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00:00:20.160Hi everyone.
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00:00:22.719Welcome to the Game Changers Clinical Update Podcast.
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00:00:27.600I'm your host, Rachel Maynard, and I'm excited to dive into our discussion today about functional medicine.
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00:00:36.960There's growing interest in functional medicine, and more patients are coming to us as pharmacists with questions about things like supplements, specialized testing, and root cause approaches to chronic disease.
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00:00:48.079So today we're going to clear up the confusion about what functional medicine is, examine where the evidence is strongest, and clarify how to navigate these patient conversations using an evidence-based and patient-centered framework.
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00:00:50.799And I'm so pleased to welcome our expert guest for this topic, Dr.
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00:00:51.840Josie Phillips Ross.
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00:00:52.719So welcome, Josie.
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00:00:53.520Thank you.
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00:00:55.119Great to have you.
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00:00:57.359Very happy to have your expertise here today.
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00:01:03.600And to help our listeners learn a little bit about you, maybe you could share a little bit about your background and your current role and why you're passionate about this topic.
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00:01:04.480Sure.
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00:01:11.840I first opened a retail pharmacy about 14 years ago in right outside of Kansas City, Missouri.
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00:01:19.840And first we kind of started with just the general delivery and patient-centered approach for having a retail pharmacy.
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00:01:26.239I started getting a lot of questions about how I can help patients in different areas of their life.
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00:01:34.879And it really made me curious to start my own research on or go down the pathway of learning about functional medicine.
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00:01:36.400So that's kind of how I started.
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00:01:38.000It was patient-centered.
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00:01:46.560And a lot of it came back to bioidentical hormones and specific supplements that they asked me about, or testing is more in the last 10 years.
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00:01:51.920But the questions from the patients is what got me interested in going down the pathway of functional medicine.
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00:01:54.879So that was almost 10 years ago now.
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00:02:07.439I completed an A4M advanced endocrinology fellowship, as well as got my A4M practitioner license and completed an IFM with have a practitioner license there.
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00:02:15.280And so now we run a compounding pharmacy, a functional medicine consulting business, and then a retail pharmacy.
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00:02:16.800So it's kind of how I got started.
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00:02:19.759It was it was based on patients asking me for help.
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00:02:22.159And so now that's what I do full time.
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00:02:22.879Yeah.
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00:02:27.919Well, and one of my questions was going to be thank you so much, Josie, for that background and also for spending the time with us today.
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00:02:30.240I know you got you're super busy, got a busy practice.
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00:02:34.960Um, but that was going to be one of my questions is why do you think even in the last 10 years?
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00:02:41.199So this started early for you, but I think even more recently, functional medicine has gotten a lot of attention, a lot of buzz.
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00:02:45.680Sort of this term I shared with you, I'm not super familiar with it.
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00:02:57.520So I think helping us understand what functional medicine is and how it's different or similar to sort of that traditional conventional medicine, how would you describe functional medicine to a colleague?
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00:03:02.879So when we're talking about functional medicine, we are talking about an individualized approach, right?
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00:03:05.199So it begs the question: why?
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00:03:06.719Why do you have diabetes?
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00:03:08.080Why do you have hypertension?
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00:03:15.919What kind of scenarios, lifestyle factors, environmental factors, genetic factors got you into these chronic disease states in the first place?
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00:03:27.759So I think it truly goes back to the why of most chronic diseases and tries to peel back the layers to figuring out the root of these chronic diseases and how to fix the root.
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00:03:31.199That's why we coined the term root cause medicine.
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00:03:42.560Instead of putting you in the box of treatment-based, it's more of prevention and or looking for why you have these chronic disease states in the first place.
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00:03:43.439Okay.
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00:03:45.280So that's great clarification.
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00:03:50.960And I think that focus on prevention versus treating after the fact is so important.
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00:03:52.479And I think we can all agree with that.
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00:03:56.879That is something we've all learned about in pharmacy school is the importance of prevention.
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00:04:02.719But um, that sounds like the foundation of functional medicine versus the treatment after the fact.
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00:04:09.120And again, as pharmacists, we're often thinking about the medications, the treatments, but reframing that and focusing more on prevention.
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00:04:11.039That's a fair summary.
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00:04:11.599Yeah.
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00:04:29.360And I and I think in in when we're taught as pharmacists, right, we we get um all of the knowledge of the drugs and how they work and all of that, but very little about lifestyle factors and environmental factors, genetic factors, like those types of things that play a huge role in these diseases.
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00:04:33.680So peeling back why functional medicine to me is figuring out the why.
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00:04:34.319Okay.
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00:04:41.600Are there any other sort of um you mentioned the root cause, but also that personalized care and really focusing on the patient.
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00:04:43.360So the why for that patient, right?
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00:04:50.319And so digging a little deeper into all of those specific factors that might have come up for them and that's leading to where they are now.
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00:05:01.680Um, and I think that really ties in nicely with what you shared earlier about patients coming to you asking these questions, and maybe you were encouraging them to ask that why and to dig a little deeper into why they got to where they are now.
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00:05:12.959So it makes me wonder why do you think patients now, more so than ever, are interested in functional medicine, hearing about functional medicine, wanting to pursue people with expertise in this area?
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00:05:14.319Yeah, great question.
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00:05:21.680I think that obviously social media has brought a lot to the forefront and asking more questions and being your own patient advocate.
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00:05:22.879I think that that's so important.
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00:05:26.399I think our healthcare system is overburdened everywhere you look, right?
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00:05:30.079Um, our chronic disease is about 60% of Americans now.
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00:05:35.759And there's many factors to that reasoning, but we have to figure out another pathway.
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00:05:37.600We are overburdened with chronic disease.
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00:05:40.480So we have to figure out the whys at this point.
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00:05:50.399And I think the patient population either isn't getting answers to their specific questions and they're looking elsewhere, or trying to be their own patient advocate to figure it out for themselves.
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00:05:52.160We're seeing a lot of that now.
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00:05:52.879Mm-hmm.
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00:05:54.240And I agree.
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00:05:59.519I mean, information is also more widely accessible too, not only on social media, but AI and everywhere.
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00:06:14.879So, yes, they are accessing information that they didn't have 10 years ago and leading to some of these questions for themselves and looking for expert advice and coming to us as pharmacists, I think, oftentimes for that, which is, or or if they're not, maybe they should be, and we should be serving as that expert.
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00:06:19.279So you talked a little bit about your your training here and and in this area.
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00:06:32.000So for people listening, I mean, what sort of additional education resources, where where can we be thinking about getting some additional information if you're new to this sort of space?
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00:06:35.759Yeah, I think I think starting with the questions of why, right?
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00:06:40.240Um, if if you're a pharmacist and you're questioning, okay, why is this patient on 16 minutes?
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00:06:47.360They're coming to me asking about all these side effects, like, what can I do in order to help them become healthier in general?
00:06:47.519 -->
00:06:50.959Like we all went to pharmacy school to help patients, correct?
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00:06:54.160Not give them more disease burden and more drugs, right?
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00:06:57.040So I think peeling back that layer of the why.
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00:07:01.120And then if you're curious on functional medicine, there's a lot of different programs out there to learn.
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00:07:10.399The ones that I was trained in, obviously, but there's also tons of publications now, many resources, many books, many MDs that are practicing this way too.
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00:07:13.600So coming out with different publications and books as well.
00:07:13.759 -->
00:07:19.439There's lots of places to start when you're looking into functional medicine now, as opposed to 10 years ago when I started.
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00:07:20.720Right, right, right.
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00:07:25.040And that's where I do, I do think it's this term that's getting a lot of buzz.
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00:07:33.120And so thank you for helping to clarify that and also sharing some of those um, you know, concepts related specifically to functional medicine and where that fits in.
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00:07:40.000So, in terms of that overlap um with conventional medicine, where would you say are the biggest areas of overlap?
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00:07:50.720Again, we we think about prevention in in traditional medicine too, but uh would it be sort of lifestyle sorts of modifications that we should be thinking about?
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00:07:53.600Where are those sort of common areas of common ground?
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00:07:58.800Yeah, so I always say that you're gonna need both functional medicine and conventional medicine, right?
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00:08:00.000For for treatment basis.
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00:08:03.680I would never take a patient that has diabetes off of their diabetic medications, right?
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00:08:17.680We would teach them, you know, through different programs of CGM or testing, or we would teach them what their body needs in order to decrease on those, but I would never start with like you need to go full functional medicine or full conventional medicine.
00:08:17.759 -->
00:08:19.839I think it has to be a bridge of both.
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00:08:24.800But the where we both find common ground is the lifestyle factors.
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00:08:31.839Functional medicine is more based on those, and conventional medicine brushes the top of that, right?
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00:08:40.320What we're taught on our one nutrition class, or you know what I mean, the small lifestyle factors that we get in diabetic education.
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00:08:53.120So it's more about teaching and learning, and on that front for the lifestyle, environmental, all of those things, but they they both need to be used together, is what the people do not have to go full force one or the other.
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00:09:07.919That's a great uh point to clarify because even if you if you have a patient who is interested in functional medicine, seeing a functional medicine provider, it doesn't mean they're not coming to your pharmacy for other for you know right their prescription medicines too.
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00:09:16.320So yeah, you definitely need both.
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00:09:18.879Okay, okay, that's good clarification.
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00:09:33.840So the the fact that this is still sort of a growing area, I think, begs the question of well, what is the evidence to support the various area, you know, uh interventions that might be done in functional medicine.
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00:09:50.720And maybe you can share a little bit about uh what sorts of interventions are maybe thought of commonly with functional medicine and the evidence to support those and how that may vary based on the specific approach you're talking about.
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00:09:51.600Right.
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00:09:57.039So there's there are a lot of things with strong evidence uh in the lifestyle category.
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00:10:08.639Obviously, diet being one of those, Mediterranean diet has tons and tons and tons of studies, lots of evidence to support that type of eating and anti-inflammatory lifestyle.
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00:10:10.399So diet is one area.
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00:10:16.480Um exercise also has a ton of studies and support and evidence, as well as strength training.
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00:10:27.200Um, and then there are some studies with uh supplements, specifically like omegas, vitamin D's, creatine now is a new one that's getting a lot of support in studies.
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00:10:30.879There, there's definitely a lot of evidence for those types of things.
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00:10:51.759So, how do you go about assessing, like say, say you have a patient who hears about a particular supplement, for example, how do you go about assessing whether that is something that what what level of evidence there is to support that particular supplement and how that fits in with the patient specifically?
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00:10:52.960I know that's a pretty big question.
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00:11:01.919So maybe, maybe when you're thinking about a supplement, for example, or any other intervention, how do you go about assessing the level of evidence to support that intervention?
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00:11:03.440Okay, good question.
00:11:03.519 -->
00:11:13.360Um because that needs to kind of start out with supplements don't have the billion-dollar industry that other drugs do.
00:11:13.519 -->
00:11:21.600So the studies are limited based on support from other groups, but I typically take it patient-by-patient basis.
00:11:21.759 -->
00:11:29.120So my job is to assess the full patient from their history to their symptoms to their family history, and I kind of match and labs.
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00:11:30.799We we evaluate tons of labs.
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00:11:38.159So I work through the knowledge that I have gotten from the different education places that I've gotten.
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00:11:44.159Um they provide tons of resources and studies for everything in particular that they're teaching, obviously.
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00:11:46.000So that's a great resource to have.
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00:11:48.639Um, but this is very patient specific.
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00:11:51.039So I think that that's important to learn.
00:11:51.120 -->
00:11:58.639And when you're a pharmacist and you're at the counter and somebody's asking you about a supplement, just right off, you know, you're doing a thousand things.
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00:12:08.000There's just a few that obviously you need to be aware of, you know, for the anti-inflammatory purposes or the drug depletions that I know we'll talk about.
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00:12:18.480Um, there's not a lot of time for a pharmacist to truly dive in to the evidence supporting supplements with everything on their plate.
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00:12:26.799It's it's that's why this whole other uh career path has been born for people begging the question and wanting more answers and wanting more time.
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00:12:31.120So my consultations are typically 30 minutes to an hour per session.
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00:12:37.919So you get that time and individualized treatment, protocols, lifestyle factors, all of that.
00:12:38.320 -->
00:12:47.600And in those sessions, I'm uh thinking you probably do like a medication review to be able and and including supplements, all all basically again, that holistic approach, right?
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00:12:49.360Yes, absolutely.
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00:12:50.799Yeah, yeah.
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00:13:01.840So uh you mentioned a few examples like the Mediterranean diet and um omega-3s, or uh and then some other, and uh like you say, there's thousands of supplements out there.
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00:13:06.080So it's really hard to keep up with all of them and all the emerging evidence with them.
00:13:06.240 -->
00:13:25.200And so again, with any specific intervention, I think we were chatting a little bit earlier before the start of the podcast about how there's a sort of spectrum of evidence with anything in medicine and including functional medicine from randomized controlled trials, which are often considered the gold standard, all the way to sort of expert opinion or anecdotal evidence that from a patient as you're working with a patient.
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00:13:27.200So, you know, there's that whole spectrum.
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00:13:36.399And I think that's where it gets a little difficult with thinking about evidence-based approaches because sometimes you are tailoring to the patient and and what works for them.
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00:13:38.480And you know, that that's very specific.
00:13:38.559 -->
00:13:41.919Maybe you could speak a little bit more about that or some some experiences you've had.
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00:13:44.240Well, and truly, I was I was talking to you too.
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00:13:47.840It's it's all about like trial and error in this field, too.
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00:13:53.519Um because all of my training, I've been in this world for eight to ten years.
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00:14:03.759And so obviously, I know what works now, I know what doesn't work, I know what patients respond to, I know what they don't respond to, I know what testing to do, I know what testing not to do.
00:14:04.000 -->
00:14:08.240So it's been a labor of love per se for a long time.
00:14:08.480 -->
00:14:14.960So just diving in feet first um obviously is hard to do in this realm without the education piece.
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00:14:20.000That kind of gives you the forefront and the background uh to start with for functional medicine.
00:14:20.240 -->
00:14:24.080But um, yeah, it's a it's a tricky field to navigate, I would say.
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00:14:24.879Yeah.
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00:14:25.440Yeah.
00:14:25.600 -->
00:14:32.639Well, okay, let's because that's tricky, and we're talking at very high level here, and there's, you know, I keep saying interventions, but what are we specifically talking about?
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00:14:38.879Um, so one example that I think is helpful to think about is with drug-induced nutrient deficiencies or depletions.
00:14:38.960 -->
00:14:48.240And that's something that many pharmacists may know about, regardless of their background, simply because we know there are certain prescription medications that lead to some of these deficiencies.
00:14:48.320 -->
00:14:58.879So maybe you can speak to a few what that means in a bit more detail than what I just said, and also some examples that often come to mind and how you manage those when you see patients on these medications.
00:14:59.200 -->
00:14:59.440Yeah.
00:14:59.519 -->
00:15:09.679So I would recommend to all pharmacists to have a chart to print off for them to be able to recognize on a quick manner what is being depleted.
00:15:09.919 -->
00:15:21.840But also, we also talk about these drugs giving the deficiencies and causing them, but we don't consider what's happening in the background, too.
00:15:22.080 -->
00:15:25.200So, what if like metformin decreases B12?
00:15:25.360 -->
00:15:27.120So, what is B12 used in?
00:15:27.279 -->
00:15:30.480What is it a cofactor of all of these support systems?
00:15:30.720 -->
00:15:38.080And we talk about it and kind of throw it in the air, like, oh, you need B12, but like actually go back and why do you need B12 in your body?
00:15:38.240 -->
00:15:39.279Like, what is it used for?
00:15:39.440 -->
00:15:41.120What processes is it needed for?
00:15:41.360 -->
00:15:43.120Same thing with like birth controls.
00:15:43.200 -->
00:15:50.799Birth controls are a big one that deplete many nutrients, and all of those nutrients are used for specific things in your body.
00:15:51.120 -->
00:15:58.799So not only is it a nutrient deficiency, but it might be causing a lot of symptoms in your patient that you might be completely unaware with.
00:15:59.120 -->
00:16:07.679You know, fatigue being one of those, um, restless leg syndrome being one of those, like there's tons of things, uh, brain fog, skin type reactions.
00:16:07.759 -->
00:16:15.440There's tons of things that the symptoms could show up because of these nutrition deficient nutrient deficiencies that we're not even considering.
00:16:15.600 -->
00:16:18.480We're just throwing around, like, oh, this drug can cause that.
00:16:18.639 -->
00:16:24.799And maybe mentioning it to a patient, but not considering the background of what it could be causing for that patient.
00:16:25.039 -->
00:16:44.240And I think that goes back to your earlier point why of why why are you having the symptoms and ruling in medications as one potential cause before you can rule them out and sort of thinking through that whole perspective and possible consideration on why that might be having those symptoms or that problem.
00:16:44.559 -->
00:16:49.919And one area that I always hone in on is detoxification through the liver process, right?
00:16:50.000 -->
00:16:52.480There's three processes of detoxification.
00:16:52.720 -->
00:16:57.519Most of those need tons and tons of nutrients to help make things soluble and get out.
00:16:57.759 -->
00:17:03.279And a lot of our food is stripped of it, and now we're getting drugs that are stripping our body of those nutrients.
00:17:03.360 -->
00:17:05.359And so it's like a twofold approach.
00:17:05.440 -->
00:17:10.240Like, if we can't process things out properly, now we're having all these symptoms on top of that.
00:17:10.319 -->
00:17:15.200But we don't even consider that when we're talking about these drugs just causing depletions, you know what I mean?
00:17:15.440 -->
00:17:20.319So getting a chart to let you know, like, and then putting the why behind it.
00:17:20.480 -->
00:17:25.759Like if a patient is deficient in iron or B12 or vitamin C, what is that causing?
00:17:25.839 -->
00:17:27.039And what's that going to show up?
00:17:27.119 -->
00:17:32.480Like if a patient comes to you and, like, I'm so fatigued, and you look at their patient profile, like, oh, you're on metformin.
00:17:32.799 -->
00:17:35.599Like, this is what we can do to hand-in-hand approach.
00:17:35.680 -->
00:17:37.920That is like the number one place for a pharmacist to start.
00:17:38.160 -->
00:17:39.279But you have to question the why.
00:17:39.440 -->
00:17:42.799You can't just put the horse before, right?
00:17:42.880 -->
00:17:49.839You have to question the why and what is it causing in the body in order to actually put the elements together with the patient and the symptoms.
00:17:50.000 -->
00:17:51.759I think that that's the most important part.
00:17:51.920 -->
00:17:54.240Because we do throw around that a lot as a pharmacist.
00:17:54.480 -->
00:17:56.799And even in the hospital, it's it's gaining some traction, right?
00:17:56.880 -->
00:18:07.759We're giving OTCs in the hospital a little bit more, but pharmacists aren't considering what's that doing or symptoms that's exhibiting in a patient to put those together.
00:18:07.920 -->
00:18:11.599So I think that that's that's more important to go back to the why too.
00:18:12.160 -->
00:18:17.279Well, and I I like how you called out that this is a very narrow consideration.
00:18:17.920 -->
00:18:31.599The why helps make it broader, but also thinking about okay, even if this person is potentially taking a medic medication that might deplete uh B12 with metformin, for example, there's also the dietary considerations.
00:18:31.680 -->
00:18:34.640It goes back to the nutrition and your total lifestyle approach.
00:18:35.680 -->
00:18:36.319Yeah, yeah.
00:18:36.480 -->
00:18:51.599And so it really does tie back to sort of that preventive and holistic concept and ensuring, okay, we're not just necessarily giving you a B12 because you're on metformin, it's because you we also have to think about what is your diet like otherwise, and and how is that contributing to your overall health?
00:18:51.920 -->
00:18:58.400Yeah, yeah, there's huge misconceptions with diet as well in our health care today, I would say.
00:18:58.640 -->
00:19:05.200I feel like what especially when I was sitting in functional medicine school, I was like, this needs to be public knowledge.
00:19:05.359 -->
00:19:13.440Like this needs to go out to everybody, everybody needs to learn the nutrition piece aspect behind all of this.
00:19:13.599 -->
00:19:19.119We would all much be in a much better place if we did, and maybe not need as many of these interventions.
00:19:19.359 -->
00:19:22.559But um that nutrition plays a huge role, right?
00:19:22.720 -->
00:19:23.440With how you feel.
00:19:23.599 -->
00:19:32.799And and there's a lot of misconceptions too with symptoms nowadays, like, oh, you're getting older, you're probably gonna be more fatigued, or you know, these types of hormonal issues.
00:19:32.960 -->
00:19:40.400It's normal to be constipated, or it's normal to have gut issues or or feel bloated, like those things are are normal, but they're really not.
00:19:40.559 -->
00:19:45.519And so honing into the why that's happening behind that is really important.
00:19:45.920 -->
00:19:49.359And knowing that these things might be common, but they're not normal.
00:19:49.680 -->
00:20:03.839And yeah, going back to that idea of the patient advocate and and wanting to not just saying, okay, I guess I I have this symptom and I'm gonna live with this for the rest of my life, but digging a little deeper to find out what might be able to help with that.
00:20:04.240 -->
00:20:05.519Yeah, absolutely.
00:20:06.079 -->
00:20:20.880And so what uh when thinking about maybe those conversations with patients and how to help direct them to what's going to most benefit them, where do you start in that sort of triage process?
00:20:20.960 -->
00:20:26.079Like what are what are some the key things that you're thinking about when a patient is coming to you, maybe with a symptom?
00:20:26.319 -->
00:20:29.839And how do you identify what might be the cause?
00:20:30.319 -->
00:20:34.319Yeah, so I look at all of my patients like a puzzle and I'm putting the pieces together.
00:20:34.480 -->
00:20:35.519And I've done that from the start.
00:20:35.680 -->
00:20:38.799I love puzzles, I love logic problems, like that's what I love to do.
00:20:38.960 -->
00:20:42.079So it kind of fits in right where with what I love.
00:20:42.319 -->
00:20:57.759But I usually use the cannabis of what we have, lab-base-wise, symptom-based wise, history-based wise, just even like the small factors of like heat sensitivity or chemical sensitivity, like those things all matter when you're talking about symptoms and causes.
00:20:58.079 -->
00:21:03.440So I like to put the why in all of those categories and go kind of brush back.
00:21:03.599 -->
00:21:10.880Go through we go through diet, we go through lifestyle, we go through obviously medications, diagnoses, OTCs, um, family history.
00:21:10.960 -->
00:21:15.599It's really a deep dive into why and how they're feeling right now.
00:21:15.759 -->
00:21:17.359A lot of my patients are hormone patients.
00:21:17.440 -->
00:21:19.279We do a lot of bioidentical hormones.
00:21:19.440 -->
00:21:25.119Um, and so a lot of those factors come into play, especially when we're talking about metabolizing hormones out.
00:21:25.359 -->
00:21:28.240Are you doing things that are hurting or helping that process?
00:21:28.480 -->
00:21:37.119Those are those are key things to look for, and they're important to me as far as doing no harm, extra harm to the patient and making them feel better, obviously.
00:21:37.440 -->
00:21:41.279Because you're you're gonna gain patients just by them feeling better, truthfully.
00:21:41.519 -->
00:21:43.359It doesn't even have to be a lab number.
00:21:43.440 -->
00:21:50.559It's just like this pharmacist made a difference in my life because I feel this much better on these specific symptoms.
00:21:50.880 -->
00:21:51.599Absolutely.
00:21:51.759 -->
00:21:52.079Yeah.
00:21:52.319 -->
00:21:53.759I think we can all relate to that, right?
00:21:53.839 -->
00:21:56.720Where we've had patients that we've made a positive difference.
00:21:56.799 -->
00:21:59.599And if you can do it with something, I say S.
00:22:00.240 -->
00:22:05.839simple as a lifestyle change, but as um maybe uh benign.
00:22:05.920 -->
00:22:12.799I I don't know what the word is, but something that's simple and just something maybe they hadn't thought of in the past, you know, that that can make a huge difference.
00:22:13.279 -->
00:22:14.079Yeah, I agree.
00:22:15.039 -->
00:22:21.200So when thinking about you mentioned sort of the I think you alluded to the safety considerations.
00:22:21.279 -->
00:22:47.119And so are there any uh sort of red flags that you would want a patient asking about some particular product or process any any safety considerations that people who aren't as familiar with functional medicine should be aware of and helping patients steer clear of so first thing that I consider especially on the supplement base is professional grade ones that have certificate of analyst of exactly what's in them.
00:22:47.359 -->
00:22:55.759It is a huge market like you said and regulations are some are there but there are a lot that are not.
00:22:56.079 -->
00:22:57.599And not the same as prescription drugs.
00:22:57.680 -->
00:22:59.599Again like not regulated like that regulated.
00:23:00.319 -->
00:23:13.680Yeah they're technically regulated as food right um and there's not a lot of regulation in that field either but that's to say I usually use professional grade because I can have a certificate certificate of analyst to know exactly what's in them.
00:23:13.839 -->
00:23:14.720That's super important.
00:23:14.960 -->
00:23:32.319Quality is super important when you're when you're talking about these something as simple as omega threes if we go back to that there is a specific point where those omegas can get rancid and so if you're taking a rancid omega three it's actually causing more inflammation and you're the reason you're taking it is to decrease inflammation.
00:23:32.559 -->
00:23:38.480And so obviously that's not a regulated field for the rancidity of omegas.
00:23:38.640 -->
00:23:45.200So having something in place or looking at places that do that study is important for us.
00:23:45.279 -->
00:23:58.640And that's just like one super specific example but I think having that know how in the professional grade is really important when I'm recommending or even storing those on the shelf.
00:23:58.720 -->
00:23:59.920That's important for me.
00:24:00.240 -->
00:24:23.759Absolutely and I think I mean the thing I learned about is looking so maybe not everyone has access to the COAs like you're talking about if it's something you're ordering specifically but for a person looking on a shelf even like the USP verification or I think there are some other certifications that are available that at least is like another check to make sure that they have what they say they have in the box at least.
00:24:24.079 -->
00:24:38.400Agree agree and that should be on the bottle either professional grade will be listed almost every single professional grade is going to have a certificate of analyst so you can actually call the bottle and say can I see your certificate of analyst they should be able to send it we send ours um pretty quick.
00:24:38.640 -->
00:24:56.640And so just having that knowledge if you're housing or storing them in your pharmacy that's important to know the regulating bodies how to look for those C of A's if a patient were to ever ask you because I'm sure patients are listening to this and they might start asking great point.
00:24:56.720 -->
00:25:13.920Yeah absolutely and I mean I think too um because it's not just in pharmacies right people are are getting supplements online from friends, neighbors, you know, who knows and so as you said it's it's sometimes hard to tell but there are some steps we can take to at least confirm the quality is there.
00:25:14.160 -->
00:25:23.519Because there there have been cases where supplements have been because as we said before they're not um tested for safety and efficacy the same way as prescription drugs.
00:25:23.680 -->
00:25:43.200But once they're on the market FDA can pull them or you know cause them uh with recall if they are found to have contaminants or found to cause harm or these sorts of things but it's after the fact and so we don't want people to be taking something potentially risky in terms of do no harm do no harm.
00:25:43.279 -->
00:25:43.359Right.
00:25:43.680 -->
00:26:08.480Do no harm yep we all sign out of and then I guess along those lines too in terms of safety so thinking about um in in how do you approach a patient with the considerations of potential interactions with maybe other prescription medicines they're taking or other supplements they're taking or dosing what kinds of thought processes are you using when evaluating that?
00:26:08.799 -->
00:26:22.720Yeah so having the full patient profile because a lot of times they'll think like oh I got these supplements OTC and they're not even considering an interaction between their medications and asking those specific questions are you taking any over the counter medications?
00:26:22.880 -->
00:26:24.079Are you taking supplements?
00:26:24.400 -->
00:26:40.079Because then they will identify that oh yeah I am taking this vitamin D and K2 and give you those kinds of information that is a lot of times not in the pharmacy profiles right in the pharmacies we don't have access to what they're taking outside of what we are giving them.
00:26:40.880 -->
00:26:43.039So having that kind of data is important.
00:26:43.200 -->
00:26:46.079Asking those kind of questions to patients is important.
00:26:46.319 -->
00:26:51.039Disease state and symptoms is also important if it's a time limiting factor.
00:26:51.279 -->
00:27:15.680So if you have a pharmacist that is doing something in the functional medicine realm and kind of guiding them for more help if they're asking for it so they can get all of the details yeah I think again for for any pharmacist regardless of practice setting those are just good reminders to be aware of and again sort of principles we've often learned in pharmacy school but good reminders regardless.
00:27:15.920 -->
00:27:16.640Yeah I agree.
00:27:16.880 -->
00:28:25.920Are there any other areas of functional medicine that you think uh listeners should know about as sort of uh emerging or potentially those that are you know have a strong evidence base that we haven't talked about yet so gut health is a huge one right now and I think that in our conventional care model they're identifying inflammation and not identifying causes of inflammation and so I feel like that's a big area for functional medicine with a lot of emergent emerging um details and studies probiotics are becoming widely used and accepted and studied and so that I feel like is a going to be a huge topic obviously coming up and that also plays a role with how we're processing out our drugs and our as well as supplements but also like mental health obviously everything's connected and I think that that's another difference in conventional medicine is is we go to specialties in order to like endocrinology specialty gastro specialty in functional medicine I look at this as related to this as related to this as a whole body system.
00:28:26.079 -->
00:28:28.720So that that could be a a difference as well.
00:28:29.039 -->
00:28:42.240Mm-hmm yeah I mean I think and again I think we are getting a better understanding of how that all interacts and you know we are one person so it makes sense that this is all interconnected in some way.
00:28:42.559 -->
00:28:54.000But and again goes back to your point about the the why and what might be causing this symptom is it is it just something that that's passing or is it something that's related to a more chronic potentially issue?
00:28:55.519 -->
00:28:56.160Yeah agree.
00:28:56.319 -->
00:29:18.079Yeah yeah so what what else would you advise pharmacists about to think about if they're supporting patients with functional medicine just as a sort of a broad broad approach having those conversations patients are asking what what like key takeaways would you recommend that pharmacists be thinking about or be aware of before those questions get asked?
00:29:18.480 -->
00:29:42.720Yeah I mean going back to to the the why like for our own information to help patients navigate this field because it is going to be talked about a lot more in the future and you are going to start getting questions no matter if you work in a hospital or community setting you're gonna get a lot more questions about functional medicine or even homeopathic therapies, supplements you're gonna be getting a lot more questions because there's a lot more information out there.
00:29:42.880 -->
00:29:44.400Like you said it's everywhere.
00:29:44.720 -->
00:29:47.119Information is at patients' tips of their fingers.
00:29:47.279 -->
00:29:48.960So asking the why, right?
00:29:49.039 -->
00:29:56.640So even if you have a patient and that you have no idea they come to you for fatigue or have a question about migraines or brain fog or something like that.
00:29:56.880 -->
00:30:16.880And asking the why like doing a little bit of research on your own is going to be helpful for you to navigate those patients moving forward or identifying similarities in other patients um especially with nutrient depletions and correlating those and being like oh I remember that this can cause this and this patient might have the same thing going on.
00:30:17.119 -->
00:30:26.000Obviously they are all bioindividual but we do have some similarities and overlap with that when it goes back to especially nutrient depletions.
00:30:27.039 -->
00:30:33.920And maybe it's just quickly you can give we gave Metformin as the example are there other sort of three to five that come top of mind to you?
00:30:34.400 -->
00:30:40.319PPIs are a huge one or any type of acid reducer is a huge one.
00:30:40.559 -->
00:30:59.279Birth control is a huge one a lot of seizure medications have a lot of nutrient depletions as well as blood pressure medications they all have um some major and it's not commonly one like metformin probably more than one but most of the studies are on the B12 for metformin.
00:30:59.519 -->
00:31:07.680They just haven't done enough studies to see what else it depletes because obviously that takes a lot of time and sure yeah yeah clinical knowledge.
00:31:08.079 -->
00:31:19.839Well and interestingly um I saw that there was an FDA warning just recently or alert about vitamin B6 deficiency and associated seizures for drugs containing carbidopolidopa.
00:31:20.079 -->
00:31:31.680So just another example of how this is continuing to be studied is going to continue to come up and another possible thing to have on your radar when you're seeing patients on carbidopolidopa as just one example.
00:31:32.079 -->
00:31:42.720Also to the the other thing that comes to mind is people with a particular diet so like vegetarian or vegan diets that's it's not just medications too it's also your dietary and again tying that back to the nutrition aspect as well.
00:31:42.799 -->
00:31:45.599So thinking about that that holistic approach and full patient approach.
00:31:46.319 -->
00:32:03.920This has been fascinating for me and I think going back to the why yeah yeah for like these things that's a co-factor in many systems throughout the body and so what that can cause and what that can show up as symptom wise in a patient is important to notate before you know seeing the patient's roll in with the sufficiency.
00:32:04.240 -->
00:32:04.559Right.
00:32:04.720 -->
00:32:25.039And I I think um the get the sense I'm getting is that in your education you got a lot of that additional background and that we maybe didn't get in pharmacy school the rest of us in terms of sort of that physiological how it all ties together physiologically and and how that can impact clinical symptoms even from this sort of mechanistic approach.
00:32:25.440 -->
00:32:32.160Absolutely yeah so yeah like I say this was great discussion great overview of what to be thinking about with functional medicine.
00:32:32.319 -->
00:32:54.480I think we got some uh practical points in there and just thinking about sort of that uh person-centered approach that root cause consideration that why those were the things that came through to me and also the considerations around safety and prioritizing that um and understanding that we have this varying level of evidence for certain interventions but you know that's that's okay we just have to work with the patient and and work through that.
00:32:54.559 -->
00:33:27.200So Josie, we always wrap up with the game changer and so what would you say is the game changer around this topic that you'd want our listeners to walk away with I would say we'll stay on the theme of questioning why I figured that yeah I would say I would say because honestly one of my first um questioning why is I had a I had a patient come to me he was a business owner in his 50s very vibrant and then I saw the rapid decline in his health over like eight years and I started asking why like why is this happening?
00:33:27.359 -->
00:33:40.160Why is early onset dementia is it hereditary is there some nutrients that are missing are like I started questioning why in my own head and that's what kind of led me to dig deeper is those specific patients that led me to the why.
00:33:40.319 -->
00:33:54.960So I think that as pharmacists we get into maybe a mundane routine of doing the same types of things and if you look out more broad spectrum and say okay I need to start asking why like why is that patient asking for folate?
00:33:55.039 -->
00:33:55.839Why is there slow?
00:33:56.160 -->
00:33:57.759What is that causing your body?
00:33:58.000 -->
00:34:06.640Like simple things that you can start putting together just for your own knowledge and to help your patients in any setting that you're in any pharmacist setting.
00:34:07.039 -->
00:34:17.119Absolutely I love that that's a great wrap up and again I think we are pharmacists so traditionally we think about medications but it is much broader than that when we're thinking about taking care of the whole patient.
00:34:17.360 -->
00:34:22.880Yeah and then even in the next 10 years it's going to be a changing ever changing field.
00:34:23.360 -->
00:34:28.800Yes yes absolutely so we'll have to have you back on as things continue to evolve.
00:34:29.119 -->
00:34:36.719They will they will for sure Josie thank you so much for your time this is great and uh really appreciate your perspective and expertise here.
00:34:37.039 -->
00:34:58.400Awesome thank you for those of you who are interested in this topic CE Impact offers a certificate program called a pharmacist guide to functional medicine which takes a much deeper dive into this topic than we could do today including how to implement a functional medicine service in your pharmacy agency I actually think we could probably have a whole other podcast on that alone and I would love to learn a little bit more about how you did that and how you get reimbursed for that and all that.
00:34:58.719 -->
00:35:08.159But this course does provide over six hours of CE so if you're interested check that out and Josie is one of the faculty on that course so you'll be hearing directly from her in that as well.
00:35:08.639 -->
00:35:14.719And we talked about a lot of great practical tips today these will all be summarized in the practice research that goes along with this podcast.
00:35:14.880 -->
00:35:18.880And we hope today's conversation gave you something useful to bring back to your practice that's always our goal.
00:35:19.119 -->
00:35:24.559Before you go be sure to claim your continuing education credit, your time and engagement count and we want you to make sure you get credit for it.
00:35:24.800 -->
00:35:26.960Thanks so much for being part of the Game Teachers community.
00:35:27.119 -->
00:35:29.199We look forward to the conversation with you all next week.
