Scientifically Based Recommendations 

for Nutritional Supplements.

The following are some recommendations as to some of the most beneficial supplements that may be worth consuming to improve health, prolong life, and increase performance, based on current scientific research. However, while nutritional supplementation may be helpful, there is no substitute for a healthy diet. There are also recommendations for avoiding certain supplements due to safety or efficacy concerns. This section is continually being worked on and revised.

Please note: You should always check with your physician before consuming any supplements, as some of them may be contraindicated for health conditions you may have or may interact unfavorably with medications you are taking.

1. Vitamin C (Ascorbic acid). The RDA (recommended daily allowance) for vitamin C for adults is 75 mg for women and 90 mg for men, but surveys indicate that most Americans do not consume this amount in their daily diet. In fact, studies indicate that up to 30% of Americans have depleted levels of vitamin C in their bodies.(1) Humans are one of only a few animals that are incapable of synthesizing vitamin C inside our bodies and we therefore need to consume it on a daily basis. But how much is needed? Is the RDA sufficient?
   
   The RDA for vitamin C is the amount needed to prevent scurvy, with a slight additional cushion. It is really a minimal amount. The RDA was set in 1989 and it does not take into account all of the research on vitamin C since 1989 or the potential health benefits of vitamin C, such as its anti-oxidant properties. It should be pointed out that considerable research indicates that free radical reactions cause much tissue damage and are involved in many diseases, including cancer and heart disease. Therefore, it clearly appears to be beneficial to consume substantially more vitamin C than the RDA. In my opinion, a supplemental dosage of 500 to 1000 mg per day appears to be both reasonable and safe for adults.
   
   Research has shown that this important anti-oxidant, when supplemented, strengthens the immune system, and reduces both the severity and the length of symptoms from the common cold. (2) Vitamin C may help to prevent heart disease (3), it decreases the risk of gall bladder problems, esp. in drinkers(3.5), it seems to slow the progression of osteoarthritis (4,5), helps to prevent the growth of the ulcer-causing bacteria-H. pylori in the stomach(6), helps to prevent cancer (7), and prolongs life when taken at a dosage of 500 mg/day, more than 8 times the RDA (8). Another study found that high blood levels of Vitamin C reduces the risk of death from all causes in both men and women.(24) It accomplishes these tasks through various mechanisms, of which the most important is by blocking free-radical reactions.
   
   Vitamin C enhances immune function and is beneficial in the treatment of infectious conditions. Immune function is improved through various mechanisms, including the improvement of white blood cell response. Vitamin C has been compared to interferon in its anti-viral effects.(16,17,18) Vitamin C supplementation has been shown in a number of double-blind, placebo controlled trials to reduce the severity, frequency, and duration of the common cold.(2,19,20) It also may be helpful in fighting off other infections as well.(21) The recommended dosage for fighting a cold is higher than the normal daily dosage--from one to ten grams per day.
   
   Vitamin C has also been shown to lower LDL cholesterol levels (the 'bad' kind of cholesterol) in women.(9) After supplementing with 1000 mg per day of vitamin C, they had 16% lower levels of LDL cholesterol. LDL cholesterol is associated with an elevated risk of heart disease. Other research has shown vitamin C to lower total cholesterol and triglyceride levels, to inhibit platelet aggregation, to protect the blood vessel walls from damage from oxidized LDL, and to raise the levels of the good kind of cholesterol--HDL.(10,11,22) A recent study indicates that taking 500 mg/day of vitamin C lowers blood pressure by up to 9 percent.(23) All of these factors mean that vitamin C may help to prevent heart disease.
   
   Vitamin C is a principal component of collagen, which is a protein that makes up connective tissue, cartilage, and tendons in the body. Therefore, vitamin C may help in the repair of injury, wounds, bruising, and will help to promote healthy gums, blood vessel walls, and tendons and ligaments.(12) It may help to rebuild some of the connective tissue breakdown associated with osteoarthritis (OA). Since reactive oxygen (free radical) reactions have been implicated in the joint and cartilage destruction associated with OA, vitamin C's antioxidant properties may help to prevent this. Individuals from the Framingham Study who had the lowest one third of vitamin C intake had 3 times the risk of knee OA progression and a higher risk of knee pain than those individuals with a higher vitamin C intake.(13)
   
   High vitamin C intake appears to reduce the risk of many forms of cancer, including cancers of the breast, cervix, colon, esophagus, lung, stomach and pancreas.(14,15)  Khaw et al found that higher blood levels of vitamin C have an inverse ratio with cancer-related mortality.(24) It is believed that one way vitamin C can prevent cancer is by blocking reactive oxygen intermediates, which have been shown to cause cancer.(25)
   
   Good dietary sources of vitamin C are broccoli, cauliflower, brussel sprouts, strawberries, cantaloupe, peppers, potatoes, honeydew melons, and citrus fruits. However, it should be kept in mind, that exposure to air will destroy vitamin C. Fresh fruits and vegetable should be eaten as soon after cutting and peeling as possible. Cutting and slicing fruits and vegetables and then leaving them in the refrigerator or exposed, such as at a salad bar, results in a significant loss of the vitamin C content.
   
   Is there any risk associated with the intake of megadoses of vitamin C?  There appears to be no increased risk of kidney stones, despite the fact that most kidney stones are composed of calcium oxalate and oxalate is a breakdown product of vitamin C metabolism.(16) However, those patients with a history of kidney stones should probably restrict vitamin C intake to approximately 100 mg/day, in order to err on the safe side. There also is no increased risk of gallstones or gallbladder problems.(17)
   
   While considerable research indicates a chemo-protective effect of vitamin C intake, patients undergoing chemotherapy need to exercise caution how and when to supplement with vitamin C, as it could decrease the effectiveness of their chemotherapy. This is because some chemotherapy works by killing cancer cells with free radicals and vitamin C can block free radicals.
   
   References:
   1. Johnston CS; Thompson LL. Vitamin C status of an outpatient population. Journal of the American College of Nutrition. 1998;17:366-370.
   2. Hemila H, Herman ZS. Vitamin C and the common cold: A retrospective analysis of Chalmer's review. J Am Coll Nutr. 1995; 14:116-23.
   3. Vita JA, Keaney JF Jr, Raby KE, et al. Low plasma ascorbic acid independently predicts the presence of an unstable coronary syndrome. Journal of the American College of Cardiology.1998; 31:980-986.
   3.5. Simon JA; Grady D; Snabes MC; Fong J; Hunninghake DB. Ascorbic acid supplement use and the prevalence of gallbladder disease. J Clin Epidemiol. 1998; 51(3):257-654.
   4. McAlindon TE, Jacques P, Zhang Y. Arthritis Rheum, 1996; 39(4):648-56.
   5. McAlindon T, Felson. Nutrition: risk factors for osteoarthritis. Annals of the Rheumatic Diseases. 1997; 56:397-402.
   6. Zhang HM, Wakisaka N, Maeda O, Yamamoto T. Vitamin C inhibits the growth of a bacterial risk factor for gastric carcinoma: Helicobacter pylori. Cancer. 1997; 80(10):1897-1903.
   7. Block G. Vitamin C and cancer prevention: the epidemiologic evidence. American Journal of Clinical Nutrition, 1991; 53, 270S-282S.
   8. Enstrom JE, Kanim LE, Klein MA. Epidemiology. 1992; (3):194-202.
   9. Gatto LM, Hallen GK, Grown AJ. Ascorbic acid induces a favorable lipoprotein profile in women. Journal of the America College of Nutrition. 1996; 15:154-158.
   10. Simon JA. Vitamin C and cardiovascular disease: A review. J Am Coll Nutr. 1992; 11:107-25.
   11. Hallfrisch J, et al. High plasma vitamin C associated with high plasma HDL and HDL2 cholesterol. Am J Clin Nutr. 1994; 60:100-105.
   12. McAlindon TE, Jacques P, Zhang Y, Hanan MT, et al. Do anti-oxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996; 39:648-656.
   13. Levine M. New concepts in the biology and biochemistry of ascorbic acid. New Engl J Med. 1986; 314:892-902.
   14. Block G. Vitamin C and cancer prevention: The epidemiologic evidence. Am J Clin Nutr. 1991; 53: 270S-282S.
   15. Gerster H. No contribution of ascorbic acid to renal calcium oxalate stones. Ann Nutr Metab. 1997; 41(5):269-82.
   16. Beisel W, Edelman R, Nauss K, and Suskind R. Single nutrient effects of immunologic functions. JAMA. 1981; 245:53-8.
   17. Bendich A. Vitamin C and immune responses. Food Technol. 1987; 41:112-4.
   18. Scott J. On the biochemical similarities of ascorbic acid and interferon. J Theor Bio. 1982; 98:235-8.
   19. Hemila H. Vitamin C and the common cold. Br J Nutr. 1992; 67:3-16.
   20. Hemila H. Does vitamin C alleviate the symptoms of the common cold? A review of current evidence. Scan J Infect Dis. 1994; 26: 1-4.
   21. Hunt C, et al. The clinical effects of vitamin C supplementation in elderly hospitalized patients with acute respiratory infections. Int. J Vit Nutr Res. 1994; 64: 212-219.
   22. Slow RC, Richards JP, Pedley KC, et al. Vitamin C protects human vascular smooth muscle cells against apoptosis induced by moderately oxidized LDL containing high levels of lipid hydroperoxides. Arterioscler Thromb Vasc Biol. 1999; 19(10): 2387-94.
   23. Duffy SJ, Gokce N, Holbrook M, et al. Treatment of hypertension with ascorbic acid. Lancet. 1999; 354 (9195):2048-9.
   24. Kwaw KT, Bingham S, Welch A, et al. Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. Lancet. 2001; 357: 657-63.
   25. Lee KW, Lee HJ, Surh YJ, Lee CY. Vitamin C and cancer chemoprevention: reappraisal. Am J Clin Nutr 2003; 78:1074-8.
   
   
2. Vitamin E  (alpha, gamma, and six other forms of tocopherol). Alpha tocopherol is often considered to be the most biologically active form of vitamin E, however, recent research indicates that the gamma form also plays a very beneficial role in the body. Therefore, I recommend that if vitamin E supplements are taken, it is preferred to take a form of mixed tocopherols, such as Metagenics' E-Complex 1:1, which contains equal amounts of alpha and gamma tocopherol. 
   
   Vitamin E is an important antioxidant that works synergistically with other antioxidants, such as vitamin C and selenium, to block free-radical formation. Vitamin E is a fat soluble vitamin that protects fats from free radical damage, such as those that make up the cell membranes. Vitamin E helps to protect the immune system from free radicals that are released both by invading bacteria and viruses and also by the immune system in an effort to kill the invaders.(1)
   
   Sources of vitamin E in the diet are polyunsaturated vegetable oils, nuts, seeds, and whole grains. However, it is very difficult to attain adequate levels of vitamin E from the diet, as you only get relatively low levels in food with the exception of wheat germ oil. In addition, many intestinal disorders, like Crohn's Disease, result in malabsorption of vitamin E.  Close to 30% of Americans are deficient in vitamin E, with African Americans having the lowest levels.(15) And African Americans have higher risk of heart disease. Therefore, it may be prudent to take some supplemental E. The best type of vitamin E supplements are the natural rather than the synthetic form. Natural vitamin E has twice the bio-availability of synthetic vitamin E.(2) A daily dosage of 400 i.u. is reasonable when taken along with additional vitamin C, such as in a multivitamin. Clinical trials have tested dosages of 3,200 i.u. for up to 2 years without any unfavorable side effects.(3)
   
   Vitamin E may help to prevent against heart disease and stroke, however, some of the research has been mixed, with some studies showing no benefit. Vitamin E appears to protects LDL (bad) cholesterol from free radical damage (oxidation), which is a necessary step in the LDL adhering to the artery walls to form a plaque.(4) Vitamin E reduces the activity of an enzyme--5 lipoxygenase--which is involved in arterial plaque formation. Therefore, vitamin E may help to prevent plaquing through a biological mechanism in addition to its antioxidant properties.(5) Several large studies have shown a significantly lowered risk of dying from a stroke or heart attack if low dose supplements of vitamin E (30-100 iu) are taken on a daily basis.(6,7,8) The Cambridge Heart Antioxidant Study found that either 400 or 800 IU/day of vitamin E was effective in reducing the risk of a heart attack in patients with proven coronary heart disease.(9,10) On the other hand, a more recent study (the Hope Trial) found slightly increased risk of heart failure, though no increased risk of cardiovascular effects, in subjects who took 400 iu/day of vitamin E.(17)  However, these results may only apply to seniors (average age of 70) with a history of heart attack, diabetes or stroke, and contradict most other studies.  The Center for Responsible Nutrition recently concluded that Vitamin E supplements appear to be safe in dosages up to 1000 mg/day for normal healthy adults (www.crnusa.orgvitaminEissafe.html). 
   
   In addition to its antioxidant properties, vitamin E helps boost the immune system, esp. in the elderly. One study demonstrates that vitamin E increased T-cell function, and the effect was dose related. The most dramatic effects were seen in those patients who were supplemented with 200 and 800 IU dosages per day.(11) Some research also indicates that vitamin E may help to prevent certain forms of cancer, including prostate cancer(12), colon cancer in women(18), and bladder cancer(19). 
   
   Vitamin E supplements appear to help counteract the peripheral nerve damage associated with Type 2 diabetes.(13) At least one small study has demonstrated that high dose vitamin E can help in the treatment of Type 1 diabetes. It was found to help normalize blood flow to the retina of the eye, thus preventing diabetic retinopathy. Vitamin E supplements also help to normalize kidney function in diabetic patients.(14)

   Research has also shown that elderly with lower levels of vitamin E are more likely to have memory problems.(15) Vitamin E may help to prevent the oxidative (free radical) damage of brain cells that tends to occur over time and may play a role in preventing Alzheimer's disease.

   References:
   1. Pizzorno J. Total Wellness. Rocklin, CA: Prima Publishing, 1998, p.62.
   2. Burton GW, et al. Human plasma and tissue alpha-tocopherol concentrations in response to supplementation with deuterated natural and synthetic vitamin E. Am J Clin Nutr. 1998; 67:669-684.
   3. Murray MT. Encyclopedia of Nutritional Supplements. CA: Prima Publishing, 1996, p.53.
   4. Princen HMG, et al. Supplementation with low doses of Vitamin E protects LDL from lipid peroxidation in men and women. Arterioscler, Thromb, and Vasc Biol. 1995; 15: 325-333.
   5. Devaraj S, Jialal I. Alpha-tocopherol decreases interleukin-1 beta release from activated human monocytes by inhibition of 5-lipoxygenase. Arterioscler, Thromb, and Vasc Biol. 1999; 19(4):1125-33.
   6. Belcher JD, Balla J, Balla G, et al. Vitamin E, LDL, and endothelium. Brief oral vitamin supplementation prevents oxidized LDL-mediated vascular injury in vitro. Arterioscler Thromb. 1993; 13: 1779-1789.
   7. Leppälä JM, Virtamo J, Fogelholm R, et al. Vitamin E and beta carotene supplementation in high risk for stroke: A subgroup analysis of the alpha-tocopherol, beta carotene cancer prevention study. Archives of Neurology. 2000; 57:1503-1509.
   8. Stampfer MJ, Hennekens CH, Manson JE, et al. Vitamin E consumption and the risk of coronary heart disease in women. New Engl J of Med. 1993; 328:1444-1449.
   9. Stephans NG, Parsons A, Schofield PM, et al. Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study. Lancet. 1996; 347(9004): 1849-54.
   10. Davey PJ, et al. Cost-effectiveness of vitamin E therapy is the treatment of patients with angiographically proven narrowing (CHAOS trial). Am J Cardiol. 1998; 82:414-7.
   11. Meydani SN, Meydani M, Blumberg JB, et al. Vitamin E supplementation and in vivo immune response in healthy elderly subjects. A randomized controlled trial. JAMA. 1997; 277: 1380-6.
   12. Rimm EB, Stampfer MJ, Ascherio A, et al. Vitamin E consumption and the risk of coronary heart disease in men. New Engl J of Med. 1993; 328: 1450-1456.
   13. Tutuncu NB, Bayraktar M, Varli K. Reversal of defective nerve conduction with vitamin E supplementation in type 2 diabetes: a preliminary study. Diabetes Care. 1998; 21(11):1915-1918.
   14. Diabetes Care. 1999; 22:1245-1251.
   15. Perkins AJ, Hendrie HC, Callahan CM, et al. Association of antioxidants with memory in a multiethnic elderly sample using the Third National Health and Nutrition Examination Survey. .American Journal of Epidemiology. 1999; 150: 37-44.
   16. American Journal of Epidemiology. 1999; 150:290-300.
   17. Lonn E, Bosch J, Yusuf S, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial.  JAMA. 2005; 293 (11): 1338-47.
   18. Bostick RM, Potter JD, McKenzie DR, et al. Reduced risk of colon cancer with high intakes of vitamin E: The Iowa Women's Health Study. Cancer Res 1993;15: 4230-17.
   19. Jacobs EJ, Henion AK, Briggs PJ, et al. Vitamin C and vitamin E supplement use and bladder cancer mortality in a large cohort of US men and women. American Journal of Epidemiology. 2002;156: 1002-10
   

3. Selenium.  This is a mineral that is toxic in large amounts, but trace amounts are essential for the function of all cells. Selenium functions as a cofactor for the reduction of antioxidant enzymes such as glutathione peroxidase.  It also plays a role in the functioning of the thyroid gland in that it is necessary for the conversion of the thyroid hormone thryoxine (T4) into its more active counterpart, triiodothyronine. 
   
    This essential trace mineral is another important anti-oxidant that helps to protect against cancer and other diseases. Numerous studies since the 1960s have investigated the potential for selenium to prevent cancer, including the anti-tumorigenic effects of selenium supplementation in animals.(1,2)  Research also indicates that selenium may help to prevent the development of lung, colorectal and prostate cancer.(3,4,5,6,7)  The Clark study that showed surprising decreased cancer rates with vitamin E supplementation, also utilized 200 mcg. supplements of selenium per day, which is the amount we would recommend.
   
   Another study found that those individuals who have hepatitis B or C, who also have low selenium levels, are more likely to end up with liver cancer.(8) Still another study found that selenium supplementation improved the effectiveness of treatment using chemotherapeutic drugs, such as Taxol and Adriamycin.(9) The SU.VI.MAX study found that low-dose supplementation of several anti-oxidants (120 mg of ascorbic acid, 30 mg of vitamin E, 6 mg of beta carotene, 100 µg of selenium, and 20 mg of zinc) resulted in a 31% reduction in the incidence of cancer and a 37% reduction in all cause mortality in males, but did not get a significant result for females.(15)
   
   Research has shown that selenium deficiency results in depressed immune system function(8). Supplementation with selenium enhances the immune system, even in those who are not deficient.(10)
   
   Low levels of selenium appears to be linked with a higher risk of HIV/AIDS infection. While most of sub-saharan Africa has very low levels of selenium, Senegal, which has higher levels of selenium, also has lower levels of HIV/AIDS infection. Low levels of selenium in AIDS patients have been directly correlated with decreased immune cell count, increased disease progression, and risk of mortality.(11,12,13) Supplementation with selenium may help to mitigate the symptoms of AIDS and reduce the risk of death.
   
   Selenium appears to improve sperm motility and may reduce the risk of miscarriage.(14)
   
   References:
   1.  Shamberger RJ, Frost DV. Possible protective effect of selenium against human cancer. Can Med Assoc J. 1969;100:682.
   2.  Combs GF. Selenium and cancer. In: Wang Z, ed. Biochemistry and Molecular Biology of Selenium. Beijing, China: Chinese Academy of Science. 1995.
   3.  Clark LC, Combs GF, Turnbull BW, Slate EH, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. JAMA. 1996; 276(24):1957-1963.
   4.  Knekt P, Marniemi J, Teppo L, Heliovaara M, Aromaa A. Is low selenium status a risk factor for lung cancer? Am J of Epidemiology. 1998; 148: 975-982.
   5.  Giovannucci E. Selenium and risk of prostate cancer. Lancet. 1998; 352(9130): 755-756.
   6.  Yoshizawa K, Willett WC, Morris SJ, et al. Study of prediagnostic selenium level in toenails and the risk of advanced prostate cancer. J Natl Cancer Inst. 1998; 90(16): 1219-1224.
   7.  Clark LC, Dalkin B, Krongrad A, Combs GF Jr, et al. Decreased incidence of prostate cancer with selenium supplementation: results of a double-blind cancer prevention trial. Br J Urol. 1998; 81(5):730-4.
   8.  American Journal of Epidemiology. 1999;150:367-374.
   9.  Vadgama JV, Wu Y, Shen D, et al.  Effect of Selenium in Combination with Adriamycin or Taxol on Several Different Cancer Cells. Anticancer Research 2000; 20: 1391-1414.
   10.  Kiremidjian-Schumacher L, Stotsky G. Selenium and immune responses. Environmental Res. 1987; 42:277-303.
   11.  Baum MK, Shor-Posner G, Lai S, et al. High risk of HIV-related mortality is associated with selenium deficiency. J Acquir Immune Efic Hum Retrovirol. 1997; 15 (5): 370-4.
   12. Campa A, Shor-Posner G, Indacochea F, et al. Mortality risk in selenium-deficient HIV-positive children.J Acquir Immune Efic Hum Retrovirol. 1999; 20(5): 508-13.
   13. Baum MK, Shor-Posner G. Micronutrient status in relationship to mortality in HIV-1 disease. Nutrition Rev 1998 Jan;56(1 Pt 2):S135-9.
   14. Rayman MP. The importance of selenium to human health. The Lancet. 2000;  356: (9225), pp. 233-241
   15. Hercberg S, Galan P, Preziosi P, et al. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med. 2004 Nov 22;164(21):2335-42.

   
   
   

4. Carotenoids (Carotenes). This is a group to nutrients, of which Beta carotene is the most well-known, that have powerful anti-oxidant and other health-enhancing properties. Beta carotene is also known as pro-vitamin A, since it can be converted by the body into vitamin A. Other carotenoids include Alpha carotene, Gamma carotene, Cryptoxanthin, Lutein, Zeaxanthin, and Lycopene. They are naturally occurring pigments and are responsible for the green, yellow, orange and red color in many fruits and vegetables. They are found most frequently in green leafy vegetables and yellow and orange fruits and vegetables, such as carrots, apricots, spinach, squash, tomatoes, mango, and yams. Some of these other carotenes may have more powerful antioxidant properties than b-carotene.
   
   Consumption of increased levels of b-carotene and other carotenes in some studies has been associated with lowered risk of cardiovascular disease.(1,2,3) B-carotene may inhibit oxidative damage to cholesterol and the lining of the arteries, though it is less effective that vitamin E in this function.(4)
   
   While hundreds of studies have shown a lowered risk of various forms of cancer with a diet high in carotene containing foods, a well publicized study appears to demonstrate that synthetic b-carotene supplements may have adverse effects for certain high risk groups. The Alpha-tocopherol, Beta-carotene Cancer Prevention Study(5), a.k.a., the Finnish smoker's study, found that men who took b-carotene alone had an 18% increase in lung cancer. Does this mean that b-carotene supplementation increases your risk for lung cancer?
   
   You have to look more closely at this study for the answer to this. To begin with, the study group of 29,000 men in Finland were both heavy drinkers and smokers. Second, the group that supplemented with b-carotene and vitamin E had no increase in lung cancer. We also know that b-carotene may be susceptible to oxidative damage without the presence of other antioxidants, such as vitamin E. And alcohol and smoking may both increase the rate of oxidative damage in the body. Therefore, in this specific group of subjects--men who smoke and drink regularly--beta-carotene may turn into a potential carcinogen if not consumed with other anti-oxidants, (such as vitamin E).
   
   
   References:
   1. Gaziano JM, Manson JE, Branch LG, et al. A prospective study of consumption of carotenoids in fruits and vegetables and decreased cardiovascular mortality in the elderly. Ann Epidemiol. 1995; 5:255-260.
   2. Tavani A, Negri E, D'Avanzo B, La Vecchia C. Beta-carotene intake and risk of nonfatal acute myocardial infarction in women. Eur J Epidemiol. 1997;13:631-637.
   3. Kritchevsky SB, Tell GS, Shimakawa T, Dennis B, Li R, Kohlmeier L, Steere E, Heiss G. Provitamin A carotenoid intake and carotid artery plaques: the Atherosclerosis Risk in Communities Study. Am J Clin Nutr. 1998;68:726-733.
   4. Murray MT. Encyclopedia of Nutritional Supplements. CA: Prima Publishing, 1996, p.34.
   5. Alpha-tocopherol, Beta-carotene Cancer Prevention Study Group, The effect of vitamin E and beta-carotene on incidence of lung cancer and other cancers in male smokers. NEJM. 1994; 330: 1029-1035.
   
   
   
5. Calcium.  Calcium is the most abundant mineral in the body. Calcium is extremely important for maintaining proper acid/alkaline balance (pH) in the body, for strong bones and teeth, for regulation of the heart beat, and for proper muscular function. Calcium may help to protect against high blood pressure and colon cancer. It is so important to keep the blood levels of calcium within a narrow range, that the body will demineralize the bones to maintain normal blood calcium. This is why dietary intake of calcium is so important. 
   
   The current RDA by the Institute of Medicine (IOM) of the National Academy of Sciences for calcium is 1000 mg/day for adults. 1300 mg/day is recommended for children over age 9 and for pregnant and lactating women. For postmenopausal women, 1500 mg/day is recommended to prevent osteoporosis. For those who already have osteoporosis, treatment may require much higher levels. One recent study found that 3000 mg calcium carbonate and 1400 IE cholecalciferol (Vit D) was more effective than lower doses at reducing bone turnover and at increasing bone mineral density.(1)
   
   Which form of calcium supplement is most effective is controversial. The above study used calcium carbonate, which is the least expensive form, though it is also the least absorbable form, esp. in older individuals. Calcium citrate, hydroxyapatite, and phosphate are all more absorbable than carbonate. 
   
   The highest levels of calcium are found in dairy products, though kale, collard greens, broccoli, and tofu are also good sources. Spinach contains fair amounts of calcium, but the calcium in spinach is poorly absorbed due to the oxalic acid present in spinach. Those who choose not to consume dairy products will have trouble getting adequate levels of calcium intake on a daily basis and should consider supplementation. An 8oz glass of nonfat milk contains 302 mg. calcium, while a 1/2 cup of broccoli contains only 21 mg. calcium.  Studies show that most Americans do not get the recommended level of calcium.
   
   Most interest in calcium concerns bone density and the prevention and treatment of osteoporosis, a thinning of the bones that can result in susceptibility to fractures of the hips and other bones. Calcium supplementation has been shown to help increase bone density and to slow bone loss, even in post-menopausal women. (2,3) Vitamin D helps to improve calcium absorption and low levels of Vitamin D will result in decreased bone density.
   
   Those who suffer with or are at risk for osteoporosis, besides taking calcium supplements, should avoid foods that may increase calcium loss. High sodium in the diet increases calcium excretion (loss).(4,5)  Increased potassium intake may decrease calcium excretion.(6) Caffeine (coffee) causes a small loss of calcium but is not that significant at low doses.(7) For example, one cup of coffee causes a loss of only 2-3 mg of calcium.(6) Carbonated beverages, such as coca cola, contain phosphorus, which results in depleted calcium levels.(9,10,11) In addition, high protein intake is likely to leach calcium out of the system.(4,5) 
   
   Low calcium levels can result in muscles spasms or leg cramps, and may contribute to high blood pressure, osteoporosis, and colon cancer.
   
   Because kidney stones are often made of calcium oxalate, some have claimed that high calcium intake may lead to kidney stone formation.  However, the research actually shows the opposite: that high dietary intake of calcium reduces the risk of kidney stones.(12,13,14)
   
   References:
   1. Hitz MF, Jensen JB, Eskildsen PC. Bone mineral density and bone markers in patients with a recent low-energy fracture: effect of 1 y of treatment with calcium and vitamin D1-3. Am J Clin Nutr 2007;86;251-9. 
   2. Elders PJM, et al. Long-term effects of calcium supplementation on bone loss in perimenopausal women. J Bone Min Res. 1994; 9:963-70.
   3. Devine A, et al. A 4-year follow-up study of the effects of calcium supplementation on bone density in elderly postmenopausal women. Osteoporosis Int. 1997; 7:23-28.
   4. Weaver CM, Proulx WR, Heaney RP. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin Nutr 1999;70:543S-8S.
   5. Heaney RP. Bone mass, nutrition, and other lifestyle factors. Nutr Rev 1996;54:S3-S10.
   6.  Sellmeyer DE, Schloetter M, Sebastian A. Potassium citrate prevents increased urine calcium excretion and bone resorption induced by a high sodium chloride diet. J Clin Endocrinol Metab 2002;87:2008-12.
   7.  Barrett-Connor E, Chang JC, Edelstein SL. Coffee-associated osteoporosis offset by daily milk consumption. JAMA 1994;271:280-83. 
   8.  Murray MT. Osteoporosis Prevention and Treatment--Beyond Calcium. Natural Medicine Journal. 1999; 2: 3-13.
   9.  Mazaregos-Ramos E, et al. Consumption of soft drinks with phosphoric acid as a risk factor for the development of hypocalcemia in children: A case-control study. J Pediatr. 1995; 126: 940-2.
   10. Calvo MS. Dietary phosphorus, calcium metabolism and bone. J Nutr 1993;123:1627-1633.
   11. Heaney RP, Rafferty K. Carbonated beverages and urinary calcium excretion. Am J Clin Nutr 2001;74:343-47.
   12. Curhan G, Willett WC, Rimm E, Stampher MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 1993;328:833-8.
   13. Bihl G, Meyers A. Recurrent renal stone disease-advances in pathogenesis and clinical management. Lancet 2001;358:651-56.
   14. Hall WD, Pettinger M, Oberman A, et al. Risk factors for kidney stones in older women in the Southern United States. Am J Med Sci 2001;322:12-18.
   
   
6. Magnesium.  Magnesium is an essential mineral for bone health, for the contraction of muscles (including the heart muscle), for energy production, as well as an important electrolyte. Magnesium is involved as an enzyme activator in more than 300 different metabolic reactions in the body. The average human body contains 21 to 28 grams of magnesium. The RDA for magnesium is 350 mg/day for adult males and 280 mg for adult females.(1)
   
   The average level of magnesium taken in by Americans is between 143 and 266 mg per day, which is much below recommended intake levels. Therefore, we should make an effort to increase magnesium intake, either through food choices or through supplementation. The best dietary sources of magnesium are green leafy vegetables, nuts, peas, beans, and whole grain cereal. A diet high in fat may cause less magnesium to be absorbed. Cooking may decrease the magnesium content of food. Magnesium in supplemental dosages may be helpful in the treatment of a variety of health conditions, including asthma, cardiovascular disease, acute myocardial infarction, angina, cardiac arythmias, congestive heart failure, diabetes, high blood pressure, mitral valve prolapse, osteoporosis, fibromyalgia, and chronic fatigue syndrome.(2)
   
   Magnesium may be nearly as important for building bone as calcium. Laboratory research indicates that magnesium supplementation suppresses bone turnover and bone turnover is associated with bone loss. (3) A small study (n=31) found that when supplemented with up to 750 mg/day of magnesium, postmenopausal women demonstrated a slight increase in bone density as compared to those who were taking a placebo, who showed a slight decrease in bone.(4) Magnesium supplements also slow the normal loss of bone that occurs in young healthy males who do not have magnesium deficiencies. This study indicates the potential benefits of magnesium supplementation for children and young adults in promoting peak bone mass, as well as for those with osteoporosis.
   
   Magnesium interacts with calcium and can block the influx of calcium into cardiac (heart) muscle cells and the smooth muscle cells in the walls of the blood vessels. Thus, magnesium is important in helping to regulate cardiac function and the vascular resistance that plays an important role in blood pressure. Intravenous magnesium has been used with some success in hospitals for patient suffering with an acute myocardial infarction (a heart attack).(5) Oral magnesium supplementation has been shown to help lower blood pressure in those suffering with hypertension.(6,7)
   
   Adequate levels of magnesium in the body are important in maintaining proper blood sugar levels. Magnesium is involved in insulin secretion and enhances insulin sensitivity. Research shows magnesium supplementation may improve blood sugar control (glucose tolerance) and insulin response, esp. in the elderly.(8) Magnesium deficiency is common in diabetes and magnesium supplementation may help to prevent some of the complications of diabetes, like retinopathy and heart disease.(9,10)
   
   Magnesium is also particularly important during pregnancy, when the need for it increases to approximately 450 mg/day.(11) Magnesium supplementation may reduce the incidence of cerebral palsy and mental retardation, may prevent pre-eclampsia, and may prevent some of the other complications of pregnancy.(11) Prenatals should contain between 350 and 500 mg/day of magnesium.
   
   Recent research indicates that magnesium is particularly important for mitochondria function and its deficiency may cause fatigue. Many patients with chronic fatigue have low levels of magnesium in their red blood cells.(12) Supplementation of magnesium may help patients with chronic fatigue and also with fibromyalgia, a related disorder.(13)
   
   References:
   1. Murray MT. Encyclopedia of Nutritional Supplements. CA: Prima Publishing, 1996, p.159.
   2. Murray. Ibid., p.163.
   3. Dimai HP, Prolta S, Winsberger G, et al. Daily oral magnesium supplementation suppresses bone turnover in young adult males. Journal of Clinical Endocrinology and Metabolism. 1998; 83: 2742-48.
   4. Stendig-Lindberg G, Tepper R, Leichter I. Trabecular bone density in a two year controlled trial of peroral magnesium in osteoporosis. Magnesium Res. 1996; 6: 155-63.
   5. Nakashima H, Katayama T, Honda Y, et al.  Cardioprotective effects of magnesium sulfate in patients undergoing primary coronary angioplasty for acute myocardial infarction.  Circ J. 2004; 68(1): 23-8.
   6. Kawano Y, Matsuoka H, Takashita S, et al. Effects of magnesium supplementation in hypertensive patients: assessment by office, home, and ambulatory blood pressures. Hypertension. 1998; 32(2): 260-5.
   7. Witteman JCM, et al. Reduction of blood pressure with oral magensium supplementation with mild to moderate hypertension. Am J Clin Nutr. 1994; 60: 129-135.
   8. Paolisso G, Sgambato S, Gambardella A, et al. Daily magnesium supplements improve glucose handling in elderly subjects. Am J Clin Nutr. 1992; 55: 1161-1167.
   9. Murray. Ibid. p.169.
   10. White JR, Campbell RK. Magnesium and diabetes: A review. Ann Pharmacother. 1993; 27: 775-780.
   11. Ames M. Nourishing mother and fetus. International Journal of Integrative Medicine.1999; 1: 13-18.
   12. Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome. Lancet. 1991; 337: 757-760.
   13. Murray. Ibid. pp.170-171.
   
   
   
7. Folic Acid (folate).  This essential B vitamin is important for cell growth and development. Studies show that taking supplemental folic acid helps to prevent neural tube birth defects, like spina bifida.(1) Approximately 400 mcg per day of folic acid is necessary, an amount difficult to get from food alone. Wheat bread is often touted as a source of folic acid, but you would have to eat an entire loaf to get 400 mcg of folic acid. And the folate found in foods is not as absorbable as the folate contained in vitamin pills. Therefore, it is recommended that you take daily multivitamin containing 400 mcg of folic acid.
   
   Folic acid has been recently shown to help prevent heart disease, stroke, and possibly cancer. Research indicates that folic acid supplements can lower the risk of heart disease and stroke.(2) This occurs through lowering the level of an amino acid--homocysteine --that is toxic to blood vessels. Individuals with higher levels of homocysteine have a greater risk of heart disease and stroke.(3,4) Taking supplemental dosages of Vitamin B6 and B12 also help to lower homocysteine levels.
   
   References:
   1. Milunsky, et al. Multivitamin/folic acid supplementation in early pregnancy reduces the prevalence of neural tube defects. JAMA. 1989; 262: 2847-2852.
   2. Malinow, et al. Reduction of plasma homocysteine levels by breakfast cereal fortified with folic acid in patients with coronary heart disease. NEJM. 1998; 338(15): 1009-1015.
   3. Stampfer MJ, et al. A prospective study of plasma homocysteine and risk of myocardial infarction in US physicians. JAMA. 1992; 268(7): 877-881.
   4. Nygard O, Nordrehaug JE, Refsum H, et. al. Plasma homocysteine levels and mortality in patients with coronary artery disease. NEJM. 1997; 337(4):230-6.
   
   
8. Zinc. This important mineral is involved in a large number of metabolic reactions in the body as an enzyme cofactor. Zinc is important for immune function, wound healing, sexual function, and for the health of the sensory system. The RDA for zinc is 15 mg/day for adults.
   
   Zinc gluconate lozenges have been shown to be effective in a number, though not all, studies to reduce the length and severity of the common cold.(1,2)
   
   References:
   1. Godfrey JC; Conant Sloane B; Smith DS; Turco JH; Mercer N; Godfrey NJ. Zinc gluconate and the common cold: a controlled clinical study. J Int Med Res 1992 Jun;20(3):234-46.
   2. Garland ML; Hagmeyer KO. The role of zinc lozenges in treatment of the common cold. Ann Pharmacother 1998 Jan;32(1):63-9.

   
   
   

9. L-glutamine. This is an amino acid that is found in great abundance in muscle tissue and is found in most protein foods, such as fish, red meat, beans and dairy products. In addition to its importance to skeletal muscle, glutamine is an important nutrient for the gastrointestinal tract.(1) 
   
   References: 
   1. McAnena OJ, Moore FA, Moore EE, et al. Selective uptake of glutamine in the gastrointestinal tract: confirmation in a human study. Br Med J 1991 Apr;78(4):480-2.

   
   

10. Creatine. This may be the most important ergogenic aid ever discovered! Creatine monohydrate helps in building muscle mass and strength and currently is being used by a large number of both professional and amateur athletes. Many current NBA, NFL, NHL, and MLB players use it regularly. More than a hundred studies have documented creatine's potential benefit in improving athletic performance and enhancing the muscle building process.
    
    Creatine is an amino acid that occurs naturally in the body and supplies energy for the muscles through its involvement in the reactions that result in the formation of ATP. Creatine is stored in the muscles either as free creatine or as phosphocreatine. Power output often drops as phosphocreatine becomes depleted as the body cannot regenerate ATP fast enough to meet the demands of the exercise. Ingestion of creatine orally has been shown to increase the level of phosphocreatine in the muscles.(1,2) This allows for enhanced performance in high intensity activities, such as sprinting and weight training, which rely upon phosphocreatine for energy.(3) Creatine also serves as a hydrogen ion buffer, which helps the body to maintain normal pH levels, thus avoiding the acid build up that can result in fatigue while exercising.(4) In addition, creatine supplementation appears to result in increased protein synthesis and muscle hypertrophy.(3,5,24)
    
    Creatine monohydrate supplementation has been shown to result in increases in strength during weight training(6,7,8,9,10) and in improved performance while running(9,11,12,13), cycling(6,14,15,16), rowing(17), swimming(18), and in vertical jump.(24) Improvements during weight training have been in maximal(9) and near maximal bench press strength(8,10), in increased number of reps performed with a moderate weight(6,7,8), in increased number of reps while performing knee extensions(7), and in increased power while performing jump squats.(10)
    
    Creatine has been used in the medical setting as an antiarrhythmic agent and in the treatment of ischemic heart disease, as a cardio-protective agent during heart surgery, and to prevent post-surgical wasting of muscle tissue.(19) Recent research indicates it may be beneficial in the treatment of ALS (Lou Gehrig's Disease)(20) and muscular dystrophy.(21)
    
    Creatine has not been shown by research to result in any negative side effects, except for some weight gain, even in studies looking at dosages of 25g/day for up to 1 year.(19) Recently there has been much discussion and anecdotal reports among the sports coaching and trainers community about increased rate of muscle cramping related to creatine supplementation. It is believed that a dehydration effect may result from the intracellular muscle fluid retention that results from creatine. In fact, a number of amateur and professional teams have banned their players from using it over concerns about the possible increase in cramps and muscle pulls. No serious scientific data has yet been published to either verify or deny these claims. However, none of the creatine studies, including those using intense training in hot and humid conditions, have reported any cramping, dehydration or increased susceptibility to muscle strains or pulls.(19)
    
    There has been some controversy about three wrestlers who died from dehydration while taking creatine. They were trying to make weight for a wrestling match and were purposely dehydrating themselves. Could creatine have contributed to their deaths? Could creatine have placed an additional load on their already stressed out kidneys? On the other hand, why were they taking creatine when they were trying to lose weight? These questions have not been answered and additional research should look into them.
    
    The medical community has expressed its concern over the possibility that long term creatine use could have a negative effect on cancer risk, the heart, the brain, or the reproductive organs, since these organs naturally contain creatine.(25,26) However, to date, no research has shown any negative effects from creatine on any of these organs or on cancer risk. For all we know, it may help protect the body from cancer by preventing some of the wasting of tissue associated with cancer.  In fact, one report in the Journal of Neurology recently found that taking creatine helped to prevent brain damage due to a blow to the head. 
    
    I recommend that if you choose to supplement with creatine, that you drink additional quantities of water--both with the creatine and after consuming it. Also, avoid taking in creatine when your body is not properly hydrated--therefore avoid taking it at halftime during a game, etc.. You should ingest creatine with some carbohydrates to take advantage of the insulin uptake effect. The carbohydrate intake has been shown to enhance the benefits of creatine.(22,23)  Caffeine should be avoided as it has a diuretic effect and this may counteract some of creatine's ergogenic effects.(19)
    
    References:
    1. Crim MC, Calloway DH, Margon S. Creatine metabolism in men: Creatine pool size and turnover in relation to creatine intake. Journal of Nutrition. 1976; 106: 371-381.
    2. Harris RC, Soderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin Sci. 1992; 83: 367-374.
    3. Volek JS, Kramer WJ. Creatine supplementation: Its effect on human muscular performance and body composition. Journal of Strength and Conditioning Research. 1996; 10(3): 200-210. [Note: This article is one of the better reviews of the literature related to creatine supplementation and is a good starting point for additional reading.]
    4. Greenhaff PL. Creatine and its application as an ergogenic aid. Int J Sports Nutr. 1995; 5: S100-S110.
    5. Ingwall JS. Creatine and the control of muscle specific protein synthesis in cardiac and skeletal muscle. Circ Res. 1976; 38: 115-123.
    6. Earnest CP, Snell PG, Rodriguez R, Almada AL, Mitchell TL. The effect of creatine monohydrate ingestion on anaerobic power indices, muscular strength and body composition. Acta Physiol Scand. 1995; 153:207-209.
    7. Greenhaff PL, Casey A, Short AH, Harris R, Soderlund K, Hultman E. Influence of oral creatine supplementation of muscle torque during repeated bouts of maximal voluntary exercise in man. Clin Sci. 1993; 84:565-571.
    8. Kelly VG, Jenkins DG. Effect of oral creatine supplementation on near-maximal strength and repeated sets of high-intensity bench press exercise. Journal of Strength and Conditioning Research. 1998; 12(2):109-115.
    9. Stout JR, Eckerson J, Noonan D, Moore G, Cullen D. The effects of exercise performance and fat-free mass in football players. Med Sci Sports Exercise. 1997; 29:S251.
    10. Volek, JS, Kraemer WJ, Bush JA, et al. Creatine supplementation enhances muscular performance during high-intensity resistance exercise. J Am Diet Assoc. 1997; 97:765-770.
    11. Harris RC, Viru M, Greenhaff PL, Hultman E. The effect of oral creatine supplementation on running performance during maximal short term exercise in man. J Physiol. 1993; 267:74P.
    12. Kreider RB, Ferreira M, Wilson M, et al. Effects of creatine supplementation on body composition, strength, and sprint performance. Medicine and Science in Sports and Exercise. 1998; 30:73-82.
    13. Earnest CP, Almada AL, Mitchell TL. The effect of creatine monohydrate ingestion on intermediate duration anaerobic treadmill running to exhaustion. J Strength Cond Res. 1997; 11(4): 234-238.
    14. Birch R, Noble D, Greenhaff PL. The influence of dietary creatine supplementation on performance during repeated bouts of maximal isokinetic cycling in man. Eur J Appl Physiol. 1994;69: 268-270.
    15. Balsom PD, Ekblom B, Soderlund K, et al. Creatine supplementation and dynamic high-intensity intermittent exercise. Scan J Med Sci Sports. 1993; 3: 143-149.
    16. Jacobs I, Bleue S, Goodman J. Creatine ingestion increases maximal accumulated oxygen deficit and anaerobic exercise capacity. Medicine and Science in Sports and Exercise. 1995; 27:S204.
    17. Rossiter HB, Cannell ER, Jakeman PM. The effect of oral creatine supplementation on the 1000-m performance of competitive rowers. J Sports Sci. 1996; 14:175-179.
    18. Grindstaff PD, Kreider RB, Bishop R, et al. Effects of creatine supplementation on repetitive sprint performance and body composition in competitive swimmers. Int J Sport Nutr. 1997; 7:330-346.
    19. Plisk SS, Kreider RB. Creatine controversy? Strength and Cond J. 1999; 21:14-23.
    20. Klivenyi P, Ferrante RJ, Matthews RT, et al.. Neuroprotective effects of creatine in a transgenic animal model of amyotrophic lateral sclerosis. Nat Med. 1999; 5(3):347-350.
    21. Tarnopolsky M; Martin J. Creatine monohydrate increases strength in patients with neuromuscular disease. Neurology. 1999; 52:854-857.
    22. Green AL, Hultman E, Macdonald IA, et al. Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans. American Journal of Physiology. 1996; 271: E821-E826.
    23. Stout JR, Eckerson JM, Housh TJ, Ebersole KT. The effects of creatine supplementation on anaerobic working capacity. Journal of Strength and Conditioning Research. 1999; 13: 135-138.
    24. Kirksey B, Stone MH, Warren BJ, et al. The effects of 6 weeks of creatine monohydrate supplementation on performance measures and body composition in collegiate track and field athletes. Journal of Strength and Conditioning Research. 1999; 13: 148-156.
    25. Juhn MS, Tarnopolosky M. Potential side effects of oral creatine supplementation: a critical review. Clin J Sports Med. 1998; 8(4):298-304.
    26. Juhn MS. Oral creatine supplementation. The Physician and Sportsmedicine. 1999; 27(5):47-56.
    
    
    

11. Omega 3 Fatty Acids.   There are three main omega 3 fatty acids--alpha linoleic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).  Along with the main omega 6 fatty acid, linoleic acid (LA), alpha linoleic acid (ALA) is considered essential to human health. EPA and DHA can be synthesized from ALA, but humans are not very efficient at this conversion, so an argument can be made that EPA and DHA should also be considered essential.  
    
    Omega 3 fatty acids are extremely important in promoting health and in preventing disease and the best source of the omega-3 oil is in the form of fish oil.  Flax seed, flax seed oil, soybeans, soybean oil, canola oil, and walnuts are also good sources of omega 3 fatty acids, particularly alpha linolenic acid (ALA). However, while humans can convert the 18 carbon ALA into the 20 carbon EPA or the 22 carbon DHA, this is not a very efficient process. Studies show that approximately only 8% of dietary ALA is converted to EPA and only 0-4% is converted to DHA in healthy young men. It is much more efficient to consume a high quality fish oil supplement and/or consume fish on a weekly basis, in addition to consuming some ALA containing foods.
    
    There are many positive health benefits of increasing consumption of omega-3 fats. They are essential for normal growth and development.  All cell membranes are made of phospholipids, which incorporate fatty acids, and a higher consumption of omega 3 fatty acids has been shown to positively influence membrane formation.  
    
    Omega-3 fats have been shown to be helpful in preventing and treating heart disease(5,6), diabetes(7), kidney disease(8), rheumatoid arthritis(9), chronic obstructive pulmonary disease(10), and various inflammatory disorders.  This is done partially through regulation of hormones in the body known as prostaglandins.  For example, higher consumption of omega-3 fats leads to decreased concentration of thromboxane A2, which leads to platelet aggregation and vasoconstriction.  Therefore, consumption of omega-3 fats reduces the likelihood of heart attacks and strokes.  On the other hand, by decreasing platelet aggregation, blood clotting is decreased, so be careful if you are taking coumadin or warfarin to reduce blood clotting.
    
    Fish oil has been shown to reduce hardening of the arteries. 
    
    Fish oil supplements appear to reduce the death rate in former heart attack patients. A little oil on the valve train can help keep a car running smoothly and extend its life span. The same holds true, it seems, for humans. The 1999 GISSI-Prevenzione trial found that omega-3 oils appear to reduce the chances that former heart attack patients will suffer a fatal cardiovascular event, and may protect them from other causes of death, as well.(12)
    
    Researchers tracked the efficacy of nutritional supplement programs for 11,324 patients who recently suffered heart attacks from hundreds of hospitals and clinics throughout Italy. They examined the effects of daily supplementation with omega-3 fatty acids (1 g), vitamin E (300 mg), or both, on fatal and non-fatal cardiovascular events over the next three and a half years.
    
    Compared to controls, the group receiving omega-3 fatty acids showed a 30% decrease in cardiovascular-related deaths, and a 20% reduction in mortality from all causes. Overall, the rigorous statistical analysis revealed a combined 20% drop in the overall rates for cardiovascular death, non-fatal heart attack, and non-fatal stroke.  While vitamin E supplementation did not significantly affect the combined, overall outcomes in the patients, researchers nevertheless pointed out "an indication of a possible beneficial effect of vitamin E" in several important secondary indices, including a 20% reduction in all types of cardiovascular deaths.
    
    A recent review paper looked at all the published research and compared the benefits of fish oil compared with diet, lipid lowering drugs categorized as statins, fibrates and resins, and niacin.(13) While the fibrate class of drugs failed to influence overall mortality and mildly elevated  non-cardiac mortality, and while diet, resins, and niacin appeared to provide insignificant benefits, statins and omega-3 fatty acids significantly lowered both overall and coronary heart disease mortality risk during the trial periods. The risk of overall mortality was reduced by 13 percent by statins and 23 percent by omega-3 fatty acids compared to the risk experienced by those who did not receive treatment. When the risk of mortality from heart disease alone was analyzed, the use of statin drugs and omega-3 fatty acids were found to lower the risk by 22 and 32 percent, respectively. In other word, fish oil was more effective than than prescription statin drugs (like lipitor) and other drugs that lower cholesterol in reducing mortality from heart problems, even though it was not as effective at lowering cholesterol.
    
    Several published trials demonstrate that higher intake levels, blood levels, and brain levels of EPA and DHA may help preserve cognitive function as we age and reduce the risk of senile dementia and Alzheimer's disease.(16) DHA is the most common fatty acid in the brain and the brains of Alzheimer's patients have been shown to contain a lower content of DHA.(17)  Two recent studies in the American Journal of Clinical Nutrition indicate that a moderate intake of EPA and DHA is strongly associated with reduce risk of cognitive decline.(18,19)
    
    Another recent study also found that young men who have higher levels of omega 3 fats, esp. DHA, in their blood, have more bone density.(14)
    
    
                                                                    HISTORICAL DISCUSSION
    
    Humans evolved consuming a diet that contained approximately equal amounts of omega-6 and omega-3 fats. As consumption of omega-3 fats has decreased and consumption of omega-6 fats has increased, the modern diet in Western cultures now contains a ratio of omega-6 to omega-3 fats of approximately 20 or 30:1.(1) This is due to several factors:                                                                                                                         
    1. Increased intake of vegetable oils from corn, safflower, sunflower, cottonseed, and soy, which contain primarily omega-6 fats.
    2. Decrease in fish consumption compared to primitive cultures.                                                                   
    3. Cultivated animal meats, vegetables, eggs and even fish that are lower in omega-3 fatty acids.(2,3,4)  Cattle and chickens, for example, are fed grains that are high in omega-6 fats, thus resulting in cattle and chickens who have higher levels of omega-6 fats in their meat. 
    
    In order to positively influence our health status and reduce inflammation in our bodies, we should attempt to increase consumption of omega-3 fatty acids while reducing consumption of omega-9 and omega-6 fatty acids.  This can be accomplished by reducing the consumption of meat (which is high in arachidonic acid), hydrogenated oils (such as found in margarine), and vegetable oils that contain omega-6, such as corn oil and safflower oil.  We should make an effort to consume sources of omega-3 fatty acids, such as olive oil and cold water fish, such as salmon. 
    
    
                                                            Should I take flax seed oil supplements?
    
    What about supplementing with flax seed oil?  I used to be a big believer in flax oil supplements, however, it is now becoming clear from the literature that fish oil is the preferred form of omega-3 oil supplement.  For one thing, only a small percentage of the ALA in flax oil is converted by the body into EPA and DHA, the most active forms of omega-3 in the body.  Secondly, in recent research, there appears to be an association between elevated levels of ALA in the body and increased risk of prostate cancer.(11) Therefore, we do not recommend supplements of flax seed oil.  Likewise, mixed oil supplements that include a combination of omega-3, omega-6, and omega-9 oils should probably be avoided, as we already take in too much omega-6 fats and this would just continue the imbalance. Eat wild salmon or other fish at least two times per week and supplement daily with a high quality fish oil (EPA/DHA) supplying at least 500mg per day of both EPA and DHA. As always, check with your doctor to make sure that these recommendations are appropriate for you. 
    
    
    References:
    1.  Simopoulos AP. Essential fatty acids in health and chronic disease.  Am J Clin Nutr. 1999; 70:560S-569S.
    2.  Crawford MA.  Fats in free-living and domestic animals. Lancet. 1968; 1: 1329-33.
    3.  Van Vliet T, Katan MB. Lower ratio of omega-3 to omega-6 fats in cultured than in wild fish.  Am J Clin Nutr 1990; 51:1-2.
    4.  Simopoulos AP, Salem N.  Omega-3 fats in eggs from range-fed Greek chickens.  N Engl J of Med. 1986; 315:833 (letter).
    5.  De Lorgeril M, Renaud S, Mamelle N.  Mediterranean linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994; 343: 1454-9.
    6.  Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish and fibre intakes on death and myocardial infarction: diet and reinfarction trial (DART). Lancet 1989; 2:757-61.
    7.  Raheja BS, Sadikot SM, Phatak RB, Rao MB. Significance of the omega-6/omega-3 ratio for insulin action in diabetes. Ann NY.  Acad Sci. 1993; 683: 258-71.
    8.  Donadio JV Jr, Bergsalh EJ, Offord KP et al.  A controlled trial of fish oil in IgA nephropathy. Mayo Nephrology Collaborative Group. N Engl J Med. 1994; 331: 1194-9.
    9.  Kremer JM, Lawrence DA, Petrillo GF, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Arthritis Rheum 1995. 38(8): 1107-14.
    10. Matsuyama W, Mitsuyama H, Watanabe M, et al. Effects of Omega-3 Polyunsaturated Fatty Acids on Inflammatory Markers in COPD. Chest. 2005; 128:3817-3827.
    11. Leitzmann MF, Stampfer MJ, Michaud DS, et al. Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer. Am J Clin Nutr 2004;80:214-216.
    12. GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999; 354(9177): 447-55. (No individual authors were listed. Nearly 50 scientists were involved, and the trial centers numbered over 200. The Medline UI: 99392837 can be used to locate the abstract and order the article.)  
    13. Studer M,  Briel M, Leimenstoll B, et al.  Effect of different antilipidemic agents and diets on mortality: A systematic review.  Arch Intern Med. 2005;165:725-730.
    14. Högström M, Nordström P, Nordström A. N–3 Fatty acids are positively associated with peak bone mineral density and bone accrual in healthy men: the NO₂ Study. Am. J. Clinical Nutrition, Mar 2007; 85: 803 - 807.
    15.  Nestel P, Shige H, Pomeroy S, et al. The n-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid increase systemic arterial compliance in humans. American Journal of Clinical Nutrition. 2002; 76: 326-330.
    16.  Conquer JA, Tierney MC, Zecevic J, et al. Fatty acid analysis of blood plasma of patients with Alzheimer's disease, other types of dementia, and cognitive impairment. Lipids. 2000; 35:1305-12.
    17.  Connor WE, Connor SL. The importance of fish and docasahexanoic acid in Alzheimer's disease. Am J Clin Nutr. 2007; 85:929-30.
    18.  Beydoun MA, Kaufman JS, Satia JA, et al. Plasma n-3 fatty acids and the risk of cognitive decline in older adults: the Atherosclerosis Risk Communities Study. Am J Clin Nutr. 2007; 85: 1103-11.
    19.  Van Gelder BM, Tijuis M, Kalmijn S, Kromhout D. Fish consumption, n-3 fatty acids, and subsequent 5-year cognitive decline in elder men: the Zutphen Elderly Study. Am J Clin Nutr. 2007; 85:1142-7.

    
    

12. Glucosamine sulfate.  This nutrient has been shown to be effective in helping individuals with joint pain. Glucosamine sulfate is believed to help to regenerate cartilage and other forms of connective tissue, such as tendons and ligaments. It has been most thoroughly tested with patients with osteoarthritis of the knee. Glucosamine is the precursor and the rate-limiting substrate for the production of hyaluronic acid and some of the other proteoglycans present in cartilage and the synovial fluid in joints.(1) Proteoglycans are the water-retaining molecules that are the building blocks of cartilage.  
    
    A number of controlled studies (2,3,4,5,6,7,8,9) using 750-1500 (3 used the 1500) mg/d oral glucosamine sulfate in patients with osteoarthritic knees, showed significant reductions in pain and analgesic use, as well as improved joint function. It seems to be at least as effective as anti-inflammatories, such as ibuprofen, for the long term treatment.  There is now good evidence that it promotes cartilage regeneration, or at least that it decreases cartilage degeneration, as demonstrated by preventing the joint space narrowing that typically occurs with osteoarthritis.(6,9,10)
    
    There seems to be very few side effects of oral administration of glucosamine sulfate.  There was one report of an allergic reaction.(11)  There was been several concerns raised over the years, such as adverse changes in insulin sensitivity and raising of cholesterol, but these have never been verified scientifically. Quite the opposite. Glucosamine sulfate, with or withour chondroitin sulfate, appears to be both a very safe and effective nutritional supplement. In fact, a very well controlled study conducted over 3 years, showed no adverse reactions to taking 1500 mg./day of glucosamine sulfate.(10)
    
    
    References:
    1. McCarty MF; Russell AL; Seed MP. Sulfated glycosaminoglycans and glucosamine may synergize in promoting synovial hyaluronic acid synthesis. Med Hypotheses. 2000; 54(5):798-802.
    2. Drovanti A. Therapeutic activity of glucosamine sulfate in osteoarthritis: A placebo-controlled double-blind investigation. Clin Ther. 1980; 3: 260-72.
    3. Pujalte JM. Double-blind clinical evaluation of oral glucosamine sulfate in the basic treatment of osteoarthritis. Curr Med Res Opin. 1980; 7: 110-14.
    4. D'Ambrosio E. Glucosamine sulphate: A controlled clinical investigation in arthrosis. Pharmatheriputica. 1981; 2: 504-8.
    5. Val AZ. Double-blind clinical evaluation of the relative efficacy of ibuprofin and glucosamine sulfate in the management of osteoarthritis of the knee in outpatients. Curr Med Res Poin. 1982; 8: 145-9.
    6. Arthritis Rheum 2000; 43 (Suppl.): 1908
    7. Leffler CT; Philippi AF; Leffler SG; Mosure JC; Kim PD.Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med 1999 Feb;164(2):85-91.
    8. Qiu GX; Gao SN; Giacovelli G; Rovati L; Setnikar I. Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis. Arzneimittelforschung. 1998; 48(5):469-74.
    9. Pipitone V. A multicenter triple-blind study to evaluate galactosaminoglucuronoglycan sulfate versus placebo in patients with femorotibial gonarthritis. Curr Ther Res 1992; 52: 608-22.
    10. Reginster, JY, Deroisly R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomized, placebo-controlled clinical trial. The Lancet. 2001; 357: 251-256.
    11. Matheu V, Gracia Bara MT, Pelta R; Vivas E, Rubio M. Immediate-hypersensitivity reaction to glucosamine sulfate. Allergy. 1999; 54(6):643.

    
    
    

13. Ginkgo biloba extract.  This herbal nutrient has been approved in Germany for treating memory problems in patients suffering from dementia,(1) for treating dizziness and ringing in the ears (tinnitus),(2) for treating depression,(3) and for improving circulation in patients with blocked arteries in their legs.(4) Recent research indicates that it may be effective in reducing the symptoms of dementia due to cerebral insufficiency in patients with or without Alzheimer's disease.(5,6) Gingko may improve concentration and memory in the elderly.
    

    The active ingredients in ginkgo are believed to be flavinoids, referred to as ginkgo flavone glycosides, and terpenoids (ginkgolides and bilobalide). Most of the research has used a standardized extract containing 24% ginkgo flavone glycosides and 6% terpenoids, at a dose of 40 to 80 mg three times per day.(7)
    
    Ginkgo has been shown to improve blood flow to the brain through several mechanisms, including improving vasoregulatory activity, decreasing blood viscosity, and antagonizing platelet activating factor.(8)
    

    Ginkgo is an anti-oxidant that acts to scavenge free radicals and to prevent peroxidation of lipids. Alzheimer's disease results from free radical damage to the brain, esp. peroxidation of the lipids that make up the membranes of the neurons in the brain. Thus, ginkgo may help to reduce loss of cognitive function in patients with Alzheimer's and other forms of dementia.(5)
    

    Ginkgo must be considered relatively safe, given the studies that have been conducted over the last 15 years. There have only been a few, relatively minor reported side effects related to taking ginkgo, including headaches and dizziness. Large dosages have occasionally caused mild stomach or intestinal upset. Ginkgo may be contra-indicated for patients taking blood thinners such as coumadin or warfarin.

    References:
    1. Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind, placebo-controlled trial of the ginkgo biloba extract EGb 761 in dementia. Dement Geriatr Cogn Disord. 2000 Jul-Aug;11(4):230-7.
    2. Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol. 1999 Jun;24(3):164-7.
    3. Schubert H, Halama P. Dpressive episode primarily unresponsive to therapy in elderly patients. Efficacy of Gingko Biloba in combination with antidepressants. Geriatr Forsch. 1993; 3: 45-53.
    4. Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials. Am J Med. 2000 Mar;108(4):276-81.
    5. Kleijenen J, Knipschild P. Ginkgo biloba for cerebral insufficiency. Br J Clin Pharmac. 1992; 34:352-8.
    6. Le Bars PL, Katz MM, Berman N, et al. A placebo controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA. 1997; 278:1327-32.
    7. Kleijenen J, Knipschild P. Ginkgo biloba. Lancet 1992; 340:1136-9.
    8. Krigelstein J, Beck T, Seibert A. Influence of an extract of Gingko biloba on cerebral blood flow and metabolism. Life Sci. 1986; 39:2327-34.
    

14. Pycnogenol. This refers to supplements derived from either grape seed or pine bark extracts. These supplements contain a group of flavonoids referred to as pro-anthrocyanidins. Proanthrocyanidins have extremely powerful anti-oxidant properties.
    
    
    
15. Garlic. This nutrient appears to help prevent heart disease and stroke. A number of studies have documented garlic's ability to lower LDL cholesterol and to raise HDL cholesterol. (1,2,3) Garlic has also been used to help lower blood pressure.(4)  One study indicated that garlic may prevent the stiffening of the blood vessel walls that tends to occur with aging.(5)  Garlic is also a natural blood thinner, which can help to increase circulation in those with clogging of the arteries.  A recent paper found that garlic supplements reduce and prevent the buildup of plaque in arteries.  In this study, the participants took 900 mg of garlic powder per day for 4 years.(6)
    
    Garlic also helps to strengthen the immune system. Garlic enhances various aspects of immune function, including natural killer cell activity. (7,8,9)
    
    References:
    1. Warshafsky S, Kamer RS, Sivak SL. Effect of garlic on total serum cholesterol. Ann Intern Med. 1993 119: 599-605.
    2. Jain AK, et al. Can garlic reduce levels of serum lipids? A controlled clinical study. Am J Med. 1993; 94: 632-5.
    3. Bordia A. Effect of garlic on blood lipids in patients with coronary heart disease. Am J Clin Nutr. 1981; 34: 2100-3.
    4. Steiner M, Khan AH, Holbert D, et al. A double-blind crossover study in moderately hypercholesterolemic men that compared the effect of aged garlic extract and placebo administration on blood lipids. Am J Clin Nutr. 1996; 64: 866-70.
    5. Breihaupt-Grogler K, Ling M, Boudala H, et al. Protective effect of chronic garlic intake on elastic properties of aorta in the elderly. Circulation. 1997; 96(8): 2649-55.
    5. Atherosclerosis. 1999;144:237-249.
    
    
16. Green tea. This form of tea, which is consumed primarily in China and Japan, has powerful anti-oxidant properties and may help to protect against certain forms of cancer. Green tea contains a number of compounds known as polyphenols, which are powerful antioxidants. The most important of these is epigallocatechin gallate, or EGCG. EGCG is believed to be 100 times as effective at soaking up free radicals as vitamin C and 25 times more powerful than vitamin E. It also enhances the actions of vitamin C and E. Epidemiological studies indicate that green tea consumption is associated with decreased risk of skin, esophageal, stomach, colon, lung and breast cancer.(1,2)
    
    The quantity of green tea consumed by the average Japanese is 3 cups of green tea per day, which provides approximately 240-320 mg of polyphenols. In order to receive the cancer protective effect, an individual would need to consume this amount of green tea daily, or the equivalent amount of polyphenols in a green tea extract.(3)
    
    References:
    1. Gao YT, et al. Reduced risk of esophageal cancer associated
    with green tea consumption. J Natl Can Inst. 1994; 54: 3428-2435.
    2. Yang CS, Wang ZY. Tea and cancer. J Natl Can Inst. 1993; 85(13):1038-49.
    3. Murray M. Green tea. The Am J of Natural Med. 1997; 4(5):18-19.
    
    
    
17. Echinacea. (purple coneflower) This is an herb that is commonly used both in the U.S. and in Europe to enhance the immune system. It was used extensively by Native Americans. There are at least nine species of the echinacea plant, though at least two of them--echinacea purpurea and echinacea angustifolia--have been shown to have beneficial effects on the immune system.(1,2)
    
    Echinachea has a number of beneficial effects on the immune system, including elevating the white blood cell count,(1,3) promotes T-cell activation(1), enhance macrophage activity(1), reduces the severity and duration of the flu(4) and the common cold.(5) 
    
    Echinacea is available in various preparations, including the crude plant ground or powdered, freez dried, alcohol based tinctures, and dry powdered extracts. The fresh pressed juice of Echinacea purpurea may be the most effective form, esp. if it has been standardized to contain a minimum of 2.4 percent beta-1,2-fructofuranosides. The usual dosage is 1/2 teaspoon taken 3 times/day.(1) If pills are taken, a dosage level of the dry, powdered extract that has been standardized to contain 3.5% echinacosides of 300 mg. 3 times per day has been recommended by experts. This is equivalent to 1/2 teaspoon of the fresh pressed juice of E. purpurea. It should be noted that alcohol based tinctures may be less effective, since they typically supply a very low dosage of echinacea. Research also indicates that the alcohol may result in a breakdown of the immunoactive polysaccharides contained in echinacea. This explains why one study showed echinacea not to be effective.(6)
    
    Since echinacea stimulates the immune system, it could theoretically counter the effects of immune suppressing drugs such as cortisone or cyclosporine. Individuals with autoimmune diseases, such as multiple sclerosis, lupus, rheumatoid arthritis, and inflammatory bowel disease should avoid echinacea.(7) Echinacea may interfere with sperm enzymes and should be avoided if trying to have a baby.(8)
    
    References:
    1. Murray MT. The Healing Power of Herbs. 2nd ed. (Rocklin, CA: Prima Publishing,1995), p.96.
    2. Rehman J; Dillow JM; Carter SM; Chou J; Le B; Maisel AS. Increased production of antigen-specific immunoglobulins G and M following in vivo treatment with the medicinal plants Echinacea angustifolia and Hydrastis canadensis. Immunol Lett. 1999; 68(2-3):391-5.
    3. Bauer R, Wagner H. Echinacea species as potential immunostimulatory drugs. Econ. Med Plant Res. 1991. 5: 253-321. 
    4. Lindenmuth GF; Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000; 6(4): 327-34.
    5. Schoneberger D. The influence of immune-stimulating effects of pressed juice from Echinacea purpurea on the course and severity of colds. Results of a double blind study. Forum Immunol. 1992; 8: 2-12.
    6. Melchart D. et al. Echinacea root extracts for the prevention of upper respiratory tract infections. Arch Fam Med. 1998; 7:541-5.
    7. Coleman E. Herb and drug interactions. Sports Medicine Digest. 21(9): 104.
    8. Ondrizek RR; Chan PJ; Patton WC; King A. Inhibition of human sperm motility by specific herbs used in alternative medicine. J Assist Reprod Genet. 1999; 16(2): 87-91.

    
    

18. St. John's Wort. (Hypericum Perforatum) This herb has powerful anti-depressant properties through its ability to increase serotonin levels in the brain.(1)  St. John's wort acts by inhibiting monamine oxidase, which results in an increase in serotonin. 
    
    The recommended dosage of St John's wort extract standardized to contain 0.3% hypericin is 300 mg. taken 3 times per day. 
    
    Hypericum at high concentrations may interefere with sperm motility and should be avoided if your goal is to reproduce.(2)
    
    References:
    1.  Murray MT. The Healing Power of Herbs. 2nd ed. (Rocklin, CA: Prima Publishing,1995)
    2.  Ondrizek RR; Chan PJ; Patton WC; King A. Inhibition of human sperm motility by specific herbs used in alternative medicine. J Assist Reprod Genet. 1999; 16(2): 87-91. 
    
    
19. Reservatol.  Reservatrol is a polyphenolic compound found in grapes, red wine, purple grape juice, peanuts, and some berries. Reservatrol has powerful anti-oxidant properties and it has been shown to inhibit LDL cholesterol oxidation, thus potentially playing a role in preventing cholesterol buildup in arteries. This could explain why moderate alcohol consumption has been associated with lower risk of cardiovascular disease, though more research is needed.
    
      
20. Cinnamon. Cinnamon has been shown in several relatively small studies to reduce blood glucose levels in Type II diabetics, though not all the published studies have shown a positive benefit. Cinnamon has been shown to enhance insulin activity in vitro.(1) In a study of 60 type II diabetics, cinnamon consumed in capsule for 40 days was found to reduce serum glucose, triglycerides, LDL cholesterol, and total cholesterol at a dosage of 1, 3, or 6 grams per day.(2)  A study published in 2007 demonstrates that adding 6 grams of cinnamon to pudding significantly lowers the post-prandial glucose response and also delays gastric emptying.  The blood sugar response was more pronounced than might be expected by the slowing of the gastric emptying rate (GER), so this cannot be a full explanation of how cinnamon works. Animal studies have shown cinnamon to act directly on the insulin receptors to decrease insulin resistance and enhances insulin signaling.
    
    Cinnamon has been used for centuries without harm, so we know it is safe. Therefore, given it's potential to improve insulin sensitivity of the cells, we recommend consuming cinnamon, esp. if you have hypoglycemia or diabetes. Cinnamon is found in the Metaglycemx tablets as well as in the Ultrglycemx medical food from Metagenics.
    
    References:
    1. Broadhurst CL, Polansky MM, Anderson RA: Insulin-like biological activity of culinary and medicinal plant aqueous extracts in vitro. J Agric Food Chem. 2000;48:849-852.
    2. Khan A, Safdar M, Khan MMA, et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003; 26:3215-3218.
    3. Hlebowicz J, Darwiche G, Bjorgell O, Almer L-O. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects. Am J Clin Nutr. 2007;85:1552-6.
    
    
    

NOT RECOMMENDED:

The following are some supplements that we do not recommend as there is either a lack of sufficient research at the present time to back up the claims made about them or there is considerable concern about their safety:

1. Pyruvate. This product is touted for bodyfat/weight loss, however, the research backing it up is slim at best. Nearly all of the dozen or so studies were done by the same researcher (Stanko), which should make you suspicious. Although about half of these studies were animal (rat) studies, they did show benefits from pyruvate supplements. However, most of the weight or fat loss due to the pyruvate was rather modest and the dosages used were extremely high--15 to 25 grams per day--higher than the 3 to 5 grams recommended by most available supplements. This makes pyruvate an extremely expensive supplement of questionable benefit.
   
   
2. Ephedrine. This herb is used for an energy boost or for weight loss. It is sold either as ephedrine, as the herb Ma Huang, or the herb Sida Cordifolia. Some of the swimmers and other athletes were using it, until it was banned by both the International Olympic Committee and the NCAA.  Ephedrine is often combined in products also containing caffeine and aspirin, a combination that has been touted for reducing bodyfat.(1)
   
   Ephedrine is a stimulant, similar in chemical structure to the amphetamines. It raises both heart rate and blood pressure. There have been numerous reports of adverse reactions, including insomnia, cardiac arrhythmia, heart attack, stroke, seizure, and death.(2,3,4)  It does have a weight loss and ergonomic effect, but it is unsafe and should not be taken. It is even more dangerous if it is taken in combination with caffeine containing products, such as coffee or guarana, or with other stimulants.
   
   References:
   1.  Daly PA, et al. Ephedrine, caffeine and aspirin: Safety and efficacy for treatment of human obesity. Int J Obesity. 1993; 17 (Suppl 1): S73-78.
   2.  Coleman E. Herb and drug interactions. Sports Medicine Digest. 21(9): 104.
   3.  Zahn KA; Li RL; Purssell RA. Cardiovascular toxicity after ingestion of "herbal ecstacy". J Emerg Med. 1999; 17(2): 289-91. 
   4.  Cupp MJ. Herbal remedies: adverse effects and drug interactions.  Am Fam Physician. 1999; 59(5): 1239-45.
   
3. HMB. HMB is short for Beta-Hydroxy Beta-Methylburate, which is a leucine metabolite, and is one of the newer sport supplements. It is claimed that HMB improves recovery of muscle cells after workout induced damage. There is very little research to back it up and both of the studies that seem to show efficacy have been performed by the folks at the University of Iowa who hold the patent rights--Metabolic Technologies Inc. (MTI)--which makes it suspect. Other research seems to indicate no increase in either muscle hypertrophy or strength with supplementation with HMB.(1,2) Combine this with the fact that it is extremely expensive--approximately $100 for a month's supply--and we must give this product a thumb's down until more research has been able to validate the claims that it results in increased muscle mass and strength.
   
   References:
   1.  Effects of beta-hydroxy beta-methylbutyrate on power performance and indices of muscle damage and stress during high-intensity training. Hoffman JR, Cooper J, Wendell M, et al.  J Strength Cond Res. 2004; 18(4):747-52.
   2.  The effect of beta-hydroxy beta-methylbutyrate on muscular strength and body composition in collegiate football players. Ransone J, Neighbors K, Lefavi R, Chromiak J.  J Strength Cond Res. 2003; 17 (1): 34-9.  
   
   
   
4. DHEA. Dihydroepiandosterone (DHEA) is a steroid hormone secreted by the adrenal glands that tends to decrease with aging. DHEA is used by the body to make other hormones, especially testosterone and estrogen. Middle aged men, athletes, and even women are supplementing DHEA and other hormones (such as testosterone and growth hormone) in an attempt to regain a more youthful appearance and vigor, to increase muscle mass, and to improve their health.
   
   While there may be some individuals who are really benefiting from taking supplemental DHEA, we feel it would be more prudent to inquire why the DHEA levels dropped? Perhaps smoking cessation, stress reduction, and other lifestyle and dietary changes can help normalize hormone levels. And perhaps our hormone levels are supposed to slowly decrease as we age. It may be seen as a way for our bodies to naturally slow down. Consider that a 70 year old may be better off not having the jacked up hormone levels of a 20 year old. Supplementing with hormones is the trendy way to try to reverse the effects of aging, but is it really the healthiest thing to do, esp. if the goals are more related to vanity than to health, such as a younger appearance and larger muscles?
   
   In addition, recent research indicates that long term administration of low levels of DHEA (25 mg./day) may not result in elevated DHEA and testosterone levels, as is presently believed. A recent study using postmenopausal women found that while DHEA supplements initially resulted in increases in serum DHEA, testosterone, and IGF-1, after 6 months, these hormone levels had dropped back to their prior levels.(1) Even worse, the levels of HDL cholesterol (the good kind of cholesterol) had decreased by 12.9% in the DHEA group. Thus, at least in post-menopausal women, low dose DHEA therapy may not be helpful and may even have harmful consequences.
   
   References:
   1.  Casson PR, Santoro N, Elkind-Hirsch K, et al. Postmenopausal dehydroepiandosterone administration increases free insulin-like growth factor and decreases high-density lipoprotein: a six-month trial. Fertil Steril. 1998; 70: 107-110.
   
   
5. Chaparral.  This herb is unsafe and a potential cause of liver damage.(1,2)  I strongly recommend that you avoid any supplements containing chaparral.
   
   References:
   1.  Herbal roulette. Consumer Reports. November 1995:698-705.
   2.  Hinck G. The role of herbal products in the prevention of cancer. Top Clin Chiro. 1999; 6:54-62.
   3.  Toxic acute hepatitis and hepatic fibrosis after consumption of chaparral tablets. Kauma H, Koskela R, Makisalo H, et al. Scand J Gastroenterol.  2004; 39(11): 1168-71. 
   
   
6. Kombucha tea.  When home brewed, this tea has been found to have unsafe levels of contaminants, such as bacteria, and some deaths have occurred from drinking this tea.(1,2)  There is very little scientific evidence of there being any benefits from drinking Kombucha tea.
   
   References:
   1. Spaulding-Albright N. A review of some herbal and related products commonly used in cancer patients. J Am Diet Assoc. 1997; 97(10): S208-S215.
   2. Hinck G. The role of herbal products in the prevention of cancer. Top Clin Chiro. 1999; 6:54-62.