II. Supplements

RESEARCH UPDATE: Research studies released in 2012 have shown that a nutrient cocktail that is largely similar to the recommendations below has been shown to extend lifespan in mice. For more on this breaking news, see our post on the subject here: http://www.bridgeplan.org/?p=1455

Recommended Daily Vitamin and Mineral Supplements

A. General Principles on Choosing Supplements
I have generally been guided by four guidelines in my selection of dietary supplements for myself, my family, or my patients:
1. We have reason to believe, based on empirical data, that the supplement will actually do some good (this may include either anecdotal evidence or a clinical trial);
2. Even if not scientifically proven, there is a proposed mechanism of action or hypothesis that explains the observed good effects;
3. There is evidence for the conclusion that the supplement is non-toxic in humans, at least in the range of dosages being considered (therapeutic index)(even water when drunk to excess can be toxic!) and that any excess beyond that utilized by the body for beneficial purposes gets excreted, i.e., doesn't accumulate;
4. The supplement is affordable. (It’s not going to break the bank.)

B. A Brief Note Regarding Dosages
Doses are among the most controversial aspects of prescription writing and nutritional recommendations. In order to maintain proper health and well-being, everyone will agree that a wide variety of nutrients are needed, but consensus as to how much of each and in what form is difficult to achieve. Opinions vary from those practitioners who feel that all drugstore supplements are a waste of money, assuming of course that one eats a well-balanced diet, to those who take supplements by the carload (so-called "megadoses"). There is little or no valid scientific evidence to support megadose claims, such as made by longevity-authors Dirk Pearson and Sandy Shaw [24]. Here, scientific comparisons between species gets a bit murky, since a dose that works well in a mouse may or may not be linearly related to benefits obtained in humans per kilogram of body weight, possibly due to idiosyncratic variations in rodent physiology, even acknowledging that we both belong to the "mammalian" family. The late Linus Pauling was considered to be an "old quack" by some regarding his use of ascorbic acid (Vitamin C), since he recommended (and took himself) 10 or more grams every day! The jury is still out on such a high dose, but we shouldn't forget that Dr. Pauling (double Nobel Prize winner) had always been a controversial character throughout his distinguished careers at both CalTech and Stanford Universities, and he has frequently been proven correct over time on other matters [9].
After many years, the U.S. Food and Drug Administration (FDA) has formulated what is referred to as the RDA (Recommended Daily Allowance) oriented toward the avoidance of clear pathological states rather than the amounts needed to maintain optimal health. Therefore, the average adult, even though not suffering from a specific disorder, should observe all RDAs and then some. The chart of recommendations listed above should be thought of as a guideline. The amounts listed are safe (will not cause toxicity), but may be varied according to an individual's size, weight, gender, and health status. All other things being equal, and in the absence of specific laboratory blood chemistries, those who exercise heavily need higher doses. Also, those who are under great stress, on medications, on restricted diets, bed ridden, females on oral contraceptives or pregnant, recovering from surgery, smokers, heavy drinkers, etc. may need greater or lesser amounts of certain vitamins and minerals.

It is suggested that you take nearly all your supplements at the same time each day with a regular meal to establish a pattern. The fat-soluble vitamins A, D, E, and K are more readily absorbed with food. When traveling, you need to prepare collections of pills, labeled day-by-day, for as many days as you expect to be away from home. I generally place all opened vitamin bottles in my refrigerator to keep them away from children and to preserve their freshness.

C. A Brief Note Regarding Prices

All of the vitamins or hormones listed below, with certain exceptions as noted, are typically available inexpensively from local drug stores (or health-food stores) in your home neighborhood. Others, however, may need to be special ordered (See source where noted) or obtained under a physician’s prescription. However, prices are widely variable, even for an identical product. Shop around at different stores, and only buy supplements when they are on sale. When buying by mail-order over the telephone, make sure you ask AIs this your best price?@ You may be surprised to find that simply asking can help lower your costs. A month’s full supply of antioxidants may cost $40.

D. For Both Men and Women

Unfortunately, there isn’t one supplement that compounds all required vitamins into a single pill. Therefore, one should expect to buy most if not all of the following items separately:

1. A standard multivitamin (not "therapeutic") with mineral supplements (e.g., Centrum [Lederle], Central-Vite [Your Life], etc.) The multi should include Vitamin A 5000 iu (vision, skin, and hair), Vitamin B1 (Thiamin) 1.5 mg (muscles and nervous system), Vitamin B2 (Riboflavin) 1.7 mg (nervous system), Niacin 20 mg (metabolism), Vitamin B12 (Cyanocobalamin) 6 mcg (vital for healthy GI track and nervous system, blood), Biotin 30 mcg (metabolism), Folic Acid 400 mcg (blood, growth, and development)(for women who may become pregnant to prevent Spina Bifida), Vitamin D3 (Ergocalciferol)[400-1,000] iu (bones and teeth), Vitamin K1 (Phytonadione) 25 mcg (clotting), Vitamin K2 (Menaquinone-4 or -7) [20-45] mg, and a collection of trace minerals (Boron, Chloride, Copper, Iodine, Magnesium, Manganese, Molybdenum, Nickel, Phosphorus, Potassium, Silicon, Tin, Vanadium, and Zinc) (Optional Note: Additional Phosphorus 60 mg, Magnesium 500 mg, or Zinc 60 mg [15] may be added with still further benefit.)
2. Fish Oil Capsules (Omega-3 Fatty Acids: Eicosa Pentaenoic Acid [EPA], and Docosa Hexaenoic Acid [DHA]) [l,000 – 1,200] mg (increases HDL)
3. Vitamin C (Ascorbic Acid) l,000 mg (Antioxidant)
4. Vitamin E (Alpha-Tocopherol) [400-800] iu [international units] (Antioxidant)[A mixed tocopherol including both alpha and gamma [230 mg] forms has been recommended by Prof. Bruce Ames of UC Berkeley as superior to either alpha or gamma alone.]
5. Pantothenic Acid (B Vitamin) 250 mg [for growth and development.]
6. Soya Lecithin (Phosphatidylcholine) 1200 mg (For cell membranes; boosts acetylcholine)(PC55 [Twin Labs] or Maxicholine are best with 55% and 65% ratios, respectively, compared to only 5% for regular lecithin.)
7. Super Garlic 3X (odorless tablets) 440 mg raw garlic concentrate; Source: Metagenics, Inc. of San Clemente, California 92672; however, any odor-modified kyolic garlic extract is acceptable. (Ca-Chrome caplets combine both of the above.)
8. Calcium l,000 mg (Oyster Shell), especially useful for females susceptible to osteoporosis. We suggest increasing the dose to 1500 mg for post-menopausal women not on ERT (Estrogen Replacement Therapy) along with 800 iu of Vitamin D (ordinary multivitamin tabs contain only 400 iu)(Calcium supplements have been shown to prevent osteoporotic bone loss by 1/3 to 1/2 in a placebo-controlled study with 122 women over 2 years.)
9. CoEnzyme Q10 [60 - 120] mg (Ubiquinone)(Antioxidant)[11]. (CoQ-10 is found in mitochondria, as part of a unique metabolic pathway that synthesizes ATP, the body's general-purpose energy molecule at the cellular level. CoQ-10 is reputed to benefit the immune system [12], allergies, asthma, respiratory and heart diseases, duodenal ulcers, and also serves to prevent some types of cancer. We have observed statistically significant increases in average life-expectancy in rodents on CoQ-10 [13], but a dose-response curve for humans has not yet been established)(Typical Food Sources: salmon, sardines, and mackerel; Supplements available from Twin Labs, Natural Life, or NOW Natural Foods)
10. Pycnogenol (proanthocyanidins, bioflavenoids)(Antioxidant-- claimed to 30-50 times more powerful at scavenging free radicals than Vitamins C and E, respectively)(Sources: maritime pine-tree bark or grape-seed extract.)
11. Flax Seed Oil 1-2 tablespoons per day (cold-pressed unrefined)(obtainable in black [opaque] plastic bottles in the refrigerated section of your local health food store [not available in regular supermarkets]. It must show a "date of pressing" and a four-month "date of expiration" listed on the bottle. It is light yellow in color with a slightly nutty flavor. Keep it refrigerated at all times. I use Barlean’s at a cost of $7.95 for an 8 fl. oz. bottle.)(Function: Flaxseed [Linseed] Oil rebalances the ratio of Omega-3 to Omega-6 fatty acids in your body, since this particular oil has the ratio of 3:1 while almost all other processed vegetable/cooking oils are in the reverse ratio).
12. Ginseng Root [250-500] mg (Antioxidant) (This ancient Chinese herb is alleged to improve cerebrovascular circulation, normalize blood sugar, and stimulate the immune system.)
13. [INTENTIONALLY OMITTED - Note: In May 2013, Gingko Biloba was removed from this position on the grounds that an NIH toxicology study of Gingko Biloba given to female and male rats and mice in three different doses of the extract five times a week and found "clear evidence" of liver cancer and "some evidence" for thyroid cancer. Furthermore, they found that Gingko doesn't improve memory or concentration, as supplement manufacturers have claimed for many years. Several large clinical trials have found no evidence that the supplement delays memory loss or other cognitive decline.]
14. Ginger. 125 mg. Herbal supplement.
15. Alpha Lipoic Acid, [100 - 150] mg (another strong Antioxidant)(est. $15.00 per month) There is a whole society of researchers devoted to this simple ring compound.
16. Acetyl-L-Carnitine (ALCAR)([500 - 2,000] mg)(a powerful Antioxidant; Sigma Tau, Inc.)(The principal mechanism of action is to facilitate the transport of free fatty acids through mitochondrial inner-membranes to facilitate the synthesis of new ATP [the application of 1 micromole of ALC to mitochondria increases oxidative activity 260 percent], although there are other mechanisms as well, such as improving cognitive function in Alzheimer’s patients.)
Omit for men; DHEA (DeHydrdoEpiAndrosterone) or DHEA-s (DHEA-sulfate) 50 mg qod (every other day); (est. $5.00 per month; although DHEA was remarkably difficult to obtain as recently as five years ago and could only be gotten from a few compounding pharmacies around the country, it is now available in all health food stores without prescription in either pill form or even as a gum.) At age 25-30, levels of DHEA peak and then begin to decline. By age 75, levels decay exponentially to 80 percent of youthful levels. This steroid promises to boost libido for both men and women, as well as prevent atherosclerosis, some cancers, and memory loss; it also builds muscle and bone mass, reduces obesity, and strengthens immunity [68-70]. As a supplement, this hormone, has only one precaution: potential androgenic conversion means that men with a history of prostate gland problems should have their PSA level checked before starting on DHEA (A home saliva test-kit for DHEA levels is now available for $30.00; Call Life Enhancement Products, Inc. of Petaluma, California at 1-800-543-3873). In the latter part of this year various patented formulations of DHEA are expected to come out on the market, and a more precise dose recommendation will be made at that time. (See the Newsletters in Appendix A for future announcements.)
17. Melatonin, [0.5-3.0] mg; take each night just before bed time, not two hours before. (Antioxidant [44-47]). Enhances immune function, but also acts as a natural sleeping pill. See Ref. [5, p. 57] for dosage information. For those few who experience Arebound insomnia@ on melatonin (waking up ready to go at 4:00 AM), you may wish to consider the time-release version (See Emerald Labs: 619-930-8078). Melatonin is especially valuable in cases of Ajet lag@ or whenever traveling across major changes in time zones.
18. Zinc Gluconate Lozenges, OTC treatment for the "Common Cold"; 13.3 mg six-times-a-day; Physicians at the Cleveland Clinic Foundation in Ohio recently found that patients sucking these lozenges suffered cold symptoms for half as many days as did untreated individuals (average 4.4 days instead of 7.6 days for controls). For example, Cold-Eeze Ionic Zinc Lozenges taken within 48 hours of the onset of symptoms was shown to provide relief and reduce the severity and duration of symptoms by 42 percent [Journal of International Medical Research, Vol. 20, No. 3 (June 1992) and Annals of Internal Medicine, Vol. 125, No. 2 (July 1996)]. How this compound works is not yet clear. However, in vitro, zinc can, among other flu-fighting activities, impair viral replication. In vivo, it is proposed that zinc coats mucous membranes and presumably helps to block viral penetration by reducing membrane stickiness.
19. SAM-e (S-AdenosylMethionine) [200 - 400] mg per day best taken on an empty stomach 30 minutes before a meal. First discovered in Italy in 1952, S-AdenosylMethionine 1,4-butanedisulfonate is the most stable form of SAM-e, and is involved in transmethylation. It is important for joint health, mobility, and joint comfort, as well as liver function, mood, and emotional well being.
20. Curcumin (Turmeric) 400 mg (useful in the prevention of Alzheimer’s Disease – Curry is heavily used for cooking in India, and the incidence of Alzheimer’s is much reduced per capita. [118])
21. Lysine (Amino Acid) [1 - 3] gm per day for a few days for the indication of cold sores or fever blisters on the lips secondary to Herpes Simplex-1 Virus. Proposed Mechanism: Arginine appears to be required exclusively by the virus for its replication, while lysine competitively inhibits the supply of arginine. Lysine seems to reduce flare-ups and severity and reduces healing time for herpes blisters. There may be side effects associated with long-term administration, however, including gallstones, or elevation of cholesterol.
22. BenaGene (Oxaloacetate) – 1 capsule per day [Terra Biological; San Diego, CA; www.benegene.com]
23. Vitamin D3 (Cholecalciferol) 1,000 iu per day

E. For Females Only
Based on the latest studies implicating excessive iron in increased risk of heart attacks, we have withdrawn our previous recommendation that menstruating women take a multivitamin with an iron (Fe++) supplement. Except in conditions of pregnancy or heavy bleeding, the risk of Iron Deficiency Anemia is actually negligible compared with the risk of iron accumulation (hemosiderosis and its associated cardiac side effects). Indeed, donating a pint of blood each year for both men and women may not only be humanitarian for the potential recipient, it may be beneficial for the donor by reducing the load of excess iron in the body.
According to the latest studies, we strongly recommend ERT (Estrogen/Progesterone Replacement Therapy) for postmenopausal women, not just to end the discomfort of "hot flashes," but more importantly to achieve significant protection against osteoporosis and heart disease. The benefits of hormone replacement outweigh the risks to such a degree that treatment should even be contemplated in women with a family history of breast cancer. See your personal gynecologist for more details.
For women suffering from a lagging libido and energy loss, adding Testosterone (Yes, women have Testosterone as well as men) is indicated. Possible side effects range from oily skin, acne, and body hair growth, as well as a possible increase in the risk of heart disease. Even though there is now substantial evidence from clinical trials that it works, the debate over safety is still continuing. (See below.)

F. For Males Only
After age 50, if cholesterol > 180, Aspirin 325 mg qod (every other day)(anti-platelet/anti-clotting)(Halfprin, enteric coated aspirin, 165 mg qd is recommended for those with pre-existing stomach problems, which are an occasional side effect of aspirin in its pure form.)
Niacin (Flush Free Inositol Nicotinate) 1,000 mg per day to reduce LDL Cholesterol
For men aged 60 and above, Testosterone (by prescription) for increased well-being, libido, muscle strength, bone hardness, and achieving significant drops in LDL and total cholesterol levels. Routes of Administration: Testoderm from Alza [approved by the FDA in 1993] is a nonadhesive transdermal patch applied to the skin daily; BioTechnology General is working on a testosterone wafer that will dissolve under the tongue and be quickly absorbed into the blood stream; endocrinologists are also testing a chewing-gum tablet at Johns Hopkins University. A month’s supply is about $[25 - 40].
Also for men over age 60, Deprenyl (Eldepryl)(Selegiline Hydrochloride) 1 mg may be taken daily. Although Deprenyl is a prescription drug specifically indicated for Parkinson's Disease, it can help stabilize memory loss in geriatric patients in general (proposed mechanism = SOD [Super Oxide Dismutase] enzyme antioxidant). Note: Deprenyl is readily available over-the-counter in Mexico, and many persons routinely travel to border cities to legally acquire a three-month supply for personal use [14].
Regular blood donations to the Red Cross or any convenient hospital in your area, at least one pint (unit) annually, are also a good idea, as indicated above.

G. For Children Only
A standard children's chewable (as tolerated) from ages 2 to 10 is sufficient. Of course, it is assumed that everyone's water supply contains Fluoride, essential to the proper hardening of teeth. Otherwise, a supplement is required (tablets or drops). It's never too early to have dental checkups in anticipation of potential future problems. Immunizations are described later.

H. Hormones and Supplements That We Hope to Recommend in the Near Future
1. rhGH (recombinant human Growth Hormone)
rhGH is an expensive anti-aging intervention, and the FDA has explicitly excluded all off-label prescriptions other than for the original pediatric indication for hypopituitary dwarfism (children destined to have extremely short stature) or “AIDS wasting” and specifically disallows treatment for "growth hormone deficiency" in older normal adults. In our view, the potential side effects of excess hGH (acromegaly) are overrated when taken only in “replacement doses.” Conversely, the benefits, based on controlled clinical trials sponsored by the National Institute on Aging (NIA), were disappointing when they are announced in the Summer of 1998. The real barrier for a new geriatric indication is that it's an injectable protein with upscale prices ($[800 – 1,000] per month). These costs have not fallen rapidly as expected, as the current U.S. suppliers (Genentech, Inc. with 70% of the market and Eli Lilly with the balance) attempt to meet competition from European suppliers (Bio-Technology General Corp. and Novo Nordisk, AS (Denmark)), who were expected to get FDA approval to market in the U.S. Also, we should note that Merck is testing a non-peptidal oral agent (MK0677) to stimulate the pituitary into releasing more hGH, but this compound has never been submitted to the FDA for human clinical trials. (See Chapter 21, [72] for more details.) Peptidal secretagogues of growth hormone, like hexarelin (a hexapeptide), are encouraging and may be considerably less expensive in the future. Sermorelin may be even more effective, as it is closer to the native GHSH. None of the recent data about hGH, however, convinces us to believe that it should be indicated for anyone except those who have a demonstrable reduction with respect to age- and gender-matched controls for this hormone. The latest rodent experiments lead us to the conclusion that GH can in fact be a life-shortening rather than a life-lengthening hormone, even though it may make patients feel better in the short term.
2. Thymosin Alpha-1
Thymosin is another promising agent, which will serve to enhance immune competence is undergoing clinical trials now and is expected to be available sometime next year.
3. L-Glutathione
Glutathione is a natural antioxidant synthesized by the body that is now alleged to be contained in a chewable tablet that will not be easily destroyed by stomach acid. ThiOTab tablets also contain Xylitol, a sugar-free sweetener, known for its beneficial oral and dental hygiene properties (distributed by Thione International of Atlanta, GA 30305). We are still waiting for scientific documentation.

I. Agents That Are Not Recommended at the Present Time
The following agents are all under investigation at various clinical and animal research centers but, in our view, their value and/or risk still needs to be proven:
1. Prescription Drugs:
Centrophenoxine (Lucidril)(Reverses some brain aging and decreases lipofuscin formation in neurons), BCE-001; Hydergine (Very safe Ergot Alkaloid)(Increases metabolic efficiency in the brain leading to increased blood supply, and therefore protects against hypoxia; decreases lipofuscin formation); Vasopressin (Diapid)[nasal spray](memory); Piracetam (Very safe; claimed to increase left/right hemispheric transmission in the brain, across the corpus callosum; claimed to help with Alzheimer’s Disease, especially when combined with choline), L059; Metformin (Phenformin, Buformin), Dilantin (Diphenylhydantoin, DPH)(Normally thought of as an anticonvulsant, but has other properties); Aminoguanadine (blocks formation of Advanced Glycosylation Products, AGEs); Quercetin; and RU-486 (Normally thought of as an abortifacient, but has other important properties), Bromocriptine (increases dopamine); Pimagedine (a new solvent for the breakup of AGEs [Advanced Gylcosylation End-Products], Dr. Richard Bucala, Picower Institute for Medical Research in New York).
2. Herbs:
Kava; Shitaki Mushrooms; Echinacea; Pantocrinum (deer antler velvet); cordyceps; galanthamine (bulbs of daffodils). With sales of $300 million annually, echinacea doesn’t prevent the common cold after all. As reported in the December 3, 2003 issue of the Journal of the American Medical Association, in a study of 707 upper respiratory infections in more than 400 otherwise healthy kids aged [2-11] years in the state of Washington, not only did echinacea fail to make a dent in their illnesses, it also produced more skin rashes than a placebo! We have only recently learned that Saw Palmetto does not reduce the symptoms of Benign Prostatic Hypertrophy (BPH) in men as had been claimed for decades by the health-supplement industry [120].
3. Amino Acids:
Various popular Amino Acids, like Glutamine, Arginine, L-Ornithine, L-Cystine, L-lysine, Phenylalanine, Methionine, L-Tryptophan, L-Tyrosine, etc., are not recommended at this time, since one probably gets adequate levels of these amino acids already, assuming a normal health status and diet. However, Amino Tropin 6, a patented combination of the nutrients GABA (Gamma Amino Butryic Acid, a known neurotransmitter substance), Arginine, Lysine, and Xanthinol Nicotinate (a B Vitamin), may have potent growth-hormone-releasing effects and must be studied further. The problem is to distinguish between statistically-significant increases, as published in the scientific literature, and clinically-significant increases for humans having a normal health status and diet and without simultaneously undergoing protein restriction.
4. Miscellaneous Compounds:
PBN (Phenyl Butyl Nitrone)(Significant age-reversing properties have been reported for white mice particularly in terms of memory and learning; it was placed in the mouse’s water supply); TNF (Tumor Necrosis Factor); Phosphotidylserine; Bromocriptine, BHT (Butylated Hydroxy Toluene), GHB (Gamma Hydroxy Butyrate; significant side effects include nausea, disorientation, and blackouts, and sometimes called the “date-rape drug”).
5. Discredited Agents:
According to the Mayo Clinic, the belief that shark cartilage contains a protein that inhibits tumor angiogenesis has now been shown to be false [29]. Sharks do get cancer, just like any other animal, contrary to advertising claims we have seen for this product.

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