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Off The Charts
Off The Charts episodes
- PMS, PMDD, Perimenopause & ADHD: Why Symptoms Overlap in Women with Dr. Alexandra Sisam, ND
PMS, PMDD, perimenopause and ADHD can produce overlapping symptoms, but similar symptoms do not always mean the same thing is happening.
In this episode of Off the Charts, Dr. Bobby Parmar sits down with Dr. Alexandra Sisam, ND, to unpack the intersection of hormones, mood, ADHD, stress and the nervous system. They discuss PMS vs PMDD vs premenstrual exacerbation (PME), why perimenopause can complicate the picture, and why ADHD-like symptoms, hormonal changes and stress can sometimes be difficult to separate.
They also explore progesterone and estrogen, ADHD assessment, stimulant medications, trauma, iron, blood sugar and other factors that may influence symptoms.
The central idea: there may not be one thing going on.
WHAT YOU’LL LEARN
- PMS vs PMDD vs premenstrual exacerbation (PME)
- Why PMDD, perimenopause and ADHD symptoms can overlap
- How hormonal changes may affect mood, focus and cognition
- Why ADHD can be difficult to assess during midlife
- How stress and trauma may complicate the clinical picture
- Why similar symptoms may require very different approaches
TIMESTAMPS
- 00:00 — Hot open: “There isn’t one thing going on”
- 00:58 — Introducing Dr. Alexandra Sisam
- 01:12 — ADHD, perimenopause and PMDD
- 05:20 — Perimenopause, anger and mood changes
- 10:43 — What is PMDD?
- 11:06 — PMS vs PMDD vs PME
- 12:31 — Progesterone and PMDD
- 16:27 — Is perimenopause prolonged PMS?
- 18:48 — Trauma, stress and biological resilience
- 23:49 — ADHD and hormonal transitions
- 25:12 — Psychiatric or gynecologic?
- 30:05 — Why does ADHD seem to be everywhere?
- 32:03 — ADHD assessment and diagnostic uncertainty
- 37:45 — Stimulants and ADHD
- 41:03 — Iron, nutrition and blood sugar
- 43:04 — Estrogen, ADHD and perimenopause 46:14 — Neuroinflammation
- 47:46 — Why this needs a Part Two
- 48:44 — Closing
REFERENCES & RESOURCES
- ACOG — Management of Premenstrual Disorders https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/12/management-of-premenstrual-disorders
- NICE — Menopause: Identification and Management https://www.nice.org.uk/guidance/ng23
- ADHD and Sex Hormones in Females: A Systematic Review https://pubmed.ncbi.nlm.nih.gov/40251875/
- The Menopause Society — Mental Health and the Menopause Transition https://menopause.org/patient-education/menopause-topics/mental-health
CONNECT WITH THE GUEST
Dr. Alexandra Sisam, ND
- Instagram → https://www.instagram.com/alexandrasisam.nd/
- Website → https://dralexandrasisam.com/
- Mint Integrative Health → https://mintintegrative.com/dr-alexandra-sisam-naturopathic-doctor/
CONNECT WITH GRAVITY HEALTH
- Website → https://www.gravityhealthclinics.com/
- Book a Consult → https://gravityhealth.janeapp.com/
FOLLOW US
- Gravity Health Clinics → https://www.instagram.com/gravityhealthclinics/
- Dr. Bobby Parmar, ND → https://www.instagram.com/docparmar_nd/
- Dr. Paul Maximus, ND → https://www.instagram.com/drmaximus/
DISCLAIMER
This episode is for general educational and informational purposes only and does not constitute medical advice, diagnosis or treatment.
Always consult a qualified healthcare professional before starting, stopping or changing medication, supplements, testing or treatment.
- https://www.gravityhealthclinics.com/terms-of-use
- https://www.gravityhealthclinics.com/medical-disclaimer
50 min - When Medicine Doesn’t Believe You: Contested Illnesses with Dr. David Scales & Dara Parker
What happens when you know something is wrong, but medicine cannot measure it, explain it, or agree that it is real?
In this episode of Off the Charts, Dr. Bobby Parmar is joined by Dr. David Scales and returning guest Dara Parker for a candid conversation about contested illnesses—conditions patients may have to fight to have recognized.
They examine the divide between what patients experience and what the medical system is prepared to diagnose, especially when symptoms do not fit neatly within one specialty. Using IBS as an example, they explore how objective testing helped transform an illness that had often been dismissed into one medicine was more willing to accept as “real.”
The conversation expands into Long COVID, ME/CFS, chronic Lyme disease, trauma and chronic pain, specialist silos, private testing, and the line between respecting uncertainty and offering unsupported diagnoses or treatments.
They also discuss naturopathic and conventional medicine, health equity, and positive care effects: how trust, competence, reassurance, time, and the patient-provider relationship can influence treatment.
Finally, Bobby shares how changing the language used before iron infusions appeared to change patient reactions—bringing the conversation back to placebo, nocebo, the nervous system, and Dara’s reminder that stories can both heal and harm.
This is not about believing every diagnosis or abandoning scientific standards. It is about listening carefully, acknowledging uncertainty, and recognizing that the absence of an explanation does not mean a patient’s suffering is not real.
WHAT YOU’LL LEARN
- What contested illnesses are
- Why some conditions are accepted only once suffering becomes measurable
- What rectal distention testing reveals about IBS pain sensitivity
- How Long COVID changed chronic illness research
- Why complex symptoms fall between specialties
- How clinicians navigate uncertain tests and diagnoses
- Where naturopathic and conventional medicine overlap
- What positive-care, placebo, nocebo, and negative-care effects mean
- How supportive care becomes a health-equity issue
- Why clinical language can influence patient experience
TIMESTAMPS
- 00:00 — Hot open: “Illnesses you have to fight to get”
- 00:38 — Introducing Dr. David Scales and Dara Parker
- 02:25 — What are contested illnesses?
- 05:23 — When patients do not fit the medical model
- 06:24 — IBS and becoming a “real” illness
- 10:22 — Gender, pain, and medical research
- 13:33 — Trauma, IBS, endometriosis, and chronic pain
- 16:14 — Medicine, social science, and the missing evidence
- 17:41 — Long COVID and infection-associated chronic conditions
- 20:57 — Can infections leave lasting effects?
- 25:19 — Dr. House and the problem with medical silos
- 27:26 — Specialists versus generalists
- 30:28 — A better model for complex patients
- 33:00 — Wait times, private testing, and searching for answers
- 36:14 — When medical uncertainty becomes quackery
- 39:03 — Where Bobby draws the line
- 45:56 — Bridging naturopathic and conventional medicine
- 47:34 — How allopathic medicine views naturopathy
- 49:50 — Positive care effects versus placebo
- 52:47 — Supportive care as a health-equity issue
- 54:11 — Nocebo and negative-care effects
- 55:30 — Iron infusions and the power of language
- 57:56 — Harold R. Johnson and stories as medicine
- 59:16 — Evidence, storytelling, and the art of medicine
- 59:56 — Closing and the call for part two
REFERENCES AND RESOURCES
- Rectal distention testing in IBS https://pubmed.ncbi.nlm.nih.gov/12055583/
- National Academies definition of Long COVID https://www.ncbi.nlm.nih.gov/books/NBK605676/
- Placebo and nocebo effects https://pubmed.ncbi.nlm.nih.gov/33075796/
- Harold R. Johnson, The Power of Story https://www.haroldrjohnson.ca/
CONNECT WITH THE GUESTS
- Dr. David Scales https://weillcornell.org/david-alaistair-scales-md-phd
- Dara Parker https://www.daraparker.com/
CONNECT WITH GRAVITY HEALTH
- Website → https://www.gravityhealthclinics.com/
- Book a Consult → https://gravityhealth.janeapp.com/
FOLLOW US
- Gravity Health Clinics → https://www.instagram.com/gravityhealthclinics/
- Dr. Bobby Parmar, ND → https://www.instagram.com/docparmar_nd/
- Dr. Paul Maximus, ND → https://www.instagram.com/drmaximus/
DISCLAIMER
This episode is for general educational and informational purposes only and does not constitute medical advice, diagnosis, treatment, or the practice of medicine or any other healthcare service. Always consult a qualified healthcare professional before starting, stopping, or changing medication, testing, or treatment. Listening to this podcast does not create a doctor-patient relationship.
For more information:
- https://www.gravityhealthclinics.com/terms-of-use
- https://www.gravityhealthclinics.com/medical-disclaimer
1 hr 1 min - IBS, SIBO, and the Gut-Brain Connection with Dr. Rachael Lovink, ND
What if IBS isn’t “just in your head” — but it also isn’t just about food, bacteria, or SIBO?
In this episode of Off the Charts, Dr. Bobby Parmar sits down with Dr. Rachael Lovink, ND, a naturopathic doctor and gut health strategist, for a deep conversation about IBS, constipation, gut-brain communication, visceral hypersensitivity, SIBO testing, pelvic floor dysfunction, neuromodulators, and why so many patients get stuck chasing one “root cause.”
Dr. Rachael shares how her own experience with IBS shaped the way she now works with patients, especially those dealing with chronic constipation, bloating, abdominal pain, food fear, and long histories of trying diets, antimicrobials, SIBO treatments, functional testing, and supplement protocols without lasting relief.
Together, Bobby and Rachael explore why IBS is better understood as a disorder of gut-brain interaction, why validation and education matter so much in care, and why the path forward often requires looking beyond the usual rabbit holes: dysbiosis, SIBO, food triggers, and test results.
They also discuss why constipation can be missed even when someone is going to the bathroom daily, why pelvic floor coordination matters, when PEG or RestoraLAX may help or make symptoms worse, what dyssynergic defecation means, and why biofeedback can be an important part of chronic constipation care.
This conversation is for anyone who wants a more nuanced way to understand IBS, SIBO, constipation, gut pain, and the nervous system.
WHAT YOU’LL LEARN
- Why IBS is not “just in your head”
- What disorders of gut-brain interaction are
- Why visceral hypersensitivity can make normal digestion feel painful
- Why neuromodulators are used in IBS care
- Why SIBO testing is not always the best place to start
- Why dysbiosis does not always mean you need antimicrobials
- How constipation can be missed, even when someone poops daily
- Why “just get them pooping” can change the clinical picture
- When PEG / RestoraLAX may help — and when it may make symptoms worse
- What dyssynergic defecation means
- Why pelvic floor assessment matters in chronic constipation
- Why biofeedback can be important for pelvic floor coordination
- How IBS, endometriosis, migraines, fibromyalgia, and other chronic pain conditions may overlap
- Why some patients get stuck in the SIBO treatment loop
- Why GLP-1 research in IBS is an emerging area to watch
REFERENCES
Rome IV — Disorders of Gut-Brain Interaction https://pubmed.ncbi.nlm.nih.gov/27147121/
Rome Foundation — Rome IV Criteria https://theromefoundation.org/rome-iv/rome-iv-criteria/
ACG Clinical Guideline: Management of Irritable Bowel Syndrome https://pubmed.ncbi.nlm.nih.gov/33315591/
Diagnosis and Treatment of Dyssynergic Defecation https://pmc.ncbi.nlm.nih.gov/articles/PMC4930297/
ANMS-ESNM Position Paper and Consensus Guidelines on Biofeedback Therapy https://pmc.ncbi.nlm.nih.gov/articles/PMC4409469/
Pain relief and pain intensity response to GLP-1 receptor agonist ROSE-010 in IBS https://pubmed.ncbi.nlm.nih.gov/35234561/
Improvement of irritable bowel syndrome with glucagon-like peptide-1 receptor agonists https://pmc.ncbi.nlm.nih.gov/articles/PMC11932899/
CONNECT WITH GRAVITY HEALTH
- Website → https://www.gravityhealthclinics.com/
- Book a Consult → https://gravityhealth.janeapp.com/
FOLLOW US
Gravity Health Clinics → https://www.instagram.com/gravityhealthclinics/
Dr. Bobby Parmar, ND → https://www.instagram.com/docparmar_nd/
Dr. Paul Maximus, ND → https://www.instagram.com/drmaximus/
Dr. Rachael Lovink, ND → https://www.drlovink.com/
DISCLAIMER ⚠️
This video is for educational and informational purposes only and is not medical advice. Always consult a qualified healthcare provider before starting or stopping medication, supplements, diets, or treatment plans.
Off the Charts is a podcast by Gravity Health, created for general informational and educational purposes only. It does not constitute the practice of medicine, nursing, or any other healthcare service, and should not be taken as medical advice.
Listening to this podcast does not create a doctor–patient relationship. Listeners should always seek the guidance of qualified healthcare professionals regarding any medical condition or treatment.
For more information about content use and disclaimers, please visit: https://www.gravityhealthclinics.com/terms-of-use https://www.gravityhealthclinics.com/medical-disclaimer
1 hr 17 min - Why We Need to Talk About Race in Medicine with Nneka Allen
What happens when race is treated as a side note in medicine, instead of a central part of how people move through the world?
In this episode of Off the Charts, Dr. Bobby Parmar sits down with Nneka Allen for a deeply personal and necessary conversation about race, medicine, Whiteness, anti-Blackness, and the lived experience of Black patients navigating healthcare systems that were not built with them in mind.
They begin with a question that is often avoided: why are people so uncomfortable talking about race, even when race clearly shapes outcomes, experiences, and access to care?
From there, the conversation moves through the history of slavery in Canada, the invention of Whiteness and Blackness as social constructs, the medical dehumanization of Black bodies, and the ways these histories continue to show up in modern healthcare.
Bobby and Nneka also discuss fibroids, pain treatment, maternal mortality, medical mistrust, weathering, microaggressions, race-conscious care, and what it means to move from bystanding to truth-telling.
This is not a conversation about blame for the sake of blame. It is a conversation about responsibility, awareness, history, and what clinicians need to understand if they are serious about providing better care.
WHAT YOU’LL LEARN
- Why race cannot be separated from conversations about medicine and healthcare
- How Whiteness and Blackness were socially constructed, and why that history still matters
- Why Black patients often cannot “escape” race in healthcare settings
- How medical systems have historically dehumanized Black bodies
- Why Black women’s experiences with fibroids, pain, hysterectomy, and maternal care require more attention
- What weathering means, and how chronic racist stress can affect health
- Why “microaggressions” may be better understood as racist abuse
- What institutional untrustworthiness means in healthcare
- Why race-conscious care matters more than simply having a provider who looks like you
- The difference between perpetrating, bystanding, truth-telling, and dissenting behaviors
TIMESTAMPS
- 00:00 — Opening: “Black people don’t have the luxury of escaping race”
- 00:46 — Introducing Nneka Allen
- 02:37 — Why people avoid talking about race
- 05:29 — Slavery in Canada and the erasure of Black history
- 07:34 — Non-Black people and the racial continuum
- 08:19 — Why Black people can’t avoid race
- 09:55 — Fibroids, Black women, and being treated as a footnote in medicine
- 13:52 — Dr. Uché Blackstock, medical racism, and unequal care
- 15:03 — Self-advocacy, alternative medicine, and distrust of the medical system
- 19:08 — Medical experimentation, pain treatment, and maternal mortality
- 20:29 — Chattel slavery and the dehumanization of Black bodies
- 22:23 — The speculum, gynecology, and medical history
- 23:13 — Slavery as an economic system
- 26:16 — Storytelling, humanity, and listening differently
- 28:42 — Community, survival, and collective care
- 30:24 — The duty of non-Black clinicians
- 31:39 — Weathering and the health effects of chronic racist stress
- 32:49 — Microaggressions, racist abuse, and Ibram X. Kendi
- 35:03 — Why minimizing racism causes harm
- 36:30 — Nneka’s Substack and responding to racism
- 38:15 — A bank incident and the cost of confronting racism
- 42:22 — Diversity statements vs accountability
- 43:58 — Does your doctor have to be Black?
- 44:12 — What race-conscious care looks like
- 48:30 — Medical distrust vs institutional untrustworthiness
- 50:46 — Racism as behavior, not identity
- 52:21 — Perpetrating, bystanding, truth-telling, and dissenting behaviors
- 53:11 — Why silence is not neutral
⚠️ This video is for educational and informational purposes only and is not medical advice. Always consult a qualified healthcare provider before starting or stopping medication.
REFERENCES
Nneka Allen, The Empathy Agency
https://www.theempathyagency.ca/meet-the-founderThe Empathy Agency
https://www.theempathyagency.ca/Ian Williams, Disorientation: Being Black in the World
https://www.penguinrandomhouse.ca/books/671554/disorientation-by-ian-williams/9781039000247Dr. Uché Blackstock, Legacy: A Black Physician Reckons with Racism in Medicine
https://www.penguinrandomhouse.com/books/705871/legacy-by-uche-blackstock-md/Ibram X. Kendi, How to Be an Antiracist
https://www.penguinrandomhouse.com/books/564299/how-to-be-an-antiracist-by-ibram-x-kendi/Audre Lorde, The Master’s Tools Will Never Dismantle the Master’s House
https://awpc.cattcenter.iastate.edu/communication/masters-tools-will-never-dismantle-masters-house-oct-29-1979Canadian Museum for Human Rights, The story of Black slavery in Canadian history
https://humanrights.ca/story/story-black-slavery-canadian-historyThe Underground Railroad in Canada
https://www.thecanadianencyclopedia.ca/en/article/underground-railroadWeathering hypothesis and racial health disparities
https://pmc.ncbi.nlm.nih.gov/articles/PMC10676285/Race-conscious medicine
https://pmc.ncbi.nlm.nih.gov/articles/PMC7544456/Institutional distrust and building institutional trustworthiness in healthcare
https://pmc.ncbi.nlm.nih.gov/articles/PMC7988507/Canadian Human Rights Commission: About discrimination
https://www.chrc-ccdp.gc.ca/individuals/human-rights/about-discriminationHistory of the speculum, J. Marion Sims, and medical experimentation on enslaved Black women
https://www.pbs.org/wgbh/americanexperience/features/cancer-detectives-brief-history-speculum/Racial disparities in uterine fibroids and hysterectomy
https://pmc.ncbi.nlm.nih.gov/articles/PMC3874080/Racial disparities in pain treatment
https://www.aamc.org/news/how-we-fail-black-patients-painBlack maternal mortality and pregnancy-related mortality disparities
https://projects.apnews.com/features/2023/from-birth-to-death/black-women-maternal-mortality-rate.htmlCONNECT WITH GRAVITY HEALTH
Website → https://www.gravityhealthclinics.com/
Book a Consult → https://gravityhealth.janeapp.com/FOLLOW US
Gravity Health Clinics → https://www.instagram.com/gravityhealthclinics/
Dr. Bobby Parmar, ND → https://www.instagram.com/docparmar_nd/
Dr. Paul Maximus, ND → https://www.instagram.com/drmaximus/
Nneka Allen / The Empathy Agency → https://www.theempathyagency.ca/Off the Charts is a podcast by Gravity Health, created for general informational and educational purposes only. It does not constitute the practice of medicine, nursing, or any other healthcare service, and should not be taken as medical advice. Listening to this podcast does not create a doctor–patient relationship.
Listeners should always seek the guidance of qualified healthcare professionals regarding any medical condition or treatment.
For more information about content use and disclaimers, please visit:
https://www.gravityhealthclinics.com/terms-of-use
https://www.gravityhealthclinics.com/medical-disclaimer55 min - I Almost Fainted From My IUD — Why Is This Still Normal? | Dr Alex Dragan, ND
Why Women Aren’t Offered Pain Management for IUDs
IUD insertion is often described as quick, simple, and routine.
But for many patients, “routine” does not mean painless.
In this episode of Off the Charts, Dr. Bobby Parmar, ND sits down with Dr. Alex Dragan, ND to ask a question that should feel obvious: Why are so many IUD procedures still done without adequate pain management?
Starting with Dr. Dragan’s own experience of nearly passing out during IUD insertion, they unpack what actually happens during the procedure, why some patients experience intense pain, dizziness, or near-fainting, and how that reality has been minimized, normalized, or dismissed in clinical practice.
From there, the conversation moves beyond IUDs.
They examine how outdated assumptions, gaps in training, misinformation, and systemic bias shape the way women’s pain is understood and treated — and why something as basic as pain relief is still inconsistent across providers.
This is not a takedown of individual practitioners.
It is a closer look at the gap between what patients experience, what medicine has normalized, and what better, more informed care could look like.
WHAT YOU’LL LEARN
- Why IUD insertion can be significantly more painful for some patients than expected
- What actually happens physiologically during an IUD procedure (and why pain varies)
- The role of the cervix, nerve pathways, and the vagal response in pain and fainting
- Why pain management isn’t consistently offered — even when options exist
- The difference between ibuprofen, local anesthesia, and newer tools like Penthrox
- How fear, misinformation, and real patient experiences all shape perception of IUDs
- Why IUDs are used for more than contraception (including heavy bleeding and perimenopause)
- How consent, communication, and patient trust influence the overall experience
- What a more informed, patient-centered approach to procedures could look like
TIMESTAMPS
- 00:00 — Opening: “Why don’t we offer pain management?”
- 01:30 — A real IUD experience (pain, dizziness, near fainting)
- 04:45 — What actually happens during insertion
- 08:20 — The cervix, nerves, and the vagal response
- 12:10 — Why pain has been minimized in clinical settings
- 16:30 — What pain management options exist (and why they’re not always used)
- 22:40 — IUD myths vs reality
- 28:15 — Fear, TikTok, and patient perception
- 34:20 — IUDs beyond birth control (bleeding, perimenopause)
- 40:10 — What better care could look like
⚠️ This video is for educational and informational purposes only and is not medical advice. Always consult a qualified healthcare provider before starting or stopping medication.
TOP REFERENCES:
Pain Management for Gynecologic Procedures
American College of Obstetricians and Gynecologists (ACOG)
https://www.acog.org/Long-Acting Reversible Contraception (IUDs)
ACOG Practice Bulletin
https://www.acog.org/Heavy Menstrual Bleeding Guidelines
NICE Guideline NG88
https://www.nice.org.uk/Endometriosis Overview
World Health Organization (WHO)
https://www.who.int/Vasovagal Syncope (Fainting Response)
StatPearls / NCBI
https://www.ncbi.nlm.nih.gov/CONNECT WITH GRAVITY HEALTH
Book a Consult → https://gravityhealth.janeapp.com/
Gravity Health Clinics → https://www.gravityhealthclinics.com/
Mint Reproductive Health → https://mintreproductivehealth.com/FOLLOW US
Gravity Health Clinics → https://www.instagram.com/gravityhealthclinics/
Dr. Bobby Parmar, ND → https://www.instagram.com/docparmar_nd/
Dr. Paul Maximus, ND → https://www.instagram.com/drmaximus/
Dr. Alex Dragan, ND → https://www.instagram.com/dralexdragan/Off the Charts is a podcast by Gravity Health, created for general informational and educational purposes only. It does not constitute the practice of medicine, nursing, or any other healthcare service, and should not be taken as medical advice. Listening to this podcast does not create a doctor–patient relationship.
Listeners should always seek the guidance of qualified healthcare professionals regarding any medical condition or treatment.
For more information about content use and disclaimers, please visit:
https://www.gravityhealthclinics.com/terms-of-use
https://www.gravityhealthclinics.com/medical-disclaimer55 min - Why Confident People Can Feel Powerless in a Medical Setting with Dara Parker
Have you ever left a medical appointment feeling unsettled — not because of what was said, but because of how it felt?
You understood the recommendations.
You answered the questions.
And yet, something didn’t quite land.In this episode of Off the Charts, Dr. Bobby Parmar sits down with Dara Parker to examine that gap — the space between how care is delivered, and how it is actually experienced by patients.
Drawing from lived experience, they explore why even confident, well-resourced individuals can feel hesitant, exposed, or less certain of themselves in a clinical setting — and why patients don’t always share everything, even when it matters.
This isn’t framed as a failure of individual practitioners. Instead, the conversation looks at the systems, training, and cultural norms that shape how care is practiced — often in ways that are difficult to see from within.
The question isn’t simply whether healthcare is working or failing. It’s whether we are paying close enough attention to how it is being experienced.
WHAT YOU'LL LEARN
- Why medical interactions can feel misaligned, even when technically correct
- How assumptions and communication style shape patient trust
- Why patients don’t always share everything — even when it matters
- The role of power dynamics in clinical environments
- How bias operates within systems, not just individuals
- What a more collaborative, patient-centered approach to care could look like
TIMESTAMPS
- 0:00 – Opening: When care feels “off”
- 1:12 – Introducing Dara Parker 2:42 – “Mediocre” experiences across the system
- 4:19 – Is healthcare shaped by bias?
- 6:15 – Systems, assumptions, and lived experience
- 8:12 – Awareness doesn’t remove bias
- 10:33 – Pain, dismissal, and women’s bodies
- 12:16 – The role of humility in medicine
- 14:27 – Patients, information, and trust
- 19:06 – Lived experience and belief
- 20:15 – Assumptions in practice (birth control example)
- 21:54 – Why patients hold things back
- 24:56 – Confidence vs vulnerability in clinical settings
- 26:06 – Physical and emotional exposure
- 29:37 – What a different experience can feel like
⚠️ This video is for educational and informational purposes only and is not medical advice. Always consult a qualified healthcare provider before starting or stopping medication.
REFERENCES
The Yentl Syndrome
Bernadine Healy, The New England Journal of Medicine
https://www.nejm.org/doi/abs/10.1056/NEJM199107253250408
The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain
Diane E. Hoffmann and Anita J. Tarzian
https://journals.sagepub.com/doi/10.1111/j.1748-720X.2001.tb00037.xPain Management for In-Office Uterine and Cervical Procedures
American College of Obstetricians and Gynecologists
https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2025/05/pain-management-for-in-office-uterine-and-cervical-proceduresImplicit Bias in Healthcare Professionals: A Systematic Review
Clemence FitzGerald and Samia Hurst
https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-017-0179-8Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to Clinicians
Andrea G. Levy et al.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2716996Towards a Sociological Understanding of Medical Gaslighting in Western Health Care
Jessica C.H. Sebring
https://onlinelibrary.wiley.com/doi/abs/10.1111/1467-9566.13367Overview of the National Institutes of Health Investment in Women’s Health Research National Academies / NIH
https://www.ncbi.nlm.nih.gov/books/NBK612400/CONNECT WITH GRAVITY HEALTH
- Website → https://www.gravityhealthclinics.com/
- Book a Consult → https://gravityhealth.janeapp.com/
FOLLOW US
- Gravity Health Clinics → https://www.instagram.com/gravityhealthclinics/
- Dr. Bobby Parmar → https://www.instagram.com/docparmar_nd/
- Dr. Paul Maximus → https://www.instagram.com/drmaximus/
- Dara Parker → https://www.daraparker.com/
Off the Charts is a podcast by Gravity Health, created for general informational and educational purposes only. It does not constitute the practice of medicine, nursing, or any other healthcare service, and should not be taken as medical advice.
Listening to this podcast does not create a doctor–patient relationship. Listeners should always seek the guidance of qualified healthcare professionals regarding any medical condition or treatment.
For more information about content use and disclaimers, please visit:
- https://www.gravityhealthclinics.com/terms-of-use
- https://www.gravityhealthclinics.com/medical-disclaimer
46 min - The Low-Histamine Diet That Patients “Hate” (But Works) with Dr Krista Moyer, ND
Histamine isn’t just about allergies.
In this episode of Off the Charts, Dr. Bobby Parmar sits down with Dr. Krista Moyer, ND to unpack one of the most misunderstood mechanisms in medicine right now: histamine.
From brain fog and anxiety…
To IBS, GERD and diarrhea…
To heavy bleeding, PMS and perimenopause shifts…Histamine can act as a systems-level amplifier — especially in people with Mast Cell Activation Syndrome (MCAS) or histamine intolerance.
Dr. Moyer shares her origin story into histamine medicine and explains:
- What mast cell activation syndrome (MCAS) actually is
- How MCAS differs from histamine intolerance
- The role of DAO and HNMT enzymes
- When genetics matter — and when they don’t
- Why perimenopause can amplify histamine symptoms
- The estrogen ↔ histamine feedback loop
- How antihistamines (H1, H2) and quercetin are used clinically
- Why the low histamine diet is temporary — not a life sentence
- The link between histamine and menstrual pain
- Brain fog and anxiety as histamine-driven symptoms
- Why allergist testing doesn’t always rule this out
They also break down when to experiment with antihistamines, when diet matters most, and why a bucket-load theory of “histamine burden” often makes more sense than chasing a single trigger.
This episode is for anyone who has been told their labs are normal — but still doesn’t feel normal.
WHAT YOU'LL LEARN
- The difference between MCAS and histamine intolerance
- How histamine affects the gut, brain, skin, and hormones
- Why perimenopause can amplify histamine symptoms
- The bucket theory of “histamine load”
- When the low histamine diet is useful (and how long to try it)
- How antihistamines and quercetin are used clinically
- Why allergy testing doesn’t rule histamine issues out
TIMESTAMPS
- 00:00 – Why the low histamine diet feels impossible
- 02:30 – Dr. Moyer’s origin story
- 03:55 – What is MCAS?
- 06:25 – The histamine “bucket” theory
- 09:27 – Perimenopause & estrogen connection
- 13:27 – What the low histamine diet involves
- 19:42 – Antihistamines: H1, H2 & quercetin
- 22:35 – MCAS explained simply
- 26:55 – MCAS vs histamine intolerance
- 29:55 – Digestive symptoms & IBS
- 31:07 – Pain, PMS & inflammation
- 32:02 – Brain fog & anxiety
- 38:04 – Is histamine a villain?
- 39:18 – Cetirizine & the blood-brain barrier
- 41:37 – Benadryl for period pain?
⚠️ This video is for educational and informational purposes only and is not medical advice. Always consult a qualified healthcare provider before starting or stopping medication.
REFERENCES
- American Academy of Allergy, Asthma & Immunology (AAAAI) — Mast Cell Activation Syndrome (MCAS)
https://www.aaaai.org/conditions-and-treatments/library/allergy-library/mast-cell-activation-syndrome- National Institutes of Health (NIH) — Mast Cell Activation Syndrome Overview
https://www.ncbi.nlm.nih.gov/books/NBK539870/- Johns Hopkins Medicine — Mast Cell Disorders https://www.hopkinsmedicine.org/health/conditions-and-diseases/mast-cell-disorders
- Cleveland Clinic — Histamine Intolerance https://my.clevelandclinic.org/health/diseases/24854-histamine-intolerance
- Mayo Clinic — Hives (Urticaria) and Mast Cell Overview https://www.mayoclinic.org/diseases-conditions/chronic-hives/symptoms-causes/syc-20352719
- Journal of Allergy and Clinical Immunology (JACI) — Mast Cell Activation Disorders https://www.jacionline.org/
- National Institutes of Health (NIH) — Histamine Metabolism Overview https://pubmed.ncbi.nlm.nih.gov/17272405/
CONNECT WITH GRAVITY HEALTH
- Website → https://www.gravityhealthclinics.com/
- Book a Consult → https://gravityhealth.janeapp.com/
- Mint Reproductive Health → https://mintreproductivehealth.com/
- Dr. Krista Moyer → http://www.drkristamoyer.com/
FOLLOW US
- Gravity Health Clinics → https://www.instagram.com/gravityhealthclinics/
- Dr. Bobby Parmar → https://www.instagram.com/docparmar_nd/
- Dr. Paul Maximus → https://www.instagram.com/drmaximus/
- Mint Reproductive Health → https://www.instagram.com/mintreproductivehealth/
- Dr. Krista Moyer → https://www.instagram.com/drkristamoyer/
Off the Charts is a podcast by Gravity Health, created for general informational and educational purposes only. It does not constitute the practice of medicine, nursing, or any other healthcare service, and should not be taken as medical advice. Listening to this podcast does not create a doctor–patient relationship.
Listeners should always seek the guidance of qualified healthcare professionals regarding any medical condition or treatment.
For more information about content use and disclaimers, please visit:
- https://www.gravityhealthclinics.com/terms-of-use
- https://www.gravityhealthclinics.com/medical-disclaimer
45 min - Should You Test Your Fertility Before Trying? with Dr. Alana Shaw, ND
Fertility testing has become mainstream — but most women still don’t fully understand what those results actually mean.
In this episode, Dr. Parmar sits down with Dr. Alana Shaw, ND to unpack what fertility testing actually tells you — and what it doesn’t — in a world flooded with online fertility advice.
They break down AMH, antral follicle count, and pelvic/endovaginal ultrasound as screening tools, then connect it to the real-life questions women are asking:
- “Should I test before I even start trying?”
- “Does low AMH mean infertility?”
- “Why is IVF a numbers game?”
They also touch on the bigger clinical context — including painful periods that get normalized, and why better screening and better explanations matter.
Dr. Shaw also shares about her clinical work at Mint Integrative Health (Vancouver).
WHAT YOU'LL LEARN
- What AMH measures (ovarian reserve) vs what it doesn’t measure (natural fertility prediction)
- Why low AMH ≠ “you’re infertile”
- Why IVF outcomes are a “numbers game”
- What antral follicle count (AFC) is and why it’s often paired with AMH
- Why age tends to predict egg quality better than AMH does
- What clinicians can learn from endovaginal ultrasound (cysts, endometriomas, fibroids, adenomyosis screening)
- Who fertility “pre-screening” may be most helpful for (especially people who want kids but don’t have a pathway yet)
TIMESTAMPS
- 00:00 — Painful periods being normalized
- 02:00 — “Fertility online” and why people are confused
- 24:30 — Who should consider prescreening
- 25:50 — Low AMH: what it means (and what it doesn’t)
- 26:10 — IVF is a numbers game
- 35:45 — AFC + endovaginal ultrasound explained
- 51:50 — IUDs as “good medicine” / non-contraceptive use
⚠️ This video is for educational and informational purposes only and is not medical advice. Always consult a qualified healthcare provider before starting or stopping medication.
TOP REFERENCES:
- Ovarian Reserve Testing (AMH, AFC) + Interpretation ASRM Practice Committee Testing and interpreting measures of ovarian reserve (Committee Opinion, 2020) https://www.asrm.org/practice-guidance/practice-committee-documents/testing-and-interpreting-measures-of-ovarian-reserve-a-committee-opinion-2020/
- NCBI Bookshelf (Endotext) Ovarian Reserve Testing https://www.ncbi.nlm.nih.gov/books/NBK279058/
- ACOG Practice Bulletin Long-Acting Reversible Contraception: Implants and Intrauterine Devices https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/11/long-acting-reversible-contraception-implants-and-intrauterine-devices
- Heavy Menstrual Bleeding Guidance NICE Guideline NG88 (PDF) Heavy menstrual bleeding: assessment and management https://www.nice.org.uk/guidance/ng88/resources/heavy-menstrual-bleeding-assessment-and-management-pdf-1837701412549
- Endometriosis (Prevalence + Overview) World Health Organization (WHO) Fact Sheet Endometriosis https://www.who.int/news-room/fact-sheets/detail/endometriosis
CONNECT WITH GRAVITY HEALTH
- Website → https://www.gravityhealthclinics.com/
- Book a Consult → https://gravityhealth.janeapp.com/
- Mint Reproductive Health → https://mintreproductivehealth.com/
- Dr. Alana Shaw → https://alanashawnd.com/
FOLLOW US
- Instagram (Clinic) → https://www.instagram.com/gravityhealthclinics/
- Dr. Bobby Parmar → https://www.instagram.com/docparmar_nd/
- Dr. Paul Maximus → https://www.instagram.com/drmaximus/
- Mint Reproductive Health → https://www.instagram.com/mintreproductivehealth/
Off the Charts is a podcast by Gravity Health, created for general informational and educational purposes only. It does not constitute the practice of medicine, nursing, or any other healthcare service, and should not be taken as medical advice. Listening to this podcast does not create a doctor–patient relationship.
Listeners should always seek the guidance of qualified healthcare professionals regarding any medical condition or treatment.
For more information about content use and disclaimers, please visit:
- https://www.gravityhealthclinics.com/terms-of-use
- https://www.gravityhealthclinics.com/medical-disclaimer
55 min - The Truth About Antidepressants: Depression, Hormones, Pain, and Stigma
Many people wonder whether antidepressants are the right choice — but the conversation is often oversimplified, stigmatized, or incomplete.
In this episode of Off the Charts, Dr. Bobby Parmar, ND takes a grounded, compassionate look at antidepressants: how they actually work in the body, why they’re prescribed for more than depression, and how hormones, pain, life stress, and brain chemistry all play a role in mental health decisions.
WHAT YOU'LL LEARN
- How antidepressants affect serotonin, dopamine, and norepinephrine
- Why antidepressants are used beyond depression, including pain, PMDD, and postpartum mood changes
- Common concerns around weight gain and side effects
- How clinicians think about matching medications to symptoms
- The difference between dependence and discontinuation
- What to consider if you’re thinking about starting — or eventually coming off — antidepressants
This conversation is for anyone who wants a clearer, more honest understanding of antidepressants without fear, judgment, or oversimplification.
TIMESTAMPS
- 0:00 – Why this question matters
- 0:48 – Why a holistic doctor prescribes antidepressants
- 5:20 – When lifestyle changes aren’t enough
- 9:09 – How antidepressants work in the brain
- 12:05 – Weight gain, metabolism, and SSRIs
- 15:48 – Side effects and early tolerance
- 18:22 – Matching antidepressants to symptoms
- 22:12 – Hormones, depression, and sex differences
- 24:12 – PMDD and why SSRIs are used
- 28:43 – Postpartum depression and hormonal shifts
- 31:30 – Hormones vs depression — does the distinction matter?
- 33:59 – Antidepressants and chronic pain
- 39:28 – Dependence vs discontinuation
- 45:55 – When and how tapering is considered
- 48:06 – Treatment resistance and alternatives
- 52:38 – Reducing stigma and fear around antidepressants
⚠️ This video is for educational and informational purposes only and is not medical advice. Always consult a qualified healthcare provider before starting or stopping medication.
TOP REFERENCES:
- Antidepressant Medications (Overview)
- National Institute of Mental Health (NIMH): https://www.nimh.nih.gov/health/topics/mental-health-medications
- Choosing the Right Antidepressant
- Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273
- Antidepressant Discontinuation Syndrome
- American Family Physician: https://www.aafp.org/pubs/afp/issues/2006/0801/p449.html
- Going Off Antidepressants: What to Know
- Harvard Health Publishing: https://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants
- Premenstrual Dysphoric Disorder (PMDD)
- Johns Hopkins Medicine: https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd
- Antidepressants for Chronic Pain
- Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/back-pain/in-depth/pain-medications/art-20045647
- Pharmacogenomics & Medication Metabolism
- Clinical Pharmacogenetics Implementation Consortium (CPIC): https://cpicpgx.org
CONNECT WITH GRAVITY HEALTH
- Website → https://www.gravityhealthclinics.com/
- Book a Consult → https://gravityhealth.janeapp.com/
FOLLOW US
- Instagram → https://www.instagram.com/gravityhealthclinics/
- Dr. Bobby Parmar, ND → https://www.instagram.com/docparmar_nd/
- Dr. Paul Maximus, ND → https://www.instagram.com/drmaximus/
Off the Charts is a podcast by Gravity Health, created for general informational and educational purposes only. It does not constitute the practice of medicine, nursing, or any other healthcare service, and should not be taken as medical advice. Listening to this podcast does not create a doctor–patient relationship.
Listeners should always seek the guidance of qualified healthcare professionals regarding any medical condition or treatment.
For more information about content use and disclaimers, please visit:
- https://www.gravityhealthclinics.com/terms-of-use
- https://www.gravityhealthclinics.com/medical-disclaimer
55 min - Inside the Confident Clinician with Dr. Jordan Robertson, ND
In this episode of Off the Charts, Dr. Bobby Parmar, ND and Dr. Paul Maximus, ND sit down with Dr. Jordan Robertson, ND, founder of The Confident Clinician, for a grounded conversation on what leadership actually looks like in modern clinical practice.
Using the Confident Clinician framework, the discussion examines why confidence in medicine is built through judgment, systems, and decision-making—not busyness, credentials, or hustle. Together, they explore why linear growth models break under ambitious goals, how clinicians can expand their impact without burning out, and what it means to lead responsibly as practices and platforms scale.
Dr. Robertson shares candid insights on betting on yourself before certainty, building systems instead of relying on individual capacity, and why the most effective clinicians think differently about growth, responsibility, and long-term impact. The conversation also addresses the realities faced by under-resourced clinicians, the importance of dialogue and accountability within professional communities, and how emerging tools like AI should be used to support—rather than replace—clinical judgment.
Rather than focusing on trends or quick fixes, this episode positions leadership as a daily practice and scalability as a design challenge. It reflects the core philosophy of The Confident Clinician: that confidence is earned through clear thinking, strong systems, and intentional leadership.
This discussion is especially relevant for clinicians navigating growth, leadership responsibilities, or systemic constraints, and for anyone interested in how modern medicine can evolve thoughtfully without compromising trust, expertise, or integrity.
WHAT YOU'LL LEARN
- Why getting “busier” often leads to diminishing returns in clinical practice
- What leadership looks like when decisions are made without perfect conditions
- How clinicians can scale their impact without relying on hustle or burnout
- The difference between linear growth and system-level thinking in healthcare
- Why under-resourced clinicians experience stress, criticism, and negativity differently
- How to approach growth as an ecosystem design problem rather than an individual effort
- The role of judgment, communication, and leadership in a future shaped by AI
- Why betting on yourself — and building the right support systems — matters in long-term clinical impact
TIMESTAMPS
- 0:00 – Leadership Is a Daily Choice
- 4:07 – Breaking Rules to Lead Better
- 10:05 – Building Outside Broken Systems
- 15:48 – Under-Resourced Clinicians
- 19:47 – Leadership Means Disappointment
- 23:43 – Saying Yes Before Certainty
- 29:04 – Why 10x Requires Different Thinking
- 34:03 – Designing Systems for Scale
- 37:59 – AI Won’t Replace Clinicians
- 41:51 – Sandboxed AI in Medicine
- 45:07 – What Patients Actually Need
- 58:41 – Raising the Standard in ND Medicine
- 1:06:02 – Final Takeaways
TOP REFERENCES
- The Confident Clinician - https://confidentclinicianclub.com/
- Dr. Jordan Robertson, ND - https://drjordannd.com/
This resource page is for educational purposes only and does not constitute medical advice.
CONNECT WITH GRAVITY HEALTH
- Website → https://www.gravityhealthclinics.com/
- Book a Consult → https://gravityhealth.janeapp.com/
FOLLOW US
- Instagram → https://www.instagram.com/gravityhealthclinics/
- Dr. Bobby Parmar, ND → https://www.instagram.com/docparmar_nd/
- Dr. Paul Maximus, ND → https://www.instagram.com/drmaximus/
- Dr. Jordan Robertson, ND → https://www.instagram.com/drjordannd/
Off the Charts is a podcast by Gravity Health, created for general informational and educational purposes only. It does not constitute the practice of medicine, nursing, or any other healthcare service, and should not be taken as medical advice. Listening to this podcast does not create a doctor–patient relationship. Listeners should always seek the guidance of qualified healthcare professionals regarding any medical condition or treatment.
For more information about content use and disclaimers, please visit:
- https://www.gravityhealthclinics.com/terms-of-use
- https://www.gravityhealthclinics.com/medical-disclaimer
1 hr 9 min
About Off The Charts
From the publisher's feed
How many podcasts could there poddibly be about correcting medical misinformation now?
Why would I add my voice to the chorus that can be so deafening?
I've had 18+ years of experience seeing tons and treating everything from A to Z and lemme tell you there's plenty I can add to the conversation. Dive with me into the science of medicine with a heaping side of sass and spice.