ADT and Heart Disease: Hello to... - Advanced Prostate...

Advanced Prostate Cancer

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ADT and Heart Disease


Hello to everyone. My husband was diagnosed in June after his PSA went from 2.2-3.2 in 6 mths and then to 6.7 in another two months. Fusion biopsy diagnosed PCa with Gleason 9 and PET scan detected one positive lymph node in pelvic area. Rejected surgery in favor of ADT ( firmagon and zytiga) followed by brachytherapy and SBRT. ADT just started this month and already he has some indication of heart arrhythmia. Not sure if he will need new cardiovascular meds or pacemaker.

I am in awe of the knowledge and courage of this community. Any information would be greatly appreciated.

42 Replies

SBRT? or did you mean IMRT? He didn't have whole pelvic radiation?

No radiation as yet. The radiologist at Sloan Kettering wants him to take 4 firmagon injections, take Zytiga for 12-18 mths and do radiation therapy starting in Nov. But just 2 wks of ADT has already caused some heart beat changes( irregular, not rapid).

I developed a-fib while on Eligard/Zytiga/Prednisone regimen and was just placed on blood thinner Eliquis to stave off blood clots.

Vitaminlover in reply to Mkeman

Did the afib resolve on it’s own?

Mkeman in reply to Vitaminlover

No. Not yet. Cardiologist says there is no good treatment....’it ALWAYS comes back. Max heart rate still under 100.

Vitaminlover in reply to Mkeman

Cardiologist appt next week and will also see what MSK oncology dept has to say. Good luck to you.

RICH22 in reply to Mkeman

have had 3 cardiologists push eliquis on me like street drug dealers! have tried it 3 times and all 3 times have felt like a steam roller ran over me. i use aspirin and that's all she wrote. Rxed afib in 2014, started valsartan and metoprolol in 2015, no problems since. been on bicalutamide for 3 months. so far so good, getting PSA next week, started with 14.8, June 1st. never had radiation nor anything beside biopsy (GL 4+3).

Vitaminlover in reply to RICH22

Thank you. We are going to ask about Vallarta’s and Toprol.

Within one year of Lupron, I had a triple bypass operation. Granted choices before contributed, but it was sped up considerably. Also, the second time on Lupron, much concern about a blood clot in my heart! A second opinion later brought that into question. After the second start of Lupron, I quickly developed cataracts, both were removed this last spring. I will be doing all that I can to avoid Lupron again!

Vitaminlover in reply to Don1157

These side effects are definitely a concern. All the best to you.

I'm 71, and have had ADT since 2010 when the docs found they could not remove PG, because too much local Pca was present. But since 2006, I have cycled 130,000km on a bicycle to keep BMI < 25 and resting heart rate <55, and waist < 100cm.

I had EBRT and two different drugs to stop bone density loss.

But in 2004, and again in 2015, I had tachy cardia where heart rate doubled for a day or two, in 2004 due to quitting Vioox for knee pain, and 2015 for quitting cycling, so my heart is a little uncertain, but my mother had this at times, all the way to 98, when she passed due to old age. A young wife I had at 22 also had it, and blamed it on emotional stress, and it was part of her mental decline at 22, and she left me within 6 months. Her mind said yes, her heart said no to marriage; she was more surprised by that than I was, but at 29, I was not very skilled at persuading dear ladies to stay when they change their mind.

So it seems to hearts can be slightly unpredictable, caprecious, but docs say it generally is not life threatening. But other types of arrythmia may be very dangerous to ignore, and not because of emotions or stress, and so the only way to get any peace of mind is try to get best advice and take it, and try not to have a heart attack when you get the doctors bills.

Normal injections of ADT worked for me to suppress Pca to end of 2015, so 5 years, and I felt real strong on bicycle and proved I did not need testosterone to ride faster with all the other guys my age or a bit younger, and all the women of all ages in rides of over 80km.

heart often had resting rate of 45. An hour after a long hard ride, HR was up a bit at 60 but by midnight was back to 50. Now had my HR been 80 at midnight, Its a sure sign of bad heart health somewhere.

When injected ADT failed, and Psa crept up, I had Cosadex, and Psa was kept low for 6 months, but then Psa went up, so I began abiraterone, ( Zytiga ) and three of the side effects in list of 10 were about HR too fast, irregular, etc, and I was on that that for 8 months when it stopped working, and by then my HR had become a bit irregular, missing 1 beat in every 5, adding two extra beats in fast sequence, but I was not frightened, because the body's HR is governed by a number of substances in blood and by heart tissue properties, so if one thing is altered, the heart won't stop, but timing can alter a bit.

All my relatives had good hearts. But they all suffered as they aged from one darn thing or other, and sometimes they had more than one condition than might threaten their life.

Not everyone can spend an average of 11 hours a week cycling about between 59 and 71. But I let myself be addicted to a bicycle, and I live in a city of 420,000 with about 500km of off road sealed bike paths, and away from city the roads are quiet and safe so no dangers. I was lucky to enjoy my health even with a chronic condition that will probably kill me.

My heart seems to be on my side.

I am on chemo each 3 weeks and that has made me give up cycling so far, and I have a range of unpredictable and undiagnosable side effects and aiks and pains which come and go and i just have to be strong, and as they say, "suck it up bro", but I am now busy with craft work in my shed, and I enjoy each day's wondements, and meeting good ppl, and I seemed to have learnt to not worry about heart drugs or pacemakers; I did worry about these during the two occasions I spent a day at a hopspital getting special drugs intravenously to get heart to stop fibrilating, ie, have twice normal HR. I drove myself to the hospital on both occasions, and home again. I have no partner, so the buck stops with me.

But each and every one of us will have a slightly of greatly different experience of Pca or of the side effects of treatments, and nobody can ever say that if they get the same treatment as anyone else in a group that they might get the same medical result, or the same side effects.

Cancer was just another thing which forced me to be more broad minded than I was already. But no matter what I learn about everyone's different journey, I still have to cope with my own, with all of its uncertainty, but so far I seem to have avoided depression and anxiety, although sometimes I just crack up in tears when I have read some posts from wives who have lost their husband, and I wonder if part of life's success is to have a sad wife when you depart, because it means you have been loved.

Getting Pca compels a man to review his direction with life; lots of things suddenly become irrelevant, because time has been shortened, investments seem silly because doctors need to be paid just to get longer life.

loved ones need more love than ever, and we often don't want that test, but it just seems sensible to consider it.

I let myself cry, and laugh, and life is still good...... I love the nurses at the hospital.....

Patrick Turner.

What a remarkable story. You have a great attitude which is the most important thing of all.

I have had older guys of 80+ call me "just a boy" but when I am 80+, if I make it, I will have numerous "co-morbidities", which is a cold hearted medical term for the numerous medical conditions all leading and contributing to a persons tenure on life; and often nobody know what condition will finally win, but one thing is for sure, I cannot live forever, so If I live long enough, I won't be able to do any of the things I like to do now. Maybe not even type to anyone else across the world about anything, and I hope my present attitude of being able to survive living alone stays constant, but one day someone might come and see I am living in such a mess they will put me somewhere else i might not like to be. I have seen it happen here and often the person's cancer and 3 other illnesses have become so limiting, the person must be given 24/7 care. Some I know were split from their wives or husbands because she of he suffered dementia, just another thing that prevents any sort of normal life.

I would bet that some here with heart problems after ADT may have had a potential heart problem all along, but ADT just made the problem surface. There is no easy answer because the statistics show heart disease is a leading cause of death, and

we all know about the obesity epidemic; ppl just cannot control the amount they eat.

In fact, as a species, we have terrible control over our unthinking impulses, and it all speeds up our decline from youth.

Any study of long term effects of ADT show that a man without testosterone declines faster than one with "full bottle". One reason why I was so unsuccessful with staying married was that the girls thought I was a rabid extremist if I said they were overweight and did no exercize, but those sorts of things had to be said, tactfully, but it made no difference, the ladies were determined to self destroy their health, I was not, and believed I had to raise a good sweat doing something, 6 days a week, and this made the ladies all feel inadequate. I never ever met anyone with high health standards of living life, and who were consistent. So just was my attitude so good? I really don't know, but I do know that staying fit has made it completely easy to deal with ADT without heart being compromised, I have no fatigue, I stay busy, and I didn't moan and groan about finding that ADT completely sexually mutilated all sex function that so many other just don't like. But I have a sister who lost both breasts with Bca, and she went from wanting sex at 65 to avoiding it completely, and never wanting any relationship. She's 73, alive, and she and I get on fine. I became fully able to live alone at 40, because I was never wealthy, and the ladies all had children from other marriages, and I would have had to fund these kids, and many would have never accepted me so marriage became impossible for me, despite the dating sites et all.

So with nobody to love, I didn't mind being neutered. There is a lot more to life than sex! I have since seen a few fellows in their 50s with Pca and loss of sex and they are lucky because their lady stands by them. But the guy in next chair along at chemo is about 50 and his wife left him.

Well, the churning and changing of who is with who is always going happen and I mostly find most ppl in groups are married, and I am the odd man out, and I don't care now about that either; cancer teaches you to not care about such things.

There are enough ppl in world; there was never any need to have kids, and my health did NOT suffer and I was always independant, and whether all that was good for my heart is a moot point. I did smoke for 14 years, but never more than 10 a day, then I gave up cold turkey at 34, and THAT probably stopped a pile of problems later.

But half the ladies around when I was 34 smoked, so by by my quitting, I limited my choices; they didn't like being with a non smoker, and they would not give up.

I ws never a big drinker, so all those who did drink to be drunk once a week of more had no chance with me. Behind my attitude, there's a pile of personal stuff many others thought was boring and anti-fun, and I missed the company of the healthy ladies who all married other fellows, younger, richer, etc, and more likely to go under the thumb. I felt real heart ache over ladies who left, so was a lady good for me? does love overcome? Yes was always a doubtful answer, and now? at 71? The doubt remains.

I just stay busy, the world mostly ignores me, although I support the lifestyles of the medicos and despite their shortcomings, I am always nice to all of them.

I might be alive tomorrow, and if so, I know I'll enjoy the day, and if I did die, ppl would come around and find some bicycles, and electronic stuff in a shed that indicated that I loved cycling and electronics. They will find a daily diary, a life of a non prominent nondescript man who made it without bothering God or many other ppl, and they won't find any debts, and the National Economy will be better off because someone else gets a house, and stuff, but I am sure a few will winge about me and the junk.

I don't care what they think. Being in my NOW seems about as OK as it can be.

I am lucky to be able to sleep fairly well, essential for heart health, and a lot of other things.

Whether our stories can trigger awareness of how to be in others is also a moot point. But I found it never could happen in social media like Farcebook, let alone Twatter. No human comfort at either for me. I joined twice, then deleted account, after never making any friends. But before the Internet, pubs were no place to make good friends; it was always difficult to find friends, and keep them, life was never easy, and when young I always found many things were not so hot. Life just is. I'll try for a cycle ride today, blue sky, not too cold..... all is OK.

I've probably said too much, all the best,

Patrick Turner.

It is so true that lifestyle often leads to our medical problems. People have to learn for themselves though. Thanks for the help.

All the best to you too!

kindred spirit! relate so closely to almost everything you said - had you not credited yourself, i might have mistaken it for my own writing! i'm also 71, and a 4-time loser, with 4 women walking out on me... not that i blame them one iota. i too intense for most people's liking, male or female. have so many friends complaining about senior life becoming more difficult; i'm loving it! not crazy about the physical issues but wouldn't trade my mental acuity, collection of experiences, knowledge, appreciation and gratitude, for all the tea (or American currency) in China. thanks for sharing, brother. see you on the other side one fine day.

Rich Haber

Reno, NV

I tried 13 times to marry women, one did, and 4 lived with me for about as long as it takes for a woman to transition from deep love to deep hate, with a myriad of emotions us men never feel. I had a single one night stand which went on and on for 3 years, utterly blissful without argy bargy.

I really cannot accept that you are a loser. Such a statement needs proof, and really, this is probably not the right group to prove anything. So I'll assume you are a winner, and gained your freedom 4 times, and as long as you were polite and didn't blacken any female eyes, then don't you think you succeded 4 times? You need an extra star awarded if you managed to not be financially ruined 4 times, or even once, but I'll take the star back if you used the same lawyers who defended the biggest crooks in the USA. In my case, the wife who left wanted a huge pile of dough, so I suggested she select a lawyer of her own choice, and discuss why she ought to get the dough.

I did not want to ever be known as someone to rip off a confused and mentally unstable young lady who tried marriage before she was really ready for it.

Love can warp ppl's lives, and thousands of books and stories are written about the pitfalls of falling in love.

Anyway, her lawyer agreed with mine that my offer was entirely generous, 10% of the house value, about $60,000 in today's dough for being my wife for 18mths, and she paid not a cent towards the house, and there was no capital gain while she'd been away. She accepted the outcome, and after settling property matter I spent a week with her. But she'd grown fat, was sharing a house with 2 dope smoking lads, and had a terrible shift worker job, a bit of a step down to typing the Prime Minister's letter's while with me. She'd grown dull, even more uncomunicative. So although I had room in my silly heart to fall inlove again, and try to get it right ort better this time around, there was a kind of dead vacuum in her being, so I spent the week being kind, before returning 3,000km back to where I lived. My conscience was clear, and I got much wiser about females. If we had had children it would have been a disaster.

I have zero idea what she's doing now, there had to be a complete separation in our minds because the past prevents the future happening.

The ladies who followed her were always ppl I had to addapt to. None wanted more than a nice big dose of sexual daliance with someone who always brought them their own maximum jollies. None thought beyond sex, none asked "where do we go from here?", and none mentioned having a child, and at 35, I had paid off my house, had a good business, and was theoretically amoung the most marriagable bachelors in this town, then 300,000 souls. They'd get to The End, and go off travelling, or in one case, back out because the mum and dad thought I wasn't good enough, so they didn't have the guts to back their own feelings or thoughts.

Everyone wanted love, and so few ppl knew how to give it. But give it thay had to or else their life and mine and the life of both of us is a sham, just BS.

My mum stayed with dad until he died at 60, so 35 years, through good and bad times,

and most women I met had parents equally together, but the generation I met had no intentions of anything long term.

By 40, I bought a sewing machine. I could repair my own clothes, and cycling gear, and it added to the huge tool set I had as a builder. I pleased many ppl I worked for, mainly happily married couples extending their houses to have a better lifestyles.

These ppl were the salt of the earth IMHO, and good ppl to work with and for. It didn't really matter too much if love escaped me, I coped very well without any.

In my cycle ride of about 25km around town, I stopped to chat to a couple of workers repairing a road, brought a smile, a said hello to many, saluted a courteous driver, chatted to a barista, and had a real nice trip about. No need for me to travel to Europe or anywhere else; I am actually happy right here right now. I hardly spend any money.

I drive a 1986 Ford Laser. Modernity and keeping up with Kadashians is utterly ridiculous. No putting on style and agony for me.

There are a few who resonate with this way of being, and I buy them lunch whenever they let me.

I do feel that Personal Unity makes anyone's heart run better. I saw so many ppl who felt one way, said a lot of things that didn't indicate that at all, and their spending patterns were also inconsistent. Now if someone commands themself to be unified, they'll try to say what the feel and spend accordingly, so all their actions, thoughts, feelings are consistent, so anyone who tries to get close does not get stung by nasty suprizes. Is that intense? or am I just stupid and antisocial? I have no idea now because it just don't matter any more, and I feel I have the unity thinge fairly sussed out for me.

I've dropped God out of my life because I see that its impossible for present definitions of Him, Her, It to be able to exist. This means Goodness with out God, a MUCH better building block for life, IMHO. God merely confuses all ppl, and all Gods are invented by believers, ie, man made God, and God did not make us. Something whe cannot understand allowed evolution, and to me its a fabulous grand way of getting existance to exist, and how the hell would any god have figured out how to make the DNA we have, and the Universe, including the billions of planets where life was once, is right now, or will be in future?

So I can't go to a church and be lectured on God. Its just too simple, and all fairytale stuff. And God beliefs led to rivers of blood in many wars, so stupid! I can talk of goodness, badness, and so on, sure.

Last time I was in a small but very pleasant modern church it was a day for classical music, played by local musicians doing Baroque music. Over two hours It brought me to tears, but that's the effect of moving music, and at a time after I'd had both knees replaced, and somehow something went on inside me I could not identify, but it sure didn't seem God was there, it was just a rare combintion of connection with others in a beautiful place bathed in fabulous sound. This experience is so uncommon for me. Another humbling experience. Of course when such music was composed, people were as human as they remain now, but then, the Religious Police murdered anyone who stepped out of line about God, and if I said there is no God in 1600, I'd have been tied to a post and burned. When I cycle under road where there's a short tunnel, and especially when someone comes the other way, I'll sing "AHHHH LEY LUUULIA, Gee its good to see ya," and they get a kind of nice crazy shock.

But I never sing God Is Great. He's just not there, so he can't be great. But the Majesty of Nature is just there, it either has wonderment for you, or not. Why does mankind try to make a person out of what we see that Is Great, but not personal?

Now DNA is a wondrous thing, but like every system everywhere, it cannot last forever, so thus we must die, so IMHO, I should not winge until my end, but realise that all good things cannot go on for Eternity.

Patrick Turner.

We're way off topic here, so I wrote you in message instead. Hope you can find it.

I agree, off topic. I've replied to your email....

But everyone's story has us contemplating life, and gives some togetherness but without much in the way of a panacea for life's pain of existing.

We exist, therefore we are, therefore we have aches and pains, we are not alone, so how can we cope with these things better? By just asking ourselves to be stronger, we may cope better.......

Patrick Turner.

My husband has been on Lupron, avodart, Xtandi plus other adt over many years. Dx; 2004, G9, IMRT, Brachytherapy, recurrence; 2008; DART. Like you, he has been very active over the years, biking, golf. All of that stopped after suffering cardiac arrest in 2017. Now he does cardio rehab in place of more active sports. He has a defibrillator to protect against tachycardia events. Thank goodness he has not experienced any heart events in the last year. We suspected that long term ADT might have contributed to the arrest. We raised the cardiac issue with our oncologist and cardiologist and both agreed that any heart impact would have occurred within months of starting ADT, not years after their use. It’s hard for us to deny a cause and effect because no other explanation for the arrest has been offered. Looking at the big picture, we are choosing our poison: ADT . Started apalutamide last week.

It has certainly been quite a journey for you and your husband since 2004 dx. So glad that his heart problems have not occurred recently. Stay strong!

I’m new here reasearching the connection of ADT and cardiac effects. It’s helpful to read your comment AND that your oncologist admitted to the ADT being a player.

My husband (63) began STAMPEDE this past January after being diagnosed PCa in Nov. 2017. He was first given two shots of firmagon at his diagnosis in November, then he was moved to Lupron/Zytiga after the first treatment of Firmagon.

All things going great until his onco checkup in July where the ct scan showed heavy arterial plaque. (Good news is that his cancer is “dormant” and no “live cancer cells” detected, the cancer train has stopped.)

The MO told us to get to a cardiologist no later than August and we couldn’t get in until early September.

Long story short his C Calcium score is in the severe range, and ECHO confirmed cardiomyopathy, and 50-55% left ventricular output. He doesn’t have any symptoms.

I began researching ADT and cardiac issues. Oh my. Of course there’s a connection! They know this!

All of this within six months of diagnosis. I’m also finding most cardiac events are within the 6 -12 months of beginning ADT. More with Lupron than Firmagon, it seems.

My husband is doing a low-carb diet and supplements which has kept him from metabolic syndrome, so they cannot think that is the cause here.

We have a conference call with the oncologist this evening discussing discontinuing the ADT, I mean, what other choice do we have?

What is your new protocol? How is it going? Was there any symptoms coming off of ADT?


Sorry my reply is so late: a lot going on here. In the fall of 2018 my husband suffered heart failure. We were fishing in Canada and after spending 3 days in hospital we were medivaced back to Ct. Had a stent put in artery but that did not improve his injection fraction under stress so he had additional blockages reamed out twice and is going in for more stents this month. Doc says his arteries were loaded with calcium. After all is completed back to Onc in NY to determine next treatment. Doc wants him to get back on Lupron and erleada but gradually. Does believe years of hormones have contributed to heart disease. Hope this helps u.

No worries, we all have things that need attention.

Since my questions my husband did go off Lupron and stayed on Zytiga. He has seen an IC and they do want to cath and stent. We decided to take December and February off from docs to regroup bu we are back at it with a cardio appt today and Onc appt last Friday. Currently, my husband is feeling great...Really great. He seems to be feeling like he’s not sick at all. We are very grateful for him feeling so well. If he goes back on ADT we will go with Firmagon which has a bit less effect on the heart. We have had more than a few docs (cardio & others) tell us the Lupron is the cardio culprit in the couple of shots he was given. We had one cardiologist tell us no way it could have done this in a few months time but only if he had been on it for an extended amount of time.

We have been told the stent will not prevent a cardiac event and that if my husband needs surgery he will have to wait for six months because of the blood thinner he will be taking the rest of his life with a stent. This is a concern for me...are surgeries in the future for prostate cancer patients? I’m not sure. More research and many questions to be asked.

Thanks for your reply. All the best to you and your husband as you walk this path.

how old is your husband Donna? I hope you and him are doing ok now.

ADT as a treatment should not be ruled out fearing for cardiac irregularities. I have not heard of Lupron causing such cardiac events.

As for the cardiologist who says there is no good treatment for a fib. He is misinformed. Are you sure he is a heart specialist?

Good luck 👍

Vitaminlover in reply to Hirsch

I totally agree. I believe the cardiologist remark was another post. We haven’t seen our doctor yet. Our friend was treated with a pacemaker for afib but hope that is not needed. Thank you!

GeorgeGlass in reply to Hirsch

a study was done on taurine and arginine by the nih. i take them daily

Thank you so much for your reply! Since I wrote my husband has concluded his 18 mth ADT and his heart arrhythmia has stabilized. How much do you take? Stay well and Happy Holidays

I take 1000mg of taurine morning and night, and 500-1000mg arginine morning and night. I also take a combo pill with proline and lysine morning and night. Some that I know take 2000mg of Taurine morning and night.

Good to know. Thank you so much for your reply. Best of health to you.

You're welcome. Good luck to you too. 👍

My oncologist said approximately 7% of men experience heart rhythm issues with zytiga. Contact your oncologist immediately. To offset heart issues I excercise, both strength training and cardio 5-6 times per week. I have been doing this for about a dozen years and exercise helps me avoid the more severe aspects of side effects. I also watch what I eat. Make sure you doc clears him for exercise if he hasn't been doing so recently. BTW I am 63.

Vitaminlover in reply to jholmq

Yes, we are seeing the oncologist and cardiologist in the next few days. Exercise is definitely important. Thanks so much!

A lot of men deal with atrial fibrillation as they get older. I've been dealing with it for over 20 years and well before I was diagnosed with PC. It runs in my family. I was put on various prescriptions that weren't very effective. Rhythmol (propafenone) finally did the job ... but put me in atrial flutter ( a known effect of this drug). I had flutter ablation surgery, which is easier to arrange and a shorter operation than atrial fibrillation ablation. The rhythmol manages my a-fib very well. I was concerned that eligard (ADT) might cause a problem with my heart but for the duration of the six month shot I had no a-fib episodes at all. Your mileage may vary. Stay hydrated to avoid a-fib. There are supplements that help with heart issues: CoQ10, L-Arginine, L-Taurine, Acetyl-L-Carnitine. Magnesium. I take aspirin daily but your doctor might recommend a prescription blood thinner. Having said all this, I'm not a doctor. Good luck.

Thank you. Very informative post.

Yes vitaminlover, i was on Adt for about 5 months & first time in my life i had heart murmours or tightening in the chest area along with every side effect in the book. Now i have just said no more as they wanted me to go to chemo 7 the side effects are much the same they said. Anyway it is not for me & psa is rising but i feal great & isnt that what its all about?

Ga 68 pet scan next week & lutetium 177 if it has gone further than the lymph nodes.

Fight the good fight,exercise & deep breathing,it hates oxygen!

Vitaminlover in reply to ARIES29

I encourage my husband to exercise and do deep breathing. All the best to you!

I believe heart disease is the still the most common killer of men in the US. Not sure about Australia but when I studied nutrition 40 years ago it was already a huge problem even in younger men's death. When autopsied it would show advanced heart disease and lots of plaque. Perhaps statins have improved that outcome.

Yes, they have but a healthy lifestyle is still the best medicine for most to prevent development.

Definately healthy life style & what a pity we didnt do it earlier. I take a product cardioclear with a garlic gold capsule & its main ingredient is only coQ10 not every day but when i think of it now. The garlic gold is prescribed by cardio specialist 1 every day. Just a thought.

Vitaminlover in reply to ARIES29

Would that be Nutrigold? I also see black garlic gold capsules sold on Amazon. Both look interesting. Thank you for your help

Australia naturalcare here sell the Garlic gold 3000mg or 3g of garlic oil, it says 1 to 2 capsules three times a day but 1 is enough i think,it helps thin the blood from plaque which is caused by excessive vit c or just bad diet but the Q10 also is a boost & breathing that oxygen fresh air. Havnt heard of black garlic gold but 3g of fresh bulb or even crushed garlic in food should have same effect. Glad to help.

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