The Root Cause Medicine Podcast

New research is raising important clinical questions about the long-term effects of GLP-1 receptor agonist therapy during significant weight loss. A recent five-year observational study reported associations between GLP-1 use and higher rates of osteoporosis, osteomalacia, and gout in some adults with obesity and type 2 diabetes, particularly in the setting of rapid weight reduction (Wajahath et al., 2026). While GLP-1 therapies may support glycemic control, cardiometabolic health, and surgical outcomes, these findings highlight the importance of proactive monitoring and individualized patient support.

In this episode, we explore practical clinical considerations, including:

• How clinicians may approach bone health monitoring more proactively during significant weight loss
• Which patients may warrant closer nutritional or musculoskeletal assessment
• Symptoms that may merit further evaluation during GLP-1 therapy, including fatigue, weakness, diffuse bone pain, or mobility-related concerns

We also discuss another emerging area of research: the role of exercise in mental health care. Drawing from a large umbrella review involving nearly 80,000 participants, we examine how aerobic exercise, walking, resistance training, and group-based movement may support depression and anxiety outcomes when implemented consistently and tailored to patient capacity (Munro et al., 2026).

This conversation focuses on practical, evidence-informed strategies clinicians can integrate into care plans immediately - from resistance training and hydration strategies to helping patients build sustainable movement habits during periods of stress, fatigue, or overwhelm.

Clinical Takeaways From This Episode

• Rapid weight loss may increase the need for nutritional and musculoskeletal support: Emerging observational evidence suggests GLP-1 therapy during significant weight loss may be associated with higher rates of bone- and uric acid-related complications in some patients, highlighting the importance of muscle preservation, hydration, and nutritional status monitoring (Wajahath et al., 2026).
• Some musculoskeletal symptoms may warrant additional evaluation: Fatigue, weakness, diffuse bone discomfort, and mobility changes may justify further clinical assessment in patients experiencing rapid weight loss or reduced nutritional intake (Wajahath et al., 2026).
• Exercise may support both mental and metabolic health: Research suggests moderate-intensity aerobic exercise, resistance training, walking, and group movement may support mood, resilience, and long-term metabolic health outcomes when patients can engage consistently over time (Munro et al., 2026).

FAQ

Do GLP-1 medications affect bone health?

• Some emerging observational evidence suggests GLP-1 receptor agonist therapy may be associated with increased rates of osteoporosis and osteomalacia during rapid weight loss in certain populations. Additional research is still needed to better understand causality, mechanisms, and which patients may be at greatest risk (Wajahath et al., 2026).

What labs may help clinicians monitor patients on GLP-1 therapy?

• This episode discusses clinical considerations that may include alkaline phosphatase, vitamin D, calcium, phosphate, parathyroid hormone (PTH), and other markers of bone or metabolic health when clinically appropriate and individualized to the patient context (Wajahath et al., 2026).

Can exercise support anxiety and depression symptoms?

• Research suggests aerobic exercise, walking, resistance training, and mind-body movement practices may support improvements in mood and anxiety symptoms when practiced consistently over time as part of a comprehensive care plan (Munro et al., 2026).

Timestamps

00:00 — Clinical questions emerging around GLP-1 therapy and rapid weight loss

03:00 — Osteomalacia symptoms that may overlap with fatigue and chronic pain presentations

10:33 — Why rapid weight loss may influence gout risk in some patients

15:29 — The large exercise and mental health review clinicians are discussing

20:50 — How to help patients build sustainable movement habits

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.

Citations

1. Wajahath M, et al. GLP-1 Receptor Agonist Use Is Associated with Increased Risk of Osteoporosis, Gout, and Osteomalacia in Adults with Type 2 Diabetes and Obesity. 2026.
2. Munro NR, Teague S, Somoray K, et al. Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-analysis. British Journal of Sports Medicine. 2026;60:590–599.

In this episode, Dr. Kate Kresge speaks with Mosaic Diagnostics CEO Scott Mattivi and Chief Medical Officer Dr. Kurt Woeller to explore how specialty laboratory testing is used in functional and integrative medicine. Mosaic Diagnostics offers tests such as organic acids, environmental exposure biomarkers, and microbiome assessments, which may help clinicians evaluate complex, multi-system presentations. These tools are typically used as part of a systems-based clinical framework, supporting pattern recognition rather than serving as standalone diagnostic tests. The discussion also explores how clinicians interpret multi-system lab data, the role of practitioner education, and how emerging technologies—such as AI-assisted tools—may support clinical efficiency and decision-making.

Mosaic Diagnostics provides specialty lab testing commonly used in integrative and functional medicine, including:

• Organic acids testing (OAT)
• Environmental toxin and mycotoxin testing
• Microbiome and gastrointestinal assessments
• Metabolic and immune-related biomarkers

These tests are designed to provide insight into biochemical pathways, microbial activity, and environmental exposures. Results are generally interpreted alongside clinical history, symptoms, and conventional labs to support individualized care.

Organic acids testing evaluates urinary metabolites involved in intermediary metabolism. It may provide insight into:

• Mitochondrial function
• Nutrient metabolism (e.g., B vitamins, amino acids)
• Oxidative stress patterns
• Microbial activity

When interpreted within clinical context, OAT may support identification of metabolic patterns and inform clinical hypotheses (Gallagher, 2018).

Environmental exposure testing evaluates biomarkers associated with compounds such as:

• Mycotoxins
• Heavy metals (in some panels)
• Industrial chemicals

These tests may help characterize exposure patterns, though interpretation can be complex due to variability in exposure timing, metabolism, and elimination. Clinical relevance should be assessed cautiously and within the broader evidence base (Warth, 2013; Owolabi, 2024).

• Organic acids testing may offer a systems-level view of metabolism and support pattern recognition when interpreted in context (Gallagher, 2018).
• Environmental testing may help identify exposure patterns, though clinical actionability varies (Warth, 2013; Owolabi, 2024).
• Specialty lab testing is most effective when used to evaluate patterns across systems, rather than isolated biomarkers.
• Practitioner education plays a key role in appropriate interpretation and application of these tests.
• AI tools may enhance data interpretation and workflow efficiency but should be used alongside clinical expertise.

Who Should Listen to This Episode?

This episode is designed for healthcare providers who:

• Use or are considering functional or integrative lab testing
• Work with complex, chronic, or multi-system conditions
• Want to better understand organic acids testing or mycotoxin testing
• Are interested in clinical data interpretation strategies
• Are exploring AI tools in clinical practice

FAQ: Mosaic Diagnostics and Specialty Lab Testing

Mosaic Diagnostics is known for specialty laboratory testing used in functional and integrative medicine, including organic acids testing, environmental exposure assessments, and microbiome analysis.

Timestamps

00:00 – Introduction to Mosaic Diagnostics

03:22 – Origins of organic acids testing

08:26 – Expansion into environmental and microbiome testing

23:41 – Environmental exposures and clinical applications

31:57 – Overview of testing portfolio

42:09 – Organic acids testing in practice

47:41 – Innovation and AI in clinical workflows

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 health care provider before making any changes to your health care routine.

1. Gallagher RC, Pollard L, Scott AI, Huguenin S, Goodman S, Sun Q; ACMG Biochemical Genetics Subcommittee of the Laboratory Quality Assurance Committee. Laboratory analysis of organic acids, 2018 update: a technical standard of the American College of Medical Genetics and Genomics (ACMG). Genet Med. 2018 Jul;20(7):683-691. doi: 10.1038/gim.2018.45. Epub 2018 Mar 15. PMID: 29543224.
2. Warth B, Sulyok M, Krska R. LC-MS/MS-based multibiomarker approaches for the assessment of human exposure to mycotoxins. Anal Bioanal Chem. 2013 Jul;405(17):5687-95. doi: 10.1007/s00216-013-7011-1. Epub 2013 Jun 18. PMID: 23774829; PMCID: PMC3695324.
3. Owolabi, Iyiola & Siwarak, Kawisara & Greer, Brett & Rajkovic, Andreja & Dall’asta, Chiara & Karoonuthaisiri, Nitsara & Uawisetwathana, Umaporn & Elliott, Christopher & Petchkongkaew, Awanwee. (2023). Applications of Mycotoxin Biomarkers in Human Biomonitoring for Exposome-Health Studies: Past, Present, and Future. Exposure and Health. 16. 1-23. 10.1007/s12403-023-00595-4.
4. Muñoz JP, Bleak TC, Calaf GM. Glyphosate and the key characteristics of an endocrine disruptor: A review. Chemosphere. 2021 May;270:128619. doi: 10.1016/j.chemosphere.2020.128619. Epub 2020 Oct 19. PMID: 33131751.

When OCD, anxiety, or food restriction appears overnight in a child, that’s a different clinical problem—and it requires a different lens.

In this episode, we sit down with Dr. Lindsey Wells to walk through how to recognize and approach PANS and PANDAS in practice. We focus on the hallmark presentation: abrupt-onset neuropsychiatric symptoms, often with a clear “before and after” that families can describe in detail. From there, the conversation shifts to what may be driving that change—whether that’s infection, immune activation, inflammation, or broader system vulnerability.

We also get practical. What does an initial workup look like? How do you think about common triggers like strep or other infections? When do you stay with foundational labs versus expanding further? And how do you support families who are often dealing with a sudden and destabilizing shift in their child’s behavior?

This episode is for clinicians who want a clearer, more grounded way to recognize PANS and PANDAS—and to start thinking through these cases without overcomplicating or overinterpreting limited evidence.

• Abrupt-Onset OCD in Children: Sudden onset OCD, food restriction, or severe anxiety should immediately shift your differential toward PANS/PANDAS
• Clinical Diagnosis Over Lab Reliance: There is no confirmatory test—history, timing, and symptom clustering drive diagnosis (AAP, 2025)
• Infection–Immune Connection: PANDAS is associated with streptococcal infection, while PANS includes broader potential triggers (Swedo et al., 1998; AAP, 2025)
• Practical Lab Workup: Foundational labs (CBC, inflammatory markers, autoimmune screening, nutrients) can help inform clinical direction (Vitiello, 2026)
• Relapsing–Remitting Course: These conditions often follow a flare-based pattern, requiring longitudinal care planning (Johnson et al., 2019)

Dr. Lindsey Wells is a naturopathic physician specializing in pediatric PANS and PANDAS. Her clinical work focuses on identifying potential infectious and immune contributors to abrupt-onset neuropsychiatric symptoms while supporting long-term stabilization. She is also the author of Super Sam and the Battle Against PANS/PANDAS, a children’s book designed to help families, siblings, and educators better understand these conditions.

• What is PANS? PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is defined by the sudden onset of OCD or severe food restriction, along with at least two additional neuropsychiatric symptoms such as anxiety, regression, tics, sleep disruption, or urinary changes. It is a clinical diagnosis without a disease-specific biomarker (AAP, 2025).
• What is PANDAS? PANDAS is a subset of PANS associated with group A streptococcal infection, characterized by abrupt-onset OCD and/or tics with a relapsing-remitting course linked to infection (Swedo et al., 1998).
• What causes sudden OCD in children? In some cases, abrupt-onset OCD may be associated with post-infectious immune activation or neuroinflammatory processes, although mechanisms remain under investigation (Snider & Swedo, 2004).
• How is PANS diagnosed? PANS is diagnosed clinically based on symptom onset, pattern, and exclusion of other neurologic or psychiatric conditions. Laboratory testing supports—but does not establish—the diagnosis (AAP, 2025).
• What labs should be considered? A phased approach may include CBC, inflammatory markers (CRP, ESR), metabolic panel, and autoimmune screening, with additional testing guided by presentation (Vitiello, 2026).

00:00 – PANS/PANDAS overview

02:03 – How to explain PANS/PANDAS to families

06:33 – What is PANS? What is PANDAS? Diagnostic criteria and symptom clusters 

10:20 – Why PANS/PANDAS is often missed

14:06 – How is PANS diagnosed?

18:37 – What causes PANS/PANDAS? Infection triggers, immune response, and neuroinflammation explained

24:55 – PANS/PANDAS treatment approaches: antimicrobials, anti-inflammatories, and symptom support

27:11 – Using anti-inflammatory trials in PANS: when ibuprofen response may inform clinical direction

34:02 – Can teens or adults have PANS/PANDAS?

41:38 – Long-term management of PANS/PANDAS: preventing flares and supporting immune resilience

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 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. American Academy of Pediatrics. Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Clinical Report. Pediatrics. 2025;155(3):e2024070334.
2. Johnson M, Fernell E, Preda I, Wallin L, Fasth A, Gillberg C, Gillberg C. Paediatric acute-onset neuropsychiatric syndrome in children and adolescents: an observational cohort study. Lancet Child Adolesc Health. 2019 Mar;3(3):175-180. doi: 10.1016/S2352-4642(18)30404-8. Epub 2019 Jan 29. PMID: 30704875.
3. Sigra S, Hesselmark E, Bejerot S. Treatment of PANDAS and PANS: a systematic review. Neurosci Biobehav Rev. 2018 Mar;86:51-65. doi: 10.1016/j.neubiorev.2018.01.001. Epub 2018 Jan 6. PMID: 29309797.
4. Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998;155(2):264–271.
5. Vitiello B. Clinical Utility of Medical Investigations in Pediatric Acute-Onset Neuropsychiatric Syndrome. JAMA Netw Open. 2026;9(3):e262624. doi:10.1001/jamanetworkopen.2026.2624
6. Snider LA, Swedo SE. PANDAS: current status and directions for research. Mol Psychiatry. 2004 Oct;9(10):900-7. doi: 10.1038/sj.mp.4001542. PMID: 15241433.

There’s a category of patients every clinician recognizes immediately.

They’re exhausted.

Their hair is thinning.

They’re getting sick more often than they used to.

Their focus isn’t what it was.

And their labs?

“Normal.”

This episode is about what gets missed in that gap.

We sit down with Lara Zakaria to discuss some of the least commonly tested for (but most commonly occuring) nutrient deficiencies that can help to explain symptoms like fatigue, hair loss, impaired immune function, and reduced resilience.

We walk through how a structured nutrition panel combining familiar markers like CBC and iron studies with underutilized ones like vitamin B6, folate, zinc, and RBC magnesium can reveal patterns that standard interpretations often overlook.

Because the future isn’t more testing - it’s running the right labs and using smarter interpretation to uncover what’s been hiding in plain sight.

• Pattern recognition is the clinical upgrade: Interpreting CBC, iron studies, and nutrient markers together - rather than in isolation - helps connect symptoms to physiology and identify contributing drivers earlier.
• Iron deficiency can exist before anemia: Hemoglobin is often a late marker; early depletion may only be visible through ferritin and iron transport patterns (Dhurde, 2025).
• Intracellular status matters:  Serum values alone may miss functional deficiencies—markers like RBC magnesium offer insight into cellular availability and physiologic demand (Razzaque, 2018).
• Underutilized nutrients complete the picture: Vitamin B6 and zinc play roles in neurotransmitter pathways, immune signaling, and metabolic function—but are rarely assessed together in standard workflows.

Dr. Lara Zakaria is an integrative pharmacist, nutritionist, and professor specializing in Functional Medicine and Personalized Nutrition. In addition to clinical practice and teaching, her work focuses on translating complex science—spanning nutrition, natural products, diagnostics, and health technology—into clear, clinically relevant frameworks that support education, implementation, and informed decision-making. You can sign up for the Journeys webinar series with Dr. Zakaria here. 

• What types of symptoms should prompt nutrient testing? Fatigue, brain fog, hair loss, reduced exercise tolerance, and frequent illness are common presentations where nutrient patterns may play a role.
• Why isn’t hemoglobin enough to assess iron status? Hemoglobin changes occur later in the course of deficiency. Ferritin, transferrin saturation, and TIBC provide earlier insight into iron availability and storage (Dhurde, 2025).
• Why include markers like B6 and zinc? These nutrients are involved in neurotransmitter production, immune response, and metabolic pathways. They are often under-assessed but may contribute to overlapping symptom patterns.
• What’s the benefit of RBC magnesium vs serum magnesium? Serum magnesium reflects a small, tightly regulated portion of total body magnesium, while RBC magnesium offers a better proxy for intracellular status (Al Alawi, 2018).

• 02:36 – The new way to test for nutrient deficiencies
• 03:55 – Building a smarter, structured nutrition panel
• 10:54 – Vitamin D and why “adequate” isn’t always enough
• 17:34 – Iron deficiency and early clinical clues
• 24:43 – B vitamins and functional metabolism
• 30:53 – Zinc: the overlooked but essential nutrient
• 34:57 – Answering “Am I inflamed?” with data
• 43:31 – Fatty acids and inflammation patterns
• 48:33 – Making personalized care scalable and efficient

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. We’ll catch you next time on the Root Cause Medicine Podcast.

1. Dhurde VS, Patel AB, Locks LM, Hibberd PL. Diagnostic performance of red cell indices in detecting iron deficiency and iron deficiency anemia among rural adolescent girls aged 14-19 years in Nagpur District. PLOS Glob Public Health. 2025 Sep 29;5(9):e0005108. doi: 10.1371/journal.pgph.0005108. PMID: 41021630; PMCID: PMC12478879. 
2. Chaudhry, H. S., & Kasarla, M. R. (2026). Microcytic hypochromic anemia. StatPearls. Retrieved March 31, 2026 from https://www.ncbi.nlm.nih.gov/books/NBK470252/
3. Razzaque MS. Magnesium: Are We Consuming Enough? Nutrients. 2018 Dec 2;10(12):1863. doi: 10.3390/nu10121863. PMID: 30513803; PMCID: PMC6316205.
4. Al Alawi AM, Majoni SW, Falhammar H. Magnesium and Human Health: Perspectives and Research Directions. Int J Endocrinol. 2018 Apr 16;2018:9041694. doi: 10.1155/2018/9041694. PMID: 29849626; PMCID: PMC5926493.

Dr. Cheng Ruan is a fascinating physician on the leading edge of medicine, and in this episode we explore his story, how he thinks, and what he sees coming next in healthcare. What I loved most about this conversation is how it expands the way we think about practicing medicine - beyond protocols and productivity into something more human and sustainable. While we touch on integrative care, insurance models, and AI, the deeper thread is that physicians are being asked to evolve - not just clinically, but personally and systemically. Dr. Ruan reminds us that care isn’t just about what we prescribe, but how we listen, communicate, and design the environments we work in. It’s an invitation to step back and ask: what kind of medicine are we building, and does it truly support both our patients and ourselves?

Guest Introduction

Dr. Cheng Ruan, MD, is the founder of the Texas Center for Lifestyle Medicine, an integrative, insurance-based practice focused on chronic disease, mind-body medicine, and personalized care. He is also the co-founder of the Physician Transformation Institute, where he works with clinicians to address burnout, reconnect with purpose, and explore new ways of practicing medicine. His work sits at the intersection of clinical care, systems design, and emerging technology.

Key Moments from This Episode

• From transactional to transformational care: Dr. Ruan shares a pivotal moment early in his career that led him to rethink the purpose of clinical practice and move toward a more patient-centered, root-cause approach.
• Medicine as a system, not a set of diagnoses: He introduces the idea of viewing health through a systems-based “flowchart,” focusing on upstream drivers rather than isolated conditions.
• Reframing physician burnout: The conversation shifts burnout from a workload issue to something deeper—touching on identity, alignment, and meaning in medicine.
• Building an insurance-based integrative model: He walks through how he created a lifestyle medicine practice that operates within traditional reimbursement structures.
• Group care as a tool for chronic disease: Dr. Ruan highlights how cohort-based care models may support patient engagement, accountability, and long-term behavior change.
• AI as a support layer in clinical practice: The episode explores how AI can assist with education, workflows, and communication - while emphasizing the need for thoughtful implementation.
• Digital twins and patient experience: He introduces the concept of clinician “digital twins” as a way to extend communication and improve access while maintaining consistency in care delivery.
• Raising resilient kids in an uncertain world: The conversation closes on a personal note, focusing on how to support the next generation through emotional safety, curiosity, and critical thinking.

Timestamps

• 00:00 – Introduction to Dr. Cheng Ruan and his work
• 02:29 – Early life and integrative medicine background
• 05:21 – Systems thinking and reimagining clinical care
• 09:20 – Behavioral observation and patient insight
• 20:54 – Physician burnout and meaning in medicine
• 24:31 – Community, retreats, and clinician support
• 42:42 – AI in healthcare and patient communication
• 47:40 – Safety considerations and AI guardrails
• 58:16 – The future of medicine and education
• 01:06:23 – Inside his clinical model and practice design

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 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.

Citations

• West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272-2281.
• Zhang X, Li L, Zhang Q, Le LH, Wu Y. Physician Empathy in Doctor-Patient Communication: A Systematic Review. Health Commun. 2024 May;39(5):1027-1037. doi: 10.1080/10410236.2023.2201735. Epub 2023 Apr 16. PMID: 37062918.
• Tang MY, Graham F, O'Donnell A, Beyer F, Richmond C, Dhami R, Sniehotta FF, Kaner EFS. Effectiveness of shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials. BMJ Open. 2024 Mar 7;14(3):e067252. doi: 10.1136/bmjopen-2022-067252. PMID: 38453205; PMCID: PMC10921542.

Magnesium is one of those nutrients clinicians think they understand—until they take a closer look. In this episode, we sit down with Dr. Robert Fredrickson, author of Magnesium Answers, to unpack why this foundational mineral continues to create confusion in modern practice. We explore the gap between what standard lab testing shows and what may be happening intracellularly, how lifestyle factors like stress may influence magnesium balance, and how to think more precisely about selecting the right form for the patient in front of you. This conversation is a reminder that advancing patient care isn’t always about adding more complexity—it’s about seeing the fundamentals more clearly.

Why serum magnesium may not reflect total body or intracellular magnesium status

• Serum magnesium represents a small fraction of total body stores, which may limit its utility as a standalone marker; intracellular measures like RBC magnesium may offer additional insight (NIH, 2022).

Magnesium’s foundational role in ATP production and metabolic processes.

• Magnesium is required as a cofactor in ATP synthesis and numerous enzymatic reactions, supporting energy metabolism and overall cellular function (Gröber et al., 2015).

Magnesium as a cofactor in vitamin D metabolism and nutrient synergy.

• Magnesium participates in multiple steps of vitamin D activation, highlighting the importance of evaluating nutrient interactions in clinical planning (Uwitonze & Razzaque, 2018).

Dr. Robert Fredrickson is a clinician, educator, and author of Magnesium Answers: Unlocking the Secrets of Magnesium. With a background in sports medicine and functional medicine, he focuses on helping clinicians better understand mineral balance, metabolic health, and evidence-informed supplementation strategies. He also works with Fullscript, supporting providers with clinical decision support and access to professional-grade supplements and nutraceuticals. Dr. Fredrickson also has his own podcast, the Fredrickson Health Show.

• Not always. Serum magnesium reflects a small percentage of total body magnesium
• Intracellular markers, such as RBC magnesium, may provide additional context
• Interpreting trends alongside clinical presentation may support decision-making (NIH, 2022)

• Dietary intake and food quality
• Malabsorptive disorders like celiac and IBD
• Alcohol intake
• Insulin resistance or type 2 diabetes
• Vitamin D deficiency (NIH, 2022)



• Magnesium acts as a cofactor in enzymes required for vitamin D metabolism
• Inadequate magnesium status may influence how vitamin D is processed in the body (Uwitonze & Razzaque, 2018)

• 00:00 – Why magnesium remains overlooked in modern clinical care
• 02:20 – Dr. Fredrickson’s shift from sports medicine to functional medicine
• 05:32 – Limitations of serum magnesium testing in clinical practice
• 07:27 – Understanding intracellular magnesium and RBC testing
• 09:51 – Magnesium’s role in ATP production and metabolic function
• 13:25 – Dietary patterns, food quality, and nutrient density challenges
• 15:55 – How to select the appropriate form of magnesium
• 18:33 – Magnesium citrate and GI motility considerations, including GLP-1 support
• 20:46 – Common clinical patterns associated with low magnesium status
• 22:09 – Safety considerations and when to individualize magnesium use

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 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. Gröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients. 2015 Sep 23;7(9):8199-226. doi: 10.3390/nu7095388. PMID: 26404370; PMCID: PMC4586582.
2. Rosanoff A, Weaver CM, Rude RK. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev. 2012 Mar;70(3):153-64. doi: 10.1111/j.1753-4887.2011.00465.x. Epub 2012 Feb 15. PMID: 22364157.
3. Uwitonze AM, Razzaque MS. Role of Magnesium in Vitamin D Activation and Function. J Am Osteopath Assoc. 2018 Mar 1;118(3):181-189. doi: 10.7556/jaoa.2018.037. PMID: 29480918.
4. National Institutes of Health. “Magnesium.” National Institutes of Health, 2022, ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/.