Is the integrative process outdated? a debate with Christa Biegler, RD and Jen Fugo, MSS, CNS

This week on The Less Stressed Life Podcast, I have my dear friend Jen Fugo on for a friendly debate on the integrative process. We talk about what research says versus what we have experienced in our practices. Jen and I also talk about how our practices have evolved. I think the biggest takeaway here is, whether you are a client or a practitioner, there are multiple ways of doing things. Jen adds, "everyone's journey is going to look different and that's ok."

More episodes with Jen:
#58 Why you shouldn't use coconut oil on your skin
#191 Are Skin Rashes Related to Parasites?

KEY TAKEAWAYS:

• What is evidence based medicine?
• What is the integrative process?
• Practice: how did we start vs where we are now?
• Practice versus research
• How are clients changing?

ABOUT GUEST:
Jennifer Fugo, MS, LDN, CNS is a clinical nutritionist empowering adults who’ve been failed by conventional medicine to beat chronic skin + unending gut challenges. She has experience working with conditions such as eczema, psoriasis, rosacea, dandruff + hives — with clientele ranging from regular folks to celebrities + professional athletes.
Jennifer also founded her own line of skincare + supplements available at www.QuellShop.com specifically for people struggling with these chronic skin issues. 
She holds a Master’s degree in Human Nutrition from the University of Bridgeport and is a Licensed Dietitian-Nutritionist and Certified Nutrition Specialist. Jennifer is the host of the Healthy Skin Show podcast with over 1 MILLION downloads.

WHERE TO FIND:
URL: https://www.skinterrupt.com + https://www.jenniferfugo.com
Healthy Skin Show Podcast: https://skinterrupt.com/listen
Quell Shop: https://www.quellshop.com
Facebook: https://www.facebook.com/GlutenFreeSchool
Pinterest: http://www.pinterest.com/gfreeschool
Instagram: http://www.instagram.com/jenniferfugo
Twitter: https://twitter.com/jenniferfugo
Tiktok: https://www.tiktok.com/@jenniferfugo
Youtube: https://www.youtube.com/jenfugo
LinkedIn: https://www.linkedin.com/in/jenniferfugo/

WHERE TO FIND CHRISTA:
Website: https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
Leave a review, submit a questions for the podcast or take one of my quizzes here: https://www.christabiegler.com/links

WORK WITH CHRISTA:
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TRANSCRIPT: 

[00:00:00] Christa: Stress is the inflammation that robs us of life, energy, and happiness. Our typical solutions for gut health and hormone balance have let a lot of us down. We're over medicated and underserved. At The Less Stressed Life, we're a community of health savvy women exploring solutions outside of our traditional Western medicine toolbox and training to raise the bar and change our stories.

[00:00:26] Christa: Each week, our hope is that you leave our sessions inspired to learn, grow, and share these stories to raise the bar in your life and home.

[00:00:45] Christa: All right. Today on the less stressed life, I have invited back my dear friend, Jennifer Fugo, to talk about a topic that's not really maybe characteristic for us, but kind of sassy, kind of spicy, and we're excited to talk about it. So first things first, Jen Fugo is a clinical nutritionist, empowering adults who've been failed by conventional medicine to beat chronic skin and unending gut challenges.

[00:01:05] Christa: She's has experience working with conditions like eczema, psoriasis, rosacea, dandruff, and hives with clientele ranging from regular folks to celebrities and professional athletes. She also has her own skincare line and supplements available at quail shop. com specifically for people struggling with these chronic skin rashes, and she's been featured on Dr. Oz, Reuters, Yahoo, CNN, many podcasts and summits. 

[00:01:27] Christa: And Jen and I go a long time back years and years back. Because not that many people work in skin issues and we both do. And not that long ago, she was off on a rant, a tangent as we like to do every once in a while. And she was talking about something that I was like, Ooh, this is an interesting conversation.

[00:01:43] Christa: Correct me if I'm wrong here in a second, Jen. She was saying, you know, the integrative process is a bit dated, right? It's not like custom enough or some respect to that. So we're going to talk a little bit, we're going to riff a little bit about integrative process and the proper way to address things in this kind of DIY world.

[00:01:57] Christa: And we are, we're both trying to be out there empowering people to help them heal themselves, but there's nuance. So how did this conversation even get started? And then maybe I'll define integrative process a little bit, and then we'll go in from there. So where'd this come from, Jen? Like, what was Making you angry.

[00:02:13] Jen Fugo: Well, I was at A4M, which is one of the functional medicine conferences for mostly MDs. I feel like most of the people there were more like the MD class of people. And I would sit in on these talks and there was one doctor who was presenting on different like probiotics and things like that.

[00:02:33] Jen Fugo: And I'm just like, okay, first of all, this research is that it's research. It's not exactly applicable like, this is nice, but when you work in this field and you apply that data to various clients, you will very quickly discover that does not work as well as you're presenting it to work because it's also like very, so a lot of them were very small studies.

[00:03:02] Jen Fugo: So it's a very small group of people that they tested this on. It wasn't for a long enough period of time. There was also a lot of complexity to these cases that, you know, you can't tell from these little research papers. And, you know, it's just frustrating to me because like somebody will go online and I get it.

[00:03:18] Jen Fugo: You want to try to figure out what's wrong with your health and your doctor might not have any idea. Of what the heck is going on and they might not understand. All of the things that you and I do and see on a regular basis, but you'll see a study and just be like, Oh my gosh, I need to do this.

[00:03:36] Jen Fugo: This is the missing key. Why did nobody tell me about, some supplements, some vitamin, some diets, any number of things, and then you try it and you're like, why didn't this work? And so I think that's mostly, my biggest frustration is in how we present data and also considering, like, does this person actually use this in practice?

[00:04:00] Jen Fugo: Have they actually tried this? Does it really work as well as this study is saying it does? 

[00:04:07] Christa: Well, I mean, you had a very specific story about Instagram, so I'm going to come back to that in a second. But a couple of things you said there that I wanted to find is evidence, and I've talked about this before, but this isn't really important to me.

[00:04:16] Christa: I'm sure it's important to you. Evidence based medicine. And you know, we get this in our practice or like in, our profession where people are like, Oh, is this evidence based? Okay. Well, let's talk about what the event diagram of evidence based medicine is. Evidence based medicine is the current clinical research, the current research that we have, the current body of research that we have, it is the client or patient experience their own lived experience.

[00:04:39] Christa: And it is our clinician experience. That is the Venn diagram of evidence based medicine, and we tend to forget about those other 2 quite a bit, whereas I feel that we need to almost emphasize them. I say this a lot that we need to look at symptoms over testing. Or I might even say, I say, I've been saying this a lot recently.

[00:04:57] Christa: I learned the most I've ever learned from my clients. I have made the integrated part of our conversation day is integrated process. So let me define that and then we'll jump in here, but I have created my own timelines and ways I utilize. What is sort of kind of this overall framework that I think has been a successful framework.

[00:05:17] Christa: Big picture last September. I think I was at some conference and I was standing in the back of the room and Jeff Bland was standing back there. Jeff bland. Is, considered the father of functional medicine. I don't know how he got that title. Who titles these people? 

[00:05:30] Jen Fugo: Who knows? 

[00:05:30] Christa: That's what we call Jeff Bland.

[00:05:32] Christa: He's a nice, jolly guy. And I was talking to him at the back of the room and I let him know that I thought the integrative process, which is something he coined, it was the framework he created. I said, I think this was really helpful. And this is why we're having this Slight debate, like this jovial debate, man, Jen, because she's like, I don't, I think the integrated process is outdated.

[00:05:50] Christa: I was like, Oh, I love the integrated process, but we'll get to it. So I said, Jeff,, I really appreciate the integrated process. It really changed how I practice. And he said, you know, we've done a lot of things over the last, over many decades. And he's like, but I'm really proud of that, framework.

[00:06:03] Christa: I think that was good work. And so it was just kind of like a cute. You know, dude conversation, but the integrative process is a framework that apparently Jeff Bland coined and there's maybe 4, maybe 5 steps of it. And the 1st step is remove. The 2nd step is replace or replete. The 3rd step is I just combine these repair and repopulate.

[00:06:24] Christa: And then there's been another step kind of added, so we could call this maybe the 5th step because I kind of group in repair and repopulate personally. The last step is, maybe reassess or rebalance and up for discussion. I didn't pull this up. I'm just like, going with what's in my head how I think of it.

[00:06:39] Christa: So, if I may elaborate just a little bit remove is I talk about removing the stressors of life. Like, what are the barriers or the stressors that are in place? And this is where this kind of can fall apart is sometimes people do this out of order, or they do something for too long.

[00:06:53] Christa: So something people do a lot for too long is remove. Remove should have a finite timeline. And sometimes, and I think Jen's story, I hope you'll tell this story a little bit about this person who reached out to you on Instagram, because if we can make it really tangible, it's kind of interesting. And this person is just.

[00:07:06] Christa: Some stranger and we don't have identifying information. So remove, removing the stressors might look like removing stressors, improving nervous system stress, removing gut imbalances. I know Jen and I emphasize that quite a bit. Maybe people might say, where does food fit? Maybe removing food stressors.

[00:07:22] Christa: I think Jen and I both agree that like, that's actually not an essential step very often. Occasionally it is, and then removing maybe like liver stress. So those are some options for moving stressors. Those are some of the ones I think of. The second one, replacing. Replacing I consider this like replacing nutrients missed like nutrient deficiencies and replacing enzymes, which I doesn't, I don't mean just taking enzymes, but improving how your body's making enzymes.

[00:07:46] Christa: Cause that makes all the magic happen. And then repair and repopulate, it's like repairing tissue lining. So since we both work in skin, externally tissue repairing tissue, right. And internally repairing tissue, right. If there's gut permeability, whatever, and repopulating, right. Filling in the good bacteria in the gut.

[00:08:00] Christa: And so another common thing is people read things online and they start just like. You know, repairing, right? They like go take themselves some gut healing support, and I don't really care if you take gut healing support or not. Like, it's neither here nor there to me. You know, what really matters is how does it work for you?

[00:08:15] Christa: Right? Or, you know, because what happens for Jen and I is we get to talk to people who something didn't work. So then they're looking for help. So we have to kind of dissect why that didn't work. So repairing or populate and then maybe reassess and rebalance. So anyway, that's what I want to say about integrative process as like, as a definition.

[00:08:30] Christa: Please feel free to fill in anything you think that I missed, Jen. But then also, like, if you will, jump in anywhere you want there, but if you will, will you share that story you shared with me that was like really irking you about where this integrated process gets used incorrectly or gets used as a canned protocol without individualization.

[00:08:50] Jen Fugo: Yeah, I think that's my biggest issue is that I think that it's nice to have a framework and most people need some sort of guideline, especially. And when I say people, I'm specifically talking about practitioners, but like, that can apply to a regular person for just about anything. But what I quickly realized because at least as a CNS or a certified clinical nutritionist, our master's program trained us in the five hours. And so when I got out of school, I quickly realized that it didn't work so well in practical. You know, situations, real situations with real people, because there were times where if you don't do things, actually sometimes almost like kind of backwards or out of order because of the case.

[00:09:35] Jen Fugo: And like you were saying, you can't just go by test results. Like you have to look at the symptoms that are presenting. And figure out like what exactly is the biggest factor here. And so one of the big things that we look for in certain types of cases is, really significant nutrient depletions that are drastically hindering the liver from being able to do what it needs to do from a detox perspective, because phase two is so highly dependent on nutrients.

[00:09:59] Jen Fugo: And we've had some incredible, like, especially with psoriasis, some really incredible turnarounds. It's not magical. I just want to be really clear, but there have been some cases where I'm like, Wait, how many days apart were those photos? Like, is that real? Can you double check those dates? Because I just was so taken back by how much this high level of nutrient repletion without doing any of the remove and killing anything in their microbiome and dealing with anything in their gut.

[00:10:25] Jen Fugo: Made such a drastic improvement. It gets, it was quite staggering. But like one example, you were saying about the person that contacted me on Instagram, she's working with a nutritionist who had her do the five hours and she was getting worse. The more she was increasing, Like different, gut herbs and formulations to try to kill things in her GI tract, but it was very apparent from a few things that she had sent me that her liver detox system, like specifically phase two.

[00:10:53] Jen Fugo: So that's what I look at mostly because that's what we can control most easily with nutrients. What really needed support and I was like, you know. Maybe you're reactive because it is, maybe, I mean, there's so many factors, it could be the herbs, you could be sensitive to the herbs, it could be too much of a dose for you, but if your liver can't handle the die off, and all of the waste products as a result of killing things, in addition to what it's already trying to deal with, you're going to have a problem, and so, usually that's where we start, and she's like, yeah, but we have to do the five R's, and I was like, Well, it doesn't with skin issues.

[00:11:27] Jen Fugo: It doesn't always work that way. Like you have to really look at the case in front of you. And that's why I always like to start with writing digestive function and supporting liver detox because those two pieces for me tend to move the marker, the biggest in terms of like the physical stressors, not like, mental stress, emotional stress, et cetera.

[00:11:47] Jen Fugo: And so she was really struggling because she has on one hand a practitioner is telling her to do one thing and here seeing me on Instagram saying something entirely the opposite. And I was like, look, I'm not your practitioner. I'm not saying she's wrong. That's just her way. That's what she was trained in.

[00:12:03] Jen Fugo: And so you have to decide what's right for you. And so you need to have a conversation with her. I'm not trying to poach you from her. It's not my interest. I don't even know if we would be a good fit to work together. So let's not even have that conversation right now. But if you're having issues, you have to go back and speak with her.

[00:12:18] Jen Fugo: And so just my long and short is I think that it's nice to have a framework, but if you cannot start thinking outside of the box and you constantly need a canned protocol. It's one of my biggest grievances with kind of the IFM model is they just give people these like, canned protocols that are being handed to patients and they don't get better.

[00:12:41] Jen Fugo: And I'm like, well, they were never going to get better. If you actually looked at all of their test results and you looked at their clinical symptoms, there's no way this protocol was going to help. I don't even know who this was for. It was clearly a canned protocol. So like, I don't know. 

[00:12:55] Christa: There's no shortcut to experiences.

[00:12:58] Christa: And I'm sure , we both have like a full barrage inside of us of like failing forward experiences from early practice where it was like, you just had to keep, like, I just kept seeing the client fixing the problems right. To the point where now it's like, of course I know what the problem is.

[00:13:12] Christa: Cause I've seen this like a zillion times. So. In summary, what you were just sharing to summarize again, but it's this person reached out. Someone put her on, remove microbes situation, which when you have a skin issue and your skin is a detox organ, it can show up on your skin because you had like having company over.

[00:13:30] Christa: It's a coming company over and they have a lot of extra trash and you're taking out more trash and so it can make your skin worse. I never really liked, and I like almost cringe when people say it might get worse before it gets better. It, but that's not really the goal, right? Like, unfortunately that just means like, Oh, we're probably have like a strangle detoxification situation.

[00:13:49] Christa: And so when Jen's talking about phase two, I always think of it like a garden hose. It's kind of like, Oh, you got to kink in the garden hose. So when you straighten out the garden hose, you're really supporting phase two detoxification. Works like a friggin charm and, skin cases a lot, but devil's advocate . So I often, one thing I really like is I like people to understand what they're doing.

[00:14:06] Christa: Like, I don't think people like to be led around by a leash, right? I'm sure you 

[00:14:09] Jen Fugo: I agree, 

[00:14:09] Christa: obviously. For me, I must like, even when people ask me exactly what to do, even though we give them exactly what to do. When they ask me things that I could empower them to understand. I want to answer it in that context.

[00:14:21] Christa: So people will say, do I need to reorder blah, blah, blah, blah, blah, blah. I'm like, let me help you understand the framework of where this fits in. So you can also answer that question because that's more empowering. So I will often go through integrated process with people to help them understand where these pieces can fit and where they are in their overall processor framework.

[00:14:39] Christa: And to be honest, when I'm adding liver support in, I feel like you can put it in multiple sections because if we're removing liver stress, then maybe supporting it with nutrients as part of that, that's just a perspective. So if you support with nutrients, like you should, when you're doing skin stuff and they have a clear detoxification burden, if you know about this, that should be done first.

[00:15:00] Christa: So you could consider it first step, or I actually like to put it in the second step, but I use it right away. No matter what, like you said, it's kind of like you can have a framework, but, I will leave out the cuss words that were used in this group chat, but we all said we would do whatever we want that fits the client.

[00:15:16] Christa: Right? Like, yeah, we like this framework. We're going to do what works. We just don't even think about it. We're just like, oh, of course we must do this. So the point is, I'm just trying to say is couldn't let's just say generically liver support because that's a very generic thing to say couldn't liver support or moving burden on the liver fit under remove or replete.

[00:15:34] Christa: Technically, if it's under replete better, which Jen saying, well, this is out of order. You should do repletion first. And she's right. Because this is the reality we live in. People are in more depleted than they've ever been. Because of stressors, stress depletes nutrients and minerals, and you can't digest.

[00:15:49] Christa: So digestion, you can't digest, you can't digest. You're not digesting protein. You're not getting amino acids rich. You're a huge backbone of phase two detox. If you can't digest, you're totally depleted. And then you're limiting your diet. And you're depleting yourself even further. So between your stress, compromising your digestion, so you're not digesting, absorbing nutrients, plus your limited diet that you've been on, we're in a depleted world.

[00:16:11] Christa: Plus our like crazy stressful elastin or whatever. And plus some people are super depleted. So what to Jen's point is when you see that person arrive in your office and they're like, just like kind of a hot mess. And we know what a hot mess is like someone might think they're a hot mess and we might be like, oh, you'll be fine.

[00:16:28] Christa: Or someone might come in and they don't even realize that happened. Like you're a hot mess. Like you need some repletion support, or you are not going to do good. Cause you just said, if they don't have the resources at the liver to do the job, then nothing really matters right. 

[00:16:42] Jen Fugo: Yeah, it's just like a mom, like, you know, if you don't have what you need to take care of the kids in the house, it's going to be a bad day for you and maybe everybody else, but definitely for you, the mom or whoever's managing the house.

[00:16:55] Jen Fugo: I would also argue that there have been times where. You have to, I don't know. I just, I also kind of feel like, and this is just another slight grievance. And then we can talk about some ways in which like research and whatnot doesn't work. But I just also feel that there are times where there's a lot of unnecessary tests being run.

[00:17:16] Jen Fugo: Just I don't understand why other than wasting people's money. And That they don't really know how to read the tests and so they're like, Oh, well, this is present, but it's fine. Don't worry about it. And yet the person has like a really bad amount of overgrowth, for example, and they're just handed like vitamin D and some probiotics and some other.

[00:17:38] Jen Fugo: And I'm like, 

[00:17:39] Christa: That's the real sign of not knowing anything 

[00:17:41] Jen Fugo: expect the person to get better? I mean, I literally had a conversation with a client last night who she's been working with a different doctor. And she's been a part of my group program. I've known her for a while and she said, well, the doctor wants me to do the five hours all at the same time.

[00:17:55] Jen Fugo: And I'm like, all at the same time. That's, that's a first. I'm not sure that I've ever heard of that. But the problem is she's in a severe flare. And I'm like, that makes me nervous for you to take all of these Herbs like you might not tolerate these and like you said Krista, it could make things worse.

[00:18:12] Jen Fugo: So I like to stagger things. I like to help people. I'm like, look if you feel fine and fine not being better, but like you feel like you normally feel for a while and you're at least tolerating things. I prefer that than you feeling like you can't get out of bed and you can't do the things that you need to do.

[00:18:29] Jen Fugo: I think non functional is not a state that we should somehow justify, as practitioners. Like, I think that's really questionable to be like, you could feel way worse. I mean, I think there are some instances where that might be possible, but the fact that it's like a normalcy to be like, quote unquote, detoxing and being really sick as a result is, I think that's a failure upon practitioners not actually knowing what the body needs to be supported appropriately.

[00:18:58] Christa: I think a lot of this, and this has come up in different ways, subtly here and there, but this is a, what does this look like in practice? And I don't ever want to go back to the beginning of my practice because I had to learn so much. And that was something we wanted to say is like, this isn't like a pedestal, but the challenges is that often, and anytime I did try to do some mentorship, people like, well, what's a protocol for this?

[00:19:22] Christa: I'm like, well, I can give you a protocol, but You might have to adjust it. I don't know if it's going to work for that person. 

[00:19:27] Christa: So I'm thinking of like this great on that. I have that. Like, I'm trying to get the Cougar recipe from her. It's a German dessert, by the way, or whatever. And I'm trying to like, get these recipes and they're like, well, you just put it until it feels right. So I'm like, I feel like practice can be that way sometimes.

[00:19:43] Christa: And so hiring and having people on staff that are, I'm trying to have them help me do some of the, what I consider the easy stuff initially and then I can kind of like I'm living in my dream version of practice right now, where it's like, I get to see my clients, but I get to see them at a juncture that it's my favorite, right?

[00:19:58] Christa: So I have someone that helps me at the beginning of time and whatever. So that doesn't matter. But my point is, yeah, it was hard to help bestow some of that knowledge and information onto that person. If you're constantly changing, adjusting the protocols, and I'm not trying to make this an unhelpful episode.

[00:20:12] Christa: What I'm trying to say is that when you are a provider, and you're getting into functional medicine for the 1st time, I think there's just so much to be said for listening to your client to death, like, I'm not joking, like following up a lot, getting a lot of data. Like, I developed all of my timelines on how things worked based on my own individual clinical research that I conducted unofficially by seeing my clients.

[00:20:37] Christa: I was like, Hey, this person resolves at this phase and this phase, and this is when they don't relapse. And I put that together over time, and I don't wish I had to go back to that point at all, like, that's wonderful. But there's a lot to be said about practice. And to your point, you said there's a difference between research and practice.

[00:20:52] Christa: And I think, I've also been feeling this a lot lately, like, oh, I love to get a practicing clinician in here. I can interview and talk to them about what actually works more than like, what in theory might work in a set of 10 people that we studied for a few months. 

[00:21:08] Jen Fugo: And that's one problem, and speaking of that, I think, one thing that a lot in our eczema community find is that study on L histidine, which is an amino acid for those who don't know what that is, and It's funny because I've seen this presented multiple times.

[00:21:24] Jen Fugo: I've talked about it on the healthy skin show and I know it's been on other podcasts. You might have talked about it on your show. 

[00:21:30] Christa: I've never talked about it. So just tell us what's going on. 

[00:21:32] Jen Fugo: Basically, long story short is that L histidine was supplemented at four grams per day in the morning. I think they put it in some juice with adults.

[00:21:41] Jen Fugo: They were over 18 and this was done for a month. So four weeks. In 24 people now, after four weeks, I guess they rescored people. I don't know what their score, what exact scoring system they used. And they said that there was a 40% improvement in their overall scores and symptoms. And it had, I think the quote was that it was, the effect was equal to a mid potency steroid.

[00:22:07] Jen Fugo: And I was like, that's a pretty bold statement there to say that it has that level of potency. So at first when I found this, I know, but also too, I was like, wow, I mean, that sounds amazing. And if you understand what L histidine does and it helps the body produce filaggrin, which is a very high in technically we'll just say high.

[00:22:29] Jen Fugo: I think it's something like 11 or 13% of the filaggrin protein is made up of L histidine. The problem is that when we would try this. Over and over and over again, we didn't see those type of results. Like, the majority of people didn't notice any improvement at all. A handful did, but like, I can't tell you why that the individuals who did see an improvement improved.

[00:22:58] Jen Fugo: I don't know. And so you have to be careful because like when I go into Facebook groups, I've seen it posted up again and again, Oh, you got to do this and it'll improve your skin barrier and filaggrant. I'm like, it doesn't work that way. I think that was one of the studies that was shared at a four M.

[00:23:14] Jen Fugo: It does not work that way. It was in 24 people. It's a very small sample size. And that's one of the problems when we present research, we have to be very careful about. Was the population that was studied, is it a sufficient amount of people that we could really assume, make assumptions about the data, right?

[00:23:33] Jen Fugo: And the results and how efficacious it was, but also was it in the right group? I've seen studies where they did them on healthy people. Not the sick people that are actually looking at this research and hopefully that the maybe like a supplement product, for example, was targeted towards. But 24 is a really small sample size.

[00:23:53] Jen Fugo: So I think that's an important thing to keep in mind is that when research is presented before, like, jumping on it and being like, oh my gosh, I have to try this. The first thing to look at is really looking at the study. When was it done? So there's a one skin condition called prurigo nodularis, which you'll probably all hear more about because it got clearance through one of the biologic drugs.

[00:24:14] Jen Fugo: It's like one of the first clearances. So, It will probably have advertisements on TV for it now. And so my associate and I had found a whole bunch of research on different like cayenne preparation, like these different, I think it was capsinian or something like that. There was all these different preparations of creams and things to use on these extremely itchy nodules that form on the skin.

[00:24:38] Jen Fugo: And I asked the researcher who's the top researcher in the United States. He's at Johns Hopkins University. He's been on my podcast. He's a colleague and friend. I was like, does any of this work? Have you ever tried this? And he was like, none of it works, but there's all this research online that looks really promising, but it was done in these really tiny groups.

[00:24:54] Jen Fugo: And it just does for whatever reason, it just does not work. So I think we have to ask ourselves when people present data. Number one, are they testing this data out? Are they using it in practice? Like, do they actually practice this way? Because some doctors don't. They present papers at integrative conferences, but they don't actually practice in an integrative fashion.

[00:25:14] Jen Fugo: So they're not using it clinically. I think that's an important factor to consider. 

[00:25:20] Christa: Does your provider practice or do they have recent practice experience? Because that's essentially what you're saying is like, because sometimes we complain about, Oh, there's no research for this.

[00:25:31] Christa: Oh, the research takes 17 years to get into practice. Oh, the research what's showing up doesn't seem to translate very well in a human population, but the researchers don't actually practice. And so how do you know for sure? We've talked about this in a different context as well, but let me go back to, our humble beginnings if I may, because I don't want this to feel at all like a pedestal.

[00:25:55] Christa: Jen, you and I just might be observing someone else's beginnings and failing forward perhaps, right? As a devil's advocate point. So when we're talking about this integrated process, remove, replace, repair, repopulate. Let's talk about where we both first started because my practice started with food.

[00:26:11] Christa: I am a dietitian by trade, by training, by continuing education units. I love the food. but there was some training that I did, that helped you really focus food eliminations. And you know, it's funny, it worked really well for a while right. Diet is foundational, right, it gives you the nutrients.

[00:26:35] Christa: And so why do sometimes elimination diets work? Are we reducing toxic burden load because our food system has some toxic burden load and we're enhancing a lot of, because usually these are really antioxidant rich diets also. So are we doing a ton of like other really great antioxidant rich foods? 

[00:26:51] Christa: That are beneficial for a multitude of reasons. Is that why it helps or is it the immune imbalances for me? I'm kind of like, oh, well, this is not root cause enough anymore. Cause of course, what happened was I did this and made my own skin worse, but my clients were doing fine. I like made myself worse because my skin did not.

[00:27:08] Christa: Like, this was not relevant for my case because my case was not the same. But my point is, I started in the remove, I started in this area until it wasn't enough, right? Until it wasn't enough or wasn't good enough. So tell us a little bit about maybe where you started as well and how you grew from there.

[00:27:23] Jen Fugo: Definitely started in food as well. I started back in 2009 as a health coach. Oh gosh. And I had a website called gluten free school, which was all about teaching people how to move gluten and live gluten free and elimination diets. And so I do feel some regret. I know better now, right?

[00:27:43] Jen Fugo: You know better. And I think it's really important too. And I wanted to say this after the, like, kind of your point in ship before shifting gears. Like, I don't think I'm the smartest person. I know that I am not the smartest person. I am. I am always learning. And that's why I go to conferences. That's why I love like, We are friends outside of this little podcast moment.

[00:28:04] Jen Fugo: So like, I love at throwing questions at Krista and she throws questions at me and like we all talk and we learn from one another because again, clinical experience is not something you're going to read in a book. And I am constantly fascinated by all the things that we don't know. So I think that that's a really cool thing that has driven me to realize that food was not the end all be all and some of the research that I have also participated in that it potentially contributes to a really negative relationship with food and diet.

[00:28:38] Jen Fugo: And so I just want to be very sensitive to that and also a lot more sensitivity towards people who've had a prior history of eating disorders, because I think a lot of times we say, oh, well, I'm in remission. It doesn't matter. But then the elimination diets can re trigger that individual. And I just think as a whole, just as practitioners, we need to be a little bit more aware that might not be the best way forward for someone and asking them questions about their history is really, really crucial.

[00:29:08] Jen Fugo: But I have learned the most from the people that things have not worked out or, they had symptoms or right. And also it pushed me to learn, to dig even deeper and to do more research and to ask questions because honestly, I wouldn't even know about topical steroid withdrawal had I not failed with one specific client and couldn't figure out what the heck was wrong with her because it looked like she had a super rare disease. And she was actually the one who found the documentary online that then clued her into what she actually had and then shared it with me. And I was like, Oh my gosh, there's this whole world out there of problems that I knew nothing about.

[00:29:45] Jen Fugo: So I think when we keep an open mind about what we don't know. I was very close minded about the minerals thing, like, in terms of, like, really drastically increasing sodium and chloride and whatnot. And then I remember I had talked to you and Kaylee McDevitt and Robin Johnson.

[00:30:05] Jen Fugo: And I was like, I don't know. And I tested it out for a year ahead of time on myself before I even really started recommending it to clients. Cause I was just like, I really want to come at it from the skeptic standpoint. And I was like, wow, this really is a big deal. So we learn. 

[00:30:20] Christa: I mean, if we have to kind of summarize a few things and you think about what you want to summarize as part of this as well, it's like, so Jen brought up, she's like, man, this integrated process is dated or people are using it as kind of a canned protocol and that, unfortunately, this is actually the biggest grievance of all is that when you have a condition with the name on it.

[00:30:42] Christa: Let me use eczema because I use it all the time, right? That's kind of my more preferred skin condition. You cannot treat it all exactly the same. It's just has the technical same name. It doesn't mean it has the same root cause or behaves the same. So that would be my 1 of my overall grievances is that you can't treat everything just alike, but there are some common denominators that might work really well on people and they're not restricting food because the real situation is that when you are depleted, you do not win to very much paraphrase.

[00:31:15] Christa: I'm like digging into cancer textbooks now, integrative cancer textbooks. I don't know if it was that or something else. Anyway, someone quoted Dr. Sidney Baker and I don't know if he is deceased or still alive, but his work was beautiful.

[00:31:26] Christa: He wrote a book on detoxification. He has an MD and it was written from those humble, cool, open minded perspective. And I loved his stories he put in there. So when I see his name pop up anywhere, I'm like, Oh, I'm listening. I'm listening. I love this guy. Might be 90 now. Not sure. But anyway, this is a very loose quote and it's all over the place, but it's like, you know, a lot of stuff boils down to what is the toxicity and what is the deficiency?

[00:31:49] Christa: Right. And so we cannot just remove, remove, remove if you don't have the resource. Our body requires a ton of resources. And so whether you consider supporting phase two detox in the remove phase or the replete phase or whatever, we're in living in a, I think an undernourished world. And I think people are a little more depleted than I remember seeing them.

[00:32:09] Christa: They're even a little bit more complex than I remember seeing them at the beginning of my practice might just be. Who I'm attracting, I'm not sure it's really hard to say. It's just feels that way. It just feels like people are more complex, but that's I'm not saying that as a problem. It's just like, this is our new reality.

[00:32:25] Christa: This is my reality that I'm into. Maybe it's a part of no better do better. And that's okay too. So my point is, is like for me, integrative process framework works, but I make it my own all of the time. And so nourishment is a huge thing., people just getting into functional medicine, you can't treat it like your conventional medicine with supplements.

[00:32:44] Christa: It doesn't work. And I see that problem. Showing up a lot as well, unfortunately. So those are some of the bottom lines, I guess I would want to make sure I'd like share with people in today's episode. What about you? Like coming in with this topic, big picture, like, what do you want to make sure we share with people when we're talking about, what's the framework that works versus not works, et cetera, 

[00:33:05] Jen Fugo: I would say that you want to ask probably tougher questions of your practitioner when you're thinking about working with them. And it's okay. I actually appreciate questions. And I would also be really aware of what you're comfortable doing and what you're not comfortable doing. It's okay to have boundaries as A client or a patient, and stating those clearly up front, if you're not comfortable doing food eliminations, because you have a history of bulimia or anorexia or whatever, that's okay stated up front.

[00:33:34] Jen Fugo: And if that does not mesh, if that doctor or that nutrition professional only works with elimination diets, they're probably not the right fit for you. But I also think I think there's in some regard, this weird, like humbling. That also needs to happen within our own space of asking ourselves repeatedly, like, are we doing what's best for our clients?

[00:33:58] Jen Fugo: Are we constantly pushing ourselves to learn more and do better and to test things out? And also to be honest, like if I find a study, I'll say, look, I don't know if this is going to work. I've no clue. I've no doubt. On it. Do you want to give it a try? And I find that a lot of times things aren't presented that way to individuals.

[00:34:18] Jen Fugo: It's just like, oh, well, there's research on this. So let's do it instead of I don't actually know if this is going to work. I like people to be in the boat with me and test things out and know right up front that it may or may not make an improvement and to empower them to feel at peace with the decisions that they're making.

[00:34:35] Jen Fugo: Like, know, Krista, one thing I love about you is, the way that you empower your clients to feel more confident in the decisions that they are making and to be more informed and to not feel as like they need someone to tell them what to do. Which is beautiful to empower someone like that. And I think when we take a step back and realize there's so much we don't know and that maybe that just from there calls us to into a conversation about how could we continue to improve our skills?

[00:35:10] Jen Fugo: How could we ask better questions? How could we improve care? Even maybe how we could improve cost of care. Because in general, like this shouldn't be, and that's a whole other conversation, which I know you've had, like, I don't know that integrative, if we really are serious about functional and integrative medicine being infused into a more conventional model right now, , it is a huge investment, which is wonderful if people are able to make it, but it's also very difficult for the majority of people to afford.

[00:35:40] Jen Fugo: And so how can we approach the different problems with open mindedness and, also better understand that research is research. Clinical experience is just as valuable as research. And perhaps when we combine the two, we'll keep learning and pushing forward, the type of outcomes that we can get for our clients in general.

[00:36:03] Jen Fugo: That hopefully doesn't have any detox issues, detox. I'll put that in air quotes, detox burdens that pop up or her thing that pops up in the process. 

[00:36:13] Christa: And I will say, I need to make sure I pay credit to where credit is due. I definitely sought out mentorship and paid mentors to help me understand what I was doing.

[00:36:21] Christa: So when we talk about people not really knowing how to read test results, it's pretty common. People don't exactly know how to read them. And I definitely found mentors to help me along the way, read them in a different way. And I'm going to go ahead and address what I see here and not just pretend that it's not a thing.

[00:36:34] Christa: Cause I like results. And we're all wired a little bit differently. I'm toxically wired for results and achievement to the point where, and I think you probably I know you actually are. Quite a bit too. And that's okay. But it kind of makes me a little bit of a crazy person. And also I want to say, here's you said a lot of things really beautifully and eloquently there.

[00:36:51] Christa: And I also just want to acknowledge that all of this is hard work , and it's hard to support people and what is a lot of emotions and also a lot of physical manifestations. And so I think. Always taking care of yourself. I always come back and I'm better. I filter what I'm doing a lot now with, like, what's going to support my client best, but also not burn me out because if I burn me out myself out, it doesn't really matter what I did to support my client best because I've become a fried egg on the cement here.

[00:37:21] Christa: And so like taking care of yourself, and you have to know your own limits. Like for me, if I can create some space in time, I can become a better practitioner because I have time to then research. And like, I'm excited then about the stuff I get to learn and gamify for my clients, et cetera.

[00:37:37] Christa: So I don't know at the end of the day, have fun, find a mentor. I hope protocols work and if they don't just adjust them, like there's so many options, I would say, like, you just have so many options. And I will say also, there's multiple ways to do something. So, just because we're talking about the integrative process as a framework that's been around for a while.

[00:37:55] Christa: It doesn't mean that someone else's framework that they made up based on however they want to say, if Jen wanted to say, like, this is the 1st step for me, she's made it into her own thing because of what works best for her. 

[00:38:05] Jen Fugo: I was just going to say too, the other important thing just to, I think, leave this off of this, everybody's journey is going to look different.

[00:38:11] Jen Fugo: And that's okay. 

[00:38:12] Christa: Yeah, for sure. Where can people find you online? 

[00:38:15] Jen Fugo: They can find me at the healthy skin show podcast, which you've been on a bunch of times and, healthy skin show. com. And I'm also over on Instagram as well. 

[00:38:25] Christa: Perfect. Thank you so much for debating kindly with me today about the integrative process.

[00:38:31] Christa: And I hope that some clinicians and you ran some clients found this useful today, especially as they dig through their own stuff as they find online. Whether they're in their process or getting some support in it.

[00:38:43] Christa: Sharing and reviewing this podcast is the best way to help us succeed with our mission to help integrate the best of East and West and empower you to raise the bar on your health story. Just go to review this podcast. com forward slash less stressed life. That's review this podcast. com forward slash less stressed life.

[00:39:04] Christa: And you'll be taken directly to a page where you can insert your review and hit post.