Maintaining Muscle When You’re Sick or Injured: Why It Matters and How to Do It

Muscle loss is accelerated in response to serious illness or injury, and that can have a direct impact on your recovery, which is why maintaining muscle mass when you’re sick is so very important. Essential amino acids can help reverse muscle loss associated with illness, injury, or high stress levels, and help accelerate recovery.

It is unfortunately true that, at some point in our lives, most of us will have to deal with a major health issue. This may be surgery, serious illness such as pneumonia, or chronic disease such as kidney disease. Muscle loss is accelerated under such conditions, which can have a direct impact on your recovery. In this article, I’ll first explain the biological processes that contribute to accelerated muscle loss and why it’s so vital to counteract those. Then I’ll equip you with evidence-based good advice on maintaining muscle when you’re sick, a key piece of which is to focus on obtaining a steady supply of essential amino acids to help reverse muscle loss and accelerate your recovery.

The Importance of Maintaining Muscle When You’re Sick or Injured

The consequences of muscle loss as a result of serious injury or illness can be severe and immediate. Muscle mass can be a direct contributor to survival during times of critical illness and can significantly contribute to the speed and extent of recovery. When we age, we lose muscle slowly and gradually. However, battling a serious illness or injury can result in rapid weight loss—a significant portion of which may come from the loss of muscle tissue rather than body fat. This deterioration of muscle mass occurs so quickly that consequences can be evident in a matter of days or weeks.

Understanding the Catabolic State

In technical terms, the biological mechanisms that result in rapid muscle loss can be referred to collectively as a catabolic state. This state itself can be seen as a subcomponent of the body’s overall physiological response to intense stress. Regardless of the underlying cause of that stress (i.e., cancer, injury, surgery, etc.), the body’s response features certain common aspects.

In a catabolic state, you not only lose an increased percentage of your muscle mass in a shorter period of time, but you also experience decreased appetite as well as metabolic changes, such as reduced sensitivity to the action of the hormone insulin, that intensify the associated adverse outcomes. The loss of appetite results in decreased nutritional intake at a time when demand for dietary nutrients, particularly protein, is increased.

Interestingly, regardless of the clinical condition that causes the stress response, changes in muscle protein metabolism are basically the same. Therefore, the body’s response to stress and the effects of the catabolic state can be discussed generally without the need to specify what instigated them.

Muscle Protein Metabolism in a Catabolic State

The rapid loss of muscle protein that transpires during a catabolic state reflects an imbalance between the rates of muscle protein synthesis and muscle protein breakdown. This imbalance has less to do with changes to muscle synthesis (muscle growth) and instead stems from a large increase in the rate of muscle protein breakdown. You can see in the figure below how different illnesses affect a similar increase in muscle protein breakdown.

Maintaining muscle when you're sick

Certain physiological states, such as illness, cause the rate of muscle protein breakdown to accelerate. This, in turn, releases a flood of essential amino acids into the muscle cells to stimulate muscle protein synthesis. The message sent by the availability of essential amino acids is to amp up muscle growth to attempt to keep pace with muscle loss. However, the increased synthesis is still not enough to balance the dramatic increase in breakdown. The net result is a large increase in the loss of muscle mass because muscle protein synthesis just can’t match the speed of muscle protein breakdown.

While free amino acids released during muscle protein breakdown can be reincorporated during muscle protein synthesis, that process is further stimulated only marginally (or not at all) by nutritional intake. The catabolic state suppresses appetite so much that it is hard to eat enough food, and even when you do force down food or rely on traditional protein shakes and meal replacement beverages, you see little or no beneficial response. Food doesn’t have much of a beneficial effect due to the abundance of essential amino acids already available. Accelerated protein breakdown has freed so many essential amino acids for protein synthesis that the rate of synthesis is already close to maximal.

Furthermore, the catabolic state causes severe anabolic resistance, which means eating dietary protein doesn’t increase muscle protein synthesis in times of injury and stress as it does in times of optimal health. The body absorbs essential amino acids from intact protein slowly and the extent of the increase in essential amino acids is not particularly large. Therefore, dietary protein is essentially rendered ineffective in stimulating protein synthesis because consuming it doesn’t induce enough of a change in essential amino acid concentrations in the muscle.

Activating Muscle Building In a Catabolic State

In order for muscle protein synthesis to be further increased in the stress response, there must be an activation of the intracellular molecules involved in initiating protein synthesis. The central factor in this process is an initiation factor of protein synthesis called mTOR.

New evidence indicates that the most effective way to activate mTOR is to fortify your body with an essential amino acid supplement formulated with a high proportion of leucine. The leucine stimulates mTOR activity, and the available essential amino acids serve as precursors for newly synthesized protein. If enough essential amino acids are consumed, concentrations will rise high enough to inhibit muscle protein breakdown as well. The combination of activating mTOR and stimulating protein synthesis while inhibiting protein breakdown improves the net balance between protein synthesis and breakdown.

To synthesize the most important and actionable point: supplementing with a mixture of free essential amino acids high in leucine can slow the net loss of muscle protein, whereas consuming intact protein in a meal or a meal replacement beverage is ineffective during physiological stress.

Why Inactivity Exacerbates Muscle Loss

Illness, injury, and surgery bring about inactivity. If you are ill or injured enough to be admitted to the intensive care unit, you will almost certainly be confined to bed. Those over 65 years old may find themselves confined to their beds during hospital stays even when they are capable of walking due to concerns with stability and risk of a fall.

After surgery, you are likely to be physically limited until incisions are healed and you show some degree of recovery. This is particularly true after orthopedic surgery. Even illnesses that don’t require hospitalization take a serious toll on the body and health care practitioners advise pausing your exercise program until you have fully recuperated.

Hopefully, you have made sleep a priority during times of health. Your body needs high-quality rest to recover between training sessions and maximize the strength and fitness gains you hope to achieve with your hard work. Short-changing your rest periods will hold you back. This holds particularly true when you’re sick or injured. Not only do sleep and rest enhance immune function, but physical activity can also suppress it. Plus, if you’ve fallen victim to flu season or a respiratory infection, heading back to the gym too soon means you’re likely to infect your fellow gym-goers. And while injuries are not contagious, returning to your usual exercise program too soon increases the likelihood that the original injury will not heal properly, which often necessitates further time off in order to make a full recovery.

Scientific Studies on Inactivity and Muscle Loss

For all these reasons, the metabolic effects involved in muscle loss that I explained above are usually coupled with the catabolic impact of inactivity.

A series of studies sponsored by the National Aeronautics and Space Agency (NASA) showed how inactivity amplifies the catabolic response to stress. Spaceflight offers a perfect model for experimentation. The lack of gravity during spaceflight reduces the physical work of movement drastically, and muscle loss during space flight can be severe.

NASA has used strict bed rest as a model for the effects of zero gravity during space flight. Bed rest studies have been done on young, healthy subjects and older subjects. As you might expect, inactivity produces the opposite effects of exercise. Muscle mass and strength are reduced, and the rate of deterioration is faster in older individuals.

By itself, inactivity is detrimental to muscle mass and function. When coupled with the physiological stress response to illness or injury, inactivity accelerates muscle loss.

Studies have shown that the use of amino acids can, once again, effectively counterbalance the processes that result in the loss of muscle mass. Consumption of a balanced essential amino acid mixture (15-gram doses) throughout bed rest slowed the loss of muscle mass and strength in both young and older subjects as illustrated in the figure below.

Further confirmation of the role essential amino acids play in maintaining muscle mass comes from a blinded study of a large number of patients in which a carefully formulated blend of amino acids was shown to speed recovery from hip or knee replacement, procedures which inevitably involve a significant limitation in activity.

How to Maintain Muscle During Acute Crises and Ongoing Recovery

The acute period of the catabolic state can be considered the most severe phase. The word “acute” implies a short time, but in fact, this phase can last for months in some cases, such as for individuals with cancer. During the acute phase, body weight and muscle mass are rapidly lost. Decreased appetite complicates the metabolic response.

Essential amino acid supplements are uniquely suited for the acute phase because they can be formulated to elicit a stimulation of muscle protein synthesis, even in the state of anabolic resistance. Given that your appetite is flagging, many find it preferable to consume the necessary essential amino acids in supplement form because of the small volume in which an effective dose can be delivered.

The recovery phase still presents metabolic challenges, as many of the responses in the acute phase are slow to heal in the recovery phase. For these reasons, an essential amino acid supplement should be used as a supportive aid during the recovery phase. Essential amino acid intake is crucial to avoid replacing lost muscle with fat.

The specific goals for recovery and strategies for achieving those goals will vary from person to person, however, the following pieces of advice apply almost universally for everyone seeking to preserve muscle in the wake of sickness or injury.

Maintaining muscle when you're sick

1. Fuel the Healing Process

As discussed, the catabolic state decreases appetite. You may also find that nutrient-poor comfort food such as ice cream holds the most appeal. While there’s no shame in indulging (in moderation, of course), be sure to provide your immune system with the nutrients it needs to carry out the healing process.

If you’re in the habit of targeting your caloric intake in accordance with your weight-training regimen, for instance, you should err on the side of generosity when calculating your maintenance caloric intake. It’s more likely that you will undershoot your nutrient goals, catalyzing further muscle loss. If you do overshoot and gain a little fat, chances are your weight will even out once you start training again.

Given that you’ll likely be working with lower appetite levels, it can be helpful to divide your overall caloric intake into six smaller meals spread throughout the day.

2. Prioritize Protein Intake

While dietary protein intake does not get utilized as effectively when your body is coping with injury or illness, that does not mean you should neglect to consume an appropriate quantity of protein.

As a general rule, you should aim to take in approximately 1 to 1.5 grams of protein per pound of lean body mass. This will help to prevent excess muscle protein breakdown.

According to a study published in the American Journal of Clinical Nutritionwhen critically ill patients in hypermetabolic and catabolic states consumed higher quantities of protein they had positive nitrogen balances. Those with lower protein intakes, however, had continued negative nitrogen balances and continued to experience muscle protein catabolism.

Work with the constraints of your appetite and seek out easy-to-eat, easy-to-digest sources of protein, such as cottage cheese, yogurt, and omelettes.

3. Avoid Simple Carbohydrates

Though it can be tempting to base your diet on white toast with cinnamon and sugar, that type of meal plan will compromise muscle mass maintenance and encourage your body to store any calories not used for essential functions as fat.

If you are going to eat a carbohydrate-heavy meal, timing matters. Plan to consume your simple carbohydrates early in the day when your muscle cells are primed to store calories as glycogen.

4. Liberalize Fats

Per the American Journal of Clinical Nutrition study cited earlier, your body can use fats more effectively than it can carbohydrates while in a catabolic state.

While an increased carbohydrate intake was associated with lipogenesis (fat formation) and decreased fat oxidation (fat burning), the reverse proved to be true for an increased fat intake.

Furthermore, fatty acids form a crucial element of cell membranes, which your immune system will be rapidly generating as you navigate the recovery process. Ensure your immune response can produce all the new cells it needs (in particular, white blood cells) by providing it with a steady supply of healthy fats. A good goal would be to take in 30% of your total daily caloric intake from high-quality, omega-3-rich fatty foods.

5. Hydrate, Hydrate, Hydrate

It bears repeating. Our bodies constantly lose fluids, and when you consider increased mucus production, fevers, rapid generation of new cells, and so on, you can easily see how your hydration needs increase when your health has been compromised.

It’s incredibly unlikely you will over-hydrate. According to some experts, a gallon of water is the minimum you should consume during an acute health crisis. And it should go without saying that you should continue to drink plenty of water as you move from the crisis to recovery phase.

Autoimmune Diseases: When the Body Attacks Itself

Autoimmune diseases are relatively common in the United States. Autoimmune disease does not refer to one particular disease but rather a group of diseases that all stem from the body’s immune system misfiring or malfunctioning. Let’s answer some of the most common autoimmune-related questions.

Autoimmune diseases are relatively common in the United States. The American Autoimmune Related Diseases Association reports that 50 million Americans have some form of autoimmune disease. Of those 50 million Americans, 75% are women.

Let’s answer some of the most common autoimmune-related questions:

  1. What exactly is an autoimmune disease?
  2. What are the most common autoimmune diseases?
  3. Why do autoimmune diseases affect women so much more frequently than men?

What Is Autoimmune Disease?

Autoimmune disease does not refer to one particular disease but rather a group of diseases, or autoimmune disorders, that all stem from the body’s immune system misfiring or malfunctioning.

The body’s immune system is comprised of white blood cells that produce antibodies. These antibodies are the body’s defense system against everything from common colds and sinus infections to shingles, pneumonia, and cancer. The immune system’s job is to produce these white blood cells and antibodies so they can protect the body from illness and help it heal from injury.

But sometimes, the immune system confuses healthy cells and tissue for foreign cells and germs. When this happens, the immune system produces autoantibodies that may attack the body’s own tissues, organs, cells, joints, and muscles, although the body’s connective tissues (skin, muscle, and joints) are the most vulnerable to attack. So, a simple definition of an autoimmune disorder is a disease in which the immune system attacks the body.

Autoimmune diseases take many forms. They are often systemic, meaning they attack numerous parts of the body. An example is rheumatoid arthritis, which attacks multiple joints and the surrounding tissue. An autoimmune disease may also focus on one main part of the body, such as Graves’ disease, which attacks the thyroid. Autoimmune diseases may develop at any age but often start at a young age or in middle age.

What Causes Autoimmune Diseases?

Doctors know that autoimmune diseases are brought on by the body’s immune system misfiring and launching missiles at healthy cells. But they do not know what causes this autoimmune response to begin. Several risk factors are thought to contribute to one’s risk for developing an autoimmune condition.


Some autoimmune diseases, such as lupus, are more frequently diagnosed in Hispanic and African-American people. Overall, African American, Latino, and American Indian ethnic groups tend to be at a higher risk for autoimmune conditions.


Autoimmune diseases do have a hereditary link. Often, several members of the same family are found to have an autoimmune disease, even though they may not all have the same disease. For example, it is possible for three different members of the same family to each have an autoimmune disease for a total of three different autoimmune diseases in one family. Each of the three family members would likely have something written in his or her genetic code that made them develop an autoimmune disease, even though the autoimmune response may manifest as a different disease in each person.

Environmental Factors

Some doctors believe that environment plays a critical role in the onset of autoimmune diseases. A 2016 study published in Cellular and Molecular Life Sciences and a 2004 study published in the European Journal of Endocrinology highlighted key environmental factors such as diet, smoking, radiation exposure, and bacterial or viral infections that are thought to contribute to the development of certain autoimmune diseases, including thyroid diseases and multiple sclerosis.

Some people may develop more than one autoimmune disease. A study published in Maedica A Journal of Clinical Medicine revealed that about 25% of autoimmune patients tend to have one or more additional autoimmune diseases. If a patient develops three or more autoimmune diseases, it is known as multiple autoimmune syndrome, or MAS.

Autoimmune Diseases: When the Body Attacks Itself

Symptom Triggers

Regardless of the genetic or environmental factors that may cause a person to develop an autoimmune disease, there are certain triggers that may bring about the initial onset of symptoms. These triggers may also induce a flare of symptoms, even if the disease has been in a state of remission for some time. Common triggers of autoimmune activity and symptoms include:

  • Stress—thought by some to be the number one cause of symptom flares
  • Allergens
  • A diet high in inflammatory foods like sugar, sodium, and alcohol
  • Infection
  • Injury
  • Environmental factors such as exposure to chemicals

Women vs. Men

For years, doctors and scientists have been trying to figure out why autoimmune diseases are more prevalent in women than in men. While no one knows the exact reason, various studies lean toward a genetic predisposition and environmental factors.

A study published in the journal Emerging Infectious Diseases suggests that infections may play a role, as women have been shown to have an increased immune response over men when it comes to severe infection. Researchers believe that when women face a serious infection or illness the elevated response from their immune systems may be a triggering factor in the development of autoimmune diseases, though further research is needed to confirm this.

Other studies suggest a link between autoimmune diseases and sex chromosomes. A 2015 study published in Frontiers in Genetics suggests that, because women have two X chromosomes while men have only one X and one Y chromosome, the additional X chromosome in women may play a part as to why women develop autoimmune diseases more frequently than men do.

Despite many studies and theories as to why autoimmune diseases develop more often in women than in men, the short answer is that no one quite knows for sure yet.

Symptoms of Autoimmune Disease

According to the American Autoimmune Related Diseases Association, there are over 100 different types of autoimmune diseases. Many autoimmune diseases present with similar symptoms.

More specific symptoms will be found when looking into different diseases. For example, lupus may present with a butterfly-shaped rash across the face and joint pain, and Graves’ disease may present with unexplained weight loss and a goiter, or enlarged thyroid, that can be seen and felt when swallowing. Psoriasis shows up as scaly, silvery plaques on the skin due to the immune system’s overproduction of T-cells.

With some diseases, a patient may experience periods of remission, in which the symptoms go away. When the symptoms return, the patient is considered to be having an active flare.

Diagnosing Autoimmune Diseases

Diagnosing an autoimmune disease can be very difficult. Many autoimmune diseases present with similar symptoms and most do not have a single definitive test that will provide a simple positive or negative result. The American Autoimmune Related Diseases Association states that the average autoimmune patient spends over 3 years seeking a correct diagnosis and will see 4 different doctors during that time.

Diagnosing an autoimmune disease often consists of running a variety of tests and ruling out certain conditions to try to narrow things down. If a doctor suspects a patient’s symptoms are from an autoimmune disease, he or she will typically order a series of blood tests. Common blood tests used for diagnosing autoimmune diseases include:

  • Antinuclear antibody test (ANA): An ANA test is a blood test that checks for autoantibodies. If a patient has a positive ANA test, it doesn’t necessarily mean he or she has an autoimmune disease, but it does let the doctor know that an autoimmune disease shouldn’t be ruled out.
  • Inflammation test: Some autoimmune diseases, such as rheumatoid arthritis, cause chronic inflammation throughout the body. If a patient’s inflammatory markers are high, it helps point the doctor toward an inflammatory disease.
  • Organ function tests: Some autoimmune diseases, such as Graves’ disease or lupus, target specific organs like the thyroid or kidneys. So most health care providers want to see how well a patient’s organs are functioning. If there is any indication that a specific organ is not working properly, then the doctor may be able to narrow down the list of possible diseases.

In addition to blood tests, a doctor may order images such as X-rays, sonograms, or MRIs. X-rays and sonograms may be able to show damage from a condition like rheumatoid arthritis. MRIs can be useful in diagnosing multiple sclerosis, as the disease typically causes lesions on the brain and spinal cord. A colonoscopy may be used to diagnose or rule out inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease.

Types of Autoimmune Disease

The American Autoimmune Related Diseases Association lists over 100 different autoimmune diseases. Here are just a few of the most common.

  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Celiac disease
  • Pernicious anemia
  • Psoriasis and psoriatic arthritis
  • Inflammatory bowel disease
  • Hashimoto’s disease
  • Autoimmune Addison’s disease
  • Sjogren’s disease
  • Type 1 diabetes
  • Graves’ disease
  • Guillain-Barre syndrome
  • Autoimmune hepatitis
  • Myasthenia gravis
  • Multiple sclerosis

Autoimmune Diseases: When the Body Attacks Itself

Autoimmune Diseases Treatment

Treating autoimmune diseases can be a tricky business as not all patients will respond to the same treatments and some autoimmune diseases may be more aggressive in some patients than in others. The type of treatment a doctor recommends will depend upon the type of autoimmune disease he or she thinks is present. Treatments usually consist of a variety of medications including:

  • Pain relievers
  • Anti-inflammatories
  • Immunosuppressant drugs

From there it gets more specific. For instance, type 1 diabetes patients require insulin injections to regulate blood sugar, and people with underactive thyroid are prescribed thyroid hormone replacement to restore thyroid hormone levels.

In some cases, surgery may be required depending upon the disease, its impact on the body, and the overall health of the patient. For example, sometimes lupus patients will need to undergo a kidney transplant or Graves’ disease patients may need a partial or total thyroidectomy. These are usually done in cases in which the disease was caught in a late stage and much damage had already occurred or the patient did not respond well to medications and treatments and so the disease continued to progress and cause damage.

Depending upon the disease, some patients may also find relief in alternative therapies such as:

Any treatment plan should first be discussed with a physician to ensure it is safe for the particular autoimmune disease that has been diagnosed. Most autoimmune diseases are chronic and last a lifetime. While patients can achieve periods of remission, autoimmune diseases are unpredictable and can flare up at any time.

Breast Ultrasound: Should It Replace My Annual Mammogram?

A healthy debate exists over the methods used for breast cancer screening as well as the optimal frequency of screenings. While mammograms remain the most commonly recommended option, interest in the use of breast ultrasound as a screening test continues to grow.

Since the American Cancer Society first recommended mammograms in 1976, they have reigned as the primary test used for breast cancer screening. Millions of women receive an annual mammogram as part of a concentrated effort to increase early detection of breast cancer. Health care practitioners agree that early detection leads to better outcomes, in part because it allows for treatment using less invasive therapies. However, a healthy debate exists over the methods used for breast cancer screening as well as the optimal frequency of screenings. While mammograms remain the most commonly recommended option, interest in the use of breast ultrasound as a screening test continues to grow.

In this article, we’ll discuss the differences between the two types of imaging tests to help you understand the benefits and drawbacks of each method.

What Is a Mammogram?

Most of us have heard the word mammogram before, and know that it’s a breast cancer screening test. Unless you’ve had a mammogram yourself, however, you may not know exactly what the procedure entails.

The simplest explanation of a mammogram is that it’s a low-dose X-ray examination of the breasts. During a mammogram, you stand facing a special X-ray machine while a radiologic technician places each of your breasts in turn between an X-ray plate and a plastic plate. The X-ray machine then presses the plates together to flatten the breast, spreading out the tissue so a clearer image can be created when the X-ray is transmitted. The sensation is certainly not a comfortable one—many report feeling pinched or squeezed. However, this discomfort only lasts a few seconds.

Typically, two pictures will be taken of each breast, one from the side and one from above. The images—recorded either on X-ray film or on a computer—are called mammograms. A radiologist examines those images to look for changes in breast tissue that could indicate cancer. The whole mammogram process typically takes 20 minutes from the moment you enter the room until you leave.

Mammograms can be used as a part of routine screening for women who have no concerns about their breasts or for women worried about symptoms like changes to the size or shape of a breast, lumps that can be felt in breast tissue, nipple discharge, or pain. While many breast changes turn out to be benign, only a doctor can conclusively determine that.

According to the Office on Women’s Health, a division of the U.S. Department of Health and Human Services,  high-quality mammograms are “the most effective way to detect breast cancer early. Finding breast cancer early greatly improves a woman’s chances for successful treatment.”

The Limits of Mammograms

While mammograms are promoted by health institutions as the most effective method for early detection of breast cancer available at this time, they do have drawbacks.

The Office on Women’s Health lists the following limitations for the efficacy and use of mammograms:

  • False negatives: While this does not happen often, in some cases, mammogram images may indicate that all is well when cancer is actually present. According to the American Cancer Society, screening mammograms fail to find breast cancer in about 20% of all recorded cases. This is more common among younger women than older women, largely because of differences in breast tissue (more on that later).
  • False positivesIn certain instances, a mammogram result may make it appear that cancer is present when it is not. This can lead to unneeded worry and follow-up tests. Per the American Cancer Society, about 50% of women who receive annual mammograms over a 10-year period will receive at least one false positive. Having past mammogram results available for comparison dramatically decreases false positives, again, by around 50%. False positives happen at higher rates for young women, women who have had breast biopsies, women with family histories of breast cancer, and women taking estrogen.
  • Exposure to radiation: As is true of dental X-rays and other routine X-rays, mammograms expose us to small doses of radiation. This carries a very low risk of harm, though the accumulation of repeated X-rays over the course of a lifetime may slightly elevate your risk of developing cancer. It’s a good idea to speak with your doctor about the need for any type of X-ray, how to shield parts of your body not in the X-ray picture, and any possibility that you might be pregnant.
  • Increased likelihood of unnecessary interventions: Because mammograms can detect small breast lumps, masses, and calcifications, they may alert you to the presence of changes in your breast tissue that do not yet require treatment or may never require treatment. However, once those changes have been spotted, many do feel the need to intervene.

How Breast Density and Breast Implants Influence Mammogram Results

There are two types of breast tissue: fatty breast tissue and dense breast tissue. Mammograms are highly reliable when it comes to detecting changes in fatty breast tissue, but less so when it comes to dense breast tissue.

Fatty breast tissue appears black or gray on a mammogram while cancerous masses or calcium buildups appear white. This makes it fairly easy for a radiologist to spot cancer in fatty breast tissue. Dense breast tissue, however, is much thicker than fatty breast tissue and appears white on a mammogram just like cancer does. As a result, a radiologist may miss cancerous masses that are surrounded by similar-looking dense breast tissue.

According to the Susan G. Komen Foundation, 40-50% of U.S. women ages 40-74 have dense breast tissue, and these women are 4 to 5 times more likely to get breast cancer than women with mostly fatty breast tissue. For these individuals, it can be extremely valuable to use other breast cancer screening tests instead of or in addition to mammograms.

Mammograms can also be less effective for those with breast implants. Individuals who had reconstructive surgery including implants after a mastectomy should consult their doctor about the necessity of mammograms. In most cases, mammograms are still considered the most effective breast cancer screening test for those with breast implants who have not had mastectomies.

If you have breast implants, you should mention this when scheduling a mammogram so you can be paired with a technician and radiologist experienced in X-raying patients with implants. The reason for this is that implants can hide some breast tissue, so the technician will need to gently lift the breast tissue away from the implant and create additional images.

General Guidelines for Mammograms

Different organizations offer varying guidelines for both the age at which routine mammogram screening should begin as well as the ideal frequency of screenings.

The latest guidelines issued by the United States Preventative Services Task Force (USPSTF) recommends that women between the ages of 50 and 74 schedule mammograms every 2 years. This recommendation mirrors those of most European countries, but differs from those of other U.S.-based organizations.

For instance, both the American College of Radiology as well as the Society of Breast Imaging currently advise that women should schedule annual mammograms beginning at the age of 40. Meanwhile, the American Cancer Society holds that women between 45 and 54 years of age should schedule annual mammograms, then space that out to a mammogram every 2 years from the age of 55 onward.

The goal behind the more conservative recommendations in terms of the age at which screening should begin as well as frequency of screening is to reduce the rate of false positives, which some evidence shows increases among younger women as well as women who receive annual screenings.

What Is Breast Ultrasound?

The American Cancer Society describes breast ultrasound as a useful method for examining some types of breast changes, particularly lumps that can be felt during a physical exam but not identified on a mammogram or changes in the breasts of women with dense breast tissue.

Breast ultrasound can also be an advantageous next step after a mammogram to gather more information about breast changes, since ultrasound can distinguish between fluid-filled cysts—which tend not to be cancerous—and solid masses—which usually require additional testing such as biopsies to determine whether or not they’re cancerous.

Breast ultrasound uses high-frequency sound waves to create images of the interior of each breast. A trained ultrasound technician, typically a sonographer, first physically examines the breasts. If the purpose of the ultrasound is to gather more information about an identified change, such as a lump, they will also ask questions about when the change was first detected, whether you’ve noticed any other symptoms, and so on. Next, the sonographer will apply clear gel to the breast, which improves the ability of the high-frequency sound waves to move through the breast tissue, and gently move a wand-like device called a transducer over the breast.

As the sound waves emitted by the device bounce off body tissues, they create echoes that form ultrasound images on a computer screen in real time. A breast ultrasound typically lasts between 15 and 30 minutes, and while you will feel some pressure as the device moves across the surface of each breast, it will likely be painless unless your breasts themselves are tender at the time.

Because breast ultrasounds do not use radiation, they are the safest option for women who are not good candidates for screening tests that involve radiation, like mammograms. If you are pregnant or trying to become pregnant, for instance, you should avoid exposure to radiation.

Breast ultrasound can also be an advisable breast cancer screening measure for women with dense breast tissue. Because cancerous masses appear black on an ultrasound, as opposed to white on a mammogram, ultrasound can be a more reliable means of locating breast cancer in dense breast tissue.

The Limitations of Breast Ultrasound

Common consensus among health care providers at this time is that the limitations of breast ultrasound disqualify it as a screening test in most instances. Those limitations include:

  • Limited imaging capacity: The hand-held devices typically used for breast ultrasounds cannot take a comprehensive image of the entire breast. They also cannot take images of areas deep inside the breast, so while they can be used to detect and evaluate superficial lumps, deeper abnormalities may be missed. Ultrasound images also fail to capture architectural distortions and asymmetries.
  • Inaccurate diagnostic images: The increased specificity of ultrasound images which makes them advantageous as a screening tool for women with dense breast tissue also increases the likelihood that inaccurate diagnostic images will be produced. A great diversity exists both among ultrasound images of healthy breast tissue and pathological lesions, due to factors such as the age of the patient, hormone levels, and previous breast surgery, trauma, or radiotherapy. This can make it challenging to differentiate between benign variations and changes that indicate cancer.
  • Inability to detect microcalcifications: Early detection of breast cancer often results from the discovery of microcalcifications, tiny deposits of calcium that commonly appear in the tissue surrounding a tumor. Microcalcifications do not register on breast ultrasound, meaning a diagnosis could be delayed.
  • Impact of technician skill: The skill and experience of a sonographer can significantly impact the results. Human error can cause lesions to be overlooked or images to be misinterpreted.
  • False positives and false negatives: While mammograms can also deliver false positives, this happens at a higher rate with ultrasounds when they are conducted along with mammograms. As discussed previously, a false positive can lead to more tests, including invasive breast biopsies. This can send health care costs and anxiety levels soaring. Ultrasounds can also turn up false negatives, though this is less of a concern.

When to Consider Automated Whole Breast Ultrasound

By this point, it has hopefully become clear that neither mammograms nor breast ultrasound using a hand-held transducer are foolproof. Automated whole breast ultrasound is an option that some believe can be more reliable.

Concerns about the dangers of inadequate breast cancer screenings led board-certified diagnostic radiologist Dr. Kevin Kelly of the Breast Ultrasound Center in Pasadena, California to patent SonoCine automated whole breast ultrasound in 1999. According to Dr. Kelly, automated whole breast ultrasound eliminates some of the disadvantages associated with conventional breast ultrasound screenings, such as the inability to create a comprehensive image of each breast and the errors introduced by sonographers.

Automated whole breast ultrasound slowly scans the entire breast, capturing images that include the underarm area, the lymph nodes, the sides of the breasts, and the areas above and below each breast. The procedure captures thousands of pictures of the breast that are then played back like a movie for the radiologist to review. As with traditional breast ultrasound screenings, automated whole breast ultrasound is typically recommended as a secondary screening measure for women with dense breast tissue or breast implants. Again, as with hand-held breast ultrasound screening, the procedure typically takes about 30 minutes to complete and, in the absence of breast tenderness, does not cause pain.

Dr. Kelly is an advocate of breast health education and wants women to understand their breast type, risk factors, and options when it comes to breast cancer screening and diagnostics. He has given a Tedx Talk in which he highlighted the dangers of inadequate breast cancer screenings and the importance of making ultrasound procedures like AWBUS the standard in care.

As of 2012, the FDA has approved the use of automated whole breast ultrasound as a secondary breast cancer screening test, but not as a replacement for an annual screening mammogram.

Breast Ultrasound: Should It Replace My Annual Mammogram?

Breast Ultrasound vs. Mammogram: Which Is Best?

A study published in the Journal of the National Cancer Institute, a peer-reviewed journal that’s internationally acclaimed as the source for the most up-to-date information from the fields of cancer research and treatment, directly compared the efficacy of breast ultrasounds and mammograms. The lead author, Dr. Wendie A. Berg, concluded that: “Where mammography is available, ultrasound should be seen as a supplemental test for women with dense breasts who do not meet high-risk criteria for screening MRI and for high-risk women with dense breasts who are unable to tolerate MRI.”

Other experts agree. Sharon L. Koehler, an assistant professor of breast surgical oncology in the Department of Clinical Specialties at the New York Institute of Technology College of Osteopathic Medicine, believes mammography is the best primary screening test for most women, since the results are less dependent on the operator and the images show calcifications, architectural distortions, and asymmetries in addition to masses.

However, because hand-held ultrasounds are more portable and less expensive than the machines needed for mammograms, an emerging consensus among medical practitioners holds that they can be a crucial screening tool in developing countries. “As long as we are aware of ultrasound’s limitations, in countries where mammogram is not available, ultrasound is a good option,” Dr. Lusi Tumyan, City of Hope assistant clinical professor and section chief of breast imaging in the Department of Radiology, said in an interview.

According to Dr. Kelly of the automated whole breast ultrasound, approximately 50% of American women have dense breast tissue, and 70% of all breast cancers occur in dense breasts. Dr. Kelly has stated that one of the biggest misconceptions currently surrounding breast cancer screenings is that mammograms are believed to be fully able to find cancer whenever it’s in the breast, but this is not necessarily true. Dr. Kelly has stated that 50% of cancers in dense breasts are felt before they’re seen on a mammogram. According to Dr. Kelly, mammograms work well, but unfortunately, they don’t work often.

Another common misconception about mammograms that Dr. Kelly has observed is the belief that mammograms usually find cancers when they’re small. But Dr. Kelly has stated that this is not true. The average size of breast cancer when it is detected by mammogram is 17 mm. The ideal size for treatment of cancer is between 5-10 mm. While mammograms often find cancer once it’s past the ideal treatment stage, the AWBUS can find 5 mm invasive breast cancer. The AWBUS is far more accurate in detecting breast cancer in women with dense breast tissue and implants, and in clinical trials was 300% more accurate than mammograms at detecting small invasive breast cancers. The earlier cancer is discovered, the more likely that it can be monitored and treated, eliminating extreme and traumatic treatments like chemotherapy and mastectomies and saving tens of thousands of lives in the U.S. every year.

However, Dr. Melanie Royce, an oncologist who specializes in breast cancer, finds it frustrating when people try to equate mammograms and breast ultrasound. “One is not better than the other, they are complementary” said Royce, the director of the breast cancer multidisciplinary team at the University of New Mexico Comprehensive Cancer Center. “They are complementary. They should be seen as such and used as such rather than one as a substitute for the other. At least this is the case where both are widely available.”

At this time, neither breast ultrasound using a hand-held transducer nor automated whole breast ultrasound have been proven or approved as a substitute for a mammogram.

This means that while breast ultrasound may be covered by insurance, patients should be sure to verify that prior to scheduling an appointment. The out-of-pocket cost of a breast ultrasound ranges between $150-500 for an exam using a hand-held transducer and $160-400 for automated whole breast ultrasound. Routine screening of both breasts typically costs more than the use of ultrasound as a follow-up test to examine breast abnormalities in a particular area of concern.

An additional hurdle patients interested in automated whole breast ultrasound may encounter is availability. At this time, it’s less common for facilities to use this technology. If you believe automated whole breast ultrasound could be the best screening test for you, it could be worthwhile to mention it to your primary care physician or OB-GYN.

It’s important to note, too, that both mammograms and ultrasounds can only suggest the possibility of cancer. In order for a definitive diagnosis to be made, a biopsy that removes a tissue sample for examination under a microscope must be carried out.

Ultimately, experts agree that no single screening test can be declared superior for all women in all instances. The best option for patients would be to have a balanced discussion with a health care provider about their individual risk factors and the pros and cons of available screening technologies.


Amino Acids for Hair Loss

If you’re noticing more hair loss than normal and witnessing visible thinning of your hair, then you could be dealing with an imbalance of hormones, low thyroid, too much testosterone, or a nutritional deficiency, such as too little protein or iron. If nutritional deficiencies are at play, amino acids for hair loss are an effective and natural first line of defense.

We lose anywhere from 50 to 100 strands of hair a day, so there’s no need to be alarmed by clumps of hair in the shower drain or loose hairs on the carpet. But if you’re noticing more hair loss than normal and witnessing hair thinning, then you could be dealing with an imbalance of hormones, low thyroid, too much testosterone, or a nutritional deficiency, such as too little protein or iron. If nutritional deficiencies are at play, amino acids for hair loss are an effective and natural first line of defense. After all, amino acids are the building blocks of protein, and protein is needed to grow tissue cells, including the cells that make up your hair.

Lysine and Iron for Hair Loss

Iron deficiency is the number one nutritional deficiency in the world. If your hair loss is caused by a lack of iron, there’s a chance that you may also be low in the essential amino acid lysine. Studies link hair loss to low levels of both iron and lysine. A 2002 study published in Clinical and Experimental Dermatology showed that when female participants supplemented with iron and lysine, hair loss decreased, but when subjects supplemented with just iron, hair loss stayed the same. Researchers note that patience is required, as the benefits of iron and lysine supplementation for hair loss may take a few months to be noticeable.

Lysine is one of nine essential amino acids that your body cannot make on its own. In addition to supporting the body’s uptake of iron, it also plays a role in zinc uptake. Low levels of zinc have been linked to pattern baldness, which accounts for 95% of hair loss in men and affects 45% of women. Lysine also helps to build collagen, a protein component of hair.

Complete proteins such as red meat, poultry, pork, eggs, cheese, cod, sardines, soybeans, nuts, legumes, and brewer’s yeast are rich in lysine. If you’re on a low-protein or vegan diet you may be at risk for not just iron and lysine deficiency, but a possible protein deficiency overall. Being deficient in even just one amino acid could accelerate hair loss. If you think you might be protein deficient, start by following the Recommended Dietary Allowance (RDA) for protein: 0.36 grams of protein for every pound of body weight.

Amino Acids for Healthy Hair Growth

Healthy hair depends on two amino-acid-built proteins: keratin and collagen.

Ninety percent of every strand of hair on your head is made of a tough, fibrous protein called keratin. Keratin is formed from long chains of amino acids that allow your hair to bend, twist, and turn without breaking, lending strength and elasticity to hair.

Collagen is another building block of hair. A 2016 study from Japanese researchers linked hair loss to decreased collagen near hair follicle stem cells beneath the scalp. Eating protein-rich foods and taking essential amino acid supplements can support the health of your hair by helping your body produce more keratin and collagen.

The 4 amino acids that help boost keratin hair growth are:

  • Cysteine
  • Lysine
  • Arginine
  • Methionine

The 4 amino acids that help increase collagen production are:

  • Lysine
  • Methionine
  • Glycine
  • Proline

But amino acids don’t stop there. They also help form red blood cells that carry oxygen and nutrients to hair cells. Healthy hair depends on these nutrients.

We’ve already seen how lysine can help protect against hair loss, but let’s take a look at other key amino acids for hair loss in more detail.


Beyond producing keratin for healthy hair, arginine (or L-arginine) can help put a stop to hair loss in several ways. It’s an excellent immune enhancer, and as such provides a shield against disease-related hair loss.

Arginine is best known for boosting nitric oxide levels in the body. Nitric oxide is a vasodilator that relaxes blood vessels and opens up the potassium channels of cells, thereby improving blood flow throughout the body. By increasing nitric oxide, arginine supports optimal circulation and reinforces blood supply to the hair root, which helps boost hair growth.

Arginine has also demonstrated effectiveness as a topical agent that can help protect hair from bleaching and coloring treatments. When researchers replaced part of the ammonia in a coloring agent with arginine, hair did not sustain as much damage.

Arginine is not an essential amino acid, which means the body can make it on its own, but during times of stress or injury, arginine may become a conditionally essential amino acid (not enough arginine is being produced to meet all demands and dietary support may be called for). Arginine is abundant in dairy, fish, poultry, beef, sesame seeds, chickpeas, oatmeal, soybeans, granola, pumpkin seed, sunflower seeds, and nuts.


Cysteine is a nonessential amino acid that makes up a quarter of keratin. Several studies indicate that cysteine supplementation can help decrease hair loss in men and women with androgenic alopecia (pattern baldness/hair loss).

Cysteine also helps produce a very potent antioxidant called glutathione, which can help protect hair follicles from oxidative stress. Topical cysteine is considered a safe treatment for straightening hair.

To ensure adequate cysteine intake, eat dairy, pork, poultry, legumes, broccoli, Brussels sprouts, and grains. Taking a supplement of L-cysteine or N-acetyl cysteine can induce vomiting and other symptoms of gastric distress. Cysteine is produced from the essential amino acid methionine, and adequate methionine intake generally ensures a sufficient amount of cysteine.


Methionine is an important amino acid necessary for the production of keratin and procollagen—the precursor of collagen. It lends structure and strength to your hair and helps to prevent hair loss by building a sulfurous network of chains.

Researchers presented the results of a study examining the efficacy of methionine as a hair loss treatment at a dermatological congress in Florence in 2006. Scientists divided 30 people into two groups. The control group took a placebo and the variable group supplemented with an amino acid preparation containing methionine and vitamin B complex. After 6 months, those supplementing with methionine had 10% more hair regrowth than participants taking the placebo. Other studies show that methionine may help slow hair thinning and greying.

Unlike arginine and cysteine, methionine is an essential amino acid that you must get from the foods you eat and the amino acid supplements you take. Methionine amino acid-rich foods include:

  • Eggs
  • Fish
  • Seeds
  • Leafy greens
  • Broccoli
  • Zucchini
  • Squash
  • Nuts, especially Brazil nuts

Glycine and Proline

Glycine impacts hair health because it’s central to collagen production, as is proline, which also plays a key role in cartilage production. Both are nonessential amino acids that you can find in fish, meat, dairy products, soybeans, spinach, cabbage, beans, kale, banana, kiwi, legumes, broccoli, spinach, and soybeans.


In addition to thinning hair and hair loss, the color of hair might also take a hit due to stress or adrenal, thyroid, or pituitary gland dysfunction. This is where the amino acid tyrosine can come to our aid.

Tyrosine helps form melanin, which imparts color to our skin and hair. By keeping tyrosine levels adequate in the body, we can help stabilize the body’s production of melanin. Food sources of melanin include pumpkin seed, lima beans, dairy and soy products, almonds, and fish.

Important Hair-Loss Nutrients

Healthy hair depends on a nutritive diet full of vitamins, minerals, and antioxidants. In addition to amino acids for hair loss, the following nutrients help keep hair in lustrous condition.

  • Vitamin A supports sebum production to keep hair follicles lubricated.
  • Vitamin C is a key nutrient in collagen synthesis for strong hair.
  • Iron, silica, and zinc encourage new hair growth and protect against hair loss.
  • Vitamins E, B5, B6, B12, and folic acid improve blood circulation for better nutrient delivery to hair follicles.
  • Essential fatty acids such as omega-3 contribute to hair health by promoting circulation and cell growth.

If you are deficient in any of these nutrients or an amino acid, hair is likely to feel dry and brittle and a supplement program may be in order. However, it’s important not to take hair loss supplements that target a specific nutrient if you are not deficient in that nutrient, as too much of a vitamin, such as too much vitamin A or C, can actually cause hair loss. A complete and balanced essential amino acid supplement, however, does not carry that same risk.

If you’re noticing more hair loss than normal and witnessing visible thinning of your hair, then you could be dealing with an imbalance of hormones, low thyroid, too much testosterone, or a nutritional deficiency, such as too little protein or iron. If nutritional deficiencies are at play, amino acids for hair loss are an effective and natural first line of defense.

The Rationale for Choosing Natural Ways to Lower Cholesterol Over Prescription Drugs

Cholesterol is perhaps the most misunderstood nutrient of all. Let’s get clear on what cholesterol is, how it works in the body, and useful strategies for optimizing your cholesterol levels.

Cholesterol is perhaps the most misunderstood nutrient of all. To many of us, it functions essentially as a bogeyman, hence the plethora of articles out there promising to provide you with the most effective natural ways to lower cholesterol.

It’s understandable how it got cast in that role. After all, the statistics can be overwhelming. For instance, the Centers for Disease Control and Prevention (CDC) lists the following alarming facts about cholesterol:

  • High blood cholesterol significantly increases your risk of heart disease, the leading cause of death in America.
  • 71 million American adults—or 33.5% of the population—have high levels of low-density lipoprotein (LDL, colloquially known as the “bad” kind of cholesterol).
  • Only 1 out of every 3 adults with high LDL cholesterol has that serious health condition under control.
  • Because high cholesterol itself, separate from the chronic diseases it can instigate, has no symptoms, many people are unaware that their cholesterol levels are too high.
  • By lowering your cholesterol levels, you can reduce your risk of facing serious consequences stemming from heart disease, such as suffering a heart attack, undergoing heart bypass surgery or angioplasty, or even dying from heart disease.

After reviewing those sobering facts, you may be wishing you could magically remove all the cholesterol from your body. If you could achieve that, however, you would soon regret it. Cholesterol actually carries out a number of vital functions inside the body, such as helping to keep the walls of your cells flexible and facilitating the production of several hormones.

Before diving into my recommendations on truly useful strategies for optimizing your cholesterol levels, let’s get clear on what cholesterol is, how it works in the body, and the connection between dietary cholesterol and blood cholesterol.

What Is Cholesterol?

Cholesterol, in the simplest terms, is a waxy, fatty substance made by the liver. As touched on above, your body needs some cholesterol for certain key functions. When it begins to accumulate, however, it can cause problems.

Cholesterol belongs to a category of particles called blood lipids. In fact, cholesterol is the best-known blood lipid. While the term “blood lipids” technically refers to fat particles circulating in the bloodstream, it’s conventionally used to refer to particles in the blood that are combinations of lipids and protein, like cholesterol.

The Basics of High-Density Lipoprotein, Low-Density Lipoprotein, and Very Low-Density Lipoprotein

Because cholesterol is a combination of lipid and protein, cholesterol-containing particles in the blood are called lipoproteins. These include high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoproteins (VLDL). The other primary type of fat in the blood are triglycerides, so named because they form when three fatty acid molecules hook together.

Each type of lipoprotein affects your health in different ways. Excess quantities of low-density lipoprotein, for example, can build up on the walls of your blood vessels, resulting in clogged arteries, strokes, heart attacks, and even kidney failure. High-density lipoprotein, however, actually clears away cholesterol deposits from blood vessel walls, thereby lowering your risk of the same set of adverse health outcomes.

So, when we talk about finding ways to lower cholesterol, the precise target of those strategies is low-density lipoprotein, not high-density lipoprotein.

The liver is the main site of fatty acid and cholesterol production. Fatty acids produced in the liver link together to form triglycerides. While triglycerides and cholesterol are made in the liver, the liver is not equipped to store much of either. Consequently, they are packaged with proteins and secreted into the blood as very-low-density lipoproteins (VLDL).

VLDL molecules serve as the primary transporters of fat from the liver to the peripheral fat stores. As VLDL circulates in the blood, it deposits fatty acids and cholesterol in your adipose tissue—otherwise known as body fat.

I should briefly note here that not all the triglycerides produced by the liver are excreted as VLDL—some can be secreted in the form of triglycerides directly into the blood. This is another way that fatty acids are transferred from the liver to adipose tissue for storage.

Adipose tissue is the proper storage site for triglycerides. A larger amount of fat can be stored in adipose tissue. Under normal conditions, fat can be stored in adipose tissue without any adverse impact on overall health, though an excessive amount of triglyceride storage factors into obesity.

The triglycerides in the VLDL molecules are taken up by the adipose tissue thanks to a protein called lipoprotein lipase. This enzyme is not completely effective, though, resulting in incomplete clearance of the VLDL by the adipose tissue. The fat that remains in the blood becomes low-density lipoproteins (LDL), which circulate back to the liver where they are either cleared from the blood or taken up by other cells in the body. This is the main route by which cholesterol is delivered to the tissues of the body.

A special receptor on the membranes of the liver and other tissues plays a key role in taking up the cholesterol from LDL molecules. If the cholesterol in LDL is taken up by the liver, it is then metabolized and eliminated from the body. Conversely, cholesterol taken up by other tissues can remain and disrupt normal bodily functions.

I previously mentioned that low-density lipoprotein has earned itself the infamous nickname “bad” cholesterol. As you may already know, or be able to intuit, that makes high-density lipoprotein (HDL) the “good”cholesterol, in large part because it clears LDL from the blood.

HDL cholesterol, also released by the liver, carries unabsorbed, un-utilized cholesterol back to the liver in a process called reverse cholesterol transport. This keeps your arteries free from cholesterol accumulation, which in turn reduces your risk of heart disease and stroke.

The more HDL in your bloodstream relative to LDL, the more rapidly cholesterol will be cleared by the liver, broken down, and excreted. When evaluating your cholesterol levels, doctors commonly test for and give serious weight to your LDL:HDL ratio.

Cholesterol is perhaps the most misunderstood nutrient of all. Sure, the stats are overwhelming, but let’s take the “scare” out of the statistics and really get clear on what cholesterol is, how it works in the body, and the most natural ways to lower cholesterol levels to optimal.

The Role of Cholesterol in the Body

During a physical exam, it is routine to have the concentrations of these blood lipids measured, and if the values are out of the normal range, treatment options are recommended. This gives us the very distinct feeling that the blood lipids are all bad.

Normal values for blood lipids are as follows:

  • LDL < 100 mg/dl
  • HDL ≥ 40 mg/dl
  • Triglycerides < 150 mg/ml

While elevated levels of some of the blood lipids are indeed associated with bad health outcomes, let’s first consider some of the beneficial roles of blood lipids.

Cholesterol plays many roles in the body, including helping the body produce certain hormones, vitamin D, and enzymes that help you digest food. Cell membranes are largely made up of lipids. Problems arise, however, when you have high cholesterol levels, high triglyceride levels, or both. Excess is never a good thing.

How Excess Cholesterol Harms Your Health

LDL, as previously touched on, has the reputation of being the worst of the blood lipids. The cholesterol in LDL can accumulate and form plaques that stiffen your arteries. This condition is called atherosclerosis.

Cholesterol-rich plaques can clog the arteries, leaving less room for blood to circulate. Plaques can also rupture, which causes platelets to come to the site of rupture and form blood clots. If the clot is big enough, it can block blood flow. If this happens in a vessel supplying blood to the heart, it will cause a heart attack, and if it happens in a vessel supplying blood to the brain, it will cause a stroke.

Triglycerides are also a risk factor for atherosclerosis and, therefore, heart attack and stroke. Recently physicians have been paying even more attention to an elevated triglyceride level because that is one of the underlying factors that leads to metabolic syndrome. Triglyceride accumulation in the liver, specifically, has been shown to drive the progression of metabolic syndrome, which is itself a precursor to diabetes. This means the diagnosis and treatment of metabolic syndrome is critical to diabetes prevention.

Conventional Strategies to Lower LDL Cholesterol and Triglyceride Levels

A class of drug called statins are widely prescribed to lower LDL cholesterol levels. While statins are usually effective in doing so, they come with side effects—most commonly, muscle pain. The side effects of statins can be particularly pronounced in older individuals. In some cases, that muscle pain can be alleviated by switching to a different type of statin, or by taking a dietary supplement called Coenzyme Q10, or CoQ10. One of the side effects of statins is CoQ10 depletion, and given that CoQ10 contributes to the body’s energy production system, it can be quite worthwhile to reestablish healthy levels.

There are other medications to help lower LDL levels, including cholesterol absorption inhibitors, fibrates, and niacin. Again, all these drugs commonly come with adverse side effects. The cholesterol absorption inhibitors that block fat absorption can lead to diarrhea, fibrates can impair normal liver function (again, especially in older individuals), and niacin can cause itching and flushing.

Keep in mind that while these medications may help lower cholesterol, they usually do not affect triglyceride levels. Fibrates are the most effective prescription medication to lower triglycerides, but adverse effects on the liver limit the use of these drugs.

Plus, of those medications, only fibrates have been shown to effectively lower triglycerides, and their adverse effects on the liver limit their use.

Thus, though there are several prescription drug options shown to effectively lower LDL cholesterol levels, most do not address high levels of triglycerides. That, in combination with the numerous potential side effects associated with those medications, inspires many to seek out more natural ways to lower cholesterol.

The Link Between Your Diet and Lifestyle Choices and Your Blood Cholesterol Levels

The cholesterol myth is still holding strong: that you can lower cholesterol by cutting out cholesterol in the diet. This is a fallacy. Cholesterol in the blood is produced in the liver, not absorbed from digested food.

Though food manufacturers continue to shill low-cholesterol products, the truth is that dietary cholesterol has a fairly small impact on the amount of cholesterol circulating in the body. One reason for that is your liver’s ability to modulate how much cholesterol it produces in response to how much cholesterol your diet contains. If you’re taking in more cholesterol from the foods you eat, your liver scales back cholesterol production accordingly.

Take eggs, for example, which have long been scapegoated as unhealthily high in cholesterol. According to a study published in the European Journal of Nutrition, study participants randomly assigned to increase their dietary cholesterol intake by adding two eggs to their daily diet did not experience increases to their total cholesterol or lipoprotein levels compared to participants following diets with fewer high-cholesterol foods.

No wonder then that the most recent dietary guidelines from the U.S. Department of Agriculture give the green light to eating eggs, cholesterol-rich yolks and all. Feel free to enjoy whole-egg omelettes, with no side of guilt needed.

Although dietary cholesterol does not substantially influence your cholesterol levels, other foods in your diet do affect them—both for the good and the bad. Certain behaviors, such as smoking or the amount of physical activity you get, can also have an influence.

Read on to learn about the lifestyle changes that can increase your good HDL cholesterol levels while lowering your bad LDL cholesterol and triglyceride levels.

10 Natural Ways to Lower LDL Cholesterol and Triglyceride Levels

Certain dietary and lifestyle behaviors are associated with lowering cholesterol, but it should be noted that some of these are merely associations, and association does not prove cause and effect. Studies showing a significant effect of certain changes in diet or behavior may be occurring at the same time as other changes that are actually responsible for the observed response. So, let’s stick to approaches that have a physiological rational, if not a scientifically proven mechanism of action.

Cholesterol is perhaps the most misunderstood nutrient of all. Sure, the stats are overwhelming, but let’s take the “scare” out of the statistics and really get clear on what cholesterol is, how it works in the body, and the most natural ways to lower cholesterol levels to optimal.

1. Up Your Physical Activity

When it comes to improving your heart health, few lifestyle changes can be as impactful as increasing your physical activity. Strong evidence shows that exercise can optimize cholesterol levels, both by decreasing damaging LDL cholesterol as well as increasing healthful HDL cholesterol.

According to one 12-week study, a program that combined aerobic and resistance exercise successfully reduced LDL cholesterol. Participants spent 3 days weekly engaging in a variety of aerobic activities, including walking, jumping jacks, resistance-band training, and Korean dance.

Research indicates that exercise can increase HDL cholesterol too. A review of multiple published investigations indicate that both aerobic exercise and resistance training of varying volumes and intensities can beneficially impact all different types of cholesterol.

The review found that 30 minutes of exercise carried out 5 days a week can optimize cholesterol levels and lower your risk of heart disease.

The authors found that the ideal threshold for aerobic activity is to raise the heart rate to approximately 75% of its maximum. When your heart rate reaches 85% of its maximum, you both increase your HDL and decrease your LDL.

For resistance training, you should strive to hit at least 50% of your maximum exertion, though even a lower intensity effort can decrease LDL. As your exertion level increases, you begin positively impacting your HDL. By increasing the number of sets and repetitions you carry out, you maximize the benefits you experience.

2. Consider Weight Loss

Solid evidence shows that losing weight can decrease the amount of cholesterol your liver generates.

A study published in the American Journal of Clinical Nutrition showed that one mechanism by which weight loss decreases cholesterol production is by increasing the absorption of cholesterol from the food participants ate. Over the course of the study, participants levels of HDL cholesterol increased and participants’ risk of heart disease dropped.

A similar study conducted by the American Heart Association that looked specifically at the use of a diet found that weight loss can also decrease LDL cholesterol levels, which may have an even more direct effect on heart health.

3. Increase Monounsaturated Fat Intake

From a certain angle, it might seem logical to reduce overall fat intake in order to support the dual goals of losing weight and optimizing cholesterol levels. However, at least one study found that when participants followed a low-fat diet, HDL levels dropped along with LDL levels.

By contrast, it appears that adhering to a diet high in monounsaturated fat can cut LDL levels while leaving HDL levels intact or even increasing them. One study compared the effect of a diet high in monounsaturated fat to that of a diet low in saturated fat, and found that the diet that prioritized monounsaturated fat increased HDL levels by 12%.

As opposed to saturated fats, unsaturated fats have at least one double chemical bond that changes the way they are used in the body. Monounsaturated fats have only one double bond.

Valuable dietary sources of monounsaturated fats include:

  • Olives and olive oil
  • Avocados and avocado oil
  • Tree nuts including almonds, walnuts, pecans, hazelnuts, and  cashews
  • Cooking oils made from plants, such as sesame and sunflower oil

4. Avoid Trans Fats

In order to make unsaturated fats more stable, which then increases the shelf life of products that contain them, manufacturers use a process known as hydrogenation.

This results in fats that are not fully saturated, but remain solid at room temperature. It’s common to find trans fats in products such as spreads, pastries, and cookies, since they result in a more desirable texture than unsaturated, liquid oils do.

The effects these partially hydrogenated trans fats have on the human body, however, are far from desirable. Not only do they increase total cholesterol and LDL cholesterol, but they also decrease HDL cholesterol—in some cases, by up to 20%.

One study estimated that trans fat intake may account for 8% of heart disease deaths worldwide, while another predicted that by restricting the use of trans fats, heart disease deaths could be reduced by 4.5%.

While food companies are required to disclose the presence of trans fats in their products, they are allowed to round down when the amount of trans fat per serving is under 0.5 grams. As a result, some foods feature labels proclaiming that they contain 0 grams of trans fat per serving when, in fact, they do contain trans fats.

Outsmart manufacturers by reading the ingredients list in addition to the nutrition facts. If you see partially hydrogenated oil, or a similar phrase, the product in question contains trans fats and should be avoided.

5. Boost Omega-3 Fatty Acid Intake

Omega-3 fatty acids are a particularly heart-healthy, cholesterol-lowering kind of polyunsaturated fat.

Research shows that due to their multiple double bonds, polyunsaturated fats function differently inside the body than saturated fats do. It appears they can lower levels of LDL cholesterol, consequently lowering your risk of heart disease too.

Multiple studies indicate that prioritizing your intake of polyunsaturated fats while cutting back on saturated fats can decrease your LDL and total cholesterol levels. This benefits your overall health by reducing your risk of coronary artery disease, metabolic syndrome, and type 2 diabetes.

Good sources of omega-3 fatty acids include:

  • Fatty fish such as salmon, sardines, herring, and bluefin or albacore tuna
  • Scallops and mussels
  • Seeds and tree nuts
  • Eggs

6. Eat More Soluble Fiber

Humans can’t digest soluble fiber, yet it’s still important to include it in our diets. The probiotics that live in our intestines thrive off soluble fiber, and these industrious little bacteria can clear out both LDL and VLDL cholesterol from the bloodstream.

Studies have primarily focused on the use of soluble fiber supplements as well as foods fortified with added soluble fiber. According to one, taking 3 grams of soluble fiber each day over the course of 12 weeks led to an 18% drop in LDL cholesterol levels.

When researchers looked more generally at the health benefits of fiber, they linked an increased intake of fiber-rich grains and cereals to a longer lifespan. One study that surveyed over 350,000 adults found that those eating the most fiber were between 15% and 20% less likely to die during the course of the 14-year study.

Key sources of soluble fiber include:

  • Beans, peas, and lentils
  • Apricots, nectarines, and pears
  • Oats and whole grains
  • Psyllium supplements

7. Stop Smoking

As you are likely aware, one of the many negative ways smoking impacts your health is by elevating your risk of heart disease.

One reason for this is that smoking changes the way the body metabolizes cholesterol. Tobacco tar damages the immune cells, rendering them unable to remove cholesterol from blood vessel walls so it can be transported back to the liver. Experts believe that, due to these dysfunctional immune cells, smokers develop clogged arteries faster than non-smokers do.

The good news is, the damage appears to be reversible. Smoking cessation, with or without the use of transdermal nicotine patches, can undo the harmful effects of tobacco tar and return immune cells to full, cholesterol-removing capacity.

8. Drink Alcohol Moderately

As is true of cholesterol itself, the right amount of alcohol can improve your health, but if the balance skews too far, the effects can be quite detrimental.

Thanks to the ethanol it contains, alcoholic drinks can raise your HDL cholesterol levels, which as I have stated previously, lowers your risk of heart disease.

One study compared the effects of 24 grams of white wine to an equal quantity of white grape juice. The wine improved HDL levels by 5%.

Separate findings indicate that alcohol can also beneficially impact reverse cholesterol transport, which decreases the likelihood of clogged arteries as well as heart disease. The standard recommendation is no more than two drinks per day for men and one drink per day for women.

9. Add Plant Sterols and Stanols to Your Diet

Plant stanols and sterols are, in essence, the plant versions of cholesterol. They resemble the cholesterol produced by human livers, but because of certain differences in their chemistry, they do not accumulate on the walls of blood vessels.

In fact, they actually lower total cholesterol levels. When the body absorbs plant sterols, they replace the absorption of human cholesterol.

While research indicates plant sterols and stanols can lower LDL cholesterol levels—by between 15% and 20%—it remains to be seen whether those benefits lower a person’s risk of heart disease.

Some of the top sources of plant stanols and sterols include:

  • Wheat germ and wheat bran
  • Peanuts
  • Almonds
  • Brussels sprouts

10. Try Science-Backed Supplements

Both fish oil and psyllium fiber have been shown to optimize cholesterol levels and enhance heart health, while CoQ10 shows clear promise in its effect on cholesterol levels though its long-term benefits have yet to be fully mapped.

Last but certainly not least, exciting new findings reveal that consuming essential amino acids in the form of a nutritional supplement can lower liver and blood triglycerides as well as total cholesterol, LDL cholesterol, and VLDL cholesterol, whether taken alone or with plant stanols and sterols.

Fish Oil

Given the focus on fish in the section on omega-3 fatty acids, the source of fish oil’s influence on cholesterol levels should come as no surprise: the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).

Researchers have found that taking fish oil can decrease the total amount of cholesterol present in the blood, increase HDL cholesterol levels, reduce your risk of heart disease, and prolong your overall life expectancy.

Psyllium Fiber

There’s no question that the supplemental form of soluble fiber can reduce both total cholesterol and LDL cholesterol.

Studies show that the daily use of a psyllium fiber supplement can lower cholesterol levels by between 5% and 10%.

Coenzyme Q10

As touched on previously, coenzyme Q10, or CoQ10, assists with the cellular production of energy. Though the body can produce its own CoQ10, deficiencies can arise. And even in the absence of a deficiency, it can be beneficial to supplement with CoQ10.

Multiple studies show that taking a CoQ10 supplement can reduce total cholesterol levels. Plus, it seems increasing your CoQ10 intake can help treat heart failure.

Essential Amino Acids

Essential amino acids (EAAs) are the only required dietary macronutrient. They are involved as key components of all proteins in the body and play various physiological roles. EAAs are in all forms of dietary protein, so regardless of the nature of your diet, you consume at least some EAAs.

EAAs stimulate the synthesis of proteins involved in transporting lipids from the liver to peripheral fat, as well as the protein required for the clearance of fatty acids into adipose tissue for storage. Dose response studies have not been done, but successful reduction of blood and liver lipids was achieved with two doses of 11 grams of EAAs twice per day.

The great advantage of EAA supplements is that they are natural, and essential, components of our regular diet and pose no known risks of adverse responses. Not only can they impart beneficial effects by themselves on blood and liver lipids, but they can also boost the effectiveness of statins. In addition to the positive influence EAAs have on blood lipids, they also have proven benefits for muscle health and physical function.

Cholesterol is perhaps the most misunderstood nutrient of all. Sure, the stats are overwhelming, but let’s take the “scare” out of the statistics and really get clear on what cholesterol is, how it works in the body, and the most natural ways to lower cholesterol levels to optimal.

Osteopenia Treatment: Let’s Exercise Those Bones!

If you’re interested in finding out how to keep your bones strong and healthy for the rest of your life, read on to learn about osteopenia treatment and how exercise can help increase bone density and reduce the risk of fracture.

According to the National Osteoporosis Foundation (NOF), roughly 54 million Americans have either osteopenia or the more severe bone condition osteoporosis. What’s more, research suggests that approximately 50% of women and 25% of men aged 50 and older diagnosed with osteoporosis will experience bone fractures at some point in their lives. And because more people are living longer, experts predict that the problem is only going to get worse. So if you’re interested in finding out how to keep your bones strong and healthy for the rest of your life, read on to learn about osteopenia treatment and how exercise can help increase bone density and reduce the risk of fracture.

What Is Osteopenia?

The term osteopenia refers to bone mass that’s lower than normal but not yet low enough to be considered osteoporosis. Without proper intervention, people with osteopenia may go on to develop osteoporosis. But because osteoporosis is considered a silent disease, you may not know there’s anything wrong until a simple accident results in a hip or vertebral fracture.

However, a bone density test can diagnose both osteopenia and osteoporosis. It does this by calculating bone mineral density (BMD)—a measure of the amount of minerals in a segment of bone.

A bone density test is performed using a DXA scan, or dual-energy x-ray absorptiometry. The results of the test are reported using T-scores, which are based on your individual bone density as compared with that of an average 30-year-old. Scores of -1.0 and above are considered normal, while scores between -1.0 and -2.5 indicate osteopenia and scores below -2.5 signify osteoporosis.

The average person’s bone density usually peaks by their late 20s. And the rate at which they begin losing bone mass depends on several factors.

For example, the hormone estrogen affects bone health by inhibiting the resorption of bone, which is why the sharp drop of this hormone at menopause puts postmenopausal women at a high risk of osteopenia and osteoporosis. However, as alluded to earlier, men lose bone mass as they age, too, and are more likely—after the age of 50—to experience a bone fracture due to osteoporosis than they are prostate cancer.

In addition to experiencing broken bones, especially wrist, vertebral, and hip fractures, the weak and brittle bones of osteoporosis can lead to height loss and stooped posture.

Depending on how strong your bones are early in life, you may not develop osteopenia at all, or you may lose bone mass earlier and at a faster rate than you can build new bone. However, the basic rule of thumb is the denser your bones are when you’re young, the less likely you’ll develop osteopenia when you’re older.

Factors like age, sex, and race play a significant role in an individual’s risk of osteopenia, but there are a number of other risk factors as well, including:

Lack of exercise Poor diet
Vitamin and mineral deficiencies Cigarette smoking
Excessive alcohol consumption Lack of sunlight exposure
Prior cancer treatment Family history of bone disorders
Menopause Atopic dermatitis
Kidney disease Celiac disease
Chronic obstructive pulmonary disease (COPD) Thyroid disorders
Cushing syndrome History of eating disorders

However, it’s important to note that not everyone with osteopenia will go on to develop osteoporosis. By getting regular exercise and eating a healthy diet that includes sufficient vitamins, minerals, antioxidants, protein, and amino acids, it’s possible to keep bones healthy and prevent the progression of low bone density.

Osteopenia Treatment

If you’ve been diagnosed with osteopenia, treatment will likely be based on your risk of breaking a bone within the next 10 years. If that risk is determined to be low, your health care provider may recommend foregoing medication and opting instead for lifestyle changes, with a special focus on diet and exercise.


An effective osteopenia diet should address the vitamin and mineral deficiencies that contribute to bone loss. Vitamins and minerals crucial for building and maintaining strong, healthy bones include iron, phosphorus, vitamin D, vitamin K, vitamin C, calcium, and magnesium.

Meat, seafood, spinach, and beans are good sources of iron, while leafy green vegetables, including kale, spinach, and collard greens, are a great source of vitamin K. And vitamin C is abundant in pineapples, mangoes, papaya, and berries.

To ensure you’re getting enough calcium, look not only to dairy products but also to almonds, legumes, tofu, sardines, spinach, and kale. For magnesium, eat plenty of almonds, dark chocolate, whole grains, and artichokes.

Foods that contain wheat also tend to provide healthy doses of several vitamins and minerals needed for bone growth. However, individuals with celiac disease should avoid gluten-containing foods. In fact, studies suggest that individuals with celiac disease who ingest gluten damage not only their small intestine but their bones as well.

For example, a 2017 study published in the Indian Journal of Pediatrics found a strong correlation between gluten consumption and low bone mineral density in children diagnosed with celiac disease.

If your diet is lacking in appropriate food sources, you might also consider taking a vitamin and mineral supplement. Look for a supplement that contains the following bone-building nutrients:

Phosphorus Iron
Vitamin D Vitamin K
Vitamin C Vitamin B12
Calcium Magnesium
Potassium Boron
Copper Silicon
Sulfur Manganese

Oxidative Stress and Bone Loss

A number of studies have hypothesized that oxidative stress plays a major role in the decline of bone mass.

Oxidation occurs as a natural byproduct of metabolic activity in the body. However, the reactive oxygen species produced during metabolism—including free radicals—damage the body’s cells. What’s more, negative influences like chronic stress, poor diet, smoking, and environmental pollution can further aggravate oxidative stress.

But by eating a diet rich in antioxidants, such as polyphenols, carotenoids, and vitamins C and E, and limiting or avoiding processed foods, trans fats, added sugar, and preservatives, the effects of oxidative stress can be minimized.

In addition, the body produces its own “master” antioxidant called glutathione, which is comprised of the amino acids glycine, glutamate, and cysteine. By consuming more foods like tomatoes, peaches, spinach, and walnuts, as well as the amino acid N-acetylcysteine (NAC), the production of glutathione can be increased.


A 2018 report published in the Journal of Physical Activity and Health found that adults who engaged in sports early in life had higher bone density than adults who were inactive. This beneficial effect was even more pronounced in women.

However, if you’ve already been diagnosed with osteopenia, simply engaging in regular exercise won’t ensure a decreased fracture risk because increasing bone strength depends on participating in physical activity at the right intensity level.

In other words, people with poor bone health who engage in vigorous physical activity may actually be putting themselves at risk of doing more harm than good. Therefore, to avoid the possibility of fracturing the very bones you’re trying to make stronger, you should focus on engaging in low-impact weight-bearing exercises.

Moreover, exercises that involve bending and twisting motions, such as those seen in golf, should be avoided, as these maneuvers place added strain on the spinal column. Exercises that carry a high risk of falls, such as skiing, should be avoided as well.

Safe and effective exercises that increase strength, flexibility, and stability in people with osteopenia and osteoporosis include:

  • Resistance band training
  • Walking
  • Dancing
  • Stair climbing
  • Gardening
  • Tai chi
  • Yoga
  • Elliptical machine training


As discussed, people deemed to have a low risk of facture within the next 10 years may not be recommended medication at all. However, if your health provider determines that your situation warrants added support, medication to help prevent bone loss may be prescribed.

The most commonly used medications in the treatment of osteoporosis and osteopenia—the bisphosphonates—include risedronate (Actonel), alendronate (Fosamax), zoledronic acid (Reclast), and ibandronate (Boniva).

Other medications, including raloxifene (Evista), calcitonin (Miacalcin), denosumab (Prolia), and teriparatide (Forteo), may also be prescribed to prevent bone fractures and increase bone mass.

Be sure to speak with a health care professional before beginning any of these medications, as they may cause serious side effects, including anemia and osteonecrosis (death of bone tissue).


Vitamin D is vital for the proper metabolism of both calcium and phosphorus, which makes it critical for maintaining strong bones. And the human body produces vitamin D in response to exposure to sunlight. So aim to get at least 15 to 20 minutes of direct sun exposure—without sunscreen—on your bare skin daily.

However, people living at higher latitudes should consider adding an additional 1,000 to 4,000 International Units of vitamin D to their diet as well.

If you’ve been diagnosed with osteopenia or have a family history of osteopenia or osteoporosis, be sure to speak with your doctor about things you can do to reduce your risk of further bone loss. By taking steps now to improve bone health, you can help decrease your risk of potentially disabling bone fractures in the future.

8 Exercises for Osteopenia

The Many Faces of Depression and How to Recognize Them

If you aren’t suffering from depression, the odds are good that you know someone who is. According to the World Health Organization, 300 million people worldwide have this debilitating condition. The statistics surrounding depression are grim, but the good news is that you don’t have to suffer in silence.

If you aren’t suffering from depression, the odds are good that you know someone who is. According to the World Health Organization (WHO), 300 million people worldwide have this debilitating condition. Major depressive disorder, a serious mental illness characterized by feelings of sadness, hopelessness, loss of interest in formerly pleasurable activities, anger, and frustration, affects close to 6.7% of the adult population in the United States. In severe cases, depression can lead to suicidal thoughts. Joint findings from WHO and the Centers for Disease Control and Prevention (CDC) put the number of people who die from depression-related suicides each year at 800,000.

If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the National Suicide Prevention Lifeline is available 24/7 at 1-800-273-TALK (8255) or via their site here. This national network of local crisis centers provides free, confidential counseling for those in suicidal crisis or emotional distress as well as the loved ones of people who are experiencing suicidal ideation or have committed suicide. También disponible en español.

While everyone feels sad, overwhelmed, or irritable from time to time, those feelings typically pass. For individuals with depression, however, negative feelings linger. Experts consider this chronic illness to be a significant public-health issue. Not only are people with depression more likely to die from suicide, but they also face an elevated risk of health conditions such as heart disease.

While the statistics surrounding depression sound grim, the good news is that the vast majority of people with depression who seek treatment find relief. The first step in getting help is admitting that you need it.

What Causes Depression?

Depression has no single cause. Researchers have identified a variety of factors that can trigger its onset, including the loss of a loved one, a serious illness such as cancer, social isolation, and life stresses such as divorce or financial troubles. It’s also entirely possible for depression to arise without any distinguishable external cause.

The following risk factors, according to experts in the field, may make a person more prone to develop depression:

  • Genetics: Mood disorders like depression often run in families.
  • Childhood trauma: This can create lasting changes to brain pathways for processing fear and stress.
  • Substance abuse: An estimated 30% of people who drink or use drugs in problematic ways are dealing with depression, necessitating a dual treatment approach.
  • Anxiety: Individuals diagnosed with anxiety are at high risk of developing depression, and vice versa. Nearly half of those with depression also have anxiety.
  • Other medical conditions: It appears that sleep disorders, chronic pain, and attention deficit hyperactivity disorder (ADHD) can also make someone more likely to develop depression.

Scientists have found certain changes in the brains of those with depression, specifically, the frontal lobe becomes less active, but it’s not clear whether those changes cause depression or arise because of it.

Recognizing Signs of Depression

A common condition, depression results in physical and emotional problems that affect the way individuals feel, think, and act.

You’ve probably heard the expression that depression has many faces. With that in mind, it’s important to understand that the myriad symptoms of depression can vary significantly from person to person. If you’re wondering whether you or a family member might be struggling with depression, consider whether you’re experiencing any of the following in your daily life:

  • Sad, empty, anxious, or hopeless feelings
  • Outbursts of anger or frustration
  • Lack of interest in activities you previously enjoyed
  • Unexplained physical problems, such as back pain or headaches
  • Exhaustion, trouble sleeping, or a habit of sleeping too much
  • Increase or decrease in appetite
  • Problems with concentration, decision-making, or memory
  • Thoughts of suicide

5 Common Types of Depression

Most of us have days when we feel mopey, blue, or out of sorts. However, if you’re experiencing persistent or severe depression, you should consider seeking medical attention. A doctor or therapist can help you determine whether you’re suffering from a temporary condition or a more severe form of clinical depression that requires treatment.

Here are some of the most common types of depression along with their distinguishing traits.

  1. Major depression: Also called major depressive disorder, this is likely the type of depression you think of when a friend or loved one says they’re depressed. Patients with this condition often experience feelings of worthlessness, trouble sleeping, and a loss of interest in daily activities. In some cases, patients with major depression have thoughts of suicide, so exploring depression treatment options is crucial.
  2. Persistent depressive disorder: It’s possible to experience clinical depression arising from known or unknown causes for a short period of time, or more chronically. In order to be diagnosed with persistent depressive disorder, also known as dysthymia, a person must be experiencing a depressed mood for a duration of 2 years or longer. The severity of symptoms may fluctuate over that time, but they must be consistently present.
  3. Postpartum depression: A type of depression affecting women who have just given birth, postpartum depression is characterized by intense feelings of depression, anxiety, and exhaustion. It’s quite common for new mothers to experience some anxiety and depression after giving birth, but in most cases, that resolves within about two weeks. Despite its name, postpartum depression may arise during pregnancy or after giving birth. Mothers experiencing postpartum depression may struggle to care for themselves or their infants.
  4. Seasonal affective disorder (SAD): This type of depression tends to impact patients during the cold-weather months and is believed to result from a reduced exposure to sunlight. SAD symptoms, which include social withdrawal, fatigue, and weight gain, typically improve in the spring and summer but return when the days grow shorter and colder.
  5. Psychotic depression: This serious condition refers to a combination of serious depression and some type of psychosis, such as hallucinations (seeing or hearing things that others cannot) or delusions (upsetting and rigid false beliefs), and feelings of paranoia. In most cases, psychosis symptoms center on a theme such as persecution, guilt, or illness. According to the American Psychiatric Association, early, well-coordinated treatment is vital to securing good outcomes for individuals experiencing psychosis.

A few other types of depressive disorders recently added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).

Though it was formerly called manic depression, and does include episodes of extremely low moods that meet the criteria for major depression, bipolar disorder is a separate disorder and requires its own distinct treatment approaches. The key difference between bipolar disorder and depression is that the former features periods of extremely elevated moods—usually either euphoria or intense irritability—called mania or less intense versions of the same called hypomania.

How Many People Experience Depression?

Depression is one of the most common mental health disorders, both in the United States as well as worldwide. Statistics show rates of depression are rising, particularly among adolescents.

Data shared by the National Institutes of Health (NIH) shows that in 2016, 16.2 million adults over the age of 18 had experienced at least one major depressive episode. The number of adolescents with depression has climbed more steeply than that in any other age group. In 2016, that number reached 3.1 million—19.4% of girls and 6.4% percent of boys.

In fact, unlike many other health conditions, the risk of depression actually drops as you age. Adults between 18 and 25 face the highest risk of depression (10.9%) while older adults who’ve reached the age of 50 and beyond face the lowest risk (4.8%).

Across all age groups, women in the United States are substantially more likely to experience depression than men—8.5% compared to 4.8%.

Race plays a role in depression risk too. Adults who identify with two or more racial or ethnic groups have the highest risk of depression at 10.5%.

Having had a prior depressive episode also increases the likelihood you’ll experience another. Researchers from Pro Persona at the Institute for Mental Health Care in the Netherlands found that more than 13% of individuals who recover from an episode of major depression will experience another within five years. When they extended the time frame to 10 years, that rises to 23%, and for 20 years, to 42%.

Though depression is highly treatable, the Pro Persona researchers found that less than 50% of those with this condition receive adequate care. In some countries, a mere 10% receive the treatment they need. A variety of factors contribute to this problem, including a lack of knowledgable health care professionals, misdiagnosis, and social stigma.

Seeking Help for Depression

Multiple treatments exist to help depression patients reduce symptoms and improve quality of life. Statistics show that between 80% and 90% of individuals with depression who seek treatment will find an option that works for them. However, finding the right one can be a complicated process, and individuals often have to try different options to achieve positive results.

Lifestyle Changes and Alternative Treatments

Many patients also rely on lifestyle adjustments to ease their depression symptoms. Some popular alternative treatments that can complement traditional approaches to treating depression include:

  • Prioritizing physical activity, such as yoga
  • Committing to a regular meditation practice
  • Using acupuncture to alleviate physical and mental distress
  • Building a supportive social network
  • Caring for your physical self by, for example, eating a nutrient-rich diet

There are also a number of herbal supplements, such as St. John’s wort, that have been shown to effectively address symptoms of depression. Since supplements can interact with other medications, be sure to speak with your doctor about any possible interactions.

Nutritional therapy using amino acids is an especially exciting approach to depression treatment. “Supplements that contain amino acids also reduce symptoms, because they are converted to neurotransmitters that alleviate depression and other mental disorders. Based on emerging scientific evidence, this form of nutritional supplement treatment may be appropriate for controlling major depression,” explained an article written by two scientists at the Global Neuroscience Initiative Foundation in Los Angeles.

The amino acid L-tyrosine, for instance, supports the synthesis of the neurotransmitters epinephrine, norepinephrine, and dopamine, which can result in decreased depression symptoms.


In addition to lifestyle changes, individuals with depression may experience significant benefits from therapy. Interpersonal and problem-solving approaches can be helpful, but the strongest evidence to date supports an approach called cognitive-behavioral therapy (CBT).

A wealth of research indicates that CBT, a form of psychological treatment, can bring about significant improvements in terms of both functioning and quality of life for people with depression and other mental health issues.

The goal of CBT is to alleviate depression symptoms by modifying behaviors, thoughts, and feelings and breaking larger problems down into smaller ones that can be easily managed. Some of the core principles of this therapy approach include the idea that depression and other psychological problems arise because of unhelpful ways of thinking and behaviors. By changing those thought and behavior patterns, people can experience significant and measurable relief.

In a sense, CBT practitioners teach people how to be their own therapist by helping them build more effective coping skills. The focus in each session is on the current realities of a person’s life, rather than historical events that may have contributed to the difficulty they are experiencing. Some information about a person’s history will, of course, be necessary, but the overall emphasis is on learning how to effectively interact with emotions and challenges that arise in daily life.

Prescription Drugs

If lifestyle changes or therapy cannot resolve symptoms of depression, medications can be a useful additional treatment option. The CDC estimates that 13% of Americans age 12 and older take antidepressant medication, an increase of 65% from 1999 to 2014.

When delving into the world of pharmaceutical treatments for depression, you’ll encounter what at first may appear to be a bewildering array of acronyms: SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), NDRIs (norepinephrine–dopamine reuptake inhibitors), TCAs (tricyclic antidepressants), and MAOIs (monoamine oxidase inhibitors). Each string of letters refers to a category of drugs that have been grouped together due to the similar way in which they impact the neurotransmitters in your brain.

SSRIs, the most commonly prescribed class of antidepressants, work by boosting serotonin levels. Individuals with depression often display strikingly low levels of this important neurotransmitter, which impacts mood, sleep, and appetite. You may be familiar with brand names within this drug class such as Prozac, Celexa, and Zoloft. By stopping the reabsorption of serotonin, these drugs make more of the substance available in the brain.

Antidepressants usually take between 2 weeks to 2 months to produce noticeable changes, and they often come with side effects. Working with a skilled professional will be key to determining which antidepressant (if any) offers relief for you.

Options for Treatment-Resistant Depression

For individuals with severe, persistent depression that does not respond to other treatments, doctors may recommend more invasive options such as electroconvulsive therapy (ECT).

While many understandably have negative associations based on the primitive versions of electroshock therapy administered beginning in the 1940s, ECT treatments have evolved drastically. Today, patients can typically resume normal activities in about an hour after the procedure concludes.

Ketamine, a drug initially intended for use primarily as an animal tranquilizer that became popular on the black market for its ability to create a detached, dream-like state, can bring remarkably rapid  relief for individuals suffering intransigent depression. Clinical trials have shown highly promising results. In 2019, the U.S. Food and Drug Administration (FDA) approved the use of Spravato, a drug based on ketamine, to treat depression via a nasal spray. Given its potential for abuse, it’s only available in controlled clinical settings.

Dealing with Depression? You’re Not Alone

Whether you’re dealing with depression yourself, or supporting a child, parent, spouse, or friend, remember that support is always available to you.

An abundance of reliable, up-to-date information can be found on websites run by organizations like the National Institute of Mental Health (NIMH), while grassroots groups like the National Alliance on Mental Illness (NAMI) can help connect you with support groups in your area. Many also find comfort from personal essays that describe another person’s lived experience with depression.

Depression can make you feel helpless and alone, but even taking small steps, like chatting with a trained counselor from your own home, can show you that’s not the case.

What You Should Know About Depression

Cultivate a Positive Attitude for Greater Longevity

You want longevity. A life of happiness and vigor. We can relate. Read on to discover how the power of positive thinking can help you achieve the happiness, vigor, and longevity you desire.

You want longevity. A life of happiness and vigor. We can relate. Because, really, who wouldn’t want these things? The problem is that the many ups and downs of life can make these goals seem like little more than pipe dreams. But what if we told you that living a longer, more vibrant life could be achieved—in great measure—by simply cultivating a positive attitude? And what if we told you that more and more research is suggesting that this is anything but a pipe dream?

Interested? Then read on to discover how the power of positive thinking can help you achieve the happiness, vigor, and longevity you desire.

Attitude Is Everything

You already have the power to starve your negative experiences of too much attention. Because it’s your mental attitude that determines whether negative thoughts from these experiences snowball into something worse. In other words, if bad things are destined to happen—after all, it’s just a natural part of the human experience—you can control how you respond.

Consider the concept of locus of control.

This phrase, taken from personality psychology, refers to the degree to which we believe we have control over our own lives.

A study in the Review of European Studies measured the impact of locus of control on the level of subjective well-being of study participants. Researchers found that a significant relationship exists between an individual’s locus of control expectancy—or expectation of being in control—and their level of happiness.

Specifically, they found that people with high levels of self-confidence and belief in their ability to create positive change feel more contented in their daily lives. But they also found that a balanced approach was important too. It appears that people experience less happiness when they hold on too tightly to control, lack trust in others, and can’t accept that bad situations are a natural part of life.

Recognizing that you have ultimate control over your attitude and outlook doesn’t just help you feel better overall. By consistently practicing positive thinking, you may be able to live a longer life as well.

The Science of Longevity

Studies of centenarians have found that the power of positive thinking is not just a tired cliché. On the contrary, a positive attitude may just be the best way to ensure a long life.

For example, the annual 100@100 surveys conducted by UnitedHealthcare have consistently found that looking on the bright side and maintaining a positive state of mind are essential to a long and happy life. In fact, the 2015 survey of 100 people over the age of 100 found that:

  • 61% view themselves as “very positive” people
  • 84% think laughing and having a sense of humor are important to healthy aging

What’s more, centenarians rank having a positive attitude (25%) as more critical to overall good health than both eating a healthy diet (21%) and getting regular exercise (10%). Finally—and this may seem a bit counterintuitive—almost half of all respondents said that maintaining a positive attitude gets easier with age.

In addition, a study out of Yale University found that people with a positive view of aging live an average of 7-1/2 years longer than those with more negative attitudes.

So how do you resist negative feelings and keep the positive thoughts flowing? While there’s no one-size-fits-all answer, there are some practical steps you can take that will help you develop and maintain a more positive outlook.

Cultivate a Positive Attitude for Greater Longevity

Developing a Positive Attitude

Becoming a more positive person doesn’t have to be an exercise in futility. Like most things in life, all it takes is a little commitment to personal development and some old-fashioned hard work.

So in this proactive spirit, we now offer up some practical steps you can take to cultivate a positive attitude and increase your longevity.

Drop Dead Weight

It’s difficult to be positive when negative people and situations are weighing you down. So dump them! Well, unless it’s a close relative or life event you can’t avoid, in which case, might we suggest you just do your best to guard your time and maintain perspective. Whatever you can do to limit the time you spend giving energy to the people and situations that only drag you down will not only reduce stress but will also add to your happiness.

Honor Yourself

Dropping dead weight becomes much easier when you begin to honor yourself. Far from coming from a place of selfishness, honoring yourself means respecting and loving yourself enough to do what’s right for your highest good. When you learn to do that, the dead weight in your life will naturally begin to fall away, and you’ll attract the people and situations that contribute to a healthier and happier life.

Practice Gratitude

Let’s be honest. Most of us tend to take things for granted. It doesn’t matter if it’s the greatest job, the closest family, or the best health, we rarely take a moment to be thankful for what we have. So whether it’s a once-in-a-lifetime vacation or simply a beautiful wildflower that catches your eye, take a moment to stop and really appreciate it.

Use Affirmations

Positive affirmations can be a useful tool for encouraging more positive behaviors. By repeating a chosen set of positive words several times throughout the day, you can reprogram self-sabotaging thoughts. What makes this approach so user-friendly (and effective) is both its simplicity and the ease of molding the technique to suit your individual preference. After all, since you’re saying your affirmations in front of an audience of one, there’s no need to dress them up. Just focus on the changes you want to see in your life, compose a few succinct phrases that are easy to remember and worded as if the change has already taken place (such as I have… or I am…), and repeat as often as you like. The more you practice this simple technique—and believe in what you’re saying—the more positive your life will be.

Get a Hobby

In an ongoing study from the University of California Irvine Institute for Memory Impairments and Neurological Disorders (UCI MIND), researchers have discovered that people who spend at least 2 hours a day engaged in a hobby are 21% less likely to die early. So if you already have a hobby, keep at it. And if you’ve always wanted one but didn’t think you had the time, indulge yourself. You may just be adding years to your life and added enjoyment to your years.

Have Fun! 

Just like having a hobby, finding time to have fun is a must for longevity. After all, when you’re having fun, you’re living in the present moment—a place where regrets regarding the past and worries for the future don’t exist. What’s more, having fun releases powerful feel-good brain chemicals like dopamine and serotonin. So what are you waiting for? Get out there and have some fun!

Get a Pet

Few things keep you more present-focused and positive than having a pet. And there’s actually data to prove it. In a study conducted by the American Psychological Association of people who had pets and those who didn’t, it was found that people with pets had greater levels of physical and psychological well-being—including improved self-esteem—than their counterparts without pets.

Practice Mindfulness

When you practice mindfulness—the nonjudgmental awareness of your thoughts, internal sensations, surroundings, etc.—whether by engaging in meditation or by simply enjoy a relaxing, thoughtful walk in the woods, you’re focused on the present moment and fully engaged with life. And just like having fun, mindfulness pulls you away from negative emotions like regret and worry and brings a sense of connectedness that can improve your overall well-being.

No matter how old you are, practicing just a few of these techniques on a daily basis can help train your brain to look at life in a more positive way. And as we’ve seen, cultivating a positive attitude may just be the key to a long and fulfilling life.

6 Natural Ways to Treat and Prevent Gout

According to a study from 2011, the number of Americans with gout has been rising steadily over the past several decades, most likely because of increasing rates of obesity and high blood pressure. Here are six natural ways you can prevent gout and lessen attacks if you are prone to them.

According to a study from 2011, the number of Americans with gout has been rising steadily over the past several decades, most likely because of increasing rates of obesity and high blood pressure. At the time the study was published, it was estimated that the number of people in the United States with gout had risen to 8.3 million. Similar figures are being seen in the United Kingdom as well, with rates of gout increasing by about 4% a year. With numbers like these, more and more people need to be aware of this particularly painful form of arthritis as well as the methods available to treat and prevent gout.

What Causes Gout?

Gout is a type of arthritis that’s been around at least as long as the ancient Egyptians, who first described it in 2640 BCE. Historically, it’s been called both the “disease of kings” and the “rich man’s disease” because of its association with rich foods and alcohol consumption.

The condition is caused by the accumulation of urate crystals in the joints—especially the big toe. These crystals form when too much uric acid is present in the blood. While uric acid is a natural byproduct of the body’s breakdown of purines—substances that are naturally present in all body tissues—certain foods also contain purines.

And when too many of these foods are consumed, the body’s systems can be overwhelmed, with the resultant buildup of uric acid and eventual formation of sharp, needlelike urate crystals in a joint or its surrounding tissues.

The key word here is “eventual” because, interestingly enough, the high uric acid levels that lead to gout are typically elevated for 20 to 30 years before symptoms arise. This is why gout usually occurs in people who are middle-aged and older.

Symptoms of Gout

A gout attack can—and usually does—strike suddenly, often waking a person up in the middle of the night with the sensation that the affected joint is on fire. In fact, the joint can be so hot, swollen, and tender that even something as light as a bedsheet may be more than an individual can stand.

Whether a gout attack affects the feet, ankles, knees, elbows, wrists, or hands (though almost half of all cases occur in the big toe), the inflammation can be so intense that it leads to fever, muscle aches, and other flu-like symptoms. And after the initial joint pain subsides—usually within 4 to 12 hours—discomfort can continue for a few days to weeks.

In people whose gout is left untreated, chronic swelling and permanent joint damage can occur. Moreover, urate crystals may continue to build up until they form grotesque deposits known as tophi or even kidney stones.

Gout Risk Factors

Because the risk of gout is tied to increased levels of uric acid in the body, you’re more likely to develop the condition if you have certain qualities that increase these levels. These include:

  • Family history: People with family members with gout are more likely to develop the condition.
  • Sex and age: Men naturally have higher levels of uric acid and so are more likely to develop gout than women. However, after menopause, women’s levels approach those of men, and their rates of gout subsequently rise.
  • Weight: People who are overweight or obese produce higher levels of uric acid, which increases the risk of gout.
  • Diet: Drinking alcohol (especially beer) and eating a diet rich in red meat, seafood, organ meats, and fructose—including the high fructose corn syrup found in sugary drinks and various and sundry processed foods—increase levels of uric acid in the body.
  • Health problems: Certain medical conditions, including high blood pressure, kidney disease, diabetes, and heart disease, are linked to an increased risk of gout.
  • Medications: The use of thiazide diuretics, aspirin, and immunosuppressants (in people who’ve undergone organ transplants) can increase the risk of developing gout.

Diagnosing Gout

While an acute gout flare in the big toe is a hallmark of the disease and easy to diagnose, diagnosis can be a bit tricky when other joints are involved. Therefore, your health care provider may use a series of tests to determine whether it’s really gout or another condition that mimics the disease, such as rheumatoid arthritis or pseudogout, which is caused by calcium pyrophosphate crystals. These tests include:

  • Blood test: A blood test to check levels of uric acid may be performed, though some people with elevated levels never experience gout, while others have symptoms of gout but normal levels. Therefore, additional tests may be performed to confirm the diagnosis.
  • Synovial fluid test: This test is performed with the use of a needle to withdraw fluid from the affected joint. The joint fluid is then checked for urate crystals under a microscope.
  • X-ray: Imaging of the affected joint can be helpful in determining whether something else is causing inflammation of the joint.
  • Ultrasound: This test detects the presence of urate crystals within a joint with the use of sound waves.

Conventional Treatment of Gout

If you’re confirmed to have gout, you may be recommended medications to both treat the acute attack and help prevent gout flare-ups. These medications include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen or indomethacin may be used at high doses during acute attacks and at low doses for prevention of future flares.
  • Colchicine: Like NSAIDs, colchicine is used to both treat gout and prevent future flare-ups.
  • Steroids: These medications are generally only used in people who can’t take either NSAIDs or colchicine.
  • Xanthine oxidase inhibitors (XOIs): This class of drugs, which includes allopurinol, helps block the production of uric acid.
  • Uricosurics: These drugs include probenecid and may be used to help improve the kidneys’ ability to remove uric acid from the body.

Natural Remedies to Treat and Prevent Gout

For those who find the side effects of traditional medications prohibitive or simply wish to go a more natural route, there are actually several methods that have been shown to aid in the treatment and prevention of gout. Six remedies that have demonstrated particular promise are:

  • Cherries and cherry extract
  • Gout diet
  • Exercise
  • Limited alcohol
  • Coffee
  • Vitamin C

1. Cherries and Cherry Extract

A 2012 study published in the journal Arthritis & Rheumatology showed that consumption of both cherries and cherry extract reduced the risk of gout attacks by about 35%. These findings were corroborated by a 2014 study that demonstrated that Montmorency tart cherry concentrate reduced blood levels of uric acid and the inflammatory marker C-reactive protein.

2. Gout Diet

A gout diet focuses on helping people achieve a healthy weight by teaching good dietary habits, including which purine-rich foods to avoid and which foods can help control uric acid levels. The diet emphasizes the consumption of whole grains, fruits, and vegetables and the avoidance or limitation of processed foods, high fructose corn syrup, and fruit juices.

It also encourages weight loss by restricting calories and puts limits on the consumption of red meat, organ meats, fatty poultry, some types of seafood, and high-fat dairy products. Instead, a gout diet focuses on lean meats and poultry, low-fat dairy products, and lentils as protein sources. Interestingly, vegetables high in purines, such as asparagus and spinach, are an acceptable part of a gout diet, as studies have shown they don’t increase the risk of gout attacks.

In addition, the diet recommends the ingestion of plenty of water, as increased water intake is linked to lower blood levels of uric acid.

3. Exercise

Exercise helps address two risk factors for gout: excess weight and obesity. In those who aren’t currently overweight or obese, regular exercise can also help maintain a healthy weight, thereby reducing the risk of gout. However, be careful about losing weight too quickly, as both rapid weight loss and fasting can lead to excess lactic acid, which hinders the ability of the kidneys to process uric acid and can trigger a gout attack.

4. Limited Alcohol

Consumption of beer and liquor is associated with an increased risk of gout and gout flares. However, there’s some disagreement when it comes to wine, with some studies indicating moderate consumption doesn’t appear to increase risk and others indicating it does. So the best advice may be to avoid all forms of alcohol during attacks of gout and to limit alcohol intake (especially beer) between attacks.

5. Coffee

Studies have shown that coffee consumption is associated with lower uric acid levels. In fact, one study found that men who drank 4 to 5 cups per day lowered their risk of gout by 40%, and those who drank 6 or more cups lowered theirs by a whopping 59%.

6. Vitamin C

Several studies have indicated that increased vitamin C intake is associated with reduced uric acid levels. One study from 2009 found that the risk of gout fell by 17% for every 500-milligram increase in vitamin C intake, with a drop in risk of 45% with doses of 1,500 milligrams or more.

If you or someone you love is dealing with gout, speak with your health care provider about your options and what treatments might be right for you. Whether you decide to try dietary and lifestyle changes alone or combine them with medication, early treatment of gout can help prevent serious complications down the road.

6 Natural Ways to Treat and Prevent Gout

How Can I Boost My Immune System? Amino Acids and Immune Function

Proper nutrition is a must for a strong immune system. Immune-boosting vitamins like zinc, copper, B vitamins, and iron are some of the key micronutrients that help keep immune function running at full strength. In fact, many multivitamins are marketed as “immune system boosters.” The most important nutrient for optimal immune function, however, may be protein. If you’re interested in optimizing the way your immune system responds to threats, however, it’s vital that you understand the connection between amino acids and immune function.

Studies of malnourished children in developing countries have demonstrated the strong link between protein intake and immunocompetence, or the ability to fight off infection and disease. Most components of the immune system defense arsenal are proteins, so it’s only logical that in order to have an immune system that operates at peak capacity, the building blocks for these proteins, amino acids, must be in plentiful supply.

Before delving into the relationship between amino acids and immune function, let’s take a moment to review some basics about the immune system itself.

Understanding the Inner Workings of the Immune System

Chances are, you have a basic grasp of the role of the immune system: it prevents you from getting sick. To get a bit more precise, a well-functioning immune system protects the body from the threat posed by infectious agents such as bacteria, viruses, fungi, parasites, and other noxious invaders.

All the cells of the immune system originate in the bone marrow, whether they go on to circulate through the bloodstream, disperse to other locations throughout the body, or develop into the lymphoid organs: the thymus, spleen, and lymph nodes.

The immune system has what can be thought of as two different modes: innate immunity and acquired immunity (also called specific or adaptive immunity). Both modes involve the same collection of immune cells described above, but it’s important to differentiate between the two.

The Innate Immune System

Innate immunity functions as the the first line of defense against infectious agents. Its primary purpose is to prevent those pathogens from entering the body, and, if they do manage to enter, swiftly disposing of them. Often, this involves an inflammatory response in which compounds called prostaglandins cause blood vessels to dilate so that blood flow to the infected area can increase.

The innate immune system also relies on physical barriers and blood-borne defenders such as cytokines and a type of white blood cell called leukocytes. Phagocytes, the most abundant of the many types of leukocytes, specialize in physically engulfing infectious organisms, a process known as phagocytosis, then destroying them using naturally generated toxic chemicals, such as superoxide radicals or hydrogen peroxide. Natural killer cells, another key element of the innate immune response, use a similar process to destroy pathogens.

The central difference between innate immunity and acquired immunity is that the innate immune system has no memory and does not alter its response based on prior exposure to a specific pathogen. The innate immune system takes on invaders first, but the acquired immune system is both more powerful and more flexible.

The Acquired Immune System

The acquired immune response relies on cells called lymphocytes, specifically B cells and T cells, each of which responds specifically to a single pathogen. Lymphocytes remain active for some time after they first detect a threat, which allows for the development of immunological memory. This lays the foundation for a fortified, more effective immune response when facing off against a pathogen it has encountered before.

Infectious invaders carry with them substances known as antigens. Lymphocytes recognize pathogens based on these antigens. B lymphocytes carry antibodies on their surfaces that bond to the antigens on invaders to form an antigen-antibody complex. Once the B cell processes this complex, it displays certain proteins which attract matching helper T cells that release chemicals called lymphokines. The lymphokines, in turn, signal the B cells to release a flood of antibodies into the bloodstream where they then bind to invaders, marking them for phagocytosis or destroying them on the spot. This is known as the humoral immune response.

Some infection agents, viruses in particular, enter directly into the cells of the human body, thus escaping detection by the antibodies B cells release into the bloodstream. The acquired immune system deals with these via a process called cell-mediated immunity. T lymphocytes confer this immunity. Infected cells signal to T lymphocytes by expressing peptide fragments derived from the invader in conjunction with proteins called the major histocompatibility complex (MHC) on their surface.

The acquired and innate immune systems communicate via cell-to-cell contact as well as the use of chemical messengers, chiefly cytokines. When everything works as it should, the systems carry out different tasks while working closely together.

The Relationship Between Dietary Protein and Immune System Health

Both the innate and acquired immune system need soluble substances found in the blood and other bodily fluids. According to a study done by the Institute for Quality and Efficiency in Health Care (IQWiG) in Cologne, Germany, “These are mainly proteins like enzymes, antibodies and short amino acid chains.”

Proteins are of particular importance to the complement system, a part of the immune system made up of a group of proteins found in the blood that are critical in the defense against infection. Producing these specialized cells and proteins requires an abundant supply of amino acids, some of which must come from the diet. When the immune system can’t keep up with the production of these molecules, we become vulnerable to many health problems and diseases.

While very few people in the United States are “protein-malnourished,” many people may not be consuming enough high-quality proteins to obtain the amount of essential amino acids needed for optimal nutrition.

Dietary protein is broken down to provide amino acids. Essential amino acids are those that cannot be made by the body and therefore must be obtained from the diet. Nonessential amino acids can be synthesized in the body. However, under conditions of stress when the immune system is challenged, the body cannot keep up with the demand for certain amino acids so they are considered conditionally essential in that dietary sources are required to meet the demand.

How Amino Acids Can Improve Immune Function

As touched on previously, dietary protein deficiencies have long been known to impede immune function. Over the last decade and a half, scientists have begun to investigate the cellular and molecular mechanisms underlying the influence of protein on the immune system.

One of the most thorough inquiries into the link between amino acids and immune function, published by the British Journal of Nutrition, noted that recent studies show amino acids play several important roles in immune responses. They:

  • Regulate the activation of T lymphocytes, B lymphocytes, natural killer cells, and macrophages
  • Manage cellular redox state
  • Modulate gene expression and lymphocyte proliferation
  • Orchestrate the production of antibodies, cytokines, and other cytotoxic substances

The article, authored by Drs. Peng Li, Yu-Long Yin, Defa Li, Sung Woo Kim, and Guoyao Wu, gives a comprehensive look at the evidence supporting the beneficial effects of dietary supplementation of amino acids on immune function. It appears that functional amino acids and sulfur amino acids in particular can enhance immune status.

Like all other cells, the cells that make up the immune system require energy. In fact, when immune system cells are challenged by a pathogen or disease, they require lots of energy in a hurry.

Mitochondria are the engines of cells and produce the energy needed to support all cellular functions. Balanced mixtures of essential amino acids have been shown to increase mitochondrial number and function. Studies show that when essential amino acids are consumed, they stimulate the production of mitochondrial proteins (a process called mitochondrial protein synthesis) including the production of enzymes that contribute to immune system functions. Amino acids help improve mitochondrial function by increasing the available number of enzymes involved in energy production.

If essential amino acid concentrations fall below the appropriate level, the number of mitochondria and their ability to work at full capacity is compromised. This energy shortage limits the ability of the immune system to keep producing all the cells needed to fight off the threat presented by pathogens and disease.

Beyond serving as the fuel source to build up and support the defense system arsenal, mitochondria also get directly involved in killing off infected cells and helping to coordinate signals and messages sent out by the immune system. Nutrients that support mitochondria, therefore, help to improve immune function.

The authors of the British Journal of Nutrition study cited earlier also state that advances in our comprehension of amino acid metabolism in leucocytes will likely prove critical to the development of effective methods for preventing and treating diseases linked to immunodeficiency. They concluded that amino acids “hold great promise in improving health and preventing infectious diseases.”

Here are eight amino acids shown to have powerful benefits for immune function.

How Can I Boost My Immune System? Amino Acids and Immune Function

1. Alanine

Though alanine is a nonessential amino acid, it can become essential under certain circumstances. Vast concentrations of alanine can be found in muscle tissue. When the body detects an excess of alanine, it uses a process called catabolism to break it down into glucose and use it as energy. Alanine has also been shown to contribute significantly to immune cell function.

Per the British Journal of Nutrition article cited previously, the primary influence of alanine on immune function has to do with its role as a precursor for glucose, a key energy substrate of leucocytes. Evidence shows that supplementing with alanine can prevent immune cell apoptosis (cell death), enhance immune cell growth, and augment antibody production in B-lymphocytehybridoma.

Researchers have yet to identify the underlying mechanism for alanine’s beneficial effects but believe it may have to do with the inhibition of protein degradation in immunocytes.

2. Arginine

Our bodies require a plentiful supply of arginine, specifically L-arginine (if you would like, you can learn more about the difference between L- and D- amino acids here), for white blood cell proliferation and functionality. These cells need certain structures on their surface in order to recognize diseased or damaged cells, and arginine is involved in the formation of the molecules that serve this purpose.

Arginine is also involved in wound repair, and its availability is important for the production of nitric oxide (NO) through nitric oxide synthase. NO plays an important role in regulating the dilation of blood vessels, which decreases blood pressure by making it easier for blood to flow. Increased blood flow to an injured area of the body is important because it helps to deliver immune cells along with extra oxygen and nutrients needed to repair the damage.

NO is also important in the activation of inflammation as part of the immune response. Macrophages and a number of other immune system cells, including inflammatory cytokines, can actually make NO, which they then use to neutralize infectious organisms.

While increased availability of arginine can lead to higher levels of NO metabolites, the best way way to elevate arginine levels may be supplementing with citrulline, rather than arginine. The amino acid citrulline helps elevate arginine levels inside the cell, thereby boosting NO.

Both increased dietary L-arginine intake as well as arginine supplementation can majorly enhance immune function.

3. Glutamine

The amino acid glutamine (L-glutamine) plays a significant central role in maintaining immune function. The effects of glutamine include helping to create and mobilize white blood cells and aiding in phagocytosis. These processes are influenced by glutamine availability and may run inefficiently if glutamine concentrations drop too low.

Immune system cells use glutamine at a high rate, particularly in stressful situations like sepsis, injury, burns, surgery, and endurance exercise. In each of these conditions, the immune system is often suppressed. Glutamine supplementation has been shown to be valuable in maintaining immune function in these circumstances.

4. Glutathione

Glutathione, an antioxidant made of three amino acids, is produced endogenously within the human body. Antioxidants work by donating electrons to free radicals, which neutralizes them before they can cause harm. In addition to its antioxidant properties, glutathione is an important anti-inflammatory compound that can eliminate toxins. It is present in all cells and is believed to help prevent cancer.

Located in the mitochondria of the cell, glutathione is responsible for getting rid of the free radicals that occur naturally from energy-producing reactions in the cell. It does this by protecting vital parts of the cells from the destructive effects of reactive oxygen species (ROS), a chemical species that includes free radicals as well as heavy metals, peroxides, and lipid peroxides.

In the liver, glutathione binds to and neutralizes toxins by converting them to compounds that can be safely excreted from the body. Glutathione is recycled to some extent, but when free radicals, inflammation, and toxin levels are high, available glutathione levels decrease.

There are nutritional strategies to overcome this deficit but what would seem to be the most obvious, a glutathione supplement, is not the most efficient or effective. The reason is that glutathione is a small protein (called a peptide) made up of three amino acids: cysteine, glycine, and glutamate. If taken orally, the stomach does what it does to proteins, which is to digest it down to its component amino acids such that glutathione itself is not absorbed intact.

Increasing blood levels of the three component amino acids is a starting point to encourage glutathione synthesis. Glycine and glutamate are nonessential amino acids and usually present in good supply. Cysteine is considered semi-essential because it can be produced in the body, but it needs methionine, an essential amino acid, as a starting point.

Boosting cysteine in the cell is not an easy task. High doses of supplemental cysteine or its precursor methionine can be toxic or result in homocysteinemia, which is related to early development of heart and blood vessel disease.

Because of its unique chemical structure, N-acetyl-cysteine (NAC) can effectively increase cysteine levels in the cell. NAC is used for treating asthma and in the emergency room to reverse acetaminophen (Tylenol) poisoning. However, NAC is a medicine and therefore presents the potential for side effects including nasal irritation, vomiting, and development of a rash, among other problems.

Glutathione and its constituent amino acids are naturally present in many foods, in particular cruciferous vegetables as well as a variety of meat and dairy products. Whey protein is especially rich in cysteine and overall is a very good source of all essential amino acids. These dietary sources at a minimum provide the building blocks for glutathione synthesis.

A balanced essential amino acid supplement containing methionine is an effective approach for improving immune function and glutathione levels since the methionine can be converted to cysteine in the cell, ensuring that intracellular concentrations of cysteine are plentiful.

Glutathione can be replenished more successfully when other vitamins for immune system health, such as vitamins C and E, are available in good supply, as well as folate, B vitamins, and zinc, all of which act as cofactors in the synthesis of glutathione.

5. Isoleucine

Isoleucine, one of the branched-chain amino acids, can be found in many cells of the immune system, such as lymphocytes, eosinophils, and neutrophils.

Researchers have studied the uptake of isoleucine and the other BCAAs by a B cell line through the cell cycle and found that the pattern of uptake for all three is the same.

Decreasing concentrations of isoleucine and the other BCAAs can significantly impair immune cell production, but increasing them has not been shown to result in significant changes. In other words, the focus of supplementation with isoleucine and the other BCAAs should be on preventing a deficiency more than creating a surplus.

6. Taurine

Taurine, a conditionally essential amino acid, can be found throughout the body. It is the single most abundant free amino acid making up many key body parts, from your retinas to your heart to your skeletal muscles. Concentrations of taurine become especially dense leukocytes, a type of white blood cell, where they top out 50 mM.

Taurine offers particular benefits for wound healing. Studies have shown it has impressive tissue-protective capacities, perhaps because it reacts with hypochlorous acid (HOCl) to taurine chloramine, an oxidant derivative with greater stability and lesser toxicity than taurine itself. Researchers have found that taurine chloramine exerts an impressive regulatory influence over the immune system.

Evidence has shown that taurine chloramine can decrease production of pro-inflammatory mediators in white blood cells. It appears to do this by activating NFkappaB, a protein complex that relays signals related to the production of inflammatory cytokines.

7. Threonine

Threonine, an essential amino acid, is a vital component of healthy immune function. The thymus gland uses threonine to produce T lymphocytes, which then fight off infections.

Without an adequate supply of threonine, the body cannot produce enough T lymphocytes to protect the body from disease and injury.

8. Valine

Valine, another branched-chain amino acid, also makes integral contributions to immune system function. It seems to bring the immune system into balance, both enhancing the immune responses that protect us from infectious agents and reducing inappropriate immune responses such as chronic inflammation and autoimmune conditions.

Amino Acids and Immune Function: Final Takeaways

A strong immune system is the key to staying healthy, and the key to a strong immune system is proper nutrition with nutrient-dense foods and high-quality proteins and amino acids.

While specific amino acids have been shown to be particularly useful when it comes to enhancing immune function, the British Journal of Nutrition article explains that care must be taken when supplementing due to “the negative impact of imbalance and antagonism among amino acids.”

In simple terms, taking a well-formulated essential amino acid supplement will likely result in greater benefits for immune function than the use of a single amino acid supplement would. The effective use of amino acid supplements for immune support will consider the biochemistry and physiology of amino acids, their roles in immune responses, the nutritional and pathological states of individuals and expected treatment outcomes.