Dr Dingle's Blog

The Mediterranean Diet and RA

The Mediterranean Diet and RA

The Mediterranean Diet (MD) is one of the healthiest dietary pattern existing and consists in the high consumption of products like fruits, vegetables, legumes, unrefined cereals and nuts, the moderate consumption of fish, poultry and dairy products as cheese and yoghurt, and the low consumption of red meat products. Olive oil is used as the main edible-fat source and wine is consumed in a regular, but moderate, basis with a meal. The reduction in overall mortality and morbidity has been linked to a greater adherence to the MD and this food pattern is highly proposed as a beneficial dietary approach for patients with inflammatory diseases.

Studies have shown rheumatoid arthritis disease characteristics namely, inflammatory activity disease, physical function and vitality, may be clinically related to MD pattern, particularly when compared to a western diet. One study, after 12 weeks of intervention, patients in the MD group showed a significant improvement in Disease Activity Score (28 joints), Health Assessment Questionnaire, whereas subjects in the control group displayed no significant changes in these parameters. In another study, after 6 months, patient global pain (Visual Analog Scale), and morning stiffness were significantly improved in the intervention group when compared to controls.

Rich fibre foods such as fruit, vegetables, and legumes, all regularly consumed by individuals who practice a MD pattern, have the ability to become degraded by the gut bacteria 'Firmicutes' and 'Bacteroidetes' bacteria, leading to high feacal Short Chain Fatty Acids (SCFA’s). Fibre is the most well-known nutrient with an important impact on microbiota. Diets rich in this nutrient increase SCFA producing bacteria, with benefits on intestinal barrier structure. Particularly the butyrate strengthens the barrier and decreases intestinal permeability and bacterial translocation. This has been shown to prevent the activation of undesirable local and systemic inflammatory responses. The changes in gut microbial ecology and associated SCFA driven immune modulation can, in a logical way, explain the mechanisms behind clinical amelioration of RA in individuals exposed to MD.

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The Benefits of CoQ10

The Benefits of CoQ10

Randomised controlled clinical trials have shown supplementation with CoQ10 or CoQ10 plus selenium reduces mortality by approximately 50% in patients with cardiovascular disease, or in the normal elderly population, respectively. Similarly, CoQ10 supplementation improves glycaemic control and vascular dysfunction in type II diabetes, improves renal function in patients with chronic kidney disease, and reduces liver inflammation in patients with non-alcoholic fatty liver disease. The beneficial role of supplemental CoQ10 in the above disorders is considered to result from a combination of its roles in cellular energy generation, as an antioxidant and as an anti-inflammatory agent. 

The rationale for CoQ10 supplementation in these disorders is based on its key role in cellular metabolism; in addition to its role in cellular energy generation, CoQ10 has antioxidant and anti-inflammatory action

Meta-analyses of clinical studies have demonstrated that supplementation with CoQ10 significantly reduces levels of the inflammatory mediators C-reactive protein (CRP), interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) respectively.

Most of the body’s daily CoQ10 requirement is derived from endogenous synthesis, and this is known to decline substantially with age [7]. This age-related decline in endogenous CoQ10 synthesis may, therefore, be directly linked to longevity via the development of these degenerative disorders.

The role of CoQ10 supplementation in the treatment or prevention of cardiovascular disease has been detailed in previous reviews [9,10].

Two recently published randomised, double-blind, placebo-controlled clinical trials have demonstrated the efficacy of supplementation with CoQ10 (Q-SYMBIO) or CoQ10 plus selenium (KISEL-10) in substantially reducing mortality risk in patients with heart failure, or in the normal elderly population, respectively.

The potential benefit of CoQ10 supplementation in type II diabetes has been shown repeatedly in studies. A number of studies have identified depleted blood CoQ10 levels in patients with type II diabetes.

Over a dozen controlled clinical trials supplementing CoQ10 (typically 100–200 mg/day for 3–6 months) in type II diabetic patients

CoQ10 supplementation significantly improved fasting plasma glucose and HbA1c (glycated haemoglobin )levels.

Similarly, glycaemic control and blood antioxidant levels were significantly improved in type II diabetics following supplementation (100 mg/day for three months) with the reduced (ubiquinol) form of CoQ10 [29

Supplemental CoQ10 may benefit type II diabetes via several mechanisms, for example by promoting enhanced levels of cellular energy required for glucose metabolism, or via direct modulation of the expression of genes relevant to glucose metabolism, or via its antioxidant action [35].

The use of statins (particularly simvastatin) has been associated with an increased risk of between 10% and 40% of developing type II diabetes [40,41]; this is thought to result from statin-induced depletions of circulatory levels of CoQ10, adiponectin and glucose transporter-4 (GLUT4) protein [42]. Although CoQ10 administration has been shown to prevent simvastatin-induced GLUT4 protein levels in cell culture [43],

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The Health Benefits of Green Spaces

The Health Benefits of Green Spaces

Growing up as a child in the 60’s there was lots of space to play on the street, in the big back yards, nearby parks, creeks, the beach and lots of green spaces. While we we have lost a lot of these spaces research is showing that the more “green” we are surrounded with the the healthier it is for us. We exhibit more than just a preference for natural scenes and settings; we suffer health problems when we lose contact with our green surrounds. Increasing evidence indicates that nature provides restorative experiences that directly affect people's physical, social and mental well-being and health in a positive way including decreased mortality.

A recent study found that living in more densely vegetated areas was associated with fewer deaths from causes other than accidents. Using data from the Nurses’ Health Study researchers estimated a 12% lower rate of non-accidental death between women who lived in the most densely versus least densely vegetated areas. When looking at specific causes of death, the researchers estimated a 41% lower rate of kidney disease mortality, a 34% lower rate of respiratory disease mortality, and a 13% lower rate of cancer mortality in the women who lived in the greenest areas, compared with those in the least green areas. A study in the Netherlands found a lower prevalence of diseases in areas with more green space, including coronary heart disease and diabetes. In a cross-sectional study of 11,404 adults in Australia the odds of hospitalization for heart disease or stroke was 37% lower, and the odds of self-reported heart disease or stroke was 16% lower, among adults with highly variable greenness around their home, compared to those in neighborhoods with low variability in greenness. The odds of heart disease or stroke decreased by 7% per unit with every 25% increase in the level of greenness. In an interesting experiment where 14 children undertook two, 15 min bouts of cycling at a moderate exercise intensity while in one situation viewing a film of cycling in a forest setting and another with no visual stimulus. The systolic blood pressure (the top or higher number) 15 minutes after exercise was significantly lower following green exercise compared to the control condition. So if it works for kids it should also work for us we get older.

The rise in obesity is well documented and while there are many contributing factors a systematic review of green space research from sixty studies reported the majority (68%) of papers found a positive association between green spaces and obesity-related health indicators. One study found that increased vegetation was associated with reduced weight among young people living in high population densities and across eight European cities, people were 40% less likely to be obese in the greenest areas. Overall, the majority of studies found some evidence of a relationship with weight and green space. The lower rates of obesity, adverse health and improved health outcomes may be attributable to higher levels of physical activity, such as neighborhood walking which is positively influenced by the natural environment. Walking is the most popular physical activity particularly as we age, and levels of recreational walking have been linked the distance to and attractiveness of local parks and ovals.  Many studies have reported that adults with access to a large high-quality park within walking distance (within 1600 m) from home have elevated levels of walking and and in general live longer. In a review of 50 studies twenty studies (40%) reported a positive association between green space and physical activity, including older adults.

Being around vegetation can lead to better mental health and less stress, positive emotions, focus and attention, as well as reduced stress. While walking itself can reduce stress, walking in a natural setting provides greater stress-relieving benefits. Accessible green spaces are ‘escape facilities’, and lack of access to green space contributes to poor mental health. Some of the more potent restorative effects of nature relate to being able to ‘get away’ from everyday settings and immerse oneself in an extensive natural setting that creates a sense of being in a ‘whole other world’.

Perhaps as we decide to age healthier we need to spend more time near green spaces.

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Personal care products and at risk populations

Personal care products and at risk populations

Some people are more likely to have health problems as a result of exposure to cosmetics and personal care products than others, even when the amounts of contaminants present are seemingly quite low. However, when the studies are done, the focus is on one ingredient and its exposure to a healthy animal fed a well-balanced nutritional diet. As individuals, we each have different levels of resilience and tolerance to toxic chemicals based on our genetics and our current level of health, nutrition and even lifestyle factors.

Susceptible groups include:

  • The developing foetus
  • Infants and newborns
  • Pregnant mothers
  • Asthmatics
  • People who are already sick or immune-compromised
  • Chemically sensitive individuals
  • The aged
  • Genetically susceptible individuals
  • Lower socioeconomic groups
  • Stressed individuals

… to list the obvious.

Asthmatics have particular sensitivities. Any chemicals, gases or particulates that cause irritation of the respiratory system’s mucous membranes will aggravate an asthmatic’s condition. Allergy-prone people who already show sensitivity to a substance with reactions such as sinusitis, hay fever, atopic eczema and other forms of atopic dermatitis are likely to react with heightened sensitivity to indoor air pollution. They may experience an aggravation of their allergies or develop additional sensitivities. The increasing number of people who suffer from 21st-century diseases such as chronic fatigue and multiple chemical sensitivities will also react to even very low levels of these chemicals.

Pregnant women, who may themselves enjoy robust health, are at risk because some of these contaminants pass over the placenta to the foetus. People under stress are more at risk because their immune systems are often not functioning at optimum levels. Other factors determining susceptibility include gender, genetic makeup, pre-existing health conditions and predisposition to disease, as well as lifestyle considerations such as work, diet and exercise.

There is little doubt that our kids have a greater susceptibility to toxic chemicals than we do. The younger they are, the more vulnerable they are. Every day we expose our children to hundreds of different chemicals in personal care and cosmetic products and yet remain puzzled as to why they get sick and why the rates of childhood asthma, allergies and cancer are higher than ever. Childhood leukaemia and brain tumours are leading causes of death of children in most developed countries and many studies are now showing a link between these conditions and increased toxic chemical exposure.

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The healing power of raw cabbage

The healing power of raw cabbage

Another reason to add some of the cabbage family to your daily diet, preferably raw is because of their gut healing properties and how they promote gut health through the gut microbiome. The Brassica family including cabbage, broccoli, brussel sprouts, kale, arugula (rocket), bok choy, cauliflower, collard greens, radish, turnip and others have been recognized for their gut healing and gut health properties for hundreds of years and modern epidemiologic studies have shown a frequent consumption of cruciferous vegetables is associated with lower risk of cancer, especially cancers of the digestive tract, bladder, breast, prostate, and lung. However, only now are we recognizing that many of these benefits are mediated through the microbiome and that their frequent consumption alters the composition of the microbiome.

Cruciferous vegetables are a rich source of glucosinolates a precursor to the Isothiocyanates (ITC), which exhibit powerful biological functions in fighting cancers, cardiovascular, neurodegenerative diseases and gut healing. The Isothiocyanates are a by product of specific plant enzymes (myrosinase) active during chewing or crushing when broccoli is consumed raw or lightly steamed, however, like all enzymes myrosinase is deactivated by cooking and ingestion of cooked broccoli typically provides only about one tenth the amount of isothiocyanates as that from raw broccoli. So to maximize the gut healing, gut health and overall benefits of these foods they are best eaten raw or just lightly steamed.

Instead when cooked cruciferous vegetables are consumed, gut bacteria are mainly responsible for ITC production in the gut. This is highlighted after taking oral antibiotics, the ITCs availability and uptake decreases after eating cooked cruciferous vegetable. It also appears that there is considerable difference in the ability of individuals, due to individual differences in gut microbial community, to produce the isothiocyanates. Although, the gut communitys ability is altered over just 4 days. In one study feeding raw or cooked broccoli for four days or longer both changed the microbiota composition and caused a greater production of isothiocyanates. Interestingly, a three-day withdrawal from broccoli reversed the increased microbial metabolites suggesting that the microbiota requires four or more days of broccoli consumption and is reversible.

The lactic acid bacteria appear to have myrosinase-like activity and the fermented Brassica food products, such as sauerkraut and kimchi, are particularly rich in Lactobacillus, and a diet rich in Brassica may promote Lactobacillus growth in the colon.

 

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Environmental Estrogens and Endocrine Disrupting Chemicals (EDC's)

Environmental Estrogens and Endocrine Disrupting Chemicals (EDC's)

Since the 1980's, there has been a growing amount of research toward the potential interaction between these environmental estrogens and wild animals, with a number of reports detailing the emergence of 'feminised wildlife’ around the world, and a range of adverse effects in humans including decreased sperm count, increased cases of testicular cancer and testicular abnormalities, increased breast cancer in men and women and premature or precocious puberty. Other adverse health outcomes linked with EDC’s include headache, migraine, depression, gastrointestinal disturbances, insomnia, changes in breast tissue and in vaginal bleeding. More chronic symptoms affect the cardiovascular system, the skin (itching, rash, abnormal pigmentation), the gallbladder, and tumours particularly of the breast but also uterus, cervix, vagina and liver. While other studies have shown increases in the organ weight of estrogen-sensitive tissues such as the uterus, and calcium and bone metabolism are all examples of the estrogenic effects. Even how we age and age at menopause can be affected by these chemicals. In support of this at least one professional and very conservative group, the Endocrine Society, has concluded that sufficient evidence now exists linking endocrine disrupting chemicals (EDCs) to adverse human reproductive effects, including possible epigenetic and trans-generational effects.

Unfortunately, our babies are being born pre-polluted with chemicals detectable in their blood, in the placenta and in amniotic fluid because of exposure to these chemicals during pregnancy and throughout the mother’s life. The placental barrier has been shown to allow these chemicals to cross, as many of them have been measured in human fetal cord blood, fetal serum, human amniotic fluid and even newborn stools (meconium). Exposure to these chemicals before birth poses a serious health risks to developing fetus, infants and young children as shown by the increasing adverse effects including negative birth outcomes, childhood obesity and increasing intellectual disabilities. It is believed that current levels of environmental estrogen exposure results in lower birth weights, smaller head circumferences, poorer neuromuscular maturity and visual recognition, delays in psychomotor development, short term memory problems, and growth retardation in newborn babies. Fetal exposure to these environmental estrogens are suspected of disrupting thyroid functioning, sexual differentiation of the brain in foetal development and cognitive motor function and cause anxious behaviour. They are also able to bind to neurotransmitters such as epinephrine, neuroepinophrine and dopamine enabling estrogens to influence the body's central nervous system (CNS). Environmental estrogens have also been shown to effect the body’s immune system.

Studies have found strong links with exposure to excessive levels of estrogen in males with penis abnormalities, lower libido, congenital anomalies, failure of the testes to descend and testicular cancer, reduced penis size and increased embryo mortality.

What is most concerning regarding control of these chemicals is that there are no indications given or regulations set regarding the minimal age at which they should be used or exposed to them. Increasingly, pregnant mothers, infants, pre-pubescent and pubescent children are being exposed to a large number of products containing these chemicals, with no research to show that exposure is safe during these critical periods of development.

Equally strong is the evidence that these same chemicals can cause some of the most common cancers: prostate and testicular cancer in men and breast cancer in women. One of the most troubling is their association with breast cancer. Breast cancer is the major cancer affecting women in the Western world and one of the most disturbing and well documented current trends is the alarming increase in breast cancer incidence over the past few decades. Fifty years ago the risk rate was one woman in 20; today it is one in 8 and approximately two-thirds of breast tumors are estrogen receptive, and environmental estrogens like parabens, phthalates and BPA are known to bind to estrogen receptors. Estrogen-dependent cancers, such as breast cancer, are known to be highly responsive to estrogens for growth. Even more disturbing is the increase in numbers of young girls developing breast cancer.

 

https://www.drdingle.com/collections/book-sales/products/dangerous-beauty-1

 

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Curcumin (turmeric)stops age and diet relted arterial damage

Curcumin (turmeric)stops age and diet relted arterial damage

Curcumin, a main component of natural turmeric (Curcuma longa Linn, Turmeric), is a type of polyphenol, which has long been used for curry spice, Chinese traditional herbal medicine, or in Japan, as food coloring for Japanese confectioneries.
Recent studies have shown that curcumin has different beneficial physiological activities in the body. Curcumin is known to have anti-oxidative and anti-inflammatory actions and anticancer action through multiple actions (cytostasis, induction of apoptosis, and anti-angiogenesis, anti-virus action, and cytoprotective).
Furthermore, curcumin is known to lower blood lipid (fat) levles, affecting various transcription factors that control gene expression involved in glucose and fat metabolism, and curcumin intake is expected to reduce different disorders caused by a high-fat diet (HFD).
In this study, they examined the effects of long-term administration of curcumin on artery aging and chronic inflammation—the causes of arteriosclerotic disease. in the high fat diet group oxidative stress increased with cell regulation in the arteries followed by increased dying cells and enhanced inflammation. While the group with curcumin added had suppression of oxidative stress and the arteries of mice at 80 weeks (old age) were the equivalent of those of the 8 week old mice in the experiment.
It seems curcumin has anti-ageing effects on our arteries which is why I supplement with it every day
Source. Curcumin Inhibits Age-Related Vascular Changes in Aged Mice Fed a High-Fat Diet.
https://www.mdpi.com/2072-6643/10/10/1476/htm
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Fasting reverses Type 2 diabetes

Fasting reverses Type 2 diabetes

Despite what we are often told the overwhelming evidence shows that Type 2 diabetes is a diet and lifestyle illness. It also shows that when you reverse the conditions that caused it the disease is also reversible.

Type 2 diabetes (T2D) is a chronic disease closely linked to the epidemic of obesity that requires long-term medical attention to limit the development of its wide range of complications. Many of these complications arise from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Approximately 10% of the population of the USA and Canada have a diagnosis of T2D, and the morbidity and mortality rates associated with it are fairly high. The economic burden of T2D in the USA is $245 billion and around $20 billion in Australia.

This case documents three patients referred to the Intensive Dietary Management clinic in Toronto, Canada, for insulin-dependent type 2 diabetes. It demonstrates the effectiveness of therapeutic fasting to reverse their insulin resistance, resulting in cessation of insulin therapy while maintaining control of their blood sugars. In addition, these patients were also able to lose significant amounts of body weight, reduce their waist circumference and also reduce their glycated haemoglobin level.

These three cases exemplify that therapeutic fasting may reduce insulin requirements in T2D. Given the rising cost of insulin, patients may potentially save significant money. Further, the reduced need for syringes and blood glucose monitoring may reduce patient discomfort.

Therapeutic fasting has the potential to fill this gap in diabetes care by providing similar intensive caloric restriction and hormonal benefits as bariatric surgery without the invasive and dangerous surgery. During fasting periods, patients are allowed to drink unlimited amounts of very low-calorie fluids such as water, coffee, tea and bone broth. A general multivitamin supplement is encouraged to provide adequate micronutrients. Precise fasting schedules vary depending primarily on the patient’s preference, ranging from 16 hours to several days. On eating days, patients are encouraged to eat a diet low in sugar and refined carbohydrates, which decreases blood glucose and insulin secretion.

This means that patients with T2D can reverse their diseases without the worry of side effects and financial burden of many pharmaceuticals, as well as the unknown long-term risks and uncertainty of surgery, all by means of therapeutic fasting.

 

Source http://casereports.bmj.com/content/2018/bcr-2017-221854.full

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What is stress

What is stress

Despite the increases in technology, life style changes and the promise of more free time, it is becoming apparent that stress is becoming one of the greatest health concerns of the Western World. Recent statistics indicate that between 70 ‑ 80 percent of all health related problems are either precipitated or aggravated by stress. Although the way we live, and the situations we face everyday have changed over thousands of years, our modern brain still has the ability (as it has had for thousands of years) to give us the same feelings and responses to stress. This is because these are deeply instinctive responses of protection and survival.

‘Distress’ is stress that arises from a negative situation such having an argument, being under too much pressure at work, or being called into the bosses office. ‘Eustress’ on the other hand, is stress that results from a positive situation, such as getting married or receiving an award . A mild amount of pressure can be beneficial; making a person more motivated to increase performance. However, the major difference between the positive eustress and the negative distress is how you perceive them. To one person public speaking creates eustress but to another it creates distress and high pressure for one individual in the work environment may not be experienced by another, being instead seen as more of a personal challenge. They both place the same physiological demands on the body, but are processed mentally and emotionally in different manners.

However, too much pressure or pressure for a long period of time can lead to excessive stress, a state of distress, which is unhealthy for both the mind and body. Stress can also be looked at from being acute and chronic stress.

The evolutionary explanation behind stress is that ancestor’s perceived reaction to threats and dangers has survival value. When hunter-gathers would risk their lives in hunting for food or defending their community they would experience dangers that would trigger the bodies stress response, preparing them for action, to either fight or flee from the threat. In today’s society, stress experienced is not usually life threatening but still triggers the same stress response.
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Dr Dingle’s Blood Pressure Smoothie

Dr Dingle’s Blood Pressure Smoothie

The reason I call it the blood pressure smoothie is all of the ingredients have been shown in many scientific studies to reduce blood pressure. By no way is this meant to replace advice from you GP but you can share it with them and see if they are interested in preventing the problem rather than just treating it with pharmaceuticals. Remember also that I am not a GP I am just the guy who does all the research which is why I have a PhD.

4 ingredients in order of importance

Beetroot

Almonds (soaked for at least 8 hours)

Linseed (flaxseed)

Filtered re-mineralised ionized water.

 

Extras for taste and minerals

Banana

Coconut

Dates

 

Start by grinding the linseed and the almond in the smoothie maker.

Add the beetroot and the filtered water to make up to the constituency you need.

If you want to make it a bit sweeter add some ripe banana, dates or coconut water (and coconut meat if you have the whole coconut) as they are rich in Potassium (and other minerals) which is essential for muscle relaxation and tastes great. But wait till the banana is ripe for the best taste. You can also cold green tea instead of water to add to the antioxidant mix.

The properties that make this smoothie such a potent blood pressure mix is all of the ingredients have excellent antioxidant properties, rich in minerals and other nutrients liked with lowering blood pressure in scientific studies.

Background

High blood pressure or hypertension is having a blood pressure reading of above of around 90mm Hg on 140mm Hg. Hypertension itself is not a disease but a condition or as an indicator of ‘increased risk’ of cardiovascular disease. Patients who are hypertensive have an increased risk of heart attack and stroke due to the direct correlation between the two. Hypertension also contributes significantly to the increased risk of kidney failure and other chronic illness.

In healthy people the cells of blood vessels produce the substance called nitric oxide (NO) which instructs smooth muscles surrounding arteries to relax. If they cant relax they stay rigid and you end up with high blood pressure. The NO is produced in a single layer of cells that line the inside of the arteries called the endothelium. If this tissue is damaged in the case of too much pressure, oxidation or through other means it stops producing NO and blood pressure rises.

Many of the beneficial actions of nutrition on lowering blood pressure results both directly and indirectly through improving endothelial tissue and NO production and release from this tissue. Two major pathways to increase NO are increase the rates of nitrates in the diet, the building block for NO, and L-Arginine which stimulate the enzyme to manufacture NO. Endothelial-derived NO also inhibits platelet adhesion, activation, secretion, and aggregation and promotes platelet disaggregation so you are less likely to have a stroke. A third mechanism that is absolutely critical is to protect and repair the endothelium, remember it is only one cell thick and very susceptible to damage. Vitamin C and antioxidants are essential for this part.

Diets high in dietary nitrate such as beetroot are associated with reduced blood pressure increased exercise performance as a result of vasodilation (expansion) of the blood vessels and a decreased incidence in cardiovascular disease. 100-200mg of beetroot per day has been shown to produce immediate effects of lowering blood pressure by around 15 mm of Hg. Beetroot is also rich in vitamins, phytochemicals and contains large amounts of iron and folic acid Mg, Na and Ca. Apart from the nitrates the major bioactive molecules in beet are polyphenols, flavonoids, betalains, therapeutic enzymes, ascorbic acid, and dehydroascorbic acid (DHAA). So they not only provide the ingredients for NO production but also help in repair and protection of the endothelium.

Almonds have one of the highest sources of L-Arginine (most nuts have lots of L-Arginine so you can substitute the almonds if you want) which stimulates NO synthesis. Studies of almonds have shown reductions of 5-6 mm of blood pressure. It is important to soak the almonds as they (all nuts and seeds) have enzyme-inhibiting factors in them which stop them from germinating until they have enough water. These enzyme inhibitors also stop the absorption of some nutrients, particularly minerals. When you soak the nuts many of the nutrients also become more available for digestion.

Flaxseed is rich in Omega 3 fatty acids, L Arginine (about 20% less than almonds), lignans, antioxidants and fiber that together probably provide benefits to patients with cardiovascular disease. Studies on consuming 30g of flaxseed have been shown to reduce blood pressure by up to 15 mm Hg.

The great thing about this smoothie is that you can add just about anything else you want to it and it will make it even tastier and better for you.
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