By Amy Doyle, MS, CNS⁺

Supporting Motility and Bowel Regularity: A Step-by-Step Approach

1. Introduction
2. Step One: Foundational Assessments and Identification of Subtype
3. Step Two: Investigation of Key Drivers
4. Step Three: Individualized Care
5. Step Four: Track Outcomes and Adjust
6. Pure Encapsulations® Nutrient Solutions
7. Conclusion
8. Resources

Introduction

Altered gastrointestinal motility is one of the most prevalent symptoms of functional bowel GI concerns encountered in clinical practice.¹ Despite its frequency, altered motility remains challenging to address due to its heterogeneity and the influence of gut–brain interactions.

A clinically useful lens for understanding motility concerns involves shifting the focus from symptom suppression to addressing physiology across multiple systems, including digestion, absorption, immune signaling, barrier integrity, microbial ecology and neuroendocrine regulation.

Patient care can differ significantly depending on the patient’s predominant clinical presentation: occasional diarrhea, occasional constipation or mixed bowel patterns - primarily occasional constipation with intermittent episodes of diarrhea.

Rather than being defined by structural changes, motility-related functional bowel concerns are characterized by symptom clusters that reflect shifts not only in motility but also potentially in other core physiological processes, including²:

• Visceral sensitivity
• Mucosal or immune activation patterns
• Changes within the gut microbial ecosystem
• Alterations in central nervous system processing influencing digestive function

This blog outlines a stepwise care strategy to support your decision-making in practice.

Step One: Foundational Assessments and Identification of Subtype

Functional bowel GI concerns can share similar clinical patterns with other health concerns.³ The first step is to perform a comprehensive functional assessment to confirm that the patient’s symptoms are not due to structural changes, non-beneficial microbial exposure or underlying metabolic, enzymatic or molecular contributors.⁴ Additional indications that advanced assessments may be needed include, but are not limited to, unintended weight loss, nocturnal symptoms, changes in iron levels, symptom onset after age 50 and family history.⁴

Step Two: Investigation of Key Drivers

While no single causative factor has been isolated for functional bowel GI concerns, several key drivers have been identified.

Additional assessments can help uncover contributors and support a personalized plan of care. For more information about foundational and supplemental assessments, refer to our Functional Bowel GI Health Protocol^‡.

Step Three: Individualized Care

Unique dietary triggers, stress, mood, sleep and exercise can strongly impact symptom levels, making nutrition, lifestyle and targeted supplementation essential components of care.¹⁰

Nutrition directly influences microbial fermentation, motility, immune signaling and epithelial integrity, making it foundational to supporting motility.⁹ For example:

• Occasional diarrhea: A short-term low-FODMAP diet can reduce fermentative load, osmotic activity and gas production, often improving stool urgency and frequency.¹¹
• Occasional constipation: Gradual introduction of soluble fiber supports stool hydration and colonic transit without excessive mechanical irritation.

Dietary changes should be used therapeutically and often temporarily, with structured reintroduction to prevent unnecessary restriction, nutrient depletions and unfavorable microbiome changes.

To explore more dietary strategies that support motility and bowel regularity, refer to our Functional Bowel GI Health Protocol^‡.

Lifestyle considerations include acknowledging stress, mood and the gut-brain connection. Patients with functional bowel GI concerns often present with a broad range of somatic concerns—such as fatigue, sleep disturbances, diffuse musculoskeletal discomfort and cardiopulmonary sensations—that may arise in the absence of identifiable structural changes.¹² Patterns of mood disturbance, including low mood, occasional anxiety and somatic preoccupation can influence how patients process and respond to visceral and extraintestinal signals.¹³

Any stress-management technique that supports physiological downregulation and enhances the body’s relaxation response can help patients feel more empowered in managing their symptoms and can promote greater parasympathetic activity.

Targeted nutraceutical support also differs depending on subtype but should focus on supporting digestion, microbial balance, intestinal barrier integrity and function, cytokine balance and motility.

Step Four: Track Outcomes and Adjust

Clinical outcomes should be tracked for 4-6 weeks at a time and include:

• Stool frequency and form (Bristol scale)
• Abdominal discomfort
• Bloating and gas
• Urgency or incomplete evacuation
• Sleep quality
• Energy levels
• Cycle-related symptom shifts (in women)

Structured dietary and supplement recommendations should be adjusted every 8-12 weeks, based on your patient’s response to care. Laboratory assessments can be completed every 3-6 months as necessary.

Ongoing assessment and refinement of diet, lifestyle and supplement strategies ensure that care remains responsive to changing clinical needs. Compassionate, individualized guidance can help patients build greater resilience, improve daily functioning and experience meaningful progress over time.

Pure Encapsulations Nutrient Solutions

PureGG 25B contains Lactobacillus rhamnosus GG, which is well known for its favorable effects on bowel function, particularly abdominal comfort, bowel motility and occasional diarrhea.^‡
Suggested Dose: 1 capsule daily, with or between meals

Epi-Integrity Powder promotes healthy modulation of mucosal immune responses to support GI integrity in a great-tasting powder.^‡
Suggested Dose: 1 scoop, 1-2 times daily. Add 1 serving to 8 oz of water or juice. Shake or stir until dissolved.

Conclusion

Altered gastrointestinal motility requires a personalized, systems-based approach—one that moves beyond symptom suppression to address the interconnected physiological processes that shape digestive function. By identifying each patient’s predominant symptom pattern, investigating key drivers and applying targeted nutrition, lifestyle and supplement strategies, clinicians can create highly individualized care plans that meaningfully reduce symptom burden and improve daily functioning.^‡

Resources

For more comprehensive recommendations on supporting functional bowel concerns, refer to:

• Functional Bowel GI Health Protocol^‡
• Barrier Builders: Nutrients to Support Mucosal Immune Responses and the Intestinal Barrier
• Unraveling the Complexity of Functional GI Concerns: Understanding Types, Causes and Solutions
• Is It a Leaky Gut? Defining What Lurks Beneath a Patient’s Symptoms
• Nutrient Solutions to Complement the 5R Protocol: A Comprehensive Approach to Maintaining Gut Health

Drug-Nutrient Interactions Checker: Provides valuable information on potential interactions between your patients' prescriptions, over-the-counter medications and nutritional supplements.

You can also explore Pure Encapsulations^® to find On-Demand Learning, Clinical Protocols and other resources developed with our medical and scientific advisors.

1. Bharucha AE, et al. Mayo Clin Proc. 2016 Aug;91(8):1118 1132
2. American Gastroenterological Association. Accessed February 9, 2026
3. Chen M, Ruan G, Chen L et al. Front Endocrinol (Lausanne). 2022;13:817100. doi:10.3389/fendo.2022.817100.
4. Lacy BE, Pimentel M, Brenner DM et al. Am J Gastroenterol. 2021;116(1):17 44. doi:10.14309/ajg.0000000000001036.
5. Schiller LR. Cleve Clin J Med. 2020;87(8):501 507. doi:10.3949/ccjm.87a.19102.
6. Su Q, Tun HM, Liu Q, et al. Gut Microbes. 2023;15(1):2157697. doi:10.1080/19490976.2022.2157697
7. Jeffery IB, Das A, O'Herlihy E, et al. Gastroenterology. 2020;158(4):1016-1028.e8. doi:10.1053/j.gastro.2019.11.301
8. Pozuelo, M., Panda, S., Santiago, A. et al. Sci Rep 5, 12693 (2015). https://doi.org/10.1038/srep12693
9. Robles A, Perez Ingles D, Myneedu K, et alNeurogastroenterol Motil. 2019;31(12):e13718. doi:10.1111/nmo.13718
10. Radziszewski M, Smarkusz Zarzecka J, Ostrowska L. Nutrition, 2023;15(16):3662. Available from: https://www.mdpi.com/2072-6643/15/16/3662
11. Varjú P, Farkas N, Hegyi P, et al. PLoS One. 2017;12(8):e0182942. Published 2017 Aug 14. doi:10.1371/journal.pone.0182942
12. Ohlsson B. Ther Adv Gastroenterol. 2022;15. doi:10.1177/17562848221114558
13. Grover M, Kolla B, Pamarthy R, Mansukhani M. et al. PLoS One. 2021;16. doi:10.1371/journal.pone.0245323.
14. Guandalini et al. J Pediatr Gastroenterol Nutr, 2000:30(1), 54-60.

⁺Amy Doyle, MS, CNS is an employee of Pure Encapsulations.

By Kim Ross, DCN, CNS, LDN, IFMCP⁺

How to Evaluate Suspected Histamine Intolerance

1. Introduction
2. What is Histamine?
3. What is Histamine Intolerance?
4. Six Evaluation Techniques
5. Pure Encapsulations® Nutrient Solutions
6. Conclusion
7. Resources

Introduction

Self-reported food intolerances, including histamine intolerance, affect between 15-20% of individuals.¹ A challenge clinicians face is that patients can experience a wide range of symptoms, often mimicking food allergies or other health concerns, compounded by the lack of a validated diagnostic test for a histamine intolerance.¹ Current guidelines therefore emphasize a careful history, exclusion of other causes and a structured dietary “test and retest” approach.^1,2

This blog will describe histamine and histamine intolerance and focus on six evaluation techniques to employ when you suspect a patient has a histamine intolerance.

What is Histamine?

Histamine is a bioactive amine that is synthesized from the amino acid histidine. It is primarily synthesized and stored in basophils and mast cells, as well as within cells of the gastrointestinal tract, lymph nodes and thymus.

The two main pathways by which it is metabolized involve the enzymes diamine oxidase (DAO) and histamine-N-methyltransferase (HNMT). Intestinal DAO is a class of enzymes that helps eliminate histamine from the body, specifically histamine ingested from food.

Histamine is involved in many functions of the body, including multiple immune mechanisms, cytokine production and neurotransmission.³

What is Histamine Intolerance?

Histamine intolerance (HIT) is a practical label clinicians use to describe the accumulation of histamine at a rate that exceeds the body’s ability to eliminate it.4 As a result, patients with a histamine intolerance may report a repeatable group of symptoms after eating histamine-rich foods, such as wine, cheese, spinach, fermented foods, some fish and meat.⁴

Because histamine receptors are widely distributed, symptoms can span multiple systems and may include, but are not limited to^1–3:

• Abdominal discomfort
• Occasional constipation or diarrhea
• Bloating
• Dizziness
• Headaches
• Nasal congestion and sneezing
• Flushing
• Itchy skin
• Skin rashes

Six Evaluation Techniques

1. Track the Symptom Pattern and Timing

Pattern recognition is an important evaluation technique. The first step is to encourage patients to track symptoms in relation to meals and timing. If symptoms occur within 20-30 minutes and resolve within a few hours, a histamine-related mechanism becomes more plausible.³

Ask your patients to track:

• Their symptoms, rating scale and frequency as accurately as possible
• The time from first bite to the onset of the symptoms, as well as the time to resolution
• Co-factors that may worsen symptoms, such as alcohol, exercise, heat, poor sleep and stress. Alcohol can interfere with histamine degradation.²

2. Identify Exposure Sources and Amplifiers

Histamine content of food varies greatly with maturity, storage time and processing. Some patients tolerate foods when fresh but react when aged or eaten as leftovers, suggesting it could be more about the way the food is aged or prepared rather than the food itself.⁵ Histamine content increases as food ripens and in leftovers.

Cooking methods also can alter histamine levels. For example, grilled seafood has higher histamine levels over raw or boiled seafood, while boiling helps decrease histamine levels.⁶

Therefore, as your patients track foods and symptoms, it is beneficial to also have them notate how the food was cooked, prepared and stored.

3. Review Medications and Decide When to Refer to a Specialist

Review a patient’s medications, both prescribed and over the counter, as some inhibit the function of the DAO enzyme.^2,4 This may also rule out high-histamine foods as the potential culprit.

Refer to a specialist if there is a history of anaphylaxis, airway symptoms, decrease in blood pressure or other rapidly progressive symptoms. For chronic conditions, refer to a specialist when there are unexplained changes in symptoms such as weight loss or persistent fevers. These symptoms may be indicative of a more serious issue.

4. Work the Differential on Purpose

Guidelines recommend ruling out alternative explanations before labeling symptoms as histamine related.² If it is within your scope of practice, it can be helpful to rule out food or environmental allergies, malabsorption concerns or other reasons mast cell activation may be present. If diagnostics are not within your scope of practice, refer accordingly.

5. Use Testing Strategically and Set Expectations

Patients may expect a definitive “histamine test.” Despite the availability of some testing options, these can produce false negatives and generally have low sensitivity and specificity.⁵ The 2021 guideline states there is no reliable procedure or test to confirm adverse reactions to ingested histamine, and determination must be made based on symptoms after other causes are excluded.² Testing for genetic polymorphisms that encode the DAO enzyme has the potential to uncover the genetic etiology of histamine intolerance.³

6. The Most Practical Evaluation Tool: A Structured Diet Trial and Re-challenge

Because biomarkers are limited, a time-limited histamine-reduced trial followed by systematic reintroduction is the most actionable evaluation tool.^2,4,7 Rather than promoting generalized or highly restrictive food lists, it is recommended to personalize food restrictions and emphasize nutrient optimization. Inform your patients that the goal is to identify patterns that influence symptoms and minimize unnecessary restriction.

• Baseline 7 days: During this time, have the patient follow their usual diet while keeping a diary as detailed in steps 1-2 above (food, timing, symptoms, stress, sleep, alcohol).
• Histamine-reduced/avoidance trial: For up to 4 weeks, emphasize fresh foods and minimize the foods, sources or amplifiers the patient identified in steps 1-2. Keep the diet broad for nutrient adequacy.
• Re-challenge: Reintroduce smaller and larger portions of one histamine-rich food category at a time over the next 1-6 weeks, notating any adverse reactions and frequency of symptoms if they return.

If symptoms improve and recur with re-challenge, shift from restriction to tolerance building and address amplifiers (food storage habits, alcohol, sleep, stress). If there is no meaningful change, revisit the differential rather than tightening the diet indefinitely.

Pure Encapsulations Nutrient Solutions

DAO Enzyme: An estimated 1-3% of the population cannot digest dietary histamine efficiently, often because of low intestinal diamine oxidase (DAO), an enzyme in the gastrointestinal (GI) tract that normally breaks down histamine.³ Supplementation with DAO enhances DAO activity in the GI tract, promoting breakdown of dietary histamine and reducing gastrointestinal discomfort (e.g., occasional diarrhea, bloating and gas) associated with sensitivity to histamine-rich foods.⁸ DAO may also reduce skin symptoms associated with high intestinal histamine levels.^9‡

Suggested Dose: As a dietary supplement, take 1 capsule, 2-3 times daily with meals or as directed by a healthcare professional.

Hist Reset: This formula promotes healthy mast cell stabilization and supports healthy histamine metabolism. Quercetin, luteolin and rutin are flavonoids known to exhibit antioxidant and immune modulating activity.^10–12 Bromelain supports healthy T-cell function and cytokine production.¹³ Riboflavin, niacinamide and molybdenum are included as cofactors for aldehyde dehydrogenase, a key enzyme in the breakdown of histamine. Preliminary research suggests that supplementation with vitamin C modulates bronchial responsiveness to histamine in sensitive subjects.14 Optimal vitamin C serum levels have been associated with lower blood histamine levels.¹⁵ NAC promotes immune and lung defense through mucolytic and antioxidant actions. It acts as a free radical scavenger by supporting glutathione production.^16‡

Suggested Use: As a dietary supplement, take 2 capsules daily, between meals or as directed by a healthcare professional.

Seeking medical advice from a professional may be appropriate for managing more serious symptoms and/or cases. Dietary supplements are not intended to replace the use of medications or alternative treatment.

Conclusion

Suspected histamine intolerance is best approached as a clinical pattern recognition problem. Because symptoms can overlap with food allergy, malabsorption concerns and other drivers of mast cell activation, your most valuable tools for assessment include a detailed history, intentional differential thinking and a structured “test and retest” plan that links symptoms to specific exposures and co-factors. When you guide patients to track timing, preparation methods, storage habits, alcohol intake, stress and sleep, you often uncover that the issue is not simply the food itself, but rather the combination of histamine load and the rate of histamine clearance that varies day to day.

With this structured approach, supportive tools such as meal-timed DAO and targeted antioxidant and flavonoid blends can be positioned as adjuncts within an individualized plan, while keeping the focus on sustainable dietary patterns, realistic next steps and appropriate referral when red flags are present.

Resources

For additional information, including diet and lifestyle recommendations for supporting histamine intolerance, refer to the resources listed below:

Histamine Intolerance Protocol^‡: Designed by our scientific and medical advisors to help you deliver the most effective care and support histamine intolerance.

To learn more about the research behind selected nutrient solutions, download the following:

• DAO Enzyme
• Hist Reset

Drug-Nutrient Interactions Checker: Provides valuable information on potential interactions between your patients' prescriptions, over-the-counter medications and nutritional supplements.

You can also explore Pure Encapsulations^® to find On-Demand Learning, Clinical Protocols and other resources developed with our medical and scientific advisors.

1. Jackson K, Busse W, Gálvez-Martín P, Terradillos A, Martínez-Puig D. Int J Mol Sci. 2025;26(18). doi:10.3390/ijms26189198
2. Reese I, Ballmer-Weber B, Beyer K, et al. Allergologie. 2021;44(10). doi:10.5414/ALX02269
3. Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MDC. Biomolecules. 2020;10(8). doi:10.3390/biom10081181
4. Jochum C. Nutrients. 2024;16(8). doi:10.3390/nu16081219
5. Eade G. J Evol Health. 2018;2(1). doi:10.15310/2334-3591.1054
6. Chung BY, Park SY, Byun YS, et al. Ann Dermatol. 2017;29(6). doi:10.5021/ad.2017.29.6.706
7. Rentzos G, Weisheit A, Ekerljung L, van Odijk J. Eur J Clin Nutr. 2024;78(8). doi:10.1038/s41430-024-01448-2
8. Schnedl WJ, Schenk M, Lackner S, Enko D, Mangge H, Forster F. Food Sci Biotechnol. 2019;28(6). doi:10.1007/s10068-019-00627-3
9. Yacoub MR, Ramirez GA, Berti A, et al. Int Arch Allergy Immunol. 2018;176(3-4). doi:10.1159/000488142
10. Kimata M, Shichijo M, Miura T, Serizawa I, Inagaki N, Nagai H.Clinical and Experimental Allergy. 2000;30(4). doi:10.1046/j.1365-2222.2000.00768.x
11. Weng Z, Zhang B, Asadi S, et al. PLoS One. 2012;7(3). doi:10.1371/journal.pone.0033805
12. Theoharides TC, Stewart JM, Hatziagelaki E. Front Neurosci. 2015;9(JUN). doi:10.3389/fnins.2015.00225
13. Rathnavelu V, Alitheen NB, Sohila S, Kanagesan S, Ramesh R. Biomed Rep. 2016;5(3). doi:10.3892/br.2016.720
14. Bucca C, Rolla G, Oliva A, Farina JC. Ann Allergy. 1990;65(4).
15. Johnston CS, Solomon RE, Corte C. J Am Coll Nutr. 1996;15(6). doi:10.1080/07315724.1996.10718634
16. Raghu G, Berk M, Campochiaro PA, et al. Curr Neuropharmacol. 2020;19(8). doi:10.2174/1570159x19666201230144109

⁺Dr. Ross is a paid consultant for Pure Encapsulations.

By Kim Ross, DCN, CNS, LDN, IFMCP⁺

Evidence-Based Strategies for Clinicians: Addressing the Four Key Factors of Sleep Disturbances

1. The Importance of Sleep for patients
2. The Four Underlying Factors of Sleep Disturbances
3. Sleep Interventions
4. Pure Encapsulations Nutrient Solutions
5. Conclusion
6. Resources

The Importance of Sleep

Sleep is not a passive state. It is an active period of metabolic regulation, memory consolidation, immune signaling and cellular repair. Insufficient sleep has been associated with impaired glucose tolerance, reduced insulin sensitivity, altered cytokine signaling, decreased cognitive performance and increased vulnerability to mood changes.^1–3

Humans should spend an average of one-third of their lives asleep; however, 50-70 million Americans suffer from chronic sleep disturbances.⁴ According to the Centers for Disease Control, approximately 35% of adults in the U.S. report sleeping fewer than seven hours per night. Of concern, about 40-50% of your patients are likely to report significant sleep disturbances.⁵

Improving sleep enhances resilience to stress, improves emotional regulation and supports mood stability and should be considered a nonnegotiable intervention for your patients.⁶ This blog will focus on the four underlying causes of sleep disturbances and provide practical tips to help your patients achieve restorative sleep.

The Four Underlying Factors of Sleep Disturbances

Circadian Rhythm Dysregulation

Circadian rhythms are daily cycles that regulate everything from body temperature to hormone levels. They’re primarily controlled by the suprachiasmatic nucleus (SCN) in the hypothalamus. The SCN is a tiny region of nerve cells that uses light information from the retina to synchronize our internal clocks with the outside world. Among its functions, the SCN modulates body temperature, cortisol rhythm, melatonin secretion and sleep timing.⁷ The SCN has two main clocks: a central one that controls sleep and wake cycles, and an external one that is synchronized with the environment. These two clocks work together to help us fall and stay asleep at night and wake up in the morning.

Glycemic Control

Maintaining stable blood glucose and supporting healthy insulin sensitivity are important for promoting uninterrupted, restorative sleep. Fluctuations in glucose, particularly in the evening, can trigger nocturnal dips and trigger a cortisol response that increases nighttime waking and reduces sleep efficiency.

Stress

Stress is an adaptive physiological response intended to maintain homeostasis by activating the hypothalamic-pituitary-adrenal (HPA) axis and releasing cortisol.

Psychological stress and pre-sleep cognitive arousal are among the most common contributors to fragmented sleep and delayed sleep onset. Healthcare providers often focus on supplements or sleep hygiene first, but addressing stress physiology and mental load may produce the most meaningful improvements for some patients.

• Rumination
• Worry about next-day tasks
• “Mental clutter”
• Difficulty disengaging from work, caregiving or digital stimuli

Together, these factors create a state known as pre-sleep cognitive arousal, which interferes with sleep onset and/or sleep efficiency.

Poor Sleep Hygiene Practices

Sleep hygiene is often misunderstood as basic advice. In reality, it is a targeted set of environmental and behavioral strategies that strengthen the circadian signal, reduce nighttime arousal and improve sleep efficiency.

Four Underlying Factors of Sleep Disturbances^8–15

Other Root Causes of Sleep Disruptions

Sleep Interventions

To determine the best intervention, begin with a clinical assessment of sleep that considers both sleep onset (how long it takes to fall asleep) and sleep efficiency (the proportion of time in bed that is spent asleep). Additionally, take the time to uncover the root cause(s) of your patients’ sleep disturbances.

Realigning Circadian Rhythm

Light exposure remains the primary synchronizer of the circadian rhythm. Research reinforces that both timing and spectral quality of light matter.^16,17

• Adequate daytime (especially morning) light exposure supports more robust circadian entrainment, reduced sleep latency and improved subjective sleep quality.
• Evening or pre-bed exposure to bright or blue-enriched light is associated with delayed sleep onset, reduced sleep quality and poorer next-day alertness.

For individuals with shift work or irregular schedules, strategic light management (bright light during wake periods; dim or filtered light before sleep) can partially re-align the circadian system and mitigate some of the metabolic and sleep-related risks associated with misalignment.¹⁸

Restoring Glycemic Control and Enhancing Dietary Intake

Dietary patterns play a meaningful role in sleep quality, circadian stability and next-day energy regulation. Address one or more of the following dietary factors with your patients, as needed.

Managing Stress

Clinicians sometimes feel uncertain about initiating stress management counseling. It is important to acknowledge and normalize the stressors patients experience. Rather than focusing on excluding or reducing stress, consider strategies to help your patients manage the stress they have.

There are many stress management techniques to consider, so work with your patient to determine which strategies are easiest for them to implement.

Stress Management Strategies to Support Sleep^25–27

Improving Sleep Hygiene Practices

Most sleep hygiene practices, properly applied, are a high-yield, low-risk intervention set.

Pure Encapsulations Nutrient Solutions

Circadian Rhythm and Sleep Support

Melatonin supports the body’s natural sleep cycle^‡ and helps facilitate the onset of sleep, as well as promotes sleep efficiency^‡.²⁹ Available options include Melatonin 0.5 mg, Melatonin-SR, Melatonin 3 mg and Melatonin liquid 30 ml

Suggested Dose: Melatonin 0.5 mg, Melatonin-SR and Melatonin 3 mg: 1 capsule, 30-60 minutes before bedtime; Melatonin Liquid: 1 ml (full dropper), 30-60 minutes before bedtime

Melatonin Dosing: Clinical use of supplemental melatonin ranges widely depending on the intended use. For sleep, doses of 0.3-3 mg are the most studied, with a consensus to start low and increase the nightly dose as needed.²⁹

Pure Sleep is for patients requesting a melatonin-free product to promote sleep quality^‡. Pure Sleep combines Suntheanine^® along with three clinically studied botanical extracts, KSM-66^® ashwagandha, valerian root and Affron^® saffron, to help patients fall asleep, stay asleep and experience the restorative, restful sleep they need without morning grogginess.

Suggested Use: 2 capsules, 30-60 minutes before bedtime

Best Rest Formula contains valerian, passionflower, chamomile, lemon balm and hops, which act to calm and relax the central nervous system; melatonin to facilitate the onset of sleep and promote sleep efficiency; and GABA and l-theanine to promote alpha wave production in the brain, an indication of relaxation.^29–32

Suggested Use: 2 capsules, 30-60 minutes before bedtime

Glucose Regulation Support

Metabolic Xtra provides a combination of nutrients to support healthy glucose metabolism and insulin receptor function and signaling^‡. It contains 350 mg berberine HCl per capsule, which has been shown to provide statistically significant support for healthy glucose and lipid metabolism.³³

Suggested Use: 1 capsule, 1-3 times daily, with meals

Occasional Stress Support

Daily Stress Formula is a blend of botanicals, herbs and other nutrients that supports the body’s resilience when faced with occasional stress.^‡ Chamomile and lemon balm promote calmness and relaxation^‡, rhodiola supports physical and mental stress^‡, and Eleutherococcus senticosus is an adaptogen that helps bolster adrenal function and stress resilience^‡.

Suggested Use: 3 capsules daily, with or between meals

Cortisol Calm promotes relaxation and healthy cortisol response^‡, may support healthy sleep, positive mood and cognitive function^‡ and provides support for occasional stress, calm and emotional well-being^‡. This formula contains vitamin D and a blend of herbal extracts, including Sensoril ashwagandha, rhodiola, magnolia and l-theanine.^‡.

Suggested Use: 1 capsule in the morning and 1 capsule in the evening, with meals

Conclusion

Sleep disturbances are common and often driven by four core factors: circadian rhythm disruption, glycemic changes, occasional stress and mental overload, and poor sleep hygiene. By addressing these root contributors through light exposure, nutrition, stress management and targeted lifestyle changes, clinicians can help patients achieve more restorative, resilient sleep.

Resources

For additional information, including diet and lifestyle recommendations for supporting optimal sleep, refer to the resources listed below:

Protocols:

• Sleep Protocol^‡: Designed by our scientific and medical advisors to help you deliver the most effective care and support for sleep.
• Emotional Wellbeing Protocol^‡: Designed by our scientific and medical advisors to help you deliver the most effective care and support for emotional wellbeing.

Webinar:

• “Optimizing Restful Sleep: Strategies and Tips for Supporting Overall Sleep Quality^‡,” presented by Peter Bongiorno, ND

Blogs:

• Reducing Mental Load: Practical Tips to Help Patients Declutter Their Minds
• Cortisol: How It Shapes Occasional Anxiety

To learn more about the research on selected nutrient solutions, download the following: 

Drug-Nutrient Interactions Checker: Provides valuable information on potential interactions between your patients' prescriptions, over-the-counter medications and nutritional supplements.

PureInsight^™: Our streamlined platform easily collects patient data and provides valuable recommendations to help achieve their health goals.

Virtual Dispensary: Our Pure Patient Direct program provides account holders FREE access to our virtual dispensary to help simplify patient sales and reduce in-office inventory.

You can also explore Pure Encapsulations^® to find On-Demand Learning, Clinical Protocols and other resources developed with our medical and scientific advisors.

1. Pinheiro MC, Costa HE, Mariana M, Cairrao E. Endocrines. 2025;6(4):49. doi:10.3390/endocrines6040049
2. Banks S, Dinges DF. . Journal of Clinical Sleep Medicine. 2007;3(5). doi:10.5664/jcsm.26918
3. Garbarino S, Lanteri P, Bragazzi NL, Magnavita N, Scoditti E. . Commun Biol. 2021;4(1). doi:10.1038/s42003-021-02825-4
4. Patel AK, Reddy V, Araujo JF. StatPearls [Internet]. 2020;3(Stage 3).
5. Benca RM, Bertisch SM, Ahuja A, Mandelbaum R, Krystal AD. . J Clin Med. 2023;12(7):2498. doi:10.3390/jcm12072498
6. Lo Martire V, Berteotti C, Zoccoli G, Bastianini S. . Curr Sleep Med Rep. 2024;10(1). doi:10.1007/s40675-024-00274-z
7. Kvetnoy I, Ivanov D, Mironova E, et al.. Int J Mol Sci. 2022;23(3):1835. doi:10.3390/ijms23031835
8. Steele TA, St Louis EK, Videnovic A, Auger RR. Neurotherapeutics. 2021;18(1). doi:10.1007/s13311-021-01031-8
9. Reid KJ, Abbott SM Sleep Med Clin. 2015;10(4):523-535. doi:10.1016/j.jsmc.2015.08.006
10. Depner CM, Melanson EL, Eckel RH, et al. Current Biology. 2019;29(6):957-967.e4. doi:10.1016/j.cub.2019.01.069
11. Yang Y, Zhao L hua, Li D dan, et al. Diabetol Metab Syndr. 2021;13(1):102. doi:10.1186/s13098-021-00720-w
12. Ring M. . Am J Med. 2025;138(10):1451-1463. doi:10.1016/j.amjmed.2025.05.044
13. Guidi J, Lucente M, Sonino N, Fava GA. . Psychother Psychosom. 2021;90(1). doi:10.1159/000510696
14. Knezevic E, Nenic K, Milanovic V, Knezevic NN. Cells. 2023;12(23). doi:10.3390/cells12232726
15. McEwen BS, Akil H. Journal of Neuroscience. 2020;40(1). doi:10.1523/JNEUROSCI.0733-19.2019
16. Didikoglu A, Mohammadian N, Johnson S, et al. . Proc Natl Acad Sci U S A. 2023;120(42). doi:10.1073/pnas.2301608120
17. Siraji MA, Spitschan M, Kalavally V, Haque S. Sci Rep. 2023;13(1). doi:10.1038/s41598-023-39636-y
18. Zhao C, Li N, Miao W, He Y, Lin Y. . Sci Rep. 2025;15(1). doi:10.1038/s41598-024-83789-3
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⁺Dr. Ross is a paid consultant for Pure Encapsulations.