The Root Cause Medicine Podcast

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.

Clinical Highlights: PANS/PANDAS
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)

Guest Introduction
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.

FAQ
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).

Timestamps
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

Sponsor Section
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
American Academy of Pediatrics. Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Clinical Report. Pediatrics. 2025;155(3):e2024070334.
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.
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.
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.
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
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.

Clinical Takeaways from This Episode
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.

Guest Introduction
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.

FAQ
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).

Timestamps
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.

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

Citations
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.
Chaudhry, H. S., & Kasarla, M. R. (2026). Microcytic hypochromic anemia. StatPearls. Retrieved March 31, 2026 from https://www.ncbi.nlm.nih.gov/books/NBK470252/
Razzaque MS. Magnesium: Are We Consuming Enough? Nutrients. 2018 Dec 2;10(12):1863. doi: 10.3390/nu10121863. PMID: 30513803; PMCID: PMC6316205.
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.

Clinical Takeaways from This Episode

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).

Guest Introduction
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.

FAQ
Is serum magnesium a reliable marker for magnesium status?
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)

What factors may influence magnesium status in patients?
Dietary intake and food quality
Malabsorptive disorders like celiac and IBD
Alcohol intake
Insulin resistance or type 2 diabetes
Vitamin D deficiency (NIH, 2022)

How does magnesium interact with vitamin D?
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)

Key Moments (Timestamps)
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

Sponsor Message
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
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.
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.
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.
National Institutes of Health. “Magnesium.” National Institutes of Health, 2022, ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/.

What if the real problem with hormones isn’t what’s broken… but what’s being missed?

In this conversation, Dr. Cheryl Burdette invites us to rethink everything we’ve been taught about hormonal health. Instead of chasing isolated lab values or treating systems in silos, she introduces a more useful question: what if hormones only make sense when you look at how they talk to each other?

We explore the concept of the hormonal matrix—a lens that connects thyroid, adrenal, and reproductive hormones into one dynamic, interdependent network. Because in the body, nothing operates alone. Signals overlap. Pathways intersect. And small imbalances can ripple across systems in ways we don’t always measure.

This systems-based perspective isn’t just philosophical—it’s increasingly supported by emerging research on the cross-talk between the HPTA axis, the gut, and broader metabolic and immune signaling. When you zoom out, patterns start to appear. And when you see the pattern, your clinical decisions can change.

This episode is about shifting from fragments to frameworks—and why that shift may open up entirely new possibilities for understanding and supporting hormonal health.