Coenzyme Q10. CoQ10 is essential for proper
mitochondrial function and acts as an antioxidant (Murray R et al
1999). Human studies have found that ALS patients have a higher
percentage of oxidized CoQ10, a condition the researchers blamed on
oxidative stress caused by the disease (Sohmiya M et al 2005). Several
animal studies, including the following, have indicated the promise of
CoQ10 in treating ALS:
Among mice models of familial ALS, administration of coenzyme Q10
significantly extended life span, and oral administration significantly
increased CoQ10 concentrations in the brains and mitochondria of the
test animals (Matthews RT et al 1998).
Another study found that CoQ10 significantly reduced weight
loss, delayed motor deficits, and extended survival in ALS (Beal MF
2002).
Acetyl-L-carnitine. Acetyl-L-carnitine has been
shown to improve mitochondrial function (Carta A et al 1993), which is
impaired in ALS. It could have neurotrophic activity and increase
glutathione concentrations (Thal LJ et al 2000). In one animal study,
the effects of acetyl-L-carnitine were increased when it was
administered in conjunction with alpha-lipoic acid (Hagen TM et al
2002).
Alpha-lipoic acid. Alpha-lipoic acid has been shown
to have antioxidant properties, increase intracellular levels of
glutathione (Zhang WJ et al 2001), and chelate metals such as iron and
copper (Pioro EP 2000). Furthermore, alpha-lipoic acid has been shown
to protect cells against glutamate-induced excitotoxicity (Muller U et
al 1995). In one study, significant increases in survival and delays in
symptom onset were measured among animal models of ALS (Andreassen OA
et al 2001b).
Amino acids. Studies have shown that ALS patients
are significantly deficient in up to nine amino acids. A Portuguese
study suggested that dietary supplementation with amino acids may have
some beneficial effects on the course of the disease (Palma A et al
2005).
Creatine. Creatine is synthesized in the kidneys,
liver, and pancreas. In cells, creatine aids in the formation of ATP,
which is the primary source of cellular energy. In multiple animal
studies, creatine has been shown to provide protective mechanisms
against neurodegenerative diseases. For example, it has been suggested
that creatine helps to stabilize cellular membranes and mitochondrial
energy-transfer complexes (Persky AM et al 2001). Creatine may also
reduce oxidative stress (Tarnopolsky 2001) and increase glutamate
uptake (Andreassen OA et al 2001a). Furthermore, creatine
supplementation has been shown to increase survival times and improve
motor performance (Tarnopolsky MA 2001; Andreassen OA et al 2001a). In
human ALS patients, there is evidence to suggest that creatine may
reduce motor neuron death by improving mitochondrial function
(Vielhaber S et al 2001). In addition, a small preliminary study found
that creatine supplementation helps reduce the loss of muscle strength
in ALS patients (Mazzini L et al 2001).
Curcumin. Curcumin is a pigment found in turmeric,
one of the main ingredients in curry. There is evidence that curcumin
has antioxidant properties (Li J et al 2001; Naidu KA et al 2002; Lim
GP et al 2001). More recent data has suggested that curcumin may help
improve calcium status in muscle tissue and reduce inflammatory
processes in the mouse brain (Logan-Smith MJ et al 2001; Sumbilla C et
al 2002). While human studies are needed to confirm these results,
preclinical evidence suggests that curcumin could be useful in ALS.
Dehydroepiandrosterone (DHEA). DHEA is a naturally
occurring steroid hormone with anti-aging properties. In several in
vitro studies, DHEA has been shown to protect against glutamate-induced
toxicity (Lapchak PA et al 2001; Kimonides VG et al 1998; Mao X et al
1998), although few studies have examined DHEA in ALS patients.
Glutathione. Glutathione is a peptide with
antioxidant properties that is naturally synthesized by the body.
Increasing glutathione levels could help prevent free radical damage to
cells (Exner R et al 2000). The glutathione precursor N-acetylcysteine
(NAC) has been shown to boost blood levels of glutathione.
Green tea. Green tea contains a high concentration
of catechins, which are flavonoids with strong antioxidant properties
(Hu M et al 2002). Green tea extracts have been demonstrated to have
metal-chelating properties (Levites Y et al 2002) and anti-inflammatory
activity (Hong JT et al 2000).
N-acetylcysteine. Along with being a glutathione precursor, NAC has antioxidant activity of its own.In
mouse models of ALS, NAC administration has also been shown to decrease
motor neuron loss, improve muscle mass, and increase survival time and
motor performance (Andreassen OA et al 2000; Henderson JT et al 1996).
Pycnogenol. Pycnogenol is an extract of marine pine
bark that includes procyanidins and phenolic acids (Packer L et al
1999). It has been shown to have antioxidant properties (Packer L et al
1999), as well as protective effects against glutamate excitotoxicity
(Kobayashi MS et al 2000). Procyanidins, which can also be found in
grape seeds, cranberries, blueberries, almonds, and peanuts,
demonstrate potent antioxidant properties (Packer L et al 1999).
Pycnogenol is a common complementary therapy option among ALS patients
(Cameron A et al 2002).
Resveratrol. A powerful antioxidant found in red
grape skins, resveratrol has been found to suppress the influx of
calcium into cells, which is associated with glutamate-induced cell
toxicity (Wu SN 2003). Resveratrol may also affect the movement of
calcium into the cells that line the inside of arteries (Li HF et al
2000).
Selenium. Used in conjunction with a traditional
calcium channel blocker, such as nimodipine, and antioxidants, selenium
was shown to increase the amount of vitamin E in the blood and increase
the activity of glutathione, a powerful internal oxidant, among ALS
patients. Antioxidant activity is often impaired in ALS patients, and
treatment with this regimen was demonstrated to slow the course of the
disease (Apostolski S et al 1998).
Vinpocetine. Vinpocetine inhibits the influx of
calcium into the cell, which has been associated with glutamate-induced
cell toxicity (Wu SN et al 2001). This is similar to the mechanism of
action of riluzole, the only FDA-approved drug used to treat ALS.
Life Extension Foundation Recommendations
The goal of dietary and supplement therapy with ALS patients is
twofold. First, patients need to slow neuronal damage, potentially
slowing progression of the disease. Second, therapy must promote the
optimization of function of the neuromuscular junction, thus
maintaining a high quality of life. Life Extension's recommendations
address both these areas by offering a comprehensive portfolio of
supplements. No one should begin a regimen of dietary supplementation
unless under the supervision of a qualified physician. Also, blood
tests are highly recommended prior to DHEA supplementation to establish
a baseline hormone level. Blood testing is available by calling
1-800-544-4440. Life Extension's recommendations include the following
nutrients:
Vitamins and Minerals
Vitamin B12: up to 25 mg daily, sublingual or administered intramuscularly (IM).
Vitamin E (Gamma E Tocopherol/Tocotrienols): one to two softgels per day with food.
Zinc: 15 mg daily. ALS patients can also consider taking 1 mg of copper in conjunction with zinc.
Creatine: Micronized Creatine, two to four capsules per day with or without food.
DHEA:
A typical starting dose of DHEA is 15 mg to 75 mg. Blood testing is
recommended after three to six weeks to make sure levels of this
hormone are optimal.
Glutathione: L-Glutathione, L-Cysteine and C, one capsule one to three times per day before food.
Selenium:
200 mcg daily. This may be administered in conjunction with a calcium
channel blocker, such as nimodipine. Calcium channel blockers are
available only by prescription.
Mitochondrial Energy Optimizer.
This is a special antioxidant blend available only through the Life
Extension Foundation. Please note that this product contains the proper
doses of R-dihydro-lipoic acid and acetyl-L–carnitine arginate.
Therefore, individuals may eliminate them from the list above if they
take this product.
An aggressive program of dietary supplementation should not be
launched without the supervision of a qualified physician. Several of
the nutrients suggested in this protocol may have adverse effects.
These include:
Acetyl-L-Carnitine
Acetyl-L-carnitine can cause gastrointestinal symptoms such as nausea and diarrhea.
Coenzyme Q10
See your doctor and monitor your blood glucose level frequently if
you take CoQ10 and have diabetes. Several clinical reports suggest that
taking CoQ10 may improve glycemic control and the function of beta
cells in people who have type 2 diabetes.
Statin drugs (such as lovastatin, simvastatin, and pravastatin) are known to decrease CoQ10 levels.
Creatine
Do not take creatine if you have diabetes, kidney failure, a kidney
disorder such as nephrotic syndrome, or are otherwise at risk of having
a kidney disorder.
If you take creatine, have your serum creatinine level monitored frequently.
Creatine can cause muscle cramping, muscle strains, and gastrointestinal symptoms such as nausea and diarrhea.
Curcumin
Do not take curcumin if you have a bile duct obstruction or a
history of gallstones. Taking curcumin can stimulate bile production.
Consult your doctor before taking curcumin if you have
gastroesophageal reflux disease (GERD) or a history of peptic ulcer
disease.
Consult your doctor before taking curcumin if you take
warfarin or antiplatelet drugs. Curcumin can have antithrombotic
activity.
Always take curcumin with food. Curcumin may cause gastric
irritation, ulceration, gastritis, and peptic ulcer disease if taken on
an empty stomach.
Curcumin can cause gastrointestinal symptoms such as nausea and diarrhea.
DHEA
Do not take DHEA if you could be pregnant, are breastfeeding, or could have prostate, breast, uterine, or ovarian cancer.
Ginkgo biloba
Do not take ginkgo biloba if you have a known risk factor for
intracranial hemorrhage such as systematic arterial hypertension,
diabetes, or amyloid senile plaque.
Ginkgo biloba can cause allergic skin reactions, elevated
blood pressure, and gastrointestinal symptoms such as nausea and
diarrhea.
Ginkgo Biloba
Individuals with a known risk factor for intracranial hemorrhage,
systematic arterial hypertension, diabetes, or seizures should avoid
ginkgo.
Do not use prior to or after surgery.
Avoid concomitant use of ginkgo with NSAIDS, blood thinners, diuretics, or SSRI’s.
Gastrointestinal symptoms (nausea and diarrhea) may occur.
Allergic skin reactions may occur.
Elevations in blood pressure may occur.
Ginseng
Consult your doctor before taking ginseng if you have high blood pressure. Overuse of ginseng can increase blood pressure.
Consult your doctor before taking ginseng if you take
nonsteroidal anti-inflammatory drugs (NSAIDs) and/or warfarin
(Coumadin). Taking NSAIDs or warfarin with ginseng can increase the
risk of bleeding.
Consult your doctor before taking ginseng if you have
diabetes. Taking ginseng can cause an extreme drop in your blood
glucose level.
Ginseng can cause breast pain, vaginal bleeding after menopause, insomnia, headaches, and nosebleeds.
Green Tea
Consult your doctor before taking green tea extract if you take
aspirin or warfarin (Coumadin). Taking green tea extract and aspirin or
warfarin can increase the risk of bleeding.
Discontinue using green tea extract 2 weeks before any surgical procedure. Green tea extract may decrease platelet aggregation.
Green tea extract contains caffeine, which may produce a
variety of symptoms including restlessness, nausea, headache, muscle
tension, sleep disturbances, and rapid heartbeat.
Lipoic Acid
Consult your doctor before taking lipoic acid if you have diabetes
and glucose intolerance. Monitor your blood glucose level frequently.
Lipoic acid may lower blood glucose levels.
NAC
NAC clearance is reduced in people who have chronic liver disease.
Do not take NAC if you have a history of kidney stones (particularly cystine stones).
NAC can produce a false-positive result in the nitroprusside test for ketone bodies used to detect diabetes.
Consult your doctor before taking NAC if you have a history of
peptic ulcer disease. Mucolytic agents may disrupt the gastric mucosal
barrier.
NAC can cause headache (especially when used along with nitrates) and gastrointestinal symptoms such as nausea and diarrhea.
Rhodiola rosea
Do not take Rhodiola rosea if you have anxiety or bipolar disorder.
SODzymes
Do not take SODzymes if you are allergic to soy, corn, or wheat.
Vinpocetine
Do not take vinpocetine if you have a history of allergic or hypersensitivity reactions to any vinca alkaloids.
Consult your doctor before taking vinpocetine if you take
warfarin (Coumadin). Have your international normalized ratio monitored
frequently by your doctor if you take vinpocetine and warfarin.
Consult your doctor before taking vinpocetine if you have
low blood pressure (including transient low blood pressure or
orthostatic hypotension). Prolonged use of vinpocetine may lead to
slight reductions in systolic and diastolic blood pressures.
Vinpocetine can cause temporary rapid heartbeat, pressure
headache, facial flushing, dizziness, insomnia, drowsiness, and
gastrointestinal symptoms such as nausea and diarrhea.
Vitamin C
Do not take vitamin C if you have a history of kidney stones or of
kidney insufficiency (defined as having a serum creatine level greater
than 2 milligrams per deciliter and/or a creatinine clearance less than
30 milliliters per minute.
Consult your doctor before taking large amounts of vitamin C
if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle
cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD)
deficiency. You can experience iron overload if you have one of these
conditions and use large amounts of vitamin C.
Vitamin E
Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
Consult your doctor before taking vitamin E if you have a
history of any bleeding disorder such as peptic ulcers, hemorrhagic
stroke, or hemophilia.
Discontinue using vitamin E 1 month before any surgical procedure.
Zinc
High doses of zinc (above 30 milligrams daily) can cause adverse reactions.
Zinc can cause a metallic taste, headache, drowsiness, and gastrointestinal symptoms such as nausea and diarrhea.
High doses of zinc can lead to copper deficiency and hypochromic microcytic anemia secondary to zinc-induced copper deficiency.
High doses of zinc may suppress the immune system.
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