pennis enlargement pills review

So, Where’s the Infamous “G-Spot”? The term "G-Spot" was first introduced to the public in the book, "The G Spot and Other Recent Discoveries About Human Sexuality" in the 1980s. It referred to an article from 1950 in the International Journal of Sexology in which gynecologist, Dr. Ernest Grafenberg wrote about erotic sensitivity along the anterior vaginal wall. While many people have read or heard about Grafenberg, few have read his actual words. In reality, Grafenberg only uses the word "spot" twice and he uses it to make the opposite point to the way it has been popularly used. He states "there is no spot in the female body, from which sexual desire could not be aroused. Innumerable erotogenic spots are distributed all over the body, from where sexual satisfaction can be elicited; these are so many that we can almost say that there is no part of the female body which does not give sexual response, the partner has only to find the erotogenic zones." The Grafenberg spot (G-Spot) is said to be a sensitive area just behind the front wall of the vagina, between the back of the pubic bone and the cervix. Beverly Whipple, a certified sex educator and counselor, and John D. Perry, an ordained minister, psychologist, and sexologist, named the G-Spot after gynecologist Ernest Grafenberg (1881-1957). Dr. Grafenberg was the first modern physician to describe the area and argue for its importance in female sexual pleasure. His claim is that when this spot is stimulated during sex through vaginal penetration of some kind (fingers during masturbation, penis or other object partly thrusting into the vagina), some women have an orgasm. This orgasm may include a gush of fluid from the urethra -- sometimes called the “female ejaculation” -- however, many experts do not agree on this. It is not considered urine? Is this real? Many gynecologists and physiologist still argue and the debate will probably continue. There has been a large amount of controversy among sex researchers regarding this theory. For women who have felt this gush of urethral fluid, or for those who have found a new pleasure spot, having a name for it confirms their experience. But remember, not all women are sensitive in this area, so be careful not to set up unrealistic expectations for yourself. Try it out; if it works, great, if it doesn't seem sensitive, try to find the spot(s) that are right for you! And of course, enjoy! penis girth enhancement penis enlargment before and after photo vigrx pills best penis enhancement pills cheap vigrx pill natural pennis enlargement penile enlargement do penile enlargment pills really work

pennis enlargement pills review

Whenever we read the great tales of ghosts and goblins, of gods and their helpers, of priests, lore, and magic, we are always struck with the idea that these spirits have emotions, that they are suffering from human frailties, and that they have a will power. The origin of the idea of the soul, of the spirits and the gods, all comes from the most human desire: immortality, freedom from fear of death. As it so happens to be natural, humans desire to avoid pain, suffering, misery, and death. The idea that death or the end of life is not really the end of life, and that a misery-less future awaits those who die, this idea is a relatively attractive one. With an afterlife, there is no death, so it is easy to see why one might enjoy such a theory, regardless of the lack of any evidence whatsoever. Since this idea in an afterlife flourishes considerably, there is are other popular ideas about spirits, souls, and other items that exist in this afterlife theory. Our memories, our experiences, our thoughts, ideas, notions, character, attitude, and feelings are all stored within the mind. Science, or at least all honest investigative studies, would tell us that our mind is located within the physical brain of the body. So far, no other theory has come up with any verifiable evidence to the contrary. Another theory, with much less evidence, does exist. It is the idea that the mind is a part of the soul -- that when the body dies, the mind leaves the body with the soul. Some individuals have offered evidence on behalf of such a trite idea. They have argued that since it is a part of the spiritual realm, one which tools and devices and technology cannot reach nor see, that it is out of their jurisdiction of judgment. An interesting idea, I admit. One might as well claim that they have invented, discovered, or uncovered something that is wonderful and beautiful, but that is completely unsensible by human senses. (i.e. we might have a tourist trap with the holy grail, only to find a plaque "If you have sinned, you cannot see or feel it, but you must believe it is there.") One might be so educated and thoughtful enough to feel that the theory of a soul is so discredited, that it needs no further examination; it becomes a moot point. However, there are some things in this field that might want to be considered, just in a hypothetical point of view at most. So it indeed happens that every folk story and every old religion regards spirits as vibrant and powerful beings. In Greek mythology, the gods often came down from their clouds, to mate with earthlings, or kill them, or have dealings with them. In the stories of these gods, they all seem to have the exact same characteristics of any human being. They have desires, wants, fears, hopes, beliefs. They react to their environment. When they are informed that their plans have failed, they react with disappointment, and maybe rage or violence. When they are informed that their plans have succeeded, they react with happiness, and maybe feasting or gloating. The gods are essentially the most human of any theoretical being, and this is no surprise when we think of their creator. I cannot, for the life of me, suppose any idea or theory as to why any of the gods are endowed with desires or wants anyway. When I think of the origin of such psychological phenomena in humans, or any other organism, my question is immediately answered. Humans are endowed with a complex brain because it is necessary towards survival. The same can be argued for any other living creature. Desire motivates, it creates movement. When a predator, either a crocodile or a lion or any other for that matter, is hungry, it hunts to satisfy its desire. In this situation, the component of the brain that creates desire and want, especially for satisfying hunger, this component is essential. Those predators that were born without this capability could not hunt or eat as effectively, and could not fight for breeding rights very well either, since they could not want them. And, so, it would die, leaving no offspring, leaving no other organisms on this planet with their DNA -- DNA which contains a lack of desire. We can apply this to other organisms, too. Prey that is born without a desire to flee its natural predator, for example, will not live long enough to reproduce. The same can be said of prey that does not want to eat to satisfy its hunger, either. It will waste away to weakness and then be taken by its predator. Desire definitely plays a strong and important role in the psyche of all consciousness-endowed organisms. However, it is not the only important part of consciousness. For example, there is also pain, the physical affliction, or misery, the mental affliction. An animal can suffer, and it is this suffering that they will forever be afraid of. Their fear and their suffering gives them something to desire: happiness and security. Without pain, an organism will not react negatively to another trying to kill it -- at least, if instincts were gone as well. Without happiness, an animal would not know whether it was doing something right or wrong. The social instinct, to be in a collective of like organisms, is natural to almost every mammal. When wolves hunt in packs, they are more effective killers. When humans band together to form societies and civilizations, the fruit of their labor increases. When zebras feed and mate in packs, all of their stripes form a natural defense, by disallowing predators from knowing where one zebra starts and another ends. The social instinct has given each organism a strong advantage in survival. And, when organisms survive, they can reproduce, and more organisms like themselves, with the same emotions and mental faculties, will be produced. Let us not forget the importance of the mating instinct. The sexual arrousal caused by flirting or foreplay plays a significant role in the mating act. The orgasm itself and the sexual drive to achieve are important to every creature. It seems that in every group of thoughtful organisms, there is not competition for the right to reproduce, some how or some way. Often, it is the male competing for the female, but this is not the only case. In some cases, there is polygamy, and in others, there is polyandry. Every rule of behavior that we can think of for other organisms will always have exceptions to it. The underlying fact that sex plays an important role in the mental faculties of conscious organisms is important to my thesis. The mind is full of complexities and faculties that make it conscious. All of these emotions, these feelings, play a strong sense in the conscious organism. Now that I have covered a great deal on the complexities of conscious organisms, one might be curious as to why I brought up this subject in the discussion of spirits. First of all, all of the components of the mind that I mentioned above -- desire, fear, social instinct, sex -- all of these components have a reason for existence. By this, I mean that they all exist because of the natural and perpetual struggle that goes on in the natural world. Without desire or fear or sexual impulses, an organism would not reproduce, and therefore, no other organisms with that mentality would be created, except by chance of reversion, which is very unlikely. My question is this: why is it that spirits and souls are endowed with these psychological aspects? In all of the stories I have read of the gods, I have uncovered all of these impulses. I have encountered the sexual urge of the gods of Greece and Rome. I have discovered the ability to desire and feel accomplishment or disappointment in the gods and spirits of Animist cultures. It seems that there is no god, excepting the god of Deism, that has no interest in being involved with the people who believe in him. The Christians believe their god will save them. The Hindus believe their god will reincarnate them. The Jews believe that their god has smashed societies and cultures for the tiniest of reasons. Every religion remains identical in this fact. Okay, so, we have spirits, souls, and gods, many of them endowed with human mentality. I am quite curious, though. Why is it that no playwright in ancient Greece ever described one of the gods as rubbing his belly and hungry? Why have I seen no spirits that get hungry? Some cultures feed their spirits, but that's even more absurd. They leave only enough food for a few days or a weeks. And why leave any food at all? Will the spirits decompose and go to the state of the after-afterlife? The sexual urge that seems so prevalent in so many religions, from the god of Christianity violating a virgin meant to be married to the Greek gods that committed such fornication on a regular basis -- just why does the sexual urge prevail? Of what use is it? Are the gods going to mate and then produce spiritual offspring? What seems a thousand times more odd is that the gods are lacking those parts that make sexual activity useful, for procreation or recreation. The penis and the vagina, these two parts that are responsible for producing the pleasure of sex, are non-existent on ghosts. If a human loses such a part, it is impossible to engage in sexual activity. And, it seems that these ghosts have lost all their bodies. Yet, the urge to have sex is prevalent, while their sex organs are not prevalent. One may argue with me, "But the gods and ghosts have physical bodies that they can use!" If this is true, then it shouldn't be even slightly difficult to get evidence of god. Whenever pressed for evidence, the religionist usually claims, "But they are noncorporal entities -- they are not physical, they are spiritual." No thoughtful spiritualist will claim their god is actually physical, because in doing so, they have opened the doors to dispelling their beliefs in a heartbeat. The need to eat is as absurd as the desire to have sex for the gods. Other things, such as the social instinct and any desire at all, seem to also be quite absurd. Why animals and other conscious organisms are equipped with desires and the social instinct is easy to understand. With regard to the social instinct, it has helped organisms to survive against the natural elements, or predators, or aided in obtaining their prey. When organisms had a social instinct, they were more effective at survival, and that means they were more effective at reproducing. When organisms had no social instinct, they died rather quickly -- not able to reproduce something like themselves, leaving the world destitute of such types of species. (And while there may be exceptions to this rule of the social instinct, the previous description is how Evolution works: those unfit, do not survive.) Why would the gods ever be needing of the social instinct? Why ever should the gods band together with other gods? In all honesty, I am bankrupt of any answer. The gods cannot die, they cannot suffer afflictions caused by natural disasters, they cannot be wounded. Everything that makes the social instinct desirable and useful is nonexistent with the gods. Banding together does nothing for them. One might argue "It cures loneliness," but loneliness may in fact just be that instinct to band together unsatisfied. Then there is the idea of desire. In all my studying of literature, I must say that the mythology of Greece, Egypt, and the entire Fertile Crescent is full of gods with more desires and wants than any sane man. Since it seems very easy to believe that the gods are simply an image of mankind, exaggerrated in many aspects, so it seems that these gods are endowed with many supernatural wants, needs, impulses, desires. Sometimes the drowning of an entire civilization in blood is not enough to quell the heart of the least dominant deity. I am also curious here... Why is it that the gods have been endowed with this ability of desiring? To what use is it really, when one is a god? It has no use. For, if god, or the gods, are capable of doing anything, then they would not desire, but simply have. I can see the use of the desire ability in organisms and animals on our own planet. When there is hunger, or sexual lust, or gaining security in society, all of these desires push and motivate the organism to do what is necessary to live and to reproduce. And, once reproduction has occured, the cycle can happen all over again. When an animal is not fit enough to reproduce, or cannot live to that stage, then the genes that cursed it to a sexless life will not be found again, exception in the rare instances of reversion perhaps. Many of the Freethinkers and philosophes of earlier years, and even our own day, have attacked the idea of religion. God created man in his own image was a questioned idea, and we reversed it: man created god in his own image. This would seem to be the more credulous case of the matter. We find gods in each civilization, taking the race and species of its people. This has varied in some cases, where gods take on the forms of reptiles, mammals, and birds. However, there is one thing in the nature of gods, spirits, and souls that seems to be consistent in every religion we investigate: they have wants, desires, lust, hunger, and needs. Where every human being -- no, where every living creature is the same, in having a consciousness, we find that same consciousness in a rather inplausible place: in a god, or a soul, or a spirit. It is clearly understood, then, that these gods and spirits are based on human ideas, that they come from the minds of men, that they spread by our mouths. And, it must also be clearly understood, that the gods are nothing more than an imperfect creation by the hands of man. www.punkerslut.com For Life, penis elargement tool medical penis enargement truth about penis enlargment pills herbal penis enhancement pills enlagement free penis pills sample safe penis elargement pnis enlargement pills review cheap penile enlargement pennis enlargement pills review

Sexual health has been defined as the state of sexuality related to physical, emotional, mental and social well-being. A positive and respectful approach towards sexuality and sexual relationships is vital for attaining a sound sexual health. Your feelings have a great impact on your sexual appetite. For example, if you are feeling anxious, bitter or angry towards your spouse you will not feel like having a sex with them. Men’s sexual health is of immense concern nowadays. You could be the most affectionate man in the world but if you are unable to satisfy your spouse in the bed it can lead to relationship issues. Sex is very important for a relationship to go smooth. Your inability to last in bed can turn your relationship bitter. Anxiety builds up in your mind making sex one of the most traumatic things in your life. Various psychological factors are also considered while discussing men’s sexual health. Men’s failure to achieve their goal in life can put them into a state of depression. Avoidance to sex becomes natural in such a situation. Other topics relating to men’s sexual health are as follows-: • Desire • Pleasure • Orgasm • Rapid or delayed ejaculation • Prostate health • Masturbation A decrease in the production of testosterone in men makes them loose their desire in sex. Low sexual desire can also be the result of some chronic disease, hormonal imbalances, stress, fatigue or a poor body image. Most of the men today suffer from erectile dysfunction. Erectile dysfunction is a sexual dysfunction that immobilizes a man to develop an erection of the penis. Health problems such as high blood-pressure, cardiovascular disease, diabetes, high cholesterol or depression contribute to erectile dysfunction. Anybody can be affected by this illness at any stage of life, but more often it is seen in men above the age of 40 years. Early ejaculation in men who are single debars them from seeking an ideal partner. Men usually hesitate to talk about their sexual health as it might hurt their ego. They take it as a curse and begin living with it. Living under such a stress can lead to depression. If your husband feels the same, try taking to him. Make him feel comfortable and share his feelings with you. If necessary consult a doctor. If you want to keep this issue as private, the best option for you is to seek levitra power. Levitra is a drug that helps men to improve their sexual health. It works by blocking an enzyme called phosphodiesterase-5, then relaxes smooth muscles in the penis and helps improve the blood flow. This results in a natural erection of the penis. Erection of penis will ultimately enhance your sexual desire thus giving you more pleasure. Men’s sexual health needs considerate assistance. Do not dither to talk about your sexual problems with your spouse. penile enlargement doctor enlargement erection penis pills vimax do penis enlargment pills really work penis enlagement review pnis enlargement before and after photo magnarx home penis enlarement does penis enlargement work pennis enlargement pills review

Viagra has clearly blown away erection problems for many men. Yet there are still some rumors floating around Viagra that makes people a bit edgy about taking it. Is Viagra safe to take? Is there an alternative to this “wonder drug”? Let’s find out… Viagra has been touted by many as the perfect solution for erection problems. Many men take it for an added sex boost as it has been known to bring many benefits beyond helping to keep an erection. Sure, you remember the hype around this “amazing” cure for erection problems but what you may not know are some of the negative side effects that came about from frequent use of Viagra. To put it simply, a man-made drug like Viagra may or may not mix well with your specific body chemistry as everyone is a little different. This and other reasons were the cause behind around 50 deaths stemming from heavy use of Viagra in the first few months of its release. Clearly Viagra, as with all medication, must be taken with a very careful eye on the recommended dosage, which should never be abused or exceeded. Men also have reported other side effects such as loss of vision, chest pains and stomach pains. Whether or not Viagra is safe for you to take is something to talk about with your doctor. While some men prefer not to talk about it with their doctors, most pharmaceutical companies are just looking to sell their product. A promising alternative that has been gaining momentum and wide support by doctors is the natural penis enlargement pills. Have you heard of them? What are they about? Well at first I must admit I was curious as to whether they worked, so I tried some. Penis enlargement pills like ProSolution are a rich blend of herbal sexual nutrients gathered from the rain forests around the world. The better pill companies work in FDA approved laboratories, and the results for many men from taking these pills have been amazing. These natural penis enlargement pills have no side effects and can end and prevent any erection problems or other sexual ailments you might have. As a bonus, they also work to permanently lengthen and thicken your penis. All in all it may take 10, 20, or even 30 years to know just how safe it is to take any of these pills. While many men are seeing fantastic results with Viagra and with the penis enlargement pills, the decision to try any of these solutions is ultimately up to you, and only time will tell how safe and effective they really are. top rated pennis enlargement pills herbal penis enlargement pills penis enlargment photo penile enlargement review penis enlargement traction device vimax free exercise tip for penis enlargement penis elargement tool vigrx pic pennis enlargement pills review

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.