Bonus: Women’s Health & Functional Medicine Mini-Training For Health Coaches with Dr. Aviva Romm

Would you love to be able to go beyond the basics of health coaching and offer more for your clients? If so, you’re in for a treat. In this bonus episode, Michelle interviews Dr. Aviva Romm about how health coaches can play a central role to healing in a functional medicine model. They discuss Dr. Romm’s professional training program and take listener questions about gluten, Hashimoto’s, lab testing and more.

Get more information about Dr. Romm’s Women’s Functional & Integrative Medicine Professional Training Program (And tell her Michelle sent you!)

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Michelle:             Hello health coaches. I am Michelle Pfennighaus. I want to welcome you all to the Health Coach Power Community for a very, very special event. Today we have a women’s health and functional medicine mini-training specifically for us health coaches and if you’re like me and you thought you know, my health coach certification was pretty good, but you’d love to be able to offer more to your clients than you are in for a treat. I want to introduce you to our special guest. I don’t know if you’re on my right or my left, Dr. Aviva Romm. Aviva, you became my personal hero like seven years ago when they do a fireside chat you did about vaccines. Oh, do you remember that? Yeah. That, that was it for me because I’m like finally someone who’s level-headed on a topic where most people are usually not and it just struck me that this is someone I had to really pay attention to. So, um, Aviva has it all you guys? Oh my gosh. The medical, herbal, the earthy, crunchy, the science. We’ve got it all. Thank you so much for being here.

Aviva:                  Yeah, well you’re supposed to delight and it’s such a pleasure and I love this power community. That’s. That’s awesome.

Michelle:             You know what so many health coaches are and then we have, men, we have all types of people in this group, but for the most part I noticed there’s a lot of health coaches who maybe like me, they left the career. They want to leave another career where they’re feeling drained. They want to step into their power or they’ve been a mother a stay at home mom for the past 10 years and they’re ready to step into their power. That’s why we call it bad.

Aviva:                  I love that. You know, so many women in my own medical practice have had some form of health epiphany. Either something that brought them to my practice where they realized they weren’t quite getting what they needed from conventional medicine or in working together. They made some major health changes and they’re like, yeah, you know, I’ve got three little kids or I’ve been, you know, corporate at Amex or whatever and I don’t really want to go to medical school because I’m whatever age or just not, that’s not the road I want. And so women all the time are contacting me and saying, well, what should I do? I’m like, well yeah, health coach. It’s like one of the fastest growing professions and honestly I feel like for me as a medical doctor, I couldn’t really do what I do without that extra support. I feel like health coaches in an of yourselves, you are a profession. And then also for me, like as a doc who is responsible for not only communicating the nutritional and lifestyle aspects, I’m still responsible for interpreting the labs and communicating that. And so there’s a lot there that I have to cover in one visit. And sometimes what happens is, is a patient leaves a visit and I know like I’ve done my best to kind of download everything, but then they get home and they’re like deer in the headlights. What do I do? And that is such a powerful time for me when I know I have that support team on board who carries them through.

So, it was like from ideas to implementation and then of course you have your own ideas as well. But this implementation piece is so important because as we all know, it’s like the proverbial you can lead a horse to water but you can’t make her drink. Um, there’s a lot of behavioral aspects that go into switching the paradigm from conventional medicine to being an integrative and functional medicine client or patient to actually doing it. And we’re so used to and accustomed. I think growing up in our culture too, you know, you take a pill, you have a quick fix. Whereas getting healthy does actually require some, sometimes steep changes for people. So I love it that, that you know, you’re there and doing what you’re doing. I really couldn’t do, do it on my own. And um, and then also I feel like there are so many tools that health coaches bring that add to either what I do or in and of themselves for people who maybe don’t need a doctor right then or a licensed health professional right then, but what they’re pretty well but they want to make changes to be healthier or they know what they need to do but don’t know how to do it. I feel like there’s so many roles that you can play. It’s amazing.

Michelle:             And that’s just about everybody out there. They mostly know what to do or think they know what to do. But actually implementing is another story I like you were talking about how health coaches can really fit into this functional medicine model helping us implementation. Can you speak a little bit about how health coaches can be part of what functional medicine is all about, even if we’re not working hand in hand with a doctor’s office?

Aviva:                  Yeah. So absolutely. So what are the things I hear most commonly from health coach school graduates and it, it sort of depends on the school. So like from the Duke Students I’ve heard, you know, this is really great sort of intellectual training, but it’s not necessarily super warm and touchy feely and really deep enough in some ways to go into all the nuances of what people need when they come through a functional medicine or integrative doctor’s office. And then I hear of course a lot I have IIN students in my program and work with patients who are students and the biggest thing I hear there is there’s a big gap between information and how to communicate that and like you get great training and skills and you get great training in business. Then how do I really work with that person one on one and what can I do and what can I do?

And I think there’s a lot of room in all of that for health coaches to kind of figure out and to some extent define what role that you want to have. So I think working in a clinician’s office with another health professional is maybe a little bit more obvious, but working on your own. I feel like first of all, one of the biggest questions I get every single day, literally like email after email after email, is Dr Romm, where do I find someone like you, I’ve got this problem or that question, and sometimes they don’t really need another doctor. They just assumed that that’s what they need. What they really need is someone who can make sense of a lot of the different information that’s out there. So should I intermittent fast or how do I know if Ketogenic is right for me or should I be Paleo or should I be Vegan or pagan or whatever it is.

You don’t actually have to go to an md for that in nine out of 10. MDs are not going to be able to answer those questions anyway. So obviously as a health coach it’s important to know, you know, is somebody tired because maybe they’re anemic or maybe their thyroid is a problem or maybe they’re depressed or maybe something more serious is going on and so it’s good to know and work with practitioners that you can send people to, but if they’re otherwise, well, right. A lot of times it’s just about resetting how we live our lives and that’s where I feel like you have so much latitude and interestingly a lot of times people come to me as an md and even though they know I do things completely differently in their mind and they’ve read that about me and they’re coming for something different, they actually sort of, some part of them still wants the fix and the pill, right?

They still see me as a doctor where so I have to work harder to disrupt the paradigm for them. Right. I have to break it down and unpack it and say, yeah, you know, supplements aren’t meant to replace. They’re meant to support extra, but you really have to do is get sleep. Right? We can’t just give you supplements because you’re not sleeping or I can’t give you a supplement because you’re not eating vegetables and they don’t fully necessarily actually want to hear that from an empty. They kind of want to hear here’s the supplement and to some extent functional medicine has trained them for that, right? Like we do a lot of supplements. We do a lot of testing as a model, shouldn’t be that way, but it is that way. Whereas for health coach, they’re already coming to you for the lifestyle piece. They’re coming to you for life guidance and so there’s so much opportunity to provide even as an independent practice, that very big piece that’s missing in conventional medicine and I think it’s the biggest piece that’s missing. We know we know without a doubt from good studies that had been published in the New England Journal of Medicine Journal of the American Medical Association. Big The big journals, right? That only 15 percent at most 15 percent of disease. Chronic disease is genetic. 80 five percent at least is diet, exercise, not smoking, getting enough sleep and stress reduction, and that’s the most important thing we can be giving people and that’s the most important thing that’s missing.

Michelle:             Go to a doctor and pay so much money to have them say, I’ve heard so many doctors say this. I tell everyone that they have to drink more water. Like I say that a hundred times a day. Meanwhile…

Aviva:                  Yes. That’s the next piece of it too is that even though I believe you guys should also be charging what you need to charge to have it really be valuable for you to give your time and energy, it’s still going to be more cost effective than most mds and it’s still going to be way more cost effective than most integrative and functional medicine doctors. And so the price point of accessibility for literally most Americans to work with you and what they get out of it is so huge. And honestly I also don’t feel like there’s any sort of socio economic divide in the same way that optimally social workers would be the front end of providing sort of social services. Health coaches should be the front end in every community of providing this lifestyle support, lifestyle change. So I mean it’s, it’s pretty important, you know, and that combined with nutrition and there’s so much that you guys can do with nutrition too. So. But to me like the health coach nutrition, his team, that’s the like on the ground most important team for changing the way healthcare is being done. MDS, I mean we’re important for things like making sure somebody’s fatigue isn’t because it’s leukemia, do you know what I mean? And if it is, heaven forbid it is, then we can take care of that, but in many ways I feel like in a healthy society we would need way few doctors and we’d have way more health coaches.

Michelle:             That does make a lot of sense. One thing that I’ve really gotten from you recently, and for those of you who don’t know this, I recently completed Aviva’s professional training program, so I’ve. That was really fun was first class. It was amazing. I didn’t expect to be lit like a fire lit under my, but the way that ended up happening, but suddenly I realized there is this urgency, you know, that women really, women in particular really needed this kind of medicine like yesterday. Could you a little bit about that urgency?

Aviva:                  Yeah, I mean on every level, you know, there’s so many things that are getting better, right? Like we’re talking about periods, we’re talking about menopause, we’re talking about sex, we’re talking about gender differences. We’re talking about so much. I mean, there’s like Ruby Carr and I’m Karen, Karen Debbie, I think it was her name, the runner in England who ran a time period, product free or Ruby Carr waking up in her bed, you know, with the periods that we’ve all had at some point on her sweatpants and on her mattress. And so there’s this forward facing liberty liberation happening and yet every statistic, every single health statistic from heart disease to diabetes to dementia to autoimmune disease and every hormonal problem, pcos, endometriosis, infertility and on and on and on are significantly escalating. And so we’ve got this really crazy situation in that it’s great.

We can talk about all these things, but that we can’t confuse being able to talk about it with somehow being liberated from it or that it’s getting better for women. And you know, I feel like we almost need a, me too medical of all the women who have gone to doctors who have said, who had been told, you know, oh no, you’re fine. It’s just that you have the period from hell when she actually is struggling with endometriosis. The average time to diagnosis in the United States, depending on which study you look at, is a minimum of nine point three years and as much as 11 point seven years to get an endometriosis diagnosis so this can be girls starting at age 14 having their first period feeling like they’ve got steak knives going through their uterus and vagina and they’re like, uh, they’re mom is saying, well, I always had painful periods and they get taken to the doctor and the doctor saying, Oh, you just need to learn to cope better.

Michelle:             Use a hot water bottle and take some Ibuprofen and we’re really missing a lot. And the reality is that mds are not learning this in medical school. I can tell you that for sure. Having gone through medical training and it’s not. And still providing medical education, it’s not getting better. I mean it’s a smudge. Like there’s more awareness. Like I just, I get this feed called medscape where I am like getting regular downloads of current medical information in a variety of different areas. And there was one that just came through and it’s like five things you need to know about endometriosis and a few different articles about endometriosis. And I was like, oh this is pretty good. Well you opened the first article and guess what it is, it’s a pharmaceutical ad for a new medication that’s just been approved for endometriosis pain of course on narcotic non and said medication.

Aviva:                  And this is fairly typical so it’s not like even if you learn about it, you’re actually getting meaningful answers. So things are getting worse. The information is not really becoming more accessible. And even in what I would call sort of the women’s movement right now. You’ve got wonderful people like Lena Dunham speaking up about her endometriosis, but she also had a hysterectomy at age 30 and she had 10 surgeries that did not make her feel better. And I’m not saying that you shouldn’t have surgery for endometriosis. There’s absolutely a time and a place. But she wasn’t given the alternative that may or may not have helped her, but at least she could have tried. And this is an increasing trend of women just having surgical or medical menopause or women who are in their late twenties, early thirties already going through fertility treatment. I’m just lacking the alternative information that there are actually other ways to achieve those goals.

And even if there aren’t, for some women, it’s really important to have tried those ways first to be sure that something safer and more natural isn’t going to get you where you want to get. So, you know, I just feel like this is such an important time for women to be educated in a new and fresh way. And the, there’s another urgency which is that know I just posted an article on my Facebook page today, which is what is today, September fifth. I don’t know. Look at my calendar if you want to see the door on my Facebook on September fifth and it’s about supplement sales. And um, there’s one particular company that is, um, does a beautiful looking product. It’s aimed at women and what they’re doing is they are doing paid for articles. Now this is not different than what we accused the pharmaceutical industry of doing.

Pharmaceutical injuries. Industry creates paid for medical articles that get into medical journals. They look like authentic information to doctors and then doctors are prescribing based on what our actually infomercial looking at, looking like a medical journal study. Well basically a lot of the same is happening in the supplements world and so this article in the New York Times today was about how this one particular company headed up by a woman. A lot of women working there, so you know, we’re not exempt from getting on this bandwagon, are creating these paid for articles. They’re getting the articles placed everywhere, like everywhere from like places like well and good to the New York Times. Then they go into the articles which looked like an article written about them as opposed to it’s an ad space that was paid for by them. Then they take a quote out of the article, so the quote might say, so and so’s supplement and it’s, you know, it does this, this, this and this, this and it’s.

And it’s in the New York Times. Then back on their website page and back in their marketing or they’re saying the New York Times says, but the New York Times said about us and it’s so misleading. And so that’s another big piece is that we, you know, we can’t just become ambassadors. I have a friend who used to say, you know, sometimes people get so openminded that their brains fall out. We can’t just become ambassadors and cheerleaders for the big health industry, which is now the supplement industry is over a $20,000,000,000 a year industry. Just supplements that are expected to grow another 4 billion years for a billion dollars in the next, the next couple of years. So, I mean, this is huge and the same kinds of, um, you know, smoke and mirrors shows are now being done. So we have to also be discriminating, you know, I, um, I was giving a talk, I’m sorry, it was um, I was a consultant at recently at a $2,000,000,000 supplement company.

I’m on their scientific advisory committee. I have been for four years and I give them honest feedback and one of the things that they were thinking of doing is jumping onto the genetic testing bandwagon and so they were going to. They were all set up to do this, get these genetic tests that you can order on their website, and then when you get your genetic test back, they target you to like or funnel you to one or another supplement packet. So let’s say you come back with Mthfr positive on your genetic testing. Then you would get funneled to maybe let’s say a methyl folate and maybe some be 12 and maybe something else as an antioxidant or detoxifier or if you came back, comt, they funneled you to something else where if you came back and vitamin D receptor the Saturday. Other than I was at this dinner with the vice president, president of marketing, the scientific directors and I’m like, you guys, all you’re doing is really selling fear and you’re selling supplements because there is absolutely no connection between having the receptor.

Having the deficiency and later having a disease. And so what they’re basically saying is, oh, you know, if you have mthfr, you might develop a heart disease or stroke, so in order to prevent that, you should take this, this, this, and this for the rest of your life basically, because the genetic change is not going to go away. Unlike thankfully I think they’re not doing it. Like they actually contacted me about a week later and said we want to switch completely to a women’s health platform, or you guide us on that. There were a few others at the meeting who backed me up. I’m including a professor from Yale who’s a preventative medicine doctor there, but this is what’s happening a lot, right? We’re learning in functional medicine. Oh, you know, you take this test, that means this is gonna happen, so we should tell people to take these supplements.

But all we’ve really done is given people what’s called a no cbo effect, which is the opposite of placebo. No, CBO is when you tell someone that they have a negative potential for something bad to happen, you’re actually increasing their stress about it and possibly increasing the likelihood that it would happen. This is a very well studied phenomenon and so you know, we have to give people yes, if they want the genetic tests fine, but then let’s say, okay, well this may possibly show a connection but not definitively and if you want to protect yourself a little bit extra, here’s what you can do with your diet. Here’s what you can do with your lifestyle and possibly consider supplements or here’s some tests you can get once a year or once every couple of years. Right? And this is so much saner than what’s happening, which is this crazy, wild west.

So, I feel like as health coaches, you know, it’s so important because you will be seeing a lot of the people who are hearing this information or going to functional doctors who are telling them they have all these things wrong with them and need all these supplements are diets. That happens a lot and it does. I do. I really have to buy all these supplements. He did more than 15 minutes or something. I know. I mean I used to work at a very well known functional medicine practice and there were quite a number of people who would go into a couple of particular doctor’s offices and come out and say things like, wow. I went in thinking I had a little gas and indigestion and now I’ve come out thinking I’m really sick because I have detoxification problems and I have a microbiome problem and I have leaky gut and I think I have a thyroid problem and I have an adrenal problem and my mitochondria aren’t working and I have probably have the snips that mean I’m going to die on and literally and people will come out with 800 or $1,200 a month worth of supplements and sometimes as much as 6,000 or $8,000 worth of testing.

And most of this is not even validated. And that comes back to sort of the 15 percent of health issues being genetic and 85 percent being modifiable by lifestyle. And look, I use supplements. I use herbs, I do some testing in my practice, but we have to not be just throwing the kitchen sink at everything because it’s available and there’s a lot more that each of you can do just by staying up on current information and being careful of what your information sources are. Like goop is not an information source. I mean it’s a source of information in terms of what people are thinking about and trending, but it’s also as much as I keep up with groups so I know what the next thing that I need to either validate or clarify is. And a lot of times, and not to pick on Google at all, but I mean it can be any number of things, you know, I’ve had patients who have said, oh, I saw Dr so and so’s infomercial on pbs and I’m like, what are you talking about?

And there are these paid programming things that happen on PBS, PBS that people pay for to promote their books and so forth. Um, and so there’s a lot of misinformation out there, so you can be really important resource for that. The other thing I want to share too is that doctors and other health professionals get really busy and often don’t listen to women really well. Particularly Women’s can happen to men too, but this is well documented that this happens disproportionately and women and I have personally had patients who have gone to doctors who have had breast cancer including a stage four breast cancer missed because the doctor didn’t listen. Thyroid problems completely missed endometriosis, completely missed. I mean the list goes on and on and on and sometimes these women are people get disenchanted with going to the doctor and then they come to you and you might be the only one who hears the story that does actually uncover that.

Something more serious maybe going on and you may even sometimes hear something that a functional medicine doctor said, Oh, it’s this. Like there are a lot of garbage can diagnosis, right? Like lime, adrenal fatigue and thyroid are three big ones. Dysbiosis, leaky gut, and when I say garbage can diagnosis, what I mean is that those really happen, but it’s very easy to just have them lumped in like everyone who comes and gets lumped into one of those big categories. So, for example, IBS is a really common medical diagnosis. We don’t typically call it IBS. In functional medicine we usually call it dysbiosis and we work on the gut, but one of the biggest misdiagnosed conditions that’s called IBS are called dysbiosis is actually endometriosis. A large number of women have endometriosis and they’re told by an integrative or functional or conventional doctor, it’s their gut and cause you can have constipation, bloating, abdominal pain, you can have that with ovarian cancer too. And so a really thoughtful health coach. Maybe the one who says, you know, maybe it’s good to get another medical opinion and that can make a huge difference in someone’s life.

Michelle:             Yeah, no doubt. It’s so true. Women don’t want to go to the doctor either because they’re forced to stand on a scale and they don’t up something as simple as that like you’re describing. They’ve been to doctors for years and they are just like all set, but they will talk to a Health coach. It’s much more on a peer to peer level.

Aviva:                  Absolutely. I didn’t even have scale in my office. And you’re right, it’s a huge issue and it’s very hard to decline these things because there’s a lot of pressure to comply or you know, go along with what the authority says when you go to a doctor’s office. Totally.

Michelle:             Now, I have lots of questions coming in. That’s great. Let’s do it. Let’s see. I’m going to have to save them for the end, but I want you guys to know that we’re going to do some q and a at the end, so just we’ll do a few more minutes of what and I have planned and then we’ll hit these. So if you have some more questions, go ahead and throw them in the feed. One thing that I know you wanted to share with us is about root causes here. That is like the buzzword a lot these days. What I need to know about root causes,

Aviva:                  So, root causes is a very lovely term, but a lot of people don’t realize that if we go deeper, no pun intended, and get to the science behind root causes, there’s an entire emerging field of medicine called as you know, expose ohm medicine because you’ve learned all about this with me and expose our medicine. Basically says I, I personally call it women’s health ecology and it says that everything that’s going on in our external world and our internal world meets together and of those old venn diagrams where you’d have like a circle and excuse my favorite. Like they’re stigma but a circle and then another circle and there’s that place where they cross in the middle and the external environment and the internal environment cross in the middle and that oval in the middle is your health. So external environment includes things like toxin exposures which are very real.

I mean again, you know, place places like goop or Sacara, whatever. These online wellness information sites that are run by beautiful women who are doing great things with food and making it gorgeous, often get disparaged exactly because of that, right? It looks she, she and very white woman and very wealthy, but what they’re talking about often does have important kernels or grains of truth in them and so think so detoxification is sort of laughed at, but the reality is from a basic environmental medicine perspective, we’re exposed to over 80,000 environmental chemicals, many of them which will never go away. They’re persistent organic pesticides. In our environment, women are particularly vulnerable because we have more fat than men do, and then we tend to store it in our fat. Although baby boy’s gestating are actually very vulnerable to because they get a lot of exposure to estrogen.

So, we get this environmental toxin exposure. We get a very significant lack of exposure to environmental microbes. So if you think about our ancestors, they lived close to the earth. It got their food from the earth. They pick things up off the ground, dusted them off and ate them. They ate tubers, maybe renting them, but if they were renting them, they certainly weren’t rinsing them in filtered water and the world’s microbe organisms. Microbial origin became part of us, but we’re living in a fairly sterilized environment where we don’t get those exposures and then stress is actually according to environmental medicine, environmental science. Stress is a toxin, and so we’re exposed to tremendous amounts of stress and then we’re exposed to things that may be less obvious, triggers like lack of darkness or continual exposure to environmental light which disrupt our circadian rhythm, so all of these are examples of the external root causes or expose them, and then there’s the internal expose on which does include our genetics and our predispositions.

It includes our own intrinsic microbiome, the microbiome that we did or didn’t get nurtured healthily by the form of birth we had or whether or not we were breastfed or how many antibiotics we had as children. Of course, things like sleep have an impact. That’s an internal status. How we, how we cope with stress, our resilience mechanisms, our ability to detoxify, how well our liver is working, how well our elimination systems like our gut is working, how well are mitochondrial function is working. All of these are parts of our internal expose them. And so we use this term root causes to sort of encapsulate and describe in a more poetic way the idea that we can’t just look at what’s happening in the leaves and branches. That’s the manifestation of disease, but we have to actually get to the roots and what’s going on below the surface and address those to really start to stop disease in its tracks, but also prevent it and even reverse it. So that’s the idea behind root cause medicine. And it’s, it’s really, um, it’s really next level. It’s very important for us to, you know, and as health coaches to understand that everything that you’re doing with diet, with lifestyle changes in one way or another is actually impacting this expose on and, and you have a huge amount of influence over it. And then we can start to add in things like supplements, nutrients, botanicals, specific meditation or mind body practices, a time in nature. All of these things help to reset us to a healthier expose on.

Michelle:             I think that for many of us health coaches, if you think about root causes, it can feel scary. Like, oh, but I don’t know how to test for that. And like I don’t know anything. And one thing that I really felt going through the course was that there were, yes, there are tests that I may not be able to order or run myself. But there are so many things that I can do to help a woman, like you mentioned with her Circadian Rhythms are obviously your Diet and her lifestyle and her, relationships you know, loneliness being such an enormous factor on someone’s health. And these are things they probably not even talking to their doctor about.

Aviva:                  And their doctor’s not asking. And honestly even their integrative and functional medicine doctor might not be asking. I mean, sadly, um, I feel like so much of functional medicine is getting much more focused on what tests can I order? What did the numbers show and what supplements can I give to fix that or what specific diet can I give an often this very restrictive diet and there’s a time and a place for those things, but it’s not always the primary thing and it’s not always the thing that’s going to move the needle. I mean I ran a program online two years ago in the fall. We’re going to actually run it in January called the gut 20, 28 day gut reset, no testing, very few supplements and the supplements were optional and people could get them on their own and we did 30, 28 days of just looking for triggers, like learning to look at interior body.

Basically, know what’s going on in there and start to make connections between what you’re eating and how you feel. And we had. The turnarounds were incredible. I mean women losing like four inches, 15 pounds in two and three weeks. I mean it was way beyond what I ever expected. People came off of blood pressure, medications, cholesterol medications. We had two women who came off of ADHD medications, people peeling off sleep medications. We had two women who had been trying to get pregnant for years before both of them who got pregnant within the month after and sent me pictures of their babies and this is completely like high touch, low tech and that to me is we’re really, I like to call it good medicine and I feel like it’s this is what we need a new medicine and I think functional medicine has gotten us thinking about root causes and thinking out of the box of conventional medicine in many ways which herbalist and natural paths have been doing for decades or centuries really.

But it’s taken functional. It’s taking conventional medicine and put a root cause spin on it, but if all we’re doing is replacing one form of conventional medicine with tests and pills with another form with tests and supplements, have we changed that much? I mean yes. I think that we’re giving people healthier options. I think it’s healthier overall. If you can take ginger for your period pain than taking Ibuprofen, but we still want to figure out why you have period pain and that doesn’t necessarily take genetic testing or inflammatory marker testing or hormone testing. It doesn’t take a Dutch test. Sometimes it just takes, let’s take the coffee out. Let’s let you get some better sleep. Let’s figure out how we can get you some downtime to start to, you know, just reset your circadian clock. We know that there’s tremendous connection between menstrual problems and circadian disruption and there’s so much you can do with a good questionnaire that really a lot of times supplants the need for testing.

So, a really good questionnaire. We’ll point you in the direction of the right test anyway because if you’re just randomly testing, then you’re just throwing the kitchen sink out. So in order to even figure out what tests do you need, you need to know what you’re looking for. So if you, if you’re already three quarters of the way they’re thinking something is probably x, y, or Z, you probably don’t need the test. You can probably do the intervention me, the tests are more important for I think something serious is going on and so somebody needs to make sure it’s not before I take this route or I have no idea what’s going on and this is such a wackadoodle situation. Let’s maybe get some testing, but nine out of 10 times you don’t need.

Michelle:             That is really important for everybody to hear. And I agree. I think you always say if it looks like a duck and quacks like a duck…

Aviva:                  It’s a duck.

Michelle:             You don’t have to find a doctor to run the test for you necessarily.

Aviva:                  Exactly.

Michelle:             That’s really amazing. That’s definitely something that I feel much more confident about now. And I want to touch on, um, one tool real quick before we get to your guys’ questions, which I keep pointing again, the Matrix, the matrix. We got to talk about the Matrix, tell everyone how they can be using the matrix,

Aviva:                  The red pill or the blue pill. So I’m the Matrix is actually a functional medicine tool that was developed within IFM Institute for Functional Medicine and I actually had a really fun opportunity in that before it was revealed by ism. I was actually working in David Jones and Leslie and Michael Stones Medical Practice in Ashland, Oregon. And David came out when David was the, um, he was executive director of IFM at the time or president of IFM at the time. He was the founding one of the founding fathers of IFM. And um, he said, Aviva, I want you to try out this tool because I know you’re going to know how to use it really intuitively. And it was a great tool. So he brought me the matrix. And the timeline in the matrix is simply a visual tool that you can use, you know, like when a client comes in and they’ve got 25 different symptoms and it’s all over the place and you’re like, do I help them with their sleep and their circadian rhythm? First stress, do I start with their gut? Is it their immune system and inflammation? And you’re like, what is it? You can take the matrix and literally just parse out the symptoms according to the areas of the Matrix. And I think that the functional medicine names for them are a little bit less accessible. So they have, um, the digestion and assimilation,

I just call it the gut. They have immunity. What do they have? They have, um, I’m going to pull one out. I break it up by the gut immune system and inflammation, energy, detoxification systems, cardiovascular hormones and musculoskeletal. And then the center is mind, body and spirit. And I think that’s really important that it’s in the center because we can get so busy like, oh, let me do something for the Mitochondria. Let me do something for the gut. Let me do something for immunity. And we forget there’s a reason that mind body is in the middle and that, that is the linchpin to everything. And like you said, I mean, the inter-heart study, which was this a multicenter study of something like 17,000 women found that loneliness is more of a contributing, um, heart disease factor. Then diabetes, overweight. And was it cigarette smoking? It’s three things, a diabetes, overweight and cigarette smoking put together, put together as much as triples your likelihood depending on how serious you rated your loneliness it either what increased it by one point three up to three point two times the likelihood of having a heart attack just from loneliness.

Michelle:             Amazing. So I’ll just show you guys. This is like a notebook, just scribbling as I talked to one of my clients, but I’m able to put together like some of their different symptoms and figure out how they kind of work together so I can like Aviva’s saying take a look and say where do we start here? And yes, I still use a paper notebook.

Aviva:                  I keep. I keep paper. I’ll my matrices and all my notes for my patient visit and then I type them in. There is an APP now that you can get, I don’t know how many people are using it, but the. There was a private organization that created an APP that is being or was being used by IFM and it does create a matrix for you, so you type in the symptoms or the conditions and it creates the matrix and then it creates a recommendations for you. I personally like to think through the systems and symptoms on my own so I don’t use that, but it is available and I, I do think it helps create some algorithms for treating on the next level too. There’s an APP for that. Yeah, and it’s a great device if you’re writing it out because I read it out and I show it to my patients.

So, let’s say somebody comes in and they have allergies and they get hives and they get, um, let’s say that allergies, hives and Eczema. And I’m looking at their situation going, wow, this is a 28 year old woman who has allergies, hives and Eczema. And from the time she was 21 till she was 25, she had six urinary tract infections and got antibiotics every time. And she had bronchitis twice. One time it turned into pneumonia. But both times she got antibiotics, she has bloating all the time, she has a bowel movement once every five days and she’s tired all the time and so she’s coming in for allergies and hives and Eczema and the Eczema is making her miserable because it’s on her face and it’s on her elbows and it’s going into summer and she’s embarrassed and I’m saying, well, let’s work on your gut, and she’s like, well, but why? I came here for my Eczema. That would never happen if you’re using a tool like this because you can explain the connection between Gut and inflammation and show her this is the symptom, but this is the route and so you can explain how dysbiosis works or leaky gut works and how that creates inflammation. Then you can tie it into an elimination diet. And I know listening it sounds like, whoa, that’s way above where I am, but when you break it down, it’s very usable.

Michelle:             Yeah, I found it very useful and I had never heard of the matrix before. It was all brand new to me when I started the course and I thought, all right, let’s give this baby a try. So that’s how I started to integrate things. Like as I took on a new client, I would. Let’s try the matrix. Let’s try using the timeline. Yeah. And just little by little started incorporating it into my health coaching practice.

Aviva:                  Yeah, the timeline’s amazing too because it’s almost like you’re creating a visual story for the client and a lot of people will come to me for example, and I’m sure you guys have this too, where it’s like, it seems like all of a sudden like I’ll have somebody say I was fine three months ago and now I’ve gained 30 pounds and my hair’s falling out and I’m tired all the time and I’m cold all the time and I have no idea why this came on. So suddenly. But then you do her timeline and this has happened to me so many times. Like her mom died six months ago and her mother in law got cancer six months before that and one of her kids got, you know, I don’t know, had diagnosed with ADHD and then she found out something was going on, not so great with her husband or maybe something was stressful at her work and it’s like all of these things that we just take in stride as life and that we’re not taught can impact our health and you know, when all that stuff’s going on, it’s like, yes, there’s stress that can suddenly lead to what looks like a diagnosis, but then what happens when we’re stressed, we’re not sleeping as well.

We’re eating more sugar or eating more carbs, were having more alcohol or we’re not eating enough are exercise. Practice goes out the window and so when I draw it out for a woman, it’s almost like her own inner light bulbs start going off, but also she’s able to be more gentle with herself. She’s able to say, oh, like this isn’t just something wrong with me. This has been brewing and something just happened and now I need to be gentle with myself to replenish and restore and that transformation. I mean, isn’t that what we’re all looking for? Right? It gives someone the why and the permission and sort of that internal reset that room for self love and self compassion

and this is all stuff that we can be doing as health coaches and not amazing guys.

Yes. And honestly I don’t, I don’t know that a lot of other people are going to be doing it. So I mean, I’m hoping the docs I train docs coming out of good integrated programs are. But it’s tough. September the time and I mean most mds are given seven to 20 minutes for a patient appointment. So where is that all going to happen?

Michelle:             Right? It’s up to us. You guys. It’s up to us.

Aviva:                  Yeah. And it sounds just docs. It’s like, I mean the woman who was my nurse practitioner, my practice, she now has her own practice but she was seeing 30 patients a day. So I mean here you have this wonderful woman who goes into nursing to be a nurse practitioner because she didn’t want to have that MD model hanging over her head and she ended up with. Yeah. So she went an integrative functional route.

Michelle:             Well, let’s do questions. We have so many. First of all, have you guys loved hearing from Aviva so far? Have you already learned some stuff? I know you’re taking them. I know you’re all very avid students. I know I’m going to go sort of backwards through it. So Lisa just asked, when does your next program begin?

Aviva:                  So, we have one that’s still registering now and that begins on September 20th. It’s a 10 month program, but you actually have 16 months to finish it, which means that there’s 10 months guided by me and then six months, you know how life happens. Right? So if you need extra time for overflow and um, so we start every September and then registration closes all the way till next week, late April, early May. So you can register through, um, September 14th. Next, I think it’s a week from Friday.

Michelle:             Right? And I just dropped into. Yes. And for anybody listening later, you know, you can just go to and under courses you’ll find the professional training program or ugly. All right, let’s go to some of the other juicy ones. Umm, Rebecca says, do either of you have best references or reputable companies to apply to work as a virtual health coach to supply income and experience while building our own practices? They seem far and few between.

Aviva:                  That’s a great question. So I would look in a few areas. One, telemedicine is exploding and so I would look at telemedicine companies and see if they have health coaches and look at some of the practices that are, are primarily using telemedicine. So like Jeffrey, glad he does a lot of telemedicine and I’m sure there are others that are doing significant telemedicine base and see if that’s somewhere that you could add in. That would be, that’s where I would start.

Michelle:             Good thinking. I got national on that one, Rebecca. So it is hard to find places to work. Um, let’s see. Oh, Susan was just saying

Aviva:                  Well, can I add? I want to add just one thought to that. One of the big, like my big thing is that I’m really working toward creating a national telemedicine platform on integrative and functional medicine for women and kids. And the goal with this training program is partly, not everyone obviously has to come through and work in this telemedicine business, but for those who want to, it’s creating teams of mds and slash or nurse practitioners, plus a health coach plus a nutritionist so that people can have like really affordable access online because the people that write to me, they’re all over. I mean, they could be in like des Moines or Kansas City or in New York City, shockingly, there’s a dearth of practitioners even in New York City. So stay tuned for that too.

Michelle:             Very exciting. Yeah. Okay. Here’s another question. Would love to know your bottom line opinion on gluten and Hashimoto’s antibodies are present but not super high, but his is 100 percent gluten free, absolutely necessary. And is just reducing gluten. Still helpful.

Aviva:                  Um, so. Okay, good. Great question. All great questions so far. Um, so here’s the thing. Not everyone who has Hashimoto’s has it because they have gluten intolerance, but there is a very strong connection between celiac disease and Hashimoto’s. So if somebody has celiac disease, which is an autoimmune form of gluten intolerance and they have Hashimoto’s, they absolutely have to go off of all gluten and probably most gluten cross reactivity as well. So corn, millet, oats, things like that. Um, regardless of what their antibodies are. Now, not everyone who has gluten intolerance has Hashimoto’s, mean has celiac. So for Celiac, if you’re trying to figure out if somebody has it or not, the first step is to send them to a primary practitioner who can check them. For CELIAC and CELIAC’s genes, it’s the h, l, a, dq eight or Hla Dq two. If they don’t have those genes, they cannot have celiac disease.

You can’t get celiac without the genes. You can have the genes but not have celiac, but you can’t have celiac and not have the genes. The problem with Celiac is that the testing for it isn’t always so great. So if I have a patient who has celiac disease who has the jeans, but I don’t know they have celiac or not, and we don’t want to do the biopsy because that is very invasive. I will run CELIAC. Gluten antibodies, if they have the gene and they have the antibodies, they have celiac disease, no gluten for them ever, ever, ever whether or not they have Hashimoto’s, but if they have Hashimoto’s and Celiac, zero gluten ever like ever, if you can help it. If they have the gene for Celiac and the antibodies come back normal and they don’t want to do a biopsy, but they have Hashimoto’s and they know they’re triggered by gluten, I would take it out 100 percent at least for a year and see if their Hashimoto’s antibodies resolve.

If they resolve and you can always trial and add gluten back in and see if symptoms or the antibodies creep back up, but I have patients who we’ve done gluten free for months. They’re celiac negative. They really don’t have any symptoms when they eat gluten or gluten in their celiac and a gluten antibodies are negative and it doesn’t seem to be. What’s the trigger for Hashimoto’s? In which case I don’t take luke out. Now I will say if somebody’s doing a science experiment, right? Let’s say you did a science experiment where you were trying to see if a plant that grew in darkness grew or not, but 30 percent of the day it got daylight. You can’t know if that plant grow in darkness with 30 percent daylight. When you do an experiment, you have to do it all the way so you either have to be completely gluten free or don’t bother and that can be for just a period of time.

So, let’s say somebody goes gluten free for six months and they feel so much better and then they decided they want to add gluten back in, but they only added in maybe like once every few weeks. They don’t get symptoms when they add it back in infrequently and they’re not CELIAC, it’s probably fine. Um, but if they get symptoms, I would say once in a while is not worth it because that once in a while is still creating inflammation. I had a patient a bunch of years ago, you can’t make this up. She actually grew up on a wheat farm in the Midwest. I mean, I guess you can make it up, but why? So this woman, she got diagnosed with Hashimoto’s and she was about to start. I’m thyroid medication, but she noticed that her belly was constantly bloated and she said she, when she first wrote to me to set up an appointment, she said that she looks like she’s seven months pregnant and I thought in my mind, I don’t know why, maybe I thought that was a little bit of an because you know, when women were more bloated, we’re like, oh my God, I’m seven months, but I look like I’m seven months pregnant, and she sent me pictures and she was this tall, very slim woman and being a midwife, I’m a pretty good eyeball of seven months pregnant and she looked seven months pregnant and she came to see me and I did her a anybody’s and she was.

She was celiac positive and we took her off of all gluten, all cross-reactive and amazingly, her antibodies normalized almost a completely normal. She never needed thyroid medication. It was, it was the gluten contributing, so I hope that helps. It’s a little complex. We do go through it in an elaborate detail so that you really understand it in the course, but that’s sort of a primer.

Michelle:             I think that was very good thing. There’s no easy answer, right? You can’t just say yes or no and that’s it.

Aviva:                  Exactly, exactly. It’s always worth a try with Hashimoto’s though, because it is a big trigger for a lot of people.

Michelle:             Yeah. Yeah. One of the first things to try.

Aviva:                  Just for the record, I’m not a hundred percent gluten free. I don’t make my patients all go 100 like that can make them, but encourage them all to go 100 percent gluten free, but some people just really do well with it.

Michelle:             Are you ready for one for Mary? Mary says, do you help health coaches learn to interpret testing and I most of your other students may not need help with this, but I’m thinking of health coaches that receive referrals or I guess information from doctors, etc.

Aviva:                  I do and I do for a few reasons. I recognize that it’s not within your scope of practice to interpret and make recommendations based on the tests and so you know, I’m really careful to make sure to let you guys know like keep it legal. You don’t want to lose your certification or get into trouble. On the other hand, people get really confused about their labs. They may or may not get full information from their doctor or they may feel like they can’t ask their doctor or primary provider to go deeper and so having that information as a health coach does huge justice for your clients because you can actually sit down and it’s not like you’re saying, okay, you have this antibody so this means you have x, y, z. Right? You’re not diagnosing them, but you’re able to say this is what this test means and this is what it means when it’s positive and this is what it means when it’s borderline and this is what it means when it’s normal and this is sort of the what you can expect to need to do based on this.

I feel like it’s so important for health coaches to be able to personally to be able to provide that information, but also to be able to interface if you are working with medical doctors or nurse practitioners or any licensed professionals, naturopath, anyone who’s doing chiropractors, whatever, to be able to also with them, if they’re handling recommendations off to a patient or you know someone who’s going to be your client and they’re saying to this patient, oh, you have mthfr positive and so you should take methyl folate and then they go and look online and you know, maybe they’re thinking of having a baby in the next six months. They’re thinking about getting pregnant and all of a sudden they read, oh my gosh, this could increase the risk of autism, but also if I take too much methyl folate, that can increase the risk and they’re super confused.

Where are they going to. It’s almost like, who are you gonna call ghostbusters. You know where you’re going to call your health coach. Who can really break that down and also amplify the anxiety and fear and these are not hypothetical. I get these kinds of questions all the time, not for my patients because of course I’m breaking it down for my patients, but I get these kinds of questions all the time on by email on my Facebook page or just go to any of my blogs and look at some of the kinds of questions people are asking and this is the kind of information that you can be so valuable at helping to interpret.

Michelle:             And I have been, by the way, I’ll have clients send me blood work if they want to, if they’re comfortable with it, um, send me their blood work and sometimes the distrust of doctors or there’s just wanting to get another opinion and while I’m not there to be like, yes, this is low, this is high, this is what you should do. Sometimes I’ll just say, well this does say normal, normal range, but according to the functional medicine community, the range is slightly different and I’ll just use that information and then they can decide where to go with that.

Aviva:                  Yeah. Or I mean, here’s another example. I had a patient who came to me who had been seeing a number of different other integrative and functional doctors and everyone kept telling her she had a thyroid problem and she finally got put on thyroid medication and I went and I looked at her last five years of labs before she came to me. Her thyroid labs were completely normal. Every single time her t three was normal. Her t four, her TSH weren’t even borderline, but she was severely anemic and nobody had ever said anything to her. And that’s the kind of thing. I mean, I caught it, but health coach can also catch something like that and say, you know, it might be good to bring this to somebody’s attention.

Michelle:             Uh hm, right. I just noticed acting as another set of eyes who does not have a dog in the race necessarily.

Aviva:                  It’s really important to actually. It really is, um, you know, one of the things that ideally, a primary care providers should be doing. And at one point, this idea of medical home got introduced and what it meant was not that you go somewhere and live there, but that there is a provider who’s keeping an eye on everything. And typically, and this especially gets to be the case as we get a little bit older, so older meaning like my age, I’m 52 women my age already on average in the United States, 50 percent of women over 50 are on at least two medications. Many of them have their primary doctor or their gynecologist or psychologist or psychiatrist, their cardiologists, their endocrinologist. I think about it, you’ve got someone for your cholesterol and blood pressure. You’ve got someone for your thyroid, you’ve got someone for your anxiety and your depression and nobody’s minding the store.

So suddenly you’ve got somebody who’s got no sex drive because she’s on an SSRI or she’s got depression because she’s on a blood pressure lowering medication. And now her psychiatrist says, oh, you’ve got depression. Let’s put you on an antidepressant without thinking maybe it’s the beta blocker. Right? And then then she’s got low libido and she goes to her endocrinologist for her thyroid and the endocrinologist like, well, we can give you something for the low libido when the low libido is from SSRI and the beta blocker and ideally a primary care provider should be looking at this. Everybody, every doctor along the way, every nurse practitioner, every naturopath, every chiropractor along the way, whoever they’re seeing should be looking at this that I can’t tell you how many times nobody’s looking at it. And so you’re also in a position to not obviously not diagnosed, not say to someone, go off your beta blocker, but you might be the person who can say, have you noticed that you’re on three medications when I go these medications.

The side effects are depression, fatigue, low sex drive, right? And that is really critically important because we also know that the medication problems in the United States, medication adverse reactions are the third leading cause of death, death, and those are appropriate place drive. We’re not talking about narcotics overdoses here. We’re talking about you go to your doctor, you get a medication, you have an adverse reaction. So, oh my goodness. So many things. Everyone wants to talk all about this and I think Michelle, you’d be a better one to answer, but I feel like we do. I mean, I tried to do a really good job of saying and for health coaches and nutritionists in the program and one thing that we’re going to be doing this year is that Michelle is actually going to be providing some extra coaching, um, as a graduate for health coaches and then also be interacting with me separately about, oh, you know, um, this is, uh, this is coming up for the health coaches.

Let’s talk about this in a special separate Facebook live or special separate teleconference just to make sure that it’s especially dialed in for you guys. Or if something comes up that is, um, maybe sort of like top drawer science information that might not be something that you covered as a health coach. We can separately break that down for you so that it’s really understandable and meaningful for what you’re going to use it for. I don’t. I don’t feel like you guys should be marginalized as some kind of like second class non health system providers. I feel like you should be a fully integrated part of the system and that every doctor’s office should have health coaches. It’s like the way midwives were 30 years ago. Every office needs midwives. We know there’s better care provided, better one-on-one and better attention to what’s really going on for the patient. So I feel the same way. And if you don’t have the fully dialed in information, how can you make sense of it? When a patient comes from a medical office with all these supplements and they’re trying to figure out what to do with them or all these tests and they’re trying to make meaning of it and now somebody also made them feel sick, you know, because suddenly they’ve got all these weird diagnosis and 18 supplements and now they’re really worried.

Michelle:             Yeah. So, I hope you guys can see how much Aviva is invested in helping health coaches really elevate, elevate ourselves and not just be the person that says eat more greens. I don’t really know why. But you can play like, an essential role in the healing of women across the country, across the whole world. So this just been a really exciting to have you here Aviva. I’m going to drop your link just one more time into the comments and while I do that, do you want to just do one more question? This one came from Eileen and I think it’s a good one. She said Dr. Romm, do you still have a private practice and if so where?

Aviva:                  I do still have a private practice. I actually took a year off between January end of January, 2017 till march. No, sorry, 2018. So this year till march of 2019. I didn’t take on any new patients because my patient roster was so full, so right now I’m just keeping up with my follow up patients, but also I’m really envisioning a whole new practice model which I’m really excited about, but for me it’s super important to continue to see patients because otherwise I feel like I’d become a talking head, you know what I mean? And you start to lose touch with what really works for people. not just like does this supplement work, but does it really work for someone to take it? What is the experience like? So for me, it keeps me in the sandbox. um, plus I love that one on one with, with real people. Um, my practice is based in New York city. I live in western Massachusetts. So when I see new patients it’s been going down to New York city a few days a month, clustering all my new patients with some room for people who are in the city or in the metro area who want to follow up with me physically. But my patients come from all over the country. And so for many of them, if not most of them, we do teleconference as, um, as follow up. So when you tell telemedicine.

Michelle:             There you go, still in practice

Aviva:                  I am. It’s, I mean, my practice is much smaller than it was years ago, uh, because, well, it’s just, um, you know, my patient care is so important to me and that one on one time so you know, when I’m there for you, they’re for you. And at some point, I realized I could only be there one on one for so many women and the need is so much greater than I can ever fill. So it’s like that old tv commercial I told two friends and they told you friends and so on and so on, you know, it’s just about now training other people to not do what I do so much as to have the information that I have and then be able to interpret it and put your own spin and flavor on it. But offer what I really do feel is good medicine. It’s not throwing all the conventional knowledge out with the bathwater and it’s also not jumping onto every new bandwagon that gets introduced as you know, the latest diet or the latest supplement either, but I’m jokingly calling it the course for discerning women. I’m seeing patients but also teaching more.

Michelle:             Amazing. Well, thank you everybody for joining us today live and also so many will be watching the replay and listening to this leader and I’m so glad you were able to join us Aviva, thank you.

Aviva:                  Oh my gosh Michelle. Thank you for having me. Thank you for having confidence in doing the first round of the course. It was an amazing adventure to share together, so.

Michelle:             That was a no brainer for me. Awesome stuff. You guys have a great day. Thanks. Bye.