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 Array 3, 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 LearnWhy 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 Array 3 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 PugliaRobyn 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.FAQWhat 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 Array 3?Array 3 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 Array 3, 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?”Timestamps02:42 — The patients who pulled Robyn deeper into immunologyHow celiac disease and unexplained illness changed her approach to complex patients.11:41 — TG6: When gluten becomes a brain conversationWhy gluten-related immune activity isn’t necessarily confined to the gut.13:49 — Are we asking enough questions about wheat?The thinking behind Cyrex Array 3 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 storyT cells, B cells, natural killer cells, and the Cyrex Lymphocyte Map.39:25 — The abnormal result is where the investigation startsHow immune patterns can generate better clinical questions.44:20 — Stop looking for one perfect root causeRobyn’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 workupWhy 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. 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.CitationsFrazzei, 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/fulltextLeonard, 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/2648637Ma, 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/S0896841117303542Mearns, 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 practiceCoach youth sportsParent a competitive athleteWork in sports medicine, functional medicine, pediatrics, or primary careWant to better understand the foundations of long-term athletic performanceWhat You'll LearnHow Dr. Peterson gets his athletes results using only food, supplements and lifestyleCommon mistakes young athletes make when trying to optimize performanceWhy body composition and metabolic health matter more than weight aloneThe important role parents and coaches play in creating healthy performance habitsDr. Peterson's journey from emergency medicine physician to functional medicine practitionerWho 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 TakeawaysPerformance 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. 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.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/2072-6643/15/12/2724Blyth, 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.13909Cunha, 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/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/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/

How to Build a Thriving Practice Without Burning OutOne 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 ConversationLesli's journey from aspiring clinician to healthcare executive and back to patient careWhat years in corporate healthcare taught her about running a successful practiceWhy so many practitioners feel confident clinically but overwhelmed by the business side of medicineHow marketing can become an authentic extension of patient educationSimple systems that create more time, less stress, and better patient experiencesThe connection between practice design, boundaries, and practitioner well-beingBuilding a practice that reflects your strengths, values, and vision for your careerA Few Takeaways I'll Be Thinking AboutAuthentic 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 Timeline00:00 — Welcome and introduction02:30 — Lesli's journey into healthcare05:00 — Lessons from corporate healthcare10:00 — Why clinicians struggle with practice ownership18:00 — Rethinking marketing28:00 — Systems that support sustainable growth39:00 — Burnout, boundaries, and practice design48:00 — Building a practice around your values55:00 — Final reflectionsWant 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.

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 TakeawaysPlant 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 FAQ1. 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 Moments00:01:43 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 mattersBotanicals and Compounds DiscussedAshwagandha root and leafWithanolidesGlycosidesWithanoneCurcumin and curcuminoidsQuality Methods and Documents DiscussedBotanical identity testingPlant-part verificationHPTLC chemical fingerprintingStandardization testingAdulterant screeningMicrobial and heavy-metal testingCertificates of analysisThird-party testingcGMP complianceBatch-to-batch consistencyBranded ingredient researchWant 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 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.ReferencesBjörnsson, 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-111National 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/ashwagandhaNational 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

SummaryThis 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 EpisodeNot 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 IntroductionVeronica KentVeronica 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.comKristen Trainer, RDKristen 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 DiscussedNote: 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 testingEnvironmental allergy testingComponent-resolved allergy diagnosticsIgG food sensitivity testingIgA food sensitivity testingCandida antibody testing (IgG, IgA, IgM)Candida immune complex testingMold antibody testingAlpha-gal IgE testingTick-borne immune testingCeliac disease testingTotal IgE testingLifestyle & Clinical Strategies MentionedStructured elimination dietsGradual food reintroductionIndividualized meal planningRotation dietsShopping list developmentFamily-based nutrition planningReducing environmental mold exposurePersonalized patient educationLong-term dietary follow-upCollaboration between laboratory professionals and cliniciansClinician FAQ1. 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 Moments00:02:22 Veronica Kent and Kristen Trainer introduce Alletess00:03:36 Food allergy, sensitivity, candida, mold, and tick-borne testing00:04:54 How Alletess began as a specialized laboratory00:08:16 Bridging the gap between lab results and patient care00:09:27 How allergy and immunology testing has evolved00:13:23 How elimination diets and reintroduction work00:15:19 When mold-related illness testing may be warranted00:17:38 Alpha-gal syndrome and missed tick-borne allergy cases00:25:38 Common misconceptions about food allergy testingWant 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 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.ReferencesAhmed 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.23-22Cai, 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/S0360132324000684Kelso, 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.2025.1578654Platts-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.70035Santos, 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.15902Santos, 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.16345Thompson, 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 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.

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

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 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 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.