Regular Exercise Prevents Tooth Loss

Research conducted at the Western Reserve School of Dental Medicine, and published in the Journal of Periodontology, found the prevalence of periodontitis, a gum infection that causes the loss of teeth, was reduced by 29% among adults who exercise regularly!

Periodontitis is the main cause of tooth loss.   23% of adults, age 65 and older suffer from periodontitus.   30% of Americans, age 65 and older no longer have any natural teeth.

Exercise and Sleep in Older Americans

Findings from a Stanford University Medical School Study may come as no suprise:  older and middle-age people reported sleeping better when they added regular exercise to their routine.   After 16 weeks in a moderate intensity exercise program, subjects were able to fall asleep about 15 minutes earlier and sleep about 45 minutes longer at night.

The link between aerobic exercise and sleep may seem obvious, but until this study, there has been very little controlled research to support this conventional wisdom.    They they are only 20% of the population, older Americans recieve almost half of the medications prescribe to aid sleep.

The potential side effects of these drugs - confusion, falls, extended drowsiness, agitation, and interactions with other medications - can be especially problematic for this group.    Until this study, there were few attempts to identify effective non-drug approaches ot treating mild to moderate sleep disorders.

The Many Health Benefits of Cilantro

Cilantro aka Coriander aka Chinese Parsley is an annual herb, and all parts of the plant are edible.  Cilantro is used in cuisines all over the world.  It is a tasty addition to soups, salads, and other dishes.  Cilantro has many health benefits.

Antioxidants

Cilantro is a rich source of antioxidant compounds that protect cells from damage from the many free radicals that are produced daily in all the cells of the body.    It contains a significant amount of quercetin which has many benefits (see this blogpost for more information on quercetin and its many benefits:  http://workoutanytime.blogspot.com/2018/03/cut-your-risk-for-catching-viral.html )

Chelates Heavy Metals

Heavy metals are not referring to a type of rock music!   Heavy metals include arsenic, cadmium, aluminum, lead and mercury and they are HIGHLY toxic.   They are directly linked to heart disease, cancer, hormonal imbalance, neurological conditions, infertility and much more.    Cilantro binds these metals and facilitates their removal from the body so regular intake ramps up the bodies detoxification of these toxins which every person is exposed to at some level!

Unfortunately, many medicines such as vaccines and antibiotics contain significant quantities of these metals, and they are in our environment due to pollution..

Lower Anxiety and Improved Sleep

Cilantro helps calm nerves and is shown to improve sleep through its natural and safe sedative effects.   A Indian Study showed that high intake of Cilantro produced the same anti-anxiety effects as Valium without all the side effects or addiction potential!

Controls Blood Sugar

Cilantro has been shown to lower blood sugar levels safely, and a study showed that cilantro helps support liver function and balance blood sugar in diabetes.   Chop cilantro leaves and stems and add to salads, salsa and smoothies to lower your blood sugar.

Improved Cardiovascular Health

In the same study mentioned above about diabetes – researchers found that cilantro lowers cholesterol and triglycerides.   Cilantro also helps lower blood pressure.

 Protection from Food Poisoning

Cilantro has antibacterial properties help protect against both food and water based diseases including food poisoning, dysentery, salmonella, cholera, and listeria.   This is the reason it was used initially because before modern times and refrigeration preventing illness from food and water was extremely important and people learned that spices and herbs could prevent illness.   This is why cuisine from warmer climates tends to be spicier since there was no way to prevent bacterial contamination prior to refrigeration.

Urinary Tract Infection

Cilantro’s antibacterial compounds specifically target bacteria that commonly cause urinary tract infections.    If you soak 1 and ½ teaspoons of dried cilantro seeds overnight in 2 cups of water then strain and drink or add to smoothies – it will help relieve the discomfort of a urinary tract infection and accelerate recovery.

Digestive Discomfort

Cilantro has been used for thousands of years to effectively teat nausea, gas and bloating, relieve indigestion and heart burn, and ease digestive cramps.    Cilantro helps increase digestive enzymes that breakdown foods.     Cilantro also makes spicy dishes more tolerable and helps prevent heartburn.   

Try adding a touch of chopped cilantro to these dishes.

Improved Hormonal Balance

Cilantro helps to regulat proper endocrine gland function, and the hormones that regulate menstrual cycles in woman.     Together with its ability to reduce bloating and cramps this makes cilantro a great choice for woman with menstrual discomfort.

Skin Health

Cilantro contains natural anti-histamines and internal and external use can help calm skin irritations that are commonly caused by the immune system overreacting to allergens.     In these cases chop finely and mix with coconut oil and apply to the skin while also taking it internally.

Side Effects and Contraindications

Individuals who are allergic to fennel, dill, aniseed, caraway or other similar herbs can have an allergic reaction to cilantro and should avoid it.  In rare cases these reactions can be severe.     Individuals with asthma or bronchitis should be very careful using dried, ground coriander because it can cause irritation in the bronchial arteries.

Genetic Taste Response to Cilantro

For all its benefits, cilantro contains aldehydes that provide a highly pungent odor that some people find highly disagreeable.    This is thought to be caused by a genetic variation and is just one of many examples that each person is different.   So if you do not like it – don’t eat it!

Does Whey Protein Decrease Testosterone?

On the surface this statement seems implausible, but there is research showing that protein intake immediately before or after a workout can reduce the increase in testosterone that occurs after when you train with high intensity.

There are also studies that showed that high protein diets lower resting levels of testosterone, while other studies have shown that protein intake can increase the availability of testosterone.

These seeming contradictory studies may be explained by a theory that protein could cause an increase in total testosterone while also lowering circulating levels of testosterone.  The theory postulates that protein intake increases the sensitivity of testosterone receptors on cells so that the increased testosterone is being pulled into the cells which decreases circulating levels of testosterone!

A 2008 study showed an increase in the production of testosterone receptors within exercised muscles in response to whey protein supplementation done at 1 hour and 48 hours post-exercise.  More receptors mean more testosterone is taken up by the cells!

The 2008 study results were supported by a 2015 study using rats which showed that whey protein supplementation immediately after “training” resulted in a 90.5% increase in intracellular testosterone.   Rats were forced to exercise vigorously and then given 500 milligrams of whey protein (this is equivalent to 19 grams of whey protein in a human which is a typical post-exercise dose).

Given that many other studies have shown increases in muscle growth with whey protein intake post strength training it is pretty safe to assume that whey protein intake after strength training will improve muscle growth and recovery.

How Much Time Should You Rest Between Resistance Training Exercises?

One of the most common questions about weight training aka resistance training is how long should you rest between each exercise set?     If you take a look at the relevant research concerning this topic there are some good answers.

For a long time, researchers believed that shorter rest periods were better for increasing muscle size which was thought to occur because of increased levels of metabolic stress by not allowing complete recovery.    However, research done in 2015 shows that using longer rest periods actually results in better results for both increased muscle size and increased muscle strength.     It is thought that this occurs because longer rest periods allow a higher training volume (more repetitions of each exercise).

Another aspect to consider is whether most of your workout uses compound exercises (compound exercises use multi-joint exercises using more muscle mass such as a chest press vs a pec dec or pull-up vs an Lat Pullover).      In a 2012 study researchers found that with shorter rest periods workout volume decreased for both single-joint and multi-joint compound exercises.       However, the decrease in volume in workouts with short rest periods tended to be significantly greater with multi-joint compound exercises vs single-joint exercise (29% reduction in volume with multi-joint as compared to 15% with single- joint exercise). So for strength routines focused on compound, multi-joint movements increased rest time is probably a good idea.

Another study which looked at the effects of rest interval length on training volume discovered another important item:    reduction in training volume occurs mainly between 1 and 2-minute rest periods.    The percentage difference between 2 and 3-minute rest periods is much smaller, except when doing 5 or more sets of an exercise.     So, for people doing 3 – 4 sets per exercise, 2 minutes is a good rest interval, but if doing 5 or more sets you should probably extend the rest interval to 3 minutes.

Another important piece of information is that recreational lifters who self-determine rest periods tend to rest just under 2 minutes between sets meaning that for most lifters doing 3 to 4 sets of several exercises whose goal is increased muscle size and strength you probably do not need to time your rest intervals and can go just go by feel.

Timing rest intervals becomes more important for advanced resistance training such as Power Lifting and Bodybuilding, but for most of us we can just go by how we feel!

PQQ – Safe Supplement for Improved Cellular Energy

Pyrroloquinoline quinone aka PQQ is a chemical found in plants that is a key factor in stimulating cell growth, differentiation and survival.    PQQ is also a strong antioxidant that is capable of continuous cycling much more than other antioxidants.   For example, PQQ can quench free radicals over 20,000 times compared to only 4 for vitamin C.

Although you may not heard of it before – PQQ plays a critical role in human nutrition and is found in all plant foods in very small amounts.   If PQQ is completed removed from the diet it leads to slowing of growth, decreased immunity, and abnormal reproductive function.

Cellular Energy Production

PQQ promotes the generation of new mitochondria within cells – including aging cells.     This is a very important benefit because cells derive their energy from mitochondria and mitochondrial function decreases with aging and is one of the key factors in cellular aging and dysfunction.  

  

Research on PQQ

PQQ has a wide range of physiological effects can be extremely helpful for conditions related to low mitochondrial function including aging, along with many brain and neurological disease along with other chronic degenerative diseases.      Most research has focused on how PQQ protects memory and cognition during aging.

PQQ is particularly effective when combined with ubiquinol which is the activated form of Coenzyme Q10.    In a study with over 70 people between the ages of 40 – 70, 20mg per day of PQQ resulted in significant improvements in cognitive function, but in the group receiving 20mg of PQQ AND 300mg of Ubiquinol the results were very dramatic.

PQQ has been shown to go to work immediately.   In one study subjects were given a single dose of .2mg per kilogram of bodyweight and then measurements were taken over the next 48 hours.    The measurements showed a significant increase in antioxidant potential from this single dosage.    The same group was given an even higher single dose and measurements showed a significant decrease in C-reactive protein and interleukin 6 72 hours later which are key markers for inflammation.

Other Benefits of PQQ

PQQ has also been shown to lower LDL (bad cholesterol) on par with Statin Drugs but with no side effects!

Lowers risk of Parkinson’s and Alzheimer’s

Increases Nerve Growth Factor

Dosage

Studies show the best results with 10 – 20mg per day (nice because it is a very small pill!) and even better when combined with 300mg of Ubiquinol.    For even stronger results combine with Berberine – see this blog post on Berberine - http://workoutanytime.blogspot.com/2018/04/berberine-for-cancer-prevention-anxiety.html

High Intensity Exercise and Brain Health

Physical fitness has been linked to brain health and is an important strategy to prevent dementia.  In fact, compelling evidence shows that physical exercise helps build a brain that not only resists shrinkage but increases cognitive abilities and creativity.

We also know that exercise promotes your brain’s ability to adapt and grow more cells. Exercise also promotes brain health by controlling insulin resistance and boosting hormones and neurotransmitters associated with mood control, including endorphins, serotonin, dopamine, glutamate and GABA. 

A Canadian Study showed that high-intensity workouts helped boost memory by improving hippocampal function — a finding that may prove to be an important prevention strategy against Alzheimer’s disease.

High-Intensity Exercise Improves Memory

In the Canadian study, 95 healthy young adults were put into one of three groups: One group completed six weeks of HIIT plus cognitive training; the other treatment group did HIIT only, while the control group remained inactive and got no cognitive training. Both HIIT groups experienced significant improvements in high-interference memory.

Interference memory is when information a person has already memorized interferes with their ability to learn and memorize new information.  It is directly linked  to the ability to learn and retain information.

Improvement in Fitness Level seems to be linked with Brain Benefits

Those who achieve the greatest improvements in fitness also have more significant increases in brain-derived neurotrophic factor aka (BDNF). BDNF is a protein that has rejuvenating effects on both your muscles and your brain. High BDNF levels have also been correlated to a dramatic reduction in Alzheimer's risk, as it helps you grow new brain cells and protect old ones from deterioration.

As one would expect, those who participated in both HIIT and cognitive training saw the greatest improvements in memory in this study, and “high responders to exercise,” meaning those who gained the greatest fitness improvements, gained the greatest memory improvements of all.

Exercise Also Increases Mitochondrial Health in Your Brain

Other research has shown that exercise also increases the levels of peroxisome proliferator-activated receptor gamma coactivator (PGC-1α), which increases mitochondrial biogenesis (the production of new mitochondira within cells). The PGC-1α pathway regulates both mitochondrial activity and mitochondrial replication. This is very significant for the brain as it is the most mitochondrially-dense organ in your body.  Mitochondria are the key energy producing organelle’s in the cells, and one of the primary causes of aging and cellular dysfunction is defective mitochondia.   Without enough health mitochondia cells cannot function properly.

Exercise Triggers the Growth of New Neurons

As noted by psychiatrist Dr. John J. Ratey in his book “Spark: The Revolutionary New Science of Exercise and the Brain,” there’s overwhelming evidence showing that exercise produces large cognitive gains and helps fight dementia.

There are several studies showing that exercise boosts gray matter in the hippocampal region of the brain. A 2013 study found the total minutes of weekly exercise correlated with volume of the right hippocampus, meaning the more exercise people got, the larger their right hippocampus — the area associated with nonverbal memory functions and spatial relationship memories.

Exercise also preserves gray and white matter in your frontal, temporal and parietal cortexes, thereby preventing cognitive deterioration. In a 2012 study, those who exercised the most had the least amount of brain shrinkage over a follow-up period of three years.

Berberine - for Cancer Prevention, Anxiety, Depression, Increased Fat Burning, and More!

Berberine – for Cancer Prevention, Anxiety, Depression, Increased fat burning, and more!

Berberine is a yellow alkaloid found in several plants/herbs such as goldenseal and phellodendron.   It is a powerful plant chemical with proven antibacterial, anti-inflammatory, anti-diabetic, anti-cancer, and immune enhancing properties.    Herbs containing berberine have a long history of effective use and there is considerable science backing these uses.

It is also extremely helpful for treatment of seasonal allergies traveler’s diarrhea, food poisoning, and as an oral hypoglycemic for Type 2 diabetes.

As per Dr. Michael Murray Berberine has been shown to: 

• Produce results in clinical trials in improving Type 2 diabetes on par or better than conventional drugs including metformin.
• Improve blood lipid levels better than statins.
• Lower blood pressure in many subjects as well as any class of antihypertensive medication.
• Improve liver function and promote anti-obesity effects.
• Exert significant beneficial effects on digestive health and the microbiome.
• Produce very encouraging experimental data in a wide range of modern health issues including cancer, Alzheimer’s disease, Parkinson’s disease and others.

How does Berberine work?

Berberine activates adenosine monophosphate-activated protein kinase (AMPK).  AMPK is sometimes referred to as a "metabolic master switch" because it plays an important role in regulating metabolism.

AMPK causes a cascade of effects within cells involved with maintaining energy homeostasis.  AMPK helps shift energy towards cellular repair and maintenance.   It has many of the same effects as increasing exercise while at the same time restricting caloric intake.

Other benefits of Berberine include:

• Slowing the release of free fatty acids to help prevent harmful fat deposits
• Promoting insulin, leptin, and adiponectin function for a healthy metabolism
• Supporting healthy blood sugar levels already in the normal range
• Promoting healthy insulin sensitivity
• Promoting healthy gut microflora
• Supporting healthy lipid metabolism
• Stimulating the release of nitric oxide for healthy blood flow

Berberine Helps Ease Anxiety and Depression

Another benefit of AMPK is that it protects neurons and increases key neurotransmitters which improves brain function and psychological well-being.  So, it should not be surprising that several studies have shown that Berberine is very useful for anxiety and depression.

Berberine and Cancer Prevention

Berberine slows cancer growth and causes cancer cell death through a variety of mechanisms: tumor cell apoptosis and cell cycle arrest, inhibits blood vessel growth to tumors, inhibition of tumor cellular invasion and metastases (spread), etc.

One of the main anti-cancer targets that is inhibited by berberine is NF-kappa B. NF-kappa B is one of the most important proteins in our cells, acting as a key switch in the development and progression of inflammation and cancer.

·       Cancer (and precancerous cells) often have a permanently activated NF-kappa B, which keeps the cells proliferating and prevents them from dying (apoptosis.)

·       Chronic inflammation can also be a result of activated NF-kappa B, and we know that chronic inflammation can lead to cancer growth

·       Additionally, Berberine sensitizes cancer cells to the effects of radiation but NOT of normal cells. So Berberine may make radiation therapy more effective. 

Berberine also inhibits the tendency of cancer cells to become drug resistant over time by inhibiting the cellular membrane proteins that pump drugs out of the cell. When Berberine is taken with numerous chemotherapy drugs, studies have shown that they work synergistically to fight cancer.

Contraindications for Berberine

·       Displaces bilirubin and should not be administered to jaundiced neonates (may increase bilirubin levels due to displacement of bilirubin from albumin)

·       May cause a prolonged QT (a variable in cardiac electrical conduction) in patients with underlying heart disease

Drug Interactions

While Berberine is quite safe and well-tolerated, it may be contraindicated if you’re taking medications.  For example, Berberine may hinder absorption of tetracycline and other similar antibiotics, rendering them ineffective. Also, because Berberine significantly inhibits CYP3A enzymes — enzymes needed to metabolize most drugs — it can lower the clearance of medications, which in turn can augment their effect. This can lead to overdose, the risks of which will vary depending on the drug in question.

Berberine increases the effects of drugs that lower blood sugar so it is critical that you not mix Berberine with these drugs unless under the supervision of a physician.  IT is important to note that Berberine produces all the benefits of Metformin with much lower risks!

Sources of Berberine

Berberine is available as an isolated supplement OR through certain herbs such as goldenseal or Phellodendron.    Nexrutine is a patented Phellodendron Extract with high levels of Berberine that is particularly effective at reducing joint pain, improving mood, and reducing prostate inflammation and likely prostate cancer risk.   Phellodendron also has has a long history of being used to treat prostate inflammation and prostatitis.

Training Biceps and Triceps with Fat Circular Bands

If you want to take your guns to the next level consider adding in band training.    Those flat circular bands you see in the MX4 Area of the club are serious training tools!    These bands provide the advantage of increasing resistance throughout the range of motion to challenge your muscles in a different, yet complimentary way to free weights or machines.

There are a number of ways to trains biceps with bands from the most simple which is just standing on the band with feet spread and holding the upper loop of the band on both or one and handing and curling up and down.      You can also stand  with one or two feet in the center of a band and grap the two looped ends and curl the end/ends up to pump up those biceps.       Another option is to attach band handles to the band to allow you to use even more resistance.     Standing on one foot in the enter of the band will give less resistance than standing with two feet spread apart.

You can also attach a band to an immovable object like a post or even a door using a door holder (see www.resistancebandtraining.com to purchase one of these.  Another option to create more length is to attach a band low and behind you and then loop another band through this band and attach handles to the band on both ends.      With your back to the anchor grasp the handles and step forward to create some level of tension in the band keep your fee in a split stance and head-up.   Do a bicep curl  with the handles and as you fatigue take small steps back to do drop sets.   This exercise emphasizes the stretched position of the bicep comapred with the single band bicep curl described above.

You can also get an incredible tricep workout using bands using the set-up described above with handles attached to the bands.    In this case turn your back to the anchor grasping the handles with elbows held high by the sides of your heads.   Brace the core while in a split stance and keep the elbows high and motionless then extend your elbows - wow does that create a pump and burn!

To see exactly how to set-up and perform these incredible bicep and tricep exercises using flat circular bands and handles check out this video from resistancebandtraining.com:  https://youtu.be/mF-FbNSPF2Q

How to Deal with Yourr Seasonal Allergies

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Seasonal allergies to pollen and mold seem to getting more and more prevalent each year with progressively more severe symptoms in sufferers.    Treating allergies with nutrition and nutrition supplements can have big advantages over using medications.   

Allergy medication most commonly comes in the form of Antihistamines, and there are some big problems with long-term use of these medications.     It is now known that prolonged use of antihistamines decreases levels of acetylcholine which is a key neurotransmitter involved in memory and other important functions.   In fact, antihistamine use increases the risk of senility, dementia and Alzheimer’s Disease.

What are Allergies Anyway?

Allergies are abnormal immune reactions to specific agents (proteins) known as antigens/allergens, which include many substances such as foods, drugs, pollens, dust mites, animal danders, feathers, along with many others. 

Allergies may also develop when an otherwise innocent substance has significant contact with an already inflamed surface (known as sensitization).  For example, when sick with a respiratory illness, respiratory surfaces are already inflamed and substances present at this time may be “remembered” as being foreign.  This can also occur with chemical substances known as “haptons” which are combinations of self and non-self which can lead the immune system to attack the self. 

Since there are multiple pro-inflammatory substances involved with allergies it is rare to obtain adequate control with single products/medications.  The most potent chemical mediators in allergies and asthma are leukotrienes.  Some leukotrines are one thousand times more potent than histamine as stimulators of bronchial constriction and allergy. 

Interestingly, many medications that reduce one inflammatory pathway actually boost leukotrienes.    For example, Aspirin and other NSAIDs (Non-Steroidal Anti-Inflammatory Drugs like Ibuprofen) result in the production of excessive levels of leukotrines in sensitive individuals although they decrease prostaglandins associated with inflammation and thereby relive pain.  So long term they can create a much more severe problem.

Asthma is linked to allergies and can be a severe and life threatening condition.   Do NOT try to self-treat Asthma – see a physician!

Strategies for Allergies

Try to avoid allergens by using air filters, regularly cleaning all surfaces and vacuuming and keeping your air-conditioning system on while regularly changing filters to filter out as many allergens as possible.   Remember your car cabin filter as well, and take showers and wash clothes after being outside for long periods of time.

Change your diet to reduce inflammation.    Dramatically reduce your intake of refined carbohydrate – sugar and starch which drive insulin which drives inflammation.  At the same time increase your intake of low glycemic, organic fruits and vegetables such as berries, broccoli, Brussel Sprouts, etc.   These plant foods contain polyphenols which are potent anti-oxidants and help to reduce inflammation and allergies without side effects.

Increase your intake of Omega 3 Fatty Acids from cold water fish such as Alaskan Wild Salmon and/or take an Omega 3 Supplement such as Krill Oil.    Omega 3 fatty acids will always reduce inflammation if taken in sufficient dosages so this should be a primary strategy for allergy sufferers because they produce many side benefits.   The only exception is people taking any type of medication to thin blood and reduce clotting like Coumadin.   In this case the combination can be dangerous!

Nutritional Supplements for Allergies

There are several highly effective nutrition supplements for allergies including some key herbs.

Local Raw Honey – it MUST be local and must be raw because it will contain small amounts of local pollen and works by getting the body used to pollen much like an allergy shot.     A Tablespoon a day is as much as you need.   Many people swear by this simple and safe remedy!

Stinging Nettle Extract – this herb has a long history of effective use for allergies and freeze dried preparations seem to work the best and are best taken BEFORE allergy season even begins to put a damper on symptoms before they start – this is true of all nutritional approaches to allergy by the way!

Euphrasia Officianalis – aka “Eyebright” is an herb which name says it all – it is highly effective for eye allergy symptoms.

Quercetin – is a flavonoid contained in high amounts in apples, peppers, red wine, dark cherries and berries, tomatoes, cruciferous vegetables such as broccoli, cabbage and sprouts, and raw red onions.   To treat allergies taking supplemental quercetin is the way to go, and a good quercetin supplement is a product called “AllQlear” by Integrative Therapeutics and can be purchased on Amazon.     It also contains “ovomucoids” from quail eggs that act as tryptase inhibitor and prevent release of histamine.    Another excellent Quercetin Supplement is "Qforce" - http://www.qforce.com/ Quercetin is proven to decrease yur chance of contracting a viral illness like the cold or flu by 9 times!

Boswellia Extract – Boswellia aka Frankincense (yes the herb mentioned in the bible!) can be highly effective for allergies and other forms of inflammation including arthritis because it blocks the formation of leukotrienes!    To get the benefits you must take 5-loxin which is a specific extract.   Note that in some individuals 5-loxin can cause or excacerbate heart burn so it is not for everyone, but when it works it can be highly effective!

Butterbur Extract – this plant extract can be highly effective for inhibiting leukotrienes and allergy symptoms or side effects.   You need to take a standardized extract with standardized levels of Petasin and Isopetasin) and free of Pyrrolizidine Alkaloids aka PA.  High quality brands include Life Extension, Swanson, and Enzymatic Therapy to name a few.   This product can also help many migraine sufferers and is a well-researched, proven treatment.

NAC – N-Acetyl Cysteine - helps thin mucus naturally and boost levels of the body’s most important antioxidant Glutathione – every allergy sufferer should be taking 600 – 1,200mg per day!

You will also find combination of these ingredients in particular products, and it is worth experimenting a bit because if you find the right product or combination of natural products you can find relief without sedation and without the side effects associated with antihistamines and more potent drugs like steroid nasal sprays or oral steroids.