The Root Cause Medicine Podcast

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• Perimenopause as a Portal to Power with Dr. Aviva Romm 03.07.2026 1t 24min

  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 EpisodeA 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 IntroductionDr. 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 CareWhat symptoms are common during perimenopause?Perimenopause may include:Sleep disruptionMood changesHot flashes or night sweatsChanges in menstrual cyclesThese 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 levelsBlood sugar patternsSleep habits and environmentHow does stress actually affect my health?Chronic stress may influence:Hormone signalingImmune and inflammatory pathwaysMood and cognitive functionThese effects are mediated in part through the HPA axis and inflammatory signaling pathways (Russell, 2019).Key Moments from This Episode02:30 – Aviva’s journey: from herbalist and midwife to Yale-trained medical doctor10:41 – Going back to medical school as a parent: what it really takes28:14 – Stress physiology and the root causes of chronic symptoms32:58 – Reframing perimenopause as a transition, not a decline35:17 – Building a real-world toolkit: sleep, nourishment, nervous system support41:01 – Botanical medicine in practice: motherwort and lemon balm57:28 – Hypervigilance, burnout, and how they show up in the body01:17:18 – The Yerkes-Dodson curve: finding your optimal stress zone01:19:41 – How to think about labs without overtestingWant 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.DisclaimerThe 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.CitationsCrandall 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.
• Integrative and Functional Nutrition Dietitians: How They Amplify Care 26.06.2026 38min

  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 EpisodeBehavior Change Is Often the Missing PieceMany 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 NutrientsFood 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 DiseaseMany 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 PlansMany 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 SupportIntegrative 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 IntroductionMonique Richard, MS, RDN, LDNMonique 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, RDNHolly 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, RDNSudha 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.FAQWhat 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)Timestamps00:00:00 – Why nutrition changes are powerful but hard for patients to implement00:02:17 – Why the new IFN dietitian scope paper matters now00:03:51 – Integrative vs. functional nutrition and the “nutrition detective” role00:05:00 – The biggest gaps IFN-trained RDNs can fill in patient care00:08:22 – What a visit with an integrative and functional RDN actually looks like00:12:16 – How labs and testing fit into nutrition care00:15:11 – How dietitians train in integrative and functional nutrition00:18:59 – Eating disorders, elimination diets, and the need for collaboration00:25:55 – Where to find IFN-trained dietitians and build referral relationships00:29:43 – The future of medical nutrition, value-based care, and whole person health00:35:09 – Rapid-fire: misconceptions, sustainable habits, and underappreciated nutrition careFuture Discussion — The expanding role of RDNs in multidisciplinary healthcare teamsWant 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 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.ReferencesAdams, 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.0b013e3181eab71bCrowe-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.pdfFederal Trade Commission. (2022). Health products compliance guidance. https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidanceKörner, 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/10.3109/13561820.2015.1051616Moloney, 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.2025.10.010Odoms-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.ES01Senkus, 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
• The PCOS Name Change and What It Means for Women’s Health 18.06.2026 18min

  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 EpisodePMOS 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 IntroductionDr. 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_naturopathLabs MentionedFasting insulinFasting glucoseHemoglobin A1c (HbA1c)Lipid panelLiver enzymesTestosteroneDHEA-SSex Hormone Binding Globulin (SHBG)Thyroid markersBlood pressureWaist circumference assessmentLifestyle & Exercise Strategies MentionedBlood sugar stabilizationHigher protein intakeIncreased dietary fiber intakeResistance trainingRegular movement and exerciseSleep optimizationCircadian rhythm supportNervous system regulationStress managementInflammation reduction strategiesNutrient sufficiencyRecovery optimizationClinician FAQ1. 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 cyclesClinical or biochemical hyperandrogenismPolycystic ovarian morphology or elevated AMH in adultsAdolescents 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 TopicsThe decade-long effort behind the name changeWhy the old terminology was biologically inaccurateUnderstanding PMOS as a multisystem conditionInsulin resistance and androgen excessThe role of inflammation, sleep, and stress physiologyLean PMOS and underrecognized presentationsCurrent diagnostic criteria and clinical considerationsRoot-cause laboratory assessment strategiesWhole-person treatment approaches for PMOSWhy lifestyle medicine remains foundationalThe future of women's endocrine and metabolic careTimestamps00:00 - Why the shift from PCOS to PMOS matters02:10 - How language shapes diagnosis and care03:29 - Why the old terminology missed the bigger picture05:18 - The root physiology of PMOS07:47 - How PMOS can present beyond the stereotypical picture09:33 - Why diagnosis requires a deeper clinical lens11:23 - A whole-person approach to PMOS care12:25 - Why this shift is so meaningful for patients and practitionersWant 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.DisclaimerThe 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.ReferencesGibson-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.2016-2963Houston, 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/jcm12030856Teede, 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/dgad463Teede, 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, Hormones, and Perimenopause: What Your Skin Is Trying to Tell You 11.06.2026 22min

  Adult Acne in Perimenopause: Hormones, Diet, Supplements, and Root Causes With Dr. Mamina TureganoAdult 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 MattersMany 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 TakeawaysPerimenopause may contribute to acne flaresHormonal 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 strategyCompared 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 foundationalEvidence-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 severityResearch 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 personalizedSome 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 individualsAlthough uncommon, acneiform eruptions associated with vitamin B12 supplementation have been reported in the medical literature. (Bowden 2023)Topics CoveredWhy adult acne is becoming more commonAcne during perimenopause and menopauseHormonal changes and androgen activityStress and skin healthEnvironmental and lifestyle contributorsRetinoids, azelaic acid, sulfur, and benzoyl peroxideWhen systemic therapies may be appropriateDiet, blood sugar regulation, and dairySupplements commonly discussed for acne supportBiotin, vitamin B12, and acne concernsPractical skincare strategies for adult womenGuest BioDr. 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.Timestamps00:00 Introduction02:04 Why adult acne develops during perimenopause04:01 Adult acne versus teenage acne05:00 Topical treatment approaches07:22 Supplements and acne support09:47 Biotin, vitamin B12, and breakouts14:32 Acne in men versus women15:35 Diet, dairy, fiber, and blood sugar17:04 Final thoughts and resourcesSponsor CopyPractitioners, 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.ReferencesAlexandre, 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.S431523Bagatin, 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/abd1806-4841.20198203Bowden, 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.43275Dréno, 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.12061Meixiong, 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.2022.02.012Reynolds, 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.2023.12.017Shields, 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.2023.3949
• Hair Loss: Root Causes and Treatment Options 04.06.2026 37min

  Hair loss can feel deeply personal, especially when it happens after illness, stress, rapid weight loss, postpartum changes, or a hormonal transition. In this episode, Dr. Mamina Turegano joins Dr. Kate Kresge to unpack the most common patterns of hair shedding and thinning, including telogen effluvium and androgenetic alopecia.Dr. Turegano explains why hair loss is often multifactorial and why the timing matters: shedding may appear months after a physiologic or emotional stressor. She walks through the root-cause workup she considers in practice, including thyroid function, ferritin, vitamin D, B12, zinc, sex hormones, inflammation, scalp health, and medication history.The conversation also covers postpartum hair loss, dandruff and scalp inflammation, protein intake, GLP-1-related weight loss, birth control changes, and evidence-informed options such as minoxidil, red light therapy, scalp massage, and PRP. Throughout the episode, Dr. Turegano brings a practical, compassionate approach to helping patients understand what may be driving hair loss and when a dermatology referral matters.Clinical Takeaways from This EpisodeTelogen effluvium timing matters: Diffuse shedding often appears two to four months after a stressor such as illness, surgery, childbirth, hemorrhage, crash dieting, low protein intake, thyroid dysfunction, or medication changes. (Malkud 2015)(Hughes 2024)Pattern recognition guides the workup: Telogen effluvium, androgenetic alopecia, alopecia areata, traction alopecia, and scarring alopecias can look different clinically, which is why scalp exam and referral are important when diagnosis is uncertain. (Mubki 2014)Nutrient status can inform care: Ferritin, vitamin D, B12, zinc, and thyroid markers may help identify contributing factors in selected patients, though deficiencies are not the only explanation for shedding. (Ahmed 2026)(Durusu 2024)Postpartum shedding is common but still deserves context: Hormonal shifts, delivery-related stress, sleep disruption, breastfeeding, and blood loss may all contribute, and persistent or patterned loss should be evaluated. (Hirose 2023)Treatment should match the diagnosis: Topical minoxidil, low-level laser therapy, and PRP have evidence for androgenetic alopecia, but protocols, response, safety considerations, and patient context vary. (Adil 2017)(Perez 2024)(Yao 2024)Guest Bio: Mamina Turegano, MD, is a triple board-certified dermatologist, internist, and dermatopathologist based in New Orleans. She specializes in medical, cosmetic, and integrative dermatology, blending conventional and holistic approaches to skin health. With over 2 million followers across social media, she shares dermatologist-backed skincare and wellness insights with a broad audience. She also co-hosts a podcast, called Skin Deep MDs, has been published in leading medical journals, and frequently contributes her expertise to major press outlets, TV, and beauty publications.Frequently Asked QuestionsWhat is telogen effluvium?Telogen effluvium is a form of diffuse, nonscarring hair shedding that often follows a physiologic or emotional stressor. The shedding commonly appears a few months after the trigger rather than immediately. (Malkud 2015)(Hughes 2024)What labs may be useful for hair shedding?Depending on the patient’s history and exam, clinicians may consider CBC, ferritin, thyroid markers, vitamin D, B12, zinc, and selected hormone testing. Lab results should be interpreted in context rather than used as a stand-alone explanation. (Malkud 2015)(Durusu 2024)Can postpartum hair loss be normal?Postpartum shedding is common and often related to hormonal shifts after delivery, but persistent, severe, patterned, or scarring hair loss should be evaluated. Blood loss, low iron stores, thyroid changes, and sleep disruption may also matter. (Hirose 2023)Does washing hair make shedding worse?Not necessarily. Infrequent washing may make shedding look more dramatic because shed hairs accumulate between washes. Scalp inflammation or seborrheic dermatitis may also contribute to ongoing irritation and should be addressed when present.When should a patient see a dermatologist for hair loss?Referral is especially important for patchy hair loss, scalp pain, itching, redness, scaling, shiny or scarred areas, rapid progression, frontal hairline recession, or hair loss that does not fit a clear trigger pattern. Scarring alopecias can cause permanent loss if not recognized early. (Mubki 2014)Timestamps00:00 — Why hair loss and shedding deserve a root-cause conversation06:44 — Telogen effluvium vs androgenetic alopecia10:31 — Ferritin, vitamin D, thyroid, B12, zinc, hormones, and ANA15:09 — When to refer for scarring alopecia or autoimmune causes17:54 — Hair washing, dandruff, scalp oil, and local inflammation24:03 — GLP-1 medications, birth control, beta blockers, statins, and SSRIs29:18 — Protein, calorie restriction, vegetarian diets, and nutrient status35:42 — Postpartum shedding, hemorrhage, breastfeeding, and recovery38:55 — Minoxidil, breastfeeding considerations, red light therapy, and PRP44:15 — Scalp massage, circulation, and realistic supportive strategiesWant 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 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.CitationsAdil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Jul;77(1):136-141.e5. doi: 10.1016/j.jaad.2017.02.054. Epub 2017 Apr 7. PMID: 28396101.Ahmed A, Alali A, Alahmadi M, Alghamdi S, Khawaji Z, Humedi A, Alqurashi S. Association between Serum Trace Elements and Telogen Effluvium: A Systematic Review and Meta-Analysis. Skin Appendage Disord. 2026 Mar 18. doi: 10.1159/000550921. Epub ahead of print. PMID: 42077991; PMCID: PMC13134860.Durusu Turkoglu IN, Turkoglu AK, Soylu S, Gencer G, Duman R. A comprehensive investigation of biochemical status in patients with telogen effluvium: Analysis of Hb, ferritin, vitamin B12, vitamin D, thyroid function tests, zinc, copper, biotin, and selenium levels. J Cosmet Dermatol. 2024;23:4277-4284. doi:10.1111/jocd.16512 Hirose A, Terauchi M, Odai T, Fudono A, Tsurane K, Sekiguchi M, Iwata M, Anzai T, Takahashi K, Miyasaka N. Investigation of exacerbating factors for postpartum hair loss: a questionnaire-based cross-sectional study. Int J Womens Dermatol. 2023 Jun 16;9(2):e084. doi: 10.1097/JW9.0000000000000084. PMID: 38323220; PMCID: PMC10846762.Hughes EC, Syed HA, Saleh D. Telogen Effluvium. 2024 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. PMID: 28613598.Malkud S. Telogen Effluvium: A Review. J Clin Diagn Res. 2015 Sep;9(9):WE01-3. doi: 10.7860/JCDR/2015/15219.6492. Epub 2015 Sep 1. PMID: 26500992; PMCID: PMC4606321.Mubki T, Rudnicka L, Olszewska M, Shapiro J. Evaluation and diagnosis of the hair loss patient: part I. History and clinical examination. J Am Acad Dermatol. 2014 Sep;71(3):415.e1-415.e15. doi: 10.1016/j.jaad.2014.04.070. PMID: 25128118.Perez SM, Vattigunta M, Kelly C, Eber A. Low-Level Laser and LED Therapy in Alopecia: A Systematic Review and Meta-Analysis. Dermatol Surg. 2025 Feb 1;51(2):179-183. doi: 10.1097/DSS.0000000000004442. Epub 2024 Oct 15. PMID: 39404126.Yao J, Zhu L, Pan M, Shen L, Tang Y, Fan L. The additive value of platelet-rich plasma to topical Minoxidil in the treatment of androgenetic alopecia: A systematic review and meta-analysis. PLoS One. 2024 Aug 28;19(8):e0308986. doi: 10.1371/journal.pone.0308986. PMID: 39197003; PMCID: PMC11356437.
• New GLP1 Risks & Exercise as a Mental Health Prescription 21.05.2026 29min

  New research is raising important clinical questions about the long-term effects of GLP-1 receptor agonist therapy during significant weight loss. A recent five-year observational study reported associations between GLP-1 use and higher rates of osteoporosis, osteomalacia, and gout in some adults with obesity and type 2 diabetes, particularly in the setting of rapid weight reduction (Wajahath et al., 2026). While GLP-1 therapies may support glycemic control, cardiometabolic health, and surgical outcomes, these findings highlight the importance of proactive monitoring and individualized patient support.In this episode, we explore practical clinical considerations, including:How clinicians may approach bone health monitoring more proactively during significant weight lossWhich patients may warrant closer nutritional or musculoskeletal assessmentSymptoms that may merit further evaluation during GLP-1 therapy, including fatigue, weakness, diffuse bone pain, or mobility-related concernsWe also discuss another emerging area of research: the role of exercise in mental health care. Drawing from a large umbrella review involving nearly 80,000 participants, we examine how aerobic exercise, walking, resistance training, and group-based movement may support depression and anxiety outcomes when implemented consistently and tailored to patient capacity (Munro et al., 2026).This conversation focuses on practical, evidence-informed strategies clinicians can integrate into care plans immediately - from resistance training and hydration strategies to helping patients build sustainable movement habits during periods of stress, fatigue, or overwhelm.Clinical Takeaways From This EpisodeRapid weight loss may increase the need for nutritional and musculoskeletal support: Emerging observational evidence suggests GLP-1 therapy during significant weight loss may be associated with higher rates of bone- and uric acid-related complications in some patients, highlighting the importance of muscle preservation, hydration, and nutritional status monitoring (Wajahath et al., 2026).Some musculoskeletal symptoms may warrant additional evaluation: Fatigue, weakness, diffuse bone discomfort, and mobility changes may justify further clinical assessment in patients experiencing rapid weight loss or reduced nutritional intake (Wajahath et al., 2026).Exercise may support both mental and metabolic health: Research suggests moderate-intensity aerobic exercise, resistance training, walking, and group movement may support mood, resilience, and long-term metabolic health outcomes when patients can engage consistently over time (Munro et al., 2026).FAQDo GLP-1 medications affect bone health?Some emerging observational evidence suggests GLP-1 receptor agonist therapy may be associated with increased rates of osteoporosis and osteomalacia during rapid weight loss in certain populations. Additional research is still needed to better understand causality, mechanisms, and which patients may be at greatest risk (Wajahath et al., 2026).What labs may help clinicians monitor patients on GLP-1 therapy?This episode discusses clinical considerations that may include alkaline phosphatase, vitamin D, calcium, phosphate, parathyroid hormone (PTH), and other markers of bone or metabolic health when clinically appropriate and individualized to the patient context (Wajahath et al., 2026).Can exercise support anxiety and depression symptoms?Research suggests aerobic exercise, walking, resistance training, and mind-body movement practices may support improvements in mood and anxiety symptoms when practiced consistently over time as part of a comprehensive care plan (Munro et al., 2026).Timestamps00:00 — Clinical questions emerging around GLP-1 therapy and rapid weight loss03:00 — Osteomalacia symptoms that may overlap with fatigue and chronic pain presentations10:33 — Why rapid weight loss may influence gout risk in some patients15:29 — The large exercise and mental health review clinicians are discussing20:50 — How to help patients build sustainable movement habitsWant 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 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.CitationsWajahath M, et al. GLP-1 Receptor Agonist Use Is Associated with Increased Risk of Osteoporosis, Gout, and Osteomalacia in Adults with Type 2 Diabetes and Obesity. 2026.Munro NR, Teague S, Somoray K, et al. Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-analysis. British Journal of Sports Medicine. 2026;60:590–599.
• Inside Mosaic Diagnostics 14.05.2026 1t

  Inside Mosaic Diagnostics: Clinical Applications of Organic Acids, Environmental, and Microbiome TestingWhat Is Mosaic Diagnostics and How Are Its Lab Tests Used in Clinical Practice?In this episode, Dr. Kate Kresge speaks with Mosaic Diagnostics CEO Scott Mattivi and Chief Medical Officer Dr. Kurt Woeller to explore how specialty laboratory testing is used in functional and integrative medicine. Mosaic Diagnostics offers tests such as organic acids, environmental exposure biomarkers, and microbiome assessments, which may help clinicians evaluate complex, multi-system presentations. These tools are typically used as part of a systems-based clinical framework, supporting pattern recognition rather than serving as standalone diagnostic tests. The discussion also explores how clinicians interpret multi-system lab data, the role of practitioner education, and how emerging technologies—such as AI-assisted tools—may support clinical efficiency and decision-making.What Does Mosaic Diagnostics Test For?Mosaic Diagnostics provides specialty lab testing commonly used in integrative and functional medicine, including:Organic acids testing (OAT)Environmental toxin and mycotoxin testingMicrobiome and gastrointestinal assessmentsMetabolic and immune-related biomarkersThese tests are designed to provide insight into biochemical pathways, microbial activity, and environmental exposures. Results are generally interpreted alongside clinical history, symptoms, and conventional labs to support individualized care.Key Clinical InsightsWhat Is Organic Acids Testing (OAT)?Organic acids testing evaluates urinary metabolites involved in intermediary metabolism. It may provide insight into:Mitochondrial functionNutrient metabolism (e.g., B vitamins, amino acids)Oxidative stress patternsMicrobial activityWhen interpreted within clinical context, OAT may support identification of metabolic patterns and inform clinical hypotheses (Gallagher, 2018).What Does Environmental Toxin Testing Measure?Environmental exposure testing evaluates biomarkers associated with compounds such as:MycotoxinsHeavy metals (in some panels)Industrial chemicalsThese tests may help characterize exposure patterns, though interpretation can be complex due to variability in exposure timing, metabolism, and elimination. Clinical relevance should be assessed cautiously and within the broader evidence base (Warth, 2013; Owolabi, 2024).Clinical TakeawaysOrganic acids testing may offer a systems-level view of metabolism and support pattern recognition when interpreted in context (Gallagher, 2018).Environmental testing may help identify exposure patterns, though clinical actionability varies (Warth, 2013; Owolabi, 2024).Specialty lab testing is most effective when used to evaluate patterns across systems, rather than isolated biomarkers.Practitioner education plays a key role in appropriate interpretation and application of these tests.AI tools may enhance data interpretation and workflow efficiency but should be used alongside clinical expertise.Who Should Listen to This Episode?This episode is designed for healthcare providers who:Use or are considering functional or integrative lab testingWork with complex, chronic, or multi-system conditionsWant to better understand organic acids testing or mycotoxin testingAre interested in clinical data interpretation strategiesAre exploring AI tools in clinical practiceFAQ: Mosaic Diagnostics and Specialty Lab TestingWhat Is Mosaic Diagnostics Known For?Mosaic Diagnostics is known for specialty laboratory testing used in functional and integrative medicine, including organic acids testing, environmental exposure assessments, and microbiome analysis.Timestamps00:00 – Introduction to Mosaic Diagnostics03:22 – Origins of organic acids testing08:26 – Expansion into environmental and microbiome testing23:41 – Environmental exposures and clinical applications31:57 – Overview of testing portfolio42:09 – Organic acids testing in practice47:41 – Innovation and AI in clinical workflowsSponsor SectionThis 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.DisclaimerThe 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 health care provider before making any changes to your health care routine.CitationsGallagher RC, Pollard L, Scott AI, Huguenin S, Goodman S, Sun Q; ACMG Biochemical Genetics Subcommittee of the Laboratory Quality Assurance Committee. Laboratory analysis of organic acids, 2018 update: a technical standard of the American College of Medical Genetics and Genomics (ACMG). Genet Med. 2018 Jul;20(7):683-691. doi: 10.1038/gim.2018.45. Epub 2018 Mar 15. PMID: 29543224.Warth B, Sulyok M, Krska R. LC-MS/MS-based multibiomarker approaches for the assessment of human exposure to mycotoxins. Anal Bioanal Chem. 2013 Jul;405(17):5687-95. doi: 10.1007/s00216-013-7011-1. Epub 2013 Jun 18. PMID: 23774829; PMCID: PMC3695324.Owolabi, Iyiola & Siwarak, Kawisara & Greer, Brett & Rajkovic, Andreja & Dall’asta, Chiara & Karoonuthaisiri, Nitsara & Uawisetwathana, Umaporn & Elliott, Christopher & Petchkongkaew, Awanwee. (2023). Applications of Mycotoxin Biomarkers in Human Biomonitoring for Exposome-Health Studies: Past, Present, and Future. Exposure and Health. 16. 1-23. 10.1007/s12403-023-00595-4. Muñoz JP, Bleak TC, Calaf GM. Glyphosate and the key characteristics of an endocrine disruptor: A review. Chemosphere. 2021 May;270:128619. doi: 10.1016/j.chemosphere.2020.128619. Epub 2020 Oct 19. PMID: 33131751.
• PANS/PANDAS: The Testing and Treatment Options You May Not Know About 07.05.2026 50min

  When OCD, anxiety, or food restriction appears overnight in a child, that’s a different clinical problem—and it requires a different lens.In this episode, we sit down with Dr. Lindsey Wells to walk through how to recognize and approach PANS and PANDAS in practice. We focus on the hallmark presentation: abrupt-onset neuropsychiatric symptoms, often with a clear “before and after” that families can describe in detail. From there, the conversation shifts to what may be driving that change—whether that’s infection, immune activation, inflammation, or broader system vulnerability.We also get practical. What does an initial workup look like? How do you think about common triggers like strep or other infections? When do you stay with foundational labs versus expanding further? And how do you support families who are often dealing with a sudden and destabilizing shift in their child’s behavior?This episode is for clinicians who want a clearer, more grounded way to recognize PANS and PANDAS—and to start thinking through these cases without overcomplicating or overinterpreting limited evidence.Clinical Highlights: PANS/PANDASAbrupt-Onset OCD in Children: Sudden onset OCD, food restriction, or severe anxiety should immediately shift your differential toward PANS/PANDASClinical Diagnosis Over Lab Reliance: There is no confirmatory test—history, timing, and symptom clustering drive diagnosis (AAP, 2025)Infection–Immune Connection: PANDAS is associated with streptococcal infection, while PANS includes broader potential triggers (Swedo et al., 1998; AAP, 2025)Practical Lab Workup: Foundational labs (CBC, inflammatory markers, autoimmune screening, nutrients) can help inform clinical direction (Vitiello, 2026)Relapsing–Remitting Course: These conditions often follow a flare-based pattern, requiring longitudinal care planning (Johnson et al., 2019)Guest IntroductionDr. Lindsey Wells is a naturopathic physician specializing in pediatric PANS and PANDAS. Her clinical work focuses on identifying potential infectious and immune contributors to abrupt-onset neuropsychiatric symptoms while supporting long-term stabilization. She is also the author of Super Sam and the Battle Against PANS/PANDAS, a children’s book designed to help families, siblings, and educators better understand these conditions.FAQWhat is PANS? PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is defined by the sudden onset of OCD or severe food restriction, along with at least two additional neuropsychiatric symptoms such as anxiety, regression, tics, sleep disruption, or urinary changes. It is a clinical diagnosis without a disease-specific biomarker (AAP, 2025).What is PANDAS? PANDAS is a subset of PANS associated with group A streptococcal infection, characterized by abrupt-onset OCD and/or tics with a relapsing-remitting course linked to infection (Swedo et al., 1998).What causes sudden OCD in children? In some cases, abrupt-onset OCD may be associated with post-infectious immune activation or neuroinflammatory processes, although mechanisms remain under investigation (Snider & Swedo, 2004).How is PANS diagnosed? PANS is diagnosed clinically based on symptom onset, pattern, and exclusion of other neurologic or psychiatric conditions. Laboratory testing supports—but does not establish—the diagnosis (AAP, 2025).What labs should be considered? A phased approach may include CBC, inflammatory markers (CRP, ESR), metabolic panel, and autoimmune screening, with additional testing guided by presentation (Vitiello, 2026).Timestamps00:00 – PANS/PANDAS overview02:03 – How to explain PANS/PANDAS to families06:33 – What is PANS? What is PANDAS? Diagnostic criteria and symptom clusters 10:20 – Why PANS/PANDAS is often missed14:06 – How is PANS diagnosed?18:37 – What causes PANS/PANDAS? Infection triggers, immune response, and neuroinflammation explained24:55 – PANS/PANDAS treatment approaches: antimicrobials, anti-inflammatories, and symptom support27:11 – Using anti-inflammatory trials in PANS: when ibuprofen response may inform clinical direction34:02 – Can teens or adults have PANS/PANDAS?41:38 – Long-term management of PANS/PANDAS: preventing flares and supporting immune resilienceSponsor SectionThis 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.DisclaimerThe 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.CitationsAmerican Academy of Pediatrics. Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Clinical Report. Pediatrics. 2025;155(3):e2024070334.Johnson M, Fernell E, Preda I, Wallin L, Fasth A, Gillberg C, Gillberg C. Paediatric acute-onset neuropsychiatric syndrome in children and adolescents: an observational cohort study. Lancet Child Adolesc Health. 2019 Mar;3(3):175-180. doi: 10.1016/S2352-4642(18)30404-8. Epub 2019 Jan 29. PMID: 30704875.Sigra S, Hesselmark E, Bejerot S. Treatment of PANDAS and PANS: a systematic review. Neurosci Biobehav Rev. 2018 Mar;86:51-65. doi: 10.1016/j.neubiorev.2018.01.001. Epub 2018 Jan 6. PMID: 29309797.Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998;155(2):264–271.Vitiello B. Clinical Utility of Medical Investigations in Pediatric Acute-Onset Neuropsychiatric Syndrome. JAMA Netw Open. 2026;9(3):e262624. doi:10.1001/jamanetworkopen.2026.2624Snider LA, Swedo SE. PANDAS: current status and directions for research. Mol Psychiatry. 2004 Oct;9(10):900-7. doi: 10.1038/sj.mp.4001542. PMID: 15241433.
• Are Your Patients Nutrient Deficient? Inflamed? Here's How to Tell 30.04.2026 42min

  There’s a category of patients every clinician recognizes immediately.They’re exhausted.Their hair is thinning.They’re getting sick more often than they used to.Their focus isn’t what it was.And their labs?“Normal.”This episode is about what gets missed in that gap.We sit down with Lara Zakaria to discuss some of the least commonly tested for (but most commonly occuring) nutrient deficiencies that can help to explain symptoms like fatigue, hair loss, impaired immune function, and reduced resilience.We walk through how a structured nutrition panel combining familiar markers like CBC and iron studies with underutilized ones like vitamin B6, folate, zinc, and RBC magnesium can reveal patterns that standard interpretations often overlook.Because the future isn’t more testing - it’s running the right labs and using smarter interpretation to uncover what’s been hiding in plain sight.Clinical Takeaways from This EpisodePattern recognition is the clinical upgrade: Interpreting CBC, iron studies, and nutrient markers together - rather than in isolation - helps connect symptoms to physiology and identify contributing drivers earlier.Iron deficiency can exist before anemia: Hemoglobin is often a late marker; early depletion may only be visible through ferritin and iron transport patterns (Dhurde, 2025).Intracellular status matters:  Serum values alone may miss functional deficiencies—markers like RBC magnesium offer insight into cellular availability and physiologic demand (Razzaque, 2018).Underutilized nutrients complete the picture: Vitamin B6 and zinc play roles in neurotransmitter pathways, immune signaling, and metabolic function—but are rarely assessed together in standard workflows.Guest IntroductionDr. Lara Zakaria is an integrative pharmacist, nutritionist, and professor specializing in Functional Medicine and Personalized Nutrition. In addition to clinical practice and teaching, her work focuses on translating complex science—spanning nutrition, natural products, diagnostics, and health technology—into clear, clinically relevant frameworks that support education, implementation, and informed decision-making. You can sign up for the Journeys webinar series with Dr. Zakaria here. FAQWhat types of symptoms should prompt nutrient testing? Fatigue, brain fog, hair loss, reduced exercise tolerance, and frequent illness are common presentations where nutrient patterns may play a role.Why isn’t hemoglobin enough to assess iron status? Hemoglobin changes occur later in the course of deficiency. Ferritin, transferrin saturation, and TIBC provide earlier insight into iron availability and storage (Dhurde, 2025).Why include markers like B6 and zinc? These nutrients are involved in neurotransmitter production, immune response, and metabolic pathways. They are often under-assessed but may contribute to overlapping symptom patterns.What’s the benefit of RBC magnesium vs serum magnesium? Serum magnesium reflects a small, tightly regulated portion of total body magnesium, while RBC magnesium offers a better proxy for intracellular status (Al Alawi, 2018).Timestamps02:36 – The new way to test for nutrient deficiencies03:55 – Building a smarter, structured nutrition panel10:54 – Vitamin D and why “adequate” isn’t always enough17:34 – Iron deficiency and early clinical clues24:43 – B vitamins and functional metabolism30:53 – Zinc: the overlooked but essential nutrient34:57 – Answering “Am I inflamed?” with data43:31 – Fatty acids and inflammation patterns48:33 – Making personalized care scalable and efficientThis 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.DisclaimerThe 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. We’ll catch you next time on the Root Cause Medicine Podcast.CitationsDhurde VS, Patel AB, Locks LM, Hibberd PL. Diagnostic performance of red cell indices in detecting iron deficiency and iron deficiency anemia among rural adolescent girls aged 14-19 years in Nagpur District. PLOS Glob Public Health. 2025 Sep 29;5(9):e0005108. doi: 10.1371/journal.pgph.0005108. PMID: 41021630; PMCID: PMC12478879. Chaudhry, H. S., & Kasarla, M. R. (2026). Microcytic hypochromic anemia. StatPearls. Retrieved March 31, 2026 from https://www.ncbi.nlm.nih.gov/books/NBK470252/Razzaque MS. Magnesium: Are We Consuming Enough? Nutrients. 2018 Dec 2;10(12):1863. doi: 10.3390/nu10121863. PMID: 30513803; PMCID: PMC6316205.Al Alawi AM, Majoni SW, Falhammar H. Magnesium and Human Health: Perspectives and Research Directions. Int J Endocrinol. 2018 Apr 16;2018:9041694. doi: 10.1155/2018/9041694. PMID: 29849626; PMCID: PMC5926493.
• Dr. Cheng Ruan on Physician Burnout, AI, and the Next Decade of Healthcare 23.04.2026 1t 11min

  Dr. Cheng Ruan is a fascinating physician on the leading edge of medicine, and in this episode we explore his story, how he thinks, and what he sees coming next in healthcare. What I loved most about this conversation is how it expands the way we think about practicing medicine - beyond protocols and productivity into something more human and sustainable. While we touch on integrative care, insurance models, and AI, the deeper thread is that physicians are being asked to evolve - not just clinically, but personally and systemically. Dr. Ruan reminds us that care isn’t just about what we prescribe, but how we listen, communicate, and design the environments we work in. It’s an invitation to step back and ask: what kind of medicine are we building, and does it truly support both our patients and ourselves?Guest IntroductionDr. Cheng Ruan, MD, is the founder of the Texas Center for Lifestyle Medicine, an integrative, insurance-based practice focused on chronic disease, mind-body medicine, and personalized care. He is also the co-founder of the Physician Transformation Institute, where he works with clinicians to address burnout, reconnect with purpose, and explore new ways of practicing medicine. His work sits at the intersection of clinical care, systems design, and emerging technology.Key Moments from This EpisodeFrom transactional to transformational care: Dr. Ruan shares a pivotal moment early in his career that led him to rethink the purpose of clinical practice and move toward a more patient-centered, root-cause approach.Medicine as a system, not a set of diagnoses: He introduces the idea of viewing health through a systems-based “flowchart,” focusing on upstream drivers rather than isolated conditions.Reframing physician burnout: The conversation shifts burnout from a workload issue to something deeper—touching on identity, alignment, and meaning in medicine.Building an insurance-based integrative model: He walks through how he created a lifestyle medicine practice that operates within traditional reimbursement structures.Group care as a tool for chronic disease: Dr. Ruan highlights how cohort-based care models may support patient engagement, accountability, and long-term behavior change.AI as a support layer in clinical practice: The episode explores how AI can assist with education, workflows, and communication - while emphasizing the need for thoughtful implementation.Digital twins and patient experience: He introduces the concept of clinician “digital twins” as a way to extend communication and improve access while maintaining consistency in care delivery.Raising resilient kids in an uncertain world: The conversation closes on a personal note, focusing on how to support the next generation through emotional safety, curiosity, and critical thinking.Timestamps00:00 – Introduction to Dr. Cheng Ruan and his work02:29 – Early life and integrative medicine background05:21 – Systems thinking and reimagining clinical care09:20 – Behavioral observation and patient insight20:54 – Physician burnout and meaning in medicine24:31 – Community, retreats, and clinician support42:42 – AI in healthcare and patient communication47:40 – Safety considerations and AI guardrails58:16 – The future of medicine and education01:06:23 – Inside his clinical model and practice designWant 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.DisclaimerThe 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.CitationsWest CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272-2281.Zhang X, Li L, Zhang Q, Le LH, Wu Y. Physician Empathy in Doctor-Patient Communication: A Systematic Review. Health Commun. 2024 May;39(5):1027-1037. doi: 10.1080/10410236.2023.2201735. Epub 2023 Apr 16. PMID: 37062918.Tang MY, Graham F, O'Donnell A, Beyer F, Richmond C, Dhami R, Sniehotta FF, Kaner EFS. Effectiveness of shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials. BMJ Open. 2024 Mar 7;14(3):e067252. doi: 10.1136/bmjopen-2022-067252. PMID: 38453205; PMCID: PMC10921542.
• Magnesium Answers with Dr. Robert Fredrickson 02.04.2026 32min

  Magnesium is one of those nutrients clinicians think they understand—until they take a closer look. In this episode, we sit down with Dr. Robert Fredrickson, author of Magnesium Answers, to unpack why this foundational mineral continues to create confusion in modern practice. We explore the gap between what standard lab testing shows and what may be happening intracellularly, how lifestyle factors like stress may influence magnesium balance, and how to think more precisely about selecting the right form for the patient in front of you. This conversation is a reminder that advancing patient care isn’t always about adding more complexity—it’s about seeing the fundamentals more clearly.Clinical Takeaways from This EpisodeWhy serum magnesium may not reflect total body or intracellular magnesium statusSerum magnesium represents a small fraction of total body stores, which may limit its utility as a standalone marker; intracellular measures like RBC magnesium may offer additional insight (NIH, 2022).Magnesium’s foundational role in ATP production and metabolic processes.Magnesium is required as a cofactor in ATP synthesis and numerous enzymatic reactions, supporting energy metabolism and overall cellular function (Gröber et al., 2015).Magnesium as a cofactor in vitamin D metabolism and nutrient synergy. Magnesium participates in multiple steps of vitamin D activation, highlighting the importance of evaluating nutrient interactions in clinical planning (Uwitonze & Razzaque, 2018).Guest IntroductionDr. Robert Fredrickson is a clinician, educator, and author of Magnesium Answers: Unlocking the Secrets of Magnesium. With a background in sports medicine and functional medicine, he focuses on helping clinicians better understand mineral balance, metabolic health, and evidence-informed supplementation strategies. He also works with Fullscript, supporting providers with clinical decision support and access to professional-grade supplements and nutraceuticals. Dr. Fredrickson also has his own podcast, the Fredrickson Health Show.FAQIs serum magnesium a reliable marker for magnesium status?Not always. Serum magnesium reflects a small percentage of total body magnesiumIntracellular markers, such as RBC magnesium, may provide additional contextInterpreting trends alongside clinical presentation may support decision-making (NIH, 2022)What factors may influence magnesium status in patients?Dietary intake and food qualityMalabsorptive disorders like celiac and IBDAlcohol intakeInsulin resistance or type 2 diabetesVitamin D deficiency (NIH, 2022)How does magnesium interact with vitamin D?Magnesium acts as a cofactor in enzymes required for vitamin D metabolismInadequate magnesium status may influence how vitamin D is processed in the body (Uwitonze & Razzaque, 2018)Key Moments (Timestamps)00:00 – Why magnesium remains overlooked in modern clinical care02:20 – Dr. Fredrickson’s shift from sports medicine to functional medicine05:32 – Limitations of serum magnesium testing in clinical practice07:27 – Understanding intracellular magnesium and RBC testing09:51 – Magnesium’s role in ATP production and metabolic function13:25 – Dietary patterns, food quality, and nutrient density challenges15:55 – How to select the appropriate form of magnesium18:33 – Magnesium citrate and GI motility considerations, including GLP-1 support20:46 – Common clinical patterns associated with low magnesium status22:09 – Safety considerations and when to individualize magnesium useSponsor MessageThis 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.DisclaimerThe 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.CitationsGröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients. 2015 Sep 23;7(9):8199-226. doi: 10.3390/nu7095388. PMID: 26404370; PMCID: PMC4586582.Rosanoff A, Weaver CM, Rude RK. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev. 2012 Mar;70(3):153-64. doi: 10.1111/j.1753-4887.2011.00465.x. Epub 2012 Feb 15. PMID: 22364157.Uwitonze AM, Razzaque MS. Role of Magnesium in Vitamin D Activation and Function. J Am Osteopath Assoc. 2018 Mar 1;118(3):181-189. doi: 10.7556/jaoa.2018.037. PMID: 29480918.National Institutes of Health. “Magnesium.” National Institutes of Health, 2022, ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/.
• Is the Hormonal Matrix the Missing Link for Your Patients? 26.03.2026 24min

  What if the real problem with hormones isn’t what’s broken… but what’s being missed? In this conversation, Dr. Cheryl Burdette invites us to rethink everything we’ve been taught about hormonal health. Instead of chasing isolated lab values or treating systems in silos, she introduces a more useful question: what if hormones only make sense when you look at how they talk to each other? We explore the concept of the hormonal matrix—a lens that connects thyroid, adrenal, and reproductive hormones into one dynamic, interdependent network. Because in the body, nothing operates alone. Signals overlap. Pathways intersect. And small imbalances can ripple across systems in ways we don’t always measure. This systems-based perspective isn’t just philosophical—it’s increasingly supported by emerging research on the cross-talk between the HPTA axis, the gut, and broader metabolic and immune signaling. When you zoom out, patterns start to appear. And when you see the pattern, your clinical decisions can change. This episode is about shifting from fragments to frameworks—and why that shift may open up entirely new possibilities for understanding and supporting hormonal health.
• The Moringa Recall & Salmonella Outbreak: What Clinicians Need to Know 19.03.2026 14min

  Are your patients putting Salmonella in their morning smoothie? That’s essentially what happened recently when people added what they believed was a safe, antioxidant-packed greens powder to their daily routine. The ingredient? Moringa. Moringa leaf powder is often marketed as a nutrient-dense botanical containing vitamins, minerals, antioxidants, and plant compounds that may support general wellness. For many people, it feels like an easy health habit: add a scoop to a smoothie and start the day feeling proactive about nutrition. But recently, moringa powder was linked to Salmonella infections that resulted in hospitalizations. In this episode, we chat through what clinicians needs to know to keep their clients safe.
• When Labels Lie: The St. John's Wort Report 12.03.2026 16min

  A recent analysis of 22 St. John’s Wort supplements purchased online found that only one actually matched its label for the key compound hypericin. Several products contained little to none of the active ingredient, and some appeared to use synthetic dyes to mimic the color of hypericin, potentially misleading simple testing methods (Now, 2025). Why does this matter? Because when a supplement doesn’t contain the ingredient it claims, patients may not receive the support they expect. That can lead to wasted money, confusing clinical outcomes, and lost trust in integrative care. In this episode of the Root Cause Medicine Podcast, we’re joined by Dr. Eric Viegas, Medical Product Manager at Fullscript, to unpack what this report means for clinicians and patients. We discuss how ingredient discrepancies can happen—from plant sourcing and manufacturing to risks in online marketplaces—and how practitioners can help protect patients from misleading products. We also explore what clinicians should look for when choosing supplements, including validated testing methods, Certificates of Analysis, and quality standards that help ensure products contain what the label promises.
• Anyone Can Order Labs Now. Who’s Interpreting Them? 05.03.2026 21min

  In this episode of the Root Cause Medicine Podcast, we explore a growing clinical reality: patients now have immediate access to advanced bloodwork but not necessarily interpretation with a clinician. In this conversation, we introduce Fullscript Journeys, the provider-led answer to direct-to-consumer lab platforms. With lab testing, AI-supported interpretations and wellness plans, and seamless follow-ups, Journeys empowers providers to deliver a modern patient experience — without compromising clinical guidance.
• Building an Integrative Pharmacy Practice with Dr. Emlah Tubuo, PharmD 19.02.2026 53min

  On this episode of Root Cause Medicine, we’re honored to share the story of Dr. Emlah Tubuo, PharmD, MS, an integrative pharmacist who came to the U.S. in 2003 with $300 in her wallet and built what many of us wish existed in every community: a pharmacy designed around whole person care. Dr. Emlah explains how growing up around infectious disease in Cameroon shaped her prevention-first mindset, and how arriving in the U.S. revealed a different challenge: chronic disease that silently progresses for years before symptoms demand urgent intervention.
• Is Creatine Safe for Kids? What Parents and Practitioners Should Know 12.02.2026 15min

  Creatine is one of the most extensively researched nutrients in sports, metabolic, and brain health, yet parents and practitioners alike have questions about its use in children and adolescents. In this episode, Dr. Kate Kresge speaks with Jeff Gladd, MD, Chief Medical Officer at Fullscript, to clarify how creatine functions in normal physiology, what the research shows about pediatric safety, and how clinicians can guide families with confidence. Together, they explore growth-related energy needs and practical clinical considerations—offering an evidence-informed framework for responsible conversations about creatine use in youth.
• Ashwagandha & Liver Injury: What Clinicians Need to Know with Dr Eric Viegas 05.02.2026 12min

  In this Root Cause Medicine podcast episode, we explore emerging concerns around ashwagandha-associated drug-induced liver injury (DILI). While ashwagandha remains one of the most widely used adaptogens in integrative medicine, recent international case reports have highlighted rare but clinically meaningful hepatic adverse events. This episode equips clinicians with a mechanistic understanding of potential risk factors, extraction methods that may increase vulnerability, and practical strategies for patient screening, education, and monitoring—without dismissing the therapeutic value of this foundational herb.
• Voice Disorders & Chronic Cough: Integrative Approaches With Dr. Linda Dahl, MD — Integrative Otolaryngologist & Voice Specialist 29.01.2026 52min

  Nearly one in three adults will experience a voice disorder at some point in their lifetime, often without realizing it may be connected to their overall health (Stachler et al., 2018). In this episode, we sit down with integrative otolaryngologist Dr. Linda Dahl to unpack how subtle changes in vocal tone, stamina, and clarity can serve as early clues to what’s happening systemically - from inflammation and hormonal shifts to nervous system stress, reflux, and microbiome changes - and what to do next depending on what you hear. From simple in-office listening strategies and targeted questions to appropriate referrals, lab considerations, and integrative support options, this episode helps clinicians effectively resolve common voice issues using a whole person approach.
• SIBO 2026 Treatment Updates: Nutrition & Adjunctive Care 22.01.2026 36min

  In part two of our SIBO series, we’re joined again by Dr. Allison Siebecker to focus on what often determines whether patients stabilize or relapse: nutritional management and supportive care during and after SIBO treatment. We explore how to use prokinetics to support migrating motor complex function, when digestive aids like bile acids and enzymes may be appropriate, and how to apply SIBO dietary frameworks as personalized, flexible tools—not rigid rules. We also cover practical approaches to suspected yeast/dysbiosis overlap, how to support gut barrier integrity without worsening fermentation, and the key myths that can derail outcomes. This episode helps clinicians move from “eradication mode” to sustainable, integrative SIBO care.