Participants:

Rudrani Banik, MD, IFMCP, Double Board-certified Neuro-Ophthalmologist and Functional Medicine Physician, Associate Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai, Co-director of the Neuro-Ophthalmology Service, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, www.drranibanik.com

Serena Goldstein, ND, Delray Beach, FL, www.drserenagoldstein.com

Holly Lucille, ND, RN, Naturopathic Doctor, Educator and Natural Products Consultant, www.drhollylucille.com

Jessica Maloh, ND, San Jose, CA, www.decode-me.com

Allie Buttarazzi, MD dipABLM, CHWC, Brunswick, ME, www.mainestreetmedical.com; www.alliemd.com

Heather Gosnell, MD, Pediatrician, Plant-based Health Coach, and Founder of Eat Plants MD Coach, Phoenix, AZ, www.eatplantsmdcoach.com

Amy Koch, DC, Clinician, Viscerosomatic Center, Logan University, Chesterfield, MO, www.logan.edu

Dr. Rosia Parrish, Boulder, CO (also licensed in California and Washington), www.nawellness-boulder.com

Since Natural Practitioner’s (NP) inception, the field of complementary and integrative health (CIH) has grown. Here, NP talks with a panel of practitioners about trends they are noticing, technology, patient- and self-care, as well as the future of CIH.

NP: Are there any health issues that you are seeing a rise in? Why do you think this is the case?

Dr. Banik: I am seeing more dry eye, digital eye strain, migraine and light sensitivity, as well as chronic eye conditions, such as macular degeneration, glaucoma and diabetic eye disease. The main contributors are modern-day lifestyle factors, such as increased screen time, ultra-processed diets, environmental exposures, poor sleep, sedentary habits and chronic stress. These, combined with longer life expectancy and metabolic dysfunction, are all likely contributing and taking a toll on our vision.

Dr. Goldstein: I have noticed a few more cold and flus during the summer than I have in the past—honestly unsure why. Whether it’s something in the air, or people not being as diligent about their health, as summertime can either be “watch your figure” or “it’s vacation and downtime before things pick up again in the fall.” Or often life events can happen any time of year, creating undue stress, which can compromise anyone’s immune system.

Dr. Lucille: I am seeing more people dealing with fatigue, sleep disruption, digestive complaints, hormonal changes, metabolic dysfunction, anxiety and complex inflammatory patterns. Frequently, these concerns do not occur in isolation. A person may come in with poor sleep, digestive symptoms, blood sugar instability, and low energy all at the same time.

I believe this reflects the cumulative effects of chronic stress, disrupted circadian rhythms, increasingly sedentary lifestyles, ultra-processed foods, environmental exposures, post-viral or post-treatment recovery, and the sheer pace of modern life. Many people are also overwhelmed by conflicting health information. They are trying very hard to feel better, but they often lack a clear, individualized plan.

Dr. Maloh: I’m seeing a lot of inflammatory skin conditions—this includes acne, eczema and rosacea. While genetics play a role, changes in environmental and lifestyle factors can also contribute to the development and severity of these conditions. Overall, when diets are low in fiber and plant diversity, when stress levels are elevated, and when sleep is compromised, it can influence inflammation, immune function, and the health of both the gut and skin microbiome.

I think there has also been a tendency to overcomplicate skin care—using multiple active ingredients, harsh cleansers and introducing many products into a routine to improve the skin. However, while topical products can certainly have a role when used appropriately, overuse can disrupt the skin barrier and contribute to irritation and inflammation. I think we’re developing a better appreciation that more skin care isn’t necessarily better skin care, and that supporting the skin barrier and maintaining a healthy skin microbiome are important pieces of the equation.

Dr. Buttarazzi: I’m seeing a significant rise in chronic inflammatory conditions, autoimmune disorders and vague multi-system symptom clusters that conventional Western medicine often struggles to fully categorize or manage. Much of this stems from modern lifestyle drivers: ultra-processed diets, chronic sedentary behavior, and unmanaged psychological stress. Additionally, our medical system historically excels at acute intervention rather than root-cause prevention for complex, lifestyle-driven diseases.

Dr. Gosnell: I’m seeing a rise in obesity, high cholesterol and prediabetes, and it’s showing up in younger patients, even children. I think a big driver is our growing reliance on processed, convenience foods. Life is busier than ever, and nutrition is often the first thing to get sacrificed.

Dr. Koch: I’m seeing is an increase in chronic inflammatory conditions, digestive disorders, anxiety, infertility, sleep disturbances and metabolic health concerns. I believe this is likely due to factors such as chronic stress, poor sleep quality, environmental exposures, ultra-processed diets and sedentary lifestyles. Patients are seeking more comprehensive solutions that address the root causes of illness rather than simply managing symptoms.

Dr. Parrish: Yes. In my fertility practice, I am seeing a rise in complex, multifactorial cases rather than one isolated diagnosis. More patients are presenting with diminished ovarian reserve, recurrent pregnancy loss, repeated implantation failure, endometriosis, adenomyosis, uterine fibroids, irregular or absent ovulation, thyroid and autoimmune conditions, chronic inflammation, and metabolic dysfunction.

Polyendocrine metabolic ovarian syndrome (PMOS), formerly called polycystic ovary syndrome (PCOS), remains one of the most common concerns. The updated name better reflects that this is not simply an ovarian condition involving “cysts,” but a multisystem disorder that can affect androgen levels, insulin sensitivity, metabolism, inflammation, ovulation and long-term health.

I am also seeing greater recognition of male-factor infertility. Part of this apparent rise is that men are being assessed more thoroughly. For decades, fertility care focused primarily on maternal age and health, while the male partner often received only a basic semen analysis or no evaluation at all. We now understand that sperm concentration, motility, morphology, DNA integrity and overall paternal health can influence fertilization, embryo development, implantation, pregnancy viability and placental health.

Elevated sperm DNA fragmentation is associated with poorer reproductive outcomes and recurrent pregnancy loss. Emerging research is also examining relationships between paternal health, sperm genomic and epigenetic integrity, preeclampsia, preterm birth, and the future health of the child. Paternal age, environmental exposures and sperm abnormalities are also being investigated in relation to certain pediatric cancers and neurologic or neurodevelopmental conditions. Although many of these relationships are still being studied, the larger message is clear: the father’s preconception health can affect not only the ability to conceive, but also the pregnancy, the pregnant mother, and the future child. This is shifting the long-standing narrative that fertility and pregnancy outcomes are primarily reflections of maternal health.

Why are these issues rising? I believe it is a combination of true changes, better detection, and greater awareness. People are starting families later, when age-related changes in both egg and sperm quality become more relevant. We are also identifying contributors that were historically missed, including chronic or asymptomatic genitourinary infections, systemic inflammation, post-viral changes following infections such as COVID-19, and possible exposure to mycotoxins.

Environmental pollutants and toxicants are another significant concern. Endocrine-disrupting chemicals, pesticides, heavy metals, air pollution and plastics-related chemicals are increasingly associated with changes in reproductive hormones, oxidative stress, sperm concentration, motility, morphology, DNA fragmentation and epigenetic regulation. I often describe sperm health as a sensitive barometer of our broader environmental and metabolic health. Because sperm develop continuously, they can respond to infection, fever, inflammation, nutrient status, sleep, stress, medications, substance use, occupational exposures and environmental toxicants. Declining sperm quality may therefore be warning us about what is happening both within the individual and in the environment in which we all live.

Other emerging complexities include the widespread use of GLP-1 medications among reproductive-aged patients, which creates new considerations around preconception medication timing, rapid weight loss, and nutritional status. I am also seeing greater demand for fertility preservation and oncofertility as more patients seek to protect their reproductive options before cancer treatment or other fertility-altering therapies.

From a naturopathic and functional medicine perspective, fertility cannot be separated from whole-person health or from the health of both partners. The conversation is shifting from asking only what is wrong with the woman to evaluating the couple, their health histories, their exposures and their environment. That broader lens helps us identify modifiable contributors and provide comprehensive, collaborative fertility care.

NP: What trends are you noticing in the field of complementary and integrative health?

Dr. Banik: Ophthalmology has traditionally been a surgical field with a reactive “wait and watch” approach, in which ophthalmologists monitor patients until they develop advanced disease, at which point an intervention is offered, be it prescription medication or surgery. However, over the past five to 10 years, there has been more emphasis on preventative care, as well as more science-based research using complementary therapies such as nutrition, targeted eye supplements, photobiomodulation (red and infrared light therapies), and acupuncture for eye conditions like macular degeneration, dry eye and glaucoma.

Dr. Goldstein: In the field of medspa and aesthetics, people are becoming increasingly interested in what they can do over the long-term, or especially once they stop a GLP-1 treatment (I see some of these clientele) when it comes to nutrition, exercise, lifestyle habits and often supplements.

Dr. Lucille: One encouraging trend is a move away from one-size-fits-all wellness toward more personalized, evidence-informed care. We are paying greater attention to the microbiome, metabolic health, healthy aging, sleep, stress physiology, hormone health, and the ways these systems interact.

I am also seeing greater demand for transparency and quality, particularly in dietary supplements and laboratory testing. Patients and practitioners want to know what is actually in a product, whether the form and dose match the evidence, and whether the recommendation is appropriate for the individual.

There is also a welcome movement toward collaboration. Integrative care works best when it is not positioned as conventional medicine versus natural medicine, but as thoughtful, coordinated care that uses the safest and most appropriate tools available.

Dr. Maloh: One of the biggest shifts is the move toward evidence-informed integrative care. Data from clinical research allows us to better understand not only whether a topical, supplement or lifestyle intervention work, but also for whom it works, how effective it is, and how safe it is within the specific populations it is intended to serve.

This has been a particularly meaningful part of my own work. I’ve been involved in conducting and publishing clinical research across a range of integrative dermatology topics, including studying almond consumption and its effects on photoaging in post-menopausal women, topical therapies and L-histidine for eczema, and probiotics and topical approaches for acne.

What I find particularly interesting about these studies is that their value often extends beyond the primary clinical outcomes. By also looking at measures such as the gut and skin microbiome, skin barrier integrity, mood and other biomarkers, we can learn more about the underlying pathophysiology of these conditions and potential mechanisms of action of the interventions we are studying.

Dr. Buttarazzi: Patients are taking a far more proactive role in their personal health narratives. There is a growing demand for root-cause medicine, functional lab testing and personalized lifestyle strategies alongside standard medical care. I’m also seeing a welcome shift toward stronger collaboration between conventional MDs and integrative practitioners, as well as a heavier focus on bio-individuality over one-size-fits-all protocols.

Dr. Gosnell: Food as medicine is the trend I’m most excited about. I spend a lot of my time with patients and clients showing them that small, consistent changes to what’s on their plate can move the needle on their health in a big way.

Dr. Koch: Patients are becoming more informed and proactive about their health. There is growing interest in personalized medicine, functional nutrition, microbiome health, hormone balancing, stress management and lifestyle-based interventions.

Dr. Parrish: One of the exciting trends I am noticing in complementary and integrative health is the growing interest in women’s health as a serious and distinct area of research. For decades, many aspects of female physiology were understudied, minimized or viewed primarily through the lens of reproduction. We are now seeing greater attention to menstrual health, ovarian aging, endometriosis, adenomyosis, PMOS, perimenopause, menopause, autoimmune disease, metabolic health and the influence of female hormones on the brain, bones, cardiovascular system, immune system and longevity.

Within fertility care, this research is changing how we understand the ovary. Rather than viewing it simply as a container holding a fixed supply of eggs, scientists are studying it as a living, metabolically active organ with its own complex ecosystem. That ecosystem includes immune cells, blood vessels, connective tissue, mitochondria, hormones, follicles, supporting cells and nerves. It changes throughout the menstrual cycle and across a woman’s lifespan, and it may be influenced by inflammation, metabolic health, oxidative stress, vascular function, environmental exposures and communication between an egg and its surrounding cells.

The most provocative development is the renewed scientific debate over whether the ovarian reserve is as fixed and nonrenewable as we have long believed. For approximately 70 years, the prevailing view has been that women are born with all the eggs they will ever have and that this supply only declines. Researchers have now identified cells in adult ovaries with characteristics of oogonial stem cells. Under certain laboratory conditions, these cells appear capable of developing into immature oocyte-like cells.

This raises the possibility that the ovary may be more dynamic and potentially more regenerative than previously understood. There are fascinating parallels with male reproductive biology, in which spermatogonial stem cells continually generate new sperm. Continuous sperm production is well established, whereas researchers have not yet demonstrated that adult human ovaries routinely produce new, viable eggs. Scientists are still determining whether these ovarian cells can generate functional eggs, support existing follicles, repair ovarian tissue, or serve another regenerative role. Even so, this research challenges the idea that ovarian aging is simply the passive depletion of a fixed “egg bank.”

Another remarkable finding is the direct connection between the nervous system and the ovary. A 2025 study mapped dense, branching networks of sympathetic nerves within human and mouse ovaries, along with glial cells that support those nerves. These are the same sympathetic nerves involved in the body’s “fight-or-flight” response, and researchers found that their density increased with ovarian aging.

When sympathetic nerves were removed in mice, more immature eggs remained in reserve, but fewer follicles progressed toward maturity. This suggests that neural signals may help regulate when follicles begin growing and how they mature. The ovary is therefore responding not only to reproductive hormones such as FSH and LH, but also to direct signals from the nervous system.

This provides an important biological framework for understanding the relationship between stress and fertility. Sympathetic nerves release messengers such as norepinephrine that can affect ovarian blood flow, steroid hormone production, follicular development and ovulation. It does not mean that stress alone causes infertility or that women would become pregnant if they would “just relax.” That message is inaccurate and places an unfair burden on patients. However, it does show that stress is not merely an emotional experience occurring separately from the reproductive system. The stress-response system is physically and functionally connected to ovarian tissue.

For complementary and integrative practitioners, these discoveries support a more sophisticated approach to women’s health. Nutrition, sleep, metabolic health, inflammation, environmental exposures, mitochondrial function, emotional health and nervous-system regulation are not disconnected wellness topics. They are part of the biological environment in which follicles develop and reproductive hormones communicate.

This is why approaches, such as counseling, mindfulness, breathing practices, acupuncture, yoga, appropriate movement, sleep restoration and other mind-body therapies are receiving more attention in fertility care. These therapies are not replacements for appropriate medical evaluation or reproductive treatment, but they may help address the physiological effects of chronic stress and support autonomic regulation.

The larger trend is a shift from viewing female fertility as a fixed countdown toward understanding the ovary as a responsive, interconnected and potentially more regenerative organ than previously recognized. Women’s health research is finally exploring how the ovary communicates with the nervous, immune, metabolic and vascular systems. That evolving science closely reflects the whole-person perspective that has always been central to naturopathic and integrative medicine.

NP: What do you do to stay healthy and de-stress?

Dr. Banik: I follow a predominantly plant-forward diet rich in eye nutrients (the macular carotenoids—lutein and zeaxanthin), fiber, live probiotics and prebiotic foods. I prioritize daily movement (i.e., swimming, dancing, walking, heated yoga or HIIT classes), hydration, meditation and time away from screens. I use photobiomodulation to support my eye and overall health. Cooking, spending time outdoors, travel and connecting with family and friends also help me recharge.

Dr. Goldstein: During the day, I take an hour lunch break, some of which I will get outside, and put my feet in the grass. No phone, either. I journal regularly, take my supplements, keep a general anti-inflammatory diet upon cooking and going out to eat, and go to the beach/go into the ocean once a week. I workout to a routine supported by a personal trainer two to three times per week, heated yoga once a week, and may vary up the third workout at the gym with a Pilates reformer class. On other days, I bike, take walks listening to my music or stretch. Socially, I chat (via calls or in person) with friends and family, and send an Instagram reel if I find something funny. For fun, especially on the weekend, I enjoy car shows, art fairs, outdoor events, fireworks, or if there’s an interesting exhibit nearby.

Dr. Lucille: I try to return to the basics: morning light, hydration, movement, nourishing food, time outside, sleep and protecting some quiet space before the world starts asking things of me.

I also believe strongly in boundaries. Sometimes the healthiest thing we can do is say no, delay a response, turn off the data, or stop treating every request as an emergency.

Music is another important reset for me. I play bass, and there is something wonderfully grounding about putting my attention on rhythm, creativity and being completely present. Humor helps too. I take health seriously, but I try not to take myself too seriously.

I am not perfect at any of this. For me, self-care is less about performing an ideal wellness routine and more about consistently noticing when I need to come back to myself.

Dr. Maloh: Sometimes, the small things we do can go a really long way. I love going for walks in nature, and I love the research around going for an “awe walk.” In one study, participants that were asked to take a 15-minute walk and cultivate a sense of awe just once a week for eight weeks, experienced improvements in emotional wellbeing. It’s a great reminder that supporting our health doesn’t always have to be complicated or time-consuming.

It’s also so important for me to spend time with the people I love and to spend time doing the things I enjoy like cooking and trying new recipes. For me, those simple routines like getting outside, connecting with loved ones, and preparing a meal are some of the best ways to slow down and recharge.

Dr. Buttarazzi: I prioritize daily foundational health routines. My stress management includes regular breathwork, brief mindfulness practices, and somatic release techniques to foster emotional resilience. Physically, I aim for 8,000-11,000 steps daily through outdoor walking and incorporate strength training several times a week. Having celiac disease, I maintain a strict gluten-free, whole-food-focused diet. Dr. Gosnell: To stay healthy and reduce stress I eat a whole food, plant-based diet, exercise five days a week, and make time for daily meditation and a gratitude practice. Those last two get skipped the most easily, so I treat them as non-negotiable.

Dr. Koch: I believe practitioners should model the habits they encourage in their patients. I try to prioritize healthy movement, balanced nutrition and quality sleep. Spending time outdoors, maintaining meaningful relationships and a good work/life balance also help me manage stress. Wellness is not a destination so much as a journey toward long-term health.

Dr. Parrish: I try to stay healthy by doing things that make me feel strong, connected and genuinely happy. For exercise, I love reformer Pilates and Lagree Pilates. Both challenge my strength, balance and focus, and I appreciate that I can adapt them to what my body needs during different stages of life and recovery.

A lot of my favorite movement does not feel like formal exercise because it happens with my children. We love swimming, biking, visiting bike parks, hiking, playing in streams and catching crawdads. Being outside with them pulls me away from work and into the present moment. It also reminds me that health can be playful. It does not always need to involve a structured workout or a perfectly optimized routine.

Gardening is another way I slow down and reconnect with nature. I enjoy caring for plants, watching the garden change and spending time outside with my hands in the soil. Our backyard also has more than 10 bird feeders, and feeding and watching the birds has become a small source of daily joy. There is something grounding about noticing which birds arrive and watching the seasons change through their activity.

I also attend Herbal Plant Temples with Rachel Weitz Healing Arts almost every month. These gatherings give me space to slow down, connect with plants and experience herbal medicine in a personal and experiential way. As a naturopathic doctor, I spend much of my professional life thinking clinically. The plant temples allow me to reconnect with the relational, sensory and traditional aspects of herbal medicine that first drew many of us to natural healing.

My newest obsession is the Little Free Library that was recently donated to our family. We are constantly checking that it has enough books, decorating it and adding bookmarks, literary keychains, stickers and other small surprises. Our entire family is having so much fun with it, and we are all reading more. Our HOA may not share my level of enthusiasm, but the Little Free Library has brought us a tremendous amount of joy!

NP: Overall, how can practitioners better serve and help their patients?

Dr. Banik: We need to treat the whole person, not just an isolated organ such as the eye or a specific diagnosis such as glaucoma or macular degeneration. We need to incorporate counseling on nutrition, sleep, stress, hormonal and metabolic health, medications and daily habits into our patient care regimens. Listening carefully, collaborating across disciplines, and creating realistic, personalized plans help patients become active participants in their health.

Dr. Goldstein: I often find it’s understanding your patients in a way they need. I hear the venting of “I just got sold 30 bottles of supplements!” or “I was told I have to eat this way or I would lose the weight [or add in concern].” In these scenarios, I turn the attention away from “who said what,” and focus on what the patient feels they want and need. Perhaps they bought a bunch of supplements, wanted to incorporate those, and didn’t feel heard. Maybe the person told to eat a certain way is refusing because it’s too different from their culture, and their heritage and what we enjoy brings a sense of belonging and comfort. In this sense, it’s part looking at the big picture, and allowing them space to free-flow talk about their feelings, concerns, and often fears, underneath.

Dr. Lucille: Listen more carefully. Explain the “why.” Treat the person, not simply the test result.

Patients often arrive feeling dismissed, confused or overwhelmed. They may have seen several practitioners and received several disconnected plans. We can serve them better by slowing down enough to understand the timeline, the context, the patient’s priorities, and what is realistically sustainable.

A good plan should be clear enough that the patient understands why each recommendation is there. It should address foundational needs, avoid unnecessary complexity, acknowledge uncertainty and include a way to evaluate whether it is working.

We also need to remain within our scope, coordinate with other members of the health care team, and refer when another practitioner’s expertise is needed. Collaboration is not a failure. It is good medicine.

Dr. Maloh: I think one of the most valuable things we can do is listen. Patients should feel heard, understood and involved in their care. I also think that as a provider, it’s important to remain curious, committed to lifelong learning, and open to collaboration across health care disciplines. The best outcomes often come from combining evidence-based medicine with individualized care that considers a patient’s lifestyle, goals and lived experience.

Dr. Buttarazzi: By meeting patients exactly where they are. Sustainable change doesn’t happen through rigid prescriptions; it happens through collaboration. If a patient isn’t ready to revamp their entire diet, we start with a small, accessible step—like adding a post-dinner walk or a single serving of fruit to meals. Tapping into their intrinsic motivation is what builds momentum and drives long-term success.

Dr. Gosnell: Practitioners can best serve their patients by meeting them where they are. That means listening with real curiosity instead of jumping straight to advice, then working together on goals and concrete next steps they can actually stick with.

Dr. Koch: I believe the key is listening. Patients want to feel heard, understood and involved in their care. Practitioners can better serve patients by taking a comprehensive approach, providing education, fostering realistic expectations, and empowering individuals to take an active role in their own health journey. Building trust and creating a partnership often leads to better outcomes than simply delivering recommendations.

Dr. Parrish: Practitioners can better serve patients by slowing down, listening carefully and believing them when they say something is not right. Many of my fertility patients have been told that everything is “normal,” yet they are experiencing irregular cycles, infertility, recurrent pregnancy loss or repeated treatment failure. A laboratory result within a reference range does not erase a patient’s symptoms or lived experience.

An important conversation in women’s health right now is the tendency to attribute nearly every unexplained symptom in women to anxiety. Anxiety is real, common and deserving of compassionate treatment, but it should not become a convenient explanation that ends the medical evaluation. Anxiety may be a primary condition, coexist with a physical illness or develop in response to frightening symptoms and repeated medical dismissal.

A racing heart, dizziness or shortness of breath may occur with anxiety, but those symptoms can also be associated with anemia, thyroid dysfunction, an arrhythmia, dysautonomia, medication effects or blood-glucose changes. Fatigue and brain fog may reflect stress, but they may also occur with iron or vitamin B12 deficiency, autoimmune disease, a sleep disorder, hormonal changes or metabolic dysfunction. Pelvic pain and bloating should not automatically be labeled psychosomatic when endometriosis, adenomyosis, fibroids, ovarian conditions, gastrointestinal disorders or genitourinary conditions have not been adequately evaluated.

Likewise, insomnia, mood changes, palpitations and changes in concentration during the reproductive years or perimenopause should not be reduced to anxiety without considering hormonal physiology. Chest discomfort, visual changes, fainting or new neurologic symptoms require an appropriate physical assessment rather than reflexive reassurance that the patient is “just stressed.”

This is especially relevant in fertility care. Infertility and pregnancy loss understandably cause anxiety, but that does not mean anxiety caused the infertility or loss. Sometimes the anxiety is a response to years of symptoms, uncertainty, expensive treatment and being told repeatedly that nothing is wrong. We can screen for and treat anxiety while continuing to investigate physical symptoms. Those two responsibilities are not mutually exclusive.

We also need to be careful about medical gaslighting more broadly. A mismatch between symptoms and laboratory findings should prompt curiosity, not dismissal. If a patient has symptoms but the initial testing is normal, we should ask whether the correct tests were ordered, whether they were performed at the appropriate time and what other conditions could explain the symptoms.

For example, a woman may have irregular or absent menstrual cycles even though a single hormone panel appears normal. Hormones fluctuate throughout the cycle, so testing performed on an arbitrary day may not answer the clinical question. A patient may have severe menstrual pain, painful intercourse or heavy bleeding despite an unrevealing basic ultrasound; that does not necessarily exclude endometriosis or adenomyosis. Someone may have symptoms suggestive of thyroid dysfunction despite a TSH within a broad reference range; that should prompt a thoughtful assessment of the full clinical picture rather than being told that the symptoms are imaginary.

A couple may be labeled with “unexplained infertility” even though the male partner received only a basic semen analysis without sperm DNA-fragmentation testing or evaluation for inflammation and genitourinary infections. A patient experiencing recurrent pregnancy loss may be told that it was simply bad luck before both partners have received an appropriate evaluation. These are opportunities to investigate more carefully, collaborate with specialists and acknowledge what remains unknown.

The reverse mismatch also matters. An abnormal laboratory result does not automatically mean the patient has a disease or requires treatment. A test may be affected by menstrual-cycle timing, fasting status, recent illness, medication, supplements or laboratory variability. A low AMH value, for example, can provide information about anticipated ovarian response, but it does not independently determine whether a woman can conceive naturally. Practitioners should treat the patient rather than reacting reflexively to a single number.

Patients should also be encouraged to participate actively in their care, including conducting their own research. People living with infertility, pregnancy loss or chronic illness often spend hundreds of hours reading studies, tracking symptoms and learning from others with similar experiences. They may identify a question, emerging area of research or possible connection that deserves consideration.

Our role is not to discard that work because it came from the internet or because the patient does not have medical training. Our role is to help them evaluate it. I want to know what they found, where it came from and why it resonated with them. Together, we can assess whether the source is credible, whether the research was performed in humans, how well the study was designed, whether the findings have been replicated and whether they apply to that individual patient.

Not everything a patient finds will be accurate or clinically appropriate, but dismissing it without discussion damages trust and may cause us to miss something important. A patient bringing in an article or asking about a treatment is not challenging our authority. It is an invitation to collaborate. Even when I disagree with the conclusion, I can explain why and help the patient distinguish a plausible hypothesis from established evidence.

The best practitioners combine curiosity with humility. We listen to the patient, examine the evidence, take their questions seriously, acknowledge what we do not know and remain willing to change course.

NP: What advice do you have for someone looking to get into the field of complementary and integrative health?

Dr. Banik: Develop a strong foundation in anatomy, physiology and evidence-based medicine, and pursue rigorous training through a reputable program like IFM’s certification pathways. Remain open-minded but scientifically discerning, stay within your scope of practice, and remember that “natural” does not automatically mean safe or effective.

Dr. Goldstein: I’d say that’s exactly what’s needed nowadays, and if they feel that pull to serve both others and themselves (especially the latter), then dive in. And be prepared to get some pushback, as well as to find people just as passionate as you.

Dr. Lucille: Begin with a strong, legitimate education and understand the licensing and scope-of-practice requirements where you intend to work. Learn physiology, pathology, pharmacology, nutrition, research literacy and clinical reasoning. Natural medicine still requires rigorous thinking.

Find good mentors and remain teachable. Learn how to evaluate evidence rather than simply repeating claims from a company, conference or social media post. Do not chase every shiny new test, ingredient or trend.

Communication skills are just as important as technical knowledge. Patients need someone who can listen, explain complex information clearly, admit when the answer is not known, and help them make informed decisions.

Finally, develop boundaries early. Caring deeply does not require being available every minute of every day. A depleted practitioner cannot provide excellent care for very long.

Dr. Maloh: I would encourage them to find an area they are genuinely curious about and become deeply knowledgeable in it. Integrative health can be a broad field, and it can be tempting to try to learn everything at once. Developing a strong area of expertise, learning how to critically evaluate research, and gaining experience both clinically and academically can be incredibly valuable. I’d also encourage them to seek out mentors and collaborators from different disciplines.

Dr. Buttarazzi: Because this space can feel like the “wild west,” ground your knowledge in reputable, evidence-based education and accredited credentials. It requires effort to navigate the noise, but helping patients create lasting transformations in their vitality makes it incredibly rewarding.

Dr. Gosnell: My advice is to set big goals and don’t let fear or self-doubt talk you out of them. It’s a lot of hard work, but it’s worth it if this is genuinely where your passion is.

Dr. Koch: Commit to lifelong learning. Build a strong foundation in science while remaining open to emerging research and diverse healing approaches. Develop excellent communication skills, seek mentorship and remember that successful practitioners focus not only on knowledge but also on relationships. Most importantly, keep the patient’s well-being at the center of everything you do.

Dr. Parrish: My first advice is to take both the education and the responsibility seriously. Complementary and integrative health is not a shortcut around science. It requires a strong understanding of physiology, pathology, pharmacology, laboratory interpretation, clinical research, nutrition and natural therapeutics, along with the ability to recognize red flags and know when a patient needs conventional treatment, emergency care or referral to a specialist.

Before committing to a program, become very clear about the role you want to have and the scope in which you hope to practice. The education, licensing requirements and legal scope of practice for a naturopathic doctor, acupuncturist, nutrition professional, herbalist, health coach or other integrative practitioner are very different. Research the regulations where you intend to practice and choose an appropriately accredited program. Personal experience with healing can be a powerful inspiration, as it was for me, but it is not a substitute for comprehensive clinical training.

I also recommend spending time observing or speaking with established practitioners before making a decision. Try to see several different practice models, because the daily reality of clinical practice can look very different from what is presented online. Ask about training, patient care, documentation, collaboration, business expenses, professional liability, continuing education and the emotional demands of the work.

The best integrative practitioners are fluent in both conventional and natural medicine. They do not reject conventional care, and they do not assume that everything natural is automatically safe or effective. They understand medication interactions, supplement quality, dosing, contraindications and the limitations of testing. They can read the primary literature and distinguish between a promising theory, a laboratory or animal study, and an intervention that has demonstrated meaningful clinical outcomes in people.

My own education at Bastyr University gave me a broad naturopathic medical foundation. My fertility specialty developed over time through advanced functional medicine training, continued research, complex patient cases, mentorship and collaboration with reproductive endocrinologists, OB-GYNs, reproductive urologists, oncologists, acupuncturists and other specialists. I would encourage a new practitioner to build that broad foundation before narrowing too quickly into a specialty. A meaningful niche should develop through rigorous study, clinical experience and the needs you repeatedly observe in patients, not simply because a topic is popular on social media.

Mentorship is invaluable. Find practitioners who are willing to discuss difficult cases, acknowledge uncertainty, and tell you when they have changed their minds because the evidence changed. Be cautious of training programs that suggest every patient has the same hidden root cause, that one test explains every chronic condition, or that a single protocol can treat everyone. Integrative health should be individualized, but individualized care still needs evidence, clinical reasoning, ethical boundaries and appropriate follow-up.

It is equally important to learn how to listen. Patients frequently arrive after feeling dismissed, rushed, or told that their symptoms are merely anxiety. They may also bring articles, podcasts, online research or theories about their health. Rather than feeling threatened by that information or immediately discarding it, help them evaluate the quality of the evidence and determine whether it applies to their situation. Patients should be active participants in their care, but they also need a practitioner who can provide context, identify misinformation and communicate uncertainty honestly.

Finally, learn the practical side of practice. Documentation, informed consent, privacy, licensure, professional boundaries, malpractice coverage, financial transparency and dependable follow-up systems are not separate from patient care. They are part of patient safety. It is also important to create a sustainable practice and protect your own health, because curiosity and compassion become difficult to maintain when a practitioner is chronically overwhelmed.

This field needs practitioners who can be curious without being gullible, confident without becoming rigid, and open-minded without abandoning scientific standards. If you can combine intellectual rigor with humility, collaboration and genuine respect for the person sitting in front of you, complementary and integrative health can be an extraordinarily meaningful career.

NP: What does the future hold for the field complementary and integrative health?

Dr. Banik: The future of eye care will be more personalized, preventive and data-informed, combining nutrition, lifestyle, genetics, laboratory testing, advanced imaging, targeted supplements and complementary therapies. The emerging field of “oculomics” may eventually help us identify risks involving the heart, brain, kidneys and metabolism before symptoms develop.

Dr. Goldstein: I’d love to say that’s exactly where we’re going, soon this will be mainstream (especially have NDs licensed in every state, or just make it on a federal level), and everyone will get along. Realistically, there’s opposition in every profession, though can we come together enough to keep rising in popularity—NDs, integrative practitioners alike? I believe so. Can we work together with Big Pharma? I’d like to think so too, especially over the course of generations (where the younger ones tend to be more open to integrative medicine), as we also are in a world where we need an ER and fast acting medication. The bigger issue is not shaming one against the other or creating [more] division. We have enough of that.

Dr. Lucille: I believe the future will be increasingly personalized, collaborative and data-informed. We will continue to learn more about the microbiome, metabolic health, genetics, environmental influences, healthy aging and the interconnected nature of human physiology.

Technology, telehealth, remote monitoring and AI will help us collect and organize more information. However, more information does not automatically create more understanding. The practitioner’s role will be to help determine what matters, what is actionable, and what is simply noise.

I also believe the field will face greater expectations around evidence, supplement quality, laboratory validation, transparency and accountability. That is a good thing. Integrative health should continue to evolve without losing its central strengths: individualized care, prevention, education, respect for the whole person, and an appreciation for both the science and the art of healing.

Dr. Maloh: I think the future holds a lot of opportunity, and also a responsibility to continue asking good questions. There is growing interest in complementary and integrative health, which is exciting, but with that growth comes the need for rigorous research and thoughtful clinical practice. I’m hopeful that we’ll continue building the evidence base while remaining open to new ideas and willing to change our approach when the evidence tells us to. I think the balance between curiosity and scientific rigor will be important as the field continues to evolve.

Dr. Buttarazzi: Integrative strategies will increasingly become the standard of care rather than an alternative option. As health care continues to pivot toward longevity and disease prevention, conventional and complementary methodologies will merge into a cohesive, evidence-based framework for patient-centered care.

Dr. Gosnell: I think we’ll keep seeing technology and science used to make healthful, food-as-medicine living more accessible, whether that’s through virtual care, better research or tools that make it easier for people to actually change their habits.

Dr. Koch: I believe the future involves greater integration between conventional medicine and evidence-informed complementary approaches. Patients increasingly want personalized, preventive, and holistic health care experiences. Alternative health care is well-positioned to play a growing role in prevention, wellness and chronic disease management.

Dr. Parrish: The conversation will become less about choosing between conventional and natural medicine and more about using the best of both safely, thoughtfully, and collaboratively, and with convergence. Whole-person health will also become a more measurable clinical model, examining how the endocrine, immune, metabolic, nervous, vascular, gastrointestinal and reproductive systems interact with nutrition, sleep, stress, relationships and environmental exposures.

Fertility care will be transformed by this broader perspective. Fertility has traditionally been approached as a problem involving the reproductive organs, with a disproportionate focus on the woman. It will increasingly be recognized as an important marker of the health of both partners. Ovulation, menstrual regularity, ovarian function, sperm health, placental development and pregnancy outcomes can all provide information about metabolic, hormonal, inflammatory, vascular and environmental health.

Preconception care will become one of the earliest and most meaningful forms of preventive medicine. Rather than waiting until a couple experiences infertility, recurrent pregnancy loss, or unsuccessful treatment, practitioners will evaluate reproductive health earlier. This will include thyroid function, insulin sensitivity, nutrient status, inflammation, medications, infections, sleep, stress physiology, environmental exposures, and the health of both the egg and sperm contributors.

Male fertility evaluation will also become far more comprehensive. A basic semen analysis is valuable, but it does not tell the entire story. I expect greater attention to sperm DNA fragmentation, oxidative stress, reproductive hormones, metabolic health, testicular and genitourinary infections, paternal age, medications, lifestyle and environmental toxicants. In my practice, evaluating the male partner comprehensively is already a pivotal part of fertility care. The future will continue shifting the narrative away from asking only what is wrong with the woman.

Women’s health research will be another major driver of change. We are finally seeing serious scientific interest in menstrual health, endometriosis, adenomyosis, fibroids, PMOS, ovarian aging, perimenopause and the relationship between reproductive health and long-term cardiovascular, neurological, metabolic, bone and immune health. The menstrual cycle will increasingly be viewed as an indicator of whole-person health rather than something that matters only when a woman wants to become pregnant.

One of the most fascinating emerging areas is the study of menstrual blood, more accurately called menstrual effluent. It is not simply blood or biological waste. It contains endometrial tissue, immune cells, proteins, inflammatory mediators, genetic material, microorganisms, signaling molecules, and stem or progenitor-like cells. Researchers are studying these cellular, immune, genetic, proteomic and microbial patterns as potential biomarkers of endometriosis, abnormal inflammation, impaired decidualization, endometrial dysfunction and infertility. In the future, an at-home menstrual sample may provide a noninvasive window into the uterine environment and become a meaningful form of reproductive “bloodwork.”

Menstrual effluent also contains mesenchymal stem or stromal cells that can be collected repeatedly and noninvasively. These cells demonstrate self-renewal and multipotent characteristics, but much of their healing potential may come from the growth factors, cytokines and extracellular vesicles they release. In laboratory and animal studies, these signals have demonstrated anti-inflammatory, immunomodulatory, pro-angiogenic, antifibrotic and tissue-repairing effects.

This research has significant implications for fertility. Investigators are studying whether a patient’s own menstrual blood-derived cells could help regenerate an endometrium damaged by intrauterine adhesions, Asherman syndrome, surgery, infection, inflammation or an abnormally thin uterine lining. Preclinical studies have reported improvements in endometrial thickness, gland formation, blood-vessel development, fibrosis, and fertility outcomes. Small early human studies have also reported increased endometrial thickness and pregnancies following autologous cell transplantation in patients with severe intrauterine adhesions.

The regenerative potential of menstrual blood-derived cells is also being investigated in models of wound healing, fibrosis, liver and lung injury, cardiac repair and cartilage damage. These treatments are not yet ready for routine clinical use, and collecting or banking menstrual blood does not guarantee a future therapy. Larger controlled human trials, standardized processing, long-term safety data, and regulatory oversight are still needed. Even so, this research reframes menstrual blood as a biologically valuable and potentially regenerative resource.

Endometriosis is another area in which the future may look very different from the past. For decades, women have been told that exploratory or diagnostic laparoscopic surgery is the only definitive way to identify the disease. That has forced many patients to choose between living without answers and undergoing anesthesia, abdominal incisions, expense and recovery simply to confirm that their symptoms are real.

Clinical practice is already shifting. Current European guidelines no longer consider laparoscopy the automatic diagnostic gold standard for every patient. A careful history, examination, expert transvaginal ultrasound, and specialized MRI can identify many endometriomas and forms of deep endometriosis. Imaging can still miss superficial peritoneal disease, however, so a normal scan does not exclude endometriosis.

The next generation of diagnostics may combine expert imaging with molecular biomarkers and artificial intelligence. Researchers are investigating protein, immune, metabolic, microRNA, DNA-methylation, and gene-expression patterns in menstrual effluent, blood, saliva and urine. Salivary microRNA signatures and newer menstrual blood-based platforms have already shown promising results in early studies. Investigational molecular imaging may also make superficial lesions visible by targeting biological processes such as the new blood-vessel formation associated with endometriosis.

I hope we reach a point where a woman no longer needs surgery simply to be believed or receive a diagnosis. Menstrual-effluent testing, saliva and blood biomarkers, expert ultrasound, advanced MRI, molecular imaging and AI-supported analysis could substantially reduce the need for purely diagnostic laparoscopy. This is especially important in fertility care because unnecessary ovarian surgery, including some endometrioma procedures, can affect ovarian reserve.

Surgery will not disappear. It may still be necessary to remove endometriosis, release adhesions, address bowel or bladder involvement, obtain tissue when the diagnosis is uncertain, or investigate a possible malignancy. The distinction is that surgery should be recommended because it is likely to help the patient, not because it is the only way to prove that her disease exists.

Naturopathic fertility medicine has an important future within this evolving model. I believe it will move beyond being viewed as a collection of supplements for “egg quality” and become recognized as a clinically sophisticated, evidence-informed specialty. A well-trained naturopathic fertility doctor can conduct a comprehensive history, order and interpret appropriate testing, identify modifiable contributors, evaluate both partners, and collaborate with reproductive endocrinologists, OB-GYNs, reproductive urologists, oncologists, acupuncturists and other specialists.

This care is not intended to replace reproductive endocrinology or assisted reproductive technology. It can support patients pursuing natural conception, IUI, IVF, donor conception, fertility preservation, or oncofertility care. Naturopathic fertility doctors can help patients improve their health before treatment, prepare for pregnancy, recover between treatment cycles, and make sense of increasingly complex medical information.

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