Supplements

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Vitamins and minerals
While there is no question that adequate intake of vitamins is critical to
good health, blindly taking vitamin supplements is not necessarily a
smart approach. There are some substances in which almost everyone
is deficient, such as magnesium, and there are some substances that
one cannot have too much of, such as Vitamin B12, but many
substances taken in large amounts can create health issues.
  
For example:
• Excess Vitamin E can encourage bleeding and interfere with Vitamin
K status. Vitamin E is made up of four tocopherols and four
tocotrienols. Many supplements contain Vitamin E as dl-alpha
tocopherol a synthetic version of only one of the eight isoforms. Even if
natural d-alpha tocopherol is used, high levels of alpha-tocopherol may
decrease levels of the more bioactive gamma-tocopherol.
  
• Excess Vitamin A has been linked to increased risk of hip fractures
  
• Excess Vitamin C can increase iron, which can be dangerous for
someone who has elevated iron levels
  
• Excess calcium without sufficient Vitamin K2 may increase arterial
calcification
  
• Multi vitamin or mineral preparations frequently contain the cheapest
form of the substances they include. Even the higher quality
preparations are likely to include some substance that a particular
individual would do better without
   
With few exceptions, it is good sense to only supplement when a
deficiency or specific need has been demonstrated.

For adrenal support

Cortex-only adrenal glandulars / Adrenal Cortex Extract
• Helps the adrenal glands to produce cortisol
• Bovine, porcine in origin
• Raw cortex is best
• Does not contain adrenaline as can whole adrenal glandulars
• Is dosed in higher amounts earlier in the day. Can be dosed similarly
to hydrocortisone







Licorice root (Glycyrrhiza glabra and Glycyrrhiza uralensis)
• Extends the life of one's own cortisol
• Deactivates an enzyme that inactivates cortisol in the vicinity of
mineralocorticoid receptors giving it mineralocorticoid affects
• In high doses (10 grams) can
• elevate blood pressure
• decrease testosterone
• increase conversion of testosterone to estrogen
(for deglycyrrhized licorice root (DGL) see Digestive Issues below)

Adaptogens
In theory, adaptogens are expected to increase cortisol where low and
decrease where high. In reality, they all lower cortisol
• Rhodiola (Rhodiola rosea)
• Schizandra (Schisandra chinensis)
• Ashwagandha (Withania somnifera sometimes called Indian ginseng)
• Astragalus (Astragalus spp)
• Holy basil (Ocimum sanctum L.)

Ginsengs
Various ginsengs are considered by some to be adaptogenic, but they
are likely too stimulating for fatigued adrenals.
• Siberian ginseng (Eleutherococcus senticosus, not a true ginseng)
• American ginseng (Panax quinquefolius)
• Red ginseng (Panax, Chinese, Korean or Japanese ginseng)

Adrenal formulas
• Contain both cortisol-lowering and cortisol-raising ingredients
• Not recommended

Isocort®
• No longer on the market

DHEA
• A prohormone primarily needed to convert to other hormones
• Most likely will not convert properly in adrenal fatigue
See steroid conversion pathways chart here
• Will lower cortisol so is not recommended in adrenal fatigue


Digestive Issues
Deglycyrrhized (DGL) licorice root
• Supports the mucous lining of the stomach
• Chewable type can be carried and used anywhere

Hydrochloric acid
• Provides stomach acid when natural production is too low, common in
hypothyroidism
• Usually combined with betaine or pepsin
• Over the counter, inexpensive
• Take immediately before or in the middle of a meal
• Dose usually one, two or three 650 mg capsules
• Higher amount with protein-heavy meal
• Too much causes sensation of heat in the stomach.
• Over time may improve stomach acid production
• Never take without food

Saccharomyces boulardii probiotic (S. boulardii)
• Prevent/treat
• antibiotic associate diarrhea
• C. difficile
• inflammatory bowel disease
• Resistant to all antibacterial antibiotics
• Minimum 10-20 billion organisms per day
• Approximately three days to achieve viable concentrations
• Cleared 2-5 days after oral supplementation


To correct deficiencies

Vitamin B12
• Most effective oral form is generally sublingual methylcobalamin

• For an individual who has an issue with overmethylation,
hydroxocobalamin or adenosylcobalamin are usually the
recommended forms

• Adenosylcobalamin  may also be known as dibencozide,
5'-deoxyadenosylcobalamin, cobamamide or cobinamide

• Hydroxocobalamin is the preferred form used in B12 injections

• Preservative-free injectable available from compounding pharmacies

• Avoid cyanocobalamin in either oral supplements or injectable

• A reaction to a high methyl dose can be counteracted with 50 mg of
timed-release niacin

Folate/methylfolate (not folic acid)
• Not all methylfolate is the same
• D forms of methylfolate should be avoided
• L forms of methylfolate is the desired form
• 5- forms may or may not contain available folate
• Preferred forms of folate will be labeled:
• L-5-MTHF (also L-5-Methyltetrahydrofolate)
• 6(S)-L-MTHF (also 6(S)-L-Methyltetrahydrofolate)
• L-Methylfolate Calcium
• Metafolin
• Levomefolic Acid
• Quatrefolic
• Folate supplementation can increase need for B12 and vice versa

B-Complex
• Use when taking any single B vitamin
• Choose one with a non-cyanocobalamin form of vitamin B12 and a
preferred form of folate

Vitamin D3, softgel
• Vitamin D3 is the active form and best for supplementation
• Increasing vitamin D intake increases the need for vitamin K2
• D3 is fat soluble so should be in a supplement with fatty acids such as
in a softgel or otherwise taken with fats
• Supplement from 1000 to 10,000 i.u. a day to achieve optimal levels
• Actual toxicity is extremely rare with the only reported cases occurring
with supplementation of 40,000 i.u. or more a day

Vitamin K2 MK7, softgel
Helps balance D, A and E
Prevents the calcium that taking vitamin D helps absorb from
calcifying soft tissue; 100 to 200 mcg per day

Vitamin A
• Supplement cautiously, factoring in the vitamin A in foods eaten
• A total of no more than 8-10,000 i.u. a day average, with only half of
that as preformed vitamin A
• Reduce those numbers by half for the elderly
• Vitamin A is fat soluble and builds up in the body
• Optimal serum vitamin A is in the upper quarter of the range
• Test to verify levels

Medication note: Retinoids or retinoid analogs, including acitretin,
all-trans-retinoic acid, bexarotene, etretinate and isotretinoin
(Accutane), should not be used in combination with vitamin A
supplements, as they may increase the risk of vitamin A toxicity.

Magnesium
Needed by everyone on a western diet
• Magnesium glycinate
• chelated form of magnesium
• may provide highest level of absorption and bioavailability
• choose to correct deficiency
• Magnesium-L-threonate
• new type of magnesium
• can penetrate the mitochondrial membrane
• increases magnesium levels in the brain
• improves neurological function
• Magnesium taurate
• combination of magnesium and taurine
• calming effect
• helps sleep
• can help reduce blood pressure and improve arrhythmias
• Magnesium malate
• combination of magnesium and malic acid
• recommend for pain in chronic fatigue syndrome and fibromyalgia
• minimum of eight weeks to see an affect
• Magnesium citrate
laxative properties
• Magnesium chloride
• low content of magnesium with high absorption
• Magnesium lactate
• low content of magnesium with high absorption
• Magnesium carbonate
• antacid properties
• Magnesium oxide
• very low absorption
• stool-softening properties
• Magnesium sulfate/hydroxide (milk of magnesia)
• laxative (easy to overdose; take only as directed)

Iron
• Albion® chelated bisglycinate iron is well tolerated
• BlueBonnet Albion Chelated Bisglycinate
• Swanson Vitamins Ultra Albion Chelated Ferrochel Iron Glycinate
• Vitacost Chelate Iron - Albion® Ferrous Bisglycinate Chelate
• and others
• When raising levels is difficult
• heme iron polypeptide (brand name Proferrin®)
• Iron Protein Succinylate (brand Life Extension)
• Ferrous sulphate when red blood cell count is low
• 325 mg ferrous sulphate = 65 mg elemental iron
Discussion of how to supplement iron here
Discussion of using raw liver to supplement iron here

Anti-inflammatory supplements

Omega 3 fish oils
• Choose high levels of EPA and DHA
• Molecular distillation removes contaminents
• Ethyl ester (EE) forms have reduced bioavailability
• Re-esterified triglyceride (rTG) forms have increased bioavailability
• Prescription pharmaceutical products currently are only EE form
• Do not use beyond expiration date

Ginger
• As a food or supplement

Tumeric or curcumin
• As a spice or supplement
• Black pepper improves bioavailability

Krill Oil, 2000 mg
• Helps reduce inflammation and move iron from ferritin into serum
• Choose one high in phospholipids and astaxanthin

Glucosamine and chondroitin
• Shown to reduce C-reactive protein and joint inflammation

Modified citrus pectin
• Shown to reduce galectin-3 and C-reactive protein

To lower homocysteine
• Cocktail of B vitamins twice a day
folate, as much as 2400 mcg per dose
• vitamin B12, sublingual, 1000 mcg per dose
• vitamin B6 P-5-P 25 to 50 mg per dose
• TMG (trimethylglycine, also called anhydrous betaine) added when
the B vitamins are no longer sufficient

To lower elevated blood pressure
• Bring potassium up to 4.2-4.4
• use only sustained-release potassium and/or high potassium foods
• choose high potassium foods that are not high carb
• Magnesium
• magnesium glycinate daytime
• magnesium taurate bedtime
• Vitamin D3
• Coenzyme Q10 (CoQ10)
• Omega-3 oils
• Hawthorn
• Resveratrol
• Acetyl-L-carnitine
• Vasodilators such as cocoa or garlic
• Olive leaf extract
• Melatonin at bedtime to reduce nighttime hypertension

For recalcitrant idiopathic arrhythmias
• 10 to 20 grams taurine per day
• 3 to 6 grams L-arginine
L-arginine cautions
• large doses worsen inflammation in the lungs and can contribute
to asthma and allergy symptoms
• may interact with anticoagulants and antiplatelet and blood
pressure drugs; may change coumadin requirements
• may stimulate recurrence of latent herpes infections
• with liver or kidney disease use only under medical supervision