早晨血压上扬， 建议高血压药服用时间

人的血压在早上会有~2小时的上扬。 作为一个正常的生理现象，当人早上起床时，血压会上扬来给大脑和全身供血，以及准备一天的活动。 同理可证，大多数的心脏病发作和中风都在早晨发生。 

许多高血压的药品，尤其是剂量比较低的时候，药效不能持续24小时。如果您早上服药，服药前的药效也许不能够压住早上的血压上扬。

药剂师建议- 如果您吃高血压的药品，把服药时间定位晚上。这样，不用改变剂量，就可以保证早上的药效可以足够保护您。

"Heart Burn" or reflux vs Heart Pain 胃酸上扬 对比 心绞痛

胃酸上扬：

• 发作： 一般为饭后，身体弯曲（ex.饱餐一顿后立刻坐着办公）
• 痛感： 火烧，大面积，胸前，食管
• 疼痛时间 - 不等。几分钟到几小时
• 其他症状： 口中有酸味。肌肉力度，呼吸应该均和平常一样。
• 治疗：服用antacids (ex. Gaviscon, Tums, Diovol, Milk of Magnesia)。 如经常出现，与医师药剂师讨论强化治疗和用药。

心绞痛：（一般心绞痛的病人有高血压，高血脂，家庭历史等风险因素）

• 发作： 可以是任何时间（很多人在坐着或睡觉时候会突然发作）；一般情况下为运动后，饭后，心情紧张后，忽然着凉等。
• 痛感： 胸口痛，时常有压迫，胸口紧， 挤压，“绞”，肿胀，重压，火烧等等。 痛感因人而异，甚至一个人2次心绞痛都可能感觉不一样。痛感做什么都无太大的改变。（无论你是呼吸，咳嗽或者改变身体姿势）
• 疼痛时间 - 一般只有几分钟（1-5分钟），很少很少超过20分钟。如果长时间疼痛，一般会伴有如下的“其他症状”。而且长时间心绞痛是一个很不好的前兆。
• 其他症状：因人而异 - 上身其他部位（脖子，下颚，肩膀，上臂，后背）不舒服； 呼吸紧张（呼吸供氧下降很大一部分是心脏功能下降导致）； 虚汗； 呕吐和晕眩； 严重的情况会血压下降。
• 治疗：需和医师药剂师讨论。舌下用的Nitroglycerin (硝酸甘油）一般是救急用品。硝酸甘油一般可以在1分钟内缓解疼痛。如果您第一次心绞痛，或者心绞痛严重，请立刻叫救护车。如果5分钟内疼痛没有缓解，可以服用第二剂硝酸甘油。（硝酸甘油需坐下，或躺下时服用；如果服用者在过去的24小时内服用过伟哥等治疗勃起功能障碍药物，不得服用nitroglycerin。会导致血压剧降！必须有急救人员在场方可服用nitroglycerin）

高血压多种药物; treating high blood pressure with multiple medications

高血压的治疗一向给很多人带来困扰。血压该如何合理用药物控制总是一个不解的问题。很多人认为用药数量越少越好，其实并非如此：

研究证明，很多高血压的药品，盲目增加剂量会是副作用大大增加，而药效的增加幅度却非常小。如果您服用一个降血压的药品，但血压仍就偏高，先有的研究推荐少剂量添加另一类降血压的药品。用2味药达到的降压效果超出仅用一种药双倍剂量的效果的4倍之多。同时，不同类型的高血压药，药理不同，所以低剂量的2味药产生的副作用远远小于高剂量的一味药。 

如果您不介意吃多个药片，同时又对副作用有所顾虑，在您的医生提高药物剂量的时候，可以和您的医生讨论试用2味降血压药品的话题。 

Vitamin E as supplements NOT recommended routinely 减少维他命E的服用

Quite a number of patients are visiting the pharmacy for vitamin E supplements. I personally recommend against stand-along supplementation of vitamin E. Reasons are below,

vitamin E is an antioxidant that was marketed towards general health and boosting immune function many years ago. The marketing was based on the theory that antioxidants decrease free radicals in the body thus preventing cellular damage. Evidence did not exist in full strength then on the safety of supplementation. Multiple studies looking at such concern was published around 2004-2005, suggesting that supplementing with vitamin E can possibly cause HARM with NO BENEFIT in cardiovascular protection. It is suggested that vitamin E supplementation if necessay must be kept under 400IU daily and an intake of 400IU or greater has been shown to increase risk of heart failure minimally in high risk patients and increase all-cause-mortality with dose >400IU/day.

In addition, vitamin E has been noted to increase bleeding tendency in patients taking NSAIDs, Warfarin, ASA or other blood thinning products. It is suggested to limit supplementation to 200IU if necessary or discontinue supplementation if vitamin E is not necessary.

Vitamin E:
sources: nuts, seeds, vegetable oils
daily requirement ~22.4IU from natural sources daily for general population (value may vary with references)
Usual commercially available products, 200IU and 400IU from natural or synthetic sources

虫咬，野外植物过敏现象 - bug bites and plant contact allergy

虫咬或被植物蛰了过后，

1. 用水和肥皂洗净
2. 可以考虑用上敷药品 - Astringents, Oatmeal baths (Aveeno), Calamine Lotion，此类产品可以使皮肤舒服一些，止痒，晾干。
3. OTC非处方 hydrocortisone 也可以使用，但效果并没有处方类药品理想。如果情况不严重，不需要用hydrocortisone, 情况严重的话，建议见医生开处方类上敷皮质类固醇。
4. 口服过敏药效果未必理想，应为痒的感觉不完全是由于histamine release. 口服过敏药效果平平
5. 上敷过敏药，麻醉药（止痛药）以及抗生素也不建议，应为会刺激皮肤。

hydrocortisone和其他上敷皮质类固醇需1-2日才能见效，保留此类药为中等-严重蚊虫叮咬现象。

Hypoglycemia

These has been a lot of talk about treating hypoglycemia/low blood sugar,

Remain calm, Suggested treatment include - 15g of simple sugar (glucose or table sugar, etc), use 20g of simple sugar to correct severe hypoglycemia. This is about 3-4 glucose tablets, 5-6 hard candy and 120mL of REGULAR soda.

Suggest retesting 15min after a hypoglycemia episode,

and suggest a small meal after blood sugar has been corrected.

treatment of diarrhea - children

Always rehydrate.

Rehydration solutions are available and if diarrhea is not severe, rehydrate as needed. DO NOT over rehydrate with plain WATER. This may cause eletrolyte imbalance which can be dangerous as well.

Rehydration solution calculation (with rehydration solution)

Home-made rehydration solution - 1 teaspoon (5mL) of salt AND 8 teaspoon of sugar (40mL) in 1 litter of water. DO NOT use pop or certain juice, due to large amount of sugar. 

for mild-moderate dehydration,

50mL/kg over the first 4 hours (NOT ALL TOGETHER in one dose) 

moderate-severe dehydration, (must seek medical attention)

100mL/kg over the first 4 hours

rehydration should continue beyond 4 hours if needed. 

Plain water is harder to absorb than rehydration solution in case of diarrhea and plain water has no eletrolytes to replenish the loss.

Drugs

In case of suspected infectious causes - ex. unsanitized food, house hold, school, work place outbreak. Some drug therapy may not be used.

DO NOT use,

bismuth subsalicylate - Pepto Bismo - contains salicylate, not recommended in children. In addition, efficacy data is not firmly established.

Loperamide, Imodium - not approved to be used in children <2. Must consult physician <12. Risk of mental side effects with Imodium. 

Psyllium, metamucil - can be used with physician's guidance. Do not use products with laxative. 

Attapulgite - not recommended. very weak efficacy data. 

not suggesting adding niacin to statins?

Recent meta-analysis this January, 2013 suggests benefit of adding niacin to existing therapy to further alter lipid levels looking at current data available (11 trials, n=~10000).

The AIM-HIGH (n=3500, established CV disease) showed no benefit for hard end points (ex. first event of the composite of death from coronary heart disease, nonfatal myocardial infarction, ischemic stroke, hospitalization for an acute coronary syndrome, or symptom-driven coronary or cerebral revascularization.)



Lavigne PM, Karas RH.The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression. J Am Coll Cardiol. 2013 Jan 29;61(4):440-6. doi: 10.1016/j.jacc.2012.10.030. Epub 2012 Dec 19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23265337?dopt=Abstract

The AIM-HIGH Investigators. Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy. N Engl J Med 2011; 365:2255-2267. Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa1107579

an interesting article on myth about weight losing

Heard about this all over the media - sex only burns 21 Cal (or kcal) on average?
The original paper looks into different myths regarding weight losing. Part of this article touches on the subject of sexercise. It calculated the amount of energy needed for sex using the average energy expendature per hour times the average length of sex (only 6 minutes! - Bohlen JG, Held JP, Sanderson MO, Patterson RP. Heart rate, rate-pressure product, and oxygen uptake during four sexual activities. Arch Intern Med 1984;144:1745-1748) This gives the shocking number 21 Cal per sexual activity!

We might as well spend 20 minutes watching TV, we burn the same amount of energy...

Original source - http://www.nejm.org/doi/full/10.1056/NEJMsa1208051#t=articleDiscussion
published on new england journal of medicine.

Grapefruit & Drugs

It takes as little as 1 grapefruit or 1 cup of grapefruit juice to interact SIGNIFICANTLY with conventional drugs. Spacing apart drugs from eating grapefruit does NOT help the problem in any way. Grapefruit has the ability to inhibit enzyme (CYP3A4) in the gut that is responsible for some of the breakdown of certain drugs. Drugs are designed to take this effect into account. By eating grapefruit juice, you will have MORE (or less depending on which drug) drug in your system causing toxic effects. This effect can last 2-3 days due to permanent inhibition and time delay for production of new enzymes. Always tell your health care professional, esp pharmacist, that you are a grapefruit consumer!

more serious adverse reactions linked to energy drinks

Several new case reports of adverse reactions to energy drinks have been documented including 18 fatalities possibly linked to energy drink consumption. Caffeine content seems to be the cause. Mind the caffeine content and per serving size. (some brand contain multiple small servings per bottle). Stay within the daily limits.

antidepressants cause suicide or NOT?

ever since the black box warning of SSRI increasing depression, prescription of SSRI decreased by 22%, while suicide rate increased 14% between year 2003-2004. In Netherlands, a 49% increase in suicide between 2003-2005 was noted inversely related to prescription of SSRI. Cochrane review deems that more evidence is needed to agree with either side of the coin.

Kevin Wang http://www.ncbi.nlm.nih.gov/pubmed/17728420
Kevin Wang http://www.ncbi.nlm.nih.gov/pubmed/17636776

断开血脂指标和高血脂治疗

高血脂的治疗并不用考虑血脂的指标。2008年的ENHANCE研究又一次证明降低血脂并不直接等于保护心血管。说实在的，药理学还有待提高。人类并不了解降血脂药的工作原理。现阶段的有效治疗：高血脂人群适合用他汀类药物。如果血脂还高，大可不必担心。应为再增加药物来降低血脂对心血管健康并无大帮助。最有效的治疗还要归功于运动，减肥和饮食。

药名限加拿大药。

简介：1960s, 避孕药被研究出来。当年的避孕药有100-150mg estrogen。导致了相当多的副作用。现在的避孕药，仅仅只有20-50mg estrogen. 避孕效果不减，但副作用大大减少了。

避孕药分好多种，estrogen + progesterone 和 progesterone only。也分口服和注射。但并不完善。

成功率：如果按时服药，不忘记，成功率高达99.7%。如果忘记服药了。。。当然，就不太好啦。

避孕药一定要21天吃么？ - 不用。避孕药完全可以无间断的吃。无间断吃避孕药不但没有想象中的坏处，反而有利于记着服药，有利于于女生身体。21天间断的好处就是，如果怀孕了，你会知道。（也是差不多唯一的好处）

避孕药会导致以后不孕么？ - 不会。 大量研究证明。

避孕药的副作用如下：（副作用由药物分类。如果你有以下的副作用，可以调整药剂的含量（就是换一个牌子）来控制副作用）

太多estrogen: 恶心，胀气，色斑，头痛，头晕，乳房肿胀 (ps. 有的避孕药是没有estrogen的。如果你不能接受estrogen，试一试那些避孕药)

太少estrogen: 经常在吃药期间流血。

太多progesterone：累（原因很多，不要盲目认定是药物作用）， 心情不好，抑郁，口味大增（也不算是坏事，哈哈）

太少progesterone：副作用很少。（如果药挺了，但流血来得很晚，也许是应为progesterone太少）

太多androgen：（progesterone其实是很多种不同药物的统称。有些药物带有男性荷尔蒙的功能）青春痘。换个牌子可以帮助，尤其是青春痘的问题

紧急避孕药：

每个国家的药都不一样。在加拿大，成分为Levonorgestrel 0.75mg 2片装（ex. Plan B）。 2片可以相隔12小时吃，或者一起吃。（如果你想分开吃副作用会少，那大可不必。副作用是一样的。分开吃反而容易忘）

紧急避孕药无法堕胎！！只是防止身体排卵而已。如果已经排卵了，紧急避孕药的用处其实不大。紧急避孕药不会对胎儿造成伤害。

不要相信紧急避孕药可以代替普通避孕措施。。。一是，成功率低；二是，副作用大（药剂很大）

每一片相当于普通避孕药4-5颗。如果你无法买到紧急避孕药，你有普通的避孕药，紧急情况可以用多颗来代替。如下 （美国和加拿大牌子）（来自于http://ec.princeton.edu/questions/dose.html#dose - 普林斯顿大学著）

Brand	Company	First Doseb	Second Doseb (12 hours later)	Ulipristal Acetate per Dose (mg)	Ethinyl Estradiol per Dose (µg)	Levonorgestrel per Dose (mg)c
Ulipristal acetate pills
ella	Watson	1 white pill	Noneb	30	-	-
Progestin-only pills
Levonorgestrel Tablets	Perrigo	2 white pills	Noneb	-	-	1.5
Next Choice	Watson	2 peach pills	Noneb	-	-	1.5
Next Choice One Dose	Watson	1 peach pill	None	-	-	1.5
Plan B One-Step	Teva	1 white pill	None	-	-	1.5
Combined progestin and estrogen pills
Altavera	Sandoz	4 peach pills	4 peach pills	-	120	0.60
Amethia	Watson	4 white pills	4 white pills	-	120	0.60
Amethia Lo	Watson	5 white pills	5 white pills	-	100	0.50
Amethyst	Watson	6 white pills	6 white pills	-	120	0.54
Aviane	Teva	5 orange pills	5 orange pills	-	100	0.50
Camrese	Teva	4 light blue-green pills	4 light blue-green pills	-	120	0.60
CamreseLo	Teva	5 orange pills	5 orange pills	-	100	0.50
Cryselle	Teva	4 white pills	4 white pills	-	120	0.60
Enpresse	Teva	4 orange pills	4 orange pills	-	120	0.50
Introvale	Sandoz	4 peach pills	4 peach pills	-	120	0.60
Jolessa	Teva	4 pink pills	4 pink pills	-	120	0.60
Lessina	Teva	5 pink pills	5 pink pills	-	100	0.50
Levora	Watson	4 white pills	4 white pills	-	120	0.60
Lo/Ovral	Akrimax	4 white pills	4 white pills	-	120	0.60
LoSeasonique	Teva	5 orange pills	5 orange pills	-	100	0.50
Low-Ogestrel	Watson	4 white pills	4 white pills	-	120	0.60
Lutera	Watson	5 white pills	5 white pills	-	100	0.50
Lybrel	Wyeth	6 yellow pills	6 yellow pills	-	120	0.54
Nordette	Teva	4 light-orange pills	4 light-orange pills	-	120	0.60
Ogestrel	Watson	2 white pills	2 white pills	-	100	0.50
Portia	Teva	4 pink pills	4 pink pills	-	120	0.60
Quasense	Watson	4 white pills	4 white pills	-	120	0.60
Seasonale	Teva	4 pink pills	4 pink pills	-	120	0.60
Seasonique	Teva	4 light-blue-green pills	4 light-blue-green pills	-	120	0.60
Sronyx	Watson	5 white pills	5 while pills	-	100	0.50
Trivora	Watson	4 pink pills	4 pink pills	-	120	0.50

有糖尿病的高血压用药

高血压可以用很多种不同的药物来控制。但是，如果病人同时又糖尿病和高血压，血管紧张素转换酶抑制剂 （ACE inhibitor. 英文药名有相同词尾：xxxxxpril） 是必须的（单独吃或者和其他降血压药物组合在一起都可以）！血管紧张素转换酶抑制剂可以保护肾功能。肾功能下降是糖尿病和高血压患者中常见的并发症。就算病人血压控制的很好，如果病人的降血压药并不是血管紧张素转换酶抑制剂，请考虑更换药物。（为什么血压控制住了还要换药？降血压的目的就是为了保护内脏健康。如果你的药品仅仅把血压的数字降下来，这个药品是毫无意义的。血管紧张素转换酶抑制剂可以最大化对肾脏的保护。）

顺带 - 有糖尿病的高血压患者，血压应该控制在130/80 mmHg以内。（比普通患者更低，普通患者应控制在140/90以内。）血压，血糖，血脂，是精密相连的，控制住任何一个都可以帮助控制其他的2个。 

回国大众化补品 - 鱼油 和 银杏，好与不好

在加拿大，购买任何药物补品前，请注意NPN, DIN或者EN编号。拥有这些编号的产品，不论是产品还是厂家都是被health canada检查过的。但是，这并不代表这些产品有益，或者无害。（任何产品运用不对都有可能造成伤害）

鱼油：
每种鱼油成分各不相同。购买之前，需细读成分列表。
常见成分：
vitamin A: 在饮食正常的情况下，缺少vitamin A是很少见的。少量补充维他命A并无害处，但是大量摄取维他命A会导致头痛，厌食，晕眩，皮肤干燥起皮。每日vitamin A摄取量应该控制在10000IU以内。

Vitamin D: 现阶段的研究证明vitamin D对骨骼，以及对其他身体机能有好处。适量补充vitamin D并无害处。摄取量应该控制在每日4000IU以内（虽然有专家认为一日4000-5000IU并无害处）

DHA and EPA: 是鱼油中富含的2中omega-3 fatty acid. 也是很多消费者购买鱼油的主要原因。要注意的是，在研究中，为了降血脂和保护心血管，DHA+EPA应该达到每天2g（2克）。很多鱼油产品含有非常少的DHA/EPA. 为了达到每日2g，仅仅靠饮食是很难达到的。除非每日饮食大部分都是肥的鱼（100g Atlantic 三文鱼=2gDHA+EPA; 100g鲱鱼=1.4g; 100g sockeye三文鱼=1.2g; 100g虾=0.5g, 100g 金枪鱼=0.3g）
但是。。。。鱼油虽好，也不是没有副作用！2g以上的鱼油可以导致出血。如果病人再服用aspirin（阿司匹林），warfarin (华法林) 或者其他的稀血药品，鱼油可以与这些药品产生同样的作用，导致出血。手术前2个星期，病人不应该吃鱼油。



银杏：
银杏对老年痴呆的预防和对智力的保护并没有实在的研究资料。大部分研究资料证明银杏并没有绝对的好处。现代西医对这方面也是作为不大。少量服用银杏并无害处。但是。。银杏可以导致流血。如果病人再服用aspirin（阿司匹林），warfarin (华法林) 或者其他的稀血药品，应该注意。如果可以，不要服用银杏产品。手术前更不要服用。质量不过关的产品可能参杂银杏本身的毒素（ginkgotoxin），可能导致癫痫发作。购买产品前，请确认产品质量。

B12, B6, Folic acid combo for heart?

For short... doesn't do you much good.

Let's take a look at the real science behind why not...

Long ago... people observed that in patients with high homocysteine level, they have increased risk of heart diseases, depression and death. One effective way to decrease homocysteine is to take B12-B6-Folate combination.

in 2002 - a research called "Swiss Heart Study" showed great benefit in taking B12-B6-Folate. They showed this combination actually helped heart health. HOWEVER...

in 2006, NORVIT showed increased heart diseases by taking B12-B6-Folate (however, not statistically significant... meaning this increase can be due to chances).

in 2006 again, HOPE 2 study showed absolutely no differences between taking B12-B6-Folate and the placebo (sugar pill).

In 2008, WENBIT study.... there is again... no difference between taking B12-B6-Folate and placebo.

also in 2008, WAFACS study..... absolutely no difference

in 2009, Cochrane review summarized all the data and agreed that B12-B6-Folate provides no significant benefit.

Funny thing this year... in 2009, NOVIT and WENBIT came together and took a look at the data again... they found out... Folic acid actually INCREASED CANCER, cancer death and death-in-general.

However... DON'T worry yet.... in 2010, SEARCH study didn't find that increase in cancer. They found no difference between taking B12-B6-Folate with placebo... (no benefit, no harm)

In 2010 again... VITATOPS study found no difference either...


So.... Overall.... B12-B6-Folate for heart health is not recommended at this stage. There are evidence suggesting no benefit for this combination in heart health. 

Rest = Wellness

Meditate for 30 minutes a day! Let your mind and body take a rest.

lower cholesterol, triglycerides, blood pressure

Some of the ingredients here for your information:

before heading into natural health products, keep in mind, statins (conventional medicine) lowers LDL by 55%. They are effective and safe for many patients.

Can be recommended: 

1. Plant Sterol - aka phytosterols, beta-sitosterol.
It doesn't let cholesterol get absorbed! However, plant sterol itself is very hard to absorb. Taking plant sterol by itself won't help you much. It has to be inside fat (ex. margarines) to work. These margarines are widely available from many supermarkets.
If you see a capsule product containing plant sterol, think again...

Overall pretty safe. If you are taking a medication called "ezetimide", this medication will block plant sterol absorption, making the plant sterol useless.

It lowers LDL mildly (6-15%) and does not change HDL.

2. Fish Oil
2-4g of EPA-DHA a day have been shown to lower triglycerides (25-30%) (but increase LDL and HDL cholesterol a bit). However, for patients with high triglycerides, they are a good choice of medicine. They have been shown to mildly decrease cardiovascular death and all-cause death in high risk patients.

Note: fish liver oil may contain little EPA/DHA and lots of Vitamin A and D. Make sure you check the vitamin A dose and not to over dose on vitamin A. It can be dangerous to take too much vitamins.

Safety concern! Fish Oil will increase LDL by a little bit. High dose (ex. 3g/day) can cause bleeding! If you are taking aspirin, warfarin or other blood thinning medication, be cautious and consult a licensed health care professional. BUY trust-worthy products (ones with NPN number). Bad products can have quality problems.

3. Coenzyme Q (CoQ)
Have been shown to decrease blood pressure. But there are not that much evidence. More evidence is needed to say for sure whether CoQ works or not.
CoQ has been used widely in Japan for heart failure. Health Canada allows the claim "helps to maintain and support cardiovascular health".

Safety concern! CoQ is safe. If you are taking warfarin, be cautious. CoQ may reduce warfarin's affect.


THINK again before you try: (not recommended)

Red Yeast Rice: the active ingredient of this product is lovastatin! Lovastatin, a conventional statin drug is a purified version of red yeast rice!
Red yeast rice can contain toxins due to improper manufacturing, ex. citrinin that can cause kidney damage. Purification process of lovastatin as a drug removes impurities.

Basically, if you want to try red yeast rice... why don't you try a normal statin. If you are on a statin already, this is CERTAINLY not a good product for you.

Flaxseed Oil: 
Whole flaxseed contains flaxseed oil, lots of fiber and a class of chemical called lignans. Flaxseed oil only has the oil part (mostly ALA). Flaxseed OIL has NOT been shown to reduce LDL cholesterol! Health Canada does NOT allow claims for LDL cholesterol either!
Whole flaxseeds however, have been shown to reduce LDL mildly and Health Canada allows the claim that it "reduce blood lipid levels".

So... if you want to use flaxseed to lower LDL cholesterol, eat whole flaxseeds from bread, etc and NOT flaxseed oil.

Losing weight?

Try not to use weight loss products. 1. they may not be safe; 2. they likely won't work. (will work for some people, I won't argue with that)

Caution: if you have diabetes or other conditions, talk to a licensed health care professional before buying anything. May be dangerous.

A few kinds that are out on the market are discussed here.

OK to try:

1. Bean Pod: blocks starch digestion theoretically. Pretty safe overall, not for diabetic patients.

2. Glucomannan: soluble fiber that can form a glue-like gel in water. Taken with lots of water can stuff you up! Getting you that sense of fullness. Should take with lots and lots of water, else it may bulk up and cause some obstruction in the gut.
PGX has a similar property, but a different molecule. (you really need that 500mL of water with PGX dose, because PGX's own research study did it this way to get the result. And 500mL is a lot...)

3. CLA (conjugated Linoleic Acid): an omega-6 fatty acid. Can decrease body fat. Have shown to work mildly (~2% drop in body weight in 1 year). Pretty safe, but avoid in diabetic patients.


Maybe think again: (not recommended)

4. 5-HTP: aka 5-hydroxytryptophan. Body uses it to make serotonin and serotonin can reduce appetite (besides other things it can do). Interacts with many drugs, always check with your pharmacist! (ex. some anti-depressants, migraine drugs).

5. Caffeine (aka on label: coffee, tea, cacao, kola nuts, guarana, yerba mate, etc): said to burn the fat... but high doses can cause problems (just like coffee). Very little evidence suggest that they work. Just try coffee. Coffee tends to be cheaper as well~

6. Bitter Orange: aka Seville orange, citrus aurantium. Active chemical is synephrine. It's a stimulant, can cause increased heart rate and blood pressure. Not that safe at higher doses >54mg. Research has shown no efficacy. Highly discouraged.

7. Laxatives and Diuretics: You really shouldn't try. Body can get dependent on long term laxative use and you lose nutrients using them. Diuretics really doesn't help you lose fat, they only help you lose water and important electrolytes. Too much of either can cause big problems. Ask your pharmacist if you are not sure what the ingredients do. Many products do contain these ingredients!