THE BRIDGE PLAN

Thomas Kincade: The Bridge of Hope

NUTRITION AND LIFE-STYLE RECOMMENDATIONS

L. Stephen Coles, M.D., Ph.D.,

Co-Founder and Executive Director

Los Angeles Gerontology Research Group

664 West Arbor Vitae Street, Suite 1

Inglewood, CA 90301-3160; USA

Voice: 310-412-7787; FAX: 310-412-7788; Pager: 1-800-471-5431

E-mails: scoles@grg.org; scoles@ucla.edu; scoles@earthlink.net;

URL: http://www.grg.org

TABLE OF CONTENTS

DISCLAIMER.. 6

I. INTRODUCTION.. 6

A. General Principles on Choosing Supplements. 6

B. A Brief Note Regarding Dosages. 7

C. A Brief Note Regarding Prices. 8

D. For Both Men and Women. 8

E. For Females Only. 144

F. For Males Only. 155

G. For Children Only. 166

H. Hormones and Supplements That We Hope to Recommend in the Very Near Future. 166

1. rhGH (recombinant human Growth Hormone) 166

2. Thymosin Alpha-1. 177

3. L-Glutathione. 177

I. Agents That Are Not Recommended at the Present Time. 177

1. Prescription Drugs: 177

2. Herbs: 177

3. Amino Acids: 187

4. Miscellaneous Compounds: 188

5. Discredited Agents: 188

III. DIETARY RECOMMENDATIONS. 199

A. High Fiber. 199

B. Low Fat 20

C. Total Calories. 20

D. Miscellaneous. 22

1. Wines and Spirits. 22

2. Tobacco Products. 22

3. Caffeine. 22

4. Green Tea. 22

5. Prescription Drugs. 22

IV. ANNUAL CHECKUPS. 23

V. ORAL HYGIENE AND DENTAL VISITS. 233

VI. FIRST AID.. 24

VII. THE NEED FOR REGULAR EXERCISE.. 244

VIII. THE FREQUENCY OF SEXUAL INTERCOURSE.. 255

IX. HOW TO REDUCE OR AVOID UNNECESSARY STRESS. 255

X. A BRIEF WORD ABOUT CHARLATANS. 299

REFERENCES: 333

APPENDIX A. HEALTH-RELATED NEWSLETTERS. 44

APPENDIX B. NUTRITIONAL ASSOCIATIONS. 44

APPENDIX C. HEALTH SOURCES ON THE INTERNET.. 455

APPENDIX D. PERSONAL COMPUTER SOFTWARE.. 455

APPENDIX E. HEALTH RISKS TRAVELING ABROAD.. 466

APPENDIX F. LABORATORIES CAPABLE OF MEASURING OXIDATIVE-STRESS PROFILES FROM URINE AND/OR BLOOD.. 466

TABLE OF CONTENTS

Page

DISCLAIMER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

I. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

II. RECOMMENDED DAILY VITAMIN AND MINERAL SUPPLEMENTS . . . . . . . . . 6

A. Evidence-Based Principles For Choosing Supplements . . . . . . . . . . . . . . . . . . . . 6

B. A Brief Note Regarding Dosages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

C. A Brief Note Regarding Prices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

D For Both Men and Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

E. For Females Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

F. For Males Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

G. For Children Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

H. Hormones That We Hope to Recommend in the Very Near Future . . . . . . . . . 16

1. Human Growth Hormone and its Secretagogues . . . . . . . . . . . . . . . . . . 17

2. Thymosin Alpha-1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

I. Agents That are Specifically Not Recommended at the Present Time . . . . . . . 17

1. Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

2. Herbs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3. Amino Acids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

4. Miscellaneous Compounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

5. Discredited Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

TABLE OF CONTENTS (CONT’D.)

Page

III. DIETARY RECOMMENDATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

A. High Fiber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

B. Low Fat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

C. Total Calories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

D. Miscellaneous Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

1. Wine and Alcoholic Spirits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

2. Tobacco Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

3. Beverages with Caffeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

4. Green Tea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

5. Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

IV. THE NEED FOR ANNUAL CHECKUPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

V. ORAL HYGIENE AND DENTAL VISITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

VI. FIRST AID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

VII. THE NEED FOR REGULAR EXERCISE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

VIII. THE FREQUENCY OF SEXUAL INTERCOURSE . . . . . . . . . . . . . . . . . . . . . . . . 25

IX. HOW TO REDUCE OR AVOID UNNECESSARY STRESS . . . . . . . . . . . . . . . . 25

X. A BRIEF WORD ABOUT CHARLATANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

3. There is evidence that the supplement is non-toxic for humans, at least in the range of dosages being considered (therapeutic index)(even water when drunk to excess can be toxic!) and that any excess beyond that utilized by the body for beneficial purposes gets excreted, i.e., doesn't accumulate dangerously;

4. The supplement is affordable (it’s not going to break the bank.).

Seven additional guidelines that should be taken into consideration include the following:

1. Has the given study been replicated by others?

2. What was the size of the effect being reported?

3. Was the result merely a proportional trend or was it statistically significant?

4. What was the power of the study (the size of the population studied)?

5. What was the duration of the follow-up?

6. Are the findings internally consistent based on tight confidence intervals?

7. Was the result published in a reputable journal?

B. A Brief Note Regarding Dosages

Doses are among the most controversial aspects of prescription writing and nutritional recommendations. In order to maintain proper health and well-being, everyone will agree that a wide variety of nutrients are needed, but consensus as to how much of each and in what form is difficult to achieve. Opinions vary from those practitioners who feel that all drugstore supplements are a waste of money, assuming of course that one eats a well-balanced diet, to those who take supplements by the carload (so-called "megadoses"). There is little or no valid scientific evidence to support megadose claims, such as made by longevity-authors Dirk Pearson and Sandy Shaw [24]. Here, scientific comparisons between species gets a bit murky, since a dose that works well in a mouse may or may not be linearly related to benefits obtained in humans per kilogram of body weight, possibly due to idiosyncratic variations in rodent physiology, even acknowledging that we both belong to the "mammalian" family. The late Linus Pauling was considered to be an "old quack" by some regarding his use of ascorbic acid (Vitamin C), since he recommended (and took himself) 10 or more grams every day! The jury is still out on such a high dose, but we shouldn't forget that Dr. Pauling (double Nobel Prize winner) had always been a controversial character throughout his distinguished careers at both CalTech and Stanford Universities, and he has frequently been proven correct over time on other matters [9].

After many years, the U.S. Food and Drug Administration (FDA) has formulated what is referred to as the RDA (Recommended Daily Allowance) oriented toward the avoidance of clear pathological states rather than the amounts needed to maintain optimal health. Therefore, the average adult, even though not suffering from a specific disorder, should observe all RDAs and then some. The chart of recommendations listed above should be thought of as a guideline. The amounts listed are safe (will not cause toxicity), but may be varied according to an individual's size, weight, gender, and health status. All other things being equal, and in the absence of specific laboratory blood chemistries, those who exercise heavily need higher doses. Also, those who are under great stress, on medications, on restricted diets, bed ridden, females on oral contraceptives or pregnant, recovering from surgery, smokers, heavy drinkers, etc. may need greater or lesser amounts of certain vitamins and minerals.

It is suggested that you take nearly all your supplements at the same time each day with a regular meal to establish a pattern. The fat-soluble vitamins A, D, E, and K are more readily absorbed with food. When traveling, you need to prepare collections of pills, labeled day-by-day, for as many days as you expect to be away from home. I generally place all opened vitamin bottles in my refrigerator to keep them away from children and to preserve freshness.

C. A Brief Note Regarding Prices

All of the vitamins or hormones listed below, with certain exceptions as noted, are typically available inexpensively from local drug stores (or health-food stores) in your home neighborhood. Others, however, may need to be special ordered (See source where noted) or obtained under a physician’s prescription. However, prices are widely variable, even for an identical product. Shop around at different stores, and only buy supplements when they are on sale. When buying by mail-order over the telephone, make sure you ask AIs this your best price?@ You may be surprised to find that simply asking can help lower your costs. A month’s full supply of antioxidants may cost $40.

D. For Both Men and Women

Unfortunately, there isn’t a single supplement that compounds all required vitamins into one pill. Therefore, one should expect to buy most if not all of the following items separately:

128. &nbs p; 1. A standard multivitamin (not "therapeutic") with mineral supplements (e.g., Centrum [Lederle], Central-Vite [Your Life], etc.) The multi should include Vitamin A 5000 iu (vision, skin, and hair), Vitamin B₁ (Thiamin) 1.5 mg (muscles and nervous system), Vitamin B₂ (Riboflavin) 1.7 mg (nervous system), Niacin 20 mg (metabolism), Vitamin B₁₂(Cyanocobalamin) 6 mcg (vital for healthy GI track and nervous system, blood), Biotin 30 mcg (metabolism), Folic Acid 400 mcg (blood, growth, and development)(for women who may become pregnant to prevent Spina Bifida), Vitamin D3 (Ergocalciferol)[400-1,000] iu (bones, teeth, anti-cancer of the colon), Vitamin K₁ (Phytonadione) 25 mcg (clotting), Vitamin K2 (Menaquinone-4 or -7) [20-45] mg, and a collection of trace minerals (Boron, Chloride, Copper, Iodine, Magnesium, Manganese, Molybdenum, Nickel, Phosphorus, Potassium, Silicon, Tin, Vanadium, and Zinc) (Optional Note: Additional Phosphorus 60 mg, Magnesium 500 mg, or Zinc 60 mg [15] may be added with still further benefit.)

2. Fish Oil Capsules (Omega-3 Fatty Acids: Eicosa Pentaenoic Acid [EPA], and Docosa Hexaenoic Acid [DHA]) [l,000 – 1,200] mg (increases HDL)

3. Vitamin C (Ascorbic Acid) l,000 mg (Antioxidant)

4. Vitamin E (Alpha-Tocopherol) [400-800] iu [international units](Antioxidant)[A mixed tocopherol including both alpha and gamma [230 mg] forms has been recommended by Prof. Bruce Ames of UC Berkeley as superior to either alpha or gamma alone.] Early anecdotal evidence from large observational studies showing that Vitamin E might reduce the risk of heart disease or protect against cancer has not held up under the closer scrutiny of randomized clinical trials. The August 13, 2007 Archives of Internal Medicine [122 - 124] reported that 8,000 women with an average age of 61 involved in a study over nine years did not benefit from taking Vitamins C, E, or Beta Carotene. Scientists had previously thought that these antioxidants benefited the heart by counteracting free radicals that can damage artery linings, encourage blood clots, and otherwise alter the function of blood vessels. A 1988 epidemiological study in more than 21,000 Finish men found that 40 percent with the highest blood levels of alpha-tocopherol had a 36 percent reduction in the risk of developing cancer. But a seven-year randomized trial published in 2005, of more than 700 patients with Vascular Disease or Diabetes Mellitus, found no protection from cancer from a 400 iu daily dose. [125]. Because these studies involved high-risk populations or had other limitations, the possibility that these vitamins may provide some protection has not been completely ruled out. On the other hand, most experts no longer recommend taking Vitamins C or E supplements for heart or cancer protection.

5. Omit Beta-Carotene (Vitamin A precursor) 25,000 iu (Antioxidant) Current nutritional research is filled with gaps and contradictions; e.g., a 1994 study showed that, in Finland, cigarette smokers were more likely, not less likely, to develop lung cancer when taking Beta Carotene. Nevertheless, benefits for nonsmokers are undisputed, but, of course, none of our readers are smokers. Therefore, one could either take or omit this supplement.

6. Omit Selenium [50-200] mcg [micrograms] (Antioxidant)(Shown to protect against lung, colon, rectal, and prostate cancer, as well as Diabetes Mellitus.)

It has long been recommended that 200 micrograms of the mineral Selenium every day as a dietary supplement should lower one's risk of Diabetes. Now, according to an article appearing in the August 21, 2007 issue of The Annals of Internal Medicine, the opposite may be true [114]. 1,250 persons who took 200 mcg qd of this mineral for seven years in a randomized, double-blind, placebo-controlled study were seen to have a 50 percent higher risk of Type-2 Diabetes [115, 116].

We are therefore withdrawing our prior recommendation to take daily Selenium supplements until further notice. Although no single study can provide a final answer, there is enough concern that we should all stop talking this mineral for the time being.

7. Omit Chromium Picolinate [400-800] mcg (shown to preserve muscle mass while dieting; mechanism: increases the body's sensitivity to insulin [10].)

We all know that Chromium is an essential ingredient of our nutritional profile, but Chromium Picolinate [200 - 500] mcgs qd no longer makes sense as a GRG-recommended supplement based on newly-discovered scientific data. The claims made by the health-food industry (with an obvious self-interest in selling us their products, but no funds to perform double-blind clinical trials to support their position) has told us for decades based on anecdotal and epidemiological evidence...

(1) 90 percent of us don't get enough Chromium in our normal diets;

(2) It reduces appetite;

(3) It breaks down fat;

(4) It causes weight loss;

(5) It adds muscle; and

(6) It turns sugar into energy;

However, all of these claims are now shown to be false based on a placebo-controlled clinical trial by the US Department of Agriculture [Journal of Nutrition] of 83 women for 12 weeks [117]. "Chromium is an essential nutrient, but supplements won't help anyone lose weight or build muscle," said Henry Lukaski, a U.S. Department of Agriculture researcher who specializes in dietary trace metals. "People are using this doggone stuff with high hopes, and it's not working." Lukaski and his colleagues recently put chromium supplements to a rigorous test. They kept 83 women on carefully controlled diets for 12 weeks. About half of the women also received 200 mcgs of Chromium each day, while the other women took a placebo. As reported earlier this year in the journal Nutrition, the women taking Chromium didn't lose more weight or gain more muscle than the women taking placebos. Many other studies have reached the same conclusion: Chromium supplements don't have any effect on weight loss.

Believers might claim that Chromium only works at doses much higher than 200 micrograms. But more isn't better, says John B. Vincent, a Professor of Chemistry at the University of Alabama.

Rat studies conducted by Vincent and others show that even massive amounts of Chromium --

far more than a person taking supplements would ever get -- won't speed weight loss.

Chromium is generally considered safe in amounts of up to about 1,000 micrograms (or 1

mg) a day, but doses higher than that could be risky, Vincent says. Chromium is an oxidant -- the opposite of an antioxidant -- and large doses could potentially damage cells and even DNA. Indeed, there have been scattered reports of liver and kidney damage in people taking more than 1,200 micrograms of Chromium each day for months at a time.

According to Vincent, claims of widespread chromium deficiencies are "absolutely false." In reality, he says, about 98 percent of all Americans get at least 30 micrograms of chromium each day, putting them in line with recommendations from the Institute of Medicine (IoM). Chromium is found in grains, beans, peas, meats, red wine and many other foods and drinks.

8. Omit Vitamin B₆ (Pyridoxine HCl) 50 mg (Antioxidant) [as this dose tends to accumulate over the years, it has been found to cause peripheral sensory neuropathy. Extra B6 has also been found to in ]

9. Pantothenic Acid (B Vitamin) 250 mg [for growth and development.]

10. Soya Lecithin (Phosphatidylcholine) 1200 mg (For cell membranes; boosts acetylcholine)(PC55 [Twin Labs] or Maxicholine are best with 55% and 65% ratios, respectively, compared to only 5% for regular lecithin.)

11. Super Garlic 3X (odorless tablets) 440 mg raw garlic concentrate; Source: Metagenics, Inc. of San Clemente, California 92672; however, any odor-modified kyolic garlic extract is acceptable. (Ca-Chrome caplets combine both of the above.)

12. Calcium l,000 mg (Oyster Shell), especially useful for females susceptible to osteoporosis. We suggest increasing the dose to 1,500 mg for post-menopausal women not on ERT (Estrogen Replacement Therapy) along with 800 iu of Vitamin D (ordinary multivitamin tabs contain only 400 iu)(Calcium supplements have been shown to prevent osteoporotic bone loss by 1/3 to 1/2 in a placebo-controlled study with 122 women over 2 years.) (The Lancet (August 25, 2007) recommends Calcium at 1,200 mg Calcium and Vitamin D 800 iu in a review of 29 randomized trials, including more than 63,000 men and women older than 50.) [129]

13. CoEnzyme Q₁₀ [60 - 120] mg (Ubiquinone)(Antioxidant)[11]. (CoQ-10 is found in mitochondria, as part of a unique metabolic pathway that synthesizes ATP, the body's general-purpose energy molecule at the cellular level. CoQ-10 is reputed to benefit the immune system [12], allergies, asthma, respiratory and heart diseases, duodenal ulcers, and also serves to prevent some types of cancer. We have observed statistically significant increases in average life-expectancy in rodents on CoQ-10 [13], but a dose-response curve for humans has not yet been established)(Typical Food Sources: salmon, sardines, and mackerel; Supplements available from Twin Labs, Natural Life, or NOW Natural Foods)

14. Pycnogenol (proanthocyanidins, bioflavenoids)(Antioxidant-- claimed to 30-50 times more powerful at scavenging free radicals than Vitamins C and E, respectively)(Sources: maritime pine-tree bark or grape-seed extract.)

15. DMAE (Di Methyl Amino Ethanol) 100 mg (Membrane stabilization; alleged to help improve memory by increasing the availability of acetylcholine.)

16. Flax Seed Oil 1-2 tablespoons per day (cold-pressed unrefined)(obtainable in black [opaque] plastic bottles in the refrigerated section of your local health food store [not available in regular supermarkets]. It must show a "date of pressing" and a four-month "date of expiration" listed on the bottle. It is light yellow in color with a slightly nutty flavor. Keep it refrigerated at all times. I use Barlean’s at a cost of $7.95 for an 8 fl. oz. bottle.)(Function: Flaxseed [Linseed] Oil rebalances the ratio of Omega-3 to Omega-6 fatty acids in your body, since this particular oil has the ratio of 3:1 while almost all other processed vegetable/cooking oils are in the reverse ratio).

17. Ginseng Root [250-500] mg (Antioxidant) (This ancient Chinese herb is alleged to improve cerebrovascular circulation, normalize blood sugar, and stimulate the immune system.)

18. Gingko Biloba Extract (24%) 60 mg. (Antioxidant) (Claimed to increase microcapillary beds in brain, peripheral nervous system, and liver tissue. Can enhance alertness and short-term memory in the elderly.)

19. Ginger. 125 mg. Herbal supplement.

20. Bilberry. 80 mg. Herbal supplement.

21. Dong Quai. 150 mg. Chinese herbal supplement.

22. St. John’s Wort, [300-600] mg. Herbal supplement indicated for mild to moderate depression.

23. Feverfew. Herbal supplement indicated for migraine headaches and possibly for arthritis pain.

24. Goldenseal. Herbal supplement indicated for diarrhea.

25. Horse Chestnut Extract. Herbal supplement indicated for varicose veins.

26. Milk Thistle. Herbal supplement indicated for liver disorders.

27. IP-6 (Inositol Hexaphosphate). A natural B vitamin supplement derived from corn or wild rice indicated for reduction of risk of cancer from all causes. Take IP-6 1-2 capsules as a NK T-cell immune booster for those who have a family history of cancer and wish to take a preventative agent.

28. Alpha Lipoic Acid, [100 - 150] mg (another strong Antioxidant)(est. $15.00 per month) There is a whole society of researchers devoted to this simple ring compound.

29. Acetyl-L-Carnitine (ALCAR)([500 - 2,000] mg)(a powerful Antioxidant; Sigma Tau, Inc.)(The principal mechanism of action is to facilitate the transport of free fatty acids through mitochondrial inner-membranes to facilitate the synthesis of new ATP [the application of 1 micromole of ALC to mitochondria increases oxidative activity 260 percent], although there are other mechanisms as well, such as improving cognitive function in Alzheimer’s patients.)

30. DHEA (DeHydrdoEpiAndrosterone) or DHEA-s (DHEA-sulfate) 50 mg qod (every other day); (est. $5.00 per month; although DHEA was remarkably difficult to obtain as recently as five years ago and could only be gotten from a few compounding pharmacies around the country, it is now available in all health food stores without prescription in either pill form or even as a gum.) At age 25-30, levels of DHEA peak and then begin to decline. By age 75, levels decay exponentially to 80 percent of youthful levels. This steroid promises to boost libido for both men and women, as well as prevent atherosclerosis, some cancers, and memory loss; it also builds muscle and bone mass, reduces obesity, and strengthens immunity [68-70]. As a supplement, this hormone, has only one precaution: potential androgenic conversion means that men with a history of prostate gland problems should have their PSA level checked before starting on DHEA (A home saliva test-kit for DHEA levels is now available for $30.00; Call Life Enhancement Products, Inc. of Petaluma, California at 1-800-543-3873). In the latter part of this year various patented formulations of DHEA are expected to come out on the market, and a more precise dose recommendation will be made at that time. (See the Newsletters in Appendix A for future announcements.)

31. Pregnenolone, [10-30] mg qod (est. $7.00 per month). Pregnenolone is synthesized from cholesterol within many different tissues, particularly including the adrenal glands, the brain, and the skin. As a hormone, it is similar in many respects but not identical to DHEA, for which it is an immediate precursor. It has been studied since the 1940s, and human and animal studies have found virtually no adverse side effects after pregnenolone supplementation, even after very high doses for long time periods. However, extra caution must be observed by those choosing to take Pregnenolone and DHEA concurrently, since they are both on a common biochemical pathway that synthesizes many other steroid hormones downstream, and they may have synergistic or antagonistic effects not proportional to their individual dosages. This steroid is sometimes called a neurosteroid, since brain tissue contains very high levels. Indeed, improved memory and cognitive thinking in humans and animals has been associated with pregnenolone supplementation. It also improves sleep patterns and psychological mood. It has been especially good for arthritis patients. Studies from the University of Massachusetts found better performance in healthy young subjects being tested in flight simulators. Like DHEA, pregnenolone appears to maintain the body’s resistance to stress.

32. Melatonin, [0.5-3.0] mg; take each night just before bed time, not two hours before. (Antioxidant [44-47]). Enhances immune function, but also acts as a natural sleeping pill. See Ref. [5, p. 57] for dosage information. For those few who experience Arebound insomnia@ on melatonin (waking up ready to go at 4:00 AM), you may wish to consider the time-release version (See Emerald Labs: 619-930-8078). Melatonin is especially valuable in cases of Ajet lag@ or whenever traveling across major changes in time zones. According to Prof. Russel Reiter at the University of Texas in San Antonio, human studies have suggested that melatonin can reduce tumor growth and prolong survival, and by boosting the natural production of glutathione and SOD, it is an unusually potent immune system stimulator.

33. Zinc Gluconate Lozenges, OTC treatment for the "Common Cold"; 13.3 mg six-times-a-day; Physicians at the Cleveland Clinic Foundation in Ohio recently found that patients sucking these lozenges suffered cold symptoms for half as many days as did untreated individuals (average 4.4 days instead of 7.6 days for controls). For example, Cold-Eeze Ionic Zinc Lozenges taken within 48 hours of the onset of symptoms was shown to provide relief and reduce the severity and duration of symptoms by 42 percent [Journal of International Medical Research, Vol. 20, No. 3 (June 1992) and Annals of Internal Medicine, Vol. 125, No. 2 (July 1996)]. How this compound works is not yet clear. However, in vitro, zinc can, among other flu-fighting activities, impair viral replication. In vivo, it is proposed that zinc coats mucous membranes and presumably helps to block viral penetration by reducing membrane stickiness.

34. SAM-e (S-AdenosylMethionine) [200 - 400] mg per day best taken on an empty stomach 30 minutes before a meal. First discovered in Italy in 1952, S-AdenosylMethionine 1,4-butanedisulfonate is the most stable form of SAM-e, and is involved in transmethylation. It is important for joint health, mobility, and joint comfort, as well as liver function, mood, and emotional well being.

35. Curcumin (Turmeric) 400 mg (useful in the prevention of Alzheimer’s Disease – Curry is heavily used for cooking in India, and the incidence of Alzheimer’s is much reduced per capita. [118])

36. Lysine (Amino Acid) [1 - 3] gm per day for a few days for the indication of cold sores or fever blisters on the lips secondary to Herpes Simplex-1 Virus. Proposed Mechanism: Arginine appears to be required exclusively by the virus for its replication, while lysine competitively inhibits the supply of arginine. Lysine seems to reduce flare-ups and severity and reduces healing time for herpes blisters. There may be side effects associated with long-term administration, however, including gallstones, or elevation of cholesterol.

E. For Females Only

Based on the latest studies implicating excessive iron in increased risk of heart attacks, we have withdrawn our previous recommendation that menstruating women take a multivitamin with an iron (Fe⁺⁺) supplement. Except in conditions of pregnancy or heavy bleeding, the risk of Iron Deficiency Anemia is actually negligible compared with the risk of iron accumulation (hemosiderosis and its associated cardiac side effects). Indeed, donating a pint of blood each year for both men and women may not only be humanitarian for the potential recipient, it may be beneficial for the donor by reducing the load of excess iron in the body.

According to the latest studies, we strongly recommend ERT (Estrogen/Progesterone Replacement Therapy) for postmenopausal women, not just to end the discomfort of "hot flashes," but more importantly to achieve significant protection against osteoporosis and heart disease. The benefits of hormone replacement outweigh the risks to such a degree that treatment should even be contemplated in women with a family history of breast cancer. What was learned from the WHI (Woman’s Health Initiative) trial, however, is that one should never wait for a few years before starting on Estrogen replacement for the first time. The KEEPS Study (Kronos Longevity Institute of Phoenix, AZ) is currently underway to prove this point once and for all. The route of administration (pill vs. patch) is important to the so-called first-pass effect (through the liver). The type of estrogen (bioidentical) is also critical. See your personal gynecologist for more details. The herbal Black Cohosh (often called Black Snakeroot), a member of the buttercup family, has been recommended to ease the discomfort of hot flashes. Enzymatic Therapy claims that its own proprietary extract called Remifemin has been shown to be effective in clinical trials. [128]

HRT can be inhibited by 27-HydroxyCholesterol (27HC). When estrogen levels fall as happens in menopause, 27HC is able to beat the hormone to the targeted receptors and block its beneficial effects. As reported in the journal Molecular Endocrinology, 27HC acts in a different way in breast tissue, activating estrogen receptors that promote tumor growth. [130]

For women suffering from a lagging libido and energy loss, adding Testosterone (Yes, women have Testosterone as well as men) is indicated. Possible side effects range from oily skin, acne, and body hair growth, as well as a possible increase in the risk of heart disease. Even though there is now substantial evidence from clinical trials that it works, the debate over safety is still continuing. (See below.)

F. For Males Only

After age 50, if cholesterol > 180, Aspirin 325 mg qod (every other day)(anti-platelet/anti-clotting)(Halfprin, enteric coated aspirin, 165 mg qd is recommended for those with pre-existing stomach problems, which are an occasional side effect of aspirin in its pure form.)

For men aged 60 and above, Testosterone (by prescription) for increased well-being, libido, muscle strength, bone hardness, and achieving significant drops in LDL and total cholesterol levels. Routes of Administration: Testoderm from Alza [approved by the FDA in 1993] is a nonadhesive transdermal patch applied to the skin daily; BioTechnology General is working on a testosterone wafer that will dissolve under the tongue and be quickly absorbed into the blood stream; endocrinologists are also testing a chewing-gum tablet at Johns Hopkins University. A month’s supply is about $[25 - 40].

Also for men over age 60, Deprenyl (Eldepryl)(Selegiline Hydrochloride) 1 mg may be taken daily. Although Deprenyl is a prescription drug specifically indicated for Parkinson's Disease, it can help stabilize memory loss in geriatric patients in general (proposed mechanism = SOD [Super Oxide Dismutase] enzyme antioxidant). Note: Deprenyl is readily available over-the-counter in Mexico, and many persons routinely travel to border cities to legally acquire a three-month supply for personal use [14].

Regular blood donations to the Red Cross or any convenient hospital in your area, at least one pint (unit) annually, are also a good idea, as indicated above.

G. For Children Only

A standard children's chewable (as tolerated) from ages 2 to 10 is sufficient. Of course, it is assumed that everyone's water supply contains Fluoride, essential to the proper hardening of teeth. Otherwise, a supplement is required (tablets or drops). It's never too early to have dental checkups in anticipation of potential future problems. Immunizations are described on p. 19 and in Appendix E.

H. Hormones and Supplements That We Hope to Recommend in the Near Future

1. rhGH (recombinant human Growth Hormone)

rhGH is an expensive anti-aging intervention, and the FDA has explicitly excluded all off-label prescriptions other than for the original pediatric indication for hypopituitary dwarfism (children destined to have extremely short stature) or “AIDS wasting” and specifically disallows treatment for "growth hormone deficiency" in older normal adults. In our view, the potential side effects of excess hGH (acromegaly) are overrated when taken only in “replacement doses.” Conversely, the benefits, based on controlled clinical trials sponsored by the National Institute on Aging (NIA), were disappointing when they are announced in the Summer of 1998. The real barrier for a new geriatric indication is that it's an injectable protein with upscale prices ($[800 – 1,000] per month). These costs have not fallen rapidly as expected, as the current U.S. suppliers (Genentech, Inc. with 70% of the market and Eli Lilly with the balance) attempt to meet competition from European suppliers (Bio-Technology General Corp. and Novo Nordisk, AS (Denmark)), who were expected to get FDA approval to market in the U.S. Also, we should note that Merck is testing a non-peptidal oral agent (MK0677) to stimulate the pituitary into releasing more hGH, but this compound has never been submitted to the FDA for human clinical trials. (See Chapter 21, [72] for more details.) Peptidal secretagogues of growth hormone, like hexarelin (a hexapeptide), are encouraging and may be considerably less expensive in the future. Sermorelin may be even more effective, as it is closer to the native GHSH. None of the recent data about hGH, however, convinces us to believe that it should be indicated for anyone except those who have a demonstrable reduction with respect to age- and gender-matched controls for this hormone. The latest rodent experiments lead us to the conclusion that GH can in fact be a life-shortening rather than a life-lengthening hormone, even though it may make patients feel better in the short term.

2. Thymosin Alpha-1

Thymosin is another promising agent, which will serve to enhance immune competence is undergoing clinical trials now and is expected to be available sometime in the near term.

3. L-Glutathione

Glutathione is a natural antioxidant synthesized by the body that is now alleged to be contained in a chewable tablet that will not be easily destroyed by stomach acid. ThiOTab tablets also contain Xylitol, a sugar-free sweetener, known for its beneficial oral and dental hygiene properties (distributed by Thione International of Atlanta, GA 30305). We are still awaiting scientific documentation.

I. Agents That Are Not Recommended at the Present Time

The following agents are all under investigation at various clinical and animal research centers but, in our view, their value and/or risk still needs to be proven:

1. Prescription Drugs:

Centrophenoxine (Lucidril)(Reverses some brain aging and decreases lipofuscin formation in neurons), BCE-001; Hydergine (Very safe Ergot Alkaloid)(Increases metabolic efficiency in the brain leading to increased blood supply, and therefore protects against hypoxia; decreases lipofuscin formation); Vasopressin (Diapid)[nasal spray](memory); Piracetam (Very safe; claimed to increase left/right hemispheric transmission in the brain, across the corpus callosum; claimed to help with Alzheimer’s Disease, especially when combined with choline), L059; Metformin (Phenformin, Buformin), Dilantin (Diphenylhydantoin, DPH)(Normally thought of as an anticonvulsant, but has other properties); Aminoguanadine (blocks formation of Advanced Glycosylation Products, AGEs); Quercetin; and RU-486 (Normally thought of as an abortifacient, but has other important properties), Bromocriptine (increases dopamine); Pimagedine (a new solvent for the breakup of AGEs [Advanced Gylcosylation End-Products], Dr. Richard Bucala, Picower Institute for Medical Research in New York).

2. Herbs:

Kava; Shitaki Mushrooms; Echinacea; Pantocrinum (deer antler velvet); cordyceps; galanthamine (bulbs of daffodils). With sales of $300 million annually, echinacea doesn’t prevent the common cold after all. As reported in the December 3, 2003 issue of the Journal of the American Medical Association, in a study of 707 upper respiratory infections in more than 400 otherwise healthy kids aged [2-11] years in the state of Washington, not only did echinacea fail to make a dent in their illnesses, it also produced more skin rashes than a placebo! We have only recently learned that Saw Palmetto does not reduce the symptoms of Benign Prostatic Hypertrophy (BPH) in men as had been claimed for decades by the health-supplement industry [120].

3. Amino Acids:

Various popular Amino Acids, like Glutamine, Arginine, L-Ornithine, L-Cystine, Phenylalanine, Methionine, L-Tryptophan, L-Tyrosine, etc., are not recommended at this time, since one probably gets adequate levels of these amino acids already, assuming a normal health status and diet. However, Amino Tropin 6, a patented combination of the nutrients GABA (Gamma Amino Butryic Acid, a known neurotransmitter substance), Arginine, Lysine, and Xanthinol Nicotinate (a B Vitamin), may have potent growth-hormone-releasing effects and must be studied further. The problem is to distinguish between statistically-significant increases, as published in the scientific literature, and clinically-significant increases for humans having a normal health status and diet and without simultaneously undergoing protein restriction.

4. Miscellaneous Compounds:

PBN (Phenyl Butyl Nitrone)(Significant age-reversing properties have been reported for white mice particularly in terms of memory and learning; it was placed in the mouse’s water supply); TNF (Tumor Necrosis Factor); Phosphotidylserine; Bromocriptine, BHT (Butylated Hydroxy Toluene), GHB (Gamma Hydroxy Butyrate; significant side effects include nausea, disorientation, and blackouts, and sometimes called the “date-rape drug”). For Resveratrol [1 – 5 mg], a number of beneficial health effects, such as anti-cancer, antiviral, neuroprotective, anti-aging, anti-inflammatory, and life-prolonging effects have been reported, although some of these studies used animal subjects, such as rats. Resveratrol is found in the skin of red grapes and is a constituent of red wine but, based on extrapolation from animal trials, apparently not in sufficient amounts to explain the “French paradox” that the incidence of coronary heart disease is relatively low in southern France despite high dietary intake of saturated fats. Konrad T. Howitz and Robert Zipkin of BIOMOL International discovered that Resveratrol increases the activity of an enzyme called SIR-T1. They then contacted David Sinclair of the Harvard Medical School, and co-founder of Sirtris Pharmaceuticals, in order to initiate a collaboration. Sinclair found that Resveratrol significantly increases the lifespan of yeast and mice. There is hope that it could do the same for humans.

5. Completely Discredited Agents:

According to the Mayo Clinic, the belief that shark cartilage contains a protein that inhibits tumor angiogenesis has now been shown to be false [29]. Sharks do get cancer, just like any other animal, contrary to the advertising claims we have seen for this product.

III. DIETARY RECOMMENDATIONS

A. High Fiber

No White Flour.

Whole Grains Only (wheat berries, millet, barley, brown rice, oat meal).

(sprinkle Wheat Germ on your morning cereal)

All Fruits and Vegetables (esp. bananas, apples, oranges, jicama).

Any natural fiber laxative (e.g., Aloe Vera) prn (as required) constipation.

A Harvard School of Public Health Health-Professionals Follow-up Study of nearly 31,000 men ages 40-75, who have been followed for four years to ascertain the role of nutrition in determining blood pressure, has found that those who routinely ate little or no fruit had a 46 percent greater risk of developing high blood pressure than did men who ate the equivalent of at least five apples daily. Indeed, fiber from fruits seemed to be more beneficial than that from vegetables or cereals. The other nutrients tested made little or no difference, including fats, alcohol, sodium, potassium, and magnesium.

Citrus fruits not only contain Vitamin C and folic acid, but also coumarin and D-limonene believe to protect against cancer. Green leafy vegetables, like spinach, contain lutein which guards against chromosomal damage. Orange vegetables like carrots, sweet potatoes, and pumpkin, as well as fruits like cantaloupe, papaya, and mango contain beta carotene, a precursor of Vitamin A that promotes normal cell differentiation. (Recall that Vitamin A taken in great excess can be toxic, but there is no corresponding toxicity for excess beta carotene.) Tomatoes contain lycopene, giving them there rich red color. Indeed, there may be over 100 carotenoids in fruits and vegetables that play some role in fighting cancer.

Cruciferous greens such as broccoli, cabbage, cauliflower, or Brussels sprouts (brassicae) contain organo-sulfur compounds that help detoxify carcinogens that also protect against cancer. Allium-based vegetables, including onions, garlic, scallions, leeks, and chives, inhibit bacteria in the stomach and reduce the formation of cancer-causing nitrosamines. Soybeans contain an array of cancer fighters, including isoflavones, saponin, genistein, and phytoesterol. In countries like Japan, the low rates for certain cancers may be attributable to this where soy is a dietary stable. Finally, many fruits and vegetables contain Vitamin E, selenium, and flavonoids, compounds that have the ability to pump carcinogens out of cells and normalize cellular proliferation. Five servings of fruits and vegetables a day is the best nutritional strategy, since foods seem to work best together.

Amid all the interest in the medicinal benefits of food, we should never forget that plants synthesize these chemical defenses for their own selfish benefit; but there is no reason why we shouldn’t exploit them for ours. Fruits are plants’ adaptation to the presence of animals in the same way that pretty colored flowers are plants’ adaptation to the presence of insects in the environment. This heuristic is generally true with the obvious exception of poisonous mushrooms, which have adapted with a different agenda as a defense against being eaten.

B. Low Fat

No Butter; No Margarine; No Hydrogenated Oils (Palm, Cottonseed, Coconut, etc. In particular, never eat movie-theater popcorn popped in coconut oil. It's like eating three days worth of fat in one sitting!).

However, moderate vegetable oils are acceptable (canola, walnut, safflower, sunflower, corn, sesame, soybean, olive, etc.). (A new Greek study of Mediterranean women finds that olive oil in the diet may greatly reduce the risk of breast cancer [25 percent reduction].)

Reduce whole milk and dairy products as much as possible

(ice cream, cheese, etc.).

Do use Low-fat (or Non-fat) milk and yogurt

No egg yolks (egg whites, however, are OK)

Avoid french fries or potato chips

Lean red meat only (no bacon); Fish (especially salmon) is recommended;

Poultry (chicken or turkey) is acceptable

Never, never, never eat animal brains or anything that goes under the name "sweetbreads" (sheep thymus gland)

C. Total Calories

Average less than 2,000 Kcal for "the standard 70 Kg man." All calories are equivalent. A tuna fish sandwich made with mayonnaise purchased in a health food store may actually be worse for your heart than a hamburger with mustard or ketchup bought at a MacDonald’s Restaurant. If you are overweight and think you need to diet, calculate your BMI (Body Mass Index) [BMI = Kg/(m)²]. First measure your weight (in pounds) and your height (in feet/inches) (your height squared is proportional to surface area), and then look your BMI up in the table below.

BMI			B	O	d	y		M		a	s	s		I	n	d	e	x		C	h	a	r	t
Weight> Lbs.	1 00	1 05	1 10	1 15	1 20	1 25	1 30		1 35	1 40	1 45	1 50	1 55	1 60	1 65	1 70	1 75	1 80	1 85	1 90	1 95	2 00	2 05	2 10	2 15
5'0"	19	20	21	22	23	24	25		26	27	28	29	30	31	32	33	34	35	36	37	38	39	40	41	42
5'1"	18	19	20	21	22	23	24		25	26	27	28	29	30	31	32	33	34	35	36	36	37	38	39	40
5'2"	18	19	20	21	22	22	23		24	25	26	27	28	29	30	31	32	33	33	34	35	36	37	38	39
5'3"	17	18	19	20	21	22	23		24	24	25	26	27	28	29	30	31	32	32	33	34	35	36	37	38
5'4"	17	18	18	19	20	21	22		23	24	24	25	26	27	28	29	30	31	31	33	33	34	35	36	37
5'5"	16	17	18	19	20	20	21		22	23	24	25	25	26	27	28	29	30	30	31	32	33	34	35	35
5'6"	16	17	17	18	19	20	21		21	22	23	24	25	25	26	27	28	29	29	30	31	32	33	34	34
5'7"	15	16	17	18	18	19	20		21	22	22	23	24	25	25	26	27	28	29	29	30	31	32	33	33
5'8"	15	16	16	17	18	19	19		20	21	22	22	23	24	25	25	26	27	28	28	29	30	31	32	32
5'9"	14	15	16	17	17	18	19		20	20	21	22	22	23	24	25	25	26	27	28	28	29	30	31	31
5'10"	14	15	15	16	17	18	18		19	20	20	21	22	23	23	24	25	25	26	27	28	28	29	30	30
5'11"	14	14	15	16	16	17	18		18	19	20	21	21	22	23	23	24	25	25	26	27	28	28	29	30
6'0"	13	14	14	15	16	17	17		18	19	19	20	21	21	22	23	23	24	25	25	26	27	27	28	29
6'1"	13	13	14	15	15	16	17		17	18	19	19	20	21	21	22	23	23	24	25	25	26	27	27	28
6'2"	12	13	14	14	15	16	16		17	18	18	19	19	20	21	21	22	23	23	24	25	25	26	27	27
6'3"	12	13	13	14	15	15	16		16	17	18	18	19	20	20	21	21	22	23	23	24	25	25	26	26
6'4"	12	12	13	14	14	15	15		16	17	17	18	18	19	20	20	21	22	22	23	23	24	25	25	26

TABLE -- BMI Score Calculated from Height (feet/inches) and Weight (pounds)

Legend: Color Codes for Weight Ranges for different BMI Scores …

	Body Type	BMI Range
	Underweight	BMI < 18.5
	Healthy Weight	BMI = [18.5 - 24.9]
	Overweight	BMI = [25.0 - 29.9]
	Obese	BMI = [30.0 - 39.9]
	Extremely Obese	BMI > 40.0

If your BMI > 30 [or > 25 if accompanied by one of the following: High Blood Pressure, Diabetes, Coronary Artery Disease, Hyperlipidemia, or Stroke] then you definitely need to reduce your caloric intake and/or increase your exercise program. As BMI increases, so does blood pressure and total cholesterol, while the level of HDL (good cholesterol) tends to decline also. You should weigh yourself monthly, preferably on the same bathroom scale. If you are not maintaining at least a four-pound-per-month weight loss, your regimen is not really effective and you should stop fooling yourself. That's when you need to go see your physician or get some professional help.

D. Miscellaneous

1. Wines and Spirits

Interestingly, one or two glasses of wine (either red or white) per day at the beginning of a meal have been shown to be beneficial to one's heart; obviously, other alcoholic beverages (beer, spirits) are to be imbibed in moderation. Never take more than a few ounces at any one sitting. Needless to say, never ever drive when intoxicated, even if only a little bit.

2. Tobacco Products

All tobacco products are absolutely contraindicated in any form, including cigarettes (low tar/filter brands provide no real protection), pipes, cigars, snuff, and chewing tobacco. There exists a nicotine-based chewing gum to help break this unsavory habit. Studies have revealed that cigarettes are insidious instruments for the delivery of nicotine by way of the lungs to the blood stream where it is unconsciously titrated by the addict to a "therapeutic" concentration. Of course, it is extremely dangerous to smoke while simultaneously wearing a nicotine-replacement transdermal patch. Even slight exposure to "second-hand" smoke has now been shown to be deleterious to one's health, not just for the child-to-be of a pregnant mother.

3. Caffeine

Coffee, Tea, and Soft Drinks (Coke, etc.) are acceptable in moderation. Studies have shown a positive correlation between coffee-drinking and alertness with few side effects. Use "decaf" after dinner if "regular" coffee keeps you up.

4. Green Tea

Speaking of tea, we should not neglect to mention that green tea, derived from the dried leaves of the evergreen shrub Camellia sinensis, long-time favorite in the Orient, but gaining popularity in the West, contain polyphenols (Phenol EpiGalloCatechin Gallate [EGCG]) alleged to prevent cancer, protect your heart from atherosclerosis, lowers serum cholesterol and triglycerides with improved HDL/LDL ratios, exhibits antioxidant properties, decreases hypertension, possibly due to the sedative action or the neurotransmitter GABA (Gamma Amino Butyric Acid), is an antibacterial (cholera and typhus), decreases tooth decay, and is an antiviral (influenza). The antioxidant effects of green tea don’t rely on caffeine, since neither coffee nor caffeine alone provide the same benefits. Neither are other teas as good as green tea. Oolong tea is semi-fermented, while traditional black tea is "fermented" through a non-alcoholic process to convert the tannins contained in the leaves, and in this process something is lost.

5. Prescription Drugs

Try to minimize multiple prescriptions. At least one physician must be aware of all your "meds" so as to minimize side effects. Furthermore, do not allow obsolete prescriptions to accumulate in your medicine chest; instead, just throw them away when.

IV. ANNUAL CHECKUPS

Obviously, children need pediatric care to get their routine periodic vaccinations (DPT [Diphtheria, Tetanus, Pertussis {Whooping Cough}], OPV [Oral Polio], MMR [Measles, Mumps, Rubella {German Measles}], HepB [Hepatitis B], Hib [Haemophilias influenzae Type b], BCG [Tuberculosis], Chicken Pox [The FDA has approved the Merck vaccine and it is now routinely available], etc.) and to make sure they fall within the standard growth profiles for height and weight. Pregnant females obviously need prenatal care, including special vitamins and a couple of routine ultrasounds. Otherwise, however, we don’t believe that healthy young adults really need to see a doctor every year. On the other hand, after age 50, one should check with one's family physician on a regular basis every couple of years or so, to measure blood pressure and so forth. A standard laboratory blood screen and stool sample for occult bleeding is also useful. A blood screen may detect lab values outside normal physiological limits (modulo lab error) for one's age (not just outside clinical limits for pathology). As mentioned earlier, this is recommended for fine tuning the doses of one's dietary supplements. After age 50, getting a Flu Vaccines is increasingly important. Males: A rectal exam for early detection of prostate cancer (a new laboratory test that compares the free and bound levels of PSA will prove increasingly important); Females: Annual PAP smears after age 21 as well as biannual mammograms (or even every three years) after age 50.

V. ORAL HYGIENE AND DENTAL VISITS

Seventy-five percent of adults in our country will be affected by bleeding gums secondary to gingivitis in their lifetime. An antibacterial mouthwash (Scope, Listerine, etc.) should be gargled/swished at least twice a day (bid) and three or four times a day (tid or qid), if possible, in addition to dental flossing once a day, and brushing after meals, while at home. An anti-plaque rinse post-flossing is urged (e.g., Oral-B). Prophylactic cleaning by a professional dental hygienist to remove plaque build-up should be done twice a year without fail.

Score	Interpretation
0-15	Your life is a "bowl of cherries." You're not sufficiently challenged.
16-30	Congratulations! You're well adapted (your risk-taking is well calculated).
31-40	You have an average ability to cope with stress.
41-99	You are experiencing a high level of stress. It is important to get advice about how to change your lifestyle or daily habits in order to diminish your rate of stress-provoking events.
100-135	Your life is a "veil of tears." It's time to move on to a new rose garden.