Continuing her exploration of oxidative stress and Alzheimer’s Disease, Dr. Doni explains the importance of antioxidants and recommends the 10 top supplements that can help alleviate symptoms—or prevent its onset.
Part 5 of Dr. Doni’s Series on Oxidative Stress
Oxidative Stress Leads To Inflammation
As we have discussed in previous articles in this series, one of the most important things to recognize about oxidative stress (that is, too much oxidation happening and not enough antioxidants to deal with it) is that it leads to inflammation in the nervous system. It’s the same reaction you get when you stub your toe—the toe becomes red, swollen, throbbing—but in your brain and nervous system. We can’t see this “neuro-inflammation.” Instead, we notice it as “brain fog,” forgetfulness, dizziness, and fatigue. Even anxiety, depression, irritability, and insomnia can be caused by inflammation in your brain. It is thought that, over time, oxidative stress and neuro-inflammation can lead to Alzheimer’s Disease.
When it comes to Alzheimer’s disease (and many other conditions that are a result of oxidative stress) our best strategy is prevention, especially because, as we discussed in the previous article, there is not currently a cure. Remember that the best way to prevent oxidative stress is twofold:
- Making diet and lifestyle changes, including decreasing toxic exposures, avoiding sugar and gluten, stress-reduction, and getting plenty of sleep.
- Increasing the antioxidants in your body by eating the right anti-oxidant rich foods and taking the right supplements.*
Antioxidants are a not a foreign substance to us. In fact, our bodies make them every day as a normal process. The issue is that we are often exposed to so much stress and toxicity that our body’s ability to make antioxidants is overwhelmed. And it doesn’t help that, when we are at our most stressed, we become depleted in the nutrients that are essential for antioxidant production. So if you live a constantly stress-filled life, it is quite likely you need to take in some extra antioxidants.
Antioxidants are not fancy. They are simple nutrients like zinc, selenium, and vitamins C & E. They are found in fruits, vegetables, legumes, nuts, and seeds. When you know what you’re looking for, you’ll find that they are everywhere. So, increasing your intake of antioxidants simply means reaching for colorful fruits and veggies each time you eat. I write this having just finished a salad of mixed greens, dried cranberries, walnuts, and beets—all rich in antioxidants and absolutely delicious.
How Do You Know You Need More Antioxidants?
The signs that you are lacking in antioxidants might surprise you. It can be as simple as noticing that you are “run-down” and not feeling your best, or seeing the signs of aging such as grey hair, wrinkles, vision changes, and decreased stamina. Or it could be that your mind is not as sharp as usual, your energy is low, or your waist is getting bigger. Many patients tell me that other practitioners have told them that they are “just getting older and there is nothing to do about it.” That’s when you know that you likely need more antioxidants and to support your body with nutrients, sleep, and stress recovery.
In fact, there are tests your family doctor or naturopathic doctor might do that would tell them more and help them tailor your treatment. In blood work from a standard lab, you can have HgbA1c, triglycerides, and Cardio CRP (C reactive protein) checked—elevated levels indicate oxidative stress and inflammation. There are also tests your naturopathic doctor can order for you from labs that offer less conventional testing – via blood or urine. These tests can measure glutathione levels (best is to know reduced versus oxidized), lipid peroxidase (whether fats are being oxidized), and super oxide dismutase activity. There is also a urine test that shows damage to DNA due to oxidative stress, called 8-OHdG.
If you are interested in having these tests done, be sure to ask your naturopathic doctor and, if you don’t have one or would like to consult with me about this, you can find out more and make an appointment by clicking here. In the New Year, I will have a new consultation package ready that includes tests to assess for oxidative stress and consultations to help you manage it.
What Can I Do In Addition To Changing my Diet?
Research on various nutrients and herbs that help with oxidative stress and Alzheimer’s is coming in left and right at the moment. I wish I could say that product development is keeping up with that trend, but sadly, I can’t. Don’t get me wrong—there are hundreds, if not thousands, of supplements that contain antioxidants. The question is, are they high-quality and do they contain effective dosages without fillers and unwanted contaminants?
I’ve combed through the research to gather information about ten top supplements—herbs and nutrients—that have been shown to help either directly prevent oxidative stress and neuro-inflammation, or to specifically help with Alzheimer’s disease. Here are my top ten recommendations:
Top 10 Supplements to Drop Oxidative Stress and Prevent Alzheimer’s
- Glutathione and the nutrients that support glutathione production in the body: cysteine (NAC), glycine, and glutamine.1,4
What it is and what it does: Glutathione is an antioxidant that is produced, used, and recycled within our bodies. It is made from three amino acids – cysteine, glycine, and glutamine—and protects our cells from oxidative stress. Exposure to toxins and stress depletes our glutathione levels, and those of us with genetic mutations related to glutathione (such as GSTM1) are especially susceptible to depleted glutathione levels.
When to try it: If you know you have been exposed to stress and toxins and if you know you have genetic mutations related to glutathione, or if lab tests show that your glutathione level is low, then taking glutathione, and/or the precursor nutrients, could be beneficial.
When to avoid it: Glutathione is made up of sulfur molecules, so if you are allergic or sensitive to sulfur, or if you have elevated cysteine levels, you may react to taking glutathione. In that case you’ll want to work with a practitioner who can help you manage sulfur metabolism and support glutathione levels without making you feel worse.
I recommend: Glutathione is not well absorbed from the digestive tract, so it is important to take a form that has been formulated for increased absorption or to consider working with a practitioner who offers glutathione by IV therapy. I recommend Liposomal Glutathione. There are also products in capsule form with enhanced absorption, such as Thorne Glutathione-SR. You might also consider a product containing glutathione precursor nutrients (NAC and glutamine) and milk thistle, which is known to improve glutathione production – see Glutathione Recycler here. Keep in mind that exercise also boosts glutathione production in your own body.
- Vitamin D2
What it is and what it does: Vitamin D is known for being produced in the body when you’ve been exposed to sunlight. However, just because you’ve been in the sun doesn’t mean you’ll necessarily have enough vitamin D. Research is finding that people who have Alzheimer’s Disease tend to have low vitamin D levels, and that people who have a genetic mutation related to vitamin D (called VDR) also tend to have low vitamin D levels. Vitamin D is protective to our brain cells, and is also known to decrease oxidative stress and inflammation.
When to try it: Vitamin D can be measured in blood work—both 25OH vitamin D and 1,25 vitamin D (the active form in the brain) should be measured. If your levels of either or both forms are low (less than 70), then you should work with a practitioner who can help you with the best dosing and products for your body, and to evaluate your levels over time. This is also true if you have a VDR genetic mutation.
When to avoid it If your vitamin D levels are elevated on blood work, you may need to stop taking vitamin D (for a while).
I recommend: Research indicates that both liquid and capsule forms of vitamin D are well-absorbed. Some people prefer a liquid, such as this product, which can also be applied directly to the skin. Others prefer a capsule, such as this product. I find that consistent daily dosing (versus once weekly dosing) leads to the most consistent improvement in vitamin D status.
- Alpha lipoic acid3
What it is and what it does: Our bodies can make alpha-lipoic acid (ALA) but, when we are stressed and depleted, production decreases leaving our cells vulnerable to oxidative stress. Research shows that alpha-lipoic acid is protective to brain cells. It also helps with glutathione production, blood sugar balance and mitochondrial function, so if you have insulin resistance or elevated HgbA1c, it could help in more than one way. I call that “multi-tasking” with nutrients.
When to try it: High blood sugar levels and fatigue are two of the common signs that tell me alpha-lipoic acid could be helpful.
When to avoid it Alpha-lipoic acid contains sulfur, so if you are allergic or sensitive to sulfur, you may react to taking it. In that case you’ll want to work with a practitioner who can help you manage sulfur metabolism.
I recommend: You can either take alpha-lipoic acid alone (be sure to choose the “R” form), or in combination with other ingredients, such as this product which also helps improve insulin function and lower blood sugar levels.
- Methylfolate (5MTHF) and methylcobalamin (B12)4,5
What it is and what it does: Folate and B12 in the “methyl” form feed into the methylation cycle, which is extremely important for detoxification of toxins and hormones in the body, as well as for energy and neurotransmitter production, and healthy DNA and cells in general. If you don’t have enough methylfolate or methylcobalamin, then you are vulnerable to oxidative stress, and if you have high oxidative stress, you are likely low on methylation. Research indicates that when folate levels are low, homocysteine levels are higher—this situation is associated with increased degeneration (damage) of nerve cells. Genetic mutations that involve MTHFR can affect your ability to make active methylfolate from folic acid, and that’s why knowing your MTHFR status can be very helpful for the prevention of health issues. You can read more about MTHFR mutations in this article.
When to try it: If you are feeling tired, your mood is low, you have brain fog, and/or are just not yourself. If you have adrenal exhaustion with low epinephrine levels (which can be tested in urine). Or if you have low thyroid function or symptoms that indicate estrogen dominance (PMS, menstrual cramps, cervical dysplasia, fibroids, breast cysts, and/or irregular menstrual cycles). Also if your RBC folate blood level is low or your methylmalonic acid or homocysteine level is high.
When to avoid it It is not so much of “avoid” as it is to more carefully introduce methylfolate and B12 if you have an MTHFR and/or MTR or MTRR genetic mutations. This is because, even though your body likely needs it, it could become overwhelmed by it if your metabolism is not fully supported and ready for it. You’ll want to work with a practitioner who can help you cover all the bases and bring in the right doses at the right time. If you have elevated nitric oxide levels, or depleted glutathione levels, you’ll need to correct those issues prior to starting methylfolate and methylcobalamin. You can read more about steps to supporting methylation in this article.
I recommend: I would suggest that EVERY multivitamin, B complex and prenatal vitamin should contain methylfolate, instead of folic acid, and methylcobalamin, instead of cyanocobalamin. That is because those are the most active and usable forms of the nutrients, and without knowing whether you have a mutation in the processing of B vitamins, it is better to assume that you might so you’re more likely to benefit from the supplements you are taking. So I encourage you to check your multivitamin and/or B complex right now, and if it is not the right form, throw it away and look for a new product, such as this multivitamin and/or this B complex, or one of these prenatal vitamins. From there, you should work with a practitioner to help you know whether you need more methylfolate and methylcobalamin that what is in your multi or B complex.
- Coconut Oil6
What it is and what it does: The oil from coconut, which you can purchase in health food stores and online, contains a specific type of fat called medium chain fatty acids (MCFA), including lauric acid and caprylic acid, which can fuel brain cells (instead of glucose). Eating coconut oil is also part of a ketogenic diet because it allows the body to “run on” ketones instead of glucose. As we discussed in this previous article, elevated blood sugar levels increase risk of Alzheimer’s disease, so it follows that alternative forms of nutrition, such as healthy fats, can help. Coconut oil (especially when processed with some heat) also contains antioxidants. Early research indicates that coconut oil may alleviate mitochondrial dysfunction and prevent damage to the nerve cells. More research is clearly needed.
When to try it: Coconut oil can be tried by most anyone. Start with a small amount (say 1/2 tsp) if you have had gall bladder issues, as any fat can trigger bile release.
When to avoid it If you have food sensitivities to coconut, you may need to avoid it. Be sure to check with your naturopathic doctor.
I recommend: Unrefined, virgin coconut oil is preferred, such as from Skinny and Company, and organic if possible (coconuts are not heavily exposed to pesticides) such as Ziggy Marley’s coconut oils which come in delicious flavors (I love the lemon ginger). Some companies sell a product called “MCT” oil, but this is more refined, often has added sugar, and contains fewer antioxidants than pure coconut oil. You can eat coconut oil right off a spoon, add a spoonful to your protein shake, stir into granola, or use to cook leafy greens and veggies. Many people like the taste of coconut oil (and grassfed butter) in their coffee. You may have heard of “bulletproof coffee,” coined by Dave Asprey after being served a native version in Tibet.
What it is and what it does: Also known as turmeric, curcumin is an herb that is known to be anti-inflammatory. It is used for all sorts of inflammatory conditions, from inflammatory bowel to inflammatory joint and skin issues. It is also known to help with neuro-inflammation, such as Alzheimer’s disease.
When to try it: Curcumin has so many potential benefits, it is truly a “super-herb.” Most anyone who is looking to prevent health issues, including Alzheimer’s, should consider taking it either alone or in a combination product.
When to avoid it: Be careful with curcumin if you have a history of oxalate kidney stones or high oxalate levels in general as it does contain oxalates. It may be a matter of managing the oxalates with calcium or magnesium citrate and vitamin B6 (P5P) so that you can benefit from curcumin. Best to work with a practitioner to help you.
I recommend: Curcumin is another one, like glutathione, that needs help to be absorbed from the digestive tract. So you’ll want to choose a product that has improved absorption, such as liposomal curcumin or Meriva, which has phosphatidylcholine to assist with absorption.
- Green Tea7,8
What it is and what it does: Green tea, and specifically its main constituent, EGCG (epigallocatechin gallate), is known to act as an anti-oxidant in our bodies, protecting our cells, especially from oxidative stress associated with Alzheimer’s disease.
When to try it: If you want to decrease your intake of coffee, green tea can be a great alternative. You may also want to consider taking green tea if you are dealing with a health issue related to oxidative stress, including Alzheimer’s disease.
When to avoid it Caffeine in regular green tea can interact with medications and/or cause issues if you are sensitive to caffeine. It inhibits the COMT enzyme and can increase anxiety or other symptoms. Green tea in capsule form is often caffeine-free, so this may be a solution for you. There are several medications that interact with green tea, so if you take prescription medications, you’ll want to check with a practitioner on whether green tea is okay with what you are taking.
I recommend: Drinking green tea is great, just be sure to choose organic. You can also find products with standardized doses of EGCG, such as this product by Thorne or another by Vitanica, which make it easy to get the equivalent to three cups of tea in one capsule. Or you can take it in this combination product with other ingredients I’ve mentioned – a sort of “all-in-one” approach.
What it is and what it does: Resveratrol is a substance found in red grapes, red wine, and chocolate—some of our favorite things! Research last month found that people who took a high dose of resveratrol (more than you could get from 1,000 bottles of wine per day) had decreased amyloid, the protein that causes the plaques and brain cell damage in Alzheimer’s disease. Resveratrol is known to be an anti-oxidant that helps with other oxidative stress related conditions, perhaps that’s why it is helping with Alzheimer’s disease.
When to try it: If you have memory loss and/or signs of any age-related condition.
When to avoid it: Resveratrol was, however, found to stimulate estrogen receptors, so if you have a history of estrogen receptor positive breast cancer, it is best to not take it.
I recommend: To get the dose of resveratrol that is needed, you’ll need to take it as a supplement (not from drinking a ton of wine or eating your body weight in chocolate). You can get it alone in a supplement, or in combination with other ingredients we’ve discussed like green tea and curcumin in this product.
- CDP Choline10,11
What it is and what it does: Choline (also known as phosphatidylserine and phosphatidylcholine) is produced in the body and is a major component of cell walls throughout our bodies. In fact, choline is one of the main substances produced by a healthy methylation cycle. When we are over-stressed and exposed to toxins, methylation can’t keep up and choline is depleted. When this happens, our cells become damaged and our mitochondria are less able to produce energy. We become fatigued and experience aging throughout our bodies, including in our cognition. Research indicates that taking choline as a supplement can help improve the health of cells and improve cognition, which is very exciting considering there is not a cure for Alzheimer’s Disease.
When to try it: If you are experiencing signs of aging or a decline in memory. Studies show that it helps both vascular (blood flow related) and degenerative (oxidative and inflammatory related) causes of cognitive decline.
When to avoid it If you are taking medications that affect acetylcholine, dopamine and/or norepinephrine, and/or if you have blood pressure or blood sugar issues, it is best to work with a practitioner if you want to try taking CDP choline.
I recommend: The specific form of choline that can cross the blood brain barrier and get into the nervous system where it can help your brain cells is called “CDP choline.” You can take it in a supplement, such as this one.
What it is and what it does: Astaxanthin is a red pigment found in algae, fish, and crustaceans (think of red lobster) that is a powerful antioxidant. It has been researched in relation to dementia and was found to cross the blood-brain barrier and prevent damage to brain cells.
When to try it: If you are looking to boost antioxidants, reduce oxidative stress, and prevent Alzheimer’s disease, Astaxanthin should be on your list of supplements to take.
When to avoid it: If you have a shellfish allergy, you should avoid astaxanthin made from crustaceans. If you have high blood pressure, and you’re taking medications to address it, watch your blood pressure carefully if you add in Astaxanthin because it could lower your blood pressure, making it necessary to have your medication dosage adjusted.
I recommend: You can take in a combination product or alone, such as this product.
There are many more supplements that didn’t make this list but that could potentially help prevent or alleviate Alzheimer’s disease. Melatonin (which is a hormone produced by our bodies and is available in the U.S. as a supplement) for example, is often decreased in patients with Alzheimer’s disease, so supporting the levels is being studied. Probiotics, pomegranate, gingko, ginseng, schisandra, carnosine, arginine, and more are also being investigated for their potential benefit. I’ll be interested to see what the studies continue to show us. A recent study even describes a form of ultrasound that can stimulate microglial cells (waste-removal cells) in the brain and (so far just in animals) reverse Alzheimer’s plaques and restore memory.
At this point, if I could recommend any product, it would be a simple dose of stress-reduction!13 While it is tempting to start popping pills, we should always start by making sure we engage every day in activities that help our bodies recover from stress, such as exercise, meditation, enjoying time outdoors, spending time with friends, family and pets, and experiencing emotions (including laughter and joy). Remember, they not only drop your stress, but they also boost your antioxidant production.
Moving on in the New Year
When I return to blogging in the New Year, I’m going to continue on the subject of oxidative stress and discuss a few more conditions that I see very often in practice—chronic fatigue and fibromyalgia. If you’d like to make sure to receive those articles, please subscribe to my weekly e-newsletter.
When you sign up, you’ll also receive a free copy of my 8-page Wellness Action Guide, which guides you through integrating stress reduction into your day and life, which is essential for reducing your risk of both oxidative stress and Alzheimer’s disease.
Wishing you and your family a happy and healthy New Year!
18th December 2015
UPDATE 1/28/16: I just launched my new Oxidative Stress Consultation Package, please check it out to see if it’s right for you.
*Please keep in mind that any and all supplements—nutrients, herbs, enzymes, or other—should be used with caution. My recommendation is that you seek the care of a naturopathic doctor (with a doctorate degree from a federally-accredited program) and that you have a primary care physician or practitioner whom you can contact to help you with individual dosing and protocols. If you ever experience negative symptoms after taking a product, stop taking it immediately and contact your doctor right away.
- Braidy N1, Zarka M, Welch J, Bridge W. Therapeutic Approaches to ModulatingGlutathione Levels as a Pharmacological strategy in Alzheimer’s Disease. Curr Alzheimer Res. 2015 Mar 24.
- Banerjee A, Khemka VK, Ganguly A, Roy D, Ganguly U, Chakrabarti S. Vitamin D and Alzheimer’s Disease: Neurocognition to Therapeutics. Int J Alzheimers Dis. 2015;2015:192747.
- Veskovic M1, Mladenovic D1, Jorgacevic B1, Stevanovic I2, de Luka S1, Radosavljevic T3. Alpha-lipoic acid affects the oxidative stress in various brain structures in mice with methionine and choline deficiency. Exp Biol Med (Maywood). 2015 Apr;240(4):418-25.
- McCaddon A1, Hudson PR. L-methylfolate, methylcobalamin, and N-acetylcysteine in the treatment of Alzheimer’s disease-related cognitive decline. CNS Spectr. 2010 Jan;15(1 Suppl 1):2-5; discussion 6.
- Farkas M1, Keskitalo S, Smith DE, Bain N, Semmler A, Ineichen B, Smulders Y, Blom H, Kulic L, Linnebank M. Hyperhomocysteinemia in Alzheimer’s disease: the hen and the egg? J Alzheimers Dis. 2013;33(4):1097-104.
- Nafar F1, Mearow KM1. Coconut oil attenuates the effects of amyloid-β on cortical neurons in vitro. J Alzheimers Dis. 2014;39(2):233-7.
- Venigalla M, Gyengesi E, Sharman MJ, Münch G. Novel promising therapeutics against chronic neuroinflammation and neurodegeneration in Alzheimer’s disease. Neurochem Int. 2015 Oct 31. pii: S0197-0186(15)30061-9.
- Afzal M1, Safer AM, Menon M. Green tea polyphenols and their potential role in health and disease. Inflammopharmacology. 2015 Aug;23(4):151-61.
- Turner RS1, Thomas RG2, Craft S2, van Dyck CH2, Mintzer J2, Reynolds BA2, Brewer JB2, Rissman RA2, Raman R2, Aisen PS2; Alzheimer’s Disease Cooperative Study. A randomized, double-blind, placebo-controlled trial of resveratrol for Alzheimer disease. Neurology. 2015 Oct 20;85(16):1383-91.
- Gavrilova SI, Fedorova IaB, Gantman, Kalyn IaB, Kolykhalov IV. [Ceraxon (citicoline) in the treatment of the mild cognitive impairment syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova. 2011;111(12):16-20. [Article in Russian]
- García-Cobos R1, Frank-García A, Gutiérrez-Fernández M, Díez-Tejedor E. Citicoline, use in cognitive decline: vascular and degenerative. J Neurol Sci. 2010 Dec 15;299(1-2):188-92.
- Chang CH1, Chen CY, Chiou JY, Peng RY, Peng CH. Astaxanthine secured apoptotic death of PC12 cells induced by beta-amyloid peptide 25-35: its molecular action targets. J Med Food. 2010 Jun;13(3):548-56.
- Baglietto-Vargas D1, Chen Y2, Suh D1, Ager RR1, Rodriguez-Ortiz CJ1, Medeiros R1, Myczek K1, Green KN1, Baram TZ2,3, LaFerla FM1. Short-term modern life-like stress exacerbates Aβ-pathology and synapse loss in 3xTg-AD mice. J Neurochem. 2015 Sep;134(5):915-26.