The Root Cause Medicine Podcast

Dr. Kate Kresge is joined by psychiatrist James Greenblatt, MD, to discuss themes from his book Finally Hopeful, including nutrition, depression, laboratory assessment, and antidepressant withdrawal.

Clinical Takeaways

• Depression warrants a broad clinical assessment. Symptoms may overlap with medical conditions and nutritional deficiencies. (Bode 2021)https://pubmed.ncbi.nlm.nih.gov/32291287/(Lee 2020)https://pubmed.ncbi.nlm.nih.gov/28759846/(Bender 2017) The episode discusses thyroid function, iron, vitamin B12, folate, vitamin D, and other factors as part of a broader evaluation—not as universal causes of depression.
• Antidepressant discontinuation should be individualized. Abruptly stopping an antidepressant can cause withdrawal symptoms. (Henssler 2024)https://pubmed.ncbi.nlm.nih.gov/30850328/(Horowitz 2019) Gradual, clinician-supervised tapering is important; nutritional status may also be considered, although supplementation has not been established as a way to prevent withdrawal. (Horowitz 2019)
• Nutrition can be considered within whole-person mental healthcare. Protein, amino acids, omega-3 fatty acids, B vitamins, zinc, and magnesium are discussed. Testing and supplementation should reflect individual needs rather than assuming a common deficiency.

Guest: James Greenblatt, MD

James Greenblatt, MD, is a psychiatrist and educator in integrative and functional psychiatry. He discusses a whole-person framework for evaluating depression, nutritional status, and antidepressant discontinuation.

Clinician FAQ

1. Can nutritional deficiencies contribute to depressive symptoms?

Yes, nutritional status can be clinically relevant, but depression is multifactorial. (Bender 2017)https://pubmed.ncbi.nlm.nih.gov/30396512/(Malhi 2018) The episode discusses iron, vitamin B12, folate, vitamin D, zinc, and other nutrients clinicians may evaluate when appropriate.

2. Why distinguish antidepressant withdrawal from depression?

Withdrawal can occur when antidepressants are reduced or stopped, and symptoms may overlap with psychiatric symptoms. (Henssler 2024)https://pubmed.ncbi.nlm.nih.gov/30850328/(Horowitz 2019) Distinguishing withdrawal from recurrence of depression is important during discontinuation. (Horowitz 2019)

3. Should nutritional status be assessed before antidepressant tapering?

The episode proposes evaluating nutritional status before and during tapering. Medication changes should be individualized and managed with the prescribing clinician.

4. What role do amino acids play in mental health?

Amino acids from dietary protein are precursors for many biologically important molecules, including neurotransmitters. (Tang 2025) The episode discusses amino acid assessment as part of Dr. Greenblatt’s clinical approach.

5. Why screen for medical conditions in patients with depression?

Some medical conditions may produce symptoms that resemble or coexist with depression. (Bode 2021)https://pubmed.ncbi.nlm.nih.gov/32291287/(Lee 2020)https://pubmed.ncbi.nlm.nih.gov/31947912/(Clappison 2020) The episode highlights thyroid disorders, anemia, and celiac disease as examples clinicians may investigate when clinically indicated.

Key Moments

03:44 Whole-person framework for depression

07:46 Antidepressant withdrawal

11:29 Nutritional assessment before tapering

23:23 Amino acids and nutrition

37:26 B vitamins and minerals

46:15 Depression and celiac disease case

Disclaimer

The views expressed on this podcast are those of the hosts and the guests, and they don't necessarily reflect the views of FullScript or any affiliated organizations. This podcast is for informational and educational purposes only, and it's not intended to be medical advice. For your safety, always check with your healthcare provider before making any changes to your healthcare routine.

References

• Bender, A., Hagan, K. E., & Kingston, N. (2017). The association of folate and depression: A meta-analysis. Journal of Psychiatric Research, 95, 9–18.https://doi.org/10.1016/j.jpsychires.2017.07.019https://doi.org/10.1016/j.jpsychires.2017.07.019
• Bode, H., Ivens, B., Bschor, T., Schwarzer, G., Henssler, J., & Baethge, C. (2021). Association of hypothyroidism and clinical depression: A systematic review and meta-analysis. JAMA Psychiatry, 78(12), 1375–1383.https://doi.org/10.1001/jamapsychiatry.2021.2506https://doi.org/10.1001/jamapsychiatry.2021.2506
• Clappison, E., Hadjivassiliou, M., & Zis, P. (2020). Psychiatric manifestations of coeliac disease, a systematic review and meta-analysis. Nutrients, 12(1), 142.https://doi.org/10.3390/nu12010142https://doi.org/10.3390/nu12010142
• Henssler, J., Schmidt, Y., Schmidt, U., Schwarzer, G., Bschor, T., & Baethge, C. (2024). Incidence of antidepressant discontinuation symptoms: A systematic review and meta-analysis. The Lancet Psychiatry, 11(7), 526–535.https://doi.org/10.1016/S2215-0366(24)00133-0https://doi.org/10.1016/S2215-0366(24)00133-0
• Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538–546.https://doi.org/10.1016/S2215-0366(19)30032-Xhttps://doi.org/10.1016/S2215-0366(19)30032-X
• Lee, Y.-J., & Kim, H.-B. (2020). Association between anaemia and adult depression: A systematic review and meta-analysis of observational studies. Journal of Epidemiology and Community Health, 74(7), 565–572.https://doi.org/10.1136/jech-2020-213842https://doi.org/10.1136/jech-2020-213842
• Malhi, G. S., & Mann, J. J. (2018). Depression. The Lancet, 392(10161), 2299–2312.https://doi.org/10.1016/S0140-6736(18)31948-2https://doi.org/10.1016/S0140-6736(18)31948-2
• Tang, J., Krushelnycky, L., Shaqo, A., & Cho, C. E. (2025). A comprehensive review of nutritional influences on the serotonergic system. Advances in Nutrition, 16(11), 100524.https://doi.org/10.1016/j.advnut.2025.100524https://doi.org/10.1016/j.advnut.2025.100524

What to do at the first sign of a cold: an evidence-informed toolkit

Dr. Holly Lucille, ND, is joined by Lara Zakaria, PharmD, MS, CNS, to discuss what people can do when a scratchy throat, fatigue, or other early respiratory symptoms begin. The conversation covers rest and recovery, respiratory virus testing, zinc, vitamin C, elderberry, echinacea, honey, green tea, garlic, ginger, turmeric, and practical ways to prepare for cold and flu season.

Early symptoms of COVID-19, influenza, and other respiratory infections can overlap, making symptom pattern alone an unreliable way to identify the cause. Testing, individual risk factors, symptom severity, and timing can all affect the appropriate next step. (CDC 2026a)https://www.cdc.gov/respiratory-viruses/prevention/testing.html(CDC 2025)

Clinical Takeaways

• Start with the fundamentals: rest, fluids, testing when appropriate, and risk assessment. Most uncomplicated colds improve without specific treatment, and supportive measures such as adequate rest and fluids remain foundational. (CDC 2026b) Testing can help distinguish respiratory infections such as COVID-19 and influenza when the result may affect treatment or precautions, particularly for patients at higher risk of severe illness. (CDC 2025)
• Zinc and vitamin C have different levels of evidence for the common cold. Zinc has been studied extensively, particularly as lozenges started early in a cold, but results vary substantially by formulation, dose, and study design. (Nault 2024)https://pubmed.ncbi.nlm.nih.gov/28480298/(Hemilä 2017)https://pubmed.ncbi.nlm.nih.gov/31980506/(Hemilä 2020) Regular vitamin C supplementation may modestly shorten cold duration, while evidence for starting vitamin C only after symptoms appear has been less consistent. Long-term or excessive zinc supplementation also warrants attention because sustained high intake can interfere with copper status. (NIH 2022)
• Botanical evidence is ingredient- and formulation-specific. (Karsch-Völk 2014) Elderberry and echinacea have both been studied for respiratory infections, but findings are mixed and should not be generalized across products. (Wieland 2021)https://pubmed.ncbi.nlm.nih.gov/24554461/(Karsch-Völk 2014)https://pubmed.ncbi.nlm.nih.gov/31126553/(David 2019) Evidence for elderberry remains limited and uncertain, while echinacea studies vary considerably according to species, plant part, extraction method, and formulation. (Wieland 2021)https://pubmed.ncbi.nlm.nih.gov/24554461/(Karsch-Völk 2014) Garlic, green tea, ginger, turmeric, and honey may have nutritional or symptom-support roles, but they should not be presented as established treatments for viral respiratory infections. (Lissiman 2014)https://pubmed.ncbi.nlm.nih.gov/32817011/(Abuelgasim 2021)

Guest: Lara Zakaria, PharmD, MS, CNS

Lara Zakaria is a pharmacist and clinical nutritionist with a background spanning community pharmacy, functional medicine, and personalized nutrition. In this episode, she discusses how conventional pharmacy knowledge and nutrition can be brought together when thinking about early respiratory symptoms, supplement use, and practical supportive care.

Clinician FAQ

1. What should patients do when they first feel a cold coming on?

Supportive care is a reasonable starting point for uncomplicated symptoms. Rest, adequate fluids, and attention to symptom progression can help patients through a typical viral illness. Testing for COVID-19 or influenza may also be useful when results could affect treatment or precautions, particularly in higher-risk patients. (CDC 2026b) (CDC 2025)

Patients at increased risk for severe respiratory illness should contact a healthcare provider promptly because prescription antiviral treatment for influenza and COVID-19 is time-sensitive. (CDC 2026a)

2. Does zinc shorten a cold?

Possibly, but the evidence is formulation-dependent. (Nault 2024) Trials of zinc lozenges have produced conflicting findings, with some showing shorter illness duration and others showing no meaningful benefit. (Hemilä 2017)https://pubmed.ncbi.nlm.nih.gov/31980506/(Hemilä 2020) Differences in zinc salt, formulation, dose, timing, and lozenge composition complicate comparisons across studies. (Nault 2024)

This means findings from a specific zinc-lozenge trial should not automatically be extrapolated to zinc supplements in general. Prolonged high zinc intake can also impair copper absorption, making duration and total intake relevant to safety. (NIH 2022)

3. Should vitamin C be started when cold symptoms appear?

The evidence is stronger for regular supplementation than for starting vitamin C after symptoms begin. A large systematic review found that routine vitamin C supplementation did not substantially reduce cold incidence in the general population but was associated with modest reductions in cold duration. (Hemilä 2013) Trials starting vitamin C therapeutically after symptom onset have not demonstrated a consistent benefit. (Hemilä 2013)

Practitioners should therefore distinguish evidence for ongoing vitamin C intake from evidence for using vitamin C as an acute intervention.

4. Do elderberry and echinacea help with colds and respiratory infections?

The evidence is mixed. A systematic review of elderberry found that it may reduce the duration or severity of some viral respiratory illnesses, but the certainty of the evidence was insufficient for firm conclusions. (Wieland 2021) Echinacea research is complicated by substantial differences among preparations. (Karsch-Völk 2014) Systematic reviews and individual trials have reached differing conclusions, and some well-controlled studies have not found significant reductions in cold duration or severity. (Karsch-Völk 2014)https://pubmed.ncbi.nlm.nih.gov/31126553/(David 2019) Product-specific evidence matters when interpreting these findings.

5. When should respiratory symptoms prompt testing or medical evaluation?

Testing becomes particularly important when identifying COVID-19 or influenza could change treatment or precautions. (CDC 2025) Patients at higher risk for severe illness should seek healthcare promptly because antiviral treatments for influenza and COVID-19 work best when initiated early. (CDC 2026a)https://www.cdc.gov/common-cold/treatment/index.html(CDC 2026b) Trouble breathing, chest pain or pressure, confusion, inability to stay awake, dehydration, severe weakness, or symptoms that improve and then significantly worsen warrant prompt medical assessment. (CDC 2026a)

Timestamps / Key Moments

00:03:00 Early signs that an illness may be developing

00:04:00 Temperature, heart rate, and HRV changes

00:06:35 When testing and medical evaluation may be appropriate

00:08:46 Why rest and recovery matter

00:09:55 Respiratory virus testing and RSV

00:12:15 Vitamin C and zinc

00:14:35 Vitamin C formulations and intake

00:15:24 Zinc supplements and lozenges

00:17:15 Long-term zinc intake and copper balance

00:20:30 Vitamin D status and seasonal preparation

00:22:33 Elderberry, echinacea, honey, and other botanicals

00:26:45 Symptom relief versus the underlying infection

00:30:20 Echinacea preparations

00:32:47 Green tea and EGCG

00:34:10 Garlic and allicin

00:35:15 Ginger and turmeric

00:36:49 Building a practical early-symptom toolkit

Nutrients and botanicals discussed

• Zinc
• Vitamin C
• Vitamin D
• Elderberry
• Echinacea
• Honey
• Manuka honey
• Green tea
• EGCG
• Garlic
• Allicin
• Ginger
• Turmeric

Supportive strategies discussed

• Rest and sleep
• Hydration
• Respiratory virus testing
• Monitoring symptoms
• Reviewing wearable trends
• Warm fluids and tea
• Supplement preparation before cold and flu season
• Evaluating zinc intake and copper balance
• Individualizing supplement use

Want to elevate your practice?

This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript helps clinicians bring supplement dispensing, lab ordering, and patient education into one centralized workflow.

For more practitioner education on supplements, nutrition, and evidence-informed clinical care, visit Fullscript Academy at academy.fullscript.com.

Disclaimer

The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for informational and educational purposes only and is not medical advice. Dietary supplements can cause adverse effects and interact with medications. Patients should consult a qualified healthcare professional when symptoms are severe, persistent, worsening, or when individual health conditions or medications may affect appropriate care.

References

• Abuelgasim, H., Albury, C., & Lee, J. (2021). Effectiveness of honey for symptomatic relief in upper respiratory tract infections: A systematic review and meta-analysis. BMJ Evidence-Based Medicine, 26(2), 57–64.https://doi.org/10.1136/bmjebm-2020-111336https://doi.org/10.1136/bmjebm-2020-111336
• Centers for Disease Control and Prevention. (2025, August 18). Testing and respiratory viruses.https://www.cdc.gov/respiratory-viruses/prevention/testing.htmlhttps://www.cdc.gov/respiratory-viruses/prevention/testing.html
• Centers for Disease Control and Prevention. (2026a, September 10). About respiratory illnesses.https://www.cdc.gov/respiratory-viruses/about/index.htmlhttps://www.cdc.gov/respiratory-viruses/about/index.html
• Centers for Disease Control and Prevention. (2026b, March 11). Manage common cold.https://www.cdc.gov/common-cold/treatment/index.htmlhttps://www.cdc.gov/common-cold/treatment/index.html
• David, S., & Cunningham, R. (2019). Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. Complementary Therapies in Medicine, 44, 18–26.https://doi.org/10.1016/j.ctim.2019.03.011https://doi.org/10.1016/j.ctim.2019.03.011
• Hemilä, H., & Chalker, E. (2013). Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews, 2013(1), Article CD000980.https://doi.org/10.1002/14651858.CD000980.pub4https://doi.org/10.1002/14651858.CD000980.pub4
• Hemilä, H., Fitzgerald, J. T., Petrus, E. J., & Prasad, A. (2017). Zinc acetate lozenges may improve the recovery rate of common cold patients: An individual patient data meta-analysis. Open Forum Infectious Diseases, 4(2), ofx059.https://doi.org/10.1093/ofid/ofx059https://doi.org/10.1093/ofid/ofx059
• Hemilä, H., Haukka, J., Alho, M., Vahtera, J., & Kivimäki, M. (2020). Zinc acetate lozenges for the treatment of the common cold: A randomised controlled trial. BMJ Open, 10(1), e031662.https://doi.org/10.1136/bmjopen-2019-031662https://doi.org/10.1136/bmjopen-2019-031662
• Karsch-Völk, M., Barrett, B., Kiefer, D., Bauer, R., Ardjomand-Woelkart, K., & Linde, K. (2014). Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews, 2014(2), Article CD000530.https://doi.org/10.1002/14651858.CD000530.pub3https://doi.org/10.1002/14651858.CD000530.pub3
• Lissiman, E., Bhasale, A. L., & Cohen, M. (2014). Garlic for the common cold. Cochrane Database of Systematic Reviews, 2014(11), Article CD006206.https://doi.org/10.1002/14651858.CD006206.pub4https://doi.org/10.1002/14651858.CD006206.pub4
• National Institutes of Health, Office of Dietary Supplements. (2022). Copper: Fact sheet for health professionals. Retrieved October 21, 2026, fromhttps://ods.od.nih.gov/factsheets/Copper-HealthProfessional/https://ods.od.nih.gov/factsheets/Copper-HealthProfessional/
• Nault, D., Machingo, T. A., Shipper, A. G., Antiporta, D. A., Hamel, C., Nourouzpour, S., Konstantinidis, M., Phillips, E., Lipski, E. A., & Wieland, L. S. (2024). Zinc for prevention and treatment of the common cold. Cochrane Database of Systematic Reviews, 2024(5), Article CD014914.https://doi.org/10.1002/14651858.CD014914.pub2https://doi.org/10.1002/14651858.CD014914.pub2
• Wieland, L. S., Piechotta, V., Feinberg, T., Ludeman, E., Hutton, B., Kanji, S., Seely, D., & Garritty, C. (2021). Elderberry for prevention and treatment of viral respiratory illnesses: A systematic review. BMC Complementary Medicine and Therapies, 21(1), 112.https://doi.org/10.1186/s12906-021-03283-5https://doi.org/10.1186/s12906-021-03283-5

Health Meets Wellness: The App and Dr. Edens’ Story

Dr. Elizabeth Sharp Edens is the founder of Health Meets Wellness, an integrative practice where every patient gets three plans: a medical plan, a movement plan and a nutrition plan. Guideline-based medicine is her North Star, and she layers in nutrition, yoga, herbal therapies and acupuncture, with dietitians on her team. It’s whole-person care built around how each patient actually lives.

But she didn’t stop at the exam room. She’s spent three years building the Health Meets Wellness app to bring that same care to patients between visits, and to people far beyond her own practice. It features meal plans, photo food logging, an AI health coach, symptom tracking for patients on GLP-1s, yoga videos she filmed herself, and 20-minute, no-equipment strength workouts developed with a former Milwaukee Bucks performance lead. Now it’s being rebranded for women, with cycle tracking that adapts meal and exercise plans to each phase. There’s a free version, and practitioners can use it with their own patients.

Elizabeth is double board-certified in internal medicine and obesity medicine, certified in functional medicine and a certified yoga instructor, and her path ran through Mount Sinai, a healthcare startup and One Medical. We talk about how she built her practice and her app without a tech background, why she became a yoga teacher, and how she supports patients on GLP-1s with movement and nutrition.

If you love whole-person care but work in a hospital or conventional system without a roadmap, this one’s for you.

Timestamps

• 03:33 — What drew Dr. Elizabeth to medicine, and then to functional medicine
• 08:15 — What her practice looks like today
• 11:25 — From Mount Sinai to a startup to One Medical to her own practice
• 14:14 — How to find opportunities beyond one-to-one care
• 18:38 — Why she built an app, and why it’s designed for women
• 25:54 — Advice if you’re not tech-savvy
• 28:57 — Why she became a yoga teacher + fitting training into a full schedule
• 32:25 — Metabolic health and what she sees as non-negotiable with GLP-1s
• 35:41 — Movement on a GLP-1: building and measuring muscle at home

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer: The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.

Dr. Oscar Coetzee joins Dr Lara Zakaria on the Root Cause Medicine Podcast to discuss emerging research on keystone commensal organisms and how microbial communities interact within the gut ecosystem.

The conversation focuses on organisms including Akkermansia muciniphila, Faecalibacterium prausnitzii, Roseburia, Bifidobacterium longum, and Bifidobacterium adolescentis. Rather than viewing individual microbes in isolation, Dr. Coetzee describes an ecosystem model centered on cross-feeding, short-chain fatty acid production, and the intestinal environment.

The episode also notes an important context: research on next-generation commensals is still developing, meaning findings from mechanistic studies, case reports, and early clinical research offer initial insights that complement rather than replace evidence from larger randomized controlled trials. (Jan 2024)https://pubmed.ncbi.nlm.nih.gov/42104000/(Kern 2026)

Clinical takeaways

• Keystone organisms are discussed as members of an interconnected ecosystem. The episode explores how organisms can produce metabolites or modify environmental conditions that may influence other members of the microbial community. (Belzer 2017)https://pubmed.ncbi.nlm.nih.gov/37432351/(Fusco 2023)
• Short-chain fatty acids are a major theme. Akkermansia, Faecalibacterium, and Roseburia are discussed in relation to acetate, propionate, and butyrate production and their potential roles within the intestinal environment. (Martin-Gallausiaux 2021)https://pubmed.ncbi.nlm.nih.gov/40788133/(Tingler 2025)
• Clinical evidence remains emerging. Dr. Coetzee describes early clinical observations and studies in progress, while the conversation acknowledges the need for additional published research, including controlled trials, before broader clinical conclusions can be drawn. (Jan 2024)https://pubmed.ncbi.nlm.nih.gov/42104000/(Kern 2026)

Guest: Oscar Coetzee, PhD, DCN

Dr. Oscar Coetzee is Vice President of Clinical Education and Practitioner Support at Designs for Health. In the episode, he discusses his work in nutrition and microbiome research and his interest in next-generation commensal organisms.

His discussion centers on moving beyond a single-organism view of probiotics toward understanding microbial communities, cross-feeding, and the environment in which commensal organisms coexist.

Clinician FAQ

1. What are keystone commensal organisms?

They are microbes discussed for their potentially important roles within the broader gut ecosystem. (Rios Garza 2026)

The episode focuses on how selected commensals interact with other organisms and their environment rather than evaluating them solely by abundance. (Banerjee 2018)

2. Which organisms are discussed?

The main organisms include Akkermansia muciniphila, Faecalibacterium prausnitzii, Roseburia, Bifidobacterium longum, and Bifidobacterium adolescentis.

The conversation also discusses Anaerostipes caccae separately in the context of butyrate production and microbial cross-feeding. (Belzer 2017)

3. What is microbial cross-feeding?

Cross-feeding describes how metabolites produced by one organism can serve as substrates or influence conditions for another. (Culp 2023)https://pubmed.ncbi.nlm.nih.gov/27928878/(Louis 2017)

The episode uses this concept to explain why microbial communities may be more informative than considering individual organisms in isolation. (Culp 2023)

4. Why are short-chain fatty acids discussed?

They are microbial metabolites that form part of the communication between gut microbes and their environment. (Martin-Gallausiaux 2021)

The conversation highlights acetate, propionate, and butyrate while exploring how different commensal organisms contribute to their production. (Martin-Gallausiaux 2021)

5. How established is the clinical evidence?

Research on these next-generation commensals is still evolving. (Jan 2024)https://pubmed.ncbi.nlm.nih.gov/42104000/(Kern 2026)

The guest describes case observations, prospective studies, and additional research underway. These early findings can generate hypotheses, but they do not establish that a specific probiotic combination prevents or treats disease.

Timestamps / key moments

00:00:00 Introducing keystone commensal organisms

00:05:35 Why newer technology matters for anaerobic microbes

00:08:09 Moving beyond probiotic quantity and individual strains

00:13:32 Microbial compensation and ecosystem dynamics

00:18:00 Keystone organisms and emerging clinical observations

00:21:28 Akkermansia and microbial metabolites

00:24:08 Faecalibacterium prausnitzii and butyrate

00:30:49 Roseburia and the anaerobic environment

00:32:24 Bifidobacterium species in the microbial community

00:35:52 Anaerostipes caccae and cross-feeding

00:39:58 Supporting the microbial ecosystem

00:44:18 Current research and evidence limitations

00:48:02 Clinical considerations and unanswered questions

01:02:15 Future research and closing discussion

Want to learn more about microbiome science?

This episode highlights an evolving way of thinking about the microbiome: not simply as a collection of individual organisms, but as an ecosystem shaped by microbial interactions, metabolites, available substrates, and environmental conditions.

For additional practitioner education on supplement quality and clinical decision-making, visit Fullscript Academy.

Disclaimer

The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations.

This episode is for informational and educational purposes only and is not medical advice. Research on next-generation commensal organisms and related probiotic formulations is evolving, and emerging findings should be interpreted in the context of the strength and limitations of the available evidence.

References

• Banerjee, S., Schlaeppi, K., & van der Heijden, M. G. A. (2018). Keystone taxa as drivers of microbiome structure and functioning. Nature Reviews Microbiology, 16(9), 567–576.https://doi.org/10.1038/s41579-018-0024-1https://doi.org/10.1038/s41579-018-0024-1
• Belzer, C., Chia, L. W., Aalvink, S., Chamlagain, B., Piironen, V., Knol, J., & de Vos, W. M. (2017). Microbial metabolic networks at the mucus layer lead to diet-independent butyrate and vitamin B12 production by intestinal symbionts. mBio, 8(5), e00770-17.https://doi.org/10.1128/mBio.00770-17https://doi.org/10.1128/mBio.00770-17
• Culp, E. J., & Goodman, A. L. (2023). Cross-feeding in the gut microbiome: Ecology and mechanisms. Cell Host & Microbe, 31(4), 485–499.https://doi.org/10.1016/j.chom.2023.03.016https://doi.org/10.1016/j.chom.2023.03.016
• Fusco, W., Lorenzo, M. B., Cintoni, M., Porcari, S., Rinninella, E., Kaitsas, F., Lener, E., Mele, M. C., Gasbarrini, A., Collado, M. C., Cammarota, G., & Ianiro, G. (2023). Short-chain fatty-acid-producing bacteria: Key components of the human gut microbiota. Nutrients, 15(9), 2211.https://doi.org/10.3390/nu15092211https://doi.org/10.3390/nu15092211
• Jan, T., Negi, R., Sharma, B., Kumar, S., Singh, S., Rai, A. K., Shreaz, S., Rustagi, S., Chaudhary, N., Kaur, T., Kour, D., Sheikh, M. A., Kumar, K., Yadav, A. N., & Ahmed, N. (2024). Next generation probiotics for human health: An emerging perspective. Heliyon, 10(16), e35980.https://doi.org/10.1016/j.heliyon.2024.e35980https://doi.org/10.1016/j.heliyon.2024.e35980
• Kern, L., Tofield, A., Frame, J., & Elinav, E. (2026). Next-generation probiotics: An outlook into current applications and future developments. Nature Reviews Microbiology, 24(8), 539–558.https://doi.org/10.1038/s41579-026-01311-0https://doi.org/10.1038/s41579-026-01311-0
• Louis, P., & Flint, H. J. (2017). Formation of propionate and butyrate by the human colonic microbiota. Environmental Microbiology, 19(1), 29–41.https://doi.org/10.1111/1462-2920.13589https://doi.org/10.1111/1462-2920.13589
• Martin-Gallausiaux, C., Marinelli, L., Blottière, H. M., Larraufie, P., & Lapaque, N. (2021). SCFA: Mechanisms and functional importance in the gut. Proceedings of the Nutrition Society, 80(1), 37–49.https://doi.org/10.1017/S0029665120006916https://doi.org/10.1017/S0029665120006916
• Rios Garza, D., Gonze, D., & Faust, K. (2026). Keystone concept revisited: Insights into microbial community dynamics and control. Nature Reviews Microbiology, 24(5), 359–371.https://doi.org/10.1038/s41579-025-01266-8https://doi.org/10.1038/s41579-025-01266-8
• Tingler, A. M., & Engevik, M. A. (2025). Breaking down barriers: Is intestinal mucus degradation by Akkermansia muciniphila beneficial or harmful? Infection and Immunity, 93(9), e0050324.https://doi.org/10.1128/iai.00503-24https://doi.org/10.1128/iai.00503-24

Dr. Eric Viegas joins the Root Cause Medicine Podcast to discuss an often-overlooked part of evaluating botanical supplements for menopause: whether the product being used actually matches the ingredient that was studied.

The conversation focuses on five botanicals and botanical categories—black cohosh, Vitex (chasteberry), rhapontic rhubarb, maca, and soy isoflavones. Rather than framing individual herbs as simply effective or ineffective, Dr. Viegas emphasizes three considerations: identity, standardization, and patience.

Identity refers to confirming the correct plant species and plant part. Standardization addresses whether relevant constituents or studied extracts are consistently represented in a product. Patience refers to allowing an appropriate evaluation period rather than judging a botanical after only a few days of use.

Clinical takeaways

• Botanical evidence is closely tied to the ingredient that was actually studied. Dr. Viegas emphasizes that results from research on a particular species, plant part, extract, or standardized preparation cannot automatically be generalized to every product carrying the same botanical name.
• Black cohosh has a substantial research history, but product characteristics matter. The episode discusses Actaea racemosa and the importance of confirming botanical identity, the appropriate plant part, and the characteristics of the extract being used. Standardized preparations feature prominently in the research discussed. (Castelo-Branco 2021) (NIDDK 2025)
• Vitex is discussed primarily in the context of cyclical symptoms and perimenopause. Also known as chasteberry (Vitex agnus-castus), Vitex is presented as having a stronger research history for premenstrual and cyclical symptoms than for classic postmenopausal symptoms. The episode also highlights variation in extracts and marker compounds. (Csupor 2019)
• Rhapontic rhubarb illustrates the importance of extract-specific evidence. The discussion focuses on the studied rhapontic rhubarb extract ERr 731 rather than treating all rhubarb preparations as interchangeable. This provides an example of why practitioners should identify the exact preparation evaluated in clinical research. (Dubey 2024)
• Maca presents additional standardization challenges. The episode discusses differences among maca varieties and processing methods and notes that there is not one universally dominant marker used across all products. Maca is discussed in relation to menopausal symptoms, mood, and sexual function without positioning it as a direct hormone replacement. (Lee 2011)
• Soy isoflavone response may vary between individuals and formulations. The conversation highlights differences among individual isoflavones and discusses equol production as one possible contributor to variability in response. (Mayo 2019)
• Time is part of interpreting a botanical trial. A recurring theme throughout the episode is that botanical interventions studied over weeks or months should not necessarily be judged after a very short trial. Appropriate duration depends on the ingredient, formulation, patient, and clinical context.

Guest: Eric Viegas, ND

Dr. Eric Viegas is a naturopathic doctor based in Ottawa, Canada, and works with Fullscript’s quality program.

In the episode, he describes Fullscript’s approach to supplement quality, including supplier qualification and review of product documentation. He also discusses Fullscript Tested, a program in which products are selected from Fullscript distribution centers and submitted to third-party laboratories for testing related to factors such as identity, potency, and contaminants.

His discussion of menopause botanicals centers on connecting published research with the practical question practitioners face when evaluating supplements: Does the ingredient in the product correspond to the ingredient evaluated in the research?

Clinician FAQ

1. What do identity and standardization mean for botanical supplements?

Identity refers to confirming what botanical material is actually present, while standardization addresses consistency in relevant constituents or preparations.

Depending on the botanical, identity can include species, plant part, variety, and other characteristics. Standardization may involve a marker compound, defined extract, or another specification associated with the preparation used in research.

2. Why does the episode focus on patience?

Because botanical research generally evaluates outcomes over a defined period rather than after only a few doses.

Dr. Viegas argues that stopping a botanical substantially earlier than the period evaluated in research can make it difficult to determine whether the preparation received a meaningful trial. The appropriate evaluation period varies by ingredient and clinical context.

3. What does the episode say about black cohosh?

Black cohosh is presented as a botanical for which product identity and extract characteristics can affect how research is interpreted.

The discussion focuses on Actaea racemosa, particularly root and rhizome preparations, and distinguishes studied standardized extracts from unspecified black cohosh products. (Castelo-Branco 2021) (NIDDK 2025)

4. Is Vitex primarily a menopause botanical?

The episode describes its strongest evidence base as being related to premenstrual and cyclical symptoms rather than classic menopause symptoms. (Csupor 2019)

Dr. Viegas discusses why Vitex may nevertheless appear in conversations about perimenopause and also notes that some research evaluates it as part of multi-ingredient botanical combinations.

5. What is different about rhapontic rhubarb?

The discussion centers on a specific studied extract rather than rhapontic rhubarb as a broad ingredient category.

Dr. Viegas identifies ERr 731 as the preparation featured in the research discussed during the episode. This serves as an example of why botanical extract identity can matter when translating research findings to commercial products. (Dubey 2024)

6. What quality considerations are discussed for maca?

The episode highlights botanical variety, processing, and the absence of a single universally dominant standardization marker. (Lee 2011)

Different maca varieties and processing approaches can make product-to-product comparisons more complicated than simply confirming that “maca” appears on the label.

7. Why might people respond differently to soy isoflavones?

Both formulation and individual biology may contribute to variation.

The episode discusses differences among isoflavones and describes the conversion of daidzein to equol by certain gut microorganisms as one potential source of individual variation. (Mayo 2019)

8. Does a botanical's presence on the label mean it matches the clinical research?

Not necessarily.

The episode emphasizes checking the species, plant part, preparation or extract, relevant standardization information, and other product specifications before assuming that findings from a particular study apply to another formulation.

Timestamps / key moments

00:00:00 Introducing menopause botanicals, identity, standardization, and patience

00:02:59 The three themes: identity, standardization, and patience

00:04:15 Black cohosh and its research history

00:07:41 Standardized black cohosh extracts and product testing

00:10:13 Vitex (chasteberry) and where it fits clinically

00:14:14 Introducing rhapontic rhubarb

00:16:28 Maca, menopause, libido, and mood

00:20:04 Soy isoflavones and the evidence discussion

00:21:15 Daidzein, equol, and individual response

00:22:54 Soy isoflavones and evaluation over time

00:25:08 Fullscript Academy and closing remarks

Want to learn more about supplement quality?

This episode highlights how botanical identity, standardization, formulation, and research design can affect the way practitioners interpret supplement evidence.

For additional practitioner education on supplement quality and clinical decision-making, visit Fullscript Academy.

The goal is not to reduce botanical selection to a single marker or label claim, but to help practitioners evaluate whether a product meaningfully corresponds to the ingredient and preparation described in the available evidence.

Disclaimer

The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations.

This episode is for informational and educational purposes only and is not medical advice. Botanical supplements may have contraindications, adverse effects, and medication interactions, and suitability can vary by patient. Patients should consult a qualified healthcare professional before making changes to their healthcare routine.

References

• Castelo-Branco, C., Gambacciani, M., Cano, A., Minkin, M. J., Rachoń, D., Ruan, X., Beer, A.-M., Schnitker, J., Henneicke-von Zepelin, H.-H., & Pickartz, S. (2021). Review & meta-analysis: Isopropanolic black cohosh extract iCR for menopausal symptoms – an update on the evidence. Climacteric, 24(2), 109–119.https://pubmed.ncbi.nlm.nih.gov/33021111/https://pubmed.ncbi.nlm.nih.gov/33021111/
• Csupor, D., Lantos, T., Hegyi, P., Benkő, R., Viola, R., Gyöngyi, Z., Csécsei, P., Tóth, B., Vasas, A., Márta, K., Rostás, I., Szentesi, A., & Matuz, M. (2019). Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complementary Therapies in Medicine, 47, 102190.https://pubmed.ncbi.nlm.nih.gov/31780016/https://pubmed.ncbi.nlm.nih.gov/31780016/
• Dubey, V. P., Sureja, V. P., & Kheni, D. B. (2024). Efficacy evaluation of standardized Rheum rhaponticum root extract (ERr 731) on symptoms of menopause: A systematic review and meta-analysis study. Journal of Biomedical Research, 38(3), 278–286.https://pubmed.ncbi.nlm.nih.gov/38646867/https://pubmed.ncbi.nlm.nih.gov/38646867/
• Lee, M. S., Shin, B.-C., Yang, E. J., Lim, H.-J., & Ernst, E. (2011). Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas, 70(3), 227–233.https://pubmed.ncbi.nlm.nih.gov/21840656/https://pubmed.ncbi.nlm.nih.gov/21840656/
• LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2025). Black cohosh. National Institute of Diabetes and Digestive and Kidney Diseases.https://www.ncbi.nlm.nih.gov/books/NBK547990/https://www.ncbi.nlm.nih.gov/books/NBK547990/
• Mayo, B., Vázquez, L., & Flórez, A. B. (2019). Equol: A bacterial metabolite from the daidzein isoflavone and its presumed beneficial health effects. Nutrients, 11(9), 2231.https://www.mdpi.com/2072-6643/11/9/2231https://www.mdpi.com/2072-6643/11/9/2231

You've been hearing new voices in the host chair lately — so this week we're pulling back the curtain to introduce them properly. Dr. Kate Kresge sits down with Dr. Holly Lucille, Dr. Lara Zakaria, and Dr. Jessica Christie for a roundtable on the winding, deeply personal paths that led each of them into root-cause medicine.

A pharmacist nearly buried under her own stack of nutrition books who came out dual-licensed. A psychology student who couldn't find a medical school that took food and sleep seriously, so she built her own path. A holistic nurse turned naturopathic doctor who fought for her profession on the statehouse floor. And a host whose decade-long "mystery illness" resolved in three days once the right test was finally run. What ties them together is a stubborn refusal to stop at the easy answer — the instinct to say, let's think this through, because so often the protocol failed the patient, not the other way around.

Consider this your proper introduction to the team learning and sharing what works, right alongside you.

What you'll hear

• Why every one of these clinicians came to functional medicine as a "detective" — and often as a patient first.
• Dr. Lara Zakaria's path from community pharmacist to dual-licensed nutritionist, and a clear-eyed explainer on what the CNS credential actually requires.
• Dr. Jessica Christie's move from developmental psychology into naturopathic medicine, becoming her own first patient, and finding her way into fertility and women's health.
• Dr. Holly Lucille's journey through holistic nursing and naturopathic medicine — and helping pass California's ND licensing bill (SB 907) in 2004.
• Dr. Kate Kresge's decade of misdiagnosed illness that resolved in days once the root cause was identified — and why it reshaped how she thinks about mental-health symptoms with a physiological root cause.
• How Rupa and Fullscript coming together puts labs, education, boot camps, webinars and AI-assisted evidence in one free place for clinicians.
• The team's reframe of "the patient failed treatment" into "the treatment failed the patient" — and what patient-centered care really means.

Key themes

• Let's think things through — clinical reasoning over the 15-minute prescribe-and-go visit.
• The empowered, informed patient is a good thing; clinicians add the nuance.
• Whole-person care means mind and body are never truly separate.
• Personalization: the protocol fits the patient, not the other way around.

Timestamps

• 02:21 — Welcoming the hosts
• 03:13 — Naming the listeners
• 05:35 — "Let's think things through"
• 06:40 — Nuance and the empowered patient
• 09:02 — Dr. Lara Zakaria's story
• 12:16 — Dr. Jessica Christie's story
• 16:00 — Rupa magazine + free education
• 17:03 — What a CNS is
• 20:10 — Dr. Holly Lucille's story
• 28:17 — Whiskey Flower + Wipeout
• 30:16 — Rupa + Fullscript coming together
• 32:20 — AI Assist for whole-person care
• 34:00 — Dr. Kate Kresge's story
• 44:11 — The protocol failed the patient
• 46:05 — What excites the team next
• 53:21 — Wrap-up + listener name reveal

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer: Views expressed are those of the hosts and guests and do not necessarily reflect Fullscript or affiliated organizations. For informational and educational purposes only; not medical advice.

Dr. Lara Zakaria is joined by Stephanie Venn-Watson, DVM, MPH, to explore emerging research on pentadecanoic acid (C15:0), an odd-chain saturated fatty acid initially studied through research involving bottlenose dolphins.

The conversation connects C15:0 with cell-membrane composition, lipid peroxidation, ferroptosis, iron metabolism, metabolic health, and steatotic liver disease. It also examines research on circulating C15:0 as a biomarker associated with cardiometabolic outcomes and early human trials of C15:0 supplementation. (Imamura 2018)https://pubmed.ncbi.nlm.nih.gov/33399331/(Sawh 2021)

C15:0 has been proposed as a candidate essential fatty acid, however, that classification and a specific human “C15:0 deficiency syndrome” remain emerging hypotheses rather than established clinical diagnoses.

Clinical Takeaways

• Ferroptosis is an iron-dependent form of regulated cell death. First characterized in 2012, ferroptosis involves iron-dependent lipid peroxidation and differs mechanistically from apoptosis and other forms of cell death. (Dixon 2012) Polyunsaturated fatty acids in phospholipids are particularly relevant substrates for ferroptotic lipid peroxidation. (Yang 2016)
• C15:0 is an odd-chain saturated fatty acid being studied for metabolic effects. Pentadecanoic acid, or C15:0, is found in dairy fat and smaller amounts in other foods. Higher circulating C15:0 has been associated with lower incidence of type 2 diabetes in prospective observational research, but these associations do not establish that C15:0 itself prevents diabetes. (Imamura 2018)
• Calling C15:0 an “essential fatty acid” remains an emerging scientific proposal. Experimental work has proposed C15:0 as a candidate essential fatty acid based on dietary exposure, biological activity, and associations between circulating levels and health outcomes. More research is needed before C15:0 can be treated as equivalent to the established essential fatty acids linoleic acid and alpha-linolenic acid. (Venn-Watson 2020)(Venn-Watson 2022)
• Metabolic hyperferritinemia is a recognized clinical framework, but it is not synonymous with ferroptosis or C15:0 deficiency. Metabolic hyperferritinemia describes elevated ferritin occurring with metabolic dysfunction. Ferritin is also an acute-phase reactant, so elevated values require evaluation in clinical context rather than being interpreted as tissue iron overload by themselves.https://www.nature.com/articles/s41574-023-00807-6(Valenti 2023)
• Human C15:0 supplementation evidence is early. Within this broader metabolic context, circulating C15:0 is an emerging biomarker of interest. In a small 12-week randomized, placebo-controlled trial in young adults with overweight or obesity, 200 mg/day oral C15:0 significantly increased circulating C15:0 concentrations. Exploratory analyses suggested that participants who achieved post-treatment circulating C15:0 concentrations above 5 µg/mL had greater reductions in ALT and AST and a greater increase in hemoglobin; these achieved-level findings were not definitive treatment effects and require replication in larger trials designed for liver and hematologic outcomes. (Robinson 2024)
• Diet and lifestyle remain the better-established foundation for metabolic and liver health. Dairy fat is the principal dietary source of C15:0, although circulating odd-chain fatty acids may also be influenced by endogenous production. (Weitkunat 2017) For people who avoid or tolerate little dairy, C15:0 supplementation is an emerging option that may be useful alongside high-fiber, Mediterranean-style minimally processed dietary patterns, regular exercise, metabolic-risk reduction, and appropriate evaluation and treatment of fatty liver disease or abnormal iron markers. (Chooi 2024)

Guest: Stephanie Venn-Watson, DVM, MPH

Stephanie Venn-Watson is a veterinary epidemiologist whose research has included comparative medicine and the health of bottlenose dolphins cared for through the U.S. Navy Marine Mammal Program.

Research involving dolphins identified similarities in metabolic and age-associated physiology that led investigators to study odd-chain saturated fatty acids, including C15:0 and C17:0. Her subsequent research has focused on the biological activity of C15:0 and the hypothesis that inadequate C15:0 may contribute to cellular vulnerability.

Some of this research is connected with patents and commercial C15:0 products, making independent replication and larger human clinical trials particularly important when interpreting the findings.

Clinician FAQ

1. What is C15:0?

C15:0, or pentadecanoic acid, is a 15-carbon odd-chain saturated fatty acid.

It occurs in foods including dairy fat and has historically been studied as a biomarker related to dairy-fat intake. (Imamura 2018) More recent research is examining whether C15:0 itself has biologically relevant metabolic effects. (Venn-Watson 2020)

2. Is C15:0 an essential fatty acid?

Not yet by established nutritional consensus.

C15:0 has been proposed as a candidate essential fatty acid, but this remains an emerging area of research. (Venn-Watson 2020)(Venn-Watson 2022) Linoleic acid and alpha-linolenic acid remain the conventionally recognized essential fatty acids in human nutrition.

3. What is ferroptosis?

Ferroptosis is a regulated, iron-dependent form of cell death characterized by damaging lipid peroxidation. (Dixon 2012)

The process involves interactions among cellular iron, oxidizable membrane phospholipids, and antioxidant defense systems. Ferroptosis is being investigated across metabolic, neurologic, cardiovascular, liver, and cancer biology.

4. Is high ferritin evidence that a patient is undergoing ferroptosis?

No.

Ferritin reflects iron storage but is also an acute-phase reactant. Elevated ferritin can occur with inflammation, liver disease, metabolic dysfunction, infection, malignancy, iron overload, and other conditions. (Valenti 2023) Ferroptosis cannot be diagnosed from serum ferritin alone.

5. What is metabolic hyperferritinemia?

Metabolic hyperferritinemia describes elevated serum ferritin occurring in the context of metabolic dysfunction.

A published consensus framework proposes ferritin above 300 ng/mL in men or 200 ng/mL in women together with specified metabolic criteria, while excluding or reassessing alternative explanations for hyperferritinemia. (Valenti 2023) The framework also distinguishes hyperferritinemia from confirmed tissue iron accumulation. (Liu 2024)

6. Does elevated ferritin mean a patient needs phlebotomy?

Not necessarily.

The metabolic hyperferritinemia consensus states that evidence supporting routine iron-depletion therapy is insufficient. (Valenti 2023) Phlebotomy should not be inferred from ferritin alone; evaluation of the cause of hyperferritinemia and, when appropriate, tissue iron burden is important.

7. What foods contain C15:0?

Dairy fat is one dietary source of C15:0, and C15:0 is also present in smaller amounts in some meats, fish, and other foods.

Circulating odd-chain fatty acids are not exclusively determined by dairy intake. Research also suggests that endogenous pathways involving gut-derived propionate can contribute to odd-chain fatty acid production. (Weitkunat 2017)

8. Does eating more full-fat dairy increase C15:0?

Dietary dairy fat can contribute to circulating C15:0, but the health implications of increasing full-fat dairy cannot be reduced to C15:0 alone.

Dairy foods contain multiple fatty acids, proteins, carbohydrates, minerals, and other components, and observational evidence differs by dairy-food type.https://pubmed.ncbi.nlm.nih.gov/30303968/(Imamura 2018)https://pubmed.ncbi.nlm.nih.gov/33399331/(Sawh 2021) Dietary recommendations should therefore consider the patient's overall diet and clinical context.

9. What has human supplementation research shown?

Human evidence remains limited.

One randomized trial studied 200 mg/day of C15:0 for 12 weeks in 30 young adults with overweight or obesity and found increased circulating C15:0. (Robinson 2024) A separate randomized trial evaluated 300 mg/day as an addition to an Asian-adapted Mediterranean-style diet in women with fatty liver and reported an additional reduction in LDL cholesterol and an increase in Bifidobacterium adolescentis abundance. (Chooi 2024)

Neither study establishes C15:0 supplementation as treatment for metabolic disease, ferroptosis, or metabolic hyperferritinemia.

10. Can C15:0 levels be used as a clinical treatment target?

A standardized clinical target has not been established.

Thresholds such as 5 μg/mL or 0.2% of total fatty acids have been proposed and explored in C15:0 research, but they should not currently be treated as universally validated diagnostic thresholds for deficiency or treatment targets. (Robinson 2024)https://www.mdpi.com/2218-1989/14/7/355(Venn-Watson 2024)

Timestamps / Key Moments

00:00:18 Introducing C15:0, cellular aging, and ferroptosis

00:02:19 Stephanie Venn-Watson’s background and dolphin research

00:05:29 How C15:0 emerged from metabolomics research

00:10:20 Alzheimer’s disease-like pathology in dolphins

00:11:33 What C15:0 is and how fatty acids are classified

00:18:18 C15:0, membrane stability, and lipid peroxidation

00:19:25 Understanding ferroptosis

00:24:34 Metabolic hyperferritinemia and clinical patterns

00:27:37 Proposed C15:0 thresholds and metabolic research

00:30:43 Dietary sources of C15:0

00:40:19 Measuring circulating C15:0

00:45:49 Human clinical research on C15:0

Fatty acids and biological processes discussed

• Pentadecanoic acid (C15:0)
• Heptadecanoic acid (C17:0)
• Odd-chain saturated fatty acids
• Saturated fatty acids
• Polyunsaturated fatty acids
• Linoleic acid
• Alpha-linolenic acid
• EPA
• DHA
• Cell-membrane lipids
• Lipid peroxidation
• Ferroptosis
• Reactive oxygen species
• Mitochondrial function
• Iron metabolism
• Ferritin

Clinical markers and conditions discussed

• Ferritin
• Transferrin saturation
• Hemoglobin
• Red blood cell distribution width (RDW)
• ALT
• AST
• GGT
• Lipid peroxidation
• LDL cholesterol
• Glucose
• Insulin
• Metabolic hyperferritinemia
• Insulin resistance
• Type 2 diabetes
• Metabolic syndrome
• MASLD
• MASH
• Iron overload
• Cognitive decline

Want to elevate your practice?

This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript helps practitioners bring supplement dispensing, lab ordering, patient education, and care planning into a centralized workflow.

The goal is not to replace clinical judgment, but to support thoughtful, individualized care and reduce unnecessary administrative steps.

For more practitioner education on supplement quality, metabolic health, and clinical decision-making, visit Fullscript Academy.

Disclaimer

The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for informational and educational purposes only and is not medical advice.

C15:0 research is evolving. C15:0 is not currently an established treatment for ferroptosis, metabolic hyperferritinemia, diabetes, MASLD, MASH, or neurodegenerative disease. Elevated ferritin has multiple potential causes and should be interpreted in clinical context. Patients should consult a qualified healthcare professional before changing their diet, supplements, iron intake, or treatment plan.

References

• Chooi, Y. C., Zhang, Q. A., Magkos, F., Ng, M., Michael, N., Wu, X., Brok Volchanskaya, V. S., Lai, X., Wanjaya, E. R., Elejalde, U., Goh, C. C., Yap, C. P. L., Wong, L. H., Lim, K. J., Velan, S. S., Yaligar, J., Muthiah, M. D., Chong, Y. S., Loo, E. X. L., … Eriksson, J. G. (2024). Effect of an Asian-adapted Mediterranean diet and pentadecanoic acid on fatty liver disease: The TANGO randomized controlled trial. American Journal of Clinical Nutrition, 119(3), 788–799.https://pubmed.ncbi.nlm.nih.gov/38035997/https://pubmed.ncbi.nlm.nih.gov/38035997/
• Dixon, S. J., Lemberg, K. M., Lamprecht, M. R., Skouta, R., Zaitsev, E. M., Gleason, C. E., Patel, D. N., Bauer, A. J., Cantley, A. M., Yang, W. S., Morrison, B., III, & Stockwell, B. R. (2012). Ferroptosis: An iron-dependent form of nonapoptotic cell death. Cell, 149(5), 1060–1072.https://pubmed.ncbi.nlm.nih.gov/22632970/https://pubmed.ncbi.nlm.nih.gov/22632970/
• Imamura, F., Fretts, A., Marklund, M., Ardisson Korat, A. V., Yang, W.-S., Lankinen, M., Qureshi, W., Helmer, C., Chen, T.-A., Wong, K., Bassett, J. K., Murphy, R., Tintle, N., Yu, C. I., Brouwer, I. A., Chien, K.-L., Frazier-Wood, A. C., del Gobbo, L. C., Djoussé, L., … Forouhi, N. G. (2018). Fatty acid biomarkers of dairy fat consumption and incidence of type 2 diabetes: A pooled analysis of prospective cohort studies. PLOS Medicine, 15(10), e1002670.https://pubmed.ncbi.nlm.nih.gov/30303968/https://pubmed.ncbi.nlm.nih.gov/30303968/
• Liu, W.-Y., Lian, L.-Y., Zhang, H., Chen, S.-D., Jin, X.-Z., Zhang, N., Ye, C.-H., Chen, W.-Y., Goh, G. B. B., Wang, F.-D., Miele, L., Corradini, E., Valenti, L., & Zheng, M.-H. (2024). A population-based and clinical cohort validation of the novel consensus definition of metabolic hyperferritinemia. Journal of Clinical Endocrinology & Metabolism, 109(6), 1540–1549.https://pubmed.ncbi.nlm.nih.gov/38124275/https://pubmed.ncbi.nlm.nih.gov/38124275/
• Robinson, M. K., Lee, E., Ugalde-Nicalo, P. A., Skonieczny, J. W., Chun, L. F., Newton, K. P., & Schwimmer, J. B. (2024). Pentadecanoic acid supplementation in young adults with overweight and obesity: A randomized controlled trial. Journal of Nutrition, 154(9), 2763–2771.https://pubmed.ncbi.nlm.nih.gov/39069269/https://pubmed.ncbi.nlm.nih.gov/39069269/
• Sawh, M. C., Wallace, M., Shapiro, E., Goyal, N. P., Newton, K. P., Yu, E. L., Bross, C., Durelle, J., Knott, C., Gangoiti, J. A., Barshop, B. A., Gengatharan, J. M., Meurs, N., Schlein, A., Middleton, M. S., Sirlin, C. B., Metallo, C. M., & Schwimmer, J. B. (2021). Dairy fat intake, plasma C15:0, and plasma iso-C17:0 are inversely associated with liver fat in children. Journal of Pediatric Gastroenterology and Nutrition, 72(4), e90–e96.https://pubmed.ncbi.nlm.nih.gov/33399331/https://pubmed.ncbi.nlm.nih.gov/33399331/
• Vacher, M. C., Durrant, C. S., Rose, J., Hall, A. J., Spires-Jones, T. L., Gunn-Moore, F., & Dagleish, M. P. (2023). Alzheimer's disease-like neuropathology in three species of oceanic dolphin. European Journal of Neuroscience, 57(7), 1161–1179.https://pubmed.ncbi.nlm.nih.gov/36514861/https://pubmed.ncbi.nlm.nih.gov/36514861/
• Valenti, L., Corradini, E., Adams, L. A., Aigner, E., Alqahtani, S., Arrese, M., Bardou-Jacquet, E., Bugianesi, E., Fernandez-Real, J.-M., Girelli, D., Hagström, H., Henninger, B., Kowdley, K., Ligabue, G., McClain, D., Lainé, F., Miyanishi, K., Muckenthaler, M. U., Pagani, A., … Zoller, H. (2023). Consensus statement on the definition and classification of metabolic hyperferritinaemia. Nature Reviews Endocrinology, 19(5), 299–310.https://pubmed.ncbi.nlm.nih.gov/36805052/https://pubmed.ncbi.nlm.nih.gov/36805052/
• Venn-Watson, S., Smith, C. R., Stevenson, S., Parry, C., Daniels, R., Jensen, E., Cendejas, V., Balmer, B., Janech, M., Neely, B. A., & Wells, R. (2013). Blood-based indicators of insulin resistance and metabolic syndrome in bottlenose dolphins (Tursiops truncatus). Frontiers in Endocrinology, 4, 136.https://pubmed.ncbi.nlm.nih.gov/24130551/https://pubmed.ncbi.nlm.nih.gov/24130551/
• Venn-Watson, S., Parry, C., Baird, M., Stevenson, S., Carlin, K., Daniels, R., Smith, C. R., Jones, R., Meegan, J., Simmons, J., Gomez, F., & Jensen, E. D. (2015). Increased dietary intake of saturated fatty acid heptadecanoic acid (C17:0) associated with decreasing ferritin and alleviated metabolic syndrome in dolphins. PLOS ONE, 10(7), e0132117.https://pubmed.ncbi.nlm.nih.gov/26200116/https://pubmed.ncbi.nlm.nih.gov/26200116/
• Venn-Watson, S., Lumpkin, R., & Dennis, E. A. (2020). Efficacy of dietary odd-chain saturated fatty acid pentadecanoic acid parallels broad associated health benefits in humans: Could it be essential? Scientific Reports, 10, 8161.https://pubmed.ncbi.nlm.nih.gov/32424181/https://pubmed.ncbi.nlm.nih.gov/32424181/
• Venn-Watson, S. K., & Butterworth, C. N. (2022). Broader and safer clinically-relevant activities of pentadecanoic acid compared to omega-3: Evaluation of an emerging essential fatty acid across twelve primary human cell-based disease systems. PLOS ONE, 17(5), e0268778.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268778https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268778
• Venn-Watson, S. (2024). The cellular stability hypothesis: Evidence of ferroptosis and accelerated aging-associated diseases as newly identified nutritional pentadecanoic acid (C15:0) deficiency syndrome. Metabolites, 14(7), 355.https://www.mdpi.com/2218-1989/14/7/355https://www.mdpi.com/2218-1989/14/7/355
• Weitkunat, K., Schumann, S., Nickel, D., Hornemann, S., Petzke, K. J., Schulze, M. B., Pfeiffer, A. F. H., & Klaus, S. (2017). Odd-chain fatty acids as a biomarker for dietary fiber intake: A novel pathway for endogenous production from propionate. American Journal of Clinical Nutrition, 105(6), 1544–1551.https://pubmed.ncbi.nlm.nih.gov/28424190/https://pubmed.ncbi.nlm.nih.gov/28424190/
• Yang, W. S., Kim, K. J., Gaschler, M. M., Patel, M., Shchepinov, M. S., & Stockwell, B. R. (2016). Peroxidation of polyunsaturated fatty acids by lipoxygenases drives ferroptosis. Proceedings of the National Academy of Sciences, 113(34), E4966–E4975.https://pubmed.ncbi.nlm.nih.gov/27506793/https://pubmed.ncbi.nlm.nih.gov/27506793/

Dr. Geeta Maker-Clark joins the Root Cause Medicine Podcast to discuss ideas from her book, Medicine for All People: Science and Ancient Wisdom for Revolutionary Healing. Drawing from family medicine, integrative medicine, culinary medicine, community health and her own upbringing, she explores a broader view of medicine that includes food, plants, nature, community, service, trust, dance, gratitude, and play.

The conversation centers on a simple idea: health is shaped not only by what happens in the clinic, but also by the environments, relationships, resources, cultural traditions, and daily practices that surround a person. Dr. Maker-Clark organizes these ideas into three areas—medicines of the earth, medicines of connection, and medicines of spirit—and discusses how practitioners can think about them alongside conventional medical care.

Clinical Takeaways

• Food and nutrition are part of whole-person care. Dr. Maker-Clark describes food as a central part of her clinical philosophy and discusses culinary medicine as a way to combine nutrition education with practical cooking skills. Her University of Chicago culinary medicine work includes medical students, community members, and middle school students, with an emphasis on nutrition literacy, accessibility, and culturally relevant food education. (Maker-Clark 2023)
• Nature exposure may support stress regulation and mental well-being. The episode frames time outdoors and connection with the natural environment as accessible ways to support well-being. Research has associated nature exposure with lower perceived and physiologic stress, although study designs, settings, and outcomes vary. (Shuda 2020)
• Social connection deserves attention in clinical assessment. Dr. Maker-Clark emphasizes community, belonging, and service as dimensions of health. Research supports associations between loneliness and social isolation and adverse cardiovascular, brain, mental health, and inflammatory outcomes, although mechanisms and the effectiveness of specific interventions continue to be studied. (Cené 2022) (Smith 2020)
• Trust includes both healthcare relationships and self-trust. The conversation explores how previous negative healthcare experiences, chronic illness, and unexplained symptoms can affect trust. Dr. Maker-Clark describes rebuilding trust through relationships and small, achievable commitments rather than treating trust as something patients should simply provide.
• Dance combines movement, cognition, emotion, and often social interaction. Dance is presented as an accessible form of joyful movement rather than a replacement for clinical care. Research suggests dance can influence cognitive and neuroplasticity-related outcomes, particularly in older adults, although effects vary by population and intervention. (Teixeira-Machado 2019) (Hewston 2021)
• Gratitude and play can be viewed as practices that support well-being. Gratitude interventions have shown generally modest benefits for well-being and some psychological outcomes. (Diniz 2023) (Kerry 2023) Adult play can take many forms, including creativity, competition, collecting, storytelling, exploration, and restorative activities. (Blanche 2024)

Guest: Geeta Maker-Clark, MD

Dr. Geeta Maker-Clark is a family and integrative medicine physician whose work spans patient care, nutrition education, culinary medicine, and community health. In the episode, she describes early clinical work in high-risk obstetrics and underserved communities as formative in expanding her understanding of health beyond the clinic.

She co-developed culinary medicine programming connected with the University of Chicago, including medical student education and community-based nutrition programs. Her book, Medicine for All People: Science and Ancient Wisdom for Revolutionary Healing, brings together themes of ancestral knowledge, scientific research, social justice, connection, and accessible approaches to well-being.

Clinician FAQ

1. What does Dr. Maker-Clark mean by “medicine for all people”?

She uses the phrase to describe a broader framework for health that includes conventional medicine alongside food, nature, relationships, community, cultural knowledge, and everyday practices. Accessibility and social justice are central themes in the framework.

2. What is culinary medicine?

Culinary medicine combines nutrition education with practical food preparation and cooking skills. In the program discussed in the episode, medical students learn nutrition counseling and cooking skills while community and middle school programs focus on nutrition literacy, food preparation, food justice, and culturally relevant education. (Maker-Clark 2023)

3. What does research say about nature exposure and stress?

Research generally supports an association between exposure to natural environments and improvements in some measures of perceived and physiological stress. Results vary across studies, and the effects depend on factors such as the population, type of nature exposure, comparison environment, and outcome measured. (Shuda 2020)

4. Why are loneliness and social connection clinically relevant?

Social isolation and loneliness have been associated with poorer cardiovascular and brain health and with some inflammatory markers. However, loneliness and objective social isolation are distinct concepts, and evidence does not establish that every health effect attributed to social disconnection operates through inflammation. (Cené 2022) (Smith 2020)

5. Can dance support brain health?

Dance combines physical movement with rhythm, learning, coordination, and sometimes social interaction. Systematic reviews have reported changes in cognitive and neuroplasticity-related outcomes, particularly among middle-aged and older adults. The magnitude of benefit and the cognitive domains affected vary across studies. (Teixeira-Machado 2019) (Hewston 2021) (Fong Yan 2024)

6. Does practicing gratitude improve mental health?

Gratitude interventions have been associated with small improvements in well-being and, in some studies, psychological symptoms. Results are heterogeneous, and gratitude should be viewed as a supportive practice rather than a substitute for appropriate mental healthcare. (Diniz 2023) (Kerry 2023)

Timestamps / Key Moments

00:01:41 Fullscript and whole-person care

00:02:39 Introducing Medicine for All People

00:03:09 How the book’s title and philosophy developed

00:06:07 Family medicine, obstetrics, and community health

00:07:18 How living conditions shaped Dr. Maker-Clark’s view of medicine

00:10:00 Food as a central part of whole-person care

00:11:02 Growing up with food and traditional practices

00:13:19 Bringing nutrition back into clinical practice

00:15:14 Culinary medicine and medical student education

00:16:03 Bringing food education into Chicago public schools

00:17:23 Plants, ancestral knowledge, and connection with the natural world

00:20:29 Developing relationships with plants in everyday environments

00:22:49 Plants and the history of medicines

00:24:52 Nature, stress regulation, and belonging

00:27:19 Access to nature as a health-equity issue

00:31:26 Community as a medicine of connection

00:35:16 Service, or seva, and connection with others

00:41:31 Trust in healthcare relationships

00:45:22 Rebuilding trust in the body during chronic illness

00:46:39 Small practices for rebuilding self-trust

00:49:21 Why dance, gratitude, and play are “medicines of spirit”

00:50:36 Dance, movement, and neuroplasticity

00:53:28 Dance as culture, ancestry, and expression

00:54:27 Gratitude without toxic positivity

00:58:22 Why adults still need play

01:00:44 Different adult play personalities

01:03:20 Play and social development

01:05:56 Where to find Dr. Maker-Clark and her book

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer

The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for informational and educational purposes only and is not medical advice. Practices discussed in the episode should not replace individualized medical assessment or treatment. Patients should consult a qualified healthcare professional before making changes to their healthcare routine.

References

• Maker-Clark G, McHugh A, Shireman H, et al. Empowering Future Physicians and Communities on Chicago’s South Side through a 3-Arm Culinary Medicine Program. Nutrients. 2023;15(19):4212.
• Shuda Q, Bougoulias ME, Kass R. Effect of nature exposure on perceived and physiologic stress: A systematic review. Complement Ther Med. 2020;53:102514.
• Smith KJ, Gavey S, Riddell NE, Kontari P, Victor C. The association between loneliness, social isolation and inflammation: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2020;112:519–541.
• Cené CW, Beckie TM, Sims M, et al. Effects of Objective and Perceived Social Isolation on Cardiovascular and Brain Health: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2022.
• Teixeira-Machado L, Arida RM, de Jesus Mari J. Dance for neuroplasticity: A descriptive systematic review. Neurosci Biobehav Rev. 2019;96:232–240.
• Hewston P, Kennedy CC, Borhan S, et al. Effects of dance on cognitive function in older adults: a systematic review and meta-analysis. Age Ageing. 2021;50(4):1084–1092.
• Fong Yan A, Nicholson LL, Ward RE, et al. The Effectiveness of Dance Interventions on Psychological and Cognitive Health Outcomes Compared with Other Forms of Physical Activity: A Systematic Review with Meta-analysis. Sports Med. 2024.
• Diniz G, Korkes L, Tristão LS, et al. The effects of gratitude interventions: a systematic review and meta-analysis. Einstein (São Paulo). 2023.
• Kerry N, Chhabra R, Clifton JDW. Being Thankful for What You Have: A Systematic Review of Evidence for the Effect of Gratitude on Life Satisfaction. Psychol Res Behav Manag. 2023;16:4799–4816.
• Blanche EI, Chang MC, Parham LD. Experiences of Adult Play. Am J Occup Ther. 2024;78(4).

Dr. Holly Lucille, ND, is joined by Ellie Abraham, PhD, to explain why two curcumin or Boswellia supplements may not be equivalent, even when the front of the label looks similar. The conversation covers boswellic acid standardization, AKBA, curcumin delivery systems, piperine, botanical sourcing, finished-product testing, certificates of analysis, and supply-chain controls. Research supports meaningful variation in Boswellia composition and curcumin formulations, making the specific extract and formulation relevant when interpreting product labels and published evidence.https://pubmed.ncbi.nlm.nih.gov/27054914/(Meins 2016)https://pubmed.ncbi.nlm.nih.gov/36015087/(Mimica 2022)

Clinical Takeaways

• “Boswellic acids” describes a group of compounds. Boswellia preparations can contain different proportions of individual boswellic acids, including AKBA, KBA, and alpha- and beta-boswellic acids. Products with similar total boswellic acid claims therefore may not have identical chemical profiles.https://pubmed.ncbi.nlm.nih.gov/27782055/(Mannino 2016)https://pubmed.ncbi.nlm.nih.gov/27054914/(Meins 2016)
• Curcumin formulation matters. Conventional oral curcumin has low bioavailability, and formulations including phytosomes, liposomes, micelles, and piperine combinations have been studied as strategies to alter absorption. However, different formulations should not automatically be treated as interchangeable because comparative pharmacokinetic results vary.https://pubmed.ncbi.nlm.nih.gov/37008131/(Hegde 2023)https://pubmed.ncbi.nlm.nih.gov/33877323/(Fança-Berthon 2021)
• Standardization provides more information than an ingredient name alone. Botanical composition can vary with species, growing conditions, extraction, processing, and other supply-chain factors. Standardization and appropriate quality controls can help establish more consistent composition.https://pubmed.ncbi.nlm.nih.gov/18258640/(Ribnicky 2008)https://pubmed.ncbi.nlm.nih.gov/32955961/(Sarma 2021)
• Potency is only one part of quality. Botanical quality also involves identity, purity, contaminants, adulteration, and finished-product verification. Published investigations have identified labeling and authenticity concerns in both Boswellia and turmeric/curcumin products.https://pubmed.ncbi.nlm.nih.gov/27054914/(Meins 2016)https://pubmed.ncbi.nlm.nih.gov/34507212/(You 2022)
• Quality does not equal clinical fit. A well-characterized supplement still needs to be considered in the context of the individual patient, including the formulation, dose, supporting evidence, medication use, and potential botanical-drug interactions.https://pubmed.ncbi.nlm.nih.gov/18258642/(van Breemen 2008)

Guest: Ellie Abraham, PhD

Ellie Abraham has a PhD in plant biology, with research focused on developing analytical methods for testing finished botanical products. Her background includes botanical chemistry, finished-product testing, standardization, and dietary supplement quality. In this episode, she explains how practitioners can look beyond an ingredient name to assess what a curcumin or Boswellia product is actually formulated to deliver.

These five questions best match the broad topics addressed in the episode, particularly searches around Boswellia standardization, AKBA, curcumin absorption, piperine, and supplement quality. Exact search volume is not publicly available from a standard web search. These topics are also represented in published research on botanical quality and curcumin formulation.

Clinician FAQ

1. Are all Boswellia supplements the same?

No. Boswellia products may differ in species, extract composition, total boswellic acid content, and concentrations of individual boswellic acids such as AKBA and KBA. A survey of commercial Boswellia supplements found substantial variation in composition and label compliance.https://pubmed.ncbi.nlm.nih.gov/27054914/(Meins 2016)

2. What does boswellic acid standardization mean?

It indicates that an extract is standardized to a stated amount of boswellic acids or, in some products, a particular constituent such as AKBA. Boswellia contains multiple boswellic acids, and their relative concentrations can vary by species and extract.https://pubmed.ncbi.nlm.nih.gov/27782055/(Mannino 2016)https://pubmed.ncbi.nlm.nih.gov/38701576/(Lauß 2024)

3. Why is AKBA listed separately on some Boswellia products?

AKBA, or 3-O-acetyl-11-keto-β-boswellic acid, is one individual boswellic acid that has received substantial pharmacologic research attention. Calling it out separately provides more specific compositional information than reporting total boswellic acids alone.https://pubmed.ncbi.nlm.nih.gov/27671822/(Ammon 2016)

4. Why do curcumin supplements use phytosomes, liposomes, or piperine?

Conventional oral curcumin has limited bioavailability. Phospholipid complexes, liposomal and micellar systems, and co-administration with piperine are among the approaches studied to alter its absorption and pharmacokinetics. Results vary by formulation, so an “enhanced absorption” format does not by itself establish that two products are equivalent.https://pubmed.ncbi.nlm.nih.gov/27930973/(Mirzaei 2017)https://pubmed.ncbi.nlm.nih.gov/36720711/(Heidari 2023)https://pubmed.ncbi.nlm.nih.gov/36015087/(Mimica 2022)

5. How can practitioners assess curcumin and Boswellia supplement quality?

Look beyond the ingredient name. Relevant product information may include botanical identity, extract and standardization details, branded ingredients tied to specific research, contaminant and adulteration testing, finished-product verification, and manufacturer transparency. Published studies have documented variability and authenticity concerns in commercial Boswellia and turmeric products.https://pubmed.ncbi.nlm.nih.gov/27054914/(Meins 2016)https://pubmed.ncbi.nlm.nih.gov/34507212/(You 2022)

Timestamps / Key Moments

00:00:36 Why familiar botanical names do not make products equivalent

00:01:27 Understanding Boswellia and boswellic acid standardization

00:02:05 Total boswellic acids and individual compounds

00:03:47 Why the boswellic acid profile matters

00:05:40 Matching botanical extracts to the supporting evidence

00:06:09 Curcumin delivery methods and formulation differences

00:07:12 Phospholipid-based curcumin formulations

00:08:29 How piperine is used with curcumin

00:10:43 Finished-product testing and label claims

00:13:43 Heavy metals and synthetic curcumin concerns

00:14:09 Understanding California Proposition 65

00:16:40 Curcuminoid complexes and certificates of analysis

00:18:18 How supply-chain controls affect botanical composition

00:20:07 Why standardization matters from batch to batch

00:21:05 What practitioners can look for when reviewing products

00:22:40 Fullscript's approach to supplier and product quality review

Botanicals and Compounds Discussed

• Boswellia
• Boswellia extracts
• Boswellic acids
• AKBA (3-O-acetyl-11-keto-β-boswellic acid)
• Beta-boswellic acid
• Turmeric
• Curcumin
• Curcuminoids
• Piperine
• Phospholipids

Quality Methods and Documents Discussed

• Botanical standardization
• Finished-product testing
• Ingredient identity verification
• Potency testing
• Heavy-metal testing
• Adulteration screening
• Synthetic curcumin testing
• Certificates of analysis
• Branded ingredient documentation
• Raw-material sourcing
• Supply-chain controls
• Extraction methods
• Stability data
• Batch-to-batch consistency
• Supplier and brand vetting

Want to elevate your practice?

This episode is sponsored byhttps://fullscript.com/Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one centralized system. For practitioners, Fullscript provides access to professional-grade supplements and practitioner education while incorporating quality review processes for brands and products offered through its catalog. The goal is not to replace clinical judgment, but to help practitioners make thoughtful, individualized decisions with clearer product and quality information.

For more practitioner education on supplement quality and clinical decision-making, visit Fullscript Academy athttps://academy.fullscript.com/https://academy.fullscript.com/.

Disclaimer

The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for informational and educational purposes only and is not medical advice. Dietary supplements may cause side effects or interact with medications. Patients should consult a qualified healthcare professional before changing their healthcare routine.

References

• Ammon, H. P. T. (2016). Boswellic acids and their role in chronic inflammatory diseases. Advances in Experimental Medicine and Biology, 928, 291–327.https://pubmed.ncbi.nlm.nih.gov/27671822/https://pubmed.ncbi.nlm.nih.gov/27671822/
• Fança-Berthon, P., et al. (2021). Pharmacokinetics of a single dose of turmeric curcuminoids depends on formulation: Results of a human crossover study. The Journal of Nutrition, 151(7), 1802–1816.https://pubmed.ncbi.nlm.nih.gov/34363434/https://pubmed.ncbi.nlm.nih.gov/34363434/
• Hegde, M., Girisa, S., BharathwajChetty, B., Vishwa, R., & Kunnumakkara, A. B. (2023). Curcumin formulations for better bioavailability: What we learned from clinical trials thus far? ACS Omega, 8(12), 10713–10746.https://pubmed.ncbi.nlm.nih.gov/37008131/https://pubmed.ncbi.nlm.nih.gov/37008131/
• Heidari, H., Bagherniya, M., Majeed, M., Sathyapalan, T., Jamialahmadi, T., & Sahebkar, A. (2023). Curcumin-piperine co-supplementation and human health: A comprehensive review of preclinical and clinical studies. Phytotherapy Research, 37(4), 1462–1487.https://pubmed.ncbi.nlm.nih.gov/36720711/https://pubmed.ncbi.nlm.nih.gov/36720711/
• Lauß, J., Kappacher, C., Isser, O., Huck, C. W., & Rainer, M. (2024). Species-specific quantification of bioactive boswellic acids in Boswellia resin using NIR spectroscopy, HPLC and multivariate data analysis. Spectrochimica Acta Part A: Molecular and Biomolecular Spectroscopy, 316, 124384.https://pubmed.ncbi.nlm.nih.gov/38701576/https://pubmed.ncbi.nlm.nih.gov/38701576/
• Mannino, G., Occhipinti, A., & Maffei, M. E. (2016). Quantitative determination of 3-O-acetyl-11-keto-β-boswellic acid (AKBA) and other boswellic acids in Boswellia sacra and Boswellia serrata. Molecules, 21(10), 1329.https://pubmed.ncbi.nlm.nih.gov/27782055/https://pubmed.ncbi.nlm.nih.gov/27782055/
• Meins, J., Artaria, C., Riva, A., Morazzoni, P., Schubert-Zsilavecz, M., & Abdel-Tawab, M. (2016). Survey on the quality of the top-selling European and American botanical dietary supplements containing boswellic acids. Planta Medica, 82(6), 573–579.https://pubmed.ncbi.nlm.nih.gov/27054914/https://pubmed.ncbi.nlm.nih.gov/27054914/
• Mimica, B., Bučević Popović, V., Banjari, I., Jeličić Kadić, A., & Puljak, L. (2022). Methods used for enhancing the bioavailability of oral curcumin in randomized controlled trials: A meta-research study. Pharmaceuticals, 15(8), 939.https://pubmed.ncbi.nlm.nih.gov/36015087/
• Mirzaei, H., Shakeri, A., Rashidi, B., Jalili, A., Banikazemi, Z., & Sahebkar, A. (2017). Phytosomal curcumin: A review of pharmacokinetic, experimental and clinical studies. Biomedicine & Pharmacotherapy, 85, 102–112.https://pubmed.ncbi.nlm.nih.gov/27930973/https://pubmed.ncbi.nlm.nih.gov/27930973/
• Ribnicky, D. M., et al. (2008). Evaluation of botanicals for improving human health. The American Journal of Clinical Nutrition, 87(2), 472S–475S.https://pubmed.ncbi.nlm.nih.gov/18258640/https://pubmed.ncbi.nlm.nih.gov/18258640/
• Sarma, N., Upton, R., Rose, U., Guo, D.-A., Marles, R., Khan, I., & Giancaspro, G. (2021). Pharmacopeial standards for the quality control of botanical dietary supplements in the United States. Journal of Dietary Supplements, 20(3), 485–504.https://pubmed.ncbi.nlm.nih.gov/34699287/https://pubmed.ncbi.nlm.nih.gov/34699287/
• van Breemen, R. B., Fong, H. H. S., & Farnsworth, N. R. (2008). Ensuring the safety of botanical dietary supplements. The American Journal of Clinical Nutrition, 87(2), 509S–513S.https://pubmed.ncbi.nlm.nih.gov/18258648/https://pubmed.ncbi.nlm.nih.gov/18258648/
• You, H., Gershon, H., Goren, F., Xue, F., Kantowski, T., & Monheit, L. (2022). Analytical strategies to determine the labelling accuracy and economically-motivated adulteration of “natural” dietary supplements in the marketplace: Turmeric case study. Food Chemistry, 370, 131007.https://pubmed.ncbi.nlm.nih.gov/34507212/https://pubmed.ncbi.nlm.nih.gov/34507212/

What if metabolism and immune function aren’t separate systems, but part of one continuous conversation?

In this episode of the Root Cause Medicine Podcast, Dr. Jeffrey Bland joins Kate Kresge to explore immunometabolism, the study of how immune activity and cellular metabolism influence one another. They discuss how inflammation can affect energy use across tissues, why metabolic health is about far more than weight, and how systems biology is changing the way clinicians think about chronic disease. (O'Neill 2016)

Dr. Bland also introduces emerging inflammatory indices—including the Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI)—that can be derived from components of a routine CBC with differential. (Islam 2024) The conversation explores their potential role as contextual markers of inflammatory activity, while emphasizing how Journeys can help to automate CBC calculations and help create customized reports for practitioners using blood labs values, history, symptoms and more.

The episode closes with a practical look at nutrition, polyphenol-rich foods, lifestyle medicine, large-scale health data, and the growing potential for personalized care.

Clinical Takeaways from This Episode

• Immunometabolism connects immune signaling with cellular energy use. Immune cells alter their metabolic activity when activated, and immune-derived signals can influence the function of tissues throughout the body. (O'Neill 2016)
• Chronic inflammation is a systems-level process. Rather than viewing inflammation as an isolated problem within one organ, immunometabolism highlights communication among adipose tissue, the liver, brain, muscles, immune cells, and other tissues. (Burak 2024) (Juárez-Rojas 2024)
• A CBC may contain more information than clinicians traditionally use. SII and SIRI combine routinely measured blood-cell populations into indices being studied as markers of systemic inflammatory and immune activity. (Islam 2024) They should be interpreted in clinical context rather than used independently to diagnose disease or dictate treatment. (Mangoni 2024)
• Lifestyle interventions affect multiple biological systems at once. Dr. Bland discusses dietary patterns rich in diverse plant compounds alongside movement, sleep, and stress management as components of a broader approach to metabolic and immune health. (Koelman 2022)
• Practitioners can order Dr. Jeff Bland’s Immunometabolic Journey on Fullscript.com

Guest Introduction

Dr. Jeffrey Bland is a longtime leader in functional and systems-based approaches to health and one of the influential voices behind the development of functional medicine. His work focuses on translating complex biology—including immunology, metabolism, nutrition, genetics, and systems medicine—into clinically meaningful ways of thinking about health. In this conversation, he brings that systems perspective to immunometabolismand explores how clinicians may begin connecting familiar laboratory data with a deeper understanding of immune and metabolic function.

FAQ

What is immunometabolism?

Immunometabolism examines the two-way relationship between immune function and metabolism. Immune cells require energy to perform their functions, and changes in their metabolic state can influence inflammatory signaling and communication with other tissues. (O'Neill 2016)

What are SII and SIRI?

SII and SIRI are calculated indices derived from blood-cell counts commonly included in a CBC with differential. They have been studied across several clinical populations as markers associated with systemic inflammatory and immune activity, but they are nonspecific and should be interpreted alongside the broader clinical picture. (Islam 2024)

Can SII or SIRI diagnose chronic inflammation?

No single index can establish the cause or clinical significance of inflammation on its own. These measures may provide additional context, but symptoms, medical history, other laboratory findings, medications, acute illness, and underlying conditions can all influence blood-cell counts. (Mangoni 2024)

Why does mitochondrial function come up in a discussion about immunity?

Immune activation changes cellular energy demands. Because mitochondria and other metabolic pathways help determine how cells generate and use energy, cellular metabolism is closely connected with immune-cell behavior. (O'Neill 2016)

How can practitioners order a CBC with SIRI and SII calculations included?

Ordering a CBC and other biomarkers included in the Immuno-Metabolic Journey from Dr. Jeff Bland allows for automatic calculation of SIRI and SII, as well as recommending next steps for clinicians depending on findings.

Timestamps

02:22 — What immunometabolism means

Why immune function and metabolism can no longer be viewed as separate biological systems.

06:15 — From “angry fat” to systems biology

How communication between immune cells and adipose tissue helped shape modern thinking about immunometabolism.

09:31 — Immunometabolism and root-cause thinking

Looking upstream from organ dysfunction toward the processes that may be influencing it.

17:23 — Metabolism is more than weight

Cellular energy production, mitochondria, inflammation, and why metabolic function affects the entire body.

22:01 — What a routine CBC may reveal

Moving beyond gross abnormalities to explore patterns within the CBC with differential.

23:20 — Introducing SII and SIRI

How researchers combine neutrophils, lymphocytes, platelets, and monocytes into inflammatory indices.

34:06 — Translating biomarkers into whole-person care

Nutrition, polyphenols, movement, sleep, and stress management enter the conversation.

39:27 — Why food complexity matters

Dr. Bland uses buckwheat to illustrate the diversity of plant polyphenols.

46:38 — Big data and personalized medicine

How large health datasets may help researchers identify more individualized biological patterns.

54:43 — Owning your health

Dr. Bland closes with a message about agency, personalization, and creating healthier patterns over time.

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer: The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.

Citations

• Burak, M. F., Stanley, T. L., Lawson, E. A., Campbell, S. L., Lynch, L., Hasty, A. H., Domingos, A. I., Dixit, V. D., Hotamışlıgil, G. S., Sheedy, F. J., Dixon, A. E., Brinkley, T. E., Hill, J. A., Donath, M. Y., & Grinspoon, S. K. (2024). Adiposity, immunity, and inflammation: Interrelationships in health and disease—A report from the 24th Annual Harvard Nutrition Obesity Symposium, June 2023. The American Journal of Clinical Nutrition, 120(1), 257–268. https://www.sciencedirect.com/science/article/abs/pii/S0002916524004556
• Islam, M. M., Osoydan Satici, M., & Eroglu, S. E. (2024). Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review. Turkish Journal of Emergency Medicine, 24(1), 8–19. https://pubmed.ncbi.nlm.nih.gov/38343523/
• Juárez-Rojas, J. G., Reyes-Barrera, J., & Medina-Urrutia, A. X. (2024). Adipose tissue immunometabolism: Unveiling the intersection of metabolic and immune regulation. Revista de Investigación Clínica, 76(2), 65–79. https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0034-83762024000200001
• Koelman, L., Egea Rodrigues, C., & Aleksandrova, K. (2022). Effects of dietary patterns on biomarkers of inflammation and immune responses: A systematic review and meta-analysis of randomized controlled trials. Advances in Nutrition, 13(1), 101–115. https://pmc.ncbi.nlm.nih.gov/articles/PMC8803482/
• Mangoni, A. A., & Zinellu, A. (2024). The diagnostic role of the systemic inflammation index in patients with immunological diseases: A systematic review and meta-analysis. Clinical and Experimental Medicine, 24(1), Article 27. https://link.springer.com/article/10.1007/s10238-024-01294-3
• O'Neill, L. A. J., Kishton, R. J., & Rathmell, J. (2016). A guide to immunometabolism for immunologists. Nature Reviews Immunology, 16(9), 553–565. https://pubmed.ncbi.nlm.nih.gov/27396447/
• Zeevi, D., Korem, T., Zmora, N., Israeli, D., Rothschild, D., Weinberger, A., Ben-Yacov, O., Lador, D., Avnit-Sagi, T., Lotan-Pompan, M., Suez, J., Mahdi, J. A., Matot, E., Malka, G., Kosower, N., Rein, M., Zilberman-Schapira, G., Dohnalová, L., Pevsner-Fischer, M., … Segal, E. (2015). Personalized nutrition by prediction of glycemic responses. Cell, 163(5), 1079–1094. https://www.cell.com/cell/fulltext/S0092-8674(15)01481-6

What happens when a patient with multiple autoimmune conditions has already addressed the obvious contributors—but continues to experience flares?

In this Root Cause Medicine Podcast case study, Dr. Kate Kreske sits down with clinical nutritionist and IFM-certified practitioner Robyn Puglia to explore a complex case involving polyautoimmunity and persistent immune dysregulation. The patient had already worked with multiple practitioners and undergone extensive evaluation, including assessments related to gut health, food reactivity, mold, and stress. Yet something was still being missed.

Robyn explains how additional testing shifted her attention away from the gut and toward an unexpected area: the respiratory tract. She walks through how those findings changed her clinical thinking, why complex cases sometimes require practitioners to reconsider their assumptions, and what happened when the care plan was adjusted based on this new information.

The conversation offers an important reminder for practitioners: deeper testing can sometimes provide useful clues, but results need to be interpreted within the broader clinical picture rather than treated as a diagnosis on their own.

Key Takeaways

• How Robyn approaches highly complex patients who have already addressed many common contributors
• Why gut health should not automatically be assumed to be the primary driver of every autoimmune presentation
• How testing identified a respiratory microbial pattern that had not been clinically obvious
• Why laboratory findings are most useful when interpreted alongside symptoms, history, prior testing, and the overall clinical picture
• How unexpected findings can change clinical decision-making in complex cases
• Why an individual case can illustrate clinical reasoning without establishing that the same testing or intervention will produce similar outcomes in other patients

Episode Highlights

When the obvious answers have already been explored

Robyn describes her practice as serving patients at the “zebra” or even “unicorn” stage—people who have often seen multiple experienced practitioners and already addressed common areas such as nutrition, metabolic health, circadian rhythms, stress, and gut health.

Looking beyond the gut in autoimmunity

The featured patient had four autoimmune conditions and continued experiencing immune dysregulation and flares despite significant previous investigation and improvement. Rather than assuming the gastrointestinal tract remained the primary contributor, Robyn expanded the investigation.

An unexpected respiratory finding

Testing suggested a respiratory tract microbial pattern despite the absence of obvious respiratory symptoms. This finding shifted Robyn's clinical hypothesis and became an important part of how she approached the case.

Practitioner Takeaway

When a complex patient has already addressed the most plausible contributors but continues to experience symptoms, repeating the same investigation may not provide the missing answer. Consider stepping back and asking whether another system, exposure, infection, or contributor deserves evaluation.

At the same time, avoid allowing a single specialized test result to become the new explanation for the entire case. Use testing to inform clinical reasoning alongside the patient's history, symptoms, conventional evaluation, and other relevant findings.

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer

The views expressed on this podcast are those of the hosts and the guests, and they don't necessarily reflect the views of FullScript or any affiliated organizations. This podcast is for informational and educational purposes only, and it's not intended to be medical advice. For your safety, always check with your healthcare provider before making any changes to your healthcare routine.

What if some of the immune activity we’re looking for isn’t showing up where we expect to find it?

In this episode, I sit down with Robyn Puglia of Cyrex Laboratories to explore TG6, lymphocyte patterns, and early autoimmunity—and specialized testing many practitioners may not realize is available through Cyrex Wheat Burden panel, the Lymphocyte Map, and Array 5.

We look at neurological manifestations of gluten-related disease, what different immune cell populations may add to the clinical picture, and how autoantibodies can sometimes appear before autoimmune disease is diagnosed.

The bigger question: Can seeing more of the immune story help us ask better questions about what may be driving a complex presentation?

What You’ll Learn

• Why gluten reactivity isn’t always a gut story. TG6 has been studied in gluten-related neurological disorders, particularly gluten ataxia. (Hadjivassiliou 2019) We discuss why neurological symptoms may belong in the gluten conversation and what Cyrex Wheat Burden Panel is designed to investigate beyond conventional celiac markers. (Mearns 2019)
• What your lymphocyte count may not tell you. T cells, B cells, natural killer cells, and their subsets have different jobs. Robyn explains how the Cyrex Lymphocyte Map looks at these populations and how patterns may help practitioners decide what to investigate next.
• Why autoimmunity may start before the diagnosis. Disease-associated autoantibodies can precede clinical disease in several autoimmune conditions. (Ma 2017) We explore Cyrex Array 5, tissue-associated autoantibodies, and what these earlier immune signals may—and may not—tell us. (Frazzei 2022)

Meet Robyn Puglia

Robyn Puglia’s work with celiac disease, neurological symptoms, autoimmunity, and complex chronic illness pushed her to ask what the immune system might be telling us beyond a routine workup. Today, as Vice President of Practitioner Education at Cyrex Laboratories, she teaches practitioners how to think about specialized immune testing without treating an abnormal biomarker as a diagnosis.

FAQ

What is TG6, and why does it matter?

Most practitioners know tissue transglutaminase 2 (TG2) from celiac testing. Tissue transglutaminase 6 (TG6) has been studied in gluten-related neurological disorders, particularly gluten ataxia. (Hadjivassiliou 2019)

TG6 isn’t part of routine guideline-supported celiac screening, but it highlights an important point: gluten-related immune disease can have extraintestinal manifestations, including neurological symptoms. (Mearns 2019) (Rubio-Tapia 2023)

What is Cyrex Wheat Burden Panel?

The Wheat Burden panel evaluates antibody reactivity to multiple wheat-associated antigens and transglutaminases, including TG6.

It provides a broader look at wheat-associated immune reactivity than conventional celiac serology. It shouldn’t replace established evaluation for celiac disease or wheat allergy; the value of additional biomarkers depends on the clinical question and the evidence supporting their intended use. (Rubio-Tapia 2023) (Leonard 2017)

What can the Lymphocyte Map show?

The Cyrex Lymphocyte Map examines populations and subsets of T cells, B cells, and natural killer cells.

Instead of asking whether one value is simply high or low, Robyn looks at the pattern and asks what might explain it. Infection? Medication effects? Immune dysfunction? Another clinical process?

The pattern isn’t the diagnosis. It helps sharpen the investigation.

Can autoimmunity start before the diagnosis?

Yes. In several autoimmune diseases, researchers have detected disease-associated autoantibodies before patients meet formal diagnostic criteria—sometimes years earlier. (Ma 2017)

Cyrex Array 5 evaluates multiple tissue-associated autoantibodies that Robyn discusses in this context. But an autoantibody isn’t a crystal ball. Its significance depends on the specific marker, the patient, and the evidence supporting its clinical use. (Ma 2017)

Does Cyrex offer all of these tests?

Yes. Cyrex offers the specialized tests discussed in this episode, including Wheat Burden Panel, the Lymphocyte Map, and Array 5, along with additional testing related to mucosal immunity and barrier function.

The important question isn’t, “How much can I test?”

It’s “What am I trying to understand, and will this result change what I do next?”

Timestamps

02:42 — The patients who pulled Robyn deeper into immunology

How celiac disease and unexplained illness changed her approach to complex patients.

11:41 — TG6: When gluten becomes a brain conversation

Why gluten-related immune activity isn’t necessarily confined to the gut.

13:49 — Are we asking enough questions about wheat?

The thinking behind Cyrex Wheat Burden Panel and its broader look at wheat-associated antigens and transglutaminases.

28:29 — What if autoimmunity starts before the diagnosis?

Tissue-associated autoantibodies, Array 5, and preclinical autoimmunity.

33:49 — Your lymphocyte count isn’t the whole story

T cells, B cells, natural killer cells, and the Cyrex Lymphocyte Map.

39:25 — The abnormal result is where the investigation starts

How immune patterns can generate better clinical questions.

44:20 — Stop looking for one perfect root cause

Robyn’s “aggregate gains” approach to complex illness.

50:49 — What else can we see in the immune system?

Tissue autoantibodies, mucosal immunity, and barrier biomarkers.

57:42 — When neurological symptoms change the workup

Why brain symptoms may require a broader metabolic, vascular, and immune picture.

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer

The views expressed on this podcast are those of the hosts and the guests, and they don't necessarily reflect the views of FullScript or any affiliated organizations. This podcast is for informational and educational purposes only, and it's not intended to be medical advice. For your safety, always check with your healthcare provider before making any changes to your healthcare routine.

Citations

• Frazzei, G., van Vollenhoven, R. F., de Jong, B. A., Siegelaar, S. E., & van Schaardenburg, D. (2022). Preclinical autoimmune disease: A comparison of rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis and type 1 diabetes. Frontiers in Immunology, 13, 899372. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9281565/
• Hadjivassiliou, M., Croall, I. D., Zis, P., Sarrigiannis, P. G., Sanders, D. S., Aeschlimann, P., Grünewald, R. A., Armitage, P. A., Connolly, D., Aeschlimann, D., & Hoggard, N. (2019). Neurologic deficits in patients with newly diagnosed celiac disease are frequent and linked with autoimmunity to transglutaminase 6. Clinical Gastroenterology and Hepatology, 17(13), 2678–2686. https://www.cghjournal.org/article/S1542-3565(19)30278-2/fulltext
• Leonard, M. M., Sapone, A., Catassi, C., & Fasano, A. (2017). Celiac disease and nonceliac gluten sensitivity: A review. JAMA, 318(7), 647–656. https://jamanetwork.com/journals/jama/article-abstract/2648637
• Ma, W. T., Chang, C., Gershwin, M. E., & Lian, Z. X. (2017). Development of autoantibodies precedes clinical manifestations of autoimmune diseases: A comprehensive review. Journal of Autoimmunity, 83, 95–112. https://www.sciencedirect.com/science/article/abs/pii/S0896841117303542
• Mearns, E. S., Taylor, A., Thomas Craig, K. J., Puglielli, S., Cichewicz, A. B., Leffler, D. A., Sanders, D. S., Lebwohl, B., & Hadjivassiliou, M. (2019). Neurological manifestations of neuropathy and ataxia in celiac disease: A systematic review. Nutrients, 11(2), 380. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412791/
• Rubio-Tapia, A., Hill, I. D., Semrad, C., Kelly, C. P., Greer, K. B., Limketkai, B. N., & Lebwohl, B. (2023). American College of Gastroenterology guidelines update: Diagnosis and management of celiac disease. The American Journal of Gastroenterology, 118(1), 59–76. https://pubmed.ncbi.nlm.nih.gov/36602836/

What does it take to help young athletes perform at their best—not just today, but for decades to come?

In this episode of Root Cause Medicine, Dr. Kate Kresge sits down with emergency medicine physician and functional medicine practitioner Dr. Erik Peterson to discuss a whole-person approach to adolescent athletic performance. Drawing from more than 20 years in emergency medicine, his background as a collegiate athlete, and his work caring for young competitors, Dr. Peterson explains why optimizing performance starts with supporting the developing body rather than simply pushing it harder.

The conversation explores how nutrition, sleep, recovery, body composition, metabolic health, and resilience influence athletic success during adolescence. Dr. Peterson also shares why he believes healthcare providers, coaches, and parents have an opportunity to improve long-term health by focusing on foundational physiology during these critical developmental years. Beyond sports performance, this episode is also a conversation about the evolution of medicine—from treating illness in the emergency department to helping people stay healthy through proactive, root-cause care.

Listen If You...

• Treat adolescent athletes in your practice
• Coach youth sports
• Parent a competitive athlete
• Work in sports medicine, functional medicine, pediatrics, or primary care
• Want to better understand the foundations of long-term athletic performance

What You'll Learn

• How Dr. Peterson gets his athletes results using only food, supplements and lifestyle
• Common mistakes young athletes make when trying to optimize performance
• Why body composition and metabolic health matter more than weight alone
• The important role parents and coaches play in creating healthy performance habits
• Dr. Peterson's journey from emergency medicine physician to functional medicine practitioner

Who Is Dr. Erik Peterson?

Dr. Erik Peterson is a board-certified emergency medicine physician who has practiced emergency medicine for more than two decades while also leading a precision medicine practice focused on performance optimization, men's health, women's health, and preventive care. A former collegiate athlete, he combines his experience in acute care with evidence-informed lifestyle medicine to help athletes and active individuals optimize health, resilience, and long-term performance. Learn more about his program at https://firstcallperformance.com/

Key Takeaways

• Performance is Built Outside the Gym: Training is only one part of athletic success. Nutrition, sleep, recovery, stress management, and overall metabolic health create the foundation that allows athletes to adapt and perform. (Mountjoy 2023) (Cunha 2023)
• Adolescence Is a Critical Opportunity: The teenage years represent an important period for developing healthy habits that influence performance, injury risk, and long-term health. (Blyth 2025)
• Parents and Coaches Matter: The adults surrounding young athletes often shape their relationship with food, training, recovery, and health. Creating supportive environments can have lasting effects beyond sports. (Baceviciene 2023)
• Functional Medicine Complements Performance Care: Looking upstream at nutrition, biomarkers, lifestyle, and physiology may help identify opportunities to support athletic performance while promoting long-term wellness. (Haller 2023)

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer: The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.

Sources:

• Baceviciene, M., Jankauskiene, R., & Rutkauskaite, R. (2023). The comparison of disordered eating, body image, sociocultural and coach-related pressures in athletes across age groups and groups of different weight sensitivity in sports. Nutrients, 15(12), 2724.https://www.mdpi.com/2072-6643/15/12/2724https://www.mdpi.com/2072-6643/15/12/2724
• Blyth, F., Haycraft, E., Peral-Suarez, A., & Pearson, N. (2025). Tracking and changes in the clustering of physical activity, sedentary behavior, diet, and sleep across childhood and adolescence: A systematic review. Obesity Reviews, 26(6), e13909.https://onlinelibrary.wiley.com/doi/10.1111/obr.13909https://onlinelibrary.wiley.com/doi/10.1111/obr.13909
• Cunha, L. A., Costa, J. A., Marques, E. A., Brito, J., Lastella, M., & Figueiredo, P. (2023). The impact of sleep interventions on athletic performance: A systematic review. Sports Medicine – Open, 9(1), 58.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10354314/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10354314/
• Haller, N., Behringer, M., Reichel, T., Wahl, P., Simon, P., Krüger, K., Zimmer, P., & Stöggl, T. (2023). Blood-based biomarkers for managing workload in athletes: Considerations and recommendations for evidence-based use of established biomarkers. Sports Medicine, 53(7), 1315–1333.https://pubmed.ncbi.nlm.nih.gov/37204619/https://pubmed.ncbi.nlm.nih.gov/37204619/
• Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., Sundgot-Borgen, J. K., Torstveit, M. K., Jacobsen, A. U., Verhagen, E., Budgett, R., Engebretsen, L., & Erdener, U. (2023). 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine, 57(17), 1073–1097.https://pubmed.ncbi.nlm.nih.gov/37752011/https://pubmed.ncbi.nlm.nih.gov/37752011/

How to Build a Thriving Practice Without Burning Out

One of my favorite parts of hosting the Root Cause Medicine Podcast is introducing you to practitioners who are making a real difference—not only in the lives of their patients, but in the lives of other clinicians.

Today's guest is Lesli Bitel, a registered dietitian whose career has taken a path that many practitioners may recognize pieces of. She began in clinical practice, spent years in leadership roles across the pharmaceutical and diagnostics industries, and eventually found her way back to patient care with an entirely new perspective. Today, she helps practitioners build businesses that allow them to do their best work without burning themselves out along the way.

Because the reality is, most of us were trained to care for patients. Very few of us were taught how to build a practice that can sustainably support both our patients and ourselves.

In this conversation, Lesli shares how her experience in business transformed the way she thought about practice ownership. We talk about why marketing doesn't have to feel uncomfortable, how thoughtful systems can create more time for patient care, and why building a successful practice isn't about doing more—it's about building one that's aligned with your values.

Whether you're just starting your practice or looking for a more sustainable way to grow, I think you'll come away from this conversation with practical ideas—and maybe a little reassurance—that it's possible to build a thriving practice without losing sight of why you became a clinician in the first place.

In This Conversation

• Lesli's journey from aspiring clinician to healthcare executive and back to patient care
• What years in corporate healthcare taught her about running a successful practice
• Why so many practitioners feel confident clinically but overwhelmed by the business side of medicine
• How marketing can become an authentic extension of patient education
• Simple systems that create more time, less stress, and better patient experiences
• The connection between practice design, boundaries, and practitioner well-being
• Building a practice that reflects your strengths, values, and vision for your career

A Few Takeaways I'll Be Thinking About

• Authentic marketing starts with clarity, not self-promotion.
• Good systems free you to spend more time doing what only you can do.
• Sustainable growth should support your life, not just your business.

Who Should Listen?

This episode is for any clinician who has ever wondered:

• How do I build a practice that actually feels sustainable?
• How can I grow without sacrificing patient care?
• Is there a way to market my practice that still feels authentic?
• What does long-term success really look like?

Whether you're starting your first practice or reimagining an established one, I think you'll find something valuable in Lesli's story.

Episode Timeline

00:00 — Welcome and introduction

02:30 — Lesli's journey into healthcare

05:00 — Lessons from corporate healthcare

10:00 — Why clinicians struggle with practice ownership

18:00 — Rethinking marketing

28:00 — Systems that support sustainable growth

39:00 — Burnout, boundaries, and practice design

48:00 — Building a practice around your values

55:00 — Final reflections

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer: The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.

Dr. Holly Lucille is joined by Ellie Abraham, PhD, to explain why two ashwagandha supplements may not be the same, even when they list the same ingredient. (Thalhamer 2024) This conversation covers differences between root and leaf extracts, withanolide standardization, botanical identity testing, certificates of analysis, and manufacturing quality. It also emphasizes that a well-made product may still not be appropriate for every patient. (NCCIH 2025)

Clinical Takeaways

• Plant part matters. Ashwagandha root, leaf, and combined extracts may have different chemical profiles and should not automatically be treated as interchangeable. (Chaurasiya 2008)
• Higher is not always better. The most concentrated product is not necessarily the safest or most effective. Clinical relevance depends on the extract, dose, intended use, and supporting research. (Thalhamer 2024) (NCCIH 2025)
• Quality testing matters. Botanical authentication, contaminant testing, certificates of analysis, and cGMP compliance can help confirm that a product meets its specifications. (ECFR 2026)
• Quality does not equal clinical fit. Patient history, medications, allergies, diagnoses, and potential interactions must still be considered. (NCCIH 2025)

Guest: Ellie Abraham has a PhD in plant biology and a background in analytical chemistry, ethnobotany, botanical testing, and dietary supplement quality control. She explains how manufacturers and laboratories verify botanical identity, plant part, standardization, contaminants, and product documentation.

Clinician FAQ

1. Are all ashwagandha supplements the same? No. Products may differ in plant part, extraction method, dose, standardization, chemical profile, and manufacturing quality. (Thalhamer 2024)

2. Why does ashwagandha root versus leaf matter? The root and leaf of ashwagandha contain different combinations of plant compounds. These differences may affect the product’s clinical properties, supporting research, and safety profile. (Chaurasiya 2008)

3. What does “standardized to 5% withanolides” mean? It means withanolides account for approximately 5% of the tested material. It does not identify each individual withanolide or describe the rest of the extract. (Thalhamer 2024)

4. Is a higher withanolide percentage better? Not necessarily. A higher percentage does not automatically mean that a product is safer or more effective. The appropriate concentration depends on the extract, dose, intended use, and supporting research. (Thalhamer 2024)

5. Can ashwagandha cause liver injury? Rare cases of liver injury associated with ashwagandha products have been reported. The exact cause and individual risk factors remain uncertain, but practitioners should consider supplement use when evaluating unexplained liver symptoms or abnormal liver tests. (NCBI 2012) (Philips 2023) (Björnsson 2020)

Timestamps / Key Moments

00:01:43 Ellie Abraham’s background in botanical testing

00:02:36 The ashwagandha leaf discussion in India

00:04:00 Differences between root and leaf

00:05:44 How botanical identity is verified

00:07:25 Why standardization matters

00:09:07 Why higher withanolides are not always better

00:10:56 Comparing two ashwagandha products

00:12:17 Red flags on supplement labels

00:14:42 When to request a certificate of analysis

00:16:27 Why cGMP compliance matters

Botanicals and Compounds Discussed

• Ashwagandha root and leaf
• Withanolides
• Glycosides
• Withanone
• Curcumin and curcuminoids

Quality Methods and Documents Discussed

• Botanical identity testing
• Plant-part verification
• HPTLC chemical fingerprinting
• Standardization testing
• Adulterant screening
• Microbial and heavy-metal testing
• Certificates of analysis
• Third-party testing
• cGMP compliance
• Batch-to-batch consistency
• Branded ingredient research

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer

The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for educational purposes only and is not medical advice. Dietary supplements may cause side effects or interact with medications. Patients should consult a qualified healthcare professional before changing their healthcare routine.

References

• Björnsson, H. K., Björnsson, E. S., Avula, B., Khan, I. A., Jonasson, J. G., Ghabril, M., Hayashi, P. H., & Navarro, V. (2020). Liver injury due to ashwagandha: A case series from Iceland and the U.S. Drug-Induced Liver Injury Network. Liver International, 40(4), 825–829. https://pubmed.ncbi.nlm.nih.gov/31991029/
• Chaurasiya, N. D., Uniyal, G. C., Lal, P., Misra, L., Sangwan, N. S., Tuli, R., & Sangwan, R. S. (2008). Analysis of withanolides in root and leaf of Withania somnifera by HPLC with photodiode array and evaporative light scattering detection. Phytochemical Analysis, 19(2), 148–154. https://pubmed.ncbi.nlm.nih.gov/17879227/
• ECFR. (2026). Current good manufacturing practice in manufacturing, packaging, labeling, or holding operations for dietary supplements (21 C.F.R. Part 111). https://www.ecfr.gov/current/title-21/chapter-I/subchapter-B/part-111
• National Center for Complementary and Integrative Health (NCCIH). (2025). Ashwagandha. National Institutes of Health, U.S. Department of Health and Human Services. https://www.nccih.nih.gov/health/ashwagandha
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2024). Ashwagandha. In LiverTox: Clinical and research information on drug-induced liver injury. https://www.ncbi.nlm.nih.gov/books/NBK548536/
• NCBI. (2012). Ashwagandha [Review of Ashwagandha]. PubMed; National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/NBK548536/
• Philips, C. A., Valsan, A., Theruvath, A. H., Ravindran, R., Oommen, T. T., Rajesh, S., Bishnu, S., & Augustine, P. (2023). Ashwagandha-induced liver injury: A case series from India and literature review. Hepatology Communications, 7(10), e0270. https://pubmed.ncbi.nlm.nih.gov/37756041/
• Thalhamer, B., Himmelsbach, M., Schatzmann, B., Klampfl, C., & Buchberger, W. (2024). A feasible procedure to detect widespread wrong labeling of ashwagandha root extracts in dietary supplements. Exploration of Foods and Foodomics, 2, 460–470. https://www.explorationpub.com/Journals/eff/Article/101046

Summary

This episode explores the role of immune-mediated testing in the evaluation of complex, chronic symptoms that may not respond to conventional approaches. Dr. Jessica Christie is joined by Veronica Kent, CEO of Alletess Medical Laboratory, and Kristen Trainer, Registered Dietitian and Clinical Educator, to discuss food allergies, food sensitivities, mold exposure, Candida, Alpha-gal syndrome, elimination diets, and the evolving landscape of laboratory testing.

The conversation examines the differences between IgE-mediated food allergies and IgG food sensitivity testing, when clinicians may consider specialized laboratory assessments, and the importance of combining laboratory data with a comprehensive patient history and individualized care plans. The guests also discuss laboratory quality standards, patient education, and why test interpretation should be viewed as one component of clinical decision-making rather than a standalone diagnostic tool. (Santos 2023)

Clinical Takeaways from This Episode

• Not all adverse food reactions are food allergies. The episode distinguishes between IgE-mediated food allergies and other forms of food-related symptoms, including food sensitivities, while acknowledging that diagnostic approaches differ depending on the clinical presentation. (Sicherer 2018)
• Patient history remains foundational. Laboratory testing should be interpreted alongside symptoms, clinical history, dietary patterns, and physical examination rather than in isolation. (Santos 2023)
• Elimination diets require structured implementation. The guests discuss elimination and systematic food reintroduction as part of evaluating whether certain foods may contribute to symptoms, emphasizing individualized guidance and monitoring. (Santos 2023)
• Alpha-gal syndrome is an emerging clinical consideration. Tick-associated mammalian meat allergy is becoming increasingly recognized and may present with delayed allergic reactions that can be difficult to identify. (Platts-Mills 2025) (Thompson 2023)
• Environmental exposures may contribute to symptom burden. Mold exposure is discussed as one possible consideration in select patients presenting with persistent respiratory or inflammatory symptoms, although appropriate testing strategies remain an area of ongoing research and debate. (Cai 2024)
• Patient education is essential. Laboratory testing alone does not improve outcomes; patients benefit from clear interpretation, education, and individualized follow-up plans. (Santos 2025)
• Quality systems matter in laboratory medicine. The discussion highlights the importance of standardized laboratory procedures, quality assurance, and timely reporting in supporting clinical decision-making. (Pillai 2025)
•

Guest Introduction

Veronica Kent

Veronica Kent is the Chief Executive Officer and owner of Alletess Medical Laboratory. She has spent decades working in specialty laboratory medicine and oversees operations focused on allergy, immunology, and immune-based laboratory testing. During the episode, she discusses laboratory quality systems, emerging testing technologies, and the role of clinician education in laboratory medicine.

Website:https://foodallergy.comhttps://foodallergy.com

Kristen Trainer, RD

Kristen Trainer is a Registered Dietitian and Clinical Educator at Alletess Medical Laboratory. She has worked with clinicians and patients for more than two decades, helping interpret laboratory results and develop individualized nutrition and elimination diet plans for patients undergoing food allergy and food sensitivity testing.

Tests Discussed

Note: Discussion of these tests during the episode should not be interpreted as endorsement or guideline recommendations. Clinical appropriateness depends on the individual patient and current evidence.

• IgE food allergy testing
• Environmental allergy testing
• Component-resolved allergy diagnostics
• IgG food sensitivity testing
• IgA food sensitivity testing
• Candida antibody testing (IgG, IgA, IgM)
• Candida immune complex testing
• Mold antibody testing
• Alpha-gal IgE testing
• Tick-borne immune testing
• Celiac disease testing
• Total IgE testing

Lifestyle & Clinical Strategies Mentioned

• Structured elimination diets
• Gradual food reintroduction
• Individualized meal planning
• Rotation diets
• Shopping list development
• Family-based nutrition planning
• Reducing environmental mold exposure
• Personalized patient education
• Long-term dietary follow-up
• Collaboration between laboratory professionals and clinicians

Clinician FAQ

1. What is the difference between a food allergy and a food sensitivity?

The discussion differentiates IgE-mediated food allergies, which may produce immediate immune reactions, from food sensitivities, which are proposed to involve different immune pathways and may present differently clinically. (Santos 2023) The role of IgG food sensitivity testing remains controversial and is not universally recommended by major allergy organizations. (Kelso 2018)

2. When should clinicians consider specialized allergy testing?

According to the discussion, testing decisions should begin with a comprehensive patient history and symptom evaluation. Testing should be selected based on the suspected underlying mechanism rather than using broad screening panels indiscriminately. (Santos 2023)

3. What is component-resolved diagnostics?

Component-resolved diagnostics evaluates specific proteins within an allergen rather than testing only the whole allergen, potentially providing additional information regarding sensitization patterns in certain allergic conditions. (Santos 2023)

4. What is Alpha-gal syndrome?

Alpha-gal syndrome is an IgE-mediated allergy associated with tick bites that may result in delayed allergic reactions after consuming mammalian meat or products derived from mammals. Recognition of this condition has increased in recent years. (Platts-Mills 2025) (Thompson 2023)

5. How are elimination diets used?

The guests describe elimination diets as a structured process involving temporary removal of selected foods followed by gradual reintroduction while monitoring symptoms under clinician supervision. (Santos 2023)

6. Why is patient education emphasized?

The episode stresses that laboratory testing is only one part of patient care and that interpretation, counseling, dietary guidance, and follow-up are necessary to help patients implement meaningful changes. (Santos 2025)

7. Why does laboratory quality matter?

Standardized testing procedures, accreditation, quality control, and timely reporting all contribute to reliable laboratory results that clinicians can incorporate into patient care. (Chaudhry 2023)

8. What future developments are discussed?

The guests discuss advances including miniaturized laboratory technologies, capillary blood collection, microbiome research, and genetics as potential future areas of development in allergy and immunology testing.

Timestamps / Key Moments

00:02:22 Veronica Kent and Kristen Trainer introduce Alletess

00:03:36 Food allergy, sensitivity, candida, mold, and tick-borne testing

00:04:54 How Alletess began as a specialized laboratory

00:08:16 Bridging the gap between lab results and patient care

00:09:27 How allergy and immunology testing has evolved

00:13:23 How elimination diets and reintroduction work

00:15:19 When mold-related illness testing may be warranted

00:17:38 Alpha-gal syndrome and missed tick-borne allergy cases

00:25:38 Common misconceptions about food allergy testing

Want to elevate your practice?

This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer

The views expressed on this podcast are those of the hosts and guests and do not necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to provide medical advice. Healthcare decisions should be made in consultation with a qualified healthcare professional.

References

• Ahmed Shabbir Chaudhry, Inata, Y., & Nakagami-Yamaguchi, E. (2023). Quality Analysis of the Clinical Laboratory Literature and Its Effectiveness on Clinical Quality Improvement: A Systematic Review. Journal of Clinical Biochemistry and Nutrition, 73(2), 108–115. https://doi.org/10.3164/jcbn.23-22
• Cai, J., Yang, M., Zhang, N., Chen, Y., Wei, J., Wang, J., Liu, Q., Li, W., Shi, W., & Liu, W. (2024). Effects of residential damp indicators on asthma, rhinitis, and eczema among children: A systematic review and meta-analysis of the literature in the past 33 years. Building and Environment, 251, Article 111226. https://www.sciencedirect.com/science/article/abs/pii/S0360132324000684
• Kelso, J. M. (2018). Unproven diagnostic tests for adverse reactions to foods. The Journal of Allergy and Clinical Immunology: In Practice, 6(2), 362–365. https://pubmed.ncbi.nlm.nih.gov/29524991/
• Pillai, S. P., & Fox, E. (2025). Laboratory quality management system fundamentals [Review of Laboratory quality management system fundamentals]. Frontiers in Bioengineering and Biotechnology, 13. https://doi.org/10.3389/fbioe.2025.1578654
• Platts-Mills, T. A. E., Gangwar, R. S., Workman, L., & Wilson, J. M. (2025). The immunology of alpha-gal syndrome: History, tick bites, IgE, and delayed anaphylaxis to mammalian meat. Immunological Reviews, 332(1), Article e70035. https://onlinelibrary.wiley.com/doi/10.1111/imr.70035
• Santos, A. F., Riggioni, C., Agache, I., Akdis, C. A., Akdis, M., et al. (2023). EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy, 78(12), 3057–3076. https://onlinelibrary.wiley.com/doi/10.1111/all.15902
• Santos, A. F., Riggioni, C., Agache, I., Akdis, C. A., Akdis, M., et al. (2025). EAACI guidelines on the management of IgE-mediated food allergy. Allergy, 80(1), 14–36. https://onlinelibrary.wiley.com/doi/10.1111/all.16345
• Thompson, J. M., Carpenter, A., Kersh, G. J., Wachs, T., Commins, S. P., & Salzer, J. S. (2023). Geographic distribution of suspected alpha-gal syndrome cases — United States, January 2017–December 2022. MMWR. Morbidity and Mortality Weekly Report, 72(30), 815–820. https://www.cdc.gov/mmwr/volumes/72/wr/mm7230a2.htm

What if the most powerful shift in how we practice medicine starts with one person deciding to do it differently?

Aviva’s story is that kind of shift.

Long before she ever sat in a medical classroom, she had already built a life as a midwife, herbalist, and mother of four who was deeply embedded in her community. Then, in what most of us would consider the busiest, most demanding years of life - years that often overlap with perimenopause - she made a radical decision: she went back to school. Back into training. Back into the system she wanted to help change.

Not because something was broken, but because she saw what was missing.

That’s what makes this episode different. It’s about what happens when women get to reframe the perimenopausal transition as one of the most powerful, generative, expansive years of their lives.

Instead of accepting the status quo, Dr. Aviva Romm built an entirely different way of seeing things - one that doesn’t reduce symptoms to problems, but places them in context. One that connects sleep, stress, nourishment, physiology, and even relationships into a bigger picture of health.

You can feel that perspective ripple through the entire conversation. It gently challenges the idea that you need more interventions, more testing, more fixing, and replaces it with something both simpler and harder: paying attention, understanding what your body is asking for, and supporting it instead of overriding it.

By the end, something shifts.

You’re not just thinking differently about perimenopause - you’re thinking differently about what’s possible during this phase of life. And maybe, like Aviva did, you start to wonder: what could change if perimenopause wasn’t seen as the end of something, but the beginning of something else entirely?

Clinical Takeaways from This Episode

• A root-cause, whole-person approach to perimenopause may support more sustainable outcomes. Perimenopause often includes symptoms like sleep disruption, mood changes, and cycle irregularities, and may benefit from a broader, individualized care approach rather than a single intervention (Santoro et al., 2018).
• Stress physiology and HPA axis patterns may influence how symptoms show up. Chronic stress is associated with changes in inflammatory signaling and neuroendocrine regulation, which may shape mood, immune function, and metabolic health (Russell, 2019).
• Sleep is foundational—and CBT-I is an evidence-informed place to start. Cognitive Behavioral Therapy for Insomnia (CBT-I) is supported by clinical evidence and may help improve sleep quality without medication in many individuals (Rossman, 2019).
• Connection and community are not “extras”—they’re part of physiology. Social isolation has been associated with increased mortality risk, which reinforces the importance of connection as part of whole-person care (Naito et al., 2023).
• Thoughtful, targeted lab testing supports better clinical decision-making. Strategic use of labs—guided by symptoms and clinical context—may reduce unnecessary testing and help clinicians focus on meaningful data.

Guest Introduction

Dr. Aviva Romm, MD, is a Yale-trained physician, herbalist, and midwife with over four decades of experience in women’s health. She has trained hundreds of clinicians in integrative and functional medicine and is the author of multiple bestselling books, including Hormone Intelligence and The Adrenal Thyroid Revolution. Her work bridges conventional and integrative medicine in a way that centers women and their paths to thriving.

Interested in advancing your clinical training? Explore Dr. Aviva Romm’s Women’s Integrative Functional Medicine Certification Program. Use code FULLSCRIPT26 in the “How did you learn about the course?” box to receive $1,000 off.

FAQ: Clinician & Patient Questions on Perimenopause and Integrative Care

What symptoms are common during perimenopause?

• Perimenopause may include:
• Sleep disruption
• Mood changes
• Hot flashes or night sweats
• Changes in menstrual cycles
• These are part of a normal physiologic transition, though symptom severity varies. Dr. Aviva uses a whole-person, root cause approach to successfully manage many of these symptoms. (Crandall, 2023).

What can I do if I’m struggling with sleep in midlife?

• Cognitive Behavioral Therapy for Insomnia (CBT-I) is a well-studied, non-pharmacologic option clinicians may consider (Rossman, 2019).
• It may also help to evaluate:
• Stress levels
• Blood sugar patterns
• Sleep habits and environment

How does stress actually affect my health?

• Chronic stress may influence:
• Hormone signaling
• Immune and inflammatory pathways
• Mood and cognitive function
• These effects are mediated in part through the HPA axis and inflammatory signaling pathways (Russell, 2019).

Key Moments from This Episode

• 02:30 – Aviva’s journey: from herbalist and midwife to Yale-trained medical doctor
• 10:41 – Going back to medical school as a parent: what it really takes
• 28:14 – Stress physiology and the root causes of chronic symptoms
• 32:58 – Reframing perimenopause as a transition, not a decline
• 35:17 – Building a real-world toolkit: sleep, nourishment, nervous system support
• 41:01 – Botanical medicine in practice: motherwort and lemon balm
• 57:28 – Hypervigilance, burnout, and how they show up in the body
• 01:17:18 – The Yerkes-Dodson curve: finding your optimal stress zone
• 01:19:41 – How to think about labs without overtesting

Want to elevate your practice?

This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer

The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.

Citations

• Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023 Feb 7;329(5):405-420. doi: 10.1001/jama.2022.24140. PMID: 36749328.
• Rossman J. Cognitive-Behavioral Therapy for Insomnia: An Effective and Underutilized Treatment for Insomnia. Am J Lifestyle Med. 2019 Aug 12;13(6):544-547. doi: 10.1177/1559827619867677. PMID: 31662718; PMCID: PMC6796223.
• Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019 Sep;15(9):525-534. doi: 10.1038/s41574-019-0228-0. Epub 2019 Jun 27. PMID: 31249398.
• Naito R, McKee M, Leong D, Bangdiwala S, Rangarajan S, Islam S, Yusuf S. Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies. PLoS One. 2023 Jan 12;18(1):e0280308. doi: 10.1371/journal.pone.0280308. PMID: 36634152; PMCID: PMC9836313.

What happens when patients leave an integrative or functional medicine appointment with multiple recommendations but limited practical support for implementation?

In this episode, Kate Kresge sits down with Monique Richard, Holly Van Poots, and Sudha Raj to discuss the evolving role of Registered Dietitian Nutritionists (RDNs) trained in Integrative and Functional Nutrition (IFN). The conversation centers on the Revised 2025 Scope and Standards of Practice for RDNs in Nutrition in Integrative and Functional Medicine, which clarifies the scope, standards, and clinical contribution of IFN practitioners. (Crowe-White 2025)

Together they explore why nutrition may remain underused in some conventional care settings, including concerns that many medical providers receive limited formal nutrition training. (Adams 2010) They also discuss why sustained behavior change often requires more time, context, and follow-up than a brief visit can provide, and why food choices are shaped by more than nutrient content alone. The discussion highlights how IFN dietitians can help translate complex plans into sustainable daily habits while helping patients connect symptoms, lifestyle patterns, culture, stress, and nutrition.

The episode makes a practical case for team-based care and shows how integrative nutrition practitioners can help bridge the gap between clinical recommendations and meaningful long-term change.

Clinical Takeaways From This Episode

Behavior Change Is Often the Missing Piece

Many visits focus on diagnosis and treatment decisions, while meaningful behavior change takes time, relationship-building, and ongoing support. (Crowe-White 2025) (Körner 2016) IFN dietitians help patients put recommendations into practice in real-world settings.

Food Is More Than Nutrients

Food choices are shaped by culture, identity, family history, emotional experience, access, and lifestyle. Accounting for these factors may help make nutrition recommendations more realistic, acceptable, and sustainable; effects on clinical outcomes depend on the condition, intervention, and patient context. (Odoms-Young 2024) (Crowe-White 2025)

Nutrition Is Central to Complex Chronic Disease

Many patients present with concerns where nutrition may be one component of care, including issues related to digestive health, metabolic health, immune function, and quality of life. (Crowe-White 2025) (Moloney 2025)

Dietitians Serve as Translators of Functional Medicine Plans

Many patients leave appointments with extensive recommendations. IFN practitioners can help patients prioritize, personalize, and implement clinician recommendations within the patient’s preferences, resources, culture, and care plan. (Moloney 2025) (Senkus 2024)

Team-Based Care Improves Patient Support

Integrative care tends to work best when physicians, naturopathic doctors, nurse practitioners, health coaches, and nutrition professionals collaborate on whole-person care. (Körner 2016) (Crowe-White 2025)

Guest Introduction

Monique Richard, MS, RDN, LDN

Monique Richard is an experienced registered dietitian nutritionist specializing in integrative and functional nutrition. Known for her practical and patient-centered approach, she helps individuals explore lifestyle, nutrition, and environmental factors that may be relevant to their health goals and care plans. She often describes IFN practitioners as "nutrition detectives" who help connect the dots between symptoms, habits, and underlying patterns.

Holly Van Poots, MS, RDN

Holly Van Poots is a leader in integrative and functional nutrition education and one of the contributors to the newly published guidance paper on the role of IFN dietitians. Her work focuses on defining how nutrition professionals contribute to whole-person care beyond traditional dietary counseling.

Sudha Raj, PhD, RDN

Sudha Raj brings a deep understanding of nutrition behavior change, cultural competency, and patient-centered care. Her work emphasizes the importance of relationship-based nutrition counseling and understanding the lived experiences that shape food choices and health behaviors.

The statements, information and opinions shared by each individual are not in the capacity as official spokespeople, or, on behalf, of the Academy of Nutrition and Dietetics. They volunteered to be authors/contribute to the NIFM SOP and received no funding from the Academy.

FAQ

What is integrative and functional nutrition?

Integrative and functional nutrition combines evidence-informed nutrition science with a whole-person approach that considers lifestyle, environment, stress, sleep, culture, and other contributors to health.

How is an IFN dietitian different from traditional nutrition counseling?

While foundational nutrition principles remain the same, IFN practitioners often spend more time exploring nutrition- and lifestyle-related factors, patient context, and personalized behavior-change strategies.

Why are dietitians important in functional medicine practices?

Dietitians can help patients translate complex recommendations into practical daily actions, which may support adherence and follow-through. Evidence for clinical outcomes varies by condition and intervention. (Moloney 2025)

What are patients often missing after a functional medicine visit?

Patients frequently understand what they should do but struggle with how to implement recommendations. IFN practitioners help bridge that gap.

Why is food considered more than just nutrition?

Food carries cultural, emotional, social, and historical meaning. Accounting for these factors can help build realistic, sustainable nutrition strategies. (Odoms-Young 2024)

Timestamps

00:00:00 – Why nutrition changes are powerful but hard for patients to implement

00:02:17 – Why the new IFN dietitian scope paper matters now

00:03:51 – Integrative vs. functional nutrition and the “nutrition detective” role

00:05:00 – The biggest gaps IFN-trained RDNs can fill in patient care

00:08:22 – What a visit with an integrative and functional RDN actually looks like

00:12:16 – How labs and testing fit into nutrition care

00:15:11 – How dietitians train in integrative and functional nutrition

00:18:59 – Eating disorders, elimination diets, and the need for collaboration

00:25:55 – Where to find IFN-trained dietitians and build referral relationships

00:29:43 – The future of medical nutrition, value-based care, and whole person health

00:35:09 – Rapid-fire: misconceptions, sustainable habits, and underappreciated nutrition care

Future Discussion — The expanding role of RDNs in multidisciplinary healthcare teams

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer: The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.

References

• Adams, K. M., Kohlmeier, M., & Zeisel, S. H. (2010). Nutrition education in U.S. medical schools: Latest update of a national survey. Academic Medicine, 85(9), 1537–1542.https://doi.org/10.1097/ACM.0b013e3181eab71b
• Crowe-White, K. M., Richard, M., & Raj, S. (2025). Revised 2025 scope and standards of practice for registered dietitian nutritionists in nutrition in integrative and functional medicine. Commission on Dietetic Registration.https://www.cdrnet.org/vault/2459/web//20251215%20NIFM%20Article%20FINAL%20-%202.pdf
• Federal Trade Commission. (2022). Health products compliance guidance.https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance
• Körner, M., Bütof, S., Müller, C., Zimmermann, L., Becker, S., & Bengel, J. (2016). Interprofessional teamwork and team interventions in chronic care: A systematic review. Journal of Interprofessional Care, 30(1), 15–28.https://doi.org/10.3109/13561820.2015.1051616
• Moloney, L., Rozga, M., Steiber, A., & Handu, D. (2026). The effectiveness of medical nutrition therapy in prevention and treatment of chronic disease: A position paper of the Academy of Nutrition and Dietetics. Journal of the Academy of Nutrition and Dietetics, 126(2), Article 156219.https://doi.org/10.1016/j.jand.2025.10.010
• Odoms-Young, A., Stanford, F. C., Palacios, C., Anderson, C. A. M., Andres, A., Fisher, J. O., Gardner, C. D., Giovannucci, E., Hoelscher, D. M., Jernigan, V. B. B., Raynor, H. A., Webster, A., Fultz, A. K., Bahnfleth, C., English, L. K., Higgins, M., Lawless, M., Momin, S., Butera, G., … Obbagy, J. (2024). Culturally tailored dietary interventions and diet-related psychosocial factors, dietary intake, diet quality, and health outcomes: An evidence scan. U.S. Department of Agriculture, Nutrition Evidence Systematic Review.https://doi.org/10.52570/NESR.DGAC2025.ES01
• Senkus, K. E., Dudzik, J. M., Lennon, S. L., DellaValle, D. M., Moloney, L. M., Handu, D., & Rozga, M. (2024). Medical nutrition therapy provided by a dietitian improves outcomes in adults with prehypertension or hypertension: A systematic review and meta-analysis. The American Journal of Clinical Nutrition, 119(6), 1417–1442.https://doi.org/10.1016/j.ajcnut.2024.04.012

This episode explores one of the most significant developments in women's health in recent years: the proposed transition from Polycystic Ovary Syndrome (PCOS) to Polyendocrine Metabolic Ovarian Syndrome (PMOS). (Teede 2026) Dr. Jessica Christie and Dr. Camille Krause discuss why experts believe the traditional name no longer reflects the full complexity of the condition and how the PMOS framework better captures its endocrine, metabolic, reproductive, inflammatory, and neuroendocrine dimensions. (Teede 2026) Clinicians will learn why insulin resistance, androgen excess (Houston 2025), stress physiology, sleep, inflammation, and cardiometabolic health (Wekker 2020) are central to understanding PMOS, and how a systems-based approach can improve earlier identification, assessment, and treatment. (Teede 2026)

Clinical Takeaways from This Episode

• PMOS reflects a multisystem condition: The proposed name change recognizes that the condition extends beyond ovarian function and includes endocrine, metabolic, inflammatory, and neuroendocrine dysfunction. (Teede 2026)
• Insulin resistance is a major physiologic driver: Hyperinsulinemia may contribute to increased ovarian androgen production, ovulatory dysfunction, and metabolic symptoms, often before glucose markers become abnormal. (Houston 2025)
• PMOS is not defined by ovarian cysts: Many individuals diagnosed with PCOS do not demonstrate polycystic ovarian morphology, and the follicles observed are not true ovarian cysts. (Houston 2025) (Teede 2026)
• Early metabolic screening matters: Fasting insulin, glucose regulation, lipid markers, liver function, and cardiometabolic risk factors may shift years before overt disease develops. (Houston 2025) (Teede 2026)
• Clinical presentations vary widely: Symptoms may include irregular cycles, infertility, acne, hirsutism, hair thinning, fatigue, mood changes, sleep disruption, dyslipidemia, and fatty liver patterns. (Manzano-Nunez 2023) Lean PMOS can occur and is often overlooked. (Zheng 2025)
• Treatment requires a whole-person approach: Nutrition, movement, sleep, stress regulation, inflammation management, and metabolic support should be considered alongside conventional treatment options. (Teede 2023)

Guest Introduction

Dr. Camille Krause is a Naturopathic Doctor with a clinical focus on fertility, women’s hormones, and nutrition. She works collaboratively with fertility physicians to provide evidence-based, complementary care, using specialized testing, nutrition, botanical medicine, lifestyle interventions, and acupuncture to support reproductive health. Dr. Krause is a member of the Canadian and Ontario Associations of Naturopathic Doctors. She holds an Honours Bachelor of Science from the University of Toronto and completed her naturopathic training at the Canadian College of Naturopathic Medicine.

Website: https://www.conceivehealth.com/staff/camille-krause-naturopathic-doctor/

Instagram: @waterloo_fertility_naturopath

Labs Mentioned

• Fasting insulin
• Fasting glucose
• Hemoglobin A1c (HbA1c)
• Lipid panel
• Liver enzymes
• Testosterone
• DHEA-S
• Sex Hormone Binding Globulin (SHBG)
• Thyroid markers
• Blood pressure
• Waist circumference assessment

Lifestyle & Exercise Strategies Mentioned

• Blood sugar stabilization
• Higher protein intake
• Increased dietary fiber intake
• Resistance training
• Regular movement and exercise
• Sleep optimization
• Circadian rhythm support
• Nervous system regulation
• Stress management
• Inflammation reduction strategies
• Nutrient sufficiency
• Recovery optimization

Clinician FAQ

1. Why is PCOS being renamed PMOS?

The proposed term Polyendocrine Metabolic Ovarian Syndrome better reflects the endocrine, metabolic, reproductive, and inflammatory aspects of the condition rather than focusing primarily on ovarian findings. (Teede 2023)

2. Are ovarian cysts required for diagnosis?

No. Many individuals diagnosed with PCOS do not have polycystic ovarian morphology. The follicles seen on imaging are generally immature follicles associated with disrupted ovulation rather than true ovarian cysts. (Teede 2026) (Houston 2025)

3. Why is fasting insulin clinically important in PMOS?

Elevated insulin levels may occur years before fasting glucose or HbA1c become abnormal and can contribute directly to ovarian androgen production and ovulatory dysfunction. (Houston 2025)

4. What systems are involved in PMOS?

PMOS may involve insulin signaling, androgen regulation, neuroendocrine function, inflammatory pathways, reproductive physiology, sleep, circadian rhythms, and cardiometabolic health. (Teede 2026) (Wekker 2020)

5. Can patients have PMOS without obesity?

Yes. Lean PMOS exists and may be underrecognized. Patients can experience reproductive, metabolic, and hormonal symptoms across a wide range of body compositions. (Zheng 2025)

6. What are the current diagnostic criteria?

Current criteria include combinations of:

• Ovulatory dysfunction or irregular cycles
• Clinical or biochemical hyperandrogenism
• Polycystic ovarian morphology or elevated AMH in adults

Adolescents generally require the first two criteria rather than ovarian imaging findings. (Teede 2023)

7. Why is diagnosis often delayed?

Presentations vary substantially, and many patients do not fit traditional stereotypes. Symptoms may emerge years before fertility concerns arise, contributing to missed or delayed diagnosis. (Gibson-Helm 2017)

8. What is the role of lifestyle medicine in PMOS?

Lifestyle interventions targeting blood sugar regulation, nutrition, physical activity, sleep, stress physiology, and inflammation are foundational components of a whole-person treatment strategy. (Teede 2023)

Conversation Topics

• The decade-long effort behind the name change
• Why the old terminology was biologically inaccurate
• Understanding PMOS as a multisystem condition
• Insulin resistance and androgen excess
• The role of inflammation, sleep, and stress physiology
• Lean PMOS and underrecognized presentations
• Current diagnostic criteria and clinical considerations
• Root-cause laboratory assessment strategies
• Whole-person treatment approaches for PMOS
• Why lifestyle medicine remains foundational
• The future of women's endocrine and metabolic care

Timestamps

00:00 - Why the shift from PCOS to PMOS matters

02:10 - How language shapes diagnosis and care

03:29 - Why the old terminology missed the bigger picture

05:18 - The root physiology of PMOS

07:47 - How PMOS can present beyond the stereotypical picture

09:33 - Why diagnosis requires a deeper clinical lens

11:23 - A whole-person approach to PMOS care

12:25 - Why this shift is so meaningful for patients and practitioners

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscriptallows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

Disclaimer

The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.

References

• Gibson-Helm, M., Teede, H., Dunaif, A., & Dokras, A. (2017). Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 102(2), 604–612. https://doi.org/10.1210/jc.2016-2963
• Houston, E. J., & Templeman, N. M. (2025). Reappraising the relationship between hyperinsulinemia and insulin resistance in PCOS. Journal of Endocrinology, 265(2), e240269.
• Manzano-Nunez, R., Santana-Dominguez, M., Rivera-Esteban, J., Sabiote, C., Sena, E., Bañares, J., Tacke, F., & Pericàs, J. M. (2023). Non-alcoholic fatty liver disease in patients with polycystic ovary syndrome: A systematic review, meta-analysis, and meta-regression. Journal of Clinical Medicine, 12(3), 856. https://doi.org/10.3390/jcm12030856
• Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., & Joham, A. E. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 108(10), 2447–2469. https://doi.org/10.1210/clinem/dgad463
• Teede, H. J., Khomami, M. B., Morman, R., Laven, J. S. E., Joham, A. E., Costello, M. F., Patil, M., Rees, D. A., Berry, L., Cree, M. G., Zhao, H., Norman, R. J., Dokras, A., & Piltonen, T. (2026). Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: A multistep global consensus process. The Lancet. Advance online publication.
• Wekker, V., van Dammen, L., Koning, A., Heida, K. Y., Painter, R. C., Limpens, J., & Hoek, A. (2020). Long-term cardiometabolic disease risk in women with PCOS: A systematic review and meta-analysis. Human Reproduction Update, 26(6), 942–960.
• Zheng, C., Lin, Y., Zhang, Z., Ye, J., Lin, Y., & Tian, J. (2025). Analyzing and evaluating the metabolic and endocrine characteristics between lean and obese patients with polycystic ovary syndrome: A systematic review and meta-analysis. Frontiers in Endocrinology, 16, 1680685.

Adult Acne in Perimenopause: Hormones, Diet, Supplements, and Root Causes With Dr. Mamina Turegano

Adult acne can be especially frustrating when it appears after years—or even decades—of relatively clear skin. In this bonus episode, Dr. Kate Kresge sits down with dermatologist Dr. Mamina Turegano to explore why acne often emerges or worsens during perimenopause and what may be driving those changes beneath the surface.

Dr. Turegano explains how shifting hormone patterns, particularly changes in the balance between estrogen and androgens, may contribute to breakouts during midlife. She also discusses the potential roles of stress, diet, skincare habits, environmental exposures, and select supplements in acne management.

The conversation offers a practical, evidence-informed look at adult female acne, emphasizing individualized treatment approaches that support both skin health and overall wellbeing.

Why This Matters

Many women are surprised when acne appears in their 30s, 40s, or 50s. Adult female acne is increasingly common and often requires a different treatment approach than adolescent acne. Understanding the hormonal, metabolic, and lifestyle factors that may contribute to breakouts can help patients make more informed decisions about treatment and self-care.

Key Clinical Takeaways

Perimenopause may contribute to acne flares

Hormonal changes during the menopausal transition may alter the balance between estrogen and androgen activity, contributing to increased sebum production and acne in susceptible individuals. (Bagatin 2019) (Alexandre 2024)

Adult skin requires a different acne strategy

Compared to adolescent acne, adult female acne often occurs in skin that is more prone to dryness, irritation, and barrier dysfunction, making gentle treatment approaches especially important. (Dréno 2013)

Topical therapies remain foundational

Evidence-based acne management continues to rely heavily on topical retinoids, benzoyl peroxide, and other targeted therapies such as azelaic acid. (Reynolds 2024)

Diet may influence acne severity

Research suggests that higher-glycemic dietary patterns may contribute to acne severity, while evidence regarding dairy intake remains mixed and population dependent. (Meixiong 2022)

Supplements should be personalized

Some nutraceuticals—including zinc, probiotics, vitamin D, omega-3 fatty acids, and pantothenic acid—have been studied for acne support, but evidence varies considerably by ingredient and study quality. (Shields 2023)

Vitamin B12 may be a trigger in some individuals

Although uncommon, acneiform eruptions associated with vitamin B12 supplementation have been reported in the medical literature. (Bowden 2023)

Topics Covered

• Why adult acne is becoming more common
• Acne during perimenopause and menopause
• Hormonal changes and androgen activity
• Stress and skin health
• Environmental and lifestyle contributors
• Retinoids, azelaic acid, sulfur, and benzoyl peroxide
• When systemic therapies may be appropriate
• Diet, blood sugar regulation, and dairy
• Supplements commonly discussed for acne support
• Biotin, vitamin B12, and acne concerns
• Practical skincare strategies for adult women

Guest Bio

Dr. Mamina Turegano is a board-certified dermatologist with expertise in medical, surgical, and cosmetic dermatology. She is known for translating complex skin science into practical, patient-centered guidance and frequently speaks about acne, skin aging, hormone-related skin concerns, and integrative approaches to dermatologic care.

Timestamps

00:00 Introduction

02:04 Why adult acne develops during perimenopause

04:01 Adult acne versus teenage acne

05:00 Topical treatment approaches

07:22 Supplements and acne support

09:47 Biotin, vitamin B12, and breakouts

14:32 Acne in men versus women

15:35 Diet, dairy, fiber, and blood sugar

17:04 Final thoughts and resources

Sponsor Copy

Practitioners, what if your supplement dispensing, patient education, and treatment planning all lived in one powerful platform built for whole person care? Meet Fullscript—the comprehensive care delivery platform designed to reduce administrative burden and enhance clinical impact. From automated refills and lab ordering to evidence-based protocols and adherence support, Fullscript helps streamline care while keeping the focus where it belongs: on patients. In a recent survey, 74% of providers reported saving up to three hours per week using Fullscript to create treatment plans. Visit fullscript.com to learn more.

References

• Alexandre, M., Saint Aroman, M., Mengeaud, V., Carballido, F., Doat, G., Coutinho, A., & Bagatin, E. (2024). Unveiling the nuances of adult female acne: A comprehensive exploration of epidemiology, treatment modalities, dermocosmetics, and the menopausal influence. International Journal of Women’s Health, 16, 663–678.https://doi.org/10.2147/IJWH.S431523https://doi.org/10.2147/IJWH.S431523
• Bagatin, E., de Freitas, T. H. P., Rivitti-Machado, M. C., Ribeiro, B. M., Nunes, S., & da Rocha, M. A. D. (2019). Adult female acne: A guide to clinical practice. Anais Brasileiros de Dermatologia, 94(1), 62–75.https://doi.org/10.1590/abd1806-4841.20198203https://doi.org/10.1590/abd1806-4841.20198203
• Bowden, A., Ekeh, O., Brownstone, N. D., & Hsu, S. (2023). Acneiform eruption secondary to over-the-counter vitamin B12. Cureus, 15(8), Article e43275.https://doi.org/10.7759/cureus.43275https://doi.org/10.7759/cureus.43275
• Dréno, B., Layton, A., Zouboulis, C. C., López-Estebaranz, J. L., Zalewska-Janowska, A., Bagatin, E., Zampeli, V. A., Yutskovskaya, Y., & Harper, J. C. (2013). Adult female acne: A new paradigm. Journal of the European Academy of Dermatology and Venereology, 27(9), 1063–1070.https://doi.org/10.1111/jdv.12061https://doi.org/10.1111/jdv.12061
• Meixiong, J., Ricco, C., Vasavda, C., & Ho, B. K. (2022). Diet and acne: A systematic review. JAAD International, 7, 95–112.https://doi.org/10.1016/j.jdin.2022.02.012https://doi.org/10.1016/j.jdin.2022.02.012
• Reynolds, R. V., Yeung, H., Cheng, C. E., Cook-Bolden, F., Desai, S. R., Druby, K., Freeman, E. E., Keri, J. E., Stein, L. F., Tan, J. K. L., Tollefson, M. M., Weiss, J. S., Wu, P. A., Zaenglein, A. L., Han, J. M., & Barbieri, J. S. (2024). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 90(5), 1006–1030.e30.https://doi.org/10.1016/j.jaad.2023.12.017https://doi.org/10.1016/j.jaad.2023.12.017
• Shields, A., Ly, S., Wafae, B., Chang, Y.-F., Manjaly, P., Archila, M., Heinrich, C., Drake, L., Mostaghimi, A., & Barbieri, J. S. (2023). Safety and effectiveness of oral nutraceuticals for treating acne: A systematic review. JAMA Dermatology, 159(12), 1373–1382.https://doi.org/10.1001/jamadermatol.2023.3949https://doi.org/10.1001/jamadermatol.2023.3949