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The Protocol itself is a living document developed and updated by members of the ALSTDI forum (principally Dave Johnson) at a dedicated thread on that forum. Anyone interested in the up-to-date protocol should sign up on the said forum and get their information straight from the horse's mouth.

This page is meant as my personal tool for acquiring, collecting and organizing information concerning the different substances mentioned in the Proletariat Protocol discussions. I will start at the list as it was on on May 5 and most probably diverge from that in the coming weeks and months. In short, this page is meant to be a collection of the substances, not a presentation of the entire protocol. The actual Protocol document contains a lot of other information than just the list of supplements (such as lifestyle dos and dont's etc.) that I strongly encourage people to go and see for themselves. 

As things progress, I intend to give each substance its own short article to help developing the information in a more efficient manner.


All that follows is from Dave Johnson's keyboard and I claim no credit in any of it. This is just the starting reference for my own research on any of the substances mentioned.


* * * * * THE PILE OF PILLS * * * * * * * * *

1. Dextromethorphan (DM). Over-the-counter cough suppressant, usually in the form of cough syrup. There are several kinds. Read the label carefully (get the pharmacist to help you if necessary). Get something that has only DM as the active ingredient, no antihistamines or decongestants or expectorants. Then take the stuff at twice the label recommended dosage for two days. There's a good chance it will help with bulbar and/or upper motor neuron symptoms. (You know what those are, right? If not, you need to revisit ALS 101.) Probably won't help with lower motor neuron symptoms. ...If you see improvements in symptoms, keep it up, but cut dosing back to the label recommendation. If at any time you notice mental side effects, reduce dosage or stop entirely. .....Long term use of DM probably reduces the rate of disease progression when combined with other cocktail ingredients: the mere fact of being a Ca++ channel inhibitor suggests this, see also . WARNING: if you are taking any prescription antidepressants, before taking DM you need to read up on Serotonin Syndrome inasmuch as combining DM with prescription antidepressants can lead to that syndrome: other potentially problematic substances include diphenhydramine (Benadryl) and grapefruit juice. If you experience any symptoms of serotonin syndrome, stop the DM and tell your medical doctor what happened. If the DM seemed to help with ALS symptoms, you might want to tinker with dosing or switching to a different antidepressant. Also, some of the other things you'll likely be taking (for example vitamin D, 5-HTP, and magnesium) have antidepressant action and may allow reduction in dosage of the prescription antidepressant. 

2. Zinc 50 mg/day as chelate(for example picolinate). Do NOT supplement with copper. There is a lot of information in this forum about zinc. You probably won't feel any immediate effects, just do it on faith. Available almost anywhere that nutritional supplements are sold. UPDATE 23 Feb 2013: gluconate is the form preferred in treating Wilson's disease, and there's a pharmaceutical grade nutritional supplement form available that's designed for and marketed to Wilson's patients.

3. Magnolia extract, for bulbar and UMN symptoms. In Chinese traditional medicine (and in my personal experience and that of others), especially effective in treating problems related to swallowing. Magnolia is rather new to ALS but it's gotten good reviews. The best dosage seems to be about 100 mg of the standardized concentrate, but that disappeared from the market late 2013 and now it's either 30 mg or 200 mg. I regard 200 mg as too high a dosage, and I expect that problems with that dosage unit will drive it out of the market. My source for 30 mg is .......Give Magnolia extract a 2-day test drive. If no improvement in symptoms, stop. If improvement, continue, but be aware that there are theoretical reasons be concerned that tolerance may develop. My personal opinion is that this concern is unfounded but this is new territory and the verdict isn't in yet. ......Honokiol is a PPAR agonist, suggesting it may be of value to treat neurodegenerative processes, not just symptoms.

4. 5-HTP (anecdotal report of benefit, information scattered, use search tool)
5-HTP may help with lower motor neuron symptoms such as cramps and muscle spasms. It may also help slow down neurodegeneration. Before taking 5-HTP, read and understand the precautions. 5-HTP raises serotonin levels (that's its purpose) but so do many other drugs (esp. many prescription antidepressants). Too much serotonin leads to serotonin syndrome. If you are at risk for serotonin syndrome, learn the symptoms in detail and watch out for them. 

5. Vitamin D3. Most PALS are shut-ins and without exposure to sunlight, they're deficient in this very important anti-inflammatory and calcium regulator. 5,000 IU/day. Best to also take Vitamin K2, which is a co-factor with D3. 

6. Magnesium taurate. Glutamate antagonist and GABA agonist. Magnesium deficiency is widespread in the modern diet. Only manufacturer of mag taurate I know of is Cardiovascular Research Ltd., but it's widely available. If you can't get it, then do magnesium citrate or orotate(NOT oxide)and taurine separately, those are even more widely available. .......Magnesium is a traditional remedy for muscle cramps. ......At magnesium dosages above about 200 mg per day, you may experience noticeable improvement in some ALS symptoms. Also be aware of the potential for "intestinal relaxation": with magnesium "more" isn't always "better". Most people can tolerate up to about 400 mg/day of magnesium without any difficulty. .......Since many people are magnesium-deficient anyhow, and since magnesium has so many health benefits, taking magnesium supplements makes good sense. 

7. Curcumin (turmeric extract)-- an anti-inflammatory that crosses the BBB and which is also a heat shock protein inducer. Don't expect immediate noticeable effects. However among old-timers who are doing cocktail therapies, curcumin is almost always on their list. ....Curcumin is variously marketed as "turmeric", "turmeric extract", "curcumin", and "curcuminoids". Bioavailability is poor, which has led to the development of formulas which supposedly enhance absorption. LEF Super Bio-Curcumin is an example of such a product which is widely available. NOTE: if you're concerned about the piperine in Super Bio-Curcumin, they've recently taken that out and replaced it with tumerones. And there's the phospholipid complex formulation Meriva:

8. Glutathione support: NAC, selenium chelate, and milk thistle extract. N-acetyl-cysteine, 1.2 grams per day. Selenium, 100 micrograms/day (see post on page 3 of this thread for discussion). Milk thistle extract: commercial product is typically standardized to about 80% silymarin, 500 to 800 milligrams per day of extract is about right on dosage. 

9. Mitochondrial support: acetyl-L-carnitine (800 to 1200 mg/day) plus alpha lipoic acid (500 to 1,000 mg/day).
NOTE: recently R-lipoic acid has become commercial available, with appropriate dosing about 1/3 to 1/2 of the regular (racemic) alpha lipoic acid. 

10. Water-pack sardines, several ounces a day. Yep, them little fishies. They're high in CoQ-10 (an important antioxidant), Omega-3's (anti-inflammatories), purines (raise uric acid levels), protein, and minerals. Darn near a miracle health food-- IF you don't have gout. ......If you have gout, you already know to avoid sardines, you can get CoQ10 and Omega-3's in pill form almost anywhere that nutritional supplements are sold. Omega-3's are also widely available as hemp, flax, and fish oil. If you don't know if you have the metabolic disorder called "gout", before you start loading up on sardines, get your uric acid levels checked and then discuss the results with your doctor. 

10A. Suppose you can't do the sardines? In my opinion, when it comes to CoQ10, 100 mg/day of an advanced form (for example ubiquinol in oil) is probably enough, I haven't seen evidence that piling it on is better. My preferred brands are Dr. Mercola Ubiquinol 100 mg, and LEF Super Ubiquinol CoQ10 100 mg. When it comes to the Omega-3's, there are many ways to do that, from canned salmon (which is not high in purines like sardines are) to fish oil pills to flax oil to hemp oil and others. My personal preference is cold-pressed organic hemp oil inasmuch as it has a pleasant taste that goes well with almost anything. Hempseed is good stuff too, doesn't have that paint taste that flax has. Chia is another alternative, but tends to become a gooey mess. 

11. Citicoline (also called CDP choline), 400 to 1,000 mg/day. Try it for a couple days to see if you get a noticeable improvement in energy and reduction in "brain fog". Unclear if it has any effect on disease progression.

12. Vitamin E complex (natural mixed tocopherols and tocotrienols). These can be purchased separately, but my personal preference is "TOCO-SORB", Jarrow #112026, which has everything in one softgel that's small enough to actually swallow. LEF has recently introduced Gamma E Tocopherol/Tocotreinols #00559 which as far as I can tell is the same thing. 

13. B-complex. There are lots of choices and I don't have strong opinions about them.
B6 (pyridoxine) important, but not more than 50 mg/day: My presently preferred formulation is Solaray B-Complex 100, which however contains 100 milligrams of B-6: I don't take the pill on days that I eat foods high in B-vitamins. Be warned also that quite a few nutritional supplements you wouldn't expect B-6 in contain B-6: read the fine print on the label. ...There's a whole slew of B-vitamins with different possible impacts on ALS, and it's going to take years to figure out what sort of combination is optimum. Some people are really big on B-12. ....12 April 2014 I started a new thread on B-vitamins:

B-1 (Thiamine) deserves special attention (see ). Here's a summary I posted about page 5 in that thread: 

Most of the posting relating to thiamine is over my head, but I do skim through it anyhow hoping to absorb some information by osmosis. The encouraging PubMed is tempered by an anecdotal report of benfotiamine toxicity.

Here's my tentative summary of what I think I've seen so far.

1. Thiamine deficiency is very common in ALS, probably because of genetic abnormalities and/or disease processes rather than inadequate dietary intake with food. 

2. Therefore supplementation is advisable at a level many times the RDA (1.6 mg). So-called "B-100" formulations usually contain 100 milligrams, or nearly 70 times the RDA.

3. Because benfotiamine is lipophilic (and perhaps for other reasons also), it has pharmacological actions of types believed to be beneficial in ALS, which go beyond what you get from regular thiamine. Therefore benfotiamine is the preferred form of thiamine supplementation. 

4. Ordinary B-complex vitamin "pills" always include thiamine but to my knowledge never include benfotiamine. Therefore benfotiamime supplementation has to be done separately. 

14. Trimethylglycine (TMG, Betaine). The addition of TMG to the list emphasizes lower motor neurons: see Persevering's "Fasciculations" thread for more details. TMG is also a methyl donor which (like methylcobalamin B-12 and methylfolate helps to suppress the inflammatory factor homocysteine. 

15. 3nB (celery seed extract) anti-inflammatory, gliosis inhibitor

16. ibuprofen anti-inflammatory, anti-gliosis, disinhibits neuron repair. see also apigenin.

17. Peony root
Peony is usually taken with non-DG licorice, which enhances its effects. Two anecdotal reports here of benefit, good underlying science. Usually thought of in terms of HSP up-regulation, peony is also a sodium channel inhibitor, which makes it a promising therapeutic for lower motor neuron disease particularly: see Persevering's "Fasciculations" thread. 

18. Resveratrol + nicotinamide NOTE: nicotinamide = niacinamide.
Solaray B-complex 100 contains 100 mg of niacinamide. For more detailed discussion regarding this combo, see the paragraph below on "Nicotinamide riboside + resveratrol". WARNING: if you're taking riluzole, be aware that resveratrol and several other natural substances may increase the toxicity of riluzole. I'd argue that if you're doing things that make sense, you shouldn't be taking riluzole anyhow. ......See also the thread wherein we discuss ideal dosing of resveratrol and come to a tentative conclusion that the customary high dosages found in most supplements nowadays are inappropriate, and that dosage should probably not exceed more than several tens of milligrams. Another link supporting the assertion that high doses are a bad idea: 

The following are under consideration for addition to the list. Of course nobody needs my permission to go ahead and decide on their own to take them! ....The ones I regard as most promising (based on what I think I know at the moment) are at the top of the list, less promising stuff on the bottom. 


Ethyl alcohol (the beverage kind) Glutamate antagonist, GABA agonist, synergistic with glycine. "Candy is dandy but liquor is quicker", you'll know real soon if it provides symptomatic relief for you, plus it's cheap and needs no Rx. Epidemiological study showed drinkers are only half as likely to develop ALS as non-drinkers: the benefit would presumably extend to reduced rate of progression among those who get ALS anyhow. ......WARNING: Too much booze can be bad for you, I hope everyone knows that. Plus, some people readily become addicted to the stuff, which probably results from upregulation of NMDA receptors which would be a bad thing in ALS. So-- I'm not recommending getting smashed every day; and, if you have a family history of alcohol addiction, alcohol may be bad medicine for you. As I sometimes say, "Some people should drink, and some people shouldn't." It's up to you to figure out which category you're in. .......If you drink on a daily basis, it's a good idea to quit cold turkey for a week every now and then. Some people will experience withdrawal symptoms and others won't. If you experience withdrawal symptoms, probably the best thing to do is to taper off the drinking over a period of several weeks in order to detox without landing in the hospital, and thereafter don't touch the stuff. (Yep, I know this is contrary to AA dogma.)........ Going on a ketogenic diet? Sorry, the liver metabolizes alcohol into glucose, that's gonna work against you. .......If you drink, quaff a few pints (not all at once!) to support ALS research, no I'm not kidding: Since this is all about the hops, some pretty good IPA's are likely to come out of that project.

Nicotinamide riboside plus resveratrol
see also
Looks fairly promising, see especially the -NR thread. The related Nicotinamide is also worth investigation. The related NADH is so far looking like something we do not want to take. Although resveratrol seems to be the most popular candidate as a co-factor for NR, other molecules such as fisetin and even telmisartan have been proposed. NOTE: both theory and anecdotal reports indicate that NR should not be taken without a suitable co-factor. 

Baicalin (Baical Skullcap extract) Complex interactions (apparently mostly favorable) in molecular pathways involved in ALS.

Idebenone Synthetic analogue of CoQ10 said to be much improved over the natural stuff. It'd be on "the list" except that its commercial availability has diminished probably due to harrassment by the FDA. 

Creatine (long history of use in ALS, probably slightly beneficial, but several grams a day are needed)

Forskolin (cAMP agonist, information scattered, use search tool to search cAMP as well as forskolin)

Methylcobalamin B12 (methylating agent etc., info scattered, use search tool)

Vinpocetine There was a flurry of interest in it here a year or two ago. Usually thought of as a nootropic, but its sodium channel modulation properties make it of special interest as a prospective LMN therapeutic. 

Magnesium L-threonate Supposedly gets magnesium past the BBB better than other mag supplements. 

Sex hormone boosters and modulators DHEA, Tribulus, chrysin, natural estrogen and progesterone creams, Pueraria. Note: there is evidence that beta sitosterols (present in saw palmetto, nettle root, and pygeum) displace cholesterol in the formation of nervous tissue and may thus contribute to neurodegeneration. 

Green tea extract (popular anti-aging agent, specificity for ALS unclear)

Pomegranite extract (popular anti-aging agent, specificity for ALS unclear)

Fisetin (new but popular anti-aging agent, specificity for ALS unclear)

"Brain food", I'd rather get mine by eating eggs than popping pills. Mackerel and herring are high in PS (and also in purines if that matters to you for better or for worse). Soy-derived PS lacks the effectiveness of animal source PS; for this reason I don't think much of soy lecithin as a supplement. 

Lion's Mane Mushroom

Berberine (most common herbal source of berberine)

Butyrates HDAC inhibitors
NOTE: although butyrate could theoretically be offered as a nutritional supplement, to my knowledge it's available only as Rx medications. 

Gardenia extract mitochondrial UCP2 agonist

Apigenin anti-inflammatory, anti-gliosis. See also ibuprofen.

Luteolin closely related to apigenin and more widely available as a supplement.

Vitamin B-1 thiamine, benfotiamine If this makes it into the Prole Prote Toplist, it'll probably be as benfotiamine.
Note: anecdotal report of benfotiamine toxicity, second post in the following thread: This was at high dosage, same patient chose to continue benfotiamine at a more moderate dosage. 
NOTE: Solaray B-complex 100 contains 100 mg of thiamine. 

Nutritional supplements, herbs, and OTC's rejected for Proletariat Protocol: 
NOTE: This category does not mean the item is "bad", it only means that it seemed worthy of consideration, I did consider it, and regarded it as unsuited for the Proletariat Protocol. 

inosine raises uric acid levels,disinhibits neuron repair esp. of axons. Probably worthwhile under careful medical supervision, but the risk of gouty arthritis and/or kidneystones mean it's not for newbies. Inosine has been discussed quite a bit here on the forum.

Cannabis and CBD For most patients, cost, quality of the product, and legal obtainability are problems. If the goddamn government would treat it like tobacco or alcohol, it'd be legal, affordable, and you could know what you were buying. US government has patented the use of cannabidiol to treat neurodegenerative diseases (which however wouldn't stop individuals), see The inventors seem to think that dosing on the order of half a gram a day would be appropriate, but this seems to be extrapolation from in vitro research and so may be highly inaccurate. In the absence of clinical data, actual anecdotal reports would have more relevancy. 

Ginseng Although popular, the evidence in its favor is decidedly mixed, and unwanted side effects are common. 

Ginkgo biloba Like aspirin, the stuff turns many people into "bleeders". (Like me for instance, this isn't just hypothetical.) Ginkgo might have value for someone who pays close attention to its anti-coagulation properties and makes sure they don't get into trouble with the stuff. 

Methylene Blue TDP-43 aggregation inhibitor and other interesting actions. Not sold as a nutritional supplement, but available with Rx as a dye used in biological research. Failed in both SOD-1 and TDP-43 fALS mouse models, but that doesn't end interest in the stuff. 


Research carefully both here and on the Internet, any Rx drug before taking it. The Proletariat Protocol is based on the assumption of no Rx drugs (since doctors usually won't cooperate). However, realistically speaking, most patients who are on a do-it-yourself protocol such as the Prole Prote will also taking one or more Rx drugs either with the cooperation of their medical doctor, or without it. The following list is not intended to be a comprehensive list of interesting Rx drugs, but may serve as a place to begin investigation. Those drugs which in my opinion show the most promise I have shown in boldface. BOILERPLATE: I am not endorsing anything on this list. The only drug on this list that I take specifically for ALS is Deprenyl (Jumex), but that doesn't mean anyone else should. I also take Telmisartan for hypertension and occasionally inhaled beta agonists and steroids for COPD.

Riluzole (I'll catch hell for even mentioning that stuff!)

Memantine NMDA receptor antagonist (Ca++ channel blocker), also 
exhibits activity at several other receptors of neurological interest.
Clinical trial failed (of course) since it was not cocktailed.

Prozac and other SSRI's (risky if used with other serotonin enhancers)

Tricyclics (risky if used with other serotonin enhancers) 

Prednisone and other corticosteroids

Dilantin (phenytoin) sodium channel inhibitor, long history of use
as an anti-epileptic drug.

Deprenyl (selegiline)and related drugs MAO-B inhibitor; may also 
inhibit apoptosis in neurons. Widely used to treat Parkinson's. probably superior to selegiline (rasagiline)

Losartan and related drugs

Albuterol and other selective beta agonists

Theophylline and theobromine
Theophylline used to be an OTC bronchodilator but was reclassified as an
Rx drug with the popularization of the safer inhaled beta agonist drugs.
Theophylline raises cAMP, inhibits TNF-alpha, is an adenosine receptor
antagonist, and histone deacetylase agonist. ......The closely related
theobromine and caffeine have somewhat similar drug actions but with 
different profiles.

Valproic acid and valproates Sodium channel blocker, 
HDAC1 inhibitor, possible neuron apoptosis inhibitor.

Ramelteon ("sleeping pill", melatonin agonist)

Copper chelating agents


Brintellix (Vortioxetine) new antidepressant different from the oldies, acts on a number of different types of serotonin receptors, Jason (jchexpress) reports definite improvement in motor neuron symptoms.

Quinidine (often used in conjunction with dextromethorphan)

B12 injection

Acamprosate NMDAr antagonist, GABA agonist, used to suppress alcohol withdrawal.

Gabapentin (Neurontin) GABA agonist, although its pharmacology
is poorly understood.

Pregabalin (Lyrica) GABA agonist closely related to gabapentin, 
Schedule V drug in the USA. 

Baclofen GABA-B agonist often used to control cramps and spasms, but 
once you're on it, stopping is difficult due to withdrawal syndrome. (that link looks wrong but works)

Naltrexone (low dose protocol) 

Edaravone (MCI-186) powerful nervous system antioxidant

Mexiletine (sodium channel inhibitor)

Ivermectin (AMPA antagonist?)

Retigabine and Flupirtine (Potassium channel openers)

Dichloroacetic acid (DCA) This stuff's a chemical, not an approved drug or natural supplement. Looks easy to obtain on the gray market. A lot of excitement over its purported anti-cancer benefits, including in neuroblastomas.

Prescription drugs and related OTC's etc. to avoid in ALS

Statins (unless supplementing generously with CoQ10) This includes Red Yeast Rice, a natural source of lovastatin. 

Anticholinergic antihistamines (including non-Rx OTC's)

Retinoids (related to vitamin A) 

Drugs or supplements containing copper

Drugs or supplements intended for supplementing iron, unless for the purpose of correcting a diagnosed iron deficiency

Arguably the GABA agonists Neurontin and Lyrica: