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The Root Cause Medicine Podcast: Daily Summaries Delivered
by Rupa Health
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.
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- 1 weeks ago26 min
Menopause Botanicals: Identity, Standardization & Patience
Dr. Eric Viegas joins the Root Cause Medicine Podcast to discuss an often-overlooked part of evaluating botanical supplements for menopause: whether the product being used actually matches the ingredient that was studied.The conversation focuses on five botanicals and botanical categories—black cohosh, Vitex (chasteberry), rhapontic rhubarb, maca, and soy isoflavones. Rather than framing individual herbs as simply effective or ineffective, Dr. Viegas emphasizes three considerations: identity, standardization, and patience.Identity refers to confirming the correct plant species and plant part. Standardization addresses whether relevant constituents or studied extracts are consistently represented in a product. Patience refers to allowing an appropriate evaluation period rather than judging a botanical after only a few days of use.Clinical takeawaysBotanical evidence is closely tied to the ingredient that was actually studied. Dr. Viegas emphasizes that results from research on a particular species, plant part, extract, or standardized preparation cannot automatically be generalized to every product carrying the same botanical name.Black cohosh has a substantial research history, but product characteristics matter. The episode discusses Actaea racemosa and the importance of confirming botanical identity, the appropriate plant part, and the characteristics of the extract being used. Standardized preparations feature prominently in the research discussed. (Castelo-Branco 2021) (NIDDK 2025) Vitex is discussed primarily in the context of cyclical symptoms and perimenopause. Also known as chasteberry (Vitex agnus-castus), Vitex is presented as having a stronger research history for premenstrual and cyclical symptoms than for classic postmenopausal symptoms. The episode also highlights variation in extracts and marker compounds. (Csupor 2019) Rhapontic rhubarb illustrates the importance of extract-specific evidence. The discussion focuses on the studied rhapontic rhubarb extract ERr 731 rather than treating all rhubarb preparations as interchangeable. This provides an example of why practitioners should identify the exact preparation evaluated in clinical research. (Dubey 2024) Maca presents additional standardization challenges. The episode discusses differences among maca varieties and processing methods and notes that there is not one universally dominant marker used across all products. Maca is discussed in relation to menopausal symptoms, mood, and sexual function without positioning it as a direct hormone replacement. (Lee 2011)Soy isoflavone response may vary between individuals and formulations. The conversation highlights differences among individual isoflavones and discusses equol production as one possible contributor to variability in response. <a href="https://www.
- 2 weeks ago55 min
Meet the New Voices of the Root Cause Medicine Podcast
You've been hearing new voices in the host chair lately — so this week we're pulling back the curtain to introduce them properly. Dr. Kate Kresge sits down with Dr. Holly Lucille, Dr. Lara Zakaria, and Dr. Jessica Christie for a roundtable on the winding, deeply personal paths that led each of them into root-cause medicine.A pharmacist nearly buried under her own stack of nutrition books who came out dual-licensed. A psychology student who couldn't find a medical school that took food and sleep seriously, so she built her own path. A holistic nurse turned naturopathic doctor who fought for her profession on the statehouse floor. And a host whose decade-long "mystery illness" resolved in three days once the right test was finally run. What ties them together is a stubborn refusal to stop at the easy answer — the instinct to say, let's think this through, because so often the protocol failed the patient, not the other way around.Consider this your proper introduction to the team learning and sharing what works, right alongside you.What you'll hearWhy every one of these clinicians came to functional medicine as a "detective" — and often as a patient first.Dr. Lara Zakaria's path from community pharmacist to dual-licensed nutritionist, and a clear-eyed explainer on what the CNS credential actually requires.Dr. Jessica Christie's move from developmental psychology into naturopathic medicine, becoming her own first patient, and finding her way into fertility and women's health.Dr. Holly Lucille's journey through holistic nursing and naturopathic medicine — and helping pass California's ND licensing bill (SB 907) in 2004.Dr. Kate Kresge's decade of misdiagnosed illness that resolved in days once the root cause was identified — and why it reshaped how she thinks about mental-health symptoms with a physiological root cause.How Rupa and Fullscript coming together puts labs, education, boot camps, webinars and AI-assisted evidence in one free place for clinicians.The team's reframe of "the patient failed treatment" into "the treatment failed the patient" — and what patient-centered care really means.Key themesLet's think things through — clinical reasoning over the 15-minute prescribe-and-go visit.The empowered, informed patient is a good thing; clinicians add the nuance.Whole-person care means mind and body are never truly separate.Personalization: the protocol fits the patient, not the other way around.Timestamps02:21 — Welcoming the hosts03:13 — Naming the listeners05:35 — "Let's think things through"06:40 — Nuance and the empowered patient09:02 — Dr. Lara Zakaria's story<strong style="background-color:
- 3 weeks ago54 min
C15:0, ferroptosis, and metabolic health: What practitioners should know
Dr. Lara Zakaria is joined by Stephanie Venn-Watson, DVM, MPH, to explore emerging research on pentadecanoic acid (C15:0), an odd-chain saturated fatty acid initially studied through research involving bottlenose dolphins.The conversation connects C15:0 with cell-membrane composition, lipid peroxidation, ferroptosis, iron metabolism, metabolic health, and steatotic liver disease. It also examines research on circulating C15:0 as a biomarker associated with cardiometabolic outcomes and early human trials of C15:0 supplementation. (Imamura 2018) (Sawh 2021) C15:0 has been proposed as a candidate essential fatty acid, however, that classification and a specific human “C15:0 deficiency syndrome” remain emerging hypotheses rather than established clinical diagnoses.Clinical TakeawaysFerroptosis is an iron-dependent form of regulated cell death. First characterized in 2012, ferroptosis involves iron-dependent lipid peroxidation and differs mechanistically from apoptosis and other forms of cell death. (Dixon 2012) Polyunsaturated fatty acids in phospholipids are particularly relevant substrates for ferroptotic lipid peroxidation. (Yang 2016)C15:0 is an odd-chain saturated fatty acid being studied for metabolic effects. Pentadecanoic acid, or C15:0, is found in dairy fat and smaller amounts in other foods. Higher circulating C15:0 has been associated with lower incidence of type 2 diabetes in prospective observational research, but these associations do not establish that C15:0 itself prevents diabetes. (Imamura 2018)Calling C15:0 an “essential fatty acid” remains an emerging scientific proposal. Experimental work has proposed C15:0 as a candidate essential fatty acid based on dietary exposure, biological activity, and associations between circulating levels and health outcomes. More research is needed before C15:0 can be treated as equivalent to the established essential fatty acids linoleic acid and alpha-linolenic acid. (Venn-Watson 2020) (Venn-Watson 2022) Metabolic hyperferritinemia is a recognized clinical framework, but it is not synonymous with ferroptosis or C15:0 deficiency. Metabolic hyperferritinemia describes elevated ferritin occurring with metabolic dysfunction. Ferritin is also an acute-phase reactant, so elevated values require evaluation in clinical context rather than being interpreted as tissue iron overload by themselves. (Valenti 2023)Human C15:0 supplementation evidence is early. Within this broader metabolic context, circulating C15:0 is an emerging biomarker of interest. In a small 12-week randomized, placebo-controlled
- 4 weeks ago1h 6m
Medicine for All People: Food, Nature, Community, and Joy as Part of Whole-Person Care
Dr. Geeta Maker-Clark joins the Root Cause Medicine Podcast to discuss ideas from her book, Medicine for All People: Science and Ancient Wisdom for Revolutionary Healing. Drawing from family medicine, integrative medicine, culinary medicine, community health and her own upbringing, she explores a broader view of medicine that includes food, plants, nature, community, service, trust, dance, gratitude, and play.The conversation centers on a simple idea: health is shaped not only by what happens in the clinic, but also by the environments, relationships, resources, cultural traditions, and daily practices that surround a person. Dr. Maker-Clark organizes these ideas into three areas—medicines of the earth, medicines of connection, and medicines of spirit—and discusses how practitioners can think about them alongside conventional medical care.Clinical TakeawaysFood and nutrition are part of whole-person care. Dr. Maker-Clark describes food as a central part of her clinical philosophy and discusses culinary medicine as a way to combine nutrition education with practical cooking skills. Her University of Chicago culinary medicine work includes medical students, community members, and middle school students, with an emphasis on nutrition literacy, accessibility, and culturally relevant food education. (Maker-Clark 2023)Nature exposure may support stress regulation and mental well-being. The episode frames time outdoors and connection with the natural environment as accessible ways to support well-being. Research has associated nature exposure with lower perceived and physiologic stress, although study designs, settings, and outcomes vary. (Shuda 2020)Social connection deserves attention in clinical assessment. Dr. Maker-Clark emphasizes community, belonging, and service as dimensions of health. Research supports associations between loneliness and social isolation and adverse cardiovascular, brain, mental health, and inflammatory outcomes, although mechanisms and the effectiveness of specific interventions continue to be studied. (Cené 2022) (Smith 2020)Trust includes both healthcare relationships and self-trust. The conversation explores how previous negative healthcare experiences, chronic illness, and unexplained symptoms can affect trust. Dr. Maker-Clark describes rebuilding trust through relationships and small, achievable commitments rather than treating trust as something patients should simply provide.Dance combines movement, cognition, emotion, and often social interaction. Dance is presented as an accessible form of joyful movement rather than a replacement for clinical care. Research suggests dance can influence cognitive and neuroplasticity-related outcomes, particularly in older adults, although effects vary by population and intervention. (Teixeira-Machado 2019) (Hewston 2021)Gratitude and play can be viewed as practices that support well-being. Gratitude interventions have shown generally modest benefits for well-being and some psychological outcomes. <a href="https://pubmed.ncbi.nlm.nih.gov/37
- Aug 27, 202624 min
Beyond the Label: What Matters in Curcumin and Boswellia Quality
Dr. Holly Lucille, ND, is joined by Ellie Abraham, PhD, to explain why two curcumin or Boswellia supplements may not be equivalent, even when the front of the label looks similar. The conversation covers boswellic acid standardization, AKBA, curcumin delivery systems, piperine, botanical sourcing, finished-product testing, certificates of analysis, and supply-chain controls. Research supports meaningful variation in Boswellia composition and curcumin formulations, making the specific extract and formulation relevant when interpreting product labels and published evidence. (Meins 2016) (Mimica 2022)Clinical Takeaways“Boswellic acids” describes a group of compounds. Boswellia preparations can contain different proportions of individual boswellic acids, including AKBA, KBA, and alpha- and beta-boswellic acids. Products with similar total boswellic acid claims therefore may not have identical chemical profiles. (Mannino 2016) (Meins 2016)Curcumin formulation matters. Conventional oral curcumin has low bioavailability, and formulations including phytosomes, liposomes, micelles, and piperine combinations have been studied as strategies to alter absorption. However, different formulations should not automatically be treated as interchangeable because comparative pharmacokinetic results vary. (Hegde 2023) (Fança-Berthon 2021)Standardization provides more information than an ingredient name alone. Botanical composition can vary with species, growing conditions, extraction, processing, and other supply-chain factors. Standardization and appropriate quality controls can help establish more consistent composition. (Ribnicky 2008) (Sarma 2021)Potency is only one part of quality. Botanical quality also involves identity, purity, contaminants, adulteration, and finished-product verification. Published investigations have identified labeling and authenticity concerns in both Boswellia and turmeric/curcumin products. (Meins 2016)<a href="https://pubmed.ncbi.nlm.nih.gov/3
- Aug 22, 202659 min
Immunometabolism: What Your Immune System Can Teach You About Metabolic Health
What if metabolism and immune function aren’t separate systems, but part of one continuous conversation? In this episode of the Root Cause Medicine Podcast, Dr. Jeffrey Bland joins Kate Kresge to explore immunometabolism, the study of how immune activity and cellular metabolism influence one another. They discuss how inflammation can affect energy use across tissues, why metabolic health is about far more than weight, and how systems biology is changing the way clinicians think about chronic disease. (O'Neill 2016)Dr. Bland also introduces emerging inflammatory indices—including the Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI)—that can be derived from components of a routine CBC with differential. (Islam 2024) The conversation explores their potential role as contextual markers of inflammatory activity, while emphasizing how Journeys can help to automate CBC calculations and help create customized reports for practitioners using blood labs values, history, symptoms and more. The episode closes with a practical look at nutrition, polyphenol-rich foods, lifestyle medicine, large-scale health data, and the growing potential for personalized care.Clinical Takeaways from This EpisodeImmunometabolism connects immune signaling with cellular energy use. Immune cells alter their metabolic activity when activated, and immune-derived signals can influence the function of tissues throughout the body. (O'Neill 2016)Chronic inflammation is a systems-level process. Rather than viewing inflammation as an isolated problem within one organ, immunometabolism highlights communication among adipose tissue, the liver, brain, muscles, immune cells, and other tissues. (Burak 2024) (Juárez-Rojas 2024)A CBC may contain more information than clinicians traditionally use. SII and SIRI combine routinely measured blood-cell populations into indices being studied as markers of systemic inflammatory and immune activity. (Islam 2024) They should be interpreted in clinical context rather than used independently to diagnose disease or dictate treatment. (Mangoni 2024)Lifestyle interventions affect multiple biological systems at once. Dr. Bland discusses dietary patterns rich in diverse plant compounds alongside movement, sleep, and stress management as components of a broader approach to metabolic and immune health. <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8803482/" target="_b
- Aug 17, 202612 min
One Hidden Immune Trigger Everyone Misses: A Complex Autoimmune Case Study
What happens when a patient with multiple autoimmune conditions has already addressed the obvious contributors—but continues to experience flares?In this Root Cause Medicine Podcast case study, Dr. Kate Kreske sits down with clinical nutritionist and IFM-certified practitioner Robyn Puglia to explore a complex case involving polyautoimmunity and persistent immune dysregulation. The patient had already worked with multiple practitioners and undergone extensive evaluation, including assessments related to gut health, food reactivity, mold, and stress. Yet something was still being missed.Robyn explains how additional testing shifted her attention away from the gut and toward an unexpected area: the respiratory tract. She walks through how those findings changed her clinical thinking, why complex cases sometimes require practitioners to reconsider their assumptions, and what happened when the care plan was adjusted based on this new information.The conversation offers an important reminder for practitioners: deeper testing can sometimes provide useful clues, but results need to be interpreted within the broader clinical picture rather than treated as a diagnosis on their own.Key TakeawaysHow Robyn approaches highly complex patients who have already addressed many common contributorsWhy gut health should not automatically be assumed to be the primary driver of every autoimmune presentationHow testing identified a respiratory microbial pattern that had not been clinically obviousWhy laboratory findings are most useful when interpreted alongside symptoms, history, prior testing, and the overall clinical pictureHow unexpected findings can change clinical decision-making in complex casesWhy an individual case can illustrate clinical reasoning without establishing that the same testing or intervention will produce similar outcomes in other patientsEpisode HighlightsWhen the obvious answers have already been exploredRobyn describes her practice as serving patients at the “zebra” or even “unicorn” stage—people who have often seen multiple experienced practitioners and already addressed common areas such as nutrition, metabolic health, circadian rhythms, stress, and gut health.Looking beyond the gut in autoimmunityThe featured patient had four autoimmune conditions and continued experiencing immune dysregulation and flares despite significant previous investigation and improvement. Rather than assuming the gastrointestinal tract remained the primary contributor, Robyn expanded the investigation.An unexpected respiratory findingTesting suggested a respiratory tract microbial pattern despite the absence of obvious respiratory symptoms. This finding shifted Robyn's clinical hypothesis and became an important part of how she approached the case.Practitioner TakeawayWhen a complex patient has already addressed the most plausible contributors but continues to experience symptoms, repeating the same investigation may not provide the missing answer. Consider stepping back and asking whether another system, exposure, infection, or contributor deserves evaluation.At the same time, avoid allowing a single specialized test result to become the new explanation for the entire case. Use testing to inform clinical reasoning alongside the patient's history, symptoms, conventional evaluation, and other relevant findings.Want to elevate your practice? This episode is sponsored by <a href="https://fullscript.com/?utm_source=fame&utm_medium=podcast&utm_campaign=fs_provider_2026-01_
- Aug 13, 20261h 7m
TG6, Lymphocyte Patterns and Early Autoimmunity
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. <a href="https://www.cghjournal.org/article/S1542-3565(19)30278-2/fulltext"
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About 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.
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