Dr. Eric Viegas joins the Root Cause Medicine Podcast to discuss an often-overlooked part of evaluating botanical supplements for menopause: whether the product being used actually matches the ingredient that was studied. The conversation focuses on five botanicals and botanical categories—black cohosh, Vitex (chasteberry), rhapontic rhubarb, maca, and soy isoflavones. Rather than framing individual herbs as simply effective or ineffective, Dr. Viegas emphasizes three considerations: identity, standardization, and patience . Identity refers to confirming the correct plant species and plant part. Standardization addresses whether relevant constituents or studied extracts are consistently represented in a product. Patience refers to allowing an appropriate evaluation period rather than judging a botanical after only a few days of use. Clinical takeaways Botanical evidence is closely tied to the ingredient that was actually studied. Dr. Viegas emphasizes that results from research on a particular species, plant part, extract, or standardized preparation cannot automatically be generalized to every product carrying the same botanical name. Black cohosh has a substantial research history, but product characteristics matter. The episode discusses Actaea racemosa and the importance of confirming botanical identity, the appropriate plant part, and the characteristics of the extract being used. Standardized preparations feature prominently in the research discussed. (Castelo-Branco 2021) (NIDDK 2025) Vitex is discussed primarily in the context of cyclical symptoms and perimenopause. Also known as chasteberry ( Vitex agnus-castus ), Vitex is presented as having a stronger research history for premenstrual and cyclical symptoms than for classic postmenopausal symptoms. The episode also highlights variation in extracts and marker compounds. (Csupor 2019) Rhapontic rhubarb illustrates the importance of extract-specific evidence. The discussion focuses on the studied rhapontic rhubarb extract ERr 731 rather than treating all rhubarb preparations as interchangeable. This provides an example of why practitioners should identify the exact preparation evaluated in clinical research. (Dubey 2024) Maca presents additional standardization challenges. The episode discusses differences among maca varieties and processing methods and notes that there is not one universally dominant marker used across all products. Maca is discussed in relation to menopausal symptoms, mood, and sexual function without positioning it as a direct hormone replacement. (Lee 2011) Soy isoflavone response may vary between individuals and formulations. The conversation highlights differences among individual isoflavones and discusses equol production as one possible contributor to variability in response. (Mayo 2019) Time is part of interpreting a botanical trial. A recurring theme throughout the episode is that botanical interventions studied over weeks or months should not necessarily be judged after a very short trial. Appropriate duration depends on the ingredient, formulation, patient, and clinical context. Guest: Eric Viegas, ND Dr. Eric Viegas is a naturopathic doctor based in Ottawa, Canada, and works with Fullscript’s quality program. In the episode, he describes Fullscript’s approach to supplement quality, including supplier qualification and review of product documentation. He also discusses Fullscript Tested, a program in which products are selected from Fullscript distribution centers and submitted to third-party laboratories for testing related to factors such as identity, potency, and contaminants. His discussion of menopause botanicals centers on connecting published research with the practical question practitioners face when evaluating supplements: Does the ingredient in the product correspond to the ingredient evaluated in the research? Clinician FAQ 1. What do identity and standardization mean for botanical supplements? Identity refers to confirming what botanical material is actually present, while standardization addresses consistency in relevant constituents or preparations. Depending on the botanical, identity can include species, plant part, variety, and other characteristics. Standardization may involve a marker compound, defined extract, or another specification associated with the preparation used in research. 2. Why does the episode focus on patience? Because botanical research generally evaluates outcomes over a defined period rather than after only a few doses. Dr. Viegas argues that stopping a botanical substantially earlier than the period evaluated in research can make it difficult to determine whether the preparation received a meaningful trial. The appropriate evaluation period varies by ingredient and clinical context. 3. What does the episode say about black cohosh? Black cohosh is presented as a botanical for which product identity and extract characteristics can affect how research is interpreted. The discussion focuses on Actaea racemosa , particularly root and rhizome preparations, and distinguishes studied standardized extracts from unspecified black cohosh products. (Castelo-Branco 2021) (NIDDK 2025) 4. Is Vitex primarily a menopause botanical? The episode describes its strongest evidence base as being related to premenstrual and cyclical symptoms rather than classic menopause symptoms. (Csupor 2019) Dr. Viegas discusses why Vitex may nevertheless appear in conversations about perimenopause and also notes that some research evaluates it as part of multi-ingredient botanical combinations. 5. What is different about rhapontic rhubarb? The discussion centers on a specific studied extract rather than rhapontic rhubarb as a broad ingredient category. Dr. Viegas identifies ERr 731 as the preparation featured in the research discussed during the episode. This serves as an example of why botanical extract identity can matter when translating research findings to commercial products. (Dubey 2024) 6. What quality considerations are discussed for maca? The episode highlights botanical variety, processing, and the absence of a single universally dominant standardization marker. (Lee 2011) Different maca varieties and processing approaches can make product-to-product comparisons more complicated than simply confirming that “maca” appears on the label. 7. Why might people respond differently to soy isoflavones? Both formulation and individual biology may contribute to variation. The episode discusses differences among isoflavones and describes the conversion of daidzein to equol by certain gut microorganisms as one potential source of individual variation. (Mayo 2019) 8. Does a botanical's presence on the label mean it matches the clinical research? Not necessarily. The episode emphasizes checking the species, plant part, preparation or extract, relevant standardization information, and other product specifications before assuming that findings from a particular study apply to another formulation. Timestamps / key moments 00:00:00 Introducing menopause botanicals, identity, standardization, and patience 00:02:59 The three themes: identity, standardization, and patience 00:04:15 Black cohosh and its research history 00:07:41 Standardized black cohosh extracts and product testing 00:10:13 Vitex (chasteberry) and where it fits clinically 00:14:14 Introducing rhapontic rhubarb 00:16:28 Maca, menopause, libido, and mood 00:20:04 Soy isoflavones and the evidence discussion 00:21:15 Daidzein, equol, and individual response 00:22:54 Soy isoflavones and evaluation over time 00:25:08 Fullscript Academy and closing remarks Want to learn more about supplement quality? This episode highlights how botanical identity, standardization, formulation, and research design can affect the way practitioners interpret supplement evidence. For additional practitioner education on supplement quality and clinical decision-making, visit Fullscript Academy. The goal is not to reduce botanical selection to a single marker or label claim, but to help practitioners evaluate whether a product meaningfully corresponds to the ingredient and preparation described in the available evidence. Disclaimer The views expressed on this podcast are those of the host and guest and do not necessarily reflect those of Fullscript or affiliated organizations. This episode is for informational and educational purposes only and is not medical advice. Botanical supplements may have contraindications, adverse effects, and medication interactions, and suitability can vary by patient. Patients should consult a qualified healthcare professional before making changes to their healthcare routine. References Castelo-Branco, C., Gambacciani, M., Cano, A., Minkin, M. J., Rachoń, D., Ruan, X., Beer, A.-M., Schnitker, J., Henneicke-von Zepelin, H.-H., & Pickartz, S. (2021). Review & meta-analysis: Isopropanolic black cohosh extract iCR for menopausal symptoms – an update on the evidence. Climacteric, 24 (2), 109–119. https://pubmed.ncbi.nlm.nih.gov/33021111/ Csupor, D., Lantos, T., Hegyi, P., Benkő, R., Viola, R., Gyöngyi, Z., Csécsei, P., Tóth, B., Vasas, A., Márta, K., Rostás, I., Szentesi, A., & Matuz, M. (2019). Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complementary Therapies in Medicine, 47 , 102190. https://pubmed.ncbi.nlm.nih.gov/31780016/ Dubey, V. P., Sureja, V. P., & Kheni, D. B. (2024). Efficacy evaluation of standardized Rheum rhaponticum root extract (ERr 731) on symptoms of menopause: A systematic review and meta-analysis study. Journal of Biomedical Research, 38 (3), 278–286. https://pubmed.ncbi.nlm.nih.gov/38646867/ Lee, M. S., Shin, B.-C., Yang, E. J., Lim, H.-J., & Ernst, E. (2011). Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas, 70 (3), 227–233. https://pubmed.ncbi.nlm.nih.gov/21840656/ LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2025). Black cohosh. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/NBK547990/ Mayo, B., Vázquez, L., & Flórez, A. B. (2019). Equol: A bacterial metabolite from the daidzein isoflavone and its presumed beneficial health effects. Nutrients, 11 (9), 2231. https://www.mdpi.com/2072-6643/11/9/2231