Supplements as alternatives to benzodiazepines

Here’s an update on this topic:

In her 2007 book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition, Dr. Hyla Cass has an interesting section (pp. 139-140) dealing with supplement alternatives to benzodiazepines and other drugs such as Ambien. (These drugs are generally prescribed as anti-anxiety agents and as sleep aids.)

Dr. Cass is a practicing physician and an expert on integrative (“holistic”) health, and one of her main concerns is to present ways to counter prescription medication side effects, or to identify supplement alternatives to prescription drugs.

Of benzodiazepines (the best-known tradenames in this category are Valium, Xanax, Ativan, Klonopin, Librium, Halcion), Dr. Cass writes that a principal problem is that these drugs develop dependence, and so can require steadily increasing dosages as time goes on. (Ideally, she says, they are intended as short-term therapies, but in fact many patients end up being prescribed them for a much longer time.) Withdrawal from these drugs can be quite hazardous, and should be done only under medical surpervision. Moreover, the effect of this class of medications is often a dulling of response, so their use can be associated with accidents.

Since benzodiazepines deplete needed nutrients, Dr. Cass advises supplementing as follows if you take them:

1000-1200mg Calcium/day, plus 400-600mg/Magnesium
400-800mg Folic acid/day
1000 IU Vitamin D/day
30-100mcg Vitamin K/day

She also states that in her own practice she has often successfully substituted supplements for these prescription drugs. Among the calming supplements that she has used:

5-HTP: 100-200mg at bedtime
Melatonin: 0.5-3.0mg at bedtime
L-theanine: 200mg, one to three times daily, as needed

In Dr. Cass’s view, supplements such as these, sometimes used in combinations, can provide a good alternative to the addictive benzodiazepines and their side effects (which, she says, are also characteristic of the newer drug Ambien).


See the following NYBC entries for additional information on the supplements mentioned above:

Melatonin 1mg and Melatonin 3mg

Theanine Serene (includes L-theanine)

NYBC also stocks 5-HTP and the closely related Tryptophan.

Also note that the Jarrow supplement Bone Up very closely matches the set of supplements recommended by Dr. Cass to offset the nutrients depleted by taking benzodiazepines (Calcium, Magnesium, Folic acid, Vitamin D, Vitamin K).

Drugs versus supplements as sleep aids

One of the reasons people turn to supplements is that drugs often have side-effects which make their use, especially over the long term, more damaging than helpful. That may be the case with long-term use of some common over-the-counter drugs to aid sleep.

A 2010 study published in the journal Neurology, for example, looked at drugs called anticholinergics, which block acetylcholine, a nervous system neurotransmitter. They include such common over-the-counter brands as Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM, and Unisom. They are taken for a variety of common medical conditions including insomnia or allergies. Unfortunately, according to this Indiana University study, over the long term these drugs also produce cognitive impairment. According to the study authors, taking “one anticholinergic significantly increased an individual’s risk of developing mild cognitive impairment and taking two of these drugs doubled this risk.”

Given these risks, it makes sense to consider such alternatives as Melatonin or 5-HTP. While these supplements, like many others, should be taken carefully and according to recommendations, we don’t know of any research suggesting that they produce cognitive impairment over the long run!

NEW! Managing and Preventing HIV Med Side-Effects

To mark its fifth anniversary, the New York Buyers’ Club has prepared a special edition of SUPPLEMENT. In it you will find a concise Guide to managing and preventing HIV medication side effects with supplements and other complementary and alternative therapies.

This is an invaluable introduction to how nutritional supplements can be used to counter those side effects that can make life miserable–or even disrupt treatment adherence–in people taking antiretroviral medications for HIV.

Read about approaches to dealing with diarrhea, nausea, heart health issues, diabetes, insomnia, fatigue, liver stress, lipodystrophy, anxiety and depression.

This FREE Guide is available online at:

On the NYBC website you can also SUBSCRIBE to the nonprofit co-op’s quarterly FREE newsletter, THE SUPPLEMENT, which continues to offer a unique perspective on current evidence-based use of supplements for chronic conditions including cardiovascular disease, diabetes/insulin resistance, hepatitis and other liver conditions, anxiety/depression, osteoarthritis, cognitive and neurorological issues, and gastrointestinal dysfunction.

The Problem with Celebrex and other NSAIDS: Another Reason to Consider Glucosamine and Chondroitin as Alternative for Osteoarthritis Pain

As Dr. Hyla Cass points out in her excellent book Supplement Your Prescription: What Your Doctor Doesn’t Know about Nutrition, NSAIDs (including older ones such as aspirin, as well as newer ones like Celebrex), which are very widely used for arthritis pain, have the unfortunate side effect of inhibiting the enzymes needed to create cartilage. “Essentially,” she writes, “this means that the drugs used to relieve arthritis-related discomfort accelerate the progression of the disease.” (p. 86)

Indeed, as Dr. Cass goes on to note, there’s a study showing that people taking NSAIDs on a regular basis to relieve knee arthritis pain actually have a greater risk of worsening the disease over time than people who take a dummy pill! Moreover, another study showed that people taking NSAIDs for knee arthritis were at higher risk for developing arthritis in the hip or in the other knee, compared to people who did not take these drugs.

Just another reason to consider use of the supplement glucosamine chondroitin to support joint health. See additional information, including dosage recommendations, at NYBC’s Glucosamine Chondroitin entry.

Book Review: “Supplement Your Prescription — What Your Doctor Doesn’t Know About Nutrition,” by Hyla Cass, M.D.

This is an excellent guide to managing the side effects of prescription drugs through better nutrition and nutritional supplements. Published in 2007 by Basic Health Publications, it synthesizes much recent research on how the most frequently prescribed drugs for Type 2 diabetes, cardiovascular disease, osteoarthritis, and depression often cause nutrient deficiencies that can lead to additional health problems. Dr. Cass, who is a practicing physician and a specialist in integrative medicine, provides clear analyses of these damaging side effects and offers recommendations on how to address them.

The first condition discussed by the book is Type 2 Diabetes/insulin resistance/metabolic syndrome. For those who are taking the most commonly prescribed drug for Type 2 Diabetes, metformin, Dr. Cass stresses the importance of supplementing with Vitamin B12 (200-1000mg/day) folic acid (400-800mg/day) and CoQ 10 (30-200mg/day) to make up for the nutrient-depleting effects of the medication. Vitamin B12 and folic acid, together with Vitamin B6, are crucial for keeping levels of an amino acid called homocysteine in check in the body. Since elevated levels of homocysteine are associated with heart disease, stroke, hypertension, neuropathy, and Alzheimer’s, it’s a top priority to keep the body supplied with the B vitamins that can control it.

Dr. Cass also provides a “Diabetes Supplement Program” especially directed to pre-diabetics who may be able to address their condition with diet, exercise, and supplements (the B vitamins and CoQ 10 mentioned above, plus alpha lipoic acid, antioxidants, and the trace minerals chromium and vanadium, which are needed in blood sugar processing).

Much more to discuss in this very useful book, so we will come back to it again!

Most Important CAM Q in HIV to you–

There is an NIH grant that FIAR is considering applying for with collaborators on Complementary and Alternative Medicine (CAM) in the context of HIV disease.

If you could have one clinical question answered about CAM and HIV, what would it be?

Would it be about slowing disease progression? Managing a side effect?

What agents—vitamins, minerals, antioxidants, amino acids, herbs, etc.—are most important to you?

Please don’t hesitate to write to reply here or email me at or with your ideas.

Thanks for your thoughts!
George M. Carter

When FDA-Approved Drugs Stumble, Shouldn’t Patients and Healthcare Providers Consider Dietary Supplements Instead?

Our friends at the FDA have come under a lot of criticism lately.

It seems that every time you open a newspaper (OK, we actually open our browser these days), there’s a new revelation about problems with an FDA-approved drug:

• Vioxx: approved by the FDA in 1999 to treat arthritis pain; withdrawn by manufacturer Merck in 2004 because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use

• Statins: a class of FDA-approved drugs to lower cholesterol, including such well-known names as Lipitor; studies have found statin therapy may be associated with heart problems and myopathy (muscle weakness)

• Procrit: one of several drugs for anemia that now carry FDA-mandated “black-box” warnings indicating that they can increase risk of death or serious medical complication, especially when used at high dosage. Procrit and other red blood cell-stimulating drugs had been advertised as “improving quality of life,” but can worsen cancer and increase the risk of blod clots

• Avandia: in May, 2007 the New England Journal of Medicine published a report concluding that this FDA-approved diabetes drug is associated with increased heart attack risk; federal drug reviewers agreed, and said that Avandia is particularly dangerous for people also taking insulin

These and other revelations led Congress to pass legislation this year aimed at improving the FDA’s ability to force follow-up studies on approved drugs, so that serious problems could be detected earlier. (There’s a lot to say about how the FDA approval process has been corrupted by its dependence on funding from pharmaceutical companies, but for the moment we’ll pass by that topic!)

Here we’d just like to ask whether it doesn’t make sense–given such issues as these with prescription drugs—-for patients and their healthcare providers to consider dietary supplements and nutritional strategies as an alternative whenever possible.

Some specific alternatives to the drugs above:

• Glucosamine and chondroitin for osteoarthritis pain; SAMe also effective for this purpose in some trials.

• Niacin and/or fish oil to manage cholesterol; CoQ 10 to offset statin-related side effects. (See the studies on CoQ 10 in this Blog for evidence about how this supplement can counter statin-related muscle pain and diastolic function impairment.) 

• Marrow Plus to counter anemia; may be useful for chemotherapy-associated anemia. See this comment on Marrow Plus from one NYBC member who used it to maintain blood counts during six months of Pegasys/Ribavirin combination therapy for Hep C.

• Chromium supplementation may improve insulin function in diabetics; dietary supplements such as Glycemic Balance may also be useful.