Category: Uncategorized

Mood Disorder

(Depression / Anxiety / Stress)

Depression and anxiety are two terms used to describe a variety of mood disorders. Although these two moods seem like opposites, depression and anxiety often occur together. Symptoms of depression and anxiety can include any of the following: chronic fatigue, insomnia, irritability, loss of appetite or increased appetite, headaches, backaches, inability to concentrate, memory loss, constipation or diarrhea, disinterest in sex, inability to make decisions, feelings of hopelessness or helplessness, feeling “blue,” suicidal thoughts. In fact, a mood disorder can cause symptoms in virtually any part of the body. (I recommend my Body/Mind Connection video for a full discussion on this).

Nearly everyone suffers from some of these difficulties some time. External events can cause a person to feel depressed or anxious. Loss of a loved one is an example of a “trigger” event that can cause these symptoms. In mood disorders, there may not be identifiable “triggers” for the anxiety or depression. Even where there is an identifiable “trigger” event, the feelings of anxiety or depression are often overwhelming and persistent.

There are as many causes of the disorder as there are symptoms. Nutritional deficiencies, blood sugar imbalances (hypoglycemia or diabetes), poor diet, hormone imbalances, physical inactivity, prescription or over-the-counter drugs, allergies, and serious illnesses can all trigger anxiety/depression. Mood disorder is also a symptom of age-related memory change. In addition, there may be mental patterns (habits and behaviors) that magnify the problem.

Because there are many physical imbalances that can cause or contribute to mood disorder, it is important to get a thorough medical evaluation. The physician who performs your physical exam may recommend evaluation by a psychiatrist who can give your disorder a diagnostic name and advise you of conventional medical and counseling options available. You may also want to consult an holistic medical practitioner who can help you explore the various causes of mood disorder and offer you options to conventional drug treatment.

Diet and Lifestyle Recommendations

  • Don’t smoke! Smoke contains carbon monoxide which is toxic to the brain.
  • Eat a nutritious diet. Nutrient deficiencies cause decreases in brain chemicals (neurohormones).
  • Be sure that you are evaluated for hypoglycemia and food allergy. Both are common causes of mood disorder. The Super Fast Diet, a low carbohydrate diet, corrects hypoglycemia quickly and reliably.
  • Exercise regularly. Exercise stimulates the production of the body’s natural “feel good” hormones called endorphins. Exercise also helps normalize blood sugar levels.
  • Practice stress reduction techniques and emotional re-education. Negative thought habits can cause or aggravate anxiety and depression.
  • Do not use stimulants: caffeine, nicotine, alcohol or recreational drugs.

Primary Support

  • Maxi Multi: 3 caps, 3 times per day with meals. Optimal (not minimal) doses of vitamin B complex vitamins and the minerals calcium and magnesium are particularly important, but a deficiency of any nutrient can cause alterations in neurotransmitter (brain chemical) production and mood.
  • Omega 3 fatty acids:
    Flax seed meal, 2 teaspoons per day with food
    OR
    Flax seed capsules: 2-4 caps, 3 times per day (target dose range: 6-12 caps per day)
    OR
    Flax seed oil: 1 tablespoon per day
    OR
    Max EPA (Omega-3 rich fish oil): 1-2 caps, 3 times per day with meals (target dose: 3-6 caps per day).
  • Melatonin: this hormone decreases with age. It is a potent antioxidant and one of the only ones to cross the blood-brain barrier. It should be used in almost all cases of mood disorder and is an important part of longevity and anti-aging programs. Melatonin helps to regulate Circadian rhythms and is an “anti stress” hormone.
  • L-5-HTP (5-Hydroxy-Tryptophan) 100 mg: 1 cap, 3 times per day with meals. Dosage may be increased to 2 caps, 3 times per day after 2 weeks if response is inadequate. L-5-HTP is a neurotransmitter precursor and antidepressant.
    AND/OR
  • Hypericum (St. John’s Wort): 1 cap (300mg), 2-3 times per day. (target dose 900mg per day)
    [NOTE: Do not take Hypericum or 5-HTP if you are on a prescription drug for mood disorder and DO NOT discontinue prescription antidepressants without the advice of a physician. Some antidepressants can cause serious side effects if suddenly discontinued].
  • L-5-HTP and St. John’s Wort can be taken together in more resistant depressions, but this should be done with the help of an holistic physician. I am available for telephone consultations.

Additional Support

For anxiety:

  • Magnesium: 1 tab, 3-5 times per day (target dose: 300-500 mg per day.) NOTE: Maxi Multi contains 500mg of magnesium. If taking Muaxi Multi as your multiple, additional magnesium supplementation is unnecessary.

For depression:

  • SAMe: 400mg, 4 times daily.

For depression in the elderly:

MSM (Methylsulfonylmethane)

Get the Sulfur Your Body is Missing

MSM is a source of biologically active sulfur.

Sulfur is a mineral that is plentiful in the human body and is found in particularly high concentrations in structural tissues (joints, skin, hair, nails), and serum proteins (transferrin, albumin, and immunoglobulin).

Clinical studies have shown that MSM benefits:

  • arthritis
  • skin health
  • immunity
  • constipation
  • circulation
  • detoxification

MSM is also useful for detoxification of the liver.

Although sulfur occurs widely in food, it is highly volatile and easily destroyed by even moderate processing or heating.

MSM-750 (Methylsulfonylmethane) a high-potency source of Fundamental Sulfur.

Suggested dose: 1 capsule 3-4 times daily with meals or food.

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Order This Concierge Product WellevateThis is a separate website and you will need to create a new account to order.

Butterbur (MigraMAXX)


Natural Support For Migraine Headache and Hay Fever

ButterburrButterbur (Petasites hybridus) contains petasin, a substance which relaxes blood vessels and certain smooth muscles and is anti-inflammatory. Studies have shown that butterbur is useful for:

  • hay fever
  • migraine headaches

Butterbur and Hay Fever

Butterbur has been shown in studies to be as effective as drugs at relieving hay fever symptoms but without adverse side effects

One study compared Butterbur to the drug cetirizine (Zyrtec) and found that both relieved symptoms equally well. However, the drug was associated with a higher rate of adverse side effects including drowsiness.

A second study compared butterbur extract with fexofenadine (Allegra). Butterbur was just as effective as fexofenadine at relieving symptoms.

Butterbur and Migraine Headache

Studies have shown that Butterbur reduces the frequency of migraine headaches. The amount of Butterbur needed to be effective was 75mg of a standardized 15% petasin extract taken at least twice per day. Smaller doses were not effective in reducing migraine frequency.

Butterbur may contain pyrrolizidine alkaloids which can cause liver damage, use only extracts which have the pyrrolizidine alkaloids removed. This will be stated on the label.

References

1.) Wang GJ, Shum AY, Lin YL, et al. Calcium channel blockade in vascular smooth muscle cells: Major hypotensive mechanism of S-petasin, a hypotensive sesquiterpene from Petasites formosanus. J Pharmacol Exp Ther 2001;297:240–6.
2.) Thomet OA, Schapowal A, Heinisch IV, et al. Anti-inflammatory activity of an extract of Petasites hybridus in allergic rhinitis. Int Immunopharmacol 2002;2:997–1006.
3.) Lipton RB, Gobel H, Einhaupl KM, et al. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology 2004;63:2240–4.
4.) Lee DK, Haggart K, Robb FM, Lipworth BJ. Butterbur, a herbal remedy, confers complementary anti-inflammatory activity in asthmatic patients receiving inhaled corticosteroids. Clin Exp Allergy 2004; 34:110–4.
5.) Ziolo G, Samochewiec L. Study on clinical properties and mechanism of action of petasites in bronchial asthma and chronic obstructive bronchitis. Pharm Acta Helv 1998;72:378–80.
6.) Schapowal A, Petasites Study Group. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ 2002;324:144–6.
7.) Lee DK, Gray RD, Robb FM, et al. A placebo-controlled evaluation of butterbur and fexofenadine on objective and subjective outcomes in perennial allergic rhinitis. Clin Exp Allergy 2004;34:646–9.
8.) Schapowal A; Petasites Study Group. Butterbur Ze339 for the treatment of intermittent allergic rhinitis: dose-dependent efficacy in a prospective, randomized, double-blind, placebo-controlled study. Arch Otolaryngol Head Neck Surg. 2004 Dec;130(12):1381-6.
9.) Lee DK, Carstairs IJ, Haggart K, Jackson CM, Currie GP, Lipworth BJ. Butterbur, a herbal remedy, attenuates adenosine monophosphate induced nasal responsiveness in seasonal allergic rhinitis. Clin Exp Allergy. 2003 Jul;33(7):882-6.
10.) Käufeler R, Polasek W, Brattström A, Koetter U. Efficacy and safety of butterbur herbal extract Ze 339 in seasonal allergic rhinitis: postmarketing surveillance study.Adv Ther. 2006 Mar-Apr;23(2):373-84.
11.) Diener HC, Rahlfs VW. Danesch U. The first placebo-controlled trial of a special butterbur extract for the prevention of migraine: reanalysis of efficacy criteria. Eur Neurol 2004;51:89–97.
12.) Grossmann M, Schmidramsl H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Int J Clin Pharmacol Ther 2000;38:430–5.
13.) Pothmann R, Danesch U. Migraine prevention in children and adolescents: results of an open study with a special butterbur root extract. Headache 2005;45:196–203.
14.) Lipton RB, Gobel H, Einhaupl KM, et al. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology 2004;63:2240–4.

 

Macular Degeneration


Age-Related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is a disease that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. AMD affects the macula, the part of the eye that allows you to see fine detail. AMD causes no pain.

In this simulation, how a person with AMD sees the world is presented graphically. As the disease progresses the area of central vision deteriorates. The gradual destruction of light sensitive cells continues until large areas are totally lost. Peripheral vision remains, but the ability to clearly see straight ahead is gradually lost. Credit: National Eye Institute, National Institutes of Health

In some cases, AMD advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to a loss of vision in both eyes. AMD is a leading cause of vision loss in Americans 60 years of age and older.

Wet AMD versus dry AMD

Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula occurs rapidly.

With wet AMD, loss of central vision can occur quickly. Wet AMD is also known as advanced AMD. It does not have stages like dry AMD.

An early symptom of wet AMD is that straight lines appear wavy. If you notice this condition or other changes to your vision, contact your eye care professional at once. You need a comprehensive dilated eye exam.

Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye.

The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces. You may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected.
 

Normal vision and the same scene as viewed by a person with age-related macular degeneration. Normal vision
Normal vision   The same scene as viewed by a person with age-related macular degeneration
The same scene as viewed by a person with age-related macular degeneration

Causes and Risk Factors

Who is at risk for AMD?

The greatest risk factor is age. Although AMD may occur during middle age, studies show that people over age 60 are clearly at greater risk than other age groups. For instance, a large study found that people in middle-age have about a 2 percent risk of getting AMD, but this risk increased to nearly 30 percent in those over age 75.

Other risk factors include:

  • Smoking. Smoking may increase the risk of AMD.
  • Obesity. Research studies suggest a link between obesity and the progression of early and intermediate stage AMD to advanced AMD.
  • Race. Whites are much more likely to lose vision from AMD than African Americans.
  • Family history. Those with immediate family members who have AMD are at a higher risk of developing the disease.
  • Gender. Women appear to be at greater risk than men.
  • Aspirin. A new study links daily aspirin use to an increased risk of macular degeneration.16

Can my lifestyle make a difference?

Diet and lifestyle can play a role in reducing your risk of developing AMD.

  • Eat a diet high in green leafy vegetables and fish.
  • Don’t smoke.
  • Avoid daily aspirin use.16

Conventional Medical Treatment for Macular Degeneration

Wet AMD can be treated with laser surgery, photodynamic therapy, and injections into the eye. None of these treatments is a cure for wet AMD. The disease and loss of vision may progress despite treatment.

  1. Laser surgery. This procedure uses a laser to destroy the fragile, leaky blood vessels. A high energy beam of light is aimed directly onto the new blood vessels and destroys them, preventing further loss of vision. However, laser treatment may also destroy some surrounding healthy tissue and some vision. Only a small percentage of people with wet AMD can be treated with laser surgery. Laser surgery is more effective if the leaky blood vessels have developed away from the fovea, the central part of the macula. (See illustration at the beginning of this document.) Laser surgery is performed in a doctor’s office or eye clinic.

    The risk of new blood vessels developing after laser treatment is high. Repeated treatments may be necessary. In some cases, vision loss may progress despite repeated treatments.

     

  2. Photodynamic therapy. A drug called verteporfin is injected into your arm. It travels throughout the body, including the new blood vessels in your eye. The drug tends to “stick” to the surface of new blood vessels. Next, a light is shined into your eye for about 90 seconds. The light activates the drug. The activated drug destroys the new blood vessels and leads to a slower rate of vision decline. Unlike laser surgery, this drug does not destroy surrounding healthy tissue. Because the drug is activated by light, you must avoid exposing your skin or eyes to direct sunlight or bright indoor light for five days after treatment.

    Photodynamic therapy is relatively painless. It takes about 20 minutes and can be performed in a doctor’s office.

    Photodynamic therapy slows the rate of vision loss. It does not stop vision loss or restore vision in eyes already damaged by advanced AMD. Treatment results often are temporary. You may need to be treated again.

     

  3. Injections. Wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor.

    You will need multiple injections that may be given as often as monthly. The eye is numbed before each injection. After the injection, you will remain in the doctor’s office for a while and your eye will be monitored. This drug treatment can help slow down vision loss from AMD and in some cases improve sight.

Nutritional Treatment of Age-Related Eye Disease Study (AREDS)

Age-Related Eye Disease Study (AREDS)

The National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific high-dose formulation of antioxidants and zinc reduces the risk of advanced AMD and its associated vision loss by 25%, slowing AMD’s progression from the intermediate stage to the advanced stage.

 The specific daily amounts of antioxidants and zinc used by the study researchers were 500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene (often labeled as equivalent to 25,000 International Units of vitamin A), 80 milligrams of zinc as zinc oxide, and two milligrams of copper as cupric oxide. Copper was added to the AREDS formulation containing zinc to prevent copper deficiency anemia, a condition associated with high levels of zinc intake.

Can diet alone provide the same high levels of antioxidants and zinc as the AREDS formulation?

No. The high levels of vitamins and minerals are difficult to achieve from diet alone. However, previous studies have suggested that people who have diets rich in green leafy vegetables have a lower risk of developing AMD.

Can a daily multivitamin alone provide the same high levels of antioxidants and zinc as the AREDS formulation?

No. The formulation’s levels of antioxidants and zinc are considerably higher than the amounts in any daily multivitamin.

If you are already taking daily multivitamins and your doctor suggests you take the high-dose AREDS formulation, be sure to review all your vitamin supplements with your doctor before you begin. Because multivitamins contain many important vitamins not found in the AREDS formulation, you may want to take a multivitamin along with the AREDS formulation. For example, people with osteoporosis need to be particularly concerned about taking vitamin D, which is not in the AREDS formulation. 1

How to Make Vision Supplements Work Better

Many people who take the AERDS nutritional supplement formula do not benefit from it and the disease progresses. Only about 25% of study participants benefited. Also note that this formula often slows the advancement of the disease. Just because you don’t notice improvement doesn’t mean it isn’t working.

Some holistic physicians, myself included, have found that poor assimilation — especially a decrease of gastric acid function in the stomach — is an important factor in the development of AMD. No matter how many supplements one takes, if they are not assimilated, they are of no value.

It is probably no coincidence that the risk of AMD increases with age and so does the decline of stomach acid production. Contrary to popular belief, most people who experience “heartburn” actually have too little stomach acid, not too much. Find out how that happens in this article: What’s Burning You?

So, in addition to taking eye nutrients, improving digestion and assimilation is also highly recommended.

Dr. Myatt’s Recommendations for Macular Degeneration

  1. Diet: eat a diet high in antioxidant nutrients (especially green vegetables), high in Omega-3 fatty acids (from fish) and low in Omega-6 fatty acids.
  2. Gastric function: Perform a Gastric Acid Self-Test or ask your holistic physician to perform a Heidleberg gastric analysis. Make corrections to gastric acid function as indicated by the test.
  3. Vision supplements: The following are specifically recommended for macular degeneration:

    I) Maxi Multi– optimal potency multiple vitamin / mineral / trace mineral supplement. 3 caps, 3 times per day with meals.

    Vision was the same or better in 88% of people with AMD who took a multiple vitamin / mineral supplement compared with 59% of those who those who did not take the supplement. This is a statistically significant difference. The supplement used in this study contained beta-carotene, vitamin C, vitamin E, zinc, copper, manganese, selenium, and riboflavin. 2  Other studies have confirmed the importance of vitamins A, C, E, zinc and other nutrients found in a quality multiple vitamin/ mineral formula. 3,5 More recent studies have also shown the importance of B complex vitamins in AMD.4

    II.) Maxi Marine O-3: (high potency fish oil). 1 cap, 2 times per day. A diet high in omega-3 fatty acids, especially from fish oil, has been associated with lower risk of macular degeneration in multiple studies. 5-10

    III.)  Lutein Plus (lutein and zeaxanthin).  1 cap, 1-2 times per day with meals. Lutein and zeaxanthin are two carotenoids that act directly in the macula to protect it from damaging effects of excess light.  Along with vitamins C and E, they are part of the antioxidant defense system of the macula.11      

    Studies have shown that lutein and zeaxanthin reduce the risk of AMD and may slow progression. 3-5, 11-14
    Smokers have an increased need for these carotenoids. 14      

How Long to See Results?

One study suggests that it takes at least 6 months of supplementation to see results. 15
 

References

  1. www.nei.nih.gov
  2. Olson RJ. Supplemental dietary antioxidant vitamins and minerals in patients with macular degeneration. J Am Coll Nutr 1991;10:550.
  3. Krishnadev N, Meleth AD, Chew EY. Nutritional supplements for age-related macular degeneration. Curr Opin Ophthalmol. 2010 May;21(3):184-9.
  4. Olson JH, Erie JC, Bakri SJ. Nutritional supplementation and age-related macular degeneration. Semin Ophthalmol. 2011 May; 26(3):131-6.
  5. Ho L, van Leeuwen R, Witteman JC, van Duijn CM, Uitterlinden AG, Hofman A, de Jong PT, Vingerling JR, Klaver CC. Reducing the genetic risk of age-related macular degeneration with dietary antioxidants, zinc, and ω-3 fatty acids: the Rotterdam study. Arch Ophthalmol. 2011 Jun;129(6):758-66.
  6. Mance TC, Kovacević D, Alpeza-Dunato Z, Stroligo MN, Brumini G. The role of omega 6 to omega 3 ratio in development and progression of age-related macular degeneration.Coll Antropol. 2011 Sep;35 Suppl 2:307-10.
  7. Merle B, Delyfer MN, Korobelnik JF, Rougier MB, Colin J, Malet F, Féart C, Le Goff M, Dartigues JF, Barberger-Gateau P, Delcourt C. Dietary omega-3 fatty acids and the risk for age-related maculopathy: the Alienor Study. Invest Ophthalmol Vis Sci. 2011 Jul 29;52(8):6004-11. Print 2011 Jul.
  8. Sangiovanni JP, Agrón E, Meleth AD, Reed GF, Sperduto RD, Clemons TE, Chew EY; Age-Related Eye Disease Study Research Group. {omega}-3 Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30, a prospective cohort study from the Age-Related Eye Disease Study. Am J Clin Nutr. 2009 Dec;90(6):1601-7. Epub 2009 Oct 7.
  9. SanGiovanni JP, Chew EY, Agrón E, Clemons TE, Ferris FL 3rd, Gensler G, Lindblad AS, Milton RC, Seddon JM, Klein R, Sperduto RD; Age-Related Eye Disease Study Research Group. The relationship of dietary omega-3 long-chain polyunsaturated fatty acid intake with incident age-related macular degeneration: AREDS report no. 23. Arch Ophthalmol. 2008 Sep;126(9):1274-9.
  10. Seddon JM, Rosner B, Sperduto RD, Yannuzzi L, Haller JA, Blair NP, Willett W. Dietary fat and risk for advanced age-related macular degeneration. Arch Ophthalmol. 2001 Aug;119(8):1191-9.
  11. Fletcher AE. Free radicals, antioxidants and eye diseases: evidence from epidemiological studies on cataract and age-related macular degeneration. Ophthalmic Res. 2010;44(3):191-8. Epub 2010 Sep 9.
  12. SanGiovanni JP, Chew EY, Clemons TE, Ferris FL 3rd, Gensler G, Lindblad AS, Milton RC, Seddon JM, Sperduto RD. The relationship of dietary carotenoid and vitamin A, E, and C intake with age-related macular degeneration in a case-control study: AREDS Report No. 22.  Arch Ophthalmol. 2007 Sep;125(9):1225-32.
  13. Tan JS, Wang JJ, Flood V, Rochtchina E, Smith W, Mitchell P. Dietary antioxidants and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study.Ophthalmology. 2008 Feb;115(2):334-41. Epub 2007 Jul 30.
  14. Schweigert FJ, Reimann J. [Micronutrients and their relevance for the eye–function of lutein, zeaxanthin and omega-3 fatty acids]. Klin Monbl Augenheilkd. 2011 Jun;228(6):537-43. Epub 2010 Aug 25.
  15. Cangemi FE. TOZAL Study: an open case control study of an oral antioxidant and omega-3 supplement for dry AMD. BMC Ophthalmol. 2007 Feb 26;7:3.
  16. Paulus T.V.M. de Jong, Usha Chakravarthy, Mati Rahu, Johan Seland, Gisele Soubrane, Fotis Topouzis, Johannes R. Vingerling, Jesus Vioque, Ian Young, Astrid E. Fletcher. Associations between Aspirin Use and Aging Macula Disorder:The European Eye Study. Ophthalmology Volume 119, Issue 1 , Pages 112-118, January 2012

 

Magnesium Stearate: In Search of The Truth


An interview with  Dr. Dana Myatt, N.M.D.

Biography:
Dr. Myatt is a graduate of the National College of Naturopathic Medicine and has been in multi-disciplinary, full-scope family practice for 23 years. In addition to her nationwide family practice, she frequently speaks at medical and lay conferences across the country on topics in holistic medicine.  She is the founder and CEO of  Dr. Myatt Nutritionals, her own line of nutritional supplements since 1994.

Dr. Myatt is author of “A Physician’s Diary” (A.R.E. Press, 1994) and the upcoming “Ketone Zone Diet” .  She is a member of  The American Association of Naturopathic Physicians, the Arizona Naturopathic Medical Association, the American Academy of Anti-Aging Medicine and the American Society for Reproductive Medicine.  She is also a certified Advanced Hazmat Life Support provider and instructor.

Magnesium stearate, a common ingredient in many nutritional supplements, has gotten a bad rap from several nutritional supplement companies and online physicians.  One doctor has gone so far as to claim that it forms a deadly “biofilm” in the intestines and suppresses the immune system.  Since magnesium stearate is so widely used in the nutritional industry, we felt it important to carefully examine these claims.

 

After watching this thorough and completely scientifically referenced video by Dr. Dana Myatt on the subject, a nutritional supplement industry reporter named Jill requested an interview to learn the truth about magnesium stearate.

Here is that interview.

Jill: Dr. Myatt, what exactly is magnesium stearate and what is its role in nutritional supplements?

Dr. Myatt:  Magnesium stearate is a simple salt of two common substances, the mineral magnesium and the saturated fat stearic acid.  It is used as a “flow agent” in many nutritional supplements and pharmaceuticals.

Jill: Could you explain a bit more about magnesium stearate?

Dr. Myatt:  Magnesium stearate is a salt that contains two common ingredients, a fatty acid called stearic acid and the mineral magnesium. Together they form magnesium stearate.

Magnesium stearate contains two molecules of stearic acid and one molecule of magnesium.  The molecule is held together by ionic bonds — the definition of a salt — that break apart easily in acid, the condition found in the human stomach.  Though the name may make it sound like a synthetic, space-age molecule, both magnesium and stearic acid are abundantly available in many foods in our diet.  In order to really understand magnesium stearate, let’s look at its two components.

Magnesium is an essential mineral, the major mineral most likely to be deficient in the American diet. (1)  I don’t think anyone would argue the safety of magnesium.

Stearic acid is a saturated fatty acid found in many foods including eggs, chicken, grass-fed beef, coconut oil, walnuts, cheese, chocolate , salmon and human breast milk to name just a few. (2)

Both magnesium and stearic acid are not only safe, they are beneficial to human health. Magnesium stearate is simply a salt that combines both of these molecules.

Jill: What is a “flow agent” and why is it used?

Dr. Myatt:  Flow agents help ensure a consistent dose of product in each capsule. Magnesium stearate does this by preventing individual ingredients from sticking to each other and from sticking to the encapsulating machines.  It allows manufacturers to create a consistently homogenous mix, so the amount of active ingredients is the same from capsule to capsule or tablet to tablet.  In other words, the use of magnesium stearate and other flow agents helps ensure consistency and quality control.

Jill: Some companies claim to fame is that they do not use flow agents or other “inert ingredients.” Is that a good thing?

Dr. Myatt: This might sound good to consumers who do not understand the nuances of good supplement manufacturing practices,  so some companies use it as a selling point.

The truth, however, is that companies who don’t use flow agents are more likely to have inconsistent doses of ingredients in each capsule or tablet. This aspect of quality control is so important that the FDA is said to be considering the issue as part of their new GMP (Good Manufacturing Practices) guidelines.  If flow agents are added to the GMP’s, all manufacturers may be required to use flow agents to ensure consistency. Flow agents are that important for quality control.

Jill: Do most drugs, vitamins and supplements contain more than just the active ingredient? Can they be made without them?

Dr. Myatt:  Almost all drugs and supplements contain inactive ingredients. These “inactives” serve multiple purposes.  Flow agents, as we discussed, help ensure consistent dosing in each tablet or capsule. Some products contain fillers like cellulose which acts as a binder in tablets and helps fill out the size of tablets or capsules.

Herbs can be encapsulated and additional herb used as filler, so these products may contain only “actives.”

So yes, it is possible to make capsules or tablets without inactive ingredients, but quality control becomes more difficult.  Manufacturing without minute amounts of inactives is possible but drives the price of the supplement up unnecessarily.  There is no proven benefit to manufacturing without magnesium stearate except as a marketing angle.

Jill: One doctor claims that magnesium stearate suppresses immune t-cell function and causes the collapse of cell membrane integrity in helper t-cells.  Is there any scientific support for this?

Dr. Myatt: (laughing) Not unless you’re a mouse. This claim amuses me the most, because the doctor who promotes the idea that magnesium stearate is dangerous also promotes and sells a lot of foods that are high in steric acid, claiming it to be a healthy fat, which it is.

The entire argument is based on the gross misrepresentation of a single mouse study. Here’s the “Cliff notes”:

The entire claim is based on a single study—- that’s right, one study — performed in 1990, using mouse T-cells in a Petrie dish. When mouse T-cells were incubated (read that: “soaked” or bathed) with stearic acid — not magnesium stearate, but stearic acid — there was indeed a collapse of the cell membrane and a loss of T-cell function. (3) This study was never repeated.

But here’s the factoid that magnesium stearate naysayers conveniently “forget” to mention.  Mouse t-cells are known to lack the delta-9 desaturase enzyme that converts stearic acid into oleic acid. This was mentioned right in the same mouse-cell study.  Mouse T-cells can apparently become toxic from high levels of stearic acid, at least in a Petrie dish and at levels far above what could ordinarily be achieved from diet.

Human t-cells have the delta-9 desaturase enzyme that converts stearic acid to oleic acid, so human T-cells don’t develop this same toxic build-up when exposed to stearic acid. (4)

Bottom line: Mice lack an enzyme in their T-calls that humans have, so stearic acid is toxic to mouse T-calls and not to human T-cells. Stated another way: humans are not mice.

Jill: So… stearic acid isn’t bad for humans? What’s the difference between stearic acid and stearate?

Dr. Myatt: Stearic acid is a saturated fatty acid and one of the most common saturated fatty acids found in nature.(5) The term “stearate” is used when steric acid is part of a salt (as when stearic acid combines with magnesium to form magnesium stearate). The terms steric acid and stearate can be used interchangeably.

Jill:  But isn’t stearic acid or stearate toxic at some dose?

Dr. Myatt:  Water is toxic if the dose is high enough.

Anybody concerned about the minute amount of stearic acid in supplements should know the following:

  • The daily adult intake of stearic acid from food (US adult) averages about 7,000 mg/day.(6)
  • A person taking 20 vitamin capsules weighing 500 mg each and containing 1% magnesium stearate would take in less than 96 mg of stearic acid per day. Manufacturers typically use 0.25% – 5% magnesium stearate in nutritional formulations.
  • The amount of stearic acid from supplements in the above scenario is 1.3% of the total daily adult intake.
  • Magnesium stearate is considered safe for human consumption at levels below 2,500 mg/kg per day. This equates to 170,000 mg per day as a safe dose for a 150-pound adult.(7) That’s almost 6 ounces of pure magnesium stearate.

Jill: Got it. Magnesium stearate is magnesium plus stearic acid, correct?  Is there something about the two molecules that, once combined, makes it behave differently than the two separate molecules? In other words, is magnesium stearate actually different than magnesium and steric acid?

Dr. Myatt:  No, there is nothing special or different about magnesium stearate. It is a simple salt of magnesium and stearic acid. Here is the chemical “short course”:

Magnesium Stearate = 2 stearic acid + 1 magnesium

This salt disassociates (comes apart) readily in the acidic medium of the human digestive tract.

One claim I’ve seen is that the addition of magnesium stearate to supplements decreases bioavailability. What the studies actually show is that absorption might be slowed somewhat but overall absorption is not decreased. (8,9)

Jill:  Another claim is that magnesium stearate a chalklike substance that gums up your intestines and prevents absorption of your nutrients.  Fact or fiction?

Dr. Myatt: Fiction.

Magnesium stearate is definitely not a chalk. Chalks are soft, stone-like minerals, including things like gypsum (calcium sulfate) CaCO3 (calcium carbonate) and CaO (calcium oxide).  Remember that magnesium stearate is a salt, containing approximately 96% stearic acid, which is a saturated fat. The other 4% is magnesium. Chalks are combinations of minerals, but magnesium stearate is mostly saturated fat.

How could a fat be a chalk? It isn’t, not by any known scientific definition of a chalk.

Even if it were a chalk, you shouldn’t be worried about it gumming up your intestines or “caking the lining.” Why? Because if you did eat chalk, like calcium carbonate, which is a form of calcium used in many nutritional supplements, your digestive system would break it down to its mineral components. Human digestion is truly amazing.

By the way, I used to perform quite a few endoscopies in clinic. This is where you examine the lining of the large intestine with a special scope, looking for polyps. I never once saw anyone with a “caking of the lining” of their intestinal tract.  Tenacious, dry stool sometimes, yes. But “caking” with a chalk-like substance? Never. If this story about “caking the lining” is told by a doctor, it must be one who has never actually visualized the inside of the large intestine.

Jill: OK. No T-cell collapse in humans, no “caking of the lining” of intestines. How about the claim that magnesium stearate stimulates the gut to form a biofilm? And is a biofilm a sludge that would act as a barrier to the absorption of nutrients?

Dr. Myatt: There is not one single scientific reference or study to support this claim.  In fact, if you know what a biofilm is — and I’m going to tell you in just a minute — you’ll see that this entire argument is completely preposterous. It has no basis in any known science.

To clarify for those readers who haven’t seen it, this internet legend, promoted by a well-known doctor, says that a biofilm is basically like the “sludge in your toilet tank,” and that magnesium stearate causes this sludge and prevents nutrient absorption. Just as there is a big difference between a chalk and a fat, a biofilm is not akin to sludge, a.k.a. “soap scum” that you might find in your toilet tank.  By the way, I don’t have soap scum in my toilet tank. But I digress.

A toilet tank film or bathtub ring occurs when hard water, containing calcium or magnesium, reacts with fatty acid in soap to form a so-called “soap scum.” If you live in a hard-water area, you’ll see this as an annoying white film on your shower curtain.

Humans get significant amounts of magnesium, calcium and fatty acids — the ingredients in soap scum —from diet. But we don’t form soap scums in our bodies because of our digestive enzymes and acids. Further, soap scum is not biofilm — not even close.

We learned that soap scum is a mineral (usually calcium or magnesium) plus fatty acids. Humans eat both all day, every day and do not develop a “scum” in their intestines.

Biofilms are layers of bacteria or yeast embedded in the gel-like substance they secrete. They tend to be highly antibiotic-resistant and often fatal.  As to the claim that stearic acid causes biofilms, this is completely without any scientific evidence. In fact, several studies have shown just the opposite — stearic acid actually helps prevent the formation of biofilms. (10,11)

Jill:  Next claim.  Magnesium stearate made from contaminated oils from genetically engineered crops. True?

Dr. Myatt:  OK, let’s talk dirty. Magnesium stearate is most commonly sourced from cottonseed oil or palm oil and it’s true that cotton can be a GMO crop and is typically high in pesticides. But even if the starting cottonseed oil is contaminated, the finished product, stearic acid, is so highly purified that contamination really isn’t an issue. Cottonseed-derived stearic acid is so purified and the final molecule so far-removed from the original source, it doesn’t carry any pesticide residue. We might as well worry about the food-grade additive cellulose, which is also obtained either from wood waste (we call that “sawdust” out here in Arizona) or cotton waste (known as “gin trash,” — the waste cotton remaining in the cotton gin). (12)

Just like taking dirty water and purifying it into something clean and drinkable, purifying cottonseed oil to obtain stearic acid delivers a pure finished product.

And by the way, stearic acid can also be derived from palm oil, which many manufacturers, myself included, use as the source of their stearic acid.

Jill:   Is magnesium stearate often contaminated during processing, as one doctor claims?

Dr. Myatt:  Contamination during the manufacture of supplements or pharmaceuticals can occur anywhere along the entire manufacturing process.   That is why quality supplement manufacturers test raw materials before purchase; after purchase when they are received; after mixing and after encapsulating. Raw materials can occasionally become cross contaminated, and that’s why quality manufacturers employ so many tests and inspections all along the process.

Now, is magnesium stearate one of the substances more likely to be contaminated? Absolutely not. There is one reported instance of a raw materials manufacturer notifying the World Health Organization that several batches of magnesium stearate had been cross contaminated with zeolite (sodium aluminum silicate), calcium hydroxide, and several other substances. The contamination was determined to be due to incomplete cleaning of air milling equipment. This was traced to a single raw materials manufacturer and was an isolated event.  Moreover, WHO found the contaminating substances to be present in such minute amounts that they posed no health risk.  And this was self-reported by the manufacturer of the raw material before it was used in product.(13)

Jill:  Is magnesium stearate going to be removed from supplements by the Codex Committee on Food Additives?

Dr. Myatt:  No. The Codex Committee considered removing magnesium stearate from the acceptable food list, not because of any danger, but because they didn’t see the use for it in food. They were simply trying to trim up their list of allowed food additives.  When food manufacturers pointed out that magnesium stearate is an important and safe anti-caking agent, it was reinstated.  Removing magnesium stearate from Codex for use in nutritional supplements has never been considered as far as I can determine.

Magnesium stearate is currently approved by FDA regulations for use in food and supplements. (14,15)

Jill: Is there room for disagreement in the supplement industry on what is safe and effective?

Dr. Myatt:  (laughing) Is the Pope Catholic?

I don’t always agree with my colleagues in the nutritional supplement industry. Some ingredients and doses based on the scientific literature are arguable. With most issues in medicine, there is no black and white. There is instead, “ten thousand shades of gray.” In many instances, there is evidence on both sides of the question.

But the evidence is not “mixed” on the safety of magnesium stearate. The evidence says that magnesium stearate, a simple salt of magnesium and stearic acid, is a safe and effective flow agent that helps maintain dose consistency, and there really isn’t any evidence to the contrary.  At least I haven’t found any, and I’ve looked long and hard at these claims because I, too, manufacture nutritional supplements and use magnesium stearate as a flow agent.  So I had to know if any of these claims had even a shred of basis in fact. They don’t.

That’s not to say that new evidence won’t emerge, but right now, the damning claims for magnesium stearate are completely without scientific verification or substantiation.

Jill:  Dr. Myatt, you have completely dismantled the “danger claims” of magnesium stearate, all supported with verifiable references.  Why would some companies and doctors make these claims if they have no basis in fact?

Dr. Myatt: There is a lot of competition in the nutritional industry today. Everybody and their brother is selling supplements, or so it seems. Companies must distinguish themselves in order to get a toe-hold in the industry. Think about it.

If 537 other companies are selling a calcium supplement, why should you buy mine? Everybody is looking for a unique selling angle.  “More bioavailable,” “72% more absorbable,” “nano-technology,” and on and on. Some of these claims have merit, but many are just marketing hype.

One “angle” is to claim that magnesium stearate is dangerous, bad, or evil — never mind the proof aspect. To paraphrase the movies, “We don’t need no stinking proof”!  And since the majority of manufactures who use magnesium stearatedo so because it is one of the absolute safest and best flow agents, claiming that it is bad and then making a supplement without it is a marketing strategy, nothing else.  Considering how few people do their “homework” on such claims — witness how these many unsubstantiated claims about magnesium stearate are now accepted “facts” in the minds of many — the technique is probably  fairly effective as a marketing tool.  But in my opinion this is not simply “misrepresentation.” Someone is telling outright lies.

Jill: (laughing) Wow — don’t hold back, Dr. Myatt. Why don’t you tell us what you really think?! Do you have any parting thoughts for our readers?

Dr. Myatt: Don’t believe something just because you read it, heard it or learned it at the University of Google. Check references. See if there is known science or studies to support claims.  Blind sheep can easily be led off a cliff.

Also, use supplements from manufacturers that you have researched and trust.  There are a number of quality manufacturers who are just as concerned with providing pure and health-giving products as they are with their bottom line and who believe that quality is the best way to stay in business.

Jill: Thank you Dr. Myatt for this most informative and, dare I say, entertaining Q & A.

Dr. Myatt: It’s always a pleasure to help set the scientific record straight.

References:

1.) National Institutes of Health, Office of Dietary Supplements: Magnesium.
http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
2.) USDA National Nutrient Database for Standard Reference, Release 24
3.) Tebbey PW, Buttke TM. Molecular basis for the immunosuppressive action of stearic acid on T cells. Immunology. 1990 Jul;70(3):379-84.  Full Text article: NCBI
4.) Anel A, Naval J, González B, Uriel J, Piñeiro A. Fatty acid metabolism in human lymphocytes. II. Activation of fatty acid desaturase-elongase systems during blastic transformation. Biochim Biophys Acta. 1990 Jun 14;1044(3):332-9.
5.) Dietary Supplement Fact Sheet. Office of Dietary Supplements, National Institutes of Health. http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional
6.) U.S. Department of Agriculture, Agricultural Research Service. What we eat in America,
NHANES 2001-2002, individuals 2 years and over (excluding breast-fed children).www.ars.usda.gov/SP2UserFiles/Place/12355000/pdf/Table_1_BIA.pdf., page 5. Accessed 06/28/12
7.) Søndergaard D, Meyer O, Würtzen G. Magnesium stearate given perorally to rats. A short term study.Toxicology. 1980;17(1):51-5.
8.) Alija Uzunović, Edina Vranić; “Effect Of Magnesium Stearate Concentration On Dissolution Properties Of Ranitidine Hydrochloride Coated Tablets”; Bosnian Journal Of Basic Medical Sciences, 2007, 7(3): 279-283
9.)  Natalie D. Eddington, Muhammad Ashraf, Larry L. Augsburger, James L. Leslie, Michael J. Fossler, Lawrence J. Lesko, Vinod P. Shah, Gurvinder Singh Rekhi; “Identification of Formulation and Manufacturing Variables That Influence In Vitro Dissolution and In Vivo Bioavailability of Propranolol Hydrochloride Tablets”; Pharmaceutical Development and Technology, Volume 3, Issue 4 November 1998 , pages 535–547
10.) Soni KA, Jesudhasan P, Cepeda M, Widmer K, Jayaprakasha GK, Patil BS, Hume ME, Pillai SD. Identification of ground beef-derived fatty acid inhibitors of autoinducer-2-based cell signaling. J Food Prot. 2008 Jan;71(1):134-8.
11.) Liaw SJ, Lai HC, Wang WB. Modulation of swarming and virulence by fatty acids through the RsbA protein in Proteus mirabilis. Infect Immun. 2004 Dec;72(12):6836-45.
12.) USDA. Cellulose. www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELPRDC5066975
13.) World Health Organization Quality of Medicines for Everyone, Contaminated magnesium stearate VG EP excipient manufactured by Ferro, supplied by Signet and used in finished pharmaceutical products, December 22, 2011. http://apps.who.int/prequal/info_press/documents/Mg-Stearate_InformationNote_Dec2011.pdf
14.) Food and Drug Administration, CFR – Code of Federal Regulations Title 21, accessed Sept. 10, 2012.
15.) Food and Drug Administration, Select Committee on GRAS Substances (SCOGS) Opinion: Magnesium stearate, accessed Sept. 10, 2012

Maxi Fiber™

 

Maxi FiberFormulated By
Dr. Myatt To Be
The Best-Tasting,
Most Complete
Fiber Available

Maxi Fiber is once again temporarily unavailable – sorry!

Fiber is one of the most important components of a healthy diet, but few of us get enough for optimal health.

  • Fiber Complex™ is a great-tasting, easy to use blend that provides the full spectrum of fibers found in a nutritious, whole food diet such as gums, pectins, mucilages, and lignans.
  • Fiber Complex™ contains both soluble and insoluble fiber for digestive, heart health and glucose-regulating benefits.
  • Fiber Complex™ is suitable for everyday use, since it contains no laxative herbs.
  • Fiber Complex™ mixes easily, without becoming gritty or thick
  • Fiber Complex™ is hypoallergenic: no corn, soy or gluten, and no artificial flavors, colors or sweeteners.

People on the standard American diet often do not consume the recommended fiber intake per day. The standard American diet consists mostly of refined and processed foods that are literally stripped of their natural fiber content. A fiber intake of 38 grams a day for men and 25 grams per day for women is the recommendation for people under 50 years old. If you are above the age of 50, men and woman should be consuming 14 grams of fiber for every 1,000 calories.

Fiber is the component of food that is either minimally digested or in most instances not digested at all. The positive health effects of fiber are well documented. Some researchers suggest that low fiber diets are a major contributor of the chronic health problems seen in America today.

Fiber is described as either being soluble or insoluble, with each having different properties that are beneficial to your health. Soluble fiber helps modulate blood cholesterol levels, blood glucose levels and reduce the risk of heart disease. Soluble fiber is traditionally found in oats, apples, pears and legumes. Insoluble fiber typically is only minimally digested and adds the necessary bulk that speeds up the digestive system which reduces transit time and promotes regularity. It also aids in reducing toxins that can potentially be absorbed through decreasing the transit time. Insoluble fiber is traditionally found in foods like bran, whole grains, certain fruits and vegetables.

Fiber Complex™ offers a good tasting solution that can be used to supplement the diet, and help those that are striving to improve their nutritional intake and meet the recommended levels.

Maxi Fiber for Health

Maxi Fiber Supplement Facts

Larch (Larix occidentalis)


Natural Anti-Metastatic and Immune Stimulant

Larch ArabinogalactansLarch is a deciduous conifer that contains an arabinogalactan similar to those found in other “immune-enhancing” herbs such as Echinacea, Baptisia and Turmeric.

Larch arabinogalactans have been shown to reduce the number of liver metastasis in multiple studies, perhaps by acting as a “reverse lectin” and blocking tumor binding sites. A similar effect has been noted for Modified Citrus Pectin. Larch also nourishes the gut flora and acts as a source of dietary fiber. A summary of the benefits of Larch are:

  • stimulates the immune system
  • helps prevent cancer metastasis
  • improves bowel flora (friendly gut bacteria)
  • acts as a source of dietary fiber

Larch and/or Modified Citrus Pectin should be considered by anyone with cancer to help prevent or delay metastasis.

Suggested Dose: two teaspoons, 2-3 times per day. This may be added to your Super Shake.

REFERENCES

1.) Hagmar B, Ryd W, Skomedal H. Arabinogalactan blockade of experimental metastases to liver by murine hepatoma. Invasion Metastasis 1991;11:348-355.
2.) Beuth J, Ko HL, Oette K, et al. Inhibition of liver metastasis in mice by blocking hepatocyte lectins with arabinogalactan infusions and D-galactose. J Cancer Res Clin Oncol 1987;113:51-55.
3). Beuth J, Ko HL, Schirrmacher V, et al. Inhibition of liver tumor cell colonization in two animal tumor models by lectin blocking with D-galactose or arabinogalactan. Clin Exp Metastasis 1988;6:115-120.
4). Hauer J, Anderer FA. Mechanism of stimulation of human natural killer cytotoxicity by arabinogalactan from Larix occidentalis. Cancer Immunol Immunother 1993;36:237-244.

 

LBC-LAX


Aid Constipation with this Superior Bowel-Toning Formula

LBC-Lax - A Superior Formula To Aid Constipation And Tone The BowelConstipation is no fun, and it’s not healthy for the body either. Although LBC-LAX used alone is a laxative formula, used with fiber according to my instructions it becomes part of a “bowel re-education” and toning program.

When used as part of my bowel protocol, this formula will NOT cause laxative dependence.

Each (one) capsule contains: Cascara sagrada 95 mg in a proprietary base of Barberry root bark, fennel seed, Ginger root, Goldenseal root, Lobelia, Red raspberry leaves, Turkey Rhubarb root and Cayenne.

LBC-Lax is no longer available – Dr. Myatt now recommends 3A Magnesia to her patients.

 

IMPOTENCE (ERECTILE DYSFUNCTION, ED)


Natural Support For This Distressing Condition

Erectile dysfunction (ED), also called impotence, is the inability to achieve and maintain an erection. The cause may be psychogenic (mental/emotional) or physical. More than 90% of the cases are due to physical causes. In men over age 50, a leading cause of impotence is due to atherosclerosis. Many medications can cause loss of erectile ability.

DIET AND LIFESTYLE RECOMMENDATIONS

  • Exercise regularly. Exercise improves blood flow.
  • Don’t smoke. Smoking reduces blood flow to the penis by constricting arteries.
  • Avoid excess alcohol. Alcohol alters hormone balance in males, tending to increase estrogens.

PRIMARY SUPPORT

  • Maxi Multi: 3 caps, 3 times per day with meals. Optimal (not minimal) doses of vitamins A, E, B6, and zinc are particularly important for correcting ERD.
  • Omega 3 fatty acids:
    Flax seed meal, 2 teaspoons per day with food
    OR
    Flax seed capsules: 2-4 caps, 3 times per day (target dose range: 6-12 caps per day)
    OR
    Flax seed oil: 1 tablespoon per day
    OR
    Max EPA (Omega-3 rich fish oil): 1-2 caps, 3 times per day with meals (target dose: 3-6 caps per day).

With arteriole insufficiency (decreased blood supply)

  • Ginkgo: 1 cap, 3 times daily

With decreased libido

  • Korean Panax Ginseng: 1 cap, 2 times per day. (target dose: 15 mg ginsenosides per day)

ADDITIONAL SUPPORT

  • If cholesterol is high: see recommendations for High Cholesterol.
  • If diabetic; see recommendations for Diabetes.
  • Support any organ system that scored high on the self-appraisal questionnaire found on pages 6-8 in your Holistic Health Handbook.

TESTS

A cardiovascular evaluation should be performed as part of a complete physical examination. A male hormone profile should be performed so that imbalances can be corrected. Consultation with an alternative medicine physician is highly advisable, since ED is both a health problem AND reflects underlying additional health imbalances.