Ashwagandha

Ashvaganda - Vitánia Opojná is the Ayurvedic response to Asian ginseng (Panax ginseng) in traditional Chinese medicine, and its rejuvenating properties are similarly used in this regard.

Ashwagandha means "horse scent". These words are interpreted differently. For example, it can spread the energy and power of a horse. [1]

In practice

Ashwagandha has a wide range of traditional uses, many of which have already undergone scientific testing. However, many of them are still waiting to be confirmed by studies, despite the fact that the plant has been used for health for many centuries.

Dr. In his book Rasayana: the Fountain of Life (Partridge Publishing, 2015), Mayank S. Vora summarized the effect of intoxicating vitals on health:

• tonic, acts on the nervous system, has sedative effects, regenerates the nervous system, is adaptogenic, aphrodisiac, anti-inflammatory, antioxidant, immunomodulatory, scavenges free radicals, anti-stress, rejuvenates, lowers blood pressure, anticonvulsant, acts against arthritis, helps a healthy condition.
• Other options for taking ashaganda are for colds, fevers, ulcers, in the treatment of alcoholism, anemia, insomnia, lumbag, to strengthen memory. [2], [3]
• It is also discussed the possible use in the treatment of anxiety, support of immunity and healthy joints.

Ashwagandha is not suitable for pregnant women.

Safety of Ashwagandha

A one-time, uncontrolled study evaluated the safety, tolerability, and activity of increasing doses of Ashwagandha. For 30 days, 18 healthy participants took increasing doses of Ashwagandha at 10-day intervals.

In the first 10 days in the morning 250 mg and 500 mg in the evening (750 mg total / day), on the 11th to 20th day 500 mg in the morning and 500 mg in the evening (1000 mg total / day) and in the last 10 days it was 500 mg in the morning and 750 mg in the evening (1250 mg total / day). Baseline factors such as blood pressure, pulse, body temperature and respiration rate were monitored continuously during the study. No negative signs were found, not even in body weight and appetite. 33% of people reported better sleep quality. Muscle strength increased significantly. Although body weight and body mass index (BMI) did not change significantly, there was a tendency for weight gain and a decrease in body fat. Total cholesterol was significantly reduced and declining trends were found in fasting blood sugar, triglycerides and LDL cholesterol. [4]

Characteristics of Ashwagandha

The small shrub of the Solanaceae family has yellow flowers and is native to the arid regions of India and North Africa. Today, however, it is also grown in milder climates. It grows to a height of about 70 cm. There are large morphological and chemo-typical differences between local species. However, it appears that the root phytoactive substances of wild and cultivated species appear to be the same.

The roots are mainly used therapeutically.

Ashvaganda can be found under the names Ashwagandha, the intoxicating / sleeping sleeper, Withania somnifera, also known as Indian ginseng.

Although Ashwagandha is currently grown on farms outside the natural habitat and unprocessed dried roots are used as part of food supplements and natural health products, in Indian medicine, dried roots can still be fermented in the traditional way.

Ashvaganda is India's most popular botanical plant and has been used for centuries in Ayurveda, a 5,000-year-old Indian healing system, as a rejuvenating and daily tonic (rasayana) to refresh a person's physical and mental condition. Because pharmacological studies come with good findings, Ashwagandha is becoming increasingly popular.

With its potential in preventive care and healing approach, Ashwagandha is a typical Ayurvedic plant. Ashvaganda works throughout the body by helping to maintain balance. As a powerful antioxidant, it strengthens the immune system.

Ashvaganda is one of the adaptogens

Ashvaganda is considered a natural adaptogen, which are substances that are resistant to internal and external stressors.

Ingredients of the intoxicating welcome

More than 80 substances are said to be active ingredients in Ashvaganda. These are mainly alkaloids (isopelletierin, anaferrin, anahygrine, withasomnin, cuscohygrin, ashwagandhin, ashwagandhinine), steroid lactones (withanolides, withanosides, withaferins and others), saponins (sitoindosides), phytosterols and flavosols, phytosterols, and phytosterols. [5]

This herb is known for its strong adaptogenic action, which has also been confirmed by modern research. This is evidenced by the fact that sitoindosides and sapherins excel in anti-stress properties. Research shows that the natural antidepressant effect of welcome is to reduce inflammation and stress hormone levels. In addition, it improves sleep.

Ashwagandha's health benefits

The main advantages of this plant are mainly in the relief of stress, energy supply and support of the immune system. Allanols are responsible for all of these beneficial effects, which help normalize biochemical processes in the body.

Ashvaganda is attributed to the following effects:

• abortion,
• adaptogenic,
• analgesic,
• antiarthritic,
• antiasthmatic,
• antibiotic,
• antidyspeptic,
• anti-inflammatory,
• antitumor,
• aphrodisiac,
• astringent,
• bactericidal,
• carminative,
• contraceptive,
• depurative,
• diuretic, e
• metric,
• fungicidal,
• hypnotic,
• immunomodulatory,
• laxative,
• proteolytic,
• toning and
• nerve sedative.
• In addition, it may have cytotoxic, chemopreventive and radiosensitizing effects [3], [6], [7], [8], [9].

Ashvaganda is also consumed for longevity and youth support. [2]

It should especially affect the rejuvenation of men, strengthen sperm, bone marrow and muscles. It adds youthful vitality. [6] At the same time, however, it is believed that welcome is also useful for the elderly, because it provides energy, mild pain, inflammation, but also nervousness.

Bone and Mills (2013) reported four studies between 1980 and 2008 that examined Ashwagandha's tonic activity, for which Western medicine does not have much understanding. Tonics can be renewed, supported and help the body to adapt to stressors. Studies have shown that Ashwagandha significantly increases hemoglobin, red blood cell counts as well as decreases serum and erythrocyte sedimentation, and improves sexual performance. The vigilance and reactions, sleep and physical abilities of the participants of the climbing event were also improved: a 6-day trek with an altitude of up to 5,200 m. In addition, muscle strength and muscle performance improved slightly in healthy older men. Another positive manifestation was better symptoms of stress in patients with chronic stress. [3]

Ashwagandha fights stress and anxiety

Ashwagandha is best known for its ability to reduce anxiety and relieve stress. Clinical studies in humans have shown that intoxicating vitreous acts strongly as a natural sedative and can effectively reduce symptoms in people with stress and anxiety disorders. But the plant also has other health benefits: it reduces fatigue and tension. Increases mental alertness, improves concentration and memory. By promoting endurance, it balances energy levels. Ashvaganda can be taken alone or with other herbs that are known to soothe and help with stress.

A 60-day study in 64 people with chronic stress found a 69% reduction in anxiety and insomnia, compared with 11% in the placebo group. [10]

In another 6-week study, 88% of those taking Ashwagandha had a reduction in anxiety compared with 50% of those taking placebo. [11]

Studies have also been performed in animals and have confirmed that intoxicating vitamin contains active ingredients that manage stress and help with adaptogenic action.

The action on the hypothalamic-pituitary-adrenal axis was found and confirmed to reduce the level of the stress hormone cortisol. This axis is the communication network between the part of the brain and the main glands that secrete hormones. Helps regulate stress levels.
Gamma-aminobutyric acid (GABA) is a neurotransmitter. This chemical is involved in biochemical reactions in the brain, including mood swings. When severe traumatic stress occurs, an imbalance in GABA levels leads to cell death of neurons in the hippocampus (the part of the brain responsible for preserving memories). [12]

A study published in 2015 in The Journal of Ethnopharmacology showed that GABA receptors activate two major active substances of intoxication: withaferin A and withanolid A. [13] This could explain the adaptogenic effect and the effect on stress.

Chandrasekhar et al. performed a double-blind, randomized, placebo-controlled study of 64 subjects with chronic stress without a psychiatric history. During the 60-day study, participants received 300 mg of root intoxicating vitamin extract - twice daily after meals or placebo. The level of stress hormone and other parameters related to stress were evaluated.

After 60 days, a 44% decrease in perceived stress was observed, while only a 5.5% reduction was observed in the placebo group.
The welcome group showed a reduction in values such as "somatic", "anxiety and insomnia", "social dysfunction" and "severe depression" compared to the placebo group.

On the DASS scale, where stress is divided into the categories "depression", "anxiety" and "stress", there was a 77% reduction in the treated group in the "depression" subgroup, by 75.6% in the "anxiety" subgroup and by 64, 2% in the "stress" subgroup.
Interestingly, there was a slight increase in anxiety scores in the placebo group. Cortisol levels decreased by 27.9% in the Ashvaganda group and by 7.9% in the placebo group. Ashvaganda has been found not only to alleviate the main aspects of stress. It can also help prevent and manage side effects. [14]

Cooley et al. in another study, they examined the natural anxiolytic effects (reduction or elimination of anxiety) of intoxicating welcome. They compared the effect of naturopathic care and psychotherapeutic interventions on moderate to severe anxiety, which lasted longer than 6 weeks.
Naturopathic care included not only nutritional counseling, relaxation techniques and multivitamin pills, but also Ashvaganda. It contained 1.5% withanolides and was tested by the testers at a dose of 300 mg twice daily for 12 weeks. Anxiety decreased by 56.5% in the group with naturopathic treatment, in the group with psychotherapy it was 30.5%. The overall improvement in quality of life showed better overall results in the naturopathic treatment group. [15]

A systematic evaluation of studies of the effects of ashvaganda on anxiety in humans has shown that the herb is more effective in relieving stress and anxiety than placebo. At a dose of 500-600 mg / day, Ashvaganda has been shown to reduce the symptoms of anxiety. But it is important to do more research. [16] A study published in the journal Phytomedicine in 2000 found that glycowithanolides from intoxicating vitreous have a similar effect on anxiety as lorazepam (benzodiazepine) and on depression as imipramine (a tricyclic antidepressant). [17]

Studies in both animals and humans have shown that the active ingredients in Ashvagand have a similar effect on depression as conventional medicine.

Ashvaganda can improve sleep in depressed people

Deteriorated sleep quality in depression has a higher risk of suicidal behavior and may impair cognitive ability. [18] [19] A 2017 study published in the journal PLOS One states that the intoxicating vitamin contains the ingredient triethylene glycol, which could be used in the treatment of insomnia. [20]

In addition to inducing sleep, Ashvaganda can alleviate anxiety caused by sleep deprivation and at the same time nerve inflammation. [21]

Researchers believe that Ashvaganda may have a neuroprotective effect. As a dietary supplement, it can also help impair memory and learning as a result of sleep deprivation. [22]

Natural neuroprotective agent

McKernan et al. pointed out that chronic stress, which can result in depression, increases the tendency of some neurons in the brain to apoptosis, i.e. cell death. [23]

And it is antidepressants of herbal origin, such as intoxicating vitreous, that protect neurons and prevent this cell death, as found in a study in rats. [24]

The researchers believe that the contained ananolides contribute to the neuroprotective effect of this herb. [25]

Vareed and colleagues found that the active ingredients - withanamides - have a neuroprotective effect, and at the same time scientists believe that Ashvaganda can be used as a prevention or therapeutic drug for stress-induced neurological disorders. [26]

A review study published in 2015 in Psychoneuroendocrinology highlighted the fact that oxidative stress increases with depression. [27] This oxidative stress in brain cells can be reduced by bioactive compounds from intoxicating leaves. At the same time, they support the renewal and growth of brain cells. The compounds have neuroprotective potential and are expected to be used as a supplement to brain health. [28]

Oxidative changes and other stress signs have been observed in rodent brains. At the same time, researchers point to the need to determine therapeutic efficacy and safety in humans. Researchers point out that it can provide protection to neurons and therefore could serve as a supplement for a healthier brain. [29]

Ashvaganda is a natural neuroprotective that can help protect brain cells from biochemical changes caused by stress. The antioxidant effect can contribute to the reduction of oxidative stress arising from depression.

It can improve brain function, including memory

Animal studies suggest that Ashwagandha may reduce memory and brain function problems caused by injury or disease.
The results of studies suggest that Ashwagandha may be a means of suppressing the acute effects of insomnia on learning and memory disorders and may emerge as a new dietary supplement to control cognitive disorders caused by sleep deprivation. [23]

Ashvaganda root extract improved memory impairment induced by hypobaric hypoxia and hippocampal neurodegeneration by modulating nitric oxide-mediated corticosterone levels. [30]

A study in epileptic rats examined treatment with intoxicating root extract intoxicating and Withanolide A, which resulted in physiological expression of NMDA receptors. From the data it can be deduced that oxidative stress has an effect on the membrane structure. This leads to a decrease in the density of NMDA receptors and thus to a disruption of spatial memory. Treatment improved spatial memory deficits by increasing the antioxidant system and restoring altered NMDA receptor density. [31]

Research has shown that vitamin intoxication promotes antioxidant activity that protects nerve cells from harmful free radicals.

In a controlled study, men took 500 mg of Ashvaganda daily or placebo. Men who consumed the herb achieved a significant improvement in their reaction time and performance. The results suggest that vitamin extract can improve cognitive and psychomotor performance and can therefore be considered a valuable adjunct in the treatment of cognitive impairment. [32]

During an 8-week study in 50 adults, taking 300 mg of Ashwagandha root extract twice a day was found to significantly improve overall memory, performance, but also attention. [33]

Ashvaganda takes care of the condition of the brain and protects cognitive functions

Cognitive functions (sometimes also cognitive functions) are among the main areas of the human psyche. Through these functions, a person perceives the surrounding world, acts, reacts or manages various tasks. They represent memory and concentration, attention, speed of thinking, speech, the ability to understand information. Executive functions then include the ability to assess and solve problems, plan and organize. If these abilities are impaired, these are important symptoms of depressive disorder. Antidepressants, such as SSRIs and relapses, can cause cognitive numbness.

As vitany is an intoxicating natural nootropic (substances that improve the ability of human thinking), it can help restore cognitive activity and maintain healthy brain function. [34]

Administration of Ashvaganda to healthy individuals has been shown to significantly improve cognitive and psychomotor performance when consumed with 250 mg capsules twice daily for 14 days. [35]

Researchers believe that intoxicating vitreous improves cognitive ability and memory by regulating various neurotransmitters in the brain.
Supplements from intoxicating welcome can improve brain function, including cognitive abilities.

It can reduce the symptoms of depression

Several studies suggest that Ashwagandha may be beneficial in alleviating depressive states. [56] [55]

In a controlled 60-day study in 64 stressed adult patients who received 600 mg of Ashwagandha daily, a 79% reduction in major depression was observed. The placebo group, on the other hand, showed a 10% increase.
But it is also worth mentioning that in the past only one participant had depression. [56]

Available research suggests that ashwagandha may help reduce depression.

Ashvaganda prevents weight gain due to stress

Chronic stress can have a negative effect on eating habits. These include food eaten under the influence of emotions and subsequent weight gain. A study published in the 2017 Journal of Evidence-Based Complementary and Alternative Medicine pointed out that taking an asvaganda supplement (300 mg twice daily for 8 weeks) may support weight maintenance in adults with chronic stress.
The use of the intoxicating vitamin supplement with root extract with 5% withanolides led to a decrease in perceived stress by 32.7% and also to a 22% decrease in cortisol levels. In addition, the weight decreased by 3.03%, in the placebo group it was 1.46%. [36]

Ashwagandha helps with diabetes

Several studies, not only in animals but also in diabetic patients, have shown that Ashwagandha can lower blood sugar through effects on insulin secretion and sensitivity.

An in vitro study confirmed that withaferin A has at least partial responsibility for the antidiabetic manifestations of asvaganda. Insulin secretion is increased and insulin sensitivity is improved in muscle cells. [37].

Several human studies have confirmed the ability of welcome to lower blood sugar not only in healthy individuals but also in diabetics [38] [39] [40] [41].

In addition, in a 4-week study in people with schizophrenia, patients treated with Ashwaganda showed an average reduction in fasting blood sugar of 13.5 mg / dL compared to those receiving placebo (4.5 mg / dL) [40]. .

Ashvaganda acts against cancer

Although the treatment of cancer is becoming increasingly successful in some cases, ways are being sought to help patients with the disease.

Animal and in vitro studies suggest that Ashwagandha inhibits the growth of cancer cells in several ways and helps to induce programmed cancer cell death, i.e. apoptosis. The antitumor effect of ashvaganda is attributed to a steroid lactone, called withanolides. Here too, withferrin A, a natural substance from welcome, has an effect. The antitumor effects are so interesting that the challenges for the clinical development of Ashvaganda for the prevention and treatment of cancer have been highlighted. [42]

Ashwagandha is thought to produce reactive oxygen species (ROS), which are toxic to cancer cells but no longer to normal cells. In addition, it can make cancer cells less resistant to apoptosis. [43]

Studies in rats and mice suggest that Ashvaganda may benefit from its immunomodulatory effects in the treatment of several types of cancer. Whether it is breast, lung, colon, glioblastoma multiforme cancer and fallopian tube cancer. [44] [45] [46] [47] [48]

For example, in a mouse study, fallopian tube tumors were treated with Ashwaganda either alone or in combination with another anti-cancer drug. The result was a 70-80% reduction in tumor growth. At the same time, the treatment prevented the spread of cancer to other organs. [48]

Although no studies are available to confirm these results in humans, they are also encouraging.

An open-label, prospectus, non-randomized, comparative clinical study (published in 2013) looked at the potential use of Ashwagandha root extract powder. It was about the possibility of relieving fatigue caused by chemotherapy and the overall improvement in quality of life in patients with breast cancer. Patients were alternately assigned to a group (n = 50) or a control group (n = 50) and fatigue was assessed. The group received 500 mg of dry Ashwagandha extract 3 times a day for 6 cycles of chemotherapy. These patients experienced less fatigue during chemotherapy and felt better than the control group. [49]

Animal and in vitro studies have shown that Ashwagandha promotes tumor cell death and can be used against several types of cancer

Ashvaganda can lower cortisol levels

Cortisol is known as a "stress hormone". The adrenal cortex releases cortisol in response to stress. Cortisol primarily regulates nutrient metabolism. Long-term cortisol production, especially in chronic stress, leads to significant physiological changes.
Chronic increases in cortisol levels result in high blood sugar and an increase in belly fat.
Studies have shown that Ashwagandha can help lower cortisol levels. [38] [44] [50]

In one study in chronically stressed adults, patients taking Ashwaganda had a significantly greater decrease in cortisol compared with controls. In patients receiving the highest dose, cortisol was reduced by an average of 30%. [38]

Ashwagandha supplements may help reduce cortisol levels in chronically stressed individuals.

Improving sexual function

Chronic stress and depression affect sexual dysfunction. If patients are treated with certain antidepressants, sexual dysfunction may occur or worsen. [51]

The reward pathway in the brain controls the response to food, social contact, but also sex. High levels of the stress hormone disrupt this pathway and can lead to sexual dysfunction.
Clinical studies in humans have confirmed that asvaganda treatment in healthy women improves sexual function and has a positive effect on stress-induced infertility. [50] [52]

In addition, it can also affect stress-induced heart function and immune function. [53] [54]

Ashvaganda supplements help manage the symptoms of stress by lowering cortisol levels and affecting chemicals in the brain. It has been shown to protect against the adverse effects of chronic stress, such as weight gain, sexual dysfunction, venous deterioration, and the like.

It can increase testosterone levels and increase fertility in men

Ashwagandha supplements can have a strong effect on testosterone levels and reproduction. [50] [57] [58] [59]

In a study of 75 infertile men, the Ashwaganda group showed a significant increase in testosterone and a consequent increase in sperm count and motility. In addition, the number of antioxidants in the blood has increased. [59]

Men who took Ashwagandha to relieve stress showed higher antioxidant levels and better sperm quality. During 3 months of treatment, 14% of male partners were able to reproduce. [50]

Ashwagandha helps increase the levels of the male sex hormone testosterone and significantly increases sperm quality and fertility in men.

It can increase muscle mass and strength

Research shows that Ashvaganda can support body structure and strength. [58], [60]

In the health study, men took 750-1,250 mg of Ashvaganda daily. After 30 days, they showed higher muscle strength and a lower percentage of body fat. In addition, there was a reduction in total and LDL cholesterol. The total percentage of body fat shows a decreasing trend. Vitania was well tolerated at increasing doses. [39]

In an 8-week, randomized, double-blind, placebo-controlled clinical study, 57 young men (18-50 years) with little experience of resistance training were randomized to receive 300 mg of asvaganda root extract (29 subjects) or placebo (28 subjects). . Men who consumed the extract twice a day eventually showed a significantly higher increase in muscle mass and strength. Compared to the placebo group, body fat was more than doubled [58].

Research to date has shown that Ashwagandha increases muscle mass and strength in men and also reduces body fat.

May reduce inflammation

Animal studies have shown that Ashwagandha helps reduce inflammation. [61] [62] [63]

Studies in humans have found increased activity of immune cells that destroy the infection (natural killer cells) and promote good health. [64] [65]

C-reactive protein (CRP) has been shown to be a sign of inflammation and is associated with a higher risk of heart disease.

In a controlled study, the 250 mg Ashwagandha group had an average of 36% reduced CRP compared with placebo, which had a 6% reduction in their level. [38]

The hypothalamic-pituitary-adrenal axis is part of mood regulation and also affects the levels of cortisol, which is a stress hormone. With depression, hyperactivity of this axis occurs, which leads to an increase in cortisol levels and thus to inflammation. [66]

Ashvaganda extracts have been shown to suppress nerve or brain inflammation by slowing down the action of pro-inflammatory substances while activating cells that take care of the immune defense of the central nervous system. [67]

Nerve inflammation gets worse with oxidative stress. Withanolides contained in Ashvaganda alleviate oxidative stress and inflammatory processes in microglial cells. [68]

High levels of inflammation in the brain contribute to depression. Because ashvaganda extracts have anti-inflammatory properties, they manage nerve inflammation in the brain. This is important for the antidepressant effect of welcome. Ashwagandha increases the activity of natural cells (killers) and reduces the signs of inflammation.

It lowers cholesterol and triglycerides

In addition to its anti-inflammatory effects, Ashvaganda helps lower cholesterol and triglycerides and thus cares for a healthy heart.

A study in rats showed a reduction in total cholesterol of 53% and a reduction in triglycerides of less than 45%. [69]

Controlled human studies show results that are not as high. Nevertheless, there has been an improvement. [38] [39] [40] [41]

In a 60-day study in chronically stressed adults, the group taking the highest dose of Ashwaganda showed an average of 17% reduction in LDL, ie 'bad' cholesterol, and an 11% reduction in triglycerides. [38]

Ashwagandha can reduce the risk of heart disease by lowering cholesterol and triglycerides.

Vitamin intoxication normalizes the activity of the thyroid gland

The thyroid gland produces hormones that affect the functioning of the human body. Proper thyroid function is therefore essential for the body.
Thyroid antibodies associated with diseases such as Hashimoto's disease have also been found to be biomarkers of immune dysfunction in depression. [55] [70]

Demartini et al. observed a strong association between subclinical hypothyroidism and symptoms of depression. Subclinical hypothyroidism is defined as an elevated level of thyroid stimulating hormone (TSH) with free thyroxine (T4) in the normal range. [71] [72]

In a pilot study involving 50 patients with subclinical hypothyroidism, ashvaganda supplements were found to improve thyroid health. Patients aged 18-50 years with mildly elevated TSH levels were treated with this herb (600 mg daily) or placebo for 8 weeks. During 8 weeks of welcome, it significantly improved TSH, T3 and T4 levels compared to placebo and normalized thyroid function.
Ashvaganda's ability to normalize thyroid function may be part of her multimodal action against depression. [73]

Impaired thyroid function is associated with a higher incidence of depressive symptoms. Ashvaganda has been shown to normalize thyroid function. This can help relieve the symptoms of depression.

So far, no study has examined the safety of taking Ashvaganda supplements with conventional antidepressants; can be combined with SSRI antidepressants. It is recommended to keep a distance between them and consult a competent healthcare professional.

Availability of Ashwagandha

Ashvaganda is safe for most people. However, the plant should not be consumed by breastfeeding and pregnant women. The same should be done for people with autoimmune diseases without the consent of a doctor. In particular, these are diseases such as type 1 diabetes, rheumatoid arthritis, lupus or e.g. Hashimoto's thyroiditis. Asvaganda can lower blood sugar and blood pressure, and this should be done with medication. Because the plant can increase thyroid hormone levels, caution should also be exercised in patients with thyroid drugs.

In studies, doses of Ashwagandha 125-250 mg per day were usually given, at higher doses then 450-500 mg once or twice a day. As a rule, if a higher dose was given, it usually caused the most significant improvement.
It was mostly a root extract. When choosing a product from intoxicating, it is necessary to make sure that it is a quality and certified extract, where all active substances are maintained in a natural balance.

Conclusion

Ashwagandha is a traditional medicinal herb that benefits health in many ways. Above all, it affects its effects on stress and depression and also supports brain activity. The scientific evidence gathered so far suggests quite convincingly that Ashvaganda can be used as an adjunct treatment for depression. Then there is the effect on testosterone. Further investigation would be appropriate in all cases.

However, if a person has health problems and is taking medication, he should consult the appropriate doctor about taking welcome.

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