Coenzyme Q10 (CoQ10) is a powerful antioxidant found in every cell of our body. It is necessary for the production of cellular energy, which is essential for every single process of life. Ubiquinol is the active form of CoQ10.

From 2007 to 2012, CoQ10 use increased from 574,000 to over 3 million US adults (1). As one of the most commonly used dietary supplements in the United States, CoQ10 has been studied extensively for the prevention and treatment of chronic conditions and diseases (1). 2018 publications have added to our repertoire of CoQ10 knowledge, suggesting its role in promoting cardiovascular health.

Heart Health

“Heart failure is a complex clinical syndrome that results in an inadequate cardiac output and reduced ejection capacity due to serious structural or functional abnormalities of the heart,” (2). Millions of people are diagnosed with heart failure worldwide every year (2).

Prior to the release of the 2018 publications, research has suggested that CoQ10 supplementation increases CoQ10 levels in plasma, platelets, and white blood cells (2). To investigate and further validate the beneficial role of CoQ10 on heart disease management, a 2018 systematic review was conducted. The literature suggests CoQ10 supplementation in patients with heart failure not only improved functional capacity, but also significantly reduced cardiovascular events and mortality (1).

Additionally, a 12-year follow-up study found that those who supplemented with selenium and CoQ10 had a significantly reduced cardiovascular mortality risk of more than 40%, and a significant risk reduction in those with hypertension, ischemic heart disease, impaired cardiac function, and diabetes (3).

Where can I find CoQ10?

CoQ10 can be found in your diet from foods such as beef, chicken, peanuts, oranges, strawberries, broccoli and cauliflower. Alternatively, you can supplement your diet with epic4health’s bioenhanced and easily absorbed CoQ10.

Not only can CoQ10 be found in a variety of foods and dietary supplements, but also in skincare products, such as Derma Q-Gel®!

Skin Care

In addition to its role in heart disease management, CoQ10 acts as an anti-aging and anti-wrinkle agent due to its insolubility and poor permeability (4).

Due to its direct contact with the environment, skin cells are constantly involved in tissue regeneration and repair, which require high amounts of energy and a well-regulated cellular metabolism (5). With increasing age, however, energy production and mitochondrial activity decline which results in the well-known signs of skin aging, such as the appearance of wrinkles and lines, as well as loss of elasticity (5).

During the process of energy production, CoQ10 is converted into its reduced form, known as ubiquinol (Q10), which protects mitochondria, lipid membranes, lipoproteins, and also DNA from oxidative damage. In skin, Q10 levels decline with increasing age as well as UV-irradiation exposure. With this in mind, Knott and colleagues (2015) investigated whether human skin may benefit from a topical Q10 treatment. Their findings suggest that topical Q10 treatment is effective in replenishing Q10 and enhancing cellular energy metabolism and antioxidant effects (5).

A more recent publication aimed to improve skin permeability by creating an oil-in-water nanoemulsion. This nanoemulsion was formulated to serve as an efficient vehicle for delivering CoQ10 through the skin barriers. CoQ10 nanoemulsions successfully reduced skin wrinkles and created a smoother skin appearance. With that being said, this study suggests the potential use of CoQ10 nanoemulsions as a method for enhancing solubility and permeability of CoQ10 and thus improving its anti-wrinkle efficiency (4).

Curious to learn about CoQ10 and its role in the treatment of mitochondrial diseases? Find out by visiting our blog!

References

(1) Ayers J, Cook J, Koenig RA, Sisson EM, Dixon DL. Recent Developments in the Role of Coenzyme Q10 for Coronary Heart Disease: A Systematic Review. Curr Atheroscler Rep. 2018 May 16;20(6):29. doi: 10.1007/s11883-018-0730-1. Review.

(2) Lei L, Liu Y. Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials. BMC Cardiovasc Disord. 2017 Jul 24;17(1):196. doi: 10.1186/s12872-017-0628-9.

(3) Alehagen U, Aaseth J, Alexander J, Johansson P. Still reduced cardiovascular mortality 12 years after supplementation with selenium and coenzyme Q10 for four years: A validation of previous 10-year follow-up results of a prospective randomized double-blind placebo-controlled trial in elderly. PLoS One. 2018 Apr 11;13(4):e0193120. doi: 10.1371/journal.pone.0193120. eCollection 2018.

(4) El-Leithy ES, Makky AM, Khattab AM, Hussein DG. Optimization of nutraceutical coenzyme Q10 nanoemulsion with improved skin permeability and anti-wrinkle efficiency. Drug Dev Ind Pharm. 2018 Feb;44(2):316-328. doi: 10.1080/03639045.2017.1391836. Epub 2017 Nov 2.

(5) Knott A, Achterberg V, Smuda C, Mielke H, Sperling G, Dunckelmann K, Vogelsang A, Krüger A, Schwengler H, Behtash M, Kristof S, Diekmann H, Eisenberg T, Berroth A, Hildebrand J, Siegner R, Winnefeld M, Teuber F, Fey S, Möbius J, Retzer D, Burkhardt T, et al. Topical treatment with coenzyme Q10-containing formulas improves skin’s Q10 level and provides antioxidative effects. Biofactors. 2015 Nov-Dec;41(6):383-90. doi: 10.1002/biof.1239. Epub 2015 Dec 9.

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

Best ice pops to keep you cool in the summer heat while keeping your health in check.

When looking at a nutrition label, it can be overwhelming. You might wonder what you should be looking for, or what values are “good” and what values are “bad”. When it is hot and humid and you are looking for something to cool you off, the last thing you want to do is dissect a nutrition label.

So, to make it simple, look at these three things: total carbohydrates, total fat, and the INGREDIENTS list!

It is so important not to forget to look at the ingredients. As a general rule of thumb, try selecting products with no more than 10-12 ingredients and products with ingredients that you can actually pronounce. If you can’t read the ingredients, chances are they are not what you want in your body.

*As we take a closer look at the specifics, please note that all referenced ice pops contain < 130 calories and < 2 g total fat.

Although the Skinny Cow Full on Fudge Bar is known to be a low calorie sweet treat, it contains high amounts of sugar. With that being said, it is extremely important to remember to look beyond the calories. Just because the box screams, “100 calories”, does not make it “healthy”!

The Creamsicle and Yasso Frozen Yogurt Pops are also relatively high in total carbohydrates and are accompanied by a long list of ingredients.

However, Ruby Rocket’s Galaxy Green Pops are here to save the day! They are not only tasty and refreshing, but also low in sugar and fat with relatively few ingredients! This one is definitely a winner!

As follow ups, we have Simply Popsicles and Minute Maid Juice Bars which both contain less than 10 g total carbohydrates each and consist of a reasonably short list of ingredients.

Other ice pops that are noteworthy, in terms of total carbohydrates, total fat, and listed ingredients are as follows:

• GoodPop Frozen Pops Strawberry
• Whole Fruit Organic Juice Tubes Apple Cherry
• Chloe’s Pops Mango
• Lifeway Frozen ProBugs Orange Creamy Crawler
• Lifeway Frozen Kefir Bars Vanilla
• Outshine Fruit & Veggie Bars Acai Blueberry

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

Does your body have enough carnitine?

Carnitine palmitoyltransferase II (CPT-II) is an enzyme located in the inner membrane of the mitochondria and a vital component of the carnitine transport system. A CPT-II deficiency is one of the most common mitochondrial beta-oxidation defects and is a result of a genetic mutation. When the body is deficient of CPT-II, it is unable to metabolize long chain fatty acids and convert it to energy in the form of ATP.

There are three main types of CPT-II deficiencies: a lethal neonatal form, a severe infantile hepatocardiomuscular form, and a myopathic form. The neonatal form is rapidly fatal and presents itself shortly after birth. This form can be characterized by respiratory distress, seizures, altered mental status, hepatomegaly, cardiomegaly, cardiac arrhythmia, and, in many cases, dysmorphic features, renal dysgenesis, and neuronal migration defects. The infantile form usually presents between 6 and 24 months of age causing loss of consciousness and seizures, liver failure, and transient hepatomegaly.

The myopathic form of CPT-II deficiency is most frequently found in adolescents or young adults. Compared to infants, the adult onset CPT-II deficiency is less severe because infants rely on fats as their primary source of caloric intake, while adults have a greater variety of foods that can contribute to his or her total caloric intake.

Given its importance in fatty acid oxidation and energy metabolism, l-carnitine has been investigated as ergogenic aid for enhancing exercise capacity and acute physical performance. An increase in serum and muscle L-carnitine is suggested to enhance blood flow and oxygen supply to muscle tissue. Furthermore, L-carnitine supplementation can have a positive impact on the recovery process after exercising by alleviating muscle injury and reducing markers of cellular damage and free radical formation accompanied by attenuation of muscle soreness. Research conducted in older populations showed that l-carnitine intake can even lead to increased muscle mass, accompanied by a decrease in body weight and reduced physical and mental fatigue.

Due to the complexity of treating a CPT-II deficiency, it is important to point out that kidney, liver, and cardiovascular concerns may be provoked. With that being said, it is important to discuss treatment options with a healthcare professional.

For individuals with the myopathic form of CPT-II deficiency, it is recommended to consume a high carbohydrate (70%) and a low fat (<20%) diet for the purposes of energy production. Furthermore, it is important to avoid extended periods of fasting and strenuous exercise, and to be sufficiently hydrated in order to avoid potential kidney problems. Individuals with this deficiency should also have easy access to a source of simple carbohydrates, such as a piece of fruit and increase their carnitine intake by consuming red meat and dairy products. Carnitine can also be found in fish, poultry, tempeh, wheat, asparagus, avocados, and peanut butter. However, if levels remain low, it may be beneficial to use a carnitine dietary supplement.

References

Du S, Zhang F, Yu Y, Chen C, Wang H, Li D. Sudden infant death from neonate carnitine palmitoyl transferase II deficiency. Forensic Science International. 2017; 278: e41-e44.

Fielding R, Riede L, Lugo JP, Bellamine A. l-Carnitine Supplementation in Recovery after Exercise. Nutrients. 2018; 10(3): 349.

Hori T, Fukao T, Kobayashi H, Teramoto T, Takayanagi M, Hasegawa Y, Yasuno T, Yamaguchi S, Kondo N. Carnitine Palmitoyltransferase 2 Deficiency: The Time-Course of Blood and Urinary Acylcarnitine Levels during Initial L-Carnitine Supplementation. The Tohoku Journal of Experimental Medicine. 2010; 221(3): 191-195.

Joshi PR, Deschauer M, Zierz S. Clinically symptomatic heterozygous carnitine palmitoyltransferase II (CPT II) deficiency. The Central European Journal of Medicine. 2012; 124(23-24): 851-854.

Knottnerus SG, Bleeker JC, Wüst RI et al. Disorders of mitochondrial long-chain fatty acid oxidation and the carnitine shuttle. Rev Endocr Metab Disord. 2018: 1-14.

Lehmann D, Motlagh L, Robaa D, Zierz S. Muscle Carnitine Palmitoyltransferase II Deficiency: A Review of Enzymatic Controversy and Clinical Features. International Journal of Molecular Sciences. 2017; 18(1): 82.

Longo N. Primary Carnitine Deficiency and Newborn Screening for Disorders of the Carnitine Cycle. Annals of Nutrition and Metabolism. 2016; 68(3): 5-9.

Longo N, Filippo CA, Pasquali M. Disorders of carnitine transport and the carnitine cycle. Am J Med Genet Part C Semin Med Genet. 2006; 142C(2): 77-85.

Magoulas PL, El-Hattab, AW. Systemic primary carnitine deficiency: an overview of clinical manifestations, diagnosis, and management. Orphanet Journal of Rare Diseases. 2012; 7: 68.

Ringseis R, Keller J, Eder K. Role of carnitine in the regulation of glucose homeostasis and insulin sensitivity: evidence from in vivo and in vitro studies with carnitine supplementation and carnitine deficiency. Eur J Nutr. 2012; 51(1): 1-18.

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

“Energy and persistence conquer all things*”

– and all things including a productive, high-intensity workout!
*Quoted from Benjamin Franklin

Whether it is your favorite pre-workout powder or a banana smoothie, fueling up before you exercise gives you more energy during your workouts, protects your hard-earned muscle, and increases your muscle growth.

Pre-workout foods and supplements

Coffee, whole wheat foods, smoothies, yogurts, cottage cheese and fruits

• Fruits promote endurance, muscle strength, and fat loss
• Nuts are high in protein and fiber—slowing the digestion to provide a long-lasting source of energy
• Dairy contains protein and calcium to help build strong muscles and bones
• Whole wheat products digest slowly which keep you energized throughout your workout
• Coffee increases circulation, providing more oxygen to the muscles and it increases your metabolism

 
For a list of the top-quality pre-workout supplementation, visit epic4health.com

Components of a good PRE-workout meal

• Aim to eat 2 to 4 hours before exercising
• Consume meal high in carbohydrates and low in fats, protein, and dietary fiber
• Choose a meal that is not calorically dense
• Drink 16-20 fluid ounces of water at least four hours before exercise and 8-12 fluid ounces 10-15 minutes before exercise

 
Helpful Tips

• Do not overdo the protein
• Do choose energy bars wisely
• Do not work out on an empty stomach

 
Components of a good POST-workout meal

• Aim to eat within the first half hour after you finish exercising
• Consume carbohydrates, protein, and fat to replenish glycogen stores and build and repair muscle tissue
• Drink 20-24 fluid ounces of water for every one pound lost

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

(MSUD) is an autosomal recessive disorder that has a worldwide incidence of approximately 1:185,000. This disease results from the defective activity of branched chain ketoacid dehydrogenase (BCKAD). This enzyme is responsible for the breakdown of branched chain amino acids (Minnesota Department of Health, 2012). If the activity of this enzyme is defective, branch chain amino acid (BCAA) levels will become elevated in the blood and urine (Dolins, 2016). High levels of leucine, one of the three BCAAs, create a strong affinity for transporting protein to the brain. This large influx of leucine prevents the passage of other amino acids. It is important to recognize that it is leucine that is problematic. However, if valine and isoleucine are too low, leucine will not decrease (Dolins, 2016). With that being said, isoleucine and valine supplementation is only necessary to maintain proper concentrations of plasma leucine, isoleucine, and valine. It is important for leucine and isoleucine to be approximately of equal amounts and for valine to have at least a twofold plasma leucine concentration (Strauss, 2013).

Suggestions related to nutritional therapy include, a diet restrictive of BCAAs, necessary vitamins to prevent malnutrition, and the administration of 150 calories/kg/day as carbohydrates and fat. It is important for individuals to achieve and maintain plasma BCAA concentrations within targeted treatment ranges and monitor nutritional status to promote normal growth, development and health maintenance. The dietary requirements for BCAAs vary as a function of age, growth rate, calorie intake, illness, and residual in vivo BCKAD enzyme activity. The recommendations for maintaining appropriate BCAA blood concentrations are as follows:

Infants can consume formulas that include protein equivalents, such as Ketonex I, BCAD I, and Analog MSUD. Artificial formulas are also available for children and adults with MSUD and consist of synthetic amino acid mixtures that restrict BCAAs, but contain other essential macro- and micronutrients (Boyer, 2015). These formulas are the primary source of calories and nutrients for individuals with MSUD.

It is also important to be aware that low protein foods may lack other important nutrients (Dolins, 2016). In order to prevent malnutrition, it may be necessary to use dietary supplementation to maintain sufficient levels of calcium, magnesium, zinc, folate, selenium, and omega-3 essential fatty acids (Strauss, 2013). Furthermore, thiamine supplementation has shown to be beneficial in those who have residual BCKAD activity (Abdulahad, n.d.). If an individual is responsive to thiamine, supplementation of 50-100 mg/day thiamine is suggested (Strauss, 2013). New and novel therapies, such as the use of phenylbutyrate, are being examined for the treatment of MSUD. However, the research is limited and recommendations for these new therapies cannot currently be addressed.

Additional Resources

Nutrition Management Guideline for MSUD

References

Abdulahad, B. (n.d.). Thiamin-Responsive Maple Syrup Urine Disease. Retrieved December 13, 2016, from http://www.msud-support.org/index.php/articles/news/592-thiamin-responsive-maple-syrup-urine-disease

Boyer, S. W., Barclay, L. J., & Burrage, L. C. (2015). Inherited Metabolic Disorders: Aspects of Chronic Nutrition Management. Nutrition in Clinical Practice. 30(4). doi:10.1177/0884 533615586201

Dolins, K. R. Inborn Errors of Metabolism [PowerPoint]. Retrieved from https://moodle2.tc. columbia.edu/course/view.php?id=24428

Frazier, D. M., Allgeier, C., Homer, C., Marriage, B. J., Ogata, B., Rohr, F., Splett, P. L., Stembridge, A., Singh, R. H. (2014). Nutrition management guideline for maple syrup urine disease: An evidence- and consensus- based approach. Molecular Genetics and Metabolism. 112(3). https://doi.org/10.1016/j.ymgme.2014.05.006

Strauss, K. A., Puffenberger, E. G., Morton, D. H. (2013). Maple Syrup Urine Disease. GeneReviews. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK1319/

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

Menopausal women experience a hormonal imbalance which can lead to a number of different clinical syndromes and disorders (1). Menopause is characterized by a decrease in estrogen, which triggers uncomfortable symptoms such as hot flushes, night sweats, sleep disturbances, vaginal dryness (2), and an increased risk of osteoporosis (3).

Estrogen is a hormone that is naturally produced by your body and plays an important role in managing your reproductive system, protecting your bones, and helping your skin heal. Phytoestrogens on the other hand are produced by plants but are functionally similar to estrogen (2). When we eat foods with phytoestrogens, our bodies may respond as if our own estrogen were present.

Although phytoestrogens can easily be found in legumes, such as soybeans, chickpeas, alfalfa and red clover (4), most American women fail to consume these food items in adequate amounts. Meanwhile, Asian women incorporate higher amounts of phytoestrogen-rich foods into their diet and experience menopausal symptoms less frequently than American women (2,5). Could this absence of symptoms be a coincidence—or could this be due to their phytoestrogen-rich diet?

Various research studies have focused on phytoestrogens as a safe and effective treatment for menopausal symptoms. One study investigated the effects of Femarelle—a natural medication that contains a variety of phytoestrogens derived from tofu— on 631 Spanish menopausal or perimenopausal women. After 4 weeks, 80.7% of patients reported that their hot flushes were ‘better’ or ‘much better’. With that being said, the authors of this study concluded that treatment with Femarelle resulted in a “significant reduction in the number and intensity of hot flushes in postmenopausal women, especially in those with frequent symptoms, and these effects were observed within the first month of treatment,” (3).

Aside from this prospective study, several systematic reviews have also been published related to phytoestrogens and menopausal symptom relief—all of which found a reduction in the frequency or severity of hot flashes in menopausal women (2,5,6).

Although estrogen- and progestogen-based hormone therapy are commonly used as a first treatment option for menopause symptom relief, these treatments have numerous risks (3). According to the Women’s Health Initiative, hormone replacement therapy as a means for alleviating symptoms related

to menopause can increase the risk of stroke and venous thromboembolism, which can inadvertently lead to breast cancer or a heart attack (2).

Instead of hormone replacement therapy, menopausal symptom relief can be treated with a phytoestrogen-rich diet and/or dietary supplementation. If you would like to incorporate phytoestrogens into your diet, here are three Registered Dietitian-approved tofu recipes…

Food, Pleasure, and Health’s Baked Tofu Fries                                            

Wellness Simplified’s Crispy Tofu Meatballs                                                 

The Conscious Dietitian’s Tofu Salad Bowl with Glory Bowl Dressing          

…OR if tofu doesn’t do it for you,

try Femarelle Recharge from epic4health.com.

References

(1) Rosic S, Kendic S, Rosic M. Phytoestrogens impact on menopausal symptomatology. Materia Socio-Medica. 2013; 25(2): 98.

(2) Chen M, Lin C, Liu C. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric. 2015; 18(2): 260-269.

(3) Sánchez-Borrego R, Mendoza N, Llaneza P, Sánchez-Borrego R. A prospective study of DT56a (Femarelle®) for the treatment of menopause symptoms. Climacteric. 2015; 18(6): 813-816.

(4) Eden JA. Phytoestrogens for menopausal symptoms: A review. Maturitas. 2012; 72(2): 157-159.

(5) Lagari VS, Levis S. Phytoestrogens for menopausal bone loss and climacteric symptoms. The Journal of Steroid Biochemistry and Molecular Biology. 2014; 139: 294-301.

(6) Roberts H, Lethaby A. Phytoestrogens for menopausal vasomotor symptoms: A Cochrane review summary. Maturitas. 2014; 78(2): 79-81.

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders among children—many of whom have trouble paying attention, controlling impulsive behaviors, or being overly active (1).

It is estimated that 5% of US children have ADHD, with 6.1 million in 2016 (2).

The rise of ADHD in young children ages 2-5 is particularly alarming, as rates more than doubled from 2007 to 2012 (2).

Oftentimes, ADHD occurs with other disorders and conditions, such as depression, autism spectrum disorder, and Tourette Syndrome. In 2016 alone, 75% US children with ADHD had at least one other mental, emotional, or behavioral disorder (2).

Causes of ADHD

The cause(s) and risk factors for ADHD are unknown, despite the common, yet inaccurate, belief that ADHD is caused by consuming too much sugar, watching too much television, parenting, or social and environmental factors. However, there is strong enough evidence to show that genetics plays an important role. Other possible causes and risk factors include brain injury, alcohol and tobacco use during pregnancy, premature delivery, and low birth weight (1).

Signs and symptoms

Although most children typically have trouble focusing, children with ADHD have trouble outgrowing such behaviors (1).

A child with ADHD might:

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others (1)

Treatment for ADHD   

Treatment for ADHD can include behavior therapy and/or medication. For children 6 years of age and older, the American Academy of Pediatrics recommends both behavior therapy and medication. For younger children under the age of 6 with ADHD, behavior therapy is recommended as the first line of treatment, before medication is introduced (2).

However, every child is unique and may take to a particular treatment differently. With that being said, it is important that treatments are closely monitored (1).

What about L-theanine?

L-theanine is a water-soluble amino acid known to promote a “relaxed, yet alert, feeling at rest” (3). Aside from its ability to reduce stress, anxiety, and blood pressure, L-theanine may also be effective in the treatment of ADHD.

Evidence-based research has shown a variety of benefits from taking L-theanine. It has been shown to have a calming effect when people are under physical and psychological stress, enhance attentional capacity and mental clarity, and improve overall cognitive performance. It has also been found to improve simple reaction time, speed of numeric working memory, word recognition, and accuracy of sentence verification.

A 2011 randomized controlled clinical trial investigated the efficacy and safety of L-theanine as an aid to improving sleep quality among 98 boys, ages 8-12, who have been formally diagnosed with ADHD. Participants consumed two chewable tablets of L-theanine twice daily, totaling 400 mg/day for six weeks. After collecting and analyzing the data, the authors concluded that 400 mg/day of L-theanine is safe and effective in improving some aspects of sleep quality in boys diagnosed with ADHD (4).

Managing ADHD

Although being healthy is important for all children, it is particularly important for children with ADHD. Having a healthy lifestyle can help children deal with symptoms relating to ADHD. According to the Centers for Disease Control and Prevention, healthy behaviors for children with ADHD include:

• Eating a healthful diet centered on fruits, vegetables, whole grains, legumes, lean protein sources, and nuts and seeds
• Participating in physical activity for at least 60 minutes each day
• Limiting screen time from TVs, computers, phones, etc.
• Getting the recommended amount of sleep each night based on age (1)

References

(1) Attention-Deficit/Hyperactivity Disorder (ADHD): General Information. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/facts.html. Updated May 31, 2017. Accessed June 22, 2018.

(2) Attention-Deficit/Hyperactivity Disorder (ADHD): Data & Statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/data.html. Updated March 20, 2018. Accessed June 22, 2018.

(3) Owen GN, Parnell H, De Bruin EA, and Rycroft JA. The combined effects of L-theanine and caffeine on cognitive performance and mood. Nutritional Neuroscience. 2008; 11(4), 193-198.

(4) Lyon MR. The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): A randomized, double-blind, placebo-controlled clinical trial. Alternative medicine review. 2011; 16: 348-354.

Barrett JR, Tracy DK, Giaroli G. To Sleep or Not To Sleep: A Systematic Review of the Literature of Pharmacological Treatments of Insomnia in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. Journal of Child and Adolescent Psychopharmacology. 2013; 23(10) :640-647.

Giesbrecht T, Rycroft JA, Rowson MJ, De Bruin EA. The combination of L-theanine and caffeine improves cognitive performance and increases subjective alertness. Nutritional Neuroscience. 2010; 13(6), 283-290.

Millichap JG, Yee MM. The Diet Factor in Attention-Deficit/Hyperactivity Disorder. Pediatrics. 2012; 129(2): 330-337

Rucklidge JJ, Frampton CM, Gorman B, Boggis A. Vitamin–mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. British Journal of Psychiatry. 2014; 204(4): 306-315.

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

Omega-3 fatty acids are essential fatty acids, vital for normal body functioning. The three most important types are alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These essential fatty acids have an array of health benefits and are considered by many investigators to be beneficial in the prevention or treatment of several diseases, such as heart disease, non-alcoholic fatty liver disease, Alzheimer’s disease, inflammatory disease, eye disease, and bone disease. Other health benefits of omega-3 fatty acids include…

1. Reducing waist circumference
2. Maintaining healthy skin
3. Lowering the risk of cancer
4. Encouraging early growth and development
5. Reducing the risk of childhood asthma and allergies

…and the list goes on and on and on…

Although omega-3 fatty acids are popularly known for their heart-healthy benefits, growing evidence suggests they can also serve as a potential treatment for major depressive disorder. Taking a closer look at omega-3 supplementation in pediatric populations, multiple randomized controlled trials suggest its positive role on children and adolescents with mood disorders, such as depression or bipolar disorder, or on children at ultra-high-risk for psychosis. Key findings are highlighted below:

1. Decreased impairment in executive functioning* was associated with omega-3 supplementation in youth with mood disorders (Vesco, 2018)
2. Data suggests a lower dietary intake with omega-3 polyunsaturated fatty acids in those with depression (Sweene, 2011)
3. n-6 to n-3 polyunsaturated fatty acid ratio is associated with an increased risk for mood disorders in young people exhibiting an ultra-high-risk for psychosis (Berger, 2017)
4. Combined psychoeducational psychotherapy** and omega-3 supplementation is a promising treatment for co-occurring behavior symptoms in youth with depression (Young, 2016)

* Executive functions are a set of cognitive processes that are necessary for the cognitive control of behavior

**Psychoeducational psychotherapy is an evidence-based therapeutic intervention often associated with serious mental illness

Excellent sources of omega-3 fatty acids include salmon, trout, sardines, anchovies, herring, Pacific oysters, Atlantic and Pacific mackerel, algae, and krill.

Excellent sources of omega-3 fatty acids include salmon, trout, sardines, anchovies, herring, Pacific oysters, Atlantic and Pacific mackerel, algae, and krill.

Recipe Alert! If you are looking for a summery, savory, salmon recipe, try Chili Lime Salmon with Peach Salsa from The Real Food Dietitians.

Aside from seafood, other sources of omega-3 fatty acids include:

1. Certain plant and nut oils
2. Flax, chia, hemp seeds
3. Walnuts
4. Wheat germ
5. Fortified foods such as certain brands of eggs, yogurt, juices, milk, soy beverages, and infant formulas

While we’d love have a perfectly balanced diet, sometimes life gets in the way and we need help to get the nutrients our bodies need. This is where supplements can make a huge difference.

Although seafood is an excellent source of omega-3, not everyone loves seafood, or gets enough of it in their diet. A great alternative, or in addition, to seafood, is omega-3 supplementation. It is important to find a high quality, potent omega-3 supplement—and unlike many other omega-3 supplements, Health Thru Nutrition’s Highly Purified Omega 3 Premium Fish Oil offers such potency and purity our bodies need.

References

Cornu C, Mercier C, Ginhoux, T et al. A double-blind placebo-controlled randomised trial of omega-3 supplementation in children with moderate ADHD symptoms. Eur Child Adolesc Psychiatry 2018; 27: 377-384.

Berger ME, Smesny S, Kim S-W, et al. Omega-6 to omega-3 polyunsaturated fatty acid ratio and subsequent mood disorders in young people with at-risk mental states: a 7-year longitudinal study. Translational Psychiatry 2017; 7(8).

Young A. Psychoeducational Psychotherapy and Omega-3 Supplementation Improve Co-Occurring Behavioral Problems in Youth with Depression: Results from a Pilot RCT. Journal of abnormal child psychology 2017; 45: 1025-1037.

Vesco AT, Lehmann J, Gracious BL, Arnold LE, Young AS, Fristad MA. Omega-3 Supplementation for Psychotic Mania and Comorbid Anxiety in Children. Journal of Child and Adolescent Psychopharmacology 2015; 25(7): 526-534.

Lopresti AL. A review of nutrient treatments for paediatric depression. Journal of Affective Disorders (2015); 181: 24-32.

Swenne I, Rosling A, Tengblad S, Vessby B. Omega‐3 polyunsaturated essential fatty acids are associated with depression in adolescents with eating disorders and weight loss. Acta Paediatrica 2011; 100: 1610-1615.

Mocking RJ, Harmsen I, Assies J, Koeter MW, Ruhé HG, Schene AH. Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry 2016.

Appleton KM, Sallis HM, Perry R, Ness AR, Churchill R. ω-3 Fatty acids for major depressive disorder in adults: an abridged Cochrane review. BMJ Open 2016; 7(1).

Appleton KM, Sallis HM, Perry R, Ness AR, Churchill R. Omega-3 fatty acids for depression in adults. Conchrane Database Syst Rev 2015; 11.

Vesco AT, Young AS, Arnold LE, Fristad, MA. Omega-3 supplementation associated with improved parent-rated executive function in youth with mood disorders: secondary analyses of the omega 3 and therapy (OATS) trials. J Child Psychol Psychiatr 2018; 59(6): 628-636.

Stonehouse W, Conlon CA, Podd J, Hill SR, Minihane AM, Haskell C, Kennedy D. DHA supplementation improved both memory and reaction time in healthy young adults: a randomized controlled trial, The American Journal of Clinical Nutrition 2013; 97(5): 1134-1143.

Written by Nicole Lindel, MS in Nutrition Education from Columbia University

As many of us have learned in science class, mitochondria are often referred to as the powerhouse of the cell because of their role in energy production. When mitochondria become dysfunctional, energy production comes to a grand halt. This dysfunction is often a result of a mitochondrial disease or disorder, including “autism, Parkinson’s disease, Alzheimer’s disease, muscular dystrophy, Lou Gehrig’s disease, diabetes, and cancer,” (1). According to the Cleveland Clinic, one in 5,000 individuals has mitochondrial disease and approximately 1,000 to 4,000 US children are born with this disease every year.

Current treatments for mitochondrial diseases rely on alleviating the severity of the symptoms rather than eliminating them. A common intervention for symptom relief is exercise. However, symptom relief for more serious forms of mitochondrial disease requires a more intensive intervention (2).

A common strategy is the so-called “mitochondrial cocktail”, a mixture of vitamins and supplements, designed to counteract mitochondrial dysfunction. Common “ingredients” of a “mitochondrial cocktail” include L-carnitine, Coenzyme Q10, riboflavin, and thiamine (2).

Coenzyme Q10 is a vitamin-like powerful antioxidant nutrient naturally found in every cell in our body. It is necessary for the production of cellular energy, which is essential for every single process of life. Ubiquinol is the active, antioxidant, form of Coenzyme Q10. It shuttles and delivers electrons to oxygen to assist in energy production.

Not only can Coenzyme Q10 be beneficial in those who with mitochondrial disease, but also can be beneficial in those who are chronically fatigued, over the age of 40, or in those who exercise often.

Coenzyme Q10, as an energy producer, has also been shown to promote cardiovascular health, due to the heart’s high energy demands.

Furthermore, numerous scientific studies have indicated the need for Coenzyme Q10-containing supplements for prevention and successful treatment of disorders associated with the gums—or other supporting structures of the teeth. A majority of patients with periodontal disease have a Coenzyme Q10 deficiency. Scientific evidence suggests the “extraordinary” healing power of Coenzyme Q10 supplements on periodontal disease. An adequate supply of Coenzyme Q10 ensures efficient energy production and tissue oxygenation for the healing and repair of periodontal tissue. Health experts believe that Coenzyme Q10 supplementation can be used for the treatment of periodontitis, by itself, or in combination with traditional non-surgical periodontal therapy.

Supplementation for Coenzyme Q10 can be found at epic4health in the form of H2Q—a Bioenhanced Coenzyme Q10 for enhanced dissolution and easier absorption. In fact, H2Q promotes absorption up to 8 times over standard Coenzyme Q10! Once Coenzyme Q10 is absorbed, it is released into the the bloodstream where cellular uptake occurs.

In addition to H2Q, Health Thru Nutrition recently debuted Cellurex—a unique formulation of red spinach extract leaves, pyrroloquinoline quinone, Coenzyme Q10, L-Arginine, and epicatechin. Together, these ingredients may have a beneficial effect on a variety diseases and conditions related to mitochondrial dysfunction.

For more information, visit epic4health.

References

(1) Mitochondrial Diseases. Cleveland Clinic. https://my.clevelandclinic.org/health/ diseases/ 15612-mitochondrial-diseases Accessed June 7, 2018.

(2) Slone J, Gui B, Huang T. The current landscape for the treatment of mitochondrial disorders. Journal of Genetics and Genomic 2018; 45(2): 71-77

Do you suffer from chronic gastrointestinal pain and discomfort? If so, a low-FODMAP diet may be just what you need.

Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal (GI) disorder characterized by
abdominal pain or discomfort, and changes in bowel movement patterns and defecation (1, 2).

There are four IBS subtypes, including IBS + diarrhea, IBS + constipation, mixed IBS and unsubtyped IBS, with IBS + diarrhea being the most common. The physiological mechanism differs depending on subtype. IBS can be attributed to visceral hypersensitivity, altered brain-gut signaling, immune dysregulation, microbiota, and psychosocial factors (1).

IBS-related symptom relief can often be found through modifying dietary fiber intake and restricting potential triggers such as caffeine, alcohol, and fat. However, a new dietary approach, known as the low-FODMAP diet, has been proven to relieve pain and discomfort in patients with IBS (1).

With annual IBS-related healthcare costs up to $1.66 billion, the low-FODMAP diet may prove to be an affordable and symptom-relieving solution (1). This diet “produces gastrointestinal symptom relief by reducing the fermentable load on the colon, in order to reduce gas production and luminal distension” (2).

FODMAP stands for Fermentable Oligosaccharide, Disaccharide, Monosaccharide, And Polyol. These short-chain fermentable carbohydrates increase small intestinal water volume and colonic gas production, which induces GI symptoms in those with IBS (1).

In addition to a low-FODMAP diet, patients with IBS have found yoga to be helpful in symptom relief. A 2018 randomized controlled trial investigated the effect of a yoga-based intervention versus a low-FODMAP diet on 59 patients with IBS. Although there was no statistically significant difference between groups, there was a statistically significant difference within each group. In other words, both yoga and a low-FODMAP diet were equally beneficial in reducing GI symptoms (2).

Research has also compared a high- and low-FODMAP diet in athletes with a history of nonclinical exercise-associated GI symptoms. Compared to the athletes on the high-FODMAP diet, athletes on the low-FODMAP diet had significantly lower GI symptoms including flatulence, urge to defecate, loose stool, and diarrhea (3).

Similar randomized controlled trials examined the effects of a low-FODMAP diet on patients with IBS and found significant reductions in symptom relief (4, 5, 6), In addition to symptom relief, two additional studies found an improved quality of life in participants assigned to a low-FODMAP diet (7, 8).

Although the low-FODMAP diet brings symptomatic relief to those with IBS, starting this diet can be daunting. Similar to most diets, a low-FODMAP diet is restrictive in nature. You can say goodbye to lactose-containing products, a range of fruit high in fructose, wheat-based products, onions and garlic, and fruits with pits (3).

To guide you through this process, a registered dietitian can help you 1) eliminate FODMAPs from your diet and 2) monitor your symptoms while gradually adding FODMAPs back into your diet.

To learn more about the low-FODMAP diet, visit Harvard Health Publishing.

References

(1) Staudacher HM, Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut. 2017; 66(8): 1517-1527.

(2) Schumann D, Langhorst J, Dobos G, Cramer H. Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2018; 47(2): 203-211.

(3) Lis DM, Stellingwerff T, Kitic CM, Fell JW, Ahuja KD. Low FODMAP: A Preliminary Strategy to Reduce Gastrointestinal Distress in Athletes. Med Sci Sports Exerc. 2018; 50(1): 116-123.

(4) Staudacher HM, Lomer MCE, Farquharson FM, Louis P, Fava F, Franciosi E, Scholz M, Tuohy KM, Lindsay JO, Irving PM, Whelan K. A Diet Low in FODMAPs Reduces Symptoms in Patients With Irritable Bowel Syndrome and A Probiotic Restores Bifidobacterium Species: A Randomized Controlled Trial. Gastroenterology. 2017; 153(4): 936-947.

(5) McIntosh K, Reed DE, Schneider T, Dang F, Keshteli AH, De Palma G, Madsen K, Bercik P, Vanner S. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut. 2017; 66(7): 1241-1251.

(6) Böhn L, Störsrud S, Liljebo T, Collin L, Lindfors P, Törnblom H, Simrén M. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015; 149(6): 1399-1407.

(7) Harvie RM, Chisholm AW, Bisanz JE, Burton JP, Herbison P, Schultz K, Schultz M. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol. 2017; 23(25): 4632-4643.

(8) Pedersen N, Ankersen DV, Felding M, Wachmann H, Végh Z, Molzen L, Burisch J, Andersen JR, Munkholm P. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease. World J Gastroenterol. 2017; 23(18): 3356-3366.

Written by Nicole Lindel ~ Nutrition Education Master’s Student at Columbia University