A Clinical Perspective on Coaching Collaboration for Effective Supplement Use

Supplements can be a powerful tool for supporting health, but lasting results depend on far more than what’s in the bottle. Join two leading functional medicine practitioners as they explore where evidence-based supplementation fits within a personalized care plan, the critical role of behavior change, and how health coaches help bridge the gap between clinical recommendations and sustainable, real-world implementation.

• Panelists: Sanjay Bhojraj, MD, FACC, FMCP-M, and Stefanie DeFiglia, CRNP, FNP-BC, FMCP-M.
• Key Themes: Evidence-based supplementation, practitioner and health coach collaboration, behavior change, adherence, and personalized care.

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Panel: A Clinical Perspective on Coaching Collaboration for Effective Supplement Use:

Transcript

Dr. Sandi: So, let’s get started with looking at…just in a broad sense, looking at the landscape. Because many people are hoping that supplements are the answer. You know, they may be thinking that, oh, if I just take a supplement… My husband. Case in point, he doesn’t change his diet, he’s not into exercise, but just any supplement I throw at him, okay, I can take that. So, I wonder if you would start out sharing your perspective. So, I’m gonna ask you, Stefanie, first. Give me your thoughts on that.

Stefanie: So, we all have love-hate relationships with different types of supplements. I’m sure Dr. Sanjay has the same experience. And I use them as tools all the time, and I think they absolutely have their place within healthcare. So, I do a lot of gut work. So, I’ll see folks that will have had longstanding diarrhea, they’ve been to GI, they’ve seen specialists, and they haven’t been able to figure out what the problem is, or women in that menopausal window that have tried hormones and that wasn’t really the answer. So, I think sometimes when we narrow ourselves down to just one answer, like it’s either medicines or it’s supplements, we kind of miss the bigger picture of wellness.

And so, I completely agree with what Dr. Sanjay had said earlier that we…as providers in the functional medicine and integrative space, we’re looking at the landscape of people’s lives. And so, all of that is important. It’s what we eat and how we sleep and how we stress and what we do when we’re under stress. All of those things really matter. So, you can use supplements to help to target some of those things, but if you never really get to the big picture, then people don’t get true healing. They don’t achieve the kind of wellness that we’re trying to do.

So, the way I look at things in my practice when people come in, having them leave me is the victory. Because when I can get people to a point where they can say, of the five things that I had when I came in, we’ve addressed these five things, I have nothing to talk to you about today. That’s when I do my happy dance. Because I know that we’ve been able to get them through and answer some of these questions and solve the problems.

And I think that supplements are a really integral part of that, but for me, it’s a larger part of a larger scheme where I’m helping people figure out what it is that their bodies are saying to them, how do I need to eat to support myself in this stage of life, how do I need to exercise for bone health and for muscle maintenance and for wellness and for mobility so I can get on the floor and play with my grandkids. Those are the things that we’re really looking to address in integrative and functional medicine.

And so, when I’m using supplements as a tool, oftentimes, it’s for a purpose and a limited time frame. And then little by little, I’ll pull away the ones I don’t need anymore. And then we’ll stick with certain foundational supplements long-term that I know are necessary for maintaining brain health and maintaining bone health and those kind of things. So, I think they’re a really important part of the puzzle, but I wouldn’t say they’re the only part of the puzzle.

Dr. Sandi: What do you think, Dr. Sanjay?

Dr. Sanjay: I mean, I think I should have gone first because she’s so eloquent, Stefanie. But I think, for me, supplements, the role is in the title. When you’re supplementing something, that doesn’t mean that that’s the main character. That’s an additional thing on top of. And so, I think that people that come in with the mindset…and I’ve got them… I’ve been a victim of this personally myself. I remember my first IFM conference ever, I came back with 30 bags of supplements. And I was taking 50 pills the next day. And my daughters were just looking at me like, Dad, you’re not gonna have any room for food. You’re taking all these pills. So, I’ve been there. I’ve lived it.

But supplements are something that you add on top of. And I love the way you said it, Stefanie, a foundational lifestyle intervention. And for me, it’s like… I live in Orange County, and I practice there, and I’ve got all these people that want to jump into cold plunges and then go to infrared saunas. And then wear their blue light glasses then do all these things. But they are iterative…those technologies are iterative to sleeping correctly and eating well and not being a jerk and playing with puppies and things like that.

So, I think there’s so many different things that we need to target that when we look at supplements, they are… I like how…Sandi, when…before we all got on formally, you were saying how you cycle off and on. And Stefanie, you were saying that there’s foundational. I think that we need to understand that there are different roles for different things. If you cut your finger, you need a Band-Aid or whatever. But you don’t need to put a Band-Aid on forever. It’s not gonna do anything if you’re not in the healing process.

So, similarly, when we look at supplements, I think, number one, we have to be very cautious about understanding the evidence behind them. I’m sure all of our eyes roll on our Instagram algorithms when we see some bro or…I don’t know what the female equivalent of a bro is, sis, whatever it is, going on there, saying, I did this supplement. It changed my life and you should do it, too. And they have no health background, whatever. They’re making claims that anybody who’s licensed could never make. They are touting that there’s one…this one thing is gonna cure you of every ill. There’s nothing, there’s no one anything that’s gonna cure you of every ill. Rome wasn’t built in a day nor was it torn down in a day.

So, when I get people with complex metabolic disease or whatever, the first thing I say is this is a multi-pronged approach. It’s not just one thing is gonna fix it. And that goes back to… I mean, even if… Let’s talk about insulin resistance that I focus on a lot. Metformin is not gonna cure the insulin resistance. You have to go back. Sure, it’ll alter a number, but you have to look at your muscle mass and you have to training and you have to look at the inflammatory foods and this, that and the other. So, when it comes to supplementation, I think it’s important to realize that there’s no one supplement, just like there’s no one medication, just like there’s no one anything that’s gonna completely cure any of this. It’s a multi-pronged approach. And as you said, Stefanie, that these are tools in our toolbox. They’re not cures in our toolbox.

Dr. Sandi: These are such important points because it’s common to hear people talk about supplements as if it is like there’s one magic supplement just like there’s one magic medication to take. And they’re not seeing that this is systems biology, functional medicine is that everything is connected. And it is an integrative approach where we’re just talking about all these areas of lifestyle and then adding on supplement if needed.

So, what would you say in terms of the…so many misconceptions about supplements. And I’d like to start off with what I’m still hearing from conventional doctors and nurse practitioners that, oh, I don’t believe in supplements. So, how would you counter that if you’re at a party and someone I don’t believe…oh, you functional medicine people, you’re all about supplements. I don’t believe in supplements. What would you say? Whoever wants to take that.

Stefanie: I’ll take that first. So, you must have been at the same party that I was at, Dr. Sandi, because I think I just heard that not that long ago. And so, the supplements tend to fall one of two camps. Either people are on the I take a handful of it a day and there’s no room for food, and because I’ve seen all of this stuff I have to have all of these things in my body every single day. Or there’s the folks that are anti-supplements or anti-medications or anti-something. So, I get to see where I am in this area of the country, I get lots of different types of people with lots of political and spiritual beliefs. And so, I have the opportunity to chat with all kinds of folks about that.

My feeling is that…I have my foundational things that I use. I think there’s absolutely benefits to them. If you look at the data on the percentage of people that have, for example, magnesium deficiency, I think the last study that I read, it was almost 70% because our land isn’t the same as it was a hundred years ago. So, the broccoli that we’re eating today is not the same as the broccoli that my great grandmother was able to eat. And so, you can eat really well and still find yourself with functional deficiencies.

I test every single person who walks in my door for vitamin D and B12 and magnesium. And I find them pretty regularly. And we’re in Maryland. We have plenty of sun between May and September. And yet, I would say, of the folks that I see, probably 60% of them are deficient in vitamin D and don’t realize it. These are the folks that are not taking anything. So, I think that the risk of low levels of important…of important vitamins and minerals is there, for sure. And so, appropriate supplementation is good for often 60% 70% of the folks that I see.

That being said, I’m not a handful person. I don’t think that that should replace things, and I don’t think that you can supplement your way out of a French fry diet. So, you have to make sure that your foundations are correct. You can’t use that as an excuse to eat fast food every day and think that a pill is gonna fix and replace what you’re not getting from regular food. There are things in broccoli and meat and all of these other things that we come in contact with in our food that we can’t put in a pill. There’s these phytonutrients and minerals. And there’s stuff that we can’t replace with a pill.

So, I think that, again, supplements are supplemental. They have their place. They work for lots of folks. And for specialized cases, I may use more. But a regular expectation that we can go without anything ever our entire lives may be unreasonable just knowing what our food supply looks like today.

Dr. Sanjay: Yeah. And it may have been different when we all had 40 acres and a mule, and we were growing our own food and we’re out in the sun farming and singing to the crops and all this stuff. But the number of micronutrient deficiencies that are present in Americans is crazy. I think you’re referencing the NHANES data about magnesium in particular. But when you look across the board, we know this right now is that the orange or the apple of 2026 is very different than the orange or the apple of 2006. It’s very different from 1986. And when you look at agribusiness…I did a lecture on this for my wellness community.

The food supply chain is crazy. So, for an apple to get from a field in Michigan to me in California, takes anywhere…can take anywhere from six to eight months. And so, they’re pre-picking. They’re not letting sunlight and bird song and all these things ripen the food. They’re giving chemicals to ripen the food. Anybody who’s ever bought bananas that…you bring them home from the store and then the next day, they’re all brown. You know this because they’re spraying the ripening chemicals on there. So, the nutrient value of the food is not there anymore. Sorry. My dog is not barking and now someone’s got a my throat.

But when it comes to supplementation, we need to be smart. And just like with anything, you want to be very intentional about what you’re supplementing because I do feel there’s a role for supplements. Again, I do feel there are some foundational supplements, like in my world, fish oil, and I love berberine things. But we also have to realize that these are bioactive chemicals that can, in some cases, be metabolized by the same liver enzymes, the P450 system as the pharmacological medications that we’re taking.

And so, for me, that line between supplements and pharmacological therapies, conventional medical therapies isn’t as black and white as people think because I need to know what else you’re taking because that could affect the metabolism of this, that, the other or for…the supplement could affect the metabolism of any other medications. So, that’s why we need to integrate the two. It’s not one or the other. It’s kind of a little bit of an awareness of both.

But, yeah, I get told all the time by my conventional colleagues in cardiology, you can imagine how crazy my colleagues are. They’re like, oh, this twig and berries nonsense that you’re doing, it doesn’t make a difference. But when you do supplement somebody correctly…and one of my front lines, for instance, for palpitations in my conventional practice was magnesium, just magnesium citrate or magnesium glycinate. And all of a sudden, people feel better. It brings your blood pressure down. And people are like, wait, what are you doing with that magnesium? The other docs, that doesn’t make sense. Well, we may not have a 10,000-person randomized controlled trial of this, that, the other, but it works. Lack of evidence doesn’t mean lack of efficacy. Just means that you didn’t have a company spending $10 million dollars on a clinical trial.

And I’m not saying go crazy and bonkers and do whatever you want for whatever indication, but there are things that work. And you can’t just base it on mechanism. You have to kind of try, put your foot…toe in the water. But there are a lot of conventional therapies that I’ve now replaced with targeted supplementation, intentional supplementation. And we’re not suffering a lot of the side effects, the drug-drug interactions, but you have to be smart. You have to be intentional about it.

Dr. Sandi: I love what you’re both saying. Being smart, being intentional. And also, often, people will just…maybe they’ll hear an ad on the radio, they’ll go to the store and, oh, someone said it’s good or a friend said they’re taking this, and then they go get it and then they have bags and bags or pantries full of supplements. But which ones…you’ve mentioned magnesium, mentioned fish oil. Dr. Sanjay, which ones would you say this is my…this one I’m telling people about over and over again. What are some of the ones that you would say are in that category? Again, keeping in mind this is personalized. It’s never one size fits all.

Dr. Sanjay: So, for me, in my practice, I’m dealing with mostly cardiometabolic patients. And so, that kind of informs what are…the kind of daily standards that I use. Number one, fish oil. There is some concern about atrial fibrillation, but I think in terms of membrane health and cardiovascular health, makes a big difference.

Number two, I love me some berberine, to be honest with you. It activates MK. Helps with insulin resistance, helps with lipids. But you have to use the right berberine. Berberine HCL, really, is more of the gut one, and then the other formulation of berberine that escapes my brain…my caffeine level is low this morning. It’s the one that I use for cardiovascular health. So, that’s kind of a longer term one that I use.

I’m trying to think of what’s in my supplement stack right now. Because I do rotate things. I think those are the two…and magnesium of any sort. I like magnesium threonate a lot, particularly for sleep. It crosses the blood brain barrier pretty well in terms of bioavailability, that along with glycinate. Doesn’t cause the GI upset that…like magnesium oxide which is basically garbage or magnesium citrate which is milk of magnesia. Causes a lot of GI movement, which you don’t want for all of your patients.

So, I think in terms of the cardiovascular stack that I use, fish oil, berberine, magnesium. But of course, it depends on what else people are on and what our goals are. I’m a big fan of chromium and ALA as well for my insulin-resistant patients. But those are more kind of cycle off and on, depending on their level of stress. I may go to an adaptogen as well.

But the point is I’m not just randomly putting people on eight supplements on the first visit. We’re putting our toe in the water, we’re starting things, we’re rechecking, we’re looking at omega-6 3 levels and whatever test you like to do for that. We’re looking at blood pressure. We’re looking at all sorts of metrics to see how they’re responding, and then slowly building them up over time.

Dr. Sandi: How about you, Stefanie? What do you find you’re going to recommending writing down for people all the time?

Stefanie: Yeah. So, I see a lot of women in that perimenopause and menopause transition. And so, that’s a time where low vitamin D levels become really problematic when it comes to hormone balance and how women are feeling. So, vitamin D is definitely in my frequently recommended list. In terms of the magnesium types I use for women, I tend to use more of the magnesium glycinate because that can be relaxing to the brain. And I find magnesium taurate can be helpful with palpitations and also muscle spasm. So, I tend to kind of give them magnesium, based on what problem I’m trying to solve. There’s different types of magnesium that can go to different tissues and have different affinity for different tissues. And so, they give you different results.

Other things that I tend to use a lot of. Myo-inositol is one of my absolute favorites for women in the perimenopausal window. It does a lot for regulation of hormones. It helps with sleep. So, as a typical container of the powder, one scoop is usually around 4,000 milligrams or 4 grams. So, 4 grams a day is…can be very helpful for helping women get better sleep, which is often an issue during that perimenopause-menopause window, and helps kind of stabilize mood also during the day. So, that’s one of my favorites along with L-theanine for anxiety just because anxiety and stress is part of that perimenopause to menopause transition. Almost nobody has…gets through it unscathed. There’s some impact on neurotransmitters as our hormone levels are declining. So, those ones are kind of key for that particular population.

And then I agree with Dr. Sanjay on the metabolic health side of things. I use inositol as well for blood sugar control. I do use some berberine and those kind of things as well. If I have folks that are taking a statin, then my…CoQ10 in the morning is part of what I’ll recommend with the caveat that CoQ10 boosts energy. So, if you take it a dinner, you may not be sleeping at night. So, I think timing matters for some of these things as well. If the side effect is sleep, then nighttime is the right time. If it’s gonna give you a burst of energy like B12 can or like CoQ10, then I think morning dosing makes the most sense.

And then there are some really wonderful multivitamins out there that have activated B vitamins that have a little bit of magnesium. So, depending on who’s sitting in front of me and what the needs are, I do have some go-tos for that that I really like, a good basic multivitamin. But I don’t tend to do the very high-dose ones. I tend to err on the side of a little bit less rather than a little bit more just to make sure that we’re not overdoing things.

And for some of those things like a multivitamin, I’m often recommending that folks do a supplement holiday on weekends. So, taking something five days a week and giving yourself a body…your body a break to clear out any excess that we may be building up over time. I think, giving the liver an opportunity to clear is important when it comes to supplementation. And I’ve seen that for things like, for example, selenium or people that are taking some of these micronutrients. When you don’t give your body the opportunity to clear out the excess, you can end up with too much. And sometimes, too much is just as bad as too little with some of these supplements.

Dr. Sandi: These are all such good points that you’re making. So, are there any emerging supplements, any areas that you’re particularly excited about as you look to the future? And then we’ll start talking about collaborative care and the role of coaches.

Stefanie: Yeah. So, I love me a good probiotic. So, I do a lot of gut work, and I do a lot of hormone work. And the more that we’re learning about hormone balance during menopause, metabolic health, the more the gut comes into play. And so, there’s so much interesting research out there about specific strains of probiotics. And so, that’s one of the things that I’m constantly going back to the research, again, to see what’s out there. I’m really excited Akkermansia in particular and what that is starting to show in terms of blood sugar regulation and how that can make a big impact on the lining of the gut. And so, I’m starting to use a little bit more of that in my gut protocols now than I was before.

Dr. Sandi: All right. Thank you. Dr. Sanjay, anything on the horizon, anything new or new-ish that you think, oh, this is really exciting, promising?

Dr. Sanjay: Yeah. I’m really excited about mitochondrial support and membrane health, I think. So, when we talk about our cell membranes, it’s the wall around the city. And you want that to be very fluid, very open. And when we talk about 6 3 ratios of omega acids and things like that, that’s where these compounds go. And so, now, there’s targeted supplements that with…I don’t know if, name the company. But the targeted supplement that I work with, that is specifically looking at mitochondrial membrane health. And the deeper I dive into mitochondrial membranes, I mean the components are very similar, but that…mitochondria is more than just the powerhouse of the cell. It’s the quarterback of immunity and the quarterback of calcium regulation in our body and so many other factors. And so, that’s the one that, really, I think, is exciting me right now.

And then getting a little bit low-tech is I’m kind of excited that fiber is making a comeback. We see these cycles, and fiber is kind of having its moment. And it’s not just fiber through a pill, but actually natural fibers. I remember one of the very foundational lectures I love, if you know, Kazarian. He did this lecture for us. Yeah… is a great guy.

And so, he said, go to…every week, the challenge is I want you to go to whatever ethnic markets are in your vicinity, and buy the weirdest looking fruits and vegetables, and learn how to cook them and eat them at least once a week because we want to get this variety of fiber sources to really boost our microbiome. And when I look at cardiovascular disease, and in particular, microbiome signatures and metabolic signatures of mitochondrial health, I think those are the two areas that I’m just really jazzed about right now, as of July 22nd. The 23rd, it might be completely different, but those are top of my list right now.

Dr. Sandi: Yeah. Those are all very promising and a lot of good research starting to emerge on those. But let’s go to the other side. What about something that might be trending? And biohackers are excited. Then you think, oh, this is hype. This is not…potentially even dangerous, but you see it is as trendy. It’s featured at Erewhon in LA, the gourmet grocery store for health foods. But anything like that that you’d say, oh, yeah, you hear people taking these. And is this good for you or is it just hype?

Dr. Sanjay: Stefanie, you want to take that one? I certainly have.

Stefanie: You saw me nodding. So, I can always tell what’s making the rounds in podcast land based on what patients come in and tell me. Because I’ll get the same question every day for a week on a specific thing. So, I kind of get a sense for what’s out there. Recently, there was a lot of conversation about methylene blue in particular. It absolutely has its place when it comes to chronic infection treatment, things like Lyme disease. There’s lots of folks that use it for that. There’s other targeted times where it makes sense for that, but it is not an everybody supplement, for sure. That concerns me.

Some of the very high-dose recommendations of stuff, that concerns me. I have a liver specialist that I refer to up at Johns Hopkins that I’ve had some conversations with. And he’s scared to death of some of these high-dose supplements because he says, “I’m seeing these people that are younger than they should be, coming to me with liver failure that don’t have risks for liver failure aside from the very high-dose stuff that they’re taking.” So, I do get a little bit concerned about people thinking, if some is good, then more is better. I do think there’s a Goldilocks spot when it comes to a lot of supplements where you have to get the dosing right, you have to do it in a safe way. So, that’s definitely something that I’m always looking out for

Dr. Sandi: Dr. Sanjay.

Dr. Sanjay: Yeah. Nattokinase. Oh. It’s the bane of my existence right now. I’ve got people saying, oh, I saw this thing and it says that if your doctor puts you on a statin without recommending nattokinase, they should never have graduated med school, blah, blah, blah. There is a role for nattokinase. I think that the expectations are getting overinflated by people that are selling it. And so, there is…and I think something we should talk about is the awareness of the source of the information that you’re getting. Because there are so many people that are saying, oh, I stopped the medicines that I use because of nattokinase. And I’m like, you’ve had two strokes and three bypass surgeries. No. You’re different than a primary prevention patient who’s never had an issue, where it might be a little bit more likely to deploy.

And this is, unfortunately, the burden of the intentional health care providers if you know both sides of the equation, you know that you can’t just wholesale kind of use natural on everybody. And you can’t wholesale use pharmacologic therapies on everybody. There’s a blended balance. But, yeah, nattokinase has been the one that has really been kind of in the cardiovascular universe pushed.

And we’ve been here for a while, the three of us. And so, we see these cycles of…a couple years ago, it was CBD. Remember CBD was like the cure-all for everything. And then it was NAD was supposed to cure everything. And now, they’re saying that NAD may cause over methylation and some concerns. And same with methylated B12, getting over methylated. So, Stefanie, I like what you said about having some time for the body to clear. So, yeah, nattokinase is one.

And the other are these meal replacements. They kind of frustrate me where it’s like, oh, yeah, put this powder in water and mix it up and drink it. It’s like getting all your vegetables in one serving, or the protein powders. Number one, you have to be careful about heavy metal content in the protein powders in particular and those powders. But number two is food is information. And we don’t…we shouldn’t be replacing meals. We should just be eating the right meals. So, you can’t just…being from Chicago, you just can’t say that I had a deep dish spinach pizza and say those are my greens for the day. No, that doesn’t make sense. There’s no amount of vegetable powder that’s gonna absolve you the sin of one pound of mozzarella cheese in a deep dish.

So, yeah, nattokinase. And then patients come to me with these new protein powders and vegetable replacement powders. God gave us vegetables in vegetable form for a reason. Otherwise, there would just be a powder tree somewhere that we could harvest. So, yeah. I think those are the three that kind of stick out for me.

Dr. Sandi: Yeah. Full disclosure, I do get sucked in by…I’ll read something, something’s good and I grow broccoli sprouts. And then I’ve been hearing a lot about the…there’s companies that are bottling this, and it’s 25 times stronger and better. And I think, oh, should I really be doing the sprouts? No. I’m gonna stick with my sprouting… kitchen counter.

So, we’re bringing up so many good points. I’d like to turn to the role of collaborative care team because it’s common for people to…they’ll go to a functional integrative provider, and they get a long list of supplements. But it’s really, are they gonna take them? Are they going to buy the right brand or get a cheaper version that may be adulterated? What do you think of the role of a health coach in terms of helping people with compliance and sticking to it, taking it as indicated, or also providing everything you’re saying a health coach can provide that kind of education about not buying everything just because it’s trend…they’re trending.

Stefanie: I can’t say enough about the role of health coaches in my practice. It’s been huge for us. And so, we tend…in our practice, everything tends to start with the provider. So, if I’m doing…I’m bringing in a new patient, I do a 90-minute initial consultation. I’m looking at their labs. I’m having them do questionnaires, symptom questionnaires. I’m asking them questions. I’m looking at their physical exam. And then by the end, we’re putting together a plan of care. And somewhere in that plan of care we’ll be…we need to look at food, we need to look at movement, we need to look at sleep. And that’s where, a lot of times, the health coach can come in.

So, Barb, who’s my health coach at the moment, has been working with me for the last three years. And she knows exactly the population that we’re working with. She’s comfortable with the glucometer piece. So, she’s looking at the back end of the Dexcom system and seeing what’s going on, and talking to people about what they’re eating, and helping them tweak their meals to have better glucose control because that’s a problem across the board. There’s a lot more folks that are metabolically unhealthy in this country than are metabolically healthy. And they don’t have to be overweight to be metabolically unhealthy.

So, we are trying to deal with the things that are going to be the most meaningful so that the person that’s sitting in front of me is not fracturing a hip at 85, and they’re not in a wheelchair, in a nursing home at 75. I’m looking at those things as much as I’m looking at the problem that they came in to me for.

So, if you’re not looking at lifestyle, behavior change, helping people make those adjustments, helping people decide where do I take my supplements, how do I make sure I’m taking my supplements, how do I make sure that I’m gonna do the exercise I said I was gonna do. Maybe that’s putting your walking shoes in front of the door, maybe that’s putting a reminder in place, maybe that’s what we call habit stacking, taking a new habit and attaching it to something that you do all the time without thinking about it in your day. Those are the places where health coaches really shine.

So, we say in our relationship that I’m the what person. This is what I think needs to be done. And then Barb in the health coach side becomes the how person. So, she takes that information and helps that patient integrate it into their life in a way that’s sustainable. Because I can make the most amazing recommendations in the world, but if it doesn’t work for the person sitting in front of me, it doesn’t matter. And so, for us, that behavior change piece, that information is absolutely critical.

Dr. Sandi: Such an important point. And I want to point out that Stefanie hires FMCA grads.

Stefanie: I do.

Dr. Sandi: Exclusively. So, Dr. Sanjay, what do you think is the role of the health coach?

Dr. Sanjay: Yeah. Well, as I mentioned in the outset, I’m launching a new integrative cardiology practice and health coaching. I’ve got a health coach from FMCA graduate that we’re kind of onboarding. Because I think that is the most central kind of role. And I used to tell patients this in my conventional practice all the time is that if you see me even 30 minutes every 6 months, that’s an important 30 minutes. But even more important are the 179 days, 23 hours, and 30 minutes that I’m not with you. And so, I thought that I could brute force that through education during those 30 minutes. And I always say, hey, you’re the most important member of the team. Pain is weakness leaving the body, all the coaching things that I knew how to say, which were primitive.

And what I love about the health coaches is that, number one, they’ve got the knowledge base, they know kind of where they begin…where I end and they began. As long as we’ve got that defined, I think that’s very important that…for…as a physician, somebody isn’t overstepping their bounds and doing doctor type things, number one.

But then number two is that once we’re kind of dialed in, they’re the implementer. They’re the person kind of figuring out, okay, why didn’t you take your medicines? Okay. You didn’t take your medicines because you broke your leg and you couldn’t get to CVS. That’s different than I forgot or, you know…or my hands don’t work and I have a hard time opening the bottles and opening the pill case and putting the pills in there. With my supplements, it’s a pain in the neck that I have to fix…refill the bottles once a week, my little supplement case. But for people that have arthritic issues, that might be even more difficult.

So, kind of targeting some of the barriers to implementation that may not be intentional but organic, I think, has been kind of a big difference for me. And I think it’s just…in a weird way, whenever…and Stefanie, I don’t know how it is as…in your practice. But there’s this weird distance that is not intentional, but it’s created between the doctor and the patient. They’re like, oh, I don’t want to play…blame… And I have people call me…like it’s a first name. I’m trying to level out the…flatten the world as much as I can. But there’s that, oh, I don’t want to ask him or I don’t want to waste his time which it’s never a waste of time. But they’ll be more likely to ask the coach because they are seen more at a more approachable level. But then that filters up to me to say, hey, Mr. Jones or whatever, this came up this week. And he didn’t want to mention it to you, but this is why he couldn’t get to the exercise or whatever it might be.

So, it’s almost like having this secret army of spies that is actually getting the real information for you. And then what does that do? Well, that just allows me to kind of pivot the plan or work with the coach to pivot the plan so they can become more tactical. And you can start to make those 1% changes that will really kind of make the difference.

Stefanie: I completely agree with that. Can I say one thing?

Dr. Sandi: Oh, please do.

Stefanie: I have noticed the same thing in my practice that… It’s a couple different things that I’ve seen. Either folks, I think, have had some negative experiences with providers in the past. And I think the system that we have right now is really not built for providers just like it’s not built for patients. And so, people go to primary care, they go to their specialists, they have a very limited amount of time. The specialist has specific questions that they need to get in that the insurance requires, that the EMR requires. And that leaves this much space for you.

And so, I think, sometimes people come out of a traditional practice appointment, and they’re feeling unheard, unseen. And so, they’re not going to tell you the vulnerable stuff. I’ve learned that you don’t say the scary things to the provider because the provider isn’t going to hear what I have to say. So, I think that’s one piece of it.

And then the other piece is, I think what we do in functional medicine is we encourage people to experiment and think a little deeper, and ask different questions. And I think, sometimes that takes a little time. So, people will walk out of the door out of my office. And then two weeks later, they’re still thinking about that one thing that I said. And now, it’s starting to make a little bit more sense. So, by the time they’re sitting in Barb’s office and they’re having a conversation about something, they’re saying, you know, Stefanie mentioned this thing. And I didn’t realize it at the time, but now that I’m thinking about it, I think this is important.

So, I think there’s a spirit in functional medicine of don’t be afraid to ask questions. It’s the asking of the questions that gets us to those deeper levels of why things are happening. You can’t do this without asking questions. So, I think we’re encouraging people to open up in a way that hasn’t always felt safe to them before. And that’s one of the real gifts that, I think, functional medicine gives patients is that we come from a completely different perspective. It tends to be a safer environment. I have a sign up at the front of my office that says this is a shame-free office. And that means people need to be able to feel comfortable saying whatever it is that they need to say, and nobody’s going to judge them for it. And that’s the expectation for everybody on my team.

And so, I think that that’s what people should be expecting from their providers in general. But I think the system that we have oftentimes prevents that in conventional care.

Dr. Sanjay: And I just want to hop in real quick, Sandi. Sorry. And I think this is, I think, the importance of human intelligence versus artificial intelligence. Because how many of us have…oh, I put my labs into ChatGPT or I did this or that. There are people that are having relationships with their AI. We are oddly…some of us are getting more and more fractured from human intervention. But when it comes to the sanctity, the sacred bond of a healthcare kind of relationship, you need a person. You need that person, that touchstone person that makes you feel safe.

And I think, to your point, Stefanie, there is this weird kind of almost like I need to sit up straight when I’m at the doctor. And it’s probably from when we’re kids. Kids are climbing on the… I remember when I would go to the pediatrician office with my kids and the doctor was about to come in. And all of a sudden, we all just kind of sit up straight. And we’re all…we’re just sitting there like it’s church on Sunday, like quiet as a church mouse. You know what I mean? And there’s that weird kind of barrier that’s there.

And so, you’re not connected…as much as I try with my patients, there’s still like a weird hierarchy there. But the human intelligence part of health coaching, I think, is something that will never be replaced. And that’s the most important part is really having that trust, that feeling of safety around somebody on your healthcare team because without that, I don’t care how great your doctor is. If he or she doesn’t make you feel safe or their team doesn’t make you feel safe, you’re not gonna heal. It’s just not gonna happen.

Dr. Sandi: These are such good points. And this has been well validated because people see the health coach more like a peer. And so, if they’re learning things, often they’ll say, well, all those supplements the doctor…I can’t afford them. So, I went to Costco and got their brand, or I’m not taking them because my husband says I’m spending too much money on these, or I don’t need them, or my conventional doctor said I don’t need them. But I didn’t tell Dr. Sanjay. They’ll be much more open with the health coach.

We’re gonna open it up. We have some questions that have come in. But I have one final question I’d like to post. And this is something I’d like to hear your thoughts because we see all the time there are schools out there, they’re placing ads, they’re very aggressive and they’re saying you can…we’re gonna give you the treatment protocol, and this includes supplements for…just take our course, learn this. Now, you’re a health coach. You can triple your income because you can be working with supplements and then you will have labs for you to…you can order and interpret. And so, I’d love to hear your thoughts on this, how you would react. We are about a collaborative care model and working together and respecting providers and staying in your lane. Would you hire a coach like that?

Stefanie: Dr. Sanjay had mentioned earlier about scope of practice. And I think that that’s really critical. There are things that, as a nurse practitioner, I’m trying to do. There are certain things I’m not trying to do. You don’t want me doing your open heart surgery because I don’t have the training for that. So, there are certain things that we’re all trained for.

And so, I think the health coaching space…if you’re actually following your…what you’re supposed to be doing, you should not be interpreting labs for patients. And so, I know that there are some schools out there that will tell you you’re doing it in an educational way, you’re not really interpreting. But they like to kind of skirt the law wherever they can to say this is kind of okay, but not… There are real risks to that.

And so, I think that you gotta think about the fact that…here I am as a provider, I’ve been doing this for 20 years. I’ve had my own practice since 2019, and I’m still looking things up every day. I’m constantly learning more. And so, I have a really strong base of medical practice both from the conventional world in primary care, I’ve done long-term care, I’ve done street-level outreach with homeless populations before I came into integrative health. So, I have a really strong clinical background, and yet, sometimes I still have to sit back and look at all the data and say, what does this actually mean? So, my CBC says, and my vitamin D says, and my lab’s saying this. What’s the big picture here?

There’s so much more to bloodwork than just what this little number says. And I don’t think that you can take a five-week course to figure that out. I really think that things like lab interpretation really needs to be done by providers that have that background that can look at the full picture and say, I know that this is what this says. However, I’m still concerned because this is what I saw from you two years ago. And this symptom that you mentioned, and this imaging that you had from before creates a picture that I’m concerned about. There’s a lot more to medical decision-making than just deciding whether this is in an ideal range or not.

Dr. Sandi: And medical decision-making regarding supplements and designing the protocol.

Stefanie: Yes.

Dr. Sandi: Dr. Sanjay, what are your thoughts on this?

Dr. Sanjay: Yeah. I mean I have a lot of strong thoughts. So, I’ll try to temper them and make them nice. But number one, I mean, medical school is hard for a reason. And if you want to be a doctor, go to medical school. But don’t do a weekend course and expect to have that. Gandhi had these seven sins outlined, and one of them was knowledge without wisdom. And I think that’s what happens… I mean, fine, you can get a sodium of, let’s say, 126. Not horrible. But what does that mean? Is there a brain tumor? Is there something else going on? What’s the deeper issue? Like Stefanie was saying, there’s more than just in range, out of range, because if you tell that person with a sodium of 126, just eat more salt, you may just put them at risk for their brain falling apart. You don’t know.

From a liability standpoint, our industry is nursing, MD, kind of these things are so regulated because we take on quite a bit of liability. And health coaches don’t have that same thing yet. But I mean, they’re…you know, we saw this with this case in Texas of this woman that was running a med spa and kind of gave somebody…I think it was potassium chloride as a bolus or something. And now, she’s being charged with murder. And the doctor who…I don’t know where the case is now. Somebody might know in the comments or something. But I think that’s justified because this person did not have the medical expertise. So, just because you can access a vein and connect an IV bag, doesn’t mean you understand all of what that means.

And so, from a liability…from a legal standpoint, I mean I think that we will see more and more of these cases as more and more people practice without a license, without a scope. I just saw a story yesterday of a doctor in New York who’s an MD, but he was licensed in Puerto Rico. Gave some infusion to a woman in New York where he’s not licensed and is under criminal prosecution right now. So, I think we’ll see more and more of these high-profile cases, and we’ll start to see these liabilities add up. And I can tell you, as someone who practices or practice in a very high liability field, don’t take that on. It’s the dumbest decision you can make. Stay in your lane, do what you’re good at, and if you do want to interpret labs and start prescribing, great, go to med school.

I had a woman in my first year…in my med school class who started med school when she was 40. And she’s a great physician now. She was an interior decorator before and decided she wanted a career change. It’s possible. But I would say, really stay in practice. And Sandi knows this. One of our first conversations because I had met a health coach who did one of those weekend classes and her opening salvo to me was, well, I’m smarter than any doctor would ever be. And it just set me…I just…there was a lot of service recovery that needed to happen in terms of my mental approach to health coaches after that, to be honest with you. Because I was like, so, you went to a weekend course and you think that that’s more than the 15 years of training that…15 years of my life that was sacrificed into this. No. I mean, I’m sorry. You may be an intelligent person, but I don’t accept that as a thesis.

And so, we just have to be very kind of collaborative. In the same way that if I went to an OBGYN and said I delivered three babies in med school. So, I’m as good at you as delivering babies. That would not fly. So, I’m not saying there’s not a role. I think it’s…be very clear, be very understanding. And if you want to practice medicine and if you want to prescribe medicines and all that stuff, awesome. Go to med school. I know that’s…that’s a bit more aggressive of a stance than I wanted to take intentionally. But I mean, it’s something I do feel very strongly about.

Dr. Sandi: And we’re with you. And that’s why you hire our graduates. And we have doctors coming to hire our graduates, to refer to them if they are building their own business. So, value of staying in your lane. So, I want to open the Q&A, keeping in mind that we are not diagnosing or giving particular recommendations for anybody. So, let’s see. What supplements would you recommend for focusing on brain health for people with a family history and maybe hyper absorber of cholesterol?

Stefanie: Dr. Sanjay, you want to take that one?

Dr. Sanjay: Yeah. Sure. So, just what is a hyper absorber? So, there’s two ways that you can get too much cholesterol. You can either make too much or you can absorb too much through your gut. And so, hyper absorbers tend to take more. In terms of supplementation, those are the folks that really respond well to fiber. That goes over pretty well. Also, bergamot, for whatever reason, kind of using these hyper absorbers as well, that seems to do the trick.

In terms of brain health, I think that brain health, for me, it’s…there are specific types of brain health. But in terms of cognitive issues, I think number one, a good fish oil and mitochondrial support is really helpful. I think, though, it’s more dietary, looking at the foods that they’re eating, get rid of the ultra-processed foods, getting rid of the processed sugars. So, that’s where I think foundational support, exercise, resistance training, bumping up your BDNF, looking at sleep. I think those are all very important.

In terms of APOE4 carriers, for those who don’t know, APOE4 is a gene that puts you at risk for Alzheimer’s, what’s his name, the big, good looking X-Men guy or whatever, Chris Hemsworth or Hollingsworth or whatever his name is. He had found out that he had APOE, and that can predispose you to Alzheimer’s.

But again, genetics is not our destiny. So much of it is lifestyle on top of genetics. So, optimizing your genetics can really help. But those are people for whom…like high-fat diets, like keto diets might be very pro-inflammatory. So, I don’t know that there’s any one supplement. Again, it’s all kind of together. But mitochondrial support, dietary optimization, fiber, and you know…again, I think you can never get too much magnesium. I think magnesium threonate would be good in that situation as well.

Dr. Sandi: Okay. And I’m just running through. And if you see Q&A that strikes you as something you want to answer, I’m trying to find things that might applicable.

Dr. Sanjay: There was one that popped up…somebody was asking about how come some people can’t take supplements. And they might increase their blood pressure. And I think…so, this is important to…back to my point of… Supplements are still pharmacologically active agents. And so, there, you might like…so, for instance, for my wife when she takes B vitamins, she gets kind of amped up And you know, she’s got a snip that niacin can kind of really rev her up.

And so, realizing that supplements have these effects, depending on your genes. So, you might want to do SNIP testing or something there. Liquid versus tablet really depends on a lot of different things. It depends on your stomach acidity and the breakdown of the tablet. I mean, if you’re seeing in your poop that you’ve got non-digested pill fragments, there’s probably some gut imbalance or some acidity issues and things. And so, you can avoid first pass with sublingual. I do this a lot with B12. People that have methylation issues, they’ll say, take a sublingual B12 because you avoid the liver metabolism. It gets in your system a lot faster.

So, again, this is where good knowledge of biology and medicine kind of comes into play. If you do have people like that, then if it’s outside of your scope, then talk with your collaborating physician about…or a collaborative healthcare provider about why might this person be reacting this way to this. There’s a reason. So, there’s always a reason. You just have to be able to ask the right questions to find out.

Dr. Sandi: Question about inositol. Do you taste something? I don’t know if she meant do you take something, or do you taste something before inositol.

Stefanie: So, inositol does…is actually…has a… If you’re talking about taste, it has a little bit of a sweet taste. And I find that inositol works best directly on the tongue rather than mixing it in water and taking it down because it’s got a little bit of a sweet flavor. Usually, if you’re taking a half a scoop or a scoop of that directly on the tongue, you’re allowing some absorption through the tissues of the mouth that it tends to work even better than if you just swig it down.

So, it’s not offensive at all. I had one person tell me it reminded them of chocolate. I’ve had someone else say that it reminded them of some of their other favorite sweet treats. I don’t taste that, but I think the taste is in the eye of the taster. But I’ve never had anybody complain about that. Some of the powdered supplements can be yucky, but not that one in particular.

And there was another question about vegan omega-3. I’m happy to answer if you’re okay with that. There are some really nice algae-based omega-3s out there. Most of the omega-3 supplements are fish-based. If you go down the food chain, a lot of the omega-3 is coming from the algae, and concentrated in the fish as the fish eat the algae, and then the bigger fish eat the smaller fish that eat the algae. So, you can get algae-based omega-3s that are quite good out on the market. If you want specific recommendations, I can give that, too. The one I recommend the most is by Deva, D-E-V-A. They have a really nice omega-based…algae-based omega-3. They have one that’s just specific for DHA and EPA, if you wanted them individually. But they have some good combinations as well.

Dr. Sandi: Okay. We are going to address probiotics in the next talk. There’s a question about CoQ10 because…in conjunction with a statin, how does this play into taking a supplement holiday? Should we stop CoQ10 for our holiday?

Stefanie: So, I guess, if you’re taking it with a statin, then I think a lot of these can…you can often still have a supplement holiday even in that situation. But I think, depending on the dose that you’re taking and depending on the statin, for some people, it can make a difference in terms of the side effects of the statin. There’s a lot of fatigue that comes with statin. There’s some other things that come with statins that I find that the CoQ10 can be helpful. There are some other supplements that can also be helpful with statins. Dr Sanjay, if you wanted to weigh in on that as well.

Dr. Sanjay: Yeah. I mean, I’ve never seen anybody overdose on CoQ10 the way that you can overdose on curcumin. You can get too much methylated B vitamins and things. So, I don’t think…I don’t really have people take a holiday from CoQ10. There’s ubiquinone and ubiquinol, and there’s that. And so, you want to make sure that you’re using the higher affinity ubiquinone.

But in terms of other medicines…whatever it is, GG, I can never remember what it is. I think it’s really interesting in this space. There’s a couple of companies now, Designs and Apex, that have their CoQ10 supplements that have the GG in there as well that kind of helps supplement kind of HMG-CoA reductase, which is what statin works on. Depletes CoQ10, but it also depletes the downstream factors of that cholesterol synthesis pathway that, now, we’re learning more and more increasingly do have some benefit to other areas of the body. So, you’re supporting that downstream. So, you’re inhibiting.

So, those would be…those two, I think, would be important. But, yeah, I wouldn’t have…I wouldn’t feel that a CoQ10 holiday is really needed.

Stefanie: Yeah. I do the holidays mostly for your minerals. Especially those microminerals, things like molybdenum and chromium and vanadium and selenium and some of these that that are in multiple supplements. So, you’re taking the multivitamin and then you’re taking this thing for bone health and then you’re taking this other thing for hair. And you don’t realize that every single one of them has a high dose of zinc in it. And now, you’ve got a little too much zinc in your system. So, I think it’s…for me, it’s really the minerals that I think we have…often have a really good system for uptake. We don’t always have a great system in place for detoxification. And sometimes you need to give the body a little space to clear those.

Dr. Sandi: All right. Well, this has been a wonderful panel discussion. Thank you both. Thank you, Dr. Sanjay. Thank you, Stefanie, for all that you do on this field and for your support of health coaches and FMCA. We have some questions that we didn’t get to for the sake of time. And we will look these over. Many of these subjects, like peptides I saw, that will be in Ask the Expert. When we have interest in subjects like this, we often do Ask the Expert that will be dedicated to that particular topic. So, thank you so much for being with us today.