Building an Integrative Pharmacy Practice with Dr. Emlah Tubuo, PharmD

On this episode of Root Cause Medicine, we’re honored to share the story of Dr. Emlah Tubuo, PharmD, MS, an integrative pharmacist who came to the U.S. in 2003 with $300 in her wallet and built what many of us wish existed in every community: a pharmacy designed around whole person care. Dr. Emlah explains how growing up around infectious disease in Cameroon shaped her prevention-first mindset, and how arriving in the U.S. revealed a different challenge: chronic disease that silently progresses for years before symptoms demand urgent intervention.


Together, we unpack what it looks like to practice evidence-informed integrative pharmacy: counseling on “drug–food interactions,” recognizing drug–nutrient depletion, creating space for 45-minute medication + supplement reviews, and using biomarker-driven, HIPAA compliant clinical decision support (including AI-powered planwriting) to personalize care. This is a must-listen for clinicians building integrative care models that support metabolic health, inflammation balance, and sustainable lifestyle medicine - true whole person pharmacotherapy.


Clinical Takeaways from This Episode

• Whole person integrative pharmacy workflow: 45-minute consults that reduce pill burden and improve supplement safety
  • Dr. Tubuo describes a structured visit where patients bring every bottle in their medicine cabinet (including prescription and supplements) to review for relevance, timing, and potential interactions—an approach that can support safety, simplification, and adherence.
• Drug–nutrient depletion and medication counseling that goes beyond “drug–drug interactions”
  • Dr. Emlah highlights real-world examples (metformin → B vitamins, long-term PPIs → bone/nutrient considerations, statins → CoQ10 conversations) and models how clinicians can educate with connection, kindness and humor.
• Advanced cardiovascular and inflammation lab testing: why LDL alone may miss risk
  • Dr. Emlah teaches pharmacists to think beyond the standard lipid panel by considering ApoB, Lp(a), homocysteine, and hs-CRP—plus using “lie detector” biomarkers like HDL, body composition, and movement patterns to connect lifestyle interventions to measurable outcomes.
    
    

Guest Introduction


Dr. Emlah Tubuo, PharmD, MS, BS is an integrative pharmacist, entrepreneur, and founder of Powell Pharmacy, an independent integrative pharmacy practice built on intentional living and lifestyle medicine principles. She trained at The Ohio State University (PharmD), has experience in retail and hospital pharmacy. She now mentors pharmacy students and teaches clinicians how to confidently incorporate evidence-informed supplement guidance, nutrient monitoring, and biomarker-driven preventive strategies into practice.

• Powell Pharmacy: https://powellpharmacy.com
• Podcast: Intentional Living with Emlah: Trying to Optimize Your Health (Apple, Spotify, YouTube)
• Pharmacist education/resources: https://dremlahtubuo.com
• Instagram: @Dr.EmlahTubuo
  
  

FAQ: Integrative Pharmacy Labs, Nutrition, and Lifestyle Support


What advanced cardiovascular risk labs and inflammation markers should pharmacists consider for preventive care? 

• Standard lipid panel: baseline context, not the whole story
• ApoB: atherogenic particle burden
• Lp(a): genetically influenced risk marker; discussed as especially important for awareness in practice
• hs-CRP (high-sensitivity C-reactive protein: for inflammatory risk context
• Homocysteine: cardiovascular + cognitive risk context discussed (White-Al Habeeb, 2023.
• Consider APOE discussion/testing when clinically appropriate and aligned with patient goals and counseling capacity (Marais, 2019)
  
  

What biomarkers can integrative pharmacists use to help clients see if their lifestyle efforts are having an impact on their health beyond their blood labs?

• HDL as Dr. Emlah’s movement “truth-teller” (her memorable framework: movement is the main lever)
• Body composition / muscle mass + body fat mass (InBody-style measurement referenced)
• Habit tracking tools: workout checklists and simple “report card” accountability
  
  

What foundational supplements should integrative pharmacists be prepared to counsel their clients about in an evidence-informed, interaction-aware way?

• Omega-3 fish oil (EPA/DHA) – Positioned as a commonly taught inflammation-support tool; caution and interaction awareness emphasized particularly in regards to anticoagulant considerations and peri-procedure planning. (Custodero, 2018).
• Turmeric/curcumin – Discussed as another inflammation-support staple, with interaction awareness as part of counseling (Tabrizi, 2019).
• Probiotics (strain + CFU-aware) – She emphasizes gut-brain and gut-skin connections and the importance of quality/strain selection (Custodero, 2018).
• Magnesium (form matters) – Highlighted for broad cofactor roles, sleep support, muscle relaxation, and cardiometabolic context; also framed as a practical intervention for people with mild sleep or stress issues (Zhang, 2022).
• Vitamin D – Discussed as especially relevant in low-sunlight regions; framed as a “check and personalize” nutrient (Demay, 2024).
• Methylated B-complex – Emphasized for synergy across B vitamins and low interaction risk; practical counseling tip: “take in the morning” (Fairfield, 2002).
  
  

What are Dr. Emlah’s “Pillars of intentional living”?

• Nutrition: food-first counseling and practical “80/20” sustainability approach
• Movement: daily movement as a non-negotiable lever (especially for HDL and cardiometabolic resilience)
• Inner alignment: grounding practices + biomarker feedback (gratitude journaling + labs as a two-pronged model)
• Positive social connections: relationships and community as health infrastructure
  
  

Are there AI-powered lab interpretation tools that allow integrative practitioners to provide personalized reports to their clients?

• Dr. Emlah uses practitioner-designed, AI-powered tools like Fullscript’s Journeys for symptom + lab interpretation can support clinician efficiency and consistency. She describes leveraging AI-enabled reporting so clinicians can spend more time in relationship-based care.
  
  

Timestamps (Key Moments)

• 01:09 – Arriving in the U.S. in 2003 with $300 and pursuing PharmD training
• 03:07 – From infectious disease to chronic disease: why prevention became the mission
• 05:18 – The PPI case that changed everything: osteopenia risk and “we weren’t trained to think that way”
• 07:02 – Practicing integrative care inside a conventional system: “drug–food interactions” in real life
• 10:28 – What care looks like at Powell Pharmacy: the four legs of intentional living
• 12:24 – The 45-minute consult: bring all meds and supplements
• 13:48 – Foundational supplements pharmacists should know: fish oil, turmeric, probiotics
• 16:12 – Magnesium as the “favorite supplement child”: forms, sleep, and practical counseling
• 36:13 – Labs that matter: Lp(a), ApoB, homocysteine, hs-CRP, and the HDL “lie detector test”
  
  

Want to elevate your practice?

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

Disclaimer


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


Sources

1. White-Al Habeeb NMA, Higgins V, Wolska A, Delaney SR, Remaley AT, Beriault DR. The Present and Future of Lipid Testing in Cardiovascular Risk Assessment. Clin Chem. 2023 Apr 28;69(5):456-469. doi: 10.1093/clinchem/hvad012. PMID: 37000150.
2. Marais AD. Apolipoprotein E in lipoprotein metabolism, health and cardiovascular disease. Pathology. 2019 Feb;51(2):165-176. doi: 10.1016/j.pathol.2018.11.002. Epub 2018 Dec 28. PMID: 30598326.
3. Custodero C, Mankowski RT, Lee SA, Chen Z, Wu S, Manini TM, Hincapie Echeverri J, Sabbà C, Beavers DP, Cauley JA, Espeland MA, Fielding RA, Kritchevsky SB, Liu CK, McDermott MM, Miller ME, Tracy RP, Newman AB, Ambrosius WT, Pahor M, Anton SD. Evidence-based nutritional and pharmacological interventions targeting chronic low-grade inflammation in middle-age and older adults: A systematic review and meta-analysis. Ageing Res Rev. 2018 Sep;46:42-59. doi: 10.1016/j.arr.2018.05.004. Epub 2018 May 25. PMID: 29803716; PMCID: PMC6235673.
4. Tabrizi R, Vakili S, Akbari M, Mirhosseini N, Lankarani KB, Rahimi M, Mobini M, Jafarnejad S, Vahedpoor Z, Asemi Z. The effects of curcumin-containing supplements on biomarkers of inflammation and oxidative stress: A systematic review and meta-analysis of randomized controlled trials. Phytother Res. 2019 Feb;33(2):253-262. doi: 10.1002/ptr.6226. Epub 2018 Nov 7. PMID: 30402990.
5. Custodero C, Mankowski RT, Lee SA, Chen Z, Wu S, Manini TM, Hincapie Echeverri J, Sabbà C, Beavers DP, Cauley JA, Espeland MA, Fielding RA, Kritchevsky SB, Liu CK, McDermott MM, Miller ME, Tracy RP, Newman AB, Ambrosius WT, Pahor M, Anton SD. Evidence-based nutritional and pharmacological interventions targeting chronic low-grade inflammation in middle-age and older adults: A systematic review and meta-analysis. Ageing Res Rev. 2018 Sep;46:42-59. doi: 10.1016/j.arr.2018.05.004. Epub 2018 May 25. PMID: 29803716; PMCID: PMC6235673.
6. Zhang Y, Chen C, Lu L, Knutson KL, Carnethon MR, Fly AD, Luo J, Haas DM, Shikany JM, Kahe K. Association of magnesium intake with sleep duration and sleep quality: findings from the CARDIA study. Sleep. 2022 Apr 11;45(4):zsab276. doi: 10.1093/sleep/zsab276. PMID: 34883514; PMCID: PMC8996025.
7. Marie B Demay, Anastassios G Pittas, Daniel D Bikle, Dima L Diab, Mairead E Kiely, Marise Lazaretti-Castro, Paul Lips, Deborah M Mitchell, M Hassan Murad, Shelley Powers, Sudhaker D Rao, Robert Scragg, John A Tayek, Amy M Valent, Judith M E Walsh, Christopher R McCartney, Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 109, Issue 8, August 2024, Pages 1907–1947, https://doi.org/10.1210/clinem/dgae290
8. Fairfield KM, Fletcher RH. Vitamins for Chronic Disease Prevention in Adults: Scientific Review. JAMA. 2002;287(23):3116–3126. doi:10.1001/jama.287.23.3116

Is Creatine Safe for Kids? What Parents and Practitioners Should Know
Creatine is one of the most extensively researched nutrients in sports, metabolic, and brain health, yet parents and practitioners alike have questions about its use in children and adolescents. In this episode, Dr. Kate Kresge speaks with Jeff Gladd, MD, Chief Medical Officer at Fullscript, to clarify how creatine functions in normal physiology, what the research shows about pediatric safety, and how clinicians can guide families with confidence. Together, they explore growth-related energy needs and practical clinical considerations—offering an evidence-informed framework for responsible conversations about creatine use in youth.


Clinical Takeaways from This Episode

• Creatine Supports Pediatric Energy Metabolism: Creatine is synthesized endogenously and obtained through diet, primarily from meat and fish. Average turnover is estimated at 2–4 g/day in adults, with children excreting approximately 14–15 mg/kg/day, reflecting ongoing metabolic demand during growth (Wang, 2018).
• Available Evidence Supports Safety in Healthy Youth: Although long-term pediatric-specific trials are limited, existing studies and decades of clinical use report no serious adverse events in healthy children and adolescents at typical doses (Kreider, 2017)
• Creatine Status Is Associated With Lean Mass and Bone Health: Lower creatine availability has been linked to lower lean mass accrual, lower bone mineral content, and less favorable body composition in youth (Korovljev, 2021).
• Clinical Context and Product Quality Are Key: Caution may be appropriate for individuals with known kidney disease. Professional-grade, single-ingredient creatine monohydrate is preferred over blends, which may contain unintended additives (Kreider, 2017).

Guest Introduction

Jeff Gladd, MD is a practicing integrative physician at GladdMD and the Chief Medical Officer at Fullscript. He specializes in translating nutrition and metabolic research into practical, evidence-informed clinical decision support for healthcare professionals.


Labs, Nutrition, and Lifestyle Support


Nutrition & Lifestyle Foundations Discussed

• Emphasize a nutrition-first framework, with supplements as adjunctive support
• Review total protein and animal protein intake, especially in low-meat or vegetarian diets
• Assess caloric adequacy during growth spurts and high physical activity
• Adequate sleep and recovery during growth and training
• Balanced training loads to reduce overuse and endurance-related stress (Kreider, 2017).

Creatine Supplement Quality

• Creatine monohydrate is the most studied and evidence-supported form of creatine
• Professional-grade, third-party tested products, including NSF Certified for Sport® options for athletes. Practitioners can prescribe these through Fullscript (Kreider, 2017).

Labs to Consider When Clinically Indicated

• Basic metabolic panel to assess renal function and electrolytes
• Body composition tracking when relevant
• Additional evaluation only when rare creatine synthesis or transport disorders are suspected (Kreider, 2017).

Key Moments from the Episode

• 00:00 – Why creatine raises concerns for kids and teens
• 03:28 – How the body produces and uses creatine
• 05:39 – Low creatine availability and body composition
• 07:18 – Safety data and common side effects
• 09:07 – Addressing the “gateway supplement” myth
• 10:48 – Labs clinicians may consider for patients taking creatine
• 12:44 – Why supplement quality matters
• 13:45 – Choosing NSF Certified for Sport® creatine monohydrate
• 14:47 – Practical takeaways for families and clinicians
  
  

Clinician FAQ: Creatine Use in Children and Adolescents


Is creatine naturally present in the body?
Yes. Creatine is synthesized daily from amino acids and obtained from dietary sources, supporting normal cellular energy metabolism (Kreider, 2017).


Is creatine considered safe for kids and teens?
Available evidence suggests creatine is well-tolerated in healthy youth at usual doses, though long-term pediatric-specific data remain limited (Kreider, 2017) (Jagim, 2021).


Who should use creatine with caution?
Individuals with known kidney disease or fluid balance concerns may warrant closer clinical evaluation (Antonio, 2021).


Are labs required before starting creatine?
Routine labs are not necessary, though a basic metabolic panel may be considered in select cases (Kreider, 2017).


Why is supplement quality emphasized?
Risks are more commonly associated with blends or pre-workout supplements that contain other / unlisted ingredients, not creatine monohydrate itself (Geyer, 2004).

Want to elevate your practice? The Root Cause Medicine Podcast is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one centralized system. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient treatment planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. 
Disclaimer


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


Citations

• Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, Candow DG, Kleiner SM, Almada AL, Lopez HL. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017 Jun 13;14:18. doi: 10.1186/s12970-017-0173-z. PMID: 28615996; PMCID: PMC5469049.
• Wang W, Du C, Lin L, Chen W, Tan L, Shen J, Pearce EN, Zhang Y, Gao M, Bian J, Wang X, Zhang W. Anthropometry-based 24-h urinary creatinine excretion reference for Chinese children. PLoS One. 2018 May 23;13(5):e0197672. doi: 10.1371/journal.pone.0197672. PMID: 29791502; PMCID: PMC5965866.
• Korovljev D, Stajer V, Ostojic SM. Relationship between Dietary Creatine and Growth Indicators in Children and Adolescents Aged 2-19 Years: A Cross-Sectional Study. Nutrients. 2021;13(3):1027. Published 2021 Mar 23. doi:10.3390/nu13031027
• Antonio J, Candow DG, Forbes SC, Gualano B, Jagim AR, Kreider RB, Rawson ES, Smith-Ryan AE, VanDusseldorp TA, Willoughby DS, Ziegenfuss TN. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr. 2021 Feb 8;18(1):13. doi: 10.1186/s12970-021-00412-w. PMID: 33557850; PMCID: PMC7871530.
• Jagim AR, Stecker RA, Harty PS, Erickson JL, Kerksick CM. Safety of Creatine Supplementation in Active Adolescents and Youth: A Brief Review. Front Nutr. 2018 Nov 28;5:115. doi: 10.3389/fnut.2018.00115. PMID: 30547033; PMCID: PMC6279854.
• Geyer H, Parr MK, Mareck U, Reinhart U, Schrader Y, Schänzer W. Analysis of non-hormonal nutritional supplements for anabolic-androgenic steroids - results of an international study. Int J Sports Med. 2004 Feb;25(2):124-9. doi: 10.1055/s-2004-819955. PMID: 14986195.

Summary
In this Root Cause Medicine podcast episode, Dr. Kate Kresge is joined by Dr. Eric Viegas, quality and safety lead at Fullscript, to explore emerging concerns around ashwagandha-associated drug-induced liver injury (DILI). While ashwagandha remains one of the most widely used adaptogens in integrative medicine, recent international case reports have highlighted rare but clinically meaningful hepatic adverse events. This episode equips clinicians with a mechanistic understanding of potential risk factors, withanolide content that may increase vulnerability, and practical strategies for patient screening, education, and monitoring—without dismissing the therapeutic value of this foundational herb.
Clinical Takeaways from This Episode

• Ashwagandha-Associated Drug-Induced Liver Injury (DILI) Is Rare but Documented
  Case reports from Japan, Iceland, and the U.S. describe hepatocellular injury typically occurring within 2–12 weeks of initiation, often resolving after discontinuation (Björnsson, 2020).
• Withanone and Oxidative Stress as a Proposed Mechanism
  The withanolide withanone may contribute to genotoxic and oxidative stress, particularly in states of depleted glutathione, potentially impairing hepatic detoxification capacity (Siddiqui, 2021).
• Withanolide Concentration Matters
  Products standardized to high withanolide content may pose greater theoretical risk compared to traditional whole-root or aqueous preparations (Björnsson, 2020).
• Patient Vulnerability Influences Risk Profile
  Individuals with pre-existing liver concerns, polypharmacy, high oxidative stress burden, or impaired phase II detoxification may warrant closer consideration and monitoring (Siddiqui, 2021).
• Clinical-Grade Supply Chains Support Risk Mitigation
  Practitioner-dispensed platforms with transparent sourcing, certificates of analysis, and clear extract documentation may help reduce exposure to adulterated or mischaracterized products.
• Patient Education and Monitoring Remain Frontline Tools
  Counseling on symptom awareness and considering baseline and follow-up liver enzymes may support safer use when ashwagandha is clinically appropriate.

Guest Introduction
Dr. Eric Viegas is a quality expert at Fullscript, where he oversees supplement quality programs, supply chain integrity, and clinical-grade standards. With expertise in pharmacology, toxicology, and nutraceutical regulation, Dr. Viegas supports practitioners in making evidence-informed decisions around supplement sourcing, formulation, and patient safety. Learn more: https://fullscript.com
Labs, Nutrition, and Lifestyle Support
Liver Function and Safety Monitoring Labs

• Comprehensive Metabolic Panel (CMP)
• ALT
• AST
• Total and direct bilirubin
• Alkaline phosphatase, as clinically indicated  (Björnsson, 2020)

Nutritional Considerations for Hepatic Resilience

• Adequate dietary protein to support glutathione synthesis (Siddiqui, 2021)

Lifestyle and Integrative Support Strategies

• Review of total supplement and medication load with attention to polypharmacy
• Patient education on early symptoms of liver stress such as fatigue, pruritus, dark urine, and jaundice (Björnsson, 2020)

All strategies are intended for educational support and clinical consideration and should be applied within the context of individualized care.
SponsorThis episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient treatment planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.
FAQs
1) Can ashwagandha cause liver injury?Yes, but it appears to be rare. Published case series and reports describe ashwagandha-associated drug-induced liver injury (DILI) with symptom onset most often within weeks (commonly ~2–12 weeks) after starting, and improvement typically occurring after stopping the product. Clinicians should treat this as an uncommon, but plausible, idiosyncratic adverse event rather than a predictable toxicity for all users (Björnsson et al., 2020).


2) What are the typical symptoms of ashwagandha-related liver injury?Reported presentations resemble other forms of DILI and may include fatigue, pruritus, dark urine, and jaundice; some patients may have nonspecific malaise before overt cholestatic or hepatocellular patterns are recognized on labs. Educate patients to discontinue the product and seek evaluation promptly if these symptoms occur (Björnsson et al., 2020).


3) How long after starting ashwagandha might liver injury show up?In published cases, liver injury has typically appeared within 2 to 12 weeks after initiation (though individual variability exists, as with other DILI phenotypes). This timing supports a practical monitoring window for higher-risk patients, especially early in therapy (Björnsson et al., 2020).


4) Who is at higher risk for ashwagandha-associated DILI?Risk appears to be influenced by host vulnerability and context, including pre-existing liver disease or prior liver injury, significant polypharmacy, and higher oxidative stress burden. Because DILI is often idiosyncratic, risk stratification is imperfect; however, these factors justify a more conservative approach and closer follow-up (Siddiqui et al., 2021; Björnsson et al., 2020).


5) What is the safest way to use ashwagandha clinically?A clinically cautious approach is to:

• Prefer transparent, clinically vetted supply chains with clear extract specifications and quality documentation.
• Screen for liver history and medication/supplement load.
• Educate patients on early warning symptoms.
• Consider baseline and follow-up liver enzymes (e.g., ALT, AST, bilirubin) in higher-risk individuals or if symptoms develop.
• This framing supports safer use without implying the product is universally unsafe or “detoxifying,” and keeps claims within educational and clinical-monitoring boundaries (Björnsson et al., 2020; Siddiqui et al., 2021).
  
  

Citations

1. Björnsson HK, Björnsson ES, Avula B, Khan IA, Jonasson JG, Ghabril M, Hayashi PH, Navarro V. Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver Int. 2020 Apr;40(4):825-829. doi: 10.1111/liv.14393. Epub 2020 Feb 11. PMID: 31991029; PMCID: PMC8041491. 
2. Siddiqui S, Ahmed N, Goswami M, Chakrabarty A, Chowdhury G. DNA damage by Withanone as a potential cause of liver toxicity observed for herbal products of Withania somnifera (Ashwagandha). Curr Res Toxicol. 2021;2:72-81. Published 2021 Feb 16. doi:10.1016/j.crtox.2021.02.002

Nearly one in three adults will experience a voice disorder at some point in their lifetime, often without realizing it may be connected to their overall health (Stachler et al., 2018). In this episode, we sit down with integrative otolaryngologist Dr. Linda Dahl to unpack how subtle changes in vocal tone, stamina, and clarity can serve as early clues to what’s happening systemically - from inflammation and hormonal shifts to nervous system stress, reflux, and microbiome changes - and what to do next depending on what you hear. From simple in-office listening strategies and targeted questions to appropriate referrals, lab considerations, and integrative support options, this episode helps clinicians effectively resolve common voice issues using a whole person approach. 

CLINICAL TAKEAWAYS FROM THIS EPISODE

• Using the Voice as a Functional Assessment Tool in Whole-Person Care
  • Changes in vocal tone, strength, endurance, or ease can provide early clues to systemic stressors such as inflammation, neuroendocrine imbalance, sleep disruption, microbiome dysfunction, or neurological or autonomic issues (Stachler et al., 2018).

• Integrative Treatment Considerations for Voice-Related Symptoms
  • When vocal changes are present, supportive strategies may include addressing reflux, nutrient insufficiencies, nervous system regulation, breath mechanics, posture, microbiome optimization, referral to physical therapy and more (Stachler et al., 2018).

GUEST INTRODUCTIONDr. Linda Dahl, MD, is a board-certified otolaryngologist, voice specialist, and integrative ENT physician. Her clinical work focuses on functional voice disorders, laryngeal health, and the intersection of vocal performance with systemic physiology. Dr. Dahl is known for integrating conventional ENT diagnostics with evidence-informed strategies that address inflammation, reflux, hormonal balance, and nervous system regulation. She regularly educates clinicians on using the voice as a meaningful window into whole-person health.

LABS, NUTRITION, AND LIFESTYLE SUPPORT

Dr. Dahl’s Clinical Lab Considerations for Voice Issues and Cough

• Inflammatory and metabolic markers as clinically appropriate (Stachler, 2018).
• Hormonal assessment as clinically indicated (Yalim, 2025).

Dr. Dahl’s Nutrition and GI Support Considerations for Vocal Issues and Chronic Cough

• Hydration assessment and counseling (Verdolini, 1994).
• Address reflux holistically if present (Stachler, 2018).
• Support the microbiome as clinically indicated and consider candidiasis overgrowth in patients with a history of oral corticosteroid use (Pinto, 2013).

Lifestyle and Nervous System Support for Voice 

• Consider humidified air and environmental support for laryngeal tissue health (Levendoski, 2014).
• Vocal hygiene education, including pacing and rest—even in non-performers.
• Referral to voice therapy when functional misuse or strain is suspected (Wolfberg, 2024).

KEY MOMENTS

02:10 - Why the voice functions as a clinical vital sign
06:45 - Systemic conditions commonly reflected in voice changes
11:30 - Nutritional and hormonal influences on vocal tone
17:05 - Practical voice assessment in the exam room
22:40 - When to refer to ENT or voice therapy
28:10 - Reflux, inflammation, and chronic hoarseness
33:55 - The voice–nervous system connection
39:20 - Breath, posture, and vagal tone in vocal health
44:15 - Rapid-fire clinical insights on dysphonia
48:30 - Using the voice to track healing over time


DISCLAIMER

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

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

1. Stachler, R.J., Francis, D.O., Schwartz, S.R., Damask, C.C., Digoy, G.P., Krouse, H.J., McCoy, S.J., Ouellette, D.R., Patel, R.R., Reavis, C.W., Smith, L.J., Smith, M., Strode, S.W., Woo, P. and Nnacheta, L.C. (2018), Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngology–Head and Neck Surgery, 158: S1-S42. https://doi.org/10.1177/0194599817751030
2. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. Stephen W. Porges. W.W. Norton & Company:  New York, NY,  2011.
3. Yalim SD, Bayram S, Bayar Muluk N, Cingi C. Association Between Menopause and Voice. Ear, Nose & Throat Journal. 2025;105(2):91-98. doi:10.1177/01455613251395924
4. Levendoski EE, Sundarrajan A, Sivasankar MP. Reducing the negative vocal effects of superficial laryngeal dehydration with humidification. Ann Otol Rhinol Laryngol. 2014 Jul;123(7):475-81. doi: 10.1177/0003489414527230. PMID: 24690983; PMCID: PMC5441306. 
5. Verdolini K, Titze IR, Fennell A. Dependence of phonatory effort on hydration level. J Speech Hear Res. 1994 Oct;37(5):1001-7. doi: 10.1044/jshr.3705.1001. PMID: 7823546.
6. Pinto CR, Almeida NR, Marques TS, Yamamura LL, Costa LA, Souza-Machado A. Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma. J Bras Pneumol. 2013;39(4):409-417. doi:10.1590/S1806-37132013000400003
7. Wolfberg J, Whyte J, Doyle P, Gherson S, Muise J, Petty B, Tolejano CJ, Hillman RE, Stadelman-Cohen T, Van Stan JH. Rehabilitation Treatment Specification System for Voice Therapy: Application to Everyday Clinical Care. Am J Speech Lang Pathol. 2024 Mar 7;33(2):814-830. doi: 10.1044/2023_AJSLP-23-00283. Epub 2023 Dec 19. PMID: 38101322; PMCID: PMC11001165. 

In part two of our SIBO series,  we’re joined again by Dr. Allison Siebecker to focus on 2 key pillars that can influence whether patients stabilize or relapse: nutritional management and supportive care during and after SIBO treatment. 
We explore how to use prokinetics to support migrating motor complex function, when digestive aids like bile acids and enzymes may be appropriate, and how to apply SIBO dietary frameworks as personalized, flexible tools—not rigid rules. 
We also cover practical approaches to suspected yeast/dysbiosis overlap, how to support gut barrier integrity without worsening fermentation, and the key myths that can derail outcomes. This episode helps clinicians move from “eradication mode” to sustainable, integrative SIBO care.
Clinical Takeaways from This Episode

• How do prokinetics help to prevent SIBO relapse and support the migrating motor complex?
  • Dr. Siebecker frames prokinetics as a core strategy to support upper GI motility and migrating motor complex activity, particularly between treatment rounds and for maintenance after major symptom improvement, individualized to relapse risk and underlying drivers. Prokinetics help to accomplish roles that the migrating motor complex and motilin typically perform in the GI tract, including the routine out-movement of foodstuffs, resulting in less time for bacteria to ferment specific carbohydrates (Deloose, 2015).

• Can you use prokinetics in diarrhea-predominant patients, or are they basically laxatives?
  • They’re not laxatives by definition. Prokinetics are intended to support coordinated GI motility (often esophagus, stomach, small intestine) and may still be considered in diarrhea-predominant cases when small intestine motility impairment is part of the picture; dose and individual tolerance matter (Camilleri, 2021).

• Should clinicians use restrictive SIBO diets during treatment, and can diet “cure” SIBO?
  • Food based diets are best positioned as symptom support, not a standalone cure. Low-fermentable carbohydrate approaches may reduce gas-related symptoms and improve adherence during treatment, and clinical experience shared here suggests improvement can still occur even when diets are quite restricted. Food is distinct from the elemental diet, where patients only intake a supplement for 2 weeks, discussed part of the series (Knez, 2024).

• How should clinicians approach SIBO diet personalization and food reintroduction after treatment?
  • Dr. Siebecker recommends using established dietary frameworks (low FODMAP, SCD, hybrid approaches like the SIBO-specific guide/biphasic structure) as starting points, then customizing based on symptom response. Food reintroduction can be gradual, sometimes using “micro-dosing” exposures, with repeat trials to reduce confounding factors. Not everyone with the same subtype of SIBO will be able to tolerate the same foods.

• What supportive care is commonly missed in complex or relapsing SIBO cases?
  • Commonly missed supports discussed by Dr. Siebecker include: physical medicine for for structural contributors, thoughtful use of digestive support (enzymes, bile acids when clinically indicated), and careful selection of gut barrier supports—noting that some mucopolysaccharide-rich “leaky gut” agents may aggravate symptoms in active SIBO for some patients.

Guest Introduction
Dr. Alison Siebecker is a clinician and educator recognized for her work in SIBO subtyping, breath test interpretation, treatment sequencing, and relapse prevention strategies. She provides practitioner education, patient resources, and community learning through siboinfo.com 
Labs, Nutrition, and Lifestyle Support Mentioned
Motility support: prokinetics (pharma and botanical options discussed)

• When used: between rounds and for remission maintenance (often at least ~3 months, individualized).
• Options discussed: prucalopride, low-dose erythromycin, LDN (adjunct), ginger and ginger-based blends, Iberis amara–containing multi-herbal combinations.

Digestive support: bile acids and enzymes (individualized)

• Bile support may be considered when clinical suspicion of low bile flow exists; enzymes may support digestion during symptom management and re-expansion.

Yeast/dysbiosis overlap: testing options

• Stool testing (colonic yeast), urine organic acids (yeast metabolites), Candida immune markers (reactivity patterns), and symptom questionnaires as pragmatic adjuncts.

Gut barrier support during active SIBO: choose lower-fermentation options first

• Trial cautiously: marshmallow, aloe, comfrey (may aggravate symptoms for some).
• Often better tolerated options discussed: IgG/colostrum, zinc carnosine, non-fermentable anti-inflammatory supports.

Integrative lifestyle medicine and structural support

• Physical medicine, acupuncture, chiropractic when appropriate.

Key Moments03:30 – Why some physical medicine modalities may improve outcomes in complex SIBO04:45 – Prokinetics explained: migrating motor complex support vs laxative misconceptions06:45 – Timing between treatment rounds and how practice scheduling impacts success14:31 – Foods for symptom relief: why diet alone may not resolve relapse drivers23:00 – Leaky gut support during active SIBO: what may aggravate symptoms vs better-tolerated options27:06 – Biphasic/SIBO-specific dietary frameworks and personalization principles30:26 – Common SIBO myths that derail care and patient confidence31:40 – Clinical hope message: troubleshooting why patients aren’t improving
Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient treatment planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.
DisclaimerThe views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.
Citations

1. Camilleri M, Atieh J. New Developments in Prokinetic Therapy for Gastric Motility Disorders. Front Pharmacol. 2021;12:711500. Published 2021 Aug 24. doi:10.3389/fphar.2021.711500
2. Deloose E, Janssen P, Depoortere I, Tack J. Redefining the functional roles of the gastrointestinal migrating motor complex and motilin in small bacterial overgrowth and hunger signaling. Am J Physiol Gastrointest Liver Physiol. 2015;309(9):G649-G661.
3. Knez E, Kadac-Czapska K, Grembecka M. The importance of food quality, gut motility, and microbiome in SIBO development and treatment. Nutrition. 2024 Aug;124:112464. doi: 10.1016/j.nut.2024.112464. Epub 2024 Apr 5. PMID: 38657418.

The research around SIBO is evolving, and 2026 has brought more subtypes, testing and treatment options than ever before. Our guest this week, Dr. Allison Siebecker, is an expert in conventional and natural approaches to SIBO, helped to open one of the first integrative SIBO centers in the nation, and frequently teaches physicians about how to effectively treat even the toughest cases of SIBO, ISO, IMO and more. 
Today, we explore how hydrogen, methane (IMO), and hydrogen sulfide–associated (ISO) pattern-typing can help us choose treatment options that help to decrease SIBO symptoms effectively. We discuss how impaired motility - particularly dysfunction of the migrating motor complex - can impact symptom persistence and relapse in addition to microbial type and load, and why we should address it in treatment plans. Dr. Siebecker also reviews the newest advances in SIBO testing, breath test interpretation, and how long to test depending on what you’re looking to discover. 
If SIBO has felt like a guessing game in your practice, or if you’re just looking to stay on the leading edge, this episode offers a clearer, physiology-driven framework grounded in education that will help your clients get and stay well. 
Timestamps

00:00 - Introduction to the episode and guest
03:45 - What SIBO is and how it’s currently defined (including ICD-10 update)
06:50 - Differentiating hydrogen, methane, and hydrogen sulfide subtypes
08:40 - Key symptoms: bloating, IBS symptoms, mood, fatigue
10:54 - Why gas types matter and how they affect motility
15:00 - Primary causes and risk factors: infections, meds, mold, structural changes
18:40 - Mold and mycotoxin impact on gut motility
21:59 - How to test: glucose vs. lactulose, two-hour vs. three-hour tests
24:14 - Choosing a testing method and interpreting flatlines
29:01 - Cost, access, and why testing saves time and money long term
31:03 - Choosing treatment based on gas type and severity
36:32 - Understanding treatment rounds and when to stop or switch protocols
38:59 - Why methane and hydrogen sulfide SIBO are more difficult to treat
43:26 - Nystatin, yeast overgrowth, and when to co-treat for CIFO
47:55 - Rifaximin as a eubiotic and why it’s well tolerated
49:46 - Preview of Part 2: Nutrition, prokinetics, supportive therapies



Clinician Questions & Evidence-Informed Takeaways

• How is SIBO defined and what testing is recommended?
  • SIBO is best understood as a clinical syndrome requiring both characteristic gastrointestinal symptoms and objective evidence of microbial overgrowth in the small intestine. Breath testing may support diagnostic clarity, subtype identification, and treatment planning, particularly in patients with IBS or recurrent digestive disorders (Pimentel, 2020).

• What are the differences between hydrogen-, methane-, and hydrogen sulfide–associated SIBO patterns?
  • Hydrogen-predominant SIBO typically reflects small intestinal fermentation, whereas methane-associated IMO and hydrogen sulfide patterns may involve both the small intestine and colon. Hydrogen predominant types are also usually caused by bacterial overgrowth, while methane and sulfide-predominant types can involve overgrowth of archaea. These distinctions influence motility, symptom expression, and selection of appropriate treatment options (Pimentel, 2020).

• How does impaired gas handling contribute to SIBO and IBS symptoms?
  • Symptom severity may be driven by reduced clearance of gas rather than gas volume alone. Dysfunction of the migrating motor complex and altered neuromuscular signaling can result in significant bloating, distension, and pain even with modest gas elevations. Helping patients restore normal gas-clearing abilities can help to alleviate symptoms, according to Dr. Siebecker (Serra, 2001).

• How does methane slow intestinal transit and result in constipation-predominant presentations?
  • Methane functions as a gasotransmitter that interacts with the enteric nervous system and may slow gut motility. This provides a physiologic explanation for constipation-predominant IBS patterns and the increased treatment complexity seen in methane-associated cases (Park, 2017).

• Which breath test substrate provides the most clinically useful data for SIBO evaluation?
  • There are multiple non-invasive tests available for the detection of SIBO that contain a carbohydrate drink and containers designed to collect breath samples at regular intervals (Losurdo 2020).
  • Lactulose is preferred by Dr. Siebecker in clinical practice because it traverses the full length of the small intestine and into the colon, potentially reducing false-negative results associated with early glucose absorption that can occur in some patients. Dr. Siebecker recommends tests that are at least 3 hours in duration for most patients. (Pimentel, 2020)

• How does breath test duration impact the detection of methane and hydrogen sulfide patterns?
  • Shortened testing protocols may fail to capture later-rising methane or persistently low hydrogen and methane patterns. According to Dr. Siebecker, extended collection windows can improve detection of methane-associated IMO and suspected hydrogen sulfide physiology. It could also help to capture patients with SIBO who also have impaired motility and transit time (Tansel, 2023).

• What is the clinical interpretation of a flatline hydrogen and methane breath test for SIBO?
  • A flatline pattern (i.e. low and relatively stable hydrogen and methane values) could give clues to abnormal function in symptomatic patients. Dr. Siebecker suggests that in appropriate clinical contexts, abnormal patterns like flatline may suggest hydrogen sulfide overproduction or altered microbial metabolism of gases (Lakhoo, 2018).

• How should breath test severity inform SIBO treatment sequencing and prognosis?
  • In Dr. Siebecker’s experience, higher gas levels may justify consideration of strategies with greater average reduction potential, such as elemental diet, while lower or moderate elevations may be approached with pharmaceutical or herbal treatment options. Severity-based planning can improve timelines and patient expectations.

• If patients relapse after SIBO treatment, what does that mean?
  • Symptom recurrence shortly after treatment more often reflects incomplete microbial reduction or the existence of undertreated root causes rather than true relapse. This distinction supports staged treatment approaches with reassessment rather than premature abandonment of therapy. Patients with incomplete resolution can also be evaluated for other disorders like pancreatic exocrine insufficiency, bile acid malabsorption, lactose intolerance, etc. (Rao, 2019).

• Under what circumstances should coexisting fungal overgrowth be considered in SIBO patients?
  • Dr. Siebecker explains that small intestinal fungal overgrowth (SIFO) testing could be considered in patients with prior candidiasis, repeated antibiotic exposure, or persistent symptoms despite improving SIBO markers. Evaluation is typically individualized rather than routine (Soliman, 2025). 

• What is the role of prokinetics in long-term SIBO management?
  • Prokinetics support the migrating motor complex and may help maintain treatment gains following antimicrobial therapy. Addressing motility is central to relapse prevention and sustained gut health (Kim, 2023).

• What factors should be reassessed in patients with recurrent or refractory SIBO?
  • Persistent or relapsing SIBO warrants reassessment of medications (particularly opioids), structural contributors, metabolic and neurologic conditions, immune dysfunction, environmental exposures, and lifestyle factors influencing gut physiology (Rao, 2019 and Pimentel, 2020).

Guest 
Dr. Alison Siebecker, ND is a naturopathic physician, internationally recognized SIBO expert, and educator whose work has shaped how clinicians understand small intestine overgrowth, breath testing, and integrative treatment options. She is known for her clear clinical algorithms, deep expertise in SIBO subtypes, and commitment to practitioner education. Her ongoing collaboration and dialogue with leading researchers—including Dr. Mark Pimentel’s research group—continues to advance the field. You can learn more about her at https://www.siboinfo.com/

SIBO Testing

• Learn more about Optimizing SIBO Diagnosis with Testing 
• Order SIBO testing for patients through Rupa Health and Fullscript with a free account

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient treatment planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.
Disclaimer
The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.
Citations

1. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020;115(2):165-178.
2. Rezaie A, Buresi M, Lembo A, et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017;112(5):775-784. 
3. Serra J, Azpiroz F, Malagelada JR. Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut. 2001;48(1):14-19. 
4. Park H, Lee K, Park S, et al. The effects and mechanism of action of methane on ileal motor function. Neurogastroenterol Motil. 2017;29(9):e13067. 
5. Losurdo G, Leandro G, Ierardi E, Perri F, Barone M, Di Leo A. Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis. J Neurogastroenterol Motil. 2020;26(1):16-28.
6. Tansel A, Levinthal DJ. Understanding Our Tests: Hydrogen-Methane Breath Testing to Diagnose Small Intestinal Bacterial Overgrowth. Clin Transl Gastroenterol. 2023;14(4):e00567. Published 2023 Apr 1. doi:10.14309/ctg.0000000000000567
7. Birg A, Hu S, Lin HC, et al. Reevaluating our understanding of lactulose breath tests by incorporating hydrogen sulfide measurements. JGH Open. 2019;3(2):228-233.
8. Lakhoo, Krutika MD1; Liu, Xiaochen MSc1; Lentz, Greg2; Lin, Eugenia BS1; Chang, Bianca W. MD3; Pimentel, Mark MD1; Pichetshote, Nipaporn MD1; Rezaie, Ali MD, MSc1. Phenotype and Antibiotic Response in Patients With Flat Line Breath Test Results: A Large Scale Database Analysis: 448. American Journal of Gastroenterology 113():p S261, October 2018. 
9. Soliman N, Kruithoff C, San Valentin EM, Gamal A, McCormick TS, Ghannoum M. Small Intestinal Bacterial and Fungal Overgrowth: Health Implications and Management Perspectives. Nutrients. 2025;17(8):1365. Published 2025 Apr 17. doi:10.3390/nu17081365 
10. Rao, Satish & Bhagatwala, Jigar. (2019). Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management. Clinical and Translational Gastroenterology. 10. e00078. 10.14309/ctg.0000000000000078. 
11. Kim YJ, Jo IH, Paik CN, Lee JM. Efficacies of prokinetics and rifaximin on the positivity of a glucose breath test in patients with functional dyspepsia: a randomized trial. Rev Esp Enferm Dig. 2023 Mar;115(3):121-127. doi: 10.17235/reed.2022.8735/2022. PMID: 35748472.

Summary
In this month's CMO Industry Update, Dr. Jeff Gladd, MD joins us to unpack three timely topics for whole-person clinicians: 

• Emerging human data on urolithin A as a mitophagy-activating postbiotic that may support mitochondrial function and immune aging
• How to help patients engage with the “fiber maxing” trend in a safe, sustainable way that supports metabolic health, GI function, and diet adherence
• A new industry survey showing that 94% of pharma leaders are running or exploring direct-to-patient (DTP) programs, with implications for medication access, continuity of care, and the clinician’s central role in guiding treatment decisions. 

As always, Dr. Gladd gives clinicians practical takeaways and next steps to stay on the leading edge of integrative medicine. 


Clinical Takeaways from This Episode

• Urolithin A postbiotic and mitophagy support for immune aging
  Urolithin A (UA) is a gut-derived postbiotic produced from ellagic acid–rich foods (e.g., pomegranate, walnuts, raspberries) by specific microbiome profiles. Only a minority of patients appear to generate robust amounts endogenously, making it a candidate for targeted supplementation in select cases (Kuerec, 2024).

• Randomized controlled trial of urolithin A and “younger” immune phenotypes
  A 4-week randomized, double-blind, placebo-controlled trial in 50 middle-aged adults (1,000 mg/day UA) found favorable shifts in T-cell subsets (more naïve, fewer exhausted CD8+ cells) and improved mitochondrial activity in immune cells, suggesting UA may help support a more “youthful” immune profile and mitigate aspects of inflammaging (Denk, 2025).

• Mitophagy, mitochondrial fitness, and healthspan-focused care
  UA may act as a mitophagy inducer, potentially enhancing removal of dysfunctional mitochondria and supporting mitochondrial biogenesis; this aligns with broader healthspan strategies aimed at maintaining immune competence, muscle function, and cardiorespiratory fitness across the lifespan, without framing UA as a standalone longevity cure (Keurec, 2024).

• Integrating urolithin A within comprehensive mitochondrial and metabolic health plans
  Rather than “hero-ing” a single ingredient, Dr. Gladd underscores that any consideration of UA belongs alongside foundational lifestyle medicine: resistance training for muscle preservation, VO₂-max–oriented movement, nutrient-dense diets, sleep, stress regulation, and microbiome-supportive nutrition.

• Evidence-informed high-fiber nutrition to support metabolic and GI health
  Only about 5% of the U.S. population meets daily fiber intake recommendations, with average intakes around 17 g/day compared to suggested ranges of roughly 21–25 g for adult women and 30–38 g for adult men (Dahl, 2015). Clinicians can frame fiber not as restriction, but as “nutrition by addition” for metabolic health, GI regularity, cholesterol balance, and satiety.

• Coaching patients through the ‘fiber maxing’ trend safely
  Social media trends promoting 30–40+ g/day of fiber can be beneficial in concept but may trigger gas, bloating, or bowel changes if patients increase too quickly or consume large bolus doses; gradual titration across meals, adequate hydration, and movement can improve tolerability and outcomes (McRae, 2020).

• Whole-food fiber strategies pair protein, polyphenols, and GI support
  The episode highlights simple upgrades—adding berries, flax, or psyllium to yogurt; spinach and lentils to egg scrambles; swapping regular pasta for lentil pasta; and building soups and stews around beans and lentils—allowing patients to hit fiber goals while supporting blood sugar steadiness, microbiome diversity, and adherence to higher-protein diets.

• Supplemental fibers: powders, liquids, and gummies in integrative GI care
  When diet alone is insufficient, blended soluble/insoluble fiber powders (e.g., psyllium, FOS, apple pectin) and pediatric-friendly liquids or travel-ready gummies can help bridge gaps. The conversation emphasizes quality sourcing, gradual introduction, and pairing supplements with water and movement to reduce GI side effects (McRae, 2020).

• Direct-to-patient pharma programs and the future of GLP-1 therapy access
  A recent ixlayer/DHC Group survey found that 94% of pharma leaders are running, planning, or exploring direct-to-patient programs, which may bundle telehealth, diagnostics, and medication fulfillment—including access to GLP-1 therapies for obesity and metabolic disease (Park, 2025). While this may reduce wait times for some medications, it also risks further fragmenting care.

• Preserving the provider–patient relationship in a DTP landscape
  Dr. Gladd frames this shift as a “rallying cry” for clinicians and platforms like Fullscript to double down on coordinated, whole-person care—ensuring someone is monitoring polypharmacy, side effects, risks, and lifestyle interventions, rather than allowing care to be driven solely by DTP marketing pipelines.

• Leveraging digital tools to scale integrative, whole-person care
  The episode closes with an invitation for clinicians to lean on practice-support tools (e.g., supplement quality curation, lab testing support, interaction checkers, AI-assisted plan-building) so they can stay at the center of patient care while reducing administrative burden and burnout.

Guest Introduction
Jeff Gladd, MD is an integrative and family medicine physician and the Chief Medical Officer at Fullscript, where he guides clinical strategy and product direction with a focus on evidence-informed, whole-person care. He is the founder of GladdMD Integrative Medicine, an Indiana-based clinic that blends conventional primary care with lifestyle medicine, nutrition, and high-access digital tools. Dr. Gladd completed medical training at Indiana University School of Medicine and an integrative medicine fellowship at the University of Arizona under Dr. Andrew Weil. He is a frequent national speaker on physician entrepreneurship, supplement quality, health IT, and the future of integrative primary care. Clinicians can explore more of his work through Fullscript’s practitioner education resources and his GladdMD practice content.


Labs, Nutrition, and Lifestyle Support

• Urolithin A
• Fiber powders
• Fiber liquids
• Fiber gummies

Citations

1. Bischof-Ferrari HA, et al. Effect of the mitophagy inducer urolithin A on age-related immune decline: a randomized, placebo-controlled trial. Nature Aging (2025).https://www.nature.com/articles/s43587-025-00996-x.pdf 
2. Slavin JL et al. Position of the Academy of Nutrition and Dietetics: Health Implications of Dietary Fiber. J Acad Nutr Diet. 2015;115(11):1861–1870.https://www.jandonline.org/article/S2212-2672(15)01386-6/abstract 
3. Park, A. DHC Group / ixlayer industry survey reporting that 94% of pharma leaders are currently running, planning, or exploring DTP programs, including telehealth and at-home diagnostics. 2025. https://www.fiercepharma.com/marketing/direct-patient-programs-are-works-94-pharmas-set-become-standard-practice-survey 
4. Kuerec AH, Lim XK, Khoo AL, Sandalova E, Guan L, Feng L, Maier AB. Targeting aging with urolithin A in humans: A systematic review. Ageing Res Rev. 2024 Sep;100:102406. doi: 10.1016/j.arr.2024.102406. Epub 2024 Jul 11. PMID: 39002645. 
5. Denk, D., Singh, A., Kasler, H.G. et al. Effect of the mitophagy inducer urolithin A on age-related immune decline: a randomized, placebo-controlled trial. Nat Aging 5, 2309–2322 (2025). https://doi.org/10.1038/s43587-025-00996-x 
6. Dahl, Wendy J. et al. Position of the Academy of Nutrition and Dietetics: Health Implications of Dietary Fiber. Journal of the Academy of Nutrition and Dietetics, Volume 115, Issue 11, 1861 - 1870
7. McRae MP. Effectiveness of Fiber Supplementation for Constipation, Weight Loss, and Supporting Gastrointestinal Function: A Narrative Review of Meta-Analyses. J Chiropr Med. 2020 Mar;19(1):58-64. doi: 10.1016/j.jcm.2019.10.008. Epub 2020 Aug 29. PMID: 33192192; PMCID: PMC7646157. 

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

Summary

In this episode of the Root Cause Medicine Podcast, Dr. Kate Kresge is joined by Dr. Eric Viegas, a leader in supplement safety at Fullscript, for a timely and evidence-informed discussion on lead exposure in protein powders and nutritional supplements. Amid rising media attention and consumer concern, the conversation unpacks how and why trace amounts of lead can appear in supplements, how different regulatory thresholds (Prop 65 vs. USP/ICH) should be interpreted clinically, and what toxicologically relevant exposure actually means. Clinicians will gain practical insight into cumulative lead exposure, patient risk stratification, and how Fullscript is advancing supplement quality through enhanced testing, transparency, and practitioner-facing safeguards.


Clinical Takeaways from This Episode

• Lead Detection vs. Clinical Risk Assessment in Supplements
  • Dr. Eric explains that detecting trace lead does not automatically equate to clinical harm; modern analytical testing is extremely sensitive, and risk must be contextualized using toxicology-based thresholds and cumulative exposure.
• Understanding Prop 65 vs. USP/ICH Lead Thresholds
  • California Prop 65 applies large safety buffers designed to trigger warnings, while USP 232 and ICH Q3D limits are toxicologically derived and commonly used in pharmaceutical-grade quality systems.
• Cumulative Lead Exposure and Patient-Specific Risk Factors
  • Total exposure from diet, water, environment, and supplements—especially in pregnancy, pediatrics, kidney disease, or high environmental burden—should guide clinical decision-making (FDA, 2025).
• Why Plant-Based Protein Powders Are More Vulnerable
  • Ingredients such as rice, peas, and hemp may bioaccumulate heavy metals from soil and water, and processing can further concentrate these compounds (Hasan, 2022).
• Beyond Heavy Metals: Broader Protein Powder Quality Metrics
  • Clinicians should also consider microbes, pesticides, residual solvents, phytates, and banned substances when evaluating protein powders.
• Clinical Value of Certificates of Analysis (COAs)
  • Batch-specific COAs provide greater transparency than general certifications and allow clinicians to verify contaminant screening for the exact product lot (CHPA, 2010).
• Role of Enhanced Finished-Product Testing in Integrative Care
  • Platforms like Fullscript are supporting clinicians by conducting independent, third-party testing and surfacing results directly within the clinical workflow.
    
    

Timestamps

00:00 Welcome and episode overview
01:48 Why lead in protein powders is trending now
03:58 Detectable does not always mean dangerous
04:30 How to interpret lead amounts and cumulative exposure
05:58 Other supplement contaminants to consider
07:45 Why plant-based proteins carry higher risk of heavy metal uptake
10:55 What certifications to look for and why they matter
13:10 What Fullscript is doing, enhanced testing, and safeguards
15:10 How to assess lead exposure in clinical practice18:11 What Dr. Viegas wants to change in the supplement industry20:02 How to choose a safer protein powder21:59 Final takeaways and closing


Guest Introduction


Eric Viegas, ND
Dr. Eric Viegas is a leader in supplement safety and quality assurance at Fullscript, where he oversees contaminant screening, regulatory alignment, and enhanced testing initiatives across multiple supplement categories. His work focuses on bridging pharmaceutical-grade toxicology standards with real-world clinical practice to support practitioner confidence and patient safety. Fullscript Quality & Education: https://fullscript.com


Labs, Nutrition, and Lifestyle Support


Lead Exposure Assessment and Monitoring

• Blood lead testing for evaluating current exposure (CDC, 2024)
• Environmental assessment of drinking water and occupational or environmental exposure (PEHSU, 2025)

Protein Powder Selection and Nutrient Quality Considerations

• Preference for brands with third-party cGMP certifications
• Review of batch-specific Certificates of Analysis (COAs) (CHPA, 2010)
• Awareness that organic certification does not eliminate heavy metal risk (Ramakrishnan, 2021)

Citations

• Clean Label Project. Heavy Metals in Protein Powders. Retrieved October 2025 from https://cleanlabelproject.org/protein-study-2-0/ 
• Consumer Reports. Protein Powders and Lead Levels. October 2025. https://www.consumerreports.org/lead/protein-powders-and-shakes-contain-high-levels-of-lead-a4206364640/ 
• United States Food and Drug Administration. FDA Draft Guidance on Lead in Food Intended for Babies, Children, and Adults. Updated January 2025. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/guidance-industry-action-levels-lead-processed-food-intended-babies-and-young-children 
• EFSA. EFSA scientific report on dietary exposure to lead in the European population. June 30, 2025. https://efsa.onlinelibrary.wiley.com/doi/10.2903/j.efsa.2025.9577 
• World Health Organization. Lead Poisoning and Health. September 2024. https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health 
• Centers for Disease Control. CDC Updates Blood Lead Reference Values. April 2024. https://www.cdc.gov/lead-prevention/php/news-features/updates-blood-lead-reference-value.html
• US Pharmacopeia. USP 232 Elemental Impurities - Limits. https://www.usp.org/sites/default/files/usp/document/our-work/chemical-medicines/key-issues/c232-usp-39.pdf 
• International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Harmonised Guideline: Guideline for Elemental Impurities Q3D(R2). 26 Apr. 2022. https://database.ich.org/sites/default/files/Q3D-R2_Guideline_Step4_2022_0308.pdf 
• Consumer Healthcare Products Association. Certificate of Analysis for Dietary Supplement Components. Consumer Healthcare Products Association. Apr. 2010, www.chpa.org/public-policy-regulatory/voluntary-codes-guidelines/certificate-analysis-dietary-supplement 
• Hasan, G. M. M. Anwarul, et al. “Accumulation of Heavy Metals in Rice (Oryza Sativa. L) Grains Cultivated in Three Major Industrial Areas of Bangladesh.” Journal of Environmental and Public Health, vol. 2022, 8 Mar. 2022, p. e1836597, https://doi.org/10.1155/2022/1836597 
• “Chemical Exposure Warnings (Proposition 65 Warnings).” Ca.gov, 2021, www.p65warnings.ca.gov/ 
• Ramakrishnan, Balasubramanian, et al. “Organic Farming: Does It Contribute to Contaminant-Free Produce and Ensure Food Safety?” Science of the Total Environment, vol. 769, 15 May 2021, www.sciencedirect.com/science/article/abs/pii/S0048969721001455 
• “Lead Exposure: Information for Health Professionals.” PEHSU - Pediatric Environmental Health Specialty Units, 7 Nov. 2025, pehsu.net/health-issue/lead-hcp/ Accessed 31 Dec. 2025.

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

In this rapid-fire “Health or Hype” installment, Dr. Kate Kresge sits down with performance specialists Dr. Chris Sands, DPT, OCS, and Dr. Gabe Kresge, DPT, to pressure-test the most common running claims through a clinically grounded lens. The conversation moves quickly—but stays evidence-oriented—clarifying where strength training supports running economy, why single-leg capacity matters for load management, how footwear choices should be individualized (especially during transitions), and what the research actually suggests about long-term joint health. They also reframe running assessments as a proactive performance-and-longevity tool, and close with a key injury-prevention principle: for most runners, training load and recovery patterns drive risk more than biomechanics alone.


Clinical Takeaways from This Episode

• Strength Training as a Performance Amplifier (Not a “Bulking” Risk): The guests emphasize that most runners are unlikely to gain meaningful muscle mass that slows them down without a significant caloric surplus and bodybuilding-style programming. In typical runner programming, strength work more often improves running economy, stride efficiency, and neuromuscular coordination (Rønnestad 2014, Llanos-Lagos 2024). 

• Bilateral Strength Helps—But Running is a Single-Limb Sport: Squats can be useful for global strength, but running requires repeated single-leg force absorption and production. Unilateral patterns (split squats, step-downs, single-leg hinge work) better reflect the frontal-plane control, pelvic stability, and side-to-side comparisons that matter for durability and efficiency, particularly over long distances (Li, 2025).

• Minimalist Footwear is a Contextual Tool, Not a Universal Upgrade: Barefoot/minimalist shoes may nudge stride length and foot strike mechanics, but the guests stress that this is only helpful when the runner has adequate calf/soleus capacity and introduces changes gradually. Rapid transitions can increase injury risk (Altman 2015).

• Running and Joint Health: “Cyclic Loading” Can Be Supportive in Moderate Doses: Dr. Chris Sands frames the “running ruins your knees” claim as largely hype for recreational runners, noting that well-programmed, moderate running is not inherently degenerative and may correlate with better long-term joint outcomes compared with sedentary patterns—especially when recovery and cross-training are addressed.

• Running Assessments as Preventive Medicine for the Athlete: A running assessment isn’t positioned solely as an injury service. Instead, Dr. Gabe Kresge describe it as a way to identify subclinical deficits, asymmetries, or capacity gaps before they become pain-limiting—supporting performance, longevity, and more individualized programming.

• Most Injuries Track with Training Errors and Under-Recovery: Biomechanics can contribute, but the episode highlights a consistent theme in the literature: volume spikes, poor programming, and inadequate recovery (sleep quality, nutrition, chronic stress load) are common drivers of injury risk at the population level (Hamstra-Wright, 2021).

Dr. Chris Sands, DPT, OCS, and Dr. Gabe Kresge, DPT, are performance and movement specialists with a clinical background in working with runners across rehab, training, and long-term durability. Their approach emphasizes objective testing, individualized programming, and evidence-based decision-making to support both performance goals and lifelong movement capacity. You can find them at https://kineticptpa.com/

Sponsor: Fullscript – a comprehensive care delivery platform for supplement dispensing, patient education, treatment planning, adherence support, and lab ordering with interpretation. (Visit: fullscript.com)

Clinician FAQ: Running Myths, Load Management, Footwear, and Injury Prevention

• Does strength training usually slow runners down?
  • In this episode, the guests label that claim as hype for most runners and point to evidence that strength work more often improves running economy and efficiency when programmed appropriately.
• Are squats “the best” exercise for runners?
  • The experts say this is partially true: squats can be helpful, but unilateral work more directly matches the single-leg demands of running and helps reveal side-to-side differences.
• Should everyone switch to minimalist shoes?
  • They emphasize a strong “it depends.” Minimalist footwear may change mechanics, but tolerance is highly dependent on calf/soleus strength and a gradual transition plan.
• Is running inherently bad for knees and hips?
  • The experts frame this as largely hype for recreational runners, stressing moderation, recovery, and cross-training as key contextual factors.
• If a runner isn’t injured, is a running assessment still useful?
  • Yes—this episode positions assessments as preventative and performance-oriented, designed to identify capacity and movement risks early.
• Why does poor sleep increase injury risk?
  • The guests distinguish acute tiredness from chronic under-recovery—highlighting that consistently poor sleep quality and insufficient recovery capacity can raise injury susceptibility over time.

Timestamps
00:00 – Welcome to “Health or Hype” + episode setup
00:30 – Sponsor: Fullscript
02:03 – Myth #1: Strength training makes runners bulky/slower
03:23 – Myth #2: Squats are the best exercise for running strength
04:41 – Myth #3: Everyone should run in minimalist/barefoot shoes
06:17 – Cushion vs. stiffness: how distance and running type can matter
07:40 – Myth #4: Running breaks down your joints over time
10:33 – Myth #5: No injury = no need for a running assessment
13:52 – Myth #6: Most injuries are training errors, not biomechanics
15:04 – Why chronic under-recovery (especially sleep quality) raises risk
16:00 – Wrap + listener feedback request + disclaimer

Citations

1. Rønnestad BR, Mujika I. Optimizing strength training for running and cycling endurance performance: A review. Scand J Med Sci Sports. 2014 Aug;24(4):603-12. doi: 10.1111/sms.12104. Epub 2013 Aug 5. PMID: 23914932.
2. Altman AR, Davis IS. Prospective comparison of running injuries between shod and barefoot runners. Br J Sports Med. 2016 Apr;50(8):476-80. doi: 10.1136/bjsports-2014-094482. Epub 2015 Jun 30. PMID: 26130697.
3. Llanos-Lagos C, Ramirez-Campillo R, Moran J, Sáez de Villarreal E. Effect of Strength Training Programs in Middle- and Long-Distance Runners' Economy at Different Running Speeds: A Systematic Review with Meta-analysis. Sports Med. 2024 Apr;54(4):895-932. doi: 10.1007/s40279-023-01978-y. Epub 2024 Jan 2. PMID: 38165636; PMCID: PMC11052887.
4. Prieto-González P, Sedlacek J. Effects of Running-Specific Strength Training, Endurance Training, and Concurrent Training on Recreational Endurance Athletes' Performance and Selected Anthropometric Parameters. Int J Environ Res Public Health. 2022 Aug 29;19(17):10773. doi: 10.3390/ijerph191710773. PMID: 36078489; PMCID: PMC9518107.
5. Huffer D, Hing W, Newton R, Clair M. Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Phys Ther Sport. 2017 Mar;24:44-52. doi: 10.1016/j.ptsp.2016.08.008. Epub 2016 Aug 18. PMID: 27692740.
6. Sun X, Lam WK, Zhang X, Wang J, Fu W. Systematic Review of the Role of Footwear Constructions in Running Biomechanics: Implications for Running-Related Injury and Performance. J Sports Sci Med. 2020 Feb 24;19(1):20-37. PMID: 32132824; PMCID: PMC7039038.
7. Willwacher S, Sanno M, Brüggemann GP. Fatigue matters: An intense 10 km run alters frontal and transverse plane joint kinematics in competitive and recreational adult runners. Gait Posture. 2020 Feb;76:277-283. doi: 10.1016/j.gaitpost.2019.11.016. Epub 2019 Dec 13. PMID: 31884254.
8. Li X, Mao L. Characteristics of Lower Limb Dominant and Nondominant Joint Load Changes After Long-Distance Running in Young Male Runners Under OpenSim Environment. Sensors (Basel). 2025 Oct 11;25(20):6301. doi: 10.3390/s25206301. PMID: 41157355; PMCID: PMC12567293.
9. Hamstra-Wright KL, Huxel Bliven KC, Napier C. Training Load Capacity, Cumulative Risk, and Bone Stress Injuries: A Narrative Review of a Holistic Approach. Front Sports Act Living. 2021 May 28;3:665683. doi: 10.3389/fspor.2021.665683. PMID: 34124660; PMCID: PMC8192811.

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

This episode of the Root Cause Medicine Podcast explores the Modern Running Assessment, an evidence-informed, data-driven framework for evaluating runners’ biomechanics, load tolerance, and performance capacity. Host Dr. Kate Kresge interviews Dr. Chris Sands, DPT, OCS, and Dr. Gabe Kresge, DPT, from Kinetic Physical Therapy to examine how modern tools—dynamometry, force plate testing, slow-motion gait analysis, cadence and vertical oscillation metrics, and single-leg endurance testing—provide objective information that visual observation alone may miss. These measurable insights help clinicians better understand strength-to-body-weight ratios, inter-limb asymmetries, foot-strike loading patterns, and fatigue-related movement changes, offering a clearer picture of the factors that may influence running efficiency, durability, and injury risk.


Clinical Takeaways: Evidence-Informed Running Biomechanics and Performance Metrics

• Dynamometry can quantify strength and help to reveal relevant asymmetries. 
  • Consider dynamometry for hip and knee strength assessment to reveal inter-limb asymmetries that can affect gait and joint load. 
• Limb asymmetries should be interpreted within a broader biomechanical context.
  • Inter-limb differences are common, and evidence for their direct impact is mixed. Reviews indicate that asymmetry effects vary across athletes and may be most useful when tracked over time rather than interpreted as a single cutoff. This conversation focuses on asymmetric joint loading during runs, which can increase with distance and fatigue (Li, 2025).
• Gait analysis is still relevant.
  • High-speed and slow motion video helps clinicians evaluate variables such as vertical oscillation, cadence, pelvic motion, and trunk rotation—mechanics that may support targeted interventions.
• Optimal foot strike patterns can shift depending on a runner’s goals.
  • Reviews show that foot strike patterns redistribute forces differently across joints but do not consistently prevent injury (Altman 2015). Pronation is a normal shock-absorption mechanism, and comfort is a meaningful predictor for footwear selection.
• Progressive strength training supports running economy and performance.
  • Strength programs integrated with endurance training support improvements in running economy (Rønnestad 2014, Llanos-Lagos 2024) and performance (Prieto-Gonzalez, 2022).
• There is no perfect running shoe.
  • Thousands of studies have helped us understand all of the variables that go into shoe choice, from stack height to lace patterns, heel flares and heel-toe drop, bending stiffness, heel cup and more.  The short answer: there’s no perfect shoe. Runners should work with professionals to help them choose the shoes with the right combinations of features for their mileage, pace, goals and physiology. (Sun, 2020) 
• Implement periodic reassessment to refine training and monitor adaptation.
  • Regular reassessment of strength, asymmetry, and gait metrics supports adaptive programming and individualized progression.

Timestamps:

00:00 – Welcome back and introduction to the Modern Running Assessment
03:52 – Setting goals first: performance vs. pain and how that shapes the assessment
05:47 – Dynamometry explained: measuring force, 2–4x bodyweight load, and asymmetry
11:53 – Strength vs. endurance: calf fatigue, single-leg control, and why bilateral lifts don’t always translate
18:13 – Force plate testing, vertical oscillation, and how cadence tweaks can reduce impact
26:58 – Born to Run, barefoot trends, foot strike, and what really changes with minimalist running
30:38 – Shoes, pronation, anti-pronation models, and when added support actually makes sense
34:24 – Trunk and thoracic mobility: how chest position affects breathing, heart rate, and endurance
37:46 – Foundational strength for runners: split squats, single-leg RDLs, lateral work, and deficit calf raises
41:09 – Will strength training make you “too bulky”? What the research says about muscle, speed, and long-term joint health, plus shoe rotation and clinician action steps toward objective running assessments


Guest Introduction: Experts in Running Biomechanics and Strength-Based Performance
Dr. Chris Sands, DPT, OCS: Dr. Chris Sands is a Doctor of Physical Therapy and Board-Certified Orthopedic Clinical Specialist with advanced training in running biomechanics and force-based assessment. At Kinetic Physical Therapy, he co-leads the Modern Running Assessment program, using tools like handheld dynamometry, force plates, and high-speed gait analysis to quantify strength, asymmetry, and load tolerance. His work focuses on helping runners and clinicians connect objective metrics with tailored training plans that support performance, resilience, and long-term joint health.

Dr. Gabe Kresge, DPT: Dr. Gabe Kresge is a Doctor of Physical Therapy and USA Powerlifting coach who specializes in strength and movement optimization for runners and lifters. At Kinetic, he partners with Dr. Sands to deliver data-driven running assessments that merge objective strength profiling, unilateral endurance testing, and individualized programming. His clinical lens emphasizes building durable, strong runners through intelligently progressed strength training, volume programming, and practical education that athletes can apply for life.

Learn more: Kinetic Physical Therapy — Website: https://kineticptpa.com/
Strength, Mobility, and Volume Progression Strategies for Durable, Efficient Runners


Foundational unilateral strength exercises for runners to consider

• Single-leg Bulgarian split squats
• Single-leg Romanian deadlifts
• Single-leg deficit calf raises
• Lateral band walks / hip abduction work

Cadence, gait mechanics, and shoe strategy for optimized load distribution

• Trial modest cadence adjustments and monitor symptoms and perceived effort.
• Teach foot strike as a load-distribution choice dependent on goals and physiology, not as a right-or-wrong pattern.
• Encourage shoe rotation and prioritize comfort and function over marketing claims.

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




Citations

1. Rønnestad BR, Mujika I. Optimizing strength training for running and cycling endurance performance: A review. Scand J Med Sci Sports. 2014 Aug;24(4):603-12. doi: 10.1111/sms.12104. Epub 2013 Aug 5. PMID: 23914932.
2. Altman AR, Davis IS. Prospective comparison of running injuries between shod and barefoot runners. Br J Sports Med. 2016 Apr;50(8):476-80. doi: 10.1136/bjsports-2014-094482. Epub 2015 Jun 30. PMID: 26130697.
3. Llanos-Lagos C, Ramirez-Campillo R, Moran J, Sáez de Villarreal E. Effect of Strength Training Programs in Middle- and Long-Distance Runners' Economy at Different Running Speeds: A Systematic Review with Meta-analysis. Sports Med. 2024 Apr;54(4):895-932. doi: 10.1007/s40279-023-01978-y. Epub 2024 Jan 2. PMID: 38165636; PMCID: PMC11052887.
4. Prieto-González P, Sedlacek J. Effects of Running-Specific Strength Training, Endurance Training, and Concurrent Training on Recreational Endurance Athletes' Performance and Selected Anthropometric Parameters. Int J Environ Res Public Health. 2022 Aug 29;19(17):10773. doi: 10.3390/ijerph191710773. PMID: 36078489; PMCID: PMC9518107.
5. Huffer D, Hing W, Newton R, Clair M. Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Phys Ther Sport. 2017 Mar;24:44-52. doi: 10.1016/j.ptsp.2016.08.008. Epub 2016 Aug 18. PMID: 27692740.
6. Sun X, Lam WK, Zhang X, Wang J, Fu W. Systematic Review of the Role of Footwear Constructions in Running Biomechanics: Implications for Running-Related Injury and Performance. J Sports Sci Med. 2020 Feb 24;19(1):20-37. PMID: 32132824; PMCID: PMC7039038.
7. Willwacher S, Sanno M, Brüggemann GP. Fatigue matters: An intense 10 km run alters frontal and transverse plane joint kinematics in competitive and recreational adult runners. Gait Posture. 2020 Feb;76:277-283. doi: 10.1016/j.gaitpost.2019.11.016. Epub 2019 Dec 13. PMID: 31884254.
8. Li X, Mao L. Characteristics of Lower Limb Dominant and Nondominant Joint Load Changes After Long-Distance Running in Young Male Runners Under OpenSim Environment. Sensors (Basel). 2025 Oct 11;25(20):6301. doi: 10.3390/s25206301. PMID: 41157355; PMCID: PMC12567293.