Written by Julia Mellios

Your gut is one of the hardest working systems in your body. Meal after meal, it hustles to digest your food and extract the nutrients required to sustain you. Despite it’s solid work ethic, your gut can experience occasional performance hiccups, leading to digestive symptoms. While many of these are normal, others may indicate something more serious. Read on to discover what your symptoms say about your gut and ways to improve them.

Normal, Everyday Symptoms

Transient Belly Bloating
​What is it? Short-lived abdominal swelling due to trapped gas.

• What causes it? During and after meals, your gut produces enzymes and acids that break down your food, creating gas during this process. While bloating isn’t considered normal, it commonly occurs if you deviate from your standard diet, such as eating larger portions, rich and fatty meals or foods that are more laborious to breakdown, including excess carbohydrates and fibre. These place more burden on your digestive processes, subsequently increasing gas production and bloating. 
• How do you improve it? While mild bloating generally passes with time, chewing your food thoroughly, consuming smaller meals and spacing out your carbohydrate and fibre intake can help.

During and after meals, your gut produces enzymes and acids that break down your food, creating gas during this process. While bloating isn’t considered normal, it commonly occurs if you deviate from your standard diet, such as eating larger portions, rich and fatty meals or foods that are more laborious to breakdown, including excess carbohydrates and fibre. These place more burden on your digestive processes, subsequently increasing gas production and bloating. 

Flatulence

• What is it? Farting.
• What causes it? Gas is produced by normal digestive processes, and ‘passed’ at regular intervals. Additionally, increased fibre, fat or sugar intake can create gas. Your microbiome (gut bacteria) also influences the amount of gas produced by fermenting foods to help your digestion.1
• How do you improve it? It is normal to pass wind around 15 times per day.2 Additionally, the odd smelly fart is no big deal, particularly if caused by an increase in refined, processed foods (who can say no to the occasional slice of pizza?). However, if you would like to reduce flatulence, moderate your intake of these foods.

Borborymus

• What is it? Stomach growling or rumbling.
• What causes it? The movement of food, liquid or gas through your digestive tract. Your gut may also ‘growl’ to signal hunger.
• How do you improve it? Give your gut a helping-hand by chewing your meals thoroughly, which helps break down your food more efficiently prior to digestion, and reduces gas. Additionally, satisfying your hunger will stop the growl.

Symptoms That Require Attention

Chronic Constipation

• What is it? The infrequent passage of hard poop (less than once daily), often accompanied by straining, a sense of incompletely emptying the bowel and discomfort.3
• What causes it? Insufficient fibre or reduced fluid intake can slow your transit time (the time it takes for your food to travel from your mouth through to the other end), making you less ‘regular’. Dysbiosis (an imbalance in the types and levels of gut bacteria) can also influence digestive processes and reduce your transit time.4 Additionally, chronic constipation is associated with irritable bowel syndrome (IBS), a condition that affects the function of the bowel.5
• How do you improve it? Consume more fibre-rich foods, including fruit and vegetables, and drink enough water. A prebiotic and probiotic supplement may also support bowel regularity and provide relief for symptoms of medically diagnosed IBS.

Diarrhoea

• What is it? Soft, loose or watery stool that occurs more than three times daily.
• What causes it? Diarrhoea may be a symptom of a bacterial or viral infection, such as gastroenteritis, or be related to certain medications, particularly antibiotics.6 Additionally, IBS and inflammatory bowel disease (IBD), a condition involving inflammation of the digestive tract, may cause diarrhoea.
• How do you improve it? IBS and IBD are serious conditions that require a professional diagnosis and care from a health Practitioner. However, if your symptoms are associated with antibiotic use, Metagenics Ultra Flora Intensive Care may help to restore healthy intestinal bacteria and relieve diarrhoea.

Malodorous Gas

• What is it? Farts that clear a room.
• What causes it? Your microbiome consists of a range of bacteria (38 trillion microbes!) that help digestion by fermenting your food, particularly fibre. Imbalances in the levels of different bacterial species can lead to increased gas production with a pungent odour.
• How do you improve it? Metagenics Ultra Flora Intensive Care provides three specific probiotic strains (types of bacteria), Lactobacillus rhamnosus (LGG®), Saccharomyces cerevisiae (boulardii) and Bifidobacterium animalis ssp lactis (BB-12®), which have been shown to help restore a healthy balance of bacteria within your microbiome.

Abdominal Pain

• What is it? Sharp, dull, stabbing, cramp-like, or twisting pain in your abdomen. Most people experience occasional gut discomfort, however severe gut pain that is episodic, regular or continuous requires assessment, particularly if accompanied by other symptoms such as fever, changes to your poop, nausea and/or vomiting.
• What causes it? Abdominal pain has many potential causes, the most common being gas pain, food intolerances or allergies, or indigestion. However, abdominal pain can also be a sign of something more serious, including appendicitis, gallstones, ulcers, infections, kidney stones, and many other conditions.
• How do you improve it? If gut pain has become a pattern rather than a one-off incident, seek guidance from a healthcare professional.

If you regularly experience one or more problematic symptoms, consult with a Natural Health Practitioner for further investigation, particularly if it is new or getting worse. Additionally, healthcare Practitioners have a suite of testing available to investigate the driver behind your symptoms. For instance, a stool test enables Practitioners to identify all of the bacteria and other microorganisms that inhabit your gut and how they contribute to your gut function and digestive symptoms.

Ditch the Gut Glitches
Don’t let your gut feelings bum you out! Instead, switch up your diet and lifestyle habits and rid yourself of symptoms such as bloating, gurgles and gas. If your gut symptoms are troubling you, speak with a natural healthcare Practitioner for a comprehensive plan to get you gut comfort, today.

References1 Manichanh C, Eck A, Varela E, Roca J, Clemente JC, González A, et al. Anal gas evacuation and colonic microbiota in patients with flatulence: effect of diet. Gut. 2014 Mar;63(3):401-8. doi:10.1136/gutjnl-2012-303013.
2 Victoria State Government, Better Health Channel. Flatulence [Internet]. Melbourne VIC: Victoria State Government, Better Health Channel; 2014 [updated 2014 Aug; cited 2020 Jan 30]. Available from: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/flatulence.
3 Colledge NR, Walker BR, Ralston SH. Davidson’s principles and practice of medicine. 21st ed. Edinburgh (UK): Elsevier/Churchill Livingstone; 2010. p. 763-844.
4 Zhao Y, Yu YB. Intestinal microbiota and chronic constipation. Springerplus. 2016 Jul 19;5(1):1130. doi: 10.1186/s40064-016-2821-1.
5 Colledge NR, Walker BR, Ralston SH. Davidson’s principles and practice of medicine. 21st ed. Edinburgh (UK): Elsevier/Churchill Livingstone; 2010. p. 763-844.
6 NPS Medicinewise. What are the side effects of antibiotics? [Internet]. Sydney NSW: NPS Medicinewise; 2012 [updated 2017 Mar; cited 2020 Feb 18]. Available from: http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/for-individuals/side-effects-of-antibiotics.

Written by Rachel Baudistel

​Fermented foods and beverages, such as sauerkraut, kimchi and kombucha, were a regular part of our ancestors’ diets for thousands of years. Originally a method of preserving produce from harvest time through the cold days of winter;1 fermentation involves adding a bacterial or yeast starter to a food. These organisms convert starches and sugars to alcohol or acids, lengthening the food’s shelf life and producing the unique and tangy flavours we associate with fermented foods. Recently, these foods have seen a resurgence in popularity, not for their shelf lives but for their claimed digestive health benefits. As probiotics have also risen in popularity for similar reasons, let us explore how fermented foods stack up against a high quality probiotic.

It All Begins In The Gut
Our interest in strategies to improve digestive health has been fuelled by an expanding body of research indicating that poor gut health negatively affects many other body systems.2 Specifically, imbalances in the microbiome, the ecosystem of approximately 38 trillion bacteria and other organisms living in your digestive tract, have been connected not only to gut disorders but to mood, immune, inflammatory and autoimmune diseases, cancer and even cardiovascular disease.3,4 

Research shows that taking live beneficial bacteria, such as probiotics, can improve microbiome health, reducing the symptoms of many health conditions,5,6 improving general health and lowering the risk of diseases such as those mentioned above.7 In light of this, probiotic supplements and fermented foods, both sources of potentially beneficial bacteria, have been put forward as effective options for improving microbiome health. Consequently, there is a misconception that they are interchangeable; however, there are fundamental differences between them.

The Pros of Probiotics
​Probiotics are defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”.8 Research has shown that specific types (strains) of probiotics, at defined doses, can help manage particular health conditions or symptoms, such as hayfever9 or bloating.

To understand this further, let us use irritable bowel syndrome (IBS), a painful digestive disorder, as an example. (To read more about IBS, click here). Research indicates that the specific probiotic strain, Lactobacillus plantarum 299v, can relieve the bloating, intestinal pain and inflammation of medically diagnosed IBS.10,11 This benefit occurs when the probiotic is taken at a dose of 20 billion colony-forming units (CFU), which is a way of expressing the amount of live bacteria contained per probiotic capsule or dose of powder.

Scientists give probiotic bacteria three names we can use to identify them and connect them to their health benefits: genus (e.g. Lactobacillus), species (e.g. plantarum), and strain (e.g. 299v). To get the health benefits associated with that strain, all three names must match the probiotic used in the scientific research, as well as the dose. Luckily, you can find information on strains and doses in a probiotic supplement just by reading the label.

By choosing a probiotic from a reputable brand committed to quality, you can feel confident that you will receive:

• A guaranteed strain of bacteria effective for your health condition
• A correct quantity of live bacteria necessary for the benefit you require
• Bacteria that are alive at the label dosage until the expiry date

So, if you are looking to improve a particular health condition, choose a strain-specific probiotic for best results. What’s the easiest way to find the right probiotic for your condition? See a Natural Healthcare Practitioner.

Fermented Foods Vs Probiotics
Although fermented foods contain live bacteria, the microbes responsible for fermentation do not confer the same health benefits as a probiotic supplement. In fact, an expert panel of scientists concluded that fermented foods have unidentified microbial content, meaning there is no guarantee of what bacterial strains or doses will be present in them. For this reason, they are fundamentally different from probiotics.12

That being said, many people experience non-specific digestive health benefits from including fermented foods in their diet, which could be related to the bacteria present, however, more research is needed to confirm this. Since fermentation breaks ingredients down into simpler parts, these foods are generally easier to digest, and fermentation also increases the nutritional value of the food.13 If you are healthy and do not require specific health benefits, fermented foods may be appropriate for you.
​
Be aware that, while fermenting at home can be fun, it is not a risk-free process. Exposure to oxygen, for example, can allow mould, yeast and less beneficial bacteria to grow. High-quality probiotics, on the other hand, are produced under strict hygienic conditions that minimise the risk of introducing ‘bad’ microorganisms into your gut. If your digestive system is sensitive, you may be better off taking a probiotic.

Choose What’s Right For You
Fermented foods are a tasty addition to the diet and do appear to provide some non-specific digestive benefits to relatively healthy people, on the proviso that they are prepared correctly. However, for support with specific health conditions, it is important to choose a specific probiotic strain, at the right dose, for your condition. To access high-quality probiotics for your particular health needs, contact a Natural Healthcare Practitioner.

References1 Chambers PJ, Pretorius IS. Fermenting knowledge: the history of winemaking, science and yeast research. EMBO Rep. 2010 Dec;11(12):914-20. doi: 10.1038/embor.2010.179.
2 Alam R, Abdolmaleky HM, Zhou JR. Microbiome, inflammation, epigenetic alterations, and mental diseases. Am J Med Genet B Neuropsychiatr Genet. 2017 Sep;174(6):651-660. doi: 10.1002/ajmg.b.32567.
3 Alam R, Abdolmaleky HM, Zhou JR. Microbiome, inflammation, epigenetic alterations, and mental diseases. Am J Med Genet B Neuropsychiatr Genet. 2017 Sep;174(6):651-660. doi: 10.1002/ajmg.b.32567.
4 Maranduba CM, De Castro SB, de Souza GT, Rossato C, da Guia FC, Valente MA et al. Intestinal microbiota as modulators of the immune system and neuroimmune system: impact on the host health and homeostasis. J Immunol Res. 2015;2015:931574. doi: 10.1155/2015/931574.
5 Niedzielin K,  Kordecki H, Birkenfeld B. A controlled, double-blind, randomised study on the efficacy of Lactobacillus plantarum 299v in patients with irritable bowel syndrome. Eur J Gastro Hepat 2001;13:1-5. PMID: 11711768.
6 Costa DJ, Marteau P, Amouyal M, Poulsen LK, Hamelmann E, Czaaubiel M, et al. Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind, randomised, placebo-controlled trial (GA2LEN) study. Eur J Clin Nutr. 2014;1-6. doi: 10.1038/ejcn.2014.13.
7 Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001 Apr 7;357(9262):1076-9. doi: 10.1016/S0140-6736(00)04259-8.
8 Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014 Aug;11(8):506-14. doi: 10.1038/nrgastro.2014.66.
9 Costa DJ, Marteau P, Amouyal M, Poulsen LK, Hamelmann E, Czaaubiel M, et al. Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind, randomised, placebo-controlled trial (GA2LEN) study. Eur J Clin Nutr. 2014;1-6. doi: 10.1038/ejcn.2014.13.
10 Niedzielin K,  Kordecki H, Birkenfeld B. A controlled, double-blind, randomised study on the efficacy of Lactobacillus plantarum 299v in patients with irritable bowel syndrome. Eur J Gastro Hepat 2001;13:1-5. PMID: 11711768.
11 Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012 Aug 14;18(30):4012-8. doi: 10.3748/wjg.v18.i30.4012. 
12 Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat RevGastroenterol Hepatol. 2014 Aug;11(8):506-14.doi: 10.1038/nrgastro.2014.66.
13 Coyle D. What Is Fermentation? The Lowdown on Fermented Foods.  https://www.healthline.com/nutrition/fermentation#what-it-is. Healthline. Accessed July 8, 2019.

By Melissa Blake, ND

Our bodies have an amazing natural ability of keeping to a daily schedule via an internal 24-hour master clock.1 This clock contributes to the patterns, also known as circadian rhythms, of many biological activities including sleep-wake cycles, eating patterns, and hormone function.1
Finding ways to support and balance this clock, along with the many systems it regulates, may offer a novel way to optimize health. One way to optimize is through diet timing.
The circadian diet as a way of eating takes into account not only what we eat, but when.2 It is an approach to eating that synchronizes food intake around our biological clocks, emphasizing eating in sync with the body’s natural tendencies and instincts. This means eating during daylight hours or hours when we are naturally more active. Eating in this way can help support circadian rhythms and contribute to overall health and wellness.2

As diets and terms including intermittent fasting, circadian diet, and time-restricted eating gain popularity, the question may arise as to whether the principle on which this “circadian approach” applies to other aspects of nutrition, including supplementation.

5 common supplements
Although there’s still much to learn about optimal timing for both food and supplements, current evidence suggests it may play a role.3 Here are a few general guidelines for five common supplements to help you add the extra layer of timing and optimize your plan:

B complex
B vitamins are often recommended to support healthy energy and mood.4 There is some evidence that taking B vitamins before bed can have a negative effect on sleep quality.5 Consider taking any B vitamins, including a B complex, earlier in the day with food.

Fish oil
The most common complaints I hear about fish oil are burping or nausea. Taking fish oil supplements with food, divided into two doses, may help reduce these harmless yet annoying side effects.

Magnesium
Magnesium is an essential micronutrient that plays a role in hundreds of reactions in the body.6
Due to the overall benefits of magnesium supplementation, consistency is more important than any timing in this case. Known for muscle relaxation and improved sleep, taking magnesium before bed may enhance those benefits in some people.7 Others may notice digestive issues and may choose to take with food.

Probiotics
Any recommendation related to probiotic supplementation should be based on the specific strain; however, much of this detailed evidence does not yet exist.  Meal timing has more or less of an impact on probiotics depending on the strain, the dose, delivery method, etc.8 The consensus, however, is to take probiotics 30 minutes before or during a meal versus after eating.9 Another guideline is to space probiotics away from antibiotic medications by two hours to reduce interaction.

Vitamin D
Along with vitamins A, E, and K, vitamin D is a fat-soluble vitamin that is better absorbed when taken with a fat-containing meal (ex. fatty fish, avocado, olive oil, cheese, eggs).10 Although we do not have substantial evidence to support specific timing, it may make sense to take vitamin D supplements in the morning with breakfast to mimic the timing of exposure to natural sunlight.

Summary
As we continue to learn about specific supplements and optimal timing, consider that the best timing is the one you can stick with. You cannot benefit from a supplement you do not take. The most important thing is to take your supplements at a time that is convenient for you so you can be consistent.
Work with a knowledgeable healthcare provider to determine the optimal plan for you that includes quality, quantity, and timing.

References:

1. Rosenwasser AM et al. Sleep Med Clin. 2015;10(4):403-412.
2. Challet E. Nat Rev Endocrinol. 2019;15(7):393-405. 
3. Oike H et al. Curr Nutr Rep. 2014;3(3):204-212.
4. Young LM et al. Nutrients. 2019;11(9):2232.
5. Aspy DJ et al. Percept Mot Skills. 2018;125(3):451-462.
6. Rosanoff A et al. Adv Nutr. 2016;7(1):25-43.
7. Altura BM et al. Med Hypotheses. 2001;57(6):705-713.
8. Pot B et al. Eur J Med Res. 2021;26(1):40.
9. Tompkins TA et al. Benef Microbes. 2011;2(4):295-303.
10. Dominguez LJ et al. Metabolites. 2021;11(4):255.

By Cassie Story, RDN

We are social creatures. Hardwired in our being is the desire to belong, fit in, and play with our fellow humans. In fact, survival depends on our ability to bond.

So what happens to your mental state when you remove yourself from others over the course of a year and a half? While long-term data on the mental health implications of isolation are currently being studied, we do have short-term studies emerging, which evaluated mental health concerns over the past year.

A new phenomenon has occurred for workers who have been utilizing online video platforms for a majority of their day-to-day work. “Zoom fatigue” may have inadvertently activated the fight or flight system within the brain.1 This is according to a recent report from Stanford that offers four potential aspects of Zoom fatigue and the unintended psychological consequences that follow.1

With this knowledge, it is important to recognize the spectrum of emotions that you might be feeling as you prepare to “get back” into the real world—to step out from behind the screen and live life again.

This article identifies common emotions that you may be experiencing, effective mantras for change, and supportive nutrients that can play a role in taking you from feeling blah to rah!

Emotional state: fear & anxietyIt is understandable to have some lingering fear and anxiety about social reentry. Due to our constant connection to news and information, many people have likely experienced some level of fear and anxiety that is atypical for themselves over the past year. It wouldn’t be realistic to expect yourself to go from living in that state of mind, to complete joy and jubilation.
Mantra: I am safe

Supportive nutrients: palmitoylethanolamide (PEA) and hemp

PEA is a bioactive lipid molecule that the body produces naturally and is found in the lipid extracts of foods.2 PEA has been researched for over 70 years and has a wide range of clinical applications from mild bodily discomfort and immune system support to mood and neurological health.2-6

Full-spectrum hemp is sourced from aerial plant parts including the stalk, stems, seed, and flower of the hemp plant and contains beneficial phytocannabinoids and terpenes.
They work together to produce a synergistic effect on the endocannabinoid system, which has been found to support a healthy stress response and has positive neurological benefits.7
Emotional state: stressLoneliness and isolation have been found to increase stress levels in the body.8 Couple that with uncertainty about the future and worry for your own health and wellbeing, as well as that of your friends and family, and this creates a perfect brew for stress to thrive. Are you ready to reclaim your balance?
Mantra: I am at peace

Supportive nutrient: phosphatidylserine

Phosphatidylserine is an important phospholipid in the brain and a key building block of nerve cell membranes.9 Research suggests that it may support mental focus and help support a healthy endocrine response to acute mental stress.10
Emotional state: low self-confidence or decline in body imageFor most people, due in part, to our society’s environmental factors of convenience foods and little built-in day-to-day movement, maintaining health and wellbeing requires routine and planning. Removing ourselves from typical day-to-day activities, and increasing a sedentary lifestyle, may lead to undesired weight gain.
If you have experienced an increase in body weight, first remind yourself, you are not alone. Second, find something about your body to be grateful for right now. Third, speak kindly to yourself.
If you have now found that a majority of your “real life” clothes no longer fit, maybe it is time to implement a supportive weight-loss routine.
Mantra: I am strong (or flexible, sexy, healthy)

Supportive nutrient: meal replacements

Meal replacements are reduced-calorie portion-controlled products often fortified with micronutrients. Studies show that replacing just one or two meals per day with a meal-replacement product produces greater total weight loss, and a greater proportion of participants meet their total weight-loss goals both in the short- and long-term, compared to a low-calorie diet without the use of meal replacements.11
Emotional state: lack of motivationSpending the majority of your time in a seated position, whether the couch or an office chair, can wreak havoc on motivation levels. Going from staring at one screen to the next, between your computer, TV, and phone, can cause a numbness of sorts and lead to lack of desire or motivation to try new things. We are hardwired to want to try new things. Being limited from participating in your favorite activities may have decreased your motivation without your realizing it.
Mantra: I enjoy new experiences

Supportive nutrients: holy basil, ashwagandha, amla fruit

These are a classic blend of Ayurvedic herbs. Holy basil (Ociumum sanctum) leaves and stems contain a variety of compounds including triterpenes (oleanolic and ursolic acid), saponins, flavonoids, and phenols.12 Roots of ashwagandha (Withania somniferum), an herb grown in India, contain withanolides.13 Amla fruit, or Indian gooseberry (Phyllanthus emblica), is rich in vitamin C, a potent antioxidant.14 
Research suggests these adaptogens may support the body in adjusting to various stressful environmental challenges.15 These herbs may help reduce some of the challenges associated with stress.16

Emotional state: excitementPerhaps you are experiencing a different type of emotion than those listed above. Maybe you are excited and “champing at the bit” to get back out into your typical social life. If you feel that you need some calming support because you just cannot wait to get back out there, here are some things to consider:
Mantra: I am calm

Supportive nutrients: folate, magnesium, vitamins B12 and B6

Folate & vitamin B12 are cofactors in the synthesis of neurotransmitters, including serotonin.17-18 Serotonin is associated with mood, sleep, and relaxation.19

Vitamin B6 is a factor in the body’s conversion of glutamate, which is a stimulatory neurotransmitter, into gamma-amino-butyric acid (GABA), which is associated with calming and relaxation.20

Magnesium is an essential mineral and acts as a cofactor in numerous metabolic processes. There is evidence that specific nutrients, such as magnesium, may help to promote muscle relaxation and restfulness—possibly playing a role in reducing daily stress levels.21

Conclusion
However you are feeling in any given moment is okay. As humans, we experience a multitude of emotions that change throughout the day. If you’ve noticed you haven’t felt yourself lately, remind yourself that every day is a new day—filled with opportunities for growth and change. Be kind to yourself, use the mantras within this article or create your own that speak to you and consider adding the supportive nutrients listed above to your routine if you are seeking nutritional support for your emotional state.

References:
1. Bailenson J. Technology, Mind, and Behavior. 2021;2:1.
2. Beggiato S et al. Front Pharmacol. 2019;10:821.
3. PubChem, U.S. National Library of Medicine, National Center for Biotechnology Information. https://pubchem.ncbi.nlm.nih.gov/compound/4671. Accessed September 20, 2019.
4. Passavanti MB et al. Syst Rev. 2019;8(9).
5. Hesselink JM et al. Int J Inflamm. 2019;2013(9).
6. Hesselink JMK. J Pain Res. 2013;6:625–634.
7. Tagne AM et al. Pharmacol Res. 2021:105545.
8. Hwang TJ et al. Int Psychogeriatr. 2020;32(10):1217-1220.
9. Kim H et al. Prog Lipid Res. 2014;56:1-18.
10.Benton D et al. Nutr Neurosci. 2001;4(3):169-178.
11. Heymsfield S et al. Int J Obes Relat Metab Disord. 2003;27(5):537-549.
12. Cohen MM. J Ayurveda Integr Med. 2014;5(4):251-259.
13. Mirjalili MH et al.  Molecules 2009;14:2373–2393.
14. Mindell E. New York, NY, Hachette Book Group, 2011.
15. Panossian AG et al. Med Res Rev. 2021;41(1):630-703.
16. Panossian A. Pharmaceuticals. 2010;3:188-224.
17. NIH Office of Dietary Supplements. Office of Dietary Supplements – Vitamin B12. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ . Accessed: August 5, 2021.
18. NIH Office of Dietary Supplements. Office of Dietary Supplements – Folate. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ . Accessed: August 5, 2021.
19. Young SN. J Psychiatry Neurosci. 2007;32:394-399.
20. Dakshinamurti K. Adv Nutr Res. 1982;4:143-179.
21. de Baaij JH, et al. Physiol Rev. 2015; 95:1-46.