The Omega-3 Supremacy
By Zoltan P. Rona, M.D., M.Sc.
Virtually every new patient I have seen in my private office practice in the past 10 years has been taking at least one or more nutritional supplement. In my experience, the most popular one by far is omega-3 fatty acids coming from fish oil, seafood and other animal life. If it isn’t the tried and true cod liver oil, it’s halibut liver oil, salmon oil, krill oil or seal oil. Aside from the fact that the natural health industry has been promoting omega-3 for decades, numerous conventional doctors (GPs, psychiatrists, cardiologists, and rheumatologists) now also recommend it to many of their patients.
Omega-3 fatty acids are also often referred to as essential fatty acids (EFAs) or polyunsaturated fatty acids (PUFA). EFA’s make up at least 60% of the mass of our brains. These are called essential because our bodies cannot produce these from other nutrients. They must therefore be obtained from either diet or supplements. They are needed as basic elements of our cell membranes. They control the inflammatory response and, hence pain and the spread of disease. They also mediate the immune response, control hormone production and regulate nerve transmission.
The ideal ratio of omega-6 to omega-3 fatty acids is 1:1. The standard North American diet, due to the over consumption of breads, cereals, eggs, poultry, nuts, vegetable oils such safflower, corn, soy and sunflower from processed foods has a ratio of between 20:1 and 30:1. This relative omega-3 deficiency is what is believed to be the cause of numerous health problems.
Why are so many people recommending and using Omega-3 oils? Conventional doctors will usually only recommend something if there is enough evidence to warrant a prescription. Numerous epidemiological studies and randomized clinical trials have documented the benefits of certain amounts of the omega-3 oils known as EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid) in several major areas:
Brain and Cognitive Health
Omega-3 fatty acids are critical to the structure and function of neuronal membranes. The communication between various nerves could not occur in a normal way without omega-3 fatty acids. As a result, just about every brain condition would benefit from optimal levels of DHA and EPA.
Depression is one of many common conditions that could benefit from omega-3 fatty acids. They influence something called the cytokine system in the brain. These cytokines are known as interleukin-1 -2 and -6, interferon-gamma, and tumor necrosis factor alpha. They can directly and indirectly influence the severity and outcome of depression.
Cognitive health promotion is another area of proven benefit of omega-3 fatty acids. The incidence of ADHD (Attention deficit Hyperactivity Disorder) is rapidly escalating with a greater and greater dependency on drugs such as Ritalin (an amphetamine). In fact, at one time in the 1990s, so much Ritalin was being prescribed that the drug companies manufacturing it ran out of stock and could not keep pace with the demand.
The good news is that there are now numerous studies supporting the use of EPA and DHA in the treatment of ADHD. EPA and DHA are crucial in proper retinal and brain development. They improve school performance, learning, focusing on tasks and behaviour in children.
One study from Australia published in 2007 by Sinn and Bryan concluded that a 30 week treatment of children with ADHD with fatty acid capsules (providing 560 mg/day of EPA, 175 mg/day of DHA, 60 mg/day of gamma-linolenic acid, and 10 mg/day of vitamin E) plus a multivitamin tablet containing low (RDA) amounts of vitamin and minerals yielded slightly better results than seen in children who used Ritalin. These fish oils reduce ADHD symptoms whether or not a child is on Ritalin.
For those wanting an official seal of approval, Health Canada’s Natural Health Product Directorate (NHPD) requires a minimum of 1.5 – 3.0 g of EPA and DHA per day including at least 1.0g of EPA per day (at a ratio of 2:1) to support mood balance. As we all know, if Health Canada says so, it must be true.
Cardiovascular Health
Back in the 1970s, it was reported that despite a relatively high-fat diet, the Inuit people of Greenland had little incidence of heart disease. They had long winters with little sun exposure, a factor thought to increase the risk of psoriasis yet psoriasis was rare in the Inuit. Their secret was a large consumption of omega-3 fatty acids.
It is now a fairly well established fact that heart disease, especially coronary artery disease, is the end result of inflammation. Omega-3 fatty acids are anti-inflammatory so it would stand to reason that EPA and DHA would be of help in both the prevention and treatment of cardiovascular disease. A review paper of 25 clinical trials by Harris showed exactly this to be true. Major cardiovascular events were inversely correlated with the tissue levels of EPA and DHA.
EPA and DHA also prevent blood from being too sticky and forming arterial blockages. All those people who have been recommended to take a baby aspirin a day would do just as well to take adequate amounts of DHA and EPA. I usually recommend about 1000 mg in a 2:1 ratio of EPA:DHA for prevention of heart disease and significantly more (4000 – 8000 mg) for various inflammatory conditions (e.g. arthritis, multiple sclerosis, colitis, Crohn’s disease, psoriasis etc.).
Three major trials have documented the efficacy of Omega-3 fatty acids in secondary prevention of coronary artery disease. The DART (Diet and Reinfarction Trial) was a randomized trial on 2,033 men with recent heart attacks. EPA and DHA was administered in either the form of oily fish or fish oil capsules. The results showed that a 2-year all cause mortality was reduced in the study group by 29% mostly from heart disease. Of particular interest was the fact that the subgroup that consumed only fish oil capsules as opposed to increasing fish consumption, showed a more remarkable reduction in cardiovascular events.
In my practice I test every fish and seafood eater for high mercury blood and hair levels. Invariably, those who eat fish or seafood on a regular basis have elevated mercury levels either in the blood or hair or both. The bigger the fish, the higher the mercury levels. Most polluted are tuna, sea bass, swordfish and Japanese sushi. Smaller fish like salmon, anchovies, mackerel and tilapia are relatively lower in mercury but still unacceptably contaminated with PCBs and dioxins.
Those who rarely eat fish or seafood but use fish oil supplements never have elevated mercury levels unless they have numerous mercury amalgam dental fillings. Most manufacturers remove mercury and other toxic heavy metals from their fish oil supplements.
The second trial was called the GISI study. It randomized 11,323 post-heart attack patients to one capsule per day of Omega-3 fatty acids, providing 850mg EPA/DHA. At the end of year one, patients had a 21% reduction in all cause mortality and a 30% reduction in cardiovascular mortality. After 4 months of fish oil supplementation, there was a 45% reduction in sudden cardiac death.
The third trial, the JELIS trial, studied 18,645 patients with high blood levels of cholesterol of which 70% were women. The patients were randomized to a statin drug (e.g. Lipitor, Crestor) alone or a statin with EPA/DHA of 1,800/day. Five years later, those randomized to EPA/DHA had a 19% reduction in major cardiovascular events.
Researchers now believe that the mechanism by which EPA/DHA works is by the enrichment of cell membrane phospholipids. Omega-3 fatty acids also reduce blood pressure, increase vasodilation (enlarge the caliber of arteries), improve arterial and endothelial function and reduce platelet aggregation. They also raise the levels of HDL (the “good” cholesterol carrying lipoprotein).
High blood levels of triglycerides, another risk factor for coronary artery disease, are also improved by supplementation of omega-3 EPA/DHA intake. In fact, in 2011, The American Heart Association (AHA) recommended between 0.5 – 1 gram of omega-3 EPA and DHA for people with borderline high triglyceride levels, between 1 – 2 grams for individuals with high triglyceride levels and 2 – 4 grams for those with very high triglyceride levels. Those with documented coronary artery disease should take between 1 -3 grams of omega-3 daily. The proof of omega-3 supremacy in this area is almost universally accepted.
Rheumatoid Arthritis
According to Health Canada’s Natural Health Products Directorate (NHPD), fish oil supplementation between 2,800 and 3,000 EPA + DHA per day at a ratio of 2:1 in conjunction with conventional therapy is considered efficacious for rheumatoid arthritis.
In a study by Kremer et al., the fish oil group (compared to a group that took corn oil capsules) had significant decreases in tender joints, duration of morning stiffness and overall evaluation of global arthritis activity.
In another double-blind study, Cleland et al. compared a fish oil supplement (18g/day) with an olive oil supplement for 12 weeks and found that the production of leukotrienes (inflammatory molecules) was reduced by 30% in the fish oil group and unchanged in the olive oil treated group.
The message here is obvious. If you have inflammation, there’s a very good chance that omega-3 fatty acids will help reverse your disease, especially if it’s rheumatoid arthritis.
Other Major Benefit of Omega-3 Oils
Are you one of those people that constantly needs to visit your doctor to have your earwax flushed out because it accumulates so rapidly? Ever wonder why this happens? Well, it turns out that earwax buildup that hardens and needs constant clearing with instilled oils or water is really the result of omega-3 deficiency. Get enough omega-3 and the earwax fails to harden in the ear canals and can easily come out on its own. Forget those messy ear drops and start supplementing with at least 5 grams of omega-3 every day.
Allergies, asthma, eczema, constipation and learning disabilities have all been linked to a deficiency of omega-3 fatty acids.
Omega-3 fatty acids preserve the blood levels of vitamin D, now universally acknowledged as being one of the most important nutrients for the prevention of cancer, heart disease, inflammation of any kind, diabetes and all auto-immune diseases. Most scientists now believe that the reason why omega-3 is so important is that it supports the many functions of vitamin D. If you want to read more about vitamin D but do not want to spend weeks doing that, read my new book, “Vitamin D, The Sunshine Vitamin”.
Cautions with Omega-3
If you are on blood thinning medication, omega-3 supplementation may potentiate the action of the blood thinning drug and unwanted bleeding may occur. This does not mean that you cannot use fish oil. It only means you may have to tell your doctor about it so that the prescription blood thinner dosage can be reduced.
Fish oil supplements are usually highly beneficial for diabetics because they improve circulation and reduce high triglyceride levels. Some Type 2 Diabetics develop a slightly elevated fasting blood sugar level with fish oil supplements and there may be some interactions with certain anti-diabetes medications. Check with your doctor if there are any concerns and use fish oil supplements at lower doses or as directed by your doctor.
How to Choose Omega-3 Supplements
Look for purity, potency and freshness. The brand name you choose should have a Natural Health Product number (NPN) and be able to provide you with a detailed biochemical and toxicological analysis of the contents of the bottle, whether in capsule or liquid form.
The potency should be measured in milligrams, with a ratio of 2:1 EPA: DHA. Ignore products with “extra high potency” claims that charge up to 4 times the price for regular potency brands. This is a gimmick. The total milligrams per bottle should be the deciding factor in your choice. Also, make sure you check the expiry date and avoid buying any supplements that do not give you enough time to consume the product.
If you are buying capsules, make sure you purchase ones that are enteric coated. This is important so that the oils reach the small intestines before they are dissolved higher up in the stomach. Capsules that are not enteric coated produce a fishy regurgitation smell. Unless you have no sense of smell, you will find non-enteric coated supplements very unpleasant.
Do not buy any supplements containing omega-3, 6 and 9 no matter how well they are hyped. Buy only omega-3. Nobody, except for people who have suffered from protein calorie malnutrition for months, needs to take omega-6. All of us get enough omega-6 fatty acids from our diet, so supplementation is unwarranted. Too much omega-6 blocks the absorption of omega-3 and creates a relative deficiency. If you have any questions concerning supplementation, consult a natural health care practitioner.
Dr. Zoltan P. Rona practises Complementary Medicine in Toronto and is the medical editor of “The Encyclopedia of Natural Healing.” He has also published several Canadian best-selling books, including “Return to The Joy of Health.” For more of his articles, seehttp://mydoctor.ca/drzoltanrona
REFERENCES
Rona, Zoltan P. Rheumatoid Arthritis. Vancouver:Alive Books. 2000.
Rona, Zoltan P. Vitamin D, The Sunshine Vitamin. Tennessee, USA: Alive Books, 2010 http://www.amazon.com/Vitamin-D- Sunshine-Zoltan-Rona/dp/0920470823
Colter, AL, et al. Fatty acid status and behavioural symptoms of Attention Deficit Hyperactivity Disorder in adolescents: A case-control study. Nutrition Journal, Vol. 7, No. 1, February 14, 2008, p. 8 www.nutritionj.com/content/7/1/8
Harris WS, Poston WC, Haddock CK. Tissue n-3 and n-6 fatty acids and risk for coronary artery disease events. Atherosclerosis 2007;193:1-10.
Germano, M, et al. Plasma, red blood cells phospholipids and clinical evaluation after long chain omega-3 supplementation in children with attention deficit hyperactivity disorder (ADHD). Nutritional Neuroscience, Vol. 10, February/April 2007, pp. 1-9
Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet And Reinfarction Trial (DART). Lancet 1989;2:757-61.
Sorgi, PJ, et al. Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder. Nutrition Journal, Vol. 6, 2007, pp. 16-23
Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI- Prevenzione trial Fruppo Italiano per lo Studio dell Sopravvivenza nell’Infarto miocardico (errata in Lancet 2001;357:642 and Lancet 2007;369:106). Lancet 1999;354:447-55.
Sinn, N. and Bryan, J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. Journal of Developmental & Behavioral Pediatrics, Vol. 28, April 2007, pp. 82-91
Schachter, HM, et al. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? Canadian Medical Association Journal, Vol. 165, November 27, 2001, pp. 1475-88
Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomized open-label, blinded end-point analysis. Lancet 2007; 369:1090-8.
Richardson, A.J. and Montgomery, P. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics, Vol. 115, May 2005, pp. 1360-66
Harris WS. Omega-3 fatty acids and cardiovascular disease a case for omega-3 index as a new risk factor. Pharmcol Res 2007;55:217-23.
Arnold, L. Eugene. Alternative treatments for adults with ADHD. Annals of the New York Academy of Sciences, Vol. 931, June 2001, pp. 310-41
Lavie DJ, Milani RV, Mehra MR, et al. Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Diseases. JACC 2009;54:585-94.
Burgess, John R., et al. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. American Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 327S- 30S
Fish Oil Monograph. Retrieved November 1, 2009 from http://www.hc-sc.gc.ca/dhp-mps/prodnatur/applications/licen-prod/monograph/mono_fish_oil_huile_poisson-eng.php. Natural Health Products Directorate, Health Canada.
Stordy, B. Jacqueline. Dark adaptation, motor skills, docosahexaenoic acid, and dyslexia. American Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 323S-26S
Kremer JM, Lawrence DA, Petrillo GF et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal anti-inflammatory drugs. Clinical and immune correlates. Arthritis Rheum 1995;38(8):1107-14.
Cleland LG, French JK, Betts WH et al. Clinical and biochemical effects of dietary fish oil supplements in rheumatoid arthritis. J Rheumatol. 1988;15:1471-5.
Logan AC. Omega-3 fatty acids and major depression: A primer for the mental health professional. Lipids in Health and Disease 2004;3:25.
Bourre JM, Dumont O, Piciotti M et al. Essentiality of omega-3 fatty acids for brain structure and function. World Rev Nutr Diet 1991, 66:103-117.
Maes M, Smith RS. Fatty acids, cytokines, and major depression. Biol Psychiatry 1988, 43:313-314.
Suarez EC, Krishnan RR, Lewis JG. The relation of severity of depressive symptoms to monocyte-associated proinflammatory cytokines and chemokines in apparently healthy men. Psychosom Med 2003, 65:362-368.
Omega-3s and Children. Joey Shulman.
http://www.alive.com/2052a5a2.php?subject_bread_cramb=156
AHA Recommends Omega-3 for Triglyceride Management. www.heart.org
MACA MANIA
By Dr. Zoltan Rona, M.D., M.Sc.
About a year ago, numerous patients were visiting my office singing the praises of a miraculous herbal remedy known as maca. I’ve learned a great deal from patients over the years and decided to pay attention to a growing number of reports praising this increasingly popular plant. Until that time, I had only heard of Maca as an obscure tonic.
Was this just another fast-fading fad like coral calcium, noni juice and kombucha? The major benefit reported by these people was energy enhancement but several women were also making claims of relief of menopausal hot flashes, insomnia and depression. Men too were boasting of their better sexual performance and just about all were raving about being able to deal much easier with stress since starting maca supplements.
What caught my attention about maca the most was the story of one of my patients, a 49 year woman who had been on hormone replacement (HRT) for over five years. She had just heard of the studies that linked breast cancer, stroke and heart disease with the use of HRT and wanted to stop using the estrogen and progesterone combination immediately. She tried soy products, black cohosh, ginseng, evening primrose oil, progesterone cream and numerous other natural remedies to relieve her hot flashes and insomnia but none were totally effective until she tried maca. She was able to stop the HRT and get complete menopausal symptom relief with maca in a matter of days. She initially thought that the effects were just placebo but going on and off the supplement proved that the effects of maca were very real. Incidentally, she was also able to off her anti-depressants because her depression and sleep had improved so dramatically.
Scientific studies using maca in humans are few and far between with most of the research having been conducted with animals. Human data is still mostly anecdotal and open to debate but several double-blind placebo-controlled studies are underway. What is proven about maca is that it appears to be very safe to use in virtually any amount. In fact, native Peruvians have been feasting on it for centuries.
Anecdotally, I recently participated in a senior tennis tournament and made it to the finals of a provincial event for the first time ever. Not bad for someone who only plays twice a week. On one day I played two matches, each over 2 hours and credit my energy, performance and endurance on taking maca in high doses before each match. I normally take a lot of supplements but this was the first time I used maca as a tennis performance enhancer.
What is maca and why is it suddenly so popular in North America?
Maca is a unique perennial that grows at altitudes of 14,500 feet in the Andean mountains of Peru. It has one of the highest frost tolerances of any cultivated plant and grows where no other plant can survive. One would expect such a hardy plant to have therapeutic properties and in this area, maca does not disappoint. Maca is rich in numerous medicinal compoundsincluding alkaloids, amino acids, beta-ecdysone, calcium, carbohydrates, iron, magnesium, p-methoxybenzyl isothiocyanate, phosphorus, potassium, protein, saponins, sitosterol, stigmasterol, tannins, vitamin B1, vitamin B2, vitamin B12, vitamin C, vitamin E and zinc.
From strictly a nutritional point of view, the contents of this plant, at worst, would supply individuals with much more than the bare minimal daily requirements of numerous vitamins, minerals, amino acids and essential fatty acids. The fact is that at least 50% of North Americans suffer from at least one or more of the nutrients that could easily be obtained from supplemental maca. Understandably, the following beneficial effects of maca in both men and women have been reported:
I recommend buying maca only from reputable companies that have knowledge and expertise in maca. Here are some points to consider when shopping for maca:
Because Peru is a third world country, look for companies who employ fair trade practices with local farmers and support traditional farming and sustainable harvesting to ensure the long-term health of maca and its environment.
Keep in mind that when it comes to maca, you truly do get what you pay for. For example, organic certification and gelatinization will cost you a bit more but for many consumers it may be worth the extra investment for the peace of mind, assurance of quality and greater efficacy.
Typical dosage for most adults is 1,500mg of gelatinized maca twice daily in capsule or powder form. However, one can safely take 6 or more times this amount for enhanced athletic performance amongst other active lifestyle purposes. If you are in your 40s, 50s, 60s or beyond, male or female, maca is a supplement well worth trying. Enjoy, and I would be pleased to hear of your results.
Dr. Zoltan Rona is a medical doctor with a private practice in Toronto. He is the author of 10 books on nutritional medicine and the medical editor of The Encyclopedia of Natural Healing. He contributes articles frequently to Alive magazine, Vitality and other publications.
by Dr. Zoltan P. Rona, MD, M.Sc.
Intravenous nutritional therapy is invasive and should only be considered by those who have tried unsuccessfully to use strict diet changes and oral supplements to heal chronic health conditions. Although it is often used by healthy individuals, including elite athletes, to improve performance, it is by no means everybody’s first choice in complementary or alternative medicine.
Linus Pauling was right! Long before his death, he had published a great deal about vitamin C’s ability to effectively fight cancer when given in doses greater than 10,000 mg daily. On September 20, 2005, a team of scientists from the National Institutes of Health in Bethesda, MD, published the results of a landmark study done using human lymphoma cells. The study argues strongly in favour for the use of intravenous vitamin C treatment as a scientifically proven way of beating cancer.
Similar positive findings were also published in the usually conservative Canadian Medical Association Journal earlier this year (CMAJ, March 28, 2006). This research basically demonstrated that, once in the bloodstream at high doses, vitamin C increases hydrogen peroxide (H2O2). This natural body biochemical then destroys cancer cells while leaving healthy cells and tissues unharmed. Hydrogen peroxide is also one of the body’s best defenses against bacteria, viruses, fungi, parasites and other microbes. Theoretically and in practice, IV vitamin C can therefore successfully fight a long list of infectious diseases through this peroxide mechanism.
Doesn’t the oral form of vitamin C work as well? Oral vitamin C, although beneficial for immunity, will not work to reverse cancer. One must get this nutrient in an intravenous form, using doses ranging from 25 to 75 grams (75,000 mg).
The late Dr. Hugh Riordan and his research group in Wichita, Kansas, studied the effects of intravenous vitamin C in cancer therapy for over 28 years. His findings, and those of other independent investigators, give new hope to cancer victims. Of further interest is the fact that intravenous vitamin C will work for practically all kinds of cancer regardless of the stage of the disease.
All cancer treatments, natural or otherwise, have potential drawbacks. While recent studies at NIH and elsewhere have shown no side effects or toxicities associated with intravenous vitamin C, there are some relative contra-indications and theoretical dangers. These include local pain at the infusion site, rapid tumour death (necrosis) with resulting toxemia, and allergic reactions and hemolytic anemia due to hereditary G6PD (glucose-6-phosphate-dehydrogenase deficiency). With the exception of G6PD deficiency, all of these issues can be successfully dealt with to achieve the treatment benefits.
It has been falsely reported that vitamin C in mega doses can cause high blood levels of oxalic acid and oxalate kidney stones. Research over the past two decades has proven the opposite to be true – vitamin C actually prevents kidney stones. In those who already suffer from kidney stones, and who wish to use IV vitamin C, supplementation with vitamin B6 (100 – 300 mg daily) should be taken as a way of reducing oxalic acid levels in the body.
Blood tests can be done for G6PD deficiency before starting the IVs in order to rule out hereditary reasons to avoid vitamin C supplementation. Calcium and magnesium supplements could also be taken if one is sensitive to the acidity effects of vitamin C. Care must also be taken by anyone adversely affected by the infusion of relatively large amounts of fluid such as might occur in people suffering from congestive heart failure. Here, the infusions can be given over a longer period of time.
Intravenous vitamin C is just one example of a natural therapy that works differently from the oral intake form. Regardless of the amounts taken orally, only intravenous administration can achieve the blood levels required to kill viruses, bacteria, parasites, fungi and cancer cells. Even intramuscular vitamin C cannot provide adequate levels to do the job. The story is the same for many other nutrients. To achieve therapeutic results in many chronic, seemingly incurable conditions, the vitamins and minerals must be given intravenously.
Another reason for using IV vitamins and minerals is the aging factor. As one gets older, the ability of the digestive tract to absorb certain nutrients is reduced. People who need various digestive enzymes to help absorb vitamins and minerals often benefit dramatically from IV nutrients because this procedure circumvents the stomach and intestines altogether.
The best example of this is the Myers’ Cocktail, a mixture of intravenous vitamins and minerals that have a long track record of safely reversing numerous health problems. Named after the late Dr. John Myers, the cocktail is known to help alleviate acute asthma attacks, migraines, fatigue (including chronic fatigue syndrome), fibromyalgia, acute muscle spasm, anxiety, depression, upper respiratory tract infections, chronic sinusitis, seasonal allergic rhinitis, angina, hypertension and other cardiovascular disease disorders.
Magnesium chloride hexahydrate 20% (magnesium) 2-5 mL
Calcium gluconate 10% (calcium) 1-3 mL
Hydroxocobalamin 1,000 mcg/mL (B12) 1 mL
Pyridoxine hydrochloride 100mg/mL (B6) 1 mL
Dexpanthenol 250 mg/mL (B5) 1 mL
B complex 100 (B complex) 1 mL
Vitamin C 222 mg/mL (C) 4-20 mL
Some doctors also add glutathione and adrenal cortical extract to the mixture for added antioxidant and energy boosting. The majority of individuals who get this IV will do so twice a week until feeling better, then maybe once a week or once a month depending on the case.
There are a growing number of naturopaths and medical doctors who offer IV therapies as well as our Thornhill Intravenous Clinic at HIgh Level Wellness.
The best thing to do is to first get a referral from your family doctor. Alternatively, contact the Canadian Complementary Medical Association (http://www.ccmadoctors.ca) or the Canadian College of Naturopathic Medicine (http://www.ccnm.edu).
Dr. Zoltan P. Rona practices Complementary Medicine in Toronto and is the medical editor of The Encyclopedia of Natural Healing. He has also published several Canadian best selling books including Return to The Joy of Health and Vitamin D, The Sunshine Vitamin. For more of his articles, see www.highlevelwellness.ca
HELP FOR SNORING
Snoring can disturb sleeping patterns, occasionally leading to sleep apnea, a potentially life threatening breathing condition. Sleep apnea can cause abnormally low blood oxygen levels leading to chronic fatigue, irregular heartbeats, high blood pressure, memory loss and strokes. Habitual snorers are three times more likely to get into a car accident than the rest of the population. Snoring is associated with the accumulation of secretions in the back of the throat combined with tissue swelling. This produces a partial airflow obstruction with narrowed airways leading to unwanted, noisy sleep.
CAUSES
Poor muscle tone (lack of tightness) in the muscles of the tongue and throat caused by alcohol, drugs, tobacco smoke or other irritants. Large tonsils, adenoids or excessive bulkiness of other tissues of the throat. Being overweight (associated with excessively bulky neck tissues), excessive length of the soft palate and uvula obstructed nasal airways due to allergies, chronic infection or a deviated nasal septum. Dood allergies, most commonly to milk, dairy products, eggs, wheat, chocolate, citrus or soy cysts or tumors (rare).
TREATMENTS
Adopting an athletic life-style with daily exercise and weight loss, if overweight. Avoidance of drugs affecting the nervous system, especially tranquilizers, sleeping pills, and antihistamines before bedtime. Avoidance of alcoholic beverages. Avoidance of meals within 3 hours of retiring. Establishing regular sleeping patterns. Sleeping sideways rather than on the back, tilting the entire bed with the head upwards. Food allergy testing and elimination of reactive foods. UvuloPalatoPharyngoPlasty (UPPP) surgery on the throat and palate to tighten up flabby tissues and expand the air passages.
COMPLEMENTARY NUTRITIONAL SUPPLEMENTS
vitamin C, bioflavonoids, cayenne, slippery elm, echinacea, elderberry, eucalyptus, licorice root, ginger root, fenugreek, red clover and yarrow can all offer limited symptomatic relief.
DRUGS YOU MAY NOT NEED & THEIR NATURAL ALTERNATIVES
By Dr. Zoltan P. Rona
Dr. Zoltan P. Rona practices Complementary Medicine in Toronto and is the medical editor of “The Encyclopedia of Natural Healing.” He has also published several Canadian best selling books including “Return to The Joy of Health”. For more of his articles, seehttp://www.mydoctor.ca/drzoltanrona
CHALLENGING THE STATIN DOGMA
Do we all suffer from a statin deficiency? Cholesterol lowering drugs are a $26 billion a year industry in North America. Statins are no less a medical dogma than the swine flu vaccine. Do we dare question it?
The commitment by mainstream doctors to these drugs, in fact, is so powerful that many physicians themselves take one of the statins even though their cholesterol levels may be normal. In the past year alone, I have seen at least two dozen patients who were prescribed statins by other physicians, even though their blood levels of cholesterol were normal. In many cases the physicians prescribing the drugs boasted that they were taking the same prescription.
Few conventional MDs ever question the validity of taking statins. Ask anyone over 50 and there’s at least a 50% chance they take a statin of some kind. That’s all provided they are not a regular reader of this magazine. Unfortunately, statins may well be the biggest scam ever perpetrated upon an unwary public and the medical profession by Big Pharma. Big Pharma spends big bucks to make sure all doctors are continuously prescribing these money makers and great efforts are also made to minimize the significance of side effects.
Most Common Statins
Lipitor (atorvastatin)
Zocor (simvastatin)
Pravachol (pravastatin)
Lescol (fluvastatin)
Mevacor (lovastatin)
Crestor (rosuvastatin)
Statins are believed to be “preventive medicine” against heart disease but are they really? If one looks at actual statistics in the prevention of a first heart attack, statins only prevent 1% of first heart attacks over a period of 10 years. For every life saved by a statin an equal number of deaths occur that are caused by adverse reactions to statins in the form of accidents, infections, suicide and cancer (also 1% over 10 years). As a form of first heart attack prevention, statins are an ineffectual waste of money. The evidence for reduction of mortality is, at the very least, highly debatable.
All statins work primarily by blocking an enzyme (HMG CoA reductase) in the liver that helps manufacture cholesterol. Unfortunately, this is the same enzyme the body uses to manufacture coenzyme Q10, the most important antioxidant for the cardiovascular system. Consequently, coenzyme Q10 tissue levels are lowered and numerous side effects occur.
If you suffer from Fibromyalgia, statins are definitely not for you. Statins have been proven to turn on the gene that causes muscle damage leading to atrophy (shrinkage) and wasting. It’s a given. Everyone (that’s 100% of the time) taking statins gets muscle damage. It’s just a question of degree. You may not have muscle pain or weakness now from taking a statin but you definitely have microscopic muscle damage.
The most serious form of muscle damage is called rhabdomyolysis (major muscle cell death) and is said to occur in only 1% of statin users. This damage is permanent and only partial relief is seen when the statin is stopped. At least 5 – 7% of statin users report varying degrees of muscle pain or discomfort. That percentage goes up to 10% in those using higher statin doses and to 25% in those engaged in regular vigorous exercise. These are facts based on research done using muscle biopsies. Let’s not forget that the heart itself is a muscle. Statin use has been shown to worsen the signs and symptoms of congestive heart failure perhaps through this muscle wasting effect.
Cardiomyopathy is a known but under-reported side effect of statins and is thought to be due to a combination of statin induced coenzyme Q10 deficiency and the gene activation of muscle damage. Unfortunately, we cannot do biopsies as readily on the heart so heart muscle damage caused by statins could only be proven at autopsy.
The nerve damaging effects of statins are also well documented. Memory and cognitive loss, neuropathy, anemia, cataracts, sexual dysfunction, liver dysfunction, fatigue, immune system weaknesses and mental depression side effects have often been reported. If you suffer from cancer and use statins, it’s time to rethink that repeat statin prescription.
Adverse Effects of Low Cholesterol
Cholesterol has become unfairly synonymous with evil, disease and death. At least 85% of the cholesterol in your blood came from your liver’s own manufacture of it. If you consume high cholesterol foods, your cholesterol blood levels do go higher temporarily but the liver then manufactures less and eventually the blood levels go lower. Eliminate cholesterol entirely from your diet and the liver starts manufacturing more of it.
Cholesterol blood levels can change significantly from one time of the day to another. In northern latitudes especially, higher levels of cholesterol are seen in the winter than summer, possibly because of the cholesterol lowering effect of vitamin D during the summer. Cholesterol goes high after an injury such as can occur with surgery. It can also go higher as a response to mental stress, an infection as well as during and after a heart attack.
Why does the body go to such lengths to maintain cholesterol levels if it’s something that is so horrible? Are there good reasons to have adequate amounts of cholesterol in the body? Overwhelmingly, the answer is yes. Cholesterol is a healing or repair agent and the body makes more of it as a response to oxidant stress from numerous sources. For example, if you smoke cigarettes, your cholesterol level is likely to be high because the body needs protection against the toxins found in tobacco smoke.
We are all exposed to toxins from food, water and air on a regular basis. The greater the toxin exposure, the more the body needs to protect itself. One of the mechanisms by which this occurs is the production of more cholesterol by the liver. Suppress that function with a statin and you risk developing degenerative diseases more easily.
Half of all heart attacks occur with cholesterol levels well within the normal range. This “normal” range has changed frequently over the past 30 years, going lower and lower and thus accommodating the hypothesis that just about everyone has too high cholesterol levels.
Cholesterol is an integral part of the structure of every cell in the body including the cells of all your blood vessels. Life would cease to exist without cholesterol. Cholesterol is used by the body to manufacture testosterone, estrogen, progesterone, cortisol and DHEA. Low levels of cholesterol could lead to deficiencies in these hormones and subsequent acceleration of aging.
Cholesterol insulates nerves and is responsible for healthy nervous system function. Many diseases of the brain and nervous system could be aggravated, if not caused by, low cholesterol levels.
Cholesterol deficiency could lead to numerous digestive system problems because bile salts are made in the liver from cholesterol and bile salts are important for proper digestion.
The body also manufactures vitamin D from cholesterol and, if cholesterol levels are low, a vitamin D deficiency could result. As we now all know, low levels of vitamin D can increase the risk of getting cancer by as much as 60%. Could this be one of the mechanisms by which statin drugs increase cancer incidence? Low levels of vitamin D have been proven to weaken immunity.
The brain accounts for approximately a quarter of all the cholesterol in the body. The myelin sheath that covers every nerve in the body is made of at least one-fifth cholesterol. The communication between nerves and the integrity of messages between neurons is partially dependent on adequate cholesterol levels. The brain functions abnormally without adequate cholesterol because receptors for serotonin require cholesterol to work properly. Depression, violence, memory impairment and suicide are all more likely to occur.
It has never been conclusively shown that lowering cholesterol levels saves lives. Certainly, its efficacy in preventing a first heart attack is unproven. Lowering cholesterol can, in fact, be related to a greater death risk, especially from cancer.
Since the correlation between total cholesterol and heart disease is practically non-existent, a stronger correlation was sought many years ago. Hence the myth of a “good” (HDL or high density lipoprotein) and a “bad” (LDL or low density lipoprotein) cholesterol was created. The truth is that cholesterol is just cholesterol. In the blood, it combines with other things like proteins simply because fat and water do not mix well and proteins are good carriers of fat molecules.
The real cause of heart disease of almost any type is inflammation and not the levels of any cholesterol sub fraction. Where the inflammation comes from is the subject of great debate but there is growing evidence for an infectious disease source amongst many other theories.
We are now being told more and more by Big Pharma and their puppets that statins are also anti-inflammatory and that the real reason they work in preventing heart disease is through their anti-inflammatory effect. Curcumin, omega-3 oils, vitamin E, vitamin C, digestive enzymes like pancreatin and bromelain and many other natural remedies are also anti-inflammatory and at a significantly lower price. Further, none carry any of the outrageous side effects seen with the statins.
What Are the Alternatives?
High cholesterol levels are a response by the body to a variety of physical toxins and mental stress. Heredity also plays a part but can be overcome naturally. The first thing to do is find out what is really going wrong in the body? Is there an infection? Is something causing inflammation? What are the toxins that could potentially be involved? Is there a low thyroid condition? Does the person smoke cigarettes? Is blood sugar control out of balance? Is there little or no physical activity? Is there obesity?
The next thing is to realize that eating a diet rich in antioxidants and as toxin-free as possible can lower high cholesterol levels naturally and without significant side effects. In 2003, a study done by the University of Toronto showed that a vegetarian diet (Ape Man Diet) was every bit as good at lowering abnormally high cholesterol levels as any drug.
It is also interesting that most of the supplemental nutriceuticals, antioxidants and herbs that have been shown to lower cholesterol accomplish this feat by neutralizing the toxic agents that stimulated the high cholesterol levels in the first place. Below is a list of things that can be done through diet and supplements to lower cholesterol naturally. Seeing a natural health care practitioner can help direct you in any changes you may want to make.
Diet
The so-called Ape Man Diet (primarily vegan as demonstrated by what gorillas eat) has been demonstrated to lower cholesterol as well as any statin. But, can we really eat like apes?
If you cannot fancy yourself as an ape, at least consume two or more servings of each of the following proven cholesterol lowering foods every day:
Soy products like tofu, tempeh and soymilk contain saponins which prevent the absorption of excess cholesterol from the gastrointestinal tract.
High pectin fruits like pears, apples, grapefruit and oranges also prevent cholesterol absorption. Drinking pomegranate juice also lowers cholesterol because of its antioxidants and polyphenols.
Garlic, onions, carrots, walnuts, almonds, oat bran cereal, milled (ground) flax seed, seaweed products like kelp, dulse and kombu lower cholesterol via their content of fiber, antioxidants and trace minerals.
Supplements
Cholesterol lowering with most of these natural remedies can take 3 months or longer to achieve. Unlike drugs, side effects of such products are minimal.
Soluble fibers like psyllium, guar gum and pectin -15 grams or more daily.
Milled flax seed – 15 grams or more daily.
Curcumin – 1000 mg 3 times daily – strongly anti-inflammatory and liver protective. It aims at lowering inflammation, tissue damage and ultimately high cholesterol levels.
Omega-3 oils – 2000 mg twice daily - Prevent abnormal blood clotting and reduce the risk of heart disease. Higher doses may be required by some individuals.
Garlic – 1000 mg. or more daily – eating real garlic cloves is preferred but social interactions may necessitate the alternative use of supplemental capsules.
Coenzyme Q10 – 200 mg. twice daily – a strong multi-purpose antioxidant with especially good cardiovascular protective properties.
Niacin - 1000 - 3000 mgs. daily (N.B. niacin can cause a red or flushing reaction which is usually temporary and harmless which lessens with regular use; may cause liver irritation.
Inositol hexaniacinate - 600 - 1800 mgs. daily - a compound of niacin and inositol which does not produce flushing or liver toxicity but cost at least three times more than regular niacin.
Tocotrienols - 600 mgs. or more daily- a form of vitamin E originating from rice bran oil which blocks the cholesterol synthesizing enzyme in the liver. Most vitamin E complex formulae include tocotrienols as part of the complex.
Vitamin C - 3000-6000 mgs. - lowers cholesterol, regenerates and reactivates vitamin E. Vitamin C protects the body from oxidant stress, thereby lowering cholesterol.
Beta Sitosterol - (500 mg daily) Over 50 human and animal studies since the 1960’s and published in scientific journals, show that beta-sitosterol has a powerful hypocholesterolemic effect in humans. It has a similar chemical structure to cholesterol. Beta-sitosterol interferes with cholesterol absorption, which prevents the rise in serum cholesterol. In one study (American Journal of Clinical Nutrition) there was 42% decrease in cholesterol absorbed when taking beta-sitosterol before eating scrambled eggs. Beta-sitosterol is also believed to reduce serum cholesterol by inhibiting the intestinal re-absorption of circulating cholesterol, which is secreted in the bile.
Berberine – 1000 mg. 3 times daily – an extract of several herbs used for their antibiotic properties and cholesterol and triglyceride lowering ability. It also has antioxidant benefits.
Artichoke leaf extract – 1000 mg. 3 times daily – works by enhancing bile acid production by the liver from cholesterol.
Guggulsterones – 1000 mg daily – a resin from the Guggul tree with antioxidant properties but also able to lower cholesterol by regulating bile metabolism.
Ferulic acid – 1000 mg daily – lowers cholesterol by as yet an unidentified mechanism; known to be a strong antioxidant.
Green tea extract (Theaflavin) – 500 mg 3 times daily – a polyphenol derived from catechins found in green tea that has both cholesterol lowering and antioxidant effects.
Red Yeast Rice – 1000 mg twice daily – if you are between 50 and 75 years old and have proven coronary artery disease or have had a heart attack you may want to take this naturally occurring statin as an anti-inflammatory preventive remedy. Side effects are minimal according to a 2005 study.
REFERENCES
Krumholz HM and others. Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years.Journal of the American Medical Association 272, 1335-1340, 1990.
Ravnskov U. High cholesterol may protect against infections and atherosclerosis. Quarterly Journal of Medicine 96, 927-934, 2003.
Rauchhaus M and others. The relationship between cholesterol and survival in patients with chronic heart failure. Journal of the American College of Cardiology 42, 1933-1940, 2003.
Horwich TB and others. Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure. Journal of Cardiac Failure 8, 216-224, 2002.
Muldoon MF and others. Immune system differences in men with hypo- or hypercholesterolemia. Clinical Immunology and Immunopathology 84, 145-149, 1997.
Jun-ichi Hanai1, Peirang Cao1, Preeti Tanksale1, Shintaro Imamura2,3, Eriko Koshimizu3,4, Jinghui Zhao5, Shuji Kishi3, Michiaki Yamashita2, Paul S. Phillips6, Vikas P. Sukhatme1 and Stewart H. Lecker1 The muscle-specific ubiquitin ligase atrogin-1/MAFbx mediates statin-induced muscle toxicity J. Clin. Invest. 117(12): 3940-3951 (2007). doi:10.1172/JCI32741.
Jackson PR, Wallis EJ, Haq IU, Ramsay LE. Statins for primary prevention: at what coronary risk is safety assured? Br J Clin Pharmacol. 2001 Oct;52(4):439-46.
Vrecer M, Turk S, Drinovec J, Mrhar A. Use of statins in primary and secondary prevention of coronary heart disease and ischemic stroke. Meta-analysis of randomized trials. Int J Clin Pharmacol Ther. 2003 Dec;41(12):567-77.
Markus G. Mohaupt, MD, Richard H. Karas, MD PhD, Eduard B. Babiychuk, PhD, Verónica Sanchez-Freire, Katia Monastyrskaya, PhD, Lakshmanan Iyer, PhD, Hans Hoppeler, MD, Fabio Breil and Annette Draeger, MD. Association between statin-associated myopathy and skeletal muscle damage. CMAJ • July 7, 2009; 181 (1-2).http://www.ecmaj.ca/cgi/content/full/181/1-2/E11
Huang CF, Li TC, Lin CC, Liu CS, Shih HC, Lai M. Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients. Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):438-40.
Ziajka PE, Wehmeier T. Peripheral neuropathy and lipid-lowering therapy. South Med J 1998;91:667-68. Gaist D, Jeppesen U, Andersen M, Garcia Rodriguez
LA, Hallas J, Sindrup SH. Statins and risk of polyneuropathy: a case-control study. Neurology 2002;58:1333-7.
Lin CC, Li TC, Lai MM. Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia. D Eur J Endocrinol. 2005 Nov;153(5):679-86.
Ragi E. Neuropathy from statins. BMJ 2001http://bmj.bmjjournals.com/cgi/eletters/322/7293/1019#17446
Golomb BA, Kane T, Dimsdale JE. Severe irritability associated with statin cholesterol lowering. QJM 2004;97:229-35.
Edison RJ, Muenke M. Central nervous system and limb anomalies in case reports of first-trimester statin exposure. N Engl J Med 2004;350:1579-82.
Oliver MF. Doubts about preventing coronary heart disease. Multiple interventions in middle aged men may do more harm than good. British Medical Journal 1992;304:393-394.
Ardiansyah, Ohsaki Y, Shirakawa H, Koseki T, Komai M. Novel effects of a single administration of ferulic acid on the regulation of blood pressure and the hepatic lipid metabolic profile in stroke-prone spontaneously hypertensive rats. J Agric Food Chem. 2008 Apr 23; 56 (8):2825-30.
Englisch W, Beckers C, Unkauf M, Ruepp M, Zinserling V. Efficacy of artichoke dry extract in patientswith hyperlipoproteinemia. Arzneim.-Forsch. Drug Res. 2000; 50: 260-265.
Maron DJ, Lu GP, Cai NS, Wu ZG, Li YH, Chen H, Zhu JQ, Jin XJ, Wouters BC and Zhao J. Cholesterol-lowering effect of a theaflavin-enriched green tea: a randomized controlled trial. 2003. Arch Intern Med; 163(12): 1448-1453.
Urizar NL and Moore DD. Gugulipid: a natural cholesterol lowering agent. 2003. Annu Rev Nutr; 23: 303-313.
Yin J, Xing H and Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008; 57(5): 712-717.
Sinatra, Stephen, MD. Clearing Up the Cholesterol Confusion
http://www.townsendletter.com/June2009/clearingcholesterol0609.htm
Joseph Mecola.The Dangers of Statin Drugs (a 3-part article)
http://www.mercola.com/2004/jul/28/statin_drugs.htm
Sally Fallon and Mary Enig. How Statins Work
http://www.westonaprice.org/moderndiseases/statin.html
The International Network of Cholesterol Skeptics (THINCS) (links to papers)
http://www.thincs.org/
Cholesterol is not the cause of heart disease. Dr. Ron Rosedale.http://www.drrosedale.com/resources/pdf/Cholesterol%20is%20NOT%20the%20cause%20of%20heart%20disease.pdf
Can drinking pomegranate juice help lower my cholesterol?
http://www.mayoclinic.com/health/pomegranate-juice/AN01227
Curcumin's cholesterol-lowering mechanism proposed
http://www.foodnavigator.com/Science-Nutrition/Curcumin-s-cholesterol-lowering-mechanism-proposed
Ape Man Diet Lowers Cholesterol And Inflammation Markerhttp://www.futurepundit.com/archives/001516.html
Treatment of Statin Damage (aside from visiting a malpractice lawyer). http://www.newmediaexplorer.org/chris/2008/04/23/treatment_of_statin_damage.htm
THE IDEAL MULTIPLE
How to Avoid the Hype and Gain Real Benefits
By Zoltan P. Rona, M.D., M.Sc.
It is estimated that close to 70 per cent of all Canadians and Americans take nutritional supplements regularly. In part, this is because of mounting scientific evidence supporting their use, as well as growing concerns about the quality of our food supply. Although much of our food is either genetically engineered, irradiated, chemically sprayed or otherwise adulterated, some health experts continue to hold on to the erroneous belief that diet alone can provide all our essential nutrition. It cannot.
Studies indicate that approximately half of Americans (and most likely Canadians) suffer from marginal nutritional deficiencies. Some reputable scientists estimate that at least 80% of the public is deficient in vitamin D. While it may be theoretically possible to get all of our required nutrients from diet alone, the fact is that most people in North America do not do so. Even if one consumes a carefully created and prepared diet that meets the Recommended Dietary Allowances (RDAs), scientific research now indicates that the “optimal” level of nutrients may be much higher than the currently published RDAs.
What Everyone Needs
Just about everyone needs to take at least a high quality multiple vitamin and mineral supplement as “insurance” against possible deficiencies. Unfortunately, many “natural” food supplements contain an awesome list of synthetic fillers, additives which are detrimental to health. With some exceptions, pure vitamin and mineral chelates cannot be compressed directly into tablet form without the addition of binders, lubricants, diluents, disintegrators and colouring and flavouring agents. Some national brands even contain saturated hydrocarbons such as paraffin or wax, which can be deposited in the plaque of individuals suffering from coronary artery disease. People who use large numbers of vitamin and mineral tablets may actually be contributing to the diseases they are attempting to prevent.
The larger the tablet, the more it requires the use of binders such as hydrogenated oils (e.g., calcium or magnesium stearate). Time-release tablets are perhaps the most worrisome. For example, the release of 1,000 mg of vitamin C over a period of six hours may require the addition of 400 mg of hydrogenated oil to the tablet. Under the microscope, this oil looks almost identical to plastic. If you are a strict vegetarian, beware of gelatin-encapsulated supplements, which are derived from collagenous beef (bovine) or pork (porcine/swine) material.
Most healthy people will have no obvious side effects from ingesting the small amount of toxins in vitamin or mineral tablets. Over 7 per cent of people, however, are sensitive to these chemicals. Allergic reactions can affect any organ system in the body including the brain. This produces symptoms such as fatigue, memory loss, depression, anxiety, hallucinations and insomnia.
When purchasing supplements, watch out for:
•Propylene glycol – an antifreeze used in products such as windshield washer fluid, brake and hydraulic fluid. Documented to cause skin, liver and kidney damage.
•Sodium lauryl sulphate and sodium laureth sulphate – used in shampoos for their detergent and foam-building abilities, but also added to food supplements. Studies show that these additives react with the other ingredients to form cancer-causing nitrates and dioxins.
•Other potentially harmful additives – sodium benzoate, aluminum, BHT, BHA, tartrazine, lactose, peanut oil, hydrogenated cottonseed oil, titanium dioxide, polysorbate 80, microcrystalline cellulose, magnesium stearate, red dye no. 33 and 40, ethyl cellulose, sorbic acid, fractionated coconut oil and cornstarch. The Centrum brand even contains toxic heavy metals such as nickel and aluminum, two minerals that are best avoided.
Purchase supplements in vegetable soft gel capsules, naturally compressed tablets, powders or liquids that contain the fewest possible additives. A good multiple supplement will always tell what’s also not in their product (especially wheat, dairy, yeast, eggs and other common allergens). Always check with the manufacturer and demand full disclosure before purchasing any food supplement.
What About Whole Food Supplements?
The science of nutrition has not yet discovered the complete range of vital nutrients found only in natural foods. Live, whole food concentrates have the unique advantage of supplying the body with enzymes and cancer-preventing phytochemicals like carotenoids, indoles, isothiocyanates, isoflavones and phytosterols. These substances do not exist in any vitamin or mineral supplement. Additionally, whole foods provide vitamins, minerals, amino acids, polypeptide hormone precursors and other nutrients that support the vital life force needed by all cells for optimal health.
Examples of whole food supplements are as follows:
Spirulina
Chlorella
Blue green algae
Other green drinks or green food concentrates like barley green and green kamut
Bee pollen
Whole leaf aloe vera juice
Nutritional yeast
Garlic
Desiccated liver
Wild yam extract
Kelp, dulse and other seaweeds in powder, tablet or capsule form
Various tissue concentrates like pancreatin and raw adrenal glandular concentrate
Wheat germ
Lecithin granules
Isoflavones from soy or kudzu
Milled flaxseed
Whole food concentrates of cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, etc.)
All herbs
Given our present state of knowledge, it’s very good health insurance to have one or more whole food supplements added to a daily multiple vitamin and mineral supplement.
A good multiple vitamin and mineral supplement cannot usually fit into a single tablet or capsule. Your supplement should contain at least the following levels of essential nutrients:
The nutritional needs of men are significantly different from those of women. This is because of hormonal, organ and metabolic differences between the two sexes.
You will notice below that the ideal men’s multi does not contain any iron. This is because, unlike women, men do not lose iron through menses every month. Men rarely, if ever, need iron in supplemental form. In fact, too much iron can be harmful in that accumulation of iron causes free radical oxidizing damage to numerous organs and is a risk factor for heart disease, cancer and diabetes.
Men, especially as they age, often develop enlargement of their prostate gland. Herbs such as saw palmetto can prevent the prostate from enlarging. So, look for some saw palmetto in any ideal multiple for men.
The ingredients of an ideal multi for me are listed below. Look for these ingredients at your local health food store:
Product Name:Ideal Multi Caps for Men
Manufacturer:Purity, Potency and Freshness
Capsules per Serving:3 Veggie Capsules per day
IngredientsLABEL CLAIM (per day)LABEL CLAIM (per cap)
(mg or as noted)
Vitamin A Palmitate2500IU833.3 IU
Beta Carotene 20%3000mcg / 5000IU1666.7 IU
Vitamin D3 (Cholecalciferol), 100,000IU/g10mcg / 400IU133.3 IU
Natural Vitamin E (d-Alpha Tocopherol Acetate), 50%45mg AT / 100IU33.3 IU
Calcium ascorbate, 77% Vitamin C120mg40.0
Thiamin HCl, 78% Vitamin B125mg8.3
Riboflavin, 98% Vitamin B225mg8.3
Niacinamide, 99% Vitamin B325mg8.3
Pyridoxine HCl, 80% Vitamin B625mg8.3
Cyanocobalamin, 1% Vitamin B12100mcg33.3 mcg
Biotin 1%100mcg33.3 mcg
Folic Acid 10%500mcg166.7mcg
D-Calcium Pantothenate, 90% Pantothenic acid25mg8.3
Choline Bitartrate, 97%50mg16.7
Inositol, 98%50mg16.7
Calcium from:120mg40.0
Calcium citrate tetrahydrate, 20.5% Calcium
Calcium carbonate, 40% Calcium
Magnesium from:60mg20.0
Magnesium citrate hydrate, 11.2% Magnesium
Magnesium oxide heavy, 60% Magnesium
Potassium citrate, 38% Potassium15mg5.0
Zinc citrate dihydrate, 31% Zinc10mg3.3
Copper citrate hemitrihydrate, 36% Copper1mg0.33
Manganese Citrate, 28% Manganese2mg0.67
Potassium Iodide, 76% Iodine50mcg16.7 mcg
Chromium HVP Chelate, 10% Chromium200mcg66.7 mcg
Selenium HVP Chelate, 2% Selenium100mcg33.3 mcg
Molybdenum citrate, 1% Molybdenum25mcg8.3 mcg
Silica (silicon dioxide), 46% Silicon5mg1.7
Boron citrate, 5% Boron500mcg166.7 mcg
Vanadium citrate 1% Vanadium50mcg16.7 mcg
Milk Thistle, 80% Silymarin30mg10
Cranberry Concentrate powder10mg3.3
Green Tea Extract, 95% Polyphenols10mg3.3
CoQ1010mg3.3
Grape Seed Extract, 95% Polyphenols20mg6.7
Betaine Hydrochloride12.5mg4.2
PABA12.5mg4.2
Citrus Bioflavonoids, 27% Bioflavonoids30mg10
Quercetin30mg10
Billberry extract, PE 120:110mg3.3
Lycopene extract, 5%250mcg83.3 mcg
Rhodiola rosea PE, 3% Rosavins30mg10
Papain 48,000, 42000IU/mg3.5mg1.17
Lutein 5%250mcg83.3 mcg
Grape skin extract, 20%20mg6.7
Turmeric, 95%30mg10
Ashwagandha extract, PE 30:125mg8.3
Reishi mushroom extract, PE 8:15mg1.67
Shiitake mushroom extract, PE 10:112mg4.0
Stinging Nettle extract, PE 8:150mg16.7
Saw Palmetto extract 45%10mg3.3
Siberian Ginseng extract, PE 12:1200mg66.7
Below is an ideal multi for women. Notice that it contains evening primrose oil, something that supports female hormonal balance. The men’s multi contains saw palmetto, an herb known for its ability to prevent prostate enlargement.
Product Name:Ideal Multi Caps for Women
Manufacturer:Purity, Potency and Freshness
Capsules per Serving:3 Veggie Capsules per day
IngredientsLABEL CLAIM (per day)LABEL CLAIM (per cap)
(mg or as noted)
Vitamin A Palmitate, 250,000IU/g5000IU1666.7 IU
Beta Carotene 20%3000mcg / 5000IU1666.7 IU
Vitamin D3 (Cholecalciferol), 100,000IU/g25mcg / 1000IU333.3 IU
Vitamin E (d-Alpha Tocopherol acetate), 50%45mg AT / 100IU33.3 IU
Calcium ascorbate, 77% Vitamin C120mg40.0
Thiamin HCl, 78% Vitamin B125mg8.3
Riboflavin, 98% Vitamin B225mg8.3
Niacinamide, 99% Vitamin B325mg8.3
Pyridoxine HCl, 80% Vitamin B650mg16.7
Cyanocobalamin, 1% Vitamin B12100mcg33.3 mcg
Biotin 1%150mcg50.0 mcg
Folic Acid 10%1000mcg333.3mcg
D-Calcium Pantothenate, 90% Pantothenic acid50mg16.7
Choline Bitartrate, 97%50mg16.7
Inositol, 98%50mg16.7
Calcium from:150mg50.0
Calcium citrate tetrahydrate, 20.5% Calcium
Calcium carbonate, 40% Calcium
Magnesium from:75mg25.0
Magnesium citrate hydrate, 11.2% Magnesium
Magnesium oxide heavy, 60% Magnesium
Potassium citrate, 38% Potassium15mg5.0
Zinc citrate dihydrate, 31% Zinc10mg3.3
Copper citrate hemitrihydrate, 36% Copper1mg0.33
Manganese Citrate, 28% Manganese2mg0.67
Potassium Iodide, 76% Iodine50mcg16.7 mcg
Chromium HVP Chelate, 10% Chromium200mcg66.7 mcg
Selenium HVP Chelate, 2% Selenium100mcg33.3 mcg
Molybdenum citrate, 1% Molybdenum25mcg8.3 mcg
Silica (silicon dioxide), 46% Silicon5mg1.7
Boron citrate, 5% Boron700mcg233.3 mcg
Vanadium citrate, 1% Vanadium50mcg16.7 mcg
Milk Thistle, 80% Silymarin30mg10
Cranberry Concentrate powder10mg3.3
Green Tea Extract, 95% Polyphenols10mg3.3
CoQ1010mg3.3
Grape Seed Extract, 95% Polyphenols20mg6.7
Betaine Hydrochloride12.5mg4.2
PABA12.5mg4.2
Citrus Bioflavonoids, 27% Bioflavonoids30mg10
Quercetin30mg10
Rutin10mg3.3
Billberry extract, PE 120:110mg3.3
Rhodiola rosea PE, 3% Rosavins30mg10
Papain 48,000, 42000IU/mg3.5mg1.17
Lutein 5%200mcg66.7 mcg
Turmeric, 95%30mg10
Reishi mushroom extract, PE 8:120mg6.67
Shiitake mushroom extract, PE 10:112mg4.0
Maitake mushroom extract10mg3.3
Rosemary leaf extract10mg3.3
Evening Primrose oil powder150mg50.0
Highest Quality Supplements
According to recent reports in the Toronto Star and other lay media, many national brand nutritional supplements and herbal remedies available from health food stores and pharmacies contain little to no active ingredients. The only reliable manufacturing practice to guarantee that what’s on the label is actually in the bottle is called HPLC (high pressure liquid chromatography).
High quality supplement manufacturers use HPLC and keep the chemicals, lactose and other additives out of their products to prevent potential allergic reactions. These hypoallergenic supplements are also better absorbed. This is especially important in people over age 60, when stomach acidity and digestive juices are produced at lower levels.
Finally, a high quality multiple vitamin and mineral supplement should be free of potential toxins such as lead, mercury, cadmium and aluminum. The manufacturer should be able to supply toxicology reports proving the purity of the supplement.
The Pros and Cons of MLM Supplements
Multi-level marketing (MLM) companies sell their products through individual distributors, who either resell at retail prices to the general public or at wholesale prices to their “down line” of distributors, who have “signed up.” The layers of salespeople run from six levels to hundreds deep, depending on the company. Commissions are made from the sales of distributors occupying positions below/under each salesperson. The higher up you are on this money food chain, the greater the financial rewards. While technically, this is not pyramiding sales, it’s close enough to the shady practice to be of some concern.
Studies done on the MLM biz indicate that the lion’s share of the cash filters up to the top 5 per cent of company executives. Over 80 per cent of the signed-up salespeople abandon the company, usually because of lower-than-expected incomes for the amount of time spent working.
On the positive side, MLM companies market some of the highest quality nutritional supplements available. Thousands, if not millions, of testimonials on product quality attest to this, as well as the spectacular growth of the MLM industry in general. Satisfied customers are the rule.
One major problem with MLM company products is the price. As you can imagine, the need to provide sales commissions to multiple levels of salespeople drives up the cost of products. It’s not unusual to see an herbal remedy selling for five times the price of an equivalent product sold at health food stores or over the Internet.
Another disturbing point with some MLM products is their failure to disclose the dosages of various herbs or active ingredients on the label. When questioned as to why any company would not want to say, for example, “saw palmetto - 25 mgs” on its label, the usual response is that the company’s formulas are a “trade secret.” This may be fine for perfumes and cosmetics. However, people interested in health enhancement really do need to know the levels of various ingredients they consume from tablets or capsules. Use MLM products at your own risk.
Hype, Fraud and False Hope Supplements
Critics of nutritional supplements often say, “If it sounds too good to be true, it’s probably not true.” The hype, false hope and outright fraud seen in the supplement industry are something I have had the occasion to study for over 33 years. Here are some key things to watch out for:
Be very careful if you use Chinese herbs, especially those coming in tiny pellets with hokey labels (“Arthritis Pills”) or with vague descriptions of the ingredients and amounts of each herb in the tablet. Many of these products imported from Hong Kong are contaminated with lead, mercury, other toxic heavy metals, steroids and non-steroidal anti-inflammatory drugs. “Natural” is not always necessarily “safe.” As with all chemicals, nutrients and plant extracts taken in high enough doses and for long enough periods can be toxic.
Avoid colloidal minerals. Marketers of colloidal minerals have generated a great deal of hype. They insist their products are the easiest to absorb and that other forms of mineral supplements are just a waste of money. Unfortunately, there is not a shred of evidence to support their claim.
Colloidal minerals sold in liquid form contain between 1,800 and 4,400 ppm of aluminum, a recognized toxic heavy metal. By contrast, food rarely contains even 10 ppm. Whether or not the high aluminum content of colloidal minerals leads to Alzheimer’s disease or other neurological disorders is unknown.
Do not buy any supplement containing “coral” calcium. Studies show that this form of calcium contains lead and other toxic heavy metals.
If you’re deficient in a mineral, your body will absorb a higher level of that mineral from any source including food, colloidal minerals, ionic mineral solutions or amino acid chelated minerals. The best example of this occurs during pregnancy, when just about any source of iron or calcium is absorbed in higher amounts than usual. This is because of normal homeostatic mechanisms in the gastrointestinal tract and elsewhere, which are aimed at maintaining an optimal blood level of the mineral in question.
The human body is capable of extracting minerals from virtually any source. Many studies show that it matters not whether a mineral is “organic,” inorganic, chelated with amino acids, malate, picolinate, fumarate, ascorbate, etc. When consumed as a food or beverage, the absorption rate for minerals is the same given the condition and mineral levels of the individual before consuming that food or beverage.
Colloidal minerals are, at best, a good supplement for some people who have difficulty swallowing pills. Beyond this, there is no proof they offer any advantages over other mineral sources.
My Best Advice on Supplements
In the future, you will no doubt be approached to buy various natural health products to treat an ailment, feel better, look better, boost energy or reverse aging. How can you tell whether or not the product is legitimate? The best way to answer this is to consult a well-researched and documented reference text that contains reliable information and is not obviously attempting to sell you something.
The worst place to look for such information is in a health magazine. Most are designed to sell supplements and will rarely give the reader unbiased information. The following is a list of the best factual references on nutritional and herbal supplements. If you cannot find information on a particular product, consult a naturopath or holistic medical doctor for advice.
Dr. Zoltan P. Rona practices Complementary Medicine in Toronto and is the medical editor of “The Encyclopedia of Natural Healing.” He has also published several Canadian best-selling books, including “Vitamin D, The Sunshine Vitamin.”
References
Alive Research Group; Gursche, Siegfried, Publisher; Rona, Zoltan P., Medical Editor. Encyclopedia of Natural Healing. Vancouver: Alive Books, 1998.
Murray, Michael T. Encyclopedia of Nutritional Supplements. Rocklin, Calif.: Prima Publishing, 1996.
Murray, Michael T. Natural Alternatives to Over-the-Counter and Prescription Drugs. New York: William Morrow and Company, 1994.
Werbach, Melvyn R. Foundations of Nutritional Medicine. Tarzana, Calif.: Third Line Press, 1997.
Werbach, Melvyn R. Nutritional Influences on Illness, Second Edition. Tarzana, Calif.: Third Line Press, 1993.
Werbach, Melvyn R. Nutritional Influences on Mental Illness. Northamptonshire, England: Thorsons, 1991.
Werbach, Melvyn, R. Textbook of Nutritional Medicine. Tarzana, Calif.: Third Line Press, 1999.
N.B. All of Dr. Werbach’s books are available from Third Line Press, 4751 Viviana Dr., Suite 102, Tarzana, California 91356, USA. Phone: 800-916-0076; fax: 818-774-1575.
KIDNEY STONE PREVENTION & TREATMENT
The incidence of kidney stones is steadily increasing. In fact, it is 10 times more common now than at the turn of the century. It parallels the dramatic increase in the consumption of animal proteins. It also parallels the rise in other diseases (heart disease, gallstones, high blood pressure and diabetes) associated with the standard North American diet. Over 10% of all males and 5% of all females experience a kidney stone during their lifetime. Most victims are over 30 years of age.
Kidney stones are usually composed of calcium and oxalic acid. Less commonly, stones are made of uric acid (in people suffering from gout) and other mixed minerals and amino acids (especially cystine). It is important to determine the type of stone and its cause because this leads to a better designed prevention program. If a stone is passed and caught in the urine with the help of a stainer an analysis can be done by a lab to measure its mineral content. If this has not or cannot be done the alternative is to evaluate a number of criteria. These include diet, any underlying metabolic problems or diseases, blood and urine tests for calcium, uric acid, creatinine, electrolyte levels, 24 hour urinalysis for minerals, urine culture and hair mineral analysis. A combination of these things will usually determine the composition of the stone. Any physician can help you in this respect.
The majority of kidney stones are completely preventable. Once you have a stone, no diet or supplement can reverse the problem. You need medical attention but you can certainly do a lot to prevent the problem from getting worse. Studies indicate that acute attacks of kidney stone pain that lead to hospital admission can be significantly reduced or eliminated by diet and nutritional supplement therapy alone. Occasionally, kidney stones may be the result of metabolic diseases such as hyperparathyroidism, hyperthyroidism, cystinuria, vitamin D excess (caused by over-supplementation), the milk-alkali syndrome (caused by excessive use of dairy products or antacids), destructive bone diseases, primary oxaluria, Cushing’s Syndrome and sarcoidosis.
All stone formers should drink enough water to produce 2-3 quarts of urine daily. A recent study published in the British Journal of Urology found that about 19% of those diagnosed with kidney stones were suffering from chronic dehydration. A study done on tap water in 1989 concluded that the higher the magnesium to calcium ratio in the water, the lower the incidence of kidney stones. Get an analysis done on the water you use for daily drinking. One laboratory that can do this for you is Anamol Laboratories (83 Citation Dr., Unit #9, Concord, Ont. L4K 2S4; phone:416-660-1225). It just so happens that most patients suffering from kidney stones benefit from magnesium citrate supplementation (300-400 mgs. daily). Magnesium increases the solubility of calcium oxalate and prevents precipitation in the urine. A large number of studies support its routine use as a stone preventive supplement.Irrespective of the type of stone you have, avoid sugar and refined carbohydrates. This is because sugar, including the lactose found in milk, stimulates the release of insulin which, in turn, causes a higher calcium excretion by the kidney. Sugar increases the absorption of calcium from the intestines. Most kidney stone formers benefit from a high fiber, vegetarian (vegan) diet. This is because the metabolic breakdown products of animal proteins are uric acid and oxalic acid, both of which are involved in kidney stone formation. Red meat, in particular, is very high in phosphorus which causes the body to excrete more calcium into the urine. It is therefore not surprising that vegans have a 40-60% less chance of forming kidney stones than the average population.
Contrary to popular belief, high calcium intakes do not cause kidney stones but actually prevent them. If calcium absorption from the diet is adequate, the body has no need to dissolve the calcium in bone, raise the blood levels of calcium thence depositing this calcium into the kidneys. But, what about milk and dairy products? Aren’t they high in calcium and, if so, why are they associated with a higher kidney stone formation rate? The answer is that, although large amounts of calcium are indeed found in dairy products, absorption is often poor because of allergy, lactose intolerance, the high phosphorus content or the high fat content of dairy products. All this is evidenced by the fact that virtually all bone diseases, especially osteoporosis and kidney stones are worsened by high dairy product intakes. The calcium from greens, beans and other plant sources is far better absorbed and utilized in the body than it is from dairy products. Cultures from around the world who avoid dairy products have significantly lower or non-existent incidences of kidney stones, osteoporosis and arthritis.
Kidney stone victims that have a high calcium excretion in the urine should limit their intake of high animal protein foods, sodium, vitamin D and caffeine. A high intake of milk, cheese, and antacids for the treatment of peptic ulcers may all increase the predisposition to stones. Urologists have often joked that if every adult suddenly decided to quit dairy products the resulting decrease in the number of surgical procedures would quickly put them out of the kidney stone business.
In some individuals, a high salt intake from the diet results in increased losses of calcium from the urine leading to stone formation. Vitamin D increases calcium absorption from the gastrointestinal tract and releases calcium from bone leading to stone formation in susceptible individuals. Since milk is fortified with vitamin D, this becomes another potential reason for the high association between dairy product consumption and kidney stone incidence. Caffeine may also increase urinary calcium.
Oxalate stone formers should limit their intake of high oxalate foods but only if they are also consumers of animal proteins. High oxalate foods include beans, cocoa, coffee, parsley, rhubarb, spinach, tea, beet tops, carrots, celery, chocolate, grapefruit, kale, peanut, pepper and sweet potato. Oxalate stone formers should take a supplement of pyridoxine (vitamin B6) of not less than 150 mgs. daily. Deficiency of vitamin B6 is more common than we may think. B6 deficiency prevents oxalic acid from being degraded in the body. Dietary avoidance of high oxalate foods will make only a slight difference with respect to urinary oxalate excretion. Vitamin B6 supplementation, however, may be far more crucial in the overall prevention of oxalate stones.
Vitamin A and K deficiency may help promote the formation of kidney stones. This is because both vitamins are required by the body to make a common protein found in urine which inhibits calcium oxalate crystalline growth. Low levels of glutamic acid also increase calcium oxalate precipitation. Supplementation of of glutamic acid (300 mgs. daily) may be important as a preventive in some cases.
Uric acid stone formers are helped by a vegetarian diet and supplementation with folic acid (25-50 mgs. daily) and potassium citrate (60 milliequivalents. daily). Citrate is an inhibitor of stone formation and is usually recommended as a supplement by most kidney specialists treating stones. Low levels of citrate are found in 20-60% of all patients with kidney stones. Avoidance of alcohol is important because it increases the excretion of uric acid, calcium and phosphate. Alcohol also has adverse effects on vitamin B6 and magnesium, both of which help in stone prevention.
Megadoses of vitamin C (more than 6000 mgs. daily) increase urinary oxalate excretion and may be a factor precipitating stones in a minority of cases. There is no study, however, that proves that megadoses of vitamin C leads to a greater incidence of kidney stones. In nearly 20 years of practice, I have never been able to document a single case of kidney stones stemming from vitamin C supplementation. Neither has anyone else. The conventional medical profession, nevertheless continues to spread the false information that vitamin C and calcium causes kidney stones. Several published studies claim that the opposite is true - that vitamin C and calcium supplementation prevents kidney stones. If vitamin C intake is combined with supplementation with calcium and magnesium citrate and vitamin B6 one can be even more confident about prevention.
High body burdens of cadmium have also been associated with an increased incidence of kidney stones. Cadmium excess can be reliably determined by hair mineral analysis. Excesses can be removed from the body by supplementation with zinc, vitamin B6, magnesium and vitamin C. Intravenous chelation therapy with EDTA can also be done in severe cases. Finally, if you have a history of kidney stones, avoid supplementation with the amino acid L-cystine, a build-up of which can lead to stone formation in genetically susceptible individuals. A prevention program against kidney stones must be individualized as much as possible and followed for life. Work with your natural health care practitioner in determining what works best in your particular case.
REFERENCES
Bateson-Koch, Carolee. Allergies, Disease in Disguise. Vancouver: Alive Books. 1994. Baroody, Dr. Theodore A. Jr. Alkalinize or Die. California:Portal Books, 1995.
Bland, Jeffrey. The 20-Day Rejuvenation Diet Program. New Canaan, Connecticut: Keats Publishing, 1997.
Embon, O.M. et al. Chronic dehydration stone disease. British Journal of Urology. 1990;66:357-362.
Fromberg, M. Diet and calcium stones. Canadian Medical Association Journal,1992;146(11):1894.
Gaby, Alan. Preventing and Reversing Osteoporosis. Rocklin, CA:Prima Publishing, 1994. Hughes, J. and Norman, R. Diet and calcium stones. Canadian Medical Association Journal,
1992;146(2):137-143.
Kohri, K. et al. Magnesium-to-calcium ratio in tap water and its relationship to geological features and the incidence of calcium-containing urinary stones. Journal of Urology, Nov. 1989;142:1272-1275.
Kok, D.J. et al. The effects of dietary excesses in animal protein and in sodium on the composition and the crystallization of kinetics of calcium oxalate monohydrate in the urines of healthy men. Journal of Clinical Endocrinology and Metabolism. 1990;71(4):861-867.
Norman, R.W. and Manette, W.A. Dietary restriction of sodium as a means of reducing dietary cystine. Journal of Urology, June 1990;143:1193-1194.
Robbins, John. Diet for a New America, Walpole, New Hampshire:Stillpoint, 1987. Robbins, John. May All Be Fed, Diet for a New World, New York: William Morrow and
Company, Inc., 1992.
Rona, Zoltan P. and Martin, Jeanne Marie. Return to the Joy of Health, Vancouver: Alive Books, 1995.
Smith, L.H. Diet and hyperoxaluria and the syndrome of idiopathic calcium oxalate urolithiasis. American Journal of Kidney Diseases, April 1991;17(4):370-375.
