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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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- Yesterday37 min
Hair Loss: Root Causes and Treatment Options
Hair loss can feel deeply personal, especially when it happens after illness, stress, rapid weight loss, postpartum changes, or a hormonal transition. In this episode, Dr. Mamina Turegano joins Dr. Kate Kresge to unpack the most common patterns of hair shedding and thinning, including telogen effluvium and androgenetic alopecia.Dr. Turegano explains why hair loss is often multifactorial and why the timing matters: shedding may appear months after a physiologic or emotional stressor. She walks through the root-cause workup she considers in practice, including thyroid function, ferritin, vitamin D, B12, zinc, sex hormones, inflammation, scalp health, and medication history.The conversation also covers postpartum hair loss, dandruff and scalp inflammation, protein intake, GLP-1-related weight loss, birth control changes, and evidence-informed options such as minoxidil, red light therapy, scalp massage, and PRP. Throughout the episode, Dr. Turegano brings a practical, compassionate approach to helping patients understand what may be driving hair loss and when a dermatology referral matters.Clinical Takeaways from This EpisodeTelogen effluvium timing matters: Diffuse shedding often appears two to four months after a stressor such as illness, surgery, childbirth, hemorrhage, crash dieting, low protein intake, thyroid dysfunction, or medication changes. (Malkud 2015)(Hughes 2024)Pattern recognition guides the workup: Telogen effluvium, androgenetic alopecia, alopecia areata, traction alopecia, and scarring alopecias can look different clinically, which is why scalp exam and referral are important when diagnosis is uncertain. (Mubki 2014)Nutrient status can inform care: Ferritin, vitamin D, B12, zinc, and thyroid markers may help identify contributing factors in selected patients, though deficiencies are not the only explanation for shedding. (Ahmed 2026)(Durusu 2024)Postpartum shedding is common but still deserves context: Hormonal shifts, delivery-related stress, sleep disruption, breastfeeding, and blood loss may all contribute, and persistent or patterned loss should be evaluated. (Hirose 2023)Treatment should match the diagnosis: Topical minoxidil, low-level laser therapy, and PRP have evidence for androgenetic alopecia, but protocols, response, safety considerations, and patient context vary. (Adil 2017)(Perez 2024)(Yao 2024)Guest Bio: Mamina Turegano, MD, is a triple board-certified dermatologist, internist, and dermatopathologist based in New Orleans. She specializes in medical, cosmetic, and integrative dermatology, blending conventional and holistic approaches to skin health. With over 2 million followers across social media, she shares dermatologist-backed skincare and wellness insights with a broad audience. She also co-hosts a podcast, called Skin Deep MDs, has been published in leading medical journals, and frequently contributes her expertise to major press outlets, TV, and beauty publications.Frequently Asked QuestionsWhat is telogen effluvium?Telogen effluvium is a form of diffuse, nonscarring hair shedding that often follows a physiologic or emotional stressor. The shedding commonly appears a few months after the trigger rather than immediately. (Malkud 2015)(Hughes 2024)What labs may be useful for hair shedding?Depending on the patient’s history and exam, clinicians may consider CBC, ferritin, thyroid markers, vitamin D, B12, zinc, and selected hormone testing. Lab results should be interpreted in context rather than used as a stand-alone explanation. (Malkud 2015)(Durusu 2024)Can postpartum hair loss be normal?Postpartum shedding is comm
- 2 weeks ago29 min
New GLP1 Risks & Exercise as a Mental Health Prescription
New research is raising important clinical questions about the long-term effects of GLP-1 receptor agonist therapy during significant weight loss. A recent five-year observational study reported associations between GLP-1 use and higher rates of osteoporosis, osteomalacia, and gout in some adults with obesity and type 2 diabetes, particularly in the setting of rapid weight reduction (Wajahath et al., 2026). While GLP-1 therapies may support glycemic control, cardiometabolic health, and surgical outcomes, these findings highlight the importance of proactive monitoring and individualized patient support.In this episode, we explore practical clinical considerations, including:How clinicians may approach bone health monitoring more proactively during significant weight lossWhich patients may warrant closer nutritional or musculoskeletal assessmentSymptoms that may merit further evaluation during GLP-1 therapy, including fatigue, weakness, diffuse bone pain, or mobility-related concernsWe also discuss another emerging area of research: the role of exercise in mental health care. Drawing from a large umbrella review involving nearly 80,000 participants, we examine how aerobic exercise, walking, resistance training, and group-based movement may support depression and anxiety outcomes when implemented consistently and tailored to patient capacity (Munro et al., 2026).This conversation focuses on practical, evidence-informed strategies clinicians can integrate into care plans immediately - from resistance training and hydration strategies to helping patients build sustainable movement habits during periods of stress, fatigue, or overwhelm.Clinical Takeaways From This EpisodeRapid weight loss may increase the need for nutritional and musculoskeletal support: Emerging observational evidence suggests GLP-1 therapy during significant weight loss may be associated with higher rates of bone- and uric acid-related complications in some patients, highlighting the importance of muscle preservation, hydration, and nutritional status monitoring (Wajahath et al., 2026).Some musculoskeletal symptoms may warrant additional evaluation: Fatigue, weakness, diffuse bone discomfort, and mobility changes may justify further clinical assessment in patients experiencing rapid weight loss or reduced nutritional intake (Wajahath et al., 2026).Exercise may support both mental and metabolic health: Research suggests moderate-intensity aerobic exercise, resistance training, walking, and group movement may support mood, resilience, and long-term metabolic health outcomes when patients can engage consistently over time (Munro et al., 2026).FAQDo GLP-1 medications affect bone health?Some emerging observational evidence suggests GLP-1 receptor agonist therapy may be associated with increased rates of osteoporosis and osteomalacia during rapid weight loss in certain populations. Additional research is still needed to better understand causality, mechanisms, and which patients may be at greatest risk (Wajahath et al., 2026).What labs may help clinicians monitor patients on GLP-1 therapy?This episode discusses clinical considerations that may include alkaline phosphatase, vitamin D, calcium, phosphate, parathyroid hormone (PTH), and other markers of bone or metabolic health when clinically appropriate and individualized to the patient context (Wajahath et al., 2026).Can exercise support anxiety and depression symptoms?Research suggests aerobic exercise, walking, resistance training, and mind-body movement practices may support improvements in mood and anxiety symptoms when practiced consistently over time as part of a comprehensive care plan (Munro et al., 2026).Timestamps<p
- 3 weeks ago1h 0m
Inside Mosaic Diagnostics
Inside Mosaic Diagnostics: Clinical Applications of Organic Acids, Environmental, and Microbiome TestingWhat Is Mosaic Diagnostics and How Are Its Lab Tests Used in Clinical Practice?In this episode, Dr. Kate Kresge speaks with Mosaic Diagnostics CEO Scott Mattivi and Chief Medical Officer Dr. Kurt Woeller to explore how specialty laboratory testing is used in functional and integrative medicine. Mosaic Diagnostics offers tests such as organic acids, environmental exposure biomarkers, and microbiome assessments, which may help clinicians evaluate complex, multi-system presentations. These tools are typically used as part of a systems-based clinical framework, supporting pattern recognition rather than serving as standalone diagnostic tests. The discussion also explores how clinicians interpret multi-system lab data, the role of practitioner education, and how emerging technologies—such as AI-assisted tools—may support clinical efficiency and decision-making.What Does Mosaic Diagnostics Test For?Mosaic Diagnostics provides specialty lab testing commonly used in integrative and functional medicine, including:Organic acids testing (OAT)Environmental toxin and mycotoxin testingMicrobiome and gastrointestinal assessmentsMetabolic and immune-related biomarkersThese tests are designed to provide insight into biochemical pathways, microbial activity, and environmental exposures. Results are generally interpreted alongside clinical history, symptoms, and conventional labs to support individualized care.Key Clinical InsightsWhat Is Organic Acids Testing (OAT)?Organic acids testing evaluates urinary metabolites involved in intermediary metabolism. It may provide insight into:Mitochondrial functionNutrient metabolism (e.g., B vitamins, amino acids)Oxidative stress patternsMicrobial activityWhen interpreted within clinical context, OAT may support identification of metabolic patterns and inform clinical hypotheses (Gallagher, 2018).What Does Environmental Toxin Testing Measure?Environmental exposure testing evaluates biomarkers associated with compounds such as:MycotoxinsHeavy metals (in some panels)Industrial chemicalsThese tests may help characterize exposure patterns, though interpretation can be complex due to variability in exposure timing, metabolism, and elimination. Clinical relevance should be assessed cautiously and within the broader evidence base (Warth, 2013; Owolabi, 2024).Clinical TakeawaysOrganic acids testing may offer a systems-level view of metabolism and support pattern recognition when interpreted in context (Gallagher, 2018).Environmental testing may help identify exposure patterns, though clinical actionability varies (Warth, 2013; Owolabi, 2024).<span style="background-color
- 4 weeks ago50 min
PANS/PANDAS: The Testing and Treatment Options You May Not Know About
When OCD, anxiety, or food restriction appears overnight in a child, that’s a different clinical problem—and it requires a different lens.In this episode, we sit down with Dr. Lindsey Wells to walk through how to recognize and approach PANS and PANDAS in practice. We focus on the hallmark presentation: abrupt-onset neuropsychiatric symptoms, often with a clear “before and after” that families can describe in detail. From there, the conversation shifts to what may be driving that change—whether that’s infection, immune activation, inflammation, or broader system vulnerability.We also get practical. What does an initial workup look like? How do you think about common triggers like strep or other infections? When do you stay with foundational labs versus expanding further? And how do you support families who are often dealing with a sudden and destabilizing shift in their child’s behavior?This episode is for clinicians who want a clearer, more grounded way to recognize PANS and PANDAS—and to start thinking through these cases without overcomplicating or overinterpreting limited evidence.Clinical Highlights: PANS/PANDASAbrupt-Onset OCD in Children: Sudden onset OCD, food restriction, or severe anxiety should immediately shift your differential toward PANS/PANDASClinical Diagnosis Over Lab Reliance: There is no confirmatory test—history, timing, and symptom clustering drive diagnosis (AAP, 2025)Infection–Immune Connection: PANDAS is associated with streptococcal infection, while PANS includes broader potential triggers (Swedo et al., 1998; AAP, 2025)Practical Lab Workup: Foundational labs (CBC, inflammatory markers, autoimmune screening, nutrients) can help inform clinical direction (Vitiello, 2026)Relapsing–Remitting Course: These conditions often follow a flare-based pattern, requiring longitudinal care planning (Johnson et al., 2019)Guest IntroductionDr. Lindsey Wells is a naturopathic physician specializing in pediatric PANS and PANDAS. Her clinical work focuses on identifying potential infectious and immune contributors to abrupt-onset neuropsychiatric symptoms while supporting long-term stabilization. She is also the author of Super Sam and the Battle Against PANS/PANDAS, a children’s book designed to help families, siblings, and educators better understand these conditions.FAQWhat is PANS? PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is defined by the sudden onset of OCD or severe food restriction, along with at least two additional neuropsychiatric symptoms such as anxiety, regression, tics, sleep disruption, or urinary changes. It is a clinical diagnosis without a disease-specific biomarker (AAP, 2025).What is PANDAS? PANDAS is a subset of PANS associated with group A streptococcal infection, characterized by abrupt-onset OCD and/or tics with a relapsing-remitting course linked to infection (Swedo et al., 1998).What causes sudden OCD in children? In some cases, abrupt-onset OCD may be associated with post-infectious immune activation or neuroinflammatory processes, although mechanisms remain under investigation (Snider & Swedo, 2004).How is PANS diagnosed? PANS is diagnosed clinically based on symptom onset, pattern, and exclusion of other neurologic or psychiatric conditions. Laboratory testing supports—bu
- Apr 30, 202642 min
Are Your Patients Nutrient Deficient? Inflamed? Here's How to Tell
There’s a category of patients every clinician recognizes immediately.They’re exhausted.Their hair is thinning.They’re getting sick more often than they used to.Their focus isn’t what it was.And their labs?“Normal.”This episode is about what gets missed in that gap.We sit down with Lara Zakaria to discuss some of the least commonly tested for (but most commonly occuring) nutrient deficiencies that can help to explain symptoms like fatigue, hair loss, impaired immune function, and reduced resilience.We walk through how a structured nutrition panel combining familiar markers like CBC and iron studies with underutilized ones like vitamin B6, folate, zinc, and RBC magnesium can reveal patterns that standard interpretations often overlook.Because the future isn’t more testing - it’s running the right labs and using smarter interpretation to uncover what’s been hiding in plain sight.Clinical Takeaways from This EpisodePattern recognition is the clinical upgrade: Interpreting CBC, iron studies, and nutrient markers together - rather than in isolation - helps connect symptoms to physiology and identify contributing drivers earlier.Iron deficiency can exist before anemia: Hemoglobin is often a late marker; early depletion may only be visible through ferritin and iron transport patterns (Dhurde, 2025).Intracellular status matters: Serum values alone may miss functional deficiencies—markers like RBC magnesium offer insight into cellular availability and physiologic demand (Razzaque, 2018).Underutilized nutrients complete the picture: Vitamin B6 and zinc play roles in neurotransmitter pathways, immune signaling, and metabolic function—but are rarely assessed together in standard workflows.Guest IntroductionDr. Lara Zakaria is an integrative pharmacist, nutritionist, and professor specializing in Functional Medicine and Personalized Nutrition. In addition to clinical practice and teaching, her work focuses on translating complex science—spanning nutrition, natural products, diagnostics, and health technology—into clear, clinically relevant frameworks that support education, implementation, and informed decision-making. You can sign up for the Journeys webinar series with Dr. Zakaria here. FAQWhat types of symptoms should prompt nutrient testing? Fatigue, brain fog, hair loss, reduced exercise tolerance, and frequent illness are common presentations where nutrient patterns may play a role.Why isn’t hemoglobin enough to assess iron status? Hemoglobin changes occur later in the course of deficiency. Ferritin, transferrin saturation, and TIBC provide earlier insight into iron availability and storage (Dhurde, 2025).Why include markers like B6 and zinc? These nutrients are involved in neurotransmitter production, immune response, and metabolic pathways. They are often under-assessed but may contribute to overlapping symptom patterns.What’s the benefit of RBC magnesium vs serum magne
- Apr 23, 20261h 11m
Dr. Cheng Ruan on Physician Burnout, AI, and the Next Decade of Healthcare
Dr. Cheng Ruan is a fascinating physician on the leading edge of medicine, and in this episode we explore his story, how he thinks, and what he sees coming next in healthcare. What I loved most about this conversation is how it expands the way we think about practicing medicine - beyond protocols and productivity into something more human and sustainable. While we touch on integrative care, insurance models, and AI, the deeper thread is that physicians are being asked to evolve - not just clinically, but personally and systemically. Dr. Ruan reminds us that care isn’t just about what we prescribe, but how we listen, communicate, and design the environments we work in. It’s an invitation to step back and ask: what kind of medicine are we building, and does it truly support both our patients and ourselves?Guest IntroductionDr. Cheng Ruan, MD, is the founder of the Texas Center for Lifestyle Medicine, an integrative, insurance-based practice focused on chronic disease, mind-body medicine, and personalized care. He is also the co-founder of the Physician Transformation Institute, where he works with clinicians to address burnout, reconnect with purpose, and explore new ways of practicing medicine. His work sits at the intersection of clinical care, systems design, and emerging technology.Key Moments from This EpisodeFrom transactional to transformational care: Dr. Ruan shares a pivotal moment early in his career that led him to rethink the purpose of clinical practice and move toward a more patient-centered, root-cause approach.Medicine as a system, not a set of diagnoses: He introduces the idea of viewing health through a systems-based “flowchart,” focusing on upstream drivers rather than isolated conditions.Reframing physician burnout: The conversation shifts burnout from a workload issue to something deeper—touching on identity, alignment, and meaning in medicine.Building an insurance-based integrative model: He walks through how he created a lifestyle medicine practice that operates within traditional reimbursement structures.Group care as a tool for chronic disease: Dr. Ruan highlights how cohort-based care models may support patient engagement, accountability, and long-term behavior change.AI as a support layer in clinical practice: The episode explores how AI can assist with education, workflows, and communication - while emphasizing the need for thoughtful implementation.Digital twins and patient experience: He introduces the concept of clinician “digital twins” as a way to extend communication and improve access while maintaining consistency in care delivery.Raising resilient kids in an uncertain world: The conversation closes on a personal note, focusing on how to support the next generation through emotional safety, curiosity, and critical thinking.Timestamps00:00 – Introduction to Dr. Cheng Ruan and his work02:29 – Early life and integrative medicine background05:21 – Systems thinking and reimagining clinical care09:20 – Behavioral observation and patient insight20:54 – Physician burnout and meaning in medicine24:31 – Community, retreats, and clinician support42:42 – AI in healthcare and patient communication47:40 – Safety considerations and AI guardrails58:16 – The future of medicine and education01:06:23 – Inside his clinical model and practice designWant to elevate your practice? This episode is sponsored by <a href="https://fullscript.c
- Apr 2, 202632 min
Magnesium Answers with Dr. Robert Fredrickson
Magnesium is one of those nutrients clinicians think they understand—until they take a closer look. In this episode, we sit down with Dr. Robert Fredrickson, author of Magnesium Answers, to unpack why this foundational mineral continues to create confusion in modern practice. We explore the gap between what standard lab testing shows and what may be happening intracellularly, how lifestyle factors like stress may influence magnesium balance, and how to think more precisely about selecting the right form for the patient in front of you. This conversation is a reminder that advancing patient care isn’t always about adding more complexity—it’s about seeing the fundamentals more clearly.Clinical Takeaways from This EpisodeWhy serum magnesium may not reflect total body or intracellular magnesium statusSerum magnesium represents a small fraction of total body stores, which may limit its utility as a standalone marker; intracellular measures like RBC magnesium may offer additional insight (NIH, 2022).Magnesium’s foundational role in ATP production and metabolic processes.Magnesium is required as a cofactor in ATP synthesis and numerous enzymatic reactions, supporting energy metabolism and overall cellular function (Gröber et al., 2015).Magnesium as a cofactor in vitamin D metabolism and nutrient synergy. Magnesium participates in multiple steps of vitamin D activation, highlighting the importance of evaluating nutrient interactions in clinical planning (Uwitonze & Razzaque, 2018).Guest IntroductionDr. Robert Fredrickson is a clinician, educator, and author of Magnesium Answers: Unlocking the Secrets of Magnesium. With a background in sports medicine and functional medicine, he focuses on helping clinicians better understand mineral balance, metabolic health, and evidence-informed supplementation strategies. He also works with Fullscript, supporting providers with clinical decision support and access to professional-grade supplements and nutraceuticals. Dr. Fredrickson also has his own podcast, the Fredrickson Health Show.FAQIs serum magnesium a reliable marker for magnesium status?Not always. Serum magnesium reflects a small percentage of total body magnesiumIntracellular markers, such as RBC magnesium, may provide additional contextInterpreting trends alongside clinical presentation may support decision-making (NIH, 2022)What factors may influence magnesium status in patients?Dietary intake and food qualityMalabsorptive disorders like celiac and IBDAlcohol intakeInsulin resistance or type 2 diabetesVitamin D deficie
- Mar 26, 202624 min
Is the Hormonal Matrix the Missing Link for Your Patients?
What if the real problem with hormones isn’t what’s broken… but what’s being missed? In this conversation, Dr. Cheryl Burdette invites us to rethink everything we’ve been taught about hormonal health. Instead of chasing isolated lab values or treating systems in silos, she introduces a more useful question: what if hormones only make sense when you look at how they talk to each other? We explore the concept of the hormonal matrix—a lens that connects thyroid, adrenal, and reproductive hormones into one dynamic, interdependent network. Because in the body, nothing operates alone. Signals overlap. Pathways intersect. And small imbalances can ripple across systems in ways we don’t always measure. This systems-based perspective isn’t just philosophical—it’s increasingly supported by emerging research on the cross-talk between the HPTA axis, the gut, and broader metabolic and immune signaling. When you zoom out, patterns start to appear. And when you see the pattern, your clinical decisions can change. This episode is about shifting from fragments to frameworks—and why that shift may open up entirely new possibilities for understanding and supporting hormonal health.
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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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