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Death by spam is now possible with a new device by Microsoft. The device when implanted in the user’s skull allows downloading of email directly into the brain. Niles Bookbinder, 37, an assistant working for Jon Hanson, author of Good Debt, Bad Debt was accidentally spammed to death Tuesday morning using a beta version of a new email device called, “MS Mind.” A Microsoft spokesperson said, “We don’t have all of the bugs worked out yet, but this is the first death we know of.” Mr. Bookbinder had unwittingly “unchecked” the spam filter in the MS Mind control panel. Without the spam filter, apparently Niles unleashed the entire world of spam into his "medulla interface" and was literally spammed to death. It’s likely the last words Mr. Bookbinder heard were, “You’ve got mail!” Wireless Medulla Interface providers are popping up everywhere. Dr. Jack Kevorkian sees the new Wireless "G" Medulla cards as a real advance for him. With these systems, euthanasia supporters predict quick, painless death by simply bypassing the filters and downloading thousands of spam emails quickly. Kevorkian said, “I have been looking forward to killing patients by email.” Kevorkian expects his prices to be competitive with AOL. While it is not a victimless crime, it would be a crime without a knowable perpetrator. You would have no way of knowing whether your "loved one” was finished off by the breast enlargement, Viagra softabs starting at $2.99, or $ave $$$ now refinance emails. A PETA spokesperson, Ima Chihuahua, said she found the idea disturbing because it could lead to so-called Spam Collars that would be used to kill pets as they aged, or "convenience" killings, such as when a young couple could not find a kennel on their way to Vegas or they simply change their minds about having a pet. PETA may be right. It has long been rumored that KFC has been testing the effectiveness of spamming chickens to death versus simply whacking off their heads. In earlier tests, chickens were forced to watch Gili and Ishtar until they simply cut off their own heads, but this experiment was discontinued because of the cruelty to experimenters. Spamicide, accidental or not, will undoubtedly set off a bitter debate in America as Anti-Spammers and Right-to-Spam groups rally to raise money and jockey for political clout. George W. Bush seemed bewildered at this morning’s briefing. He looked to his press secretary and said, "Are we Right-to-Spam or Anti-Spammers?" Elsewhere, Jesse Jackson, finding it difficult to be Right-to-Spam said, "It should be the choice of the spammee. Spamicide should be legal, available, and rare." NEXT WEEK: Partial Spam Deletion. Should this barbaric practice be outlawed? Are thousands of viable spams being killed in spam filters, just before being downloaded? The debate continues... Jon Hanson www.gooddebt.com jon[at]gooddebt.com truth about penile enlargement penile enlargment surgeon penis enargement tool enlagement erection penis pill vimax penile enlargement doctor penile enlargment stretcher pnis enlargement without pills homemade penis enargement

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Whoever sends junk emails has got me completely wrong. They seem to think I’m a seedy, hypochondriac bloke with a lot of problems down below. Not only am I cursed with a miniscule member, it’s about as reliable as the old A40 Mum used to drive. Apparently, my girlfriends are sniggering among themselves about my shrunken, faulty manhood. And my long suffering wife (I have one of those as well as the girlfriends) is concerned I may not be able to get her pregnant. Nevertheless, my alter ego’s appetite is insatiable. I’m in the market for a sexy Russian girl who can’t spell but has breasts the size of bowling balls. When not performing disappointingly in the bedroom, I’m swallowing dodgy prescription drugs with names that sound only partially familiar like Aspromix and Pethadinerole. My other obsession is cheap, immitation watches. While the real me usually deletes these messages without opening them, I’ve taken a look at one just now - in the interests of journalism. Apparently, if I buy one particular outlet’s Viagra, I’ll be able to open a beer bottle with my penis. That could be handy. Finding the bottle opener’s always tricky. It gets lost among the tangle of spatulas and serving spoons in the middle drawer. The advertisement says I may even be invited to become a porn star. Well, I guess it’d be more lively than cleaning up the cat litter box. Most of the time I delete junk mail messages on automatic pilot. Their lurid subject headings are easy enough to detect among precious emails from readers. Often the highlight of my week, readers’ emails mean a lot. I try to reply to them all (except unspeakably abusive ones). The other day as I was deleting Viagra advertisements, I had a horrible sinking feeling. Without meaning to I wiped an email titled Velcro. No doubt it was a reader’s response to a comment I made about Velcro being one of the best inventions of the 20th Century. They were probably telling me off, saying advances in medicine and science were far more important. They’re right, of course. Velcro isn’t that great. It didn’t even supplant zips the way people said it would. When I asked my husband why men still prefer zips on their trousers, he said Velcro would be too noisy in public toilets - and somewhat mood shattering in other circumstances. Nevertheless, some inventions have been undervalued for their simple elegance and versatility. Take dental floss, for instance. According to that Bible of the Internet, Google, it was invented by a New Orleans dentist who recommended passing a piece of silk between teeth in the early 1800’s. He shouldn’t take too much credit, though. It wasn’t long before Taranaki people were using their mothers’ sewing cotton to remove chunks of mutton wedged between their molars. Nylon dental floss was created during World War Two. Americans use enough of it every year to stretch from Earth to the Moon and back four times. I buy almost that much for our household. Dental floss is great for all sorts of things around here – hanging Christmas decorations and paintings, training grape vines, oh and occasionally for teeth. I’ve used it to string broken necklaces and earrings together. Floss is excellent for cutting through dough and cheesecake. It can successfully repair tents and backpacks or reattach umbrella sections back to their spines. I’m not the only one to explore its potential. In 1994 a prison inmate in Virginia used braided floss to scale a wall and escape. Another seriously undervalued item is the plastic clothes peg. I’ve yet to discover a better way to seal a half eaten bag of chips. Rubber bands are clumsy by comparison, and those plasticised bits of wire laughingly called “ties” never hold. Half the stuff in our kitchen cupboards and freezer is held together with clothes pegs – from cereal and frozen peas to rice and some strange brown powder that seems to be a maternity ward for moths. Pegs are essential for holding music on its stand when our daughter goes busking with her violin at Christmas. Some people use them to hold curtains together, squeeze the last out of the toothpaste tube or to hold the end of matches so their fingers don’t get burnt. I look forward to hearing from readers about their favourite undervalued inventions – and hope the person whose message was deleted forgives me. It’s so easy these days to mistake Velcro for Viagra. truth about penis enargement free penile enlargement technique penis enlagement pills product safe penile enlargement penis enhancement supplement natural penis enlargement and lengthening penis enlargment pill magna rx vigrx penis pills real pennis enlargement

Only you are able to decide which path is best for your needs, but do keep in mind that the herbal approach is safe to undertake and has many benefits. What are some of these benefits? The herbal approach uses the endocrine system of your own body to increase your breast size naturally and safely, adding size, firmness and fullness. It is your own tissue growth. Your body does it by itself. The results are long lasting and you have your own naturally larger breasts. The most dramatic and unique effect of the herbal approach comes during the early stages while your body is changing. As you begin to see and feel your body shape changing, a new and wonderful relationship with your body takes place. Your body is like a new friend, bringing you new levels of happiness every day while providing delight in the gradual changes taking place. It is a journey of body re-discovery, as what has often been merely a dream now becomes a reality. Even more than the tangible physical changes that take place to your appearance, you begin to realize a daily increased feeling of self worth. Other important benefits include the safety of using all natural ingredients, comparative cost effectiveness, and heightened feminine physical sensations in the breast area and throughout the body. Why Choose Herbal? When beginning your journey of transition, you are offered a barrage of options to consider. Though temporary, the choice of breast forms is the most easily accessible. Hormone therapy is another choice available to you, characterized by high cost and a level of physical risk. The more drastic alternative of breast implants comes with a high level of complications and risk over a lifetime. Breast implants can be cost-prohibitive and need further surgical intervention often in 3 to 5 years and in at least 8 to10 years. And then there’s the herbal approach, which can result in substantial and impressive results with significantly lower risk, minimal cost and virtually no adverse side effects. Using all-natural herbs, significant long lasting results of up to two or more cup sizes are being routinely reported. The percentage of people who are getting good or excellent results approaches close to 100% satisfaction for herbal breast enhancement programs that are individually monitored and adjusted. The most successful programs use ingredients based on concentrated herbal extracts that are 10 times the strength of standard herbs. A personalized herbal program is about a tenth of the cost of breast implants. The safe, non-invasive and low cost herbal approach has many advantages not found in any other method. The herbal approach is the only one that heightens breast sensation so that you feel the same sensual and sensory effects in the breast area that are normally experienced only by women. Surgical implants will reduce sensation to the breast area and almost always result in a partial or complete loss of sensitivity. By way of comparison, herbal breast enhancement has few if any side effects. Other than some temporary tingling, itching, or even soreness felt in the breast area, a normal occurrence while your breast size is increasing, you will notice softening of the skin and hair, rounding of the hips and a noticeable increase in sexual libido. So you’re thinking, “Sounds great, but how does it work?” How Does It Work? Estrogen, often thought of as the “female” hormone, but also present in males, is critical for sexual functioning, boosts the immune system and supports bone growth. Estradiol is one of sixteen different types of human estrogen. It is the estrogen responsible for a long lasting size increase in the breast area. The key to a natural and long-lasting breast size increase is stimulating the body to produce a large quantity of its own human estradiol. When human estradiol production increases beyond the necessary threshold level, it will go to the breast tissue where it binds to the estrogen receptor sites. Every person, regardless of sexual orientation, has literally millions of unused estrogen receptor sites in the breast area that can be used for size increase. Most herbal products found in today’s market do not contain the necessary component that stimulates the endocrine system to produce its own human estradiol, but rather offer only phytoestrogen, or plant estrogen. Human estrogen is from 200 to 1000 times more potent than phytoestrogen and bonds strongly to the estrogen receptor sites in the breast tissue. The drawback to just using phytoestrogen-based herbals for breast enhancement is their inherent inability to bond strongly to the human receptor sites for any length of time. Although these plant estrogens will go to the breast tissue and provide temporary results, you will have to constantly use these products to maintain any size increase. So how do we get long lasting results? We tap into the power of your human body as an efficient biological factory. With our personalized program we introduce a separate set of herbs that are adjusted for each person’s body to stimulate the body’s endocrine system to produce its own human estradiol. Now, when your body finds the plant estrogen we bring into your program it will use it as the ideal building blocks for creating your own human estradiol. When your body produces its own human estradiol you achieve long lasting results. When the correct amount of concentrated phytoestrogen is readily available in the body, the body uses very little energy to produce a large quantity of human estradiol. The results are your own naturally larger breasts, made from your own breast tissue. It is real, it is natural, you did it yourself, it is long lasting and it is authentically you. What to look for in an effective herbal breast enhancement product: Dosage: The best products for TG use are based on herbal ingredients that are highly concentrated extracts. Herbal breast enlargement products not based on extracts are usually too weak to give significant results for TG. A typical women’s formula will deliver less than 200mg a day of the needed ingredients, while an effective TG program will provide ingredient dosages in the range of 15,000mg to 20,000mg a day. Without using concentrated extracts, the conventional capsule requirement could be an impractical quantity of 100 or more capsules a day. Ingredients: You will find Saw Palmetto in almost all of the herbal formulas available in the market. It is one of the richest sources of plant estrogen. Other significant and common working ingredients are Wild Mexican Yam, Fenugreek Seed, Fennel Seed, Pueraria, Red Clover and Avena Sativa. However, to get a long lasting result, the single most important herbal ingredient is Lepidium Meyenii, commonly known as Maca. Be sure your breast enhancement program includes Maca in an extract 10:1 concentrate. This is the most important ingredient for attaining results that will last for years. With Maca present and adjusted to the proper personalized dosage, you will not have to continue on any herbal regimen once you have achieved the size you want. Starting Evaluation: A successful program should include a personal evaluation. Because each of us is unique, it is important for you to choose an herbal program that will factor such details as your age, weight, height, metabolism and level of physical activity, as well as your breast size objectives and goals. Other factors affecting personalization are caffeine and nicotine use as well as digestion and any other issue that might adversely affect an individual’s personal progress. Follow Up: Follow-ups are a crucial part of any successful breast enlargement program. Each individual’s program should be reviewed in 30-day intervals for analysis of individual progress and to assist in what can be done to help the client get the best results possible. Your customer service representative should be knowledgeable. You should have personalized treatment. Be sure the sales staff members are not merely “order takers” but consultants that care about your progress and success. Toll free access to your personal consultant is an equally important factor in choosing your program. Results: Are the results long lasting? A properly formulated and administered program should take about 180 days to get the long lasting results you want. The most effective breast enlargement programs will strongly stimulate the body to produce its own human estrogen. This in turn will convert any phytoestrogen that is provided by the breast enhancement program into human estradiol, which gives you long lasting results. You only have to take those products until you get the size you want and then you can stop taking the product while keeping the size you achieve. Effective programs have achieved results that are very near the 100% success rate. Product Comparison: Do your research. There are significant differences between breast enhancement products. Look carefully at the ads & call the companies that advertise with us to compare. 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Most of these problems are usually related to using high dosage or individual genetics. For convenience we’ve divided the potential side effects into those experienced by men, women, and teenagers. Men - Although anabolic steroids are derived from the male sex hormone, testosterone, men who take them may actually experience a "feminization" side effect along with a decrease in normal male sexual function. This is because one of the metabolic breakdown products of testosterone is the female hormone, estrogen. Some possible anabolic steroid side effects in men include: Reduced sperm count Impotence Development of breasts Shrinking of the testicles Difficulty or pain while urinating Women – It’s not surprising that women who take the drugs may develop masculinizing effects. These include the following: Facial hair growth Deepened voice Breast reduction Menstrual cycle changes Clitoral enlargement Both sexes - With continued use of anabolic steroids, both sexes can experience the following anabolic steroid side effects, which range from the merely unsightly to the life-endangering. They include: Acne Water retention Rapid weight gain Clotting disorders Liver enzyme irregularities Elevated cholesterol levels Tendon damage from proportionally stronger muscles Mood swings Teenagers - anabolic steroid side effects can pose several serious health side effects in teens. Anabolic steroids have been known to fuse the growth centers (epiphyseal plates) in teens’ bones. Once these growth plates are closed, they cannot reopen so adolescents that abuse anabolic steroids may end up shorter than their natural genetic height. Anabolic steroids have also been known to cause severe mood swings. This could have severe consequences in many teens as this age group is characterized by naturally occurring behavioral changes. Although not conclusive, there have been a few cases where anabolic steroids may have contributed to suicide in a few teens. It’s because of these serious anabolic steroids side effects that teenagers should under no circumstances use these drugs. Are anabolic steroids addictive? Although the evidence is limited it is possible that addiction may be one of the most serious of anabolic steroids side effects. Recent evidence suggests that long-time users of anabolic steroids and steroid abusers may experience some of the classic characteristics of addiction including cravings, difficulty in stopping steroid use and withdrawal symptoms. As the research is limited, it’s not known if the symptoms of addiction are psychological or physiological in nature. For those who use anabolic steroids, coming off the “juice” can be very traumatic as they begin to lose muscular size and strength. This loss of a key component of their identity can leave them suffering many of the same symptoms and side effects as those using common street drugs. How to minimize the risk of anabolic steroid side effects Given that anabolic steroids are illegal in many countries, it’s probably a good idea to avoid them altogether. If you do decide to use them, the following tips will help you reduce the risk of side effects: Use oral steroids as sparingly as possible. They have been chemically modified to survive the digestive system and hence much harder on the liver. Never stay on a steroid cycle for more than 6 to 8 weeks. Never use any steroids that have a questionable manufacturing background. Beware of the blackmarket. At the first sign of any serious side effect (chest pain, blood in urine, etc), stop all steroids and see a physician. Article 02/01 2006 prosolution penile enlargement pills penis elargement operation safe penile enlargment prosolution pnis enlargement pills penis elargement pump vimax manual penis enlargement exercise free penile enlargment exercise vimax penis enlagement real pennis enlargement

If you’ve ever witnessed someone suffer a stroke, you understand the humbling nature of this disease. It can reduce the mightiest human being to an immobile, helpless creature. Impairment of crucial functions like speech, walking, and control of bowel and bladder can wrench control from the body in a moment. Even perpetually youthful TV personality Dick Clark was struck down by stroke at age 75, despite the outward appearance of perfect health. Clark’s stroke resulted in a six-week hospital stay and, judging from fragmented reports, significant disability. Stroke can be like a devastating fire that strikes without warning, leaving only smoldering rubble. Stroke can so ravage basic bodily functions that often all you can hope for is to regain a portion through rehabilitation. The disease process that underlies stroke requires decades—30 or 40 years—to develop. With that much lead time, why aren’t we better able to detect or stop this crippling disease? The truth is that we are able to predict many, if not most, strokes. Advances in imaging technology allow detection of atherosclerotic plaque that cause stroke years before it becomes a threat. Progress in deciphering the causes of stroke has also leapt forward. Unfortunately, your neighborhood physician still focuses on diagnosing the crisis rather than anticipating it. Physicians prefer to deal with catastrophes and are just not that interested in prevention. Most physicians ask: “Is it time to operate or not?” The medical community obsesses over procedures like carotid endarterectomy (surgical removal of plaque) or carotid stents. Even when a person is afforded the warnings of a “mini-stroke”, or transient ischemic attack (TIA), little more is done once it’s determined that surgery is not necessary—even though this person has high risk for future stroke (50% over 10 years). Let’s flip-flop this approach to stroke. Procedures represent a failure of prevention! Where do strokes come from? Stroke develops when some portion of the brain is deprived of blood. This usually results from a tiny bit of debris that dislodges from an atherosclerotic plaque along the walls of an artery (the same sort that accumulates in coronaries causing heart attack). The sources of debris have been a subject of controversy, but new imaging technologies have settled the question. Any blood vessel that leads from the heart to the brain can be a source. The two carotid arteries on both sides of your neck are a frequent source, as these arteries are prone to develop plaque. (Our discussion will be confined to what are called thromboembolic, or ischemic, strokes, i.e, strokes that occur from plaque that fragments, sending debris to the brain, and will not include the far less common hemorrhagic strokes due to rupture of small vessels in the brain, nor will we discuss atrial fibrillation and other heart causes of stroke. The thromboembolic strokes we discuss cause around 88% of all strokes.) Over the last 10 years, the aorta has been recognized as another important source of stroke. The aorta is the main artery of the body whose branches go to the head, arms, and legs. Atherosclerotic plaque is a live tissue that, through poor diet, inactivity, high cholesterol, overweight, etc., grows and becomes progressively more unstable. At some point, plaque fragments. Little bits break away, traveling to the brain. Fractured plaque also exposes its deeper structures to flowing blood, triggering blood clot formation, which in turn can also fragment and go to the brain. Atherosclerotic plaque is a prerequisite for the most common causes of stroke. If the majority of strokes originate from plaque, why not measure plaque to determine if you’re at risk for stroke? How can we easily, safely, and accurately measure plaque in the carotid arteries and aorta? And if plaque can be measured, can it be shrunk or inactivated to reduce or eliminate risk for stroke? How can plaque be measured? Just 20 years ago, the only practical method of identifying plaque in the carotids or aorta was through angiography, requiring catheters inserted into the body to inject x-ray dye. Angiography was impractical as a screening measure. CT scanning and magnetic resonance imaging (MRI) are emerging as exciting methods of imaging both carotids and aorta. Unfortunately, most centers and physicians are much more focused on the diagnostic uses of these technologies for people who have already suffered stroke or other catastrophe, and application of these devices for preventive uses is still evolving. One exception is when aortic calcification or aortic enlargement is incidentally noted on the increasingly popular CT heart scans; this is an important finding that can signal presence of aortic plaque. The one test that is widely available and can be performed in just about any center is carotid ultrasound. It’s simple, painless, and precise. Two basic observations can be made: 1. Plaque detection—Atherosclerotic plaque can be clearly visualized. If plaque blocks more than 70% of the diameter of the vessel, or if there are “soft” (unstable) elements in plaque, then stroke risk may be high enough to justify surgery or stents. However, if there are plaques that are less severe, substantial risk for stroke may still be present that can be reduced with preventive measures. 2. Carotid intimal-medial thickness—This is a measure of the thickness of the lining of the carotid artery in areas not involved by plaque, but often precedes the development of mature plaque. Carotid intimal-medial thickness also provides an index of body-wide potential for atherosclerotic plaque that can place you at risk for stroke. The aorta, for instance, cannot be well imaged by surface ultrasound but can still be a source for stroke. Increased carotid intimal-medial thickness and carotid plaque are closely associated with likelihood of aortic plaque. The Rotterdam Study of 4000 participants demonstrated that if carotid intimal-medial thickness is greater than normal (1.0 mm), then you can be at risk for stroke (and heart attack), even if no carotid plaques are detected. Carotid ultrasound is the one test you should consider that provides the most information with least effort. Ultrasound is harmless, painless, and can be obtained just about anywhere. Even if your doctor disagrees with your request for a carotid ultrasound, an increasing number of mobile services are popping up nationwide that make this test available for around $100. One important point: many scanners and interpreters will only report whether plaque is present or not. While this is important information, you should request that the carotid-intimal medial thickness be made as well. Not all centers can make this simple measure (because of software requirements), but it doesn’t hurt to try. Any amount of carotid plaque is reason to follow a preventive program, even if the plaque is insufficient to justify surgery. Can plaque be reduced? Can we shrink plaque in carotid arteries and aorta and thereby reduce, perhaps eliminate, these sources of stroke? That question is gaining momentum as effective therapies become available that pack real punch for reducing plaque. Study after study has now documented that plaque can be reduced and, with it, risk for stroke. Reduction in plaque of 10–20% is possible within a year or two. Let’s consider the most potent influences on carotid and aortic plaque growth that need to be considered in a plaque-reducing program. (I assume that you are a non-smoker—if you are a smoker, you first need to concentrate on quitting.) Hypertension Considerable experience documents the power of blood pressure-lowering for prevention of stroke. The most recently updated guidelines, the JNC–VII, recommends a blood pressure of 407 mg/dl heightens stroke risk six-fold. C-reactive protein (CRP) This measure of inflammation is proving to be a useful marker for identifying people at risk for stroke, with increased risk beginning at a level of 0.5 mg/l. High CRP also predicts more rapidly growing carotid plaque. Homocysteine Homocysteine is an important marker of increased likelihood of both carotid and aortic plaque, as well as stroke. In 1997, the European Concerted Action Project reported more than a doubling of stroke when homocysteine levels exceeded 12 mol/l. As homocysteine increases to 20 μmol/l, risk for stroke and heart attack increases an amazing 10-fold over that at a level of 9 μmol/l. Asymmetric dimethylarginine (ADMA) ADMA is recently discovered amino acid whose blood levels can skyrocket up to 10-fold in the presence of hypertension, metabolic syndrome, diabetes, high cholesterol and triglycerides, obesity, and high homocysteine levels. ADMA blocks the action of the amino acid, l-arginine. This mimicry reduces the availability of nitric oxide, a powerful dilator and protector of arteries. ADMA levels in the top 10% predict a six-fold heightened risk for future stroke, and ADMA levels in people with strokes are double that in other people. A carotid ultrasound study in 116 subjects showed that higher blood levels of ADMA are associated with more severe carotid plaque. Because of ADMA’s shared role across a variety of abnormal conditions, correction or blocking the action of ADMA has been suggested as a unique therapeutic tool to reduce stroke risk. Cholesterol Data suggest that lowering cholesterol with statin cholesterol-lowering drugs slows carotid plaque growth and reduce stroke risk approximately 22%. An interesting study from the Cardiovascular Institute at Mt. Sinai School of Medicine in New York using the precise measuring ability of MRI of the carotids and thoracic aorta showed an impressive 20% regression of plaque area with simvastatin (Zocor®) taken for two years. Although guidelines for cholesterol treatment recommend reduction of LDL cholesterol to 100 mg/dl in high-risk persons, a report from the Walter Reed Army Medical Center in Washington, DC, showed that carotid plaque was more effectively reduced when LDL cholesterol of 70 mg/dl or lower was achieved with statin cholesterol drugs. Lower LDL cholesterol may, therefore, be better. Treatment Strategies to Reduce Carotid and Aortic Plaque The essential question: How do we reduce carotid and aortic plaque? If we make this the focus of our efforts, many pieces begin to fall into place. If you’ve had any measure of carotid or aortic plaque such as a carotid ultrasound or aortic calcification on a CT heart scan, you know that you’re at increased risk for stroke. You also have a baseline for future comparison to gauge whether your program is working or not. Because most people have not one but several causes of carotid and aortic plaque, there is no one single treatment that effectively eliminates risk for stroke. Instead, most people require a comprehensive program of healthy diet, exercise, supplements, and medication when indicated. Here, we focus on the nutritional supplements that can be critical components of your plaque-reduction program. Fish oil Fish oil is a cornerstone of your stroke prevention program. Epidemiological observations suggest a strong relationship of fish intake and reduction of stroke risk. Carotid ultrasound studies demonstrate less carotid plaque with greater intakes of fish. A cleverly designed University of Southampton study made the fascinating observation that fish oil transforms the structure of carotid plaque. 150 people with severe carotid plaque scheduled for carotid endarterectomy (surgical removal of the plaque) were given fish oil, sunflower oil, or no treatment over several months while waiting for their procedure. (Delays in the British health system permitted this unique design.) Plaque was removed at surgery and examined. Participants taking fish oil had reduced inflammation in plaque and thicker tissue covering the fatty core, markers of more stable plaque. Those taking sunflower oil or no treatment had unstable plaques with greater inflammation and thinner, less sturdy covering tissue. This suggests that fish oil stabilizes carotid plaque, making it less likely to rupture and fragment. A standard capsule of fish oil (containing 300 mg of EPA + DHA) contains the same amount of omega-3s as a 3 oz serving of cod or halibut; three capsules (900 mg DHA + EPA) contain the equivalent of a serving of farm-raised salmon. The dose that seems to provide greatest protection from stroke, lowers triglycerides (that form abnormal lipoproteins; see above), and reduces fibrinogen, is four capsules per day (1200 mg EPA + DHA). Coenzyme Q10 (CoQ10) Although there are no data specifically addressing whether CoQ10 reduces plaque, it is a marvelously effective way to reduce blood pressure, one of the crucial factors causing carotid and aortic plaque growth. A pooled analysis of eight studies showed that, on average, CoQ10 in daily doses of 50–200 mg reduced systolic blood pressure by 16 mm Hg, diastolic pressure by 10 mm Hg. Data suggest that CoQ10 can reverse abnormal heart muscle thickening (hypertrophy), another manifestation of high blood pressure, strongly suggesting that CoQ10 has benefits beyond just reducing pressure. Supplements to correct the metabolic syndrome Weight loss is, without question, the most immediate and direct path to correction of this dangerous pre-diabetic condition. A drop of even 10–20 lbs yields improvements across the board: increased sensitivity to insulin, increased HDL, and reductions in triglycerides, CRP, fibrinogen, small LDL particles, and blood pressure. Diet and exercise are fundamental components of an effort to lose weight; low carbohydrate or reduced glycemic index diets (e.g., South Beach or Mediterranean) rich in fibers are clearly effective. Several supplements can amplify weight-reduction efforts and be useful adjuncts to your lifestyle program. Among them: White bean extract White bean extract blocks intestinal absorption of carbohydrates by 66%. 1500 mg twice a day with meals yields, on average, 3–7 lbs of weight loss in the first month of use. The only side-effect is excessive gas, due to unabsorbed starches. Glucomannan This unique fiber taken prior to meals absorbs many times its weight in water and thereby fills your stomach. You consequently take in less food. Most people lose around four lbs per month using 1500 mg prior to each meal. Interestingly, glucomannan also blunts the rise in blood sugar after meals, an effect that, by itself, may lead to weight loss. Be sure to take with plenty of water. DHEA This adrenal hormone is key to maintaining physical stamina, mood, muscle mass in men, and libido in women. A recent randomized, placebo-controlled study at Washington University in 56 subjects showed a 13% decline in abdominal fat (fat that drives resistance to insulin) measured by MRI with 50 mg of DHEA per day at bedtime, along with improved sugar control and lower insulin levels. Pectin, beta-glucan Pectin is the soluble fiber in citrus rinds, green vegetables, and apples, also available as a supplement. Beta-glucan is the soluble fiber of oats and is also available as a supplement. Both are wonderful fibers that provide feelings of fullness, lower cholesterol, slow release of sugars, and can yield modest weight reduction. A USC study in 573 subjects using carotid ultrasound showed that greater intake of healthy fibers like pectin and beta-glucan is associated with less carotid plaque growth. Folic acid, vitamins B6 and B12 Dr. Daniel Hackam at the Stroke Prevention and Atherosclerosis Research Centre in Ontario conducted a study using carotid ultrasound in 101 participants treated with folic acid 2.5 mg, vitamin B6 25 mg, and B12 250 mcg per day. Treatment resulted in plaque reduction, especially when homocysteine levels exceeded 14μmol/l at the start, compared to untreated participants who experienced substantial plaque growth. An attempt to clarify the role of homocysteine treatment was made through a National Institute of Health-sponsored study of stroke prevention. 3680 participants with a prior history of stroke were enrolled and given either a “low-dose” (20 mcg folic acid, 0.2 mg B6, 6 mcg B12) or a “high-dose” (2.5 mg folic acid, 25 mg B6, 400 mcg B12) regimen. Although starting homocysteine levels showed a graded association with stroke risk (higher homocysteine levels predicted greater stroke risk), the treatment groups experienced, on average, only a 2 μmol drop in homocysteine levels and no reduction in stroke risk over two years. The study investigators as well as critics have suggested that the study failed due to an insufficient treatment period and that the doses were too low. (The doses we use in our plaque reduction program are folic acid 2.5–5.0 mg, B6 50–100 mg, B12 1000–2500 mcg.) L-arginine L-arginine can be used to overpower the adverse effects of ADMA. L-arginine is emerging as an important carotid plaque-reversing tool. Early reports in animals showed that l-arginine completely halted growth of aortic plaque, and did so more effectively than lovastatin (a cholesterol-lowering drug). In humans, L-arginine reduces blood pressure, abnormal constriction of carotid and coronary arteries, blocks entry of inflammatory cells into plaque, increases sensitivity to insulin, and heightens exercise capacity. Following coronary angioplasty or stent placement, l-arginine results in up to 36% reduction in plaque growth. The average American takes in 5400 mg of l-arginine through food every day. Supplementing with doses of 3000–12,000 mg per day has proven useful to correct many of these phenomena. (We use a dose of 6000 mg of l-arginine powder, twice a day on an empty stomach, dissolved in water, for our plaque regression program.) Does this result in a reduction of stroke risk? The emerging data suggest that l-arginine is likely to exert a powerful plaque-reducing and stroke-preventing benefit, but we await more clinical trial data. Conclusion Reducing stroke risk by reversing carotid and aortic plaque is becoming an everyday reality, with better tools becoming available. To know whether you’re at risk, the best and most available imaging tool is carotid ultrasound, aiming to identify intimal-medial thickness >1.0 mm, or carotid plaque. Any degree of calcification of the aorta, such as on a CT heart scan, is another useful measure of risk. Treatment to reduce risk is multi-faceted but is based on examining all your sources of risk, including metabolic syndrome, small LDL, lipoprotein(a), and C-reactive protein. Fish oil is the one absolutely crucial ingredient in any stroke prevention program. Other supplements can be used in a targeted fashion, depending on the causes identified for your carotid or aortic plaque. Ideally, repeat scanning of your carotids should be done sometime after your program has begun to assess whether you’ve successfully achieved reversal of plaque growth.