Anemia – Healthy.net

Dangers of Iron Supplements

Leo Galland MD FACN — Wed, 06 Dec 2000 13:28:52 +0000

Iron is unique among essential minerals, because there is no mechanism for its excretion once absorbed into the body. Whatever iron is absorbed must either be used or stored and excessive storage of iron in the body promotes the generation of free radicals. Excess dietary iron has been implicated by some scientists as a cause of cancer and heart disease. It also increases the risk of bacterial infection.

Except for the lactic acid bacteria like Lactobacilli, all microbes require iron for growth. Many of them produce special binding proteins to secure iron from their environments. Humans also produce iron-binding proteins which have as their role the capture of free iron so that microbes can’t use it. An excess of iron overcomes this protective mechanism and in-creases susceptibility to bacterial infection. The amount of iron needed for optimal health reflects a delicate balance between deficiency and excess.

The best known effect of iron deficiency is anemia, which is the name given to a state in which the number of red blood cells is lower than normal. Anemia is not the same as iron deficiency, however. There are many different causes of anemia, which include folic acid deficiency, vitamin B12 deficiency, disorders of the bone marrow and conditions which increase the rate at which red blood cells are broken down in the spleen. Iron deficiency, when mild, may not produce anemia but may still cause fatigue, im-mune de-fects or fungal infections of skin. There are probably twenty million people in the U.S. who are iron deficient and half of them are not anemic. Wom-en with chronic fatigue and mild iron deficiency who are not anemic improve their energy after taking low doses of iron. Twenty milligrams per day is all that’s needed, no more. Low-dose iron supplements can cure people with recurrent boils on the skin, but only if those people have mild iron deficiency. Presumably, correcting iron deficiency improves metabolism and immunity.

It is unfortunate that most commercial iron pills contain sixty to three hundred milligrams of iron, far more than are needed or than can even be absorbed from a single pill. High dose iron supplements, taken orally or by injection, increase susceptibility to bacterial infec-tion. Studies in southeast Asia and in Africa demonstrate that even low-dose iron can be harmful. When Indonesian school children who are not iron deficient take iron pills, they fail to grow normally. When iron supplements are given to Somali nomads or Masai tribes-man, their rate of infection increases, even though their iron deficiency is corrected. The high frequency of negative responses to iron supplements in Africa and Asia may reflect the interaction between iron and zinc.

Iron in food or pills interferes with zinc absorption and supplemental iron can aggravate zinc deficiency. The recommended daily allowance for zinc (RDA) is based on the assumption that forty per cent of the zinc that is swallowed is absorbed into the body. Actually, zinc absorption is only seventeen to thirty-five per cent and depends upon what is eaten along with zinc. Starch and fiber interfere with zinc absorption, as do calcium and iron. Lack of stomach acid, which may be caused by infection or acid-lowering drugs, also interferes with zinc absorption. Zinc deficiency is common in Africa and Asia, where people consume large quantities of milk, which is high in calcium and low in zinc, and of starches and fibres which inter-fere with zinc absorption. Zinc deficiency profoundly depresses immunity and administering iron to a zinc-deficient person is extremely risky. Not only does iron stimulate bacterial growth, but, by aggravat-ing zinc deficiency, it weakens the immune system of the person being supplemented.

No one should ever take iron supplements unless iron deficiency is present, with the possible exception of pregnant women. The best test for iron deficiency is a blood test called the serum ferritin level. Ferritin is a protein that carries iron, and low ferritin levels are a common sign of iron deficiency. Like all laboratory tests, the interpretation of ferritin levels is subject to interpretation. Because the body has a limited capaci-ty for iron absorption, it does not make any sense to administer more than twenty milligrams of elemental iron at a time. Iron should not be taken as part of a multivitamin or multimineral preparation. Iron interferes with the absorption of the essen-tial minerals zinc, manganese and molybdenum; it destroys vitamin E; its own absorption is blocked by calcium and magnesium. Iron is best absorbed after a meal, with a small quantity of vitamin C (between one hundred and five hundred milligrams).

Motherwort

David L. Hoffmann BSc Hons MNIMH — Wed, 06 Dec 2000 13:28:02 +0000

Leonurus cardiaca

Labiatae

Names: Lion’s Tail.

Habitat: Throughout Europe and occasionally in Britain.

Collection: The stalks should be gathered at the time of flowering, which is between June and September.

Part Used: Aerial parts.

Constituents:

Iridoids: leonuride and others not yet identified
Diterpenes of the labdane type, such as leocardin, a mixture of two epimers of 8[[beta]]-acetoyx-9[[alpha]], l3[[alpha]], l5, l6-bisepoxy-l5-hydroyx-7-oxo-labdan-6[[beta]], l9-olide
(This is why shorter names are coined!)
Flavonoids; rutin, quinqueloside, genkwanin, quercitin, quercetrin, isoquercetrin, hyperoside, and apigenin and kaempferol glucosides
Caffeic acid 4-rutinoside.

Actions: Nervine, emmenagogue, anti-spasmodic, hepatic, cardiac tonic, hypotensive.

Indications: The names of this plant show its range of uses. `Motherwort’ shows its relevance to menstrual and uterine conditions whilst`cardiaca’ indicates its use in heart and circulation treatments. It is valuable in the stimulation of delayed or suppressed menstruation, especially where there is anxiety or tension involved. It is a useful relaxing tonic for aiding in menopausal changes. It may be use to ease false labor pains. It is an excellent tonic for the heart, strengthening without straining. It is considered to be a specific in cases of tachycardia (heart palpitations), especially when brought about by anxiety and other such causes. It may be used in all heart conditions that are associated with anxiety and tension. Chinese research referred to in Potters Cyclopedia found that it both reduced blood platelet aggregation and decreased levels of blood lipids.

Priest & Priest tell us that it is “diffuse, stimulating and relaxing, an antispasmodic nervine: indicated for reflex conditions affecting cardiac function, and as a simple cardiac tonic. It also influences pre-menstrual nerve tension and muscular rigidity.” They give the following specific indications: anaemic nervousness and insomnia; palpitations, cardiac weakness after infections; neurosis; hyperthyroid cardiac reactions; P.M.S., congestive amenorrhoea or dysmenorrhoea.

Ellingwood considered it specific for “suppressed lochia from any cause, amenorrhoea from cold; dysmenorrhoea, with morbid nervous excitability and hysteria.” He says it may be used with value in cases of: delirium tremens, typhoid state in fevers, chronic disease with wakefulness, restlessness, disturbed sleep, spinal irritation, neuralgia of the stomach and head, feeble digestion, general debility, chorea, convulsions, nervousness from irregular menstruation, palpitation of the heart, pain in the pelvic and lumbar regions in females.

Combinations: May be freely combined in any prescription, especially with Hawthorn.

Preparations & Dosage: Infusion: pour a cup of boiling water onto l-2 teaspoonfuls of the dried herb and leave to infuse for l0-l5 minutes. This should be drunk three times a day. Tincture: take l-4ml of the tincture three times a day.

Discomforts of Pregnancy

David L. Hoffmann BSc Hons MNIMH — Wed, 06 Dec 2000 13:28:02 +0000

The First Trimester

Threatened Miscarriage

For many who have suffered miscarriage in the past, herbs may prove effective
in preventing this from happening again, provided that the foetus is normal
and general health, physical, emotional and mental, is good. No herbal remedy
will block appropriate miscarriage. Most cases of miscarriage are a natural
rejection of a malformed foetus. When it occurs more than once in the same
woman, it may be related to a problem on her part, rather than the baby’s.
In this case it is especially important to build up her general health as
well as that of her partner before they attempt to conceive again. To ensure
fewer complications, women should take longer at least six to twelve months
between pregnancies

Where chronic poor health, inadequate diet, or trauma and stress of any
kind have depleted general strength, herbs can provide extra strength and
vitality, especially to the womb, and so help avoid unnecessary miscarriage.

If abdominal cramping pains and bleeding occur, medical attention is
needed immediately.

Specific Remedies

A number of plants have well deserved reputations in preventing miscarriage.
It may be significant that two of them are now endangered species. Important
plants are listed here, with the endangered ones in bold type:

Caulophyllum thalictroides (Blue cohosh)

Chamaelirium luteum (False unicorn root)

Cypripedium pubescens (Lady’s Slipper)

Dioscorea villosa (Wild yam)

Viburnum opulus (Cramp Bark)

Viburnum prunifolium (Black Haw)

Other plants that have been widely used to prevent miscarriage include Rosemary,
Raspberry leaves, Hawthorn, Partridge Berry, Ginseng, Motherwort, Garlic
and Fenugreek.

One Possible Prescription

Viburnum prunifolium 2 parts

Cimicifuga racemosa 2 parts

Caulophyllum thalictroides 1 part 2.5 ml of tincture three times
a day, building up to 5 ml. three times day

This supplies the following actions :

Uterine tonic (Viburnum prunifolium, Cimicifuga racemosa,
Caulophyllum thalictroides)

Nervine relaxant (Viburnum prunifolium, Cimicifuga racemosa)

Anti-spasmodic (Viburnum prunifolium, Cimicifuga racemosa, Caulophyllum
thalictroides)

Broader Context of Treatment

Plenty of foods containing vitamins E and C should be eaten. Asparagus and
celery are said to be strengthening.

Nausea, Vomiting (Morning Sickness)

It is seen in about 50% of pregnancies, and tends to be worse with each
successive pregnancy. In most cases it will subside at the fourth month
of pregnancy. The exact cause of is not known but there are various theories
associated with it. Two important ones are:

1. The rapid change of hormone levels in early pregnancy, with resultant
high levels of progesterone, may be related due to a stimulation of the
vomit center in the brain. Progesterone relaxes the smooth muscle throughout
the body, including that found in the arteries, and this produces a drop
in blood pressure, which may account for the tiredness and lethargy associated
with the nausea and sickness. During the first l2-24 weeks of the pregnancy,
when most women experience sickness, the hormones are mostly produced in
the corpus luteum in the ovaries. After this time the emphasis changes towards
production of hormones from the placenta, possibly explaining why the sickness
stops at around the time of the change over, l2-l4 weeks. Sickness could
also be related to low blood pressure, especially with a relative lack of
blood getting to the brain on rising which is caused by high progesterone
levels. Getting up slowly will help to relieve this.

2. It may also be associated with low blood sugar, which normally occurs
in early pregnancy. The nausea is often relieved through raising blood sugar
levels by eating small, frequent meals. This should not have a high sugar
concentration as sugar in the stomach can aggravate nausea.

Specific Remedies

There are no general rules for treating morning sickness, as the causes
vary from one woman to another. Treatment should aim at what is seen as
the underlying cause. Anti-emetics are important as they will reduce the
vomit reflex whatever the cause. Valuable anti-emetics that are safe to
use in early pregnancy include:

Ballota nigra (Black Horehound)

Filipendula ulmaria (Meadowsweet)

Gentiana lutea (Gentian)

Rosemarinus officinalis (Rosemary)

Many of the herbs which aid digestion will help. The carminative, anti-spasmodic
and relaxing nervines are especially important. Examples include:

Cinnamomum aromaticum (Cinnamon bark)

Dioscorea villosa (Wild Yam)

Eugenia spp. (Cloves)

Foeniculum vulgare (Fennel seeds)

Humulus lupulus (Hops)

Lavandula spp. (Lavender)

Matricaria recutita (Chamomile)

Melissa officinalis (Balm)

Mentha piperita (Peppermint)

Rubus idaeus (Raspberry leaves)

Zingiber officinale (Ginger root)

Mucilage rich demulcents such as Chondrus crispus (Iceland Moss)
and Ulmus fulva (Slippery Elm) will soothe the whole of the digestive
tract. They are both highly nutritious containing many minerals and trace
elements and easily digested, ideal for conditions associated with weakness
of the stomach.

One Possible Prescription

Zingiber officinalis

Dioscorea Villosa

Ballota nigra equal parts 2.5 ml of tincture at night and in morning
building up to 5 ml. if needed

Mentha piperita

Matricaria recutita equal parts of dried herb to make an infusion

1 teaspoonful to a cup.

Broader Treatment Considerations

Eat small meals all day rather than three large meals.
Avoid certain foods or odors that bring on symptoms.
Small starch snacks such as eating crackers in bed before arising.
100-300mg of B6/day.
Maintain electrolyte balance if vomiting is severe.

Constipation

Progesterone relaxes the intestinal muscles and so reduces their power to
propel the contents of the bowel towards the rectum and out of the body.
As pregnancy progresses, and the weight of the baby and placenta increases,
the tendency to constipation is aggravated by the pressure exerted by these
on the lower bowel. When the enlarged uterus impedes the circulation to
the bowel, the action of the intestinal muscles is also restricted, as it
is by any tension or anxiety which a pregnant woman experiences. Intake
of iron as a supplement exacerbates or can cause constipation. Eating small
starchy meals consisting of refined flour also contributes to the
problem.

For more details about the herbal treatment of constipation please refer
to that section in the digestive system.

DO NOT USE ANTHRAQUINONE CONTAINING STIMULANT LAXATIVES.

Please consult the section on constipation. Aim for gentle therapy, utilizing
the following treatment considerations:

Increase water intake to 8 glasses per day.

Increase exercise, walk 1/2 mile per day.

Increase intake of fresh fruits and some dried fruits such as prunes, raisins,
figs.

Increase roughage.

Bulk laxatives such as Psyllium seeds (1 tablespoonful 3 times a day in
1/4 cup juice).

Varicosities

These may occur early in pregnancy but generally get worse as the pregnancy
advances. Symptoms vary from painless cosmetically problematic regions to
mild or severe pain. Sometimes there may be a varicosity in the labia majora.
For more details on the herbal treatment of varicosities please refer
to the section in the Cardio-Vascular chapter.

Fatigue and Somnolence

It is normal for some pregnant women to require excessive periods of rest
or sleep during the first trimester. Sleep requirements can be as much as
18 hours per day. If the woman is not working or going to school and does
not have young children it is advisable to sleep whenever possible. Some
women become depressed at their inability continue the normal daily activity
levels established before the pregnancy. Women should be counseled that
this symptom usually remits totally by the fourth month of gestation. Blood
studies should be checked to rule out anemia. Sometimes ingestion of protein
will alleviate this symptom.

Avoid herbal stimulants, neurological of metabolic.

Anaemia

The prevention of anaemia is a most important aspect of ante-natal care.
Haemoglobin, the iron and protein compound contained in red blood cells
(erythrocytes), is responsible for transporting oxygen from the lungs around
the body including (of course) both placenta and foetus. If haemoglobin
levels in the blood fall, so the body’s ability to access oxygen falls accordingly.

During pregnancy the blood volume increases at a faster rate than the erythrocytes
multiply, so they are diluted by extra fluid. There is a relative drop in
haemoglobin carried by the erythrocytes of about 1 gm to approximately 11
gms. Below this level anaemia is said to exist, and may be identified by
lethargy, irritability and breathlessness on slight exertion. Anaemia commonly
occurs in the last two months of pregnancy, when the baby takes a high proportion
of the mother’s iron. It helps to build up iron reserves before pregnancy
starts, so that the mother meets the increased iron demands without any
problems. A history of menorrhagia would also suggest iron reserves might
be low.

The best approach is to increase dietary intake of iron-containing foods.
These include:

liver (best only from organically produced meat, as the liver is
the detoxifying organ of mammals, and may contain residues of chemicals
if it was factory reared),

free range eggs,

dairy produce,

watercress,

dried apricots,

whole-wheat bread,

cocoa and carob,

cabbage,

alfalfa,

beetroot,

cherries,

currants and raisins,

brown rice,

kelp,

wheatgerm,

sunflower seeds,

parsley,

chicory,

lentils.

blackcurrants, blackberries, strawberries

spinach

Leafy herbs that can be added to salads or cooked as a vegetable and added
to soups include :

Crataegus spp. Hawthorn flowers and leaves.

Rumex acetosella Sorrel

Symphytum officinale Comfrey leaves (in moderation)

Taraxacum officinale Dandelion leaves

Urtica dioica Nettles

Herbs which contain valuable levels of iron include :

Arctium lappa Burdock leaves

Gentian lutea Gentian

Crataegus spp. Hawthorn

Humulus lupulus Hops

Rubus idaeus Raspberry leaves

Scutellaria spp. Skullcap

Verbena officinalis Vervain

Rumex crispus Yellow Dock

All iron-containing foods are better absorbed in the presence of an animal
protein. Vitamin C also enhances iron absorption. Watercress, Rose hips,
Blackberries, Blackcurrants, Elderberries, Parsley, Spinach, Dandelion leaves
(the list is endless) all contain both iron and vitamin C, and natural iron
never causes constipation.

Dizziness

This is common in pregnancy due to relaxation of the blood vessel walls
by progesterone. It is a form of postural hypotension. However, this does
not call for hypertensives such as Scot’s Broom as such herbs may be too
strong for both mother and foetus. More frequently seen in early pregnancy.

Change positions slowly.
Eat small meals rather that 3 large meals.
Maintain blood sugar level.

Heartburn

This is one of the most common complaints of pregnancy, caused by reflux
of gastric contents into the esophagus due to back pressure. The treatment
approach is discussed in the section on gastritis and reflux in the Digestive
System chapter.

The relaxing effects of progesterone reach the cardiac sphincter, the valve
guarding the entrance to the stomach at the bottom of the oesophagus. As
a result of this, as the enlarging uterus pushes up against the stomach,
small amounts of the stomach’s contents are passed into the lower oesophagus.
Hydrochloric acid mixed with the stomach contents irritate and burn the
oesophagus, and result in an inflammatory process. In more extreme cases,
parts of the stomach itself can be pushed up through the diaphragm or into
the oesophagus, and cause some degree of hiatus hernia.

Bleeding Gums

Frequently seen in pregnancy. Gingival hypertrophy is also seen in 40% of
pregnancies. Follow the topical advice given for gingivitis but not
the internal treatment.

Brush gums frequently with a soft brush.
Vitamin C and bioflavonoids complex to 2000mg daily

Headache

Seen in early pregnancy and worse between 3 and 5 months. A few cases may
result from eye strain as pregnancy can result in a change in the amount
of refractive error. Some cases result from sinusitis. Frontal headaches
are seen with hypertension. Please refer to the section on headaches
in the Nervous System chapter.

Vaginal Infections

These are discussed in the chapter on immunity and infections.

Hemorrhoids

May occur for the first time during pregnancy or the pregnancy may exacerbate
an already existing condition. This is caused by increased pressure and
impairment of return of venous fluid in the hemorrhoidal veins by the pressure
of the enlarging uterus. Constipation makes the problem worse. Congestion
of liver function caused by intake of junk foods, refined flour and alcohol
encourage the problem as the hemorrhoidal veins are part of the portal drainage
system.

The treatment approach is discussed in the section on hemorrhoids in
the Digestive System chapter.

Discomforts of Pregnancy: The Second and Third Trimesters

Stretch Marks

Genetic predisposition is the predominant factor in the development of stretch
marks. When new the marks resemble purple striae, and after a period of
time they revert to silvery cicatrix. They occur when the skin is stretched
beyond normal capacity and elasticity, in this case related to progesterone
and rapid weight gain. The tendency to develop stretch marks can be reduced
by eating appropriately and using remedies to address the collagen problems
in the skin.

Vitamins E, C and B5 (pantothenic acid) can help as well as Zinc. These
can all be obtained from the diet. The following are recommended in Herbs
for Pregnancy and Childbirth by Anne McIntyre:

Sunflower seeds and oil, pumpkin seeds, wheatgerm, onions, eggs,
lettuce, cucumber,

cabbage, radishes, horseradish, rice bran, asparagus, parsnips,

brewer’s yeast, whole grains, fish, alfalfa, molasses.

Wheatgerm or vitamin E oil massaged into the breasts, abdomen and thighs
daily will reduce the likelihood of marks developing. Calendula oil
mixed with wheatgerm oil is especially helpful.

Backache

High levels of progesterone during pregnancy affect the tendons and ligaments
throughout the body, having a softening effect which allows them to expand
where necessary to accommodate the growing baby. This affects the spine
particularly, and the relaxation of the ligaments supporting the spine plus
the weight of the growing abdomen pulling on it often causes backache. The
characteristic posture adopted by quite heavily pregnant mothers, leaning
backwards, places added strain on the lower joints of the spine.

Bad posture will aggravate this. Too much exercise or bending the wrong
way will certainly not help, and a rapid weight gain in pregnancy may bring
out symptoms of previous damage to the back as increasing strain is imposed
upon it. Yoga exercises may be helpful, with the certain asanas being recommended
by experts. Rest is important to prevent or relieve backache, especially
in the last three months. Deep breathing and relaxation exercises also help.
Baths with Lavender and Rosemary can help soothe the pain. Massage of the
whole spine with a mixture of Chamomile and Geranium oil can be effective.

Hypertension

Gestational hypertension is characterized by a steady rise in blood pressure
after the 28th week of gestation. The general rule for the upper limit of
gestational hypertension is 140/90. It may be caused by:

Emotional and physical stress.
Obesity.
Lack of exercise.
Drugs and stimulants.
Diet including processed & heavily salted carbohydrates with inadequate
protein intake.

Herbal treatment can do much to mitigate this form of secondary hypertension,
but the blood pressure must be monitored closely as it may rise dangerously
fast in some situations. Please refer to the section on hypertension in
the chapter on the cardio-vascular system.

Exercise: this forces blood through the vasculature and the vasculature
will respond by stretching and relaxing if it is healthy and flexible. Brisk
walking or swimming is recommended. This works best when a tendency for
blood pressure rise is first noted and is not appropriate for very elevated
pressures.
Deep relaxation or meditation, please refer to the appropriate section.
No stimulants including coffee, nicotine, cocaine: all are linked to
hypertension, restriction of blood flow to the placenta and small-for-gestational-age
babies.
Improved diet: good quality protein and fresh fruits.
Increase water intake.
Rest, particularly lying on the left side.

Women’s Health: Anemia

American Institute for Preventive Medicine — Wed, 06 Dec 2000 13:28:02 +0000

Are you tired and weak? Does the lining of your lower eyelids look pale?

If so, you could be anemic. But what does that mean?

It means that either your red blood cells or the amount of hemoglobin (oxygen-carrying protein) in your red blood cells is low.

There are several types of anemia:

Iron-deficiency anemia is the most common one. In the United States, 20 percent of all women of childbearing age have iron-deficiency anemia, compared to only 2 percent of adult men. The primary cause is blood lost during menstruation. But eating too few iron-rich foods or not absorbing enough iron can make the problem worse. The recommended daily allowance for iron ranges from 6 milligrams for infants, to 30 milligrams for pregnant women. Yet one government source found that females between 12 and 50 years old (those at highest risk for iron-deficiency anemia), get about half of what they need. Pregnancy, breast-feeding and blood loss from the gastrointestinal tract, either due to ulcers or cancer, can also deplete iron stores. Older women who have poor diets, especially when they live alone, often have iron-deficiency anemia.
Folic-acid deficiency anemia (megaloblastic anemia), occurs when folic-acid levels are low, usually due to inadequate dietary intake or faulty absorption. The need for this vitamin more than doubles during pregnancy. This is often not met by diets of pregnant women, so a supplement of 400 micrograms (mcg) to 1 milligram (mg) per day of folic acid is recommended throughout pregnancy. You should even take this supplement when you plan to become pregnant. Adquate folic acid should be in your system when you conceive and during the first month you are pregnant. Low folic acid intakes have been associated with low birth weight and neural tube defects, such as spina bifida in babies. Folic-acid deficiency can lead to infertility and an increased risk of infection. Also, a deficiency of this vitamin is seen frequently among elderly women, especially those who have poor diets.

Other, less common forms of anemia include:

Pernicious anemia – the inability of the body to properly absorb vitamin B12..
Hemolytic anemia – when red blood cells are destroyed prematurely.
Sickle cell anemia – an inherited disorder that occurs primarily in blacks, which affects the red blood cells’ ability to carry oxygen to the body’s tissues.
Thalassemia anemia – an inherited disorder in the synthesis of hemoglobins (substances that carry oxygen). It is also known as Mediterranean Disease.
Aplastic anemia – a serious disease of decreased bone marrow production. Alcohol, certain drugs, large amounts of aspirin and some chronic diseases can also cause anemia.

[Note: Keep in mind that fatigue is often the first symptom of pregnancy.]

Treatment

The first step in treating anemia is to pinpoint the cause. When it results from disease, such as a peptic ulcer, you will need to follow your doctor’s advice to get the condition under control. If it’s due to a poor diet, you’re in luck: Iron deficiency anemia is not only the most common form of anemia, it’s the easiest to correct if it’s due to heavy periods or taking in inadequate amounts of certain foods. Folic acid vitamin supplements may also be necessary. See self-care procedures below.

Self Care Procedures

Are you weak and do you have any of these signs and symptoms? Palpitations, fast or irregular heart beat. Faintness and breathlessness. Bleeding from the nose, mouth, gums, vagina or rectum that is spontaneous. Red dots of bleeding under the skin. Ulcers in the mouth, throat or rectum. Bruising that occurs without reason.

Do you have blood in your stools or urine or have black, tar-like stools?

Are you dizzy when you stand up or when you exert yourself?

Do You: Have menstrual bleeding between periods? Have heavy menstrual bleeding for several months? Normally bleed seven days or more every month? Suspect that you are pregnant?

Do you have ringing in your ears?

Do symptoms of anemia, i.e., tiredness and weakness, go on for at least two weeks despite using self-care procedures (listed below) ?

Self-Care Procedures for Iron-Deficiency Anemia

You may need to:

Eat more foods that are good sources of iron.
Concentrate on green, leafy vegetables, lean, red meat, beef liver, poultry, fish, wheat germ, oysters, dried fruit and iron-fortified cereals.
Boost your iron absorption.
Foods high in vitamin C – like citrus fruits, tomatoes and strawberries – help your body absorb iron from food.
Red meat not only supplies a good amount of iron, it also increases absorption of iron from other food sources.
Limit the use of tea. It contains tannins, substances that can inhibit iron absorption. Herbal tea is okay though.
Take an iron supplement.
- Consult your physician for proper dosage.
- While iron is best absorbed when taken on an empty stomach, it can upset your stomach. Taking iron with meals is less upsetting to the stomach.
  
  [Note: Recent research is suggesting that high levels of iron in the blood may increase the risk for heart attacks. Do check with your doctor before taking iron supplements, especially if you have already gone through menopause.]
Avoid antacids, phosphates (which are found in soft drinks, beer, ice cream, candy bars, etc.) and the food additive EDTA. These block iron absorption.
Increase dietary fiber to prevent constipation.
Avoid aspirin and products with aspirin.

To get and/or make the best use of folic acid:

Eat good food sources of folic acid daily.
- These include vegetables like asparagus, brussels sprouts, spinach, romaine lettuce, collard greens and broccoli.
- Black-eyed peas, cantaloupe, orange juice, oatmeal, whole grain cereals, wheat germ, liver and other organ meats are excellent sources also.
- Eat fresh, uncooked fruits and vegetables often. Don’t overcook food. Heat destroys folic acid.
Take a multi-vitamin supplement daily that has 100% of the RDA for folic acid.
Don’t smoke. Smoking increases vitamin needs.
Don’t drink alcoholic beverages

Fibroids

American Institute for Preventive Medicine — Wed, 06 Dec 2000 13:28:02 +0000

Fibroids are benign (not cancerous) tumors made mostly of muscle tissue. They are found in the wall of the uterus and sometimes on the cervix. They can range in size from as small as a pea to as large as a basketball! With larger fibroids, a woman’s uterus can grow to the size of a pregnancy that is more than 20 weeks along. About 20-25% of women over 35 get fibroids. A woman is more likely to get fibroids if:

She has not been pregnant
She has a close relative who also had or has them
She is African American. The risk is 3 to 5 times higher than it is for Caucasian women.

Why fibroids occur is not really known. They do, however, depend on estrogen for their growth. They may shrink or even disappear after menopause.

Signs and Symptoms

Some women with uterine fibroids do not have any symptoms or problems from them. When symptoms or problems occur, they vary due to the number, size, and locations of the fibroid(s). These include:

Abdominal swelling, especially if they are large
Heavy menstrual bleeding
Bleeding between periods or after intercourse
Pain (backache, during sex, with periods)
Bleeding after menopause
Anemia from excessive bleeding
Frequent urination from pressure on the bladder
Constipation from pressure on the rectum
Infertility (the fallopian tubes may be blocked)
Miscarriage (if the fibroid is inside the uterus, the placenta may not implant the way it should)

You can find out if you have fibroids when your doctor takes a medical history and does a pelvic exam. The doctor can also do other tests such as an ultrasound or a D & C to confirm their presence, location, and size. The ultrasound is the most common test for diagnosing fibroids.

Treatment

Treatment for fibroids includes:

“Watchful waiting” if fibroids are small, harmless, and painless or not causing any problems. Your doctor will “watch” for any changes and may suggest “waiting” for menopause, since fibroids often shrink or disappear after that time. If you have problems during this “waiting” period (too much pain, too much bleeding, etc.), you may decide that you do not want to “wait” for menopause, but choose to have something done to treat your fibroids.
Medication. One type, gonadotropin-releasing hormone (GnRH) agonists, blocks the production of estrogen by the ovaries. This shrinks fibroids in some cases but is not a cure. The fibroids return promptly when the medicine is stopped. Shrinking the fibroids might allow a minor surgery to be done instead of a major one. (See surgical methods below.) GnRH agonists are taken for a few months, but not more than 6, because their side effects mimic menopause.
Surgery. There are two basic surgical methods:
- Myomectomy-The fibroids are removed, but the uterus is not. There are 3 approaches.
  - Laparascopic-A laparascope is used with a laser to remove the fibroids.
  - Hysteroscopic-The fibroids are cut out and the uterine lining is destroyed by laser (ablation). This makes a woman sterile (no lining, no bleeding). Laser ablation can also be done with a small electrocautery ball. This is known as “Rollerball.”
  - Laparotomy-Surgery in which the abdomen is opened and the fibroids are removed under direct vision. Fibroids can still be present, grow, and cause future trouble.
- Hysterectomy-Surgery that removes the uterus and the fibroids with it. Depending on the size of the fibroids, this can be done:
  - Vaginally
  - Through abdominal surgery

A hysterectomy may be recommended when the fibroid is very large or when there is severe bleeding that can’t be stopped by other treatments. This leaves a woman sterile. It is the only way to get rid of fibroids for sure. A hysterectomy may also be done in the rare occasion that the fibroid becomes cancerous.

Questions to Ask

Do you have severe abdominal pain?

Do you have any of these problems? Heavy menstrual bleeding (you saturate a pad or tampon in less than an hour) Bleeding between periods or after intercourse Bleeding after menopause Anemia (noted by paleness, weakness, fatigue)

Do any of these things define the pain? It comes during sexual intercourse. It comes with your menstrual periods. It is in the lower back, and is not caused by strain or any other condition.

Do you have to urinate often or do you feel pressure on your bladder or rectum?

Self-Care/Prevention Tips

Maintain a healthy body weight. The more body fat you have, the more estrogen your body is likely to have, which enhances fibroid growth.

Exercise regularly. This may reduce your body’s fat and estrogen levels.
Follow a low-fat diet.

Fainting

American Institute for Preventive Medicine — Wed, 06 Dec 2000 13:28:02 +0000

Just before fainting, you may feel a sense of dread followed by the sense that everything around you is swaying. You may see spots before your eyes. Then you go into a cold sweat, your face turns pale and you topple over.

A common cause of fainting is a sudden reduction of blood flow to the brain which results from a temporary drop in blood pressure and pulse rate. These lead to a brief loss of consciousness. A fainting victim may pass out for several seconds or up to ½ hour.

There are many reasons why women faint. Medical reasons include:

Low blood sugar (hypoglycemia) which is common in early pregnancy.
Anemia.
Any condition in which there is a rapid loss of blood. This can be from internal bleeding such as with a peptic ulcer, a tubal pregnancy or a ruptured cyst.
Heart and circulatory problems such as abnormal heart rhythm, heart attack or stroke.
Eating disorders such as anorexia, bulimia.
Toxic shock syndrome.

Other things that can lead to feeling faint or fainting include:

Any procedure that stretches the cervix such as having an IUD inserted, especially in women who have never been pregnant.
Extreme pain.
A sudden change in body position like standing up too quickly (postural hypotension).
Sudden emotional stress or fright.
Taking some prescription drugs. Examples are: Some that lower high blood pressure, tranquilizers, antidepressants, or even some over-the-counter drugs such as antihistamines, when taken in excessive amounts.
Know, also, that the risk for fainting increases if you are in hot, humid weather, are in a stuffy room or have consumed excessive amounts of alcohol.

Here are some dos and don’ts to remember if someone faints:

Dos:

Catch the person before he or she falls.
Place the person in a horizontal position with the head below the level of the heart and the legs raised to promote blood flow to the brain. If a potential fainting victim can lie down right away, he or she may not lose consciousness.
Turn the victim’s head to the side so the tongue doesn’t fall back into the throat.
Loosen any tight clothing.
Apply moist towels to the person’s face and neck.
Keep the victim warm, especially if the surroundings are chilly.

Don’ts:

Don’t slap or shake anyone who’s just fainted.
Don’t try to give the person anything to eat or drink, not even water, until they are fully conscious.
Don’t allow the person who’s fainted to get up until the sense of physical weakness passes and then be watchful for a few minutes to be sure he or she doesn’t faint again.

Questions to Ask

Is the person who fainted not breathing and does he/she not have a pulse?

Are signs of a heart attack also present with the fainting? Chest pain or pressure. Pain that spreads to the arm, neck or jaw. Shortness of breath or difficulty breathing. Nausea and/or vomiting. Sweating. Rapid, slow or irregular heartbeat. Anxiety.

Are signs of a stroke also present with the fainting? Numbness or weakness in the face, arm or leg. Temporary loss of vision or speech, double vision. Sudden, severe headache.

Did the fainting come after an injury to the head.

Do you have any of these with the fainting? Pelvic pain? Black stools?

Have you fainted more than once?

Are you taking high blood pressure drugs or have you recently taken a new or increased dose of prescription medicine?

Self-Care Procedures

Do these things when you feel faint:

Lie down and elevate both legs.
Sit down, bend forward and put your head between your knees.

If you faint easily:
Get up slowly from bed or from a sitting position.
Follow your doctor’s advice to treat any medical condition which may lead to fainting. Take medicines as prescribed but let your doctor know about any side effects, so he/she can monitor your condition.
Don’t wear tight-fitting clothing around your neck.
Avoid turning your head suddenly.
Stay out of stuffy rooms and hot, humid places. If you can’t, use a fan.
Avoid activities that can put your life in danger if you have frequent fainting spells, such as driving a motor vehicle and climbing to high places.
Drink alcoholic beverages in moderation.

When pregnant:
Get out of bed slowly.
Keep crackers at your bedside and eat a few before getting out of bed. Try other foods such as dry toast, graham crackers, bananas, etc.
Eat small, frequent meals instead of a few large. Have a good food source of protein, such as lean meat, low-fat cheese, milk, etc., with each meal. Avoid sweets. Don’t skip meals or go for a long time without eating.
Don’t sit for long periods of time.
Keep your legs elevated when you sit.
When you stand, as in a line, don’t stand still. Move your legs to pump blood up to your heart.
Take vitamin and mineral supplements as your doctor prescribes.
Never lay on your back during the 3rd trimester. It is best to lay on your left side. If you can’t, lay on your right side

Cervical Cancer

American Institute for Preventive Medicine — Wed, 06 Dec 2000 13:28:02 +0000

Cervical cancer accounts for about 4% of all cancers found in women. Each year, about 15,000 women in the United States learn that they have this type of cancer.

Cancer of the cervix, the lower, narrow part of the uterus, can occur at any age, but is found most often in women over the age of 40.

Cells on the surface of the cervix sometimes appear abnormal but are not cancerous. It is thought that these abnormal changes are the first step in a slow series of changes that can lead to cervical cancer many years later. That is, some abnormal changes are precancerous.

Causes

Certain risk factors have been identified that increase the chance that cells in the cervix will become abnormal or cancerous. It is believed, in many cases, that cervical cancer develops when two or more of these risk factors act together:

Having a history of the sexually transmitted human papilloma virus (HPV). There are many types of this virus. Some types put women at greater risk than others. {Note: Not all women who are infected with HPV develop cervical cancer, and the virus is not present in all women who have this disease.}
Having had frequent sexual intercourse before age 18
Having multiple sex partners. The greater the number of partners, the greater the risk.
Having sex partners who:
- Began having sexual intercourse at a young age
- Have had many sexual partners
- Were previously sexually active with a woman who had cervical cancer
Having had a sex partner with HPV
Smoking
Being the daughter of a mother who took a drug known as DES during pregnancy. This drug was used from about 1940 to 1970, mostly to prevent miscarriage.
Having a weakened immune system due to such things as:
- Having human immunodeficiency virus (HIV)
- Having taken drugs to prevent rejection with an organ transplant

Signs and Symptoms

Any abnormal pap test can be an early sign of cervical cancer. There are often no symptoms, though, especially in the early stages. In very late stages the symptoms include:

Vaginal bleeding or spotting between periods
Bleeding after intercourse
Thick vaginal discharge that may have an odor
Watery vaginal discharge
Pain in the pelvic area

The final stages can result in:

Anemia
Appetite and weight loss
Pain in the abdomen
Leakage of urine and feces through the vagina

Detection

Early diagnosis of cervical cancer is important. If the cancer is found early, most women can be cured. The best way to find it early is to have pap tests and pelvic exams on a regular basis. These should start when a female begins having sex or is over 18. Ask your doctor how often you should have pap tests and pelvic exams. His or her advice will be based on your age, medical history, and your risk factors for cervical cancer. Also ask your doctor about tests for sexually transmitted diseases (STDs), especially if you or your sex partner have or have had multiple sex partners.

Pap tests are the initial screening tool for cervical cancer. During this test, the doctor or nurse collects cells from the opening of the cervix and surfaces that surround it. The pap test is then checked to see:

Whether or not the sample taken is adequate
If the cells are normal or abnormal
If there is an infection, inflammation, or cancer

In addition to your pap test or if an abnormal pap test is found, your doctor may use a special magnifying instrument called a colposcope. This will allow your doctor to look for any abnormal cells on the surface of the cervix. If your doctor notices a suspicious area on your cervix during this procedure, he/she may choose to take a biopsy of the area. These small pieces of cervical tissue will give your doctor an accurate diagnosis of your problem.

Treatment

Treatment will depend on the exact diagnosis. The precancerous form of cervical cancer is known as dysplasia. This can be treated with laser, conization (removal of a portion of the cervix), or cryotherapy (freezing). Surgery and/or radiation therapy may be required for cervical cancer. Chemotherapy is used in late stages. Sometimes more than one form of treatment is necessary. If the cervical cancer has not spread and a woman wants to become pregnant in the future, a conization may be done. If a woman does not want a future pregnancy, removal of the uterus may be chosen (a hysterectomy).

Questions to Ask

Do you have these problems? A leakage of urine and feces through the vagina Pain in the abdomen Anemia (noted by paleness, weakness, fatigue) Appetite and weight loss

Do you have any or these problems? Constant vaginal bleeding Spotting between periods or bleeding after intercourse Pelvic pain Thick or watery vaginal discharge

Do you have 2 or more risk factors for cervical cancer? (See risk factors under “Causes” on page 226.) And, have you not had a pap test and pelvic exam for more than a year?

Self-Care Tips

Remember to schedule and have pap tests and pelvic exams as often as your doctor suggests. Schedule these near your birthday to help you remember that they need to be done.
Take measures to prevent getting HPV and other sexually transmitted diseases (STDs) (see “Self-Care/Prevention Tips” on page 275)
Avoid douching. If you do, don’t do so more than once a month.
Don’t smoke.
Unless you are in a monogamous relationship in which you and your partner are free of STDs, use a latex condom every time you have sexual intercourse. Do this especially if your sex partner has a history of multiple sex partners.

Anemia

American Institute for Preventive Medicine — Wed, 06 Dec 2000 13:28:02 +0000

Are you tired and weak? Do the linings of your lower eyelids look pale? If so, you could be anemic. But what does that mean? It means that either your red blood cells or the amount of hemoglobin (oxygen-carrying protein) in your red blood cells is low.

Iron-deficiency anemia is the most common form of anemia. In the United States, 20 percent of all women of childbearing age have iron-deficiency anemia (compared to 2 percent of adult men). The primary cause is blood lost during menstruation. But eating too few iron-rich foods or not absorbing enough iron can make the problem worse. (The recommended daily allowance for iron ranges from 6 milligrams (infants) to 30 milligrams (pregnant women). Yet one government source found that females between 12 and 50 years old, those at highest risk for iron-deficiency anemia, get about half of what they need). Pregnancy, breast-feeding a baby, and blood loss from the gastrointestinal tract (either due to ulcers or cancer) can also deplete iron stores. Older persons who have poor diets, especially when they live alone, often have iron-deficiency anemia.

Folic-acid deficiency anemia, another type of anemia, occurs when folic-acid levels are low, usually due to inadequate dietary intake or faulty absorption. The need for this vitamin more than doubles during pregnancy.

Other less common forms of anemia include pernicious anemia (inability of the body to properly absorb vitamin B12), sickle cell anemia (an inherited disorder), and thalassemia anemia (also inherited).

Alcohol, certain medicines, and some chronic diseases can also cause anemia.

Self-Care Tips

The first step in treating iron-deficiency anemia is to pinpoint the cause. If it’s due to a poor diet, you’re in luck: Iron deficiency anemia is not only the most common form of anemia, it’s the easiest to correct if it’s due to being female or taking in inadequate amounts of certain foods. Folic acid vitamin supplements may also be necessary.

You may need to:

Eat more food that are good sources of iron. Concentrate on green, leafy vegetables, lean, red meat, beef liver, poultry, fish, wheat germ, oysters, dried fruit, and iron-fortified cereals.
Boost your iron absorption. Foods high in vitamin C, such as citrus fruits, tomatoes, and strawberries, help your body absorb iron from food. And red meat not only supplies a good amount of iron, it also increases absorption of iron from other food sources.
Don’t drink a lot of teaÑit contains tannins, substances that can inhibit iron absorption. (Herbal tea is okay, though).
Take an iron supplement. (Consult your physician for proper dosage). While iron is best absorbed when taken on an empty stomach, it can upset your stomach. Taking iron with meals is less upsetting to the stomach. [Note: Recent research is suggesting that high levels of iron in the blood may increase the risk for heart attacks. Do check with your doctor before taking iron supplements.]
Avoid antacids, phosphates (which are found in soft drinks, beer, ice cream, etc.) and the food additive EDTA. These block iron absorption.

Questions to Ask

Do you have blood in your stools or urine or have black, tar-like stools with these problems? Light headedness Weakness Shortness of breath Severe abdominal pain

Are you dizzy when you stand up or when you exert yourself?

Do you have ringing in your ears?

For women: Do you have menstrual bleeding between periods? Has menstrual bleeding been heavy for several months? Do you normally bleed seven days or more every month? Do you suspect that you are pregnant?

Do symptoms of anemia (paleness, tiredness, listlessness and weakness) persist despite using self-care tips (listed below) for at least two weeks?

Peptic Ulcers

American Institute for Preventive Medicine — Wed, 06 Dec 2000 13:28:02 +0000

Ulcers located in the stomach (gastric ulcers) and ulcers in the first section of the small intestine (duodenal ulcers), are grouped under the label “peptic ulcers”. They afflict men, women and children. No one knows exactly what causes ulcers, but doctors think they’re a combination of excess stomach acid and failure of the stomach’s inner lining to protect it from the acid. Also, bacteria called Heliobacter pylori may help cause some ulcers. Tests can be done by your doctor to find out if you have this bacteria by doing a blood test, breath test and a biopsy of stomach tissue during an endoscopy, a procedure that looks at your stomach through a tube that is inserted via your mouth. If Heliobacter pylori bacteria are present, antibiotics should be prescribed. One study has shown that treating ulcers of this type protected nearly 90% of those affected from future ulcer attacks. Another showed that only 15% of persons with Heliobacter pylori treated ulcers had recurrent ulcers after two years if treated with antibiotics. Persons with a family history of ulcers tend to be at greater risk for developing an ulcer as do persons with type O blood. Eighty to 90 percent of the time, peptic ulcers recur within two years of the initial attack. Certain things increase the risk of peptic ulcers in susceptible individuals:

Stress and anxiety.
Irregular meal times and improper diet or skipping meals.
Excess alcohol intake; taking medicine such as aspirin; and the use of caffeine. All of these irritate the stomach.

Signs and Symptoms

Peptic ulcers are characterized by:

A gnawing or burning just above the navel within 1-1/2 to 3 hours after eating.
Pain that frequently awakens the person at night.
Relief of the pain within minutes with food or antacids.
Pain that recurs, with each cluster of attacks lasting from several days to several months.
Pain that feels like indigestion, heartburn, or hunger.
Nausea.
Unintentional weight loss or loss of appetite.
Anemia.

Treatment and Care

Doctors can diagnose gastric and duodenal ulcers on the basis of X-rays or endoscopy.

Notify your doctor if:

Your stools are ever bloody, black or tarry looking. (Take a specimen to your doctor’s office).
You vomit blood or material that looks like coffee grounds.
You become unusually pale and weak.
You have diarrhea with intolerable pain.
You have very severe abdominal pain.

For treatment, your doctor may prescribe:

Over-the-counter antacids.
Antibiotics and bismuth (Pepto-Bismol) if he/she thinks that Heliobacter pylori bacteria is contributing to your ulcer. [Note: Do not give aspirin or any medication containing salicylates such as Pepto-Bismol to anyone 19 years of age or younger, unless directed by a physician due to its association with Reye’s Syndrome, a potentially fatal condition.]
Medicines to decrease or stop the stomach’s production of hydrochloric acid.
Smokers, because tobacco smoke paralyzes the tiny hairs that otherwise help to expel germ-ridden mucus from the lungs.
People who suffer from malnutrition, alcoholism, or viral infections.
Anyone with a recent respiratory viral infection.
People with emphysema or chronic bronchitis.
People with sickle cell anemia.
Cancer patients undergoing radiation treatments or chemotherapy, both of which wear down the immune system.
People with AIDS – HIV (acquired immune deficiency syndrome-human immune deficiency virus).

Nutritional Program for Fatigue

Michael Janson MD — Wed, 06 Dec 2000 13:28:02 +0000

When patients come to me for advice about specific medical problems, they usually have been told that they need medication or surgery, and they are seeking ways to avoid those treatments. Sometimes they have already tried medications, which have produced significant side effects.

Usually, they have many treatment alternatives but they have no information about their choices. One example of effective alternatives is the reduction in blood pressure that meditation produces. Others are the dietary changes and exercise programs that lead to lowered cholesterol. Since the medical treatments for these two conditions are often more dangerous than the problems, it is worth seeking safer alternatives.

Dr. Dean Ornish has shown that patients with heart disease can often avoid surgery and reverse their heart disease with a combination of a low-fat diet, meditation, and exercise. Norman Cousins healed his ankylosing spondylitis (a form of arthritis of the spine) with laughter and high doses of vitamin C. He wrote about his experience in the New England Journal of Medicine, and followed this article with a book, The Anatomy of an Illness. Many patients have cured their digestive disturbances simply by avoiding certain foods.

Over and over, we are seeing the results of lifestyle changes in health care. A recent scientific medical conference put on by the American College for Advancement in Medicine was entitled: Lifestyle Medicine—Medicine for the Nineties. Researchers and physicians both attended and taught at this scientific meeting. Much of it related to the role of dietary supplements in medical therapy.

Dietary supplements are among the safest and most effective choices in health care. They are almost free of side effects, they are easy to take, they are relatively inexpensive, and they usually enhance many life functions besides the specific condition for which they are being given. Following is an example of how nutritionally oriented physicians might use supplements as part of the treatment for a specific health problem. This is a suggestion that is supported in the medical literature and in the experience of many physicians.

Remember this is an example, not a prescription for you, and the supplement list is in addition to many other health practices. Other supplements may be helpful, and you may not need all of these to get results. For more information on any one supplement, look for its description in Dietary Supplements. No one program is appropriate for everybody, but these suggestions are good starting points from which individual programs can be modified.

Fatigue Treatment Programs

One of the most common complaints in any medical practice is fatigue (usually for both the patient and the doctor). There are many causes of persistent fatigue, as opposed to simply being tired from exercise or a heavy work load. There may be a serious medical disorder such as anemia, diabetes, heart disease, chronic fatigue/immune-dysfunction syndrome (also called CFIDS), and infection.

Some chronic everyday problems may also cause significant ongoing fatigue, such as stress, dietary imbalance, food allergy, nutritional deficiency, environmental toxicity, low blood sugar (hypoglycemia), and low-grade depression. Sometimes the problem is as simple as a lack of adequate exercise or boredom. There are some general principles for reducing fatigue after eliminating any of the serious medical conditions as the underlying cause.

Again, eating properly, exercising, and reducing emotional stressors can help increase your energy. Avoiding food allergens and environmental toxins helps reduce exposure to the chemical stressors. A general dietary supplement is often adequate to help fatigue due to nutritional imbalances or borderline deficiencies.

Do not ignore the need to find out if persistent fatigue is the result of a serious medical problem. Treatment may require medical management in addition to lifestyle change and dietary supplements. The following supplement program often helps with fatigue from many causes:

	AM	PM
Basic Multiple Formula	3	3
Vitamin C 1000 mg	2	2
Niacin, timed release, 250 mg	1	1
Magnesium aspartate 200 mg	1	1
GLA 240 mg (from borage oil)	1	—
Vitamin E 400 IU natural, mixed	1	1
Coenzyme Q10 100 mg	1	—
Chromium 200 mcg	1	1
l-Glutamine 500 mg	1	1
l-Carnitine 250 mg	2	2