[INTERVIEW]
Ronda Nelson: I’m gonna let you in on a little secret. When a new patient comes in to see me, no matter what they’re dealing with — I don’t care — I very rarely start with the thing they came in for. I don’t start with their thyroid if they have Hashimoto’s. I don’t start with their hormones if they have PMS. I don’t start by going in with a hardcore SIBO protocol. I start with foundational support. You’ve heard me say it before. It is so important. I know it sounds boring. It sounds basic. You want to get in and get the problem fixed. But here’s what I’ve learned after 20-plus years of being in clinical work: if the foundations are not addressed in the very beginning, nothing else will work. If you’ve ever put a patient on a protocol that should have worked and it didn’t work, this episode is going to tell you why. Let’s get into it.
Welcome to the Clinical Entrepreneur Podcast. I’m Ronda, your no-fluff, tell-it-like-it-is business bestie for wellness practitioners just like you who want to build a practice you love, make a bigger impact, and a little money while you’re at it. So if you’re ready to ditch the overwhelm, attract your dream ideal patients, and finally run your practice with complete confidence, you’re in the right place. Each week we’re tackling things from programs to patient retention to marketing strategies that actually work — sprinkled, of course, with a little sass, a lot of heart, and the step-by-step strategies that will help you get there. So grab your cup of coffee, your notebook, or whatever keeps you going, and let’s build a practice you love — and a life you love — together.
Well, hello. Welcome back. Today we’re going to talk about some important things. Very important things. I’m glad you’re here. We’re going to talk about the foundations. Now, I know — we just came out of the clinical series, and I did talk about that. You might be thinking, “Listen, you already said don’t automatically start with the foundation.” I kind of did, but I kind of didn’t either. So I’m going to give more context here because it did cause a little bit of confusion. I had a few people email me. So let’s start at the beginning.
When a patient comes in the door, we know they are more than just a collection of their symptoms. We know that. We also know they’re more than just a blood test. And unfortunately, we know that Western medicine — this is what they do, right? They look at a blood test, and that quantifies the whole of the person. Or some kind of imaging — that’s what’s wrong with them for sure — without looking at it from a 5,000- or 10,000-foot perspective, which is what I always like to do.
One of the number one complaints I hear from newly emerging practitioners is, “I need to know more before I start.” I kind of giggle under my breath because I think, yeah… you never know it all. And the more you know, the more you know you don’t know. And it just becomes this ever-widening sucking hole sound that we go down, down, down into the rabbit hole of learning all the things. It is never-ending. There’s no way to know it all. And it’s always so sad to me when a practitioner says, “I’m not quite ready yet because I just don’t know enough. I need to finish FMU before I start. I need to finish IFM before I start. I need to finish my clinical nutrition training before I start.” No, you don’t. News flash — you don’t. All you have to do, my friend, is know a little bit more than they do. Especially when you start with the essentials.
Today I’m going to talk about three of my five core foundations. They’re the essentials. They’re the non-negotiables for me. We’re going to talk about three of them because we don’t have time to do them all. When you know these, the rest will come. You can reach out. You can get help. You can go on Facebook. You can be in the Facebook group. You can be in Clinical Academy. There are lots of places to get help. But you have to be good at the foundational. And that’s all. If you’re good at those, it buys you time.
So when a new patient comes in — and let’s say they have some crazy thing and I have no clue what it is — I just use these foundational non-negotiables and I start with them. If for no other reason than it buys me time so I can go look for answers. But what I’ve found is that when I skip them — when I fast-forward, when I leapfrog over them because they’re kind of boring — I waste time. My protocols don’t work. And I have to go back and do them anyway. I’ve made that mistake over and over and over again. I’ve done it with my family. I’ve done it with my kids. I think, “Oh, that’s the problem,” and I go do that. Then they take supplements and they’re like, “Yeah, I’m 20% better.” And I think, “Oh… that’s why we have to go do this first.” I should have just started with the foundation.
When we skip over that because we’re so eager to solve the problem — a patient comes in with a hormonal headache and we go after the thyroid and give them chaste tree — no. No and no. Not going to work. You have to address the foundational stuff. And if there was a hill I was going to die on — and I have several — this is one of them. A patient comes in with Hashimoto’s and you’re like, “Oh great, here. Let’s go with the thyroid protocol.” You give them selenium. You give them Thytrophin PMG. You go down that rabbit hole. No. It’s not going to work. Then you test and you realize there was severe anemia. You can’t fix a thyroid if someone’s anemic. There are very basic foundational things that have to be addressed before you move forward.
So let’s talk about three of the five. The first one — you already know what I’m going to say. Say it out loud. Upper digestion. We have to start with upper digestion. If we don’t improve the capacity of the stomach to break down food, how in the world do you think they’re going to repair? Hydrochloric acid does some very key things. It breaks down proteins into amino acids and peptides. You need those to produce neurotransmitters, hormones, and for tissue repair. If there’s no HCL, how are we going to repair? What are you going to give them? Perfect Aminos by the thousand? No. You have to get upper digestion working.
I am shocked at how many times I ask a practitioner, “What have you done already?” and they say, “Well, I went in and did the Hashimoto’s thing or the SIBO thing.” I ask, “What about digestion?” “Oh, they said they weren’t symptomatic.” I don’t care. Is there anyone who has zero stress? Anyone? Because a sympathetic state shuts down digestion so fast. Money stress. Political stress. Relationship stress. Job stress. Environmental stress. Toxin stress. Raising kids stress. Running a business stress. Stress is ubiquitous. So how well is upper digestion working? How well is hydrochloric acid working? How well are they staying in a parasympathetic state? Probably not well.
You cannot let the patient call the shots and say, “No, I’m fine.” Maybe they’ve always been bloated and don’t know it. Maybe they have reflux and don’t recognize it. Everyone is guilty until proven innocent when it comes to digestion. That’s how I think about it. Do not pass go. Do not collect $200. Upper digestion first. Signs it’s compromised: bloating within 30 minutes after a meal, feeling overly full, burping, undigested food in stool, odorous gas. I’ll often start with digestive bitters and some HCL support. I still love Zypan from Standard Process. It’s strong. It works. Unless they have an ulcer, it’s great. If I have to, I’ll use enzymes. But do not get out of jail until upper digestion is working.
Foundation number two: bile flow. If stomach acid isn’t acidic enough, bile release is impaired. Nobody talks about bile. Everyone talks about the microbiome, SIBO, dysbiosis, leaky gut. But bile is quietly doing some of the most important work in the body. It breaks down fat. It binds and carries toxins out of the body. It’s part of cholesterol metabolism. It keeps peristalsis moving. It prevents bacterial overgrowth. If bile gets thick and sticky, the gallbladder may contract — but nothing comes out.
Signs: difficulty digesting fats, pain under the right rib cage, light-colored stools, floating stools, skin issues, hormonal headaches, elevated cholesterol that doesn’t respond to diet. If someone’s had their gallbladder removed, they still make bile — they just don’t have a place to store and concentrate it. They may need bile salts. Ox bile. Phosphatidylcholine. Bitter herbs. Beets. If they can’t tolerate fats, that’s your biggest clue. Upper digestion and bile are part and parcel. If one’s off, the other usually is too.
Foundation number three: adrenals. This ties back to digestion because you cannot break down food in a sympathetic state. You could go deep into HPA axis support — hypothalamus, pituitary, adrenals. That’s fine. But in my opinion, upper digestion support and stress support go hand in hand. I don’t think you should support one without the other. If hydrochloric acid isn’t working, I would argue stress is probably contributing. So I support both. Adaptogens are your friend. Ashwagandha is my favorite. Holy basil. Rhodiola. Eleuthero. They help take the bite out of stress. They help the patient rest in their body. You cannot out-supplement a nervous system stuck in fight-or-flight. Tattoo that on your eyelid.
When stress is chronic: cortisol dysregulates, adrenaline spikes, sleep is disrupted, sex hormones get disrupted, immune system lags, blood sugar swings. There is no amount of HRT that fixes a dysregulated HPA axis. It just doesn’t. So I’ll often put someone on ashwagandha or Gaia’s Daytime HPA or Revive HPA. I love those. And I’m always thinking about blood sugar because blood sugar instability dysregulates adrenals too.
So how do these work together? A woman comes in and she’s a hormonal mess. First, we make sure she’s breaking down her food. Hormones are chemicals. They need amino acids. They need nutrients. So we start with upper digestion and stress support. Then we look at bile because bile is critical for hormone metabolism. Women with sluggish bile often struggle more near menopause. I ask about bloating, nausea, right-sided pain. These three — upper digestion, bile flow, adrenals — they triangulate together. I don’t ignore what they came in for. But I get the foundation sealed first. I patch the holes. I tape the windows. I make sure there’s no draft. Then we go specific. Patients don’t always understand that. “I came in for my thyroid.” Yes. And we’re going to fix your thyroid. But we have to do this first or we’re not going anywhere.
[CLOSING]
Ronda Nelson: So go grab the free resource. It gives more detail on all five non-negotiables. Go to rondanelson.com/nonnegotiables. Download it. Keep it. Use it. Refer to it. And save this episode because I just downloaded a ton of clinical information for you. If you’re stuck and you don’t know what bitters to use, how to dose ox bile, what to do if someone doesn’t have a gallbladder, which adaptogen to use, how to interpret an adrenal saliva test — that’s what we do inside Clinical Academy. rondanelson.com/clinicalacademy. It’s $99 a month. No contracts. Jump in, jump out — but you’ll want to stay. Grab the resource. rondanelson.com/nonnegotiables. I’ll see you next week on the podcast. Take care.
[END]