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 D-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
D
Non-RDBPC human or In-vivo animal trials
 

The US and global prevalence of obesity has been rising steadily in the past decades. Obesity and higher weights are associated with various health complications, including type 2 diabetes, cardiovascular disease, stroke, certain cancers, obstructive sleep apnea syndrome (OSAS), non-alcoholic fatty liver disease (NAFLD), and musculoskeletal disorders.

Addressing obesity and weight management requires a thoughtful and comprehensive approach. Whole person care considers not only physical health but also a patient’s unique goals, preferences, and challenges. By integrating advanced diagnostics, mental health support, lifestyle practices, medications, and evidence-based supplements, this approach empowers individuals to make meaningful, sustainable changes. Whole person care supports metabolic health and overall quality of life by focusing on long-term wellness rather than short-term solutions.

Labs 

GI360 TM stool profile

The GI360™ test by Doctor’s Data is a comprehensive stool analysis that provides detailed insights into gastrointestinal (GI) health using multiple testing methodologies. It evaluates gut microbial conditions, digestion/absorption markers, and inflammation indicators, screening for over 80 microorganisms including bacteria, parasites, and fungi. The test offers a broad assessment of the gut microbiome, digestive function, and potential pathogens, enabling healthcare providers to develop personalized plans for various GI and systemic health issues.

GI360 TM Stool Profile in the Fullscript catalog

Ingredients

Akkermansia muciniphila 

10–12 billion CFU per day (Depommier 2019)(Perraudeau 2020)

A 15–30 g dose is required to leverage glutamine’s beneficial metabolic effects as a GLP-1 enhancer. (Meek 2016)

  • Akkermansia muciniphila (live and pasteurized) was safe, well tolerated, and improved metabolic parameters, including insulin sensitivity, insulinemia, and cholesterol levels, in individuals with overweight, obesity, and insulin resistance. Pasteurized A. muciniphila also slightly reduced body weight, fat mass, and hip circumference, with additional benefits for markers of liver dysfunction and inflammation. (Depommier 2019)
  • In a 12-week human study on adults with type 2 diabetes, the multi-strain probiotic WBF-0011, containing live A. muciniphila, Anaerobutyricum hallii, Clostridium beijerinckii, Clostridium butyricum, and Bifidobacterium infantis, was shown to be safe and well tolerated. The probiotic significantly improved metabolic outcomes, reducing glucose total area under the curve (AUC) by 36.1 mg/dL, decreasing glycated hemoglobin (A1c) by 0.6%, and lowering glucose incremental-AUC by 28.6 mg/dL. These improvements suggest potential benefits in postprandial glucose control and overall metabolic health in individuals with type 2 diabetes. (Perraudeau 2020)
  • Researchers in a mouse study identified P9, a protein secreted by A. muciniphila, as a crucial factor in enhancing metabolism by stimulating GLP-1 secretion and thermogenesis in brown adipose tissue. (Yoon 2021)
  • In a 12-week study, researchers evaluated A. muciniphila abundance, gut microbiome gene richness, and metabolic health in 49 individuals with overweight or obesity. Higher baseline levels of A. muciniphila were linked to healthier metabolic markers, such as lower fasting glucose and improved fat distribution. After calorie restriction, participants with higher initial A. muciniphila levels experienced greater improvements in insulin sensitivity and other clinical metrics, despite a modest decline in its abundance. These findings highlight A. muciniphila as a potential contributor to improved metabolic health during weight loss. (Dao 2016)
Akkermansia muciniphila in the Fullscript catalog

Berberine

600–1,500 mg per day, minimum 12 weeks (Asbaghi 2020)(Xiong 2020)

  • A meta-analysis of 12 randomized controlled trials found berberine supplementation moderately but significantly decreased body weight (-2.07 kg), BMI (-0.47 kg/m2), waist circumference (-1.08 cm), and C-reactive protein concentrations (-0.42 mg/L). (Asbaghi 2020)
  • A meta-analysis of 12 randomized controlled trials found berberine supplementation significantly reduced BMI and waist circumference but not body weight. Subgroup analysis revealed that berberine supplementation reduced waist circumference, particularly in females and in subjects with a baseline BMI >30 kg/m2, when the intervention lasted longer than 12 weeks and the dose exceeded 1 g per day. (Xiong 2020)
  • In a randomized placebo-controlled trial involving 106 patients with diabetes mellitus and dyslipidemia, berberine supplementation at 1 g per day significantly reduced fasting plasma glucose (~20%), postload plasma glucose (~25%), hemoglobin A1C (HbA1c) (~12%), triglycerides (~35%), total cholesterol (~18%), and LDL levels (~21%) compared to the placebo group. (Zhang 2008)
Berberine in the Fullscript catalog

Conjugated linoleic acid

3–4.5 g per day for 4–12 weeks (Namazi 2019)(Hamdallah 2020)

  • Conjugated linoleic acid (CLA) supplementation had a moderate anti-obesity effect on body weight, BMI, and total body fat reduction in women when supplemented over 6–16 weeks. (Hamdallah 2020)
  • In CLA groups, significant body weight (-0.51 kg) and BMI (-0.18 kg/m2) reductions were found compared to controls. In metabolic syndrome patients, CLA was effective in reducing weight and BMI, but it adversely reduced high-density lipoprotein (HDL). Thus, precautions should be taken with CLA use for metabolic syndrome patients. (Namazi 2019)
  • Supplementation with CLA increased lean body mass (0.19 kg) and slightly reduced body weight (-0.52 kg), BMI (-0.23 kg/m2), and fat mass in individuals with overweight or obesity. (Namazi 2019)
Conjugated linoleic acid in the Fullscript catalog

Epigallocatechin gallate

500–800 mg per day for 12 weeks (Lin 2020)

  •  ≥800 mg per day of green tea extract for <12 weeks or <500 mg per day of green tea for 12 weeks decreased waist circumference in participants with obesity. (Lin 2020)
  • After 12 weeks of high-dose epigallocatechin gallate (EGCG) treatment, the treatment group experienced significant reductions in weight (76.8 ± 11.3 kg to 75.7 ± 11.5 kg), BMI, and waist circumference. Additionally, reduced LDL plasma levels were observed, and total cholesterol levels decreased by up to 5.33%. (Chen 2016)
Epigallocatechin gallate in the Fullscript catalog

Fiber

5–20 g per day for 12–16 weeks (Huwiler 2022)(Jovanovski 2020)

  • Soluble dietary fiber supplementation ranging from 2.6–29 g per day (mean of 11 g per day) for at least 12 weeks in patients with overweight and obesity showed a significantly higher reduction in body weight (-1.25 kg) accompanied by a significant decrease in BMI (-0.47 kg/m2), waist circumference (-1.33 cm), fasting blood insulin (-1.49 mIU/L), and HOMA-IR (-0.92) compared to the control group. (Huwiler 2022)
  • Viscous fiber supplementation within a calorie-restricted diet significantly decreased body weight (-0.81 kg), BMI (-0.25 kg/m2), and body fat compared (-1.39%) to controls. (Jovanovski 2020)
  • Weight, BMI, and percent total body fat were significantly reduced in participants who consumed 12 g of a psyllium fiber supplement. Significant total cholesterol and LDL reductions were observed compared with controls after six and 12 weeks. (Pal 2010)
Fiber in the Fullscript catalog

Glutamine

15–30 g daily

  • A 15–30 g dose is required to leverage glutamine’s beneficial metabolic effects as a GLP-1 enhancer. (Meek 2016)
  • A review article summarizing findings from multiple animal, cell model, and human studies investigated the effects of various food factors, such as amino acids, including glutamine, on GLP-1 secretion and their potential impact on glucose metabolism. Glutamine, in particular, was shown to elevate cytosolic calcium and cell adenosine 3′,5′-cyclic monophosphate (cAMP) in enteroendocrine L cells, promoting GLP-1 secretion in experiments. This suggests that glutamine could play a role in improving glucose tolerance by stimulating GLP-1 secretion. However, the study also notes that effective doses of glutamine (15–30 g) are needed to achieve beneficial metabolic effects in humans, as lower doses have not consistently led to significant metabolic improvements. (Meek 2016)
Glutamine in the Fullscript catalog

Omega-3 fatty acids (EPA/DHA)

400–2,040 mg (as 180–600 mg EPA/120–1,620 mg DHA), 1–3 times per day, for 4–12 weeks

  • A meta-analysis of nine studies examined the effects of omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation in managing overweight and obesity. Results demonstrated that n-3 PUFA was superior to placebo in reducing serum triglyceride levels, and a significant reduction in waist circumference was observed. (Zhang 2016)
  • A systematic review and meta-analysis of studies examined fish or n-3 PUFA intake and body composition. Participants who consumed fish or fish oil lost 0.59 kg more body weight than controls. Treatment groups lost 0.24 kg m-2 (BMI) more than controls and 0.49% more body fat than controls. Fish or fish oil reduced waist circumference by 0.81 cm compared to controls. (Bender 2014)
  • Thirty-four overweight women participated in a parallel-group, three-arm, randomized trial for 12 weeks. Compared to the placebo (corn oil), the lifestyle modification and EPA+DHA concentrate (1.5 g per day, containing ~0.6 g EPA+DHA) group had an increased VO2max/kg and decreased body weight, waist circumference, and body fat. (Sedláček 2018)
  • Another study found that participants prescribed omega-3 supplementation and exercise experienced significant reductions in body weight, body fat percentage, waist circumference, and abdominal skinfold thickness compared to the control group (placebo and exercise). Supplementation of omega-3 also significantly improved the VO2max outcome compared to the control group. (Haghravan 2016)
Omega-3 fatty acids (EPA/DHA) in the Fullscript catalog

Whey protein

30–60 g per day (Sepandi 2022)(Badely 2019)

  • A meta-analysis determined that whey protein supplementation positively affected body composition indicators, including weight, body fat, lean body mass, fat-free mass, and waist circumference. (Sepandi 2022) 
  • In a systematic review and meta-analysis, whey protein supplementation significantly reduced systolic blood pressure, diastolic blood pressure, HDL, waist circumference, triglyceride, and fasting blood sugar in intervention groups compared to control groups. (Badely 2019)
  • In a systematic review and meta-analysis, a significant reduction of body weight, lean mass, and fat mass was observed in whey protein supplement groups. (Wirunsawanya 2017)
Whey protein in the Fullscript catalog

Lifestyle recommendations

The Mediterranean diet 

  • A meta-analysis revealed that the Mediterranean diet is associated with beneficial changes in biomarkers of metabolic dysfunction including body weight, BMI, waist circumference, serum glucose, insulin, HOMA-IR, advanced lipid profiles, hepatic function tests, and inflammatory markers. (Papadaki 2020) 
  • The macronutrient profile of the Mediterranean diet supports cardiovascular health, promotes anti-inflammatory effects, and aids in metabolic regulation. (Ge 2020)(Willett 1995)

Patient resources:

Fasting

  • A 12-month randomized clinical trial found intermittent energy restriction (two days per week) was as effective as continuous energy restriction (seven days per week) for reducing HbA1c levels in patients with type 2 diabetes, yielding similar weight loss outcomes in both groups. (Carter 2018)(Vasmin 2022)
  • Intermittent and continuous energy restrictions were equally effective for weight loss and improving health biomarkers in 107 women with overweight or obesity and premenopause over six months. Intermittent energy restriction resulted in slightly greater improvements in fasting insulin and insulin resistance. (Harvie 2011)(Vasmin 2022)
  • In a smaller study of 32 participants, alternate-day fasting over 12 weeks led to significant weight loss, fat mass reduction, and improvements in cardioprotective markers, such as decreased triacylglycerol levels, increased LDL particle size, and reduced C-reactive protein (CRP) levels in normal-weight and overweight individuals. (Varady 2013)(Wang 2022)

Patient resources:

Movement

  • Sedentary activity for four or more hours daily has been associated with an increased risk of metabolic syndrome, independent of physical activity. (Deng 2024)(Wu 2022)
  • Resistance training to promote lean muscle mass has been associated with reduced body fat percentage, body fat mass, and visceral fat in healthy adults. (Wewege 2022)
  • When combined with high-intensity aerobic training, high-load resistance training can have beneficial effects for reducing abdominal adiposity, increasing lean body mass, increasing cardiorespiratory fitness, and overall metabolic health. (O’Donoghue 2021)

Patient resources:

Stress management

  • While adults who experience psychological stress may have an increased risk of metabolic syndrome compared to adults who experience less stress, (Kuo 2019) low levels of or no stress may be associated with a reduced risk of metabolic syndrome. (Deng 2024) 
  • Stress management interventions commonly involve mindfulness practices, such as meditation and deep breathing, alongside cognitive behavioral therapy (CBT) to help patients reframe maladaptive thought patterns. Incorporating physical activity, particularly yoga or aerobic exercise, can enhance relaxation and mood regulation. 

Patient resources: 

Sleep 

  • Correcting sleep apnea is critical, as hypoxia is a major driver of mitochondrial dysfunction, inflammation, and insulin resistance. (Chasens 2021) 
  • Those with normal sleep (7–8 hours per day) were shown to have a lower risk for metabolic syndrome compared to those with five hours or less and nine hours or more of sleep per day. (Chasens 2021) 
  • Encourage better sleep by: 
    • Eating three or more hours before bedtime
    • Supporting the circadian rhythm
    • Wearing blue light-blocking glasses at night
    • Getting exposure to morning light/sunshine

Patient resources:

Social

  • Research shows an association between social connectedness and a reduced risk of obesity and hypertension, highlighting the protective impact of social integration across life stages. (Yang 2016) 
  • Strategies to improve social connection include:
    • Participating in group activities or community events, which can foster a sense of belonging
    • Building active listening and empathy skills to enhance interpersonal relationships
    • Leveraging technology for virtual meetups and support groups, particularly for individuals who face barriers to in-person socializing

Disclaimer

The Fullscript 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 on Fullscript
References
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