Happy Halloween!
Today's email will touch on additional supplements that can help with anxiety. I will touch on dosing, side effects, and other ways these may help patients.
- Magnesium L-Threonate
- Ashwagandha (with bonus recipe!)
- Niacinamide
1: Magnesium L-Threonate
Magnesium L-Threonate was discovered in 2010 by a team at MIT who were trying to identify substances that could enhance cognitive function. A bit more about it:
- This form of magnesium readily crosses the BBB
- L-threonic acid, the salt that is attached to the magnesium, is a derivative of vitamin C (but it doesn't supply any vitamin C)
- Seems to be helpful in reducing anxiety and pain, as well as improving sleep quality, memory, and cognition
- Some studies for your perusal: RCT Study on anxiety; RCT study on sleep and overall well-being
Recommended dosage:
Multiple studies used doses of around 1-2 grams magnesium L-threonate (2-3 capsules daily if using an isolated form; may be best taken in divided doses for optimal benefit)
2: Ashwagandha
Known as Indian Ginseng, ashwagandha seems to be helpful in “calming the nerves”, as well as anxiety, sleep, pain, libido, and may increase testosterone and sperm quality in men (I've seen testosterone levels improve in more than dozen men). A bit more information:
- It's been used in traditional Indian medicine for almost 3,000 years, primarily as a substance to strengthen the nervous system.
- Risks include GI symptoms and sedation in larger quantities (source); caution in those with hyperthyroidism (some studies suggest it increases conversion of T4 to T3); some anecdotal reports of depression and elevated LFTs after a few weeks of daily use
Recommended Dosage:
500mg daily or BID (option to take as a drink, which is how it's traditionally been consumed in India; see recipe below)
- Ideally use a source that isn't from Asia and has been tested for heavy metals; take as needed, but no more than 5 days a week
3: Niacinamide
Niacinamide appears to be similar to benzodiazepines (study with a case report; another paper with 3 case reports) and may increase serotonin levels. A few more facts:
- Also known as nicotinamide, a form of vitamin B3; the precursor to this is niacin (but less chance of flushing)
- Other benefits of niacinamide include treatment for acne and melasma, and may delay the onset of Type 1 Diabetes for those at high risk
- Risks = Sedation in doses over 6 grams a day, as well as nausea (which may be a parameter for individual dosing, i.e. dose 500-1000mg under a dose that causes nausea)
Recommended Dosage:
1000 - 2000mg BID; start at a lower dose if concerns of nausea or sedation; monitor LFTs if using more than 3 grams a day
**Note: Dr. Greenblatt (Psychiatry Redefined) uses this with Ashwagandha 300-500mg and 400mg magnesium in most of his patients who present with anxiety
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