Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through C-quality evidence.

Class
Qualifying studies
Minimum requirements
A
Systematic review or meta-analysis of human trials
 
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study

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.

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 in the Fullscript catalog

Probiotics

Dosages vary widely across studies and product formulations; depending on the patient’s individual needs.

  • Digestive health: A systematic review of 15 studies involving 1,793 patients found that probiotics reduced pain and symptom severity scores in patients with IBS. (Didari 2015) Another systematic review of 43 RCTs found that probiotics reduced the risk of persistent symptoms compared to placebo (RR 0.79); benefits were seen among global IBS, abdominal pain, bloating, and flatulence scores (Ford 2014)
  • Immune health: 1 billion CFU of Lactobacillus paracasei 8700:2 (DSM 13434) and Lactobacillus plantarum HEAL 9 (DSM 15312), once per day for 3 months (Berggren 2010) reduced the incidence of developing more than one common cold episode and number of days with a cold, reduced total symptom scores and pharyngeal symptoms, and reduced B lymphocyte proliferation (Berggren 2010)
  • Allergies: A systematic review and meta-analysis found that supplementation with probiotics improved Rhinitis Quality of Life (RQLQ) scores compared to placebo; however, probiotics had no effect on Rhinitis Total Symptom Scores (RTSS) or total IgE levels. (Zajac 2015)
Probiotics in the Fullscript catalog

Omega-3 fatty acids (EPA/DHA)

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)
View Omega-3 fatty acids in the ingredient library
Omega-3 fatty acids in the Fullscript catalog

Zinc

25-50 mg per day, (Yosaee 2022)(Faghfouri 2021)(Mousavi 2018) or 75-100 mg of elemental zinc as zinc acetate or zinc gluconate lozenges, once per day, within 24 hours symptom onset if used for acute common cold symptoms. (Hemilä 2017)(Hemilä 2017)

Zinc in the Fullscript catalog

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 in the Fullscript catalog

Resources

The following blog articles may support your patient with their spring wellness journey.  Check out the in-app patient resource library for additional downloadable handouts, guides, and infographics.

Personal care products for spring wellness 

Improving overall wellness and making sustainable, positive changes often means prioritizing health in many areas of life — not just taking the right supplements. That’s why Fullscript is continuously growing its catalog to include new personal care items from high-quality, trusted brands. 

As the seasons change, we all turn to various lifestyle products to keep us feeling our best. The brand experts at Fullscript recommend these wellness products for spring! Similar to our practitioner-grade supplements, you can trust that these products are non-toxic and only contain the highest-quality ingredients. Include them in your Spring Wellness protocol along with supplements to help your patients make more positive choices as part of their wellness journeys.

Personal care product 1

Lavender Coconut Organic Hair Creme by Dr. Bronner's in the Fullscript catalog

Personal care product 2

Fig.1 Pro-Retinol Eye Cream by Fig.1 Beauty in the Fullscript catalog

Personal care product 3

Kids Sunscreen SPF 45 by Alba Botanica in the Fullscript catalog

Personal care product 4

Fizzy Cherry Organic Lip Balm by Makes 3 Organics in the Fullscript catalog

Personal care product 5

Skin Food Light Nourishing Cream by Weleda in the Fullscript catalog

Personal care product 6

Bug Spray by Dr. Mercola Premium Products in the Fullscript catalog

Personal care product 7

Fx Exhale by Fx Chocolate in the Fullscript catalog

Disclaimer

The Fullscript 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 adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

View template in-app
References
  1. Abdelhamid, A. S., Brown, T. J., Brainard, J. S., Biswas, P., Thorpe, G. C., Moore, H. J., Deane, K. H., Summerbell, C. D., Worthington, H. V., Song, F., & Hooper, L. (2020). Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, 2020(3), CD003177. https://pubmed.ncbi.nlm.nih.gov/32114706/
  2. Antico, A., Tampoia, M., Tozzoli, R., & Bizzaro, N. (2012). Can supplementation with vitamin D reduce the risk or modify the course of autoimmune diseases? A systematic review of the literature. Autoimmunity Reviews, 12(2), 127–136. https://pubmed.ncbi.nlm.nih.gov/22776787/
  3. Bakhshaee, M., Sharifian, M., Esmatinia, F., Rasoulian, B., & Mohebbi, M. (2019). Therapeutic effect of vitamin D supplementation on allergic rhinitis. European Archives of Oto-Rhino-Laryngology, 276(10), 2797–2801. https://pubmed.ncbi.nlm.nih.gov/31332549/
  4. Berggren, A., Lazou Ahrén, I., Larsson, N., & Önning, G. (2010). Randomised, double-blind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections. European Journal of Nutrition, 50(3), 203–210. https://pubmed.ncbi.nlm.nih.gov/20803023/
  5. Cooper, R. E., Tye, C., Kuntsi, J., Vassos, E., & Asherson, P. (2015). Omega-3 polyunsaturated fatty acid supplementation and cognition: A systematic review and meta-analysis. Journal of Psychopharmacology, 29(7), 753–763. https://pubmed.ncbi.nlm.nih.gov/26040902/
  6. Derom, M. L., Sayón-Orea, C., Martínez-Ortega, J. M., & Martínez-González, M. A. (2013). Magnesium and depression: A systematic review. Nutritional Neuroscience, 16(5), 191–206. https://pubmed.ncbi.nlm.nih.gov/23321048/
  7. Didari, T. (2015). Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World Journal of Gastroenterology, 21(10), 3072. https://pubmed.ncbi.nlm.nih.gov/25780308/
  8. Faghfouri, A. H., Baradaran, B., Khabbazi, A., Khaje Bishak, Y., Zarezadeh, M., Tavakoli-Rouzbehani, O. M., Faghfuri, E., Payahoo, L., Alipour, M., & Alipour, B. (2021). Profiling inflammatory cytokines following zinc supplementation: A systematic review and meta-analysis of controlled trials. British Journal of Nutrition, 126(10), 1441–1450. https://pubmed.ncbi.nlm.nih.gov/33468279/
  9. Ford, A. C., Quigley, E. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M., & Moayyedi, P. (2014). Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. The American journal of gastroenterology, 109(10), 1547–1562. https://doi.org/10.1038/ajg.2014.202 
  10. Gao, X. R., Chen, Y. S., & Deng, W. (2017). The effect of vitamin D supplementation on knee osteoarthritis: A meta-analysis of randomized controlled trials. International Journal of Surgery, 46, 14–20. https://pubmed.ncbi.nlm.nih.gov/28797917/
  11. Hemilä, H. (2017). Zinc lozenges and the common cold: A meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage. JRSM Open, 8(5), 205427041769429. https://pubmed.ncbi.nlm.nih.gov/28515951/
  12. Hemilä, H., & Chalker, E. (2015). The effectiveness of high dose zinc acetate lozenges on various common cold symptoms: A meta-analysis. BMC Family Practice, 16(1), 24. https://pubmed.ncbi.nlm.nih.gov/25888289/
  13. Hemilä, H., Fitzgerald, J. T., Petrus, E. J., & Prasad, A. (2017). Zinc acetate lozenges may improve the recovery rate of common cold patients: An individual patient data Meta-Analysis. Open Forum Infectious Diseases, 4(2), ofx059. https://pubmed.ncbi.nlm.nih.gov/28480298/
  14. Hemilä, H., Petrus, E. J., Fitzgerald, J. T., & Prasad, A. (2016). Zinc acetate lozenges for treating the common cold: An individual patient data meta-analysis. British Journal of Clinical Pharmacology, 82(5), 1393–1398. https://pubmed.ncbi.nlm.nih.gov/27378206/
  15. Jolliffe, D. A., Camargo, C. A., Sluyter, J. D., Aglipay, M., Aloia, J. F., Ganmaa, D., Bergman, P., Bischoff-Ferrari, H. A., Borzutzky, A., Damsgaard, C. T., Dubnov-Raz, G., Esposito, S., Gilham, C., Ginde, A. A., Golan-Tripto, I., Goodall, E. C., Grant, C. C., Griffiths, C. J., Hibbs, A. M., . . . Martineau, A. R. (2021). Vitamin D supplementation to prevent acute respiratory infections: A systematic review and meta-analysis of aggregate data from randomised controlled trials. The Lancet Diabetes & Endocrinology, 9(5), 276–292. https://pubmed.ncbi.nlm.nih.gov/33798465/
  16. Li, B., Lv, J., Wang, W., & Zhang, D. (2016). Dietary magnesium and calcium intake and risk of depression in the general population: A meta-analysis. Australian & New Zealand Journal of Psychiatry, 51(3), 219–229. https://pubmed.ncbi.nlm.nih.gov/27807012/
  17. Mah, J., & Pitre, T. (2021). Oral magnesium supplementation for insomnia in older adults: A systematic review & Meta-Analysis. BMC Complementary Medicine and Therapies, 21(1), 125. https://pubmed.ncbi.nlm.nih.gov/33865376/
  18. Melrose, S. (2015). Seasonal affective disorder: An overview of assessment and treatment approaches. Depression Research and Treatment, 2015, 1–6. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4673349/
  19. Menon, V., & Vellekkatt, F. (2018). Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials. Journal of Postgraduate Medicine, 0(0), 0. https://pubmed.ncbi.nlm.nih.gov/29943744/
  20. Mousavi, S. M., Djafarian, K., Mojtahed, A., Varkaneh, H. K., & Shab-Bidar, S. (2018). The effect of zinc supplementation on plasma C-reactive protein concentrations: A systematic review and meta-analysis of randomized controlled trials. European Journal of Pharmacology, 834, 10–16. https://pubmed.ncbi.nlm.nih.gov/30012497/
  21. National Institutes of Health. (2021a). Magnesium fact sheet for health professionals. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
  22. National Institutes of Health. (2021b). Vitamin D fact sheet for health professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
  23. Prasad, A., Beck, F., Bao, B., Snell, D., & Fitzgerald, J. (2008). Duration and severity of symptoms and levels of plasma interleukin-1 receptor antagonist, soluble tumor necrosis factor receptor, and adhesion molecules in patients with common cold treated with zinc acetate. The Journal of Infectious Diseases, 197(6), 795–802. https://pubmed.ncbi.nlm.nih.gov/18279051/
  24. Science, M., Johnstone, J., Roth, D. E., Guyatt, G., & Loeb, M. (2012). Zinc for the treatment of the common cold: A systematic review and meta-analysis of randomized controlled trials. Canadian Medical Association Journal, 184(10), E551–E561. https://pubmed.ncbi.nlm.nih.gov/22566526/
  25. Singh, M., & Das, R. R. (2015). Zinc for the common cold. Cochrane Database of Systematic Reviews, CD001364. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6457799/
  26. Veronese, N., Demurtas, J., Pesolillo, G., Celotto, S., Barnini, T., Calusi, G., Caruso, M. G., Notarnicola, M., Reddavide, R., Stubbs, B., Solmi, M., Maggi, S., Vaona, A., Firth, J., Smith, L., Koyanagi, A., Dominguez, L., & Barbagallo, M. (2019). Magnesium and health outcomes: An umbrella review of systematic reviews and meta-analyses of observational and intervention studies. European Journal of Nutrition, 59(1), 263–272. https://pubmed.ncbi.nlm.nih.gov/30684032/
  27. Wolters, M., von der Haar, A., Baalmann, A. K., Wellbrock, M., Heise, T. L., & Rach, S. (2021). Effects of n-3 polyunsaturated fatty acid supplementation in the prevention and treatment of depressive Disorders—A systematic review and Meta-Analysis. Nutrients, 13(4), 1070. https://pubmed.ncbi.nlm.nih.gov/33806078/
  28. Yosaee, S., Clark, C. C., Keshtkaran, Z., Ashourpour, M., Keshani, P., & Soltani, S. (2022). Zinc in depression: From development to treatment: A comparative/ dose response meta-analysis of observational studies and randomized controlled trials. General Hospital Psychiatry, 74, 110–117. https://pubmed.ncbi.nlm.nih.gov/32829928/
  29. Yurko-Mauro, K., Alexander, D. D., & van Elswyk, M. E. (2015). Docosahexaenoic Acid and Adult Memory: A Systematic Review and Meta-Analysis. PLOS ONE, 10(3), e0120391. https://pubmed.ncbi.nlm.nih.gov/25786262/
  30. Zajac, A. E., Adams, A. S., & Turner, J. H. (2015). A systematic review and meta-analysis of probiotics for the treatment of allergic rhinitis. International Forum of Allergy & Rhinology, 5(6), 524–532. https://pubmed.ncbi.nlm.nih.gov/25899251/
  31. Zhao, L., Hu, M., Yang, L., Xu, H., Song, W., Qian, Y., & Zhao, M. (2019). Quantitative association between serum/dietary magnesium and cardiovascular disease/coronary heart disease risk. Journal of Cardiovascular Pharmacology, 74(6), 516–527. https://pubmed.ncbi.nlm.nih.gov/31815866/