Most vitamin studies are flawed by poor methodology

In a new published analysis, researchers at the Linus Pauling Institute of Oregon State University report that many large clinical trials of vitamin supplements, especially antioxidants like vitamin C, have flawed methodologies that make them 'useless' in determining the real value of such nutrients.

It is on the basis of such flawed studies created by researchers that are uninformed as to the nature of nutrients that their studies may conclude that vitamins are of no value or may even be harmful.

Of course, common sense tells us that essential nutrients cannot be inherently useless or harmful in reasonable doses, but those are messages that we repeatedly hear in the media reports.  Such flawed science leads to the equally flawed calls for vitamins to be regulated as drugs, adding a new logical error in failing to consider the vast difference in safety between nutrients and drugs.

Drugs are typically synthetic, isolated substances that are foreign to the body and don't act like nutrients, and it is this foreignness of drug properties that make them inherently toxic to the body. That toxicity is the legal basis of regulating drugs as controlled substances, and the failure to demonstrate toxicity of nutrients, except in studies with such flawed methodogies as we are discussing, makes calls to regulate vitamins as drugs hollow and illogical.

A report on that article:
http://www.nutraingredients.com/Research/Most-vitamin-studies-are-flawed-by-poor-methodology-say-Linus-Pauling-researchers

The original peer-reviewed publication in a peer-reviewed nutrition journal:
http://www.mdpi.com/2072-6643/5/12/5161

Supplements vs. Food to Obtain Key Nutrients

Supplements vs Food [Infographic] by the team at Supplement Centre

Antioxidants misunderstood

In “Radical thinking on antioxidants” (Chicago Tribune, Oct. 6) there is a useful discussion of the controversial role of antioxidant nutrients in our health. While much of the information presented was fair, there were omissions and inaccurate statements made that should be addressed.

To understand the controversy over antioxidant nutrition, it is important to remember that this particular class of nutrients consists of individual substances that, unlike drugs, do not operate independently in the body. The failure to respect that fact has caused many researchers, especially those assembling and publishing statistical models of supposedly similar already-published studies, to veer way off course from reality. The most common errors include the use of the so called “gold standard” model used for pharmaceutical studies that looks at the intake of an individual substance and is randomized, double-blinded, and placebo controlled. But that model often fails to produce meaningful or consistent results when antioxidant nutrients are involved. Why?

One big problem is that antioxidants are synergistic and depend on one another to survive in a healthy state. A classic example is vitamin C, with a half-life of about 30 minutes. We would all die of scurvy in a few hours if we didn’t have a mechanism for recycling and recharging that spent antioxidant vitamin. That mechanism is antioxidant synergy, where other antioxidants recharge the spent ones so they can continue their essential work in our bodies. Antioxidants that have used one of their electrons to stop a dangerous chain reaction of free radicals ripping electrons from healthy cells –an otherwise uncontrolled electrical spark - can themselves become a problem if they over-accumulate, which is a signal that we lack other types of antioxidants that could restore their antioxidant potential.

Another problem is the tendency of supplement critics to exaggerate their opinions. In this article, a cardiologist reportedly claimed that, “there is little to no data supporting the use of antioxidants to protect against disease.” That can be easily disproven by a cursory look at medical journals. For example, the American Journal of Cardiology reported evidence that “coenzyme Q10 supplementation may decrease muscle pain associated with statin treatment... supplementation may offer an alternative to stopping treatment with these vital drugs.” Another issue of that journal noted that “coenzyme Q10 supplementation in patients with worsening diastolic function with statin therapy improved parameters of diastolic function.” And the Journal of the American College of Cardiology published a referenced Expert Consensus Document that listed evidence for cardiovascular health benefits of antioxidants CoQ10, hawthorn extract, and ginkgo leaf extract.

http://articles.chicagotribune.com/2011-10-06/health/ct-met-antioxidants-20111006_1_antioxidants-dietary-supplements-free-radicals

My Interview on Memory and Brain Health for a trade magazine

The brain must be intact and healthy in order for it to perform normal functions like thought and memory. There is evidence that chronic or acute inflammation, or other insults to brain cells/tissues from chemicals or other damaging agents, can provoke negative health effects. In essence, the brain is literally under attack on a daily basis, requiring a constant infusion of supporting protective nutrients to maintain proper brain health and functionality.

Antioxidants and magnesium are key nutrients needed to protect the brain from chemicals called excitotoxins, such as MSG, which are damaging to brain cells when levels of various nutrients are insufficient to control them. The physical damage to brain cells that can be caused by oxidation, sometimes in the form of a bio-electrical spark causing a chain reaction that rips electrons from a string of innocent cells until an antioxidant ‘electron donor’ puts an end to it, can be prevented or stopped by antioxidants. Antioxidants also protect fats from oxidizing (going rancid), and since the brain is nearly half fat it is dependent on both fatty acids and antioxidants to protect its structural integrity.

While it is normally not necessary to see a physician before taking a brain/memory support dietary supplement, people on medications should always check if there are known interactions before using any new supplement and it is wise to always bring a list of your supplements to share with your doctor at your annual check-up. Those with known memory problems should request a medical evaluation to set a baseline level in order to maintain their mental assets and be able to compare future mental performance.

To aid this preservation of our mental faculties, it is obviously best to consume adequate levels of relevant protective nutrients for many years, rather than waiting until the senility of old age creeps up on us and then trying to regain lost abilities. Otherwise, careful eating and appropriate supplementation may be started ‘too little, too late.’

The best mental/brain support nutrients include some surprisingly ordinary ingredients: Lecithin, Vitamins A-E, and Antioxidants. Lecithin provides essential phospholipids for the brain, nerves, and cell membranes; including Choline, Serine, and other brain nutrients that directly support neurotransmitter production and memory. Lecithin’s Phosphatidyl Choline (PC) is a precursor of the neurotransmitter acetylcholine; in the central nervous system acetylcholine is involved in learning, memory, and mood. Phosphatidylserine (PS) also affects the levels of neurotransmitters in the brain related to mood, memory, and mental function.

Lecithin, which is a highly processed extract of soybean oil, does not in itself contain protein (allergens) or genetic material (GMOs), which the original soybeans may have contained. Some Lecithin products are derived from certified non-GMO soybeans or even sunflower seeds.

Another way to get Lecithin’s benefits is in the form of Krill Oil. Krill has its Omega-3 fatty acids bonded to phospholipids similar to those found in soy or egg lecithin. So krill not only supplies EPA, DHA, and phospholipids for brain, nerve, and membrane health but also enhances their bioavailability and access to the brain due to the ability of phospholipids to cross the blood-brain barrier better than ordinary fish oils. Fish Oils providing EPA and DHA should also be considered brain nutrients, as DHA is a significant physical component of the brain.

Vitamin E and its related compounds (the tocotrienols) have been shown to protect neurons (brain and nerve cells) from being damaged or even killed off by excitotoxic chemicals. The antioxidant benefits of this essential vitamin’s “family” of compounds also help to prevent oxidative reactions that can damage brain tissues. Look for gamma-tocopherol along with the usual alpha-tocopherol plus higher amounts of gamma- and delta- form tocotrienols.

Vitamin C directly pumps excitotoxins from neurons, protecting the brain and nerve cells from being damaged by these potentially toxic chemicals. There are several populations with impaired ascorbate absorption; including those with poor insulin sensitivity, those with gut inflammation, those who take aspirin, and those on low sodium diets; all situations where normal vitamin C uptake and utilization is often suboptimal.

Other antioxidants of benefit for brain health include Alpha Lipoic Acid, various carotenoids including Astaxanthin (also found in Krill oil), and Pycnogenol®. In addition to supplementation, it always helps to consume a variety of antioxidants from fruits and vegetables to maintain a good level and balance of antioxidants.

The formation of abnormal structures in the brain may in part be due to oxidative damage that perhaps can be kept within normal acceptable ranges by having a variety of antioxidant nutrients available. Genes in the subject cells are controlled by “switches,” that are in turn modulated by environmental “triggers.” The presence of various protective nutrients helps to maintain proper cellular health; whereas the deficiency of adequate protective nutrients can allow potentially damaging effects, leading to cell death and the subsequent formation of abnormal brain structures.

The presence of excessive amounts of saturated fats in the diet, especially if from an excess of processed foods, inevitably reduces the amount of available long-chain fatty acids EPA and DHA (DHA can be made from EPA) that are essential for brain and nerve health. The deficit of these two fatty acids increases the likelihood of uncontrolled inflammatory processes in the body, as an imbalance of beneficial dietary fats like EPA, DHA and GLA that can reduce the fatty acids needed to make prostaglandins responsible for maintaining a healthy inflammatory response. The fact that EPA is needed for healthy membranes throughout the body and DHA is an important constituent of the brain itself also testify to the importance of these fatty acids for healthy brain structures and functions, including memory.

• Natural antioxidant vitamins Beta-Carotene, C, and E are protective of brain tissues and are available in antioxidant formulas and multiple vitamins..

• Alpha GPC is a form of choline that is bioavailable to the brain; an acetylcholine precursor, it supports memory and cognitive acuity.

• DMAE is a naturally occurring amino metabolite known primarily as a precursor to choline and acetylcholine, chemicals in the brain responsible for nerve transmissions and cognitive function; DMAE has been used most predominantly to improve memory and focus while stimulating neural activity.

• NADH is a metabolite of niacin (vitamin B3) that is directly involved in neurotransmitter production to support mental alertness.

• Ginkgo biloba extract is thought to improve memory and quality of life, and is available in various strengths.

• Acetyl-L-Carnitine is a form of an important amino acid, which in short-term studies has improved memory in older adults.

• Vitamin B1 deficiencies have been associated with confusion and memory loss in seniors deficient in that nutrient.

• High strength fish oils and Krill oil supply the omega-3 fatty acids DHA and EPA that are important brain and nerve components often deficient in the general population.

• Genistein, a phytoestrogen found in Soy Protein Isolates and Soy Isoflavones, has been shown to act as an antioxidant to preserve brain cell integrity.

• Ashwagandha has been shown to be protective of brain cells in non-clinical laboratory experiments.

Functional Doses of Vitamins and Minerals for Bones

• Protein: 0.8 grams per kilogram of body weight

• Calcium: Over 1 gram per day

• Magnesium: 310 – 420 mg per day

• Zinc: 15 mg per day

• Copper: 2.5 to 3 mg per day

• Boron: 3 mg per day

• Manganese: 5 mg per day

• Potassium: 3,500 to 4,000 mg per day

• Vitamin D: over 500 IU daily

• Vitamin K: Levels are not well understood; at least 90 mcg/d for women and 120 mcg/d for men

• Vitamin C: over 500 mg daily

• Vitamin A: 2333 IU in women and 3000 IU in men; avoid low and excessive amounts

Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutr. 2006;46(8):621-8. Review. PubMed PMID: 17092827.

Nutrients for Heart Health interview

From an interview of me by Whole Foods Magazine, february 2011:

Our aging population will naturally turn to nutrients as a core defense of their heart and cardiovascular (CV) health. Research continues to pile up to support the benefits of various vitamins, minerals, amino acids, herbs, antioxidants, and other dietary supplements to optimize heart health. The trick is to communicate clear benefits associated with specific nutrients and formulas while treading on the right side of the label claims limits.

There are products that support various aspects of CV health. These include circulation, vascular health, heart energetics, fat metabolism, stress and cortisol control targeting abdominal fat, electrolyte metabolism, etc.

Additional heart support could be associated with blood sugar health, since diabetics disproportionately suffer and die from cardiovascular disease. Supporting nutrients to maintain healthy glucose metabolism include alpha lipoic acid, chromium, cinnamon, biotin, Gymnema sylvestre, corosolic acid, and others. The use of stevia as a sweetener can also be helpful in cutting carbohydrate intake; the whole herb, not the “Reb A” fraction commonly sold as a mass market sweetener, also has been shown to have supportive effects on pancreatic function, insulin sensitivity, and antioxidant benefits.

Many isolated nutrients have historically been used to support cardiovascular health, including amino acids (l-arginine, l-citrulline, l-carnitine), lecithin, vitamin E complex, CoQ10, B complex vitamins, methylators like TMG and SAMe, magnesium, antioxidants, plant sterols, sugar cane policosanol, and nattokinase. At the same time there are many botanicals for the same purpose such as hawthorn leaf and flower extract (not the berries, which are not shown to help the heart), and prickly ash bark. Whole foods or botanicals that support heart health include cayenne, garlic, ginger, cayenne, and whole fermented organic red yeast rice. And let’s not forget the benefits of fish oils and fiber, which do have FDA-approved qualified health claims.

Vitamin D also has a role in heart health, a benefit which the Institute of Medicine’s committee that released the new dietary recommendations did not endorse. By contrast, the FDA’s European counterpart EFSA (the European Food Safety Agency) has acknowledged a role for vitamin D in heart health: "The Panel concludes that a cause and effect relationship has been established between the dietary intake of vitamin D and contribution to the normal function of the immune system and healthy inflammatory response, and maintenance of normal muscle function." The heart, of course, is a muscle; the body’s control of inflammation, calcium metabolism, and muscle function are all intimately related to heart health.

How Nutrition Affects Swine Flu (Influenza) and Immunity

Why are the Public Health authorities silent on the role of nutrition to protect us during an official national health emergency? Do they not know, or simply not care? Is either answer acceptable to citizens concerned about their health and wanting to get practical/real/fair/impartial information that we can utilize to help protect our families? Here's what the experts are not telling us:

• Did you know that if you had the seasonal flu vaccine last year it may make you more vulnerable to the swine flu this year? Vaccines create antibodies that actually make you more susceptible to other organisms, like viruses and bacteria. (Four Canadian studies reported by CBC News, 9/23/09)
• Did you know that side effects of vaccines can be minimized if there are adequate levels of vitamin D in the person? (Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129-40. Review.)
• Did you know that a lack of vitamin D makes people far more likely to have respiratory infections? (On the epidemiology of influenza. Virol J. 2008 Feb 25;5:29. Review.) Did you know that the virus itself can become less aggressive and less prone to mutating into more dangerous forms if a person has adequate levels of nutrients, especially antioxidants? (Host nutritional status: the neglected virulence factor. Trends Microbiol. 2004 Sep;12(9):417-23. Review.)
• Did you know that antioxidants, like selenium, not only reduce our vulnerability to getting influenza but also reduce the chances that it will progress into pneumonia! (Host nutritional status: the neglected virulence factor. Trends Microbiol. 2004 Sep;12(9):417-23. Review.)

Nutrients of interest to stroke victims

Sorry there's not much detail but this is a list that I made of nutrients that may be useful for someone who has had a stroke. I would suggest that you look each one up at a reputable online database, if interested. Of course, there are often difficulties at getting stroke survivors to take nutritional pills/caps; everything from swallowing to drug interactions. In no particular order: Vinpocetine Pycnogenol Nattokinase Rosemary Thyme Proline CoQ10 Phosphatidyl Choline Acetyl-l-carnitine vitamin E (all 8 tocopherols and tocotrienols) alpha-lipoic acid silymarin magnesium acetylcholine precursors: choline, PC, B5, huperzine

Studies fail, not vitamins

Single antioxidants have far less power than mixtures of synergistic dietary nutrients, and both dietary and supplemental antioxidants should be considered to determine total antioxidant status before undertaking a well-designed clinical trial. Even the ability of most animals to synthesize their own vitamin C, which is not possible in humans, guinea pigs and some fruit-eating bats, affects one’s antioxidant status. The failure of most nutrient/supplement trails to consider these additional and critical variables casts most such studies in doubt, and is undoubtedly responsible for the conflicting and confusing results of so-called “gold standard” studies that are tarnished by the common failure to consider both nutrient sources and how nutrients interact. But that’s what happens when drug researchers attempt to study nutrients in the usual manner that they successfully use for pharmaceutical drugs. They simply do not understand or consider the additional variables, do not measure them or screen for them as variables, and thus fail to reach valid conclusions. Of course, the media parrots their triumphant press releases that nutrients are both dangerous and worthless. It makes me wonder why I bother to eat…

Cardiovascular Health

Cardiovascular Health By Neil E. Levin, CCN, DANLA For a healthy cardiovascular system it is important to get plenty of nutrients over the whole range. B-Vitamins, for example, help to produce energy and to control metabolic processing, including the one that results in excessive levels of the inflammatory compound homocysteine. Homocysteine is a greater risk factor for cardiovascular risk than total cholesterol level. Antioxidants support each other, and clinical research indicates that total antioxidant status is more important than a single level of a single antioxidant nutrient. Antioxidants protect cholesterol from oxidizing, and also protect arterial surfaces from being damaged, leading to plaque formation and cholesterol “patches”. Minerals are also useful for cholesterol metabolism - especially chromium - also calcium, copper, and possibly magnesium and selenium. With the recent stories about obese children – some with Type-2 “adult-onset” diabetes - and with kids getting heart attacks in their teens, there is a growing awareness that cardiovascular health issues are not limited to middle aged men. Recent reports also point to the increased risk for women after menopause or who are on hormone replacement drugs, hammering the point home that age and gender are no longer rigid dividers of people into cardiovascular risk groups. That’s not to say that everyone is aware of these cardiovascular risk factors, but the risk categories in terms of age have certainly broadened dramatically in recent years. We have seen an increasing number of college-aged young men be afflicted by cardiac events at sports or training events, with some dying. Still, the risks do not seem as immediate to young adults with their heightened sense of immortality, especially young men. By the time men hit their 40s, there is an increased awareness of cardiac risks that keeps increasing throughout their lives. The young are mostly oblivious to health risks unless some event creates the beginnings of awareness that they may be at risk, such as a close relative suffering a cardiac event at an early age or a health scare. Unfortunately, these events seem to be increasing. Genetics, sedentary lifestyles, poor diet and obesity all make people susceptible to vascular problems. The emergence of hemorrhoids or any hint of varicose veins should be obvious indications of cardiovascular weakness at any age. Obesity and lack of stamina are also good indicators. Family health history is another consideration that should affect awareness. Circulation depends on body movement/exercise and requires an unobstructed blood flow through flexible blood vessels that have structural integrity. Collagen, elastin and supporting nutrients (proline, lysine, Vitamin C, Pycnogenol®, rutin) help to strengthen these tissues, while certain herbs (cayenne, garlic, horse chestnut, prickly ash extract, hawthorn extract) help to improve blood flow. Smoking and stress narrow the blood vessels, increasing the risk of forming clots or obstructions. Certain amino acids in the diet (arginine, citrulline) support NO (nitric oxide) formation that dilates blood vessels to reduce blood pressure and enhance blood flow to the peripheries. The presence of these components and modulators in the diet help to maintain cardiovascular health and vascular integrity. People should be eating a variety of fruits and vegetables, along with whole grains, in order to provide nutrients essential to the integrity of blood vessels. Products include beta sistosterol, vitamin C, Vitamin E, chromium, garlic, guar gum, Guggul extract, tocotrienols, policosanol, vitamins B1, B6, folate, B12, iodine, magnesium, selenium, potassium, carnitine, ginger, cayenne, hawthorn extract, CoQ10, lipoic acid, homocysteine regulators (B6, B12, folate, TMG), Policosanol, Red Yeast Rice Extract (plain or with CoQ10, alpha lipoic acid and silymarin), prickly ash extract, horse chestnut extract, butcher’s broom extract, grape seed extract, Pycnogenol® and rutin. However, other products are also helpful for cardiovascular health including gamma and delta tocotrienols, amino acids (taurine, carnitine, lysine, proline), Nattokinase (fibrin enzyme for supporting the body’s control of clotting), fish oil, and lecithin. Remember, you must take care of your heart and cardiovascular system if you expect them to take care of you for a lifetime!

Nocturnal leg cramps: quinine vs nutrients

Quinine is kind of dangerous (real risk of multiple organ failure). It's basically an old folk remedy lacking validity. In fact, the FDA banned the marketing of quinine in 1994 due to its toxicity and lack of evidence that it even helps with nocturnal leg cramps. (Procedings of Baylor University Medical Center, 2003 January; 16(1): 21–26. PMCID: PMC1200805) Since 2007, the Food and Drug Administration has recommended that quinine be prescribed only for the prevention and treatment of malaria. For nocturnal leg cramps, "better to rely instead on stretching exercises to flex the legs before bedtime," according to the Mayo Clinic, which also recommends drinking plenty of fluids and eating foods high in potassium. (NY Times 8/5/08) There are certainly much safer and more convincingly effective things to take for leg cramps. Giving elderly patients a vitamin B supplement providing 250 micrograms of B-12, 30 mg of B-6, 5 mg of riboflavin (B-2), and 50 mg of thiamine (B-1) for three months, doctors found that 86 per cent of their patients who took vitamin B complex vitamins enjoyed complete remission for noctural leg cramping. The researchers reported that, in their view, safe and effective vitamin B should be the treatment of choice for nighttime leg pain in older people. (Chan P, Huang TY, Chen YJ, Huang WP, Liu YC. Randomized, double-blind, placebo-controlled study of the safety and efficacy of vitamin B complex in the treatment of nocturnal leg cramps in elderly patients with hypertension. J Clin Pharmacol. 1998 Dec;38(12):1151-4.) [The B vitamins will be found in multiple vitamins and B-Complex vitamins, but some are far weaker than these amounts.] Vitamin E may also be helpful (about 400 IU minimum). (Robert F. Cathcart, III, M.D. The Journal of the American Medical Association, Vol. 219, No. 2.) http://naturalsolutionsradio.com/articles/article.html?id=6614 And another study showed that calcium, magnesium, and B Vitamins were all effective at dramatically reducing or eliminating noctornal leg cramps. (Int J Gynecol Obstet 2006 Aug 17 [e-pub ahead of print]) http://bastyrcenter.org/content/view/1131/ Some people may simply require more than normal of some specific nutrients...probably due to recent medical history, such as GI problems. Muscle cramps can be aggravated by some drugs, but rarely remedied by any drug. After all, all drugs are "controlled substances" precisely because of their known toxicities and side effects.

Cardiovascular Health

Cardiovascular Health By Neil E. Levin, CCN, DANLA For a healthy cardiovascular system it is important to get plenty of nutrients over the whole range. B-Vitamins, for example, help to produce energy and to control metabolic processing, including the one that results in excessive levels of the inflammatory compound homocysteine. Homocysteine is a greater risk factor for cardiovascular risk than total cholesterol level. Antioxidants support each other, and clinical research indicates that total antioxidant status is more important than a single level of a single antioxidant nutrient. Antioxidants protect cholesterol from oxidizing, and also protect arterial surfaces from being damaged, leading to plaque formation and cholesterol “patches”. Minerals are also useful for cholesterol metabolism - especially chromium - also calcium, copper, and possibly magnesium and selenium. With the recent stories about obese children – some with Type-2 “adult-onset” diabetes - and with kids getting heart attacks in their teens, there is a growing awareness that cardiovascular health issues are not limited to middle aged men. Recent reports also point to the increased risk for women after menopause or who are on hormone replacement drugs, hammering the point home that age and gender are no longer rigid dividers of people into cardiovascular risk groups. That’s not to say that everyone is aware of these cardiovascular risk factors, but the risk categories in terms of age have certainly broadened dramatically in recent years. We have seen an increasing number of college-aged young men be afflicted by cardiac events at sports or training events, with some dying. Still, the risks do not seem as immediate to young adults with their heightened sense of immortality, especially young men. By the time men hit their 40s, there is an increased awareness of cardiac risks that keeps increasing throughout their lives. The young are mostly oblivious to health risks unless some event creates the beginnings of awareness that they may be at risk, such as a close relative suffering a cardiac event at an early age or a health scare. Unfortunately, these events seem to be increasing. Genetics, sedentary lifestyles, poor diet and obesity all make people susceptible to vascular problems. The emergence of hemorrhoids or any hint of varicose veins should be obvious indications of cardiovascular weakness at any age. Obesity and lack of stamina are also good indicators. Family health history is another consideration that should affect awareness. Circulation depends on body movement/exercise and requires an unobstructed blood flow through flexible blood vessels that have structural integrity. Collagen, elastin and supporting nutrients (proline, lysine, Vitamin C, Pycnogenol®, rutin) help to strengthen these tissues, while certain herbs (cayenne, garlic, horse chestnut, prickly ash extract, hawthorn extract) help to improve blood flow. Smoking and stress narrow the blood vessels, increasing the risk of forming clots or obstructions. Certain amino acids in the diet (arginine, citrulline) support NO (nitric oxide) formation that dilates blood vessels to reduce blood pressure and enhance blood flow to the peripheries. The presence of these components and modulators in the diet help to maintain cardiovascular health and vascular integrity. People should be eating a variety of fruits and vegetables, along with whole grains, in order to provide nutrients essential to the integrity of blood vessels. Products in the Cholesterol/Cardiovascular Support category include plant sterols (containing beta sistosterol), ascorbyl palmitate, Vitamin E, chromium, garlic, guar gum, Guggul extract, tocotrienols, policosanol, B1, B6, folate, B12, iodine, magnesium, selenium, potassium, garlic, carnitine, ginger, cayenne, hawthorn extract, CoQ10, alpha lipoic acid, TMG, Red Yeast Rice Extract, prickly ash extract, horse chestnut extract, butcher’s broom extract, grape seed extract rutin, nattokinase (fibrin enzyme for supporting the body’s control of clotting), fish oil, lecithin, Pycnogenol®, as well as hawthorn leaf and flower extract. Remember, you must take care of your heart and cardiovascular system if you expect them to take care of you for a lifetime! Neil E. Levin, CCN, DANLA is a nationally certified clinical nutritionist with a Diplomate in Advanced Nutritional Laboratory Assessment. He is a professional member of the International & American Associations of Clinical Nutritionists. Neil is the nutrition education manager and a product formulator. Neil is a member of the Scientific Council of the national Clinical Nutrition Certification Board and serves on the board of directors of the Mid-American Health Organization (MAHO), the Midwest regional affiliate of the National Products Association (formerly NNFA). Neil is routinely interviewed for articles in trade magazines serving the natural products industry and has published articles in magazines and newspapers, contributed to scientific journals and has been a guest on numerous radio shows. He has been interviewed for television news reports many times over a 36-year period. You can read some of Neil’s recent articles at his non-commercial website: http://www.honestnutrition.com/