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Chapter 11
Processing Your Results
You now have the data you need to make two primary determinations about your Switch
function:
PHASE 1—OVERALL STATUS: OPTIMAL OR SUBOPTIMAL?
If suboptimal, where on the suboptimal continuum
PHASE 2—SUBOPTIMAL STATUS
Dysfunctional
Delayed
Suppressed
Now, read through the instructions for each section to your results. Note: Some
sections deliver intel on only the first phase of the results; others reveal for both.
SECTION A: WHAT DO YOUR FEELINGS TELL US ABOUT YOUR
CURRENT SWITCH FUNCTION? (PHASE 1 AND 2)
In this section, you will evaluate your data in two steps. First, look at the letters that
correlate with each answer. This may not seem like “good data” to a scientist but it is
money when it comes to understanding your Switch’s current function. Why? Because a
huge part of the Switch’s job is to interpret and send signals based on and resulting in
choices and your feelings about those choices.
SUBOPTIMAL OR OPTIMAL?
Add up all of your As, Bs, and Cs. Then add up all your Ds. Is the total for your
As, Bs, and Cs more than your total Ds?
Yes? You are on the part of the continuum described as suboptimal function.
No? Your starting Switch status is optimal function.
For those with the suboptimal function result, let’s get more details. Look at the
letters you picked and select which of the below applies:
If you have two or more A answers, your current Switch-function status starts off
as suboptimal-dysfunctional.
If you have two or more B answers or if you answered one of each (A, B, C),
your current Switch-function status starts off as suboptimal-delayed.
If you have two or more C answers, your current Switch-function status starts off
as suboptimal-suppressed.
Record your result as section A, noting the date.
SECTION B: HOW IS YOUR BREATHING AFFECTING YOUR SWITCH
FUNCTION (AND VICE VERSA)? (PHASE 1 ONLY)
Any no answers? If any of your results in this section are a no, your current Switch
status is suboptimal. As you progress through Switch Optimization, let’s see how
your breathing improves your Switch function and how your Switch functioning
better improves your BOLT, pulse, and respiratory rate.
All yes answers? Then no part of this section suggests you have suboptimal Switch
status. Record your answer to this section as optimal.
Record your status for section B and the date, and then move on to the next
section.
SECTION C: WHAT DOES YOUR LAB DATA TELL US? (PHASES 1 AND 2)
Someday, just like they figured out how to turn Gila monster venom into a longer-lasting
hormone, the white-coat people may figure out how to easily and effectively test our
Switch functions (as they have done with other hormones). Even better, they’ll come up
with a gadget to monitor the Switch, the way a continuous glucose monitor monitors
blood sugar. Until then, it’s on us. Remember, do this section after you have gathered
recent data for at least five of the core lab values (marked with an asterisk). Note:
When processing these results as optimal or suboptimal, we are looking at the upper or
lower end of a range. In your lab results, you are used to seeing a range defined as
“normal.” We are only scoring your labs here for their Switch-function value, not for
your overall health. For that you talk with your practitioner.
If you answered yes to all of the data points in this section, or at minimum if you
answered yes to all the five core, there’s good objective data that your Switch
status is optimal based on blood work lab data. That’s all you record for this
section.
If you answered any questions with no in this section (at minimum the five core),
your Switch is expressing some degree of suboptimal Switch function.
If your data includes only one no (the rest are yes), then your status is more likely
suboptimal-delayed.
If your data includes more than one no, then your Switch function is suboptimal-
dysfunctional.
Record your status results for section C and the date, then move on to the next
section.
SECTION D: WHAT IS YOUR CURRENT DIGESTION AND HYDRATION
TELLING US? (PHASES 1 AND 2)
If your answers are all no, then record optimal for this section.
If you answered yes to any of the questions, you have a suboptimal Switch function
today.
If you answered yes to two or more questions, your suboptimal function is
dysfunctional.
If you answered yes to only one question, your answers here indicate suboptimal-
delayed status.
Our digestion and hydration status is constantly shifting in response to external and
internal stimuli. While you are collecting your results, they have shifted. Thus no result
is forever. Whether your answers were all no, yes, or some combo, you don’t get to skip
future assessment and assume all good or bad.
Record your results for section D and the date, and continue to the next
section.
SECTION E: WHAT IS YOUR WEIGHT COMPOSITION TELLING US?
(PHASE 1)
If you answered no to any of these questions, record suboptimal.
If you answered yes to all these questions, then you either have an optimal Switch
function or, based on your answers in the other sections, you have a type of
suboptimal function but you are optimizing your body composition with your
current choices, so you are more likely to have suboptimal-suppressed function.
For now, record “optimal” for this section.
Record your status from section E and the date.
So now you have multiple indications of your Switch-function status, in five
sections. You can aggregate these to determine your Switch-function status.
OPTIMAL VERSUS SUBOPTIMAL
If your answer for each section was optimal, that is your current Switch-function
status.
If you answered suboptimal for any of the sections, your current Switch-function
status is suboptimal. Proceed to the next section to determine your phase 2
suboptimal status.
WHAT TYPE OF SUBOPTIMAL?
Count up the number of answers you have for each type of suboptimal function—
how many suppressed, how many delayed, how many dysfunctional. The one you
have the most of is your current type of suboptimal Switch function.
For clarity and how to handle a tie, review the following:
If you answered some with delayed and some with dysfunctional, your status is
tied between the two. You can note this as dysfunctional (but closer to delayed).
If you answered some with delayed or dysfunctional and your section A answer
is suppressed, your status is suboptimal-delayed (but closer to suppressed).
Phase 1 result: Date:
Phase 2 result: Date:
What do these specifics mean?
If you’re dealing with a suboptimal Switch function, you are like almost all of us at
some point. Your suboptimal Switch function—dysfunctional, delayed, or suppressed—
will guide personalization in your plan with the goal of moving along the continuum
toward optimal as you reassess your Switch function following experiments and efforts
made in the coming weeks.
Here’s a recap of the Switch statuses and what they indicate:
Dysfunctional: You’ve got a breakdown or multiple breakdowns impacting Switch
hormone production, deployment, and messaging quality.
Delayed: While technically working, there is one or more challenge to Switch
function resulting in suboptimal messaging, deployment, or receipt of signals.
Suppressed: Switch function is poised to work properly from a function standpoint
but your choices are interfering with operations.
If your results say your Switch function is optimal, you may choose to continue
exploring this system, looking at the recommendations to better understand this system
and your Switch. Today your Switch status does not indicate a need for optimization. So
if you have other things on your to-do list, move on. But before you do, check out “Your
(Re)Optimization,” which includes two lists—one lays out signals that your Switch
status may be or has changed, and the other includes Switch challengers that can trigger
suboptimal function. Knowing these will give you a good sense of when to check in on
your Switch by redoing the assessment. That said, I highly recommend quarterly Switch
assessment—just like you change your closet for the season, see if you need to make
changes to your choices to get or maintain optimal function.
That was so much fun—when do we get to do it again?!
Okay, that may not be how you’re feeling, so I’ll wrap up this section with quick
notes on reassessment. Some parts of Switch Optimization may produce rapid results or
feedback or both. For example, when you did the BOLT, you may have experienced a
shift in how you felt; you now have a resource you can use regularly. Others, such as
addressing the root causes of digestive or sleep disturbances, may take a few weeks or
longer. And we know all too well that changing the scale—especially the one you are
now using that looks at muscle, bone, and fat mass—may take longer than one better
food choice, one week of exercising, and so forth. The key is to stick with it rather than
giving in to old habits or giving up entirely. Reassessment can help us put together a
realistic picture of how our Switch is adjusting to new choices and keep it while
retaining old choices that are also better for our body.
GPS ALERT
DEGREE OF DIFFICULTY IS PERSONAL, TOO
Given the arrows between the four status results, there’s a natural tendency to read the continuum as a difficulty
scale. Those results describe types of suboptimal function but don’t rank them by how hard they are to address.
Here’s an analogy I don’t love, as it talks about pounds and scales. I’ll use it because by this point in the
Switch story, I think we know how to adapt it. Two persons each set out to lose five pounds by a given date. For
one, that’s five pounds of ten total. For the other, that’s five pounds of fifty total. The ease and pace for them is
very different, while the near-term goal is the same.
You may make one or two adjustments based on the recommendations, experiments, insights, and support
materials for personalization—and voilà, your Switch function moves along the continuum to delayed, suppressed,
even to optimal. For another person whose function result is comparable, finding the one or two successful
adjustments may take a fair amount more experimentation.
Scales of difficulty exist for lots of efforts. We find them on ski mountains and guides to mental games such
as Rubik’s Cube and Sudoku. Those are ratings for the problem—the slope or run, the configuration of the
blocks, the numbers in the squares. Not for the solver. For each solver, degree of difficulty is personal, individual,
and subjective.
We take on the challenge with the objective of getting there more easily, yes, and faster—but above all,
better.
In the realm of suboptimal function, it can feel worse to have results that show dysfunction or delay and
much better to have those that show suppressed. While these positions on the continuum indicate degrees of
suboptimal function, the results do not reveal who has an easier path or whose road trip will be shorter or faster.
As you navigate making new choices, consider doing a quarterly (or more frequent)
reassessment of Switch function—the whole thing or one or more sections. Doing so
reinforces accountability and may also show you that your efforts are paying off when
you may be less likely to see or feel them.
Part V
Hitting the Bull’s-Eye
YOUR BLUEPRINT IS YOUR BEST SHOT.
All the things you’ve done and discovered so far put the target in view and in range.
You may have even fired a few shots that landed on the board.
From here, we are going for the bull’s-eye.
You’ve been building your force field—unlearning to create space, constructing
your pizza—to identify where your body is today, how it feels about your current
choices, and where to start experimenting with new choices. These phases built your
foundation: giving your body more of what it needs and removing impediments. Now, as
you choose your toppings, it’s all about optimally resourcing your Switch and weight-
health ecosystem to help them work optimally. You recall how I got nostalgic about the
A-Team. You’ve got one. It’s you. And you’re your own John “Hannibal” Smith. Taking
your best shot, you’re bringing your plan together.
Chapter 12
Toppings
“Ashley, does ________ work?” Via text, on phones, in patient sessions, (weirdly)
across bathroom-stall dividers, and on airplanes—I get multiple Ask Ashleys each day;
more if in a nonwork situation, I mention what I do or that I’m an RD. Ninety-six
percent of the questions are not about pizza—literal or the one you’ve made, my
metaphor for Switch Optimization. They are about supplements, the Shot, other
medications, diets, and foods . . .
You’ve been wondering about those, too?
I get it.
The allure of the toppings is earned. They absolutely can make a pizza delicious to
you in the moment. My digestion needed a few key toppings—probiotics, magnesium,
glutamine—as supplements before my pizza could come together. All the sauce and
cheese edits I tried wouldn’t work until my pizza got the toppings it needed. In my case,
like so many patients, those needed to come in the easiest-to-recognize, most readily
available form for my irritated body. The same could be said for several of the patients’
stories you’ve heard so far. The Shot or the GLP-1 activator supplement they added
made it deliciously doable for them to build their pizza.
But ever had a delicious topping on a poorly assembled or not delicious pizza?
Yeah, me too. Pass. On. That.
Too often, weight-health ecosystems get a lot of toppings thrown at them that are
then relatively quickly discarded because they “don’t work.” These are cases of
toppings applied to a suboptimal pizza foundation. Failure on the Shot? Toppings
without a better pizza foundation. Failure on multiple diets resulting in a monogamous
pizza relationship? Toppings without a better pizza foundation. Failure to optimize
blood sugar despite taking berberine? Toppings without a better pizza foundation. And
so on. You get it, right?
There is not one right order to Switch Optimization. But there is a better one.
Which is why we are here now—after assessment—for the toppings.
Selection of and experimentation with toppings will help you refine your plan into
your blueprint for Switch Optimization. It’s what makes the Switch Optimization plan
your best shot.
So let’s do it.
As you go through this section, be wary of the natural desire (due to decades of
marketing) to read about an ingredient or protocol, believe it relates to you, and do it,
expecting it will be “the solution” for your best pizza. Instead, the way you move
through this section is to gather intel about different choices, home in on those that apply
to you—based on your assessment—and choose one or maybe two to implement and
then evaluate the impact. Was it doable? Did it improve your Switch function and
weight-health ecosystem? If yes, then it is a keeper, at least for now and until
reassessment shows you your body needs something different to become optimally
resourced.
He deems it successful in the same way that a surgeon deems an operation successful when the patient leaves
the operating theatre alive.
—Eric Ambler, The Mask of Dimitrios
It’s common practice today to take a pill, look at one lab marker, and determine
success. You’ve learned that we need to unlearn this approach in favor of optimally
resourcing your body for optimal health span. This section is designed to help you
identify where to invest your resources right now.
GPS ALERT
TAKE IT ONE AT A TIME
You are already making many better choices that we want to protect, and how you’ve learned to make and
prioritize them will help you adopt new choices. A good rule of thumb, in our modern lives with ample to-do lists,
is that the body and mind may be able to experiment with and evaluate at most one new thing a week, and it is
nearly impossible to manage multiple experiments effectively at the same time. Go with one, assess, and either
add it to your plan or pivot to a new experiment. Repeat.
With that preamble completed, it’s time to build your force field.
Let’s personalize your Switch Optimization.
I’m going to kick off with one last not—“Here’s where we’re not (going), first.”
We’re not going to begin with toppings with a focus on food, the Shot, or Shot-like
supplements. Don’t worry; we will get there and you will get what you need when you
need it.
What matters more to your Switch and weight-health ecosystem is nutrients.
Nutrients provide the body the resources it needs to operate optimally . . . or not. The
better course toward optimizing nutrient intake and utilization begins not at food but
rather with your crust and (re)building it better with digestion.
GPS ALERT
BUT SHOULDN’T WE TEST FIRST?
A common scenario, now that direct-to-consumer testing is available, plays out for patients experiencing
digestive complaints. They come to me having invested in tests for food allergies and intolerances, stressed about
results implicating multiple ingredients. The kicker? The “triggers” ID’d are what they consume most often.
Typically they’ve been instructed to reduce or eliminate these, and often have tried, or they’re stuck between
options like a deer in the headlights.
What did their tests really reveal? Digestive irritation. You put just about anything into an irritated system and
it will respond by saying it is irritated. Anyone who’s ever come home from a trying day at work and snapped at
their kid/spouse/partner/parent/pet can testify to that. The test results gave us intel we already had. Their system
being irritated meant that their food choices were irritating to it—because they asked an irritated system to do
more work. This does not mean digestive testing is a bad tool. It’s an invaluable tool when used with the right
timing. The better order: (1) solid, multi-aspect assessment (as you’ve done), (2) get into toppings for digestion,
as we’re about to do, (3) invest in testing to further personalize a plan.
My own story—with the belly, the worm, the probiotics—showed me that. My work
with patients showed it to me again. And again. Hundreds and eventually thousands of
times. For most of us struggling with weight health—the overwhelming majority of us—
digestion is the primary issue. It’s the right starting point. It’s our base camp. Because
our digestion is suboptimal, often wildly so, our bodies are unable to convert food into
usable nutrients in the amounts and forms, and at the pace, our bodies need.
We don’t win without optimal digestion—as seen on TV.
The first reality show hit the screen in 1948 with Candid Camera, but for most of
us, The Real World introduced this genre. Reality TV has gone on to make celebrities
out of “ordinary” people willing to share their lives for us all to voyeur. In the early
2000s, reality TV came for the weight-loss market. Why not? If the diet industry could
make billions, wasn’t there a slice of the pie for the entertainment industry to eat? Turns
out yes, big time. For me, this version of edutainment seemed like a major teachable
opportunity, a chance to bring my personalized nutrition message to millions nationally.
I was already doing that with my magazine and news media interviews, so I dove in as
the on-air dietitian for four reality shows. That almost none of my on-air content made it
into this book tells you everything you need to know about whether reality TV shows
are a better source of recommendations for your health goals.
BUT DOC, SHE’S NOT A “FAILURE”
I met Paula over twenty years ago. She was hitting her stride as an award-winning
actress, singer, and a new mom. We met because we both had agreed to be on a reality
show—she would join her peers because, for the first time in her life, she was
struggling with her weight (post baby #2). She and her team would be a great storyline,