Vitamin D supplementation and major cardiovascular events: D-Health randomised controlled trial
Abstract
ObjectiveTo investigate whether supplementing older adults with monthly doses of vitamin D alters the incidence of major cardiovascular events.
DesignRandomised, double blind, placebo controlled trial of monthly vitamin D (the D-Health Trial). Computer generated permuted block randomisation was used to allocate treatments.
SettingAustralia from 2014 to 2020.
Participants21 315 participants aged 60-84 years at enrolment. Exclusion criteria were self-reported hypercalcaemia, hyperparathyroidism, kidney stones, osteomalacia, sarcoidosis, taking >500 IU/day supplemental vitamin D, or unable to give consent because of language or cognitive impairment.
Intervention60 000 IU/month vitamin D3(n=10 662) or placebo (n=10 653) taken orally for up to five years. 16 882 participants completed the intervention period: placebo 8270 (77.6%); vitamin D 8552 (80.2%).
Main outcome measuresThe main outcome for this analysis was the occurrence of a major cardiovascular event, including myocardial infarction, stroke, and coronary revascularisation, determined through linkage with administrative datasets. Each event was analysed separately as secondary outcomes. Flexible parametric survival models were used to estimate hazard ratios and 95% confidence intervals.
Results21 302 people were included in the analysis. The median intervention period was five years. 1336 participants experienced a major cardiovascular event (placebo 699 (6.6%); vitamin D 637 (6.0%)). The rate of major cardiovascular events was lower in the vitamin D group than in the placebo group (hazard ratio 0.91, 95% confidence interval 0.81 to 1.01), especially among those who were taking cardiovascular drugs at baseline (0.84, 0.74 to 0.97; P for interaction=0.12), although the P value for interaction was not significant (<0.05). Overall, the difference in standardised cause specific cumulative incidence at five years was −5.8 events per 1000 participants (95% confidence interval −12.2 to 0.5 per 1000 participants), resulting in a number needed to treat to avoid one major cardiovascular event of 172. The rate of myocardial infarction (hazard ratio 0.81, 95% confidence interval 0.67 to 0.98) and coronary revascularisation (0.89, 0.78 to 1.01) was lower in the vitamin D group, but there was no difference in the rate of stroke (0.99, 0.80 to 1.23).
ConclusionsVitamin D supplementation might reduce the incidence of major cardiovascular events, although the absolute risk difference was small and the confidence interval was consistent with a null finding. These findings could prompt further evaluation of the role of vitamin D supplementation, particularly in people taking drugs for prevention or treatment of cardiovascular disease.
Trial registrationACTRN12613000743763
ThompsonB,WaterhouseM,EnglishD R,McLeodD S,ArmstrongB K,BaxterCet al.Vitamin D supplementation and major cardiovascular events: D-Health randomised controlled trialBMJ2023;381:e075230doi:10.1136/bmj-2023-075230
Both vitamin D insufficiency and deficiency are now well-documented worldwide in relation to human health, and this has raised interest in vitamin D research. The aim of this article is therefore to review the literature on sources of vitamin D. It can be endogenously synthesised under ultraviolet B radiation in the skin, or ingested through dietary supplements and dietary sources, which include food of animal and plant origin, as well as fortified foods. Vitamin D is mainly found in two forms, D3 (cholecalciferol) and D2 (ergocalciferol). In addition to the D3 and D2 forms of vitamin D, 25-hydroxy vitamin D also contributes significantly to dietary vitamin D intake. It is found in many animal-derived products. Fortified food can contain D3 or D2 forms or vitamin D metabolite 25-hydroxy vitamin D. Not many foods are a rich source (> 4 μg/100 g) of vitamin D (D represents D3 and/or D2), e.g., many but not all fish (5-25 μg/100 g), mushrooms (21.1-58.7 μg/100 g), Reindeer lichen (87 μg/100 g) and fish liver oils (250 μg/100 g). Other dietary sources are cheese, beef liver and eggs (1.3-2.9 μg/100 g), dark chocolate (4 μg/100 g), as well as fortified foods (milk, yoghurt, fat spreads, orange juice, breakfast grains, plant-based beverages). Since an adequate intake of vitamin D (15 μg/day set by the European Food Safety Authority) is hard to achieve through diet alone, dietary supplements of vitamin D are usually recommended. This review summarizes current knowledge about different sources of vitamin D for humans.
Benedik E. Sources of vitamin D for humans. Int J Vitam Nutr Res. 2022 Mar;92(2):118-125. doi: 10.1024/0300-9831/a000733. Epub 2021 Oct 18. PMID: 34658250.
Raspberries have been a popular fruit for centuries due to their sweet taste and numerous health benefits. Among the various types of raspberries, red and black raspberries stand out for their rich nutritional profile and therapeutic properties. In this article, we will explore the history, mechanism of action, health benefits, contraindications, nutritional information, health conditions, usage, side effects, interactions, dosing, eastern and western applications, and associated meridians of these delicious berries.
History
The history of raspberries dates back to ancient Greece. They were highly valued for their medicinal properties and were used to treat various ailments. In the 18th century, Europeans began cultivating raspberries for their culinary and medicinal uses. In the 19th century, red raspberries were introduced to North America. Black raspberries, on the other hand, are native to North America and have been used by Native Americans for centuries.
Mechanism of Action
Red and black raspberries contain various compounds such as anthocyanins, ellagitannins, flavonoids, and phenolic acids that contribute to their health benefits. These compounds have antioxidant, anti-inflammatory, and antimicrobial properties that help protect the body against oxidative stress and inflammation.
Health Benefits
The consumption of red and black raspberries has been associated with numerous health benefits. Some of these include:
Boosting the immune system: Raspberries are rich in vitamin C, which is essential for a healthy immune system. They also contain antioxidants that help protect the body against infections.
Supporting heart health: The anthocyanins in raspberries have been linked to improved cardiovascular health by reducing inflammation and improving blood flow.
Controlling blood sugar levels: Raspberries are low in glycemic index and high in fiber, making them a great choice for people with diabetes.
Promoting digestive health: The fiber and water content in raspberries can help regulate bowel movements and prevent constipation.
Protecting against cancer: The ellagic acid found in raspberries has been studied for its potential anti-cancer properties, particularly in preventing colon, breast, and prostate cancers.
Contraindications
While raspberries are generally safe for consumption, there are a few contraindications to keep in mind:
Allergies: Individuals with allergies to other berries or salicylates may also be allergic to raspberries.
Gout: People with gout should limit their intake of raspberries as they contain purines that can worsen symptoms.
Nutritional Information
Red and black raspberries are a great source of nutrients, including:
Vitamin C: One cup of raspberries (123 grams) provides 54% of the recommended daily intake of vitamin C.
Fiber: One cup of raspberries contains 8 grams of fiber, which is about one-third of the daily requirement for adults.
Manganese: One cup of raspberries provides 41% of the recommended daily intake of manganese, an essential trace mineral.
Vitamin K: Raspberries contain vitamin K, which is important for blood clotting and bone health.
Health Conditions, Illnesses and Diseases
Raspberries have been studied for their potential benefits in managing or preventing various health conditions, illnesses, and diseases:
Cardiovascular disease: The antioxidants and anti-inflammatory compounds in raspberries may help reduce the risk of heart disease.
Hypertension: Studies have shown that consuming raspberries can help lower blood pressure levels.
Obesity: Due to their low calorie and high fiber content, raspberries can be a great addition to a weight loss diet.
Usage
Raspberries can be consumed in a variety of ways, such as:
Eating them fresh or frozen
Adding them to smoothies or oatmeal
Using them in baked goods like muffins or cakes
Making homemade raspberry jam or jelly
They can also be used topically for skincare purposes, as the antioxidants and anti-inflammatory compounds in raspberries may help improve skin health.
Side Effects
Raspberries are considered safe for consumption in most people. However, some potential side effects to be aware of include:
Allergic reactions: Some individuals may have an allergy or sensitivity to raspberries, which can cause symptoms like itching, swelling, or difficulty breathing.
Pesticide exposure: Raspberries are often sprayed with pesticides, so it’s important to wash them thoroughly before consuming.
Blood thinning: Due to their vitamin K content, raspberries may interact with blood thinning medications. It’s best to consult with a healthcare provider before consuming large amounts of raspberries if you are taking these medications.
Interactions
Raspberries may interact with certain medications or supplements, including:
Blood thinners: As mentioned above, raspberries contain vitamin K which can affect blood clotting.
Diabetes medications: Raspberries may lower blood sugar levels, so it’s important to monitor your levels closely if taking medication for diabetes.
Iron supplements: Raspberries are rich in vitamin C, which can enhance the absorption of iron. If you are taking iron supplements, it’s best to avoid consuming large amounts of raspberries at the same time.
Dosing
There is no official dosing recommendation for raspberries, but it is generally safe to consume them in moderation as part of a healthy diet. It’s important to note that eating large quantities may cause digestive upset or other side effects, so it’s best to start with small servings and increase gradually if desired.
Eastern and Western Applications
In traditional Chinese medicine, raspberries are believed to have a cooling effect on the body and are used to treat conditions such as excessive sweating, irritability, and dry cough. In Ayurvedic medicine, they are also considered cooling and are used to balance excess heat in the body.
In Western herbalism, raspberries are often used to support digestion and as a general tonic for overall health. They are also commonly included in herbal remedies for respiratory conditions, such as coughs and sore throats.
Associated Meridians
In traditional Chinese medicine, raspberries are associated with the Lung meridian, which is responsible for the respiratory system and immune function. They may also have an influence on the Stomach meridian, which is related to digestion.
References
“Raspberry.” Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/raspberry
“Rubus idaeus L.” American Botanical Council. https://www.herbalgram.org/resources/macropleasures/article/raspberry/
“Red Raspberry.” University of Michigan Medicine. https://www.uofmhealth.org/health-library/hn-2157006
“Raspberry.” National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/red-raspberry
“Rubus idaeus (raspberry).” University of Maryland Medical Center. https://www.umms.org/ummc/health-services/complementary-terapias/raspberry
“Raspberry.” American Herbalists Guild. https://www.americanherbalistsguild.com/herb-library/raspberry-rubus-idayeus 7. “Health Benefits of Raspberries.” Healthline. https://www.healthline.com/nutrition/raspberry-nutrition
“Raspberries: Benefits, Nutrition Facts & How to Eat Them.” Live Science. https://www.livescience.com/51000-raspberry-nutrition.html
“The History of Raspberries.” Britannica. https://www.britannica.com/story/the-history-of-raspberries
“10 Impressive Health Benefits of Raspberries.” Organic Facts. https://www.organicfacts.net/health-benefits/fruit/raspberries.html
“Raspberry: Uses, Side Effects, Interactions, Dosage, and Warning.” WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-309/raspberry
“Raspberry (Rubus idaeus).” Herbal Medicine Materia Medica. https://herbpathy.com/Uses-and-Benefits-of-Raspberry-Cid3285
Balick, Michael J., and Roberta Lee. “The Use of Raspberry Leaf in Pregnancy: A Comprehensive Review.” Journal of Midwifery & Women’s Health 52, no. 3 (2007): 307-317.
“Raspberry Fruit Nutrition Facts and Health Benefits.” Vegetarian Times. https://www.vegetariantimes.com/health-and-nutrition/raspberry-fruit-nutrition-facts-and-health-benefits
“The Amazing Health Benefits of Raspberries.” Mercola. https://foodfacts.mercola.com/raspberry.html
“Raspberry and Blood Sugar Control.” American Diabetes Association. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/non-starchy-vegetables.html
Black cumin seed, also known as Nigella sativa, has been used for centuries in traditional medicine in the Middle East and India. It is believed to have originated from Eastern Europe and Western Asia. Its use can be traced back to ancient civilizations such as the Assyrians, Egyptians, and Greeks. In ancient Egypt, black cumin seed was considered a panacea, meaning it was believed to cure all ailments. It was used for respiratory problems, digestive issues, and as a tonic for overall health.
In traditional Ayurvedic medicine, black cumin seed was used to treat conditions such as asthma, allergies, and skin disorders. It was also believed to have anti-inflammatory and anti-bacterial properties. Over the years, black cumin seed has gained popularity and is now used in various forms of medicine, including traditional Chinese medicine and modern natural remedies.
Mechanism of Action
Black cumin seed contains many active compounds, including thymoquinone, phytochemicals, and fatty acids. Thymoquinone is believed to be the key component responsible for its therapeutic effects. Studies have shown that thymoquinone has antioxidant, anti-inflammatory, and immunomodulatory properties. It also has been found to have anti-cancer effects by inhibiting cell growth and inducing apoptosis (programmed cell death) in cancer cells.
Health Benefits
The potential health benefits of black cumin seed are numerous and have been studied extensively. Some of the reported health benefits include:
Anti-inflammatory properties: Black cumin seed has been found to have anti-inflammatory effects, which can help reduce symptoms of chronic inflammatory conditions such as arthritis and asthma.
Antioxidant effects: Thymoquinone in black cumin seed has antioxidant properties that protect against cell damage caused by free radicals.
Immune system support: Black cumin seed has been shown to enhance the immune system, making it an effective natural remedy for colds and infections.
Antimicrobial properties: Studies have shown that black cumin seed has antibacterial, antifungal, and antiviral effects, making it a potential treatment for a variety of microbial infections.
Respiratory health: Traditionally, black cumin seed has been used to improve respiratory health and treat conditions such as coughs, bronchitis, and asthma.
Digestive health: Black cumin seed has been found to have a protective effect on the gastrointestinal system, reducing inflammation and promoting healthy digestion.
Contraindications
While black cumin seed is generally considered safe for consumption, there are some potential contraindications to be aware of:
Pregnancy and breastfeeding: Due to limited research, it is recommended that pregnant or breastfeeding women avoid consuming black cumin seed as a precaution.
Allergies: As with any food or supplement, some individuals may have an allergic reaction to black cumin seed. It is important to consult with a healthcare professional if you have known food allergies before incorporating black cumin seed into your diet.
Blood thinners: Black cumin seed may interfere with blood clotting, so individuals taking blood thinning medication should consult with their healthcare provider before consuming black cumin seed.
Nutritional Information
Black cumin seed is a rich source of essential nutrients and minerals such as:
Protein
Fiber
Iron
Calcium
Magnesium
Zinc
Vitamin A, B, and C
Health Conditions, Illnesses, and Diseases
While black cumin seed has been traditionally used to treat a variety of health conditions, there is limited scientific research on its effectiveness. However, some studies have shown potential benefits for the following:
Respiratory conditions: Black cumin seed has been used to improve respiratory health and treat conditions such as coughs, bronchitis, and asthma.
Inflammatory diseases: Due to its anti-inflammatory properties, black cumin seed may offer relief for individuals suffering from inflammatory conditions such as arthritis and eczema.
Diabetes: Some studies have shown that black cumin seed may help regulate blood sugar levels and improve insulin resistance in individuals with diabetes.
High blood pressure: The antioxidant properties of black cumin seed may help lower blood pressure and reduce the risk of heart disease.
Usage and Dosage
Black cumin seed can be found in various forms:
Whole seeds: These can be eaten raw or added to dishes for a subtle nutty flavor.
Oil: Black cumin seed oil is commonly used in cooking and can also be applied topically for skin and hair health.
Supplements: Black cumin seed extract is available in supplement form, but it is important to consult with a healthcare provider before incorporating it into your routine.
The dosage may vary depending on the form and purpose of use. For general health maintenance, a daily dose of 2-3 grams of black cumin seed is recommended. It is essential to consult with a healthcare professional before starting any new supplement or herbal remedy.
Side Effects and Interactions
Black cumin seed is generally considered safe for most people when taken in recommended doses. However, some individuals may experience mild side effects such as nausea, bloating, or allergic reactions, there are some potential side effects and interactions to be aware of:
Allergic reactions: Individuals with allergies to plants in the Apiaceae family (such as celery and carrots) may also have an allergic reaction to black cumin seeds.
Pregnancy and breast-feeding: There is limited research on the safety of black cumin seed during pregnancy or while breastfeeding, so it is best to consult with a healthcare provider before consuming it.
Interactions with medications: Black cumin seeds may interact with certain medications, including those for blood pressure and diabetes. It is important to speak with a healthcare provider if you are taking any medications and considering incorporating black cumin seeds into your routine.
It is essential to discontinue use if any adverse reactions occur and consult with a healthcare professional.
Eastern and Associated Meridians
In traditional Chinese medicine (TCM), black cumin seed is known as “Hei Zhong Cao” and is believed to have a warm nature and acrid taste. It is associated with the Lung, Large Intestine, and Stomach meridians, making it useful for treating respiratory issues, digestive disorders, and promoting overall wellness. TCM practitioners also believe that black cumin seed can help strengthen the immune system and tonify the Kidney and Spleen organs, which play a crucial role in maintaining overall health.
Western Applications
In Western herbalism, black cumin seed is commonly used for its anti-inflammatory, antibacterial, and antifungal properties. It has been studied for its potential to treat various health conditions such as allergies, asthma, diabetes, cancer, and neurological disorders. Additionally, it has been used to support the immune system and improve overall metabolic functions.
Conclusion
Black cumin seed has a long history of use in traditional medicine and is still being studied for its potential health benefits. While it is generally considered safe, it is important to consult with a healthcare provider before incorporating it into your routine, especially if you have any underlying health conditions or are taking medications. Further research is needed to fully understand the mechanisms of action and potential side effects of this powerful seed. Overall, black cumin seed shows promise as a natural remedy for a variety of health conditions and may be worth considering as part of a holistic approach to wellness. As always, it is important to make informed decisions about your health and consult with a healthcare professional when making changes to your health routine. So, consider adding black cumin seed to your pantry and explore its potential benefits for yourself.
References
Ahmad A, Husain A, Mujeeb M et al. (2013). A review on therapeutic potential of Nigella sativa: a miracle herb. Asian Pacific Journal of Tropical Biomedicine, 3(5), 337-352.
Bamosa AO, Kaatabi H, Lebda FM et al. (2019). Effect of Nigella sativa supplementation on lung function and inflammatory mediators in partly controlled asthma: a randomized placebo-controlled trial. Annals of Saudi Medicine, 39(5), 342-349.
Cheikh-Rouhou S, Besbes S, Hentati B et al. (2008). Nigella sativa L.: chemical composition and physicochemical characteristics of lipid fraction. Food Chemistry, 28(4), 619-625.
Farhangi MA, Dehghan P, Tajmiri S et al. (2019). Dietary Nigella sativa supplementation improves insulin sensitivity and lipid profile in type 2 diabetic patients: a randomized, double-blind, placebo-controlled trial. Health Promotion Perspectives, 9(3), 188-193.
Kanter M, Coskun O, Korkmaz A et al. (2011). Effects of Nigella sativa on oxidative stress and beta-cell damage in streptozotocin-induced diabetic rats. Anatomical Record, 294(4), 685-691.
Salem ML (2005). Immunomodulatory and therapeutic properties of the Nigella sativa L. seed. Research Journal of Immunology, 1(2), 50-56.
Sezikli M, Koc A, Yildiz D et al. (2018). The potential anti-inflammatory and antinociceptive effects of Thymoquinone and Nigella Sativa seeds oil in a model of acute cutaneous inflammation. Turkish Journal of Medical Sciences, 48(2), 275-281.
Tajmiri S, Farhangi MA, Dehghan P et al. (2019). Nigella sativa supplementation improves asthma control and biomarkers: a randomized, double-blind, placebo-controlled trial. Phytotherapy Research, 33(4), 940-946.
Tavafi M, Ahmadvand H (2017). Nigella sativa L. and its active constituent thymoquinone: a review on antioxidant protection against natural toxins. Iranian Journal of Basic Medical Sciences, 20(2), 111-119.
Almonds have been prized for their nutritional and medicinal properties since ancient times. They are one of the oldest tree nuts still consumed today, with evidence of their cultivation dating back to at least 3000 BC in civilizations such as Egypt and Mesopotamia.
History
Almonds were originally believed to have originated in the Mediterranean region, but recent studies suggest that they may have actually originated in Central Asia. They were eventually brought to Europe by the Romans and spread throughout the world through trade routes. During medieval times, almonds were considered a luxurious food item and were often used as gifts for royalty and nobility. In fact, during this period, almonds were even thought to have magical healing powers and were used to treat various ailments.
Mechanism of Action
Almonds are a powerhouse of nutrition, providing a wide range of vitamins, minerals, and antioxidants. They are also high in monounsaturated fats, which can help reduce the risk of heart disease by lowering LDL (bad) cholesterol levels while increasing HDL (good) cholesterol levels. Almonds also contain plant-based protein, making them an excellent option for vegetarians and vegans.
One particular compound found in almonds called amygdalin has been shown to have anti-inflammatory and antioxidant properties. This compound is converted into cyanide in the body, but only in very small amounts that are not harmful to humans. This conversion occurs when the almond is chewed or ground, releasing the amygdalin and allowing it to interact with enzymes in the gut.
Health Benefits
Almonds have been linked to numerous health benefits. Some of these include:
Improved heart health: The monounsaturated fats found in almonds can help lower cholesterol levels and reduce the risk of heart disease.
Better brain function: Almonds are a good source of vitamin E, which has been shown to improve brain function and protect against cognitive decline.
Reduced risk of diabetes: Studies have shown that including almonds in your diet can help lower blood sugar levels and reduce the risk of developing type 2 diabetes.
Improved bone health: Almonds are a good source of calcium, magnesium, and phosphorus, all of which are important for maintaining strong bones.
Skin and hair health: The vitamin E and antioxidants in almonds can help promote healthy skin and hair, reducing signs of aging and preventing damage from free radicals.
Contraindications
While almonds are generally safe for consumption, there are a few contraindications to keep in mind:
Allergy: Almonds are one of the top eight allergens, so those with a tree nut allergy should avoid consuming almonds.
Digestive issues: Some people may experience digestive discomfort when consuming almonds, as they contain high amounts of fiber and can be difficult to digest for some individuals.
Nutritional Information
A 1-ounce (28 gram) serving of almonds contains:
Calories: 164
Fat: 14 grams
Protein: 6 grams
Carbohydrates: 6 grams
Fiber: 3.5 grams
Vitamin E: 37% of the recommended daily intake (RDI)
Magnesium: 20% of the RDI
Calcium: 8% of the RDI
Almonds also contain small amounts of other essential vitamins and minerals such as iron, zinc, and B vitamins.
Health Conditions, Illnesses, and Diseases
Some evidence suggests that almonds may be beneficial for managing or preventing the following health conditions:
Heart disease
Type 2 diabetes
Osteoporosis
However, more research is needed to confirm these potential benefits.
Usage
Almonds can be consumed in a variety of ways, including:
Raw or roasted as a snack
Added to salads, stir-fries, and other dishes for added crunch and nutrition
Ground into almond flour for baking
Side Effects and Interactions
In general, almonds are safe for consumption. However, consuming too many almonds may lead to digestive discomfort due to their high fiber content. Additionally, those with a tree nut allergy should avoid consuming almonds.
Almonds may also interact with certain medications, such as blood thinners and diabetes medication. It is important to consult with a healthcare professional before consuming almonds if you are taking any medications.
Dosing
There is no specific recommended daily intake for almonds, but it is generally recommended to consume them in moderation as part of a balanced diet.
Eastern and Western Applications and Associated Meridians
In traditional Chinese medicine, almonds are believed to tonify the lung and spleen meridians. They are often used to treat coughs, asthma, and digestive issues. In Western herbalism, almonds have been used to aid digestion, improve skin health, and promote overall wellness.
“Potential Health Benefits of Almonds.” https://www.healthline.com/nutrition/benefits-of-almonds
“Traditional Chinese Medicine (TCM) and the Lung Meridian.” https://www.verywellhealth.com/lung-meridian-what-you-need-to-know-for-tcm-health-4123210
“Almonds: Benefits, nutrition, and risks.” https://www.medicalnewstoday.com/articles/269468.php .”Traditional Chinese Medicine (TCM) and the Spleen Meridian.” https://www.verywellhealth.com/spleen-meridian-what-you-need-to-know-for-tcm-health-4123192
“Almonds: A Source of Healthy Fats and Nutrients.” https://www.eatright.org/food/vitamins-and-supplements/types-of-vitamins-and-nutrients/almonds-a-source-of-healthy-fats-and-nutrients. .”Herbs and Supplements: Almonds.” https://www.uofmhealth.org/health-library/hn-4386006
“TCM Diagnostics for Common Digestive Disorders.” https://www.emperorsherbologist.com/tcm-diagnostics-common-digestive-disorders/.
“Traditional Chinese Medicine (TCM) and the Liver Meridian.” https://www.verywellhealth.com/liver-meridian-what-you-need-to-know-for-tcm-health-4123208