lens I was looking at, there was the genes, digestion, and inflammation. There were always the three roots, and all three with autoimmunity needed to be addressed. Not one. It wasn’t a mold issue. It wasn’t a histamine issue. Those aren’t roots, those are part of the soil.
That impact the roots. So the roots are always the genes, that genetic predisposition you mentioned, the gut, which I know you talk about a lot, and inflammation, also part of your paradigm. And then what I was looking at is what are this the circle of influence around each of those roots? So what are the factors?
Circle of influence is, you know, a Stephen Covey term for if we focus too narrow, we can’t get to the problem. We have to influence, yeah. And that’s the soil. That’s the terrain. So I labeled for each of those roots what the circle of influence was. So for the genes, it’s the epigenetic factors, the food, the movement, the environment, and the mindset. For digestion, it’s the mechanical.
Inna Topiler CNS MS (34:40.697)
See it. Yeah.
Andrea Nakayama (35:01.026)
the structural, the chemical, and the microbial. And we want to skip to the microbial, but we forget those other ones. And for inflammation, it’s clear, calm, enhance, modulate. And so that became kind of like being a disc jockey, you know, saying, okay, I’m thinking through the ground, not through the leaves, the branches, the trunk, the root, never one root.
Inna Topiler CNS MS (35:07.958)
Yes, yes.
Inna Topiler CNS MS (35:18.841)
Yeah.
Andrea Nakayama (35:30.392)
thinking through the soil. So what led me to the gut piece was understanding I gotta chew. I gotta make sure the secretions are working. How do I do that? I’ve gotta rebuild the structural piece which is connected to them. They’re all connected. They’re all interconnected.
Inna Topiler CNS MS (35:50.62)
Yeah. It’s so true. And just speaking of digestion, there’s so many people that I see they’re like, I tried a new digestive enzyme and it worked for like three days and now I don’t notice it. And again, I love digestive enzymes. There’s a time and place as well as hydrochloric acid if someone’s low on stomach acid, which so many of us with Hashimoto’s are. But it’s like, can we talk about the big elephant in the room? Like you are chewing two and a half times.
Andrea Nakayama (36:16.556)
Yes. Yes.
Inna Topiler CNS MS (36:17.147)
Per bite. Like that’s not enough. No amount, like if you swallow a piece of lettuce whole, there’s no amount of enzymes. You could take a whole bottle of enzymes. It’s not gonna break down the whole piece of lettuce. It’s gonna come out whole. That’s just nature.
Andrea Nakayama (36:33.176)
Yes, and chewing activates the chemical secretions that we get through the enzymes and the hydrochloric acid. Not saying we don’t need to take them at times, but the chewing is what activates that process. If we don’t chew, we’re not giving the body the chance to do what the body is meant to do. And like you said, you know, I have had a lot of stress. I’ve had a lot of
Fortune as well, I’ve been very fortunate, but there it’s come with a lot of stress and mitigating that and realizing that there’s nothing I can do to make the stress go away, but how I tune in, how I do self care, what are the things I can do to take care of myself to balance out the load of stress and I’ll just
Give you a couple of examples that I think get so overlooked in health when we’re striving and in that sympathetic dominant where the fix is. I dance four times a week. I go to dance class, and I go to dance class, somebody’s on stage telling me what to do. I don’t have to make a decision. I just get to move my body with like 50 other people of all shapes and sizes, ages, colors, and have a
Great time. That is a release for my body. There’s more and more research showing that joy and connection and movement are as anti inflammatory as the fish oil or the turmeric. And we’re not allowing ourselves those moments. The moments where healing and help can be done for us, like through a massage or through.
guided breath work or guided meditation where we don’t have to be in doer mode are huge for our healing as well. And so I think it’s like it’s a balancing act. I mean clearly I’m a like go get person, but like I have to notice that and make sure I’m tuned in and taking time.
Inna Topiler CNS MS (38:42.928)
Yeah.
Inna Topiler CNS MS (38:49.617)
Yeah. And this is so important, I think, for everyone listening. We overlook a lot of that. And for many of us with Hashimoto’s and women in general, when we have a lot of responsibility, as we all do, it’s just so common for us to put ourselves last and say, Well, this would make me happy, but it’s okay because I’m just gonna do this and I should be doing this, right? Or we do it and then
At the same time as we do, we feel guilty. That happens to me. And I’ve worked on this for years, but it’s a work in progress, right? Like I’ll go out with girlfriends. And my husband’s very like, he’s always, please go. Like it’s never a weird thing where he’s like, No, you should be here. Like he’s really encouraged because he knows the more I do for myself, the happier I am. And if I’m happy, he’s happy, you know. So we have a happy home. And so he’s always encouraging me. And so it’s not like I have.
Andrea Nakayama (39:14.99)
Yes. Yes.
Andrea Nakayama (39:32.014)
Yeah.
Inna Topiler CNS MS (39:37.466)
Anyone tell him you shouldn’t go. Like, if anything, he’s Please go. Even like going on a trip. I’m like, I don’t want to go for three nights. I’ll like leave. You’ll have to do more. He’s like, It’s fine, I’ll do it. Plus his parents live close by. He’s like, I’ll have my mom come over. It’s all good. Like, go. And so I go. But then I feel guilty for going, even though he was like, Please go. And sometimes we can’t help that. But you know, and I understand this.
Andrea Nakayama (40:01.144)
Totally.
Inna Topiler CNS MS (40:01.157)
But it’s hard to still shift because we know then that if you’re going and you feel guilty, you’re not gonna be in that joy. You’re not gonna be in the relaxation. And it’s just understanding that and sitting with that, and then slowly, you know, the more we practice that it starts to shift. I’ve been better. But you know.
Andrea Nakayama (40:17.996)
Yes, and just recognizing, recognizing that moment, like, this is guilt. Why you know this is I’m gonna be sitting with this. Hello, guilt. Like, thanks for being here. I don’t need you here right now. But just really being able to step away, take those moments, take that time, and not constantly be in that sympathetic, dominant go, go, go. When I talk about that circle of influence around inflammation.
And I label it clear, calm, enhance, and modulate. Part of that clearing, it might be clearing mold. It might be clearing an infection or an EBV or something, but it’s also clearing, as you and I started our conversation, the things that don’t serve us in our life. It’s clearing, you know, beliefs that we have that maybe are getting in our way. It’s coming into that place where we can be calm.
And if you’re watching this, you’ll notice I’m putting my body forward and back. That sympathetic dominant state, that fight or flight, I have to fix it, I have to be all things to all people, which is so common for women with autoimmunity, especially Hashimoto’s, isn’t a state we can heal in. It’s actually doing us a disservice. We cannot heal when the body is in fight or flight.
Not happening. So, where do we say, part of my healing is having a digital detox for half a day and not buying is taking that pause before I’m, you know, inspired to hit buy and say, Do I need that? Is there someone I can ask? What is it I think I’m gonna get out of that? Take that synaptic pause. All of those little moments put us back.
Into that rest and digest state, so we’re not constantly in action.
Inna Topiler CNS MS (42:19.865)
Yeah. It’s just part of our society to be in action these days, right? So we have to very consciously work on that for sure. Yeah. You know, one of the things that you mentioned before we hit record was that your son lives in Tokyo right now and you went to visit him. And you were saying that that’s the culture that we study so much in terms of their longevity. And, you know, there’s a lot of diseases that they it did they don’t exist there.
Andrea Nakayama (42:23.318)
I know, I know, I get it. Get it, yeah.
Inna Topiler CNS MS (42:50.269)
And we try to emulate that in ways to try to eat maybe some of those foods or even like put into supplement form what some of those foods would give us. But when you went there and you stayed there for a while, it was this, and you said it was like a pair what was the term you used? Yeah. So I mean it was very interesting because I think it relates to everything we’re saying. Can you talk about that a little bit and exactly?
Andrea Nakayama (43:10.414)
Parallel universe. Yeah, it’s like a par
Inna Topiler CNS MS (43:19.76)
Why?
Andrea Nakayama (43:20.854)
Yes. Yeah. So I will say, and you know, I loved being in Tokyo and my son loves being there. And there are downsides to the culture for sure. So I don’t want to just paint a pretty picture because there’s a lot of shame in the culture. It’s very safe because there’s a lot of shame. People behave a certain way. But the thing that I noticed that was really eye-opening and refreshing.
Is I mean there were a number of things, but I feel like health is that old form of health. It’s that flourishing, it’s just being and being in community. The older person at the metro or on the street isn’t the exception that we’re all sitting there applauding and taking pictures of. It’s just the norm. Old people are on the subway, they’re going up and down the stairs. health isn’t packaged like you were saying into a supplement or a protein bar.
I didn’t see anything about like creatine or collagen. The convenience stores are selling freshly made food, rice balls with miso or umabashi for digestion, you know, that helps with digestion or fish. The regular breakfast is filled with those foods that do all the things for the digestive system. I was telling you that my son every morning
For seven dollars, he goes to the same place and eats a piece of fish, rice, miso, pickled vegetables, and another vegetable every morning. Just eats that, it’s fresh, and he doesn’t even know how he would start his day anymore without that food versus what we think of as breakfast. So what I noticed is just a feeling of that eudaimonia, that flourishing, that
Quiet attention to a happy, connected life versus this performative way that I feel like we have done and been sold health here. And you could feel it. You could you could really feel it in the way that people behaved and interacted.
Andrea Nakayama (45:40.833)
I I want to tell you about one cafe I went to where you it’s it was so narrative medicine. I loved it. You walk into the cafe, I was able to get a gluten-free muffin and some tea. They give you a little postcard with a poem and you write a note to yourself that they mail you in a year.
Inna Topiler CNS MS (46:02.939)
My gosh. Wow.
Andrea Nakayama (46:04.054)
And just like the fact that that exists as a cafe where you can like sit down, spend time. There were pens and colored pencils and wax that I could seal my little envelope with, and just that kind of attention to detail and care and connection to myself, even over time.
versus myself right now having to be the best in my bathing suit for this summer trip or whatever it is. It’s this continuous, this longitudinal collective sense that I felt that was really surprisingly delightful and so different, which is why I think I felt it so acutely.
Inna Topiler CNS MS (46:56.581)
Yeah. Yeah, it is so different. But this is something that we all can give to ourselves. We just have to understand the importance of it, which I think everything you explained today, even though I know people know about sleep and all the things, but like it’s just there’s so much more. And I think you explained that so eloquently. And so having people first understand it and then allow themselves to do that, that’s when
Andrea Nakayama (47:13.57)
Yes.
Inna Topiler CNS MS (47:25.851)
things are really going to start to move. And especially if you’re in a place now where, you know, you don’t have to be in the flare, but maybe you’re just not exactly where you need to be yet. Like of course we want to do the foundations of the things that you’re doing. But really, really, really think about how you can just tune in and tend to yourself. I think that’s so important.
Andrea Nakayama (47:35.832)
Yes.
Andrea Nakayama (47:46.029)
Yeah, I want to give people permission as just like a final note. You know, when we were teaching thousands of clinicians, we had a clinic and the clinic was mostly for clinicians to come through. And they would come through and say, like, you really do this. Like you you really slow it down. And they would feel so much better because the expectation is that we’re gonna.
Come in and do some fancy mancy thing that’s gonna fix all the things, but that’s not how we get there. And I know that through seeing thousands of clients over the year, it really does take that solid foundation. And so as patients, I wanna give everyone listening the permission to just take a step back and say, I can focus on one of those things. Like
If I say sleep, and we all know sleep is what we should have more of, like ask yourself questions. What is happening with your sleep? What do you notice? Just slow it down without having to diagnose or analyze. Just get curious. And the more curious we are about ourselves, the more we learn. And I feel like the more room we provide for true healing.
Inna Topiler CNS MS (49:05.851)
So true. And that curiosity is so important because we don’t want to look at something as good or bad, like, no, my sleep is bad. But it’s just getting curious. What doesn’t feel right about it? Right. Yeah. Yeah. Andrea, this has been so healing speaking with you and connecting with you and having you share your story. I think that.
Andrea Nakayama (49:14.552)
Yes. Yeah.
Inna Topiler CNS MS (49:26.011)
People listening are going to not just hear it, they’re gonna feel it because like I feel the energy is literally coming through. We’re not doing this live, we’re doing it through the computer and yet like it’s it’s really coming through and I think it’s so, so important. Now for people who want to connect with you, he want to learn more from you, how do they contact you and where do they find you?
Andrea Nakayama (49:29.398)
Mm.
Andrea Nakayama (49:46.86)
Yes, please find me on Substack. I am having so much fun. I’m publishing every week that writing can really be inspiring. So you can either go to Andrea Nakiyama.substack.com or Google Substack and my name and you will find me there. and you can find me at my name on all the platforms as well.
Inna Topiler CNS MS (50:09.937)
Put all of that in the show notes. Your writing is really beautiful and it’s just very healing to read. So thank you for all of the work that you have done, all the people you’ve taught, all of the paradigms that you have shifted because you’re such a big name in this space. And the work that you’re doing now to just continue to move people forward and to just really have them come back to themselves, really.
Andrea Nakayama (50:13.568)
thank you. thank you.
Andrea Nakayama (50:39.0)
Beautiful, thank you. I had such a good time spending time with you, Ina.
Inna Topiler CNS MS (50:43.033)
Me too. We’ll talk soon.
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