Supplements for the Brain (and Nerves)

“For Your Peace of Mind…”

Recent research on supplements for memory, cognition and other neurological functions
You may remember (we hope you remember!) the Scarecrow’s petition to the Wizard of Oz for a brain. Be advised–we at NYBC do not stock new brains, so don’t come to us with that request.

However, we do follow the sometimes startling new research on supplements, brain function and related neurological issues. In this department, there’s special cause for concern for people with HIV. According to a Canadian study released in 2010, in a group of 1615 people receiving treatment for HIV during the decade 1998-2008, one fourth had neurological problems, including memory loss, cognitive impairment and peripheral neuropathy. Of course being worried about brain function–and neurological function in general–is not unique to people with HIV. As people age, they are more likely to experience memory loss or forms of dementia such as Alzheimer’s. And the nerve condition called peripheral neuropathy (pain, tingling in the feet and hands) is found not just in people with HIV, but also among the growing population with Type 2 diabetes.

Now, on to what we see as some of the most valuable recent findings about supplements and brain or neurological function:

B vitamins can be considered a foundation because they are needed in so many processes essential to the brain’s operation, from energy supply and healthy blood flow, to the formation of neurotransmitters (=chemical messengers of neurologic information from one cell to another). Furthermore, there is evidence that several groups of people, including those over 60 and those with HIV, have a greater risk for Vitamin B deficiencies. So supplementing with a B complex vitamin is a sensible start to cognitive health. More specifically, there is good research linking deficiency of vitamins B12 and B6 to mood disorders like depression—and depression earlier in life is associated with higher risk of dementia in later life. Last, there is also some evidence that B vitamins may reduce stroke risk in older people.

Omega-3 fatty acids (fish oil) support cognitive health in a variety of ways. In 2008, UCLA researchers reported on a lab study showing that the omega-3 fatty acid DHA, together with exercise, improved cognitive function. This caught our attention, because there is wide agreement that regular exercise strongly supports brain function as we age, and here the suggestion is that omega-3 fatty acids multiply that known benefit. A diet rich in omega-3 fatty acids/fish oil has also been linked to lower risk of depression—another plus. And still more: recent research found that omega-3 fatty acids block the development of retinopathy, a chief cause of blindness as we age. (The retina of the eye is actually part of the brain–it is full of nerve cells essential for vision.) All in all, the neurological benefits of omega-3 fatty acids seem both wide-ranging and quite convincing, so it’s high on our recommended list.

The amino acid acetylcarnitine has shown benefit for brain function in a number of studies with humans. In the last decade, acetylcarnitine has also been investigated for peripheral neuropathy in people with HIV. (Some recommend using it with evening primrose oil and Vitamin C.) A 2008 study found that acetylcarnitine influences a chemical process in the brain that triggers Alzheimer’s, so researchers are continuing to puzzle out how this supplement produces its neurological benefits.

Antioxidants. There’s much suggestive research about how antioxidants counter destructive oxidative processes in the brain, thus blocking memory loss and cognitive decline. For example, a 2003 report found that the antioxidant combination alpha lipoic acid and NAC reversed memory loss in aged laboratory mice. And there’s also been a lot of attention to the combination acetylcarnitine and alpha lipoic acid for memory impairment. Furthermore, other antioxidants such as curcumin are under study for their potential to fight the processes that lead to declining brain function.

Acetylcholine. The first neurotransmitter to be identified, acetylcholine is closely associated with memory, with lower levels linked to memory loss. NYBC currently stocks two combination supplements that support acetylcholine levels in the brain, while also providing other nutrients for neurological function: Neuro Optimizer (Jarrow), which includes acetylcholine enhancers, acetylcarnitine, and alpha lipoic acid; and Think Clearly (SuperNutrition), which includes B vitamins, as well as acetylcholine enhancers and a botanical traditionally used for cognitive support, ginkgo biloba.

Resveratrol. In the past decade, there has been intense scientific interest in this compound, most famously found in red wine. While some research ventures have hoped to find in resveratrol a life-extending supplement (a capacity demonstrated in animal studies), others have focused on its therapeutic value for conditions like diabetes or cognitive decline. For example, Cornell researchers reported in 2009 that resveratrol reduced the kind of plaque formation in animal brains that causes Alzheimer’s. And a year later another lab investigation, this one at Johns Hopkins, found that a moderate dose of the compound protected animal brains from stroke damage.

Ginkgo biloba, a botanical derived from Earth’s most ancient tree species, has been widely used for cognitive function. In the late 1990s, two reviews of dozens of ginkgo studies concluded that it could improve symptoms of dementia. However, a long-term trial of ginkgo published in the Journal of the American Medical Association in 2008 found that the supplement did not prevent development of dementia in a group of more than 3000 older people who had normal cognitive function at the start of the research. One possible conclusion: ginkgo may help symptoms of cognitive decline, but doesn’t address underlying causes.

NYBC’s RECOMMENDATIONS: A B complex supplement (like Jarrow’s B-right) and fish oil (like Jarrow’s Max DHA) are foundations for maintaining cognitive health, especially important for people with HIV or people over 60. There is some evidence for acetylcarnitine, alpha lipoic and acetylcholine supplementation for memory impairment and possibly for cognitive decline. Acetylcarnitine and other supplements can be used to address peripheral neuropathy. And stay tuned for emerging research on preserving brain function with compounds like resveratrol, NAC and curcumin.

MMS Botanicals at NYBC

NYBC carries selected botanicals from the manufacturer “MMS Pro,” which has been a supplier of “phytomedicines” (=plant-derived remedies) for 80 years. We like the fact that this supplier subscribes to Good Manufacturing Practices (GMP), an industry-recognized standard for quality control, and that its botanicals have been used in numerous clinical trials. MMS Pro also posts on its website independent certificates of analysis for many of its products. (Certificates of analysis provide evidence of independent verification of the purity and potency of a botanical.)

Here are the MMS Pro botanicals currently stocked by NYBC. Please
read carefully the descriptions on the NYBC website.

Astragalus

Echinacea

Eleuthero – also known as Siberian Ginseng

Garlicin Pro

Gingko-D

Horsechestnut Pro

St John’s Wort – Perika Pro

Ginkgo biloba: new research on a traditional botanical used for cognitive decline and circulatory health issues

Ginkgo biloba, thought to be the oldest living tree species on Earth, is also the source for one of the most widely used medicinal botanicals in the world. It is widely prescribed in Europe as a treatment for atherosclerosis (hardening of the arteries) and for memory loss and cognitive decline. In the US, where it is available as a dietary supplement, ginkgo has been the subject of intensified research in the last few decades, which has highlighted its capacity to improve blood flow/circulation and the benefits of its particular blend of antioxidants (called “flavonoids” and “terpenoids”).
There are a number of impressive findings from research on gingko:
1. Several investigations have found that ginkgo is comparable in effectiveness to leading prescription medications for Alzheimer’s in delaying the symptoms of dementia. In people with Alzheimer’s it has been shown to improve thinking, learning, and memory, and may also relieve depression.
2. A clinical study suggested that ginkgo can reduce the side effects of menopause and the risk of osteoporosis and cardiovascular disease. Menopausal women seeking to avoid hormone replacement therapy due to the side effects (such as increased risk of breast cancer) may be able to use ginkgo as an alternative.
3. The flavonoids in ginkgo may lessen problems in the back part of the eye (the retina). In particular, research suggests that ginkgo may help preserve vision in people with age-related macular degeneration, a retinal condition that is the number one cause of blindness in the US.
4. Ginkgo has been used for erectile dysfunction, especially in people who experience sexual dysfunction as a side effect of antidepressants. In one study of 60 men with ED, there was a 50% success rate after six months of treatment with ginkgo.
5. Three research centers at the National Institutes of Health are collaborating on a large-scale, long-term study to find out if ginkgo can prevent or delay the kinds of changes in memory and thinking that can occur as people get older. A secondary aim of the study is to assess the botanical’s ability to reduce the rate of cardiovascular disease as people age. This research may provide further guidance about the potential of ginkgo to prevent the onset of cognitive decline and cardiovascular disease.
6. A two-year study of health outcomes for HIV positive people who use botanical or herbal remedies concluded that ginkgo was associated with beneficial results in several measures of health status. This research was presented at the 15th International Conference on AIDS in Bangkok, Thailand in 2004.
For further information, see the description of the MMS standardized Ginkgo Biloba Extract on the NYBC website. Concentrated extracts, which are prepared from the green leaves of the tree, appear to be the most clinically effective form. Note that ginkgo is well tolerated and has few side effects, but should not be used with blood-thinning medications (like aspirin or Coumadin), since one of its main actions is also to thin the blood.

NYBC also stocks the SuperNutrition product Think Clearly, a formula that includes Ginkgo biloba along with other nutrients that support cognitive function.

Gingko Biloba used for dementia and for Alzheimer’s Disease

The University of Maryland Medical Center’s Complementary Medicine website, reviews recent studies of gingko biloba for dementia, cognitive decline, and Alzheimer’s disease. Here is an excerpt:

Dementia and Alzheimer’s Disease

Ginkgo is widely used in Europe for treating dementia. It use is primarily due to its ability to improve blood flow to the brain and because of its antioxidant properties. The evidence that ginkgo may improve thinking, learning, and memory in people with Alzheimer’s disease (AD) has been highly promising.

Clinical studies suggest that ginkgo may provide the following benefits for people with AD:

Improvement in thinking, learning, and memory (cognitive function)
Improvement in activities of daily living
Improvement in social behavior
Fewer feelings of depression

Several studies have found that ginkgo may be as effective as leading AD medications in delaying the symptoms of dementia in people with this debilitating condition. In addition, ginkgo is sometimes used preventively because it may delay the onset of AD in someone who is at risk for this type of dementia (for example, family history).

Citation (one of several recent studies cited by UMMC): Mazza M, Capuano A, Bria P, Mazza S. Ginkgo biloba and donepezil [Aricept]: a comparison in the treatment of Alzheimer’s dementia in a randomized placebo-controlled double-blind study. Eur J Neurol . 2006;13(9):981-5.

See also the NYBC entry on Gingko Biloba for additional information on use of this botanical for cognitive function.

Pro Greens and Green Defense: green foods plus select botanicals plus probiotics

NYBC stocks two supplements that provide an array of nutritious green foods and select botanicals (such as gingko biloba) combined with probiotics. ProGreens has the wider spectrum of greens, botanicals and probiotics, while Green Defense is the purchasing co-op’s basic greens + select botanicals + probiotics product. As you’d expect, they vary in price as well, with Green Defense being about half the price of Pro Greens. Both are one-month supplies, so we are talking about a daily expense of a little more than a dollar (for Pro Greens), or about 50 cents per day (for Green Defense).

ProGreens (NutriCology). This contains greens together with a wide spectrum of probiotics to support gastrointestinal health.  Used as directed, this is a 30-day supply.

Each serving (approximately 8.8 grams) contains:
Organic Wheat grass powder 350 mg
Organic Barley grass powder 350 mg
Organic Alfalfa grass powder 350 mg
Organic Oat grass powder 350 mg
Organic Spirulina 1,000 mg
Chlorella (cracked-cell) 350 mg
Dunaliella salina 40 mg
Dulse powder 30 mg
Licorice root powder 100 mg
Eleuthero Root Extract 130 mg
Pfaffia paniculata (Suma root powder) 60 mg
Astragalus root extract 60 mg
Echinacea purpurea leaf and stem extract 60 mg
Ginger root powder 5 mg
Soy Lecithin (99% oil-free) 2,000 mg
Wheat sprout powder (gluten-free) 350 mg
Acerola berry juice powder 200 mg
Beet juice powder 200 mg
Spinach powder (1.5% octacosanol) 150 mg
Royal jelly (5% 10-HDA) 150 mg
Bee pollen 150 mg
Flax Seed powder 500 mg
Apple pectin and fiber 500 mg

Total count non-dairy probiotic cultures: 5.0 billion
Lactobacillus group (L.rhamnosus A, L.rhamnosus B,
L.acidophilus, L.casei, L.bulgaricus) 3.5 billion
Bifidobacterium group (B.longum, B.breve) 1 billion
Streptococcus thermophilus 500 million
Fructooligosaccharides (FOS) 500 mg
Milk Thistle extract (80% silymarin) 60 mg
Ginkgo biloba leaf extract 20 mg
Green tea extract (60% catechins) 20 mg
Grape pip extract (92% proanthocyanidins) 20 mg
Bilberry extract (25% anthocyanidins) 20 mg
——
Green Defense (Jarrow). This is a mix of greens with a probiotic to support gastrointestinal health as well. Used as directed, it’s a 30-day supply.

Each single (6 g) scoop provides:
Grasses and Algaes – 980 mg
The following are organic:
Barley Grass Juice
Quinoa Grass
Spirulina
Oat Grass Juice
Wheat Grass Juice
[The remainder are not organic]
Vegetables – 1,430 mg
Spinach Juice Powder
Broccoli Juice Powder
Tomato Powder
Beet Powder
Botanicals – 320 mg
Tiger cane extract (Resveratrol source)
Quercetin
Milk Thistle Extract
Citrus Bioflavonoids
Green Tea Extract
Grape Seed Extract
Ginkgo biloba
Ginger Root
Fibers – 2,760 mg
FOS (Fructooligosaccharide)
Rice Bran Powder
Apple Fiber Powder
Probiotic Metabolites – 60 mg
Metabolin (Propionibacterium shermani)

Pro Greens and Green Defense can be added to juice or water. Drink immediately; best taken on an empty stomach. More than one scoop per day may be used if desired. Pregnant or lactating women considering taking more than one serving per day should consult their healthcare practitioner prior to use.

Acetyl-l-carnitine: anti-aging applications and dosing recommendations

Acetyl-l-carnitine, which is available through the NYBC purchasing co-op at the lowest price we’ve seen, is one of the key components of the NYBC MAC Pack, and may be especially useful in counteracting peripheral neuropathy.

Furthermore, it’s also one of the most studied dietary supplements to counter the effects of aging; taking 1,500 mg a day (a commonly suggested dose) of this supplement may improve cognitive function and mood. As we’ve written elsewhere on this blog, the B vitamins and the botanical gingko biloba also have good evidence to support their use to address the effects of aging. Finally, don’t forget that recent research has pointed to daily physical exercise–such as walking–as one of the most important things you can do to counter age-related cognitive decline.

FAQ on nutritional supplements

This post runs a little long, but we think it’s worthwhile to put up the FAQ about nutritional supplements recently posted by the New York Buyers’ Club. It answers a lot of (sometimes anxious) queries about supplements, and also gives a quick rundown on some of the top uses of supplements among the NYBC membership.

What are supplements?
A nutritional or dietary supplement (or just plain supplement), as defined by the Dietary Supplement Health and Education Act (DSHEA) of 1994, is “a product (other than tobacco) that is intended to supplement the diet and that contains one or more of the following: vitamins, minerals, herbs or other botanicals, amino acids, or any combination of the above ingredients,” and can be taken in tablet, capsule, powder, or liquid form.
NYBC specializes in supplements for those with HIV, hepatitis C, and other chronic conditions. Our Supplement Fact Sheets contain information on more than 100 supplements commonly used by our Members. Our nonprofit purchasing co-op stocks these supplements on a regular basis, and can also special-order many other supplements on request.
Why take supplements?
There is a great deal of research showing that supplements can help people manage serious chronic conditions such as HIV and hepatitis. Supplements can also be useful in addressing many common health issues, such as high cholesterol, diabetes, depression, arthritis pain, gastrointestinal disorders, etc. (see our short list of specifics below). Some supplements are derived from ancient traditions of use (for example, the botanicals of India’s Ayurvedic tradition), while other items (such as vitamins or amino acids) have been isolated and used as supplements much more recently. The scientific study of supplements has blossomed in recent decades, so we now have better evidence about many of them—even traditional botanicals—than we ever did in the past.
Are supplements considered “medicine”?
While supplements may have medicinal properties, they are not regulated in the same way that prescription drugs are, and are therefore accompanied by the disclaimer: “These statements have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
The fact that supplements are not regulated in the same way that prescription drugs are naturally gives rise to concerns about purity, efficacy, and safety – so it’s good to have a knowledgeable ally like NYBC on your side! Collectively, we have many years of experience in using supplements, in researching information on them, and in evaluating suppliers to obtain the best quality product.
Are supplements “safe”?
Under current US regulations, supplements are assumed to be safe on the basis of their history of use, or because they are found in the food supply (like the microorganisms in yogurt or the vitamins and minerals in foods). The US Food and Drug Administration is responsible for removing supplements from the market if it finds evidence that they are unsafe, but it’s worth noting that this happens quite rarely. (The removal from the market of ephedra [aka the Chinese herb Ma huang], used at high dosage as a diet pill, is practically the only significant example since 1994). However, while supplements may be “assumed to be safe,” everyone who takes them needs to pay attention to the recommended dosage and any cautions or warnings. If you exceed the recommended dosage of certain supplements, there may be side effects, sometimes serious. Furthermore, a supplement may have negative interactions with other medications you are taking, or a particular supplement may not be a wise choice for you due to other health concerns. That’s why it’s always important to discuss your supplement use with your doctor.

Here are just a few examples of potentially dangerous supplement-medication interactions (from the National Center for Complementary and Alternative Medicine’s website) – further proof that consulting your physician about supplement use is crucial:

• St. John’s Wort can increase the effects of prescription drugs used to treat depression. It also dangerously interferes with drugs used for HIV, cancer, birth control, and rejection of organ transplants

• Ginseng can increase the stimulant effects of caffeine (as in coffee, tea, and cola). It can also lower blood sugar levels, creating the possibility of problems when used with diabetes drugs

• Ginkgo, taken with anticoagulant or antiplatelet drugs, may increase the risk of bleeding. Ginkgo may also interact with certain psychiatric drugs and with certain drugs that affect blood sugar levels

Of course, doing your own “homework” is also encouraged. Be sure to bring any notes or printouts from your research to share with your healthcare provider. That way, you’ll both be literally on the same page.
Identity, Purity and Potency
Safety is also a matter of product quality. Is the product what it claims to be on the label (that is, is it really fish oil)? This is the product Identity. Does the product contain any unwanted contaminants like heavy metals, insect parts, rodent droppings? All foods and medicinal products face these issues of Purity. And finally, does it have as much of the claimed amount of a substance? For example, if it says 100 mg of niacin, does it have that amount? This is the product’s Potency. These issues are of ongoing concern. NYBC has done everything possible to assure that products meet these standards. Websites such as http://www.consumerlab.com can help. Also indications of quality such as USP or other labels further add assurance. The good news is that the vast majority of products tested by consumerlab, for example, pass their tests. Still, NYBC believes an appropriately funded agency of the FDA could do more rigorous, routine and comprehensive testing.
What is CAM?
CAM is an acronym for complementary and alternative medicine. The use of supplements is considered CAM. Some prefer the term integrative medicine.
The National Center for Complementary and Alternative Medicine (NCCAM), a division of the US National Institutes of Health, defines CAM as “a group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional medicine.” NCCAM, like the US Office of Dietary Supplements, came into being after passage of DSHEA, and marks the federal government’s decision to commit funding to research and education about CAM. Over a billion dollars in your tax dollars have been spent by these agencies since their start.

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Using Supplements
What supplements can I use to improve my immune system?
Agents such as a potent multivitamin, NAC (N-acetyl cysteine), alpha lipoic acid and whey can all help offset oxidative stress and nutrient losses caused by HIV as well as the free radical generation and inflammation-related damage that some antiretroviral drugs cause.
For those with HIV, supplementation can be a valuable assist in restoring the body’s immune system, as evidenced by many studies, such as Dr. Jon Kaiser’s HIV Micronutrient Study, which showed a significant increase (26%) in the CD4 counts of the subjects who maintained a supplement regimen in addition to their regular medications. FYI: NYBC offers a “MAC Pack” (Micronutrient – Antioxidant Combination Pack), a product very similar to the one used in the study.
What supplements can be used to improve gut function?
Acidophilus or bifidus, glutamine, whey proteins, Saccharomyces boulardii (Florastor) and a good multi can all be important to offset gastrointestinal problems, whether HIV-related or of other origin.
What supplements can I use to manage my blood fats (cholesterol and triglyceride levels)?
“Bad cholesterol” (LDL) and triglycerides can be reduced with agents such as carnitine, pantethine, and fish oils. Niacin may be an excellent option which can also help increase HDL (“good cholesterol”). For heart health in general, aside from diet and exercise, CoEnzyme Q10 may also be of help (may also be useful in countering statin-related side effects).
What supplements are used to improve mental function and/or mood?
Acetylcarnitine, 5-HTP, tyrosine, ginkgo biloba, fish oils, SAM-e, DHEA, theanine, or St. John’s Wort may help mental function and alleviate depression, though each of these must be taken with some care (and not all together!)
See also: a full dossier on Memory Loss and Other Brain Problems from our Health+HIV section of Recommended Reading on the website http://www.newyorkbuyersclub.org; also recommended is the NYBC info sheet on Depression and supplements on this blog, under “Depression.”
What supplements can I use to combat fatigue?
Various conditions can cause fatigue, but in general, B12 (methylcobalamin) and Eleuthero (used to be “Siberian ginseng” – don’t use with high blood pressure!) may all help to improve energy. A good start may also be as simple as a good multivitamin!
For more information about the causes and treatments for fatigue, see our Fatigue Fact Sheet on the NYBC website.
What supplements can I use to stabilize my weight?
For those experiencing weight loss, whey proteins, carnitine and creatine plus CLA may all help – but of course especially in conjunction with a good diet and routine exercise! And we agree with Dr. Jon Kaiser and many others: resistance exercise remains an important component of a successful HIV management plan.
What supplements are used to treat nausea?
NYBC recommends ginger; marijuana, while effective, is not carried by the NYBC, as it is not yet approved for medical use in New York. For detailed information about the causes and treatments for nausea, see Health+HIV section of Recommended Reading on the NYBC website.
What supplements are used to improve liver function?

Liver function can be impaired due to several reasons, including disease, alcohol abuse, and the effects of some cholesterol-lowering drugs (statins).
While making sure there aren’t any interactions with your meds, supplements like milk thistle (Silymarin), NAC, alpha lipoic acid, Hepato-C or Hepato-Detox, Hepatoplex I or II, Ecliptex, SAM-e and Clear Heat are options to consider (again, not all at once!)
What supplements can be used to treat diarrhea?
NYBC suggests supplementing your diet with glutamine and calcium. For more information about the causes and other possible treatments, see our Fact Sheet about diarrhea in Recommended Reading, at http://www.newyorkbuyersclub.org.
What supplements can combat neuropathy?
Much scientific evidence now points to acetylcarnitine as an effective approach to countering neuropathy (numbness, tingling, or pain, usually in the extremities, which can be caused by HIV, diabetes or by some medications).