The Root Cause Medicine Podcast

What to do at the first sign of a cold: an evidence-informed toolkit

Dr. Holly Lucille, ND, is joined by Lara Zakaria, PharmD, MS, CNS, to discuss what people can do when a scratchy throat, fatigue, or other early respiratory symptoms begin. The conversation covers rest and recovery, respiratory virus testing, zinc, vitamin C, elderberry, echinacea, honey, green tea, garlic, ginger, turmeric, and practical ways to prepare for cold and flu season.

Early symptoms of COVID-19, influenza, and other respiratory infections can overlap, making symptom pattern alone an unreliable way to identify the cause. Testing, individual risk factors, symptom severity, and timing can all affect the appropriate next step. (CDC 2026a) (CDC 2025)

Clinical Takeaways
Start with the fundamentals: rest, fluids, testing when appropriate, and risk assessment. Most uncomplicated colds improve without specific treatment, and supportive measures such as adequate rest and fluids remain foundational. (CDC 2026b) Testing can help distinguish respiratory infections such as COVID-19 and influenza when the result may affect treatment or precautions, particularly for patients at higher risk of severe illness. (CDC 2025)
Zinc and vitamin C have different levels of evidence for the common cold. Zinc has been studied extensively, particularly as lozenges started early in a cold, but results vary substantially by formulation, dose, and study design. (Nault 2024) (Hemilä 2017) (Hemilä 2020) Regular vitamin C supplementation may modestly shorten cold duration, while evidence for starting vitamin C only after symptoms appear has been less consistent. Long-term or excessive zinc supplementation also warrants attention because sustained high intake can interfere with copper status. (NIH 2022)
Botanical evidence is ingredient- and formulation-specific. (Karsch-Völk 2014) Elderberry and echinacea have both been studied for respiratory infections, but findings are mixed and should not be generalized across products. (Wieland 2021) (Karsch-Völk 2014) (David 2019) Evidence for elderberry remains limited and uncertain, while echinacea studies vary considerably according to species, plant part, extraction method, and formulation. (Wieland 2021) (Karsch-Völk 2014) Garlic, green tea, ginger, turmeric, and honey may have nutritional or symptom-support roles, but they should not be presented as established treatments for viral respiratory infections. (Lissiman 2014) (Abuelgasim 2021)

Guest: Lara Zakaria, PharmD, MS, CNS
Lara Zakaria is a pharmacist and clinical nutritionist with a background spanning community pharmacy, functional medicine, and personalized nutrition. In this episode, she discusses how conventional pharmacy knowledge and nutrition can be brought together when thinking about early respiratory symptoms, supplement use, and practical supportive care.

Clinician FAQ
1. What should patients do when they first feel a cold coming on?
Supportive care is a reasonable starting point for uncomplicated symptoms. Rest, adequate fluids, and attention to symptom progression can help patients through a typical viral illness. Testing for COVID-19 or influenza may also be useful when results could affect treatment or precautions, particularly in higher-risk patients. (CDC 2026b) (CDC 2025)
Patients at increased risk for severe respiratory illness should contact a healthcare provider promptly because prescription antiviral treatment for influenza and COVID-19 is time-sensitive. (CDC 2026a)
2. Does zinc shorten a cold?
Possibly, but the evidence is formulation-dependent. (Nault 2024) Trials of zinc lozenges have produced conflicting findings, with some showing shorter illness duration and others showing no meaningful benefit. (Hemilä 2017) (Hemilä 2020) Differences in zinc salt, formulation, dose, timing, and lozenge composition complicate comparisons across studies. (Nault 2024)
This means findings from a specific zinc-lozenge trial should not automatically be extrapolated to zinc supplements in general. Prolonged high zinc intake can also impair copper absorption, making duration and total intake relevant to safety. (NIH 2022)
3. Should vitamin C be started when cold symptoms appear?
The evidence is stronger for regular supplementation than for starting vitamin C after symptoms begin. A large systematic review found that routine vitamin C supplementation did not substantially reduce cold incidence in the general population but was associated with modest reductions in cold duration. (Hemilä 2013) Trials starting vitamin C therapeutically after symptom onset have not demonstrated a consistent benefit. (Hemilä 2013)
Practitioners should therefore distinguish evidence for ongoing vitamin C intake from evidence for using vitamin C as an acute intervention.
4. Do elderberry and echinacea help with colds and respiratory infections?
The evidence is mixed. A systematic review of elderberry found that it may reduce the duration or severity of some viral respiratory illnesses, but the certainty of the evidence was insufficient for firm conclusions. (Wieland 2021) Echinacea research is complicated by substantial differences among preparations. (Karsch-Völk 2014) Systematic reviews and individual trials have reached differing conclusions, and some well-controlled studies have not found significant reductions in cold duration or severity. (Karsch-Völk 2014) (David 2019) Product-specific evidence matters when interpreting these findings.
5. When should respiratory symptoms prompt testing or medical evaluation?
Testing becomes particularly important when identifying COVID-19 or influenza could change treatment or precautions. (CDC 2025) Patients at higher risk for severe illness should seek healthcare promptly because antiviral treatments for influenza and COVID-19 work best when initiated early. (CDC 2026a) (CDC 2026b) Trouble breathing, chest pain or pressure, confusion, inability to stay awake, dehydration, severe weakness, or symptoms that improve and then significantly worsen warrant prompt medical assessment. (CDC 2026a)

Timestamps / Key Moments
00:03:00 Early signs that an illness may be developing
00:04:00 Temperature, heart rate, and HRV changes
00:06:35 When testing and medical evaluation may be appropriate
00:08:46 Why rest and recovery matter
00:09:55 Respiratory virus testing and RSV
00:12:15 Vitamin C and zinc
00:14:35 Vitamin C formulations and intake
00:15:24 Zinc supplements and lozenges
00:17:15 Long-term zinc intake and copper balance
00:20:30 Vitamin D status and seasonal preparation
00:22:33 Elderberry, echinacea, honey, and other botanicals
00:26:45 Symptom relief versus the underlying infection
00:30:20 Echinacea preparations
00:32:47 Green tea and EGCG
00:34:10 Garlic and allicin
00:35:15 Ginger and turmeric
00:36:49 Building a practical early-symptom toolkit

Nutrients and botanicals discussed
Zinc
Vitamin C
Vitamin D
Elderberry
Echinacea
Honey
Manuka honey
Green tea
EGCG
Garlic
Allicin
Ginger
Turmeric

Supportive strategies discussed
Rest and sleep
Hydration
Respiratory virus testing
Monitoring symptoms
Reviewing wearable trends
Warm fluids and tea
Supplement preparation before cold and flu season
Evaluating zinc intake and copper balance
Individualizing supplement use

Want to elevate your practice?
This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript helps clinicians bring supplement dispensing, lab ordering, and patient education into one centralized workflow.
For more practitioner education on supplements, nutrition, and evidence-informed clinical care, visit Fullscript Academy at academy.fullscript.com.

Disclaimer
The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for informational and educational purposes only and is not medical advice. Dietary supplements can cause adverse effects and interact with medications. Patients should consult a qualified healthcare professional when symptoms are severe, persistent, worsening, or when individual health conditions or medications may affect appropriate care.

References
Abuelgasim, H., Albury, C., & Lee, J. (2021). Effectiveness of honey for symptomatic relief in upper respiratory tract infections: A systematic review and meta-analysis. BMJ Evidence-Based Medicine, 26(2), 57–64. https://doi.org/10.1136/bmjebm-2020-111336
Centers for Disease Control and Prevention. (2025, August 18). Testing and respiratory viruses. https://www.cdc.gov/respiratory-viruses/prevention/testing.html
Centers for Disease Control and Prevention. (2026a, September 10). About respiratory illnesses. https://www.cdc.gov/respiratory-viruses/about/index.html
Centers for Disease Control and Prevention. (2026b, March 11). Manage common cold. https://www.cdc.gov/common-cold/treatment/index.html
David, S., & Cunningham, R. (2019). Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. Complementary Therapies in Medicine, 44, 18–26. https://doi.org/10.1016/j.ctim.2019.03.011
Hemilä, H., & Chalker, E. (2013). Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews, 2013(1), Article CD000980. https://doi.org/10.1002/14651858.CD000980.pub4
Hemilä, H., Fitzgerald, J. T., Petrus, E. J., & Prasad, A. (2017). Zinc acetate lozenges may improve the recovery rate of common cold patients: An individual patient data meta-analysis. Open Forum Infectious Diseases, 4(2), ofx059. https://doi.org/10.1093/ofid/ofx059
Hemilä, H., Haukka, J., Alho, M., Vahtera, J., & Kivimäki, M. (2020). Zinc acetate lozenges for the treatment of the common cold: A randomised controlled trial. BMJ Open, 10(1), e031662. https://doi.org/10.1136/bmjopen-2019-031662
Karsch-Völk, M., Barrett, B., Kiefer, D., Bauer, R., Ardjomand-Woelkart, K., & Linde, K. (2014). Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews, 2014(2), Article CD000530. https://doi.org/10.1002/14651858.CD000530.pub3
Lissiman, E., Bhasale, A. L., & Cohen, M. (2014). Garlic for the common cold. Cochrane Database of Systematic Reviews, 2014(11), Article CD006206. https://doi.org/10.1002/14651858.CD006206.pub4
National Institutes of Health, Office of Dietary Supplements. (2022). Copper: Fact sheet for health professionals. Retrieved October 21, 2026, from https://ods.od.nih.gov/factsheets/Copper-HealthProfessional/
Nault, D., Machingo, T. A., Shipper, A. G., Antiporta, D. A., Hamel, C., Nourouzpour, S., Konstantinidis, M., Phillips, E., Lipski, E. A., & Wieland, L. S. (2024). Zinc for prevention and treatment of the common cold. Cochrane Database of Systematic Reviews, 2024(5), Article CD014914. https://doi.org/10.1002/14651858.CD014914.pub2
Wieland, L. S., Piechotta, V., Feinberg, T., Ludeman, E., Hutton, B., Kanji, S., Seely, D., & Garritty, C. (2021). Elderberry for prevention and treatment of viral respiratory illnesses: A systematic review. BMC Complementary Medicine and Therapies, 21(1), 112. https://doi.org/10.1186/s12906-021-03283-5

Health Meets Wellness: The App and Dr. Edens’ Story

Dr. Elizabeth Sharp Edens is the founder of Health Meets Wellness, an integrative practice where every patient gets three plans: a medical plan, a movement plan and a nutrition plan. Guideline-based medicine is her North Star, and she layers in nutrition, yoga, herbal therapies and acupuncture, with dietitians on her team. It’s whole-person care built around how each patient actually lives.

But she didn’t stop at the exam room. She’s spent three years building the Health Meets Wellness app to bring that same care to patients between visits, and to people far beyond her own practice. It features meal plans, photo food logging, an AI health coach, symptom tracking for patients on GLP-1s, yoga videos she filmed herself, and 20-minute, no-equipment strength workouts developed with a former Milwaukee Bucks performance lead. Now it’s being rebranded for women, with cycle tracking that adapts meal and exercise plans to each phase. There’s a free version, and practitioners can use it with their own patients.

Elizabeth is double board-certified in internal medicine and obesity medicine, certified in functional medicine and a certified yoga instructor, and her path ran through Mount Sinai, a healthcare startup and One Medical. We talk about how she built her practice and her app without a tech background, why she became a yoga teacher, and how she supports patients on GLP-1s with movement and nutrition.

If you love whole-person care but work in a hospital or conventional system without a roadmap, this one’s for you.

Timestamps
03:33 — What drew Dr. Elizabeth to medicine, and then to functional medicine
08:15 — What her practice looks like today
11:25 — From Mount Sinai to a startup to One Medical to her own practice
14:14 — How to find opportunities beyond one-to-one care
18:38 — Why she built an app, and why it’s designed for women
25:54 — Advice if you’re not tech-savvy
28:57 — Why she became a yoga teacher + fitting training into a full schedule
32:25 — Metabolic health and what she sees as non-negotiable with GLP-1s
35:41 — Movement on a GLP-1: building and measuring muscle at home

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

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

Dr. Oscar Coetzee joins Dr Lara Zakaria on the Root Cause Medicine Podcast to discuss emerging research on keystone commensal organisms and how microbial communities interact within the gut ecosystem.

The conversation focuses on organisms including Akkermansia muciniphila, Faecalibacterium prausnitzii, Roseburia, Bifidobacterium longum, and Bifidobacterium adolescentis. Rather than viewing individual microbes in isolation, Dr. Coetzee describes an ecosystem model centered on cross-feeding, short-chain fatty acid production, and the intestinal environment.

The episode also notes an important context: research on next-generation commensals is still developing, meaning findings from mechanistic studies, case reports, and early clinical research offer initial insights that complement rather than replace evidence from larger randomized controlled trials. (Jan 2024) (Kern 2026)

Clinical takeaways
Keystone organisms are discussed as members of an interconnected ecosystem. The episode explores how organisms can produce metabolites or modify environmental conditions that may influence other members of the microbial community. (Belzer 2017) (Fusco 2023)
Short-chain fatty acids are a major theme. Akkermansia, Faecalibacterium, and Roseburia are discussed in relation to acetate, propionate, and butyrate production and their potential roles within the intestinal environment. (Martin-Gallausiaux 2021) (Tingler 2025)
Clinical evidence remains emerging. Dr. Coetzee describes early clinical observations and studies in progress, while the conversation acknowledges the need for additional published research, including controlled trials, before broader clinical conclusions can be drawn. (Jan 2024) (Kern 2026)

Guest: Oscar Coetzee, PhD, DCN
Dr. Oscar Coetzee is Vice President of Clinical Education and Practitioner Support at Designs for Health. In the episode, he discusses his work in nutrition and microbiome research and his interest in next-generation commensal organisms.
His discussion centers on moving beyond a single-organism view of probiotics toward understanding microbial communities, cross-feeding, and the environment in which commensal organisms coexist.

Clinician FAQ

1. What are keystone commensal organisms?
They are microbes discussed for their potentially important roles within the broader gut ecosystem. (Rios Garza 2026)
The episode focuses on how selected commensals interact with other organisms and their environment rather than evaluating them solely by abundance. (Banerjee 2018)

2. Which organisms are discussed?
The main organisms include Akkermansia muciniphila, Faecalibacterium prausnitzii, Roseburia, Bifidobacterium longum, and Bifidobacterium adolescentis.
The conversation also discusses Anaerostipes caccae separately in the context of butyrate production and microbial cross-feeding. (Belzer 2017)

3. What is microbial cross-feeding?
Cross-feeding describes how metabolites produced by one organism can serve as substrates or influence conditions for another. (Culp 2023) (Louis 2017)
The episode uses this concept to explain why microbial communities may be more informative than considering individual organisms in isolation. (Culp 2023)

4. Why are short-chain fatty acids discussed?
They are microbial metabolites that form part of the communication between gut microbes and their environment. (Martin-Gallausiaux 2021)
The conversation highlights acetate, propionate, and butyrate while exploring how different commensal organisms contribute to their production. (Martin-Gallausiaux 2021)

5. How established is the clinical evidence?
Research on these next-generation commensals is still evolving. (Jan 2024) (Kern 2026)
The guest describes case observations, prospective studies, and additional research underway. These early findings can generate hypotheses, but they do not establish that a specific probiotic combination prevents or treats disease.

Timestamps / key moments
00:00:00 Introducing keystone commensal organisms
00:05:35 Why newer technology matters for anaerobic microbes
00:08:09 Moving beyond probiotic quantity and individual strains
00:13:32 Microbial compensation and ecosystem dynamics
00:18:00 Keystone organisms and emerging clinical observations
00:21:28 Akkermansia and microbial metabolites
00:24:08 Faecalibacterium prausnitzii and butyrate
00:30:49 Roseburia and the anaerobic environment
00:32:24 Bifidobacterium species in the microbial community
00:35:52 Anaerostipes caccae and cross-feeding
00:39:58 Supporting the microbial ecosystem
00:44:18 Current research and evidence limitations
00:48:02 Clinical considerations and unanswered questions
01:02:15 Future research and closing discussion

Want to learn more about microbiome science?
This episode highlights an evolving way of thinking about the microbiome: not simply as a collection of individual organisms, but as an ecosystem shaped by microbial interactions, metabolites, available substrates, and environmental conditions.
For additional practitioner education on supplement quality and clinical decision-making, visit Fullscript Academy.

Disclaimer
The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations.
This episode is for informational and educational purposes only and is not medical advice. Research on next-generation commensal organisms and related probiotic formulations is evolving, and emerging findings should be interpreted in the context of the strength and limitations of the available evidence.

References
Banerjee, S., Schlaeppi, K., & van der Heijden, M. G. A. (2018). Keystone taxa as drivers of microbiome structure and functioning. Nature Reviews Microbiology, 16(9), 567–576. https://doi.org/10.1038/s41579-018-0024-1
Belzer, C., Chia, L. W., Aalvink, S., Chamlagain, B., Piironen, V., Knol, J., & de Vos, W. M. (2017). Microbial metabolic networks at the mucus layer lead to diet-independent butyrate and vitamin B12 production by intestinal symbionts. mBio, 8(5), e00770-17. https://doi.org/10.1128/mBio.00770-17
Culp, E. J., & Goodman, A. L. (2023). Cross-feeding in the gut microbiome: Ecology and mechanisms. Cell Host & Microbe, 31(4), 485–499. https://doi.org/10.1016/j.chom.2023.03.016
Fusco, W., Lorenzo, M. B., Cintoni, M., Porcari, S., Rinninella, E., Kaitsas, F., Lener, E., Mele, M. C., Gasbarrini, A., Collado, M. C., Cammarota, G., & Ianiro, G. (2023). Short-chain fatty-acid-producing bacteria: Key components of the human gut microbiota. Nutrients, 15(9), 2211. https://doi.org/10.3390/nu15092211
Jan, T., Negi, R., Sharma, B., Kumar, S., Singh, S., Rai, A. K., Shreaz, S., Rustagi, S., Chaudhary, N., Kaur, T., Kour, D., Sheikh, M. A., Kumar, K., Yadav, A. N., & Ahmed, N. (2024). Next generation probiotics for human health: An emerging perspective. Heliyon, 10(16), e35980. https://doi.org/10.1016/j.heliyon.2024.e35980
Kern, L., Tofield, A., Frame, J., & Elinav, E. (2026). Next-generation probiotics: An outlook into current applications and future developments. Nature Reviews Microbiology, 24(8), 539–558. https://doi.org/10.1038/s41579-026-01311-0
Louis, P., & Flint, H. J. (2017). Formation of propionate and butyrate by the human colonic microbiota. Environmental Microbiology, 19(1), 29–41. https://doi.org/10.1111/1462-2920.13589
Martin-Gallausiaux, C., Marinelli, L., Blottière, H. M., Larraufie, P., & Lapaque, N. (2021). SCFA: Mechanisms and functional importance in the gut. Proceedings of the Nutrition Society, 80(1), 37–49. https://doi.org/10.1017/S0029665120006916
Rios Garza, D., Gonze, D., & Faust, K. (2026). Keystone concept revisited: Insights into microbial community dynamics and control. Nature Reviews Microbiology, 24(5), 359–371. https://doi.org/10.1038/s41579-025-01266-8
Tingler, A. M., & Engevik, M. A. (2025). Breaking down barriers: Is intestinal mucus degradation by Akkermansia muciniphila beneficial or harmful? Infection and Immunity, 93(9), e0050324. https://doi.org/10.1128/iai.00503-24

Dr. Eric Viegas joins the Root Cause Medicine Podcast to discuss an often-overlooked part of evaluating botanical supplements for menopause: whether the product being used actually matches the ingredient that was studied.
The conversation focuses on five botanicals and botanical categories—black cohosh, Vitex (chasteberry), rhapontic rhubarb, maca, and soy isoflavones. Rather than framing individual herbs as simply effective or ineffective, Dr. Viegas emphasizes three considerations: identity, standardization, and patience.

Identity refers to confirming the correct plant species and plant part. Standardization addresses whether relevant constituents or studied extracts are consistently represented in a product. Patience refers to allowing an appropriate evaluation period rather than judging a botanical after only a few days of use.

Clinical takeaways
Botanical evidence is closely tied to the ingredient that was actually studied. Dr. Viegas emphasizes that results from research on a particular species, plant part, extract, or standardized preparation cannot automatically be generalized to every product carrying the same botanical name.
Black cohosh has a substantial research history, but product characteristics matter. The episode discusses Actaea racemosa and the importance of confirming botanical identity, the appropriate plant part, and the characteristics of the extract being used. Standardized preparations feature prominently in the research discussed. (Castelo-Branco 2021) (NIDDK 2025)
Vitex is discussed primarily in the context of cyclical symptoms and perimenopause. Also known as chasteberry (Vitex agnus-castus), Vitex is presented as having a stronger research history for premenstrual and cyclical symptoms than for classic postmenopausal symptoms. The episode also highlights variation in extracts and marker compounds. (Csupor 2019)
Rhapontic rhubarb illustrates the importance of extract-specific evidence. The discussion focuses on the studied rhapontic rhubarb extract ERr 731 rather than treating all rhubarb preparations as interchangeable. This provides an example of why practitioners should identify the exact preparation evaluated in clinical research. (Dubey 2024)
Maca presents additional standardization challenges. The episode discusses differences among maca varieties and processing methods and notes that there is not one universally dominant marker used across all products. Maca is discussed in relation to menopausal symptoms, mood, and sexual function without positioning it as a direct hormone replacement. (Lee 2011)
Soy isoflavone response may vary between individuals and formulations. The conversation highlights differences among individual isoflavones and discusses equol production as one possible contributor to variability in response. (Mayo 2019)
Time is part of interpreting a botanical trial. A recurring theme throughout the episode is that botanical interventions studied over weeks or months should not necessarily be judged after a very short trial. Appropriate duration depends on the ingredient, formulation, patient, and clinical context.

Guest: Eric Viegas, ND
Dr. Eric Viegas is a naturopathic doctor based in Ottawa, Canada, and works with Fullscript’s quality program.
In the episode, he describes Fullscript’s approach to supplement quality, including supplier qualification and review of product documentation. He also discusses Fullscript Tested, a program in which products are selected from Fullscript distribution centers and submitted to third-party laboratories for testing related to factors such as identity, potency, and contaminants.
His discussion of menopause botanicals centers on connecting published research with the practical question practitioners face when evaluating supplements: Does the ingredient in the product correspond to the ingredient evaluated in the research?

Clinician FAQ

1. What do identity and standardization mean for botanical supplements?
Identity refers to confirming what botanical material is actually present, while standardization addresses consistency in relevant constituents or preparations.
Depending on the botanical, identity can include species, plant part, variety, and other characteristics. Standardization may involve a marker compound, defined extract, or another specification associated with the preparation used in research.

2. Why does the episode focus on patience?
Because botanical research generally evaluates outcomes over a defined period rather than after only a few doses.
Dr. Viegas argues that stopping a botanical substantially earlier than the period evaluated in research can make it difficult to determine whether the preparation received a meaningful trial. The appropriate evaluation period varies by ingredient and clinical context.

3. What does the episode say about black cohosh?
Black cohosh is presented as a botanical for which product identity and extract characteristics can affect how research is interpreted.
The discussion focuses on Actaea racemosa, particularly root and rhizome preparations, and distinguishes studied standardized extracts from unspecified black cohosh products. (Castelo-Branco 2021) (NIDDK 2025)

4. Is Vitex primarily a menopause botanical?
The episode describes its strongest evidence base as being related to premenstrual and cyclical symptoms rather than classic menopause symptoms. (Csupor 2019)
Dr. Viegas discusses why Vitex may nevertheless appear in conversations about perimenopause and also notes that some research evaluates it as part of multi-ingredient botanical combinations.

5. What is different about rhapontic rhubarb?
The discussion centers on a specific studied extract rather than rhapontic rhubarb as a broad ingredient category.
Dr. Viegas identifies ERr 731 as the preparation featured in the research discussed during the episode. This serves as an example of why botanical extract identity can matter when translating research findings to commercial products. (Dubey 2024)

6. What quality considerations are discussed for maca?
The episode highlights botanical variety, processing, and the absence of a single universally dominant standardization marker. (Lee 2011)
Different maca varieties and processing approaches can make product-to-product comparisons more complicated than simply confirming that “maca” appears on the label.

7. Why might people respond differently to soy isoflavones?
Both formulation and individual biology may contribute to variation.
The episode discusses differences among isoflavones and describes the conversion of daidzein to equol by certain gut microorganisms as one potential source of individual variation. (Mayo 2019)

8. Does a botanical's presence on the label mean it matches the clinical research?
Not necessarily.
The episode emphasizes checking the species, plant part, preparation or extract, relevant standardization information, and other product specifications before assuming that findings from a particular study apply to another formulation.

Timestamps / key moments
00:00:00 Introducing menopause botanicals, identity, standardization, and patience
00:02:59 The three themes: identity, standardization, and patience
00:04:15 Black cohosh and its research history
00:07:41 Standardized black cohosh extracts and product testing
00:10:13 Vitex (chasteberry) and where it fits clinically
00:14:14 Introducing rhapontic rhubarb
00:16:28 Maca, menopause, libido, and mood
00:20:04 Soy isoflavones and the evidence discussion
00:21:15 Daidzein, equol, and individual response
00:22:54 Soy isoflavones and evaluation over time
00:25:08 Fullscript Academy and closing remarks

Want to learn more about supplement quality?
This episode highlights how botanical identity, standardization, formulation, and research design can affect the way practitioners interpret supplement evidence.
For additional practitioner education on supplement quality and clinical decision-making, visit Fullscript Academy.
The goal is not to reduce botanical selection to a single marker or label claim, but to help practitioners evaluate whether a product meaningfully corresponds to the ingredient and preparation described in the available evidence.

Disclaimer
The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations.
This episode is for informational and educational purposes only and is not medical advice. Botanical supplements may have contraindications, adverse effects, and medication interactions, and suitability can vary by patient. Patients should consult a qualified healthcare professional before making changes to their healthcare routine.

References
Castelo-Branco, C., Gambacciani, M., Cano, A., Minkin, M. J., Rachoń, D., Ruan, X., Beer, A.-M., Schnitker, J., Henneicke-von Zepelin, H.-H., & Pickartz, S. (2021). Review & meta-analysis: Isopropanolic black cohosh extract iCR for menopausal symptoms – an update on the evidence. Climacteric, 24(2), 109–119. https://pubmed.ncbi.nlm.nih.gov/33021111/
Csupor, D., Lantos, T., Hegyi, P., Benkő, R., Viola, R., Gyöngyi, Z., Csécsei, P., Tóth, B., Vasas, A., Márta, K., Rostás, I., Szentesi, A., & Matuz, M. (2019). Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complementary Therapies in Medicine, 47, 102190. https://pubmed.ncbi.nlm.nih.gov/31780016/
Dubey, V. P., Sureja, V. P., & Kheni, D. B. (2024). Efficacy evaluation of standardized Rheum rhaponticum root extract (ERr 731) on symptoms of menopause: A systematic review and meta-analysis study. Journal of Biomedical Research, 38(3), 278–286. https://pubmed.ncbi.nlm.nih.gov/38646867/
Lee, M. S., Shin, B.-C., Yang, E. J., Lim, H.-J., & Ernst, E. (2011). Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas, 70(3), 227–233. https://pubmed.ncbi.nlm.nih.gov/21840656/
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2025). Black cohosh. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/NBK547990/
Mayo, B., Vázquez, L., & Flórez, A. B. (2019). Equol: A bacterial metabolite from the daidzein isoflavone and its presumed beneficial health effects. Nutrients, 11(9), 2231. https://www.mdpi.com/2072-6643/11/9/2231

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

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

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

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

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

Want to elevate your practice? This episode is sponsored by Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.

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