By Kim Ross, DCN, CNS, LDN, IFMCP⁺

Reducing Mental Load: Practical Tips to Help Patients Declutter Their Mind

1. Introduction to Emotional Wellbeing
2. Reducing Mental Load
3. 4 Key Messages to Relay to Patients
4. 5 Practical Strategies You Can Teach Your Patients
5. Conclusion
6. Resources

What is Emotional Wellbeing?

Emotional wellbeing is an umbrella term that is used to describe the “overall positive state of one’s emotions, life satisfaction, sense of meaning and purpose and ability to pursue self-defined goals.”¹

Clinically, poor emotional wellbeing is linked to adverse mental health outcomes.^3–5 For practitioners, understanding emotional wellbeing opens opportunities for early intervention and holistic care. Promoting emotional wellbeing is not ancillary to clinical practice; it is central to improving patient outcomes, adherence and overall quality of life.

Reducing Mental Load and Mental “Decluttering”

Many patients describe feeling “wired and tired,” “mentally overloaded” or “unable to turn my brain off at night.” Clinically, this often reflects cognitive or emotional overload rather than a mood disorder.

What is Mental Load?

The ongoing, often invisible cognitive and emotional work of planning, tracking details, anticipating needs, managing others’ needs and self-monitoring, is continuous, boundaryless and rarely “done.” High mental load is associated with elevated perceived stress, sleep disturbances, role strain and lower wellbeing.^6,7

Mental load is not just “a busy schedule.” It’s internal vigilance: remembering appointments, monitoring others’ moods, preventing conflict and emotional caretaking. This is especially common in caregivers and working parents and is strongly linked to burnout and emotional exhaustion.⁷

Decluttering or Cognitive Offloading to Reduce Mental Load

Mental decluttering or cognitive offloading is the process of moving tasks, worries, decisions, reminders and unresolved thoughts out of working memory and into an external system (e.g., lists, calendars, notes, shared task boards and voice memos) so the brain is not holding them on constant “standby.”⁸ This process reduces cognitive load, frees attention and is associated with less rumination and better task performance.⁸ Clinically, offloading also supports sleep initiation, because pre-sleep rumination is often driven by unclosed loops (e.g., “Don’t forget to…,” “What if…,” “I still haven’t emailed…”). Patients who externalize those loops tend to fall asleep more easily and report less pre-bed hyperarousal.⁹

Clinical Goal: For emotional wellbeing, the goal is not to “empty the mind” in a spiritual sense. The clinical goal is to reduce relentless cognitive and emotional demands so that self-regulation systems (e.g., mood, sleep and stress response) can recover. Collaboration with a life coach or expanding your knowledge of tools to help patients “declutter their mental load” can support their emotional wellbeing. You can frame this for patients as: “We’re going to clear mental bandwidth so your nervous system can downshift.”

4 Key Messages to Relay to Patients

1. A persistent cluttered mental environment keeps the stress system (HPA axis) in a semi-activated state. Patients feel on alert, even at rest. This can impair sleep and mood stability.⁹
2. Decluttering the mind is not avoidance. It is structured processing plus externalizing: notice → name → park it somewhere reliable.
3. Cognitive or emotional load is often invisible labor. Validating it, especially in caregivers, women and high-responsibility professionals, is therapeutic and reduces shame.^6,7
4. Reducing mental load supports sleep quality, which supports emotional regulation, stress resilience and positive affect. Poor sleep is consistently linked to increased negative mood and decreased positive mood the next day.⁹

5 Mental Decluttering Strategies You Can Teach Your Patients

These strategies are appropriate for most patients and do not require advanced psychotherapy training to be introduced.

1. Nightly Brain Download (“Parking the Thoughts”)

Before bed, ask the patient to spend five minutes writing down unfinished tasks, unsent messages, unresolved conversations, worries, “what if” loops or tomorrow’s priorities. Include only the top one or two, not 20.

The instruction is: “You do not have to solve any of it right now. You’re just placing it in a holding area so your brain doesn’t have to rehearse it all night.” This is essentially cognitive offloading. Offloading reduces working memory demands and subjective workload, which in turn lowers perceived stress and improves cognitive performance.⁸

Clinically useful language: “We are telling your nervous system: you are allowed to power down.”

2. Externalize Responsibilities, Don’t Mentally Juggle Them

Recommend a shared calendar, task board or responsibility map for households, teams or co-parents. This is especially important for patients carrying a high “anticipatory load” in keeping track of who needs what and by when. Research on mental load shows that this anticipatory, emotional caretaking work is ongoing, boundaryless and associated with emotional fatigue and decreased wellbeing, especially in women managing work and caregiving simultaneously.⁷

Framing for the clinician: Moving invisible tasks into a shared system is not “being controlling,” it is redistributing cognitive and emotional labor.

3. Limit Unfinished Loops During the Day

Ask patients to notice “micro-rumination spirals,” e.g., mentally replaying a conversation, rehearsing an argument or repeating a worry.
Coach them on a brief containment script:

1. Name it (e.g., “I am worrying about X”).
2. Decide if it is actionable now.
3. If it’s not actionable now, write it down and schedule a review block, even if it is10 minutes tomorrow.

What you are doing here is teaching cognitive reappraisal and structured containment, which have been shown to reduce cognitive load associated with emotional rumination and supports adaptive regulation rather than ongoing perseveration.¹⁰

4. Create One “White Space Block” Daily

Ask the patient to incorporate a short, non-screen, nonproductive (five-to-ten-minute block once per day. No email, no scrolling and no multitasking. The point is for their nervous system to downshift. Even brief unstructured pauses are associated with reduced sympathetic arousal and allow emotional states to surface and resolve rather than stack. This supports both mood stability and a clearer internal state.

5. Tie Mental Decluttering to Sleep Hygiene

Have patients pair their cognitive offloading with their pre-bed wind-down routine. Sleep quality is tightly linked to emotional regulation and next-day positive affect. Inadequate or fragmented sleep increases negative affect and blunts positive mood the next day.​9​ Helping the mind “power down” protects both sleep and emotional resilience.

Guidance for Clinicians

• Validate first. Acknowledge that invisible mental load is legitimate, has physiological effects and is commonly carried by people in caregiving or leadership roles.
• For patients in high-load caregiving or high-responsibility roles, “declutter” does not mean “drop responsibilities.” The intervention is redistributing cognitive responsibility across systems and people and introducing scheduled mental rest states.
• Avoid framing this as a need for better time management or organization. Instead, frame it as “your nervous system has been carrying too much for too long; let’s design supports so your brain can rest.”
• Teach externalization early. Getting thoughts or tasks out of working memory is often the fastest relief lever for patients.
• Reinforce that this is not about perfection or minimalism. The goal is to create enough cognitive space so that self-regulation (e.g., mood control, impulse control and boundary setting) can be restored.
• If the patient’s “mental clutter” contains trauma, intrusive thoughts or self-harm ideation, that is outside general lifestyle work and warrants referral to a licensed mental health professional.

Conclusion

Emotional wellbeing is both a reflection and a regulator of overall health. Helping patients reduce mental load is not about “doing less” but about creating the cognitive and emotional space necessary for recovery, balance and self-regulation. When you teach patients to declutter their minds, you are empowering them to rebuild resilience, protect sleep and reconnect with a sense of calm and purpose that supports healing on every level.

Resources

For more information, including diet and lifestyle recommendations for supporting emotional wellbeing, refer to the resource listed below: 

Emotional Well-Being Protocol^‡: Developed with our clinician partners to support emotional well-being through foundational health, targeted interventions, and lifestyle strategies.^‡

1. Park CL, Kubzansky LD, Chafouleas SM, et al. Affect Sci. 2023;4(1). doi:10.1007/s42761-022-00163-0
2. Gallup Inc. State of the World’s Emotional Health 2025. Gallup.com. 2025. Accessed November 5, 2025. https://www.gallup.com/analytics/349280/state-of-worlds-emotional-health.aspx
3. Ryff CD. Persp Psychol Sci. 2018;13(2). doi:10.1177/1745691617699836
4. Chida Y, Steptoe A. Psychosom Med. 2008;70(7). doi:10.1097/PSY.0b013e31818105ba
5. Kubzansky LD, Huffman JC, Boehm JK, et al. J Am Coll Cardiol. 2018;72(12). doi:10.1016/j.jacc.2018.07.042
6. Kelloway EK, Dimoff JK, Gilbert S. Ann Rev Org Psychol Org Beh. 2023;10(1):363-387. doi:10.1146/annurev-orgpsych-120920-050527
7. Dean L, Churchill B, Ruppanner L. Comm Work Fam. 2022;25(1). doi:10.1080/13668803.2021.2002813
8. Morrison AB, Richmond LL. Cogn Res Princ Implic. 2020;5(1). doi:10.1186/s41235-019-0201-4
9. Tomaso CC, Johnson AB, Nelson TD. Sleep. 2021;44(6). doi:10.1093/sleep/zsaa289
10. Brockbank RB, Feldon DF. Educ Sci (Basel). 2024;14(8):870. doi:10.3390/educsci14080870

⁺Dr Ross is a paid consultant for Pure Encapsulations.

By Kim Ross, DCN, CNS, LDN, IFMCP⁺

Berberine and Blood Sugar: Unlocking Clinical Potential with Enhanced Absorption

1. Introduction to Berberine
2. Berberine and Insulin Signaling and Glucose Metabolism
3. Bioavailability and Absorption Concerns
4. Pure Encapsulations Nutrient Solutions
5. Conclusion
6. Resources

Introduction to Berberine

Berberine is a bioactive isoquinoline alkaloid found in several botanicals, including barberry (Berberis vulgaris), Oregon grape (Berberis aquifolium), Indian barberry (Berberis aristata), Chinese goldthread (Coptis chinensis) and goldenseal (Hydrastis canadensis). Its oldest use dates back to 3000 BC,1 though it has been more commonly used for over 400 years as a traditional therapeutic agent in China, India and the Middle East and offers a wide array of health benefits.²

Researchers are interested in berberine for its capacity to reduce oxidative stress, modulate cytokine production, suppress adipogenesis and lipid accumulation, provide neuroprotection, restore the gut microbiome and regulate glucose metabolism and insulin signaling.^2,3

One key challenge of administering berberine is oral bioavailability. These pharmacokinetic constraints have driven the development of enhanced delivery systems. Among these, phytosome formulations have been investigated to improve absorption and clinical performance. Recent work has demonstrated improved pharmacokinetic profiles for food-grade berberine formulations.⁴ Randomized trials of berberine phytosome have reported favorable metabolic effects compared with standard preparations.⁵

This blog will focus on how berberine supports glucose metabolism and the clinical importance of choosing the right formulation to enhance absorption in your patients.

Berberine and Insulin Signaling and Glucose Metabolism

Berberine's clinical effects on glucose metabolism and insulin signaling are shaped by its pharmacological behavior. Although oral absorption is limited (less than 1%), berberine and its active metabolites primarily concentrate in the liver to govern glucose production and utilization.¹ Within the liver, berberine influences pathways that regulate gluconeogenesis. After entering circulation, berberine is rapidly and widely distributed to muscle, lung, brain, heart, pancreas, adipose and kidney tissue.¹

Mechanisms of Action

Berberine influences multiple, interconnected aspects of metabolic health, which helps explain its broad clinical relevance:

Glucose metabolism: Berberine affects glucose metabolism by stimulating glycolysis, the fundamental metabolic process for energy production. It also impacts gluconeogenesis, which is important since altered gluconeogenesis contributes to changes in fasting glucose states and insulin signaling. Furthermore, berberine enhances the production of GLP-1, thereby improving insulin signaling.²

Insulin signaling: After insulin is produced by the b-cells of the pancreas, it binds to insulin receptor sites on the cell surface. This process activates a chain reaction within the cell, known as the insulin signaling cascade. Insulin receptor substrate 1 (IRS-1) and protein kinase B (PKB, also known as Akt) are key messengers within cells. This promotes the translocation of the glucose transporter 4 (GLUT-4) protein to the cell surface, allowing glucose to be shuttled into the cells.

Berberine has been reported to have an impact on several areas of this chain reaction:

1. It reduces the inhibitory signal of IRS-1, thereby improving intracellular communication.⁶
2. It enhances Akt signaling and improves cellular glucose uptake.⁶
3. It promotes the movement of GLUT4 transporters to the cell surface. This enhances the ability of skeletal muscle cells to absorb glucose from the circulation and store it as glycogen, thereby improving whole-body glucose utilization.⁷
4. It activates AMP-activated protein kinase (AMPK), a central "energy sensor" in cells. AMPK activation redirects metabolism toward energy-efficient pathways, promoting glucose uptake and utilization while inhibiting processes that contribute to excess glucose production.^2,8 Further, there is an increased expression of peroxisome proliferator-activated receptor-gamma coactivator 1-alpha (PGC1), a key regulator of mitochondrial biogenesis.⁹
5. Berberine also upregulates SIRT1, a key regulator in adipose tissue, that contributes to insulin signaling, as well as promotes insulin secretion from b-cells.⁷

BERBERINE’S IMPACT ON INSULIN SIGNALING AND GLUCOSE METABOLISM

Additionally, berberine has an impact on other key mechanisms of action, including:

Lipid balance: Berberine reduces the liver's tendency to produce new fats from excess carbohydrates (a process known as de novo lipogenesis) and promotes fat burning for energy. Clinically, this supports fat metabolism within liver cells.¹⁰

Gut microbiota interaction: Berberine directly influences the gut microbiome in several ways. It encourages growth of beneficial bacteria, modulates the intestinal barrier and increases the production of bile acids (BA), short-chain fatty acids (SCFA), dopamine and branched-chain amino acids (BCAA), while reducing the production of trimethylamine (TMAO).¹¹

Healthy cytokine balance and antioxidant support: It has been reported that berberine supports healthy cytokine balance, inhibits leukocyte adhesion, suppresses oxidative stress and promotes immune regulation.^2,12

Notably, one study identified 22 pathways and molecular mechanisms that berberine impacts for glucose regulation alone, underscoring the depth of this topic, which extends beyond the scope of this blog.¹³

Phytosome^™ Technology for Increased Absorption

Phytosomes, also referred to as herbasomes, protect herbal extracts from digestive fluids and intestinal microbes, allowing them to enter the bloodstream, prolong circulation and delay clearance.²⁰ Phytosome^™ technology combines a botanical extract with phospholipids, improving membrane affinity, lymphatic uptake and resistance to P-gp efflux, which together enhance oral absorption and systemic exposure at a given dose.⁴ For berberine, this strategy aims to deliver higher effective concentrations to the liver and muscle, which are central to gluconeogenesis control, GLUT4-mediated uptake and overall glucose homeostasis, while potentially reducing GI intolerance seen with conventional forms.

Evidence for Enhanced Delivery

Berbevis^® is a form of berberine that utilizes Phytosome^™ technology. A pharmacokinetic study utilizing Berbevis^® showed significantly improved plasma exposure versus conventional berberine (chloride), confirming better absorption with the phospholipid complex.⁴ This led to further research, including:

• A double-blind, placebo controlled RCT reported that Berbevis^® (550 mg, twice daily) promoted healthy glycemic control and insulin signaling over placebo, while also supporting healthy lipid profiles.⁵
• Additional studies support similar promotion of healthy lipid profiles and cardiometabolic risk factors with Berbevis^® at a single dose of 500 mg per day.^21,22
• Two other studies using 550 mg twice daily of Berbevis^® reported support for healthy glucose metabolism and insulin signaling, with one study also showing significant support for cardiometabolic parameters.^23,24

Taken together, these data indicate that formulation matters. A phytosome form of berberine increases exposure, improves tolerability and results in clinically meaningful improvements in endpoints related to insulin signaling and glucose regulation, potentially at lower total daily doses than conventional berberine.

Pure Encapsulations Nutrient Solutions

Berberine UltraSorb^™ provides Berbevis^®, which is manufactured from Berberis aristata root extract. This berberine phytosome provides enhanced bioavailability that promotes healthy glycemic control, helps maintain healthy glucose levels already within normal ranges and promotes healthy insulin receptor function and signaling.⁴ Berberine UltraSorb^™ provides 550 mg of clinically studied berberine phytosome that is four times more bioavailable than standard berberine.

Suggested Dose: As a dietary supplement, take 1 capsule 1 to 2 times daily, with or between meals.

Conclusion

Berberine, a natural alkaloid with a long history of medicinal use, continues to demonstrate strong clinical relevance in modern metabolic care. While its low oral bioavailability has historically limited application, advances such as Phytosome^™ technology now offer improved absorption and greater clinical utility at lower and better tolerated doses.

By targeting multiple pathways simultaneously, berberine provides a multifaceted approach to restoring metabolic balance. For clinicians, berberine phytosome represents a promising adjunctive option for patients to support their metabolic health, particularly when combined with foundational nutrition and lifestyle strategies.^‡

Resources

For additional information that includes diet and lifestyle recommendations for supporting glucose regulation and insulin signaling, refer to the resources listed below:

Cardiometabolic Support Protocol: Designed by our scientific and medical advisors to help you deliver the most effective care and support insulin signaling and glucose metabolism.

Berberine Webinar: Watch the webinar “Berberine Deep Dive: An Update to Evidence-Based Clinical Use for Cardiometabolic Applications^‡,” presented by Kelly Heim, Ph.D.

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

• Berberine UltraSorb^™ Sales One Pager
• Berberine UltraSorb^™ Product Info Sheet

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. Khoshandam A, Imenshahidi M, Hosseinzadeh H. Phytother Res. 2022;36(11). doi:10.1002/ptr.7589
2. Utami AR, Maksum IP, Deawati Y. Biology (Basel). 2023;12(7). doi:10.3390/biology12070973
3. Och A, Och M, Nowak R, Podgórska D, Podgórski R. Molecules. 2022;27(4). doi:10.3390/molecules27041351
4. Petrangolini G, Corti F, Ronchi M, Arnoldi L, Allegrini P, Riva A. Evid Based Complement Alternat Med. 2021;2021. doi:10.1155/2021/7563889
5. Rondanelli M, Gasparri C, Petrangolini G, et al. Eur Rev Med Pharmacol Sci. 2023;27(14). doi:10.26355/eurrev_202307_33142
6. Li A, Lin C, Xie F, Jin M, Lin F. Metab Syndr Relat Disord. 2022;20(8). doi:10.1089/met.2022.0017
7. Lv X, Zhao Y, Yang X, et al. Front Pharmacol. 2021;12. doi:10.3389/fphar.2021.720866
8. Bellavite P, Fazio S, Affuso F. Molecules. 2023;28(11). doi:10.3390/molecules28114491
9. Qin X, Jiang M, Zhao Y, et al. Br J Pharmacol. 2020;177(16). doi:10.1111/bph.14935
10. Cai Y, Yang Q, Yu Y, Yang F, Bai R, Fan X. Front Pharmacol. 2023;14. doi:10.3389/fphar.2023.1283784
11. Cheng H, Liu J, Tan Y, Feng W, Peng C. J Pharm Anal. 2022;12(4). doi:10.1016/j.jpha.2021.10.003
12. Wang K, Yin J, Chen J, Ma J, Si H, Xia D. Phytomedicine. 2024;128:155258. doi:10.1016/j.phymed.2023.155258
13. Han Y, Xiang Y, Shi Y, et al. Evid Based Complement Alternat Med. 2021;2021. doi:10.1155/2021/9987097
14. Kwon M, Lim DY, Lee CH, Jeon JH, Choi MK, Song IS. Pharmaceutics. 2020;12(9). doi:10.3390/pharmaceutics12090882
15. Solnier J, Zhang Y, Kuo YC, et al. Pharmaceutics. 2023;15(11). doi:10.3390/pharmaceutics15112567
16. Liu CS, Zheng YR, Zhang YF, Long XY. Fitoterapia. 2016;109. doi:10.1016/j.fitote.2016.02.001
17. Feng X, Wang K, Cao S, Ding L, Qiu F. Front Pharmacol. 2021;11. doi:10.3389/fphar.2020.594852
18. Tan XS, Ma JY, Feng R, et al. PLoS One. 2013;8(10). doi:10.1371/journal.pone.0077969
19. Moon JM, Ratliff KM, Hagele AM, Stecker RA, Mumford PW, Kerksick CM Nutrients. 2022;14(1). doi:10.3390/nu14010124
20. Kalaivani, P, Kamaraj, R. Cureus. 2024;16(8):e68180. doi:10.7759/cureus.68180
21. Cesarone MR, Hu S, Belcaro G, et al. Minerva Gastroenterol. 2024;70(1). doi:10.23736/s2724-5985.23.03540-4
22. Cesarone MR, Hu S, Belcaro G, et al. Minerva Med. 2025;116(4):285-291. doi:10.23736/S0026-4806.25.09637-5
23. Di Pierro F, Sultana R, Eusaph AZ, et al. Front Pharmacol. 2023;14. doi:10.3389/fphar.2023.1269605
24. Rondanelli M, Riva A, Petrangolini G, et al. Nutrients. 2021;13(10). doi:10.3390/nu13103665

⁺Kim Ross is a paid consultant for Pure Encapsulations.

By Kim Ross, DCN, CNS, LDN, IFMCP⁺

Polyphenols in Practice: Targeted Strategies to Support Liver Health

1. Introduction
2. The Liver-Metabolic Health Connection
3. Polyphenols: Bergamot & Artichoke Extracts in Supporting Liver Health: A Summary of the Evidence
4. Pure Encapsulations Nutrient Solutions
5. Conclusion
6. Resources

Introduction to Liver Health

The liver is a central metabolic hub, responsible for nutrient processing, energy regulation and detoxification processes. With functions such as glycogen storage, lipid metabolism, bile production and clearance of endogenous and exogenous toxins, it plays a critical role in maintaining homeostasis. It also regulates circulating glucose and lipid levels, synthesizes essential proteins and processes hormones and cytokine mediators.¹

Given its pivotal role, changes to hepatic function have systemic consequences. When fat accumulation occurs within hepatocytes, it can lead to altered metabolic health and disrupt normal metabolic processes.²

Prevalence of Altered Metabolic Health and Fat Accumulation in the Liver³

The most vulnerable and at-risk populations include those who carry extra weight, have alterations in glucose and/or insulin regulation and cardiovascular concerns.

The Liver–Metabolic Health Connection

Body Fat Distribution

The liver is a central regulator of energy balance, integrating signals from dietary intake, adipose tissue and peripheral organs to maintain homeostasis. In states of energy excess, these finely tuned pathways become altered, contributing directly to systemic metabolic changes.

Central adiposity, measured via waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), consists of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT).⁵

Visceral adiposity is of particular concern, since this becomes metabolically active tissue that drives higher levels of adipokines, cytokines produced by adipose tissue (i.e., TNF-α, IL-6) and is associated with increased changes in glucose and insulin regulation.6 Visceral adiposity promotes increased lipolysis, releasing free fatty acids (FFAs) directly into the portal circulation. The liver becomes flooded with FFAs, which are either re-esterified into triglycerides or incompletely oxidized.

Glucose and Insulin Metabolism

The liver stores glucose as glycogen during times of energy abundance and releases it via glycogenolysis during fasting. It also produces glucose through gluconeogenesis from substrates like lactate, glycerol and amino acids to maintain blood glucose levels.

When there is a consistent surplus of calories, the body experiences changes in insulin responses. Over time, this will impact the way the liver responds to insulin to reduce glucose production and continues to release glucose into the bloodstream, even when energy needs are already met.

While insulin fails to suppress gluconeogenesis, it activates pathways in the liver that convert excess carbohydrates into fat through a process called de novo lipogenesis. These newly created fats (triglycerides) are stored in liver cells, contributing to increased fat accumulation.

Lipid Metabolism

The liver plays a central role in regulating lipid balance, acting as the body's main processing center for fats. It packages triglycerides and cholesterol into very-low-density lipoproteins (VLDL) for delivery to other tissues, removes excess cholesterol from the bloodstream and helps break down dietary fats through bile acid production.

When the system becomes overwhelmed by a surplus of calories and circulating fats, the liver begins to store more fat than it can process or export. Over time, this leads to an accumulation of triglycerides within liver cells, reducing its efficiency and altering metabolic pathways.

As fat continues to accumulate, the liver produces more VLDL particles, contributing to an altered lipid profile.⁷ These changes affect not just liver health but also overall cardiometabolic risk, making lipid metabolism a critical link between liver function and systemic health.

Prevalence of Altered Metabolic Health and Fat Accumulation in the Liver³

Excess visceral fat = “Overflowing Delivery Trucks”-too many incoming deliveries (FFAs)

Imagine visceral fat as a fleet of delivery trucks constantly sending shipments of fat (free fatty acids) to the liver.

In excess weight, these trucks are working overtime, sending far more cargo than the liver’s “receiving docks” can handle. With nowhere else to go, the liver starts storing the excess inventory as fat.

Glucose/Insulin = “Mixed Messages from the Control Tower”

The liver is like a shipping control center that coordinates what gets produced and where it goes. Normally, insulin acts like a dispatcher, telling the liver to slow glucose production when supplies are sufficient and direct energy elsewhere.

But in states of energy surplus, the dispatcher’s messages get scrambled. The glucose “production line” keeps running at full speed, adding more cargo to already full warehouses, while the liver simultaneously ramps up fat production from excess carbs. The result? A backlog of stored products and a growing traffic jam in energy management.

Lipid Metabolism = “An Overloaded Shipping Hub” managing excess inventory

The liver functions as the body’s central shipping hub for fats. It receives cargo (free fatty acids from adipose tissue and dietary fats), processes it and packages triglycerides and cholesterol into VLDL particles for delivery throughout the body.

When too much cargo arrives too quickly, the hub becomes overloaded. This excess cargo is stored inside the “warehouse” (liver cells), slowing operations, while an increasing number of overflow packages spill into circulation.

Analogy created with the assistance of AI. Reference: OpenAI. ChatGPT [Large language model]. Version GPT-5. Published September 2025. Accessed September 2, 2025. https://chat.openai.com

Polyphenols: Bergamot & Artichoke Extracts in Supporting Liver Health: A Summary of the Evidence

Polyphenols are bioactive plant-derived compounds with antioxidant and metabolic-regulatory properties. In particular, BergaCynFF^®, a patented blend of bergamot flavonoids and artichoke (Cynara cardunculus) polyphenols, has demonstrated significant benefits for supporting lipid metabolism in the liver with the added benefits of promoting healthy uric acid levels, decreasing oxidative stress and supporting vascular endothelial health.^{8–11‡ 8–11‡}

A 12-week, randomized, placebo-controlled trial (n=102) assessed BergaCynFF^® (300 mg/day) in individuals with altered liver health. Compared to placebo, BergaCynFF^® significantly reduced hepatic fat measured by controlled attenuation parameter (CAP) score (P = .02). Subgroup analysis revealed the most pronounced benefit among participants aged >50 years and those with android adiposity (response rates: 78% vs 44%; P = .007).¹¹

Endothelial Function Improvement

A 12-week RCT of 32 adults with altered liver health and impaired endothelial function found that BergaCynFF^® supplementation significantly improved reactive hyperemia index (RHI) compared to placebo (P = .02). Improved endothelial reactivity supports the potential role of BergaCynFF^® in mitigating the heightened health risk factors.^12‡

Clinical Integration

BergaCynFF^® at 300 mg/day for 6–12 weeks may complement lifestyle interventions for liver health. Clinicians should monitor liver enzymes, CAP score, lipids, glycemic control and vascular markers to assess therapeutic response.^‡

Pure Encapsulations Nutrient Solutions

Lipid Support Complex is for patients seeking support for healthy fat metabolism. Lipid Support Complex supports hepatic fat metabolism with a combination of berberine and clinically studied BergacynFF^®, a patented extract blend of bergamot citrus and Cynara cardunculus. BergacynFF^® supports lipid metabolism in the liver, with the added benefits of promoting healthy uric acid levels, decreasing oxidative stress and supporting vascular endothelial health.^{8–11 ‡}

Suggested Dose: Take 2 capsules daily, with a meal.

Conclusion

The liver serves as a central hub for energy balance, nutrient processing and metabolic regulation. Disruptions in these pathways, driven by factors such as excess visceral fat, altered glucose handling and lipid imbalances, altered liver health.

Emerging evidence highlights the role of targeted nutraceutical strategies in supporting liver health. BergaCynFF^®, a patented combination of bergamot and artichoke polyphenols, demonstrates multi-faceted benefits, improvements in lipid profiles and glycemic control, enhanced antioxidant defenses and improved endothelial function.^‡

For clinicians, integrating BergaCynFF^® alongside foundational lifestyle interventions offers a promising approach to supporting liver function and broader metabolic health.^‡

Resources

For additional resources that include diet and lifestyle recommendations for supporting occasional anxiety, refer to the protocols listed below:

Hepatic Fat Metabolism Protocol: Designed by our scientific and medical advisors to help you deliver the most effective care and support liver health

For more details on the research on the selected nutrient solutions, download the product information sheets: Lipid Support Complex

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. Rhyu J, Yu R. World J Hepatol. 2021;13(11). doi:10.4254/wjh.v13.i11.1611
2. Rinella ME, Sookoian S. J Lipid Res. 2024;65(1). doi:10.1016/j.jlr.2023.100485
3. Younossi ZM, Kalligeros M, Henry L. Clin Mol Hepatol. 2025;31(Suppl):S32-S50. doi:10.3350/cmh.2024.0431
4. Chalasani N, Younossi Z, Lavine JE, et al. Hepatology. 2018;67(1). doi:10.1002/hep.29367
5. Nahorna A, Baur H. Obes Sci Pract. 2025;11(3):e70078. doi:10.1002/osp4.70078
6. Schousboe JT, Kats AM, Langsetmo L, et al. J Am Heart Assoc. 2018;7(16). doi:10.1161/JAHA.118.009172
7. Targher G, Byrne CD, Tilg H. Gut. 2020;69(9). doi:10.1136/gutjnl-2020-320622
8. Parafati M, Lascala A, Morittu VM, et al. Journal of Nutritional Biochemistry. 2015;26(9). doi:10.1016/j.jnutbio.2015.03.008
9. Musolino V, Gliozzi M, Bombardelli E, et al. J Tradit Complement Med. 2020;10(3). doi:10.1016/j.jtcme.2020.02.004
10. Ferro Y, Maurotti S, Mazza E, et al. Medicina (B Aires). 2022;58(12):1728. doi:10.3390/medicina58121728
11. Ferro Y, Montalcini T, Mazza E, et al. Front Endocrinol (Lausanne). 2020;11. doi:10.3389/fendo.2020.00494
12. Maurotti S, Pujia R, Ferro Y, et al. Nutrition. 2024;118. doi:10.1016/j.nut.2023.112294

⁺Kim Ross is a paid consultant for Pure Encapsulations.

Think Ahead: Cognitive Wellness Today for Tomorrow

By: Amy Doyle, MS, CNS⁺

1. Introduction
2. Age-Related Changes in the Brain
3. Oxidative Stress and Brain Health
4. Antioxidant Intake and Cognitive Function
5. Nutrient Solutions for Cognitive Function
6. Pure Encapsulations^® Nutrient Solutions for Cognitive Function
7. Summary
8. Resources
9. References

Introduction

As we age, supporting brain health and cognitive function increasingly becomes a focal point of our health. Mild memory deficits and slower cognitive processing are a normal part of aging. It has been estimated that 1 in 9 adults in the US age 65 and older experience memory loss, thinking difficulties and other cognitive changes that could interfere with daily life and activities.¹

By age 45, the risk of these types of cognitive changes is 1 in 5 for women and 1 in 10 for men.¹

Read on to discover how you can proactively target metabolic processes and related pathways to support your patients’ brain health and cognitive function throughout their lifetime.

Age-Related Changes in the Brain

Changes in brain neurons can begin 20 years or more before cognitive symptoms develop, with the prevalence of these changes doubling every five years after age 65.^1,2

Age-related chemical and physical changes in the brain can include:³

• Changes in vascular makeup, reduced blood flow and oxygen
• Decline in production of hormones and neurotransmitters
• Decreased antioxidant defenses

While these underlying brain changes can occur for decades, one factor is emerging as a significant player in the development and occurrence of cognitive changes: oxidative stress.

Oxidative Stress and Brain Health

Oxidative stress occurs when there’s an imbalance between free radicals and antioxidants in the body resulting in greater reactive oxygen species (ROS) production.  Free radicals are a natural byproduct of many physiological processes, but they can also be introduced by external sources like diet, toxins and environmental factors.

While free radicals play essential roles in cellular signaling and immune function, an excess can lead to cellular damage, an immune response and mitochondrial dysfunction that can progress to adverse effects on brain function.⁴ Highly metabolic, the brain is a large consumer of oxygen and is rich in polyunsaturated fatty acids. These characteristics combined with its high production of ROS and low levels of antioxidant enzymes make it particularly vulnerable to oxidative damage.^5,6

When ROS production overwhelms the brain’s antioxidant defenses, oxidative stress damages proteins, DNA and cell membranes, disrupts neuronal cell functions and triggers neuronal cell death.⁴ Regulation of ROS in the brain is critical for memory consolidation and long-term potentiation.⁷

Antioxidant Intake and Cognitive Function

Several prospective studies have found that people who consume an antioxidant rich diet of fruits and vegetables can reduce their risk of cognitive changes.^8,9,10

In a 2023 meta-analysis of cohort studies, researchers sought to investigate the association of antioxidant intake with the risk of cognitive changes.¹¹

The meta-analysis included 17 articles with 98,264 participants. Of the total, 7,425 participants had cognitive changes after 2-3 years of follow up, that interfered with their daily living. Studies included participants from Europe, Asia and North America.  The studies considered antioxidant intake from diet, supplements or both.  The antioxidants studied included vitamin A, vitamin C, vitamin E and flavonoids. Additional subgroup analyses were conducted based on the participants’ kind of nutrition, diet and supplement, geographical region and study quality.

Overall, the researchers determined that a high antioxidant diet or supplement intake significantly decreased the incidence of cognitive changes that interfere with daily living by 16% (RR =.084, 95% CI 077.-091(p_t <0.001).

In subgroup analysis by nutritional type, high dietary and supplement intake of vitamin C or vitamin E alone significantly reduced risk of cognitive changes (RR= 0.81, 95% CI 0.70-0.94, I² = 37.9%, p = 0.097), and (RR=0.77, 95% CI 0.64-0.92, I²=54%, p=0.013), respectively.

Both vitamin A and flavonoid intake were also shown to decrease risk of cognitive changes, however results were not statistically significant.

High dietary and supplement antioxidant intake demonstrated a greater risk reduction with statistical significance in North American populations (RR=.083, 95% CI 0.75-0.93, I²=47.3%, p=0.003), compared to European populations, where although risk was reduced, results were not statistically significant.

The authors concluded that consuming fruits and vegetables rich in antioxidants or antioxidant supplements can have a protective effect on cognitive function and reduce risk of cognitive changes.

Nutrient Solutions for Cognitive Function

It is important to educate patients about modifiable risk factors associated with mild, age-related cognitive decline like an antioxidant-rich diet, physical activity, managing stress, prioritizing sleep and engaging in social and mental stimulation.¹² In addition, the practitioner can support the brain’s resilience against oxidative stress with targeted nutrient solutions.

Magnesium L-threonate Animal research suggests that magnesium-l-threonate may promote synaptic plasticity and density in the regions of the hippocampus correlated with learning and memory.^13‡

Acetyl-L-carnitine supports the availability of acetyl-CoA, an important energy-generating metabolite. In addition, it supports healthy mitochondrial function and cell membrane stability.^14‡

Phosphatidylserine supports cognitive function, emotional well-being and behavioral performance. It has also been shown to support healthy memory.^15,16‡

Resveratrol promotes cardiometabolic, neuronal and cellular health through a variety of effects on cell signaling, mitochondrial function and endogenous antioxidant defenses.^{17,18,19,20‡}

Omega 3 Fatty Acids encourage cardiovascular health by supporting lipid metabolism and healthy blood flow. ^21,22,23 In addition, studies indicate these oils help maintain healthy endothelial function.^24‡

Curcumin supports neuronal stability and function, in part, by promoting healthy cytokine balance and antioxidant defenses.^25‡

Bacopa monnieri has been utilized traditionally for centuries in Ayurvedic medicine to support the nervous system, cognitive capacity and memory. A three-month trial conducted by Australian scientists suggests that bacopa may support learning, moderate stress and support memory.^26‡

Luteolin promotes neuronal health through antioxidant, immunomodulating and mast cell stabilizing actions, helping to moderate the release of immune mediators.^‡

Ginkgo biloba helps sustain the strength and elasticity of blood vessels and capillaries. It may also promote the flow of oxygen and blood to the brain. ^‡

With oxidative stress and related metabolic shifts occurring early in the development of changes in cognitive function, identifying and addressing these processes can be crucial for healthy function.

Pure Encapsulations^® Nutrient Solutions for Cognitive Function

As the most trusted brand and leader in the professional supplement space, Pure Encapsulations^® is committed to helping healthcare professionals understand and apply personalized, evidence-based nutrition to achieve optimal patient outcomes.

The following supplements can support neuronal health, vascular integrity, memory, mental sharpness and overall cognitive function.^‡

Memory Pro promotes neural health, cognitive function and memory. Also supports vascular integrity and promotes relaxation.^‡
Suggested use: As a dietary supplement, take 3 capsules daily, with or between meals.

BenfoMax is a fat-soluble vitamin B₁ (thiamine) derivative that maintains healthy advanced glycation end (AGE) product activity to support vascular, nerve, retinal and kidney cellular health. It also promotes healthy glucose metabolism.^‡
Suggested use: As a dietary supplement, take 1 capsule, 1-3 times daily, with meals.

O.N.E. Omega contains triglyceride form EPA and DHA from fish oil produced through a unique solvent free, supercritical, CO2-based extraction method. Encourages cardiovascular health by supporting lipid metabolism and healthy blood flow.  Also helps maintain healthy endothelial function.^‡
Suggested use: As a dietary supplement, take 1 capsule daily, with a meal.

CurcumaSorb Mind contains Meriva^® bioavailable curcumin phytosome; support for mood, memory and mental sharpness.^‡
Suggested use: As a dietary supplement, take 2 capsules, 1-2 times daily, with meals

CogniMag  promotes cognitive function, learning ability and working memory. Also supports optimal brain magnesium levels.^‡
Suggested use: As a dietary supplement, take 2 capsules, twice daily, with a meal and at bedtime.

Brain Reset promotes concentration, mental clarity and memory with a multi-faceted blend of nutrients and herbal extracts. Promotes neuroimmune health by supporting cellular function, neuroprotection and immune mediator balance.^‡
Suggested use: As a dietary supplement, take 2 capsules daily, between meals.

AntiOxidant Formula  supports the body’s natural defense mechanism against free radicals.^‡ Offers a synergistic, broad spectrum of antioxidants, including essential vitamins and minerals like vitamin A, E and B complex vitamins.
Suggested use: As a dietary supplement, take 1 capsule, 1-2 times daily, with meals.

Ester-C^® & Flavonoids offers a blend of Ester-C^® and flavonoid compounds to provide vitamin C support for healthy immune and cellular function as well as blood vessel integrity.^‡
Suggested use: As a dietary supplement, take 1 capsule, 1-2 times daily, with or between meals.

Summary

In the quest to maintain optimal brain health, understanding and addressing the role of oxidative stress is key to safeguarding your patient’s cognitive function

Resources

Mild Age-Related Cognitive Decline Protocol^‡: Developed in collaboration with our scientific and medical advisors to support cognitive health in older adults^‡

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.

References

1. ALZ.org. Facts and Figures 2024. Accessed May 14, 2024.
2. CDC.gov. Accessed May 14, 2024.
3. NCOA. Accessed May 12, 2024.
4. Song T et al. Ageing Res Rev. 2021;72:101503. doi:10.1016/j.arr.2021.101503
5. Bai R et al.  Ageing Res Rev. 2022;77:101619. doi:10.1016/j.arr.2022.101619.
6. Qin P, Sun Y, Li L.  Int J Mol Med. 2024;53(5):47. doi:10.3892/ijmm.2024.5371.
7. Serrano, F., & Klann, E.  Ageing Research Reviews, 2004. 3(4): 431–43. doi:10.1016/j.arr.2004.05.002.
8. Dai Q, Borenstein AR, Wu Y, Jackson JC, Larson EB. Fruit and vegetable juices and Alzheimer's disease: the Kame Project. Am J Med. 2006;119(9):751-759. doi:10.1016/j.amjmed.2006.03.045
9. Barberger-Gateau P et al. Neurology. 2007. 69(20):1921-30. doi:10.1212/01.wnl.0000278116.37320.52.
10. Hughes TF et al. Am J Geriatr Psychiatry. 2010.18(5):413-20. doi:10.1097/JGP.0b013e3181c65250.
11. Zhao R et al. J Alzheimers Dis. 2024. 99(s1):S35-S50. doi:10.3233/JAD-220909.
12. Livingston G et al. Lancet. 2020. 396(10248):413-46. doi:10.1016/S0140-6736(20)30367-6.
13. Slutsky I, et al. Neuron. 2010 Jan 28;65(2):165- 77.
14. Kerner J, et al. Mech Ageing Dev. 2015 Jan;145:39-50.
15. Maggioni M, et al. Acta Psychiatr Scand. 1990 Mar;81(3):265-70.
16. Hirayama S, et al. J Hum Nutr Diet. 2013 Apr;27 Suppl 2:284-91.
17. Xia N, et al. Br J Pharmacol. 2017 Jun;174(12):1633-1646
18. Brito PM, et al. Atherosclerosis. 2009 Jul;205(1):126-34.
19. Pyo IS, et al. Molecules. 2020 Oct 12;25(20):4649.
20. Ghanim H, et al. J Clin Endocrinol Metab. 2010 Sep;95(9):E1-8.
21. Ottestad I, Hassani S, Borge GI, et al. PLoS One. 2012;7(8):e42550
22. Ebrahimi M, Ghayour-Mobarhan M, Rezaiean S, et al. Acta Cardiol. 2009 Jun;64(3):321-7.
23. Geleijnse JM, Giltay EJ, Grobbee DE, et al. J Hypertens. 2002 Aug;20(8):1493-9.
24. Khan F, Elherik K, Bolton-Smith C, et al. Cardiovasc Res. 2003 Oct 1;59(4):955-62.
25. Braidy N, et al. FEBS J. 2010 Jan;277(2):368-82.
26. Stough C, et al. Psychopharmacology (Berl). 2001 Aug;156(4):481-4.

Watch the Webinar

Felice L. Gersh, M.D. is an award-winning physician, board-certified in both OB/GYN and Integrative Medicine. She has special expertise in the use of female hormones, the impact of environmental toxicants on metabolic and reproductive functions and on all aspects of lifestyle medicine. She graduated from Princeton University and the University of Southern California School of Medicine. She completed her OB/GYN residency at Kaiser Hospital in Los Angeles and was fellowship-trained in integrative medicine at the University of Arizona School of Medicine.  

⁺Dr. Gersh is a paid advisor for Pure Encapsulations.
1. Santoro N. J Womens Health (Larchmt). 2016 Apr;25(4):332-9.