Fitness
**The Root Cause Medicine Podcast**

In each episode, we’ll meet renowned medical experts, specialists and pioneers who’ve influenced the way certain conditions and diseases are understood and treated. We focus on giving you the information you need to understand the root cause, symptoms and treatments available for specific medical conditions.

Latest Episodes:

Food, Mold, Ticks, and the Immune System with Alletess Medical Laboratory Jul 10, 2026

Show notes

Summary

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

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

Clinical Takeaways from This Episode

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

Guest Introduction

Veronica Kent

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

Website: https://foodallergy.com

Kristen Trainer, RD

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

Tests Discussed

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

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

Lifestyle & Clinical Strategies Mentioned

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

Clinician FAQ

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

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

2. When should clinicians consider specialized allergy testing?

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

3. What is component-resolved diagnostics?

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

4. What is Alpha-gal syndrome?

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

5. How are elimination diets used?

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

6. Why is patient education emphasized?

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

7. Why does laboratory quality matter?

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

8. What future developments are discussed?

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

Timestamps / Key Moments

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

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

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

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

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

00:13:23 How elimination diets and reintroduction work

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

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

00:25:38 Common misconceptions about food allergy testing

Want to elevate your practice?

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

Disclaimer

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

References

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

Perimenopause as a Portal to Power with Dr. Aviva Romm Jul 03, 2026

Show notes

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

Aviva’s story is that kind of shift.

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

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

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

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

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

By the end, something shifts.

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

Clinical Takeaways from This Episode

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

Guest Introduction

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

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

FAQ: Clinician & Patient Questions on Perimenopause and Integrative Care

What symptoms are common during perimenopause?

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

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

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

How does stress actually affect my health?

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

Key Moments from This Episode

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

Want to elevate your practice?

Disclaimer

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

Citations

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

Integrative and Functional Nutrition Dietitians: How They Amplify Care Jun 26, 2026

Show notes

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

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

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

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

Clinical Takeaways From This Episode

Behavior Change Is Often the Missing Piece

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

Food Is More Than Nutrients

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

Nutrition Is Central to Complex Chronic Disease

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

Dietitians Serve as Translators of Functional Medicine Plans

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

Team-Based Care Improves Patient Support

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

Guest Introduction

Monique Richard, MS, RDN, LDN

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

Holly Van Poots, MS, RDN

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

Sudha Raj, PhD, RDN

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

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

FAQ

What is integrative and functional nutrition?

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

How is an IFN dietitian different from traditional nutrition counseling?

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

Why are dietitians important in functional medicine practices?

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

What are patients often missing after a functional medicine visit?

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

Why is food considered more than just nutrition?

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

Timestamps

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

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

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

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

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

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

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

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

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

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

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

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

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. 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.

References

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

The PCOS Name Change and What It Means for Women’s Health Jun 18, 2026

Show notes

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

Clinical Takeaways from This Episode

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

Guest Introduction

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

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

Instagram: @waterloo_fertility_naturopath

Labs Mentioned

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

Lifestyle & Exercise Strategies Mentioned

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

Clinician FAQ

1. Why is PCOS being renamed PMOS?

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

2. Are ovarian cysts required for diagnosis?

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

3. Why is fasting insulin clinically important in PMOS?

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

4. What systems are involved in PMOS?

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

5. Can patients have PMOS without obesity?

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

6. What are the current diagnostic criteria?

Current criteria include combinations of:

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

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

7. Why is diagnosis often delayed?

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

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

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

Conversation Topics

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

Timestamps

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

02:10 - How language shapes diagnosis and care

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

05:18 - The root physiology of PMOS

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

09:33 - Why diagnosis requires a deeper clinical lens

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

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

Disclaimer

References

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

Adult Acne, Hormones, and Perimenopause: What Your Skin Is Trying to Tell You Jun 11, 2026

Show notes

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

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

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

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

Why This Matters

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

Key Clinical Takeaways

Perimenopause may contribute to acne flares

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

Adult skin requires a different acne strategy

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

Topical therapies remain foundational

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

Diet may influence acne severity

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

Supplements should be personalized

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

Vitamin B12 may be a trigger in some individuals

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

Topics Covered

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

Guest Bio

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

Timestamps

00:00 Introduction

02:04 Why adult acne develops during perimenopause

04:01 Adult acne versus teenage acne

05:00 Topical treatment approaches

07:22 Supplements and acne support

09:47 Biotin, vitamin B12, and breakouts

14:32 Acne in men versus women

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

17:04 Final thoughts and resources

Sponsor Copy

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References

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

Hair Loss: Root Causes and Treatment Options Jun 04, 2026

Show notes

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 Episode

Telogen 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 Questions

What 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)

Timestamps

00:00 — Why hair loss and shedding deserve a root-cause conversation

06:44 — Telogen effluvium vs androgenetic alopecia

10:31 — Ferritin, vitamin D, thyroid, B12, zinc, hormones, and ANA

15:09 — When to refer for scarring alopecia or autoimmune causes

17:54 — Hair washing, dandruff, scalp oil, and local inflammation

24:03 — GLP-1 medications, birth control, beta blockers, statins, and SSRIs

29:18 — Protein, calorie restriction, vegetarian diets, and nutrient status

35:42 — Postpartum shedding, hemorrhage, breastfeeding, and recovery

38:55 — Minoxidil, breastfeeding considerations, red light therapy, and PRP

44:15 — Scalp massage, circulation, and realistic supportive strategies

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

Citations

Adil 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 May 21, 2026

Show notes

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 loss
Which patients may warrant closer nutritional or musculoskeletal assessment
Symptoms that may merit further evaluation during GLP-1 therapy, including fatigue, weakness, diffuse bone pain, or mobility-related concerns

We 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 Episode

Rapid 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).

FAQ

Do 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).

Timestamps

00:00 — Clinical questions emerging around GLP-1 therapy and rapid weight loss

03:00 — Osteomalacia symptoms that may overlap with fatigue and chronic pain presentations

10:33 — Why rapid weight loss may influence gout risk in some patients

15:29 — The large exercise and mental health review clinicians are discussing

20:50 — How to help patients build sustainable movement habits

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

Citations

Wajahath 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 May 14, 2026

Show notes

Inside Mosaic Diagnostics: Clinical Applications of Organic Acids, Environmental, and Microbiome Testing

What 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 testing
Microbiome and gastrointestinal assessments
Metabolic and immune-related biomarkers

These 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 Insights

What Is Organic Acids Testing (OAT)?

Organic acids testing evaluates urinary metabolites involved in intermediary metabolism. It may provide insight into:

Mitochondrial function
Nutrient metabolism (e.g., B vitamins, amino acids)
Oxidative stress patterns
Microbial activity

When 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:

Mycotoxins
Heavy metals (in some panels)
Industrial chemicals

These 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 Takeaways

Organic 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 testing
Work with complex, chronic, or multi-system conditions
Want to better understand organic acids testing or mycotoxin testing
Are interested in clinical data interpretation strategies
Are exploring AI tools in clinical practice

FAQ: Mosaic Diagnostics and Specialty Lab Testing

What 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.

Timestamps

00:00 – Introduction to Mosaic Diagnostics

03:22 – Origins of organic acids testing

08:26 – Expansion into environmental and microbiome testing

23:41 – Environmental exposures and clinical applications

31:57 – Overview of testing portfolio

42:09 – Organic acids testing in practice

47:41 – Innovation and AI in clinical workflows

Sponsor Section

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 health care provider before making any changes to your health care routine.

Citations

Gallagher 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 May 07, 2026

Show notes

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/PANDAS

Abrupt-Onset OCD in Children: Sudden onset OCD, food restriction, or severe anxiety should immediately shift your differential toward PANS/PANDAS
Clinical 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 Introduction

Dr. 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.

FAQ

What 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).

Timestamps

00:00 – PANS/PANDAS overview

02:03 – How to explain PANS/PANDAS to families

06:33 – What is PANS? What is PANDAS? Diagnostic criteria and symptom clusters

10:20 – Why PANS/PANDAS is often missed

14:06 – How is PANS diagnosed?

18:37 – What causes PANS/PANDAS? Infection triggers, immune response, and neuroinflammation explained

24:55 – PANS/PANDAS treatment approaches: antimicrobials, anti-inflammatories, and symptom support

27:11 – Using anti-inflammatory trials in PANS: when ibuprofen response may inform clinical direction

34:02 – Can teens or adults have PANS/PANDAS?

41:38 – Long-term management of PANS/PANDAS: preventing flares and supporting immune resilience

Sponsor Section

Disclaimer

Citations

American 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.2026.2624
Snider 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 Apr 30, 2026

Show notes

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 Episode

Pattern 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 Introduction

Dr. 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.

FAQ

What 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).

Timestamps

02:36 – The new way to test for nutrient deficiencies
03:55 – Building a smarter, structured nutrition panel
10:54 – Vitamin D and why “adequate” isn’t always enough
17:34 – Iron deficiency and early clinical clues
24:43 – B vitamins and functional metabolism
30:53 – Zinc: the overlooked but essential nutrient
34:57 – Answering “Am I inflamed?” with data
43:31 – Fatty acids and inflammation patterns
48:33 – Making personalized care scalable and efficient

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. We’ll catch you next time on the Root Cause Medicine Podcast.

Citations

Dhurde 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.

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The Root Cause Medicine Podcast

Summary

Clinical Takeaways from This Episode

Guest Introduction

Veronica Kent

Kristen Trainer, RD

Tests Discussed

Lifestyle & Clinical Strategies Mentioned

Clinician FAQ

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

2. When should clinicians consider specialized allergy testing?

3. What is component-resolved diagnostics?

4. What is Alpha-gal syndrome?

5. How are elimination diets used?

6. Why is patient education emphasized?

7. Why does laboratory quality matter?

8. What future developments are discussed?

Timestamps / Key Moments

Want to elevate your practice?

Disclaimer

References

Clinical Takeaways From This Episode

Behavior Change Is Often the Missing Piece

Food Is More Than Nutrients

Nutrition Is Central to Complex Chronic Disease

Dietitians Serve as Translators of Functional Medicine Plans

Team-Based Care Improves Patient Support

Monique Richard, MS, RDN, LDN

Holly Van Poots, MS, RDN

Sudha Raj, PhD, RDN

FAQ

What is integrative and functional nutrition?

How is an IFN dietitian different from traditional nutrition counseling?

Why are dietitians important in functional medicine practices?

What are patients often missing after a functional medicine visit?

Why is food considered more than just nutrition?

Timestamps

References

Clinical Takeaways from This Episode

Guest Introduction

Labs Mentioned

Lifestyle & Exercise Strategies Mentioned

Clinician FAQ

1. Why is PCOS being renamed PMOS?

2. Are ovarian cysts required for diagnosis?

3. Why is fasting insulin clinically important in PMOS?

4. What systems are involved in PMOS?

5. Can patients have PMOS without obesity?

6. What are the current diagnostic criteria?

7. Why is diagnosis often delayed?

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

Conversation Topics

Timestamps

Disclaimer

References

Why This Matters

Key Clinical Takeaways

Perimenopause may contribute to acne flares

Adult skin requires a different acne strategy

Topical therapies remain foundational

Diet may influence acne severity

Supplements should be personalized

Vitamin B12 may be a trigger in some individuals

Topics Covered

Guest Bio

Timestamps

Sponsor Copy

References

Inside Mosaic Diagnostics: Clinical Applications of Organic Acids, Environmental, and Microbiome Testing

What Is Mosaic Diagnostics and How Are Its Lab Tests Used in Clinical Practice?

What Does Mosaic Diagnostics Test For?

Key Clinical Insights

What Is Organic Acids Testing (OAT)?

What Does Environmental Toxin Testing Measure?

Clinical Takeaways

What Is Mosaic Diagnostics Known For?

Sponsor Section

Citations