The Root Cause Medicine Podcast

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
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/
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/
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
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
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/
NCBI. (2012). Ashwagandha [Review of Ashwagandha]. PubMed; National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/NBK548536/
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/
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

Summary

This episode explores the role of immune-mediated testing in the evaluation of complex, chronic symptoms that may not respond to conventional approaches. Dr. Jessica Christie is joined by Veronica Kent, CEO of Alletess Medical Laboratory, and Kristen Trainer, Registered Dietitian and Clinical Educator, to discuss food allergies, food sensitivities, mold exposure, Candida, Alpha-gal syndrome, elimination diets, and the evolving landscape of laboratory testing.

The conversation examines the differences between IgE-mediated food allergies and IgG food sensitivity testing, when clinicians may consider specialized laboratory assessments, and the importance of combining laboratory data with a comprehensive patient history and individualized care plans. The guests also discuss laboratory quality standards, patient education, and why test interpretation should be viewed as one component of clinical decision-making rather than a standalone diagnostic tool. (Santos 2023)

Clinical Takeaways from This Episode

Not all adverse food reactions are food allergies. The episode distinguishes between IgE-mediated food allergies and other forms of food-related symptoms, including food sensitivities, while acknowledging that diagnostic approaches differ depending on the clinical presentation. (Sicherer 2018)
Patient history remains foundational. Laboratory testing should be interpreted alongside symptoms, clinical history, dietary patterns, and physical examination rather than in isolation. (Santos 2023)
Elimination diets require structured implementation. The guests discuss elimination and systematic food reintroduction as part of evaluating whether certain foods may contribute to symptoms, emphasizing individualized guidance and monitoring. (Santos 2023)
Alpha-gal syndrome is an emerging clinical consideration. Tick-associated mammalian meat allergy is becoming increasingly recognized and may present with delayed allergic reactions that can be difficult to identify. (Platts-Mills 2025) (Thompson 2023)
Environmental exposures may contribute to symptom burden. Mold exposure is discussed as one possible consideration in select patients presenting with persistent respiratory or inflammatory symptoms, although appropriate testing strategies remain an area of ongoing research and debate. (Cai 2024)
Patient education is essential. Laboratory testing alone does not improve outcomes; patients benefit from clear interpretation, education, and individualized follow-up plans. (Santos 2025)
Quality systems matter in laboratory medicine. The discussion highlights the importance of standardized laboratory procedures, quality assurance, and timely reporting in supporting clinical decision-making. (Pillai 2025)

Guest Introduction

Veronica Kent
Veronica Kent is the Chief Executive Officer and owner of Alletess Medical Laboratory. She has spent decades working in specialty laboratory medicine and oversees operations focused on allergy, immunology, and immune-based laboratory testing. During the episode, she discusses laboratory quality systems, emerging testing technologies, and the role of clinician education in laboratory medicine.
Website: https://foodallergy.com

Kristen Trainer, RD
Kristen Trainer is a Registered Dietitian and Clinical Educator at Alletess Medical Laboratory. She has worked with clinicians and patients for more than two decades, helping interpret laboratory results and develop individualized nutrition and elimination diet plans for patients undergoing food allergy and food sensitivity testing.

Tests Discussed

Note: Discussion of these tests during the episode should not be interpreted as endorsement or guideline recommendations. Clinical appropriateness depends on the individual patient and current evidence.
IgE food allergy testing
Environmental allergy testing
Component-resolved allergy diagnostics
IgG food sensitivity testing
IgA food sensitivity testing
Candida antibody testing (IgG, IgA, IgM)
Candida immune complex testing
Mold antibody testing
Alpha-gal IgE testing
Tick-borne immune testing
Celiac disease testing
Total IgE testing

Lifestyle & Clinical Strategies Mentioned

Structured elimination diets
Gradual food reintroduction
Individualized meal planning
Rotation diets
Shopping list development
Family-based nutrition planning
Reducing environmental mold exposure
Personalized patient education
Long-term dietary follow-up
Collaboration between laboratory professionals and clinicians

Clinician FAQ

1. What is the difference between a food allergy and a food sensitivity?
The discussion differentiates IgE-mediated food allergies, which may produce immediate immune reactions, from food sensitivities, which are proposed to involve different immune pathways and may present differently clinically. (Santos 2023) The role of IgG food sensitivity testing remains controversial and is not universally recommended by major allergy organizations. (Kelso 2018)

2. When should clinicians consider specialized allergy testing?
According to the discussion, testing decisions should begin with a comprehensive patient history and symptom evaluation. Testing should be selected based on the suspected underlying mechanism rather than using broad screening panels indiscriminately. (Santos 2023)

3. What is component-resolved diagnostics?
Component-resolved diagnostics evaluates specific proteins within an allergen rather than testing only the whole allergen, potentially providing additional information regarding sensitization patterns in certain allergic conditions. (Santos 2023)

4. What is Alpha-gal syndrome?
Alpha-gal syndrome is an IgE-mediated allergy associated with tick bites that may result in delayed allergic reactions after consuming mammalian meat or products derived from mammals. Recognition of this condition has increased in recent years. (Platts-Mills 2025) (Thompson 2023)

5. How are elimination diets used?
The guests describe elimination diets as a structured process involving temporary removal of selected foods followed by gradual reintroduction while monitoring symptoms under clinician supervision. (Santos 2023)

6. Why is patient education emphasized?
The episode stresses that laboratory testing is only one part of patient care and that interpretation, counseling, dietary guidance, and follow-up are necessary to help patients implement meaningful changes. (Santos 2025)

7. Why does laboratory quality matter?
Standardized testing procedures, accreditation, quality control, and timely reporting all contribute to reliable laboratory results that clinicians can incorporate into patient care. (Chaudhry 2023)

8. What future developments are discussed?
The guests discuss advances including miniaturized laboratory technologies, capillary blood collection, microbiome research, and genetics as potential future areas of development in allergy and immunology testing.

Timestamps / Key Moments

00:02:22 Veronica Kent and Kristen Trainer introduce Alletess
00:03:36 Food allergy, sensitivity, candida, mold, and tick-borne testing
00:04:54 How Alletess began as a specialized laboratory
00:08:16 Bridging the gap between lab results and patient care
00:09:27 How allergy and immunology testing has evolved
00:13:23 How elimination diets and reintroduction work
00:15:19 When mold-related illness testing may be warranted
00:17:38 Alpha-gal syndrome and missed tick-borne allergy cases
00:25:38 Common misconceptions about food allergy testing

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 do not necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to provide medical advice. Healthcare decisions should be made in consultation with a qualified healthcare professional.

References

Ahmed Shabbir Chaudhry, Inata, Y., & Nakagami-Yamaguchi, E. (2023). Quality Analysis of the Clinical Laboratory Literature and Its Effectiveness on Clinical Quality Improvement: A Systematic Review. Journal of Clinical Biochemistry and Nutrition, 73(2), 108–115. https://doi.org/10.3164/jcbn.23-22
Cai, J., Yang, M., Zhang, N., Chen, Y., Wei, J., Wang, J., Liu, Q., Li, W., Shi, W., & Liu, W. (2024). Effects of residential damp indicators on asthma, rhinitis, and eczema among children: A systematic review and meta-analysis of the literature in the past 33 years. Building and Environment, 251, Article 111226. https://www.sciencedirect.com/science/article/abs/pii/S0360132324000684
Kelso, J. M. (2018). Unproven diagnostic tests for adverse reactions to foods. The Journal of Allergy and Clinical Immunology: In Practice, 6(2), 362–365. https://pubmed.ncbi.nlm.nih.gov/29524991/
Pillai, S. P., & Fox, E. (2025). Laboratory quality management system fundamentals [Review of Laboratory quality management system fundamentals]. Frontiers in Bioengineering and Biotechnology, 13. https://doi.org/10.3389/fbioe.2025.1578654
Platts-Mills, T. A. E., Gangwar, R. S., Workman, L., & Wilson, J. M. (2025). The immunology of alpha-gal syndrome: History, tick bites, IgE, and delayed anaphylaxis to mammalian meat. Immunological Reviews, 332(1), Article e70035. https://onlinelibrary.wiley.com/doi/10.1111/imr.70035
Santos, A. F., Riggioni, C., Agache, I., Akdis, C. A., Akdis, M., et al. (2023). EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy, 78(12), 3057–3076. https://onlinelibrary.wiley.com/doi/10.1111/all.15902
Santos, A. F., Riggioni, C., Agache, I., Akdis, C. A., Akdis, M., et al. (2025). EAACI guidelines on the management of IgE-mediated food allergy. Allergy, 80(1), 14–36. https://onlinelibrary.wiley.com/doi/10.1111/all.16345
Thompson, J. M., Carpenter, A., Kersh, G. J., Wachs, T., Commins, S. P., & Salzer, J. S. (2023). Geographic distribution of suspected alpha-gal syndrome cases — United States, January 2017–December 2022. MMWR. Morbidity and Mortality Weekly Report, 72(30), 815–820. https://www.cdc.gov/mmwr/volumes/72/wr/mm7230a2.htm

What if the most powerful shift in how we practice medicine starts with one person deciding to do it differently?

Aviva’s story is that kind of shift.

Long before she ever sat in a medical classroom, she had already built a life as a midwife, herbalist, and mother of four who was deeply embedded in her community. Then, in what most of us would consider the busiest, most demanding years of life - years that often overlap with perimenopause - she made a radical decision: she went back to school. Back into training. Back into the system she wanted to help change.

Not because something was broken, but because she saw what was missing.

That’s what makes this episode different. It’s about what happens when women get to reframe the perimenopausal transition as one of the most powerful, generative, expansive years of their lives.

Instead of accepting the status quo, Dr. Aviva Romm built an entirely different way of seeing things - one that doesn’t reduce symptoms to problems, but places them in context. One that connects sleep, stress, nourishment, physiology, and even relationships into a bigger picture of health.

You can feel that perspective ripple through the entire conversation. It gently challenges the idea that you need more interventions, more testing, more fixing, and replaces it with something both simpler and harder: paying attention, understanding what your body is asking for, and supporting it instead of overriding it.

By the end, something shifts.

You’re not just thinking differently about perimenopause - you’re thinking differently about what’s possible during this phase of life. And maybe, like Aviva did, you start to wonder: what could change if perimenopause wasn’t seen as the end of something, but the beginning of something else entirely?

Clinical Takeaways from This Episode
A root-cause, whole-person approach to perimenopause may support more sustainable outcomes. Perimenopause often includes symptoms like sleep disruption, mood changes, and cycle irregularities, and may benefit from a broader, individualized care approach rather than a single intervention (Santoro et al., 2018).
Stress physiology and HPA axis patterns may influence how symptoms show up. Chronic stress is associated with changes in inflammatory signaling and neuroendocrine regulation, which may shape mood, immune function, and metabolic health (Russell, 2019).
Sleep is foundational—and CBT-I is an evidence-informed place to start. Cognitive Behavioral Therapy for Insomnia (CBT-I) is supported by clinical evidence and may help improve sleep quality without medication in many individuals (Rossman, 2019).
Connection and community are not “extras”—they’re part of physiology. Social isolation has been associated with increased mortality risk, which reinforces the importance of connection as part of whole-person care (Naito et al., 2023).
Thoughtful, targeted lab testing supports better clinical decision-making. Strategic use of labs—guided by symptoms and clinical context—may reduce unnecessary testing and help clinicians focus on meaningful data.

Guest Introduction
Dr. Aviva Romm, MD, is a Yale-trained physician, herbalist, and midwife with over four decades of experience in women’s health. She has trained hundreds of clinicians in integrative and functional medicine and is the author of multiple bestselling books, including Hormone Intelligence and The Adrenal Thyroid Revolution. Her work bridges conventional and integrative medicine in a way that centers women and their paths to thriving.

Interested in advancing your clinical training? Explore Dr. Aviva Romm’s Women’s Integrative Functional Medicine Certification Program. Use code FULLSCRIPT26 in the “How did you learn about the course?” box to receive $1,000 off.

FAQ: Clinician & Patient Questions on Perimenopause and Integrative Care
What symptoms are common during perimenopause?
Perimenopause may include:
Sleep disruption
Mood changes
Hot flashes or night sweats
Changes in menstrual cycles
These are part of a normal physiologic transition, though symptom severity varies. Dr. Aviva uses a whole-person, root cause approach to successfully manage many of these symptoms. (Crandall, 2023).

What can I do if I’m struggling with sleep in midlife?
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a well-studied, non-pharmacologic option clinicians may consider (Rossman, 2019).
It may also help to evaluate:
Stress levels
Blood sugar patterns
Sleep habits and environment

How does stress actually affect my health?
Chronic stress may influence:
Hormone signaling
Immune and inflammatory pathways
Mood and cognitive function
These effects are mediated in part through the HPA axis and inflammatory signaling pathways (Russell, 2019).

Key Moments from This Episode
02:30 – Aviva’s journey: from herbalist and midwife to Yale-trained medical doctor
10:41 – Going back to medical school as a parent: what it really takes
28:14 – Stress physiology and the root causes of chronic symptoms
32:58 – Reframing perimenopause as a transition, not a decline
35:17 – Building a real-world toolkit: sleep, nourishment, nervous system support
41:01 – Botanical medicine in practice: motherwort and lemon balm
57:28 – Hypervigilance, burnout, and how they show up in the body
01:17:18 – The Yerkes-Dodson curve: finding your optimal stress zone
01:19:41 – How to think about labs without overtesting

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
Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023 Feb 7;329(5):405-420. doi: 10.1001/jama.2022.24140. PMID: 36749328.
Rossman J. Cognitive-Behavioral Therapy for Insomnia: An Effective and Underutilized Treatment for Insomnia. Am J Lifestyle Med. 2019 Aug 12;13(6):544-547. doi: 10.1177/1559827619867677. PMID: 31662718; PMCID: PMC6796223.
Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019 Sep;15(9):525-534. doi: 10.1038/s41574-019-0228-0. Epub 2019 Jun 27. PMID: 31249398.
Naito R, McKee M, Leong D, Bangdiwala S, Rangarajan S, Islam S, Yusuf S. Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies. PLoS One. 2023 Jan 12;18(1):e0280308. doi: 10.1371/journal.pone.0280308. PMID: 36634152; PMCID: PMC9836313.

What happens when patients leave an integrative or functional medicine appointment with multiple recommendations but limited practical support for implementation?

In this episode, Kate Kresge sits down with Monique Richard, Holly Van Poots, and Sudha Raj to discuss the evolving role of Registered Dietitian Nutritionists (RDNs) trained in Integrative and Functional Nutrition (IFN). The conversation centers on the Revised 2025 Scope and Standards of Practice for RDNs in Nutrition in Integrative and Functional Medicine, which clarifies the scope, standards, and clinical contribution of IFN practitioners. (Crowe-White 2025)

Together they explore why nutrition may remain underused in some conventional care settings, including concerns that many medical providers receive limited formal nutrition training. (Adams 2010) They also discuss why sustained behavior change often requires more time, context, and follow-up than a brief visit can provide, and why food choices are shaped by more than nutrient content alone. The discussion highlights how IFN dietitians can help translate complex plans into sustainable daily habits while helping patients connect symptoms, lifestyle patterns, culture, stress, and nutrition.
The episode makes a practical case for team-based care and shows how integrative nutrition practitioners can help bridge the gap between clinical recommendations and meaningful long-term change.

Clinical Takeaways From This Episode

Behavior Change Is Often the Missing Piece
Many visits focus on diagnosis and treatment decisions, while meaningful behavior change takes time, relationship-building, and ongoing support. (Crowe-White 2025) (Körner 2016) IFN dietitians help patients put recommendations into practice in real-world settings.

Food Is More Than Nutrients
Food choices are shaped by culture, identity, family history, emotional experience, access, and lifestyle. Accounting for these factors may help make nutrition recommendations more realistic, acceptable, and sustainable; effects on clinical outcomes depend on the condition, intervention, and patient context. (Odoms-Young 2024) (Crowe-White 2025)

Nutrition Is Central to Complex Chronic Disease
Many patients present with concerns where nutrition may be one component of care, including issues related to digestive health, metabolic health, immune function, and quality of life. (Crowe-White 2025) (Moloney 2025)

Dietitians Serve as Translators of Functional Medicine Plans
Many patients leave appointments with extensive recommendations. IFN practitioners can help patients prioritize, personalize, and implement clinician recommendations within the patient’s preferences, resources, culture, and care plan. (Moloney 2025) (Senkus 2024)

Team-Based Care Improves Patient Support
Integrative care tends to work best when physicians, naturopathic doctors, nurse practitioners, health coaches, and nutrition professionals collaborate on whole-person care. (Körner 2016) (Crowe-White 2025)

Guest Introduction

Monique Richard, MS, RDN, LDN
Monique Richard is an experienced registered dietitian nutritionist specializing in integrative and functional nutrition. Known for her practical and patient-centered approach, she helps individuals explore lifestyle, nutrition, and environmental factors that may be relevant to their health goals and care plans. She often describes IFN practitioners as "nutrition detectives" who help connect the dots between symptoms, habits, and underlying patterns.

Holly Van Poots, MS, RDN
Holly Van Poots is a leader in integrative and functional nutrition education and one of the contributors to the newly published guidance paper on the role of IFN dietitians. Her work focuses on defining how nutrition professionals contribute to whole-person care beyond traditional dietary counseling.

Sudha Raj, PhD, RDN
Sudha Raj brings a deep understanding of nutrition behavior change, cultural competency, and patient-centered care. Her work emphasizes the importance of relationship-based nutrition counseling and understanding the lived experiences that shape food choices and health behaviors.

The statements, information and opinions shared by each individual are not in the capacity as official spokespeople, or, on behalf, of the Academy of Nutrition and Dietetics. They volunteered to be authors/contribute to the NIFM SOP and received no funding from the Academy.

FAQ

What is integrative and functional nutrition?
Integrative and functional nutrition combines evidence-informed nutrition science with a whole-person approach that considers lifestyle, environment, stress, sleep, culture, and other contributors to health.

How is an IFN dietitian different from traditional nutrition counseling?
While foundational nutrition principles remain the same, IFN practitioners often spend more time exploring nutrition- and lifestyle-related factors, patient context, and personalized behavior-change strategies.

Why are dietitians important in functional medicine practices?
Dietitians can help patients translate complex recommendations into practical daily actions, which may support adherence and follow-through. Evidence for clinical outcomes varies by condition and intervention. (Moloney 2025)

What are patients often missing after a functional medicine visit?
Patients frequently understand what they should do but struggle with how to implement recommendations. IFN practitioners help bridge that gap.

Why is food considered more than just nutrition?
Food carries cultural, emotional, social, and historical meaning. Accounting for these factors can help build realistic, sustainable nutrition strategies. (Odoms-Young 2024)

Timestamps
00:00:00 – Why nutrition changes are powerful but hard for patients to implement
00:02:17 – Why the new IFN dietitian scope paper matters now
00:03:51 – Integrative vs. functional nutrition and the “nutrition detective” role
00:05:00 – The biggest gaps IFN-trained RDNs can fill in patient care
00:08:22 – What a visit with an integrative and functional RDN actually looks like
00:12:16 – How labs and testing fit into nutrition care
00:15:11 – How dietitians train in integrative and functional nutrition
00:18:59 – Eating disorders, elimination diets, and the need for collaboration
00:25:55 – Where to find IFN-trained dietitians and build referral relationships
00:29:43 – The future of medical nutrition, value-based care, and whole person health
00:35:09 – Rapid-fire: misconceptions, sustainable habits, and underappreciated nutrition care

Future Discussion — The expanding role of RDNs in multidisciplinary healthcare teams

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.

References

Adams, K. M., Kohlmeier, M., & Zeisel, S. H. (2010). Nutrition education in U.S. medical schools: Latest update of a national survey. Academic Medicine, 85(9), 1537–1542. https://doi.org/10.1097/ACM.0b013e3181eab71b
Crowe-White, K. M., Richard, M., & Raj, S. (2025). Revised 2025 scope and standards of practice for registered dietitian nutritionists in nutrition in integrative and functional medicine. Commission on Dietetic Registration. https://www.cdrnet.org/vault/2459/web//20251215%20NIFM%20Article%20FINAL%20-%202.pdf
Federal Trade Commission. (2022). Health products compliance guidance. https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance
Körner, M., Bütof, S., Müller, C., Zimmermann, L., Becker, S., & Bengel, J. (2016). Interprofessional teamwork and team interventions in chronic care: A systematic review. Journal of Interprofessional Care, 30(1), 15–28. https://doi.org/10.3109/13561820.2015.1051616
Moloney, L., Rozga, M., Steiber, A., & Handu, D. (2026). The effectiveness of medical nutrition therapy in prevention and treatment of chronic disease: A position paper of the Academy of Nutrition and Dietetics. Journal of the Academy of Nutrition and Dietetics, 126(2), Article 156219. https://doi.org/10.1016/j.jand.2025.10.010
Odoms-Young, A., Stanford, F. C., Palacios, C., Anderson, C. A. M., Andres, A., Fisher, J. O., Gardner, C. D., Giovannucci, E., Hoelscher, D. M., Jernigan, V. B. B., Raynor, H. A., Webster, A., Fultz, A. K., Bahnfleth, C., English, L. K., Higgins, M., Lawless, M., Momin, S., Butera, G., … Obbagy, J. (2024). Culturally tailored dietary interventions and diet-related psychosocial factors, dietary intake, diet quality, and health outcomes: An evidence scan. U.S. Department of Agriculture, Nutrition Evidence Systematic Review. https://doi.org/10.52570/NESR.DGAC2025.ES01
Senkus, K. E., Dudzik, J. M., Lennon, S. L., DellaValle, D. M., Moloney, L. M., Handu, D., & Rozga, M. (2024). Medical nutrition therapy provided by a dietitian improves outcomes in adults with prehypertension or hypertension: A systematic review and meta-analysis. The American Journal of Clinical Nutrition, 119(6), 1417–1442. https://doi.org/10.1016/j.ajcnut.2024.04.012

This episode explores one of the most significant developments in women's health in recent years: the proposed transition from Polycystic Ovary Syndrome (PCOS) to Polyendocrine Metabolic Ovarian Syndrome (PMOS). (Teede 2026) Dr. Jessica Christie and Dr. Camille Krause discuss why experts believe the traditional name no longer reflects the full complexity of the condition and how the PMOS framework better captures its endocrine, metabolic, reproductive, inflammatory, and neuroendocrine dimensions. (Teede 2026) Clinicians will learn why insulin resistance, androgen excess (Houston 2025), stress physiology, sleep, inflammation, and cardiometabolic health (Wekker 2020) are central to understanding PMOS, and how a systems-based approach can improve earlier identification, assessment, and treatment. (Teede 2026)

Clinical Takeaways from This Episode

PMOS reflects a multisystem condition: The proposed name change recognizes that the condition extends beyond ovarian function and includes endocrine, metabolic, inflammatory, and neuroendocrine dysfunction. (Teede 2026)
Insulin resistance is a major physiologic driver: Hyperinsulinemia may contribute to increased ovarian androgen production, ovulatory dysfunction, and metabolic symptoms, often before glucose markers become abnormal. (Houston 2025)
PMOS is not defined by ovarian cysts: Many individuals diagnosed with PCOS do not demonstrate polycystic ovarian morphology, and the follicles observed are not true ovarian cysts. (Houston 2025) (Teede 2026)
Early metabolic screening matters: Fasting insulin, glucose regulation, lipid markers, liver function, and cardiometabolic risk factors may shift years before overt disease develops. (Houston 2025) (Teede 2026)
Clinical presentations vary widely: Symptoms may include irregular cycles, infertility, acne, hirsutism, hair thinning, fatigue, mood changes, sleep disruption, dyslipidemia, and fatty liver patterns. (Manzano-Nunez 2023) Lean PMOS can occur and is often overlooked. (Zheng 2025)
Treatment requires a whole-person approach: Nutrition, movement, sleep, stress regulation, inflammation management, and metabolic support should be considered alongside conventional treatment options. (Teede 2023)

Guest Introduction

Dr. Camille Krause is a Naturopathic Doctor with a clinical focus on fertility, women’s hormones, and nutrition. She works collaboratively with fertility physicians to provide evidence-based, complementary care, using specialized testing, nutrition, botanical medicine, lifestyle interventions, and acupuncture to support reproductive health. Dr. Krause is a member of the Canadian and Ontario Associations of Naturopathic Doctors. She holds an Honours Bachelor of Science from the University of Toronto and completed her naturopathic training at the Canadian College of Naturopathic Medicine.
Website: https://www.conceivehealth.com/staff/camille-krause-naturopathic-doctor/
Instagram: @waterloo_fertility_naturopath

Labs Mentioned

Fasting insulin
Fasting glucose
Hemoglobin A1c (HbA1c)
Lipid panel
Liver enzymes
Testosterone
DHEA-S
Sex Hormone Binding Globulin (SHBG)
Thyroid markers
Blood pressure
Waist circumference assessment

Lifestyle & Exercise Strategies Mentioned

Blood sugar stabilization
Higher protein intake
Increased dietary fiber intake
Resistance training
Regular movement and exercise
Sleep optimization
Circadian rhythm support
Nervous system regulation
Stress management
Inflammation reduction strategies
Nutrient sufficiency
Recovery optimization

Clinician FAQ

1. Why is PCOS being renamed PMOS?
The proposed term Polyendocrine Metabolic Ovarian Syndrome better reflects the endocrine, metabolic, reproductive, and inflammatory aspects of the condition rather than focusing primarily on ovarian findings. (Teede 2023)

2. Are ovarian cysts required for diagnosis?
No. Many individuals diagnosed with PCOS do not have polycystic ovarian morphology. The follicles seen on imaging are generally immature follicles associated with disrupted ovulation rather than true ovarian cysts. (Teede 2026) (Houston 2025)

3. Why is fasting insulin clinically important in PMOS?
Elevated insulin levels may occur years before fasting glucose or HbA1c become abnormal and can contribute directly to ovarian androgen production and ovulatory dysfunction. (Houston 2025)

4. What systems are involved in PMOS?
PMOS may involve insulin signaling, androgen regulation, neuroendocrine function, inflammatory pathways, reproductive physiology, sleep, circadian rhythms, and cardiometabolic health. (Teede 2026) (Wekker 2020)

5. Can patients have PMOS without obesity?
Yes. Lean PMOS exists and may be underrecognized. Patients can experience reproductive, metabolic, and hormonal symptoms across a wide range of body compositions. (Zheng 2025)

6. What are the current diagnostic criteria?
Current criteria include combinations of:
Ovulatory dysfunction or irregular cycles
Clinical or biochemical hyperandrogenism
Polycystic ovarian morphology or elevated AMH in adults
Adolescents generally require the first two criteria rather than ovarian imaging findings. (Teede 2023)

7. Why is diagnosis often delayed?
Presentations vary substantially, and many patients do not fit traditional stereotypes. Symptoms may emerge years before fertility concerns arise, contributing to missed or delayed diagnosis. (Gibson-Helm 2017)
8. What is the role of lifestyle medicine in PMOS?
Lifestyle interventions targeting blood sugar regulation, nutrition, physical activity, sleep, stress physiology, and inflammation are foundational components of a whole-person treatment strategy. (Teede 2023)

Conversation Topics
The decade-long effort behind the name change
Why the old terminology was biologically inaccurate
Understanding PMOS as a multisystem condition
Insulin resistance and androgen excess
The role of inflammation, sleep, and stress physiology
Lean PMOS and underrecognized presentations
Current diagnostic criteria and clinical considerations
Root-cause laboratory assessment strategies
Whole-person treatment approaches for PMOS
Why lifestyle medicine remains foundational
The future of women's endocrine and metabolic care

Timestamps

00:00 - Why the shift from PCOS to PMOS matters
02:10 - How language shapes diagnosis and care
03:29 - Why the old terminology missed the bigger picture
05:18 - The root physiology of PMOS
07:47 - How PMOS can present beyond the stereotypical picture
09:33 - Why diagnosis requires a deeper clinical lens
11:23 - A whole-person approach to PMOS care
12:25 - Why this shift is so meaningful for patients and practitioners

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.

References

Gibson-Helm, M., Teede, H., Dunaif, A., & Dokras, A. (2017). Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 102(2), 604–612. https://doi.org/10.1210/jc.2016-2963
Houston, E. J., & Templeman, N. M. (2025). Reappraising the relationship between hyperinsulinemia and insulin resistance in PCOS. Journal of Endocrinology, 265(2), e240269.
Manzano-Nunez, R., Santana-Dominguez, M., Rivera-Esteban, J., Sabiote, C., Sena, E., Bañares, J., Tacke, F., & Pericàs, J. M. (2023). Non-alcoholic fatty liver disease in patients with polycystic ovary syndrome: A systematic review, meta-analysis, and meta-regression. Journal of Clinical Medicine, 12(3), 856. https://doi.org/10.3390/jcm12030856
Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., & Joham, A. E. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 108(10), 2447–2469. https://doi.org/10.1210/clinem/dgad463
Teede, H. J., Khomami, M. B., Morman, R., Laven, J. S. E., Joham, A. E., Costello, M. F., Patil, M., Rees, D. A., Berry, L., Cree, M. G., Zhao, H., Norman, R. J., Dokras, A., & Piltonen, T. (2026). Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: A multistep global consensus process. The Lancet. Advance online publication.
Wekker, V., van Dammen, L., Koning, A., Heida, K. Y., Painter, R. C., Limpens, J., & Hoek, A. (2020). Long-term cardiometabolic disease risk in women with PCOS: A systematic review and meta-analysis. Human Reproduction Update, 26(6), 942–960.
Zheng, C., Lin, Y., Zhang, Z., Ye, J., Lin, Y., & Tian, J. (2025). Analyzing and evaluating the metabolic and endocrine characteristics between lean and obese patients with polycystic ovary syndrome: A systematic review and meta-analysis. Frontiers in Endocrinology, 16, 1680685.