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Breast implants are a popular area of plastic surgery. This leads us to the debate on the type of implants that are best and the government’s role in the decision The debate on silicone and saline implants is a hot one. For a long period of time, silicone was dominant, but health concerns led to saline coming to the front. Silicone first became a popular enlargement resource after World War II. Doctors would shoot silicone directly into women’s breasts to create enlargement. This direct approach resulted in numerous complications including cysts, sores and systematic illness. These complications led to the reduction of interest in silicone, but it would make a comeback. In the early 1960s, two Houston plastic surgeons developed the first contained silicone implants with Dow Corning. To say the two plastic surgeons, Thomas Cronin and Frank Gerow, revolutionized plastic surgery would be a minor understatement. The procedure because very popular and there was practically more demand than there were plastic surgeons to satisfy it. The implant was made of a harder silicone sack covering soft silicone gel. The implant was very popular because it held form better than saline implants. The implants, however, were not regulated at the time. As time passed, the Federal Drug Administration was given oversight and concerns started to arise regarding problems associated with leaks or complete failures of the implants. This was particularly true for second generation implants which were designed to be as soft as possible per surgeon requests, a situation that led them to be very thin and result in failures. One version had a polyurethane coating that actually degraded into a carcinogen, a product quickly pulled from the market. The debate on silicone implants is heated, but surprisingly bereft of facts. What is clear is silicone implants leak silicone into the body. Silicone in the body is assumed to be a bad thing, but the exact correlation to specific diseases and problems are not clear. The primary reason is there has not been sufficient time to study the issue long-term and get verifiable results. Many women, however, have shown distinct negative health problems when suffering from leaking silicone implants, complaining of chronic fatigue, neurological and rheumatologic problems. While studies have found conflicting results, it is clear women who have had ruptured silicone implants removed tend to show improved health. The debate continues to this day, but the FDA restricted the use of silicone implants to medically necessary procedures as of 1992. With the restrictions on silicone implants, saline implants have come on the scene. Originally developed in the 1960s, the implants were overshadowed by silicone until the 1992 ban. Saline implants have a rubberized surface and are filled with a saline solution. In general, they are considered safer than silicone because leaking results in fewer health risks as saline is not toxic in the body. That being said, there have been some complaints regarding saline implants. Specifically, the implants can be difficult to manipulate into the correct form, they can wrinkle and can bottom out – a situation where they sag at the bottom. While these are concerns you should discuss with your plastic surgeon, what is clear is the saline implants do not involve the risks associated with silicone implants. There is an ongoing debate regarding implants. Since the FDA has banned silicone, it is a debate being won by saline breast implants. penis elargement procedure does vig rx really work vigrx penis enlargement pill best enhancement exercise penis com enlargement pennis pennis pump guide to penis enlargment penis elargement testimonials pennis enlargement picture

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When my daughter was born, I must admit there was a distinctly different feeling to it. Part of me was thrilled, but part of me was unsure of how to deal with a gender I still couldn’t quite understand. When my son was born, there was a clear sense that this was territory that I knew: there will be wrestling, playing ball together, playing with cars and, he has a penis! There was a sense of security from all of this and a deep sense of knowing. Raising a daughter creates different issues for many fathers; it is even more challenging considering the cultural landscape that exists today. To better understand these issues, it is helpful to explore the expectations of girls that we have as fathers, many of which may be expectations handed down from our own fathers. Some men feel a strong need to control their daughters, and expect them to act “nice” at all times. Others shower their daughters with all of the gifts and "things" that they’ll ever need, seeing them as weaker than boys (therefore not encouraging strength and discipline in them). It’s easy for fathers to treat their sons and daughters differently. They can be rough-and-tumble with their sons…but treat their daughters with kid gloves. This opportunity to wrestle or to play physically with your daughters is extremely important, because it shows them that you believe they are capable enough to handle it. (If your daughter is eighteen, it’s probably not a good idea to start now.) The cultural messages we get are that girls and young women are valued for being beautiful, thin, talented, etc. Girls should also be happy, agreeable and eager to please. This cultural backdrop may be partly responsible for the alarming statistics concerning rates of depression, anorexia, bulimia, and other disorders for girls when they are approaching or have entered their teen years. So how can fathers overcome some of these Barriers and help create daughters who become strong, secure women? If fathers want their daughters to grow up to be strong and secure women, it is absolutely essential that they like women and that they respect them. No matter how negative and pervasive the cultural messages are, your daughter’s self-esteem is greatly impacted by your attitude. If fathers think that women are weaker and need protection, they will tend to raise daughters who are weak and dependent. To a significant degree, your daughter’s success in life and in love is in your hands. As fathers go through the process of raising daughters, they may have to question everything they thought they knew about the sexes and the difference between men and women. How is it that you learn about these things? You learn by allowing your daughters to teach you about them every day. You learn by not attempting to control or protect your daughters. You learn by opening up your hearts, and not having the answers all of the time for your daughters (or your sons). If you can allow your daughters to enjoy being female as much as you enjoy being male, you’ve taken a big first step. If you can also allow your daughter to make most of her own decisions, you will probably enjoy a great relationship with her. You will also know a lot more about women than you did before. Here are some action points for fathers with their daughters: • Fully explore your expectations for your daughter. See where you may be too controlling in her life, or are overly protecting her. • Create special times with your daughter each week, one-on-one, when you can ask her questions about her life and become more fully aware of who she is. Make this time sacred and let her know it’s important to you. • Expect your daughter to be strong and competent; she’ll know that you do and will respond accordingly. • If your daughter is a teen-ager or close to it, explore your attitude about your daughter’s sexuality; many fathers are uncomfortable with this and leave their daughters emotionally when they need them the most. • Be a great model for how men treat women in your relationship with your wife. • Talk to other fathers who have had daughters, and find out how they have dealt with the challenges of raising a daughter. Your daughter is depending on your healthy attitude to help her to navigate a culture that is not always positive for girls. Take a step back and examine your view towards women and girls. Are there changes you want to make? Your daughter will help you to make those changes if you’ll just listen. magna rx plus compare penis enargement pills free penis enargement video male penis elargement penis enargement operation penis enhancement cream magna rx testimonials best enargement exercise penis penile enlargement information

So, you've just put up a profile on some online dating or social networking site. Or maybe you've been online for awhile now, and you think you know the ropes pretty good, right? I'm going to enlighten you on what both sexes have to worry about online and what both sexes have to go thru so you know the truth for once! For one of the online dating guide books I'm writing for guys, I have, for the last 2 ½ years, been on about 35 different dating websites meeting and getting to know women and discovering the true art of online dating or online meeting people. What I have learned about men and women is equivalent to a Ph.D. from Harvard on human behavior, sexuality, and psychology. The biggest things ALL guys have to worry about are women using fake pictures that aren't them and lying about their age online - usually they're older than they say. (Note: The 3 things women lie about the most offline is their real age, weight, and dress size.) The biggest thing women have to worry about guys online is they're married or have a girlfriend, outdated pictures, and of course their own personal safety. (Note: The 3 things guys lie about the most offline is how much they really make, how big their penis is, and how long they can last in bed.) If a guy says he makes $40K, a FedEx driver, says he has an average size thingy, and can last about 15 minutes, he's probably telling you the truth ladies! 1/2 of all single Americans are now or have been online dating. Why you ask? Because the bar, nightclub and dating scene just gets old eventually. Maybe it takes you until you're 25, 30, 35, maybe 40 years old, but it will eventually get old believe me. It's not so much in going out and partying that gets old, but more looking and hoping to meet some hot and great person that you want to date, hook up with, or marry down the road. Having to hear the same drunk meatheads hit on you or grab you. Or for guys look around and see the same unappealing women out and about The intelligent single person of the 21st century also knows it's a numbers game. (I don't mean sleeping around or trying to get a lot of action either for all you players and playettes. Ladies, you have all heard you have to kiss a lot of toads to find your prince, right? Well, online you can kiss hundreds maybe even a thousand times more toads in a tenth of the time you ever could offline. I personally know within minutes of reading most profiles, if any woman has a chance or not with me to go to the next levels. I will explain in greater detail in a few moments. From just talking on the phone or IMing with a woman for an hour or so, I can tell if there is some good chemistry or any kind of anything in the future. I have just honed in on my "Spidey Senses" so much now, and I don't want to waste even a minute of my time or another person's if I don't think anything will ever come of it. This is not rude or mean at all. It's the right and honest thing to do I believe. You're not leading on someone, wasting their time, or setting them up to really get their feelings hurt. Too much of that crap happening already without you contributing to it with all the heartless, selfish, ungiving, and cheating people in the world today and online. What are the 7 stages of online dating and what happens in each stage? Stage 1 In this stage someone winks at you, shows interests in you by posting a comment on your profile, or invites you to their network of friends. Whatever dating site you're on, they all have similar type features. What does this stage mean? Not a whole lot. The person obviously didn't think enough of you or at least not yet to actually take the time and email you. So in our ADD/lazy ass society we just click a button or two to let you know we checked out your profile (Usually that's a lie. They saw your pictures and then on a purely physically based decision they contacted you because of that). Then, we hope the other person sees that we commented or invited them to our network and they make the next move back or take it to the next stage - to email you. Basically the person is trolling the whole ocean looking for a few bites and thinking even a broken watch is right twice a day! Sound familiar? Stage 2 In this stage, someone actually thought enough of your pictures and/or profile to take the time to email you their opinions, curiosity, or interest in you using your dating sites email account. This is the safe, secure way because you're not letting that person into your life at all, and they can only contact you thru that dating site; not your personal email account that you only share with friends, family, business associates, or people you trust at least a little. What does this stage mean? Well, the person took the time out of their day to email you something which is a good thing sometimes and shows their level of interest is now past stage 1. The email could be something crude, lude, sexual, sweet, nice, funny, romantic, flattering, etc. so the jury's out on whether what they send you is a good or bad thing. But unlike a posted comment or invite many people will at least reply back to someone's email that took the time to email them, so if you want to get to know someone I would do this stage for sure. Stage 3 In this stage, mutual cooperation is usually needed because you exchange (or one of you gives the other) you're personal email address. Unless of course the person has their personal email address, which most sites block from showing if you try but some people put their personal email addresses on their site so you can contact directly that way. What does this stage mean? Well, you just let them into your little world a tad bit. Now you can exchange pictures with each other as well as use emoticons and different font styles to get your email message to them more convincingly. That person also, with very little effort, can track down where your internet connection is coming from meaning city/state. It's a good thing to find out to see if someone's lying about where they live or bad if you don't want to give out the city/state of where you live for safety reasons if you're like a porn star, model, or someone in the media and would be prone to get whacko's and stalker types. Keep a look out for Part 2, with further explanations of stages 4-7 about online dating. cheap penis enlargment penile enlargement testimonials does penis enargement work medical pnis enlargement penis enargement drug penile enlargment pills product penis enhancement without pills penis elargement surgeon penile enlargement information

One of the problems with benign prostatic hypertrophy (an enlargement of the prostate which affects the majority of men above the age of 60) is that the symptoms can vary widely from one person to the next and it can be difficult to assess the degree of treatment required, or indeed whether treatment is needed at all. To assist in this assessment the American Urological Association has designed a short questionnaire consisting of just seven questions. For the first six questions you allocate yourself a score according to your answers as follows: 0 points - not at all. 1 point - less than 1 time in 5. 2 points - less than half the time. 3 points - about half the time. 4 points - more than half the time. 5 points - almost always. The questions, which apply to the previous period of one month, are: How often have you experienced a sensation of not emptying your bladder after urinating? How often have you had to urinate less than two hours after your previous urination? How often have you stopped and started again several times during urination? How often have you experienced an urgent need to urinate and found it difficult to hold on? How often have you experienced a weak flow of urine? How often have you felt the need to urinate but have had to strain to begin urination? For the final question, which also applies to the previous month, you simply allocate a point score equal to your answer (up to a maximum of 5). So, if your answer is twice you allocate 2 points and if your answer is four times you give yourself 4 points. The question is: On average, how many times have you had to get up during the night to urinate? Once you have completed the questionnaire and allocated a points score to each answer you then total up your score, which will fall somewhere between 0 and 35. The higher your score the more severe your symptoms and the greater your need for treatment. In general, a score of 7 or less would indicate that your condition does not warrant treatment at this time. It should be stressed that this test is just one test among several that your doctor may use to assess whether you are suffering from benign prostatic hypertrophy and, if so, what treatment would be appropriate. It is not designed to be used in isolation or for self-diagnosis. If you are experiencing problems and suspect that you may be suffering from benign prostatic hypertrophy then you should consult your doctor. penile enlargement pic before and after pnis enlargement traction device enlargment erection penis pill vimax com enlargement penis penis pump pnis enlargement traction device permanent penis enlarement top penis enargement pills best penis enlargement pill penile enlargement information

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.