Anti-Narcoleptic Vitamin Regimen

BIG FAT DISCLAIMER: I am not a medical doctor. The following is not advice or medical recommendation. Please see the official disclaimer here.

 

I have been off of conventional narcolepsy treatments for 3 years, and gluten free for 4 years. Over time, I have found a host of vitamins and non-prescription nutritional supplements that have greatly increased my wakefulness and helped with other aspects of daily functioning. Please note that this is my personal log. What they are, and how I think they are helping are below.

L-tyrosine :

I began taking L-tyrosine about a year ago following a blog post concerning “Narcolepsy, dopmine and tyrosine“. I started the tyrosine regimen (between six and nine grams a day, broken up into two doses [1 at breakfast, 1 at lunch]) following reading a paper in the Lancet that reported total remission of daytime sleep attacks and cataplexy after six months of treatment. The military has also used L-tyrosine in sleep-deprived pilots to improve performance during long flights. Another report which included more rigorous controls noted that only 3 of 10 patients noted a positive effect, and so L-tyrosine could not be considered therapeutically relevant. Personally, I noticed that at the 9 gm dose I experienced a great deal of anxiety – particularly in the evenings. However, lowering the dose to 3-5 gm per day and them in the morning and early afternoon gives me the benefits of wakefulness during work hours without increased evening anxiety. A summary of how I think it’s working is below:

L-carnitine: I take 1000 mg of L-carnitine per day (500 mg in the morning, 500 mg at night). Carnitine is is an important essential nutrient, and has been demonstrated to be therapeutic for individuals with narcolepsy. Click here for my long blog post on L-carnitine and narcolpesy.

In short, individuals with narcolepsy have very low levels of serum acylcarnitine. Reduced acylcarnitine means impaired fatty acid oxidation, disturbed sleep, and impaired orexin cell functioning.

Oral supplementation of L-carnitine restores β-oxidation (fatty acid oxidation) and mitochondrial ATP generation from fatty acids.

Carnitine also has marked effects on proper intestinal development and function and reduces intestinal inflammation.   Carnitine is also necessary for proper immune functioning and promotes regulatory cell function (think: anti-autoimmune). Carnitine supplementation can also improve obesity, glucose tolerance and energy expenditure

 

 

Narcolepsy, dopamine and tyrosine.

Recently, I have been intrigued by the link between dopamine and narcolepsy.  About a year ago, I had a blood test done for neurotransmitters, which indicated that I had normal serotonin, but low circulating dopamine. Nutritionally, this would indicate a deficiency in intake of L-tyrosine, or maybe a defect in the conversion to dopamine, or some other mechanism of dopamine release in the brain.

I didn’t really appreciate the bloodwork, until I realized there were signs of dopamine deficiency in family members on my mother’s side. My maternal grandfather has long suffered with restless legs syndrome, which can be caused by dopamine deficiency (and, also iron deficiency, which is important for dopamine storage and neurotransmission in the brain). Prior to going gluten free, I often struggled with restless legs, and still cannot take anti-histamines without feeling like my legs are going to dance off my body (anti-histamines are known to aggravate RLS).

I also am a runner, and thrive off of the runner’s high that I get. Running stimulates the release of beta-endorphins, which disinhibit dopamine transmission. In otherwords, running increases dopamine levels in the brain.

In addition, my mother, sister, and I have all struggled with attention deficit disorder (ADD), which has been demonstrated to be connected to low dopamine transmission.

Though not well currently reviewed in the literature, dopamine and narcolepsy appear to have a close association with one another. Orexins act on dopaminergic nuclei, which express orexin receptors, indicating that orexin influences dopamine neurotransmission. In rats, infusion of orexin increases dopamine in the brain. Additionally, increases in orexin (and correspondingly dopamine) increased the time the rats spent awake. For narcoleptics, a deficiency in orexin neurons and orexigenic neurotransmission could cause a secondary dopaminergic neuron transmission deficiency. (i.e. – if orexin isn’t released, dopamine isn’t released).

From a therapeutic perspective, dopamine agonists have long been used to treat cataplexy and excessive daytime sleepiness associated with narcolepsy.  Amphetamines (such as Ritalin) have long been used to reduce daytime sleepiness associated with narcolepsy, and amphetamines have been shown to increase levels of dopamine in the brain. In addition to the traditional stimulants, a more recently adopted wakefull-ness promoting drug, Modafinil, has also been shown to increase dopamine (and histamine) release, potentially by inhibiting the reuptake of dopamine.

In addition to conventional medicinal treatments, administration of the amino acid L-tyrosine, which is a precursor to dopamine, has been shown to positively affect symptom management in narcolepsy.  Patients were administered 100 mg/kg/day (which is about 6 grams of L-tyrosine for the average person) for 6 months, and were reported to have complete remission of symptoms.  Another study found that quantities of about 9 grams/day provided some wakefulness promoting effects, but it was not deemed a suitable alternative for use alone.  There are limited reports of the use of L-tyrosine in scientific literature, however, and no studies have been published on it’s use recently.

Another compelling  piece of the dopamine/narcolepsy connection comes from another neurodegenerative disorder, Parkinson’s disease (PD), whereby individuals lose dopamine-producing neurons in the brain. In fact, PD shares many features with narcolepsy including REM disorder and hallucinations as well as daytime sleep attacks. Indeed, it has been demonstrated that orexin-producing neurons are also lost in individuals with Parkinson’s disease, and narcolepsy has recently been implicated as a potential risk factor for PD, although it is unclear if this is an intrinsic risk factor, or if the treatments associated with  narcolepsy (i.e. long-term amphetamine use) contribute to the deterioration of dopaminergic neurons and development of PD.

Due to the compelling literature evidence that dopamine and narcolepsy are interconnected, I recently began a regimen of 6 grams of L-tyrosine a day. I have had great results so far, and have noticed a significant reduction in daytime sleepiness and  total time spent at night sleeping. I suspect that the effect will gradually wear off (I have been taking L-tyrosine for about 4weeks now), and I am interesting in speaking with others using L-tyrosine for it’s wakefulness-promoting uses; so, anyone out there?