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

The transition between any season can pose challenges to our health; however, optimizing health during the summer months can help individuals prepare for a busy fall season, when work demands and the back-to-school season shifts into high gear.

Therefore, the summer season offers a unique opportunity for practitioners to support their patients’ wellness. Concerns around topics such as sleep support, anxiety and stress management, and immune health are common themes that may become particularly relevant this time of year.

This protocol focuses on the top evidence-based ingredients for concerns such as immune, sleep, anxiety, and stress support selected by our Integrative Medical Advisory Team (IMAT), as well as seasonally relevant personal care products selected by our merchandise and brand experts.

In combination with healthy behavioral and lifestyle 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 as individuals transition from summer to fall, and beyond. 

Magnesium

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

  • Sleep: Sleep latency was found to be significantly reduced by magnesium supplementation in a 2021 meta-analysis (MA) where < 1000 mg of elemental magnesium 3 times per day was recommended. (Mah 2021)
  • Anxiety: A systematic review (SR) of 18 studies found subjective anxiety to improve from magnesium supplementation; stress exposure has been shown to increase renal excretion of magnesium, and magnesium may act as a modulator for the HPA axis by reducing adrenocorticotropic hormone (ACTH) and cortisol. (Boyle 2017)
Magnesium in the Fullscript catalog

Probiotics

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)

  • Immune support: 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, the number of days with a cold, total symptom scores and pharyngeal symptoms, and B lymphocyte proliferation. (Berggren 2010)
  • Anxiety support: A MA and SR of 34 controlled clinical trials found probiotics to significantly improve depression and anxiety. (Liu 2019)
  • Digestive health related to stress: A SR of 15 studies involving 1,793 patients found that probiotics reduced pain and symptom severity scores in patients with IBS. (Didari 2015) Another SR 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)
Probiotics in the Fullscript catalog

Vitamin D

1000–7160 IU per day for 3 months in children; (Glabska 2021) Upper Limit (UL) of vitamin D for adults is 4,000 IU per day (NIH 2021)

  • Mental health: A 2021 SR of vitamin D intake and status on mental health in children supported a positive influence on mental health across a wide variety of issues: mental health, level of distress, quality of life, well-being, and mood. (Glabska 2021)
  • Immune support: A 2021 MA of 46 randomized controlled trials (n=75,541) found that 400–1,000 IU per 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)
Vitamin D in the Fullscript catalog

Zinc

Attention and focus: 10–15 mg of elemental zinc, 1–2 times per day, for a minimum of 5–13 weeks (Arnold 2011)(DiGirolamo 2010)(Uckardes 2009)(Zamora 2011);

Immune support: 75–100 mg of elemental zinc once per day, within 24 hours of symptom onset (Hemilä 2017a)(Hemilä 2017b)

  • Attention and focus: Improved various scores in attention, hyperactivity, impulsivity, oppositional behavior, conduct, and impaired socialization were observed, as measured by the Attention Deficit Hyperactivity Disorder Scale (ADHDS) and the Conners Global Index and Rating Scales. (Zamora 2011)(Uckardes 2009) Increased attention was observed in children with ADHD when concomitantly administered with methylphenidate compared with methylphenidate alone. (Noorazar 2020)
  • Immune support: Zinc supplementation has been shown to reduce cold duration by 33%, (Hemilä 2017b) and the incidence of cold symptoms after 5–7 days in healthy adults and children. (Hemilä 2017a)(Singh 2015)
Zinc in the Fullscript catalog

Melatonin 

3 mg for 4-week duration in children aged 6–12 (Van der Heijden 2007)

  • Sleep: Pooled data from a MA and SR of 7 studies found melatonin to be effective for management of secondary sleep disorders as demonstrated by reduced sleep onset latency and increased total sleep time. (Li 2019) Melatonin was also found to increase total sleep time in children with attention-deficit/hyperactivity disorder. (Van der Heijden 2007)
  • Headaches: A 2019 SR found melatonin to be a promising ingredient for migraine prevention, as 3 mg of immediate-release or 4 mg of prolonged-release melatonin were both found to significantly decrease migraines over a 3-month duration. (Long 2019)
Melatonin in the Fullscript catalog

Resources

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

Personal care products for summer 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. 

In addition to the evidence-based ingredients above, several possible recommendations for Personal Care Products relevant to Summer Health have been selected by the Fullscript Merchandising and Brand experts. As always, practitioners are encouraged to use their clinical judgment when making recommendations based on individual patient needs.

Personal care product 1

The DivaCup Menstrual Cup by Diva Cup 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 protocol in-app
References
  1. 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://doi.org/10.1016/j.autrev.2012.07.007 – A
  2. Arnold, L. E., Disilvestro, R. A., Bozzolo, D., Bozzolo, H., Crowl, L., Fernandez, S., Ramadan, Y., Thompson, S., Mo, X., Abdel-Rasoul, M., & Joseph, E. (2011). Zinc for attention-deficit/hyperactivity disorder: placebo-controlled double-blind pilot trial alone and combined with amphetamine. Journal of Child and Adolescent Psychopharmacology, 21(1), 1–19. https://doi.org/10.1089/cap.2010.0073 – B
  3. Berggren, A., Lazou Ahrén, I., Larsson, N., & Önning, G. (2011). 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://doi.org/10.1007/s00394-010-0127-6 – B
  4. Boyle, N. B., Lawton, C., & Dye, L. (2017). The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review. Nutrients, 9(5). https://doi.org/10.3390/nu9050429 – A
  5. Didari, T., Mozaffari, S., Nikfar, S., & Abdollahi, M. (2015). Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World Journal of Gastroenterology: WJG, 21(10), 3072–3084. https://doi.org/10.3748/wjg.v21.i10.3072 – A
  6. DiGirolamo, A. M., Ramirez-Zea, M., Wang, M., Flores-Ayala, R., Martorell, R., Neufeld, L. M., Ramakrishnan, U., Sellen, D., Black, M. M., & Stein, A. D. (2010). Randomized trial of the effect of zinc supplementation on the mental health of school-age children in Guatemala. The American Journal of Clinical Nutrition, 92(5), 1241–1250. https://doi.org/10.3945/ajcn.2010.29686 – A
  7. Ford, A. C., Quigley, E. M. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & 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), 1547–1561; quiz 1546, 1562. https://doi.org/10.1038/ajg.2014.202 – A
  8. Głąbska, D., Kołota, A., Lachowicz, K., Skolmowska, D., Stachoń, M., & Guzek, D. (2021). The Influence of Vitamin D Intake and Status on Mental Health in Children: A Systematic Review. Nutrients, 13(3). https://doi.org/10.3390/nu13030952 – A
  9. 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), 2054270417694291. https://doi.org/10.1177/2054270417694291 – A
  10. 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://doi.org/10.1093/ofid/ofx059 – A
  11. Jolliffe, D. A., Camargo, C. A., Jr, 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://doi.org/10.1016/S2213-8587(21)00051-6 – A
  12. Li, B., Lv, J., Wang, W., & Zhang, D. (2017). Dietary magnesium and calcium intake and risk of depression in the general population: A meta-analysis. The Australian and New Zealand Journal of Psychiatry, 51(3), 219–229. https://doi.org/10.1177/0004867416676895 – A
  13. Li, T., Jiang, S., Han, M., Yang, Z., Lv, J., Deng, C., Reiter, R. J., & Yang, Y. (2019). Exogenous melatonin as a treatment for secondary sleep disorders: A systematic review and meta-analysis. Frontiers in Neuroendocrinology, 52, 22–28. https://doi.org/10.1016/j.yfrne.2018.06.004 – A
  14. Liu, R. T., Walsh, R. F. L., & Sheehan, A. E. (2019). Prebiotics and probiotics for depression and anxiety: A systematic review and meta-analysis of controlled clinical trials. Neuroscience and Biobehavioral Reviews, 102, 13–23. https://doi.org/10.1016/j.neubiorev.2019.03.023 – A
  15. Long, R., Zhu, Y., & Zhou, S. (2019). Therapeutic role of melatonin in migraine prophylaxis: A systematic review. Medicine, 98(3), e14099. https://doi.org/10.1097/MD.0000000000014099 – A
  16. 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://doi.org/10.1186/s12906-021-03297-z – A
  17. NIH. (2021). Magnesium. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ – F
  18. Noorazar, S. G., Malek, A., Aghaei, S. M., Yasamineh, N., & Kalejahi, P. (2020). The efficacy of zinc augmentation in children with attention deficit hyperactivity disorder under treatment with methylphenidate: A randomized controlled trial. Asian Journal of Psychiatry, 48, 101868. https://doi.org/10.1016/j.ajp.2019.101868 – B
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  21. Van der Heijden, K. B., Smits, M. G., Van Someren, E. J. W., Ridderinkhof, K. R., & Gunning, W. B. (2007). Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. Journal of the American Academy of Child and Adolescent Psychiatry, 46(2), 233–241. https://doi.org/10.1097/01.chi.0000246055.76167.0d – B
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