Expanding the Clinical Toolkit for Better Patient Care: Dr. Lanae Mullane, Head of Clinical Strategy at Joi + Blokes

Lindsey
Hi, I'm Lindsey Smith welcoming you to Raise the Line with Osmosis from Elsevier an ongoing exploration about how to improve health and healthcare.

Today's episode is especially meaningful for me as I get to welcome my childhood friend, Dr. Lanae Mullane to the podcast. With over a decade of experience as a naturopathic doctor, product innovator, and educator, she has been at the forefront of bridging functional medicine, nutraceutical development, and digital health.

In addition to providing whole person care through her telehealth clinic, Dr. Mullane is head of clinical strategy at Joi + Bloke’s, and a functional health advisor at SuppCo. She's known for blending science, biochemistry, and behavioral change to empower patients to take an active role in their health.

Thank you so much for joining us today, Dr. Mullane.

Dr. Mullane
Thanks so much for having me, grateful to be here.

Lindsey Smith
We're gonna start with just talking a little bit about you first. So what inspired you to pursue a career in medicine? and how did you kind of find your way into naturopathic practice?

Dr. Mullane
I have incredibly deep respect for, of course, allopathic medicine. It's vital and life-saving, but it really felt more of a call to be an extension of that care and more a part of the patient's broader health village, if you want to say that. That curiosity really led me to kind of pursue a doctorate in naturopathic medicine, where I could integrate both evidence-based science with other things like nutrition, behavioral changes, nutraceuticals, and of course, prescriptive therapies when necessary.

My goal is really just to always offer additional layers of support, empower people on their own unique health journeys.

Lindsey Smith
That's such a great story. For those of you who are listeners who might not be familiar, can you give us an explanation of what naturopathic medicine is and how it differs from the conventional approaches?

Dr. Mullane
So naturopathic medicine really is kind of a distinct healthcare profession that blends the wisdom of nature with the rigor of modern science. We focus on education, of course, and prevention and sustainable changes. That's really important with helping patients feel heard, while also supporting, you know, primary care providers by filling gaps in ongoing care. Our approach often begins with utilizing more of the lowest intervention strategies and then, of course, build up as needed, while we also recognize when higher interventions are necessary, not just stopping there, ensuring that foundational supports are in place. 

It's not really about replacing conventional medicine -- that's important for naturopathic medicine. It's not an either and or. It's really just about expanding the toolkit, you know, working alongside other specialists and providers and in some states, naturopathic doctors are recognized as primary care providers themselves.

So it's really to create a collaborative model of care that keeps the patient at the center. So we're gonna use more again, nutraceuticals, maybe nutrition, behavioral changes, stress modifications, while still utilizing prescriptive therapies when needed. So kind of looking at the whole person approach to medicine.

Lindsey Smith
That's really helpful context. So to kind of play that back, naturopathic medicine is really focusing on treating that whole person, addressing the root causes with maybe more natural therapies, while conventional medicine typically emphasizes diagnosing and treating the symptoms. But it's not an either or thing, and they're very complementary to one another.

Dr. Mullane
They definitely need each other for sure.

Lindsey Smith
So you kind of just touched on this, so this is a perfect tie into our next question, but you're a really strong advocate for collaboration across healthcare disciplines... working with doctors of medicine, doctors of osteopathic medicine, nurse practitioners and more. Can you tell us what you see as the biggest benefits of this integrative approach to patient care?

Dr. Mullane
I think especially right now it can easily feel like -- if you look on social media or in different spaces and know different government policies at the moment -- that things are separated and it's an either/or and that should definitely not be the case. We work better together and collaboration really is the future to me of medicine. When both know MDs and DOs and like you said MPs and MDs can come together the patient's gonna win.

Each discipline is going to bring unique strengths, whether that's advanced imaging or pharmaceuticals or surgery if needed, while also touching base on nourishing the body through food and lifestyle interventions, which we know are also backed by research to help support someone's health. By working together, we help reduce more blind spots and create more safety nets is kind of the way I look at it and give patients more of a comprehensive care as possible.

And to me, it's been eleven years now as a practicing naturopathic doctor. I've always worked in integrative settings throughout my career. What stands out is how much we lean on each other, you know, with the same shared goal, which is helping the patient get better. It's not always about competing or working again against each other, which is, you know, not a benefit to the patient. It's really about combining those expertise because I'm going to have a limitation to what I can offer as will they due to either time, skill set, education, and we can lean on each other to support so that our patient is the full focus of our attention there.

Lindsey Smith
Absolutely. I think there's such value in bringing those diverse clinical perspectives together. And it's something that we emphasize a lot through our Osmosis Health Leadership Initiative, which is our student community program, where we bring together MDs, DOs, NP's, RNs across all health disciplines to kind of learn side by side. I think the kind of collaboration that you're talking about really reflects that team-based care, but also I would assume leads to better patient outcomes.

Dr. Mullane
Definitely. It's kind of that thing about, you know, it takes a village to raise a child. I really think it takes a village to treat a patient in certain situations and no better way than getting support from all different angles.

Lindsey Smith
So you've been practicing for eleven years now, and I want to know how your training has shaped the way you approach treatment and patient relationships today.

Dr. Mullane
Yeah, so my naturopathic training really, you know, provided again, the science aspect and the art of medicine while I'm still trained in diagnostic and pharmaceuticals and physiology, but again, have a strong background in nutrition, behavioral changes, and nutraceutical therapies, so supplements as well. That blend shaped how I approach every patient. I don't just see a lab value or a diagnosis. I really try to look at the whole person and the story behind their health because we are very complex creatures. 

It also taught me the importance of listening. Many patients come in feeling unheard, especially women navigating hormonal changes, which is a big focus of what I treat now. Taking the time to understand their experience helps me personalize their care and build trust, of course. My goal is also to combine evidence-based medicine with genuine connection with patients so they leave feeling supported, empowered, and an advocate in their own healthcare.

Lindsey Smith
Thank you so much for sharing that, Dr. Mullane. So you touched on your work in women's health and a lot of your work is centered around that, especially in the perimenopausal transition. Could you walk us through when this phase usually begins, the symptoms that people should be watching out for, and how someone might know they're entering it?

Dr. Mullane
So the average age of menopause in the United States is about fifty-one and perimenopause can start as early as ten years before that. So we're talking like your mid to late thirties, sometimes even a little earlier, depending on the person. It's really a transitional phase where we're fluctuating our hormones. They start to fluctuate a little bit.

It's not, we think of sometimes, perimenopause or menopause is a decrease in estrogen. Of course, once we hit perimenopause our estrogen will go down, but that transitional period, it's actually a little bit of a roller coaster and our estrogen can be high some months and low the others. Those are gonna have different symptoms based on where you are. If you're higher in estrogen one month, you might experience things like water retention, mood changes, even things like fullness in breasts or tenderness in our breasts before our cycle.

And then it also can mean fibroids or heavier cycles where lower dips in our estrogen can be signs of like hot flashes and night sweats and maybe again irregular cycles...so kind of what we think about when we're thinking of menopause. But really there's so much nuance even between that when it comes to symptoms. So things like sleep issues and brain fog, mood changes, shifts in our weight, changes in our libido, even things that most wouldn't even think about, itchy ears actually or a frozen shoulder or even starting to see our cholesterol climb. Those can be signs that our estrogen is decreasing or shifting and changing.

The challenge that many women face is they don't recognize these as being hormonally driven and even providers don't always recognize that. Or if they do, it's kind of like a ‘be tough, get through it. This is just a phase of life. This is what you have to do.’ Thinking about doing that for a whole decade does not sound fun. It isn't a fun experience for everyone. There are lots of things, you know, we can do to help support that.

Just thinking about, you know, a lot of women will come in thinking they're stressed or just aging and not taking care of themselves. There's a lot of shame on women thinking that they're not doing something enough. Unfortunately, that's just not the case. That can even be things like changes with weight. Once we hit the age of forty, something called sarcopenia, not exactly hard forty, but around forty for both men and women, sarcopenia starts to happen where we start to lose muscle mass at more of an accelerated rate. That's some metabolically active tissue. So when that's shifting and that moves towards a little bit of more adipose tissue or fat tissue.

 

Does it matter necessarily what we eat? Did we eat the exact same? Our metabolism has now shifted a little bit in the sense of how it's working and our ability to be sensitive to insulin can shift and change based off our estrogen levels as well. So I'll see a lot of women being undernourished because they are not eating, thinking that's how they're going to lose weight, which is not the case in this situation.

So it's really about taking that shame and the blame off of women and helping them raise awareness about kind of this unspoken piece that is incredibly important transition and they need support and it is not them doing something wrong. A lot of times it's their body shifting and changing and really it's a medical condition that they need support with.

 

Now the levels of intervention for that can definitely be different, of course. It doesn't always have to go straight to pharmaceuticals or hormone replacement, but a lot of lifestyle strategies and nutrition when appropriating on hormones can really make women feel informed and supported. The most important to me is equipped. Rather than just saying, you know, suck it up and push through it, they're feeling equipped with knowledge to support their healthcare moving forward. That's pretty powerful and also shifting that shame or blame off themselves.

Lindsey Smith
That was really insightful, and this is such a hot topic today. So many people are curious about this and want clearer answers on it. Another hot topic that we have is hormone therapy, especially around testosterone for women. Can you speak to the current landscape, including the fact that there's no FDA-approved testosterone treatment for women and what that means for care for women?

Dr. Mullane
Yeah, so hormone therapy, like you said, is a hot topic right now, and rightfully so. It is getting some of the sunshine and spotlight that it rightfully deserves and has not received in a long time, if anything, in a negative spotlight before. Honestly, for decades, many providers avoided prescribing HRT and are still little apprehensive to prescribe it, particularly after the Women's Health Initiative that was done, a study which we now know had incredibly significant limitations, whether due to the form of estrogen used, and the age that they started HRT. 

We've now done much more research showing the benefits of what estrogen can play as well as bioidentical micronized progesterone can play on the body with or without a uterus, then of course testosterone and as a result of that, an entire generation of women really missed out of the protective benefits of hormone therapy, which is incredibly unfortunate. But the landscape is starting to shift, and recently the FDA even reviewed the possibilities of removing the black box warning on vaginal estrogen, which can be incredibly game-changing for chronic UTIs, as well as vaginal irritation and pain and vaginal dryness, which can affect things like intimacy.

I also had a discussion about making testosterone FDA approved for women, which is mind boggling that it is not yet. Of course it is for men, but it is not for women. And guess what? We make testosterone as well. So having these conversations is a huge step forward in the right direction. Even though right now there's no FDA approved testosterone therapy and many women have to rely on men's dosed testosterone and have to micro dose that to get a level that's appropriate for women. There are conversations happening and a lot more research coming out showing clear benefits for, again, libido for women, energy, mood, muscle mass, bone density, cognition -- I could keep going -- heart health when it comes to testosterone. I'm glad it's getting some of the spotlight and hopefully this year or next year we have some developments in FDA approved treatments for women in regards to testosterone. 

But I think the bigger issue when it comes to women's hormones is we simply just don't have enough or haven't been prioritizing enough research and regulation with women. Testosterone has been labeled as a male hormone and it's typically thought of as a male hormone, but in reality, women need it too. Many times in our life, we'll actually have more testosterone than estrogen.

Again, it plays a really important role on long-term health, quality of health. HRT can be an incredibly important piece for those who need it in women's health care. It's not only for symptom relief, although that can be incredibly important to utilize it for symptom relief. Even when it comes to things like estrogen, progesterone, we can even give estrogen or progesterone just based off symptoms alone and not even seeing labs for that value because it's pretty specific when women come in with certain symptoms. 

That whole perimenopause journey, and this is where also I love naturopathic medicine, is we realize that every single person is different and their experience into that transition is going to be different than their friends. But having conversations to talk about different symptoms makes it easy for women to identify if they're experiencing certain symptoms.

Where something like testosterone, we would want to see lab work and look at that as well. Of course, lab work can be important also for supporting and making sure that you don't have other symptoms like maybe your fatigue or some of these issues aren't from your thyroid or from low ferritin, which we know our iron in women can actually be very under diagnosed. They actually even raise the bar for low iron for women or ferritin levels actually higher. So many women have gone with lower iron levels and not been treated for a long time. Again, just focusing on research and treatment for specifically women.

This is in the health and wellness space as well. There's a lot of research that went out about intermittent fasting and also for cold plunges. You know, certain people like Stacey Sims are really great with focusing on research for women and how those were done on men and they may actually affect us differently than men and we're not the same. We're not just smaller versions of them. We need to have dedicated research for us. 

Just to bring it together with HRT, it has been shown to reduce dementia and cardiovascular disease and bone health. So to me, as a naturopathic doctor, I'm thinking prevention as well as symptom relief, which is important as even reducing our reliance on antidepressants because it can affect mood for certain people.

So I think the key is just individualized care, listening to women when they say they don't feel like themselves, even if lab work looks OK, really listening to them because they know themselves. Also if they say they have no sex drive, that is a part of health, so making sure that that is enough of a symptom to dive deeper, monitor closely and tailoring therapy based off their needs or family history, of course. 

But my hope is really in the coming years, we'll see safe, standardized FDA approved options for women, as well as better provider training in menopause, perimenopause, and more comfort in prescribing. If not, great time to refer to your colleagues who maybe are more comfortable. But ultimately, women deserve to be both a choice and access when it comes to their hormone health and their health in general.

Lindsey Smith
Hormone therapy is a complex and important topic and sounds like there's a lot more work to be done for women in particular, so thank you for shedding some light on it. You mentioned cold plunges in your last response there and there are always a lot of health fads for people to consider. Some current examples that you mentioned are keto diets, you mentioned fasting. How do you advise your patients to sift through the hype, especially maybe on social media? And what core recommendations do you consistently come back to for more sustainable, meaningful health outcomes for your patients?

Dr. Mullane
Great question. It can really be overwhelming to the point where we don't start anything. Some of these practices can be incredibly helpful for certain people, but they're rarely, you know, a magical quick fix. That's what I always like to say. At the basis, I'm a big advocate for telling patients, you know, it's less about chasing that newest trend and more about nailing her foundations in health. 

What I mean by that is balanced nutrition. So making sure you're getting enough protein in. Again, it doesn't need to be all animal-based. It doesn't need to be over the top at a balanced amount to make sure that we're creating a balanced blood sugar and satiety and supporting our muscle mass. Because to me, I always say, when I think about longevity and health, muscle is so important for that independence as we get older.

So yes, I want to live to ninety, one hundred, but I want to be able to open my own jars. I want to be able to walk without a walker. I want to be able to reduce my risk of falling. That's important. So that being a key piece, making sure that you're feeding yourself nourishing foods, not only about, quote unquote, healthy foods or whole foods, but also foods that maybe are culturally significant or socially significant can be important.

Regular movement, which includes definitely strength training, especially in that perimenopause, menopause state, but that can help anybody making sure they're getting in some strength training as well as some more cardiovascular exercise for that heart health. Then sleep. Sleep is something that we need, it’s incredibly important for our immune health, for our testosterone is the highest, you know, supporting the highest levels when we're sleeping. So really important for recovery. 

So stress management to me is also one of the biggest pieces that is the hardest behavioral change to implement. That's just finding tools when we are having moments of stress to help alleviate that, go back to that rest and digest parasympathetic phase of our nervous system, which is also different for everyone. It might be punching a gym bag, or it might be going for a walk, it might be calling your friend, it might be, you know, doing a yoga class, but for some it's going to be different. Finding those tools, but then utilizing them when we need them. It's a lot easier said than done, but being able to pull from that toolkit is important.

So I think the core habits are the things that, you know, really when it comes to foundational health are not as flashy as those trends, but really are going to be the things that move the needle in long-term health and how you feel day to day, which to me is the most important. Then of course on top of that you can layer on additional things as needed. If a new therapy or practice excites you, go for it and explore it but always build on top of that solid foundation and that way you're not chasing fads. You're actually creating sustainable meaningful health outcomes.

Lindsey Smith
I like what you said there about focusing on the foundation, things like nutrition, movement, sleep, stress management, instead of chasing that latest trend and really focusing on that evidence-based and sustainable treatment in the meantime, and then adding on those other fads that might help you in your health journey. 

We talked a little bit about some of the gaps that exist in women's health already. We talked about research with hormone therapy. But I want to know, where do you think the biggest knowledge gaps still exist in women's health and what would you love to see change in the next few years, maybe beyond the testosterone piece?

Dr. Mullane
Yeah, I think just one of the biggest gaps in medicine is still women's health, particularly around midlife. So for decades, again, most research, as I noted, has been done on men and then applied to women. This really leaves blind spots, especially around that perimenopause, menopause, and hormones in general. Especially things like PCOS, there's so many different avenues with women's health care that I'm excited and hope to see that gap narrow when it comes to their health.

 

We're only now starting to have real conversations about declining estrogen effects, everything in the brain, including heart health, bone density, and mood. Because these changes haven't been prioritized, many women end up being dismissed, and even misdiagnosed or simply told it’s just aging. So I would love to see more research focused specifically on women, especially in midlife and beyond, and more provider training and hormone therapy and more access to integrative care. 

Women shouldn't feel like they have to fight to be believed or to get the right treatment option that works for them. You know, the progress we're making is exciting, but there's still so much room to grow. I think the stigma around HRT needs to shift and change as well. I think that comes with research backing that up to undo what has happened with Women's Health Initiative.

So my hope is just in the coming years, women's health won't be seen as really like a niche area. It will actually be just seen as foundational to healthcare.

Lindsey Smith
Those are all such important areas and definitely lots of room for growth there, so we'll keep watching that space. So today you juggle so many roles, mom, wife, friend. On top of that, you work at Joy + Blokes and SuppCo. Could you give us an overview of these companies, the work you do for them, and lastly, how do you manage it all?

Dr. Mullane
Just like yourself and a lot of women who wear many hats -- a mom, partner, friend, doctor -- and I don't think I ever balance them ever perfectly by no means. It's really about what needs my attention in the given season and giving myself permission to really shift as I need to. 

But I think, you know, professionally, I've been fortunate to work with companies like Joy + Bloke's and SuppCo which align with my passion. Joy + Bloke's is a telehealth company, so making health accessible across the United States, working with more hormones, so providing HRT, labs, supplements, and peptides, which is really exciting, and being able to create a dynamic with a provider and a clinician that just answers questions, makes you feel seen and heard. Really allowing those therapies to be more accessible has been great and creating educational tools so patients feel. And supported and not overwhelmed. So that's a great company that I'm excited to be working with. 

Then SuppCo, which is a digital health platform is going to be an app on your phone, which is building more expert design supplement protocols. It's really trying to take away this overwhelm from supplements by creating trust scores, which allows us to make sure certain supplements, which are technically under the FDA scope, but aren't tightly regulated, to prioritize companies that do those extra third party tests to make sure that you can trust what you're taking is what it says it is.

 

So allowing that trust score on there and then also adding things like reminders and protocols to allow you to be more efficacious with your supplement routine. We know with supplements, they work. They're going to be gentler than pharmaceuticals. So you've got to take them consistently. So it allows you to help put a routine in place so you can be more consistent with those. But both really bring me together the integrative healthcare side of things with patient education, which are both passions of mine.

Alongside that, I always continue to see patients in my own private practice. To me, giving any type of health advice in the health field means never leaving side of the individual, which affects the most, right? So practicing medicine, directly and with patients keeps me grounded and connected and better to, you know, able to translate what I learn in more of a meaningful care and innovation way. I think I see a lot of times different people or healthcare providers kind of lose that a little bit as they step onto different platforms and it removes what may actually work with the person in front of them. So it's important for me to always do that.

But the honest answer is I don't do it alone and I have a support team at home and the importance again of collaboration in both family and in medicine is a perfect example of that.

Lindsey Smith
That village mentality keeps shining through throughout this interview. You're certainly weaving together a lot of purpose-driven work with a whole lot of life and juggling a lot, so we are so impressed with how you're doing it all. Given everything that you've learned through your medical journey across clinical care innovation and life outside of work, what advice would you offer to medical students or early career clinicians who are curious about integrative or naturopathic medicine?

Dr. Mullane
I would say my biggest advice is stay curious, stay collaborative. Medicine is truly a team sport. You do not have to have all the answers. I know on social media, it seems like everybody's supposed to know about nutrition and pharmaceuticals and every single aspect of health, but you do not have to carry the weight of medicine alone. Integrative and naturopathic care can really broaden the toolkit, not narrow it. So keep an open mind. Lean into the expertise of other providers, even in the fields you may be a little bit less familiar with, like naturopathic medicine. At the end of the day, it's again, collaboration and connection that create the best outcomes for the people we serve, which is our patients.

Lindsey Smith
So stay curious, stay collaborative, and healthcare is the ultimate team sport. That is great advice. Before we wrap up today's episode, is there anything we didn't cover that maybe we should have?

Dr. Mullane
This is a great intro to things with hormones and peptides and supplements and just kind of talking about the different elements that natural health and naturopathic medicine can bring. But when it comes to women's health and HRT, there is so much of the conversation there. So I always recommend diving in, learning more, asking questions. But I could talk about this for... how many days do we have? But I think we covered a good start of it.

Lindsey Smith
We are just scratching the surface of this. Dr. Mullane, I can't thank you enough for joining us today. We are so appreciative of the insights that you've shared with us and really look forward to seeing what you're gonna do next.

Dr. Mullane
Thank you so much.

Lindsey Smith
I'm Lindsey Smith. Thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.