What is Astaxanthin?

Updated: March 19, 2024

astaxanthin

Reviewed By:
Dr. Loren Fishman – AlgaeCal Scientific Advisory Board Member
MD, B.Phil.,(oxon.)
Medical Director of Manhattan Physical Medicine & Rehabilitation and Founder of the Yoga Injury Prevention Website.

Astaxanthin is a powerful antioxidant and anti-inflammatory compound that falls under the carotenoid category of phytochemicals. Most carotenoids, including beta-carotene, lutein, zeaxanthin, and lycopene, exude beautiful orange, red, and yellow colors, which is why we often find these nutrients in produce like tomatoes, carrots, and pumpkins.

Astaxanthin, on the other hand, is a bit special as this phytonutrient isn’t found in produce but comes primarily from microalgae. Therefore, if you want to get more astaxanthin in your diet, you’ll have to look to marine life that consumes algae, such as salmon and shrimp (note their orange-pink color).

But before we get ahead of ourselves, let’s look at why you want to get more astaxanthin in your diet in the first place. 

In this article, we’ll discuss:

  • The many health benefits of astaxanthin
  • How astaxanthin stacks up against other antioxidants
  • The optimal dosage for astaxanthin
  • Tips for buying a high-quality astaxanthin supplement
  • And more

The Many Health Benefits of Astaxanthin

Astaxanthin is a relatively new compound in the health scene. While it was first discovered in 1938, researchers have only just begun to uncover all of the potential health benefits associated with this nutrient. 

That said, just five years ago, there were already around 2,000 research articles published on astaxanthin, and today there are well over 3,000 – pretty good for the new kid [1]. 

As already mentioned, astaxanthin is a potent antioxidant and anti-inflammatory compound, but research to date has shown that the benefits of astaxanthin are much more specific than general inflammation and oxidative stress. 

Let’s dig in.

benefits of astaxanthin

Bone Health

Anything that combats inflammation and oxidative stress is going to have a positive effect on your bones. However, research shows that astaxanthin may specifically impact the activity of osteoclast cells (the ones that break down bone) and, therefore, may assist in preserving bone density [2]. 

Heart Health

It’s well understood that inflammation and oxidative stress play significant roles in the progression of heart disease. Studies show that astaxanthin may help to protect heart health by reducing inflammation and specifically inhibiting the oxidation of LDL cholesterol – a key step in the progression of atherosclerotic plaque formation [3][4].

Cognitive Health

Animal research suggests that astaxanthin’s ability to suppress the inflammatory response may be responsible for improved cognitive function in cerebrovascular diseases such as vascular dementia [5].

In human trials, studies show that taking astaxanthin results in improved memory function in adults experiencing memory decline [6][7].

Immunity

Inflammation and oxidative stress are intimately tied to your immune response, which makes it no surprise that astaxanthin has been shown to support immune function. In one study, a group of participants taking astaxanthin for eight weeks showed increased activity in several lines of immune cells and reduced levels of c-reactive protein, a marker for inflammation [8].  

Vision

Studies show that astaxanthin may protect eye health via several mechanisms, including its anti-inflammatory, antioxidant, and antiapoptotic (anti-cell death) activity. By disrupting the damaging activity of free radicals in the eye, astaxanthin may benefit age-related macular degeneration, cataract, glaucoma, and corneal damage [9].

Skin Health

Want healthier, younger-looking skin? Protect yourself from ultraviolet (UV) rays. UV rays are responsible for a great deal of skin aging as they slowly deteriorate the skin’s barrier, resulting in wrinkles, leathery skin texture, and reduced elasticity. Due to the antioxidant activity of astaxanthin, studies show that this compound may protect the skin against oxidative damage and therefore reduce signs of aging [10][11].

Male Fertility

Some studies show promise for astaxanthin, as an antioxidant, in improving sperm function in male infertility. That said, more studies need to be conducted before we draw any firm conclusions [12][13].

Muscular Endurance and Performance

Strenuous exercise training can result in increased production of reactive oxygen species (ROS), which may consequently result in cellular damage. Research shows that the antioxidant potential of astaxanthin may support your body in combating, or even preventing, the production of exercise-induced ROS and, therefore, may protect your cells and tissue from exercise-induced damage [14].

This improvement in antioxidant activity may enhance exercise performance. In one trial, 21 competitive cyclists improved their cycling time performance after 28 days of supplementing with astaxanthin [15].

astaxanthin antioxidant

How Does Astaxanthin Stack Up Against Other Antioxidants?

There are plenty of antioxidants out there, so what makes astaxanthin so special? In study after study, astaxanthin has proved to be one of the most powerful antioxidants found in nature. Let’s take a look at how astaxanthin stacks up against some other common antioxidant compounds.

Vitamin C vs. Astaxanthin

Vitamin C is well-known for its immune-enhancing properties, as well as being a potent antioxidant. There’s a good reason we’re told to stock up on this vitamin during the flu season.

When compared to astaxanthin, however, studies show that astaxanthin is 6000 times more powerful than vitamin C [16].

Vitamin E vs. Astaxanthin

Vitamin E is a fat-soluble vitamin that’s most well-known for its role in protecting skin health – much like astaxanthin. But when you compare the two in terms of free-radical scavenging potency, astaxanthin is the winner with 550 times more antioxidant activity than vitamin E [16].

CoQ10 vs. Astaxanthin

CoQ10 is a coenzyme and antioxidant naturally produced by your body that’s known to be heart-protective, neuroprotective, and may enhance physical stamina due to its role in energy production.

That said, when comparing the two, research shows astaxanthin is 800 times more powerful than CoQ10 [16].

Zeaxanthin vs. Astaxanthin

Zeaxanthin is a type of carotenoid that’s found in abundance in your eyes. Research shows that zeaxanthin has potent antioxidant properties and can be especially helpful in conditions that impact the eyes such as macular degeneration and cataract.

As mentioned, astaxanthin has also been studied for its potential eye-health benefits, and when these two carotenoids are compared astaxanthin comes out on top as ten times more powerful than zeaxanthin [17]. 

Lutein vs. Astaxanthin

Lutein is another carotenoid with a claim to fame focused around eye health. Just like zeaxanthin, however, lutein doesn’t compare to the antioxidant powerhouse of astaxanthin. In fact, astaxanthin is also 10 times more potent than lutein [17]. 

β-carotene vs. Astaxanthin

In addition to eye health, β-carotene is a carotenoid known to enhance immunity and protect skin from UV damage.

As one of the most well-known carotenoids, β-carotene still doesn’t hold up next to astaxanthin – which is 10 times more powerful than β-carotene [18].  

Phytonutrients are known to be powerhouses when it comes to antioxidant capacity. Still, even next to phytochemicals in its own class (β-carotene, zeaxanthin, and lutein), astaxanthin is ten times more powerful – that’s impressive.

Astaxanthin Dosage

While a handful of foods contain astaxanthin, you would have to be pretty diligent about your diet if you wanted to increase your astaxanthin intake through diet alone. For example, the most potent dietary source of astaxanthin is sockeye salmon, but you would have to consume eight ounces of salmon every day to get a meaningful amount [19].

While salmon and other fish have plenty of health benefits, if you really want to increase your astaxanthin intake, it’s best to go with a high-quality supplement. What exactly is a “high-quality supplement”? We’ll go into detail on that question in the next section. For now, let’s look at the optimal dose of astaxanthin.

Currently, there is no official daily recommended intake for astaxanthin – as is true for most phytonutrients. That said, most clinical trials have studied the effects of astaxanthin at a dose range between 1 and 40 mg. That’s a pretty wide range, but at the beginning of 2020, the European Food Safety Authority (EFSA) confirmed that astaxanthin supplementation at levels of up to 8 mg a day could be used without any risk to health [20]. 

This is likely a conservative number, but it is a fair guideline. 

Tips for Choosing The Best Astaxanthin Supplement

So now that you know how powerful astaxanthin is, how do you choose a high-quality supplement? When it comes to this nutrient in particular, there are three things to pay attention to:

#1. Opt For All-Natural

You’ll find two main types of astaxanthin: esterified astaxanthin and non-esterified astaxanthin. The difference is that esterified astaxanthin has a fatty molecule attached, while non-esterified astaxanthin is “free.” In basic terms, esterified astaxanthin is natural, and non-esterified astaxanthin is largely a synthetic, chemical version.

Generally speaking, whenever you can get supplements in their natural form, it’s always best. When compounds are produced in a lab, you never know how well they will interact with a biological system (like your body). Natural compounds have been produced by mother nature and therefore tend to be absorbed and assimilated optimally. Furthermore, synthetic astaxanthin was developed to feed farmed salmon to give them a desirable, consumer-friendly color. It has not been extensively studied regarding safety for human consumption.

#2. Combine With Fish Oil

Astaxanthin is a powerful antioxidant, but this nutrient is fat-soluble, which means that for optimal bioavailability, it must be taken with a source of fat.

While you could combine astaxanthin with any fat, studies show that omega-3-rich oils are the ideal carriers for astaxanthin. If you think about it from the perspective of the natural world, this makes a lot of sense since astaxanthin and omega-3 oils both come from the same primary source; microalgae [21].

Furthermore, fish oil and astaxanthin have similar anti-inflammatory and antioxidant activities, making them a perfect pairing.

That’s precisely why AlgaeCal’s Triple Power Omega 3 Fish Oil comes packed with omega-3 fats, astaxanthin, and curcumin. When it comes to fighting inflammation and oxidative stress, the more, the merrier.

Astaxanthin Side Effects

Astaxanthin taken at levels provided by most supplements has been shown in clinical trials to be safe, particularly if you stay below that 8 mg per day range [22].

That said, there are some potential side effects that can come with astaxanthin when taken in extremely high doses (50mg or more). These include [23][24]: 

  • Orange pigmentation of the skin
  • Lowered blood sugar levels
  • Lowered blood pressure
  • Inhibition of 5-alpha-reductase, thereby inhibiting the conversion of testosterone to dihydrotestosterone (DHT)

Due to its potential immune-enhancing activity, astaxanthin should be used cautiously in those autoimmune disorders or people taking immunosuppressants. 

Please note: As we’ve outlined, astaxanthin is considered safe for humans to consume. But there’s still not enough research on the safety of astaxanthin for pregnant women. So we advise pregnant women to check with their healthcare provider before adding astaxanthin to their diet in any meaningful amount.

Takeaway

Astaxanthin may be newish on the scene, but the research so far is nothing less than astounding. With 6000 times more antioxidant activity than vitamin C and 10 times more activity than its counterpart phytonutrients – this is one antioxidant that deserves a special place in your diet.  

If you’re looking for ways to boost your antioxidant defenses with astaxanthin, look no further than Triple Power Omega 3 Fish Oil. In addition to over 1400 mg of omega 3s, one tablespoon of Triple Power Omega 3 Fish Oil provides 3 mg of astaxanthin – about as much as you would get in one serving of sockeye salmon. 

And the best part is that instead of that fishy taste that normally comes with these oils, Triple Power Omega 3 Fish Oil has a delicious mango flavor. Yes, if you have kids, they’ll be begging you for more fish oil. When was the last time that happened? 

To learn more about all things bone health and healthy aging, sign up for the AlgaeCal Newsletter.

What is astaxanthin derived from?

Astaxanthin is naturally derived from microalgae, yeast, and marine life that consume algae, such as salmon, krill, and shrimp.

What is astaxanthin good for?

Astaxanthin is a powerful antioxidant and anti-inflammatory compound that may benefit heart health, bone health, cognitive health, vision, immunity, endurance, and male fertility.

How much astaxanthin should you take per day?

The European Food Safety Authority (EFSA) confirmed that astaxanthin supplementation at levels of up to 8 mg per day can be used without any risk to health.

 Is astaxanthin hard on kidneys?

Studies show that astaxanthin may have a protective effect on kidney disease due to its role in reducing oxidative stress and inflammation.

How long does it take to see astaxanthin benefits?

The time it takes to see benefits from astaxanthin will depend on your current health status and the dose and quality of your supplement. That said, many people start experiencing benefits within four to eight weeks.

Is astaxanthin better than CoQ10?

Astaxanthin is 800 times more powerful as an antioxidant when compared to CoQ10.

References

  1. https://pubmed.ncbi.nlm.nih.gov/?term=astaxanthin
  2. Hwang, Y. H., Kim, K. J., Kim, S. J., Mun, S. K., Hong, S. G., Son, Y. J., & Yee, S. T. (2018). Suppression effect of astaxanthin on osteoclast formation in vitro and bone loss in vivo. International Journal of Molecular Sciences, 19(3), 912.
  3. Fassett, R. G., & Coombes, J. S. (2009). Astaxanthin, oxidative stress, inflammation and cardiovascular disease. Future cardiology, 5(4), 333-342.
  4. Iwamoto, T., Hosoda, K., Hirano, R., Kurata, H., Matsumoto, A., Miki, W., … & Kondo, K. (2000). Inhibition of low-density lipoprotein oxidation by astaxanthin. Journal of atherosclerosis and thrombosis, 7(4), 216-222.
  5. Zhu, N., Liang, X., Zhang, M., Yin, X., Yang, H., Zhi, Y., … & Li, H. (2020). Astaxanthin protects cognitive function of vascular dementia. Behavioral and Brain Functions, 16, 1-10.
  6. Sekikawa, T., Kizawa, Y., Li, Y., & Takara, T. (2020). Cognitive function improvement with astaxanthin and tocotrienol intake: A randomized, double-blind, placebo-controlled study. Journal of Clinical Biochemistry and Nutrition, 67(3), 307-316.
  7. Katagiri, M., Satoh, A., Tsuji, S., & Shirasawa, T. (2012). Effects of astaxanthin-rich Haematococcus pluvialis extract on cognitive function: a randomised, double-blind, placebo-controlled study. Journal of clinical biochemistry and nutrition, 51(2), 102-107.
  8. Park, J. S., Chyun, J. H., Kim, Y. K., Line, L. L., & Chew, B. P. (2010). Astaxanthin decreased oxidative stress and inflammation and enhanced immune response in humans. Nutrition & metabolism, 7, 1-10.
  9. Giannaccare, G., Pellegrini, M., Senni, C., Bernabei, F., Scorcia, V., & Cicero, A. F. G. (2020). Clinical applications of astaxanthin in the treatment of ocular diseases: Emerging insights. Marine drugs, 18(5), 239.
  10. Davinelli, S., Nielsen, M. E., & Scapagnini, G. (2018). Astaxanthin in skin health, repair, and disease: A comprehensive review. Nutrients, 10(4), 522.
  11. Ito, N., Seki, S., & Ueda, F. (2018). The protective role of astaxanthin for UV-induced skin deterioration in healthy people—A randomized, double-blind, placebo-controlled trial. Nutrients, 10(7), 817.
  12. Donà, G., Kožuh, I., Brunati, A. M., Andrisani, A., Ambrosini, G., Bonanni, G., … & Bordin, L. (2013). Effect of astaxanthin on human sperm capacitation. Marine drugs, 11(6), 1909-1919.
  13. Comhaire, F. H., Garem, Y. E., Mahmoud, A. H. M. E. D., Eertmans, F., & Schoonjans, F. R. A. N. K. (2005). Combined conventional/antioxidant “Astaxanthin” treatment for male infertility: a double blind, randomized trial. Asian Journal of Andrology, 7(3), 257-262.
  14. Brown, D. R., Gough, L. A., Deb, S. K., Sparks, S. A., & McNaughton, L. R. (2018). Astaxanthin in exercise metabolism, performance and recovery: a review. Frontiers in nutrition, 4, 76.
  15. Earnest, C. P., Lupo, M., White, K. M., & Church, T. S. (2011). Effect of astaxanthin on cycling time trial performance. International journal of sports medicine, 32(11), 882-888.
  16. Zhang, Z. W., Xu, X. C., Liu, T., & Yuan, S. (2016). Mitochondrion-permeable antioxidants to treat ROS-burst-mediated acute diseases. Oxidative Medicine and Cellular Longevity, 2016.
  17. Giannaccare, G., Pellegrini, M., Senni, C., Bernabei, F., Scorcia, V., & Cicero, A. F. G. (2020). Clinical applications of astaxanthin in the treatment of ocular diseases: Emerging insights. Marine drugs, 18(5), 239.
  18. https://www.sciencedirect.com/topics/neuroscience/astaxanthin
  19. Ambati, R. R., Siew Moi, P., Ravi, S., & Aswathanarayana, R. G. (2014). Astaxanthin: Sources, extraction, stability, biological activities and its commercial applications—A review. Marine drugs, 12(1), 128-152.
  20. EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA), et al. “Safety of astaxanthin for its use as a novel food in food supplements.” EFSA Journal 18.2 (2020): e05993.
  21. Ambati, R. R., Siew Moi, P., Ravi, S., & Aswathanarayana, R. G. (2014). Astaxanthin: Sources, extraction, stability, biological activities and its commercial applications—A review. Marine drugs, 12(1), 128-152.
  22. Fassett, R. G., & Coombes, J. S. (2011). Astaxanthin: a potential therapeutic agent in cardiovascular disease. Marine drugs, 9(3), 447-465.
  23. Al Nasser, Y., Jamal, Z., & Albugeaey, M. (2021). Carotenemia. In StatPearls [Internet]. StatPearls Publishing.
  24. https://www.naturalmedicinejournal.com/journal/astaxanthin-review-literature 

Article Comments

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  1. Dagmar

    June 18, 2017 , 8:29 am

    Super informative article! Thank you AlgaeCal team for your great work!!!

  2. Roger Kingsbury

    October 23, 2018 , 6:24 am

    I am currently trying to lower my triglyceride level.
    It was 239 in September 2018.
    I take 4mg of Astaxanthin and 1 fish oil capsule daily.
    Does this regimen help lower my triglyceride level?

  3. Jenna AlgaeCal

    October 23, 2018 , 2:58 pm

    Hi Roger,

    Yes, astaxanthin and fish oil can both help lower triglycerides when taken in the right form and at the right dosage!

    For astaxanthin, as we stated in the article, experts recommend 2 to 4mg of astaxanthin per day to experience the benefits. Of course, depending on the condition and individual, this may vary. This study found 12 and 18 mg/day of astaxanthin significantly reduced triglyceride levels.

    To experience this benefit with fish oil, the American Heart Association and the European Food Safety Authority recommend 2 to 4 grams (2,000-4,000 milligrams) of EPA and DHA each day for people with high triglyceride levels. For information on getting the right form of omega 3s go here.

    And if you’re interested in a product that combines these two ingredients plus turmeric curcumin, we have a fantastic product called Triple Power Fish Oil that you can check out here.

    I hope this information is helpful! 🙂

    – Jenna @ AlgaeCal

  4. Wilibald

    October 30, 2018 , 10:07 am

    I have been trying to take astaxanthin for about four months now, but every time I do I suffer a very bad anal leakage. I began taking 12 mg. a day and have gradually reduced the dose to 2 mg. per day, but the problem persists. I don’t understand how studies have been done using 12 mg. a day for many months, so I suppose there must be something unique about my physiology. I eat only pureed food, so I’m wondering if insufficient dietary ruffage may be producing a bad interaction with astaxanthin.

  5. Jenna AlgaeCal

    November 7, 2018 , 10:04 am

    Hi Wilibald,

    So sorry to hear you’re experiencing this when you take astaxanthin. Our best suggestion is to work with a functional medicine doctor who can help you determine what might be causing this for you!

    – Jenna @ AlgaeCal

  6. Robin Tan

    December 17, 2018 , 5:55 am

    Great article

  7. Kirk

    December 20, 2018 , 3:58 pm

    I have Astaxanthin extract powder,what’s the easiest way to injest this? Add it to a drink or food?

  8. Jenna AlgaeCal

    December 28, 2018 , 11:18 am

    Hi Kirk,

    Astaxanthin is fat soluble, so to increase absorption it’s best to take with a meal with healthy fats (avocado, wild fatty fish, coconut, etc.) ?

    – Jenna @ AlgaeCal

  9. Erzsebet NILSSON

    December 29, 2018 , 2:18 pm

    SORRY but

    2 -4 gram is ( 200 -400 milligram)

    what you converted is

    2000 -4000 milligram is = 2 -4 Kilogram which is EXTRA ORDINARY AMOUNT
    1 kilogram is 1 litre so your converting is like to drink 2 – 4 litre of it which you would not EVEN DO WITH MILK or WATER a DAY so with this would be an VERY DANGEROUS HAZARD OF HEALTH

  10. Jenna AlgaeCal

    December 31, 2018 , 11:52 am

    Sorry if there’s been some confusion, Erzsebet!

    You can use this online calculator to see that 2 grams is equal to 2,000 milligrams, or 0.002 kilograms. 🙂

    If you have any questions let us know!

    – Jenna @ AlgaeCal

  11. Nailejhcia Crawford

    January 1, 2019 , 1:04 pm

    Where can I purchase astaxanthin powder?

  12. Jenna AlgaeCal

    January 7, 2019 , 12:05 pm

    Hi Nailejhcia,

    You should be able to find astaxanthin powder at your local health food store! Keep in mind, astaxanthin is fat soluble so you can increase the absorption by taking it with healthy fats like avocado, wild fatty fish, and coconut. You can also get it preblended with healthy fats in our super powerful natural anti-inflammatory Triple Power Fish Oil!

    – Jenna @ AlgaeCal

  13. Ruth

    January 22, 2019 , 5:46 am

    Hello!
    I wanted to ask you: for how long it is safe to take astaxanthin?
    Is it like the Vitamin A? (that you need to rest from time to time in order to avoid accumulation in the body?)
    Thank you in advance!

  14. Jenna AlgaeCal

    January 28, 2019 , 2:36 pm

    Hi Ruth,

    We aren’t able to give a definitive answer here as there doesn’t appear to be any long-term safety studies done on astaxanthin just yet. We’ll revisit the research on astaxanthin in the future to check-in on new studies. 🙂

    In the meantime, you can definitely take breaks from supplementing with astaxanthin if you prefer!

    – Jenna @ AlgaeCal

  15. Monica

    January 25, 2019 , 4:35 am

    Can we take Astaxanthin as a life long supplement?????? Can we include this capsule in our diet????

  16. Jenna AlgaeCal

    January 28, 2019 , 2:56 pm

    Hi Monica,

    More research needs to be done on taking astaxanthin long-term, however, human clinical studies have shown no significant side effects to date!

    You should be able to find astaxanthin powder at your local health food store in a capsule or powder form. Astaxanthin is fat soluble so you can increase the absorption by taking it with healthy fats like avocado, wild fatty fish, and coconut. You can also get it preblended with healthy fats in our natural anti-inflammatory Triple Power Fish Oil!

    – Jenna @ AlgaeCal

  17. Sonia Joseph

    December 14, 2019 , 10:49 am

    Hi Monica, I have been taking 12mg of Astaxanthin for 8years now. I am 68 and I do not require any medicines. My BP is 118/60. My heart is perfect, All my blood tests come out normal. I am certain this good health is from taking my Astaxanthin and watching what I eat. I do eat healthy lots of vegetables, fruits and all types of meat and fish. I will not stop taking this supplement I believe it is helping me stay healthy!!

  18. Barbara Lamb

    February 2, 2019 , 9:04 pm

    Is there a vegetarian source of astaxanthin?

  19. Jenna AlgaeCal

    February 4, 2019 , 11:19 am

    Yes there is Barbara! You can find astaxanthin supplements sourced from marine algae.

    – Jenna @ AlgaeCal

  20. Ellouise

    February 3, 2019 , 4:03 am

    I am a vegan. What form of astaxanthin can I take?

  21. Jenna AlgaeCal

    February 4, 2019 , 11:25 am

    Hi Ellouise,

    There are vegan supplements available! You can purchase them online or at your local health food store.

    – Jenna @ AlgaeCal

  22. Maria Baker

    February 3, 2019 , 4:56 am

    Is any amount of astaxanthin present in AlgaeCal Plus?

  23. Jenna AlgaeCal

    February 4, 2019 , 11:31 am

    Good question, Maria. No, AlgaeCal Plus doesn’t include astaxanthin — it specifically contains the vitamins and minerals essential for strong healthy bones!

    We do have a wonderful anti-inflammatory product called Triple Power Omega 3 Fish Oil that contains astaxanthin, turmeric, and omega 3 fatty acids. You can see it here.

    – Jenna @ AlgaeCal

  24. Linda Corsetti

    February 3, 2019 , 1:55 pm

    I know fish eat the algae, but I am a vegetarian and do not eat any fish, chicken, beef or anything with a face!
    How can I get Astaxanthin in supplement form? I do not take fish oil.
    Thank You, Linda

  25. Jenna AlgaeCal

    February 4, 2019 , 11:21 am

    Hi Linda,

    I think you’ll be able to find astaxanthin supplements at your local health food store! If not, there are lots of companies selling it online. 🙂

    – Jenna @ AlgaeCal

  26. Cheryl Jolley

    July 2, 2019 , 3:37 pm

    I have introduced to Wonderful product and I’m on my second bottle I’ve also started my husband on it as well
    I buy mine on line at “Stop Aging” they have very decent cost and this last order was for Two bottles and I received a bottle of Memory Help at not cost . I truly believe I’m feeling better and have more energy and my short term memory is actually coming along well.. Thanks Cheryl Jolley

  27. Gloria Armstrong

    February 3, 2019 , 9:44 pm

    Will it lower my LDL?

  28. Jenna AlgaeCal

    February 11, 2019 , 3:45 pm

    Good question, Gloria.

    ‘Improved Heart Health’ didn’t make it to our ‘Proven Health Benefits of Astaxanthin’ because the research isn’t super strong. In saying that, some research does show that astaxanthin can inhibit LDL (bad cholesterol).

    Hopefully more studies will be done on astaxanthins benefits in the future!

    – Jenna @ AlgaeCal

  29. Linda Hoover

    February 12, 2019 , 1:06 pm

    I would love to take your fish oil and even ordered it once awhile back – but cannot given the sweetener. Please offer this wonderful supplement without the alcohol-based sweeteners so I can use it too! Thanks.

  30. Jenna AlgaeCal

    February 12, 2019 , 2:47 pm

    Oh no, sorry to hear that Linda! I’ll share your feedback with the rest of the team — we’d love to carry a fish oil product that suits you. 🙂

    – Jenna @ AlgaeCal

  31. Norberto Haro

    March 4, 2019 , 3:42 am

    I started taking astaxanthin about two months ago,I had teeth work done at the dentist and she said my gums where bleeding unusualy a lot.
    So my question is does astaxanthin make your blood thinner?

  32. Jenna AlgaeCal

    March 4, 2019 , 11:55 am

    Hi Norberto,

    Astaxanthin is not a blood thinner, but it may increase the risk of bleeding or blood clotting when taken with drugs that increase such risks. So it would be a good idea to check with your doctor if astaxanthin could be interacting with any prescription medications you take.

    Hope that helps!

    – Jenna @ AlgaeCal

  33. Ashok jain

    March 8, 2019 , 12:27 am

    Can flaxseed be useful instead of fish

  34. Jenna AlgaeCal

    March 15, 2019 , 2:07 pm

    Hi Ashok,

    Flaxseed does contain fatty acids so it should help increase the absorption of astaxanthin! If you’re interested, we compare animal vs. plant-based omega 3’s in this blog post.

    – Jenna @ AlgaeCal

  35. Patricia Szydlo

    June 2, 2020 , 7:14 am

    I cannot take Turmeric or Curcumin or any root based herbs or vegetable. Do you carry Astaxanthin as a sole ingredient? Thank you , Patricia

  36. Megan AlgaeCal

    June 2, 2020 , 10:31 am

    Hi Patricia, sorry to hear this.

    We don’t offer astaxanthin on its own and do apologize for any inconvenience this causes!

    -Megan @ AlgaeCal

  37. Von

    March 18, 2019 , 5:42 pm

    I read that this may cause loose bowel movements is this true?

  38. Jenna AlgaeCal

    March 27, 2019 , 8:53 am

    Hi Von,

    I haven’t heard this from customers who are taking Triple Power Fish Oil which includes astaxanthin! I’m guessing loose bowels could be caused by taking very high doses.

    – Jenna @ AlgaeCal

  39. Christina

    April 6, 2019 , 10:08 pm

    All this consuming of krill should be examined for its effect on the ocean life. Are we overfishing this resource which is the basic food at the bottom of the food chain.

  40. Naomi Johnston

    April 13, 2019 , 3:14 am

    I am 52 years old and after surgery 12 months ago to correct a leg surgery my leg was broken twice then I had metal plate and screws put into my leg. These caused my immune system to break down. While I used to get cold sore once every 6 months now I couldn’t get rid of them I had night sweats and rashs and a constant chest infection which I never had before. One day I went into my health food shop and found the hawaiian astaxanthin and it sounded great. So I started 1 x 12mg capsule a day and was amazed at the results. I became well and got rid of the awful coldsores. Twice I have gone away for a couple days and forgot to take this wonder vitamins and symtoms started straight away and could feel cold sores coming. As soon as I started back on hawaiian astaxanthin my symptoms completely disappeared. I am hoping to get plate and screws out of my leg in next few month’s as I feel this is the problem with my immune system. My physio told me others were affected after there surgery with plate and screws and 1 man got them out and no more problems. Anyway this product is helping me until surgery and I can not believe it’s control on the constant cold sore problems I was facing. Funny enough I have not seen anything where it says it fixs that problem. Worth a try goodluck.
    Naomi

  41. Shaheen

    October 9, 2019 , 4:25 am

    Hi Ms. Jenna,
    I am taking it from the last 02 days and I found a deep red color oil leakage just before making pressure to move the bowels out. Is this safe? or I have to discontinue? I am taking 08 mg immediately before breakfast. I am thinking that my body is not absorbing Astaxanthin. Why this may happen? I am a frequent smoker and my age is 29 years.
    Please suggest me what to do next.
    Thank you so much.

  42. Megan AlgaeCal

    October 11, 2019 , 9:39 am

    Hi Shaheen,

    Sorry to hear that! Please do discontinue use for now. Shaheen, are you able to provide us with more information so that we can better help you? Are you taking a product containing only astaxanthin at 8mg a day?

    Thanks and we look forward to helping you along your bone health journey! ❤️

    -Megan @ AlgaeCal

  43. Shaheen

    October 12, 2019 , 10:12 am

    Ms. Megan,
    Thank you so much for your reply. I am taking the astaxanthin 08 mg in a gelatin capsule form which solely Astaxanthin. I am a male of 29 years old. I noticed after 05 days of serving, the above condition is happening each one day after one day. Total 02 days within 05 days of serving. What does it mean? Am I not eligible to digest it? I am not under any type of medical conditions and drugs. Naturally, I am physically well except for inflammation.
    Regards from,
    Shaheen

  44. Diane

    November 15, 2019 , 8:28 am

    Dr Mercola recommended krill oil with no mention of side effects as you don’t either. I tried krill in place of fish oil and it sent my blood pressure dangerously low and heart rate dangerously high. I have since read the is a side effect.

  45. Megan AlgaeCal

    November 19, 2019 , 9:18 am

    Hi Diane, thanks for reaching out.

    We’re sorry to hear about your experience with krill oil ❤️ Typically, omega 3s help to lower heart rate and improve blood pressure by lowering it (but not to a dangerously low level). We would recommend checking in with your doctor about any health conditions or medications that may have impacted how your krill oil supplement affected you. Other things to consider are whether your krill supplement contains other ingredients, if you started any other new supplements, or had major changes in lifestyle.

    It’s a good idea to discontinue your krill oil if you haven’t already. Please do keep us updated on how you’re doing! If you prefer, we’re available by phone at 1-800-820-0184 ?

    -Megan @ AlgaeCal

  46. KRISTA

    November 19, 2019 , 3:44 am

    Hi

    I was taking a krill supplement daily and have now started to take 12mg of Astaxanthin. Should I continue to take my fish oil or is this now a suitable subsitute, I do not want to take too many supplements.
    Thank you

  47. Megan AlgaeCal

    November 19, 2019 , 3:40 pm

    Hi Krista, glad you reached out!

    You likely do not need to take both your krill oil and fish oil. If you’re interested in a fish oil that includes astaxanthin, as well as the powerful anti-inflammatory turmeric, feel free to learn more about our Triple Power fish Oil here.

    Let us know if you have further questions!

    -Megan @ AlgaeCal

  48. KRISTA MADDEN

    November 20, 2019 , 2:05 am

    Thanks for your reply, I will check it out

  49. Blaire AlgaeCal

    November 20, 2019 , 12:06 pm

    Sounds wonderful, Krista! 🙂

    – Blaire @ AlgaeCal

  50. Maureen Burley

    October 16, 2020 , 2:41 pm

    My understanding is that Omega 3’s are ok to take with Astaxanthin, that Omega 3’s, help the absorption of Astaxanthin, because it’s a “good fat”. Also, 12mg of Astaxanthin is a ideal daily dosing, 4mg didn’t prove to show much of the benefits of Astaxanthin.

  51. Emee

    March 5, 2020 , 1:02 pm

    I have read that turmeric or curcumin can cause macular degeneration. Do you have any studies or info on this?

  52. Blaire AlgaeCal

    March 6, 2020 , 1:18 pm

    Hi Emee,

    Thanks for bringing this to our attention!

    We’re happy to clear up any confusion – it seems that curcumin can actually be beneficial for macular degeneration. You might find this study informative.

    Hope that helps! Please let us know if you have further questions ?

    – Blaire @ AlgaeCal

  53. NITHIN

    August 2, 2020 , 1:00 pm

    Going through some reddit comments I found that astaxanthin is 5α-Reductase inhibitor is there any study confirm that

  54. Megan AlgaeCal

    August 4, 2020 , 2:01 pm

    Hi Nithin!

    There are some preliminary studies showing that astaxanthin may act as a 5α-Reductase inhibitor. In saying that, more evidence is needed to support this claim.

    -Megan @ AlgaeCal

  55. Connie Cavender

    September 6, 2020 , 10:17 am

    I read that taking this supplement can make for reddish stools…this happened to me. Do you agree with this finding?

  56. Megan AlgaeCal

    September 6, 2020 , 1:35 pm

    Hi Connie!

    Yes, this can happen with astaxanthin supplements and shouldn’t be a cause for concern. If you are experiencing any other symptoms, however, please do check in with your doctor. ❤️

    -Megan @ AlgaeCal

  57. Terri

    September 8, 2020 , 8:09 am

    How much should be taken if your a 21 year old male athlete? For muscle recovery?

  58. Megan AlgaeCal

    September 9, 2020 , 9:29 am

    Hi Terri!

    Most research studies on exercise recovery use a daily dose of 4mg a day. We recommend consulting a health care professional who is familiar with your medical history before starting a new supplement. Hope this helps!

    -Megan @ AlgaeCal

  59. Darren Couling

    September 24, 2020 , 7:15 am

    Do you know if astaxanthin has been studied in human trials for interstitial lung disease?

  60. Megan AlgaeCal

    September 25, 2020 , 10:56 am

    Hi Darren,

    It looks like the studies on astaxanthin and interstitial lung disease are primarily animal studies and in vitro studies. Hope this helps!

    -Megan @ AlgaeCal

  61. Summer

    October 23, 2020 , 10:21 am

    I have found articles that link Astaxanthin to gynecomastia in men. Do you have anymore I for on this?

  62. Megan AlgaeCal

    October 27, 2020 , 9:24 am

    Hi Summer!

    It looks like there isn’t enough research on this to confirm a direct link between astaxanthin and gynecomastia. We would recommend checking in with a health professional if you’re concerned about this, particularly if you have hormone disorders or are using medications that can affect hormones. Hope this helps! ❤️

    -Megan @ AlgaeCal

  63. Rubin

    January 31, 2021 , 7:10 am

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  64. Cecelia Antilla

    April 20, 2021 , 11:56 pm

    I am having alot of unusual bloating and discomfort in my upper abdomable since taking 4mg of astaxanthin about 1 month now. I do take my usual vitamins & B/P meds as well

  65. Megan AlgaeCal

    April 21, 2021 , 9:20 am

    Hi Cecelia,

    Sorry to hear this. We would recommend checking in with a health care professional who is able to assess what might be going on based on your medical history. ❤️

    -Megan @ AlgaeCal

  66. Chris

    May 21, 2021 , 11:02 am

    I have to watch my potassium level. Will any of the ingredients in this product raise potassium levels?

  67. Blaire AlgaeCal

    May 21, 2021 , 3:07 pm

    Hi Chris,

    Thank you for reaching out to us!

    Are you referring to the ingredients in Triple Power Fish Oil?

    Looking forward to hearing from you ?

    – Blaire @ AlgaeCal

  68. Valene

    September 13, 2022 , 6:17 pm

    I read bone density can’t be replaced. I’ve been taking heartburn medication for years and a few yrs. ago found information on how it depletes bone density. So approximately a year and a half ago I quit taking heartburn medication because of this and was just wondering what your thoughts are on this And if you feel your supplements can or will reverse this damage or build the bone density back . Thanks!

  69. Chelsea Dugas

    September 14, 2022 , 1:55 pm

    Thanks for reaching out, Valene.

    We’ve helped thousands of men and women over the years, with varying degrees of bone loss, to increase their bone density safely and naturally, and the proof is in their results! If you’d like to hear some of their inspiring success stories, you can visit our site HERE. Please know that you can also contact our Bone Health Consultants 7 days a week at 1-800-820-0184 (USA & Canada, toll-free) or email [email protected] for more information and personalized support. Hope this helps! 🙂

    – Chelsea @ AlgaeCal

  70. Barbara

    September 15, 2022 , 5:08 pm

    My husband started taking astaxanthin the past month and has recently had trouble on and off with blurry vision. He got eyes checked today and they are fine. The only thing he’s changed in the past month is taking the astaxanthin. Could blurry vision be a side effect.
    Thank you,
    Barbara

  71. Chelsea Dugas

    September 19, 2022 , 12:47 pm

    Thanks for reaching out, Barbara,

    This is quite unusual and definitely not something we would expect. We recommend speaking with your doctor about this. Best of luck!

    – Chelsea @ AlgaeCal

  72. Patricia Favreau

    September 21, 2022 , 6:41 am

    One article suggests astaxanthin needs fats to be absorbed (fish oil of some variety) and so should be taken with meals. Another says it should be taken before bedtime, as it is also a sleep aid. Which is correct?

  73. Chelsea Dugas

    September 22, 2022 , 1:14 pm

    Hi, Patricia!

    The good news is that if you are taking our Triple Power Fish Oil (which contains astaxanthin) the fish oil will help with the absorption and you can easily take it before bed! Two birds with one stone! Hope this helps! 🙂

    – Chelsea @ AlgaeCal

  74. Coleen C Long

    October 8, 2022 , 3:46 pm

    Turmeric curcumin interacts with blood thinners. I’ve always wished I could take this supplement but because I am on a blood thinner, I cannot. I enjoyed your article though and I will try to eat more salmon, although it’s very expensive. I do eat three avocados a week, I used to take a fish oil but I stopped because of the cost. I am going to have to start up again. I have a heel spur. I’m in terrible pain and am also very active. It’s difficult. Thank you for the info.

    Coleen

  75. Brianne Bovenizer

    October 9, 2022 , 8:25 am

    Hi Coleen,

    Thanks so much for your comment, and we are so sorry to hear of the pain you are in! We would suggest working with a Functional Medicine Doctor if you haven’t already considered this. You could also look out for a designated Astaxanthin supplement at your local health food store if you’re looking for an option without curcumin 🙂

    Please don’t hesitate to reach out to us at 1-800-820-0184 if you have any additional questions!

    – Brianne @ AlgaeCal

  76. Frank

    October 31, 2022 , 10:36 am

    is astaxanthin better than glutathione

  77. Chelsea Dugas

    October 31, 2022 , 1:51 pm

    Great question, Frank!

    From what we understand, both offer powerful antioxidant benefits! Interestingly though, one study has found that supplementing with astaxanthin increases levels of glutathione! You can view that study HERE. Hope this helps to answer your question!

    – Chelsea @ AlgaeCal

  78. Georgia Marinelli

    November 24, 2022 , 4:52 pm

    I’m so glad you have fish oil that tastes good because I can’t swallow pills. When I used to have to open up the capsules, it tasted so disgusting, not at all like fish which I love.
    Thank you so much.

  79. Brianne AlgaeCal

    November 27, 2022 , 9:37 am

    Hi Georgina,

    Thank you so much for commenting! We are so happy to hear that Triple Power Fish Oil has made your life a little easier! 🙂

    – Brianne @ AlgaeCal

  80. lanette smith

    December 3, 2022 , 1:35 pm

    Could this help with Vitiligo

  81. Shelby AlgaeCal

    December 6, 2022 , 12:55 pm

    Hi Lanette,

    Thank you for reaching out to us – this is a great question, and I’m happy to help!

    Lanette, Astaxanthin is an antioxidant that has been shown to have benefits for reducing inflammation and can be beneficial for skin – and, Astaxanthin and is one of the ingredients in our Triple Power Fish Oil! That said, we haven’t done studies to determine if Astaxanthin or our Triple Power Fish Oil would be helpful for conditions like Vitiligo, so it’s tough to say for sure! We would encourage you to check in with a doctor or dietician for their best advice, as they would likely have more information on this topic. Hope this helps!

    – Shelby @ AlgaeCal

  82. Lolly

    January 8, 2023 , 2:45 pm

    is cod liver oil an Omega 3?

  83. Brianne AlgaeCal

    January 9, 2023 , 1:26 pm

    Hi Lolly,

    Cod liver oil is a wonderful source of the omega 3 fatty acids EPA and DHA. It also contains vitamin A and vitamin D! 🙂

    – Brianne @ AlgaeCal

  84. Gwendolyne H Vint

    February 26, 2023 , 4:30 pm

    Please advise…. if Astaxanthin…. assists in ….. weight loss…

    thqnkw

  85. Chelsea Dugas

    February 28, 2023 , 8:07 am

    Hi, Gwendolyne! There are some studies that suggest astaxanthin can assist in weight loss due to its antioxidant properties as well as important preventative and therapeutic effects on liver health. When combined with exercise, it becomes even more effective! Be sure to always consult your doctor when considering adding new supplements to your regimen. Hope this helps!

    – Chelsea @ AlgaeCal

  86. Gloria Valle

    March 14, 2023 , 1:34 pm

    Thank you for such good and clear information. Thank you.

  87. Manja

    March 15, 2023 , 7:51 am

    Thank you for your feedback, Gloria!
    It is truly our pleasure to inform and empower you and support you on your bone health journey.

    Manja @ AlgaeCal

  88. JOHN DI RESTA

    April 5, 2023 , 6:40 am

    how can you get astaxanthin?

  89. Megan Khera

    April 5, 2023 , 10:28 am

    Hi John!

    Our Triple Power Fish Oil provides you with 3 mg of astaxanthin in just one tablespoon!

    – Megan @ AlgaeCal

  90. Armando Zamora

    April 5, 2023 , 8:42 pm

    what brand of astaxanthin do you recommend?

  91. Shelby AlgaeCal

    April 6, 2023 , 8:47 am

    Hello Armando! While we don’t recommend a particular brand of astaxanthin, it may help to know that our Triple Power Fish Oil contains 3 mg in a daily serving of one tablespoon! You are welcome to read more about Triple Power and the benefits of astaxanthin in general HERE.

    We hope this helps, and do let us know if you have any further questions! 🙂

    – Shelby @ AlgaeCal

  92. Debbie Burness

    April 14, 2023 , 7:14 am

    What is the reason the triple power fish oil has guar gum, xylitol, and the other additives to the product? Are these preservatives? Are those preservatives healthy for you?

  93. [email protected]

    April 14, 2023 , 8:52 am

    Hello Debbie,

    We add a very small amount of guar gum to our Triple Power Fish Oil as it helps with the consistency, ensuring a smoothie like texture and preventing separation between the oil and water in the final product! The xylitol is added as a natural sweetener and helps contribute to the delicious mango (fish free) taste! Actually, xylitol has some surprising bone health benefits, which you can read more about HERE! Don’t hesitate to reach out if you have any more questions 🙂

    – Hillary @ AlgaeCal

  94. Mary

    June 11, 2023 , 5:25 am

    Hi is there a 100 % money back guarantee. That this will work

  95. Shelby AlgaeCal

    June 12, 2023 , 12:57 pm

    Great question, Mary! our Stronger Bones for Life guarantee HERE promises that your next DEXA scan will show an increase in bone density after you take AlgaeCal Plus and Strontium Boost as directed for at least 6 months! There’s just a couple of important steps to make sure we can guarantee your results:

    To start, you must have a DEXA scan within 30 days of starting AlgaeCal to establish a baseline measurement of your current bone density. Then, you must take both AlgaeCal Plus and Strontium Boost at their full clinical dose for at least 6 months but up until your next DEXA scan. Finally, you must have your follow-up DEXA scan from the same clinic as your first scan! It doesn’t matter when… six, twelve, even 24 months after you start – as long as you have continued to use AlgaeCal Plus and Strontium Boost between scans. If you don’t see a measurable increase in bone density in the hip and/or the spine, we’ll refund the cost of your supplements between scans!

    I hope this information helps, and of course, please feel free to reach out at 1-800-820-0184 (USA & Canada toll-free) if you have any questions about your eligibility for our guarantee! 🙂

    – Shelby @ AlgaeCal

  96. Mary Jane Ostendorf

    June 17, 2023 , 9:34 am

    You are leaders in public health education. Many thanks!

  97. Shelby AlgaeCal

    June 19, 2023 , 1:10 pm

    It’s truly our pleasure, Mary Jane! It’s our goal to inform and empower all of those in our community, and we always do our best to achieve this. We appreciate you sharing your feedback, and so let us know if there’s anything we can do to support you moving forward!

    – Shelby @ AlgaeCal

  98. S K

    June 17, 2023 , 3:30 pm

    3 Tips for Choosing The Best Astaxanthin Supplement
    You only list 2. What is the third?

  99. Shelby AlgaeCal

    June 19, 2023 , 1:27 pm

    Thank you so much for reaching out and calling this to our attention! I have promptly shared your feedback with our team for review, as it looks like this may have been a typo. Of course, do let us know if you have any additional questions or feedback, and we’ll be happy to help!

    – Shelby @ AlgaeCal

  100. Michi

    June 17, 2023 , 3:51 pm

    Can astaxanthin replace vitamin C, A, E, and Co-Q10 if I am taking all those supplements???

  101. Shelby AlgaeCal

    June 19, 2023 , 3:12 pm

    Great question, Michi! While astaxanthin does have many shared benefits with the other supplements you’ve mentioned, it’s my understanding that Vitamins C, A, E, and CoQ10 all have their own benefits for health. As such, it’s likely fine for you to continue to astaxanthin alongside your other supplements to make sure that you’re still getting the unique benefits of each, although you’re welcome to confirm this with a heath care professional! 🙂

    – Shelby @ AlgaeCal

  102. Marilyn Story

    June 17, 2023 , 5:45 pm

    I am a vegan. Can I consume astaxanthin directly and not from krill, salmon or shrimp?

  103. Shelby AlgaeCal

    June 19, 2023 , 3:17 pm

    Thank you for reaching out, Marilyn! This is a great question, and while we don’t have any specific brand recommendations, it’s my understanding that there certainly are options for vegan astaxanthin supplements available. Of course, do let us know if you have any additional questions, and we’ll be happy to assist you! 🙂

    – Shelby @ AlgaeCal

  104. Chong Lek Koh

    January 19, 2024 , 5:54 am

    Do most brands of astaxanthin softgels contain esterified astaxanthin or free form astaxanthin from Haematococcus pluviali?
    Is esterified astaxanthin or free form astaxanthin readily abosorbed in human intestines?
    Is esterified astaxanthin or free form astaxanthin more beneficial to humans?
    Is it safe for humans to consume 12 mg of astaxanthin daily?
    Thank you.

  105. [email protected]

    January 19, 2024 , 12:14 pm

    Thank you for reaching out Chong Lek,

    While we can’t speak to the form of astaxanthin used in other brands, you’ll mainly find esterified astaxanthin and non-esterified astaxanthin.

    Whenever you can get supplements in their natural form, it’s always best. When compounds are produced in a lab, you never know how well they will interact with a biological system (like your body). Natural compounds have been produced by mother nature and therefore tend to be absorbed and assimilated optimally. Furthermore, synthetic astaxanthin was developed to feed farmed salmon to give them a desirable, consumer-friendly color. It has not been extensively studied regarding safety for human consumption.

    The European Food Safety Authority (EFSA) confirmed that astaxanthin supplementation at levels of up to 8 mg per day can be used without any risk to health. For reference, each tablespoon of Triple Power fish oil provides 3mg of astaxanthin! Let us know if you have any further questions!

    – Sammy

This article features advice based on cutting-edge research from our industry experts to give you the best possible information to support your bone-building journey.

Lara Pizzorno
MDiv, MA, LMT - Best-selling author of Healthy Bones Healthy You! and Your Bones; Editor of Longevity Medicine Review, and Senior Medical Editor for Integrative Medicine Advisors.,
Dr. Liz Lipski
PhD, CNS, FACN, IFMP, BCHN, LDN - Professor and Director of Academic Development, Nutrition programs in Clinical Nutrition at Maryland University of Integrative Health.,
Dr. Emma Gasinski
PT, DPT, RYT - Physical therapist and certified yoga teacher with a Doctorate in Physical Therapy from Rocky Mountain University of Health Professionals,
Dr. Lawrence (Larry) A. May
MD, FACP, Harvard Medical School Graduate, Physician, Author, Public Speaker - Doctor of Internal Medicine at Providence Cedars-Sinai Tarzana Medical Center and author of several articles and books, including the widely utilized and best selling medical textbook Primary Care Medicine,