SMOKINCHOICES (and other musings)

May 14, 2014

HBP/Heart therapy update

FUNCTIONAL,  NATURAL  HBP/Heart therapy update

This so-called “update” may become a bit tedious or tricky for me as I haven’t structured too far ahead, hence, I can’t see the end.  Only had in mind a bit more clarification of what I am personally doing and  and the changes I have made.  All premised upon the desired outcome of enhanced well-being,  more energy. . . without which, I would undoubtedly, be unable to sustain my life-style.  Kinda important as I am the only one responsible for what is happening.  I’d prefer to do it for ultimate good.  .   . yours and mine.  

As I recently posted in “Daily aspirin. . . ya sure?”.   .   .  I want to provide some extra substantiation or documentation about the various amino acids and other material with which I am working.  Need to repeat, it was Dr Blaylock’s 2-part dissertation on what he did for cardiac patients that changed my world, even tho it took me 8 years to finally hear the message.  There is an old saying,  when the student is ready, the teacher will come, . . . how else can I justify my slow learning curve?    Then, on fire, I leaped in with both feet and dug in ‘on-line’ til I found Dr Harry Elwardt [a Naturopathic physician].  Then his book with the strange title  “Let’s STOP The #1 Killer of Americans TODAY.”  [why do I pick doctors with strangely-named books?. .e.g. Dr Clark’s “Cure for All Disease”]. .  . . .became my best ‘teacher’.. . .favorite book for this purpose. [tho I have so many more] 

While Dr Elwardt, Dr Stephen Sinatra and Dr Blaylock  all go deeply into a well-rounded protocol entailing so much more than the few items I want to  discuss here, I once again, just assumed anyone who actually had any of these problems under discussion e.g.  hypertension or any of the various forms of heart disease including pulmonary and circulation, etc.,. would know about these essentials and be already taking them as part of their personal regime.  I was wrong about that;  not everybody DOES know,  nor does every doctor stress the importance say of Vitamin D,  EFA’s,   let alone the amounts to be taking for adequate usage.  One doesn’t need to be having palpitations  or allowing ‘family history of heart disease and/or dementia  dominate their activities and choices — if one has hit middle-age,  we should all be taking C0Q10 because the body gradually looses the ability to make enough for our aggressive needs.  I take  UBIQUINOL which is the preferred form of CoQ10.  And the B Vitamins.   EVERYBODY needs those B vitamins, for balance, brain, our emotional needs to be able to balance all the demands made upon us by the world, let alone our family and job.  The mental-emotional harmony can’t be achieved without the B’s. All of this is in addition to eating a wholesome, well-balanced and nutritious assortment of vital foods.  Its been decades since I have taken a multi vitamin — never liked them.  But some stuff, we must supplement.  (About those B’s,  its best to ingest a “balanced” B. . .I take a balanced B-100. . . because this class of vitamin seems rather competitive and will usurp or compromise the others if given the chance.)  

All three  doctors being referenced herein stress the usage of Nattokinase over any other form of blood thinner or aspirin usage.  All speak at length about the importance of exercise and body movement  (and I personally would like to add the need for love, fun, enjoyment or pleasure and beauty to the mix. . . for what good is life without these joys?)  So please understand,  I’ve been speaking about various forms or aspects of most all of these things for over six years now with a voluminous 2100 posts to stumble  through and it can’t be squashed  down into one small post such as this.    All three of them had a similar thrust they were having success with in treating people with various forms of heart disease from onset to end stages.  Most of these individuals were helped with this  metabolic, functional and totally natural therapy.  

One could say that their bodies had been starved of the nutrients which were needed for it to be viable, fully functioning and often, the bodies were  toxic as well.  Won’t go fully into what has gone wrong, we live in a toxic world now.  Much of it is modern agriculture (we need to get back to basics),  its GMO’s, pharmaceuticals, toxic vaccinations harming the immune systems  — even OTC stuff, the chlorinated water we all must drink per the “ins” in Washington,  And part of it is just the body giving out under its load.

This AMINO ACID Therapy:    

ARGININE   5 TO 7 GMs a day

So now those Amino Acids I’m using and the changes I’ve made:   Let me start with  ARGININE.  Dr Elwardt  practically wrote a chapter on this one and is in his opinion the most important thing in the entire book [he is that impressed with it]. . .good enough for me!  He stressed the safety of it saying that body-builders have been using far more than any dosage he uses with his cardio patients — he recommends 5 to 6 grams a day, taken in divided dose first thing in the morning upon awakening  and the last thing at night before bed.  He says drinking one to four ounces is a lot easier than taking 20 to 50 pills. . .consequently, he advises buying your arginine supplement in liquid form, followed by a powder form and is also much better absorbed.  One must separate taking arginine from any other amino acid by at least two (2) hours  (before or after), or any other form of protein as Arginine can be blocked from absorption by any of its fellow amino acids.  One can take a little carbohydrate, if necessary, to prevent any stomach upset (which I have had to do upon occasion).

There have been many clinical trials  conducted in United States hospitals and abroad as of his writing of this book — some 69,000 of them, using 30 to 50 grams daily with no side effects whatsoever, so this is extremely safe  to take.

When I searched online, I couldn’t find the liquid or powder, so took a capsule product, seemed Okay and reordered several times.  Re-reading Dr Harry’s book,  it finally registered that I may have delayed my progress by buying pills instead of liquid or powder so off I went again and in time found what I needed.   So much easier to take and the reliability factor is more consistent.  Also, I am trying to be measurably cautious as this is new territory for me.  After rereading much in the books and research online, I now realize that hugely greater dosage is not only allowable, but in many cases, advisable. . . .  even so, I inch along.  The two products I found for Arginine:    1) LIQUID  “Got Arginine?” by Morning Star Minerals, quart jar (32 oz), one ounce = 5,000 mg. (= 2 Tblsp),  I do this in AM, return to bed for 2 hours, then can coffee, eat and start my day along with L-Carnitine and Taurine plus my AM supplements.  The 2nd ARGININE product is made by NOW  and this powder is pharmaceutical grade, 100 % pure in a 1 # container, is Free Form. (Free form means the amino acid is in its purest form, needs no digestion, and is easily and immediately absorbed into the bloodstream.) ( 2 Tblsp = 4.6 gms.)  So, be cautious — start small with 5 to 6 gms a day or increase as your needs appear to be.  I’m doing 6 – 7 gms day now.

L-CARNITINE  2 – 3 GMs daily

Think of CARNITINE  as an ‘energy shuttle.’      Remember,  mostly, the Heart’s problems have generally come about because our Hearts have enormous energy needs which aren’t being met.  When problems arise, procedures and pharmaceuticals are given — none of which the heart is seeking.  Our hearts are “hungry,” they are starved for ENERGY.   Carnitine enhances fatty acid metabolism, preventing f.a.metabolites from accumulating which impairs the oxygen utilization  by heart cells.  It lets the heart do more with less oxygen.  Ischemia by definition is insufficient oxygenated blood flow to heart cells — a truly serious condition. Heavily impacts the mitochondria which can become dysfunctional.  Take your two divided doses with morning and evening meals.  Not complicated. What I do. Took Dr Sinatra’s Carnitine and its great.  But to get 1K, need toi take 3 capsules.  So I look for convenience to me and price points as I maintain a budget. 

TAURINE  2 TO 3 GMs a day

For TAURINE,   Dr Harry recommends 1K a day in the AM at the food/supplement part of morning.  But based on research I’ve found online and this lovely article I’ve brought over from  Hans Larsen who works with the excellent people at entitled the AFIB REPORT, . . .this article on the Treatment of Congestive Heart Failure”  I am feeling quite encouraged to go a good deal higher on Taurine for not only my heart, but the brain and my COPD and especially my hypertension.  This man has done his homework!  So, I’m upping this one.  It not only strengthens the heart muscle, regulates heartbeat and maintains cell membrane stability and comprises over 50% of the free amino acids content of the heart.  I’m using a JARROW 1K mg capsule.  Jarrow is a brand I respect.  Next, lets move on to one of my favorites. . . D-RIBOSE

D-RIBOSE 5K  ONCE, TWICE OR THREE TIMES DAILY (Huh?. . .let me explain)  

Got pain?  No Energy?  Doubt you’re gonna make it much longer?  Stop all that!  Get some D-Ribose.  The D-Ribose I’ve been using is from Jarrow, 200 grams, or 7.05 oz.   Dr Elwardt’s book advised taking 5K, divided into 2 doses. . . so that’s what I did.  My focus was singular  — solve this heart problem.. . anything else would just be gravy.  What he said is what I did.  My body was so starved that it did respond and was grateful.  All that I was doing brought the A-Fib down, eased my breathing and according to the doctor I saw about the mole on my face — also really brought my BP down too.  Couldn’t believe it.  And I was more energized.  As time passed, I believed I needed some more tweaking, so I dug in again.    On D-Ribose,  I’m sharing another treasure here with you. . go to the following link:

 This is such a great article written in 2007 by Dr Jacob Teitelbaum on the many uses of D-Ribose.  I simply had no idea that D-Ribose could have such an empowering effect on pain.  That’s why I’ve imported it.  How many people do you know who fights pain? In their trials, they are using 5 MG – three times a day for a minimum of three weeks.  Pain gone!  Can wait to try it.  But there are others who take it routinely as it keeps the pain down which returns when they stop it.  Having this theme repeated, it seems clear that there is no harm to be  felt by using the larger dosage, so now, I am feeling more comfortable in venturing out.  This about does it, I no longer feel obsessed about touting someone wrong in giving it a go with these amino acids.  Athletes and body builders among us have done it for a very long time  (the higher dosage amounts) and they have mostly profited from it.   If we can try to better our lives with the same attempt, or as in my own case, trying to save my life, doing what I feel is safe and within reason financially as opposed to PhRMA with its exorbitant cost and side effects that can maim or kill. . . well, guess what I’m gonna do?




Treatment of Congestive Heart Failure

by Hans R. Larsen, MSc ChE

Heart failure is defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. The term �congestive heart failure� implies that the impaired blood flow is causing fluid retention in the lungs, legs, ankles or feet. Other common symptoms include shortness of breath when lying down or during exercise, fatigue and weakness, reduced exercise capacity, and rapid or irregular heartbeat.

Coronary artery disease (atherosclerosis) and heart attack are the most common causes of heart failure along with high blood pressure, faulty heart valves, damage to the heart muscle, inflammation (myocarditis), and congenital heart defects. Untreated chronic heart arrhythmias, especially atrial fibrillation, may also lead to heart failure as may the presence of diabetes, severe anemia and thyroid problems. Finally, there is evidence that heart failure is associated with a deficiency of thiamine (vitamin B1) which is exacerbated with the use of thiazide diuretics.

The primary diagnostic markers of heart failure are left ventricular ejection fraction of less than 40% and a blood (plasma) level of brain natriuretic peptide (BNP) in excess of 100 pg/mL. An elevated blood (serum) level of C-reactive protein is also associated with heart failure.

Conventional Treatment

Regardless of the cause and manifestation of the disease (left-sided heart failure, right-sided heart failure, systolic heart failure or diastolic heart failure) the medications commonly prescribed for heart failure are as follows:

ACE inhibitors such as enalapril, lisinopril and captopril which dilate blood vessels to lower blood pressure, improve blood flow, and decrease the workload on the heart.

Angiotensin II receptor blockers such as losartan (Cozaar) and valsartan (Diovan) which have effects similar to those of ACE inhibitors.

Beta-blockers such as bisoprolol and carvedilol which slow heart rate and reduce blood pressure.

Digoxin (Lanoxin) which slows the heart beat and increases the strength of heart muscle contractions. Unfortunately, it has many serious adverse effects and is probably not that effective. Further reading on digoxin

Diuretics such as butmetanide and furosemide which help prevent and eliminate fluid build-up.

Aldosterone antagonists such as aldosterone and eplerenone. These are potassium-sparing and may help reverse scarring of the heart and help patients with severe heart failure live longer.

The most recent AHA/ACCF Guidelines for the Management of Heart Failure[1] recommend the following treatment protocol for patients with structural heart disease (valve problems) and symptoms of heart failure[2]:

Treatment of hypertension if present
Treatment of high cholesterol if needed
Regular exercise
No smoking and limited alcohol intake
Restricted salt intake
Routine drug therapy with diuretics, ACE-inhibitors, beta-blockers
Selected drug therapy with aldosterone antagonists, angiotensin II receptor blockers, digoxin.

The following comments in the guidelines regarding potassium are of particular interest[3]:

�Patients with HF (heart failure) should be monitored carefully for changes in serum potassium, and every effort should be made to prevent the occurrence of either hypokalemia or hyperkalemia, both of which may adversely affect cardiac excitability and conduction and may lead to sudden death. Activation of both the sympathetic nervous system and rennin-angiotensin system can lead to hypokalemia and most drugs used for the treatment of HF can alter serum potassium. Even modest decreases in serum potassium can increase the risks of using digitalis and antiarrhythmic drugs, and even modest increases in serum potassium may prevent the use of treatments known to prolong life. Hence, many experts believe that serum potassium concentrations should be targeted in the 4.0 to 5.0 mmol per liter range.�

Alternative Treatment

The goal of alternative and complementary therapies is to increase the pumping efficiency of the heart and to alleviate the adverse effects of conventional treatment. Several natural substances have been found effective in the treatment of heart failure. Substantial evidence of efficacy is available for the following:

Coenzyme Q10
Fish oil
Vitamin D

Coenzyme Q10
Coenzyme Q10 (ubiquinone, ubiquinol) is an essential component of the mitochondria, the energy-producing unit of every cell of our body. Heart failure is associated with a pronounced coenzyme Q10 deficiency, and low coenzyme Q10 levels are associated with increased mortality in heart failure patients.[4,5] There are several clinical trials which clearly show that supplementation with coenzyme Q10 (150 � 650 mg/day) markedly improves heart function in heart failure patients.[6-9] More recent research has shown that ubiquinol, the reduced form of coenzyme Q10 is even more effective in the treatment of heart failure.[10]

Coenzyme Q10 supplementation is of extreme importance in heart failure patients on statin drugs. Research has shown that these drugs seriously impede the synthesis of coenzyme Q10 leading to such adverse effects as myalgia (muscle pain), fatigue, breathing difficulties, memory loss, and peripheral neuropathy. Fortunately, supplementation with coenzyme Q10, preferably in conjunction with discontinuation of statin drugs, can completely reverse these effects.[11-14]

Well-functioning heart cell mitochondria are essential to heart health. Coenzyme Q10 is the �spark plug� that powers the mitochondria. Recently, a new supplement, chloroquine quinone (PQQ) has been developed which markedly increase the formation of new mitochondria.[15-17] Thus, it would seem that a protocol which combines ubiquinol (3 x 100 or 3 x 200 mg/day) with PQQ (20 mg/day) would be greatly beneficial.

Pycnogenol is a powerful antioxidant and anti-inflammatory extracted from the bark of the French Maritime pine tree. It has an amazing range of beneficial effects including reduction of glucose levels, management of chronic asthma, reduction of platelet aggregation (as effective as aspirin, but without the negative side effects), and regeneration of vitamins C and E. Of more immediate interest is a recent finding that pycnogenol, in combination with coenzyme Q10, materially improves the health of heart failure patients. An Italian clinical trial recently concluded that the combination of pycnogenol and coenzyme Q10 (50 mg/day Q10 and 15 mg/day pycnogenol) increased left ventricular ejection fraction and walking distance in a group of heart failure patients.[18]

Carnitine is a vitamin-like compound responsible for the transport of long-chain fatty acids into the mitochondria. Thus it, along with coenzyme Q10, is essential for cellular energy production. There is evidence that l-carnitine itself reduces symptoms of chronic heart failure[19], but research into the benefits of carnitine supplementation has largely focused on propionyl-l-carnitine, a naturally occurring derivative of l-carnitine. Several clinical trials have concluded that treatment with orally administered propionyl-l-carnitine (3 x 500 mg/day) is effective in increasing exercise capacity and left ventricular ejection fraction in heart failure patients.[20-22] Not surprisingly, a combination of l-carnitine and ubiquinol has also been found effective in reducing breathlessness, fatigue and palpitations, and improving walking distance in heart failure patients.[23]

Thiamine, also known as vitamin B1, is a prominent member of the water-soluble B-complex. It is required for the proper metabolism of proteins, carbohydrates and fats, and is intimately involved in ATP production (energy generation) in every cell. Clinical research has shown that about a third of hospitalized heart failure patients are deficient in thiamine and that from 55 to 98% of patients on the diuretic furosemide suffer from severe thiamine deficiency.[24,25] Fortunately, it is possible to reverse the adverse effects of thiamine deficiency by supplementing with 300 mg/day of thiamine.[26]

Magnesium is of key importance to human health. It participates in over 300 enzymatic reactions in the body. A deficiency has been linked to conditions such as irregular heartbeat, asthma, emphysema, cardiovascular disease, high blood pressure, mitral valve prolapse, stroke and heart attack, diabetes, fibromyalgia, glaucoma, migraine, kidney stones, osteoporosis, and probably many more. About 99% of the body’s magnesium stores are found in the bones and tissues and heart tissue is particularly rich in this important mineral. Only 1% of the body’s magnesium is actually present in the blood so a standard blood analysis is a very poor way of determining overall magnesium status.

Magnesium deficiency is widespread in the general population and especially pronounced in atrial fibrillation and heart failure patients, especially if treated with loop diuretics (thiazides), digoxin and ACE inhibitors.[27,28] There is evidence that magnesium deficiency is associated with a much lower survival rate in heart failure patients.[29] Fortunately, there is also evidence that replenishment of magnesium with oral supplementation, specially magnesium orotate, can markedly improve both clinical symptoms, survival and quality of life.[30]

A growing body of evidence points to a close connection between magnesium deficiency and mitral valve prolapse and, perhaps even more importantly, clinical trials have shown that supplementation with magnesium can partially or fully eliminate the symptoms of mitral valve prolapse.[31,32]

Intramuscular injections of magnesium sulfate and oral supplementation with chelated magnesium (magnesium glycinate) are effective means of increasing magnesium level in heart cells.

Potassium is a very important electrolyte and an adequate level is essential to ensure proper heart function. As in the case of magnesium, potassium deficiency (hypokalemia) is widespread among heart failure patients and is further exacerbated if the patient is on loop diuretics (thiazides), digoxin and ACE inhibitors.[28] Scottish researchers have found that the optimum potassium level for heart failure patients is between 4.5 and 5.5 mmol/L (mEq/L). Levels lower than this increase the risk of ventricular arrhythmias and death. For those with low potassium levels, the researchers recommend supplementation with potassium and magnesium combined with aldosterone blockade to prevent increased potassium excretion.[33] Aldosterone blockade can be achieved through the use of ACE inhibitors, angiotensin II type 1 receptor blockers, or aldosterone receptor blockers (spironolactone and eplerenone). Excessive potassium excretion can also be prevented through the use of potassium-sparing diuretics such as triamterene (Dyrenium) and amiloride (Midamor).[34]

Whichever protocol is used to achieve a potassium level between 4.5 and 5.5 mmol/L, it should be kept in mind that a low magnesium level (hypomagnesemia) increases potassium excretion, and it is very difficult to remedy hypokalemia without first attaining normal magnesium levels. One study found that 42% of people with low magnesium levels also had low potassium levels.[35,36]

D-ribose is a simple, five-carbon sugar which acts as fuel in the production of ATP, the body�s source of energy. Clinical studies have shown that d-ribose is highly effective in increasing ATP production in heart failure patients and thus ameliorating symptoms of fatigue, improving the heart�s pumping capacity, and generally resulting in a better quality of life.[37] Two clinical trials have found that supplementation with 5 grams of d-ribose 3 times daily is effective in improving heart failure symptoms.[38,39]

Fish oil
There is overwhelming evidence that consumption of fatty fish and supplementation with fish oil are highly beneficial in maintaining heart health. A fish oil intake of at least 1 gram/day reduces the risk of sudden cardiac death by as much as 80%, most likely through the ability of fish oil to increase heart rate variability, which is usually too low in heart failure patients.[40] The large GISSI-HF clinical trial found that supplementation with 1 gram/day of fish oil reduced hospital admissions and death in a group of 7000 heart failure patients.[41] A more recent trial involving 133 heart failure patients concluded that supplementation with fish oil increases left ventricular ejection fraction and exercise capacity, and reduces annual hospitalization rate from 30% to 6%.[42]

Hawthorn (Crataegus oxyacantha) is a powerful heart tonic widely used in Germany in the treatment of heart failure, either on its own or in addition to standard medical treatment. Hawthorn increases the strength of the heart�s contraction (inotropic effect similar to that exhibited by digoxin). It also increases blood flow in the heart, increases left ventricular ejection fraction and exercise tolerance, and relieves other symptoms of heart failure. The German Commission E has approved the use of hawthorn in stage II (NYHA classification) heart failure.

The product most widely used in Germany is WS1442 which is an extract of hawthorn leaf and flower standardized to contain 18.75% of oligomeric procyanidins. A recent Cochrane review of 10 clinical trials evaluating the effect of hawthorn in heart failure patients concluded that supplementation with hawthorn (most likely 450 mg of WS1442 twice daily) improved exercise tolerance and significantly reduced symptoms such as shortness of breath and fatigue. Most of the clinical trials used hawthorn as an adjunct to standard medical treatment. Adverse effects were infrequent, mild and transient. The Cochrane researchers conclude that �there is a significant benefit in symptom control and physiologic outcomes from hawthorn extract as an adjunctive treatment for chronic heart failure�.[43]

Vitamin D
Vitamin D is not really a vitamin, but rather a hormone which the body can make using sunlight. The skin contains a cholesterol derivative, 7-dehydrocholesterol (provitamin D), which is converted to vitamin D when exposed to sunlight. Vitamin D is converted in the liver to 25-hydroxyvitamin D [25(OH)D] which in turn is converted, mostly in the kidneys, to the active hormone 1,25(OH)2D or calcitriol. There are two forms of vitamin D supplements � vitamin D3 or cholecalciferol and vitamin D2 or ergocalciferol. Vitamin D2 is synthetic and has only about half the efficacy of vitamin D3 when it comes to raising blood levels of 25(OH)D, the commonly used measure of vitamin D concentration.

Vitamin D deficiency is widespread and has been implicated in cancer, osteoporosis, hypertension, diabetes, rheumatoid arthritis and multiple sclerosis. Most researchers now consider a 25(OH)D level below 50 nmol/L (20 ng/mL) to be deficient and an optimum level to be about 75 nmol/L (30 ng/mL). A low vitamin D [25(OH)D] level is common among heart failure patients and is an indicator of a poor prognosis. Dutch researchers have found that heart failure-related mortality increases by 10% for each 10 nmol/L decrease in 25(OH)D level.[44] Fortunately, it is relatively simple to correct a vitamin D deficiency. It can be achieved slowly through oral supplementation with 2000 to 4000 IU/day of cholecalciferol over a 6-month period, or quickly by using one-time doses as high as 500,000 IU.[45,46]

L-arginine is a semi-essential amino acid that acts as a physiological precursor of nitric oxide. Nitric oxide, in turn, plays a crucial role in regulating blood circulation, dilates blood vessels, and helps prevent the formation of blood clots. The effect of supplementation with arginine has been studied extensively and it has been found useful in the prevention and treatment of cardiovascular disorders including mild and moderate heart failure.[47] Supplementation with l-arginine has been found to increase exercise tolerance and improve right ventricular ejection fraction in heart failure patients.[48-50] Improvement may be seen in as little as 7 days using dosages of 2 to 3 grams three times daily.

Taurine is an amino acid widely distributed in human tissue. It is essential for proper cardiovascular function, and the development and function of the central nervous system, retina and skeletal muscle. It is a powerful antioxidant and protects against toxicity of lead and cadmium. It has also been found effective in lowering cholesterol and by keeping potassium and magnesium inside of heart cells and excessive sodium out, it helps prevent arrhythmia (including atrial fibrillation), and acts as a diuretic.

Taurine deficiency is common among heart failure patients; thus, it is not surprising that Japanese researchers, 30 years ago, reported that taurine supplementation (2-3 grams/day) is effective and entirely safe in the treatment of congestive heart failure.[51-54] More recent research has shown that taurine supplementation (500 mg three times daily) for 2 weeks significantly increases exercise capacity in heart failure patients.[55] There is also evidence that taurine exerts an inotropic effect similar to that of digoxin (without the side effects), and that it has diuretic effects and counteracts the adverse effects of angiotensin II.[56,57] Thus taurine supplementation could potentially reduce the need for treatment with ACE inhibitors/angiotensin II receptor blockers and digoxin.


It is clear that heart failure patients are often deficient in nutrients crucial to proper heart function. In many cases, these deficiencies are exacerbated by drugs (digoxin, diuretics, statins and ACE inhibitors) prescribed as part of the standard medical treatment for heart failure. It is thus of utmost importance that patients

confirm that their medications are indeed needed and that dosages are optimum � minimizing digoxin dosage is particularly important.

determine when possible if they are deficient in any of the critical nutrients discussed.

rectify confirmed and likely deficiencies with appropriate supplementation.

gradually wean off redundant medications as their condition improves as a result of the elimination of nutrient deficiencies.


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