Insomnia is the chronic inability to sleep or to remain asleep through the night. The condition is caused by a variety of physical and psychological factors. These include emotional stress, physical pain and discomfort, disturbances in brain function, drug abuse and drug dependence, neuroses, psychoses, and psychological problems that produce anxiety, irrational fears, and tensions. Conventional medical treatments may include giving sedatives, tranquilizers or hypnotics, psychotherapy, and exercise. However, there are also a variety of natural substances, which may help. These are discussed below.

MELATONIN

Melatonin is a hormone produced by the small, pea-shaped pineal gland located in the brain. During daylight hours, light entering the eye stimulates neurons to transmit impulses to the pineal gland that inhibit melatonin secretion. But at night, the pineal gland is able to release melatonin, which causes relaxation and initiates the sleep cycle.

As the body ages, it produces less melatonin—which may explain why elderly people often have difficulty sleeping1 and why melatonin supplements improve sleep in the elderly.2 This does not mean that the use of melatonin should be limited to the elderly. Other research has shown that non-elderly adults with insomnia can also have lower melatonin levels.3 Also, research has demonstrated that melatonin even helps facilitate sleep in young adults.4 An appropriate dose would be 3–6 mg melatonin taken one hour before bedtime.

VALERIAN ROOT

Valerian root is considered by many to be the "granddaddy" of all sleep-promoting herbs, and is the leading herb for insomnia in modern herbal medicine. Valerian root makes getting to sleep easier and increases deep sleep and dreaming. Valerian does not cause the morning "hangover" which is a common side effect of prescription sleep drugs and melatonin in some individuals.5,6 By itself, a valerian root supplement (standardized for percent of valerenic acid), in doses of 300–400 mg can be taken thirty minutes before bedtime. Also, Valerian may be combined with other herbs. For example, one German study compared the effect of a combination product containing an extract of valerian root (320 mg at bedtime) and extract of lemon balm, Melissa officinalis, with the sleeping drug Halcion®.7 After monitored sleep for nine nights, the herbal duo matched Halcion in boosting the ability to get to sleep as well as in the quality of sleep. However, the Halcion group felt hung over and had trouble concentrating the next day, while those taking the valerian/lemon balm combination reported no negative effect.

HOPS

Hops have a history of use as nature's best sleep "inducer." Though many natural substances are more effective at keeping one asleep, Hops is often considered best at inducing sleep. The German Commission E recommends Hops for anxiety or insomnia.8

PASSION FLOWER

Passion flower has been, and continues to be an extremely popular herb in Europe where it is often used to induce relaxation and sleep. In the United States, however, medical use of the herb did not begin until the late nineteenth century when passion flower was used to treat nervous restlessness and gastrointestinal spasms—the belief being that passion flower worked primarily on the nervous system, particularly for anxiety due to mental worry and overwork.9 Research has demonstrated that the flavonoids in passion flower are the primary constituents responsible for its relaxing and anti-anxiety effects.10

SCULLCAP

Scullcap has been used historically and in modern times as a sedative for people with nervous tension as well as for insomnia. Unfortunately, very few studies have been conducted on Scullcap. However, one double-blind, placebo-controlled study11 of healthy subjects demonstrated noteworthy anxiolytic (anxiety-reducing) effects from Scullcap. Also, one of Scullcaps constituents known as scutellaria has been shown to have mild sedative and antispasmodic actions in animal research.12

GRIFFONIA SIMPLICIFOLIA (5-HTP)

5-Hydroxy-L-Tryptophan (5-HTP) is a natural peptide, which the human body uses to make the neurotransmitter serotonin. Serotonin is important for normal nerve and brain function, and plays an important role in sleep. In fact, your body can convert serotonin into melatonin.13 The concept is that by taking supplemental 5-HTP your body should be able to make serotonin, which ultimately, should help promote sleep. In fact, in one placebo-controlled trial 5-HTP was able to improve the duration and depth of sleep in individuals with insomnia.14 In addition, 5-HTP was able to improve sleep quality in a preliminary trial of people with fibromyalgia.15 Commercially, 5-HTP can be derived from the seeds of a West African plant called Griffonia simplicifolia. Some Griffonia extracts are standardized to 10 percent 5-HTP.

GABA

Gamma-Amino Butyric Acid (GABA) is a natural peptide, which is manufactured from the amino acid glutamine and glucose. In the central nervous system, GABA exerts anticonvulsant, sedative, and anxiolytic effects at the cellular level.16,17 GABA supplements appear to promote relaxation and sleep.18 GABA itself does not cause drowsiness. Instead, by easing anxiety, it simply makes it easier to fall asleep.

DIET AND/OR OTHER CONSIDERATIONS

For many insomniacs, avoiding caffeine may be an absolute necessity. After all, caffeine is a well-known stimulant, which can keep you awake.19 Now if you're thinking, "Fine, I'll just make sure not to have any coffee in the evening," you may be in for a disappointment. The effects of caffeine can last up to twenty hours,20 so you may need to stop drinking coffee altogether. Now besides regular coffee, black and green tea, cocoa, chocolate, some soft drinks, and many over-thecounter pharmaceuticals also contain caffeine, so be sure to limit or avoid the intake of these items as well. Another dietary consideration is that eating high-carbohydrate food before bedtime, such as a slice of bread or some crackers, can significantly increase serotonin levels in the body—and the neurotransmitter serotonin is known to reduce anxiety and promote sleep.

Non-dietary considerations include stress and smoking. Insomnia can be triggered by, or exacerbated by psychological stress. Dealing with that stress through counseling has helped in many studies.22 Another method of intervention, which has helped is listening to relaxation tapes.23

In addition, research has shown that smokers are more likely to have insomnia than non-smokers,24 which is one more good reason for smokers to quit.

Another non-dietary approach to insomnia can include lavender oil. The volatile or essential oil of lavender contains many medicinal components, including perillyl alcohol, linalool, and geraniol. The oil is calming25 and thus can be helpful in some cases of insomnia. One study of elderly persons with sleeping troubles found that inhaling lavender oil was as effective as tranquilizers.26 The German government approves lavender for people with insomnia.27

References

  1. Haimov I, et al, BMJ (1994) 309:167.
  2. Singer C, et al, J Am Geriatr Soc (1996) 44:51 [abstr #A1].
  3. Attenburrow MEJ, et al, BMJ (1996) 312:1263–64.
  4. Zhadanova IV, et al, Clin Pharmacol Ther (1995) 57:552–58.
  5. Leathwood PD, Chauffard F, Planta Medica (1985) 51:144–48.
  6. Leathwood PD, et al, Pharmacol Biochem Behav (1982) 17:65–71.
  7. Dressing H, et al, Therapiewoche (1992) 42:726–36.
  8. Blumenthal M, et al. (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines (1998) Austin: American Botanical Council and Boston: Integrative Medicine Communications, pp. 147.
  9. Foster S, Herbs for Your Health (1996) Interweave Press, Loveland, Colorado, pp. 68–9.
  10. Meier B, Zeitschrift Phytother (1995) 16:115–26.
  11. Wolfson P, Hoffmann DL. An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers. Alternative therapies in health and medicine 2003; 9(2):74-8.
  12. Foster S. Herbs for Your Health. Loveland, CO: Interweave Press, 1996, 86–7.
  13. Guyton AC, Hall JE. Textbook of Medical Physiology, 9th ed. Philadelphia: W. B. Saunders, 1996.
  14. Soulairac A, Lambinet H. Etudes cliniques de líaction du precurseur de la serotonine le L-5-hydroxy-tryptophane, sur les troubles du sommeil. Schweiz Bundschau Med (PRAXIS) 1998;77(34a):19–23.
  15. Puttini PS, Caruso I. Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90 day open study. J Int Med Res 1992;20:182–9.
  16. Kalant H, Roschlau WHE, Eds. Principles of Med. Pharmacology. New York, NY: Oxford Univ Press, 1998.
  17. Bloom FE, Kupfer DJ. Psychopharmacology: The Fourth Generation of Progress. New York, NY: Raven Press, Ltd., 1995.
  18. GABA. WholeHealthMD.com. Accessed on December 1, 2005 from http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10027,00.html.
  19. Weiss B, Laties VG, Pharmacol Rev (1962) 14:1–36.
  20. Hollingworth HL, Arch Psychol (1912) 20:1–66.
  21. Blum I, et al, Metabolism (1992) 41:137–40.
  22. Morin CM, Culbert JP, Schwartz SM, Am J Psychiatr (1994) 151:1172–80.
  23. Fuerst ML, JAMA (1983) 249:459–60.
  24. Phillips BA, Danner FJ, Arch Intern Med (1995) 155:734–7.
  25. Buchbauer G, et al, Z Naturforsch [C] (1991) 46:1067–72.
  26. Hardy M, Kirk-Smith MD, Stretch DD, Lancet (1995) 346:701 [letter].
  27. Blumenthal M, et al, (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines (1998) Austin: American Botanical Council and Boston: Integrative Medicine Communications, pp. 159–60.

Recipe Perspective
Soups, of new varieties this foodie doctor has never heard of, are a stable in Ecuador and served with most meals as the first of several courses. I have always been a soup lover and learned how to make soup from almost anything being raised by a South American paternal grandmother. Therefore, my new test kitchen has been very busy adapting recipes to healthier nightshade- free versions of local delicacies for my international readers and patients.

Historical Perspective
In Ecuador, they make this soup from potatoes. Since my passion and goal is education against foods that "ignite" inflammation, I had to not only adapt the recipe but also work with local farmers to begin raising what American's know as white sweet potatoes—Ecuadorians call them camoté blanco salado. Fortunately, the soil and climate is perfect for any genre of potatoes so it wasn't a challenge, it just took education. The rate of inflammatory diseases is very high in most South American countries; as it is in America, so my task is to help them, and you, find healthy tasty alternatives…stay tuned for my monthly recipe article.

Ecuadorian Locro de Camoté Salado

(white sweet potato soup) with Cheese

Ingredients

  • 10 medium-sized white sweet potatoes, peeled and chopped into small pieces
  • 2 tablespoons coconut oil (you can use another healthy oil of choice but the flavor is best with coconut oil)
  • 1 white onion, diced
  • 2 garlic cloves, minced
  • 2 tsp cumin powder
  • 1 tsp achiote powder (also known as Annatto powder and often available in ethnic Latin or Asian markets)
  • 7 cups of water or organic chicken broth
  • 1 cup milk (or milk alternative such as coconut), or more to taste
  • 1 cup grated or crumbled cheese (quesillo, queso fresco, mozzarella or Monterey jack—make sure the cheese is one that easily melts)
  • 1 bunch cilantro, leaves only, minced
  • Salt/Pepper to taste
To serve:
  • 1 cup of queso fresco, feta cheese, or grated mozzarella
  • Finely chopped cilantro and green onions
  • Avocados, sliced or diced

Instructions:

  1. Prepare a refrito (sauté), base for the soup, by heating the oil over medium heat in a large soup pot; add the diced onions, minced garlic cloves, cumin, and achiote powder. Cook, stirring frequently until the onions are tender, about 5 minutes.
  2. Add the white sweet potatoes to the pot and mix until they are coated. Continue cooking for about 5 minutes, stirring every couple of minutes.
  3. Add the water and/or broth and bring to boil, cook until the white sweet potatoes are very tender. Use a potato masher to mash the potatoes in the pot, don't mash all of them; the consistency of the soup should be creamy with small tender chunks of potatoes.
  4. Turn the heat down to low, stir in the milk and let cook for about 5 more minutes. You can add more milk if the soup is too thick. NOTE: A delicious non-dairy alternative is to use almond or coconut milk (rice milk is too high in carbs but can be used).
  5. Add salt to taste
  6. Add the grated cheese and cilantro, mix well, and remove from the heat.
  7. Serve warm with the avocados, scallions, queso or feta cheese.

Ingredient Perspective:
Achiote Powder: Used as both a spice and food colorant, it is a bright hued ingredient that brings a mild sweet and earthy aroma to a variety of Latin American and Southeast Asian recipes and is also called the Cuban Turmeric. It is made from annatto seeds and its taste is commonly described as a subtle flavor of nuts, a peppery aroma, sweet, and earthy. In natural food products, it is used to color foods like butter, cheddar, and a variety of other cheeses.

The high level of fiber found in annatto seeds, as well as the edible leaves of the achiote plant, means that it can be very good for human digestion by promoting the smooth passage of food through the bowels and the efficient uptake of nutrients.

This is the brand we find here in Ecuador but most Latin and Asian markets have it readily available.

More History: Rainforest tribes have used annatto seeds and leaves for a variety of medicinal purposes for centuries.

As reported by Phyllis A. Balch, CNC in her book Prescription for Nutritional Healing, annatto contains amino acids, calcium, iron and phosphorus, as well as vitamins B-2 and B-3. Annatto also contains beta-carotene and vitamin C, both potent antioxidants that help to prevent free-radical induced damage to your cells and DNA. In addition, annatto contains the phytochemicals cyanidin, ellagic acid, salicylic acid, saponins and tannins. Phytochemicals are compounds found naturally in plants that help to prevent and treat disease in humans.

Annatto seeds and leaves have diuretic, antibacterial and astringent properties. In addition, Balch states that annatto seeds and leaves help to protect and strengthen the kidneys. Annatto is also said to promote digestive system health and is used to relieve constipation, indigestion, heartburn and stomach distress caused by the consumption of spicy foods. Annatto has been traditionally used as an aphrodisiac and to promote weight loss, as well as to treat fevers, hepatitis, malaria, dysentery and venomous snakebites. These uses are based on anecdotal and not scientific evidence, however.

Cumin Powder: The health benefits of cumin include its ability to aid digestion, improve immunity and treat hemorrhoids, insomnia, respiratory disorders, asthma, bronchitis, common cold, lactation, anemia, skin disorders, boils and cancer.

White Sweet Potatoes: Sweet potatoes are an excellent source of vitamin A (in the form of beta-carotene). They are also a very good source of vitamin C, manganese, copper, pantothenic acid and vitamin B6. Additionally, they are a good source of potassium, dietary fiber, niacin, vitamin B1, vitamin B2 and phosphorus.

Coconut Oil: The health benefits of this amazing oil are too extensive to list, the following is a small sampling. It's important to note that medical science is now confirming how coconut products are health-enhancing for many disorders and diseases. Published studies in medical journals show that coconut, in one form or another, provides a wide-range of health benefits as listed below, but not limited to:

  • Kills viruses that cause influenza, herpes, measles, hepatitis C, SARS, AIDS, and other illnesses.
  • Kills bacteria that cause ulcers, throat infections, urinary tract infections, gum disease and cavities, pneumonia, and gonorrhea, and other diseases.
  • Kills fungi and yeasts that cause candidiasis, ringworm, athlete's foot, thrush, diaper rash, and other infections.
  • Expels or kills tapeworms, lice, giardia, and other parasites.
  • Improves digestion and absorption of other nutrients including vitamins, minerals, and amino acids.
  • Improves insulin secretion and utilization of blood glucose.
  • Relieves stress on pancreas and enzyme systems of the body.
  • Reduces symptoms associated with pancreatitis.
  • Helps relieve symptoms and reduce health risks associated with diabetes.
  • Improves calcium and magnesium absorption and supports the development of strong bones and teeth.
  • Helps protect against osteoporosis.
  • Helps relieve symptoms associated with gallbladder disease.
  • Relieves symptoms associated with Crohn's disease, ulcerative colitis, and stomach ulcers.
  • Improves digestion and bowel function.
  • Reduces inflammation.
  • Supports tissue healing and repair.
  • Supports and aids immune system function.
  • Is heart healthy; improves cholesterol ratio reducing risk of heart disease.
  • Helps protect against kidney disease and bladder infections.
  • Supports thyroid function.
  • Promotes loss of excess weight by increasing metabolic rate.
  • Does not form harmful by-products when heated to normal cooking temperature like other vegetable oils do.
  • Has no harmful or discomforting side effects.
  • Is completely non-toxic to humans.

Cilantro: This herb is not just a side dish for Mexican food, in fact, far from it. This nutritious herb looks very much like parsley, that is, until you taste it.

Cilantro is widely known for its ability to detoxify the body. According to Dr. Edward Group, CEO of the Global Healing Center—“Cilantro is most often cited as being effective for toxic metal cleansing and rightfully so, this herb is a powerful, natural cleansing agent. The chemical compounds in cilantro bind to toxic metals and loosen them from the tissue.” That said, a word of caution, always work with a trusted wholistic healthcare provider—when it comes to detoxification issues—because once these toxins are ‘mobilized,' one must be sure to quickly eliminate these poisons from the body to avoid physical harm and a healing crisis.

Cilantro is a very good source of vitamins A, C, K and traces of the B vitamins. In the minerals department, it provides high amount of calcium and potassium. In addition, cilantro is rich in iron, manganese and sodium. Remember, especially these days, how important it is to keep the body rich in minerals.

Garlic and Onion (Allium genre): Contains potent medicinal properties from its main component called allicin—a plant in the allium (onion) family closely related to onions, shallots and leeks. Allicin enters the body from the digestive tract and then travels throughout the body where it exerts its potent biological health properties. Garlic is known to boost your immune defenses. One large study found that a daily garlic supplement reduced number of colds by 63 percent. High doses of garlic appear in studies to improve blood pressure (hypertension) as well as help reduce total cholesterol. The heavy dose of antioxidants in garlic protect against cell damage and aging, and researchers now believe it can reduce the risk of Alzheimer's and dementia.

Locro de papa is more common in the Andes highlands (where my health sciences division is located), specifically in the high Andes region of Ecuador. Quito (the capital of Ecuador) probably has the biggest claim on this soup, it is even known as locro quiteño by some. Like many Ecuadorian dishes, the ingredients and preparation will vary from one city to another. Some variations of the locro de papa add fresh corn to the soup, others add chopped cabbage or leafy greens. There's even a variation with blood sausage called yaguarlocro. Recently, one of my friends made my recipe for Locro de Camoté Salado without cheese because she is dairy-intolerant and used fresh finely ground peanuts instead; the soup was good but I missed the cheese. In Quito and the northern part of Ecuador they usually serve this potato soup with maiz tostado or Andean corn nuts—which, for me, brings back memories of hiding them as a child in my school bag to munch on during class. It can be served as a first course, but is satisfying and filling enough to make a complete meal.

Chronic insomnia can contribute to the development of many illnesses including heart disease, diabetes and cancer. A vast majority of sleep problems are due to faulty brain chemistry, but there are often contributing factors in other parts of the body such as the digestive process, the liver, the kidneys, etc. This is important because concentrating only on the brain may not resolve the sleep problem.

Getting a proper diagnosis is the key and doctors trained in holistic medicine can properly diagnose these complicated sleep issues. They treat the whole body while most sleep specialists treat only the brain with reliance on prescription medications. This can produce short-term success, but not sustainable solutions since the root of the problem may not have been addressed.

Assuming that any non-brain related issues have been addressed we can now fix the brains chemistry. Sleep is crucial to our overall health because it is during sleep that the brain and the body re-energize, detoxify and re-balance. For example, it is during sleep that the body attempts to balance acid and alkalinity in the blood. A proper pH of 7.0 –7.4 in the urine, upon waking, is vital to the health of every part of our body. Disease does not thrive in a body with a balanced pH. If you did not eat enough vegetables and ate too much meat, dairy, sugar and processed foods your body will steal minerals from your bones and muscles to achieve this balance.

THINGS TO AVOID INCLUDE: Alcohol—Tobacco—Caffeine—Cold medicines late at night—Eating before bedtime—Exercise close to bedtime— Eating foods such as bacon, cheese, ham, eggplant, spinach, sauerkraut, sugar, sausage, chocolate, tomatoes, wine or potatoes close to bedtime. These foods contain norepinephrine a brain stimulant that can impede sleep.

THINGS TO INCLUDE: Exercise in the late afternoon—Hot bath one to two hours before bedtime— Music—Meditation—Consistent bedtime—Eating foods such as bananas, figs, dates, nut butters, tuna, turkey, whole grains and yogurt, because these foods contain tryptophan, which helps make melatonin and is very beneficial to good sleep.

SUPPLEMENTS THAT IMPROVE SLEEP: Calcium, magnesium, vitamin B, vitamin C, Zinc, Melatonin, 5-Htp, DHEA, Chamomile, GABA Calm (an actual product name), Kavinace PM (an actual product name) and natural hormone replacement (plant based hormones).

Every sleep problem can be different so be certain to get a proper diagnosis from a Holistic Medical Doctor and incorporate these recommendations.

Omega-3 Fatty Acids

Omega-3 fatty acids-eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)-are derived from fish oils of cold water fish (salmon, trout, or most commonly menhaden fish) and flaxseed. Omega-6 fatty acids-linoleic acid (LA) and gamma-linolenic acid (GLA)-are derived from the oils of seeds such as evening primrose, black currant, and borage. Often, fatty acids are added to the diet with other supplements to attain an additive effect.

In transplanted tumor models, omega-3 fatty acids reduced tumor development while omega-6 fatty acids stimulated tumor development. Omega-3 fatty acids have been shown to inhibit tumor growth as well as the spread of cancer. Reduced radiation damage in the skin was also seen following supplementation with omega-3 fatty acids.

The use of omega-3 fatty acids can promote weight gain and may have anticancer effects, and warrants special mention. In people, the use of omega-3 fatty acids, such as those found in fish oils, improves the immune status, metabolic status, and clinical outcomes of cancer patients. These supplements also decrease the duration of hospitalization and complication rates in people with gastrointestinal cancer. In animal models, the omega-3s inhibit the formation of tumors and metastasis. Finally, omega-3 supplementation shows anticachetic (anti-wasting) effects.

Note: Flaxseed oil is a popular source of alpha-linoleic acid (ALA), and omega-3 that is ultimately converted to EPA and DHA. However, many species of pets (probably including dogs) cannot convert ALA to these other more active non-inflammatory omega-3s. Also, flaxseed oil contains omega-6, which are not recommended in pets with cancer. In one study in people, flaxseed oil was ineffective in reducing symptoms or raising levels of EPA and DHA. While flaxseed oil has been suggested as a less smelly substitute for fish oil, there is no evidence that it is effective when used for the same therapeutic purposes as fish oil. Therefore, supplementation with EPA and DHA is important, and this is the reason flaxseed oil is not recommended as the sole fatty acid supplement for pets.

While many doctors use fatty acids for a variety of medical problems, there is considerable debate about the use of fatty acids. The debate concerns several areas.

Dosages
What is the "best" dose to use in the treatment of pets? Most doctors use anywhere from two to ten times the label dose. The recommended dosage for pets with cancer is approximately 1500 mg/100 kcal of food. In order to get this dose, depending upon the product selected, you would need to feed your dog about five capsules per 100 kcal of diet. This is a LOT of fatty acid capsules!

Is supplementation with fatty acid capsules or liquids the best approach, or is dietary manipulation preferred for treatment of cancer? There is one diet, Prescription Diet n/d, made for dogs with cancer. This diet contains the "proper" amount of omega-3 fatty acids, and it is impossible to add enough fatty acids in the form of supplements to equal the amount found in this diet. However, the protein source, beef lung, is not the most wholesome protein source, which is a concern for holistic pet owners. Many owners use some of the n/d with a homemade diet plus additional fatty acids to achieve a compromise.

Studies done in dogs with lymphoma and nasal tumors have shown that dogs eating the n/d showed increased disease-free intervals and survival times when compared with similarly treated dogs not eating this diet. While research has not been reported in dogs with other cancers or in cats with cancers, it is recommended to use fatty acid supplementation in pets with any kind of cancer due to the potential benefit.

Fish Oils For Pets

Since fish oils can easily oxidize and become rancid, some manufacturers add vitamin E to fish oil capsules and liquid products to keep the oil from spoiling. (Others remove oxygen from the capsule.)

The bottom line is there are many questions regarding the use of fatty acid therapy. More research is needed, as well as the proper dosage needed to achieve clinical results. Until definitive answers are obtained, you will need to work with your doctors to determine the use of these supplements for your pet.

Fish oil appears to be safe. The most common side effect is a fish odor to the breath or the skin.

Because fish oil has a mild "blood-thinning" effect, it should not be combined with powerful blood-thinning medications, such as Coumadin (warfarin) or Heparin, except on a veterinarian's advice. Fish oil does not seem to cause bleeding problems when it is taken by itself at commonly recommended dosages. Also, it does not appear to raise blood sugar levels in people or pets with diabetes.

Flaxseed Oil For Pets

Flaxseed oil is derived from the seeds of the flax plant and has been proposed as a less smelling alternative to fish oil. Flaxseed oil contains alpha-linolenic acid (ALA), an omega-3 fatty acid that is ultimately converted to EPA and DHA. In fact, flaxseed oil contains higher levels of omega-3 fatty acids (ALA) than fish oil. It also contains omega-6 fatty acids.

As mentioned, many species of pets (probably including dogs and cats) cannot convert ALA to these other more active non-inflammatory omega-3 fatty acids. In one study in people, flaxseed oil was ineffective in reducing symptoms or raising levels of EPA and DHA. While flaxseed oil has been suggested as a substitute for fish oil, there is no evidence that it is effective when used for the same therapeutic purposes as fish oil. Unlike the case for fish oil, there is little evidence that flaxseed oil is effective for any specific therapeutic purpose.

Therefore, supplementation with EPA and DHA is important, and this is the reason flaxseed oil is not recommended as the sole fatty acid supplement for pets. Flaxseed oil can be used to provide ALA and as a coat conditioner.

Flaxseed oil also contains lignans, which are currently being studied for use in preventing cancer in people. To date, we have no information to recommend their use in pets with cancer.

The essential fatty acids in flax can be damaged by exposure to heat, light, and oxygen. For this reason, you shouldn't cook with flaxseed oil. A good product should be sold in an opaque container, and the manufacturing process should keep the temperature under 100 degrees F. Some manufacturers combine the product with vitamin E because it helps prevent rancidity.

The best use of flaxseed oil is as a general nutritional supplement to provide essential fatty acids. It appears to be a safe nutritional supplement when used as recommended.

Glycoproteins
Glycoproteins are protein molecules bound to carbohydrate molecules. Glycoprotein molecules coat the surface of every cell with a nucleus in the human body. The body uses the glycoproteins on cell surface glycoconjugates as communication or recognition molecules. These communications may then result in other cellular events, including secretion of bioactive substances (interferon, interleukin-1, complement), ingestion of bacteria and cell debris, inhibition of adherence necessary for bacterial infection, and the spread of cancer cell metastasis.

Scientists have identified eight sugars, glycoforms, found on human cell surfaces that are involved in cellular recognition processes. Of the 200 such sugars occurring naturally in plants, to date only these eight have been identified as components of cellular glycoproteins. These eight sugars that are essential for glycoconjugate synthesis (mannose, galactose, fucose, xylose, glucose, sialic acid, N-acetylglucosamine, N-acetylgalactosamine) can be readily absorbed and directly incorporated into glycoproteins and glycolipids.

Research has found specific cell surface glycoforms to be characteristic of many disease conditions. In some people with rheumatoid arthritis, some of these patients' defense cells (IgG antibody) bear malformed glycoproteins. These cells are missing required galactose molecules; the extent to which the galactose molecules are missing correlates with disease severity and reverses in disease remission. In people with cancer, more than 20 different malignancies are known to be associated with characteristic glycoproteins.

Glyconutritional supplements are designed to provide substrates for the body to use in building part of the glycoconjugates on cell surfaces. These supplements, most commonly acemannan and mannose, are designed to make the necessary sugars available to the cells quicker and in greater quantity.

Acemannan is a glycoprotein (a long chain of mannan polymers with random o-acetyl groups) derived from the aloe vera plant that has been shown to increase the body's production of immune-modulating chemicals, including interleukins 1 and 6, and Prostaglandin E2 and tumor necrosis factor alpha by macrophages. Acemannan also enhances macrophage phagocytosis and nonspecific cytotoxicity, which increases the ability of white blood cells (macrophages) to destroy infectious organisms. Glycoproteins such as acemannan also offer antiviral activity as well as bone marrow stimulating activity.

Scientific Evidence
Acemannan has been approved as an adjunct therapy for solid tumors called fibrosarcomas. Intralesional injection into the tumor (2 mg weekly for up to six weeks), combined with intraperitoneal injections (1 mg/kg of body weight given weekly for six weeks, followed by monthly injections for one year), has been shown to be effective in shrinking tumors (via necrosis and inflammation).

All eight of the glycoconjugate sugars are readily absorbed from the intestines when taken orally. Studies has shown intact mannose molecules are rapidly absorbed from the intestine of rats into the blood, elevate the blood mannose levels by 3-to 10-fold, and is cleared from the blood within hours. The conclusion reached was that mannose was absorbed from the intestinal tract into the blood and from the blood into the cells. These studies suggest that dietary mannose may make a significant contribution to glycoforms synthesis in mammals.

Other human and animal ingestion studies show mannose is readily absorbed, and is cleared from the blood over several hours; some of the mannose was incorporated into glycoproteins. After absorption into the blood, glycoconjugate sugars generally become distributed (usually as glycoproteins and glycolipids) into body fluids, organs, and various body tissues.

In one study, healthy humans were given radiolabeled galactose, mannose, or glucose. This study showed galactose and mannose were directly incorporated into human glycoproteins without first being broken down into glucose. The conclusion was specific dietary sugars could represent a new class of nutrients and the use of these nutrients could have important consequences. Therapy with mannose offers a treatment that is easy to administer and is nontoxic.

Most of the essential glycoconjugate sugars have demonstrated an ability to inhibit cancer growth and the spread of tumor cells both in vitro and in vivo (in experiments in pets and people). The ability of the glycoproteins to inhibit tumor growth may be related to their ability to alter the activities of the immune system. Glycoconjugate sugars stimulate white blood cells (macrophages), which secrete interferons. The interferons activate natural killer cells that help eliminate cancer cells. The glycoproteins may inhibit the spread of tumor cells by preventing them from adhering to each other as a result of competitive inhibition of glycoconjugate receptor binding.

Adverse effects caused by glycoconjugate sugars are rare and usually occur when they are injected or when doses greatly exceed levels that would be expected in normal diets. For pets being treated with the most commonly used glycoproteins (acemannan and mannose), side effects would not be expected.

The final part of our cancer in pets series concludes next month. We will discuss the use of antioxidants, and conventional therapies such as surgery, radiation and chemotherapy.

A 2016 survey conducted by the National Coffee Association revealed that an average of about 56 percent of all Americans 18 years and older drink coffee daily.1 Likewise, on any given day, more than 50 percent of the American population drinks tea.2 Unquestionably, that represents a lot of caffeine being consumed—but is that a good thing or a bad thing? The answer is that it could be either, depending upon the individual. This article will examine the pros and cons of caffeine, but first let's take a look at the common sources of caffeine, and how much of caffeine is provided in each.

Caffeine sources
Coffee and tea are the most prevalent sources of caffeine. An 8 oz. cup of brewed coffee can contain 95–200 mg of caffeine—depending upon who is brewing it. An 8 oz. cup of brewed black tea provides 14–70 mg, and green tea provides 24–45 mg. Cola drinks (regular or diet), provide 23–39 mg per 12 oz. can, and MTN DEW® provides 42–55 mg of caffeine. Energy drinks provide varying amounts of caffeine: 200–207 mg in a 2 oz. 5-Hour Energy shot, and 70–80 mg in a 8.4 oz. can of Red Bull®. Over-the-counter medications can also contribute to total caffeine intake: 65 mg/tablet of Excedrin® Extra Strength, and 200 mg/tablet NoDoz® Max Strength. Even chocolate provides caffeine—104 mg in one cup of semisweet chocolate chips.3 Of course some dietary supplements also contain caffeine. The caffeine may be added as concentrated caffeine anhydrous, or as part of herbal botanical extracts. Guarana, Maté (yerba maté) and cola nut (bissy nut) are examples. The amounts of caffeine provided in the herbs can vary greatly depending on how the herb is processed and concentrated.

Now let's take a look at caffeine's benefits.

The benefits of coffee and caffeine

Despite years of negative press about caffeine, there are, in fact, quite a few significant benefits associated with caffeine intake—and those benefits go beyond energy and weight loss. Following is a brief overview.

Asthma: The use of caffeine in people with asthma has been shown to modestly improve airway function for up to 4-hours in people.4

Diabetes: Consumption of caffeine from beverages such as coffee or tea is associated with a lower risk of developing type 2 diabetes. What's more, this effect appears to be dose-dependent: 200 mg/day caffeine is associated with a 14 percent decrease in the incidence of type 2 diabetes,5 while 417 mg/day caffeine is associated with 20 percent lower risk of developing type 2 diabetes.6

Energy: Caffeine has been shown to reduce fatigue, reduce sleepiness and provide general energizing effects.7,8,9,10,11

Exercise: Research has demonstrated that caffeine increases muscle strength by seven percent and physical endurance by 14 percent,12 and can even decrease subjective feelings of exertion and fatigue during such exercise as fencing and cycling.13

Gallbladder Disease: Also dose-dependent, consumption of caffeine beverages providing 400 mg/day or more caffeine is significantly reduces risk of developing gallstone disease, while 800 mg/day caffeine has the greatest reduction in risk.14 Hypotension: Consuming caffeine beverages has been shown to increase blood pressure in elderly people with low blood pressure following a meal.15

Memory: Memory function was improved in individuals taking 65–200 mg/day caffeine. In research, this included those with extraverted personalities, and college students.16,17,18 Mental Alertness: Caffeine is FDA-approved to help "restore mental alertness or wakefulness during fatigue or drowsiness."19 Other studies have similarly shown that caffeine is beneficial for promoting long-term memory, and improving mental alertness.20,21,22

Migraine Headache: The use of caffeine orally in combination with acetaminophen, aspirin23, and/or sumatriptan24 (a medication used for the treatment of migraine and cluster headaches) is effective for treating migraine headache. In fact, caffeine is FDA-approved for use with analgesics for the treatment of migraine.

Pain: The use of caffeine in combination with pain-relieving agents such as acetaminophen and ibuprofen can reduce acute pain better than pain-relieving agents alone.25

Parkinson's Disease: Large epidemiological studies indicate that people who consume caffeine-containing beverages, such as coffee, tea, and cola, have a decreased risk of Parkinson's disease.26,27

Tension Headache: The use of caffeine in combination with analgesics is effective for treating simple tension headaches.28 As with migraine headaches, caffeine is also FDA-approved for use with analgesics for improving pain relief associated with tension headaches.

Weight Loss: Research has shown that consumption of 100–400 mg/day caffeine increased energy expenditure (calories burned), and thermogenesis (fat burning) and metabolic rate.29,30,31 Caffeine was even found to help reduce waist circumference and body weight.32

Contraindications for caffeine intake
In general, some people are sensitive to caffeine and get the "caffeine jitters" even with relatively small amounts of caffeine, while other people seem to have no negative effects associated with caffeine intake. Clearly, those who are sensitive to caffeine should avoid it since it may cause them to experience insomnia, nervousness, restlessness, gastric irritation, nausea, quickened respiration, tremors, premature heartbeat, arrhythmia and excessive urination (although this latter symptom may occur in anyone who consumes caffeine).33,34,35

It should also be noted that, although acute administration of caffeine can cause increased blood pressure, regular consumption does not seem to increase either blood pressure or pulse, even in mildly hypertensive patients.36,37,38 Also, evidence regarding the relationship between caffeine use and the risk for osteoporosis is contradictory. Caffeine can increase urinary excretion of calcium. However, moderate caffeine intake, less than 300 mg per day, does not seem to significantly increase osteoporosis risk in most postmenopausal women with normal calcium intake.39,40,41

In any case, individuals with the following medical conditions may need to avoid caffeine or limit its intake. Anxiety Disorders: In some research, caffeine has been shown to aggravate anxiety disorders.42

Bipolar Disorder: In a case study, a 36-year-old man with bipolar disorder was hospitalized with symptoms of mania after consuming several cans of an energy drink (containing caffeine) over a period of four days43.

Cardiac Conditions: Caffeine, taken in high doses (e.g. 750 mg for a 165 lb person), can induce cardiac arrhythmias in sensitive individuals.44

Glaucoma: People with glaucoma should be aware that caffeine increases intraocular pressure. The increase occurs within 30 minutes of ingesting the caffeine, and lasts for at least 90 minutes.45

Conclusion
Caffeine is neither good for everyone, nor bad for everyone. It has many benefits to offer for many people, but care must be taken if you're one of those individuals who are sensitive to caffeine, or who have one of the medical conditions listed under the "Contraindications" section above.

References:

  1. Share of coffee drinking consumers in the United States in 2016, by age group. ©Statista 2017. Retrieved January 24, 2017 from https://www.statista.com/statistics/250091/coffeedrinking-consumers-in-the-us-by-age-group-2010/.
  2. Tea Fact Sheet—2015. Tea Association of the U.S.A. Inc. Retrieved January 24, 2017 from http://www.teausa.com/14655/tea-fact-sheet.
  3. Mayo Clinic Staff. Caffeine content for coffee, tea, soda and more. May 13, 2014. Retrieved January 24, 2017 from http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthyeating/in-depth/caffeine/art-20049372?pg=1.
  4. Welsh, E. J., Bara, A., Barley, E., and Cates, C. J. Caffeine for asthma. Cochrane.Database. Syst.Rev. 2010;(1):CD001112.
  5. Jiang X, Zhang D, Jiang W. Coffee and caffeine intake and incidence of type 2 diabetes mellitus: a meta-analysis of prospective studies. Eur J Nutr. 2014 Feb;53(1):25–38. doi:10.1007/s00394-013-0603-x. Epub 2013 23.
  6. Salazar-Martinez E, Willett WC, Ascherio A, et al. Coffee consumption and risk for type 2 diabetes mellitus. Ann Intern Med 2004;140:1–8.
  7. Food and Drug Administration. Code of Federal Regulations: Part 340—Stimulant Drug Products for Over-The-Counter Human Use, Subpart A and B; 2000: 235.
  8. Institute of Medicine. Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations. Washington, DC: National Academy Press, 2001. Available at: http://books.nap.edu/books/0309082587/html/index.html.
  9. Miller LS, Lombardo TW, Fowler SC. Caffeine and time of day effects on a force discrimination task in humans. Physiol Behav 1995;57(6):1117–25.
  10. Griffiths RR, Evans SM, Heishman SJ, Preston KL, Sannerud CA, Wolf B, Woodson PP. Low-dose caffeine discrimination in humans. J Pharmacol Exp Ther. 1990 Mar;252(3):970–8.
  11. Smith A. Effects of caffeine in chewing gum on mood and attention. Hum Psychopharmacol. 2009 Apr;24(3):239–47.
  12. Greer F, Friars D, Graham TE. Comparison of caffeine and theophylline ingestion: exercise metabolism and endurance. J Appl Physiol 2000;89:1837–44.
  13. Backhouse SH, Biddle SJ, Bishop NC, Williams C. Caffeine ingestion, affect and perceived exertion during prolonged cycling. Appetite 2011;57:247–52.
  14. Leitzmann MF, Willett WC, Rimm EB, et al. A Prospective study of coffee consumption and the risk of symptomatic gallstone disease in men. JAMA 1999;281:2106–12.
  15. Heseltine D, Dakkak M, woodhouse K, et al. The effect of caffeine on postprandial hypotension in the elderly. J Am Geriatr Soc 1991;39:160–4.
  16. Capek, S. and Guenther, R. K. Caffeine’s effects on true and false memory. Psychol. Rep. 2009;104(3):787–95.
  17. Smillie, L. D. and Gokcen, E. Caffeine enhances working memory for extraverts. Biol Psychol. 2010;85(3):496–98.
  18. Smith AP. Caffeine, extraversion and working memory. J Psychopharmacol. 2013 ;27(1):71–6. doi:10.1177/0269881112460111. Epub 2012 26.
  19. Food and Drug Administration. Code of Federal Regulations: Part 340—Stimulant Drug Products for Over-The-Counter Human Use, Subpart A and B; 2000: 235.
  20. Institute of Medicine. Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations. Washington, DC: National Academy Press, 2001. Available at:http://books.nap.edu/books/0309082587/html/index.html.
  21. Miller LS, Lombardo TW, Fowler SC. Caffeine and time of day effects on a force discrimination task in humans. Physiol Behav 1995;57(6):1117–25.
  22. Griffiths RR, Evans SM, Heishman SJ, Preston KL, Sannerud CA, Wolf B, Woodson PP. Low-dose caffeine discrimination in humans. J Pharmacol Exp Ther. 1990 Mar;252(3):970–8.
  23. Goldstein J, Hoffman HD, Armellino JJ, et al. Treatment of severe, disabling migraine attacks in an over-thecounter population of migraine sufferers: results from three randomized, placebo-controlled studies of the combination of acetaminophen, aspirin, and caffeine. Cephalalgia 1999;19:684–91.
  24. Pini LA, Guerzoni S, Cainazzo M, Ciccarese M, Prudenzano MP, Livrea P. Comparison of tolerability and efficacy of a combination of paracetamol +caffeine and sumatriptan in the treatment of migraine attack: a randomized, double-blind, double-dummy, cross-over study. J Headache Pain. 2012 Nov;13(8):669–75. doi: 10.1007/s10194-012-0484-z. Epub 2012 2.
  25. Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database Syst Rev. 2014 Dec 11;12:CD009281. doi: 10.1002/14651858. CD009281.pub3. Review.
  26. Costa, J., Lunet, N., Santos, C., Santos, J., and Vaz-Carneiro, A. Caffeine exposure and the risk of Parkinson’s disease: a systematic review and meta-analysis of observational studies. J Alzheimers. Dis. 2010;20 Suppl 1:S221–S238.
  27. Liu R, Guo X, Park Y, Huang X, Sinha R, Freedman ND, Hollenbeck AR, Blair A, Chen H. Caffeine intake, smoking, and risk of Parkinson disease in men and women. Am J Epidemiol. 2012 Jun 1;175(11):1200–7. doi: 10.1093/aje/kwr451. Epub 2012 13.
  28. Migliardi JR, Armellino JJ, Friedman M, et al. Caffeine as an analgesic adjuvant in tension headache. Clin Pharmacol Ther 1994;56:576–86.
  29. Astrup A, Toubro S, Cannon S, Hein P, Breum L, Madsen J. Caffeine: a double-blind, placebo-controlled study of its thermogenic, metabolic, and cardiovascular effects in healthy volunteers. Am J Clin Nutr. 1990 May;51(5):759–67.
  30. Hollands MA, Arch iRS, Cawthrone MA. A simple apparatus for comparative measurements of energy expenditure in human subjects: the thermic effect of caffeine. Am J Clin Nutr. 1981;34:2291–4.
  31. Koot P, Deurenberg P. Comparison of changes in energy expenditure and body temperatures after caffeine consumption. Ann Nutr Metab. 1995;39(3):135–42.
  32. Arciero PJ, Bougopoulos CL, Nindl BC, Benowitz NL. Influence of age on the thermic response to caffeine in women. Metabolism. 2000 Jan;49(1):101–7.
  33. Institute of Medicine. Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations. Washington, DC: National Academy Press, 2001. Available at: http://books.nap.edu/books/0309082587/html/index.html.
  34. Holmgren P, Norden-Pettersson L, Ahlner J. Caffeine fatalities—four case reports. Forensic Sci Int 2004;139:71–3.
  35. Leson CL, McGuigan MA, Bryson SM. Caffeine overdose in an adolescent male. J Toxicol Clin Toxicol 1988;26:407–15.
  36. Wakabayashi K, Kono S, Shinchi K, et al. Habitual coffee consumption and blood pressure: A study of self-defense officials in Japan. Eur J Epidemiol 1998;14:669–73.
  37. Hodgson JM, Puddey IB, Burke V, et al. Effects on blood pressure of drinking green and black tea. J Hypertens 1999;17:457–63.
  38. Nurminen ML, Niittynen L, Korpela R, Vapaatalo H. Coffee, caffeine and blood pressure: a critical review. Eur J Clin Nutr 1999;53:831–9.
  39. Rapuri PB, Gallagher JC, Kinyamu HK, Ryschon KL. Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. Am J Clin Nutr 2001;74:694–700.
  40. Massey LK. Is caffeine a risk factor for bone loss in the elderly? Am J Clin Nutr 2001;74:569–70.
  41. Massey LK, Whiting SJ. Caffeine, urinary calcium, calcium metabolism and bone. J Nutr 1993;123:1611–4.
  42. Smith A. Effects of caffeine on human behavior. Food Chem Toxicol 2002;40:1243–55.
  43. Machado-Vieira R, Viale CI, Kapczinski F. Mania associated with an energy drink: the possible role of caffeine, taurine, and inositol. Can J Psychiatry 2001;46:454–5.
  44. Cannon ME, Cooke CT, McCarthy JS. Caffeine-induced cardiac arrhythmia: an unrecognised danger of healthfood products. Med J Aust 2001;174:520–1.
  45. Avisar R, Avisar E, Weinberger D. Effect of coffee consumption on intraocular pressure. Ann Pharmacother 2002;36:992–5.

Much evidence suggests that gastrointestinal tract problems are on the rise in the modern world with significant health consequences that extend well beyond the gut itself. For instance, autism is increasing, especially in male children, and researchers at MIT and elsewhere point to the GI-tract and disturbances caused by glyphosate and other chemicals used in industrial agriculture as among the causes. Food processing with its emulsifiers and storage techniques likewise may play a role in the upsurge in the prevalence of various inflammatory bowel conditions. Modern over-nutrition and other dietary habits, such as over-consumption of refined carbohydrates and under consumption of omega-3 fatty acids are yet other factors implicated. Researchers trying to uncover patterns underlying contemporary GI-tract issues have been attempting to fit the various known and suspected causes into manageable conceptual models. Recent work suggests that a three-part model involving gut bacteria, gut barrier function ("leaky gut") and inflammation may help with prevention and therapy.1 The components of the model have emerged from studies of inflammatory bowel disease (IBD, including Crohn's Disease and ulcerative colitis), yet they clearly have application to more ordinary and quite common forms of bowel irritation and discomfort.

Irritable bowel syndrome (IBS) is a catch-all for common bowel conditions. It currently affects 10–20 percent of the adult population in developed countries. To be sure, the causes of IBS have not been definitively identified and can vary among individuals (food allergies, over-reactive immune system, stress, hormone imbalance, etc.). Symptoms include abdominal pain, flatulence, bloating, change in bowel habits, diarrhea, constipation (or a combination of both), and these often interfere with daily activities and affect the quality of life of the sufferers. Available medications exhibit only limited efficacy and fail to relieve all IBS symptoms over the long term.

Current science no longer views the gastrointestinal system as a simple digestive and disposal apparatus. It is estimated that sixty percent or more of all the macrophages, the first line immune cells of the body, line the GI-tract. Specialized cells in the gut constantly sample its contents in active surveillance for external threats. Microbes in the small and, especially, the large intestine perform a multitude of functions, including aspects of nutrition, such as synthesizing some vitamins and making minerals and other nutrients more available. The intestinal wall controls not only the passage of nutrients and the disposal of bodily wastes, but also regulates immune interaction with the contents of the intestines. GI-tract disturbances can involve any one of the major aspects of gut health or combinations of these. Hence, gut complaints can involve disturbed intestinal microbiome (dysbiosis), disrupted barrier function (leaky gut) and/or improper immune system activation (inflammation).

The Inhabitants of the Gastrointestinal Tract
The microbes present within the body collectively are termed the microbiota. The genomic content (the complete set of genes in the microbiota) is termed the microbiome. Both genetic and environmental factors shape the microbiome. Important early factors are natural birth versus cesarean section, breast-feeding versus formula feeding, and so forth. In adults, dietary habits are highly significant. Vegetarians and meat eaters differ in the make-up of the bacteria in the gut. The amounts and types of fiber in the diet, the amounts and types of carbohydrates and fats, under-nutrition and over-nutrition all matter. So do the level of hygiene and exposure to infections, antibiotics and other drugs.

The human gut consists of a series of micro-environments. Except for the stomach and the upper two thirds of the small intestine, there are differing bacteria and ratios of bacteria in each of these areas, starting with the mouth. In fact, the human gastrointestinal tract contains a large and diverse population of microorganisms — over 800 different bacterial species comprising nearly 100 trillion living organisms. The composition of this gut flora varies among individuals depending on diet, age, medication (antibiotics), stress, and physiological conditions. Not surprisingly, different probiotics perform different functions and offer different benefits. One big divide, of course, is between the two most important groups of probiotic bacteria, Lactobacilli, found mostly in the lower small intestine and upper large intestine, and Bifidobacteria, found mostly in the large intestine, i.e., the areas of lower pH.

For clarity's sake, keep in mind that scientists use a standard genus, species, strain taxonomy in describing bacteria. An example is the probiotic bacterium, Lactobacillus rhamnosus R0011. The genus is Lactobacillus, the species is rhamnosus and the strain is R0011. Dietary supplements properly list all three components of the name because strains even of the same species can exhibit divergent effects in the body.

Broadly speaking, the Lactobacilli act on sugars and starches to create lactic acid, among other things. For instance, L. acidophilus La-14 assists in breaking down lactose (milk sugar) and 15 other carbohydrates and this may improve digestion of dairy products by those individuals who are lactose intolerant. Clinical trials have shown that this strain may improve immune response and bowel regularity. It works especially well in conjunction with another bacteria strain, L. rhamnosus R0011. Interestingly, L. rhamnosus R0011 in conjunction with L. helveticus R0052 in humans enhances the eradication of H. pylori (a cause of stomach ulcers) in combination with conventional medical treatment.

Bifidobacteria, such as B. longum BB536, have been shown to colonize the intestine, stimulate immune response, and promote the growth of other beneficial bacteria. BB536 also decreased the incidence of influenza in seniors. Blood analysis showed significantly higher bactericidal activity of neutrophils and higher NK cell activity at the fifth week of administration compared to pre-administration. There has also been evidence reported that suggests BB536 can help modulate allergies and possess antiallergenic effects. Other bifidobacteria provide their own ranges of benefits.

Increases in certain bacteria and decreases in others— both in absolute numbers and the varieties present—are observed in disturbed gut function. Typically, the more severe the dysfunction, the greater the divergences from normal microbiota. It is unclear to what extent these specific changes are the driving forces for inflammatory and related immune processes and to what extent they reflect the condition, although feedback is highly likely. The finding that certain strains of probiotics reduce excessive inflammation by means of modulation of immune and other responses via the gut is one of the major advances in the knowledge of probiotics in recent years.

Inasmuch as different probiotic species and different strains of the same species often provide different and distinct benefits and also often interact to lead to yet other results, there are good reasons for supplementing with more than one strain and/or species. Similarly, different probiotics may be more to be desired at certain ages or under particular conditions. No single strain can easily fulfill all these requirements. A mixture of species, therefore, is usually most suitable for supplementation.

Mucosal Barrier Function & The Leaky Gut Syndrome
The mucosal barrier of the gut performs many functions, one of which is to separate the contents of the gut from immediate contact with the gut wall and direct access to the body's immune system. Ideally, the contents of the intestines are sampled routinely by specialized cells located in Peyer's patches along the far end of small intestine. Allopathic medicine does not recognize leaky gut syndrome as a distinct condition, yet in IBD it has been demonstrated that the contents of the intestine do, in fact, have direct access to the surface of the intestinal wall and perhaps beyond. Mucus barrier changes may be as much the result of unwanted bacteria (dysbiosis) as a cause. It is possible for substances even to leak into the bloodstream due to defects in the tight junctions that normally characterized the
intestinal wall. Leaky gut can be described as intestinal permeability or intestinal hyperpermeability.

There is little doubt but that leaky gut syndrome involves chronic inflammation. However, controversy arises as to whether this inflammation is a cause or a consequence. Likewise, is the inflammation local or does it prime further inflammation throughout the body leading to or aggravating a host of other conditions, such as allergies?

In IBD, toxemia, meaning the passage of toxins into the blood, is well documented, as are immune system irregularities. The extent of leaky gut in less active and less severe bowel conditions is debated hotly. Nevertheless, indications of intestinal barrier dysfunction and dysbiosis, such as inappropriate immune activation, abdominal pain, flatulence, etc., strongly suggest that leaky gut is, in fact, an aspect of IBS and other less well defined GI-tract issues.

As noted already, available medications have only limited efficacy and fail to relieve IBS symptoms over the long term. Fortunately, there are a number of natural supplements that are documented to help prevent and/or relieve symptoms associated with IBS. For instance, fiber can help with the toxemia issues as well as promote normal intestinal flora. Research has shown that soluble fiber, such as psyllium, can be fermented in the gut and the metabolites may decrease transit time and pressure. Some fibers can increase water retention, thereby increasing the stool mass and, again, reducing transit time. Fiber supplementation in IBS patients promotes significant improvements in constipation and general IBS symptoms.

Similarly, clinical studies have shown the benefits of Lactobacillus and Bifidobacteria species in the treatment of IBS or IBS-like symptoms. This is probably due to their abilities to reduce inflammation, visceral hypersensitivity, and stress responses. Studies have shown that some strains are effective in treating bloating and flatulence while others relieve gastrointestinal pain and irregularity. It has also been reported that effects can vary among individuals. Thus, one may want to try different strains and dosages or a blend of multiple strains and monitor the response.

Another useful supplement is the amino acid L-glutamine to support the health of the cells that make up the enterocytes in the gastrointestinal tract. It not only directly nourishes the mucosal lining of the intestine, but also helps repair it when it is damaged by hypersensitivity, physical stress, or an overreactive immune system. Lglutamine can stimulate the bowel to re-absorb the water from the stool, reducing the number and frequency of bowel movements.

Then there are the everuseful omega-3 fatty acids. Omega-3 fatty acids can replace omega-6 fatty acids in the cell membrane and prevent their harmful effects by reducing the secretion of unwanted prostaglandins and proinflammatory molecules. They also reduce production of platelet aggregators and vasoconstrictors while increasing the secretion of vasodilators and platelet aggregation inhibitors.

Other supplements that have shown the ability to promote improvements in tight junctions include curcumin, boswellia, bile acid supplements and butyric acid supplements.

Immune Function
Both the microbiota and the barrier function aspects of GI-tract health at various points tie into immune function. Therefore, it would seem to be clear that the overall regulation of the immune system necessarily plays a role in the control of immune-related inflammation in the gut. Diet is one of the most significant components involved in what should be a homeostatic system.

Omega-6 fatty acids account for the majority of polyunsaturated fatty acids found in Western diets. Omega-6 fatty acids can stimulate production of harmful prostaglandins and leukotrienes, as well as platelet aggregators and vasoconstrictors. Omega-3 fatty acids, on the other hand, compete with omega-6 fatty acids by replacing omega-6 fatty acids in the cell membranes and provide beneficial effects such as:

  1. a reduction in harmful prostaglandin E2 (PGE2) metabolite production,
  2. a decrease in thromboxane A2, a strong platelet aggregator and vasoconstrictor,
  3. suppressed formation of leukotriene B4, a proinflammatory molecule that is also responsible for leukocyte chemotaxis and adherence, and
  4. maintained or increased production of beneficial prostaglandins such as PGI2 and PGI3, protective vasodilators, and inhibitors of platelet aggregation.

In autoimmune diseases, such as inflammatory bowel disease, Crohn's disease, and ulcerative colitis, the major contributors to disease development are thought to be proinflammatory mediators that include omega-6 fatty acid, arachidonic acid metabolites, harmful prostaglandins, leukotrienes, and pro-inflammatory cytokines. It has been reported that people who are affected by these diseases have elevated levels of leukotriene B4 and other arachidonic acid metabolites. Interestingly, in clinical studies, omega-3 fatty acid or fish oil supplementation significantly decreased the production of leukotriene B4 and overall leukotrienes in these patients. Omega-3 fatty acid supplementation was also able to induce dramatic improvements in tissue histology, the rate of disease relapse, clinical activity, and steroid-sparing effect after treatment, although responses to supplementation varied among individuals reflecting that there are underlying differences as well as common factors in these diseases.

In all cases, the goal should be to normalize immune function. Scientists understand that the immune system can be overactive as well as underactive and that balance is the key. On the one hand, the immune systems needs vigilante macrophages, natural killer cells and other "soldiers" to be on alert to attack invading organisms before these can take hold in the body. For instance, the cold virus is most successfully combatted if the immune system can react and eliminate it before it has had a chance to multiply. On the other hand, rheumatoid arthritis and other autoimmune diseases in which the body attacks itself afflict millions of Americans. Immune overactivity causes unpleasant side effects, such as allergies and inflammation, and can lead to immune exhaustion and collapse. The answer, therefore, is to balance the body's immune system so that it is neither overactive nor underactive.

Much of this balance is maintained by subsets of helper T cells (Th). There is a ratio between the Th1 subset that is involved mainly in inflammation and the activation of white cells (phagocytes, NK cells, etc.) and the Th2 subset that activates specific B cells. The Th1 and Th2 cells may cross-inhibit function, which means that the more active the one set is, the less active the other set is. Most Americans initially have too much Th1 function and too little Th2. This is one reason that chronic inflammation is so very common in the US. However, the body cannot allow chronic high levels of inflammation, and therefore the immune system begins to shut down as a result. Stimulating more Th1 activity—leading to more inflammation—will never be more than a short term fix if inflammation is not controlled because the body will again attempt to turn off Th1 function in order to reduce the level of inflammation. Hence, there is a common pattern in which chronic immune activation aggravates allergies, IBS, even weight gain, yet at the same time a reduction in immune surveillance allows the development of cancer in later life.

Balancing the immune system is a bit harder than simply stimulating it. Fortunately, there are a few supplements that do this and more. One of the most extensively tested of these supplements is called Moducare®. Developed by Patrick Bouic, Ph.D., head of Immunology at the University of Stellenbosch in South Africa, Moducare® consists of a proprietary blend of phytonutrients called sterols and sterolins. The sterol family of compounds includes fatty substances such as betasitosterol found in saw palmetto. Sterolins are sterols with a glucose (sugar) molecule attached, something that greatly improves absorption into the body. Taken together, sterols and sterolins are more active than when supplemented as single pure substances.

A number of other immune regulators are available. Chamomile extracts (German chamomile) are useful as anti-inflammatories and calm some forms of allergies. Chamomile is particularly interesting because of its calming and immune-regulating effects complement its antioxidant benefits. Another significant immunomodulator is the flower pollen extract sold under names such as Cernitin™. Items already mentioned include turmeric extracts and boswellia extracts, to which can be added quercetin and a number of herbal extracts available as dietary supplements. None of these will be sufficient in the long run, however, without changes in the diet to improve the balance between omega-6 and omega-3 fatty acids or the inclusion of more fiber and consumption of more vegetables and whole fruit.

Some Conclusions
As noted at the outset, GI-tract disturbances can involve any one of the major aspects of gut health or combinations of these. Hence, gut complaints can involve disturbed intestinal microbiome (dysbiosis), disrupted barrier function (leaky gut) and/or improper immune system activation (inflammation). There are strong feedback loops linking these aspects of gut health and therefore solutions to gut issues typically are most successful if all three are addressed together. This means appropriate changes in diet, adoption of probiotic supplementation (either as supplements or via dietary sources), nutrition aimed specifically at improving the health of the cells lining the GI-tract and adopting strategies to reduce inflammation and balance the immune system.

References:

  1. Vindigni SM, Zisman TL, Suskind DL, Damman CJ. The intestinal microbiome, barrier function, and immune system in inflammatory bowel disease: a tripartite pathophysiological circuit with implications for new therapeutic directions. Therap Adv Gastroenterol. 2016 Jul;9(4):606 –25.

Caring for our selves and finding ways to handle our stresses are clearly important practices for assuring our long-term health. They are definitely key aspects of Preventive Medicine, Along With the right nutrition and exercise programs for our body, getting proper sleep, and maintaining a positive attitude toward our self, others, and the world. Learning the individual lifestyle path that generates health rather than disease is really the finest art of medicine and personal development, and an extremely important process in which to invest. Let's look at ways to protect our body and heart from the negative effects of stress and to create better health.

A self-inventory
One of the first steps in stress reduction is an honest inventory of where we are. Ask yourself:

  • What is my biggest life challenge now?
  • Is anything very out of balance in my life? If so, what is upsetting me?
  • Why don't I feel fully relaxed, happy, and able to sleep well?
  • What do I need to do to restore balance?
  • Is there anything I can do something about?
For most of us, the key life challenges are in areas of:
  1. Health–how we care for ourselves and the result we hu-manifest,
  2. Career–what we share with the world and the support that is returned, and
  3. Relationships–how we give and receive love.

If we can master these three primary areas of life, some might say we're near enlightenment.

Expectations
One of the sources of stress is inner tension between what we expect of ourselves and what actually happens. Often these expectations are quite unconscious. It's important to identify unspoken expectations or attachments. Sometimes we need to work a little harder to bring reality in line with our expectations— and to really go for our dream.

Letting Go
At other times, we need to develop more detachment to let go of counter-productive thoughts or desires. In this effort, a meditation practice can be very valuable. All the major religions of the world include some type of meditation or prayer. Your practice can be aligned with your spiritual beliefs.

Types of Stress (adapted from the Anti-Stress Program of Staying Healthy with Nutrition textbook)

Stress comes in many forms. For example, many of us are surprised to learn that intense joy is a source of stress, but since it requires more of our body and mind, it genuinely qualifies as stress (with an increased heart rate and the manufacture of certain neurotransmitters, such as adrenaline). Exercise can also be a stressor even though it is great for us. This is because of the repetitive movement in certain areas of the body, and because we create and release more free radicals and toxins into the blood and tissues. This biochemical process can best be handled by being sure you drink enough water and take antioxidant nutrients, such as vitamins A and C. According to researchers on stress, the most optimal combination for vitamin C is to pair it with the bioflavonoid, quercetin.

The various types of stress and some of the factors that contribute to them include:

  • Mental—high responsibility; financial or career pressures; working long hours at mental tasks, perfectionism, anxiety, and worry
  • Emotional—attitude toward self; issues or imbalances in our relationships; anger, fear, frustration, sadness, betrayal, and bereavement
  • Psycho-Spiritual—issues of life goals; spiritual alignment, imbalance, or lack of spiritual nurturing; general state of contentment
  • Physical—exercise and physical labor; pregnancy and giving birth; developmental or life changes (adolescence, menopause, and aging)
  • Traumatic—infection, injury, burns, surgery, and extreme weather and temperatures
  • Biochemical—deficiencies of vitamins, minerals, specific amino acids, protein, or fats and fatty acids; food allergies; genetic errors in metabolism that can result in alcoholism, other addictions, or mental illness
  • Toxic—environmental pollutants such as pesticides, cleaning solvents, and other toxins; non-organic foods with additives; and the use of chemicals such as prescription and OTC drugs, in cosmetic and hair products, and overuse/abuse of sugar, alcohol, caffeine, or nicotine

What is Stress?

Please realize that stress is not dictated by situations or incidents themselves; rather, real stress comes from the way we react to the issues of our lives. For stress to negatively influence our health, we must experience something as danger. If we experience a threat as stress, we may go into fight-or-flight mode, which shifts us into the sympathetic (adrenaline) side of our nervous system. That means our body actually prepares to battle or run, i.e. "fight or flight." Our circulation slows and there may be greater muscle tension; our digestion slows down, heart rate goes up, and we begin using up important nutrients. Often immune function is affected—our level of T-cells may even be depressed. And clearly then, we are more prone to become ill or "catch whatever's going around."

Sometimes there's no way around stress. For example, when a child falls on the playground, or we're putting out a fire, our body prepares us for the emergency so we can respond immediately. That's the way it should be as this level of response/reaction allows us to be more alert and ready for action.

But sometimes stress is subtler—and it may be more psychological or emotional. When there really is no physical danger, our body may still react as if there is. Then, if there's no physical activity to provide an outlet for the increased internal activity, the response may remain inward and play havoc with our physiology and organs, as well as with our emotions and our mind. At that point, we run the risk of exhausting the adrenal glands and flooding our body with metabolic toxins, such as damaging free radicals (associated with the aging process and diseases such as heart disease and cancer). This example also shows the reason why "a walk to cool down" really is a good idea.

When we're under emotional or mental stress, and still stay in a relaxed mode, we can respond more calmly and experience less emotional and biochemical wear-and-tear. Then our body doesn't shift into full battle mode and begin pouring out the chemical signals that we're in danger and must react. This relaxed approach usually leads to a better outcome as well.

Anti-Stress Nutrients
Many anti-stress formulas are based on the B-complex vitamins and vitamin C because these important nutrients are all significantly depleted by stress. In addition, stress-related problems may be compounded by deficiencies resulting from generally poor nutrition. All of the B vitamins are important here—especially pantothenic acid (B5). B5, folic acid, and vitamin C are essential for the functioning of our adrenal glands. The adrenals carry perhaps the greatest load when our body is under stress.

The B-complex vitamins are ideally taken two or three times a day, particularly when we are under a lot of stress. This is especially important if the stress lasts over a period of months— for example from a big project at work or a challenging job, a chronically ill child or parent, unemployment, divorce—any of the life events that tend to deplete us over time. It's best to take the B-vitamins before dark so that we don't become over-stimulated when it's time to wind down and relax. I do suggest more minerals in the evening, as they tend to help with relaxation, especially a calcium and magnesium supplement. However, most vitamins and minerals are best assimilated if they're taken with a meal.

Note: Prolonged stress or lack of sleep can lead to a myriad of health problems. If these issues do not resolve with home treatment, you may need to see your doctor or other health professional.

Stress is a funny word. Loaded with the emotional bias of being a “bad” thing, the word stress can be quite deceiving, making it harder to handle than it needs to be. So we will offer a new way to look at it—and very effective ways to address it.

As the healing arts grows, it is important to remember that there are four key domains in healing:

  1. Biochemistry. This includes herbals, nutrition and medications.
  2. Structural. Including areas such as manipulation, surgery, breathing, exercise, and ergonomics.
  3. Biophysics. For example, Acupuncture, Chakra work, Yoga, and NAET.
  4. Mind-Body-Spirit. Understanding how the body is a metaphor for what is occurring at a deeper level. For most illnesses, including anxiety and even cancer, complete healing is unlikely to occur unless this is also attended to.

You will find that healing occurs best when all four of these areas are addressed. No individual healer is likely to have complete expertise in all of these areas. As our new healthcare system evolves, and the current one heads to extinction, it is good to see health practitioners from diverse backgrounds communicating and working together more.

So let's look at how a Comprehensive Medicine approach works when addressing anxiety and stress. I will focus predominantly on mind-body and biochemical aspects, as these are where my expertise is.

Treating Mind-Body Issues
Stress is not inherently good or bad. In fact, stress can be used to force flowers to bloom, and this analogy applies to people as well. The problem is when stress becomes chronic, and is no longer enjoyable. This then contributes to chronic elevation of the stress hormone cortisol, directly triggering anxiety. As the excessive stress becomes chronic, cortisol levels then go too low—ironically also triggering anxiety by causing recurrent bouts of low blood sugar.

A simple way to tell if stress is healthy? Simply check in to see how it feels. If it feels good, it is healthy. What is enjoyable can vary markedly from person to person. For example I enjoyed the stress of skydiving, while for my wife it would feel awful.

A Novel Treatment
The key stress antidote? Check in to see how things feel. This is so important, that I am being purposely redundant. Learn to say NO to things that feel bad. Leave your brain out of it. Our brain is the product of our societal and family training. It simply feeds back to us what we were taught that we should do to make others happy. Our feelings, on the other hand, tap into our own personal authenticity. So choose to focus on, and do, those things that feel good. Once you've determined what feels good, then your mind can figure out how to make it happen.

And yes, it is OK to simply choose to focus on what feels good in life, without being in constant battle mode against things you don't like. Like food choices at a buffet, we don't have to protest for the removal of those foods we don't choose to eat. Simply ignore them and pick those things you like. You will find that the rest will soon stop appearing in your life. This is part of how I suspect “free will” works. Our focus is like the remote control on our TV. What we focus on keeps showing up on our screen. This is why our constant “Wars on…” just seem to create more of what we are attacking.

Is it truly OK to do what feels good? Some will make the argument that “Heroin feels good, and perhaps also smacking that person who makes me angry over the head with a two-byfour.” This is why we add two caveats:

  1. Don't hurt others.
  2. Ask yourself “How is that working out for me?”

Doing this, people will find their anxiety is often coming from their choosing what they think they should do over what feels good (i.e. doing what others want, instead of what is authentic to them). Notice if you are constantly feeling, “I should do this, or I should do that.” This is euphemistically called “Shoulding on yourself.” I invite you to change that toxic behavior.

If hyperventilation is present, one will usually have buried feelings that are bubbling to the surface during periods of relative calm. Counseling to help them learn to feel their feelings helps over time. Also, as panic attacks often leave people feeling like they are going to die, understanding that the symptoms are not dangerous helps. Simply being told this may not be enough to reassure you though. You can confirm hyperventilation is the cause by breathing rapidly for up to 30–60 seconds and seeing how it amplifies your symptoms. Unfortunately, this can also precipitate a full-blown panic attack, so be forewarned, and pick a safe time and place to do this test!

My e-book, “Three Steps to Happiness—Healing through Joy,” can help guide you through the mind-body healing process.

Balance The Biochemistry
Begin with ruling out and treating overt issues, including:

  1. Overactive thyroid. Consider this if your Free T4 thyroid test is even in the upper 20th percentile of the normal range.
  2. Low progesterone (women). Progesterone is like our body's natural Valium. Consider this if anxiety is worse around menses and ovulation.
  3. Low testosterone (men). Consider if testosterone levels are in the lower quarter of the normal range.
  4. Adrenal fatigue—caused by drops in blood sugar. A key tip-off? Irritability and anxiety that triggers sugar cravings and improves after eating.

Also optimize nutrient status, especially magnesium and B vitamins. Instead of blood testing, which is of questionable value here, I simply recommend (for most people—whether or not they have anxiety) a high potency multi powder called the Energy Revitalization System (by Enzymatic Therapy). With this, one drink replaces well over 35 pills, optimizing levels of most nutrients. Also have the person decrease sugar and caffeine intake to see if this helps.

Herbals can also be very helpful. For example, there is a unique extract, which can be as effective as Xanax, but is very safe. This special extract stimulates one of the most abundant neuroreceptors in the body, the cannabinoid receptors. Many of you may recognize this as the marijuana receptor, and in fact many people use cannabis to self-medicate for their anxiety. But what if you could get the benefits without the sedation and side effects?

The good news is that now you can. Recent research showed that a special extract of the roots of the narrow leafed coneflower (Echinacea angustifoliae) was more effective than the tranquilizer Librium, with none of the side effects. It also worked quickly, with effects building with continued use. This is not the same component used for immune enhancement, and isn't found at needed levels in standard Echinacea. It is available though as AnxioCalm (by EuroPharma—20 mg per tablet).

Let's look at a few studies of this unique extract.
A study published in the March 2012 issue of Phytotherapy Research included 33 volunteers. All experienced anxiety, assessed using the validated State-Trait Anxiety Inventory (STAI). The extract decreased STAI scores within three days, an effect that remained stable for the duration of the treatment (seven days) and for the two weeks that followed treatment. There were no dropouts and no side effects.

Another study looked at higher dosages (40 mg 2 x day) in a multi-center, placebo-controlled, double-blind Phase II study involving 26 volunteers diagnosed with generalized anxiety disorder (GAD). Over a three week period, the number of severely anxious patients (HADS-A scores larger than 11) decreased from 11 to zero!

So I begin with two tablets of AnxioCalm 2x day for severe anxiety. After three weeks, the dose can often be dropped to one 20 mg tablet twice a day. It can also simply be used as needed, and serves as an excellent sleep aid.

Other helpful herbals include valerian, passion flower, hops, theanine, and lemon balm. These can be found in a combination called the “Revitalizing Sleep Formula,” which helps anxiety during the day and sleep at night. I personally use both AnxioCalm and the Revitalizing Sleep Formula at night to ensure 8–9 hours of deep sleep.

The smell of lavender oil is also calming, and a small drop on the upper lip, or even having a lavender bouquet in one's room, can be helpful.

Structural And Biophysics
Simply going for regular walks in the sunshine, and doing yoga, tai chi, and meditation can be very helpful. A technique called centering can help people feel that they are in the calm “eye of the cyclone” when panic attacks hit. In addition, it is helpful to explore a technique called Butyko breathing, which can be very helpful for anxiety and hyperventilation.

For PTSD or old emotional traumas, a technique called EFT (Emotional Freedom Technique) can give near miraculous benefits in as little as 20 minutes (see EFT.Mercola.com). It may seem odd, but try it and you'll be amazed. Releasing old traumas through a simple “trembling” technique is also helpful, and the person can do it on their own. It is easy and simple instructions can be found in the book Waking the Tiger.

By having the entire healing arts toolkit available, and not just using the “medical hammer,” anxiety can now be effectively treated!

Not a month goes by without headlines in the media proclaiming either that vitamins do amazing things or that they do nothing at all. Such concerns no longer are limited to those whose jobs are to raise such issues. Individuals purchasing health foods and related products increasingly are asking questions about the cost and effectiveness of supplements. Likewise, governmental watchdog agencies, such as the Food and Drug Administration (FDA), expect that the manufacturers and marketers of nutrients and herbs be able to back up claims with sound research. Total Health Magazine Online took an in-depth look at some of the issues back in 2011, for which see “Are Vitamin Supplements Safe?

Unfortunately, responses to these demands for better backing for claims often are less than satisfactory. Marketing-driven science is as common as is science-driven marketing. Distinguishing between the two requires familiarity with the standards that universities and research institutions have adopted to evaluate medical evidence. This means knowing about the types of studies available and about the elements found in every properly designed study.

There are three basic types of clinical investigations: case-control studies, cohort studies and randomized controlled trials. For most nutritional supplements, the last of these is the primary form of investigation. However, for completeness, a few words should be spared to describe the other two. Case-control studies start with individuals who have already developed a disease or special condition and the controls are matched individuals who do not have the disease in question. An example is an analysis of heart disease rates in male smokers versus rates in otherwise similar males who have never smoked. This is an observational study because there is no intervention by the researchers. The strength of this study type is that it allows researchers to explore how variables influence the development of the condition being examined. The major drawback is that the study can easily be biased with regard to observations and other factors.

Cohort studies differ from case-control studies in that researchers start with individuals who have not yet developed the disease or condition being investigated. Hence, a cohort study on athletic supplements might start with two groups of similar athletes before one group begins supplement use. The analysis would consist of determining whether the group taking the supplement improved as measured by some marker for performance or perhaps had fewer injuries. This is an observational study because there is no intervention by the researchers. Cohort studies have the virtue of allowing investigators to more reliably establish whether a particular action (taking a supplement) leads to a particular outcome (fewer injuries). However, cohort studies may require years of following the subjects and also depend upon the subject populations being properly identified as identical with regard to the studied condition(s) at the start of the study rather than being weighted with some underlying predisposition. In other words, it is easy to introduce bias into cohort studies.

In many ways, the “gold standard” of investigational studies is the randomized placebo-controlled double-blind clinical trial. Ideally, the trial population is relatively uniform to start. Subjects are then randomly assigned to active and placebo arms, further helping to reduce any bias or predisposition in the groups being tested. The test is double-blind, meaning that neither the participants nor the investigators know who is taking the compound being tested. Finally, inasmuch as there often is a large psychological effect (the placebo or “sugar pill” effect) during the first weeks of a study, there is an arm of the trial that receives an item that appears to be identical to the compound being tested, but which has no effect. Note that this is an intervention study— the research actively intervenes by giving the compound to be studied to one or more of the arms in the trial. The idea here is to clearly demonstrate whether there is a cause and effect relationship between the item being studied and the outcome with the subjects. When possible, there is also a “cross-over” phase in which, after a sufficient washout period, the group that was used as the placebo arm becomes the active group and the group that had been the active arm becomes the placebo group. Not all studies lend themselves to this, but cross-over studies insure that there are no unrecognized predispositions in the subject that might bias the test results. All of this sounds good in theory. Unfortunately, as shortly will be shown, this “gold standard” of clinical trials still can be biased in a variety of ways.

The design of trials involves at least one more component that is important for evaluating whether the results of a given study are weak or strong.

The first step in any clinical trial is the production of a study protocol. This protocol presents three very important elements. First is the hypothesis of the study: what question is the study intended to answer?

Second is the study population: how and why were subjects picked to be in the study; what are the criteria for inclusion and exclusion; are special conditions involved?

Third is the size of the study sample: how many subjects are needed to insure that the results represent true findings rather than mere chance? All studies contain these three elements and the validity of these components—was the study question correctly framed, was the proper study population chosen, was the study carried on for an appropriate period of time, were enough subjects included to yield statistical significance, etc.— are essential for evaluating the worth of the trial.

Before moving to examples of weak and strong of clinical trials, a few words need to be said regarding statistical significance. The usual cut-off level is given as “p< 0.05,” which means there is only a five percent chance that the study findings represent mere chance. Some statistical models are more strict than others for performing this calculation, but readers actually need to be worried about something else, which is the study sample size. If a study uses, say, only seven subjects per arm, the small size of the study means that the reported effect will need to be very large to achieve statistical significance. Conversely, and one sees this all the time in pharmaceutical studies, a trial monitoring 100,000 subjects may find significance for what, in practice, are effects that are so weak that they are clinically only marginally useful!

As noted above, randomized placebo-controlled double-blind clinical trials are considered to be the ggold standardh for research. Nevertheless, many such trials are quite weak and misleading. For one thing, it all to often turns out to be the case that the placebo is not actually inactive, for instance, the practice of using maltodextrin or other sugars as the so-called placebo in weight loss studies. Relatedly, especially in studies involving weight loss, the placebo effect can be very strong for many weeks. The placebo effect in diet studies commonly leads to the loss of two pounds in eight weeks, and much more if diet and exercise changes are included. A BBC News report on the Internet (March 10, 2004) on trials of the drug rimonabant noted that participants taking the placebo were five pounds lighter at the end of one year. In some large pharmaceutical diet trials in which subjects changed behavior, diet and exercise, the weight loss in two months using the placebo exceeded 11 pounds!

Similarly, if exercise is included in a weight loss trial with healthy subjects, then LDL cholesterol, total cholesterol, triglycerides and leptin levels normally will go down, whereas HDL cholesterol will go up. Moderately increasing the amount of protein in the diet, likewise, will produce such trends. Hence, if a weight loss trial includes exercise and a controlled diet with increased protein, yet reports results opposite of these or fails to find weight loss in participants using the placebo (as happened recently in a highly promoted trial), then the reader should seriously wonder whether there was a lapse somewhere in either design or implementation because of the divergence from independently established outcomes. Moreover, it is often the case that even the most rock-solid of results cannot be extrapolated from one group to another. To stay with diet trials, studies performed in Asia or Latin America usually cannot be applied to American experience because the study populations and eating habits are so different. One has the right to question the reproducibility and applicability of studies.

Of course, many studies are very strong, although this, too, can be misleading. A recent one measured the effects of short-term, oral L-arginine supplements (12 g/d for 3 weeks) in 16 hypercholesterolemic men with normal blood pressure (BP). In this randomized, double-blind, two-period crossover design study, L-arginine tablets (1 g each) and matched placebos (microcrystalline cellulose) were used. The researchers demonstrated that the L-arginine supplement increased blood plasma levels of L-arginine and significantly reduced systolic BP (p<.05) and diastolic BP (p<.001), both at rest and during acute laboratory stressors. BP reductions were associated with a significant decrease in heart output (p<.01); these changes were mediated by small reductions in the volume of blood pumped with each heart beat (p = 0.07). These results were reproduced when the placebo group crossed over, plus they make sense in terms of what is known of the role of L-arginine in the body. Note that this study examines only one intervention which is tested in several ways rather than examining several interventions (e.g., diet + exercise + compound). With only one intervention, it is relatively easy to establish a clear cause and effect relationship.

This arginine study is an excellent example of a good study with strong results that can be completely misleading. The study lasted only three weeks. Based on a large number of similarly successful studies lasting only one or two months at a time, the temptation is to conclude that supplementing with L-arginine is a great recourse for those who are hypercholesteremic, hypertensive, need a boost in exercise, and so forth. Unfortunately, such conclusions would be wrong. As uncovered by a researcher who had been a proponent of L-arginine supplementation, long-term supplementation with L-arginine—in this case, six months.may lead either to null results or to actual harm—1 The body consists of a vast number of interconnected metabolic processes that are taking place simultaneously. A beneficial effect in one area sometimes is followed by a not so good effect someplace else. Hence, even with well-designed trials, there can remain hidden or submarine issues of which we become aware only much later.

Judging a clinical trial first requires establishing what type of test is involved—case-control, cohort or randomized controlled trial—because the type of test is the first clue as to how impartial the observations might be. Next, one must look closely at the components of the trial—the hypothesis of the study, the study population and the size of the study sample. A lack of clarity or inappropriateness in any one of these will reduce the quality of the data and undermine the analyses, interpretations and extrapolations based on the trial. Finally, clinical trials seldom exist in a vacuum. A given trial needs to be evaluated in light of related trials, especially trials conducted by researchers whose concerns and orientations are different from those involved with the test being evaluated. Readers interested in pursuing this topic are urged to examine Richard K. Riegelman, Studying a Study and Testing a Test (6th edition, 2012).

Endnote:
1 Wilson AM, Harada R, Nair N, Balasubramanian N, Cooke JP. L-arginine supplementation in peripheral arterial disease: no benefit and possible harm. Circulation. 2007 Jul 10;116(2):188.95. Epub 2007 Jun 25.

Antioxidants, Our Natural Protectants: Metabolic Regulators, Antitoxins and Anti-inflammatories

Antioxidants protect us. They are the sub-stances that naturally regulate the fires within our bodies.

The fires are sparked by metabolic errors in our cells—errors that are unavoidable as our cells make and use energy for the business of life. The fires can be managed when we are young and very healthy but become harder to control as we get older. Aging is not so much bad genes as it is a slow, inexorable, cumulative consequence of tissue damage from internal fires, sparked by these unavoidable errors of metabolism.

The sparks of metabolism come from living with oxygen. Our life forms breathe in oxygen and use it to do controlled “burns” that extract energy from our foods. Oxygen-based energy allows us to become more sophisticated than amoebas, but comes with a big price. Oxygen is so reactive that it draws single electrons to it, generating oxygen-free radicals within our cells. These “oxyrads” are our unavoidable “sparks of metabolism.” Antioxidants keep them from destroying our cells.

Our tiny metabolic sparks are generated at a steady rate, the oxyrads having single electrons which cause them to attack biological molecules. Molecules with single electrons are aggressive oxidants: they steal single electrons to become paired up. Antioxidants block this process by donating their own electrons.

The antioxidant defenses dare not fail. When they do, important bio-molecules lose single electrons, themselves become unstable, and initiate spreading chain reactions. A chain reaction that escapes control becomes inflammation, with cell and tissue death and progressive loss of functional capacity. Inflammatory events are our internal fires, opposed by antioxidant enzymes backed up by our dietary antioxidant intakes. Our antioxidant defenses give us power to head off degenerative disease and achieve long life.

By quenching the metabolic sparks, antioxidants are also our natural antitoxins. But if the oxygen-free-radical toxins were the only problem, we'd likely all live 120 years or more. Think about cigarette smoke—100 trillion free radicals per puff. A total 4,000-plus synthetic chemicals in everyday use; even drugs we buy over the counter set small fires. Not to mention the illicit “recreational drugs.” Even emotional stress can overheat our metabolism. In this crazy world it's not good to leave home without your antioxidants.

Infectious agents are consistently linked to inflammation. In 1990 I documented inflammatory depletion of antioxidants by HIV-1. Then there's Hepatitis C virus in the livers of four million Americans. The bacterium Helicobacter pylori accounts for the majority of inflammatory stomach and intestinal ulcers. About half of the chronically ill American veterans of the Gulf War have mycoplasmal infections. We also can't forget Chlamydia pneumoniae, the fungus Candida albicans and Giardia and amebic protozoal parasites.

Our own host immune system may trigger inflammation from over-reaction to resistant pathogens. The immune cells produce huge quantities of free radicals when on the attack. When pathogens are not easily eliminated, the immune oxidant production can get out of control, resulting in local exhaustion of antioxidant defenses and another inflammatory focus.

Almost every toxic substance steals electrons and therefore can deplete the body's antioxidants. Thus, the body's own efforts to process some substances can actually make them worse toxins. The P450 detoxification system, located mostly in the liver, combines oxygen with water-insoluble substances such as cholesterol, estrogens, pollutants, pharmaceuticals, even herbal constituents. They are made into free radicals, to be later combined with antioxidants and made water-soluble for clearance with the urine or bile. But things don't always go as planned.

The P450 system wasn't designed to deal with the huge mass of toxins that enter the body. Let's talk about acetaminophen. This legal, over-the-counter drug (Tylenol®) is made highly reactive by the liver P450 enzymes. Then it burns away glutathione, the major liver antioxidant, and begins to kill liver cells. Liver failure can result. Organochlorine pollutants, indoor pesticides, mercury and other heavy metals (and let's not forget alcohol and cigarette smoke derivatives) all deplete glutathione and threaten all the tissues.

I recently did a series of in-depth reviews of degenerative diseases. The major pattern I see with atherosclerosis, coronary heart disease, bowel diseases, liver diseases, Alzheimer's disease, multiple sclerosis, Parkinson's, cataract, arthritis, osteoporosis, macular degeneration, prostate diseases, many cancers—is inflammation. By combating inflammation, antioxidants are our essential natural defense against premature suffering and death.

The body relies on foods to replenish its internal antioxidant stores. From our whole, unprocessed foods come the antioxidant vitamins A, C and E; the antioxidant essential minerals, selenium and zinc and copper and manganese; the semi-essential antioxidants coenzyme Q10 (COQ) and alpha lipoic acid (ALA); lutein, lycopene and other carotenoids; the polyphenolic flavonoids and various substances from traditional herbs. These circulate in our blood and contribute integratively to the blocking of free radicals. But a growing body of research indicates we aren't getting enough from our foods for optimal protection against disease.

The healthy body tries to conserve the nutritional antioxidants through metabolic recycling. But still there is a “burn” on our reserves. Dr. Robert Cathcart, the foremost authority on vitamin C , speaks of a “hundred-gram cold,” an influenza so severe it can burn away 100 grams (not milligrams) of vitamin C in just a day or two. A flu attack can be held to just a few days instead of a few weeks by taking lots of C and other antioxidants.

Integrative medical practitioners report that just about all their patients benefit from supplemental antioxidants. Vitamin E has been known for decades to be lifesaving against heart disease.Most of the health food community thinks of vitamin E as tocopherols. But tocotrienols are legitimate members of the vitamin E family and are excellent antioxidants. They are under clinical investigation for benefit against atherosclerotic blood vessel disease and experimentally for the slowing of cancer cell growth and proliferation.

Stephen Sinatra, M.D., a cardiologist and leader in the practice of integrative medicine, has long been a booster for COQ. I can relate to this because I also see COQ's fantastic promise. As I read about health care costs soaring through the roof, I wonder why COQ is not being fortified in our foods to lower gum disease, to improve heart and blood vessel health, to boost immunity and fight cancer development, even (yes!) to lengthen everyone's productive lifespan.

Coenzyme Q10 is unique as a potent antioxidant and indispensable energy catalyst (only ALA has a similar double role). Many of Dr. Sinatra's patients are very deficient in COQ. People taking statin drugs, beta-blockers or certain of the anti-depressants may have their internal COQ synthesis blocked. For them and probably for many of the sick and elderly, COQ is practically a vitamin. Any insufficiency of COQ can endanger the heart through impairing its energetic capacity.

Dr. Sinatra has linked much of the heart disease he sees in women to COQ deficiency. More than 100 clinical studies document that COQ improves congestive heart failure, angina, high blood pressure. About 15 percent of Dr. Sinatra's patients do not improve satisfactorily on COQ alone; these he gives carnitine and then improvement usually occurs. He also sees in the clinical evidence a potential link between poor COQ status and cancers, especially in women.

Selenium is an essential trace mineral, required through the diet though only in small quantities. Selenium has importance for human health that belies its plain mineral status. It is specific for the active sites of the antioxidant enzyme glutathione peroxidase (GP). GP is a central player in control over free radicals.

In 1996 a major paper appeared in the prestigious (and conservative) New England Journal of Medicine, making an almost unbelievable claim. It described a double-blind, randomized, placebo-controlled trial in which more than 1,300 subjects were followed for up to 10 years. Dietary supplementation with selenium produced a 50 percent reduction in total cancer mortality. The incidence of cancer was reduced by one-third. Lung, colorectal and prostate cancer incidence were markedly reduced. The material used was SelenoExcell™, an organic selenium concentrate that resembles the selenium found in food.

The carotenoids are, like vitamin E, fat-soluble antioxidants. One of them—lycopene—has been linked to exciting early results against prostate cancer. A small but controlled, clinical trial focused on male subjects undergoing surgery for prostate cancer. Half were offered a dietary supplement of LYC-O-MATO®, a standardized natural tomato extract with four times the typical lycopene content. PSA (Prostate Specific Antigen) levels and prostate tumor size were significantly reduced, compared with the control subjects.

More recently, in a placebo-controlled, crossover trial, LYC-O-MATO® also showed good results in lowering high blood pressure. Its natural combination of lycopene with other plant nutrients may offer a unique synergy for the protection of our health against free radical and other toxic damage.

Lutein is the only carotenoid found in high concentrations in the retina, a thin cell layer at the back of the eye which constantly takes a high dose of light radiation. Macular degeneration destroys the retina and afflicts one out of four Americans over age 65. Lutein is being researched for its capacity to protect the retina and the lens of the eye and it also has anticancer potential.

Grape seed extracts are concentrates of flavonoid polymers. When the great scientist Albert Szent-Gyorgyi received the Nobel Prize for discovering vitamin C, he commented that he had expected to get it for discovering the flavonoids. The small polymers (oligomeric procyanidins) and polyphenols in grapes work synergistically with vitamin C to conserve the functions of the blood vessel linings and walls. Some of these flavonoids also have antiviral and possible anticancer actions.

As scientists continue with their dedicated investigations of food constituents, the latest phytonutrient star is rosmarinic acid (RA). This substance is extracted from a naturally high-yielding strain of oregano and also occurs in thyme and rosemary. All three of these plants have been revered for their medicinal properties literally for centuries. RA appears to have anti-inflammatory and anti-allergic properties, while its high antioxidant potency has proved useful for stabilizing vegetable oils against frying. It has been prepared as a powder without solvents or other processing chemicals. Antibacterial, antifungal and antiviral effects are also being investigated.

Antioxidants are, together with phospholipids, nutrients with profound nutraceutical potential. Whether supplementation with these nutrients will extend the maximum lifespan remains to be proven. Certainly the clinical and experimental studies suggest that functional deficiencies of these nutrients result in cell-level dysfunctions with the potential to spark inflammation that progresses to life-shortening degenerative disease.

We need to keep the fires within us at a very low ebb lest they develop into the raging infernos of uncontrolled inflammation. Consumption of a variety of functional foods and supplements enriched with these nutrients will help keep that doctor away.

Phospholipids, Functional Partners of Antioxidants

by Parris M. Kidd, Ph.D.

Within the cells, circulating lipoproteins, digestive fluids and elsewhere in the body, phospholipids co-occur and co-function with antioxidants. The phospholipids (pronounced fos-fo-lip-ids) self-assemble into membranes and other multidimensional structures, together with antioxidants to protect them against oxidative destruction. This partnership between nutrient classes profoundly influences the health of the whole being.

The cell membranes are dynamic molecular assemblies that house life's plethora of biochemical processes. Our 100 trillion cells all rely on membranes to carry out their functions. Cell membrane organization is shown on the left of the illustration. Catalytic proteins are housed within a flexible bilayer (two molecular sheets), the phospholipid matrix. The matrix also houses antioxidants, including tocopherols and tocotrienols of the vitamin E family; lycopene, lutein and other carotenoids and ubiquinone (coenzyme Q10 or COQ). Also present is the antioxidant enzyme glutathione peroxidase, using selenium as its mineral co-factor.

Phospholipids (PL) are the most biochemically-suited building blocks for membranes. The right side of the illustration shows the molecular plan of a common membrane PL such as PS (PhosphatidylSerine)or PC (PhosphatidylCholine).

The fatty acid tails often are highly unsaturated and therefore susceptible to oxyradical or other oxidant attack. The more unsaturated the membrane, the more antioxidant protection is required. The PL head groups each bring special properties to the membrane. In PS the head group has serine, in PC it has choline. The “prophospholipid” GPC (GlyceroPhosphoCholine) has the choline head group but lacks fatty acid tails, and is absent from the membrane proper.

PS is most concentrated in nerve cell membranes. Its head group associates with membrane proteins particularly crucial to nerve cell functions. These include:

  • The sodium-potassium AND calcium-magnesium transporters that use up to 70 percent of all the cell's energy;
  • Enzymes for signal transduction—protein kinases and adenylyl cyclases;
  • Receptors, sensors for chemical transmitters (acetylcholine, adrenaline, noradrenaline, serotonin, others), also for nerve growth factors;
  • Proteins of the mitochondrial membranes, central to energetics. Here PS also is a backup for other phospholipids.

These membrane-level functions of PS translate to health for the whole being. Double-blind trials (20 of them) show PS a superior nutrient for memory support, for partial restoration of declining cognitive function, for coping with stress in the healthy young. Preliminary research suggests PS can improve attention, learning and behavior in children.

The energy for life is generated in cell membranes. In the process oxygen radicals (“oxyrads”) are generated which are highly reactive. However good the antioxidant defenses are, some oxyrads escape control and attack membranes. Thus the brain, with its intense energy generation (up to 60 percent of the body's total), must continually renew its cell membranes. Antioxidants such as vitamins C and E, the minerals selenium, zinc and manganese, the energizers COQ and alpha-lipoic acid, the carotenoids lutein and lycopene, standardized polyphenolic flavonoids and other food borne antioxidants, all synergize with PS to help optimize brain functions.

The liver is our workhorse organ; its cells contain a total eight football fields worth of membrane area, to perform 500 different functions. In its efforts to detoxify foreign substances it generates a further oxidative load on top of its usual oxyrad burden. Oxidants from foods, viruses, pollutants and drugs challenge the liver's antioxidant capacity. Though the healthy liver is well endowed with antioxidants, oxidant overload can kill cell membranes. Enter PC (PhosphatidylCholine), the most common phospholipid of membranes.

Dietary supplementation with PC has clinically important, sometimes lifesaving benefits for the liver. In eight double-blind clinical trials, PC protected the human liver against alcoholic inflammation, viral infection and toxic prescription rugs, markedly improving the speed and extent of patient recovery.

The liver also carries a substantial reserve of GPC, which is readily converted into PC to make membrane. It is the most bioavailable source of choline to help the liver cells regenerate and perhaps for similar reasons is highly concentrated in mother's milk.

Taken by mouth, GPC quickly clears the blood-brain barrier to reach the brain. Working through various mechanisms, it sharpens attention and immediate recall in young, healthy subjects. In the middle-aged it benefits information processing and general mental focus. In the elderly it improves declining cognitive functions linked to circulatory damage. GPC's support for nerve cell functions, including a protective role as osmotic buffer, make a convenient biochemical fit with the antioxidant defenses operative in the brain.

Functional partnership between phospholipids and the antioxidants is not limited to membranes. The circulating lipoproteins produced in the liver (HDL, LDL and others) are made mostly from PL building blocks. Dietary PL facilitate normal, pro-homeostatic lipoprotein status, probably through their support of the liver.

The LDL are the main vehicles for delivery of fat-soluble antioxidants—E, COQ, alpha-lipoic, carotenoids, others—to the tissues. In all of 12 double-blind trials, phospholipid mixtures lowered abnormally high total- and LDL- cholesterol without harming the HDL levels. In another double-blind trial, PL significantly improved blood flow to the brain and improved abnormal platelet aggregation. These marked circulatory benefits of the PL clearly complement antioxidants' benefits for the circulating lipoproteins and blood vessel walls.

Phospholipids combine with antioxidants in facilitating digestion. The bile fluid is essential for fat digestion and absorption. Bile has a large content of PL, functioning with the antioxidant taurine as micellizing agents to fully disperse the fat molecules. Fatty acids of the omega-3 or omega-6 class make up many of the phospholipid “tails.” These are held in position by their parent PL molecules while enzymes break away prostaglandins (PG) and other messenger molecules. Membrane antioxidants help regulate the PG formed, to support a favorable balance.

The natural co-functioning of phospholipids with antioxidants in our cells and tissues suggests combination supplements for synergistic benefits. In particular, a new technology (NutriVail™) employs custom phospholipids to make monomolecular dispersions of antioxidants, with the aim of substantially enhanced bio-availability and unique clinical benefit.

Peer-reviewed publications available on request. Dr. Kidd is scientific consultant to Lipoid USA.

Lutein For Eye Health

Recent scientific studies showing a clear association between lutein intake and a decreased risk of age-related macular degeneration (AMD) and cataracts are capturing the attention of both consumers and their eye doctors. The need is growing clearer:

  • One out of four people aged 65 or older has early signs of AMD.
  • One out of two people aged 65 or older has a cataract or cloudiness in the eye's lens.
  • As the largest population group in the United States ages, many people are facing the likelihood of what some simply accept as part of aging, vision loss.

A Food and Nutrition Board report found that lutein is the nutrient most strongly associated with decreased risk of AMD and cataracts.

Lutein and Age-Related Macular Degeneration

Prevent Blindness America estimates that 13 million people in this country have evidence of AMD, a condition that gradually destroys central vision. While the exact cause of this debilitating condition is still unknown, family history and age are known factors.

Lutein is found in the macula's “yellow spot,” a tiny region at the center of the retina. This tiny yellow spot filters blue light for the color vision cells within the retina. The researchers found that lutein is deposited in the retina and macula, increasing its density and protecting the tissue from oxidation by filtering blue light and quenching free radicals.

Experts say that by the time a person exhibits symptoms of AMD the disease has been developing for decades. Baby Boomers are showing concern about their aging eyesight and stocking up on supplement products formulated with lutein to reduce risk of age-related macular degeneration.

Lutein and Cataracts

While cataracts generally occur in people over the age of 65, they are occasionally found in younger people as well. A cataract is a clouding that develops in the normally clear lens of the eye. This process prevents the lens from properly focusing light on the retina at the back of the eye, resulting in a loss of vision.

Lutein's link to cataracts is recent but well documented. Studies published in The American Journal of Clinical Nutrition found that women with the highest intake of lutein and its fellow carotenoid antioxidant, zeaxanthin, had a 22 percent reduced risk for cataracts; men had 19 percent reduced risk.

“Many people have been told that nothing can be done about cataracts—that they are a natural effect of the aging process,” says Robert Abel, Jr. M.D., author of The Eye Care Revolution and member of the Lutein Information Bureau Advisory Board. “But they're now finding out that dietary changes, including consumption of lutein, may have a significant impact on risk reduction.”

At the same time, consumers are taking charge of their eye health and seeking out possible solutions. A recent independent survey of consumers shows lutein awareness at 44 percent across all age groups and at more than 57 percent among consumers aged 65 years or older.

Mounting scientific evidence also has convinced eye doctors of the many benefits of lutein, with 84 percent currently recommending lutein to their patients, according to an independent survey of 300 U.S. ophthalmologists and optometrists.

These eye doctors also support use of lutein for long-term eye health (91 percent), believe consumers should supplement their diet with lutein daily (71 percent) and believe lutein is the nutrient that best supports long-term eye health (58 percent).

Natural product supermarket sales of supplements containing carotenoids and antioxidants grew to $13.7 million in 2001 —an almost eight percent jump over the previous year. The top four products in that category all contain lutein. In fact, supplements containing lutein are growing five times faster than those without.

What is lutein?

Lutein (LOO-teen) is a nutrient found predominantly in vegetables, particularly in dark green, leafy vegetables such as spinach and kale. Lutein belongs to a class of natural, fat-soluble pigments called carotenoids. It promotes long-term eye health in two ways. First, acting as a light filter, lutein protects the eyes from some of the damaging effects of the sun. Second, as an antioxidant, it protects the eyes from the damaging effects of aging.

Lutein is found naturally in the human body. In fact, it is the only carotenoid found in large quantities in the retina and at low levels in the lens of the eye. The human body is unable to manufacture lutein, however, so the body must rely on the consumption of lutein-rich foods or lutein supplements to replenish lutein levels and counteract oxidative damage from light as well as the effects of aging.

A 1994 Harvard University study by Dr. Johanna Seddon pointed first to lutein's important role in maintaining long-term eye health. Since then, more than a dozen scientific studies published by such peer-reviewed medical journals as the Journal of the American Medical Association, Archives of Ophthalmology and the American Journal of Clinical Nutrition have continued to show an association between lutein intake and various long-term eye health benefits.

Since the groundbreaking Harvard research, Kemin Foods, an Iowa-based global manufacturer of natural ingredients, has been helping vitamin and dietary supplement manufacturers meet the demands of a growing market interested in maintaining long-term eye health.

Kemin's FloraGLO® brand lutein is a purified and patented lutein available for use in vitamins, foods/beverages and personal care/cosmetic products. It is the only lutein product that is GRAS (generally recognized as safe) for breakfast and granola bars, energy bars, energy drinks, fruit drinks, fruit juice, meal replacement drinks, mixed vegetable juice, cereals and soy milk.

About Kemin Foods

Superior science and service sets Kemin Foods apart from many other companies serving the vitamin and supplement industry. Nearly 10 percent of the company's employees have doctorate degrees in various disciplines, working in a team-based environment to produce products based on scientific research at the molecular level. Once Kemin scientists understand how products work at the molecular level, the company supports those products with a commitment to superior customer service, including extensive market research and co-branding efforts that leverage brand value.

Lyc-O-Mato® Standardized Natural Lycopene Complex

by James Balch, M.D.

The good news is that there is clinical proof you can build a powerful antioxidant defense system against prostate cancer. By incorporating LYC-O-MATO® (standardized natural tomato extract) into your daily nutrition program you can access remarkable fighting power against prostate cancer and a host of other degenerative diseases.

The standardized natural tomato extract contains several phytonutrients found in tomatoes including lycopene, tocopherols, vitamin E, phytofluene, phytoene, phytosterols, beta carotene and more. LYC-O-MATO is extracted from non-GMO tomatoes grown in Israel that contain four times the lycopene content of tomatoes grown elsewhere.

A six-year Harvard Medical School study of healthy males found that consuming tomatoes, tomato sauce or pizza more than twice a week, as opposed to never, was associated with a reduced risk of prostate cancer of 21 to 34 percent, depending on the food.

As exciting as its cancer-prevention potential is the evidence that shows lycopene may help fight existing cancer. A recent paper published in the Cancer Epidemiology, Biomarkers and Prevention by Omer Kucuk, M.D., professor of medicine and oncology, and his colleagues at the Karmanos Cancer Institute in Detroit, Michigan, evaluated the effect encapsulated LYC-O-MATO had on patients with existing prostate cancer. In this study, Dr. Kucuk and colleagues followed 30 men with localized prostate cancer who were scheduled to undergo surgical removal of the prostate. For three weeks prior to surgery the study participants were randomly assigned to receive either 250 milligrams LYC-O-MATO from LycoRed Natural Products, Beer-Sheva, Israel (which contains 15 milligram of lycopene) twice daily or no intervention. Following removal of the prostates, the glands were analyzed to determine whether there were any differences between the two study groups.

The investigators found that the treated group had smaller tumors, which were more likely to be confined to the prostate. Levels of serum PSA were found to decline in the patients who received LYC-O-MATO tomato extract. In addition, the tumors in patients who consumed this natural lycopene showed signs of regression and decreased malignancy.

“This was the first published report from a randomized prospective clinical trial showing the efficacy of a tomato extract supplement against prostate cancer,” said Dr. Kucuk. “Previous reports were largely epidemiological studies showing an association between consumption of tomato products and decreased risk of prostate cancer. Furthermore, our findings suggest that a tomato extract in the form of LYC-O-MATO may not only help prevent prostate cancer but also may be useful in treating prostate cancer.”

Research using standardized LYC-O-MATO natural tomato extract is also good news for mild hypertensive patients reluctant to make lifestyle changes.

New findings published in the May issue of The American Journal of Hypertension provide evidence that LYC-O-MATO may help lower blood pressure in hypertensive patients. The study, presented at the Sixteenth Annual Scientific Meeting of the American Society of Hypertension on May 18, 2001, may provide a new alternative for about 50 million Americans who have hypertension.

Americans interested in lowering their risk of high blood pressure are frequently encouraged to exercise and follow a low-fat diet rich in fruits and vegetables. Typically, however, many are reluctant to make changes in their lifestyles. In fact, according to NOAH, an online health resource maintained by City University of New York, only 68 percent are aware of their high blood pressure condition and only 27 percent have it under control. High blood pressure contributes to 75 percent of all strokes and heart attacks.

Now there is a natural alternative to controlling hypertension that may prevent Americans from making difficult lifestyle changes and/or taking drugs with harmful side effects.

In a single-blind, placebo-controlled crossover trial, Esther Paran, M.D., the study's principal investigator, evaluated the effect of LYC-O-MATO® on grade 1 hypertensive patients. In this study, 30 grade 1 hypertensive patients between the ages of 45–60 were administered a daily dose of identical placebos for the first four weeks of the study, followed by a 250 mg daily dose of LYC-O-MATO® for the final eight weeks of the study.

Preliminary results of this study indicate a significant reduction in systolic blood pressure in treated patients. “We are optimistic about LYC-O-MATO'S potential in managing hypertension,” Dr. Paran said. “The results of this study demonstrate the ability of LYC-O-MATO® to reduce systolic blood-pressure, warranting additional studies in the future.”

Other recent studies suggest that LYC-OMATO ® also provides a considerable level of defense against degenerative diseases including heart disease. Considering the results of these studies, combined with its positive effects on blood pressure, the importance of maintaining a normal level of natural phytonutrients like lycopene, phytoene, phytofluene and beta carotene in the human body is evident. It is recommended that individuals consume at least 80–250 mg of LYC-O-MATO® per day, which contains 15 mg of lycopene as well as other phytonutrients, to maintain good health.

www.lycomato.com, or visit the American Society of Hypertension Web site at www.ash-us.org

Grape Seed Extract and the French Paradox

What is the French paradox?

Several years ago, epidemiologists studying heart disease in Europe noticed something strange—high fat leads to heart disease, right? Not in France. The French eat a large amount of cream, rich sauces, delicious desserts and a wide variety of tasty cheeses. Yet heart disease is lower in France than the rest of Europe. This phenomenon is called the French paradox. Check this out—the French imbibe more wine than the rest of Europe.

The goodness of wine—flavonoids

What's in the wine? Water, alcohol and several other compounds (such as sulfur dioxide, carbon dioxide, tartaric acid) and more importantly flavonoids. Flavonoids are a large group of phenolic compounds that occur in fruits, cereals, legumes, vegetables, nuts, seeds, herbs, spices, stems and flowers and also in beverages such as tea, cocoa, beer and wine. Flavonoids have several properties that could prevent heart diseases. They are antioxidants that help with the oxidation of low-density lipoproteins (LDL). They also have anti-inflammatory properties and a beneficial effect on blood vessels as well.

Grape seed—a vital source of flavonoids Grape seeds contain 5–8 weight percent of flavonoids. Commercially available grape seed extracts such as MegaNatural™ Gold (Polyphenolics, Madera, California) are a rich source of flavonoids. Benefits of flavonoids For several years scientists at the University of California-Davis have studied the effect of flavonoids from grape seeds on blood vessels and how it can reduce cardiovascular risk factors. Loss of endothelium-dependent relaxation (EDR) due to atherosclerosis is the primary cause for the formation of plaque in coronary arteries that leads to heart disease. EDR is caused by the release of nitric oxide (NO) from endothelial cells of the blood vessel. Experimental evidence led to the speculation that the release of NO could be mediated by a series of events that are initiated by a receptor, which is specific to flavonoids. EDR can be readily demonstrated by control experiments using established procedures. The effect of flavonoids on EDR was studied in detail over the past several years. Previous studies regarding the effect of flavonoids on EDR yielded conflicting results, possibly due to the variations in he quality of the extracts examined. However, recent studies using the commercially available grape seed extract MegaNatural Gold provided conclusive evidence that flavonoids have a protective effect against the development of endothelial dysfunction.

In the experiments, a group of rabbits fed only with cholesterol showed loss of EDR. But, a group of rabbits fed with both grape seed extract, MegaNatural Gold and cholesterol showed no loss of EDR, proving the protective effect of the grape seed extract, MegaNatural Gold.

Antioxidant activity of grape seed extracts Another study at the University of Scranton has demonstrated the superior antioxidant activity of grape seed extracts (GSEs) overwine, grape juice, vitamin C and vitamin E. Commercial products like MegaNatural Gold were used for both the in vitro and in vivo studies.

In one such study, a significant increase in the blood plasma antioxidant activity was observed within one or two hours after the consumption of grape seed extract. Nine human volunteers were given a 600 mg dosage of GSE and by using the RANDOX bio-assay study an increase up to 12 percent of blood plasma antioxidant activity was observed. This dosage could be correlated to drinking 300 ml of red wine or consuming 1250 mg of vitamin C.

In order to determine the GSE dosage that is required to have a higher bio-availability of polyphenols in blood plasma for improved antioxidant activity, nine subjects were given varied dosages of the flavonoid, epicatechin. Epicatechin is one of the flavonoids present in all grape seed extracts. The in vivo antioxidant study has shown that a dosage of 300 mg was more effective than 200 mg. In fact at 300 mg the antioxidant capacity in the blood was still increasing after four hours, indicating that at this dose the antioxidant effect will remain in the blood for six to eight hours.

A long-term study involving a dosage of 2 x 300 mg/day of GSE with 17 human volunteers was also conducted to understand the beneficial effect of GSE in reducing high cholesterol. Patients with high cholesterol experienced a decline in total cholesterol up to 12 percent and a corresponding decrease up to 16 percent in LDL, the so-called “bad cholesterol” as well.

These studies have once again confirmed the long-term effect of GSE s in controlling the level of cholesterol and triglycerides and reducing the risk of heart disease.

Implications for heart disease Endothelial dysfunction (loss of EDR) exists in hypertensives, diabetics, smokers, postmenopausal women and individuals with hyperlipidemia. All of these conditions are potential cardiovascular risk factors. Experimental evidence leads to the belief that polymeric flavonoids as a part of the diet may have a protective effect against the development of endothelial dysfunction. These findings, along with the established anti-inflammatory and antioxidant effects of flavonoids, could be a possible explanation for the French paradox.

Also for your consideration A substitute for aspirin for heart health

Many individuals take an aspirin a day to prevent their blood from becoming too “sticky.” Technically they are trying to prevent an increase in platelet aggregation. Blood platelets are like tiny band-aids in that they help to seal wounds by causing the blood to clot. Unfortunately, if the platelets clump (aggregate) too readily, they can cause a great deal of damage to the arteries. They can further the development of arterial plaques and they can reduce the flow of blood through the capillaries. Diabetics and smokers are two groups which commonly suffer from poor circulation and excessive platelet aggregation. Not surprisingly, both groups suffer from elevated rates of damage to the arteries.

Aspirin may provide some potential benefits for the heart, but it also has a number of side effects. The best known of these are damage to the stomach and the small intestine, but there are other dangers such as excessive bleeding (an increase in bleeding time—including inside the eye) and a reduced rate of repair to the tendons and the joints.

Do we really need these side effects? Of course not. Grape seed extract provides extended protection against platelet aggregation without causing any unwanted increase in bleeding time. A number of tests have confirmed this protection including human trials conducted by Serge Renaud of the French National Institute of Health and Medical Research. Dr. Renaud demonstrated that grape seed extract can protect against the rebound in platelet aggregation which follows the ingestion of alcohol. Moreover, the compounds found in grape seed extract have a special affinity for the surfaces of the vascular system, the “pipes” as it were, of the body. This special affinity appears to improve the elasticity and the permeability of the capillaries, veins and arteries—the entire vascular system. Grape seed extract protects the ground substance (the proteoglycan matrix) of the blood vessels directly while at the same time it reduces the unwanted adhesion of platelets and other blood components. The suggested intake for these benefits is 200 to 300 milligrams (mg) per day.

The Health Advantage of Food-form Selenium

by Bill Sardi

“The finding that selenium, an essential nutrient posing negligible risk at the 200 mcg intakes studies, can substantially cut the risk of death from cancer is really a revolutionary finding. I cannot think of any other agent, nutritional or pharmaceutical, that is proven to cut the deaths from cancer by half in any human population anywhere in the world. “These remarkable clinical outcomes with selenium for cancer prevention are not a deviation from other research with selenium conducted with animals, with selenium-antioxidant enzymes, with cells in culture. Yet the potential they represent for cutting the emotional, spiritual and financial costs that cancer imposes on human society is almost beyond belief. Just shut your eyes for a moment, take a deep breath and think of all the people you have known who suffered and died from cancer.”

—Parris M. Kidd, Ph.D., science editor Total Health

SCIENTISTS FIRST CALLED SELENIUM TOXIC. THEN FOLLOWING ITS RECOGNITION FOR ANIMAL HEALTH, RESEARCHERS IDENTIFIED IT AS AN ESSENTIAL ELEMENT FOR HUMAN GROWTH.

Now investigators wonder where the health benefits of selenium stop. The first selenium function in animals wasn't discovered until 1973. Dr. John Rotruck and his colleagues at the University of Wisconsin demonstrated that selenium was incorporated into molecules of an enzyme called glutathione peroxidase (GPX). This vital enzyme protects red blood cells, cell membranes and sub-cellular components against undesirable reactions with soluble peroxides. The discovery of GPX opened the door to our understanding of how selenium is protective against cancer, heart disease, arthritis and accelerated aging.

This much misunderstood trace mineral may not gain the status of a drug simply because its primary role is disease prevention. Wherever soil is rich in selenium, certain diseases of livestock are virtually non-existent.

But how could selenium, provided in dosages less than the weight of a paper clip, protect a 150-pound human from disease?

Selenium and cancer

In what was called the most startling cancer prevention study ever published, University of Arizona and Cornell University researchers recently discovered that selenium food supplements significantly reduce the incidence of nearly all forms of cancer. In 1996 researchers Larry Clark, Gerald Combs and Bruce Turnbull of Cornell University reported on the 10-year use of a 200 microgram supplement of protein-bound selenium among 1312 patients with a history of basal cell or squamous cell skin cancer. While selenium had no effect upon skin cancer, it had a startling effect upon other types of tumors.

A Harvard researcher was quoted as saying: “If the effect of selenium is this large, it would be more important than anything else we know about in cancer prevention.” The results of the multi-center study were so surprising, many health researchers still want more proof.

Larry Clark, the senior researcher in this study, remarked that the type of selenium used in this study is not commonly found in all vitamin supplements. It's a special type of selenium that is grown organically in yeast. “Most of the selenium on the market is inorganic sodium selenite or sometimes they throw sodium selenite into yeast, but they are not bound together as the yeast grows, yet it is still called high-selenium yeast.”

Which type of selenium supplement?

In plant foods, selenium is bound to an array of amino acids (methionine, cysteine, others) and is thus a more stable form. In 1984, a MIT study determined that organically-bound forms of selenium are able to increase the body selenite exchangeable pool size about 70 percent more effectively than inorganic selenite or selenate. The superiority of protein-bound selenium is demonstrated in recent study where selenium-enriched broccoli was shown to inhibit colon tumors in rodents. Researchers observed that selenium-enriched broccoli is more effective than inorganic forms of selenium against colon tumor formation.

Another example of the superiority of protein-bound selenium over inorganic selenium has become apparent in studies of eye disease. One report suggests that “dietary supplementation with selenium should be explored as a means of preventing macular degeneration.” However, researchers have found that blood levels of selenium were lower among patients with macular degeneration even though seven of 10 patients studied took selenium supplements, mostly consisting of 80 micrograms of inorganic selenium (selenate). Lack of consumption of selenium does not appear to be the problem in these cases. Researchers surmise that the form of selenium is of importance. Some studies report that even 200 microgram doses of inorganic selenium fails to increase blood plasma levels of selenium in the eye, while amino acid-bound selenium increases plasma and whole blood levels.

Consumers should look for organically-bound selenium in supplements rather than the inorganic forms (selenite, selenate). The question is how to duplicate the same selenoproteins provided in plant foods in a food supplement?

Slow-growing Saccharomyces cerevisiae, baker's yeast, is employed to bind amino acids naturally with selenium. Some selenium food supplements only mix inorganic selenium with yeast but this is a shortcut that fails to do what nature does—slowly incorporate selenium into an array of about 20 amino acids. Yet the label on these food supplements may still read “selenium yeast.”

Numerous food supplements provide selenium bound only to one amino acid, selenomethionine. But the food supplement that dramatically reduced the cancer risk in 1996 employed a form of selenium bound to a full array of amino acids, like in foods. Only one brand of food supplement provides this complete food-form selenium, called SelenoExcell.

Due to years of misinformation the word “yeast” draws the attention of some consumers who believe they must avoid yeast products. Beneficial nutritional baker's yeast does not contribute to yeast infections such as Candida albicans. Selenium yeast is carefully pasteurized and dried after it is grown. This kills the yeast and it can no longer grow or multiply. Brewer's yeast has been a staple of the health food industry since its inception and is no cause for concern.

Only one company is going through all the trouble to manufacture a consistently reliable form of selenium organically bound to a full array of amino acids as found in foods. It goes by the trade name SelenoExcell.™. All forms of selenium have health benefits. But we have to go with the science. Until we know more, look for that branded ingredient.

Bill Sardi is president of Knowledge of Health, San Dimas, California.

ROSMARINIC ACID

by Rina Reznik, Ph.D.

To protect ourselves we invest in lifestyle changes, exercise, a healthy diet and supplementation. Antioxidants are only one element in the big picture, so products with multiple uses are particularly useful. After all, there's a limit to the number of supplements we can swallow in a day, let alone afford, so we need to supplement wisely. For example, consuming un-denatured whey protein raises intracellular glutathione levels and takes advantage of its three protective functions: T-cell synthesis, anti-oxidation and detoxification. Spirulina is an effective dietary antioxidant with dozens of well-known health benefits. Rosmarinic acid is another product that offers multiple advantages.

Rosemary and its cousins, oregano and thyme, have been known for their medicinal properties for centuries and rosemary oil has long been used in cooking, aromatherapy and in hair and skin tonics. It has been described traditionally as good for the skin, scalp, digestion and treatment of colds and is used as an antiseptic, stimulant and antispasmodic. Today medical scientists are particularly interested in rosmarinic acid for its anti-inflammatory, antiallergic and antioxidant properties.

Rosmarinic acid's multiple value also lies in its boxer's one-two approach: first, as a purely natural food additive it prevents or neutralizes the harmful oxidation that takes place while food is on the shelf, enhancing its quality and helping to prevent an additional tax on the body's over-burdened defense system. Then once the food is eaten, the same additive turns out to be a powerful dietary antioxidant. Of course it can also be used for direct supplementation. An added bonus is that rosmarinic acid does not interfere with intracellular oxidant-antioxidant balance and enables the immune system's phagocytes to use their free-radical weapons effectively against incoming disease organisms.

RA's antioxidant power

The most common free radicals attacking living tissue are reactive oxygen species (ROS)—or oxyradicals. They include the peroxyl, nitric oxide and superoxide-anion radicals plus singlet oxygen, peroxynitrite and hydrogen peroxide. Worst of all is the dangerous hydroxyl radical, formed by the combination of the weaker superoxide radical with hydrogen peroxide. Rosmarinic acid neutralizes the superoxide-anion and thus makes a major contribution to curbing oxidative damage in the body.

Rosmarinic acid also takes the heat of the more well-known antioxidants by getting into the fray and dealing with free radicals first, leaving vitamins C, E and others intact for later use. This extract is also one of the few antioxidants able to cross the blood-brain barrier and combat the superoxide radical in the brain, where researchers hope it may help prevent or combat such degenerative conditions as Alzheimer's disease.

Researchers at the Israeli biotechnology company, RAD Natural Technologies, discovered that certain natural species of the plant Origanum vulgare contained particularly high concentrations of rosmarinic acid. Without genetic modification the plant yields a highly purified extract that is effective in very low concentrations. With neither solvents nor processing chemicals, RAD Natural Technologies is able to preserve the integrity of the plant extract and produce a water-soluble powder that can alternatively be emulsified and thus dissolved in fats and oils. It is ideal for industrial applications. If you've always thought of antioxidants as pills and dietary supplements, think again.

The company's rosmarinic acid product is called Origanox and it is sold for food processing, cosmetic and dietary purposes. Its antioxidant properties preserve natural pigments, odors and flavors and also protect vitamins and other active ingredients from the degenerative effects of oxidation. It also possesses antibacterial, antifungal, antiviral and anti-inflammatory properties and is easily absorbed into the skin, where it potentially supports to neutralize the harmful effect of ultraviolet radiation.

Rosmarinic acid maintains its electron-absorbing properties at sustained high temperatures. That means that when it is added to edible oils, the number of free radicals released by frying is diminished. It is stable for long periods and at temperatures as high as 180 C/356 F so it can be baked into foods without impairing its antioxidant properties.

In Summary

Free radicals come at us from every conceivable direction and we need a good variety of antioxidants to protect ourselves. Some, like glutathione, are produced by the body, and are dependent upon a supply of raw materials from dietary sources. Others, like vitamins C and E, are built into the foods we eat or supplement in our diets. We may not be used to thinking of food preservatives as health aids but rosmarinic acid is a valuable aid that supports to preempt free radicals before they form in stored food and prevents the most harmful effects resulting from cooking with all sorts of oils. It also functions as a powerful antioxidant with the rare ability to cross the blood-brain barrier.

The essential oil of Origanum vulgare is a powerful, anti-microbial agent and natural, antiseptic product. It has many, very promising applications in certain feed and food products besides being a flavor enhancer and therapeutic component in health food supplements. This potent and adaptable product promises to become a valuable addition to our preventive medicine arsenal.

Tocotrienols—Their Role In Health

by Andreas M. Papas, Ph.D.

TOCOTRIENOLS ARE MEMBERS OF THE VITAMIN E FAMILY.

Mention vitamin E and most people, even scientists, think alphatocopherol. It is only recently that scientists and now the consumers have been reminded that vitamin E is a family of compounds.

Tocotrienols are members of the vitamin E family. Unlike some vitamins which consist of a single compound, vitamin E consists of eight different compounds, four tocopherols and four tocotrienols (designated as alpha, beta, gamma and delta). Our food contains all eight compounds. Most vitamin E supplements, however, contain only alphatocopherol because it was thought that only this one was important. Emerging research proved this understanding wrong. In order to get the full spectrum of the many benefits of vitamin E we must use products that contain the complete family of tocopherols plus tocotrienols.

Tocotrienols are most abundant in cereal grains and the fruit of palm and are extracted commercially from palm oil and rice bran oil.

Tocopherols and Tocotrienols: Similarities and Differences

Each tocotrienol has similarities to the corresponding tocopherols. For this reason tocotrienols, like tocopherols, are excellent antioxidants. Tocotrienols however, have three unsaturated sites on the tail of the molecule. Scientists are discovering important and unique benefits of tocotrienols.

Underscoring the importance of taking the whole vitamin E family is the evidence that not only tocotrienols but even the other tocopherols have unique functions different from those of alpha-tocopherol. For example:

  • Gamma-tocopherol, not alpha, is the effective form for fighting nitrogen radicals which contribute to the development of arthritis, multiple sclerosis (MS) and diseases of the brain such as Alzheimer's.
  • Gamma-tocopherol and its major metabolite inhibit cyclooxygenase activity. This effect is very important because cyclooxygenase causes inflammation, which contributes to the progression of chronic diseases including heart disease and cancer.
  • High blood levels of gammatocopherol in men are associated with lower risk of prostate cancer.

The Science Behind the Unique Functions of Tocotrienols

Research produced evidence of the biochemical basis of the important and unique effects of tocotrienols. Tocotrienols and in particular gamma-tocotrienol appear to act on a specific enzyme called 3-hydroxy-3-methylglutarylcoenzyme A reductase (HMG-COA) involved in cholesterol production in the liver. Tocotrienols suppress the production of this enzyme, which may result in less cholesterol being manufactured.

Tocotrienols slow down the growth of some types of human cancer cells, and particularly breast cancer cells, while alpha, beta and gamma tocopherols are ineffective. Gamma-tocotrienol suppresses the growth of rat melanoma and human leukemia cells, human breast adenocarcinoma and human leukemic cells.

Benefits for Cardiovascular Health—Clinical Evidence

The strongest evidence yet for tocotrienols comes from a clinical study in which 50 patients had stenosis of the carotid artery. These patients, ranging in age from 49 to 83 years, were divided in two groups. One group received approximately 650 milligrams of tocotrienols plus tocopherols. The other group received a placebo. All patients were examined with ultrasonography which measures the narrowing of the carotid artery.

  • Placebo group: Fifteen patients showed worsening of the stenosis, eight remained stable and two showed some improvement.
  • Tocotrienol (plus tocopherol) group: Three patients showed minor worsening and 12 remained stable. What is remarkable is that 10 patients showed regression of stenosis—their condition improved.

The tocotrienol group had also significant reduction in TBARS, a test that measures oxidation. A tocotrienol-rich extract from rice bran oil reduced triglycerides and LDL in these patients. We are studying further these effects of tocotrienol-rich products from rice bran oil.

Topical Use of Tocotrienols

Tocotrienols, like tocopherols, protect the skin against damage from ultraviolet radiation, pollution, cigarette smoke and other stress factors. Topically applied tocotrienols and tocopherols penetrate the entire skin to the subcutaneous fat layer within 30 minutes and significantly increase the concentration of these antioxidants in the deeper subcutaneous layers.

Safe and Effective Use Levels

Tocotrienols and vitamin E in general have an excellent safety record.

How much tocotrienols to take? Please remember that tocotrienols are available commercially as mixtures with tocopherols. If you are at high risk for heart disease, you may consider levels up to 300 mg per day of tocotrienols. For the great majority of consumers who want to get the benefit of the complete vitamin E family, much lower levels may still provide benefits.

It is extremely important to take products that contain natural tocopherols plus tocotrienols. While our individual needs differ, the following general guidelines might help choose the right level for you.

  • The adequate level—the 100/100 system: Take 100 IU plus 100 mg of mixed tocopherols and tocotrienols. For healthy young adults with no family history of chronic disease.
  • The medium level—the 200/200 system: Take 200 IU plus 200 mg of mixed tocopherols and tocotrienols. For young adults with some risk factors and healthy people without risk factors up to 50 years old.
  • The high, yet very safe dose—the 400/400 system: Take 400 IU plus 400 mg of mixed tocopherols and tocotrienols. This is the level for people who, because of their family history for chronic disease, age, level of stress, diet and other factors, want to take a higher level.

Andreas M. Papas, Ph.D., is the author of The Vitamin E Factor (paperback) and editor of the scientific book Antioxidant Status, Diet, Nutrition and Health, Dr. Papas is senior technical associate at Eastman Chemical Company and adjunct professor, at the College of Medicine of East Tennessee State University and senior scientific advisor, Cancer Prevention Institute, Harvard School of Epidemiology. —www.vitaminefactor.com

 

Ten Additional Important Antioxidants

COQ10 FOR ANTI-AGING AND A HEALTHY HEART

Coenzyme Q10 is an antioxidant compound similar to vitamin K and is naturally manufactured in the liver as well as every cell in the body. But even though COQ10 is produced in the body, many people have deficiencies, especially those suffering from cardiovascular disease and heart failure.

Every cell must have a way of obtaining energy. In cardiac cells, as well as throughout the body, oxygen-based production occurs within the cellular power plants called mitochondria. Here COQ10 provides essential energy in its most basic form—adenosine triphosphate (ATP)—the energy of life. Without adequate COQ10 as a cofactor, ATP synthesis slows down, eventually leaving the cell in a vulnerable state.

Dietary sources of COQ10 come mainly from beef heart, pork, chicken liver and fish (especially salmon, mackerel and sardines). Vegetarians typically will not get enough COQ10 unless they eat large quantities of peanuts and/or broccoli. The average person only gets five to 10 mg of COQ10 each day from diet alone. Most people would benefit from far more COQ10 than can be gleaned from the daily diet.

Although COQ10 can be synthesized by the body, many individuals are deficient in this vitamin. Illness depletes the body's stores even further. Taking cholesterol-lowering drugs such as HMG-COA reductase inhibitors can literally “kill” COQ10 synthesis. Other drugs, such as beta blockers and some of the older antidepressants, also interfere with COQ10-dependent enzymes, lowering its concentration in the body.

Any women taking a statin drug, especially those at high risk for breast cancer, should take at least 100 mg of COQ10 a day.

VITAMIN C

Vitamin C (ascorbic acid) is a very powerful nutrient and the premier water-soluble antioxidant. It participates in over 300 biochemical reactions in the body and is important in maintaining homeostasis as well as building tissue.

Death is inevitable if vitamin C is not provided. It is truly essential to human life. New research into the actions of vitamin C has sparked a greater understanding of the remarkable health-promoting properties of this essential nutrient. The new evidence validates that vitamin C supports cardiovascular and respiratory function, cognition, bone development and mineralization, vision and may even lower the risk of stress-related diseases and certain types of cancer.

  • Cardiovascular Health. High dietary vitamin C intake has been shown to significantly reduce the risk of death from heart attacks and strokes in numerous population studies. Also, researchers have found that vitamin C offsets spasms of the coronary arteries.
  • Immunity Booster. A recent study reported an 85 percent lower incidence in cold and flu symptoms with high vitamin C doses.
  • Collagen Maintenance. Vitamin C is important for the formation and maintenance of collagen, the intercellular cement that binds tissues together. Collagen provides tensile strength to bones, cartilage, teeth, tendons and ligaments. There is a positive association between vitamin C and bone mineral density (BMD) in postmenopausal women.
  • Cancer. Vitamin C functions as an antioxidant to protect cellular structures, including genetic mechanisms, an enhancer of the immune system and to protect against cancer-causing environmental irritants and pollutants. Many of the benefits of vitamin C supplementation stem from its antioxidant properties. The antioxidant properties of vitamin C become more important as aging occurs, especially if there is stress or disease.

ASTAXANTHIN

Astaxanthin is a member of an elite class of carotenoids known as xanthophylls.

Astaxanthin is believed to be the most active of these carotenoids. Researchers have discovered that the most abundant and concentrated form of astaxanthin is found in the natural, renewable material extracted from microalgae.

Because of its unique molecular structure, astaxanthin is unlike any other antioxidant in that it can perform a wide variety of tasks including:

  • increasing HDL (good cholesterol)
  • increasing strength and endurance
  • stimulating the immune system
  • protecting and enhancing eye health.

Astaxanthin has been shown to perform effectively the three key tasks of an antioxidant: quenching, scavenging and trapping free radicals. Astaxanthin is more powerful than many other carotenoids because:

  • its low molecular weight allows it to actually cross the blood-brain barrier, making it available to the eye, brain and central nervous system
  • it is more resistant to damage, allowing it to scavenge longer and trap more types of free radicals
  • it acts like a bridge, transporting free radicals along its long chain to water-soluble antioxidants like vitamin C inside and outside of the cell.

ACETYL-L-CARNITINE

Acetyl-L-carnitine is a special form of carnitine that has the particular ability to optimize brain function. Acetyl-L-carnitine is able to cross into the brain more effectively than regular carnitine. It therefore enhances brain cell function much better than regular carnitine. As we age, acetyl-L-carnitine levels in our brains go down and for optimal brain function, supplements of acetyl-L-carnitine become mandatory.

Acetyl-L-carnitine acts in many ways to prevent the deterioration of brain cells that normally happens with age. It does this in many ways. It acts as a powerful antioxidant, provides the brain with healing energy and increases levels of a very important messenger molecule called acetylcholine. It is acetylcholine which becomes deficient in the brains of Alzheimer's patients and that is why these patients have such poor memory function. By increasing levels of acetylcholine, acetyl-L-carnitine helps the memory work better and may help prevent Alzheimer's disease as well.

GREEN TEA

Green tea is the antivirus, anticancer, super antioxidant. It is the most popular of Asian drinks and has been known for centuries to have a long list of health benefits. Interestingly, after water it is the most widely consumed beverage on the earth.

Dr. Earl Mindell states, “The antioxidants specific to green tea are polyphenols, bioflavonoids that act as super antioxidants by neutralizing harmful fats and oils, lowering cholesterol and blood pressure, blocking cancer-triggering mechanisms, inhibiting bacteria and viruses, improving digestion and protecting against ulcers and strokes. The specific type of polyphenol found in green tea is called a “catechin.”

Other ingredients in green tea include the green chlorophyll molecules but also important are the proanthocyanadins similar to those found in grape seed extract, pine bark, bilberry and gingko. The specific tea is a variety called Camellia sinensis. Camellia sinensis in the West is known as black tea, such as Earl Grey tea, orange pekoe tea or English breakfast tea.

The antioxidant properties of green tea are responsible for its most important benefits. The Chinese always claimed that tea slows aging but it was not until we understood the role of oxidation in aging and the antioxidant function of flavonoids that we knew how this mechanism might work. Researchers at University of California- Berkeley found that green tea extract was the best at scavenging the deadly hydroxyl radicals. Three diseases that we focus on regarding green tea are heart disease, AIDS and cancer.

GREEN FOODS

It is well known now through modern research that green foods are rich in vitamins, minerals and enzymes. They help protect against cancer, heart disease, digestive problems and many other modern disorders. Green vegetables are excellent sources of complex carbohydrates, dietary fiber, beta carotene and chlorophyll. Possibly most important of all, they have potent antioxidant activity. Besides, they are low in fat and high in nutrients, an excellent combination.

The importance of green foods in the diet is now being validated scientifically worldwide. It is amazing how long it takes us to discover that foods were made correctly in the first place. They contain exactly what we need in their natural state. We have to find a way to take advantage of the whole foods naturally made and most of us are not doing that presently with our diets. In fact, it would be difficult for anyone to eat green plants to equal the amount of nutrition in concentrated green food supplements. So until you are ready to sidle up to a fivepound salad of spinach, watercress, alfalfa and kelp, the concentrated supplements mentioned here are probably your best source for the vital nutrients you need from green foods.

ALPHA LIPOIC ACID

Alpha lipoic acid is a vitamin-like antioxidant that is produced naturally in the body and found in certain foods such as potatoes and red meat.

It is the only fat and water soluble free radical antioxidant, therefore, it is easily absorbed and transported across cell membranes, protecting us against free radicals both inside and outside our cells.

Alpha lipoic acid has been used for years throughout Europe to treat and prevent complications associated with diabetes, including neuropathy, macular degeneration and cataracts. Studies show that diabetics lower their insulin requirements; this also helps reduce complications.

An abundance of promising research has also shown the ability of alpha lipoic acid to inhibit replication of HIV and other viruses, to protect LDL cholesterol from oxidation which is associated with cardiovascular disease, to protect the liver from damage from alcohol or other toxins and also to prevent damage from radiation.

We do not obtain enough alpha lipoic acid through the diet to obtain this protection, so supplementation is required—100 to 200 mg daily. Therapeutic doses are higher.

GLUTATHIONE

Essential for many cellular functions, glutathione is a tripeptide of connected molecules composed of three nonessential amino acids: cysteine, glutamic acid and glycine.

Without glutathione people suffer from an inability to detoxify metabolic wastes and in eliminating toxic substances like heavy metals and other environmental poisons. This may lead to heart disease, joint disorders, cancer and problems with the endocrine, immune and nervous systems.

Even healthy people under stress can become subject to a disrupted balance. They could be sick or battling an inflammation or infection, or healing from an injury, while more free radicals are created and must be eliminated. Glutathione will do the job. It will also seek out the free radicals formed when people are exposed to cigarette smoke, alcohol, mercury, air pollution, food additives, pesticides and ultraviolet light.

Needed cofactors that properly assist glutathione function are the following: alpha lipoic acid, riboflavin (vitamin B2) and the minerals selenium and zinc, of which selenium is a vital component.

PYCNOGENOL®

Extracted from the bark of Pinus maritima, the coastal pine tree found in abundance in southern France, pycnogenol is made up of a combination of flavoids that occur naturally in small amounts in some fruits and vegetables. However, antioxidant-rich fruits, vegetables and nuts lose their potency when they are harvested, processed, frozen and cooked. A study in the British scientific journal, The Lancet, showed that risk of heart disease was 50 percent lower in populations that consumed high amounts of flavonoids (at least 30 mg a day) than groups that took in low amounts of these antioxidants.

Decades of laboratory research and clinical studies conducted by Dr. Jack Masquelier show that pycnogenol contains approximately 40 natural ingredients including proanthocyanadins, organic acids and related bioavailable components such as glucosides and glucose esters. It is a potent antioxidant that protects against free radicals, has been shown to be many times more powerful than vitamin C or vitamin E and has the added benefit of working synergistically with many nutrients that support health.

Millions of people in Europe and the United States, athletes in particular, rely on pycnogenol to maintain skin health and overall health during the aging process. It is one of the best tried-and-tested products in its category, non-toxic and non-carcinogenic.

GARLIC

Garlic is the most studied herb in history. It has more benefits than any other single food. Tradition has told us that garlic has beneficial effects on health and longevity. Science is beginning to validate many of these claims including garlic's ability to prevent heart disease, fungal overgrowth and infectious diseases, the ability to remove toxic metals from the body and its powerful antioxidant and anticancer effects.

A Summary of Garlic's Many Benefits Includes:

 

  • having been shown to have powerful immune-boosting properties and may be valuable in fighting off viral infections such as the common cold.
  • having been shown to help lower blood pressure in those with hypertension.
  • working as a natural antibiotic and reducing the number of harmful bacteria in the body.
  • reducing blood cholesterol and triglyceride levels and has been shown to limit the deposition of plaque on artery walls.
  • having been shown to help the body eliminate parasites.
  • reducing the amount of the yeast, Candida albicans, in the human GI tract and has been shown to be beneficial in fighting systemic yeast infections.
  • having been shown to lower blood sugar and be of significant benefit to diabetics.
  • having been shown in population and laboratory studies to help prevent a wide variety of cancers.
  • containing selenium, a cancerpreventing, immune-boosting and antiinflammatory nutrient.

BOOKS FOR FURTHER READING ON ANTIOXIDANTS:

Brain Longevity
by Dharma Singh Khalsa, M.D. with Cameron Stauth
Warner Books, New York, NY (1997)

The Garlic Cure
by James F. Scheer, Lynn Allison and Charlie Fox
Alpha Omega Press, Fargo, ND (2002)

Linda Page's Healthy Healing—A Guide to Self-Healing for Everyone
by Linda Page, N.D., Ph.D.
Healthy Healing Publications, Carmel Valley, CA (2002)

Prescription Alternatives
by Earl L. Mindell, R.Ph., Ph.D.
Keats Publishing, Los Angeles, CA (1999)

Prescription for Nutritional Healing
by Phyllis A. Balch, CNC • James F. Balch, M.D.
Penguin Putnam, Inc., New York, NY (2000)

Robert Crayhon's Nutrition Made Simple—A Comprehensive Guide to the Latest Findings in Optimal Nutrition
by Robert Crayhon, M.S., C.N.
M. Evans and Company, Inc., New York, NY (1994)

The Super Antioxidants—Why They Will Change the Face of Healthcare in the 21st Century
by James F. Balch, M.D.
M. Evans and Company, Inc., New York, NY (1998)

The Multivitamin-Mineral Cornerstone of a personal program

The first step in establishing your personal vitamin program is to ensure that every day you are receiving those vitamins and other nutrients that are truly essential to the human body. Since thousands of dietary supplement products are available, claiming to benefit every manner of body function, here are some guidelines to help separate the wheat from the chaff. Let’s start with the multivitamin- mineral (MVM) product.

To do what it is supposed to do, your MVM should provide just about ALL the vitamins and minerals truly proven essential to human health. The list of known vitamins hasn’t changed much in recent decades; it includes vitamin A, vitamins B1, B2, B3, B5, B6, and B12, (the missing numbers were those which proved not to be truly essential) and vitamins C, D, E and K. Folate and biotin are also vitamins, as are the essential fatty acids, which are discussed below. Choline was recently established as essential. A number of minerals are also proven essential to survival.

Minerals are not organic since they do not contain carbon and thus cannot be called vitamins. However, certain minerals are as essential to survival as are the vitamins. For a number of minerals, deficiency states are established and recommended dietary allowances exist. Of these, sodium and phosphorus don’t need to be supplemented since they are more than adequately represented in the daily diet. Vanadium has never been proven essential and has some suspicious actions; microgram amounts may be acceptable in your MVM, but milligram amounts cannot be justified. Similarly, fluorine can be toxic and very likely is not essential.

Unequivocally, every person, whatever their age, gender or state of health can benefit from taking a multivitamin-mineral product on a daily basis. A good MVM will provide all the vitamins and essential minerals, minimally in amounts of at least 100 percent of the “daily values.” The daily values seen on the dietary supplement product labels are the RDAs (Recommended Dietary Allowances) recalculated on the basis of each 2000 “calorie” intake of food per day (kilocalories, really). A good multivitamin-mineral will also supply close to 100 percent of the daily values for the following minerals: magnesium, calcium, iron, zinc, copper, selenium, silicon, iodine, manganese, molybdenum, boron, and chromium. Potassium, unfortunately, is kept low (around 99 mg daily maximum) by regulation.

Don’t take “one-a-day” MVM formulas seriously: one tablet or capsule a day simply cannot pack in decent amounts of all the necessary nutrients. A good MVM cannot be packed into less than 2–4 or up to six capsules or tablets per day, divided between two or three meals.

As you shop for a good MVM, you must examine the label carefully or you’ll waste your money. By law, the manufacturer has to list the ingredients on the label. Also, some MVMs provide meaningful amounts of certain standardized herbal extracts, namely minimum tens of milligrams each of ginkgo biloba extract and/or milk thistle extract, grape seed extract, pine bark extract, bilberry standardized extract, and hawthorn berry extract. These add to the quality of the product, since they have proven health benefits.

There are two kinds of EFA, omega-6 and omega-3, the two kinds compete with each other for uptake and utilization and play a “yin-yang” role in the body by delicately balancing and complementing each other’s effects. It’s been found that supplementing the diet with certain omega-3s will protect against heart attacks and strokes, and generally help protect the body against inflammatory damage.

Take extra Vitamin C and Vitamin E

As the scientific research on vitamins and minerals has progressed, the recommended daily amounts of minerals necessary for good health have not changed much. Among the vitamins, the benefits of some extend to such large amounts that we cannot expect full intakes from our MVM product and are forced to take them as additional supplements. Two proven examples are vitamin C (ascorbate) and vitamin E (d-alpha, beta, gamma, and delta tocopherols [ VERY IMPORTANT ]).

It used to be that so-called experts would scoff at the late Professor Linus Pauling when he talked about taking grams of vitamin C every day. They said we would just be making expensive urine if we tried to do what he did. yet there was good research even then to show that Pauling was right; those “experts” just didn’t want to work the data into their ideological agenda. Some went so far as to fudge existing data in order to deny that vitamin C helps prevent the common cold; others purposely miss-designed human studies to try to show that vitamin C could not help treat disease. But the majority of researchers stayed honest, as their own research led them to discover that, yes, Hoffer, Cathcart, Cheraskin, Pauling and the others were right: vitamin C could do marvelous things for human health.

The essential fatty acids are Vitamins

The essential fatty acids (EFA) are oily substances, which are really vitamins because deficiency states have been demonstrated for them. There are two kinds of EFA, omega-6 and omega-3, differing in their molecular details but sharing the same enzyme systems. The two kinds compete with each other for uptake and utilization and play a “yin-yang” role in the body by delicately balancing and complementing each other’s effects. unfortunately, in today’s world we are getting either too little of both kinds if we eat a lot of junk food, or too little of the omega-3s if we eat the typical Western diet. Now it’s been found that supplementing the diet with certain omega-3s will protect against heart attacks and strokes, and generally help protect the body against inflammatory damage.

The omega-3s that work best are DHA and EPA, some of which can be obtained by consuming cold water fish, though we do recommend supplementation. A certain amount of omega-6 intake is also important, and this is best obtained from GLA. In the future, you will see the EFA included in MVM products, but for now they are mostly available only as oils in softgel capsules.

Conditionally-essential nutrients sometimes May be Vitamins

A number of substances that have not been established as vitamins through deficiency assessment are nonetheless intricately involved in life processes. One that has been extensively researched is coenzyme Q10 (“CoQ”), otherwise called ubiquinone. CoQ is crucial for the generation of energy in all our cells and makes important contributions to our protective antioxidant defense system. Technically, our cells have the enzyme machinery to make their own CoQ. Why, then, do people with heart problems develop a functional deficiency of CoQ? Alpha-lipoic acid also is crucial for making energy and is also a potent antioxidant. Another example is taurine, which is an antioxidant, antitoxin and electro-osmotic buffer substance found in the heart tissue, the nerve tissues and in all our cells. yet another is carnitine, which is also important for the heart and is central to the body’s energetics. These nutrients all fit the category of conditionally-essential nutrients in that portions of the population are critically unable to make enough to keep up with body demand for them. Occasionally, a nutrient previously thought conditionally-essential is proven fully essential for humans, as recently occurred with choline.

Deficiencies in the conditionally-essential nutrients can be life-threatening. For CoQ, taurine, carnitine, and some other such nutrients, the bio-synthetic pathways are especially complex and energy intensive. Elderly or sick people, or people with chronic viral infections, may produce either none at all or quantities insufficient to keep up with demand. For such people, supplementing with these nutrients is likely to be a good idea. For individuals with heart failure, a condition in which deficiencies of all three of these nutrients can manifest, supplementing with all three daily may be a lot more than just a good idea.

The conditionally-essential nutrients are all orthomolecules. As conceived by Professor Pauling, orthomolecules are substances orthodox to our metabolism; that is, they are part and parcel of our normal enzyme pathways. Certain more sophisticated MVMs have included carnitine, taurine, NAC (N-acetyl cysteine), alpha-lipoic acid, MSM (methylsulfonylmethane), DMAE (dimethylaminoethanol), and other orthosubstances. These are undeniably valuable for your health, but your MVM will not be able to provide all that you need, and for your special health needs you’ll need to consider additional supplement products.

Stress of any kind increases the body’s nutrient requirements Never underestimate the power of stress to make you sick. Emotional stress works through many mechanisms to damage our tissues. But stress is far more than just emotional.

Although the word “stress” is commonly taken to mean emotional stress, its meaning for the body is much broader. In a biological sense, stress means any challenge to the body’s life processes and survival skills. For example, exposure to too much cold or heat is stressful. Malnourishment or eating junk food is stressful. Too much noise is stressful. Fits of anger are stressful, and anxiety and depression exacerbate emotional stress. Chemicals foreign to the body cause stress, as they react with our biological molecules and so modify our body chemistry.

One of the most stressful chemical agents is cigarette smoke. Oxygen free radicals, tars, heavy metals, and radioactive substances in cigarette smoke, whether inhaled actively or passively, deplete virtually all the types of nutrients in the body, and as this happens, the risk of asthma, bronchitis, cancer, and heart disease skyrockets. Chlorinated hydrocarbon pollutants entering our bodies from the air, water and foods deplete our antioxidants and many other orthomolecules and thereby increase the risks of cancer, nerve damage, memory loss, and liver or kidney failure. Alcohol intake is stressful, whether or not a person is an alcoholic.

Other sources of stress include infectious agents (ALL viruses or bacteria, fungi such as yeasts and molds, protozoan or worm parasites, mycoplasmas such as the one that causes pneumonia). Infectious agents hijack our biochemical machinery to meet their needs. These intruders also siphon off vitamins and minerals that we need to make energy and otherwise conduct our life processes. As the immune system mounts assaults these unwanted guests, fever and other inflammation develop that literally burn away our antioxidant reserves and accelerate our losses of B vitamins and minerals. That’s why increasing your intake of the superb antioxidant vitamin C and minerals such as zinc and magnesium can make such a difference when you have a cold. Don’t underrate the importance of nutrients against the stress of infection. Increased nutrient intakes will even help slow AIDS progression.

OTC and other drugs Can deplete nutrients

Many over-the-counter drugs can deplete the body of essential nutrients. Acetaminophen (Tylenol®) depletes glutathione, an antioxidant substance that is key to the functioning of the liver. Liver failure can be the result. Aspirin, one of Tylenol’s competitors, is no more innocent except that it targets the stomach rather than the liver. Aspirin can deplete folate and vitamin C, and it breaks up the phospholipid surfactant layer that normally protects the stomach lining, with ulcers often arising that then bleed and deplete the body of iron.

Antacid use also can be a problem, depleting the body of folate as well as copper. Certain laxatives and stool softeners can do tremendous damage by reducing the absorption of minerals, vitamins and other nutrients and depleting the body of water. Overuse of laxatives is common, especially among girls and women concerned about gaining weight, depressed people preoccupied with bowel function, and constipated elderly patients. Prescription drugs are worse than the OTCs, and more than 600 of these are known to be toxic to the liver.

Among prescription drugs, those classes most proven to deplete nutrients include oral contraceptives (vitamin B6, vitamin C, folate), antibiotics (vitamin B12, vitamin K, iron, magnesium, calcium; also the friendly gut bacteria), cholesterol-lowering agents (coenzyme CoQ), and diuretics (sodium, potassium, calcium). Tricyclic antidepressants can deplete vitamin B2 and CoQ. We could go on and on about drugs and the damage they do to our bodies, but the pattern is clear: persons taking pharmaceuticals of any kind need to increase their daily intakes of multivitamin-minerals and antioxidants.

Managing specific health problems and healing organ damage

The topic of therapeutic nutritional supplementation is a huge one. Hundreds of books have been written, and tens of thousands of scientific papers have been published on the uses of vitamins and other nutrients to treat clinical disease conditions in order to achieve healing. Drugs don’t heal, and government regulatory agencies, goaded on by the pharmaceutical drug interests, have done their best to shut down this entire field of nutritional application. They’ve spectacularly failed, though, because the records show that vitamins and minerals can be employed in combination with other orthomolecules and with herbal preparations to manage, heal or cure just about any disease or dysfunction. Not only this, but in so doing they outperform the drugs in all areas. Here nutrients become nutraceuticals, to be administered in doses sufficient to give maximum benefit against a disease. Sophisticated nutraceutical combinations are personalized to the needs of the individual. Some clinicians and scientists believe, as do we, that even aging can be slowed using this strategy.

Every one of us has an “Achilles Heel” in our body makeup, some weakness or weaknesses that will likely bring on ill health or premature aging and without intervention will likely shorten life. By learning to be aware of our body’s grunts, groans, squeaks, and quirks, and by working with trained professionals, we can target these weaknesses for special treatment in order to slow progressive functional loss (as the liver carrying a chronic virus, for example), to reverse existing loss (as memory function) or even to heal longstanding zones of trauma (as a damaged joint). At this level of a personal vitamin program, the potential benefit is lifesaving, and this is both the promise and challenge of 21st century health care.

For us to stay healthy and active our bodies need energy…lots of energy. The energy produced by each of the trillions of cells in our bodies keeps our hearts beating, our muscles contracting, our brains functioning to send signals to the far reaches of our bodies, and our nerves carrying those signals to each of our organs to sustain life. Each day, our bodies produce and consume extraordinary amounts of energy. Let’s take the heart for example.

At any given moment an average heart contains less than one gram of stored energy, about 0.7-grams to be exact. But every day our hearts consume almost 6,000-grams of energy in performing its ceaseless work of pumping blood and delivering life-giving oxygen to tissues throughout our bodies. Think about the magnitude of this feat! Six-thousand grams is more than 10 times the average weight of a heart and almost 10,000 times the amount of energy that is normally found in the heart at any one time. Ask yourself, “Where does this energy come from?” and “How can the heart produce such an extraordinary volume of energy?”

In large part, the answers to these questions are found with D-ribose, as you will see.

ATP —The Currency of Life
The energy that fuels our bodies is held in a small molecule with a large name. Adenosine triphosphate, or simply ATP, is the compound found in every cell in our bodies that gives us energy. In fact, virtually all the energy used by our bodies comes from ATP. Because of its universal importance in the body, ATP is commonly referred to as the “energy currency” of the cell. In each cell, ATP is made, consumed, and re-processed in a cycle that keeps a continual supply of energy flowing. And our bodies have developed very elaborate metabolic processes to make sure we don’t run out. These processes efficiently recycle energy as it is used, making fresh energy constantly available to sustain life.

As chemical compounds in the body go, ATP is simple. It is made of three basic parts. The first is D-ribose, commonly called Ribose. Ribose provides the structural foundation upon which ATP is built and starts the process of ATP synthesis in the body. Without ribose ATP could not be formed and our cells would be energy deprived.

Attached to Ribose is a compound called adenine. Combined, ribose plus adenine form adenosine, as in adenosine triphosphate. The adenine portion of ATP is not simply added to the Ribose molecule in the cell. Instead, the cell makes adenine by building it, adding one element at a time to Ribose. When this process is completed, adenosine is the result and we have now formed the basis for ATP. To this basic structure we add three phosphate molecules. The energy in the ATP molecule is found in the chemical bonds that hold these phosphate molecules together. When the chemical bond holding the last phosphate molecules in place breaks, it releases chemical energy that is transformed in the cell to mechanical energy to do work.

But that is not the end of the story. Our bodies need to use the basic structure of ATP over and over again to keep the energy supply flowing. To do this, our cells recycle the spent ATP molecule by re-attaching a fresh phosphate group to replace the energy that was used. The cycle works like this. ATP is consumed, leaving a free phosphate group and adenosine diphosphate, or ADP. Remember, adenosine triphosphate (ATP) has three phosphate groups and adenosine diphosphate (ADP) has two. The cell then takes a free phosphate group that is floating around in the cell and reattaches it to ADP, re-forming ATP and replacing the consumed energy. This process of energy consumption and supply must accelerate to accommodate increasing energy needs, such as in exercise.

As long as we stay reasonably physically fit, and our cells get the oxygen they need to fuel metabolism, this cycle of energy utilization and supply can keep turning unimpeded. The problem com

es when our cells are unable to get enough oxygen to keep the process flowing. Many conditions can affect how well oxygen flows to our cells, or how well our cells can use the oxygen that is supplied. Ischemic heart disease, of course, restricts blood flow to the heart muscle itself, and this can impact blood flow and oxygen delivery to the rest of the body. Other heart conditions, such as congestive heart failure or cardiomyopathy, can similarly affect how well the heart functions, and, therefore, how efficiently it can deliver blood and oxygen to our tissues. Many non-disease conditions can also affect blood flow or oxygen delivery. As we age, for example, our tissues lose their ability to use oxygen efficiently. Older tissue, then, has a harder time keeping up the continual demand for energy. Even strenuous exercise can impact the relationship between energy supply and demand. If we exercise beyond the point at which our cells are taking up their maximal amount of oxygen, we overtake the cycle of energy re-supply and begin to use energy more quickly than it can be restored. No matter the cause, when our cells and tissues are unable to get the oxygen they need to maintain the balance of energy supply and demand the results are similar…fatigue, muscle pain, stiffness and soreness, a reduced ability to exercise, and lower quality of life.

Putting Gas in Your Tank

Think of this process of supplying energy to your cells like keeping gasoline in your car. When your car is sitting in the garage with a full tank of gas it is fully fueled and ready for a long drive. When you start the car and head it down the road, you begin to consume the gas in the tank and the supply of energy gets progressively lower until you have to fill the tank with gas or you will run out of fuel and the engine will stop, leaving you stranded by the side of the road. The same thing is true in your body. When you have enough food and oxygen to supply energy your engine will keep running and you will never run out of gas. But if you can’t get enough oxygen to keep the cell’s energy tank fully fueled you will progressively lose energy until you run out of gas. Then, you have to refill your tank before you can start down the road of life once more.

If you are healthy, you can refill your tank simply by resting long enough for new energy fuel to fill your cells. In a normal, healthy person that has been strenuously exercising over a few days in a row, it takes more than three days of rest for cells to be fully recharge. This is a typical situation in young athletes who might exercise every day. Frequently, these athletes do not let their bodies rest long enough to restore lost energy and, in a short time, they become fatigued, sore, stiff, weak, and out of sorts. They simply try to do too much work with too little fuel, and run out of gas.

As we age, or if we suffer with heart or muscle disease, however, the situation can be much more complicated. In contrast to the athlete performing strenuous exercise, if we belong to this group the normal course of daily activities might be enough to fully consume the energy in our cells and tissues. As a result of running out of fuel we might become persistently, or chronically, fatigued, we could have leg soreness and muscle stiffness, we frequently can’t face the prospect of climbing stairs or even walking out to the mailbox, we may be too tired to go shopping or to play with the grandchildren, and our quality of life suffers as a result. To make matters worse, our bodies might never deliver enough oxygen to let our cells fully recover once the energy in our cells and tissues is fully consumed.

Whether it is an athlete that wants to recover more quickly so they can get back on the field, an aging grandparent who longs for the energy to take the grandchildren to the park, an active professional with too much work, too much stress, and too little sleep, or a heart patient who can’t face the prospect of climbing the stairs to bed, the issue is replacing fuel in the tank. Like the fuel pump at the gas station, Ribose is the metabolic fuel the body uses to recharge the energy batteries and put gas back in the tank.

The Recovery Power of Ribose

Replacing the energy that drains from our cellular gas tanks is fundamentally important to recovering cell and tissue function. This process of energy recovery begins with Ribose. Our cells use this simple, five-carbon carbohydrate to initiate ATP synthesis, allowing our bodies to rebuild lost energy and recharge the cellular batteries. If there is not enough ribose present in the cell to begin this vital process, we cannot restore this lost energy.

Every cell in our bodies makes ribose every day

The problem is that our cells lack the metabolic machinery they need to make very much ribose, or to make it quickly when our bodies need it. Our cells make Ribose from a very abundant and highly important carbohydrate called glucose, which is also known as dextrose. In the body, glucose is used as the primary metabolic fuel for many cellular reactions, and because of its importance it is rationed. This rationing prevents too much glucose from moving down the metabolic pathway to make ribose. And so, when our bodies are stressed by strenuous exercise, metabolic dysfunction, or disease our cells cannot recover until enough ribose is made to stimulate ATP synthesis and refill our energy fuel tank. Although this delay can last for several days, if we are healthy, have a good supply of oxygen to our tissues, and take enough time to rest, we can fully recover. If, on the other hand, our cells are aging or not functioning normally, we are not able to supply enough oxygen to our tissues, or we don’t allow ourselves sufficient rest, there might never be enough time to make an adequate amount of Ribose for our energy batteries to recharge.

This is exactly what happens in people with ischemic heart disease. When the arteries supplying blood to the heart become clogged they cannot deliver enough oxygen to fully supply the metabolic demand of the heart. The condition by which blood flow to a tissue is restricted is called ischemia. In the case of ischemic heart disease, this lack of blood flow is to the heart itself. Because the heart does not get enough blood flow, it is also deprived of oxygen and this oxygen deprivation slows the normal process of energy recycling. As the heart keeps beating, energy demand outstrips energy supply, resulting in a continual drain on energy reserves. The heart’s energy tank is always running low.

Because the heart beats continually, it cannot rest while its energy tank is refilled. Instead, the heart slows down certain energy consuming functions, conserving the energy left in its tank for contraction. The energy-starved heart tries its best to push blood and oxygen to the body, but because it does not have enough energy its efforts are inefficient and inadequate. As time goes on, this inefficient blood flow to the rest of the body begins to take a toll. As heart disease progresses, for example, patients may complain of overwhelming fatigue, shortness of breath, sore legs, or an inability to perform even simple exercise, such as walking up stairs or around the block.

The same is true of people with fibromyalgia or other neuromuscular disease affecting muscle metabolism. In fibromyalgia, for example, research shows that the muscle can become oxygen deprived. Certain studies have concluded that a combination of poor muscle energy metabolism and changes to the capillaries delivering blood to the muscle affect the level of oxygen available to the tissue and its ability to recycle its energy supply efficiently. As in ischemic heart disease, this metabolic insufficiency drains the energy fuel tank leaving the muscle energy starved.

This chronic and persistent energy drain forces a series of cellular reactions ending in muscle pain, soreness, stiffness, and fatigue. In many cases, the pain and fatigue can be severe and highly debilitating. Patients with fibromyalgia, for example, often face the prospect of major changes in their daily quality of life. They are often too fatigued to maintain normal interaction with their friends or family, and may have too much pain to stay active or even keep their jobs. In many cases, these patients must be treated with anti-depressants because of the psychological stress inflicted by their illness, and in virtually every case doctors treat patients only with pain pills that do not treat the underlying cause of the disease.

In both ischemic heart disease and muscle disease, such as fibromyalgia, a major root cause of concern is energy starvation in the affected tissue. These conditions force the affected hearts and muscles to consume energy more quickly than it can be restored, creating a continual energy imbalance. Unfortunately, the metabolic imbalance caused by these conditions cannot be corrected with rest alone. Neither ischemic hearts nor fibromyalgic muscle have the metabolic capacity to recover. That is where ribose comes in. Supplying affected tissues with Ribose stimulates the process of energy recovery and helps hearts and muscles refill their energy tanks. Supplemental ribose allows cells to bypass the slow process of natural Ribose synthesis and accelerates ATP recovery.

While the biochemistry of energy metabolism is complex, it is consistent. It doesn’t matter whether we are talking about hearts or muscles, if we are healthy or sick, or if we are old or young, certain consistencies remain. Cells need energy, and that energy is supplied by a continual recycling of the cellular energy reserve. If tissues become oxygen deprived, or if the normal metabolic processes of energy recycling are disrupted, energy demand will outstrip supply and the tissue will become energy starved. Ribose is fundamentally required to restore this lost energy and put the energy demand and supply ratio back in balance. In healthy, normal tissue, several days of rest can rebuild these lost energy pools, but in stressed, diseased, or aging tissue, rest is often not enough. Supplemental ribose will accelerate energy recovery, rebuild cellular energy pools, and restore cell and tissue function. For you this can mean less fatigue, less muscle pain, soreness, or stiffness, greater exercise tolerance, and a higher quality of life.

Clinical Implications of Ribose

Although research revealing the clinical implications of Ribose therapy has been going on for decades, it is a fairly new entrant in clinical medicine. The widespread use of ribose in cardiology began in about 2003 following publication of an important clinical study by the noted cardiologist, Dr. Heyder Omran, at the University of Bonn, Germany.

Over the past decade there have been numerous clinical and laboratory studies that prove the beneficial impact of ribose on stressed tissue. In fact, the number of studies published in the scientific and medical literature now exceeds 100. And research continues, with studies now being conducted at major universities in the U.S. and abroad focusing on heart disease, muscle disease, athletic performance, and improving the supply of blood available. But despite this overwhelming scientific evidence, very few doctors have even heard of ribose. All of them studied ribose in their first year medical school biochemistry class, but few have any idea how it works and even fewer recommend it to patients. Most doctors have been taught to rely on pharmaceutical drugs and consider nutritional support products to be “unscientific” or unsafe, and others simply don’t understand the science. Others, regrettably, are just disinterested, feeling they are too busy seeing patients to stay current in the considerable body of nutrition research reported monthly in major scientific journals. But the number of doctors who are seeing for themselves how ribose can improve the lives of their patients is growing daily. These doctors have proven to themselves that ribose supplementation can, and does, give their patients a new lease on life.

How Do I Know I Need Ribose?

At some point in his or her life, everyone needs supplemental Ribose. We all face situations where ribose supplementation could help us overcome the pain and stiffness of muscle overexertion, the fatigue of chronic disease, the weakness after strenuous exercise, or the inability to do the things we want to do. We all want to be as active and healthy as we can, and we need a full supply of energy in all our cells and tissues to reach that goal.

In each of our lives, we will face times when we need ribose to help our bodies make the energy we need. But our cells and tissues cannot store ribose for future use. Instead, our bodies can only make ribose when it is needed, and that is where the trouble comes in. Remember, although ribose is made naturally in all our cells and tissues, it is a slow process. And it is this delay that limits the speed with which our bodies can restore lost energy. Ribose is the limiting factor in ATP synthesis, and our bodies have an absolute and fundamental need for ATP to fuel the multitude of biochemical reactions that keep us alive and vital. ATP is the fuel of life, and ribose is the foundation upon which ATP is built. Therefore, when our bodies need energy it makes sense to supplement our natural metabolism with ribose. Let’s look at an example to help make this point.

A very important series of animal studies was conducted at the University of Minnesota beginning in the mid-1980s. In these studies, researchers used elaborate surgical techniques to place balloons around the main artery supplying blood to the heart so they could control the blood flow going to the heart tissue, and used delicate measuring devices to record the result. They found when they blew up the balloons and restricted the blood flow to the heart the energy level in the heart tissue would drop quickly, finally leveling at about 50 percent of normal. As might be expected, this energy drain severely impacted heart function. Primarily, the heart would become stiff and would not fill with blood properly. In turn, this reduced the amount of blood that could be pumped to the rest of the body.

When the air was let out of the balloons normal blood flow would return to the heart. But even after blood flow was restored it took these hearts more than 10 days for the energy level to normalize. Interestingly, the function of the heart closely paralleled energy restoration. As with the energy supply, normalization of heart function took more than 10 days. When the animals were given ribose during and following the test, however, the hearts recovered both their energy level and function in an average of 1.2 days! To further prove the ribose effect, in some studies researchers took away the ribose after 24 hours and found that energy and functional recovery reversed. When ribose supplementation was restored, recovery followed suit.

Metabolically what happened was simply this. When the hearts were not given ribose they were forced to make it before they could begin the process of energy restoration. This delayed energy recovery. But giving ribose to these hearts allowed them to bypass the much slower process of making ribose naturally, and the process of energy synthesis was accelerated. Once ribose is present in the cell, either through natural ribose synthesis or supplementation, energy recovery can proceed very quickly. The delay in restoring energy to stressed tissue rests in the rate at which our bodies make ribose naturally.

So, when we consider whether or not we need supplemental Ribose, we should remember some of the simple basics of metabolism. Cells and tissues become stressed when they don’t get enough oxygen or if the normal processes of energy recycling are disrupted. In either case, this stress causes the cells to use energy faster than it can be supplied. This energy supply and demand mismatch causes us to lose energy from our cells and tissues, draining cellular energy reserves and depleting energy stores. To maintain normal cell and tissue function this energy must be restored, and ribose is fundamental to this process. If we are young and healthy and our cells are functioning normally, we can rest and, after several days, we will make enough ribose for our energy levels to be restored. On the other hand, if we are chronically oxygen deprived, or if our cells are not functioning normally, we may never be able to fully recover.

Who Should Take Ribose and When

With these basics in mind it is easy to determine who should take Ribose, and when. Anyone with a highly active lifestyle, for example, can certainly benefit from ribose. High-intensity exercising three or more times per week puts a substantial strain on hearts and muscles. Repeated bouts of strenuous exercise drains energy from hearts and muscles, leaving them weakened for the next exercise session. When athletes take ribose before, during, and after exercise, however, they can better maintain the energy in their muscles and quickly restore any energy that may have been lost. In this way, athletes can keep their hearts and muscles in top physiological condition for their next exercise session.

But what defines an athlete or a strenuous bout of exercise? The answer to that question depends on the individual. For top athletes, high-intensity exercise may be defined as a long distance run or several miles on their bike over hilly terrain. For most, however, strenuous exercise may be much less intense. Some one who is normally sedentary, for example, might face several days of muscle soreness, stiffness, and weakness following a day of hard work in the garden or a weekend softball game. Others who might be a little older or perhaps have problems with their circulation may complain of sore legs after only a short walk or a day of shopping. No matter where you fall along this spectrum, however, what is happening in your muscle is the same. Your muscle is fully consuming the available energy, and that energy drain translates to weak, spongy, and sore muscles. This muscle soreness does not go away until the muscle has recovered its energy balance. Ribose supplementation helps maintain the muscle’s energy balance and can be the answer to relieving this post-exertional muscle soreness and stiffness

Age is another factor to consider when deciding if ribose supplementation is right for you. Research has shown as we age our muscles lose energy recycling efficiency. Aging muscle generally has fewer of the energy recycling powerhouses, called mitochondria, than younger muscle. The continual loss of mitochondria as we age makes it more likely our muscles will run out of energy with exertion. This is a primary reason when we become older we become stiff and sore after only mild exercise, and explains why we run out of gas so quickly. Also, as we age our hearts begin to show more and more signs of dysfunction. A recent research report from the Mayo Clinic, showed almost 25 percent of the population, both male and female, showed signs of heart failure, and the percentage increased as people grew older. While this effect was more pronounced in people with high blood pressure or in those with heart valve problems, it was found across the aging population. Taking ribose regularly may help relieve the chronic muscle soreness and stiffness that comes from even mild exercise and, as has been shown in many clinical studies, could help maintain healthy energy levels in the heart.

We also need to include patients with heart disease when considering who should take Ribose. Research has proven, heart disease drains the heart of much needed energy. This is especially true in patients who are taking drugs to make their hearts beat more strongly. These drugs, called inotropes, force the heart to beat, causing it to consume even more energy. As such, over time these hearts can become severely energy starved. It is important that people with heart disease take ribose regularly to offset the effects of energy drain in their hearts. This is particularly true of patients on inotropic drugs. These patients face a continual energy drain that cannot be overcome with rest alone, and they should discuss this issue with their doctors. Research has shown ribose can be taken effectively with drugs, without losing any of the therapeutic benefit of either the drug or the ribose.

When we think about heart and circulatory diseases in the broader sense the benefit of Ribose supplementation on maintaining energy levels cannot be overstated. Hearts and muscles rely heavily on oxygen to fuel the process of energy recycling. When they are deprived of oxygen our hearts and muscles become energy starved. This energy drain can have a severe impact on heart and muscle function, and this impact becomes progressively more severe as oxygen deprivation and energy loss continues over a prolonged period of time. This effect is well-known in a wide range of cardiovascular diseases including congestive heart failure, coronary artery disease, certain types of cardiomyopathy, certain diseases affecting heart valves, and peripheral vascular disease, a condition that restricts blood flow to the limbs, especially the legs.

Patients with diseases that impact muscle metabolism should also seriously consider ribose supplementation. Diseases such as fibromyalgia, chronic fatigue syndrome, myoadenylate deaminase disease, and McArdle’s disease, for example, drain energy from muscles, and this energy drain shows itself in the form of fatigue, muscle pain, soreness, and stiffness. Patients are also frequently weak and have a great deal of trouble performing the simple tasks of daily living. Ribose has been shown in clinical studies to help offset all these symptoms. By supplementing with ribose, patients give their muscles the chance to overcome the energy drain and refill their energy fuel tanks.

All of us need energy—lots of energy. Whether we are healthy or sick, top-level athletes or couch potatoes, stressed out professionals or grandparents wanting to spend an active day with their grandchildren, our bodies must rely on energy to keep them alive and vital. Most of us don’t know we have a problem with the energy in our hearts and muscles until we get sore legs, worn out, or chronically fatigued. But even after these symptoms hit us, it is not too late. Ribose supplementation can quickly help replace energy in stressed hearts and muscles, and help maintain the normal energy balance in our tissue.

How Much Ribose Should I Take?

Studies have shown that virtually any amount of Ribose you can give to stressed hearts and muscles will help. A very important study investigating this question was conducted at the University of Missouri in the laboratory of the noted muscle physiologist, Dr. Ronald Terjung. This study proved even very small amounts of ribose, an amount that approximately equaled 500 milligrams (one-half of one gram) if taken orally, increased the energy recovery in stressed leg muscle by 100 percent. Raising the dose to a level that would approximately equal 2.5 grams if taken orally increased recovery by about 250 percent, and the equivalent of a five-gram dose increased the recovery rate by a whopping 350 percent. At the maximum dose tested, the recovery increased by as much as 650 percent.

The amount of Ribose you should take is really dependent on what you want it to do. For example, if you simply want to give your heart and muscles a little boost so you can be sure they are maintaining a healthy energy pool, you can get by with less. If you want to increase your athletic performance, reduce soreness and stiffness following exercise, or give your muscles a recovery boost after some strenuous work or exercise, you might need a little more. If you need help overcoming the effects of persistent fatigue or chronic muscle pain, still more may be needed. And, if you have heart disease, peripheral vascular disease or other chronic conditions that impact energy metabolism in your heart or muscles, more aggressive supplementation may be required.

DRIBOSE4

To get to the point of how much ribose should be taken, I offer the following suggestions on dosage:

  • 2 to 5 grams (about one-half to one slightly rounded teaspoonful of powder) daily to help hearts and muscles maintain a healthy energy pool.
  • 5 to 7 grams (about one level to slightly rounded tablespoonful of powder) every day as a preventative in cardiovascular disease, for athletes who want to recover faster from high-intensity exercise, and for healthy people doing strenuous work or activities that are outside their normal level of daily exercise.
  • 7 to 10 grams daily for most patients with heart disease or peripheral vascular disease, for patients recovering from heart surgery or heart attack, and for athletes who work out frequently in high-intensity activities.
  • 0 to 15 grams daily for patients with more advanced heart disease, patients awaiting heart transplant, and patients with fibromyalgia or neuromuscular disease.

I suggest that patients with heart disease, peripheral vascular disease, fibromyalgia or other muscle diseases begin taking ribose in the upper level of the range. Once they see for themselves that ribose supplementation is helping, they can reduce the daily dose until they find the level that is exactly right for them. It is also recommended that daily doses not be taken all at once. Actually, smaller more frequent doses are better than larger less frequent doses. Therefore, if you want to take daily doses of 10-grams or less, I suggest you take ribose two times per day. For most of us, the best time to take ribose is with morning and evening meals, but if we want to take ribose for exercise it should be taken just before and just after the exercise or activity. If you think you should take 15-grams of ribose per day, I suggest you take it in three equal doses, with breakfast, lunch, and dinner. Although there are no safety concerns with taking ribose (it is, after all, a simple carbohydrate), I do not recommend taking more than 20-grams per day. If you do not feel the benefit of ribose supplementation at that level, you don’t need it. Once they have given their hearts and muscles a chance to regain their energy balance, most people stabilize at about 10-grams per day.

It generally takes no more than a few days to feel the effect of ribose supplementation. Some people report an improvement in symptoms much more quickly, often in just a day or two. If you don’t begin to feel an effect after two or three days, try increasing the dose. Remember, your heart and muscles continually burn energy, and it is possible that the smaller Ribose dose is simply not enough to overcome the persistent energy drain. The sickest patients usually feel the greatest benefit, but almost everyone taking ribose regularly reports a significant benefit. You should also remember that your energy drain is chronic and ribose cannot be stored in your cells and tissues. Therefore, if you stop taking ribose you will lose all the benefit you’ve gained and your heart or muscles will again become energy starved. As a result, you must take ribose every day, and you must keep on taking it. While this sounds like a commercial for the ribose companies, it is not. Instead, it is hard-learned advice from the reports of hundreds of people who now take ribose religiously.

Where is Ribose Found?

Ribose is found in many product forms, such as powders, beverages, nutrition bars, and tablets. As a practical matter, therapeutic levels are found only in powders. An effective dose of ribose, two or more grams, is simply too much to put in tablets or capsules, so I recommend staying away from those dose forms. Beverages and nutrition bars tend to contain about one-half to one gram of ribose, so in normal healthy people looking to maintain the energy level in their tissue these products may be adequate. For disease patients, however, the amount that is given in beverages and nutrition bars is simply not high enough to give a therapeutic benefit. Hopefully, this will change in the future as food and nutrition companies increase the dose level per serving of their products. For now, though, I suggest powders or chewable tablets (wafers) as the best product forms to supply consistently adequate dose levels.

Although I usually don’t recommend one supplier of a product over another, I feel I should do so here. One company, Bioenergy Life Science (Minneapolis, Minnesota) has exhaustively studied both the benefits and possible adverse reactions of ribose supplementation. To the best of my knowledge, they are the only ribose company to have done so. Therefore, all the safety data that has been supplied to regulatory agencies has come from this company. These safety assessments have shown that ribose is 100 percent safe if it is taken as directed and manufactured according to the strict specifications of Bioenergy Life Science.

To confirm the safety of Ribose an expert panel of food and nutrition scientists has concluded that it is Generally Regarded as Safe (GRAS) according to the guidelines established by the U.S. Food and Drug 14 D-Ribose

Administration. This is the highest level of safety affirmation available and with this GRAS affirmation ribose can be safely used in both foods and clinical nutrition products. It is important to note, however, that only ribose manufactured according to the specific process Bioenergy Life Science carries this GRAS affirmation. Like all other nutrition and drug products, the quality of manufacturing is paramount in assuring both safety and effectiveness.

Although there are no known side effects, Bioenergy Life Science recommends that pregnant women ask their doctor before taking ribose. Insulin dependent diabetics should also carefully monitor their blood glucose levels after taking their first several doses. Ribose is a carbohydrate and, as a result, you would expect that it would increase your blood glucose level. In fact, ribose slightly decreases blood glucose level, and that is what should be monitored.

There are very few reports of side effects while taking ribose. Some people have reported being light headed if they take doses greater than 10-grams on an empty stomach. That is why label instructions suggest that ribose be taken with juice or another beverage that contains some additional carbohydrate. Sprinkling ribose on fruit or cereal is also a good way to take it, or, if it is taken with a meal, it can be mixed with water, tea, or coffee. Another reported side effect reported by people taking large doses is loose stools or mild diarrhea. This is common with any carbohydrate that absorbs water, as does ribose. Neither side effect is significant, and neither is found when ribose is taken as directed. Ribose is also safe to take with your usual medicine and with other nutritional therapies. There have not been any reported drug or nutritional interactions with ribose supplementation.

Tens of thousands of people now take Ribose every day. They are feeling for themselves how this energy-giving nutrient can change their lives. Ribose stands alone as a nutrient that can increase the energy level in hearts and muscles, and restore energy that is depleted by over-exertion or disease that robs cells and tissues of the energy they need to survive and thrive. No other compound, whether it is a drug or other nutrient, can do what ribose does in the body. Only ribose can accelerate the complex metabolism that restores energy in our bodies, making it one of the most profound nutrients to ever be introduced.

This article is excerpted from “The Top 20 Life-Changing Nutrients You Shouldn’t Live Without” by Dr. Ward Bond. Dr. Bond graduated Clayton College of Natural Health, Birmingham, Alabama with a doctor of philosophy degree in holistic nutrition and has a chartered herbalist degree from Dominion Herbal College. He is the author of several additional books including “Dr. Ward Bond’s Vitamin, Mineral & Antioxidant Guide” and “The Healing Fields.” Visit his website at www.drwardbond.com.

Infertility is becoming widespread these days but in the early 1900's, families with five children or more were commonplace. A century later, we now have fertility clinics available to women who want to just have one child. Infertility treatment is expensive and painful for couples who often become desperate after years of failed treatments. One common overlooked reason is low DHEA levels. DHEA is short for DeHydroEpiAndrosterone.

This is the "fountain of youth" hormone and it's a natural adrenal hormone which peaks at age 25, then steadily declines as we age. DHEA can be converted into testosterone and estrogen. Less DHEA means less of these sex hormones. Blood or saliva tests are available to gauge DHEA levels which must be in balance with other adrenal hormones, especially cortisol. High cortisol will cause you to hold on to belly fat.

Cortisol goes up in response to stress. Remember, these two are supposed to be in balance, like a see-saw. So you can see where I'm going with this. Cortisol climbs up and up in many women given the fast paced 21st century non-stop information overload, lack of sleep, caffeine, work-related stress, financial obligations or relationship stress. When it comes time to have a baby, cortisol could be high while DHEA levels may be seriously tanked! Some signs and symptoms include bad PMS (premenstrual syndrome), fatigue, brain fog, mood swings or high cholesterol.

But wait, the fertility doctor told you it was a low count of eggs! Yes that could be true, it's technically termed "Low Functional Ovarian Reserve" or LFOR, which could occur from aging ovaries. At puberty, you may have had 250,000 to 500,000 eggs, but by age 37 perhaps there are 25,000 eggs, and by the time you hit menopause you may have less than 1,000 eggs. If you have LFOR, a specialist in this field will often complement in-vitro fertilization (IVF) with DHEA supplements and/or testosterone medications. According to a recent study published in the Journal of Ovarian Research research supports it. Female participants received 75 mg of DHEA for three consecutive menstrual cycles prior to IVF experiences. Those who received DHEA had more embryos leading to more successful pregnancies. But don't supplement with DHEA by yourself, dosing is dependent on many factors, especially genes which I study every day.

Your response and metabolism of DHEA is dependent on your personal genetic variants meaning supplementation can be good or bad depending on your genes. Cellular and animal studies show that SNPs in any of the following genes affect your metabolism of DHEA: Aromatase, steroid 5?-reductase, sex-hormone binding globulin (SHBG), fragile X mental retardation protein and breast cancer type 1 (BRCA1 gene) can affect levels of androgens in women. Short of screening yourself for all potential genetic variants, I think it's better for you to just do hormonal assessments to see if you have low DHEA or low testosterone.

I've been a pharmacist for 25 years now. Let's face, I know the good, the bad and the ugly drugs. I know we need some of them, and I know that others are not useful, or worse, they are harmful. So today I've decided to share the best remedies that help from head to toe:

Headaches- Taking butterbur (Petasites hybridus) at a dose of 75mg twice daily helps reduce the frequency and intensity of migraines. You can take all the triptan drugs you want (ie Imitrex, Zomig or others) but these drugs usually just reduce pain, sometimes they abort a headache. The butterbur may slash the number of attacks in half. This is HUGE if you have to hold down a job or take care of kiddos. I discussed butterbur and dozens of other solutions my book, Headache Free.

Hypothyroidism- It's impossible to have healthy thyroid function without selenium. Not only will it hinder your ability to make thyroid hormone, it will also stifle your ability to use the hormone inside the cell. There's more about selenium, iodine, B12 and ashwagandha at my website where I archive other articles on thyroid health.

Heart Failure- Niacin (vitamin B3) was found to reduce heart attack and stroke risk in a 2010 study published in the Journal of Cardiovascular Pharmacology and Therapeutics. Doses vary tremendously, so please do nothing until you have your physician's approval. Niacin causes vasodilation (opens vessels) which reduces arterial pressure. I would be remiss if I didn't mention CoQ10 while discussing the heart or heart failure. CoQ10 also lowers blood pressure. I like about 100 to 200 mg daily but again, please always ask your doctor what's right for you.

Digestive disorders- My number one go-to supplement is probiotics. These improve digestion and support a healthy immune system and mood. Digestive enzymes break down the food you eat into absorbable molecules. For heartburn, I recommend slippery elm or marshmallow root. As for nausea and vomiting, ginger tea is gentle and popular. It's a mild blood thinner though, so be careful. And finally peppermint supplements can help with irritable bowel syndrome. The value of peppermint has been discussed many times, even in the British Medical Journal in 2008.

Bone loss- We all know about calcium. But did you know without enough magnesium, vitamin D or K2, you don't even incorporate the calcium into your bones?! So keep in mind the best bone-building supplements contain key minerals, you don't just push one like calcium all by itself. Natural strontium is another over-the-counter mineral used for bone integrity.

Painful knees- Glucosamine sulfate promotes cartilage formation. Collagen is another supplement that reduces pain in the knee joint of osteoarthritis sufferers. A 2012 study in the Annals of Rheumatic Disease found that losing weight helped reduce the amount of cartilage loss while increasing proteoglycan content (squishiness).

Toenail fungus- Apply essential oil of tea tree, and eliminate all sugars. You should also be checked for diabetes if you have a lot of toenail fungus.

Many of you take bisphosphonate drugs for bone loss and you write to me with complaints. Lawyers handle cases now due to the reports of catastrophic reactions like osteonecrosis or femur fractures. It's a terrible irony.

Here's another idea. Nobiletin. This is different than strontium which I've written about before. Nobiletin is a powerful "polymethoxylated" flavonoid that comes from the white stringy fiber and peel of citrus fruits (termed "pith"). You probably spit that out, throw it away or put it in your compost pile don't you? Tangerines and Mandarin oranges have awesome amounts of nobiletin, however other citrus rinds such as oranges, lemons, and grapefruit also contain nobiletin.

Nobiletin has been researched extensively over the last 10 to 15 years. It positively impacts cholesterol and reduces inflammation. Great news for those struggling with atherosclerosis and heart disease, or those of you supported on statin cholesterol drugs. Nobiletin also blocks the NF kappaB pathway which induces pain. Nobiletin has anti-cancer activity, confers brain protection and improved symptoms of Alzheimer's in an animal model. Since I'm already on a tangent, I'll also tell you that adolescents and adults dealing with acne may benefit by nobiletin because it blocks sebum production. Now, let me circle back to your skeleton.

Bone loss in humans occurs as the result of one of two things. Either your bone cells fail to make new bone, or you break down old bone too quickly. There needs to be a steady balance: Discard old bone, make new bone, discard old bone, make new bone. You probably didn't realize your bones are not solid, they are dynamic throughout your lifetime.

Two major players affect the process of bone building. One is inflammation and the other is estrogen. Chronic low grade inflammation and/or too little estrogen contribute to osteoporosis.

Research published in the Journal of Pharmacological Science showed very promising evidence of nobiletin on bone health. Scientists used rodents that had their ovaries removed (which causes estrogen deficiency). Nobiletin was given, and stopped the progression of osteoporosis. Not only that, it significantly restored bone mass in severely osteroporotic critters!

How you wonder? This natural citrus derived antioxidant suppressed pathways responsible for inflammation, namely the COX2, NF-kappa B, and prostaglandin pathways. Just amazing when you think about the potential harm done by bisphosphonate drugs given by conventional physicians. By no means am I saying an orange a day will keep the hip fracture away! But regular consumption of citrus fruits or pith-derived supplements might help, and can usually be taken with certain medications (not all). Ask doc if it's okay for you, and look online or at health food stores nationwide. It's sold as Sytrinol, or as "citrus bioflavonoids" and I want you to be real careful because some of the products contain "naringen" which comes from grapefruit and this compound can dangerously spike your blood levels of medications. My point is self-treatment with natural dietary supplements -even wonderful ones- may not be right for you. Find yourself a holistic-minded practitioner to ask.

Help for Cold Sores and Herpes Infections

Are you worried about painful cold sores? They are highly contagious. If you kiss someone with a cold sore, or drink from their cup, you could get it too. I don't personally get them, so last week, I inwardly freaked out when the woman who was giving me a much-needed manicure had two large blisters on her lips. This incident made me wonder what I would do if I had these painful sores, and how can I help you with them.

Cold sores are caused by the herpes simplex virus (HSV) which belongs to a large family of herpes pathogens which cause chicken pox, shingles or keratitis (can cause corneal blindness). Millions of folks carry herpes viruses, and the cold sores in particular are not only embarrassing, but painful too. Oral herpes causes cold sores on the lips, inside the roof of your mouth or on your gums. Genital herpes causes lesions where the sun don't shine. Either way, ouch!

You can get it if someone touches their sore, then you; you can get it sharing utensils or kissing and making out. Once inside your body, your immune system jumps to it and hopefully it's just a single episode. If your immune system is sluggish, you're in for a lifelong battle with frequent outbreaks. The frequency is impacted by your diet, lifestyle and immune strength (which is dependent on having healthy intestinal flora).

Running yourself into the ground with chronic stress or worry can activate the virus and cause lesions. Pulling all-nighters, eating candy bars, drinking alcohol, smoking, eating white flour goodies and junk food can increase risk. Ingesting foods you are intolerant to, or being deficient in probiotics can increase those flare-ups. Diets high in arginine are thought to activate herpes so avoid avoid all nuts, cashews, chocolate, cereal, lentils and sunflower seeds.

Antiviral drugs like acyclovir or Valtrex are commonly used to treat HSV infections. Unfortunately, there are increasing problems with drug resistance, similar to the problem with antibiotics and superbugs. If you do take the antiviral drug and use them long term, often there are plenty of side effects and potential damage to the kidneys and liver. I'm passionate about natural remedies, so here's a few to ponder:

Lemon balm. I'd make a tea out of this, and drink it. Let the herb steep (not boil) for about 15 minutes then drink. I'd also apply it to your sore with a cotton pad. You can cool the tea first to make it feel better upon application.

Curcumin. It's well known for antiviral, antifungal and antibacterial power but it also fights HSV which means it could help you reduce the frequency and severity of your infection. We have a study to show that. Supplement, or try applying a mini-poultice to your lip sore by mixing turmeric spice with just enough water to form a paste. For extra effect, dump a little curcumin powder from your capsule into the mixture.

Lavender and myrrh. Buy both of those and combine them, apply to the sore. Dilute if it stings.

For more natural remedies, come to my website, www.SuzyCohen.com and sign up for my newsletter. You'll get the longer version of this article with more pain-relieving tips.

Have you ever had a sore throat, been stung by a bee, or twisted your ankle? Do you have arthritis, back pain or headaches? Whenever you are in pain, even post-surgical pain, your body makes compounds in response to the injury which cause temporary redness, heat, swelling, and pain. Then naturally produced enzymes in your body eat up these inflammatory compounds, and that is when you notice the swelling goes down, the pain is relieved and the redness or stiffness recedes.

One second ago, an enzyme in your body called superoxide dismutase (SOD) just chased out a cancer-causing toxin that your cell accidentally spawned. You make all sorts of enzymes, and what's cool is that you can also buy certain enzymes as a dietary supplement, including SOD. Lactose is an enzyme that chews up milk sugars, helping some people to tolerate milk. Bromelain, derived from pineapples, helps with allergies and helps people post-surgically. It might even reduce scarring if taken soon enough. People who take acid blockers could benefit from papain, an enzyme derived from papaya fruit that works nicely with your stomach's pH range.

Proteolytic enzymes another type of enzyme. They chew up proteins and help with digestion. I think they're great for chronic pain syndromes. They help dissolve fibrin deposits which helps bruising. As a teenager (way back in the 1980's) we played a game called Pac Man. Remember?(Please tell me you remember). This popular arcade game included a Pac-Man which traveled a maze and gobbled up ghosts. I was a monster at Pac-Man in my hey day! Proteolytic enzymes work in the same way, they just gobble up debris, as opposed to ghosts.

With less debris, there is improved circulation. That means more oxygen and healing nutrients to the site of injury. As a pharmacist, I recommend you reach for proteolytic enzymes before you NSAIDs such as acetaminophen, naproxen or ibuprofen. Why? Because they are temporary and they have side effects. It's the equivalent of applying a bandage, and while most of you fair out well, the unlucky few experience diarrhea, nausea, headaches, dizziness, bleeding ulcers or heaven forbid, kidney damage. Besides, if you mask your pain with medicine, but continue to operate as normal, you increase your risk of permanent damage.

A German paper studied proteolytic enzymes in 100 athletes. The results were shocking. More than 75 percent said the enzyme treatment was favorable and no side effects were reported! So incredible were the results that the German government sent millions of enzyme capsules to the Olympics to help their athletes heal quicker.

Enzymes are a necessity to life, just like oxygen, food, clean water and shelter. (Some may argue that chocolate should be included as well).

For chronic pain syndromes, as opposed to digestive issues, I recommend that you take your proteolytic enzyme supplement on an empty stomach. This increases the 'Pac-Man' effect by up to 40 percent. While these supplements are generally well-tolerated, I occasionally hear of allergies, rashes and digestive upset.

You're methylating right now! This means you're turning folate (vitamin B9) from your food, into something else called SAMe. It's the process called "methylation" and SAMe is your body's head honcho, the CEO if you will!

SAMe stands for S-adenosylmethionine and drives hundreds of chemical reactions in your body. If you ate a salad for lunch, you're turning that folate into SAMe as we speak. Well, let's hope because SAMe helps you get rid of poisons. The biggest mistake you could make is thinking that methylation problems don't apply to you because you don't have the gene mutation, what we call the genetic snp (pronounced "snip"). Nothing could be further from the truth. As a pharmacist, and a Functional Medicine practitioner, I assure you that your medicine has the capacity to mess up your methylation! Then poisons back up.

Don't think you make poisons in your body because you eat well and exercise? Wrong. Your cells churn poisons out as metabolic waste products probably a million times a minute! You better hope and pray your methylation pathway is up to snuff because if you don't methylate, toxic by-products build up all over your body. This equates to pain, depression, inflammation, elevated homocysteine, cognitive dysfunction, depression, higher risk for neural tube defects and much more discomfort. If you have the genetic snp it's a one-two punch for health problems galore.

So in summary, medications hinder your methylation pathway, whether or not you have a snp. These are the primary offenders:

Cholestyramine. This is a bile acid sequestrate used for reducing cholesterol as well as reducing Herxheimer (die-off) reactions. It is a drug mugger of folate and fat-soluble vitamins like vitamin D, A, E and K. Remember, no folate, no methylation!

Birth control or hormonal replacement drugs with estrogen. these drugs are known drug muggers of magnesium, B6 and B2 (riboflavin); that puts the breaks on methylation. Started 'The Pill' recently, and now you feel down in the dumps? This could be why.

Proton Pump Inhibitors (Nexium, Prilosec, Prevacid, others). Lowering natural acid production in the stomach reduces levels of magnesium, and critical B vitamins. Snp or not, your body simply cannot conduct methylation adequate levels of these nutrients!

Antibiotics like amoxicillin, sulfamethoxazole, doxycycline and dozens more. Antibiotics kill your intestinal microflora (what you call your probiotics). Without the friendly gut flora, you cannot produce vitamin B12 (methylcobalamin). You also cannot activate riboflavin or folate so therefore, your methylation is blocked.

Ibuprofen. This is a drug mugger of folate, so it blocks methylation directly by stealing your folate.

Blood pressure pills like ACE inhibitors. These drugs (enalapril, lisinopril, etc) cause added zinc excretion. You need zinc to conduct methylation.

Nitrous oxide. Been to the dentist lately? If you got NO gas, then no methylation took place for awhile!

There are hundreds of other medicines that hinder your ability to methylate, snp or not! You may not have your genetic details or tests yet, so here are clues to poor methylation: Nerve pain, numbness or tingling, chronic fatigue, anxiety, insomnia, depression, mood swings, attention problems, cervical dysplasia, miscarriage, brain fog, weakness and lots of allergies.