Dr. Brett Osborn’s Recommended Supplements from The “Get Serious” Book
Dr. Brett Osborn’s Supplements comes in the Get Serious Book, Dr. Osborn is a board-certified Neurological Surgeon with a secondary certification in Anti-Aging and Regenerative Medicine. He recommended some supplements in his book Get Serious that you can review in this post. please don’t forget to share your comments and thoughts below!
Work Your Brain, Protect Your Brain
Exercise is protective of the heart, we all know that. The transient stress imposed on the heart (by the working muscles) makes the heart a more efficient pump through a variety of mechanisms that will not be detailed here. Suffice it to say that getting your heart rate up every day is beneficial. Sitting on your ass all day exerts just the opposite effect.
As detailed elsewhere in this book, your brain benefits from exercise as well. I know, it’s not a muscle. Physiologically, mechanistically and structurally, it is in no way related to muscle. But it can be worked as muscle is worked during exercise.
Exercise forges neural pathways in the brain. Let’s face it, there is a component of learning in exercise. As you learn to write with your left hand, for example, you learn to properly execute a squat. The process of learning literally rewires the brain. That’s why it takes time. You cannot master the squat overnight.
Why? The brain has to change. Neuronal connections or “synapses” are formed through very complex biophysical mechanisms under the influence of growth factors such as NGF (nerve growth factor) and BDNF (brain-derived nerve factor).
These “neurotrophins” provide neuroprotection, exert anti-inflammatory effects on the brain, reverse age-associated spatial memory loss, and enhance learning. Akin to foods with high levels of antioxidants, NGF and BDNF act as free radical scavengers as well. And you know what free radicals do to your brain? Let’s put it this way: free radical-induced damage has been implicated in the genesis of neurodegenerative diseases such as Parkinson’s and Alzheimer’s.
In the Alzheimer’s brain, there is noted degeneration of “cholinergic” neurons, the subset of neurons that use a chemical known as acetylcholine to talk to one another. These are critical to the formation of new memories which is why grandma can’t remember what she had for dinner last night, yet recalls the names of her childhood friends. Tell grandma to get more exercise! Studies have shown that the associated up-regulation of nerve growth factor (NGF) could reverse the destruction of cholinergic neurons seen in the Alzheimer’s brain.
But don’t wait until you develop Alzheimer’s dementia to start running. Start now! Increased physical activity is protective of the brain as it prevents the progression of age-related brain atrophy. And this is not only inclusive of the brain’s memory centers, but of every region of the brain. Yes, neuronal death is inhibited by physical activity. This too is likely a function of stimulated expression of nerve growth factors. There is also recent evidence that the augmented blood flow to the brain during exercise promotes neurogenesis. Exercise can enhance both your learning abilities and memory!
How else can you turbo-charge your brain? Easy. Learn a new skill (like a properly executed squat or a deadlift). Or what about a new language? Try holding your fork with your non-dominant hand. Can you juggle three balls? No? Well then learn. I routinely do problems from SAT or LSAT prep books under time constraints to keep my mind sharp (in addition to keeping up with my ever-endeavoring children).
Daily mental challenges are important, but not because they will make you “smarter” as is often advertised by those standing to earn millions, effectively selling intelligence. I mean, who doesn’t want to be smart? Mental exercise like physical exercise is task-specific. As discussed in another chapter, the concept of “functional training” is bunk. You don’t swing a weighted golf club to better your swing. This does not work! And may in fact prove detrimental. One task does not translate to the other. The best way to better your golf swing is to… play golf! And the same is true for your brain. It is unlikely that your I.Q. will skyrocket as a result of these “brain games,” however you may become a more astute test taker or a more efficient problem solver. And that may provide some collateral benefit. The magnitude of this effect is a topic of ongoing debate in fact. Is it that intelligent adults do crossword puzzles or are the crosswords to some degree making them intelligent?
My 96-year-old grandmother, for instance, did crosswords into her final days. Sharp as a tack, she routinely took me to school in the daily word scramble. I was both mortified yet proud at the same time. Was it her voracious appetite for books and the daily Jumble® that fostered intelligence, or was it her intelligence that demanded she read and challenges herself with puzzles? All I know is that she remained “smart” until the very end, which is what we all aspire to.
We’ve all heard about drugs that reportedly make you smart, so-called “smart drugs” or nootropics. But is this myth or reality? I can tell you one thing for sure:
many pharmaceuticals are being used as “neuro-enhancers.” In Europe, where regulations are less stringent, many brand-name drugs are utilized off-label to enhance cerebral blood flow, increase the concentration of a particular neurotransmitter, and/or stimulate neurogenesis. These include Hydergine, Deprenyl, and Prozac (respectively) to name a few. Yes, Prozac (that wasn’t a typo) has been shown to enhance neurogenesis in patients who have suffered a stroke. Whether or not this will ultimately translate into a functional improvement in healthy individuals is unknown.
There are some smart drugs that are also available over-the-counter: They are sold as nutritional supplements. Below, I review some of my favorites.
In my opinion, the oldest and most popular is Piracetam, the mechanism of action of which remains unclear. Its index 1976 study involving college students demonstrated improvements in verbal learning after 14 days. This smart drug has also been shown to have a variety of positive effects in patients with cognitive disorders (i.e. dementia) and epilepsy. The side effect profile of Piracetam, marketed interestingly as Nootropil, is very benign; the reported side effects like headache and irritability are mild.
800 mg twice daily.
Derived from the periwinkle plant, vinpocetine is a smart drug that has been demonstrated to have potent anti-inflammatory effects which are at least partly responsible for its beneficial effects on demented patients. Remember, inflammation is a key component in the pathogenesis of Alzheimer’s disease and other neurodegenerative conditions.
Vinpocetine also improves neuronal plasticity, blood flow to the brain and maintains healthy levels of neurotransmitters. It has anti-seizure activity in animal models as well, stabilizing the brain. Available with a prescription in Europe, Vinpocetine was historically used for age-related memory decline. In the context of its reported effects on the brain, we Americans use it as a neuro-enhancer. And you can buy it in most health food stores!
10mg, 1-3 times daily.
Caution: Speak to your doctor before starting Vinpocetine as there may be an interaction between it and blood-thinning medications.
Everyone has heard of the next one: Ginkgo Biloba. I’ve personally witnessed many people buying ginkgo in the health food store; they’ve been told: “it’s good for the brain.” And there’s likely truth to it. Ginkgo exerts its effects by increasing levels of neurotransmitters in the brain, reducing blood viscosity, and quenching free radicals (as an antioxidant).
Do you notice a trend here? Several small studies have substantiated ginkgo’s beneficial effects on performance in tests of attention and memory. And while larger randomized trials have yielded inconsistent results, there clearly is promising evidence of improvement in cognition and function associated with ginkgo. Some individuals use the prescription drug donepezil (Aricept) in an effort to thwart off Alzheimer’s disease. Why not use ginkgo instead? A trial comparing the two in fact demonstrates similar efficacy in the treatment of mild to moderate Alzheimer’s disease. So save your money (and your brain). Add ginkgo to your regimen.
100-600 mg daily.
Caution: As ginkgo is a blood thinner, discuss its usage with your doctor.
Last but not least is pregnenolone. It’s literally a steroid hormone for the brain, similar in structure to progesterone. And we know progesterone does wonders for the brain, right? Pregnenolone has come to the forefront recently, possessing numerous potential benefits. As it or its derivatives play roles in myelinization and confer neuroprotection, studies have demonstrated benefit in animal spinal cord injury models and in those designed to assess learning and memory. But are these studies applicable to humans? Large randomized trials simply do not exist.
We do know that pregnenolone is found in high concentrations in the healthy brain. It’s made there! Levels fall however as you age, and its neuroprotective effects by virtue, are diminished. Your memory begins to deteriorate. Sometimes depression sets in…
Pregnenolone levels are significantly reduced in the cerebrospinal fluid of depressed patients which bespeaks its potential as a non-pharmaceutical therapeutic. In fact, among users, pregnenolone has often been labeled as the “happiness hormone” on the basis of its mood-enhancing effects, but don’t assume you have to be depressed to use it!
50 mg daily
Caution: Keep in mind too that pregnenolone is a hormone. That being said, there are potential associated side effects (akin to hormone replacement therapy). At low doses, however, pregnenolone is very well tolerated. If you have hormone-sensitive cancer, be sure to discuss its usage with your doctor.
DR.BO: Rarely a day goes by when someone doesn’t ask me about what supplements I take to stay in shape. (Note: I am rarely asked about my workout routine or dietary recommendations!) I believe that many people regard supplements as magical elixirs that can fast-track you to a better body.
A case in point is my friend, who I recently encountered while browsing through the supplement shelves in Whole Foods. Karen mentioned that “someone” had told her that “cat’s claw” was good for heartburn (GERD), and she wanted my opinion. Karen is severely obese. My first thought was, this woman has much bigger battles to fight. What she really needs to do is lose 150 pounds! My guess is, once her weight problem is resolved, her GERD will disappear. I didn’t push the subject because I understand that people are very sensitive about their weight, and it wasn’t the time or place for me to start prescribing. I did, however, tactfully suggest that she try taking high-dose omega-3 fatty acids, which not only address both her digestive and weight issues to some degree, but I also believe provide the most benefit of any supplement on the market.
There are countless people like Karen, who can’t see the forest through the trees. They have little insight into their medical conditions; they lack introspection. Instead of coming to grips with their problem, they look for remedies for ancillary issues. They seek laxative supplements instead of modifying their diets to include at least 20-25 grams of daily fiber and increasing their water intake. They seek supplements touted to lower blood pressure when their diets are laden with sodium and carbohydrate. Obviously, the real and long-lasting solution is to fix the primary issue first. The majority of health problems can be solved with dietary modification and daily exercise. (More than 90 percent of chronic diseases are environmental, remember?)
Don’t misconstrue this. I am in no way recommending that you abandon nutritional supplements, quite the opposite in fact. I use them aggressively. So should you. But understand their rationale, keeping in mind that they are not cure-alls, but rather health “supplements.” Supplements are not to be used as primary treatments for ailments that should be otherwise addressed. They are as their name infers, “supplements,” to be taken in addition to an optimal diet and lifestyle. They will not, unto themselves, remedy your elevated blood sugar, gouty arthritis, and hypertension. Only you can. Stop looking for the easy way out (an all too common ailment of today’s society). I can assure you raspberry ketone, in isolation, is not the answer to your obesity. Ignore the sensationalized claims! Dig deep inside yourself prior to stepping foot into the health food store. Forget about the cat’s claw and the cat’s foot. Educate yourself, and in the same vein, stop wasting your money.
Big Pharma Enters the Picture
I’m the first to admit that some supplements that are heavily hyped are completely worthless. (You could say the same about many medical procedures and prescription drugs too!) I don’t want to beat up on the supplement industry; there are enough people out there doing it. Supplements have been the whipping boys of the health industry since Linus Pauling touted the merits of vitamin C, or before. As they are considered foodstuffs, supplements roam outside the radar range of the FDA.
Essentially, anyone can manufacture a supplement; it’s as simple as concocting a novel dessert recipe. For better or for worse, this has attracted a significant amount of scrutiny from various governing bodies and their proponents. Quite frankly, Big Pharma is pissed. Supplements, some of them, truly has the potential to impact disease incidence and therefore, company revenue. Remember, companies like Pfizer and Merck thrive on the treatment of illness. There is money in disease, not health. Due to this, supplement manufacturers have been vilified and touted as the mortal enemy threatening to rob the gravy train. And that’s exactly what it is.
The pharmaceutical industry is corrupt. Overtly. Drug trials are falsified. Indications for medications are extended to squeeze every last cent out of patients. Billions, in fact. And yes, supplement manufacturers are similarly culpable with one exception: there are far fewer deaths associated with such nutrients. Acetaminophen overdose accounts for an estimated 450 deaths each year due to acute liver failure. Tylenol! And what about Vioxx? And Bextra? In 2010, there were 16,451 unintentional deaths related to pharmaceutical drugs. Clearly, Big Pharma CEOs didn’t receive the “Primum Nil Nocere” memo—(First, do no harm!). Or were they too busy (filling their coffers with gold bars) to read it?
Billions of dollars in pharmaceutical company revenue are potentially lost with widespread acceptance and usage of nutritional supplements. Not surprisingly, there has been a backlash in response to this perceived threat. Supplement manufacturers (Life Extension®) have been raided by the FDA, utilizing military-style tactics and dubious studies refuting the efficacy of supplements (when in fact such studies often have serious design flaws). Naysayers abound.
Except, of course, when Big Pharma figures out a way to make money on supplements—then it’s a wholly different narrative. The efficacy of several key supplements has recently been recognized by the pharmaceutical industry. Ever heard of omega-3 fatty acids or fish oil? What about resveratrol?
Of course, you have. GlaxoSmithKline invested $1.65 billion to purchase Reliant Pharmaceuticals specifically to acquire the manufacturing rights of Lovaza®, an omega-3 fatty acid supplement that had been vetted by the FDA, therefore classifying it as a pharmaceutical. Yes, you need a prescription for it. And yes, it is expensive as hell: $265.00 per month vs. $35.00 for an OTC substitute! Because it is “pharmaceutical grade.” Umm… who cares? Bottom line: the stuff works! For years, claims touting the efficacy of omega-3 fatty acids (in the context of a variety of disease states) have fallen on deaf ears. Until relatively recently. Interestingly, when Big Pharma jumped aboard the bandwagon, so did some of my colleagues.
I remember banging my head against the wall in frustration, as I tried to convince a local neurologist of the merits of omega-3 fatty acids. For years this banter continued. Ultimately I threw in the towel, only to find out that she now prescribes omega-3 fatty acids to all of her patients with memory disorders. Ironically, she’ll never remember arguing with me. At least we’re getting somewhere though, right? Big Pharma steps in, people listen. Right or wrong (and often duped), people listen. Hopefully, the same thing will happen in the case of this next supplement, a soon-to-turn drug.
Resveratrol is an antioxidant and anti-inflammatory agent found in the skin of red grapes and in the Japanese knot wood plant. It is the molecule suspected to give red wine its cardio-protective effects and may extend human lifespan, as it does in experimental animals. GlaxoSmithKline (again) paid a boatload of money for Cambridge-based Sirtris Pharmaceuticals, a biotechnology company synthesizing a proprietary formulation of the compound resveratrol.
A patentable version of the readily available OTC supplement. In regular English, that means DRUG! Sounds enticing, right? I can just picture the commercials detailing this novel “life-extending” drug. Now imagine the riots in doctor’s waiting rooms as patients await their prescription for this propagandized, chemically modified supplement. Who doesn’t want to be younger? But akin to Lovaza and the readily available supermarket-grade omega-3 fatty acids, this uber-drug will be chemically and functionally similar to the native compound available at Walmart for a quarter of the price. If anything, the guerilla-style marketing tactics employed by the pharmaceutical companies to advertise such drugs will raise awareness of the many benefits of resveratrol. If it’s not a household name by now, it will be, and on their dollar no less.
I would urge you not to wait for the launch of this “miracle” drug. GSK has recently internalized Sirtis Pharmaceuticals but continues to research the compound’s effect on human metabolism. And unless the drug is fast-tracked through the FDA, years will pass prior to its release. Worry not, it is readily available. But wait, where’s the data? My friends, if you are waiting for “the data” that establishes the health benefits of nutritional supplements prior to investing your money, you’ll be long dead before that “data” is published.
The proof is in biochemistry. I again point you to the French Paradox. Research it for yourself. And look at the Japanese. They live on average five years longer than Americans. Seems like they have a secret “anti-aging” strategy, right? Wrong. It’s simply high omega-3 fatty acid intake, limited non-vegetable carbohydrates, and daily exercise. The upshot? High insulin sensitivity. And the ingestion of resveratrol has similar effects. It is likely then that resveratrol will extend human life. Don’t wait for FDA “approval.” Its only motivation is money. And there is money in disease, not health. So act now! Optimize your diet, exercise, and take the proper supplements.
So which ones qualify as “proper?” Well, that’s purely a matter of opinion. Everyone is distinct physiologically. Some may be better served with one versus the other ultimately. At this point, however, detailed metabolic testing can be cost-prohibitive and therefore not readily available to the masses. I choose to take those supplements that logically appear to have the most benefit given the limited available data.
I know what you’re thinking. Dr. Osborn is taking excessive amounts of supplements when he is probably getting the necessary amounts of these micronutrients from his food. Wrong. Neither you nor I am obtaining adequate micronutrients from the food we eat. There are two reasons for this truism. One, your diet simply does not provide adequate amounts of cold-water fish, green tea, curcumin (in curry powder), and resveratrol to name a few. It doesn’t. And two, if you think it does, you’re wrong. Our food is nutritionally depleted of vital nutrients, and it is laden with toxins (i.e. pesticides). So don’t be fooled by package labeling: err on the side of supplementing.
I know what you’re thinking. If you take high doses of certain vitamins, you will either “overdose” on them, or your body will dispose of them in what critics of supplements so disparagingly dismiss as “expensive urine.” First, the safety profiles of the recommended supplements (and supplements in general) are excellent (far better than that of pharmaceuticals). You are extremely unlikely to overdose. In fact, I have never even heard of a supplement overdose (this does not include ergogenic aids which are often abused). My point? If you can afford to supplement, and your diet and exercise regimens have been optimized, do it! Err on the side of “expensive urine,” particularly in regards to vitamin C, as it has been shown to reduce the risk of bladder cancer (yes, that vitamin C sitting in your bladder is a chemopreventive agent!)
So how, from the literally thousands of supplements on the market, do I select the few that I should take? I chose my supplements logically, based upon what we know to be the agents of the aging process and particularly age-related disease. And they are the same: free radical damage, oxidative stress, and chronic inflammation. While these to some degree are by-products of normal metabolic processes, our systems are easily overloaded despite fairly robust defense mechanisms (antioxidant systems, for example). Therefore, supplementation for most of the non-genetically-endowed populace is essential for health.
Listen to me. No, look at the pictures! I am healthier than I’ve ever been at age 43. My mind is sharp and I’m in better shape than I was as an adolescent. And you can be too! If you assume control. To a great degree, you can thwart the development of age-related bodily changes, the accumulation of which leads to disease.
As discussed previously, vitamin D3 is a vital hormone involved in hundreds of biological processes. Until relatively recently, its importance was underappreciated. Yes, we were aware of its effects on bone health and calcium regulation, and yes, we knew that it was produced when one’s skin was exposed to ultraviolet radiation. But now, we are aware of its wide array of benefits (and I mean wide). You see, vitamin D3 receptors have been identified on many cell types including those of the heart and the brain.
Its presence is required for normal cell function. Knowing this, why is it that so many Americans are vitamin D3 deficient? It boils down to two things really: lack of awareness of its health-promoting effects and poor surveillance. Whatever the case may be, do not hesitate. Get tested and intervene if necessary, as failure to do so will predispose you to a variety of diseases.
Why is the knowledge of your vitamin D3 level so critical? There is evidence that Vitamin D3 deficiency is associated with stroke, insulin resistance, Alzheimer’s dementia, coronary artery disease, and cancer. So supplement aggressively, and strive for a serum level of 50-65 ng/mL.
Do not for a second assume that the RDA of 600 International Units (I.U.’s) is sufficient. It’s not (unless you literally live in the sun). Similarly, do not rely on a daily glass of “fortified” milk to satisfy your daily vitamin D3 requirements. That’s a joke. The 100 plus I.U.’s supplied per eight-ounce glass is a drop in the bucket relative to your needs. I take 10,000 units daily to maintain my level of near 65 ng/mL. Take it from me, your levels are suboptimal. Don’t believe me? Go get tested, I’ll prove it to you…
Hormone panels (i.e. thyroid function tests) and replacement therapy (HRT) will be discussed in chapter 11. Keep in mind too, that there is a myriad of laboratory tests, many of which are esoteric, available to you. I would not recommend a shotgun approach, however; do not subject yourself to every laboratory test under the sun. The above are excellent screening tests, the results of which you will potentially act upon. They may change your life. Insist that your doctor orders them.
OMEGA-3 FATTY ACIDS
Omega-3 fatty acids: if you could choose one, this would be it! It is by far the best supplement out there for all-around health benefits. There are literally volumes of data demonstrating the beneficial effects of omega-3’s stemming from their robust anti-inflammatory and antioxidant capacities.
An integral part of your cell membranes (walls surrounding your cells), omega-3 FA (fatty acids) are vital to your health and particularly beneficial to your heart and brain. You truly are what you eat. All fish oil is not created equal. Do not buy the first “fish oil” supplement you come across. In fact, stay clear of such supplements, as most are laden with omega-6 FA. And while these fatty acids are needed to mount an inflammatory response (immune system response, wound healing, and muscle repair), I can assure you that your diet supplies surplus amounts.
Remember the omega-6:omega-3 ratio of the American diet is 20:1; optimal is 1:1 (Japan is closest with 4:1). Instead, purchase purified omega-3 FA capsules. Pay particular attention to the quantity of omega-3 per capsule and dose accordingly. In the event that you are unable to find purified preparations and have to buy “fish oil,” attempt to find those capsules that have the most omega-3 FA per capsule and the least omega-6. Your goal is to minimize the intake of omega-6 FA and maximize omega-3 FA intake. Do not assume that your “Fish oil 1200” has 1200 mg of omega-3 fatty acids per capsule. It doesn’t. Likely it has 300 mg. So don’t be fooled! Read your labels carefully, twice.
In order to optimize that critical omega-6: omega-3 ratio (discussed previously), take this supplement liberally. I recommend a minimum of 3 grams (3,000 mg) daily in divided doses. Many individuals take 10 to 15 grams daily without adverse effects (Eskimos eat a lot of fish, right?).
Caution: Omega-3 fatty acids may interfere with blood clotting particularly at high dosages (> 3,000 mg daily). Please discuss usage with your doctor particularly if you are taking blood thinners (warfarin) or medications that interfere with platelet function (aspirin, for example). Accordingly, alert your surgeon if you have a procedure scheduled.
Those with allergies to fish should use precautions when taking omega-3 FA. Discuss this with your doctor (and preferably an allergist) prior to starting the supplements. And here’s a trick. Bloating, belching, and diarrhea are common side effects of omega-3 supplements. Simply store your capsules in the freezer; the fatty acids will be released in a more delayed manner and these side effects diminished. This may not be a bad idea anyway as it slows down the oxidation process (fish oil can be oxidized prior to its consumption).
As discussed previously, resveratrol is one of the compounds found in wine thought to confer protection against coronary events in people consuming a high-fat diet. Remember the French Paradox? There are numerous animal studies demonstrating its life-extending effects. And biochemistry has, to a great degree, been elucidated. In addition to providing robust anti-inflammatory effects, resveratrol influences the expression of several gene products which influence metabolism. In past chapters, I’ve talked about the inflammatory effects of insulin, particularly excess insulin. Remember, the more circulating insulin, the more bodily inflammation, resulting in more inflame-aging. People suffering from type II diabetes are ravished by the effects of elevated circulating insulin.
They are the poster children for accelerated aging (particularly those who are poorly controlled). Hmm… so what happens when we attenuate the insulin signal? The opposite occurs theoretically: we age slower. And this is precisely the line of logic utilized by those practicing caloric restriction or CR. By no means is this an easy protocol (30 percent reduction in caloric intake); it is not for the faint-hearted. Yet it potentially offers life-extending benefits (studies are obviously difficult to perform given the endpoint: death). Don’t worry! You can derive similar benefits from resveratrol supplementation. Mark my words, a chemical modification of resveratrol will be launched one day as an “anti-aging drug.” Diabetics, this is an extremely important supplement for you.
20 mg daily. For the record, 20-mg resveratrol supplements provide approximately 220 times the amount of resveratrol found in one fluid ounce of that red wine the French are drinking! Is it really better to consume more? Would we derive similar benefits from a smaller dose? We simply do not know as longitudinal studies in humans have not been performed.
GREEN TEA EXTRACT
Likely a factor in the enhanced longevity of the Japanese, green tea is a robust antioxidant that has anti-cancer effects probably through its epigallocatechin gallate or EGCG content. EGCG works by protecting cells from lipid peroxidation and DNA damage thought to be integral to atherogenic and neurodegenerative processes. Yes, green tea may slow the progression of Alzheimer’s disease by inhibiting plaque formation. Its anti-cancer effects are due to inhibition of tumor angiogenesis (tumor blood vessel formation) and its ability to induce apoptosis (programmed cell death) in tumor cells.
Take a minimum of 900 mg daily in divided doses. Ideally, one should drink several cups of green tea daily if possible (and in this case, scrap the extract).
It is suspected that the incidence of Alzheimer’s disease in India is approximately 50 percent lower than that in the United States because of the high quantities of turmeric consumed, the main ingredient of curry powder. Fifty percent! Curcumin (a derivative of the turmeric spice) has powerful antioxidant and anti-inflammatory properties, both of which thwart the formation of amyloid plaque. With regard to the latter, curcumin has been utilized to treat osteoarthritis and inflammatory bowel disease.
Researchers are now pursuing its potential anti-cancer (chemopreventive) effects. Here’s the issue. The bioavailability of curcumin is low (i.e. it is poorly absorbed) at oral doses < 4 grams. To remedy this, choose a curcumin preparation with piperine (a black pepper derivative), which has been demonstrated to enhance bioavailability in the first several hours after ingestion. Taking your curcumin with a fish oil supplement may also increase bioavailability by promoting absorption.
800-1,000 mg. Caution: Curcumin may interfere with platelet function and therefore blood clotting. Please discuss usage with your doctor particularly if you are taking blood thinners (warfarin) or other medications that interfere with platelet function (aspirin, for example). Alert your surgeon preoperatively as well!
These days, you always hear about B-complex vitamins in the context of energy drinks (sheer nonsense!). B-complex vitamins are important for what is termed “methylation,” a cellular process that occurs a billion times per second. It’s a complicated process involving the transfer of a “methyl” group from one molecule to another.
It is critical to the regulation of protein function and gene expression, without which, well, we’d all be goners. Deficient or “hypo” methylation is associated with a variety of diseases such as cancer, coronary artery and cerebrovascular disease, and neural tube defects to name a few. Faulty methylation is associated with elevated homocysteine levels in the blood (more on this later). This often can be remedied by supplementing with B vitamins (“complexed” to include the eight chemically distinct forms). I typically stick with the preparations that have the most folic acid per tablet (with a little bit of searching you will find those with 400 mcg).
1 tablet daily. And when, not if, your urine turns bright yellow and quite frankly “stinks,” do not equate this to inefficacy or malabsorption of the product. The former is an effect of riboflavin (the Latin word “flavus” means yellow or golden) and the latter, pyridoxine in the preparation.
Nobel prize winner Linus Pauling alerted us to the vast role that vitamin C plays in the human body. It is integral to numerous biological processes such as tissue repair, the quenching of free radicals (antioxidant), and the formation along with the maintenance of skin, tendons, ligaments, and blood vessels. With regard to the latter, Pauling asserted that chronically low levels of vitamin C (“chronic scurvy”) are a cause of atherosclerosis.
In the same vein, it has been postulated that a bear’s ability to thwart off atherosclerotic disease (despite elevated inflammatory markers and high cholesterol levels during prolonged periods of hibernation) is causally related to their high circulating levels of vitamin C. Why? Because they synthesize it! And guess what? Humans don’t. We must obtain it from our diet or through supplementation. Do not neglect your vitamin C. It is protective of your cells and particularly your vascular endothelium. Statistically, you are likely to die of vascular disease, right? So get a jump on it.
2-5 grams. Those of you who smoke, err on the high end of that range. Better yet, scrap the cigarettes now. Don’t be an idiot.
VITAMIN E (mixed tocopherols and tocotrienols)
Firstly, vitamin E does not cause prostate cancer, as a recent study suggested. I’m calling bullshit on this one too (as is every respectable scientist vaguely familiar with the flawed study). The poorly designed SELECT study published in JAMA utilized 400 IU/day of all rac-∝-tocopheryl acetate, instead of a complete vitamin E supplement, with mixed tocopherols and tocotrienols. This better emulates the vitamin E found in fruits and vegetables. Do fruits and vegetables cause prostate cancer?
The benefits of vitamin E are numerous. For example, supplementation has been demonstrated to reduce atherosclerotic plaque burden and improve one’s lipid profile in the context of complete preparations. You will not derive the benefits with ∝-tocopherol alone. In fact, ∝–tocopherol, given in isolation, which is standard for commercial vitamin E preparations, reduces γ–tocopherol levels by 30-50 percent. And guess which one is the far more powerful antioxidant? γ–tocopherol! Do you now see why the SELECT study is ridiculous? The results are spurious. This also highlights the importance of a complete vitamin E supplement from which you will derive a variety of protective effects.
Select a preparation of mixed tocopherols and tocotrienols. I would shoot for one that has a minimum of 250 mg in a total of these eight vitamin E components (Vitamin E historically has been α–tocopherol only). Caution: Vitamin E may interfere with platelet function and therefore blood clotting. Please discuss usage with your doctor particularly if you are taking blood thinners (warfarin) or other medications that interfere with platelet function (aspirin, for example). Alert your surgeon pre-operatively as well. Prior to brain operations, my patients are advised to stop both fish oil and vitamin E supplements (it is extremely rare that I find an individual on curcumin).
Ok, there is no arguing about this one: magnesium stabilizes the heart muscle and prevents arrhythmias. It lowers blood pressure by relaxing blood vessels, plays a role in carbohydrate metabolism, and reduces one’s risk of osteoporosis by augmenting bone density. And what caliber neurosurgeon would exclude exciting new data on magnesium’s effects on the brain? A recently published study suggested that elevation of brain magnesium exerts substantial protective effects in a mouse model of Alzheimer’s disease. Specifically, magnesium-L-threonate conferred protection against plaque formation and synaptic (neuron-neuron connection) loss, characteristic of Alzheimer’s disease. And this may have treatment implications for humans. 68 percent of Americans are deficient according to a government-sponsored study.
1,000 mg. Take your magnesium supplement at night, preferably before bed; it will help you sleep.
This is the good bacteria that most of us lack in our gut. Yes, there are “good” bacteria that maintain the health of our bowels, the interface between our bodies and the outside world. Unfortunately, our guts are often overpopulated with “bad” bacteria which interfere with normal physiologic processes, leading to illness. A case in point is antibiotic-associated colitis or “c diff” due to overgrowth of the pathogenic bacteria Clostridium difficile. Antibiotics eradicate the protective bacteria of the gut. The “bad” bacteria seize the opportunity to multiply, evoking an inflammatory response that can prove fatal (20,000-30,000 Americans succumb annually to c. difficile colitis).
There is a very complex bacterial microcosm in one’s gut composed of trillions of bacteria. The interactions between the bacteria and the lining of the bowel modulate, via chemical messengers, our immune response and various metabolic processes, which in part dictate insulin sensitivity. Alterations in gut integrity for these reasons can prove disastrous. Unfortunately, this has been underappreciated until relatively recently. If the gut is inflamed, you are inflamed. Just because the bowel in actuality is external to the body, does not permit you to neglect it. Nurture it instead for optimal health. Try eating yogurt daily for a week. You’ll feel better, guaranteed!
(for those not in favor of yogurt) Buy a preparation with at least 2 billion CFU (bacteria essentially) per serving. Take one to two servings daily. Double your daily dosage while on antibiotics, or for five days pre-and post-operatively in the event you are having surgery. Another tip: always store your probiotics in the refrigerator. These are live cultures. Would you leave your yogurt out of the fridge for days on end? I think not.
Multivitamin or Not?
Several of the above may be found in multivitamin preparations. In that vein, choose a multivitamin that is just that, “multi,” multiple capsules or tablets per day. I personally steer clear of the single-tablet preparations for two reasons:
1. The dosages of the individual components are fairly low. Vitamin C quantities, for example, position one just over the threshold of scurvy. Multi-tablet preps typically contain higher quantities of micronutrients. My preference is Life Extension® Mix tablets (9 pills daily).
2. Serum levels of the micronutrients are inconsistent throughout the day. A steady supply of micronutrients (theoretically provided by a multi-table prep) increases the probability of your cells being saturated with vital cofactors around the clock.
Water: An Unsung Hero
While water is not considered a supplement, it should be. The majority of people are dehydrated, plain and simple. You may not think you are, but you are. Yes, you! Do you drink 10-12 cups of water daily? Doubtful. Well, this is your water requirement under normal conditions; in extreme conditions, it can be double that amount. Even mild dehydration can affect mental and physical performance.
The gastrointestinal function may also be impaired, resulting in delayed transit times and constipation. And while the latter may be unpleasant, even more, unpleasant is your prolonged exposure to potential carcinogens as their passage through the gut is delayed. A common cause of constipation is dehydration.
Optimal hydration is associated with a reduced incidence of fatal coronary artery disease, stroke, hypertension, diabetes-related complications such as ketoacidosis, kidney stones, and urinary tract infections. Those bouts of dizziness you experience when standing up too abruptly? That may be a function of dehydration. Hydration also affects the fullness of your skin and more importantly its integrity and efficacy as a barrier to pathogens. Remember, you are 60 percent water! It is absolutely essential to life and therefore not to be neglected, although often is.
So “supplement” aggressively with water, 1 gallon per day as a rule (unless instructed otherwise by your doctor), bodyweight aside. Your urine should be clear and odorless. That is unless you just took your B-vitamins…
The “Supplements” You Never Hear About
As usual, there’s more here than meets the eye. Many pharmaceuticals have off-label usages with demonstrable benefits but are simply not offered to patients. Why? Because they are “off label,” and doctors are quite frankly nervous. Of lawsuits. And that’s a crying shame. Why? Because your doctor may be taking them! In that regard, I have listed several that I consider crucial to health. But first, allow me to refresh your memory. What are the two biggest killers worldwide? Ischemic heart disease and cerebrovascular disease. Keep that in mind…
Long thought of for its anti-platelet (blood thinning) effects, aspirin has anti-inflammatory properties to which its benefits can also be attributed. Remember, virtually every disease has an inflammatory component to it. If you tamp down inflammation, it will have an impact on disease incidence and severity.
Yes, aspirin even reduces the incidence of a variety of cancers! Its health-promoting effects extend beyond the vascular system, beyond heart attack and stroke. According to a study published recently in Lancet Oncology, regular aspirin use reduces the risk of colorectal, esophageal, gastric, biliary, and breast cancer.
And by nearly 40 percent. Good ol’ aspirin. Bang for the buck, the best medication there is! As of this writing, 125 tablets of Ecotrin 325 mg cost $7.00, or less than six cents per dose. Its effects are wide-reaching. I would recommend it to everyone age 35 and older, barring any contraindications (i.e. bleeding disorder or active peptic ulcer disease). Don’t wait until you’re 50 when risk factors for the disease have already accumulated (there is evidence that risk factors begin accumulating during adolescence, in fact). So how much should people take? My standard advice is an enteric-coated baby aspirin every other day (as a starting dosage).
BETA-BLOCKER AND/OR ACE INHIBITOR
Ever hear of the Framingham Study? Allow me to explain. The Framingham Study investigators followed thousands of men and women over several decades and found an increasing relation between systolic blood pressure, and all-cause cardiovascular mortality. While this relationship is not strictly linear, it goes without saying that hypertension, chronic hypertension, in particular, is a key promoter of the atherogenic process.
Plaque formation begins with injury to the arterial wall as a result of the increased shear force placed upon it. The response to the injury is atherogenesis with progressive arterial narrowing. Your goal: minimize arterial injury. How? Normalize your blood pressure. And then normalize it further. Aim for the low end of the “normal” range for your age. Ideally, this should be attained through diet and exercise.
Even still, a low-dose antihypertensive may prove beneficial long-term. Both ACE inhibitors and beta-blockers have their merits (and demerits). Discuss these with your physician. And don’t be satisfied with serial blood pressures at the high end of the “normal” range for your age group; shoot for more optimal blood pressure. Treat early and aggressively. Hypertension is a silent killer.
As most of you probably know, statin drugs can lower cholesterol levels, but what you may not know is how many doctors (like me) are taking these drugs, even those who don’t have cholesterol problems. Why? Statins are also potent anti-inflammatory agents. And we all know by now, (it’s like beating a dead horse) that chronic inflammation underpins nearly every disease, especially those that kill us!
From that standpoint alone, everyone should at least consider discussing statin usage with his or her doctor. Of course, this may be contraindicated in the context of a normal lipid profile. This brings me to my next point. In previous chapters, I had discussed cholesterol, and in particular, why we need it floating around our bodies. Cholesterol is not “bad,” yet has been vilified by the pharmaceutical industry, specifically by those companies manufacturing (and profiting from) statins. It is in their best interest to demonize cholesterol, and then present a “miraculous” cure for the masses.
As it turns out, for a variety of reasons, statins are not the panacea they’ve been touted to be clinically (when analyzing outcome data). But they do aggressively lower cholesterol by inhibiting the rate-limiting step in cholesterol synthesis. Therefore, for those at high risk of a coronary event in the context of dyslipidemia, statins are an integral part of treatment. In other cases, however, the indications become a bit fuzzier. Statins have side effects which must be taken into consideration. Myalgias (muscle aches), memory loss, drug-induced hepatitis, and statin-associated neuropathies are well described in the literature. So your decision to use statins should not be taken lightly.
I use statins to maintain my LDL 100-110 mg/dL, no less, and to drive my CRP (serum inflammatory marker) down to nearly zero. Remember, we rely on cholesterol for endothelial repair and equally as important, for hormone production. And we certainly don’t want to interfere with those processes! An ideal lipid profile often times can be obtained with rigorous attention to diet and exercise. Some of us, however, have difficulties reaching the “target” LDL level, as cholesterol production is predominantly a function of our genes, and less so diet, as was once suspected. To me, that equates to more potentially oxidized LDL substrate or atherogenic LDL. Remember, native LDL unto itself is harmless (particularly the pattern A subtype); it is the oxidized LDL particle that causes the problems.
Therefore, keeping oxidative stress in check is more important than your “cholesterol number.” As we are burdened by, and in fact, bombarded with oxidative stress on a daily basis, one’s antioxidant systems may be overwhelmed (hence the need for supplements) and LDL particles oxidized. I choose to utilize statins with the intention of lowering my LDL to “target” levels and increasing my HDL (although quite frankly, niacin, a B-vitamin sold over the counter for a lot less, does a way better job with the latter). The choice is yours. Discuss it with your doctor in light of your past medical and family history.
In the event that you choose to take a statin, you must supplement with CoQ- 10 (available over the counter), as this will reduce the incidence of muscle-related side-effects (pain and dysfunction). You probably know someone who, after being placed on statins, developed leg pain and appropriately stopped the medication. Likely, their physician did not recommend CoQ-10, as many are unaware of this potentially protective agent. Take 200 mg (of CoQ-10) daily should you choose to use a statin; don’t even start the statin otherwise.
Wait, the diabetic drug? You got it. Remember resveratrol? Well, guess what, metformin (generic Glucophage) acts on similar enzymatic pathways, increasing insulin sensitivity, and by virtue, reducing the insulin signal. You’re probably thinking, “I thought I needed insulin?” You do! But not in excess. This is our nation’s biggest risk factor for disease. EXCESS INSULIN. Yes, we need insulin for growth and repair, but excess insulin is associated with type II diabetes, atherosclerotic disease, cancer, Alzheimer’s disease, and hypertension. Need I say more? OK.
Reducing the insulin signal secondarily reduces inflammation in animal models; this likely occurs in humans as well, given the anti-tumoral effects metformin has on a variety of cancers. This effect too is the result of reduced growth factor expression in response to metformin. It acts at the level of the gene! And its actions are not limited to the insulin signaling pathway; they are wide-reaching, affecting and modulating many bodily processes. As you’ve heard me say before (in the context of resveratrol), an analog of metformin will one day be launched as an “anti-aging” drug. Why?
It mimics the effect of caloric restriction (CR). This significantly extends life in animal models. By reducing the insulin signal and therefore the risk of cancer, diabetes, vascular disease, and obesity, will likely have similar effects in humans. Are you going to wait and see if it extends life prior to discussing this option with your doctor? Or do you plan to assess the available data and make an educated decision, potentially extending your life? I’ve been on metformin for years. Not a single untoward effect (although they are reported, albeit infrequently). And no, it typically does not make one hypoglycemic.
500 mg twice daily. Should you choose to take metformin, you must supplement with additional B vitamins, particularly B12 and folate (which you should be on anyway, right?).
You will not become wiser nor become capable of performing differential calculus while speculating on the laws of the universe by virtue of smart drug usage. We simply aren’t there yet. In fact, we are only beginning to understand intelligence. I ask you this, what makes someone intelligent, on a neuronal basis? And if we don’t know the answer to this fundamental question, how can we augment intelligence? At this point, therefore, it is nothing short of a crap-shoot.
Tweak your biochemistry; trial the various smart drugs for three-month intervals at a minimum. Has your work productivity improved? Do you have fewer memory lapses? Is your mood better? Are you having any side effects? Attempt to establish a regimen that suits you best. Or not. At worst, you’ve spent some hard-earned money. At best, well… And rest assured, if you choose to pass on the smart drugs yet are taking the 10 recommended supplements detailed later, your brain is fairly well protected. Keep in mind, however, that these supplements are part and parcel of a healthy lifestyle, diet and exercise included. Do not rely on supplements alone to mitigate your risk factors for disease, be it coronary artery or cerebrovascular disease. They are adjuncts only.
And never forget that these diseases are essentially the same pathophysiologically. Treat one, you treat the other. A healthy body begets a healthy mind. Conversely, a healthy mind begets a healthy body. Of course, I prefer the latter. But don’t tell the cardiac surgeons…
Please consult with your doctor prior to the start of any supplement regimen, as there may be a contraindication that you are unaware of. These drugs have side effects (in my opinion, worth the risk) that must be discussed prior to their initiation. That being said, the medications are typically well-tolerated, and I take all of them…
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