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The Crucial Role of Terrain in Functional Medicine - Blog Image

The Crucial Role of Terrain in Functional Medicine

BY: Andrea Nakayama

DATE: 2019-12-03

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The first tenet of Function Medicine and Nutrition – of any functional practice –  is to address the root cause or, as I like to say, the ‘root causes’ (as most conditions are multifactorial).

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 alone. 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 an important 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…

An analogy for root causes

Once a year, when my son was younger, he and I would travel to Hawaii to see family, get a bit of R&R, and 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 primary concept of Functional Medicine very briefly through a historical lens.

Germ Theory vs. Biological Terrain Theory

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 pleomorphic (many formed) concept. This is the basis of the Biological Terrain Theory.

Applying the Biological Terrain Theory in Functional Medicine

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 Pasteur and Rife had somewhat opposing theories, 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 Medicine Nutritionist, dedicated to dietary and lifestyle modifications for the eradication of diseases, 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 work in the field of Functional Medicine or Nutrition (or aim to) like I do, then you are uniquely suited to nurture 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
True but partial

Andrea Nakayama

By: Andrea Nakayama, FxNA Founder & Functional Medicine Nutritionist

Functional Nutrition Alliance provides the comprehensive online Functional Nutrition training in the Science & Art of the Functional Nutrition practice. Learn to address the roots of your clients’ suffering with client education, diet & lifestyle modifications.


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