The heart is a functioning muscle and needs oxygen and fuel in order to do its work. It is the job of the coronary arteries to supply the necessary oxygen and nutrients to the muscle. When one of the three major coronary arteries become narrowed or blocked, blood flow to the muscle is reduced, resulting in angina pectoris—a feeling of tightness or pressure in the chest often associated with shortness of breath. At first, angina may only be obvious during periods of exercise or emotional stress, and may go away when the activity ceases. Later, it may occur even while resting. If the blood flow to an area of the heart completely stops, heart muscle cells die, causing a heart attack, or myocardial infarction. While healing, the infarcted or damaged area forms a scar, but is no longer a functioning part of heart muscle.

Conventional medical treatments for angina include blood vessel dilators such as nitroglycerine and other nitrites and calcium channel blockers. If arteriograms show clogged coronary arteries, bypass surgery is usually recommended.

Dietary Supplements: Primary Recommendations

Vitamin C
Those pesky little free radicals really get around. They seem to be involved in almost every cardiovascular condition, and angina is no exception.^1,2 Consequently, it's not surprising that vitamin C and other antioxidants, which neutralize free radicals, are beneficial in the prevention and treatment of angina. In fact, studies have shown that men and women with lower blood levels of vitamin C have a higher risk for angina.^3,4,5,6 Furthermore, research has also shown that vitamin C supplementation, with or without other antioxidants, has been able to reduce the incidence of angina.^7,8,9 About 2,000 mg of vitamin C daily is recommended.

Co-enzyme Q10
Co-enzyme Q10 is a vitamin-like substance involved in cellular energy metabolism. It is also an antioxidant, like vitamin C, that is beneficial in the prevention and treatment of angina. In a study, which reviewed the scientific literature, Co-enzyme Q10 was revealed to be used in oral form to treat various cardiovascular disorders including angina.¹⁰ In one study, patients with acute myocardial infarction experienced a significant reduction in angina, arrhythmias (abnormal heartbeat), and poor heart function when supplemented with 120 mg of Co-enzyme Q10 daily.¹¹ Of course everyone knows that exercise is good to prevent cardiovascular disease. But in one study, patients with ischemic heart disease/effort angina were found to experience a faster loss of Co-enzyme Q10 during exercise.¹² Does this mean that you shouldn't exercise if you have angina? No, it just means you should supplement with Co-enzyme Q10. In another study, 150 mg of Co-enzyme Q10 given to angina patients not only increased their blood levels of Co-enzyme Q10, but also increased their ability to exercise longer. These results lead the researchers to conclude, "This study suggests that Co-enzyme Q10 is a safe and promising treatment for angina pectoris."¹³ (Note: If you have acute angina, you should only exercise in accordance to a program approved by your physician.)

Vitamin E
Vitamin E is considered by many to be the granddaddy of all antioxidant and cardiovascular support vitamins—and this reputation certainly holds true in the case of angina. As with vitamin C and Co-enzyme Q10 previously discussed, vitamin E protects against the free radical damage associated with angina. But what happens when there are inadequate levels of vitamin E? Not surprisingly, research shows that blood levels of vitamin E are significantly lower in patients with angina, and that these lower levels render them more susceptible to further cardiovascular damage.^14,15,16 And what happens if vitamin E is supplemented? Various studies show that vitamin E supplementation, with or without other antioxidants, is able to successfully decrease the incidence of angina in affected patients.^17,18,19 In fact, in a study, which examined vitamin use in 2313 men, vitamin E supplementation was found to have the strongest association with a reduced risk of ischemic heart disease, including angina.²⁰ Finally, vitamin E supplementation together with conventional anti-anginal drug therapy has been found to bring a higher response and exercise improvement, as well as other positive changes, than drug therapy alone.²¹ About 100 –400 IU of vitamin E daily is recommended.

L-Carnitine
L-carnitine is an amino acid involved in energy metabolism. Extensive research has also shown that l-carnitine has a valuable role to play in cardiovascular disease, especially where angina is concerned. Several studies have demonstrated that supplementation with l-carnitine (2000 to 4000 mg daily) is able to reduce the incidence of anginal attacks in cardiovascular disease patients.^22,23,24,25 Furthermore, in studies involving patients with angina pectoris and effort angina (i.e., angina induced by physical effort, such as exercise), supplementation with l-carnitine (2000 or 3000 mg daily) was able to improve exercise performance.^{26,27,28,29,30} Furthermore, in a study where l-carnitine was given to patients with effort angina along with anti-arrhythmic drugs, the l-carnitine was found to improve the action of those drugs.³¹

Hawthorne
Germany's Commission E has validated the use of Hawthorn in cases of cardiac insufficiency, resulted in an improvement of subjective findings as well as an increase in heart work tolerance, and a decrease in pressure/heart rate product.³² (Although Hawthorne Berry products are often marketed, it is the Hawthorne leaves and flowers which have been so carefully researched and validated.). In one study, a 60 mg hawthorn extract taken three times per day improved heart function and exercise tolerance in angina patients.³³

L-Arginine
Typically physicians will give their angina patients a prescription for nitroglycerin tablets, which are used in case of an angina attack. Nitroglycerine works through dilation of arteries, which in turn, works through an interaction with nitric oxide, which stimulates dilation. It is interesting to note that nitric oxide is made from the amino acid arginine. Furthermore, blood cells in people with angina have been shown to make insufficient nitric oxide,³⁴ (possibly due to abnormalities of arginine metabolism). Of greatest significance is research showing that 2 grams (2,000 mg) of arginine, three times per day for as little as three days improved the ability of angina sufferers to exercise.³⁵ Additional research has shown that the mechanism by which arginine operates is through stimulating blood vessel dilation.₃₆ (Note: If you have an active herpes virus, you should avoid arginine supplements since they can "feed" the virus.)

Dietary Supplements: Secondary Recommendations

Magnesium
The heartbeat normalizing effects of magnesium has been described repeatedly since 1935, both as a factor in human disease and in animal experiments. Nevertheless, this therapeutic effectiveness is rarely mentioned in textbooks. Both the therapeutic effect of magnesium and the correction of magnesium deficiency have been used in treatment of digitalis toxicity (a drug used to treat angina), angina, as well as in arrhythmia (abnormal heartbeat) of unknown origin. Magnesium deficiency can be caused by a number of situations. Of possible concern to the angina sufferer are the uses of drugs such as digitalis, diuretics, gentamicin, as well as cisplatinum, which appreciably enhance urinary magnesium loss. Correction of magnesium deficiency should lead to recovery.₃₇ About 300 – 500 mg daily is recommended. Please note, however, that it may take weeks or even months of magnesium supplementation, to achieve an angina-relieving result.

Omega-3 fatty acids
The omega-3 fatty acids EPA and DHA have been studied in the treatment of angina. Some research indicates that 3 grams or more of omega-3 oils (e.g., fish oils) three times per day (providing a total of about 3 grams of EPA and 2 grams of DHA) have reduced chest pain as well as the need for nitroglycerin, a common medication used to treat angina.₃₈ However, other research did not confirm these benefits.₃₉ In any case, if omega-3's are used, vitamin E should be supplemented with it, since the vitamin E may protect the oils against free radical oxidation.₄₀ Also, if you are using any type of blood-thinning medication, consult with your doctor before using omega-3 fatty acids.

Bromelain
Bromelain acts naturally as a blood thinner agent since it prevents excessive blood platelet from clumping together,₄₁ which would otherwise cause "sludgy" blood. Furthermore, there have been positive reports in a few clinical trials of bromelain to decrease thrombophlebitis (inflammation of veins) and pain from angina and thrombophlebitis.^42,43 About 1200–1500 mg daily (derived from at least 900 GDU/Gram material) is recommended.

References:

1. Ito K, et al, Am J Cardiol(1998) 82 (6):762-7.
2. Kugiyama K , et al, J Am Coll Cardiol (1998) 32(1):103–9.
3. Ibid.
4. Riemersma RA, et al, Ann NY Acad Sci (1989) 570:29–5.
5. Riemersma RA, et al, Lancet (1991) 337(8732):1–5.
6. Ness AR, et al, J Cardiovasc Risk (1996) 3(4):373–7.
7. Ito K, et al, Am J Cardiol (1998) 82 (6):762–7.
8. Kugiyama K, et al, J Am Coll Cardiol (1998) 32(1):103–9.
9. Singh RB, et al, Am J Cardiol (1996) 77(4):232–6.
10. Greenberg S, Frishman WH, J Clin Pharmacol (1990)30(7):596–608.
11. Singh RB, et al, Cardiovasc Drugs Ther (1998) 12(4):347–53.
12. Karlsson J, et al, Ann Med (1991) 23(3):339–44.
13. Kamikawa T, Am J Cardiol (1985) 56 (4):247–51.
14. Miwa K, et al, Cardiovasc Res (1999) 41(1):291–8.
15. Miwa K, et al, Circulation (1996) 94(1):14–8.
16. Pucheu S, et al, Free Radic Biol Med (1995) 19(6):873–81.
17. Rapola JM, et al, JAMA(1996) 275(9):693–8.
18. Singh RB, et al, Am J Cardiol (1996) 77(4):232–6.
19. Motoyama T, et al, J Am Coll Cardiol (1998) 32(6):1672–9.
20. Meyer F, Bairati I, Dagenais GR, Can J Cardiol (1996)12(10):930–4.
21. Pimenov LT, Churshin AD, Ezhov AV, Klin Med (1997) 75(1):32–5.
22. Singh RB, et al, Postgrad Med J (1996) 72(843):45–50.
23. Davini P, et al, Drugs Exp Clin Res (1992) 18(8):355–65.
24. Fernandez C, Proto C, Clin Ter (1992) 140(4):353–77.
25. Ferrari R, Cucchini F, Visioli O, Int J Cardiol (1984) 5(2):213–6.
26. Kobayashi A, Masumura Y, Yamazaki N, Jpn Circ J (1992) 56(1):86–94.
27. Cacciatore L, et al, Drugs Exp Clin Res (1991) 17(4):225–35.
28. Canale C, et al, Int J Clin Pharmacol Ther Toxicol(1988) 26(4):221–4.
29. Cherchi A, et al, Int J Clin Pharmacol Ther Toxicol (1985) 23(10):569–72.
30. Kamikawa T, et al, Jpn Heart J (1984) 25(4):587–97.
31. Mondillo S, et al, Clin Ter (1995) 146(12):769–74.
32. Blumenthal, M., et al, The Complete German Commission E Monogrpahs: Therapeutic Guide to Herbal Medicines/CD version (1998) American Botanical Council, Austin, Texas.
33. Hanack T, Bruckel MH, Therapiewoche (983) 33:4331–33 [in German].
34. Mollace V, et al, Am J Cardiol (1994) 74:65–68.
35. Ceremuzynski L, Chamiec T, Herbaczynska-Cedro K, Am J Cardiol (1997) 80:331–33.
36. Egashira K, et al, Circulation (1996) 94:130–34.
37. Laban E, Charbon GA, J Am Coll Nutr (1986) 5(6):521–32.
38. Saynor R, Verel D, Gillott T, Atheroscl (1984) 50:3–10.
39. Mehta JL, et al, Am J Med (1988) 84:45–52.
40. Wander RC, et al, J Nutr (1996) 126:643–52.
41. Heinicke R, van der Wal L, Yokoyama M, Experientia (1972) 28:844–45.
42. Nieper HA, Acta Med Empirica (1978) 5:274–78.
43. Seligman B, Angiology (1969) 20:22–26.

Lack of energy is a constant theme in the lives of countless Americans. For many, tiredness is so routine that they accept it as a natural state. Family and work by themselves are exhausting; unexpected demands or a restless night can deplete the remaining energy reserves. What is to be done? The American answer is caffeine. Pick your flavor: coffee (then more coffee), energy drinks (which flavor and how tall?), sodas (nothing beats caffeine plus sugar!) and the list goes on. The idea is that, if the metabolism is flagging whip it harder or, better yet, throw in a quick burst of energy from a simple carbohydrate. Caffeinate, crash, repeat (perhaps several times throughout the day), then start over the next morning.

And start over we do. Ninety percent of all American adults ingest caffeine daily. It is the go-to stimulant of choice, so much so that for a while Wrigley was producing eight stick chewing gum packs each stick of which contained as much caffeine as half a cup of coffee. To be sure, it is not as if caffeine has no benefits. After all, people consume caffeine mostly to improve productivity and related outcomes, not for pleasure. But what if the lack of energy is really just the body's response to a lack of rest (sound sleep usually is an early casualty of too much caffeine) and to a failure to recover from demands placed on it day in and day out? Under such circumstances, the daily caffeine fix is always needed and creates the conditions of its own demand along with downsides. Fortunately, it is possible to get off this merry-go-round.

Controlling Caffeine
Researchers have often wondered why it is that tea, despite its caffeine content, tends to relax individuals without making them drowsy. Similarly, those engaging in meditation practices may drink tea to dispel mental sluggishness and yet not become mentally agitated, as is typical with the consumption of too much coffee. Black and green teas give somewhat different answers. Black tea, for instance, contains one or more compounds that open up the peripheral circulation and also reduce blood levels of cortisol, the stress hormone. Likewise, blood platelet activation, which is linked to blood clotting and to the risk of heart attack, was lower in the tea drinkers in a clinical trial and this group reported a greater degree of relaxation in the recovery period after a stressful task.¹ This is good news for the 65 percent of adult Americans who suffer from daily stress. L-Theanine, found in green and oolong teas, is more complicated. In one trial in which caffeine (250 milligrams) increased self-rated alertness along with jitteriness and blood pressure, theanine (200 milligrams) antagonized the effect of caffeine on blood pressure, but did not significantly affect jitteriness, alertness or other aspects of mood.² At a lower level of caffeine consumption (150 milligram), theanine (250 milligrams) actually further improved the normal cognitive benefits of caffeine.³ Affects on stress per se also are found with theanine, with the degree of benefit depending on conditions and individuals.

Various tests have demonstrated the anti-stress effects of L-theanine. One of the more revealing of these experiments examined brain wave patterns after the ingestion of theanine. This research built on the knowledge that humans produce specific patterns of electrical pulses on the surface of the brain that mirror brain states. The four primary wave patterns are known as the alpha, beta, delta and theta (a, b, d and q) brain waves, representing, respectively, 1) relaxed wakefulness, 2) excitation, 3) sound sleep, and dozing sleep.⁴

In one experiment, 50 women volunteers (aged 18–22 years old) were divided into high-anxiety and low-anxiety groups. Each group was given either 50 or 200 mg theanine in water once a week. Their brain waves were measured during the 60 minutes after ingestion. The measurements were repeated twice during a two-month test period. The results were a marked increase in a-waves starting roughly 40 minutes after ingestion. Researchers concluded that theanine rapidly enters the system when ingested and that it heightens the index of the brain wave that is known to be linked to a state of relaxed wakefulness. Researchers also have explored whether the response to theanine might be influenced by the level of anxiety found in test subjects. As might be expected, the greater degree of change is found in those manifesting high anxiety.

Theanine appears to protect against certain so-called "excitotoxins." It modulates the motor-stimulation associated with caffeine and it inhibits some of the actions of norepinephrine in the central nervous system, for instance. In tests with gerbils, theanine protected against the destruction of neurons induced ischemia, a condition that can lead to a rapid increase in glutamate in neurons and result in the death of these cells. Theanine taken in the evening may support improved sleep quality not by sedation, but through anxiolysis.⁵ The other herbs mentioned below also tend to improve sleep quality at least in part through the same mechanism.

Saffron for Replacing Jitters with Emotional Balance
Although small amounts of caffeine, meaning usually less than 400 milligrams per day, for the vast preponderance of individuals provides mostly an upside with little downside, excessive caffeine can lead to anxiety, physical and emotional "jitters," as well as insomnia. For many, black, oolong and green teas are more gentle alternatives to the concentrated caffeine of coffee, yet coffee is a preferred beverage for many. Moreover, caffeine is added to so many other pick-me-ups that individuals often are unaware of how much they are consuming throughout the day. Several herbs and spices are useful remedies to this excess. Saffron is one of these.

Saffron is far more than merely a spice that gives color to rice and paella along with a distinctive aromatic signature. Crocins are the source of saffron's coloring properties, whereas its aromatic aspects come from picrocrocins and safranal. Medical texts from ancient Egypt, Persia and the Roman Empire attest to healing properties, including pain relief and calming effects. Similarly, Chinese and Indian healing systems ascribe these and more benefits to saffron. Other healing aspects include the treatment of coughs, better movement of nutrients into tissues and aphrodisiac qualities.

At least eleven clinical studies have evaluated saffron for its impact on aspects of emotional balance, such as anxiety and depression. In comparative clinical trials, saffron intake after one or two weeks has proven to be comparable in efficacy to the drugs fluoxetine and imipramine. The mechanism of action seems to be the regulation of neurotransmitters.⁶ Other conditions that have been explored clinically with saffron include erectile dysfunction, vision, Alzheimer's disease and cosmetic benefits. In general, it is thought that there is a complementary action from more than twenty-five active compounds in saffron to yield the demonstrated clinical effects. One special extract that has been extensively clinically tested gives benefits when ingested at the level of 30 milligrams per day.

Lemon Balm's Calming Effects, Sleep Benefits
Another useful traditional herb is lemon balm (Melissa officinalis L.). Since the 19th Century, it has been recognized as being soothing during stress and anxiety. Lemon balm contains hydroxycinnamic and rosmarinic acids. Studies have shown that lemon balm consumption increases sleep quality, reduces stress and improves mood.⁷ Clinical trials have demonstrated the effects of lemon balm extract on cognitive health. Lemon balm improves cognitive performance by enhancing memory and accelerating the visual information processing.^8,9 One high quality and tested extract is recommended at an intake level of 600 milligrams per day.

Blue Dogbane Is a Bane for Stress
Apocynum venetum L., commonly known as Luobuma in China, is a traditional and popular Chinese herb with a long history of use as a medicine and tea, both in Chinese and Uygur medicine. In fact, Apocynum venetum L. is mentioned in the ancient Dun Huang Manuscripts (written in the 5th to early 11th centuries A.D.) as a powerful longevity tonic. It especially is useful in cases of hypertension and anxiety.¹⁰ Among its other notable benefits is support for sleep. According to the official Chinese Pharmacopoeia, the herb calms the liver, soothes the nerves, treats palpitations and improves insomnia. As a tea in China, it is used especially for the elderly as a sleep aid and to reduce high blood pressure. Indeed, a commercial Luoboma "antihypertensive tea" is available commercially in the western province of China. Care should be taken to not confuse it with Indian Hemp (I), Apocynum androsaemifolium, poacynum pictum, I, or the blue dogbane native to Texas. Chinese White and Pink Dogbanes are inferior substitutes often presented as the same plant.

Anxiety afflicts more than forty million Americans, hence is hardly a minor issue. As already explored above, caffeine and "energy" drinks aggravate anxiety, jitteriness and blood pressure. The exact mechanisms of blue dogbane's action, which likely are multiple, only partially have been elucidated. For instance, the herb inhibits superoxide generated from both the NADPH oxidase and the xanthine/xanthine oxidase systems in the arteries. The upshot of these actions is that there is more nitric oxide (NO) available locally to relax the vessels.¹¹ Rather than taking multiple grams of L-arginine to provide a building block precursor for the production NO, just a little bit of this herb prevents the excessive destruction of NO and achieves the same benefit. The vasculature dilation effects of the blue dogbane extract, including in the brain, can be considerable. The benefits for relaxation, cortisol and stress reduction are significant. Clinical work indicates that the extract induces deeper sleep, meaning that it makes sleep more restful.12

An interesting finding is that Apocynum venetum L. is a particularly rich source of isoquercitrin, the more active and much better absorbed form of the antioxidant quercetin. Some research suggests that Apocynum venetum L. is a safe alternative to St. John's Wort. Suggested consumption of the extract depends on its quality and the condition in mind; 50–150 milligrams represents typically suggested dosages.12

Southern Ginseng
Most Westerners have heard of ginseng and think that the Chinese name applies to only one species. However, in fact there are various "ginsengs" in Chinese medicine, each displaying particular benefits. Gynostemma pentaphyllum is "southern ginseng"; it also is called jiaogulan. It is considered to have powerful antioxidant and adaptogenic effects purported to increase longevity.13 The plant belongs to a family that includes cucumbers, gourds, and melons—its fruit is a small purple inedible gourd. It is little known in traditional Chinese medicine (TCM) because TCM is largely based on the dried materials that could be transported to the Imperial Court of the Chinese Emperors in Beijing. Research indicates significant effects of southern ginseng in the areas of blood glucose, improved insulin sensitivity, improved HbA1c (indicating improved glucose control in diabetics and reduced glycation) as well as other benefits.14

Although local Chinese traditions long have reported adaptogenic effects, the impact of jiaogulan on stress and related conditions only recently has been explored by Western allopathic research. Nevertheless, a body of animal trials currently backs traditional uses to support human resilience to physical and mental challenges. For instance, a 2012 paper reports that oral administration of the ethanol extract of Gynostemma pentaphyllum can increase host defense in immunocompromised situations such as stress-induced immunosuppression.^15,16 A report from the next year indicates that there are anxiolytic effects of an herbal ethanol extract from Gynostemma pentaphyllum in mice after exposure to chronic stress.¹⁷ In yet another model of chronic stress and related anxiety disorders in mice, gypenosides, proposed active ingredients in the herb, improved stress-induced anxiety disorders by modulating brain dopamine and serotonin activities and corticosterone levels.¹⁸ (Corticosterone in mice plays the same role as cortisol in humans.) Finally, a recent randomized, double-blind, placebo-controlled clinical trial lasting 12 weeks demonstrated that an extract of Gynostemma pentaphyllum led to significant decreases in total abdominal fat area, body weight, body fat mass, percent body fat, and body mass index. (BMI).¹⁹ It is likely that more than one mechanism of action was important in bringing about these clinical results.

Magnesium
Do not forget magnesium! An estimated 68 percent of Americans do not consume the recommended daily allowance for magnesium. Some attribute this to modern dietary patterns, such as a failure to consume green vegetables and less refined grains. Others have observed that reduced magnesium levels can be attributed to food refining, processing and the use of industrial fertilizers, which typically lack magnesium. Magnesium deficiency has been associated with poor sleep quality, muscle tension and anxiety. Raising tissue levels with oral supplementation of magnesium may promote more restful sleep and relaxation. Preferred forms include magnesium glycerophosphate, magnesium malate and magnesium threonate. Each of these forms exhibits special characteristics based on its ligand. Better results with magnesium supplementation are realized with chronic usage to build up tissue stores.

Conclusion
Too often, the demand for more energy really is just a symptom of inadequate rest and poor quality sleep. The majority of adults is chronically stressed and sleep deprived. Good sleep affects alertness, energy, creativity, indeed, mental and physical performance and productivity in general. The common solution to being tired and under-performing is to consume caffeine in the form of coffee and energy drinks. There are alternatives, however, to the "caffeinate, crash, repeat" model of daily existence. Some of these alternatives support the positive effects of caffeine while mitigating the side effects. Others moderate jitteriness and "wired" effects of stimulants by reducing the stress hormone release found with too much stimulation. A common benefit of this approach is to improve the ability to sleep without forcing slumber and to make the time spent sleeping more restful.

References:

1. Steptoe A, Gibson EL, Vuononvirta R, Williams ED, Hamer M, Rycroft JA, Erusalimsky JD, Wardle J. The effects of tea on psychophysiological stress responsivity and post-stress recovery: a randomised double-blind trial. Psychopharmacology (Berl). 2007 Jan;190(1):81-9. Epub 2006 Sep 30. Erratum in: Psychopharmacology (Berl). 2007 Jan;190(1):91.
2. Rogers PJ, Smith JE, Heatherley SV, Pleydell-Pearce CW. Time for tea: mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together. Psychopharmacology (Berl). 2008 Jan;195(4):569-77.
3. Haskell CF, Kennedy DO, Milne AL, Wesnes KA, Scholey AB. The effects of L-theanine, caffeine and their combination on cognition and mood. Biol Psychol. 2008 Feb;77(2):113-22.
4. Juneja LR, Chu D-C, Okubo T, Nagato Y, Yokogoshi H. L-Theanine––a unique amino acid of green tea and its relaxation effect in humans. Trends in Food Science & Technology 1999;10:199-204.
5. Rao TP, Ozeki M, Juneja LR. In Search of a Safe Natural Sleep Aid. J Am Coll Nutr. 2015;34(5):436-47.
6. https://www.naturalproductsinsider.com/whitepapers/2016/09/safrinside.aspx
7. Cases J, Ibarra A, Feuillere N, Roller M, Sukkar S. Pilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances. Mediterranean journal of nutrition and metabolism. 2011; 4(3): 211-8.1.
8. Scholey A, Gibbs A, Neale C, et al. Investigation of a Melissa officinalis special extract on Cognition II: Human study - Lemon balm extract administered in confectionary bars. Agro FOOD Industry Hi Tech2015; 26(2): 12-4.
9. Kennedy D, Wake G, Savelev S, et al. Modulation of mood and cognitive performance following acute administration of single doses of Melissa officinalis (Lemon balm) with human CNS nicotinic and muscarinic receptor-binding properties. Neuropsychopharmacology 2003; 28(10): 1871-81.
10. Xie W, Zhang X, Wang T, Hu J. Botany, traditional uses, phytochemistry and pharmacology of Apocynum venetum L. (Luobuma): A review. J Ethnopharmacol. 2012 May 7;141(1):1-8.
11. Lau YS, Ling WC, Murugan D, Kwan CY, Mustafa MR. Endothelium-Dependent Relaxation Effect of Apocynum venetum Leaf Extract via Src/PI3K/Akt Signalling Pathway. Nutrients. 2015 Jun 30;7(7):5239-53.
12. Yamatsu A, Yamashita Y, Maru I, Yang J, Tatsuzaki J, Kim M. The Improvement of Sleep by Oral Intake of GABA and Apocynum venetum Leaf Extract. J Nutr Sci Vitaminol (Tokyo). 2015;61(2):182-7.
13. Blumert, Michael; Jialiu Liu. Jiaogulan: China's "Immortality" Herb. (2003: Badger, CA: Torchlight Publishing.)
14. https://examine.com/supplements/gynostemma-pentaphyllum/
15. Im SA, Choi HS, Choi SO, Kim KH, Lee S, Hwang BY, Lee MK, Lee CK. Restoration of electric footshock-induced immunosuppression in mice by Gynostemma pentaphyllum components. Molecules. 2012 Jun 25;17(7):7695-708.
16. Shang X, Chao Y, Zhang Y, Lu C, Xu C, Niu W. Immunomodulatory and Antioxidant Effects of Polysaccharides from Gynostemma pentaphyllum Makino in Immunosuppressed Mice. Molecules. 2016 Aug 19;21(8).
17. Choi HS, Zhao TT, Shin KS, Kim SH, Hwang BY, Lee CK, Lee MK. Anxiolytic effects of herbal ethanol extract from Gynostemma pentaphyllum in mice after exposure to chronic stress. Molecules. 2013 Apr 12;18(4):4342-56.
18. Zhao TT, Shin KS, Choi HS, Lee MK. Ameliorating effects of gypenosides on chronic stress-induced anxiety disorders in mice. BMC Complement Altern Med. 2015 Sep 14;15:323.
19. Park SH, Huh TL, Kim SY, Oh MR, Tirupathi Pichiah PB, Chae SW, Cha YS. Antiobesity effect of Gynostemma pentaphyllum extract (actiponin):
20. a randomized, double-blind, placebo-controlled trial. Obesity (Silver Spring). 2014 Jan;22(1):63-71.

Dental health is something that is often neglected in favor of more pressing health concerns like weight loss and fat loss. Dental health, however, is just as important as overall physical health. Believe it or not, poor dental health has just as much effect on a person as their overall physical health.

Importance of diet in dental health
Diet plays a very important role in dental health. A healthy, balanced diet should contain the essential vitamins and minerals that keep the teeth and gums in optimum condition for a long time.

A diet rich in vegetables, lean protein, healthy fats, and lowglycemic carbohydrates (e.g., fibrous vegetables and fruit) and low in simple sugars (e.g., bread, cakes and candies) go a long way in preventing tooth decay.

Link between dental health and disease
Researchers have discovered a correlation between gum (periodontal) disease and cardiovascular disease. While a concrete scientific relationship has yet to be established, the researchers reported two interesting findings.

First, the type of bacteria present in gum disease is also present in the blood vessels undergoing atherosclerosis (the prelude to heart disease). Second, inflammation of the gums increases the levels of a body protein called CRP (C-reactive protein). CRP is also one of the indicators used by doctors to evaluate a person’s risk of having heart disease, and interestingly enough, CRP levels are also higher in those suffering from obesity (another well-known risk factor for heart disease).

Cancer is another health condition that has correlation with oral health. A study by Harvard researchers showed a link between periodontal disease and pancreatic cancer. While the study has not yet been verified by laboratory experiments, it is the initial speculation of the researchers that gum inflammation is a significant factor, as it also causes inflammation in other parts of the body.

Nutrients for optimum tooth and gum health

Just like the rest of the body, the gums and the teeth also require specific nutrients to keep them in optimum shape and prevent infection, inflammation, and damage. The following nutrients are essential for dental health:

1. Calcium
Calcium is a trace element that is the main component of the physical structure of teeth and bones. Normal calcium levels help keep the tooth enamel healthy and resistant to erosion caused by bacteria. Calcium deficiency leads to tooth decay brought about by the weakening of tooth enamel.

The US National Institutes of Health recommends the following daily intake for calcium: 1200 milligrams for men and women over the age of seventy, 1000 milligrams for men and women aged nineteen to seventy, 1300 milligrams for children who are between the ages of nine and eighteen, 1000 milligrams for children between four and eight years old, and 700 milligrams for children between one and three years old.

Calcium is readily available in dairy products (e.g., milk and yogurt), turnip and collard greens, and kale. It can also be found in its most bioavailable form within humic acid (i.e. Leaf- Source).

2. Zinc
Zinc is another important trace element that is also involved in many body processes. While not as abundant as calcium, it plays an important role in maintaining dental health by preventing gum infection and plaque build-up. Deficiency in zinc can lead to mouth sores and gingivitis.

Aside from preventing infections, zinc has also been proven to significantly reduce bad breath. Researchers have conducted studies on the effect of zinc-fortified mouthwashes and chewing gum on bad breath. They discovered that the zinc in the oral products reduced the real cause of bad breath—sulphurcontaining compounds.

The recommended daily intake for zinc is eight milligrams for adult females and eleven milligrams for adult males. Zinc can be easily incorporated into one’s diet, as its sources are readily available to everyone. Oysters are said to contain the highest amount of readily available zinc, followed by liver and beef. Other sources include wild rice, cheese, and humic acid (i.e. LeafSource).

3. Iron
This trace mineral functions mainly as a carrier of oxygen throughout the body via the bloodstream. Lack of iron in the diet causes anemia, which in turn reduces oxygen flow in the various body cells and tissues. Lack of oxygen flow has been linked to infections and sores. In the mouth, this is manifested by bleeding gums and painful canker sores that often take a long time to heal.

Just like zinc, dietary sources of iron are plentiful and inexpensive. Good sources are liver and other meat products. Iron-fortified foods like breakfast cereals can also help a person meet the recommended daily iron intake of eight milligrams (for adult males) and 18 milligrams (for adult females), however in my opinion, most are way too high in sugar, which negates any of their fortification.

4. Magnesium
Together with calcium, magnesium helps strengthen the tooth enamel and prevents the formation of cavities and the onset of tooth decay. The recommended daily requirement for magnesium is 400 milligrams.

One of the best supplemental sources of magnesium is magnesium bisglycinate (magnesium bound to the amino acid glycine). The bisglycinate form is believed to be many times more absorbable than the citrate form. Dietary magnesium can be found in a wide variety of sources—fish, dark green leafy vegetables, dark chocolate, and bananas.

Visit: www.AbundantHealthSystems.com

References:

1. Slade GD, et al. Relationship between periodontal disease and Creactive protein among adults in the Atherosclerosis Risk in Communities study. Arch Intern Med. 2003 May 26;163(10):1172–9.
2. Michaud DS, et al. A prospective study of periodontal disease and pancreatic cancer in US male health professionals. J Natl Cancer Inst. 2007 Jan 17;99(2):171–5.
3. Periodontal Disease and Systemic Health. American Academy of Periodontology. (Accessed May 21, 2015).
4. NIH Medline Plus. http://www.nlm.nih.gov/medlineplus/magazine/issues/winter11/articles/winter11pg12.html.
5. Fedorowicz Z, et al. “Mouthrinses for the treatment of halitosis.” Cochrane database of systematic reviews (Online) (4): CD006701. Oct 8, 2008.
6. http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/.

Brad King, MS, MFS is a highly sought after authority on nutrition, obesity, longevity and one’s health and he has been touted as one of the most influential health mentors of our time. Brad can be heard live every week on Wednesday at noon Pacific/3 P.M. Eastern as he hosts the talk radio program “Transforming Health with Brad King” on Blog Talk Radio. https://www.facebook.com/TransformingHealth and www.Twitter.com/HealthyKingBrad.

Have you checked your blood pressure recently? It probably would be a really good idea to do so. Why? Because you may, in fact, be one of the 103 million Americans who are at risk for heart attacks and strokes.

According to the American Heart Association's Heart Disease and Stroke Statistics–2018 Update published in the journal Circulation, nearly half of American adults are in this risk category. In 2013, more than 360,000 deaths included high blood pressure as a primary or contributing cause.¹ That's a shocking statistic of almost 1,000 deaths each day.

In November 2015 another major study called the SPRINT trial published important findings in the New England Journal of Medicine. It led to a new re-definition of high blood pressure or hypertension. The standard used to be a reading of 140/90. The SPRINT study found that health risks from hypertension increased if the readings were over 130/80.²

The Blood Pressure Risks 101

The tricky thing about hypertension is that fact that 20 percent of people have no idea that they even have high blood pressure. Your blood pressure can be quietly creeping up without any obvious symptoms. So it certainly makes sense to check your blood pressure on a regular basis.

Healthy arteries should be flexible, strong and elastic. In a healthy artery, the lining is smooth allowing an adequate blood flow to supply nutrients and oxygen to vital organs and tissues. Hypertension gradually increases the pressure of blood flowing through your arteries. According to the Mayo Clinic, this can cause many health issues including damaged arteries and increased risk of an aneurysm. It can damage the heart causing coronary artery disease and heart failure.

But, high blood pressure is a risk factor for more than just heart disease.

Hypertension can be a serious risk factor that damages the brain. This can lead to a TIA (mini-stroke), strokes, mild cognitive impairment or dementia.

Healthy blood vessels are necessary for optimal kidney function. Hypertension can injure both the blood vessels in and leading to your kidneys, impairing kidney function. Thus, hypertension can cause kidney failure, kidney scarring or kidney artery aneurysm.

Blood vessels leading to the eye can also be damaged by impaired blood pressure. Retinopathy often referred to as retinal vascular disease, and nerve damage to the optic nerve are potential health issues.

Poor blood flow causes erectile dysfunction, and sexual dysfunction in women including low libido, vaginal dryness or difficulty achieving orgasm.

It's no surprise that the maintaining the health of your blood vessels and blood flow is critical for just about every aspect of your wellbeing.

The Problem with High Blood Pressure Medications

High blood pressure medications are usually the first thing that your doctor will prescribe if your blood pressure meets the new hypertensive guidelines.

There are many pharmaceutical options to choose from i.e., ACE inhibitors, Alpha blockers, Angiotensin II receptor blockers, Beta blockers, Calcium Channel Blockers, Central-acting agents, diuretics, and vasodilators. Sometimes, a combination of these medications will be prescribed.

But none of these are without side effects. A partial list of side effects includes dizziness, persistent cough, rashes, kidney failure, headaches, allergic reactions, fatigue, constipation, swelling in lower legs and feet, dry mouth, depression and too much potassium.

It is also important to remember that there is not one hypertensive medication that can truly heal high blood pressure. The best that the medications can do is merely regulate it.

Natural Solutions to the Rescue for High Blood Pressure

Hypertension is a symptom of an underlying physiological imbalance due to a variety of factors including poor nutrition, stress, lack of sleep, sedentary lifestyle, being overweight, and having heavy metal toxicity.

New research suggests that the hormone insulin plays a primary role in raising blood pressure. A high carbohydrate diet along with medications that raise insulin levels may be key root factors in high blood pressure.

For women, the risk of hypertension increases with the use of oral contraceptives and Hormone Replacement Therapy.

Researchers have found that long-term estrogen exposure generates excessive levels of a compound, superoxide, which causes stress in the body. The build-up of this compound occurs in an area of the brain that is crucial to regulating blood pressure, suggesting that chronic estrogen induces a buildup of superoxide that in turn causes blood pressure to increase.^3,4

A consistent blood pressure reading above 130/80 is an early warning alert. It is the flashing red light letting you know that it is time to make significant changes to a healthier, low carb diet, regular exercise, meditation, and other stress reduction programs and weight loss.

It is also time to look for safe, effective and natural solutions with proven blood pressure lowering benefits.

It's time to get to back to nature!

The 120/Life^TM Story

Bad health news can often lead to a new discovery for healing the problem. This is the story behind the formulation of 120/Life^TM, the first functional drink created from a blend of six natural blood pressure lowering ingredients. Based on clinical studies, each one of these ingredients demonstrated the ability to support the body to manage hypertension and normalize blood pressure.

Ira Antelis, at 57 years old, had a big shock when during a routine check-up his cardiologist told him that his blood pressure was dangerously high. Like so many people who never think of themselves of being at risk of high blood pressure, the news caught him unaware. This was especially upsetting since Ira's father had died from a stroke, a known condition caused by high blood pressure.

Ira knew he had to get his blood pressure under control right away. But, concerned about the many side effects of prescription medications, he was on a mission to find a safer solution. Researching the literature on natural blood pressure solutions, he discovered there were many clinical studies showing impressive results for lowering blood pressure from plants. These included pomegranate, cranberry, hibiscus, tart cherry and beetroot. Magnesium, an essential mineral, was one more ingredient that had repeatedly shown significant success in helping to reduce blood pressure.

He began to incorporate all of these foods into his daily regime. Within just weeks, he was pleasantly surprised by how much his blood pressure had dropped.

Dr. Lowell Steen, Ira's cardiologist was amazed and impressed at his results. "When I read Ira's blood pressure level after using these natural ingredients, I recommended them to my other patients with blood pressure concerns."

Rather than take each individual ingredient separately, he looked for a drink that incorporated all of these powerful anti-hypertensive heavy hitters. Unfortunately, there was none to be found.

Thus, the idea for 120/Life^TM was born. With the help of a registered dietician, an effective blood pressure lowering drink called 120/Life^TM was formulated. 120/Life^TM is the only functional beverage that is blended with pomegranate, cranberry, hibiscus, tart cherry, and beetroot juices along with the essential mineral, magnesium. And it is sweetened with stevia, a natural sweetener that also helps to lower blood pressure.

The Rock Star Ingredients of 120/Life^TM

Beetroot has been used since the Middle Ages as a treatment for ailments, especially those relating to blood and digestion. Beetroot contains high levels of dietary nitrate (NO3), which the body converts to biologically active nitrite (NO2) and nitric oxide. Both are powerful vasodilators. A study carried out at Queen Mary University of London and published in the journal Hypertension found the "Inorganic nitrate and beetroot juice supplementation was associated with a significant reduction in systolic blood pressure."

Dr. Shannon Amoils, a senior research advisor with the British Heart Foundation states, "This interesting study builds on previous research by this team and finds that a daily glass of beetroot juice can lower blood pressure in people with hypertension—even those whose high blood pressure was not controlled by drug treatment."

Hibiscus has been used to treat high blood pressure in both African and Asian traditional medicine. A study published in the Journal of Nutrition found that hibiscus tea significantly improved lowering blood pressure in the participants. How does hibiscus lower blood pressure? It has diuretic properties, it opens the arteries and it appears to act as a natural angiotensin-converting enzyme (ACE) inhibitor. This means that it slows the release of hormones that constrict blood vessels. In addition, hibiscus boosts immunity and is an effective antioxidant.

Pomegranate has been known throughout the centuries for its healing powers. According to a study published in the Pharmacological Research journal, drinking 2 ounces daily can lower blood pressure, improve cholesterol and cleanse arterial plaque. The research found that "Its ability to act as an ACE inhibitor is what allows pomegranate juice to lower blood pressure. Inhibiting ACE helps blood vessels to relax and open up, thus lowering blood pressure and allowing more blood and oxygen to get to the heart."

Tart Cherry, also known as Montmorency cherry, has proven to be as effective at lowering blood pressure as many hypertensive drugs—such as beta blockers and diuretics. Lead author of the study published in the American Journal of Clinical Nutrition reported, "The magnitude of the blood pressure lowering effects we observed was comparable to those achieved by a single anti-hypertensive drug and highlights the potential importance that Tart Cherries could have in the effective management of high blood pressure."

Cranberries have been reported to reduce blood pressure by dilating blood vessels and increasing blood flow. They contain phenolic compounds, which work as anti-inflammatories. According to a 2010 study published in the Journal of Agricultural and Food Chemistry, cranberries have an antioxidant called proanthocyanidins, which inhibit synthesis of a compound called ET-1 that plays a role in contracting blood vessels.

Magnesium is an essential mineral that helps to regulate hundreds of body systems, including blood pressure. Magnesium can lower blood pressure by preventing blood vessels from constricting as well as helping to improve blood flow. Magnesium has also been shown to decrease sodium concentrations in RBCs without changing potassium concentration.

A Sip Away to Healthy Blood Pressure

While high blood pressure is a serious problem affecting nearly a third of American adults, you can turn it around by implementing effective lifestyle changes such as a plant-based, whole food diet, regular exercise, daily relaxation and weight reduction.

However, one of your best friends for lowering blood pressure is the functional beverage drink, 120/Life^TM. The synergy from the six natural ingredients, beetroot, hibiscus, pomegranate, tart cherry, cranberry, and magnesium have been clinically proven to safely and successfully lower blood pressure as effectively as the most commonly prescribed blood pressure medications without the side-effects.

Thomas Edison's quote rings so true. "There were never so many able, active minds at work on the problems of disease as now, and all their discoveries are tending toward the simple truth that you can't improve on nature."

Ira Antelis would definitely agree. His unique all-natural functional beverage has helped thousands of people to successfully lower their blood pressure.

One bottle of 120/Life^TM a day can help keep your high blood pressure away!

Let's all drink to that!

References

1. Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123:933¡V44.
2. https://www.nejm.org/doi/pdf/10.1056/NEJMoa1511939
3. https://www.scind.org/1244/Health/main-reasons-of-higher-bloodpressure.html
4. https://www.sciencedaily.com releases/2011/05/110526114533.htm

Two years ago in this space the topic was the entourage effect and how it differed from nutritional and medical findings involving synergy: "Whereas synergism involves components each of which is active on its own and which in combination yield effects greater than the sum of the individual contributions, the entourage effect may involve components most of which on their own may exhibit little or no benefit or may yield benefits that are otherwise unrelated."¹ In practice, of course, there is more than a little overlap and one finds this all the time with foods and supplements. A good example is the so-called French paradox, generally presented as the supposed paradox between the French consumption of comparatively large percentage of calories as fat, especially as animal fat, and the Gallic low rate of heart disease.

Is the French Paradox Explained by Nutrient Synergies?
Sardonic observers sometimes remark that Americans count calories with neat little categories for carbohydrates, fat and protein whereas the French are only concerned with how food tastes and how the meal looks, its "presentation." Assuming that the consumption of animal fat matters, a point increasingly in question, the French classically have not cared while enjoying enviable levels of health, hence, by Anglo- American lights, the paradox. The traditional French diet is >42 percent fat, much of it either saturated or monounsaturated. The French (traditionally, at least, maybe still) drink red wine daily, yet outlive Americans (81.6 years versus 78.8 years, as of 2015, other statistical bases giving similar results).² The French also suffer from fewer cases of coronary heart disease and, in actuality, remain ambulatory and self-sufficient much longer than do Americans, meaning that statistics of relative life expectancy should be balanced by a close look at morbidity statistics. According to the 2014 World Health Organization data set, the French rank second in the world, behind South Korea, for having the lowest mortality rates from coronary heart disease. America? We rank 44th.³ Significantly, in France they consume almost no sugary drinks and eat very little sugar in any form. These dietary practices should be contrasted with those in the States.⁴

A new report from the USDA says Americans are eating less fat than we did 30 years ago. Here's the opening from an online article about the report:⁵ On average, Americans are eating 10g less fat per day today than they were in the late 1970s, according to new research. In a report comparing food consumption patterns in 1977–78 versus 2005–2008, Biing-Hwan Lin and Joanne Guthrie from USDA's Economic Research Service found that on average, Americans consumed 75.2g of fat in 2005–08 compared with 85.6g in 1977–78. Meanwhile, the percentage of total calories derived from fat also declined substantially from 39.7% to 33.4% between 1977 and 2008, said the authors.

Of course, there is no paradox if the long-standing condemnation of the role of fat and saturated fats in cardiovascular disease is mistaken, as discussed in last month's column and previously in Heart Matters Do Statin Drugs. However, let's assume that there is a connection and that the paradox, as often suggested, is a result of the French love of red wine. Is wine's protection from a single magic phytonutrient, resveratrol, or is the combination of ingredients the key?

Many who argue that there is a paradox suggest that the phytochemical known as resveratrol is responsible for the low rates of cardiovascular disease. Critics argue that this is nonsense because there simply is not enough of the compound present to exert any effect. In fact, just this point was the focus of an exchange back in 2008 in which a colleague, Joseph Evans, and I were participants.⁶ Subsequent findings decisively have proven that Evans and I were correct and our interlocutor mistaken in both his evidence and his arguments.

The skeptic's argument went like this: "The potency of most of the nutritional supplements labeled as resveratrol is in the range of 30 mg to 100 mg. This is 30 to 100 times lower than doses thought to be in the range for therapeutic effects in humans." Our response was that red wine is a widely studied source of the combination of resveratrol and quercetin and that significant health benefits are associated with men it was demonstrated that "the platelet antiaggregatory effect of de-alcoholized red wines could be computed...from its concentrations of resveratrol and quercetin."⁷ Similarly, the combination of resveratrol and quercetin exerts a powerful synergy in the inhibition of inducible nitric oxide (the form linked to inflammation).⁸ In animals fed a high-cholesterol diet, the human equivalent of 210 mg resveratrol per day improved endothelial function.⁹ However, more was not better, with animal experiments demonstrating that, in human equivalent amounts, approximately 360 mg per day led to greater life expectancy than approximately 1,565 mg per day.¹⁰ Finally, there is experimental evidence that the combination of nutrients such as pterostilbene, quercetin, and resveratrol might be more active than any one of these alone at much higher dosages with research showing that subeffective doses of combinations of anti-inflammatory compounds can inhibit, for instance, carcinogenesis.¹¹

In contention was whether relatively modest amounts of resveratrol in combination yield significant health benefits for humans despite the amounts being ineffective on their own. A recent clinical study provides an instance of proof that is in line with other studies published since 2008.¹² In a randomized, placebo-controlled crossover clinical trial with 29 overweight and obese subjects, trans-resveratrol and hesperetin taken together were effective in altering a marker related to insulin resistance and improving metabolic and vascular health. (Hesperetin is a flavanone, a particular type of flavonoid.) Treatment was one capsule daily for eight weeks and a washout period of six weeks with 90 mg resveratrol and 120 mg hesperetin and placebo. Neither resveratrol nor hesperetin was efficacious by itself, whereas together they significantly decreased fasting and postprandial plasma glucose, increased the oral glucose insulin sensitivity index and improved arterial dilatation.¹³ In other words, combining these nutrients is pivotal in promoting their benefits.

Underappreciated Nutrient Combinations

Magnesium and Potassium
Not usually considered as an aspect of the French diet that separates it from American nutrient intake is the ingestion of minerals important for blood pressure and blood sugar regulation, such as magnesium and potassium. Americans notoriously do not consume green vegetables, primary dietary sources of both minerals. This is a shame because dietary potassium regulates vascular calcification and arterial stiffness, which is to say, two major factors determining cardiovascular health.¹⁴ There is much noise made about lowering sodium intake, but it is the ratio of sodium to potassium in the diet that determines blood pressure, not the simple amount of sodium.¹⁵

The combination of magnesium and potassium arguably is particularly efficacious for a number of reasons. For one, the development of insulin resistance impedes the proper uptake of potassium.¹⁶ Magnesium deficiency inclines subjects toward insulin resistance. There is considerable evidence that inadequate magnesium predisposes individuals to potassium deficiency and makes this deficiency difficult to treat with potassium alone. Magnesium, which is a natural calcium channel blocker, controls the flow of sodium and potassium across the cell membrane and therefore potentiates cellular replenishment of potassium.¹⁷ Significantly, Mildred Seelig, the great magnesium researcher, pioneered an approach in which the ingestion of a potassium and magnesium salt with fixed ratios of the two minerals and a certain minimum per day proved to be adequate to reverse and control moderate hypertension.^18,19

Improvement in bone health is another benefit that long-time readers of these TotalHealth articles may recall is associated with an adequate consumption of magnesium and potassium. In older individuals an increased intake of animal protein (but not plant) in conjunction with a significant intake of green vegetables, i.e., sources of magnesium and potassium, is associated with better bone health.

How About Food/Nutrient Combinations?
Some quite simple food combinations easily improve nutrient uptake. For instance, today there is much hype about the development of "golden rice" via genetic modification as a means of overcoming vitamin A deficiencies in poorer regions of the world. Not mentioned in this hype is that these areas are so poor that they have no fats or oils available with which to cook food and that the mere cooking of vegetables in oil largely resolves the vitamin A issue. In fact, the same approach is true for improved nutrient bioavailability in developed countries. In one trial, merely adding soybean oil in salad dressing improved carotenoid and fat-soluble vitamin bioavailability in salad vegetables.²⁰ Similarly, co-consuming cooked whole eggs is an effective way to enhance carotenoid absorption from other carotenoid-rich foods, such as a raw mixed-vegetable salad.²¹

A word of caution on oils: Recent research strongly suggests that olive oil and coconut oil are preferable to soybean oil. "Rich in unsaturated fats, especially linoleic acid, soybean oil is assumed to be healthy, and yet it induces obesity, diabetes, insulin resistance, and fatty liver in mice."^22,23 Moreover, in general the US diet exhibits an excessive and unhealthful ratio of omega-6 to omega-3 fatty acids.²⁴ Butter, by the way, after years of condemnation, appears to be neutral as a fat for most purposes. A recent systematic review and meta-analysis suggests relatively small or neutral overall associations of butter with mortality, CVD, and diabetes.^25,26 Any worries would appear to be easily overcome by simply eating more leafy green vegetables to increase daily magnesium intake!²⁷

HCA and a Largely Unknown Positive Combination
One of the more interesting compounds available in the American health food market, albeit of highly variable and often suspect quality, is (–)-hydroxycitric acid (HCA, always sold as a salt) (extracted from Garcinia cambogia, G. atroviridis, G. indica and other G. species).²⁸ Medically, HCA has been shown to exhibit potential additive effects of with, for instance, atorvastatin treated hyperlipidemic patients.²⁹ Almost never pointed out by the marketers of HCA is that the compound's mechanism of action is inhibited by diets that are very high in fats and/or alcohol just as the mechanism is not operational under fasting conditions. Just as an inadequate level of intake or the intake of poor quality salts leads to a failure to achieve benefits, so does intake under improper conditions.^30,31,32 One approach to preserving benefits even in the face of high fat and/or high alcohol intake is to ingest HCA along with the phytonutrient known as caffeic acid. Caffeic acid is found in quite small amounts in some, but not all green coffee bean extracts; it should not be confused with chlorgenic or caffeoquinic acids.^33,34 Effectively using HCA with a coffee extract to reduce the reverse effects of fat and alcohol is patented.³⁵

Two Bad Combinations Typical of the American Diet
Just as there are "good" nutrient combinations, such as examined above, there are "bad" nutrient combinations. Sugars and refined carbohydrates increase the absorption of fats from meals while reducing the oxidation of fats for energy. The evidence against coupling refined carbohydrates and fats is clear and unambiguous. Similarly, there is an unfortunate interplay between the consumption of sugars/ refined carbohydrates and table salt leading to impaired blood pressure regulation.³⁶

• Low glycemic index diets improve glycemic (blood sugar) response and variability as well as promote the metabolism of fat for energy; they may promote long-term health.^37,38
• Taken in a milkshake, fructose (30 g) increased postprandial lipemia by 37 percent compared with control; glucose (17.5 g) increased postprandial lipemia by 59 percent.³⁹ (Lipemia is the presence in the blood of an abnormally high concentration of emulsified fat, meaning primarily triglycerides, not cholesterol.)
• In Syndrome X/insulin resistant subjects (BMI of 30), glucose consumption (50 g) led to a 15.9 percent greater glycemic response and a 30.9 percent greater insulin response than did fructose (50 g). This is true in part because fructose is processed in the liver and then released later as glucose and/or converted into fat.
• On an energy balanced diet in these same subjects, fructose compared with glucose increased carbohydrate oxidation 31 percent, but decreased fat oxidation by 39 percent.⁴⁰
• Low-fat/high-carbohydrate diets in Syndrome X individuals reduce levels of HDL cholesterol and increase triacylglycerol concentrations.⁴¹
• Sucrose is glucose + fructose; lactose is glucose + galactose; grape sugar (dextrose) is glucose.

Conclusion
The benefits of foods and the nutrients that they supply, as also is true of supplements, is highly dependent on food and nutrient combinations. Many nutrients that clinically are inactive on their own, including even at large levels of intake, are beneficial when consumed with appropriate partners. Resveratrol, so often associated with red wine and the French paradox, is but one example of this phenomenon. Many other everyday combinations, such as magnesium and potassium, similarly exhibit positive dose relations. Contrarily, certain combinations are not good if habitually practiced. The combination of sugars/refined carbohydrates with fats, such as the far too widely consumed omega-6 fatty acids found in, for instance, soybean oil, is one example of a pairing that, if consumed regularly, tends to impair aspects of metabolism, including the oxidation of fats for energy. Likewise, consumption patterns that couple sugars with salt can lead to health consequences, such as blood pressure dysregulation, not typical of either nutrient consumed by itself.

References:

1. Beyond Synergy-the Entourage Effect in Nutrition and Herbalism TotalHealth Sep 2015
2. http://www.geoba.se/population.php?pc=world&page=1&type=15&st=rank&asde=&year=2015
3. http://www.worldlifeexpectancy.com/cause-of-death/coronary-heart-disease/by-country/
4. http://www.fathead-movie.com/index.php/2013/01/14/usda-report-we-eat-less-fat-but-fat-is-killing-us
5. http://www.foodnavigator-usa.com/Science/Americans-are-eating-10g-less-fat-per-day-than-they-did-in-the-late-1970s
6. Bland J. Resveratrol opportunism: what is the science behind the claims? Integr Med Clin J. 2009;7(6):50–1 and the response by Evans JL, Clouatre DL. Reservations about the Resveratrol Article. Integr Med Clin J. 2009;8(3):16–8.
7. Soleas GJ, Diamandis EP, Goldberg DM. Wine as a biological fluid: history, production, and role in disease prevention. J Clin Lab Anal. 1997;11(5):287–313.
8. Chan MM, Mattiacci JA, Hwang HS, Shah A, Fong D. Synergy between ethanol and grape polyphenols, quercetin, and resveratrol, in the inhibition of the inducible nitric oxide synthase pathway. Biochem Pharmacol. 2000;60(10):1539–548.
9. Zou JG, Wang ZR, Huang YZ, Cao KJ, Wu JM. Effect of red wine and wine polyphenol resveratrol on endothelial function in hypercholesterolemic rabbits. Int J Mol Med. 2003;11(3):317–20.
10. Pearson KJ, Baur JA, Lewis KN, et al. Resveratrol delays age-related deterioration and mimics transcriptional aspects of dietary restriction without extending life span. Cell Metab.2008;8(2):157–68.
11. Khor TO, Yu S, Kong AN. Dietary cancer chemopreventive agents—targeting inflammation and Nrf2 signaling pathway. Planta Med. 2008;74(13):1540–47.
12. Biesinger S, Michaels HA, Quadros AS, Qian Y, Rabovsky AB, Badger RS, Jalili T. A combination of isolated phytochemicals and botanical extracts lowers diastolic blood pressure in a randomized controlled trial of hypertensive subjects. Eur J Clin Nutr. 2016 Jan;70(1):10-6.
13. Xue M, Weickert MO, Qureshi S, Kandala NB, Anwar A, Waldron M, Shafie A, Messenger D, Fowler M, Jenkins G, Rabbani N, Thornalley PJ. Improved Glycemic Control and Vascular Function in Overweight and Obese Subjects by Glyoxalase 1 Inducer Formulation. Diabetes. 2016 Aug;65(8):2282-94.
14. Sun Y, Byon CH, Yang Y, Bradley WE, Dell'Italia LJ, Sanders PW, Agarwal A, Wu H, Chen Y. Dietary potassium regulates vascular calcification and arterial stiffness. JCI Insight. 2017 Oct 5;2(19). pii: 94920.
15. Linder, Maria C, ed., "Nutritional Biochemistry and Metabolism" (1991) 197–202.
16. DeFronzo RA, Felig P, Ferrannini E, Wahren J. Effect of graded doses of insulin on splanchnic and peripheral potassium metabolism in man. Am J Physiol. 1980 May;238(5):E421–7.
17. Altura BM, Altura BT. New perspectives on the role of magnesium in the pathophysiology of the cardiovascular system. II. Experimental aspects. Magnesium. 1985;4(5-6):245–71.
18. Karppanen H. An antihypertensive salt: crucial role of Mildred Seelig in its development. J Am Coll Nutr. 1994 Oct;13(5):493–5.
19. Sarkkinen ES, Kastarinen MJ, Niskanen TH, Karjalainen PH, Venäläinen TM, Udani JK, Niskanen LK. Feasibility and antihypertensive effect of replacing regular salt with mineral salt -rich in magnesium and potassium- in subjects with mildly elevated blood pressure. Nutr J. 2011 Sep 2;10:88.
20. White WS, Zhou Y, Crane A, Dixon P, Quadt F, Flendrig LM. Modeling the dose effects of soybean oil in salad dressing on carotenoid and fat-soluble vitamin bioavailability in salad vegetables. Am J Clin Nutr. 2017 Oct;106(4):1041–51.
21. Kim JE, Gordon SL, Ferruzzi MG, Campbell WW. Effects of egg consumption on carotenoid absorption from co-consumed, raw vegetables. Am J Clin Nutr. 2015 Jul;102(1):75–83.
22. Deol P, Fahrmann J, Yang J, Evans JR, Rizo A, Grapov D, Salemi M, Wanichthanarak K, Fiehn O, Phinney B, Hammock BD, Sladek FM. Omega-6 and omega-3 oxylipins are implicated in soybean oil-induced obesity in mice. Sci Rep. 2017 Oct 2;7(1):12488.
23. Deol P, Evans JR, Dhahbi J, Chellappa K, Han DS, Spindler S, Sladek FM. Soybean Oil Is More Obesogenic and Diabetogenic than Coconut Oil and Fructose in Mouse: Potential Role for the Liver. PLoS One. 2015 Jul 22;10(7):e0132672.
24. Lazic M, Inzaugarat ME, Povero D, Zhao IC, Chen M, Nalbandian M, Miller YI, Cherñavsky AC, Feldstein AE, Sears DD. Reduced dietary omega-6 to omega-3 fatty acid ratio and 12/15-lipoxygenase deficiency are protective against chronic high fat diet-induced steatohepatitis. PLoS One. 2014 Sep 24;9(9):e107658.
25. Brassard D, Tessier-Grenier M, Allaire J, Rajendiran E, She Y, Ramprasath V, Gigleux I, Talbot D, Levy E, Tremblay A, Jones PJ, Couture P, L marche B. Comparison of the impact of SFAs from cheese and butter on cardiometabolic risk factors: a randomized controlled trial. Am J Clin Nutr. 2017 Apr;105(4):800–9.
26. Pimpin L, Wu JH, Haskelberg H, Del Gobbo L, Mozaffarian D. Is Butter Back? A Systematic Review and Meta-Analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality. PLoS One. 2016 Jun 29;11(6):e0158118.
27. Kummerow FA, Wasowicz E, Smith T, Yoss NL, Thiel J. Plasma lipid physical properties in swine fed margarine or butter in relation to dietary magnesium intake. J Am Coll Nutr. 1993 Apr;12(2):125–32.
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Taking Supplementation Seriously Part I:

There is an ongoing debate on whether dietary supplements deserve to be part of a health-promoting strategy. Several medical organizations do not advise routine supplementation for people, without underlying deficiencies, citing safety concerns or lack of clear evidence of benefits, and suggest that an adequate diet should be sufficient in obtaining proper nutrition. Prophylactic use of supplemental vitamins or minerals, like iron, has sparked controversy. On the other hand, there is a wealth of published, peer-reviewed scientific data that present strong correlations between adequate nutrient intake and lowered disease risk/incidence, as well as studies in which nutrient interventions demonstrated significant health benefits. Hyperbolic media reports that “resveratrol may make you live longer” or “multivitamins may cause prostate cancer” further complicate the dialog.

THE FOOD—MOOD CONNECTION PLAYS A MASSIVE ROLE IN HOW WE FEEL.

The nutritionally depleted wasteland we call the Standard American Diet is causing widespread nutritional deficiencies, along with an epidemic of anxiety and depression. The solution is simple, and it's NOT more Prozac. Instead, simply eating a diet high in fish, meat, fruits and vegetables, and low in processed foods and added sugar, can help you feel dramatically better. To make this easier, low cost nutritional and herbal support can also give people their lives back, without the toxicity of psychiatric medications.

Here are the key ones, which I take myself each day to turbocharge energy and optimize health, while also leaving me being a calm, happy soul:

1. B vitamins and folate. These are critical for proper brain function. Research has shown that supplementing with vitamin B1 improved mood, likely by increasing a brain neurotransmitter called acetylcholine. It also decreases anxiety. A side benefit? Improving memory at the same time. Vitamin B1 deficiency was also shown to worsen learning disorders in young children, and increase aggressive behavior to the point where some had to enter a mental hospital. This problem resolved with vitamin B1 supplementation. Vitamin B2 has been associated with decreasing risk of postpartum depression, while also decreasing migraine frequency by an astounding 69 percent! B12 and folic acid have also been shown to be helpful for depression. Ignore the RDAs, which I call Ridiculous Dietary Allowances, and instead take a 50 mg B complex each day. Make sure that some of folic acid is in a form called 5MTHF.
2. Magnesium is critical in hundreds of reactions in the body, and deficiency is present in the majority of Americans. Low magnesium will put you on a hair trigger for anxiety, as well as for pain. Take 200 mg a day.
3. NAC, which our bodies use to make the critical antioxidant called glutathione, has been shown to be helpful in a wide array of psychological problems. For day-to-day supplementation, I recommend 250 mg.
4. Vitamin D* deficiency is associated with many autoimmune problems as well as with depression. As this is the "sunshine vitamin," the insane advice to avoid sunshine has triggered an epidemic of vitamin D deficiency. Take 1000 units daily. To make this simple and low-cost, all of the above can be found for about $.60 a day in a single drink called the Energy Revitalization System by Enzymatic Therapy. Another key cause of depression and anxiety is deficiency of omega-3 fish oils. Unfortunately, it takes seven large capsules a day of most forms to get the proper therapeutic effect. A simpler low-cost solution? A special form of pure omega-3's that have been vectorized (which is another way of saying that they remain bioidentical) can be found in a product called Vectomega by Terry Naturally. One a day replaces seven fish oil pills.
5. Got depression? Repeated studies have shown that a special highly absorbed form of curcumin called CuraMed (also by Terry Naturally) 750 mg 2x day was more effective than antidepressants in head on studies. In addition, instead of the side effects of the medications, curcumin is associated with side benefits, including less pain, optimizing immunity to decrease cancer risk, and likely lower risk of Alzheimer's.
6. For anxiety, it is not necessary to be addicted to Xanax. A special herbal called AnxioCalm, two twice a day, was shown to be as effective at restoring calm as the Valium family medications after six weeks of use. With no addiction or side effects.

This simple regimen can leave you feeling fantastic, at lowcost. Give it six weeks to see the full effect. It can also safely be combined with mood medications. It's easy to feel calm and happy—naturally!

*Editor's Note: We strongly recommend you visit GrassrootsHealth.net to learn more about Vitamin D, its importance, how to determine what dosage is right for you, and most of all, why it is so darn important you have sufficient levels of Vitamin D. Did you know serum levels greater than 40 ng/ml are associated with > 65% lower risk of cancer?¹ Or that serum levels of 40-60 ng/ml may provide a significant reduction in breast cancer risk? Or lower risk for type 2 diabetes, colorectal cancer and much, much more.

GrassrootsHealth is a nonprofit public health research organization dedicated to moving public health messages regarding vitamin D from research into practice. It has a panel of 48 senior vitamin D researchers from around the world contributing to its operations. GrassrootsHealth is currently running the D*action field trial to solve the vitamin D deficiency epidemic worldwide. Under the D*action umbrella, there are also targeted programs for breast cancer prevention and a ‘Protect Our Children NOW!’ program to stop vitamin D deficiency where it starts, in utero.

End Notes:

1. Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml Are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study