CHAPTER 16: MIND MEDS VERSUS NUTRACEUTICALS: WHAT DOES THE SCIENCE SAY?
Millions of Americans today are taking dietary supplements, practicing yoga and integrating other natural therapies into their lives. These are all preventive measures that will keep them out of the doctor’s office and drive down the costs of treating serious problems like heart disease and diabetes.
ANDREW WEIL, MD
ALICIA
Alicia, 53, was struggling with brain fog, memory problems, anxiety, and symptoms of ADD/ADHD (short attention span, distractibility, disorganization, impulsivity) when she first came to the Amen Clinics. Her SPECT scan showed low overall activity, especially in the prefrontal cortex (see images below). As we attacked each of her BRIGHT MINDS risk factors and used nutraceuticals—including omega-3 fatty acids, multiple vitamins, ginkgo, huperzine A, and phosphatidylserine—her brain fog cleared, and her memory and focus were better. And one more thing that was very important to her—her Ping-Pong game dramatically improved.
Alicia’s Surface SPECT Scans: Before and After
ALICIA’S SURFACE SPECT SCANS: BEFORE AND AFTER
Before: low prefrontal cortex activity
After: overall improved
Alicia had been playing Ping-Pong for months in an effort to boost her brain (I think Ping-Pong is the best sport for your brain), but initially she always lost to her husband because her mind would wander. Her husband even played left-handed in order to give her an advantage. After starting the nutraceuticals, she said, “I was beating my husband in Ping-Pong every game, and it happened overnight . . . my husband was really angry that I was beating him.” Alicia then hired a Ping-Pong coach because, “I want to keep beating my husband.” About work, she said, “I’m getting a lot more done, and I am happier.” Her follow-up scan was also much better. Not to be outdone, her husband started the nutraceuticals, lost 30 pounds, and became serious about his brain health. I’ll bet they have a fierce Ping-Pong competition now. In addition, her adult children, who saw the benefit in their mother, started eating better, exercising, and taking nutraceuticals.
After starting the nutraceuticals, she said, “I was beating my husband in Ping-Pong every game, and it happened overnight.”
At Amen Clinics we are not opposed to medications for your mind and prescribe them when necessary. However, we are opposed to medications being the first and only thing you do to help your brain and your mind. As you’ve seen throughout this book, there is so much more that can and needs to be done to end mental illness now.
The pharmaceutical revolution has consumed psychiatry for the past 50 years, but unfortunately, outcomes have not improved along with the enthusiasm. As discussed earlier, one of the reasons outcomes lag behind is that medical professionals are working within the wrong paradigm—making diagnoses based on symptom clusters without any biological information while ignoring overall brain health and the BRIGHT MINDS risk factors.
I first became interested in using nutraceuticals for brain health/mental health issues once I started using SPECT scans. I could see that some of the medications I was taught to prescribe, especially benzodiazepines for anxiety and opiates for pain, were clearly associated with unhealthy looking scans.
Toxicity on Surface SPECT Scans of Some Medications
TOXICITY ON SURFACE SPECT SCANS OF SOME MEDICATIONS
Benzos
Opiates
Thinking of the principle all physicians are taught the first year of medical school—Primum non nocere, which is Latin for “First do no harm”—I started looking for less toxic options for my patients and was surprised to find a growing body of scientific literature to support the use of supplements for many brain health/mental health issues. In making treatment recommendations for our patients, we always try to keep a number of principles in mind:
First, do no harm.
Use the least toxic, most effective, science-based treatments.
Consider short-term pain versus long-term gain (don’t fix one problem just to cause another one).
Don’t start something a patient will have a hard time stopping (withdrawing from many anti-anxiety or antidepressant medications can be very hard), just to deal with the anxiety of the moment.
Nutraceuticals or medications should never be the first and only thing people do. Until we understand this concept, we will never truly get well as a society.
I always consider, What would I prescribe if this were my mother, my wife, or my child? After nearly 40 years as a psychiatrist, I recommend more and more treatments from nature, including foods and nutraceuticals. We want you to use all the tools available, especially if they are science based, effective, and cheaper, and have minimal side effects.
A number of websites are dedicated to the extensive science of nutraceuticals for health, including brain health, such as MedlinePlus from the National Library of Medicine (medlineplus.gov) and Natural Medicines (naturalmedicines.therapeuticresearch.com). They often grade nutraceuticals from the clinical science evidence similarly to how they rate pharmaceuticals (see chart below).
GRADE
SCIENTIFIC EVIDENCE
A
Robust research conducted with more than two placebo-controlled, double-blind clinical trials
B
Multiple studies where at least two are placebo-controlled, double-blind trials
C
Single double-blind, placebo-controlled trial (only one study so far)
D
Open-label trials (participants and researchers know who is getting the drug or the placebo)
F
Research suggests it does not work
A second chart on the next page shows nutraceuticals with A or B evidence ratings for specific brain health/mental health issues. One major flaw in prescribing nutraceuticals, as with medications, is that they are generally recommended based on symptoms, rather than biology. Our experience is that treatment is much more effective with nutraceuticals and/or medications when we add the biological information from our brain imaging work. Surveys by the CDC find most people are deficient in one or more of these vital nutraceuticals because of their poor-quality diet, or the nutrients are being depleted from their bodies due to stress or the effects of certain medications. It’s important to work with a knowledgeable health-care provider to determine the best approach and nutraceuticals for your particular brain health/mental health issues.
SCIENTIFIC EVIDENCE FOR COMMON CONDITIONS AND NUTRACEUTICALS
NAC may be most useful for preventing relapse[746]
My colleague Dr. Parris Kidd, who has more than 35 years of experience working with supplements, recommends that everyone have a core nutraceutical program that includes a broad-spectrum “multiple” (nutraceutical multiple vitamin-mineral supplement), plus a concentrated fish oil or vegan source of omega-3s EPA and DHA. These are all critical for your enzyme systems to work.
For more severe mental health issues, such as schizophrenia or true bipolar disorder, I usually start with medications, such as antipsychotics, like olanzapine (Zyprexa), aripirazole (Abilify), or risperidone (Risperdal), or mood stabilizers, such as lamotrigine (Lamictal). Yet, even when I am prescribing medication, I am also recommending the support of nutraceuticals, such as omega-3 fatty acids, multiple vitamins, and vitamin D. This is in addition to attacking the BRIGHT MINDS risk factors and making nutritional changes. By supporting overall brain health in this way, people typically get better faster and have fewer relapses. For example, here are interventions we typically recommend for these patients.
SCHIZOPHRENIA, TRUE BIPOLAR DISORDER, AND ANY PSYCHOTIC PROCESS
1. Get any psychotic process under control, using the appropriate medications.
2. Support with basic nutraceuticals, including multiple vitamins, folate, and fish oil.
3. Attack the BRIGHT MINDS risk factors.
4. Eliminate artificial dyes, preservatives, and sweeteners from the diet.
5. Try an elimination diet for three weeks, eliminating sugary food, gluten, dairy, corn, soy, and other categories of potentially allergenic foods. Then add these back one at a time (except for sugar) and be alert for reactions to them, which would indicate that you should permanently avoid that food. In general, it’s advisable to keep sugar out of your diet.
6. Begin taking the following nutraceuticals:
Longvida curcumin, a formulation much more efficiently absorbed than other curcumin supplements
Magnesium
Zinc
Probiotics
For most other disorders, such as ADD/ADHD, anxiety, depression, insomnia, and addictions, I often start with nutraceuticals. If they are ineffective, then I consider medications.
For example, here are the steps I recommend for my patients for some common brain health/mental health issues before considering prescription medications.
ADD/ADHD
Symptoms of ADD/ADHD include short attention span, distractibility, disorganization, procrastination, impulsivity, and restlessness.
1. Attack the BRIGHT MINDS risk factors.
2. Eliminate artificial dyes, preservatives, and sweeteners from the family’s diet.
3. Minimize or eliminate processed foods (anything in a box).
4. Try an elimination diet for three weeks. (See step 5 on page 297.)
5. Try a higher-protein, lower carbohydrate diet. Boost exercise—30 minutes or more five times a week.
6. Increase sleep and good sleep habits.
7. Decrease screen time.
8. Work closely with an integrative physician to check ferritin, vitamin D, magnesium, zinc, and thyroid levels, as well as all the other lab chemistry tests, and balance any that are not optimal.
9. Begin taking the following nutraceuticals:
EPA-rich fish oil
Dose suggestion: 1,000 mg a day of EPA and DHA per 40 pounds of body weight, to maximum 3,000 mg a day EPA and DHA
Phosphatidylserine (PS)
Dose suggestion: 200–300 mg a day
Zinc as citrate or glycinate
Dose suggestion: 30 mg a day (tolerable upper levels are 40 mg a day for adults, 34 mg a day for adolescents; less for younger kids)
Magnesium as glycinate, citrate, or malate
Dose suggestion: 100–400 mg a day
10. Consider neurofeedback.
11. Start kids a bit later in school (the youngest kids in a class are more likely to be diagnosed with ADD/ADHD).
If someone truly has ADD/ADHD, they will still have it a few months after I first see them, so taking some time to get their brain health/mental health optimized is worth the investment before starting a medication that they may be on for years or even decades. At this point, I’ll recommend nutraceuticals or medications targeted to someone’s specific type of ADD/ADHD (see Healing ADD: The Breakthrough Program That Allows You to See and Heal the 7 Types of ADD).
In the case of ADD/ADHD, which has been one of my primary areas of expertise, there is a great deal of negative bias against medication in our society. I’ve heard countless parents say:
“I’m not going to drug my kid.”
“If you take this drug, you won’t be creative.”
“You won’t be yourself.”
The problem is that most physicians assume ADD/ADHD is one thing, so they start everyone on the same class of medications—stimulants, such as Ritalin or Adderall. These medications help many people, but they also make many others much worse.
Both “miracle” and “horror” stories about stimulants abound. One of my own children went from being a mediocre student to getting straight As for ten years while using a stimulant medication to optimize the low activity in her prefrontal cortex, and she was accepted to one of the world’s best veterinarian schools. The medication stimulated her frontal lobes, giving her greater access to her own abilities, which also enhanced her self-esteem. On the other hand, I have another patient who was referred to me because he became suicidal on Ritalin. His brain was already overactive to start, so stimulating it only made him more anxious and upset. The problem comes when physicians assume everyone with the same symptoms has the same brain patterns, which is just not true and invites failure and frustration.
ADDICTIONS
1. Stop the addictive substance, which is directly or indirectly a toxin to your brain!
2. Twelve step program, such as Alcoholics Anonymous
3. BRIGHT MINDS brain rehabilitation program, attacking all the risk factors
4. BRIGHT MINDS diet to help prevent relapse—most treatment programs serve very unhealthy foods that promote relapse
5. HALT to prevent relapse—do not get too Hungry (balance blood sugar), Angry (kill the ANTs), Lonely (connect with others), or Tired (sleep).
6. Eliminate the ANTs (automatic negative thoughts).
7. Begin taking the following nutraceuticals:
Omega-3 fatty acids
Dose suggestion: 1,400 mg or more with a ratio of approximately 60/40 EPA to DHA
NAC
Dose suggestion: 1,200–2,400 mg a day; clinical research very promising
If the above interventions are ineffective, I’ll try other nutraceuticals or medications targeted to someone’s specific type of addiction (see my book Unchain Your Brain: 10 Steps to Breaking the Addictions That Steal Your Life).
ANXIETY DISORDERS
1. Attack the BRIGHT MINDS risk factors.
2. Check for hypoglycemia, anemia, and hyperthyroidism.
3. Eliminate artificial dyes, preservatives, and sweeteners from the diet.
4. Try an elimination diet for three weeks. (See step 5 on page 297 for more details.)
5. Practice prayer, meditation, and hypnosis. (Research shows they can calm stress and anxiety, and you can use helpful audio programs for guided meditation and self-hypnosis.)
6. Heart rate variability (HRV) training. (Anxiety is linked to low levels of HRV,[747] but you can hack your way to a healthier HRV with biofeedback apps. Read more about this in my book Feel Better Fast and Make It Last.)
7. Diaphragmatic breathing and hand-warming biofeedback. (Read more about these in my book Feel Better Fast and Make It Last.)
8. Eliminate the ANTs.
9. Calming exercise, such as yoga, qi gong, and tai chi.
10. Begin taking the following nutraceuticals:
L-theanine
Dose suggestion: 200–400 mg a day
GABA
Dose suggestion: 500–1,000 mg a day
Magnesium as glycinate, citrate, or malate
Dose suggestion: 100–500 mg with 30 mg of vitamin B6 a day
Probiotics
11. Check your Omega-3 Index (www.omegaquant.com) and get it above 8 percent using 1,400 mg or more omega-3 fish oil with a ratio of approximately 60/40 EPA to DHA.
12. Consider neurofeedback.
Anxiety disorders are very painful, but too often people reach for marijuana, alcohol, or prescribed benzodiazepines, which can be of short-term benefit but can cause long-term problems with addiction and memory issues. If the above interventions are ineffective or only partly effective, I’ll try other nutraceuticals or medications targeted to someone’s specific type of anxiety (see my book Healing Anxiety and Depression).
DEPRESSION
1. Attack the BRIGHT MINDS risk factors.
2. Check for and correct low thyroid function.
3. Work with a nutritionally informed physician to optimize your folate, vitamin B12, vitamin D, homocysteine, and other nutrient levels.
4. Check your Omega-3 Index (www.omegaquant.com) and get it above 8 percent using 1,400 mg or more omega-3 fish oil with a ratio of approximately 60/40 EPA to DHA. (I’m convinced that without doing these nutritional fixes, patients are very unlikely to respond to the medications.)
5. Eliminate processed foods as well as artificial dyes, preservatives, and sweeteners.
6. Try an elimination diet for three weeks. (See step 5 on page 297 for more details.)
7. Increase protein, lower carbs, and add colorful vegetables into your diet.
Curcumin, not as turmeric root but as Longvida, which is much more efficiently absorbed
Magnesium as glycinate, citrate, or malate
Dose suggestion: 100–500 mg with 30 mg of vitamin B6 a day
Zinc as citrate or glycinate
Dose suggestion: 30 mg (tolerable upper levels are 40 mg a day for adults and 34 mg a day for adolescents; less for younger kids)
Probiotics
Depression can be devastating, but too often during quick office visits physicians put patients on SSRIs rather than attack the underlying cause. SSRIs are often very hard medications to stop. If the above interventions are ineffective, I’ll try other nutraceuticals or medications targeted to their specific type of depression (see my book Healing Anxiety and Depression).
INSOMNIA
1. Care about your sleep. Make it a priority.
2. Avoid anything that hurts sleep, such as caffeine; blue light from gadgets; a light, warm room; noise; alcohol; evening exercise; unchallenged negative thoughts; and worries.
3. Treat any issues that steal your sleep—restless leg syndrome, sleep apnea, hyperthyroidism, low progesterone, or chronic pain.
4. Engage in positive sleep habits, such as blue-light blockers, turning off gadgets, prayer, hypnosis, meditation, soothing music, a warm bath, a cool room and pillow, a regular sleep schedule, and lavender aromatherapy.
5. Begin taking the following nutraceuticals:
Melatonin
Dose suggestion: 0.3–5 mg before bedtime, gradually increasing it until it works for you
Magnesium
Dose suggestion: 100–500 mg a day
Zinc
Dose suggestion: 15–30 mg a day
5-HTP
Dose suggestion: 100–200 mg a day if you are a worrier
GABA
Dose suggestion: 250–1,000 mg a day
Too often, people are prescribed addictive sleeping pills that can affect memory without searching for the underlying cause or doing the simple strategies first. If the above interventions are ineffective, I’ll try nonaddictive sleep-promoting medications, such as low-dose trazodone, gabapentin, or amitriptyline.
Remember, whether you use medications or supplements or a combination of them, they are only a part of our Amen Clinics Four Circles BRIGHT MINDS Program. Do not expect that a pill, natural or not, by itself will change your life for the better.
PROS AND CONS OF MEDICATIONS
Based on 40 years of studying and practicing psychiatry, I have compiled the following list of pros and cons of medications for your mind:
Pros
1. For more serious mental health conditions, such as schizophrenia, true bipolar disorder (I say true bipolar because people are often misdiagnosed as having bipolar disorder when they have the lasting effects of traumatic brain injury), severe major depression, and OCD, medications are often the most effective and fastest acting treatments.
2. For ADD/ADHD, stimulant medications work quickly and can be very effective, if they are given for the right type of ADD/ADHD. As discussed earlier, stimulants work for two of the seven types of ADD/ADHD.
3. Prazosin (Minipress—a blood pressure medication) is often an effective, quick-acting, safe treatment for nightmares in people with PTSD.
4. Physicians are trained in using medications for mental health issues, so they are used to prescribing them, and they are a part of regular medical practice.
5. Medical insurance plans often cover them.
Cons
1. Mind medications have significantly more side effects than nutraceuticals. Most have a “black box” warning, which is the FDA’s strictest warning associated with the labeling of prescription drugs. It is used when there is reasonable evidence of an association of a serious hazard with the drug.
2. They are generally much more expensive than nutraceuticals, although they tend to be covered by medical insurance.
3. Once started, many medications are often hard to stop. Withdrawal from antidepressant and antianxiety medications can be long and painful.
4. Once started, many people feel dependent on them and do not do the work to truly get their brains healthy over time.
5. Some medications change your brain so you then need them in order to feel normal.
6. As awful as it sounds, taking prescription medications can affect your insurability. I know many people who have been denied or made to pay higher rates for health insurance because they have taken certain medications.
7. For ADD/ADHD, if stimulants are prescribed without taking into consideration the particular type of ADD/ADHD you have, they can do more harm than good. For example, for five types of ADD/ADHD, stimulants can make you much worse.
An important note: Check with your health-care provider before stopping any medication.
PROS AND CONS OF NUTRACEUTICALS
Based on more than three decades of diving into the research on nutraceuticals to help the brain and using them in my clinical practice, I have compiled the following list of pros and cons of taking nutraceuticals.
Pros
1. They are often effective when prescribed properly.
2. They have dramatically fewer side effects than most prescription medications.
3. They are significantly less expensive than medications.
4. You never have to tell an insurance company that you have taken them, so they will not affect your insurability.
5. When people start to take supplements to optimize their health, they often start to engage in other healthy habits.
Cons
1. Even though they tend to be less expensive than medications, insurance usually does not cover them.
2. Many people are unaware that nutraceuticals can have side effects and need to be thoughtfully used. Just because something is natural does not mean it is innocuous. Both arsenic and cyanide are natural, but that doesn’t mean they are good for you. For example, St. John’s wort used to be one of my favorite natural antidepressants, but it can cause sun sensitivity and it can also decrease the effectiveness of a number of other medications, such as birth control pills.[749] Oh great! Get depressed, take St. John’s wort from the grocery store, and now you are pregnant when you don’t want to be. That may not be the outcome you were planning on.
3. One of the major concerns about nutraceuticals is the lack of quality control. There is variability, so you need to find trustworthy brands. I do my very best to recommend only nutraceuticals that have been put through stringent quality control. You can find the high-quality products and brands we recommend to our patients on our site (www.brainmedhealth.com).
4. Another disadvantage is that many people get their advice about supplements from the teenage clerk at the health food store who may not have the best information, or from secondary sources on the Internet. You need advice from health-care professionals who are trained and competent to give you the best advice.
Even though they have limitations, the benefits of nutraceuticals compared with their minimal risks make them worth considering, especially if you can get thoughtful, research-based information.
INFORMED CONSENT
In the first year of medical school, all students are taught about informed consent. When it comes to treatment for any medical or brain health/mental health condition, it is not our job to tell you what to do; it is our job to give you the options and inform you about the pros and cons of each option. This is critical. Too many physicians tell you what treatment they’ll prescribe rather than giving you all of the options. Your doctor is not your father, mother, or boss; they should be your partner in wellness. Ask for options.
