No How: Supporting Vascular Health

Dr. Jeff Gladd MD

Dr. Jeff Gladd MD

One of my goals as a provider is truly preventative medicine. It’s essential to get out ahead of disease or event rather than deal with the consequences. One tool in this fight is to understand the strategies for treating the condition when it’s already established and find low side effect and natural ways to support the body. To me, that’s the essence of building a solid nitric oxide (NO) support plan for my patients.

Next to aspirin, nitroglycerin is the other essential medication given to the patient who shows up to the emergency department with a myocardial infarction. Why? It is a drug that works by increasing NO release from endothelial cells allowing for the vasodilation essential to protecting the heart. NO, a signaling molecule in the cardiovascular system has been recognized for its role in smooth muscle relaxation, inhibition of leukocyte aggregation and attenuation of vascular cell proliferation; all essential components of a healthy blood vessel.

Long thought to be second in line to arginine as the NO support nutrient, citrulline has demonstrated it capacity to be as good, if not entirely surpass, arginine in this area. In reality, the mechanism of citrulline rests entirely on its conversion into L-arginosuccinate and subsequent conversion to arginine itself. The research relating to arginine directly supporting healthy nitric oxide levels has been mixed. However, the American Heart Journal conducted a meta review in 2011 that looked at L-arginine’s role as a substrate of nitric oxide synthase as well as the relationship to blood pressure. They identified 11 RDBPC trials that clearly demonstrate arginine’s role as a substrate and the subsequent ability to support healthy blood pressure levels.

Most of the literature focuses heavily on lysine’s necessary inclusion to an arginine formula to prevent a potential viral exacerbation. But lysine both on its own, and along with proline, has many attributes worthy of inclusion in a vascular support product. In 2014 it was found in an animal study that lysine intake was able to aid in supporting the health, integrity and mitigate the level of calcification of the vessel wall. It is theorized that proline aids in the binding of lipoprotein (a) thus diverting aggregation along the vessel wall and subsequent oxidative stress.

The dire consequence of cardiovascular disease is the heart attack. At that point, NO is stimulated by nitroglycerin to protect the heart and the patient’s life. Why not get out ahead of this and put a plan in place to support as much NO as possible in an effort to support your patient’s cardiovascular health?

Am Heart J. 2011 Dec;162(6):959-65

J Am Soc Nephrol. 2014 Sep;25(9):1954-65

The Latest Research On K2

Reviewed by: Adam Killpartrick, DC CNS

Author: Knapen MH, et al.

Reference: Menaquinone-7 supplementation improves arterial stiffness in healthy postmenopausal women. A double-blind randomized clinical trial. Thrombosis and Haemostasis. 2015 May;113(5):1135-44.

Objective: Investigation of long-term effects of MK-7 (180 µg MenaQ7/day) supplementation on arterial stiffness in a double-blind, placebo-controlled trial. Continue reading

Broader Application of CoQ10 and Curcumin

Dr Ronald Hoffman

Dr Ronald Hoffman

By: Dr. Ron Hoffman, MD

CoQ10 and Curcumin have long been applied in clinical practice, and are considered a staple for many, to support healthy cardio function. One unique aspect to consider about these nutrients, while recommended on their own or together, is not just their impact on cardiovascular health, but the breadth of application they have in practice beyond the heart. A couple of areas they support might actually surprise you. Continue reading

The Impact of Betaine HCL

Dr. BhogalBy Ramneek S. Bhogal, DC DABCI

As you’re walking past the café’s, delis, and bakeries in town and you realize that your digestion process is activated. You sense the increase in saliva production and the gurgling and churning of your stomach because this process starts in the mind. This is a valuable physiological process as it prepares the mouth and stomach to receive and process information and nutrients in the form of food by activating acid production and digestive enzyme activity.

Among many of the critical ‘moving parts’ in the digestion process one of them is the gentle and necessary increase of stomach acidity. Many deal with hypochlorhydria or achlrohydria, a condition in which there is a remarkable decrease in stomach acid production. This can be caused by an array of things ranging from chronic anti-acid drug therapy, by-pass surgery, a poor diet of processed foods, and even auto-immunity. As such, low stomach acid can make the digestion / absorption process less effective and negatively impact the growth of critical gastrointestinal bacteria. From a nutrient standpoint, most notable concerns are a decrease in pancreatic enzyme activation, the lack of breakdown of protein and the absorption of calcium, iron, and vitamin B12.

In terms of HCl’s role in GI flora population, when low acidity allows the introduction of potentially pathogenic microbes to the lower intestine, the patient is now at risk for disruption of the gut ecology. This state of dysbiosis has been theorized to contribute to enterocyte damage and be a contributing factor to a leaky gut and even autoimmune challenges.

The decrease in pancreatic enzyme activation is a basic physiologic mechanism that is disrupted with low acidity. When there is not adequate HCl introduced into the duodenum, Cholecystokinin, which stimulates the pancreas to release digestive enzymes, is not triggered and released as part of a functional digestion process. This can have a negative effect downstream on nutrient liberation, absorption and utilization.

The nutrient malabsorption is well documented and something to pay close attention to with patients complaining of fatigue. When B12 and iron are not being absorbed properly, laboratory tests may appear normal from the body’s attempt to maintain homeostasis, but the patient may present with the prodromal signs of fatigue due to the subclinical deficiency created by the lack of HCl.

Incorporating natural supplemental acids can be a very effective step in activating natural digestive acids for healthier digestion and absorption. Betaine HCl is one naturally occurring acid found in grains and beets that has been used for centuries as a digestive ‘bitter’ or tonic. When timed well and in the correct dosage, betaine HCl naturally acidifies the stomach so that digestion can be optimal both mechanically and chemically. Given the gut’s connection and ability to cross talk to so many other bodily systems, it makes sense to ensure you start off with the right amount of acidity.


Beasley DE, Koltz AM, Lambert JE, Fierer N, Dunn RR. The Evolution of Stomach
Acidity and Its Relevance to the Human Microbiome. PLoS One. 2015 Jul
29;10(7):e0134116. doi: 10.1371/journal.pone.0134116. Review. PubMed PMID: 26222383

Yago MR, Frymoyer AR, Smelick GS, Frassetto LA, Budha NR, Dresser MJ, Ware JA, Benet LZ. Gastric reacidification with betaine HCl in healthy volunteers with rabeprazole-induced hypochlorhydria. Mol Pharm. 2013 Nov 4;10(11):4032-7. doi: 10.1021/mp4003738. PubMed PMID: 23980906

Methylation Matters


Dr. Adam Killpartrick

By Dr. Adam Killpartrick

What is Methylation?
We can think of the addition and subtraction of methyl groups as a switch. When a methyl group is added to a compound, a reaction begins. Perhaps it is the turning “on” of a gene or the activation of one enzyme. When a methyl group is taken away from a compound, a reaction such as this is being turned “off.”

Prevalence of Variation Within Methylation Pathways
It has been estimated that 40 percent of the population may have some sort of variation in the MTHFR gene, which regulates the methylenetetrahydrofolate reductase (MTHFR) enzyme and its activity.1  because these variations can directly affect methylation processes through their impact on the folate cycle, they are a necessary component of any conversation about healthy methylation reactions. Continue reading

Embracing Fibromyalgia Visits

Dr. Jeff Gladd MD

Dr. Jeff Gladd MD

Dr. Jeff Gladd, MD

We’ve all been there. The slumped shoulders and trapezius tightness of seeing “fibromyalgia” as the reason for visit before we enter the room. A couple deep breaths. A look at the watch. A sigh in entering the room, knowing we do not have much to offer this unfortunate patient for relief of their chronic pain.

That’s what I used to think too. Until I found a supplement regimen whose benefits can provide energy to tense muscle trigger points and building that into a lifestyle regimen that patients can follow. After following the evidence that exists, trialing it on patients and getting reports of success, I am embracing these visits and enjoy every minute of it.

Continue reading

The 3 Pillars of Healthy Sleep

Ideal SleepBy Dr. Fred Pescatore

Sleeping is as vital to human health as food, water and air. It has been directly connected to weight management, heart health, cognitive health as well as brain detoxification and mitochondrial function. And I think we’ve all had patients that present with a seemingly unbeatable case of insomnia. They’ve tried everything: low dose melatonin, high dose melatonin, teas, going to bed at the same time every night, relaxing music that sounds like the beach, meditation, copious amounts of alcohol and the list goes on. While a number of these strategies work for select patients, I’ve run into many patients that have needed a more complete approach.

Continue reading

Decreasing Cortisol: The Weight Is Over

By Dr. Gary Kracoff, RPh, NMD

One of the most prevalent ways that elevated cortisol presents is abdominal adiposity and obesity.  This is driven by two areas of physiology that I would say are ‘somewhat’ understood by the majority of practitioners I speak with.  More than ever people are making the connection between cortisol and abdominal adiposity, but the most significant mechanisms have remained unexplored in the recesses of physiology texts.

Dr. Gary Kracoff, RPh, NMD

Dr. Gary Kracoff, RPh, NMD

As doctors continue to bring this information to the forefront of their patients’ minds, the clinical outcomes will continue to improve as will the health of the practice itself.

The two target tissues that cortisol hones in on are the adipocytes themselves and thyroid hormone.  Repeated activation of the HPA axis results in excessive secretion of cortisol.  The cortisol then binds to the glucocorticoid receptors on fat cells which in turn activate lipoprotein lipase, which leads to…you guessed it, fat storage in the adipocytes.  And it just so happens that there are a greater concentration of glucocorticoid receptors in visceral as opposed to peripheral adipose tissue.  This observation of the presence of abdominal fat is the basis upon which practitioners make clinical judgement regarding the presence of excessive cortisol. Continue reading

What is DIM?

Dr Ronald Hoffman

Dr Ronald Hoffman

By Dr. Ronald Hoffman

Diindolylmethane (DIM) is a versatile nutraceutical for which I find many uses in my practice. It is naturally obtained via dietary consumption of cruciferous vegetables. Brussel Sprouts, Garden Cress, Mustard Greens, Turnip, and Kale are rich sources of glucobrassicans, the mother compounds of beneficial glucosinolates like indole-3-carbinol, which is metabolized into DIM. However, heat treatment, particularly boiling and microwaving, degrades?myrosinase, the plant compound responsible for bio-transformation of glucobrassicans into useful compounds like DIM and sulforaphane.

An advantage of supplementation with DIM over consumption of large amounts of raw cruciferous vegetables is avoidance of goitrogenic isothiocyanates. These compounds compete with iodine for binding in the thyroid, potentially contributing to hypothyroidism. DIM is thought not to have goitrogenic properties. To obtain the benefits of DIM contained in just two capsules per day, it is estimated that the average person would have to consume two pounds of raw cabbage family vegetables per day, an intake that might court the danger of thyroid suppression. Continue reading

How does stress affect weight and metabolism?

stress phases metabolismBy Ramneek S. Bhogal, DC, DABCI

As health care practitioners, we are all very well aware of the role that stress plays in our patient’s well-being. We see clinical presentations like anxiety, sleeplessness, insomnia, fatigue, trouble with motivation, moodiness, changes in sexual and/or reproductive health, changes in weight, and even compromised immunity to everyday infections.

One of the most impactful symptoms of stress on patients today is that of weight gain and difficulty losing weight. When we dig into this elegant “stimulus and response” type of mechanism, it’s amazing how the secretion of such simple chemicals in the body can trigger such changes in our metabolic health.

Defining Stress

What exactly is this thing we call “stress?” We understand that the human body is influenced by physical trauma, by mental or emotional challenges and by chemical or toxic challenges. All three of these things can be categorized as stress.

So let’s agree on our working definition of stress as being anything threatening or stimulatory to the point where it causes us to respond in an inadequate or dysfunctional manner. It could be physical, chemical or of a mental/emotional etiology. Basically, this is the body’s natural instinct to protect itself. These very stressors are what impact weight and metabolism physiology.

The great scientist and physician, Hans Selye, gave the world the General Adaptation Model of stress in 1936. Simply put, he organized stress into three stages.

The First Stage of Stress: ALARM STAGE

In this stage, stress and cortisol output should function as expected. In the face of a stressful event, your body alarms you with a sudden jolt of hormonal changes, namely an elevation of catecholamines, and you are now immediately equipped with enough energy to handle it. Then you normalize relatively quickly. In short…cortisol rises and then falls back to normal.

The Second Stage of Stress:  RESISTANCE STAGE

If a stressful condition persists, your body adapts by a continued effort in resistance and remains in a state of arousal. This ongoing state of stimulus or stress begins demanding of your body, a steady outpouring of cortisol. We find more of this stress hormone lingering at higher than desired levels. This is an upregulatory state of awareness, alertness, alarm, and often the stage where a patient will iterate that they are “stressed out.”

It is in this stage where we can see the effect of stress on weight and weight gain, namely in the form of increased body fat and obesity. Studies have made clear that an elevation in stress and subsequent cortisol output directly increase individual appetite and craving for sugar. This carbohydrate craving often leads to poor selection of foods as simple processed carbohydrates are in convenient supply in society.

With cortisol elevated in the bloodstream, it acts as a ligand mimic and effectively binds to target tissues designated for glucose. Glucose, then, not only elevates but renders the patient in search of “quick carbs.” This mechanism is ultimately responsible for the aforementioned cravings. In addition, stress stimulates the hypothalamus to produce corticotropin releasing factor (CRF). CRF is also directly known to stimulate appetite.


Once stress becomes so pervasive and ongoing, your body’s ability to resist is lost because its adaptation energy supply is gone. The body is no longer able to sustain a constant level of cortisol output and this chronic failure is often characterized with fatigue, exhaustion, and increased hippocampal dysfunction. This change in brain chemistry lends itself to apathy, lack of motivation and sadness. Physical activity is no longer a priority and neurochemically, fat is being deposited faster than it can be decreased with dieting and exercise.

It becomes imperative to modulate and control stress in any patient’s lifestyle to not only impact overall health and well-being, but also weight and metabolism changes. This will help curtail negative cardiovascular and pre-diabetic/insulin resistant outcomes as well.

When a patient is identified as being in stage two, management strategies should include helping the patient down-regulate their stress, make healthier choices with a diet with ample healthy protein and fiber from fruits and vegetables. While this is also the case with a patient in stage three, clinical consideration needs to be given to replenishing cortisol function with nutraceutical support.

Want to learn more about the three phases of stress? Read the HPAT Axis white paper here.





The legacy of Hans Selye and the origins of stress research: a retrospective 75 years. Szabo S, Tache Y, Somogyi A. Stress. 2012 Sep;15(5):472-8. doi: 10.3109/10253890.2012.710919.

Stress. 2015;18(5):498-506. doi: 10.3109/10253890.2015.1067677. Epub 2015 Aug 13.Endocrine stress responses and risk of type 2 diabetes mellitus. Siddiqui A1,2, Madhu SV2, Sharma SB3, Desai NG4.

J Clin Endocrinol Metab. 1982 Jan;54(1):131-8. Cortisol-induced insulin resistance in man: impaired suppression of glucose production and stimulation of glucose utilization due to a postreceptor detect of insulin action. Rizza RA, Mandarino LJ, Gerich JE.

Cochrane Database Syst Rev. 2015 Feb 10;2:CD003200. doi: 10.1002/14651858.CD003200.pub3. Exercise therapy for chronic fatigue syndrome. Larun L1, Brurberg KG, Odgaard-Jensen J, Price JR.