PEER-REVIEW | NEUROSCIENCE | Recommendations for management
Neurotransmitter support supplements ■ Acetyl L Carnitine: 2000 mg/day/oral
■ Alpha Lipoic Acid: 500–1000 mg/day/ oral
■ CoQ10, oral 100 mg 2–3 times per day to boost energy ■ Essential fatty acids ■ Folic acid: 800 mcg/day/ oral
■ L-glutamine 1 g/day/oral on empty stomach ■ N-acetylcystine: 600–1200 mg/day/oral
■ SAMe: 200–1600 mg/day/oral (helpful in homocystine and glutathione metabolism)
■ Tyrosine: 1500 mg daily/oral
Hormones ■ Cortisol 10–20 mg oral divided dose daily (25 mg cortisone = 20 mg hydrocortisone)
■ DHEA: 15–25 mg (women) and 50–100 mg (men) daily oral
■ Melatonin: 3 mg daily at bedtime, oral
■ Pregnenolone: 25–50 mg (women) and 50–100 mg (men) daily, oral
Only if the deficiency is established after lab work and clinical assessment ■ Oestrogen: 1.5–2.5 mg (women) ■ Progesterone: 50–150 mg (women)
■ Thyroid: ¼–½ grain T3/T4 am. Starting dose. Monitor regularly
■ Testosterone transdermal: 50–150 mg (men)
■ Growth hormone: 0.1–0.5 IU S/C Inj (only in GH deficient cases; check IGF-1; monitor Adrenal function before giving HGH)
■ 9α Fluorohydrocortisone: + SBP: 110 mmHg: 50–75 mcg/day am; + SBP: 96–109 mmHg/Orthostatic Hypotension:
100 mcg/day am; + SBP: 80–95 mmHg: 125–150 mcg/day am; SBP=systolic blood pressure
Rule out past history, family history and evidence of hormone-dependent cancer in any patient before treating any hormone like HGH, oestrogen, DHEA and testosterone, etc.
Balanced diet
■ Dopamine-rich foods: beans, fish, meat, milk products, nuts, soy products
■ Serotonin-rich foods: breads, cereals, pasta, potatoes, starchy vegetables
■ Acetylcholine-rich foods: broccoli, cauliflower, cabbage, cheese, egg yolks, fish, liver, meat, peanuts, vegetables, wheat germ
Avoid
■ Sweets, chocolate, soft drinks, avoid high temperature cooked food
Increase ■ (Animal) protein intake, but cooked at low temperature
■ Fresh vegetables and fruit intake
Improve sleep hygiene ■ Dark bedroom
■ Increased exposure to morning (day) light ■ No electric furniture near the bed
Treat nutritional deficiencies ■ Folic acid ■ Iron ■ Magnesium ■ Vitamin B12 ■ Vitamin E
REM cycles. Niacinamide might be helpful for sleep enhancement. A small, 3-week study34
of six subjects with
normal sleep patterns and two with insomnia used EEG, electromyograms, and electrooculograms to evaluate sleep patterns at baseline and after niacinamide treatment (500 mg twice daily for 1 week; 1000 mg twice daily in week 2; and 1000 mg three times daily in week 3). There was a significant increase in REM sleep in all normal-sleeping subjects (P=0.0002). The two subjects with moderate-to-severe insomnia experienced significant increases in REM sleep by the week 3 (P=0.001); awake time was also significantly decreased.
Evidence
indicates adrenal cortex function is compromised in the event of a deficiency of vitamin B5 derivatives and metabolites.
Sleep
efficiency in the two subjects with insomnia was 58.5% at baseline, dropped to 55.7% after 2 weeks, but was at 79.5% after 3 weeks. After withdrawing niacinamide, sleep efficiency dropped to 41.5%. As tryptophan can either be converted to melatonin, niacin, or
serotonin, niacinamide may signal via feedback inhibition to decrease the activity of tryptophan pyrrolase (the enzyme that converts tryptophan to niacin). This would allow more tryptophan to be converted to 5-HTP and then to serotonin.
Pantethine/pantothenic acid (vitamin B5) Evidence indicates adrenal cortex function is compromised in the event of a deficiency of vitamin B5 derivatives and metabolites. On the other hand, administration of pantethine (active vitamin B5) in a number of experimental animal models appeared to enhance adrenal cortex function. Administration of pantethine to humans with a variety of clinical conditions buffered the rise in urinary cortisol metabolites expected to occur secondary to a loading dose of ACTH, suggesting pantethine can down-regulate hyper-secretion of cortisol secondary to high stress conditions. Men receiving 10 g of pantothenic acid daily for 6 weeks had a less pronounced drop in white blood cell counts and vitamin C levels subsequent to cold-water immersion stress, compared with pre-supplementation values.
58 ❚
Pyridoxal 5’-phosphate (active vitamin B6) P5P (the active form of vitamin B6) is a necessary cofactor for the formation of a number of enzymes important for neurotransmitter pathways associated with stress-like serotonin and niacin. Within the brain, glutamic acid is converted to GABA via the enzyme glutamate decarboxylase and its cofactor pyridoxal 5Õ -phosphate. GABA is metabolised by gamma-aminobutyrate transaminase, also a P5P-dependent enzyme, forming an intermediate metabolite succinate-semialdehyde. P5P is a cofactor in the conversion of 5-HTP to serotonin. It is important to know that conversion of L-tryptophan to
January/February 2013 |
prime-journal.com
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