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Answers To Your Questions From Dr. Dan Johnston

What are the benefits of omega-3 fatty acids?
IN THE TOPIC: DIET
Deficiency in Omega-3 fatty acids is now considered widespread in the US and other developed countries, leading to a variety of poor health outcomes (also a result of an excess of Omega-6s). Not all Omega-3 fatty acids are the same in known health benefits. Together, however, I call them part of my “nutritional armor” for inside cellular protection against aging and disease with a critical role in military performance. There are 3 main dietary Omega-3s called ALA, EPA, and DHA which are all polyunsaturated essential fatty acids. For your own health, it is wise to understand the differences in these three Omega-3 fatty acids because they are often marketed under the same “Omega-3” umbrella. Omega-3 ALA comes from certain plants and seeds like flax, chia seeds and almonds. Diets rich in Omega-3 ALA sources (like Mediterranean diets) appear to reduce your risk for heart disease and heart attacks. So Omega-3 ALA seems to “Assist” in eliminating disease. The other two, Omega-3 EPA/DHA come from marine sources like fish and fish oil and have much more direct scientific evidence for even more widespread benefits that include organs such as the brain (see below). I call these the “wellness molecules of life.” The brain requires more Omega-3 EPA/DHA than any other organ. EPA seems to provide functional benefits to cells and DHA plays more of the structural role. To remember these Omega-3s, EPA/DHA, you can use the phrase, “E-and-D-Omega-3s-Eliminate-Disease.” There are drugs now based on Omega-3 EPA/DHA from fish oil. DHA, a critical component of brain health, is also available alone in algae based products. A recent study released showed that if Americans simply consumed more of Omega-3 EPA/DHA, 84,000 lives would be saved per year!
“Womb to Tomb” benefits of Omega-3 EPA/DHA:
1) Pregnancy and breastfeeding—improves brain development, child’s IQ, and post partum depression.
2) Childhood—learning ability, reading and writing and coordination, depression, ADHD, behavioral problems
3) Elderly—improves cognition and possibly memory problems such as dementia/Alzheimer’s
Summary of Specific Omega-3 EPA/DHA benefits
1) Reduces risk of heart attack and death, stabilizes heartbeat, reduces risk of stroke
2) Lowers triglycerides (risk factor for heart disease)
3) Effective for depression, anxiety, memory, learning
4) Decreases inflammation/arthritis, helps with Ulcerative Colitis/Crohns
5) Improves bone mass/osteoporosis

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What are the health benefits of chia seed?
IN THE TOPIC: HEALTHY EATING
What an amazing seed with an amazingly long history of delivering on taste, health and performance for humans dating back to the Aztec Warriors! Chia seeds are truly nature’s most powerful and delicious grain and besides really enjoying their taste, I found them to be a critical source of nutrients and energy during my day to day routine in the clinic or hospital or while out on missions as an Army physician. The seeds are perfect mixed into a smoothie, yogurt, on cereal or part of a bar. When I am in a hurry, I also mix several tablespoons of the seeds together in water, let sit for 5 minutes, add a touch of agave nectar or honey, and then grab a spoon and dig in! I call this “chia-meal” and it replaces my over the counter fiber supplements and I love it. The seeds are jam-packed with an array of disease-fighting and health-promoting nutrients. Chia is loaded withprotein, very high in fiber, antioxidant content (they contain similar antioxidant power as blueberries!), and lots of water molecules which helps you stay hydrated when needing to perform your best and aids in digestion. They are also very high in an Omega-3 called ALA. Sources rich in ALA have been shown to reduce cardiovascular disease and heart attacks. Note: Omega-3 ALA does not appear as powerful however as the other two dietary Omega-3s, EPA and DHA). To me, the Omega-3 ALA in chia though is just a small bonus on top of a ton of other nutrients. Chia seeds are also high in important minerals including calcium, phosphorous, and manganese that further help improve bone mineral density. There is something else interesting about chia seeds –the seeds dissolve inside your stomach and intestine to form a smooth, soft, gel-like substance that helps your body digest carbohydrates more efficiently before the glucose enters your bloodstream. This means a slower blood glucose and insulin rise, leading to better glucose stability and energy. This makes chia a “low glycemic index” food. Studies show that diabetics, who especially need to control their blood sugar, really benefit from adding chia to their diet. The unique combination of nutrients, great taste, energy profile, and physical properties of the chia seed make this a true (and proven) winner for endurance, bone mass, heart health, gastrointestinal health, and general wellness. As the Aztecs Warrior believed, chia seeds are part of my essential “nutritional armor” for internal cellular health and performance.

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Can you get any smarter than you already are?
IN THE TOPIC: BRAIN HEALTH
Fatigue has wrongly been viewed in our society as “the price you pay” to get ahead, or even by some as a “badge of honor” to climb that ladder in corporate America, earn that title of “surgeon”, or get those straight A’s in the classroom. For some, fatigue is simply the result of all the distractions of modern day living—always one more email to read, another topic to surf on the web, or another video game to master. The boom in caffeine consumption across America probably tells us something about how much sleep people are getting.
In the military aviation environment as well as the civilian workforce, experts recognize this view of fatigue costs lives through its effect on brain performance–your memory, communication, patience, and ability to make good decisions. The effects of fatigue on brain performance are similar to drinking alcohol. A new study suggests that an afternoon power nap may boost your ability to process and store information tenfold! However, this is only if you dream while you’re asleep. The study, conducted at the Center for Sleep and Cognition at Beth Israel Deaconess Medical Center, in Boston, Massachusetts reveals the importance of naps and the dream (“or REM”—Rapid Eye Movement) period. “In the dream…the brain tries to figure out what’s important and what it should keep or dump because it’s of no value.” Also, did you know that during REM is when your body releases the most growth hormone? Did you know that alcohol and certain drugs can interfere with your ability to dream while sleeping even though you are “asleep” or the drug “makes you sleepy”? Bottomline, quality sleep and REM is critical to your brain’s “smartness” as well as your overall physical health.
What nutrients can make you smarter? Fish oil that is high in the Omega-3s called EPA/DHA seem to play a critical role both throughout fetal development, early infancy/childhood, and into adulthood affecting mood and cognition. DHA seems especially critical in cognition and memory specifically. Why? These fatty acids seem to have a critical role in neuronal cell function through allowing the cell wall to remain “fluid”. This allows them to transmit important signals and optimize the health and function of neurons and other cells.

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How does eating fish benefit the brain?
IN THE TOPIC: DIET
The dry weight of the human brain is 60% “fat” that is full of critical polyunsaturated fatty acids that include those found in certain fish called Omega-3 EPA/DHA! Even the retina, the very rear part of the eye (that is really a “stem” from the brain) is rich with Omega-3 DHA.
There are actually two classes of polyunsaturated fatty acids that are essential to healthy human brain function: Omega-3s and Omega-6s. Today, there is a tremendous overabundance of Omega-6s in our diet, yet this is not the case for Omega-3s. The ideal ratio of dietary Omega-6 to Omega-3 is said to be anywhere from 1:1 or 5:1 but our current diet is 25:1 or worse. The most critical Omega-3s are EPA and DHA found in certain oily fish and fish oil supplements (WARNING: not all fish oil supplements, or fish, are high in EPA/DHA so be sure to read the facts label, not just the front “fish oil” label on supplements).
Omega-3s are particularly critical to the developing brain of the young and are a consistent component of human breast milk but not cow’s milk.The work of Dr Joseph Hibbeln at the National Institutes of Health (NIH) has shown that mother’s who eat more seafood (greater than the recommended 340 grams per week) while pregnant actually have children with better neuro-developmental outcomes, including higher IQs and better social behaviour, communication, and fine motor skills! This far outweighed the risk from harm from any of the trace contaminants sometimes found in certain fish. Other research shows that people who eat more fish have lower rates of depression. A new study, just released, shows the benefit of these Omega-3s to improve memory in adults suffering from memory loss or impairment. Fish rich in Omega-3 EPA/DHA seem to combat mood disorders such as depression, possibly stress/anxiety, as well as cognitive problems (memory and IQ) from the young to the very old. This is the reason for my interest in them in the US military—a population who is very deficient in them and who needs these added benefits for mission effectiveness and resilience.
Omega-3 EPA/DHA seems to have what I call a long and intimate “health relationship” with human civilization whether from a biblical or evolutionary perspective. Maybe subconsciously this explains some of the joys we experience from beautiful ocean and coastal vistas.

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How does fish oil benefit health?
IN THE TOPIC: FATTY ACIDS OMEGA-3
Today they are somewhere around 14,000 studies showing us the benefits of fish oil, more than any one single drug! In the military pilots, I use fish oil to enhance the “resilience” of the men and women and improve their mood and heart health status. I also have worked with professional athletes who have noticed considerable benefits in their sports from the mental and mood benefits. At NASA we will soon be researching it to help with cognitive functioning (“brain smartness”).
But don’t be fooled, not all fish oil is the same.
Cool Facts: You need fish oil high in Omega-3 EPA/DHA as some fish oil uses filler oil and disguises low EPA/DHA levels. So be sure to read the back of the label and look for high EPA and DHA levels (above 600 grams per 1 gram capsules) and take at least 2 grams total Omega-3 EPA/DHA per day (not just 2 gram capsules). Some companies can tailor the ratios of EPA/DHA to target certain benefits!
Omega-3 EPA/DHA made from fish oil is also a drug now, being prescribed all over the world today to reduce heart disease by reducing cholesterol (specifically, high triglycerides). But you don’t need a prescription to get the natural benefits of this wonderful organic compound found in certain oily fish and fish oil supplements.
Summary of the benefits:
1) Lowers risk of death from heart disease, heart attack, and decreases stroke by preventing clots, decreasing inflammation in the vessels, decreasing cholesterol, and stabilizing the heart beat to prevent irregular heart contractions. Studies show that fish oil has been shown to save lives and sudden death from heart attacks!
2) Reduces inflammation in the body which helps conditions such as arthritis and possibly inflammatory bowel disease.
3) Improves mood and cognition and overall “brain health” and treats depression. It lower rates of depression and suicide in populations with higher Omega-3 EPA/DHA (fish oil) intake from seafood. It also decreases post-partum depression.
4) It improves IQ and overall motor control in children. Possibly decreases memory loss in adults suffering from cognitive decline. Mom’s who eat more seafood during pregnancy have smarter babies with less behavioral problems.
5) Fish oil might help prevent osteoporosis
6) Fish Oil might help to prevent breast cancer
6) Fish Oil might improve skin quality and texture.
Bottomline, “oil your body” with the wonderful wellness molecules of life found in fish oil, Omega-3 EPA/DHA!

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Should I take aspirin even if I take omega 3 supplements daily?
IN THE TOPIC: DIETARY SUPPLEMENTS
The scientific evidence shows that taking aspirin (in the standard recommended doses) while taking fish oil (in the range of 1-4 grams per day of fish oil) does not increase the risk of bleeding or adverse effects; even in patients that undergo surgery while using both together. Furthermore, fish oils do not have additive anti-platelet (blood thinning) effects when combined with aspirin.
The American Journal of Cardiology in 2007 published an expert research opinion on this topic. The research presented examined many studies in which patients were undergoing surgeries such as heart surgery and surgeries that repaired neck vessels with disease (thickening/clotting) to see if patients had an increased risk of bleeding. The patients taking fish oils were being treated with either anti-platelet (“Aspirin”) or antithrombotic (anti-clotting) medications such as Heparin and Coumadin and there were no serious adverse bleeding events in all the studies examined.
Recent evidence from a trauma surgeon at Oregon Health Sciences, Dr Robert Martindale, indicates fish oil actually improves surgical outcomes in the critical care setting when fish oil is given in and around the time of surgery. This is through the ability to decrease inflammation, improve and stabilize the heart beat, and other mechanisms.
You should always discuss medication interactions and medications in and around the time of surgery with your healthcare provider.

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Can omega-3s help prevent post-partum depression?
IN THE TOPIC: DEPRESSION
Depression during pregnancy is estimated to occur in 10-20% of women and is associated with adverse outcomes for boththe mother and child. Although depression during pregnancy is relatively common in Western countries, researchers at the National Institutes of Health in Bethesda, MD have found that in other countries with a high seafood intake, depression during and after pregnancy is virtually non-existent while it is more common in those with lower seafood intake. Other research indicates that high seafood intake during pregnancy and after delivery is also associated with healthier children who have better IQ scores, as well as behavioral and communication skills. Seafood is high in Omega-3 EPA/DHA (flax, while high in Omega-3, is in the form of ALA not EPA/DHA).
Mothers may become depleted of critical Omega-3s called EPA/DHA found in seafood and fish oil because the fetus receives them preferentially for neurological development from mom (even while breastfeeding); therefore this can leave mom with a deficiency of these Omega-3s. Omega-3 EPA/DHA deficiency has been associated with an increased risk of depression. We know that the Western diet is already deficient in these so moms may have little reserve when the need for Omega-3 EPA/DHA climb during and after pregnancy and therefore possibly leaving them more susceptible to post-partum depression.
Regular (2-4 times per week) consumption of Omega-3 EPA/DHA (especially in seafood) has major public health consequences that can benefit the mother, improve the chances of a safe delivery of the fetus, and the overall health of the newborn child. More studies will determine if fish oil alone in supplement form can replicate the same benefits as seafood consumption seems to have throughout pregnancy. Other fish oil supplement trials in depression (not necessarily post-partum) seem very promising.

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What are the benefits to consuming fish and fish oil?
IN THE TOPIC: FATTY ACIDS OMEGA-3
Key Benefits to fish/fish oil: a “miracle” ingredient to healthy living!
*Lowers triglycerides (part of total cholesterol) by 20-50%!
*Lowers risk of death from heart attack by 15-25%!
*If you have had heart surgery for a clogged vessel, it will help to prevent re-clogging
*Lowers death and hospitalizations if you have heart failure
*Lowers blood pressure
*Decrease risk of stroke from clogged vessels (“brain attack”)
*Improves weight loss
*Lowers blood pressure
*Improves symptoms of asthma
*Decreases blood glucose and insulin in overweight patients
*Decrease inflammation in the body which helps conditions such as rheumatoid arthritis
*Helps treat and prevent depression. Suicide and depression is less likely in populations with higher intake of seafood. Seafood during pregnancy decreases post-partum depression.
*If eaten regularly in pregnancy, improves IQ and overall motor control and behavior/communication in offspring
*Possibly decreases memory loss in adults suffering from cognitive decline.
*Fish oil might help improve bone mass/decrease osteoporosis
*Fish Oil prevents age related visual loss and prevents dry eyes
*Improves symptoms of ADHD
*Might prevent breast, colon, and prostate cancer
*Decreases the pain from menstruation
Background:
Biblical, scientific and evolutionary history speaks volumes about life’s relationship with fish/fish oil. In the military pilots and professional athletes I work with, I use high quality fish oil to enhance overall “resiliency”. Considerable benefits on the playing field or in a demanding, military operational setting have been observed in my experience. Soon, myself and others will be conducting research to also examine the benefits of fish oil in astronauts while in space.
If water is the molecule of life, Omega-3 EPA/DHA sustain and allow life to thrive yet most of us are grossly deficient. The “long chain” Omega-3s are called EPA and DHA found in fish and fish oil (not ALA another Omega-3 in flax). EPA is a powerful anti-inflammatory and seems to be the most mood-promoting ingredient in fish oil. DHA is an important part of cell membranes throughout the body but highest in the brain, retina, and sperm. DHA is crucial for optimal neuro-development and optimal visual and cognitive functioning.
I am not convinced yet that we have unlocked all the secrets in fish. For now, the Omega-3s, EPA/DHA seem to be critical.

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How do omega-3 fatty acids fight inflammation?
IN THE TOPIC: NUTRITION
Background: Not all Omega-3s are the same. Fish oil (and seafood) contains two critical Omega-3s called EPA and DHA which promote a multitude of health benefits that enhance the quality of life and reduce the risk of premature death. EPA and DHA seem to have distinct and unique roles in the body. Algae based supplements (not from fish) and many infant formulas currently contain only DHA. Both are often marketed under the umbrella “Omega-3” so be sure to read the fine print for what omega-3s they contain (eg EPA and DHA or DHA alone).
Fish Oil supplements = EPA + DHA
Algae supplements = DHA alone
So which Omega-3 really fights inflammation?…and the winner is….
Research supports that EPA, found in fish oil, is the key anti-inflammatory. EPA regulates the effects of Omega-6s in the body and reduces the associated inflammatory disease risks including heart attacks (inflammation in vessels) and arthritis (inflammation in joints). DHA is critically important for visual and brain development but less so as an anti-inflammatory.
EPA produces anti-inflammtory hormones that counteract those produced by Omega-6s which are far too high in our diet and body. Even certain auto-immune diseases such as rheumatoid arthritis have shown to benefit from regular fish oil consumption as a result of the high EPA concentrations. When specifically trying to reduce inflammation, be sure to read the nutrition facts labels and pick a high EPA:DHA ratio product in the range of 2:1 EPA to DHA.
My Recommendation: I personally like to see a high EPA:DHA ratio of at least 400mg of EPA and 200mg of DHA per 1 gram of fish oil when using it to combat inflammation in patients, athletes, and soldiers. (I use fish oil for various reasons and pick EPA and DHA ratios to fit the condition). So, being aware of your EPA/DHA levels in supplements might can help target certain conditions or personal needs. But remember, lower your Omega-6 intake as well to really maximize the benefits of the Omega-3s.

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Can taking fish oil supplements benefit your joints?
IN THE TOPIC: BONE JOINT AND MUSCLE HEALTH
Research supports that EPA, one of the Omega-3s found in fish oil, is the key anti-inflammatory. Fish oil contains 2 “miracle” Omega-3s, EPA and DHA (algae products contain only DHA). EPA regulates the effects of Omega-6s in the body and reduces the associated inflammatory disease risks including heart attacks (inflammation in vessels) and arthritis (inflammation in joints) which can benefit overall joint function. Even certain auto-immune diseases such as rheumatoid arthritis have shown to benefit from regular fish oil consumption as a result of the high EPA concentrations.
The Omega-6 called ARA (arachidonic acid) is strongly pro-inflammatory. Omega-6s are now abundant in our food supply and the EPA from fish oil helps regulate the Omega-6 effects. The ratio of Omega-6 to Omega-3 is upwards to 25:1 which leads to a variety of chronic diseases from the inflammation besides joint pain or worsening arthritis–so while we need to increase the amount of fish oil and thus EPA, we need to also decrease the Omega-6 intake.
My Take Home Point:
Fish oil through the actions of EPA can help “oil” your joints and feel better with less pain if the pain is due to inflammation in the joint such as osteoarthritis from overuse or “aging” of the joint. But it won’t happen overnight. The Omega-6 to Omega-3 “inflammation balance” takes time to restore (give it a month or two). When specifically trying to reduce inflammation, be sure to read the nutrition facts labels and pick a high EPA:DHA ratio product in the range of 2:1 EPA to DHA. I personally like to see at least 400mg of EPA to 200mg of DHA per fish oil capsule to combat inflammation and improve joint function. Once you have the ratio right in each capsule, consume at least 2-4 capsules per day.

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What oil in fish lowers triglycerides?
IN THE TOPIC: TRIGLYCERIDES
Bottom Line Up Front: Omega-3 EPA/DHA in fish oil lowers triglycerides. Triglycerides are an important component of your total cholesterol and a major risk factor for heart disease. Therefore, when looking at fish oil supplements to reduce cholesterol and triglycerides, you want to choose fish oil supplements with the highest concentration of EPA and DHA per capsule but balancing the cost factor as well (the higher the concentration of EPA and DHA in each fish oil capsule, the higher the cost because of the added manufacturing steps required). You can get this information by carefully reading the “Nutritional Facts Label” on the back of the supplement but be sure to also read the serving size (some read “2 capsules”).
Fish Oil as a Drug to Lower Triglycerides: There is a drug now on the market that is nothing more than highly concentrated fish oil Omega-3 EPA/DHA (46% EPA and 38% DHA) that is prescribed to lower triglycerides. There is another drug that is pure EPA which is used to treat “clogging” of the heart vessels and reduce triglycerides. So, there is no doubt that fish oil high in Omega-3 EPA/DHA will reduce triglycerides. But remember to always read the label because not all fish oil supplements are high in EPA/DHA.
Bonus Fact: Even if you don’t have high triglycerides or are already taking another drug to lower your cholesterol, consider talking to your doctor about adding fish oil high in Omega-3 EPA/DHA to your daily regimen for added wellness and reduce the “clotting” tendency of the blood.

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What effect do fish and fish oil have on blood pressure?
IN THE TOPIC: DIET
Bottom Line Up Front: Taking fish oils orally seems to produce modest and significant reductions in systolic and diastolic blood pressure (the top and bottom numbers) in patients with mild hypertension (high blood pressure).
Why is this important? Reducing your blood pressure is important because studies show that high blood pressure is a major risk factor for heart disease, heart attacks, and stroke later in life. It is never too early to start treating your blood pressure and remember, high blood pressure is a “silent killer” because most people have no symptoms of hypertension (high blood pressure). Also, just because your young and active doesn’t mean your blood pressure isn’t high. This is just one of many benefits that “oiling” your body with fish oil provides.
How does it work?
Fish Oil seems to lower blood pressure in a few different ways. First, it lowers the viscosity of the blood (the “thickness”) which means the blood flows through the vessels with more freedom and ease and lowers the pressure needed to produce the flow. Also, fish oil reduces the constriction of blood vessels and promotes “relaxed” blood vessels which also reduces the pressure in the “pipes” (your circulatory system). Fish oil seems to reduce heart rate a little too which reduces the work load of the heart and one reason it might help your “pump” last longer.
What do others day?
The National Institutes of Health (NIH) in Bethesda, MD has said: “There is evidence from multiple studies (that the) intake of Omega-3 EPA/DHA in the form of dietary fish or fish oil supplements lowers triglycerides, reduces risk of death, heart attack, abnormal heart rhythms, and strokes in people with known cardiovascular disease, slows the buildup of atherosclerotic plaques and lowers blood pressure slightly.”
Action Point: Quality and Quantity is Everything
When using fish oil supplements, always check the fish oil supplement “nutritional label” on the back of the bottle and look at the Omega-3 EPA and DHA content. Be sure to read the serving size so you know what is in each capsule. You want to get a high level of Omega-3 EPA/DHA content (the active ingredients) while balancing the cost of the product. Always look for high quality and high quantity.

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What is the role of fish oil in high cholesterol?
IN THE TOPIC: CHOLESTEROL
Bottom Line: Fish Oil contains 2 important fatty acids called EPA and DHA (eicosopentaenoic acid and docosahexaenoic acid) which lower your triglyceride level (part of your total cholesterol calculation) and have a host of other benefits for your heart. 1-5 grams per day of fish oil has been shown to lower triglycerides by 20-50%! Fish oil high in EPA and DHA is so powerful, there is a prescription fish oil drug on the market now that doctors can prescribe for elevated triglycerides that contains high amounts of EPA/DHA in each capsule (about 840mg per capsule). The dose of the drug is 4 grams (4 capsules) per day.
Why is this important? Reducing your cholesterol reduces your risk for developing heart disease. Triglycerides are an important component of your total cholesterol (the other 2 components are LDL and HDL). Fish oil also slightly increases your HDL which is your good cholesterol. This is an added benefit to consuming fish oil. Although slight increases in LDL have been reported in some patients, this has not been shown to be clinically relevant.
Background: Remember that the beauty of fish oil is that it is a natural substance found in a supplement or a diet rich in oily fish (or now in a drug as well). It has a lot of other benefits for your heart besides the reduction in cholesterol such as lower inflammation and lower “stickiness” of the blood and clotting tendency. You don’t want to wait until you have high cholesterol to be pro-active and do a great thing for your heart: add fish oil to your diet. The fact that it is a drug should tell you that something about the power of fish oil to treat but I prefer to prevent when possible.
Before You Use: They key is to checking the EPA and DHA levels of the fish oil supplement you use in each capsule. Not all fish oil supplements have high levels and most are quite low. Remember to also check the serving size when reading the nutritional label to ensure you divide by two if it says “2 capsules.” For cholesterol reduction, get a high EPA/DHA ratio and while balancing cost, try to get a high concentration of total EPA/DHA per capsule.

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What is neurofeedback?
IN THE TOPIC: STRESS
Neurofeedback is an exciting, high-tech, computer-video based method using special brainwave analytical software and active patient participation to enhance and optimize brain function through visual and auditory feedback. It provides a safe, non-pharmacologic and training based methodology to help you learn how to train and improve the key driver to overall health, wellness and performance: the six inches between your ears. I have witnessed the power of neurofeedback first-hand and am very excited about this technology to help millions of people especially as it becomes more portable and affordable.
Neurofeedback is rapidly advancing and gaining more and more research support for a variety of different uses: from managing specific medical conditions such as ADHD, depression, migraines, and addictions as well as performance enhancement for the serious athlete. The underlying premise with neurofeedback is that faulty brainwave patterns can be changed and re-conditioned through training sessions; much like repeated sessions at the gym with a trainer can improve strength and flexibility.
Like any form of “biofeedback”, the key feature of its effectiveness is its ability to give you instant information on a physiological process, in this case, your brain. This is done through visual and auditory presentations of brainwave function which then conditions you how to change and optimize neuron function, depending on the protocols set. In general, an in-depth QEEG analysis is done prior to starting therapy so that a thorough diagnostic picture can help guide the treatment protocols determined by the technician.
I am extremely excited about the promise of neurofeedback and its approach to train and condition versus pharmacologic therapy alone which often has unwanted side effects. In the military it will help support performance and help those suffering from physical and mental health conditions (such as depression, PTSD and TBI) as a result of their time in combat. I have witnessed first-hand the clinical and performance benefits in patients and world-class professional athletes alike, especially when combined with nutritional interventions such as Omega-3 EPA/DHA fish oil. There are approximately 100 billion neurons in your brain and just like you wouldn’t dream of improving your muscles without exercise and diet, neurofeedback and Omega-3 EPA/DHA fish oil is the same for our “brain strength.”

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Will neurofeedback help people who have ADHD?
IN THE TOPIC: ADD/ADHD
Neurofeedback is a safe, non-pharmacologic alternative approach to improving mental health and mental performance and is effective for the treatment of ADHD, a disorder characterized by inattention, impulsivity, and hyperactivity. It seems to especially effective for the inattention and impulsivity aspects of the disorder. There are several excellent clinical trials to support its effectiveness. In fact, in the last few years, two major scientific organizations in this field, the AAPB (Applied Psychophysiology and Biofeedback) and ISNR (International Society for Neuronal Regulation) have raised its efficacy rating to “Level 5” (which means it is generally recognized by experts as being “efficacious and specific”), the highest rating given out by the organizations.

Background: Children with this disorder have very specific physiological problems in brainwave activity, which can be seen most clearly when a QEEG (baseline brainwave analysis) is performed and this is generally recommended prior to initiating the training protocols. It is well known that different brain “states” (e.g. sleep, drowsiness, awake, focused, anxious, etc) are associated with various brainwave patterns and frequencies in specific locations. Children that are hyperactive with concentration problems produce too much “Theta wave forms” and too little “Beta wave forms” in some parts of the brain. These two types of brainwaves (Theta/Beta) are associated with drowsiness/inattention and alert/focused, respectively.

Neurofeedback uses instant video feedback on brainwave activity (measured by sensors on the scalp) so that the parts of the brain generating the abnormal proportions of brainwaves can be taught to function normally by teaching the brain to produce the correct proportions of brainwaves through several “training” sessions (generally 10-20 sessions over several weeks). Basically, it is similar to playing a video game using your brain; with the game set up specifically to improve andoptimize specific types of brainwave activity set in the protocols. This allows transition of the performance to day to day experiences (in the classroom, at home, work, etc) rather than only when sitting at the consoles of a game.

I am very excited about this technology and combining neurofeedback with Omega-3 EPA/DHA fish oil for enhanced outcomes in mental performance and ADHD. I have witnessed first-hand the dramatic benefit this confers to patients and athletes.

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What is SAMe?
IN THE TOPIC: DEPRESSION
SAMe is a chemical (S-adenosylmethionine) that is found naturally in the body and brain but it can also be made in the laboratory. Concentrations are highest in childhood but then decrease with age. SAMe plays an essential role in more than 100 biochemical reactions within the body. It contributes to the synthesis and metabolism of hormones, neurotransmitters (signaling molecules in the brain), phospholipids (structural building blocks of cells walls). It plays a role in pain, depression, liver disease, and other conditions. People who don’t make enough SAMe naturally may be helped by taking SAMe as a supplement. SAMe increases a brain chemical called serotonin. Many common medications for depression also increase the brain chemical serotonin. SAMe supplementation may also work by altering cellular membrane fluidity, increasing transmission of signals. Neuroimaging studies and EEGs (brainwave analysis) confirm that SAMe affects the brain similarly to conventional antidepressants.
Background: SAMe has been available as a dietary supplement in the US since 1999, but it has been used as a prescription drug in Italy since 1979, in Spain since 1985, and in Germany since 1989. Researchers discovered the potential usefulness of SAMe for treating osteoarthritis by chance. They were studying SAMe’s effect on depression when the patients they were following reported an improvement in their osteoarthritis symptoms. SAMe supplementation may be beneficial in osteoarthritis due to analgesic (pain blocking) and anti-inflammatory effects as well as its possible role in re-building damaged cartilage.
Uses: SAMe is used for depression, anxiety, heart disease, fibromyalgia, osteoarthritis, bursitis, tendonitis, chronic lower back pain, dementia, Alzheimer’s disease, slowing the aging process, chronic fatigue syndrome (CFS), improving intellectual performance, liver disease, and Parkinson’s disease. It is also used for attention deficit-hyperactivity disorder (ADHD), multiple sclerosis, spinal cord injury, seizures, migraine headache, and lead poisoning. Some women use SAMe for premenstrual syndrome (PMS) and a more severe form of PMS called premenstrual dysphoric disorder (PMDD).
It seems most effective as “nutritional armor” for depression and osteoarthritis. It is safe for most people. Don’t take it if you have been diagnosed with bipolar disorder, however. I am exploring the use of SAMe with Omega-3 EPA/DHA fish oil and neurofeedback for brain health.

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What are the side effects of fish oil supplements?
IN THE TOPIC: DIET
Fish oil is SAFE for virtually all people, including pregnant and breast-feeding women. They are essential for wellness, health, and optimal performance. “Western” diets are typically very deficient in them. The high demand has led to rapid growth of the fish oil market which has created many brands and a spectrum of quality. Adverse effects depend on quality as with all supplements.
Fish oil can occasionally cause minimal side effects including belching and a fishy “burp back.” Both effects can be minimized with a high quality supplement that has not undergone “oxidation” (degradation) prior to putting in capsules/bottles. Consuming the capsules (or oil) with meals can minimize burp back as can refrigerating or freezing the capsules. In rare occasions, one can experience heartburn, nausea, loose stools, and a skin rash. Again, high quality products can help minimize side effects while ensuring efficacy of the product.
Taking more than 3 grams per day does “thin” the blood and therefore may increase your bleeding time. Yet some studies have found benefits of high dose fish oil; even around surgery (actually given through the veins) showing that the benefits on the immune system and infection rates outweigh any theoretical bleeding risk. While taking more than 3 grams per day might “thin” the blood this may be precisely what contributes to the anti-clotting benefit; helping to lower the risk of heart attacks and strokes. Fish oil should be thought of as “normalizing” bleeding since most of us have an excess amount of Omega-6s in our diet leading to “sludgy” blood; now considered “normal.” That said, if you have a bleeding problem or risk of bleeding problem, talk to a provider. Extremely high doses of 30-40 grams per day or more are not recommended for this reason. Personally, I have not used higher than 9 grams per day in clinical practice.
Some fish meats (especially shark, king mackerel, and farm-raised salmon) can be contaminated with mercury and other industrial and environmental chemicals, but high quality fish oil supplements typically do not contain these contaminants.
High quality fish oil is very safe. 3 to 4 grams (usually 3-4 fish oil 1000mg capsules with high EPA/DHA) is a great dosage for general health benefits. Some conditions or situations may require higher dosages but discuss with an expert in nutraceutical science. If you have liver disease or seafood allergies, consult your provider.

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What is melatonin?
IN THE TOPIC: HORMONES
Melatonin is a hormone found naturally in the body and is produced by a gland in the center of the brain called the pineal gland. It is secreted when you visually see that it is becoming dark outside to trigger you to get sleepy and regulate your normal sleep patterns and keep your “internal biological clock” on time. Melatonin can also be found in over the counter supplements (or prescription medicine in some countries) and therefore can be made synthetically in a laboratory. It is most commonly available in pill form, but melatonin is also available in forms that can be placed in the cheek or under the tongue. These other forms allow the melatonin to be absorbed directly into the body. I have found melatonin works great in my pilots and professional athletes to help them maintain their operational readiness when changing time zones due to travel schedules or having problems sleeping for other reasons. It improves the quality of sleep versus prescription drugs which can decrease the quality of the sleep and have more side effects (being a detriment to performance upon awakening).

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How is melatonin used?
IN THE TOPIC: HORMONES
People use melatonin to adjust the body’s internal clock(what is called a “circadian rhythm”) which is maintained normally by melatonin secreted from a gland in the brain when your eyes see it is becoming dark outside. Think of your circadian rhythm has being a whole host of biological functions inside that occur based on what time it is in your sleep wake cycle. If a battery keeps a clock working, melatonin does likewise for your body’s hormonal systems. It is my first line choice for anyone having trouble with sleep in combination with good sleep hygiene techniques.
It is used for jet lag, for adjusting sleep-wake cycles in people whose daily work schedule changes (shift-work disorder), and for helping blind people establish a day and night cycle. I use it extensively in pilots in the US military to help reduce the downtime from jet lag and improve operational performance. It is also useful when people have odd jobs and don’t get exposed to normal cues of sunlight and darkness and have trouble falling asleep at night. I also recommend it to the military athletes I work with because it is non-addictive and has fewer side effects without leaving you “groggy” and unable to perform your best the next day. Melatonin is also used for the inability to fall asleep (insomnia); delayed sleep phase syndrome (DSPS); insomnia associated with attention deficit-hyperactivity disorder (ADHD); insomnia due to certain medications; and sleep problems in children with developmental disorders including autism, cerebral palsy, and mental retardation. It is also used as a sleep aid after discontinuing the use of benzodiazepine drugs and has much fewer side effects than this prescription sleep aids.
Other interesting uses: reducing anxiety before surgery, helping decrease symptoms in people who are quitting smoking, improving the effectiveness of certain cancer medications used to fight tumors.
Dosages: For insomnia: 0.3-5 mg at bedtime is a typical dose. In children with insomnia due to delayed sleep onset, melatonin 5 mg at 6:00 PM daily. In children with developmental disorders (including cerebral palsy, autism, and mental retardation), melatonin 5 mg at 8:00 PM daily. For jet lag: 3-5 mg at bedtime is commonly taken on the arrival day at the destination, continuing for 2-5 days.

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What is creatinine?
IN THE TOPIC: BLOOD
Creatinine should not be confused with creatine, the popular dietary supplement. Creatinine is a break-down product of creatine phosphate found in muscle (which your body needs for energy conversion and gets from your diet or a dietary supplement), and is usually produced at a fairly constant rate but is dependent on body mass. As a breakdown product of the energy system of muscle, creatinine is not useful to the body and is mostly removed through the kidneys through filtering urine. If there is a problem with renal function (kidney function), blood levels will rise and therefore, measuring serum (from blood) creatinine is a simple test and it is a common indicator of renal function.

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Do we need multivitamins?
IN THE TOPIC: VITAMINS
While serving as a military physician deployed in combat and charged with carrying for our nation’s finest men and women in uniform, I know firsthand the benefits of a good diet but also the benefits of supplements and multivitamins. Whether for performance or health, I have to know what works. Their lives depend on it.
A good diet is the foundation for better health, but obviously even those of us that know how to eat right don’t always eat the way they should with our busy schedules and mostly inadequate intake of fresh fruits and vegetables and fish (the ideal but not always practical, I can tell). And some nutrients, like vitamin E, are beneficial in amounts far beyond the levels that can be obtained even in a good diet, especially with the way our modern food is grown, harvested, and prepared.
I have developed a type of dietary supplement guide that allows for modifications for athletic and military performance objectives as well as variations in diet. It is a model based on the “food guide pyramid”, so that one understands the proper way to view supplements for health, wellness and performance.
After the importance of daily fish oil (Omega-3 EPA/DHA), a high quality (and bio-available) multivitamin/mineral product is the foundation and will fill most nutrient gaps in normal diets which is essential for healthy living.
A multivitamin will provide the 400 mcg of folic acid that women of childbearing age should get every day, for the sake of their unborn babies. Since most pregnancies are unplanned, women need to be ready for the unexpected. Folic acid taken before pregnancy and during the first trimester can greatly reduce the risk of having a baby with neural tube birth defect such as spina bifida, according to the Centers for Disease Control and Prevention (CDC).
But multivitamins are not just for young women. Multivitamins with folic acid may also help reduce the risk of heart disease and stroke in men and women of all ages. Folic acid, vitamin B-6 and vitamin B-12 help reduce blood levels of homocysteine (an amino acid produced in the body), and people with lower homocysteine levels have a lower risk of heart disease and stroke.
Eat right but use a multivitamin to fill in the gaps; it’s just plain smart and provides some cheap health insurance. Remember, quality and bioavailability is everything and don’t forget the importance of Omega-3 EPA/DHA fish oil.

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What foods and nutrients will benefit my sex life?
IN THE TOPIC: SEXUAL HEALTH AND WELLNESS
Libido, or sex drive, varies with each person and is supported by the production of testosterone, both in males and females. Libido tends to naturally decreases with age. Lifestyle and diet play a role in how active a person’s libido is. Unhealthy lifestyle habits and foods consumed decrease testosterone production, depressing libido, whereas healthy habits and foods can increase testosterone production, improving libido.

Being overweight or obese, high amounts of stress, not getting enough sleep, taking anti-depressants, and for those with diabetes, having uncontrolled blood glucose levels all decrease testosterone production and negatively affect libido. Consuming large amounts of unhealthy items like high saturated fat foods, caffeine, and alcohol can decrease testosterone production.

But improving your sex life is also about improving blood flow to key organs and tissues so foods good for your heart are good for sex.

Consuming foods high in Zinc and B Vitamins, and in general foods found in the Mediterranean Diet can aid in the production of testosterone. Omega-3 EPA/DHA fish oil and the amino acid L-arginine are good for healthy blood flow; a critical requirement of important sex organs such as the penis and clitoris in males and females, respectively.

Below is a checklist of foods for both men and women to consume regularly to help support testosterone production, healthy blood flow and an overall healthy sex life:

Salmon (wild not farmed), and mackerel – high in Omega-3 EPA/DHA, B vitamins, B5, B6 and B12
Avocados – high in vitamin B6 and potassium
Bananas – high in potassium and B vitamins, especially riboflavin
Almonds, pine nuts and other nuts – high in zinc and essential fatty acids
Oysters – high in zinc
Asparagus – contain B vitamins
Eggs – good source of B vitamins
Brown rice, cheese, turkey – all great sources of zinc
Almonds, granola, oatmeal, peanuts, pine nuts, cashews, walnuts, soybeans—these are high in L-arginine which studies show improve blood flow and sexual function in men.

Exercising regularly, getting adequate sleep (7-9 hours) each night, managing stress levels, and being at a healthy body weight all help support testosterone production, and a healthy libido.

Remember, just eating the right foods is only part of the solution–Be sure to exercise, get plenty of sleep, stress less and consume “heart healthy” foods to reinvigorate your sex life!

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Are there certain foods that could really help boost libido?
IN THE TOPIC: SEXUAL HEALTH AND WELLNESS
Libido, or sex drive, varies with each person and is supported by the production of testosterone, both in males and females. Libido tends to naturally decreases with age. Lifestyle and diet play a role in how active a person’s libido is. Unhealthy lifestyle habits and foods consumed decrease testosterone production, depressing libido, whereas healthy habits and foods can increase testosterone production, improving libido.
Being overweight or obese, high amounts of stress, not getting enough sleep, taking anti-depressants, and for those with diabetes, having uncontrolled blood glucose levels all decrease testosterone production and negatively affect libido. Consuming large amounts of unhealthy items like high saturated fat foods, caffeine, and alcohol can decrease testosterone production.
Consuming foods high in Zinc and B Vitamins, and in general foods found in the Mediterranean Diet can aid in the production of testosterone. Below is my “better health and better sex” list of great foods:
Salmon (wild not farmed), and mackerel – high in Omega-3 EPA/DHA, B vitamins, B5, B6 and B12
Avocados – high in vitamin B6 and potassium
Bananas – high in potassium and B vitamins, especially riboflavin
Almonds, pine nuts and other nuts – high in zinc and essential fatty acids
Oysters – high in zinc
Asparagus – contain B vitamins
Eggs – good source of B vitamins
Brown rice, cheese, turkey – all great sources of zinc
Almonds, granola, oatmeal, peanuts, pine nuts, cashews, walnuts, soybeans—these are high in L-arginine which studies show improve blood flow and sexual function in men (but remember that women have an erectile response as well).

Eating the foods above and exercising regularly, getting adequate sleep (7-9 hours) each night, managing stress levels, and being at a healthy body weight all help support testosterone production, and a healthy libido. So if just being healthy wasn’t a strong enough motivator to eat right and exercise, maybe sex is!

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What are some foods that are important for healthy skin?
IN THE TOPIC: SKIN
There are many nutrients that play an important role in skin health and thus should be part of your nutritional armor. One of the top nutrients is antioxidants, which are critical in order to maintain the integrity and strength of cells, including skin cells. The primary antioxidants are Beta-carotene, Lutein, Lycopene, Selenium, Vitamin A, Vitamin C, Vitamin E and powerful Bioflavonoids such as quercetin. Omega-3 EPA/DHA (from fish and fish oil supplements) is also important to help decrease inflammation that often manifests in the skin as “dermatitis.”
Food sources of Beta-carotene include sweet potatoes, carrots, kale, spinach, turnip greens, winter squash, collard greens, cilantro and fresh thyme. Food sources of Lutein include eggs, kale, spinach, turnip greens, collard greens, romaine lettuce, broccoli, zucchini, corn, garden peas and brussels sprouts. Foods highest in lycopene include tomatoes, pink grapefruit, watermelon, and guava. Other foods containing small amounts of lycopene include persimmon and apricots. Those foods high in selenium include button mushrooms, shitake mushrooms, cod, shrimp, snapper, tuna, halibut, calf’s liver, and salmon. Food sources rich in Vitamin A include carrots, calf’s liver, spinach, sweet potato, kale, turnip greens, winter squash, collard greens, swiss chard, and red bell peppers. Vitamin C is abundant in parsley, broccoli, bell pepper, strawberries, oranges, lemon juice, cauliflower, papaya, kale, mustard greens, and Brussel sprouts. Mustard greens, chard, sunflower seeds, turnip greens, almonds and spinach are all excellent sources of Vitamin E. Quercetin is found in black and green tea, onions, tomatoes, apples, elderberries, and citrus fruit.
Other foods that may help with internal defense as nutritional armor against skin damage and aging are brazil nuts (good source of selenium), berries (good source of Vitamin C and E), Avocados (good source of Vitamin C and E), dairy products (excellent source of Vitamin A), and Green tea (contains Vitamin C and E). So, for healthy skin adopt a Mediterranean diet, eat lots of “oily” fish and eat lots of fruits and vegetables.

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What is the best way for me to lose weight?
IN THE TOPIC: OBESITY
A good weight loss plan should focus on three primary concepts – total calorie intake, food choices and meal timing.
When it comes to weight loss, total calories consumed must be less than what is needed by the body. The total amount of calories that equals one pound of body fat is 3500 calories. In order to lose one pound of fat, a 3500 calorie deficit must be created. That is very difficult to do in one day but over a period of time (i.e. a week) that is very feasible. As long as calories consumed stays consistently less than calories burned, weight loss can be achieved. A healthy weight loss goal would be 1-2 pounds per week. That is a calorie deficit of 500-1000 calories per day. Generally, most females should consume 1200-1800 calories per day and males 1800-2500 calories for weight loss.
Even if your calorie intake is less than what you are burning, if you continually choose unhealthy sources of calories, weight loss may be slowed or not seen at all. Calories count and the types of calories most certainly count. A majority of calories need to come from whole grains, fruits, vegetables, lean protein (fish) and dairy, and healthy fats. Only a small amount of calories should come from things like fried foods, sodas, potato chips, desserts, candy, or other high calorie, low-nutrient dense foods.
Most people do not realize the importance of meal timing. Our bodies are very good at preserving themselves, especially during times of starvation, and when our bodies go long periods of time without eating, the metabolism begins to slow down in order to preserve the tissue. Additionally, going long periods of time without eating will trigger overeating when food is finally eaten. When food is consumed, regardless of how long it has been since the last meal or snack was eaten, only a certain amount of calories are utilized and the rest are stored as fat. When going long periods of time without eating, even more calories have the potential to be stored as fat as metabolism slows. Eating regular meals, about every 3-4 hours, keeps the metabolism elevated. This is important when you are trying to lose weight. Each day should always start with breakfast to increase metabolism and then meals and/or snacks should occur about every 3-4 hours after that. Consistent meals and snacks eaten about 3-4 hours apart will ensure a healthy metabolism and successful weight loss. Fish oil (Omega-3 EPA/DHA) supplementation also maintains a healthy body weight.

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How can probiotics reduce GI problems?
IN THE TOPIC: DIGESTIVE SYSTEM
Probiotics are fascinating because through them we take advantage of the mutually beneficial vital relationship we have with bacteria inside our GI tract. Probiotics are live microorganisms (in most cases, bacteria) that are similar to the beneficial microorganisms found naturally in the human gut. They are also called “friendly bacteria” or “good bacteria.” Probiotics are available to consumers mainly in the form of dietary supplements but they are also placed in foods.
Probiotics are used to prevent many different conditions but particularly those that affect the gastro-intestinal tract (“GI” tract). Although the mechanism is not clearly known, probiotics might help create a healthy environment in the GI tract where “foreign invaders” cannot take up residence. They have been shown to help prevent some very common and occasionally serious infections in the GI tract that cause diarrheal disease. For example, a type of serious infection in newborns in the lining of the intestine can be reduced by through specific probiotics. Probiotics have also been shown to help prevent the common diarrheal infection in children caused by a virus called “rotavirus” (often spread at day care centers, preschools, etc). Studies also support that probiotics decrease the chance of getting “traveler’s diarrhea” the travel-ruining disease often acquired when in other parts of the world with less than optimal water sanitation practices. There is evidence that probiotics might help with colitis (inflammation in the bowel) and irritable bowel syndrome.
Also, some people take probiotics to restore the good bacteria in the gut that have been killed or removed by diarrhea, radiation, chemotherapy, antibiotics, or other causes. The most common of these is probably antibiotic associated diarrhea (AAD). Antibiotics can kill the good bacteria in the intestines and evidence supports that probiotics can help by replenishing and reconstituting the bacteria in the GI tract.
I am very excited about probiotics, their current role and developing research in the treatment, prevention, and management of a variety of diseases as a type of internal “nutritional armor” starting in the GI tract. We must not also forget that microorganisms living in your intestines are in close association with cells that affect your entire immune system. Therefore, the role in probiotics in enhancing immunity, inflammation and hypersensitivity throughout the body starting within the GI tract is also exciting.

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