PCT: A Clinician's View Part III - Post Cycle Supplements In Practice

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PROSTATE HEALTH

As a male, you are likely to be bombarded by information pertaining to clinical syndromes surrounding the prostate. It is imperative that you seek the help of an examining physician to make a definitive diagnosis and steer clear of not trying to self-dianose. The following three items have shown some positive report in the literature surrounding PREVENTATIVE measures and thus are considered here.

Saw Palmetto (Serenoa rapens)

EVIDENCE-BASED EFFICACY: Numerous double-blinds have shown an extract of the berries from this Florida-native palm tree to be efficacious in the realm of treating benign prostatic hyperplasia (BPH), a significant concern when introducing exogenous androgens into the male human body. Newer data suggests that this may be an even larger concern in the post-cycle realm considering the increasing support for both estrogen and DHT as two sources of the seven accepted contributing mechanisms of action to date. While it usually takes a reported average of 4-7 weeks to see results, planning accordingly would imply the need for this supplement in a pre-cycle preventative mode.

FORMS & DOSAGES: Crude form available in bulk as dried berries and in tea bags. Also available are tinctures, fluid extracts, fat-soluble extract in a soft gel cap, hard gel cap, and tablets. Dosage will depend on standardization (see later).

POTENTIAL SIDE EFFECTS / INTERACTIONS: The caveat here is that there is a case-report of saw-palmetto induced hepatitis (presented to the American College of Physicians in 2005 by one of my colleagues, however, this has NOT been reproduced nor published in a peer-reviewed journal to date as far as I am aware though the presenter of the aforementioned case is preparing a subsequent article.). Nonetheless, it stands to reason that this area would need to be further explored before making definitive recommendations especially when considering recovery from a C17 alkylated product. Aside from this, rather detailed toxicology studies in rodents and clinical trials in humans have shown a tremendous track record in the way of safety and current use of the product alongside a basic LFT studies would offer good indication of what may necessitate further exploration from a clinical standpoint.

Dinoiii’s tip(s):
(1) It is imperative to keep in mind that an overwhelming majority of studies used fat-soluble saw palmetto extracts standardized to 85-95% fatty acids and sterols so replication may require the use of such standardized forms in your own practice. The aforementioned individual with the saw-palmetto-induced hepatitis could NOT report if there was standardization to the formula he used. The results remain suspect.
(2) Prostate-Specific Antigen (PSA) serum studies remain a poor deliniating factor between BPH and Prostate cancer. However, elevated levels usually imply some form of increased tissue (see Part II for specifics). Saw Palmetto remains unable to modify PSA serum values that would correspond to symptomatic improvement, which may imply yet another to-be-determined mechanism of action to add to the seven current.

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Pygeum (Pygeum africanum)

EVIDENCE-BASED EFFICACY: 36 clinical studies, 14 of which, double-blind have shown efficacy [author’s note: this efficacy has unfortunately been limited by the number of objective measures – urine flow rate (ml/sec), residual urine content, and prostate size - used in many, yet not all, of them] with regards to improvement of many of the symptoms surrounding BPH (nocturia: nighttime urinary frequency, difficulty in starting urination, and incomplete bladder emptying).

An area that may be worth exploring is something not replicated in the saw palmetto groups. That being the additional benefits seen with improvements in erectile dysfunction, an obvious concern for some people in the post-cycle realm considering hormonal flux. A question to ask is whether or not this is attributed to a vascular mechanism or hormonal? Additionally, there is minor evidence to suggest some potential benefit in the realm of male infertility. This last one is likely ONLY to be effective in cases where prostatic secretion and its contribution to the total ejaculate is significantly reduced.

FORMS & DOSAGES: Clinical studies have been done on Prunuselect, a fat-soluble extract standardized to contain 14% triterpenes. Its availability is either in as a stand-alone in soft gel form or as a soft gel or capsule in various multi-ingredient products on the market. A few liquid multi-ingredient formulas have started popping up on the market as of late.

POTENTIAL SIDE EFFECTS / INTERACTIONS: Most common side effect remains GI upset (nausea, vomiting, abdominal pain, diarrhea, constipation).

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ERECTILE DYSFUNCTION ALLEVIATION

Yohimbe (Pausinystalia johimbe)

Only one additional comment need be made at this time as I delved into thorough discussion of this compound in the last part of this article series.

POTENTIAL SIDE EFFECTS / INTERACTIONS: Yohimbine can cause many side effects, including anxiety, tremors, insomnia, a rise in blood pressure, palpitations, nausea and vomiting, and hallucinations. Taken in high doses, it can cause a SEVERE drop in blood pressure (recall: AUTOREGULATION posts I have spoken at length about), weakness, and paralysis. Some states have banned the nonprescription sales of yohimbine (even as a yohimbe extract), and the FDA has ruled it unsafe as an over-the-counter product in the past.

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ANTIHYPERTENSIVES

Unless you have a firm grip on how PS/PH/AAS have affected your blood pressure (BP), the following supplements are potentially better left alone until you establish a true baseline set of values (systolic and diastolic).

Hawthorn Berry

EVIDENCE-BASED EFFICACY: Considerable research, both in animal and human studies, supports the claims about hawthorn’s heart benefits. For example, double-blind studies of hawthorn versus placebo have shown improvements in people with heart failure, demonstrating better heart function, less shortness of breath, and fewer palpitations. In a study of thirty patients with congestive heart failure, half were given a placebo and the other half given twice daily capsules of hawthorn extract standardized to contain 15 mg procyanidin oligomers per 80 mg capsule. After 8 weeks, the hawthorn group had statistically significant improvements in heart function and lower blood pressure, with no adverse reactions observed. In a study of 78 patients with the same level of heart failure, those given 600 mg of standardized hawthorn extract were able to exercise much longer than those who received the placebo [now, before every supplement manufacturer gets excited and says boy, we got to market that – the same results have NOT been duplicated in non-heart failure patients]. Based on numerous studies, German health authorities have approved of hawthorn for treating mild heart failure, stable angina, and the slow heart rhythms known as bradycardia.

Less evidence, in animals only, is available to support hawthorn’s potential benefits in lowering cholesterol, triglyceride, and blood sugar levels. Similarly, no human research supports its use in treating insomnia, although it is known that high doses can markedly slow down the nervous system.

FORMS & DOSAGES: Hawthorn is available in many forms, including dried leaves, berries, and flowers, and in elixirs, extracts, infusions, capsules, and tinctures. Usually taken 2 or 3 times a day, the dosage depends on the type of preparation and source material. An infusion dose can be made with a teaspoon of chopped leaves and flowers. Tinctures may be recommended at 4 to 5 ml per dose. Flower extracts, standardized to contain 1.5 percent vitexin-4’-rhamnoside, may be prescribed at 100-250 mg per dose. It may take UP TO 3 MONTHS to note improvement; hawthorn may be taken indefinitely to treat chronic heart failure and other disorders.

POTENTIAL SIDE EFFECTS / INTERACTIONS: Toxic problems with hawthorn are NOT commonly seen and usually only have shown the potential of appearing when overdosed. In such cases, dangerously low blood pressure and sedation may occur. However, because of its potent effects, it should be used with care and only under the supervision of physicians experienced in its impact (unfortunately this is very few). In particular, its use with other heart medication is a serious problem. We’ll use beta-blockers as an example. Because beta-blockers lower blood pressure by reducing cardiac output, simultaneous use of hawthorn may produce a mild RISE in blood pressure (remember, how much I have spoken at length about autoregulatory effects). In contrast, hawthorn can markedly INCREASE the effects of digitalis and other herbs containing cardiac glycosides to enhance their effects. When used with prescription heart drugs, the dosage of the LATTER can be lowered. It should be noted that hawthorn will NOT stop an angina attack.

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Celery

Its diuretic action of the active ingredient (3-n-butyl phthalide) may be left for late PCT time if you are opting to use concurrent cell volumizers.

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CoQ10

EVIDENCE-BASED EFFICACY: Several well-regarded studies indicate that adding CoQ10 supplements to the conventional regimen for treating cardiomyopathy and congestive heart failure show MORE improvement than with medications alone. In a study involving more than 2,500 heart patients in Italy, 80% experienced reduced symptoms (shortness of breath, swelling of the legs and feet, difficulty sleeping) after 3 months of taking CoQ10. It is also a standard treatment of congestive heart failure in Japan. However, the American Heart Association and the American College of Cardiology do NOT advocate CoQ10 as a treatment for heart disease. In any event, CoQ10 should NOT be taken as a substitute for prescribed medication to treat heart failure or any other cardiovascular disease, and if you do take it as part of an overall treatment program, be sure to tell your doctor that you are taking it.

Several studies are underway to investigate whether Co Q10 may help slow the progression of degenerative nerve diseases, such as Parkinson’s and Alzheimer’s, as well as fibromyalgia. Though claims abound concerning CoQ10’s ability to slow aging, reduce fatigue, and improve the quality of life for AIDS patients, promote healing of periodontal disease, and even aid weight loss, more study is needed to document whether it really works in these instances.

FORMS & DOSAGES: CoQ10 typically comes in tablet or pill form, but is also available as a liquid or softgel capsule. It’s even found in some skin creams. Doses thought to be effect for heart disease range from about 100 to 360 mg / day. One small study found that people with cardiomyopathy who took 100 mg or CoQ10 per day, in addition to regular therapy, showed significant improvement compared to those who received a placebo. In another study, a significant number of patients given CoQ10 were able to reduce the number of heart medications they were taking.

POTENTIAL SIDE EFFECTS / INTERACTIONS: There are NO reports of side effects from CoQ10 supplements.

Dinoiii’s Tip(s):
(1) Take your CoQ10 supp with a MINIMUM of a teaspoon of oil mixed in a protein shake. This should aid + increase its absorption potential.
(2) If taking either a beta-blocker or statin drug OR red yeast rice supplement, there is a potential of dramatic decreases in CoQ10 levels in the body. People who take either of these medications (while NOT advised to be on PH/PS/AAS in the first place) should consult with a health care provider to see if CoQ10 supplementation is advisable.

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Garlic

EVIDENCE-BASED EFFICACY: Researchers have been studying the effects of garlic on the body for years, and hundreds of studies have been published suggested how garlic works and trying to pinpoint the specific properties of the herb that are responsible for its metabolic and disease-fighting effects. Many positive results have been found in animal studies, but the findings have NOT been duplicated in controlled clinical studies in humans. For example, garlic has been fed to hypertensive rats and dogs, with statistically significant reductions in blood pressure. Other animal studies suggest that garlic’s sulfur-containing compounds inhibit the stiffening of the aorta in an aging population. But human studies have NOT been so conclusive. Although many researchers believe that garlic has definite health benefits, is NOT known how much must be consumed to be effective. Nonetheless, population studies in Italy and Spain, where large amounts of garlic are consumed, have found that atherosclerosis is uncommon, despite a high-fat diet, although its becoming more common in large cities even there.

Compounds in garlic have been shown to have anti-clotting properties when mixed with blood platelets in a test tube. In one laboratory study, ajoene prevented the formation of blood clots in dogs undergoing open-heart surgery. Other studies have found that ajoenes and dithiins may possess anti-tumor and anti-fungal activities, and thus may help prevent cancer and various yeast infections.

Researchers are also investigating the antioxidant properties of compounds in garlic, which may also help prevent cancer. Sixteen separate animal studies suggest that garlic inhibits the development of tumors, even in those exposed to carcinogenic materials such as carbon tetrachloride, isoproterenol, and heavy metal poisoning. But other studies found that, in rats, garlic does NOT inhibit tumor growth once cancer has developed.

FORMS & DOSAGES: Garlic is available in many forms – fresh bulbs that can be bought in any produce market as well as pills and extracts. Many experts believe that the most benefits are obtained from the whole garlic, preferably raw or very lightly cooked. When pills are taken, the recommended daily dosage is 300 mg of powder per day, the equivalent of the allicin in one or two whole cloves.

POTENTIAL SIDE EFFECTS / INTERACTIONS: Garlic is notorious for causing an unpleasant breath and body odor. This problem can be lessened by taking deodorized garlic pills, but even in pill form, large dosages of 900-1,200 mg a day can cause a garlicky body odor. Some people also experience an upset stomach, heartburn, and other intestinal problems, even when they only eat a small amount of garlic. Because of its anti-clotting properties, high doses of garlic should NOT be used by anyone taking blood-thinning medications OR who have bleeding problems.

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Taurine

EVIDENCE-BASED EFFICACY: This amino acid is involved in the regulation of heartbeat, maintenance of cell membrane stability, and prevention of brain cell overactivity. It has been shown in small double blinds to be effective in heart failure prevention, lowering blood pressure, and seizure reduction in people with poorly-controlled epilepsy. Larger studies would be appreciated to better assess the therapeutic value here.

FORMS & DOSAGES: Every version short of an ethyl ester – oh, wait a minute – as we speak it is likely on the way. Author's Note: Sure enough, it came since this had originally been written! 2g taken up to 3 times a day is what is shown in the aforementioned studies to be efficacious dosing.

POTENTIAL SIDE EFFECTS / INTERACTIONS: None known.

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CHOLESTEROL/DYSLIPIDEMIA-MODIFYING AGENTS

Wow! This particular category needs addressing. While there are some negative cholesterol modifications (i.e. – decrease HDL, etc...) while during cycle, post-cycle, when an inherent ABSOLUTE NEED for steroidogenic substrate predominates, the use of cholesterol-modifying agents should be used with ABSOLUTE DISCRETION. Couple this with my Cholesterol Controversy series and the lipid outcomes may simply require monitoring them through serum studies. Our driving back substrate is the rationale for these modifiers.

[Author’s note: in the case of familial dyslipidemia syndromes, the use of such agents is better-warranted at the discretion of your primary health care giver / endocrinologist]

PRIMARY GOAL: LOW HDL CORRECTION

Niacin (Vitamin B3) + My Anti-Flush Protocol

EVIDENCE-BASED EFFICACY:

FORMS & DOSAGES: Niacin (nicotinic acid or nicotinate), inositol hexaniacinate, niacinamide. Niacin and inositol hexaniacinate are useful in blood cholesterol modification, while niacinamide has shown some positives in arthritis literature and a few very old studies with improvements in early-onset type 1 diabetes.

Niacin is available as pure crystalline niacin and in sustained- or timed-release preparations. Because of the risk of liver toxicity (namely following the use of C17 alkylated PH/PS/AAS), sustained release niacin should not be used in the post-cycle time frame (sometimes a time-released version is snuck into multi-vitamin formulas – be very careful). Inositol hexaniacinate yields slightly better results orally than standard niacin but is much better tolerated in terms of flushing and, more important, long-term side effects.

POTENTIAL SIDE EFFECTS / INTERACTIONS: Because niacin can cause liver damage, periodic checking of LFTs is still recommended every 3-4 months of therapy to assess damage. Telling your physician that you are taking niacin is a good way to have him monitor alongside you changes as they should occur.

Dinoiii’s tip(s):
(1) Remember here again, LFT’s – despite their connotation are NOT liver-specific. You must also make your doctor aware of your weight lifting lifestyle as a concurrent CPK should be drawn. Muscle breakdown, which is not abnormal for you may cause slight elevation of these levels.
(2) What’s an anti-flush protocol? Standard Niacin 50mg or less + Inositol hexaniacinate 500mg – should fend off the harmless yet


PRIMARY GOAL: HIGH LDL REDUCTION

Red Yeast Rice

EVIDENCE-BASED EFFICACY: ONLY two of the more than two dozen clinical studies using red yeast rice were done in the United States; the rest have been done in China. Taken as a whole, the studies have found that red yeast rice can lower cholesterol by 16 to 26 percent as well as lower triglyceride levels and raise beneficial HDL cholesterol. A recent study found that red yeast rice lowered blood cholesterol an average of 40 points over a twelve-week period compared to just 5 points in people who only made dietary changes. Benefits are greatest in people with total cholesterol levels above 200, the cutoff point of desirable cholesterol set by the American Heart Association.

FORMS & DOSAGES: The standard dose is two 600 mg capsules twice a day. It is sold in capsule form at pharmacies and health food stores, and it costs ONLY a fraction of what prescription statin drugs cost. Red Yeast Rice is recommended for people with borderline-high cholesterol levels (200 – 240) and NO other risk factors for heart disease. A low-fat diet is also recommended while taking the supplement. To avoid stomach upset, it should be taken with fluid or fluids.

POTENTIAL SIDE EFFECTS / INTERACTIONS: Minor side effects reported include heartburn, bloating, and dizziness. Because of its similarity to statin drugs, which should NOT be taken with niacin, erythromycin, cyclosporin, fibrates or other statin drugs, the same cautions should be applied to red yeast rice. Red yeast rice could cause some of the same side effects as statin drugs, including elevated liver enzymes (which is what you are trying to return to normal in the post cycle period), damage to skeletal muscle, and a possible increased risk of cancer! Individuals with severe liver or kidney damage need avoid this compound like the plague. NO ONE UNDER THE AGE OF 21 SHOULD TAKE RED YEAST RICE.

Dinoiii’s tip(s):
(1) Cholestin is the ONLY red yeast rice product that is standardized and that has been shown to be effective in clinical trials.

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Guggulipid

EVIDENCE-BASED EFFICACY: This guggul derivative gained approval as a lipid-lowering drug in India in 1986, although as stated in Part II, the herbal use dates back numerous centuries. Numerous studies in animals AND humans over the past 40 years, conducted by researchers in India and elsewhere, have demonstrated the ability of guggul to lower cholesterol and triglycerides. Research was prompted by exploration of the association between obesity and atherosclerosis in ancient Ayurvedic texts. This led to animal studies showing that it lowered both weight and cholesterol levels in rabbits (I know, I know what you’re thinking – you don’t have the same size ears nor a button tail...of course – but bear with me – this was landmark at the time). Further studies showed similar results in humans.

In one study involving 50 patients with coronary artery disease, those who took 10-15 grams of guggul daily for three months showed an average 25 percent drop in total cholesterol and a 30 percent reduction in triglyceride levels. In another study, 22 patients with high blood cholesterol and other lipids were given 1,500 mg of guggulipid daily. Cholesterol levels began to drop within 2 weeks and were significantly reduced in 59 percent of the patients at the end of six weeks. Among responders, serum cholesterol and triglyceride levels and triglyceride levels were lowered 24.5 and 27.3 percent respectively. One could question if the “non-responders” would have seen better results in either a longer-term study or increased dose – if a shorter span were to be effective due to volume of distribution data potentially challenging efficacy. One of these questions was answered. In a multicenter trial involving 205 patients, 1,500mg of guggulipid daily for 3 months (obviously, longer than the 6 weeks used in the previous report) resulted in a 23.6 percent lowering of total cholesterol and a 22.6 percent decline in serum triglycerides in 70 percent of patients treated. In yet another study, the effects of guggulipid on cholesterol and triglyceride levels were found to be similar to those of clofibrate, a popular cholesterol-lowering drug.

Preliminary studies also support guggul’s antioxidant properties and ability to inhibit blood clots, although more research is needed to get me to buy into how accurate these latter effects are. Similarly, although the oldest uses of guggul as an anti-inflammatory agent for such conditions as arthritis, less research has been done in this area as scientists have been focused on its potential cardiac benefits. Thus, only a few animal studies have been done in demonstrating its anti-inflammatory value and it is NOT known whether this will translate into clinical benefits in humans.

FORMS & DOSAGES: Although guggul is available in its crude resin form, clinical studies have involved capsules and tablets that are purified to remove the insoluble components and standardized for guggulipid or guggulsterone concentration. Indeed the guggulipid dosage is usually based on guggulsterone concentration. Most commonly prescribed in clinical trials has been 25 mg of guggulsterones (or 500 mg of product standardized for 5% guggulsterone content), to be taken THREE TIMES DAILY. A comparable dose of the crude gum guggul powder would be 4 to 16 g per day divided into 3 doses.

POTENTIAL SIDE EFFECTS / INTERACTIONS: The only side effects associated with guggul are TRANSIENT and MINOR gastrointestinal problems such as nausea and diarrhea and, less commonly, restlessness, headache, and hiccups. Such problems are less likely when purified guggulipids are given, rather than the crude resin – which is consistent with MOST supplements today. Use in someone who is already taken other medications/supplements MUST be fully evaluated – especially with antihypertensives. Why am I saying this? In one study, for example, guggul reduced peak plasma concentration of propoanaolol and diltiazem – drugs used commonly to treat high blood pressure and heart disease.

There has been discussion as of late regarding guggulsterones cytotoxic nature as well as interaction of with the androgen receptor. First, the cytotoxicity is very specific and actually a good thing. This specificity is through myeloid precursor cells via inhibition of proliferation of HL60 and U937. From the research group in question: “These growth inhibitory effects correlated with externalization of phosphatidylserine and loss of mitochondrial membrane potential, suggesting that these isomeric steroids induce apoptosis in leukemia cells.” This study was the first of its kind to show anti-leukemic effects offering us hope at another chemotherapeutic agent. If you haven’t guessed this is a positive finding.

On to talk of the androgen-receptor binding. First of all, it should be noted that the studies here are funded by a particular competitive drug company (in various drug categories that span many of the aforementioned positives of guggul we have talked about here) and are somewhat tainted in that regard. Additionally, the binding pretty much spans many nuclear receptors and has been demonstrated solely in vitro. It is uncertain whether any outward physical signs are to ever be reported as with MANY years of supported use and positive effect, and clearly further study is needed but hopefully that of the independent variety.

For now, no hypogonadal signs clinically, a definitively higher binding capacity to other receptors – namely mineralocorticoid, and the plethora of good effects already stated topped off by anti-leukemia action leaves this a very strong supplement to consider. Its purported estrogen agonistic effect may be a bit frightening to many in the immediate post-cycle realm, but all ER’s are not identical (just as estrogens) and its affinity for the sub-alpha receptor is NOT seen with the sub-beta. For various reasons, progesterone stimulation (another purported action) kept at a minimum during PCT could offer benefits in an entirely different regard.

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ANTI-CATABOLICS

7-oxo DHEA (3-acetoxyandrostat-5-ene-7,17-dione) / 7-ketoDHEA

DHEA finds conversion into some 150 metabolites (that we are currently aware of), each with unique actions within the body. One of the reasons my aforementioned comments about the mother-compound DHEA on how I think it is a prohormone that should in fact be banned are worrisome is due to the likely subsequent banning of potentially-useful metabolites. In the early get-go, 7-oxo, TM’d as 7-keto products seem to hold the most promise supported by the literature. I like its seemingly absent conversion to estrogen or testosterone and its anti-catabolic properties (which are purported to control and/or reduce body fat.

The rationale supplied for use of this compound in the post-cycle era, however, through cortisol suppression, I have never understood effectively as stated in Part II and in various posts. Exogenous androgen introduction tends to universally suppress the adrenal gland via feedback inhibition of ACTH. Recall that ACTH subsequently imparts action on production of various adrenal hormones, in this case cortisol being one. For how this effect is seen here, I offer the following “simplified” model:

Step 1: “On” cycle = exogenous androgen introduction, not only leading to subsequent endogenous shutdown of the Leydig cell production of testosterone through feedback inhibition of the pituitary’s production of LH, but also a negative feedback that mimics adrenal cortical (zona reticularis) overproduction of androgenic outflow offering negative feedback tie-in to ACTH pathways.

Step 2: “Off” cycle (PCT) = cessation of exogenous androgen introduction in a still suppressed ACTH (albeit partial) environment (hypOadrenalism) and subsequent low-level cortisol production, amongst other adrenal byproducts.

Step 3: ACTH regeneration BEFORE LH regeneration (due to partial vs. complete negative feedback mechanisms). The question we set out to answer was when this becomes clinically significant. The answer appears to be more complex than the time I would like to offer here, however, I will summarize a few key points:

(1) Half-life of the exogenous compound seems to play a role on ACTH regeneration (which may seem “common sensical”, but how many automatically have assumed immediate catabolism?).
(2) Many factors (dietary as well as other) seem to impart a role on anti-catabolic nature of post-cycle time frame (again, perhaps another “common-sensical” point, but how often is it seen that people go from a hypERcaloric state while “on” cycle into a state of immediate hypOcalorism?).
(3) Another in-house study has given us some answers into regeneration-time frames. Oveall, the 3-week mark post-cycle appears preliminarily to be a time of universal cortisol up-regulation. The first two weeks are assumed to remain in suppression almost independent of the type of agent used. Use of substances such as 7-oxo / 7-keto compounds seems better left out of post-cycle planning for that immediate 2-week time frame.

[author’s note: complete in-house study results will too appear in upcoming book release!]

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Conclusion

As we come to the conclusion of this part of the PCT: ACV series, you may be caught up in the science or you may be dazed by what you are going to do with all that extra NAC you made sure you stocked up on. Below I have summarized my thoughts on the various supplements presented here. Again, this is an incomplete list of supplements but some of the more common used. If there are additional questions regarding any particular agent, add comments below.

Summary of “PCT: ACV-approved” supplements:

Anti-Estrogenics
1. Aromatase Inhibitors (AT/ATD): - -
2. Estrogen Channeling Agents (I3C): ++++

Pro-Testosterone
1. DHEA: -
2. Tribulus Terrestris: ++
3. Stinging Nettle: +++
4. Magnesium: ++
5. Zinc: ++

Antioxidants
1. ALA: ++++
2. L-carnitine: ++++
3. ALCAR: +++
4. PLC: +++
5. ACES: +++

Hepatoprotectants
1. NAC: -
2. SAMe: +++++
3. Silymarin: +++

Prostate Health
1. Saw Palmetto: +++
2. Pygeum: +
3. Boron: +++

Erectile Dysfunction
1. Yohimbine HCl: -

Antihypertensives
1. Hawthorn Berry: +++, - (w/ cP450 3A4 inhibitors)
2. Celery: - (immediate post-cycle or w/ cell-volumizers)
3. CoQ10: +++++
4. Garlic: ++
5. Taurine: ++

Cholesterol / Dyslipidemia – Modifiers
1. Niacin / Inositol Hexaniacinate Anti-Flush Protocol: +++
2. Red Yeast Rice: -
3. Guggulipid: ++
4. Policosonol: ++

Anticatabolics
1. 7-oxo / 7-keto: - (immediate post-cycle), + (roughly 3-weeks post-cycle)

Others - not discussed
1. Corosolic Acid: +++
2. Fenugreek: +
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Key:

- = evidence-based efficacy lagging, innumerable potential for side effect or interactions, alternatively inappropriate for the post-cycle time frame

+ = some in vitro / hypothetical evidence to support its rationale, further research needed for general use as well as PCT use

++ = quality in vitro / some in vivo, post-cycle rationale requires further research

+++
or
higher = good in vivo studies + at least one double-blind regarding scenarios that mimic PCT considerations, the more stars above this point is due to the more quality research support
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Outside of taurine, many aminos (BCAAs, EAAs) and EFAs, CLA, Sesamin as well as glucose in the post-cycle realm are talked about at length in part VI of the series to follow. For now, it’s time to turn our attention to the world of pharmaceutics. The discussion that follows is NOT for the weak at heart – as stated earlier: the usual suspects (nolvadex, clomid, hCG, arimidex, etc...) will all be covered at length. Stay tuned.

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