Cascaid Effect Podcast | Episode 5
Health Happens in the 364 Days Between Doctor Visits
“Health doesn’t happen at that medical visit. It happens in the daily friction of life, in those 364 days between your visits.”
— Tram Le
Most people already know what they should be doing for their health. Move more. Eat better. Manage stress. The information is not the problem. The problem is that a doctor gets fifteen minutes once a year, and life happens in the other 364 days. In this episode of Cascaid Effect, host Alex Galeazzi sits down with Tram Le, Director of Health Coaching at Cascaid Health, to explore the discipline that lives in that gap. They cover what a health coach actually does and how it differs from every other role on a care team, why ambivalence is normal rather than a character flaw, the difference between motivation that lasts and motivation that burns out, and the single most practical idea in the episode: shrink the goal until there is almost no friction left. Along the way, Tram walks Alex through a live coaching session on his own diet that turns a simple intention into a map of every hidden decision standing in the way.
Topics Discussed
- What health coaching actually is, and how Tram moved from dietitian to whole-person coach
- Coach versus doctor versus dietitian versus therapist: who does what, and why the distinction matters
- Self-compassion as a performance tool, and the research behind it
- Where the health coach sits on a multidisciplinary team, and why someone has to connect the dots
- Ambivalence: why the push and pull is normal, and what “sitting in the muck” means
- The structural gap: fifteen minutes a year versus 364 days of real life
- Why “eat less salt and move more” almost never works on its own
- Extrinsic versus intrinsic motivation, and when each one is the right tool
- Toxic motivation, interoceptive awareness, and why “no pain, no gain” backfires
- The yo-yo cycle: how external motivators quietly set up burnout
- What a goal actually is, and the Maps app analogy for longevity
- The wellness vision: using imagery and positive psychology to find the why
- Shrinking the goal by 80 percent, and a live coaching demo on Alex’s diet
- Activation energy, habit stacking, and clearing the weeds before planting the seeds
- Values alignment: the grandmother who wanted to participate, not spectate
- Self-determination theory: autonomy, competence, and relatedness explained through pickleball
- Motivational interviewing and the elicit, provide, elicit technique
What a health coach actually does
Tram began her career as a dietitian. Over the years, the opportunities she was given let her zoom out and see health from a more holistic vantage point, one that took in not just nutrition, sleep, and movement, but social health, emotional health, and mental health alongside them. That widening is what took her into health coaching, a discipline built around treating the person as a whole rather than as a collection of symptoms.
She draws the distinction between roles carefully. A physician identifies what is wrong, diagnoses it, and provides a treatment plan. A dietitian or personal trainer writes a therapeutic prescription on paper for you to follow. A therapist looks backward, at how the past shapes the present, and treats specific mental health conditions. A health coach works differently. The work happens in the present moment, collaboratively, and it looks forward. The past comes into the room only when a health seeker wants to bring it, and usually only to provide context on what is blocking them now.
Self-compassion is not softness, it is adaptability
Asked about the gap between emotional health and physical performance, Tram goes immediately to self-compassion, a concept she says ties intimately to whether people reach their health goals at all. Her reasoning is practical rather than sentimental. Someone with very high expectations of themselves who cannot meet those expectations, and who has no self-compassion to fall back on, will find that failure completely blocking. Life delivers a curveball, a parent gets sick, performance drops, and without flexibility the person simply cannot find their way back.
She cites Dr. Kristin Neff, whose research established the field, on the point that matters most here. When people with self-compassion scale a goal down or substitute one activity for another, that is not laziness. It is evidence of adaptability, of a growth mindset that can bend without breaking. The people who can shrink a goal in a hard week are the people still doing it a year later.
Connecting the dots on a multidisciplinary team
Alex asks where the health coach fits among the specialists people already know about. Tram uses the Cascaid board of directors as her example: physicians, specialists, dietitians, trainers, performance coaches, and health coaches together. Each of those disciplines is very good at surfacing something. Hidden risk. A diagnosis. A blood biomarker that has drifted out of range. What none of them is structurally positioned to do is help the health seeker make sense of all of it at once.
That is the coach’s seat. Tram describes the modern health seeker as inundated with information, and the coaching role as one of simplification. Alex reflects back that confusion itself is a barrier for most people, and Tram agrees without hesitation. The coach takes the blood work, the imaging, the diagnostics, and the recommendations, and helps a person turn them into something they can actually act on inside their own life.
“We help take all of the data and all of the information, because we are inundated with health information these days. What we are trying to do is simplify it and help make sense of it all.” — Tram Le
Ambivalence is normal, and the coach sits in it with you
One of the clearest philosophical differences Tram describes is how coaching treats ambivalence, that push and pull of wanting to do something and not wanting to do it at the same time. In a directive model, a patient who says they do not have time to exercise might be told simply to make it a priority. In coaching, ambivalence is treated as a completely normal human state rather than a failure of will.
Her phrase for the work is sitting in the muck with the health seeker. Alex offers “getting in the trenches with them,” and she takes it. The premise underneath is autonomy: Cascaid’s model holds that the health seeker’s own desire to change, their own priorities, and their own readiness to take the next step are what determine whether anything sticks. The coach does not override that. The coach works with it.
The structural gap nobody accounts for
This is the section that gives the episode its title. Tram lays out why coaching is not part of the standard system and why that absence has consequences. The medical model can support a fifteen to thirty minute office visit, perhaps once a year. That leaves 364 days in between, and health does not happen during the appointment. It happens in the daily friction of ordinary life.
She walks through a concrete example. A patient is diagnosed with hypertension and handed a PDF: eat less salt, move more. The intentions leaving that office are genuine. Then the person goes straight to work, spends the day putting out fires with stress running high, sits for ten hours, arrives home with no time to cook, and orders delivery. Nothing about the advice was wrong. Everything about the structure made it impossible. Coaching exists to fill that structural gap, working out a person’s actual daily routines and translating a clinical recommendation into something that survives contact with them.
Extrinsic, intrinsic, and toxic motivation
Tram breaks motivation into two categories and then adds a warning about a third. Extrinsic motivation comes from outside: fear of developing the heart disease a parent has, a cash prize for completing a workplace challenge, a wedding dress that needs to fit in three weeks. Intrinsic motivation comes from within: enjoyment, pride, fulfillment, the sense of flow where you lose track of time.
External motivators genuinely work, but they are short term by nature. After the wedding, the eating and the movement usually revert. Tram describes the pattern as a yo-yo cycle. Someone gets alarming blood work, commits to an intensive dietary overhaul, and sustains it for a couple of weeks until deadlines at work make the food preparation impossible. What follows is not a character failure. It is burnout built into the design. Her recommendation is to use extrinsic motivation deliberately, as a way to get a habit started, and then let intrinsic motivation take over once the person discovers the goal is meaningful, enjoyable, and improving their sleep and mental health.
Then there is toxic motivation, the “no pain, no gain” and “go harder, do more” culture Alex raises. Tram identifies precisely why it is harmful. It overrides interoceptive awareness, the body’s own signalling system. A rumbling stomach means hunger. Pain means stop. A motivational framework that trains you to ignore those signals pushes people past soreness into injury, fatigue, and relentless internal pressure. Expecting yourself to be a superhero every single day, as she puts it, is not a balanced or healthy way to live.
“They are toxic because they ignore the body’s inherent signals. Pain is a signal to stop.” — Tram Le
What a goal actually is
Tram defines a goal as a self-directed desire to achieve an outcome, and the emphasis lands on self-directed. Everyone is motivated toward something during the day, including hitting the snooze button. Goals matter because they give the brain a chance to form a path toward a destination.
Her analogy is the Maps app. A goal is the address you type in. Without one, there is no route to plot. With one, and crucially with a specific and actionable one rather than a vague aspiration, the individual steps become visible. She is careful about who holds the wheel in this metaphor: the health seeker is in the driver’s seat of their own health journey, and the coach rides in the passenger seat helping plot the points along the way.
This extends into what Cascaid calls a wellness vision. Drawing on research into imagery and on positive psychology, Tram asks health seekers not only what they want to achieve but what would become possible as a result. Would achieving this give them the freedom to travel? Would reducing stress mean more time with family? Knowing the why turns a goal into a story a person is actually living inside, which she notes is something standard medical care rarely provides.
Shrink the goal by 80 percent
This is the most practical and most memorable segment of the episode, and Tram demonstrates it live on Alex. He says he would like a more well-rounded diet, more fiber and vegetables. She narrows it with him: which days does he cook, how many nights realistically, steamed vegetables or a side salad. They land on a small, concrete goal of steaming vegetables twice a week for dinner.
Then she reverse engineers it, and the point becomes obvious. Getting to Costco. Finding vegetables that work around his allergies. Researching recipes he will actually enjoy. Deciding fresh or frozen. Building the extra time into an evening. Having the transportation, the time, and the cognitive reserves to do any of it after a full workday. What looked like one small goal turns out to be a cascade of decisions, and Tram notes that when cognitive reserves run low, motivation drops with them. Alex recognises the pattern immediately as the moment he reaches for frozen food instead.
Her rule of thumb is to shrink a goal by roughly 80 percent, because what you want is the minimum possible activation energy, the effort required to actually execute the behavior. One of the most reliable ways to lower it is to pair the new action with something already happening. If a Costco run is already in the week, the goal becomes stopping in the freezer aisle for a bag of broccoli. And shrinking a goal until it is almost nothing, she stresses, is not failure.
“When you shrink a goal to being almost non-existent, it doesn’t mean that you’re failing. You’re just clearing the weeds before you plant the seeds.” — Tram Le
Does the goal actually match your values?
Asked about the biggest mistake people make, Tram points to goals set for the wrong reasons: societal expectation, or because other people are doing it. Those never last. So when a health seeker brings her a goal, she digs to find out whether it genuinely matters to them, and whether achieving it would matter to anyone else in their life.
Her example is an older woman who wanted to build a strength training routine. The reason was her grandchildren. She wanted to be involved as they grew up, and the word she used, the one Tram still remembers, was participate. She wanted to participate in their lives rather than sit on the sidelines. That is what a meaningful anchor looks like. The goal mattered to her, and achieving it changed her grandchildren’s experience too.
Self-determination theory, explained through pickleball
The framework Tram carries into every coaching relationship is self-determination theory, a theory of motivation built on three components. Autonomy is foundational: the health seeker is the driver, with a genuine sense of control. Competence asks whether they have the skill, and whether there are people around them who can uplift them and hold them accountable while they build it. Relatedness asks whether they have a sense of belonging and connection. If any one of the three is missing, she says, motivation starts leaking out.
She illustrates it with pickleball. Suppose she decides to learn, in a community full of excellent players. Autonomy is intact, since it was her decision and she wants to spend time with friends. Competence is low, but she is working on it. If she then walks into a drop-in session and meets a contentious atmosphere, the sense that she does not belong there and is not good enough to be there, relatedness collapses and the motivation drains away regardless of how much she wanted it.
Motivational interviewing: elicit, provide, elicit
The episode closes on technique. Motivational interviewing is the practice of working with ambivalence rather than steamrolling it, and Tram says it requires proceeding with caution. She is careful to defend directive care where it belongs: when something is wrong, patients want and deserve a clear diagnosis and treatment plan, and that is incredibly valuable. Coaching operates in a different register, one built on questions.
Her example is a perimenopausal woman with rising blood pressure who already eats a spectacular Mediterranean diet, low in salt. A doctor who tells her to eat less salt and less red meat has, without meaning to, humiliated her. She is already doing that. The elicit, provide, elicit technique opens differently. First, elicit: estrogen levels change during perimenopause and can affect blood pressure, so what else do you know about lowering it, and can you tell me more about your daily life? That invitation lets the patient explain that she eats well, that she is stressed, that she has not been able to exercise. Then, provide, but only with permission: I have information on exercise and blood pressure, would you be open to hearing it? And finally, elicit again: how did that land for you?
The result is a conversation that meets people where they are, acknowledges what they are already doing well, and delivers information at the moment they are ready to receive it.
About Tram Le
Tram Le is the Director of Health Coaching at Cascaid Health. She began her career as a registered dietitian before broadening into whole-person health coaching, a discipline that takes in physical, social, emotional, and mental health together rather than treating any one of them in isolation.
In her role at Cascaid, Tram translates clinical theory and behavioral science into the coaching experience health seekers actually encounter, working alongside physicians, specialists, dietitians, and performance coaches to help people turn health information into action. Her practice draws on self-determination theory, motivational interviewing, positive psychology, and the research on self-compassion.