Mar 30, 2022

Disclaimer 

Our Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By following this protocol, you understand and accept that the recommendations in the protocol are for initial guidance and need to seek medical professional advise.  

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Spring Health

Many individuals may report feeling physically and mentally depleted following the winter months. (Melrose 2015) Therefore, springtime offers a unique opportunity for practitioners to support their patients’ wellness. Seasonal allergies, upper respiratory tract infections, digestive health concerns, and depression are common health concerns that may affect patients this time of year. 

In combination with healthy behavioral changes, including adhering to a healthy diet, engaging in daily physical activity, obtaining optimal sleep, and managing stress levels, the following evidence-based dietary supplement ingredients may support general wellness this spring and beyond. 

While there are many ingredients that may be considered part of a wellness protocol, the Integrative Medical Advisory Team (IMAT) has selected these based on general safety, effectiveness, and broad applicability and availability to the adult population.

Probiotics

2-8 billion CFU, total per day, minimum 3 months (10)(14) 

  • Probiotics have been shown to decrease diarrhea in conditions like traveler’s diarrhea and antibiotic-associated diarrhea (1)(15)(8)  
  • Bacillus coagulans decreased stool frequency in diarrhea-associated irritable bowel syndrome (IBS-D) (14)  
  • A blend of probiotics including Lactobacillus acidophilus and Bifidobacterium bifidum, has shown to decrease daily stool frequency (10)(17) 
  • Patients with moderate to severe symptomatic diarrhea-predominant IBS (IBS-D) experienced improved quality of life (QOL), decreased IBS severity scoring system by 145 points from baseline, decreased severity of abdominal pain by 69% (compared to 47% in placebo) and lowered proportion of patients with symptoms to 14% (compared to 48% in placebo) when given multi-strain probiotic Bio-Kult® for 16 weeks (10) 
  • When given 2 billion CFU per day of single strain probiotic of B. coagulans MTCC 5856 for 90 days, quality of life, disease severity, and symptoms in patients with IBS-D all improved as shown by a decrease in bloating, vomiting, diarrhea, abdominal pain and stool frequency when compared to placebo (14)
  • In a meta-analysis of travelers diarrhea, probiotics were found to be beneficial as a preventative measure (1)
  • Meta-analysis of probiotic S. boulardii was found to be efficacious and safe in treatment of several types of diarrhea, particularly in antibiotic associated diarrhea (15)
  • Systematic review and meta-analysis of 82 randomized controlled trials found that the majority of studies used single strain and multi-strain probiotics containing lactobacillus based formulas which decreased occurrences of antibiotic associated diarrhea (8)
Probiotics

Vitamin D

400-3000 IU per day for ~6 months. (Gao 2017)(Jolliffe 2021)(NIH 2021) Upper limit (UL) of vitamin D is 4,000 IU per day (NIH 2021)

  • Immune health: A 2021 meta-analysis (MA) of 46 randomized controlled trials (n=75,541) found that 400-1,000 IU/day of vitamin D safely reduced acute respiratory infection (ARI) risk by 8%. (Jolliffe 2021) Vitamin D may also play a role in autoimmune health. (Antico 2012)
  • Allergies: 50,000 IU (as vitamin D pearl) per week with concomitant cetirizine for 8 weeks to adults with vitamin D deficiency reduced symptom severity for rhinorrhea, nasal itching, sneezing, and postnasal drip after 8 weeks but not after 4 weeks compared to cetirizine alone. (Bakhshaee 2019) 
  • Mood: A 2019 meta-analysis found an association between vitamin D and moderate effect size improvements in symptoms of major depression. (Menon 2018)
Vitamin D

Omega-3 fatty acids

2-4 g EPA + DHA daily for a minimum of 3 months

  • Mood: A 2021 meta-analysis found omega-3 supplementation to benefit depressive symptoms regardless of severity; subgroup analyses identified possible additional benefits with lower severity (no, or mild-moderate depression), and with longer treatment duration (>12 weeks). (Wolters 2021)
  • Cardiovascular disease: A 2020 Cochrane review of 86 RCTs (n=162,796) concluded EPA+DHA reduced coronary heart disease mortality (10%), but not overall risk of CVD (primary or secondary), or all-cause mortality, noting that high intake of EPA+DHA vs. low decreased triglycerides by 15%. (Abdelhamid 2020)
  • Cognitive function: Omega-3 fatty acid supplementation increased short-term memory only in populations with low baseline omega-3 status, (Cooper 2015) and episodic memory in adults with mild memory complaints. (Yurko-Mauro 2015)
Omega-3

Zinc

15 mg per day, for a minimum of five days, in children (22)

  • Meta-analysis of acute diarrhea trials in children found zinc supplementation to decrease the duration of symptoms (24)
  • When provided with 15 mg/day for five days, the percentage of children with diarrhea decreased at hours 72 and 96 when treated with zinc as well as decreased duration of diarrhea compared to control group (22)
  • A systematic review and meta-analysis of children under age 5 with acute diarrhea showed decreased duration of diarrhea as well as incidence when given zinc compared to placebo and/or oral rehydration therapy; although risk of nausea and vomiting was higher in the zinc group (6)
  • Zinc supplementation decreased frequency of stools and duration of acute and persistent diarrhea in meta-analysis of children in developing countries with acute or persistent diarrhea; when comparing zinc formulations, zinc gluconate had more incidences of vomiting compared to zinc sulfate and zinc acetate (13)
  • Low dose (20 mg/day, 10-14 days) was found to be effective in treating diarrhea in children; Additionally vomiting decreased (3)
Zinc

Magnesium

325-​​400 mg per day (NIH 2021)(Zhao 2019)(Li 2016) for a minimum of 8 weeks (Mah 2021)

  • Headaches: A 2020 meta-analysis demonstrated that magnesium reduced the intensity and frequency of migraine relapses in patients who experience migraine headaches. (Veronese 2019)
  • Sleep: Sleep latency was found to be significantly reduced by magnesium supplementation in a 2021 meta-analysis where < 1000 mg of elemental magnesium three times per day was recommended. (Mah 2021)
  • Mood: A systematic review found dietary magnesium levels to be associated with lower depressive symptoms, and indicated possible use of oral magnesium supplementation as an adjunctive therapy. (Derom 2013)
Magnesium

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