Natural Energizers: A Better Boost
There are a number of substances that can give us a boost without compromising our health.These safe and natural supplements don't deplete our reserves. Instead they help us to:
- Sustain our energy.
- Raise our spirits.
- Optimize our performance.
- Overcome our cravings to addictive stimulants.
Adaptogens: Support Your Adrenals
Since the adrenal glands are the foundation of natural energy and stimulation, we will start by looking at your level of adrenal health. Check your score on the Stress questionnaire on. If your score is above 40, chances are your adrenal glands are depleted. Use the recommendations in the following section to help to restore their function. Remember, if you are stressed out, don't use stimulants, which can cause further burnout.
While Western medicine tends to ignore adrenal function unless it is either extremely low or high, traditional Chinese medicine (TCM) has subtle ways of diagnosing and treating adrenal overuse and burnout. It relies on the principles of balancing the opposites in the mind, body, and spirit. The goal is to restore the natural flow of energy using specific herbs called adaptogens. These herbs help the body adapt to a range of stresses, such as heat, cold, exertion, trauma, sleep deprivation, toxic exposure, radiation, infection, and psychological stress. They have few, if any, side effects, are effective for treating a wide variety of illnesses, and help return the body to homeostasis – its natural balance. By supporting and rebuilding the system in this way, adaptogens promote feelings of increased energy and well-being, with no tolerance, downregulation, or addiction.
Several groups of products help restore and enhance energy. These are the "adaptogenic" herbs, amino acids, and vitamins.
Adaptogenic herbs include ginseng (Siberian, Asian, or American), ashwaganda, licorice, reishi mushroom, and rhodiola. The stimulating amino acids include phenylalanine and tyrosine, while vitamins include pantothenic acid (vitamin B5) and vitamin C, needed to make adrenaline and cortisol. Finally, three other substances – green tea, coenzyme NADH, and coenzyme Q10 – are also excellent additions to your anti-exhaustion arsenal.
Taking these substances won't give you the kind of instant jolt you'd expect from a cup of coffee or a cigarette, or the intensity of cocaine or amphetamines, but they deliver a consistent and more sustainable level of energy, alertness, and well-being. Once you feel this good, your desire for stimulants will fall away.
The more stressful your lifestyle, the more nutrients you need. To complete your program, add the energizing and de-stressing exercises covered in Part Three.
Ginseng: King of Tonics
In continuous use in China for more than 2,000 years, ginseng, called "the king of all tonics," restores vital energy throughout the entire body, helping to overcome stress and fatigue and to recover from weakness and deficiencies. There are actually three different herbs commonly called ginseng: Siberian ginseng (Eleutherococcus senticosus), Asian ginseng (Panax ginseng), and American ginseng (Panax quinquefolius). The Siberian herb is not really ginseng at all, but the Russian scientists who researched it found that it functions nearly identically.
Asian ginseng is a perennial that grows in northern China, Korea, and Russia. In traditional Chinese terms, Asian ginseng is seen as more yang, or stimulating, than yin. It raises body temperature, improves digestion, strengthens the lungs, and calms the spirit. Its close relative, American ginseng, is cultivated in the United States, though largely exported to Asia. It is prized there as a yin herb – less heating, less stimulating, and more balanced than Asian ginseng.
The active ingredients in ginseng are called ginsenosides. There are many different ones, each having its own specific effects. Most of the modern-day research has been done on the clinical effects of single components. In 1988, a German university professor, E. Ploss, published a summary and analysis of studies on the clinical use of Asian ginseng, followed in 1990 by a review by U. Sonnenborn and Y. Proppert. All together, these articles surveyed thirty-seven experiments done between 1968 and 1990, on a total of 2,562 cases, with treatments averaging two to three months. In thirteen studies, the individuals showed an improvement in mood, and in eleven, improvement in intellectual performance. All showed a near absence of side effects.
Ginseng is available as powdered root in capsules or tablets, or as an alcohol-based tincture. The recommended dose is 100-200 mg daily of a standardized extract containing 4 to 7 percent ginsenosides. The Russians have been far ahead of us in their recognition of Siberian ginseng, which is a valuable, less costly ginsenglike herb. In the 1940s, a Russian scientist concluded that Siberian ginseng was as good as the "real" ginsengs. Russian athletes take Siberian ginseng for months before the Olympics. Cosmonauts take it to remain alert and energetic, to help with the physical and mental stresses of life in space. It can be taken for a longer time than chemical products, since it is less stimulating.
Besides protecting the body from stress, Siberian ginseng also increases oxygenation of the cells, thereby increasing endurance and the ability to handle heavy workloads, and it improves alertness and visual-motor coordination. Siberian ginseng also tones up the body while adjusting and normalizing blood pressure and blood-sugar levels. It has the rare ability to boost both immediate and long-term energy. Research shows Siberian ginseng to be effective in improving intellectual performance and enhancing mental stamina. This makes it useful in the elderly, particularly when combined with ginkgo.
Whether you're overworked, exhausted, coping with a hangover, or involved in a taxing job such as long-distance driving, ginseng is an ideal antidote. In these cases, short-term use is all you need to get you through the emergency. It can be used safely in the long term, as well, to help you cope with the stresses of daily life.
Siberian ginseng is taken at a dose of 200-400 mg daily of standardized extract, containing greater than 1 percent eleutherosides. The dose of tincture is 5 ml twice daily of a 1:5 concentration (that is, 5 parts alcohol to 1 part ginseng).
Siberian ginseng is the safest and healthiest known stimulant, with generally no side effects. It contains no steroids or other dangerous chemical agents. It does not have the depressing qualities or addictive potential of most other pharmacological and biological stimulants, such as caffeine, amphetamines, and cocaine. It doesn't "stress" the system in stimulating it and doesn't provoke any downregulation.
As with any substance, however, allergy can occur with ginseng. Menstrual abnormalities and breast tenderness have been reported with Asian ginseng; so, for women, Siberian ginseng is often recommended instead. Overuse can cause overstimulation, including insomnia in those who are in a more advanced stage of adrenal exhaustion. Unconfirmed reports of excessive doses raising blood pressure and increasing heart rate have been largely discredited. In traditional Chinese medicine, ginseng is prescribed for pregnant women, but, as with any herb, pregnant women should use ginseng only under the care of a health-care practitioner.
According to Chinese tradition, ginseng is best used as part of a two-month restoration program. This is a time to gather and store energy, with a plan that incorporates exercise, rest, and relaxation, and avoidance of stress, drugs, and alcohol. Coupled with regular ginseng intake, this approach helps to build reserves of energy and vitality. Traditional sources recommend that you take a short break from ginseng after this renewal period. After that, it can be used as a tonic as needed. The German Commission E, a body similar to the U.S. Food and Drug Administration (FDA), concurs, recommending no more than three months at a time on any of the ginsengs, including Siberian.
Maureen's case is a good example of the appropriate use of ginseng:
Maureen, a forty-year-old actress, complained of being exhausted for the previous six months. She had trouble sleeping, couldn't get out of bed in the morning, and would collapse after only 15 minutes of light exercise. I prescribed Siberian ginseng (200 mg, twice daily), along with licorice root and reishi mushrooms. Within four weeks, she was sleeping well and felt rested, able to get up easily in the morning. She was even able to exercise moderately for 30 minutes with no fatigue.
Ginseng – Siberian, Asian, and American
How they work: Adaptogens; support the adrenal glands.
Positive effects: Enhance the body's response to stress; decrease feelings of anxiety and stress; increase immediate energy (stimulants); restore vitality, energy, and endurance over time (tonics); increase mental and physical performance.
Cautions: None for Siberian ginseng. For Asian ginseng, possible menstrual abnormalities and breast tenderness. Overuse can cause overstimulation, including insomnia in sensitive individuals. Take a one-month break after taking ginseng for three months.
Dosage: 200-400 mg daily of Siberian ginseng; or 100-200 mg daily of Asian or American ginseng (standardized extract containing 4 to 7 percent ginsenosides).
Ashwaganda: Indian Ginseng
An herb from India used in traditional Ayurvedic medicine, ashwaganda (Withania somnifera), also known as Indian ginseng, is increasingly being integrated into Western herbal practice. A versatile adaptogen, ashwaganda can enhance the immune system, boost energy, calm the stress response, and reduce levels of the stress hormone cortisol. It can also enhance memory and mental acuity due to its antioxidant effect and ability to increase acetylcholine-receptor activity. On top of all this, it's an aphrodisiac!
Ashwaganda also increases thyroid hormone levels and basal body temperature – speeding up the metabolism – in some people. In a study on animals with arthritis, ashwaganda proved better at reducing symptoms than hydrocortisone, suggesting that it has potent effects on adrenal hormone balance.
Ashwaganda (Withania somnifera)
How it works: Acts as an adaptogen; stabilizes cortisol levels; acetylcholine enhancer.
Positive effects: Energizes and calms; reduces high cortisol levels; enhances libido, memory, and cognition.
Cautions: None.
Dosage: 300 mg two to three times daily.
Licorice: Balancing Act
Licorice root (Glycyrrhiza glabra) provides support for the adrenal glands, helping with mild adrenal insufficiency and hypoglycemia. It is also used in women for its estrogen-balancing properties. It stimulates the adrenal cortex to elevate cortisol and adrenal sex hormones by preventing their breakdown. So if you take licorice, the cortisol you make lasts longer. While we have repeatedly talked about cortisol as negative, it is essential in the short-term handling of stress. Only under chronic stress does it become a problem.
Licorice helps to raise low blood pressure, which often accompanies chronic fatigue, but this can also lead to hypertension (high blood pressure) in susceptible individuals. To avoid this side effect, the deglycyrrhinized form is used in many instances, such as in treating ulcers, but then the hormonal effect is lost.
Licorice
How it works: Adaptogen; prevents the breakdown of cortisol, thereby raising cortisol levels.
Positive effects: Improves adrenal function, including raising low blood pressure.
Cautions: Can raise blood pressure in susceptible individuals. Not recommended for those with raised cortisol levels.
Dosage: 500 mg twice a day, morning and midday, not in the evening.
Reishi Mushroom
The glossy red or black cap of this Chinese mushroom looks unusual, especially to Western eyes. Inside are phytochemicals (plant chemicals) that make it one of the most respected tonics in herbal medicine. In Asia, especially in China and Japan, it has been revered for 5,000 years. Chinese reishi mushroom (Ganodermum lucidum) is often used to modify or enhance the effects of other stress-fighting herbs. With multiple benefits, it has no significant side effects.
You can use it to calm your mind, sharpen your thinking, and energize you when you feel fatigued. Reishi can even lower high blood pressure. Says herbalist Christopher Hobbs: "I often take reishi myself and have experienced immediate calming and sleep-promoting effects. I have noticed an amazing feeling in my chest with some reishi extracts, as if my heart area has 'opened up.' This unique effect, while not scientifically proven, is entirely enjoyable and often is accompanied by a feeling of immediate serenity." This certainly sounds like a natural high!
Reishi Mushroom
How it works: Adaptogen; stabilizes adrenal hormones.
Positive effects: Both calms and energizes.
Cautions: None.
Dosage: In tincture form (20 percent), 10 ml three times a day; as tablets, 1,000 mg, one to three tablets three times a day.
Rhodiola (Rhodiola Rosea)
Another amazing adaptogen from the East with a long history of use is rhodiola. Growing in the Arctic regions of eastern Siberia, it is also called Arctic root. Folklore says that "those who drink rhodiola tea regularly will live more than 100 years." Chinese emperors, in search of the elixir of life, would send expeditions to Siberia to bring back this potent herb.
But it isn't all folklore. Modern science has confirmed that rhodiola has many proven benefits. Among them are its ability to improve energy, balance stress hormones, improve mood, and boost immunity. As an adaptogen, it appears to be at least as powerful as ginseng, and it protects against high levels of the stress hormone cortisol. However, rhodiola also stimulates both mental and physical performance. For this reason, it was used in the Soviet Union to improve athletic powers.
Rhodiola's effects on the brain are perhaps the most interesting. Numerous studies have shown it to improve concentration, especially in tired individuals. In one proofreading test, those taking rhodiola decreased their number of errors by 88 percent! It also helps the brain produce serotonin, which is a key "happy" neurotransmitter. In one study, 128 people suffering from depression were given 200 mg of rhodiola. Two-thirds of the patients (65 percent) had major reduction or complete disappearance of their symptoms. On top of this, rhodiola boosts immunity and has proven anticancer properties.
As with other herbs, make sure you are getting the real thing. There are many plant varieties of rhodiola, but the one that works is called Rhodiola rosea. While it has many active ingredients, the key components are called rosavin and salidroside. So it is best to take rhodiola supplements that are standardized and can therefore guarantee at least 2 percent rosavin and 1 percent salidroside.
Rhodiola
How it works: Adaptogen; stabilizes adrenal hormones; promotes serotonin production.
Positive effects: Improves concentration, stress resistance, physical performance, and mood; boosts immunity.
Cautions: None.
Dosage: 100 mg of standardized extract two to three times daily with meals.
Stimulating Amino Acids: Liven Up Your Brain
Certain amino acids are essential for brain function because they provide the building blocks (precursors) for neurotransmitters and hormones. Essential, too, are the vitamin and mineral cofactors needed to convert the amino acids into neurotransmitters. The key brain-stimulating amino acids are phenylalanine and tyrosine, which enhance all of the following: mood, energy, sexual interest, mental performance, and memory.
Since amino acids are found in high-protein foods, including meat, fish, and eggs, you might think that the way to increase your amino-acid levels would be just to eat more of these foods. However, each protein supplies a different combination of amino acids. People who have specific amino-acid deficiencies or increased needs due to prolonged stress, for instance, will require more specific supplementation.
For the best results, follow the instructions below for each of the amino acids. Since certain amino acids compete with others for transport into the brain, they are best taken separately from each other, and away from other proteins, as well. On the other hand, practicality reigns, and it's better to take them together than not at all.
Phenylalanine: Natural Caffeine
Found in meats, wheat germ, dairy products, granola, chocolate, and oatmeal, phenylalanine is an essential amino acid. It is converted by the body into tyrosine, which in turn is converted into the neurotransmitters dopamine, noradrenaline, and adrenaline. It acts like natural caffeine but without the downside.
Phenylalanine becomes depleted in cases of chronic stress and burnout, as well as by overuse of stimulant drugs such as cocaine, speed, and nicotine. It helps alleviate symptoms of withdrawal, since it restores normal brain chemistry.
If you are low in phenylalanine or tyrosine, you may feel tired and slow and have trouble concentrating. You may also find it hard to get out of bed in the morning. A dose of either amino acid can help get you mobilized.
Supplements of phenylalanine are available in three different forms: DL-phenylalanine (DLPA), D-phenylalanine, and L-phenylalanine. The D- and DL-forms have been proven to act as natural painkillers. They enhance the action of endorphins and enkephalins, the natural opiates that reduce pain and produce feelings of well-being, even euphoria. Although some effect is felt within days, the full effect takes a few weeks to build up.
L-phenylalanine combines with vitamin B6 to produce phenethylamine, the stimulating "love drug" that we find in chocolate. One study from 1986 showed that thirty-one of forty depressed patients with low levels of phenythylamine responded well to large doses of L phenylalanine (up to 14 g a day), making it a very acceptable antidepressant (and, by extension, an antidote for chocolate cravings). In a double-blind study reported in 1979, DLPA (150-200 mg a day) or the antidepressant imipramine was administered to forty depressed patients (twenty in each group) for one month. Both groups had the same positive result, with no statistical difference found between the two groups using both objective and subjective tests.
Taking too much L-phenylalanine or DLPA can lead to overstimulation, resulting in anxiety, insomnia, and hypertension (elevated blood pressure). If this happens, you should then lower the dose, and if symptoms persist, stop taking it altogether. Overall, the best form to use is DLPA, since it is the most comprehensive and least expensive.
The effective dose is usually 500-1,000 mg of DLPA on an empty stomach first thing in the morning. Since everyone has different needs, it's better to start with about half the contents of a 500-mg capsule, taken alone. For quick absorption, open the capsule and put the powder under your tongue. Watch your energy and mood go up. If necessary, you can repeat your dose twice more – mid-morning and mid-afternoon, but not too close to bedtime. You will also need 25-50 mg of vitamin B6 and 500 mg of vitamin C daily to enhance its conversion to tyrosine.
DL-phenylalanine (DLPA)
How it works: Precursor for tyrosine, which converts to dopamine, adrenaline, and noradrenaline.
Positive effects: Enhances mood; promotes energy; relieves pain; controls appetite.
Cautions: Can be too stimulating, generating anxiety, high blood pressure, and/or insomnia; should not be taken by phenylketonurics. Not recommended for those with a history of mania or other types of mental illness.
Dosage: 500-1,000 mg daily before morning meal. Can be repeated later in the day, but not too close to bedtime. Add 25-50 mg of vitamin B6 and 500 mg of vitamin C daily to enhance its conversion to tyrosine.
Tyrosine: For Performance
Tyrosine is made in the body from phenylalanine and has the same effects on the brain. It usually acts more rapidly, as it is one step further down the metabolic line. It readily crosses the blood-brain barrier to produce the energizing neurotransmitters dopamine, noradrenaline, and adrenaline. It also is used to make thyroid hormone, the body's energy controller, which manages both metabolic rate and energy production. When your thyroid function is low, so is your energy.
Some people find DLPA more effective than tyrosine for stimulation, but remember that in some people, DLPA is more likely to cause hypertension (high blood pressure). DLPA also differs in its ability to control appetite by releasing CCK, an appetite suppressant made in the gut, and in its action as a pain reliever.
Neither amino acid should be taken with MAOIs, antidepressants involving certain food restrictions; by phenylketonurics; by those with malignant melanomas; or by pregnant or breast-feeding women.
Tyrosine has long been known by the military to improve mental and physical performance under stress. Research by the U.S. military found that soldiers given tyrosine in stressful conditions of extreme cold, or while undertaking intense physical activity over prolonged periods of time, showed clear improvements in both mental and physical endurance. More recent research from Holland demonstrates how tyrosine gives you the edge in conditions of stress. A total of twenty-one cadets were put through a demanding one-week military-combat training course; ten of them were given a drink containing 2 g of tyrosine a day, while the remaining eleven were given an identical drink without the tyrosine. Those on tyrosine consistently performed better, both in memorizing the task at hand and in tracking the tasks they had performed.
Since individual sensitivity varies, start with 100 mg or so of tyrosine, even if it means partially emptying out a capsule, and work your way up to your ideal dose. You can take another dose later in the day when your energy is flagging, since DLPA and tyrosine are good, quick energizers. If you are feeling like you need a caffeine boost, open a 500-mg DLPA or tyrosine capsule and put half of the contents under your tongue. It will be quickly absorbed and will give you the kick you want, without the rebound. You may need a whole one, but it's best to try half first. This avoids too much of a rush if you are particularly sensitive to its effects.
In response to regular usage, your brain actually produces more dopamine receptors to "receive" this amino acid. This will raise mood over time in those with depression related to insufficient dopamine receptors, as in reward deficiency syndrome. On the other hand, if you don't require it regularly, it's better to use it as needed for a good boost. In clinical practice, we measure the client's amino acid levels and determine if he or she actually needs to supplement. We then recommend supplementation, often in higher doses than those mentioned here, and monitor the patient to be sure that balance is maintained.
Tyrosine
How it works: Precursor to the stimulating neurotransmitters dopamine, adrenaline, noradrenaline, and the thyroid hormone, thyroxine.
Positive effects: Enhances mood; promotes energy and motivation; supports healthy thyroid function.
Cautions: Hypertension in those susceptible. Should not be taken by phenylketonurics, those with melanomas, or pregnant or nursing women. Not recommended for those with a history of mania, unless under a doctor's care.
Dosage: 100-1,000 mg daily before morning meal to prevent competition from other amino acids. Can be repeated in mid-afternoon.
Other Stimulants: Best Of The Rest
Green Tea
Green tea contains certain important health-giving compounds. Its polyphenols or catechins are potent antioxidants, with cancer-protective and antiaging effects. Tea also has a blood-thinning effect, similar to that of aspirin. As it turns out, black tea, a fermented form of the same leaf, also contains these compounds, but with proportionately more caffeine along with them. Green tea contains only 20-30 mg of caffeine per cup, as compared to 50 mg in a regular cup of tea, and is consequently less stimulating, even relaxing to many people.
In fact, Asian monks have traditionally used green tea to help keep them awake, but calm, during meditation practice. This is likely due to its content of the amino acid L-theanine (gamma-ethyl-amino-glutamic acid). Mitigating the stimulation of caffeine, within 30-40 minutes of consumption, it produces an increase in alpha brain-wave activity, without drowsiness. The average cup of green tea contains 26-46 mg of theanine, which is available in capsule form as well, in doses of 50-200 mg.
Considering the health benefits, we can count green tea, in moderation (meaning no more than two cups a day), as an acceptable "natural stimulant."
Green Tea
How it works: Contains potent antioxidants, theanine, and caffeine.
Positive effects: Lowers cholesterol and blood pressure; increases HDL, the so-called "good" cholesterol; thins the blood; reduces risk of heart attack, stroke, and cancer; enhances immune function; prevents dental caries and hypertension; aids weight loss by encouraging the body to burn fat; produces a state of alert relaxation.
Cautions: Contains caffeine.
Dosage: 1-2 cups a day.
NADH
NADH, or nicotinamide adenine dinucleotide, is a small organic molecule found naturally in every living cell. NADH is necessary for thousands of biochemical reactions within the body and plays a key role in the energy production of cells, particularly in the brain and central nervous system. It stimulates cellular production of the neurotransmitters dopamine, noradrenaline, and serotonin, thereby improving mental clarity, alertness, and concentration. The more NADH a cell has available, the more energy it can produce, and the more efficiently it can perform. It also enhances physical performance and energy. We have found it very useful in the treatment of chronic fatigue syndrome.
NADH
How it works: Stimulates cellular production of the neurotransmitters dopamine, noradrenaline, and serotonin.
Positive effects: It is a good antioxidant; improves mental clarity, cellular memory, alertness, and concentration; enhances energy and athletic endurance.
Cautions: None.
Dosage: 2.5-10 mg daily, depending on individual requirements.
Coenzyme Q10 (Ubiquinone)
No list on natural energizers would be complete without mention of Coenzyme Q10, or CoQ10. Called "ubiquinone" due to its being so ever-present ("ubiquitous"), it is a significant cofactor in driving our engines on a cellular level. From our hearts to our brains, CoQ10 helps to convert the nutrients we eat into energy. It is also a potent antioxidant. Another side benefit: it has been shown to stop gums from receding. The recommended dose is 30 mg twice daily, or more if you are taking cholesterol-lowering drugs that deplete CoQ10. Being fat-soluble, it should be taken with a little fat-containing food, such as peanut butter. CoQ10 is expensive, but don't just shop price, since the quality is especially important. It is too valuable for your health not to have the most effective products.
Coenzyme Q10 (CoQ10)
How it works: Stimulates cellular production of energy; antioxidant.
Positive effects: Is a good antioxidant; enhances energy and endurance; helps repair receding gums.
Cautions: None.
Dosage: 30-300 mg daily, depending on individual requirements.
Action Plan For Natural Stimulation
The first steps to maximizing your natural energy and motivation are to reduce your stress level, balance your blood sugar, and avoid or reduce your intake of stimulants to an absolute minimum. A good all-around multivitamin is key.
Adaptogens are the key supplements for natural, sustained, and healthy stimulation. Asian ginseng can, however, be overstimulating if you have very raised cortisol levels or are exhausted. The same caution does not apply to Siberian ginseng. Licorice can also be overstimulating, so don't supplement it if you are very stressed or exhausted.
The nutrients in the following table are worthy additions to a supplemental program designed to enhance your energy and motivation. Combination formulas are available. It you are taking the supplements individually, start gradually and add new ones only after you have given the products two to three weeks to begin working.
| Natural Energizers | Daily Dose |
| Adoptogenic herbs: | |
| Siberian ginseng | 100-200 mg |
| Asian/American ginseng | 100-200 mg |
| Ashwaganda | 400-900 mg |
| Rhodiola | 100-200 mg |
| Reishi mushroom | 300-1,000 mg |
| Amino acids: | |
| D, L-phenylalanine | 100-2,000 mg |
| Tyrosine | 100-2,000 mg |
| Vitamin: | |
| Vitamin B5 (pantothenic acid) | 100-500 mg |
So, to sum up, you should take the following to feel alert and energetic:
- A good all-around multivitamin supplying optimal amounts of B vitamins, especially pantothenic acid (vitamin B6) and vitamin C.
- A "stimulant" formula providing Siberian, Asian, or American ginseng, ashwaganda, reishi mushroom, DLPA, and tyrosine.
- Optional licorice, as needed, but only if you are not seriously stressed, and not at night.
From NATURAL HIGHS: Supplements, Nutrition, and Mind/Body Techniques to Help You Feel Good by Hyla Cass and Patrick Holford. Copyright © Hyla Cass, M.D., and Patrick Holford. Used by arrangement with Avery, a member of Penguin Group (USA) Inc.
To order this book visit www.penguin.com. Get a 15% discount with the coupon code FENPARENT.
