Information on nutritional supplements people with ALS have been taking

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This is a list of supplements people with ALS have reported taking. Along with each supplement, its supposed pathways of functioning are given, along with typical dosages and potential side effects. The aim is to create a specific data page on each supplement, including links to scientific research articles etc.

Substance	Means of functioning	Possible synergies	Potential side effects	Form	Typical dosage
5-HTP	Serotonin upregulator	Vitamin B6	Risk for serotonin syndrome if many serotonin boosters are taken at the same time. Not together with green tea (EGCG, EGC)	Capsule	100 mg, twice a day
Acetyl L-carnitine (ALCAR)	Mitochondrial support, prolonged survival time for 23 month in this trial	Possibly more effective with alpha lipoic acid. L-carnitine without the acyl group is more bioavailable but unable to pass BBB; thus better for targeting muscles.	If taken orally, may feed harmful gut bacteria.	Capsule or powder	1 - 3 g a day, max. 0.5 g at a time
Alpha ketoglutarate (AKG)	Krebs cycle support	Arginine (in the form of 1:1 AAKG) increases bioavailability.		Capsule	3 - 20 g a day
Baicalin	VEGF upregulator, NF-kappab inhibitor, IL-6 downregulator (?)			Capsule	400 mg a day
Berberine	Anti-microbial, AMPK activator, Anti-leaky gut		May interact with microlide antibiotics such as azithromycin and clarithromycin at hERG channels on the heart, leading to serious cardiotoxicity. Excessive AMPK activation may induce TDP-43 mislocalisation. Possibly detrimental in SOD1 ALS. Contributes to muscle degradation.	Capsule	0.9 - 2 g a day, max. 0.5 g at a time
Coconut oil / MCT oil	By raising ketone levels, could theoretically help compensate for mitochondrial dysfunction and impaired energy production. Could slow progression simply by acting as a high calorie supplement that increases circulating lipids.		Stomach upset, diarrhea in large amounts. Gradual increase 1 tsp/day to minimize possible gastrointestinal side effects.	Virgin coconut oil, avoid hydrogenated or otherwise chemically altered products.	1-9 Tbsp/day.
Curcumin	Anti-inflammatory, HSP inducer, Iron chelator	Valproate potentiates curcumin's neuroprotective effect. Piperine or complexing with phosphatidylcholine (Meriva) improves otherwise poor bioavailability when taken orally. Slow release products exist.	Consult a doctor first if you have problems with gallbladder.	Capsule	400 mg to 3 g a day, depending on the formulation
Dexthromethorphan	Anti-bulbar/pseudobulbar symptoms, Serotonin upregulator, Calcium channel inhibitor, NMDA antagonist	Quinidine slows the breakdown of dextromethorphan in the body, improving its bioavailability.		Liquid	20 mg dex + 10 mg quinidine twice a day
Dichloroacetate (DCA)	Glycolysis inhibitor		Severe, including peripheral neuropathy if taken too much or for too long.	Powder	2 g a day
DMAE	Increases acetylcholine production, Antioxidant		Confusion, drowsiness, elevated blood pressure, insomnia	Capsule	130 - 400 mg a day
European milk thistle extract	Mitochondrial support, GSH production support, Liver support			Softgel	500 mg, once a day
Gastrodia elata	Endothelin-1 downregulator			Capsule
Ginger				Fresh or root extract
Ibuprofen	Anti-inflammatory (general)		Stomach issues that do not vanish over time.	Pill	200 mg, twice a day
Inosine	Axon growth stimulation, Anti-glutamate, Elevates uric acid (?)			Capsule	500 mg, once a day
Leucine	GDH activator			Powder	1 g a day
Magnolia bark extract	Anti-anxiety, Anti-bulbar/pseudobulbar symptoms, Anti-inflammatory		Enhances TNF induced apoptosis	Capsule	30 mg, 2-4 times a day
Methylcobalamin (Vitamin B12)	In cell culture studies, ameliorates oxidative stress, glutamate toxicity and apoptosis. High doses can inhibit DNA methylation. Lowers plasma homocysteine levels.			Capsule, oral spray, injection	1-25 mg per day or 50 mg twice a week
N-Acetyl-cysteine (NAC)	Glutathione synthesis			Capsule	600 mg, twice a day
	Prevents TDP-43 misconfiguration
Niacin (vit. B3)			Increases plasma homocysteine levels, Causes release of PGD2
Niacinamide (nicotinamide)
Nicotinamide riboside
Peony root extract	HSP-70 inducer, Anti-inflammatory				600 mg, once a day
Protandim	Nrf2 activator		According to Protandim advocating doctor 8 % of 18 000 people has had side effects; these include loose stools and rash. Agents that increase SOD levels such as Protandim could theoretically accelerate ALS progression.	Tablet	Usually 1 tablet (675 mg) daily, sometimes more
Pu-erh tea	Pu-erh tea extract may prevent the onset of FET family protein-associated neurodegenerative diseases and delay the progression of ALS by inhibiting the cytoplasmic aggregation of FET family proteins.
R Alpha Lipoic Acid (R-ALA)	Mitochondrial support. Na-R-ALA is the sodium salt of R-alpha lipoic acid, and is more bioavailable than unmodified R-ALA.			Capsule	300 mg, once a day
Resveratrol	AMPK activator, Inhibits PGE2, SIRT1 activator	Leucine and HMB significantly increase resveratrol's ability to activate Sirt1, Sirt3 and AMPK.	Excessive AMPK activation may induce TDP-43 mislocalisation. Possibly detrimental in SOD1 ALS. May increase toxicity of riluzole. Depletes NAD.	Capsule	50 - 400 mg a day. NAD supplementation should be considered esp. on highes dosages.
Selenium	Glutathione synthesis			Pill	0.1 mg, once a day
Sodium benzoate	Ammonia scavenger	Needs arginine supplementation to be fully effective		Powder	2-4 g a day (?)
Spirulina (blue-green algae)
Taurine
Trimethylglycide (TMG)	Homocysteine suppression			Capsule	750 mg, twice a day
Ubiquinol (COQ-10)	Mitochondrial support	Life extension Foundation claims that shilajit doubles levels of CoQ10 in mitochondria.		Capsule	100 mg, once a day
Vitamin D	Anti-inflammatory (general)
Vitamin K	Calcium management
Zinc gluconate	Copper inhibitor		Copper deficiency if taken in excess. GDH downregulation?	Capsule	25 mg, three times a day