# Supplements for CFS Supplements can be wonderful when used in conjunction with pacing and other lifestyle modifications. Supplements will not cure ME/CFS but they can support the body in healing. I tend to be conservative in my recommendations of supplements because the financial cost and pill burden must be carefully weighed against the low quality of evidence available for most supplements. To help you decide how best to prioritize what to buy I have included a list of my favorite supplements followed by additional supplements and protocols to consider. # My Favorite Supplements ## Magnesium Magnesium is an essential mineral that plays a crucial role in numerous physiological processes. It acts as a counterion for ATP, stabilizing many ATP-dependent processes, and contributes to the structural integrity of nucleic acids, proteins, and mitochondria. As a cofactor in over 300 enzymatic reactions, magnesium is vital for normal cellular function. It also serves as a calcium antagonist, preventing excessive acetylcholine release and stimulation. Magnesium glycinate is my favorite type. It is well absorbed and has a calming effect that promotes sleep. A typical dosing range is 200-400 mg per day. ## CoQ10 **Coenzyme Q10** (CoQ10) or **ubiquinone** is found in the mitochondria and as a component of the electron transport chain plays an important role in aerobic respiration. It is one of the more expensive supplements but also one of the more well studied and supported. I recommend taking 200-300 mg daily. CoQ10 may improve fatigue, PEM, cognitive function and dysautonomia. **Benefits of CoQ10 for ME/CFS Patients** - **Energy production**: CoQ10 supports the mitochondria, the energy powerhouses of the cell, which may improve overall energy levels and reduce fatigue. - **Antioxidant support**: CoQ10 helps neutralize free radicals, potentially reducing oxidative stress, which is thought to contribute to symptoms in ME/CFS and fibromyalgia. - **Cardiovascular health**: CoQ10 supports heart health and circulation, which can be beneficial for those with POTS and related issues. **Types of CoQ10** - **Ubiquinone**: The oxidized form of CoQ10. It is more affordable but may not be as easily absorbed, especially in older adults or those with compromised health. - **Ubiquinol**: The reduced, active form of CoQ10. It is more bioavailable and may be better for individuals with impaired mitochondrial function, such as those with ME/CFS. **Recommended Dosages** - **General dose**: 100-200 mg per day is commonly recommended for individuals with ME/CFS or fibromyalgia. However, one survey reported that doses of 200 mg or more per day was significantly more beneficial than lower doses. **How to Take CoQ10** - **With food**: CoQ10 is fat-soluble, so it should be taken with a meal containing fat to enhance absorption. - **Timing**: It can be taken in the morning or spread throughout the day to support energy levels. Taking CoQ10 too late in the day might interfere with sleep for some individuals. **Side Effects and Risks** - CoQ10 is generally well-tolerated, but mild side effects such as stomach upset or insomnia may occur. - Always consult a healthcare provider before starting CoQ10, especially if you are on medications for blood pressure, blood thinners, or other heart-related medications. ## Carnitine **Carnitine** (also known as **L-carnitine**, or as the acylated form **Acetyl-L-Carnitine**) is a naturally occurring amino acid nutrient in the body that is important for turning fat into energy. It is a derivative of the amino acid, lysine. Its function in fatty acid metabolism is to transport long-chain acyl groups from fatty acids into the mitochondrial matrix so that they can be broken down through beta-oxidation to acetyl CoA to generate energy in the citric acid cycle. Carnitine plays an especially important role in energy production by transporting fatty acids into the mitochondria, where they are burned for energy. For ME/CFS patients, carnitine supplementation may help improve fatigue, cognitive function, and muscle weakness, as mitochondrial dysfunction is thought to contribute to the symptoms of these conditions. ME/CFS patients have been found to have statistically significantly lower serum total carnitine, free carnitine, and acylcarnitine levels. These serum levels were also found to correlate with clinical symptoms, where higher serum carnitine levels correlated with better functional capacity. Serum carnitine levels appeared to return to normal during remission. As carnitine is needed by the mitochondria, these findings may imply mitochondrial dysfunction. Carnitine is generally well-tolerated, but mild side effects such as nausea or diarrhea may occur in some individuals. Always consult a healthcare provider before starting carnitine, especially if you have thyroid issues, seizures, or are on blood thinners. **Types of Carnitine** - **L-Carnitine**: The standard form of carnitine. It supports muscle function and energy production and may improve physical and cognitive symptoms in ME/CFS. - **Acetyl-L-Carnitine (ALC)**: The preferred form for ME/CFS. This form crosses the blood-brain barrier more easily and is thought to be more effective for improving cognitive function and reducing brain fog. It may also help with mood regulation. - **Propionyl-L-Carnitine**: This form is often used for cardiovascular support and improving blood flow, which may benefit individuals with POTS. **Recommended Dosages** - **Acetyl-L-Carnitine**: 1000 mg twice daily x3 months, then 500 mg daily. Use for 9 months, then drop to the lowest dose that maintains effect, or stop if no benefit. **How to Take Carnitine** - **With or without food**: Carnitine can be taken with or without food, though taking it with meals may reduce any potential stomach discomfort. - **Timing**: Split doses throughout the day (e.g., morning and afternoon) may help maintain steady energy levels. Some people find it stimulating, so it’s best to avoid taking it late in the day to prevent sleep disturbances. ## D-ribose D-ribose is a naturally occurring sugar that plays a key role in energy production, specifically in the formation of ATP (adenosine triphosphate), the body's primary energy currency. For ME/CFS patients, who often experience significant energy deficits and mitochondrial dysfunction, D-ribose supplementation may help improve energy levels, reduce fatigue, and enhance overall well-being by bypassing some metabolic pathways that may be sluggish. **Benefits of D-Ribose for ME/CFS Patients** - **Energy production**: D-ribose helps replenish ATP levels, which may lead to increased energy and reduced fatigue. - **Muscle recovery**: It may support muscle recovery after physical activity, reducing muscle pain and soreness. - **Heart health**: Some research suggests D-ribose can improve cardiovascular function, which may benefit those with POTS or heart-related symptoms. - **Cognitive function**: By supporting energy production, D-ribose may help improve mental clarity and reduce brain fog in ME/CFS patients. **Recommended Dosages** - **General dose**: 5 grams (1 teaspoon) taken 2-3 times per day is commonly recommended for ME/CFS patients. - **Duration**: Some studies suggest that benefits can be seen within a few days to weeks of regular use, though it may take longer for chronic conditions. **How to Take D-Ribose** - **With or without food**: D-ribose can be mixed with water or juice and taken with or without food. Many prefer to take it with meals to avoid potential stomach upset. - **Timing**: It’s typically taken in the morning and early afternoon. Avoid taking it late in the day, as it could lead to increased energy that interferes with sleep. **Risks and Side Effects of D-ribose** - D-ribose is generally safe and well-tolerated, though some individuals may experience mild side effects like diarrhea or low blood sugar (especially in those with hypoglycemia or diabetes). - D-ribose can give "false energy," making pacing more difficult and increasing risk of PEM. - Always consult with a healthcare provider before starting D-ribose, particularly if you have diabetes, as it may affect blood sugar levels. ## NAC N-acetyl-cysteine (NAC) is a powerful antioxidant and precursor to glutathione, the body's most important detoxifying agent. For ME/CFS patients, who often experience oxidative stress, mitochondrial dysfunction, and impaired detoxification, NAC supplementation may help reduce fatigue, improve immune function, and support overall well-being. **Benefits of NAC for ME/CFS Patients** - **Glutathione production**: NAC boosts glutathione levels, which may help protect cells from oxidative damage and support detoxification processes. - **Antioxidant support**: NAC directly scavenges free radicals, reducing oxidative stress, which is a common issue in ME/CFS and fibromyalgia. - **Immune function**: By supporting glutathione and reducing inflammation, NAC may help improve immune function and resilience. - **Respiratory health**: NAC acts as a mucolytic agent, thinning mucus, which may be beneficial for respiratory symptoms like congestion or chronic sinus issues common in ME/CFS patients. - **Mental health**: NAC has shown potential benefits for improving mood and reducing anxiety, which can be helpful for those with ME/CFS and associated mood disorders. **Recommended Dosages** - **General dose**: 600-1,800 mg per day is commonly recommended for most adults, including those with ME/CFS. - **Form**: NAC is typically available in capsule or powder form and can be taken in divided doses throughout the day. **How to Take NAC** - **With or without food**: NAC can be taken with or without food, though some individuals may experience mild nausea if taken on an empty stomach. - **Timing**: Split doses throughout the day (e.g., morning and afternoon) for consistent antioxidant support. Avoid taking it too late in the day as it may lead to increased energy. **Additional Considerations** - NAC is generally safe and well-tolerated, though mild side effects like gastrointestinal upset or headache may occur in some individuals. - Always consult a healthcare provider before starting NAC, especially if you are on medications that affect the immune system, blood thinners, or have specific medical conditions. ## Omega-3 Fish Oil Fish oil, derived from fatty fish such as salmon, mackerel, and sardines, is rich in omega-3 fatty acids, particularly EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). These essential fats have anti-inflammatory properties and are vital for brain health. For individuals with ME/CFS, fish oil supplementation may help reduce inflammation, improve cognitive function, and enhance overall well-being. One study showed better benefits with an EPA rich formulation rather than EPA + DHA. **Benefits of Fish Oil for ME/CFS Patients** - **Anti-inflammatory effects**: Omega-3 fatty acids in fish oil help reduce inflammation, which may alleviate symptoms such as pain, fatigue, and muscle soreness common in ME/CFS. - **Cognitive support**: DHA is crucial for brain health and may help improve cognitive function, addressing issues like brain fog and memory problems often experienced by ME/CFS patients. - **Mood enhancement**: Fish oil may help improve mood and reduce anxiety or depressive symptoms, which can be prevalent in chronic illness. - **Cardiovascular health**: Omega-3s support heart health by reducing triglycerides and improving overall cardiovascular function. **Risks of Fish Oil** - **Gastrointestinal issues**: Some individuals may experience digestive discomfort, nausea, or diarrhea, especially at higher doses. - **Blood thinning**: Fish oil has blood-thinning effects, which may increase bleeding risk, particularly in individuals on anticoagulant medications. - **Allergic reactions**: Those with fish allergies should avoid fish oil supplements or choose algal oil (plant-based omega-3). **Recommended Dosage** - **General dose**: 1,000-2,000 mg of combined EPA and DHA per day is commonly recommended for general health and anti-inflammatory effects. Krill oil is better absorbed than fish oil. **How to Take Fish Oil** - **With meals**: Fish oil is best absorbed when taken with meals containing fat, which can also help minimize gastrointestinal discomfort. - **Choose quality supplements**: Look for high-quality fish oil supplements that are third-party tested for purity and potency, ensuring they are free from heavy metals and contaminants. ## Vitamin D I recommend 2,000 IU vitamin D daily with dose adjustments increased until vitamin D is well within normal limits. For some patients, this dose can be 10,000 IU daily or higher. ## Beta Glucan Beta-glucan is a powerful prebiotic, metabolized into short-chain fatty acids (SCFAs), which serve as an energy source for cells and help regulate blood sugar levels. Beta-glucan enhances macrophage-mediated tissue repair at the intestinal level, accelerating the healing of ulcers and improving tissue regeneration. A daily dose of 250 mg of beta-glucan has been found to reduce brain fog in individuals with ME/CFS. This amount is equivalent to less than a tablespoon of oatmeal per day, as one cup of dry oats contains approximately 6,500 mg of beta-glucan. Similarly, one tablespoon of nutritional yeast can provide a comparable amount. Beta-glucan is also a potent immune system regulator, allowing for a more targeted response to pathogens while minimizing excessive inflammation or tissue damage. It promotes antiviral activity and can activate immune cells when combined with whey protein. Specifically, (1→3)-β-glucan binds to complement component C3, triggering a cascade that leads to the formation of the C3 convertase enzyme, ultimately marking pathogens for destruction by immune cells. The FDA recommends 200 mg of beta-glucan daily to support immune function, while doses of 3-15 grams per day have been shown to improve blood sugar control and aid in weight management. Rich dietary sources include oatmeal, nutritional yeast, reishi and shiitake mushrooms, and brown seaweed (such as kelp and kombu, particularly _Laminaria digitata_). Nutritional yeast, in addition to providing beta-glucans, is a valuable source of B vitamins, including riboflavin, vitamin B6, niacin, and vitamin B12, which are often difficult to obtain outside of animal products. # Mitochondrial Support My general recommendation is to be cautious with mitochondrial support supplements. The theory is that the mitochondria have been shut down by the body as a survival mechanism. The body will fight them being turned back on in absence of safety signals so energizing supplements may increase risk and severity of PEM later. ## PQQ (Pyrroloquinoline Quinone) Pyrroloquinoline quinone (PQQ) is a powerful antioxidant and a compound that supports mitochondrial function. It is found in various foods, including fermented foods, green tea, and certain vegetables. For individuals with ME/CFS, PQQ may help improve energy production, reduce oxidative stress, and enhance cognitive function. **Benefits of PQQ for ME/CFS Patients** - **Mitochondrial support**: PQQ stimulates the growth of new mitochondria, improving energy metabolism, which can be particularly beneficial for those experiencing fatigue in ME/CFS. - **Antioxidant properties**: PQQ helps reduce oxidative stress by neutralizing free radicals, potentially alleviating symptoms associated with cellular damage. - **Neuroprotection**: PQQ may support cognitive function and memory, addressing the brain fog often experienced by ME/CFS patients. - **Cardiovascular health**: Some research suggests PQQ may help improve heart health by reducing inflammation and improving blood flow. **Risks of PQQ** - **Gastrointestinal discomfort**: Some individuals may experience nausea, headaches, or digestive issues, particularly at higher doses. - **Interactions with medications**: PQQ may interact with certain medications, particularly those affecting mitochondrial function or antioxidants. Always consult with a healthcare provider if you are on other treatments. **Recommended Dosage** - **General dose**: 10-20 mg per day is commonly recommended for supporting mitochondrial function and overall health. **How to Take PQQ** - **With or without food**: PQQ can be taken with or without food, but taking it with meals may help reduce any potential gastrointestinal discomfort. - **Combination with other supplements**: PQQ is often combined with other mitochondrial support supplements like CoQ10 or alpha-lipoic acid for enhanced effects. **Additional Considerations** - Always consult with a healthcare provider before starting PQQ, especially if you have underlying health conditions or are on medication. - Monitor your body’s response when starting PQQ, and adjust the dosage as needed based on your individual tolerance and benefit. ## Quercetin Quercetin is a natural flavonoid found in many fruits and vegetables, known for its antioxidant, anti-inflammatory, and antihistamine properties. For people with ME/CFS, quercetin may help by reducing inflammation, improving immune function, and managing symptoms such as fatigue, pain, and histamine intolerance. It was also shown to increase biogenesis of mitochondria in animal studies. **Benefits of Quercetin for ME/CFS Patients** - **Antioxidant support**: Quercetin helps neutralize free radicals, reducing oxidative stress that may contribute to ME/CFS symptoms. - **Anti-inflammatory properties**: It may help lower chronic inflammation, which is common in ME/CFS and fibromyalgia. - **Immune modulation**: Quercetin supports the immune system and may help reduce susceptibility to infections, which can trigger or worsen ME/CFS. - **Antihistamine effects**: Quercetin can block histamine release, making it useful for those with allergies or [[Mast cell activation disorders]], which is common in ME/CFS patients. - **Mitochondrial support**: Quercetin was shown to increase the number of mitochondria in animal models **Risks of Quercetin** - **Gastrointestinal issues**: Some individuals may experience nausea or digestive discomfort, especially at higher doses. - **Interaction with medications**: Quercetin can affect the absorption or metabolism of certain medications, including antibiotics, blood thinners, and chemotherapy drugs. - **Kidney risks**: Very high doses of quercetin (over 1,000 mg/day) may have the potential to affect kidney function in rare cases. Always use under medical supervision. **Recommended Dosage** - **General dose**: 500-1,000 mg per day, divided into 2 doses (morning and evening), is commonly recommended for its antioxidant and anti-inflammatory effects. - **Duration**: It can be used regularly or during flare-ups of symptoms related to inflammation or allergies. **How to Take Quercetin** - **With meals**: Since quercetin is fat-soluble, taking it with food containing healthy fats (like avocado or nuts) may enhance absorption. - **Combination with other supplements**: Quercetin is often combined with bromelain (an enzyme from pineapples) to improve absorption and enhance anti-inflammatory effects. **General Considerations** - Always consult with a healthcare provider before starting quercetin, especially if you are on medications like blood thinners or have kidney concerns. - Start with a lower dose (e.g., 250 mg) to see how your body responds before gradually increasing to the full recommended dose. # Nutritional Supplements ## Multivitamin A high quality multivitamin is recommended by many ME/CFS practitioners. A popular one I have seen recommended is K-PAX. > [!LINK] Link > [K-PAX](https://integrativepro.com/products/k-pax-mitonutrients?variant=453235366300740) K-PAX is a comprehensive multivitamin with nutrients, mitochondrial support supplements, and methylated B vitamins. It is pricy (around $50 per month on [[Fullscript|Fullscript]]) but is probably a good deal considering how many supplements it takes the place of, reducing cost and pill burden. It does contain CoQ10 but not in optimal doses. Antioxidants and micronutrients in K-PAX, such as Alpha Lipoic Acid, Acetyl-L-Carnitine and N-Acetyl-Cysteine increase cellular energy production and support the immune system. # Oxidative Stress Treatments ## Boswellia Boswellia, commonly known for its resin called frankincense, is a powerful anti-inflammatory agent. Its primary mechanism of action is the inhibition of the inflammatory enzyme 5-lipoxygenase (5-LOX), which plays a key role in the production of leukotrienes—compounds involved in chronic inflammation. ## Vitamin E People with ME/CFS have lower levels of gamma tocopherol (a subtype of vitamin E) than the general population. Gamma tocopherol is an important intracellular antioxidant. I often test vitamin E levels and supplement with gamma tocopherol if low. ## Glutathione Glutathione is the body's most important antioxidant, protecting cells from oxidative damage and supporting detoxification. Low levels of glutathione have been observed in many ME/CFS patients, contributing to poor energy production and immune dysfunction. Supporting glutathione levels through diet or supplementation (like NAC) may help reduce oxidative stress, improve mitochondrial function, and enhance overall symptom management in ME/CFS. Glutathione levels can be supported indirectly by supplementing with CoQ10, carnitine, B12, cysteine (including NAC), and undenatured whey. Cruciferous vegetables such as broccoli and cabbage also contain sulfur compounds that act as glutathione precursors. Supplementation with IV or IM glutathione appears to be more beneficial that oral supplementation. # Other Supplements ## B6 Don't take more than 45 mg of B6 per day, unless it is in the form of P5P, because high dose B6 can aggravate nerve pain ## Choline Choline is an essential nutrient that plays a critical role in various bodily functions, including neurotransmitter synthesis, cell membrane integrity, lipid transport, and methyl-group metabolism. It is a precursor for acetylcholine, a neurotransmitter important for memory and muscle control, and is involved in the formation of phosphatidylcholine, a key component of cell membranes. Choline is a precursor for the synthesis of betaine, which donates methyl groups for the regeneration of methionine from homocysteine. Methionine is then converted to S-adenosyl-methionine, a universal methyl donor involved in numerous methylation reactions, including DNA, RNA, protein, and lipid methylation. In the context of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), choline supplementation may be particularly beneficial. ME/CFS patients often experience cognitive dysfunction, muscle weakness, and fatigue, which can be exacerbated by metabolic dysfunctions, including impaired utilization of fatty acids for energy and increased reliance on protein catabolism. Choline can help improve cognitive and motor performance by enhancing cholinergic neurotransmission and reducing oxidative stress. Additionally, it supports muscle fat metabolism and protein homeostasis, potentially mitigating muscle wasting and improving overall muscle function. For dosing, the recommended adequate intake (AI) for choline is 425 mg per day for women and 550 mg per day for men. Choline can be supplemented in various forms, such as choline bitartrate, alpha-glycerophosphocholine (GPC), or citicoline, which are all effective in boosting choline levels. It is advisable to start with the AI and adjust based on individual response and clinical guidance. Choline is primarily found in animal based foods and legumes, so vegans who are abstaining from legumes due to MCAS or other sensitivities will have difficulty getting the AI daily of choline and should consider supplementation. In summary, choline supplementation can support cognitive function, muscle health, and overall metabolic balance in ME/CFS patients, making it a valuable addition to their nutritional regimen. ## Glutamine Glutamine is an amino acid that acts as the main energy source for intestinal cells. At a dose of 15 g daily it may reduce intestinal inflammation and support tight junction integrity. It can reduce symptoms of irritable bowel syndrome by up to 80%. Cabbage is a rich source of glutamine which may explain why cabbage juice is an old home remedy for stomach ulcers. 100 g of red cabbage contains 3 g glutamine. Other sources of glutamine include saltwater fish (19 g in 50 g of mackerel), whey protein (8 g in 100 g protein powder), eggs (0.8 g in 1 egg), cashews (2.2 g in a 50 g handful), soy, parsley, kidney beans, spirulina and chicken. # Supplement Protocols ## Dr. Teitelbaum's recommendations - Red Ginseng Energy - D-ribose - Ashwagandha - Rhodiola - Green tea extract - Schisandra - Licorice - Nutritional Supplements - MVI - Ribose 5000 mg, TID for 6 weeks then BID - Lipoic acid 300 mg BID for nerve pain - B12 IM (if levels are <540) 3-5 times weekly for 15 doses, then monthly or more as needed - NAC 500 mg QD for 9 months, then as needed - Iron 30 mg QD with vitamin C if ferritin <60 - Fish oil, 3-4 servings of fish per week, 8 fish oil caps, or 1 tab Vectomega daily - Use the following for 9 months, then drop the dose to the lowest dose that maintains effect, or stop if no benefit - Acetyl-L-Carnitine 1000 mg BID x3 months, then 500 mg/day - L-carnitine can be substituted if cost prohibitive - CoQ10 100-200 mg daily - Especially if on a statin - Take with a dietary fat ## Hunter-Hopkins Protocol - Multivitamin - With B complex, folate, vit D, calcium, magnesium - B12 injections - Vit D - 2,000 IU daily to reduce pain and morning stiffness - Calcium - 1000-1500 mg - Magnesium - 500-750 mg - D-ribose (helps increase ATP) - 5000 mg TID x2 weeks, then 5000 mg BID - Results usually seen within 3 weeks - NADH (helps increase ATP) - 10-20 mg daily - For his most severe patients - Improvements in 3-6 months - Acetyl-carnitine (helps increase ATP with NADH) - 1,000 mg BID - DHEA - 25-50 mg daily for women - 50-100 mg daily for men - Not needed if already on hormone replacement - Side effects - oily skin, acne, excessive hair - Lysine - 1000-2000 mg daily - Reduces frequency and severity of herpetic mouth sores - Fish oil - 3000-4000 mg dialy for pain and cholesterol ## Pall Protocol for CFS Nebulized reduced glutathione - Nebulized inhaled hydroxocobalamin - Mixed natural tocopherols - Buffered C - 500-1000 mg spread over the course of a day - Magnesium malate - Downregulates NDMA - Flavanoids: ginko, cranberry extract, silymarin, bilberry - Antiinflammatory, antioxidants, chelators of free iron (protecting against oxidative damage) - Also found in green tea, citrus, grape seed, soy, olive, hawthorn, blueberry, purple rice - Need to be taken throughout the day because they are quickly secreted - Selenium-grown yeast (selenomethionine) - Present in glutathione peroxidase - eliminates intracellular peroxide - Necessary for T3 production - CoQ10 - Take early in the day - Scavenges free radicals - Protects against loss of mitochondrial respiratory function - Increases energy metabolism - Down-regulates NMDA - Folic acid - Reduced folate (MTHF) is a potent scavenger of ONOO - Which means high oxidative stress lowers levels of MTHF and thereby lowers methylation cycle activity - Take with 500-1000 mg vitamin C - Carotenoids (lycopene, lutein, B carotene) - Plant pigments which scavenge free radicals - Lutein and zeaxanthin insert into biological membranes - Alpha lipoic acid - Scavenges free radicals, crosses the blood-brain-barrier - Zinc, modest dose - Manganese, low dose - Copper, low dose - Zinc, manganese and copper are components of superoxide dismutase - Both deficiencies and excesses of these nutrients can cause oxidative stress - B6, pyridoxal 5 phsophate - Neuroprotective - Riboflavin 5'-phosphate - Important in production of reduced glutathione - Treats migraines - B12, hydroxocobalamin - Potent nitric oxide scavenger, difficult to absorb PO - Nasal spray or injection - Betaine (trimethylglycine) - Similar to SAMe and carnitine in that it is a reductive stress agent, but it is cheaper and more stable than SAMe. - Acetyl-carnitine - Improves cellular energy by transporting fatty acids into mitochondria - Reduces NMDA activity - Taurine - Antioxidant and neurotransmitter (GABA stimulation) - Crosses the blood-brain barrier - PUFAs/Omega-3 - Depleted in context of oxidative stress - Curcumin, honokiol (from magnolia), cat's claw, vinpocetine, feverfew - Reduce inflammation by lowering NF-kappaB activity - Vitamin E as high dose gamma-tocopherol and tocotrienols with modest amounts of natural alpha-tocopherol - Antioxidant - Improves mitochondrial function - Algal supplements: chlorella, blue-green algae - Rich in antioxidants ### Van Konynenburg Protocol - General Vitamin Neurological Health Formula by Holistic Health Consultants, LLC - 1/4 tab daily and increase to 2 tabs daily - Hydroxy B12 Mega Drops by by Holistic Health Consultants, LLC - 2 drops sublingually daily - MethylMate B by Holistic Health Consultants, LLC - 3 drops under the tongue daily - Folinic acid - 200 mcg daily - Phosphatidyl Serine Complex by Vitamin Discount Center - 1 cap daily (500 mg) - Can lower cortisol so may wish to substitute phospholipids