Tieraona Low Dog, MD, ABOIM and Ashley Koff, RD, join Integrative Practitioner Content Specialist Avery St. Onge to discuss how to navigate personalized nutrition in an era where practitioners and their patients are overloaded with contradictory information and data from social media and direct-to-consumer products.

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About the Experts

Tieraona Low Dog, MD, ABOIM is a leading expert and thought leader in the fields of botanical medicine, dietary supplements, and Integrative Medicine. During her 40-year career, she has led two Integrative Medicine fellowships, chaired five expert panels at the US Pharmacopeia, received a presidential appointment under Bill Clinton, published 50+ peer-reviewed articles, written seven books (four with National Geographic), received an honorary doctorate in naturopathic medicine from Bastyr University, was honored as Time Magazine’s Innovator of the Year, and is a recipient of four Lifetime Achievement Awards, and three Awards for Excellence in Science and Public Health. She has been an invited speaker to more than 600 science/medical conferences. In addition to her medical degree, Dr. Low Dog has been trained in midwifery, massage therapy, and holds a 3rd degree black belt in Tae Kwon Do.

Ashley Koff RD is a 25+ year personalized nutrition expert. Renowned for her ability to translate nutrition science into deliciously doable recommendations, Koff is a longstanding advisor, educator and strategic consultant for the media, practitioners, businesses, and organizations. Today, as the founder of The Better Nutrition Program, Koff helms a team of clinicians, coaches, and experts to create and implement personalized health solutions at scale. She lives in Maine, plays the trumpet, loves hiking and dogs, is a connector, optimist, and humanitarian. For more information, please visit TheBetterNutritionProgram.com


Editor's note: Transcripts are autogenerated.

Avery St. Onge: Hello everyone and welcome to the integrative practitioner podcast. You're on the go resource where we bring you closer to top industry experts through exclusive interviews with leaders in integrative medicine. I'm Avery St. Onge, content specialist of integrative practitioner, and today we're talking about the importance of personalized nutrition. We're so happy to have you as part of this community of integrative health care professionals. If you're interested in learning more about our membership offerings and you can get access to exclusive content and networking opportunities, please visit integrative practitioner.com/join. For today's episode, I'm joined by Dr. Tieraona Low Dog and Ashley cough. Dr. Low Dog is an expert and thought leader in the fields of botanical medicine, dietary supplements and integrative medicine. During her 40 year career she's led to integrative medicine fellowships, published 50 Plus peer reviewed articles written seven books and received a presidential appointment under Bill Clinton. Ashley is a long standing adviser, educator and strategic consultant for the media practitioners, businesses and organizations. Today as the founder of the better nutrition program, cough helps a team of clinicians, coaches and experts to create and implement personalized health solutions at scale. Welcome Ashley and Tieraona. Thank you so much for joining me on the podcast today.

Ashley Koff and Tieraona Low Dog: Thank you for having us.

AD: This podcast is brought to you by the integrative healthcare symposium, an in person event that welcomes integrative healthcare practitioners to learn make connections and source new products and services with more than 40 educational sessions including opportunities for continuing education credits, an expert speaker lineup dedicated networking events and industry leading brands in the exhibit hall, the symposium is a can't miss event for healthcare practitioners join us in New York City that's February 15, through 17. To access all of this and so much more, use code IP podcast to save 15% on a standard conference pass and pre conference pass registration for more information and a link to register see the episode show notes. So okay, we'll start with you. Ashley, can you just give me an overview of what you will all be discussing at the symposium? Yeah.

Ashley Koff: And it may actually be better to go through what we're not discussing. I'm just joking here. But it does seem like every single day, there's a new nutrition trend or a new thing, we're supposed to be tracking a new piece, you know, maybe a new product or a test we're supposed to have our patients do or a new wearable are all of these different things in this era of personalization. And I was really excited to bring together some of the best minds in personalization to say, to help practitioners today to figure out, you know, how do I actually assess somebody? And how do I talk to them about these different tools? But also how do I personally manage like staying aware and, you know, understanding what's there? What's valuable? And also, how do I bankroll all of this, whether it's myself or whether, you know, my, my, how do we help my patient afford this? So we're gonna have a very robust discussion about all the different trends in kind of where they fit under this umbrella of personalization. There's absolutely no one better than than my podcast partner here to do that, for sure.

Avery St. Onge: Yeah, I mean, and like you said, I feel like we're hearing the term personalized medicine all the time in a lot of different contexts. So, Tieraona, could you just define what personalized medicine is? And then maybe how it, it might be being misused in some contexts?

Tieraona Low Dog: Well, I actually believe that all medicine is personalized, or should be personalized, because every single person that walks into my office has their own unique story, their own values, their own diet, their own health goals. You know, I asked them, Where do you see yourself in five years? And you know, and nobody says, Oh, I'm tired and stressed. And, you know, I mean, everybody's like, you know, give me your best day and five years, and they describe being with my family, having a wonderful life. And then we talk about how we're going to get from here today to there in five years, and that is personalized. It's personalization. I think that in some regards, if we go out to the edges, some people may be you know, the personalization has become I don't know there's there's maybe a lot of pseudoscience involved a disproportionate amount of testing and, and, and the wearables which I love, by the way, my aura ring or my watch, you can pick either one, but I see people I see people also becoming obsessed then if they didn't have a good night's sleep, then Then everything is wrapped up in this. But I believe that personalization of medicine is the only type of medicine that makes any sense. And I think that most good practitioners, no matter what their profession is, what their letters behind their name is, I believe that all good practitioners have always practiced personalized health and medicine.

Ashley Koff: I love that you say that because I've actually and you know, I have a background in marketing, I have had to actually change how I describe things. Instead of saying personalized, I say, truly personalized, it's embarrassing that we have to put that in front of it. So I love what you're saying is that it's at the core, and especially to an audience of practitioners, we can say we know that the best health care is personalized, and it has to be personalized, not just in understanding physiologically that person but as you said, like understanding their who they aren't in their path. To me, the biggest challenge is the direct to consumer products and services that are being sold as personalized, but don't actually have the resources of a practitioners mind behind them. Instead, they're using AI or they're using algorithms that they've come up with to share information. So if I was a bullseye, they might be almost personalized, but they're not personalized in that space. I think that's a really important part for that we will differentiate. And I think in the conversation will go as far as of course, having Sara Gottfried there will definitely go into the end of one conversation, you know, jeroni, you've always said to me, I love it, like in different interviews the piece about, you know, when I look at a research study, a lot of times my patients aren't in that research study. Talk a little bit about that, because I think we have to be in this era of personalized really, both evidence based and practice or person based, you know, in that can sometimes feel like you're decrying the science, if you will. So I'd love to hear your point of view on that.

Tieraona Low Dog: Well, I'll give you a good example, I had a dear friend, Freddie Cronenberg, who was NIH researcher, she was at Columbia, and she was doing a study on black cohosh in menopause for menopausal symptom relief. And she needed 80 women in her study, to have the statistical significance that she was looking for. But she interviewed almost 2000 women to get at. And I told her that I felt that what we should write a paper on was the 1920 women that did not qualify for the study because of exclusion criteria. I said, because those are actually the women I see that had breast cancer or have heart disease, or are taking medications are obese. I mean, because they're all excluded from these from that particular trial. But we see this with most research trials to, to try to trim down the variables so that we are getting as pure a result as possible. We actually, the people that end up in this study often are not representative of what we what we as practitioners see in our, in our office. So yes, as a as a physician, I practice the art of medicine. And I use science as a tool to support my decision making. But I never forget that it's an art because I don't have the perfect research person that comes to see me in my practice. So that's, again, where we talk about personalization, is that you have to use your own judgment, which comes back to what you were saying actually about algorithms and AI generating sort of what claims to be personalized, but is just an algorithmic tool that is not that different than some of the algorithms I see for guidelines that were asked to use in clinical practice, which, again, are not as personalized as they often need to be. 

Avery St. Onge: Hmm, that makes sense. And actually what you were saying about the direct to consumer products, that definitely hits home, because I remember seeing studies about like, Oh, if you're tracking your steps, or you're tracking your sleep, it's not necessarily going to change, anything. Tracking alone isn't going to do it. But it's getting that feedback and changing it based on that data. So I guess what we were just talking is one of the explanations for this question. But the basics of nutrition are pretty well established. Like, you know, we know that vegetables are good potato chips are bad. But why is it that so many people are still struggling with their nutrition?

Ashley Koff: Yeah. Well, first of all, I'm not going to agree that potato chips are bad because they can be delicious. And they can they can actually be a good source of potassium and for someone they may be the least processed item or the better option that's available and I think that in another If the space is the issue, I think that, you know, I know, going back so my first job out of college was to sell sugared cereals to America and tell you that it was good for you. So I'm very clear on where we've gone awry with nutrition we have that we've let marketing be education, and we've let marketing inform our dietary guidelines, you know, so I think in that space, we, the problem is we've had one very well intentioned goal. And that was to make things simple or easy for people. But that oversimplification has actually led to things that don't work. And when things don't work, people get frustrated. And then there's the second side, it's not well intention for the person or for the, for people as a larger space, but it's really the financial opportunity, you know, in the nutrition space. And we have to remember that that's a really big space now, because it's your total nutrition. So it also includes dietary supplements. So there are many, there are messages that are out there that are suggesting that you choose a dietary supplement instead of a food, right, and that that's just as problematic, you know, on that part. So, you know, to me, the biggest piece is that, at the core of personalization is really how you how you take something in and how it works in your body. And part of that working is also if it's delicious to you. So I, you know, I teach people to use the deliciousness test, you know, on a scale of one to 10 Is this delicious to you in the moment. And if it's not a seven or greater, let's find something else. Because the fact that something doesn't satisfy you is probably going to be more more of a reason that you go looking for something else, or you consume more, you know, in that moment. And I think there's a lot of right isms, in nutrition that has created a lot of problems for us, you know, so this concept that there are right answers. And a lot of times as practitioners, I will say, This is why I love working with health coaches, my health coaches, colleagues are never like, this is good or this is bad. As a dietitian, I don't know God for as a doctor, like, I think we get in a lot of like, this is what you should do. And this is what you shouldn't do. And that doesn't have a place in nutrition. So we in nutrition, we have to respect culture, we have to respect deliciousness, we have to respect access, we have to understand your body in a moment and help you understand your body in a moment. And then also be able to gather data about how your body actually uses something. So it is not simple at all. And so that oversimplification is to me where the biggest problems have occurred in nutrition.

Tieraona Low Dog: I agree. I agree totally. And I shudder when I hear things like good and bad. Their judgment calls. And, you know, like cake is bad. Well, cake may not be bad on your birthday, right? I mean, or at a wedding celebration. I mean, so cake every day is probably a problem, right? But the the need to simplify is strong. It's a it's a strong desire, we see it in everything, you know, the need to make things simple for people to understand. The problem is that that real nutrition in a complex environment like we live in, is is not as simple and as straight a line as it seems. Not for everybody. You know, a lot of people are like very negative on the ketogenic diet. But you know, I was put on a ketogenic diet when I was 17. I was hospitalized and put on it because I had epilepsy. And you know, and the ketogenic diet has been used in epilepsy for a very long time. And it allowed me to reduce my medication, and it was a very difficult diet to stay on. I will also be honest, this is a very long time ago. But to sort of just say keto is bad is is is really not a well thought out sort of statement. It really depends upon the individual what the goals are, what the underlying health needs are. I love dietary supplements. I do. I'm a fan of multivitamins, I think most people need vitamin D. I don't think most people get enough from just being out in the sun. I see little babies that are not getting vitamin D because moms breastfeeding and you know, they're born in the middle of winter and live in New York. I mean, so I do see that there's a real need for dietary supplementation. But I also see talk about marketing. It's like there's a supplement for everything. It's like you know, if this is it, just take the supplements and sometimes patients will come in and they'll be on 17 different 21 supplements. I just saw a man recently who was on like 21 different supplements more than 40 pills a day. And that is excessive, especially because he's a healthy 60 year old fella. So you know, but but I'm also just going to say this that I also find the marketing of natural foods, too. would be also problematic. You know, it's like there's a lot of foods that are more processed that you find in a natural grocer than you're going to find editable group, typical grocery store. And we've made people so concerned about what's good and bad in food, that they're absolutely confused about what they can and can't eat, I had somebody and recently I can't have lectins because they're really bad. So I can't eat any beans. I mean, I had another person and I heard that nightshades, you know, give you arthritis, so I can't have tomatoes, I can't have eggplants, I can't have chili, I mean, so I hear these things all the time. And they're not based actually on diagnostic testing or elimination diets or anything, they're based on pop culture and what people are out saying, and I think it further confuses the conversation. And, and it goes back to what Ashley's said, quite a quite a while ago was just, there's not a practitioner there kind of helping many people through this, it's just what they're reading or getting on tick tock or Instagram or on a on a on a Facebook post. And I do think it's the marketing, you know, I think and and to be fair to our colleagues, and I will include myself in this space to be careful how you market yourself and your business. Because to compete in today's marketing environment, you may feel that you need to be abrupt have about something or all or nothing or have a comment like seed oils kill or seed oil, you know, don't have seed oils, and you're like, wait, hold the phone. No, like, I want you to choose seeds. And I want you to choose, you know, I want to teach you what are better choices, you know, within that space. So I think it's really important for all of us to understand the power that marketing has. And to recognize that there is a very big difference between marketing and education. And then what I like to base my stuff off of is experimentation. So I want to turn around and this goes back to you know, what Tony was saying before, this is an art. So I actually my recommendations as a practitioner are the beginning of building a plan for you, they are not the culmination, I'm not turning over to you and saying, go do a keto diet, it is going to do X, I'm gonna say, let's experiment with starting with a keto diet done this way. And let's see over the course of the next four weeks, how you feel how doable it is, what you like, you know, etc. And then we continue to, you know, to work on it, I think it's really important that we move in this era of personalization that we that we really look at all of this happening on a continuum, because health is dynamic, and not in the moment, here's a recommendation go take us, you know, and go with it.

We get this question an awful lot though. Like with herbal medicines, you know, well, I'm going to put them on it. And then they sort of just get left on them. without anybody sort of saying, well, let's see, for four to six weeks, does it actually help you sleep better? Are you feeling calmer? Let's let's let's evaluate the effectiveness and how you're feeling on it. And if in six to eight weeks, we're not seeing any budge depending upon what it is for, right. But if we're not seeing any sort of budge for the thing that we we thought we should see something, then we're going to adjust and pivot. And that's the whole notion of, of, you know, I'm in family medicine. So our whole our whole, you know, training is that we have a relationship with people over time, so that we get to know people over time and their families and their kids and their parents, and we're part of a community. And so when you have that kind of philosophical underpinning, you're not thinking I have to fix everything today, because you realize you're going to have a relationship with this person over time. And it's going to give you time to adjust things. But I also want to say as a physician, I've seen patients left on medications that they should have been taken off of a long time ago, because whatever the acute nature was of the depression, or the anxiety is now very, their life is very different, and they still remained on the drug. So I don't think it's I think it's across the board that practitioners need to constantly be evaluating what's going on in that individuals life and how they're responding. And if they're making a lot of lifestyle changes, they may not need to be on the same diabetic medication, they may not need to be on the same blood pressure medication because they've made so many changes now that their underlying health has has improved. So this is why I said all medicine and health recommendations ultimately must be personalized. Because it is dynamic. We're complex creatures living in a complex environment and and dynamic is the is the name of the game. It is a dynamic situation was a good word, Ashley.

Ashley Koff: Well, I was just thinking, Gosh, I want like a T shirt that says I adjust and pivot like I mean, I think that like when you think about personalization, there's there's nothing more powerful than that. There's no answer. And so, you know, I always say to people do not invest in something that isn't truly personalized. And one of the ways to be able to figure that out is, is it selling me something as an end game? Or is it selling me something as a starting point? And I think that's, you know, that is such an important point for practitioners to try to differentiate themselves off of, especially in this era of info obesity, I mean, we just have, we have so much information coming at everyone that they, the hope is that there's a solution. So I don't have to think about this any further. And you're like, it actually isn't a solution. It's, it's an evaluation or an experiment, you know, process that we go through. Right?

Avery St. Onge: Yeah. I mean, I think in society, in general, there's a tendency to group things in to good and bad categories. And at least in the research that makes it into the media, it's usually saying, like, you know, wine is good for you one week, it's bad for you the next and then, you know, conventional wisdom says, ice cream is bad for you. But I was just listening to a podcast about how a half a cup of ice cream was associated with lower risk of heart disease in diabetics or something like that. And unfortunately, not everyone has a personalized doctor or a doctor at all, to be telling them, you know, what would be good for them personally? So do you think there's any way that maybe the research could like how could the research into nutrition change, to kind of put a more personalized spin on things, so that kind of stuff gets out into the media instead of the, this is good, and this is bad.

Ashley Koff: I think the one place I'll allow for the good and the bad is information that you get from the media in sound bites around about nutrition is bad. And information that you get from somebody who actually knows about your body and your needs, and your preferences is good. So I think there's that space, I always say, gosh, if they could have just paid me instead of doing the ice cream study, I mean, what like a happy diabetic is like, you know, if you're, if you're not told you can't have things and instead, you're told what you can have, you're going to your stress levels are going to be lower your body, you know, all these other things. And so we know that so I think the key thing that we have to, you know, that I share with anyone is do not get your information, and don't especially don't get your information as far as what you're going to actually invest in, whether that's time money, or emotional resources, from a soundbite on television there, they are not, you know, evaluating the data, and they're not evaluating it for you on that part, you raise a really good point, if you don't have an ally, a practitioner that can then step into that space with you. That's my biggest frustration in healthcare, I think we are, we're trying to do a better job of that. But by making ourselves available, but I think you can at least look for resources that are going to be that are going to be more designed more specific to who you are as a whole person. And that's where I would suggest that you gather more of that information.

Tieraona Low Dog: You have to remember that most of these Well, first of all, always know who funded the study what the goal is, right. And the second thing I would just say is that a lot of times the recommendations that we're given are for a public health perspective, right? So therefore, you know, 100 million people, what can we synthesize down to tell 100 million people they should do? Right, which is the antithesis of personalized medicine, right. And I meet many, many people in my travels across the United States who feel very, who feel that it's been very difficult for them to get the information that they need. I've had people call me to say, Can you order a vitamin D test? Because my doctor said, I don't need one. You know, Canada has said, we're not doing any more routine vitamin D testing for anybody. I mean, so it's like, just, you know, take your vitamin D 1000 units and just forget it. I think these kinds of these are our realities. And so I do tell patients, you know, it's like, well, yeah, you can order your own lab tests, you can get your own vitamin D test. And you know, then the problem is, you know, you have to also explain to them what that means. What if it comes back very low, you know, then they're a little bit confused, but that I'm all for the democratization of knowledge. I don't like that, that only you know, that it should be kept only for the elites. I mean, when I was young, and studying science, one of the most powerful things for me was that Galileo was imprisoned not because of what he said around the Sun and the Earth, but that he wrote it in Italian and not Latin, and that he made it accessible to all the people who wanted to read it, because at that time, it was only kept in the church really. And it was written in Latin, and they decided what was going to be disseminated. And I realized at a very young age, that that's a very dangerous thing that, you know, if you own the information, you know, as John Mayer said, you can bend it all you like. And so allowing people the opportunity to have access to information good and bad, but then trying to help them decipher, how do you synthesize this for yourself, I think is important. And for me, I do think there are some basics, I think there are some basics, it's like food, that's as minimally processed as possible, you know, having a lot more plants on your plate, right? I mean, so you know, minimally processed and more plant forward, it doesn't mean you can't have meat and things like that. And that, and that, to try to have diversity in the diet. You know, diversity is, is the is the secret to life, rather, it's in your family or your society or on your plate, that when you make their food choices, more and more and more and more narrow, that actually is not good for you, your microbiome or anything else. So, you know, I think there are some truths that we could all agree on, less processed, more wholesome, more plant forward. And then we can disagree around the edges on what that means for each individual person.

Ashley Koff: I think it's so powerful to think about it that way. And I want to, I want to bring us back to the start of the conversation to where this is the goal of of the panel that we're putting together, we only have one hour. So there's a lot. But you know, to have, so I imagine that every practitioner listening to this is nodding their head. And it is really important to us to remember that this is the world that we're receiving patients in today. So one of the things that I tried to practice, and I think we will talk about a lot on this panel, is how do we listen and hear what from our patients and what they're experiencing? And for a moment, set aside what our knowledge is, or what our training or what even our own personal experience with something is Tirone and I have completely opposing views on an aura ring, because I'm like, I can't stand having that information. Right. It was very valuable for a short period of time. But on a on a long period of time. I don't know. That's right. Yeah. So use it sometimes or not, right. And like, I'm kind of terrified. I'm getting one of those full body scans, you know, just because it's available. But then I was like, do I really want to get a full body scan? Because just because you know, the MRI is because it's available? And then the question that I was asking the team there is I want to understand how you can help me understand the information that you're getting, not just that, it's great that we're able to get information. And I think that's the space that we're in today. That's the trickiest spot for the practitioner, because I personally see so many referrals from you, all of you fabulous doctors, where my the patients are so overwhelmed and confused, they have so much data, or they're what we'll call a prosumer. And they're going they've gone out and gotten all this other information, they've listened to 27 podcast, read everybody's books, all of these other things. And they're trying to figure it out for themselves. And I think a huge amount of this is actually saying, let's pause there, let's get a chunk of information based on experimentation, seeing how your body responds. And then let's add to that and add, you know, kind of go from there, rather than this huge data dump of information in the beginning, and then making you know, 27 different recommendations. So part of what we want to accomplish in this panel, which I feel like we have the best people to do is to help you understand how to stage a relationship with a patient to gather that information and have it flow, you know, in more of a journey in a relationship space, rather than kind of doing it all upfront, which is I think what we're hearing here is the the challenge that we have a lot of consumers that want to do it all right away, you know, like they're going to call and say you know, things different let me get these different labs and, and I'm right there with you to Ronnie because my friend is a doctor at Mass General and she's buying her vitamin D test through my company, you know, we just use Rupa for it, because she can't get it reimbursed through her and she's a physician at Mass General, she can't get to do the follow up to improve, you know, to to get the data. I mean, we're seeing a crazy space right now. So how do we in this craziness, get tactical about doing personalized health care with the resources that we have, but avoid data overwhelm or data driven but not truly personalized? recommendations on that part?

Avery St. Onge: Right. You know, there's kind of two parts of it like the media overload and then also the data overload, but imagine being a healthcare prac To share right now, it's a lot of teaching your patients media literacy to understand like, this isn't always true, or this might not apply to you, but then also to have people able to be tracking their every move, they can make assumptions about that themselves. So how do you both kind of overcome those challenges of your patients trying to be kind of pseudo doctors, and then also them just sharing a ton of different things all at once.

Tieraona Low Dog: So the first thing, the first thing I do is walk into a room and not take on the expert role. Right? I come in to be your partner, I'm not your healthcare provider, I provided for my family, I provide it for my children, but I'm actually a healthcare partner with my patients. And when they are deeply curious about something or they're like, they're taking all these supplements, I'm like, tell me, tell me, I'm so curious about, you know, what led you to this? You know, and, and, and what have you noticed, when you're taking them? Are you feeling different? Are you feeling better? I mean, so I don't come in. I don't, I don't actually, it's just not my stance in in my relationship with my patients to judge what they're doing, either. It's like, I just become curious about it. And it's like, trying to get somebody to exercise. I'm like, well, what could you see yourself doing? You know? And it's like, well, you know, I don't really like this, I don't like that. And I'm like, Okay, I'm hearing you don't like sweating. Got it? Like, so what, you know, if you were just going to decide like what what, what would be interesting to you, what would that look like? So I actually put a lot of things back on to the person that I'm partnering with, because I believe that most people have many of the answers inside of themselves. I went to medical school, University of New Mexico, where we learned motivational interviewing, starting in our first week of school, and it has served me very well. Because we know many things. And most of the people that I see already know the things that they need to do. It's the cognitive dissonance between what I know I need to do and my ability to make those changes. And so, you know, that's where I'm curious. That's where I like to lean in is, you know, if this is your goal, and this is where we are today, how are you going to get there? And how can I help you do that. And little last little thing is, I'll just say, with all the residents, and even the fellows that I worked with, and in my many years of teaching, is when they would come in with a long list of like, 30 things. I'm like, I love this. So I am so curious, I'd like for you to go do this for the next Oh, four weeks, and then come back and report to us how that worked for you. And they'll all look at me like what? And I'm like, No, I think this is all fabulous. Like, this is amazing stuff. And I am so interested to see after you've done all of these things for four weeks, how you feel. And of course, what it does is it sets them back. And they realize I could never do all of this. And now I'm asking a single mom with three young children to suddenly change her entire life. And it's not possible. So the data, the media, the you know, for me, a lot of this just comes down to again about how do you partner with people on this amazing journey? That is their precious life? And and how do I, you know, if she likes ice cream, maybe not every day, but you know, it's like, does she have to give it up off forever? Like, I would say no. So I just I think that I, I have my own sense of this. And and it's what I've tried to convey to the doctors that I've trained over the many years is to be a little more humble, a little bit more respectful, that people have complicated lives, and to, to not judge them for trying to do what they can to feel better, even if it's something you don't think is very smart, or I mean clearly point out if it's dangerous, but, but but to recognize that there's something really good about what they're trying to do. I had a woman and you know, and it's like, you know, I she wanted to lose weight. And I said How important is that to you? And she says like a nine and I said How confident are you that you can do you know lose that 25 pounds? She said like a three? And I said that's fantastic. And she looked at me and she goes That's fantastic. I'm like, but it's not a one. There's a part of you that believes you can do this and we got to figure out how to get that three like to a seven but I'm so happy that you said three. So again, it's like how do you empower people to feel like they can make changes and and not give them so many things. They just feel like they're a failure because they couldn't do everything that you thought was best for them to do. 

Ashley Koff: So, one of the things we're going to be talking about is the myth of the noncompliant patient. And, you know, the fact that I would just the only thing I have to add to what you said there is, I've my ego, every decade gets less and less, thankfully, has a long way to go still, but on that part, but you know, just the awareness that I'm not the right person for a lot of this. So I had like very quickly had to learn I am not a health coach like so. I love that you learn motivational interviewing, I did not and so that, you know, my communication style with my patients, very empathetic led a lot of motivation, those kinds of things, but the the listening and how you interview that way, wow, that's so powerful. And so this the one of the reasons we put this panel together with doctors, dietician, CNS, pharmacist, health coach, like all on that stage and in for women, is to turn around and say, there's a lot of players here, and maybe your system to help patients be more quote, unquote, compliant. But what we really want to say is to have them experience, you know, better outcomes on this journey. It means that there are things that you are currently doing that you're not the better person to be doing. And I think that aha moment for a lot of practitioners, not only do we get demotivated when we're working outside of our zone of genius, but our patients don't actually get what they need, when we're in that space, as we talked about before, where we might be just kind of Pooh poohing or not supporting something that we've heard in our reaction, and somebody else is actually going to explore that more deeply, you know, based on on their, their practitioner style, or their or their, you know, type of training. So, it's going to be exciting, but the myth of the non compliant patient is something we in this era of personalization, we have to do, because it makes sense for things to not work in the direct to consumer space when the practitioner has been removed from that process when it's just computer or do this test, and you'll see these results. For practitioners, that shouldn't be the case that there it means that something else needs to somebody needs to go deeper, there needs to be a different resource, a different angle needs to approach the approach, even the goalpost needs to be set in a different way. And I think that's the exciting part of what we'll be able to deliver in the conversation.

Avery St. Onge: Definitely, yeah, my last question, and I don't want to keep you too much longer. But it was exactly about that, like, how does the approach to nutrition differ across professions, for instance, a dietitian and a doctor?

Ashley Koff: Well, you have two of us here, although a lot of what I learned in my approach I've learned from this lady. So I think, I don't know that it has to differ. I do think that the all of us are trained and just we just have different zones of geniuses, right. So I think one of the key things that we have to be careful about with nutrition is helping somebody understand its overall role in you know how better nutrition helps the body achieve, or get and stay healthy. And so it may be that the a doctor is in more of a diagnostic space, and that's their zone of genius. And then partnering with a dietician, health coach, a CNS, etc. May be somebody who can help with that help somebody be exposed to more choices, and then evaluate those choices. And it's a better use of that person's time to evaluate and, you know, have nuanced adjustments and you know, different things like that. There may be some doctors that that's where they want to spend their time, I'm not against that, I think it's really, you really have to evaluate, you can't do everything. And so, as terroni was talking about that partner role, I think it's really important to determine what type of a partner you're going to be. And then make sure that the person has the other partnerships. You know, they're just like, I don't spend a lot of time on fitness. I kind of take the approach that she does. And I get I tried to get people excited and try things, but then I'm going to recommend a PT or a trainer or somebody to do that actual work just because I that's not my zone of genius at all, you know, in that space. So that's how I answered I don't know, Tony, do you have a different take or an ad?

Tieraona Low Dog: Well, I love working with health coaches, I think we need to have more of them. I think they serve just such an amazing role to really partner with people in a totally different way. I love that whole coach because I had great coaches when I was young, so I know what coaches meant to me in sport. I work with dieticians, especially because I have complicated patients congestive heart failure hypertension diabetic, poorly controlled. I mean, I am not the person then to, to work with them on their diet. I'm just not it's like, I need people that can that really know this stuff and, and are trained to talk to these individuals to really get at how do we create a plan of nutrition? I do a lot of stuff that's more, you know, just kind of the healthy nutrition that people have. I do more work with maybe dietary supplements and that just because I test for them and and and I'm more sensitive to looking for deficiencies, I think, but you know, a team approach. You know, when I was going through my own cancer treatment, I had a massage therapist, I had an acupuncturist I had, I did not have a dietician, but I had a good integrative doctor, I had a whole team of people helping me, all I'm saying is that my oncologist was amazing, but I was going through a complex part of my journey. And so I brought a team of people that could really support me in what I was doing. And so, you know, I would tell patients all the time to you know, it takes a village, it does take a village. And so find those people that you that you resonate with that can help you along this, that partner with you along this part of your journey. And, and I'm certainly grateful for being invited to be on this panel. I think it's going to be amazing. I want to thank Ashley for really spearheading it and putting it together. Ashley is just brilliant. I've known her for many years and just want to say that, you know, if we had more dieticians like her, you know, we'd have a much better health care system here in the United States, truly.

Avery St. Onge: Well, those are really those are all the questions I had before I let you go. Do you have anything else that you'd like to add?

Ashley and Tieraona Low Dog: I don't think so. Just thank you for the opportunity to come and spend some time with you and be on this podcast with you. We sure appreciate it.

Avery St. Onge: Yeah, no, I appreciate it too. Thank you again to both of you and I look forward to seeing you at IHS.

Ashley Koff: Absolutely.

Avery St. Onge: Thanks for listening. We'd like to thank Scott Holmes, Kevin MacLeod and audio coffee for providing us with our theme songs. Be sure to visit our website integrative practitioner.com or send us an email at [email protected]. Remember to like and subscribe to our show. We'll see you next time.