Supplements Protocol
Evidence-based supplement management
Magnesium reduces rosuvastatin absorption by 54% when taken together.
Solution: Separate by 2+ hours. Crestor at bedtime (10 PM), Magnesium at midday (12 PM).
Baclofen crosses BBB via LAT1 transporter. Amino acids from whey compete for same transporter.
Solution: Separate baclofen from whey protein by 1-2 hours. Current schedule: Baclofen 7:30 AM → Protein 12:00 PM = 4.5hr gap = safe.
Currently Taking (3)
Dose
3g/day → titrate to 5g/day over 1-2 weeks
Timing
With meals (midday or post-physio)
Rationale
PureGanic Creaganic uses Creapure® (99.9% pure, German-manufactured). Creatine replenishes brain PCr depleted by TBI. Meta-analysis shows cognitive gains in elderly/stressed populations. 3g/day maintenance sufficient (no loading needed for rehab patient). ESPEN: helps preserve lean mass during cancer survivorship.
Creapure® certified free of contaminants (DCA, DHT). No CYP450 interactions. Safe with all current AEDs. Ensure adequate hydration (≥2L/day). Monitor renal function (already tracked via eGFR).
Dose
25g/serving (1 scoop = 30g powder)
Timing
Pre/post-physio, separate from baclofen by 1-2 hours (LAT1 transporter competition)
Rationale
Dymatize ISO100 Hydrolyzed — 100% whey protein isolate, 25g protein per 30g scoop with 5.5g BCAAs but only 2.5g leucine (below 3g anabolic threshold for elderly). Hydrolyzed for faster absorption. Informed Choice certified. Gourmet Vanilla flavor. To hit ≥3g leucine: pair with leucine-rich food (egg +0.5g, Greek yogurt +0.5g) at same meal, or use 1.5 scoops (37.5g protein, 3.75g leucine). PROT-AGE recommends ≥3g leucine per meal to overcome age-related anabolic resistance.
Hydrolyzed WPI is lowest-lactose option. Contains milk and soy (lecithin). Gluten-free. Only 2.5g leucine per scoop — insufficient alone for anabolic threshold. Separate from baclofen by 1-2 hours due to LAT1 large neutral amino acid transporter competition. Monitor ammonia if on valproate (borderline 0.86-0.87). Step-up: increase by ~5g/week over 3-4 weeks.
Dose
2000mg/day
Timing
Evening (≥2hrs after AEDs)
Rationale
Mg 1.7 mg/dL (low end of range, ref 1.9-2.5). Low Mg worsens seizures. SAFE for epilepsy - no clinical evidence of seizure risk.
Chelates AEDs (carbamazepine, valproate) and statins — must separate by ≥2 hours. Start 200mg, can titrate to 400mg if tolerated. GI-friendly (glycinate form avoids diarrhea of citrate/oxide). Monitor for excessive sedation when combined with baclofen/quetiapine.
Weight
89 kg
2026-03-14
BMI
33.1
Obese
IBW
56 kg
Devine
ABW
64.3 kg
For protein calc
Daily Protein Target
77–96 g/day
64.3 kg (Adjusted BW (sarcopenic obesity — ESPEN 2022)) × 1.2–1.5 g/kg/day
Practical target: ~85g/day (midpoint). Distribute 25-30g per meal, never >40g per sitting.
Step-Up Protocol Required
Borderline ammonia (0.86/0.87) on VPA. Increase by ~5g/week over 3-4 weeks. Check ammonia at each step. Start L-Carnitine concurrently (urea cycle support). Separate protein from baclofen by 1-2 hours (LAT1 transporter competition). After VPA taper, ammonia constraint disappears.
Leucine Gap: 2.5g per scoop (needs ≥3g)
ISO100 provides only 2.5g leucine per 25g serving — below the 3g threshold needed to overcome age-related anabolic resistance (PROT-AGE). Options: add leucine-rich food at same meal (egg = 0.5g, Greek yogurt = 0.5g), or use 1.5 scoops (37.5g protein, 3.75g leucine).
Potential Gap: below minimum target
On low-protein days, intake may fall below target. Prioritize ≥25g protein per meal with ≥3g leucine to overcome age-related anabolic resistance. Current ISO100 provides only 2.5g leucine per scoop — pair with leucine-rich food or use 1.5 scoops.
Updates automatically when you log a new weight on the Tracking page. Using Adjusted Body Weight per ESPEN 2022 sarcopenic obesity consensus (Donini et al.) and PROT-AGE (Bauer et al., JAMDA 2013). IOM notes 1.5 g/kg/day appropriate for chronic TBI. ESPEN oncology (Arends 2017): 1.0-1.5 g/kg/day.
Pending Doctor Confirmation (13)
Tier 1 — Strong Evidence
Dose
200mg/day (100mg BID)
Timing
Between meals, separated 1-2hrs from AEDs
Rationale
Functional iron deficiency (ferritin 19.4 misleadingly low-normal with elevated ESR 30, fibrinogen 443). Meta-analysis: lactoferrin superior to ferrous sulfate across all iron parameters. Mechanism: downregulates IL-6 → reduces hepcidin → unlocks ferroportin iron absorption. 200mg/day minimum effective dose for immune effects (T-cell activation CD3+/CD4+/CD8+). Acts as neutrophil survival factor.
Bovine lactoferrin shows selective cytotoxicity toward cancer cells while supporting normal cells. No CYP450 metabolism, no AED interactions. 100mg/day subtherapeutic for immune effects per Zimecki 2013.
Dose
50mg/day (increase to 100mg if behavioral symptoms persist at 4 weeks)
Timing
With food
Rationale
Both carbamazepine AND valproate deplete B6 (48% of CBZ patients are B6-deficient per Mintzer 2012). B6 depletion impairs GABA synthesis, serotonin/dopamine production. For LEV behavioral effects: 66.6% of adults responded in Alsaadi 2015 (50-100mg). Check baseline serum PLP level before initiating.
Peripheral neuropathy risk: US FNB UL is 100mg/day. Pre-existing right hemiparesis makes neuropathy detection difficult. Baseline sensory exam of unaffected limbs required. Monitor PLP every 6 months. P5P (active form) may carry reduced neuropathy risk. Safe for breast cancer survivors (protective association HR 0.67).
Dose
50,000 IU/week (loading) → then 4,000-5,000 IU/day maintenance
Timing
Weekly loading tablet with fat-containing meal. After loading phase: daily 4,000-5,000 IU with breakfast.
Rationale
VitaThrive Max Strength D3 50,000 IU — cholecalciferol, 15 tablets per bottle. Weekly loading dose to correct deficiency faster (level was 14.7 ng/mL — severe deficiency). AEDs (carbamazepine, valproate) deplete vitamin D via CYP3A4 enzyme induction. After loading phase (6-8 weeks or until level >40 ng/mL), switch to daily 4,000-5,000 IU maintenance. GMP certified, Non-GMO.
50,000 IU/week is standard medical loading dose for deficiency <20 ng/mL. Monitor 25-OH-D levels at 8 weeks. Target 40-60 ng/mL. Must pair with K2 (MK-7) to prevent vascular calcification. Must pair with calcium for bone protection. Manufactured by Liquidsun Ltd, UK.
Dose
1mg/day
Timing
With food
Rationale
Carbamazepine significantly reduces serum folate. Folate + B12 substitution for 3 months normalized levels in 95% of AED patients and reduced homocysteine and MCV (Linnebank, Ann Neurol 2011). Addresses AED-driven homocysteine elevation — cardiovascular risk compounded by LDL 101 and inflammatory markers. Use methylfolate (active form), not folic acid.
Check baseline homocysteine, folate levels. Safe for breast cancer survivors. Monitor every 3 months until stable.
Dose
1,000mg BID (2g/day)
Timing
With meals, morning and evening
Rationale
SINGLE MOST URGENT ADDITION. Valproate depletes carnitine via inhibited biosynthesis, impaired renal reabsorption, and sequestration as valproylcarnitine. Carnitine depletion shifts VPA metabolism toward hepatotoxic ω-oxidation and directly impairs the urea cycle — the primary mechanism underlying borderline ammonia (0.86/0.87). Pediatric Neurology Advisory Committee consensus recommends supplementation for at-risk VPA patients on polytherapy. Continue until VPA fully discontinued and carnitine levels normalize.
Check free and total carnitine levels at baseline. Well-tolerated. Enables safer protein optimization by supporting urea cycle function.
Dose
2-3g total EPA+DHA daily (DHA:EPA ~2:1)
Timing
With fat-containing meals, split doses
Rationale
DHA comprises 97% of brain omega-3s; promotes neurite outgrowth, synaptogenesis, myelin preservation. Preclinical TBI evidence strong for reducing neuroinflammation and axonal injury. Anti-inflammatory at ≥2g/day via specialized pro-resolving mediators (resolvins, protectins) — addresses elevated ESR and fibrinogen. Target DHA 1.5-2g + EPA 0.5-1g daily.
No significant AED interactions. Discuss with oncologist given breast cancer history — overall evidence in cancer survivorship neutral to favorable.
Dose
1,000mcg/day
Timing
With food, morning
Rationale
Valproate reduces B12. Combined with folate, normalizes homocysteine in 95% of AED patients within 3 months. Use methylcobalamin (active form). Addresses AED-driven homocysteine elevation.
Check baseline B12 level. Very safe, no upper limit established. Monitor every 3 months.
Dose
1,000-1,200mg/day (split doses)
Timing
Split into 2-3 doses with meals. Separate from AEDs and lactoferrin by 2 hours.
Rationale
Essential co-supplement with vitamin D3 for bone metabolism. DEXA scan strongly recommended given wheelchair dependence, AED-induced vitamin D depletion, and prolonged immobility. ESPEN guideline recommendation.
Do not exceed 1,200mg/day. Split doses for better absorption (≤500mg per dose). Separate from thyroid medications if applicable.
Dose
100-200mcg/day
Timing
With fat-containing meal, alongside vitamin D3
Rationale
Directs calcium to bones rather than soft tissues/arteries. Essential partner to vitamin D3 + calcium supplementation. MK-7 form has longer half-life than MK-4.
No known AED interactions. Safe in cancer survivors. Monitor if patient ever starts anticoagulant therapy (vitamin K antagonizes warfarin).
Tier 2 — Moderate Evidence
Dose
100-200mg/day
Timing
Morning with food
Rationale
Rosuvastatin-induced CoQ10 depletion (>40% reduction within 1 year of statin therapy). Supports mitochondrial function for sarcopenia and neurological recovery. Use ubiquinol form (reduced, better absorbed).
Safe. Only start if statin myopathy symptoms present.
Tier 3 — Weak/Optional
Dose
500-1000mg/day
Timing
Midday
Rationale
COBRIT trial (1,213 TBI patients) = completely negative. Weak evidence only.
Safe but evidence is weak.
Dose
2mg
Timing
2 hours before bed
Rationale
Grima 2018 RCT (N=33): significant sleep quality improvement in TBI patients. 8/9 studies positive.
Safe with quetiapine 25mg (moderate additive sedation - may allow quetiapine reduction).
Dose
600mg BID (1,200mg/day)
Timing
Between meals, morning and evening
Rationale
Crosses BBB, raises brain glutathione. 40-year FDA-approved safety history. Preclinical TBI: reduced axonal injury and neuroinflammation. Supports detoxification pathways relevant to borderline ammonia and VPA metabolism. Glutathione precursor — synergistic with whey protein (cysteine source).
Very well tolerated. May cause mild GI symptoms initially. No significant AED interactions.
8:00 AM
Morning (with food)
- · VitaThrive D3 + K2 (with fat)
- · Folate (Methylfolate)
- · B12 (Methylcobalamin)
- · B6 (Pyridoxine)
- · L-Carnitine (1,000mg)
- · Calcium (500mg)
12:00 PM
Midday (≥2hrs from AEDs)
- · ISO100 Whey Protein (pre/post PT)
- · Creaganic Creatine (with meal)
- · Omega-3 DHA (with fat)
- · Lactoferrin (between meals)
8:00 PM
Evening (with food)
- · L-Carnitine (1,000mg)
- · NOW Magnesium Glycinate (≥2hrs from AEDs)
- · Omega-3 DHA
- · NAC (600mg)
- · Calcium (500mg)
- · Lactoferrin (between meals)
10:00 PM
Bedtime
- · NOW Mg Glycinate (if not evening)
- · Melatonin PR (optional)
- · CoQ10 Ubiquinol