The Root Cause Medicine Podcast

On the Root Cause Medicine Podcast, Dr. Lara Zakaria joins Dr. Malisa Carulo to explore specialized pro-resolving mediators (SPMs), omega-3-derived precursors, and emerging pain research, with a focus on evidence limits and clinical decision-making.Clinical TakeawaysDistinguish SPMs from their precursors. TSPMs are lipid signals that help steer inflammation toward resolution. (Serhan 2018) SPM-focused marine-oil supplements contain upstream intermediates, a few enzymatic steps closer to finished SPMs than EPA and DHA, but these are not equivalent to finished SPMs. (Souza 2020)Separate mechanisms from clinical outcomes.  condition.Mechanistic research outpaces human trials, which so far center on pain and musculoskeletal conditions such as osteoarthritis. (Callan 2020) (Möller 2023) Evidence does not yet support broad benefits for autoimmune disease, gut health, or every inflammatory condition.Keep clinical response central. The conversation emphasizes pain, stiffness, and mobility alongside foundational care. Acute high-dose strategies and bedtime use are discussed as anecdotes, not validated protocols.GuestDr. Malisa Carulo holds a doctorate in naturopathic medicine and an MS in biology. Introduced as Senior Manager of Medical Information and Safety at Metagenics, her interests include chronic disease, healthy aging, and sports medicine.Clinician FAQ1. What are specialized pro-resolving mediators?SPMs, including resolvins, protectins, and maresins, as lipid signals involved in the active resolution of inflammation. (Serhan 2018)2. How do SPM-focused supplements differ from fish oil?The guest distinguishes EPA and DHA from downstream intermediates such as 18-HEPE, 17-HDHA, and 14-HDHA. This distinction alone does not establish superior clinical outcomes. (Möller 2023)3. What evidence for SPMs and joint pain does the episode discuss?The guest highlights early human research in musculoskeletal pain, including osteoarthritis, while acknowledging that clinical evidence remains limited relative to mechanistic research. (Callan 2020) (Möller 2023)4. Are SPM supplements established therapies for autoimmune or gut conditions?The discussion does not establish that use. The guest describes clinical experiences and biological hypotheses rather than condition-specific evidence sufficient to support broad treatment claims.5. Does the episode establish an SPM dosing protocol?No. Studies have used doses ranging from about 250 mg per day in early research to 500 mg and 1 g in human trials, but the guest cautions that evidence-guided dosing recommendations remain limited. (Callan 2020) (Möller 2023)Key Moments03:56 SPM biology and marine-oil intermediates07:42 Conversion pathways and inflammation resolution11:15 Mechanistic research versus human evidence13:21 Evaluating formulations and clinical outcomes18:44 Measurement limitations and pain research24:38 Dosing discussion and anecdotal strategies30:25 Tracking pain, stiffness, and mobilityDisclaimerThe views expressed on this podcast are those of the hosts and the guests, and they don't necessarily reflect the views of FullScript or any affiliated organizations. This podcast is for informational and educational purposes only, and it's not intended to be medical advice. For your safety, always check with your healthcare provider before making any changes to your healthcare routine.ReferencesCallan, N., Hanes, D., & Bradley, R. (2020). Early evidence of efficacy for orally administered SPM-enriched marine lipid fraction on quality of life and pain in a sample of adults with chronic pain. Journal of Translational Medicine, 18(1), Article 401. https://doi.org/10.1186/s12967-020-02569-5Möller, I., Rodas, G., Villalón, J. M., Rodas, J. A., Angulo, F., Martínez, N., & Vergés, J. (2023). Randomized, double-blind, placebo-controlled study to evaluate the effect of treatment with an SPMs-enriched oil on chronic pain and inflammation, functionality, and quality of life in patients with symptomatic knee osteoarthritis: GAUDI study. Journal of Translational Medicine, 21(1), Article 423. https://doi.org/10.1186/s12967-023-04283-4 Serhan, C. N., & Levy, B. D. (2018). Resolvins in inflammation: Emergence of the pro-resolving superfamily of mediators. Journal of Clinical Investigation, 128(7), 2657–2669. https://doi.org/10.1172/JCI97943Souza, P. R., Marques, R. M., Gomez, E. A., Colas, R. A., De Matteis, R., Zak, A., Patel, M., Collier, D. J., & Dalli, J. (2020). Enriched marine oil supplements increase peripheral blood specialized pro-resolving mediators concentrations and reprogram host immune responses: A randomized double-blind placebo-controlled study. Circulation Research, 126(1), 75–90. https://doi.org/10.1161/CIRCRESAHA.119.315506

Dr. Kate Kresge is joined by psychiatrist James Greenblatt, MD, to discuss themes from his book Finally Hopeful, including nutrition, depression, laboratory assessment, and antidepressant withdrawal.Clinical TakeawaysDepression warrants a broad clinical assessment. Symptoms may overlap with medical conditions and nutritional deficiencies. (Bode 2021) (Lee 2020) (Bender 2017) The episode discusses thyroid function, iron, vitamin B12, folate, vitamin D, and other factors as part of a broader evaluation—not as universal causes of depression.Antidepressant discontinuation should be individualized. Abruptly stopping an antidepressant can cause withdrawal symptoms. (Henssler 2024) (Horowitz 2019) Gradual, clinician-supervised tapering is important; nutritional status may also be considered, although supplementation has not been established as a way to prevent withdrawal. (Horowitz 2019)Nutrition can be considered within whole-person mental healthcare. Protein, amino acids, omega-3 fatty acids, B vitamins, zinc, and magnesium are discussed. Testing and supplementation should reflect individual needs rather than assuming a common deficiency.Guest: James Greenblatt, MDJames Greenblatt, MD, is a psychiatrist and educator in integrative and functional psychiatry. He discusses a whole-person framework for evaluating depression, nutritional status, and antidepressant discontinuation.Clinician FAQ1. Can nutritional deficiencies contribute to depressive symptoms?Yes, nutritional status can be clinically relevant, but depression is multifactorial. (Bender 2017) (Malhi 2018) The episode discusses iron, vitamin B12, folate, vitamin D, zinc, and other nutrients clinicians may evaluate when appropriate.2. Why distinguish antidepressant withdrawal from depression?Withdrawal can occur when antidepressants are reduced or stopped, and symptoms may overlap with psychiatric symptoms. (Henssler 2024) (Horowitz 2019) Distinguishing withdrawal from recurrence of depression is important during discontinuation. (Horowitz 2019) 3. Should nutritional status be assessed before antidepressant tapering?The episode proposes evaluating nutritional status before and during tapering. Medication changes should be individualized and managed with the prescribing clinician.4. What role do amino acids play in mental health?Amino acids from dietary protein are precursors for many biologically important molecules, including neurotransmitters. (Tang 2025) The episode discusses amino acid assessment as part of Dr. Greenblatt’s clinical approach.5. Why screen for medical conditions in patients with depression?Some medical conditions may produce symptoms that resemble or coexist with depression. (Bode 2021) (Lee 2020) (Clappison 2020) The episode highlights thyroid disorders, anemia, and celiac disease as examples clinicians may investigate when clinically indicated.Key Moments03:44 Whole-person framework for depression07:46 Antidepressant withdrawal11:29 Nutritional assessment before tapering23:23 Amino acids and nutrition37:26 B vitamins and minerals46:15 Depression and celiac disease caseDisclaimerThe views expressed on this podcast are those of the hosts and the guests, and they don't necessarily reflect the views of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only, and it's not intended to be medical advice. For your safety, always check with your healthcare provider before making any changes to your healthcare routine.ReferencesBender, A., Hagan, K. E., & Kingston, N. (2017). The association of folate and depression: A meta-analysis. Journal of Psychiatric Research, 95, 9–18. https://doi.org/10.1016/j.jpsychires.2017.07.019Bode, H., Ivens, B., Bschor, T., Schwarzer, G., Henssler, J., & Baethge, C. (2021). Association of hypothyroidism and clinical depression: A systematic review and meta-analysis. JAMA Psychiatry, 78(12), 1375–1383. https://doi.org/10.1001/jamapsychiatry.2021.2506Clappison, E., Hadjivassiliou, M., & Zis, P. (2020). Psychiatric manifestations of coeliac disease, a systematic review and meta-analysis. Nutrients, 12(1), 142. https://doi.org/10.3390/nu12010142Henssler, J., Schmidt, Y., Schmidt, U., Schwarzer, G., Bschor, T., & Baethge, C. (2024). Incidence of antidepressant discontinuation symptoms: A systematic review and meta-analysis. The Lancet Psychiatry, 11(7), 526–535. https://doi.org/10.1016/S2215-0366(24)00133-0Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538–546. https://doi.org/10.1016/S2215-0366(19)30032-XLee, Y.-J., & Kim, H.-B. (2020). Association between anaemia and adult depression: A systematic review and meta-analysis of observational studies. Journal of Epidemiology and Community Health, 74(7), 565–572. https://doi.org/10.1136/jech-2020-213842Malhi, G. S., & Mann, J. J. (2018). Depression. The Lancet, 392(10161), 2299–2312. https://doi.org/10.1016/S0140-6736(18)31948-2Tang, J., Krushelnycky, L., Shaqo, A., & Cho, C. E. (2025). A comprehensive review of nutritional influences on the serotonergic system. Advances in Nutrition, 16(11), 100524. https://doi.org/10.1016/j.advnut.2025.100524

What to do at the first sign of a cold: an evidence-informed toolkitDr. 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 TakeawaysStart 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, CNSLara 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 FAQ1. 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 Moments00:03:00 Early signs that an illness may be developing00:04:00 Temperature, heart rate, and HRV changes00:06:35 When testing and medical evaluation may be appropriate00:08:46 Why rest and recovery matter00:09:55 Respiratory virus testing and RSV00:12:15 Vitamin C and zinc00:14:35 Vitamin C formulations and intake00:15:24 Zinc supplements and lozenges00:17:15 Long-term zinc intake and copper balance00:20:30 Vitamin D status and seasonal preparation00:22:33 Elderberry, echinacea, honey, and other botanicals00:26:45 Symptom relief versus the underlying infection00:30:20 Echinacea preparations00:32:47 Green tea and EGCG00:34:10 Garlic and allicin00:35:15 Ginger and turmeric00:36:49 Building a practical early-symptom toolkitNutrients and botanicals discussedZincVitamin CVitamin DElderberryEchinaceaHoneyManuka honeyGreen teaEGCGGarlicAllicinGingerTurmericSupportive strategies discussedRest and sleepHydrationRespiratory virus testingMonitoring symptomsReviewing wearable trendsWarm fluids and teaSupplement preparation before cold and flu seasonEvaluating zinc intake and copper balanceIndividualizing supplement useWant 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.DisclaimerThe 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.ReferencesAbuelgasim, 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-2020-111336Centers for Disease Control and Prevention. (2025, August 18). Testing and respiratory viruses. https://www.cdc.gov/respiratory-viruses/prevention/testing.htmlCenters for Disease Control and Prevention. (2026a, September 10). About respiratory illnesses. https://www.cdc.gov/respiratory-viruses/about/index.htmlCenters for Disease Control and Prevention. (2026b, March 11). Manage common cold. https://www.cdc.gov/common-cold/treatment/index.htmlDavid, 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.2019.03.011Hemilä, 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.pub4Hemilä, 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/ofx059Hemilä, 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-2019-031662Karsch-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, 201

Health Meets Wellness: The App and Dr. Edens’ StoryDr. 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.Timestamps03:33 — What drew Dr. Elizabeth to medicine, and then to functional medicine08:15 — What her practice looks like today11:25 — From Mount Sinai to a startup to One Medical to her own practice14:14 — How to find opportunities beyond one-to-one care18:38 — Why she built an app, and why it’s designed for women25:54 — Advice if you’re not tech-savvy28:57 — Why she became a yoga teacher + fitting training into a full schedule32:25 — Metabolic health and what she sees as non-negotiable with GLP-1s35:41 — Movement on a GLP-1: building and measuring muscle at homeWant 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 takeawaysKeystone 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, DCNDr. 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 FAQ1. 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 moments00:00:00 Introducing keystone commensal organisms00:05:35 Why newer technology matters for anaerobic microbes00:08:09 Moving beyond probiotic quantity and individual strains00:13:32 Microbial compensation and ecosystem dynamics00:18:00 Keystone organisms and emerging clinical observations00:21:28 Akkermansia and microbial metabolites00:24:08 Faecalibacterium prausnitzii and butyrate00:30:49 Roseburia and the anaerobic environment00:32:24 Bifidobacterium species in the microbial community00:35:52 Anaerostipes caccae and cross-feeding00:39:58 Supporting the microbial ecosystem00:44:18 Current research and evidence limitations00:48:02 Clinical considerations and unanswered questions01:02:15 Future research and closing discussionWant 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.DisclaimerThe 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.ReferencesBanerjee, 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/s41579-018-0024-1Belzer, 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.00770-17Culp, 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.2023.03.016Fusco, 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/nu15092211Jan, 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.e35980Kern, 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/s41579-026-01311-0Louis, P., & Flint, H. J. (2017). Formation of propionate and butyrate by the human colonic microbiota. Environmental Microbiology, 19(1), 29–41. https://doi.org/10.1111/1462-2920.13589Martin-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/S0029665120006916Rios 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/s41579-025-01266-8Tingler, 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