Supplements to Enhance the Brain

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Supplements to Enhance the Brain:

A Summary of Ways to Optimize Brain Function and Break Bad Brain Habits. By Dr. Daniel G. Amen

Through the years many people have asked me about natural treatments. At

least once a month a parent tells me about an amazing new treatment for

ADD, depression, anxiety disorders, and so on. Vitamins, herbs, fish

oil, amino acids, grape seed extract, and magnets to name a few. Having

three ADD children of my own keeps me with an open mind. I want to know

about everything that works to help the brain. Through the years I have

tracked each of these treatments, kept up on the sparse scientific

literature where it exists, and constantly stay on the lookout to see

what works. Wading through the claims, parental excitement, and failures

is challenging. The good news, however, is that many of these treatments

are helpful, especially if you target the interventions to specific

brain systems.

A word of caution: without looking through the lens of brain systems,

some of these interventions clearly make things worse. Just because

something is natural does not mean it's innocuous. Here's an example.

Seven-year-old Justin was brought to see me by his mother. He had

symptoms of ADD (short attention span, restlessness, and impulse control

problems) along with temper problems. A month before I met Justin his

mother read a magazine article on St. John's Wort. It said that it

helped with mood and temper problems. She gave it to her son. Within a

week Justin's behavior was much worse. He was more hyperactive, angrier,

and he started to have dreams of decomposing bodies. When she stopped

the St. John's Wort his symptoms lessened. During Justin's evaluation at

my clinic I did a SPECT scan. It showed decreased activity in his left

temporal lobe. I have often seen that serotonergic interventions like

Prozac or St. John's Wort make temporal problems worse. It was clear to

me that Justin needed an anticonvulsant medication and a stimulant. He

had a very positive response to Depakote and Adderall.

Always check with your doctor before adding supplements to medication.

Some supplements will interact with medication, so caution is needed.

In this chapter I will go through each brain system and tell you what

supplements that I have seen to have clinical benefit. I'll give you the

rationale and dosage protocols that I suggest to my patients. If you

decide to use these supplements instead of medication, as many people

do, make sure you keep tabs on their effectiveness. I only want my

patients to take something that is clearly beneficial to them. I also

want them to take medication if the supplements are not effective. Many

parents say that they want to try the natural supplements before they

try medication. I'm not opposed to that, but I worry that if the

supplements are not fully effective that they will not pursue more

effective treatments. Follow through to find what works for yourself or

your child. Be open to new ideas and persist until you get the best

brain and life functioning.

No Matter What Brain System Problem Exists - 100% Multivitamin and

Mineral Supplement

No matter what brain system problem exists for you or your child has

take a 100% vitamin and minerals supplement a day. When I was in medical

school the professor who taught our course in nutrition said that if

people eat a balanced diet they do not need vitamin or mineral

supplements. I have seen that balanced diets are a thing of the past for

many of our "fast food families." In my experience, many families have

problems with planning and tend to eat out much more frequently than in

years past. Protect yourself and you child by taking a 100% vitamin and

mineral supplement. In a 1988 study published in the British Journal

Lancet, 90 children between the ages of 12 and 13 were divided into

three groups. One group took no tablet, one group took a typical

multiple vitamin and mineral tablet, and the last group took a tablet

that looked and tasted just like the vitamin and mineral tablet, yet

contained no vitamins or minerals. The results of this well controlled

study was that the group who took the vitamin and mineral tablet had a

significant increase in nonverbal intelligence, while the other two

groups showed no difference at all. The subclinical vitamin and mineral

deficiency may have been contributing to these students performing below

their abilities.

Prefrontal cortex problems (typical ADD like symptoms)

People with PFC (prefrontal cortex problems) seem to have lower

availability of the neurotransmitter dopamine. I frequently prescribe

the amino acid L-tyrosine in doses of 500-1500mg two to three times a

day for adults and 100-500mg two to three times a day for children under

10. L-tyrosine is the amino acid building block for dopamine. It is

reported to increase the level of phenylethylamine (PEA), a mild

stimulant that is found in high concentrations in chocolate. Many of my

patients have reported that it is helpful for them. It is softer in its

effect, but nonetheless they notice a positive effect. Because of

absorption patterns I recommend that they take it on an empty stomach (a

half-hour before meals or an hour after meals). I have not seen any side

effects with L-tyrosine, except for mild weight loss. If there are

cingulate problems, l-tyrosine by itself can increase the intensity of

overfocused symptoms. Symptoms of tyrosine deficiency include

hypothyroidism, low blood pressure, low body temperature (cold hands and

feet), and restless leg syndrome.

Grape seed or pine bark extract has also shown some mild benefit for pfc

issues. Grape seed or pine bark extract are proanthocyanidin compound.

These compounds have been found to increase blood flow and they act as

superantioxidants, 20-50 times as powerful as vitamin E. There are no

published studies with grape seed or pine bark extract in ADD, but there

are a number of published case reports. There is a body of medical

literature that says these compounds are very helpful for people with

varicose veins. If you have ADD and varicose veins then grape seed or

pine bark extract may be for you.

Crystal, age 48, came to the clinic for symptoms of ADD. Her whole life

she had been restless, inattentive, easily distracted, terribly

disorganized, and impulsive. After her third child she also developed

terrible varicose veins, which I had noticed in the initial interview.

When we talked about treatment options for her Type 1 Classic ADD she

said that she wanted to try the grape seed extract. Then she would see

about other options. After 3 weeks she noticed that she felt better

energy and her legs looked and felt better. Eventually we added

L-tyrosine to give her more help with focus, but the regimen has worked

well for her over the past several years.

Cingulate Hyperactivity

Cingulate hyperactivity appears to be due to a relative deficiency of

serotonin. I often use St. John's Wort or 5-HTP (5-hydroxy-tryptophan)

to help boost serotonin levels in the brain. St. John's Wort comes from

the flowers of the St. John's Wort plant (wort is Old English for

plant). It got its name from the fact that it blooms around June 24, the

feast day of St. John the Baptist and the red ring round the flowers

when crushed looks like blood, the blood of the beheaded John the

Baptist. St. John's Wort seems to be best at increasing serotonin

availability in the brain. The starting dosage of St. John's Wort is

300mg a day for children, 300mg twice a day for teens, and 600mg in the

morning and 300mg at night for adults. Sometimes I'll go as high as

1800mg in adults. The bottle should say that it contains 0.3% hypericin,

which is believed to be the active ingredient of St. John's Wort. I have

done a number of before and after SPECT studies with St. John's Wort. It

clearly decreases cingulate gyrus hyperactivity for many patients. It

also helps with moodiness and trouble shifting attention. Unfortunately,

I have also seen it decrease prefrontal cortex activity. One of the

women in the study said, "I happier, but I'm dingier." When cingulate

symptoms are present with ADD symptoms it's important to use St. John's

Wort with a stimulating substance like L-tyrosine or a stimulant such as

Adderall. It has been reported that St. John's Wort increases sun

sensitivity (you could get sunburned more easily and need to be careful

in the sun). Also don't use it if temporal lobe symptoms are present,

without first stabilizing the temporal lobes.

Elaine, 16, had always been a worrier. She also had problems with anger

at home. If things did not go her way she would explode at her parents

or at her younger sister. As a student she was a perfectionist, which

caused her to spend excessive time on assignments. Her mother, a school

principal brought her to my clinic after she heard me lecture. She told

me that she was sure Elaine had cingulate symptoms and ADD. Her SPECT

study showed marked increased activity in her anterior cingulate gyrus.

She also had mild decreased activity in her prefrontal cortex. I placed

her on St. John's Wort, 600mgs in the morning and 300mgs at night. I

also had her take L-tyrosine 500mg two to three times a day. Within a

month Elaine was much better. She was more relaxed, less reactive, and

did much better in her classes. She said that studying was easy because

she no longer felt the need to have everything just so. She still wanted

to excel, but didn't have to copy pages over three and four times until

things were perfect.

*Serotonin Pathway

*Tryptophan

*5-HTP

*Serotonin

*N-acetly-serotonin

*Melatonin

L-tryptophan (the amino acid building block for serotonin) and 5HTP

(also a serotonin building block) are other ways of increasing cerebral

serotonin. L-tryptophan was taken off the market a number of years ago

because one contaminated batch, from one manufacturer, caused a rare

blood disease and a number of deaths. The L-tryptophan actually had

nothing to do with the deaths. L-tryptophan is a naturally occurring

amino acid found in milk, meat and eggs. I have found it very helpful

for patients to improve sleep, decrease aggressiveness, and improve mood

control. In addition, it does not have side effects, which is a real

advantage over the antidepressants. L-tryptophan was recently

re-approved by the Food and Drug Administration and is now available by

prescription. I recommend L-tryptophan in doses of 1,000-3,000

milligrams taken at bedtime. One of the problems with dietary

L-tryptophan is that a significant portion of it does not enter the

brain. It is used to make proteins and vitamin B3. This necessitates

taking large amounts of tryptophan.

5-HTP is a step closer in the serotonin production pathway. It is also

more widely available than L-tryptophan and it is more easily taken up

in the brain. Seventy percent is taken up into the brain, as opposed to

only three percent of L-tryptophan. 5-HTP is about five to ten times

more powerful than L-tryptophan. A number of double blind studies have

shown that 5-HTP is as effective as antidepressant medication. 5-HTP

boosts serotonin levels in the brain and helps to calm cingulate gyrus

hyperactivity (greasing the cingulate if you will to help with shifting

of attention). The dose of 5-HTP for adults is 50-300mg a day. Children

should start at half dose. Take 5-HTP and L-tryptophan on an empty

stomach. The most common side effect of 5-HTP is an upset stomach. It is

usually very mild. Start slowly and work your way up slowly.

There have also been some recent studies with Inositol, from the B

vitamin family, which you can get from a health food store. In doses of

12-20 milligrams a day it has been shown to decrease moodiness,

depression and overfocus issues.

Do not take St. John's Wort, L-tryptophan, or 5-HTP with prescribed

antidepressants, unless under the close supervision of your physician.

Temporal Lobe Issues

From a medication standpoint I have seen antiseizure (also called

anticonvulsant) medications be the most helpful for temporal lobe

problems. One of the mechanisms these medications work is by enhancing

the amino acid gama-aminobutyric acid (GABA). GABA is an essential

neurotransmitter in the brain. It is formed in the body from glutamic

acid. It's function is to decrease neuron activity and inhibit nerve

cells from overfiring or firing erratically. GABA can be taken as a

supplement. It acts like an anticonvulsant and also as an anti-anxiety

agent. In the herbal literature it is reported to work in much the same

way as diazepam (Valium), chlordiazepoxide (Librium), and other

tranquilizers, but without fear of addiction. I have seen it have a nice

calming effect on people who struggle with temper, irritability, and

anxiety (all which may be temporal lobe symptoms). The doses of GABA

range from 100-500mg a day for adults, half that for children.

Many people with temporal lobe problems suffer from memory problems. I

have found a number of natural substances helpful to enhance memory.

These include:

* Phosphatidyl Serine (PS): PS plays a major role in determining the

integrity and fluidity of brain cell membranes. Normally the brain can

manufacture sufficient levels of PS, but if there is a deficiency of

folic acid or vitamin B12, or essential fatty acids, the brain may not

be able to make enough. Low levels of PS are associated with memory

problems and depression in the elderly. I often recommend PS as a

supplement for memory problems. There are 18 double blind studies that

report how effective PS can be for memory issues. In the largest study

494 elderly patients (65-93) with moderate to sever senility were given

PS (100mg three times a day) or placebo for six months. The patients

were assessed for cognitive function, behavior, and mood at the

beginning and end of the study. Statistically significant improvements

in all three areas were noted in the PS group. I recommend that my

patients take 100mg twice a day for 2 weeks then, if needed, 100mg three

times a day for memory.

* Gingko biloba, from gingko trees, is a powerful antioxidant that is

best known for its ability to enhance circulation. In a number of

studies at major universities gingko biloba has been shown to improve

energy, concentration, focus, and memory. Gingko biloba has been

reported to enhance cerebral blood flow and reduce or slow the symptoms

of Alzheimer's Disease. There are many different forms of gingko, making

dosing confusing. Ginkoba and Ginkgold (Nature's Way) are brands that

have been compounded to reflect those done in the major studies on

gingko biloba. I recommend doses of 60-120mg twice a day

* Vitamin E is an antioxidant that has been shown to be helpful for many

things, including memory problems and muscle movement disorders. Doses

of 400-600 IU twice a day are often recommended for enhancing memory.

* Ibuprofen: an anti-inflammatory pain medication has been shown in

several studies to enhance memory and decrease the progression of

Alzheimer's Disease. It probably works by decreasing inflammation in the

brain and allowing better circulation. Doses of 200mg twice a day are

usually recommended.

Limbic Hyperactivity

Limbic hyperactivity has many symptoms of mild depression, including

negativity, sadness, feelings of hopelessness, and an overabundance of

ANTs (automatic negative thoughts). The supplements that seem to help

limbic hyperactivity best are DL-phenylalanine (DLPA), L-tyrosine, and

S-Adenosyl-Methionine (SAMe).

DLPA is the amino acid precursor for norepinephrine. In a number of

studies norepinephrine and epinephrine (adrenaline) have been shown to

be low in both ADD and depression. The antidepressants imipramine,

desipramine, and the new one Reboxitine work by increasing

norepinephrine in the brain. By boosting norepinephrine's precursor it

makes sense that DLPA can have a positive impact on mood and focus. In

fact, in a number of studies DLPA has been found to be helpful for

depression, energy, and pain control. I have used it for 15 years as a

mild antidepressant in children, teens, and adults. It is more mild in

its effect than prescribed antidepressants, but it also has

significantly less side effects. People who have PKU (phenylketonuria)

should not take DLPA, as they do not have the enzyme that metabolizes

it. I recommend doses of 400mg three times a day on an empty stomach,

half that dose for children.

Victor, a 17-year-old high school senior came to see me at his own

request. I did an assembly lecture at his school on the brain. He said

that he often felt negative, had too many ANTs, and always disorganized.

He didn't want to take medication but wanted to know if there were

"natural things" he could do. I had him exercise, eat a more balanced

diet, and take DLPA 400mg three times a day on an empty stomach. Within

2 weeks he called me and said that he felt much better, more focused,

more energetic, and more positive. He recently wrote me from college

saying he had remained faithful to his regimen and continued to feel

well three years later.

SAMe is involved with the production of many important brain compounds,

such as neurotransmitters. It donates "methyl" groups to these compounds

so that they can function properly. Normally, the brain manufactures all

the SAMe it needs from the amino acid methionine. In depression,

however, this synthesis has been found to be impaired. Supplementing the

diet with SAMe has been found to increase the neurotransmitters involved

with depression and improve cell membrane fluidity. SAMe is one of the

best natural antidepressants, a number of recent studies have shown that

it is as effective as antidepressant medication. SAMe has also been

found helpful for people who suffer from fibromyalgia, a chronic muscle

pain disorder. Fibromyalgia and ADD run commonly together. I think the

chronic stress associated with ADD is in part responsible for the muscle

pain. People who have bipolar disorder or manic-depressive illness

should not take SAMe. There have been a number of reported cases of SAMe

causing manic or hypomanic episodes (excessively up or happy moods,

extreme impulsivity in sexuality or spending money, pressured speech, or

decreased need for sleep). I think these reports highlight that SAMe is

an effective antidepressant, as all of the prescription antidepressants

have that capability as well.

The dosage of SAMe is between 200mg to 400mg two to four times a day,

half that for children. One of the problems with SAMe is that it is

expensive, as expensive as many of the newer antidepressants. Insurance

companies do not, in general, cover herbal or supplemental treatments,

making SAMe even more expensive than prescription medication for most

people. Over time the cost is likely to come down.

Natural Treatments Summary Sheet

Through the years, many people have asked me about the best natural

treatments for brain disorders. Here is a list of interventions that I

have found helpful.

Dietary/Lifestyle Issues - These are very important. They can decrease

the amount of medication needed.

* Many people with ADD do better on higher protein, lower "simple"

carbohydrate diet

* Protein is found in meat, eggs, cheese, nuts, and beans

* Decrease the amounts of simple carbohydrates, such as sugar, corn

syrup, honey, candy, white bread, white flour, white rice, potatoes

without the skin, white pasta

* Eat more complex carbohydrates, such as fruits (oranges, tangerines,

pears, grapefruit, apples, kiwi, but not grapes, dates or bananas) and

vegetables

* Increase the amounts of Omega 3 Fatty Acids in the diet and through

supplements. Omega 3 Fatty Acids are found in cold water white fish,

such as tuna and salmon, walnuts, Brazil nuts, olive and canola oil

* Decrease artificial colors (especially red and yellow) and food

additives (nitrites, msg, aspartane, etc.)

* Eliminate caffeine, nicotine

* Evening carbohydrates help sleep

* Intense aerobic exercise for 20-30 minutes 5-7 times a week

* Diagphragmatic breathing - deep breaths in and out, for anger and

anxiety control

* Proper sleep (7-8 hours)

Amino Acids, Herbal Substances - for specific conditions these

interventions can be helpful, but just do one at a time to see if it is

indeed helpful for you or your child.

* SAMe (s-adenosyl methionine) 200mg a day, increase to 200mg twice a

day, and increase by 200 mg a week up to 1,600 mg a day for depression,

fibromyalgia, and focus

* Omega 3 Fatty Acids, evening Primrose oil + deep fish oil or Efalex

Focus, Nature's Way, (omega-3-fatty acid supplement) 450 mg tab, 1rst 12

wks 4 twice/day w/food, then 1 twice/day (1/2 dose 5 and under)

* Tyrosine: 1,000-1,500mg for energy, focus, impulsivity (this is the

amino acid precursor for dopamine)

* Phosphatidyl Serine: 100mg twice a day for 2 weeks then 100mg three

times a day for memory (see the book Memory Cure for details)

* Gingko Biloba (Ginkoba, Ginkgold): 60-120mg twice a day for energy,

concentration and focus (to enhance cerebral blood flow)

* Vitamin E 400-800 IU BID for memory

* Ibuprofen 200 mg BID for memory

* Pycnogenol (OPC grape seed or pine bark) 1mg/pound a day for

concentration, focus and mental clarity.

* Gotu kola for memory

* Inositol: 12mg/day for depression and panic disorder, 18mg/day for OCD

symptoms

* Tryptopohan: 1,000-3,000mg for sleep, depression, overfocus issues

(this is the amino acid precursor for serotonin)

* DL-phenylalanine: 400 mg three times a day on an empty stomach for

depression, energy and pain control (this is the amino acid precursor

for norepinephrine)

* St. John's Wort (0.3% hypericin) 500mg twice a day for depression and

overfocus issues (250 mg twice a day for children)

* Kava 60 mg 2-3 times a day, for anxiety, depression and insomnia (not

more than for 3 months straight)

* Valerian extract, standardized, 300-500 mg for insomnia and anxiety

* Melatonin: 1mg to enhance sleep

* Octacosanol 2,000 micrograms (oil capsule) 2-4 capsules a day for

brain injuries

 

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Keep your thoughts positive, because your thoughts become your words.Keep your words positive, because your words become your behavior.Keep your behavior positive, because your behavior becomes your habits.Keep your habits positive, because your habits become your values.Keep your values positive, because your values become your destiny.

- Mahatma Gandhi

 

 

 

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