Press Release merger fullscript natural partners np script

Press Release

Press Release - Fullscript and Natural Partners to Merge


Natural Partners and Fullscript plan to merge to create the industry-leading, technology-enabled, wellness management service for integrative healthcare practitioners and patients

Scottsdale, AZ, and Ottawa, ON, Canada, May 29, 2018 – Natural Partners, Inc. and Fullscript announced plans today to combine, bringing the best wholesale and fulfillment network in the nutritional supplement industry together with the premier online supplement dispensing platform to create a more efficient, effective, and innovative solution for integrative practitioners and patients who seek holistic and natural solutions for wellness.

Supplement protocols are notoriously complicated yet effective when followed; simplifying the patient’s process and routine is critical to improving outcomes. By providing a seamless solution for stocking, prescribing and dispensing, the new merged company gives practitioners the time and resources to create highly personalized wellness plans that are easy for patients to follow.

Natural Partners Fullscript will harness Fullscript’s excellence in software engineering and Natural Partners’ supply chain and merchandising expertise to provide a holistic management solution for integrative practitioners – no matter how they choose to prescribe and dispense. The new company, which will specialize in online dispensary management, speciality distribution, e-commerce, and patient adherence tools, is dedicated to supporting the expanding integrative healthcare market. The company’s new roadmap for service evolution and product innovation is expected to improve health outcomes for patients, while driving increased demand for wellness products and services.

“This combination is unique; we’re bringing together two teams that are completely complementary and laser focused on the future direction of the wellness industry. Fullscript’s strengths are amplified by Natural Partner’s strengths, and vice versa. The Natural Partners team is incredibly passionate, and it takes that kind of passion to make a difference in healthcare. That’s why we were so drawn to the Fullscript team. In an industry that’s fraught with complex issues that have a real impact on human lives, we’ve got something special to contribute – a great strategy, and a team of people that truly care.” said Fran Towey, Chief Executive Officer, Natural Partners Fullscript.

“When my co-founders and I started Fullscript in 2011, we knew we were embarking on a difficult journey with an incredibly worthy mission – we believe in integrative care and we need to make it easier for everyone involved in that industry, especially patients. Every decision we’ve made, every new feature or service that we’ve released in the past five years, it’s all been driven by that mission to take the hassle out of integrative health. The decision to combine with Natural Partners is no exception. They want what we want, they care about the same things we do, and together we can take our services and our platform even further in delivering on that shared goal.” said Kyle Braatz, President, Natural Partners Fullscript.

Natural Partners and Fullscript anticipate completing the transaction in June, assuming satisfaction of customary closing conditions.

About Fullscript:

Fullscript is a fast-growing, health-tech startup with over 2000% GAAP revenue growth in the past three years. Founded in 2011 by Kyle Braatz, Brad Dyment, and Chris Wise, Fullscript was the first online dispensing platform for nutritional supplements, now powering digital dispensing for over 25,000 practitioners, and over 450,000 patients across the U.S. and Canada. Fullscript’s mission is to take the hassle out of integrative healthcare by making supplementation seamless and easy. For more information, visit Fullscript.com.

Media enquiries for Fullscript should be directed to [email protected]

About Natural Partners:

Natural Partners, Inc. is a resource for integrative healthcare practitioners who strive to improve patient wellness and improve practice economics.  Founded in 1995 by Tye Smith, Natural Partners has researched trusted brands and welcomed them into their portfolio, currently offering over 16,000 premium products from hundreds of high-quality manufacturers.  No matter how integrative practitioners do business, Natural Partners ensures their patients get the products they need, when they need them, in a way they love. For more information, please visit naturalpartners.com.

Media enquiries for Natural Partners should be directed to [email protected]


natural partners & Fullscript

A New Leader in Integrative Health is Born

A New Leader in Integrative Health is Born


NP and Fullscript

Dear practitioners, suppliers, and partners:

When we launched Fullscript in 2011, we were just three guys from Canada who wanted to build something impactful – something we could work on for the rest of our lives and wake up every day excited about where we could take it next.

We owe the integrative healthcare community a great debt, because you helped us find that mission – the mission that gets us out of bed in the morning and fans the fire behind every decision and every new feature launch.

This has never been just about supplements. It has always been about the evolution of medicine. It has always been about helping practitioners provide better care, and most importantly, helping patients commit to wellness.

I often compare the practice and consumption of integrative healthcare to pushing a boulder up a mountain. It’s hard, especially when doing it on your own. If we want integrative healthcare to succeed, to be universally accepted and thoroughly integrated with our western standards and institutions, we need the entire community to get behind that boulder and push together.

Today is a milestone for Fullscript and for our community. Our community just got a lot stronger, and our power to push integrative care up that mountain just got a lot mightier. That strength comes from two companies coming together – previous competitors that realized we had the same goal, and would be stronger if we tackled it together.

By joining forces in a merger with Natural Partners, we can focus on catapulting our technology and customer experience to completely support the patient on their path to wellness, while greatly improving our fulfilment standards and adding value to the entire ecosystem.

Thanks to this merger, Fullscript customers will benefit from the following developments in the coming months:

  • 74 new brands will be added to our catalog, including Bezwecken, Professional Formulas and Enzymedica.
  • We’ll finally become the FULL script! Practitioners will be able to prescribe much more than just supplements.
  • Fullscript will be a patient’s master dashboard for their health; mission control for a multi-faceted, integrative wellness plan.
  • Instead of practitioners bringing all of their own patients to Fullscript, Fullscript will also find patients and bring them to practitioners.

Integrative healthcare is hard. It’s hard for practitioners; it’s hard for patients; it’s hard for suppliers, technology companies, and distributors; it’s hard for any company dedicated to wellness. This merger makes it just a little bit easier. It’s all about taking the hassle out of integrative healthcare, and we’re excited to continue this mission with an amazing partner and now teammate – Natural Partners.

In health and solidarity,

 

 

Kyle Braatz

CEO & Co-founder, Fullscript

 

 

Natural Partners and Fullscript anticipate completing the transaction in June, assuming satisfaction of customary closing conditions.


Platform Updates

Platform Updates (May)

Platform Updates (May)


We’re constantly working to improve the Fullscript dispensary platform based on your feedback. Here’s a look at what we’ve been up to in the last few months.

Catalog Tagging

Advanced search is now available in Canada! We’ve curated over 1300 products into 31 categories to help you search for products on Fullscript, including: probiotics, herbs, proteins, omega fatty acids, and multivitamins. Find the products you want, faster.

Design

The patient search bar is now sleeker than ever and it’s only getting better. We have big plans to expand its functionality to searching products, orders, and even help articles.

You can now find it front and center where you need it most:

search-bar

We’ve also been working on styling our prescription drawer in an effort to make it easier to use:

Prescription Drawer

Adherence

Prescribing through Fullscript is the best way to improve patient adherence to your supplement protocols. We’re excited to announce that Fullscript’s adherence is getting even better:

  • Changes to the emails that patients receive increased interaction rates by as much as 4%
  • Newly identified barriers to first orders were eliminated
  • Fixes applied to 18 separate issues improved the checkout experience

Here is a look at how our welcome email has changed:

Before

Emails Before

After

Emails After

And here is the new patient signup page (which is now 45% faster!):

Signup Page

Integration Documentation for EHR’s

We recently launched an enhanced version of our API so that your favourite EHRs can easily integrate with Fullscript. With these integrations you can have all of the benefits of Fullscript at your fingertips, without adding complexity to your workflow.

EHR integration

Autoship

You asked and we delivered! Patients now have the ability to set their autoshipment to ship every 6 weeks.

Autoship

Recommendation Warning

In order to reduce errors when matching the dosage to the quantity prescribed, we’ve added a helpful warning. You can choose to ignore this message, or click it to update the units and match the dosage

instructions.

Recommendation


Vitamin D sun fullscript sheep

Vitamin D

What is it?

We’ve all heard of vitamin D. Whether it’s from your doctor, on TV, on a cereal box, or in the health food store.  It’s an extremely common supplement, and for good reason! Vitamin D is involved with several important organ systems in the body and its deficiency can cause many different health problems.

Elmer McCollum discovered vitamin D in 1912 after noticing the positive effects of cod liver oil on rickets. It wasn’t initially clear what ingredient in the cod liver oil was providing the health effects, but this led to vitamin D being isolated and extracted. Until 1912, vitamin D was only ever available in cod liver oil! (1) The ability to take vitamin D on its own meant that vitamin D could now be shipped far and wide with far fewer concerns for whether the cod liver oil would go bad while in transit.

Vitamin D is a pro-hormone, which means that it’s an ingredient in the formation of hormones like testosterone, progesterone, estrogen, and cortisol. As a non-essential vitamin, your body does have the ability to produce it in the skin. That said, it can be hard to produce enough unless you live in a country that is close to the equator or you spend lots of time outside.

You’ll notice two letters after the dose of vitamin D on a supplement bottle or a nutrition facts panel: “IU”. This stands for “International Units”. Vitamin D can be measured in a few different ways, but the IU measurement is the most common term. Occasionally, vitamin D will be measured in micrograms (mcg).

For example:

1 IU Vitamin D = 0.025mcg Vitamin D

1000 IU Vitamin D = 25 mcg Vitamin D

Supplements Vitamin D

How is it made?

Vitamin D is one of the only vitamins that can be made by the human body. In order to have sufficient pro vitamin D3 in the skin, you need to eat enough healthy cholesterol in your diet.   When UV-B rays from the sun are absorbed by your bare skin, they cause the conversion of 7-dehydrocholesterol (or pro vitamin D3) to cholecalciferol (vitamin D3). Cholecalciferol is converted by the liver and then the kidney into the active form of vitamin D3 called Calciferol.

Chemical structure flow chart: 

Chemical Structure Flow Chart https://www.researchgate.net

  • Cholesterol
  • PRO Vitamin D
  • UVB Rays
  • PRE Vitamin D
  • Vitamin D3
    • Vitamin D2 can also convert to D3 at this step
  • Circulating Vitamin D
  • Active Vitamin D

You can also get vitamin D from plant sources like mushrooms. This form is vitamin D2 and also called ergocalciferol. It’s widely accepted that vitamin D3 is better absorbed and utilized by the body, so the recommendation when supplementing is to stick with vitamin D3.

The large majority of the vitamin D3 (cholecalciferol) on the market comes from the same source, which is a lanolin base D3. Lanolin is the waxy substances secreted by the sweat glands of sheep! Lanolin is rich in provitamin D and once it has been exposed to UV-B rays, vitamin D3 is formed. Lanolin is harvested by shearing sheep and doesn’t hurt the animal at all. In fact, it’s just like a haircut. Once cut, the fresh wool is stewed gently in hot water and over time, the lanolin separates just like oil on top of the water. Some breeds of sheep, like the merino sheep, can yield up to a whopping 300mL of lanolin from a single coat! (2)

The alternative to lanolin-based D3 is lichen-based D3. Lichen, a kind of plant that grows in moist environments, also known as moss, is one of the only non-lanolin sources that can provide vitamin D in its previtamin form. Vitamin D is also found in mushrooms, in the previtamin  form of vitamin D2 or ergocalciferol. Prior to lichen-based D3’s prominence, D2 products were the solution for patients who needed exogenous vitamin D, but chose not to use lanolin-based D3.

If you’re trying to follow a vegan diet, or trying to avoid products made from animal byproducts, choose a vegan vitamin D product, which is made from lichen (a type of seaweed) instead of sheep’s wool.

If your bottle doesn’t say the source material of the vitamin D and doesn’t say that it’s a vegan vitamin D on the bottle, then it’s most likely made from lanolin. This can happen with other products as well: source material isn’t always communicated on dietary supplements, and the lack of information about sourcing can make it difficult to choose products because you don’t know enough about it.

In which forms is it available?

There are two different kinds of vitamin D commonly available on the market: vitamin D2 and vitamin D3. Vitamin D2 is one of the precursors to active vitamin D, and needs to go through more changes than supplemental vitamin D3 to get to the active form. Fifteen years ago, there was a lot more parity between the amounts of vitamin D3 and vitamin D2 on the market, but vitamin D3 has dominated in recent years because of the additional research and confidence that it’s more bioavailable and more effective at high doses.(3)

When possible, if you’re deficient in vitamin D or could benefit from supplemental vitamin D, consider using D3 to optimize absorption and bioavailability of oral vitamin D instead of D2. (4) Spend time outdoors so the body continues to convert it’s dietary D2 into D3 as well through UVB light exposure to the skin.

When taking oral supplements, absorption can be optimized by using lipid suspensions of vitamin D3, either as a gelcap or a liquid, and by co-ingesting vitamin D with a fatty meal. While the first generation of vitamin D supplements came in the form of dry tablets, the large majority of products have now shifted to liquids and fatty liquid suspensions. An example of a fatty liquid suspension is good old cod liver oil!

Vitamin D is also added to a lot of food products that wouldn’t normally have it, and is one of the best examples of “healthwashing” products. Most people think of vitamin D as a health-promoting vitamin, so adding it to food helps to increase the public’s opinion of the health of that food. The vitamin D that is added to some orange juice products is no different than the vitamin D in a supplement.

How does it work?

Since vitamin D is a fat-soluble vitamin, it will accumulate in the body if it’s taken for a long time or in high doses. This also means that taking it daily isn’t absolutely necessary. There are even some trials that demonstrate vitamin D can be taken as infrequently as once a week in a higher dose. (5) Regardless of how you take it, vitamin D is best taken alongside a fatty meal, bound to fat, suspended in an oil-based liquid, or in an oil-suspension gelcap.

As a prohormone, vitamin D is a precursor to many other important hormones in the body. Vitamin D supplies the backbone structure of other steroid hormones through its own precursor: cholesterol. Once vilified, we now know that cholesterol is pivotal for the body’s overall function. Without that steroid backbone that cholesterol provides, we wouldn’t be able to make vitamin D in the skin, and without vitamin D, we wouldn’t be able to make testosterone, estrogen, progesterone, and cortisol properly.

How can vitamin D help?

In the developed world, vitamin sufficiency is taken for granted due to food security and fortification, or the addition of supplemental vitamins and minerals to foods. However, in developing countries where vitamin D-rich foods and food fortification aren’t as common, vitamin D supplements play a particular role in preventing osteomalacia (rickets), a common condition caused by vitamin D deficiency. It results in children with soft and brittle bones that don’t develop properly, and they end up with a bow-legged appearance. Vitamin D supplementation in the food system and through dietary supplements has significantly reduced the risk and subsequent global impact of this disease. Vitamin supplementation in the food system has also helped to prevent adult bone loss, and increase calcium absorption; another factor in keeping the bones of adults healthy.

Vitamin D’s role in immune health cannot be understated. By regulating hormone production and function, as well as being a pivotal precursor in the adaptive immune response, vitamin D is helpful in both acute and chronic immune disease states. Vitamin D insufficiency is linked with increased rates of pneumonia and the common cold in both children and adults (so you want to make sure you have adequate levels), but supplemental vitamin D above normal levels hasn’t shown to be effective for the treatment of common colds. (6) As long as you have adequate vitamin D levels, you’re getting the immune benefit of vitamin D; you don’t need to ingest excess levels in times of sickness if you’re already at a normal level.

In a review of 7 different studies, The Cochrane Collaboration found that vitamin D supplementation was able to decrease the number of emergency room visits, decrease the need for systemic corticosteroids, and improve lung function in people with asthma. The exact dosing strategy wasn’t clarified, differing between the 7 trials and ranging from 400 IU per day to over 100,000 IU in a single dose. (7)

Multiple Sclerosis is an example of an autoimmune condition that is significantly impacted by vitamin D status. Adequate levels of vitamin D can ensure that the myelin sheaths (the fatty insulating layer around nerve cells) are allowing brain signals to transmit as well as possible, despite the body attacking those very cells and making nerve transmission difficult. Low vitamin status is a risk factor for developing multiple sclerosis, and there is a notable increase in multiple sclerosis rates in countries with long winters, and less sunny weather. (8)

Low vitamin D levels are a risk factor for various aspects of cardiovascular disease, including poor lipid values and higher risk for heart attacks. (9) Considering all of the benefits of adequate vitamin D status, it’s no surprise that the College of Family Physicians of Canada (10) has taken the stance that testing vitamin D is rarely necessary in healthy patients. Prior to low dose vitamin D administration (1000-2000 IU for adults), vitamin D testing isn’t performed, since there is a high proportion of adults that are already deficient in vitamin D (<50nmol/L or < 20ng/ml) and will have a hard time getting enough production from their own body due to limited sunlight in the winter

What are the side effects?

As mentioned above, vitamin D is a fat-soluble nutrient, so there is a chance that you can store excess amounts from high-dosage intake. While the negative side effects don’tt appear until extremely high levels are consumed, there is generally very low risk for side effects unless mega-dosing for a long time.  As we mentioned above, there’s such a low risk for dosing at levels around 1000 IU per day that the Canadian government suggests recommending it to patients prior to establishing a baseline if insufficiency is suspected and then re-testing later.

The most common concern to be aware of when it comes to vitamin D is whether there is an aversion to the source material (lanolin) or other non-medicinal ingredients in the product itself. It’s otherwise an extremely safe, well studied, and a relatively benign ingredient when dosed conservatively.

When dosed aggressively for chronic periods, or in large amounts all at once, it’s important to monitor negative outcomes to bone health. Extremely high levels of vitamin D can paradoxically cause the very same bone conditions it causes at lower levels, as excess vitamin D can alter calcium metabolism in a negative fashion.


Most Recommended on Fullscript

Nothing found.

  1. Deluca, Hector F. “History of the Discovery of Vitamin D and Its Active Metabolites.” BoneKEy Reports, vol. 3, Jan. 2014, p. 479.
  2. WHAT IS LANOLIN? https://www.merinousa.com/about-lanolin.
  3. Office of Dietary Supplements – Vitamin D. https://ods.od.nih.gov/factsheets/Vitamin%20D-HealthProfessional/.
  4. Lehmann, Ulrike, et al. “Bioavailability of Vitamin D2and D3 in Healthy Volunteers, a Randomized Placebo-Controlled Trial.” The Journal of Clinical Endocrinology and Metabolism, vol. 98, no. 11, 2013, pp. 4339–45.
  5. Ish-Shalom, Sophia, et al. “Comparison of Daily, Weekly, and Monthly Vitamin D3 in Ethanol Dosing Protocols for Two Months in Elderly Hip Fracture Patients.” The Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 9, Oxford University Press, Sept. 2008, pp. 3430–35.
  6. Linder, Jeffrey A. “Vitamin D and the Cure for the Common Cold.” JAMA: The Journal of the American Medical Association, vol. 308, no. 13, Oct. 2012, pp. 1375–76.
  7. Martineau, Adrian R., et al. “Vitamin D for the Management of Asthma.” Cochrane Database of Systematic Reviews , vol. 9, Sept. 2016, p. CD011511.
  8. Sintzel, Martina B., et al. “Vitamin D and Multiple Sclerosis: A Comprehensive Review.” Neurology and Therapy, Dec. 2017, doi:10.1007/s40120-017-0086-4.
  9. Gouni-Berthold, Ioanna, et al. “Vitamin D and Cardiovascular Disease.” Current Vascular Pharmacology, vol. 7, no. 3, July 2009, pp. 414–22.
  10. Lindblad, Adrienne J., et al. “Testing Vitamin D Levels.” Canadian Family Physician Medecin de Famille Canadien, vol. 60, no. 4, The College of Family Physicians of Canada, Apr. 2014, pp. 351–351.


magnesium

Magnesium

What is it?

Magnesium is technically a metal (Mg 2+) and you may remember it from being one of the elements on the periodic table. The evidence of one of the first commercial products relating to the health effects of magnesium is a patent for Milk of Magnesia that was filed in 1873 (1), which was marketed to help patients with constipation. It was called “milk” because of the whitish appearance that the dissolved magnesium gave the solution. Original Milk of Magnesia was 8% Magnesium hydroxide and was marketed as a laxative. (2) Magnesium was eventually recognized as an essential nutrient in 1925, and has since been discovered to be the 4th most prominent mineral in the body after calcium, potassium, and sodium.

How is it made?

As a mineral, magnesium isn’t made, but sourced from ocean water (magnesium chloride) or mined from the Earth (magnesium oxide). Magnesium is rarely found as a free element since the non-oxidized form of it is very volatile and reacts vigorously with oxygen. This process creates a large flash, so much so that it’s used to create the effects of fireworks. Magnesium is commonly mined or sourced from oceans close to China, North Korea, Russia, Austria, Greece, and the USA.(3)

Foods grown in environments rich in magnesium will also become high in magnesium themselves. Most of the magnesium that we eat comes from vegetables, but often grains and prepared food products can be augmented with magnesium as well. Similar to how commercial breakfast cereals have lots of vitamins and minerals added to them (almost making them multivitamins), magnesium also gets added to foods to make sure that we eat enough magnesium.

The other most prominent source of magnesium is in soil and is transferred to the foods we grow in the soil. Magnesium levels in food have declined an average of 20% compared to 75 years ago. In large part due to industrial farming practices. By farming the same crops in the same soil over and over again, the soil itself is starting to diminish in mineral content, which is having a clear impact in the food that is grown in that overused soil.(4) This is, in turn, impacting the quantity of magnesium in our bodies, which can have significant health effects.

magnesium supplements

In which forms is it available?

When it comes to dietary supplements, magnesium can be found in several forms that can be grouped into 3 categories: inorganic salts, organic salts, and amino ccid chelates.

When magnesium is listed as an ingredient in a dietary supplement, the content will always be the amount of elemental magnesium, and not the entire chemical structure of the ingredient that it’s bound to. This makes it easy to compare total magnesium content of products, since all products are using the same standard of description.

When an atom of magnesium is bound to other atoms that don’t have any carbon in them, these are called “inorganic salts”. These are typically the lowest cost because they are readily found in nature and don’t take much money or effort to produce. They tend to have a strong laxative effect compared to other forms of magnesium, because of how much water they draw into the intestines, leading to loose stools.

Here are some common forms of inorganic salts:

  • Magnesium Oxide
  • Magnesium Hydroxide
  • Magnesium Sulphate
  • Magnesium Chloride

If an atom of magnesium is bound to a molecule that contains carbon, it’s called an “organic salt”. In this case, the “organic” doesn’t mean that it’s grown without pesticides. These forms of magnesium offer moderate tissue bioavailability while still having an osmotic effect on stools to provide a mild laxative effect.

Here are some common forms of organic salts:

  • Magnesium Citrate
  • Magnesium Malate

“amino acid chelates” are molecules where the magnesium is bound to an amino acid (the building block of proteins). These magnesium molecules are the best absorbed in the gut, because they move easily across the membrane of the intestines through special protein transporters that are specifically designed for amino acids.

Here are some common forms of amino acid chelates:

  • Magnesium Bisglycinate (glycinate)
  • Magnesium Taurate
  • Magnesium Threonate
  • Magnesium Orotate

Magnesium supplements are available in powders, capsules, tablets, and liquids. Since magnesium is water soluble and has a fairly benign taste, it’s one supplement that can be taken in many different forms without compromising its efficacy. Unlike vitamin D, which should be taken with a fatty meal, magnesium supplements can be taken anytime.

How does it work?

Magnesium’s first use was for its laxative properties. It actually works differently than other laxatives that are on the market. Magnesium is what we call an “osmotic laxative”, which means that it works by drawing water into the colon so that stool is better hydrated and softer. This is contrary to how two other common forms of laxatives work:

  • Stimulating laxatives cause colon irritation with makes the intestines get more active and move the stool;
  • Stool softeners actually change the chemical composition of the stool to make it easier to pass.

Magnesium is one of the most gentle laxative agents and has the least associated side effects compared to other forms of laxatives.

It can also help to relax muscles in the body because it opposes calcium, which helps muscles contract. Muscle contraction is initiated when calcium atoms are released into the muscle, but it takes the release of magnesium atoms to initiate complete muscle relaxation. Without sufficient magnesium, the muscle can stay in a hypertonic state that leaves people feeling tight and result in a higher rate of muscle cramps.

Magnesium is a cofactor is in over 300 biochemical reactions required to maintain normal body functioning. Some of the biological functions of magnesium include having an effect on building DNA, creating the base form of energy (ATP), regulating blood sugar through insulin release, and helping brain hormone chemistry.(5)

magnesium blood pressure supplements

Benefits of Magnesium

Adequate levels of magnesium are associated with a lower risk of cardiovascular disease and death from cardiovascular events through decreasing blood pressure and helping to relax the cardiac muscle. There are very few supplements that can consistently lower the risk of heart disease and death from cardiovascular disease. Magnesium, vitamin D, and omega 3 intake from fish oil are the three supplements that can aid in the long-term prevention of these diseases.(6)

Magnesium can be used on the skin as well. Epsom salts (Magnesium sulfate) are the most common form of topical application of magnesium, but there are also sprays, salves, and creams that impart some of the same effects. They are named after the region where they were discovered: Epsom, England, which is only a few minutes Southwest of London. While recent research has not been conclusive about the effects of Epsom salts on muscle relaxation (with researchers challenging whether magnesium sulfate can cross the skin), there has been a history of use that confirms that patients feel well after bathing in a tub with Epsom salts. There are even magnesium-containing hot springs that carry rich histories of positive health effects as well.

Oral magnesium can help with muscle cramping on a physiological basis of muscle contraction, and opposing the calcium levels in the muscle.(7) Partly related to its effects on muscle, and partly related to its effects on stress and pain sensation, Magnesium has also been shown to be a preventive treatment for migraines with minimal side effects compared to other treatments.(8)

Magnesium is used intravenously or it can be inhaled to treat childhood asthma. It acts as an anti-inflammatory agent in the lungs and can also help widen children’s airways. Magnesium supplementation resulted in shorter hospital stays and a lower dependence on inhalers after the children were discharged from the hospital.(9) Adults taking oral asthma were also able to benefit from improved quality-of-life scores, as well as a decreased dependence on their inhalers.(10)

Finally, magnesium has been shown to benefit patients with anxiety and stress-related disorders. This effect was first discussed when it was observed that urinary magnesium levels increased in situations of high stress. This led to further studies where it was discovered that magnesium may attenuate stress-related disorders by modifying the stress response and the function of cortisol in the body. 11)

Are there side effects?

Magnesium is generally well-tolerated when used in appropriate doses. Some clinical research shows no differences in adverse effects between placebo and magnesium groups. Orally, magnesium can cause gastrointestinal irritation, nausea, vomiting, and diarrhea. High doses can also increase risk of neonatal mortality and neurological defects.

When there is ample research available about particular vitamins and minerals, it’s possible to develop Tolerable Upper Intake Levels (UL), which are the maximum daily intake that have been shown to cause adverse health effects. These upper intake levels came into effect in 1997 when the dietary reference intake (RDI) ranges were developed, and the research was done in a time when magnesium salts were the only products readily available on the market. At that time, a 350mg dose of a magnesium salt was sure to cause a high likelihood of loose stools as a side effect. Today, a 350mg dose of a magnesium chelate has a much lower chance of causing such side effects due to of its increased bioavailability.(7)


Most Recommended on Fullscript

Nothing found.

  1. Wolf, Marshall A. “President’s Address: Mother Was Right: The Health Benefits of Milk of Magnesia.” Transactions of the American Clinical and Climatological Association, vol. 117, 2006, pp. 1–11.
  2. “Genuine Phillips’ Milk of Magnesia”. https://doi.org/10.1007/s11104-013-1665-5.
  3. “Magnesium | Minerals Education Coalition.” Minerals Education Coalition, https://mineralseducationcoalition.org/elements/magnesium/.
  4. Guo, Wanli, et al. “Magnesium Deficiency in Plants: An Urgent Problem.” The Crop Journal, vol. 4, no. 2, 2016, pp. 83–91.
  5. Swaminathan, R. “Magnesium Metabolism and Its Disorders.” The Clinical Biochemist. Reviews / Australian Association of Clinical Biochemists, vol. 24, no. 2, May 2003, pp. 47–66.
  6. Del Gobbo, Liana C., et al. “Circulating and Dietary Magnesium and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Prospective Studies.” The American Journal of Clinical Nutrition, vol. 98, no. 1, July 2013, pp. 160–73.
  7. Supakatisant, Chayanis, and Vorapong Phupong. “Oral Magnesium for Relief in Pregnancy-Induced Leg Cramps: A Randomised Controlled Trial.” Maternal & Child Nutrition, vol. 11, no. 2, Apr. 2015, pp. 139–45.
  8. Holland, S., et al. “Evidence-Based Guideline Update: NSAIDs and Other Complementary Treatments for Episodic Migraine Prevention in Adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.” Neurology, vol. 78, no. 17, Apr. 2012, pp. 1346–53.
  9. Davalos Bichara, Marcela, and Ran D. Goldman. “Magnesium for Treatment of Asthma in Children.” Canadian Family Physician Medecin de Famille Canadien, vol. 55, no. 9, Sept. 2009, pp. 887–89.
  10. Kazaks, Alexandra G., et al. “Effect of Oral Magnesium Supplementation on Measures of Airway Resistance and Subjective Assessment of Asthma Control and Quality of Life in Men and Women with Mild to Moderate Asthma: A Randomized Placebo Controlled Trial.” The Journal of Asthma: Official Journal of the Association for the Care of Asthma, vol. 47, no. 1, Feb. 2010, pp. 83–92.
  11. Boyle, Neil Bernard, et al. “The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review.” Nutrients, vol. 9, no. 5, Apr. 2017, doi:10.3390/nu9050429.


Multivitamins Fullscript

Multivitamins

What are they?

While the exact inclusion criteria of multivitamins isn’t standardized, they’re usually a combination of different vitamins and minerals, and often include other ingredients like amino acids and herbs.

In 1912, Casimir Funk chose the word vita amine (Vita= Life, Amine=Nitrogen in latin) to describe a substance that was present in rice bran that could cure beri-beri. Vita amine is now known as thiamine, which is Vitamin B1. Funk eventually shortened “vita amine” into “vitamin” to describe a general class of compounds that had beneficial health effects, but were found in food items.(1)

Vitamins can be water-soluble or fat-soluble, and there are important differences to know between them.

Water-Soluble Vitamins Fat-Soluble Vitamins
Absorption type Water Fat
Excretion method Urine Stool
Body retention No Yes
Vitamins B Vitamins, Vitamin C Vitamins A,D,E,K

 

You might not think of it, but multivitamins are already in much of the foods that we eat day to day. Commonly eaten foods like flour, cereal, and orange juice are all typically enhanced or “fortified” by the addition of different vitamins and minerals. Sometimes new vitamins and minerals are added to staple foods to make sure people are getting them. For example, iodine is added to table salt to make sure nobody is deficient in iodine.(2)

Oftentimes, vitamins and minerals are re-added to foods that lose them in the manufacturing process. For instance, white flour is often enriched with vitamins that would be found in whole wheat flour.

It’s recommended that everyone get at minimum the Recommended Dietary Amount (RDA) of vitamins and minerals each day. If food sources aren’t enough, a multivitamin supplement can help fill the gap.

mutlivitamin supplements nutrients

How are they made?

Multivitamins, as the name suggests, contain various different kinds of ingredients, and they each have their own associated manufacturing process. Single ingredients are manufactured individually by a raw material supplier, and get sent to the multivitamin manufacturer. There, the single ingredients chosen for the multivitamin are mixed into a blend, and then divided into the final product. Most multivitamins don’t have any special storage concerns, but there are occasionally multivitamins with additional ingredients like probiotics that do require the product to be kept in the fridge. Always check your bottle to make sure.

If you’re concerned about additives in your supplements, capsules tend to have less additional ingredients than tablets because a tablet needs to have some binders in the product to help it hold its shape. Tablets also have a higher chance of being coated with a shiny lacquer to make sure the product keeps well.

At Fullscript, we often receive requests for FoodState® or “natural” multivitamins from our practitioners. These are vitamins and minerals extracted directly from plant sources and not manufactured synthetically. If this is something you’re looking for, then you need to search explicitly for the source material of the ingredients within a product.

Source material isn’t actually mandatory to report on product labels! If you don’t see that information on the label, contact the manufacturer of the product directly, or choose another product that is explicit about its sources.

Fullscript Multivitamins Smart Dispensary integrative health

In which forms are they available?

Multivitamins are available as capsules, tablets, gelcaps, powders, and liquids. As we discussed earlier, the main ingredients in multivitamin supplements are vitamins and minerals, and they can each be found in multiple forms.

These are some of the most common forms:

Vitamins

Hydrochloride Salts

  • These are the standard and most common forms of vitamins available on the market. They’re well absorbed and applicable for most of the population.

Methylated Vitamins

  • Methylated vitamins have side chains added to them that allow them to support specific metabolic processes. As nutrigenomics have become more prominent in medicine, these forms of vitamins (like 5-methyltetrahydrofolate) have gained prominence as well because they can impact the methylation cycle and can even affect gene transcription.(3)

Minerals

As a group, minerals dissolve readily in water, but when they’re bound to other ingredients, they have important differences between the organs, tissues, and disease states that they affect:

Inorganic Salts

  • These are typically the lowest cost because the minerals are readily found in nature, so these forms don’t take much money or effort to produce. Ex: Magnesium Oxide

Organic Salts

  • They’re called organic salts because the mineral is bound to a molecule containing carbon. They typically have better absorption compared to inorganic salts. Ex: Zinc Citrate

Chelates

  • Chelates are molecules where the mineral is bound to various kinds of amino acids, which are the building blocks of proteins. These chelate molecules are the best absorbed because they move easily across the membrane of the intestines through special protein transporters that are built for amino acids. Chelates also tend to carry a higher price point because they’re more challenging to manufacture. Ex: Iron bisglycinate(4)

B Vitamins

There are many vitamin supplements that are exclusively B vitamins, as they have a more defined role in energy metabolism and deficiency symptoms, several B vitamins are linked with the same health conditions.

Antioxidants

Antioxidants are often included in multivitamin products. They are a subset of vitamins and minerals that have the ability to counter the many metabolic and environmental agents that can cause oxidation. Examples of oxidative agents include cigarette smoke, nitrites from smoked meat, or exposure to heavy metals.

Vitamins A, C, and E, zinc and selenium, and plant components like polyphenols are commonly found in antioxidant supplement products. Antioxidant multivitamins will sometimes have additional non-vitamin or mineral ingredients such as herbs and fruit extracts as well.

Condition Specific

Some multivitamins are developed for specific conditions. They may have additional ingredients particular to a health concern or health condition. Cardiovascular formulas may have a multivitamin with additional fish oils, while digestive formulas may have a combination product of probiotics and a multivitamin.

How do they work?

Ingredients in multivitamins will fall into one of two categories: essential nutrients or non-essential nutrients. The differentiator lies in the fact that some vitamins can actually be made by the body, while others cannot. Essential vitamins are the ones that we must consume in our food or supplements to be able to benefit from them, while non-essential nutrients are ones that the body can make on its own.

Vitamin C is an essential nutrient because the body has no way of making it on its own without eating vitamin C rich foods or supplements, while vitamin D is a non-essential nutrient because the body can actually make its own based on how the skin uses the UVB rays from the sun.

Overall, multivitamin supplements work by augmenting vitamin and mineral intake that would normally be found in food. It’s especially important when nutrition is nutrient-poor (low fruit/vegetable), or patients have certain health conditions.

How can multivitamins help?

Multivitamin supplements have been frequently studied, and the general consensus is that vitamins and minerals are best when they come from a varied and healthy diet. When this kind of diet isn’t possible, multivitamin supplements can help to prevent disease because they prevent deficiency across many vitamins and minerals.

Multivitamin supplements have been most notably studied for the following conditions:

  • Cardiovascular disease prevention(5)
  • Cognitive disease prevention(6)
  • GI conditions that cause malabsorption(7)

While not necessary for absolutely every patient, a multivitamin supplement that provides ½ of the RDA has been recommended in a recent trial on cognitive disability and aging as prudent.(6) As mentioned above, this is particularly applicable for patients that don’t consume a large variety of food items, especially if they have a diet that lacks fruits and vegetables.

What are the side effects?

A very benign side effect of multivitamins is that patients notice their urine gets really bright, often described as “fluorescent” yellow. This happens because of the Riboflavin content in many multivitamin supplements. “Flava” is the word for yellow in latin, which is how Riboflavin (vitamin B2) gets its name. The bright colour has no negative health effects, but it can be alarming if you’re not expecting the bright colour when you go to the bathroom.

One of the standard vitamins in a multivitamin supplement is vitamin A. For a lot of people, it’s a health-promoting vitamin. One analogue of vitamin A, called beta carotene, can however be dangerous for patients who smoke. A large study(8) was released in the early 90s on antioxidant supplementation in smokers, with the idea that smokers would have needed more antioxidants because they were inhaling dangerous chemicals in the cigarette smoke. Rather than being health promoting, the group of patients in the study receiving beta carotene that were smokers had a HIGHER risk of death from lung cancer and death from multiple causes. Beta carotene did the exact opposite of what the researchers thought.


Most Recommended on Fullscript

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  1. Eggersdorfer, Manfred, et al. “One Hundred Years of Vitamins-a Success Story of the Natural Sciences.” Angewandte Chemie , vol. 51, no. 52, Dec. 2012, pp. 12960–90.
  2. Commissioner, Office of The. Consumer Updates – Fortify Your Knowledge About Vitamins. Office of the Commissioner, https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm118079.htm. Accessed 23 Mar. 2018.
  3. Moore, Lisa D., et al. “DNA Methylation and Its Basic Function.” Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, vol. 38, no. 1, Jan. 2013, pp. 23–38.
  4. Ashmead, S. D. “The Chemistry of Ferrous Bis-Glycinate Chelate.” Archivos Latinoamericanos de Nutricion, vol. 51, no. 1 Suppl 1, Mar. 2001, pp. 7–12.
  5. Rautiainen, Susanne, et al. “Multivitamin Use and the Risk of Cardiovascular Disease in Men.” The Journal of Nutrition, vol. 146, no. 6, June 2016, pp. 1235–40.
  6. Dror, Yosef, et al. “Vitamins in the Prevention or Delay of Cognitive Disability of Aging.” Current Aging Science, vol. 7, no. 3, 2014, pp. 187–213.
  7. Rossi, RE, et al. “The role of dietary supplements in inflammatory bowel disease: a systematic review.” Eur J Gastroenterol. Hepatol, 2016 Dec;28(12):1357-1364.
  8. Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. “The Effect of Vitamin E and Beta Carotene on the Incidence of Lung Cancer and Other Cancers in Male Smokers.” The New England Journal of Medicine, vol. 330, no. 15, Apr. 1994, pp. 1029–35.


Probiotics Fullscript Smart Dispensary

Probiotics

What are they?

The word “probiotic” literally means promotion of microorganism growth, and they’re usually associated with health bacteria, but probiotic supplements can actually be made of bacteria, bacterial spores, or fungi (yeasts). The large majority of probiotic supplements are made from bacteria and can have a wide range of effects. Bacteria are everywhere on our body, and that’s okay! How many bacterial cells reside on and within our bodies is hotly debated, but it’s estimated to be anywhere from double to 10x the number of our own cells!(1) Bacteria are discussed as either commensal (found in the body) or non commensal (not found in the body).

The standard naming convention for bacteria and fungi is to have a genus and species listed for every type, and it’s a convention that you see with probiotic supplements as well. On the Supplement Facts panel, you’ll notice there is a capitalized first word, followed by a lower-case second word, and the words are usually in italics. Ex: Lactobacillus rhamnosus

Sometimes you’ll even see an extra few letters or numbers after the name: this clarifies the strain specificity of the probiotic. Ex: Lactobacillus rhamnosus GG

When the topic of strain specificity is discussed, it’s often the species of a bacteria/fungi that is being isolated, or even a subtype of a species. Each genus, species, and subtype can have different actions in the body.

You’ll also notice the word CFU, which stands for “Colony Forming Units”. This is a count of probiotics that the manufacturing company guarantees are in one serving of the product by the expiry date. It’s common practice for companies to include more CFU of the probiotic in the bottle at the manufacturing date to ensure that the product meets this posted amount.

Supplements-101-Probiotics Fullscript Integrative Health

How are they made?

Probiotic manufacturing is different than other supplement manufacturing processes because the category has such a large number of ingredients within it that lead to many different methods of manufacturing. One type of bacteria might be more resistant to heat, and can therefore tolerate higher temperature. Another type may not be able to withstand an acidic environment, and needs to be manufactured without any acidic ingredients in the process. Often times this means that individual strains are cultured individually and then mixed after the fact; it’s through this method that precision can be reached within the end product that reaches the market.

While each company has a slightly different process, the general process is the following (2)(3)(4):

  1. STRAIN SELECTION: Select the probiotic strain you want to culture from a bank of bacterial cells.
  2. BASE SELECTION: Choose the right base ingredient for the probiotic so it can grow (ferment) well in the optimal temperature and humidity for it to thrive. Some probiotics can have several different bases for optimal growth, so there can be multiple steps in this process. This base is often lactose or another easily fermentable carbohydrate like Fructooligosaccharides (FOS). If you’re seeking a dairy-free product, always make sure to look for that on the label.
  3. FILTRATION: Once fermented, the mixture is filtered so the bacterial strain that is being replicated is separated from the other ingredients that result from fermentation. This step often results in the majority of the water being removed from the mixture as well.
  4. DEHYDRATION: The mixture is then dehydrated some more, and often freeze dried to help prevent spoilage and to make the bacteria easier to mix and package.
  5. SEPARATION OR COMBINATION: After freeze drying, the single bacterial strains are mixed in with other probiotics for multi-strain blends, or left alone if they’re being sold as single blends.
  6. PACKAGING: Products get packaged (sometimes with additional methods to keep the bacteria alive), labelled, and sent to retailers ready to be used.

The shipping of products is an important factor of supplement efficacy that doesn’t often get discussed when talking about probiotics. Since many probiotics aren’t stable at high temperature and will diminish in CFU more rapidly at room temperature, it’s important that there is temperature control through the manufacturing, storage, shipping, and delivery of the product. Supplement companies each have particular standards about how their products are handled and these are standards we take very seriously at Fullscript!

In which forms are they available?

As was mentioned above, probiotic supplements are made of bacteria, bacterial spores, or fungi. This variety in sources means that products will have varied handling recommendations, which can sometimes be confusing for patients and practitioners alike. The most common bacterial families that are in supplements are Bifidobacterium spp. and Lactobacillus spp. (spp means “species”).

Bacillus coagulans (bacterial spore) and Saccharomyces boulardii (fungus) are two of the most common shelf stable probiotics that don’t need any additional preparation of manufacturing to make them shelf stable. They exist as spores and are stable (don’t degrade) at room temperature.

Other probiotic strains can be made shelf stable by limiting exposure to moisture, heat, and oxygen(5) by means of different packaging or manufacturing. If they don’t exist in a spore form, they’ll be diminishing in CFU over time regardless, albeit at a slower rate than without these means. Learn more by clicking here.

Much of the new research on probiotics focuses on specific families and species of bacteria as opposed to just meeting a desired CFU count. Choosing a probiotic can be difficult because of this precision in the research, which is why we made sure practitioners have the ability to find exactly what they’re looking for by using Fullscript’s advanced search tool.

There are also probiotics present in fermented food products, but there often aren’t accurately quantified amounts of the microorganisms. Since the fermentation of food typically isn’t as controlled as in the manufacture of dietary supplements, there are much higher variety of bacteria and fungi present in these fermented food products. It’s very seldom to have unposted species of probiotics in dietary supplements. However, when you’re purchasing fermented food like kombucha, sourdough bread, or sauerkraut, these fermented foods contain a wide variety of bacteria and yeasts that can impart health benefits, but are nearly impossible to specify for strain or quantity of probiotics.

How do they work?

Probiotic supplements are living things, so we want to make sure that they stay living as long as possible. Different probiotics can be taken orally, topically, or as a suppository depending on the research and purpose of the supplement. They work by helping to change the colonies that live naturally in the environments they’re exposed to. Sometimes, due to health concerns, antibiotic use, dietary patterns, lifestyle, or genetics, the normal bacteria (commensal bacteria) that live in one of these environments can diminish in numbers or get overrun by bacteria that aren’t supposed to be there (non-commensal bacteria).

Probiotic supplements help encourage the growth of commensal bacteria by directly supplementing their numbers, or by crowding out the non-commensal bacteria that have taken residence where they shouldn’t be. Probiotics also have effects on the immune system by activating cytokines (chemical messengers) that help the body fend off viruses, and non-commensal bacteria that can cause illness and disease. On the other hand, by influencing the population of commensal bacteria, probiotics can also have an anti-inflammatory effect by downregulating the immune system. Probiotics help the body better distinguish between self and non-self as well, an important part of helping patients with autoimmune conditions.

Most probiotics are bacteria and require refrigeration because they lose potency and numbers at warmer temperatures. Sometimes companies will add additional ingredients to probiotic products to extend their shelf life, but for the most part, probiotics should be kept in the fridge. Unless specifically stated, probiotics keep much longer in the fridge, whereas their shelf life is much shorter when not refrigerated. However, some types of probiotics are bacteria that live as spores, which means they’re in inactive states that are very resilient to fluctuations in temperature. These typically don’t need refrigeration and won’t lose CFU count or potency as time goes on.

Probiotics can also be fungi, like brewer’s yeast, which don’t require refrigeration. Refrigeration can prolong the life of these probiotics, but typical dosing should mean that the bottle runs out before the product goes bad on the shelf.

How can probiotics help?

Probiotics are well known for their beneficial effects on the gastrointestinal system, in particular helping with the cramping, bloating, and discomfort associated with irritable bowel syndrome (IBS); but this is just the tip of the iceberg. Not only are probiotics helpful for patients with IBS, but they’re also used in irritable bowel disease (IBD) and Clostridium difficile associated diarrhea to reduce the need for medications, and decrease the length of hospital stays.(6)

As our understanding of the immune system deepens, it has become more and more clear that probiotics have a role to play here as well. Over two thirds of a human’s immune system lives in the gut, and the interaction between the bacteria in our intestines and the rest of our immune system is a pivotal relationship. Probiotics have an impact on the types and numbers of bacteria that live in our guts, and research continues to be released on the effects of probiotics on a broad range of immune mediated conditions; both from external pathogenic bacteria and autoimmune conditions.(7)

Recent research has also clarified a link between the GI system and mental health status. Probiotics have repeatedly shown benefits for patients with depression in various studies. However, there remains some inconsistency in the kinds of strains, amount of CFU, and duration of treatment that lead a recent systematic review to recommend more research be performed before using probiotics in place of other effective therapies for depression.(8)

probiotic supplements gut health

Are there side effects?

Paradoxically, probiotics can sometimes cause the very symptoms they are intended to treat when it comes to gastrointestinal concerns. While most patients with IBS or IBD can benefit from probiotics and get some symptom improvement, there are some patients whose symptoms can worsen when taking probiotic supplements. This can happen for a few reasons:

Yeast vs Bacteria

  • Some patients can react to yeast more than bacteria because they can grow in different conditions. Certain strains of bacteria (or even subtypes) can cause varying side effects as well.

Combination products with other medicinal ingredients or non-medicinal ingredients

  • Prebiotics (digestible fibres) are often added into probiotic formulas to help the bacteria survive longer in the capsule and to grow better once they reach your small intestine. Unfortunately, some patients can experience gas, bloating, and cramping from the prebiotics that get added. Look for “FOS free” probiotics if prebiotics cause any digestive problems; they won’t have any added fibers in the products.

Manufacturing Process

  • Patients with dairy anaphylaxis should be careful to select dairy-free probiotics only, since many of the probiotics on the market are grown with lactose (the main carbohydrate in dairy milk) as part of the manufacturing process.

We strongly recommend that you speak with a healthcare professional before starting any dietary supplement, and if you’re currently taking a probiotic supplement, always tell your healthcare practitioner about it. With complete information about the supplements you’re taking, your practitioner will be better able to make a plan to help you reach your health goals.


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  1. Abbott, Alison. “Scientists Bust Myth That Our Bodies Have More Bacteria than Human Cells.” Nature, Jan. 2016, doi:10.1038/nature.2016.19136.
  2. http://www.lallemand-health-solutions.com/en/manufacturing/
  3. Gueimonde, Miguel, and Borja Sánchez. “Enhancing Probiotic Stability in Industrial Processes.” Microbial Ecology in Health and Disease, vol. 23, June 2012, doi:10.3402/mehd.v23i0.18562.
  4. “Production Process.” Winclove Probiotics, 30 Sept. 2016, https://www.wincloveprobiotics.com/product-quality/production-process.
  5. Shah, N. P. “Probiotic Bacteria: Selective Enumeration and Survival in Dairy Foods.” Journal of Dairy Science, vol. 83, no. 4, Apr. 2000, pp. 894–907.
  6. Goldenberg, Joshua Z., et al. “Probiotics for the Prevention of Clostridium Difficile-Associated Diarrhea in Adults and Children.” Cochrane Database of Systematic Reviews , vol. 12, Dec. 2017, p. CD006095.
  7. Yan, Fang, and D. B. Polk. “Probiotics and Immune Health.” Current Opinion in Gastroenterology, vol. 27, no. 6, Oct. 2011, pp. 496–501.
  8. Wallace, Caroline J. K., and Roumen Milev. “The Effects of Probiotics on Depressive Symptoms in Humans: A Systematic Review.” Annals of General Psychiatry, vol. 16, Feb. 2017, p. 14.


Vitamin C supplements Fullscript smart dispensary

Vitamin C

What is it?

It’s not just in your orange juice! Vitamin C is a water-soluble vitamin that is essential for human survival. The human body does not produce vitamin C, so it must be obtained from the food we eat. Dietary sources of vitamin C include various fruits and vegetables, particularly citrus fruits such as oranges. Red peppers actually have an even higher amount of vitamin C than oranges do gram per gram, and kiwis top them all with the highest density of vitamin C in a food item.

vitamin C supplements

Vitamin C is well-known for its effects on preventing scurvy. The link between vitamin C and scurvy was established in 1747 when James Lind studied several treatments for scurvy, and only lemons and oranges were helpful in preventing the disease. It wasn’t until 1933 that the exact chemical structure of vitamin C was discovered by Norman Howarth.(1)

How is it made?

Most vitamin C supplements are produced through the bacterial fermentation of sugar, called the Reichstein process.(2) Various sugar sources can be used, but the large majority of the source material of vitamin C is derived from corn (since it is a very inexpensive source of sugar), but there is no corn protein in the final products. Vitamin C is one of the ingredients that doesn’t differ too much in how it’s made from product to product, since the Reichstein process, or modifications of the process, are still the predominant method of production.

Many vitamin C products also include bioflavonoids from sources like rose hips or citrus fruits to replicate the variety of ingredients that are found in fruits and vegetables with naturally occuring vitamin C. While the large majority of the vitamin C on the market is chemically derived, rose hip extract and citrus fruit vitamin C can be suitable for patients who prefer non-synthetic vitamin C supplements.

In which forms is it available?

There are numerous kinds of vitamin C supplements on the market: tablets, powders, capsules, lozenges… you name it, there’s one available. As mentioned, most of the different forms of vitamin C still come from a similar source. The majority are derived from the Reichstein process, or a similar method to produce the vitamin C, so there is a lot of parity on the market when it comes to vitamin C.

Vitamin C is well-absorbed orally at lower doses, but absorption decreases as the single dose of vitamin C increases. Approximately 87% of a 30 mg oral dose is absorbed, 80% of a 100 mg dose is absorbed, 63% of a 500 mg dose is absorbed, and less than 50% of a 1250 mg dose is absorbed. This is due to the fact that vitamin C is transported from the intestines into the blood by a transporter that gets full quickly.(3) This is one of the reasons that vitamin C supplements are commonly recommended in divided doses, in sustained release/timed release forms, or in new liposomal preparations.

A newer form of vitamin C on the market is liposomal vitamin C. Rather than being just a powder, tablet or capsule that dissolves in water, liposomal vitamin C is suspended in a fatty cream or gel. In one recent study(4), liposomal vitamin C was able to raise vitamin C levels 50% higher than standard vitamin C at the same dose. Most liposomal vitamin C products are made with an ingredient called choline, which is also used to help liver and brain health.

Vitamin C supplements Fullscript

How does it work?

Vitamin C has an important role in skin health through collagen formation. Collagen is the protein-rich component of skin, hair, and nails to ensure they grow healthy and strong. Vitamin C’s function in the skin is twofold:

  • As a cofactor for the proper alignment of the amino acids that make collagen (Proline and Lysine),
  • As an antioxidant to prevent damage to surrounding cells from the sun’s radiation or any other noxious stimuli.

Vitamin C is so important to skin health that there are higher levels of vitamin C in your skin than there are in your blood!(5)

Vitamin C is also able to help your body better process neurotransmitters as well, including the neurohormones responsible for mood balance and overall brain function. Furthermore, vitamin C has a role in the metabolism of norepinephrine, but also helps to keep scavenge for free radicals in the brains, much in the same way it does in the skin.(6)

As an essential vitamin, vitamin C needs to be consumed in order for the body to be able to use it. The Reichstein process that was mentioned above is not a reaction that can happen in the body.

There are many other essential nutrients (some amino acids, all minerals, and omega-3 fatty acids are some others) that the body can’t make on its own, which is why they are often found as dietary supplements. Without a dietary plan that provides for all of the essential nutrients, some people may end up having low or even deficient levels of certain ingredients, which can lead to negative health outcomes.

How can Vitamin C help?

As one of the most well researched and well-used nutrients on the market, there is a myriad of uses for vitamin C. Most notably, vitamin C is used for preventing and treating scurvy, as well as preventing vitamin C deficiency in people with gastrointestinal diseases and those on chronic total parenteral nutrition, or chronic hemodialysis. Vitamin C is also used for increasing iron absorption from the gastrointestinal tract, as well as reducing the healing rate of wounds, burns, fractures, ulcers, pressure sores, and sunburn.

Vitamin C is even effective when applied to the skin in skin conditions, protecting against free radicals and pollutants, and for improving photo-aged skin.(7) Its effect on free radicals is present because vitamin C is an antioxidant. It has a particular affinity for the brain, skin, and eyes, and is often found in combination products meant to protect these organs and tissues.

As mentioned above, the chemical name of vitamin C is ascorbic acid. As an acid, this is part of the reason that vitamin C helps iron absorption. By making the stomach more acidic, the iron from food and supplements is more readily absorbed into the bloodstream.

What are the side effects?

Since vitamin C is an acid, it can wear away at the surface of your tooth enamel. Vitamin C often comes in the form of a chewable tablet and it’s this form of vitamin C that’s most commonly linked to enamel erosion due to the contact time in your mouth.

The other adverse effects of vitamin C are dose-related. The most common adverse effects include gastrointestinal effects like nausea, vomiting, heartburn, abdominal cramps, gastrointestinal obstruction or diarrhea, as well as fatigue, flushing, headache, insomnia, and sleepiness. In some patients, vitamin C may also cause kidney stones.


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  1. Carpenter, Kenneth J. “The Discovery of Vitamin C.” Annals of Nutrition & Metabolism, vol. 61, no. 3, Nov. 2012, pp. 259–64.
  2. Hancock RD, Viola R. “Biotechnological approaches for L-ascorbic acid production.” Trends Biotechnol. 2002 Jul;20(7):299-305.
  3. Jacob, Robert A., and Gity Sotoudeh. “Vitamin C Function and Status in Chronic Disease.” Nutrition in Clinical Care: An Official Publication of Tufts University, vol. 5, no. 2, Mar. 2002, pp. 66–74.
  4. Davis, Janelle L., et al. “Liposomal-Encapsulated Ascorbic Acid: Influence on Vitamin C Bioavailability and Capacity to Protect Against Ischemia-Reperfusion Injury.” Nutrition and Metabolic Insights, vol. 9, June 2016, pp. 25–30.
  5. Pullar, Juliet M., et al. “The Roles of Vitamin C in Skin Health.” Nutrients, vol. 9, no. 8, Aug. 2017, doi:10.3390/nu9080866.
  6. Harrison, Fiona E., and James M. May. “Vitamin C Function in the Brain: Vital Role of the Ascorbate Transporter SVCT2.” Free Radical Biology & Medicine, vol. 46, no. 6, Mar. 2009, pp. 719–30.
  7. Office of Dietary Supplements – Vitamin C. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/. Accessed 6 Mar. 2018.


Fish Oil

Fish Oil

What is it?

Fish oil is exactly what it sounds like: oil from the bodies of fish! Fish oil supplements as we know them today gained prominence after research from Denmark was released in the 1970s, indicating that people who ate diets rich in fish had less heart disease than those who didn’t. This led to a flood of research attention towards fish oil, which further illuminated that omega-3s in particular, and EPA and DHA specifically, imparted much of the cardiovascular benefit of fish oil.

Cod liver oil was a widely used remedy in Europe for many conditions for centuries prior to the advent of today’s fish oil products. As a part of fish manufacturing in the 18th century, fish livers and gallbladders were often thrown into buckets and left to ferment. After a period of time, this oil was then consumed as a remedy for aches and pains, rickets, gout, and even tuberculosis.(1) It was through the observed effects on rickets that cod liver oil aided in the discovery and isolation of a well-known vitamin – vitamin D!

In the past, one of the biggest knocks on cod liver oil was that its taste was horrible. You may have heard of people who were forced to take cod liver oil in childhood. This problem has largely been solved in today’s version of fish oil through improved processing, the addition of flavours to mask the taste, and the reduced use of fermented oil thanks to refrigeration.

Fish Oil supplements Fullscript Integrative health

How is it made?

Fish oil can be made from one or several different kinds of fish. The products commonly found on the market are made from the body oil of herring, sardines, mackerel, anchovy, salmon, or from the liver oil of cod fish. While not actually made from fish (since they are actually molluscs), there are also other “fish oils” made from squid and green lipped mussels as well.

Larger fish like tuna, swordfish, and sharks can also provide the omega 3s that are desired in fish oil, but at a higher cost. Since these fish are higher in the food chain and live much longer, their body oil also contains heavy metals and other contaminants accumulated from the bodies of the smaller fish they eat. It is very rare that these fish provide the source of fish oil, and even for the smaller fish mentioned above, there are methods used to ensure that heavy metal content is minimal in fish oil products.

Companies have to adhere to Good Manufacturing Practices in order for supplements to be sold, and the FDA has set some clear cutoffs of maximum allowable levels of heavy metals and other contaminants in food items. Some companies go above and beyond to ensure that their fish oil products have minimal heavy metals present. Third-party certifying bodies of dietary supplements such as NSF and USP, as well as fish oil specific standards, such as certification from the International Fish Oil Standard (IFOS), can help guarantee that fish oil products are safe and authentic for you, your family, and your patients.

Various methods of processing help limit the heavy metals in fish oil products, as well as limiting oxidation of the oil. Fish oil, like any oil, can go rancid if it’s left in open air. Because of this, bottles of liquid fish oil are often “capped” with nitrogen gas during the manufacturing process to help prevent oxidation.

Encapsulating fish oil instead of leaving it as a liquid is another way to prevent oxidation of the oil. As an added benefit, capsules don’t need to be refrigerated!

In which forms is it available?

As mentioned above, the source fish used when manufacturing fish oil can vary widely, but the one common denominator to all of the different kinds of sources is that they contain omega-3 fatty acids. The omega-3 fatty acids associated with positive health effects are EPA and DHA, so you’ll see most products quantified by the amount of

  • Total omega-3
  • EPA
  • DHA

Fish oil products will often have the ratio of EPA to DHA posted somewhere on the bottle, as varying levels of EPA and DHA can have different health effects. Here are some examples:

  • Cardiovascular support: Look for high total omega-3 content, EPA to DHA ratio less important
  • Inflammation support: Look for higher EPA content relative to DHA content
  • Cognitive support: Higher DHA content relative to EPA content

For patients without allergies or dietary restrictions, fish oil products are the most suitable source of omega-3 fatty acids due to their high bioavailability, low cost, and accessibility for the patient.

  • Krill oil: Contains lower doses of omega-3 found in the same volume of fish oil, but the omega-3 in krill are 33% better absorbed than omega-3 in fish oil (3) because they are bound to phospholipids as opposed to triglycerides or unbound as esters.
  • Squid oil: Contains mostly DHA, which can be indicated for some pediatric and neurocognitive cases.
  • Flaxseed Oil: Contains mostly alpha-Linolenic Acid (ALA), minimal EPA/DHA, and is not a direct replacement for fish oil, despite often being considered because it contains omega-3 in the form of ALA.

While there is no true vegan “fish oil”, patients who follow a vegan diet can use oils made from algae or flaxseed to get a source of EPA and DHA as part of their nutrition. The doses are far smaller than what is in fish-based oils, but it’s a much better option than not including long-chain omega-3 fatty acids at all.

How does it work?

EPA and DHA are non-selective COX inhibitors, which acts like your typical non-steroidal anti-inflammatory drug (NSAID) medications, such as aspirin or ibuprofen. As a result, they are commonly used for their anti-inflammatory effects. Some patients are even able to reduce their NSAID use when taken in combination with a fish oil supplement, which reduces their risk for adverse events commonly related to NSAIDS.(3)

One common misconception is that all omega-3s can be easily interchanged, but it’s not that easy. When someone isn’t able to or chooses not to eat fish, flaxseed oil is often presented as an alternative to fish oil as a source of omega-3s in fish’s absence. However, there is a large difference in structure between the alpha-linolenic acid (ALA) found in flax and long chain omega-3 fatty acids EPA and DHA (the fatty acids prominently found in fish oil).

fish oil fullscript supplements

Since the body cannot readily convert ALA to EPA or DHA, it is always prudent to recommend a reduction in the consumption of omega-6 fatty acids for patients that don’t consume a lot of long-chain omega-3 fats. High intake of omega-6 fatty acids found in refined seed oils such as linoleic acid (LA) in the diet have been shown to be one of the determinants of inflammation in the body, and one of the causes of metabolic and inflammatory disease.(4) Reducing the ratio of omega-6 fatty acids to omega-3 fatty acids can be done in two ways: either reducing total omega-6 content, or adding long-chain omega-3 content to the diet through food or supplements.

How can fish oil help?

Fish oil is well researched for its use in helping patients with mild to moderate depression, cardiovascular disease as well as various autoimmune and inflammatory conditions.

You may have heard that “Fish oils make you shiny!”, and there’s some truth to this. Fish oil has been used for skin and hair conditions by supplying important omega-3 fats to the body, skin, and hair, making it stronger and giving it more lustre.

In general, the omega-3s found in fish oil help the cells in our body move better. EPA and DHA are polyunsaturated fatty acids, which are much more “slippery” than their monounsaturated and saturated cousins. Since omega-3s are part of cell membranes, this means that cell membranes are more pliable and elastic, which can help our brain, blood vessels, skin, and hair to function and grow better.

Are there side effects?

Fish oil has many positive brain, heart health, and anti-inflammatory effects, and the majority of these effects are due to the fact that fish oil thins the blood and makes blood vessels less stiff. This is helpful for long term cardiovascular health and cognitive disease prevention, but thinning the blood can sometimes result in longer bleeding times by changing how well the blood is able to clot.

This is particularly important for patients who are on blood thinners, have genetic bleeding conditions, play contact sports, or are about to have surgery or go to the dentist.

Make sure that you always tell your doctor, dentist, or surgeon if you are taking a fish oil supplement – or any supplement for that matter. Although supplements are generally safe to consume, health care practitioners need to know about the supplements that you’re taking so they have all the information they need and can help you achieve the best possible health outcomes.

Of all the omega-3 supplements, fish oil is most commonly linked to bleeding risk because of its higher levels of EPA and DHA. Other omega-3 products like flaxseed, squid, and krill oil have much lower doses of EPA/DHA, and subsequent lower bleeding risk.

If you are following a vegan diet, algae oil and flaxseed oil are other omega-3 alternatives that you can use. Omega-3s can also be found in crustacean oils (krill, green lipped mussel, squid), but are not suitable for vegan patients.


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  1. “The Man with a Fish on His Back.” Science History Institute, 2 June 2016, https://www.sciencehistory.org/distillations/magazine/the-man-with-a-fish-on-his-back.
  2. Schuchardt, Jan Philipp, et al. “Incorporation of EPA and DHA into Plasma Phospholipids in Response to Different Omega-3 Fatty Acid Formulations–a Comparative Bioavailability Study of Fish Oil vs. Krill Oil.” Lipids in Health and Disease, vol. 10, Aug. 2011, p. 145.
  3. Cleland, Leslie, et al. “10.1186/ar1876.” Arthritis Res Ther, vol. 8, no. 1, 2006, p. 202, doi:10.1186/ar1876.
  4. Simopoulos, A. P. “The Importance of the Ratio of Omega-6/omega-3 Essential Fatty Acids.” Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, vol. 56, no. 8, Oct. 2002, pp. 365–79.