Terrain | Andrea Nakayama's Field Guide to Functional Nutrition


The first tenet of practicing functionally is to address the root cause (or, as I like to say, the ‘root causes’—as most conditions these days are multi-factorial).

This means that as clinicians we’re not chasing symptoms. We’re not playing “whack a mole”. And we’re not getting prescriptive based on a diagnosis. Instead we’re looking to unearth the underlying issues (again, there are often many) that are causing the symptoms to arise and the diagnosis to manifest.

You likely know this.

You also likely know that finding root causes isn’t a straightforward equation:
Inflammation isn’t always caused by egg consumption (but can be).
Butter in morning coffee won’t always lead to weight loss (but does for some).
Eliminating gluten won’t always reduce mental health concerns (but can be a step for some).

So how are we supposed to know where to look for the roots of an issue?

Great question!

We can find our answer in an analogy with botanical roots…

Plant roots: An analogy

As you may know, once a year my son and I travel to Hawaii to see family, to get a bit of R&R, and to connect with some roots (he’s actually part Hawaiian).

Last time I was there, I met a man who was trying to grow tomatoes in his yard.

His garden plot had plenty of sun, and he watered it daily, yet the plants just would not produce tomatoes.

He went to a local nursery to find answers, and here’s what the garden expert said:
“Here in Hawaii, the soil is often deficient in calcium. That means your plants will grow, but you won’t get any fruit. Add some oyster shells to the soil, and you’ll get your tomatoes!”

That seems logical…alter the soil and you’ll alter the results.

Well, the same is true with our bodies.

To get to the root causes of our clients’ issues, we need to address what those roots are growing in—the biological soil.


We all know what the word “terrain” means.

A “terrain” refers to a landscape, and all its features.

When we consider a biological terrain, we’re taking into account what I call “the environment within”—the landscape in which a sign, symptom or diagnosis was granted permission to express itself.

Think about it…

The roots that we look for in root-cause resolution exist in an environmental or biological terrain. Just as the roots of a tree grow in soil, the roots of a health issue grow in an environment that is conducive to that particular problem. When we alter the soil, we alter the roots. In this way we can bring lasting relief by changing the environment (ie. diet and lifestyle.)

Let’s look at this concept very briefly through a historical lens.

In the 1800s the French chemist, Louis Pasteur, developed what we now know as the “Germ Theory of Disease”. This theory posits that microbes from an external source can invade the body and are the primary cause of infectious disease.

It’s this theory that, in many ways, is responsible for the birth of vaccinations, antibiotics and pasteurization. And while I cannot agree with the standard overuse or excessive application of these innovations, we cannot deny that there have been some important evolutions in modern medicine due to the Germ Theory.

In the following century we meet Raymond Rife, an American inventor. Rife opposed the monomorphism (single form) approach of the Germ Theory in favor of a pleomorphistic (many formed) concept.

This is the bases of the Biological Terrain Theory.

Biological Terrain Theory

In the Biological Terrain theory we can see that early forms of pathogenic bacteria, viruses and fungi are only given the “advantage” to grow and proliferate within a certain environment.

While neither Pasteur nor Rife were alone in their posits, looking through the lens of their work, we can begin to see the validity of both assumptions. I like to call this a “yes, and…” approach.

That said, when it comes to working within my scope of practice as a functional nutrition and lifestyle practitioner, dedicated to diet and lifestyle modification for the eradication of disease, it’s a focus on the terrain that wins over target practice, every single time.

Even when the client case is complex or unknown, we can always work on terrain. And by doing so, we can shift the course of disease progression.

If you’re an allied functional medicine practitioner (or aiming to be), like me, then you are uniquely suited to work in the field, nurturing the soil within which those roots grow. In fact, if you go for root-cause resolution without addressing the terrain, you’re missing the point. You’re actually not practicing functionally.

Related Blog Posts

What’s Functional Part 1
What’s Functional Part 2
What’s Functional Part 3
Root Cause
True but partial

Functional nutritionist and educator Andrea Nakayama (FNLP, MSN, CNC, CNE, CHHC) is leading patients and practitioners around the world in a revolution to reclaim ownership over our own health. Her passion for food as personalized medicine was born from the loss of her young husband to a brain tumor in 2002. She’s now regularly consulted as the nutrition expert for the toughest clinical cases in the practices of many world-renowned doctors, and trains a thousand practitioners online each year in her methodologies at Holistic Nutrition Lab. Learn more about Andrea here.

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