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A nagging cough. Wheezing, chest tightness, fatigue. Spring allergies or a lingering touch of bronchitis from months ago may cause these symptoms, but it can be related with something more problematic. When the cough doesn’t subside, it is time to rethink what is going on. The chronic cough that makes it hard to breathe may be due to COPD or Chronic Obstructive Pulmonary Disease. COPD includes chronic bronchitis or emphysema. It is increasingly common, affecting millions of Americans. Millions more have the problem and are not diagnosed. COPD is the third leading cause of death worldwide.
[Jump to: Nutritional Options]
Symptoms of COPD
COPD symptoms are frequently attributed to or dismissed as aging, causing it to be diagnosed in later stages of the disorder. Early detection is fundamental to management and staving off the debilitating decline and accelerated aging. The chronic cough, shortness of breath with everyday activities, repeated respiratory infections, fatigue, wheezing, and increased mucus are all symptoms related to COPD.
Other symptoms can occur unrelated to the respiratory system. Most commonly seen is weakness and loss of muscle mass in the quadriceps, the thigh muscle. Loss of the strength in the thigh muscle actually reflects a worse prognosis with COPD. Loss of strength in the quadriceps can make it harder to get up from a seated position, go upstairs, or get out of the car. This loss of muscle mass in the legs is often dismissed as related to aging. This can true to a degree, but if there is a nagging cough that doesn’t go away with the loss of muscle strength, something else may be going on.
COPD symptoms occur because of diminished airflow in and out of the airways and air sacs of the lungs. This may happen because the airways and air sacs lose their elastic quality. The walls between the air sacs become thick and inflamed or are destroyed. The airways can also make more mucus than normal and clog the passageways. High levels of inflammation and oxidative stress within the lungs from various sources drive the decline and worsen respiratory function. Muscles waste away due to high levels of oxidative stress from pro-inflammatory chemicals like TNF-a, MMP9, and NF-kappa B.
What Causes COPD?
COPD has a number of causes. Chronic exposure to lung irritants that damage the lungs and airways leads to the development of COPD. Cigarette smoking is at the top of the list. Pipe, cigar, and other tobacco smoke can also cause COPD. Secondhand smoke, air pollution, chemical fumes, diesel fumes, weather patterns, wood smoke, and rare genetic conditions can cause COPD. Occupational exposures from inorganic dust, wood dust, vapors, fumes, gases and other irritants increase the risk especially in those who have never smoked. Inhalation of these pollutants provokes oxidative stress and injury to the lung tissue.
COPD and Mitochondria
A deeper level of understanding with the COPD and oxidative stress relates to the impact on mitochondria. Just like in other areas of the body such as the heart, brain, and joints, mitochondrial injury leads to functional tissue changes within the lungs. Mitochondria are the energy producing factories inside cells that burn fuel to make energy or aerobic cellular respiration. There are trillions of them throughout the body.
Research shows that mitochondrial injury within the lungs drives the development of COPD. Irritants like smoking cause injury and smother the ability for the mitochondria to repair. High levels of reactive oxygen species are released. Cell membranes break down. This causes the cells and air sacs to become stiff, abnormally change, and thicken. As a result, air doesn’t move in and out of the lungs well. Lung damage worsens as the wear and tear to the mitochondria increases. Loss of the thigh muscle strength and mass is also related to mitochondrial damage. The end consequence is that aging accelerates. Researchers recommend the use of mitochondria-targeted antioxidants to help restore respiratory and muscle function to actually reverse COPD.
Tobacco, Roundup, and Triclosan
The concept that smoking causes lung problems is obviously not new. The use of tobacco has been around for about 2,000 years, but why is COPD rampant across the globe? Consider two factors, Roundup and triclosan that are now nearly ubiquitous in the environment and how they impact lung health. Tobacco is a genetically engineered Roundup ready crop. Roundup has been used now for decades on tobacco crops. The tobacco plant that you smoke and inhale directly or as second-hand smoke contains pesticides that are in the tobacco. So not only are you getting the toxic oxidative effects of smoke inhalation, you are inhaling pesticide residues.
Roundup contains the active ingredient glyphosate in a mixture of adjuvants. Glyphosate is considered “non-toxic under normal circumstances”. Research shows otherwise. One study clearly demonstrated that when glyphosate was mixed with a surfactant and subsequently exposed to mitochondria in animals, the mitochondria were heavily damaged. It actually caused mitochondrial death. Other researchers have found that Roundup was among the most toxic herbicide and insecticide chemical soup despite its relatively benign reputation. Is the increase in COPD worldwide related to the worldwide use of Roundup?
The other common chemical in use that injures mitochondria and should be questioned in COPD is the pesticide triclosan. Triclosan, which impairs thyroid function, is a synthetic, widely used antimicrobial agent found in hand soaps, detergents, skin care products, air fresheners, and oral hygiene products. For quite some time now, researchers have known that triclosan impairs mitochondrial function in animal cells. Think of all the products you come in contact with on a daily basis that have triclosan in them. Inhaling the scents and vapors from the product, like air fresheners that contain triclosan, can get into the lungs. Is the chronic low level exposure to triclosan from clothing, bathing, hand washing, touching your face, mouth, inhaling, swallowing it, and absorbing it, disrupting your mitochondria? On some imperceptible level, it probably is.
Lung Microbiome
The microbiome refers to microorganisms found in various body parts. When the National Institutes of Health human microbiome project began in 2007, it was thought that normal, healthy lung tissue was sterile. As a result, the respiratory tract was not included in the initial research. Since that time, technology has improved allowing for advanced investigation of the lung tissue. The lungs and respiratory tract do indeed have their own microbiome. In COPD, significant fluctuations and disruptions to the healthy flora of the lungs occur. Researchers found the worse the COPD was, the worse the lung flora or aero-digestive tract microbiomes.
Bacterial and viral overgrowths are a major cause of COPD flare-ups that contribute to the worsening airway inflammation. Gingivitis and poor oral health change the flora in the mouth and worsens the prognosis for COPD. In COPD and other chronic respiratory disorders, bacteria persist in the lungs despite multiple rounds of antibiotics. This occurs because the bacteria have biofilms that protect them. The biofilm keeps them hidden from the immune system, rendering the antibiotics ineffective and further disrupting the lung microbiome.
Cigarette smoke, air pollution, and occupational exposures change the lung microbiome. Triclosan found in air fresheners damages lung tissue. Just like in the gut, steroids and antibiotics change the lung flora. Common medical treatment for COPD is steroids and/or antibiotics but at what cost to the overall terrain and health of the mitochondria and lung flora?
Breaking down the biofilms and allowing penetration of natural antibiotics may help with the infection wars. NAC (N-Acetyl Cysteine) has been shown to help reduce biofilm formation. Oregano oil and caprylic acid have been shown to inhibit the formation of biofilms from bacteria and candida problems often found in lung ailments.
Quenching Inflammation and Protecting the Lungs
Patients with COPD show inadequate antioxidants to counterattack the oxidative stress. Protecting the lung tissue and lung flora from oxidative stress, quenching inflammation, and protecting the mitochondria are essential management for COPD and other inflammatory disorders of the lungs. Several nutritional compounds buffer oxidative stress and quench lung damaging inflammatory compounds.
Recent research on astaxanthin shows that it can quench the highly toxic free radicals that damage mitochondria within lung tissue helping to reduce scar tissue. Cordyceps also provides excellent anti-inflammatory effects for lung inflammation caused by tobacco smoke and other irritants.
Vitamin E lowers reactive oxygen species (ROS) in lung tissue. In this study, researchers compared oxidative markers in smokers to non-smokers in a randomized placebo-controlled trial. Vitamin E supplementation lowered lung inflammation levels by 21 percent compared to placebo. Vitamin D is needed to protect against the inflammation. Insufficient vitamin D has been linked with increased severity of COPD. In smokers, it was found that lack of vitamin D caused more muscle tissue breakdown and worsened lung function.
The nutrient resveratrol inhibits the inflammatory compounds TNF-a, MMP-9, and NF-kappa B that are produced with COPD. Researchers have recommended that resveratrol be used as a potential drug candidate for COPD treatment. Acetyl-l-carnitine deserves a special mention as well for COPD management. Low levels of this amino acid were associated with worse health. This amino acid is vital for mitochondria, muscles, aerobic metabolism, and energy production.
Several other antioxidants like quercetin and proanthocyanidins (grape seed extract), lycopene, curcumin, green tea catechins, lipoic acid and glutathione have made it possible to positively influence COPD. Researchers have found that these compounds can modulate the cigarette smoke induced oxidative stress and cellular changes. Researchers concluded, “According to various studies, it appears that the administration of multiple antioxidants could be a more effective mode used in the treatment of COPD.”
Excess mucus may occur because of the changes in the lung flora and inflammation. Compounds like arabinogalactan, bromelain, NAC, and olive leaf extract help the lymph stagnation and lung flora. Recent research shows that the beneficial bacteria Lactobacillus rhamnosus significantly reduced inflammation in the lungs caused by cigarette smoke. The scientists recommended that “probiotics be used as anti-inflammatory agents in cigarette smoke associated diseases such as COPD.”
Physical exercise helps prevent oxidative stress induced by smoking. The last thing that someone wants to do who is exhausted and can’t breathe seems counter-intuitive. Yet, physical activity has been shown to be beneficial in COPD. COPD is a mitochondrial disorder. In order to make new mitochondria, exercise must be included as part of the regime. Just ask anyone who has given up smoking, had lung problems, and then started exercising. They will tell you that their health is completely different than if they had only given up smoking. Talk with your doctor if you have physical restrictions with exercise. Consider adding PQQ to help make new mitochondria, support aerobic activity, and reduce lactic acid.
The nagging chronic cough from low level lung irritation has many sources in today’s environment. It is often a symptom of underlying inflammation that changes the tissue and damages the mitochondria. The concept of using steroids that reduce inflammation but kill mitochondria and antibiotics that disrupt the body’s microbiome does not do justice to the underlying health of the body. Certainly, there are instances when it is vital to use these treatments under acute exacerbations, but what about the daily maintenance and protection of the mitochondria and lung microflora from ubiquitous toxins? COPD has no medical cure. Patients are often left with a dismal prognosis. Knowing, understanding, and using what recent research says about COPD, mitochondria, and the lung microbiome can go a long way towards breathing and feeling better. Start now in protecting your lung flora and mitochondria before it is too late.
Nutritional Options
Vitamin D – Every cell in the body needs vitamin D. It is a key nutrient and hormone necessary for managing inflammation. Inadequate vitamin D leads to worsening of the COPD and muscle wasting.
Resveratrol – Obtained from red wine and grapes, this superfood antioxidant may be regarded by some as the “fountain of youth”. It provides anti-inflammatory protection for the lungs, heart, brain, and mitochondria.
Acetyl-L-Carnitine – This amino acid is vital to mitochondria function. Inadequate ALC makes it difficult to make energy and aerobic cellular function. Insufficient levels significantly worsen lung and mitochondria function.
Quercetin – This natural bioflavonoid has a long-standing track record. It helps reduce inflammation and congestion. It helps support healthy sinus, mucus membranes, allergies, skin, bones, nerves, and the immune system.
Green Tea – Green tea extract is well known for its antioxidant function and metabolism support. It works nicely together with quercetin. It is often used for blood sugar, weight loss, cholesterol, and cancer risk reduction. Consider adding it in to protect your mitochondria from further stress.
NAC – NAC delivers stellar performance for respiratory function. It is a key nutrient necessary to make glutathione, the master antioxidant for the immune system. NAC has long been used to loosen thick mucus and protect the respiratory tract.
Arabinogalactan – Arabinogalactan, a unique healthy carbohydrate, helps natural killer cells fight off germs. It prevents germs from sticking to the lining of the respiratory track and helps keep the lymphatic system from becoming stagnant. Works great in all ages!
Lactobacillus – Beneficial bacteria are essential to health, affecting numerous different microbiomes environments found in the body, like the gut, lungs, and even skin. Lactobacillus helps modulate the immune system and reduce inflammation within these tissues. Risks for repeated illnesses increases the more imbalanced the flora is in the body.
Astaxanthin – This vibrant antioxidant, which is red in color, is known for its ability to support mitochondria and numerous tissues in the body like the heart, lungs, skin, and immune system. It naturally contains oxygen in its structure that helps stabilize cell membrane from free radical attack.
Cordyceps – A prized medicinal mushroom used for centuries in traditional Chinese medicine for exhaustion and loss of function. Cordyceps provides anti-inflammatory, antioxidant, immune modulating, and protective benefits for the aging and distressed body. It helps fight bacteria, viruses, and fungal problems throughout the body, especially in the respiratory tract.
PQQ – This redox agent or extreme antioxidant provides up to 5000 times more protection than vitamin C. It protects and helps make new mitochondria. PQQ research shows that it may help muscle weakness, fatigue, lactic acid build-up, and aerobic capacity.
More...
[Jump to: Nutritional Options]
Symptoms of COPD
COPD symptoms are frequently attributed to or dismissed as aging, causing it to be diagnosed in later stages of the disorder. Early detection is fundamental to management and staving off the debilitating decline and accelerated aging. The chronic cough, shortness of breath with everyday activities, repeated respiratory infections, fatigue, wheezing, and increased mucus are all symptoms related to COPD.
Other symptoms can occur unrelated to the respiratory system. Most commonly seen is weakness and loss of muscle mass in the quadriceps, the thigh muscle. Loss of the strength in the thigh muscle actually reflects a worse prognosis with COPD. Loss of strength in the quadriceps can make it harder to get up from a seated position, go upstairs, or get out of the car. This loss of muscle mass in the legs is often dismissed as related to aging. This can true to a degree, but if there is a nagging cough that doesn’t go away with the loss of muscle strength, something else may be going on.
COPD symptoms occur because of diminished airflow in and out of the airways and air sacs of the lungs. This may happen because the airways and air sacs lose their elastic quality. The walls between the air sacs become thick and inflamed or are destroyed. The airways can also make more mucus than normal and clog the passageways. High levels of inflammation and oxidative stress within the lungs from various sources drive the decline and worsen respiratory function. Muscles waste away due to high levels of oxidative stress from pro-inflammatory chemicals like TNF-a, MMP9, and NF-kappa B.
What Causes COPD?
COPD has a number of causes. Chronic exposure to lung irritants that damage the lungs and airways leads to the development of COPD. Cigarette smoking is at the top of the list. Pipe, cigar, and other tobacco smoke can also cause COPD. Secondhand smoke, air pollution, chemical fumes, diesel fumes, weather patterns, wood smoke, and rare genetic conditions can cause COPD. Occupational exposures from inorganic dust, wood dust, vapors, fumes, gases and other irritants increase the risk especially in those who have never smoked. Inhalation of these pollutants provokes oxidative stress and injury to the lung tissue.
COPD and Mitochondria
A deeper level of understanding with the COPD and oxidative stress relates to the impact on mitochondria. Just like in other areas of the body such as the heart, brain, and joints, mitochondrial injury leads to functional tissue changes within the lungs. Mitochondria are the energy producing factories inside cells that burn fuel to make energy or aerobic cellular respiration. There are trillions of them throughout the body.
Research shows that mitochondrial injury within the lungs drives the development of COPD. Irritants like smoking cause injury and smother the ability for the mitochondria to repair. High levels of reactive oxygen species are released. Cell membranes break down. This causes the cells and air sacs to become stiff, abnormally change, and thicken. As a result, air doesn’t move in and out of the lungs well. Lung damage worsens as the wear and tear to the mitochondria increases. Loss of the thigh muscle strength and mass is also related to mitochondrial damage. The end consequence is that aging accelerates. Researchers recommend the use of mitochondria-targeted antioxidants to help restore respiratory and muscle function to actually reverse COPD.
Tobacco, Roundup, and Triclosan
The concept that smoking causes lung problems is obviously not new. The use of tobacco has been around for about 2,000 years, but why is COPD rampant across the globe? Consider two factors, Roundup and triclosan that are now nearly ubiquitous in the environment and how they impact lung health. Tobacco is a genetically engineered Roundup ready crop. Roundup has been used now for decades on tobacco crops. The tobacco plant that you smoke and inhale directly or as second-hand smoke contains pesticides that are in the tobacco. So not only are you getting the toxic oxidative effects of smoke inhalation, you are inhaling pesticide residues.
Roundup contains the active ingredient glyphosate in a mixture of adjuvants. Glyphosate is considered “non-toxic under normal circumstances”. Research shows otherwise. One study clearly demonstrated that when glyphosate was mixed with a surfactant and subsequently exposed to mitochondria in animals, the mitochondria were heavily damaged. It actually caused mitochondrial death. Other researchers have found that Roundup was among the most toxic herbicide and insecticide chemical soup despite its relatively benign reputation. Is the increase in COPD worldwide related to the worldwide use of Roundup?
The other common chemical in use that injures mitochondria and should be questioned in COPD is the pesticide triclosan. Triclosan, which impairs thyroid function, is a synthetic, widely used antimicrobial agent found in hand soaps, detergents, skin care products, air fresheners, and oral hygiene products. For quite some time now, researchers have known that triclosan impairs mitochondrial function in animal cells. Think of all the products you come in contact with on a daily basis that have triclosan in them. Inhaling the scents and vapors from the product, like air fresheners that contain triclosan, can get into the lungs. Is the chronic low level exposure to triclosan from clothing, bathing, hand washing, touching your face, mouth, inhaling, swallowing it, and absorbing it, disrupting your mitochondria? On some imperceptible level, it probably is.
Lung Microbiome
The microbiome refers to microorganisms found in various body parts. When the National Institutes of Health human microbiome project began in 2007, it was thought that normal, healthy lung tissue was sterile. As a result, the respiratory tract was not included in the initial research. Since that time, technology has improved allowing for advanced investigation of the lung tissue. The lungs and respiratory tract do indeed have their own microbiome. In COPD, significant fluctuations and disruptions to the healthy flora of the lungs occur. Researchers found the worse the COPD was, the worse the lung flora or aero-digestive tract microbiomes.
Bacterial and viral overgrowths are a major cause of COPD flare-ups that contribute to the worsening airway inflammation. Gingivitis and poor oral health change the flora in the mouth and worsens the prognosis for COPD. In COPD and other chronic respiratory disorders, bacteria persist in the lungs despite multiple rounds of antibiotics. This occurs because the bacteria have biofilms that protect them. The biofilm keeps them hidden from the immune system, rendering the antibiotics ineffective and further disrupting the lung microbiome.
Cigarette smoke, air pollution, and occupational exposures change the lung microbiome. Triclosan found in air fresheners damages lung tissue. Just like in the gut, steroids and antibiotics change the lung flora. Common medical treatment for COPD is steroids and/or antibiotics but at what cost to the overall terrain and health of the mitochondria and lung flora?
Breaking down the biofilms and allowing penetration of natural antibiotics may help with the infection wars. NAC (N-Acetyl Cysteine) has been shown to help reduce biofilm formation. Oregano oil and caprylic acid have been shown to inhibit the formation of biofilms from bacteria and candida problems often found in lung ailments.
Quenching Inflammation and Protecting the Lungs
Patients with COPD show inadequate antioxidants to counterattack the oxidative stress. Protecting the lung tissue and lung flora from oxidative stress, quenching inflammation, and protecting the mitochondria are essential management for COPD and other inflammatory disorders of the lungs. Several nutritional compounds buffer oxidative stress and quench lung damaging inflammatory compounds.
Recent research on astaxanthin shows that it can quench the highly toxic free radicals that damage mitochondria within lung tissue helping to reduce scar tissue. Cordyceps also provides excellent anti-inflammatory effects for lung inflammation caused by tobacco smoke and other irritants.
Vitamin E lowers reactive oxygen species (ROS) in lung tissue. In this study, researchers compared oxidative markers in smokers to non-smokers in a randomized placebo-controlled trial. Vitamin E supplementation lowered lung inflammation levels by 21 percent compared to placebo. Vitamin D is needed to protect against the inflammation. Insufficient vitamin D has been linked with increased severity of COPD. In smokers, it was found that lack of vitamin D caused more muscle tissue breakdown and worsened lung function.
The nutrient resveratrol inhibits the inflammatory compounds TNF-a, MMP-9, and NF-kappa B that are produced with COPD. Researchers have recommended that resveratrol be used as a potential drug candidate for COPD treatment. Acetyl-l-carnitine deserves a special mention as well for COPD management. Low levels of this amino acid were associated with worse health. This amino acid is vital for mitochondria, muscles, aerobic metabolism, and energy production.
Several other antioxidants like quercetin and proanthocyanidins (grape seed extract), lycopene, curcumin, green tea catechins, lipoic acid and glutathione have made it possible to positively influence COPD. Researchers have found that these compounds can modulate the cigarette smoke induced oxidative stress and cellular changes. Researchers concluded, “According to various studies, it appears that the administration of multiple antioxidants could be a more effective mode used in the treatment of COPD.”
Excess mucus may occur because of the changes in the lung flora and inflammation. Compounds like arabinogalactan, bromelain, NAC, and olive leaf extract help the lymph stagnation and lung flora. Recent research shows that the beneficial bacteria Lactobacillus rhamnosus significantly reduced inflammation in the lungs caused by cigarette smoke. The scientists recommended that “probiotics be used as anti-inflammatory agents in cigarette smoke associated diseases such as COPD.”
Physical exercise helps prevent oxidative stress induced by smoking. The last thing that someone wants to do who is exhausted and can’t breathe seems counter-intuitive. Yet, physical activity has been shown to be beneficial in COPD. COPD is a mitochondrial disorder. In order to make new mitochondria, exercise must be included as part of the regime. Just ask anyone who has given up smoking, had lung problems, and then started exercising. They will tell you that their health is completely different than if they had only given up smoking. Talk with your doctor if you have physical restrictions with exercise. Consider adding PQQ to help make new mitochondria, support aerobic activity, and reduce lactic acid.
The nagging chronic cough from low level lung irritation has many sources in today’s environment. It is often a symptom of underlying inflammation that changes the tissue and damages the mitochondria. The concept of using steroids that reduce inflammation but kill mitochondria and antibiotics that disrupt the body’s microbiome does not do justice to the underlying health of the body. Certainly, there are instances when it is vital to use these treatments under acute exacerbations, but what about the daily maintenance and protection of the mitochondria and lung microflora from ubiquitous toxins? COPD has no medical cure. Patients are often left with a dismal prognosis. Knowing, understanding, and using what recent research says about COPD, mitochondria, and the lung microbiome can go a long way towards breathing and feeling better. Start now in protecting your lung flora and mitochondria before it is too late.
Nutritional Options
Vitamin D – Every cell in the body needs vitamin D. It is a key nutrient and hormone necessary for managing inflammation. Inadequate vitamin D leads to worsening of the COPD and muscle wasting.
Resveratrol – Obtained from red wine and grapes, this superfood antioxidant may be regarded by some as the “fountain of youth”. It provides anti-inflammatory protection for the lungs, heart, brain, and mitochondria.
Acetyl-L-Carnitine – This amino acid is vital to mitochondria function. Inadequate ALC makes it difficult to make energy and aerobic cellular function. Insufficient levels significantly worsen lung and mitochondria function.
Quercetin – This natural bioflavonoid has a long-standing track record. It helps reduce inflammation and congestion. It helps support healthy sinus, mucus membranes, allergies, skin, bones, nerves, and the immune system.
Green Tea – Green tea extract is well known for its antioxidant function and metabolism support. It works nicely together with quercetin. It is often used for blood sugar, weight loss, cholesterol, and cancer risk reduction. Consider adding it in to protect your mitochondria from further stress.
NAC – NAC delivers stellar performance for respiratory function. It is a key nutrient necessary to make glutathione, the master antioxidant for the immune system. NAC has long been used to loosen thick mucus and protect the respiratory tract.
Arabinogalactan – Arabinogalactan, a unique healthy carbohydrate, helps natural killer cells fight off germs. It prevents germs from sticking to the lining of the respiratory track and helps keep the lymphatic system from becoming stagnant. Works great in all ages!
Lactobacillus – Beneficial bacteria are essential to health, affecting numerous different microbiomes environments found in the body, like the gut, lungs, and even skin. Lactobacillus helps modulate the immune system and reduce inflammation within these tissues. Risks for repeated illnesses increases the more imbalanced the flora is in the body.
Astaxanthin – This vibrant antioxidant, which is red in color, is known for its ability to support mitochondria and numerous tissues in the body like the heart, lungs, skin, and immune system. It naturally contains oxygen in its structure that helps stabilize cell membrane from free radical attack.
Cordyceps – A prized medicinal mushroom used for centuries in traditional Chinese medicine for exhaustion and loss of function. Cordyceps provides anti-inflammatory, antioxidant, immune modulating, and protective benefits for the aging and distressed body. It helps fight bacteria, viruses, and fungal problems throughout the body, especially in the respiratory tract.
PQQ – This redox agent or extreme antioxidant provides up to 5000 times more protection than vitamin C. It protects and helps make new mitochondria. PQQ research shows that it may help muscle weakness, fatigue, lactic acid build-up, and aerobic capacity.
More...
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