Low Energy and Low Testosterone – What’s the Deal and How to Beat It?

Do you feel tired all the time, lack motivation, experience brain fog, and get sleepy during the day? Many medical and lifestyle factors can cause these symptoms, but when we are talking about men, one of those factors can be low testosterone. In fact, low energy and low testosterone can be a significant problem for men as they grow older and their T levels decline.

The hormone testosterone is responsible for many processes, during adolescence and throughout adult life, including maintaining muscle, producing sperm cells, libido, and generating energy. Although declining testosterone levels can have an impact on these and other factors as a part of normal aging, it’s not normal for testosterone to drop so low that fatigue becomes a way of life.

Symptoms of low testosterone
Low energy or fatigue is just one of the symptoms of having low testosterone. Others include:
• Depression
• Irritability
• Anemia
• Hot flushes
• Erectile dysfunction
• Decline in body hair growth
• Decrease in muscle mass
• Development of gynecomastia (man boobs)
• Trouble concentrating
• Loss of bone mass (osteoporosis)

If you are experiencing symptoms of low testosterone, talk to your doctor about having your T levels checked. All it takes is a simple blood test.

How to remedy low energy and low testosterone
If you want to boost your testosterone levels and your energy along with it, you may be tempted to listen to the commercials telling you to jump on board the testosterone replacement therapy (TRT) train. However, testosterone replacement therapy is FDA approved only for men who have low T levels associated with disorders of the pituitary gland, testicles, or brain that cause hypogonadism. The safety and benefits of using TRT for symptoms of low T for aging reasons has not been established. TRT also may increase a man’s risk of suffering a heart attack or stroke.

Instead, you can help battle low energy and low testosterone with natural options. It is recommended you adopt all of these lifestyle tips because they can work in synergy and improve your results.

Get checked out. Talk to your doctor about any medical conditions or medications that could be causing your low energy and low testosterone. Thyroid disease, sleep apnea, depression, insomnia, heart disease, diabetes, and anemia are associated with fatigue and/or low T, as are the following medications: opioids, some antidepressants, statins, ketoconazole, cimetidine, spironolactone, and chemotherapy. Discuss with your doctor lifestyle changes and alternative medications, if needed, to help you overcome the low energy and low testosterone that is affecting your quality of life.

Try natural testosterone supplements. Numerous herbs and nutrients have been shown to help boost testosterone levels naturally on various levels. Those ingredients include L-arginine, avena sativa, beetroot, beta-sitosterol, L-carnitine, L-citrulline, fenugreek, ginkgo biloba, green tea extract, pygeum africanum, resveratrol, tribulus terrestris, vitamin D, and zinc. Rather than take these substances individual, your best bet is to take one supplement that contains all or nearly all of them.

Improve your diet. Kick up your energy and T levels by keeping saturated fat intake low and fruits, vegetables, and other whole natural foods high on your menu. Alcohol consumption should be kept to a minimum: two drinks daily is considered moderation, but less is even better.

Stay hydrated. This is a simple tip that many men overlook, especially if they are exercising, working outdoors, or are elderly. Dehydration can cause fatigue and lower your energy levels. Carry a stainless steel water bottle and drink from it frequently.

Get quality sleep. Seven to eight hours every night is highly recommended. You need sleep to produce testosterone. If you are experiencing sleep apnea, get it treated. Your doctor can order a sleep study if sleep apnea is indicated.

Get help for depression. Depression, low energy and low testosterone often go hand-in-hand, so it’s important to address depression. If you are treated medically for depression, talk to your doctor about medications that are not in the selective serotonin reuptake inhibitor class, as these can interfere with libido and sexual performance.

Exercise. Regular physical activity raises testosterone levels. Be sure to choose activities you enjoy so you’ll be more likely to stick with it. You’ll feel more energized, improve your overall health, enhance muscle strength, and even drop some weight.

Bottom line
If you’re experiencing low energy or fatigue, low testosterone may be a reason. These natural testosterone and energy boosters can alter your life for the better if you’re willing to commit to change. The challenge is out!

References
Bergh SJ, Giraldi A. Sexual dysfunction associated with antidepressant agents. Ugeskr Laeger 2014 May 26; 176(22).
Food and Drug Administration. FDA drug safety communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. 2018 Feb 26
McHenry J et al. Sex differences in anxiety and depression: role of testosterone. Frontiers in Neuroendocrinology 2014 Jan 35(1): 42-57
Metcalf E. Does working out affect testosterone levels? WebMD 2015

8 Prostate Supplement FAQs & What You Should Know

You may have been thinking about taking a prostate supplement but you’re not sure what to take. Perhaps you’ve been diagnosed with an enlarged prostate, prostate cancer, or prostatitis, or you may be interested in keeping that walnut-sized gland as healthy as possible. So your interest may be preventive.

In any case, you may have some questions about prostate supplements. After all, there are numerous products from which to choose, and the information may be confusing or lacking in specificity. Maybe your healthcare provider is not familiar with prostate supplements, in which case you should find a professional who can help you make your final purchasing decision to ensure you are getting a product that is right for you.

At the same time, you can do some research on your own, and that’s where this article comes in. Here are 8 FAQs on prostate supplements to help you get started on your search for the optimal prostate product for you.

1. Why should I take a prostate supplement?

You should consider taking a prostate supplement if you:

  • Have already tried conventional treatments for a prostate condition and you want to complement your efforts
  • Do not want to take any conventional medications. This is, of course, a personal decision. However, you should take this approach only if you are under the guidance of a medical professional, especially if you have a prostate condition or disease
  • Want to enhance or maintain your current prostate health. Taking a prostate supplement may be an effective way to help prevent future prostate problems.

2. How do I know if a prostate supplement is reputable?

You should consider several factors when looking for a reputable prostate supplement. One is transparency. Is there a way to contact the company and speak with a representative about their products? If the product is online, can you clearly see the product label and ingredients?

Another important factor is, are the claims made by the manufacturer backed up with scientific evidence? The producer should provide references to support the ingredients used in their product, and you should be able to search for and read the evidence for yourself. 

Yet another factor is certification. Look for products made in manufacturing facilities that are 100 percent FDA and GMP (Good Manufacturing Practices) certified. It is also recommended that the producer be NSF (National Sanitation Foundation) certified. NSF certification guarantees that the supplement’s contents match those printed on the label, that all the ingredients in the supplement have been listed on the label, and that there are no unacceptable levels of contaminants in the supplement.

Finally, choose a supplement that does not contain synthetic or artificial ingredients or fillers.

3. How long does it take for prostate supplements to work?

That depends on the supplement and the issue you are addressing. Remember that prostate supplements are not medications, and that natural substances can take longer to initiate noticeable results. You may experience results in a few days or a few weeks. If you don’t notice any improvement after 30 days, you may need to find a different prostate supplement.

4. What prostate supplement ingredients may help with an enlarged prostate?

If you have been diagnosed with an enlarged prostate (aka, benign prostatic hyperplasia), there are several natural ingredients that can complement your management strategy. The following ingredients are among those most studied for an enlarged prostate. Although these herbal remedies can be purchased individually, it is often best to use a supplement that combines several herbs to take advantage of the synergy of the product.

Beta-sitosterol: This substance is found in many plants, including corn oils, soybeans, peanuts, rice bran, and wheat germ. Although beta-sitosterol will not have an impact on the size of your prostate, it may help improve urinary flow and allow you to better empty your bladder. In a review of four studies involving more than 500 participants, researchers reported that beta-sitosterol improves urinary flow and urological symptoms.

Pygeum africanum: The bark of the African plum tree (Prunus africana) is the source of this herbal remedy. Some studies have indicated that it may help men with nocturnal urinary urgency (nocturia), improve urine stream, better empty the bladder, and go to the bathroom fewer times during the day. Prunus africana bark may contain atranorin, atraric acid, beta-sitosterol, ferulic acid, and N-butylbenzene sulfonamide, substances that have been shown to improve the symptoms of an enlarged prostate.

Rye grass pollen extract: Evidence that rye grass pollen extract is helpful in managing an enlarged prostate is limited. In one review that involved 163 men, rye grass pollen was compared with placebo. Use of the pollen extract was associated with a significant increase in self-rated improvement and reduced need to get up at night to urinate when compared with placebo. In a subsequent study that enrolled 444 men, the pollen extract resulted in an improvement in overall urinary symptoms, including nocturia.

5. What prostate supplement ingredients may help with prostatitis?

Many of the symptoms of prostatitis are similar to those of an enlarged prostate, so some of the natural remedies are the same. However, there are a few different ingredients you should look for in a prostate supplement that may help manage this condition.

Beta-sitosterol: See question on enlarged prostate

Green tea extract: So far, the research on green tea and prostatitis has focused on animal models. The findings have indicated that the catechins in green tea have anti-inflammatory and antimicrobial effects on prostatitis. This effect was better when the catechins were altered using nanotechnology. Other work has shown that catechins combined with the antibiotic ciprofloxacin (Cipro) resulted in significant improvements in prostatitis symptoms when compared with placebo.

Quercetin: Animal study results point to the value of using quercetin against prostatitis. According to a recent study published in Prostate, quercetin helps protect against CP/CPPS, which is mediated by anti-oxidation, anti-inflammation, and specific signaling functions in the body.

Rye pollen extract: See question on enlarged prostate

Saw palmetto: Numerous studies have explained the benefits of taking saw palmetto for management of prostatitis symptoms, especially those associated with the most common form of the condition, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In a 2017 report, for example, use of 320 mg saw palmetto daily for 12 weeks resulted in dramatic improvement in lower urinary tract symptoms and in quality of life.

Zinc: The prostate has a very high concentration of zinc, which indicates that this mineral is important for the integrity of this gland. Research shows that taking zinc supplements can help individuals with chronic prostatitis because of its anti-bacterial and immune-modulatory actions in the body.

6. What prostate supplement ingredients may help with prostate cancer?

Prostate supplements should not be used as a replacement for conventional prostate cancer treatment. However, they can be a significant complementary addition to your current treatment strategy. Be sure to discuss your plans to use prostate supplements with your physician.

Green tea: Numerous studies have shown that high consumption of green tea is associated with a lower risk of prostate cancer. One such study includes a systematic review and meta-analysis published in 2017. That study was the first meta-analysis that looked at the consumption of the active ingredients in green tea (catechins) and the incidence of prostate cancer. The authors found that “higher green tea consumption was linearly reduced PCa [prostate cancer] risk with more than 7 cups/day and green tea catechins were effective for preventing PCa.”

Resveratrol: This antioxidant and phytonutrient has been demonstrating much promise in the fight against prostate cancer. In 2019 alone, there have been numerous animal studies showing how resveratrol can not only inhibit the growth of prostate cancer cells but also suppress spread of the disease and promote cell death (apoptosis). Effective doses of resveratrol have not yet been determined.

Vitamin D: The body transforms vitamin D into several factors that help prevent the spread of prostate cancer cells as well as their reproduction. A number of studies also indicate that low levels of vitamin D are more likely to be seen in men with prostate cancer than in those without the disease, and that vitamin may help lower PSA levels. However, several studies have noted that high doses of vitamin D are not recommended.

Zinc: Taking zinc supplements may reduce the risk of developing advanced prostate cancer. In animal studies, human prostate cancer cells were exposed to zinc, and the cells were prone to undergo cell suicide. Zinc also has been shown to be a player in the regulation of prostate cancer cell growth.

7. What prostate supplement ingredients are recommended for overall prostate health?

Look for a prostate supplement that offers a variety of support. The main ingredients for a prostate supplement include beta-sitosterol, green tea extract, Pygeum africanum, vitamin D, and zinc (see details about each above). Saw palmetto and pumpkin seed oil are also sometimes suggested.

8. How do I know if my prostate supplement will interact with medications or other supplements?

If you plan to take a prostate supplement (or any supplement for that matter), you should talk to a knowledgeable healthcare professional about any possible drug and/or supplement interactions. This is especially important if you have any medical issues that may be impacted by your use of the supplement. Naturally, you can do your own research online to uncover possible interactions or contraindications, but it’s always best to check with a professional; if not your doctor, then talk with a pharmacist.

References

Costello LC, Franklin RB. A comprehensive review of the role of zinc in normal prostate function and metabolism; and its implications in prostate cancer. Archives of Biochemistry and Biophysics 2016 Dec 1; 611:100-12

Goodarzi D et al. The efficacy of zinc for treatment of chronic prostatitis. Acta Med Indones 2013 Oct; 45(4): 259-64

Guo Y et al. Green tea and the risk of prostate cancer: a systematic review and meta-analysis. Medicine (Baltimore) 2017 Mar; 96(13): e6426

Jang YG et al. Resveratrol inhibits DHT-induced progression of prostate cancer cell line through interfering with the AR and CXCR4 pathway. Journal of Steroid Biochemistry and Molecular Biology 2019 Jun 8; 192:105406

Lee YS et al. Synergistic effect between catechin and ciprofloxacin on chronic bacterial prostatitis rat model. International Journal of Urology 2005 Apr; 12(4): 383-89

MacDonald R et al. A systematic review of cernilton for the treatment of benign prostatic hyperplasia. BJU International 2000 May; 85(7): 836-41

McNicholas T, Kirby R. Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMI Clinical Evidence 2011 Aug 26; 2011.

Petrou S et al. Effect of vitamin D supplementation in prostate cancer: a systematic review of randomized control trials. International Journal for Vitamin and Nutrition Research 2018 Feb; 88(1-2): 100-12

Ramakrishnan S et al. Association among plasma 1,25(OH)2D, ratio of 1,25(OH)2 D to 25(OH)D, and prostate cancer aggressiveness. Prostate 2019 Jul; 79(10): 1117-24

Shahvazi S et al. The effect of vitamin D supplementation on prostate cancer: a systematic review and meta-analysis of clinical trials. Hormone and Metabolic Research 2019 Jan; 51(1): 11-21

Thompson RQ et al. Chemical comparison of Prunus africana bark and pygeum products marketed for prostate health. Journal of Pharmaceutical and Biomedical Analysis 2019 Jan 30; 163:162-69

Wilt TJ et al. Beta-sitosterol for the treatment of benign prostatic hyperplasia: a systematic review. BJU International 1999 Jun; 83(9): 976-83

Yoon BI et al. Anti-inflammatory and antimicrobial effects of nanocatechin in a chronic bacterial prostatitis rat model. Journal of Infection and Chemotherapy 2010 Aug 7

Top 9 Ingredients for Men’s Health

The supplement market has become a challenging environment to navigate. Not only are there scores of different ingredients from which to choose; you also have different formulations, manufacturers, sources, and claims to sift through before you make up your mind which product to buy. We’re here to help make your choices a bit easier, especially in the first category by talking about the top 9 ingredients for men’s health.

The internet and other media sources often tout the supplements that are important for men’s health, and that list can be rather lengthy. However, there are certain ingredients that are especially worthy of mention because they are most often deficient in men’s lives or essential for their overall health and well-being. So if you are looking for the ingredients you should focus on the most, these are our choices. We hope you agree and will take the time to evaluate your possible need to take one or more of these substances to support and promote your health today.

Arginine

Arginine (aka, L-arginine) is an amino acid that your body produces naturally. However it is also present in foods that contain protein, such as soybeans, turkey, peanuts, and pumpkin seeds. In fact, arginine is essential for the body to make proteins.

Much of the research on arginine has involved its ability to improve compromised blood flow, which is characteristic of heart disease, erectile dysfunction, congestive heart failure, high blood pressure, male infertility, and clogged arteries. Because these are common problems among men, getting sufficient arginine is important.

Some men take arginine supplements to improve their athletic performance, but it’s also used to enhance mental function and improve immune system activity. The reason arginine is able to help with all of these conditions is that once it enters the body, it is converted into nitric oxide, a chemical that causes blood vessels to open wider for improved blood flow. The amino acid also has an ability to stimulate the release of insulin and growth hormone.

Talk to a healthcare provider before taking arginine supplements. A typical dose of arginine supplement is no less than 5 grams daily for erectile dysfunction, while men with congestive heart failure may take 6 to 20 mg daily in three doses. Dosing to enhance athletic performance should be determined by a health professional.

Coenzyme Q10

Coenzyme Q10, aka CoQ10 and ubiquinone, is a potent antioxidant that is found in nearly every cell in the body. It is most abundant in the heart, liver, kidneys, and pancreas. As a coenzyme, it helps enzymes do their job. The body’s cells use CoQ10 to produce the energy cells need to grow and thrive. More specifically, CoQ10 is key in the making of adenosine triphosphate (ATP), which is essential for energy transfer within cells.

CoQ10 is also used as an antioxidant, especially when it comes to heart health. In fact, CoQ10 is used to treat heart conditions, including heart failure, and may improve some symptoms and reduce the risk of future attacks when it is used along with traditional medications.

Levels of CoQ10 decrease with age. Research also shows that people with heart disease, brain disorders, diabetes, and cancer have low levels of this antioxidant. Do low CoQ10 levels cause or contribute to these diseases or is it the other way around? The jury is still out on this question.

CoQ10 supplements are available as ubiquinone and ubiquinol, and the latter is the more absorbable form. The standard dose ranges from 90 mg to 200 mg daily. Because this supplement is fat soluble, you should take it with a food that contains healthy fat, such as avocado, nuts, or coconut oil. Your body will absorb it up to three times faster than if you take it without food.

Fiber

Are you getting the 25 to 35 grams of fiber you should have every day for optimal health? Far too many adults don’t get the amount of fiber they need for optimal health.

What’s so great about fiber? First of all, it’s a carbohydrate that your body can’t digest, so it passes through the body and in the process performs some essential functions, such as helping in the elimination of cholesterol, moving along stool in the intestinal tract, regulating sugar, and keeping blood sugar and hunger in check.

Fiber comes in two forms, and fiber-containing foods typically have both types in varying percentages. Soluble fiber dissolves in water and helps lower cholesterol. Insoluble fiber doesn’t dissolve in water but it does promote regularity and help prevent constipation.

Fiber has been credited with assisting in reducing the risk of heart disease, constipation, diverticular disease, diabetes, and colon cancer. To increase fiber intake, you should include more foods such as whole grains, fresh fruits and vegetables, legumes and beans, and nuts. The best way to get fiber is to eat high-fiber foods.

However, fiber supplements are available in many forms. Natural fiber powders, including psyllium and methylcellulose, are typically safe to take daily. However, you should discuss fiber supplement use with your healthcare provider before you start because they can interact with some medications.

Folic acid

Folic acid (aka folate, which is the form found in foods) is a B vitamin (B9) that is essential for producing white and red blood cells in the bone marrow, converting carbos into energy, and making DNA and RNA. It also is involved in the production of sperm and may reduce the risk of depression.

The foods that are the best source of folate include leafy greens (e.g., spinach, Swiss chard, mustard greens, collard greens, kale) as well as asparagus, oranges, pinto beans, lentils, pumpkin seeds, and sesame. If you choose a supplement (folic acid), look for methylfolate on the label. The recommended daily intake is 400 micrograms. 

Magnesium

This mineral is one of the busiest in the body, as it is involved in more than 300 enzyme systems that regulate a wide range of reactions in the body. Magnesium has a role in protein synthesis, muscle and nerve function, regulation of blood pressure, energy production, and blood sugar control, among others. It also plays a role in normal heart rhythm and the conduction of nerve impulses and muscle contractions.

Magnesium insufficiency is common, and groups most often affected are those with gastrointestinal problems, type 2 diabetes, alcohol dependence, or who are 50 or older. It’s not difficult to get the amounts necessary for optimal health if you select green leafy vegetables, legumes, nuts, seeds, and whole grains on a daily basis.

If, however, you choose to take a magnesium supplement, the forms that are best absorbed are aspartate, chloride, citrate, and lactate rather than oxide or sulfate.

Omega-3 fatty acids

When you see the words “omega-3 fatty acids,” you may immediately think of fatty fish such as tuna, salmon, and sardines. These and similar fish are the richest sources of this essential fatty acid. Omega-3s are credited with many health benefits, and a reduction in the risk of prostate cancer is one of them.

In a recent case-control study, investigators discovered why omega-3 fatty acids can lower the risk of prostate cancer: the fatty acids interfere with the activity of pro-cancer molecules called soluble intercellular adhesion molecule-1 (slCAM-1).

What other benefits have been bestowed upon omega-3s? How about reduction of inflammation, lowering of triglycerides and cholesterol, prevention of excessive blood clotting, helping prevent obesity, reduction in symptoms of depression, psychosis, and bipolar disorder, and enhancement of memory.

The American Heart Association recommends eating 7 ounces of fatty fish per week to get an adequate amount of the two main omega-3s, EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid, respectively). However, if fish is not your game, then you can take fish oil supplements. An omega-3 supplement that provides approximately 1,080 mg EPA and 720 mg DHA daily in no more than three doses is suggested.

Probiotics

Beneficial bacteria, aka probiotics, play an essential role in supporting, promoting, and maintaining healthy immune function. In fact, the good and harmful bacteria in your gut form a precarious balance that makes up about 80 percent of your immune system. Therefore, you want this relationship to be harmonious as much as possible.

If the bacterial environment in your gut is out of balance, it can result in a variety of health issues, ranging from headaches and nutritional deficiencies to gastrointestinal problems, autoimmune disorders, depression, brain fog, and more. The secret is to keep the level of good bacteria up so it can counteract any ill effects of the harmful microorganisms.

To accomplish that, you can include foods rich in probiotics in your diet, such as fermented tofu (tempeh), kimchee, some yogurts (look for “active cultures” on the label), sauerkraut, kefir, or foods fortified with probiotics. However, it can be challenging to get the beneficial bacteria you need from foods alone, which is why a high-quality probiotic supplement can be a great option.

Look for products that contain a variety of bacteria species and strains that have been shown to remain viable on the shelf and in your body. Reputable brands will have available scientific evidence to back up their claims. A suggested dose is 1 to 10 billion CFUs (colony-forming units) daily, but higher doses are generally recommended if you are dealing with a health issue such as diarrhea or gastrointestinal problems.

Vitamin D

Vitamin D deficiency is one of the most common nutrient deficiencies in the world, with about 40 percent of men having levels that are below what is considered to be healthy (28 nanograms per milliliter). In fact, since many experts consider this figure to be too low, the percentage is even higher.

Best known as the sunshine vitamin because the body produces vitamin D from sunlight exposure to the skin, a deficiency of this nutrient has been associated with high blood pressure, obesity, diabetes, depression, bone loss, back pain, hair loss, poor wound healing, frequent infections, muscle pain, and fatigue.

So where should men get their vitamin D? If you don’t get at least 15 to 20 minutes of sunlight on your skin every day, there’s a good chance you are deficient in vitamin D. Only a few foods are considered good to excellent sources, including egg yolks, beef liver, fortified cereals and milk, cheese, and mushrooms.

That leaves vitamin D supplements. The National Academies of Sciences Engineering Medicine set recommendations on vitamin D intake at 600 International Units for individuals up to age 70 years and 800 IU for those aged 71 and older. These figures are considered low by some experts, however, such as the Vitamin D Council, which recommends 5,000 IU daily. You should have your vitamin D levels checked using a simple blood test to determine your specific needs before taking this supplement.

Zinc

If you want testosterone, then you need zinc. However, many adults don’t get enough of this trace element. Zinc is necessary for the production of testosterone, which in turn can affect erectile dysfunction. Other noteworthy things about zinc are its ability to help metabolize nutrients, support immune system function (which is why some people take zinc for a cold), and promote the production of protein and DNA.

Although a zinc deficiency is rare in the United States, men can notice significant problems if their levels are below the recommended threshold, which is 0.66 to 1.10 micrograms per milliliter (mcg/mL). Signs and symptoms can include low testosterone levels, decreased sense of taste and smell, diarrhea, wounds that won’t heal, lack of alertness, and diarrhea. Taking zinc supplements also has been found to boost testosterone in men with moderately low levels.

Zinc is abundant in oysters, and more moderate amounts can be found in beef, pumpkin seeds, lentils, cashews, mushrooms, spinach, whole grains, and avocados. The recommended daily intake for men is 11 mg. Zinc supplements are available alone and in multivitamins. The most accessible form of zinc for the body is zinc orotate; other forms include zinc acetate, gluconate, and sulfate.

Bottom line

No matter how much we try to eat right and take care of our body, life often gets in the way. Stress from jobs and relationships, financial worries, social demands, and environmental toxins can all take a toll on us. It’s easy to lose focus on some of the nutritional factors that can help us maintain and optimize our health. Take time to make your well-being a priority and examine your nutritional needs today.

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National Institutes of Health. Magnesium

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WebMD. Coenzyme Q10: CoQ10

WebMD. L-arginine

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