family of four pushing their bikes outside in a forest area

The Role Of Adaptogens In Stress And Fatigue

The Role Of Adaptogens In Stress And Fatigue


We have all undoubtedly experienced some sort of stress in our lives. Short-term, acute stress is not only normal but essential to survival. Whether physical, such as illness or injury, or emotional, our bodies have mechanisms in place to help us deal with both internal and external stressors. These mechanisms, controlled by the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, are known collectively as the stress response and work to maintain homeostasis in the body. Homeostasis refers to the body’s ability to respond to stimuli and maintain a state of balance in the body that is necessary for proper functioning and survival. (6)(22)

While these mechanisms exist to deal with acute stress, applying these mechanisms to cope with long-term “chronic” stress may be detrimental. Unaddressed chronic stress can contribute to a number of stress-related health conditions, such as anxiety, depression, hypertension, heart disease, memory impairment, and chronic fatigue syndrome. (18) Furthermore, chronic stress has been linked with impaired adrenal function, HPA axis dysfunction, and metabolic syndrome. (13) When you are exposed to excess stress, adaptogens may be able to help improve your resistance to stress and normalize body functions.

What are adaptogens?

Commonly used in ayurvedic and Unani traditional medicine for their rejuvenating properties, adaptogens have been around for thousands of years dating back to ancient Indian and Chinese civilizations. The modern concept of adaptogens was established in 1947 by Russian scientist Dr. Nikolai Lazarev, who studied adaptogens while searching for substances that could help soldiers improve general resistance to stressors and performance in battle. (19)

The word “adaptogen” is derived from the Greek word “adapto”, meaning “to adjust”. (19) Adaptogens include several plants or herbs and are defined as biologically active, medicinal plant substances that help your body adapt or adjust to stress. (24)

Adaptogens have the ability to improve the body’s nonspecific resistance to internal and external stressors, normalizing body functions, and maintaining homeostasis. (17)(19)(24) Nontoxic in standard doses, adaptogens may reduce both the severity and negative effects of stress from any source, such as emotional stress, physical trauma or injury, fatigue, poor lifestyle choices, illness, and pollution. (19) Adaptogens may, therefore, reduce the risk of stress-related health conditions. (16)

In addition, certain adaptogens have been shown to improve mental performance, (19) as well as physical performance, endurance, and concentration while fatigued. (16)(17)(24) While most are well-known for their stress-protective properties, adaptogens have also recently been researched for their anti-cancer, hepatoprotective, and immunomodulatory properties. (19)

How do adaptogens work?

We’ve established that adaptogens possess stress-protective properties. (18)(19) However, it’s also important to discuss how they work.

family of four pushing their bikes outside in a forest area

Did you know adaptogens can help improve your resistance to stress and fatigue?

The primary effects of adaptogens include:

  • Increased energy circulation
  • Decreased perceived stress
  • Increased resistance to stress
  • Improved mental performance
  • Improved sleep

Each of these effects is observed with adjustment of the HPA axis, indicating that the mechanism of action of adaptogens involves the regulation of this pathway. (13) It has been shown that adaptogens help the body maintain homeostasis by affecting the central nervous system (CNS) and regulating several mechanisms involved in HPA axis activity. Adaptogens affect both biochemical markers of stress and metabolic regulators, including the hormones that regulate HPA axis activity. Examples of these markers and regulators include nitric oxide, cortisol, corticosterone, glucose, cytokines, biogenic amines, and neuropeptides. (18)(19) Adaptogens also display moderate effects on the biosynthesis of eicosanoids, such as prostaglandins, leukotrienes, and arachidonic acids, which play a role in the inflammatory response. (19)

While various adaptogens exhibit similar characteristics, their properties may be specifically attributed to the chemical compounds they possess. (16)(24) These compounds can be divided into three groups: phenolic compounds, tetracyclic triterpenes, and oxylipins.

Phenolic compounds, found in the roots and rhizomes of certain adaptogenic herbs, such as E. senticosus, R. rosea, and S. chinensis, structurally resemble catecholamines. (19) Catecholamines, including epinephrine, norepinephrine, and dopamine, are hormones produced by the adrenal glands that function as neurotransmitters. (10)

Tetracyclic triterpenes resemble the structure of corticosteroids and are found in B. alba and W. somnifera extract. (19) Corticosteroids, including glucocorticoids and mineralocorticoids, are also produced in the adrenal glands and play a significant role in the regulation of stress via the HPA axis. (2)

Oxylipins, found in B. alba and G. glabra, resemble leukotrienes and lipoxins, (19) which play important roles in inflammation and immunity. (20)

5 adaptogenic herbs to target stress and fatigue

Research has demonstrated the beneficial effects of the following adaptogens on stress and fatigue.

Ashwagandha in plant and powder form

Ashwagandha is a popular herb in Ayurveda, the traditional system of medicine in India.

Withania somnifera (Ashwagandha)

Commonly known as “Indian Winter cherry” or “Indian Ginseng”, ashwagandha remains a popular herb in Ayurveda, the traditional system of medicine in India. Ashwagandha is known for its adaptogenic, antioxidant and immune-supportive properties. (21) A double-blind, placebo-controlled study with 64 adult subjects examined the effects of ashwagandha on stress, anxiety, and general well-being. Test subjects were given 300 mg twice daily of high-concentration, full-spectrum extract from the root of the ashwagandha plant over a period of 60 days. Compared to the placebo group, subjects taking ashwagandha had significantly lower serum cortisol levels. Adverse effects were mild and similar in both groups, indicating that ashwagandha may be a safe and effective way to improve an individual’s response to stress. (4) Another double-blind, randomized, placebo-controlled trial found that 300 mg of standardized ashwagandha root extract administered twice daily over eight weeks improved perceived stress and happiness, food cravings, serum cortisol, body weight, and body mass index compared to a control group. These results indicate that ashwagandha is an effective tool to address stress, as well as weight management in adults experiencing chronic stress. (5)

Rhodiola in plant and oil form in an essentials oil glass bottle

Rhodiola, originally used in traditional Chinese medicine, can help reduce stress and improve physical performance.

Rhodiola rosea (Rhodiola)

Like many adaptogens, Rhodiola was historically used in traditional Chinese medicine. It is known for its ability to reduce stress and improve physical endurance. (14) Several studies have demonstrated that Rhodiola may be effective in addressing fatigue. A double-blind cross-over study examined the effects of Rhodiola rosea L. standardized extract (RRE) on fatigue in 56 healthy physicians working overnight. The test group showed significant improvements in mental fatigue. (7) Another study found that RRE was effective in the treatment of stress-related fatigue in burnout patients. RRE improved fatigue, mental performance, and concentration, while it decreased the cortisol response to stress. (15)

Panax ginseng in plant form, full and cut into pieces

Ginseng may well be one of the most widely used to improve energy and general health.

Panax ginseng (Asian ginseng, Chinese ginseng, Korean ginseng)

Traditionally used in Korean and Chinese medicines, Panax ginseng, has demonstrated numerous therapeutic properties. These properties have been attributed to ginsenosides, P. ginseng’s primary active constituent. (12) Among the adaptogenic herbs, ginseng may well be one of the most widely used to improve energy and general health. Numerous studies have shown that P. ginseng has demonstrated anti-fatigue properties. A systematic review examining the effectiveness of ginseng as a treatment for fatigue found both American and Asian ginseng to be effective in treating fatigue in individuals suffering from chronic illness. (1) Further, a randomized, double-blind, placebo-controlled trial with 90 subjects found that P. ginseng extract administered over four weeks induced anti-fatigue effects in individuals with idiopathic chronic fatigue (ICF). The study attributed these effects in part to the antioxidant properties of P. ginseng. (11)

Siberian ginseng in dried plant form in wooden spoon and bowl

Siberian ginseng is a wild shrub of the Araliaceae family that grows extensively in several parts of Asia and Russia.

Eleutherococcus senticosus (Siberian ginseng)

Not to be confused with Panax ginseng, Siberian ginseng is a wild shrub of the Araliaceae family that grows extensively in several parts of Asia and Russia. (3) It is known primarily for its adaptogenic effect and studies on the use of Siberian ginseng for fatigue have shown promise. A randomized controlled trial examined the effects of Siberian ginseng for chronic fatigue in 96 subjects compared to a placebo. While reduction of fatigue was similar in both groups, fatigue severity and duration showed statistically significant improvements following 2-month treatment of Siberian ginseng. (9) Furthermore, Siberian ginseng may also be effective in addressing stress. In a double-blind trial, individuals received either Eleutherococcus senticosus or a placebo for 30 days and were then given a stressful cognitive task. Both men and women in the treatment group exhibited a reduced heart rate. In addition, systolic blood pressure was also reduced in female subjects, while no change was observed in the placebo group. (8)

Schisandra in plant form - berries in black bowl

Schisandra, the fruit of the Chinese magnolia vine, was first used in traditional Russian and Chinese medicines.

Schisandra chinensis (Schisandra)

Schisandra, the fruit of the Chinese magnolia vine, was first used in traditional Russian and Chinese medicines. It was believed to help with several health conditions including body fatigue and weakness, insomnia, mental health and vitality, and diseases of the digestive, respiratory, and cardiovascular systems. (23) Today, Schisandra is known to have adaptogenic effects. A recent review of the effects of adaptogens on stress and the CNS identified S. chinensis extract as an effective treatment for astheno-depressive states. Schisandra has also been shown to improve fatigue, mood, and appetite. (16)

Final thoughts

While adaptogens may help your body adapt to stress and fatigue, it is essential to address the cause of your stress and reduce your overall exposure. Eating a healthy, balanced diet, engaging in regular exercise, and utilizing relaxation techniques, such as meditation, can help you manage your stress levels and keep you feeling your best.

Also, since adaptogens can have varying effects on the body, it’s always best to consult with your integrative healthcare provider regarding the best adaptogen(s) for your specific needs.

 

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript!

  1. Arring, N. M., Millstine, D., Marks, L. A., & Nail, L. M. (2018). Ginseng as a Treatment for Fatigue: A Systematic Review. The Journal of Alternative and Complementary Medicine, 24(7), 624-633.
  2. Becker, D. E. (2013). Basic and Clinical Pharmacology of Glucocorticosteroids. Anesthesia Progress, 60(1), 25-32.
  3. Bone, K., & Mills, S. (Eds.). (2013). Principles and practice of phytotherapy: Modern herbal medicine. London, UK: Churchill Livingstone Elsevier.
  4. Chandrasekhar, K., Kapoor, J., & Anishetty, S. (2012). A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of Ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine, 34(3), 255.
  5. Choudhary, D., Bhattacharyya, S., & Joshi, K. (2016). Body weight management in adults under chronic stress through treatment with ashwagandha root extract. Journal of Evidence-Based Complementary & Alternative Medicine, 22(1), 96-106.
  6. Damasio, A. R., & Damasio, H. (2015). Exploring the concept of homeostasis and considering its implications for economics. SSRN Electronic Journal, 126, 125-129.
  7. Darbinyan, V., Kteyan, A., Panossian, A., Gabrielian, E., Wikman, G., & Wagner, H. (2000). Rhodiola rosea in stress induced fatigue — A double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine, 7(5), 365-371.
  8. Facchinetti, F., Neri, I., & Tarabusi, M. (2002). Eleutherococcus senticosus reduces cardiovascular stress response in healthy subjects: A randomized, placebo-controlled trial. Stress and Health, 18(1), 11-17.
  9. Hartz, A. J., Bentler, S., Noyes, R., Hoehns, J., Logemann, C., Sinift, S., . . . Kautzman, H. (2004). Randomized controlled trial of Siberian ginseng for chronic fatigue. Psychological Medicine, 34(1), 51-61.
  10. Hinson, J., Raven, P., & Chew, S. (2010). The endocrine system. London, UK: Churchill Livingstone Elsevier.
  11. Kim, H., Cho, J., Yoo, S., Lee, J., Han, J., Lee, N., . . . Son, C. (2013). Antifatigue effects of Panax ginseng C.A. Meyer: A randomised, double-blind, placebo-controlled trial. PLoS ONE, 8(4).
  12. Kim, J. (2018). Pharmacological and medical applications of Panax ginseng and ginsenosides: A review for use in cardiovascular diseases. Journal of Ginseng Research, 42(3), 264-269.
  13. Liao, L., He, Y., Li, L., Meng, H., Dong, Y., Yi, F., & Xiao, P. (2018). A preliminary review of studies on adaptogens: Comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chinese Medicine, 13(1).
  14. Mao, J. J., Li, Q.S., Soeller, I., Xie, S.X., & Amsterdam, J. D. (2014). Rhodiola rosea therapy for major depressive disorder: A study protocol for a randomized, double-blind, placebo-controlled trial. Journal of Clinical Trials, 4(170).
  15. Olsson, E., Schéele, B. V., & Panossian, A. (2009). A randomised, double-blind, placebo controlled, parallel group study of the standardised extract SHR-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Medica, 75(09).
  16. Panossian, A., & Wikman, G. (2010). Effects of adaptogens on the central nervous system and the molecular mechanisms associated with their stress-protective activity. Pharmaceuticals, 3(1), 188-224.
  17. Panossian, A., Wikman, G., Kaur, P., & Asea, A. (2009). Adaptogens exert a stress-protective effect by modulation of expression of molecular chaperones. Phytomedicine, 16(6-7), 617-622.
  18. Pawar, V. S., & Shivakumar, H. (2012). A current status of adaptogens: Natural remedy to stress. Asian Pacific Journal of Tropical Disease, 2(1), S480-S490.
  19. Ray, A, Gulati, K., & Anand, R. (2016). Stress, adaptogens and their evaluation: An overview. Journal of Pharmacological Reports, 1(2).
  20. Samuelsson, B., Dahlen, S., Lindgren, J., Rouzer, C., & Serhan, C. (1987). Leukotrienes and lipoxins: Structures, biosynthesis, and biological effects. Science, 237(4819), 1171-1176.
  21. Singh, N., Bhalla, M., Jager, P. D., & Gilca, M. (2011). An overview on ashwagandha: A rasayana (rejuvenator) of Ayurveda. African Journal of Traditional, Complementary and Alternative Medicines, 8(5S).
  22. Stephens, M. A. (2012). Stress and the HPA axis: Role of glucocorticoids in alcohol dependence. Alcohol Research Current Reviews, 34(4), 468–483.
  23. Szopa, A., Ekiert, R., & Ekiert, H. (2016). Current knowledge of Schisandra chinensis (Turcz.) Baill. (Chinese magnolia vine) as a medicinal plant species: A review on the bioactive components, pharmacological properties, analytical and biotechnological studies. Phytochemistry Reviews, 16(2), 195-218.
  24. Wal, P., & Wal, A. (2013). An overview of adaptogens with a special emphasis on withania and rhodiola. Nutrition and Enhanced Sports Performance, 343-350.


Ashwagandha herb in powder and solid plant form

5 Key Strategies and Best Natural Supplements For Adrenal Support

5 Key Strategies and Best Natural Supplements For Adrenal Support


Feeling constantly drained and wondering if you may be suffering from adrenal fatigue? It’s one thing to be tired after a long day, but if you are experiencing chronic fatigue and stress, there may be something off with your adrenal glands and hormone production. Find out what exactly adrenal fatigue is, and learn what specific natural supplements integrative medical experts recommend for improving adrenal gland function and overall energy levels. Chronic fatigue is a crippling disorder characterized by persistent exhaustion despite getting rest.

Though scientists haven’t figured out what exactly causes chronic fatigue, recent research has shown adrenal function seems to play an important role. (1) Data analyzed from over 50 studies on chronic fatigue and adrenal function found that the majority of chronic fatigue patients also have an abnormal adrenal function.

What are adrenal glands?

The adrenal glands, which are tiny, crescent-shaped organs seated on top of your kidneys, are in charge of releasing several important hormones. Cortisol, aldosterone, DHEA, androgenic steroids, norepinephrine, and epinephrine all come from your adrenal glands. These hormones help regulate (2) your immune system, metabolism, blood pressure, response to stress and other essential functions.

For example, cortisol is one of your primary stress hormones and helps regulate your energy levels. The two most common ways these nickel-sized organs can cause health issues are by producing too little or too much of certain hormones. If you often wake up tired in the mornings and still feel like you need a nap in the afternoon and can’t sleep at night, you may be suffering from what many integrative experts now refer to as adrenal fatigue.

man yawing at his desk

Feeling constantly tired is just one symptom of adrenal fatigue.

What is adrenal fatigue and how can you recognize it?

The term “adrenal fatigue” (AF) is used by holistic healthcare providers and functional doctors to describe a collection of nonspecific symptoms often induced by chronic stress. Even though adrenal fatigue is yet to be recognized by any American Board of Medical Specialties, there is a widely used clinical perspective (3) by holistic healers written by James L. Wilson, DC, ND, Ph.D. offering a protocol for diagnosing and successfully treating AF. (4)

Get the facts about adrenal support and adrenal fatigue!

According to Dr. Wilson, when someone suffers from adrenal fatigue, their overworked adrenal glands are unable to keep up with the fast-paced style of the multitasking 21st century. Chronically overworked stress hormones are believed to be the main cause behind adrenal fatigue. Feeling constantly tired is just one symptom of adrenal fatigue.

Other common signs of adrenal fatigue include (5):

  • A weakened immune system
  • Inability to handle stress or to focus
  • Frequent urination
  • Upset stomach
  • Loss of body hair
  • Dizziness when standing up
  • Joint aches and pains
  • Food cravings for salty foods
  • Low blood pressure
  • Decreased libido
  • Skin hyperpigmentation (discoloration)
  • Difficulty getting up in the morning
  • Mild depression
  • Overuse of stimulants (ex: caffeine or energy drinks)

Adrenal fatigue vs. adrenal insufficiency disorder

Adrenal insufficiency is a recognized disorder (6) that occurs when adrenal glands don’t make enough of certain hormones. Many natural medicine professionals accept adrenal fatigue as a definition of a mild form of adrenal insufficiency, though adrenal fatigue symptoms are more nonspecific and do not match up.

Adrenal insufficiency symptoms:

  • Extreme fatigue
  • Weight loss and decreased appetite
  • Darkening of your skin (hyperpigmentation)
  • Low blood pressure (fainting)
  • Salt craving
  • Low blood sugar (hypoglycemia)
  • Nausea, diarrhea, or vomiting
  • Abdominal pain
  • Muscle or joint pains
  • Irritability
  • Depression
  • Body hair loss or sexual dysfunction in women

Doctors are able to diagnose (7) adrenal insufficiency with regular laboratory blood tests and patients are treated with medications that replace the hormones (8) adrenals would normally make, such as DHEA. (9)

5 key strategies to combating adrenal fatigue:

  • Get serious about good nutrition
  • Watch your caffeine intake
  • Aim for daily exercise and moderate physical activity
  • Improve your sleep habits
  • Get comfortable with guided meditation
  • Take adrenal support supplements

Dr. Holly Lucille ND, RN, discusses the ins and outs of Adrenal Fatigue and HPA Axis Dysfunction.

The 10 best supplements for adrenal fatigue treatment

Research has shown that stress management is key (10) to reversing damage caused by abnormal hormone production from the adrenal glands. Vitamin and mineral supplements have been shown (11) to help ease mental stress and support healthy adrenal gland function.

Here is a roundup of the adrenal support supplements most often recommended by Fullscript practitioners.

licorice root in different forms on 4 ceramic white spoons

Licorice root can help those who experience cortisol, a steroid hormone, deficiency.

Licorice root

For people who do not produce enough cortisol, licorice root can help. Licorice root has been found to:

  • Work with cortisol to improve energy levels. (12)
  • Regulate cortisol. A study conducted at the Queen Margaret University Edinburg found licorice root aids the body in regulating cortisol. (13)

Curcumin

Curcumin is a compound found in turmeric with antioxidant properties. Curcumin has been shown to:

  • Enhance your mood. In one randomized controlled trial (14), curcumin was found to be an effective option for treating depression.
  • Exhibit neuroprotective qualities. A systematic literature review on curcumin concluded (15) that the compound is a good candidate as a neuroprotective drug for human Parkinson’s disease patients.

Many randomized controlled trials have been done on turmeric and curcumin, considered the gold standard of research.

Curcumin supplements: Extracts are the most potent form of turmeric supplements that will give you the most curcumin compound. Concentrated extracts pack up to 95% curcumin, whereas turmeric in powder form usually contains (16) around 3% curcuminoids.

Vitamin D

Vitamin D has many important functions in the body, but recently researchers have become interested in how vitamin D intake affects hormone production. Vitamin D has the following benefits:

  • Low levels of vitamin D have been linked (17) to cortisol and aldosterone overproduction.
  • Vitamin D deficiency was shown to exacerbate the effect of adrenal insufficiency on heart stability in critically ill children. (18)

Vitamin D supplements: Pinpointing an individualized and healthy vitamin D level can be complicated. It may be worth talking to your primary care practitioner about testing, if appropriate. Remember to take it vitamin D with a meal or on a full stomach to help with absorption.

Phosphatidylserine (PS)

Phosphatidylserine is a phospholipid found in cells that influence immune function and muscle metabolism. It has been shown to:

  • Balance-out cortisol overproduction. Several studies have shown that PS is especially good at regulating and balancing out cortisol levels following exercise. (19)

Phosphatidylserine Supplements: When choosing an adrenal support supplement, remember to look out for Phosphatidylserine specifically; do not get a supplement labeled “phosphorylated serine.”

Rhodiola rosea herbs surrounding a tea form with Rhodiola rosea extract

The herb Rhodiola rosea can be supplemented through tea form.

Rhodiola rosea

Rhodiola Rosea is an adaptogenic herb known for its capacity to alter hormones and has been found to:

  • Improve mental performance and energy levels. A 2000 study showed that Rhodiola improves mental performance and fatigue levels of students around exam periods. (20)
  • Decrease cortisol levels. In one double-blind, randomized controlled trial, subjects with stress-related fatigue were given two daily doses for 28 days of Rhodiola Rosea. (21)

Rhodiola Supplements: When taking Rhodiola supplements, be wary of supplements with spp, as this doesn’t tell you the type of Rhodiola you are getting.

Ashwagandha herb in powder and solid plant form

The herb ashwagandha has a correlation to stress management.

Ashwagandha (Withania Somnifera)

Ashwagandha is an adaptogenic herb that has been scientifically found to:

  • Improve the quality of life. Studies suggest that a high-concentration and full-spectrum ashwagandha root extract can be taken safely and effectively improves an individual’s resistance towards stress. (22)
  • Counteract symptoms of stress. (23)
  • Decrease symptoms of depression and anxiety. (24)

Ashwagandha supplements: It is recommended that ashwagandha supplements be taken before bedtime since the adaptogenic herb has also been linked (25) to calming effects. Large-scale clinical studies are still needed to prove the clinical efficacy of the herb being used for stress reduction.

Tyrosine

Tyrosine is an amino acid that functions (26) as a precursor to neurotransmitters such as dopamine. Tyrosine has been found to:

  • Aid neurotransmitters. Tyrosine has been shown (27) to help neurotransmitters keep up production of dopamine and norepinephrine and support the body’s response to stress.
  • Improve performance in stressful situations, such as military operations. (28)

Tyrosine Supplements: Tyrosine is most effective (29) when taken between meals and right before a stressful event along with an easily digested carbohydrate.

Magnesium

Magnesium deficiency is very common in the US, and symptoms include fatigue and depression. Magnesium deficiency plays a role (30) in adrenal insufficiency and has been shown to:

  • Induce anxiety and HPA axis dysregulation. Preclinical and some clinical studies suggest a link (31) between magnesium levels and pathological anxiety.

Magnesium Supplements: Adequate amounts of magnesium in the body has been shown to promote relaxation, improved and less restless (32) sleep.

Holy basil leaves in plant form on table

You can find holy basil leaf by also searching for Ocimum sanctum L. and tulsi when looking at ingredients.

Holy basil leaf

Holy basil leaf is not your typical basil plant. Native to Southeast Asia, holy basil leaf, also known as Ocimum sanctum L. and tulsi (in tea form), acts as an adaptogen. It has been found to:

  • Improve cognitive function and salivary cortisol levels. In one 2015 study (33) where participants were given 300 milligrams of Tulsi for thirty consecutive days, researchers concluded holy basil leaf has cognition-enhancing properties in humans.

Holy basil leaf supplements: Holy basil is most effective as a supplement when taken in tincture or pill form.

Vitamin C

The adrenal glands contain one of the highest concentrations of vitamin C in the body (34) and research has shown that these glands secrete vitamin C as a response to stress (35).

  • In a randomized, placebo-controlled trial (36), 120 participants were given a high-dose of sustained-release ascorbic acid or a placebo. Individuals receiving ascorbic acid supplementation demonstrated lower blood pressure, faster salivary cortisol recovery, and better subjective stress responses compared to the control group.

Vitamin C supplements: Vitamin C supplementation may help mitigate the stress response, as well as prevent depletion of vitamin C.

What about adrenal extracts made from bovine adrenal glands?

Adrenal extract, also known as adrenal complex — adrenal cortex when you come across it on supplement labels — and its main active ingredient is hydrocortisone. It is an extract made from the actual adrenal glands of cows, pigs, or sheep after they are slaughtered.

Some experts believe adrenal extract or adrenal cortex works well for people with low cortisol levels, but due to lack of scientific evidence, we recommend you talk to your doctor about adrenal extracts before taking any. The adrenal extract has been shown to:

  • Improve health for Addison’s Disease sufferers. A study found (37) that the removal of a whole adrenal gland from an animal and consuming it daily in small amounts can be effective at restoring a large measure of health to sufferers with Addison’s Disease.
  • Adrenal extract is believed to boost energy and memory, but more studies need to be conducted for it to be scientifically proven. Some medical experts believe the extract functions like the body’s adrenal gland.

Adrenal extract supplements: Do not take adrenal extract in injectable form, as it has been found to lead to serious infections. (38) You should also avoid adrenal extracts if you have a compromised immune system.
Ask your doctor about adaptogenic herb blends and other natural adrenal support supplements you can try that they recommend.

Takeaways

  • Your adrenal glands are two triangle-shaped, nickel-sized glands just above the kidneys. Adrenal glands produce and control cortisol, our stress hormone.
  • Adrenal fatigue is believed to be caused by chronic stress. When you are constantly stressed out, your adrenals stop producing cortisol the way they should
  • Signs of adrenal fatigue include low energy, trouble sleeping, frequent urination, weight gain, mood swings, depression, anxiety, brain fog, and autoimmune issues.
  • Stress management is the best adrenal fatigue treatment

woman and doctor chatting in the doctor's office

Chatting with your healthcare practitioner about adrenal health may help your lifestyle improve!

Talk to your doctor about adrenal fatigue and adrenal support supplements

If you feel constantly exhausted and want to figure out what the underlying cause may be, discuss your chronic fatigue symptoms with a trusted healthcare provider.

Though there are no formal tests for adrenal fatigue, a natural medicine physician may test AF by:

  • A blood test looking at DHEA-S levels (39)
  • A simple saliva test for measuring cortisol levels

If you are feeling chronically tired, weak, or depressed, your symptoms should be taken seriously. You may have undiagnosed adrenal insufficiency, obstructive sleep apnea, depression, an autoimmune disorder, or other health problems. Testing can be an important part of the process.

Once you and your healthcare provider have a better sense of what is and isn’t causing your symptoms, you can confidently start an individualized treatment plan using natural supplements.

 

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript! 

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  28. https://www.ncbi.nlm.nih.gov/pubmed/1599383
  29. https://www.ncbi.nlm.nih.gov/books/NBK209061/
  30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200035/
  31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198864/
  32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586582/
  33. https://www.ncbi.nlm.nih.gov/pubmed/26571987
  34. https://www.ncbi.nlm.nih.gov/pubmed/15666839
  35. https://www.ncbi.nlm.nih.gov/pubmed/17616774
  36. https://link.springer.com/article/10.1007%2Fs00213-001-0929-6
  37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2205609/
  38. http://wwwnc.cdc.gov/eid/article/5/5/pdfs/99-0509.pdf
  39. https://www.mountsinai.org/health-library/tests/dhea-sulfate-test


Moringa in powder form in a wooden bowl and in a wooden spoon with plant form surrounding

6 Supplements That Improve Your Kidney Health Naturally

6 Supplements That Improve Your Kidney Health Naturally


Unless you’ve experienced the misery of kidney stones, you probably haven’t give your kidney health much thought. Yet an estimated 31 million Americans suffer from chronic kidney disease (CKD). Of more concern, 9 out of 10 of those with moderately decreased kidney function don’t even know it! (1)

Did you know?
While CKD doesn’t get a lot of press, kidney disease actually kills more people than either breast or prostate cancer. (2)

close up of kidney test with ultrasound equipment

Kidney health is vital as kidney disease kills more people than either breast or prostate cancer.

One reason kidney disease isn’t on the radar for most people is that there are typically no symptoms until the disease is in an advanced stage. When they do appear, they can include a range of vague symptoms such as muscle cramps, fatigue, trouble concentrating, loss of appetite, swelling in your feet and ankles, trouble catching your breath, dry or itchy skin, insomnia, and urinating more often, especially at night. Because many of these symptoms don’t set off alarm bells, they are easy to ignore—until you’re suddenly diagnosed with kidney failure! (3) Fortunately, with a little awareness and some natural kidney support, you can avoid becoming one of these statistics.

Good kidney health: when things go right

Your kidneys are two bean-shaped organs about the size of your fist that are located behind your lower rib cage on either side of your spine. (4) Vital to your overall health, your kidneys filter waste and toxins out of the blood, shuttling them to the bladder so they can be escorted out of your body via your urine. Your kidneys also regulate your body’s fluid balance, keep the minerals (sodium, potassium, and phosphorus) in your bloodstream in balance, activate vitamin D so it can be used by the body, and release hormones that direct the production of red blood cells and hormones that regulate blood pressure. (5)

With all of these critical tasks, it’s smart to take steps to maintain kidney health, especially if you’re at an increased risk of kidney disease. You may be at a higher risk of CKD if you are:

  • Diabetic
  • Hypertensive
  • Among the 84 million Americans with some form of cardiovascular disease (6)
  • Someone with a family history of kidney disease, diabetes, or high blood pressure
  • Over the age of 60
  • African American, Native American, Hispanic, Asian, or a Pacific Islander
  • Obese
  • A smoker
  • Diagnosed with chronic urinary tract infections
  • A victim of kidney stones (7)

While some of these risk factors are beyond your control, adopting a few healthy lifestyle habits and adding kidney support supplements to your daily routine can give you an edge against CKD and other kidney woes.

variety of cut up vegetables in bowls and on plates

Choose kidney-friendly foods like those found in the Mediterranean diet.

What are the best foods for kidney health?

Lifestyle habits matter when you’re trying to optimize kidney health. While quitting smoking, drinking alcohol in moderation, and increasing your physical activity can boost overall kidney health, improving your diet is perhaps the easiest lifestyle modification you can make.

For decades, doctors recommended a renal diet that limited dietary sodium, potassium, and phosphorus. The problem was, this type of diet also reduced some important foods like fruits, vegetables, whole grains, legumes, and nuts. Recent studies point to more well-rounded diets like the Mediterranean diet or the DASH diet for those with or wanting to prevent CKD. (8) These healthier diets focus on whole minimally-processed foods and low to moderate amounts of protein. As a result, they support kidney health and reduce the risk of related health issues like high blood pressure, heart disease, obesity, and diabetes. (9)(10)

It’s also smart to drink plenty of fluids, particularly water as it helps to clear sodium and toxins from your kidneys. Aim to drink at least two liters of water daily—more if you live in a hot climate, participate in moderate to intense exercise, or have a history of kidney stones.

Nix NSAIDs

One of the biggest preventable risk factors for CKD is probably something that’s in your medicine chest right now. Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen or naproxen can cause kidney damage when taken regularly for chronic headaches, joint pain, or back problems. This damage can ultimately lead to CKD. (11)

Did you know?
These common over-the-counter drugs have also been linked to another CKD risk factor—cardiovascular disease and heart attack. (12)

NSAID overuse is the No. 1 preventable cause of kidney disease and while you’re probably in the clear if you only take NSAIDs on occasion, using them daily for pain relief may compromise kidney health. You should check with your health care provider for safer pain-relief options.

6 top kidney support supplements

Whether you are at risk for kidney disease or simply want to optimize these amazing internal filters, here are six supplements that can play a supportive role in helping to enhance your kidney health. If you’ve been diagnosed with some form of kidney disease, it’s smart to check with your doctor before starting any supplement regime.

Alpha lipoic acid

A powerful antioxidant, alpha lipoic acid is made inside the mitochondria (those tiny powerhouses inside every cell in your body) where it helps key enzymes turn nutrients into energy. But alpha lipoic acid plays another critical role—protecting your cells from oxidative damage, including those in your kidneys. This was recently shown in a study that appeared in the journal Inflammation where researchers noted that alpha lipoic acid produced a significant uptick in two other key antioxidants—superoxide dismutase (SOD) and catalase (CAT)—in kidney tissue. This, in turn, reduced inflammation and oxidative stress in the kidneys. (13) But this novel nutrient’s kidney benefits don’t stop there. Another study in the journal Natural Medicine reported that proactively supplementing with alpha lipoic acid may help prevent kidney stones. (14)

Andrographis

This kidney-supportive herb likely isn’t top of mind when you’re indulging in your favorite alcoholic beverage, but maybe it should be. Findings in the Journal of Ethnopharmacology suggest that two compounds in andrographis—andrographolide and arabinogalactan proteins—protect the kidneys from alcohol toxicity. (15) If you enjoy a glass of wine with dinner, a beer or two with friends, or the occasional cocktail, taking a dose of andrographis before you drink may provide the protection your kidneys need.

Moringa in powder form in a wooden bowl and in a wooden spoon with plant form surrounding

Moringa supplements reversed both oxidative damage and inflammation in the kidneys.

Moringa

This green superfood comes from leaves of the moringa tree, native to parts of Asia, Central and South America, Africa, and Australia. Considered a medicinal plant for at least 5,000 years in India, moringa was recently found to possess the ability to protect SOD and CAT levels in the kidneys. One study using a model of acetaminophen toxicity found that moringa supplementation reversed both oxidative damage and inflammation in the kidneys. (16) While you can find moringa in capsule form, it’s also available as a powder, making it an ideal addition to your morning smoothie.

NAC

Technically known as n-acetyl cysteine, NAC is a precursor to glutathione, commonly called the body’s master antioxidant. It’s also an antioxidant in its own right that protects kidney cells from heavy metals and other damaging toxins. (17)(18) Research shows that NAC can also limit the damage from advanced glycation end products or AGEs. AGEs are formed when glucose (sugar) reacts with proteins in the walls of your blood vessels, including those blood vessels within the kidneys. The resulting damage includes oxidative damage that can contribute to CKD. But proactively including NAC in your supplement routine can help protect against the negative effects of AGEs. (19)

Probiotics

Beneficial bacteria can do more than just enhance your gut health. They can also help protect against the complications of CKD by decreasing inflammation and the production of uremic toxins. This dual action improves kidney function. (20)(21) Probiotics may also protect against leaky gut syndrome, a common condition in people with CKD that allows harmful bacteria to “leak” from the intestinal tract into the blood. (22) Supplementing with a multi-strain probiotic may improve the bacterial balance in your gut, lessen the permeability of your intestinal barrier, and reduce the complications of CKD.

Resveratrol

Found in grapes, berries, and peanuts, resveratrol made headlines a few years ago due to its heart-healthy properties. But new evidence has found that resveratrol can also protect kidneys from a variety of toxins—including heavy metals, drugs, and alcohol—that can cause renal injury. (23) Not only does this antioxidant and anti-inflammatory compound fortify your kidneys against injury it may also improve renal function once an injury has occurred. (24)

If you’re at risk of kidney disease—and even if you’re not—it’s smart to have your kidney function tested. Then protect these small but mighty filters with healthy habits and one or more of these kidney-protective supplements to help ensure optimal kidney health for a lifetime.

 

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript! 

  1. 2015 Kidney Disease Statistics. American Kidney Fund. Available at www.KidneyFund.org
  2. Kidney Disease Statistics for the United States. National Institute of Diabetes and Digestive and Kidney Diseases. Available at https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease.
  3. About Chronic Kidney Disease. National Kidney Foundation. 2017. Available at: https://www.kidney.org/atoz/content/about-chronic-kidney-disease
  4. Biga LM, Dawson S, Harwell A, et al (Ed.) Internal and external anatomy of the kidney. Anatomy & Physiology. Open Oregon State University Textbook.
  5. Six-Step Guide to Protecting Kidney Health. National Kidney Foundation. Available at: https://www.kidney.org/atoz/content/sixstepshealthprimer
  6. Cardiovascular Disease Statistics. Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/cardiovascular_disease_statistics_85,P00243
  7. Haroun MK, Jarr BG, Hoffman SC, et al. Risk factors for chronic kidney disease: A prospective study of 23,534 men and women in Washington County, Maryland. J Am Soc Nephrol. 2003;14(11):2934-41.
  8. Chauveau P, Aparicio M, Belizzi V, et al. Mediterranean diet as the diet of choice for patients with chronic kidney disease. Nephrol Dial Transplant. 2018;33(5):725-35.
  9. Gallieni M, Cupisti A. DASH and Mediterranean diets as nutritional interventions for CKD patients. Am J Kidney Dis. 2016;68(6):828-30.
  10. Ko GJ, Obi Y, Tortorici AR, et al. Dietary protein intake and chronic kidney disease. Curr Opin Clin Nutr Metab Care. 2017;20(1):77-85.
  11. Ungprasert P, Chenungpasitpom W, Crowson CS, et al. Individual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: A systematic review and meta-analysis of observational studies. Eur J Intern Med. 2015;26(4):285-91.
  12. Pirlamaria P, Bond RM. FDA labeling of NSAIDs: Reivew of nonsteroidal anti-inflammatory drugs in cardiovascular disease. Trends Cardiovasc Med. 2016;26(8):675-80.
  13. Petronilho F, Florentino D, Danielski LG, et al. Alpha-lipoic acid attenuates oxidative damage in organs after sepsis. Inflammation. 2016;39(1):357-65.
  14. Zee T, Bose N, Zee J, et al. a-Lipoic acid treatment prevents cystine urolithiasis in a mouse model of cystinuria. Nat Med. 2017;23(3):288-90.
  15. Singha PK, Roy S, Dey S. Protective activity of andrographolide and arabinogalactan proteins from Andrographis paniculate Nees. against ethanol-induced toxicity in mice. J Ethnopharmacol. 2007;111(1):13-21.
  16. Karthivashan G, Kura AU, Arulselvan P, et al. The modulatory effect of Moringa oleifera leaf extract on endogenous antioxidant systems and inflammatory markers in an acetaminophen-induced nehrotoxic mouse model. Peer J. 2016;4:e2127.
  17. Bosgelmez II, Güvendik G. N-acetyl-l-cysteine protects liver and kidney against chromium (IV)-induced oxidative stress in mice. Biol Trace Elem Res. 2017;178(1):44-53.
  18. Xia Q, Liu C, Zheng X. N-acetylcysteine ameliorates contrast-induced kidney injury in rats with unilateral hydronephrosis. Mol Med Rep. 2018;17(2):2203-10.
  19. Thieme K, Da Silva KS, Fabre NT, et al. N-acytyl cysteine attenuated the deleterious effects of advanced glycation end-products on the kidney of non-diabetic rats. Cell Physiol Biochem. 2016;40(3-4):608-20.
  20. Koppe L, Mafra D, Fouque D. Probiotics and chronic kidney disease. Kidney Int. 2015;88(5):958-66.
  21. Vitetta L, Linnane AW, Gobe GC. From the gastrointestinal tract (GIT) to the kidneys: live bacterial cultures (probiotics) mediating reductions of uremic toxin levels via free radical signaling. Toxins. 2013;5(11):2042-57.
  22. Cigarran GS, González PE, Cases AA. Gut microbiota in chronic kidney disease. Nefrologia. 2017;37(1):9-19.
  23. Albertoni G, Schor N. Resveratrol plays an important role in protective mechanisms in renal disease—mini review. J Bras Nefrol. 2015;37(1):106-14.
  24. Al Dera HS. Protective effect of resveratrol against aluminum chloride induced nephrotoxicity in rats. Saudi Med J. 2016;37(4):369-78.


MAN WORKING OUT WITH PUSH UPS AT THE GYM

The Boost Your Muscle Needs: Building Healthy Muscle with Protein Supplementation

The Boost Your Muscle Needs: Building Healthy Muscle with Protein Supplementation

ROSS-Bailey-headshot

by Ross Bailey


Do you consume adequate levels of protein to build strong and healthy muscles? You do not need to be a competitive bodybuilder or a hardcore athlete to want the best protein for building muscle. From the active child to the resting senior, building and maintaining muscle is important for a wide variety of reasons. After all, a strong and healthy body is a strong and healthy you!

We all know that protein is important for your body, but just how much protein is needed to build muscle? What is the best protein powder for building muscle? And what are some of the best ways to use protein powder to gain muscle, naturally? Let’s strengthen that mind-muscle connection and learn how protein supplementation can benefit your lifestyle!

woman in active wear drinking protein from plastic bottle

Supplementing your diet with protein can help you build strong and healthy muscle!

Protein pro-tips

Protein is found in a wide variety of foods throughout the diet. Proteins are especially numerous in meats, fish, eggs, nuts, and dairy products. They can also be found in legumes, grain products as well as in supplements! Check out popular sources of protein and learn how to calculate protein needs, here. Remember, while protein is certainly important for maintaining, growing and building healthy and strong muscle, it is also important for a wide variety of other reasons! For example, it is used for building collagen, which is the protein used in connective tissue such as skin, ligaments, and hair. Collagen supplements are now a widely used form of protein supplements too!

The current Acceptable Macronutrient Distribution Range (AMDR) for protein shows that healthy adults should acquire between 10-35% of their energy needs from protein. Most adults should try to ingest at least 0.8 grams of protein per kg of body weight per day as a bare minimum. In practice, it has also been proposed that the ideal ingestion amount for growing muscle can be upwards of 2.0 grams of protein per kilogram of body weight per day (1). Diets high in protein can prevent age-related sarcopenia, the loss of muscle mass, reduce body weight and alter body composition as well as improve athletic performance (2).

Of course, dietary needs for protein will range from individual to individual. Factors that can play into your dietary needs can include sex, age, physical activity level, type of physical activity and more. Protein supplementation may be necessary if you are not meeting your recommended intake range. Inadequate protein intake can occur due to a variety of factors such as appetite (e.g., the elderly population), diet (e.g., vegetarians have a higher risk of protein deficiencies; vegetarian and vegan protein supplementation can be an important way to ensure adequate intake of protein), or high levels of physical activity (e.g., athletes).

Growing muscle and improving strength is especially beneficial when protein supplementation is combined with resistance training (3). Increasing muscular strength is most often observed in resistance training compared to aerobic training, although a combination of both is best for optimizing a more comprehensive positive health profile (4). When it comes to building muscle, positive caloric intake is needed in order to grow! Single bouts of exercise can stimulate muscle protein synthesis. However, if your ingestion of food is inadequate, your net muscle protein balance (i.e., muscle synthesis to breakdown ratio) will be negative (5). This means that muscle can be degraded and used for fuel instead of compiled in your musculoskeletal system!

MAN WORKING OUT WITH PUSH UPS AT THE GYM

Resistance or weight training induces increased muscle protein synthesis. You should consume adequate amounts of protein to ensure your muscle can rebuild itself after a workout!

There is no magic supplement that can be used on its own to ensure that you have healthy and strong muscle. While it is true that protein supplementation can assist with keeping your muscles strong and healthy, this should always be recommended in conjunction with regular physical activity. The saying “move it or lose it” is quite accurate when it comes to maintaining or building your muscle mass as well as increasing muscular strength.

Supplementation has become a convenient and easy way to incorporate more protein into your diet. There is no shortage of protein supplements that you can choose from to maintain and build healthy muscle. We’re here to help with highlighting some of the things that you should know and look for when choosing to supplement your diet with protein!

Protein supplements in your diet

There are a variety of protein types that you can choose from in your supplements. These include whey, casein, egg, pea, soy and rice proteins.

protein shake in clear glass with protein powder in the back and fresh fruits (apples, bananas and blueberries) surrounding

Supplementing your diet with protein powder can improve muscle growth and strength. There are a variety of sources that you can choose from to match your dietary needs!

Whey

One of the most popular protein types found in supplements is called whey protein. There are a few different kinds of whey protein. This includes whey concentrate, whey isolate, and whey hydrolysate, each of which is more and more refined (in this order). Whey proteins are some of the most widely studied proteins and are considered as fast-acting proteins that are digested and absorbed to produce quick rises in circulating amino acids in your bloodstream (6). Some studies suggest that whey protein produces the highest muscle protein synthesis compared to other types of protein (7).

Casein

Similar to whey proteins, casein is a milk-derived protein. This type of protein seems to exhibit different kinetics when ingested in the body compared to whey, and while it does not necessarily produce the same level of protein synthesis, it can confer other benefits! Compared with whey protein, casein is absorbed much more slowly. This means that circulating amino acid concentrations will not reach the same peak as with whey protein, but can have a more sustained timeframe. Additionally, casein has an inhibitory effect on the body’s breakdown of protein (6).

The prevention of protein breakdown can confer an effect of sparing muscle protein, especially as seen when exercising in underfed states. In a study with participants undertaking a hypocaloric diet, the ingestion of casein protein increased muscular strength with a resistance training protocol more than the group ingesting whey. Again, it is suggested that in the underfed state, casein proteins may be more beneficial at retaining muscle proteins (8).

Egg

While the egg protein is not quite as widely studied as whey and casein, it is another popular ingredient included in protein supplements. Compared with other sources found in milk, beef, soy and wheat proteins, egg proteins are the most easily digested and absorbed (9), making them an excellent choice to ensure ingested proteins are less likely to go to waste!

It has been shown that approximately 20g of egg protein is enough to produce the maximal protein synthesis response following exercise. In a study with healthy participants, protein drinks with 0, 5, 10, 20 or 40 grams of egg protein were provided to participants following periods of intense resistance training. While there is a positive dose-response relationship between muscular protein synthesis and protein consumption, this response plateaus after about 20 grams of protein (10).

Pea

Pea proteins are a popular choice in supplements as they provide a reliable source of protein for vegans and vegetarians. A study with 161 men has shown that it can increase muscle thickness to a similar degree as whey protein (11). Similar results have been recently found in a 2019 study with men and women performing high-intensity interval training (12). It has been shown that pea proteins exhibit digestive and absorptive properties that are more slowly absorbed than whey protein, but more quickly available than casein (13). Furthermore, the proteins derived from peas were found to increase satiety levels — suppressing your appetite — to a similar degree as whey and casein.

Soy

Similar to pea proteins, soy proteins have been widely used as a popular source of protein and an alternative to whey protein for vegan and vegetarian consumers (14). It appears that the literature seems to conflict with regard to the benefits of soy supplementation. Some studies show that soy may not induce body composition changes as compared to whey or placebo (e.g., 15), while other studies do indicate that it confers similar composition and strength benefits to whey (e.g., 16). As a popular alternative to whey, more research is certainly warranted with this type of protein source to show its merits or lack-thereof!

Brown rice

Brown rice proteins provide another vegetarian option for protein supplementation. While brown rice proteins have been scarcely studied, they have been shown to confer similar benefits to body composition and strength parameters to whey protein following 8 weeks of resistance training (17). This study also showed that there were no differences between rice protein and whey protein groups with regard to the perception of muscular soreness and readiness to exercise. Again, brown rice proteins certainly show promise, but more high-quality research is needed to fully validate their effects.

meal with protein rich foods

Building strong and healthy muscle starts with foods that are high in protein. Protein powders can conveniently boost your muscle-building capabilities and strength!

Final considerations for building healthy muscle

Remember, while protein is certainly valuable for building muscle and strength, maintaining a healthy and balanced diet is also extremely important. Muscular function, metabolism, and synthesis rely on adequate levels of energy as well as sufficient sources of vitamins and minerals.

To optimize your muscular health, consume a variety of fruits, vegetables, as well as healthy fat and protein from food sources, and, if necessary, supplement thereafter. Combine this with a regular exercise routine and you will be well on your way to meeting your muscle development goals!

 

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript! 


four spoons with leafs and cut up orange slices with vitamins on the spoons

4 Vitamins That Work Wonders For Brain Health & Memory

4 Vitamins That Work Wonders For Brain Health & Memory


Did you know that the human brain uses more energy than any other organ in the body? While the brain represents only 2% of total body weight, it accounts for more than 20% of the body’s total energy expenditure. (1) When considering vitamins that support brain health, we need to understand that the brain is like a sponge soaking up what it can — including nutrients from food and dietary supplements — to remain active. Fortunately, there are many key vitamins that can help patients maintain, and even enhance their brain function.

Like many patients, you too may be interested in supporting brain function from a cognitive and mental health standpoint. After all, the brain never takes a break. It works round the clock, 24/7!

Addressing deficiency with the best vitamins for brain health

Vitamin B

When it comes to B vitamins, you could say that the B stands for the brain! As it turns out, the best vitamins for brain health are B vitamins. Vitamin B12, in particular, is one of the best vitamins for brain health. In fact, research has confirmed that there is a direct correlation between vitamin B12 deficiency and poor brain health. (2) One connection between the B vitamins and brain health is with homocysteine. It is widely known that high homocysteine levels can contribute to poor health, which includes poor brain function. (3) It is also scientifically accepted that B vitamins help keep homocysteine levels in check.

“The B vitamins that participate in one-carbon metabolism include folate, vitamin B12, and B6; deficiency or congenital defects in enzymes involved in the metabolism of these B vitamins are associated with impairment in brain function,” wrote Irwin H. Rosenberg, MD, in the journal Nutrition Reviews. (4)

In addition to their role in homocysteine metabolism, B vitamins are intimately involved in catabolic energy production in the cells. The B vitamins are also known to easily cross the blood-brain barrier. “Once in the brain, specific cellular uptake mechanisms dictate distribution, and, whilst the B vitamins all have high turnovers, ranging from 8% to 100% per day, their levels are tightly regulated by multiple homeostatic mechanisms in the brain,” according to a 2016 review featured in the journal Nutrients. (5)

four spoons with leafs and cut up orange slices with vitamins on the spoons

There are many key vitamins that can help boost your brain health and enhance your cognitive function.

Vitamin C

In addition to the B vitamins, vitamin C can also help support brain health because of its high antioxidant activity. According to a 2017 review of 50 studies, the primary brain benefit that comes from vitamin C accrues to those of us who are deficient in the vitamin. (6) According to a 2014 paper published in the journal Nutrients, “Increasing evidence is pointing to vitamin C as an important redox homeostatic factor in the central nervous system, linking an inadequate dietary supply of vitamin C to negative effects on cognitive performance.” (7) This is especially true with aging adults as vitamin C deficiency is more common among older persons.

Vitamin E

Vitamin E has a mechanism similar to vitamin C and brain health because it too is a powerful antioxidant. Also similar to vitamin C, research demonstrates that low vitamin E levels can contribute to poor brain function. (8) Preliminary animal studies also suggest that vitamin E supplementation can have a protective effect on brain function. (9)

Vitamin K

Vitamin E benefits brain health and so does vitamin K. When we think of vitamin K we typically think of strong bones. But we should also be thinking about brain health. Regarding brain function, studies have shown that vitamin K influences sphingolipids, which are fatty acid compounds in brain cell membranes. (10) To determine the association between vitamin K status and brain function, researchers evaluated 192 people equal to or older than 65 years. This was known as the CLIP study and the researchers concluded, “The main finding of this cross-sectional study is that, irrespective of all measured potential confounders, increased dietary phylloquinone intake was associated with better cognition and behavior among geriatric patients.” (11)

It’s important to note that some common drugs can cause deficiencies in B vitamins, vitamin C and vitamin K. Learn about nutrient depletions associated with common medications, here.

Begin with the basics of brain health

close up of woman stretching arm

Regular exercise is good for your brain’s health as it enhances memory and cognition.

These foundational vitamins—Bs, C, E, and K—can help support health on many levels, including brain function. But when it comes to maintaining, enhancing, and protecting brain health, it’s also important to remind patients of these three basic and critical lifestyle factors:

  • Exercise. Research shows that exercise doesn’t just help your body stay fit, it helps your brain too. There are many brain-boosting benefits from exercise, including enhanced memory and cognition.
  • Sleep. Getting enough sleep is critical to health in general but it’s also important to brain health. While the body sleeps, the glymphatic system kicks in to start detoxifying the brain of neurotoxic waste proteins such as β-amyloid. (12)
  • Diet. The research is clear: a whole-food, unprocessed diet that includes plenty of healthy fats is good for the brain.

Protecting and enhancing brain function is important to all of us. As mentioned above, you can benefit immensely from a proactive brain health plan that includes basic lifestyle advice coupled with vitamin deficiency prevention, and supplementation with vitamins that promote brain health.

You’re now well on your way to “soaking up” all these benefits to power your super brain!

 

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript! 

  1. Raichle ME. Two views of brain function. Trends in Cognitive Science. 2010;14:180-190.
  2. Health Quality Ontario. Vitamin B12 and cognitive function. Ontario Health Technology Assessment Series. 2013;13(23):1-45.
  3. Ford AH, Garrido GJ, Beer C, et al. Homocysteine, grey matter and cognitive function in adults with cardiovascular disease. PLoS ONE. 2012;7(3).
  4. Rosenberg IH. B vitamins, homocysteine and neurocognitive function. Nutrition Reviews. 2001;59(8):S69-S74.
  5. Kennedy DO. B vitamins and the brain: mechanisms, dose and efficacy—a review. Nutrients;2016;8(2):68.
  6. Travica N, Ried K, Sali A, et al. Vitamin C status on cognitive function: a systematic review. Nutrients. 2017;9(9):960.
  7. Hansen S, Tveden-Nyborg P, Lykkesfeldt J. Does vitamin C deficiency affect cognitive development and function? Nutrients. 2014;6(9):3818-3846.
  8. Mangialasche F, XuW, Kivipelto M, et al. Tocopherols and tocotrienols plasma levels are associated with cognitive impairment. Neurobiological Aging. 2012;33(10):2282-90.
  9. La Fata G, van Vliet N, Barnhoorn S, et al. Vitamin E supplementation reduces cellular loss in the brain of a premature aging mouse model. The Journal of Prevention of Alzheimer’s Disease. 2017;Aug 8.
  10. Ferland G. Vitamin K, an emerging nutrient in brain function. Biofactors. 2012;38(2):151-7.
  11. Chouet J, Ferland G, Feart C, et al. Dietary vitamin K intake is associated with cognition and behavior among geriatric patients: The CLIP study. Nutrients. 2015;7(8):6739-6750.
  12. Shokri-Kojori E, Wang G, Wiers CE, et al. β-amyloid accumulation in the human brain after one night of sleep deprivation. PNAS. 2018;115(17):4483-4488.


woman doing a yoga pose standing on one leg and balancing

Everything You Need To Know About Hormone Health For Women

Everything You Need To Know About Hormone Health For Women

Dr. Iris Gold headshot

Hormones are messengers. They are secreted by glands, they travel to receptors on various organs and tell the cells in the organs what to do. Hormonal health is about these messages that our body receives. (1)

More importantly, hormones control how we experience our reality. They tell us to eat or stop eating, to sleep or stay awake, to gain weight, or not, and where to gain it. They control if we feel tired or energetic. They affect our moods, so they affect whether we are calm or anxious, depressed or happy. (2)

Hormones dramatically affect our bodies, our health, and our happiness too. As any woman can tell you, hormonal imbalance can make us feel pretty miserable! (3)(4)

This is the first of a three-part series on hormonal health for women. In this first blog, we’ll discuss the signs and symptoms of female hormone imbalance, which hormones are involved, and treatment strategies to restore balance. This information is excerpted from the author’s online video course, “Live Younger Longer, Improve Your Vitality at Every Age.”

woman doing a yoga pose standing on one leg and balancing

Hormonal balance is vital as hormones affect our bodies, our health, and our happiness!

What does hormonal imbalance feel like?

I like to think about women’s hormones as a beautifully orchestrated dance, usually flowing smoothly from one step to the next, and supporting each other. But sometimes they get out of step, and step on one another, or forget to come to the party altogether!

Take this mini hormone quiz: For each question, just tally the number of questions for which your answer is ‘yes’:

Do you, or your patient experience:

  • Agitation, PMS, migraines?
  • Heavy, painful periods?
  • Tender breasts?
  • Have you experienced a miscarriage or trouble getting pregnant?
  • Sugar cravings?
  • Increased belly fat?
  • Burnout, loss of stamina, and fatigue?
  • Feeling overwhelmed, everything is harder than it used to be? (5)
  • Trouble losing weight-your metabolism feels slower than it used to?
  • Sensitive to the cold? (You’re always wearing layers.)
  • Thinning of hair, including the outer eyebrows?
  • Difficulty concentrating or poor memory? (You draw a blank mid-sentence or forget why you walked into a room?)
  • Feeling tired, but hard to fall asleep and stay asleep?
  • Waking up with night sweats?
  • Depression, perhaps with anxiety or lethargy?
  • Diminished libido, or difficulty to orgasm? (6)

Every ‘yes’ is a sign of hormonal imbalance! But we’re here to help: there are dramatic improvements in hormone health with lifestyle, herbs, nutrients, and acupuncture. (7)

Which hormones are we talking about?

Estrogen

This is the feminizing hormone, that is secreted by the ovaries, and some by the adrenals after menopause. (8) Estrogen can be too high, sometimes called estrogen dominance, or too low, estrogen deficiency. Either can cause discomfort and disease. Estrogen dominance is mostly associated with symptoms like PMS, sore or fibrocystic breasts, migraines, and irritability. (9) In Chinese medicine, it is treated as Liver Qi stagnation, and treatment to sedate the liver brings dramatic results. Estrogen deficiency is associated with night sweats, dryness, heat, and insomnia. In Chinese medicine, this is known as a Yin deficiency pattern.

Progesterone

This hormone is also from the ovaries and is secreted mostly after ovulation. Progesterone means pro-gestational and helps a fertilized embryo to implant. (10) Progesterone can be very soothing & sedating and helps to balance estrogen levels.

Testosterone

Yes, testosterone is important for both men and women. It is secreted by the testes in men and the ovaries and adrenals in women. Testosterone levels are important for maintaining a sense of wellbeing, maintaining muscle mass and for libido in both sexes. (11)

Thyroxine

The thyroid gland secretes T3 and T4. T4 has to convert into T3 to be active in the body. Thyroid hormones control how we burn calories. It is believed by some specialists that a majority of postmenopausal women have undiagnosed and subclinical hypothyroidism. (12) Sometimes hypothyroidism is an autoimmune condition, called Hashimoto’s thyroiditis. Hyperthyroidism is called Graves disease. Symptoms of fatigue, low body temperature (cold all the time), infertility, depression, unexplained weight gain/loss, heart palpitations, and hoarse voice indicate testing the thyroid hormones. (13)

Cortisol

This hormone is secreted from the adrenal glands that sit above the kidneys. In times of acute stress, the adrenals secrete too much cortisol. (14) Over periods of extended stress, the adrenal glands get exhausted and produce too little cortisol. All the hormones are interrelated, and in the next blog of this series, we will look at how stress — and the stress hormone cortisol — interfere with women’s hormonal health. Since most women (and men too ) live with frequent or ongoing stress, we must address adrenal health when a woman has hormonal symptoms.

Dhea

This hormone is also from the adrenals; it helps to balance cortisol, and also converts into testosterone if T levels are low.

Insulin

Insulin is secreted by the pancreas in response to eating sugar. Insulin has two functions:

  • It is the taxi driver that carries sugar out of the blood and into the cells so it can be used for energy,
  • It tells the brain to stop eating. We are never full if insulin doesn’t work properly.

When there is chronic sugar intake, insulin stops working. It stops reacting to the sugar in the blood and becomes “resistant” to the sugar. Chronically high insulin, also known as insulin resistance or metabolic syndrome, results in pre-diabetes, or diabetes, and causes the body to store fat, mostly in the belly. (15)

Oxytocin

This is the bonding hormone! Oxytocin is secreted after birth, after orgasm or a good talk with a friend. And of course, by a hug. (16)

women running outdoors

Women should engage in activities that promote oxytocin – such as walking and cycling outdoors.

Do lifestyle choices impact hormonal health?

There are many lifestyle adjustments a woman can make to balance her hormones, even without herbs, nutrients or hormones.

  1. Number one on my list is to reduce or eliminate sugar and avoid white foods that turn quickly into sugar. Sugar is public health enemy number one, in all its 56 names! Reducing sugar will help balance weight, reduce cravings, lessen inflammation, and prevent diabetes.
  2. I recommend a clean green and lean diet, with up to 30 grams of fiber/day, with minimal, if any, red meat.
  3. Hormone balancing fiber comes from flaxseeds, chia seeds, cooked leafy greens, hemp, figs, and raspberries.
  4. Reduce caffeine and alcohol. Caffeine contains methylxanthine that makes estrogen dominance worse.
  5. On the other hand, oxytocin promoting activities balance estrogen and make women feel calm and secure. Taking a walk in nature with a friend, or calling your friends regularly, are some ways that help promote oxytocin. (17)
  6. Get a minimum of 7 hours of sleep each night. Sleep balances cortisol and helps prevent diabetes.
  7. Aerobic exercise balances cortisol and increases serotonin for better moods and better sleep. (18)

The role of herbs, and nutrients in hormone health

There are so many effective natural treatments to balance a woman’s hormones. In the third blog in this series, we will cover the best treatments specifically for each stage of a woman’s life cycle.

Flaxseeds in a white bowl next to clear jar of flaxseed oil and a wooden spoon of flaxseeds

For women with estrogen deficiency, flaxseeds have been proven to help with hormonal health.

These are herbs and nutrients that are clinically proven to be effective: If a woman has symptoms of estrogen deficiency, I recommend:

  • Flaxseed, Maca, Pueraria Mirifica, or Soy (if they are not hypothyroid)
  • Chinese herbal Yin tonics
  • Some women respond well to black cohosh or red clover
  • Estriol drops or suppositories, especially if the symptoms are not responding to herbs alone.

Did you know?
If there is a deficiency of progesterone, which is often the case with estrogen dominance, a wonderful plant is chasteberry, also known as Vitex agnus-castus. It is very powerful in helping with fertility, miscarriages, and PMS.

  • Natural progesterone cream is also very effective to balance Estrogen dominance.
  • DIM, (diindole methane) or IC-3, helps estrogen metabolism and is useful with estrogen dominant situations. It is also helpful for women on HRT, or who are breast cancer survivors.
  • Liver detox formulas, both Western and Chinese are very important, as well as liver herbs like milk thistle (Silybum marianum), and dandelion.
  • There are many thyroid support formulas available as well.
  • Other nutrients really affect moods and sleep. 5HTP increases serotonin. Serotonin helps restore a sense of wellness and promotes sleep.
  • L-theanine and GABA reduce anxiety.

Probiotics too are part of the treatment of hormonal imbalance because the gut flora in them has an effect on how estrogen is metabolized. (19)

As natural medicine practitioners, we are so fortunate to have so many potent treatments available to us and our female patients. You can be confident in reassuring your female patients who come to you in distress that with lifestyle, herbs, and supplements, they will feel better.

In fact, each one of us can balance our hormones, say bye to belly fat, brain fog, bloating and the blues.

 

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript! 


About Dr. Iris Gold, OMD L.Ac.

Dr. Iris Gold has practiced acupuncture and natural medicine in Mill Valley, CA since 1983, happily specializing in women’s health and guiding women to achieve balance and ease during the roller coaster ride of hormonal transitions. Her patients have easier passages through perimenopause, menopause, fertility, and pregnancy.

Originally trained as a microbiologist, she attended three years of naturopathic medical school before going on to Acupuncture School and then receiving her Doctorate in Oriental Medicine in China in 1989.

Besides her clinical practice, Dr. Gold consults and teaches about Health and Vitality internationally. She has recently created an online video course, “Live Younger Longer, Improve Your Vitality at Every Age”, an educational tool for both patients and practitioners.

For more info about how Dr. Gold’s patient education course can benefit your patients and your practice, go to improvingvitality.org, or contact her at [email protected].

Dr. Gold's online video course, “Live Younger Longer, Improve Your Vitality at Every Age,” an educational tool for both patients and practitioners.


close up of nutrition chart with practitioner and patient leaning over looking at the chart and chatting

Registered Dietitian: Why You Should See One And What They Can Help You With

Registered Dietitian: Why You Should See One And What They Can Help You With


Once a year, a special day is dedicated to registered dietitian nutritionists. The Academy of Nutrition and Dietetics (1) celebrates Registered Dietitian Nutritionist Day each year on the second Wednesday in March. This year it falls on March 13th. While we need to celebrate what a registered dietitian does every day, this commemoration is a welcome step. First celebrated in 2008, it was created to increase the awareness of registered dietitian nutritionists as indispensable providers of timely, scientifically validated food & nutrition information and services.

Pretty cool, right?! A whole day dedicated just to registered dietitian nutritionists! But you might be wondering, what is a registered dietitian? What do they do? Why should you see one? And what can they help you with?

close up of nutrition chart with practitioner and patient leaning over looking at the chart and chatting

A Registered Dietitian can help a patient with their digestive health, fitness goals and nutrition requirements, amongst other things.

What is a Registered Dietitian?

A registered dietitian is a nutrition professional who has been trained to meet the strict educational and experiential standards set by the Commission on Dietetic Registration (CDR) of the Academy of Nutrition and Dietetics.

In forty-seven states, Puerto Rico and the District of Columbia, dietitians are the only nutrition professionals to be regulated by licensing laws. It is these laws that help the public identify and access qualified practitioners. Licensing laws also provide health insurance companies and state & federal governments with the assurance that these practitioners meet standards of professional competence in order to be reimbursed for providing nutrition care services.

You may find dietitians in a variety of settings, including (but not limited to) hospitals, long term care facilities, schools, community health facilities, corporate nutrition programs, the food and nutrition industry, business, sports nutrition and research.

What does a Registered Dietitian do?

Registered dietitians are health professionals qualified to assess, diagnose and treat nutritional concerns at an individual and wider public health level. This means they are the ones you can head to when you are in need of nutritional expertise that is scientifically proven to help you reach your wellness goals.

A dietitian’s job description and what they do varies depending on the setting in which they work. In general, dietitians advise and counsel others on food and nutrition. Typically, they may assess the dietary and health needs of clients, explain nutrition issues to clients, develop meal plans and gauge the effectiveness of these meal plans, promote nutrition through public speaking and community outreach, and keep up to date with the latest food and nutrition research.

Since they cover such a wide range of nutrition-based subjects, in practice, you find dietitians working in various settings with a wide range of roles:

In hospitals

  • Assess and plan nutrition care for patients with a variety of ailments
  • Counsel patients—and their families—who require special diets for their medical condition
  • Ensure patient meals are prepared and delivered safely

In nursing homes

  • Plan menus to provide residents with the best nutrition
  • Ensure resident meals are prepared and delivered safely

In community health centers

  • Assess the nutrition needs of communities
  • Plan and deliver nutrition education programs
  • Develop nutrition education tools
  • Help communities stay healthy

In diabetes education centers

  • Educate and counsel clients who are living with diabetes or trying to prevent diabetes

In people’s homes

  • Counsel people who are housebound on special diets
  • Help families with healthy meal planning

In the food industry

  • Ensure manufacturers follow regulations around food labeling and nutrition claims
  • Research and develop healthier food products
  • Promote and market better food and nutrition products
  • Educate consumers on food, nutrition, and health

In the pharmaceutical industry

  • Plan and deliver education to doctors, nurses, pharmacists, and other dietitians on new products and research

In government

  • Develop food and nutrition policies
  • Provide advice on nutrition issues affecting different levels of government

In education

  • Teach nutrition to students from various programs
  • Conduct research and support development of nutrition research skills
  • Mentor future dietitians

In research

  • Plan and direct research projects and use results to increase knowledge of the relationship between nutrition and health, or to expand and improve nutrition programs

In sport and recreation

  • Help athletes of various calibers with their nutrition to optimize their health and performance
  • Counsel athletes on weight loss, hydration, eating before/during/after competitions and other nutrition concerns related to sport and physical activity

In the media

  • Provide expert guest opinion in the media: in print, on television and radio, and the internet
  • Contribute as a columnist for a media outlet such as a newspaper or magazine
  • Act as a resource for restaurants on recipe development and critique

Why should I see a Registered Dietitian?

Michael Phelps already knows how to swim. George Clooney already knows how to act. Tom Brady already knows how to play football. Do you think they still hire coaches? Of course, they do! The tricky bit with nutrition is that we all eat…often several times a day, so we are all “experienced” at eating, and automatically have strong opinions on eating. Most of us also have a lot of experience driving cars, sometimes multiple times per day, yet we’re not as eager to hand out advice on cars.

The point here is that experience does not necessarily mean expertise. Registered Dietitians have that expertise! They have completed a university degree in foods and nutrition from an accredited institution, and they have worked 900+ hours in supervised practical training. They have passed an exam to become a registered health professional and are required to complete ongoing professional development. They are also held to a rigorous professional code of ethics! If that doesn’t scream expertise in the realm of food and nutrition, what does?

close up of nutritious green drink on the ground with woman tying her running shoe in the background

Did you know Registered Dietitian can help with your fitness goals and recommend specific nutrients?

What can a Registered Dietitian help me with?

Dietitians are valuable members of your health care team and can be there to support you throughout your life. Here are just a few things that a dietitian can help you with:

  • Weight loss
  • Allergies/intolerances
  • Digestive issues
  • Diabetes
  • Heart health
  • Cancer
  • Infant nutrition and picky eating
  • Pregnancy and breastfeeding
  • Sports nutrition
  • Vegetarian and vegan diets
  • Navigating supplements

When you schedule a visit with a registered dietitian, the advice & information you receive is tailored to your personal needs and challenges. Dietitians have a unique skills-set to support people from different stages of life who are working towards leading a healthier lifestyle.

What questions should you ask a Registered Dietitian?

Finding a great dietitian can feel like a big task. Here are some questions to ask that can help you in the process.

  • What’s your specialty and approach?
    Once you find a dietitian, you want to make sure that their specialties and philosophies jive with yours. Some dietitians have additional certifications in nutrition for diabetes (CNE) or are board-certified sports dietitians (CSSD). Some will write meal plans for you, while others focus on behavioral strategies rather than calorie counting.
  • How much do sessions cost – and do you take insurance?
    Costs will vary by location, the dietitian’s experience, and their specialty. How often and how long you work with your dietitian is up to the two of you.
    Another factor that can make a difference in your bottom line is whether or not the dietitian accepts insurance.
  • Do you offer any group programs?
    Some dietitians offer both in-person sessions as well as online support groups. While they may not be right for everyone, groups can be especially helpful for people who find strength in numbers. It can help to have support from people who are experiencing similar things.

Remember, at the end of the day, the most important thing is that you are comfortable with the person you are working with. Your health is a priority, so it’s important to find someone you trust to help guide you on your journey.


Bonus content

I’d like to see a dietitian. How do I find one in my area?

The Academy of Nutrition and Dietetics has an online referral service – Find a Registered Dietitian Nutritionist (2) – that allows you to search a national database to find a qualified registered dietitian nutritionist who is right for you.

The referral service allows you to search by ZIP code, and apply filters if you are looking for a dietitian with specific expertise or who speaks a certain language.

Celebrate National Nutrition Month

Join the celebration of Registered Dietitian Nutritionist Day with your family, community, and schools by downloading some of the free handouts and tip sheets available on the Academy of Nutrition and Dietetics (3) website.

Clearly, a qualified registered dietitian nutritionist can help set the pace for your fitness journey. To successfully navigate that milestone, you need to combine your dietitian’s professional expertise and your own passion for good health. Together, you can achieve your customized nutrition goals more effectively and holistically.

So, if your health and wellness is a priority for you, celebrating the Registered Dietitian Nutritionist Day is likely a celebration that you’d love to march to!

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript! 


woman leaning on kitchen table drinking orange juice with raw fresh fruits and vegetables around her

Fitness And Nutrition: How Food Can Help You Get Fit

Fitness And Nutrition: How Food Can Help You Get Fit


Do you know true fitness isn’t built in the gym but in the kitchen? Fitness and nutrition go hand in hand, with many sports nutritionists estimating that reaching fitness goals requires 80 percent diet and 20 percent exercise. (1) Without the proper nutrition to support your active lifestyle, all those hours spent on the treadmill or lifting weights could be largely wasted! Here’s why: Even if you hit the gym every single day, even if you hire a trainer, you can’t out-exercise a bad diet. But by adopting a diet centered on nutrient-dense food and targeted meal timing, you can fuel your workouts and lose body fat while also building muscle. (2) Check out our step-by-step fitness nutrition guide below for easy nutrition and exercise strategies to help you reach your goals.

Simple steps to follow for better fitness results

Step 1: dump the junk

Whether you’re just starting your fitness journey or are a bona fide gym rat, getting in shape starts with the food you eat. Ultra-processed foods filled with refined grains, sugar, and unhealthy fats make up nearly 34 percent of calories in the average American diet. (3) Not only do these foods contribute to weight gain, but they also foster systemic low-level inflammation and, according to new research, increase the risk of chronic illness and early death. (3)(4)

What’s the difference between processed and ultra-processed foods? Processed foods are real foods that have been altered during the manufacturing process to increase the nutrient profile or extend the food’s shelf life. Good examples of this are sweetened fruit juice or frozen potatoes. Ultra-processed foods, however, are foods that contain artificial colors and flavors, added sugars, hydrogenated fats, and chemical preservatives designed to light up the reward centers in our brains. Examples of these faux foods include soft drinks, energy drinks, artificially flavored chips or crackers, and sugary breakfast cereal. Because these foods are nutritionally bankrupt, they won’t do a thing to boost your fitness levels. (5)

woman leaning on kitchen table drinking orange juice with raw fresh fruits and vegetables around her

Eating healthy is essential when it comes to optimizing your fitness routine and efforts.

Step 2: Mind your macros

Paying attention to your macros and timing your nutrition to support your workouts are two of the best ways to move closer to where you want to be. While protein gets a lot of press among athletes and weight loss gurus, it’s not the only macronutrient you need! The three primary nutrients your body needs to function are protein, carbohydrates, and fat. Each plays a different role in overall health and in helping you achieve your fitness goals. While both protein and carbohydrates provide 4 calories per gram, fat provides 9 calories per gram. To meet your daily nutritional needs and to support your workouts, the Food and Nutrition Board of the Institutes of Medicine recommends distributing your macros as follows (6):

  • Protein – 10%-35%
  • Carbohydrates – 45%-65%
  • Fats – 20% -35%

When you eat enough protein you provide your body with the building blocks (amino acids) needed to repair, maintain, and build your muscles. Including protein in every meal also boosts your leptin levels—a hormone that suppresses your appetite. (7) Pairing protein with a good quality carbohydrate can help you feel full longer. But because the body can’t store protein for later use, it’s important to include some protein at every meal and snack time. It’s also smart to space your protein intake evenly throughout the day—about every three to four hours. (8) Eggs, grass-fed beef, chicken, turkey, and omega-3 rich fish like salmon are good sources of protein.

Carbohydrates have gotten a bad name lately, but they are essential for energy and exercise performance. Healthy complex carbohydrates are an efficient source of energy that fuel muscle contractions. Carbs are broken down into smaller sugars (glucose, fructose, and galactose) in the body to be used as quick energy for immediate tasks. Any unused glucose will be converted into glycogen and stored in the muscles and liver for future use. Glycogen is the energy source most often used for short, intense bouts of exercise, such as sprinting or weightlifting. If your fitness routine falls into the low to moderate exercise category, the carbs you eat during your regular meals are probably sufficient. However, if you participate in high-intensity exercise or endurance activities that last for more than an hour, it’s smart to replenish your carbohydrate stores during your workout. (9) Look for healthy complex carbs in whole grains like oatmeal, farro, and quinoa, and starchy vegetables like sweet potatoes and parsnips.

Fat is another macronutrient that has suffered from a bad reputation in the fitness and weight loss world. But research shows that eating fat doesn’t make you fat. (10) Instead, healthy fats provide critical fuel for lower intensity activities like walking or biking, as well as endurance exercise. Essential fatty acids are also critical for overall health. Not only do these fats ensure healthy cell structure, protect your internal organs, and help to keep you warm, they are also necessary for the absorption of some nutrients and the production of hormones. (11) Healthy fats include avocados, coconut oil, extra virgin olive oil, and nuts.

two glass dishes with protein and fermented food prepped for meals

A post-workout meal packed with protein and healthy carbs can help build muscle.

Step 3: Pre and post-workout nutrition

If hitting the gym is part of your fitness routine, you’ve likely seen those bodybuilders with their gallon jugs filled with pre-workout branched chain amino acids (BCAAs) or caffeinated blends of sports nutrients like nitric oxide and creatine. But unless you train hard or workout for more than an hour at a time, you likely don’t need these specialty nutrients. That said, fueling your body with the right nutrients before a workout will ensure you have the strength and energy for optimal performance, no matter how intense your exercise.

What you eat and when you eat it matters for optimizing your metabolism, especially if you are training for or participating in an endurance activity like a half-marathon or an obstacle course races. Eating carbohydrates within 60 minutes of an endurance activity will boost your insulin and blood glucose levels just before you exercise. This can improve your performance. (12)

But if you’re just aiming to hit a Zumba class or do some moderate weight lifting, opt for a balanced pre-workout snack containing both carbohydrates and protein 45 minutes before you train. Here are some healthy, whole foods options:

  • Almond butter on whole grain bread
  • A cup of oatmeal and one scrambled egg
  • Greek yogurt and fruit
  • Dried fruit and a handful of nuts
  • Half a turkey sandwich

What you eat after a workout is as important—if not more important—than what you eat before. A post-workout meal or snack will help with muscle recovery and glycogen replacement. It also helps build muscle mass and strength after a resistance-based workout like weight lifting. (13)(14) While the pre-exercise focus is primarily on carbs, the spotlight after your workout should be on protein. And timing is critical. Try to eat your post-workout meal or snack within 45 minutes of your workout. Studies show that waiting for as little as two hours after you’ve racked that last weight can cut the rate of glycogen synthesis by as much as 50%. (15)(16)

When you choose foods that are easily digested, you promote faster absorption to speed nutrients to your depleted muscles. Here are some ideas for effective post-workout meals:

  • Grilled chicken with roasted veggies
  • Salmon with roasted sweet potatoes
  • Tuna and crackers
  • Scrambled eggs and avocado toast
  • A protein shake and a banana

woman sitting in active wear and drinking from a blue water bottle

5 ways to rock your fitness nutrition

  • Don’t skip meals. Eating three balanced meals a day and one or two healthy snacks can keep you energized and prevent blood sugar spikes and crashes.
  • Focus on whole foods. While protein drinks and bars are convenient, they are often high in sugar and additives. Fuel your workouts with real food instead.
  • Maintain your electrolytes. High-intensity workouts like aerobics or a HIIT routine that last for an hour or more can deplete your electrolytes. While coconut water is a good option, you can also replenish your electrolytes with foods like bananas, avocados, and watermelon.
  • Don’t cut too many calories. If you’re looking to lose weight, make sure you’re eating enough calories to fuel your workouts and daily activities while still creating a deficit. Cutting too many calories can put the body into “starvation mode” and may slow your metabolism. This could cause your weight loss to plateau.
  • Stay hydrated. Drink plenty of fluids throughout the day to prevent dehydration and make sure to have your water bottle handy during your workout. While there is no evidence-based “right” answer, current wisdom holds that you should drink half your body weight in fluid ounces of water daily. For example, a woman weighing 150 pounds should drink 75 fluid ounces of H20 every day.

Now that you know the importance of nutrition & exercise, and how fitness nutrition is the prelude to an active lifestyle, you can talk to your practitioner about a fitness nutrition plan that works for you — both in the kitchen and beyond!

 

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript! 

  1. Strasser B, Fuchs D. Diet versus exercise in weight loss and maintenance: Focus on tryptophan. Int J Tryptophan Res. 2016;10:9-16.
  2. Longland TM, Oikawa SY, Mitchell CJ, et al. Higher compared with lower dietary protein during an energy deficit combined with intense exercise promotes greater lean mass gain and fat mass loss: a randomized trial. Am J Clin Nutr. 2016;103(3):738-46.
  3. Schnabel L, Keese-Guyot, Allès B, et al. Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France. JAMA Intern Med. Published online February 11, 2019. doi:10.1001/jamainternmed.2018.7289.
  4. Tabung FK, Liu L, Wang W, et al. Association of dietary inflammatory potential with colorectal cancer risk in men and women. JAMA Oncol. 2018;4(3):366-373.
  5. Martinez Steele E, Popkin BM, Swinburn B, et al. The share of ultra-processed foods and the overall nutritional quality of diets in the U.S.: Evidence from a nationally representative cross-sectional study. Popul Health Metr. 2017;15(1):6.
  6. Manore MM. Exercise and the Institute of Medicine recommendation for nutrition. Curr Sports Med Rep. 2005;4(4):193-8.
  7. Weigle DS, Breen PA, Matthys CC, et al. A high-protein diet induces sustained reductions in appetite, ad libitum calorie intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. Am J Clin Nutr. 2005;82:4108.
  8. Kerksick CM, Arent S, Schoenfeld BJ, et al. International society of sports nutrition position stand: nutrient timing. J Int Soc Sports Nutr. 2017;14:33.
  9. Beelen M, Cermak NM, van Loon LJ. Performance enhancement by carbohydrate intake during sport: effects of carbohydrates during and after high-intensity exercise. Ned Tijdschr Geneeskd. 2015;159:A7465.
  10. Willett WC, Leibel RL. Dietary fat is not a major determinant of body fat. Am J Med. 2002;113 Suppl 9B:47S-59S.
  11. Lowery LM. Dietary fat and sports nutrition: A primer. J Sports Sci Metab. 2004;3(3):106-17.
  12. Ormsbee MJ, Bach CW, Baur DA. Pre-exercise nutrition: The role of macronutrients, modified starches, and supplements on metabolism and endurance performance. Nutrients. 2014;6:1782-1808.
  13. Moore DR, Camera DM, Areta JL, et al. Beyond muscle hypertrophy: why dietary protein is important for endurance athletes. Appl Physiol Nutr Metab. 2014;39(9):987-97.
  14. Van Loon LJ. Application of protein or protein hydrolysates to improve postexercise recovery. Int J Sports Nutr Exerc Metab. 2007;17 Suppl: S104-17.
  15. Aragon AA, Schoenfeld BJ. Nutrient timing revisited: is there a post-exercise anabolic window? J Int Soc Sports Nutr. 2013;10(1):5.
  16. Poole C, Wilborn C, Taylor L, et al. The role of post-exercise nutrient administration on muscle protein synthesis and glycogen synthesis. J Sports Sci Med. 2010;9(3):354-63.


grandmother, daughter, and granddaughter jump on a grey couch together

The Best Women’s Health Supplements By Age Group

The Best Women’s Health Supplements By Age Group


It’s not about what age you are – it’s about how well you age.

The journey of aging can be a beautiful experience that should be embraced by more women. However, some things may not feel or look as effortless with age. There is no way to turn back the clock on time, but you can enjoy the process of healthy aging if you understand what’s going on with your body and take steps to maintain your health. That’s where the supplements that have shown to promote women’s health, come in.

Throughout a woman’s life, her body’s nutritional and biological needs shift. Depending on her age, lifestyle, diet, and life stage, there are different natural female health supplements that a woman should consider taking.

grandmother, daughter, and granddaughter jump on a grey couch together

At any age, supplements and a healthy routine are both vital!

Women’s health: the best supplements for your age

If you are a woman trying to maximize your health, keep hormones at bay, or even slow down the signs of aging, it’s essential to know how your nutritional needs shift and evolve with every stage of life.

Women in their adolescent & teens years

Just because a lot of young women in the U.S. consume plenty of calories, doesn’t mean they’re getting the recommended amounts of essential nutrients they need.

Did you know?
According to the Dietary Guidelines for Americans 2010, the top sources of calories for adolescents age 2 to 18 in the U.S. are desserts, pizza, and soda. (1)

The focus should instead be on eating calcium-rich foods, such as kale, broccoli, figs, or almonds. Teens should aim to consume at least 1,300 mg of calcium through their diet daily. This means they should be eating healthy calcium-rich foods, such as almonds, broccoli, kale, or figs. Recommended dosage: teens should consume 1,300 mg of calcium daily. (2)

Think you may have an iron deficiency?
According to the Centers for Disease Control and Prevention, adolescent girls have an increased risk of iron deficiency when they start menstruating. Talk to your doctor about taking a multivitamin supplement containing iron and incorporating more iron-rich foods in your diet, such as spinach, poultry, egg yolks, and iron-fortified cereals. Be careful not to take too much, as it can cause constipation.
Recommended dosage: 15 milligrams of iron per day for girls ages 14 to 18. (3)

Women in their 20s

If you are a woman in her 20s, chances are you are extremely busy in school, with work, or at home with kids. It’s easy for a woman to fall into unhealthy eating and lifestyle habits during her twenties. And it’s no surprise you may have started noticing your skin, energy levels, and overall health starting to suffer.

Waking up feeling dizzy? Magnesium can help that and much more.
Magnesium is a mineral involved in over 300 reactions in the body, and yet it is one of the more common nutrient deficiencies in 20-something women. This puts a lot of young women at risk for high blood pressure, blood sugar, excess body fat around the waist, heart palpitations, and mood swings triggered by PMS. The recommended dosage of magnesium is 360 mg/ daily. (4)

Did you know?
Magnesium, as well as a combination of magnesium and B6, has been shown to effectively combat PMS symptoms when taken daily. (5)

Inside often? You probably aren’t getting enough vitamin D.
There’s a good chance you are not getting enough natural vitamin D from sunlight exposure for immune and hormone support. Many of us who work indoors should start feeling the effects of supplementing vitamin D3 in about 6-8 weeks. Vitamin D dosage: 600 IU Daily. (6)

Working out a lot? Try getting more potassium in your diet!
If you’re breaking a sweat often, you may want to consider taking a potassium supplement. Potassium is crucial for blood pressure, kidney function, and bone health. Potassium also is one of the most common nutrient deficiencies among women in their twenties, and it’s been shown to be especially helpful at preventing muscle cramps post workout. Potassium supplements only have 99 mg per serving, so experts recommend finding sources in your diet. The recommended dosage potassium: 4,700 mg from food sources. (7)

a bowl of a variety of cut up fruits

Need more potassium in your diet? Aim to get at least four fresh servings of fruit daily.

Feeling the effects of drinking alcohol? Ask your practitioner about milk thistle.
Have you ever considered what binge-drinking in your 20s may be doing to your liver and your skin? Studies suggest that milk thistle can improve liver function by reducing liver inflammation and damage. (8)(9) It has also been shown to combat acne. In one study over eight weeks, people who took 210 milligrams of milk thistle daily had a 53% decrease in acne lesions. (10) The recommended dosage of milk thistle: 210 mg daily.

Did you know?
Women taking high dose oral contraceptives (i.e., birth control) have been shown to have significantly lower levels of B6, B12, and folate compared to women who do not use them. (11)(12)

Do you have heavy menstruation cycles? Ask your doctor about iron supplements
Iron is an especially important supplement for women to consider taking in their 30s. Iron deficiency can be common in women who have heavy menstrual cycles, athletes, pregnant women, and women who don’t eat much meat in their diet. (13) Taking an iron supplement can support optimum health for a woman in her thirties, but you want to be careful not to overdo it. Taking too much iron can cause abdominal pain, vomiting, and other unpleasant symptoms. The recommended dosage of iron: 18 mg daily.

Women in their 30s

Many women in their 30s gain a bit of weight as their metabolism slows down. This is also often the time when many women start to exhibit digestive problems.

Having digestive issues? Try supplementing with probiotics.
A majority of women have digestive issues as they get older. These digestive issues are triggered by many factors. Some examples include frequent intake of antibiotic medications, high-stress levels, allergies, food sensitivities, poor diets full of processed foods, and extreme dieting low in healthy fats. Studies have shown that probiotics can help ease the symptoms of irritable bowel syndrome and can even prevent some forms of diarrhea. Recommended dosage: taking daily probiotic supplements for one to two weeks may improve conditions such as infectious or antibiotic-related diarrhea. (14)

pregnant woman sitting with doctor and talking

Pregnant women need 50% more iodine than other women. (15)

Thinking of having kids? Make sure you are taking folic acid.
Folic acid, which is also known as folate and B9, is especially important to take as a supplement if you are a woman trying to conceive. Folic acid is responsible for DNA replication, reduces the risk of neural tube defects in fetuses, and promotes healthy hair, skin, nails, and a positive mood. It’s a good idea to start taking folic acid before you conceive. The recommended dosage of folic acid: 400 mcg per day and 500-600 mcg per day if pregnant or breastfeeding. (16)

Did you know?
If you are supplementing with iron, most doctors recommend having your ferritin levels checked once a year. Ferritin is a protein that stores iron in the body, releasing it when your body needs it.

Women in their 40s

Women in their 40s generally have a unique set of nutritional needs. During this life stage, many women are preparing to enter perimenopause, which is the stage right before menopause. It’s usually when women start to experience hot flashes, experience hair loss and also start seeing signs of osteoporosis.

Keep up your vitamin D and calcium intake!
Once you reach 40, it’s all about preventing osteoporosis. Taking a vitamin D supplement has been shown to lower the risk of falls in older women. (17) The recommended dosage: 1,000 mg of calcium daily + 600 IU Vitamin D3 daily. (18)

Fish oil, which is jam-packed with healthy omega-3 fatty acids, is a great supplement for supporting a women’s overall health in her forties. Omega-3s support brain and heart health. The recommended dosage for fish oil: 1,100 mg daily. (19)

Did you know?
Generally, 3,000 mg of fish oil is considered safe for adults to consume. (20)

The vitamin B-complex is made up of 8 vitamins and it is a good idea to consider taking in your forties. The 8 B vitamins include Thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), vitamin B6, biotin (B7), vitamin B12, and folic acid. They work together and individually to support mood, digestion, heart, and sleep health. The recommended dosage is up to your doctor about a specific blend. (21)

Collagen supports skin elasticity while keeping it supple and firm. While your body naturally produces it, collagen production starts to decline as you age. It also makes your nails strong and shiny. By the age of 50, a woman may have lost up to half of the collagen in her skin, but taking collagen supplements can slow down and prevent the loss of further collagen. The recommended dosage of collagen: 50 ml daily for at least 12 weeks. (22)

collagen protein in wooden bowl and on wooden spoon

One of the main building blocks of the body, collagen makes up about 30 percent of your total body protein and 75 percent of your skin.

Women in their 50s

Reaching your 50s marks a milestone. You’ve entered the golden years! Though the hormonal changes that accompany turning fifty make hitting nutritional quotas for certain vitamins more of a challenge.

Experiencing menopause? Consider taking calcium and vitamin D.
Menopause is often the most significant change that affects a woman’s body in her fifties. Since estrogen helps maintain bone mass, a majority of women become more vulnerable to bone loss after menopause. Studies have shown that postmenopausal women are calcium deficient and have increased bone loss. (23) Recommended dosage: Take at least 600 IU of vitamin D and bump up your calcium intake to 1,200 mg of daily. The calcium can be divided into two daily doses of 600 mg (preferably calcium citrate).

Did you know?
Studies have shown that stomach acid levels begin to decline in adults in their 50s, which makes it harder for them to absorb vitamins and minerals found in foods. (24)

Worried about being forgetful? Start taking a B12 supplement!
After 50, our gut is not able to absorb B12 as well as it does when we’re younger. The Institute of Medicine advises that adults over the age of 50 get their B12 in the form of supplements instead of food sources. (25) The recommended dosage for B12 is 2.6mg daily. (26)

Did you know?
Women over fifty are four times more susceptible to osteoporosis than men. (27)

Taking an iron supplement? You may want to stop post menopause.
Once a woman moves beyond menstruation, they should stop taking an iron supplement unless otherwise instructed by their practitioner. Some research suggests high iron levels increase the risk of certain cancers. (28) The recommended dosage for iron beyond the point of menstruation is a lowered dosage from 18 mg to 8 mg daily.

Women in their 60s

Taking medications for heartburn or acid reflux? You may need more vitamin B12.
As you get older, your gut isn’t able to absorb B12 as efficiently as it used to. In addition, if you suffer from heartburn or acid reflux, you may be taking an over the counter prescription called proton-pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs). Studies have shown that taking these drugs for more than two years increases the risk of vitamin B12 deficiency. Even a mild B12 deficiency puts older adults at a much higher risk for dementia and depression. (29) The recommended dose is 2.4 micrograms daily. (30)

Feeling foggy? Take Omega-3s for memory and brain function!
As you age, your brain cells gradually lose the ability to absorb DHA, which in turn compromises memory retention and brain function. Supplementing with Omega-3s has been shown to increase the growth of brain cells, improve mood, enhance memory, and boost blood flow well into your 60s. (31)(32) The recommended dose for Omega-3 is 1,100 mg daily.

woman in a kitchen holding a jug and laughing

Taking the right supplements may avoid chronic pain for women in their 60s!

Problems with chronic pain? Supplement with vitamin D!
You have probably heard that vitamin D is essential for bone health, but did you know it can be taken to help relieve chronic pain? New research shows vitamin D can reduce chronic pain. (33) Unfortunately, the body’s ability to synthesize vitamin D from sunlight declines as we age, so it is best taken in supplement form. The recommended dose: 600 IU daily.

Women in their 70s and beyond

Along with your B12 and calcium supplements, you may want to consider adding protein powder to your diet in your 70s and beyond.

Don’t have any appetite for food? Start taking protein powder.
Once women reach the age of seventy and beyond, the ability to build muscle mass deteriorates. And on top of that, most women experience a steep decline in appetite. Supplementing with protein powder or pills can help a woman in her 70s increase lean body mass and muscle. The recommended dose for women 70+ is 20 to 30 grams of protein powder mixed into a daily shake. (34)(35)

Talk to your doctor about daily supplements for women’s health

Before you begin taking any supplements specific to women’s health, it’s always a good idea to talk to your doctor or practitioner.

Maybe modern science hasn’t cracked the code to stop aging, but research has proven that supplements can help make a real difference in how we age.

By keeping up with a few essential routine health screenings, integrating beneficial habits into your life, and taking supplements shown to promote women’s health, you can be your best at your current age and beyond!

  1. https://www.researchgate.net/publication/46425995_Dietary_Sources_of_Energy_Solid_Fats_and_Added_Sugars_Among_Children_and_Adolescents_in_the_United_States
  2. https://ods.od.nih.gov/factsheets/Calcium-Consumer/
  3. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
  4. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208934/
  6. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
  7. https://ods.od.nih.gov/pdf/factsheets/Potassium-Consumer.pdf
  8. https://www.ncbi.nlm.nih.gov/pubmed/27517806
  9. https://www.ncbi.nlm.nih.gov/pubmed/9027949
  10. https://www.omicsonline.org/effects-of-oral-antioxidants-on-lesion-counts-associated-with-oxidative-stress-and-inflammation-in-patients-with-papulopustular-acne-2155-9554.1000163.php?aid=10078
  11. https://blogs.cdc.gov/yourhealthyourenvironment/2014/03/12/are-we-getting-enough-vitamins-and-supplements/
  12. https://www.ncbi.nlm.nih.gov/pubmed/1146727
  13. https://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_data_status_t2/en/
  14. https://nccih.nih.gov/health/probiotics/introduction.htm
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218540/
  16. https://ods.od.nih.gov/factsheets/Iodine-Consumer/
  17. https://www.ncbi.nlm.nih.gov/pubmed/22536766
  18. https://www.bones.nih.gov/health-info/bone/bone-health/nutrition/calcium-and-vitamin-d-important-every-age
  19. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/#en30
  20. https://www.ncbi.nlm.nih.gov/pubmed/30000958
  21. https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/
  22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206255/
  23. https://www.ncbi.nlm.nih.gov/pubmed/21702289
  24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693682/
  25. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
  26. https://ods.od.nih.gov/pdf/factsheets/VitaminB12-Consumer.pdf
  27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380170/
  28. http://cebp.aacrjournals.org/content/23/1/12
  29. https://pdfs.semanticscholar.org/6c5e/fec0ec7180091cfe15c48b4deb8f6be1e0f1.pdf
  30. https://www.ncbi.nlm.nih.gov/pubmed/10448529
  31. https://www.ncbi.nlm.nih.gov/pubmed/24470182
  32. https://www.ncbi.nlm.nih.gov/pubmed/26890759
  33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5666851/
  34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555150/
  35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882708/