The Trusted Pharmacist

If nutrition can affect anxiety and depression, what should we actually measure, change, and investigate before reaching for another prescription?
Knowing that mental health can have nutritional and biological drivers is one thing. Knowing what to do with that information is another. Should we start with fiber, test vitamin D and iron, examine thyroid function, or investigate what is happening inside the cells? Without a clear approach, nutrition can easily become another world of guesswork, conflicting advice, and supposed quick fixes.
In Part 2, we move from understanding the nutrition, mental health connection to identifying the practical next steps. Dr. Oscar Coetzee explains why the average American may not be eating enough fiber to properly support the gut microbiome, which nutrient deficiencies he prioritizes when evaluating mental health symptoms, and how thyroid function can influence mood and energy. He also walks us through the organic acids test and what it can reveal about cellular energy, nutrient status, neurotransmitter pathways, stress, detoxification, and microbial activity.
In this episode, I continue my conversation with nutritionist, author, and speaker Dr. Oscar Coetzee. We explore how to investigate the biological factors affecting mental health without falling for quick fixes, why antidepressants should never be stopped abruptly, and the emerging probiotic research that Oscar believes could change how we support the gut and brain.
What You'll Discover in This Episode
Why fiber matters for the gut bacteria involved in producing the building blocks for serotonin and dopamine

How the average American's fiber intake compares with the amount Oscar believes is needed to improve the microbiome

Why fiber should be increased gradually instead of added in large amounts overnight

The connection Oscar sees between an underfed microbiome and rising levels of anxiety and depression

Why vitamin D deficiency and iron deficiency are among the first problems Oscar investigates

How anemia can affect mood, energy, and cognition, particularly in menstruating women

Why B vitamins also deserve attention when evaluating mental health symptoms

How selenium, iodine, and vitamin A support thyroid function—and why an underactive thyroid can resemble anxiety or depression

The role omega-3 fatty acids and zinc play in supporting brain-derived neurotrophic factor

How medication can provide short-term relief while nutritional deficiencies and other underlying problems are addressed

Why Oscar is concerned about prescribing and combining multiple psychiatric medications in children and teenagers

What an organic acids test can reveal that routine bloodwork may miss

How this test can offer insight into mitochondrial function, B vitamin status, neurotransmitter pathways, cortisol, detoxification, and microbial activity

Why mental health is too complex for TikTok remedies and one-size-fits-all solutions

Why anyone taking an SSRI should never reduce or stop it without working with the prescribing healthcare professional

How new technology is making it possible to deliver previously difficult-to-supplement anaerobic bacteria

Why emerging probiotic research could create new possibilities for mental, metabolic, and immune health

 
PS. If you enjoy the show, remember to leave a review on your favorite podcast app! Reviews help the podcast reach a wider audience and help more people.
 
 About the Guest
 
Dr. Oscar Coetzee is a nutritionist, published author, professor, and nationally recognized speaker, and VP of Clinical Education and Practitioner Support at Designs for Health. With more than 25 years of experience in nutritional science and research, he currently serves as a faculty member at the University of Bridgeport and Associate Director of the Nutrition Track within its Doctor of Health Sciences program. His work focuses on evidence-based nutritional science and developing nutrition intervention protocols for chronic disease. To learn more, visit https://www.designsforhealth.com/ or send an email to ocoetzee@designsforhealth.com. 
 
About Your Host
Steve Hoffart is an award-winning pharmacist, entrepreneur, speaker and podcaster. As the visionary founder of Magnolia Pharmacy, Steve saw a need for a more personal pharmacy that could make a bigger impact. Today, Steve and his team of experts deliver on that promise, working with patients and their physicians to solve medication problems and offer personalized solutions to achieve better health and wellness. As host of The Trusted Pharmacist podcast and through his combined reach of over 1M on social media, Steve shares actionable advice on nutrition, supplements, and wellness strategies while advocating for meaningful change in healthcare.
 
Stay Ahead with Steve the Pharmacist!
Loving the show? Want more insights into how your body works? Head over to TheTrustedPharmacist.com and sign up with your email! You'll get the latest episodes, plus exclusive health tips to help you take charge of your wellness. Don't miss out – join me today!

What if the antidepressant isn't failing because it's the wrong medication, but because the body doesn't have enough of what it needs to make serotonin in the first place?
As a pharmacist, I've filled thousands of antidepressant prescriptions. But there is a question we rarely stop to ask before increasing a dose or trying another medication: Where does serotonin actually come from? An SSRI can help the brain reuse the serotonin that is already available, but the production of neurotransmitters also depends on what is happening elsewhere in the body.
This means symptoms we identify as anxiety or depression may sometimes have more than one possible driver. Low vitamin D, iron deficiency, unstable blood sugar, poor digestion, inflammation, and an imbalanced microbiome can all influence how we feel. 
In this episode, I'm joined by nutritionist, author, and speaker Dr. Oscar Coetzee. We explore the missing nutritional and biological "third leg" of mental healthcare and why mood disorders can have a lot more to do with what's on your plate than you think. 
What You'll Discover In This Episode 
The overlooked question we should ask before assuming an antidepressant has "stopped working"

Why the gut microbiome helps provide the raw materials the body needs to make serotonin and dopamine

How nutrient deficiencies can interfere with neurotransmitter production even when someone is eating a seemingly healthy diet

Why poor digestion may matter just as much as the nutrients we consume

The "three-legged stool" of mental healthcare and the leg that is often missing

How low blood sugar, anemia, and vitamin deficiencies can mimic symptoms associated with anxiety or depression

Why a healthy gut depends on microbial balance, not simply eliminating every "bad" bacterium

How toxins released by certain gut bacteria may contribute to inflammation in the brain

Why two people with similar gut problems can experience very different mental health symptoms

How genetics can reveal vulnerabilities without determining someone's future

Why Oscar now considers diet, gut health, and cellular function before turning to extensive genetic testing

When medication may be urgently necessary and why nutrition should complement, not replace, appropriate psychiatric care

 
PS. If you enjoy the show, remember to leave a review on your favorite podcast app! Reviews help the podcast reach a wider audience and help more people.
 
 
About the Guest
Dr. Oscar Coetzee is a nutritionist, published author, professor, and nationally recognized speaker, and VP of Clinical Education and Practitioner Support at Designs for Health. With more than 25 years of experience in nutritional science and research, he currently serves as a faculty member at the University of Bridgeport and Associate Director of the Nutrition Track within its Doctor of Health Sciences program. His work focuses on evidence-based nutritional science and developing nutrition intervention protocols for chronic disease. To learn more, visit https://www.designsforhealth.com/ or send an email to ocoetzee@designsforhealth.com. 
 
About Your Host
Steve Hoffart is an award-winning pharmacist, entrepreneur, speaker and podcaster. As the visionary founder of Magnolia Pharmacy, Steve saw a need for a more personal pharmacy that could make a bigger impact. Today, Steve and his team of experts deliver on that promise, working with patients and their physicians to solve medication problems and offer personalized solutions to achieve better health and wellness. As host of The Trusted Pharmacist podcast and through his combined reach of over 1M on social media, Steve shares actionable advice on nutrition, supplements, and wellness strategies while advocating for meaningful change in healthcare.
 
Stay Ahead with Steve the Pharmacist!
Loving the show? Want more insights into how your body works? Head over to TheTrustedPharmacist.com and sign up with your email! You'll get the latest episodes, plus exclusive health tips to help you take charge of your wellness. Don't miss out – join me today!

What if the estrogen missing from your hormone therapy wasn't left out because it failed, but because no one could build a profitable drug around it?
Your body naturally produces three estrogens: estrone, estradiol, and estriol. Yet most hormone therapy replaces only estradiol. It is easy to assume that estriol was studied, found ineffective, and discarded. But that is not what happened. It didn't necessarily lose a scientific argument; it lost a business one, and over time, we mistook that silence for proof.
That missing conversation matters because estrogen does not produce the same effect everywhere in the body. And this could help explain why some women see their hot flashes disappear on estradiol while continuing to struggle with mood changes, disrupted sleep, brain fog, gut problems, recurrent UTIs, or unexplained inflammation. Their treatment may not be failing; it may simply be addressing only part of the hormonal picture.
In this episode, I talk about why you never hear about estriol, why it's not about effectiveness, and when to consider asking your doctor about it. 
What You'll Discover in This Episode
Why your body produces three estrogens, while most hormone therapy replaces only one

How estriol may have lost a business argument, not a scientific one

Why the absence of an FDA-approved estriol product does not automatically prove that estriol is ineffective

The crucial difference between a hormone binding to a receptor and fully activating it

How estrogen receptor alpha and estrogen receptor beta can produce very different effects throughout the body

Why estradiol can successfully relieve hot flashes while mood, sleep, memory, gut, or inflammatory symptoms remain

What research involving the brain, gut, immune system, and urogenital tissue suggests about receptor beta

What human multiple sclerosis trials may reveal about estriol's potential immune effects, and what those studies cannot yet prove

Why elevated cholesterol and metabolic health may further complicate estrogen receptor signaling

The strongest scientific objections to combination hormone therapy—and why they deserve serious answers

Why estriol being a "weaker" estrogen may be a feature in some formulations, not necessarily a flaw

How poorly timed blood tests can make a compounded hormone cream appear ineffective

What to ask your provider if your current estrogen therapy is helping, but you still do not feel like yourself

 
PS. If you enjoy the show, remember to leave a review on your favorite podcast app! Reviews help the podcast reach a wider audience and help more people.
 
Research Referenced in This Episode
Every study below includes a PubMed ID (PMID), which you can use to find the original paper at PubMed.
This episode discusses hormone therapy for educational purposes only. It is not medical advice or a substitute for a conversation with your healthcare provider about your symptoms, medical history, and treatment.
Estrogen Receptor Biology
Binding affinities of 74 naturally occurring estrogen metabolites at estrogen receptors alpha and beta. Estriol demonstrated preferential binding to ERβ.
Zhu BT, et al. Endocrinology. 2006. PMID: 16728493

Comparative transcriptional activity of estradiol at ERα and ERβ.
Bhavnani BR, et al. Endocrinology. 2008. PMID: 18599548

Crystal structure research examining how estradiol interacts with ERβ.
Souza PCT, et al. Scientific Reports. 2017. PMID: 28615710

27-hydroxycholesterol as a negative allosteric modifier of estradiol binding at ERβ.
Starkey NJE, et al. Endocrinology. 2018. PMID: 29579190

Brain, Mood, and Memory
Effects of an ERβ-selective agonist and estradiol on serotonergic neurons after ovariectomy.
Suzuki H, et al. Molecular Psychiatry. 2013. PMID: 22665260

Antidepressant effects of estradiol and an ERβ-selective agonist after long-term ovarian hormone deprivation.
Hou Y, et al. Journal of Psychiatry & Neuroscience. 2019. PMID: 30565903

Effects of ERβ activation on synaptic proteins, hippocampal signaling, and memory performance.
Liu F, et al. Nature Neuroscience. 2008. PMID: 18297067

Estriol treatment, cortical atrophy, remyelination, and neuronal preservation.
Meyer CE, et al. Laboratory Investigation. 2023. PMID: 37245852

ERβ-mediated neuroprotection independent of peripheral anti-inflammatory effects.
Tiwari-Woodruff S, et al. Proceedings of the National Academy of Sciences. 2007. PMID: 17785421

Gut Health
Effects of ERα- and ERβ-selective agonists and estradiol on intestinal cell proliferation and apoptosis.
Schleipen B, et al. Carcinogenesis. 2011. PMID: 21856997

The role of ERβ in intestinal tight junctions and gut permeability.
Braniste V, et al. American Journal of Physiology—Gastrointestinal and Liver Physiology. 2011. PMID: 21252046

How the gut microbiome and the estrobolome influence circulating estrogen.
Baker JM, et al. Maturitas. 2017. PMID: 28778332

Estriol and the Immune System
Immune markers in postmenopausal women receiving oral estradiol.
Itaborahy RM, de Medeiros SF. Climacteric. 2016. PMID: 27593223

Estriol treatment and changes in inflammatory and anti-inflammatory immune signals in women with multiple sclerosis.
Soldan SS, et al. Journal of Immunology. 2003. PMID: 14634144

Estriol-generated tolerogenic dendritic cells in an autoimmune model.
Papenfuss TL, et al. Journal of Immunology. 2011. PMID: 21317386

Estriol and pulmonary inflammatory gene expression during influenza infection.
Vermillion MS, Ursin RL, Klein SL, et al. Endocrinology. 2018. PMID: 30032246

Estriol regulation of TNF and IL-6 responses in a murine endotoxemia model.
Zuckerman SH, et al. Inflammation. 1996. PMID: 8979148

Review of estriol's immunomodulatory role across multiple sclerosis and other immune-mediated conditions.
Ali E, Mangold C, Peiris AN. Menopause. 2017. PMID: 28375935

Human Clinical Trials of Estriol
Phase I trial of oral estriol in women with relapsing-remitting multiple sclerosis. Inflammatory brain lesions decreased during treatment, returned after withdrawal, and decreased again when treatment resumed.
Sicotte NL, et al. Annals of Neurology. 2002. PMID: 12436153

Phase II randomized, placebo-controlled trial of estriol added to standard therapy in 164 women with relapsing-remitting multiple sclerosis.
Voskuhl RR, et al. The Lancet Neurology. 2016. PMID: 26621682

Estriol Physiology and Ovarian Function
Ovarian transplantation and immune function in post-reproductive mice.
King A, et al. Frontiers in Endocrinology. 2023. PMID: 36755910

Route of Administration and Inflammation
Changes in C-reactive protein among postmenopausal women using different hormone preparations in the PEPI trial.
Circulation. 1999. PMID: 10500035

Effects of oral and transdermal estradiol on C-reactive protein and other inflammatory markers.
Zegura B, et al. Atherosclerosis. 2003. PMID: 12732395

An Important Note About the Evidence
This research includes receptor pharmacology, animal studies, and human clinical trials conducted in specific patient populations, most notably women with multiple sclerosis. These different forms of evidence cannot automatically establish that estriol will produce the same benefits for every woman using menopausal hormone therapy.
There is currently no large randomized controlled trial directly comparing estradiol alone with combined estradiol-and-estriol therapy in postmenopausal women. There is also no equivalent trial establishing that estradiol alone replaces everything women may lose when natural production of all three estrogens declines.
The purpose of sharing this research is not to present estriol as a miracle or to suggest that women who are doing well on estradiol should change their treatment. It is to show why the scientific conversation remains open—and to give women and their healthcare providers the sources they need to examine the evidence for themselves.
 
About Your Host
Steve Hoffart is an award-winning pharmacist, entrepreneur, speaker and podcaster. As the visionary founder of Magnolia Pharmacy, Steve saw a need for a more personal pharmacy that could make a bigger impact. Today, Steve and his team of experts deliver on that promise, working with patients and their physicians to solve medication problems and offer personalized solutions to achieve better health and wellness. As host of The Trusted Pharmacist podcast and through his combined reach of over 1M on social media, Steve shares actionable advice on nutrition, supplements, and wellness strategies while advocating for meaningful change in healthcare.
 
Stay Ahead with Steve the Pharmacist!
Loving the show? Want more insights into how your body works? Head over to TheTrustedPharmacist.com and sign up with your email! You'll get the latest episodes, plus exclusive health tips to help you take charge of your wellness. Don't miss out – join me today!

What if your go-to sleep aid was keeping you from deep, restorative sleep?
People come into the pharmacy every day looking for over-the-counter sleep aids or sleep supplements, so I reached out to neurologist and sleep expert Dr Stasha Gominak. 
She has a very different view on what's disrupting our sleep, and practical steps we can take to transform our sleep.
 
What You'll Discover In This Episode 
How moving indoors wrecked the brain chemical our body needs

How common sleep aids disrupt our body's natural sleep process

The link between Vitamin D and sleep 

Sleep Trackers: The only metric that might actually be correct

The dosing mistake that might push you into Vitamin D deficiency

Practical dosing and timing for key vitamins 

 
About the Guest
Dr Stasha Gominak is a former practicing neurologist and the creator of RightSleep®, dividing her time between helping individuals, through virtual coaching sessions and teaching clinicians and coaches how to use RightSleep concepts to improve their patients' health and well being.
Dr Gominak completed a Neurology residency in 1989 at the Harvard-affiliated, Massachusetts General Hospital. In 2004 Dr. Gominak began to concentrate on treating neurological illness by improving sleep. She published a pivotal article in 2012 proposing that the global struggle with worsening sleep was linked to reduced sun exposure.
In 2016 she followed with a second article linking the change in the intestinal microbiome to the epidemic of poor sleep, and described a simple process for normalizing sleep and the intestinal bacterial population, called RightSleep®. 
Learn more about RightSleep® at https://drgominak.com/
 
About Your Host
Steve Hoffart is an award-winning pharmacist, entrepreneur, speaker and podcaster. As the visionary founder of Magnolia Pharmacy, Steve saw a need for a more personal pharmacy that could make a bigger impact. Today, Steve and his team of experts deliver on that promise, working with patients and their physicians to solve medication problems and offer personalized solutions to achieve better health and wellness. As host of The Trusted Pharmacist podcast and through his combined reach of over 1M on social media, Steve shares actionable advice on nutrition, supplements, and wellness strategies while advocating for meaningful change in healthcare.
 
Stay Ahead with Steve the Pharmacist!
Loving the show? Want more insights into how your body works? Head over to TheTrustedPharmacist.com and sign up with your email! You'll get the latest episodes, plus exclusive health tips to help you take charge of your wellness. Don't miss out – join me today!

Why do mitochondria come up so often in conversations about energy and longevity, but rarely when women are trying to understand what is happening to their bodies in menopause?
Most people have heard mitochondria described as the "powerhouse of the cell." But they also play a role in muscle function, recovery, cellular communication, and hormone production. As we age, damaged mitochondria can build up while the body becomes less efficient at clearing them away.
Could some of the fatigue, brain fog, reduced strength, and poor recovery women are told to accept as part of menopause or aging also be connected to declining mitochondrial health?
Perimenopause dietitian-nutritionist, Jen Scheinman, explains why mitochondria deserve a bigger place in the menopause conversation. 
We explore the connection between estrogen and mitochondrial function, how mitophagy helps remove damaged mitochondria, and how urolithin A may support that process.
What You'll Discover In This Episode 
Why mitochondria are often overlooked in menopause conversations

What mitochondria do beyond producing energy

How mitochondrial decline may contribute to fatigue and poor recovery

The connection between estrogen and mitochondrial function

What mitophagy is and why it slows with age

How urolithin A supports mitochondrial cleanup

How urolithin A differs from CoQ10 and NAD boosters

What the research suggests about strength, endurance, and recovery

Why mitochondrial support cannot replace sleep, exercise, and nutrition

PS. If you enjoy the show, remember to leave a review on your favorite podcast app! Reviews help the podcast reach a wider audience and help more people.
 
About the Guest
Jen Scheinman is a perimenopause dietitian-nutritionist, longevity and healthy aging expert, and women's health advocate. She holds a master's degree in integrative and functional nutrition and is the founder of Next Jen Health.
Jen also serves as Director of Science Communication at Timeline, where she helps translate emerging research on mitochondrial health, nutrition, and aging into practical guidance people can use to support their health and longevity.
Her expertise has been featured in publications including Vogue, Glamour, Mindbodygreen, and Eat This, Not That! To learn more, visit timeline.com and follow Jennifer on Instagram.
 
About Your Host
Steve Hoffart is an award-winning pharmacist, entrepreneur, speaker and podcaster. As the visionary founder of Magnolia Pharmacy, Steve saw a need for a more personal pharmacy that could make a bigger impact. Today, Steve and his team of experts deliver on that promise, working with patients and their physicians to solve medication problems and offer personalized solutions to achieve better health and wellness. As host of The Trusted Pharmacist podcast and through his combined reach of over 1M on social media, Steve shares actionable advice on nutrition, supplements, and wellness strategies while advocating for meaningful change in healthcare.
 
Stay Ahead with Steve the Pharmacist!
Loving the show? Want more insights into how your body works? Head over to TheTrustedPharmacist.com and sign up with your email! You'll get the latest episodes, plus exclusive health tips to help you take charge of your wellness. Don't miss out – join me today!