VOLUME 4 ISSUE 6

Overcome the Stress EpidemicStrategies to Relieve Stress

AdvancesI N O R T H O M O L E C U L A R R E S E A R C H

AdvancesI N O R T H O M O L E C U L A R R E S E A R C H

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RESEARCH-DRIVEN BOTANICAL INTEGRATIVE ORTHOMOLECULAR INNOVATIVE

Stressed?Ortho•Adapt

ADVANCEDORTHOMOLECULAR RESEARCH

Published in Canada byAdvanced Orthomolecular Research Inc.

Publisher/Editor-in-Chief Jaime Thomas, BSc

Research & Writing Dr. Colin O’Brien, ND Dr. Paul Hrkal, ND Dr. Cameron McIntyre, ND Dr. Chantal Ann Dumas, ND (Qc) Justine Florence, BSc Jaime Thomas, BSc

Graphic Design/Art Production Neil Bromley Alvin Cha email: graphics@aor.ca

Volume 4 Issue 6

Digital versions of this magazine and back issues are available online at www.AOR.ca

Is Stress Making You Sick?Stress is linked to illness and disease. Learn about how the body attempts to cope with stress and how the neuroendocrine system strives to maintain balance.

Vitamins Help You Manage StressMany vitamins are essential to your body to function during times of stress. Find out more about how you can feed your body the right nutrients to become more resilient against stress.

Are You Suffering From Adrenal Fatigue? Adrenal fatigue can cause symptoms of illness. Find out how you can support your adrenal glands with a healthy lifestyle, nutritious diet and by using supportive dietary supplements.

Amazing Maca Maca root possesses beneficial medicinal and nutritional properties. It is well known for its ability to boost mood and energy levels, for enhancing sexual function and for supporting memory and learning.

Sleep Disturbance: The Silent Killer Sleep disturbance does more than leave you feeling tired. It can wreak havoc on your health and contribute to premature death due to disease.

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Advances in Orthomolecular Researchis distributed through integrative physicians, health care practitioners, and progressive health food retailers.

The content of this magazine is provided for informational purposes only, and is not intended as medical advice for individuals, which can only be provided by a healthcare professional. Contents and design © 2014 AOR. Any reproduction in whole or part and in print or electronic form without express permission is strictly forbidden. Permission to reproduce selected material may be granted by contacting the publisher.

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Is Stress Making You Sick?Arguably, we are more stressed today than ever before in human history. As a result, stress accounts for 75 – 90% of all primary care visits in the US, and prescriptions for antidepressant and anti-anxiety medications are sky-rocketing. Many people recourse to self-medicating with substances such as stimulants, drugs, alcohol, tobacco and even food in an attempt to manage their mental stress. Stress is also considered to be the number one reason why people eat poorly and quit healthy lifestyle programs. Chronic stress is now acknowledged as a key driver behind most of our modern health complaints, both psychological and physical.

Reducing the Effects of StressThe use of botanical preparations

aimed at helping the body to balance is a traditional practice worldwide. The efficacy of adaptogens such as ginseng, licorice, Ashwagandha, holy basil, Bacopa, etc. is now validated by scientific studies. Formulas combining botanical and adrenal gland extracts are superior since their various mechanisms of action complement each other to modulate the multiple pathways affected by stress. Trying to reduce levels of stress in one’s life and getting proper rest and nutrition are critical in order for the body to remain biochemically balanced and equipped to cope with life’s challenges.

The Mind-Body ConnectionIn contrast to Chinese and other

traditional medicine philosophies, Western medicine has long claimed that the mind and body are separate entities. In light of recent scientific research however, an increasing number of researchers and physicians now recognize that what happens in the mind can profoundly influence the body. The Stress–Illness Connection

Stress is so widespread that the word tends to lose its meaning. In neuroscientists’ terms, stress is defined as: “Conditions where an environmental demand exceeds the natural regulatory capacity of an organism, in particular situations that include unpredictability and uncontrollability.” The stress response is meant to improve your chances of

Is Stress Making You Sick?

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surviving a physical threat to your safety temporarily, but prolonged, frequent or extreme stress can have devastating effects on the body and brain. It is fair to say that nearly all illness is stress-related: it’s either caused by stress, aggravated by stress or causes stress. While the mechanisms by which stress contributes to the disease process remains to be fully understood, research shows that chronic stress causes significant dysfunction of the neuroendocrine system.

There are many health challenges associated with chronic stress such as: hormonal imbalance, thyroid dysfunction, obesity, accelerated aging, hypertension, cardiovascular disease, suppressed immunity, cancer, Alzheimer’s disease, diabetes, gastrointestinal complaints, gastric ulcers, osteoporosis, skin issues, sexual dysfunction, and psychological problems. Stress 101 - General Adaptation Syndrome

Back in the 1930s, Hans Selye observed that both psychological and biological stress can impact our health through interactions between the mind and the adrenal glands. Selye observed that when faced with stressors (either physical or psychological), all living organisms react in physiologically predictable patterns in order to maintain their metabolic equilibrium, or homeostasis. He described this response in a three-step process which he has coined the “General Adaptation Syndrome” (GAS), see figure 2.

Stage 1 - Alarm phase: Upon encountering a stressor, the nervous system sends an immediate alarm signal to the brain, resulting in the activation of both the “fight-or-flight” response and the hypothalamic-pituitary-adrenal (HPA) axis. The “stress” hormones including corticosteroids (i.e. cortisol) and catecholamines (i.e. adrenalin) are released into the bloodstream. The body’s resources are then mobilized to deal with the perceived threat or danger.

Stage 2 - Resistance: If the perceived stressors are not countered in a timely

fashion, the parasympathetic nervous system returns many physiological functions to normal levels, while the body focuses its resources against the stressor. Although the organism appears normal, levels of blood glucose, cortisol and adrenalin remain elevated as the body stays on red alert.

Stage 3 – Exhaustion: If the stressor continues beyond the body’s capacity, the organism exhausts its resources and the adaptive mechanisms collapse. The person becomes susceptible to disease and, if the exhaustion phase continues long enough, death can occur.How Stress Affects the Neuroendocrine System: The HPA Axis

The intricate connection between our brain and the system of glands that produces hormones called our

endocrine system is known as the hyp otha lamic-pitu itar y-adrena l (HPA) axis, plays a crucial role in both mind and body health. The HPA axis starts with a part of the brain called the hypothalamus, often considered the “master gland” of the neuroendocrine system. Amongst its many functions, the hypothalamus controls the pituitary gland, a bean-sized structure which sits right underneath. During stressful periods, the hypothalamus secretes corticotropin-releasing factor (CRF), a hormone and neurotransmitter whose role is to stimulate the pituitary synthesis of adrenocorticotropic hormone (ACTH). ACTH travels through the bloodstream to reach the adrenal glands located on top of our kidneys, and causes them to release the stress hormones including cortisol and adrenaline.

Long-term E�ects of Stress on the Body

Neck• Hypothyroid• Sore throat• Mouth ulcers

Arteries• High blood pressure• Cholesterol • Stroke

Lungs• Cough• Cold • Asthma

Liver & Pancreas• Liver disease• Diabetes

Reproductive Organs• PMS• Hot sweats• Libido• Infertility

Skin• Acne• Rosacea• Psoriasis• Premature aging• Allergies

Hair• Hair loss• Thinning

Muscles & Joints• Pain• Fibromyalgia• Water retention

Heart• Heart disease• Irregular heartbeat

Stomach• Diarrhea• Constipation• IBS / IBD• Ulcers• Malabsorption

Weight Gain• Central adiposity• Food cravings

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CortisolCortisol is involved in multiple

bodily functions and its primary roles include: 1) Increasing blood sugar synthesis in the liver, 2) Assisting in fat, protein and carbohydrate metabolism, and 3) Supressing the immune system to allow the body to perform priority or life dependant upon tasks. It also decreases bone formation. Cortisol is needed to maintain optimal health, but too much or too little can be deadly. Hormones are maintained at the optimal level via a tightly regulated system of feedback loops. During stressful periods however, cortisol is secreted at an increased rate to support the breaking down and the use of fatty acids and proteins needed for energy production. Building on Selye’s original work, researchers have demonstrated that both acute and chronic levels of stress contribute to high levels of cortisol.Biochemical Effects of Stress • Steroid Hormone Imbalance

Stress-induced over-activation of the HPA axis and its resulting

adrenal dysfunction profoundly affects hormonal balance in several ways. The adrenals are responsible for approximately 35% of steroid hormone production prior to menopause and for at least half of their production after menopause onset. All steroid hormones are disrupted by stress, but progesterone is particularly vulnerable to the devastating effects of chronic stress because it is used as raw material for the production of cortisol. For examples of different types of steroid hormones see Figure 1.• Thyroid Dysfunction

In conventional medicine, thyroid disease is treated as a random malfunction of the thyroid gland. However experience in clinical practice demonstrates that poor thyroid function is often related to other issues, such as hormonal imbalance, toxicity, digestion and nutritional deficiencies. For example, malfunctioning adrenals can lead to hypothyroidism as the thyroid may decrease its hormonal activity in an attempt to reverse adrenal overdrive. Moreover, the amino acid

tyrosine is needed for the production of thyroid hormones but it is also used in the making of the stress hormones adrenaline and noradrenalin. To make matters worse, elevated levels of cortisol impair the conversion of the T4 thyroid hormone to T3, its active form. • Obesity

Emerging studies are now supporting the claims of the many people accusing stress of being a direct culprit of their weight gain. Indeed, investigators are finding correlations between stress-induced cortisol secretion and central obesity, marked by a high waist-to-hip ratio accompanied with abdominal adiposity. Raised cortisol levels may also contribute to binge eating.• Accelerated Aging

Telomeres are protective DNA strands found at the extremities of our chromosomes. They can be compared to the plastic caps on the ends of shoelaces. Every time our chromosomes divide, the telomeres shorten, until they become so depleted that the cell can no longer divide (This is known as the Hayflick limit) and eventually dies. Shortening of telomeres is an indicator of accelerated aging. Stress has been shown to accelerate the shortening of telomeres. So stress does make us age faster!• Cardiovascular Diseases

Numerous studies have linked stress and heart disease-related problems. One of the most impressive is a 21-year prospective study reported in the European Heart Journal, involving nearly 14,000 men and women. The conclusion of the research is that chronic stress is an independent risk factor for cardiovascular disease and particularly for fatal stroke. • Cancer

Provocative evidence linking cancer, stress, and elevated cortisol levels was introduced by scientists in the mid-1990s. In a case-controlled study published in 1996, researchers evaluated hormone levels of the hypothalamic-pituitary-adrenal system in women with both early-stage and metastatic breast cancer and concluded that breast cancer is associated with

Figure 1: Steroid Hormones

Cholesterol(LDL)

Pregnenolone 17-OH Pregnenolone DHEA

Cortisol TestosteroneProgesterone

Aldosterone Estrogen

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hyperactive adrenal glands. In another study published in Lancet Oncology (2004), researchers looking into the interactions between the HPA axis, stress, and cancer reported that: “stress and depression result in an impairment of the immune system and might promote the initiation and progression of some types of cancer”. • Alzheimer’s Disease

Although the root cause of this devastating illness is still being investigated, new evidence suggests that increased levels of stress, and the resulting high levels of cortisol, may be part of the equation. According to research, high cortisol levels may promote degeneration and death of neurons accompanied with decreased memory function in otherwise healthy elders from both genders. Higher cortisol levels have also been detected in Alzheimer’s disease patients and are linked to cognitive and memory impairments.

Ordinarily, after a perceived stressor has passed, our system

adjusts by raising and lowering different biochemical levels and returning the body to its state of homeostasis. In today’s world however, our regulatory capacity becomes overwhelmed by the extent, duration, intensity, frequency, or multiple layering of stressful events that can result in a prolonged state of homeostatic imbalance.

It is important to recognise that many health concerns such as cancer,

glandular disease, cardiovascular disease, Alzheimer’s disease and accelerated aging, among others, are associated with stress. Prolonged stress is specifically more likely to lead to biochemical imbalance. There is also extensive scientific evidence which explains the relationship between prolonged stress and illness and that the body goes through phases of adaptation as it attempts to cope with stressful circumstances.

What You Need to KnowIt has long been known that stress has a profound effect on our physical and mental well-being and is linked to illness and disease. Stress can upset the delicate balance of chemicals and hormones in our neuroendocrine system and specifically in the hypothalmic-adrenal-pituitary axis. Research has demonstrated that many health conditions are caused by and/or accelerated by chronic stress. The different phases of the body’s reaction to stress are described in what is known as General Adaptation Syndrome, coined in the 1930’s. Understanding how our bodies react to external and internal stressors and finding natural strategies to cope with them is vitally important in our quest for optimal health and well-being. Adopting lifestyle changes to reduce stress and supporting the body nutritionally are the first steps in coping with the stress demands that are a part of life.

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What are the Adrenal Glands?These important glands sit on top of each kidney and are approximately the size of a grape. The hormones that are produced by these glands have important functions such as regulating levels of minerals in the blood including sodium and potassium, determining how the body metabolizes food, blood pressure and heart beat regulation as well as for stress reaction functions.What Does the Term “Adrenal Fatigue” Mean?

Adrenal apathy is another name for adrenal fatigue, a condition potentially affecting millions of people around the world. However, it frequently goes unrecognized as an illness in the realm of conventional medicine. Since some argue that there is no specific

scientific evidence to support the condition, it is not well understood or explained by the majority of general practitioners. Underlying illnesses may also be responsible for causing or can be interrelated with the symptoms of “adrenal fatigue”. Conventional medical tests may not be sensitive enough to detect malfunctioning adrenal glands unless the dysfunction has become severe. When the adrenal dysfunction has become severe, Addison’s disease and Cushing’s syndrome are conditions that are generally recognized and diagnosed by medical doctors. However, many alternative practitioners argue that adrenal dysfunction can begin long before a disease diagnosis is made and therefore can also cause many

distressing symptoms. The good news is that in many cases, changing your diet and lifestyle and using specific supplements that support healthy adrenal function can help you to feel better and recover your adrenal health.What are the Causes of Adrenal Fatigue?

Adrenal fatigue is believed by some to be precipitated by either acute or long lasting circumstances or events that cause physical and or mental distress on the body such as: experiencing long lasting negative emotions and stress, sleep deprivation, chronic fatigue, chronic illness, chronic infection, over-exercising, toxin exposure, surgery or other. Adrenal fatigue can affect any person at any stage in their life, even people who have healthy lifestyle habits. Adrenal fatigue can occur if the glands have been over-functioning for an extended period of time or if they do not function properly and cause either the overproduction or underproduction of hormones. It is very helpful to have your adrenal function tested in order to correctly determine how well they are functioning.Can Adrenal Function be Tested?

The adrenal glands are extremely powerful glands in the body which produce hormones that you cannot exist without including cortisol, DHEA, adrenaline, sex hormones, and the stress hormones epinephrine and norepiniephrine that are associated with the “fight or flight” response. A saliva cortisol and DHEA hormone test can provide insight into the health of the adrenal glands by measuring the hormonal activity in the body over a period of time; you may also have other blood hormone tests and hair tissue mineral analysis completed in order to determine adrenal function. These tests can offer insight into the 2 basic phases of adrenal imbalance: adrenal hyperfunction and adrenal hypofunction. The 4-point saliva cortisol test measures the level of stress hormones and is highly effective for indicating the intracellular cortisol level, while the blood testing can reveal the extracellular level. Alternative

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medicine practitioners may agree that this test can also pick up on some biochemical imbalances associated with obesity, diabetes, depression, and insomnia.Adrenal Malfunction - Hypofunction and Hyperfunction

When cortisol levels and adrenal activity are in excess, the adrenals are said to be hyperfunctioning. This indicates an excess of [mineralocorticoid] hormones that influence sodium and water balance in the body and results in a loss of potassium in the urine. This condition can result in hypertension caused by a loss of potassium and the retention of sodium in the cells and the blood. Examples of accompanying symptoms may include headaches, irritability and anxiety. Blood tests indicate adrenal hyperfunction when potassium levels are decreased and when sodium is increased. If potassium is low inside the cells, blood and urine, this can lead to metabolic acidosis.

If cortisol and adrenal activity is insufficient, this is called adrenal hypofunction. When adrenal hypofunction occurs, there is a reduction of mineralocorticoid hormones in the blood. The cells and the blood will have an increased amount of potassium in them. Adrenal hypofunction can result in exhaustion after exercise, chronic fatigue, low blood pressure, hypothryroid conditions and abnormal fluid dynamics. Blood tests will show elevated potassium levels and lowered sodium levels. Metabolic alkalosis can result from these levels of electrolytes and is just as concerning as metabolic acidosis.

In summary, adrenal disorders can cause your adrenal glands to make too much or not enough of the steroid hormones. With Cushing’s syndrome, too much cortisol is produced, while with Addison’s disease, there is too little. Some people are born without the ability to make enough cortisol. Tumors can also cause disorders in the adrenal glands. Infection and bleeding may cause adrenal gland problems that can be fatal without prompt treatment.

What are the Treatment Options for Adrenal Fatigue?

Alternative health practitioners believe that in some cases adrenal gland malfunction may become chronic, mainly because of prolonged stressful events and poor health. However, with proper adrenal support and lifestyle modifications, most patients can be treated effectively. Lifestyle modifications include eating healthily, acquiring a regular sleep-wake cycle, getting at least 7 to 8 hours proper

sleep each night, and reducing stress as much as possible. Supplements such as glandulars can also be very helpful in supporting the health of the adrenal glands.How Glandulars Became Known to Support Adrenal Health

Historically, “organotherapy” was the term used to describe the administration of extracts of glandular tissue. The first experiments were conducted using extracts of thyroid tissue. If injected, significant toxicity

What are the Symptoms of Adrenal Fatigue?

Some of the most common symptoms associated with adrenal fatigue are the following:

• Feelingexcessivelyfatiguedandsleepyduringtheday

• Havingregularcravingsforsaltyorsweetthings

• Needing/cravingstimulantsorhighdosesofcaffeine

• Lowbloodpressure

• Lossofbodyhair

• Havingprolongedrecoverytimefromillnesses

• Bodyaches

• Havingmoreenergylaterintheafternoonsratherthanearlyintheday

• Difficultygettingoutofbedevenafteragoodnight´ssleep

• Suddenweightloss

• Sleepdisturbances

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resulted, but when taken orally, relief of syndromes associated with thyroidectomy was observed. Arsene D’Arsonval experimented with self -injections of bovine testicular extracts, as well as administering the extract to patients. He observed reversal of senility and “rejuvenation”. For centuries before this, a prevailing approach to treating diseased organs was to administer the said organ orally.

Another researcher, Thomas Addison (for whom Addison’s disease is named) observed adrenal gland atrophy in patients presenting with symptoms he had already categorized as a result of deficiency of adrenal secretions. Addison’s disease occurs when the adrenal glands are not producing enough of the steroid hormones.

The first prepared adrenal extracts failed to alleviate the symptoms of Addison’s disease. The basis for the failure was that they were based on medullary material (cortex material is required), and that they were glycerine

based extracts (more lipid-based extracts are required). Their extract did however have vascular effects (increased blood pressure). Adrenaline was soon isolated from the extract, and became the first synthetically synthesized glandular secretion by the early 1900’s.

William Osler administered whole pig-sourced adrenal extracts orally to patients with Addison’s disease with moderate success. Porcine adrenal tissue contains more hormones than most animal sources of adrenal

gland, but again, glycerine was used as the extraction method. This would therefore significantly decrease the potential efficacy of the intervention.

Since this time, adrenal extracts have been used extensively by naturopathic physicians and some health care practitioners with great success. One such example of this success included feedback from 5 naturopathic doctors and one medical doctor whom have used adrenal glandular extract. Cumulatively, they reported that in 3800 patients given a dose of 250-500 mg per day for a total of 21 cumulative years, improvements related to primary adrenal insufficiency, chronic fatigue and burnout syndrome were noted in 70-90% of the patients prescribed adrenal extracts.1 Just as important, no adverse reactions were noted.Adrenal Treatments with the Help of a Health Care Practitioner

Glandulars and other nutrients and adaptogens such as vitamin C, pantethine, licorice, Siberian ginseng, Rhodiola and ashwagandha are among the most popular supplements taken to support adrenal function. Working with a health care practitioner is always recommended before starting an adrenal health treatment program. It is important to know what state your adrenals are functioning at to ensure the best possible treatment outcome. In some cases of adrenal fatigue, supplements may cause further complications depending on the state of adrenal function. However, eating healthy, getting adequate rest and reducing stress can also have beneficial effects on the entire body.

What You Need to KnowAdrenal fatigue is a health condition that frequently goes unrecognised by medical practitioners. Both physical and emotional stress and strain on the body can eventually cause the adrenals to become fatigued and to malfunction, and as a result cause a variety of unpleasant symptoms in the body. However, some people are born with adrenal disease. Adrenal malfunction may cause symptoms of illness and can also be life threatening if it progresses to an advanced stage. Adrenal fatigue can be tested for by using saliva and blood hormone tests. Lifestyle changes as well as the appropriate supplements including nutrients, herbs and or glandulars may be helpful for improving and restoring adrenal health.

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Sleep Disturbance: The Silent KillerA bad night’s sleep can be frustrating for many reasons, but we rarely consider its impact beyond the associated fatigue or the sluggish day of work. Sleep deprivation is associated with both short and long term health concerns, and the evidence is only mounting. From a very basic standpoint, poor sleep makes us less cognitively sharp and therefore at a greater risk for careless mistakes. This is consistent with many studies finding that self-reported sleep problems, short sleep duration, fatigue and daytime sleepiness are all linked in some way to workplace injuries due to accidents.1

Nevertheless, what about the health impact of inadequate sleep beyond injury? Well, surveys taken by insomniacs have shown impairments in physical functioning, pain measures, social functioning and emotional health.2-4 Insufficient and excess sleeping duration have been associated with an increased risk of all-cause death by as much as 12% and 30%, respectively!5

In AOR’s Advances: Stress (Part 1) magazine, we thoroughly examined the sleep cycle, basic sleep physiology, common causes of sleep disturbances,

and natural sleep aid remedies (visit www.aor.ca/magazines for previous Advances issues). Here we take a look at how sleep deprivation and poor sleep habits can negatively impact all aspects of our health.

While the mechanisms responsible for sleep deprivation’s negative health consequences are still being investigated, it appears that they derive from key themes: endocrine disruption and metabolic dysregulation.6 Basically this means that there are alterations in hormone output and our body’s ability to break down and synthesize molecules, for example, for energy production and waste excretion. In healthy sleepers, growth hormone (GH) is released at nighttime and cortisol is not. In problem sleepers, the opposite is true.7 Impaired glucose tolerance, decreased insulin sensitivity, proinflammatory cytokines and low-grade inflammation (measured by an increase in C-reactive protein) are also all associated with impaired sleep.8

These factors, in combination, seem to contribute to or at least aggravate a large number and wide variety of health concerns. Given the underlying

pathological process of something like inflammation in so many chronic diseases (including cardiovascular disease, diabetes and cognitive impairment), it’s no surprise that such associations exist. See Box 1 for a quick look at some of the health conditions that have been associated with poor sleeping patterns.Cardiovascular and Coronary Heart Disease

When most people think about cardiovascular disease (CVD), they consider lack of exercise and poor diet; poor sleep habits hardly ever enter the conversation. Yet, new research is uncovering the strong association between cardiovascular events and sleep disturbances. A 2012 meta-analysis found that insomnia was associated with a 45% increased risk of death and disease from CVD.9 Given that heart disease is the number one leading cause of death in Canada and the United States,10,11 it may be time to start fixing the North American sleep pandemic.

A 2013 study examined this connection between coronary heart disease (CHD) and sleep characteristics in over 86,000 postmenopausal women.12 Specifically, sleep duration and sleep quality were assessed (i.e. how often were the women waking throughout the night, trouble falling sleep, etc.). After a 10-year follow-up period, it was discovered that women who slept the least (less than 5 hours/night) had a much higher number of CHD and CVD events. Interestingly, those who overslept (greater than 10 hours/night) were associated with an even worse cardiovascular prognosis!12

While these findings were substantial, it’s crucial to note that they were not the only discoveries. Poor sleep quality (as opposed to duration) was predictive of CVD events too, and sleep deprivation also comes with a greater risk for high blood pressure measurements!13 These associations have not just been found in female populations. In fact, both insomnia and short sleep duration were found to be associated with a 4-times greater risk of death in men according to one study.14 Researchers have determined that the mechanisms most

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likely responsible for this cardiovascular damage are increased sympathetic nervous system activity, disturbed immune function and increases in inflammation.15

Regardless of the mechanism, if insomnia and abnormal sleep duration increase the risk for CHD and CVD, then interventions that improve sleep quality and normalize sleep duration should serve as top priority treatment interventions.16 Diabetes and Obesity

In the same large-scale study examining over 86,000 postmenopausal women and their risk of CVD, a significant finding was noted regarding the incidence of diabetes. Independently, a strong association between lack of

and excess sleep was discovered with diabetes risk too!12 While this is hardly the first time researchers have made this connection, it is definitely one of the largest studies of its kind.

As we saw with the increased risk of CHD and CVD, sleep deprivation’s association with obesity and diabetic risk appears to be just as complex and multifactorial. Glucose dysregulation, insulin resistance, leptin inhibition and proinflammatory cytokine production all reasonably contribute to increased risk of obesity and diabetes, yet many negative behavioral habits tend to coexist as well.17-19

Shorter sleepers and longer sleepers have been shown to engage in less physical activity20 and watch more

television than average sleepers.21 When we combine this with the fact that even a single night of sleep deprivation (4 hours) has shown to lead to increased food consumption during the subsequent day (on average 559 more calories, or approximately 22% more of their daily energy consumption),22 we have a recipe for disaster. Subjective hunger levels before dinner and breakfast have also been noted to be higher in those with acute sleep deprivation on the night prior.22

In summary, sleep disturbances lead to less exercise, increased hunger and greater food consumption. Knowing this, is it any surprise that shorter and longer sleep durations have also been associated with higher body mass and greater abdominal fat?23, 24 Depression

Mood disorders, such as depression and anxiety, have long been associated with insomnia. It seems intuitive that when people are depressed or anxious, they tend to sleep worse. However, recent research has shown that the reverse association is also likely to be true; poor sleeping patterns and habits greatly increase the risk of mood disorders. In the case of depression, this increased risk has been found to be as much as 5 times greater with problem sleepers. Difficulty falling asleep, difficulty returning to sleep and decreased sleep duration all predicted greater depression outcomes.25

Once again, the large-scale study of over 86,000 women found a U-shaped association with sleep and depression (meaning excess and lack of sleep increase the risk of depression, just as they did with CHD and diabetes).12 In addition, a more focused study found the same connection. 555 men and women underwent insomnia labs and questionnaires and were ultimately selected based on the criteria of having no prior history of depression. Within a follow-up period of four years, 26 of these individuals developed clinical depression and, as predicted, these individuals had the worst sleeping habits.25

Perhaps the scariest discovery regarding the association between

Box 1: Health concerns that have been linked to either sleep deprivation, sleep excess or insomnia.(1, 12, 27, 30-33)

• CardiovascularDiseaseandCoronaryHeartDisease

• MoodDysregulation(suchasdepressionandanxiety)

• PoorImmuneFunction

• ImpairedBoneHealth

• DecreasedMetabolismandUnhealthyFoodCravings

• DiabetesandObesity

• SchoolandWorkPerformanceDeficits(includinglessjobsatisfactionandincreasedlikelihoodtomissdaysofwork)

• PsychomotorPerformanceDeficits

• CognitiveImpairment

• IncreasedRiskofInjury

• OverallReducedQualityofLife

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insomnia and mood disturbance is the finding that the greater risk for subsequent depression lasts for decades! Insomnia in young men was found to increase the risk for subsequent clinical depression and psychiatric distress for at least 30 years.26

In response to these findings, some researchers and practitioners have suggested that sleep disturbances are a prodrome to depression, meaning that insomnia can be viewed as an early symptom of depression. In this sense, treatment of sleep deficits is imperative for prevention of mood disorders.25

Impaired Bone Health Healthy bones need calcium – but

they also need sleep. Numerous studies have demonstrated that irregular sleep patterns may have detrimental impacts on bone health. One study in over 600 Chinese women found that shorter sleep duration was associated with decreased total bone mineral density (BMD) and regional BMD in those over the age of 45.27 Significant impairments in bone health were seen in those women sleeping less than 6 hours per night.

In this scenario, researchers conclude that the decreased BMD discovered in those with less sleep is most likely due to the corresponding elevations in cortisol during the daytime.27 In other words, stress can cause sleep deprivation and sleep deprivation can cause stress. This forms a vicious cycle of elevated cortisol that is capable of inhibiting bone formation via two methods: bone formation is inhibited through suppression of bone marrow cell production, and osteoclasts (cells that breakdown bone tissue) go from intermittent activity to full-time destroyers.27 Proinflammatory cytokine activation, once again, cannot be ruled out as a prime culprit in this mechanism of destructive bone processes!28 Impaired Immune Function

Some very interesting research has demonstrated that the disruption of our sleep-wake cycle can lead to long-lasting compromised immune function. Generally speaking, this is because our immune system is repaired while we sleep; activation and proliferation

of many immune cells have been shown to exhibit the greatest activity at nighttime.29 When our body cannot dedicate energy toward these immune building activities, we leave ourselves vulnerable to infections.

One study recorded the sleep habits of 155 healthy individuals over 14 days before administering nasal drops of the rhinovirus (the virus most commonly responsible for the common cold).30 Upon follow-up, it was discovered that people who slept for an average of less than 7 hours per night were 2.94 times more likely to develop a cold than those who slept more than 8 hours per night. Poor sleep quality (measured as less than 92% of time in bed actually spent sleeping) led to a 5.5 times increased

likelihood of contracting a cold when compared to efficient sleepers (greater than 98%).30

Sleep also enhances the formation of our immune system’s memory, meaning tonight’s sleep can affect your body’s ability to fight off an infection months from now!31 A very interesting study examined the effect of sleep deprivation after the hepatitis A vaccine administration. Subjects that slept regularly on the first night following vaccination showed twice the levels of Hepatitis A antibody in their blood samples 4 weeks later, as opposed to those who stayed awake for the duration of that first night.31 This immuno-enhancing effect of sleep was still present at a 1-year follow-up!

What You Need to KnowThe take home message here is that there are many reasons why 7 to 8 hours per night of quality sleep is recommended. Poor sleep leads to a brittle-boned, depressed, overweight, injury-prone and overall sicker version of yourself. As with most things in life, moderation and consistency are healthy habits and research supports this idea when it comes to sleep.

The research provides a reasonable argument that sleep quality and quantity should always be evaluated and monitored when treating any illness. Reduce your stress levels, maintain a healthy weight and make sleep a priority for your health. If necessary, consider gentle and effective natural health products to promote relaxation and ensure high quality sleep of adequate duration. Above all, regardless of the cause (i.e. restless leg syndrome, anxiety, stress, sleep apnea, etc.) it is well worth the investment to ensure a consistent good night’s sleep.

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Stress is practically unavoidable in our western culture. It triggers a hormonal pathway and cascade that places excess demands on the body’s nutrient and vitamin stores over and above of what is required for normal function. Almost every cell and metabolic pathway in our body requires nutrients, vitamins and minerals to act as co-factors. Co-factors are molecules that act like keys that open each step that leads to the production of essential cell components such as energy or the formation of essential proteins. This article highlights 4 key non-herbal factors that are essential to the body for dealing with stress. Essential Vitamin C

Also known as ascorbic acid, this

vitamin is one of the most well-known and widely used vitamins for the promotion of health. In the 1920s, Albert von Szent Györgyi discovered that vitamin C is the factor that was able to prevent and cure scurvy. He later went on to win the prestigious Noble Prize for his research on the function of vitamin C in human metabolism.1 Vitamin C plays a pivotal role in activating enzymes that produce collagen, a key structural protein in blood vessels, skin and other tissues. Its also is required for the activation of neurotransmitters and carnitine for energy production. This is why the symptoms of scurvy are fatigue, neurological dysfunction, and, more commonly, bleeding gums and easy bruising due to blood vessel fragility.1 In

addition, vitamin C has a broad spectrum antioxidant function with the ability to protect cell structures and DNA from free radical damage.1 This makes it particularly important in situations of increased stress since there often is an increased amount of free radical damage, cellular repair, energy production and formation of important neurotransmitters. Vitamin C also has the ability to regenerate and optimize other key antioxidants such as vitamin E.2

The adrenal gland has the highest concentration of vitamin C in the body. Here it is used as a cofactor for the production of epinephrine and steroid hormones. During times of stress the demand for the production of these hormones increases, so the body naturally has a higher demand for vitamin C. It also plays a key role in the formation of neurotransmitters

Vitamins Help You Manage Stress

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can help correct this stress-induced deficiency.

There is evidence that the administration of Pantethine in several experimental animal models appears to enhance adrenal cortex function.5-7 This would translate to a more balanced secretion of hormones such as cortisol, which is required for the body’s stress response. A human study using Pantethine showed a lower rise in urinary cortisol metabolites after simulating a stressful situation which suggests that Pantethine can down-regulate hypersecretion of cortisol.8

that regulate mood and brain function.3 One randomized, placebo controlled trial looked at 120 healthy adults and whether vitamin C supplementation had any effect on their ability to handle stress. The results showed that those people who took 3g of vitamin C daily had a lower blood pressure reading, their cortisol levels recovered quicker, and they felt less “stressed.”3

Vitamin C is found in many fruits and vegetables. While traditionally oranges have been considered highest in vitamin C, actually red bell peppers have higher levels. Its absorption is relatively efficient at 70-90% for low doses (like those found in fruits).2 Any excess vitamin C that is not absorbed in the digestive tract is excreted. This prevents the possibility for overdose through oral ingestion. Humans are one of the few mammals that are not able to produce vitamin C. We rely on dietary or supplemental intake to maintain stores. Guinea pigs and other primates also do not have the ability to produce vitamin C. This is why they have so often been used in research studies as models of human metabolism. While scurvy rarely occurs anymore, many people with low dietary intakes of fruits and vegetables have suboptimal levels of vitamin C. This can limit the body’s ability to respond adequately to stress. Vitamin B5 and Cellular Function

This vitamin is considered a key factor in supporting adrenal function. It has long been known that adrenal function is compromised if deficient in B5.4 Pantothenic acid (B5) is the standard form that the majority of supplements use, however the body does convert pantothenic acid to the active form called Pantethine using a very energy-intense process. Pantethine is so essential to cellular function because it is the active part of coenzyme A, a key compound that plays a role in numerous metabolic processes.4 Coenzyme A is a key player in the formation of fatty acids (from cholesterol), cellular energy production, liver detoxification and adrenal hormone formation.

Since the formation of Pantethine takes up a lot of the body’s resources,

its production is strictly controlled to prevent the body from using excess energy in making this compound. This highlights the importance of supplementing with the Panthethine form since it bypasses this built-in metabolic gate and supplies the required part for coenzyme A activity without using extra energy.4

The adrenal glands require coenzyme A for the synthesis of the powerful hormones through which the body adapts to stress. Stress can therefore seriously deplete the body of vitamin B5, and in-turn, supplemental B5

Stress Busting Tips

1.Talkitout.Communicateyourworriestoatrusted,emotionallystableconfidant.Oftenafriendcanhelpyouseethingsfromadifferentviewpointandregainyourperspective.

2.Sleep.Operatinginasleepdeficitcanoverburdenyournervoussystemandmakeyoumorepronetomeltdowns.Aimforeighthoursofsleepanight.Takenapswhenyou’retiredorbehindinyoursleep.Trytocatchuponshortageswithinthesameweek.

3.Breathedeeply.Sometimesafewdeepbreathscanhelpyouremaincalminthefaceofmountingpressureandchaos.Deepbreathingallowsmoreoxygenintothebodycellsandmayhelpyoutakeasecondtothinkbeforeyouact.

4.Takeastroll.Exercisetriggersthereleaseofendorphins,whichhelptoimprovemood.Getoutandwalkfor10-15minutes.

5.Listentoupliftingmusic.Therightmusiccanchangeyourmoodandhelpyoufeelmoreenergyandasenseofwell-being.Thewrongmusiccandotheopposite.Seewhatworksforyou.

6.Getamassageortakeahotbath.Physicalrelaxationgoeshandinhandwithmentalrelaxation.Findwaystorelaxphysicallyandyourbrainwillusuallyfollowsuit.

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The evidence suggests that Pantethine is not only required by the adrenal gland to properly function, it can balance excessive or inadequate cortisol production.5-8 It is also important to note that while the dosage of Pantethine shown to be effective for lowering LDL cholesterol is 300mg three times daily. Other studies have used 10g of pantothenic acid to reduce the impact of stress on the immune system. The dosing studies show that the effective amount to counteract the negative effects of stress is not achievable through a simple multivitamin and that higher doses of B5 are both effective and safe. Tyrosine for Decreasing the Effects of Stress

L-tyrosine is a non-essential amino acid that is found in protein sources such as yogurt, fish, oats, cheeses and poultry. It is a key building block for the production of dopamine and norepinephrine, which are neurotransmitters that play a key role in cognitive and central nervous system

function.9 It’s also the precursor for the formation of thyroxine, a thyroid hormone. Research supports tyrosine’s ability to help in the management of stress arising from physical or psychological origins, including lack of sleep and multitasking. Many of the studies have been conducted in military personnel that were exposed to extreme physical and mental stress. Since dopamine and norepinephrine are essential for a strong response to stressful situations, supplying tyrosine will increase their production and prevent deficiency.9

Two key areas where tyrosine supplementation has shown benefits are in sleep deprivation and multitasking. One study looked at a group of marines that had not slept for 24 hours and found that one dose of tyrosine improved memory and brain function for up to 3 hours the next day.10 Interestingly, the ability to remember tasks was improved after just one dose. The same results were found even when the subjects were

further stressed by cold temperatures. In another study, subjects found their ability to handle multiple tasks and maintain memory was improved after tyrosine supplementation earlier that same day.11 There does not seem to be an effect on cortisol and blood pressure but short and rapid effects on mental focus and function were noted.11 Another group that also found benefit from tyrosine supplementation were adults with transient attention deficit hyperactivity disorder (ADHD).12 Since dopamine and norepinephrine are both required for calm and focused cognitive function, those people with ADHD can benefit from extra supplemental tyrosine.

An important note about tyrosine is that benefits were found after just one dose, so supplementation is effective in a short time period. In fact there is actually some evidence that longer-term use can build a tolerance to the benefits of tyrosine. The studies also used a very large dose that was based on body weight so a prudent approach

Advances 17

to tyrosine supplementation would be to start increasing the daily dose by one capsule until a desired effect is achieved. Dosages over 15 g were found to be effective and safe by some participants.10,11 Maximal absorption of tyrosine is achieved when taking it away from food. A good time to take tyrosine is first thing in the morning before eating breakfast. The effect on mental function and increased focus can be similar to that of caffeine.Biological Processes Require Magnesium

Magnesium is involved in over 300 biochemical processes in the body. One of its most important functions is that it plays a key role in producing energy. This makes it vitally important for all cellular functions and processes, especially the ability to maintain function in times of stress. Over 70% of our enzymes require magnesium to function.13 This includes the activation of B-vitamins and formation of neurotransmitters and hormones. Magnesium helps maintain normal muscle and nerve function, keeps heart rhythms regular, supports a healthy immune system, and keeps bones strong. The problem with this essential mineral is that most people do not have sufficient levels for optimal health. A gradual depletion of nutrients from our soils has left many vegetables with lower levels of magnesium. In addition, various common medications, such as proton pump inhibitors and furosemide, further deplete magnesium levels. Unfortunately, stress is also a very powerful factor that leads to magnesium depletion.13

When a person is under stress one of the first signs they experience is tense muscles, especially in the neck and shoulders. In muscle tissue and blood vessels, magnesium causes relaxation while calcium levels increase muscle tone. Adequate levels of magnesium are required to offset stress related muscle hypertonicity. A number of studies have shown that deficient levels of magnesium decrease resistance to stress-related changes in blood pressure or heart rhythm. It seems that adequate magnesium levels are protective

against increased risk of cardiovascular damage.13,14

In affluent societies, severe dietary magnesium deficiency is uncommon, but chronic stress, poor diet and other factors deplete body stores to suboptimal ranges. This can be a contributing factor in a very wide range of common diseases such as diabetes, cardiovascular disease, insomnia and chronic pain. Even though assessing magnesium deficiency is difficult because red blood cell stores do not reflect the levels found in tissues, it would be a wise strategy to increase magnesium intake in times of stress. As a supplement, magnesium is most commonly found in small amounts in multivitamins and in certain over the counter laxatives. These are not good sources to replete tissue levels. Forms such as magnesium oxide

have a strong laxative effect and are very poorly absorbed. The best supplemental sources of magnesium with the highest rates of absorption are those that are joined with amino acids such as glycine, taurine, or malate. To offset the negative effects of stress and prevent disease, consider a daily supplemental dose of magnesium. Like tyrosine and vitamin C, the right amount of magnesium for each person can vary. A gradual daily increase in dosage until reaching a point of loosened stools, is an effective way to reach your optimal level.

Supplemental sources of vitamins and minerals can support the body in coping with stress. However, there are also other things you can do to help yourself be healthier, feel better and be less stressed. Try out additional stress busting tips listed on page 15.

What You Need to KnowIn times of stress the body’s need for essential minerals is greatly increased. The excess production of hormones and neurotransmitters require extra amounts of vitamin C, vitamin B5, tyrosine and magnesium. Combined with a balanced diet, active lifestyle, adaptogenic herbs and a high potency multivitamin or B-complex, and the aforementioned nutrients can have a potent effect in helping the body deal with stressful situations.

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In a busy society where stress predominates much of our lives, it is adaptogens like Maca that show great promise. As to the question of “why should I take it”, Maca has a unique chemistry that seems to address many aspects of health, not the least of which is sexual health and desire in men and women. Libido has been shown to decrease as stress levels increase. A healthy sex life has been touted as a key to overall health as has been shown to improve many things including mood, blood pressure, sleep quality and immune system function via positive hormonal and biochemical reactions.

Maca (Lepidium meyenii) is a plant native to the South American country of Peru. It has been used among Peruvians for over 2 millennia in the Central Andes at elevations of over four thousand meters. Maca grows there

in a climate of extremes, intense cold, extreme sunlight and ferocious winds. Peru has almost quadrupled its export of Maca to North America over the last decade. Maca has been the study of much research into its health benefits; experimental evidence and cultural use has shown Maca to have promise in many different areas. From energy and stress management, to fertility and sexual enhancement, to memory and learning, Maca is a plant with many chemical constituents which exert several different effects.

Maca is a member of the Brassica family of plants (cabbage, cauliflower, turnip, watercress) and consists of an above ground leafy component and a below ground root component. It is the root component that is primarily used and studied. The roots vary in size but are approximately 10 cm long by 4 cm wide. After harvest they are traditionally dried, giving it the ability to be stored for long periods of time

and then boiled in water to become soft for consumption in a liquid or juice-like form.Maca ChemistryMaca has many different chemical components including the following:•13-16% protein and rich in essential

amino acids like arginine, leucine, phenylalanine, lysine, glycine and glutamic acid. Other amino acids are also present including tyrosine, threonine, methionine and proline.

•Approximately 60% carbohydrate, 9% fibre and 2% lipids. Of the free fatty acids present, most abundant are the linoleic, palmitic and oleic acid forms.1

•Contains minerals such as iron, calcium, zinc, copper and potassium.

•Contains macridine, macaene, macamides and the maca alkyloids. Macaenes are unsaturated fatty acids. There has also been shown to be concentrations of sterols including beta sitosterol, campesterol and

Amazing Maca

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Maca to Improve Mood and Energy Levels

Maca has been shown to reduce levels of anxiety and depression on inventory scoring tests.10,11 It was also shown to act as an energizer via a self-perception survey compared against placebo in healthy men.12

Maca Lowers Blood PressureIn populations traditionally

consuming maca, systolic blood pressure was lower than those not consuming maca.13 Perhaps this is due to the high levels of potassium contained in maca, as potassium is seen as a key nutrient to help reduce risk of hypertension.13,14

Maca Benefits Memory & LearningThree varieties of maca (yellow,

red, black) have been studied on this subject, with black being the only variety to show any significant biological effect.15 Studies have been performed with both alcohol and aqueous extracts and both were found to have similar effect in improving learning and memory.15-17 This research was done in rodent models and not human trials, however.Maca for Overall health

A recent study investigated the health status of a Peruvian Andes population

stigmasterol as well as the compound benzyl glucosinolate.2

The Health Components of MacaMaca root contains greater amounts of

glucosinolates than the other members of the Brassica family. Glucosinolates contain enzymes and antioxidants that help the body to fight off breast, lung, and colon cancer, as well as esophageal, stomach, and prostate cancer. Glucosinolates work with chemicals such as folate, flavonoids, and vitamin C to cleanse the body of free radicals and other toxins. Experts suggest eating up to five servings per week in addition to other fruits and vegetables. Other glucosinolate-rich vegetables include leafy greens, such as kale, cabbage, and collard and mustard greens, as well as arugula, bok choy, and turnips.

Fertility enhancing properties are thought to be due to the action of the aromatic isothiocynates contained within the glucosinolate compounds. Aphrodisiac properties are attributed to the prostaglandins, sterols and amides contained within the polyunsaturated fatty acids.8

How Can Maca Help you Feel Better?There has been much research done

on Maca in the last decade looking at its various biological actions, both in animals and humans. Some of the health benefits of maca that have been investigated include: improving nutritional status, metabolism, bone health, sexual desire, fertility and endurance/sports performance as well as its anti-stress properties, neuroprotective effects, protection from UV radiation and ability to increase levels of antioxidants in the body.

With respect to human research, much of the study has been done in the area of sexual dysfunction. With our high stress lifestyles, issues of sexual dysfunction have been increasing. Current estimates are that they affect approximately 30 % of the male population and up to 45% of the female population.3 Most of the issues concerning women surround sexual desire (interest in sex) while in men it is related to concerns with erectile dysfunction (ED).

Maca Boosts Sexual FunctionRecently, a systematic review of

maca’s effects on sexual function in humans was performed.4 According to the review, two trials suggested a significant positive effect of maca on sexual dysfunction and sexual desire in healthy menopausal women5 or healthy adult men.6 Some other trials failed to show effect yet did show maca’s effect on self rated sexual desires compared to baseline and placebo.7 With respect to erectile dysfunction (ED), a further randomized control trial using an index scoring system showed a significant effect on the subject’s perception of general and sexual well-being.9

Additionally, a randomized, double-blind, placebo-controlled trial in healthy men aged 21-56 found that supplementation with Maca for 8-12 weeks improved sexual desire. Doses of around 3 g of Maca have also been found to reduce sexual dysfunction scores and increase libido. One study in post-menopausal women found that 3.5 g of Maca over 6 weeks reduced sexual dysfunction, anxiety and depression, all without actually changing hormone levels, suggesting that Maca also works in ways not related to hormone levels.21

Figure 1:HealthstatusscoresfrommaleandfemaleresidentsonCarhuamayo,Junin,Peru,livingat4100minthePeruvianCentralAndes.Theuppergraphrepresentsthepopulationconsumingmaca,whilethelowerlinerepresentsthepopulationnotconsumingmaca.

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that traditionally consumed maca compared to a population from the same area which did not consume it. The study included a survey based on numerous health factors of men and women aged 35-70 years old. As noted in Figure 1, Maca consumption is associated with higher scores in health status, including lower rates of fracture, lower body mass index, lower systolic blood pressure and decreased signs of mountain sickness.18 Safety of Maca

Maca has been used for centuries, traditionally in the Peruvian Andes with consumption after boiling.19 In addition, both in vivo and in vitro studies demonstrate safe use with no noted hepatotoxicity.20 The fact that this plant is technically considered food and has been used in traditional Peruvian cultures for centuries lends to its safety as well as intrigue. Look for Maca to continue to be a topic of research and discussion in the years to come as it is a unique plant with much still to be discovered.

What You Need to KnowThe root of the maca plant has long been used by ancient cultures throughout history. It is safe and effective for helping to restore balance and harmony within the body. It is also an excellent source of vitamins and minerals and important chemical components such as glucosinolates and fatty acids. Some of maca’s most well recognized health benefits include: its ability to enhance sexual desire and function, lower blood pressure and to support memory, learning, adrenal function, energy levels, and overall health and wellness.

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a critical synopsis. Toxicological Reviews. 2005;24(1):11–35.2. Zheng BL et al. Effect of a lipidic extract from Lepidium meyenii on sexual behavior in mice and rats. Urology. 2000;55(4):598–602.3. Lewis RW et al. Definitions/epidemiology/risk factors for sexual dysfunction. Journal of Sexual Medicine. 2010;7(4):1598–1607.4. Shin BC etal. Maca (L. meyenii) for improving sexual function: a systematic review. BMC Complementary and Alternative Medicine. 2010;10,

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Products. Economic Botany 2001;55:255-62.9. Zenico T et al. Subjective effects of Lepidium meyenii (Maca) extract on well-being and sexual performances in patients with mild erectile

dysfunction: a randomised, double-blind clinical trial. Andrologia. 2009;41(2):95–99.10. Brooks NA et al. Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal

women are not related to estrogen or androgen content. Menopause. 2008;15(6):1157–1162.11. Dording CM et al. A double-blind, randomized, pilot dose-finding study of maca root (L. meyenii) for the management of SSRI-induced sexual

dysfunction. CNS Neuroscience and Therapeutics. 2008;14(3):182–191.12. Gonzales GF. Biological effects of Lepidium meyenii, maca, a plant from the highlands of Peru. Natural Products. Vol. 15. Houston, Tex, USA:

Studium Press; 2006. pp. 209–234.13. Valerio LG and Gonzales GF. Toxicological aspects of the South American herbs cat’s claw (Uncaria tomentosa) and maca (Lepidium meyenii):

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