Postnatal Obesity Triggered During Pregnancy

During pregnancy, the health of the mother and the intrauterine environment can have dramatic and lasting effects on the child.

Intrahepatic cholestasis of pregnancy (ICP) is a liver disease that affects 0.5-2% of pregnant women and is characterized by increased bile acid levels in the maternal serum.

In this issue of the Journal of Clinical Investigation, Catherine Williamson and colleagues at Imperial College London studied the long term impact of ICP in a cohort of Finnish families. They found that as teenagers, individuals born to women with ICP had altered metabolic profiles and increased BMI.

To further understand this effect, Williams and colleagues developed a mouse model of ICP and found that offspring of ICP mothers were more susceptible to metabolic disease and diet-induced obesity.

In the companion commentary, Susan Murphy of Duke University points out that the mouse model of ICP may also be useful in identifying other factors that predispose individuals to metabolic syndrome.

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Healthy Living Learned By Example

Kids whose moms encourage them to exercise and eat well, and model those healthy behaviors themselves, are more likely to be active and healthy eaters, according to researchers at Duke Medicine.

Their findings, published online in the International Journal of Obesity,remind parents that they are role models for their children, and underscore the importance of parental policies promoting physical activity and healthy eating.

Exercise and healthy diets are critical in fighting childhood obesity, a considerable problem in the United States, where over a quarter of kids ages two to five are already overweight or obese.

"Obesity is a complex phenomenon, which is influenced by individual biological factors and behaviors," said study author Truls Østbye, M.D., PhD, professor of community and family medicine at Duke. "But there are variations in obesity from one society to another and from one environment to another, so there is clearly something in the environment that strongly influences the obesity epidemic."

The home environment and parenting can influence a child's health by shaping dietary and physical behaviors, such as providing access to fruits and vegetables or encouraging kids to play outside.

"The 'obesiogenic' environment is broad and multi-faceted, including the physical neighborhood environment, media and advertising, and food tax policies, but we feel that the home environment is critical, particularly among children. However, we didn't have a lot of evidence as to how important this was," Østbye said.

In this study, Østbye and his colleagues examined the relationship between the home environment and behaviors related to obesity - dietary and exercise habits - among preschoolers.

The researchers studied data from 190 kids, ages two to five, whose mothers were overweight or obese. They collected information on the children's food intake over the past week, with foods rated as junk food or healthy food. To gauge their levels of physical activity, the children wore accelerometers for a week, which measured moderate to vigorous physical activity as well as sedentary time.

The mothers reported information about their children's environments, including family policies around food and physical activity, accessibility of healthy versus junk foods, availability of physical activity equipment, and whether they model healthy eating or exercise for their kids.

When they analyzed the data, the researchers found significant associations between these environmental measures and the preschoolers' physical activity and healthy versus junk food intake. They concluded that to promote healthy behaviors in children, a healthy home environment and parental role modeling are important.

For example, limiting access to junk foods at home and parental policies supporting family meals increased the amount of healthy foods kids ate. Overall, the home environment had more influence on the children's dietary habits than on their physical activity levels.

This study reminds parents that their children are watching and learning from observing their behaviors, both good and bad.

"It's hard for parents to change their behaviors, but not only is this important for you and your own health; it is also important for your children because you are a role model for them," said Marissa Stroo, a co-investigator on the study. "This might be common sense, but now we have some evidence to support this."

The researchers also looked at socioeconomic factors of the mothers, including their education levels and whether they worked, to see if this had an effect on the children's behaviors. The mother's socioeconomic factors did not affect their kids' physical activity, but had mixed results when it came to their dietary habits.

Further research is needed to better understand how a mother's socioeconomic factors influence her child's health, but it is possible that different strategies may be needed to prevent obesity in children depending on a mother's education and work status. More research is also necessary to see if the influence of the home environment changes as children get older, and if parenting strategies should adapt accordingly.

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Causal Relationship Between Adiposity And Heart Failure, And Elevated Liver Enzymes

New evidence supports a causal relationship between adiposity and heart failure, and between adiposity and increased liver enzymes, according to a study published this week in PLOS Medicine. The study, conducted by Inga Prokopenko, Erik Ingelsson, and colleagues from the ENGAGE (European Network for Genetic and Genomic Epidemiology) Consortium, also provides additional support for several previously shown causal associations such as those between adiposity and type 2 diabetes, metabolic syndrome, dyslipidemia, and hypertension.

The authors investigated whether adiposity is causally related to various cardiometabolic traits using a Mendelian randomization analysis, in which the variation in genes associated with conditions is used to assess the causal relationship between conditions. It is known that a genetic variant (rs9939609) within the genome region that encodes the fat-mass- and obesity-associated gene (FTO) is associated with increased BMI. Using genetic and health data collected in 36 population-based studies of nearly 200,000 individuals of European descent, the authors measured the strength of the causal association between BMI and cardiometabolic traits and found that higher BMI had a causal relationship with heart failure, type 2 diabetes, metabolic syndrome, dyslipidemia, hypertension, increased blood levels of liver enzymes, and several other cardiometabolic traits.

As with all Mendelian randomization studies, the reliability of the causal associations reported here depends on several assumptions made by the researchers. The authors report, "The present study addressing the role of BMI in 24 traits in up to 198,502 individuals provides novel insights in the causal effect of obesity on heart failure and increased liver enzymes levels."

They also say that this study "provides robust support to the causal relationship between obesity and a number of cardiometabolic traits reported previously. These results support global public prevention efforts for obesity in order to decrease cost and suffering from [type 2 diabetes] and heart failure."

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Longest-Ever Intervention Study Investigating Whether Weight Loss Reduces The Risk Of Heart Disease For Patients With Type 2 Diabetes

A landmark study investigating the long-term effects of weight loss on the risks of cardiovascular disease among patients with Type 2 diabetes has now concluded, with significant results published in the New England Journal of Medicine.

Conducted at the University of Pittsburgh and at clinical facilities throughout the United States, the multicenter clinical trial investigated the effects of an intensive lifestyle intervention program, intended to achieve and maintain weight loss in overweight or obese people with Type 2 diabetes, on rates of cardiovascular disease. Begun in 2001, the trial enrolled more than 5,000 people at 16 clinical centers across the United States and is the longest intervention study of its type ever undertaken for patients with diabetes.

John Jakicic, chair and professor in the Department of Health and Physical Activity in Pitt's School of Education and Director of the Physical Activity and Weight Management Research Center, served as principal investigator for the University of Pittsburgh's role in the study. He, along with colleagues throughout the University, is among the researchers comprising the national Look AHEAD (Action for Health in Diabetes) Research Group, which carried out the study and authored the New England Journal of Medicine paper.

Among the study's main findings is that weight loss among members of the study's Intensive Lifestyle Intervention group, provided with a program of weight management and increased physical activity, resulted in no difference in heart attacks and strokes when compared with the study's control group, the Diabetes Support and Education group, which was provided with only general health information and social support.

The effect of the intervention program on weight loss, however, was significant: Participants in the intervention group lost 8.7 percent of their initial body weight after one year of the study versus 0.7 percent among the control group's members; the intervention group also maintained a greater weight loss, 6 percent of their initial weight, versus 3.5 percent for the control group, at the study's conclusion.

The Look AHEAD study is the first to achieve such sustained weight loss. A weight loss of 5 percent or more in short-term studies is considered to be clinically significant and has been shown to improve control of blood pressure, blood sugar, cholesterol, and other risk factors. Comparable weight loss can also help prevent the development of Type 2 diabetes in overweight and obese adults.

"While the findings from the Look AHEAD study did not support that engagement in a weight- loss intervention was effective for reducing the onset of cardiovascular disease incidence or mortality, this does not mean that overweight adults with diabetes should not lose weight and become more physically active," said Jakicic. "Rather, there is an overwhelming amount of evidence from this study to date that has shown that weight loss and physical activity were associated with numerous other health benefits.

"These include improving physical function and quality of life, reduction in risk factors such as lipids and blood pressure with less reliance on medication, better diabetes control with less reliance on medication, improved sleep, psychological and emotional health benefits, and many others," Jakicic said. "Thus, adults with diabetes can begin to realize many of these health benefits with even modest reductions in body weight and modest increases in physical activity."

The study sought to determine whether weight loss achieved with a lifestyle program would help individuals with diabetes live longer and develop less cardiovascular disease. While short-term studies had shown that weight loss improved control of blood sugar and mitigated risk factors for heart disease and stroke in overweight and obese individuals with Type 2 diabetes, the longer-term effects of weight loss were not well studied. In particular, it was unknown whether weight loss achieved with a lifestyle intervention alone could reduce the risk of heart disease in people with Type 2 diabetes.

Type 2 is the most common form of diabetes, affecting approximately 25 million Americans over the age of 20. Complications of Type 2 diabetes include heart disease and stroke, high blood pressure, blindness, kidney disease, the nervous system disease known as neuropathy, and amputations. The total cost of Type 2 diabetes in 2012 was estimated to be $245 billion. This disease, for which there is no cure but which involves ongoing treatment, can be managed with diet, physical activity including regular exercise equal to at least 30 minutes of brisk walking each day, modest weight loss, and a variety of medications. The Look AHEAD study has shown that these lifestyle factors are effective for improving the management of Type 2 diabetes.

Study participants were individuals between 45 and 75 years of age with Type 2 diabetes and a body-mass index of 25 or greater. Sixty percent of the study participants were women, while 37 percent were from ethnic and racial minority groups.

The University of Pittsburgh's General Clinical Research Center and Clinical Translational Research Center served as participating clinical sites, with researchers here recruiting more than 330 participants over a three-year span. Jakicic credited the Division of Endocrinology within the Department of Medicine and the Department of Psychiatry in Pitt's School of Medicine, and the Department of Epidemiology in Pitt's Graduate School of Public Health, with the success of the local clinical trials.

Participants were assigned randomly to the Intensive Lifestyle Intervention group or the Diabetes Support and Education group. Members of the Intensive Lifestyle Intervention group were enrolled in a weight management program that provided individual and group support for making changes in eating behaviors and engaging in physical activity. The intervention program focused on home-based, functional activities including helping participants balance, climb stairs, and get out of a chair, among other examples. Diabetes Support and Education group members received what Jakicic called "usual care, with some very infrequent support on general health topics that were not related to diet, physical activity, or weight loss."

Participants were required to have their own health care providers manage their diabetes and other conditions. Look AHEAD did not provide medical care, but it did assist participants in finding a health care provider if they did not have one.

The Look AHEAD study was intended to run for 13.5 years, the maximum length of time researchers had determined might be required to see a difference in heart disease between two groups. After 11 years, however, the Look AHEAD Data and Safety Monitoring Board, an independent monitoring board that provides recommendations to the National Institutes of Health, reviewed the data the study had collected and determined that Look AHEAD could reach the definite conclusion that there were no differences in cardiovascular disease rates between the study's two groups.

Speculating on the failure of weight loss to reduce the risk of cardiovascular disease, researchers suggested that even greater weight loss may be necessary to reduce cardiovascular risk in diabetes patients who are overweight or obese. They also suggested that by providing participants in both groups, and their health care providers, with annual feedback on the participants' blood pressure, lipids, and blood sugar control, the cardiovascular disease risks for all experiment participants may have been reduced at a comparable rate.

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In Animal Model, Dietary Fructose Found To Cause Liver Damage

The role of dietary fructose in the development of obesity and fatty liver diseases remains controversial, with previous studies indicating that the problems resulted from fructose and a diet too high in calories.

However, a new study conducted in an animal model at Wake Forest Baptist Medical Center showed that fructose rapidly caused liver damage even without weight gain. The researchers found that over the six-week study period liver damage more than doubled in the animals fed a high-fructose diet as compared to those in the control group.

The study is published in the American Journal of Clinical Nutrition.

"Is a calorie a calorie? Are they all created equal? Based on this study, we would say not," said Kylie Kavanagh, D.V.M., assistant professor of pathology-comparative medicine at Wake Forest Baptist and lead author of the study.

In a previous trial which is referenced in the current journal article, Kavanagh's team studied monkeys who were allowed to eat as much as they wanted of low-fat food with added fructose for seven years, as compared to a control group fed a low-fructose, low-fat diet for the same time period. Not surprisingly, the animals allowed to eat as much as they wanted of the high-fructose diet gained 50 percent more weight than the control group. They developed diabetes at three times the rate of the control group and also developed hepatic steatosis, or non-alcoholic fatty liver disease.

The big question for the researchers was what caused the liver damage. Was it because the animals got fat from eating too much, or was it something else?

To answer that question, this study was designed to prevent weight gain. Ten middle-aged, normal weight monkeys who had never eaten fructose were divided into two groups based on comparable body shapes and waist circumference. Over six weeks, one group was fed a calorie-controlled diet consisting of 24 percent fructose, while the control group was fed a calorie-controlled diet with only a negligible amount of fructose, approximately 0.5 percent.

Both diets had the same amount of fat, carbohydrate and protein, but the sources were different, Kavanagh said. The high-fructose group's diet was made from flour, butter, pork fat, eggs and fructose (the main ingredient in corn syrup), similar to what many people eat, while the control group's diet was made from healthy complex carbohydrates and soy protein.

Every week the research team weighed both groups and measured their waist circumference, then adjusted the amount of food provided to prevent weight gain. At the end of the study, the researchers measured biomarkers of liver damage through blood samples and examined what type of bacteria was in the intestine through fecal samples and intestinal biopsies.

"What surprised us the most was how quickly the liver was affected and how extensive the damage was, especially without weight gain as a factor," Kavanagh said. "Six weeks in monkeys is roughly equivalent to three months in humans."

In the high-fructose group, the researchers found that the type of intestinal bacteria hadn't changed, but that they were migrating to the liver more rapidly and causing damage there. It appears that something about the high fructose levels was causing the intestines to be less protective than normal, and consequently allowing the bacteria to leak out at a 30 percent higher rate, Kavanagh said.

One of the limitations of the study was that it only tested for fructose and not dextrose. Fructose and dextrose are simple sugars found naturally in plants.

"We studied fructose because it is the most commonly added sugar in the American diet, but based on our study findings, we can't say conclusively that fructose caused the liver damage," Kavanagh said. "What we can say is that high added sugars caused bacteria to exit the intestines, go into the blood stream and damage the liver.

"The liver damage began even in the absence of weight gain. This could have clinical implications because most doctors and scientists have thought that it was the fat in and around tissues in the body that caused the health problems."

The Wake Forest Baptist team plans to begin a new study using the same controls but testing for both fructose and dextrose over a longer time frame.

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Helping Prevent Obesity Among Children Via Community-Based Programs

When it comes to confronting childhood obesity, researchers at the Johns Hopkins Bloomberg School of Public Health conclude that community-based approaches are important. A systematic review of childhood obesity prevention programs found that community-based intervention programs that incorporate schools and focus on both diet and physical activity are more effective at preventing obesity in children. The results of the study appear online in Pediatrics.

"In measuring the effectiveness of community-based programs that impact childhood obesity - more comprehensive interventions are definitely better," said Sara Bleich, PhD, associate professor inof Health Policy and Management and lead author on the paper. "The research shows that in order to help prevent obesity among children, we must focus on both diet and exercise in the communities where children live and go to school since the environment is a key contributor to obesity risk. Focusing on the community is especially important for children since they generally have little or no control over their environment."

This shift toward a stronger community focus is echoed in a recent Institute of Medicine (IOM) report, Accelerating Progress in Obesity Prevention, which recommends a comprehensive approach to childhood obesity prevention that includes the community.

Researchers examined nine studies that featured community-based interventions and found that, among those, the two interventions that included a school component effectively prevented obesity or overweight in children. Common characteristics found across most of the nine studies included the use of multiple intervention components (e.g., health education and family outreach), the inclusion of settings other than just the community (e.g., school, home, primary care, child care), and a focus on children at middle school age or younger.

"While additional research is needed to assess the full impact of community-based interventions on the prevention of childhood obesity, our conclusions indicate that more comprehensive approaches, which attempt to modify diet and exercise in the community with engagement from the schools, weigh in everyone's favor," said Bleich.

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Study Sheds Light On Molecular Basis For Metabolic Health And Disease

Inside each of us is our own internal timing device. It drives everything from sleep cycles to metabolism, but the inner-workings of this so-called "circadian clock" are complex, and the molecular processes behind it have long eluded scientists. But now, researchers at the Gladstone Institutes have discovered how one important protein falls under direct instructions from the body's circadian clock. Furthermore, they uncover how this protein regulates fundamental circadian processes - and how disrupting its normal function can throw this critical system out of sync.

In the latest issue of the Journal of Neuroscience, Gladstone Investigator Katerina Akassoglou, PhD, and her team reveal in animal models how the production of the p75 neurotrophin receptor (p75NTR) protein oscillates in time with the body's natural circadian clock - and how these rhythmic oscillations help regulate vital metabolic functions. This discovery underscores the widespread importance of p75NTR by offering insight into how the circadian clock helps maintain the body's overall metabolic health.

Virtually every organism on the planet - from bacteria to humans - has a circadian clock, a biological timing mechanism that oscillates with a period of about 24 hours and is coordinated with the cycle of day and night. And while it runs independent of external cues, it is influenced by the rhythms of light, temperature and food availability. Intriguingly, recent studies have also found a link between circadian clocks and metabolism.

"Important metabolic functions are also heavily influenced by circadian clocks, which is why activities such as chronic night-shift work - which can cause a misalignment of this clock - increase one's risk for metabolic and autoimmune diseases such as obesity, Type 2 diabetes, cancer and multiple sclerosis," said Dr. Akassoglou. Dr. Akassoglou is also a professor of neurology at the University of California, San Francisco, (UCSF) with which Gladstone is affiliated. "In this study, we pinpointed p75NTR as an important molecular 'link' between circadian clocks and metabolic health."

Originally, p75NTR was only thought to be active in the nervous system. Later studies found it to be active in many cell types throughout the body, suggesting that it impacts a variety of biological functions. Last year, Gladstone researchers discovered that p75NTR was present in the liver and in fat cells, and that it regulates glucose levels in the blood - an important metabolic process. Since these findings uncovered a link between p75NTR and metabolism, the research team tested - first in a petri dish and then in animal models - whether there was also a link between p75NTR and the circadian clock.

The team focused on two genes called Clock and Bmal1. These so-called "circadian regulator genes," and others like them, are found throughout the body. Their activity controls the body's circadian clock. The researchers wanted to see if there was a connection between these circadian genes and p75NTR.

"Our initial experiments revealed such a connection," recalls Gladstone Postdoctoral Fellow Bernat Baeza-Raja, PhD, the paper's lead author. "In individual cells, we saw that p75NTR production was controlled by Clock and Bmal1, which bind directly to the gene that codes for the p75NTR and start production of the protein."

But perhaps even more important than how p75NTR was produced was when. The team found that p75NTR production, like the circadian clock genes themselves, oscillated in a 24-hour cycle - in sync with the cells' natural circadian rhythm. Experiments in mouse models further supported these findings.

And when the team genetically modified a group of mice so that it lacked the circadian Clock gene, everything else fell out of sync. The circadian oscillation of p75NTR production was disrupted, and p75NTR levels dropped.

However, what was most fascinating, say the researchers, was how a drop in p75NTR levels then affected a variety of circadian clock systems. Specifically, the regular oscillations of other circadian genes in the brain and the liver became disrupted, as well as genes known to regulate glucose and lipid metabolism.

"The finding that a loss of p75NTR affected circadian and metabolic systems is strong evidence that this protein is intricately tied to both," said Life Sciences Institute Director Alan Saltiel, PhD, who is also a professor at the University of Michigan and was not involved in the study. "It will be fascinating to see what additional insight Dr. Akassoglou and her team will uncover as they continue to examine the role of p75NTR in circadian clocks and metabolic function."

"While these findings reveal p75NTR to be an important link between circadian clocks and metabolism, the system is complex, and there are likely other factors at play," said Dr. Akassoglou. "We are currently working to identify the relationship between the circadian clock, metabolism and the immune system, so that one day we could develop therapies to treat diseases influenced by circadian clock disruption - including not only obesity and diabetes, but also potentially multiple sclerosis and even Alzheimer's disease."

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Obese Women Who Skip Breakfast At Greater Risk For Insulin Resistance

Overweight women who skip breakfast experience acute, or rapid-onset, insulin resistance, a condition that, when chronic, is a risk factor for diabetes, a new study finds. The results, which were presented at The Endocrine Society's 95th Annual Meeting in San Francisco, suggest that regularly skipping breakfast over time may lead to chronic insulin resistance and thus could increase an individual's risk for type 2 diabetes.

"Our study found that acute insulin resistance developed after only one day of skipping breakfast," said the study's lead author, Elizabeth Thomas, MD, an endocrinology fellow at the University of Colorado School of Medicine in Aurora.

In insulin resistance, a person requires more insulin to bring their glucose, or blood sugar, into a normal range, she explained.

Thomas and co-workers studied nine nondiabetic women, with an average age of 29, who were overweight or obese. The study took place on two days about a month apart. Subjects were randomly assigned to receive either breakfast or no breakfast at the first visit and the opposite at the second visit. Four hours later, all subjects ate the same standardized lunch at each visit. They had blood samples taken every 30 minutes after lunch for three hours to test their insulin and glucose levels.

It is normal for glucose levels to rise after eating a meal, which then triggers insulin production. The researchers found, however, that the women's insulin and glucose levels after lunch were significantly higher on the day they skipped breakfast than on the day when participants ate breakfast. The higher levels demonstrated acute insulin resistance because of skipping breakfast, according to Thomas.

It was not clear if this "heightened metabolic response" was temporary or lasting, but it may contribute to the development of chronic insulin resistance, she said. When the body becomes permanently resistant to the effects of the hormone insulin, sugar builds up in the blood, which can lead to prediabetes and diabetes over time.

"This information should help health care providers in counseling patients as to why it is better to eat a healthy, balanced breakfast than to skip breakfast," Thomas said.

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Trying To Lose Weight? Go Herbal

These days, there is a great need for overweight Americans to lose those excess pounds. Being healthy would not only lead them to have a healthier lifestyle but it will also literally lighten their load, and improve their overall well-being.

There is a long list of dieting options available. There are exercise programs, exercise machines, dietary supplements, dietary food and drinks, diet pills - there are even soaps which claim to help you lose pounds while you bathe.

One other available option to shed off those unwanted pounds is to go herbal.

Herbal weight loss products have been in great demand for people who want to lose weight the natural way. However, when you take herbal supplements to lose weight, you would have to wait for a longer time for the results because of the more subtle effects of medicines which came from plants and natural herbs.

Here are some herbal weight loss options that you might want to consider:

1. Herbal weight loss products

There are a lot of herbal weight loss products available in the market now. You can check out the Internet and you will find a lot of herbal weight loss pills and products.

Be careful, however, as there are some products which claim to be safe and natural because they are herbal, but some actually have side effects because of non-extensive research on the effects of these products.

Here are some ingredients and chemicals which make up some herbal weight loss products that you should watch out for, as they might have harmful effects to your health:

> Senna. This is an herbal laxative. Senna is a main ingredient in weight loss teas, and it works by stimulation the colon. The downside effect of this herb is dehydration. It can also lead to colon problems and can become addictive. Some people, when addicted, are unable to perform bowel movements without it, so watch out.

> Chromium picolinate. This is a synthetic compound found in herbal weight loss products. Chromium is a nutrient which helps regulate blood-sugar level. However, this ingredient, when taken in high doses, may cause damage in the chromosomes. It can also lead to dehydration.

> St. John's wort. This supplement increases the production of a chemical in the brain. If not used properly, it may cause eye and skin sensitivity, mild gastrointestinal distress, fatigue and itching.

Although a lot of herbal products claim to be safe and natural, it is better to scrutinize the ingredients and research about the effects of the product itself before going for these herbal dietary pills.

2. Organic food

In Wichita, Kansas, organic food has found its way to more homes and restaurants. Organic food devotees believe that consuming organic goodies help their bodies as well as the environment.

A person who buys organically raised eggs and vegetables claim to be healthier, and they are not spending money on doctors and prescriptions as these keep them healthier and away from the hospital. This could also be an option for weight watchers, as organic food is known to be kinder to your weight than chemically-processed food products.

3. Green Tea

Studies show that intake of green tea, or green tea extracts burns extra calories. Also, green tea with caffeine can increase fat burning by up to 40% thereby reducing fat.

This is one good option for those who want to lose weight. In a study done, people who took green tea were found to lose 2 to 3 times more weight than those who did not drink green tea.

These results show that green tea is a natural product for the treatment of obesity. Thus, it also makes for a healthier dietary option, not to mention the good effects that it has on the body as compared to caffeine. A cup of tea gives an emmediate energy lift without the side effects of caffeine.

3. Caffeine

Coffee provides an energy boost to increase fat burning. Caffeine also provides a likelihood to be active, which in turn increases your rate of calorie burn.

4. Immortality Herb

This herb, whose scientific name is Gymnostemna Pentaphyllum, is known to have the following benefits:

> increases healthy blood flow

> reduces artery blocks

> aids healthy blood pressure

> increases the rate of fat burning

5. Apple Cider Vinegar

There are pills and food supplements whose main ingredient is apple cider vinegar. Here are the benefits of taking this herbal option:

> weight loss

> improved cholesterol level

> improved high blood pressure

> helps prevent rheumatoid arthritis