CHAPTER VI
Healthy Eating
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ealthy eating is not only important, it’s easy to understand. The main point is that it is not a diet, it’s a lifestyle. The concept of a “diet” is erroneous because you follow its recommendations until you achieve an objective, namely weight reduction associated with a certain number of pounds. And when you arrive at that lower weight, you revert back to your old ways. The other problem is that most so-called diets have flaws that usually show up years later. Therefore, the biggest advantage of a diet book is making a lot of money for the author of the book and any products being promoted. As I mentioned previously, it is an erroneous concept. A healthy concept is to find out what is healthy and eat more of it. And to identify what is unhealthy, even if it is delicious, and avoid it or eat less of it.
VEGETABLES AND FRUITS These should make up the most important element of eating healthy and is also the best protection against cancer. These foods should be the main source of antioxidants, phytonutrients, vitamins, minerals, and should be the main source of fiber as well.
BASIC FOOD FACTS The basic categories are carbohydrates, fats, and proteins. • Carbohydrates are made up of simple and complex sugars; • Fats are made up primarily of fatty acids and triglycerides (triacylglycerol);
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• Proteins are made up of amino acids and in combinations such as lipoproteins (fat plus protein), glycoproteins (carbohydrate plus protein). The body has the ability to convert protein to sugar (gluconeogenesis), fat to sugar, sugar to fat, sugar to amino acid. These conversions require enzymes, cofactors. Some of the biochemical reactions will be discussed later.
CLASSIFICATION OF CARBOHYDRATES • Monosaccharides (simple sugars) — Glucose—the most basic simple sugar also called dextrose, containing 6 carbon atoms called a hexose. — Fructose — Galactose — Xylolose—a wood sugar is an aldopentose (5 carbon atoms). • Disaccharides (simple sugars) —Sucrose—made up of D-Glucose + D-Fructose. It is the sugar in fruits, vegetables and honey. —Lactose—made up of D-Glucose +D-Galactose. It is the sugar in milk and dairy products. —Maltose (malt sugar)—made up of two glucose units. In human digestion the enzyme amylase breaks down starches to maltose and finally to 2 glucose. • In Alcohol Production
• Oligosaccharides (complex carbohydrates made up of 3-12 monosaccharides) • Polysaccharides (complex carbohydrates made up of ten to thousands of monosaccharides)
Healthy Eating
Fiber is made up of plant polysaccharide plus a polymer called lignan.
METABOLISM OF CARBOHYDRATES All carbohydrates, in the intestine, whether simple or complex, are broken down or converted to glucose. It is absorbed into the enterohepatic circulation (from intestine to blood in the portal vein to the liver). In the liver cells (hepatocytes), some is used for producing cell energy. This involves production of ATP (AdenosineTriphosphate). The remainder is stored as glycogen (about 200-400gms) and fat (Triacylglycerol). The fat is combined with protein to make lipoproteins named very low density lipoprotein (VLDL). Insulin facilitates transport of glucose to the various tissues but the biggest effect is transport to muscle and fat (adipose tissue). Glucose Transport to Nervous Tissue (Brain and Peripheral Nerves) The brain is very dependent on glucose for its energy source— brain tissue is metabolically very active. That is why if the level of blood sugar falls too low (say below 50 mgm/dl) the person becomes dizzy and a further fall in the level may cause seizures. Additionally, if the brain is deprived of oxygen and glucose for as little as four to five minutes (as in cardiac arrest), there may be irreversible brain damage even if the person is successfully revived. Utilization of Glucose in the Brain This involves oxidation of glucose through glycolysis and the Tricarboxylic Acid Cycle so that the final result is production of energy (generating ATP) and carbon dioxide plus water—more on the biochemical details later within the chapter.
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Glucose is also a major source of energy for neurotransmitters (serotonin, dopamine, adrenalin, and noradrenalin), which conduct messages within the nervous system. These messages are in the form of electric impulses involving electrons. Glucose and Red Blood Cells All of the energy for red blood cells comes from glucose (by glycolysis)—they contain protein (hemoglobin) that carries oxygen which is picked up in the lungs. Thus, the oxygen carrying capacity of the entire system is determined by the amount of hemoglobin (i.e. the red blood cells). When the number of red blood cells or the level of hemoglobin is low (anemia), the person experiences low energy with very little reserve. Muscle Muscle Contraction (exercise) utilizes as source of energy: • Glucose in the blood, • The stored glycogen in the muscle, • Fatty acids from the blood. Adipose Tissue Insulin stimulates transport of glucose into muscle and adipose tissue. Some is used as a source of energy for the fat cells but the rest makes the source of the glycerol portion of the form stored in fat cells (Triacylglycerol). Tricarboxylic Acid Cycle (TCA) TCA cycle is also known as Kreb’s Cycle or Citric Acid Cycle. It accounts for more than two-thirds of the ATP (Aderosine Triphosphate) produced from fuel oxidation. This cycle shows how carbohydrates, fats, and proteins interconnect, through their ability to form Acetyl Coenzyme A.
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TCA Cycle
For several steps in this cycle, it is necessary to have minerals such as iron, magnesium, manganese, lipoic acid and several of the B vitamins. The NADH and FAD plus CoQ10 and involvement of the Cytochrome Enzyme System results in the production of energy (i.e. ATP).
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The Pentose Phosphate Pathway*
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P=Phosphate
* When I was a first year medical student taking a Biochemistry course in 1959, this pathway was called the Pentose Shunt.
Healthy Eating Glycemic Index and Glycemic Load Of the various carbohydrate classifications, some foods are basically simple sugars (table sugar, sugar in most fruits and vegetables, potatoes, sweets, white bread, pastries, etc‌) and some are complex carbohydrates (whole grain, dark pasta, dark breads, etc‌). From a physiologic and pathologic standpoint, the key aspect is effect on level of blood sugar. Simple sugars raise the blood sugar rapidly. Complex carbs raise it slowly. If the blood sugar is raised quickly then there is stimulation to the pancreas (islet cells or beta cells) to discharge a lot of insulin to the bloodstream to facilitate metabolism of the sugar and help lower the blood sugar level back to normal. Complex carbs do the same but much slower. It is the rapid rise of blood sugar level that leads to metabolic sequences that ultimately favor insulin resistance (and Diabetes Type II) as well as much more storage of fat (gaining weight). So in general, foods that raise the blood sugar rapidly are said to have a high glycemic index, and complex carbs that raise the level slowly are said to have a low glycemic index. This has to be quantified. Thus, glucose (simple sugar) is given a glycemic value of one hundred (100) and all foods are given values in relation to this baseline. Glycemic Load Takes into account the Glycemic Index coupled with the amount of that carb in a serving. There are many websites covering this subject but the most extensive is Mendosa.com by David Mendosa.
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FOUNTAIN of HEALTH METABOLISM OF FAT (LIPIDS) 80
Fat is equally important to healthy eating as carbohydrates or protein. However, the issue is the kind of fat and how much. Saturated Fats This type is characterized by the lack of double bonds—all the carbon atoms being saturated with hydrogen atoms, therefore named Saturated Fatty Acids. They are also solid at room temperature. Examples include dairy products, red meat and pork. Consumption of large amounts is associated with elevation of blood cholesterol and LDL and additionally associated with disease conditions (cardiovascular disease, inflammation, obesity, and even caner). Being overweight is a predisposition to the metabolic syndrome including diabetes type II. Trans-fats, Trans-fatty Acids (TFA) Saturated fats have no double bonds; mono unsaturated and poly unsaturated fats have double bonds. Trans-fats (TFA) have at least one double bond but structurally act similar to saturated fatty acid as they increase blood level of cholesterol, LDL, and lower level of HDL. The food industry hydrogenates (liquid) oil into (solid) margarine to give it longer shelf life. Unfortunately, the hydrogenation process converts the oil to an unhealthy product—turning an unsaturated fatty acid to one that is similar to a saturated fatty acid in its effect of raising blood level of cholesterol, LDL, and lowering HDL.
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The Triglycerides (Triacylglycerols or TAGs) in Sunflower Oil2 Contain CIS-Oleic Acid
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Foods that Contain Saturated Fatty Acids • Butter • Coconut oil • Soybean oil • Dark chocolate • Eggs • Red meat • Nuts NOTE: The above all contain different percentages of all the saturated fatty acids (lauric, myristic, palmitic, and stearic acids). However, dark chocolate, eggs and soybean oil do not have lauric or myristic acids.
THE UNSATURATED FATTY ACIDS Essential Fatty Acids 1. Omega 3 (ω3) is polyunsaturated – Alpha linolenic acid (ALA) flaxseed, walnuts – Eicosapentaenoic acid (EPA) higher concentration in cold water – Docasahexaenoic acid (DHA) fish (salmon, tuna, mackerel, cod) 2. Omega 6 (ω6) is polyunsaturated – Linoleic (L.A.) – Gamma linolenic acid ( linolenic) – Arachidonic acid (eicosatetraenoic acid)(AA) is source of the eicosanoids II. Nonessential Fatty Acids – Oleic Acid (ω9) is avocado, olive oil monounsaturated and canola oil I.
Healthy Eating De-saturation of Fatty Acids This occurs in the Endoplasmic Reticulum (ER) of the cytoplasm of cells. It is a process of oxidation and requires oxygen. It results in production of a double bond. Thus Oxidation Palmitic Acid Palmitoleic Acid
Oxidation Stearic
Oleic Acid
ω3 and ω6 Fatty acids cannot be produced by humans, and are referred to as essential fatty acids (EFAs) and are derived from food. Phytoplankton, that fish eat, is the source of their ω3 and ω6 acids. Plant oils contain linoleic acid (LA) and is an in the body ω6 Arachidonic Acid (AA) Source of Eicosanoids Alphalinolenic Acid (αALA) is an ω3 acid EPA (Eicosapentaenoic)
Fish oil has ω3 (Omega 3). DHA (Docosahexaenoic) and EPA (Eicosapentaenoic Acid) and some ω6 (Omega 6).
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FOUNTAIN of HEALTH Best Sources of Omega-3 Fatty Acids in Seafood3
Fish 84
Rainbow trout Cisco Pacific Mackerel Atlantic Herring Pacific Herring Sardine American Eel Atlantic Halibut Sablefish Atlantic Salmon Lake Trout Anchovy Coho Salmon Pink Salmon Blue fin Tuna Atlantic Mackerel King Salmon Dogfish Albacore Tuna Sockeye Salmon
Amount in grams per 100g of raw filet 1.1 grams (gm) 1.1 1.1 1.1 1.2 1.2 1.2 1.3 1.3 1.4 1.4 1.4 1.5 1.5 1.5 1.9 1.9 1.9 2.1 2.7
Healthy Eating The Eicosanoids Arachidonic (AA) Eicosatetraenoic Acid Is an ω6 acid. Provides the largest source of eicosanoids.
Eicosanoids participate in many processes especially the inflammatory response, which includes clotting. They also regulate smoothe muscle contraction. They are involved in regulating blood pressure (BP). They are also involved in constriction and dilation of the airway (Brochi). Isoprostanes are also eicosanoids. They are derived from reactions involving free radicals.
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Unsaturated Fatty Acids & Inflammation 86
É
Extra virgin olive oil is monounsaturated ω9 contains Oleic Acid plus antioxidants (VE and phenols) similar effects to ω3 on lipids – HDL – Blocks oxidation of LDL The ratio of ω6 : ω3 2:1 4:1
Healthy Eating if higher than 4 : 1 then will have more pro-inflammatory effects. The Standard American Diet (SAD) is high in ω6. Both ω3 and ω6 are Polyunsaturated Essential Fatty Acids (PUFA) that compete for the enzyme Delta 6 Desaturase (D-6-D). Essential fatty acids form part of the cell membrane. When there is too much ω6, it favors forming plaques in arteries and increase in blood pressure. With age, there is reduction in the enzyme D-6-D resulting in reduction of GLA and DHA, which results in decline in ratio of ω3 to ω6. There is decline in the series 1 prostaglandins and a decline in the series 3 prostaglandins. It is series 1 and 3 that are potent anti-inflammatory—reduction of series 1 and 3 correlates with increase in the risk for cardiovascular disease and diabetes. PE1 relaxes arteries, which increases blood flow and lowers blood pressure It decreases inflammation GLA Increases PE1 and PE3 PE2 Promotes sodium retention leading to water retention. And diets high in saturated fats (and arachidonic acid) results in increase of the inflammatory PE2 DHA has more of the beneficial effects on the cardiovascular system and blood pressure than EPA. Supplementation with GLA and DHA results in increased activity of… …omega 3 Fatty Acids (ω3) which inhibit or limit production of series 2 prostaglandins by preventing release of arachidonic acid from cell membrane, inhibiting further metabolism of arachidonic acid into inflammatory prostaglandins.
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Nettle Leaf Has several active compounds that inhibit cyclooxygenase (COX-1 + 2), and lipoxygenase and lower Tumor Necrosis Factor alpha (TNFα)and inhibit nuclear factor—Kappa Beta (NF-KB), which is a genetic transcription factor. NF-KB is elevated in chronic inflammatory conditions and it activates the TNFα. The cyclooxygenase enzyme system has two isomer forms called COX-1 and COX-2. COX-1 is present in many tissues and is involved in production of prostaglandins and thromboxanes for many normal physiologic functions. COX-2 form is affected by cytokines and growth factors. Prostaglandins are important in mediating the inflammatory response. Drugs that block prostaglandin production will relieve the pain of inflammation—Nonsteroidal Anti inflammatory Drugs (NSAIDs) are such drugs. NSAIDs can block the activity of COX-1 and COX-2 forms of the cyclooxygenase enzyme system. NSAIDs 1. Acetylsalicylic Acid (ASA or Aspirin) 2. Acetaminophen (main ingredient in Tylenol™)* 3. Ibuprofen (main ingredient in Advil™, Motrin™, Nuprin™) Side effects of these drugs target the gastrointestinal tract as with gastritis, which in rare cases can be hemorrhagic. They also affect platelet function resulting in blood thinning. They can cause minor irritation of the liver resulting in modest rise in liver enzymes. Development of selective COX-2 inhibitors such as Celebrex™ or Vioxx™ was an attempt to void gastrointestinal and platelet side effects. These drugs are powerful * Recently, the FDA announced that too much acetaminophen can cause serious liver injury.
Healthy Eating pain relievers but unfortunately can cause severe liver damage and cardiovascular side effects, which can be serious, such as heart attack.
INFLAMMATION AND ESSENTIAL FATTY ACIDS All pathologic agents that ultimately cause human disease have one thing in common—inflammation. In some cases, the main etiologic factor is inflammation such as occurs in degenerative diseases such as arthritis, atherosclerosis (which can lead to high blood pressure or heart attacks and strokes), auto-immune disease, infections, etc. Some cases have other underlying factors but inflammation is one of the prominent factors present in cancers, some genetic diseases, etc. Some conditions are pro inflammatory such as obesity, diabetes mellitus (Type I or II), dyslipidemias (cholesterol disorders), etc. A very important group of agents causing disease primarily through inflammation is chemicals. This group includes heavy metals, other toxic chemicals including those in cigarettes, alcohol, and other addicting drugs. It also includes many of the therapeutic medications (pain relievers, cholesterol medications, anti-cancer chemotherapy, etc.). Another example is the effect of a trauma such as car accident or a fall. Additionally, the recovery from the injury is partly inflammatory. From the previous analysis of the central role of inflammation in all disease conditions, it should be obvious that a potent antiinflammatory substance (namely Omega 3) gives protection against diseases of all organ systems, from the brain and skin, to the cardiovascular and musculoskeletal system, etc. According to Dr. Daniel G. Amen, M.D. in his latest book, Change Your Brain, Change Your life 4 he points out that part of the brain is ω3 so the brain likes it too. Furthermore, ω3 is anticancer, facilitates fat loss, and has some blood thinning effects.
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Healthy Eating At the beginning of this chapter, the point was made that healthy eating is not a diet. We stressed the fact that the most important items are vegetables and fruits*. In this section, I’ll help you understand the benefits of whole grains, seeds, and nuts. The importance of these foods is in the fact that they are the source of phytochemicals (phytonutrients), fiber, complex carbohydrates, antioxidants, vitamins, minerals, etc., and it is these chemicals that keep us healthy, fight disease, and prevent cancer.
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Greens (Vegetables) and Fruits Contain Several Phytochemicals5 Bioflavonoids in fruits and vegetables Chlorophyll in vegetables Glucosinolates in cruciferous vegetables Indoles in cruciferous vegetables (I-3-C, Indole-3-Carbinol) and (DIM, Diindolyl-methane) Isothiocyanates in vegetables Phenolic Acids in vegetables and whole grains Sulphoraphane in cruciferous vegetables Catechins in berries and in tea Ellagic Acid in berries, grapes, apples Limonoids in citrus fruits Terpenes in citrus fruits Lycopene in tomatoes, red grapefruit, watermelon and red bell peppers
• Garlic and onions contain allylic sulfides and organosulfur compounds. These phytochemicals have to do with enhancing the immune system and with detoxification. * The latest recommendations from the Government (U.S.D.A.) that came out in June of 2010 is for people to eat more vegetables and fruits.
Healthy Eating • Flaxseed and walnuts have lignans. • Soy has isoflavones. Lignans and isoflavones have to do with hormone balancing. • Fructooligosaccharides are in garlic, artichoke, bananas and chicory root. They have to do with increase of beneficial bacteria and detoxification.
ANTIOXIDANTS, FREE RADICALS, AND OXIDATIVE STRESS Antioxidants come from food or supplements. In the tissues, metabolism requires use of oxygen for cell energy. This oxidation creates unstable molecules as they are short one electron— the free radical is seeking another molecule to gain an electron. Oxidation of LDL-cholesterol results in a product (oxidized LDL-cholesterol) that irritates the lining of arteries producing inflammation that can ultimately result in plaque formation (i.e. atherosclerosis). Antioxidants discourage oxidation of LDL-cholesterol. In addition to the endogenous production of free radicals from biochemical processes in the cell including energy production, there are also a lot of elements in the environment such as radiation from the sun and from x-rays, heavy metals and other toxins. Inflammation, and all disease conditions, creates an abundance of free radicals. Antioxidants come from several sources—vitamins rich in antioxidants are vitamin A, C, and E and carotinoids (carotenes) including lycopene and lutein. Some are minerals such as selenium, CoQ10, and glutathione. Also, alpha lipoic acid, tocotrienols, grape seed extract and N-acetylCysteine, ginko biloba, turmeric, green tea and milk thistle are herbs that contain phytonutrients that are also antioxidants. Endogenous antioxidants (also called free radicals scavengers) have enzymes that accomplish the neutralization of free radicals. The main enzymes are SuperOxideDismutase (SOD), catalase,
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and glutathione peroxidase. Minerals are needed for the efficient function of the enzymes. These include copper, zinc, manganese, and selenium. Non-enzymatic Antioxidants The antioxidant neutralizes free radicals by giving a hydrogen atom with its one electron to the radical. Thus, the antioxidant reduces the free radical and the antioxidant is oxidized. Free Radical Reduced Free Radical
Antioxidant
Oxidized Antioxidant
Dietary Antioxidants These antioxidants include vitamin C, E, and carotinoids. Carotinoids include β carotein (vitamin A precursor), zeaxanthin, and lutein; flavonoids, in red wine, green tea, and chocolate exert some antioxidant effect; quercetin, a flavonoid, also has an antioxidant effect and is found mainly in the skins of fruits and some vegetables such as onions. Endogenous Antioxidants Uric acid is a major antioxidant in blood. Melatonin, a hormone from the pineal gland that has to do with regulation of circadian rhythm and sleep, has a free radical neutralizing effect.
PROTEINS AND PROTEIN METABOLISM The basic unit that proteins are made of is amino acid. Some amino acids the body can make such as glycine or arginine* and are called non-essential. Others have to come from food, as the body is unable to produce them, such as tryptophan or methio* Arginine is essential for growth but for adults it is not essential. In other words, the body can make it.
Healthy Eating Proteins
Amino Acid Pool in the Serum (Blood or in the Circulation) Synthesis of Proteins
Proteins in food
(is the major use)
Digestion Absorption
Amino Acid Pool Endogenous (degradation)
In the Serum (Blood or in the Circulation)
As fuel for energy production (Gluconeogenesis) amino acid becoming glucose
ATP (energy)
Nitrogen Group To urine or urea or ammonium
Urine
Other Nitrogen Products: • Purines • Pyrimidenes • Hormones • Neurotransmitters • Others
Degradation
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nine, these are called essential amino acids. The essential amino acids are: leucine, isoleucine, lysine, valine, threonine, phenylalanine, methionine, tryptophan, and histidine. Dietary proteins are broken down by the process of digestion into their basic units, which are the amino acids. Amino acids are then used to make or synthesize proteins for several functions, synthesis of other nitrogen compounds, or used for energy (oxidation). Proteins in the cells are made from amino acids. Hormones and neurotransmitters need amino acids for their synthesis. Likewise, the biggest source of fuel for the muscle activity is creatine phosphate, which is made from arginine and glycine. Glycine is also needed for production of hemoglobin, which is the protein that carries oxygen in the red blood cells. A system of enzymes called cytochrome, which is very important for detoxification, needs amino acids for their synthesis. Skin pigment, melanin, is synthesized from tyrosine. The purine and pyrimidine bases of nucleotides are made from amino acids. Nucleotides make Deoxyribonucleic Acid (DNA) and Ribonucleic Acid (RNA). Classification of Amino Acids
Essential Amino Acids (from food) Histidine Isoleucine Leucine Methionine Phenylalanine Threonine Tryptophan Valene
Non-Essential (produced in the body from Nitrogen source + glucose) Alanine Aspartic Acid Glutamic Acid Proline Arginine Glutamine Glycine Taurine
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Degradation of Nitrogen Group (of Amino Acids) 95
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Examples of Some Amino Acid Products 96
Role of Hormones
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Arginine is precursor of nitric oxide (NO) is for protein synthesis produces creatine in muscle – creatine phosphate is the main fuel storage in skeletal muscle critical role in urea cycle (clears toxic ammonia)
Nitric oxide has to do with cell signaling. Nitric oxide relaxes vessels leading to more blood flow (increase in circulation). Clinically, arginine improves coronary blood flow in patients with coronary heart disease and improves erections in men and possibly increases sperm count. Food sources of arginine include whole grains, nuts, and legumes.
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Methionine Clinically, there is association between elevation of homocysteine and coronary heart disease risk. To lower level of homocysteine, you take high dose of vitamin B6 and B12, and folate. One preparation as a pill is called Folcaps™ and contains… • Pyridoxine (VB6) 25 mgm • Cyanocobalamin (VB12) 0.5 mgm • Tetrahydrofolate (FH4) 2.2 mgm (A generic form of Folcaps is called Folplex 2.2) • Glutathione is an antioxidant and protects against oxidative stress
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• • • •
Tryptophan Essential Amino Acid—Must Come from Food Tryptophan… is source of some protein synthesis; is precursor to serotonin and niacin; serotonin is associated with mood, sleep, appetite, sex, and intestinal motility; fibromyalgia patients have low blood tryptophan.
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