Category Archives: Heart Health

Heart

A Healthy Heart is a Happy Heart!

A Healthy Heart is a Happy Heart!

Cardiovascular Disease is one of the biggest health issues in the Western World. Increasing numbers of people are suffering with high blood pressure, high cholesterol levels, atherosclerosis, heart problems and strokes – these conditions may often result in an early death.

To decrease your cardiovascular disease risk, it is crucial to keep your heart and blood vessels healthy and functioning optimally. There are many simple ways. For example, exercise is essential for optimal heart health, so it is a must for everyone! There are many foods that provide nutrients that play a vital role in heart health such as oily fish – high in omega 3 essential fatty acids (EFAs). Read on for easy and nutritious ways to keep your heart in top condition.

Exercise

We’ve all heard that it’s essential to exercise. Cardiovascular exercise increases our heart rate, blood flow, circulation, oxygen levels and more. Many of us spend hours at work or at home at a desk, then a sofa in the evening, so we’re often not moving enough. Exercise is the number one thing you can do to help your heart to be healthy. Ideally you should exercise for a minimum of 30-45 minutes per day, or at least 3 times a week. Walk rather than catching a bus, take the stairs rather than the lift, go for a brisk walk during your lunch break, take your child to the park and run around with them, go for a swim, do a yoga class. Bring exercise into your daily routine – your heart will love you for it!

Fish Oils

Oily fish such as salmon, sardines, mackerel and anchovies are a rich source of Omega 3 EFAs. Fish oils contain EPA and DHA, which are essential for hormonal regulation and most importantly in the reduction of inflammation. Inflammation is a component of all cardiovascular disease. Omega 3 oils play a role in the maintenance of healthy blood pressure and cholesterol levels.

Blood Sugar Levels

Raised blood sugar levels (BSLs) and diabetes are major health problems that are rapidly increasing. Too much sugar in the blood may damage the blood vessels and ultimately the heart, as well as exhausting the pancreas, which can lead to diabetes. Avoid sugar and many processed foods. Increase your intake of vegetables, fruit and whole foods. Protein in every meal will help to balance the meal and your blood sugar levels. Educate yourself about the Glycaemic Index of Foods and avoid high glycaemic foods, as much as you can.

Coenzyme Q10

An essential nutrient for the production of energy within ALL cells. The heart needs more Coenzyme Q10 to function properly. Those who are taking statin drugs to lower cholesterol are likely to become deficient in Coenzyme Q10, as statins block the production of Coenzyme Q10.

Magnesium

Magnesium plays an essential role in the production of energy within ALL cells, as well as the functioning of ALL muscles. The heart is the most important muscle in the body, and it needs magnesium to function properly. Increase your consumption of magnesium-rich foods such as greens, leafy vegetables, nuts and seeds, eggs and molasses.

Garlic

Countless studies have shown the positive effects that the herb Garlic has on the heart and cardiovascular system. It may help reduce cholesterol levels, blood pressure, atherosclerosis, circulation and heart health.

Walnuts

Are a fabulous source of nutrients including good oils, protein and minerals, so why not enjoy a small handful per day?

Fibre

A healthy bowel is one that moves a minimum of once a day and it is vital for your health and for your heart. Fibre increases the bulk of the stool, whilst binding excess cholesterol and toxins for excretion. It also helps to feed the healthy live bacteria in our intestines and colon, which are vital to optimum digestion and our immune system.

Stress

The more stressed we are, the harder the heart has to work, as blood pressure increases. Stress is a killer, so we must try to manage our stress so that it doesn’t take over. Talk to those you trust and work through your worries – communication is important. Practice mindfulness, learning to be in the moment. Practice deep breathing often. Start to meditate for even 10 minutes a day to centre and ground yourself.

Happiness & Gratitude

Studies have shown that those who are optimistic and positive, and who feel gratitude on a regular basis, are less likely to die from a heart attack or stroke. Happiness comes from within; no one can give it to you. Start to have gratitude as often as you can and watch it grow, the result is increased happiness, which will make your heart happy.

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Heart Health

Heart Health: How healthy is your lifestyle?

Heart Health

This month we turn our attention to heart health. Cardiovascular disease (CVD) still remains the biggest killer, accounting for 155,000 deaths per year, costing the National Health Service 8 billion pounds (1). The most common types are Coronary Heart Disease (narrowing or blockage of the coronary arteries) and Stroke (rapid loss of brain function due to disturbance in the blood supply to the brain).

The heart is responsible for pumping blood around the body, carrying all the essential nutrients to distal tissues and organs and collecting any waste products to the liver and kidneys for excretion. We often associate heart disease with old age, taking multiple medications and risk of serious complications or even death. However, even before this stage, suboptimal function can affect our general wellbeing. Poor circulation may lead to fatigue, memory problems or muscle pain for example. If they get overlooked, more serious complications can develop, so it is crucial to look after your heart with a healthy lifestyle.

Cholesterol – friend or foe?

Over the past 50 years, cholesterol has been demonised as the major cause of heart disease. The newest research however, has largely disproven this statement and we now know that although it is a factor, other elements should be taken into consideration. Cholesterol is a type of fat that is produced in the liver but we can also get from animal foods (eggs, meat, dairy). It is actually essential for the body, as a component of cell membranes and nervous tissue as well as a precursor to vitamin D, bile and some hormones. If the arteries get damaged, the body uses cholesterol as a protective plaster to patch up the walls and repair them. However, in the long term, this can lead to a build-up of plaques that could potentially be dangerous. As with everything, we need to keep it in balance. Although a low fat diet isn’t advisable, if your cholesterol levels are too high, there are ways to support your body to bring them down naturally.

Omega 3 fats (EPA and DHA) found in fish oils, have long been known for their benefits to heart health and unfortunately our diets are often lacking in those essential fats. Combining them with specific types of plant sterols provides an even better heart friendly combination. Plant sterols contribute to the maintenance of normal blood cholesterol levels.

Most studies often use doses that would be very difficult to get from your diet alone, so if you have a problem with cholesterol it may be worth supplementing with a good quality product.

BioCardio - Concentrated Liquid Fish Oil
BioCardio – Concentrated Liquid Fish Oil

Protection against free radicals

We often hear about antioxidants and free radicals, but do we really understand what they are?

Free radicals are simply unstable molecules that result from everyday physical or physiological processes or come from our environment. They are unstable because they are missing an electron and they are looking to ‘steal’ one from another molecule, damaging them in the process. This ‘other molecule’ can be your DNA, other cells or cholesterol for example. Oxidative stress is strongly linked to cardiovascular disease through damage to LDL cholesterol and increased inflammation. Our body has many ways of protecting itself from free radical damage, but for this to be effective it needs several nutrients like vitamin E or C. Many plants contain very powerful antioxidants that have numerous health benefits.

One of the most researched for cardiovascular health is proanthocyanidins found in grapeseed and pine bark extracts. They help to maintain healthy blood vessels and capillary integrity and are up to 50 times more effective at scavenging free radicals than vitamin E and C.

The secret lies in colour and flavour. Plants produce different chemicals that protect them from predators, these are often pigments, so the brighter the colour the better it is for you. Great examples include bilberries or turmeric. Anthocyanosides in bilberries can help with elasticity and integrity of blood vessels making them stronger and less prone to the harmful effect of free radicals. On the other hand, curcumin found in the orange spice turmeric helps to support the immune system.

PhytoCell - Antioxidant Blend
     PhytoCell – Antioxidant Blend

Eating for your heart

The heart never stops, so providing a steady supply of nutrients and antioxidants from a healthy diet is key to optimum function. Foods that are specifically great for the heart include: pomegranate, beetroots and almonds. Beetroots not only contain many micronutrients, but are also a source in nitrates that help to maintain healthy blood pressure.

Increasing fibre intake from vegetables, flax seeds, chia seeds and grains such as quinoa or millet will help with healthy cholesterol excretion and blood pressure.

Amongst nuts, almonds prove to be true superfoods. A study from 2014 showed that a daily portion of 50g can reduce blood pressure and increase blood levels of vitamin E (2).

One heart friendly nutrient that is relatively difficult to obtain from diet is Coenzyme Q10. It is not considered as a vitamin because our body can make it, however the levels tend to decline with age.

Microcell CoQ10 200
              Microcell CoQ10 200

References
1. British Heart Foundation, 2014.
2. K. Choudhury, J. Clark, H. R. Griffiths. An almond-enriched diet increases plasma α-tocopherol and improves vascular function but does not affect oxidative stress markers or lipid levels. Free Radical Research, 2014; 48 (5): 599

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Heart Disease

Heart Disease: Simple Steps to Reduce Your Risk

Simple Steps to Reduce Your Risk of Heart Disease

February is National Heart Month, a campaign run by the British Heart Foundation to raise awareness of the UK’s biggest killer. Heart disease is responsible for around 75,000 deaths in the UK each year, and many of these deaths are preventable.

The single biggest modifiable risk factor for heart disease is high blood pressure, also known as hypertension. One of the most common disorders in the UK, hypertension is defined as persistent raised blood pressure above 140/90mmHg.

Unfortunately hypertension, often referred to as ‘the silent killer’, typically has no outward symptoms. Around 13 million people in the UK suffer with hypertension, but 6 million of these remain undiagnosed (1).

Rule of 3: Everyday changes to protect your health

Taking control of our health means identifying those factors within our control and taking positive action to eliminate them. Unfortunately, dramatic lifestyle changes can feel overwhelming. While your GP can advise on medications, exercise and dietary changes to address heart health, there are simple changes you can begin to make every day to kick start healthy changes.

Here are three simple snacks and three supplements which have been shown to reduce blood pressure.

3 Simple Snacks

1. Snack on almonds and cashews

Replacing your usual savoury or sugary snacks with a handful of cashews or almonds will help to regulate blood sugar levels and blood pressure. These nuts are among the best sources of dietary magnesium, a mineral responsible for dilating blood vessels and preventing spasms in the heart muscle. They also help to lower cholesterol levels. Studies have found nut consumption to be linked with an 8.3% reduced risk of heart disease (2).

2. Drink Hibiscus tea

A cup of hibiscus tea before breakfast lowers both diastolic and systolic blood pressure by more than 10%. A recent study found that one cup of hibiscus tea each day for four weeks was as effective as the drug Captopril in reducing blood pressure (3).

3. Get juicing

A daily juice or smoothie containing nitrate-rich vegetables offers a simple way to help reduce blood pressure. Nitrate-rich vegetables such as beetroot and kale are important for healthy blood flow, and lower blood pressure by dilating blood vessels (4). Pomegranate enhances this effect by enhancing the activity of nitrates. Beets blend well with apples and berries, while kale blends well with tropical fruits such as pineapple or banana.

3 Key Nutrients for a Healthy Heart

1. Garlic

A recent meta-analysis provides evidence that garlic supplementation significantly reduces blood pressure in those with hypertension. In this study, doses ranged from 600mg to 900mg daily (5). The active component of garlic, called allicin, is destroyed during cooking, so supplements are a good choice for maximum benefit.

2. Fish oil

Several studies have linked fish oil supplementation with reduced blood pressure in those with hypertension (6). As well as lowering blood pressure, fish oil supplements reduce inflammation and platelet aggregation (‘sticky blood’). The American Heart Association recommends that those with coronary heart disease should take 1g of EPA plus DHA from fish oil supplements each day.

3. Magnesium

Diets high in sugar and low in plant foods tend to provide insufficient levels of magnesium. This is a concern because magnesium is important for the dilation of blood vessels. A recent meta-analysis found that magnesium supplementation does indeed lower blood pressure, but that larger studies are needed to confirm these findings (7). Those interested in supplementing magnesium have a number of options. Magnesium can be supplemented as a topical oil applied to skin, as magnesium salts in the bath or as a traditional oral supplement.

References
1. Blood pressure UK. http://www.bloodpressureuk.org/mediacentre/Bloodpressurenews/UKhighbloodpressurerisesbutmorediagnosed. Accessed 18/01/2016.
2. Hu FB, Stampfer MJ (1999) Nut consumption and risk of coronoary heart disease: a review of epidemiologic evidence. CurrAtheroscler Rep 1(3):533-40
3. Harrera-Arellano et L (2004) Effectiveness and tolerability of a standardised extract from Hibiscus sabdariffa in patients with mild to moderate hypertension: a controlled and randomised trial. 11(5):365-82
4. Kapil et al (2015) Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomised, phase 2, double-blind, placebo-controlled study. Hypertension 65(2):320-7
5. Reid et al (2008) Effect of garlic on blood pressure: A systematic review and meta-analysis. B
6. Breslow (2006) n-3 fatty acids and cardiovascular disease. Am J ClinNutr. 86(6):1477S-1482S
7. Jee et al (2002) The effect of magnesium supplementation on blood pressure: a meta-analysis of randomised clinical trials. Am J Hypertension 15(8):691-6

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Vitamin C for a Healthy Heart

A new study published in the journal Atherosclerosis earlier this month indicates that Vitamin C supplementation benefits heart health, and that its positive effects are most helpful for those with type 2 diabetes, hypertension and high cholesterol (1).

The study, a meta-analysis carried out at Newcastle University, analysed data from 44 clinical trials, and concluded that Vitamin C has positive benefits on endothelial function.

The endothelium is the inner lining of blood vessels which, in a healthy body, works to assist the immune system and regulate blood clotting. It also expands and constricts, helping to regulate blood pressure.

Endothelial dysfunction is linked to diseases such as type 2 diabetes, hypertension and high cholesterol. Unfortunately these conditions are becoming increasingly common. Currently, around 30% of men and women in the UK have hypertension, and more than 50% have raised cholesterol levels.

The endothelium can be compromised by oxidative damage and inflammation as a result of infections, smoking, or an inflammatory diet loaded with sugar and trans fats. If the endothelium ceases to function properly, there can be serious health consequences, including atherosclerosis, stroke and heart attack.

vitaminC
the best way to increase your vitamin C intake is by incorporating plenty of fresh fruit and vegetables throughout the day

There appear to be two ways that Vitamin C works to improve heart health. Firstly Vitamin C is an effective antioxidant, quenching oxidative damage to the endothelium. Secondly, this particular vitamin increases the availability of nitric oxide, a molecule that improves blood flow by causing blood vessels to relax.

The researchers found that higher doses of Vitamin C were linked with ‘significant improvement’ in endothelial function, with doses of 500mg and above showing the most benefit. The strongest benefits were seen in people with atherosclerosis, diabetes and heart failure.

For those interested in boosting Vitamin C levels, the best way to increase your vitamin C intake is by incorporating plenty of fresh fruit and vegetables throughout the day. While oranges can provide a reasonable dose of vitamin C, other fruits and vegetables contain far greater amounts. See below for the richest sources. You can also boost your nitric oxide levels by eating a large leafy green salad every day. Spinach, arugula and beetroot are particularly good sources. Finally a healthy lifestyle is essential in protecting cardiovascular health, as regular exercise, weight loss and smoking cessation can all help to improve endothelial function.

Top 10 sources of vitamin C

Food (100g serving) Vitamin C (mg)
Red bell pepper 280
Guava 230
Brussels sprouts 200
Blackcurrants 200
Kale 120
Kiwi 98
Broccoli 89
Papaya 61
Strawberries 59
Oranges 53

 

Reference
1. Ashor AW, Lara J, Mathers JC, Siervo M. Effect of vitamin C on endothelial function in health and disease: A systematic review and meta-analysis of randomised controlled trials. Atherosclerosis. 2014 Jul;235(1):9-20

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Top Nutrients for Heart Health

Collectively, conditions affecting the heart are the UK’s biggest killer. Almost 2.3 million people live with coronary heart disease (CHD), leading to annual NHS healthcare costs of almost £2 billion. Key risk factors for heart disease affect large proportions of the adult population – one third of adults have high blood pressure while 60% have sub-optimal blood cholesterol levels. Despite these alarming figures, many risk factors are within our control and making simple changes to our diet and lifestyle can have a dramatic impact on our health. As we mark National Heart month we turn our attention to key nutrients and nutrition supplements that play a strong role in maintaining a heart-healthy lifestyle.

ALA Omega-3

Alpha-linolenic acid (ALA) is a type of omega-3 essential fatty acid (or ‘good’ polyunsaturated fat) that has been shown over years of research to help maintain normal cholesterol levels. Although cholesterol is a vital resource in the body, helping to carry out a number of important functions such as repairing blood vessels, creating hormones, production of vitamin D, and helping to transport vitamins A, D, E & K, it can become a risk when levels of LDL ‘bad’ cholesterol become too high. This can trigger a build-up of plaque in the arteries, which can eventually

making simple changes to our diet and lifestyle can have a dramatic impact on our health
Making simple changes to our diet and lifestyle can have a dramatic impact on our health

lead to heart attacks and strokes.

Dual cholesterol protection

Despite popular belief, only 20% of the cholesterol in our body comes from our diet whereas the majority, the remaining 80%, is produced by our own cells, mainly in the liver. ALA directly reduces production of cholesterol in the liver at its source, which is a highly effective way of normalising cholesterol levels.

ALA is also well known for reducing inflammation in the body, which helps to slow down plaque build-up in the arteries. Taking ALA daily is a great way to favourably balance the ratio of ‘good’ to ‘bad’ fats consumed in the diet.

Ubiquinol CoQ10

Coenzyme Q10 (CoQ10) is a naturally occurring enzyme with a multitude of roles in the cardiovascular system. CoQ10 acts within our cells in the mitochondria, the body’s energy ‘powerhouse’. Maintaining healthy CoQ10 levels fuels the mitochondria and supports the high energy requirements of our organs, particularly the heart. In addition to energy production, CoQ10 plays a vital role in oxygen utilisation to further support the functioning of heart muscle cells and maintain good circulatory health. CoQ10 also helps to lower blood pressure and is recognised as an effective cholesterol lowering ‘agent’.

Research studies show that people with cardiovascular problems often have low levels of CoQ10. Risk of deficiency is even higher with patients taking statins to lower cholesterol, since not only are they likely to have low levels of CoQ10 but statins also block natural ubiquinol synthesis in the body.

Ubiquinol versus Ubiquinone

There are two types of CoQ10 used in supplements: ubiquinone and ubiquinol. Ubiquinol is ‘body-ready’, which means the body doesn’t have to convert it into a usable form – a therapeutic advantage over ubiquinone. As an antioxidant, ubiquinol also offers protection against arterial plaque, thereby reducing heart attack risk and safeguarding heart muscle cells from free radical damage. Uniquely, ubiquinol also regenerates other beneficial antioxidants such as vitamins C and E.

Ubiquinone versus ubiquinol is just half the battle with CoQ10; addressing bioavailability is a further challenge, since therapeutic outcomes are achieved by raising blood plasma levels. Most ubiquinol supplements are oil-based, which means that large ubiquinol particles struggle to pass through the gut’s water layer barrier and are poorly absorbed. A special patented delivery system called VESIsorb®, utilised by CoQ10 manufacturer Igennus, optimises absorption by converting ubiquinol into water-soluble particles, ‘pre-digesting’ it so ubiquinol is effectively fast-tracked through the digestive system. VESIsorb delivers ubiquinol into the blood stream 2 times faster than standard oil-based forms, increasing tissue distribution throughout the body to achieve significantly higher blood concentrations that remain at therapeutic levels for up to 6 times longer.

Live cultures

Three specific live cultures L. plantarum CECT 7527, 7528 and 7529, help break down bile salts, which are made from cholesterol, therefore allowing its removal from the body. These friendly bacteria also metabolise dietary cholesterol in the gut, therefore reducing its absorption into the bloodstream. The AB-LIFE strains also produce a beneficial short-chain fatty acid known as propionic acid, which signals the liver to produce less cholesterol and also has an anti-inflammatory effect.

Top heart health supplements

A new and unique formula from OptiBac Probiotics is the first of its kind formulated for heart health. For your cholesterol is a pioneering, well researched multi-targeted natural supplement that combines unique live cultures with omega-3 ALA from cold-pressed virgin flaxseed oil – offering a multitude of benefits for managing healthy cholesterol levels.

Since not all live cultures are the same, OptiBac Probiotics focuses on specific strains of natural bacteria that have been clinically tested and proven to survive stomach acidity, bile salts and digestive enzymes in order to find the best live cultures for the job.

VESIsorb® Ubiquinol-QH from Igennus provides 100 mg of fast-acting body-ready ubiquinol CoQ10 for optimal therapeutic benefits. Taken daily, this advanced supplement offers comprehensive cardiovascular support, providing potent antioxidant activity and maximal energy production.

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A Natural Approach to Heartburn

As a nutritional therapist I have recently noticed a growing number of new clients taking a particular type of heartburn medication called ‘proton pump inhibitors’ or PPIs. In my experience, PPIs are a concern because they can sometimes do more harm than good.

PPIs, such as omeprazole and lansoprazole, work by suppressing the formation of stomach acid. Contrary to popular belief, heartburn is rarely caused by excess stomach acid and we need stomach acid. It is required for the proper digestion of proteins and carbohydrates, for absorption of nutrients and for protection against harmful bacteria. Without stomach acid, our digestion and immune system is compromised. For this reason PPI use has been linked with deficiencies of nutrients such as B12 and magnesium. as well as increased risk of bone fracture and bacterial overgrowth in the digestive system (1-4).

So what really cases heartburn? Most often, the problem is caused by a problem with the Lower Esphageal Sphincter (LES) – a valve between the stomach and oesophagus which prevents stomach acid from escaping upwards. Even if our levels of stomach acid are low, we can experience heartburn if this valve is not functioning as it should. The proper functioning of this valve can be affected as we age. It can also be affected by the types of foods we eat, and our eating patterns and behaviours.

A Natural Approach to Heartburn

Those experiencing heartburn can benefit by addressing their diet. Including protein with each meal is helpful, because protein encourages the LES to close properly. On the other hand, fat has the opposite effect, and so fatty foods and meals are best avoided. Fizzy drinks, alcohol, chocolate and smoking also ‘loosen’ the LES, and so are best avoided.

Other foods can irritate the lining of the oesophagus, especially when acid reflux has already made this tissue sensitive. These foods include orange juice, tomatoes and spicy foods. Until heartburn is resolved, it can be helpful to avoid these particular foods.

Helpful foods include sources of soothing pectin such as almonds, apples, apricots plums, carrots and strawberries. A teaspoon of Manuka honey, taken twenty minutes before a meal, may also help to reduce symptoms by coating the oesophageal lining.

Simple lifestyle changes can also be beneficial. Wearing loose-fitting clothing, eating slowly and chewing thoroughly are all helpful measures. Eating small meals and remaining upright for at least three hours after eating can also eliminate symptoms of heartburn.

Slippery Elm may help coat and protect the digestive tract.

Nutritional supplements are often used in heartburn in order to protect and repair the delicate tissue of the digestive tract and to combat bacterial overgrowth. Supplements which coat and protect the digestive tract are known as ‘demulcent’ nutrients, and these include slippery elm, marshmallow root. Herbal preparations such as this have been found to improve symptoms of heartburn (5). In clinic I have also had success using deglycyrrhizinated licorice (DGL) supplements as a powder or chewable tablet before meals. DGL seems to support the mucosal barrier, promoting healing of inflamed tissues. Glutamine, an amino acid used as fuel for the cells lining the digestive tract (6), may be also beneficial. Finally, a probiotic preparation can provide useful support, especially for those taking PPIs. Treatment with probiotics is believed to help the small bowel problems such as inflammation and bacterial overgrowth seen in those taking PPIs (7).

For those looking for a more natural approach, one of my favourite formulations is Patrick Holford Digest Pro, which provides glutamine, digestive enzymes and probiotics. Biocare’s Slippery Elm Intensive is another promising formulation combining marshmallow, DGL and slippery elm alongside other nutrients designed to support the health of the digestive tract. Alongside the right dietary and lifestyle choices, supportive supplements such as these may represent a sensible approach to addressing heartburn for those wishing to avoid long-term PPI use.

References

1. Jameson RL et al (2013) Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency. JAMA 310(22):2435-2442

2. MHRA (2012) Proton Pump Inhibitors in Long-Term Use: Reports of Hypomagnesia. Drug Safety Update 5:9. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON149774

3. Yu EW et al (2011) Proton Pump Inhibitors and Risk of Fractures: A Meta-Analysis of 11 International Studies. http://dx.doi.org/10.1016/j.amjmed.2011.01.007

4. Lombardo L et al (2009) Increased Incidence of Small Intestinal Bacterial Overgrowth During Proton Pump Inhibitor Therapy. http://dx.doi.org/10.1016/j.cgh.2009.12.022

5. Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004;20:1279-87.

6. Reeds PJ, Burrin DG. Glutamine and the bowel. J Nutr 2001;131:2505S-8S.

7. Wallace JL et al (2011) Proton Pump Inhibitors Exacerbate NSAID-Induced Small Intestinal Injury by Inducing Dysbiosis. Gastroenterology. July 2011.

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