 by Deanna Minich, PhD, CNS, IFMCP You’ve likely seen, or heard, the detox debate. Experts, celebrities, and news outlets have reported the importance of detoxing or doing a cleanse. Over time, it’s thought that an accumulation of environmental toxins weighs us down, saps our energy, and prevents us from living our best lives. As a result, the best way to reduce the “toxin burden” is to bring in everyday strategies to remove them and to have dedicated times of year to do a bit more for a whole-self reset. Of course, there’s also the school of thought that suggests that our bodies are built for detoxing, and we don’t need a special diet or product to clear out the system. Detox is just a waste of time, they say. Well, there is no doubt that the body does regular cleansing through breathing, urinating, defecating, crying, secreting, and exfoliating, but are we always doing it efficiently? With all the current data on pharmacogenetics and even nutrigenomics, we now know that every individual is different when it comes to the efficiency of toxin removal. So how would you know if you are one of the “chosen ones” who needs a detox? Let’s look at the body systems from physical, emotional, and mental perspectives, as they may provide the clues. Physical detox Let’s begin by looking at what “detox” means. Over the last two decades, this word has taken on a much more dynamic meaning. In the United States, we encounter over 80,000 different chemicals,1 and an estimated 4 billion pounds of chemical pollutants from plastics, pesticides, solvents, heavy metals, etc. enter into our environment, finding their way into the air, soil, food, water supplies, our clothing, and eventually, into our bodies.2 Every year, the toxic load continues to increase. Scientists now estimate that everyone of us carries at least 700 contaminants within our bodies!3 While it is true that the human body is well-equipped to rid itself of these potentially harmful chemicals, the sheer volume of what we’re now exposed to can overburden our natural detoxification processes and allow the toxins to accumulate in our tissues. One of the first indicators that we may be harboring a toxic burden is to look at changes in the body’s immune system, such as increased susceptibility to colds, flues, and becoming sick.4 Additionally, generalized joint and muscle aches and pains, food, environmental or chemical sensitivities, headache, lethargy, weakness, and even abdominal pain could be signs that you need to help your body relieve some of the accumulated toxins. Emotional detox When we look at detoxification, we don’t just want to look at the removal of physical toxins that weigh down our bodies. We can also be burdened in other areas of life, including emotional and mental aspects that can arise from many areas in life—from the company we keep to physical and psychological stressors to sleep habits. Mental detox In addition to emotional toxicity, we may also experience mental toxins. Perhaps the most pervasive are the limiting thoughts that invade our minds throughout the day like, “Nobody cares what I think,” “I’m just not good at new things,” or “I can’t say no.” Years ago, I heard we have up to 80,000 thoughts each day, and most of them are negative. Regardless of the exact number, it’s probably reasonable to think that most people are not thinking positively most of the time. These types of mental toxins could add up to mental stress, leading to an inability to concentrate and even sleep. And, without proper sleep,6 we may not be allowing for the flux of toxins out of the brain. Steps for daily detox No matter where the toxic burden originates from, there are simple steps to take to help your body detox.
References: 1. National Resources Defense Council. https://www.nrdc.org/issues/toxic-chemicals. Accessed October 17, 2018. 2. http://scorecard.goodguide.com/env-releases/us-map.tcl. Accessed November 5, 2018. 3. Onstot J et al. Characterization of HRGC/MSUnidentified Peaks from the Analysis of Human Adipose Tissue. Volume 1: Technical Approach. Washington, DC: U.S. Environmental Protection Agency Office of Toxic Substances; 1987. 4. Sears ME et al. J Environ Public Health. 2012;2012:356798. 5. J Environ Public Health. 2012;2012:356798. 6. Inoué S. Behav Brain Res. 1995;69(1-2):91-96. 7. Ishii H et al. http://www.clinexprheumatol.org/article.asp?a=2136. Accessed 10/17/18. 8. Guan Y et al. Evid Based Complement Alternat Med. 2015:824185.
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 Nobody likes uninvited guests. This includes toxins and pollutants such as heavy metals and pesticides from the air, water, and soil that bombard our bodies every day. Over time, these “guests” can build up and can contribute to mild issues such as brain fog, tiredness, aches, and skin complaints.1,2 This is when it is important to understand the three phases of your body’s natural detoxification processes. Here’s what that looks like:
Phase I: Reaction In the first phase of metabolic detoxification, your body reacts to toxins by using enzymes (known as P450 enzymes)3 that act to turn the toxins into free radicals. This is a good thing: Free radicals are a natural occurrence that, when balanced, should not be an issue; it is when free radicals become imbalanced that they are considered an issue. Through this conversion process, toxins become water-soluble molecules that are easier for your body to get rid of via the kidneys (and eventually through the urine).3 Phase II: Neutralization Welcome to the activation phase of detox! After Phase I, some toxins are rendered as more reactive than before. In Phase II, these products are attached to other water-soluble substances to increase their solubility and make them easier to eliminate through urine or bile.3 This process is called a conjugation reaction, and requires co-factors (metal ions or co-enzymes) to make it happen.3 Phase III: Transportation Like a ferry that brings cars and people from Point A to Point B, the transporters of Phase III help ensure the water-soluble compounds created in Phases I and II are excreted from your cells. Before this occurs, Phase III neutralizes the compounds and binds them with dietary fiber. From here, it’s literally a flush when the toxins are excreted.3 References: 1. Goldman RH et al. The occupational and environmental health history. 1981 Dec 18;246(24):2831-6. 2. Nelson et al. 2011. 3. Liska D. The Detoxification Enzyme Systems. Altern Med Rev.1998 Jun;3(3):187-98. 4. Infographic: The 3 Phases of Detoxification. Metagenics Institute. Available at: https://www.metagenicsinstitute.com/ce-education/clinical-tools/3-phases-detoxification. Accessed August 30, 2018. Submitted by the Metagenics Marketing Team  Add These Detoxifying Foods to Your Shopping List
Detox is a hot topic nowadays. Many detox programs promise to cleanse your body harmful compounds, and others tout weight loss and additional health benefits. Unfortunately, many of these detox methods involve a major dietary overhaul or giving up solid foods altogether, which may actually be harmful to your body.1 Because your body is in constant detox mode, you can encourage this process, correctly and effectively, by simply eating the right foods. Scientific research has found that the nutrients, enzymes, and antioxidants found in certain whole foods can help support the liver’s detoxification pathways, prevent the buildup of toxins, and support overall health.2-4 Chemicals and toxins are everywhere, but your body is built to fight back. Here are six of your top nutritional allies: 1. Cruciferous vegetables & leafy greens Spinach, broccoli, and Brussels sprouts are among the folate- and chlorophyll-richgreens that support the body’s detoxification process by helping to detoxifythe blood and cleanse the intestines.2,4-7 All the more reason to go green! Broccoli deserves some special attention for its high concentrations of glucoraphanin, which is converted in the body to sulforaphane—an active compound associated with many positive health benefits, including its role in inducing phase II detoxification enzymes and support for overall liver health.8-10 2. Turmeric Used in many anti-inflammatory and detoxifying recipes, turmeric contains a powerful substance called curcumin, a polyphenol with anti-inflammatory and antibacterial properties. Science has found curcumin to play a role in modulating cellular response to oxidative stress—demonstrating hepaprotective and therapeutic effects on liver health.11,12 3. Sesame Commonly used in bread products, oils, and dressings, sesame is flowering plant that maybe beneficial for detox. Sulfur-containing amino acids methionine and cysteine—both of which are found at high levels in sesame—are precursors to the production ofglutathione, a key antioxidant in the detoxification process.4 4. Beets These pretty-colored veggies contain betanin, which can help repair liver cells and help support detoxification processes in the liver.13,14 It’s also great for digestion. Tell toxic chemicals to “beet” it! 5. Guacamole No party spread is complete without it! Avocado has high concentrations of the antioxidant glutathione, which has been found to neutralize free radicals to support and protect the liver—i.e., your detoxification powerhouse.4,15,16 Why guacamole? Avocado in this form often uses other healthful ingredients, like cilantro. Also known as coriander, cilantro contains oils with antibacterial, antifungal, and antioxidative properties.17 Pass the guac, please. 6. Garlic Alongside its knack for warding off vampires, garlic may be beneficial for clearing out toxins. The sulfur-containing compound allicin, which gives garlic its unique and strong-smelling aroma, may enhance antioxidation and detoxification capabilities18,19 and has also demonstrated hepatoprotective effects against heavy metals in the liver.20 Incorporating more of these foods into your diet can help support detox processes. Add them to your shopping list today! References: 1. National Institutes of Health. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/detoxes-cleanses. Accessed November 15, 2018. 2. Guan YS. Evid Based Complement Alternat Med. 2015;2015:824185. 3. V Marco. Int J Food Sci Nutr. 2011;63 Suppl 1(S1):82-89. 4. Hodges RE. J Nutr Metab. 2015;2015:760689. 5. Suparmi S. J Toxicol. 2016;2016:8515089. 6. https://www.healthline.com/health/liquid-chlorophyll-benefits-risks. Accessed November 15, 2018. 7. Welzel TM. Cancer Epidemiol Biomarkers Prev. 2007;16(6):1279-1282. 8. Kikuchi M. World J Gastroenterol. 2015;21(43):12457–12467. 9. Yoshida K. World J Gastroenterol. 2015;21(35):10091–10103. 10. Glade MJ. Nutrition. 2015;31(9):1175-1178. 11. 2018;10(7):E855. 12. García-Niño WR. Food Chem Toxicol. 2014;69:182-201. 13. Krajka-Kuźniak V. Br J Nutr. 2013;110(12):2138-2149. 14. Clifford T. Nutrients. 2015;7(4):2801–2822. 15. Kaplowitz N. Yale J Biol Med. 1981;54(6):497–502. 16. Sacco R. Minerva Gastroenterol Dietol. 2016;62(4):316-324. 17. Mandal S. Asian Pac J Trop Biomed. 2015;5(6):421-428. 18. Bayan L. Avicenna J Phytomed. 2014;4(1):1–14. 19. Wu CC. J Tradit Complement Med. 2012;2(4):323–330. 20. Nwokocha CR. Food Chem Toxicol. 2012;50(2):222-226. Submitted by the Metagenics Marketing Team  Heavy metals, pesticides, and xenoestrogens
The industrial, chemical, and technological revolutions benefited us in many ways but have also led to a highly toxic world. If we could take a look inside the food and supplements that we put into our bodies, we would expect them to not contain heavy metals and pesticides. However, this simply is not realistic given our modern environment, where we are regularly exposed to toxins through water, food, air, personal care products, and other elements such as:
While this information may come as a surprise, we are not incapable of protecting ourselves from exposure to toxins. Here are four critical ways that we can protect ourselves: 1. Be aware of safety guidelines Action begins with awareness that we need to protect ourselves from daily exposure to toxins. Regulatory agencies such as the Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) publish information and set forth safety guidelines for heavy metal intake and other manageable exposures.5,6 Being aware of these safety guidelines is a great first step toward living a cleaner lifestyle. 2. Detox your home We think our homes are safe, but they are actually where we can be exposed to heavy metals and xenoestrogens—compounds that imitate the hormone estrogen. Xenoestrogens include brominated flame retardants (BFRs) commonly found in mattresses, carpet, electronics, and more. Older homes can also harbor lead paint. Aluminum has been found in pots, pans, and various personal care products. Even scented candles and air fresheners can contain xenoestrogens and other harmful compounds.7 Plastic containers are another place where xenoestrogens lurk. While convenient, plastic containers such as water bottles and bags include chemicals that mimic estrogen in the body. Two of these chemicals, bisphenol-A (BPA) and bisphenol-S (BPS), are especially detrimental in extreme temperatures, as high heat can cause both to break down and leach into foods and liquids.8 Use glass or stainless-steel containers instead of plastic to reduce exposure. 3. Shop smart One of the easiest ways to reduce toxin exposure is by shopping smarter at the grocery store. Look for organic varieties of produce listed on the Environmental Working Group “Dirty Dozen” list, as these items have been associated with high pesticide residue levels.9 For shoppers on a budget, produce listed on the “Clean 15” are identified as non-organic produce with the lowest pesticide levels.9 For animal products, select organic meats whenever possible and pick wild-caught seafood over farm-raised. Not all fish are created equal, and in the deep blue sea, smaller is better as they are gobbled up by larger fish, thereby beginning the cycle of contaminants compounding and building in potency until they reach your plate. Because large fish such as tuna and swordfish are higher on the food chain, they usually harbor greater concentrations of toxins and contaminants being dumped into oceans and lakes than their food source (e.g., smaller fish). 4. Drink filtered water. The tap water in your area could be harboring heavy metals, pesticide runoff, and environmental estrogens like fluoride, chlorine, and other chemicals. In a 2008 study across nine states, the US Geological Survey found municipal water to contain 85 man made chemicals.10 However, adequate water is important for so many bodily processes—including detoxification—so purchase a quality water filter to stay hydrated while keeping toxins at bay. References:
Submitted by the Metagenics Marketing Team  Magnesium L-threonate is the magnesium salt of a naturally occurring vitamin C metabolite L-threonic acid. Magnesium, a divalent cation, is important for neuronal activity as it is a co-factor for enzymes present
in the neurons or glial cells.1,2 Magnesium and Cognitive Health Two observational studies found that individuals with a diet rich in magnesium have a lower risk of cognitive decline:
Mechanism of Action Magnesium regulates the opening of N-methyl-D-aspartate receptor (NMDAR) in the brain. This receptor plays a critical role in cognitive function and is the target of various neurological treatments.5 Structurally, NMDAR is made up of two glycine-binding NR1 sub-units, and two of four glutamate-binding NR2 sub-units: NR2A, NR2B, NR2C, and NR2D (Figure 1). Research Highlights
Long-Term Potentiation Out of the four NR2 subunits, NR2B is of prime importance because it confers greater synaptic plasticity which helps to create and retain memories. However, the number of NR2B sub-units have been shown to decrease with age in animals.6 Overexpression of the NR2B sub-unit enhanced memory in transgenic rats and mice compared to wild-type littermates.7 NR2B is also thought to influence memory formation by increasing the long-term potentiation (LTP) through the activation of calcium/calmodulin dependent protein kinase II (CaMKII) (Figure 2).8 Long-term potentiation is long lasting increase in synaptic efficacy, which is critical for learning and memory.9 Magnesium L-Threonate Enhances Spatial Memory in Animals Magnesium L-threonate up regulated the expression of NR2B subunit in cultured hippocampal neurons.10 Compared to control, rats treated with magnesium L-threonate had:
This increase in NR2B sub-unit expression and magnitude of LTP by magnesium L-threonate translates into enhanced hippocampus dependent memory. In this study, spatial working memory, memory regarding one’s environment, and spatial orientation, were assessed at day 0 and day 24 by T maze. At day 0, rats in both groups made 30% fewer correct choices, but at day 24 aged rats treated with magnesium L-threonate made about 15% more correct choices than untreated rats (p<0.05). Interestingly, the improvement in spatial memory of aged rats declined within 12 days of stopping the treatment but improved when the treatment was re-initiated. Magnesium L-Threonate Improves Memory in Older Adults The effect of magnesium L-threonate on memory was studied in a randomized double-blind placebo controlled study with 50 men and women between 50-70 years of age with self-reported complaints of memory and concentration. Subjects were treated with 1.5-2 g/day of magnesium L-threonate, along with 200 IU of vitamin D and 30 mg of vitamin C for 12 weeks. Working memory and capacity to store and process information, measured by digit span test, improved by 13.1% at week 6 compared to placebo (p=0.023). However, this effect on working memory approached significance at week 12, which was the end of the study (p=0.064).12 Conclusion Pre-clinical studies demonstrate that magnesium L-threonate may increase synaptic plasticity through increasing the expression of one of the NMDA receptor sub-units. In vivo and clinical study results show that magnesium L-threonate positively influences cognitive measures of memory. More clinical studies are underway to further evaluate effects of magnesium L-threonate on memory and other dimensions of cognition.  by Ashley Jordan Ferira, PhD, RDN
Recent research from three well-known cohorts, The Nurses’ Health Study (NHS), NHS2 and Health Professionals’ Follow-Up Study (HPFS), reveals that higher magnesium intake is associated with lower risk of type 2 diabetes (T2D), particularly in diets with poor carbohydrate quality.1 Green leafy vegetables, unrefined whole grains, and nuts are richest in magnesium, while meats and milk contain a moderate amount.2 Refined foods, like carbohydrates (carb), are poor sources of magnesium. Diets with poor carb quality are characterized by higher glycemic index (GI), higher glycemic load (GL), and lower fiber intake. These poor carbs require a higher insulin demand. The typical American diet is low in vegetables and whole grains, resulting in reduced magnesium intake. The Recommended Daily Allowance (RDA) for magnesium is 310-320 mg/day for adult women and 400-420 mg/day for adult men.3 Half of the US population fails to meet their daily magnesium needs, and hypomagnesemia exists in 1/3 of adults.4-5 Magnesium is needed for normal insulin signaling; current research has linked insufficient magnesium intake to prediabetes, insulin resistance and T2D.4 Increased magnesium intake has been inversely associated with T2D risk in observational studies.6 Collaborators from Tufts University, Harvard University, and Brigham and Women’s Hospital, sought to investigate the impact of magnesium intake, from both dietary and supplemental sources, on the risk of developing T2D in subjects who had diets with poor carb quality and raised GI, GL, or low fiber intake.1 They followed three large prospective cohorts, NHS, NHS2 and HPFS (totaling over 202,700 participants). Dietary intake was quantified by validated food frequency questionnaires (FFQ) every 4 years, and T2D cases were captured via questionnaires. Over 28 years of follow-up, there were 17,130 cases of T2D. Major study findings included:1
Similar to the US population estimates, 40-50% of study participants had inadequate magnesium intake. A healthful, varied diet and supplemental magnesium (especially in diets that restrict or exclude carbohydrates, dairy or meat) are essential to ensure sufficient daily magnesium intake. Why is this Clinically Relevant?
Link to Abstract Citations
 by Bianca Garilli, ND Magnesium is the 4th most abundant mineral in the human body following calcium, sodium, and potassium. Intracellularly, magnesium is the 2nd most abundant cation behind only potassium.1 The number of essential roles magnesium plays in the body is extraordinary, with over 300 enzymes requiring magnesium as a co-factor for proper functioning.1 This essential element is involved in numerous critical physiological processes such as energy production (ATP metabolism, oxidative phosphorylation, and glycolysis), protein synthesis, muscle contraction, nerve function, blood glucose control, hormone receptor binding, blood pressure regulation, trans membrane ion flux, gating of calcium channels, cardiac excitability, and synthesis of nucleic acids (RNA and DNA).1 Unfortunately, magnesium is one of the most prevalent nutrient gaps in the US. The 2015 Dietary Guidelines Advisory Committee noted a substandard intake of magnesium as compared to the Estimated Average Requirement (EAR), which is the Dietary Reference Intake (DRI) used to assess population sufficiency vs. insufficiency for nutrients.2-3 A 2016 publication in Advanced Nutrition concluded, “Approximately 50% of Americans consume less than the EAR for magnesium, and some age groups consume substantially less”.4 This is especially concerning when one considers the critical implications of long-term, frequently unrecognized magnesium deficiencies. Deficiencies in magnesium can present with overt clinical manifestations such as nausea, vomiting, lethargy, weakness, personality changes, tetany and tremor, seizures, arrhythmia, and muscle fasciculations.5 In other cases, sub clinical deficiencies may be more difficult to recognize yet have equally serious effects if left untreated. Health concerns and disease processes resulting from an underlying, subclinical magnesium deficiency may contribute to low bone mineral density and cardio-metabolic implications such as metabolic syndrome, hypertension, arrhythmia, arterial calcification, atherosclerosis, heart failure, and increased risk for thrombosis.6 A sub clinical magnesium deficiency can also disrupt sleep and cause muscle cramping, two common symptoms often glossed over but which can be signs of a bigger problem if left untreated. The impact of magnesium on these two clinical manifestations will be explored further: Magnesium and sleep A double-blind randomized clinical trial composed of 43 elderly participants between 60-75 years of age with diagnosed insomnia was conducted.7 The experimental group was given 500 mg/day of elemental magnesium for 8 weeks (250 mg elemental magnesium from 414 mg of Mg oxide, twice daily), while the control group received a placebo for the same length of time.7 A statistically significant increase was seen in sleep time, sleep efficiency, and concentration of serum renin and melatonin, as well as a significant decrease in insomnia severity index (ISI) score, sleep onset latency, and serum cortisol level.7 For many individuals, sleep is disrupted by restless leg syndrome (RLS) or periodic limb movements (PLMS).8 A study supplementing 12.4mmol of oral magnesium in the evenings for 4-6 weeks found that the overall sleep efficiency improved from 75 to 85%.9 The Mg-supplemented group also experienced a significant reduction in PLMS associated with arousal (7 PLMS/hr vs. 17 PLMS/hr at baseline).9 Magnesium and muscle cramps Muscle cramping is a common occurrence among women during pregnancy, in athletes, and in the elderly, for which magnesium is often recommended.10 There are only a few studies, however, that have reviewed the efficacy of magnesium for muscle cramping.10 In a Cochrane review, 7 trials (5 parallel, 2 cross-over design) were included, with 3 of these trials studying pregnancy-associated leg cramps in 202 females and 4 trials looking at idiopathic leg cramps in 322 participants.10 Results from the studies noted no significant improvement of muscle cramping in older adults, while results in pregnancy were mixed leading the authors to recommend further studies in this population.10 The authors of a review article in Scientifica note that the mixed findings may be explained by the potential that, “deficiencies of other elemental nutrients including calcium and potassium have also been implicated in muscle cramps and spasms. It may be that magnesium is potentially helpful in situations of magnesium deficiency but is not of use if the problem is related to deficiency of another nutrient.”1 Magnesium: Daily needs and sources Magnesium is an essential macro-mineral required by the human body. The prevalence of deficiency from serum measurements ranges from 12.5-20% of the population.11 Due to the necessity of this cation for over 300 reactions in the human body and the high risk of deficiency, magnesium levels should be routinely monitored either through blood testing and/or a diet diary review. If found to be low, magnesium stores can be replaced through increasing daily intake of the mineral through nutrition as well as routine supplementation. Foods groups high in magnesium content include green leafy vegetables, legumes, nuts, seeds, and whole grains.12 Specific foods with high magnesium levels include spinach, Swiss chard, beet greens, turnip greens, pumpkin seeds, summer squash, soybeans, sesame seeds, quinoa, black beans, cashews, sunflower seeds, brown rice and pinto beans.12 The Recommended Dietary Allowance (RDA) for magnesium varies by age, sex, and whether pregnant or lactating:13  *RDA not able to be determined; Adequate Intake (AI) reported
Supplementation with high-quality magnesium is another, targeted way to reach optimal levels and fill dietary gaps. Supplementation dosing and form can be personalized and taken orally via capsules, tablets, liquid, and even powder. Some of the different forms available in the market include Mg oxide, gluconate, chloride, citrate, sulfate, glycinate, and L-threonate. Citations
Bianca Garilli, ND Dr. Garilli is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current President of the Children’s Heart Foundation, CA Chapter. Broad health implications for general population, too  by Bianca Garilli, ND, USMC Veteran
Energy drinks have become a common sight in today’s fast-paced, “get the job done” world. In fact, according to the National Institutes of Health (NIH), next to multivitamins, energy drinks are currently the most popular dietary supplement consumed by American teens and young adults.1 These drinks are marketed as a means to improve energy, stamina, athletic performance, and concentration, as well as reducing fatigue.1-3 Energy drinks are sometime considered “functional beverages” while also falling under the umbrella of drinks or dietary supplements.1,3 The main ingredient in energy drinks is caffeine at levels 70-240 mg in a 475 ml drink or 113-200 mg if consumed as an energy “shot”.1 For comparison, a 355 ml can of soda contains around 35 mg of caffeine, while an 235 ml cup of coffee provides approximately 100 mg.1 In addition to caffeine, many energy drinks also contain other ingredients which might include: B vitamins, various forms of sugar, guarana, taurine, ginseng, glucuronolactone, yohimbe, carnitine, and bitter orange; it is important to note that some of these ingredients further increase the quantity of caffeine in the energy drink, while others may substantially spike blood glucose levels.1 There are currently no regulations in place requiring the amount of caffeine to be printed on energy drink labels.1 Sales of energy drinks have skyrocketed dramatically in the past years increasing to $9.7 billion in sales in 2015 in the US alone.3 Consumption of energy drinks may have negative health consequences, including higher levels of risk-seeking behaviors, poor mental health outcomes, adverse cardiovascular effects, and heightened risk for metabolic, renal, and dental conditions.3 With marketing campaigns geared towards teenagers and the young adult population, it’s not surprising to find that males between the ages of 18-34 are the highest consumers of these drinks.1 Moreover, one-third of teenagers consume energy drinks regularly, while 51% of college students report their consumption at least once per month.1,3 Energy drinks have a strong appeal to military service members as well, particularly with the drinks’ promises of reduced fatigue and enhanced mental and physical performance. Due to the specialized nature of their work, military personnel often seek ways to:
Statistics estimate that energy drink consumption by military personnel mirrors or exceeds that of the general public, yet the health consequences of long-term, high energy drink use in military troops has not been adequately researched.2 A recent study aimed to learn more about the associations between energy drink consumption and health outcomes in military personnel post-deployment.2 In particular, mental health variables including sleep problems, depression, anxiety, PTSD, alcohol misuse, aggressive behaviors, and overall fatigue were compared to the frequency and quantity of energy drink consumption in 627 male infantry Army soldiers 7 months post-combat deployment.2 Results from this study published in Military Medicine found that approximately 75% of soldiers reported consuming energy drinks with nearly 30% of those reporting at least daily use and 16.7% reporting high level consumption (≥ 2 drinks/day).2 Additionally, when compared to the low-frequency group (no consumption of energy drink or < 1 drink/week), the high-frequency group (≥ 2 drinks/day) had increased rates of sleep problems, depression, anxiety, PTSD, and alcohol misuse; they were also more likely to demonstrate aggressive behavioral characteristics.2 Similarly, the moderate-frequency group (at least once per week or 1 drink/day) showed greater depressive symptoms when compared to the low-frequency group.2 Although energy drinks are marketed to consumers as a means to reduce fatigue, the results from this study demonstrated that moderate and high energy drink users experienced heightened fatigued when compared to low or no use.2 The high use of energy drink may, in fact, be a hindrance to both the mission objectives and troop welfare. Authors of this study conclude that, “future research should examine whether energy drink use results in greater fatigue over time.”2 Realizing that mental health, aggressive behaviors, and PTSD are potential concerns among military personnel, the high prevalence of energy drink use in this population should be reviewed. Revised guidelines from military healthcare leaders on the consumption of energy drink would be prudent to support safe and appropriate utilization of these drinks within the military. Why is this Clinically Relevant?
Link to article Citations
 You try to eat well to feel good and stay healthy. While it’s optimal to get your daily nutritional needs from the foods you eat, it’s just plain difficult. There is conflicting information out there on the benefits of supplements, but the Dietary Guidelines for Americans 2015-2020 say that supplements may be useful for providing the nutrients you may be lacking from diet alone.
Still on the fence? Consider these top five reasons to add a multivitamin to your daily regimen. 1. Healthy aging. As we get older, our bodies have a harder time absorbing nutrients from food. The National Institute on Aging notes that starting around age 50, people begin to require increased amounts of certain vitamins and minerals.1,2 In fact, according to a study published in the American Journal of Clinical Nutrition, researchers found that taking a daily multivitamin & mineral supplement may help improve micro nutrient deficiencies associated with aging.3 2. Making up for eliminated food groups. While some people have to cut certain foods like nuts or gluten out of their diets due to allergies, many eliminate particular foods or food groups from their diet voluntarily. This can cause vitamin insufficiency and deficiencies that would be helped with a multivitamin. Trying a paleo diet? You might risk a shortage of calcium or vitamin D by eliminating dairy or grains. Cutting back on red meat? A multivitamin will replace the iron and B12 you would normally get from diet. 3. Getting the RDAs you’re not getting from food. You’ve probably heard that the typical Western diet doesn’t include nearly enough fruits, vegetables, whole grains, legumes, or lean protein. Because of that, you don’t always reap the vitamin and mineral benefits that those foods naturally supply. Consequently, nationally US adults are routinely failing to meet their daily requirements for vitamin A, C, D, E, and K, as well as for calcium, magnesium and potassium from diet alone, and this is including fortified sources!4 Supplementing with a multivitamin is therefore a prudent way to strategically fill those gaps on a daily basis. After all, the goal should not simply be to avoid blatant vitamin deficiencies, like scurvy with vitamin C deficiency. Borderline vitamin and mineral insufficiency are just as important to avoid and address. Even the most health-conscious eater will benefit from multivitamin support to achieve micro-nutrient sufficiency across the board. 4. Getting that extra energy to get through the day. In today’s “go-go-go” society, one of the top complaints is a general lack of energy. Instead of reaching for that third cup of coffee, remember that your cells require certain vitamins and minerals to power your busy life; especially if you’re not getting a full eight hours of sleep or eating a balanced diet, a multivitamin can help provide the nutrients you need to feel energetic throughout the day.5 5. Managing stress. Daily life stressing you out? You’re not alone. But vitamins and minerals play significant biochemical roles in supporting and preserving your brain’s cognitive processes, and studies have shown that a daily multivitamin—particularly one with high doses of B vitamins—can help to reduce stress and support a healthy mood.6 Ready to add a daily multivitamin to your diet? Be sure to check with your healthcare practitioner to see if he or she has personalized recommendations for you and to ensure that any medications you’re currently on won’t interfere with their effectiveness or the effectiveness of the multivitamin ingredients. Citations
 by Bianca Garilli, ND
In a single year, Clostridium difficile (C. difficile) is responsible for nearly 500,000 infections among patients in the US. Approximately 29,000 of these patients die within 30 days of initial diagnosis of the infection, and 15,000 of those deaths can be attributed directly to C. difficile infection (CDI). C. difficile is now the most common microbial cause of healthcare-associated infection in US hospitals, with excess health care costs in acute care facilities estimated to be $4.8 billion per year.1 C. difficile, an anaerobic toxin-producing gram-positive spore-forming bacterium, is also the leading cause of nosocomial diarrhea worldwide, with recent data indicating an increase in both the incidence and severity of infections.2 The most common cause of CDI is antibiotic exposure. The use of antibiotics alters the balance of flora in the gastrointestinal tract, allowing for the seeding and growth of C. diff, whose transmission is via the fecal-oral route. The manifestation of CDI is typically seen while individuals are still on antibiotic therapy and within the first month after commencing antibiotics. However, the risk of CDI may continue for up to 90 days after antibiotic treatment. Antibiotics that have been shown to carry the highest risk for CDI prevalence include clindamycin, cephalosporins and fluoroquinolones.2 Interestingly if not ironically, the recommended therapy for milder cases of CDI, including for initial and second recurrences, is antibiotics. More recently, fecal transplantation has emerged as a highly effective therapy for recurrent CDI.2 With a clear understanding of root cause and effects of CDI, altering the factors leading up to CDI becomes critical for reducing the incidence of the infection. Two such approaches have been the focus of recent research:
Reducing antibiotic use A recent study conducted by the CDC showed that a 30 percent reduction in CDI-associated antibiotics use in hospitals could reduce CDI by more than 25% in hospitalized and recently discharged patients.1 Similar results were found in a retrospective Canadian hospital study, where a 10% decrease in overall antibiotic use yielded a 34% decrease in CDI.1 Following these compelling findings, the UK adopted changes to antibiotic prescribing which has reduced their CDI infection rate by well over 60%, clearly indicating that implementing such steps in a large population is both possible and favorable.1 Giving probiotics with antibiotics A systematic review and meta-analysis of 31 randomized controlled trials was recently published in the Cochrane Database of Systematic Reviews.3 The objective of the comprehensive review, which included a total of 8672 patients who completed the analyzed trials, aimed to assess the efficacy and safety of probiotics (any strain; any dose) as a potential preventative strategy for C. difficile-associated diarrhea (CDAD) in adults and children. The Cochrane analysis demonstrated that probiotic use resulted in a 60% reduction in the risk of CDAD. CDAD incidence in the probiotic groups was 1.5% compared to 4.0% in the control groups (placebo or no treatment). The authors of the review conclude that the evidence to date suggests that probiotics are effective for preventing CDAD and that short-term use of probiotics appears safe and effective when used along with antibiotics in patients who are not immune compromised or severely debilitated.3 Why is this Clinically Relevant?
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