Welcome to the Evolution of Medicine podcast! In this episode, we sit down with the indomitable Shilpa P. Saxena, MD, who brings her expert knowledge and wit to a conversation on a hot topic in our industry: functional foods. She sees functional foods as an “idiot-proof” entry-level therapy for functional medicine and describes the five patient personas who are perfect candidates. You’ll be surprised how many patients fit into these categories! In addition, Dr. Saxena talks about leadership in functional medicine, and how her perspective on her own style of leading has changed over the years. It was a fascinating 30-minute conversation with one of functional medicine’s finest—you’re sure to enjoy it! Highlights include:
- Why functional foods are an idiot-proof entry-level therapy for functional medicine
- The five patient personas Dr. Saxena has developed and how to engage them with functional foods
- Dr. Saxena’s new perspective on leadership, and what she had to realize about herself in order to become a more effective leader in both her professional and personal life
- What functional medicine practitioners need to master in their leadership of staff and patient communities move the practice of functional medicine forward
Resources mentioned in this podcast:
lifestylematrix.com
goevomed.com/gvt
James Maskell: Hello and welcome to the podcast this week we welcome back Dr. Shilpa Saxena, one of the most popular functional medicine educators out on the circuit. She is the creator of the Group Visit Toolkits. In this session, we talked about why functional foods are an idiot-proof way on entry therapy for functional medicine. We talked about the five different personas that she has developed and how to get them engaged with functional foods and then we also talked about her new thoughts on leadership and what it’s really going to take to lead her staff and her patients and her family and her community in the functional medicine movement to success. It was a super-interesting half an hour from one of my favorite people in functional medicine, enjoy!
So a warm welcome to the podcast, Dr. Shilpa Saxena. Welcome, Doc.
Dr. Saxena: Hello, James. How are you?
James Maskell: So glad to have you here back on the podcast and today we’re just going to be talking a little bit about functional food. The reason why this came up is we were hanging out back at the Functional Medicine Pharmacist Symposium where you gave a talk on functional foods and how to engage people into the conversation. I just felt like this was a topic we’d never talked about before here on the forum. As someone who was in sales what I already felt like you were getting into was how do we sell people on being healthy and taking easy steps to be healthy? So I really wanted to bring that conversation here to the Evolution of Medicine podcast. So why don’t you just set the stage for us? I mean, you were pretty fired up at that talk. Why is this so important to you?
Dr. Saxena: It’s important to me because there are so many people who are interested in getting into functional medicine. These are patients and providers. When we talk about providers, we mean everybody who’s in the conversation of health. There’s many people who are in conventional medicine and as they first come over into functional medicine, they have this philosophy that I have to understand everything and be an expert before I can do any of it. What I would tell you is that there are some things you can do in functional medicine that are so safe and effective that it would be a crime not to introduce them early. One of those is understanding how a functional food can be a great way to introduce important supplementation into a patient without having to figure out all the exact right doses and what blends and combinations of supplements to use.
So what it is, is an idiot-proof entry-level therapy for people who are going into functional medicine early on. But I will tell you it’s been a tried and true residual revenue stream. So for those of us who have been practicing functional medicine, to reevaluate how we use functional foods for our patients because they serve five unique personas quite well and then they’re on autopilot and so it becomes a great revenue stream as well too. In fact, of course revenue makes sense, but if it’s not helping the patient, then that’s not the win-win we’re looking for. So this is great. It helps the patient, it helps the provider, it helps the staff. It helps the accountant, all good.
James Maskell: Absolutely. Yeah. No, and that’s one of the things that I got from it too. So I’m excited to dive into the five personas just because that’s one of the themes that we’ve had over the last little while, a couple of years ago, Dr. Sachin Patel came and talked about how he did his disc scoring. We’ve had Jeremy Kubicek on the podcast this year talk about the five voices. Ultimately it looks like the most sophisticated functional medicine clinics are taking an extra step to do some evaluation on their patients to be able to determine what makes them tick and how they operate. They’re not all the same and delivering your care in a way that fits the persona of that person seems to be a much higher standard of care than just doing the same thing for everyone. So I’m excited to jump into the five personas. When did you realize that there were five different types of people in this way and how they interacted specifically with this conversation?
Dr. Saxena: No, I think it’s been in my mind, I’ve never really formalized it until I was asked to speak about it. Then I realized there are some trends in my mind when I’m evaluating a person. When I have a patient in front of me, especially most of these patients who are either new to functional medicine or have been trying some aspect of functional medicine and failing, I realized, okay, they’re not failing because they don’t know what to do. They are failing and failing, I don’t mean like a negative way, but it’s not working for them the way they want it to, because the benefit hasn’t been communicated in a way that matters to them.
So once I was able to just really get in the shoes of the patient, not just speak about the features, which would be easy for me because then I can give the feature talk to whoever’s sitting across the table, but once I actually got in their shoes and understood what gets in the way of them being able to have health, I realized, oh, this person is a Busybody or this person’s a Gagger and so I created these personas and I realized I’m going to say the same information about the functional food, but I’m going to give it a twist about how it serves them as a Gagger or them as a Busybody.
That’s how it came to be. I just realized it’s the same information just messaged to how it would serve that particular patient.
James Maskell: Awesome. Okay, well let’s get into it. Let’s describe this and I have a feeling for all the practitioners that are listening today that some of these descriptions are going to be as revelatory as it was for most of the people who are sitting, the pharmacists who were sitting in the conference back at the of September because I could hear some audible gasps in the audience as people realized, “Oh yeah, I know that person or I know this person.”
Dr. Saxena: Yeah. What you’ll find is that just like in regular life, people don’t fit into one cubbyhole completely all the time. So as I’m speaking about these personas, just know that at a certain point in a patient’s journey they might be the Non-chef, then they become the chef and then they just turn into the addict or the scheduler. So you might have some overlap between these personas and you just have to speak to whichever persona is in front of you that day.
James Maskell: All right, so let’s get into it. What’s the first persona and how do we deal with them?
Dr. Saxena: So the first persona is the Non-chef. This is the patient who when you start talking about eating healthy and maybe following an elimination diet or changing the ingredients in their food, they’re like, listen, “Dr. Saxena or doc, I don’t know how to cook. I don’t want to learn how to cook, is there some frozen version of this that I could just microwave?” This person, it’s not that they don’t enjoy cooking, maybe they’re too busy, but in some way they have no interest in taking on cooking. So they tend to eat out for convenience or they like packaged meals if you will. These individuals sometimes also skip meals because it’s easier to skip a meal than to have to think about cooking a whole, gluten-free, dairy-free, soy-free, this-free, that-free breakfast. This is who we call the Non-chef, James.
James Maskell: The Non-chef. Okay. So that’s the first one. And so basically you’re selling them on, hey, functional food is an easy way to get all of these benefits and you just make it into a smoothie. Do they have to have a Vitamix?
Dr. Saxena: No, Well, if they are really not interested in making food tastes good that just want to get some calories down because I definitely have those people. Like eating is a chore for me. How can we make this easy? They could do a shaker cup with some unsweetened almond milk and two scoops of the powder, shake it up and they’re good to go. But I do recommend for many of my patients who need something a bit more than that to get something like a NutriBullet or one of those little magic bullet things so that you could put in some frozen berries or a banana or some almond butter and just change it up from time to time. But what they get is a five minute meal. It’s not cooking to them cause there’s no pots, pans, dishes really in the same way.
I generally recommend for them to do this for breakfast. If they are a data person, I love to say, listen, if you have this shake once a day, 33% of your meals are healthy. If you decide in the beginning to do it two times a day, 66% of your meals have been taken care of and you could snack in between on the elimination diet and just all you have to do is figure out how to get one meal done on this plan. Do you think you can do that for a month?
What ends up happening with the Non-chefs is that these functional foods, because they’re chock full of the stuff that repairs their gut and their brain and inflammation, they start feeling a lot better. They start enjoying foods and when they’re done with the elimination diet for example, they’re interested in eating because they feel great. So many other things improve. Not all of them turn into chefs that I would tell you that this Non-chef has been having a functional food for breakfast for 10 years and it’s the greatest way for me to reduce my cooking needs 33%!
James Maskell: Beautiful. I love it. All right, let’s do the next persona then.
Dr. Saxena: Next we have the Busybody. The Busybody is very preoccupied with all the things that they have to do. When you ask them to do something, they’re like, I’m sorry, I take my kid to soccer practice every day. No, I sit here or I travel for work or I’m just way too busy to take a bunch of supplements and carry them around with me or I’m too busy to cook. So many of these Busybodies also feeling a bit of self-importance love to treat themselves for their hard work.
So these functional foods are lovely for them because again, it’s a five minute investment, Busy Bodies I tell them, put the NutriBullet at your office and keep an assortment of shakes there. So according to your mood, you can just make a quick shake and if you are in an executive position or if you have somebody who loves doing this chef-y kind of they could make the shapes for you. So that allows, even for like my provider patients to be able to get in a proper meal, for example, breakfast or sometimes they’ll have it for lunch because they whizz through lunch because they’re seeing…working too hard or running the kids around or whatever. It takes care of getting a lot of supplements in them, a good pre-digested anti-inflammatory, low-glycemic protein in them. It’s not going to be some convenience store or fast food meal. Even if they sit down at a restaurant because they don’t get home easily the quality of the food in a functional food, the ingredients is so much better even from a nicer restaurant at times.
James Maskell: That’s good. Okay. So how do you sell that person? It’s just a time factor basically?
Dr. Saxena: Exactly. Time and the convenience and the portability of it all. Keep it at work, keep one at home, keep one at work. I mean I have a Busybody who travels for work and will sometimes be in a location for three or four days in a hotel. She will go to the local big box store, buy a cheap blender and keep it in the hotel room and just bring her shake powder. She goes to the grocery store, buys some unsweet almond milk and then she just makes her shakes in the hotel room and then she donates this like 1999 blender to the hotel staff because it’s so much easier for her to do that than to figure out what the hotel restaurant, what she can eat, what you can’t eat it and it just ends up making her feel sick anyway. So all she has to do is find one nice restaurant that she can eat a meal in the evening, which is generally when she’s entertaining her clients. But it’s not all day.
James Maskell: Absolutely. Okay, cool. That makes sense to me. So we’ve got the Non-chef, we’ve got the Busybody, who’s next?
Dr. Saxena: We’ve got the Gagger. The Gagger is that patient who does not like swallowing pills. When you say, well what about this supplement? They’re like, well, how big is it? Is it a tablet? Is it a capsule? Does it taste chalky? They’re so resistant to swallowing pills or maybe they can swallow pills but they just don’t like the idea of owning a pill box, whether it’s for prescriptions or even supplements. You’ve seen some of our colleagues who have the same amount of supplement pills in their pill box as someone else might pharmaceuticals. So the Gagger doesn’t love the idea of taking down things that feel like drugs, if you will, something that doesn’t seem like food. The Gagger likes to eat or consume things that act more like food than medicine. The Gagger also may have taste and texture issues.
So you can personalize the functional food in terms of smoothness or protein. So if they don’t have issues with dairy, sometimes a whey protein is smoother for some of my Gaggers, we tell them that they can add in almond butter or berries, banana, mint, cocoa powder, these kinds of things so that they’re actually having food instead of medicine. Of course, because Gaggers might have an issue with their digestive system already, the fact that the protein and the supplements are pre-digested and easy to absorb and bio-activate, they’re getting the nutrition they need much easier than if you give them a bunch of pills and then they’re just going to forget them. They tend to be noncompliant, these Gaggers.
James Maskell: Beautiful. Okay. So tell me about the fourth one. That makes a lot of sense. I’ve seen it and heard a lot of those kinds of people too. I think I’ve probably been one of those people in the past too. So what’s the fourth persona here?
Dr. Saxena: The fourth persona is the Addict. This person loves to…well, first of all, they could be unhealthy and they just crave sugary, sweet kinds of things. Like I deserve a dessert, I’ve had a long day. They might be the person who might in front of others eat well but then late at night tends to do the secret eating because the blood sugar spikes and crashes. They can also be the overeater of healthy food. Like they don’t take down two and three ounces of hummus, they’ll take down half the container during a good football game.
They tend to have cravings so they feel like they’re missing out when they don’t get to eat and they don’t like to be told that you’re not allowed to have something. They don’t like the restrictive aspect of what an elimination diet or just eating healthy feels like. So they want to have their cake and eat it too and instead of giving them cake, you can give them a functional food shake that tastes like a shake, like again, putting in ingredients that they enjoy, making it creamy.
It’s definitely got a sweet spin on it so it can sub as a dessert. It could sub as what they eat at late night. For example, when I had young children, we served dinner at 5:00 and if I was up at 11:00 I’m starving. It’s been six hours and I’ve been working. So this is when some of my addictive tendencies to want to treat myself to something would show up, but I could have a functional food shake and it would take care of my blood sugar issues. So then I wasn’t going to get low blood sugar at night and have poor sleep and because I was allowed to have and it was healthy for me and it tasted good, my cravings were controlled the more I took it, because it was controlling my blood sugar and I didn’t feel restricted. So I felt I actually was winning. Like nobody was telling me I can’t have this delicious shake and it was helping simultaneously.
James Maskell: That makes a big difference. I know. So, yeah. That’s an interesting point you said, because I’ve started eating dinner ridiculously early to compared to how I used to be with a child. So I know what you mean about that. So yeah, that’s a good point. All right, so we’ve got four, let’s get to the fifth one and then I want to ask you a few more questions about things that go across all of these personas. But let’s just jump into the fifth one here.
Dr. Saxena: Yeah, the fifth one is the Scheduler. This is that person who loves a good plan, just tell me what to do. Make it easy, especially when they have food allergies or food sensitivities and they want the answer and instead of telling them here’s 10 supplements and you’ve got to take this one prior to breakfast and this one this way, they like a good plan and they like the schedule but it makes it so much easier if it’s all in one shake. They like the consistency of, okay, so all I have to do is have this for breakfast or all I have to do is have this after my workout? Great.
They love the consistency because it gives them a sense of like, oh, I got a point for being health conscious today. They like to be in control. They don’t mind eating the same thing over and over and over because in their mind they’re doing the “right thing” at the scheduled time and it just feels good for them, the predictability of it all.
James Maskell: Yeah, absolutely. They can organize their lives around it, right?
Dr. Saxena: Exactly. So it’s not like 17 supplements throughout the day. You can put a lot of those right in the shake and now they have control of their life, a lot more control of their life.
James Maskell: Okay. Just to give an idea for all of these types, how are you making it easy for them to do it? What do you look for in a company that you’re working with and what are you looking in a formula that would make it easy for people to just do this, whatever persona they were?
Dr. Saxena: The first thing that you want to do is make sure that the company you’re working with does the research, does the science, gets the right source for all their raw gradients. So in the IFM and A4M markets, you’ll definitely see that there are some top vendors that for decades have been using top quality research and top quality manufacturing.
Then the next thing you’ve got to make sure is it tastes good and you can’t expect people to have this for breakfast every day if it tastes horrible. So looking for flavors and consistencies and if they’re not perfect, but they do a great job, coming up with recipes to make sure, like this unsweetened almond milk that we add in 30 calories, but it makes it creamier, which works for a lot more people to have a creamy shake.
The next thing that I make sure is that it’s easy for me to get it and it’s easy for the patient to get it ongoing. So an online dispensary or an online ordering process, because once they get used to it, they’re going to continue to order it and I don’t want them to not order it because it’s residual revenue for me.
So one of the things that I just say is a funny side, but it’s very important is I failed in the beginning because when I first told people about the benefits and features, sometimes I would do that, about a functional food. Then I sold them one canister, when they were done with their 14 servings, they thought that’s all that they needed to buy. So I was remiss in telling them this is what you should have breakfast all the time and so I don’t want you to stop doing it until I see you next time. The way that you get this ongoing is through this online thing or call me or come to the office, because what patients will do if you don’t tell them where to get it and when to stop is they generally will stop short.
Then if you don’t tell them to go to where you sell it, they’ll go to someplace like Amazon and now start buying it from some vendor that you can’t trust and of course it’s a little bit unfair that this vendor is making the revenue off of what you did your work to create. So make sure that when you up sell at point-of-purchase, all those other things are stated to the patient and the patient’s very happy to know this versus feeling silly at home, not knowing.
James Maskell: Yeah, absolutely right. So you got the right products. What’s your process for determining which type of person is coming in? Do you just wait for the queues or do you have some way of in-taking with them?
Dr. Saxena: I think any clinician who’s been around people enough when they’re bringing up like, hey, here’s the benefit for this. The resistance that they have will define which category they’re in. You don’t have to like say, “Ooh, you are a Gagger.” You just listen to what they’re saying and then reframe it as a benefit for the functional food. That’s really what it is. But I don’t have kind of a Plinko sorting system as they’re saying words that they’re falling down a certain track. You just got to be with them and understand where they’re coming from and pretend who are them and what would it be like to have three kids and schlepping them around and how could a functional food work for them based on your knowledge? Say it that way.
James Maskell: Yeah, you use the word benefit there, I want to just jump into that a little bit because ultimately, I’ve been a sales guy for 10 years, so I understand what you’re talking about there. But for practitioners who are listening, what’s your difference or how do you define the difference between a benefit and what’s a feature of a product?
Dr. Saxena: Yeah, very good question. I agree with you, doctors, we’ve generally have been trained to just list the details about a prescription or procedure and we have not been trained like salespeople to talk about how is this a benefit to the person. So there’s a quote that I have on my lecture that says it very simply. If you are a home Depot or Lowe’s and you want to hang up a picture frame or hang up something, think about this quote, “People don’t want to buy a quarter-inch drill. They want to buy a quarter inch hole.”
So what we forget is people want health, they don’t want a functional food, they don’t care about vitamin B12, they want health. That’s what they’re really looking for. So whenever we pitch anything, we’ve got to connect and bridge what are the ingredients? If it’s gluten free and there’s no added sugar and it’s organic, those are features. But the benefit is listen, this’ll keep your inflammation down so your hands won’t hurt and because there’s no sugar and you can enjoy this without guilt. Instead of going and eating ice cream here, eat this and you’ll get your sweet tooth fix. So that’s the benefit to them and it’s healthy and it will help reduce the blood sugar contribution to your rheumatoid arthritis.
So when you say words that click to them, like it’ll reduce your pain, it will substitute out something that is important to you, that’s the benefit, not that it’s no added sugar. We’ve got to take them across the bridge to benefit.
James Maskell: Yeah, absolutely. That makes a lot of sense. Ultimately, I realize that we’re all in the business of selling people on getting healthy. I mean that’s really it. I mean there is a process of this, and I remember Dan Pink’s book a few years ago, which was called To Sell is Human and he talks about education and healthcare as the two industries where we don’t think that we’re in sales, but we actually definitely are in sales and that we need to do a better job of selling people on education and healthcare and getting healthy, because obviously it’s lifestyle driven, chronic diseases that’s participating with 86% of costs and is the biggest issue in society.
So I think that’s a great starting point and I appreciate everything that you’ve shared here. I know in our time together, back in September, I was really taken by one of the conversations that we had about the way that you’re learning to lead your patients and this conversation that we’ve had today is really starting that conversation of like…you said something to me that really stuck with me is like, “How do I lead from a step behind?”
I don’t know if you’re open to talking a little bit about why you’ve decided to go down this path and what you’ve learned so far. But ultimately what you hope to be able to do with this knowledge for your patients and obviously you have a huge following in the functional medicine community. I’d love to just touch on that at the end of this conversation.
Dr. Saxena: Yeah. I am happy to out myself and what I’m learning about my leadership and lack thereof at times. When I talk about leadership, I mean with my patients, with my children, with my staff, with the people that I get to work with in education and functional medicine, I mean leadership is pervasive in your life and many of us as providers or healthcare practitioners and business owners, leadership is pervasive. But there is a style of leadership that you have, whether you chose it or not, you are doing some style of leadership. What I had learned through this leadership development course that I’ve been taking over the last year is that there was a way that I was being, which I’ll frankly just say is like a know it all with some humility over top of it so it doesn’t look like arrogance.
I was being that way because I had been valued for so long for knowing the answers and oh, Shilpa’s smart and Shilpa will know. So I started confusing leadership with making sure you have the right answer for people, because that’s why they’re seeing you. What I realized is that was quite disempowering. You see, as long as I am the holder of the answers, then patients will always not only need me, but they will think that they’re not capable of self-healing and taking charge of their own health. So what I’ve shifted in my leadership is not being the person who feels like I have to have the answers and I have to know everything. I’m letting go of being a know-it-all. What that allows me to do is take the locus of control from me and what I do is I’m spending a lot more time actually listening to what my patients are requesting.
When you’re out here with people, they have so much brilliance, they know the answer that will work perfectly for them. We don’t as providers, we might have an idea, but they know better. So if I could be out here and create the space for them to develop their own power and possibility, then that’s going to go a lot better in the long run. So my leadership is changing into moving from being a know it all to just being the space creator for them to know it all.
James Maskell: Absolutely. Yeah, that’s super empowering. I know we’ve been on this kick all year on group visits and obviously you were the person who introduced that to me back in 2013 and I remember you mentioning the name of actually Mr. Jeff Geller and I actually went to go and see him this year at the Integrative Medicine for the Underserved Conference. I saw that in action very, very clearly, was how he was solving the group’s social determinants of health in a way that didn’t require for him to have the answer. He was just actually facilitating the group and getting the answers from the group because he realized he didn’t have the same social determinants of health as the people who are in his group.
I just think that’s such an important part as integrative and functional medicine looks to move from a population of middle class and upper class people who can afford to try a different type of healthcare to functional medicine for the masses, integrated medicine for the masses. Everyone has access to this kind of care. We really need to be thinking in those kinds of terms. So I’m excited for you because it really got me fired up about the work that we’ve been doing this year on groups and the underserved.
I know that, it’s my opinion that you will be a huge force for the spread of group visits over the next decade or two as health systems realign to what it takes to really resolve chronic illness. I’m excited to hear that this is a journey that you’re going on and you’re inspiring me to do the same journey. So thank you.
Dr. Saxena: I am so blessed to have you as part of the journey. We are reflections of each other and it’s just wonderful to be able to have these types of candid conversations about who we’re being, who we’ve become and who we really can be. Thank you so much for doing these podcasts to keep that conversation alive.
James Maskell: Beautiful. While this has been Dr. Shilpa Saxena, she is the creator of the Group Visit Toolkits, the Lifestyle Matrix Resource Center that carries those is the long-term sponsor now of our podcast and the functional forum. One of the reasons why we decided to go in this direction was just the agreement that Shilpa and I have had over the last six years about where we see healthcare going and how we could facilitate it. So if you want to find out more about the Group Visit Toolkits, go to goevomed.com/gvt. If you want to get into functional foods, this has been a great starting point for really thinking about how to get all of your patients started on this program. Thanks so much for being part of the evolution of medicine community. You can catch Shilpa at all kinds of education events around the country, IFM, George Washington, she’s everywhere and thanks so much, Shilpa, for being part of it.
I’m your host, James Maskell. This has been the Evolution of Medicine podcast. Thanks so much for listening and we’ll see you next time.
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