1. glutamate considerations
   1. "glutamatergic transmission is associated with the well-established phonminon of excitotixicity. Excessive stimulation of glutamate receprots can lead to neuronal injury and death, by either direct or indirect activation of receptors on the postsynpatic neuron, leading to an opening of gated channles that allows for an influx of sodium, potassium, and calcium. This alters ionic and wtaer homeostasis and results in dendritic and cellular edema, activation of arachidonic acid, diacyl glycerol, and many other internal control mechanisms, ultimately leading to the generation of reactive oxygen metabolites, lipid peroxidation, and finally cell death" (from page P Hanaway gave me - source uncited).
2. Nutrition
   1. Fats
      1. Diagnostics
         1. Omega 6:3 ratio
            1. target ~4:1
         2. Omega 3 Index
            1. target 8-10%
         3. Dietary History, food journal, visit with dietician
      2. Treatments
         1. generally avoid seed oils
         2. DHA + EPA
            1. Supplement to Omega 3 Index target
            2. Subtopic 1
            3. caution with congophilic cerberal amyloidopathy
         3. Phophatidylserine
            1. 200mg BIDAC x 2 months then 100 mg BIDAC
         4. Glycerophosphocholine
            1. 1200mg TIDAC x 2 months then 400 mg TIDAC
         5. Healthy Food Sources
            1. egges,
            2. soybeans
            3. nuts
            4. peanuts
   2. Amino Acids
      1. Diagnostics
         1. Amino Acid Plasma Analysis
         2. Genetics
            1. THP2 SNP = 80% reduction of serotonin production
         3. Subtopic 3
            1. Dietary History, food journal, visit with dietician
      2. Treatment
         1. replete low amino acids
         2. correct stress
            1. elevated cortisol cause Trp breakdown ^ less serotonin
         3. correct inflammation
            1. cytokines breakdown tryptophan
         4. GABA support
            1. GABA 500mg once in midafternoon and qHS
            2. Theanine 200mg once in midafternoon and qHS
         5. Dopamine
            1. L-tyrosine 500mg once beofre breakfst, once mid-morning, and once mid afternoon
            2. After 3 days increase to L-tyrosine 1000mg once before breakfast, once mid-morning, and once mid afternoon
            3. After one week on L-tyrosine start I-Phenylalanine 500mg once before breakfast, once mid-morning, and once mid afternoon
            4. After 3 days of I-Phenylalanine increase to 1000mg once before breakfast, once mid-morning, and once mid afternoon
         6. Serotonin
            1. 5-hydroxytryptophan 50mg BID (once in afternoon, once before bed)
            2. add additional 50mg in the afternoon and at bedtime q3 days until max dose of 150mg in afternoon and @ HS
            3. NB: if taking an SSRI or antidepressant use caution
            4. Melatonin 1-9mg for sleep if needed
   3. Carbohydrates
      1. Diagnostics
         1. Dietary History, food journal, visit with dietician
      2. Treatment
         1. avoid processed foods, eat mostly plants
         2. Rainbow foodplan
   4. Vitamins and Minerals
      1. Diagnostics
         1. Check B12 levels
            1. esp if <500
         2. Check precursor B vitamin Levels (eg FIGLU)
         3. check MTHFR status
            1. replete with adequate methylation support
         4. check Methylmalonic acid
            1. replete B vitamin Deficiency
         5. check homocysteine
            1. replete B vitamin Deficiency
            2. Homocysteine <7
         6. RBC Magnesium
            1. goal >6-6.5mg/dL
         7. serum zinc and copper
            1. treat to ratio ideal 0.7-1.0
         8. Vitamin D
            1. goal 50-80-ng/mL
      2. Treaments
         1. methyl-B12
         2. activated Folate
            1. dose dependent on MTHFR results and other results
         3. B1
         4. B3
         5. B6 (activated)
         6. B7
3. Cellular Communications & Hormones
   1. Neurotransmitters
      1. as above
   2. Hormones
      1. Insulin
         1. Diagnostics
            1. Dietary History, food journal, visit with dietician
            2. + ROS
            3. crave sweets
            4. energy "crashes"
            5. irritable anxious or intermittent Headaches esp if misses meals
            6. eating makes calm
            7. difficulty concentrating
            8. nigh sweats
            9. constant fatigue
            10. tired after eating
            11. Family History of DM
            12. PCOS
            13. heart Disease
            14. chronic fungal infections
            15. Waist to Hip Ratio >0.8
            16. Labs
            17. 2 hour glucose tolerance test
            18. insulin
            19. glucose
            20. NMR Lipid
            21. hs-CRP
            22. LFTs
            23. GGT
            24. Subtopic 6
         2. Treatments
            1. Eating Plan
            2. Neutraceuticals
            3. alpha-lipoic acid
            4. biotin
            5. vanadium
            6. N-Acetylcysteine
            7. Herbs
            8. hops
            9. acacia bark
            10. ginseng
            11. green tea
            12. fenugreek
            13. cinnamon
            14. gymena sylvestre
            15. bitter melon
            16. garlic
            17. Medications
            18. metformin
            19. build to 2000 BIDAC
            20. Actos
      2. Thyroid
         1. Diagnostics
            1. ROS
            2. insomnia
            3. dry skin and hair
            4. constipation
            5. fluid retention
            6. menstrual problems
            7. PMS
            8. Hair loss
            9. cracked chipped gingernails
            10. low sex drive
            11. weight gain
            12. muscle aches and cramps
            13. heat or cold intolerance
            14. fatigue
            15. trouble getting up in the morning
            16. depression
            17. Subtopic 16
            18. Exposome ROS
            19. PCBs
            20. POPs
            21. chlorine
            22. Fluoride
            23. food allergies
            24. bromine
            25. rule out HPA/paraventricular nucleus stress and "fix" before directly addressing the thyroid
            26. Labs
            27. TSH
            28. FT4
            29. FT3
            30. RT3
            31. TPO
            32. anti-thyroglobulin antibodies
            33. selenium
            34. iodide
            35. iron
            36. zinc
            37. Omega 3 index (goal 8-10%)
         2. Treatments
            1. Eating Plan
            2. including
            3. seaweed or sea vegetables
            4. low mercury sea foods
            5. sardines
            6. salmon
            7. smelt
            8. herring
            9. scallops
            10. dandelion greens
            11. brazil nuts
            12. consider eliminating
            13. processed soy based foods
            14. soy cheese
            15. soy burgers
            16. bars
            17. fluoride based toothpaste
            18. gluten
            19. wheat
            20. barley
            21. rye
            22. oats
            23. spelt
            24. kamut
            25. triticale
            26. Neutraceutical
            27. Vitamin A
            28. Vitamin D
            29. Zinc
            30. T3
            31. T4
            32. combo T3+T4
            33. dose range 15-180mg
            34. selenium
      3. Sex Hormones
         1. Diagnostics
            1. ROS (women)
            2. PMS
            3. weight fluctuations
            4. edema/puffiness/water retention
            5. headaches
            6. mood swings
            7. tender enlarged breasts
            8. depressed
            9. unable to cope with normal demands of life
            10. backaches, joint of muscle pain
            11. PMS food cravings (esp salt/sugar)
            12. irregular cycles, heavy bleeding, or light bleeding
            13. infertility
            14. use OCP or other hormones
            15. PMS migrains
            16. breast cysts or lumps or fibrocystic breast
            17. FHx of breast/ovarian/uterine Cancer
            18. uterine fibroids
            19. Perimenopausal Symptoms: hot flashes/mood swings/HA irregular cycles/heavy bleeding, fluid retention, breats tenderness, vaginal dryness, brain fog, muscle/joint pain, low libido, weight gain
            20. hot flashes
            21. anxiousness
            22. night sweats
            23. insomnia
            24. low libido
            25. dry skin/hair/vagina
            26. hart palpitatoins
            27. memory changes/trouble concentrating
            28. blaoting/weight gain around middle
            29. facial hair
            30. exposed to pesticides or heavy metals (food, water, air)
            31. ROS (Men)
            32. low libido/lost vitality
            33. trouble getting or maintaining an erection
            34. infertile or low sperm count
            35. loss of muscle
            36. increased abdominal fat
            37. fatigue or low energy
            38. loss of direction and purose or sense of apathy
            39. bone loss or fractures
            40. increasing cholesterol/triglycerides
            41. increased blood sugar or insulin
            42. feeling weak
            43. depressed
            44. exposed to pesticides (air, food, water)
            45. Subtopic 14
            46. Rule out Sleep apnea
            47. add from SG
         2. Therapeutics
            1. foods
            2. tofu, tempeh, miso, nato, edemame
            3. Ground Flaxseeds 2 tablespoons BID
            4. Nutraceutical
            5. Evening Primrose Oil 1000 mg BID
            6. Menopausal Women
            7. 20mg Black Cohosh
            8. HRT
            9. estradiol
            10. estriol
            11. progesterone
            12. Testosterone
            13. DHEA
      4. HPA Axis Dysfunction
   3. Cytokines
      1. see next (inflammation)
4. Correct Inflammation
   1. Cytokines
   2. Diagnostics
      1. ROS
         1. allergies
         2. food allergies/sensitivities/don't feel well after eating
         3. poor lighting environment (home/work)
         4. poor ventilations
         5. exposure to chemicals, pesticides, loud noise, heavy metals
         6. chronic or past stress
         7. sinusitis
         8. asthma/bronchitis
         9. dermatitis
         10. arthritis
         11. autoimmune disease
         12. colitis/IBD
         13. IBS
         14. neuritis (ADHD, autism, mood/behavior problems
         15. heart disease
         16. DM or BMI>25
         17. fhx or PD or AD
         18. drink more than 3 glasses of alcohol per week
         19. don't exercise more than 30 minutes 3 times per week
      2. Labs
         1. NMR lipids
         2. ApoE status
         3. IL-1?
         4. Kynurenic/quinolinic ratio if <0.44 could suggest neurotoxicity via NDMA receptor agnost (quinolate)
         5. IL-6
         6. hs-crp
         7. TNF-alpha
         8. cyrex array 20
         9. cyrex 2
            1. if abnormal then complete IgG panel
         10. albumin:globulin ratio
             1. >1.5 optimal
         11. ESR
         12. anti-CCP
         13. TPOP
         14. ANA
         15. ?IgE food testing?
      3. Dietary History, food journal, visit with dietician
         1. sugar
         2. animal fat
         3. processed food
   3. Therapeutics
      1. Elimination Diet vs MIND v Ketogenic Diet
      2. Nutraceuticals
         1. Tumeric 200mg BIDAC
         2. Zyflamend BIDAC
         3. Digestive Enzymes (bet meals x 6 weeks)
            1. Bromelain and other proteolytic enzymes
         4. Omega 3 EPA/DHA
         5. Vitamin D
         6. Multivitamin
5. Digestion and Absorption
   1. Diagnostics
      1. Labs
         1. Subtopic 1
      2. Cyrex Array 2
         1. if + food sensitivity testing
      3. Cyrex Array 3
      4. comprehensive stool testing
      5. glucose/lactulose breath testing if evidence of SIBO
      6. Query Meds that interfere
         1. PPI
      7. ROS
         1. evidence of poor absorptions
            1. fatty/greasy/poorly formed stools
            2. constipation
            3. osteopenia/osteoporosis
            4. frequent antibiotics
            5. Subtopic 5
         2. Bloating/flatulence/buring after meals
         3. chronic yeat/fungal infections
         4. fatigue after eating
         5. heartburn
         6. chronic abdominal pain
         7. diarggea
         8. carbohydrates cause bloating
         9. anal itching
         10. geopraphic tongue
         11. sores on the tongue
         12. canker sores
         13. crave sweets and bread
         14. excessive stress
         15. antibiotics >2x per year over 3 years
         16. history of NSAID use
         17. OCP or HRT
         18. hx of prednisone/cortisone
         19. any of these diagnoses
             1. ADHD
             2. Roisacea
             3. acne after adolescence
             4. eczema
             5. psoriasis
             6. celiac
             7. chronic autoimmune disease
             8. chronic hives/urticaria
             9. IBD
             10. IBS
             11. CFS
             12. FMS
   2. Therapeutic
      1. Rifaximin
         1. if IBS-d or SIBO
      2. chew food 25 times
      3. don't stand up while eating
      4. Digestive Enzymes
         1. depending on Pancreatic Elastase level
      5. Betaine HCL
      6. saccharomyces boulardii
         1. 150mg -250mg (3 - 5 Billion cfu)
      7. L-glutamine
         1. 2500mg BID x 8 weeks
         2. Subtopic 2
      8. Quercitin 500mg BIDAC
      9. -azole
         1. if evidence of yeast
6. Detoxification & Biotransformation
   1. Diagnostic
      1. ROS
         1. difficult to have daily Bowel movement
         2. urinate small amounts of foul smelling urine daily
         3. rarely sweat
         4. chronic fatigue
         5. chronic muscle ache
            1. chronic
         6. chronic headache
         7. concentration and memory issue
         8. FMS/CFS
         9. drink unfiltered tap/well water
         10. dry clean clothes
         11. work/live in a poorly ventilated/climate controlled building
         12. live in large urban/industrial area
         13. use of household/lawn/garden chemicals to clean house/yard
         14. semi-regular exposure to pesticides/herbicides
         15. mercury/silver fillings in teeth
         16. eat large fish more than once a week (swordfish, tuna, shark, tilefish)
         17. feel wired from caffeine and experience joint pain/muscle aches or have hypoglycemic symptoms (anxiety/palpitations/sweating/dizziness)
         18. Regular consumption of
             1. acetominophen
             2. Acid blockers
             3. hormone modulating medications (pills, patches, cream)
             4. NSAIDS
             5. medications for colitis, Crohns, recurrent headaches, allergy symptoms, nausea, diarrhea, or indigestion
         19. bothered by:
             1. gasoline
             2. diesel fumes
             3. perfumes
             4. new car smells
             5. fabric stores
             6. dry cleaning
             7. hair spray
             8. strong odors
             9. sooaps
             10. detergents
             11. tobacco smoke
             12. chlorinated water
         20. negative reactions when consume foods with
             1. MSG
             2. sulfite (wine, salad bars, dried fruit
             3. sodium benzoate (preservative)
             4. red wine
             5. cheese
             6. bananas
             7. chocolate
             8. small amount of alcohol/garlic/onion
         21. History of turning yellow or Gilberts
         22. History of
             1. Breast Ca
             2. smoking induced lung Cancer
             3. other cancer
             4. prostate problems
             5. food allergies/intolerances/sensitivities
             6. Subtopic 6
         23. Family History of
             1. PD
             2. AD
             3. ALS
             4. MS
             5. other neurodegenarative disease
         24. Subtopic 24
      2. Labs
         1. genetics
            1. ApoE
            2. treat with low processed foods, low glycemic load, and exercise
            3. MTHFR
            4. replete with methyl-folate
            5. GSTM
            6. ensure adequate B6, B12 and sulfur containing amino acids, sulfur containing amino acids (eg NAC) and 2 cups of cruciferous vegetables
            7. GSTP
            8. ensure adequate B6, B12 and sulfur containing amino acids, sulfur containing amino acids (eg NAC) and 2 cups of cruciferous vegetables
            9. CETP
            10. treat with low processed foods, low glycemic load, and exercise
            11. COMT
            12. adequate B6,B9, B12
            13. SOD-2
            14. manganese, zinc, copper, + phytonutrient rich diet
         2. Tritest
         3. DMSA Urine Provocation
      3. Detoxigenomic panel
         1. 23 and me
            1. genetic genie
            2. MTHFR support
            3. Livewello
   2. Therapeutic
      1. activate NRF2 pathway
      2. Glutathione or related
         1. R-lipoic acid
            1. 200-1000 mg daily
         2. Reduced glutathione
            1. 1-3 gram per day
         3. milk thistle
            1. 140mg BID of standardize extract
            2. 400-1200 mg daily
         4. Whey Protein concentrate
            1. 2-3 servings daily
         5. NAC
            1. 600-3000 mg /day
         6. buffered ascorbic acid
            1. 1000 BID
         7. zinc
         8. selenium
         9. Magnesium
            1. 400 + mg per day
         10. Pantothenic acid
             1. 500-1000 mg daily
         11. SAM-e
             1. 400-800 mg daily
         12. extracts
             1. tumeric, pine bark, bilberry, grape, strawberry/black reasberry
      3. Phase 1 Support
         1. magnesium, copper, zinc, vitamin C, vitamins B2/3/6/12 folate
         2. Antioxidants
            1. vitamin C, E, NAC, ALA
            2. Carotenoids
            3. lycopene
            4. beta-carotene
            5. zeaxanthin, astaxanthin
            6. Lutein
            7. Flavinoids
            8. anthocyanidins
            9. Ellagic acid
            10. Quercitin
            11. Green Tea catechins
      4. Phase 2 Support
         1. whey
         2. L-glutathione
         3. NAC
         4. glutamine
         5. glycine
         6. sulfur donors (taurine, sodium sulfate)
         7. pantothenic acid
         8. magnesium
         9. methyl donors
            1. folate, choline, methionine, TMG, SAMe
         10. Glucosinolates
             1. cruciferous
         11. Milk thistle
      5. Alginate
      6. Modified Citrus Pectin
      7. B-complex
      8. sauna
         1. drink at least 16 ounces of purified water prior
         2. drink 16 ounces of purified water during treatment
         3. start with 10 miutes and increase by 5 minutes daily to max of 30-45 minnutes
         4. take a shower/cold dip every 10 min
         5. sauna temp should be 140-150 degreesF
         6. Far Infrared Sauna are lower tempratures and may be more easily tolerated
         7. shower with soap after sauna
      9. Foods
         1. collards
         2. kale
         3. cabbage
         4. kohlrabi
         5. mustard greens
         6. rutabaga
         7. turnips
         8. bok choy
         9. chinese cabbage
         10. arugula
         11. horseradish
         12. radish
         13. wasabi
         14. watercress
         15. tumeric or curry
         16. 1-2 cups green tea daily
         17. eggs, garlic, onion
      10. DMSA
          1. 10 mg/kg divided bid-tid 3 days on 11 days off (x3+ months as determined by follow up testing)
             1. Subtopic 1
          2. Zinc 40mg per day
          3. selenium 100-200 mcg daily
          4. B6, Methyltetrahydrofolate, methylcobalamin
             1. methycobalamin 5000mg IM/subQ q 2 weeks
          5. Omega 3 Fatty Acids 1000-2000 mg daily
          6. Vitamin D 2000-4000 IU daily
          7. Optional
             1. Phosphatidylcholine
             2. Protein Kinase modulators
             3. alginates
      11. Subtopic 10
      12. EDTA
7. Energy & Metabolism
   1. Diagnostics
      1. ROS (energy)
         1. chronic or prolonged fatigue
         2. aching muscle pain or discomfort
         3. sleep distrubances (falling asleep or waking up early)
         4. poor exercise tolerance/post-exertional fatiue
         5. muscle weakness
         6. touble concentrating or remembering things
         7. irritable/moody
         8. fatigue prevents from engaging socially
         9. fatigue interferes with work/family/social life
         10. distant/recent/current prolonged stress
         11. symptoms started after acute stress/infection/trauma
         12. present or history of chronic fatigue syndrome or fibromyalgia
         13. history of chronic infections (mono, respiratory, etc)
      2. ROS (Oxidative Stress)
         1. less than 7-8 hours sleep per night
         2. dont exercise more tha 15 hours per week
         3. sensitive to perfume/smoke/fumes
         4. regular dep muscle/joint pain
         5. significant level of environmental toxin exposure
         6. smoke cigarettes or cigars
         7. regular 2nd hand smoke exposure
         8. > 3 alcoholic befverages per week
         9. tanning booth or extreme sun exposure without protection
         10. taking prescription, OTC or recreational drugs
         11. life is "stressful"
         12. fried foods, margarine, high levels of animal fat (meat, dairy)
         13. processed food (white flour/sugar) > 2 times per week
         14. eat fewer than 5 servings of deeply colored vegetables daily
         15. source of water
         16. amount of water consumed on daily basis
         17. chronic colds/infections (cold/canker sores)
         18. BM ? 25
         19. DM or heart disease
         20. Arthritis or allergies
      3. Labs
         1. SOD??? (Oxidative Stress Panel 2.0 Genova
         2. Lipid Perox (Genova)
         3. glutathione
         4. selenium
         5. copper
         6. manganesse
         7. vitamin E (alpha and gamma)
         8. CoQ10
         9. investigate occult infection
            1. HHV 6
            2. HSV 1, 2
            3. EBV
            4. CMV
            5. Mycoplasma Pneumonia
            6. Chlamydia Pneumonia
            7. Subtopic 7
         10. correlate with inflammation and related work up
         11. investigate mycotoxin
         12. ?calcium Channel genetics (?related to amyloid and NMDA receptor)
             1. CACNA1C mediates excitatory signaling by regulating the influx of calcium into the cell
             2. RYR3
         13. Kynurenic/quinolinic ratio if <0.44 could suggest neurotoxicity via NDMA receptor agnost (quinolate)
         14. Subtopic 14
      4. Dietary History, food journal, visit with dietician
         1. sugar
         2. animal fat
         3. processed food
         4. NMDA stimulating foods
            1. MSG
            2. aspartame
            3. Subtopic 3
   2. Therapeutics
      1. Nutraceuticals
         1. glutathione
         2. selenium
         3. copper
         4. manganesse
         5. vitamin E (alpha and gamma)
         6. NAC
         7. glutathione
         8. creatine
         9. CoQ10
            1. 100mg daily
         10. D-ribose
             1. 5 grams daily
         11. Acetyl L-carnitine
             1. 500mg BID
         12. Alpha-lipoic acid
             1. 100 mg BID
         13. NADH
             1. 10 mg daily sublingual
         14. Resveratrol
         15. personalize based on oxidative stress/nutreval testing
      2. NMDA receptor considerations
         1. Magnesium (potent antagonist)
         2. zinc
            1. inhibits glutamate signaling and induces antidepressant effects
         3. GABA
         4. taurine
         5. viatmin B6
         6. vitamin D
         7. NAC (glutamate antagonist and antiox for the ROS)
         8. EGCG (potent)
         9. Memantine
         10. amantadine
         11. Alpha-lipoic acid (antiox that blocked GSH depletion with glutamate)
         12. Curcumin
             1. if depression involved
         13. vitamin E
         14. Melatonin
             1. acts as antiox to remove free radicals from glutamate damage
         15. CoQ10
         16. Nitrous Oxide
         17. Huperzine A
         18. vitamin B 12
         19. calcium channel blockers
      3. Subtopic 3
8. Stress (Calm your mind)
   1. Diagnostics
      1. ROS "adrenal dysfunction"
         1. low BP
         2. dizzy when stand up
         3. low blood sugar
         4. salt cravings
         5. sugar/sweet cravings
         6. dark circles under eyes
         7. trouble falling or staying asleep
         8. non-restorative sleep
         9. mental fogginess or trouble concentrating
         10. recurring headaches
         11. frequent infections
         12. post-exertional fatigue
         13. sense of "stressed out" most of the time
         14. tired but wired
         15. water retention
         16. panic attacks or easily startled
         17. heart palpitations
         18. need to start the day with caffeine
         19. poor tolerance to alcohol, caffeine, other drugs
         20. feel weak and shaky
         21. sweaty palms and feet when nervous
         22. feel fatigued
         23. muscle weakness
      2. Connected to a Life Purpose?
      3. Assessement of "automatic Negative Thoughts"
         1. Happy talk vs Negative Talk
      4. Assessment of modifiable stressors
         1. trauma/abuse
            1. sexual, physical, emotional,
            2. PTSD
         2. environmental stressors
            1. home, work, etc
            2. water damaged buildings
            3. infections
            4. hospitalizations/ new medications/procedures
            5. see McEwan, Sapolsky, Sonia Lupien
         3. recent significant major life events
         4. assessment of dietary stressors
            1. transfats
            2. processed foods
            3. sugar/high fructose corn syrup
         5. Toxins
         6. Allergins
         7. chronic infections
         8. chronic illness
         9. Overweight/obesity
         10. alcohol/tobacco/drugs
      5. Laboratory
         1. B-vitamin status
         2. DHEA-s
         3. AM cortisol
         4. Adrenocortex Stress Profile
            1. 4 samples of salivary hormones (cortisol/DHEA)
   2. Therapeutics
      1. Goal Directed Behavioral Therapy
         1. Health coaches
         2. see Fotuhi paper
      2. EMDR
         1. if PTSD
      3. Neurofeedback
      4. Exercise
         1. increase BNDF
         2. normalize cortisol
         3. decrease inflammation
         4. normalize insulin resistance
      5. Heart Rate Variability Tools
      6. Progressive Muscle Relaxation
      7. Vagus Nerve Stimulation Exercises
      8. Breathing Techniques
         1. soft-belly breathing
      9. Mindfulness Meditation approaches
      10. Magnesium Salt bath
      11. Yoga
      12. Massage
      13. Meditation
      14. Dance
      15. Tai Chi/Qui Gong
      16. Journaling
      17. Be in nature
      18. Music
      19. Arts and crafts
      20. Increase social network and engagement
      21. Nutraceuticals
          1. Asian Ginseng Root (Panax Ginseng)
             1. standardized to 8% (16mg) ginsenosides
             2. - 200mg BID
          2. Rhodiola Root Extract (Rhodiola rosea)
             1. standardized to 1 percent (o.5mg) salidroside
             2. 100mg BID
          3. Siberian Ginseng Root (Eleuthrococcus Senticosus)
             1. standardized to contain 0.8% eleutherosides
             2. 250mg BID
          4. B-complex
          5. Vitamin C
             1. 500-1500mg BID (to bowel tolerances) x 2-6 months
          6. DHEA
             1. dose depends on DHEA-s
9. Special Consideratoins
   1. Memory Enhancing Herbs
      1. Huperzine A
         1. 100 mcg BID
      2. Vinpocetine
         1. 5-10mg BID
            1. do not use if on blood thinners
      3. Ginko Leaf Extract
         1. standardized to 24% ginkgoflavonglycosides and 6% terpene lactones
            1. 80-160mg BID
   2. Mood Enhancing Nutraceutical
      1. SAM-e
         1. 400mg QID or 800mg BID to start
            1. response usually occurs within 3 weeks and can reduce the dose to 400 mg BID
            2. use as adjunct to methylation supplemenation and magnesium
            3. do not use in patient's with Bipolar Disorder