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Impotence occurs when one is unable to achieve or maintain an erection sufficient for satisfactory sexual intercourse. Although it tends to be more common in those who are over 40 year old, impotence can affect men of any age. A major study of impotence worldwide showed that over half of all men between 40 and 70 have some degree of impotence. At least one in ten men cannot get an erection at all. This website is aimed at helping those of us who believe that our penile size is insufficient to satisfy a woman fully and completely. However, if we have symptoms of impotence or erectile dysfunction, we should seek treatment for these conditions as soon as we can from a doctor. This is because impotence, even if it is just to the extent that the man cannot maintain an erection for a sufficiently long time during sexual intercourse, can also prevent a couple from having a fulfilling sexual relationship. Often, men will avoid sexual situations due to their emotional pain associated with impotence, causing their partner to feel rejected or inadequate. This also shows the importance of communicating openly with your partner, whether you may have symptoms of impotence or believe you have an inadequate penile size. A possible cause of impotency is premature ejaculation. This is the inability to maintain an erection long enough for mutual satisfaction. Primary premature ejaculation is a learned behavior that begins when a male first become sexually active. Like any learned behavior, it can be unlearned. Secondary premature ejaculation occurs when, after years of normal ejaculation, the duration of intercourse grows progressively shorter. This form of premature ejaculation is due to physical causes, usually involving the penile arteries, veins, or both. Other possible causes of impotence include performance anxiety, which is usually caused by stress or anxiety, depression, organic impotence, which involves the penile arteries, veins, or both, diabetes, nerve problems, drug-induced impotence and hormone-induced impotence. Visit Penile Enlargement Blog For More Advice. cheap vigrx pills penis enargement pic before and after vimax penis enlargement herb penis enhancement surgery picture penis elargement testimonials penis enhancement stretcher top penis enlargment pills penile enlargment traction device

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Prostate is not a problem just for elderly male population. Affecting 1 in 8 men, prostate disorders are much more common than would be expected in middle-aged individuals. The good news is that using natural treatments this battle can be a successful one. The natural approach to prostate problems involves four steps. Improving the blood and energy flow to the prostate region. This flow is affected by things like low back problems, constipation, scar tissue and injury. It can be improved by massage, manipulation therapies, acupuncture and the appropriate dietary changes. Diet targeted at improving the health of the prostate. Soy contains natural substances which help detoxify the harmful Di-Hydro-Testosterone (DHT), thereby reducing its stimulation for cell multiplication. It's a reality that Japanese men, who eat a plenty soy diet, have very low incidences of prostate problems. Therefore, products containing a high amount of soy have been recommended as preventing prostate enlargement. Vegetables containing carotenes and red-orange fruits are also associated with low prostate cancer incidence. Finally, adequate fiber in the diet, as well as pumpkin and sunflower seeds seem to improve prostate symptoms. Diet high in vitamins and supplements helping in prostate function. Zinc may be cancer protective as is required to utilize carotenes. In conjunction with vitamin B6, zinc also regulates the enzyme which converts testosterone to the harmful DHT. Vitamin E helps preserve the fatty acids and they are formatted in the human body to the messenger hormone prostaglandins which control, among other, inflammation. Use of some herbs with beneficial effects on the prostate. Saw palmetto berries contain substances which inhibit the conversion of DOT from testosterone. By consequence, they prevent the DOT that is produced from acting on the prostate, and cools inflammation in the gland itself. Saw palmetto is effective only in extract form (tinctures, capsules) while a tea made from the berries has no action. Saw palmetto is used extensively in US. In France and elsewhere in Europe, Pygeum africanum has been shown to work, again, by limiting the conversion of DHT and by reducing prostates enlargement and inflammation. This herb also is a mild antibiotic, which may explain its good effect in prostatitis as well as BAH. Finally, there is a Swiss extract of Utica devoice flower pollen (Carillon) which has potent anti-inflammatory actions and is effective in prostatitis again by blocking DOT. This type of approach may not cause any harm and it can be used as a preventive solution, but it is not a substitute for the advice of a physician or other medical professional. penile enlargement surgery cost natural penile enlargement and lengthening penile enlargment pic before and after herbal penis enargement penis enlarement cream magna rx penis enlargment picture penis girth enlargement penis elargement surgery picture

Most men don't truly understand the nature of the Vagina, its mostly a mystery, even to some women. Many complain that men are insensitive to their sexuality, but there is a growing number of women that also seek the fountain of Venus! The mystery and taboo is partly related to the female reproductive system being harder to access than its male counterpart; this concealment is extended to our culture (in the west) where female bodies are kept much more private than males, the privacy has helped shape how these are perceived as well. Female Ejaculation is a real procedure, and you need to be willing to literally study yourself, and until relatively recently the medical advice has been "don't play with, look at or do that"; the result is that generations of women have been sexually oppressed by the social mores such that they never experience a sizable part of their innate sexuality. This is partly due to the western culture of control and concealment as regards to the female form, in addition to the standard social mores concerning female body fluids. This subject, like most areas of female sexuality is looked upon with disdain in terms of "civil society", thus helping to retain this as a taboo. Women are idolised as static dry and pristine yet sexual creatures, in appearance, and are subject to unwritten laws such as not being permitted to break this illusion by openly performing normal bodily functions such as sweating or producing too much vaginal lubrication. The first modern description of female ejaculation came from the Netherlands. Here is the information you need to know: [1] All things being equal, assuming the standard female shape, it should be technically possible for anyone to experience ejaculation. However, every body is unique and geometry can certainly prevent a woman achieving this form of arousal. [2] The expelled fluid is a sexual mixture from or around the urethra consisting of fluids including a form of urine called uriar, calcium and assorted pheromones, this is a normal bodily function. [3] women can not actively control release of vaginal fluids during sexual activities, this is normal and cannot be assisted or prevented per say; so both psyche and technique are required. [4] The possible volume of ejaculate is directly proportional to sexual activities; ie avoiding sex = more material, this is not a medical problem. Anatomy dictates that positions of intercourse where the man is on top result in penetration to the posterior wall of the vagina, assuming the woman is on her back. This type of position will not provide stimulation of the cervix or the grafenberg-spot because the penis will simply go to the back of the vagina, bypassing the anterior wall which is much more sensitive than the back or posterior walls. However, positions where the woman is on top or in the case of rectal entry (not recommended without extreme care) or where the man is at an upward angle relative to the woman; penetration will occur such that the anterior wall will be stimulated. An accepted method of achieving female ejaculation is all in the finger action via clitoral, vaginal, or grafenberg stimulation, note that the clitoral system is also a powerful organ in its own right, with 8000 nerve endings, which extends 10cm down the inner leg! The lady should be lying down at an angle with her legs open to expose her volva and the labia minora, for best results, her lover should lay at her right (assuming he is right-handed). After the foreplay, this is essential, whatever is required to get her aroused, the lover must insert two fingers into her vagina, some combination of the middles is quite effective, with his palm facing the pubic bone (up). The lover must now locate her grafenberg-spot, a slightly raised, spongy bump on the "roof" of the vaginal cave; in most women, it is just behind the clitoris about 2 cm into the vagina, between the back of the pubic bone and the cervix along the course of the urethra. He should start by manipulating his fingers such that they push up and stroke the anterior wall of the vagina in a "come here" motion, while continuing the foreplay if possable. This should stimulate the pelvic nerve and the hypergastric plexus, as opposed to the clitoral stimulus which involves only the prudential nerve. Ideally, concurrent stimulation of both the cervix and grafenberg-spot is required, this involves the pelvic, hypergastric and the sensory vaguess nerve which creates more of a total body impression, and it is this type of pressure that releases a warm flow of vaginal liquid. Note that all main stream materiels designed to stimulate sexual desire including the 'Squirting Girls' movies and pictures are contrived and airbrushed, these are the last places to see natural reproductive processes! Sex is hardly ever executed as portrayed in the movies, its often dirty, noisy, smelly, oozy, and thinking about it can significantly impact sexual pleasure. The good news is that as a rule, our children are becoming sexually aware at younger ages then in the past, which is in part due to the schools so called "sex education" which serves only to demystify sex. 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I really don’t know how to say this any other way. My dog decided to talk to me the other night and he had a lot to say. It initially played like any other night really. Once again, I was tossing and turning, in and out of sleep. I was half awake, mulling over my job situation: I want to make money writing but I need an income more. Then the most bizarre thing happened. “Hey human Bob! This is your best friend speaking! Wake up!” Who the hell was that? It was a deep, low voice; strong and certain with a hint of a bourbon induced slur. Sounded like Dean Martin actually. I immediately sat up. It was pitch black. The radio clock blurred 3:53 in a dull crimson light. All I could make out was the shadowy outline of Parker, my trusty beagle, sitting upright at my feet. “Hey boy, did you hear that?” I whispered instinctively. “Someone’s in the house.” My vision was starting to warm up to the darkness. Parker just stared back at me, his head tilted, his long ears hanging to the side of his head like hand towels on a wall. He turned his head to the bedroom doorway, lifted his nose to the night and sniffed. He turned back to face me. “Don’t think so.” I swore Parker spoke but it couldn’t be. I mean his hound drawn lips seemed to move to the words I heard but that was impossible. “Who’s there?” I yelled into the night. “Whoever it is, I am warning you that I am at this moment retrieving my loaded double-barrel twelve gauge from under the bed. I will shoot you. So leave now and I want to hear the door slam behind you.” I made some dumb noises in a lame attempt to fool the intruder into believing what I had just proclaimed. I took the ruse to the next level. “Okay. I’m fully armed and about to call 911 from my fully powered cell phone. Oh yeah, strong signal, four bars. Oh yeah, this is going to be a very clear 911 call.” “You’re breaking me up. Put the phone down human Bob.” It was Parker talking. I was certain of it. Nah, it had to be a sick trick. “Okay, good one Steve. You wired up the dog with a little speaker. Very funny.” My brother Steve was known to go to great lengths to pull off pranks. But I was pretty sure he was at his apartment in the city, sixty miles away, God knows doing what, and at 48 years old, unlikely to suddenly bother me with a prank—it had been 25 years since his last one. But the mind scrambles to the most implausible scenarios when so duly challenged. “Don’t think so. Nope it’s me, Parker,” the dog mumbled. I was positive he spoke again. By now I was sitting straight up, leaning towards him. He just sat there and looked at me with those big dark eyes. His poker face was on. “Parker? Are you talking to me?” “Well I’m not talking to myself.” I leaned back against the headboard. He yawned. “This can’t be. I’ve got to stop watching Animal Planet.” “Listen, I’ve got something to say and I’m not sure how long this talking stuff is going to work so …” “You are talking!” I interrupted incredulously. “Should you want I bow wow?” “Holy cow! Parker you are talking.” “Yup. But I’m not sure for how long. So can I say a few things before …” “I can’t believe this.” “Yeah I know. Either can I but if you don’t mind.” I looked at him with a giant smile plastered across my face. Parker can talk. The dog was talking. Who was I kidding? It had to be a prank. He continued. “I’ve been listening to a lot of that talk radio and that C-SPAN channel you watch while you write. I’m here to tell ya I don’t like what I’m hearing.” “You’re kidding me right?” “Afraid not.” Oh this was good. I was really hallucinating. Talk-shmalk, I had a few nagging questions of my own. “Hey, can I ask you something before you get to your stuff?” “Make it quick. I haven’t got all night.” “You like smell things a hundred times more than we do, right?” “Four hundred.” “Okay, four hundred. Wow! Then I really wonder about this.” “Yeah I know. Why do we like to sniff every morsel of excrement or yellow patch of urine we encounter on our walks?” “Now that you bring it up, yeah, why? It must smell like the inside of Dick Cheney’s or Ted Kennedy’s septic tank? And you know how much crap they’re filled with.” “That was a funny one human Bob. But it isn’t like what you smell. We pick up a lot more notes. It’s a broader pallet if you will. We don’t smell stink. We smell identity, mood, and illness. For instance, you know that crazy cairn terrier down the street?” “Yeah.” “She has stomach cancer and her humans don’t have a clue.” “You are kidding me?” “She probably has less than six months if they don’t get her to a vet soon.” He paused to lick his right front paw. “Yeah, and another thing. Don’t take me out at nights for awhile.” “Why?” “Cause there is a rabid possum living under the porch. That’s why.” “You know this from the smell of possum poop?” “Excrement.” “Whatever.” “Yup.” Parker yawned as if bored. “So is that it? Can I say what I need to say?” “Well there is that thing you do with that licking your, you know, your …” “Penis?” “Well, yeah.” “Jealous are we?” “Well, it’s just that …” “It’s all about keeping clean. Nothing pleasurable if that’s what you’re driving at. Nothing like what you do with your hand. By the way, I’d appreciate it if you wouldn’t pet me afterwards. Nope, no pleasure; it’s all business. You made sure of that when you had me “fixed”, remember. Thank you very much.” “Oh yeah, sorry about that. I had no idea you knew any different.” “No idea my butt. I’ll ‘no idea’ ya.” He paused again to lick his right paw again and then continued. “But I don’t hold it against you. We don’t hold grudges. Heck, if we did, we would have mauled most humans dead by now. Which brings me to why I am talking to you.” “No grudges. Really? I mean that “fixing” stuff is pretty serious. That’s pretty good if that doesn’t bother you.” “You done? Can I get to my concern?” “Sure. Sorry. Go ahead.” “How can humans be so smart supposedly, while they single handedly are destroying the Earth?” “You mean global warming?” “It’s more than that. It’s the air. It’s the water. It’s the dirt. It’s the forests. It’s the killing. It’s the anger. It’s the hate. It’s the grudges. It’s the fear. It’s everything.” “Oh come on. You’re being a little dramatic.” “We don’t know dramatic.” “Well give me examples of what you mean.” “First of all, the air is filled with danger. Dogs, cats, birds, animals of all kinds can smell it. It is our biggest topic when we get together.” “I don’t smell a thing.” “Yeah, that’s part of the problem. And you can’t taste the troubled water either.” “Scientists don’t seem to be complaining. So I should be listening to a dog?” “We have no agenda. Dogs call it as they smell it.” “ ‘call it as they smell it’; I’m suppose to just accept that?” “Yeah, there is a lot you should just accept.” “Oh yeah, like what else?” “Well, and here is what I think is the crux of the problem, you keep choosing the wrong alpha humans.” “What?” “You’ve got this alpha thing all wrong. Just because animals order their packs based on physical size and strength doesn’t make it so for humans. We do it because we are simple. You do it because you are thoughtless. That’s what we, and I think it is fair to say I am speaking for all animals, don’t get. Humans are able to think things through. But they never do. Well, that’s not completely true; some have but they are mocked or marginalized. An alpha dog barks and gets all puffy, like that wacky shepherd Sarge from around the block. The worst he can do is break out of his electronic fence and charge one of us. But you humans take it up a notch.” “Can you give me a for instance?” “God there are so many. Let me see. Okay, you’ve elected a president who pounds his chest and walks around like a gorilla with its arms all out to the side, all tough and all, carrying on with ‘bring it on’. When he jumps the fence, he brings tanks and bombs and humans loaded down in weapons and in body armor. Meanwhile, you have alpha males all over the place, flexing their muscle in their packs, threatening to obtain nuclear weapons, the great equalizer, giving the president one excuse after another to hop the fence. It’s nuts. And I for one am telling you, you’ve got it all wrong.” “Well, I don’t know what to say.” “You don’t need to say anything. Just start picking the right alpha humans; humans whose visions see beyond fighting, whose hearts hold no grudges, whose thoughts and reasons are not the products of testosterone, whose collective knowledge is rooted in the concept that true peace is never the consequence of war but the outcome of constant learning, negotiating and adjusting.” “This is what you want to tell me? Nothin’ for nothin’ but it’s a little heavy for a little chat with a dog at 3:30 in the morning.” “In a nut shell, yeah.” It was hard to accept this from my beagle. I mean, he’s a dog; a sleeping, eating, sniffing, crapping dog. I was chalking this whole episode up to stress. I was apparently snapping. “That’s it. I’m pretty much done. Just one last thing while I have the chance.” “What? World hunger? String theory?” I asked sarcastically. “You get the right alpha humans and the world hunger thing will take care of itself, smart ass. As far as string theory, who do you think I am, Hawking? I’m just a dog. No it’s more pedestrian than that, something I think you can manage.” “Then what, already?” I asked impatiently. “You know that thing you do occasionally where you empty the dish washer in the buff.” “Ummm … yeah I guess.” “Put some clothes on. It’s disturbing. I’m beggin’ ya, please!” “All right, but only if you lick your privates in private.” “I’ll see what I can do. No promises.” “So this is it? No more talking? You know we could make a fortune on Letterman with his stupid pet tricks.” “It’ll never happen. You see, this is a one time deal. Not sure why or how this is happening. Maybe that God guy is involved somehow. All I know is that when it is done, it is …” He abruptly stopped talking. “Parker?” Not a grunt. He yawned and as he did he stretched his front legs out and spread across the foot of the bed, his ears resting flat on the blanket. “Parker … are you done? Is that it?” He slowly closed his eyes and floated off to sleep. “Parker … just like that?” He began to twitch; in hot pursuit of a fox I imagined. “Holy smokes. I must be dreaming myself.” I curled back down under the safety of my covers, scratched my butt and thought about the conversation I had just had with Parker or myself or both. I sniffed the air. It smelled fine to me. What the heck was he talking about, ‘danger in the air’? It had to be a dream. As I drifted off to sleep, I thought about getting a real job real soon, apparently this writing stuff was getting the best of me. I also made a point to remember to talk to the owners of that crazy cairn terrier. I thought it was the least I could do. 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If you’ve ever witnessed someone suffer a stroke, you understand the humbling nature of this disease. It can reduce the mightiest human being to an immobile, helpless creature. Impairment of crucial functions like speech, walking, and control of bowel and bladder can wrench control from the body in a moment. Even perpetually youthful TV personality Dick Clark was struck down by stroke at age 75, despite the outward appearance of perfect health. Clark’s stroke resulted in a six-week hospital stay and, judging from fragmented reports, significant disability. Stroke can be like a devastating fire that strikes without warning, leaving only smoldering rubble. Stroke can so ravage basic bodily functions that often all you can hope for is to regain a portion through rehabilitation. The disease process that underlies stroke requires decades—30 or 40 years—to develop. With that much lead time, why aren’t we better able to detect or stop this crippling disease? The truth is that we are able to predict many, if not most, strokes. Advances in imaging technology allow detection of atherosclerotic plaque that cause stroke years before it becomes a threat. Progress in deciphering the causes of stroke has also leapt forward. Unfortunately, your neighborhood physician still focuses on diagnosing the crisis rather than anticipating it. Physicians prefer to deal with catastrophes and are just not that interested in prevention. Most physicians ask: “Is it time to operate or not?” The medical community obsesses over procedures like carotid endarterectomy (surgical removal of plaque) or carotid stents. Even when a person is afforded the warnings of a “mini-stroke”, or transient ischemic attack (TIA), little more is done once it’s determined that surgery is not necessary—even though this person has high risk for future stroke (50% over 10 years). Let’s flip-flop this approach to stroke. Procedures represent a failure of prevention! Where do strokes come from? Stroke develops when some portion of the brain is deprived of blood. This usually results from a tiny bit of debris that dislodges from an atherosclerotic plaque along the walls of an artery (the same sort that accumulates in coronaries causing heart attack). The sources of debris have been a subject of controversy, but new imaging technologies have settled the question. Any blood vessel that leads from the heart to the brain can be a source. The two carotid arteries on both sides of your neck are a frequent source, as these arteries are prone to develop plaque. (Our discussion will be confined to what are called thromboembolic, or ischemic, strokes, i.e, strokes that occur from plaque that fragments, sending debris to the brain, and will not include the far less common hemorrhagic strokes due to rupture of small vessels in the brain, nor will we discuss atrial fibrillation and other heart causes of stroke. The thromboembolic strokes we discuss cause around 88% of all strokes.) Over the last 10 years, the aorta has been recognized as another important source of stroke. The aorta is the main artery of the body whose branches go to the head, arms, and legs. Atherosclerotic plaque is a live tissue that, through poor diet, inactivity, high cholesterol, overweight, etc., grows and becomes progressively more unstable. At some point, plaque fragments. Little bits break away, traveling to the brain. Fractured plaque also exposes its deeper structures to flowing blood, triggering blood clot formation, which in turn can also fragment and go to the brain. Atherosclerotic plaque is a prerequisite for the most common causes of stroke. If the majority of strokes originate from plaque, why not measure plaque to determine if you’re at risk for stroke? How can we easily, safely, and accurately measure plaque in the carotid arteries and aorta? And if plaque can be measured, can it be shrunk or inactivated to reduce or eliminate risk for stroke? How can plaque be measured? Just 20 years ago, the only practical method of identifying plaque in the carotids or aorta was through angiography, requiring catheters inserted into the body to inject x-ray dye. Angiography was impractical as a screening measure. CT scanning and magnetic resonance imaging (MRI) are emerging as exciting methods of imaging both carotids and aorta. Unfortunately, most centers and physicians are much more focused on the diagnostic uses of these technologies for people who have already suffered stroke or other catastrophe, and application of these devices for preventive uses is still evolving. One exception is when aortic calcification or aortic enlargement is incidentally noted on the increasingly popular CT heart scans; this is an important finding that can signal presence of aortic plaque. The one test that is widely available and can be performed in just about any center is carotid ultrasound. It’s simple, painless, and precise. Two basic observations can be made: 1. Plaque detection—Atherosclerotic plaque can be clearly visualized. If plaque blocks more than 70% of the diameter of the vessel, or if there are “soft” (unstable) elements in plaque, then stroke risk may be high enough to justify surgery or stents. However, if there are plaques that are less severe, substantial risk for stroke may still be present that can be reduced with preventive measures. 2. Carotid intimal-medial thickness—This is a measure of the thickness of the lining of the carotid artery in areas not involved by plaque, but often precedes the development of mature plaque. Carotid intimal-medial thickness also provides an index of body-wide potential for atherosclerotic plaque that can place you at risk for stroke. The aorta, for instance, cannot be well imaged by surface ultrasound but can still be a source for stroke. Increased carotid intimal-medial thickness and carotid plaque are closely associated with likelihood of aortic plaque. The Rotterdam Study of 4000 participants demonstrated that if carotid intimal-medial thickness is greater than normal (1.0 mm), then you can be at risk for stroke (and heart attack), even if no carotid plaques are detected. Carotid ultrasound is the one test you should consider that provides the most information with least effort. Ultrasound is harmless, painless, and can be obtained just about anywhere. Even if your doctor disagrees with your request for a carotid ultrasound, an increasing number of mobile services are popping up nationwide that make this test available for around $100. One important point: many scanners and interpreters will only report whether plaque is present or not. While this is important information, you should request that the carotid-intimal medial thickness be made as well. Not all centers can make this simple measure (because of software requirements), but it doesn’t hurt to try. Any amount of carotid plaque is reason to follow a preventive program, even if the plaque is insufficient to justify surgery. Can plaque be reduced? Can we shrink plaque in carotid arteries and aorta and thereby reduce, perhaps eliminate, these sources of stroke? That question is gaining momentum as effective therapies become available that pack real punch for reducing plaque. Study after study has now documented that plaque can be reduced and, with it, risk for stroke. Reduction in plaque of 10–20% is possible within a year or two. Let’s consider the most potent influences on carotid and aortic plaque growth that need to be considered in a plaque-reducing program. (I assume that you are a non-smoker—if you are a smoker, you first need to concentrate on quitting.) Hypertension Considerable experience documents the power of blood pressure-lowering for prevention of stroke. The most recently updated guidelines, the JNC–VII, recommends a blood pressure of 407 mg/dl heightens stroke risk six-fold. C-reactive protein (CRP) This measure of inflammation is proving to be a useful marker for identifying people at risk for stroke, with increased risk beginning at a level of 0.5 mg/l. High CRP also predicts more rapidly growing carotid plaque. Homocysteine Homocysteine is an important marker of increased likelihood of both carotid and aortic plaque, as well as stroke. In 1997, the European Concerted Action Project reported more than a doubling of stroke when homocysteine levels exceeded 12 mol/l. As homocysteine increases to 20 μmol/l, risk for stroke and heart attack increases an amazing 10-fold over that at a level of 9 μmol/l. Asymmetric dimethylarginine (ADMA) ADMA is recently discovered amino acid whose blood levels can skyrocket up to 10-fold in the presence of hypertension, metabolic syndrome, diabetes, high cholesterol and triglycerides, obesity, and high homocysteine levels. ADMA blocks the action of the amino acid, l-arginine. This mimicry reduces the availability of nitric oxide, a powerful dilator and protector of arteries. ADMA levels in the top 10% predict a six-fold heightened risk for future stroke, and ADMA levels in people with strokes are double that in other people. A carotid ultrasound study in 116 subjects showed that higher blood levels of ADMA are associated with more severe carotid plaque. Because of ADMA’s shared role across a variety of abnormal conditions, correction or blocking the action of ADMA has been suggested as a unique therapeutic tool to reduce stroke risk. Cholesterol Data suggest that lowering cholesterol with statin cholesterol-lowering drugs slows carotid plaque growth and reduce stroke risk approximately 22%. An interesting study from the Cardiovascular Institute at Mt. Sinai School of Medicine in New York using the precise measuring ability of MRI of the carotids and thoracic aorta showed an impressive 20% regression of plaque area with simvastatin (Zocor®) taken for two years. Although guidelines for cholesterol treatment recommend reduction of LDL cholesterol to 100 mg/dl in high-risk persons, a report from the Walter Reed Army Medical Center in Washington, DC, showed that carotid plaque was more effectively reduced when LDL cholesterol of 70 mg/dl or lower was achieved with statin cholesterol drugs. Lower LDL cholesterol may, therefore, be better. Treatment Strategies to Reduce Carotid and Aortic Plaque The essential question: How do we reduce carotid and aortic plaque? If we make this the focus of our efforts, many pieces begin to fall into place. If you’ve had any measure of carotid or aortic plaque such as a carotid ultrasound or aortic calcification on a CT heart scan, you know that you’re at increased risk for stroke. You also have a baseline for future comparison to gauge whether your program is working or not. Because most people have not one but several causes of carotid and aortic plaque, there is no one single treatment that effectively eliminates risk for stroke. Instead, most people require a comprehensive program of healthy diet, exercise, supplements, and medication when indicated. Here, we focus on the nutritional supplements that can be critical components of your plaque-reduction program. Fish oil Fish oil is a cornerstone of your stroke prevention program. Epidemiological observations suggest a strong relationship of fish intake and reduction of stroke risk. Carotid ultrasound studies demonstrate less carotid plaque with greater intakes of fish. A cleverly designed University of Southampton study made the fascinating observation that fish oil transforms the structure of carotid plaque. 150 people with severe carotid plaque scheduled for carotid endarterectomy (surgical removal of the plaque) were given fish oil, sunflower oil, or no treatment over several months while waiting for their procedure. (Delays in the British health system permitted this unique design.) Plaque was removed at surgery and examined. Participants taking fish oil had reduced inflammation in plaque and thicker tissue covering the fatty core, markers of more stable plaque. Those taking sunflower oil or no treatment had unstable plaques with greater inflammation and thinner, less sturdy covering tissue. This suggests that fish oil stabilizes carotid plaque, making it less likely to rupture and fragment. A standard capsule of fish oil (containing 300 mg of EPA + DHA) contains the same amount of omega-3s as a 3 oz serving of cod or halibut; three capsules (900 mg DHA + EPA) contain the equivalent of a serving of farm-raised salmon. The dose that seems to provide greatest protection from stroke, lowers triglycerides (that form abnormal lipoproteins; see above), and reduces fibrinogen, is four capsules per day (1200 mg EPA + DHA). Coenzyme Q10 (CoQ10) Although there are no data specifically addressing whether CoQ10 reduces plaque, it is a marvelously effective way to reduce blood pressure, one of the crucial factors causing carotid and aortic plaque growth. A pooled analysis of eight studies showed that, on average, CoQ10 in daily doses of 50–200 mg reduced systolic blood pressure by 16 mm Hg, diastolic pressure by 10 mm Hg. Data suggest that CoQ10 can reverse abnormal heart muscle thickening (hypertrophy), another manifestation of high blood pressure, strongly suggesting that CoQ10 has benefits beyond just reducing pressure. Supplements to correct the metabolic syndrome Weight loss is, without question, the most immediate and direct path to correction of this dangerous pre-diabetic condition. A drop of even 10–20 lbs yields improvements across the board: increased sensitivity to insulin, increased HDL, and reductions in triglycerides, CRP, fibrinogen, small LDL particles, and blood pressure. Diet and exercise are fundamental components of an effort to lose weight; low carbohydrate or reduced glycemic index diets (e.g., South Beach or Mediterranean) rich in fibers are clearly effective. Several supplements can amplify weight-reduction efforts and be useful adjuncts to your lifestyle program. Among them: White bean extract White bean extract blocks intestinal absorption of carbohydrates by 66%. 1500 mg twice a day with meals yields, on average, 3–7 lbs of weight loss in the first month of use. The only side-effect is excessive gas, due to unabsorbed starches. Glucomannan This unique fiber taken prior to meals absorbs many times its weight in water and thereby fills your stomach. You consequently take in less food. Most people lose around four lbs per month using 1500 mg prior to each meal. Interestingly, glucomannan also blunts the rise in blood sugar after meals, an effect that, by itself, may lead to weight loss. Be sure to take with plenty of water. DHEA This adrenal hormone is key to maintaining physical stamina, mood, muscle mass in men, and libido in women. A recent randomized, placebo-controlled study at Washington University in 56 subjects showed a 13% decline in abdominal fat (fat that drives resistance to insulin) measured by MRI with 50 mg of DHEA per day at bedtime, along with improved sugar control and lower insulin levels. Pectin, beta-glucan Pectin is the soluble fiber in citrus rinds, green vegetables, and apples, also available as a supplement. Beta-glucan is the soluble fiber of oats and is also available as a supplement. Both are wonderful fibers that provide feelings of fullness, lower cholesterol, slow release of sugars, and can yield modest weight reduction. A USC study in 573 subjects using carotid ultrasound showed that greater intake of healthy fibers like pectin and beta-glucan is associated with less carotid plaque growth. Folic acid, vitamins B6 and B12 Dr. Daniel Hackam at the Stroke Prevention and Atherosclerosis Research Centre in Ontario conducted a study using carotid ultrasound in 101 participants treated with folic acid 2.5 mg, vitamin B6 25 mg, and B12 250 mcg per day. Treatment resulted in plaque reduction, especially when homocysteine levels exceeded 14μmol/l at the start, compared to untreated participants who experienced substantial plaque growth. An attempt to clarify the role of homocysteine treatment was made through a National Institute of Health-sponsored study of stroke prevention. 3680 participants with a prior history of stroke were enrolled and given either a “low-dose” (20 mcg folic acid, 0.2 mg B6, 6 mcg B12) or a “high-dose” (2.5 mg folic acid, 25 mg B6, 400 mcg B12) regimen. Although starting homocysteine levels showed a graded association with stroke risk (higher homocysteine levels predicted greater stroke risk), the treatment groups experienced, on average, only a 2 μmol drop in homocysteine levels and no reduction in stroke risk over two years. The study investigators as well as critics have suggested that the study failed due to an insufficient treatment period and that the doses were too low. (The doses we use in our plaque reduction program are folic acid 2.5–5.0 mg, B6 50–100 mg, B12 1000–2500 mcg.) L-arginine L-arginine can be used to overpower the adverse effects of ADMA. L-arginine is emerging as an important carotid plaque-reversing tool. Early reports in animals showed that l-arginine completely halted growth of aortic plaque, and did so more effectively than lovastatin (a cholesterol-lowering drug). In humans, L-arginine reduces blood pressure, abnormal constriction of carotid and coronary arteries, blocks entry of inflammatory cells into plaque, increases sensitivity to insulin, and heightens exercise capacity. Following coronary angioplasty or stent placement, l-arginine results in up to 36% reduction in plaque growth. The average American takes in 5400 mg of l-arginine through food every day. Supplementing with doses of 3000–12,000 mg per day has proven useful to correct many of these phenomena. (We use a dose of 6000 mg of l-arginine powder, twice a day on an empty stomach, dissolved in water, for our plaque regression program.) Does this result in a reduction of stroke risk? The emerging data suggest that l-arginine is likely to exert a powerful plaque-reducing and stroke-preventing benefit, but we await more clinical trial data. Conclusion Reducing stroke risk by reversing carotid and aortic plaque is becoming an everyday reality, with better tools becoming available. To know whether you’re at risk, the best and most available imaging tool is carotid ultrasound, aiming to identify intimal-medial thickness >1.0 mm, or carotid plaque. Any degree of calcification of the aorta, such as on a CT heart scan, is another useful measure of risk. Treatment to reduce risk is multi-faceted but is based on examining all your sources of risk, including metabolic syndrome, small LDL, lipoprotein(a), and C-reactive protein. Fish oil is the one absolutely crucial ingredient in any stroke prevention program. Other supplements can be used in a targeted fashion, depending on the causes identified for your carotid or aortic plaque. Ideally, repeat scanning of your carotids should be done sometime after your program has begun to assess whether you’ve successfully achieved reversal of plaque growth.