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Standardized Ginkgo biloba extract contains polyphenols, flavonoids, terpene lactones, and other compounds that offer potential benefits for cognitive and physical performance. In a 2017 study published in Nutrients, researchers evaluated the effects of Ginkgo biloba supplementation on aerobic performance, blood antioxidant capacity, and expression of brain-derived neurotrophic factor (BDNF) in physically active, college-aged men.

Magnesium is an essential cofactor for hundreds of biochemical pathways, including production of hormones and neurotransmitters involved in mood regulation. Magnesium deficiency has been associated with depression, but clinical trials on magnesium as an intervention for active depression are limited. The first clinical trial on magnesium for depression in the United States was conducted by researchers Tarleton et al and published in 2017.

Atrial fibrillation is characterized by an irregular and rapid heart rate, dramatically increasing the risk of blood clot formation and stroke. Evidence suggests that the pathophysiology of atrial fibrillation begins with an inflammatory cascade, leading to production of reactive oxygen species and proliferation of fibroblasts. This cascade leads to electrical and structural remodeling of the atrium and symptoms of atrial fibrillation. It is thought that the antioxidant properties of flavonoids in chocolate might interfere with this pathophysiologic cascade and reduce the risk of atrial fibrillation. 

Coffee contains a variety of compounds, including caffeine, polyphenols, and minerals, that might contribute to cognitive health. Previous meta-analyses, based on small numbers of heterogeneous studies, have reported coffee consumption to reduce the risk of cognitive disorders. Researchers Wu at al attempted to strengthen the evidence related to coffee consumption and cognitive decline with a meta-analysis specific to prospective cohort studies and including a dose-response analysis.

Patients undergoing cardiac surgery are at an increased risk of systemic inflammation resulting from ischemia-reperfusion and oxidative stress. When surgery is performed with cardiopulmonary bypass—a technique that temporarily functions for the heart and lungs during the procedure—inflammation is further promoted by blood contact with non-endothelial surfaces. Complications of cardiac surgery are related to the inflammatory cascade and can include atrial fibrillation or stroke. Omega-3 fatty acids have shown promise for decreasing the incidence of perioperative atrial fibrillation and may reduce the risk of other complications because of their anti-inflammatory effects.

Yogurt is a rich source of calcium, magnesium, B vitamins, protein, branched-chain amino acids, bioactive peptides, and probiotics—all of which might contribute to musculoskeletal health. Results of the 12- year Framingham Offspring Study showed that yogurt intake was associated with higher bone mineral density (BMD) at the hip and had a weak protective effect against hip fracture. In a 2016 study, published by Laird et al, researchers further investigated the associations between yogurt intake and BMD, bone biomarkers, and physical function.

Fish oil is a rich source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), fatty acids that incorporate into platelet cell membranes after ingestion. As EPA replaces arachidonic acid in platelet cell membranes, plasma thromboxane B2 decreases, inhibiting platelet aggregation. A randomized controlled trial, published in 2007 in the Lancet, reported that EPA supplementation significantly increased adverse bleeding events in hypercholesterolemic patients. Because of the potential for fish oil to increase bleeding risk, it has been suggested that patients should discontinue fish oil supplementation before surgery or other invasive procedures. In a systematic review published in 2017, Begtrup et al investigated the effects of fish oil supplementation on hemostasis in healthy subjects and in those undergoing surgery.

Nonalcoholic fatty liver disease (NAFLD) includes a range of liver conditions that begin with simple hepatic steatosis and can progress to nonalcoholic steatohepatitis (NASH), liver cirrhosis, and potentially hepatocellular carcinoma. The pathogenesis of NAFLD begins with lipid deposition and progresses to involve oxidative stress, inflammation, and fibrosis. NAFLD is increasingly common, with a prevalence of 50% to 90% in obese individuals and a prevalence that exceeds 70% in patients with type 2 diabetes.

Arterial stiffness increases with age, is significantly increased in postmenopausal compared with premenopausal women, and is associated with an increased risk of cardiovascular events and mortality. Flavanol-enriched cocoa has been shown to improve vascular endothelial function, induce vasodilation, and reduce blood pressure in numerous studies. Cocoa has also been shown to reduce arterial stiffness in healthy young, middle-aged, and older adults. To assess whether the frequency of cocoa intake influences its effect on arterial stiffness, researchers Okamoto et al conducted a randomized, parallel-group study in postmenopausal women.

Magnesium acts as a cofactor for hundreds of enzymes in critical biochemical pathways, including those related to bone health. Magnesium stabilizes formation of hydroxyapatite crystals, contributing to higher bone mass. Because magnesium is required as an enzymatic cofactor for the function of parathyroid hormone (PTH), magnesium deficiency impedes release of PTH and contributes to PTH resistance at target organs. Decreased activity of PTH contributes to vitamin D deficiency, which in turn impairs calcium metabolism leading to weaker bones. Magnesium deficiency also decreases osteoblast growth, promotes oxidative stress, and perpetuates inflammation – all of which contribute to decreased bone integrity.

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