If you actually listened to the “side effects portion” or TV ads or read through all the side effects of every single drug you ever put in your mouth, I guarantee you; you’d think more than twice. Fatigue, headache, nausea are mentioned constantly, and while “sexual dysfunction” might not be listed, do you think you’ll be “in the mood” if you have nausea from a pharmaceutical? Meanwhile, there are commonly used pharmaceuticals that specifically lead to a loss of libido. Here are some of the “big players.”

Antidepressants, oddly enough, are one of the main culprits. I say “oddly enough” because depression often causes a lack of sexual interest. So when you take a depressed person and give them antidepressants that make them even less interested in sex, you’re not doing them any favors. So here are the ones to watch for.

Serotonin and noradrenaline reuptake inhibitors (SNRIs) are the most popular category of antidepressants currently prescribed. Many of them will lower the sex drive in women and men. These drugs include venlafaxine (Effexor), desvenlafaxine (Pristiq), and duloxetine (Cymbalta).

Running a close second and prescribed more by primary care practitioners are the selective serotonin reuptake inhibitors (SSRIs). These drugs and even a couple of drugs noted above are also used for menopausal symptoms (groan). Popular drugs in this category include escitalopram (Lexapro), citalopram (Celexa), fluoxetine (Prozac, Sarafem), sertraline (Zoloft), fluvoxamine (Luvox), and paroxetine (Paxil).

Non-functional doctors use tricyclic antidepressants (TCAs) to treat depression, some types of anxiety, fibromyalgia, and certain types of chronic pain. Examples include desipramine (Norpramin), doxepin (Sinequan), amitriptyline (Elavil), amoxapine- clomipramine (Anafranil),nortriptyline (Pamelor), imipramine (Tofranil), protriptyline (Vivactil) and trimipramine (Surmontil).

To round out the list without naming every drug on the market, let me mention (while we’re on the subject of mental health) that some medications used in Schizophrenia will raise prolactin levels and therefore depress libido. Then there are the very commonly used medications finasteride and dutasteride used for prostate enlargement. Next, as I’ll get into more, oral contraceptives might be a problem. Finally, many medications that lower blood pressure also results in low libido. A prime example of a blood pressure medication used to lower blood pressure, calm tremors, and even decrease anxiety is a beta-blocker such as metoprolol.

Lastly, alcohol or recreational drug use can cause low sex drive in women and men. And, it’s a bit of a mixed bag when it comes to “weed,” which will be discussed later.

Emotional and psychological factors

Most people do not have a so-called “psychiatric diagnosis.” But that doesn’t mean none of us have “issues”- in fact, most of us do deal with emotional and psychological factors that can hinder our desire for sex. Let’s start with relationship problems. A lack of trust, poor communication, any form of abuse, or stresses from financial, parental, or child-related issues can lower sexual desire on the part of one or both sexual partners. In addition, mental health issues resulting from undiagnosed depression, anxiety, eating disorders, poor self-image, or even prior sexual abuse can diminish a person’s interest in sexual activity.

Depression, Anxiety and other Mental Health Issues

Sexual disorders are prevalent problems in patients who have been diagnosed with psychiatric disorders.  As mentioned previously, medications such as antidepressants and antipsychotics will induce sexual dysfunction. A comprehensive review article looked at sexual disorders in psychiatric diseases such as bipolar disorder, schizophrenia, depression, obsessive-compulsive disorders, anxiety,  and eating disorders.

Panic disorder and obsessive-compulsive disorder are both correlated with less frequent sexual contact. Decreased sexual desire and sexual aversion are strongly associated with all types of anxiety disorders. The diagnosis of bipolar disorder significantly increases the risk of sexual dysfunction. In the manic phase, there is an increase in libido associated with risky sexual behavior. Depressive phases of this disorder or frankly depressive disorders are associated with low libido and dissatisfaction with sexual activity. In patients with eating disorders, libido and the level of sexual activity decreases, and the level of sexual satisfaction decreases as well.

The prevalence of sexual dysfunction in patients with schizophrenia is quite high among both those treated and untreated. Women who have schizophrenia have anorgasmia, decreased libido, vaginal dryness, and therefore dyspareunia (painful intercourse). Men who have schizophrenia have a decreased sex drive, difficulty maintaining an erection, and delayed orgasm.  The bottom line: if you are seeing a mental health professional, make sure to discuss your sexual needs with them.

Too much exercise

Lack of studies in females means just that: there is a lack of studies. However, it is well-documented in men that those who exercise at higher levels tend to have lower libidos. Thus, in men, higher levels of intense and greater durations of endurance training regularly are significantly associated with decreased libido scores.

Sleep deprivation

Most adults need  7 to 8 hours of good-quality sleep per night. Good quality means that the “sleeping hours” don’t include frequent arousals and are long enough for the individual to feel refreshed upon awakening. Yes, there are some (very rare) individuals who (genetically) require less than 7 to 8 hours of sleep each night. Lucky them. Most of us, when sleep-deprived, are simply pushing ourselves to sleep less. When we do this, we struggle to stay awake during the day, tend to have bouts of fatigue, and definitely suffer from a lower libido than if we were well-rested.

High cortisol

The hormone cortisol increases under stress-a good thing for your body in the short term. However, long-term high cortisol levels can lead to all sorts of physical problems. Physical problems, including immune system dysfunction, cognitive impairment, and much more, make this one of the most correctable and common functional medicine issues we see. High cortisol can also cause you to feel fatigued because the resultant decrease in mitochondrial ATP production interferes with regular sleep patterns. You can see where this is all going, right? Obviously, low libido is part of the end-game of this issue as well.

Fatigue can result from the two things discussed above: inadequate sleep and/or too much stress. Of course, many conditions interfere with sleep and many situations that may cause you to be stressed. If one of these issues is causing your fatigue, you need to address them before you regain your sex drive. If you have a “fatiguing illness,” that’s an entirely different story. I’ll explain.

Fatigue due to Mitochondrial Dysfunction 

Mitochondria (the organelles of respiration throughout the body) produce energy in the form of ATP, which your body then uses for fuel. Your brain, muscles, and heart cells contain more mitochondria than other organs such as the lungs, kidney, or liver. When your mitochondria are working “full tilt,” your energy levels are high, your brain is focused, and your muscles and heart are at peak performance. The creation of new mitochondria (mitochondrial biogenesis) is required for optimal aging and health. As you would predict, mitochondrial dysfunction tanks your energy and contributes to numerous symptoms and diseases. So-what causes this problem?

Mitochondrial dysfunction, characterized by a loss of efficiency in the synthesis of ATP, is a hallmark of aging, and essentially, of just about all chronic diseases. Loss of mitochondrial function can cause fatigue and even other symptoms in just about every chronic disease you can imagine. Examples of fatiguing illnesses with mitochondrial dysfunction include all toxin-related illnesses such as mold mycotoxin illness, anything lumped into the “wastebasket” of chronic fatigue syndrome, fibromyalgia, and autoimmune diseases, for starters. As a “side note,” when I treat these diseases, I also “treat the sick mitochondria” so patients regain energy quickly.

Bedroom Boredom

We’re all adults here. I put this header here so you’ll think about this topic and perhaps even discuss it with your partner. You don’t need me telling you what this means. You know.

Low Sex Drive in Women 

Causes of low libido in females can include anything that alters or interferes with the normal production of “female hormones” associated with libido, including estrogen, progesterone, testosterone, and possibly (but not probably) oxytocin. Let’s start by discussing the possible role of “the pill.”

Birth Control Pills

Common sense would tell you that when you interrupt normal hormonal functioning, you’d have sexual dysfunction. Not so fast! How about the psychological factors associated with knowing that sexual activity, using good oral contraceptives will generally not result in pregnancy? Do anxiety levels about pregnancy play a role? Studies have not examined that, but I suspect that it’s a factor. One very comprehensive study examined the libidos of women taking oral contraceptives in 30 studies. The results were basically “all over the place” as follows.

Menopause 

Most women experience a decrease in sex drive during menopause due to initially- drops in progesterone, then estrogen, and then testosterone. When a woman’s estrogen drops low enough, it not only suppresses her sex drive but also causes vaginal dryness and painful intercourse. In addition, a decreased production of testosterone has been linked in many studies to a decrease in female sex drive.  Conversely, replacement of these hormones with bio-identical equivalents (BHRT) can often restore a woman’s normal libido.

Pregnancy 

Hormonal changes that occur during and after pregnancy can affect a woman’s sex drive. These changes affect everyone differently. Some women may have an increased libido, while others might have little to no interest in having sex. Women’s hormones usually fluctuate during the postpartum months, which may affect sex drive during this time. Factors such as body image, breastfeeding, and fatigue all play a role in post-pregnancy sex drive.

Gynecological Issues

Medical conditions such as endometriosis, causing gastrointestinal cramping, pelvic cramping, or other symptoms can certainly dampen sex drive. In addition, post-menopausal women experience increased bladder infections due to the loss of lubrication of the bladder-also due to low estrogen levels. This type of burning pain, coupled with the other symptoms of bouts of cystitis certain dampen sex drive. In fact, any pelvic muscle problems or chronic pelvic pain will obviously result in low sex drive in women.

Causes of low libido in males 

Low testosterone 

Testosterone is the well-known sex hormone that males produce in their testicles. Testosterone is responsible for a range of male characteristics, including facial hair, muscle mass, libido, sperm production, erectile function, and bone mass. Low testosterone can be caused by trauma to the testicles, tumors, chemotherapy, and/or radiation for prostate or testicular cancers. In addition, anterior pituitary adenomas or toxins and pituitary damage due to traumatic brain injury can cause low testosterone in men. Furthermore, prior testosterone or anabolic steroid use can disrupt the testicular-pituitary axis, causing low T in later life. Lastly, any sort of chronic illness or heavy medications can lower testosterone levels as well.

Low estrogen

If a male has his testosterone replaced and is being treated too vigorously with aromatase-inhibitors, giving them virtually “no” estradiol levels, this can negatively impact male libido. In addition, occasionally, we find that a low progesterone level in a man will lower his libido and disrupt his sleep.

High Estrogen

On the other hand, testosterone which is endogenously produced but shuttled via the enzyme aromatase into estradiol as a conversion product, will impact libido when it gets too high. This is also found when testosterone is prescribed by inexperienced doctors who fail to check and then control estradiol levels.

What are Healthy Habits?

Every time I write a “what’s new” type of article, I hope the reader is up to speed with the basics of a healthy lifestyle and has at least a foundation of healthy habits for eating, exercise, and sleep. These are the real basics when we discuss healthy habits. Everyone wants to live a life absent from disease and frailty, a new term coined as a “healthspan” rather than a mere lifespan. Let me share with you the Functional Medicine developments that have taken hold as dogma over the last couple of years, making the following issues the basis of how you will (hopefully) augment your healthy habits with Functional Medicine “tricks” for a healthspan lasting until you’re 120!

Here are the healthy habits we’ll cover:

1. Healthy eating plans
2. Intermittent Fasting and Timed Eating Intervals
3. Exercise guidelines
4. Sleep updates
5. Microbiome health
6. Mitochondrial health
7. NAD enhancement
8. How to keep your mood elevated and your cognition sharp
9. CBD and Medical Marijuana
10. Lighting and EMF’s
11. Augmenting your hormones
12. Controlling your cortisol
13. Do we need to detox?
14. Proper peptide usage
15. More Emerging therapies

What should I eat to follow a healthy lifestyle? 

When I discuss the very basics of healthy habits, I’m not talking about “not smoking” or “achieve and maintain a normal weight,” which I believe are “givens” to everyone reading this article. However, what exactly constitutes a healthy lifestyle eating plan is up for discussion. You all know, as an example, that the more processed a given “edible” is, the less healthy it is for you. Most of you know that sugar (and for some: salt) needs to be kept at a minimum. I hope you know that non-GMO is the way to go, as is organic, non-factory-farmed meat, wild-caught (not farmed) fish, and minimal to no “fast foods” are best unless the industry makes huge changes.

I have covered the concepts of oxidative stress ( basically the opposite of your levels of antioxidants), inflammation regarding your food choices. Notably, I’ll outline each diet plan as healthy choices to be low in inflammatory foods and, if done right, high in anti-oxidant foods. I’m not going to cover basic supplementation in this article but let me re-iterate that a good multi-vitamin, high in antioxidants, with an accompanying fish oil supplement twice daily is a basic recommendation. Vitamin D is another widely accepted basic supplement. And then, some supplements augment immune function, which can all be found here. Here are the diet plans getting the most “press.”

Plant-based Diet

Plant-based dietary patterns include a Mediterranean and Nordic diet pattern, the dietary approaches to stop hypertension (DASH), Portfolio diet, and vegetarian- or vegan-type diet patterns. Plant-based diets- especially when rich in high-quality plant foods such as whole grains, fruits, vegetables, and nuts, have been associated with a lower risk of type 2 diabetes mellitus and cardiovascular disease (CVD) and are recommended for both health and environmental benefits.

I am very much on board with the benefits to the environment, not to mention the abolition of factory farming. However, the association between changing to a plant-based diet and overall mortality remains unclear. Studies have not borne out any consistent associations between changes in plant-based diet indices and cancer mortality as a stark example. My only reservation to an entirely plant-based diet, as most are currently constructed, is that they are filled with lectins which we know cannot be tolerated by those with autoimmune disease, with the full jury being out on the rest of the population.

Keto Diet

Many of you are on the “keto kick” or want to eat a keto diet plan, but it’s not a good idea to eat this way “all the time” without a break. Why? Because long term, uninterrupted keto eating is thought to lead to a less diverse and therefore less healthy microbiome. Eating “keto” works for weight loss and diabetic control quite nicely. When you are eating a keto diet, it’s best to stop for the weekend every couple of weeks for the health of your gut. Long-term, when you are “keto-adapted,” you can go in and out of being ketotic at will. Now, this said, I’m not saying everyone should eat this way. However, if you have tried other ways to lose weight that have not been successful, this appears to be a great way to lose body fat, especially if it’s due to high leptin levels. A full explanation is found in the article referenced above.

Anti-inflammatory Diet

The healthiest diet (IMHO) is still a basic anti-inflammatory diet that excludes sugar and focuses on whole, organic foods. The latest twist in anti-inflammatory eating is avoiding lectins–especially gluten, most grains, beans, and all but high-fat dairy, preferably A2 dairy. As mentioned previously, all of the data isn’t complete regarding lectin restriction, but in my opinion, they are harmful to most.

AIP Diet

For those with leaky gut or any autoimmune disease, an autoimmune protocol diet is recommended. This AIP diet is also great for weight loss for those who can’t tolerate “going keto.”

The fashionable plant-based eating plan is actually how I used to eat (fully vegan) and what I try to maintain about two-thirds of the week with plant-based, AIP meals. However, with zero fish or eggs, I can’t get enough protein since grains and beans are off my list. If you haven’t tried it, nutritional yeast (I like Bragg’s) is a cheesy tasting topping that adds protein to veggie dishes, almond meal pasta, and more. Also, creative companies and Etsy bakers are making all sorts of tasty dishes with nut powders substituting for grains, making this diet much more palatable than it was 10 years ago.

Paleo Diet

I like this diet: it excludes the most potent nasty lectins; gluten, grains, beans, and dairy. However, I’m not too fond of the whopping amount of animal protein this diet not only allows but recommends. First, too much animal protein “jacks up” your omega-6 fatty acid load to make your omega 6:3 ratio way too high; into the “inflammatory zone.” Next, research shows we eat too much protein as it is. Protein helps build muscles, but it also stimulates the mTOR pathway too continuously, which might increase your risk of certain cancers. Lastly, with methane being a significant source of greenhouse gas, the amount of grain necessary to create beef (as well as chicken) is shocking. In my humble opinion, it is dangerous for the people on the planet to be consuming the amount of meat that Americans tend to consume; Paleo diet or no Paleo diet.

Modified Pescatarian Diet

My “vote” goes towards a Modified Pescatarian diet, which is anti-inflammatory and low in lectins. This diet is an anti-inflammatory diet that includes fish and a little bit of high-fat dairy; while recommending avoiding grains (other than sorghum), beans, and most dairy products. It’s fairly close to being an AIP diet plan.

I’ve heard about fasting, but it’s too hard! 

Unless you have been sleeping underneath a giant pizza, you have heard about fasting, and no, it is not a “fad.” Numerous studies show that it is anti-inflammatory to the point where some forward-thinking trauma centers are “fasting” acute trauma victims. In addition, studies show it assists with weight loss and maintenance, metabolic syndromes, cardiac disease, brain health, and mitochondrial health. The different intermittent fasting schedules include time-restricted feeding (TRF), true intermittent fasting (IF), different caloric intakes for fasting, and fasting mimicry (which is relatively new and, to me-not proved.) I’ll focus here on what works and what’s absolutely “doable.”

Time-restricted eating is doable, meaning you can fit it into your daily lifestyle and not have to count calories or “go hungry.” However, let me interject here that most Americans are not used to “feeling hungry” for long; I would suggest that you tune in to how you feel when your GI tract doesn’t have to work hard all day. As a result, you might find that you have more energy and mental clarity.

What’s the perfect “eating schedule?” According to studies, a 16/8 schedule of timed eating is superior, but a 14/10 (so doable!) schedule is pretty darned good as well. You can have black coffee in the morning and then decide when your eight or 10-hour window of food consumption should be. Ideally (primarily for optimal glymphatic “cleaning” in the brain while you sleep), you should be food and beverage free four hours before you go to sleep. My personal eating window is noon-eight o’clock PM. As a final word, caloric restriction is indeed one of the healthy habits to cultivate, and you can accomplish pretty close to what you need by doing a one-day-per-week “low protein day” and use that same day to skip dinner. You’ll awaken feeling great-try it!

How little exercise can I do to be healthy and active?

Each type of exercise (cardio, HIIT, stretching, forms of yoga, and strength training) has a place in your fitness routine. However, current research shows cardiovascular benefits, weight maintenance benefits, brain, bone, muscle mass, and other benefits as follows.

You can take your dog for a brisk walk five days a week for 30 minutes and do two or three (six minutes minimum high intensity) HIIT routines, and cardio-wise, you’re “good to go.” Stretching routines can be as little as five minutes twice weekly, depending on your flexibility. Strength training can be seriously streamlined down to twice weekly, with a good one-set-per-body-part routine like this. Contrary to popular belief (and Fitbit marketers), you do not need to take 10,000 steps per day. Studies have shown no benefit comparing 2,000-4,000 steps to 10,000.

Do I really need 8 hours of sleep?  

Other than the rare few people who have demonstrable genetics, along with others in their family showing that indeed they can “get by” on four or five hours of sleep per night, less than eight hours is woefully inadequate for proper bodily repair during the night. Studies have shown that a majority of Americans are not getting enough good quality sleep.

What’s new is using products such as liposomal GABA to stop brain-race and help both sleep initiation and re-sleeping problems. The use of melatonin seems to be somewhat controversial in the “mainstream” medical literature. However, in the Functional literature, it is well established as a sleep aid and an immune booster as well as a brain booster. Liposomal preparations are useful (combined with GABA preparations) for re-sleeping issues, especially in patients with posterior pituitary problems that cause low MSH, such as all patients with toxin exposures, including (mainly) those with mold and mycotoxin illness. For the severe insomniacs, which tend to include mold and mycotoxins patients, we have a very effective peptide called DSIP.

DSIP: (Trp‐‐‐Ala‐Gly‐Gly‐Asp‐Ala‐Ser‐‐‐Gly‐Glu)

Delta sleep-inducing peptide (DSIP) is quite remarkably effective when used for severe insomnia. Research findings in humans are yet sparse, but in several clinical studies, a few weeks of nightly administration of this peptide resulted in the resolution of previously intractable insomnia.

What’s new in microbiome health? 

The human microbiome comprises 10–100 trillion symbiotic microbial cells with unique genes, principally from bacteria (and some yeast) in the gut. Our “bad” or unhealthy gut bacteria, of which we have up to ten times more than human cells, thrive on the things that create inflammation in our body, including sugar, refined carbs, unhealthy fats, and processed foods (to name the biggest offenders.)

These 100 trillion “bugs” send out chemical messages to the brain to influence our gut health, overall health, and mood. To have a healthy body and brain, you need a healthy gut. Breaches in the gut-brain barrier (from “leaky gut”) are responsible for all sorts of brain-related issues. I’m going to assume you are aware of the importance of gut protection, prebiotic fiber, and so on. A review of that information can be found in the previously cited immune health article.

What’s rather new data regarding microbiome health is the proof that a more diverse microbiome tends to lead to better health. The latest data regarding microbiome diversity is in the arenas of prebiotics (the fertilizer) and probiotics (the seeds).

Prebiotics

Prebiotic fiber comprises non-digestible carbohydrate compounds found in fibrous foods that assist in the growth of healthy bacteria in the gut. Foods, spices, and supplements high in polyphenols appear to promote gut diversity. Hazelnuts, berries, dark chocolate, cloves, red onions, and artichokes are good polyphenols sources. The ECGC in green tea supplements, as well as grape seed extract, are good polyphenol-rich supplements. Evidence is emerging in favor of using fructooligosaccharides as prebiotic supplement powder or in foods.

Onions, leeks, and scallion, as well as chicory, garlic, asparagus, unripe banana, artichoke, are great “gut foods.” They are all thought to assist gut health by producing healthy-gut-bug-food such as butyrate. Speaking of which, if you cook with either ghee or MCT oil, you’ll increase your gut butyrate production.

Probiotics

Regarding probiotics, we like to give a nice multi-strain mixture of the bifidobacterium and lactobacillus probiotics to our patients. However, long-term, especially for those with inflammatory bowel disease or even irritable bowel disease (or possibly “everyone”), sporulating probiotics are probably a better choice. The two types of sporulating probiotics being most closely studied are two in the bacillus species; bacillus subtilis and bacillus coagulans.

How do I help my mitochondria?  

Mitochondria produce energy as adenosine triphosphate (ATP), which your body then uses as fuel. Some cells have more mitochondria than others. Your brain and heart cells are jam-packed with mitochondria, as are your muscles. You want your mitochondria working at full strength to keep your energy levels up, your brain sharp, and your heart and muscles at peak performance. The creation of new mitochondria is crucial for optimal and vibrant aging. As we age, we need to stimulate mitochondrial biogenesis with activities and supplements actively. There is great data for even “crazy-sounding” things such as IV and intra-rectal ozone!

This article should help make your life no less “livable” while you develop more healthy habits, so here are behaviors everyone should have as a part of their “mitochondrial health program.” Cold is your friend. If it’s winter where you live, go outside until you shiver once or twice a day. If you live in the tropics (as I do), when you take your hot shower, turn the water to cold at the end and stand under it for about one minute to produce a shiver. And if you really want to “get into it,” get a $99 ice vest online; it feels great to wear it for 20 minutes after a workout. Next, recall the section above on exercise, and be aware that it’s the HIIT that stimulates your mitochondria. Lastly, choose good supplements for your regimen so that your mitochondria are getting a daily workout from all angles. Here is one mitochondrial supplement we should all be taking, and yes, I am.

What’s all the buzz about NAD? 

Nicotinamide adenine dinucleotide (NAD) is one of the most important chemicals in our bodies. It is necessary for over 500 enzymatic reactions, and it plays a vital role in regulating almost every major biological process. For example, healthspan-promoting activities, including caloric restriction, fasting, and exercise, increase NAD+ levels in our body. Research findings suggest that increased NAD+ levels help counteract the effects of a poor diet, promote mitochondrial health, improve several well-known markers of cardiovascular health, and slow the aging process in the body and the brain.

NAD+ (which can be given IV, sub-Q, and intra-nasally) and its related molecules, nicotinamide riboside, and nicotinamide mononucleotide have been put into popular nomenclature thanks to Dr. David Sinclair (Harvard researcher with a best selling book which touts his research findings). He discloses that he has a financial interest in some supplement companies, but that certainly doesn’t discount his discoveries.

A growing body of research from Dr. Sinclair’s lab plus multiple other labs suggests that exogenous sources of NAD+ precursors, so-called NAD+ “boosters” – nicotinamide riboside and nicotinamide mononucleotide – increase cellular levels of NAD+. The implications for health and cellular age “reversal” are just astounding. Moreover, it is more than proven in mouse studies.

I use doctors-only NAD+ products for my patients administered intra-nasally and via sub-q injection- these are the “strongest” and will activate stem cells the most efficiently. However, I also prescribe a gram per day of nicotinamide mononucleotide for energy-on-demand, mitochondrial support and to help treat mitochondrially-based diseases.

What’s new in brain health? 

Recall that the brain is loaded with mitochondria, so do “take away” that any NAD boost is helping the brain. There has been more evidence linking poor sleep to dementia, so those of you not getting good, restful sleep should do something about it! In addition, the role of the glymphatic system of “nocturnal brain cleaning” has been elucidated even more over the last year. To emphasize again, leaving a good “window” between food or beverages and sleep onset is crucial for optimal glymphatic system function. And so is “good sleep.”

In the “brain supplements we know” department, we have learned that the optimal dose of daily oral resveratrol supplementation to boost BDNF is one gram per day. The evidence is now solid that those of us who avoid depression as we age fare better cognitively. This is an entire topic in itself, but for this article, let me discuss the peptide semax.

Heptapeptide Semax: (Met-Glu-His-Phe-Pro-Gly-Pro)

Semax is considered a nootropic peptide due to its ability to increase BDNF-brain-derived neurotrophic factor. It has also been shown to increase precursors to both dopaminergic and serotoninergic precursors, thus boosting mood. More definitive mood research is needed, but it’s looking terrific thus far. Next, a huge shout-out to the major BDNF-booster peptide called dihexa, given as an oral capsule in varying strengths. And then, there is the evolving data on VIP, a peptide given as an intra-nasal spray.

VIP:

Vasoactive intestinal peptide (VIP) is an important modulatory peptide throughout the CNS, acting as a neurotransmitter, neurotrophic or neuroprotective factor. In the hippocampus, a brain area implicated in learning and memory processes, VIP has a crucial role in controlling GABAnergic transmission, which appears to impact hippocampal-dependent cognition positively. It is currently used in patients with neurodegenerative diseases, including mild cognitive impairment and CIRS, but I anticipate we’ll be using it as another nootropic peptide soon.

Do I need CBD? Is marijuana use healthy?

For years, we have known that the endocannabinoid system has receptors all over the brain, nervous system, and immune system. It very well may be that everyone would benefit from some whole hemp-CBD1 and 2 receptor supplementation as we all age. The data appears to support its usefulness in boosting immune function and brain health, including treatment of TBI (traumatic brain injury.) Right now, we know that CBD1-whole hemp supplementation is useful for pain and sleep. We know that certain types of CBD are useful for some seizures, and other types are useful for anxiety.

Medical marijuana and, in fact, marijuana, in general, has become quite a political topic. While I favor decriminalization, I do not favor “blanket legalization,” and here is why. The “pot” that existed in the marketplace 30-40 years ago had multiples less THC than the recreational or medical marijuana contains now in 2021. The amount dispensed from all sources used by consumers most definitely does what mom told you pot did—it kills brain cells. 

Anyway, yes, THC is indeed useful for some clinical applications such as chemotherapy-induced nausea. But, otherwise, it’s the CBD in medical marijuana supplying a therapeutic effect, with rare exceptions. I have looked at the ratios of THC and CBD in medical marijuana preparations and studied the recreational market. But, unfortunately, at this time, there is no “brain safe” marijuana out there that I see or that I have read about in the literature.

If formulations of marijuana can be cultivated to contain less THC and more CBD, they may be less harmful to our brains. I would also point out that the delivery route should not be in the form of smoking, either. If you are going to use “weed,” you should at least use an equivalent amount of CBD at the same time, in any form, to try to protect your brain. And I’d like this phenomenon to be studied more, of course.

Do I need blue blocker glasses? Are EMFs dangerous? 

The state of the research is in serious flux, no pun intended. So if you want to look cool, go ahead, get those orange glasses, and wear them. Who knows when it will be proven that you have saved your eyes and your brain. Right now, my recommendation for you would be to dim your home’s lighting at sunset to lower your cortisol levels and re-enforce your brain’s circadian rhythm-something required for optimal health.

There is evidence that too much “blue light” (emitted from regular light bulbs and devices) after dark will possibly impact sleep quality and other bodily functions, including night vision. Therefore, in addition to dimming the lights, turn on a “blue blocker” app on your electronic devices. Also, consider getting a “red light” next to your bed if you sit up and read before turning in, as I do.

Some studies have linked excessive cellphone usage to a type of brain cancer, but nothing is conclusive. To err on the side of caution, use headphones or your speakerphone. The data on EMF exposure is similarly inconclusive, but again, it might be prudent for some people in some homes to turn off their routers at night. At the very least, make sure your devices are placed in “airplane mode” next to the bed.

A Word about Hormones

As you age, you become catabolic due to cortisol increase and testosterone and human growth hormone decrease. This phenomenon alone makes men and women lose muscle and gain body fat. That then leads to weight gain, diabetes, metabolic syndrome, osteoporosis, heart disease, and even certain cancers. Not to mention decreased physical activity, a decreased sex life, and overall reported life dissatisfaction. Therefore, I always suggest that everyone read about bioidentical hormone replacement to decide for themselves if they think it will enhance their life.

Cortisol

The only hormone that increases as we age-cortisol-increases under stress-a good thing for your body in the short term. However, long-term high cortisol levels can lead to immune system dysfunction,  increased plaquing on your coronary arteries, decreased mitochondrial biogenesis, depressed cognitive function, and put you at higher risk for all-cause cancers. In addition, it can make you feel fatigued because the decrease in mitochondrial ATP production and high cortisol levels interfere with regular sleep patterns.

High cortisol can trigger sugar cravings. It can be the main “driver” of menopausal belly fat. If you are trying to build muscle, it does just the opposite as it again is catabolic. It not only can decrease muscle mass, but it also reduces bone mass and can slow your metabolic rate by reducing thyroid functioning. Finally, it can trigger leaky gut syndrome, which causes systemic inflammation and is one of the main root causes of all autoimmune diseases.

We, therefore, lower cortisol levels for people under constant stress and most individuals 55-65 years of age and older for the reasons mentioned above. I often re-set the adrenals with adrenal adaptogens and adrenal glandulars. Sometimes I use integratives such as a magnolia bark derivative. Sometimes I use aromatherapy or liposomal GABA. Often, I’ll turn to the intra-nasal peptide called Selank.

Heptapeptide Selank: (Thr-Lys-Pro-Arg-Pro-Gly-Pro) 

Numerous clinical studies have shown that Selank has strong anti-anxiety as well as neuroprotective effects. In addition, the clinical effects of Selank are similar to those of anti-anxiety medications such as benzodiazepines, which enhance the activity of the GABA: the calming neurotransmitter. This similarity of effect is borne out in several clinical trials. In addition, there has been a documented similarity between the changes in the expression of 45 genes one hour after either GABA or Selank is given.

What about Detoxing?

Unfortunately, what may seem to be a “common sense thing” is just not studied in the general population. Yes, we know that most of us carry around a load of toxins, including plastics, BPC’s, and even some degree of heavy metals. However, we have no medical guidelines about detoxification other than for those who genetically cannot recognize biotoxins, those with MTHFR (methylation) defects, or those who may need something to augment their liver’s detoxification functioning during, say, chemotherapy. I will always recommend that you drink reverse osmosis water, shower in filtered water, and use non-chemical cleaning products. I discourage the use of “cleansing fasts” or the overuse of colonics as a detoxification method. The judicious use of activated charcoal blends on an intermittent basis seems reasonable, albeit not scientifically proven.

Any other peptides we should know about?

I prescribe a good deal of BPC-157 for gut issues and injuries. KPV is great for psoriasis, along with other integratives in our functional arsenal. CJC-Ipamorelin is just one anterior pituitary stimulant to increase HGH levels as a secretagogue but does seem to work the best. Sex lives will never be the same since the advent of kisspeptin and PT-141. The topicals we now have for hair growth (such as zinc thymulin) are simply amazing. Lastly, GHK-Cu in topical or injectable form works wonders for collagen and elastin stimulation and visible improvements to aging skin.

What’s new for our lifespan?

Cancer cures are just on the horizon, but as always, it’s best to take preventive measures and do all that you can to avoid getting cancer in the first place. Besides implementing the healthy lifestyle discussed in the previous paragraphs, high dose antioxidants, IV or liposomal vitamin C, and even low-dose naltrexone are gaining traction as standard functional medicine practices when someone is at high risk.

The research is ongoing and fascinating regarding our future ability to cure disease by repairing our genetic material. We use stem cells (mesenchymal, umbilical, and placental) for all sorts of regenerative purposes. Perhaps the most therapeutic cellular therapy will turn out to be what the stem cells secrete-packets of “young factors” called exosomes. Clinical trials are ongoing for neurodegenerative disease, autoimmune disease, and more with IV exosomes. Joint health is being addressed with injectable exosomes. Exosome therapy may even play a role in skin rejuvenation. A lot of preliminary data looks quite promising regarding the use of IV exosomes to treat illness and perhaps even, dare I say, reverse cellular aging. I’ll leave you with that thought. Remember, 120 is the new 60.

Natural Ways to Lower Blood Pressure: Intro

If you are not currently among almost one-half of U.S. adults with high blood pressure, then the odds are that you might develop high blood pressure at some point in your life without some preventive measures. In this article, I’ll discuss all of the proven natural ways to lower blood pressure.

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure is called secondary (rather than primary) hypertension (HTN), with those underlying conditions spelled out in this article. All types of hypertension increase your risk for serious health problems, such as stroke, heart disease, ocular blood clots, kidney failure, and dementia. So, it’s clear you want to have normal blood pressure. Below you will find a blueprint for achieving your health goals naturally, which will cover the following:

• Eliminate the basic HTN risk factors
• Do the “right” type of exercise
• Eliminate two toxic types of foods right off the bat
• Address the major metabolic issues: blood sugar, insulin, and leptin
• Normalize your weight
• Balance your omega fatty acids
• Eliminate internal inflammation and oxidative stress
• Control your stress levels
• Fix your broken microbiome
• Banish toxins
• Increase nitric oxide
• Increase vitamin D
• Consider other foods, supplements, and integratives

The Basics of Treatment for Hypertension

Let’s first review risk factors you can easily control. For example, you can stop smoking, control alcohol consumption and, for those who are “salt-sensitive,” control your salt consumption. In addition, you can increase potassium-containing foods (such as bananas and raisins) and take a good magnesium supplement. Estimates show that 80% of Americans are magnesium deficient, and magnesium relaxes vascular smooth muscle; to directly lower blood pressure. In addition, your weight and the amount of exercise you do affect your blood pressure.

Exercise

It’s important to have an exercise regimen that will help to lower your insulin levels. Studies have traditionally shown that “cardio”  or “aerobic” activities such as jogging and swimming tend to be the most beneficial for lowering blood pressure.

However, more recent studies reveal the good news that you don’t need a 30-60 minute workout to reap the insulin and blood-pressure-lowering benefits. Short, intense workouts such as high-intensity interval training (HIIT) are becoming more popular for both health and efficiency. It’s fairly easy to construct a HIIT regimen to do at home. You don’t need to do exact “timed intervals”; it’s just about getting short of breath, recovering, doing it again, and so on. If you have been exercising regularly, start “low and slow,” and if you haven’t exercised much since your “school years,” get medical clearance. Try doing burpees until you’re short of breath for 3 sets and work up to 6 sets, 2x per week. You can also do sprints on a track or in a pool. You can run in place, jump rope, or do jumping jacks.

Diet changes and precautions

Before I get into a more verbose discussion about non-inflammatory eating, I mention two food items we all used to think were healthy foods. Unfortunately, these so-called health foods have become poison for most people with existing high blood pressure, grains, and sugars (including fructose). Since many people still think grains and fruit juices are healthy choices, I want to emphasize they most certainly are not. Now, the science.

Addressing “Hypertension Pathophysiology”

Closely linked are the metabolic abnormalities of high blood sugar, high insulin levels, high leptin levels, and, therefore, insulin and leptin resistance at the receptor level.

Hypertension can be caused by cellular glycation (stiffening) from high blood sugar levels, so getting your blood sugar under control is a must. In addition, most people with hypertension have insulin receptors that don’t work efficiently, called insulin resistance. To compensate for this, your body produces more insulin. To lower insulin levels, you need to replace processed foods with real, whole foods. You also need to eliminate or dramatically reduce sugar and processed fructose (fruit) sugar and grains from your diet. Some studies show a closer correlation between fructose consumption and hypertension than even sodium! And then there’s leptin, another hormone that looms upward as you eat poorly and gain weight.

You can easily become leptin-resistant (with the attendant high leptin levels) by eating the same diet full of sugar (particularly fructose and grains once again.) Together, these foods will create the perfect environment for weight-packing bacteria to thrive in your GI tract; or microbiome. You then have your gut telling your metabolism to slow down and your high leptin levels telling you to keep eating and store more fat in your fat cells. It’s not a pretty picture, but it can be easily reversed. Other factors that play into the high leptin scenario include high cortisol levels (to be discussed) and other hormone imbalances. Often this trio shows up as belly fat. Lowering blood sugar, leptin, and insulin are partially achieved by simply losing weight which I’ll discuss next.

Normalize your Weight

I’ve talked about blood sugar, insulin, and leptin. To complete the discussion of the diet plan to normalize your weight for life, you must eat an anti-inflammatory diet. This can be a basic anti-inflammatory diet, a stricter autoimmune,no-lectin diet, or even a ketogenic diet plan. A paleo diet is effective, but you must be sure to compensate for the over-abundance of omega-6 fatty acids in meat. Here’s how you do just that.

Balancing the omega fats in your diet

Just about everyone needs to normalize their omega 6-to-3 fat ratio. Also, omega-3 fatty acids are vital for healthy blood pressure. Findings from a study of 2,000 healthy men and women between the ages of 25 and 41 showed that those with the highest serum levels of omega-3 also had the lowest blood pressure readings.

Both omega-3 and omega-6 fats are essential for your health, but most Americans consume too many omega-6 fatty acids in their diets and too few omega-3s. This is because we tend to eat more meat and milk and less omega-3 fish. Eating omega-3 fats is a great way to re-sensitize your insulin receptors if you are insulin resistant. It is also essential for normal, healthy blood pressure. Wild-caught salmon and sardines are both low-mercury and high omega-3 containing fish. However, it’s hard to consume enough to compensate for all of the omega-6s we eat, so I always recommend a good omega-3 supplement.

Inflammation and Oxidative Stress

Internal inflammation is associated with all disease states, including hypertension. Because approximately 70% of Americans are overweight, this alone is considered a major cause of reversible inflammation. In addition, eating the standard American diet (S.A.D.) described above will increase inflammation levels. Add in toxins such as heavy metals (mercury) and fluoride in drinking and showering water, and you’ve piled onto our national epidemic of inflammation. On the other hand, if you reduce your weight, clean up your diet, deal with toxins, stress and heal your probable leaky gut, then you will make a big “dent” in your inflammation problem and your blood pressure level, too.

Oxidative stress (defined as an over-abundance of free radicals which are not sufficiently quenched by antioxidants) worsens inflammation. But, this can be easily reversed with enough vegetables, fruits in moderation, and a high-antioxidant supplement.

Stress and Cortisol 

There is a publicly accepted long-term myth that stress raises your blood pressure. It does short-term, and some so-called “experts” still say it doesn’t raise it or can’t raise it long term. However, sustained high cortisol will routinely cause leaky gut, disturbing the microbiome and potentially elevating blood pressure. So, based on current research, it’s now not a myth anymore! Let me explain the role of the microbiome.

Your Microbiome

Leaky gut is caused by everything from a poor diet to high “stress levels” to proton pump inhibitor antacid drugs such as Prilosec. It sometimes produces little to no symptoms, but it always causes internal inflammation, which you now know is associated with hypertension. In addition, leaky gut always produces unfavorable alterations in the composition of the GI microbiome. And this is yet another factor in the creation of the hypertensive state.

Doesn’t it seem that lately, you read that all aspects of your health are more and more related to the health of your gut? It turns out that an unhealthy gut microbiome with less “healthy bacteria” (a dysbiotic gut) will cause hypertension; via a different mechanism than through leaky gut and/or inflammation. It also seems that “hypertensive GI tracts” have fewer bacteria that produce (healthy) butyrate and acetate.

There are two easy ways to increase gut butyrate levels that help with weight loss, insulin resistance, leptin resistance, and blood pressure. One way is to take sporulating probiotics. The other is to supplement with MCT (medium-chain triglycerides) oil. I use MCT oil for cooking and suggest that “trick” rather than MCT supplements which often cause diarrhea.

Avoid toxins

Biotoxins such as mold mycotoxins and Lyme toxins and heavy metals such as lead and mercury can damage the microbiome via other mechanisms, including (most often) the sirtuin pathway, and raise blood pressure. So next, let’s talk about sirtuins.

Sirtuins are enzymes that are produced in decreased amounts in many metabolic disorders such as obesity and metabolic syndrome. SIRT1 (the most well-known and studied sirtuin) causes an increase in leptin sensitivity. It also increases adiponectin production. Both of these actions have both anti-obesity and, therefore, anti-hypertensive effects. The SIRT1 pathway is disordered in toxin-related disorders and many disorders of mitochondrial function. Therefore diseases such as Parkinson’s disease, Hashimoto’s thyroiditis, or Chronic fatigue syndrome are also associated with SIRT1 deficiency, with a built-in risk for metabolic syndrome, including hypertension.

The Role of Nitric Oxide 

Nitric oxide (NO) protects the lining of blood vessels and vasodilates them as well. When arteries are damaged by inflammation, we see a decrease in nitric oxide near the smooth muscle linings of the blood vessels. In general, nitric oxide levels tend to decrease with age. To some degree, HIIT exercise enhances NO, but to make sure your levels are adequate, try foods or supplements. Below are some foods and supplements which raise NO levels.

Beetroot Juice 

This juice is high in NO3, which converts to NO. An 8-ounce glass per day will lower your blood pressure (on average) by 8 mm Hg (systolic) and 4 mm Hg (diastolic), demonstrated in those with existing hypertension. I find this to be much more palatable when mixed with “juiced” carrots and spinach.

Examples of other vegetables high in NO3 include whole beets, arugula (the best!), celery, cabbage, leeks, scallions, radishes, kale, turnip tops, spinach, mustard greens, eggplant, carrots, and string beans.

Vitamin D 

It’s a well-known medical fact that vitamin D deficiency is associated with arterial stiffness and subsequent hypertension. Still, a large study involving over 100,000 individuals has now demonstrated that low vitamin D levels can actually cause high blood pressure. To make the correlation even stronger, the highest vitamin D levels were shown to lower hypertension risk the most. High-D foods include the healthiest fish, wild sockeye salmon, and sardines, as well as eggs (only eat “pastured,” please). Most people are clinically deficient unless they take D3+K supplements, with most individuals requiring a minimum of 6000 IU’s per day.

Resveratrol

This multi-use supplement increases endothelial NO production, reduces vascular oxidative stress, and prevents smooth muscle proliferation, vascular remodeling, and arterial stiffness. In addition, resveratrol inhibits immune cell infiltration into the vascular wall and mitigates vascular inflammation. All these mechanisms contribute to the positive effects of resveratrol on vascular function and blood pressure.

L-arginine plus l-citrulline

A good NO-enhancing supplement will contain l-arginine and l-citrulline. Bodybuilders typically use these supplements for the increased “pump,” and some men use them to enhance erectile function. However, if taken often, they too will lower blood pressure by increasing nitric oxide.

The Role of the Oral Microbiome

Other Helpful Supplements

Vitamin E

Natural vitamin E (200 IU’s per day) has been shown to lower blood pressure. Natural vitamin E is always listed as the “d-” form (d-alpha-tocopherol, d-beta-tocopherol). Synthetic vitamin E is listed as “dl-” forms. Don’t take synthetic vitamin E, as it’s ineffective and might even cause harm.

Vitamin C

Studies (meaning a review of 29 studies done in 2012) indicate that 500 mg of vitamin C per day might help lower blood pressure. In 2020, another meta-analysis was done, focusing on 8 studies published between 1991 and 2018. Overall, 614 participants were included. The number of participants in the individual studies ranged from 12 to 480. Participants’ mean age ranged from 46 to 78 years. The duration of the intervention varied from 4 to 24 weeks. All participants had essential hypertension. The average SBP and DBP of the participants ranged from 143 to 173 mmHg and from 76 to 97 mmHg, respectively. The supplementary dose of VitC in the treatment group varied between 300 and 1000 mg/dL. The results? There was indeed a correlation between supplemental vitamin C and hypertensive control.

Why? At present, the main theory is that VitC increases intracellular concentrations of tetrahydrobiopterin, an endothelial nitric oxide synthase co-factor that promotes the production of nitric oxide, which is a potent vasodilator. However, there is also evidence that Vitamin C enhances the biological activity of nitric oxide.

Garlic

This can lower blood pressure by 10%, but only if you take it as a supplement. Although allicin is produced when raw garlic is crushed or chewed, much of it is destroyed during cooking. For about ten years, researchers have been aware the allicin made from alliin in garlic blocks the activity of angiotensin II—a substance that raises blood pressure. In addition, supplemental garlic elevates levels of nitric oxide.

Note, however, the health benefits of garlic supplements are due to ajoene, diithins, and allicin, not just due to allicin. So, shop carefully since ajoene and diithins are considerably more potent than “just allicin.”

Natto

Nattokinase enzymes have potent fibrinolytic (blood-clot-busting) activity, anti-atherosclerotic, lipid-lowering, antiplatelet (anti-platelet stickiness), and even neuroprotective effects.

In addition, with regards to the topic of this article, a well done double-blind, placebo-controlled, randomized study showed that supplementing with nattokinase for eight weeks resulted in a significant reduction of both diastolic and systolic blood pressure.

Nattokinase is an enzyme found in the food natto, which is a fermented soy product. Whether consumed as fermented soy or as a supplement, the natto enzyme has been used successfully for 25 years to treat hypertension and various circulatory issues in China and continues to be studied worldwide.

Odds and Ends

The idea that menopause or the associated estrogen decrease is associated with blood pressure increase is still under debate. The epidemiological challenge is the coincidence between menopause and aging and the evidence that both rising blood pressure and menopause have common determinants such as diet, body mass index, smoking, and even socio-economic class. In addition, there seems to be no correlation between testosterone levels in men and blood pressure levels. The bottom line, as always, is to eat healthfully, exercise correctly, and supplement smartly. For some, that might include nitric oxide supplementation.

Exciting New Therapies for Natural Pain Relief

In this article I review some of the basics of pain relief you might have learned in health class, including all the ways to increase your natural painkillers: your endorphins, enkephalins, and endogenous cannabinoids (some of this might be familiar too). I also touch on some integrative, supplement-type methods you can track down on the internet by yourself and will finish by reviewing exciting and new forms of natural pain relief available only through qualified Functional medicine doctors (not on the black market please!).

I will discuss:

• Most common natural therapies
• How to increase endorphins
• Cold for natural pain relief
• Helpful herbals and supplements for natural pain relief
• Cannabinoids
• Low-dose Naltrexone
• Selank Peptide
• Semax Peptide
• DSIP Peptide
• Concluding remarks

Common Natural Pain Relief Therapies 

But a Word About Diet First

One of the first things I do with new patients is to ask them to alter their diet. Most people aren’t aware how inflammatory, and therefore pain-inducing, some of the foods they typically eat can be. The absolutely most anti-inflammatory diet is my autoimmune protocol diet. Avoiding fast and processed foods, grains (especially gluten), seed oils, dairy, and other lectins such as peppers, eggplants or white potatoes, is totally game-changing. When it comes to natural pain relief, an anti-inflammatory diet is Job #1.

Below are some other basics, which may or may not be helpful, depending where you are on your own “pain journey.” Meaning, hang on. If you are farther along on this road, there are additional and exciting compounded alternatives you have not yet heard of that I will discuss.

Fairly Well-Known Methods of Pain Relief

Many of us know the comfort of a warm bath (‘hot soak’) and a wet, dry, or far-infrared sauna. A simple, long, hot shower helps muscular or non-inflammatory joint pain when we’re stiff and achy. Massage therapy is proven to improve lymph drainage and increase endorphin levels.

Remember that endorphins are your endogenous painkillers, produced (mainly) by the posterior pituitary gland. Although there is speculation about the relative significance of endogenous cannabinoids and enkephalins, endorphins are still considered the #1 endogenous pain reliever.

For most people, the following endorphin boosting methods will bring some temporary pain relief. Unfortunately, these methods don’t work well (if at all) for patients with some pituitary tumors or active mold and mycotoxin illness. But, as someone who treats a lot of mold illness, let me tell you that the posterior pituitary does “bounce back” and these methods will indeed work again.

Increasing your Natural Pain Killers: Your Endorphins

Massage: Yes, I am repeating myself here, but if you can afford it a massage is not just a feel-good activity. A nice, firm, muscle-kneading massage increases endorphins for several hours, adding yet another layer to pain relief.

Exercise: Most of you know that exercise increases endorphins. But do you know that a “runners high” is now thought to be (at least partially) due to endogenous cannabinoids, not to endorphins? And there is definitely something to be said for group fitness activities. A clinical study found that athletes who rowed together could tolerate two times the pain compared to athletes who rowed alone.

Laughter: Laugh out loud and your body releases endorphins! Read emailed jokes. Watch comedy specials. Laugh every single day as if your health depends on it.

Eat Your Favorite Foods: If you love it on your tastebuds, you will produce endorphins. And Yes, even healthy foods can be delicious, so keep this in mind when you’re looking for an endorphin rush.

Do You Like Dark Chocolate? Dark chocolate contains much more healthy flavonoids – and far less sugar – than milk chocolate, but a couple of squares of either will give your endorphins a boost. Cocoa also contains a mood-boosting substance called phenethylamine. It is the phenethylamine in the cocoa that gives your body an endorphin boost. Interestingly, however, phenylethylamine supplements do not have the same effect.

Eat Hot Peppers: If you have a strong, healed gut and can eat the occasional “nightshade” (a lectin), these really can give you an endorphin rush. Your body senses “heat stress” and responds the same way it responds to pain – by producing endorphins.

Listen to Music: Enjoy the music you love. But did you know that your brain produces even more endorphins when you take part in creating music. If you are not a trained musician…then hum to, or sing along with, or even dance, with abandon, to your favorite tunes.

Have Sex: As you might predict, sex releases a flood of endorphins as well as other feel-good brain chemicals.

Try Acupuncture: The minor amount of pain caused by acupuncture needles sends a message to the brain, which then responds with the release of endorphins. Less data is documented regarding the placement of needles, but logically, of course, there is “something to it.”

Get Some Sunlight: A mere 5 to 10 minutes of direct sunlight will increase mitochondrial ATP as well as endorphins. And if it gets too hot for you, some cold therapy afterwards might just feel great!

Cold for Natural Pain Relief

Now that I’ve discussed endorphins, let me add another method to my list. Any sort of cold or cryo-therapy will cause your posterior pituitary to release endorphins, but referring back to the “stress” concept, when your body experiences stress or pain, the brain releases endorphins.

There is quite an accumulation of positive data on everything from winter swimming to ice baths regarding pain relief, reduction of inflammation and, Yes, even endorphin production. How to bring on the cold? If you’re up north and it is winter, go outside in shorts and a T-shirt. If not, try an ice vest, or multiple gel cold packs, or a brief ice bath, or even a cryotherapy tank. Cold works, and not just for localized pain due to injuries as most people think.

Several inflammatory cytokines, including TNF-alpha and IL-6 (both of autoimmune disease fame), will increase pain. In clinical studies, levels of TNF-alpha, IL-6, and a host of other inflammatory cytokines have been shown to be epi-genetically down-regulated systemically with the use of cold packs.

Herbals, Supplements and Integratives for Natural Pain Relief Backed by Science

Curcumin suppresses inflammation, which is a root causes of all diseases. Curcumin is the most potent of the three curcuminoids found in the spice turmeric. It suppresses pain by decreasing inflammation. It has more mechanisms of action than non-steroidal anti-inflammatory medications such as ibuprofen, and even more than steroids such as cortisone.

Curcumin is a safe inhibitor of the same pathways that the most complex drugs block: COX, COX-2, and LOX. In fact, curcumin inhibits the entire arachidonic acid cascade. In clinical studies, curcumin has worked as well as phenylbutazone and cortisone for osteoarthritis, rheumatoid arthritis, and post-operative inflammation. Studies show that curcumin inhibits the COX pathway better than indomethacin, a very strong mixed COX inhibitor that is still used to treat gouty arthritis.

Notably, curcumin has quite similar anti-inflammatory action as NSAIDs, but without the side effects. NSAIDs can have dangerous side-effects, and the COX-2 inhibitors are even required to include black-box warnings. Long-term NSAID usage causes leaky gut in just about 100% of people. Generally safe, even at doses up to 8,000 mg per day, Curcumin must be taken with meals, and under a doctor’s supervision if at doses exceeding 1-2 grams per day.

Fish Oil: There is a good deal of clinical evidence that fish oils are very anti-inflammatory and therefore pain-inhibiting. As an aside, when my patients have “the occasional headache or backache,” I ask them to take some curcumin and fish oil.

Capsaicin (trans‐8‐methyl‐N‐vanillyl‐6‐nonenamide) is an extract from hot chili peppers. It is a decent topical analgesic for a variety of painful conditions.

Devil’s Claw is a plant native to the African continent. Iridoid glycosides are the active ingredients. Several studies demonstrate relief with topical use for osteoarthritis.

Phytodolor is an herbal formulation containing alcoholic extracts of Populus tremula, Excelsior, and Solidago virgaurea. Studies show that it is often effective in various inflammatory arthritic disorders.

Glucosamine and Chondroitin Sulfate are the principal components of cartilage. There are conflicting studies on the combination of glucosamine and chondroitin, with some demonstrating a beneficial effect on arthritis pain. More recent studies find that chondroitin alone does not reduce joint pain. Therefore, the use of chondroitin has dropped off but there is better news regarding glucosamine.

Glucosamine for Arthritis: There have been 30 or so well-done studies examining the efficacy of glucosamine for joint pain. On review of all data comparing glucosamine to either NSAIDS or placebo, the glucosamine edges out the NSAIDS by a hair. Recent data shows the mechanism of action is via blocking lectins. While there haven’t been any good studies comparing glucosamine to the elimination of lectins in the diet, “it’s a very good thought.”

Cannabinoids: CBD and THC

People rarely realize that CBD is most plentiful in the hemp plant, which contains minimal THC, and that THC is found in the marijuana plant, where the concentration of CBD is more scarce. Both plants are cannabis plants, by the way.

There are many cannabis strains that vary widely in the composition of cannabinoids, terpenes, flavonoids, and other compounds. These components work synergistically to produce wide variations in benefits, side effects, and strain characteristics.

When we discuss the benefits of CBD, we’re talking about “whole hemp CBD” because “extracts” of CBD are relatively useless. Yes, check to see what you have. Medicinal THC, however, can be made in many forms, but the best benefits are found in those plants with more CBD, and the best pain relief is found in those formulations that include the other aforementioned ingredients such as the terpenes.

In a 2018 review article, multiple studies revealed mixed results. It appears that cannabinoids appear to be most effective in controlling neuropathic pain, medication-rebound headache, and chronic noncancer pain, but do not seem to offer any advantage over nonopioid analgesics for acute pain.

Something marijuana enthusiasts don’t mention is that THC-cannabinoid-based analgesia has been linked to memory deficits and cognitive impairment. As with all mood-altering substances, we must be careful of our usage, dosing, and (IMHO) brain health protection, so that we do not experience any negative effects on our most important organ: our brain.

Meanwhile, animal studies demonstrate that whole hemp CBD oil increases endorphins. This has particular implications for patients with chronic pain syndromes such as fibromyalgia, CIRS pain due to EDS (endorphin deficiency syndrome), and neuropathies. An online patient survey by the U.S. National Pain Foundation of 1,300 fibromyalgia patients rated CBD as more effective than Cymbalta, or Lyrica.

If you have fibromyalgia, please read on, as there is much more “out there” for you. Here is the first thing you might want to try.

Low Dose Naltrexone

Naltrexone, was approved in 1984 by the FDA in a 50mg dose to help addicts wean off heroin. Naltrexone’s initial use was an opioid-antagonist drug used in large doses to block opioid receptors, and therefore the effects of opioid drugs.

Naltrexone was since studied in doses of 1-5 mg (hardly even a “drug” at those doses) and was found to perform other functions. It blocks the receptors of the opioid hormones in our brain and adrenal glands. Doing so produces the anti-pain endogenous chemicals called beta-endorphins and met-enkephalins, known as the opioid rebound effect. Blocking opioid receptors also upregulates something called opioid growth factor (OGF).

The mechanism of action of pain relief via OGF is fairly simple. By up-regulation of OGF via the temporary blockade of opioid receptors, you will see an increase in circulating endorphins and enkephalins via reduction of the inflammatory response. LDN is used not only for pain relief, but also to treat many autoimmune diseases; notably Crohn’s disease via different mechanisms of action. In addition, LDN is neuroprotective via the inhibition of microglial activation. But it is in cancer research where the really promising data is being seen, where OGF is identified as an angiogenesis blocker which then suppresses the growth of many types of cancer.

Review of LDN for pain 2020

Eight articles were ultimately selected for evaluation, after hundreds of reports of benefits were identified. Six studies included data on fibromyalgia, two studies included data on chronic regional pain syndrome, and one study included patients with multiple diagnoses, including interstitial cystitis, fibromyalgia, and chronic pelvic pain. The primary outcome of all of the studies was absolute pain intensity reduction. The writers of this review concluded that “Low-dose naltrexone provides an alternative in medical management of chronic pain disorders as a novel anti-inflammatory and immunomodulator.”

Before I move on to the last three new and novel pain therapies, I want to do a quick review of peptides, in case this is your first time hearing about them. Peptides are not “drugs,” because they are recognized by our bodies as “self-produced,” much like bioidentical hormones. Peptides are short segments of amino acids, usually comprised of between two and fifty amino acids.

The peptides we use in functional medicine are derived from human secretions and, being bioidentical, there are no “drug side effects.” There are many excellent peptides that are utilized for various benefits in functional and integrative medicine, but three in particular are used in various forms and combinations for the treatment of pain. They are:

Heptapeptide Selank: (Thr-Lys-Pro-Arg-Pro-Gly-Pro)

Numerous clinical studies have shown that Selank has strong anti-anxiety as well as neuroprotective effects. The clinical effects of Selank are similar to those of anti-anxiety medications such as benzodiazepines, which enhance the activity of the calming neurotransmitter, GABA. This suggests that the molecular mechanism of action of Selank also arises from its ability to enhance GABA’s activity on its receptors. This is supported by the strong positive correlation – in several clinical trials – between the changes in the expression of 45 genes one hour after Selank or GABA is given. Additionally, there is the data that, across-the-board, anxiety increases the perception of pain.

Here is some insight into why this may be true. Examination of patients with various forms of anxiety demonstrates a considerable shortening of enkephalin half-life. Selank dose dependently inhibits enzymatic hydrolysis of plasma enkephalins. Selank has been found to be a potent enkephalinase inhibitor. In other words, the enzyme that destroys the enkephalins is blocked by Selank, which has been proven to reduce anxiety.

Study results suggest that high efficiency of Selank in the therapy of anxiety and phobic disorders is due to its ability to inhibit enkephalin hydrolysis. A very nice side effect of this is that higher enkephalin levels will reduce pain. Ongoing studies suggest that Selank may additionally act via other brain chemical systems such as those that control dopamine and serotonin. Meanwhile, the data regarding these two systems is strong for my next peptide, Semax.

Heptapeptide Semax: (Met-Glu-His-Phe-Pro-Gly-Pro)

Semax is considered a nootropic peptide due to its ability to increase BDNF-brain derived neurotrophic factor. It has the same, and perhaps more pronounced effect, as Selank on enkephalinase, leading to increased levels of enkephalins. In addition, several studies demonstrate its ability to cause the brain to release both serotonin and dopamine, enhancing feelings of well-being, which will also decrease the perception of pain. It is being increasingly recognized as a fairly decent analgesic, despite the paucity of human clinical trials.

DSIP: (Trp‐‐‐Ala‐Gly‐Gly‐Asp‐Ala‐Ser‐‐‐Gly‐Glu)

Delta sleep-inducing peptide (DSIP) has potent analgesic activity in mice. DSIP may play an important role in pain regulation in the central nervous system, but it currently is primarily used for severe insomnia in humans. Research findings in humans are yet sparse, but in a study of seven patients with migraines and vasomotor headaches, this peptide (administered for 5 consecutive days) significantly lowered the perceived pain levels of six of the seven. Additionally, as an “incidental finding,” mood was elevated in all seven subjects.

DSIP does not appear to have binding activity to any subtype of opioid receptors. Animal studies show that DSIP stimulates the release of met-enkephalins. It might also then stimulate a stronger binding effect of those endogenous pain relievers to opioid receptors. More research is obviously needed, but for those with sleep and pain issues it is a great add-on.

Additional Comments

If you are looking to ‘go it alone’ for pain relief, know that there is some data on DL-phenylalanine regarding inhibition of enkephalinase, that you can buy liposomal GABA preparations to decrease anxiety, and that you can purchase 5-HTP supplements to augment serotonin levels – all of this, in addition to the endorphin-enhancing behaviors and the use of ‘cold’ and exercise. Remember that exercise probably not only releases endorphins, but it probably also increases levels of endogenous cannabinoids.

What you do not want to do, however, is increase your use of over-the-counter drugs for pain. Acetaminophen is toxic for your liver (and somewhat so for your gut), and NSAIDs such as Motrin and Aleve are uber-toxic to your kidneys and gut and, in fact, cause many cases of leaky gut, which then leads to all sorts of other issues.

Get some help for pain that does not respond to some of the natural things I have written about here. My last word of advice: Avoid Black Market Sources of Peptides and LDN, as you simply cannot know what you will be getting.

Mitochondria are the key to energy and health -Important update: I can now get NAD+ troches for you! 

Before I dive right into a discussion about mitochondria, I’d like to ask you why you are reading this article? If you are looking for improved health and longevity, this article will give you lots of actionable information. However, if you have been feeling ill, with fatigue being a prominent component of whatever is wrong, you need Functional Medical care. You can’t “fix fatiguing illness” yourself. That’s all I’m going to say about that; now I’ll get into the topic you came for: how to boost and why to boost your mitochondrial function. Mitochondria are involved in many vital processes in human cells, including energy production, fatty-acid oxidation, and the Tricarboxylic Acid (TCA) cycle, calcium signaling, apoptosis (cellular death), and heat production. However to simplify things let’s talk about energy and longevity which is what their function translates to for practical purposes. And to help this occur, we can review the health practices, along with the best supplements to improve mitochondrial function.

• Why do we want well-functioning mitochondria?
• What happens when mitochondria malfunction?
• What about mitochondrial function and aging in general?
• Mitochondria boosting health practices
• Mitochondrial specific exercise
• CoQ10
• Alpha lipoic acid
•  PQQ
• L-carnitine
• D-ribose
• Phospholipids
• NAD
• Miscellaneous supplements
• Final words

But before we begin, I’d like to give every one of my readers “patient access” to my Designs-For-Health account so that if you want to purchase supplements, you’ll receive a 15% discount from their Amazon price. Here is their website: https://www.designsforhealth.com/ and then my practitioner code is: kimcrawford, allowing you to create a un and pw for your own account. You’re welcome! In addition, mitochondria reproduce and put out more of their “good stuff” when you lower sympathetic nervous system activity. Here’s the best and easiest way to do VNS to accomplish that goal quickly.  Feel free to use and share my patient code: DrKim25 for a $25 discount on the best thing you’ll buy this year.

Mitochondria: Why do we care?

First, let’s discuss the “energy part.” Mitochondria produce Adenosine Triphosphate (ATP). In the cell, the energy in the form of ATP is produced in two ways: in the cytosol as a product of glycolysis and in the mitochondria as a product of oxidative phosphorylation. The substrates, in the form of fatty acids and pyruvate, are oxidized via fatty acid β-oxidation and the TCA cycle, respectively. The Nicotinamide Adenine Dinucleotide (NADH) and flavin adenine dinucleotide (FADH₂) produced by these reactions are used by the electron transport chain to generate ATP. Just remember from this complex discussion of energy production that you need ATP and you need NAD+/NADH to make that ATP, so you feel as if you have enough energy.

Proper mitochondrial functioning is crucial for every nucleated cell in a body. A number of diseases are characterized by dysfunction of muscular or neural systems or metabolic reactions. All these diseases and pathophysiological conditions are developed against a specific genetic background, together with environmental factors.

Mitochondria produce energy as ATP (adenosine triphosphate), which your body then uses to fuel your daily activities. Some cells have more mitochondria than others. Your brain, muscles, and heart cells are full of mitochondria. Putting diseases and aging to the side: you want your mitochondria working at full strength to keep your energy levels up, your brain sharp, and your muscles and heart at their peak performance. The creation of new mitochondria (mitochondrial biogenesis) is needed for optimal aging, which we now call our healthspan. Not to be repetitive, but always remember this is mandatory to keep your energy levels at a peak. It’s also a part of what’s needed to protect you from oxidative stress. As you would predict, mitochondrial dysfunction tanks your energy and contributes to numerous physical ailments.

Mitochondrial Dysfunction and Disease

Mitochondrial dysfunction, characterized by a loss of efficiency in the synthesis of ATP, is a characteristic of aging and, essentially, of all chronic diseases. Loss of function in mitochondria can result in excess fatigue and even other symptoms in just about every chronic disease you can imagine.  These conditions include neurodegenerative diseases, such as Alzheimer’s disease and Parkinson’s disease, and Amyotrophic Lateral Sclerosis.

Metabolic syndrome, heart disease, and diabetes are all associated with mitochondrial dysfunction. Metabolic syndrome is a group of conditions that combine hypertension, hyperglycemia, abdominal obesity, and abnormal cholesterol or triglyceride levels. Metabolic syndrome greatly increases the risk of cardiovascular disease, stroke, and Type two diabetes. There are numerous reports mentioning mitochondrial dysfunction and lower oxidative capacity in patients with Type two diabetes compared with healthy individuals.

The cardiovascular system strongly depends on mitochondrial function. Cardiomyocytes (heart cells) have very high mitochondrial content in order to produce the necessary ATP, and mitochondrial dysfunction inevitably leads to the development of cardiovascular diseases.

There is now increasing evidence of mitochondrial dysfunction in Alzheimer’s Disease, Parkinson’s Disease, Huntington’s disease, and Amyotrophic lateral sclerosis. Even some psychiatric conditions, such as autism spectrum disorders, schizophrenia, and bipolar mood disorders, are included.

In addition, mitochondrial dysfunction plays a significant role in the inflammatory response in acute human pathologies. Systemic Inflammatory Response Syndrome (SIRS) is a pathological state with a systemic immune reaction to severe damage, including ischemia, acute pancreatitis, trauma, and sepsis.

Autoimmune diseases such as rheumatoid arthritis, Crohn’s disease, and systemic lupus erythematosus are all characterized by mitochondrial failure. Of course, truly fatiguing illnesses, such as CIRS (mycotoxin and mold illness and Chronic Lyme), Chronic fatigue syndrome, fibromyalgia, and Gulf War Syndrome have mitochondrial near-failure as a prominent component. Lastly, as you might predict, cancer and chronic infections round out the list of disorders. If you have any one of these disorders, you will need to improve your mitochondrial health and function in order to recover.

Mitochondria and Aging

A number of age-related processes (e.g., “normal aging of the brain”) are associated with mitochondrial dysfunction, so most of the popular aging theories take this into account. The mitochondrial theory of aging posits that the accumulation of damage to mitochondria DNA promotes the process of cellular aging of both humans and animals. The theory claims that there is a  vicious cycle involving the accumulation of damage in mitochondrial DNA, which then leads to more oxidative damage due to defects in the mitochondrial respiratory chain. Let’s say that this theory is true. What, then can we do to save our precious mitochondria and therefore slow the aging in our cells and help prevent diseases?

Mitochondrial health practices

Eating an anti-inflammatory diet is one of the easiest ways to improve mitochondrial function. Polyphenol-rich foods such as blueberries, red and purple foods (e.g. raspberries and purple cabbage), and many fresh green foods are high in healthy mitochondrial-boosting polyphenols. Using intermittent fasting methods such as timed eating and intermittently “going keto” are also mitochondrial boosters.

Heat shock proteins produced by extreme cold or extreme heat are great for your mitochondria. Cold exposure is an easy way to give your mitochondria a boost. Studies have demonstrated benefits with “ice jackets”, facial submersion, and ice baths. Even cryotherapy tanks! And “ice swimming.”  Based on what I personally find tolerable and affordable, you can get enough of a boost by doing the following. At the end of your daily hot shower, just turn the temperature to cold for 30 seconds. It is mostly quite invigorating!

Far-infrared saunas are another way to generate heat shock proteins.  An FIR is a great investment in your health, as it is also a great way to do a bit of a detox.

Meditation and yoga also boost your mitochondrial output.

Ten minutes of direct sunlight is great for a burst of mitochondrial activity. Conversely, most data suggest that fluorescent lighting puts a damper on ATP production and mitochondrial biogenesis. The data is rather murky when it comes to EMFs, blue-blocking glasses, and so on, but it’s something to watch, as there seems to be some correlation between better health and less high-level EMF exposure, as well as less blue light exposure.

Exercising For Mitochondrial Health

Many types of exercise are mitochondria-healthy. Walking is great. Running is great. Weight training is great. Yet, the very best type of exercise for your mitochondria is high-intensity interval training. This doesn’t need to be complicated, but do get medical clearance if this is a new activity for you. Do you know how to do a burpee? Do burpees until you’re short of breath. Then catch your breath and do it again. Repeat this a total of 6 times if you can, less if you can’t.

You can do HIIT outside, too of course. If you have access to a track, great! If not, use a treadmill if you’re inside or run in your neighborhood if you’re outside. Sprint one lap. Or half of a lap. Whatever gets you short of breath. Then, walk until you catch your breath and you can even lie down on your back for faster autonomic neurological adaptation for up to 90 seconds if you need that long to catch your breath. I do this in our lap pool and it’s far more fun than simply “swimming laps” to me.

Now, let’s discuss the best supplements to improve mitochondrial function.

The best supplements to improve mitochondrial function

I see people perk right up within (literally) 24 hours of proper mitochondrial supplementation. If someone has a chronic and/or fatiguing illness or are just suffering from age-related mitochondrial failure, supplementation absolutely works. It sure beats energy drinks which end up causing adrenal issues and potentiating energy problems.

Here are the mitochondrial supplements that have been studied and proven effective.

Co-Q 10

CoQ10 is an essential electron carrier in the mitochondrial respiratory chain. In other (more complex) words, CoQ10 passes electrons between NADH-ubiquinone oxidoreductase,  succinate-ubiquinone oxidoreductase, or succinate-cytochrome C oxidoreductase. You can now just forget you read that and rub your eyes. Basically, CoQ10 can be found in both oxidized (ubiquinone) and reduced (ubiquinol) forms, and the conversion between these oxidized and reduced states allows it to act as a cofactor of enzymatic reactions via the transfer of electrons.

CoQ₁₀ is a critical part of the mitochondrial oxidative phosphorylation system. Over ten well-done studies show that supplementation with this vitamin-like antioxidant compound in individuals with reduced CoQ₁₀ levels results in increased energy production and reduced fatigue. The most dramatic results are in those individuals with degenerative diseases. Here are some examples.

In studies using Alzheimer’s disease models, CoQ₁₀ administration significantly delays brain atrophy and characteristic β-amyloid plaquing. In a 4 month clinical study on around 100 Alzheimer’s patients who took an oral mixture of vitamins E, C, CoQ₁₀, and α-lipoic acid, the group receiving supplementation showed significant reductions in oxidative stress markers and subsequent DNA damage.

Individuals with Parkinson’s disease tend to show increased levels of oxidized (and by definition: damaged) CoQ_10.  They also have significant increases in markers of oxidative stress and damage in their brains, which is partially reversible with CoQ₁₀ administration.

One last important clinical note: recall that the heart is filled with mitochondria which are partially powered by CoQ_10. If you are taking a statin drug, please be aware that they deplete your body of CoQ10, so supplementation is a must.

Alpha-lipoic acid

ALA is a potent fat and water-soluble antioxidant vitamin. It is also a metal chelator (helping to remove iron, copper, mercury, and other heavy metals). It is also a fairly decent anti-inflammatory supplement. Clinically, α-lipoic acid has been used mostly to help treat complications associated with diabetes such as neuropathies and vascular (blood vessel)  complications. It also improves cognitive (brain) and mitochondrial function, adding to the evidence linking oxidative damage to mitochondria and cognition. The use of α-lipoic acid for chronic fatigue syndrome (CFIDS) has not yet been studied in controlled clinical trials. However, it is widely used in “fatigue regimens” (200-600 mg) as a way to both support mitochondrial function and reduce oxidative stress.

Despite its various potentials, the therapeutic efficacy of ALA is reduced due to its “pharmacokinetic profile”. Data shows that ALA has a short half-life and bioavailability (only about 30%) due to degradation in the liver and chemical instability in the stomach. The R isomer of ALA (R-lipoic acid) shows better pharmacokinetic parameters, including increased bioavailability as compared to the S isomer, ALA. Translated: just use R lipoic acid or a double dose of alpha lipoic acid for approximately the same results.

PQQ

Pyrroloquinoline quinone (PQQ) is contained in fruits and vegetables such as kiwi fruit and green peppers. It has received a lot of research attention in the past several years. PQQ can reduce reactive oxygen species (ROS) levels and improve the apoptosis (death) of tumor cells. PQQ protects tissues by regulating the redox (electron transfer) reaction. Moreover, PQQ protects overall tissue function by improving the mitochondrial function of the liver, neurons, and other important tissues. It can also reduce atrophy in mouse skeletal muscles.

PQQ decreases oxidative stress (production of ROS) and inflammation which, by definition, will protect mitochondria. It also increases mitochondrial biogenesis, which is the formation of new, young-acting mitochondria. It is neuroprotective, too. Here’s how. Recall that you have read about GABA versus glutamate or inhibitory (relaxing) versus excitatory (too stimulating) neurotransmitter activity. We want more GABA than glutamate, plain and simple. Too much glutamate damages brain cells. PQQ protects neurons by preventing the long-term over-activation of the glutamate (NMDA) receptors, which results in toxic excitotoxicity of neurons. This over-stimulation of brain cells is associated with many neurodegenerative diseases and seizure disorders.

Recall again that you have the largest concentration of mitochondria in your brain, heart, and skeletal muscles. The brain “wins” pound for pound by a little edge, which is why you feel tired after using your brain all day. With this in mind, remember that when we protect the brain, we’re protecting brain mitochondria. PQQ protects the brain (to a certain extent) against neurotoxicity induced by mercury and other potent toxins such as mold mycotoxins. Lastly, it too helps to prevent the accumulation of amyloid tau and beta proteins associated with Parkinson’s and Alzheimer’s diseases.

Acetyl-l-carnitine 

Acetyl-l-carnitine is a naturally occurring fatty acid transporting amino acids. L-carnitine supplementation has long been studied and then used in many mitochondrial dysfunction disorders. These disorders are also characterized by low concentrations of serum l-carnitine levels such as heart disease, diabetes, kidney disease, and overwhelming infections.

An important cellular longevity function of l-carnitine has been to increase the rate of mitochondrial oxidative phosphorylation (ATP production) that declines with age. A  study where old rats were fed acetyl-l-carnitine resulted in the reversal of age-related decreases in l-carnitine levels, an increase in fatty acid metabolism, and an increase in mitochondrial activity. Acetyl-l-carnitine also reverses the age-related decline in muscle mitochondria.

Clinical studies show that L-carnitine supplementation may also be useful in alleviating fatigue symptoms in hypothyroid patients, especially in those younger than 50 years and those who have hypothyroidism after thyroidectomy for thyroid cancer. Note: L-carnitine is the nomenclature used for many clinical studies, but due to l-carnitine’s ability to increase TMAO, experts suggest that all human supplementation be done with acetyl-l-carnitine.

D-ribose

We know that D-ribose has documented positive mitochondrial effects for those who are genetically d-ribose deficient. It’s a popular bodybuilding supplement which “hardcore” bodybuilders credit as being helpful with their muscular fatigue. Studies have looked at neurodegenerative diseases such as Multiple Sclerosis and ALS with promising results. Due to these studies, I decided to use it in a protocol on a dog named Charlie. Charlie is a very beloved and smart standard poodle, belonging to a favorite patient of mine. The patient (another M.D.) contacted me, quite distraught that his dog had received the diagnosis of degenerative myelopathy or “doggie ALS” as I  found upon doing some research. Charlie, it seemed, couldn’t get himself up off the floor. The same mitochondrial problem has been identified in both dogs and humans. So, I got to work on Charlie’s protocol.

I calculated doses of supplements based on Charlie’s 48-pound weight. I recommended a mitochondria-boosting ketogenic diet. Then I added ALA, ALC, CoQ₁₀, PQQ, and NAD (discussed below), as well as some d-ribose powder. I had my patient add some antioxidant powder to Charlie’s food, too. “Why not” I thought. My patient said that 24 hours after Charlie started his regimen, he was noticeably stronger, up and walking, and even playing! The patient’s Veterinarian was astounded and has gone on to use my protocol on other dogs. Now, let’s give an honorable mention to another concoction.

Phospholipids

Mixtures of probiotic, phospholipid, and antioxidant preparations have shown some clinical promise in fatiguing illness. This mixture is made using antioxidant powders, probiotics, and phosphatidylserine. The bulk of the studies have been with patients who have fibromyalgia and/or chronic fatigue syndrome (CFIDS).

NAD

NAD is now the big news, thanks largely to the research by Dr. David Sinclair and his best-selling book, “Lifespan.” Recall the mentions throughout this article about the conversion of NAD+ to NADH, and vice versa, as essential reactions in creating ATP. Recall that ATP is cranked out by mitochondria, and gives cells (and you) energy. Therefore NAD and its substrates are crucial for cellular energy, mitochondrial biogenesis and it turns out; cellular longevity. All that remains to be seen, is proof positive that one “form” of NAD is superior to another. Here are some of the data.

Oral NADH supplementation can reduce symptoms in patients with chronic fatigue. One study on patients with chronic fatigue syndrome treated participants with micro-encapsulated, oral NADH or a placebo for a month’s time. 8 of 26 study participants (about 1/3) responded positively with increased well-being and energy levels to the NADH compared with 2 of 26 (8%) in the placebo group.

This supplement also shows promise for neurodegenerative disorders such as Parkinson’s and Alzheimer’s diseases. The increase in measured NADPH levels correlates with a marker for aging: an increase in telomere length.

NAD will stimulate the SIRT1 pathway which is notably dysfunctional in those with metabolic syndrome, diabetes, and more. When you stimulate the SIRT1 pathway, you lower leptin levels, making it again possible to lose weight, improve blood sugar, cholesterol, and triglyceride levels, and in fact, all aspects of metabolic syndrome.

Taken orally, NMN (nicotinamide mononucleotide) is rapidly absorbed and converted to NAD+. In numerous studies, supplementation with NMN increases NAD+ biosynthesis, suppresses age-related fatty tissue inflammation, enhances insulin secretion and its action, improves overall mitochondrial function, and in the brain, it improves mitochondrial as well as neuronal function. In animal studies, it extends lifespan. In fact, NMN given to mice does quite a bit. Before I discuss NMN, let me give a shoutout to nicotinamide riboside- also converted to NAD+. As well as NMN? We don’t know, and the research continues. Meanwhile, we have a lot of data from mice studies.

Orally administered NMN is rapidly converted to NAD+ in mice. NMN has been shown to enhance energy metabolism and physical activity, suppress age-associated weight gain, improve insulin sensitivity and even improve ocular function. It improves mitochondrial metabolism and prevents age-related negative changes in gene expression. In mice bred to be obese or diabetic, NMN improved both the action and secretion of insulin.

NMN also protects the mouse heart from ischemia and/or reperfusion injury. It restores skeletal muscle mass in aging mice. Of special interest to those of us who treat many patients with brain issues, it has been shown to slow cognitive decline in a mouse model of Alzheimer’s disease, by improving the survival of neurons, improving energy metabolism, and reducing oxidative stress. It may also help maintain the integrity of the blood-brain barrier.

NMN also probably suppresses the increase in systemic inflammation associated with aging based on the studies which show that it lowers adipose tissue inflammation associated with age. In fact, surprisingly enough, older mice appear to be more responsive to NMN, in comparison with younger mice.

Some studies appear to suggest an increase in blood vessel formation called angiogenesis with artificially increased NAD levels for prolonged periods of time. This is why, despite the fact that I use a lot of NMN and intra-nasal NAD in my clinical practice, I have patients take intermittent breaks from it, and will do so until more data is available on this phenomenon.

Additional supplements with much promise

Studies are increasingly showing that mitochondrial illnesses are fueled by oxidative stress; implicating the use of antioxidants such as natural vitamin E and NAC (the precursor to glutathione) as well as glutathione as additional treatment considerations. We know that the sirtuin pathways are boosted by resveratrol and ECGC-green tea extract; implying mitochondrial benefit. Branched-chain amino acids, vitamin D, and creatine are all pro-mitochondrial health supplements as well, despite being poorly studied for this particular issue. Finally, there is emerging data for mitochondrial health with berberine, magnesium threonate, selenium, and even immune-boosting melatonin. B vitamins are likely involved as well. It appears that the more useful a supplement has been proven to be (vitamin D as a prime example), the less it is studied for other, more complete benefits.

Final words

In any good health regimen, you want to eat an anti-inflammatory diet and take a few supplements. It makes sense to take vitamin D and high antioxidant power supplements for many reasons, including mitochondrial health. At this juncture, if you are healthy and have specific goals in mind, you might choose, let’s say, some acetyl-n-carnitine if you are lifting weights, or some PQQ if you have a family history of neurodegenerative disease. And currently, if you have metabolic syndrome, SIRT pathway issues, or fatiguing illness, it seems prudent and helpful to take NMN and/or NAD intra-nasal spray. Yes, IV NAD is beneficial, but I am “not a fan” of this current craze of “drip bars” and feel that consumers are being, quite frankly, ripped off by this trend when alternative routes of administration can be utilized. Finally, if you’d like my opinion on what would be good for you, just ask me.

COVID-19 Functional Treatment

As I write this article, it’s early March, 2021. My original, complete and very long article was published on April 13, 2020. It’s a masterpiece of information if I say so myself, has become the gold standard for U.S. functional treatment and can be found here. Currently we are racing to beat a couple of viral variants, with two governors opening up their states too early; long before even 10% of their population is vaccinated. I desperately hope that everyone stays the course, and we take advantage of the amazing scientific developments that have produced not one, not two, but three vaccines, approved for emergency use by our FDA. Meanwhile, as the virus continues to circulate, I’m being called on by my patients, friends and neighbors for help. We will always want strong immune systems as I suspect more epidemics are coming our way. Integrative medicine will be needed more than ever. Sadly, from now until the end of the summer and perhaps beyond, there will remain a high need for COVID-19 functional treatment.

• Review of lifestyle for best immune health
• Supplements which support immune health
• Anti-viral supplements
• Anti-viral peptide
• Ozone
• Proposed regimen for prophylaxis and treatment

Basic Lifestyle Strategies for Immune Health

Diet: You want to eat a diet that doesn’t support inflammation. You want to eliminate foods which are known to trigger inflammation or cause leaky gut. Keeping it as simple as possible, I’ll tell you to watch your intake of starchy carbs, processed foods, sugars and lectins. The most gut-damaging lectins are gluten, grains, high-lectin beans (such as kidney beans versus lentils) and low-fat dairy. If you can get it, A2 dairy contains a less gut-busting type of casein and is derived from Jersey or Guernsey cows. High fat A2 dairy is pretty safe. Immune-boosting foods include garlic, horseradish and wasabi. We used to recommend hot peppers in that list, but now we know (bummer!) that they are high in lectins. Garlic is actually an anti-viral.  It’s important to eat to support the health of your microbiome. Microbiome health equals better immune health, so let’s discuss that next.

Microbiome Health
The human microbiome is made up of 10–100 trillion symbiotic microbial cells with unique genes, mostly from bacteria (and some yeast) in the gut. Our “bad” or unhealthy gut bacteria (“gut bugs”), of which we have up to ten times more than human cells, thrive on the things that create inflammation in our body. We discussed that above, but let me emphasize this again, as it is so crucially important: refined carbs, unhealthy fats, processed foods and lectins (to name the biggest offenders.) We need to consume good prebiotic food as our GI tract’s “fertilizer” for probiotics. First, let’s discuss what makes for good probiotics.

Probiotics: High quality yoghurt, kefir (preferably home-made) and fermented foods provides a fair amount, but I generally supplement everyone. The literature supports the use of sporulating probiotics as more immune-supporting and able to lead to a more diverse microbiome.

Prebiotics: Prebiotic fiber is made up of non-digestible carbohydrate compounds found in fibrous foods that support the growth of healthy gut bacteria. Foods, spices, and supplements high in polyphenols will promote gut diversity. Red onions, artichokes, berries, hazelnuts, dark chocolate, and cloves are good sources of polyphenols. White and  (better yet), red onions as well as garlic, chicory, asparagus, unripe banana and Jerusalem artichoke are great “gut foods.” A major way that they assist gut health is by producing healthy gut byproducts such as butyrate.

To further increase butyrate production, you can intermittently eat a nutritional ketosis diet. However, easier for most: simply cook with either MCT oil or ghee or to increase  butyrate production by your “gut bugs.” And by the way, try to eat lots of mushrooms which play a role in supporting your GI tract lining and boosting your immune system. More about mushroom extract to follow. In our home, we stir up the following as a veggie-topper: MCT oil-add a clove of crushed garlic, sliced red onions, sliced leeks and some baby bello mushrooms. Now, let’s cover a topic that most of you don’t realize affects many aspects of your health, including your gut and therefore your immune health.

Stress Management

Stress depresses the immune system. Notice that you get more colds when you are under stress? There’s a very good explanation. It occurs via several mechanisms of action. First; sustained high cortisol levels cause gut hyper-permeability=leaky gut- which then causes systemic inflammation as GI waste contents literally leak into the bloodstream. Cortisol also interferes with T-cell (a type of white cell) function, making your body more susceptible to certain pathogens like viruses. Easy things to help you are manage your stress include regular “COVID-safe” outdoor exercise, deep breathing, and activating the parasympathetic nervous system by singing and even gargling. Some people like liposomal GABA supplements. I prescribe the intra-nasal peptide, selank for some patients. And of course, it’s important to get adequate, restful sleep.

A Word on Sleep

We are a nation of insomniacs. We watch T.V. or use our phones in bed. We eat too late. We don’t even try to get 8 hours of sleep per night. During times like these, we should make more of an effort, so that we make sure our immune system repair systems get put through all their paces; while we sleep. There are many things we can do as Functional doctors, to help our patients sleep-from simple things such as long-acting or sub-lingual melatonin preparation or peptides such as DSIP (delta sleep inducing peptide). But first, we start by advising everyone to practice “good sleep hygiene” which includes no T.V. or computers in the bedroom, having a pre-sleep ritual, and sleeping enough hours to awaken refreshed each morning. Now let’s discuss what supplements you can take to boost your immune system.

Supplements to support the immune system

Vitamin D

Vitamin D is well-known for its role in calcium balance and bone growth, but is also well-studied for its anti-inflammatory properties. Vitamin D is also noted to be anti-cancer, anti-autoimmune disease and anti-heart disease. What you might not know is that vitamin D is needed for a properly functioning immune system.

Within the immune system, vitamin D inhibits negative immune pathways and promotes positive ones. It also positively impacts the composition of the microbiome and the gut barrier. As one small example, a study in Japan showed that children taking 1,200 units of vitamin D per day during the winter time reduced their risk of getting influenza-A-infection by approximately 40 percent. By mid-summer of 2020, several clinical studies show that low vitamin D levels are a risk factor for coronavirus infection. What level is adequate? About 75 ng/ml. I live in sunny Florida and so do 1/3 of my patients- even all of us need supplementation, as “getting enough sun” will never give you adequate vitamin D3 levels.

Multivitamin supplements

You want to make sure you are either “juicing veggies” which is easy if you have a garden but difficult for most of us, or using powdered, organic fruit and vegetable supplements. Another option is to be sure you’re taking good oral vitamin supplements, high in antioxidants- especially vitamin A variants called carotenoids. Vitamin C is necessary but you need more of it than you get in a multi-vitamin. We’ll discuss vitamin C in the “anti-virals” section.

Reishi mushroom extract

All types of mushrooms contain natural polysaccharides (beta-glucans) in their cell walls. Beta-glucans ramp up the immune system via several mechanisms, such as activating what is called the “complement” component of the immune system, enhancing macrophages (a protective white blood cell that kills certain foreign invaders) and boosting natural killer (NK) cell function. There is an especially “active” species of mushrooms called ganoderma lucidum or reishi mushrooms. They are not considered tasty enough to eat outright, but they are used to formulate potent immune enhancing supplements.

Reishi mushroom extract is quite anti-inflammatory and immune stimulating. Reishi extract has a demonstrably positive effect on natural killer cell activity. It stimulates macrophage activity, increases T cell activity and is markedly superior to other mushroom extract in terms of it’s total immune-enhancing properties.

Melatonin

Melatonin is a powerful  anti-oxidant and an anti-inflammatory- not just something you take to help you sleep. Something that surprises just about everyone-it’s a potent immune booster, too! It blocks what are called inflammasomes, which are part of our innate immune system. Once the coronavirus enters our cells, we can measure a rise in inflammasomes in the blood. These inflammasomes facilitate the release of all inflammatory cytokines which cause or at least mediate the cellular damage caused by the virus itself. We know that blocking or at least lowering the level of inflammasomes would (theoretically) be a good thing. There is ample evidence of the benefits in animal studies.

In one study (referenced below)- in an animal model of acute lung injury, melatonin markedly reduced lung damage by inhibiting the inflammasome response. In rodent models of acute respiratory distress syndrome similar to the ARDS (acute respiratory distress syndrome)  caused by coronaviruses, melatonin significantly slowed down the progression of lung damage.

When melatonin is given to mice with severe heart infection issues, it transforms the life-threatening condition into a milder one and improves the chances of survival of the mice. Finally, a study, done in 2020 demonstrates melatonin’s benefit in sepsis (severe, life-threatening infection).

As a last comment in favor of melatonin supplementation; numerous studies in humans demonstrate that it improves sleep depth and duration. When stress and sleeplessness is a national problem, given the low to no side effect profile of melatonin, it seems prudent to recommend this supplement as safe, effective and probably immune boosting.

DHEA

The intermediary hormone, DHEA is well known to positively impact adrenal function and therefore cortisol levels. It has demonstrable anti-inflammatory properties and is most likely immune-supporting and even enhancing via several complex hormonal pathways. Now let’s discuss supplements and peptides which exhibit anti-viral properties. Yes, I did mention that garlic was anti-viral, so indeed garlic supplements are also a bit anti-viral; just not enough to make it into my COVID protocol.

Specifically Anti-viral supplements and peptides

Vitamin C

For a quarter of a century, it has been known that critically ill patients, including those with sepsis and multiple organ failure, have very low vitamin C status. It has also been demonstrated that these critically ill patients have higher requirements for vitamin C, with gram doses required to normalize their blood levels, 20–30 times more than is required for the general population.

The Chinese doctors in Wuhan initially used data on intravenous vitamin C,  the anti-malarial drug hydroxychloroquine and  the antibiotic-zithromax. The Chinese doctors also gave patients oral doses of the supplements zinc and melatonin. What got the most initial attention (at least in the U.S.) was the data on the SARS virus; suggesting that hydroxychloroquine was “the” answer. Now, we have come full circle, fully excluding anti-malarials and antibiotics (and just recently ivermectin-the anti-parasitic) as treatment options.

Numerous studies in the U.S., using  doses of IV vitamin C have been approved to treat SARS-CoV-2.  Initially, a randomized clinical trial, published in JAMA in the fall of 2019 was conducted in 167 patients with sepsis-related ARDS indicated that administration of approximately 15 grams per day of IV vitamin C for 4 days may decrease mortality in these patients. It appeared to decrease the time spent on ventilators.  Many more very encouraging studies with IV vitamin C- especially in combination with other drugs or supplements are still underway. Some reports reveal an average of as low as 48 hours on a ventilator versus the national average of 10-21 days. Liposomal preparations of products can be used to substitute for IV infusions- so in light of all of the positive data on IV vitamin C, it seems prudent to extrapolate that data to liposomal vitamin C.

Zinc

Zinc is an anti-viral mineral which helps our bodies slow the replication of invading viruses. Zinc has been shown to have anti-viral activity against many viruses, including some coronaviruses- although it is not yet tested fully or specifically on the novel coronavirus. However in the summer of 2020, RNA-dependent RNA polymerase-the enzyme needed for the reproduction of RNA viruses such as SARS-CoV-2 has been found to be blocked by zinc.

Zinc has been shown to help shorten the duration of the common cold (typically a rhinovirus but sometimes a coronavirus) if it is taken early on, in a sufficient dose.  When taking long term zinc supplementation, check to make sure you have enough dietary or supplemental copper “on board.” Similarly, if you are taking the peptide GHK-Cu, you must take zinc supplementation.

It is well know that zinc deficiency causes  a decreased sense of smell. Whether or not this has anything to do with the symptomatic loss of sense of smell as a symptom of infection is unknown. We do, however know that zinc supplementation does not appear to work to restore the sense of smell.

Quercetin

Zinc is transported into cells by the ionophore-quercetin, found naturally in large amounts in capers and lesser amounts in red onions. A randomized controlled trial involving over 1,000 people indicated that supplementation with 1,000 milligrams of quercetin per day for 12 weeks was associated with a reduction in the rate and severity of upper respiratory tract infections in individuals over 40. A 2020 study using IV vitamin C and quercetin in COVID patients concluded that quercetin displays a broad range of antiviral properties which can interfere at multiple steps of pathogen virulence -virus entry, virus replication and protein assembly.

Nitric Oxide

Nitric oxide (NO) is well known to be bactericidal; able to act directly as an anti-microbial  that can disrupt  bacterial structural proteins, fats, and nucleic acids.  Certain families of immune cells have been reported to produce NO which has contributed to the resolution of both bacterial and influenza infections. The non-proven clinical inference is that higher NO levels contribute to a more rapid clearing of both bacterial and viral host invaders. Given it’s low side-effect profile and the need for adequate nitric oxide levels for good health and maintenance of our vasculature anyway, we have many reasons not to shy away from this supplement.

Anti-viral Rx peptide: Alpha-thymosin-1 

The mechanism of action of alpha-thymosin-1 (chemically “tweaked” and approved as the hepatitis treatment drug zadaxin) is not completely understood but is thought to be related to its ability to augment T-cell function. It has been shown to increase natural killer cell (NK cell) activity, T “helper cell” activity, cytotoxic T cell activity and to increase antibody responses to T-cell dependent (e.g.: viruses) antigens.

The drug is approved for primary treatment for patients with acute infections, such as seen in severe sepsis, and for chronic infections including chronic hepatitis B (CHB), chronic hepatitis C (CHC), and HIV, as an adjunct treatment for certain cancers, and as an enhancement to both hepatitis B and influenza vaccines in immune-depressed individuals.

Alpha-thymosin-1 has undergone around 80 clinical studies, with demonstrable activity against a number of viruses, with minimal to no side effects- even in the elderly and infirm. It is currently (and notably) used as a vaccine adjuvant for HINI; resulting in higher antibody (and immunity) post-vaccination in (mostly) immuno-compromised patients. aT1 has also shown been used in the successful treatment of  patients infected with the highly pathogenic avian influenza H5N1 strain.

Severe Acute Respiratory Syndrome (SARS) was identified in Asia in 2003 and then rapidly spread to many countries in Europe, South America and North America before it was contained. After a near pandemic of the virus between November 2003 and July 2003, about 8000 cases were reported with 77 deaths worldwide .

At that time, an animal model demonstrated efficacy of Alpha-thymosin 1 (aT1) against the virus. Many persons were given aT1 prophylactically during that outbreak, due to the animal studies, as well as several  published reports in China suggesting that aT1 treatment likely contributed to controlling spread of the disease. In 2020, data  regarding ACE receptor inhibition and antioxidant capacity of aT1 suggested possible mechanisms of action.

It is used widely by Functional Medicine M.D.’s  based on the experience we have with the SARS coronavirus, as well as with other respiratory coronaviruses regarding both prophylaxis and treatment. Due to the nature of drug patents, there has been little appetite to study aT1; with the two studies done demonstrating reduced mortality rates post-infection.

IV and Rectal Insufflation Ozone

Ozone whole blood irradiation is a powerful tool against viruses (and everything else including Chronic Lyme Disease). This has been studied extensive and is currently used as a major treatment modality in Europe; both by MAH (major auto hemotherapy) or rectal insufflation. I kid you not.

Timing and dosing

The COVID-19 disease progression occurs in two distinct stages as follows. First- a reminder to take your temperature and your pulse oximeter reading twice daily and keep a record of your symptoms. Note that when your pulse oximeter drops below 95%, that this warrants a call to your physician.

• The first stage of this disease is approximately the first week when your immune system is gearing up. This is when “immune boosters” as well as immune support and anti-virals are sensible choices. Take your multi-vitamin, vitamin D, melatonin, quercetin, NO supplement,  zinc, the reishi and the anti-virals. During this stage you might not even have a fever- but you’ll probably have fatigue, muscle aches, maybe an early cough and possibly a headache or some diarrhea. If you have chest pressure or  shortness of breath, seek medical assistance please.

High antioxidant MVI with fish oil: Many good brands come as a multi-capsule packet so just take 3 packets (instead of 2) daily. I like Lifepak Nano by Pharmanex. Please note that one aspirin per day is a prudent addition for some people, despite the anti-clotting activity of fish oils alone.

Melatonin: Studies have demonstrated that the maximal efficacy is 10-20 mg per night. Long-acting will give you better sleep benefits. Designs for Health has a good LA supplement, and if you need to get your stress levels down, they have a good liposomal GABA, too.

Zinc: If you haven’t been taking any zinc, assume you’re a little deficient; take 50-60 mg per day.

Quercetin: 500 mg per day and 1000 mg per day for “outings.”

Vitamin D: You want a level of 75 ng/dL which takes most Americans 2-3 weeks of 6000-8000 IU/day. If you are just starting out with vitamin D, you are presumed deficient, so 8000-10,000 IU per day is appropriate for the first week.

DHEA: Men with a history of prostate cancer and women with PCOS or a history of breast cancer must take the keto form of this hormone; if at all, since the keto form has not been studied for immune enhancement. Otherwise, men should take a daily dose of 50 mg; women-25 mg.

Reishi: Find a good brand; and follow the labeling directions. I use reishimax by Pharmanex.

NO: A popular brand gives you the accurate, typical twice daily dose. (Neo40).

Vitamin C: Liposomal preparations can generally be taken in dosing of 3 grams per dose without GI distress and I suggest you try that dose (1 TBSP: DFH or Quicksilver brands), four times daily to give you the dosing being used in some U.S. clinical studies.

Alpha-thymosin-1: There is no “accepted” dosing for COVID-19 treatment: and since there is such a large window of “no side effects” compared to upper level dosing, many functional practitioners are giving the maximal dose of 1.5-2.5 mg  2x/day for active cases. This is the dose I have used in the active cases I’ve treated, with everyone thus far (over 100 patients as of 3/2021) recovering at home. Note that all patients have been on this “full protocol” other than ozone therapy. Patients with known good NO food consumption (e.g. arugula and beets) did not necessarily take NO supplements. Due to the large % of variants in Florida, I’m prescribing on the higher end of the aT1 dosing. I am also currently having patients who already have home ozone set-ups incorporate this once daily.

• The second stage of COVID comes around week two which is often an exaggerated inflammatory response, or “cytokine storm.” This is when you want to continue “support” and anti-virals, but do back off on immune boosters such as the reishi, probiotics, colostrum (if you’re taking it-it wasn’t mentioned but some people are taking this for immune support), and DHEA. If you are not taking an aspirin daily, now is the time (with your doctor’s blessing) to add it.

COVID-10 Prophylaxis and exposure with no symptoms: For everyday immune support, I recommend a good MVI with fish oil, vitamin D, zinc, reishi, DHEA, melatonin, and, for those with high blood pressure or other NO deficiency symptoms- a NO supplement. For “outings” where you maintain social distancing and wear a mask, it also seems prudent for both you and household members to take some vitamin C and a prophylactic (450 MCG) dose of the alpha-thymosin-1.

Final thoughts on Long-Haul COVID

Although there is no definitive proof, it appears that people who suffer from brain fog, cognitive impairment, mood issues, muscle aches, fatigue for weeks and even months after recovering from acute COVID, have some sort of variant of CFIDS. They appear to have mitochondrial failure and reduced neurogenesis; and (luckily!) seem to respond to peptides and integratives that repair these pathways. Research with exosomes is also quite promising.