Commonly Used Supplements: What You Need to Know about Benefit, Safety, and Side Effects
This is a list of commonly used supplements. It is not a recommendation to take these supplements but simply offered for your information. Supplements, like medicine, are serious business and should be reviewed with your healthcare provider before starting.
1. Coenzyme Q10
Coenzyme Q10 has received a lot of attention for its possible role as a “neuroprotective” therapy. One small trial showed minor positive results in Parkinson’s disease (PD) at a dose of 1200mg per day. Currently, a much larger trial (the QE3 trial) is underway to truly determine the role of coenzyme Q10 in the treatment of PD. This trial is testing doses of 1200mg and 2400mg daily.
It does appear that people with PD have lower levels of coenzyme Q10 in their brains. Coenzyme Q10 is involved in energy use and seems to be highly concentrated in the heart and brain. This is why many people take coenzyme Q10 for heart health, even though many trials have demonstrated minimal if any benefit in patients with heart disease.
There are generally very few side effects from taking coenzyme Q10, although your wallet may “hurt” a bit since it tends to be expensive (“shock to your pocketbook”)! Taking coenzyme Q10 with a meal that includes some fat will help its absorption. Some PWP do report mild stomach upset. If you do experience stomach upset, try splitting the dose up and taking a smaller amount two or three times a day. More information on Coenzyme Q10 is available.
Creatine, like coenzyme Q10, is being studied as a possible “disease-modifying” therapy, or a therapy that may slow PD progression. Creatine is a component of the energy-building system in our body’s cells. It is often used by athletes to enhance exercise performance and build muscle mass.
For PD, doses of 5 to 10 grams daily are under study. Side effects are significant and it is not recommended that you take this supplement for Parkinson’s disease unless prescribed by your doctor. Possible side effects of creatine include weight gain (generally due to fluid or “water” retention), nausea, headache, kidney disease, and possibly joint pain. Creatine should be used cautiously if your kidneys are not working properly.
3. CDP Choline (citicoline)
CDP choline, also known as citicoline, is often used by victims of stroke or head trauma. It may also have benefit in memory loss and PD. The theory is that CDP choline may help repair damaged nerve cells in brains, including those that produce dopamine. CDP choline may also increase levels of glutathione, an antioxidant.
Initial studies of CDP choline in PD suggest it may be most beneficial for the symptoms of rigidity and bradykinesia. Doses of 500mg to 2,000mg daily, either taken orally or given as an injection, have been used. The most common side effect reported with CDP choline is slight stomach upset. Continued research is needed to determine the exact role or benefit in PWP.
As mentioned above, glutathione is an antioxidant, which helps to prevent damage to our body’s cells. Although we all have glutathione naturally in our bodies, it seems that the amount decreases with age and also in certain conditions, such as PD and diabetes.
More studies of glutathione are needed in PD to determine if it has a role in treating PD. Glutathione can be taken orally in doses of 50-600mg per day. However since it consists of amino acids (building blocks of protein), it is highly digested and little is absorbed. A recent study of IV (intravenous) therapy did not prove benefit. Glutathione is being studied for various conditions aside from PD, including cancer, glaucoma, and heart disease.
Tyrosine is an amino acid (a building block of protein) our bodies make after we eat protein from foods (meat, dairy, fish, eggs, nuts, beans, etc). It helps our bodies make various substances, including dopamine. There is some speculation that taking tyrosine supplements may help to increase dopamine production. Tyrosine is also used to help alertness after sleep deprivation, and may increase energy levels.
Tyrosine supplements in doses of up to 150mg per kilogram of body weight appear safe. For an average person weighing 150 pounds, this would equal a daily dose of about 10,000mg, or 10 grams. Reported side effects of tyrosine include nausea, headache, heartburn, and joint pain. Also, tyrosine can compete with levodopa and decrease its absorption, so if you are taking carbidopa/levodopa (Sinemet) or carbidopa/levodopa/enatacapone (Stalevo), you should take the tyrosine at least two hours apart from these other levodopa-containing drugs.
6. Ginkgo Biloba
Ginkgo biloba is most commonly used to improve memory and treat dementia. Researchers think it may help memory by increasing blood circulation through the brain. Although it hasn’t been studied very much in PD, patients with mild to moderate memory loss have shown very slight improvements with ginkgo biloba supplements.
Recommended doses of ginkgo biloba are 30mg to 40mg taken three times daily (total daily dose of 120mg to 160mg). It usually takes about 4 to 6 weeks of treatment to see the effect of ginkgo biloba. Side effects may include headache, stomach upset, and trouble sleeping. Gingko biloba doe shave a serious side effect. It may increase the risk of bleeding, so if you take “blood thinners” like aspirin, warfarin (Coumadin), or clopidogrel (Plavix), do not start gingko biloba without your doctor’s permission.
7. Milk Thistle
The active component of milk thistle is a substance called silymarin. Silymarin appears to help protect the liver from damage by potential toxins. Milk thistle seems to be beneficial in treating liver disease and diabetes, and may be of benefit in PD; however, much more research is needed to determine its true benefit.
Milk thistle should be taken before meals with a tall glass of water. The usual dose is 70mg to 140mg three times daily. There aren’t usually many side effects from milk thistle, though it may act as a mild laxative and could cause diarrhea.
8. NADH (Nicotinamide Adenine Dinucleotide)
NADH is an active form of vitamin B3 and is involved in energy production. It may improve alertness, help with memory, and may have antioxidant effects, although the results are highly variable. In PD, it is speculated that NADH may increase the production of dopamine, though this has yet to be proven. Doses of 10-15mg per day are used. NADH is generally tolerated very well, with few side effects.
A hormone that we all naturally produce, melatonin helps to regulate our sleep and wake cycles. As we age, melatonin levels tend to get lower and lower; however, that does not mean everyone needs supplementation. Melatonin supplementation is often used for difficulty sleeping or jet lag and should only be taken with your doctor’s permission.
It is important to note that melatonin may help you fall asleep faster, but it will not help you stay asleep throughout the night. If taken, melatonin should be started at a low dose of 0.5mg to 3mg, 1 or 2 hours before bedtime. Sustained release forms may work better for some individuals. Some people experience strange dreams or occasionally nightmares when taking melatonin.
10. SAMe (s-adenosyl-l-methionine)
We all naturally make SAMe, which has a role in the production of various hormones and substances in our body, including serotonin (the “happy chemical”) and dopamine. Most commonly, SAMe supplements are used to treat depression. SAMe has also been used for arthritis, anxiety, and heart disease, although the benefit of this supplement is unproved for these conditions.
The recommended dose of SAMe is 200-400mg taken three to four times daily. Side effects with SAMe supplementation include nausea and stomach upset, dry mouth, and headache. There is a slim possibility that SAMe could reduce levodopa’s effectiveness, but this has not been reported so far. If you take antidepressants, talk to your doctor before beginning SAMe, as it works in a similar way.
11. Fish Oil (Omega-3 Fatty Acids)
Fish oil has received a lot of attention for everything from diabetes to arthritis to lowering triglyceride levels. It does seem to have anti-inflammatory properties, and a high dose of fish oil (3 grams daily) is available as a prescription product to lower triglyceride levels.
Fish oil supplements are usually in doses of 1 gram to 2 grams DHA/EPA daily. As an alternative to taking a supplement, you could eat 12 oz.fatty fish (salmon, tuna, trout, etc) two to three times a week. The side effects of fish oil are stomach upset (take with meals if this happens), and experiencing a fishy taste. If you are allergic to fish, avoid these supplements. Also, at doses higher than 3 grams per day, fish oil can increase the risk of bleeding and can actually result in abnormal blood cholesterol levels.
Final Points Regarding Supplement Use
When considering any over-the-counter product, whether it is an herbal product, vitamin, or supplement, always consult with your healthcare team, including neurologist and general practitioner, before you use it. It is important to make sure the supplement will be safe with the other medications you take or with other medical conditions you may have.
Also, always buy supplements from companies that follow “Good Manufacturing Practices” (GMPs). Look for a seal on the product that says “GMP” or “USP/NF.” These symbols mean that the company has had their products tested by an outside regulator to confirm the contents match what is reported and that the products are free of potentially harmful contaminants. More information about shopping for vitamins and supplements is available to you.
Author: Lindy D. Wood, PharmD