ADD/ADHD Attention Hyperactivity Disorders

Standard Treatment of ADD/ADHD

Adderall, a potent mix of amphetamines given at low dosage, is the current drug of choice to treat ADHD in adults. Two types of Adderall are presecribed, extended release (XR) and instant release (IR). Amphetamines are thought to act to curb ADHD symptoms by increasing the amount of dopamine and norepinephrine (noradrenalin) in the brain, acting as both reuptake inhibitors and reverse transporters of the monoamines, dopamine, norepinephrine (noradrenaline), adrenalin, serotonin, melatonin, phenylethylamine, tryptamine, tyramine, and thyronamines. The mix of amphetamine chemicals in Adderall will create these effects to increase dopamine and adrenalin without the obvious adverse effects of stronger amphetamine stimulation. Concerns about long-term side effects have been voiced by the medical community, though, and prompted a ban in Canada on the sale of Adderall due to adverse cardiovascular effects and reports of sudden death syndrome in children. Adderall, like all amphetamines, may produce a rise in blood pressure, motor restlessness, and aggressive behavior, changes in vision, and decreased appetite. Other drugs that affect monoamines are contraindicated, including SSRI and SSNRI anti-depressants and anti-anxiety drugs, tricyclic anti-depressants, MAO inhibitors, Buproprion (Wellbutrin), and other atypical anti-psychotic medications, which are often prescribed off-label. Newer drugs prescribed for chronic pain may also indirectly affect dopamine availability and transport, and may be found to be problematic. The Canadian ban for Adderall was withdrawn after a year of study, but a U.S. FDA black box warning was instituted, mainly warning of the potential of high cardiovascular and psychiatric risks with concurrent use of recreational amphetamines and cocaine. Despite these well known warnings of contraindications with other drugs, an increasing prescription of these same medications has occurred, as ADHD guidelines have been expanded to 6 types, with types 3 through 6 requiring additional medications with SSRI and SSNRI antidepressants, as well as anti-seizure and anti-psychotic medications, which are now often given rather cute names to increase the compliance with use.

In 2007, the United States Food and Drug Administration (FDA) directed the manufacturers of all drug products approved for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD) to develop patient Medication Guides to alert patients to possible cardiovascular risks and risks of adverse psychiatric symptoms associated with all of these medicines. The black box warnings instituted stated that amphetamines have a high potential for abuse and drug dependence, use for prolonged periods must be avoided, and such misuse of amphetamines may have serious cardiovascular risks. Other health problems mentioned in these guidelines confirmed a negative affect on growth hormones, a lowering of convulsion thresholds, contribution to bipolar manic-depressive syndromes, and a contribution to hypertension, tachycardia, heart rhythm abnormalities, and structural cardiomyopathy.

Obviously, use of a low dosage amphetamine is popular as a means to increase mental excitation and stamina, and is now well known to be used as a stimulant. Adderall is especially popular among college students, and is referred to as a “study drug", useful for cramming and and staying up at night to study for tests. A study by William Frankenberger, a professor at the University of Wisconsin in Eau Claire, in 2004, reported that at least 14 percent of the college students on this campus used one of the amphetamine ADD drugs, including Adderall, much of it bought without prescription, although obtaining a prescription for Adderall is not very difficult, as the determination of a diagnosis of ADHD is subjective, and not based on objective tests. The use of Adderall as an athletic performance enhancing drug is also increasingly of concern, and there has been restrictions of the use of Adderall by athletes in college even by prescription now. A June 10, 2012 article in the New York Times, entitled Risky Rise of the Good-Grade Pill, Taking Stimulants Not for a High, but for a Higher SAT Score reports that even M.D. prescription for these ADHD amphetamines has reached 21 million per year for patients age 10-19. Investigative reporting found widespread and easy abuse among high school students, largely ignored by both parents and school administrators who were pleased with better grades, and some schools where anonymous survey of students found that students believed that about 40 percent of the students utilized these ADHD amphetamines as study aids. Most of these students did not view Adderall and Vyvanse, or other prescription amphetamines, as drugs, despite the fact that they are listed as Class 2, or Schedule 2, controlled substances, and giving or selling this drug to a friend may be prosecuted as a felony. This investigative reporter recounted the history of one student as he easily obtained a prescription, got his doctor to increase the dosage, started buying extra pills, and eventually was addicted in college to a 300 mg per day habit. He experienced severe tachycardia, hallucination and convulsion, and ended up in drug rehabilitation, where he was surprised to find that 2 of the 20 patients in the facility with him had also started an amphetamine abuse habit in high school, and were there solely to treat this drug problem.

While the use of Adderall is symptom relieving and stimulating of cognitive function, this drug does not address the underlying causes and imbalances of the pathology. Patients with ADD/ADHD may wish to improve the health and treat the underlying conditions, improve brain function and health, and potentially solve the health problems so that long-term use of medications is unnecessary. One problem in this regard is the common warning by the prescribing medical doctor that all herbs and nutrient medicines should be avoided due to the potential of adverse interactions. Of course, there are very few herbs and nutrients that could potentially adversely interact with a low dosage amphetamine. Only a few herbs are known to possess significant monoamine oxidase inhibitory effects (MAOI) which may increase dopamine, serotonin, and norepinephrine bioavailability somewhat. These include Saint Johns Wort and Passionflower. Since a number of chemicals are combined in these herbs, though, they exert modulatory effects, reacting to levels of monamines, and the small dosage utilized in professional herbalism make these adverse interactions with medication unlikely. Ephedrine, an herbal chemical, may also exert adverse effects, and is a stimulant as well, but is seldom used in herbal medicine, although banned in supplements and by medical doctors after the tragedy of Phenfen prescription for weight loss. A relatively large amount of study of this potential herb-drug interaction has been performed, and only a handful of herbs and foods have been found to exert a potential negative interaction, including nutmeg and licorice, also utilized professionally in such small doses in formulas that adverse interactions are highly unlikely. Pausinystalia yohimbe has also been found to have a weak MAOI effect. Actual clinical adverse effects, though, have not been found, despite the fact that amphetamines are a very popular recreational drug, for at least four decades, and Saint Johns Wort is also a popular herb, as well as passionflower. The widespread reports of potential adverse contraindications between these few herbs and ADHD medications seems unfounded, but they can easily be avoided in therapy, with so many choices available to the professional herbalist and nutrient specialist.

For patients wishing to achieve increased dopamine bioavailability, as well as the other physiologic effects of Adderall, there are a few dopaminergic herbs that exert mild effects, and increasing the modulation of various neurotransmitters may also exert positive effects on the dopamine metabolism. The overall physiologic effects of Adderall may also be achieved with various herbal and nutrient medicine strategies. For instance, dopaminergic herbs, 5HTP, L-Tyrosine and L-Phenylalanine may be used to increase bioavailability of dopamine, serotonin, melatonin, and phenylathylamine, the key physiological effects of the psychostimulants used to treat ADHD. Many patients are trying these more conservative methods of reducing symptoms in ADD and ADHD before resorting to amphetamines. Of course, considering the complexity of the health problem, and the relative mild effects of herbal and nutrient medicines, utilizing just a small dosage of just one of these medicines is unlikely to have an immediate strong effect. Prescription of a comprehensive protocol for a period of time is necessary to achieve results. A comprehensive strategy in Complementary Medicine would utilize a variety of treatment protocols to correct the underlying health problems and improve brain function and health as well. This treatment strategy could also be valuable as a preventive medicine to avoid future problems with neurodegeneration, and serve to correct or prevent problems with motor restlessness and sleep disorders, such as restless leg syndrome and nocturnal bruxism. The benefits from a comprehensive strategy with acupuncture, herbal and nutrient medicine are many, and may also resolve the problems of ADD/ADHD without permanent dependence on drug therapy, or any therapy for that matter.

Lifestyle, Diet and therapeutic regimens may be a key to successful prevention and therapy

A University of Toronto study of carbohydrates and cognitive function found a 37 percent increase in memory and cognitive function occurred in a group of subjects that ate a porridge of barley each morning. Simpler carbohydrates resulted in short lived memory and cognitive benefit. Complex carbohydrates may thus be very important to supplying your brain with the necessary chemicals for neuronal health. While barley may be difficult for many to incorporate into their breakfast diet, steel cut oats, amaranth and various whole grains can be made into delicious warm cereal porridge. Barley sprout powder can be used as a morning supplement, slowly pouring a tablespoon of the powder into warm liquid in a blender. Research concerning the effects of Ritalin on increased memory, cognition and control of hyperactivity in the brain showed that this drug increased glucose metabolism in the brain by 50%. It is suggested that an increased level of glucose bioavailability from a complex carbohydrate diet could achieve similar results. A simple carbohydrate diet supplies bursts of glucose, but not sustained bioavailability, and puts excess stress on the insulin metabolism. Many patients with ADHD state that they feel that their cognitive ability is increased with a burst of sugar food or simple carbohydrate snack, but not sustained. Complex carbohydrates supply a sustained availability of glucose.

Omega 3 fatty acids are also important to incorporate into the diet. Studies of Parkinson's patients found a consistent imbalance between Omega-6 and Omega-3 fatty acids in key areas of the brain. Deficiency of the Omega-3 DHA and EPA were common, and linked to various theories of metabolic dysfunction concerning inflammatory regulation and lipid peroxidation. DHA and EPA mutually support each other in the function of vascular renewal, and deficiency could result in a poor vascularization that contributes to neural cell death or poor neural receptor function. DHA is essential to brain development and growth, and deficiencies have been linked to poor fetal development of brain function. These essential fatty acids are obtained from both foods and supplements. Various fatty ocean fish, as well as some fresh water fish are high in these EFAs, and this preformed DHA increases level more quickly than the foods and herbs rich in alpha-linolenic acid, but this latter class of foods is more commonly eaten and dietary changes incorporating these foods is recommended. The DHA levels rise more slowly from foods and herbs containging the Omega-3 alpha-linolenic acid, but the eventual change may be more dramatic. Scientists long invested in treatment of populations with malnutrition of Omega-3 and Omega-6 fatty acids highly recommend using a combination of fatty fish with spirulina, blue-green algae and chlorella, which are rich and balanced with these nutrients. Salmon, mackeral and sardine are the fish highest in Omega-3 fatty acids. Trout, herring, anchovy, butterfish and tuna are also high in content. Various cooking, baking and salad oils are high in content, including pumpkin seed oil, and toasted walnut oil. Tempeh and dark, leafy green vegetables, such as collard greens, spinach, kale, chard, some endives, etc. are also rich in alpha-linolenic acid, the precursor to the DHA and EPA. Herbs such as digupi, and xuanshen that clear deficiency heat, and chaihu and cheqianzi, which benefit the liver and kidney, as well as duhuo, sangshen, gouqizi and nuzhenzi are all commonly used in TCM formulas and are rich in linolenic and linoleic acids.

Correcting problems with sleep disorder may be very important for a large percentage of patients with ADHD. Sleep disorders are associated with restless leg syndrome, sleep apnea, nocturnal bruxism (teeth grinding), and various parasomnias, and is also associated with dysfunction in the dopaminergic, and dopamine receptor metabolism, a key component of ADHD. Studies have noted that a large percentage of ADHD patients with sleep disorders have a delta wave deficiency. Brainwave activity, as measured by the EEG (electroencephelograph), is recorded by observing brain activity at different frequency bands, and this is an important tool in assessing pathology in sleep disorders, seizure disorders, and other neuropsychological pathologies. The lowest frequencies, associated with phases of deep sleep, are delta waves, which are less than 4 Hz, and are also associated with various parasomnias. Delta waves are noted in stages 3 and 4 of the sleep cycle, and are the dominant brain wave activity in infants. Studies of the brain note that during the waking state, delta waves increase during periods where we are less focused on the outside world, and decrease when we need to highly focus. Patients with ADHD are found to naturally increase delta waves rather than decrease them when trying to focus their attention. This creates a sensation of being in a perpetual daze, or mild trance. Sleep disorders may contribute greatly to this effect. An April 28, 2013 article in the New York Times, entitled Could an Attention Deficit Really be a Sleep Deficit, outlines the evidence linking sleep disorders and ADHD, and reveals that a number of scientific studies have shown that a large proportion of children with an ADHD diagnosis have sleep-disordered breathing such as snoring or apnea, restless-leg syndrome, or non-restorative sleep patterns. Studies have shown that infants and young children with sleep-disordered breathing were 100 percent more likely to develop behavioral disorders later in life. A study at Massachusetts General Hospital showed that sleep dysfunction in adults with ADHD closely mimics that of children with ADHD. All of this research has not led to a simple remedy, but the complexity of the problem points to a need to restore the sleep function and brain health holistically. You may read my articles on this website entitled Nocturnal Bruxism and Insomnia and its implications to gain a beter understanding.

Key herbal and nutrient medicines in the treatment of neurodegenerative disorders

Unlike synthetic pharmaceutical medicines, herbs usually contain a long list of synergistic chemicals that help your condition in a variety of ways. In this section, key herbs will be explained, but many of the beneficial actions of the numerous chemicals in the herbs will not be explained due to the need for brevity. Of course, in this complicated subject, brevity is a relative term. If you want, you may do further research on the herbs and chemicals contained within the herbs yourself. Often, a small group of herbs and nutrients will be listed in the description of the herb or nutrient, so that you may see how to increase the potential of treatment with a small formula of substances. Of course, therapy guided by a knowledgable professional will achieve the best results, tailoring the treatment to the individual, and proceeding step-by-step in a logical manner to achieve medical goals. Despite the large number of products needed in neurodegenerative therapy, which is a drawback that discourages most patients, those patients that proceed with herbal and nutrient therapy patiently and persistently are thrilled with the results over time.

While the list of herbal and nutrient medicines found effective in aiding the complex pathology of neurodegeneration is long, the patient and physician can evaluate and choose from this long list to achieve the best individualized results based on the specific patient needs. If the desired effects are achieved more simply, this is great. If the desired effects are not achieved at first, more nutrient and herbal medicines may be prescribed to achieve the goals. Persistence and thorough knowledge and assessment of individualized problems and health profile are what is important in restoring a healthy central neurological function.

Is there evidence that herbal medicine really works in the treatment of Parkinson's and neurodegenerative diseases? A growing body of evidence is proving that herbal medicine can work in a variety of ways to reverse neurodegenertion. There are currently 158 scientific citations on the NIH website PubMed concerning herbal medicine and Alzheimer's disease. See some of this great body of evidence by clicking here: http://www.ncbi.nlm.nih.gov/pubmed/18719316 and here: http://www.ncbi.nlm.nih.gov/pubmed/18324353

• Essential nutrients for cognitive function and nervous system health: patients with neurodegenerative disorders should start with a period of replenishment of key nutrients that may be deficient and thus necessary to reverse the disease. You do not need to take these nutrients constantly or forever, but replenishing the body's store and metabolism may be essential to the success of therapy. Vitamin B6 (the active metabolite is called P5P) has been found to be deficient in 50% of the U.S. population, and is essential for dopamine production. Choline is necessary for proper transmission of nerve impulses and is a key component of the cholinergic system, as well as fatty acid metabolism in the neural mitochondria. To utilize choline as as supplement, inositol (phosphatidylinositol), Vitamin B12 (sublingual high dose), folic acid (5MTHF), and Vitamin B complex are essential. Choline as a food source is available in egg yolks, legumes, milk, soy and whole grains, and the taking of choline and inositol supplement with these foods is recommended. The supplement formula Phophatidylserine Plus (Vitamin Research) contains phosphatidylcholine and phosphatidylinositol, two more usable forms of choline and inositol. DMAE, or dimethylaminoethanol, is another supplement that stimulates production of choline by the brain cells, and also may be very useful. Lecithin, a B Vitamin, is also helpful to increase choline bioavailability, and to aid nerve transmission. The natural lipid component of lecithin is called phosphatidylcholine, and is now widely used to enhance cognitive functions, as is alpha-GPC Choline, a precursor to acetylcholine, and CDP Choline, a cofactor in acetylcholine metabolism . The Glutamic acid metabolism is a necessary part of the central nervous system function and GABA regulation, and is best enhanced by taking a combination of L-Glutamate, niacinamide (Vitamin B3) and Vitamin B6 (P5P) with Choline and inositol. A complete essential nutrient formula may include choline, inositol, Vitamin B6 (P5P), L-Glutamine, Vitamin B12 (sublingual or intramuscular injection), folic acid (5MTHF), DMAE and lecithin (phosphatidylcholine). Foods that are dopaminergic include steel cut oats, fermented soy (tempeh), lentils, barley, rice, alfalfa, avocado and fenugreek. A quality dried barley sprout supplement is highly recommended for its array of beneficial chemicals, which include three types of anti-inflammatory biologics, chlorophyll, PD41 and mucopolysaccharides, as well as being a rich source of healthy proteins, enzymes and Vitamin A. Barleygrass sprouts also contain SOD, super-oxide dismutase, to help clear heavy metal toxicities and their oxidant free radicals.
• Omega-3 Fatty acids, EPA and DHA: a 2007 study listed below confirms that these essential fatty acids are often deficient in the Parkinson's, Alzheimer's and ADD patients studied. An excess of the Omega-6 essential fatty acids in our diet contributes to a dysfunction of the cells and inflammatory regulation in key areas of our brains. These Omega-6 fatty acids should be balanced with Omega-3 for optimal health of the metabolism in neurodegenerative disorders. A relative deficiency of Omega-3 fatty acids may impede membrane fluidity at the dopamine receptor sites by allowing stiff membranes to form. The best source of Omega-3 fatty acids, DHA and EPA, is krill oil, concentrated and possessing a natural preservative, unlike fish oils and flaxseed oil. EPAQ by Health Concerns is recommended. This oil is so concentrated in the right type of essential fatty acids that just one or two small capsules per day is needed, instead of the tablespoons of fish oil.
• Rhodiola rosea or Hong jin tian: improves dopamine optimization and serotonin bioavailability. Dopaminergic herbs include Muira puama, Murcuna pruriens, Salvia miltiorrhiziae (Dan shen), Alismatis orientalis (Ze xie), and Uncaria tomentosa (Gou teng or Cat's claw). Dopamine receptor sites will be enhanced through the nutrient Sam-E. Dopamine is a neurotransmitter that accounts for 90% of the catecholamines in the nervous system and is a precursor to norepinephrine and epinephrine, key adrenal neurohormones. Adrenal insufficiency could result in increased demand for dopamine as a precursor. Adrenal health can be enhanced by the use of a small formula called Adrenosen, from Health Concerns, that contains PKA, barley sprouts, wild mountain yam, schizandra berries and the hyacinth bean. In women, copper is in greater demand, and is sometimes deficient. The catecholamine oxidative metabolism of dopamine in the citric acid cycle of mitochondrial health, as well as oxidative conversion to norepinephrine, is dependant on a copper-containing enzyme, dopamine beta-monooxygenase. Copper in the diet is derived from organ meats, some seafood, dried beans, quality nuts and whole grains. Copper supplementation must include cofactors of zinc monomethionine (Opti-zinc) and folic acid to assimilate, but the 2.5 mg copper supplement (in the form copper amino acid chelate) should be taken about 2 hours after the zinc supplement to avoid competition in absorption. Rhodiola, muira puama, Cat's claw (Uncaria), Adrenosen, and an essential mineral formula with zinc monomethionine and copper sebacate or chelate may provide a complete course of therapy to help restore dopamine optimization.
• Uncaria Tomentosa or Cat's Claw: uncarine alkaloids have been studied and found to exert a beneficial effect on memory impairment induced by cholinergic dysfunction. Cat's claw is also dopaminergic and stimulating of the glutamate metabolism. Maca has been studied as a synergetic herb used in combination with Cat's claw to achieve enhanced effect. Alpha-glyceryl-phosphoryl-choline, or Alpha-GPC, also aids the cholinergic system, acting as a precursor to acetylcholine, or ACh, and has been proven in studies to enhance memory and cognitive function. Inositol and Choline are often useful to enhance the treatment of cholinergic dysfunction, allowing for greater bioavailability of choline. To enhance assimilation of Choline, inositol, Vitamin B12 (sublingual large dose), folic acid, Vitamin C, and Vitamin B complex are helpful cofactors. Alpha-GPC is available in the Health Concerns product called Cogni-Spark.
• Resveratrol, an active chemical found in the Chinese herb Polygonum cuspidatum, or Bushy knotweed, Hu zhang: this antioxidant is now well known and utilized, even by M.D.s, to protect dopamine neurons from degeneration. This active chemical from a Chinese herb is so potent that pharmaceutical companies are now introducing a synthetic version (patentable and expensive) to the market. Patients report significant benefit soon after starting the herbal supplement. Perhaps due to this success there is now a plethora of misinformation about this chemical. Many doctors tell their patients that the chemical is extracted from red wine or grapes, when all studies show that the amount of this chemical in red wine is very small, and the companies marketing this herbal supplement obtain the chemical from the Chinese herb Polygonum cuspidatum. Newer studies cite the poor absorption of reservatrol from red wine and grapes to counter it's success. The truth is that a concentrated supplement from the herb prepared properly, or an extract in an alcohol tincture is effectively absorbed and utilized by the human body. http://www.herbalextractok.com/Herbal-Extract/Resveratrol-extract.html
• Huperzine and Vinpurazine, from Clubmoss and Vinca Periwinkle: studies in Shanghai confirm that huperzine works better than tacrine or E2020, chemical anticholinesterases, to enhance memory and reverse neurodegeneration. The first group of drugs approved by the FDA to treat mild to moderate Alzheimer's are the acetylcholinesterase inhibitors, and huperzine is one of six herbal chemicals in Chinese herbs found to have significant anticholinesterase effects in scientific studies. http://www.find-health-articles.com/rec_pub_18573242-anti-acetylcholinesterase-activities-traditional-chinese-medicine.htm The Health Concerns product Vinpurazine combines these two herbal chemicals with rosemary extract to form a potent combination, which also clears excesses of chronic inflammation in the CNS cells.
• Trypterygium wilfordii or Lei gong teng, and Scutellaria baicalensis, or Huang qin:studies have confirmed that these herbs will protect dopaminergic neurons from inflammatory processes and inflammation mediated damage by inhibiting microglial activation of inflammatory mediators. Many citations of research published by the NIH on the PubMed research database show significant benefit from Trypterygium wilfordii. PMID 12504865 shows that the herb is found to benefit dopaminergic degenerative neurons. PMID 16989518 shows that there is some mild toxicity to the herb and should be used only with professional guidance, but that it contains alkaloids useful in chronic inflammatory states. PMID 16989518 shows that safety and efficacy has been confirmed in human clinical trials in the United States and abroad. PMID 17240858 shows that the herb inhibits key inflammatory cytokines that are linked to chronic inflammatory states.
• Alpha Lipoic Acid plus L-Carnitine: R-lipoic acid is the active form of ALA, and acetyl L-carnitine is the most studied nutrient chemical fo the treatment of cognitive function; this combination will aid mitochondrial efficiency and clear buildup of sticky proteins that have been linked to Parkinson's and Alzheimer's pathologies. Sticky proteins are misshapen beta-amyloid extracellular plaque deposits, sometimes called tangles. Causes of the misshapen lipoproteins may be linked to toxic heavy metal accumulation, such as alumninum from cookware, along with accumulations of oxidant free radicals as the body tries to clear this accumulation. ALA helps to neutralize the effects of free radicals by enhancing the antioxidant benefits of Vitamins C, E, and glutathione. Carnitine is a B vitamin with a chemical structure similar to amino acids, whose main function is to help transport long-chain fatty acids, and also enhances the antioxidant effects of Vitamines C and E. Carnitine is produced in the body if sufficient amounts of B1, B6, lysine and methionine are available, and Vitamin B6 deficiency is common in the population. Vegetarians are more susceptible to deficiency, and a chief symptom of deficiency is confusion. The combination of these two nutrients helps antioxidant maintenance of neuron mitochondria as well as prevention of unwanted lipid proteins called sticky proteins, which are the subject of much research into the pathophysiology of Alzheimer's.
• SAMe, or S-adenosylmethionine, converts to methionine at D4 dopamine receptors sites, which becomes part of the healthy beta-amyloid protein structure at dopamine receptors. Dopamine receptor sites also need 5MeTHF, a folate and methyl donor for homocysteine, to methylate phospholipid membranes, and allow for healthier fluidity, or transport of molecules, across the membranes of dopamine receptors. 5MeTHF is deficient in the livers of patients with riboflavin, or Vitamin B2 deficiency, which is another common deficiency in the population, especially for patients who have used oral contraceptives, consumed excess alcohol, taken prolonged courses of antibiotics, or engaged in strenuous exercise. One of the signs of B2 deficiency is slowed mental response. 5MeTHF may also be deficient if the body has a folate deficiency, and dietary folic acid does not satisfy the demand for folate metabolism. A combination of SAMe, Vitamin B2 and folic acid (5MTHF) is recommended to reduce sticky proteins and stiff membranes at dopamine receptor sites to insure healthier metabolism. To reduce beta-amyloid (Abeta) accumulation, or sticky protein plaques, the chemical S-allyl-L-cysteine from water extract aged garlic has also been proven effective. Astra Garlic is a formula from Health Concerns that is a synergistic blend of herbs for this effect. The Chinese herbs Yu jin and E zhu (curcuma zedoaria), which contain curcuma, have also been proven to break up and prevent beta-amyloid plaque accumulation. Regeneration is a formula from Health Concerns is a formula that contains curcuma and has a blend of herbs that could greatly benefit the Alzheimer's patient. Since the effects of curcuma are dose dependant, the herbalist sometimes prescribes a decoction of curcuma for a period of time, and this decoction has the added benefit of aiding digestion by increasing stomach and pancreatic secretions and bile flow, as well as being a proven anti-cancer agent.
• Bioflavonoids, such as are found in Gingko biloba and many Chinese herbs: there are many bioflavonoid chemicals in the body, including quercetin, rutin, hesperidin, and eriodictyol, and bioflavonoids cannot be produced by the body, and are thus called essential nutrients. Depletion of our soil chemistry by modern farming methods has resulted in widespread deficiencies of bioflavonoids, which are linked to neurodegenerative disorders. These nutrient chemicals are important in microcurculation, antioxidant clearing, and cellular metabolism. A number of herbs are rich in bioflavanoids, which account for much of their success in therapy, the most well known being Gingko biloba. It is recommended that you ingest a variety of bioflavonoids to insure success. I recommend the herbal formula Flavonex, from Health Concerns, along with a tincture of fresh Gingko biloba leaf, and a diet that includes organic oranges, lemons, grapes, dried apricots, dried cherries, black currants, bell peppers, and dried buckwheat sprout powder. Vitamin C is an excellent cofactor to bioflavonoids, and the supplement formula Astra C, from Health Concerns, is highly recommended a part of the flavonoid regimen.
• Antioxidants, especially CoQ10: Coenzyme Q10 is a vitaminlike substance that is also called ubiquinone, because it is needed by most cells in the body, hence ubiquitous. This chemical is essential to mitochondrial function and oxidative processes, and has long been an important part of standard medical therapy in Asia for treatment of Parkinson's, Alzheimer's and other neurodegenerative diseases. CoQ10 also aids circulation and microcirculation, stimulation of the immune system, prevention of cell aging or cell death, and tissue oxygenation. Deficiencies of CoQ10 are common, and are linked to such diseases as muscular dystrophy. Deficiencies may be caused by a number of common pharmaceutical medicines, including the cholesterol lowering statins, beta-adrenergic inhibitors prescribed for hypertension, tricyclic antidepressants, and anti-diabetic sulfonylurea drugs. More than 12 million patients are prescribed CoQ10 in Japan by their medical doctors. CoQ10 supplements vary considerably in quality and bioavailability, and enhanced forms, as well as sublingual powders are available. CoQ10 is oil soluble and best taken with fatty or oily foods, especially sardines, mackerel and salmon, which contain the highest amounts of CoQ10 in foods. Peanuts, beef and spinach also contain CoQ10. Taking CoQ10 supplement with Krill oil, a potent source of essential fatty acids, especially EPA and DHA, or omega 3 and 6, is recommended. CoQ10-H2 is a more active metabolite of Coenzyme Q10, with much better bioavailability, and is recommended for many disorders.
• Other antioxidants proven to protect dopamine neurons: epigallocatechin gallate in tea (camellia sinensis), especially quality green tea, is effective. Super oxide dismutase, or SOD, is a potent antioxidant the clear superoxides, which are a more harmful type. A short course of copper/zinc SOD may be helpful. Gingko biloba standardized extract EGb761 was shown to be significantly neuroprotecive of dopamine depletion. Go to my article on antioxidants to learn more.
• Glutathione metabolism and the nutrients needed to insure health: a deficiency of glutathione is linked to many types of oxidative stress, and oxidative stress in the mitochondria of key nerve cells is a major part of the neurodegenerative process. To insure a strong glutathione metabolism it is recommended that liver function is optimal, and that a number of nutrients that are precursors to cellular glutathione metabolism are available in the body. These include, L-glutamate, N-acetyl-L-cysteine, and L-glycine. Milk thistle and Schizandra berry are also beneficial to the glutathione metabolism of the liver. Studies of stroke patients revealed that those with deficient glutathione metabolism had a marked increase in oxidative damage in the hippocampus and corpus striatum.
• L-Tyrosine: this amino acid is a precursor to dopamine and norepinephrine, which regulate mood and muscle firing, and are the key neurotransmitters deficient in function in Parkinson's and other neureodegenerative disorders. Tyrosine is used extensively by the thyroid gland and attaches to iodine to form thryroid hormones. Hypothyroid states, as well as deficient iodine states, could be related to deficient tyrosine, and this supplement could be a key part of therapy in both neurodegenerative disorders and hypothyroid dysfunction. Food sources include almonds, avocadoes, bananas, dairy, lima beans, pumpkin seed, and sesame seed. L-Tyrosine supplements should be taken with high carbohydrate meals, such as breakfast porridge, or with a small snack at bedtime so that the intake does not compete with other amino acids in the diet. Studies have demonstrated that increased tyrosine bioavailability can enhance dopamine synthesis in and release from nigrostriatal neurons if the firing rates of these neurons are accelerated, as in more advanced cases of Parkinson's degeneration, where the surviving cells are found to fire at increased rates to compensate. (Proc Natl Acad Sci USA 1980 Jul;77(7):4305-9 6254020 (PSGEB) E Melamed, F Hefti, R J Wurtman).
• L-Phenylalanine: this essential amino acid is a strong aid to neural membrane health and bioavailability of phenylathylamine (PEA), as well as tyrosine, dopamine, norepinephrine (noradrenaline), and melanin. L-phenylalanine is an electrically neutral and nonpolar amino acid, and has been shown to also present antidepressant and mood-elevating effects. L-phenylalanine also has been shown to be a competitive antagonist at problematic NMDA glutamate receptors on neurons, implicated in the ADHD pathology, and has shown benefits in reduction of excitotoxicity and inhibition of excess neurotransmitter release at glutamatergic synpases in the hippocampus and cortex. A combination of L-phenylalanine, L-tyrosine, Vitamins B6 and B12, folic acid, and St. John's Wort is available from Vitamin Research Products, and called Syncholamine, or daytime mood support. While the effects of L-Phenylalanine may not be immediate, this combination of nutrient and herbal supports to brain function is supported with much scientific evidence, and will produce benefits over a longer course of treatment.
• R-Lipoic Acid: R-Lipoic Acid is rightly called the 'mitochondrial antioxidant', and many scientific studies (cited below) demonstrate its role in preventing or decreasing depletion of glutathione antioxidant compound (GSH). Lipoic acid is one of the most thoroughly investigated dietary supplements and most healthcare practitioners agree it is a preventive supplement of choice. R-Lipoic Acid is a more potent form – the more biologically active form – of alpha lipoic acid. As such, it offers more benefit with a lower dose. Lipoic acid serves to regenerate vitamins C and E, and helps maintain glutathione levels, a vital cellular antioxidant and liver protectant. It is a vascular and neuroprotective agent.
• 5HTP: there is some link between the serotonergic fibers in the striatal tissues of the basal ganglia and dopamine conversion and production in these 5HT (5-hydroxytryptophan) fibers in scientific study. Taking the 5HTP supplement (from Griffonia seed) may aid the dopamine metabolism. Study on animals found that the drug L-Dopa may be converted to dopamine within the 5HT fibers, and 5HTP possibly has some effect that may enhance the effectiveness for patients taking L-Dopa. 5HTP is also a precursor to melatonin, which is proven to be a potent neuroprotector for dopamine neurons.
• Bacopa Monnieri: Bacopa monnieri is a well-known and highly studied ayurvedic herb, called Brahmi, or water hyssop. Scientific studies show remarkable improvement in cognitive function with this herb. Many scientific studies in India have demonstrated that Bacopa has strong neuroprotective effects, antioxidant effects, and restoration of neural cell membrane enzymatic functions, including acetyl cholinesterase, decreased LPO (lipid peroxidation), and improvement in memory and cognitive function. Lipid peroxidation refers to oxidative degradation of lipids, where excess free radical reactive oxygen species take electrons from cell membrane lipids, resulting in neural cell damage. The decrease in LPO reflects an essential neuroprotective effect of the herb, aiding cell membrane function and health.
• St. John's Wort, Hypericum perforatum: this much maligned but effective herb has been both proven safe for use and effective in the treatment of Alzheimer's and neurodegenerative disease. Prior reports that chemicals in St. John's Wort could alter levels of other pharmaceutical medications through competition in liver catabolism of the P450 enzyme pathway were shown to be overblown. Studies revealed that the effects of chemicals in St. John's Wort were modulatory of liver function, and that effects on the P450 enzyme pathway were modulated and normalized within two weeks of use to achieve a homeostatic effect despite catabolic competition from harsh pharmaceuticals. This was accomplished because a variety of chemicals in hypericum act to improve liver function. Of course, this also implies that the whole herb extract, and not pharmaceutical products with just the active ingredient enhanced, should be used. To see the current research on St. John's Wort, click here: http://www.ncbi.nlm.nih.gov/pubmed/16880827
• Topical progesterone and pregnenelone creams: studies show that progesterone modulates dopamine release in the corpus striatum and the pregnenelone could modulate the dopamine transmission in the corpus striatum by causing changes in the activity of tyrosine hydroxylase and/or in the pre- and post-synaptic dopaminergic terminals. This neurosteroid mechanism could be a new kind of neurotransmitter systems modulation affecting dopamine metabolism significantly. (Neurol Res 2007 Jan 16; 17535560 (PGSEB)). Use of these simple bioidentical hormone therapies could have significant effect, especially if there is a progesterone deficiency. Testing and administration should be overseen by a professional. In 2007, researchers at Emory University in Atlanta, Georgia, a human clinical trial showed that patients given progesterone immediately after severe brain trauma had risk for death reduced by more than half. This research, started by a neuroscientist and professor of emergency medicine, Dr. Donald Stein, is now expanding into larger clinical trials. Experts believe that progesterone affects a number of beneficial physiological pathways, protecting from oxidant damage, promoting myelin production in damage neurons, and exerting neuroprotective tissue maintenance effects. Natural progesterone is deficient in pathologies such as premenstrual syndromes and perimenopausal syndromes, and is linked to prostate pathologies as well.
• Vitamin D3 cholecalciferol: recent studies fo Parkinson's patients found a significantly increased incidence of Vitamin D3 hormone deficiency over the general population, which also shows a 36-41% rate of defciency in this important hormonal chemical. While these results are not highly significant at this stage of investigation, supplementation with cholecalciferol might help the neurodegenerative patient. Remember that D3 converts to the active hormonal form in circulation only when the patient's skin is exposed to sunlight. Take the pills in the morning with breakfast and go for a walk in the midday sunlight with the face and arms exposed each day.
• Herbal formula to enhance brain circulation: circulatory aids are helpful both for brain circulation, as well as peripheral circulation in Parkinson's. Circulatory aid is beneficial to improve cognitive function, repair of the nervous tissues, increased benefits from the other herbal and nutrient medicines, and peripheral circulation. I recommend Cir-Q from Health Concerns.
• Red Mold Rice extract: a number of polylipids from specific fermented grains have been proven to affect lipid metabolism in a healthy way and now show promise in the treatment of Alzheimer's, and potentially ADD and ADHD. A combination of effects, including reduction of amyloid beta-peptide plaque, called neurofibrillary tangles, as well as various antioxidant and antiinflammatory mechanisms were found in this herbal supplement. I prescribe the Health Concerns supplement Polylipid, or utilize Red Yeast Rice (Vitamin Research) to achieve these effects. Red Yeast Rice extract is now famous due to studies that demonstrate the cholesterol lowering effects of this nutrient medicine as well, which are equivalent to statin drugs. To review the research, click here: http://www.ncbi.nlm.nih.gov/pubmed/18438657
• Endocannabinoids: research around the world has confirmed that cannabinoids are not just chemicals found in marijuana, but actually are important chemicals used by the brain to regulate excessive activity of dopamine neurons in the corpus striatum. Studies at numerous universities found that patients that had used marijuana for some time in their life had a 30% decrease risk of acquiring Parkinson's. Stimulation of endocannabinoid cellular production, as well as the bioavailability of endocannabinoids from hemp seed in the diet, are being explored by scientists today. It could be that a topical cannabinoid cream that is oil based is the answer to immediate effect. Such a cream has been developed in England and is used to decrease neuralgia. Unfortunately, U.S. pharmaceutical lobbying has prompted the FDA to delay approval on the U.S. market of this benign topical medicine. There is no connection between the drug effects of THC in marijuana and this valuable herbal medicine.
• Anticholinergic herbs: sometimes cholinergic dysfunction in Parkinson's can be calmed with anticholinergic chemicals, which have been used successfully at times by modern medicine. This treatment protocol runs counter to the anticholinesterase protocol, but in some cases has reduced acute symptoms related to cholinergic nerve stimulation. Some herbs have both anticholinergic chemicals and anti-cholinesterase chemicals, implying a modulatory effect on the cholinergic system. These effects will be milder than those produced by synthetic anticholinergic chemicals, but will have no side effect. The herbs that contain anticholinergic chemicals include the mulberry parts, leaf, bark, stem, and fruit, called Sang ye, Sang bai pi, and Sang shen, as well as Corydalis, or Yan hu suo, and Artemesia abrotanum, or Southernwood. Horse chestnut bark also contains an anticholinergic, and is beneficial for the health of the veins and veinous circulation. This herb is found in the Health Concerns formula, Formula V, along with butcher's broome and stoneroot. Some antichonlinergic herbs contain scopolamines, and are a little toxic, thus are rarely used, and monitored professionally. These include Jimsonweed and Anisodus tanguticus, or Zang qie. This type of therapy may be indicated for more advanced cases to control symptoms.