Jun
13
2015

Preserving Our Energy

We are all aging, and as we do we are gradually losing energy until we reach our last breath. Here I like to review where our energy comes from and what we can do to preserve our energy. When we preserve our energy we are in fact also slowing down the aging process and this in essence is the approach to anti-aging.

Mitochondria are power packs of energy

Each of our body cells has many mitochondria to give us energy. Some organs are more demanding. They are the main players in our body like the brain, the heart, the liver or the kidneys. Their cells have thousands of these energy packages. Without the mitochondria there would be no energy available to these key organs to perform all the work they do. They allow us to think and produce brain hormones, to contract our heart muscle and pump the blood through our arteries. They are organs like the liver that are in charge of all of the major metabolic reactions or the kidneys that filter our blood for impurities and eliminate them in urine. Mitochondria can be likened to our power bundles that give our organs and us energy to get through life.

Get enough sleep

Sleep is an energy rebuilder. But it has to be deep enough and long enough, and there has to be enough REM sleep to give us the feeling that we had a refreshing sleep. As we age some of our hormone production slows down. One of those substances is melatonin. It is crucial for good and restful sleep. If our body is not producing enough, we can supplement with small dosages like 3 mg orally to help our body to initiate sleep. It is not an addictive substance. It is the body’s own hormone. Should you wake up later in the night, you could take another 3 mg of melatonin. There is no risk either to feel tired or “hung over” after taking melatonin.

Exercise regularly

The cheapest energy you can get is by exercising regularly. When you exercise on a treadmill, go jogging or go for a brisk walk you condition your heart, improve your lungs; in short you develop cardiovascular fitness. At the same time your muscles are strengthened with isometric exercises. You are optimizing your energy flow. In the process of exercising you create a stimulus for your mitochondria to multiply in the affected tissues. This applies as much to your muscles as it does to your heart and to your lungs. You will find that your muscle strength increases. With exercise you spend energy, but you feel more energetic from it because your body is being tuned up.

Manage stress

Self-hypnosis is a simple way to allow your whole body to relax. However, the various forms of yoga will do the same thing for you. Meditation is another way of finding peace and tranquility. All of these methods will re-energize you. They calm your brain, help you to cope with stress and rebalance your hormones at the same time.

Lifestyle

You need a lifestyle that is conducive to keeping your energies. Listed here are several factors that interfere with energy production.

  1. Smoking: If you smoke, you burn up energy with every cigarette you consume. You interfere with the oxygen transport through your lungs, but the chemicals that poison your system also poison the mitochondria of the cells. By smoking you are destroying your power packs. Pollution damages your lungs in a similar fashion as smoking does, but it is a slower process. There are a number of big cities with severe air pollution and they may not be worthwhile visiting.
  2. Sugar and starchy foods: Back in the 1970’s based on the Framingham Heart Study it was thought that hardening of arteries would be due to an accumulation of cholesterol from fat in the diet. Saturated fatty acids were accused to be the culprit. A low fat diet was supposed to be the solution. But the end result was the obesity and diabetes wave that we still see now. There had to be another explanation of where hardening of the arteries came from. Banning fats did not lead to better statistics. The new observation was that a low carb/medium fat diet was associated with low heart attack rates, low stroke rates, and even low cancer rates. Researchers also found the real culprit: They are sugar, starchy foods and processed foods. Sugar and starchy foods are metabolized in the liver into LDL cholesterol, triglycerides and they also oxidize LDL cholesterol. This starts a vicious process of inflammation of the lining of the arteries with fat deposits into the wall of the arteries. By eating the wrong foods we interfere with our body chemistry to the point where free radicals are produced that attack everything in us including our mitochondria. I have blogged about this many times before. You can read about it here.
  3. Alcohol: the famous one glass of red wine for women and two glasses of red wine for men is supposedly keeping us younger for longer. This is true for the resveratrol in the red wine, which is a powerful antioxidant. But to say that alcohol itself would prolong your life is a white lie. Alcohol is a nerve and cell poison; it robs you of energy. I take the resveratrol as a supplement from the health food store to protect my system. I stay away from alcohol.

Keep the arteries open

We need healthy arteries to pump blood through all of the branches and deliver oxygen and nutrients to the body cells. Unfortunately, as we age our arteries tend to get deposits that make them more narrow, and this could also raise our blood pressure. The end result is that less nutrients and oxygen will reach our body cells. We perceive that something is wrong by not feeling as energetic as usual. Simple lifestyle changes as mentioned below can improve our circulation and lower our blood pressure. Chelation therapy has also been shown as helpful in the TACT study.

Get rid of inflammation

Dr. Paul Ridker found that approximately 50% of patients with heart attacks had a normal cholesterol level. He was looking for a more meaningful screening test and found it in the C-reactive protein. If the test result was higher than 3 there was a high probability that there was inflammation somewhere in the body, but a test result of less than 1 was normal. In the meantime scientists have learnt that the C-reactive protein is a very sensitive tool to measure inflammation in the body, but it is not specific for heart attacks. It is also positive in people with arthritis, cancer, and autoimmune diseases. Chronic inflammation is also destroying immune cells: this explains the development of cancer as the end stage of chronic inflammation.

Chronic inflammation robs you of energy. We can do a lot with natural anti-inflammatory supplements to quench inflammation.

Preserve your immune system

We can strengthen our immune system by exercise, taking vitamin C regularly and by taking vitamin D3 supplements to just name a few. DHEA, the precursor hormone from the adrenal gland also helps stimulate the immune system.

Balance your hormones

As we age we loose hormones one by one. With melatonin this starts happening after the age of 20, with DHEA and growth hormone after you are in your mid thirties. Women start to get into menopause at the age of 45 to 55, but this can occur earlier or later. Men are going through their hormone change (andropause) at the age of 55 to 60. Both, women and men know when they are entering their hormone change because of a lack of energy and a few other unpleasant symptoms. Women get hot flashes. Men get grumpy, have erectile dysfunction, a lack of sex drive, week muscles and slower thinking. If you feel those symptoms, seek the help of a naturopath who is knowledgeable on bioidentical hormone replacement. Chances are that your regular doctor will want to prescribe synthetic hormones unless you can find an anti-aging physician. If your blood tests show deficiencies in the sex hormones, you will need to get a bioidentical hormone prescription. They are usually dispensed as creams, which you apply to your chest wall or non-hairy forearms in the morning. After 4 weeks your energy will be back, and your body will function normally again. All the body functions that you thought were gone forever just needed that extra stimulus from the missing bioidentical hormones.

Organic, GMO free food

I was tempted to just write “good food”. But this may be confusing to people. It is difficult anywhere in the world to get good food. Often insecticides and pesticides contaminate fruit and vegetables, which function as xenoestrogens blocking hormonal receptors. These residues are toxic for your body, and they are destructive to your energy. Organic food with the USDA certification or any independent certification is the best way to ensure that you get a good food product. I take this seriously and pay the extra dollar. We do not need plates heaped with foods. Small helpings of good quality foods are more important for our well-being.

Treat depression and mental disease

People who are depressed will complain of a lack of energy. Their brain circuits are constantly in overdrive being busy with negative thinking. Cognitive therapy can help depressed patients to face their negative emotions. It is a learning process of thinking step by step to distinguish what is real and what is magic thinking. It is important to seek qualified help. Depressed patients distort the way they think, but cognitive therapy sets their thinking straight (Ref.1). When the thinking is normalizing, the drained energy returns, people sleep better again and they can use the energy to move forward.

Positive thinking

Negative thoughts are draining you of energy. You want to stay optimistic within what’s reasonable. Be thankful for all the good things in your life. Minimize what’s negative, but think about positive solutions to get rid of energy draining parts in your days. Do this persistently until it becomes part of your life and you will have extra energy that you didn’t waste in negative thinking or by getting caught up in needless anxiety. Worrying does not get us anywhere, but it depletes our energy.

Preserving Our Energy

Preserving Our Energy

What can we do to prevent aging?

It follows from all that I said that anything that preserves energy would also prevent premature aging.

As mentioned, it is important to exercise regularly (gym, swimming, dancing, fast walking, jogging etc.). Have good, balanced nutrition, preferably organic food. Some supplements are also helpful: resveratrol, Co-Q-10; pages 100 to 103 of my book contain more vitamins and supplements (Ref.2). Here is a link to my website NetHealthBook, which also addresses vitamins and supplements (scroll down to table). Avoid sugar and starchy foods to avoid oxidizing LDL cholesterol. Use bioidentical hormones to replace what is missing. Get your 7 to 8 hours of sleep and don’t forget relaxation. Detoxify to get rid of toxins that would slow you down. Infrared saunas are one way to detoxify. It is helpful to consider chelation treatments. Last but not least have a positive outlook on life.

Conclusion

Our energy that we feel tells us whether we are staying healthy or whether we are at the verge of getting sick. It is best to maintain your energy at all times by doing a combination of things outlined above. You will retain youthful energy; you prevent cardiovascular disease, Alzheimer’s and even cancer. Most of all you have the energy to do the things you want and love to do.

I prefer to work on staying well and in the process I have the energy to do the things I want to do. Part of it is blogging, part of it is writing books, and part of it is dancing. The key is that I like what I am doing. I invite you to do what will keep you energized. Listen to your body.

 

References:

1. David D. Burns, MD: “feeling good – the new mood therapy” 1999, Harper Collins.

2. Dr. Schilling’s book, March 2014, Amazon.com:“A Survivor’s Guide To Successful Aging: With recipes for 1 week provided by Christina Schilling

Apr
04
2015

Stop Suffering From Arthritis

This article shows you how to stop suffering from arthritis. Arthritis is an illness of the joints, mostly in older people (osteoarthritis or degenerative arthritis). However, a subgroup of younger patients can also develop a severe form of arthritis, called rheumatoid arthritis where autoimmune antibodies play more of a role.

In the 1950’s Dan Dale Alexander wrote a book called “Arthritis and common sense”. The medical establishment did not accept that simple remedy and Dan Dale Alexander was classified as a “quack”. However, Dr. Mirkin describes a study from Berlin that later confirmed that Dan Dale Alexander’s observation was correct: an emulsion made by shaking orange juice with cod liver oil and taken three times per day on an empty stomach would indeed improve osteoarthritis.

Dan Dale Alexander’s emulsion of orange juice and cod liver oil

In 1966, when I was still a medical student, I suggested to my future mother-in-law to give Dan Dale Alexander’s book about arthritis a try. Despite the well-established osteoarthritic condition in her left knee the arthritis vanished within 6 months and stayed controlled. I could not explain to her why this remedy was effective, as researchers had not yet described higher doses of omega-3 fatty acids and higher doses of vitamin C to be of value for arthritis.

This all changed with the advent of orthomolecular medicine (Ref.1). On page 76 of this book Dr. Frederick Klenner describes that ascorbic acid (vitamin C) at mega doses of at least 10,000 mg daily, but better even between 15,000 and 25,000 mg daily does have healing effects for arthritis. He stated further that repair of collagenous tissue (the joint surfaces) would require adequate ascorbic acid. On page 240 of Ref.1 Dr. Abram Hoffer, the founder of modern orthomolecular medicine reviewed the history of the use of vitamins in higher doses, particularly the use of vitamin B3 (niacin). He also mentioned that Dr. William Kaufman had used mega doses of vitamin B3 for arthritis as far back as 1950.

Overview of arthritis

Dr. Hoffer explains in Ref.2 that arthritis belongs into a group of diseases that are related to faulty nutrition, which in turn lead to vitamin and mineral deficiencies and a pandeficiency disease. Other diseases that belong to that group are cardiovascular disease, multiple sclerosis, cancer, diabetes, schizophrenia, mood disorders, alcoholism and autism. Contributing factors can be poor diets with overemphasis on refined and processed foods and consumption of sugar, allergies, diseases of the gastrointestinal tract and viral infections. Arthritis belongs into this group of illnesses as well. Researchers found that niacin, vitamin B6 and zinc were useful to treat arthritis, but other vitamins and minerals are also necessary. Here is a list of what Dr. Hoffer would suggest to use (Ref. 2):

  1. Vitamin B3

Vitamin B3 from 100 mg to several thousand mg three times daily following meals. With niacin there can be skin flushing, which often goes away after the body gets used to the higher doses; but niacinamide could be used instead by those who are bothered by the flushing.

  1. B complex

B complex: this contains each of the major B vitamins including vitamin B6 (pyridoxine). Take 100 mg once per day with a meal. The dose for vitamin B6 is up to 500 mg per day or more.

  1. Vitamin C

The dosage for vitamin C is between 500 mg and several thousand mg three times per day after meals.

  1. Vitamin D3

To get adequate vitamin D3 levels the patient has to take 4000 IU per day in the summer months. In the winter months particularly populations who live far north require 6000 IU per day.

  1. Vitamin B1 (thiamine)

Vitamin B1 (thiamine): alcoholics and very high sugar consumers need thiamine at 100 to 500 mg three times per day.

  1. Folic acid at mega doses

Folic acid at mega doses (prescription needed) works as an antidepressant, which requires 25 to 50 mg. To lower homocysteine levels lower doses of folic acid are sufficient.

  1. Vitamin E

Vitamin E: usually 400 IU to 800 per day. Muscle wasting diseases, Huntington’s disease and amyotrophic lateral sclerosis (ALS) require much higher doses up to 4000 IU per day.

  1. Essential fatty acids (omega-3)

Essential fatty acids (omega-3): It is strongly recommended to use a molecularly distilled product, which is free of mercury and PBC’s at 1000 mg three times daily following meals.

  1. Selenium

Selenium: The required dosage is 200 to 600 micrograms once daily (with any meal). In areas where selenium is deficient, this is particularly important.

  1. Zinc

Zinc: 50 mg of zinc citrate or 220 mg of zinc sulfate once per day with a meal.

  1. Calcium and magnesium

Calcium and magnesium: Dr. Hoffer suggested 1000 mg of calcium with 500 mg of magnesium, although many experts now say that 1000 mg of calcium with 1000 mg of magnesium may be better.

Dr. Hoffer pointed out that this program is compatible with any medication and is non-toxic.

Thoughts on treating arthritis

 

 1. Conventional methods

The conventional approach to treatment of arthritis consists of anti-inflammatory medications like ANSAIDs. Unfortunately they have side effects like causing kidney damage after several years of use. Also, NSAIDs can lead to gastric bleeding from gastric erosions, which may require blood transfusions. Physiotherapy with reactivation and swimming have been found to be useful. Electro acupuncture can help for pain control.

2. Diet changes, multivitamins and minerals

As arthritis occurs mostly in civilized nations, physicians have long suspected dietary factors to be of importance. Dr. Hoffer pointed out that arthritis is a pandeficiency disease meaning that overconsumption of sugar and processed foods has lead to multiple vitamin and mineral deficits that interfere with the cartilage metabolism leading to premature breakdown of cartilage and causing inflammation. It is not good enough to just take the supplements listed above; this needs to be combined with a fundamental change in diet. Cut out sugar and starchy foods. Return to homemade foods. Keep it simple with lots of vegetables, salads and organic meats. Now that you are starting to turn around your metabolism by a sensible diet the supplements listed above have a chance to work.

You will notice that Dan Dale Alexander’s idea of omega-3 fatty acids and vitamin C (from the freshly pressed orange juice) is contained in the list of supplements above. Dr. Klenner’s mega doses of vitamin C are also listed and Dr. Kaufman’s mega doses of vitamin B3 is contained in this list as well.

This list may not have been formally researched with controlled clinical trials, because the food industry and the makers of NSAIDs (Big Pharma) have no interest in this. But thousands of patients have been empirically treated with this regimen and a network of orthomolecular physicians has established that this regimen works to control the inflammation of arthritis and at the same time has no toxic side-effects.

 3. Laser, platelet rich plasma (PRP) and stem cells

Blue and green lasers have anti-inflammatory properties and are suitable for interstitial and intra articular laser treatments of arthritis. Dr. Weber has extensive experience with this treatment modality in Germany. I have discussed this in another blog.

However, prolotherapy, PRP and stem cell treatments are also an option for more severe cases of arthritis, particularly in arthritis of the knees, which can avoid total knee replacement surgery.

Stop Suffering From Arthritis

Stop Suffering From Arthritis

Conclusion

I met Dr. Hoffer in the early 1980’s during a meeting in Vancouver, BC when he wanted to establish a local orthomolecular division for British Columbia. Although I found the ideas fascinating, I felt that the College of Physicians and Surgeons (the regulatory body for physicians in BC) would scrutinize the practice of any orthomolecular member. At that time I would risk losing my license to practice medicine, which I just had received in 1978. So I decided not to join. Interestingly enough later in the 1980’s a member of the orthomolecular society of BC lost his license because of the use of mega doses of intravenous vitamin C. At this time the College considered these infusions useless or hazardous. Nowadays, any naturopathic and orthomolecular physician uses these intravenous vitamin C treatments as standard therapies. It shows how times have changed.

Lifestyle issues important with causation of arthritis

What has not changed is the food industry that undermines our health every day with hidden sugar contained in processed foods. In social functions it is customary to have a drink or two, if not more, which uses up our thiamine faster than we can replace it. Pan deficiency disease is alive and well as it was many years ago. It is in front of our eyes, but can we see it? Depending on what your eating habits are, do you need to make changes in your diet and perhaps take some or all of the ingredients of the multivitamin and mineral list above? Start by adopting a Mediterranean type diet, then add some of the supplements listed above. It is time to take a thorough look at natural treatment modalities against arthritis in the interest of preserving your health!

References

Ref. 1: Andrew W. Saul, Ph.D.: “The Orthomolecular Treatment of Chronic Disease. 65 Experts on Therapeutic and Preventative Nutrition”, Basic Health Publications, Laguna Beach, CA, 2014.

Ref. 2: Chapter in Ref. 1 by Dr. Hoffer: “Pandeficiency Disease”, pages 24-30 (2014).

Mar
21
2015

What Alcohol Does To You

The media has praised alcohol  for preventing heart attacks, but let us examine what alcohol does to you. There are other articles in which we hear about alcoholic hepatitis and liver cirrhosis, both of which can be killer diseases. To get some clarification, let us discuss the various facts.

Dr. Finnel points out that 7.9% of all emergency room visits in the US are due to alcohol related conditions (Ref.1). When the causes of deaths that are a consequence to alcohol are listed, the top 8 causes are: cancer of the mouth and pharynx, alcohol abuse disorders, coronary heart disease causing heart attacks, cirrhosis of the liver, traffic accidents, poisonings, falls and intentional injuries. This is not what you read in the news. What you do read about is that one glass of red wine per day would be good for women and up to two glasses of red wine would be good for men to prevent heart attacks and strokes.

Bioflavonoids

It is the bioflavonoids , and among those in particular resveratrol, that are the active ingredients responsible for heart health. Resveratrol is a powerful antioxidant that protects against ischemia-reperfusion injuries. It is responsible for the cardio protective properties of red wine known as the “French paradox” (Ref.2). According to this reference resveratrol contributes to at least 3 processes that stabilize the metabolism.

Toxicity of alcohol

Alcohol toxicity is a complex problem. According to the WHO 5.3% of all deaths worldwide are a consequence  to alcohol. In 2012 the WHO recorded that 7.6% of deaths in males were due to alcohol. In comparison, 4% of female deaths were due to alcohol. Toxicity comes from the breakdown product acetaldehyde, which all cells can convert from alcohol, but liver cells are especially able to do this. According to Ref. 3 alcohol diffuses easily through all of the cell membranes and reaches every organ in the body. The toxicity of acetaldehyde is the reason  for shutting down the mitochondria which affect the energy metabolism and causing cell death. The immune system reacts with inflammation, when it attempts to repair the damage.

So, what are the major problems what alcohol does to you? These are the processes: First fat accumulation (steatosis), next chronic inflammation followed by necrosis (dying of cells) and fibrosis. An example of fibrosis is liver cirrhosis, where non-functioning connective tissue replaces liver cells.

Different tissue sensitivity to alcohol

Certain tissues are more susceptible to alcohol toxicity than others. As the concentration of alcohol is highest in tissues that are in direct contact with alcoholic drinks, cancers related to alcohol consumption develop in the oral cavity, pharynx, larynx, esophagus, and in the colon and rectum. The pancreas is particularly vulnerable to inflammation and fibrotic changes with subsequent degeneration into cancer of the pancreas. The heart tissue and the arteries are very sensitive to alcohol; hypertension, heart attacks, stroke, cardiomyopathy and myocarditis as well as irregular heart beats (arrhythmias) can develop. The brain is very sensitive to toxic effects of alcohol as well. This causes major depression, personality changes with violent behavior, car accidents and injuries.

Other toxic effects of alcohol on organs

Kidney disease (alcoholic nephropathy) is another alcohol caused illness. 5% of breast cancers in northern Europe and North America are directly related to the toxic effects of alcohol (Ref.3). Finally, the liver being so active in detoxifying alcohol is affected by developing liver cirrhosis, which accounts for a lot of premature deaths at a relatively young age (typically in the mid to late 50’s).

Ref. 3 goes on to say that literature exists which claims that 1 to 2 drinks per day would be useful for prevention of heart disease. But the observation of the authors is that people will not discipline themselves to stick to these limits and very quickly enter into the zone of alcohol toxicity. The authors further noted that with regard to causing any kind of cancer there is no safe lower limit; the risk is directly proportional to the amount of alcohol consumed and the risk starts right above the zero point.

The pathologist has the last word

When I studied medicine at the University of Tübingen, Germany I attended lectures in the pathology department where Professor A. Bohle, M.D. demonstrated pathology findings of deceased patients. Dr. Bohle had a special interest in Mallory bodies. These are alcohol inclusion cysts within liver cells that can be stained with a bright red dye.

Histological documentation of toxic effects in livers of corpses

I will never forget when Prof. Bohle pointed out that the livers of this most diverse population whose bodies we had the privilege as medical students to study had a rate of 25% positive Mallory bodies. He wanted to impress on us as medical students to watch out for the alcoholics that are usually missed in general practice. Obviously 25% of the pathology population was affected by the consumption of alcohol. It was Prof. Bohle’s hope that we could perhaps interfere on the primary care level before things went out of control. Many of these corpses belonged to traffic accidents that could have been prevented (now seat belts and alcohol limits are standard, in 1968 they were not).

Alcohol as an aging substance

Consistent use of alcohol on a regular basis will slow down cell metabolism and hormone production significantly. The major effect of alcohol leads to poisoning of the mitochondria in multiple organs, which translates into faster aging and a shortened life expectancy. This in turn results in a change of appearance. An older person who has abused alcohol for a number of years may look 5 to 10 years older than their chronological age.

50% of people above the age of 65 drink daily (Ref.4). Some more statistics: alcohol abuse in elderly men is 4-times higher than in elderly women. 5% to 10% of all dementia cases are related to alcohol abuse. About 15% of older adults are experiencing health risks from abusing alcohol. And about 90% of older adults are using medications and close to 100% of medications can adversely interact with alcohol (Ref.4).

Social pressure

These are the scientific facts , and then there is social pressure when you are invited to a party.

When you are young and invincible, do you care what the science says? You want to have a “good time” and not worry about consequences. The data about long-term exposure and a slowly increasing cancer risk is there. The wine industry will remind you that 1 drink for women and two drinks for men will protect you from heart attacks. They will withhold the cancer information from you, as they don’t really want to hear about that (yes, it’s bad for their business!).

Resisting social pressure and doing what is good for you

Can you have a good time at a party without drinking alcohol? Yes, you can. You can talk and you can listen; you are probably more with it than those who had too much to drink. I like mineral water and hold on to a glass of that.

I explained in a blog before how I was convinced by three speakers at an A4M conference to join those who abstain from alcohol.

Socializing without alcohol is doable. You may at times miss it, but you can warm up even to a crowd that had a few drinks too much. It is about choice: we can choose what we want out of life.

What Alcohol Does To You

What Alcohol Does To You

Conclusion

I have attempted to show you the toxic effects of alcohol. Although alcohol has played an important role in the social lives of millions over the centuries, it is becoming more apparent that alcohol is a cell poison and shortens our lives. The beneficial effect of the 1 or 2 drinks marketed by the beer and wine industry and some cardiologists does nothing to counter the threat in terms of a whole array of cancers at much smaller amounts of alcohol. Fortunately, resveratrol and omega-3 fatty acids as supplements as well as exercise will more than make up for the 1 or 2 drinks that you do not really need. And neither exercise, omega-3 fatty acids, or resveratrol are cell poisons. The choice is yours!

References

Ref. 1: John T. Finnell: “: Alcohol-Related Disease“ Rosen’s Emergency Medicine, Chapter 185, 2378-2394. Saunders 2014.

Ref. 2: “Hurst’s The Heart”, 13th edition, The McGraw-Hill Companies, Inc., 2011. Chapter 54. Coronary Blood Flow and Myocardial Ischemia.

Ref. 3: Ivan Rusyn and Ramon Bataller: “Alcohol and toxicity”, 2013-08-01Z, Volume 59, Issue 2, Pages 387-388; copyright 2013 European Association for the Study of the Liver.

Ref. 4: Tom J. Wachtel and Marsha D. Fretwell: Practical Guide to the Care of the Geriatric Patient, Third Edition, Copyright 2007 by Mosby.