September Town Hall: A Different Look at Gut Health & Whole Person Care with Dr. Rob Boyd

Gut Health and Whole-Person Care

Featuring Dr. Sara Tariq and Dr. Rob Boyd

Introduction and Welcome

Dr. Sara Tariq:

A lot of you are already seeing naturopathic physicians, and that got me thinking: Why don’t we have a forum where we have an opportunity to talk with a very well-respected naturopathic physician currently working in the DMV?

I’m really excited to introduce Dr. Rob Boyd. He’s a naturopathic physician and co-founder of the Terrain Clinic in Alexandria.

A little background about Dr. Boyd: He earned his bachelor’s degree in biochemistry at the University of Texas at Austin. My sister asked me to say “Hook ’em Horns” because she’s an awesome person!

He then earned his degree in naturopathic medicine from the University of Bridgeport and completed his residency at the Center of Excellence in Generative Medicine. He also serves as adjunct faculty at Parker University and Everglades University, where he teaches herbal medicine and nutrition.

As I mentioned, many of our patients are seeing naturopaths. At NVFP, so many of our physicians and providers believe in a holistic approach to healthcare. We believe in taking care of the entire person in front of us, and that also means collaborating with different practitioners across the DMV.

Welcome, Dr. Boyd. It’s a pleasure to have you.

Dr. Rob Boyd:

Thank you so much, Dr. Tariq. I’m really excited to be here.

Dr. Sara Tariq:

Why don’t we go ahead and get started?

For those who have joined our Town Halls over the past couple of months, you know the format is very casual. We have a conversation, and I invite everyone to ask questions.

As you think of questions, please put them in the chat. I’ll be monitoring it and will take every opportunity to ask Dr. Boyd your questions.

I’m curious to hear a little about your journey, Dr. Boyd. What brought you to naturopathic medicine?

Dr. Boyd’s Journey Into Naturopathic Medicine

Dr. Rob Boyd:

Absolutely.

After I finished my bachelor’s degree in biochemistry, I started working in the healthcare IT industry.

I always had a big passion for nutrition, understanding what ideal food is and paying attention to those things.

When I was considering going back to medical school, I started investigating all my options. I was originally on the traditional medical doctor path, but then I discovered naturopathic medicine.

I felt like it was a really good fit for me and my goals around nutrition and natural healing.

That’s how I ended up in naturopathic medical school. Fast-forward through four years of school, residency, and founding our clinic back in 2019, and here we are today.

I love what I do. I feel like it’s a unique offering that we can give patients, helping them understand all their options.

I also really enjoy collaborating with the great physicians at Northern Virginia Family Practice. I’ve had the pleasure of sharing many patients, and it’s always good to give people both conventional and naturopathic perspectives when they’re interested in them.

Understanding Naturopathic and Functional Medicine

Dr. Sara Tariq:

Absolutely.

For those in the NVFP family who are new to this, can you share what naturopathic medicine is?

A lot of people use the terms naturopathic medicine and functional medicine interchangeably, but they’re not exactly the same, right?

Dr. Rob Boyd:

Right. There’s a difference.

Naturopathic medicine is a profession with its own educational training. Naturopathic physicians attend a four-year, full-time, post-bachelor’s medical program.

We learn traditional diagnostic approaches, imaging, and other aspects of medicine. But rather than primarily focusing on pharmaceuticals and surgery, we focus more on nutrition, supplementation, botanical medicine, diet, and lifestyle.

That’s where naturopathic medicine comes from and where my training lies.

Functional medicine, on the other hand, is more of an approach.

Many naturopathic doctors use functional medicine, but you’ll also find medical doctors, chiropractors, osteopathic physicians, acupuncturists, and other healthcare professionals practicing functional medicine.

It uses many of the same tools we use in naturopathic medicine, but it’s an approach practitioners can learn as an addition to their existing clinical practice.

That’s why you’ll find so many different professions within the functional medicine field.

Common Gut Health Concerns

Dr. Sara Tariq:

I see. That makes sense.

I know you do a lot of interesting work with gastrointestinal health. I’m curious about the patients you see most often.

Who comes through your door, and what are their primary concerns?

Dr. Rob Boyd:

My biggest specialty is gut health.

A lot of people come to us with chronic gastrointestinal issues, including functional constipation, diarrhea, and irritable bowel syndrome, whether that’s IBS-C or IBS-D.

We also see patients with more severe chronic conditions like inflammatory bowel disease, including Crohn’s disease and ulcerative colitis.

I focus on the GI tract, including upper gastrointestinal conditions like gastritis and GERD, or acid reflux.

We help people explore a more holistic approach to addressing these conditions.

That includes supplementation, diet, lifestyle changes, and understanding any other contributing factors.

Dr. Sara Tariq:

I’m also really interested in the concept of food as medicine.

For example, when it comes to GERD and constipation, how often do you find that changing someone’s diet makes a significant difference?

Assuming they’ll stick with it, of course. That’s always the caveat!

Dr. Rob Boyd:

Absolutely. Diet can be a factor in almost any condition like that.

Sometimes it’s a small factor, and sometimes it’s the entire issue.

The important thing is figuring that out for each individual.

There’s no cookie-cutter solution where removing one food cures everyone’s reflux or increasing water intake cures everyone’s constipation.

I wish it were that simple!

Nutrition and lifestyle can make a huge difference, but we also consider the entire picture.

That’s where some of our functional testing comes in, including gut microbiome testing, food allergy testing, and food sensitivity testing.

Those tools can help us investigate what’s happening for each person.

Collaboration Between Conventional and Naturopathic Medicine

Dr. Sara Tariq:

I love that you coordinate with so many of our NVFP physicians.

What kinds of situations do you co-manage most often?

Where do you think conventional medicine and naturopathic medicine can work together most effectively?

Dr. Rob Boyd:

A lot of the time, we’re co-managing patients who feel like they’ve hit a wall.

They’ve tried conventional treatments, perhaps several different medications, and feel like they need another approach.

They want to look at things through a more in-depth, natural lens and explore additional options.

That’s often where we come in.

We make recommendations and communicate with the patient’s physician to ensure everyone is on the same page.

Making sure there are no medication interactions is a really important part of that collaboration.

Sometimes people come to us feeling like they’ve tried everything.

But just because they’ve tried every option they’re aware of doesn’t mean there aren’t other things we can investigate.

More in-depth testing might reveal something contributing to their symptoms that hasn’t been addressed.

Dr. Sara Tariq:

Where do you send patients for testing?

Do you use Labcorp and Quest like we do, or are there specialized laboratories you prefer?

Dr. Rob Boyd:

For blood work, we definitely use Quest and Labcorp.

There’s an important distinction in Virginia, though. Naturopaths aren’t licensed in the state, so we can’t order labs through insurance.

That’s one reason I really appreciate collaborating with Northern Virginia Family Practice.

We can discuss what blood work might be appropriate, and patients can bring those recommendations back to their NVFP physician.

Then we collaborate on which tests make sense.

We also offer direct-pay blood work through Quest or Labcorp.

For functional testing, such as stool microbiome testing, patients can collect samples at home.

That makes the process more convenient.

We use the results to help develop an individualized treatment plan.

Managing Acid Reflux and Reducing Medication

Dr. Sara Tariq:

It sounds like naturopathic medicine can add quite a bit to the treatment of gastrointestinal conditions.

I have so many patients taking one or two acid reflux medications.

Is your goal often to help patients discontinue those medications?

Or do patients come to you specifically because they’re tired of taking medication and want to stop?

Dr. Rob Boyd:

This is an area where our practice differs from some people’s expectations of naturopathic medicine.

We don’t believe all medication is bad.

We want people doing things that help them feel better.

If someone’s goal is to get off reflux medication, we’re happy to support that.

But we want to work with their prescribing physician to reduce the medication responsibly.

Anyone who’s taken a proton pump inhibitor for a long time knows that stopping abruptly can be unpleasant.

We want to understand what’s triggering the reflux first.

That might involve looking at contributing bacteria, inflammation, or reactions to certain foods.

Once we’ve identified and addressed those factors, we can work toward getting the patient into a more stable condition.

Then, in conjunction with their primary care physician, we can discuss gradually reducing the medication.

But some patients don’t necessarily want to stop medication.

They simply want to feel better.

If medication helps them and they also need to adjust their diet, that’s perfectly fine.

We try to meet people where they are.

We’re here to collaborate, not insist that our approach is the only way.

Evaluating the Evidence Behind Natural Treatments

Dr. Sara Tariq:

Fantastic. I love that.

I’m trained as a conventional Western physician, but I certainly don’t believe conventional medicine holds all the wisdom and healing that medicine has to offer.

How do you determine whether a naturopathic treatment is supported by evidence?

Is there a substantial body of research that you use?

Dr. Rob Boyd:

Great question.

There’s a tremendous amount of research in the areas of nutrition, nutraceuticals, diet, and lifestyle changes.

But as with all research, we have to consider where the funding comes from.

Did a particular vitamin company fund a study showing that its own product works?

Someone has to fund research, but we need to look at the totality of the evidence.

If one study shows a benefit, what do independent studies show?

We need to examine all the available evidence before deciding whether something is a useful addition to a treatment plan.

There are thousands of published articles about natural substances and their potential applications.

Our responsibility as naturopathic physicians is to stay current with that research and be able to support our recommendations with evidence.

Supplements and Wellness Trends

Dr. Sara Tariq:

Speaking of nutraceuticals, are there supplements or natural treatments you think are overused?

Are there things patients should be cautious about?

Dr. Rob Boyd:

Definitely.

If you go on almost any social media platform, you’ll see marketing getting ahead of the evidence.

We have a robust toolkit of herbs, vitamins, nutrients, and minerals that can be useful when taken at appropriate, studied doses.

But there always seems to be a popular supplement of the month.

Right now, creatine is very popular.

Creatine can be great for certain things, but that doesn’t mean every single person needs to take it.

Six months ago, colostrum was a big trend.

There are certain people, particularly those with gut health concerns, who may benefit from it. But not everyone needs it.

The problem is when something gets marketed as a magical solution for everything.

Every supplement has its time and place.

It really depends on the individual and what they need.

Dr. Sara Tariq:

That’s helpful.

It’s actually a similar philosophy to conventional medicine in many ways.

Treatments come in cycles, and we need to review the evidence, weigh the benefits and risks, and make sound decisions.

Understanding SIBO and Treatment Options

Dr. Sara Tariq:

We have a question from one of our NVFP family members.

They’re wondering about your view of antibiotic treatment for small intestinal bacterial overgrowth, or SIBO, the recommended one-by-one food group reintroduction after treatment, and how to regulate gut motility for the long term.

That’s a big one!

Dr. Rob Boyd:

That is a big one, for sure.

I’ve seen people have really good success with antibiotic treatment. I’m assuming the medication they’re referring to is rifaximin.

I’ve seen patients do well with it, but I’ve also seen people who don’t get the results they hoped for or experience a relapse afterward.

Some of the evidence suggests that multiple rounds of rifaximin may be needed.

I’m not against it at all.

We see many patients with diagnosed SIBO who come to us because they couldn’t tolerate the medication, didn’t feel it helped, or continued experiencing symptoms.

SIBO is definitely something we see frequently in our practice.

One of the most important things is understanding the type of bacterial overgrowth involved.

That might be hydrogen, methane, or hydrogen sulfide gas.

The approach can be different depending on which type is present.

We use natural antimicrobials as part of our toolkit to help reduce bacterial overgrowth.

We also focus on gut motility, sometimes using things like ginger.

You have to be careful with artichoke in SIBO because it contains fermentable fibers that can aggravate symptoms in some people.

Another important part of our approach is supporting the gut lining.

There can be inflammation and damage to the mucosal lining over time, and we want to help address that.

We also pay attention to the body’s natural mechanisms for controlling bacteria in the small intestine.

For example, some people develop SIBO after having their gallbladder removed.

Bile plays a role in helping control bacteria in the small intestine.

Stomach acid also contributes to that process.

We look at the bigger picture to understand what’s happening and identify where additional support might be helpful.

I think there was another part of that question. What was the last piece?

Dr. Sara Tariq:

They asked how to regulate gut motility for the long term.

Dr. Rob Boyd:

Right. And I think they also asked about food reintroduction.

For long-term gut motility, we focus quite a bit on meal hygiene.

That means making sure you’re eating in a calm environment and chewing your food thoroughly.

We have teeth in our mouths because chewing is the first stage of digestion.

We don’t have teeth in our stomachs!

We also look at supporting other digestive processes, including stomach acid, bile, and digestive enzymes when appropriate.

When it comes to food reintroduction, I’m assuming they’re referring to the low-FODMAP diet.

There are different groups of foods within that diet.

Some people tolerate certain categories perfectly well but react to others.

That’s why it’s important to reintroduce one category at a time.

Reintroducing individual foods can be difficult because most people don’t eat just one food at a meal.

You have to be patient with the process.

It can take weeks to reintroduce foods and identify your triggers.

But it’s worthwhile because once you know which foods aggravate your symptoms, you can make more informed decisions about limiting or avoiding them.

The Importance of Mindful Eating

Dr. Sara Tariq:

Did I hear you correctly when you said people should eat in a low-stress environment?

Dr. Rob Boyd:

Yes! Ideally, not while they’re driving.

Dr. Sara Tariq:

That’s something I’ve never really thought about.

Dr. Rob Boyd:

Think about what happens when you’re eating in a stressful situation.

You’re probably eating quickly and not thinking about chewing thoroughly.

Maybe you’re having an angry phone conversation while you’re eating, or you’re rushing to get somewhere.

You’re just scarfing your food down.

When you’re in that high-stress state, your body is more focused on its fight-or-flight response.

Ideally, you want to sit down at a table and focus on your food.

Maybe you’re enjoying a meal with family or friends, or simply taking a little time for yourself.

The goal is to avoid treating food as just another task to complete before moving on to the next thing.

Dr. Sara Tariq:

Interesting.

It really sounds like you take a very detailed and systematic, but also holistic, approach to gut health.

Dr. Rob Boyd:

Absolutely.

SIBO is one of those conditions where you really have to think comprehensively.

And I know that can sound overwhelming because I’m listing so many different things.

Nobody does everything perfectly.

That’s true with anything in life.

It’s about identifying the key factors that are contributing to the problem for each individual.

Two people might both have SIBO but need completely different approaches.

That’s where testing and individualized treatment can be helpful.

Usually, there are a few key things that make the biggest difference for someone.

Our job is to identify what those things are.

The Role of Nutrition, Sleep, and Exercise

Dr. Sara Tariq:

There’s a lot of conversation about the role of sleep and exercise in treating chronic conditions.

We’ve known for a long time that exercise helps with so many things, including diabetes prevention and potentially slowing cognitive decline.

As a general internist, I spend much of my time reviewing medications and discussing conditions like diabetes and high blood pressure.

Then we make time to talk about nutrition.

One of the benefits of concierge medicine is that we have more time with our patients to explore these topics.

I’m curious about the role of three things in your treatment plans: nutrition, exercise, and sleep.

I imagine it depends on the individual situation, but I’d love to understand your general approach.

Dr. Rob Boyd:

Absolutely. I’ll start with nutrition because that’s probably the most complicated one.

Making food choices every day can be challenging.

There’s no single perfect diet for everyone.

When it comes to nutrition, we try to get a good understanding of what someone currently eats.

What foods do they like?

What foods do they dislike?

What are they willing to try?

I don’t want to send someone home with what looks like a perfect nutrition plan only to discover that they don’t like half the foods on it.

For example, if someone doesn’t like fish and I’ve built their entire plan around fish, we have to start over.

We want to tailor the recommendations to the person.

We also consider macronutrients, including carbohydrates, fats, and proteins.

Different people need different amounts.

Some people love tracking their food and nutrients.

Others just want general guidance.

We meet them where they are.

Then we look at specific foods in relation to their health concerns.

For someone with reflux, for example, there are common triggers like citrus, chocolate, tomatoes, garlic, and onions.

We want to identify which foods might be triggering their symptoms.

But we also want to think about foods that might help.

For example, aloe vera juice is something I sometimes recommend for people dealing with chronic reflux.

It’s available at many grocery stores, including Whole Foods.

Some people find that drinking a small amount helps with their symptoms.

So we’re not only thinking about which foods to avoid.

We’re also thinking about foods we can introduce.

Dr. Sara Tariq:

I feel like living in America, the odds are stacked against us when it comes to healthy eating and figuring out what’s actually in our food.

Dr. Rob Boyd:

Absolutely.

Especially with the abundance of processed foods.

Even when you’re shopping at a grocery store that has a reputation for healthy food, there may still be ingredients that some people have difficulty digesting.

It takes patience.

It also depends on where someone is starting.

For some people, we’re simply working on replacing fast food with more whole-food options.

Other people already eat a very healthy diet and just need some fine-tuning.

Nutrition is very individualized.

Now, sleep is another critically important factor.

Sleep is essential for our brains, but it’s also important for the functioning and restoration of cells throughout the body.

Even blood sugar regulation can be affected by how much sleep we got the night before.

It seems like new research comes out all the time showing how poor sleep can affect different health conditions.

Sleep helps replenish and restore our bodies.

People need different amounts of sleep, and we can explore different approaches when someone needs additional support.

Exercise is similar in that we have to meet people where they are.

If someone hasn’t exercised in years, I’m not going to send them home with a plan requiring four days at the gym and several days of running.

That would set them up for failure.

Instead, we introduce activity gradually.

We want to make changes that people can maintain over the long term.

This is especially important for people dealing with chronic conditions or severe arthritis.

We need to find ways for them to be active without aggravating joint pain.

If someone starts exercising, loses a little weight, but then develops severe knee pain and can’t continue, that isn’t a sustainable solution.

It’s all about personalization and gradual progress.

Nutrition and Chronic Inflammation

Dr. Sara Tariq:

That’s really helpful.

We have another question in the chat.

What is your opinion on the relationship between nutrition, specific foods, and chronic inflammation?

Dr. Rob Boyd:

Great question.

There’s definitely a biochemical component to this.

The types of fats we eat, including omega-3 and omega-6 fatty acids, can influence inflammatory processes in the body.

Different nuts, seeds, and oils contain different types and amounts of fats.

It’s important to consider the overall balance of these foods in someone’s diet.

We also sometimes see people who don’t tolerate certain foods well.

Those foods may trigger gastrointestinal symptoms or immune responses.

In those situations, we work on identifying alternatives.

We don’t want someone to feel like they can’t eat anything anymore because everything seems to bother their gut.

Instead, we look for foods they can tolerate while addressing the underlying symptoms.

Dr. Sara Tariq:

I’m really interested in food as medicine.

I’ve been reading about foods like berries, which contain compounds associated with anti-inflammatory benefits, and leafy greens, which we’ve always been encouraged to eat.

Are there certain foods you consistently recommend when someone is trying to reduce inflammation?

Dr. Rob Boyd:

Absolutely.

One of the best approaches is moving toward a Mediterranean-style diet.

That includes plenty of olive oil, omega-3-rich fish, nuts, and seeds.

Fish like salmon, cod, mackerel, and herring can be part of that approach.

Walnuts and other nuts can also be beneficial.

You don’t necessarily have to eliminate meat completely.

It’s more about making these nutritious foods a larger part of your regular diet.

You can still enjoy other foods, but you want to improve the overall balance.

The Mediterranean diet has a strong emphasis on foods associated with lower inflammation.

There are also more restrictive anti-inflammatory diets.

Some eliminate gluten, dairy, soy, and other foods that may be problematic for certain individuals.

Those approaches may be considered for people with particular chronic inflammatory conditions, such as rheumatoid arthritis or ulcerative colitis.

But they can be quite restrictive.

When appropriate, foods can be gradually reintroduced while monitoring symptoms.

For most people, a Mediterranean-style diet is a more practical middle ground.

Dr. Sara Tariq:

And it’s also recommended by cardiologists.

It’s associated with benefits for heart disease, stroke, hypertension, and kidney health.

It’s really an all-around beneficial dietary pattern.

Dr. Rob Boyd:

Exactly.

One of the reasons it’s helpful is its potential impact on inflammation.

When we think about cardiovascular health, we look at several major factors, including blood pressure, blood sugar, and inflammation.

The Mediterranean diet can help address some of those factors.

Preventive Gut Health

Dr. Sara Tariq:

Wonderful. Thank you.

We have another question in the chat, and I think this one is really about prevention versus treating an existing problem.

Do you have to have a condition like acid reflux or constipation to be concerned about your gut health?

Dr. Rob Boyd:

Great question.

This definitely falls into the preventive side of things.

I always tell people that the best time to get ahead of a problem is before you’re experiencing symptoms.

We can think about gut health from a broader perspective.

One approach is incorporating more probiotic-rich foods.

Those might include dairy-based foods like yogurt and kefir.

There are also nondairy fermented foods, such as sauerkraut, kimchi, and other fermented vegetables that are common in different cultures.

These foods can help support the gut microbiome.

We don’t have to wait until there’s a problem to start focusing on gut health.

Making dietary choices that support overall health and reduce inflammation can also be beneficial.

It’s always a good time to pay attention to digestion because what we eat and absorb plays an important role in how we feel.

Dr. Sara Tariq:

Absolutely. So incorporating some of those foods into our regular diet can be a good preventive strategy.

Dr. Rob Boyd:

Yes.

There are also direct-to-consumer gut microbiome tests available.

The cost of these tests has come down over time, similar to what we’ve seen with consumer DNA testing.

You can now get information about the composition of your gut microbiome without necessarily spending a tremendous amount of money.

That information may help guide conversations about dietary choices and ways to support gut health.

Supporting Patients Taking GLP-1 Medications

Dr. Sara Tariq:

Very helpful.

We have another question in the chat.

A significant number of people in this country are now taking GLP-1 medications.

There’s a lot of good evidence supporting their benefits for diabetes, obesity, cardiovascular health, and kidney health.

But we also know that some of the main side effects are gastrointestinal, including nausea and constipation.

What role can naturopathic support play for patients taking GLP-1 medications?

Dr. Rob Boyd:

Great question.

I work with several patients who are taking GLP-1 medications.

One of the biggest things we focus on is making sure they’re getting adequate protein.

We don’t want people losing muscle mass along with fat mass.

So we discuss ways to maintain sufficient protein intake.

But that can be challenging.

For example, someone might start drinking a protein shake with 30 grams of protein, but because of the medication’s effects on digestion, it may feel like it’s sitting in their stomach for hours.

They can feel very uncomfortable.

In some cases, we discuss digestive enzymes to support digestion.

We also want to make sure that the calories people are consuming provide good nutritional value.

If someone has a reduced appetite, it’s especially important that the foods they do eat contain beneficial proteins, healthy fats, and carbohydrates.

We want those meals to be nourishing.

Another area we focus on is managing gastrointestinal side effects.

Ginger is something we sometimes use to support digestive motility.

That might be through ginger tea or supplements.

We also emphasize exercise, particularly activities that help preserve muscle mass.

Other patients may experience muscle cramping or related symptoms.

In those cases, we look at hydration, electrolytes, and whether additional nutritional support might be appropriate.

It really depends on what the individual is struggling with.

But maintaining muscle mass and good nutrition are always major priorities.

Dr. Sara Tariq:

It’s funny you mention ginger.

For years, with our pregnant patients who complain of nausea, one of the first things we recommend is ginger tea.

It can be really helpful.

Dr. Rob Boyd:

Absolutely.

And it’s a relatively simple thing to try.

People can often tell fairly quickly whether a particular approach is helping their digestive symptoms.

We don’t necessarily have to wait months to see whether something is making a difference.

Fiber, Hydration, and Digestive Health

Dr. Sara Tariq:

For my patients taking GLP-1 medications, in addition to protein, I really emphasize fiber.

It’s something you have to be intentional about.

And hydration is so important.

You have to drink your water and get enough fiber.

Do you find that your patients struggle with getting sufficient fiber?

Are many of them relying on the fiber gummies that seem to be so popular these days?

Dr. Rob Boyd:

It can definitely be difficult, especially for patients taking GLP-1 medications.

There’s only so much food they feel comfortable eating before they start feeling overly full.

I don’t have anything against fiber gummies.

Ideally, we’d like people to get fiber from whole foods.

When you eat fiber-rich foods, you’re not just getting fiber.

You’re also getting vitamins, minerals, and beneficial plant compounds like the polyphenols found in berries.

Those nutrients are part of what makes fiber-rich foods so valuable.

But I’m not going to insist that someone achieve a perfect diet before we start helping them.

If fiber gummies or a fiber drink mix are useful while we’re working on increasing dietary fiber, that’s an option we can discuss.

Another important point is that people need to increase fiber gradually.

If someone has been eating very little fiber and suddenly decides to start consuming 30 grams a day, they’re probably going to experience bloating, gas, and discomfort.

We want to increase fiber intake slowly so the digestive system has time to adjust.

Dr. Sara Tariq:

Absolutely. We’re completely on the same page.

I’ve seen that so often.

Understanding Detoxification and Cleanses

Dr. Sara Tariq:

Another question I hear a lot in my clinic is from patients who say, “Dr. Tariq, I really need a detox.”

They’ll tell me they’ve tried a detox for a couple of days, and I sometimes pause when I hear that.

But it’s possible I’m pausing because I don’t have all the knowledge.

I’m curious about your perspective on this very popular concept of detoxification.

Dr. Rob Boyd:

Good question.

It really depends on the person’s goals.

When people talk about detoxing, sometimes they mean going on a liquid diet for a couple of days, perhaps drinking bone broth or green juices.

The idea is to give the gastrointestinal tract a break from foods that may be contributing to inflammation or discomfort.

Some people feel better after making those temporary changes.

When people talk about something like a liver detox, that’s a different conversation.

There are supplements, such as milk thistle, that are sometimes used to support liver health.

But we have to be careful with those products, especially when someone is taking medications.

Natural supplements can interact with medications, and a detox program may not be appropriate for everyone.

We also sometimes use gut microbiome testing or functional hormone testing to investigate whether someone might benefit from targeted nutritional support.

But in those situations, we’re looking for a specific reason to make a recommendation.

We’re not simply telling everyone they need a 30-day detox.

That’s a consistent theme in our practice.

Yes, we recommend natural approaches, but we try to base those recommendations on a person’s symptoms or testing results.

We’re not using a cookie-cutter approach where everyone needs the same cleanse.

There are certainly people who feel better after doing those programs, but that’s not generally how we approach care.

Adrenal Fatigue, Stress, and Chronic Exhaustion

Dr. Sara Tariq:

Understood.

There’s another common concept I hear about in my clinic.

Patients will tell me, “I think I have adrenal fatigue.”

We know the adrenal glands play an important role in hormone production and the body’s response to stress.

I’m curious about your approach to adrenal fatigue.

How do you evaluate it, and how do you address those concerns?

Dr. Rob Boyd:

When someone comes to us concerned about adrenal fatigue, we may look at how their body is producing stress-related hormones, including cortisol and catecholamines.

This is particularly something we investigate when someone is experiencing chronic, unexplained fatigue.

But we also have to look at the bigger picture.

If you’re only sleeping four hours a night because you have a busy life, children, and a lot of responsibilities, you’re probably going to feel exhausted.

A lot of people who are concerned about adrenal fatigue describe feeling chronically tired, burned out, or mentally foggy.

We sometimes use functional hormone testing to look at cortisol patterns throughout the day.

Normally, cortisol follows a daily rhythm, with higher levels in the morning that gradually decline.

We look at whether someone’s results follow that expected pattern or whether there are abnormalities.

Depending on the findings, we might discuss nutritional support, including certain vitamins or adaptogenic herbs.

But we want to understand what’s happening before making those recommendations.

We don’t want to automatically assume that every person experiencing fatigue has an adrenal problem.

Dr. Sara Tariq:

I appreciate that you take such a holistic approach and ask all these questions.

As an internist, I find this particularly challenging.

The world has been incredibly stressful over the past several years.

I wouldn’t be surprised if many of us were experiencing some degree of chronic fatigue.

It’s difficult to separate a possible medical issue from the reality that people are chronically stressed and overworked.

We live in a culture where people are constantly going.

We’re working long days, multitasking, and not getting enough sleep.

Many people are also caring for both their children and their aging parents.

There’s so much stress that I worry we sometimes want to attribute everything to one specific problem.

We want to identify one thing, fix it, and feel better.

Dr. Rob Boyd:

Exactly.

We all want a simple answer.

We want someone to tell us, “Here’s the problem, and here’s the supplement that will fix it.”

I wish it were that easy!

That’s where looking at the entire picture becomes so important.

Testing may provide additional information about someone’s hormone patterns or stress response.

But we also need to listen to what patients are telling us.

Sometimes the patient is describing the problem right in front of us.

They’re caring for their children and parents, working full-time, and not sleeping because their mind is racing all night.

Those circumstances can absolutely contribute to burnout, brain fog, and fatigue.

We have to consider all of those factors rather than focusing on one possible explanation.

Who Can Benefit From Naturopathic Care?

Dr. Sara Tariq:

Absolutely.

I’m also curious about the age groups you typically care for.

Family medicine covers everyone from children to older adults.

What age groups do you see most often?

Dr. Rob Boyd:

We see a wide range of ages.

Most of our patients tend to be middle-aged adults.

Often, people reach a point where health concerns that they’ve been living with for years start to become more noticeable.

In your twenties, unless a gastrointestinal issue is particularly severe, you might just try to manage it on your own.

But by your thirties or forties, you may start thinking, “Maybe this isn’t something I should just accept as normal.”

That’s when people begin looking for additional support.

We also work with older adults.

It’s never too late to start paying attention to gut health or other aspects of your well-being.

I do work with some children, but always in collaboration with their pediatrician.

I’m not providing routine pediatric examinations or well-child visits.

In those situations, we’re providing complementary support alongside their existing medical care.

Natural Approaches to Cholesterol and Blood Sugar Management

Dr. Sara Tariq:

We have a couple more questions coming in through the chat.

Someone is asking about alternatives to statins and ways to manage insulin and glucose levels.

I think they may be asking two separate questions: one about cholesterol management and another about blood sugar control.

Are there natural approaches you recommend?

Dr. Rob Boyd:

There are natural products that may help with cholesterol and blood sugar management.

But I always want to emphasize that patients should speak with their primary care physician or prescribing physician before trying something new.

We don’t necessarily know their entire medical history or why they’ve been prescribed a particular medication.

For cholesterol, some options we discuss include red yeast rice, plant sterols, and niacin, which is vitamin B3.

We also look at diet, exercise, hydration, and fiber intake.

Fiber can help reduce cholesterol absorption, so that’s an important part of the conversation.

When it comes to blood sugar management, we have to be particularly careful.

If someone is already taking insulin or another diabetes medication, adding supplements that lower blood sugar could cause their glucose levels to drop too far.

We don’t want to create that situation.

We often start by looking at dietary changes.

Rather than telling someone to immediately follow a strict ketogenic diet, we work with them to find a realistic middle ground.

There are also natural products, such as berberine and alpha-lipoic acid, that are sometimes used to support blood sugar management.

But again, these need to be considered carefully, particularly when someone is already taking medication.

Blood sugar management requires close attention because we don’t want to cause hypoglycemia.

Dr. Sara Tariq:

Absolutely. Thank you for that.

You’re right that blood sugar needs to be managed carefully.

We also have many patients who are in the prediabetic range and aren’t taking medications.

They’re often interested in learning what else they can do beyond diet and exercise.

Fortunately, many of our patients are already very good about focusing on those things.

Natural Approaches to Better Sleep

Dr. Sara Tariq:

Another question: What natural remedies work best when someone isn’t getting enough sleep?

Dr. Rob Boyd:

Good question.

There are different types of sleep problems, and the approach depends on what someone is experiencing.

Some people have trouble falling asleep.

Their mind is racing, and they feel like they can’t calm down.

For those individuals, we sometimes discuss supplements like L-theanine or GABA, which are used to support relaxation.

Other people don’t have trouble falling asleep, but they wake up in the middle of the night.

Maybe they’re awake from three until five in the morning, and by the time they finally fall back asleep, it’s time to get up.

In those situations, sustained-release melatonin is one option we may consider.

We also sometimes investigate whether changes in stress hormone patterns could be contributing to those nighttime awakenings.

Certain supplements, such as ashwagandha, are sometimes discussed in that context.

It really depends on whether someone has difficulty falling asleep or staying asleep.

We approach those situations differently.

Dr. Sara Tariq:

That’s interesting.

I wasn’t familiar with some of those supplements for sleep.

We recommend melatonin fairly often.

I’ve found that if it isn’t helping at a dose of 10 milligrams, increasing it further may not provide much additional benefit.

I also try to avoid prescribing sleep medications whenever possible.

Dr. Rob Boyd:

One thing to remember is that different substances can affect sleep architecture.

That includes certain medications, medicinal marijuana, and alcohol.

Sleep architecture refers to how we move through the different stages of sleep.

Those stages affect how rested we feel the next day.

Before immediately recommending melatonin or another supplement, we want to look at what’s happening before bedtime.

Are you answering work emails while lying in bed?

Are you watching television or scrolling through your phone right before trying to sleep?

Are you spending two hours looking at social media?

We also want to consider the sleeping environment.

Maybe someone’s partner snores loudly and needs to be evaluated for sleep apnea.

Maybe there’s light coming through the bedroom windows or other environmental disruptions.

All those things matter.

Sometimes a person’s sleep difficulties aren’t entirely related to something happening within their own body.

There may be external factors affecting their ability to get restful sleep.

Foods That May Help With Chronic Inflammation

Dr. Sara Tariq:

Wonderful.

We have another question related to something we discussed earlier.

Could you give us one or two examples of foods that may help with inflammation?

And more generally, how can chronic inflammation be addressed?

Dr. Rob Boyd:

Absolutely.

We come back to foods rich in omega-3 fatty acids.

Fatty fish are a great example.

We also talked earlier about nuts and seeds, including walnuts.

Olive oil is another food I often recommend.

I encourage people to choose a good-quality olive oil rather than something that’s been heavily processed or improperly stored.

Dr. Sara Tariq:

I also think about the role of sugar.

It’s so difficult with the average American diet to keep our sugar intake low.

And excessive sugar consumption can contribute to inflammation.

Dr. Rob Boyd:

Absolutely.

We don’t necessarily have to eliminate all carbohydrates or sugar.

But we can think about reducing heavily processed foods and added sugars.

For example, someone might choose to use honey or maple syrup in a recipe rather than granulated sugar.

Those alternatives still affect blood sugar, so we need to be mindful of that.

There are also teas that contain beneficial plant compounds.

Green tea and ginger tea are examples.

And again, the balance of dietary fats is important.

We want to include more foods rich in omega-3 fatty acids while maintaining an appropriate overall dietary balance.

You don’t have to eliminate every food containing omega-6 fatty acids.

It’s about creating a healthier balance in your diet.

Choosing a Good-Quality Olive Oil

Dr. Sara Tariq:

We’re almost out of time, but I have one more question.

You mentioned choosing a good-quality olive oil.

Is there a particular type or brand people should look for at the grocery store?

Dr. Rob Boyd:

Yes.

A couple of brands I like are Jovial and Graza.

Graza has different olive oils designed for different uses.

For example, they have one called Drizzle that’s intended more for finishing dishes, and another called Sizzle that’s suitable for cooking.

They have great names for their products!

In general, I recommend looking for cold-pressed, extra-virgin olive oil.

Another important consideration is the container.

Ideally, you want olive oil packaged in a dark bottle or another container that protects it from light.

Light exposure can contribute to oxidation and rancidity in oils.

Even a high-quality oil can deteriorate if it’s exposed to light for a long time.

So I recommend paying attention to the packaging and choosing brands that prioritize quality.

Closing Remarks

Dr. Sara Tariq:

That’s fantastic.

We’re coming to the end of our hour.

I really put you to work tonight, Dr. Boyd!

We had so many questions.

Dr. Rob Boyd:

We definitely did! That was a marathon, but it was great.

Dr. Sara Tariq:

I knew there would be a lot of interest in your field and in this topic.

I’m incredibly grateful that you spent your evening with us and the NVFP family, sharing your knowledge and perspective.

I’m also excited that we’ve connected because I now have another practitioner I can collaborate with to support my patients.

Before we wrap up, can you remind everyone where they can find you?

Dr. Rob Boyd:

Absolutely, and thank you so much for having me.

I really enjoyed the conversation.

I love opportunities to share knowledge and show people that different approaches to healthcare can work together.

We’re not here to say that our way is the only way.

We’re here to collaborate.

Our practice is called Terrain Clinic, and people can find us through our website.

We offer a free 15-minute consultation where prospective patients can speak with me or one of our other providers by phone.

During that conversation, we discuss their health concerns, explain our approach, and review what our visits involve.

It’s an opportunity to see whether we’re a good fit and whether we may be able to help.

Dr. Sara Tariq:

Wonderful.

And one of our NVFP family members has asked me to tell Desiree Galante hello, so I’m passing that along!

Thank you again, Dr. Boyd.

It’s been such a pleasure having you.

And thank you to all our NVFP family members for your wonderful questions and participation tonight.

This Town Hall has been recorded, so you’ll be able to access it again if you’d like to revisit any of the conversation.

We’re always here to help.

Stay safe, stay healthy, and have a wonderful evening!

Dr. Rob Boyd:

Thank you, everyone. Have a good night!