You've been hearing new voices in the host chair lately — so this week we're pulling back the curtain to introduce them properly. Dr. Kate Kresge sits down with Dr. Holly Lucille, Dr. Lara Zakaria, and Dr. Jessica Christie for a roundtable on the winding, deeply personal paths that led each of them into root-cause medicine.

A pharmacist nearly buried under her own stack of nutrition books who came out dual-licensed. A psychology student who couldn't find a medical school that took food and sleep seriously, so she built her own path. A holistic nurse turned naturopathic doctor who fought for her profession on the statehouse floor. And a host whose decade-long "mystery illness" resolved in three days once the right test was finally run. What ties them together is a stubborn refusal to stop at the easy answer — the instinct to say, let's think this through, because so often the protocol failed the patient, not the other way around.

Consider this your proper introduction to the team learning and sharing what works, right alongside you.

What you'll hear

• Why every one of these clinicians came to functional medicine as a "detective" — and often as a patient first.
• Dr. Lara Zakaria's path from community pharmacist to dual-licensed nutritionist, and a clear-eyed explainer on what the CNS credential actually requires.
• Dr. Jessica Christie's move from developmental psychology into naturopathic medicine, becoming her own first patient, and finding her way into fertility and women's health.
• Dr. Holly Lucille's journey through holistic nursing and naturopathic medicine — and helping pass California's ND licensing bill (SB 907) in 2004.
• Dr. Kate Kresge's decade of misdiagnosed illness that resolved in days once the root cause was identified — and why it reshaped how she thinks about mental-health symptoms with a physiological root cause.
• How Rupa and Fullscript coming together puts labs, education, boot camps, webinars and AI-assisted evidence in one free place for clinicians.
• The team's reframe of "the patient failed treatment" into "the treatment failed the patient" — and what patient-centered care really means.

Key themes

• Let's think things through — clinical reasoning over the 15-minute prescribe-and-go visit.
• The empowered, informed patient is a good thing; clinicians add the nuance.
• Whole-person care means mind and body are never truly separate.
• Personalization: the protocol fits the patient, not the other way around.

Timestamps

• 02:21 — Welcoming the hosts
• 03:13 — Naming the listeners
• 05:35 — "Let's think things through"
• 06:40 — Nuance and the empowered patient
• 09:02 — Dr. Lara Zakaria's story
• 12:16 — Dr. Jessica Christie's story
• 16:00 — Rupa magazine + free education
• 17:03 — What a CNS is
• 20:10 — Dr. Holly Lucille's story
• 28:17 — Whiskey Flower + Wipeout
• 30:16 — Rupa + Fullscript coming together
• 32:20 — AI Assist for whole-person care
• 34:00 — Dr. Kate Kresge's story
• 44:11 — The protocol failed the patient
• 46:05 — What excites the team next
• 53:21 — Wrap-up + listener name reveal

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 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: Views expressed are those of the hosts and guests and do not necessarily reflect Fullscript or affiliated organizations. For informational and educational purposes only; not medical advice.

Dr. Lara Zakaria is joined by Stephanie Venn-Watson, DVM, MPH, to explore emerging research on pentadecanoic acid (C15:0), an odd-chain saturated fatty acid initially studied through research involving bottlenose dolphins.

The conversation connects C15:0 with cell-membrane composition, lipid peroxidation, ferroptosis, iron metabolism, metabolic health, and steatotic liver disease. It also examines research on circulating C15:0 as a biomarker associated with cardiometabolic outcomes and early human trials of C15:0 supplementation. (Imamura 2018) (Sawh 2021) 

C15:0 has been proposed as a candidate essential fatty acid, however, that classification and a specific human “C15:0 deficiency syndrome” remain emerging hypotheses rather than established clinical diagnoses.

Clinical Takeaways

• Ferroptosis is an iron-dependent form of regulated cell death. First characterized in 2012, ferroptosis involves iron-dependent lipid peroxidation and differs mechanistically from apoptosis and other forms of cell death. (Dixon 2012) Polyunsaturated fatty acids in phospholipids are particularly relevant substrates for ferroptotic lipid peroxidation. (Yang 2016)
• C15:0 is an odd-chain saturated fatty acid being studied for metabolic effects. Pentadecanoic acid, or C15:0, is found in dairy fat and smaller amounts in other foods. Higher circulating C15:0 has been associated with lower incidence of type 2 diabetes in prospective observational research, but these associations do not establish that C15:0 itself prevents diabetes. (Imamura 2018)
• Calling C15:0 an “essential fatty acid” remains an emerging scientific proposal. Experimental work has proposed C15:0 as a candidate essential fatty acid based on dietary exposure, biological activity, and associations between circulating levels and health outcomes. More research is needed before C15:0 can be treated as equivalent to the established essential fatty acids linoleic acid and alpha-linolenic acid. (Venn-Watson 2020) (Venn-Watson 2022) 
• Metabolic hyperferritinemia is a recognized clinical framework, but it is not synonymous with ferroptosis or C15:0 deficiency. Metabolic hyperferritinemia describes elevated ferritin occurring with metabolic dysfunction. Ferritin is also an acute-phase reactant, so elevated values require evaluation in clinical context rather than being interpreted as tissue iron overload by themselves. (Valenti 2023)
• Human C15:0 supplementation evidence is early. Within this broader metabolic context, circulating C15:0 is an emerging biomarker of interest. In a small 12-week randomized, placebo-controlled trial in young adults with overweight or obesity, 200 mg/day oral C15:0 significantly increased circulating C15:0 concentrations. Exploratory analyses suggested that participants who achieved post-treatment circulating C15:0 concentrations above 5 µg/mL had greater reductions in ALT and AST and a greater increase in hemoglobin; these achieved-level findings were not definitive treatment effects and require replication in larger trials designed for liver and hematologic outcomes. (Robinson 2024)
• Diet and lifestyle remain the better-established foundation for metabolic and liver health. Dairy fat is the principal dietary source of C15:0, although circulating odd-chain fatty acids may also be influenced by endogenous production. (Weitkunat 2017) For people who avoid or tolerate little dairy, C15:0 supplementation is an emerging option that may be useful alongside high-fiber, Mediterranean-style minimally processed dietary patterns, regular exercise, metabolic-risk reduction, and appropriate evaluation and treatment of fatty liver disease or abnormal iron markers. (Chooi 2024)

Guest: Stephanie Venn-Watson, DVM, MPH

Stephanie Venn-Watson is a veterinary epidemiologist whose research has included comparative medicine and the health of bottlenose dolphins cared for through the U.S. Navy Marine Mammal Program.

Research involving dolphins identified similarities in metabolic and age-associated physiology that led investigators to study odd-chain saturated fatty acids, including C15:0 and C17:0. Her subsequent research has focused on the biological activity of C15:0 and the hypothesis that inadequate C15:0 may contribute to cellular vulnerability.

Some of this research is connected with patents and commercial C15:0 products, making independent replication and larger human clinical trials particularly important when interpreting the findings.

Clinician FAQ

1. What is C15:0?

C15:0, or pentadecanoic acid, is a 15-carbon odd-chain saturated fatty acid.

It occurs in foods including dairy fat and has historically been studied as a biomarker related to dairy-fat intake. (Imamura 2018) More recent research is examining whether C15:0 itself has biologically relevant metabolic effects. (Venn-Watson 2020)

2. Is C15:0 an essential fatty acid?

Not yet by established nutritional consensus.

C15:0 has been proposed as a candidate essential fatty acid, but this remains an emerging area of research. (Venn-Watson 2020) (Venn-Watson 2022) Linoleic acid and alpha-linolenic acid remain the conventionally recognized essential fatty acids in human nutrition.

3. What is ferroptosis?

Ferroptosis is a regulated, iron-dependent form of cell death characterized by damaging lipid peroxidation. (Dixon 2012)

The process involves interactions among cellular iron, oxidizable membrane phospholipids, and antioxidant defense systems. Ferroptosis is being investigated across metabolic, neurologic, cardiovascular, liver, and cancer biology.

4. Is high ferritin evidence that a patient is undergoing ferroptosis?

No.

Ferritin reflects iron storage but is also an acute-phase reactant. Elevated ferritin can occur with inflammation, liver disease, metabolic dysfunction, infection, malignancy, iron overload, and other conditions. (Valenti 2023) Ferroptosis cannot be diagnosed from serum ferritin alone.

5. What is metabolic hyperferritinemia?

Metabolic hyperferritinemia describes elevated serum ferritin occurring in the context of metabolic dysfunction.

A published consensus framework proposes ferritin above 300 ng/mL in men or 200 ng/mL in women together with specified metabolic criteria, while excluding or reassessing alternative explanations for hyperferritinemia. (Valenti 2023) The framework also distinguishes hyperferritinemia from confirmed tissue iron accumulation. (Liu 2024)

6. Does elevated ferritin mean a patient needs phlebotomy?

Not necessarily.

The metabolic hyperferritinemia consensus states that evidence supporting routine iron-depletion therapy is insufficient. (Valenti 2023) Phlebotomy should not be inferred from ferritin alone; evaluation of the cause of hyperferritinemia and, when appropriate, tissue iron burden is important.

7. What foods contain C15:0?

Dairy fat is one dietary source of C15:0, and C15:0 is also present in smaller amounts in some meats, fish, and other foods.

Circulating odd-chain fatty acids are not exclusively determined by dairy intake. Research also suggests that endogenous pathways involving gut-derived propionate can contribute to odd-chain fatty acid production. (Weitkunat 2017)

8. Does eating more full-fat dairy increase C15:0?

Dietary dairy fat can contribute to circulating C15:0, but the health implications of increasing full-fat dairy cannot be reduced to C15:0 alone.

Dairy foods contain multiple fatty acids, proteins, carbohydrates, minerals, and other components, and observational evidence differs by dairy-food type. (Imamura 2018) (Sawh 2021) Dietary recommendations should therefore consider the patient's overall diet and clinical context.

9. What has human supplementation research shown?

Human evidence remains limited.

One randomized trial studied 200 mg/day of C15:0 for 12 weeks in 30 young adults with overweight or obesity and found increased circulating C15:0. (Robinson 2024) A separate randomized trial evaluated 300 mg/day as an addition to an Asian-adapted Mediterranean-style diet in women with fatty liver and reported an additional reduction in LDL cholesterol and an increase in Bifidobacterium adolescentis abundance. (Chooi 2024)

Neither study establishes C15:0 supplementation as treatment for metabolic disease, ferroptosis, or metabolic hyperferritinemia.

10. Can C15:0 levels be used as a clinical treatment target?

A standardized clinical target has not been established.

Thresholds such as 5 μg/mL or 0.2% of total fatty acids have been proposed and explored in C15:0 research, but they should not currently be treated as universally validated diagnostic thresholds for deficiency or treatment targets. (Robinson 2024) (Venn-Watson 2024) 

Timestamps / Key Moments

00:00:18 Introducing C15:0, cellular aging, and ferroptosis

00:02:19 Stephanie Venn-Watson’s background and dolphin research

00:05:29 How C15:0 emerged from metabolomics research

00:10:20 Alzheimer’s disease-like pathology in dolphins

00:11:33 What C15:0 is and how fatty acids are classified

00:18:18 C15:0, membrane stability, and lipid peroxidation

00:19:25 Understanding ferroptosis

00:24:34 Metabolic hyperferritinemia and clinical patterns

00:27:37 Proposed C15:0 thresholds and metabolic research

00:30:43 Dietary sources of C15:0

00:40:19 Measuring circulating C15:0

00:45:49 Human clinical research on C15:0

Fatty acids and biological processes discussed

• Pentadecanoic acid (C15:0)
• Heptadecanoic acid (C17:0)
• Odd-chain saturated fatty acids
• Saturated fatty acids
• Polyunsaturated fatty acids
• Linoleic acid
• Alpha-linolenic acid
• EPA
• DHA
• Cell-membrane lipids
• Lipid peroxidation
• Ferroptosis
• Reactive oxygen species
• Mitochondrial function
• Iron metabolism
• Ferritin

Clinical markers and conditions discussed

• Ferritin
• Transferrin saturation
• Hemoglobin
• Red blood cell distribution width (RDW)
• ALT
• AST
• GGT
• Lipid peroxidation
• LDL cholesterol
• Glucose
• Insulin
• Metabolic hyperferritinemia
• Insulin resistance
• Type 2 diabetes
• Metabolic syndrome
• MASLD
• MASH
• Iron overload
• Cognitive decline

Want to elevate your practice?

This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript helps practitioners bring supplement dispensing, lab ordering, patient education, and care planning into a centralized workflow.

The goal is not to replace clinical judgment, but to support thoughtful, individualized care and reduce unnecessary administrative steps.

For more practitioner education on supplement quality, metabolic health, and clinical decision-making, visit Fullscript Academy.

Disclaimer

The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for informational and educational purposes only and is not medical advice.

C15:0 research is evolving. C15:0 is not currently an established treatment for ferroptosis, metabolic hyperferritinemia, diabetes, MASLD, MASH, or neurodegenerative disease. Elevated ferritin has multiple potential causes and should be interpreted in clinical context. Patients should consult a qualified healthcare professional before changing their diet, supplements, iron intake, or treatment plan.

References

1. Chooi, Y. C., Zhang, Q. A., Magkos, F., Ng, M., Michael, N., Wu, X., Brok Volchanskaya, V. S., Lai, X., Wanjaya, E. R., Elejalde, U., Goh, C. C., Yap, C. P. L., Wong, L. H., Lim, K. J., Velan, S. S., Yaligar, J., Muthiah, M. D., Chong, Y. S., Loo, E. X. L., … Eriksson, J. G. (2024). Effect of an Asian-adapted Mediterranean diet and pentadecanoic acid on fatty liver disease: The TANGO randomized controlled trial. American Journal of Clinical Nutrition, 119(3), 788–799. https://pubmed.ncbi.nlm.nih.gov/38035997/
2. Dixon, S. J., Lemberg, K. M., Lamprecht, M. R., Skouta, R., Zaitsev, E. M., Gleason, C. E., Patel, D. N., Bauer, A. J., Cantley, A. M., Yang, W. S., Morrison, B., III, & Stockwell, B. R. (2012). Ferroptosis: An iron-dependent form of nonapoptotic cell death. Cell, 149(5), 1060–1072. https://pubmed.ncbi.nlm.nih.gov/22632970/
3. Imamura, F., Fretts, A., Marklund, M., Ardisson Korat, A. V., Yang, W.-S., Lankinen, M., Qureshi, W., Helmer, C., Chen, T.-A., Wong, K., Bassett, J. K., Murphy, R., Tintle, N., Yu, C. I., Brouwer, I. A., Chien, K.-L., Frazier-Wood, A. C., del Gobbo, L. C., Djoussé, L., … Forouhi, N. G. (2018). Fatty acid biomarkers of dairy fat consumption and incidence of type 2 diabetes: A pooled analysis of prospective cohort studies. PLOS Medicine, 15(10), e1002670. https://pubmed.ncbi.nlm.nih.gov/30303968/
4. Liu, W.-Y., Lian, L.-Y., Zhang, H., Chen, S.-D., Jin, X.-Z., Zhang, N., Ye, C.-H., Chen, W.-Y., Goh, G. B. B., Wang, F.-D., Miele, L., Corradini, E., Valenti, L., & Zheng, M.-H. (2024). A population-based and clinical cohort validation of the novel consensus definition of metabolic hyperferritinemia. Journal of Clinical Endocrinology & Metabolism, 109(6), 1540–1549. https://pubmed.ncbi.nlm.nih.gov/38124275/
5. Robinson, M. K., Lee, E., Ugalde-Nicalo, P. A., Skonieczny, J. W., Chun, L. F., Newton, K. P., & Schwimmer, J. B. (2024). Pentadecanoic acid supplementation in young adults with overweight and obesity: A randomized controlled trial. Journal of Nutrition, 154(9), 2763–2771. https://pubmed.ncbi.nlm.nih.gov/39069269/
6. Sawh, M. C., Wallace, M., Shapiro, E., Goyal, N. P., Newton, K. P., Yu, E. L., Bross, C., Durelle, J., Knott, C., Gangoiti, J. A., Barshop, B. A., Gengatharan, J. M., Meurs, N., Schlein, A., Middleton, M. S., Sirlin, C. B., Metallo, C. M., & Schwimmer, J. B. (2021). Dairy fat intake, plasma C15:0, and plasma iso-C17:0 are inversely associated with liver fat in children. Journal of Pediatric Gastroenterology and Nutrition, 72(4), e90–e96. https://pubmed.ncbi.nlm.nih.gov/33399331/
7. Vacher, M. C., Durrant, C. S., Rose, J., Hall, A. J., Spires-Jones, T. L., Gunn-Moore, F., & Dagleish, M. P. (2023). Alzheimer's disease-like neuropathology in three species of oceanic dolphin. European Journal of Neuroscience, 57(7), 1161–1179. https://pubmed.ncbi.nlm.nih.gov/36514861/
8. Valenti, L., Corradini, E., Adams, L. A., Aigner, E., Alqahtani, S., Arrese, M., Bardou-Jacquet, E., Bugianesi, E., Fernandez-Real, J.-M., Girelli, D., Hagström, H., Henninger, B., Kowdley, K., Ligabue, G., McClain, D., Lainé, F., Miyanishi, K., Muckenthaler, M. U., Pagani, A., … Zoller, H. (2023). Consensus statement on the definition and classification of metabolic hyperferritinaemia. Nature Reviews Endocrinology, 19(5), 299–310. https://pubmed.ncbi.nlm.nih.gov/36805052/
9. Venn-Watson, S., Smith, C. R., Stevenson, S., Parry, C., Daniels, R., Jensen, E., Cendejas, V., Balmer, B., Janech, M., Neely, B. A., & Wells, R. (2013). Blood-based indicators of insulin resistance and metabolic syndrome in bottlenose dolphins (Tursiops truncatus). Frontiers in Endocrinology, 4, 136. https://pubmed.ncbi.nlm.nih.gov/24130551/
10. Venn-Watson, S., Parry, C., Baird, M., Stevenson, S., Carlin, K., Daniels, R., Smith, C. R., Jones, R., Meegan, J., Simmons, J., Gomez, F., & Jensen, E. D. (2015). Increased dietary intake of saturated fatty acid heptadecanoic acid (C17:0) associated with decreasing ferritin and alleviated metabolic syndrome in dolphins. PLOS ONE, 10(7), e0132117. https://pubmed.ncbi.nlm.nih.gov/26200116/
11. Venn-Watson, S., Lumpkin, R., & Dennis, E. A. (2020). Efficacy of dietary odd-chain saturated fatty acid pentadecanoic acid parallels broad associated health benefits in humans: Could it be essential? Scientific Reports, 10, 8161. https://pubmed.ncbi.nlm.nih.gov/32424181/
12. Venn-Watson, S. K., & Butterworth, C. N. (2022). Broader and safer clinically-relevant activities of pentadecanoic acid compared to omega-3: Evaluation of an emerging essential fatty acid across twelve primary human cell-based disease systems. PLOS ONE, 17(5), e0268778. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268778
13. Venn-Watson, S. (2024). The cellular stability hypothesis: Evidence of ferroptosis and accelerated aging-associated diseases as newly identified nutritional pentadecanoic acid (C15:0) deficiency syndrome. Metabolites, 14(7), 355. https://www.mdpi.com/2218-1989/14/7/355
14. Weitkunat, K., Schumann, S., Nickel, D., Hornemann, S., Petzke, K. J., Schulze, M. B., Pfeiffer, A. F. H., & Klaus, S. (2017). Odd-chain fatty acids as a biomarker for dietary fiber intake: A novel pathway for endogenous production from propionate. American Journal of Clinical Nutrition, 105(6), 1544–1551. https://pubmed.ncbi.nlm.nih.gov/28424190/
15. Yang, W. S., Kim, K. J., Gaschler, M. M., Patel, M., Shchepinov, M. S., & Stockwell, B. R. (2016). Peroxidation of polyunsaturated fatty acids by lipoxygenases drives ferroptosis. Proceedings of the National Academy of Sciences, 113(34), E4966–E4975. https://pubmed.ncbi.nlm.nih.gov/27506793/

Dr. Geeta Maker-Clark joins the Root Cause Medicine Podcast to discuss ideas from her book, Medicine for All People: Science and Ancient Wisdom for Revolutionary Healing. Drawing from family medicine, integrative medicine, culinary medicine, community health and her own upbringing, she explores a broader view of medicine that includes food, plants, nature, community, service, trust, dance, gratitude, and play.

The conversation centers on a simple idea: health is shaped not only by what happens in the clinic, but also by the environments, relationships, resources, cultural traditions, and daily practices that surround a person. Dr. Maker-Clark organizes these ideas into three areas—medicines of the earth, medicines of connection, and medicines of spirit—and discusses how practitioners can think about them alongside conventional medical care.

Clinical Takeaways

• Food and nutrition are part of whole-person care. Dr. Maker-Clark describes food as a central part of her clinical philosophy and discusses culinary medicine as a way to combine nutrition education with practical cooking skills. Her University of Chicago culinary medicine work includes medical students, community members, and middle school students, with an emphasis on nutrition literacy, accessibility, and culturally relevant food education. (Maker-Clark 2023)
• Nature exposure may support stress regulation and mental well-being. The episode frames time outdoors and connection with the natural environment as accessible ways to support well-being. Research has associated nature exposure with lower perceived and physiologic stress, although study designs, settings, and outcomes vary. (Shuda 2020)
• Social connection deserves attention in clinical assessment. Dr. Maker-Clark emphasizes community, belonging, and service as dimensions of health. Research supports associations between loneliness and social isolation and adverse cardiovascular, brain, mental health, and inflammatory outcomes, although mechanisms and the effectiveness of specific interventions continue to be studied. (Cené 2022) (Smith 2020)
• Trust includes both healthcare relationships and self-trust. The conversation explores how previous negative healthcare experiences, chronic illness, and unexplained symptoms can affect trust. Dr. Maker-Clark describes rebuilding trust through relationships and small, achievable commitments rather than treating trust as something patients should simply provide.
• Dance combines movement, cognition, emotion, and often social interaction. Dance is presented as an accessible form of joyful movement rather than a replacement for clinical care. Research suggests dance can influence cognitive and neuroplasticity-related outcomes, particularly in older adults, although effects vary by population and intervention. (Teixeira-Machado 2019) (Hewston 2021)
• Gratitude and play can be viewed as practices that support well-being. Gratitude interventions have shown generally modest benefits for well-being and some psychological outcomes. (Diniz 2023) (Kerry 2023) Adult play can take many forms, including creativity, competition, collecting, storytelling, exploration, and restorative activities. (Blanche 2024)

Guest: Geeta Maker-Clark, MD

Dr. Geeta Maker-Clark is a family and integrative medicine physician whose work spans patient care, nutrition education, culinary medicine, and community health. In the episode, she describes early clinical work in high-risk obstetrics and underserved communities as formative in expanding her understanding of health beyond the clinic.

She co-developed culinary medicine programming connected with the University of Chicago, including medical student education and community-based nutrition programs. Her book, Medicine for All People: Science and Ancient Wisdom for Revolutionary Healing, brings together themes of ancestral knowledge, scientific research, social justice, connection, and accessible approaches to well-being.

Clinician FAQ

1. What does Dr. Maker-Clark mean by “medicine for all people”?

She uses the phrase to describe a broader framework for health that includes conventional medicine alongside food, nature, relationships, community, cultural knowledge, and everyday practices. Accessibility and social justice are central themes in the framework.

2. What is culinary medicine?

Culinary medicine combines nutrition education with practical food preparation and cooking skills. In the program discussed in the episode, medical students learn nutrition counseling and cooking skills while community and middle school programs focus on nutrition literacy, food preparation, food justice, and culturally relevant education. (Maker-Clark 2023)

3. What does research say about nature exposure and stress?

Research generally supports an association between exposure to natural environments and improvements in some measures of perceived and physiological stress. Results vary across studies, and the effects depend on factors such as the population, type of nature exposure, comparison environment, and outcome measured. (Shuda 2020)

4. Why are loneliness and social connection clinically relevant?

Social isolation and loneliness have been associated with poorer cardiovascular and brain health and with some inflammatory markers. However, loneliness and objective social isolation are distinct concepts, and evidence does not establish that every health effect attributed to social disconnection operates through inflammation. (Cené 2022) (Smith 2020)

5. Can dance support brain health?

Dance combines physical movement with rhythm, learning, coordination, and sometimes social interaction. Systematic reviews have reported changes in cognitive and neuroplasticity-related outcomes, particularly among middle-aged and older adults. The magnitude of benefit and the cognitive domains affected vary across studies. (Teixeira-Machado 2019) (Hewston 2021) (Fong Yan 2024)

6. Does practicing gratitude improve mental health?

Gratitude interventions have been associated with small improvements in well-being and, in some studies, psychological symptoms. Results are heterogeneous, and gratitude should be viewed as a supportive practice rather than a substitute for appropriate mental healthcare. (Diniz 2023) (Kerry 2023)

Timestamps / Key Moments

00:01:41 Fullscript and whole-person care

00:02:39 Introducing Medicine for All People

00:03:09 How the book’s title and philosophy developed

00:06:07 Family medicine, obstetrics, and community health

00:07:18 How living conditions shaped Dr. Maker-Clark’s view of medicine

00:10:00 Food as a central part of whole-person care

00:11:02 Growing up with food and traditional practices

00:13:19 Bringing nutrition back into clinical practice

00:15:14 Culinary medicine and medical student education

00:16:03 Bringing food education into Chicago public schools

00:17:23 Plants, ancestral knowledge, and connection with the natural world

00:20:29 Developing relationships with plants in everyday environments

00:22:49 Plants and the history of medicines

00:24:52 Nature, stress regulation, and belonging

00:27:19 Access to nature as a health-equity issue

00:31:26 Community as a medicine of connection

00:35:16 Service, or seva, and connection with others

00:41:31 Trust in healthcare relationships

00:45:22 Rebuilding trust in the body during chronic illness

00:46:39 Small practices for rebuilding self-trust

00:49:21 Why dance, gratitude, and play are “medicines of spirit”

00:50:36 Dance, movement, and neuroplasticity

00:53:28 Dance as culture, ancestry, and expression

00:54:27 Gratitude without toxic positivity

00:58:22 Why adults still need play

01:00:44 Different adult play personalities

01:03:20 Play and social development

01:05:56 Where to find Dr. Maker-Clark and her book

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 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 host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for informational and educational purposes only and is not medical advice. Practices discussed in the episode should not replace individualized medical assessment or treatment. Patients should consult a qualified healthcare professional before making changes to their healthcare routine.

References

1. Maker-Clark G, McHugh A, Shireman H, et al. Empowering Future Physicians and Communities on Chicago’s South Side through a 3-Arm Culinary Medicine Program. Nutrients. 2023;15(19):4212.
2. Shuda Q, Bougoulias ME, Kass R. Effect of nature exposure on perceived and physiologic stress: A systematic review. Complement Ther Med. 2020;53:102514.
3. Smith KJ, Gavey S, Riddell NE, Kontari P, Victor C. The association between loneliness, social isolation and inflammation: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2020;112:519–541.
4. Cené CW, Beckie TM, Sims M, et al. Effects of Objective and Perceived Social Isolation on Cardiovascular and Brain Health: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2022.
5. Teixeira-Machado L, Arida RM, de Jesus Mari J. Dance for neuroplasticity: A descriptive systematic review. Neurosci Biobehav Rev. 2019;96:232–240.
6. Hewston P, Kennedy CC, Borhan S, et al. Effects of dance on cognitive function in older adults: a systematic review and meta-analysis. Age Ageing. 2021;50(4):1084–1092.
7. Fong Yan A, Nicholson LL, Ward RE, et al. The Effectiveness of Dance Interventions on Psychological and Cognitive Health Outcomes Compared with Other Forms of Physical Activity: A Systematic Review with Meta-analysis. Sports Med. 2024.
8. Diniz G, Korkes L, Tristão LS, et al. The effects of gratitude interventions: a systematic review and meta-analysis. Einstein (São Paulo). 2023.
9. Kerry N, Chhabra R, Clifton JDW. Being Thankful for What You Have: A Systematic Review of Evidence for the Effect of Gratitude on Life Satisfaction. Psychol Res Behav Manag. 2023;16:4799–4816.
10. Blanche EI, Chang MC, Parham LD. Experiences of Adult Play. Am J Occup Ther. 2024;78(4).

Dr. Holly Lucille, ND, is joined by Ellie Abraham, PhD, to explain why two curcumin or Boswellia supplements may not be equivalent, even when the front of the label looks similar. The conversation covers boswellic acid standardization, AKBA, curcumin delivery systems, piperine, botanical sourcing, finished-product testing, certificates of analysis, and supply-chain controls. Research supports meaningful variation in Boswellia composition and curcumin formulations, making the specific extract and formulation relevant when interpreting product labels and published evidence. (Meins 2016) (Mimica 2022)

Clinical Takeaways

• “Boswellic acids” describes a group of compounds. Boswellia preparations can contain different proportions of individual boswellic acids, including AKBA, KBA, and alpha- and beta-boswellic acids. Products with similar total boswellic acid claims therefore may not have identical chemical profiles. (Mannino 2016) (Meins 2016)
• Curcumin formulation matters. Conventional oral curcumin has low bioavailability, and formulations including phytosomes, liposomes, micelles, and piperine combinations have been studied as strategies to alter absorption. However, different formulations should not automatically be treated as interchangeable because comparative pharmacokinetic results vary. (Hegde 2023) (Fança-Berthon 2021)
• Standardization provides more information than an ingredient name alone. Botanical composition can vary with species, growing conditions, extraction, processing, and other supply-chain factors. Standardization and appropriate quality controls can help establish more consistent composition. (Ribnicky 2008) (Sarma 2021)
• Potency is only one part of quality. Botanical quality also involves identity, purity, contaminants, adulteration, and finished-product verification. Published investigations have identified labeling and authenticity concerns in both Boswellia and turmeric/curcumin products. (Meins 2016) (You 2022)
• Quality does not equal clinical fit. A well-characterized supplement still needs to be considered in the context of the individual patient, including the formulation, dose, supporting evidence, medication use, and potential botanical-drug interactions. (van Breemen 2008)

Guest: Ellie Abraham, PhD

Ellie Abraham has a PhD in plant biology, with research focused on developing analytical methods for testing finished botanical products. Her background includes botanical chemistry, finished-product testing, standardization, and dietary supplement quality. In this episode, she explains how practitioners can look beyond an ingredient name to assess what a curcumin or Boswellia product is actually formulated to deliver.

These five questions best match the broad topics addressed in the episode, particularly searches around Boswellia standardization, AKBA, curcumin absorption, piperine, and supplement quality. Exact search volume is not publicly available from a standard web search. These topics are also represented in published research on botanical quality and curcumin formulation.

Clinician FAQ

1. Are all Boswellia supplements the same?

No. Boswellia products may differ in species, extract composition, total boswellic acid content, and concentrations of individual boswellic acids such as AKBA and KBA. A survey of commercial Boswellia supplements found substantial variation in composition and label compliance. (Meins 2016)

2. What does boswellic acid standardization mean?

It indicates that an extract is standardized to a stated amount of boswellic acids or, in some products, a particular constituent such as AKBA. Boswellia contains multiple boswellic acids, and their relative concentrations can vary by species and extract. (Mannino 2016) (Lauß 2024)

3. Why is AKBA listed separately on some Boswellia products?

AKBA, or 3-O-acetyl-11-keto-β-boswellic acid, is one individual boswellic acid that has received substantial pharmacologic research attention. Calling it out separately provides more specific compositional information than reporting total boswellic acids alone. (Ammon 2016)

4. Why do curcumin supplements use phytosomes, liposomes, or piperine?

Conventional oral curcumin has limited bioavailability. Phospholipid complexes, liposomal and micellar systems, and co-administration with piperine are among the approaches studied to alter its absorption and pharmacokinetics. Results vary by formulation, so an “enhanced absorption” format does not by itself establish that two products are equivalent. (Mirzaei 2017) (Heidari 2023) (Mimica 2022)

5. How can practitioners assess curcumin and Boswellia supplement quality?

Look beyond the ingredient name. Relevant product information may include botanical identity, extract and standardization details, branded ingredients tied to specific research, contaminant and adulteration testing, finished-product verification, and manufacturer transparency. Published studies have documented variability and authenticity concerns in commercial Boswellia and turmeric products. (Meins 2016) (You 2022)

Timestamps / Key Moments

00:00:36 Why familiar botanical names do not make products equivalent

00:01:27 Understanding Boswellia and boswellic acid standardization

00:02:05 Total boswellic acids and individual compounds

00:03:47 Why the boswellic acid profile matters

00:05:40 Matching botanical extracts to the supporting evidence

00:06:09 Curcumin delivery methods and formulation differences

00:07:12 Phospholipid-based curcumin formulations

00:08:29 How piperine is used with curcumin

00:10:43 Finished-product testing and label claims

00:13:43 Heavy metals and synthetic curcumin concerns

00:14:09 Understanding California Proposition 65

00:16:40 Curcuminoid complexes and certificates of analysis

00:18:18 How supply-chain controls affect botanical composition

00:20:07 Why standardization matters from batch to batch

00:21:05 What practitioners can look for when reviewing products

00:22:40 Fullscript's approach to supplier and product quality review

Botanicals and Compounds Discussed

• Boswellia
• Boswellia extracts
• Boswellic acids
• AKBA (3-O-acetyl-11-keto-β-boswellic acid)
• Beta-boswellic acid
• Turmeric
• Curcumin
• Curcuminoids
• Piperine
• Phospholipids

Quality Methods and Documents Discussed

• Botanical standardization
• Finished-product testing
• Ingredient identity verification
• Potency testing
• Heavy-metal testing
• Adulteration screening
• Synthetic curcumin testing
• Certificates of analysis
• Branded ingredient documentation
• Raw-material sourcing
• Supply-chain controls
• Extraction methods
• Stability data
• Batch-to-batch consistency
• Supplier and brand vetting

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 centralized system. For practitioners, Fullscript provides access to professional-grade supplements and practitioner education while incorporating quality review processes for brands and products offered through its catalog. The goal is not to replace clinical judgment, but to help practitioners make thoughtful, individualized decisions with clearer product and quality information.

For more practitioner education on supplement quality and clinical decision-making, visit Fullscript Academy at academy.fullscript.com.

Disclaimer

The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for informational and educational purposes only and is not medical advice. Dietary supplements may cause side effects or interact with medications. Patients should consult a qualified healthcare professional before changing their healthcare routine.

References

1. Ammon, H. P. T. (2016). Boswellic acids and their role in chronic inflammatory diseases. Advances in Experimental Medicine and Biology, 928, 291–327. https://pubmed.ncbi.nlm.nih.gov/27671822/
2. Fança-Berthon, P., et al. (2021). Pharmacokinetics of a single dose of turmeric curcuminoids depends on formulation: Results of a human crossover study. The Journal of Nutrition, 151(7), 1802–1816. https://pubmed.ncbi.nlm.nih.gov/34363434/
3. Hegde, M., Girisa, S., BharathwajChetty, B., Vishwa, R., & Kunnumakkara, A. B. (2023). Curcumin formulations for better bioavailability: What we learned from clinical trials thus far? ACS Omega, 8(12), 10713–10746. https://pubmed.ncbi.nlm.nih.gov/37008131/
4. Heidari, H., Bagherniya, M., Majeed, M., Sathyapalan, T., Jamialahmadi, T., & Sahebkar, A. (2023). Curcumin-piperine co-supplementation and human health: A comprehensive review of preclinical and clinical studies. Phytotherapy Research, 37(4), 1462–1487. https://pubmed.ncbi.nlm.nih.gov/36720711/
5. Lauß, J., Kappacher, C., Isser, O., Huck, C. W., & Rainer, M. (2024). Species-specific quantification of bioactive boswellic acids in Boswellia resin using NIR spectroscopy, HPLC and multivariate data analysis. Spectrochimica Acta Part A: Molecular and Biomolecular Spectroscopy, 316, 124384. https://pubmed.ncbi.nlm.nih.gov/38701576/
6. Mannino, G., Occhipinti, A., & Maffei, M. E. (2016). Quantitative determination of 3-O-acetyl-11-keto-β-boswellic acid (AKBA) and other boswellic acids in Boswellia sacra and Boswellia serrata. Molecules, 21(10), 1329. https://pubmed.ncbi.nlm.nih.gov/27782055/
7. Meins, J., Artaria, C., Riva, A., Morazzoni, P., Schubert-Zsilavecz, M., & Abdel-Tawab, M. (2016). Survey on the quality of the top-selling European and American botanical dietary supplements containing boswellic acids. Planta Medica, 82(6), 573–579. https://pubmed.ncbi.nlm.nih.gov/27054914/
8. Mimica, B., Bučević Popović, V., Banjari, I., Jeličić Kadić, A., & Puljak, L. (2022). Methods used for enhancing the bioavailability of oral curcumin in randomized controlled trials: A meta-research study. Pharmaceuticals, 15(8), 939. https://pubmed.ncbi.nlm.nih.gov/36015087/ 
9. Mirzaei, H., Shakeri, A., Rashidi, B., Jalili, A., Banikazemi, Z., & Sahebkar, A. (2017). Phytosomal curcumin: A review of pharmacokinetic, experimental and clinical studies. Biomedicine & Pharmacotherapy, 85, 102–112. https://pubmed.ncbi.nlm.nih.gov/27930973/
10. Ribnicky, D. M., et al. (2008). Evaluation of botanicals for improving human health. The American Journal of Clinical Nutrition, 87(2), 472S–475S. https://pubmed.ncbi.nlm.nih.gov/18258640/
11. Sarma, N., Upton, R., Rose, U., Guo, D.-A., Marles, R., Khan, I., & Giancaspro, G. (2021). Pharmacopeial standards for the quality control of botanical dietary supplements in the United States. Journal of Dietary Supplements, 20(3), 485–504. https://pubmed.ncbi.nlm.nih.gov/34699287/
12. van Breemen, R. B., Fong, H. H. S., & Farnsworth, N. R. (2008). Ensuring the safety of botanical dietary supplements. The American Journal of Clinical Nutrition, 87(2), 509S–513S. https://pubmed.ncbi.nlm.nih.gov/18258648/
13. You, H., Gershon, H., Goren, F., Xue, F., Kantowski, T., & Monheit, L. (2022). Analytical strategies to determine the labelling accuracy and economically-motivated adulteration of “natural” dietary supplements in the marketplace: Turmeric case study. Food Chemistry, 370, 131007. https://pubmed.ncbi.nlm.nih.gov/34507212/

What if metabolism and immune function aren’t separate systems, but part of one continuous conversation?

In this episode of the Root Cause Medicine Podcast, Dr. Jeffrey Bland joins Kate Kresge to explore immunometabolism, the study of how immune activity and cellular metabolism influence one another. They discuss how inflammation can affect energy use across tissues, why metabolic health is about far more than weight, and how systems biology is changing the way clinicians think about chronic disease. (O'Neill 2016)

Dr. Bland also introduces emerging inflammatory indices—including the Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI)—that can be derived from components of a routine CBC with differential. (Islam 2024) The conversation explores their potential role as contextual markers of inflammatory activity, while emphasizing how Journeys can help to automate CBC calculations and help create customized reports for practitioners using blood labs values, history, symptoms and more. 

The episode closes with a practical look at nutrition, polyphenol-rich foods, lifestyle medicine, large-scale health data, and the growing potential for personalized care.

• Immunometabolism connects immune signaling with cellular energy use. Immune cells alter their metabolic activity when activated, and immune-derived signals can influence the function of tissues throughout the body. (O'Neill 2016)
• Chronic inflammation is a systems-level process. Rather than viewing inflammation as an isolated problem within one organ, immunometabolism highlights communication among adipose tissue, the liver, brain, muscles, immune cells, and other tissues. (Burak 2024) (Juárez-Rojas 2024)
• A CBC may contain more information than clinicians traditionally use. SII and SIRI combine routinely measured blood-cell populations into indices being studied as markers of systemic inflammatory and immune activity. (Islam 2024) They should be interpreted in clinical context rather than used independently to diagnose disease or dictate treatment. (Mangoni 2024)
• Lifestyle interventions affect multiple biological systems at once. Dr. Bland discusses dietary patterns rich in diverse plant compounds alongside movement, sleep, and stress management as components of a broader approach to metabolic and immune health. (Koelman 2022)
• Practitioners can order Dr. Jeff Bland’s Immunometabolic Journey on Fullscript.com

Dr. Jeffrey Bland is a longtime leader in functional and systems-based approaches to health and one of the influential voices behind the development of functional medicine. His work focuses on translating complex biology—including immunology, metabolism, nutrition, genetics, and systems medicine—into clinically meaningful ways of thinking about health. In this conversation, he brings that systems perspective to immunometabolism and explores how clinicians may begin connecting familiar laboratory data with a deeper understanding of immune and metabolic function.

Immunometabolism examines the two-way relationship between immune function and metabolism. Immune cells require energy to perform their functions, and changes in their metabolic state can influence inflammatory signaling and communication with other tissues. (O'Neill 2016)

SII and SIRI are calculated indices derived from blood-cell counts commonly included in a CBC with differential. They have been studied across several clinical populations as markers associated with systemic inflammatory and immune activity, but they are nonspecific and should be interpreted alongside the broader clinical picture. (Islam 2024)

No single index can establish the cause or clinical significance of inflammation on its own. These measures may provide additional context, but symptoms, medical history, other laboratory findings, medications, acute illness, and underlying conditions can all influence blood-cell counts. (Mangoni 2024)

Immune activation changes cellular energy demands. Because mitochondria and other metabolic pathways help determine how cells generate and use energy, cellular metabolism is closely connected with immune-cell behavior. (O'Neill 2016)

Ordering a CBC and other biomarkers included in the Immuno-Metabolic Journey from Dr. Jeff Bland allows for automatic calculation of SIRI and SII, as well as recommending next steps for clinicians depending on findings. 

02:22 — What immunometabolism means

Why immune function and metabolism can no longer be viewed as separate biological systems.

06:15 — From “angry fat” to systems biology

How communication between immune cells and adipose tissue helped shape modern thinking about immunometabolism.

09:31 — Immunometabolism and root-cause thinking

Looking upstream from organ dysfunction toward the processes that may be influencing it.

17:23 — Metabolism is more than weight

Cellular energy production, mitochondria, inflammation, and why metabolic function affects the entire body.

22:01 — What a routine CBC may reveal

Moving beyond gross abnormalities to explore patterns within the CBC with differential.

23:20 — Introducing SII and SIRI

How researchers combine neutrophils, lymphocytes, platelets, and monocytes into inflammatory indices.

34:06 — Translating biomarkers into whole-person care

Nutrition, polyphenols, movement, sleep, and stress management enter the conversation.

39:27 — Why food complexity matters

Dr. Bland uses buckwheat to illustrate the diversity of plant polyphenols.

46:38 — Big data and personalized medicine

How large health datasets may help researchers identify more individualized biological patterns.

54:43 — Owning your health

Dr. Bland closes with a message about agency, personalization, and creating healthier patterns over time.

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 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.

1. Burak, M. F., Stanley, T. L., Lawson, E. A., Campbell, S. L., Lynch, L., Hasty, A. H., Domingos, A. I., Dixit, V. D., Hotamışlıgil, G. S., Sheedy, F. J., Dixon, A. E., Brinkley, T. E., Hill, J. A., Donath, M. Y., & Grinspoon, S. K. (2024). Adiposity, immunity, and inflammation: Interrelationships in health and disease—A report from the 24th Annual Harvard Nutrition Obesity Symposium, June 2023. The American Journal of Clinical Nutrition, 120(1), 257–268. https://www.sciencedirect.com/science/article/abs/pii/S0002916524004556
2. Islam, M. M., Osoydan Satici, M., & Eroglu, S. E. (2024). Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review. Turkish Journal of Emergency Medicine, 24(1), 8–19. https://pubmed.ncbi.nlm.nih.gov/38343523/
3. Juárez-Rojas, J. G., Reyes-Barrera, J., & Medina-Urrutia, A. X. (2024). Adipose tissue immunometabolism: Unveiling the intersection of metabolic and immune regulation. Revista de Investigación Clínica, 76(2), 65–79. https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0034-83762024000200001
4. Koelman, L., Egea Rodrigues, C., & Aleksandrova, K. (2022). Effects of dietary patterns on biomarkers of inflammation and immune responses: A systematic review and meta-analysis of randomized controlled trials. Advances in Nutrition, 13(1), 101–115. https://pmc.ncbi.nlm.nih.gov/articles/PMC8803482/
5. Mangoni, A. A., & Zinellu, A. (2024). The diagnostic role of the systemic inflammation index in patients with immunological diseases: A systematic review and meta-analysis. Clinical and Experimental Medicine, 24(1), Article 27. https://link.springer.com/article/10.1007/s10238-024-01294-3
6. O'Neill, L. A. J., Kishton, R. J., & Rathmell, J. (2016). A guide to immunometabolism for immunologists. Nature Reviews Immunology, 16(9), 553–565. https://pubmed.ncbi.nlm.nih.gov/27396447/
7. Zeevi, D., Korem, T., Zmora, N., Israeli, D., Rothschild, D., Weinberger, A., Ben-Yacov, O., Lador, D., Avnit-Sagi, T., Lotan-Pompan, M., Suez, J., Mahdi, J. A., Matot, E., Malka, G., Kosower, N., Rein, M., Zilberman-Schapira, G., Dohnalová, L., Pevsner-Fischer, M., … Segal, E. (2015). Personalized nutrition by prediction of glycemic responses. Cell, 163(5), 1079–1094. https://www.cell.com/cell/fulltext/S0092-8674(15)01481-6

What happens when a patient with multiple autoimmune conditions has already addressed the obvious contributors—but continues to experience flares?

In this Root Cause Medicine Podcast case study, Dr. Kate Kreske sits down with clinical nutritionist and IFM-certified practitioner Robyn Puglia to explore a complex case involving polyautoimmunity and persistent immune dysregulation. The patient had already worked with multiple practitioners and undergone extensive evaluation, including assessments related to gut health, food reactivity, mold, and stress. Yet something was still being missed.

Robyn explains how additional testing shifted her attention away from the gut and toward an unexpected area: the respiratory tract. She walks through how those findings changed her clinical thinking, why complex cases sometimes require practitioners to reconsider their assumptions, and what happened when the care plan was adjusted based on this new information.

The conversation offers an important reminder for practitioners: deeper testing can sometimes provide useful clues, but results need to be interpreted within the broader clinical picture rather than treated as a diagnosis on their own.

• How Robyn approaches highly complex patients who have already addressed many common contributors
• Why gut health should not automatically be assumed to be the primary driver of every autoimmune presentation
• How testing identified a respiratory microbial pattern that had not been clinically obvious
• Why laboratory findings are most useful when interpreted alongside symptoms, history, prior testing, and the overall clinical picture
• How unexpected findings can change clinical decision-making in complex cases
• Why an individual case can illustrate clinical reasoning without establishing that the same testing or intervention will produce similar outcomes in other patients

When the obvious answers have already been explored

Robyn describes her practice as serving patients at the “zebra” or even “unicorn” stage—people who have often seen multiple experienced practitioners and already addressed common areas such as nutrition, metabolic health, circadian rhythms, stress, and gut health.

Looking beyond the gut in autoimmunity

The featured patient had four autoimmune conditions and continued experiencing immune dysregulation and flares despite significant previous investigation and improvement. Rather than assuming the gastrointestinal tract remained the primary contributor, Robyn expanded the investigation.

An unexpected respiratory finding

Testing suggested a respiratory tract microbial pattern despite the absence of obvious respiratory symptoms. This finding shifted Robyn's clinical hypothesis and became an important part of how she approached the case.

When a complex patient has already addressed the most plausible contributors but continues to experience symptoms, repeating the same investigation may not provide the missing answer. Consider stepping back and asking whether another system, exposure, infection, or contributor deserves evaluation.

At the same time, avoid allowing a single specialized test result to become the new explanation for the entire case. Use testing to inform clinical reasoning alongside the patient's history, symptoms, conventional evaluation, and other relevant findings.

Want to elevate your practice? This episode is sponsored by 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 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.

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

What if some of the immune activity we’re looking for isn’t showing up where we expect to find it?

In this episode, I sit down with Robyn Puglia of Cyrex Laboratories to explore TG6, lymphocyte patterns, and early autoimmunity—and specialized testing many practitioners may not realize is available through Cyrex Wheat Burden panel, the Lymphocyte Map, and Array 5.

We look at neurological manifestations of gluten-related disease, what different immune cell populations may add to the clinical picture, and how autoantibodies can sometimes appear before autoimmune disease is diagnosed.

The bigger question: Can seeing more of the immune story help us ask better questions about what may be driving a complex presentation?

• Why gluten reactivity isn’t always a gut story. TG6 has been studied in gluten-related neurological disorders, particularly gluten ataxia. (Hadjivassiliou 2019) We discuss why neurological symptoms may belong in the gluten conversation and what Cyrex Wheat Burden Panel is designed to investigate beyond conventional celiac markers. (Mearns 2019)
• What your lymphocyte count may not tell you. T cells, B cells, natural killer cells, and their subsets have different jobs. Robyn explains how the Cyrex Lymphocyte Map looks at these populations and how patterns may help practitioners decide what to investigate next.
• Why autoimmunity may start before the diagnosis. Disease-associated autoantibodies can precede clinical disease in several autoimmune conditions. (Ma 2017) We explore Cyrex Array 5, tissue-associated autoantibodies, and what these earlier immune signals may—and may not—tell us. (Frazzei 2022)

Robyn Puglia’s work with celiac disease, neurological symptoms, autoimmunity, and complex chronic illness pushed her to ask what the immune system might be telling us beyond a routine workup. Today, as Vice President of Practitioner Education at Cyrex Laboratories, she teaches practitioners how to think about specialized immune testing without treating an abnormal biomarker as a diagnosis.

Most practitioners know tissue transglutaminase 2 (TG2) from celiac testing. Tissue transglutaminase 6 (TG6) has been studied in gluten-related neurological disorders, particularly gluten ataxia. (Hadjivassiliou 2019)

TG6 isn’t part of routine guideline-supported celiac screening, but it highlights an important point: gluten-related immune disease can have extraintestinal manifestations, including neurological symptoms. (Mearns 2019) (Rubio-Tapia 2023)

The Wheat Burden panel evaluates antibody reactivity to multiple wheat-associated antigens and transglutaminases, including TG6.

It provides a broader look at wheat-associated immune reactivity than conventional celiac serology. It shouldn’t replace established evaluation for celiac disease or wheat allergy; the value of additional biomarkers depends on the clinical question and the evidence supporting their intended use. (Rubio-Tapia 2023) (Leonard 2017)

The Cyrex Lymphocyte Map examines populations and subsets of T cells, B cells, and natural killer cells.

Instead of asking whether one value is simply high or low, Robyn looks at the pattern and asks what might explain it. Infection? Medication effects? Immune dysfunction? Another clinical process?

The pattern isn’t the diagnosis. It helps sharpen the investigation.

Yes. In several autoimmune diseases, researchers have detected disease-associated autoantibodies before patients meet formal diagnostic criteria—sometimes years earlier. (Ma 2017)

Cyrex Array 5 evaluates multiple tissue-associated autoantibodies that Robyn discusses in this context. But an autoantibody isn’t a crystal ball. Its significance depends on the specific marker, the patient, and the evidence supporting its clinical use. (Ma 2017)

Yes. Cyrex offers the specialized tests discussed in this episode, including Wheat Burden Panel, the Lymphocyte Map, and Array 5, along with additional testing related to mucosal immunity and barrier function.

The important question isn’t, “How much can I test?”

It’s “What am I trying to understand, and will this result change what I do next?”

02:42 — The patients who pulled Robyn deeper into immunology

How celiac disease and unexplained illness changed her approach to complex patients.

11:41 — TG6: When gluten becomes a brain conversation

Why gluten-related immune activity isn’t necessarily confined to the gut.

13:49 — Are we asking enough questions about wheat?

The thinking behind Cyrex Wheat Burden Panel and its broader look at wheat-associated antigens and transglutaminases.

28:29 — What if autoimmunity starts before the diagnosis?

Tissue-associated autoantibodies, Array 5, and preclinical autoimmunity.

33:49 — Your lymphocyte count isn’t the whole story

T cells, B cells, natural killer cells, and the Cyrex Lymphocyte Map.

39:25 — The abnormal result is where the investigation starts

How immune patterns can generate better clinical questions.

44:20 — Stop looking for one perfect root cause

Robyn’s “aggregate gains” approach to complex illness.

50:49 — What else can we see in the immune system?

Tissue autoantibodies, mucosal immunity, and barrier biomarkers.

57:42 — When neurological symptoms change the workup

Why brain symptoms may require a broader metabolic, vascular, and immune picture.

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 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.

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

1. Frazzei, G., van Vollenhoven, R. F., de Jong, B. A., Siegelaar, S. E., & van Schaardenburg, D. (2022). Preclinical autoimmune disease: A comparison of rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis and type 1 diabetes. Frontiers in Immunology, 13, 899372. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9281565/
2. Hadjivassiliou, M., Croall, I. D., Zis, P., Sarrigiannis, P. G., Sanders, D. S., Aeschlimann, P., Grünewald, R. A., Armitage, P. A., Connolly, D., Aeschlimann, D., & Hoggard, N. (2019). Neurologic deficits in patients with newly diagnosed celiac disease are frequent and linked with autoimmunity to transglutaminase 6. Clinical Gastroenterology and Hepatology, 17(13), 2678–2686. https://www.cghjournal.org/article/S1542-3565(19)30278-2/fulltext
3. Leonard, M. M., Sapone, A., Catassi, C., & Fasano, A. (2017). Celiac disease and nonceliac gluten sensitivity: A review. JAMA, 318(7), 647–656. https://jamanetwork.com/journals/jama/article-abstract/2648637
4. Ma, W. T., Chang, C., Gershwin, M. E., & Lian, Z. X. (2017). Development of autoantibodies precedes clinical manifestations of autoimmune diseases: A comprehensive review. Journal of Autoimmunity, 83, 95–112. https://www.sciencedirect.com/science/article/abs/pii/S0896841117303542
5. Mearns, E. S., Taylor, A., Thomas Craig, K. J., Puglielli, S., Cichewicz, A. B., Leffler, D. A., Sanders, D. S., Lebwohl, B., & Hadjivassiliou, M. (2019). Neurological manifestations of neuropathy and ataxia in celiac disease: A systematic review. Nutrients, 11(2), 380. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412791/
6. Rubio-Tapia, A., Hill, I. D., Semrad, C., Kelly, C. P., Greer, K. B., Limketkai, B. N., & Lebwohl, B. (2023). American College of Gastroenterology guidelines update: Diagnosis and management of celiac disease. The American Journal of Gastroenterology, 118(1), 59–76. https://pubmed.ncbi.nlm.nih.gov/36602836/

What does it take to help young athletes perform at their best—not just today, but for decades to come?

In this episode of Root Cause Medicine, Dr. Kate Kresge sits down with emergency medicine physician and functional medicine practitioner Dr. Erik Peterson to discuss a whole-person approach to adolescent athletic performance. Drawing from more than 20 years in emergency medicine, his background as a collegiate athlete, and his work caring for young competitors, Dr. Peterson explains why optimizing performance starts with supporting the developing body rather than simply pushing it harder.

The conversation explores how nutrition, sleep, recovery, body composition, metabolic health, and resilience influence athletic success during adolescence. Dr. Peterson also shares why he believes healthcare providers, coaches, and parents have an opportunity to improve long-term health by focusing on foundational physiology during these critical developmental years. Beyond sports performance, this episode is also a conversation about the evolution of medicine—from treating illness in the emergency department to helping people stay healthy through proactive, root-cause care.

Listen If You...

• Treat adolescent athletes in your practice
• Coach youth sports
• Parent a competitive athlete
• Work in sports medicine, functional medicine, pediatrics, or primary care
• Want to better understand the foundations of long-term athletic performance

What You'll Learn

• How Dr. Peterson gets his athletes results using only food, supplements and lifestyle
• Common mistakes young athletes make when trying to optimize performance
• Why body composition and metabolic health matter more than weight alone
• The important role parents and coaches play in creating healthy performance habits
• Dr. Peterson's journey from emergency medicine physician to functional medicine practitioner

Who Is Dr. Erik Peterson?

Dr. Erik Peterson is a board-certified emergency medicine physician who has practiced emergency medicine for more than two decades while also leading a precision medicine practice focused on performance optimization, men's health, women's health, and preventive care. A former collegiate athlete, he combines his experience in acute care with evidence-informed lifestyle medicine to help athletes and active individuals optimize health, resilience, and long-term performance. Learn more about his program at https://firstcallperformance.com/ 

Key Takeaways

• Performance is Built Outside the Gym: Training is only one part of athletic success. Nutrition, sleep, recovery, stress management, and overall metabolic health create the foundation that allows athletes to adapt and perform. (Mountjoy 2023) (Cunha 2023)
• Adolescence Is a Critical Opportunity: The teenage years represent an important period for developing healthy habits that influence performance, injury risk, and long-term health. (Blyth 2025) 
• Parents and Coaches Matter: The adults surrounding young athletes often shape their relationship with food, training, recovery, and health. Creating supportive environments can have lasting effects beyond sports. (Baceviciene 2023)
• Functional Medicine Complements Performance Care: Looking upstream at nutrition, biomarkers, lifestyle, and physiology may help identify opportunities to support athletic performance while promoting long-term wellness. (Haller 2023) 

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 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. Baceviciene, M., Jankauskiene, R., & Rutkauskaite, R. (2023). The comparison of disordered eating, body image, sociocultural and coach-related pressures in athletes across age groups and groups of different weight sensitivity in sports. Nutrients, 15(12), 2724. https://www.mdpi.com/2072-6643/15/12/2724
2. Blyth, F., Haycraft, E., Peral-Suarez, A., & Pearson, N. (2025). Tracking and changes in the clustering of physical activity, sedentary behavior, diet, and sleep across childhood and adolescence: A systematic review. Obesity Reviews, 26(6), e13909. https://onlinelibrary.wiley.com/doi/10.1111/obr.13909
3. Cunha, L. A., Costa, J. A., Marques, E. A., Brito, J., Lastella, M., & Figueiredo, P. (2023). The impact of sleep interventions on athletic performance: A systematic review. Sports Medicine – Open, 9(1), 58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10354314/
4. Haller, N., Behringer, M., Reichel, T., Wahl, P., Simon, P., Krüger, K., Zimmer, P., & Stöggl, T. (2023). Blood-based biomarkers for managing workload in athletes: Considerations and recommendations for evidence-based use of established biomarkers. Sports Medicine, 53(7), 1315–1333. https://pubmed.ncbi.nlm.nih.gov/37204619/
5. Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., Sundgot-Borgen, J. K., Torstveit, M. K., Jacobsen, A. U., Verhagen, E., Budgett, R., Engebretsen, L., & Erdener, U. (2023). 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine, 57(17), 1073–1097. https://pubmed.ncbi.nlm.nih.gov/37752011/

How to Build a Thriving Practice Without Burning Out

One of my favorite parts of hosting the Root Cause Medicine Podcast is introducing you to practitioners who are making a real difference—not only in the lives of their patients, but in the lives of other clinicians.

Today's guest is Lesli Bitel, a registered dietitian whose career has taken a path that many practitioners may recognize pieces of. She began in clinical practice, spent years in leadership roles across the pharmaceutical and diagnostics industries, and eventually found her way back to patient care with an entirely new perspective. Today, she helps practitioners build businesses that allow them to do their best work without burning themselves out along the way.

Because the reality is, most of us were trained to care for patients. Very few of us were taught how to build a practice that can sustainably support both our patients and ourselves.

In this conversation, Lesli shares how her experience in business transformed the way she thought about practice ownership. We talk about why marketing doesn't have to feel uncomfortable, how thoughtful systems can create more time for patient care, and why building a successful practice isn't about doing more—it's about building one that's aligned with your values.

Whether you're just starting your practice or looking for a more sustainable way to grow, I think you'll come away from this conversation with practical ideas—and maybe a little reassurance—that it's possible to build a thriving practice without losing sight of why you became a clinician in the first place.

In This Conversation

• Lesli's journey from aspiring clinician to healthcare executive and back to patient care
• What years in corporate healthcare taught her about running a successful practice
• Why so many practitioners feel confident clinically but overwhelmed by the business side of medicine
• How marketing can become an authentic extension of patient education
• Simple systems that create more time, less stress, and better patient experiences
• The connection between practice design, boundaries, and practitioner well-being
• Building a practice that reflects your strengths, values, and vision for your career

A Few Takeaways I'll Be Thinking About

• Authentic marketing starts with clarity, not self-promotion.
• Good systems free you to spend more time doing what only you can do.
• Sustainable growth should support your life, not just your business.

Who Should Listen?

This episode is for any clinician who has ever wondered:

• How do I build a practice that actually feels sustainable?
• How can I grow without sacrificing patient care?
• Is there a way to market my practice that still feels authentic?
• What does long-term success really look like?

Whether you're starting your first practice or reimagining an established one, I think you'll find something valuable in Lesli's story.

Episode Timeline

00:00 — Welcome and introduction

02:30 — Lesli's journey into healthcare

05:00 — Lessons from corporate healthcare

10:00 — Why clinicians struggle with practice ownership

18:00 — Rethinking marketing

28:00 — Systems that support sustainable growth

39:00 — Burnout, boundaries, and practice design

48:00 — Building a practice around your values

55:00 — Final reflections

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 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.

Dr. Holly Lucille is joined by Ellie Abraham, PhD, to explain why two ashwagandha supplements may not be the same, even when they list the same ingredient. (Thalhamer 2024) This conversation covers differences between root and leaf extracts, withanolide standardization, botanical identity testing, certificates of analysis, and manufacturing quality. It also emphasizes that a well-made product may still not be appropriate for every patient. (NCCIH 2025)

Clinical Takeaways

• Plant part matters. Ashwagandha root, leaf, and combined extracts may have different chemical profiles and should not automatically be treated as interchangeable. (Chaurasiya 2008)
• Higher is not always better. The most concentrated product is not necessarily the safest or most effective. Clinical relevance depends on the extract, dose, intended use, and supporting research. (Thalhamer 2024) (NCCIH 2025)
• Quality testing matters. Botanical authentication, contaminant testing, certificates of analysis, and cGMP compliance can help confirm that a product meets its specifications. (ECFR 2026)
• Quality does not equal clinical fit. Patient history, medications, allergies, diagnoses, and potential interactions must still be considered. (NCCIH 2025)

Guest: Ellie Abraham has a PhD in plant biology and a background in analytical chemistry, ethnobotany, botanical testing, and dietary supplement quality control. She explains how manufacturers and laboratories verify botanical identity, plant part, standardization, contaminants, and product documentation.

Clinician FAQ

1. Are all ashwagandha supplements the same? No. Products may differ in plant part, extraction method, dose, standardization, chemical profile, and manufacturing quality. (Thalhamer 2024)

2. Why does ashwagandha root versus leaf matter? The root and leaf  of ashwagandha contain different combinations of plant compounds. These differences may affect the product’s clinical properties, supporting research, and safety profile. (Chaurasiya 2008)

3. What does “standardized to 5% withanolides” mean? It means withanolides account for approximately 5% of the tested material. It does not identify each individual withanolide or describe the rest of the extract. (Thalhamer 2024)

4. Is a higher withanolide percentage better? Not necessarily. A higher percentage does not automatically mean that a product is safer or more effective. The appropriate concentration depends on the extract, dose, intended use, and supporting research. (Thalhamer 2024)

5. Can ashwagandha cause liver injury? Rare cases of liver injury associated with ashwagandha products have been reported. The exact cause and individual risk factors remain uncertain, but practitioners should consider supplement use when evaluating unexplained liver symptoms or abnormal liver tests. (NCBI 2012) (Philips 2023) (Björnsson 2020)

Timestamps / Key Moments

00:01:43 Ellie Abraham’s background in botanical testing

00:02:36 The ashwagandha leaf discussion in India

00:04:00 Differences between root and leaf

00:05:44 How botanical identity is verified

00:07:25 Why standardization matters

00:09:07 Why higher withanolides are not always better

00:10:56 Comparing two ashwagandha products

00:12:17 Red flags on supplement labels

00:14:42 When to request a certificate of analysis

00:16:27 Why cGMP compliance matters

Botanicals and Compounds Discussed

• Ashwagandha root and leaf
• Withanolides
• Glycosides
• Withanone
• Curcumin and curcuminoids

Quality Methods and Documents Discussed

• Botanical identity testing
• Plant-part verification
• HPTLC chemical fingerprinting
• Standardization testing
• Adulterant screening
• Microbial and heavy-metal testing
• Certificates of analysis
• Third-party testing
• cGMP compliance
• Batch-to-batch consistency
• Branded ingredient research

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 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 host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for educational purposes only and is not medical advice. Dietary supplements may cause side effects or interact with medications. Patients should consult a qualified healthcare professional before changing their healthcare routine.

References

1. Björnsson, H. K., Björnsson, E. S., Avula, B., Khan, I. A., Jonasson, J. G., Ghabril, M., Hayashi, P. H., & Navarro, V. (2020). Liver injury due to ashwagandha: A case series from Iceland and the U.S. Drug-Induced Liver Injury Network. Liver International, 40(4), 825–829. https://pubmed.ncbi.nlm.nih.gov/31991029/
2. Chaurasiya, N. D., Uniyal, G. C., Lal, P., Misra, L., Sangwan, N. S., Tuli, R., & Sangwan, R. S. (2008). Analysis of withanolides in root and leaf of Withania somnifera by HPLC with photodiode array and evaporative light scattering detection. Phytochemical Analysis, 19(2), 148–154. https://pubmed.ncbi.nlm.nih.gov/17879227/
3. ECFR. (2026). Current good manufacturing practice in manufacturing, packaging, labeling, or holding operations for dietary supplements (21 C.F.R. Part 111). https://www.ecfr.gov/current/title-21/chapter-I/subchapter-B/part-111
4. National Center for Complementary and Integrative Health (NCCIH). (2025). Ashwagandha. National Institutes of Health, U.S. Department of Health and Human Services. https://www.nccih.nih.gov/health/ashwagandha
5. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2024). Ashwagandha. In LiverTox: Clinical and research information on drug-induced liver injury. https://www.ncbi.nlm.nih.gov/books/NBK548536/
6. NCBI. (2012). Ashwagandha [Review of Ashwagandha]. PubMed; National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/NBK548536/
7. Philips, C. A., Valsan, A., Theruvath, A. H., Ravindran, R., Oommen, T. T., Rajesh, S., Bishnu, S., & Augustine, P. (2023). Ashwagandha-induced liver injury: A case series from India and literature review. Hepatology Communications, 7(10), e0270. https://pubmed.ncbi.nlm.nih.gov/37756041/
8. Thalhamer, B., Himmelsbach, M., Schatzmann, B., Klampfl, C., & Buchberger, W. (2024). A feasible procedure to detect widespread wrong labeling of ashwagandha root extracts in dietary supplements. Exploration of Foods and Foodomics, 2, 460–470. https://www.explorationpub.com/Journals/eff/Article/101046