Newsletter 2008 - Supplement Research Update Newsletter 2008 by Ray Sahelian, M.D.

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What readers of this website are saying
If I have doubts about alternative health practices, I consider your website to be the most authoritative because it contains the most exhaustive research and references. I deeply appreciate the tone of your website---give people enough accurate information then they can make their own informed decisions. In the era of nanny-government to include the FDA, your candor and expertise are deeply appreciated. I had been on the verge of making poorly informed decisions about the use and dosage of supplements, which can be harmful, and was prevented from doing so by the comprehensive information on your website. Thank you.

I have never seen a website like this in the way of being helpful as it relates to "REAL" valuable information, it's one of a kind. Thanks and please keep up the good work as it relates the the information you provide.

Thank you for your website which gives a very balance opinion of the pro and cons of supplements which are deemed perfectly safe by others.

I've been a big fan of your newsletter and holistic approach to the healthcare profession. I've always believed that doctor's like yourself would be the leading force in change in our current medical system.

SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 15 -- December 10, 2008
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In the prior issue of the newsletter I reviewed the overly hyped cholesterol drug study that showed Crestor, an expensive statin drug similar to Lipitor and Zocor, could reduce blood levels of C-reactive protein, a marker that indicates inflammation and a possible risk for heart disease. Doctors are being encouraged to prescribe Crestor to patients with high levels of C-reactive protein (CRP) in order to reduce the levels of this marker and thus potentially reduce the risk for cardiovascular problems. I also mentioned that simple and inexpensive vitamins, such as vitamin C, can reduce the levels of CRP. This past week I came across an interesting study that even dark chocolate can lower CRP levels. The problem with chocolate is the calories, sugar and fat that may negate some of the positive benefits of the polyphenol antioxidants present in high amounts in cacao.
   As a holiday gift to our subscribers, we are offering a free bottle of a cacao supplement. All you do is pay the shipping cost, and if you are buying other supplements, anyway, the shipping cost will not change.

Dark Chocolate benefit for cardiovascular system
Researchers at Johns Hopkins University in Baltimore, MD tested the effect of dark chocolate on platelet activity, C-reactive protein and lipid profile in 28 healthy volunteers. For one week the volunteers ate dark chocolate (providing 700 mg of flavonoids per day). After seven days of regular dark chocolate ingestion, LDL cholesterol fell by 6% and HDL cholesterol rose by 9%. Dark chocolate reduced CRP levels. See http://www.raysahelian.com/cacao.html
   My comments: It's okay to eat small amounts of dark chocolate, but larger portions can lead to weight gain and excessive exposure to sugars and fats. An alternative is taking a capsule of a cacao supplement in the morning with breakfast.

Garlic lowers blood pressure
Did you know that if you have high blood pressure and you eat garlic or perhaps take garlic pills your blood pressure could be reduced? Doctors at Hartford Hospital, in Hartford, CT, reviewed several studies with garlic done in the last few years and concluded that the use of this herb, on average, can help systolic blood pressure drop by 16 mm Hg and diastolic blood pressure by 9 mmHg. The use of garlic apparently did not reduce blood pressure in those with normal blood pressure. A review by another team of researchers at The University of Adelaide in South Australia found garlic reduced systolic blood pressure by 8 mm Hg, on average, and diastolic blood pressure by 7 mm Hg. The amount of garlic used in the studies was about a gram, providing about 5 mg of allicin, one of the active ingredients in this herb.
   My comments: If you have hypertension you may consider eating more garlic or taking a garlic supplement. Sulfides present in garlic are converted by red blood cells into hydrogen sulfide which helps to dilate blood vessels. Each garlic clove weighs about 3 to 5 grams. See http://www.raysahelian.com/garlic.html

Pharmaceutical new drug studies: unfavorable outcomes often not published
Drug companies are more likely to submit for publication to medical journals outcomes of studies that favor benefits of the new drugs they are promoting. Many trials that showed poor outcomes were still not published several years after FDA approval of the new drug. An independent review of these studies concludes, "The information that is readily available in the scientific literature to health care professionals is incomplete and potentially biased."
   My comments: This should make people even more skeptical about the benefits often touted by drug companies for the new medications they promote. They tend to selectively choose to hype the studies that show good outcomes.

Emails
Q. In a recent email from Physorg dot com was an article on anti-oxidants stating that the "Fifty year old theory about the causes of ageing is wrong." The article went on to say that the original theory proposed by Dr. Denham Harmon in 1956 that antioxidants reduce the rate of ageing is probably incorrect. The article did not convince me that oxidation is not relative to ageing in the human body. Do you, Dr. Sahelian, believe the conclusion by the folks at Physorg dot com?
   A. There are literally thousands of vitamins, nutrients, herbal compounds, fruit and vegetable extracts that have antioxidant potential. Most studies testing the influence of antioxidants as anti-aging supplements test high doses of vitamins C and E and sometimes beta-carotene or the mineral selenium. These studies do not take into account the thousands of potential beneficial antioxidants that are available. Giving a high dose of one or two antioxidant supplements and making a generalization regarding the anti-aging benefits of various antioxidants does not appear to me to be a reliable way to come to an understanding of their influence on aging. Perhaps taking too high a dosage of one or two or three antioxidants is not the proper approach to living longer. I think that ingesting a variety of herbal, fruit and vegetable extracts that contain small amounts of hundreds of different flavonoids, carotenoids and other beneficial substances is more likely to provide a benefit than a massive daily dose of vitamins C or E. However, this field is very complicated and it is not easy to give definitive answers at this time. Drinking a mix of fresh vegetable juices would allow ingestion of dozens or hundreds of carotenoids and flavonoids. I personally alternate between different supplements such as acai, mangosteen, graviola, cranberry, bilberry, acerola, basil, fennel, pomegranate, goji, curcumin, barley greens, acetylcysteine, acetylcarnitine, alpha lipoic acid, and others. I try not to take too high an amount of just one or two.
See http://www.raysahelian.com/antioxidant.html 

Q. Thanks for all you do in the field of nutritional supplements. Just curious why you recommend such a lower daily amount of alpha lipoic acid. The below article is from Life Extension Research Institute. "The amount of alpha lipoic acid produced internally in the body decreases naturally with age, which could set the stage for free radical-induced damage. Although small amounts of alpha lipoic acid are available in food sources, such as dark leafy greens like spinach and collards, broccoli, beef, and organ meats, supplementation may be needed to achieve significant intake levels. Scientific studies showing the health benefits of alpha lipoic acid have used doses ranging from 300 mg to 1,800 mg per day. Alpha lipoic acid has generally been found to be safe when administered in recommended doses."
   A. Since long term human research with nutritional supplements is not extensive, there are a number of opinions regarding the best supplements to take for long term health and what the ideal dosages should be. Different doctors and scientists have different viewpoints. In my personal experience, high dosages of alpha lipoic acid can cause insomnia and ALA may cause heart rhythm disturbances in dosages greater than 100 mg. Sleep problems certainly do not lead to better health. Until we know more about the long term side effects of these supplements, I prefer to take low dosages and to take days off. See http://www.raysahelian.com/lipoic.html

Q. Are you aware of problems with taking SAM-e or 5HTP while trying to wean from Prozac? Do you recommend a "weaning program." I understand that 5HTP does not mix well with Prozac. What about 5HTP alone? I don't want to encourage a "serotonin syndrome."
    A. Each person taking Prozac or a similar SSRI medication responds in a different way and needs a different dosage of the drug. Each person weaning off Prozac or a SSRI medication while switching to natural supplements will respond in a different way depending on many variables including drug dosage, severity of depression, length of time taking the medication, etc. There is no simple answer that would apply to everyone. The best one can say is to reduce the medication dosage gradually while beginning  a low dosage of the supplements although if the depression is mild a person could lower the dosage and stop the Prozac within a few days. If a person is taking 20 mg of Prozac, the dosage could be reduced to 10 mg while adding 25 or 50 mg of 5-HTP. Ideally one should try each natural supplement by itself for a week or two rather than combining them. For instance it is a good idea to try 5-HTP by itself and SAM-e supplement by itself rather than initially taking them together. If you take two supplements together and you get a side effect, you would not know which one caused it. Please inform and consult with your doctor regarding your plans. See http://www.raysahelian.com/5-htp.html

Q. I am currently weaning off of Lexapro and Klonopin after 3 yrs, with the advice of my doctor. Is it ok to take something else like St. John's wort or 5HTP while weaning off so that I do not have the withdrawal symptoms and or have a relapse, I have done so much research on the net, so some info regarding the use of St. John's wort or 5-HTP would be helpful for me and I can pass it along to the doctor,
   A. The use of 5HTP, St. John's wort or any natural anti-depressant for medication withdrawal has not been well-studied by scientists. There are no easy answers since each person is likely to have a different response. It is not possible to predict any one person's reaction. Therefore, the best one can do is trial and error, using 5-HTP or St. John's wort beginning with low dosages under medical guidance. The 5-HTP dosage required is likely to vary and can range from 25 mg to 50 mg, or to 100 mg or more. The St. John's wort dosage could range from 300 mg every other day to 300 mg twice daily. The time of use as far as days or weeks can also vary. Some people may only need to take these supplements for a week or two whereas others may need a longer time period. Each person is unique. See www.raysahelian.com/stjohn.html

Q. This it to inform you of a statin drug danger. My wife, 67, never smoked, no alcohol, very active physically (non stop gardening and ceramicist who hunks and throws clay up to 10kg at a a time) was started on 20mg pravastatin (Pravachol) ten weeks ago for high cholesterol. Two weeks ago she felt sensitivity at upper right abdomen unabated for 7 days. Then weakness / loss of appetite/ reduced drinking during a day. Early that day a doctor muttered about gall bladder after consulting current diagnosis software: she proposed ultrasound; queue, 4 weeks. Later in day, weaker and weaker, no temp. yet, back to a different general doctor. He was concerned: to ER. Passed out sitting! amylase already 3300! Statin stopped immediately; no food, no statin, pain stopped in 15 hours. Four days in ward; starvation, iv water/salts. After four days amylase down to 100. Liver function fine apart from elevated LDH. Ultrasound was negative as also CT, no sign of biliary deposits problem. Other exclusions: hepatitis etc etc. As in many cases of pancreatitis, the doctors have no suggestions. After 3 days back home wife seems herself, eating carefully; we hope that this is first/last time. Statins can have very wide 'mild' effects over a range of systems. So damage can be slight but slow, unnoticed till the cart tips suddenly. This is a particularly dangerous kind of situation. My wife is lucky - we hope; another week to diagnosis and the pancreatitis could have led to permanent pancreatic damage (at least cartilage and muscle effects are noticeable). Not only is the public very unaware of the danger to the pancreas, but it seems most GPs too! This is unacceptable. Is the FDA unaware too? Thanks for keeping an eye out for an unsatisfactorily protected public.

SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 14 -- November 20, 2008
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"Wider cholesterol drug use may save lives. Study might lead far more Americans to consider taking statin drugs."
   Have you read or heard of this widely reported study regarding the use of a statin drug called Crestor? The media has been promoting the benefits of this drug for use by those who have normal cholesterol levels as a way to reduce the risk of heart disease and stroke. IRRESPONSIBLE. That is how I would describe the reporting of the Crestor study by news organizations. The vast majority of reporters did not offer another interpretation of the study, or interview a researcher with a contrary opinion, but just went along with the pharmaceutical company press release. Later I will discuss the flaws of this study. You can then decide if you want to take the risk of using a drug for years and decades whose side effects and dangers may be far reaching.

Maca herb helps women after menopause
Researchers at Victoria University, St. Albans, Victoria, Australia gave fourteen postmenopausal women 3.5 grams a day of maca for 6 weeks and compared them to a group receiving placebo pills. No differences were seen in blood concentrations of estradiol, follicle-stimulating hormone, luteinizing hormone, and sex hormone-binding globulin between maca treatment and placebo. The women who received the maca pills had a significant reduction in anxiety and depression and had improved sexual function. The researchers conclude, "Preliminary findings show that maca reduces psychological symptoms, including anxiety and depression, and lowers measures of sexual dysfunction in postmenopausal women independent of estrogenic and androgenic activity."
   My comments: Maca is an interesting herb that grows in the Andes mountains in Peru and other other countries in South America. Even though this study used 3.5 grams (3500 milligrams) a day, I would suggest using less, such as 500 to 2000 mg a day if you plan to take the herb for long term use. See http://www.raysahelian.com/maca.html
   I like maca herb. I have personally noticed more energy, improved wellbeing, and mild sexual enhancement after a few days of maca use. There are more potent herbs than maca in terms of sexual enhancement including tongkat ali, mucuna pruriens, tribulus, muira puama, the combination formula Passion Rx, and others. They all work in men and women. See http://www.raysahelian.com/libido.html

Will taking the statin drug Crestor help you live longer?
Here is a basic summary of this study funded by AstraZeneca, the maker of Crestor (rosuvastatin):
   About 18,000 healthy men and women with normal cholesterol levels but with elevated levels of "high-sensitivity C-reactive protein" or hs-CRP -- a marker that indicates inflammation in the body -- took 20 milligrams of Crestor a day and were compared to a group taking a placebo pill. Designed to last up to five years, the study was stopped after less than two years because endpoints were apparently met. According to the statistical interpretations, participants taking Crestor reduced their risk of heart attack, stroke and death compared with those taking the placebo pills. LDL cholesterol levels and hs-CRP levels were reduced by Crestor. Interestingly, at the time the study was stopped, it appeared that those who were taking Crestor were starting to have higher blood sugar levels. You would think the study would have continued to see if diabetes would set in after a few more months or years of use.
   Hardly any news organizations reported the potential downside of taking this drug, flaws in the study, or misinterpretation of the results. The rate of muscle aches and liver damage by statins is much higher in clinical practice than what is reported in studies. There may also be potential mental decline from the use of statins. I still have not seen any studies where the use of statins in those who have low or moderate cholesterol elevation has led to a decrease in overall mortality. it is quite possible that a statin drug can reduce cholesterol levels, reduce CRP levels, reduce the risk of heart attack and stroke, yet lead to a shorter lifespan. How could this happen you ask? This could be due to several factors including muscle damage that leads a patient doing less exercise, mental decline leading to a higher rate of dementia, lower mood or depression leading to a higher rate of suicides, liver damage, kidney damage, and other unknown and potentially serious side effects that could harm the body.
  Fortunately, the website of ABC News had an article by Dr. Nortin Hadler which reviewed the flaws of the study. Dr. Nortin Hadler is professor of medicine at the University of North Carolina at Chapel Hill. If your doctor advises you to take Crestor or another statin drug as a consequence of the results of this study, you MUST read this article and you MUST request that your doctor read it, too. The reduction in heart attack or stroke was minimal, almost insignificant, not as high as the news media made it seem. Plus, the cost of Crestor, blood tests, and doctor visits can be several thousand dollars a year. Practically speaking our health care system, particularly during these tough economic times, cannot afford this heavy cost for minimal gain, it any gain at all.
   The headlines by news organizations are sometimes misleading. If you are a regular reader of my newsletter you are aware that I have warned you not to trust headlines and to be critical of what you read or hear. The media is not sophisticated enough to understand and interpret studies. They often believe and regurgitate whatever the drug companies tell them.
   As a medical doctor who has studied natural ways to decrease inflammation and heart disease, it saddens me that more natural and safer approaches are not discussed or promoted as aggressively as studies involving expensive and unsafe medications. There are so many natural ways to reduce cholesterol, heart disease and inflammation including fish oils, psyllium and other natural fibers, and potentially the addition of spices such as curcumin, ginger, etc. I will continue researching this topic and updating the latest research on natural ways to improve cardiovascular health. See http://www.raysahelian.com/inflammation.html and http://www.raysahelian.com/cholesterol.html and http://www.raysahelian.com/statins.html

Vitamin C lowers C-reactive protein levels
Do you want to lower your CRP levels naturally? Rather than taking Crestor which can cost a couple of thousand dollars a year and cause potential harm to your body, you may be able to reduce your C-reactive protein levels by adding more fruits and vegetables to your diet and by taking vitamin C, a safe and natural supplement. One recent study showed taking 1000 mg of vitamin C lowered CRP levels. I don't think there is a need to take 1,000 mg every single day. Even 100 to 500 mg could be helpful or you can take the 1000 mg a few days a week. See http://www.raysahelian.com/creactiveprotein.html for details.

Emails
Q. I am just writing to express enormous gratitude. I am a doctor in London and have intermittently suffered from depression since my 20s. I am now 52. I have been taking amitriptyline 150mg a day for the last 10 years after my psychiatrist and I went through almost the entire pharmacopoeia, including SSRIs, SNRIs, MAOIs, lithium, sodium valproate etc. The side effects from all of those drugs were severe enough for me to be unable to tolerate any of them and amitriptyline appeared to suit me, though I still had breakthrough depressions, often quite severe, and I could do nothing about them drug wise because of my intolerances. At the moment cognitive behavioural therapy is flavour of the month here in the UK but it never had the slightest beneficial effect on me. In addition, every non-prescription chemical I tried, including St. John’s wort, produced no beneficial effect. During my most recent depressive episode I searched the internet in desperation for any possible treatment I might have missed out on, and I came across your articles on 5 HTP. I ordered some online and the effect has been spectacular. After the second dose I felt better than I have felt in so many years that my only regret is that I didn’t discover this supplement years ago. I appreciate that it is early for me (I have been on 100mg a day for the last 4 weeks) but I know that I am remarkably better. My friends and family have also noticed the positive change in my behaviour and for the first time in so many years I have positive feelings about the future.
   I also suffer from ulcerative colitis and interestingly, or rather unfortunately, my gastroenterologist started me on methotrexate 7.5mg and folic acid 5mg once weekly as my condition deteriorated over the last few months. After the second dose I started to feel extremely depressed and very tired. Surprisingly the gastroenterologist denied the possibility of methotrexate being the cause but I discovered a few reports suggesting that in some animal studies methotrexate has been shown to lower brain serotonin levels. I stopped the medication and within about 10 days I felt well again. There is no doubt in my mind that methotrexate caused this recent problem. Anyway, I’m extremely grateful to you. I feel like I have my life back after many difficult years. I worked for 7 years as a consultant in emergency medicine. I loved the work but had to leave that job because of the crippling depression I had and for the last 8 years I have worked as a general practitioner in private practice which is far less stressful. I will continue to take the 5 HTP – I am a skeptic and don’t believe in miracle-cures but in this case....
   A. Wow. I truly hope your improvement continues. There are several other natural options to consider in treating depression. See http://www.raysahelian.com/depression.html

Q. I want to say thank you for your product Eyesight Rx. My vision improved a lot with the first bottle and now I am on the second bottle. However, I have a couple of questions. Why is the dose of so low, are there any side effects to prevent?
   A. The ideal Eyesight Rx dosage varies among individuals. Some people do well on higher amounts, others do well on lower dosages. We also found that taking too much actually makes vision more fuzzy since it is possible that supplying too high dosages of lutein or other ingredients in eye formulas may throw off the delicate balance in the retina. Taking a day off every 2 or 3 days once vision has improved is likely to work better. Taking a fish oil supplement in the morning helps vision and helps Eyesight Rx work better. The fish oil dosage could be 2 to 4 or 5 softgels a day. One common side effect with Eyesight Rx is shallow sleep if one tablet is taken daily for several days in a row.
 

SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 13 -- November, 2008
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We recently received a very interesting email:  "I am a medical doctor working for a major pharmaceutical company. First, I speak for myself here, not them. I think we as an industry save lives and that some natural medicine oriented people bash the industry too much. That being said, I am very open to and use/experiment with many supplements that truly complement my standard meds. We docs who develop pharmaceutical meds are just like those on the front lines of practice. We work tirelessly to save lives. I beg you and others to bash our industry less. We add years to life and life to years--truly. But in return, I say your web site does, too. Let me tell you my experiences with some of your products."
  My problem with the pharmaceutical industry has to do with the excessive promotion of drugs for the treatment of conditions where safer, and just as effective, natural supplements are available. For instance, a recent review published on St. John's wort herb found it to be just as effective as prescription anti-depressants and with fewer side effects. A few paragraphs below you will find my full reply to his email and I include his personal reviews and comments regarding some of the supplements I have formulated.

St. John's wort for depression
German researchers at the Centre for Complementary Medicine in Munich in Germany, reviewed 29 studies involving a total of 5,500 patients with depression that compared treatment with extracts of St. John's wort with placebo treatment or standard antidepressant medications. The studies were done in a variety of countries and tested several different St. John's wort extracts. They write, "Overall, we found that the St. John's wort extracts tested in the trials were superior to placebos and as effective as standard antidepressants, with fewer side effects."  See http://www.raysahelian.com/stjohn.html for details.
   Comments: Here is an example of a natural supplement underused by the medical profession. There are several other herbs and nutrients that could be effective as natural treatments for mild to moderate depression including 5-HTP and SAM-e. See http://www.raysahelian.com/depression.html for details. 5-HTP is useful in those who have depression associated with anxiety. SAM-e is useful in those whose depression is associated with low energy. High doses of SAM-e can cause anxiety. St. John's wort can be used in several types of depression. My general advice is to use low dosages for a few days and then adjust the amounts higher if needed. 5-HTP is often taken in the evening on an empty stomach whereas SAM-e and St. John's wort are taken in the morning a few minutes before breakfast. If you use high dosages of SAM-e or St. John's wort, it could lead to insomnia. Lack of adequate sleep contributes to low mood and energy. If you notice shallow sleep after taking either SAM-e or St. John's wort, skip a dose the next day or take a lesser dose. Discuss with your health care provider regarding the use of natural supplements, particularly if you have a health issue or taking medications.

Artichoke leaf extract slightly reduces cholesterol
British researchers at the University of Reading, Reading, UK gave 130 adults who had high total cholesterol levels 1280 mg of a standardized artichoke leaf extract daily for 12 weeks and compared the results to a control group. Plasma total cholesterol decreased in the treatment group by an average of 4 percent and increased in the control group by an average of 2 percent. No significant differences between groups were observed for LDL cholesterol, HDL cholesterol or triglyceride levels.
   Comments: If someone has a cholesterol level of 250 mg, a 4 percent drop would be 10 mg, which is not bad. There are several natural supplements that could be helpful in those with high cholesterol levels. In my opinion many patients can avoid the use of statin drugs, or reduce the required dosage, with the appropriate use and combination of dietary approaches and supplement usage. See http://www.raysahelian.com/cholesterol.html. See also http://www.raysahelian.com/artichoke.html

Emails from readers
Q. I see magnesium stearate is found in many supplement capsules. I read on a web site that it may not be safe. What is your opinion of magnesium stearate?
   A. Magnesium stearate is basically a fatty acid called stearic acid, or stearate, attached to the mineral magnesium. In my opinion, there is misleading information on some websites that claim magnesium stearate, even in miniscule amounts, is dangerous. There is no evidence this is true. Most capsules that include magnesium stearate use an amount ranging from 10 to 20 milligrams. One gram equals 1000 milligrams. You can see the insignificance of this amount. If you eat chocolate, you will consume a very high amount of stearic acid, hundreds or thousands or times more than in the capsules. Chocolate contains cocoa butter, which has a number of fatty acids. One-third of chocolate's fat comes from the fatty acid stearic acid. Yet, hardly anyone worries about the stearic acid found in chocolate yet we get emails from people overly concerned about a tiny amount found in capsules. I am not aware of any studies that show magnesium stearate, in the small amounts found in capsules, has any side effects or causes any harm. If anyone knows of a study that indicates that this substance, in the small amounts found in capsules, has shown to have harmful effects, email me. I have searched extensively and not seen any such studies. I believe there is misinformation on web sites that claim this substance is harmful . If anyone tells you magnesium stearate in the small amounts found in capsules is harmful, challenge them to provide you with a human trial that proves their point. See http://www.raysahelian.com/magnesiumstearate.html for reviews and studies regarding stearic acid ingestion.

Q.  This email was by a medical doctor who works for a major pharmaceutical industry mentioned at the beginning of the newsletter. He reviews some of the products I have formulated. My comments follow each of his reviews and then I have a final comment about the pharmaceutical industry.

Mind Power Rx: Definitely more mental energy and focus. I have to take days off or it either wears off or I get very emotionally tense, "keyed up."
   Dr. Sahelian comments: Yes, most people notice improved mental concentration, focus and more mental energy, generally the same day, often within hours. I suggest not using it more than 3 days a week.

Eyesight Rx: This one is really amazing. Pastel colors came to life for me within hours of the first dose. I somehow liked and appreciated earth tones again after I had begun finding them dull and boring. The appearance of some floaters I have decreased in intensity. Complement with some fish oils which also helps the Eyesight Rx as you note on your site.
   Dr. S comments: I find the combination of several fish oils capsules in the morning on an empty stomach along with about a half of an Eyesight Rx melted under the tongue works quite well after a few days to improve day and night vision, close and distance vision, and enhancement of color perception. Some people need a full tablet, at least initially. The dosage needs to be adjusted up or down on a regular basis and it is a good idea to take a day off from the Eyesight Rx every 3 days or so. As to fish oils, about three to five softgels are helpful taken on an empty stomach in the morning a few minutes before breakfast.

Diet Rx: Definitely works, but not consistently. I wonder if it is due to what I eat with breakfast and how well it gets absorbed or not.
   Comments: Diet Rx works best when taken on an empty stomach at least 45 minutes to an hour before breakfast. When taken with food it may not be as effective. Some people do well on one capsule a day, others require two or three, and a few people may need four capsules a day split into 2 before breakfast and 2 before lunch. The vast majority of Diet Rx users notice appetite suppression and have more will power in regards to eating less.

Passion Rx: Increased libido. Most notable effect is that it sort of gives me "beer goggles." Almost any woman looks more attractive to me in some way that they would not have before.
   Comments: I have formulated two versions of Passion Rx, with and without yohimbe. If one version does not work well, the other may work better. It normally takes a few days to appreciate the full benefits. An increase in libido is one of the first benefits followed by enhanced sensation, and a few days later by enhanced erectile function. Passion Rx is taken on an empty stomach at least an hour before breakfast two days on, one day off and less frequently when it starts working. The effects are noticed even on the days when it is not taken. In the long run many people only take Passion Rx 2 days a week. Sometimes if Passion Rx does not work as well as one wishes, individual herbs may. These include tribulus terrestris, tongkat ali, mucuna pruriens, catuaba, muira puama, horny goat weed, maca etc. It is not possible to predict which formula or single herb will work in any one individual. I suggest not taking Passion Rx the same day as Mind Power Rx or Eyesight Rx or any supplement that increases energy.

I am a medical doctor working for a major pharmaceutical company. I think we as an industry save lives and that some natural medicine oriented people bash the industry too much. We docs who develop pharmaceutical meds are just like those on the front lines of practice. We work tirelessly to save lives. I beg you and others to bash our industry less. We add years to life and life to years--truly. But in return, I say your site does, too.
   Dr. Sahelian comments: Few people would deny the significant contributions made by the pharmaceutical industry in developing medications that have saved lives and reduced suffering. Almost everyone, at some point in their life, has benefited from the availability of vaccines, antibiotics, pain medications, anesthesia drugs, and a number of other drugs. My problem is with the excessive promotion of drugs for the treatment of chronic conditions where safer, and just as effective, natural supplements are available. For instance in the treatment of mild to moderately elevated cholesterol levels. I have not seen any evidence that the use of statin drugs for cholesterol management in those with mild or moderately high cholesterol levels improves longevity. Yet, I see so many people who get side effects from these drugs including severe muscle aches. Statins can cause damage to muscle tissue. Another area that natural supplements can help is with sexual enhancement. Although drugs such as Cialis, Viagra, and Levitra work very well in terms of erectile dysfunction, they do little in terms of libido enhancement, sensation, and overall sexual pleasure. The proper use of natural supplements can enhance erectile function (not necessarily as potently and quickly as the drugs), improve sexual drive, sexual stamina, and enhance genital sensation. Vision improvement and treatment of mood disorders are other areas where natural supplements are underused. The virtual monopoly of the pharmaceutical industry in terms of medication research and journal publications makes it difficult for the public, and doctors, to find out about the natural options that can work quite well in the treatment of degenerative and chronic conditions such as hypertension, high cholesterol, diabetes, heart disease, osteoarthritis, etc.

SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 12 -- October, 2008
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A newsletter reader writes, "Your September newsletter regarding soy products leaves me a bit confused. This morning I got a newsletter from an osteopathic doctor. In it he warns against the use of soy products, listing a number of serious afflictions that can be linked to it. I am not sure what to do as far as eating soy. "
   As I mentioned in the last newsletter, there are a few web sites and health writers who happen to have extreme viewpoints on the topic of soy. Whose opinion should you trust? This is a dilemma many people have when they read conflicting information on different web sites. We are exposed to a number of viewpoints by experts on a variety of topics such as nutrition, the economy, the war in Iraq, abortion, global warming, etc. It is up to the individual to decide, after evaluating opinions by several experts, which one they are most comfortable with. Japanese women live longer than any other people on the planet while consuming 60 g or more of soy products a day.
   This is my viewpoint on soy and if you are a member of the media receiving this newsletter, you can quote me: "A small amount of soy (preferably organic) a few days a week or a few days a month in the form of tofu, natto, miso, soy sauce, unsweetened soy milk, or boiled soybeans, as part of a healthy diet that includes a wide variety of vegetables, fruits, whole grains, nuts, seeds, legumes, chicken, meat, fish, dairy, etc, should not pose any health concerns." I am not encouraging anyone to eat or not to eat soy products. I am just saying that if you want to eat soy products but have been afraid to do so, I do not believe small amounts are harmful.
   We received quite a few interesting emails about the soy controversy that you will find below.
   In this issue I also discuss the potential benefit of a pine bark extract for arthritis, and acetylcysteine for chemotherapy-induced brain fog.

Pine bark extract good for arthritis pain?
Pycnogenol is an extract derived from the bark of the French maritime pine tree. Many lab studies have shown Pycnogenol to have strong antioxidant and anti-inflammatory properties. One study included 100 Slovakian adults with mild knee arthritis who were randomly assigned to take either 150 milligrams of pine bark extract or a placebo every day. According to Dr. Peter Rohdewald, of the University of Munster in Germany, knee arthritis patients who took Pycnogenol pine bark extract for three months reported an improvement in their pain, while those given a placebo had no improvement. The pain relief persisted for an additional two weeks after the patients stopped taking Pycnogenol. Switzerland-based Horphag Research Ltd., maker of Pycnogenol, funded the study. For more info, see http://www.raysahelian.com/pycnogenol.html
   Comments: There are several supplements that have been shown to be helpful for arthritis, including glucosamine and chondroitin. Joint Power Rx contains a number of beneficial nutrients including glucosamine, chondroitin, CMO, turmeric, MSM, boswellia extract, and others. Many people who have arthritis already take natural supplements for joint health support. Would the addition of Pycnogenol or another type of pine bark extract provide added benefits? Would the combination lead to unexpected side effects? There are no easy answers at this time. If your doctor approves, you could add Pycnogenol to your daily regimen. The dosage used in study was 150 mg a day. This may be an appropriate dosage in the beginning, but for long term use you may consider a maintenance dosage of 30 or 60 mg a day. Just keep in mind that we don't know the effects of Pycnogenol supplement use if taken for many years, or how this product interacts with other supplements or medications, including NSAIDs such as aspirin, naproxen or ibuprofen.

N-Acetylcysteine and chemotherapy
There is a condition called "chemo-brain," which effects a large number of cancer patients receiving chemotherapy. Patients with this condition suffer from memory loss and have difficulty with focus and concentration. Dr. Gregory W. Konat and colleagues at West Virginia University School of Medicine in Morgantown first gave one group of rats two drugs commonly used to treat cancer, Adriamycin and Cytoxan. These drugs led to memory problems. However, memory loss was prevented when the researchers gave the rats N-acetyl cysteine, or NAC, during chemotherapy.
   Comments: Since it is still not fully clear whether antioxidant treatment influences the effectiveness of cancer drugs during treatment, one option is to begin therapy with acetylcysteine, or other antioxdiants, a week after the last chemotherapy dose. The appropriate dosage of NAC for post-chemotherapy antioxidant treatment is not known, but a dosage of 500 mg three times a week seems reasonable and prudent. See http://www.raysahelian.com/acetylcysteine.html for more info.

Emails
Q. I was just reading the controversy on your site regarding soy consumption, and I just had to offer some anecdotal counter-evidence to all the alarmist discourse. My mother is from Japan, and our family was raised on quite a bit of soy-based foods: Tofu, natto, miso, cooked soy beans, soy sauce, etc. In terms of volume, tofu (an unfermented product) was probably the largest source of soy in our home. My little brother had no problem developing into a very masculine young man, and all of us were extremely healthy (I wish the soy would have boosted my breast development, but no such luck!). Anyone who says that Japanese people don't eat much soy have obviously never spent much time around traditional Japanese! Trust me: They eat  LOADS of soy! I'm not claiming that eating huge amounts of soy is ideal, but given how much they (and I) have consumed, it just doesn't make sense to talk about soy as though it is some kind of toxin. Even today, nearing 40, I eat soy foods daily (I love tofu!). I am extremely healthy, have a strong libido, and an IQ of 160. Granted I do not consume much soy milk, as most of it is way too high in sugars, and I eat very little soy protein, because intuitively it just seems overly-processed and denatured to me. Honestly, I think that Americans are trying to find an easy answer for why they don't feel good. The problem is they don't eat their veggies
(because of my mom's good influence, I probably consume 20 times more vegetables than the average American--and mostly organic), they over- consume refined carbohydrates and processed foods, don't exercise enough, and are stressed out beyond belief! Americans want a quick fix: "Just take that new supplement," "Just stop eating soy!" But building real health doesn't work that way. Dr. Sahelian, I applaud you for keeping it all in perspective. Your grounded and reasonable approach to health is a breath of fresh air in a sea of alarmists. Warm Regards, Robin H., Los Angeles, CA.
   A. I hope your email will help to ease the concern of many people who have been unduly afraid of eating even a small amount of soy due to certain websites and newsletters promoting extreme viewpoints on this topic. Soy is neither the healthiest food on the planet, nor is it a toxin. Soy is a legume that, when used in moderation, has health benefits and when used excessively may cause harm in some users.

Q. I was advised by my medical oncologist not to eat soy products because of estrogen fed breast cancer which did not spread into the lymph glands. It is difficult to find any products which do not contain soybean oil. I like tofu and soy sauce.
   A. I am not aware of any human studies that indicate eating small amounts of soy products has a negative influence on breast cancer. Studies show that eating soy does not have a major influence on hormone levels. See the above link for details and research papers on this topic.

Q. I have been purchasing Prostate Power Rx. Do you intend to add to this product selenium, zinc and pumpkin seed oil extract?
   A. Zinc and selenium are minerals that accumulate in the body and many people get adequate amounts of these through their multivitamins or their diet. Excess levels of these minerals can be harmful to health. The amount of pumpkin seed extract needed to be effective for prostate health in human is not well know. The small space in a prostate formula capsule that already has several others herbs does not allow for pumpkin seed oil to be added in adequate amounts. Furthermore, I am not aware of any extensive human studies that pumpkin seed oil shrinks an enlarged prostate. And if it does, the required dosage is not known. Not everything can fit in one pill, therefore those who wish to have pumpkin seed oil can buy and use this supplement as an addition to a prostate formula. See  http://www.raysahelian.com/pumpkinseed.html

 Q. Your position on soy is based on the latest research and sound, even-mindedness. I agree with you; unless one can produce data to support the (often) hysterical claims by health extremists in the popular press, there is nothing to discuss. Unfortunately, too many Americans have a knee-jerk approach to mass media pronouncements. This does not mean that I am not in sympathy with those whose personal experiences don't follow the usual outcome. Everybody is different and some people may indeed respond differently to certain foods or supplements. But whatever happened to personal instinct and common sense? Sheesh! Thank you for your excellent newsletter and advice. I always enjoy reading your perspective and thoughts on current research.
All the best.

Q. Dear Dr. Sahelian, thank you so much for the Eyesight Rx formula! In September 2007, my eye care professional told me I needed to have cataract surgery on my right eye, and the left one was not far behind. I was having much difficulty reading, but at the time, I just didn't see how I could take even a week to take care of this situation. I ran a search, and came upon your web site, and decided to try your Eyesight Rx, and was thrilled when it arrived so quickly. I immediately put half a tablet under my tongue and let it dissolve, then swallowed the other half with a glass of water. I couldn't believe I was seeing more clearly within hours. I continued on the program, taking breaks on the week-ends, and my eyes just kept getting better! I've been near-sighted for years, was having difficulty with night vision, floaters, and then the cataracts. I recently went in to get new glasses, and my doctor was "blown away" when he saw the improvement in my vision! I am no longer a candidate for cataract surgery, and just wanted to let you know! Thank you so very much for your work, and the help you give to others. I am still required to wear my glasses for driving, but I do not need them for reading, working at the computer, or other close vision at this time.
   A. I am thrilled when we receive such positive feedback about the products I formulate. I put so much effort and heart into making sure I develops supplement that can help people and when we gets emails such as yours, I become real happy. Many people find the required dosage of Eyesight Rx is less with time since the nutrients accumulate in the eyes. Taking two to four fish oil softgels in the morning on an empty stomach can help Eyesight Rx work even better and would reduce the needed dosage of Eyesight Rx. As a maintenance dose for long term use, many people do well taking a third of a tablet 2 days on, one day off. Some may need a higher dosage, others less.

SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 11 -- September, 2008
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In the August issue of the newsletter I wrote that eating small amounts of soy, as part of a diet that has a wide range of foods, was acceptable. Since then we received a number of emails from people who adamantly felt that including even a tiny amount of soy in the diet was harmful. When asked for research papers that support their position, they referred us to certain web sites maintained by people with extreme viewpoints. You will find some of the correspondence at the bottom of this newsletter. Apparently there are a few websites that are scaring people from consuming any type of soy. Japanese women live longer than women from any other country in the world. I looked into how much soy Japanese eat a day. On average, a Japanese man or woman eats between 50 to 100 grams of soy products a day in a variety of forms including tofu, natto, and boiled soybeans in a pod (edamame). If soy is supposed to be so bad for you, how come Japanese women live so long? How can anyone with a rational mind argue that my viewpoint that eating a small amount of soy foods such as tofu or boiled soybeans -- a fraction of what Japanese eat -- can be harmful? The discussion continues at the bottom of the page.

Brazil nuts -- great source of selenium
Researchers at the University of Otago, in Dunedin, New Zealand split 69 New Zealand adults into three groups. For a period of 12 weeks, one group was asked to eat 2 Brazil nuts a day, another group took 100 mcg of a selenium supplement, and the third group got a placebo pill. The 2 Brazil nuts provided about 50 mcg of selenium. The selenium level in the blood increased by 64 percent in the Brazil nut group, 61 percent in those who took the supplement, and hardly at all in the placebo group. The conclusion was that consumption of 2 Brazil nuts daily was as effective for increasing selenium status and enhancing glutathione peroxidase activity as taking 100 mcg of selenium. Glutathione peroxidase is one of many important antioxidant enzymes in the body. See http://www.raysahelian.com/selenium.html and http://www.raysahelian.com/glutathione.html
   Comments: There is no need to consume Brazil nuts every day since we get selenium from other food sources. However, rather than taking a selenium supplement by itself, you may consider eating one or two Brazil nuts a few times a week. One shortcoming of Brazil nuts is that they are quite high in calories. if you put a flame to a Brazil nut you will be amazed on how well it burns.

Curcumin may help Alzheimer's patients
Curcumin, a prominent antioxidant and anti-inflammatory substance found in the spice turmeric, may increase the clearance of amyloid plaques in the brain. Amyloids are insoluble protein aggregates found in the brain tissue of patients with Alzheimer's disease. Amyloid accumulation in organs leads to amyloidosis. Dr. Milan Fiala, from the Greater Los Angeles Veteran's Affairs Medical Center, found in test tube studies that immune cells called macrophages taken from patients with Alzheimer's disease cannot efficiently eliminate amyloid. Treating these cells with curcumin enhances macrophage function. Dr. Milan Fiala says, "Further studies are needed to determine if increasing blood levels of macrophages using an oral curcumin agent clear the amyloid plaques, and produce therapeutic effects, in patients with Alzheimer's disease." See http://www.raysahelian.com/curcumin.html
   Comments: It is too early to tell whether taking one or two curcumin capsules a day will help reduce the incidence of Alzheimer's disease, but since curcumin has many health benefits, I don't see any harm in taking a capsule a day or a capsule a few times a week.

Should you have a PSA test for prostate cancer if you are over 75?
A few years ago my dad was found to have a high PSA test. He was 74 at the time. He underwent multiple visits to the doctor over the next few months with repeated PSA tests and prostate exams, and eventually a prostate biopsy indicated he had a small, localized, prostate cancer. I remember my dad calling me several times a month during that period constantly asking for my thoughts on whether he should proceed with surgery, radiation or other treatments for his cancer. My dad had a preexisting heart condition known as atrial fibrillation. I suggested he not undergo any treatment for the small cancer but just to follow the PSA levels. His doctor agreed with my opinion. His PSA level stayed relatively the same over the next few years and the prostate cancer did not grow larger. My dad died at 78 from a heart rhythm problem. Ever since the discovery of the high PSA level, he was constantly worried about this prostate gland. What good did it do to have this PSA test at his age? It only led to more doctor visits, a painful prostate gland biopsy, additional medical bills and insurance forms to fill out, and constant worry. Maybe the constant worry even made his heart weaker.
   Recently the U.S. Preventive Services Task Force advised that "The benefits of prostate cancer treatment based on routine PSA screening in men over age 75 are small to none. However, treatment often causes moderate-to-substantial harms, including erectile dysfunction and bladder control and bowel problems. Doctors should stop routine prostate cancer screening of men over age 75 because there is more evidence of harm than benefit."
   A study has found that older men who already have early-stage prostate cancer are not taking a big risk by not treating it right away. The vast majority are alive 10 years later without significantly worsening symptoms, or die of other causes. See http://www.raysahelian.com/psa.html and also http://www.raysahelian.com/prostatecancer.html

Longevity fact
Japanese girls born in 2007 can expect to live until they are 86 years old, which would make them the longest survivors in the world. Boys born in 2007 can expect to live to the age of 79, ranking third after Iceland and Hong Kong. See http://www.raysahelian.com/longevity.html

Emails
Q. I have been taking SAM-e tablets for approximately three weeks and have had no urges to gamble or drink. I am a recovering compulsive gambler and alcoholic and have had recent bouts with depression. My counselor thought that giving SAM-e tablets a try would help, as she found it to help other gamblers and alcoholics such as myself. It is a blessing for me, as I can focus more clearly on rational thinking day to day instead of the delusional thoughts that compulsive gambling had led me to believe. I will not admit that I am cured but the relief I am experiencing has been amazing to say the least!.
   A. The effects of SAM-e supplements accumulate, therefore it is best to reduce the dosage with time in order to avoid SAM-e side effects. http://www.raysahelian.com/sam-e.html

Q. I have been using the Joint Power Rx formula for over 2-months and am quite happy with the results. We have several dogs (50-60 pounds) that have hip joint problems and I am curious if this joint formula can be used for them, and, if so, what dosage would be recommended. I take two caps, twice daily.
   A. This is a good question. Joint Power Rx was formulated with the intention that it be used by older men and women for joint health but we have had some positive reports from people who have given it to their dogs. It is difficult to know the appropriate dosage for a dog, but it would seem a dog of 50 pounds would tolerate two capsules a day. The capsules can be opened and sprinkle on food. Please have approval by the vet. I am aware of a vet clinic that has purchased Joint Power Rx and continues to re-order on a regular basis. http://www.raysahelian.com/jointpowerrx.html

Q. First I should tell you that I have deep respect for you and I appreciate both the products you sell, and your articles. I don't understand though how you can go on, year after year, advocating that people consume soy products, while the evidence mounts of the damage soy does. It's true, as you write, that the Japanese eat a lot of soy. But (as you know), almost all of the soy they eat is fermented. Fermentation reduces the toxicity of soy. I have friends from Japan who are shocked at the amount of soy that is eaten in the U.S. Here in the U.S. soy is in everything. It's almost impossible to find processed foods without it. We eat far more soy than the Japanese do or ever did, and we eat it in its most noxious form, the form that, when fed to animals, has been shown to disrupt their hormones, speed up their body cycles, cause early sexual maturity, and cause animals fed large doses of it to become unable to reproduce. In the U.S. today, girls are coming to sexual maturity earlier than they ever did. Boys and men have precipitously low sperm counts. It's interesting that as the amount of this pollutant has increased in our diet, we are experiencing the same symptoms animals exhibit when fed this noxious "health food." I spent years eating large amounts of soy, thinking I was doing something "healthful" and beneficial for myself. I ate soy cereal in the morning, drank soy milk instead of cow's milk, mixed tofu in my scrambled eggs, ate Tofutti for dessert. I was a "soy believer" like you. As the months went by I developed a myriad of health conditions. I felt mentally dull and lost interest in sex. I was the sickest I've ever been in my life. Finally I did some research and started wondering if soy might be contributing to my problems. I had a hard time believing it, I was so convinced it must be "good for you," but I finally tried removing it from my diet for a trial period. Within two months after I stopped eating soy, I regained my health. Virtually every health condition I was suffering from improved or disappeared. My mind is sharp and clear again. I'm in my fifties, but feel like I'm in my twenties.
   A. Your symptoms may have been due to overconsumption of soy products and this is not a good argument against my position that small amounts of soy, in the form of tofu, natto, and boiled soybeans, as part of a healthy diet that includes a variety of foods, is acceptable. Furthermore, most soy milk products have lots of added sugar. People should keep consumption of processed foods to a minimum. If soy consumption reduces fertility, it apparently has not had much effect in China or Japan. Can you provide factual data or research studies that shed light on your claims regarding:
What is the amount of soy eaten by the average Japanese?
What is the amount of soy eaten by an average American?
What is the evidence that eating small amounts of soy is harmful to health?
Which country has the longest living humans on average?
Please let us know the evidence in humans that fermentation reduces the toxicity of soy. Are you implying that eating boiled soybeans is harmful?
Please provide research studies that eating soy products reduces longevity.
   We would appreciate you referring to us the research studies you have come across that would help us understand your point of view.
   For the replies and additional communications, see http://www.raysahelian.com/soyprotein.html

SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 10 -- August, 2008
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Just about every food we consume, at some time, has had a negative review or caution. Eggs have been blamed for high cholesterol; Meats for increasing cancer risk; Fish for having high amounts of mercury; Milk for having hormones or causing allergies; Fruits and vegetables for high pesticide levels or bacterial contamination; Bread and baked goods for a cancer causing agent called acrylamide; Fruit juices for raising blood sugar in diabetics. The latest caution seems to focus on soy products. A study found that men who eat soy have a lower sperm count. We've had a few emails this week from men who are now worried about eating soy. What is a person to do? There seems to be few safe foods left to eat. My comments later.
   For the month of August, we are offering a free bottle of choline supplement.

Soy products and sperm count
Researchers at the Harvard School of Public Health in Boston found that men who consumed high amounts of soy foods had a lower sperm count compared to those who did not consume soy foods. Soy products contain plant-derived estrogens known as phytoestrogens. Some animal studies have linked high consumption of phytoestrogens with infertility. The researchers evaluated the intake of soy-based foods in men who went to a fertility clinic. They were asked how much they had eaten of soy-rich foods including: tofu, tempeh, tofu or soy sausages, bacon, burgers and mince, soy milk, cheese, yogurt and ice cream, and other soy products such as drinks, powders and energy bars. Men in the highest intake category of soy products had a lower sperm count compared to those in the lowest intake category. For details, see http://www.raysahelian.com/sperm.html and http://www.raysahelian.com/phytoestrogens.html
   My comments: A couple of decades ago soy products started becoming popular and many people switched from meat to tofu and from milk to soy drinks. More soy-based products appeared on the market and I personally know many people, particularly vegetarians, who eat a variety of soy-based foods a day, including soy-based burgers and ice cream. Based on the study presented above regarding the influence of soy on sperm count, a friend of mine now tells me he will stop eating all soy products. I think this is an overreaction. A better approach is to have a wide variety of foods in the diet rather than to completely shun some. I mentioned at the beginning of the newsletter that most foods have had some bad press at some time. Just keep in mind that if you eliminate one type of food you are more likely to overconsume another type that may not be healthy when eaten in larger amounts.
   Unless a man has a low sperm count and issues with fertility, I don't see the need to eliminate soy products from the diet. People in Japan consume a good amount of soy products yet they do not appear to have any problems with reproductive health or longevity.

Safety of saw palmetto herb
The Saw palmetto for Treatment of Enlarged Prostates study was a randomized clinical trial performed among 225 men with moderate-to-severe symptoms of benign prostatic hyperplasia, comparing a standardized extract of the saw palmetto berry (160mg twice daily) with a placebo over a 1-year period. No evidence for serious side effects or dangers of saw palmetto was observed in this 12 month long clinical trial. For details, see http://www.raysahelian.com/saw.html
   My comments: This is reassuring since saw palmetto is a supplement used by men for many months and years. I hope in a few years we can have results of a longer study, such as five years.

Drug money influences the American Psychiatric Association
The APA is the voice of establishment psychiatry. This organization publishes major journals in psychiatry and its standard diagnostic manual. Is the APA fully independent or are some of its positions influenced by the drug industry? The senate has demanded that the American Psychiatric Association give an accounting of its financing.

Email questions and comments
Q. Thanks for your honesty and responsible behavior on your website and in your newsletters. Very rare indeed especially when the comments are coming from someone that formulates the products they are discussing. I can honestly say that I don’t think I have ever read anything from a supplements related company that wasn’t somewhat cluttered with their bias and desire to sell their products. You would be the exception. Thank you.
   A. I appreciate your comments. I grew up in a culture and family that valued honesty and integrity. It is possible to help people, and make a living, by providing honest information and good products. I can't claim that every bit of information I write about is accurate or every product I formulate will help everyone, but I honestly do my best.

Q. I understand there are different extracts of tongkat ali, the sexual enhancing herb. Is a100 to 1 extract more powerful than 20 to1 extract? But what does it mean if a product has 25 mg of 100:1 compared to 200 mg of 20:1? How do I know which one works better or is more potent?
   A. It is very difficult to compare tongkat ali products since there are many companies that make tongkat ali in different potencies and one company's 100 to 1 extract may be weaker or stronger than another company's 100 to 1 extract. Also, a 100 to 1 extract may not necessarily be exactly 5 times more potent as a 20 to 1 extract since different extraction processes are used and the quality of the herbs can vary among raw material suppliers. Also, it is possible that, for marketing purposes, certain companies will attempt to make it seem that their product is a very high concentration, such as 100 to 1 or 200 to 1 whereas in actuality it is not as concentrated as they claim.
   With tongkat ali, as with most herbs, it is best to try and learn how each product works for you at different dosages, always starting with low amounts since this herb is quite potent and does have side effects when high amounts are ingested. High dosages and potencies are not always better since side effects can take away from the benefits of the sexual enhancement. I have formulated a regular tongkat ali powder at 200 mg and a high concentration extract called LJ100 at 25 mg. Some people prefer taking just tongkat ali powder, whereas others prefer taking LJ100 or other extracts. It is not possible to predict which product a person will best respond to without first trying it. Passion Rx has a combination of regular tongkat ali powder and LJ100, along with a number of other herbs. See http://www.raysahelian.com/tongkat_ali.html

Q. Does eating chocolate influence blood pressure?
   A. Most studies indicate that eating dark chocolate lowers blood pressure. The high sugar content in chocolate reduces the benefits while low sugar, or sugar-free, preparations have an even better effect on lowering blood pressure. See http://www.raysahelian.com/cacao.html

Q. I am 59 years of age (male) and have to say that Dr. Sahelian was right on the dosage of DHEA and the cautions. Before I read his website I started out taking 50mg a day which made me feel anxious and moody along with heart palpitations. I kept backing down on the daily dosage until I reached one that made me feel more normal at 10mg per day. I take DHEA because it actually gives me a mental and physical feeling of well being. I have experimented over the years with this substance until I had reached an optimal dosage for myself. I guess we are all different to a certain degree as to what we can tolerate.
   A. Even 10 mg may be too high for many people and could cause side effects in the long run. I often suggest people take breaks from the use of hormones.

Q. I have a question about Passion Rx. I have read the ingredients in this product and I have seen the same ingredients in other formulas or just slightly different than Passion Rx. Now what makes this product work so well, and other products that I have tried, not work so well. The ingredients you have in this product have been around for a long time. If the ingredients are that potent wouldn’t customers try more of this product than Viagra? I am just trying to figure out what's so special about this Passion Rx product.
   A. There are many factors that influence the effectiveness of a sexual enhancing product. The actual ingredients, whether the ingredients are just the powders or concentrated extracts, the amounts of the ingredients, the quality of the raw material, the interactions of the various herbs within the formula, etc. Also, the product may not work well if the dosages are too low, or too high. Viagra works rather quickly and many people want a quick effect and prefer a drug. However, Viagra only works for erection enhancement, not for sensation or libido. Passion Rx works in a more comprehensive manner and supports many aspects of the sexual response, including sensation, libido, stamina, and erectile function, but it does not work quickly in an hour like Viagra. Normally it takes a few days for the full benefits to be noticed although a few people notice the effects the same day or the second day. Some men only want a stronger erection, and they only want to take a product shortly before sexual activity. For these individuals, Viagra or its cousins Cialis and Levitra are good options. For those who wish to have a more comprehensive sexual enhancement, and can wait a few days for the full benefits, the herbal formulas are great options. Also, the herbs have fewer and less serious side effects than the prescription medications. If you are sensitive to herbs, or over the age of 50, use half a capsule or 3/4 of a capsule. Passion Rx is taken on an empty stomach in the morning, at least a half hour before breakfast.

SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 9 -- July 10, 2008
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I have been nearsighted since I was a child. I am not sure if it was purely genetic or because of excessive reading, or both. I was an avid reader as a child, sometimes going through several books a week, even reading in dim light late into the night and under the bed covers with a small flashlight so my parents would not see me break curfew. At age 10 I was fitted with eyeglasses but could not stand wearing them especially while involved in sports activities. In my early twenties I started wearing contact lenses which were a big help but still made my eyes uncomfortable. In my mid thirties I had radial keratotomy surgery and this helped to bring my vision to about 20/30, but over the following years this weakened to 20/40 or even 20/50 if my eyes were tired or if I was stressed. I was hoping my eyes would correct to 20/20 after the surgery but the final result was not as good as I had hoped for, but better than my original 20/100. For the last decade or more I have been trying to find natural ways to improve my vision. I tried several eye exercise programs but none seemed to help to any extent. A few years ago, while writing my book Mind Boosters, I was experimenting with dozens of nutrients and herbs to see if they had any mind enhancing effects. Surprisingly I found some that improved my vision. This gave me the idea to formulate a product for vision enhancement. After years of experimenting with various herbal extracts and nutrients, alone and in combination, I developed Eyesight Rx, a formula with a couple of dozen ingredients. People who take Eyesight Rx notice improved day and night vision, colors being richer, and improved close and distance vision. Objects are in more focus and reading becomes easier. Each time we create a new batch I tweak the formula to improve the benefits. This latest version is my favorite and we have had great feedback. Below I discuss a new study regarding the role of lutein and DHA in eye health.

Lutein and DHA are both needed for optimal vision
Lutein is a carotenoid found in some vegetables and fruits that, after ingestion, finds itself to the retina of the eye. DHA is a type of omega-3 fatty acid also found in the retina. Researchers at Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts did a study to determine the influence of lutein and DHA supplements on macular pigment optical density. Forty-nine women (aged 60-80 years) were randomly assigned to placebo, DHA, lutein, or lutein plus DHA supplement. Lutein supplementation increased macular pigment density eccentrically (beyond the center of the retina). DHA resulted in central increases.
   Comments: It appears that both lutein and DHA are needed for optimal vision since they influence different parts of the retina. Eyesight Rx has an appropriate amount of lutein along with two dozen additional nutrients and herbs that work synergistically to improve vision. If you wish to improve your eyesight, I suggest you take fish oils in addition to Eyesight Rx. Fish oils have the fatty acids EPA and DHA. DHA alone is also available as a vegetarian source from algae.
   If you eat at Japanese restaurants, you may consider ordering Ikura or salmon eggs. Or, you can buy salmon eggs or roe at your grocery store. I find fish eggs help with vision but they are quite expensive. My ideal program for vision enhancement is half a tablet of Eyesight Rx two or three mornings in a row with a day off along with two to three fish oil softgels before or with breakfast. One benefit of Eyesight Rx is that it comes in a tablet form that you can melt under the tongue for direct absorption into the bloodstream.

Vitamin D - Can You Take Too Much?
Dr. Martha E. Payne of Duke University, Durham, North Carolina, thinks high intakes of vitamin D and calcium may lead to vascular calcification in the brain since calcium is taken up into the blood vessel walls. She and her colleagues evaluated calcium and vitamin D intakes by food frequency questionnaires and performed MRI scans in more than 200 elderly men and women (average age, 71 years). All of the participants had some brain lesions of varying sizes but those reporting the highest intakes of calcium and vitamin D were more likely to have higher total volume of brain lesions. There is a concern that excessively high intakes of calcium, either through food or supplements, may end up in the brain along blood vessel walls, in addition to that of bone. This has the potential to result in cognitive decline. For an excellent article on this topic, see http://bacteriality.com/2007/10/24/brain_lesions/
   My comments: Recently a medical doctor emailed us criticizing my cautious approach on calcium and vitamin D use. He said he places his patients with osteoporosis on 1500 mg of calcium and 2000 units of vitamin D. I think one has to balance the benefits and risks of supplements. Too high dosages can have effects on parts of the body that are not easily evaluated. For instance, even though high dosages of calcium and vitamin D may help bones become stronger and reduce the risk for fractures, they could also potentially raise the risk of brain calcifications leading to mental decline. I, personally, don't recommend more than 800 mg of calcium a day and more than 400 units of vitamin D a day in the form of supplements. Some supplement companies sell vitamin D products that are 1000 units or even 2000 units. Most people do not require these high dosages and it is quite possible they could be harmful in the long run. See http://www.raysahelian.com/vitamind.html

Does watermelon have effects similar to Viagra?
The media has made a big story of watermelon having Viagra-like effects since watermelons contain a substance called citrulline which converts into the amino acid arginine. Arginine helps dilate blood vessels. Because of this biochemical connection, Bhimu Patil, a researcher and director of Texas A&M's Fruit and Vegetable Improvement Center was quoted saying, "Arginine boosts nitric oxide, which relaxes blood vessels, the same basic effect that Viagra has, to treat erectile dysfunction and maybe even prevent it." Well, this is all the media needed to hype this story. But, does eating watermelon flesh or rind have any sexual enhancing effects?
   Comments: I love watermelon, it is one of my favorite fruits. I actually love the combination of watermelon and feta cheese. I have been known to eat half a large watermelon at one sitting. I have not noticed any Viagra-like effects from eating watermelon or drinking watermelon juice. I have also tried citrulline supplements and arginine supplements and have not noticed a significant effect on erectile function. Even if citrulline and arginine dilate blood vessels, their effects are brief. If you really want to enhance libido, sensation and sexual stamina, Passion Rx with Yohimbe is one of your best options or consider a number of sexual herbs that are quite potent. See http://www.raysahelian.com/watermelon.html or, for citrulline information, see http://www.raysahelian.com/citrulline.html. To learn about herbs that increase sexual urge, see http://www.raysahelian.com/libido.html.

Foot pad scam?
Q. Do you have an opinion about Kinoki foot pads? Do detox foot pads work or are they a fraud?
   A. I have not studied foot pads in great detail, but my current opinion is that Kinoki foot pads or other pads promoted for "detox" purposes are not effective. I tend to consider these products in the "scam" category. Medically, I can't see how putting on a foot pad before bed will "draw toxins" from the body. I have not seen any studies that support the claim that wearing these foot pads overnight leads to improved health. If anyone knows about such studies, I would be glad to review them.

Toe nail fungus cure
Q. Thanks for your informative newsletter! About eight months ago I began soaking my toes in a solution of Epson Salt and water for my toe fungus. I had read about a toe nail fungus cure in your email newsletter and had put up with the toenail fungus for about 15 years, keeping it under some control with Tea Tree Oil applications. However, it never went away and had recently gotten much worse and painful. I thought when I read your suggestion, "Why not?" with a nothing to lose attitude. I am writing to tell you that IT WORKED! I tried to be consistent in the beginning, did not measure the Epson Salt, but put a few tablespoons in a half-full shallow basin of warm water and soaked for approximately ten to twenty minutes daily. As the toenails grew out they looked well and healthy! I now do this about once a week, just to be safe, but feel I can now tell you that IT WORKED and thank you. I am very grateful. PS. I am a 69 yr. old diabetic (type 2) woman who is in otherwise excellent health, exercise several times a day and am very active.
   A. I get a thrill when the readers of my newsletters are able to treat or cure their medical condition in a natural manner, particularly if modern medicine does not have a good solution. See http://www.raysahelian.com/nailfungus.html for details on how to get rid of toe nail fungus and athlete's foot.

Passion Rx fan - effective for sexual enhancement
Q. I just thought I would share my experiences with Passion Rx. Over two months ago, I chanced upon this sexual enhancing product. I was impressed by its list of ingredients, including maca, tribulus, muira puama and yohimbe, and many others. Until this time, I have been dependent on Cialis - there was no way I could perform without it. Sometimes, even with Cialis, I had to have the greatest concentration else, I will lose it. I have been on testosterone patches and got no relief. So, I decided to take the plunge and ordered one Passion Rx with Yohimbe. Around the 3rd week, I noticed that i started having spontaneous hard-ons. One night, during that week, my wife took me by surprise in the morning (I left the new pack of Cialis I just bought in my office and couldn't run downstairs before the action, so I decided to go ahead. I was surprised -- we did it. In the past, this would not have been possible, i would have lost my erection half-way.. But now I realized that I had so much libido -- the desire was strong. I decided to take the capsules for one more week. By the 4th week, I could have sex with my woman without taking the Cialis. In fact, I have used only 8 out of the 100 Cialis tabs that had arrived about 3 months ago. Interestingly, I noticed differences in how I feel even with a condom. Previously, I could not sustain an erection with a condom on, even when I take the Cialis. But now, without the Cialis and on this supplement alone, I can use a condom and still complete the act without losing it. I am so happy with your product that I reordered a second bottle and taking it now. I don't know when I would have to stop -- but realized that I can skip a couple of days and still have a long term effect. Thanks for a great product.
   Comments: We love getting these types of testimonials. For long term use, Passion Rx is only needed 2 or 3 days a week. It is a good idea to take a full week off after each month of use. Most people notice a benefit within days rather than weeks.

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SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 8 -- June 20th, 2008
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With food prices going higher, particularly for produce, some Americans are cutting back on fresh fruits and vegetables. I am concerned that more people on low incomes may turn to buying high-calorie packaged foods and visiting fast food restaurants where a meal consisting of a burger, fries and soda is still under 6 dollars. But the health risks of consuming these foods are significant. Some people think that the effects on the liver, heart, and other tissues from regular consumption of these fast foods takes years or decades to develop. Actually, the harm may occur within weeks.

Fast food damages the liver
Eating fast foods for one month has a harmful effect on the liver indicated by an elevation of certain liver enzymes. Researchers in Sweden followed 12 men and six women in their twenties for one month. All volunteers were slim and in good health and ate two meals per day at McDonalds, Burger King or other fast-food restaurants. The goal of the study was to increase body weight by 10 to 15 percent. Levels of a liver enzyme called ALT increased after only one week, and quadrupled on average over the entire period. When your doctor does a routine blood study, certain liver enzymes are evaluated, including ALT which stands for alanine aminotransferase. In the majority of the volunteers, ALT rose to levels that would normally reflect liver damage. Two of the individuals had liver steatosis. Steatosis (also called fatty degeneration) is the process of abnormal accumulation of fats within a cell. It reflects an impairment of the normal processes of synthesis and elimination of triglyceride fat. This study clearly showed that high ALT levels can occur due to unhealthy food intake alone.
   Comments: To be honest, I stop at a fast food restaurant a few times a year when I am taking a long road trip and there are few options on the road except for a highway exit that leads to a fast food restaurant. I order a burger with diet soda but I eat very little of the bun. I am not a purist in the sense that 100 percent of my food consumption has to be perfectly fresh and healthy. It's too stressful to be a perfectionist. I don't think there's any harm in eating fast foods a few times a year. My concern involves people who eat these types of foods several times a week and habituate their children to these meals.
   If you would like to see an entertaining movie regarding this topic, consider renting the 2004 movie Super Size Me. See also www.raysahelian.com/alt.html

Cod liver oil reduces the risk of diabetes in children
Recently while perusing Medline, a source of original medical research publications, I came across a study from 2003 that caught my interest. The title said, "Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes.
   Researchers at the Ulleval University Hospital, Oslo, Norway found that when infants were given cod liver oil in the first year of life, they later had a significantly lower risk for type 1 diabetes. Use of other vitamin D supplements during the first year of life and maternal use of cod liver oil or other vitamin D supplements during pregnancy were not associated with reduced type 1 diabetes. Therefore, it does not appear the vitamin D in cod liver oil is making the difference, but more likely the fish oils or some other factor. The researchers conclude: Cod liver oil may reduce the risk of type 1 diabetes, perhaps through the anti-inflammatory effects of long-chain n-3 fatty acids. See www.raysahelian.com/codliveroil.html

Practical advice regarding taking brain boosting supplements
We recently received an email from a reporter from a national health magazine. I would like to share with you my responses to the questions.

I am writing a short article about memory supplements. I see you have written a book on the topic called Mind Boosters and have a strong background in supplements, so I was hoping you would have some time to answer a few questions.
  
Q. There are so many memory supplements on the market now. How would a man or woman start to sift through the options and find one that may benefit? Are there certain things you can suggest to look out for?
   A. It is not possible to predict which nutrient, herb, or combination formula, will be effective until one takes the supplement for a few days or a couple of weeks. There are quite a number of supplements that are worth trying including acetyl l-carnitine, ginkgo biloba, DMAE, trimethylglycine, vinpocetine, fish oils, choline, cdp-choline, and bacopa monnieri. A popular combination formula is Mind Power Rx which has a small amount of more than a dozen brain nutrients and herbs. One option is to buy three of four of these supplements. Then, each morning, for a period of one week, take one capsule of a particular supplement. Next, take 3 or 4 days off and resume your experiment with a different supplement for a week. After you have experimented with each supplement you have purchased, you will have a better idea which one, or which ones, work for you. I am not aware of any other way to determine which product will be effective for any one person without actually trying it. Note: Some of these supplements are potent, so if you are over the age of 50, or are taking hormones, medications, or other supplements, discuss with your health care provider who may suggest you begin with half a capsule or a tablet rather than the full dose.
  
Q. I know some herbs, like ginkgo biloba, have a lot of research behind them in terms of being beneficial for improving blood flow to the brain and improving cognition in older subjects, but do you think it can be beneficial for a healthy man or woman in their 30s or 40s to take on an ongoing basis to prevent cognitive decline?
   A. In my opinion, mind and memory supplements, such as ginkgo biloba and others, are best reserved for occasional use in those who are in their 30s and 40s. These supplements can be taken on days when one wishes to be more alert, focus better, and have more mental stamina. But I do not recommend non-stop daily use of these brain boosters for years or decades since we don't know the long term consequences. For more information, see www.raysahelian.com/memory.html

Q. I have been using psyllium fiber and/or ground flaxseeds on a daily basis to keep regular. The info on psyllium fiber containers state that it may interfere with absorption of vitamin supplements and not to take such products at the same time. In researching, I have found information that tells me all fibers (including ground flaxseeds) interfere with vitamin absorption. I know you have addressed this issue about psyllium fiber before and wonder if you still have the same thinking that in taking psyllium at approximately the same time as vitamin supplements is not a major issue.
   A. Most vitamin supplements, including multivitamins, contain more than necessary dosages needed by the body, therefore, even if less is absorbed due to psyllium fiber use (and the decrease in absorption in many cases may not be too significant), the body is still likely to absorb sufficient amounts. For practical purposes, one can sometimes take the psyllium fiber the same time as the vitamin supplements, and others times at a different time of the day.

Q. I started taking a SAM-e product that had 400 mg. The first two days I had very bad headaches then for 2 days I had stomach cramps. This is day 5 and I'm vomiting. i just thought my body needed to get used to it. Can a person have such severe multiple reactions to a product with natural ingredients.
   A. Yes, natural products do have side effects, not as severe as drugs but nevertheless they can be quite unpleasant. SAM-e does have dangers when taken in high dosages. In my opinion, for long term use, SAM-e supplements work better at a dosage of 50 to 100 mg a day, with a day or two off a week.

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SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 7 -- June, 2008
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I just returned from a visit to Brazil, a beautiful country with people who are warm and friendly. One of the things I enjoyed most about my stay in Rio de Janeiro were the juice bars. Many of them don't even have a store front. You just walk in off the street and there are bar stools where you sit and take a look at the signs on the wall of all the juices they offer with enticing pictures of the fruits. At least one of these juice bars, a block away from Copacabana beach hotel I was staying at, was open 24 hours a day!
   During my stay I had the pleasure of tasting the juices of acai, acerola, graviola, passion fruit, cupuacu, guava, mango, cacao, and others. Yes, even cacao juice. The cacao tree is a medium sized tree that grows in the tropics. The cacao fruit ranges from 5 to 12 inches long, is the shape of an elongated egg with deep ridges on its surface and has a hard shell that you break open by hitting on a rock or hard surface. Inside is a white, creamy pulp along with lots of cacao seeds the size of fava beans. The pulp is made into a delicious juice. I had a chance to eat the cacao seeds which are slightly bitter but I did enjoy them. After cacao is processed, it is called cocoa.
   Unfortunately, many of these juices, such as acai juice, have sugar added to make them more palatable. A large glass of acai juice with sugar added can have several hundred calories. One time I ordered acai juice (it has a beautiful purple color) without added sugar and mixed the contents with calorie-free stevia packets I had brought with me. The stevia helped sweeten it to a pleasant taste.
   Many of these tropical fruits and their extracts are starting to make their way to the US market and over the next few years you will see a greater number of these fruits in stores or as herbal extracts. Already some of these are already available in extract form in capsules including acai, graviola, cacao, etc. The advantage of the capsules is that they have hardly any calories. If you do drink the juices, consider sweetening them with stevia rather than sugar. Some juices, such as mango, do not need to be sweetened.

Astaxanthin, as antioxidant, protects fatty acids from oxidation
Researchers at the University of Kuopio in Finland gave young Finnish men astaxanthin capsules daily for 3 months. Absorption of the astaxanthin from supplements was good and the supplement was found to be effective in decreasing oxidation of fatty acids in the blood. Astaxanthin is a carotenoid that is found in marine mammals, and is found in high concentrations in krill oil.
   Comments: Astaxanthin is becoming more popular as a potent antioxidant. Most supplements provide astaxanthin in a 2 mg dosage. Another option is krill oil which supplies 2.7 mg in 2 softgels. For more information, see http://www.raysahelian.com/astaxanthin.html and the krill oil page is http://www.raysahelian.com/krilloil.html

Bitter melon and blood sugar
Dcotors at the Chinese Academy of Sciences in Shanghai have found several compounds from bitter melon known as cucurbitane triterpenoids. They tested the effects of these compounds on glucose (sugar) and fat metabolism in cells and in mice. When tested in muscle and fat cells, the compounds stimulated a glucose receptor to move from the cell interior to the cell surface, thus promoting more effective glucose metabolism. Several of the tested compounds had effects comparable to those of insulin. Tests in mice of two of the compounds found that they promoted both glucose tolerance and fat burning, and one was particularly effective in promoting glucose tolerance in animals consuming high fat diets.
   My thoughts: Bitter melon is a plant eaten and used medicinally in parts of Asia for the treatment of diabetes. Bitter melon supplements are starting to become more popular. See http://www.raysahelian.com/bittermelon.html

Drugs that increase the risk for bone fracture
Two drugs prescribed by doctors to lower blood sugar and treat diabetes -- pioglitazone and rosiglitazone -- increase the risk of bone fractures. Patients who use these drugs for a year or longer are more than twice as likely as nonusers to fracture a bone. Pioglitazone and rosiglitazone, also known by the trade names Actos and Avandia, respectively, belong to a drug class called thiazolidinediones. The use of these drugs is linked to bone fractures of the hip and wrist, and the elevated risk is seen in both men and women, independent of age.
   My comments: I am nervous about using new drugs in my practice since we often find out the full range of the dangers or side effects of these medications after they are introduced to the public and hundreds of thousands of people start taking them. For someone who has type 2 diabetes, all attempts should be made to use diet, exercise, herbs and natural supplements before resorting to drugs. I much prefer using the older diabetes drugs such as metformin, rather than the new ones such as Avandia, that have not been proven to be safe. For more information, see http://www.raysahelian.com/thiazolidinediones.html and http://www.raysahelian.com/avandia.html

CpQ10 dosage
Q. Dr. Sahelian, you seem to be concerned about using high dosages of CoQ10 as mentioned in your website. I 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 from the supplement. I have had people on CoQ10 for at least 2 years on that dosage and ahve not seen a serious side effect. All my adult cancer patients take this CoQ10 dosage.
   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 of CoQ10 actually live a few years shorter or somehow their mitochondria are not functioning as well? As with hormone replacement therapy, it took decades for the scientific community to find out that it caused more problems than in solved. Initially hormone replacement therapy appeared to provide many health benefits to women. CoQ10 appears to be a healthy supplement, but who knows for certain that taking more than 100 mg is healthier than taking less? If there is no such proof, then one should be cautious and take less, not more. Many people who take CoQ10 also take other supplements or medicines and we have no idea of all 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 CoQ10 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 of CoQ10. Perhaps high doses of CoQ10 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 high dosages 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.
   See http://www.raysahelian.com/coq10.html

Milk or cream with tea and coffee
Q. I have read and seen it written a number of times on various websites that milk can almost completely inhibit the uptake of the various antioxidants in cocoa and also tea. Apparently the milk proteins combine with the antioxidants to prevent their absorption. I’m sure the majority of people tend to drink cocoa made with the addition of milk, and certainly here in the UK tea is also drunk mainly with milk. I wonder about your opinion on this and whether it might be important to stress that milk should be avoided in order to enhance absorption.
   A. Rhere was one recent study that indicated consuming tea with milk reduced the benefits from some of the antioxidants in the tea. It may be a good idea to drink herbal teas without milk until further research confirms or negates the early reports. Or, another approach is to just enjoy the tea with the milk and get antioxidants at a different time of day from different supplements, foods and drinks rather than relying on tea. If you really enjoy tea and coffee with cream or milk, don't deny yourself the pleasure.

Regulation of supplements
Q. Given that you personally feel that high dosages of tyrosine or DHEA and certain other supplements cause adverse affects, is there any regulation or FDA recommended dosage? I have had enormous problems with tyrosine in the past. Where, if anywhere are the dangers of supplements mentioned or how are they regulated?
   A. You ask a good question that deserves a somewhat philosophical answer. There are no official supplement dosage guidelines (except for certain well-known vitamins and minerals) since many such guidelines would be somewhat arbitrary and open to significant differences of opinion among various scientists. And how do we know that government officials are any more knowledgeable (or honest) than certain doctors and nutritionists who have first hand knowledge of these supplements in their clinical practice? There are thousands of herbs and individual supplements, and tens of thousands of combination formulas. How can any independent or governmental organization ever keep up knowing the appropriate dosages of these supplements, herbs, and combination formulas?
   If strict governmental guidelines are placed on supplements dosages (whether it be tyrosine, alpha lipoic acid, curcumin, mangosteen, noni, coq10, melatonin, and others), why not then follow the same logic and limit hard liquor bottle sizes to only six ounces and forbid the sale of more than one bottle at a time since there are serious risks in drinking excess alcohol? What about limiting sales of sugar-laden sodas that cause obesity and diabetes? Drinking more than one soda a day is associated with an increased incidence of metabolic syndrome. We live in a society that should accept the fact that there are risks to some of the products and foods we consume. If we were to tightly regulate every little detail of a citizen's life and what or how much they can ingest of a food, drink, or supplement, we would no longer have the freedoms we currently enjoy. Each citizen is responsible for their own health and to learn as much about a food, drink, or supplement before they ingest it.

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SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 6 -- May 20, 2008
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Does taking a multivitamin/mineral supplement help you live longer, shorter, or make no difference at all? Over the years there have been conflicting reports regarding the benefits of taking a multivitamin supplement. Some studies indicate heart and immune system benefits, and perhaps reduction in cancer, while other studies report the opposite -- taking a multivitamin supplement reduces longevity. Which is right? I discuss this in more detail below.

   Over the years I have formulated products for a number of different companies. One of the reasons I really like working with Physician Formulas is that I have the freedom to modify and improve the formulas as I wish. Other companies that I previously formulated products for did not allow me this option. It takes time and costs money to change labels, flyers, etc. I am glad to report that I now have reformulated Eyesight Rx, adding several new ingredients such as resveratrol, acetylcysteine, carnosine, taurine, and others. I really, really like this newest version. The benefits are noticed quicker and the side effects are minimal. Users notice improved day and night vision, better color perception, and improved distance and close vision. Seeing clearer gives us pleasure. Later on I discuss how to best use this product.

Multivitamin supplements - multiple points of view
Although it is tempting to cite statistics regarding the hundreds of studies done over the years to determine whether taking a multivitamin is beneficial or harmful, I will spare you all the boring numbers and details. I prefer to look at things from a larger perspective. Although the following statement may be controversial, I will come out and say it. "The majority of the studies that have been done to date regarding the influence of multivitamins on health and disease are worthless." Why? Because many of the epidemiological studies evaluating millions of multivitamin users did not bother to differentiate the fact that there are thousands of different multivitamin products and each has a different composition and dosage of vitamins and minerals. It's like grouping all wine drinkers together whether they drink white wine, rose, red wine, or whether they drink an ounce a day or a bottle a day.
   Most of the studies do not differentiate the type of vitamin E present in the supplement products. Vitamin E comes in a synthetic version and in a natural version, i.e, dl-alpha tocopherol or d-alpha tocopherol. Just this difference alone could have an effect on health. Plus, there are many other forms of tocopherols, including alpha, delta, gamma, etc. The majority of multivitamin products only have the synthetic dl-alpha tocopherol version of vitamin E. It is possible that taking a high dose of a synthetic form of vitamin E could be harmful whereas taking a vitamin E complex that includes the full range of tocopherols could be beneficial. One additional point to keep in mind is dosage. It is possible that low amounts of vitamin E complex could have a beneficial effect on longevity whereas very high dosages could have the reverse effect.
   Multivitamin and mineral supplements also contain vitamins A, B, C, D, minerals such as calcium, magnesium, chromium, selenium, etc. Over the past few years more multivitamin products now include a number of other nutrients and herbal extracts such as CoQ10, choline, bioflavonoids, green tea, etc. Therefore, a researcher who does a study lumping together all types of multivitamin products even though each product is different does not really understand supplements that well.
   One additional point I would like to make is the role of selenium. In the April 2008 issue of the newsletter I briefly mentioned that some early reports indicate that having a too low intake of selenium or taking too high a dosage of selenium could reduce longevity whereas having a normal intake was optimal. Here is another reason why these multivitamin studies could be flawed. Perhaps some of the multivitamin products people were taking had too much selenium.
   Bottom line: I personally take MultiVit Rx on days when I wish to have more energy. I take MultiVit Rx 2 or 3 days a week since it provides me with a sense of vitality and wellbeing. I feel more motivated and can get more work done. I have no idea how it influences longevity but I don't take it for that purpose. I don't think we are going to find out about the risks and benefits of multivitamins until several different formulas, developed by experienced nutritional experts, are tested for at least 10 to 20 years on a large group of people.

Ketogenic diet reduces the risk for seizures in children
A ketogenic diet is a high-fat, low-carbohydrate diet that induces excess production of ketone bodies, which are incompletely burned fat molecules. Since the 1920s this diet has been proposed as a way to reduce seizures and most recent studies have found it to be beneficial. In this latest one, Dr. Elizabeth G. Neal, from University College London, randomly assigned a group of children who were having at least seven seizures per week despite anti-seizure medication treatment to a standard diet or a ketogenic one. After three months children on the ketogenic diet had a third fewer seizures, while seizure frequency increased in children on the standard diet.
      My thoughts and hypothesis: I am aware that fish oils help reduce the risk of cardiac arrhythmias by helping stabilize neuronal excitability in heart tissue. I wonder if fish oils or eating fish could have the same benefits in brain tissue, helping reduce neuronal excitability and thus reducing the occurrence of seizures. I would be interested in getting feedback from neurologists or other experts would have studied this topic. For more information on the ketogenic diet, see http://www.raysahelian.com/ketogenicdiet.html

How to take Eyesight Rx
If you are middle aged or older you probably have noticed some degree of visual decline. Fine print is more difficult to read, colors are not as bright, and distant objects are not in focus as much. Some of you may have already started wearing glasses. Eyesight Rx is ideally suited to help those with age-related visual decline although it could easily offer a benefit to those who have been wearing glasses for a long time.
   I have been experimenting with the Eyesight Rx formula for several years, adding different herbs and nutrients, changing the dosages, etc. The latest version now available is the one I am extremely satisfied with. It comes as a tablet and it is taken first thing in the morning. Some people may notice the benefits the first day, for others it may take several days. The vast majority will notice visual enhancement by the end of the first week. Once you notice a visual enhancement, take less the next day. Once the nutrients replace the shortages in your retina, your requirement will be less and you can reduce the dosage. Once or twice a week you may wish not to take it at all. If you take a high dosage all the time, it may not work as well or even make your eyesight fuzzy since too many of these nutrients would be supplied to your retina and cause the carotenoids or other substances in the retina to be out of balance. If this happens, just take a day or two off and resume taking the Eyesight Rx again at a lower dosage.
   Eyesight Rx does not supply omega-3 fish oils which are crucial to optimal vision. You may take one to three fish oil capsules a day to supply the fatty acid DHA to the retina. For more information, see http://www.raysahelian.com/eyesight.html 

Question from a reader
Are eggs healthy or not healthy to eat?
Q. I heard on TV that those who eat a lot of eggs have a higher rate of heart disease and die sooner since eggs have a high amount of cholesterol. What are your thoughts about eggs?
   A. The media has a way to sensationalize and distort nutritional research. Eggs are a healthy addition to the diet if consumed in reasonable amounts. I don't see any harm when egg consumption is limited to half a dozen a week. Eggs are a great protein source and also provide phospholipids. Buy eggs by chickens that are raised in a cage free environment.

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SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 5 -- April 20, 2008
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A study published in 2006 in the New England Journal of Medicine (supposedly the most prestigious medical journal in America) emphatically reported that smokers undergoing lung scans would have a higher risk of detection of early cancers. The study, performed at Weill Cornell Medical College, indicated that if CT scans were used to evaluate smoker's lungs rather than plain X-rays, a significantly higher rate of early diagnoses could occur since the CT scans could detect much smaller tumors which could be removed through surgery. Finding a cancer early by CT scans could reassure smokers to continue their habit since early diagnosis could potentially cure their condition. The cancer society does not currently recommend CT scans, and most insurers don’t pay for them.
   To the shock of many people, it was discovered in March of 2008 that this lung cancer study was partly funded by a tobacco company, raising serious suspicions about its accuracy. Furthermore, the lead researcher has a financial interest in lung cancer CT scan patent technology. http://www.time.com/time/health/article/0,8599,1725719,00.html
   As a reader of my newsletter I suspect that you pay attention to news about health issues in the media. The reason I mention this topic is for you to be aware that there is a complex underworld of motivations that are not apparent when you read or see on TV the final headlines of study results. Science is, unfortunately, not pure. Personal motivations and big money influence outcomes or influence interpretations of the statistics not only on medical topics, but on nutritional supplements.

Melatonin and morning sun exposure
Sun exposure or bright light along with an evening dose of melatonin help normalize the sleep-wake cycle in elderly adults with Alzheimer's disease. Dr. Glenna A. Dowling, of the University of California, San Francisco evaluated whether light therapy -- alone or along with melatonin supplements -- could restore a more natural sleep-wake cycle. She randomly assigned 50 nursing home patients with Alzheimer's disease to one of three groups for a period of ten weeks. Patients in the first group were given light therapy for one hour consisting of either natural light alone, or additional artificial light when needed. Patients in the second group received both morning light therapy as well as a 5mg melatonin supplement a few hours before bedtime. Those in the third group were exposed to only normal indoor light and were not given melatonin. The combination of light therapy and melatonin reduced daytime sleepiness and increased patients' activity during the day.
   Comments: The ideal long term melatonin dosage for patients with Alzheimer's disease is not clear but my thought is that 1 mg or 2 mg every other night is a good option. http://www.raysahelian.com/melatonin.html

How much water to drink every day
I recently had a question from a reader regarding the ideal daily water intake.
Q. I read reports that many scientists don't think 8 glasses of water are needed daily but health articles are constantly promoting the idea of drinking lots of water. I trust your opinion and wanted your thoughts on this topic. My wife is always carrying around a water bottle and goes through several a day.
   A. There are claims that people should drink 8 glasses of water a day but there are no studies that indicate that the human body requires this much daily water unless a person lives in a hot and dry climate and does a lot of outdoor physical activity. Some people claim that drinking lots of water improves skin hydration, clears toxins, and helps suppress appetite. Some individuals drink lots of water before or during meals to suppress appetite, but water is quickly absorbed from the intestinal tract and does not stay around like fiber-rich foods to cause satiation or fullness. Drinking a reasonable amount of water by a healthy person, such as about 4 to 6 glasses a day rather than 8, is enough to flush out toxins. As to skin, drinking lots of water does not necessarily increase the water content of the skin.

Fish oil as good as Prozac?
Researchers at the Tehran University of Medical Sciences, Tehran, Iran compared the effects of eicosapentaenoic acid (EPA), fluoxetine and a combination of the two in major depression. EPA and DHA are the fatty acids found in fish. Fluoxetine is the generic name for Prozac, the SSRI type antidepressant.
   Sixty outpatients with a diagnosis of major depressive disorder were randomly allocated to receive daily either 1000 mg EPA or 20 mg fluoxetine, or their combination for 8 weeks. (Each fish oil capsule generally has about 180 mg of EPA and hence to get 1000 one would need five or six fish oil capsules daily.) Fluoxetine and EPA appeared to be equally effective in controlling depressive symptoms.  The EPA and fluoxetine combination was significantly better than fluoxetine or EPA alone.
   Comments: Perhaps doctors who treat their patients with SSRI drugs should consider adding fish oils which may help reduce the necessary dosage for the SSRIs. There are several other nutrients that are helpful for depression, see http://www.raysahelian.com/depression.html and http://www.raysahelian.com/fishoils.html.

Q. I read somewhere that garlic helps with blood vessels. How does garlic work to dilate blood vessels?
   A. Human red blood cells convert garlic-derived organic polysulfides into hydrogen sulfide, a vascular cell signaling molecule. The blood vessel activity of garlic compounds is related to hydrogen sulfide production, and their potency to induce blood vessel relaxation increases with the hydrogen sulfide content of the garlic. http://www.raysahelian.com/garlic.html

Q. I wanted to mention a Diet Rx side effect I experienced after taking this product non-stop 2 capsules a day for three months. I started feeling fatigued. When I stopped the capsules, within a few days my energy came back. Now I am taking one capsule a day and that is perfect. I feel appetite suppression without side effects. I love the benefits I have experienced and so have all my girlfriends.
   A. It is a good idea to take a week off after each bottle is finished. Initially 2 capsules a day may be required, but, for long term use, one capsule a day is sufficient. This way Diet Rx side effects would be minimized yet still provide the desired benefits. http://www.raysahelian.com/diet.html

Q. I have been using stevia for several years now and love it, knowing it doesn't have the chemical issues as other sugar substitutes such as saccharin. However, I am concerned about a Time magazine article I read about "artificial" sweeteners, such as saccharin, whose long term use researchers think may have a link to overeating and hence,
obesity. I would appreciate your response to this article. From a scientific standpoint, would stevia cause the same metabolic reaction to the sugar effect as saccharin, potentially causing overeating and weight gain?
   A. When these types of studies are done in animals, animals are fed meals almost exclusively sweetened with an artificial sweetener and the amount of artificial sweeteners fed to them as a percentage of their food intake is quite high. In contrast, most humans who consume stevia do so in small amounts, adding stevia to tea or coffee, but continue to eat other foods throughout the day that have other forms of sugars. The rodent studies are not likely to be applicable to us humans eating a regular diet with a little bit of stevia used as a sweetener. http://www.raysahelian.com/stevia.html

Q. I'm wondering about the benefits of taking so called "stress" formula B vitamins which contain 250 mg B-12, 100 mg thiamine, 100 mg Riboflavin, etc. Much higher than the recommended adult daily dose. Are there side effects to watch out for?
   A. Even though B vitamins are water soluble rather than fat soluble, meaning they are not stored in the body but excreted, they could still have an undesirable physiologic effect before they are excreted through the kidneys. It is possible taking too much can throw off the delicate body biochemistry for a while until the B vitamins are excreted. They could alter the enzymatic processes in cells, cause rapid heart beat, overstimulation and restlessness, and perhaps insomnia and fatigue. There is no evidence that taking very high amounts of B vitamins improves health. High dosages of vitamin B6 for several months can cause nerve damage. http://www.raysahelian.com/multivitrx.html and http://www.raysahelian.com/bvitamins.html

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SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 4 -- April 2008
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I recently saw a TV program where one of the topics was on human longevity. The "anti-aging" doctor interviewed in the program had prescribed one of his patients 250 supplement pills a day and recommended drinking eight cups of green tea for the purpose of improving longevity. Just a day after I saw this program, I came across a study regarding the mineral selenium. Apparently moderate levels of selenium intake are associated with longevity but when selenium levels are too low, or too high, the odds of dying from any cause begin to go upward. Even though each vitamin, mineral, or supplement is different as to its ideal dosage, in general this study indicates that excessive intake of certain supplements, particularly certain minerals, has negative health consequences. I think drinking eight cups of green tea a day could well interfere with sleep. Not having a deep sleep can actually reduce lifespan even if there are substances in green tea that are beneficial to the body. The point I want to make is to be reasonable in your use of supplements and not to go overboard. Too much of a good thing is not so good. Some "anti-aging" doctors recommend their patients take high dosages of hormones such as DHEA. I wonder if these doctors really know what they are doing. For details on the selenium study, see http://www.raysahelian.com/selenium.html

Acetylcarnitine as an alternative treatment for ADHD
Acetylcarnitine, also spelled as acetyl-l carniitne, may help with attention deficit hyperactivity disorder (ADHD) in children with the genetic disorder known as fragile X syndrome. Fragile X syndrome results from an inherited genetic defect on the X chromosome. It is associated with  mental retardation and may also cause autism and ADHD. Italian researchers gave acetylcarnitine supplements to boys between 6 and 13 years old for a period one year and compared them to a group who took placebo pills. Those who took acetylcarnitine had a much better outcome. See http://www.raysahelian.com/adhd.html
   Comments: I have not seen any studies regarding the use of acetyl l carnitine in children with ADHD who do not have fragile X syndrome, but I think the use of an acetyl l-carnitine supplement is a safer option to  prescription stimulants and is certainly worth a try. I am not sure what the ideal dosage of acetyl carnitine for long term treatment would be in children, but a dosage of 5 to 10 mg per kilo is a reasonable one to begin with This dosage can be adjusted higher or lower as needed. For a 30 kg child, (66 pounds), this would be about 200 to 300 mg per day. Inform your child's doctor about this study and both of you can agree on an appropriate dosage.

Living in sunny states no guarantee that vitamin D deficiency won't occur
Despite residing in a constantly sunny region, a study in adults who live in southern Arizona found many of them are deficient in vitamin D, particularly blacks and Hispanics.
   Comments: It appears that even if you live in a sunny state, you should evaluate whether you are getting at least 20 minutes of sun exposure a day. Many people may spend almost all their day indoors and thus may not be getting enough vitamin D. See http://www.raysahelian.com/vitamind.html

DHA supplements and eczema
German researchers evaluated the benefit of omega 3 fatty acids, such as DHA, in patients with atopic eczema. DHA and EPA are the two fatty acids that are found in high quantities in fish oils. Fifty-three patients with atopic eczema aged 18-40 years were given either DHA 5 grams daily or saturated fatty acids for a period of 8 weeks. DHA, but not the control treatment, resulted in a significant clinical improvement of the atopic eczema.
   Comments: Fish oils which have the combination of EPA and DHA act as anti-inflammatory agents and may be beneficial in many skin conditions that involve an inflammatory reaction by the body. Along with taking fish oils or DHA, people with atopic excema or acne should consume a higher intake of fish and vegetables, and reduce the consumption of sugar and bad fats such as trans fats. See http://www.raysahelian.com/dha.html

Caution combining nattokinase and aspirin
Nattokinase is a natural supplement used as a blood thinner. Doctors in Taiwan report a patient who had a bleeding stroke after taking a nattokinase supplement in addition to aspirin. Using nattokinase together with aspirin, Coumadin, Plavix, and other blood thinners should be done only under close medical supervision. Actually, it is preferable to take nattokinase only with the guidance of a medical doctor and to have regular blood coagulation studies. I have not seen comparisons regarding the potency of nattokinase versus Coumadin or aspirin so I don't know whether nattokinase is an effective and acceptable substitute to these drugs in those who require blood thinning, for instance in those who have atrial fibrillation. See http://www.raysahelian.com/nattokinase.html

Prune juice for constipation
Q. Does prune juice really work for constipation. If so, how many ounces is needed?
   A. Yes, definitely. Prune juice is an excellent choice to help with constipation. Depending on the severity of the constipation, one to six ounces is beneficial. You may consider drinking about two or three ounces late in the evening and when you wake up in the morning drink a glass or two of cool water. This will help you eliminate. Some people notice a slight mood elevation by having an empty distal colon, and even a mild sexual enhancement. Prune juice also has tons of great antioxidants. See http://www.raysahelian.com/constipation.html

Diet Rx dosage
Q. I experimented with Diet Rx at two capsules a day and one capsule a day. I find that if I take one capsule a day, it takes 3 or 4 days before I notice the appetite suppression. If I take 2 capsules a day, it starts working the second day. Is this what others have reported? When I take 2 capsules a day sometimes it gives me more energy than I need.
   A. Yes, we have had feedback from users who find one capsule a day works, but much slower. The majority of users take 2 capsules a day, and a few need 3 or 4 a day. There is a natural energy enhancement that comes on with 2 or 3 capsules that makes people want to take a walk, or take a longer walk, which burns up more calories.

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SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 3 -- March 2008
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Recently there was an article in the New York Times which caught my interest. The article begins, "Statins [drugs like Lipitor] are among the most prescribed drugs in the world, and there is no doubt that they lower not only cholesterol but also the risk for heart attack. Do they prolong your life? For many users, the surprising answer appears to be no."
   If you have a been a long time reader of my newsletter you know my opinion on the topic of statin drugs. I agree with the viewpoint of the NYT article. Although statin drugs do lower cholesterol levels, there is no good evidence that they prolong lifespan to any significant extent. At a cost of two thousand dollars a year and the unpleasant side effects they induce such as muscle aches, liver damage, and potential memory loss, I question the wisdom of doctors who prescribe them to those with mild or moderate cholesterol elevation, particularly to patients who do not have heart disease. Over the years I have had many medical doctors email my research staff in an angry tone claiming that I was misleading my readers by advising limiting the use of these drugs. I think these medical doctors should rather apologize to their patients if they have been overly aggressive in prescribing statin drugs. Perhaps statins are helpful in those with excessively high cholesterol levels or patients who have already had a heart attack. But, as of now, I see no reason to subject those who are healthy but have a mild cholesterol elevation to these dangerous and costly drugs. More on this later.

Statin drugs are not likely to prolong your life
The article in the NYT continues, "Some patients do receive significant benefits from statins, like Lipitor (from Pfizer), Crestor (AstraZeneca) and Pravachol (Bristol-Myers Squibb). In studies of middle-aged men with cardiovascular disease, statin users were less likely to die than those who were given a placebo. But many statin users don’t have established heart disease; they simply have high cholesterol. For healthy men, for women with or without heart disease and for people over 70, there is little evidence, if any, that taking a statin will make a meaningful difference in how long they live. In many statin studies that show lower heart attack risk, the same number of patients end up dying, whether they are taking statins or not."
   I was really happy to see this issue addressed in a fair manner. There are many natural and safer ways to lower cholesterol and lipid levels and to reduce the risk for heart disease. See www.raysahelian.com/heartdisease.html.

Are fish oils capsules as good as eating fish?
Does the body process fatty acids from fish oil capsules and fish in a similar way? To investigate, Dr. William S. Harris, at the University of South Dakota in Sioux Falls asked women to eat two servings of tuna or salmon each week, while other women took in the same amount of omega-3s, an estimated 485 milligrams daily, in capsule form. After four months, the amount of omega-3 fatty acids in the red blood cells of women had risen by a similar amount in both groups. Apparently it did not make much of a difference whether the healthy omega 3 fatty acids came from a capsule or from fish.

Mucuna pruriens herb for fertility problems
Investigators at  King George's Medical University, Lucknow, India looked into the role of mucuna pruriens on semen profiles and biochemical levels in seminal fluid of infertile men. Sixty normal healthy fertile men undergoing infertility screening were given mucuna pruriens. The herbal supplement increased sperm production and improved sperm motility. They investigators say, "The present study is likely to open new vistas on the possible role of mucuna pruriens seed powder as a restorative and invigorating agent for infertile men."
   Comments: For long term use, I suggest not using more than one capsule of mucuna pruiriens extract 400 mg three times a week. For more info, see http://www.raysahelian.com/mucunapruriens.html.

My personal experimentation with CDP-Choline supplement
CDP-choline stands for cytidine 5-diphosphocholine, an intermediate in the biosynthesis of membrane phospholipids and brain acetylcholine. I started one morning with a 250 mg pill. Within two hours I was more alert and focused with a slightly enhanced vision. The next day I took 500 mg and noticed even more alertness and focus, with a slight vision enhancement and perhaps a slight erectile enhancement. There was a mild improvement in mood. The side effects were increased body temperature and a little bit of underarm sweating. I like CDP-choline and I take it once in a while for a quick mental enhancement. The increased concentration and focus last several hours and then fade away. I also like Mind Power Rx a lot. If you wish, you can alternate CDP-choline one day and Mind Power Rx another day. For more info, see http://www.raysahelian.com/cdp.html.

I purchased a bottle of both Passion Rx and the one with Yohimbe last month and I am quite pleased with the results. It re-awakened a part of me that I had thought was gone forever, and I am so thankful that my libido has reached a level that I have not experienced for literally decades. I cannot tell any difference between the formula with yohimbe and that which does not. The one side effect that I have noticed is that, if I drink a cup of coffee on the same day that I take a capsule, I have a difficult time falling asleep. For that reason, I am limiting my coffee intake on the days that I take the herbal formula (which is not a great problem, given the outstanding effects of taking Passion Rx). I began taking Passion Rx right after the first of the year. I felt the effects after about a week of taking them. I am 54 years old, six feet tall, and healthy.
   A. I prefer the low dose approach using the supplement every other day and being patient rather than taking this formula every day.

DHEA caution
Q. I'm a 32 y/o male, in overall good health status. I started to take DHEA hormone due to the advertised positive effects such as increased libido, feeling of wellness and testosterone boost to improve my training performance at the gym. The dose I've been taking is 50 mg per day for about a month. In the first days i immediately noticed a considerable improvement in my mood. I also felt more alert and a bit more aggressive (something which didn't bother me though). I also felt a certain itchiness in my scalp. However after about 3 weeks i started experiencing occasional heaert palpitations and moderate hair loss, I didn't have any aesthetic damage (yet), but i was scared by the perspective, so I began phasing it off, now after 2 weeks I do not take it all anymore, and the side effects seem to have stopped. However, i seriously enjoyed its positive effects, I wonder if a dosage of 5 mg per day would still produce any tangible result, and be safe? I also would like to denounce that the company I bought the 50 mg DHEA from advertised DHEA as being completely side-effect free, and recommended a daily dosage of 25 mg a day for women, 50mg a day for men. I think this is totally unethical.
   A. For several years I have placed a warning on my website regarding DHEA side effects and asked that vitamin companies limit the DHEA dosage they make available to the public. There are still many companies who are careless and promote capsules that contain 50 and 100 mg. DHEA should only be used in a 5 to 10 mg dosage and only for a few days a month. There are many other alternatives to DHEA for energy enhancement, feelings of wellness and increased libido. For instance, MultiVit Rx increases wellbeing and energy while Passion Rx or other aphrodisiac herbs increase libido. DHEA at 5 mg could still cause side effects if used daily. I suggest not using it more than 10 days a month.

Stevia and weight gain concern
Q. I have been using the no calorie natural sweetener stevia for several years now and love it, knowing it doesn't have the chemical issues as other sugar substitutes such as saccharin. However, I am concerned about a Time article I read about "artificial" sweeteners, such as saccharin, whose long term use researchers think may have a link to overreating and hence, obesity. I would appreciate your response to this article. From a scientific standpoint, would stevia cause the same metabolic reaction to the sugar effect as saccharin, potentially causing overreating and weight gain?
   A. When these types of studies are done in animals, they are fed foods almost exclusively sweetened with an artificial sweetener. In contrast, most humans who consume stevia do so in small amounts, adding stevia to tea or coffee, but continue to eat other foods throughout the day that have sugars. Therefore, unless a person uses stevia or an artificial sweetener in large quantities in every food at every meal, the rodent studies are not likely to be applicable to us humans eating a regular diet with a little bit of stevia used as a sweetener. See http://www.raysahelian.com/stevia.html

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SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 2 -- February 2008
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Do calcium supplements increase the risk for heart attacks? I recently had a spirited discussion with a friend who happens to be a gynecologist. She insisted that calcium citrate was better than calcium carbonate for women after menopause since she claimed calcium citrate was better absorbed. Although I agreed with her that a couple of brief studies had shown that calcium citrate was better absorbed, for practical purposes I did not think one could emphatically say one form was better for overall health than the other since no long term head to head comparisons had been done. I mentioned to her that one has to balance the benefits and risks of supplements. In the case of calcium, although higher dosages have been found to increase bone strength, one drawback is that higher calcium intake through supplements increases the risk for kidney stones. And just recently, a study came out that high intake of calcium through supplements could increase the risk for heart attacks. See below for a review of this study and my thoughts on absorption.

No need to be obsessed about absorption of supplements
Have you come across advertisements for supplements where the company claims their product is better absorbed than others on the market? I see this often, particularly in regards to CoQ10 supplements. We receive emails from consumers who ask us whether the claims they read about are true. Many people get overly concerned regarding the issue of absorption. Unless you have a serious digestive problem, this should not be a major concern for you. Of course, the issue of absorption is important, but one has to realize that in some cases, the dosages of supplements or herbs that are sold are very high. For instance, some companies market CoQ10 products and as part of the sales pitch they claim their CoQ10 is absorbed better than other brands (often without providing any proof). Well, most people only need 10 to 30 mg of CoQ10 a day. If a person takes a 100 mg CoQ10 capsule, they may not need all the 100 mg. If they take a product that is 95% percent absorbed versus one that is 98% percent absorbed, practically, what's the real difference? Perhaps the lower absorbing supplement is healthier since excess levels of certain supplements can throw the body's chemistry out of balance. In the case of calcium mentioned at the beginning of the newsletter, perhaps women who take a form of calcium that is not as well absorbed would have a lower risk of kidney stones and hardening of the arteries.
   Therefore, don't overly concern yourself with the absorption issue unless you are being treated for a particular medical condition with certain supplements and it is imperative that your body gets the right dosage. If you are taking supplements routinely for long term health, the minor absorption differences between different supplement products should not be a concern.

When we all thought calcium supplements were relatively safe
Did you see this worrisome headline? "Older women who take calcium supplements to maintain bone strength may have an increased risk of heart attack." Researchers at the University of Auckland in New Zealand evaluated 1,471 healthy post-menopausal women, average age 74, for a period of five years. Half were given a daily calcium supplement and half were given a placebo. Participants received either 1 gram of elemental calcium daily as the citrate (Citracal) or identical placebo. They were asked to take two tablets (each containing 200 mg elemental calcium) before breakfast and three in the evening. Over the next few years, heart attacks were more common in the women taking the calcium supplements. For details, see www.raysahelian.com/calcium.html
   Comments: Many women take calcium supplements to try to prevent osteoporosis. Calcium supplements elevate blood calcium levels possibly accelerating vascular calcification. Doctors and patients are now presented with a very difficult challenge. At what level of calcium supplement intake do the benefits of osteoporosis prevention or treatment outweigh the possible risks of kidney stones and heart attacks? I would like to see a few more studies regarding the role of calcium supplements and heart attack rate. Perhaps the results of this study were a fluke and other studies may not find the same association. Assuming that there is such an association, recommending calcium supplements for post menopausal osteoporosis prevention becomes quite difficult. I don't have absolute answers on this issue, but, for the time being, a reasonable balance would be to reduce one's calcium intake from supplements. If you are taking 1,200 mg a day, you may wish to drop to 800 or 1,000 mg. If you are taking 800 a day, you may wish to drop to 600 mg. Discuss with your doctor the results of this study and both of you could come to a mutually satisfying decision regarding the appropriate dosage in your particular case. Different doctors and scientists are likely to have different interpretations and suggestions.

Acetyl l carnitine supplement for fibromyalgia
At the University of Verona in Italy. patients with fibromyalgia took 3 capsules daily containing 500 mg acetyl l carnitine and were compared to a group receiving placebo. The number of positive tender points declined significantly and equally in both groups until the 6th week of treatment. At the 10th week pain remained unchanged in the placebo group but continued to decline in the acetyl l carnitine group. Those taking the supplements were less depressed and had less musculoskeletal pain. The researchers say, "These results indicate that acetyl l carnitine may be of benefit in patients with fibromyalgia, providing improvement in pain as well as the general and mental health of these patients."
   Comments: You may first try a smaller dosage of 300 mg a day before increasing to higher dosages. I find that amounts greater than 500 or 600 mg a day cause nausea, restlessness, and sometimes shallow sleep. There are other natural options for reducing symptoms of fibromyalgia. See http://www.raysahelian.com/acetylcarnitine.html and  http://www.raysahelian.com/fibromyalgia.html

Mangosteen supplement
Mangosteen is a fruit grown in Thailand. Mangosteen juice and supplements have become very popular as potent antioxidants and perhaps anti-cancer agents. But is mangosteen safe? Does it have side effects? I started with one capsule of mangosteen 500 mg the first day, and took two the next day. No side effects. I increased the dosage on subsequent days to 3 and 4 a day. Still no side effects. After a week of taking 4 capsules a day, I feel comfortable that this supplement does not have short term adverse effects and a capsule or two a day can probably be combined with other supplements without untoward reactions. See http://www.raysahelian.com/mangosteen.html

Q. I think your Diet Rx pills are fantastic. I took two capsules in the morning and by lunch time I had very little appetite. The benefits of appetite suppression continued every day that I took the pills, even a day or two after I stopped. The only side effect was more energy and I used it to take a long walk each evening. I am 44 SWF, and I have been telling all my friends about this product. I have tried other diet products in the past but they either did not work or caused anxiety and speediness.

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SUPPLEMENT RESEARCH UPDATE
Vol. 5, Issue 1 -- January 2008
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I wish all of you a new year blessed with optimal health and wellbeing. In the coming year I plan to continue providing you my honest opinion on the latest natural medicine research along with which supplements work, which don't, their benefits and side effects. I will also let you know about my personal experiences trying a number of supplements. Each month I will take at least one or two new products and let you know what effect they have on me.
   It has only been a little over 3 years that I have been writing this newsletter and we already have more than 80,000 subscribers. Many write to us to let us know they appreciate the straightforward, clear and honest reviews.
   The holiday gift giving season is not over. For the first time Physician Formulas web site is giving away a free product, a bottle of Diet Rx with 15 capsules. The response to Diet Rx has been so encouraging that we feel more people should be aware of this natural product. You, too, can now try a FREE sample all natural diet pill that curbs your appetite... especially if you had a hearty appetite over the holiday season. Click on the bottle to your left for your free product. Later I discuss my experience with Diet Rx.

100 year olds benefit from Carnitine supplements
Even a hundred year old may benefit from supplements. Italian researchers at the University of Catania gave sixty-six centenarians 2 grams carnitine daily for six months. At the end of the study period, the carnitine supplement treated centenarians, compared with the placebo group, showed significant improvements in total fat mass and total muscle mass. They were also less likely to have physical and mental fatigue. Cholesterol levels fell among the individuals taking the supplement. Carnitine takers also gained on average 3.8 kilograms (8.4 pounds) of muscle mass and lost 1.8 kg (4 pounds) of fat mass. People given carnitine were able to walk several meters further during a 6-minute walking test.
   Comments: This study shows how much we still can learn about the benefits of supplements in the aged. My preference would be to use a lower amount of carnitine, such as 250 mg or 500 mg. Sometimes when high dosages of energy enhancing pills are taken for prolonged periods, they can accumulate and interfere with sleep or cause rapid heart beat. Another study indicates that carnitine could be helpful in those who have the blood disorder thalassemia. For more information on the benefits of carnitine, see http://www.raysahelian.com/carnitine.html

Glucomannan and Psyllium help with weight loss and cholesterol
If you have been a long term reader of my newsletter, you are aware of my hesitancy in using statin drugs such as Lipitor or Zocor for cholesterol reduction, or the use of pharmaceutical drugs for weight loss. Drugs should be reserved when safer methods fail. A study completed in Spain found the use of two simple and inexpensive fibers, psyllium and glucomannan, to be helpful not only in weight reduction, but also in lowering LDL cholesterol levels. For a period of 16 weeks, obese individuals at a university center in Spain were asked to consume additional fiber consisting of 3 grams psyllium husk and 1 gram of glucomannan two or three times daily. Those taking the fiber supplements had a weight loss of more than 4 kilos compared to the placebo group. The fiber supplements led to lower LDL-cholesterol levels. No side effects were reported.
   My comments: It's sad that doctors prescribe statin drugs to their patients with mild cholesterol level elevations when there are are simple and safe alternatives. I can understand using statin drugs when all natural options fail, but most doctors don't even suggest additional fiber supplements. They are quick to the draw to write a prescription for a statin drug or a prescription weight loss drug. See http://www.raysahelian.com/fiber.html for more information. See also http://www.raysahelian.com/weightloss.html

Alpha lipoic acid for Alzheimer's disease
One of the most worrisome aspects of aging is the fear of losing one's mind and memory. We are learning that the incidence of dementia or Alzheimer's disease can be reduced with life long healthy eating patterns and also by the use of certain supplements. A study recently completed in Germany found alpha lipoic acid, a potent antioxidant, was able to slow the progression of Alzheimer's disease. Patients with Alzheimer's disease received 600 mg of alpha lipoic acid daily for several years. The researchers concluded that the rate of progression of the disease was slower in comparison to normal progression of Alzheimer's disease.
   Comments: I prefer using lower amounts of alpha lipoic acid in a range of 10 to 50 mg of the more potent R alpha lipoic acid a few times a week. There are many supplements that could help mental decline. See http://www.raysahelian.com/alzheimer.html for more details.

Kava and liver concern
Kava is a plant that grows in the Pacific islands whose roots contain kavalactones which are potent anti-anxiety agents. However, there is a concern that chronic kava ingestion may harm the liver. University of Hawaii scientists tested the effects of traditionally prepared kava beverages on liver function tests of regular kava beverage consumers. The liver function tests of healthy adult kava drinkers were compared against a control group of healthy adult non kava drinkers. Chronic kava beverage consumption was associated with elevation of certain liver enzymes. This indicates that daily kava consumption for prolonged periods can be stressful to the liver.
   Comments: Kava is a great herb for reducing anxiety and helping with sleep. However, it should only be used in small amounts at most three times a week with a full week off a month. Serious liver damage has occurred in rare cases when kava supplement users have taken it daily and in high dosages. Kava is found in Good Night Rx, a product that helps with sleep. We suggest using this sleep formula no more than three nights a week. See http://www.raysahelian.com/kava.html

My experience with supplements
In each newsletter I will describe my personal experiences with herbs and supplements. Please keep in mind that your reaction may be different. Plus, the short term effects of a supplement may be different when the supplement is taken for weeks or months. Since there are hundreds of herbs and supplements that I would still like to try over the next few years, I don't have the luxury to take any particular ones for too long. When I test supplements, I take them on an empty stomach in the morning and take no other supplements or medicines that day. This month I describe Diet Rx and alpha GPC. In the coming issues I will review inositol, mangosteen, acai, resveratrol, the newest batches of Passion Rx, mucuna pruriens, and others.

How Diet Rx was formulated and my experience
One of my close friends insisted that I give him suggestions on supplements to take for weight loss. Over the past few years I had been reluctant to formulate a diet pill since I was skeptical that it would work. However, since he insisted, I asked him to take a combination of several key herbs. I had tried these herbs before by themselves and had noticed a mild appetite suppressing effect from some of them. I thought perhaps the combination would have some benefit. Within a week he called me to say his appetite had been significantly reduced and he had lost a few pounds. This encouraged me and I started further experimenting with each ingredient separately and then together. I then had my research staff and any friends and patients I could recruit try the combination of ingredients. The feedback was tremendous. Everyone reported that they were eating less. The first batch of Diet Rx was finalized by the manufacturer in October 2007 and I eagerly tested the final product on myself. I took two capsules the first morning and forgot I had taken them since it was a busy day. At 2 pm in the afternoon I realized that I had only eaten a light breakfast and had little interest in eating lunch. The effects mostly wore off by evening and I had a normal dinner but did not feel the urge to have dessert or a fruit salad. The next day I again took two capsules and this time the effects were more pronounced. I also felt that I had a lot of natural energy which motivated me to take a long walk. After 7 days of taking 2 capsules of Diet Rx (one day I took 4 but it gave me too much energy), I had lost three pounds. I really don't need to lose weight but it is reassuring to know that if I ever add a few extra pounds, there is an effective appetite suppressant that I can rely on.
   Interestingly, many people have said that, after they stopped or ran out of the pills, the appetite suppression lasted a day or two more. If you tend to consume most of your calories late at night, you may consider taking the Diet Rx pills mid morning or early afternoon as opposed to first thing in the morning.

Alpha GPC is promoted as a mind booster
Alpha GPC is a newcomer in the mind boosting supplement field. Alpha GPC stands for alpha-glycerylphosphorylcholine and is chemically related to choline and lecithin. The first morning I took one capsule at a dosage of 300 mg. By mid morning I had not felt much, so I took another capsule. Except for slight alertness, I can't say I noticed much of a positive or negative effect. A few days later, I took 3 capsules in the morning. By midday I noticed being more alert and there was a very mild relaxing effect, unlike other brain boosters which often make me feel stimulated. It seemed the alertness became more prominent in early evening. The third day I took 2 capsules and again the effects were subtle. Overall I did not find alpha GPC to be very potent. I don't have a strong urge to take it again any time soon, although I can see it being useful as a subtle mental enhancer in those who find acetyl-carnitine, gingko biloba, choline, DMAE, TMG, or other brain boosters too stimulating and would prefer a gentler brain enhancer. Alpha GPC may offer long term benefits as discussed in the research studies listed at http://www.raysahelian.com/alphagpc.html. As to side effects, I did not notice any nausea, headache, increased body temperature, or rapid heart rate.

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