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Sample Neural Protocol (NSP) Rx
Date ________________________
Dr. Name _____________________
Dr. Address_____________________
Address_____________________
Dr. Phone ____________________
Patient Name ______________________________________
Address
______________________________________
Address
______________________________________
Phone # __________________ DOB __ __/__ __/__ __ __ __
Medically Necessary Protocol
Rx Dispense NSP up to
2
____ months per patient
With NSP capsules (or B complex and /or antioxidant Rx ) always take with food in stomach. Begin gradually one with a meal for a few days,
then one with a second meal for a few days, then one with third meal. Goal is three times daily or more. For best protection take with
meals/snacks. If any stomach irritation, open capsule and begin with a pinch in food, increasing gradually to full capsule.
For NSP slowly increase to 2 with meals, then gradually increase further. If any irritation reduce and wait for further healing. As you increase
NSP you can gradually reduce/omit extra Vit. C. if loose stools or nontoxic living/work/school environment.
Bioavailable forms are given- do not substitute.
NEURAL SENSITIZATION COMPOUNDED CAPSULES PRN
INDIVIDUAL COMPONENTS
Glutathione Function/Reactivation
Ascorbic Acid _______mg/day (up to 2000 mg)
Selenomethione 400 mcg/day
Alpha lipoic acid 600mg/day
without lipoic acid
Riboflavin-5-phosphate 150mg/day
Components of Superoxide Dismutase
Zinc glycinate 20mg/day
Copper glycinate 0.5mg/day
without copper
Manganese glycinate, 2mg/day
Compounds Related to Peroxynitrite Biochemistry
Magnesium glycinate 400mg/day
Betaine (trimethylglycine) 500mg/day
MTHF (bioactive folate) 1mg/day
Scavengers of Peroxynitrite & Its Breakdown Products:
Ginkgo biloba extract, 120mg/day
Siliphos 400mg/day
Bilberry extract, 300mg/day
Cranberry extract, 400mg/day
Carotenoid mixture (5mg each lycopene, beta-carotene,
other carotenoids: 10 mg each lutein and zeaxanthine,/day
Superoxide Scavengers
Proanthocyanidin 400 mg/day: Activin
Epigallocatechin gallate (EGCG) 400 mg/day
GABA Formation to Calm NMDA Activation
Pyridoxal-5-phoshpate 150 mg/day
Energy Metabolism for Healing/ Calming NMDA
Acetyl-L-carnitine 500mg/day
Niacinamide 100mg/day
Thiamine HCL 100mg/day
CoQ10 100mg/day
Chromium glycinate 350mcg/day
Pantethine (B5) 800mg/day
Biotin 3mg/day
Detoxification
Molybdenum glycinate 200mcg/day
Glutathione Function/Reaction
Vitamin C If irritation start with a pinch and work up gradually.
Discontinue if loose bowels. Don’t use chewable!
Thorne* Buffered C ____gm twice/d. Begin slow
PRN
Xymogen* Xcellent C 750 mg twice daily
PRN
Alpha Lipoic acid 600mg/day Begin with 100mg/day Take
with food and increase gradually Thorne* Thiocid 300mg PRN
Energy Metabolism for healing and to calm NMDA
Thorne* Q Best
50mg
100mg _____/d
PRN
Xymogen* CoQ10 (gelcaps) _____mg/d
PRN
Vital Nutrients* Ultra pure fish oil with 100mg CoQ10 ___tsp/d
PRN
Compounds related to peroxynitrite biochemistry:
Thorne* Ultimate E or Xymogen* HG (E must be high
gamma) eg 200 IU) 1 daily
PRN
Metagenics* E complex 1:1 _____/d (child size)
PRN
5-MTHF Thorne* 1 mg/d
PRN
Membrane/myelin/brain/nerve repair:
Vital Nutrients* Ultra pure fish oil liquid ____tsp/d
PRN
Xymogen* Phosphaline Phosphaline 4:1;____tsp/d PRN
Metagenics* OmegaGenics Cap EPA 500mg:DHA 80mg___/d PRN
NeuroKrill (Douglas Labs*) DHA conjugated, phosphatidyl-
serine 100 mg/cap & astaxanthin 750 mcg ____/d
Bioastin (astaxanthin) 12 mg: Nutrex Hawaii*, ____/d
Carlson liquid cod liver oil (D3 400 IU) 1 tsp/d
Sleep/Reducing Sensitization/ Detoxification
Thorne* Pharma GABA 100mg 250mg, near bedtime
Thorne* Taurine 500mg
1-2 mid to late evening to help fall asleep
1-2 late evening for night awakening)
PRN
PRN
PRN
PNR
PRN
PRN
Vital Nutrients* MSM cap 1000mg
PRN
Epsom salt (Mg sulfate) baths ½-1 cup in bathwater
PRN
Uritrax/D mannose 1 tsp before bath to reduce risk of urinary tract
infection (women) Xymogen* or Pure Encapsulations
PRN
Magnesium glycinate Moss Nutrition* 150mg ____/d
PRN
THIS Rx WITH ALL COMPONENTS PRESCRIBED MUST BE TAKEN FREQUENTLY EACH DAY TO INTERRUPT THE
VICIOUS BIOCHEMICAL CYCLE OF NEURAL SENSITIZATION. For questions on NSP ingredient purity/efficacy, contact Key
Pharmacy 800-878-1322. Xymogen (800-647-6100) Thorne (800-228-1966), Vital Nutrients 888-328-9992, Moss Nutrition (800-851-5444),
Metagenics (800-638-2848), Nutrex Hawaii (800-453-1187), Douglas Labs (800-245-4440)].. All testable values should be adjusted per
Spectracell scatter plots – goal B12 top 10-20%, Copper not over 50%, other minerals up to top⅓ , other listed nutrients at least top⅓.
032014W
Dr. Signature____________________________________