Amy Doyle, MS, CNS⁺

Reducing Exposure to Endocrine-Disrupting Chemicals: Counseling Strategies for Clinicians

1. Key Points
2. Patient Concerns with Endocrine-Disrupting Chemicals
3. Start with Exposure Reduction
4. Major Sources of Endocrine-Disrupting Chemicals
5. Key Recommendations to Reduce Exposure
6. Optimizing the Body’s Detoxification Pathways
7. Clinical Takeaway
8. Pure Encapsulations® Nutrient Solutions^‡
9. Patient Handout
10. Resources

Key Points

1. Prevention by reducing ongoing exposure remains the cornerstone of managing EDC-related health risks.^1,2
2. Encouraging a focus on sustainable, high-impact changes can feel more manageable for patients and help build confidence and momentum.
3. Optimizing the body’s innate biotransformation and detoxification pathways can effectively support the elimination of toxic chemicals.

Patient Concerns with Endocrine Disrupting Chemicals

As awareness of endocrine-disrupting chemicals (EDCs) continues to grow, many patients are asking clinicians how they can reduce their exposure and "detox" their bodies. While there is no clinical evidence to support detox cleanses or expensive detoxification protocols, there is strong scientific support for counseling patients on exposure reduction and lifestyle strategies that optimize the body's innate detoxification pathways.^1,2 Practitioners can address patient concerns by providing practical, achievable recommendations that empower patients without creating unnecessary fear.

Start with Exposure Reduction

Prevention by reducing ongoing exposure remains the cornerstone of managing EDC-related health risks.^1,2 Patients may express overwhelm with feeling they need to eliminate every potential exposure overnight. Encouraging them to focus on sustainable, high-impact changes can make feel more manageable for patients and help build confidence and momentum.

Many patients are surprised to learn that endocrine-disrupting chemicals are found in everyday products they use multiple times each day.

Major Sources of Endocrine-Disrupting Chemicals

Optimizing the Body’s Detoxification Pathways

Patients often assume detoxification requires commercial detox, juicing or “cleansing” programs. Instead, explain that the liver, kidneys, gastrointestinal tract, lungs, skin and lymphatic system continuously metabolize and eliminate environmental chemicals. Nutritional recommendations, supportive nutrients and healthy lifestyle habits can help these systems function efficiently.

Dietary fiber remains one of the most evidence-based nutritional recommendations.9 Fiber supports regular bowel elimination and nourishes the gut microbiome, which plays an increasingly recognized role in xenobiotic metabolism and enterohepatic circulation.^9,10,11

Encourage patients to consume 25–38 grams of fiber daily from vegetables, legumes, fruits, nuts, seeds and whole grains whenever tolerated.

Phytochemicals from colorful fruits and vegetables may play a key role in supporting physiologic detoxification of endocrine-disrupting chemicals by modulating cellular defense and detoxification pathways.12 Nrf2-activating compounds, particularly glucosinolate-derived isothiocyanates from cruciferous vegetables, can increase the expression of detoxification and antioxidant enzymes involved in the biotransformation of environmental contaminants.¹²

Rather than focus on individual “superfoods”, encourage patients to consume a diverse, plant-rich diet that includes the regular consumption of cruciferous vegetables including broccoli, Brussels sprouts, cabbage, kale, cauliflower and arugula.

Lifestyle factors play a critical role in supporting the body's natural detoxification and elimination processes. Regular physical activity, restorative sleep, stress management, hydration and healthy bowel function help support the physiological systems responsible for transporting and eliminating metabolic waste and environmental compounds.^13,14,15,16

Encourage patients to:

• Engage in regular physical activity to support metabolic health and circulation.
• Prioritize seven to nine hours of restorative sleep.
• Maintain adequate hydration to support normal renal function.
• Maintain regular bowel habits, particularly in patients with constipation, to support elimination of metabolized compounds.

These lifestyle strategies provide broad health benefits while also supporting physiologic detoxification.

Pure Encapsulations^® Options for Targeted Nutritional Support^‡

Ultra Detox 10-Day Pure Pack is a comprehensive daily packet designed to promote liver and G.I. health and function, normal detoxification processes for common, mild environmental heavy metal exposure. Provides core nutrients, broccoli, taurine, NAC, DIM, modified citrus pectin and chlorella.^‡

Suggested Dose: 1 packet daily with a meal.

Patient Handout

Ready to help patients take the next step? Download our complimentary patient handout, Your Guide To Reducing Everyday Toxin Exposure, to provide patients with practical, evidence-informed recommendations for reducing toxicant exposure at home, at work, and in daily life. An informed patient is an empowered patient, and small changes can make a meaningful difference over time.

Resources

For additional information that includes diet and lifestyle recommendations for supporting women’s health, refer to the resources listed below:

Environmental Detoxification Support Protocol^‡: Designed by our scientific and medical advisors to help you deliver the most effective care to support environmental detoxification.

Stress Management & Relaxation Protocol^‡

Sleep Protocol^‡

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

• UltraDetox 10-Day Pure Pack

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.

References

1. Trasande L, Sargis RM. Journal of Internal Medicine. 2024;295(2):259-274.
2. Vandenberg LN. Expert Review of Endocrinology & Metabolism. 2021;16(3):135-146.
3. National Institute of Environmental Health Sciences (NIEHS). Updated March 2026.
4. de Paula LCP, J Pediatr (Rio J). 2024;100 Suppl 1(Suppl 1):S40-S47. doi:10.1016/j.jped.2023.
5. Brunn H, Arnold G, Körner W, et al. Environmental Sciences Europe. 2023;35:20.
6. Nowak K, Ratajczak-Wrona W, Górska M, et al. Mol Cell Endocrinol. 2018 Oct 15;474:238-251.
7. Zhu L, Hajeb P, Fauser P, et al. Science of the Total Environment. 2023; 874:162374.
8. Hilz EN, Gore AC. New Solutions. 2023;33(2).
9. Kieffer DA, Martin RJ, Adams SH. Adv Nutr. 2016;7(6):1111-1121.
10. Barber TM, et al. Nutrients. 2020;12(10):3209.
11. Hu W, et al. Food Front. 2022; 3:142-9
12. Li X, Zang N, Zhang N, Pang L, et al. Chemosphere. 2023 Oct; 338:139522.
13. Genuis SJ. Hum Exp Toxicol. 2011;30(1):3-18.
14. Nowak N, Gaisl T, Miladinovic D, et al. Cell Rep. 2021 Oct 26;37(4):109903.
15. Zhao M, Abbasi AA, Li P, et al. Metab Brain Dis. 2026 Apr 24;41(1):90.
16. Asokan, N., & Ullagaddi, R Shodh Sari-An International Multidisciplinary Journal. 2025. 4(4), 3–15.

⁺Amy Doyle is an employee of Pure Encapsulations^®.

Kim Ross, DCN, CNS, LDN, FMCP⁺

Ashwagandha and Women's Libido: Supporting Sexual Wellness Beyond Desire

1. Key Points
2. Women’s Libido: A Common and Layered Concern
3. Ashwagandha as an Adaptogenic Botanical
4. KSM-66 Ashwagandha®: Clinical Evidence in Women
5. Sleep, Stress and Emotional Well-Being
6. Clinical Takeaway
7. Pure Encapsulations® Nutrient Solutions^‡
8. Resources

Key Points

1. Women’s libido concerns are common in clinical practice and may reflect changes in desire, arousal, lubrication, orgasm, satisfaction, energy, sleep quality, stress load, emotional connection or comfort with sexual activity.
2. KSM-66 Ashwagandha^®, a standardized ashwagandha root extract, has been evaluated in randomized, placebo-controlled studies using 300 mg twice daily for 8 weeks, with reported support for several patient-reported sexual wellness domains.
3. Ashwagandha may also support sleep quality and stress resilience, which are clinically relevant when libido concerns occur alongside poor recovery, high stress load, or emotional depletion.^‡

Women’s Libido: A Common and Layered Concern

Overall female sexual function concerns were reported in 39% of women, with desire-related concerns reported in 29%,¹ making women’s libido concerns common enough that practitioners should feel comfortable asking about them directly. Yet, “libido” is often used as shorthand for a more layered clinical picture. Women may be describing changes in desire, arousal, lubrication, orgasm, satisfaction, energy, sleep quality, stress load, emotional connection or comfort with sexual activity.

This distinction matters. Supporting libido is not simply about targeting desire. It starts with understanding which domain has changed and what else may be contributing.

Ashwagandha as an Adaptogenic Botanical

Ashwagandha (Withania somnifera) is traditionally classified as an adaptogen, meaning it is used to support the body’s ability to adapt to physical and emotional stressors. From a clinical perspective, adaptogenic support may be understood through three broad functions: supporting normal system function, building resilience to stress and supporting performance under physical or emotional demands.² Research has explored its role as an antioxidant, healthy cytokine agent and mitochondrial regulator, while noting its role in stress resilience, sleep, cognitive, immunologic and metabolic functions, physical performance and sexual function, making it a clinically relevant botanical for women’s health and well-being.^{2,3 ‡}

KSM-66 Ashwagandha®: Clinical Evidence in Women

Although much of the historical discussion around ashwagandha and sexual function has focused on male reproductive and hormone health, its relevance for women appears to be broader than hormone support alone. Proposed mechanisms include effects on GABAergic signaling, stress-response physiology, neurotransmitter activity and antioxidant defenses. Clinically, these pathways may matter when changes in libido occur alongside fatigue, high stress load, poor recovery or difficulty with arousal and satisfaction.^{2 ‡}

For women’s libido, KSM-66 Ashwagandha^®, a standardized ashwagandha root extract, has been evaluated in randomized, placebo-controlled studies measuring patient-reported sexual wellness outcomes.^3,4

These studies are clinically useful because the outcomes reflect what patients often describe in practice. A woman may report “low libido,” but further conversation may reveal that the primary concern is arousal, lubrication, orgasm, satisfaction or a reduced sense of sexual connection.

Sleep, Stress and Emotional Well-Being

A woman’s libido does not exist in a vacuum. Sleep disruption, occasional stress, emotional depletion and poor recovery may influence a woman’s capacity for interest, arousal, pleasure and connection.

Ashwagandha may be relevant here as well. A systematic review and meta-analysis highlighted four trials that used KSM-66 Ashwagandha® and found it had significant effects on overall sleep quality and sleep onset latency, with the strongest effects reported at doses of 600 mg/day or higher, and with use for at least 8 weeks.⁵ In adults with self-reported high stress, 300 mg twice daily of ashwagandha extract was associated with improvements in moods and perceived stress and reductions in morning cortisol compared with placebo.^{6 ‡}

For practitioners, this broadens clinical conversation. Ashwagandha may offer support for sexual wellness domains while also supporting pathways that commonly intersect with libido, including sleep quality, stress resilience, emotional well-being and recovery. ^‡

Clinical Takeaway

When a patient reports low libido, start by asking what has changed: desire, arousal, lubrication, orgasm, satisfaction, energy, sleep, emotional connection or comfort with sexual activity. Ashwagandha may be a useful botanical consideration when the clinical picture includes changes in sexual wellness, especially when concerns occur alongside poor sleep, high stress load, or diminished resilience. ^‡

As always, individualize care. Review medications, hormonal stage, alcohol intake, relationship context and pelvic health concerns. Refer or collaborate when pain, medication-related concerns, trauma history, significant emotional distress, pelvic floor concerns or relationship safety concerns are present.

Pure Encapsulations^® Options for Targeted Nutritional Support^‡

FemiVive features KSM-66 Ashwagandha^®, clinically shown to enhance physical and psychological aspects of female sexual response with continued use. This formula also provides maca (Lepidium meyenii) root, also known as Peruvian ginseng, which has adaptogenic properties.^‡
Suggested Dose: 2 capsules, 1-2 times daily, between meals.

Ashwagandha with KSM-66 Ashwagandha^®, provides support for occasional stress. Contains withanolides, which are key constituents that play an important role in the herb’s physical and mental health benefits.^{7 ‡}
Suggested Dose: 1 capsule daily, with or between meals.

Resources

For additional information that includes diet and lifestyle recommendations for supporting women’s health, refer to the resources listed below:

Women’s Libido & Sexual Wellness Protocol^‡: Designed by our scientific and medical advisors to help you deliver the most effective care to support women’s libido.

Stress Management & Relaxation Protocol^‡

Sleep Protocol^‡

Emotional Well-being Protocol^‡

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

• FemiVive

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. Vechiu C, Zimmermann M, Aubuchon-Endsley N, et al. J Womens Health. Published online 2026. doi:10.1177/15409996251410095
2. Nobari H, Parnian-Khajehdizaj N, Johnson K, Ramos-Álvarez JJ.Nutr Metab (Lond). 2026;23(1). doi:10.1186/s12986-026-01093-5
3. Dongre S, Langade D, Bhattacharyya S.Biomed Res Int. 2015;2015. doi:10.1155/2015/284154
4. Ajgaonkar A, Jain M, Debnath K. Cureus. Published online 2022. doi:10.7759/cureus.30787
5. Cheah KL, Norhayati MN, Yaacob LH, Rahman RA. PLoS One. 2021;16(9 September). doi:10.1371/journal.pone.0257843
6. Chandrasekhar K, Kapoor J, Anishetty S. Indian J Psychol Med. Published online 2012. doi:10.4103/0253-7176.106022
7. Jamnekar PP, Dehankar TJ, Bedre R V., Dharan BG, Agravat B, Agravat H. Cureus. Published online 2025. doi:10.7759/cureus.96183

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

Kim Ross, DCN, CNS, LDN, FMCP⁺

The Importance of DHA During Pregnancy

1. Key Points
2. Why DHA Matters During Pregnancy
3. Assessing and Recommending DHA Intake in Clinical Practice
4. Pure Encapsulations® Nutrient Solutions^‡
5. Resources

Key Points

• DHA is an omega-3 fatty acid that is highly concentrated in the fetal brain and nervous system.
• Maternal transfer of DHA increases substantially during late pregnancy, when fetal brain and eye development are especially active.
• Many pregnant patients do not meet seafood intake recommendations, making DHA intake an important point of assessment in prenatal nutrition counseling.
• Prenatal dietary DHA intake may help support healthy birth weight and healthy pregnancy progression, in addition to its foundational role in fetal neurodevelopment.^‡

Why DHA Matters During Pregnancy

Docosahexaenoic acid (DHA) is an omega-3 long-chain polyunsaturated fatty acid and the dominant omega-3 fatty acid in the brain, as well as the most abundant omega-3 fatty acid in the nervous system. Because of its central role in neural structure and function, consuming dietary DHA is especially important during pregnancy.

DHA is involved in placental development early in pregnancy and continues to accumulate in the fetal brain throughout gestation, with the most rapid accretion occurring from approximately weeks 29 to 40, a period of accelerated brain and retinal development. DHA is also critically involved in neuronal growth and synapse formation during fetal development and early life, which helps explain why maternal DHA status before conception, during pregnancy and during lactation is clinically relevant.^{1,2 ‡}

Assessing and Recommending DHA Intake in Clinical Practice

A practical issue in clinical care is that many women enter pregnancy with suboptimal DHA status, often due to low seafood intake or a dietary fatty acid pattern that does not support adequate omega-3 status.¹ Early assessment is therefore important. A brief review of seafood intake can help determine whether a patient is likely meeting DHA needs through food alone.

Pregnant women are advised to consume 8 to 12 ounces of low-mercury seafood per week.^3–5 Salmon is a particularly rich source of DHA, providing approximately 1.2 grams per 3-ounce serving.⁵

For patients with low seafood intake, food aversions or inconsistent intake of DHA-rich foods, supplementation may be considered. Several professional groups suggest a minimum of 250 mg/day of DHA plus EPA during pregnancy, with some recommending an additional 100 to 200 mg/day of DHA and others suggesting 600 to 1,000 mg/day, ideally beginning by 20 weeks gestation.⁵

Clinical Takeaway

DHA warrants clinical consideration during pregnancy because it supports fetal brain, nervous system and eye development. It may also contribute to healthy pregnancy progression and birth outcomes. From a practice standpoint, assessing DHA intake early, encouraging regular consumption of lower-mercury seafood (8-12 ounces per week) and identifying whether additional dietary or supplemental DHA support is needed can help promote adequate intake, ideally by 20 weeks gestation.^‡

Pure Encapsulations^® Options for Targeted Nutritional Support^‡

DHA Ultimate is a supercritical CO2 extracted DHA fish oil that supports healthy neural and cognitive function.^‡ Epidemiological studies indicate that a high intake of DHA is associated with healthy cognitive function in adults as well as infants born to mothers with a diet high in DHA.^6,7
Suggested Dose: 2 softgel capsules daily, with a meal

EPA/DHA Essentials is an ultra-pure, microfiltered fish oil concentrate that supports cardiovascular health and daily wellness.^‡
Suggested Dose: 1-2 softgel capsules daily, with a meal

Resources

For additional information to help you deliver the most effective care for women’s health from preconception to postpartum, refer to the resources below:

Women’s Fertility Support Protocol

Pregnancy Support Protocol

Postpartum Care Protocol

Supporting Female Fertility with Nutrition: Blog

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

• DHA Ultimate

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. Basak S, Mallick R, Duttaroy AK. Nutrients . 2020;12(12). doi:10.3390/nu12123615
2. Ghazal RM, Naffaa MM. Exploration of Neuroprotective Therapy. 2025;2025(5). doi:10.37349/ent.2025.1004107
3. Bramante CT, Spiller P, Landa M. JAMA Pediatr. 2018;172(9):801-802. doi:10.1001/jamapediatrics.2018.1619
4. Hibbeln CJR, Spiller P, Brenna JT, et al. Prostaglandins Leukot Essent Fatty Acids. 2019;151. doi:10.1016/j.plefa.2019.10.002
5. NIH. Omega-3 Fatty Acids - Health Professional Fact Sheet. Office of Dietary Supplements. 2019.
6. Jackson PA, Reay JL, Scholey AB, Kennedy DO. Br J Nutr. 2012;107(8). doi:10.1017/S0007114511004041
7. Tahaei H, Gignac F, Pinar A, et al. Nutrients. 2022;14(3). doi:10.3390/nu14030518

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

Kim Ross, DCN, CNS, LDN, FMCP⁺

The Role of Dietary Fiber in Weight Management

1. Mechanisms Tying Dietary Fiber to Weight Management
2. Fiber Characteristics That Influence Weight Management Outcomes
3. Clinical Application
4. Pure Encapsulations® Options for Targeted Nutritional Support^‡
5. Resources

Key Points

1. Dietary fiber may support weight management through several mechanisms. These include greater satiation and satiety, slower gastric emptying, healthy glycemic responses, and colonic fermentation that may influence appetite-related signaling.
2. Not all fibers behave the same way. Viscosity, fermentability dose, and food matrix all matter clinically. This helps explain variable patient responses.
3. A practical target for many adults is to consume 25 to 30 grams of fiber per day, or about 14 grams per 1,000 kcal. Increase intake gradually to improve gastrointestinal tolerance.
4. Literature now extends the conversation beyond "bulk and regularity". It now focuses on microbiota-mediated, metabolic and gut-brain mechanisms relevant to long-term weight management.

Mechanisms Tying Dietary Fiber to Weight Management

Fiber is a practical nutritional tool in weight management because it can improve the patient's experience with food. Meals built around fiber-rich foods are often more filling. They can help soften hunger intensity between meals and may also promote a healthy postprandial glucose response.¹

Dietary fiber influences weight management through several organs and physiological mechanisms.^1–3

1. In the upper gastrointestinal tract, fiber can increase chewing time and meal volume. Depending on the type, fiber can also slow gastric emptying. These effects may support satiation during meals and satiety between meals, helping patients feel full sooner and remain satisfied longer.^‡
2. In the small intestine, dietary fiber can slow nutrient absorption which may contribute to a more gradual postprandial glycemic response. This may support healthy blood glucose and insulin. It also supports more stable energy and appetite regulation.^‡
3. In the colon, gut microbiota metabolizes fermentable fibers into short-chain fatty acids. These may participate in gut-brain and enteroendocrine signaling. This includes pathways involving hormones that modulate hunger and satiety, such as glucagon-like peptide-1 (GLP-1), peptide YY, cholecystokinin (CCK) and ghrelin.

These mechanisms suggest that fiber may support weight management not through a single effect, but through coordinated actions on digestion, healthy glycemic response, appetite signaling and energy intake.^‡

Dietary Fiber Characteristics That Influence Weight Management Outcomes

A key clinical takeaway is that fiber should not be viewed as a single intervention. Fibers differ in viscosity, fermentability, solubility, particle structure and food matrix. These characteristics influence their physiological effects.^2,4

Soluble fibers, such as psyllium, beta-glucans, pectins and inulin, dissolve in water. This may affect gel formation, glycemic response and microbial fermentation. Insoluble fibers, such as flaxseed, wheat bran, cellulose and some hemicelluloses, often relate more to stool bulk and intestinal transit. Unfortunately, these categories do not fully predict physiological response.^1,4

More viscous dietary fibers, such as psyllium, glucomannan and beta-glucans from oats and barley, are generally more relevant for gastric emptying, fullness and a healthy postprandial glycemic response. More fermentable fibers, such as inulin, fructooligosaccharides, resistant starch and some oligosaccharides, may exert greater effects in the colon through microbial metabolism and short-chain fatty acid production.^1,4

Whole food sources, such as legumes, berries, chia seeds, vegetables and intact whole grains, deliver additional variables. These include food form, cellular structure and accompanying nutrients, all of which can modify physiological response.

These differences help explain why one patient may notice better satiety and appetite control, while another experiences more prominent effects on stool quality, glycemic response or digestive tolerance. Research suggests that baseline gut microbiota composition may also influence responsiveness to specific fibers, supporting growing interest in more personalized nutrition approaches.^5,6

Clinical Application

Current guidelines suggest that adults benefit from consuming approximately 25 to 30 grams of fiber per day or about 14 grams per 1,000 kcal consumed. Notably, population intake remains well below recommended levels.⁴

Keep advice simple and direct for patients.

• Encourage patients to build meals around fiber-rich foods such as legumes, vegetables, fruit, nuts, seeds and intact whole grains, increasing intake gradually to improve gastrointestinal tolerance.
• Add one fiber-rich food to each meal as an initial step.
• Set expectations appropriately. Fiber may support weight management, but it is not a stand-alone solution.^‡

Fiber’s benefits are strongest when included in a diet that improves food quality, satiety and adherence. In that way, fiber helps support a healthy eating pattern for physiological and behavioral sustainability.^‡

Pure Encapsulations^® Options for Targeted Nutritional Support^‡

Arabinogalactan (AG) is a fermentable prebiotic fiber found in high concentrations in North American larch trees.
Suggested Dose: 1 capsule, three times daily, between meals

PureLean^® Satiety is designed to support relaxation and moderate appetite to promote healthy weight management^†. It offers clinically researched DNF-10^® to moderate caloric intake and promote satiety^‡
Suggested Dose: 1 capsule, 1-2 times daily, with meals.

Resources

For additional information that includes diet and lifestyle recommendations for supporting weight management, refer to the resources listed below:

Weight Management Protocol: Designed by our scientific and medical advisors to help you deliver the most effective care and support weight management.

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. Akhlaghi M. Crit Rev Food Sci Nutr. 2024;64(10). doi:10.1080/10408398.2022.2130160
2. Mocanu V, Madsen KL.Clin Transl Med. 2024;14(10). doi:10.1002/ctm2.70018
3. Deehan EC, Mocanu V, Madsen KL. Nat Rev Gastroenterol Hepatol. 2024;21(5). doi:10.1038/s41575-023-00891-z
4. McKeown NM, Fahey GC, Slavin J, van der Kamp JW. BMJ. 2022;378. doi:10.1136/bmj-2020-054370
5. Wang C, Qin S, Shi J, et al. Carbohydr Polym. 2025;368. doi:10.1016/j.carbpol.2025.124097
6. Murga-Garrido SM, Hong Q, Cross TWL, et al. Microbiome. 2021;9(1). doi:10.1186/s40168-021-01061-6

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

By Amy Doyle, MS, CNS⁺

Putting Pep in Their Step: Supporting Patients with Age-Related Muscle Decline

1. Introduction
2. How Muscle Mass and Strength Change with Age
3. The Mitochondria’s Role in Muscle Health
4. Exercise and Nutrition Interventions for Age-Related Muscle Decline
5. Nutrients to Support Age-Related Muscle Decline
6. Pure Encapsulations® Nutrient Solutions
7. Summary
8. Resources

Introduction

Skeletal muscle is the predominant tissue in the human body, comprising 40% of overall body weight.¹ We rely on our skeletal muscle for numerous physiological functions including movement, maintaining posture, generating force, metabolism and respiration.¹

As people age, so do their skeletal muscles.

How Muscle Mass and Strength Change with Age

Age-related muscle decline can begin at age 30.³ More pronounced in sedentary individuals, muscle mass can be lost at a rate of 1% per year.² Loss of muscle mass can also be accompanied by atrophy of muscle fibers and reduced muscle function and strength. This gradual decrease can progress, with an individual losing up to one-third of their muscle mass by age 80.²

Loss of muscle mass and strength in older individuals could contribute to fall risk, reduced mobility, loss of independence, and ability to perform daily functions.²

The Mitochondria’s Role in Muscle Health

Skeletal muscle is a tissue with high energy demands and mitochondria are primarily responsible for meeting this demand. Mitochondria not only power muscle contraction by supplying ATP, they also undertake other critical functions, including moderating intracellular calcium, cell proliferation, apoptotic signaling, regulation of redox states and immune response.³

Well-functioning mitochondria are essential for maintaining cellular homeostasis and muscle health. Cellular mitochondrial health is maintained by growing the mitochondrial pool through mitochondrial biogenesis, through preserving fusion and fission and by ensuring the removal of altered mitochondria through mitophagy.

Mitophagy is a selective autophagy process that serves as the mitochondria’s own quality-control mechanism and involves removing and recycling altered mitochondria.⁴ Mitophagy helps preserve only healthy mitochondria for the mitochondrial pool.

Just as skeletal muscle function can change as the human body ages, mitochondria are also subject to the effects of aging, as shown in the illustration below. These age-associated changes in mitochondria can lead to altered mitophagy.^5,6,7,8

When mitophagy is altered, it can lead to accumulation, rather than clearance of altered mitochondria.

Accumulation of these mitochondria can contribute to energy deficit and changes in the balance between anabolic and catabolic processes — important determinants of muscle mass, function, motor neuron and muscle fiber health.^8,9,10

Mitochondria can quickly adapt to changing conditions triggered by systemic or cellular challenges.³

Supporting mitochondrial function helps reduce loss of muscle mass and function and benefit overall health, specifically by enhancing mitochondrial dynamics and mitophagy.³

Both sedentary and physically active are susceptible to age-related muscle decline, yet the degree of severity is highly variable and dependent upon multiple risk factors beyond mitochondrial health, including hormone and cytokine balance, malnutrition and degree of physical activity.¹¹

Exercise and Nutrition Interventions for Age-Related Muscle Decline

Lack of exercise is believed to be the leading risk factor for age-related muscle loss.¹¹ Both resistance and aerobic training have been shown to improve the health of skeletal muscle by impacting mitochondrial quality and increasing muscle strength and function in older patients.^11,12,13,14

Individually tailored exercise programs can support healthy aging and be a means of prevention and intervention for age-related muscle decline.

In clinical studies demonstrating the benefits of aerobic, resistance or combined exercises, exercise was performed at least 2-3 times per week, for 30-60 minutes each session, for at least 8-12 weeks.^12,13

When recommending exercise as a therapeutic option for patients, the duration of sessions, amount of weight, distance, and number of exercises should increase gradually based on each individual’s capability and improvement.

Forty percent of older individuals do not meet the recommended .8g/kg protein intake requirements in their diet.¹⁵ Poor protein intake, combined with decreased absorption and intake of other nutrients that are essential for muscle health like amino acids and vitamins and minerals, put older individuals at a greater risk of reduced muscle protein synthesis or “anabolic resistance” and muscle loss.¹⁶ In addition, changes in mitochondrial function that also occur with aging can contribute to oxidative stress and favor catabolism of the muscle.^17,18,19

Two ways to support age-related muscle decline in the older patient involve assessing their protein and antioxidant intake. Recommended adequate protein in the older patient is 0.8 gm/2.2 lbs of body weight up to age 65, and 1 gm/2.2 lb of body weight after age 65.²⁰

Adherence to a Mediterranean diet, which promotes a high intake of proteins, fibers and polyphenols, combined with an individualized exercise regimen can be an effective approach to age-related muscle changes in the aging patient.

Nutrients to Support Age-Related Muscle Decline

Along with adequate protein, a phytonutrient rich diet and exercise, focusing on nutrients that support cellular, mitochondrial and muscle health can help improve patient outcomes.

B vitamins are essential to basal mitochondrial function, serve as metabolic coenzymes and/or methyl donors.^‡

PQQ provides B vitamin-like activity with unique antioxidant properties. PQQ supports mitochondrial, neuronal and cellular function, at least in part, by activation of Nrf2 and antioxidant gene expression. PQQ may also help to maintain cytokine balance.^‡

Amino Acids are the building blocks for all proteins, making them essential for several body functions, including fluid balance, enzyme production, cellular repair and energy metabolism.^25,26 Proper intake of amino acids is important for the synthesis, repair and metabolism of muscle, cells and tissues.^‡

Creatine is an energy carrier that is naturally present in muscles, brain and other organs. It clinically studied to increase body strength, build muscle mass, and support recovery from strenuous exercise. Creatine also promotes growth factor signaling and glycogen storage to support gains in muscle strength.^‡

Pure Encapsulations^® Nutrient Solutions

Pure Encapsulations^® offers high-quality supplements that are FREE FROM unnecessary additives and many common allergens for patients who may need support for age-related muscle changes. We offer nutrients individually and in combination to meet all your patients’ unique needs.^‡

Klean Athlete^® is a Pure Encapsulations partner brand.

Klean Athlete^® is our dedicated sports nutrition brand designed to power peak performance through optimal health. By harnessing the science of sports nutrition, Klean Athlete^® delivers safe, NSF Certified for Sport^® supplements to support healthy, active lifestyles. Klean Athlete^® is trusted by over 350 professional and collegiate sports teams and is the preferred brand of many of the world’s top coaches, trainers and health professionals.^‡

Cellular Health

Renual enhances mitochondrial renewal to support energy output/energy production. Features Mitopure^™ Urolithin A to power muscle function, increase cellular energy and promote healthy aging. Research indicates that urolithin A enhances autophagy, the natural process of cellular renewal in which the body degrades and recycles cellular components, as well as mitophagy, the clearance and recycling of older mitochondria. Resveratrol offers support for longevity, metabolic health, and mitochondrial function.^27,28 CoQ₁₀ is a key nutrient used in the energy production pathway. ^29‡
Suggested Dose: Take 2 capsules, 1-2 times daily, with or between meals.

Ultra B Complex w/PQQ combines essential B vitamins with PQQ to support cellular energy production and mitochondrial bioenergetics and function. It also contains alpha lipoic acid and luteolin for enhanced antioxidant and cellular support.^‡
Suggested Dose: Take 1 capsule, 1-2 times daily, with meals.

Muscle Health

Creatine supports muscle strength, performance and recovery^‡ It promotes growth factor signaling and glycogen storage to support gains in muscle strength and supports quick conversion of ADP to ATP energy.^‡
Suggested Dose: 1 1/2 tsp daily mixed with 8 oz of water or beverage of choice.

KLEAN Isolate^™ supplies 20 grams of high-quality whey protein isolate in each serving. The dietary protein provided by Klean Isolate^™ supplies essential amino acids, including branched chain amino acids that participate in many of the body’s metabolic and physiologic systems. With no additional flavorings or sweeteners, Klean Isolate^™ can easily be added to any beverage to enhance daily protein and amino acid intake.^‡
Suggested Dose: Adults take 1 scoop daily mixed with 10-12 oz. of water or other beverage (cool or room temperature), or as directed. For best results, take within 45 minutes after being active.

KLEAN Plant-Based Protein^™ by Klean Athlete^® supplies a blend of pea and organic brown rice protein to provide amino acids for muscle protein synthesis. ProHydrolase^® enzymes are included to break down protein for increased amino acid absorption and to ease digestion, along with Sunfiber^® for gastrointestinal health.^‡
Suggested Dose: 1 scoop daily mixed with 10-12 ounces of water or other beverage, or as directed by a trainer, coach or health professional.

Digestive Support

Digestive Enzymes Ultra w/ Betaine HCl contains an extensive profile of betaine HCl and digestive enzymes to support protein, carbohydrate, fat, fiber and dairy digestion while promoting enhanced nutrient bioavailability and absorption. Encourages optimal gastric pH with betaine HCl, which is important for the enhanced digestion of protein and other nutrients for daily wellness and healthy neurotransmitter synthesis.^‡
Suggested Dose: 2 capsules with each meal, or as directed by a health professional.

Summary

Loss of muscle mass and strength can significantly impact an individual’s well-being and ability to live independently. Providing patients with targeted, personalized nutrition and exercise interventions to enhance anabolic processes and cellular health can greatly influence their quality of life now, and as they age.

Pure Encapsulations^® provides uniquely formulated products made with high-quality, pure ingredients backed by verifiable science to complement your plan of care.

Resources

• Age Related Muscle Loss Protocol^‡

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.

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