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Natural Healing Secrets
Vol. 14, Issue 9 -- October 2017
Coconut oil -- health food or overhyped?
Most Americans have the impression that coconut oil is a healthy food. A recent report from the American Heart Association advised against its use, stating that it increases LDL cholesterol (a cause of cardiovascular disease). Dr. Walter C. Willett, professor of epidemiology and nutrition at Harvard, says, "There are many claims being made about coconut oil being wonderful for lots of different things, but we really don't have any evidence of long-term health benefits."
Other studies in past years have shown coconut oil to have some benefits. You would think by now, after decades of evaluating its uses and benefits, that science would have a better idea of its overall value. But, as with many other areas of nutritional research, these issues are complicated and it is not uncommon for studies to show conflicting results.
The professor continues, "Coconut oil is somewhere in the middle of the spectrum in terms of types of fats. It's probably better than partially hydrogenated oils (which are) high in trans fats but not as good as the more unsaturated plant oils that have proven health benefits, like olive and canola oil."
Based upon my reviews over the years, I am not keen on using too many oils, at least in high amounts, in cooking. I personally do use small amounts of extra virgin olive oil on my salads, and a small amount of butter and coconut oil in cooking, but I don't think the human body does well when exposed to high amounts of oils of any type.
Bottom line: I do not think coconut oil is unhealthy if used in small amounts, but I would suggest to those who cook with large amounts -- thinking that they are doing good to their body -- to use less. See www.raysahelian.com/coconutoil.html
Grape seed extract pills for reducing blood pressure
Thereís evidence that grape seed extract could help those with heart and blood vessel conditions. This supplement may also be of use to those with chronic venous insufficiency and high cholesterol. Add blood pressure lowering as another benefit of grape seed extract. A recent review of 16 randomized controlled trials shows this supplement to be useful for those with hypertension. The scientists conclude, "Our findings demonstrate that grape seed extract exerted a beneficial impact on blood pressure, and this impact was more obvious in younger or obese subjects, as well as in patients with metabolic disorders." See www.raysahelian.com/grapeseed.html
Alpha lipoic acid beneficial to those with high
A clinical trial was conducted to find out the role of a supplement containing α-lipoic acid in those with type 2 diabetes. Diabetics took a supplement containing 600 mg of α-lipoic acid, 165 mg of L-carnosine, 7.5 mg of zinc, and vitamins for three months and were compared to a group who took placebo pills. At the end of the study period, those who took the supplement showed improved blood sugar control, lipid profile, and anti-oxidative stress markers.
Note: In my opinion 600 mg of lipoic acid is too high. I prefer less than 100 mg a day. See www.raysahelian.com/lipoic.html
Soy products and the thyroid gland
A case report in a Japanese medical journal reviews the medical history of a 72 year old woman with a high consumption of isoflavones that resulted in low thyroid function. See www.raysahelian.com/thyroid.html
Testimonial received by email in September 2017
After first taking Mind Power Rx as part of a regime I successfully use to combat my symptoms of ADHD (predominantly inattentive, PI, type), I recommended it to my 17-year-old ADHD-PI diagnosed nephew (and his mother) who decided he wanted to cycle off of Ritalin and I have administered it to my ADHD-PI 9-year-old daughter. In the case of my daughter, I had tried supplements which mixed together similar, but not identical, combinations of substances to little effect. We all have noted very positive effects with Mind Power Rx, my daughter included. My nephew has successfully been able to stay off Ritalin and my daughter says she's able to focus in a way that she hadn't been able to previously. My own experiences with stimulant medications led me to believe that they can have very troublesome side effects and perhaps do long-term damage. I wanted to avoid having my daughter try prescription stimulants and with Mind Power Rx observe a significant enough resolution of symptoms (for several hours after her taking it) that I am able to do so. There is recent research to back up the concern about long-term changes to the brain in children who take stimulants, changes which persist into adulthood after the brain stops changing in significant ways (post-23 years old). If you ever decide to change the recipe for Mind Power Rx from its current one, please let me know so I can buy several cases of it to put in the freezer for future use!
Hair growth, the problems with finasteride
Q. I have a son who started losing his hair at age 14. We met with multiple doctors to rule out underlying medical reasons for the condition. Nothing identified except for just early balding. He started on finasteride (Propecia) in High School and is still using that. He has had unexplained depression, suicidal thoughts and insomnia. We havenít asked about libido and those related issues. Can you point me to medical research or studies that have been done on this medicine? I see that you support and market several herbal remedies for various medical conditions. I happen to agree that those are often more valuable than traditional medicine. Some in the medical field might believe your involvement in the marketing of herbal products might skew an opinion on something like finasteride. Iím not sure how much good the drug is doing for my son and Iím very concerned about the possible side effects, especially if they are well documented.
A. Finasteride, the product name being Propecia 1 mg, is prescribed by doctors for hair growth. And it works for that purpose but has to be taken for several years. Finasteride is also sold by the product name Proscar at a dose of 5 mg as a treatment for prostate gland enlargement. It also works for that condition to help reduce prostate gland size. However, over the years, multiple side effects have been noticed that did not initially appear as distinctly in the early testing. A recent article in JAMA Internal Medicine has the title, "Association of Suicidality and Depression With 5α-Reductase Inhibitors." The abstract states, "There have been concerns raised by patients and regulatory agencies regarding serious psychiatric adverse effects associated with 5α-reductase inhibitors [finasteride, dutasteride]. In men ages 66 years or older, we did not find an increased risk of suicide associated with 5α-reductase inhibitor use. However, the risk of self-harm and depression were increased."
Unfortunately, I am not aware of dietary supplement pills that have been consistently proven to grow hair but there are some early studies that show natural remedies to have some hope, see www.raysahelian.com/hair.html. In addition to low mood with the long term use of finasteride, there can be a decrease in vitality and a marked increase in sexual dysfunction, see www.raysahelian.com/finasteride.html.
Natural Healing Secrets
Vol. 14, Issue 8 -- August 2017
Alzheimer's disease and other forms of age related
mental decline are difficult to treat. Modern medicine does not have
good treatment options. If an older patient is taken to a neurologist
for evaluation and treatment, the most likely prescription given by the
doctor is for medications known as cholinesterase inhibitors [donepezil
(Aricept), galantamine (Razadyne) and rivastigmine (Exelon)], or another
drug called memantine (Namenda). Although some patients benefit from
these drugs, many don't. In these cases patients and their caretakers
remain frustrated and some seek natural alternatives. Do natural
supplements play a role in improving mental function in such patients?
Recently a middle aged woman who has been my patient off and on for more than a decade sent me an email, "Dr. Sahelian, I just wanted to let you know something interesting about my mom. She is 78 years old and for the past 6 months has been prescribed memantine for Alzheimer's disease. Even though she takes the pill daily, I have seen no change in her memory or mental functioning. If anything there has been a steady decline. Out of desperation I decided to try natural supplements. I read your article on Alzheimer's disease and it listed a number of dietary supplements that could potentially help. I called her doctor and asked if it was okay to switch her for a while to natural pills since the meds had not worked. Surprisingly the neurologist agreed to try for a month. I stopped the memantine and chose acetyl-l-carnitine, Mind Power Rx, and carnosine. Each day I alternated one pill. Within a few days she became more talkative, more alert and she herself noticed that she was thinking clearer. It has been two months now and the benefits are still there. She still has memory problems but I would say she is 20 to 30 percent better. On the other hand the memantine was doing nothing that I could notice. Oh, I forgot to mention that I also added two fish oil pills a day."
Natural alternatives to Alzheimer's medications
Over the years I have treated many patients with mental decline and have found that it takes trial and error to find out which brain boosters are of benefit. Not all patients are helped with natural treatments, but if the prescription medications are not helping there is little to lose by trying natural options. See www.raysahelian.com/alzheimer.html
Although there are more that a dozen common natural supplements that can be tried, my preferences are acetyl-l-carnitine, carnosine, Mind Power Rx, cdp-choline, huperzine, galantamine, along with fish oils and a low dose B vitamin complex (or MultiVit Rx). There is no accepted regimen on how to take these. One option is to choose one of these supplements and take it daily for a couple of weeks to see how it works. Another option is to purchase three or four of them and alternate them: For instance the first day acetyl-l-carnitine, the next day carnosine, the third day Mind Power Rx, and then repeat. It is nearly impossible to predict which one(s) will be preferred by the patient or be noticed as beneficial by the caretaker. Since these supplements are generally safe, there is little to lose by giving them a chance.
I would be very interested in feedback from any caretaker who has given any of these supplements (or others) to a person with mental decline. Another potential treatment option is to combine one of the prescription medications with a natural supplement but there is very little research on this and I would only recommend this option if the medications and supplements are not effective when taken alone. For more information on natural supplements that improve brain function, see www.raysahelian.com/memory.html
Alcohol and longevity
Q. I am confused about the role of alcohol in longevity and heart disease. I heard on TV that alcohol shortens lifespan, but then recently I heard the opposite -- that it could help one live longer. Which is it?
A. Studies are not yet conclusive as to whether drinking wine, beer, or other forms of alcohol lengthens life. Most recent studies suggest light to moderate drinking can lower the risk of premature death and, specifically, the odds of dying from heart disease. One or two drinks a day appears to be safe and potentially beneficial in most people.
Eye floater treatment
Q. I have an eye floater that started two months ago and does not seem to go away. It annoys me greatly. Is there a natural solution to get rid of it?
A. Floaters appear as spots, dots, or lines and can interrupt vision. Floaters are usually caused by bits of debris, or perhaps a small blood clot, in the vitreous humor. The vitreous humor is a clear gel-like substance that occupies the space behind the lens in front of the eye and the retina in the back of the eye.
There are three management choices for floaters: Waiting and patience; surgery; and a laser procedure known as YAG vitreolysis. About half of floaters go away after the laser procedure. I am not aware of any herbs or natural methods that get rid of floaters. Over several months or years most floaters are naturally reduced in size or disappear or move to the side and away from the direct line of vision. Most people eventually get used to the floater and instinctively ignore it.
Those who are at risk for floaters include people with known retinal diseases, diabetes, previous eye surgery, eye trauma (sometimes during sports), previous eye inflammation, bleeding disorders, chemotherapy, and blood thinning therapy. Some blood thinners that are known to cause floaters include warfarin (Coumadin), clopidogrel (Plavix), NSAIDs such as Motrin and Aleve, and aspirin (Bayer).
Yoga benefit and risk
Q. I am thinking of starting a yoga practice but a friend of mine said that when she started her arms and wrists started hurting. Do you think yoga is safe?
A. Yoga has a number of benefits that apply to almost every tissue in the body. Most people report existing aches improve after doing yoga -- most often, lower back and neck pain. But some report yoga worsened their muscle or joint pain. And a small percentage report it caused new issues -- most commonly, pain in the hand, wrist, elbow or shoulder. The idea is to start with easy classes, called relaxation or yin yoga. For a full benefit of yoga practice and the research that supports the benefits, see www.raysahelian.com/yoga.html.
Natural Healing Secrets
Vol. 14, Issue 7 -- July 2017
In the last issue of
the newsletter I talked about how we, as a culture, are eager to undergo
a vast array of blood or other tests with the idea that the more we
test, the more we try to find a medical condition sooner, the more
aggressive we treat an early diagnosis, the better. Although this is
true in many or most cases, I just want you to be aware that too much
testing or too aggressive a treatment can sometimes be
counterproductive. In the July 2017 issue of The New England Journal of
Medicine, a 20 year follow up revealed that men who were treated
aggressively with surgery for early prostate cancer did not fare any
better than those who were followed up and observed over time.
Furthermore, many of the men who had the surgery ended with
complications including urinary incontinence and ED. See
www.raysahelian.com/prostatecancer.html for natural ways to reduce
the risk of prostate cancer.
Again, I am not against blood tests, PSA tests, or mammograms, etc.. I just think that, as a society, we are doing too much testing and not enough to prevent diseases through lifestyle changes.
Krill oil supplements
for lowering lipid levels (cholesterol, trigycerides)
I am a big proponent of omega-3 fatty acids as found in fish, fish oils, and krill oil. A recent review of numerous controlled trials completed in the past few years indicates that supplementation reduces low-density lipoprotein cholesterol (LDL cholesterol, the bad type) and triglycerides. It may be a good idea for anyone who has has a problem with high cholesterol or triglyceride levels to include 2 to 4 krill oil pills a day in their supplementation regimen. Or you could take 1 or 2 krill oil pills and 1 or 2 fish oil pills. See www.raysahelian.com/krilloil.html
Overactive thyroid natural
Most cases of hyperthyroidism are treated with antithyroid medicines or radioactive iodine therapy. If you have a mild to moderate case of hyperthyroidism and wish to try a natural approach, review this study with your doctor. Researchers recruited patients with TSH levels between 0.1-0.4 mIU/L (a low TSH level is a sign of an overactive thyroid). Normal TSH levels range between 0.5 to 4. Subjects received orally for one month one tablet containing 500 mg of l-carnitine and 83 mcg of selenium. The results showed improvement in symptoms after treatment. During the following 1-month period without treatment, symptoms became worse again. Thyroid hormones and auto-antibodies remained in their normal range. The researchers conclude, "The present pilot study has shown that a combination of carnitine and selenium reduced symptoms associated with hyperthyroidism, improving quality of life of patients, without significant modifications of their hormone levels. In addition, it is noteworthy that the extension of treatment seems necessary to prevent symptoms reappearance."
Comments: This was a small study so I am not ready to jump to conclusions that carnitine treatment is an effective approach to treat symptoms of overactive thyroid, but I did find it interesting. The dosage of selenium can range from 50 mcg to 100 mcg, it does not have to be 83 mcg. You could try carnitine between 250 mg to 500 mg. Please discuss with your health care provider before making any major changes. Perhaps the use of carnitine could reduce the dosage of anti-thyroid medications, but this has yet to be studied. See www.raysahelian.com/thyroid.html
Cholesterol drugs may increase risk for Parkinson's
Certain statin medications -- those that are fat-soluble, rather than water-soluble -- are associated with an increased risk of Parkinson's disease. Fat-soluble statins can cross from the blood into the brain include drugs such as atorvastatin (Lipitor), fluvastatin (Lescol) and simvastatin (Zocor). Parkinson's is a movement disorder that affects nearly 1 million people in the United States. The cause of this potential association is not clear yet but may have, at least partly, be related to CoQ10. Statins lower not only cholesterol levels, but also coenzyme Q10. This nutrient produces energy for cells, and there is evidence it may help protect nerve cells. See www.raysahelian.com/parkinson.html
Lowering eye pressure -- glaucoma -- with supplements
Twenty-two patients with glaucoma were enrolled and randomly assigned to a food supplement or control treatment group while their intraocular pressure was being treated by topical drugs. The food supplement treatment consisted of 2 tablets per day (1 in the morning, 1 in the evening) given for 1 year of homotaurine, Coleus forskohlii root extract, L-carnosine, folic acid, vitamins B1, B2, B6, and magnesium. Patients who took the supplements had a significant further decrease in eye pressure. See www.raysahelian.com/glaucoma.html
Comments: I am not sure which of the individual supplements had more of an effect than the others. Homotaurine is related to the amino acid taurine and I don't think it is available as a supplement. Coleus forskohlii extract has been studied as a natural way to reduce eye pressure. Carnosine is an interesting substance with many health benefits.
I have used Passion Rx with Yohimbe for years and I find that it works great. I sometimes take 1 capsule in the morning and it keeps me going without any kind of over stimulation... like too much coffee. It also makes me way more talkative, more motivated, and I think clearer and better. I would like to know if there is something that you have that would have a similar effect without the increase in libido. I take the Passion Rx usually for a two days in a row prior to anticipated sex (works absolutely great). I am married so I really don't want to take the Passion Rx frequently as it can make me a bit too aggressive with other females than I should be. I usually use it 1 capsule Friday amd Saturday mornings. Also not every week... about 3 weekends a month. I have taken 2 capsules in a day before but the effects are too strong. I get way too talkative and anxious... almost slightly aggressive sexually. It has definite aphrodisiac effects and makes me physically more sensitive to touch.
A. Many users report a similar experience as yours regarding Passion Rx with Yohimbe. If you would like to feel more energetic and motivated without much of an influence on libido, MutiVit Rx works really well for this purpose, one or two capsules in the morning before breakfast. See http://www.raysahelian.com/passionrx.html
Natural Healing Secrets
Vol. 14, Issue 6 -- June 2017
I am sometimes asked, either from patients or by email,
whether genetic testing or extensive blood tests can help determine
which vitamins or supplements one should take. I have also received spam
emails encouraging me to recommend genetic testing for patients. One
such email claimed, "Our company does DNA tests of 90 genetic markers
and we provide a comprehensive personalized report that includes
nutrient, exercise and lifestyle recommendations based on the client's
genotype. We also do a comprehensive micronutrient panel that tests
genetic markers linked to the body's predisposition to absorbing
vitamins and minerals in the client's diet."
My opinion: Such tests are bogus. Of course there are some genetic conditions that influence the absorption or metabolism of vitamins and minerals in the body, but these conditions are rare and the average person will have no benefit undergoing such testing, not to mention the reliability or accuracy of the testing done by such companies that promote by email.
As to blood tests to determine vitamin and mineral levels, an argument can be made for some such as vitamin D levels, B12, and others when specific medical problems are suspected. I am not a proponent of casual routine testing for vitamin or mineral levels unless there is a clinical symptom or sign that makes a physician suspicious that there is a deficiency or a metabolic disorder. I am a big believer in a thorough medical history, family history, including a full review of one's dietary habits, stress levels, sun exposure, exercise habits, sleep patterns, alcohol, tobacco or drug use (in a nonjudgmental manner) and a full physical exam. In the vast majority of cases this thorough review (which can take a lot of a doctor's time), leads more useful information than random blood tests. Unfortunately our medical system does not reimburse doctors for taking so much time with a patient and hence patients are often sent for blood tests as a shortcut.
One additional point I would like to mention is that even when blood tests are done, the recommendations of doctors can vary. For instance if a slightly low levels of vitamin D is found in the blood test one doctor may suggest 400 units, another 1,000 units, and still others 2,000 or 5,000 units a day. Medicine is still an art rather that a science. Many people think that blood tests give definitive answers, but this is not always the case. In some cases much harm can result from testing... an example follows below.
Near fatal experience as a result of routine testing
for testosterone levels
"I was healthy until I fainted and was taken to the emergency room. They said my heart was beating irregularly and I had a heart attack," revealed a 60 year old new male patient who consulted with me a few weeks after being discharged from the hospital. He was referred to me by a close friend. He continued, "Before my heart attack I had gone to a highly regarded university doctor for a routine exam. He did a few blood studies and told me I had borderline low testosterone levels and suggested testosterone injections twice a month. At first I noticed a great boost in energy levels and libido, and a good sense of wellbeing. But, after a few weeks I started feeling heart palpitations and having trouble sleeping at night. Then, one evening, I was watching TV with my wife and then the next thing I remember I woke up and found myself in the emergency room."
Extensive testing at the hospital showed his coronary arteries to be open and healthy and the cardiologists could not explain why he had a heart attack. He had told them he was on testosterone injections but none of the hospital doctors mentioned that there could be a relation. After reviewing all the medical information that he had provided to me, my conclusion was that his heart attack could be related to his testosterone injections. Studies over the past few years have found such a connection. I recommended he stop any further hormone treatment. It has now been over a year and he has not had any heart palpitations. I cannot be 100 percent certain that the hormone injections were the cause, but there is a very high likelihood that this was the case. If so, it shows how routine testing can sometimes lead to a treatment that ultimately causes more harm than good. For more information see www.raysahelian.com/testosterone.html
My intent is not to say testing for testosterone levels or other blood tests is a bad idea, but just to point out that not all testing results in good outcomes.
French Fries -- not so good
I visited Europe in April of this year, France, Belgium, and The Netherlands. I was surprised on how often the side dish of many meals in restaurants was French fries rather than vegetables. Italian researchers recently reported that those who frequently consume fried potatoes -- which include French fries, potato chips, hash browns and any other potato foods requiring a fryer -- are much more likely to die prematurely. Although this study is not conclusive (since people who eat a lot of fried potato products may also have a diet that has other unhealthy foods), one should still be concerned and minimize such consumption. For suggestions on healthy dietary choices, see www.raysahelian.com/diet.html
Mucuna pruriens testimonial received by email
In my quest to find out why I smoke, thereby to quit smoking, I thought that boosting the dopamine receptors in the brain would give that "reward" that nicotine supposedly is providing. I bought a bottle of Mucuna Pruriens and right away noticed that it had no effect on my desire to smoke, but had a very strong impact on my nervous tension and anxiety. Shortly after this, my wife was admitted to the hospital for acute renal failure, with an ensuing diagnosis of cancer. I began taking one of the capsules each day, prior to my going to visit in the hospital. I can't say enough about how effective this has been in managing my stress levels! Mucuna has been a life-saver. I do take other nutritional supplements, and I'm fairly well versed on the overall field. For many people, the enhanced dopamine effect may just increase mood, libido or whatever else. But for me, in my stressed-out world, this herb seems to provide optimism. I can think more clearly, without the panic attacks of each new lab result, test, diagnosis and whatnot. I have a better "outlook" on events, and can navigate the days without being overwhelmed and pushed into depression.
A. We have had quite a few positive testimonials from individuals using this herbal extract, see www.raysahelian.com/mucunapruriens.html
Natural Healing Secrets
Vol. 14, Issue 5 -- May 2017
A third of new drugs approved by the FDA in recent years and then prescribed by doctors to their patients have later been found to cause major side effects that were not initially detected. The average time of awareness of these major health issues caused by these new medications (which include severe allergic reactions, liver damage, cancer, or death) is about four years. As a physician I never prescribe a new drug (unless for a life threatening condition where no other options are available) until several years have passed and much more clinical information has been gathered. Before the FDA approves a new drug, in most cases, the studies include fewer that 1,000 test subjects and a period of use less than 6 months. In the real world millions of people may eventually take the drug regularly and for much longer periods, thus unmasking adverse reactions that were not initially noticed with a smaller sample of users and for shorter periods of use. This is true also for some herbal supplements, which, although inherently much safer, have often not been studied for prolonged periods. That is why I often recommend people not take the same supplement for long periods without breaks. Before you fill out a new medication prescribed to you by your doctor, ask how long it has been on the market and how much experience your doctor with it and feedback that he or she has had from patients using it.
Sun exposure has benefits beyond vitamin D
Q. My doctor told me that I should take 3,000 units of vitamin D a day and, as a result, I don't need to be exposed to the sun. What is your opinion on this?
A. Although many people rely on vitamin D supplements, believing that it is an adequate replacement for sun exposure and useful as a nutrient or hormone to treat and prevent chronic illnesses, including cardiovascular disease, type 2 diabetes, osteoporosis, autoimmune diseases, and cancers, it is becoming more apparent that we benefit in many other ways when exposed to the broad spectrum of solar radiation. Vitamin D production from the skin when exposed to sunlight is just one of the many photochemicals produced in the skin that have important implications for overall health. Sun exposure is able to reduce blood pressure, whereas vitamin D supplementation alone is not. Exposure to sunlight leads to the production and release of nitric oxide and beta-endorphin; increased production in adrenocorticotropin hormone; and enhancement of collagen synthesis and wound healing. These processes are controlled by various energies (i.e., wavelengths within the solar spectrum including UVA, UVB, and visible and infrared radiation). In addition, solar exposure has a direct influence on the immune system, inducing immune tolerance and improving the body's ability to fight infection by dangerous germs. Source: The D-lemma: narrow-band UV type B radiation versus vitamin D supplementation versus sunlight for cardiovascular and immune health. American Journal of Clinical Nutrition, 2017.
My advice: Try to get at least 15 minutes of sun exposure a day, even if you are taking vitamin D pills.
Do bodybuilders need more protein?
The Institute of Medicine suggests that healthy adults consume daily about 0.4 grams of protein for every pound of body weight. A person weighing 150 pounds would need, for example, about two servings of meat or three eggs each day to be assured of meeting protein requirements. Children and the elderly may require more. Research suggests that bodybuilders require substantially more protein than the average adult. Some scientists are now recommending bodybuilders to consume about 1 gram of protein for every pound of body weight on a daily basis. Source: Indicator amino acid-derived estimate of dietary protein requirement for male bodybuilders on a nontraining day is several-fold greater than the current recommended dietary allowance. Journal of Nutrition, 2017. And: Protein recommendations for bodybuilders: in this case, more may indeed be better. Journal of Nutrition, 2017.
Emails from readers
Testimonial about mucuna pruriens herb (I discussed the interesting benefits of this herb in a recent newsletter)
Q. In my quest to find out why I smoke, thereby to quit smoking, I thought that boosting dopamine receptors in the brain would give that "reward" that nicotine supposedly is providing. I bought a bottle of the mucuna pruriens herb and noticed that it had no effect on my desire to smoke, but had a very strong impact on my nervous tension and anxiety. Shortly after this, my best lady was admitted to the hospital for acute renal failure. I began taking one of the capsules each day, prior to my going to visit in the hospital. I can't say enough about how effective this has been in managing my stress levels! For many people, the enhanced dopamine effect may just increase mood, libido or whatever else. But for me, in my stressed-out world, this herb seems to provide optimism. I can think more clearly, without the panic attacks of each new lab result, test, diagnosis and whatnot. I have a better "outlook" on events, and can navigate the days without being overwhelmed and pushed into depression.
A. This is interesting, others have also noted the ability to handle stress better. For more info, see http://www.raysahelian.com/mucunapruriens.html
I am a medical doctor and see a lot of people with cancer and a Danish doctor who has been doing a lot
of research with Coq10 and cancer found that they needed 400mg daily to get any
real benefit. I have had people on CoQ10 for at least 2 years on that dosage and
never seen a side effect of any kind. All my adult cancers take this CoQ10
dosage. Are your recommendations not to exceed 50 mg a day too low?
A. When people take CoQ10 in high dosages as a daily supplement for many years or decades, we have no idea how this will interfere with their metabolism. It is unnatural to expose the body to such high dosages. What if we learn 20 years from now that people taking more than 200 mg a day actually live a few years shorter or somehow their mitochondria are not functioning as well? As with post-menopausal hormone replacement therapy, it took decades for the scientific community to find out that it caused problems that they had not expected. CoQ10 appears to be a healthy supplement, but who knows for certain that taking more than 100 mg is healthier than taking less? Many people who take CoQ10 also take other supplements, or medications, and we have no idea the interactions that could occur. Plus, what if someone who is used to taking 400 mg a day goes on a trip and forgets their bottle and in the foreign country they can't find CoQ10? If, after years of taking 400 mg their body is used to it, what happens if they stop? What if when they are older and they are on a limited budget they can't afford buying it anymore? There are many answers about high dose CoQ10 use that we don't know yet. We also have reports from quite a few people who actually feel fatigued when they take more than 100 mg daily, maybe from being still too revved up at night while trying to sleep. Perhaps high doses for cancer or other conditions is appropriate, but for the general public taking CoQ10 as a supplement for health promotion, there is no proof that taking very high amounts is beneficial. We also have to consider the cost, CoQ10 is expensive. For the time being I suggest 30 or 50 mg most days of the week for those who wish to take this supplement.
Natural Healing Secrets
Vol. 14, Issue 4 -- April 2017
Pick up any health magazine and you are likely to see articles promoting the health benefits of antioxidant supplements such as vitamins C and E. There are hundreds or thousands of such beneficial antioxidant substances, and you just canít take all of them. We receive frequent emails asking us which ones to take and in what dosages. Keep in mind that as of yet there is no definitive proof that supplementation with antioxidants will help you live longer. Such long term studies are not yet available, and it is possible that taking too many such pills can be counterproductive. However, there is enough promising evidence to convince me that they could be of benefit when used wisely and could potentially reduce the risk of cancer, heart disease, and other chronic conditions.
Food and diet first before pills
Make sure you obtain the bulk of your antioxidants through fresh foods. Carotenoids, flavonoids, and many important polyphenols can be easily obtained through fresh fruits, vegetables, herbs, along with raw nuts and seeds. If you do wish to take additional supplements, I recommend a multi-mineral, multi-vitamin pill that contains small amounts of many antioxidants as opposed to large amounts of just one or two. MultiVit Rx offers such a good mix. Another option is have three or four potent antioxidant products on your kitchen counter (such as alpha lipoic acid, carnosine, acetylcysteine and acetylcarnitine) and alternate their use so you get the benefits from the different antioxidants since they each work in various ways in the body and brain to protect cells from harm.
For more information and dosage recommendations, see www.raysahelian.com/antioxidant.html.
Maca herb for women post menopause
Maca is a plant from South America that has been used for centuries for its fertility-enhancing and aphrodisiac properties. Australian researchers gave 3 grams a day of maca herb to a group of postmenopausal women for a period of six weeks. The herb did not exert any significant hormonal changes in these patients but it reduced symptoms of depression and improved diastolic blood pressure.
Comments: I like maca herb. It has a gentle way to improve energy and wellbeing and has some sexual enhancing effects, too. See www.raysahelian.com/maca.html.
Vitamin D, too much of a good thing?
Although many people, especially the elderly who stay mostly indoors, are not getting enough vitamin D, and supplementation could be helpful in many medical conditions, there are concerns with high dose use. At the annual meeting of the American Academy of Dermatology, Dr. Martin Weinstock of Brown University, Providence, R.I., mentioned findings of significantly increased risks of falls and fractures associated with vitamin D megadoses. Studies examined very-large intermittent doses of the vitamin given to elderly patients. For example, a single, annual intramuscular injection of 500,000 IU increased the risk of fracture by 50% over 3 years. And oral doses of 60,000 IU per month, given once a month, increased the chance of both falls and fractures.
Comments: I am not sure how to interpret this yet, and do not know if smaller, but still high, daily doses lead to the same risks, but I mention this as a reminder that people be a little cautious. I do not think most adults need more than 2,000 units a day as a supplement. See www.raysahelian.com/vitamind.html.
Questions from readers
Q. Would it be alright to put nutritional supplements in a blender and mix the nutritional supplements in a fruit smoothie or does blending the vitamin pills; tabs; or caps; negate there nutritional value in any way ?
A. I suspect there would not be a problem putting nutritional supplements in a blender as long as the blending is brief. Blending for too long could generate heat and potentially cause changes to the supplements. However, some supplements are more effective, or noticeable, when taken on an empty stomach.
What is the ideal or best nutritional supplement for
health and longevity?
Q. I have read a website where they claim that through an online questionnaire and a nutritional blood analysis they can determine deficiencies and which vitamins, minerals, amino acids, hormones, and antioxidants one should take. They claim they can create a customized nutritional supplement program. What is your opinion on this?
A. Each person has a unique biochemistry and metabolism, a unique diet, and a unique genetic blueprint. Although blood tests can be helpful, they do not necessarily reflect what is actually going on within cells. There are hundreds of minerals, vitamins, and nutritional substances that are necessary for optimal health. It is not possible to check every one of them (their levels can also fluctuate day to day) and to know the proper ratio to take based on blood levels. The whole field is extremely complicated and any website that makes these claims, in my opinion, should not be trusted. I prefer instead to focus on a healthy diet and certain basic supplements as listed here, www.raysahelian.com/diet.html.
Nutritional supplements for pets
Q. I have a dog who is getting older and wanted to know if vitamins would be of benefit and how much should a dog take in relation to humans.
A. Many dog owners like to give vitamins and herbs to their pets. It is difficult to know the proper dosages for a dog. One option is to use a weight ratio compared to humans. For instance, if you weigh 150 pounds and your dog weighs 50 pounds, the dosage for your dog would be a third of your dosage. Nutritional supplements for pets are sold at many stores, but not enough research has been done to determine whether some of these products are appropriate for your pet. Some companies may place products for sale without much thinking into product development and may provide a dosage on the label that could be too low or too high.
Natural Healing Secrets
Vol. 14, Issue 3 -- March 2017
Does eating soy increase or decrease the risk for breast cancer?
Over the years I have had many female patients tell me that
they have reduced or eliminated their intake of soy products due to their fear
that estrogen-like substances in these foods promote the growth of breast
cancer. If you google "soy danger" you will come across many articles that make
it seem that soy products are toxic for human consumption. Do not be misled by
such articles. I am not saying that soy products should become a large part of
your diet. My main point is that reasonable consumption of soy products,
especially organic, as part of a wide range of intake of foods, is safe.
Soy products are available in many forms, including the beans (in Japanese restaurants they are served as appetizers and called edamame), soy milk (buy unsweetened and add the no-calorie sweetener stevia), tofu, miso, tempeh, and soy powder (some bodybuilders take it as a form of extra protein). Many processed foods have added soy and it is a good idea, in general, to minimize intake of processed foods.
Substances in soy products
Soy foods contain substances known as isoflavones. Soybeans and soy derived products are the highest sources of isoflavones in the American diet. The two most common types of isoflavones in soy are genistein and daidzen. Isoflavones have many functions in the body and they also function as phytoestrogens.
What is a phytoestrogen?
The chemical structure of an isoflavone is similar to the hormone estrogen and that is why they are also called phytoestrogens (phyto means plant). Because of this similarity in structure, isoflavones can influence estrogen receptors on cells. The influence of phytoestrogens on estrogen receptors is still being actively investigated... and it is complicated. Many scientists now believe that phytoestrogens compete with estrogen for the same receptor sites and hence lower the risks of too much estrogen (thus potentially reducing the risk for breast cancer). On the other hand, since the body's natural level of estrogen drops during menopause, some claim that isoflavones can compensate this by binding to the same receptor, thereby easing symptoms of menopause. There is still a lot that we need to study on this topic before we can come to definitive conclusions.
Benefits versus risks
I am convinced that small or reasonable amounts of soy in the diet does not do harm. Perhaps very high amounts can cause problems. Here are summaries of two recent academic reviews:
Br J Pharmacology. October 9, 2016. Phytoestrogens are plant-derived dietary compounds with structural similarity to 17-β-estradiol (E2), the main female sex hormone. This structural similarity to estradiol allows phytoestrogens to cause anti-estrogenic effects by binding to estrogen receptors. Many beneficial health effects have been attributed to phytoestrogens, such as a lowered risk of menopausal symptoms like hot flushes and osteoporosis, reduced risks of heart disease, metabolic syndrome and type 2 diabetes, breast cancer, prostate cancer, and other cancers. In contrast to these beneficial health claims, the anti-estrogenic properties of phytoestrogens have also raised concerns since they might act as endocrine disruptors. A definitive conclusion on possible beneficial health effects of phytoestrogens versus risks cannot be made.
Nutrients. November 24, 2016. There is evidence that soyfoods reduce risk of coronary heart disease and breast and prostate cancer. Soyfoods are uniquely-rich sources of isoflavones which are classified as both phytoestrogens and selective estrogen receptor modulators. Despite the many proposed benefits, the presence of isoflavones has led to concerns that soy may exert untoward effects in some individuals. However, these concerns are based primarily on animal studies, whereas human research supports the safety and benefits of soyfoods. In support of safety is the recent conclusion of the European Food Safety Authority that isoflavones do not adversely affect the breast, thyroid or uterus of postmenopausal women.
Role in breast cancer
Because excess estrogen can promote the growth and spread of breast cancers, some physicians have warmed their female patients that eating a lot of soy foods or soy isoflavones (which can be taken as a dietary supplement) could increase the risk, or worsen the prognosis of women diagnosed with breast cancer. However, recent studies do not support this view. A recently published by scientists at Tufts University concludes that isoflavones could actually reduce the risk.
Cancer, 2017. Dietary isoflavone intake and all-cause mortality in breast cancer survivors. Soy foods possess both antiestrogenic and estrogen-like properties. It remains controversial whether women diagnosed with breast cancer should be advised to eat more or less soy foods, especially for those who receive hormone therapies as part of cancer treatment. The association of dietary intake of isoflavone, the major phytoestrogen in soy, with all-cause mortality was examined for a period of nine years in 6235 women with breast cancer enrolled in the Breast Cancer Family Registry. The results show, in this large, ethnically diverse cohort of women with breast cancer living in North America, that a higher dietary intake of isoflavone was associated with a reduced all-cause mortality.
I know there are people out there whose mind is set that soy ingestion, no matter how little, is dangerous. Based on everything that I have read and studied, I do not agree. If you like soy products do not be concerned about consuming small or reasonable amounts, preferably organic, as part of your wide variety of food intake. Chances are this will be more health promoting that harm producing.
For more information on natural ways to reduce the risk for breast cancer, see www.raysahelian.com/breastcancer.html
Natural Healing Secrets
Vol. 14, Issue 2 -- February 2017
Right after I finished medical school I began my
internship at a hospital near Philadelphia, PA. The hours were grueling
and twice a week I had to work an overnight shift. One night, around 2
AM, I was woken up to rush to a patient who had fallen down while making
her way to the bathroom. The nurse told me she suspected a stroke since
the patient had slurred speech and was disoriented. Fortunately the 77
year old patient, who had been admitted for gallbladder surgery, had not
broken any bones during her fall. She just had some bruises on her right
thigh. I did a full neurological exam and determined her symptoms were
not consistent with a stroke. I reviewed her chart and medical history.
It turned out her doctor had prescribed Xanax before bed (she was having
surgery the next morning and the doctor wanted her to have a good
night's rest without worry). I have personally tried Xanax at 0.5 mg. It
is a potent anti-anxiety medication. She was given 1 mg, twice the dose
that makes me groggy and sleepy. I occasionally take it during overseas
airplane flights, along with my personal concoction of sleep inducing
herbs, and it helps me catch a few hours of z's. I reassured the nurse
that I did not suspect anything serious and there was no reason to call
her attending doctor.
I went back to bed since I still had a full day of work coming up. Before breakfast I went up to her room for a follow up. The staff was getting ready to prep her and escort her to the operating room. I chatted with her a couple of minutes. There was no slurring or any signs of disorientation. Apparently she had never taken a sleeping pill before and did not know her doctor had prescribed it to her. Actually she did not remember much of her fall or what happened overnight.
This was my first month at the hospital and I was already starting to suspect that medication mistakes were not uncommon. Certain doctors just did not understand the fragile physical and mental state of some seniors. In last month's issue of the newsletter I shared with you my opinion on the importance of doctors, nutritionists, healers, etc., to try supplements themselves as an additional way to have a better understanding of their positive and negative effects. I feel the same way about certain medications. I think doctors should try themselves some medications that they often prescribe. For instance I think psychiatrists could get further insights into the effects of the antidepressants they prescribe if they themselves experiment with the different SSRI drugs, such as Prozac or Zoloft. If this woman's doctor had tried Xanax himself, he probably would have been more careful and prescribed 0.5 mg or even 0.25 mg instead of 1 mg. That could have still helped her sleep and take the edge off her worry but without the excessive sedation and disorientation.
Age limit on supplements? A question recently
received by email
Q. I am a 65 years old male in good health. In your opinion is there an age limit on taking herbals, hormone supplements or amino acids?
A. There is no age limit to taking dietary supplements (I have patients in their 90s take them) but the amounts required or tolerated by older individuals are not necessarily the same as that of those in their 20s to 50s. As we age there are issues with absorption, metabolism, and elimination. It is possible that absorption of certain supplements may not be as good as we age, but on the other hand it may be more difficult to metabolize or eliminate them from the body if high amounts are ingested. There are no easy or quick answers that apply to everyone. Many older people are on multiple medications which makes things even more complicated. There is not enough research to fully understand the interactions between natural supplements and medications prescribed for diabetes, high blood pressure, heart disease, cholesterol reduction, and others. However I will provide certain guidelines that you can suit to your specific needs.
Multivitamins - I don't see any major issues with multivitamins as long as the amounts of each ingredient is not too far off the RDA guidelines. The recommended dosage of calcium in postmenopausal women has been lowered in recent years to less than 1,000 or 800 mg a day. Vitamin D is fine at 400 to 2,000 units a day depending on diet and sun exposure.
Herbs - There are herbs that have little or no
noticeable effect on the body, whereas others can speed heart rate and
should be used in caution. Most herbs can be tolerated by older
individuals as well as the young, for instance curcumin, cinnamon,
garlic, basil, echinacea.
Herbs that should be used cautiously by older people include green tea extract, ginseng, ginkgo biloba, rhodiola, St. John's wort, and most aphrodisiac herbs such as tongkat ali, tribulus, maca, etc. since they can speed heart rate and cause sleep problems.
Fruit and berry extracts - I think these are generally quite safe in the young and the elderly. For instance acai, amla, cranberry, goji, pomegranate, mangosteen, maqui, bilberry, noni, etc. Graviola can be used a few nights a week to help with sleep.
Various dietary supplements - I will mention a
few where caution is advised and dosages should be kept low. These are
acetyl l-carnitine, carnosine, alpha lipoic acid, CoQ10, SAM-e,
vinpocetine, CDP-choline, DMAe, TMG and the amino acids tyrosine and
Fish oil, or krill oil, can be used at one to three or four softgels a day.
Probiotics are a common supplement used these days and I don't see a reason why age should be a factor in the dosage.
Glucosamine and chondroitin used for osteoarthritis can be taken in full amounts.
Hormones - Without a doubt the dosages should be
kept very low. This is one area where doctors seem to not recognize how
dangerous high amounts can be. For instance the androgens, DHEA and
testosterone, can cause heart rhythm problems. For several decades
estrogen was prescribed to women in high amounts. It was not until about
a decade ago that certain researchers started warning us of the dangers
of this hormone. Estrogen, in high amounts, is now a suspected
carcinogen since epidemiological evidence associates the hormone to
breast, endometrial, and uterine cancers.
Melatonin is a hormone but it is much much safer than the others mentioned above. A dose of 0.3 mg to 2 mg a few nights a week appears to be safe and potentially beneficial to health.
I am not able to cover all the supplements that are available over the counter but if you have any specific questions regarding a supplement and whether age should influence its intake feel free to email me.
Note about suggested dosage on a bottle label
Keep in mind that the suggested dosages on supplement bottle labels are not necessarily written by experts and sometimes they are way too high. If you have never taken the supplement before, and you are over 60, take a portion of the suggested dosage listed on the label -- at least initially to find out if there is any untoward effect.
Testimonial regarding effective aphrodisiac
I am a 61 year old male in good health, taking no medications, except the occasional use of Viagra which is not working as well as it did years ago. My doctor told me my blood pressure and blood sugar are excellent. Although my wife and I have a good sexual relationship, I find it harder to satisfy her. I used to buy 100 mg Viagra pills and take a quarter of it, and now I need half, or even a full pill, to have a strong erection. However, I wanted to share some good news with you. In the past few months I have tried a number of natural herbal aphrodisiac pills to see if my libido and performance could improve. So far I have tried arginine amino acid, ginseng herb, rhodiola extract, damiana herb, Passion Rx with Yohimbe, tongkat ali 200 mg and LJ100 25 mg (which is a tongkat ali extract). The latter 3 products worked the best. I did not notice much from the amino acids or damiana herb. I now try Passion Rx with Yohimbe, or tongkat ali, two or three days in a row before sexual activity, and, on the day of activity, I take a quarter of the Viagra pill. The herbs seem to prime or pump me up and the additional of the Viagra on the very day (since the medication works within hours) seem to be a great combination. I just wanted to share this with you since it is an example of combining herbal medicine and modern medicine together for optimal benefits that you often talk about. I really feel that my intimacy and sexual relations have improved to back what they were a decade or two ago.
A. Yes, this is my overall philosophy in medicine. Ideally I prefer trying the natural approach. If not effective alone then combining such an approach with modern medications (hopefully at a lower dose to minimize side effects).
Testimonial regarding the negative effects of
cholesterol lowering drugs
I am a 72 year old female with well controlled type 2 diabetes and hypothyroid. However, since beginning a treatment program for high cholesterol and taking Livalo (a statin drug known generically as pitavastatin), my previously slight "essential tremors" of the left hand has dramatically increased. New symptoms include painful muscles in the legs, forearms and wrists. I also have little energy and am experiencing depression for the first time in my life. I have taken metformin for 17 years which has kept my type 2 diabetes well under control, and Synthroid kept my low thyroid under control.A. Cholesterol lowering drugs (the statins such as Lipitor, Zocor, etc.) cause such symptoms much more often than doctors recognize or admit. Muscle aches, low energy, and depression, are not uncommon with their use.
Natural Healing Secrets
Vol. 14, Issue 1 -- January 2017
One of my passions as a medical doctor and nutrition expert is to self-experiment with vitamins, herbs, teas, and all sorts of dietary supplements. I learn from these trials and it helps me understand the published research in a more complete way. I also get feedback from patients and the countless emails we receive from users who tell us about their supplement use and what they notice (I really appreciate reading these anecdotes).
A few weeks ago I experimented with the interesting herb Mucuna Pruriens again (it had been several years since I last tried it). One late afternoon (after I had taken 2 capsules in the morning a half hour before breakfast) I walked in a light drizzle in a park near my home. All the plants, grasses, trees, flowers, and the wetness on them seemed so alive and vibrant. I felt content, in a subtle, peaceful way; life seemed a little more special or magical. This mood elevation was different that what I had experienced on 5-HTP, which influences serotonin levels. It was different than what I had felt on the natural anti-depressants SAM-e and St. John's wort, which influence the levels of several brain chemicals in the brain. Mucuna, also known as velvet bean, is an herb that has a chemical in it called L-Dopa which the body uses to make dopamine. It has been used by Ayurvedic doctors as a natural treatment for Parkinson's disease, depression, and libido improvement. See http://www.raysahelian.com/mucunapruriens.html.
But before I tell you more about it, let me give you a little background how I came about experimenting with dietary supplements and why I believe, as a writer on this topic, it is important that I do so.
My experimental history
Back in the December 1994 I was walking through the vitamin aisle of my local health food store when I noticed a bottle of melatonin on the shelf. From medical school I knew this was a pineal hormone that helped with sleep. I was surprised that it was now available over the counter. The owner of the store told me that they had just received a shipment a week earlier and he did not know what it was good for. I bought a bottle and that very night I took a 3 mg pill. Not only did it help with sleep onset, but in the morning I realized I had had intense, vivid dreams. I knew this hormone supplement was going to be big news and this motivated me to research and write my first book on a supplement (called Melatonin: Nature's Sleeping Pill, which, in 1995, ended up being a bestseller and launched my writing career). I tried the melatonin again several additional nights and each time the vivid dreams occurred again (once in a while I had a nightmare). About that time there were several other books being written on melatonin by researchers who had been studying this hormone for decades. I called one of these researchers, at a university in Texas, and we had a nice chat. I asked him whether he had experienced a similar effect on dreams and his answer astounded me. He said he had never taken melatonin himself, he just gave it to the mice in the laboratory. He was not aware that melatonin caused vivid dreams. I realized at that point that there was so much more to be discovered about all kinds of herbs and supplements that researchers had not even thought about looking into.
For years after that I continued writing books on many topics, including DHEA, creatine, stevia, and then on to Mind Boosters and Natural Sex Boosters. Each time I wrote a chapter on a particular supplement not only did I do a thorough review of the published medical research -- at times it is limited -- but I made sure I tried the supplement myself starting with low doses and increasing daily until I felt something, positive or negative. Over many decades of doing this self-experimentation I have learned an enormous amount about their effects on my body and I am now very sensitive to any changes that occur.
Back to the mucuna pruriens supplement
Mucuna is of one of the few plants in nature that contains L-dopa in a significant concentration. Most species have a content of about 2 to 5% L-dopa per weight. Mucuna, as a supplement, is sold as a regular powder and also in a more concentrated form where the content of L-dopa in the herb is increased. The product I tried is by Physician Formulas which has a L-dopa content standardized to 15%. Each pill has a total of 200 mg of the herb hence the content of L-dopa is 30 mg per pill. See http://physicianformulas.com/products/mucuna-pruiens-extract-200-mg-60-capsules-l-dopa-natural-dopamine-increase.
Mind you most herbs have dozens of substances in them and it is not easy to determine exactly which substance is having what kind of effect on the body or mind since they are all being ingested at the same time and working in our cells and tissues in multiple ways. The benefits that I noticed from mucuna were likely due to the L-dopa content (I took two pills which had a total of 60 mg L-dopa), combined with the other beneficial substances within the plant. Over the next few weeks I plan to continue experimenting with it in different amounts. If you wish to email me your feedback I would be very interested.
Other products online
There are some mucuna products sold online that have a concentration of L-dopa higher than 15% but they may come at the expense of some of the other beneficial substances within the plant. These are okay to use occasionally but I am concerned about the potential toxicity of high concentrations or amounts of L-dopa used for prolonged periods. When patients with Parkinson's disease are given dopaminergic medications, such as L-dopa, for several years, a condition known as drug-induced dyskinesia can occur.
L-dopa is considered the 'gold standard' for the treatment of Parkinson's disease but high amounts of L-dopa are harmful to brain cells. Fortunately the various beneficial substances within the mucuna plant have shown to be protective against the possible harmful effects of high concentrations of L-dopa. In this instance nature has provided an active ingredient in this plant, the L-dopa, along with various other substances that protect the body and brain. Modern nutritional science is able to concentrate the active ingredient while still keeping most of the rest of the beneficial substances in the pill.
After decades of experimentation I still find this whole field quite fascinating. There is so much to be learned about plants and so many possibilities for medical treatment when used alone, in combination with other dietary supplements, or with medications.
After this experimentation I revised my page on depression to include mucuna as another option to improve mood. We now have at least four dietary supplements that have a strong and immediate influence including 5-htp, Mucuna, SAM-e, and St. John's wort. See http://www.raysahelian.com/depression.html.
Tip: If you plan to take a supplement for the first time, just take it alone without other pills so you know exactly what it is doing without interference. Please review with your health care provider before you experiment with these pills especially if you have a health condition, are older, or are taking medications.