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Amyotrophic Lateral Sclerosis (ALS)

Rounding Out Your Program

Coenzyme Q10. CoQ10 is essential for proper mitochondrial function and acts as an antioxidant (Murray R et al 1999). Human studies have found that ALS patients have a higher percentage of oxidized CoQ10, a condition the researchers blamed on oxidative stress caused by the disease (Sohmiya M et al 2005). Several animal studies, including the following, have indicated the promise of CoQ10 in treating ALS:

Among mice models of familial ALS, administration of coenzyme Q10 significantly extended life span, and oral administration significantly increased CoQ10 concentrations in the brains and mitochondria of the test animals (Matthews RT et al 1998).
Another study found that CoQ10 significantly reduced weight loss, delayed motor deficits, and extended survival in ALS (Beal MF 2002).

Acetyl-L-carnitine. Acetyl-L-carnitine has been shown to improve mitochondrial function (Carta A et al 1993), which is impaired in ALS. It could have neurotrophic activity and increase glutathione concentrations (Thal LJ et al 2000). In one animal study, the effects of acetyl-L-carnitine were increased when it was administered in conjunction with alpha-lipoic acid (Hagen TM et al 2002).

Alpha-lipoic acid. Alpha-lipoic acid has been shown to have antioxidant properties, increase intracellular levels of glutathione (Zhang WJ et al 2001), and chelate metals such as iron and copper (Pioro EP 2000). Furthermore, alpha-lipoic acid has been shown to protect cells against glutamate-induced excitotoxicity (Muller U et al 1995). In one study, significant increases in survival and delays in symptom onset were measured among animal models of ALS (Andreassen OA et al 2001b).

Amino acids. Studies have shown that ALS patients are significantly deficient in up to nine amino acids. A Portuguese study suggested that dietary supplementation with amino acids may have some beneficial effects on the course of the disease (Palma A et al 2005).

Creatine. Creatine is synthesized in the kidneys, liver, and pancreas. In cells, creatine aids in the formation of ATP, which is the primary source of cellular energy. In multiple animal studies, creatine has been shown to provide protective mechanisms against neurodegenerative diseases. For example, it has been suggested that creatine helps to stabilize cellular membranes and mitochondrial energy-transfer complexes (Persky AM et al 2001). Creatine may also reduce oxidative stress (Tarnopolsky 2001) and increase glutamate uptake (Andreassen OA et al 2001a). Furthermore, creatine supplementation has been shown to increase survival times and improve motor performance (Tarnopolsky MA 2001; Andreassen OA et al 2001a). In human ALS patients, there is evidence to suggest that creatine may reduce motor neuron death by improving mitochondrial function (Vielhaber S et al 2001). In addition, a small preliminary study found that creatine supplementation helps reduce the loss of muscle strength in ALS patients (Mazzini L et al 2001).

Curcumin. Curcumin is a pigment found in turmeric, one of the main ingredients in curry. There is evidence that curcumin has antioxidant properties (Li J et al 2001; Naidu KA et al 2002; Lim GP et al 2001). More recent data has suggested that curcumin may help improve calcium status in muscle tissue and reduce inflammatory processes in the mouse brain (Logan-Smith MJ et al 2001; Sumbilla C et al 2002). While human studies are needed to confirm these results, preclinical evidence suggests that curcumin could be useful in ALS.

Dehydroepiandrosterone (DHEA). DHEA is a naturally occurring steroid hormone with anti-aging properties. In several in vitro studies, DHEA has been shown to protect against glutamate-induced toxicity (Lapchak PA et al 2001; Kimonides VG et al 1998; Mao X et al 1998), although few studies have examined DHEA in ALS patients.

Glutathione. Glutathione is a peptide with antioxidant properties that is naturally synthesized by the body. Increasing glutathione levels could help prevent free radical damage to cells (Exner R et al 2000). The glutathione precursor N-acetylcysteine (NAC) has been shown to boost blood levels of glutathione.

Green tea. Green tea contains a high concentration of catechins, which are flavonoids with strong antioxidant properties (Hu M et al 2002). Green tea extracts have been demonstrated to have metal-chelating properties (Levites Y et al 2002) and anti-inflammatory activity (Hong JT et al 2000).

N-acetylcysteine. Along with being a glutathione precursor, NAC has antioxidant activity of its own.In mouse models of ALS, NAC administration has also been shown to decrease motor neuron loss, improve muscle mass, and increase survival time and motor performance (Andreassen OA et al 2000; Henderson JT et al 1996).

Pycnogenol. Pycnogenol is an extract of marine pine bark that includes procyanidins and phenolic acids (Packer L et al 1999). It has been shown to have antioxidant properties (Packer L et al 1999), as well as protective effects against glutamate excitotoxicity (Kobayashi MS et al 2000). Procyanidins, which can also be found in grape seeds, cranberries, blueberries, almonds, and peanuts, demonstrate potent antioxidant properties (Packer L et al 1999). Pycnogenol is a common complementary therapy option among ALS patients (Cameron A et al 2002).

Resveratrol. A powerful antioxidant found in red grape skins, resveratrol has been found to suppress the influx of calcium into cells, which is associated with glutamate-induced cell toxicity (Wu SN 2003). Resveratrol may also affect the movement of calcium into the cells that line the inside of arteries (Li HF et al 2000).

Selenium. Used in conjunction with a traditional calcium channel blocker, such as nimodipine, and antioxidants, selenium was shown to increase the amount of vitamin E in the blood and increase the activity of glutathione, a powerful internal oxidant, among ALS patients. Antioxidant activity is often impaired in ALS patients, and treatment with this regimen was demonstrated to slow the course of the disease (Apostolski S et al 1998).

Vinpocetine. Vinpocetine inhibits the influx of calcium into the cell, which has been associated with glutamate-induced cell toxicity (Wu SN et al 2001). This is similar to the mechanism of action of riluzole, the only FDA-approved drug used to treat ALS.

Life Extension Foundation Recommendations

The goal of dietary and supplement therapy with ALS patients is twofold. First, patients need to slow neuronal damage, potentially slowing progression of the disease. Second, therapy must promote the optimization of function of the neuromuscular junction, thus maintaining a high quality of life. Life Extension's recommendations address both these areas by offering a comprehensive portfolio of supplements. No one should begin a regimen of dietary supplementation unless under the supervision of a qualified physician. Also, blood tests are highly recommended prior to DHEA supplementation to establish a baseline hormone level. Blood testing is available by calling 1-800-544-4440. Life Extension's recommendations include the following nutrients:

Vitamins and Minerals

Vitamin B12: up to 25 mg daily, sublingual or administered intramuscularly (IM).
Vitamin E (Gamma E Tocopherol/Tocotrienols): one to two softgels per day with food.
Zinc: 15 mg daily. ALS patients can also consider taking 1 mg of copper in conjunction with zinc.

Herbal Supplements

Ginseng: 400 mg daily.
Ginkgo biloba: Ginkgo Biloba Standardized Extract, one capsule per day.

Other Dietary Supplements

CoQ10: 1200 mg daily.
Creatine: Micronized Creatine, two to four capsules per day with or without food.
DHEA: A typical starting dose of DHEA is 15 mg to 75 mg. Blood testing is recommended after three to six weeks to make sure levels of this hormone are optimal.
Glutathione: L-Glutathione, L-Cysteine and C, one capsule one to three times per day before food.
N-Acetyl Cysteine: one capsule one to three times per day.
Alpha-lipoic acid: R-Dihydro-Lipoic Acid Liquid Caps, one to two capsules per day.
Acetyl-L-Carnitine: L-Carnitine, one to four capsules per day on an empty stomach with water or juice.
Mega Green Tea Extract: one capsule per day with or without food. Decaffeinated green tea is available for people sensitive to caffeine.
Resveratrol: 20 mg daily.
Selenium: 200 mcg daily. This may be administered in conjunction with a calcium channel blocker, such as nimodipine. Calcium channel blockers are available only by prescription.
Super Curcumin: 900 mg
Mitochondrial Energy Optimizer. This is a special antioxidant blend available only through the Life Extension Foundation. Please note that this product contains the proper doses of R-dihydro-lipoic acid and acetyl-L–carnitine arginate. Therefore, individuals may eliminate them from the list above if they take this product.
Vinpocetine: 5 mg daily.

ALS Safety Caveats

An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:

Acetyl-L-Carnitine

Acetyl-L-carnitine can cause gastrointestinal symptoms such as nausea and diarrhea.

Coenzyme Q10

See your doctor and monitor your blood glucose level frequently if you take CoQ10 and have diabetes. Several clinical reports suggest that taking CoQ10 may improve glycemic control and the function of beta cells in people who have type 2 diabetes.
Statin drugs (such as lovastatin, simvastatin, and pravastatin) are known to decrease CoQ10 levels.

Creatine

Do not take creatine if you have diabetes, kidney failure, a kidney disorder such as nephrotic syndrome, or are otherwise at risk of having a kidney disorder.
If you take creatine, have your serum creatinine level monitored frequently.
Creatine can cause muscle cramping, muscle strains, and gastrointestinal symptoms such as nausea and diarrhea.

Curcumin

Do not take curcumin if you have a bile duct obstruction or a history of gallstones. Taking curcumin can stimulate bile production.
Consult your doctor before taking curcumin if you have gastroesophageal reflux disease (GERD) or a history of peptic ulcer disease.
Consult your doctor before taking curcumin if you take warfarin or antiplatelet drugs. Curcumin can have antithrombotic activity.
Always take curcumin with food. Curcumin may cause gastric irritation, ulceration, gastritis, and peptic ulcer disease if taken on an empty stomach.
Curcumin can cause gastrointestinal symptoms such as nausea and diarrhea.

DHEA

Do not take DHEA if you could be pregnant, are breastfeeding, or could have prostate, breast, uterine, or ovarian cancer.
Ginkgo biloba
Do not take ginkgo biloba if you have a known risk factor for intracranial hemorrhage such as systematic arterial hypertension, diabetes, or amyloid senile plaque.
Ginkgo biloba can cause allergic skin reactions, elevated blood pressure, and gastrointestinal symptoms such as nausea and diarrhea.

Ginkgo Biloba

Individuals with a known risk factor for intracranial hemorrhage, systematic arterial hypertension, diabetes, or seizures should avoid ginkgo.
Do not use prior to or after surgery.
Avoid concomitant use of ginkgo with NSAIDS, blood thinners, diuretics, or SSRI’s.
Gastrointestinal symptoms (nausea and diarrhea) may occur.
Allergic skin reactions may occur.
Elevations in blood pressure may occur.

Ginseng

Consult your doctor before taking ginseng if you have high blood pressure. Overuse of ginseng can increase blood pressure.
Consult your doctor before taking ginseng if you take nonsteroidal anti-inflammatory drugs (NSAIDs) and/or warfarin (Coumadin). Taking NSAIDs or warfarin with ginseng can increase the risk of bleeding.
Consult your doctor before taking ginseng if you have diabetes. Taking ginseng can cause an extreme drop in your blood glucose level.
Ginseng can cause breast pain, vaginal bleeding after menopause, insomnia, headaches, and nosebleeds.

Green Tea

Consult your doctor before taking green tea extract if you take aspirin or warfarin (Coumadin). Taking green tea extract and aspirin or warfarin can increase the risk of bleeding.
Discontinue using green tea extract 2 weeks before any surgical procedure. Green tea extract may decrease platelet aggregation.
Green tea extract contains caffeine, which may produce a variety of symptoms including restlessness, nausea, headache, muscle tension, sleep disturbances, and rapid heartbeat.

Lipoic Acid

Consult your doctor before taking lipoic acid if you have diabetes and glucose intolerance. Monitor your blood glucose level frequently. Lipoic acid may lower blood glucose levels.

NAC

NAC clearance is reduced in people who have chronic liver disease.
Do not take NAC if you have a history of kidney stones (particularly cystine stones).
NAC can produce a false-positive result in the nitroprusside test for ketone bodies used to detect diabetes.
Consult your doctor before taking NAC if you have a history of peptic ulcer disease. Mucolytic agents may disrupt the gastric mucosal barrier.
NAC can cause headache (especially when used along with nitrates) and gastrointestinal symptoms such as nausea and diarrhea.

Rhodiola rosea

Do not take Rhodiola rosea if you have anxiety or bipolar disorder.

SODzymes

Do not take SODzymes if you are allergic to soy, corn, or wheat.

Vinpocetine

Do not take vinpocetine if you have a history of allergic or hypersensitivity reactions to any vinca alkaloids.
Consult your doctor before taking vinpocetine if you take warfarin (Coumadin). Have your international normalized ratio monitored frequently by your doctor if you take vinpocetine and warfarin.
Consult your doctor before taking vinpocetine if you have low blood pressure (including transient low blood pressure or orthostatic hypotension). Prolonged use of vinpocetine may lead to slight reductions in systolic and diastolic blood pressures.
Vinpocetine can cause temporary rapid heartbeat, pressure headache, facial flushing, dizziness, insomnia, drowsiness, and gastrointestinal symptoms such as nausea and diarrhea.

Vitamin C

Do not take vitamin C if you have a history of kidney stones or of kidney insufficiency (defined as having a serum creatine level greater than 2 milligrams per deciliter and/or a creatinine clearance less than 30 milliliters per minute.
Consult your doctor before taking large amounts of vitamin C if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD) deficiency. You can experience iron overload if you have one of these conditions and use large amounts of vitamin C.

Vitamin E

Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
Consult your doctor before taking vitamin E if you have a history of any bleeding disorder such as peptic ulcers, hemorrhagic stroke, or hemophilia.
Discontinue using vitamin E 1 month before any surgical procedure.

Zinc

High doses of zinc (above 30 milligrams daily) can cause adverse reactions.
Zinc can cause a metallic taste, headache, drowsiness, and gastrointestinal symptoms such as nausea and diarrhea.
High doses of zinc can lead to copper deficiency and hypochromic microcytic anemia secondary to zinc-induced copper deficiency.
High doses of zinc may suppress the immune system.

For more information see the Safety Appendix

*These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease.

The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. You should not stop taking any medication without first consulting your physician.