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.

1. Najm A. et al. Int J Mol Sci. 2024 Apr 12;25(8):4300. doi: 10.3390/ijms25084300. PMID: 38673885; PMCID: PMC11050002.
2. Ali S. et al. Gerontology. 2014;60(4):294-305. doi: 10.1159/000356760. Epub 2014 Apr 8. PMID: 24731978; PMCID: PMC4112511.
3. Burtscher J. et al. Front Public Health. 2024 Jan 10;11:1330131. doi: 10.3389/fpubh.2023.1330131. PMID: 38269379; PMCID: PMC10806989.
4. Faitg J et al. Calcif Tissue Int. 2024 Jan;114(1):53-59. doi: 10.1007/s00223-023-01145-5. Epub 2023 Nov 5. PMID: 37925671; PMCID: PMC10791945.
5. Aging Cell. 2016. 15(6):1132-39.
6. J Orthop Translat. 2020. 23:38-52
7. A Gerontol A Biol Sci. 2018. 17:939-45
8. Ferri E et al. Int J Mol Sci. 2020 Jul 23;21(15):5236. doi: 10.3390/ijms21155236. PMID: 32718064; PMCID: PMC7432902.
9. Kubat GB et al. Mitochondrion. 2023 Sep;72:33-58. doi: 10.1016/j.mito.2023.07.003. Epub 2023 Jul 13. PMID: 37451353.
10. Drake JC et al. FASEB J. 2016 Jan;30(1):13-22. doi: 10.1096/fj.15-276337. Epub 2015 Sep 14. PMID: 26370848; PMCID: PMC6137621.
11. Dhillon RJ and Hasni S. Clin Geriatr Med. 2017 Feb;33(1):17-26. doi: 10.1016/j.cger.2016.08.002. PMID: 27886695; PMCID: PMC5127276.
12. Chen N. et al. Eur Rev Aging Phys Act. 2021 Nov 11;18(1):23. doi: 10.1186/s11556-021-00277-7. PMID: 34763651; PMCID: PMC8588688.
13. Ni HJ et al. Arch Gerontol Geriatr. 2022 Mar-Apr;99:104605. doi: 10.1016/j.archger.2021.104605. Epub 2021 Dec 2. PMID: 34922244.
14. Yarasheski KE et al. Am J Physiol. 1999 Jul;277(1):E118-25. doi: 10.1152/ajpendo.1999.277.1.E118. PMID: 10409135.
15. Morley JE et al. J Am Med Dir Assoc. 2010 Jul;11(6):391-6. doi: 10.1016/j.jamda.2010.04.014. PMID: 20627179; PMCID: PMC4623318.
16. Cochet C et al. Nutrients. 2023 Aug 24;15(17):3703. doi: 10.3390/nu15173703. PMID: 37686735; PMCID: PMC10490489.
17. Cedikova M et alPhysiol. Res. 2016;65:S519–S531. doi: 10.33549/physiolres.933538.
18. Prado CM et al. Clin Nutr. 2022 Oct;41(10):2244-2263. doi: 10.1016/j.clnu.2022.07.041. Epub 2022 Aug 7. PMID: 36081299.
19. Romani M et al. Nutrients. 2022 Jan 22;14(3):483. doi: 10.3390/nu14030483. PMID: 35276842; PMCID: PMC8838610.
20. Age and Aging. 2023;52:10.1093
21. Besora-Moreno M et al. Clin Nutr. 2022 Oct;41(10):2308-2324. doi: 10.1016/j.clnu.2022.07.035. Epub 2022 Aug 17. PMID: 36099667.
22. Espín JC, Larrosa M, García-Conesa MT, Tomás-Barberán F. Evid Based Complement Alternat Med. 2013;2013:270418.
23. Heim KC. In: Antioxidant Polymers: Synthesis, Properties, and Applications. Cirillo G, Iemma F, eds. Taylor and Francis, c. 2012
24. Ryu D, et al. Nat Med.2016 Aug;22(8):879-88.
25. Flakoll PJ, et al. J Appl Physiol (1985). 2004 Mar;96(3):951-6.
26. Shimomura Y, et al. J. Nutr. 2006. 136(2); 529- 532.
27. Timmers S, et al. Cell Metab. 2011 Nov 2;14(5):612-22.
28. Goh KP, et al. Int J Sport Nutr Exerc Metab. 2014 Feb;24(1):2-13.
29. Zheng A, Moritani T. J Nutr Sci Vitaminol (Tokyo). 2008 Aug;54(4):286-90.
30. Yago MR, et al. Mol Pharm. 2013 Nov 4;10(11):4032-7.

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

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

1. Introduction
2. A Healthy Barrier and Its Functions
3. A Compromised Barrier
4. Factors that Impact GI Integrity and Lead to a Self-Tissue Response
5. Nutrition, Lifestyle and Health Components
6. Nutrient Solutions to Build the Intestinal Barrier
7. Pure Encapsulations Nutrient Solutions
8. Conclusion
9. Resources

Introduction

The intestinal barrier is more than just a digestive checkpoint - it's a key defender against non-beneficial microorganisms, toxins, and antigens while allowing the body to absorb vital nutrients. When this barrier is compromised, it can lead to a cascade of symptoms, including occasional bloating, abdominal discomfort, irregular bowel movements, and nutrient malabsorption.

One common consequence of a weakened barrier includes intestinal concerns, often triggered by self-tissue response. According to the CDC, over 3.1 million Americans experience intestinal immune concerns,¹ which can disrupt nutrient absorption and weaken overall immunity.

This article will explore the essential nutrients that support the mucosal immune system and strengthen the intestinal barrier, offering insights into how dietary interventions can help maintain gut integrity and overall health.

A Healthy Barrier and Its Functions

The intestinal barrier consists of a monolayer of specialized epithelial cells that line the gut lumen, forming a selectively permeable barrier. These epithelial cells are sealed together by tight junction proteins, including occludin, claudin-1, and zonula occludens-1 (ZO-1).^2,3 Tight junctions function as "gatekeepers," determining what substances can pass through the intestinal lining into the bloodstream while preventing the entry of harmful microorganisms, toxins, and antigens.

The intestinal barrier also includes a mucus layer, which provides physical protection by preventing direct contact between microbes and the epithelial cells. It contains antimicrobial peptides and secretory immunoglobulin A (sIgA), which neutralize non-beneficial microorganisms and contribute to immune defense. This layer is rich in immune cells such as macrophages, dendritic cells, and T-cells, which play key roles in maintaining immune homeostasis.³

The primary functions of the gut barrier include:⁴

• absorption of nutrients
• regulation of immune responses
• maintenance of intestinal homeostasis
• prevention of the translocation of harmful substances
• supporting bidirectional communication between the gut microbiota and the immune system

A Compromised Barrier

When the integrity of the gut barrier is compromised, it can lead to increased intestinal permeability, commonly called "leaky gut." Increased permeability allows larger molecules, such as undigested food particles, toxins, and microbes, to enter the bloodstream, potentially triggering an unbalanced state and immune activation. This, in turn, can lead to persistent intestinal distress and self-tissue response in the intestines, further exacerbating symptoms and contributing to systemic changes.

Factors That Impact GI Integrity and Lead to a Self-Tissue Response

The integrity of the intestinal barrier and the development of a self-tissue response in the intestines is rarely a result of one factor. Instead, it is a multifactorial process influenced by numerous factors, including the health of the microbiome, immune and cytokine responses, and nutrition, lifestyle, and health components.

The Health of the Microbiome

The gut microbiome is a complex ecosystem of nearly 100 trillion microorganisms that maintain mucosal health.² Beneficial microbes such as Bifidobacteria, Lactobacilli, enterococcus, and Clostridium produce short-chain fatty acids (SCFAs), which support tight junction integrity and signaling.²

Conversely, a microbial imbalance resulting from low microbial diversity or gastrointestinal infections can increase intestinal permeability and promote an increased immune response. Evidence suggests that individuals with a self-tissue response in the intestines have a reduction of beneficial bacterial species in the gastrointestinal tract.⁵

The Immune and Cytokine Responses in the Gut

The gut-associated lymphoid tissue (GALT) is an integral part of the immune system, responsible for responding to non-beneficial bacteria while maintaining tolerance to dietary antigens and commensal bacteria. Cytokines such as interleukin-10 (IL-10) promote immune tolerance, whereas excessive production of cytokines like IL-6 and TNF-α disrupt mucosal balance. Activation of these cytokines can perpetuate barrier and tissue changes, contributing to systemic immune activation.^6,7

Nutrition, Lifestyle & Health Components

Nutrition: The Standard American Diet (Western Diet) contains a high intake of refined sugars, processed carbohydrates, red or processed meat, omega-6 fatty acids, and alcohol, exacerbating the body's cytokine balance processes. The way of eating is also partially responsible for decreased bacterial diversity in the gut and contributes to inadequate intake of essential vitamins and minerals. Poor nutrient absorption is a common presentation for people with a self-tissue response in the intestines.^8,9

Conversely, a diet rich in fruits and vegetables, fiber, omega-3 fatty acids, fish, grains, and legumes protects and supports a healthy GI barrier. Studies have shown that eliminating some food groups, such as gluten and dairy or other known food allergies or intolerances, may help reduce GI symptoms and support a self-tissue response.⁹ Special attention should be given to replacing vitamins and minerals, such as B vitamins, vitamin D, electrolytes, and omega-3 fatty acids, as indicated.¹⁰

Lifestyle: Perceived stress that is uncontrolled or not well managed is considered a predictor of the exacerbation of GI symptoms and self-tissue response.¹¹ Poor sleep quality is associated with elevated levels of IL-6, TNF-α, nuclear factor-kB (NF-kB), and CRP (C-reactive protein), known markers of the immune system.¹²

Health Components: General health components such as a history of intake of medications, exposure to environmental toxins and genetic predisposition also play a role in the susceptibility to a compromised intestinal barrier and immune response.

Nutrient Solutions to Build the Intestinal Barrier

Glutamine is the most abundant amino acid in the body. It is the primary energy source for enterocytes (the cells that line the small intestine and colon), utilizing about 30% of total glutamine.^13,14 It also helps maintain healthy intestinal integrity by enhancing the intestine's protective mucosal lining and promotes tissue repair from metabolic stress.^14‡

Studies have demonstrated that L-glutamine supplementation reduces intestinal permeability and supports outcomes in patients with compromised barrier integrity.^13‡

Arabinogalactan, a fiber derived from larch trees, is a prebiotic that promotes the growth of beneficial gut bacteria. such as Bacteroidetes, Bifidobacterium, and Faecalibacterium praisnitzii, which are crucial for proper gut-associated lymphoid tissue (GALT) function and development.¹⁵ These bacteria produce SCFAs, including butyrate, which enhance epithelial integrity and modulate cytokine production.^‡

Arabinogalactan also has immunomodulatory properties, supporting the production of natural killer (NK) cells and promoting mucosal immunity.¹⁶ It may also promote healthy production of cytokines, which mediate cell-to-cell communication between cells involved in the immune response. Its dual role as a prebiotic and immune supporter makes it a valuable addition to protocols to restore gut health.^‡

Perilla (Perilla frutescens) is a traditional herb rich in polyphenols and rosmarinic acid. which promote cytokine balance and antioxidant effects. Its active compounds reduce the production of cytokines such as IL-6 and TNF-α, which are implicated in intestinal immune changes.^17‡

In a randomized, controlled trial involving 50 individuals, 150 mg of Benegut^® Perilla frutescens extract twice daily offered significant support for GI comfort.¹⁸ Perilla also stabilizes mast cells, reducing hypersensitivity reactions that can contribute to mucosal damage.^19‡

Additionally, its antioxidant properties help neutralize reactive oxygen species (ROS), protecting the intestinal lining from oxidative stress.²⁰

Astragalus (Astragalus membranaceus) is a well-known adaptogenic herb with a long history of use in Traditional Chinese Medicine (TCM). It promotes immunity by supporting B and T lymphocyte production, balancing Th1/Th2, and modulating cytokine response.²¹ It also protects the intestinal barrier by upregulating tight junction proteins and secretory IgA (sIgA) production. This key immune component coats the intestinal lining and prevents the adherence of non-beneficial microorganisms.²² Its adaptogenic properties further support resilience against stress, a contributing factor to a compromised intestinal barrier.^23‡

Deglycyrrhizinated licorice (DGL) supports the healing of the GI barrier and other mucous membranes by increasing blood supply to mucosa, increasing the production of mucus, which acts as a protective barrier for the intestinal lining and improves the life span of intestinal cells.^24‡

Pure Encapsulations^® Nutrient Solutions

Pure Encapsulations offers expertly crafted supplements made with high-quality, pure ingredients and supported by verifiable scientific research. These products are designed to complement personalized care plans.^‡

Epi-Integrity powder: is a carefully formulated blend of glutamine, prebiotic fiber, and herbal extracts that support the modulation of mucosal immune responses and promote gastrointestinal (G.I.) barrier integrity. It helps maintain a balanced microbiome, provides mucosal protection, and supports epithelial cell health for optimal gut function.^‡

Suggested Use: 1 scoop, 1-2 times daily. Add 1 serving to 8 oz of water or juice. Shake or stir until dissolved.

Conclusion

Restoring intestinal barrier integrity and supporting mucosal immune responses are essential for addressing symptoms associated with self-tissue responses in the gut. Healthcare providers can leverage evidence-based nutritional strategies to address the underlying factors contributing to a compromised barrier. Nutrients such as L-glutamine, arabinogalactan, perilla, Astragalus, and DGL offer targeted support for mucosal repair, cytokine modulation and immune balance.^‡

Resources

Gastrointestinal Self-Tissue Response Protocol: Designed by our scientific and medical advisors to help you deliver the most effective care and support for your patient's intestinal health.^‡

Drug-Nutrient Interaction 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.

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Intestinal Permeability: Evidence-Based Approaches to Supporting Gut Barrier Function

Presented by: Kelly Heim, Ph.D.⁺

Intestinal barrier hyperpermeability ("leaky gut") is a common and often overlooked feature of gastrointestinal, immunological and metabolic health. The integrity of the gut barrier is influenced by health status, dietary composition, medications, microbiota and diverse lifestyle factors. Despite over 50 years of research and thousands of scholarly publications on intestinal permeability, clinical approaches are subject to guesswork and trial and error. This webinar will distill the current clinical evidence and provide practical, evidence-based strategies to support and maintain a healthy gut barrier.

Learning objectives:

• Define "leaky gut" and its underlying causes


• Recognize the systemic impact of gut barrier integrity on metabolic, immune and mental health


• Describe simple dietary and lifestyle-based interventions that enhance or maintain intestinal barrier integrity


• Review current evidence-based modalities and condition-specific interventions that support and maintain gut barrier integrity