Mind Boosters
A Guide to Natural Supplements
That Enhance your Mind, Memory, and Mood
by
Ray Sahelian, M. D.
 
 
 

St. Martin's Griffin, New York, July, 2000, $11.96 @Amazon.com

Book Review by Bob Seitz


Background
"Mind Boosters", written by Ray Sahelian, M. D., is that rare book written by a professional in the field who isnt selling anything, and who combines professional knowledge with sound judgment. Ive long felt the need for such a book. In his book, Dr. Sahelian gives a highly detailed set of guidelines for noetic nutrients, including discussions of their efficacy, Dr. Sahelians personal experiences with them, his suggested dosage levels, a discussion of cautions and side effects, and his recommendations concerning their use.
     Although Ive tried to provide a relatively detailed review of this book, I would advise anyone interested in health foods and dietary supplements to purchase this book as a guide to their use. This book review is intended to whet the readers appetite rather than as a substitute for Dr. Sahelians book. The book isnt expensive, and its packed with useful information.
     Herbs work. The effects of some of them are palpably and rapidly felt. Some of them work better than conventional pharmaceutical agents. (In 1981, I read several papers by a cancer researcher at M. D. Anderson who had determined that two Chinese herbs, astragalus membranaceous and echinacea purpurea, were more effective immune system boosters than the then-current prescription immune system boosters.) Dr. Sahelian mentions that St. Johns wort has been prescribed in Europe for more than twenty years, and has been shown to be as effective in alleviating depression as pharmaceutical antidepressants, while exhibiting fewer side effects. (Unlike pharmaceutical products, St. Johns wort consists of a mixture of many active ingredients, so its not easily analyzed or synthesized.) Because herbs work, there is the attendant danger of side effects. I have been hesitant about using herbal remedies and other food supplements, thinking that studies of their safety and side effects may not have been performed. However, Dr. Sahelians book discusses these side effects, together with some of the clinical testing of them that has been performed. Herbs, nutrients, or techniques that could boost IQs by as little as 10 or 15 points would still seem to be worthwhile.
    
In November, 1998, Scientific American published a special issue entitled, "Exploring intelligence". One of its chapters was entitled "Seeking 'Smart' Drugs", by Margaret Holloway, Staff Writer. My impression of the article is that it is downplaying the known results with, perhaps, the hidden agenda of discouraging amateurs to avoid tinkering with potentially dangerous psychoactive agents. (Of course, this article was probably written almost three years ago.)
    The author reports that a cup of coffee with sugar in it may have been among the most effective "smart drugs" available in 1998. A nicotine patch might also temporarily boost IQ.
    Whatever the case in 1998, there are by now psychoactive agents that will modestly boost IQ, and among them are herbs and nutrients.

IQ-Enhancing Drugs
(1) Current FDA-Approved Cognitive-Enhancement Drugs
    Two of the first drugs approved by the FDA for the treatment of Alzheimer's patients, tacrine (Cognex) and donepezil hydrochloride (Aricept) are highly toxic to the liver. Huperzine-A, a Chinese herb (discussed further below), is said to be more effective than either tacrine or donepezil. Like tacrine and donepezil, it inhibits the breakdown of acetylcholine within the brain. Its long-term effects haven't been studied as well as tacrine and donepezil, but presumably, it might exhibit liver toxicity, like tacrine and donepezil. A third cholinesterase inhibitor, rivastigmine (Exelon) has recently been OK'd for administration to Alzheimer's symptoms. Another Alzheimer's drug that is currently undergoing clinical testing is galantamine (Reminyl). Galantamine is a dual-action drug that also stimulates nicotinic receptors. (Two new studies of galantamine have shown patient improvements over a 12-month period. Since Alzheimer's patients' cognitive abilities usually deteriorate over a 12-month period, this sounds like a promising Rx.)
(2) Treatment Modalities Currently Under Development or in Clinical Trials
    Inhibiting two enzymes, a subset of beta secretase and gamma secretase, that seem to be instrumental in forming amylloid plaques might block the development of Alzheimer's disease.
    Cloning cells that can produce nerve growth factor and then injecting them into the brain has largely restored youthful brain function in four monkeys. A clinical trial of this nerve growth factor approach is now underway in San Diego. "Meanwhile, human clinical trials are now underway on a number of human growth factor drugs."
    Phase I trials of a new vaccine that would marshal the body's immune system to attack amylloid plaques has been conducted in humans and "no obvious safety concerns have been identified".
Anti-oxidants appear to confer significant protection against Alzheimer's Disease.
    "Memantine" also appears to improve the memories of Alzheimer's patients by affecting the NMDA (N-methyl D-Aspartate) receptor. (Duplicate copies of the NMDA receptor give Doogie mice their elevated intelligence.)
    A high-fat diet, particularly for someone who carries the ApeE-e4 allele, increases the risk of developing Alzheimer's Disease by a factor of 7.
    Numerous recent news articles regarding progress in re Alzheimer's Disease and neurological developments may be found on the referenced web pages.
(3) Future Prospects
    In 1999, a spokeswoman for a Johns Hopkins program for gifted children told the assembled parents that within 10 years, treatments would be available that could increase a child's IQ by as much as 50 points. Of course, that's far from a sure thing, and it's far from assured that such treatments would be safe or practical. Still, with more than 30 drugs currently in the FDA approval pipeline, including techniques for directly enhancing the brain through nerve growth factors and the stimulation of new-neuron production, the coming decades appear to offer interesting vistas. We know that comestibles can affect the brain. Alcohol and cocaine are cases in point. In a November 11, 2000, article about The Future of Drugs, the author mentions in passing: Drugs that make you measurably smarter are definitely on the way.
(4) Importance of General Good Health
    Certain holistic health factors including stress levels, absence or presence of fatigue, exercise, and good circulation affect intellectual performance. Someone who takes an IQ test when they are well-rested, pumped up from moderate exercise, and happy and enthusiastic about the test is probably going to do better than someone for whom less favorable circumstances apply.

Chapter 1 - Caveats

    Dr. Sahelian begins on a note of caution. He observes that nutrients, although generally safer than drugs, aren't necessarily harmless--witness cholesterol. He cautions the reader that their effects can depend upon dosage, timing, existing medical conditions, age, sex, and interactions with other nutrients. He advises notifying one's physician of one's plans to try such "mind-boosting" nutrients. For example, someone who is under treatment for a mental condition would want to discuss any herbal supplements such as St. John's wort with his or her physician.

Chapter 2 - The Top Ten Mind-Boosting Principles

  (1) You need a variety of nutrients in small doses rather than one nutrient at a high dosage level.
  (2) Sometimes more is less. Nutrients have an ideal dosage, and taking more could lead to side effects such as restlessness, insomnia, and/or anxiety.
  (3) Start with low doses. Researchers often use large dosages to elicit a measurable response in a short time, but for continuous use with a combination of nutrients, smaller doses may be needed (since some of these notropics may produce some of the same effects).
  (4) Tolerance is possible with continuous usage--e. g., with melatonin. Should use melatonin intermittently.
  (5) Timing is critical. Caffeine and theophylline should be taken early in the day, and melatonin at bedtime.
  (6) Choose the right supplement for the right setting.
  (7) Some supplements can accumulate. Reduce your dosages if you're having side effects.
  (8) Brain supplements influence the whole body.
  (9) Some natural ingredients have not been thoroughly tested. Since 1994, new dietary supplements no longer require approval by the FDA. Don't assume that because something is available over the counter, that it's been tested for effectiveness or for safety.
(10) Train Your Mind. It used to be thought that the capacity of the brain was fixed, since it was also thought that the number of neurons in the brain was fixed*. It is now known that the number of connections made by the brain is a function of how much it's used. It's like a muscle: use it or lose it. It is also now known that some new neurons are created, particularly in the hippocampus, which plays a crucial role in short-term memory.


* - One of the alarming-sounding statistics that is often quoted about the brain is that about 1,000 neurons die every day. I'm not sure that this is still thought to be the case, but even if it is, consider the following.
    The brain contains about 100 billion neurons. If it lost 1,000 neurons a day, that would be equivalent to losing 1 neuron a day out of 100 million neurons, or 1 neuron every 1,000 days (three years) out of 100,000 neurons, or 1 neuron every 30 years out of 10,000 neurons--in other words, 1 in 10,000 every 30 years. Over the course of 60 years, the brain would lose about 0.02% of its neurons--a trivial amount. If your IQ dropped by 0.02%, or 0.02 points of IQ, between 25 and 85, the decline would be utterly undetectable.


Chapter 3 - An Owner's Manual for Your Brain

   The human brain contains about 100 billion neurons and about 900 billion glial cells that surround and support the brain. The brain occupies a volume of 1,350 cc.'s, making it about 13.6 cms. or 5.4 inches in diameter.
    Individual cells are typically 10 to 20 microns (thousandths of a millimeter) in length, or 1/1,000th to 1/500th of a centimeter, or 1/2,500th of an inch to 1/1,250th of an inch long. Since there are roughly a trillion neurons and glial cells packed into the 1,350 cubic cms. of the brain's volume, this suggests an average volume of 1,350 cubic microns for each cell, consistent with an average diameter (if the cells  were all spherical) of about 10 microns.
    Cells are extremely small compared with us, but they relate to the individual molecules that form them in just about the same way that we relate to our cells. The simplest molecules are often less than a nanometer in length, and there would be, perhaps, 25,000 to 50,000 of them along the length of a cell. Each neuron possesses, perhaps, 10,000 synapses or interconnection junctions with other neurons. Since these synapses are shared, there are, perhaps, 500 trillion unique synapses in the brain (of the order of a quadrillion). If we suppose that the weightings at each synapse could be simulated with one byte of information (256 discrete weighting levels), then the brain might store 500 terabytes (500,000 gigabytes) of information. (Note that if the weightings at the synapses lie on a continuous scale, there will be problems with the reliabilities of their values, so that outputs of several synapses would have to be averaged to arrive at a dependable value--which appears to be what happens. The brain appears to be a reliable network comprised of unreliable components.) The dendrites and dendritic brushes that form these synapses are very small, with dimensions measured in nanometers. The brain fires at a rate of about 20 times a second, so there would be up to 10 quadrillion synaptic activations a second. This has given rise for estimates of the brain's computational power of 100 to 10,000 trillion operations per second. (Our current supercomputers are operating in the 10-to-100 trillion operations per second range--at the lower threshold of these estimates.) Dr. Hans Moravec has compared the processing layers of the retina of the eye, measuring about 2 cms. by 2 cms. by 1/100th centimeters thick (0.04 cc's) with the computing power required to perform its functions, and has come up with an estimate of about one billion computations per second--about what your current desktop computer can deliver. Scaling that up to the entire brain, he arrives at a computational power for the brain of about 100 trillion calculations per second. (Dividing 0.04 cc's into 1,350 cc's, I get a ratio of about 33,750 billion, or 33.75 trillion calculations per second. But it's a very large number.) I've read about designs for artificial neurons that would require 7 transistors per neurons, and artificial synapses that would require 5 transistors per synapse. If so, then 2,500,000 billion transistors would be required to emulate the brain. We're currently sampling RAM chips that contain 1 billion transistors per chip.
    Dr. Sahelian explains that neurons communicate with each other both electrically and chemically. The chemical interactions take place through neurotransmitters such as serotonin, dopamine, norepinephrine, and acetylcholine. About one hundred or so different neurotransmitters have been identified. He presents a drawing of a neurotransmitter molecule released by one neuron docking in a receptor for that neurotransmitter on another neuron. He also discusses the cell membrane, comprised of fatty lipids, where neuron-to-neuron communication takes place, and provides a drawing of its structure. He lists the three phospholipids: phosphatidylcholine (PC or lecithin, 30%), phosphatidylethanolamine (PE, 27%), and phosphatidylserine (PS, <10%), plus cholesterol (20%), and other sterols. Cholesterol is the precursor of of such hormones as estrogen, progesterone, testosterone, and dehydroepiandrosterone (DHEA). He mentions that many parts of the brain are involved in memory and storage, including the cerebral cortex and the hippocampus. The hippocampus is involved in the conversion of short-term memories into long-term memories, and is one of the first areas damaged in Alzheimer's Disease. Finally, he discusses experiments by Gisken (1993) and by Black (1991) confirming the fact that when laboratory animals are placed in highly stimulating environments, they develop wider and longer dendrites and more synapses. When they're removed, the extra synaptic connections disappear.

Chapter 4 - Brain Chemistry Made Simple

(1) Acetylcholine
     is in short supply in Alzheimer's Disease. The over-the-counter acetylcholine precursors, choline and CDP (Cytidine-5 DiPhosphocholine) may putatively be used to boost choline levels in the brain. Alternatively, the over-the-counter Chinese herb, Huperzine-A (as described in IQ-Enhancing Drugs, above), can help retard the breakdown of acetylcholine within the brain, and is claimed to provide modest improvements in mental functioning.
(2) Dopamine
     A number of psychiatric disorders, particularly schizophrenia, Parkinson's disease, and mood disorders, are attributed to imbalances in dopamine levels. Dopamine is broken down by monoamine oxidase (MAO). (My note: As I recall, high levels of MAO, and therefore, low levels of dopamine, are associated with "thrill-seeking".) "MAO inhibitors" function as antidepressants and as treatments for Parkinson's disease.
     The metabolic pathway that leads to dopamine synthesis, and ultimately, to the production of norepinephrine, and then to epinephrine, is as follows.
    Phenylalanine is converted to tyrosine with the aid of nicotinic adenosine dinucleotide (NADH).
    Tyrosine is converted to L-Dopa with the aid of vitamin C.
    L-Dopa is converted to dopamine with the aid of vitamin B-6.
    Dopamine is converted to norepinephrine with the aid of vitamin C.
     Norepinephrine is converted to epinephrine with the aid of methyl donors.
     Dopamine levels decline with advancing age, and with Parkinsons disease.

(3) Norepinephrine and Epinephrine
    Norepinephrine and Epinephrine are arousal neurotransmitters. They can elevate mood and alertness. In excess, they produce "flight or fight" symptoms. Their precursors, Tyrosine and phenylalanine are available at health food stores, and are discussed in Chapter 13.

(4) Serotonin
    Serotonin is a multifarious neurotransmitter, with many functions. Excess amounts of serotonin cause relaxation, sedation, and a decrease in sexual drive. Prozac increases serotonin levels. There is an over-the-counter nutrient called 5-hydroxytryptophan (HTP ) that is the immediate precursor to serotonin and can, in some cases, temporarily substitute for serotonin-influencing drugs (see Chapter 13). St. Johns Wort also works by elevating serotonin levels. The starting point for serotonin is the amino acid tryptophan, found in milk and meat. (Its tryptophan that makes you sleepy after a big Christmas dinner.)Tryptophan can be converted to 5-HTP and then into serotonin. At night, the pineal gland converts serotonin into melatonin, available now at Walmart as an aid to sleep.

(5) Gamma Amino Butyric Acid (GABA)
GABA is the most important and widespread inhibitory neurotransmitter in the brain. Barbiturates and benzodiazopams stimulate GABA receptors. Its available in health food stores, but it cant cross the blood-brain barrier, so it doesnt workyet.

(6) Additional Neurotransmitters
There are dozens of other chemicals that influence mood and cognition, such as amino acids, peptides, hormones, glutamate, histamine, endorphins, enkephalins, growth hormone, vasopressin, prolactin, nitric oxide, prostaglandins, and so forth.

(7) The Brain and the Immune System
As if all the other chemicals werent enough, there are many immune-system chemicals such as cytokines that interact with the brain.
 

Chapter 5 - How to cultivate a Naturally Healthy Mind

(1) Emotional Connections
Healthy relationships contribute to mental health.
(2) Exercise
Exercise helps circulation, and may contribute to mentation in other ways. Recent studies indicate that exercise helps the brain not only through improved circulation but perhaps, even in the growth of new neurons.
(3) Learn How to Learn
Lifelong learningKeep your mind active. Evidence accumulated in the last few years suggest that the brain really is like a muscle: use it or lose it.
(4) Cultivate Your Creativity
     Dr. Sahelian feels that creativity takes the self-disciplinemotivation, effort, and perseverancenecessary to force yourself to create. He mentions that writing and English were two of his weakest subjects in high school and college, but that in spite of his initial bent toward science and mathematics, he has become a prolific writer. Creativity takes effort.
(5) Sample! Explore! Expand!
(6) Smart Eating
     A British study (Benton, 1998) found that skipping breakfast seems to compromise short-term memory, such as reverse digit span, but not IQ test scores. Dr. Sahelian recommends a balance of proteins, fats, and carbohydrates during the day, with, perhaps, a switch to carbohydrates at night in order to abet drowsiness. Some further recommendations are:

                                                                                                                                                                                                                                                                                                                                          
(7) A Note to Vegetarians
      If youre a vegetarian, you may not be getting enough CoQ10, creatine, carnitine, and omega-3 oils.
Supplement your diet with flaxseed oil for omega 3s, and take about 10 mg. of CoQ10, 100 to 250 mg. of carnitine, and about 1 gm. of creatine on a daily basis. Make sure your intake of protein is adequate. Many vegetarians have a tendency to overconsume carbohydrates at the expense of protein.
(8) The Deep Sleep

        Expose yourself to morning light for at least ten to twenty minutes. Morning light exposure helps shorten the sleep cycle so that when you go to bed at night, it will be easier to fall asleep.

        The best times to work out are in the late afternoon to early evening. Exercising just before bedtime is apt is apt to engender arousal and excess body heat. If you take some of the stimulants discussed in this book, you will definitely need to do some physical activity in order to use up the excess energy.

        Caffeine in any form should be avoided in the evening. Tyrosine can cause a restless sleep even if taken in the morning.

        Eating a small or moderate snack about one to two hours before bedtime may actually promote sleep, especially if the meal includes carbohydrates {such as bread, whole grains, legumes, fruit, potatoes, pasta, or rice.)

        Stop mental activity at least one hour before bed and allow mind to switch to fun reading, or watching a comedy film or TV show. You could tape your favorite prime-time sitcom and watch it before bed.

        Wear earplugs to shut out noise. Using earplugs has had a significant influence on my ability to get deep, uninterrupted sleep, and has enormously influenced my daytime productivity.

        Wear eyeshades to block the morning light.

        Relaxation techniques.

Chapter 6 - Beware of Brain Busters

(1) Stress, Anger, and Anxiety
A. Immune System Malfunction
B. Increased Risk for heart disease, high blood pressure, and stroke
     C. 
A higher likelihood for chronic fatigue and various musculoskeletal aches and pains
(2) Smoking

(3) Alcohol

(4) Be Kind to Your Mind

(5) Common Medical Conditions Associated with Cognitive Decline

(6) Brain-Busting Medicines
One of the most common causes of rapid cognitive decline is the use of certain prescription drugs. Continued use of sedatives and sleeping pills can sometimes cause irreversible memory impairment. Kava and 5-HTP can substitute for anti-anxiety agents. Cholesterol is central to brain functioning, and Dr. Sahelian speculates that cholesterol-reducing drugs might possibly adversely affect cognition.

Chapter 7 - Mind Your Brain Fats

60% of the brain is comprised of lipids.

WHAT COGNITIVE BENEFITS DO OMEGA-3 OILS OFFER?

        Improved mood

        Enhanced clarity of thinking

        Enhanced serenity and clarity of thinking

        Better concentration and focus

        Better vision

WHICH CLINICAL CONDITIONS CAN OMEGA-3s BENEFIT?

        Age-related cognitive decline

        Depression and bipolar disorders (manic depression)

        Anxiety disorders

        Addiction disorders

        Schizophrenia

(1) Dietary Fats and the Brain
Animal studies have shown that eating fish oils can change the fatty acid composition of the brain-cell membrane.
(2) Saturated Fatty Acids
     A. 
Monounsaturated
Found in vegetables, olives and avocados. Liquid at room temperature, but hardens in the fridge.
     B. 
Polyunsaturated
         1) 
Omega-3:  They improve communication between brain cells. Theyre found in fish, and particularly, in fatty fish, such as mackerel, salmon, tuna, and sardines. Two very important omega-3 fatty acids are EPA (eicosapentanoic acid) and DHA (docosahexanoic acid). Theyre also found in capsules at the health food store. Omega-3s concentrate in the brain, while omega-6s are found throughout the body.
         2) 
Omega-6:  Most Americans have a much higher intake of omega-6s than of omega-3s.
     C. 
Fats to shun
Trans-fatty acids not found in nature but in margarine, pastries, donuts, cornchips, and processed cereals.
Hydrogenated fats and oils. These are also not found in nature and are dangerous.
     D. 
Fish Oils and Mood
         1) 
Manic-Depression
Nine out of 14 showed improvements, compared with 3 out of 14 on a placebo. Not a substitute for lithium, but shows some benefit.
         2) 
Help for Schizophrenia?
EPA helps; DHA doesnt.
     E. 
Fish Oils and Learning
Mice fed 5% sardine oil fared better at the end of a year than mice fed 5% palm oil
     F. 
Seeing is Believing
The rods and cones of the eye are very rich in DHA. Could DHA supplementation improve vision in the elderly? Chapter 20 discusses this in greater detail.
         1) 
The Author's Experience
The author tried taking 9 gms. A day of mixed EPA and DHA, and noticed a significant improvement in vision. He currently takes 600 to 1,200 mg. Of mixed EPA/DHA except on days when he eats fish.
     G. 
The Simple "Brain Food" Plan
The typical Japanese or Eskimo may get 3 to 10 grams a day; the typical American, 200 mg. per day. Dr. Sahelian recommends eating fish two or three times a week. If not, recommends 0.5 to 2 grams a day.
         1) 
Flax or Fish?
Flaxseed oil has to be converted into omega-3 oils. Its probably better to get the omega-3oils themselves. Recommends more canola, flaxseed, and olive oils.
         2) 
Cautions and Side Effects
Omega-3 oils act as blood thinners. Need to be aware of this if already taking blood thinners.
         3) 
Recommendations
Recommends eating fish, or taking supplements if fish isnt an option.
 

Chapter 8 - Memory Boosters--Phospholipids, Choline, and Related Nutrients
WHAT BENEFITS DO CHOLINE AND PHOSPHOLIPIDS PROVIDE?
Phospholipids dont do much. Choline, and especially, CDP-Choline make their presence known.

WHICH CONDITIONS CAN CHOLINE AND PHOSPHOLIPIDS BENEFIT?

   (1) Phospholipids and Healthy Cell Membranes
        A. 
The Making of Phospholipids
            Phospholipids such as PC (phosphatidylcholine) and PS (phosphatidylserine) are synthesized from choline, turning into CDP-choline, and then to PS and PC.
   (2) Choline
        Found in eggs, fish, legumes, nuts, and meats and vegetables. Dietary intake ranges from 300 mg to 900 mg. per day. Most people get enough.
        A. 
Improving Cognitive Function
            The results have been mixed, with some studies showing positive results and some not.
        B. 
Availability and Dosage
            Health Food stores, in dosages from 250 to 500 mg.
        C. 
The authors Experience
            Improvements in focus that lasts most of the day. No side effects with dosages below 500 mg. Increased body warmth with dosage of 1,500 mg.
        D. 
Cautions and Side Effects
            Mild Gastrointestinal distress, nausea, sweating and loss of appetite
        E. 
Recommendations
            Recommends 250 mg. a day for the elderly (see Chapter 18).
   (3) CDP (
Cytidine-5 DiPhosphocholine)-Choline
        A. 
Improving Cognitive Function
            Can be considered a more potent form of choline. Has been shown to improve cognition in dogs and humans.
        B. 
Availability and Dosage
            Expensive and not widely distributed. Typically 250 mg.
        C. 
The Authors Experience
            Within an hour after taking 250 mg., becomes more alert and motivated. The effect lasts a few hours. Best taken in the morning.
        D. 
Cautions and Side Effects
            Long-term safety is not known.
        E. 
Recommendations
            Has been used successfully in Europe for many years, but not well-studied here.
   (4) Phosphatidylcholine (Lecithin)
        A. 
Improving Cognitive Function
            Reports have not been impressive. The majority of users do not notice any obvious benefits from lecithin.
        B. 
Availability and Dosage
            Available in health food stores.
        C. 
The Authors Experience
            Observed no effects.
        D. 
Cautions and Side Effects
            Keep doses below about 3 grams a day.
        E. 
Recommendations
            Skip PC (lecithin) supplements.
   (5) Phosphatidylserine
        A. 
Improving Cognitive Function
            Works when derived from bovine cortex, but may not work with soy-derived PS.
        B. 
Availability and Dosage
            Expensive. $0.50 50 $1.00 per capsule. 100 mg. of PS in a 500-mg. capsule.
        C. 
The Authors Experience
            A slight but unpleasant effect.
        D. 
Cautions and Side Effects
            Short term effects are OK. Long-term effects are unknown.
        E. 
Recommendations
            As recommended above for PC (lecithin), the author doesn’t recommend PS at this time.

Chapter 9 - Mood and Energy Lifters--B vitamins and Coenzymes

   (1) The Bs in the Brain Get an A
         Dr. Sahelian recommends routine supplementation with two to three times the RDA.

   (2) Understanding Coenzymes

         
A. The Individual B Vitamins and Their Coenzymes
             Many of the B vitamins have become available in their more activated forms known as coenzymes. For example, niacin is now available in the form of NADH (nicotinamide adenine dinucleotide). Might be advisable for the elderly, who might not be as able to convert the B vitamins into coenzymes
            
1) Thiamin (B1)Coenzyme: Cocarboxlase, or thiamin pyrophosphate (TPP).
             2) Riboflavin (B2)Coenzyme: Flavin mononucleotide (FMN)
             3) Niacin (B3)Coenzyme: Nicotinamide adenine dinucleotide (NADH)
             4) Pantothenic Acid (B5)Coenzyme: Pantethine
             5) Pyridoxine (B6)Coenzyme: Pyridoxal phosphate (PLP)
             6) Folic AcidCoenzyme: Tetrahydrofolate
             7) Cobalamine (B12)Coenzyme: Bencozide
             8) Biotin
             9) Recommendations: one to three times the RDA; higher in some individuals

    (3) NADH (Nicotinic Acid Adenine Dinucleotide)
         Found in meat, fish, and poultry.
         A. Improving Cognitive Function
             Slight to moderate benefits in short-term studies.
         B.  Availability and Dosage
             Expensive. Close to $1.00 a pill. 2.5 mg. and 5 mg. doses.
        
C. The Authors Experience
             Notices an increase in alertness, but develops a tolerance to it.
        
D. Cautions and Side Effects
             Not much. Can lead to overstimulation.
         E. 
Recommendations
             Does not recommend long-term use on a daily basis.

   (4)
B Vitamins and homocysteine
        The B vitamins help lower homocysteine levels.

   (5
) Summary
        For most people, a few times the RDA is recommended. The coenzyme forms are intriguing. Studies of their cognitive effects are few or non-existent.

Chapter 10 - Methyl Donors--For More Energy, Better Mood (and Longer Life?)

   (1) TMG (trimethylglycine) and DMG (dimethylglycine)
        
A. Improving Cognitive Function
            Both TMG (betaine) and DMG enhance mood and energy levels.
       B. 
Availability and Dosage
           Beets, broccoli, and shellfish are good sources. Doses range from 100 mg. to 500 mg.
       C. 
The Authors Experience
           Works well, but large doses can over-stimulate.
       D. 
Cautions and Side Effects
           Overdoses can cause nausea, restlessness, and insomnia along with elevated body temperature. Can cause muscle-tension headache.
       E. 
Recommendations
          
Supplementation with small amounts, such as 50 mg. to 100 mg. a day.
   (2) SAMe (s-adenosyl-methionine)
        Available by prescription in Europe for many years as an antidepressant. Used in Europe for depression, chronic fatigue syndrome, and fibromyalgia. No toxic effects. Lots of studies. Helps preserve glutathione, and aids in the formation of myelin.
        A. 
Improving Cognitive Function
            A review of existing research studies shows SAMe to be comparable to tricyclic antidepressants. Since SAMe is a naturally occurring compound with few side effects, it is a potentially important treatment for depression.
        B. 
Availability and Dosage
            Cost is the problem. About $1.00 per 200 mg. pill.
        C. 
The Authors Experience
            Felt good on 400 mg. No adverse effects.
        D. 
Cautions and Side Effects
            High doses can cause dry mouth, nausea, restlessness, and insomnia.
        E. 
Recommendations
            Other, cheaper methyl donors such as TMG, DMG, and DMAE might achieve the same results as SAMe.

   (3) DMAE (dimethyl-amino-ethanol)
         A. 
Improving Cognitive Function
             Helps mood and motivation, but not cognitive functions.
         B. 
Availability and Dosage
             Sold as 350 mg. of DMAE bitartrate, and yields about 130 mg. of DMAE.
         C. 
The Authors Experience
             The author thinks he could concentrate better.
         D. 
Cautions and Side Effects
            
Larger doses can lead to irritability, over-stimulation, anxiety, headaches and stiffness in the jaw, neck, and shoulder.
         E. 
Recommendations
             May be helpful for cognitive decline.

Chapter 11 - Keep Your Brain Young with Old and New Antioxidants

WHAT CAN ANTIOXIDANTS DO FOR YOU?

     In animal models, they extend the average (though not the maximum) lifespan. They protect the body against cellular and chromosomal damage. There are no short-term visible effects most antioxidants, but they protect against heart disease, cancer, and other degenerative diseases. Note, though, that certain antioxidants, such as Coenzyme Q10 and lipoic acid can have immediate effects upon cognition.

What conditions do antioxidants benefit?

     Probably they slow the progression of age-related cognitive decline, Alzheimers Disease, and Parkinsons Disease (to name a few).

WHAT ARE SOME EXAMPLES OF OXIDANTS?

      The most common free radicals (oxidants) are hydroxyl (OH), superoxide (O2), hydrogen peroxide (H2O2), and ozone (O3).

   (1) Understanding Antioxidants
        A. 
Brain Cells Can Get Oxidized
            The fatty acids in the brain are very susceptible to oxidation (becoming rancid).
        B. 
Antioxidants and Memory
            A 22-year Swiss study of 430 volunteers showed that higher levels of vitamin C, vitamin E, and beta-carotene were associated with better performance in memory testing.

   (2) Vitamin C
        
Recommendations
         Should get majority of vitamin C from fruits and vegetables, but might add 100 to 500 mg. per day.

   (3) Vitamin E
        
Recommendations
         Observes that the average American diet contains between 10 and 22 international units of vitamin E. Recommends 20 to 100 mg. supplement of mixed tocopherols per day. Warns that very high doses, above 1,000 mg. per day, can lead to bleeding risks and possibly, to impaired immune function (by blocking the ability of phagocytes to kill pathogens with peroxides).
        
Note: Although the average American diet may contain enough vitamin E and other essential nutrients, many of us are dieting off and on, and sometimes more on than off, and we may not get a proper variety of esculants.

   (4) Carotenoids
         Many carotenoids have anti-tumor, antibacterial, antiviral, anti-inflammatory, and antihistaminic actions. Beta-carotenoid is the best known, but some others are lycopene(a cancer-fighter found in tomatoes) lutein, zeazanthin, and others. Carotenoids are found in pink/red/orange produce.
        
Recommendations
         Dr. Sahelian recommends getting these by consuming a variety of fruits and vegetables. Variety is key.

  (5) Flavenoids
       Similar to carotenoids. Some well-known flavenoids include quercetin, apigenin, rutin, and flavones. Proanthrocyanidins are found in extracts of pine bark and grape seeds. Polyphenols are found in fruits, vegetables, herbs, wines, and certain legumes. Catechin is found in green tea.
       
Recommendations
Recommends a healthy diet of fruits (citrus, berries), grains, herbs, nuts, seeds, and vegetables (garlic, onion, broccoli). Also available in capsule form from health food stores.
 
   (6) Glutathione
        Glutathione is a sulfhydral that forms the cornerstone of one of the bodys principal antioxidants: glutathione peroxidase. (Some others are superoxide dismutase, catalase, vitamin C, vitamin E, and uric acid.) Glutathione peroxidase is destroyed in the digestive tract, so glutathione peroxidase supplements cannot be given orally. Glutathione peroxidase contains selenium, although if selenium is in short supply, copper may be used in its place. (This is one of the reasons that selenium is an important trace element in our diets. Low levels of selenium in the soil are associated with elevated levels of cancer.) Glutathione is found in foods, since all living organisms contain glutathione. Brussel sprouts, cauliflower, broccoli, and cabbage contain cyanohydroxybutene, which is thought to raise levels of glutathione peroxidase. NAC (see 7 below), methyl donors, lipoic acid, and vitamin B12 help raise glutathione levels.
         
Note that frequent use of Tylenol (acetominophen) depletes glutathione levels.
        
Recommendations
         Dr. Sahelian cant confidently recommend glutathione supplementation until further research has established that it really gets where it should, and that it doesnt inhibit the bodys own production of glutathione.

   (7) NAC (N-acetyl cysteine)
        As a resident, I prescribed NAC intravenously to patients with liver damage due to acetominophen (Tylenol) overdose. It protected the liver very well. NAC protects against stresses such as HIV, cancer, heart disease, and cigarette smoking. Contributes cysteine to help form glutathone. (Note the dangers of homocysteine.)
      
Cautions and side effects
       While low doses of NAC protect against oxidation, higher doses may have the opposite effect. Large doses can cause nausea and vomiting.
      
Recommendations
       Take no more than 50 mg. to 100 mg. a day, and then only intermittently. Like glutathione, NAC can inhibit the bodys own production of glutathione.
       Could protect the livers of those who take acetominophen on a regular basis.

   (8) Selenium
        We normally get 70 to 100 micrograms a day, but this depends upon the soil in which our vegetables are grown. (My note: One of the problems of our day is that trace elements are removed from our soil by cash crops. Farmers replace trace elements, but these turn out to be elements such as phosphorous, calcium, and potassium that plants need to grow fast, rather than elements conducive to long and healthy lives.]
       
Recommendations
        Take 70 to 100 micrograms per day in supplemental form. Selenium in much higher amounts can act as an oxidant and is counterproductive (Spallholz, 1997). (Note: Our Walmart multivitamin tablet supplies 200 micrograms a day of selenium.)

   (9) Summary
        
A. Vitamin E -20 to 200 i. u. a day of the mixed tocopherols
        
B. Vitamin C - 100 to 500 mg. a day (as calcium ascorbate?)
        
C. Selenium-20 to 100 micrograms a day
        
D. NAC 50 to 100 mg. a few times a week
        
E. Carotenoids and flavenoids are best obtained from food

Chapter 12 - Mood Energizers--Think Faster, Sharper, and Longer

WHAT CAN MIND ENERGIZERS DO FOR YOU?

        Alertness, arousal, and vigilance

        Mood, energy, and motivation

        Concentration and focus

        Verbal fluency

        Mild visual enhancement

WHAT CLINICAL CONDITIONS CAN MIND ENERGIZERS BENEFIT?

        Depression

        Age-related cognitive decline

        Alzheimers disease

        Parkinsons disease

   (1) Carnitine and ALC (acetyl-l-carnitine)
         A. 
How They Work
             Found in meat and dairy products. Most non-vegetarians get 100 mg. to 300 mg. per day. ALC is the coenzyme form, and can cross the BBB (blood-brain barrier) with ease, whereas carnitine cannot. Consumption of ALC in rats (Maccari, 1990) showed a reduction in lipofuscin levels as they aged. Carnitine also stabilizes cell membranes, protects synapses, and helps prevent oxidative damage.
         B. 
Clinical Uses
             ALC showed variable levels of minor improvement in Alzheimers patients, but significant remediation for age-related cognitive decline.
        
C. Availability and Dosage
             ALC is expensive, and available in doses from 100 mg. to 500 mg.
         D. 
An Experts Opinion
             He likes it. Increases alertness.
          E. 
The Authors Experience Same thing.
          F. 
Cautions and Side Effects
              Very well tolerated.
          G. 
Recommendations
              Recommends 100 to 250 mg. per day for vegetarians.
   (2) Coenzyme Q10

         CoQ10 is also known as ubiquinone or ubiquinol Found in foods, particularly in fish and meats. Its an antioxidant, but also provides energy and mental clarity.
        
A. How Does It Work?
            
Helps prevent the oxidation of lipoproteins, and the formation of arterial plaques.
         B. 
CoQ10 and the Brain
             Didnt help Parkinsons patients.
         C. 
Availability and Dosage
             Available in 10 to 50 mg. capsules.
         D. 
The Authors Experience
             Effects from 30 mg. are mild. 120 mg. causes trouble sleeping.
         E. 
Cautions and Side Effects
             Patients taking blood thinners such as coumadin might want to be careful about CoQ10. High doses can cause restlessness and insomnia.
         F. 
Recommendations
             Recommends 10 to 30 mg. per day.

   (3) Lipoic Acid (LA)
        Lipoic Acid is a coenzyme (also known as alpha-lipoic acid or thiotic acid). Helps raise glutathione levels. Cognitive studies so far have been performed only with animals.
       
A.Role in Neural Disorders and Memory
           Improved memory slightly in older mice but not in young mice.
       
B.Availability and Dosage
           Available in 50 and 100 mg. capsules, but you only need 5 to 20 mg.
       
C.The Authors Experience 
           Theres actually a noticeable effect from taking LA. Gives a relaxed sense of well-being and slightly enhanced visual acuity. Doses of 40 mg. or more caused insomnia.
       
D.Cautions and Side Effects
           High doses can cause stomach upset, over-stimulation, and insomnia. Can lower blood sugar levels.
       
E.Recommendations
           Doesnt recommend taking more than 20 mg. a day.


   (4) Summary

         Research is in an early phase. Recommends 10 to 20 mg. of CoQ10 for vegetarians.

Chapter 13 - Amino Acids--Building blocks for Brain Chemicals

     What Is an Amino Acid?
     The amino acids are the basic building blocks of proteins. The eight essential amino acids that we cannot synthesize and must obtain through ingestion are isoleucine, lysine, leucine, methionine, phenylalanine, threonine, tryptophan, and valine. These eight amino acids are basic building blocks of all life on earth, and are present in everything we eat*.      The non-essential (synthesizable) amino acids are alanine, arginine, asparagine, aspartate, cysteine, glutamate, glutamine, glycine, histidine, proline, serine and tyrosine.


* - If there are alien lifeforms, they probably wouldnt use the same set of essential amino acids. We couldnt survive eating alien plants or animals, nor could they survive by feasting on us. (Of course, if theyre mindless dragons, they might not know that.)


WHAT CAN AMINO ACIDS DO FOR YOU?
     Tyrosine and phenylalanine are converted into the brain chemicals dopamine and norepinephrine. They lead to alertness, appetite control, and slight mood elevation. 5-HTP is converted into serotonin, and induces relaxation, controls appetite, helps with sleep, and elevates the mood.
WHAT CLINICAL CONDITIONS CAN AMINO ACIDS BENEFIT?
     All three of these amino acids are useful in treating depression and obesity. 5-HTP can also be used for anxiety disorders and insomnia.

   (1) Phenylalanine and Tyrosine
       
A. Functions
            Phenylalanine and tyrosine are converted into dopamine and norepinephrine, and are energizers and mood elevators. They are sometimes prescribed as antidepressants. Phenylalanine may trigger the release of an appetite-reducing hormone called cholecystokinin, and is sometimes recommended as an appetite-suppressor. Dr. Sahelian mentions that his patients sometimes use these nutrients as a substitute for caffeine.
       
B. Availability and Dosage
            Dosage levels are typically 100 to 500 mg. Tyrosine is sold in its acetylated form as acetyl-tyrosine, although no human research has been performed on this form of tyrosine. Always start with a low dose, such as 50 mg. to 100 mg., in order to avoid side effects. If you can find only 500 mg. pills, you may have to open a capsule and take a portion. Be careful when you take this in concert with other stimulants such as DMAE, CDP-Choline, pantothenic acid, methyl donors, ALC, CoQ10, DHEA, pregnenolone, St. Johns wort, and ginseng.
        C. The Authors Experience
            I notice the effects from these amino acids with a dose as low as 100 mg. when taken on an empty stomach in the morning. In addition to enhanced arousal, focus, and motivation, there is some appetite suppression and slight mood improvement. However, high doses make me anxious and restless. I have occasionally experienced brief periods of heart palpitations when my dosage exceeded 750 mg.
            I have taken acetyl-tyrosine twice, at a dosage of 200 mg. The effects lasted most of the day and were similar to a higher dose of tyrosine.
       
D. Cautions and Side Effects
            Overstimulation, insomnia, and heart irregularities in susceptible individuals are high-dosage side effects. Those susceptible to phenylketonuria shouldnt take phenylalanine. They should avoid these two amino acids if taking antidepressant drugs such as monoamine oxidase (MAO) inhibitors. Caution is also advised if they are used with serotonin-reuptake inhibitors such as Prozac. Because tyrosine is a precursor to thyroid hormones, individuals with thyroid problems should consult with their physician before use.
       
E. Recommendations
            These amino acids are useful in the treatment of depression and appetite control. Dr. Sahelian does not recommend their use for older individuals, or for those with high blood pressure, cardiovascular disease, or a propensity for heart palpitations.

   (2) 5-HTP (5-Hydroxytryptophan)
            In 1989,a contaminated batch of tryptophan from Japan caused a serious illness called eosinophilia myalgia syndrome, and the FDA banned its sale without a prescription. (No further cases have been reported since then.)
            Since 1995, 5-HTP, the immediate precursor of serotonin, has become available over the counter.
        A. Functions
        Over the past three decades, scientists have tested 5-HTP for:

        Anxiety disordersCan induce relaxation and relieve anxiety

        Mild DepressionShouldnt be used more than a few weeks

        InsomniaThe occasional use of 25 to 50 mg. on an empty stomach can help induce and maintain sleep
Obesity5-HTP acts as a good appetite suppressant.

        B. Availability and Dosage
            Sold in 25 to 100 mg. capsules
       
C. The Authors Experience
            Dr. Sahelian says that it works, particularly when taken on an empty stomach. Tolerance seems to develop quickly when its taken frequently. Daytime side effects on doses greater than 50 mg. include nausea and sluggishness. Also, there can be vivid dreams on an evening dose of 100mg.
       
D. Cautions and Side Effects
            Because of limited research, caution is advised. 5-HTP should only be used for a brief period, such as a few weeks. After a break of a month or two, it can be resumed.
       
E. Recommendations
            Until more studies are available, I recommend not using 5-HTP more than four days a week, and continuously no longer than a few weeks without taking breaks. It takes time to learn how to use 5-HTP well.

Chapter 14 - Brain Hormones--Potent Memory and Sex Boosters

   (1) Cholesterol -the Source of Steroid Hormones
      Dr. Sahelian restates his concern that drastically lowering cholesterol levels may compromise cholesterol production with the brain.

    (2) Estrogen and the Brain
         There is evidence that estrogen replacement therapy for postmenopausal women slows cognitive decline.
         A. Beyond Estrogen
            
Some hormones, such  as cortisol and insulin, dont fall off with advancing age. Others, including pregnenolone, dehydroepiandrosterone (DHEA), growth hormone, progesterone, estrogens, and testosterone all decrease with age. All these hormones are possible candidates for hormone replacement therapy.
           B. Do Middle-Aged and Older Women Need Male Hormones?
             Some women are being given testosterone replacement along with estrogen. Possible side effects include loss of hair and acne. Dr. Sahelian suggests DHEA supplementation as the immediate precursor to testosterone and estrogen.
   
(3) DHEA: the Parent of Estrogen and Testosterone

        
A. Improving Cognitive Function
             DHEA is short for dehydroepiandrosterone, and is the precursor for testosterone and the estrogens. It improves mood and libido. Its produced in the adrenal glands, testicles,, ovaries, and brain. (All that backup suggests that its a very important hormone.)
        
B. Availability and Dosage
             DHEA is sold in doses of 5 mg. up to 100 mg. Side effects are common on doses geater than 10 mg. Dr. Sahelian hopes that vendors will provide only the 5 mg. dosages, and stop selling the high doses.
        
C. The Authors Experience
             The author has noted heart palpitation among his patients prone to arrhythmias, and in himself at dosages above 20 mg.
         
D. Cautions and Side Effects
            
Warning! DHEA could well influence tumor initiation, or promotion, as well as benign prostatic enlargement.
        
E. Recommendations
            Dr. Sahelian recommends using the least amount possible, and to take breaks from use (hormonal holidays).


  
(4) Pregnenalone: the Grandmother of all Steroid Hormones
       
A. Improving Cognitive Function
           
Most users of pregnenalone (Preg) find this hormone helps with learning and memory, mood and energy, speed of thinking, verbal fluency, concentration, and focus, creativity, vision, hearing, awareness, and sensory perception. Dr. Sahelian calls it the grandmother of all steroid hormones since the body converts it into DHEA, progesterone, and other steroid hormones. Human research with Preg is very limited, but several rodent studies have shown it to be a powerful memory enhancer (Flood, 1995).
       
B. Availability and Dosage
           
Pills and sublingual tablets start at 5 mg. and range up to 50 mg. Maximum daily dosage should not exceed 5 mg. He recommends regular hormone holidays, similar to DHEA.
           Young people have the ability to easily convert Preg into all the other steroid hormones. As we age, the enzymes that convert Preg to DHEA and Preg to Progesterone, may not work as well. Nor would the enzymes that convert DHEA into androgens and estrogens be as effective. Therefore, in older individuals, giving Preg alone may not be enough.
      
C. The Authors Experience
          
Pregnenalone improved his sense of well-being as well as his visual and auditory perceptions. It also gave him headaches, acne, insomnia, irritability, and heart palpitations on doses greater than 20 mg. He uses Preg only once or twice a month on days when he needs to be particularly alert. For example, visiting a Van Gogh exhibit, he took 10 mg. of Preg, and ten capsules of fish oil.
      
D. Cautions and Side Effects
          
Warning! DHEA could well influence tumor initiation, or promotion, as well as benign prostatic enlargement. It can cause acne, accelerated hair loss, irritability, aggressiveness, insomnia, anxiety, headaches, and menstrual irregularities with doses greater than 10 mg. Heart palpitations can occur with doses greater than 20 mg., or even at 5 mg. in individuals prone to irregular rhythms.
      
E. Recommendations
Dr. Sahelian recommends using the least amount possible, and to take breaks from use (hormonal holidays).

   (5) Melatonin: Natures Sleeping Pill

       
A. Improving Cognitive Function
        Claims made in 1996 are that melatonin, in addition to treating insomnia, prolongs life, act as an antioxidant, prevents tumors, treats jet lag, and improves ones sex life. Dr Sahelians clinical experience, coupled with a review of the relevant research, suggests that melatonin can aid sleep and treat jet lag. It does not improve ones sex life. There is some suggestion that it may be a tumor inhibitor. It is an antioxidant. There is not data regarding its life extension properties.
        B. 
Availability and Dosage
            Dosages usually range from 0.3 to 0.5 mg.
        C. 
The Authors Experience
            The author has taken 0.3 to 1 mg. of melatonin once or twice a week since 1995. He has noticed a tolerance effect.
        D. 
Cautions and Side Effects
            Melatonin is very safe when used appropriately. Excessive amounts can cause vivid dreams, including nightmares. Higher amounts can cause morning grogginess and lethargy.
        E. 
Recommendations
            Until more research is available, limit dosage to 0.3 to 1.0 mg. Take it to 2 hours before bedtime. Small doses of melatonin can be combined with valerian, hops, and other sedative herbs.
Melatonin should not be used regularly more than two nights a week, due to the possible induction of tolerance, and the effects are unknown when used nightly for prolonged periods.

    (6) The Multi-Hormone Replacement Solution
      
Many questions remain unanswered as to whether hormonal replacement in middle-aged and older individuals is a proper medical approach to fighting the neuronal degeneration and cognitive decline that occurs with the aging process.&but the required dosages may be much lower than are currently recommended. It may turn out that the best hormone replacement regimen involves giving a small amount of Preg, DHEA, and perhaps testosterone to men, and Preg, DHEA, and estrogens (and progesterone) to women. On the downside, its possible that regular, high-dose hormone use could increase the risk of cancer in certain individuals.

   (7) Detailed Guidelines
        
A. Preliminaries
           You need a comprehensive physical exam, and the involvement of your physician. Signing up for hormone replacement therapy is not as simple as popping a multivitamin pill. Your health care practitioner is your guide in this.
       
B. Dosages
           
1. Men, 40 to 50
                Melatonin,0.2 to 0.5 mg. once or twice a week,
                Preg:1 to 4 mg. every other day, taking frequent hormone holidays,
                                                        Or
                DHEA,1 to 4 mg. every other day, taking frequent hormone holidays
                                                        Or
                DHEA/Preg 1 to 4 mg. every other day, taking frequent hormone holidays

            2. Men, 50 to 65
                Melatonin,0.2 to 1.0 mg. once or twice a week,
                Preg:1 to 5 mg. every other day, taking frequent hormone holidays,
                                                        Or
                DHEA,1 to 5 mg. every other day, taking frequent hormone holidays
                                                        Or
                DHEA/Preg 1 to 5 mg. every other day, taking frequent hormone holidays

           
3. Men, 65 and Over 
                Melatonin,0.3 to 1.0 mg. once or twice a week,
                Preg:1 to 6 mg. every other day, taking frequent hormone holidays,
                                                        Or
                DHEA,1 to 6 mg. every other day, taking frequent hormone holidays
                                                        Or
                DHEA/Preg 1 to 6 mg. every other day, taking frequent hormone holidays
                Testosterone: Optional, if DHEA by itself does not provide enough of an androgenic effect.

             4. Postmenopausal Women, 40 to 50
                 Melatonin,0.2 to 0.5 mg. once or twice a week,
                 Preg:1 to 3 mg. every other day, taking frequent hormone holidays,
                                                        Or
                 DHEA,1 to 3 mg. every other day, taking frequent hormone holidays
                                                        Or
                 DHEA/Preg 1 to 3 mg. every other day, taking frequent hormone holidays

              5. Postmenopausal Women, 50 to 65
                  Melatonin,0.2 to 1.0 mg. once or twice a week,
                  Preg:1 to 4 mg. every other day, taking frequent hormone holidays,
                                                        Or
                  DHEA,1 to 4 mg. every other day, taking frequent hormone holidays
                                                        Or
                  DHEA/Preg 1 to 4 mg. every other day, taking frequent hormone holidays

               6. Postmenopausal Women, 65 and Over
                   Melatonin,0.3 to 1.0 mg. once or twice a week,
                   Preg:1 to 5 mg. every other day, taking frequent hormone holidays,
                                                        Or
                   DHEA,1 to 5 mg. every other day, taking frequent hormone holidays
                                                        Or
                   DHEA/Preg 1 to 5 mg. every other day, taking frequent hormone holidays

          C.Summary
             It will take decades for us to learn the long-term effects of different hormone supplements and their combinations. In the meantime, many of these hormones are readily available over the counter, and people want guidelines.
Hormone holidays means taking them every other day or every third day, or taking them for two or three weeks out of a month. Dr Sahelian recommends taking them in the morning.
             If you plan to take hormones, err on the side of taking less, not more. Please keep in mind that the dosages available over the counter are often too high and you may need to take only a tiny fraction of these pills. Have a health-care provider monitor you closely.

Chapter 15 - Psychoactive Herbs--Recommended by Mother Nature
What Can Psychoactive Herbs Do for You? 

        Herbs can increase energythese include the adaptogens ginseng, maca and schisandra, and royal jelly.

        Herbs can be particularly useful for anxiety disorderskava is the most effective, although Ashwagandha and reishi are good options, also.

        Herbs that improve memorygingko is the most well studied, although bacopa, huperzine-A, and vinpocetine can be helpful.

        Herbs that improve moodSt. Johns wort is the most consistent, although others have mild-to-moderate mood-elevating properties.

        Herbs that improve sex drivemany herbs, such as ginseng, have been promoted, but the author recommends ashwagandha.

   (1) Ashwagandha (Withania Somnifera)
        
A. Improving Cognitive Function
            
Increased acetylcholine receptors in a study of rats (Schliebs, 1997).
         B. 
Availability and Dosage
             Sold in 500 mg. capsules.
         C. 
The Authors Experience
             Made him calm and sleepy, more interested in sex.
         D. 
Recommendations
             Recommends taking it at night, unless its taken for anxiety.

   (2) Ginkgo Biloba
        
A. Improving Cognitive Function
             
Indicated for peripheral vascular disease and ARCD (age-related cognitive decline). Contains flavenoids (kaempferol, quercetin, and isorhamnetin) and terpene lactones (ginkgobides. and bilobides) At least two-thirds of its takers report noticeable results. Indicated for ARCD and Alzheimers. (Effects are slight).
         B. 
Availability and Dosage
             Patients took 40 mg. three to four times a day. Might want to start with one or two 40 mg. pills a day.
         C. 
The Authors Experience
             Effects are subtle.
         D. 
Cautions and Side Effects
             Mild anti-clotting characteristics.
         E. 
Recommendations
             Not more than 60 mg. a day long-term. Be aware that coumadin, aspirin, fish oils, and vinpocetin also have anti-coagulant properties.

   (3) Ginseng
        
Compositions are inconsistent, varying widely. Chinese ginseng stimulates and raises body temperature. American ginseng is less stimulating. Siberian ginseng is a different genus and is neutral. Contains several saponins, designated ginsenosides. Many patients who take ginseng report an improvement in energy, vitality, and mental clarity.
         
A. Improving Cognitive Function
              Three double-blind studies have shown cognitive improvements.
          B. 
Availability and Dosage
              Might try a preparation that has a standardized extract of 3% to 7% ginsenosides. Use 100 mg. of this extract several times a week. Its best to cycle ginseng. Take it a few weeks on and a few weeks off.
          C. 
The Authors Experience
              The effects are subtle but definitely present. Enhancement of alertness, motivation, focus, and mood.
          D. 
Cautions and Side Effects
              Insomnia is a serious ginseng side effect.
          E. 
Recommendations
              Good overall energizer and cognitive enhancer. May build up over time.


   (4) Huperzine-A
        A. 
Improving Cognitive Function
            Huperzine-A is an extract from a club moss (Huperzia serrata). It strongly inhibits acetylcholinesterase. Several studies have shown that Huperzine-A is many times more selective and effective than the Alzheimers drug tacrine (Aricept). One Chinese research paper gives the following report:
-------------------------------------------------------------------------------------------------

 

1: Zhongguo Yao Li Xue Bao 1999 Jul;20(7):601-3

Related Articles, Books

Huperzine-A capsules enhance memory and learning performance in 34 pairs of matched adolescent students.

Sun QQ, Xu SS, Pan JL, Guo HM, Cao WQ

Xiaoshan Mental Hospital, Zhejiang, China.

AIM: To study the efficacy of huperzine-A capsules (Hup) on memory and learning performance of adolescent students. METHODS: Using double-blind and matched pair method, 34 pairs of junior middle school students complaining of memory inadequacy were divided into two groups by normal psychological health inventory (PHI), similar memory quotient (MQ), same sex and class. The Hup group was administrated orally 2 capsules of Hup (each contains Hup 50 micrograms) b.i.d., and the placebo group was given 2 capsules of placebo (starch and lactose inside) b.i.d. for 4 wk. RESULTS: At the end of trial, the Hup group's MQ (115 +/- 6) was more than that of the placebo group (104 +/- 9, P < 0.01), and the scores of Chinese language lesson in the Hup group were elevated markedly too. CONCLUSION: The Hup capsules enhance the memory and learning performance of adolescent students.

Publication Types: 

         Clinical trial

         Randomized controlled trial
 

PMID: 10678121

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             The memory test used was the Wechsler, and the 11-point difference in Memory Quotients between the experimental and the control groups would presumably be equivalent to about 11 points of IQ.
         B. 
Availability and Dosage
             Huperzine is sold in doses of 50 micrograms. (It costs about $0.33 a capsule.)
         C. 
The Authors Experience
             Dr. Sahelian took three 50-microgram capsules in the morning and noticed subtle improvements in focus and concentration late into the evening. (Ive been taking a 50-mcg. capsule daily for the last few weeks, and I think it may be improving my Scrabble performance. Its hard to tell without formal testing.)
         D. 
Cautions and Side Effects
             A few patients have reported a slight dizziness (including me), but this did not affect the therapeutic results. (With me, its been so sporadic that its hard to decide whether theres any connection.)
         E. 
Recommendations
             Dr. Sahelian suggests that until we know more about huperzine-A, it be used only as therapy for Alzheimers Disease, and only under medical supervision.


   (5) Kava (Piper Methysticum)
        Kava contributes to relaxation and mental clarity. It contains kavalactones such as kawain, dihydrokawain, methysticin, and yangonin. It differs from St. Johns wort, in that it treats anxiety rather than depression.
         A. 
Improving Cognitive Function
             A 1997 study followed 101 patients with anxiety disorders for six months. They were given 70 gms. of kavalactones three time daily. Effects are noticed within an hour or two, and can last several hours. Whether you feel alert or drowsy will depend upon your individual biochemistry, and also upon the product that you are using. Usually, theres an initial feeling of alertness, followed by drowsiness several hours later.
             The fact that kava causes relaxation, while keeping one mentally alert, distinguishes it from many drugs used for anxiety (such as Xanax and Valium), since those drugs have a tendency to
          B. 
Availability and Dosage
              Kava is sold in a number of different dosages and forms. A dose of 70 to 100 mg. of kavalactones once or twice a day may keep anxiety at bay. Try at least two or three different products before drawing an opinion about the effectiveness of kava.
          C. 
The Authors Experience
              The author has felt relaxed without interference in mental acuity, at least for the first few hours. It has been accompanied by
- muscle relaxation
- feelings of peacefulness and contentment, with mid euphoria
- a few have reported temporary improvements in visual acuity.
           D. 
Cautions and Side Effects
               None known.
           E. 
Recommendations
               An excellent herb to relieve occasional tension and stess.


   (6) St. Johns Wort (Hypericum Perforatum)

        
A. Improving Cognitive Function
            
As effective as pharmaceutical antidepressants, but with fewer side effects. It has been popular in Europe for decades, prescribed more often that pharmaceutical antidepressants. It contains hypericins and flavenoids, with many active ingredients.
         B. 
Availability and Dosage
             Doses generally consist of 300 mg. capsules standardized to 0.3% hypericins (0.9 mg.) because this is the European formulation that has been used in testing over the years.
             Many studies used three capsules a day, but Dr. Sahelian says that he gets insomnia if he takes more than two capsules a day. He advises starting with one capsule a day, and then raising of lowering the dose as needed. (Recommendations for using St. Johns wort in concert with other mood-elevating nutrients is given in Chapter 19.)
         C. 
The Authors Experience
             The author notices effects such as an enhanced sense of well-being, the very first day, but the effects become more pronounced over the next few days of use.
         D. 
Cautions and Side Effects
             Fortunately, St. Johns Wort has few side effects. Dizziness, nausea, tiredness, restlessness, dry mouth, and allergic reactions, including hives or itching, have been reported by a small fraction of users. (These same users have reported these same symptoms from chewing Big Red chewing gum& Just kidding.)
             Its best to avoid sun exposure while taking St. Johns Wort due to possible skin reactions.
          E. 
Recommendations
              St. Johns wort is definitely a good antidepressant and an effective alternative to prescription antidepressants in cases of mild to moderate depression. However, long-term studies havent been performed. The majority of human trials have lasted less than three months.

   (7) Vinpocetine
        
A. Improving Cognitive Function
           Vinpocetine is a cardiovascular nutrient. It can dilate blood vessels, enhance circulation, improve oxygen utilization, make red blood cells more pliable, etc. It has been employed in clinical practice in Europe for more than two decades. Twelve healthy female volunteers were given vinpocetine in a double blind, crossover experiment. Memory was significantly improved with vinpocetine.
        B. 
Availability and Dosage
            Vinpocetine is sold in 5 and 10 mg. pills. Levels peak in the bloodstream within an hour-and-a-half after ingestion.
        C. 
The Authors Experience
I like the effects of vinpocetine. On 10 mg. I notice improvement in concentration and focus, and enhancement of color perception, peaking at about two hours after dosing. I do not notice any significant changes in mood or energy.
        D. 
Cautions and Side Effects
The long-term effects of vinpocetine are unknown. It has blood-thinning potential, so it must be used with caution if someone is on warfarin.
        E. 
Recommendations
Use should be limited to 2.5 to 5 mg. once or twice daily.

   (8) Additional Herbs and Food-Like Supplements
        
Many herbs are reputed to influence mental function. A partial list includes (bacopa monniera), cordyceps, gotu kola, rosemary, maca, Fo-ti, reishi, and schisandra.Then there are food-like supplements such as Spirulina, blue-gren algae, and royal jelly. The research with many of these supplements is very limited. Dr. Sahelian says that he has personally noticed increased alertness and energy levels with royal jelly, maca, and gotu kola.
       
A. Bacopa
            Bacopa is an Ayurvedic medicine used in India for memory enhancement, epilepsy, insomnia, and as a mild sedative. The dosage is 125 mg. for 50% bacosides standardized extract, or 10 ml. of the liquid extract. It has been shown to improve learning skill in rats. A few more studies are needed to determine safety and long-term effectiveness.
         B. 
Gotu Kola
             Gotu kola is an herb used in the Ayurvedic system of medicine. Its used as a memory enhancer, and is sometimes taken in lieu of coffee. One drawback is that it makes subjects a little warm. Its similar to bacopa but milder.
         C. 
Maca
             This Andean herb was used both as a food and as a medicine. It increases energy and promotes endurance. Dosage is 500 mg. of the herb. Dr. Sahelian has experimented with doses ranging from 1 to 5 grams. Effects last a few hours and then fade away.
         D. 
Reishi
             Reishi is an Asian mushroom that calms the mind eases tension, improves memory, and sharpens concentration and focus. Dr. Sahelian has used a product that contains 600 mg. of reishi per capsule. Within a couple of hours after taking two pills, there was a sense of relaxation and calmness, with the urge to take deep, relaxed breaths. His mind stayed alert without much sedation or sleepiness.

   (9) Overall Recommendations

        Buy a bottle of one adaptogenic drug such as ginseng or maca and use it regularly for about two weeks. Note how this herb influences you.

        At the end of two weeks, take a break for a week and purchase another herb. Try this one for two weeks. Again, note how it affects you.

        Continue trying the herbs discussed in this chapter and eventually, youll find out which one(s) you like most.

        Once youve determined the ones that are suitable for you, you can again try each one separately, or you can alternate their use on a daily or weekly basis. Its best not to take these herbs all the time, but instead to cycle their use. Take a few days break when switching from one herb to another.

Its important to distinguish between those herbs that can be taken regularly as adaptogens (multipurpose nutrients, such as ginseng) and those that are used for specific therapeutic purpose. For instance, kava should generally be used if you have stress or anxiety, and St. Johns wort is reserved for those with depression. Huperzine A is aimed for those with Alzheimers disease. Gingko improves concentration and memory, and is also recommended for age-related cognitive decline and Alzheimers disease.
You should also differentiate between the herbs that can cause increased energy, alertness, and warmthsuch as Chinese ginseng and gotu kolaand herbs that have a calming effect, such as ashwagandha, kava, and reishi.

Chapter 16 - The Mind-Boosting Program for Ages 25 to 40 

   (1) Routine Supplements for the 25-to-40 Age Group
        Dr. Sahelian advises, before embarking on a dietary supplement plan, reviewing the 10 mind-boosting principles he discusses in Chapter 2, and the dietary and lifestyle recommendations he espouses in Chapter 5. He recommends a good multivitamin and mineral tablet several times a week (e. g., every other day). If you dont consume fish several times a week, he recommends 500 to 1,000 mg. fish oil capsules, or one teaspoon of flaxseed oil, or some combination of these, particularly for vegetarians.

    (2) Supplements That Improve Mental Performance
         For especially demanding days on an occasional basis, he suggests that one of the supplements below be taken before lunch on an empty stomach or with a light meal. He recommends using these only a few days a month.

        A B-complex supplement supplying five to ten times the RDA.

        250 to 500 mg. of pantothenic acid (Vitamin B6)

        30 to 90 mg. of Coenzyme Q10

        250 mg. of Trimethylglycine (TMG) (DMG, DMAE and SAMe provide similar effects.

        250 to 750 mg. of Acetl-L-carnitine.

        100 to 300 mg. of phenyalanine and tyrosine. (High doses can lead to overstimulation, including racing of the heart.)

        Once you have learned about the above nutrients, you can try others if you wish. These would include NADH, lipoic acid, vinpocetine, and pregnenolone. You can also learn about other energy-inducing herbs such as ginseng, maca, gotu kola, and others in Chapter 15 (Herbs).

   (3) Mood-Improving Supplements
         Depression or low mood occurs commonly among in the 25-to-40 age group, particularly among women. As a rule, a good diet, exercise, and other positive lifestyle habits can make an enormous difference. Supplements that work well in improving mood are the B-vitamins and St. Johns wort. Chapter 19 provides a complete ste-by-step nutritional approach to treating depression.

         For PMS, the author prescribes the B-complex vitamins, Calcium at 1,000 mg. per  day, pregnenolone at 5 to 10 mg. in the morning, and 25 mg. of 5-HTP or 70 to 100 mg. of the kavalactones on an empty stomach once or twice a day for anxiety.

   (4) Stress Supplements
         For occasional stress, 70 to 100 mg. of the kavalactones once, twice, or three times a day can be helpful.
         25 to 50 mg. pf 5-HTP may also be used on an occasional basis.
         Ashwagandha, American ginseng, and reishi are useful for extended stress. Fish oil could also help.

   (5) Sleep
         Melatonin, 5-HTP, valerian, hops, and ashwagandha can be used for occasional sleep problems.

    (6) Vegetarians
          He recommends 10 mg. of CoQ10, 250 mg. of carnitine, and 1 gram of creatine. He also recommends fish-oil or flax-seed oil.

    (7) Pregnancy
          He cautions against folic acid deficiency, and refers the young mother to Chapter 19 for the treatment of post-partum depression.


Chapter 17 - The Mind-Boosting Program for Ages 41 to 60


    (1) First-Line Supplements for the 41-to-60 Age Group

        A good multivitamin and mineral tablet several times a week. You might consider taking the B vitamins in their coenzyme form.

        Vitamin C, between 100 and 250 mg.; vitamin E between 20 and 100 i. u. You dont have to take these antioxidants every day.

        Be sure you either have enough fish, or take 500 to 1,000 mg. of omega-3 fish-oil capsules.

        You can occasionally use an herbal adaptogen, such as ginseng, for additional mental and physical energy.

(2) Second-Line Supplements for the 41-to-60 Age Group
      These should be taken under medical supervision. Be careful about using multiple supplements. Could be too stimulating. When you combine, reduce the dosage of each.

        40 mg. of gingko

        10 to 30 mg. of coQ10

        100 mg. of vitamin B6

        100 mg. of TMG or DMG

        250 mg. of acetyl-L-carnitine

(3) Third-Line Supplements
      This should be done under the close supervision of a nutritionally trained M. D. You must also stop taking other supplements that could compound their effects with these, and you musnt take all of these full-strength.

        250 mg. of choline, or 100 to 250 mg. of CDP-choline

        5 to 25 mg. of lipoic acid

        2.5 to 5 mg. of NADH once or twice a week.

        Other herbs such as vinpocetine, DMAE and SAMe that you could explore with time. Please remember that these effects are cumulative. For example, choline, CDP-choline, and DMAE all affect the acetylcholine system. Therefore, if you are combining them, you will need less of each. The effects of TMG, DMG, DMAE, and SAMe are also cumulative.

(4) Hormone Replacement
      Shouldnt be needed before the late forties, and then in minute doses. Pregnenolone is a powerful memory booster. Be very careful if you have hypertension, heart disease, diabetes, thyroid problems, or other chronic medical conditions. Nutrients and hormones are powerful, and can interfere with medications, or alter the course of a medical condition, especially if you start taking many all at once.

Chapter 18 - The Mind-Boosting Program for Ages 61 and Over

      The use of mind-boosters in this age group is complicated by the fact that many seniors have preexisting medical conditions. The issue is further complicated by the fact that many older individuals are also taking pharmaceutical medicines to treat a particular condition.
   (1) Age-Related Cognitive Decline (ARCD)  It happens.

   (2) Taking Care of Medical Conditions
         Make sure you dont have a treatable cause of mental decline such as thyroid disease, elevated blood sugar, depression, or B12 deficiency. Make sure you can see and hear adequately.
       
(A) Cardiovascular and cerebrovascular disease
              Control blood pressure with mild or moderate exercise, stop smoking, reduce body weight, incorporate fresh fruits and vegetables in your diet, and add magnesium, potassium, antioxidants, and omega-3 oils.
              If you have hypertension or heart disease, good choices for mind boosters include omega-3 oils, gingko, choline, B vitamins, methyl donors, CoQ10, lipoic acid, and acetyl-L-carnitine. Its best to avoid tyrosine and phenylalanine since they increase blood pressure and cause heart-rhythm irregularities.
        (B) Elevated Cholesterol
              Dr. Sahelian suggests the same mind boosters as those recommended for cardiovascular disease (above). He also cites a UC-Irvine study that administered 1,800 mg. of EPA and 1,200 mg. of DHA (or eating fish every day), plus 1,200 mg. of garlic that lowered cholesterol 11%. However, he mentions that the cholesterol-diminishing role of garlic hasnt yet been proven.
       
(C) Osteoarthritis
             He suggests 500 to 1,000 mg. of glucosamine, plus 400 mg. of chondroitan sulfate, and vitamins C and D, omega-3 oils, and methyl donors.
       
(D) Benign Prostrate Hypertrophy
              Although the drug finasteride (Proscar) can help subdue this, 160 mg. of saw palmetto twice a day may reduce the required Proscar dose.
        (E) GI Problems
              If you take antacids or stomach-acid reducers, you may have trouble absorbing some nutrients, particularly, vitamin B12.
       
(F) Regulating Circadian Cycles
             Light exposure helps regulate this. If you feel sleepy too early, expose yourself to late-afternoon or early-evening sunlight. If you tend to become wired late at night, expose yourself to morning light.
             The occasional use of melatonin once or twice a week can help regulate Circadian rhythms.
       
(G) Supplements for Age-Related Cognitive Decline
              Age-Related Cognitive Decline results from such phenomena as

        decreased blood flow to the brain;

        insufficient enrgy productin by the brain;

        changes in levels of brain chemicals and hormones; and

        deterioration of brain cells.

        (H) Improving Blood Flow to the Brain
              Dr. Sahelian recommends gingko, omega-3 oils, and 1/4th of an adult aspirin a day.
       
(I) Improving Brain-Cell Energy Metabolism
             Dr. Sahelian recommends 250 mg. of acetyl-L-carnitine on days when someone needs to be sharp. 30 to 60 mg. of CoQ10 can also help. 5 to 25 mg. of lipoic acid will sharpen vision, but hasnt been tested for reversal of cognitive decline.The B-vitamins are also helpful.
       
(J) Influencing Neurotransmitter Levels
             Choline and CDP-choline influence acetylcholine levels and are applicable to Alzheimers patients; phenylalanine, tyrosine, and some of the B-vitamins affect dopamine levels for Parkinsons patients; and 5-HTP is a direct serotonin precursor.
       
(K) Influencing Hormone Levels
              Can be very beneficial, but caution is advised.
        (L) Rebuilding Brain Cells
             Until more is known about this nascent research area, supplementation with fish-oils and small amounts of phospholipids, such as CDP-choline, is recommended.

   (3) Step-by-Step Guide to Supplements for the 61-and-Over Age Group
       
       
(A) First-Line Therapy

        Multivitamin pills. Might need B12 injections.

        Get that fish oil

        100 to 500 mg. of vitamin C and 30 to 200 i. u. of vitamin E

        Women may want to consider adding more soy products to their diets.

        (B) Second-Line Therapy

        40 mg. of gingko for blood flow to the brain; 100 to 250 mg. of acetyl-L-carnitine to boost energy; 10 to 30 mg. of CoQ10, or 5 to 25 mg. o lipoic acid. Hormone replacement with DHEA or pregnenolone can, in some individuals, improve hearing and vision, but there are potential side effects. See Chapter 14.

        Melatonin can be used at a dose of 03, to 1 mg. one or three times a week.

        (C) Third-Line Therapy

        250 mg. of choline, or 100 to 250 mg. of CDP-choline. 100 mg. of TMG or DMG. 2.5 to 5 mg. of NADH once or twice a week, since a tolerance to NADH can quickly develop.

        There are additional nutrients, herbs, and herbal extractssuch as DMAE, SAMe, ginseng, maca, and vinpocetinethat you could explore with time. Whether supplements of PS and lecithin improve cognitive abilities in the aged has yet to be determined.

        (D) Cautions and Side Effects
              Gingko biloba, feverfew, garlic, ginger, vinpocetine, aspirin, and high doses of vitamin E may increase the risk of bleeding in patients taking antithrombotic agents.
              Always take low doses when you combine supplements.

       
(E) Summary
             Although our bodies are preprogrammed to aging, there are several steps we can take to slow this process. Many of the supplements I discuss in this book can have an enormous benefit in improving memory, vision, clarity of thought, motivation, joie de vivre, and creativity. Lets be appreciative that these nutrients are readily available.


Chapter 19 Supplements That Fight Depression
        Dr. Sahelian paints the interesting picture of a pond full of sharp rocks at the bottom that represent all the major and minor traumas that weve suffered. Normally, as long as the water level remains high, were unaware of the sharp rocks at the bottom of the pond. But when the water level gets low, the tips of the larger rocks project, and if the water level gets low enough, even the small rocks will emerge from the water.
          Dr. Sahelian argues that its important to eliminate as many big rocks as possible, through psychotherapy, self-analysis, etc., but that its also necessary to bring the water level back up. Chemically induced moods reveal the role of brain chemistry in moodiness.
   (1) Nutrients to the Rescue
         With the current availability of a number of natural supplements that influence mood, it is now possible, in my opinion, to not rely on pharmaceutical medicines for the therapy of mildand probably moderatedepression. Perhaps even in some cases of severe depression could respond, at least partially, to a suitable combination of natural nutrients and herbs. One of the first mood-influencing herbs to gain wide respect among medical doctors was St. Johns wort.
         There are different kinds of depression, and each person has a unique biochemistry. Some cases of depression are due to low levels of serotonin, while others are due to low levels of norepinephrine or dopamine. Still others may be due to abnormalities in the energy production of brain cells, abnormal cell membranes, or nerve damage. It is unlikely that a single therapy will provide complete relief to patients who are clinically depressed.
         Your health care practitioner should be intimately involved with your supplementation, and should make sure that you dont have other pre-disposing conditions such as thyroid disease, tumors, or anemia.
         
(A) First-Line Therapy
               A good diet, stress reduction, good sleep, and physical activity alone can be curative.

        Eat small, frequent meals throughout the day that consist of a well-proportioned balance between protein, fat, and complex carbohydrates. I find vegetarians sometimes suffer from low mood because they consume excess carbohydrates at the expense of adequate protein and the right kinds of fats. A large intake of carbohydrates can make one sluggish and sleepy.

        Take a multivitamin pill each morning. In addition, take a B-complex tablet that supplies 5 to 10 times the RDA for the B-vitamins. If you are older, you might consider taking the coenzyme form of these B-vitamins. After a month of taking 5 to 10 times the RDA for B-vitamins, drop to 2 to 3 times the RDA.

        Take a combination of a few antioxidants in small doses, including 30 to 100 i. u. of vitamin E and 100 to 250 mg. of vitamin C. A multi-mineral pill that provides 50% to 100% of the RDA is recommended.

        Take fish-oil capsules totaling about 2 to 4 grams a day for a month, then reduce the dose to 1 to 2 capsules a day.

(B) Second-Line Therapy
      If theres little or no improvement after two weeks, take a St. Johns wort with breakfast. If after a few days, there is still insufficient benefit, add a second St. Johns wort. If this is still insufficient, it might be advisable to add a different mood-elevating supplement.

(C) Third-Line Therapy
      If this still doesnt do the job, here are additional suggestions.

        100 mg. of tyrosine in the morning on an empty stomach. Tyrosine is more suitable for younger individuals because older individuals and those with heart problems can develop heart palpitations. If youre taking St. Johns wort, hold down the levels of tyrosine because the effects are potentially cumulative (e. g., insomnia).

        After a week, add 30 mg. of CoQ10 in the morning

        TMG, DMG, SAMe, or pantothenic acid at 100 to 250 mg. in the morning may be added. Carnitine at 250 mg. a day is another nutrient that increases energy levels.

          (D) Fourth-line Therapy
                At this stage, you should be very carefully and closely supervised by your health-care provider because the risk of interactions among the nutrients can increase significantly. There is also a possibility of overstimulation when too many energizers are used. Some of these nutrients can slowly accumulate in the system and you may bee lower dosages with time. The treatment of depression is a dynamic process, and dosages of nutrients and medicines have to adjusted up or down on a regular basis. If your depression lifts, dont try to add more nutrie ts; instead try to minimize the dosages and the number of nutrients you are taking.

        There are quite a number of other options available. For instance, the herb ginseng can provide a sense of well being. If anxiety is present, the serotonin precursor 5-HTP can be helpful. The nighttime range is 25-50 mg., about an hour or two before bed, on an empty stomach, while the daytime dosage is 25 mg. At most 5-HTP should be used only four days a week, and for no longer than two months continuously. After a months break, you can resume taking 5-htp again.

        For a deeper sleep, try melatonin at a dose of 03. to 0.5 mg once or twice a week. Reduce this dosage if youre also taking 5-HTP.

        2.5 mg. to 5 mg. of NADH can be taken two to three times a week. Acetyl-L-carnitine has mood-elevating properties, and 100 to 250 mg. is a good starting dose.

        Older people might want to add DHEA or pregnenolone, to be started at a dose of 5 mg. a day. For long-term use, I do not recommend exceeding a dose of 2 to 5 mg. per day. Take a break of at least a week from these hormones once a month.