Self-esteem Vs self-compassion (Part 1)

Welcome to this 2-part episode of the 21st century health nuts,

This will be a two-part release, this post (part-1) will look at the current social and psychological paradigm of self-esteem, its pitfalls, and look deeper into the sociological impacts governed by and contributing to the issues. The following post (part-2) will define, analyse and critically assess the viability of self-compassion as an alternative in our world as it stands. So let's get started...

Self-esteem and the consequences

For the past decade the primary measure of psychological health has been self-esteem [1]. Self-esteem is defined as a global evaluation of your own worth, you ask, 'How good am I?' and you respond 'Hmm pretty poor to be honest' or 'I'm the best thing going!' Recently however, researchers have begun to criticize self-esteem, to ask the question 'How good am I?' must relate to some predetermined standard of what good is, alongside the requirement for social comparison, 'I am better/worse than that person.' This inevitably results in self-evaluation in relation to the performance of others. Social comparison is never a good idea, if you truly are worse than somebody it is detrimental to motivation and happiness (feel of less value), and if you truly are better than them motivation begins to slide and happiness along with it (as a result of complacency and  lack  of  future

goals) [2]. Nowadays, social media sites (such as facebook) make social comparison almost unavoidable, even provoking jealous, envy, or pity with a specific type of status. Furthermore, these standards are typically defined by the media, for example body image has never been a bigger issue than it is now [3] men and women alike are having to compete with the most sexually desirable celebrities to be considered worthy of attraction and affection. It cannot be disputed that low levels of self-esteem is linked with negative psychological mind states such as stress, depression, anxiety, sadness, and suicidal ideation [1]. However, it is less clear that high self-esteem is the panacea suggested. As well as being highly resistant to change [4], if changed to high self-esteem some negative corollaries are associated. For example, Damon [5] and Seligman [6] argue that an over-emphasis on evaluation can result in narcissism, self-absorption, self-centredness, and a lack of concern for others. Which makes sense, how do you present yourself in best light compared to others? You observe the worst traits of those surrounding you. Or as a child lacking the psychological skills to manipulate reality you physically assert superiority (bullying). Supporting this high self-esteem is also correlated to increased prejudice [1,7] and the use of aggression and violence to thwart any person or persons threatening the ego [8].

To be called mediocre or average is nothing short of an insult in the 21st century, we are not content unless we are above average. Obviously we cannot all be above average and so we allow ourselves to inflate our perception of ourselves; enter narcissism (exaggerated view of one's own value, craving for admiration, and selfishness). Recently, our facebook page released a narcissism personality index (NPI) test to see how narcissistic we all are, the reason for this is that narcissism is on the increase, and has been for over 30 years. A study by Twenge & Foster [9] re-assessed the results of three meta-analysis' of contradicting views on narcissism and controlled for the significant effect of different campus' as data collection and comparison points concluding that, between 1982-2009, NPI scores significantly increased a) in a nationwide meta-analysis, b) within campus in large samples from a southern University. It is a perfectly acceptable position to hold that the degree of narcissism in USA college students has not increased at all, but a cultural development has resulted in students being more honest, resulting in increasing NPI scores. However, strong evidence supports the notion that narcissistic behaviour is  increasing;  number  of  unique  names  given  to newborns is increasing [9],

more popular songs include narcissistic and individualistic lyrics [10], high school students express unrealistically high expectations for success [11], and the number of plastic surgery cases is increasing [12]. Additionally, a clinical report [13] employed structured clinical interviews as opposed to self-reported means of data collection deducing that  in a national representative population of 34,653 Americans (2004-2005) 3.2% of subjects aged over 65 had experienced narcissistic personality disorder (NPD), whereas 5.6% aged 45-64, 7.1% aged 30-44, and 9.4% aged 20-29. If there was no newborn cohort then the older subjects with many more years of experience should display a greater percentage of NPD encounters. Narcissism is a serious social and psychological problem, people high in this trait fail to help others unless there is immediate recognition to themselves for doing so. They often trample others in an effort to rise to the top where they believe they belong and are commonly unhappy with the world not recognising their superiority. Narcissists typically display low empathy traits, empathy refers to the ability and tendency to view the world from points of view other than your own, to share in others' joy and sorrow and to care about their well-being. And so with this increase in NPI scores and NPD experiences illustrating the cultural effect of self-esteem it can concluded that the aforementioned negative effects of self-esteem (such as self-absorption, self-centredness, lack of concern for others, increased prejudice, bullying, violence and aggression in defense of own ego) are also unnecessarily existing in our current environment.

Other factors contributing to the 'me' society

Nevertheless, self-esteem only correlates .25 to narcissism and so there must be other cultural changes that have caused increases in self-absorbed personality traits. Interestingly, a decline in children's free-play time with other children has been documented [14,15]. Free-play is linked with increased empathy, the ability to get along with others, the capacity to problem solve and deal effectively with fear and anger (thus effectively safeguard against anxiety and depression) [14]. It has even been recognized that mental disorders in young Americans has steadily increased between 1938 - 2007 [16]. The study concludes by stating that like all individual characteristics psychopathological symptoms are determined by a number of factors, genetics offer much more explanation that an individuals family environment as a predictor of neuroticism. However large changes in the Minnesota multiphasic personality inventory (MMPI) scores demonstrate that there are also strong cultural influence on psychiatric symptoms. That is, an environmental influence outside of the individual family. Over time, culture has increasingly shifted towards an environment in which more and more young people experience poor mental health and psychopathology, possibly due to an increased focus on money, appearance, and status rather than on community and close relationships. Moreover, free-play is by definition voluntary and so when engaging child X must accept the perspective and wishes of child Y, otherwise child Y will leave. A harsh punishment for a mammalian infant hardwired for communication and growth. And so child X must now try harder to accommodate for child Y, this cycle is perpetually improving the communication and intra- and inter-personal skills of the subjects. Furthermore, children are raised in an extremely competitive environment where winning at any cost is the only option. We have never been more closely linked to celebrities, this proximity to celebrity status has furthered the drive for fame and success, this alongside the life lesson that others are solely obstacles to be beaten or tools to be manipulated to get to the next goal results in an individualistic and self-absorbed society. Of course in this type of society we are going to lack empathy, prejudice those from other background to reinforce the solidity of our origins. And why would we give up our time to help others if it won't fit onto our CV? If not then why bother?

Finally, if all of the points made do not get you questioning whether self-esteem is the best paradigm for yourself and this culture, consider that self-esteem is contingent on success, if we fail our global value must decrease unless everyone else in the world failed too.  How do we remove ourselves from this perpetual battle to perceive ourselves as better than all the rest? 

Conclusion

As you can see there are many flaws with the current aim of promoting , achieving, and maintaining high self-esteem. The benefits of self-esteem come hand in hand with negative psychological traits that are so common we consider them socially desirable. Self-compassion is a contemporary model that offers the benefits of self-esteem without the pitfalls of egotistical isolation upon failure. Many argue that compassion is not only 'fluffy' but a surefire road to passivity, complacency, and being exploited. I sincerely hope that your inquisitive and open-minded nature will encourage you to read the coming post and decide for yourself whether or not self-compassion is non-sense or the pathway to an improved life.

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Main sources

[1] Neff, K. (2003) Self-compassion: An alternative conceptualization of a healthy attitude towards oneself. Self and Identity, 2: pp85-101.

[2] Hill, K.L. (2001) Frameworks for sport psychologists: enhancing sport performance. Human Kinetics.

[3] Albertson, E.R., Neff, K.D. & Dill-Shackleford, K.E (2014) Self-compassion and body dissatisfaction in women: A randomized controlled trial of a brief meditation intervention. Mindfulness, 1-11.

[4] Swann, W.B. (1996). Self-traps: The elusive quest for higher self-esteem. New York: Freeman.

[5] Damon, W. (1995). Greater expectations: Overcoming the culture of indulgence in America’s homes and schools. New York: Free Press.

[6] Seligman, M.E. (1995). The optimistic child. Boston: Houghton Mifflin.

[7] Aberson, C.L., Healy, M., & Romero, V. (2000). Ingroup bias and self-esteem: A meta-analysis. Personality & Social Psychology Review, 4(2): pp157–173.

[8] Baumeister, R.F., Smart, L., & Boden, J.M. (1996). Relation of threatened egotism to violence and aggression: The dark side of high self-esteem. Psychological Review, 103(1): pp5–33.

[9] Twenge, J.M. & Foster, J.D. (2010) Birth cohort increases in narcissistic personality traits among American college students, 1982–2009. Social Psychological and Personality Science, 1(1): pp96-106.

[10] DeWall, C. N., Pond, R. S., Campbell, W. K., & Twenge, J. M. (2009). Tuning in to psychological change: Linguistic markers of selfishness, loneliness, anger, anti-social behavior, and misery increase over time in popular U.S. song lyrics. Unpublished manuscript.

[11] Reynolds, J., Stewart, M., MacDonald, R., & Sischo, L. (2006). Have adolescents become too ambitious? High school seniors’ educational and occupational plans, 1976 to 2000. Social Problems, 53(2): pp186-206.

[12] Twenge, J.M., & Campbell, W.K. (2009). The narcissism epidemic: Living in the age of entitlement. New York: Free Press.

[13] Stinson, F.S., Dawson, D.A., Goldstein, R.B., Chou, S.P., Huang, B., Smith, S.M., Ruan, W.J., Pulay, A.J., Saha, T.D., Pickering, R.P. Grant, B.F. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69(7): pp1033-1045.

[14] Connolly, J.A., & Doyle, A. (1984). Relation of social fantasy play to social competence in preschoolers. Developmental Psychology, 20(5): pp797–806.

[15] Burns, S.M., & Brainerd, C.J. (1979). Effects of constructive and dramatic play on perspective taking in very young children. Developmental Psychology, 15(5): pp512–521.

[16] Twenge, J.M., Gentile, B., DeWall, C.N., Ma, D., Lacefield, K. & Schurtz, D.R. (2010). Birth cohort increases in psychopathology among young Americans, 1938-2007: A cross-temporal meta-analysis of the MMPI. In press, Clinical Psychology Review 30(2): pp145-154.

Redefining the 21st Century Health Nut

Good afternoon readers!!

This series contains critical reviews of contemporary fads, trends and in some cases myths surrounding the 21st century health industry. Just as important as these scientific analyses this series also proposes philosophical and thought provoking ideas to grapple with the ideologies and infrastructure supporting the current system.

The definition of a '21st century Health Nut' has already been given in the original post of this series 'The 21st Century Health Nuts.' However, I feel this definition falls short of what needs to be conveyed. The definition as it currently stands is 'typically (but not necessarily) relatively young and is obsessed with the prolonging of life through healthy habits, whether this include diet, exercise, mindfulness the health nut covers a wide range of people.' However, after the publication of 'Is the health industry exploiting your desire to live forever?' it became apparent that we are all obsessed with prolonging our lives, it is this innate and sub-conscious 'will to immortality' that creates an existential struggle whilst projecting ourselves into the future. The defining characteristic in the previous definition is the methods by which a person attempts to extend their life; 'healthy habits, whether this include diet, exercise, mindfulness'. Yet, this is a crude method of measurement as the subtlety and sensitivity is near non-existent. Either the subject does partake in one of these methods or the subject does not. As with all things in life a parsimonious model (approach) should be selected over competing models including more assumption (Occam's razor), but this does not justify dramatic reduction excluding vital components. So what are these vital components that contribute to a 21st century health nut? (In no particular order)

Life extension

A health nut wishes and actively seeks out methods of extending the life of themselves and others around them. After all, isn't this why we decide to eat healthy, do exercise and persevere through hardship? However, this quality alone encompasses life as a whole, not just humans. The snake who strikes to defend himself is doing just this, the virus who alters the immediate environment to increase survival percentage cannot be classed as a health nut. The previous defining factor of method as previously mentioned holds no subtlety and so we must look elsewhere to create a holistic definition of a health nut.

Acquirement of knowledge

Knowledge is the engine behind a health nut, without knowledge the subjects survival is less promising than the virus and s/he is more gullible to false information resulting in hapless and inept venture at life extension. It is this procedure of seeking out information that begins to add a certain dynamic to the health nut definition. However, the source of information must be considered and therefore it is the quality of information that highlights a key trait, that is that information is gathered from multiple, high quality sources. Although, this offers no clarity on the processing of information, and could result in  blindly submitting to the conclusions of others. Hence the requirement for 'critique of knowledge.'

Critique of knowledge

There are a myriad of benefits to be had by constantly critiquing the world around you, such as increased self-confidence, motivation, understanding, and rationality. By critiquing information a person separates themselves from subjects being told what to eat and how to train to one capable of wholly understanding what is being suggested and generating their own perspective and fully-informed decision.

Spirituality

Spirituality is vital to the healthy existence of humans, on an individual and global level. Gaia theory suggests that the Earth is a single organism that we partake in. Healthy spirituality can not only aid in the attempt of 'life extension' but also creates harmony and congruence between yourself and your surroundings. In the 21st century it is all too easy to spend your time in your head dwelling in the past or projecting into the future, the now is forgotten (a soon-coming post will look deeper into the need for living in the now and spirituality). After all, the previous components have resulted in you gathering and assessing knowledge to generate your own perspective and lead yourself to the healthy life you dream of. How can this be completed without a true understanding of yourself, your world, and what it is exactly you want, not what you should want.

To Conclude

The absolute grey-ness of the world is difficult to encapsulate with the use of our limited vocabulary but these key components of a successful health nut definitely provide the scaffolding for future definitions to be framed and people to get a grasp of. These traits are not exclusive to the health aspect of your life, to take and appropriately apply certain or all of these will lead to an improved understanding of yourself fostering a better perception and expression of politics, science, literature and even your social life. The capacity for these vital components to spread throughout our lives accentuates our personal responsibility to arm ourselves with correct information and resist the temptation to believe and submit to the large corporations that send messages down the pipelines to get us to partake in the newest method of improving your life (and typically spending money). As suggested in 'The 21st Century Health Nuts' the exponential increase information exposure has resulted in our need to evolve. This revolution is personal and internal before it can become anything greater. And so take it upon yourself to question what you are told, think before you act and spend time getting to grips with yourself and what your goals are, not the goals you are expected to have.

Your very own health nut,

Chris

If you liked this, catch up with previous posts below or select an interest in the 'What would you like to read about' tab on the right

Juice +: Critical review of fruit and vegetable concentrates

Welcome,

This is a fan requested post on juice plus (juice +), the potential health benefits fruit and veg (F+V) and whether or not these encapsulated concentrates offer what they say. WARNING: science involved! But who doesn't like a bit of that?

We have all been told to 'eat your greens' or make sure you get your 'five a day' or even the age old 'an apple a day keeps the doctor away'. These have been used for centuries and are still around, surely this points to the possibility that F+V are good for you. To save the suspense, they are! Unbelievably vital to prolonging a healthy life and preventing illness. Increased F+V consumption is associated with reduced risk of many chronic diseases [1,2]. So what is it that makes F+V so good?

What is so good about fruit and veg?

F+V contain vast amounts of antioxidants. These are agents that prevent oxidizing atoms (oxygen-containing free-radical cells) from causing oxidative stress (oxidizing things). This is extremely important to your health as these free-radical cells are highly unstable, charged and cause oxidative stress within cells. They can take or donate electrons at will causing unprecedented damage to cells, proteins, lipids, and even DNA. This DNA damage is a common origin of cancerous cells. This oxidative damage to lipids, proteins and DNA is linked to a number of chronic diseases [7]. It is impossible for us to avoid free-radical damage because our systems are far from perfect (some argue this is the primary cause for ageing) however the serious damage occurs when free-radical numbers accumulate beyond what is manageable by the antioxidants. Therefore, the war between free-radical cells and antioxidants looks best for you with the most antioxidants on the field. Antioxidants are predominantly available in vitamin E, vitamin C, and beta-carotene; so getting these in your diet is vital.

F+V contain folate or folic acid (a B vitamin) that has been inversely correlated with homocysteine levels. elevated levels of homocysteine is very dangerous and is linked to increased independent risk of cardiovascular disease [3]. Additionally, homocysteine levels are a predictor of all-cause mortality in adults [4] essentially stating that with increased homocysteine levels you are at a higher risk of death. Consequently, a higher folate status (and therefore lower homocysteine status) is something that everybody should strive for.

The list of positives from F+V does go on and on however journal articles primarily focus on physiological markers such as oxidative stress, antioxidant levels, folate status and homocysteine levels. As a result, this review will focus on these health markers to remain concise.

The sad truth

So if I tell you that F+V consumption can increase antioxidant levels (therefore neutralizing more free-radical cells) as well as increase folate status (therefore decreasing homocysteine levels) you would go eat them right? Maybe, but the chances are it would not last, this is a result of a statistical phenomena stating any extreme scores will regress towards the norm (reversion to mediocrity) and unfortunately for you and everybody else the norm is not looking too good. 50% of households were found to consume less than the recommended daily intake of F+V in the following countries: Germany, Belgium, Greece, Hungary, Republic of Ireland, Luxembourg, Norway, Poland, Spain, UK (year 2000) [5]. And it's not like the government is not trying to show the light to the public. Despite a USA national campaign for increased F+V consumption from 1991 - 2002 Americans' F+V consumption level did not significantly increase by 2002, only 32% of adults met their daily recommended intake [6].

At this point it is pertinent to bring in juice + and other F+V powder concentrates as these products present the potential to make greater F+V consumption easier and cheaper for the masses.

What do the journals have to say?

The study of juice + and other F+V concentrate capsules is not new to the science scene. Almost 20 years ago, in 1996, it was established that the antioxidant quality in juice + did not significantly differ compared to fresh F+V. This implies that in vitro assays measuring antioxidant potential, one capsule (1g) is equivalent to ~10g of F+V [8]. In 2004, 59 subjects were assessed (aged 40-60) over 14 weeks consuming a placebo or a F+V supplement. Significant increases in beta-carotene, vitamin C and E, selenium (antioxidants), and folate were observed after active supplementation [9]. Over a shorter period (6-weeks) supplementation  resulted in increased antioxidants, vitamin A and C in addition to reduced homocysteine count [10]. 60 Japanese subjects of mixed age, gender and smoking status demonstrated significantly increased beta-carotene (528%), folate (174.3%) and decreased homcysteine levels (-19.9%) while decreasing disease risk and oxidative stress after 28 days of consuming F+V concentrate. Additionally, it was noted that smokers and non-smokers responded similarly suggesting F+V concentrate supplements may assist in relieving disease risk brought about by smoking; even if cessation of smoking is preferably advised [11]. This is supported by Housten et al., [12], Novembrino et al., [13], and Bamonti et al., [14] who found in 2007, 2011, and 2013, respectively, that consumption of F+V capsules resulted in improved pulmonary and cardiovascular parameters, decreased blood pressure, total and LDL cholesterol, oxidative stress, homocysteine levels and increased artery compliance, folate status, beta-carotene, and important antioxidants. Daily ingestion of moderate amounts of juice concentration has also been shown to reduce the immediate adverse artery flow effects of high-fatty meals [15]. I will conclude this section with the main points of a 2011 systematic review assessing previous journal utilising F+V concentrates as clinical interventions. Overall the majority of studies demonstrate F+V capsules have a high bioavailability and as such are capable of improving serum concentrations of folate and major antioxidant vitamins (C+E) and carotenoids. The majority of studies also indicated a potential for F+V capsules to decrease inflammatory biomarkers and improve immune function in addition to decreasing oxidation of lipids, proteins and DNA. [16] ‘While these supplements are not meant to replace a healthy and well balanced diet rich in fruits and vegetables, they may provide a useful means by which individuals can improve intake of FV bioactives.’ [16].

There are always two sides to a story, and the other side of this story is short and under-researched but demands acknowledgement. A 2010 paper in the American journal of medicine reporting a 51-year old woman with endometrial cancer developed liver problems that dissipated 4-weeks subsequent to the cessation of juice + consumption [17]. It is speculated that juice + caused this liver inflammation. Some cancer treatments (chemotherapy) produce free-radical cells to fight the disease, it could be a possibility that the increase in antioxidants prevented the cancer treatments from working effectively. However, such speculation exists far beyond the scope of this blog. This case highlights the necessity for subjects suffering from illness to consult their doctor before taking to alternative treatments as some side-effects may be unknown at present. Nevertheless, this is the only case of liver inflammation associated with F+V concentrates to date, most people report mild (upset stomach to begin with; fairly typical of supplements) or no side-effects.

Conclusion

Are the final products bio-available? Do the F+V concentrates offer health benefits similar to fresh F+V? Are their any side-effects or dangerous drawbacks? 

From the current literature it can be posited that F+V concentrates offer similar nutritional benefits to F+V consumption. The bio-availability is high and it can therefore be speculated that the nutritional value of the original F+V is not significantly reduced or damaged . There is a report of a dangerous side-effect however these are exiguous. Howbeit, a close eye must be kept on up-to-date research to ensure what you are putting in your body is a good idea. With the evidence presented before you what conclusions do you draw? Would you feel good taking these capsules? I know what my answer is, but that is not really any use to you now is it? It does seems that whether male, female, European, American, smoker or non-smoker, you can benefit from this product. I cannot reinforce enough that you must consult your doctor if you have any pre-existing conditions. It feels good to publish this preventing my literature from descending into yet another controversial, fear promoting, and ultimately life-paralyzing blog. As for those sites and countless TV programmes...fear fosters in ideas not fully understood, spend time to wrestle with and understand the details of ideas. Knowledge will one day replace fear and ignorance but you must take it upon yourself to start the revolution.

I cannot thank you enough for reading and promoting this site,

your very own health nut,

Chris

Main sources:

[1] Hung, H.C., Joshipura, K.J., Jiang, R. Hu, F.B., Hunter, D., Smith-Warner, S.A., Colditz, G.A., Rosner, B., Spiegelman, D. & Willet, W.C. (2004) Fruit and vegetable intake and risk of major chronic disease. Journal of the National Cancer Institute, 96(21): pp1577-1584.

[2] Block, G., Patterson, B. & Subar, A. (1992) Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence. Nutrition and Cancer, 18(1): pp1-29.

[3] Herrmann, W. (2001) The importance of hyperhomocysteinemia as a risk factor for diseases: an overview. Clinical Chemistry and Laboratory Medicine: CLM/FESCC, 39(8): pp666-674.

[4] Herrmann, W. & Knapp, J.P. (2002) Hyperhomocysteinemia: a new risk factor for degenerative diseases. Clinical Laboratory, 48(9-10): pp471-481.

[5] Naska, A., Vasdekis, V.G., Trichopoulou, A., Friel, S., Leonhauser, I.U., Moreiras, O., Nelson, M., Remaut, A.M., Schmitt, A., Sekula, W., Trygg, K.U. & Zajkas, G. (2000) Fruit and vegetable availability among ten European countries: how does it compare with the `five-a-day' recommendation? The British Journal of Nutrition, 84(8): pp549-556.

[6] Casagrande, S.S., Wang, Y., Anderson, C. & Gary, T.L. (2007) Have Americans increased their fruit and vegetable intake? The trends between 1988 and 2002. American Journal of Preventative Medicine, 32(4): pp257-263.

[7] Halliwell, B. (2007) Oxidative stress and cancer: have we moved forward? The Biochemical Journal, 401(1): pp1-11.

[8] Chambers, S,J., Lambert, N., Plumb, G.W. & Williamson, G. (1996) Evaluation of the antioxidant properties of a methanolic extract from ‘Juice Plus fruit’ and ‘Juice Plus vegetable’ (dietary supplements). Food Chemistry, 57(2): pp271-274.

[9] Kiefer, L., Lawrence, C., Wise, J., Bieger, W., Bayer, P., Rathmanner, T., Kunze, M. & ieder, A. (2004) Supplementation with mixed fruit and vegetable juice concentrates increased serum antioxidants and folate in healthy adults. Journal of the American College of Nutrition, 23(3): pp205-211.

[10] Samman, S., Sivarajah, G., Man, J.C., Ahmad, Z.I., Petocz, P. & Caterson, I.D. (2003) A mixed fruit and vegetable concentrate increases plasma antioxidant vitamins and folate and lowers plasma homocysteine in men. The Journal of Nutrition, 133(7): pp188-193.

[11] Kawashima, A., Madarame, T., Koike, H., Komatsu, Y. & Wise, J.A. (2007) Four week supplementation with mixed fruit and vegetable juice concentrates increased protective serum antioxidants and folate and decreased plasma homocysteine in Japanese subjects. Asian Pacific Journal of Clinical Nutrition, 16(3): pp411-421.

[12] Houston, M.C., Cooil, B., Olafsson, B.J. & Raggi, P. (2007) Juice powder concentrate and systemic blood pressure, progression of coronary artery calcium and antioxidant status in hypertensive subjects: a pilot study. Evidence-Based Complimentary and Alternative Medicine: eCAM, 4(4): pp455-462.

[13] Novembrino, C., Cighetti, G., De Giuseppe, R., Vigna, L., De Liso, F., Pellegatta, M., Gregori, D., Maiaavacca, R. & Bamonti, F. (2011) Effects of encapsulated fruit and vegetable juice powder concentrates on oxidative status in heavy smokers. Journal of the American College of Nutrition, 30(1): pp49-56.

[14] Bamonti, F., Pellegatta, M., Novembrino, C., Vigna, L., De Giuseppe, R., De Liso, F., Gregori, D., Noce, C.D., Patrini, L., Schiraldi, G., Bonara, P., Calvelli, L., Maiavacca, R. & Cighetti, G. (2013) An encapsulated juice powder concentrate improves markers of pulmonary function and cardiovascular risk factors in heavy smokers. Journal of the American College of Nutrition, 32(1): pp18-25.

[15] Plotknick, G., Corretti, M.C., Vogel, R.A., Hesslink, R. & Wise, J.A. (2003) Effect of supplemental phytonutrients on impairment of the flow-mediated brachial artery vasoactivity after a single high-fat meal. Journal of the American College of Cardiology, 41(10): pp1744-1749.

[16] Esfhani, A., Wong, J.M., Truan, J., Villa, C.R., Mirrahimi, A., Srichaikul, K. & Kendall, C.W. (2011) Health effects of mixed fruit and vegetable concentrates: a systematic review of the clinical interventions. Journal of the American College of Nutrition, 30(5): pp285-294.

[17] Naing, A., Aaron, J. & Kurzrock, R. (2010) Juice plus or toxicity plus. The American Journal of Medicine, 123(1): e1-e2.