Monthly Archives: September 2017

Leaky Gut, Restore (for Gut Health), Slippery Elm Intensive

Plugging a leak? A guide to leaky gut and what you should do about it

Thanks to its name, it may sound silly or twee, but a leaky gut’s no laughing matter. That’s because it means the gut’s failing in its primary function – to provide a reliable transportation route through the body for potentially harmful elements in consumed food. If you have leaky gut then, owing to perforations in your intestinal wall, molecules and micro-organisms are able to get into your bloodstream. Not nice – and not at all twee. And, unfortunately, because it can play a role in causing many different ailments, it’s often something far from easy to diagnose; resulting in any number of potential symptoms. In which case then, let’s take a closer look at what leaky gut is all about – and how you can prevent and treat it.

How does leaky gut occur?

To understand how and why leaky gut happens, it’s necessary to understand the gut itself. The gut – or the intestines – is, of course, an organ of the digestive system; in fact, its largest and most important, boasting a surface area of around 2,700 sq. ft. (250 sq. m) – about the size of a tennis court. Included in the make-up of the gut is its intestinal mucosa (lining), which itself comprises the intestines’ microbial community. So, as digested molecules (micro-, macro and phytonutrients) pass through the gut on their way through the digestive system, they inevitably encounter the gut mucosa; unfortunately, though, should you suffer from leaky gut, the tight junctions between the cells of the mucosa won’t be tight enough, so potentially harmful foreign bodies can slip through the intestine’s lining and find their way into other parts of the body1. What foreign bodies? Nasty microscopic pathogens, toxins and antigens; all getting to chance to go where they like, provoking systemic inflammation1.

What causes leaky gut?

Evidently, these tight junctions between the gut’s cells are far from a total barrier; they relax and contract often and, thus, their function’s disrupted1. Factors that cause this include:

• Diet – of course, your diet inevitably has a big effect on your gut health (and on your health in general); an abundance of the following in your diet is bound to help cause leaky gut:
1. Additives – emulsifiers, glucose, microbial transglutaminase, solvents and even salt can make leaky gut syndrome worse2
2. Alcohol – as alcohol makes its journey through the gastrointestinal system, the metabolic by-product acetaldehyde’s created, which can increase intestinal permeability3
3. Dairy products – often associated with gastrointestinal disorders, not least for people who are lactose intolerant and those who have autism4
4. Gluten – for those who have gluten sensitivity, its consumption is very likely to proliferate intestinal permeability5
5. Pesticides – the herbicide glyphosate is great at disrupting gut bacteria, which aids intestinal permeability6
6. Sugar – often a cause of inflammation in the gut; so much so that research proves analysis of glucose in urine can indicate the severity of leaky gut7

• Candida – specific species of this yeast like nothing more than interfering with gut microbiota, resulting in an imbalance known as dysbiosis that can often lead to digestive issues including leaky gut8

• Chronic stress – yes, it’s true, psychological stress contributes to gut ill-health because it boosts levels of inflammatory cytokines (immune-related proteins) that drive up leaky gut; no surprise then that studies suggests stress compromises the intestinal barrier9

• Environmental toxins – as you’ll be aware, the outside world is full of poisonous toxins; mercury10, bisphenol A (BPA)11, fungicides, and insecticides12 all have the capacity to impair intestinal permeability

• Medications – it’s well known that over-the-counter drugs, especially non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, can cause inflammation and drive up intestinal permeability13

• Zinc deficiency – an essential trace mineral for many different parts of the body, zinc is especially important for the immune system and preventing and treating irritable bowel-related conditions; as such, its deficiency can aid intestinal permeability, while its supplementation enhances tight junction activity14.

What can leaky gut cause?

Unfortunately, leaky gut’s symptoms are varied – in that, like it or not, they extend way beyond digestive disorders thanks to it enabling harmful foreign microbes to enter the bloodstream. Common symptoms then include the likes of allergies15, cardiovascular problems16 and many different metabolic issues17. Less obvious – but equally possible – illnesses that may be traced to leaky gut are both chronic fatigue syndrome and depression; research proves they can occur when the integrity of gut mucosa’s been compromised18.

Treating leaky gut

Experts agree that managing leaky gut’s best achieved by maintaining a healthy diet; particularly one that features food high in probiotics (yoghurt, kefir, microalgae and even dark chocolate are all recommended)19. Moreover, nutrients including glutamine and curcumin are great for the intestines because they help to manage the immune system’s overstimulated response to leaky gut (and the resultant escaping microbes) and, thus, the oxidative stress that further compromises the intestinal wall20.

And you may too like the idea of supplementing an improved diet to mitigate the disorder’s effects with, yes, natural leaky gut supplements. So, why not take a glance at the ‘Leaky Gut’ page of supplements on The Finchley Clinic’s website? Among which you’ll find these highly regarded products:

Restore (for Gut Health) – a unique and ground-breaking supplement that heals the gut mucosa and supports membrane integrity to give your immune system a chance to rest.

Restore (for Gut Health) (travel size) – ideal for giving Restore a trial-run or for when you’re in transit.

Slippery Elm Intensive – soothes the digestive tract and provides mucilage to support the gut’s mucous membranes.

References:

1. Lee S. H. ‘Intestinal Permeability Regulation by Tight Junction: Implication on Inflammatory Bowel Diseases’. Intest Res. 2015 Jan; 13 (1): 11–18. Published online 2015 Jan 29. doi: 10.5217/ir.2015.13.1.11.
2. Lerner A. and Matthias T. ‘Changes in intestinal tight junction permeability associated with industrial food additives explain the rising incidence of autoimmune disease’. Autoimmun Rev. 2015 Jun; 14 (6): 479-89. doi: 10.1016/j.autrev.2015.01.009. Epub 2015 Feb 9.
3. Purohit V. et al. ‘Alcohol, Intestinal Bacterial Growth, Intestinal Permeability to Endotoxin, and Medical Consequences. Alcohol’. Alcohol. 2008 Aug; 42 (5): 349–361. Published online 2008 May 27. doi: 10.1016/j.alcohol.2008.03.131.
4. Whiteley P. et al. ‘Gluten- and casein-free dietary intervention for autism spectrum conditions’. Published online 2013 Jan 4. Pre-published online 2012 Nov 27. doi: 10.3389/fnhum.2012.00344.
5. de Punder K. and Pruimboom L. ‘The Dietary Intake of Wheat and other Cereal Grains and Their Role in Inflammation’. Nutrients. 2013 Mar; 5 (3): 771–787. Published online 2013 Mar 12. doi: 10.3390/nu5030771.
6. Samsel A. and Seneff S. ‘Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance’. Interdiscip Toxicol. 2013 Dec; 6 (4): 159–184. Published online 2013 Dec. doi: 10.2478/intox-2013-0026.
7. Rao A. S. et al. ‘Urine sugars for in vivo gut permeability: validation and comparisons in irritable bowel syndrome-diarrhea and controls’. Am J Physiol Gastrointest Liver Physiol. 2011 Nov; 301 (5): G919-28. doi: 10.1152/ajpgi.00168.2011. Epub 2011 Aug 11.
8. Schulze J. and Sonnenborn U. ‘Yeasts in the Gut: From Commensals to Infectious Agents’. Dtsch Arztebl Int. 2009 Dec; 106 (51-52): 837–842.
9. Bested A. et al. ‘Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research’. Gut Pathog. 2013; 5: 3. Published online 2013 Mar 14. doi: 10.1186/1757-4749-5-3.
10. US Food and Drug Administration. ‘DAMS Fact Sheets on Mercury Exposure’. https://www.fda.gov/ohrms/dockets/dailys/02/Sep02/091602/80027de0.pdf.
11. Braniste V. et al. ‘Impact of oral bisphenol A at reference doses on intestinal barrier function and sex differences after perinatal exposure in rats’. Proc Natl Acad Sci USA. 2010 Jan 5; 107 (1): 448–453.
12. Cohen M. ‘Environmental toxins and health – the health impact of pesticides’. Aust Fam Physician. 2007 Dec; 36 (12): 1002-4.
13. Sigthorsson G. et al. ‘Intestinal permeability and inflammation in patients on NSAIDs’. Gut. 1998 Oct; 43 (4): 506–511.
14. MedlinePlus. ‘Zinc in Diet’. https://medlineplus.gov/ency/article/002416.htm.
15. Perrier C. and Corthésy B. ‘Gut permeability and food allergies’. Clin Exp Allergy. 2011 Jan; 41 (1): 20-8. doi: 10.1111/j.1365-2222.2010.03639.x. Epub 2010 Nov 11.
16. Sandek A. et al. ‘The emerging role of the gut in chronic heart failure’. Curr Opin Clin Nutr Metab Care. 2008 Sep; 11 (5): 632-9. doi: 10.1097/MCO.0b013e32830a4c6e.
17. Bounous G. et al. ‘Biosynthesis of intestinal mucin in shock: relationship to tryptic hemorrhagic enteritis and permeability to curare’. Ann Surg. 1966 Jul; 164 (1): 13-22.
18. Schnabl B. ‘Linking intestinal homeostasis and liver disease’. Curr Opin Gastroenterol. Author manuscript; available in PMC 2014 Jul 1. Published in final edited form as: Curr Opin Gastroenterol. 2013 May; 29 (3): 264-270 doi: 10.1097/MOG.0b013e32835ff948.
19. Rao R. and Samak G. ‘Protection and Restitution of Gut Barrier by Probiotics: Nutritional and Clinical Implications’. Curr Nutr Food Sci. 2013 May 1; 9 (2): 99-107.
20. Rapin J. R. and Wiernsperger N. ‘Possible links between intestinal permeability and food processing: A potential therapeutic niche for glutamine’. Clinics (Sao Paulo). 2010 Jun; 65 (6): 635-43. doi: 10.1590/S1807-59322010000600012.

Antioxidants, Free Radicals, General Health & Nutrition

When oxygen attacks: how antioxidants combat reactive oxygen species

The ancient Chinese may well have been on to something (not surprising, given their greatest thinkers were clearly a smart bunch), for the idea behind the Chinese philosophical principle that’s ‘yin and yang’ – that is, the significance of balance and the importance of its attainment and maintenance – holds true to so many things in life and the world around us. Not least when it comes to our bodies and health. Indeed, when you think about healing – returning ill-health to a point of good (or ‘normal’) health – it’s summed up by the quest for balance within one’s body. Healing and good health then could be described as the need for balance within the human body.

In which case, it’s hardly surprising that when the body feels unhealthy it seeks to heal itself; when it feels out of balance, it seeks to rectify things and return to a balanced state. And one of the critical components it calls on and throws into action for this is oxygen. Research confirms that this most commonplace of chemical elements (especially in the body) is crucial not just for generating energy for the body’s cells via a process called cellular metabolism, but also for healing in injured tissues1. Indeed, wounded tissue likes nothing more than converting oxygen into what’s known as reactive oxygen species (ROS) to encourage this healing2. However, there is a downside to this; when the body is out of balance, reactive oxygen species – or, at least, the presence of too many of them in the body – can also be damaging to your health.

 

What are reactive oxygen species?

Why is this? Well, a clue comes in the form of what reactive oxygen species can also be referred to as – pro-oxidants or oxygen radicals. That’s to say, they’re a variety of free radicals. For many that like to keep fit and healthy, that term is likely to set alarm bells ringing; for free radicals can do a lot of damage in the human body, if left to do as they please in an ‘unbalanced’ body that’s not able to use them efficiently to heal tissue.

Specifically, a free radical is a molecule without an electron that, nevertheless, is capable of maintaining its structure. To that end, it spends its existence seeking out another chemical in the body with whom it can ‘pair’ and ‘complete itself’, by trying to gain that chemical’s electron. And, as far as reactive oxygen species are concerned, that chemical is oxygen, as that’s the one they’re naturally attracted to.

 

Forms of reactive oxygen species

Reactive oxygen species, though, are actually made of oxygen. To break it down, oxygen – an element comprising eight protons and eight electrons – isn’t averse to sharing its electrons (thus, it’s reactive), which is the problem. In sharing one electron or more there’s a good chance it won’t have them returned (which technically means it becomes an ion) and when it’s ionised like this it instantly seeks to replace its missing electron(s) – hence it becomes a reactive oxygen species and, yes, becomes dangerous and destructive. Indeed, strictly speaking, there are several different sub-divisions of reactive oxygen species:

  • singlet oxygen – radical and harmful in two ways; this one can induce a cell’s genes to start ‘cell death’ and can oxidise lipids and fatty acids when it comes into contact with them3

 

  • superoxides – much is still to be discovered about these forms of oxygen, but research suggests they like to disrupt the body’s ability to heal wounds and affect its destroying of cells4

 

  • peroxides – in the body, these include the likes of hydrogen peroxide (comprising oxygen and hydrogen) and hypochlorite (oxygen and chlorine); they do good by helping to heal tissue5, but when hydrogen peroxide interacts with reduced metal ions the inevitable result are free radicals and, don’t doubt it, hydrogen radicals can be seriously destructive in the human body6

 

  • hypochlorous acid – as you might expect, this form contains both oxygen and chlorine and via either oxidation or chlorination its are the destruction of target cells by disrupting their membrane structures7.

 

Combatting reactive oxygen species

So how do you go about fighting reactive oxygen species? How can you prevent them from doing all the damage they cause? A good idea to stop them would be by preventing them from being formed in the first place; cutting off the source before it can even do anything – surely that would be the ultimate answer; yes? Unfortunately, too often that’s simply not possible, as frankly, whenever you do, well, practically anything you actually create and use reactive oxygen species.

This is because they’re generated – via energy created by mitochondria in the body’s cells – every single time a muscle contracts; indeed, it’s been proved that high-intensity exercise actually causes their levels to increase, which in turn can bring about fatigue and muscle failure8. That said, they are also created thanks to the body absorbing harmful foreign entities – the likes of alcohol, germs, polluting chemicals, tobacco and its smoke and toxic metals9 – which is something that you can control; the lesson being then to try and avoid these entities as much as possible.

But beyond this there must be a more fundamental, proactive answer? There is – antioxidants. Defined as substances that inhibit oxidation, antioxidants are simply brilliant at neutralising the oxidising efforts of free radicals. And they’re to be found everywhere in the natural world around us. Indeed, the Vitamins A, C and E and the minerals copper, selenium and zinc are all blessed with antioxidant properties and you can get your fill of them by packing your diet with antioxidant-rich foods like blueberries, cranberries, elderberries, goji berries, artichokes, pecans, kidney beans and even dark chocolate.

 

Antioxidant supplements

Fair enough, though, you may find it challenging to regularly fill your diet with a good spread of such antioxidant-packed foods as those listed above (the realities of everyday life can get in the way!). In that case then, you may be tempted to turn to naturally-derived (rather than synthetically produced) supplementation to combat the harmful effects of free radicals – reactive oxygen species among them. Indeed, among the antioxidant products you’ll find on sale at The Finchley Clinic, the following are all currently available on special offer:


Cell Fuzion – an advanced antioxidant formula designed to protect and energize mitochondrial function and protect against DNA damage.


Megahydrate Powder – a powerful antioxidant and provides full-body essential hydration for optimal health and well-being.

Super Antioxidant Protection – a powerful formula that supplies key water and fat-soluble antioxidant nutrients; by supporting the body’s major antioxidant pathways, it may protect against free radical damage and premature ageing.

 

References:

  1. Sen C. K. ‘Wound Healing Essentials: Let There Be Oxygen’. Wound Repair Regen. 2009; 17 (1): 1–18. doi:  10.1111/j.1524-475X.2008.00436.x.
  2. Ohio State University Department of Internal Medicine. ‘Scientists Identify a New Role for Oxygen in Wound Healing’. https://internalmedicine.osu.edu/article.cfm?id=2229.
  3. Triantaphylidès C., Krischke M., Hoeberichts F. A., Ksas B., Gresser G., Havaux M., Van Breusegem F. and Mueller M. J. ‘Singlet oxygen is the major reactive oxygen species involved in photooxidative damage to plants’. Plant Physiol. 2008 Oct; 148 (2): 960-8. doi: 10.1104/pp.108.125690. Epub 2008 Aug 1.
  4. Chen Y., Azad M. B. and Gibson S. B. ‘Superoxide is the major reactive oxygen species regulating autophagy’. Cell Death Differ. 2009 Jul; 16 (7): 1040-52. doi: 10.1038/cdd.2009.49. Epub 2009 May 1.
  5. Jaimes E. A., Sweeney C. and Raij L. ‘Effects of the reactive oxygen species hydrogen peroxide and hypochlorite on endothelial nitric oxide production’. Hypertension. 2001 Oct; 38 (4): 877-83.
  6. Aprioku J. S. ‘Pharmacology of Free Radicals and the Impact of Reactive Oxygen Species on the Testis’. Journal of Reproduction & Infertility. 2013; 14 (4): 158-172.
  7. Spickett C. M, Jerlich A., Panasenko O. M., Arnhold J., Pitt A. R., Stelmaszyńska T. and Schaur R. J. ‘The reactions of hypochlorous acid, the reactive oxygen species produced by myeloperoxidase, with lipids’. Acta Biochim Pol. 2000; 47 (4): 889-99.
  8. Powers S. K., Ji L. L., Kavazis A. N. and Jackson M. J. ‘Reactive oxygen species: impact on skeletal muscle’. Comprehensive Physiology. 2011; 1 (2): 941-969. doi:10.1002/cphy.c100054.
  9. Pham-Huy L. A., He H. and Pham-Huy C. ‘Free Radicals, Antioxidants in Disease and Health’. International Journal of Biomedical Science: IJBS. 2008; 4 (2): 89-96.
Liposomal Omega 3, Omega 3 fatty acids, Vegan Omega 3

Catch of the day? Where to get Omega-3 fatty acids if you’re vegetarian

Any of our regular customers – or, indeed, any regular reader of this blog – are sure to be aware that just as not all bacteria are bad for us (the intestines, of course, require ‘good’ bacteria among its gut flora), neither are all fats bad for us. A fine example is Omega-3 fatty acids. So much so, in fact, that experts, thanks to a good deal of research, believe this particular group of fats are great for contributing to everything from treating arthritis, dementia and depression to reducing the risk of heart disease and boosting brain health.

The drawback with Omega-3s, though, is that our bodies aren’t capable of synthesising them; we can’t generate them ourselves. Therefore we have to get our fill of them through diet alone – or, alternatively, through supplementation. Now, it’s very commonly known that a great source for them are fish – specifically for the Omega-3 acids that are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which generally appear to offer the most potent health benefits – but there are other sources too. And the best thing about this is for vegetarians and vegans there are alternative dietary (and now supplement) sources for Omega-3.

Omega 3 health benefits

So, what of these benefits then? Well, perhaps more than anything else, Omega-3 fatty acids are of help when it comes to heart health. Not only are they capable of curbing inflammation in blood vessels throughout the body (thus, easing the pressure of work on the heart), but can also lower heart rate and ensure the development of abnormal heart rhythms (arrhythmias) is less likely and slow down the build-up of plaque in blood vessels (which could also aid in the prevention of suffering a stroke). Research may also suggest heart attack survivors who’ve boosted their Omega-3 levels experience fewer heart attacks and are less likely to suffer a heart disease-caused death1.

Additionally, increased consumption of both DHA and EPA have the capacity to reduce levels of triglycerides (a specific blood fat that’s linked to heart disease), especially when combined with more exercise and lower intake of alcohol, sugary foods and processed carbohydrates, such as white bread and white rice. And it appears Omega-3s are also capable of lowering blood pressure – to some extent, at least – again, not least by complementing one’s Omega-3 intake with other dietary changes (i.e. less red meat and less salt). And, elsewhere in the body, research suggests that stiffness and pain in the joints of rheumatoid arthritis sufferers may experience some relief when these fatty acids are combined with anti-inflammatory medication.

In terms of mental health and brain health, there is a wealth of evidence that Omega-3 acids aids depression. We also know that depression levels tend to be lower in countries where higher levels of Omega-3s are particularly common in typical diets. One Professor of Psychiatry who the company director went to listen giving a lecture a few years ago uses it extensively and routinely in his practise with all depression sufferers. Results take a good 8 weeks to become apparent in many cases, so it should not be regarded as an overnight cure, and those who benefit may need to continue to supplements with Omega 3 for good. But even most mainstream medicines for mental health have to be taken for 4-8 weeks to assess their effectiveness, and are often taken on a long term basis , whilst all the while having potentially harmful and dangerous side-effects, whereas side-effects from supplementing with Omega 3’s are almost unheard of. It’s now accepted that that essential fatty acids play a contributory role in brain function and the development of this organ; some too believe, based on research, that they may be able to help alleviate symptoms of attention deficit hyperactivity disorder (ADHD), the suggestion being that they ought to be looked upon as supplementary to traditional treatment for this condition. Finally, it’s also believed that Omega-3s may be able to help with preventing dementia and age-related brain-function decline. More studies need to be conducted in this area, but research does suggest older people with Omega-3-rich diets are less liable to develop Alzheimer’s disease.

Omega 3 sources – including vegetarian/ vegan-friendly options

As mentioned above, certain fish are, of course, an excellent source for Omega-3 fatty acids – in particular, DHA and EPA. And some fish deliver higher does than others; high-scoring fish in this regard being the likes of anchovies, herring, mackerel, lake trout, salmon and sardines. To that end, the American Heart Association actually recommends you get at least two servings of such fish each week – perhaps with the emphasis on *at least* there!

All that said, it’s important to note you should try to steer clear of fish that may contain relatively high traces of mercury in your hunt for increased Omega-3 intake – if you’re concerned about this issue, it’s best to opt for catfish, cod, pollock, salmon, shrimp, tilapia and tuna (light canned).

But what about if you’re a vegetarian or vegan? What’s best to turn to boost your Omega-3 levels? Well, a great source are certain algae – yes, it’s both commercially grown for human consumption and, to that end, is considered mostly safe (although it’s probably best to steer clear of wild blue-green owing to potential toxins it might contain). Other vegetarian/ vegan-friendly sources – specifically for the alpha-linolenic acid (ALA) Omega-3 fatty acid, which can be converted into both DLA and EPA in the body – include broccoli, canola oil, flaxseed oil, spinach and walnuts. Plus, be aware that some food products are also fortified with Omega-3s – be sure check their ingredient details for the levels to which they are.

Omega 3 vegetarian supplements

It may be, however, that if you’re not crazy about fish, or should you be a vegetarian or vegan and find it challenging to get hold of any of the above recommended foods on a regular basis, that naturally-derived supplementation is your best option for driving up your body’s Omega-3 levels. Traditionally, this area has been a challenge for those of a vegetarian/ vegan persuasion, but with the supplement industry and the knowledge around Omega-3 benefits only ever expanding and rising, the market is beginning to cater to more and more people. So, by all means take a look at the ‘Omega-3’ page here on our site for relevant products, but be aware too that, among those products we offer at The Finchley Clinic, you’ll find these two vegetarian/ vegan-friendly options:


Vegan Omega 3 – approved by the Vegetarian Society, this supplement is one of the first available in the UK to give vegetarians and vegans a direct supply of both EPA and DHA derived not from fish but from natural algae; it’s also suitable for daily use and during pregnancy (no added Vitamins A and D) – note that maternal intake of DHA contributes to the normal brain development of the foetus and breastfed infants, as well as contributing to the normal visual development of infants up to 12 months of age.


Liposomal Omega 3 – again, the Omega 3 oil this product comprises is derived directly from algae. The supplement’s produced via Liposomal Encapsulation Technology, a new solution for delivering nutrients in supplementation thanks to the nutrients’ encasing in a nano-sized fatty bubble (a liposome), enabling it to pass effectively through the stomach and digestive acids and arrive entirely intact to the body’s cells; precisely where it’s needed.

Reference:

1. Mohebi-Nejad A. and Bikdeli B. ‘Omega-3 Supplements and Cardiovascular Diseases’. Tanaffos. 2014; 13 (1): 6–14.

Aloe Fuzion, Aloe Gold Cherry/ Cranberry, Aloe Gold Natural, Aloe vera

Good on the inside and the out: the many benefits of aloe vera supplements

Long a favourite ingredient of skincare and cosmetic products, aloe vera isn’t just good for your skin and keeping you looking young… you may not know it, but due to its plethora of beneficial components, it can help maintain your health on the inside too. Doubtful? Well, if so; you need to read on, truly. Because, as a natural ingredient, it’s been used for centuries in traditional Indian medicine for everything from constipation to infections and colic to worm infestation – as well as skin diseases. Nowadays, of course, thanks to its widespread use as an ingredient in cosmetics and food products, its production is one of the biggest botanical industries in the world. But should it be recognised for being more than it is by many? Frankly, the facts speak for themselves…

 

Aloe vera – the lowdown

Believed by experts to be the most biologically active of all the species of the aloe plant, aloe vera actually comprises more than 75 potentially active components; these constituent parts include amino acids (20 of them out the total 22 required by the human body), as well as anthaquinones, enzymes, lignin, minerals, saccharides, salicylic acids, saponins and, of course, vitamins. Here’s a breakdown of what aloe vera contains – its many active components 1:

  • Vitamin A (an antioxidant that helps to combat free radicals), Vitamin C (protects the body from cardiovascular disease, eye disease and prenatal health problems) and Vitamin E (another powerful antioxidant), as well as Vitamin B12, choline and folic acid

 

  • The health-aiding enzymes aliiase, alkaline amylase, bradykinase, carboxypeptidase, catalase, cellulase, lipase, peroxidease and phosphatase

 

  • human-body-enhancing minerals including calcium, chromium, copper, manganese, magnesium, potassium, selenium, sodium and zinc

 

  • as many as 12 anthraquinones (laxatives), including aloin and emodin that can operate as analgesics and are capable of anti-bacterial and anti-viral activity too

 

  • the fatty acids beta-sisosterol, campesterol, cholesterol and lupeol, lending aloe vera anti-inflammatory properties

 

  • the hormones that are auxins and gibberellins are also anti-inflammatory and can aid with wound-healing.

 

Aloe vera health benefits

So, thanks to all these components; aloe vera is, on the inside of the body, capable of providing significant help with the following issues, conditions and functions:

 

Constipation

A number of studies have looked into the use of aloe latex from aloe vera as a laxative; as established, its anthraquinones provide it with a potent laxative effective, thus increasing water content in the intestines, leading to stimulation of mucus secretion and bringing about intestinal peristalsis (the contractions that ensure food’s broken down and blended with the intestine’s gastric juices and acidic fluid). Taking one study as an example (among 28 healthy adults), aloe latex achieved a successful laxative effect versus a placebo, ensuring it can be claimed not just to be a natural remedy for constipation but more effective than over-the-counter synthetic medicine specifically manufactured for that purpose2.

 

Digestion

Also because of its laxative benefits (in combination with its anti-inflammatory properties), aloe vera can aid another digestive area; this one being a function rather than an issue, though – general digestion. This is because it helps in the normalisation of acid-alkaline (pH) balance, reduces the formation of harmful yeast while encouraging ‘good’ digestive bacteria and contributing to the regularisation of bowel processing.

Indeed, for those suffering from irritable bowel syndrome (IBS), research has proved that oral consumption of aloe vera twice a day can reduce the level of discomfort (and flatulence)3, while another study on rat subjects with gastrointestinal issues has found that their gastric acid levels considerably decreased thanks to aloe vera4. It should be noted too that extracts of the plant can be deployed to soothe and heal stomach ulcers thanks to anti-bacterial, healing benefits that contribute to the restoration of the stomach lining.

 

Immunity

Among the aforementioned enzymes aloe vera contains, one in particular is of great benefit to the immune system. Bradykinase does a great job in stimulating the immune system and even going so far as to kill infections. Meanwhile, zinc – again, as mentioned, one of aloe vera’s constituent mineral – is essential for effective immune function (it’s crucial for hormone receptors and proteins in the body, which play a key role in healthy immune function); all of this then means the plant is a fine source for combating zinc deficiency.

Additionally, a recent medical report points out that aloe vera is now under consideration for use in dentistry, owing to its efficacy as an antiseptic, anti-inflammatory and antifungal agent, in addition to its value in boosting the immune system without leading to allergic reactions or side effects5.

 

Diabetes

Finally, one of the major problems that those who suffer from diabetes encounter is the risk of cardiovascular complications. However, there is some evidence gleaned from human and animal subjects that points to aloe vera being effective at diminishing the chronic hyperglycaemia and perturbed lipid profile in diabetes sufferers that can lead to such cardiovascular issues 6.

 

Aloe vera natural supplements

Now, you might very well be aware of how and where to get hold of aloe vera-featuring skincare and cosmetic products, but where should you turn to for extracts of the plant that are suitable for consumption to benefit your body’s insides? Well, one way, of course – and one that’s probably not immediately obvious – is to go direct to the source itself; that is, to grow your own aloe as a potted plant at home. Yes, really. It’s not actually as expensive as it sounds. That said, if purchasing aloe vera seeds and tending to your very own plant seems a little extreme (if then you’d rather buy extracts than seeds to grow them from), then there is another option – natural supplementation. Indeed, among the different, excellent aloe vera supplements you’ll find we sell at The Finchley Clinic are these three following examples:



Aloe Fuzion – the highest quality, most bioavailable and most immunomodulatory version of aloe vera available.



Aloe Gold Natural – made from fresh, whole aloe leaves, this product uses gentle technology that extracts up to 20 times more vital nutrients than most other aloe juice and gels.


Aloe Gold Cherry/ Raspberry – a version of Aloe Gold blended with 7% unsprayed cranberry and cherry juices for a fantastic flavour.

 

References:

  1. Surjushe A., Vasani R. and Saple D. G. ‘Aloe vera: a short review’. Indian J Dermatol. 2008; 53 (4): 163–166. doi:  10.4103/0019-5154.44785.
  2. Foster M., Hunter D. and Samman S. ‘Chapter 3: Evaluation of the Nutritional and Metabolic Effects of Aloe vera’ in ‘Herbal Medicine: Biomolecular and Clinical Aspects: 2nd edition’. Boca Raton (FL): CRC Press/Taylor & Francis; 2011.
  3. Khedmat H., Karbasi A., Amini M., Aghaei A. and Taheri S. ‘Aloe vera in treatment of refractory irritable bowel syndrome: Trial on Iranian patients’. J Res Med Sci. 2013 Aug; 18 (8): 732.
  4. Keshavarzi Z. et al. ‘The effects of aqueous extract of Aloe vera leaves on the gastric acid secretion and brain and intestinal water content following acetic acid- induced gastric ulcer in male rats’. Avicenna J Phytomed. 2014 Mar-Apr; 4 (2): 137–143.
  5. Sujatha G., Kumar G. S., Muruganandan J. and Prasad T. S. ‘Aloe vera in dentistry’. J Clin Diagn Res. 2014 Oct; 8 (10): ZI01-2. doi: 10.7860/JCDR/2014/8382.4983. Epub 2014 Oct 20.
  6. Syed T. A., Ahmad S. A., Holt A. H., Ahmad S. A., Ahmad S. H. and Afzal M. ‘Management of psoriasis with Aloe vera extract in a hydrophilic cream: A placebo-controlled, double-blind study’. Trop Med Int Health. 1996; 1: 505–09.
Curcumin, Curcumin Liposomal Liquid

Six of the best: 6 reasons you should try natural curcumin supplements

Spices… what would we do without them? How bland would our food be without them as ingredients? Take, for instance, a curry without turmeric – a yellowy-orange spice that’s a member of the ginger family – what would the impact of a curry be without it? That said, spices like turmeric do far more than merely flavour our food; consumption of them do our health a great deal of good too. For example, the highly active phytochemical in turmeric that’s curcumin (which, in fact, is what gives that spice its colour) is enormously beneficial to practically every part of our bodies. Yes, really. Indeed, so inexhaustible are the curcumin health benefits that you might want to consider introducing it into your diet right now – here are just six of its major benefits:

 

  1. Aids gut health

First up then, while playing a critical role in stimulating the gall bladder to generate and release bile1 (a fluid produced by the liver that aids the digestion of lipids – fats – in the small intestine), curcumin also eases discomfort caused by stomach ulcers because it inhibits stomach acid secretion as well as the activity of pepsin (a digestive enzyme)2.

 

  1. Combats autoimmunity – and autoimmune-related conditions

Research has found that curcumin is adept at ameliorating the effects of multiple sclerosis (MS), rheumatoid arthritis, psoriasis and inflammatory bowel disease (IBD), all of which are either accepted as autoimmune diseases/ conditions or are strongly tied to autoimmunity3. Indeed, in terms of helping to treat IBD4, curcumin appears to be effective in aiding remission in those with inactive ulcerative colitis5, while for sufferers of rheumatoid arthritis, the phytochemical (in combination with the non-steroidal anti-inflammatory drug diclofenac) showed high efficacy6. And, if that’s not enough, it appears to help protect against autoimmune diabetes too7.

 

  1. All the ‘anti’s – anti-viral, anti-bacterial and anti-fungal

Curcumin can also play an important role in combating infections because of its innate capacity to activate the body’s vitamin D (or calcitriol) receptor protein. Moreover, in anti-viral terms, it helps to combat influenza, adenovirus, coxsackievirus and HIV, as well as reduce hepatitis C gene expression8. Meanwhile, operating as an anti-fungal agent, curcumin (when combined with the alkaloid piperine, a common ingredient in traditional medicine) works effectively against the yeast Candida alcibans bacteria; so often harmful to the gut9. And, when putting its anti-bacterial hat on, it helps protect against septicaemia; as proved by a study on mice, in which subjects exposed to Vibrio vulnificus (a pathogenic bacteria responsible for cholera) experienced a reduction in mortality rates10.

 

  1. Helps treat obesity and diabetes

It’s also been proved through research that curcumin, in bioavailable forms, can considerably contribute to weight loss in overweight people11. And when it comes to treating diabetes, the phytochemical’s capable of lowering blood sugar levels thanks to it stimulating insulin secretion from pancreatic cells12 and preventing insulin resistance. Moreover, it appears to drive up cardiovascular function while driving down oxidative stress in diabetic patients13, in addition to impeding obesity-induced inflammation14. Furthermore, curcumin can help reduce the chance of prediabetes evolving into type-2 diabetes and, at the same time, aid in the improvement of the overall functioning of pancreatic cells15.

 

  1. Fights oxidative stress and is anti-inflammatory

As noted already, the chemical possesses anti-inflammatory qualities; so much so, in fact, that it’s a more powerful anti-inflammatory agent than either of the over-the-counter synthetic treatments that are aspirin and ibuprofen – not least because it inhibits the chemokine interleukin 8 (IL-8) in lung cells16. Indeed, it appears its efficacy here for eye diseases is comparable to corticosteroid therapy17. Moreover, studies have discovered that it protects against oxidative stress, specifically, by impeding lipid peroxidation, as well as by boosting glutathione and superoxide dismutase (SOD) levels and by driving up the activity of the oxidative-damage-combating enzyme that’s catalase in the brain, kidneys and liver.18

 

  1. Benefits the liver and kidneys

Finally, by being so effective at both moderating inflammation and lipid peroxidation as well as boosting antioxidant enzymes (like catalase), curcumin does great work in the liver, in particular, because it can help to prevent alcohol-driven oxidative stress19 – and it’s been proved to play a significant role in the fight to prevent liver disease19. Furthermore, when it comes to the kidneys, it can aid in averting kidney cell damage that would otherwise be caused by taking too much paracetamol20.

 

Supplements

So, with curcumin boasting all these fantastic benefits, you’ll doubtless be wondering just where you can get your hands on it – and easily at that. Well, as mentioned at the outset, curcumin can be found in turmeric, but what if – for any reason – you find it difficult to purchase this spice, or if you’d prefer not to, of course? What if, you’d prefer to purchase curcumin directly? In that case, curcumin natural supplements are undoubtedly your best bet. Indeed, you’re well advised to check out the ‘Curcumin’ page of The Finchley Clinic website, where you’ll find, for example, these three excellent supplements:


Curcumin (Liposomal liquid) – developed with a new nano-particle technology, this product ensures much higher absorption of its curcumin content.


Curcumin Forte (Epigenar) – features a micellar formula, which ensures the curcumin is both water- and fat-soluble (185 times more absorbable than standard powder, in fact).


BioCare Curcumin Plus – provides curcumin in a micellised form for maximum efficacy, with antioxidants from pine bark, ursolic acid, sage and ginger.

 

References:

  1. Rasyid A. and Lelo A. ‘The effect of curcumin and placebo on human gall-bladder function: an ultrasound study’. Aliment Pharmacol Ther. 1999 Feb; 13 (2): 245-9.
  2. Mei X., Xu D., Wang S. and Xu S. ‘Pharmacological researches of curcumin solid dispersions on experimental gastric ulcer’. Zhongguo Zhong Yao Za Zhi. 2009 Nov; 34 (22): 2920-3.
  3. Bright JJ. ‘Curcumin and autoimmune disease’. Adv Exp Med Biol. 2007; 595: 425-51.
  4. Holt P. R., Katz S. and Kirshoff R. ‘Curcumin therapy in inflammatory bowel disease: a pilot study’. Dig Dis Sci. 2005 Nov; 50 (11): 2191-3.
  5. Hanai H. et al. ‘Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial’. Clin Gastroenterol Hepatol. 2006 Dec; 4 (12): 1502-6. Epub 2006 Nov.
  6. Chandran B. and Goel A. ‘A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis’. Phytother Res. 2012 Nov; 26 (11): 1719-25. doi: 10.1002/ptr.4639. Epub 2012 Mar.
  7. Aggarwal B. B. and Harikumar K. B. ‘Potential Therapeutic Effects of Curcumin, the Anti-inflammatory Agent, Against Neurodegenerative, Cardiovascular, Pulmonary, Metabolic, Autoimmune and Neoplastic Diseases’. Int J Biochem Cell Biol. 2009; 41 (1): 40–59. Published online 2008 Jul 9. doi:  10.1016/j.biocel.2008.06.010.
  8. Kim K. et al. ‘Curcumin inhibits hepatitis C virus replication via suppressing the Akt-SREBP-1 pathway’. FEBS Lett. 2010 Feb 19; 584 (4): 707-12. doi: 10.1016/j.febslet.2009.12.019. Epub 2009 Dec 17.
  9. Neelofar K. et al. ‘Curcumin as a promising anticandidal of clinical interest’. Can J Microbiol. 2011 Mar; 57 (3): 204-10. doi: 10.1139/W10-117.
  10. Na H. S. et al. ‘Protective mechanism of curcumin against Vibrio vulnificus infection’. FEMS Immunol Med Microbiol. 2011 Dec; 63 (3): 355-62. doi: 10.1111/j.1574-695X.2011.00855.x. Epub 2011 Sep 8.
  11. Di Pierro F. et al. ‘Potential role of bioavailable curcumin in weight loss and omental adipose tissue decrease: preliminary data of a randomized, controlled trial in overweight people with metabolic syndrome. Preliminary study.’ Eur Rev Med Pharmacol Sci. 2015 Nov; 19 (21): 4195-202.
  12. Abdel Aziz M. T. ‘The effect of curcumin on insulin release in rat-isolated pancreatic islets’. Angiology. 2010 Aug; 61 (6): 557-66. doi: 10.1177/0003319709356424. Epub 2010 Apr 14.
  13. Usharani P. et al. ‘Effect of NCB-02, atorvastatin and placebo on endothelial function, oxidative stress and inflammatory markers in patients with type 2 diabetes mellitus: a randomized, parallel-group, placebo-controlled, 8-week study’. Drugs R D. 2008; 9: 243–250.
  14. Woo H. M. et al. ‘Active spice-derived components can inhibit inflammatory responses of adipose tissue in obesity by suppressing inflammatory actions of macrophages and release of monocyte chemoattractant protein-1 from adipocytes’. Life Sci. 2007; 80: 926–931.
  15. Chuengsamarn S. et al. ‘Curcumin extract for prevention of type 2 diabetes’. Diabetes Care. 2012 Nov; 35 (11): 2121-7. doi: 10.2337/dc12-0116. Epub 2012 Jul 6.
  16. Biswas S. K. et al. ‘Curcumin induces glutathione biosynthesis and inhibits NF-kappaB activation and interleukin-8 release in alveolar epithelial cells: mechanism of free radical scavenging activity’. Antioxid Redox Signal. 2005 Jan-Feb; 7 (1-2): 32-41.
  17. Lal B. et al. ‘Efficacy of curcumin in the management of chronic anterior uveitis’. Phytother Res. 1999 Jun; 13 (4): 318-22.
  18. Agarwal R. et al. ‘Detoxification and antioxidant effects of curcumin in rats experimentally exposed to mercury’. Onlinelibrary.wiley.com. 2010 Mar. doi: 10.1002/jat.1517.
  19. Varatharajalu R. et al. ‘Protective Role of Dietary Curcumin in the Prevention of the Oxidative Stress Induced by Chronic Alcohol with respect to Hepatic Injury and Antiatherogenic Markers’. Oxid Med Cell Longev. 2016; 2016: 5017460. doi: 10.1155/2016/5017460. Epub 2016 Jan 5.
  20. Kheradpezhouh E. ‘Curcumin protects rats against acetaminophen-induced hepatorenal damages and shows synergistic activity with N-acetyl cysteine’. Eur J Pharmacol. 2010 Feb; 628 (1-3): 274-81. doi: 10.1016/j.ejphar.2009.11.027. Epub 2009 Nov 15.
Glutathione, Liposomal Glutathione

The grateful eight? 8 top benefits of glutathione to the body

Let’s be honest, the likelihood is you’ve never heard of glutathione. Why should you have? It’s not a vitamin, is it? Well, no. But it is a simple molecule – specifically, a peptide – to be found in every cell in the human body that comprises three amino acids (cysteine, glutamine and glycine). Fair enough; but if it’s as simple as all that, why’s it worthy of mention? Basically, because scientists believe it’s so important to humans and their health that they’ve suggested that the levels of glutathione in the body’s cells are an excellent predictor of life expectancy – that is, how much glutathione you have in your cells may greatly suggest how long you’ll live1, 2. All the more reason to boost your levels of the chemical through natural supplementation so they don’t run too low? Absolutely!

So, what is it about glutathione that makes it so essential to the healthy functioning of the human body? Why is its presence in the body’s cells so significant? Well, the reality is that this little substance helps to do a great many important things – here are eight of the most common and crucial of them…

 

Benefits of glutathione

  1. Fights oxidative stress

You may have heard of the awesome antioxidant properties of both Vitamins C and E, but don’t doubt it; glutathione is just as impressive and important an antioxidant – not least because it likes nothing more than locating itself right inside cells, the ideal position to do this work1. As an antioxidant then, it plays a critical role in reducing oxidative stress. It removes from the body free radicals and other reactive oxygen species (ROS) and defends against the harmful effects of toxic xenobiotics (such as carcinogens, pollutants and drugs); all of which contributes to protecting the body’s cells and DNA from damage and the body’s systems from deterioration and diseases – including, it’s believed, Parkinson’s, Alzheimer’s and some cancers 1, 2, 3. And, as if that wasn’t enough, it’s also great for helping regenerate other antioxidants; the likes of the aforementioned Vitamins C and E.

 

  1. Helps anti-aging

Free radicals, mentioned above, can cause much harm in the body because they like to find other health-benefitting molecules with which to pair off and ensure the latter become useless. To that end, among the myriad problems this can cause is the fact it contributes to the aging process – something then that replenished glutathione levels can naturally mitigate against1. Specifically, it’s believed that when glutathione levels are low, the efficacy of the immune system’s compromised, which speeds up the aging process – and the knock-on effect of this is that, as it ages, the body naturally produces less glutathione to keep itself healthy and, yes, ‘younger’1. Plus, it’s been posited that the drop-off in glutathione generation during the menopause may be a factor in why women tend to age dramatically during this time of life1.

 

  1. May aid brain health

Owing to the fact the brain tends to consume around 20% – that’s one fifth – of the oxygen absorbed into and created in the body, it’s critically important your glutathione levels remain high to ensure reactive oxygen species are detoxified here; indeed, research suggests that unless this takes place effectively the likelihood of the following brain-related diseases increases1:

  • Alzheimer’s disease – in part caused by oxidative stress (proved by the fact that oral Vitamin E intake can slow its progression1, 2), Alzheimer’s is notable for the DNA-binding protein TDP-43 amassing in the nervous system, a result of which is a reduction in glutathione in the body1 (creating then, yes, a vicious circle). That said, glutathione can treat symptoms of the disease – a study proved that in mice, a gluthatione-level-boosting protein increased memory in mice suffering with Alzheimer’s1.

 

  • Parkinson’s disease – again, in part, brought on by oxidative stress (specifically in the nervous system); Parkinson’s, so research has proved, ensures sufferers experience a deficit of glutathione in a specific part of the brain linked to the disease1.

 

  • Huntington’s disease – it seems it may also be possible to thwart this disease, once again caused by oxidative stress (in addition to mitochondrial dysfunction)1, in part by increasing the body’s glutathione levels so as to improve mitochondrial health1.

 

  1. May help fight infections

Reduced levels of glutathione in the body can also worsen the effect of viral infections, as it helps enable the infecting bacteria and parasites to run amok and cause abnormal amounts of oxidative stress in cells1, 2. Moreover, depleted glutathione means, as mentioned, a less effective immune system, which results in more virulent infections and worse inflammation, (certainly, for instance, in the case of influenza, cystic fibrosis, tuberculosis and AIDS)1. Additionally, one study has proved that keeping the body’s amino acid cysteine content (and thus the glutathione content) high, enhances the destruction of harmful, infection-causing mycobacteria1.

 

  1. May enhance gut health

The glutathione compound, glutathione peroxidase, is a crucial ingredient in the natural renewal of the gut wall (thereby helping to prevent leaky gut, which occurs when the gut wall becomes weakened)1, while it’s known that the peptide also works to protect the intestinal mucosa from harmful alien elements1. Plus, there may be a linkage between glutathione deficiency and the development of irritable bowel syndrome (IBS) – its sufferers appear to experience less activity of the enzymes that feature in the glutathione synthesis process and have reduced levels of the glutathione building block, cysteine1.

 

  1. May help prevent heart disease

Research has showed that an increased risk of heart attack can be linked to deficient amounts of both systemic and cardiac glutathione, as well as reduced activity of glutathione peroxidase in the body1, 2, 3, while cardiovascular disease is, to a large extent, the result of oxidative stress traced to the heart tissues (itself far less likely to take place, as is a stroke, if a body contains healthily high levels of glutathione with all its antioxidant duties1).

 

  1. May treat diabetic problems

There’s a very strong linkage between the accumulation of free radicals in the body and many harmful complications connected to type-2 diabetes (cardiovascular issues and neurodegeneration); thus, increased glutathione intake can definitely limit (if nor prevent) these complications1. Indeed, as with Alzheimer’s disease (above), a vicious circle can be created via glutathione deficiency and type-2 diabetes as, while the former can help cause the latter, type-2 diabetes and high blood sugar go on to reduce the body’s glutathione content1.

 

  1. May combat rheumatoid arthritis symptoms

Finally, not only has research suggested that antioxidant mechanisms may be compromised in the bodies of rheumatoid arthritis sufferers, but also that – unsurprisingly – their glutathione levels may be significantly lower than average1; to match the high demand their bodies have for the chemical then, it more than makes sense to top up their glutathione levels via supplementation.

 

Glutathione supplements

That said, as should now be clear, it makes perfect sense for everybody to try and ensure their glutathione levels are healthily high – so many potential ailments are its deficiency linked to. But how might you go about this? Naturally-derived supplementation is the answer – rather than any unnecessarily artificial alternative. By all means, take a look at the ‘Glutathione’ page on our website to check out the range of products available through us at The Finchley Clinic, which includes the following three examples:

Liposomal Glutathione – supplies the body’s primary detoxifier via a state-of-the-art supplement development process resulting in an extremely highly absorbable form of the chemical.

Epigenar Glutathione HPU – offers a reduced form of glutathione, but in a supplement also comprising zinc, magnesium, Vitamin B6, manganese, selenium, copper SOD and catalase.

Super Antioxidant Protection – a powerful formula that delivers the key antioxidant nutrients that are Vitamins C and E and glutathione, in addition to the key glutathione building-block N-acetyl cysteine as well as Vitamin B2, zinc, manganese and selenium.

 

References:

  1. Kern J. K., Geier D. A., Adams J. B., Garver C. R., Audhya T. and Geier M. R. ‘A clinical trial of glutathione supplementation in autism spectrum disorders’. Med Sci Monit. 2011; 17 (12): CR677–682. Published online 2011 Dec. doi:  10.12659/MSM.882125.
  2. Cascella R., Evangelisti E., Zampagni M., Becatti M., D’Adamio G., Goti A., Liguri G., Fiorillo C. and Cecchi C. ‘S-linolenoyl glutathione intake extends life-span and stress resistance via Sir-2.1 upregulation in Caenorhabditis elegans’. Free Radic Biol Med. 2014 Aug; 73: 127-35. doi: 10.1016/j.freeradbiomed.2014.05.004. Epub 2014 May.
  3. Perricone C., De Carolis C. and Perricone R. ‘Glutathione: a key player in autoimmunity’. Autoimmun Rev. 2009 Jul; 8 (8): 697-701. doi: 10.1016/j.autrev.2009.02.020. Epub 2009 Feb 13.