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.

We’re launching a new series that brings the insights that Fullscript Chief Medical Officer Dr. Jeff Gladd normally shares only with our internal team—now open to the entire integrative and functional medicine community. 

This month, Dr. Gladd breaks down three emerging clinical priorities with immediate relevance to whole-person care

• Why the American College of Cardiology is now recommending high-sensitivity CRP (hs-CRP) for universal cardiovascular screening
• How grip strength paired with BMI is outperforming traditional biomarkers in predicting metabolic decline and all-cause mortality risk
• What new evidence tells us about saffron as supportive care for patients experiencing SSRI-related sexual side effects.

Clinicians will leave with practical, evidence-informed strategies they can apply right away—from how to add grip strength testing to a routine visit, to how to interpret hs-CRP in the context of inflammation and cardiometabolic disease, to how to navigate sensitive conversations about mood medications and quality of life. If you’ve been looking for research you can trust and tools that simplify decision-making, this episode offers a clear roadmap.


Clinical Takeaways from This Episode

• Grip strength combined with BMI is emerging as a scalable, low-cost predictor of metabolic risk and all-cause mortality
  • Dr. Gladd highlights the UK Biobank’s 90,000-person longitudinal analysis, noting: “Those in the highest grip strength tertile were 20% less likely to develop obesity-related disease,” with reduced all-cause mortality. Grip strength may reflect lean mass, mitochondrial function, and insulin sensitivity better than BMI alone. (Xu, et al 2025)
• Grip strength as a lifestyle, bone health, and functional resilience indicator
  • As Dr. Kresge explains, “having a strong grip can basically imply that you’re likely living a healthier life,” given its links to nutrient-dense dietary patterns, sufficient protein intake, sleep quality, smoking avoidance, and greater sense of purpose. Evidence also shows low grip strength strongly correlates with lower bone mineral density in postmenopausal women. (Gedmantaite, 2020)
• Saffron may improve SSRI-associated sexual side effects
  • RCTs suggest saffron may support sexual function parameters in individuals using SSRIs, with sex-specific benefits observed. As Dr. Gladd notes, “We haven’t had anything, to my knowledge, that really addresses the sexual side effects head-on like this study in saffron.” Findings support integration—not substitution—within existing mental health plans. (Shaifee, 2025)
• Universal hs-CRP screening is now recommended for cardiovascular prevention
  • The American College of Cardiology now recommends hs-CRP as part of routine cardiovascular risk screening—reflecting a shift toward evaluating systemic inflammation. Dr. Gladd emphasizes: “Inflammation is now in traditional healthcare as something that can be measured and understood.” (Mesah, 2025)
• Causes of elevated hs-CRP and how to evaluate them clinically
  • Dr. Kresge outlines the major drivers to consider, including infection, autoimmune activity, periodontal disease, adiposity, insulin resistance, low fitness, smoking, poor sleep, chronic stress, and nutrition patterns. She notes: “It’s no longer enough to run a lipid panel and call it cardiovascular screening.” (Mesah, 2025)
• Dietary patterns, omega-3 fatty acids, and curcumin as inflammation-supportive strategies
  • Inflammation-modulating strategies may include nutrient-dense dietary patterns, omega-3 intake and high-bioavailability curcumin. Dr. Gladd encourages clinicians to verify product quality: “Are you getting enough EPA and DHA?” (Ahmadi, 2025)
• Nutrient monitoring opportunities for patients using SSRIs
  • SSRIs may influence B-vitamin status, and Dr. Gladd notes that clinicians may want to be “proactive in supplementing or monitoring those levels,” when appropriate for patient-centered mental health care. (Mohn, 2018)
• Ensuring AI is used to support—not replace—clinical judgment
  • Dr. Gladd discusses emerging regulations to prevent AI from impersonating clinicians, underscoring Fullscript’s stance: “We’re bringing tooling to support the practitioner, not to replace the practitioner.”
• The persistence of clinician burnout and the need for operational support
  • The 2025 Medscape Well-Being Report highlights burnout as an ongoing challenge. Streamlined clinical tools, thoughtful workflows, and comprehensive care platforms may help reduce administrative load.

Guest Bio: Dr. Jeff Gladd, MD, Chief Medical Officer at Fullscript, is a nationally recognized integrative and lifestyle medicine physician. He founded GladdMD Integrative Medicine and authors Fullscript’s CMO Monthly Dose—a monthly research and industry briefing for keeping Fullscripters up to date. His work focuses on metabolic health, clinical nutrition, and technology that enhances clinical workflow. Learn more at fullscript.com.

Assessments Mentioned in this Episode

• hs-CRP (per ACC universal screening recommendation)
• Lipid panel and triglycerides
• Fasting insulin or HOMA-IR
• CBC, ESR, ANA when clinically indicated
• Oral health evaluation for periodontal inflammation
• Magnesium and B vitamins may warrant assessment in patients on SSRIs
• Handheld dynamometer in-clinic or at-home

Timestamps
00:00 – Introduction to the new CMO Monthly Dose series.
01:53 – Dr. Jeff Gladd joins and shares the origin of the CMO Monthly Dose.
03:40 – Grip strength research overview and why it matters clinically.
05:00 – Using grip strength as a practical tool in metabolic and longevity care.
06:30 – Grip strength as a predictor of bone density and functional health.
07:30 – Lifestyle factors linked to higher grip strength.
09:34 – Emerging evidence for saffron in SSRI-related sexual side effects.
11:10 – Key findings for men and women from saffron trials.
12:30 – Nutrient considerations with SSRI use.
13:44 – ACC announces universal hs-CRP screening recommendation.
15:00 – Nutrition and supplement considerations for supporting healthy inflammation.
16:05 – Clinical causes of elevated hs-CRP and how to evaluate them.
17:20 – Why hs-CRP is essential beyond lipid panels.
18:00 – Physician burnout insights from the 2025 Medscape report.
18:30 – New AI regulations and Fullscript’s commitment to supporting clinicians.
19:12 – Closing remarks and call to share the episode.

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 fast-moving, clinically rich tour through the new frontiers of integrative eye care, Dr. Gioia connects the dots between microbiome-driven inflammation, AI-powered retinal biomarker extraction, and hormonal transitions that reshape ocular physiology—all in a way that feels practical for everyday clinical reasoning. She illustrates how gut permeability markers may parallel ocular surface symptoms, how retinal microvascular mapping can hint at systemic resilience, and why perimenopause and menopause deserve far more attention in the modern eye exam. Throughout the episode, she gives clinicians evidence-informed frameworks for synthesizing gut, hormone, nutrient, and imaging data into a more proactive, prevention-oriented approach to vision health.


Clinical Takeaways from This Episode

• Gut-Eye Axis and Systemic Inflammation Pathways: Dysbiosis may influence cytokine activity, intestinal permeability, and endotoxin load—factors that can contribute to ocular discomfort or inflammatory pathways affecting the uveal tract, conjunctiva, and retina. Clinicians may consider gut-driven contributors when chronic ocular symptoms persist despite standard care.
• AI-Driven Oculomics for Early Risk Detection: Retinal photography and OCT/OCT-A imaging combined with AI allow analysis of microvascular integrity, tortuosity ratios, nerve fiber patterns, and biological age metrics—supporting prevention-focused evaluation of cardiovascular, neurologic, metabolic, and longevity-related risk patterns.
• Hormone-Responsive Ocular Tissues and Midlife Vision Changes: Sex-hormone receptors in the lacrimal and meibomian glands, cornea, and retina help explain perimenopause- and menopause-related symptoms such as dry eye, fluctuating vision, and ocular-surface sensitivity. Hormonal transitions may influence lipid secretion, tear stability, and DHA metabolism.
• Preventive Vision Care as a Whole-Systems Touchpoint: Regular retinal imaging, nutrient status assessments, and symptom scoring may help clinicians identify early ocular patterns associated with metabolic or inflammatory changes. Annual eye exams remain essential—even when vision clarity appears stable.
• Nutrient Density and Ocular Resilience Across the Lifespan: Nutrients such as DHA, lutein, and zeaxanthin play supportive roles in retinal structure, macular function, and tear-film stability. Identifying nutrient insufficiencies or imbalances—especially in zinc and copper ratios—may help clinicians guide personalized nutrition strategies.
• Integrative Data Linking: Gut, Hormones, Labs, and Retinal Biomarkers: Combining stool markers (e.g., zonulin, calprotectin, SCFAs), hormone trends, nutrient analysis, and ocular imaging may offer a more complete preventive picture for chronic eye symptoms and systemic health mapping.

Guest Introduction
Dr. Neda (Nehda) Gioia, OD, CNS®, IFMCP, FOWNS, is the founder of Integrative Vision, where she merges optometry, functional medicine, and clinical nutrition into a prevention-first model of eye care. Drawing on her advanced training—including certification from the Institute for Functional Medicine and credentials in clinical nutrition—she educates clinicians on ocular nutrition, gut–eye interactions, and modern imaging applications. She consults nationally, offers virtual ocular nutrition services, and publishes on integrative optometry.

• Website: integrativevision.com
• Professional site: https://www.drnedagioia.com/

Labs, Nutrition, and Lifestyle Support

• Gut-Eye Axis & Microbiome Assessment
  • Stool Markers to Consider: zonulin for permeability; calprotectin for gut-immune activity; SCFAs for microbial metabolite status.
• Hormone-Aware Eye Health
  • Labs: DHEA-S, estradiol, SHBG for midlife symptom mapping; consider androgen patterns when evaluating dry eye.
  • Key Insight: Meibomian gland lipid secretion is influenced by androgen receptor activity and local conversion of testosterone to DHT.
• AI-Enhanced Oculomics
  • Tools: OCT / OCT-A, retinal photography, and AI-driven vascular analytics that assess capillary density, tortuosity, and nerve fiber patterns.
  • Use Case: May support early identification of cardiovascular, neurologic, metabolic, or other trends.
• Nutrient Support for Retinal and Tear-Film Health
  • Core Nutrients: DHA-rich marine sources; lutein and zeaxanthin; balanced zinc-to-copper intake.
  • Evidence Note: AREDS2 highlights the role of targeted nutrient formulas in reducing progression risk for specific macular conditions.
• Lifestyle Strategies for Preventive Eye Care
  • Dietary Pattern: Mediterranean-style eating pattern for broad ocular-supportive nutrient density.
  • Visit Frequency: Annual eye exams beginning in midlife, or more often with ocular or systemic risk factors, even if vision is normal. 

Clinician FAQ: Gut-Eye Axis, Oculomics, Hormones, and Preventive Eye Care

1. How strong is the evidence linking dysbiosis to ocular inflammation? Emerging research shows meaningful associations between gut dysbiosis and ocular inflammatory pathways, including effects on cytokines, permeability, SCFA signaling, and retinal immune activation. Mechanistic animal and human data continue to expand, though large interventional trials remain limited. Citation: Rowan S, et al. Front Cell Neurosci. 2024. Available at: https://www.frontiersin.org/articles/10.3389/fncel.2024.1468187/full
2. Which stool markers may be relevant when patients present with chronic ocular symptoms? Markers such as zonulin, calprotectin, and SCFAs may help clinicians understand permeability, gut-mediated immune activity, and microbial metabolite patterns that could interact with ocular-surface or retinal inflammatory pathways.
    Citation: Rowan S, et al. Front Cell Neurosci. 2024. Available at: https://www.frontiersin.org/articles/10.3389/fncel.2024.1468187/full
3. How does AI-enhanced oculomics fit into preventive medicine? AI-driven retinal imaging can identify subtle microvascular changes, nerve-fiber patterns, and tissue integrity metrics that may correlate with cardiovascular, neurologic, metabolic, and longevity-related risk. These tools expand prevention by extracting systemic biomarkers from retinal data. Citation: Keane P, et al. Theranostics. 2024. Available at: https://www.thno.org/v15p3223.pdf
4. Which hormonal shifts are most relevant to midlife changes in ocular comfort? Perimenopause- and menopause-associated fluctuations in estrogen and declines in androgen activity may impact meibomian gland lipid output, tear film stability, ocular surface sensitivity, and inflammatory thresholds.Citation: Jin, Xiuming, et al. “Hormone Replacement Therapy Benefits Meibomian Gland Dysfunction in Perimenopausal Women.” Medicine, vol. 95, no. 31, Aug. 2016, p. e4268, https://doi.org/10.1097/md.0000000000004268
5. Should clinicians routinely evaluate eye symptoms when initiating hormone therapy? Changes in ocular comfort—including dryness, irritation, or fluctuating vision—may accompany hormone transitions or therapy adjustments. Incorporating eye-symptom questions may help clinicians detect hormone-related effects on the ocular surface. Citation: Abelson MB, Lines L. Review of Ophthalmology. 2006. Available at: https://www.reviewofophthalmology.com/article/hormones-in-dry-eye-a-delicate-balance
6. Which nutrients are most essential for long-term ocular support? DHA, lutein, and zeaxanthin are well-studied nutrients supporting retinal function and macular pigment density. Balanced zinc and copper intake is also important for ocular and neural physiology. Citation: Age-Related Eye Disease Studies (AREDS/AREDS2): major findings https://www.nei.nih.gov/research/clinical-trials/age-related-eye-disease-studies-aredsareds2/about-areds-and-areds2 
7. How often should adults receive a comprehensive eye exam? Dr. Gioia explains that many adults benefit from annual examinations starting around age 40—earlier or more frequently for those with ocular symptoms or systemic risk factors—because asymptomatic conditions such as early glaucoma or macular changes may be detectable only through imaging. 
8. What’s the clinical advantage of combining gut, hormone, and retinal imaging data? According to Dr. Gioia, integrating these data streams can help clinicians observe multi-system patterns earlier—linking inflammatory load, hormonal fluctuations, nutrient availability, and microvascular integrity into a unified preventive strategy. 

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 conversation reframes joy as a physiological state with measurable clinical impact, not just an emotion. Dr. Libert blends neuroscience, functional medicine, and spiritual reflection to show how cultivating joy and gratitude can help to restore parasympathetic balance, support healthy immune function, and enhance cognitive flexibility. The episode offers an accessible, hopeful model for physicians—one that unites emotional health, brain resilience, and integrative lifestyle care.

Clinical Takeaways from This Episode

• Joy as a Measurable Biological State: Joy, positive affect and gratitude practices appear to increase activity in the ventral striatum and prefrontal cortex (Rueschkamp, 2019), and have some evidence for improving neuroplasticity, vagal tone, and immune resilience while reducing inflammatory cytokines like IL-6 (Dutcher, 2021).
• Gratitude Practices and Neurochemistry: Regular gratitude journaling boosts dopamine and serotonin, rewiring the reward pathways that reinforce positive affect and motivation. It may even help people to exercise more often over time (Emmons, 2003).
• Positive Affect and Cognitive Performance: Studies show that positive affect can enhance cognitive flexibility and attention-switching—even brief exposure to positive emotion improves executive function (Wang, 2017).
• Micro “Joy Prescriptions” for Busy Clinicians: Dr. Libert recommends short “Vitamin G” (gratitude) walks, deep-breathing practices, or quick notes of appreciation to activate joy and resilience in under 10 minutes per day.
• Integrative Cognitive Health Framework: Joy supports foundational systems—sleep, movement, nutrition, and connection—that underlie cognitive longevity, aligning with the Bredesen Protocol and functional medicine principles.

Guest Introduction

Cynthia Libert, M.D. is a board-certified family physician, educator, and founder of the Caring for the Body Functional Medicine Center in Asheville, NC. With over 20 years of experience, she specializes in cognitive health, longevity, and burnout prevention. She is the creator of ReThink Aging and The Joy Prescription, a podcast and clinical framework helping patients and practitioners reconnect with purpose and vitality. caringforthebody.org | thejoyprescription.com


Labs, Nutrition, and Lifestyle Support

Functional Labs for Brain and Mood Health

• High-sensitivity CRP, IL-6, and HbA1c for inflammatory and metabolic insight
• B12, vitamin D, magnesium, and thyroid panels for cognitive optimization
• Sex hormones, insulin resistance, and micronutrient status for personalized longevity mapping

Nutrition and Supplement Considerations

• Anti-inflammatory protocols rich in omega-3s, polyphenols, and curcumin
• Supportive nutrients for neurotransmitter balance: B-complex, magnesium glycinate, phosphatidylcholine
• Gut–brain support through probiotics, fiber diversity, and fermented foods

Lifestyle and Behavioral Strategies

• Daily gratitude or journaling rituals shown to reduce anxiety and depression by ~7 % (Diniz, 2023)
• Movement and strength training for muscle preservation and insulin sensitivity
• Structured rest—weekly breaks, retreats, or community connection for burnout prevention
• Group programs like Dr. Libert’s SoulCare circles to rebuild belonging and resilience

Timestamps

00:00 - Introduction and episode overview
02:50 - Why joy is crucial in clinical care & science behind it
05:28 - Dr. Libert’s personal story with burnout and rediscovery of joy
07:29 - Practical ways to prevent burnout and cultivate joy
11:33 - The science of joy, neuroplasticity, and brain connectivity
12:35 - Joy’s effects on the stress response and inflammation
18:37 - Observed patient changes with joy and lifestyle interventions
24:41 - Neuroanatomy: prefrontal cortex & limbic system role in emotional regulation
26:12 - Impact of brain connectivity in ADHD & emotional control
31:38 - Practical strategies for reconnecting patients with joy and purpose
36:20 - Research on gratitude and mental health improvements
38:24 - Dr. Libert’s movement and exercise routine
41:10 - Adjusting fitness goals according to life seasons
46:05 - Final thoughts on addressing neurodegeneration and root causes
48:00 - Closing remarks 

Citations

1. Emmons RA, Sefick, WJ, Froh, JJ. Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being. J Pers Soc Psychol. 2003.
2. Van der Stigchel S et al. Positive emotion and cognitive flexibility. Front Psychol. 2017.
3. Ochsner KN et al. Cognitive regulation of emotion: functional networks and mechanisms. Soc Cogn Affect Neurosci. 2012.
4. Cole SW et al. Eudaimonic well-being and gene expression: CTRA down-regulation. Proc Natl Acad Sci USA. 2013.
5. UC Braid Clinical Trials Registry: Ventral striatum activity correlated with decreases in IL-6 and CRP.
6. Diniz, et al. The effects of gratitude interventions: a systematic review and meta-analysis. PMC 2023.
7. Rueschkamp, Johanna M Grosse. “Neural Correlates of Up-Regulating Positive Emotions in FMRI and Their Link to Affect in Daily Life.” Social Cognitive and Affective Neuroscience, vol. 14, 2019

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 episode, Dr. Chris Magryta and Dr. Erik Lundquist to discuss their new course, Advanced Blood Labs 201—a masterclass in interpreting metabolic and immune biomarkers for proactive, data-informed clinical care. They explore how early identification of metabolic dysfunction and immune dysregulation can improve long-term health outcomes through advanced yet accessible diagnostics. The discussion covers biomarkers such as C-peptide, adiponectin, leptin, fructosamine, LDH, GGT, and glutathione, along with emerging immune markers like SII and SIRI. Listeners will learn how to integrate these insights into practice for earlier, more precise intervention in both children and adults.


You’ll Learn

• Why early biomarker detection matters for identifying metabolic and immune imbalances before symptoms develop
• How to interpret C-peptide, adiponectin, leptin, fructosamine, LDH, and GGT for a clearer picture of metabolic and oxidative stress
• What advanced immune markers—cytokines, NK cells, T-cells, SII, and SIRI—reveal about inflammation and immune activation
• How to use affordable tests like a CBC to gain immunometabolic insights
• Why trend tracking and pattern recognition offer more clinical value than single lab snapshots
• How oxidative stress and mitochondrial biomarkers can guide chronic disease prevention and management

About the Guests

• Dr. Chris Magryta is a pediatrician at Salisbury Pediatrics and host of Women and Children First. His work centers on identifying the root causes of pediatric chronic illness through biomarker analysis, nutrition, and early intervention.
• Dr. Erik Lundquist is the founder of Temecula Center for Integrative Medicine and host of The Root Cause Business of Medicine Podcast. He specializes in integrative and functional medicine, teaching clinicians to bridge evidence-based practice with systems biology.
• Together, they lead the Blood Labs 101 and Advanced Blood Labs 201 courses—comprehensive programs helping practitioners translate complex biomarker data into actionable insights.

Labs Mentioned

• C-peptide
• Fructosamine
• Adiponectin
• Leptin
• LDH (Lactate Dehydrogenase)
• GGT (Gamma-Glutamyl Transpeptidase)
• 8-Hydroxy-D-Guanine
• MPO (Myeloperoxidase)
• CBC (Complete Blood Count)

Supplements Mentioned

• Glutathione (discussed for educational purposes only; not intended as a treatment recommendation)

Courses Mentioned

• Advanced Blood Labs 201 November 2025

Timestamps

• 00:00 – Introduction and course overview
• 02:03 – Early biomarker detection and childhood metabolic health
• 04:07 – Evolution from Blood Labs 101 to 201
• 08:27 – Understanding C-peptide and insulin activity
• 11:08 – Fructosamine and short-term glucose trends
• 13:24 – Adiponectin and leptin in inflammation and metabolism
• 15:20 – Oxidative stress, LDH, glutathione, and DNA damage
• 17:20 – GGT and antioxidant balance
• 20:54 – Cytokines, NK cells, and the SIRI index
• 26:07 – Monocytes and immune pattern recognition
• 32:41 – Why each clinician chose medicine
• 50:52 – Personal growth and lessons beyond the clinic
• 54:00 – Final reflections

Learn More

• Dr. Chris Magryta’s Podcast: Women and Children First
• Dr. Erik Lundquist’s Podcast: The Root Cause Business of Medicine
• Course Information: Advanced Blood Labs 201 at rupahealth.com
• Sponsor: Fullscript – Free platform for whole person care, lab ordering, and supplement management

Frequently Asked Questions About Pediatric and Adult Biomarkers


What is C-peptide and why might it be important to measure in both children and adults?

C-peptide is released with insulin from pancreatic β-cells and reflects endogenous insulin production and β-cell function. Elevated C-peptide may indicate insulin resistance, while low levels can signify β-cell exhaustion. It can be a key tool for identifying early metabolic dysfunction in both pediatric and adult patients early in disease progression (American Diabetes Association, Diabetes Care, 2025).


How does adiponectin relate to inflammation and metabolism across ages?

Adiponectin regulates glucose and lipid metabolism and has anti-inflammatory properties. Low adiponectin levels are linked to insulin resistance and chronic inflammation in children and adults (Nature Reviews Immunology, 2024) and respond positively to healthy lifestyle interventions (The Journal of Clinical Endocrinology & Metabolism, 2008).


What does leptin resistance imply in pediatric and adult patients?

Leptin helps to regulate appetite and energy balance. When cells become resistant to leptin, metabolism and inflammatory control are impaired. Elevated leptin with low adiponectin can correlate with metabolic syndrome and obesity risk across age groups (Nature Reviews Immunology, 2024).


How do SII and SIRI biomarkers relate to immune dysregulation?

The Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) use platelet, neutrophil, lymphocyte, and monocyte counts from a CBC to reflect immune activation and inflammation balance. Elevated SII or SIRI can indicate systemic inflammation or immune imbalance. Recent pediatric studies found these indices correlate with insulin resistance and metabolic status in adolescents (Frontiers in Endocrinology, 2024).


Can oxidative stress markers like LDH and GGT help to assess long-term health?

These markers can reflect the body’s oxidative stress burden and antioxidant capacity. Elevated LDH or GGT may suggest increased oxidative load and reduced resilience, potentially influencing mitochondrial and metabolic health (Artery Research, 2024).


What is the role of fructosamine in blood sugar evaluation for children and adults?

Fructosamine can provide a two- to three-week snapshot of blood glucose control, offering faster feedback than HbA1c. It’s useful in both adults and children for monitoring short-term glycemic changes (BMJ Open, 2015) and for pediatric patients with variable glucose control (Diabetes Care, 1991).


Are these biomarkers clinically useful in pediatrics, or only in adults?
The guests describe that these biomarkers can be relevant across ages. Early metabolic and immune imbalances often begin in childhood, and monitoring markers like C-peptide, adiponectin, leptin, and SII/SIRI can help identify at-risk children (Frontiers in Endocrinology, 2024).

References

1. Connecting the Spots: Serial Home C-Peptide Measurements for Assessing β-Cell Function. Diabetes Care, American Diabetes Association, 2025. https://diabetesjournals.org/care/article/48/9/1472/163233/Connecting-the-Spots-Serial-Home-C-peptide
2. Adiponectin as a Key Regulator of Inflammation and Metabolism. Nature Reviews Immunology, 2024.  https://www.nature.com/articles/s41577-024-01103-8
3. Changes in Adiponectin and the Leptin/Adiponectin Ratio During Lifestyle Intervention and Association With Metabolic Improvement in Obese Children. The Journal of Clinical Endocrinology & Metabolism, Vol. 93, Issue 8, 2008. https://pubmed.ncbi.nlm.nih.gov/18492759/
4. Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) as Markers of Metabolic Risk in Adolescents. Frontiers in Endocrinology, 2024. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1426404/full
5. Oxidative Stress Biomarkers and Mitochondrial Dysfunction in Cardiometabolic Health. Artery Research, 2024. https://arteryresearch.biomedcentral.com/articles/10.1007/s44200-024-00062-8
6. Evaluation of Fructosamine as a Short-Term Glycemic Marker in Diabetes. BMJ Open, 2015. https://bmjopen.bmj.com/content/5/5/e007689
7. Use of Fructosamine Test in Diabetic Children. Diabetes Care, Vol. 14, Issue 7, 1991. https://diabetesjournals.org/care/article/14/7/578/17573/Use-of-Fructosamine-Test-in-Diabetic-Children
   
   

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.

Is lithium the missing link in brain health and dementia prevention?

In this episode of The Root Cause Medicine Podcast, Dr. Kate Kresge sits down with Dr. James Greenblatt, a renowned integrative psychiatrist and expert in nutritional psychiatry, to explore the latest research on lithium’s role in brain health. From the groundbreaking 2025 Harvard study to practical clinical applications, they discuss how low-dose lithium - particularly in the form of lithium orotate - may offer a safe, natural approach to preventing and reversing cognitive decline, including Alzheimer’s disease. The conversation covers the science, safety considerations, and how clinicians can thoughtfully integrate lithium into their practice to support neurological resilience and mental well-being.

If you’re ready to expand your understanding of mineral neuroscience and explore innovative strategies to support cognitive health, this episode provides the science, clinical insights, and practical tools you won’t want to miss.

Clinical Takeaways from This Episode

• The Latest Harvard Research & Its Implications: The recent study showing that lithium naturally exists in the brain and diminishes early in Alzheimer’s, with animal models demonstrating that lithium orotate can reverse memory deficits.
• Mechanisms of Lithium in Brain Health: Its anti-inflammatory, neuroprotective, and neuroregenerative actions, including inhibition of GSK3, enhancement of neurotrophic factors, and support of myelin integrity.
• Differences Between Lithium Forms: Lithium carbonate (medication) vs. nutritional lithium orotate; why the latter is safer at microdose levels and less sequestered by amyloid plaques.
• Safety and Monitoring: Practical considerations for dosing, laboratory testing (such as hair mineral analysis), and monitoring thyroid and kidney function over time.
• Environmental and Dietary Lithium: The influence of water sources, diet, and geographic variations on lithium status, and implications for mental health and neuroprotection.
• Impulsivity, Mood, and Behavioral Regulation: How low-dose lithium may support impulse control, reduce irritability, and improve emotional stability across various psychiatric and neurological conditions.
• Future Therapeutic Directions: The potential for broader use of low-dose lithium as a public health intervention to reduce rates of suicide, neurodegenerative diseases, and mental health disorders.

Guest Bio:

Dr. James Greenblatt, MD — An integrative psychiatrist and pioneer in nutritional psychiatry, Dr. Greenblatt has over 40 years’ experience in the field. He is the author of The Cinderella Story of Nutritional Lithium and offers extensive training programs for clinicians on natural interventions for mental health and cognitive decline.

Labs Mentioned (Monitoring & Context)

• Hair mineral analysis (lithium marker)
• Thyroid function tests
• Kidney function tests

Ingredients & Therapeutic Nutrition Mentioned

• Lithium orotate 
• Magnesium supplements
• Dietary sources of lithium (e.g., drinking water, herbs like thyme)

Resources Mention

• Nutritional Lithium: A Cinderella Story 
• Lithium deficiency and the onset of Alzheimer’s disease 2025 paper

Timestamps

• 00:00 Introduction & episode overview
• 02:04 Harvard’s groundbreaking research on lithium and cognition
• 05:36 Historical context: lithium in psychiatry and nutrition
• 07:43 Lithium’s neuroprotective mechanisms: inflammation, neurogenesis, GSK3 inhibition
• 11:54 Differences between lithium carbonate and lithium orotate—clinical implications
• 13:35 Lithium sequestration by amyloid plaques and the unique properties of orotate
• 15:28 How lithium supports neurotransmitter balance and mood stability
• 19:21 Safety strategies: dosing, lab monitoring, and real-world practice
• 23:35 Assessing lithium levels: hair analysis and environmental factors
• 26:54 Geographic influences on natural lithium exposure and implications for mental health
• 29:03 Lithium’s role in impulsivity regulation and behavioral health
• 35:16 Clinical case examples: children to adults, mood stabilization, addiction, and cognitive decline
• 37:15 Treatment timelines and patient outcomes with low-dose lithium
• 42:50 Long-term management considerations and lab monitoring protocols
• 46:12 The preventive potential of low-dose lithium for Alzheimer’s disease and dementia
• 49:18 Industry influence, patent issues, and future directions in natural lithium therapies
• 55:05 Resources for clinicians and closing remarks

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 episode of The Root Cause Medicine Podcast, Dr. Kate Kresge sits down with Margie Bissinger, PT, MS, CHC—a leading voice in integrative bone health and founder of the Certified Integrative Bone Health Practitioner Program. 
Together, they explore the new science of osteoporosis care in 2025, where bone strength is viewed as a reflection of whole-person metabolic and structural health—not just calcium and vitamin D intake. 

Clinicians will learn about the synergy between next-gen nutrients like collagen peptides, magnesium, vitamin K2 (MK-4 and MK-7), and gain a nuanced understanding of updated protein recommendations, power training, posture work, and low-intensity vibration in the treatment of bone density issues. Margie shares evidence-informed protocols, bone turnover marker monitoring, and strategies for gut–bone axis optimization—empowering practitioners to guide patients through safe, measurable, and sustainable bone rebuilding.


Clinical Takeaways from This Episode

• Osteoporosis as a Systems Issue: Bone loss is often a downstream signal of broader imbalances—inflammation, gut health, nutrient absorption, and stress physiology—not just low calcium intake.
• Vitamin K2 Synergy (MK-4 and MK-7): Margie highlights evidence for both forms: MK-4’s fracture reduction benefits and MK-7’s cardiovascular and bone maintenance support. She recommends using both for comprehensive osteocalcin activation and calcium metabolism balance.
• Magnesium and the Mineral Matrix: Magnesium glycinate, citrate, and threonate are preferred for absorption and metabolic synergy. Boron and zinc round out the trace mineral support network.
• Protein and Collagen Peptides for Bone Formation: Research in 2025 updates protein goals to ≥1.1 g/kg/day in older adults. Collagen peptides paired with vitamin C and resistance training can enhance BMD and reduce fracture risk.
• Gut–Bone Axis and Microbiome Influence: Dysbiosis and gluten sensitivity may impair bone remodeling. Stool testing can guide probiotic selection and dietary strategies; Lactobacillus reuteri and strain-diverse probiotics show early promise.
• Hormone and Parathyroid Considerations: Margie stresses evaluating estrogen, DHEA, cortisol, and parathyroid status. Subtle hyperparathyroidism can drive hidden bone resorption—often missed in standard workups.
• Bone Turnover Markers CTX and P1NP: Functional use of P1NP (bone formation) and CTX (bone resorption) provides faster feedback than DXA alone. Optimal CTX and P1NP suggest balanced remodeling.
• Power Training, Posture & the Onero Program: Evidence from the LIFTMOR and Onero trials supports high-intensity, low-rep resistance training (5 × 5 sets, twice weekly) under supervision. Margie emphasizes core stabilization, and avoiding forward flexion to reduce fracture risk.
• Jumping, Impact & WBV Platforms: Even heel-drop jumps improved BMD in trials. For non-impact populations, low-intensity vibration plates may safely stimulate mesenchymal stem cells toward osteogenesis. Margie advises avoid high intensity vibration plates. 
• Inflammation, Homocysteine, and CRP Monitoring: Elevated hs-CRP and homocysteine (>15 µmol/L) correlate with increased fracture risk. Functional ranges (<1.0 mg/L CRP; <8 µmol/L homocysteine) guide anti-inflammatory and methylation support with omega-3s and activated B vitamins.

Guest Introduction: Margie Bissinger, PT, MS, CHC is a physical therapist, integrative health coach, and founder of The Bone Health Academy and Happy Bones, Happy Life Podcast. With 30+ years of clinical and teaching experience, she integrates posture-focused PT, nutrient synergy, and mindset coaching to empower patients and practitioners alike. Margie co-founded the Certified Integrative Bone Health Practitioner Program with Dr. Kim Millman and serves on the New Jersey Interagency Council on Osteoporosis. 🔗 margiebissinger.com
Core Labs for Monitoring & Personalization

• Bone turnover: P1NP, β-CTX (baseline → 3–4 mo follow-up)
• Calcium
• Vitamin D (25-OH)
• Magnesium (RBC)
• Zinc (RBC)
• Homocysteine
• hs-CRP
• Parathyroid hormone (PTH)
• Thyroid panel
• 24-hour urine calcium
• Body composition metrics
• DEXA + trabecular bone score (TBS)

Nutrients & Supplements Discussed

• Collagen peptides
• Vitamin C
• Magnesium glycinate, citrate, threonate 
• Vitamin K2 (MK-4 & MK-7)
• Boron
• Zinc
• Tocotrienols to support osteoblast activity
• Activated B-vitamins (B6, B12, folate) to support homocysteine regulation
• Omega-3 fatty acids (EPA/DHA) for inflammation modulation

Lifestyle & Exercise Strategies

• Onero/power training
• Postural strengthening to reduce vertebral compression
• Balance work (Tai Chi, Qigong, proprioceptive drills)
• Low-intensity WBV
• Jump training
• Stress & sleep regulation

Timestamps00:00 Episode intro; topic overview (osteoporosis & bone health in 2025)
03:00 Exercise advances and empowerment through strength training
05:50 Nutrition overview: calcium, vitamin D, absorption & gut health
08:08 Vitamin K2: MK‑4 vs MK‑7 research and dosing discussion
11:50 Importance of magnesium and preferred forms
18:33 Protein needs updated: ≥1.1 g/kg for some populations and essential amino acids
24:22 Bone turnover blood markers: CTX and P1NP — interpretation & clinical use
31:05 Common drivers of elevated CTX: inflammation, hormones, parathyroid
36:43 Exercise prescription specifics, posture, stabilization, and BoneFit / PT resources
43:16  Weighted vests: when they help and when they hurt
45:35 Vibration plates: low‑intensity vs high‑intensity, safety considerations
49:01 Hormone replacement therapy: role in bone protection and CTX improvement
55:22 How Margie began focusing on bone health and integrative care
59:25 Strontium: effects on DEXA accuracy and recommendations
01:02:56 Jumping protocols and impact dosing for bone
01:07:05 Homocysteine and bone: thresholds and correction
01:13:33 Resources and recommended reading (Dr. Keith McCormick; Bone Health & Osteoporosis Foundation; BoneFit)
01:17:20 Closing: reframing diagnosis as opportunity; where to find Margie
Citations

• High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial - PubMed
• High-intensity exercise to prevent fractures — risk or gain? | Nature Reviews Endocrinology 
• Heavy resistance training provides short-term benefits on bone formation in well-functioning older adults - ScienceDirect 
• McCormick K. Great Bones: Taking Control of Your Osteoporosis. 2023.

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.

If metabolic flexibility is the key to longevity, are we missing critical opportunities to help our patients achieve it?

In this episode of The Root Cause Medicine Podcast, we sit down with Dr. Rob Downey and Monique Class, two respected functional medicine clinicians presenting at Fullscript Forward 2025, to explore how precision approaches to metabolic health are reshaping longevity care. Dr. Downey reveals how metabolic phenotyping, stress and HRV mapping, and gut function insights can inform individualized care strategies, while Monique shares her thoughtful approach to microdosed GLP-1 protocols, titration by response, and slow tapering models designed to complement lifestyle-first interventions. Together, they unpack the art and science of whole-person metabolic medicine—covering body composition tracking, lab-based decision-making, and muscle-preserving movement routines that clinicians can integrate into real-world workflows.

If you’re ready to help your clients achieve true metabolic transformation, this episode offers the frameworks, data points, and clinical pearls you won’t want to miss.

Clinical Takeaways from This Episode 

• Metabolic Phenotyping & Personalized Patterns in Longevity Care: Dr. Downey discusses using patterns such as body shape, lifestyle context, and lab trends to categorize presentations and organize evaluation, rather than applying one standardized protocol to everyone.
• “Body-Knows-the-Way” Framing & Foundational Inputs: Both Dr. Downey and Monique Class describe a model focused on reducing burdens (e.g., chronic stress, inflammation, dysbiosis) and adding supports (sleep, whole foods, movement) so adaptive pathways may function more effectively.
• Stress Physiology, HRV, Sleep & Behavior Change: Conversation covers the role of chronic sympathetic arousal and low HRV in metabolic challenges, and how breath work, meditation, or similar practices were used by some patients in their experience to shift autonomic balance.
• GLP-1 Microdosing, Titration & Slow Tapering: Monique explains her rationale for starting below common starter doses when appropriate, titrating to the lowest perceived effective dose to reduce “food noise,” and planning tapering from the outset—positioning medications as a potential bridge during lifestyle change.
• Side-Effect Themes & Constipation Workflow on GLP-1s: Both practitioners review proactive steps they consider before initiation of GLP-1s, such as addressing reflux/constipation and dysbiosis, and discussed tools often used in practice (hydration strategies; magnesium citrate/Cal-Mag; buffered vitamin C; ginger/bitters; gradual fiber; stool positioning) to manage common GI complaints.
• Nutrition Patterns, Endogenous GLP-1 Signaling & Glycemic Awareness: The dialogue highlights food-quality patterns (protein with meals; colorful produce; fermented foods/fiber) discussed in relation to satiety, SCFA production, and L-cell signaling, as well as interest in meal timing and CGM-based learning.
• Muscle Preservation & Body Composition Tracking: Monique and Dr. Downey discuss prioritizing resistance training, NEAT/micromovement, and tracking lean mass vs. visceral fat (e.g., Seca metrics, phase angle) as more informative than scale weight alone.
• Medication Reviews During Weight Loss: The guests emphasized reviewing other medications (e.g., blood pressure, lipid, glycemic, or psychiatric medications) as weight, intake, and vital signs change, with attention to orthostasis or hypoglycemia risk.
• Gut–Brain–Metabolic Axis Considerations: Guests describe empiric GI support and, in some cases, stool testing, as well as nutrients like glutamine and zinc (including zinc carnosine)in the context of comfort and barrier support.
• Metabolic Rebound & Relapse Prevention: The conversation covers reports of rebound with rapid dose escalation/high doses and abrupt discontinuation, and discussed slower titration, gradual tapering, and habit “scaffolding” (meal timing, movement, sleep, alcohol awareness) as strategies they consider to help maintain gains.

Guest Bios
Dr. Rob Downey, MD, IFMCP — Functional medicine physician at Seaworthy Medicine (AK); discussed phenotyping, HRV/stress context, and gut-metabolic foundations in complex cases.

Monique Class, FNP, IFMCP — Family nurse practitioner with 35+ years in functional medicine; discussed GLP-1 microdosing, tapering/off-ramps, and whole-person frameworks for weight management, inflammation, and longevity.

Labs Mentioned (Monitoring & Context)

• Glycemic/insulin markers: Fasting insulin, fasting glucose, HbA1c, optional CGM patterns
• Lipid & metabolic context: Standard lipid panel; triglycerides; uric acid; waist circumference
• Endocrine/sex hormones: Thyroid panel; sex hormones as indicated
• GI & micronutrients: Stool testing where applicable; micronutrient analyses
• Body composition: Visceral fat and phase angle (e.g., Seca), lean mass vs. fat mass

Ingredients & Therapeutic Nutrition Mentioned 

• Gut/immune: Boswellia, bromelain, quercetin; probiotics (product/strain selection varies)
• Stress/adaptogens: Ashwagandha, cordyceps, phosphatidylserine; ginseng/licorice when appropriate
• Metabolic support: Chromium, bitter melon; glutamine, zinc / zinc carnosine, lecithin
• Constipation toolkit: Magnesium citrate or Cal-Mag, buffered vitamin C, ginger/bitters, aloe options, gradual fiber, hydration, stool positioning

Diet patterns referenced: Protein at meals, fermented foods, colorful produce, structured meal timing, mindful alcohol intake

Fullscript Forward Details

• Fullscript Forward Summit – Oct 17 → https://www.fullscriptforward.com/

Timestamps
00:00 Intro & Fullscript Forward overview
01:54 Guest intros
03:15 Downey’s journey: autoimmunity → metabolic health focus
10:20 Phenotype & hormonal pattern assessment
13:18 Sequencing foundational interventions before advanced steps
15:39 Labs for assessing metabolism
19:22 GLP-1 tapering and off-ramp planning
22:26 Small-dose GLP-1 protocols & titration discussion
30:31 Metabolic rebound: drivers & mitigation approaches
43:03 Whole-person care & healthspan goals

Frequently Asked QuestionsQ: What makes this episode different from other GLP-1 discussions?
Most conversations stop at dosing. This one goes further—into phenotyping, nutrient status, and tapering protocols that integrate lifestyle medicine. It’s about how to use GLP-1s thoughtfully within a personalized, long-term metabolic framework.

Q: What is “metabolic phenotyping,” and why does it matter?
Dr. Downey explains how identifying phenotype patterns—such as stress physiology, body composition, and gut-driven inflammation—can help clinicians prioritize interventions and understand why certain patients plateau despite doing “everything right.”

Q: What key labs and metrics do the guests discuss?
They review labs that provide insight into insulin sensitivity, thyroid health, inflammation, and micronutrient status, as well as body composition measures (like visceral fat and phase angle) that reveal metabolic trends beyond weight alone.

Q: What can providers take away from this conversation?
A clearer view of how to connect physiology, psychology, and behavior change in metabolic medicine—plus practical insight into tapering, monitoring, and optimizing care over time.

Q: Who should listen to this episode?
Healthcare professionals interested in functional and lifestyle medicine, longevity, or integrative metabolic care—particularly those seeking to bridge the gap between pharmacology and personalized nutrition.


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 episode, we unpack the updated 2025 GLP-1 consensus advisory with Lara Zakaria, IFMCP. Lara reframes GLP-1 medications as a window of opportunity for lifestyle transformation and emphasizes that prescribing should be paired with proactive nutrition, movement, and lab monitoring. She outlines a three-tiered approach to lab work, highlights the importance of muscle preservation for long-term metabolic health, and shares practical tips for addressing common gastrointestinal side effects.


Clinical Takeaways from This Episode

• GLP-1 Therapy as a Catalyst for Metabolic Health: How to use GLP-1 medications as a tool to initiate lifestyle change, reset eating patterns, and improve overall body composition rather than relying on medication alone.
• GLP-1 Nutrition Screening & Eating Disorder Risk Assessment: Why clinicians should screen for disordered eating and evaluate baseline diet quality—including fiber, protein, and phytonutrient intake—before initiating GLP-1 therapy.
• Protein Intake & Muscle Preservation During GLP-1 Treatment: Evidence-informed guidance on maintaining protein intake (0.4–0.5 g/kg/day) and combining GLP-1s with resistance training to reduce muscle loss and support long-term metabolic health.
• Micronutrient Monitoring for GLP-1 Patients: Recommended lab tests to monitor iron, vitamin D, RBC magnesium, zinc, and fat-soluble vitamins (A, D, E, K) to help prevent nutrient insufficiency and support patient energy and recovery.
• Managing GLP-1-Related GI Side Effects Naturally: Stepwise strategies for reducing nausea, constipation, and bloating with smaller meals, fiber, hydration, magnesium, ginger, and digestive bitters.
• Tracking Body Composition in GLP-1 Weight Loss: Why measuring visceral fat, lean mass, and muscle density provides a more complete picture of progress than weight alone—and how to use body composition scales effectively.
• Multidisciplinary GLP-1 Care Team Approach: How dietitians, physical therapists, trainers, mental health providers, and pharmacists can collaborate to create comprehensive, patient-centered care plans.
• Optimizing Clinical Workflows for GLP-1 Prescribing: How to build visit templates, lab panels, and follow-up systems to integrate guideline-based nutrition, exercise, and lab monitoring into everyday practice.

Guest IntroductionLara Zakaria, PharmD, MS, CNS, CDN, IFMCP, is a licensed pharmacist and functional medicine practitioner specializing in metabolic health, neuroinflammation, and chronic disease. As a faculty member for the Institute for Functional Medicine, she teaches clinicians how to integrate pharmacology with nutrition and lifestyle medicine. Lara is passionate about helping practitioners use GLP-1s as a bridge to sustainable habit change—rather than as a stand-alone solution. Learn more at larazakaria.com or follow her at @foodiepharmacist on Instagram and LinkedIn.

GLP-1 Lab Monitoring for Nutrient Status

• CMP, CBC with iron studies
• RBC magnesium
• Vitamin D
• Full thyroid panel (TSH, free T4/T3, reverse T3, antibodies)
• Functional testing options: NutrEval, organic acids, stool test

GLP-1 Nutrition & Supplement Support for Metabolic Health

• Targeted protein intake (0.4–0.5 g/kg/day)
• Multi-mineral or multi-nutrient powder, divided doses
• Vitamin D + K2, B-complex, and iron as clinically indicated
• Electrolyte support during titration

GLP-1 Constipation Toolkit from Lara Zakaria

• Magnesium citrate or Cal-Mag combination for low magnesium constipation
• Buffered vitamin C (titrated to bowel tolerance) and hydration for osmotic constipation
• Triphala, ginger, digestive bitters as appropriate to support peristalsis
• Squatty potty and morning routines to activate parasympathetic tone and support optimal pelvic floor function

GLP-1 Lifestyle & Movement Recommendations

• Strength training 2–3x per week to protect muscle mass
• Walking, yoga, gardening, or functional movement on non-training days
• Sleep and stress hygiene support to balance circadian rhythm

Citations:

Mozaffarian D, Agarwal M, Aggarwal M, et al. Nutritional Priorities to Support GLP-1 Therapy for Obesity: A Joint Advisory From the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society. 2025.

Timestamps:

• 00:00 – Episode introduction and overview of prescribing considerations for GLP-1s
• 03:28 – Historical context: GLP-1 development and off-label use for weight loss
• 05:54 – The recent consensus statement and its implications for practice
• 06:43 – Decision tree considerations: muscle loss, fat distribution, and diet quality
• 09:05 – The importance of nutrition counseling and the gut-brain axis
• 12:05 – Holistic assessment framework: screening, laboratory biomarkers, and functional testing
• 14:10 – The role of fiber and gut health in optimizing GLP-1 outcomes
• 17:50 – The significance of screening for nutrient deficiencies: iron, vitamin D, magnesium, B vitamins, zinc
• 22:07 – Prevention of sarcopenic obesity during weight loss interventions
• 25:51 – Importance of assessing micronutrient status before and after GLP-1 therapy
• 27:54 – Lab assessments for liver, thyroid, and metabolic health indicators
• 40:51 – Advanced testing considerations and personalized evaluation strategies
• 47:02 – Managing GI side effects proactively: counseling, lifestyle, herbal supports
• 50:56 – Gut motility, herbal supports, and the importance of lifestyle factors
• 54:43 – Titrating and off-boarding GLP-1 medications for long-term health
• 55:30 – Resources