1-Carboxy and GABA

Rozman

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Would there be any advantages / disadvantages to taking 1-Carboxy and GABA together?
 
GoHardOrGoHme

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i was actually wondering the same myself

Just got off of powerfull and was considering dosing GABA pre-bed during my off time. Switching back and forth. But if its beneficial to take both why stop dosing GABA while on Powerfull.
 
DAdams91982

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Only that you are playing with a **** ton of neuro transmitters.
 
GoHardOrGoHme

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so u think it would be better to cycle between the two?
 
DAdams91982

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so u think it would be better to cycle between the two?
I personally do not like 1-Carboxy, since it is L-Dopa... only asking for parkisons.

But to your real question... if you do use both, i say alternate them.
 
GoHardOrGoHme

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L-Dopa doesnt cause parkinsons...it is used in the treatment of PD patients b/c when injected directly into the Nucleus Accumbens it will restore motor activity.

The current theories on the causes of parkinsons are either toxins, genetics, or repeated head trauma leading in the death of dopaminergic cells in the pars compactia region of the Nucleus Accumbens. The only way for for the above supplements to cause Parkinson's is if the increase in L-Dopa caused by 1-carboxy leads to cell death. To my knowledge there is no evidence suggesting this is possible.

If anything research suggest this has neuro-protective qualities.
 
DAdams91982

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L-Dopa doesnt cause parkinsons...it is used in the treatment of PD patients b/c when injected directly into the Nucleus Accumbens it will restore motor activity.

The current theories on the causes of parkinsons are either toxins, genetics, or repeated head trauma leading in the death of dopaminergic cells in the pars compactia region of the Nucleus Accumbens. The only way for for the above supplements to cause Parkinson's is if the increase in L-Dopa caused by 1-carboxy leads to cell death. To my knowledge there is no evidence suggesting this is possible.

If anything research suggest this has neuro-protective qualities.
Damn... I am at work or I would share the studies I have read. Yes it is a treatment to Parkinson, but the flood of dopamine of a normal healthy adult can destroy receptors in the brain, which can lead to neuro muscular disconnection.

Same with Ecstasy, but different hormone. The flood of serotonin causes damage to receptors which can lead to schizophrenia and depression... but funny thing is, X is being researched to treat... get this... schizophrenia and depression (Along with PTSD.)
 
Rodja

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Damn... I am at work or I would share the studies I have read. Yes it is a treatment to Parkinson, but the flood of dopamine of a normal healthy adult can destroy receptors in the brain, which can lead to neuro muscular disconnection.

Same with Ecstasy, but different hormone. The flood of serotonin causes damage to receptors which can lead to schizophrenia and depression... but funny thing is, X is being researched to treat... get this... schizophrenia and depression (Along with PTSD.)
It's kinda like Adderall for ADD.
 
GoHardOrGoHme

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Well when you get off of work i would love to read those studies.

While i was in school( oh three months ago) the most that i learned about flooding of L-Dopa may be a downregulation of the receptors, not cell death.

Think of it like this, drug chemistry doesnt destroy cells right off the bat..it downregulates the receptors which leads to tolerance. A flood of NT would only theoretically downregulate the receptors, not kill the cell. L-Dopa to my knowledge isnt membrane permeable so it couldnt destroy the cell.

The Dopamine isnt a hormone nor is L-Dopa, its a protein basaed messenger along with serotonin. Also Dopamine is used all over the brain so there is no reason why it would flood a specific area unless it was directly shot into that area.

Also shizophrenia i believe is also caused by defects within glutamte receptors, not dopamine.

Muscular disconnection...elaborate on that one
 
nattydisaster

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Well when you get off of work i would love to read those studies.

While i was in school( oh three months ago) the most that i learned about flooding of L-Dopa may be a downregulation of the receptors, not cell death.

Think of it like this, drug chemistry doesnt destroy cells right off the bat..it downregulates the receptors which leads to tolerance. A flood of NT would only theoretically downregulate the receptors, not kill the cell. L-Dopa to my knowledge isnt membrane permeable so it couldnt destroy the cell.

The Dopamine isnt a hormone nor is L-Dopa, its a protein basaed messenger along with serotonin. Also Dopamine is used all over the brain so there is no reason why it would flood a specific area unless it was directly shot into that area.

Also shizophrenia i believe is also caused by defects within glutamte receptors, not dopamine.

Muscular disconnection...elaborate on that one
Parkinsons is caused from a loss of dopaminergic neurons. Normally, these neurons function in the basal nuclei to give inhibitory signals to the thalamus and the brain stem neurons.

In parkinsons, with the loss of these neurons, the thalamus exhibits hyperexcitability on the cerebral cortex, and then on to the alpha motor neurons in the spinal cord. The brain stem neurons exhibit hyperexcitability onto alpha motor neurons in the spinal cord directly, which stimulate skeletal muscle contractions. Hyperexcitability of skeletal muscle contraction is why people with Parkinsons "shake".

So there is actually 2 pathways that Parkinsons is caused due to low dopamine. With the hyperexcitability, glutamate (excitatory), is overexpressed, which leads to neuronal death and causing the dementia symptoms seen in late Parkinson's.

Shizopherania is the OPPOSITE of all of this.
 

Rozman

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Thanks...it looks like I'll be alternating between them then. Although after reading some of the responses, I'm not sure about taking them.
 
Trauma1

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Parkinsons is caused from a loss of dopaminergic neurons. Normally, these neurons function in the basal nuclei to give inhibitory signals to the thalamus and the brain stem neurons.

In parkinsons, with the loss of these neurons, the thalamus exhibits hyperexcitability on the cerebral cortex, and then on to the alpha motor neurons in the spinal cord. The brain stem neurons exhibit hyperexcitability onto alpha motor neurons in the spinal cord directly, which stimulate skeletal muscle contractions. Hyperexcitability of skeletal muscle contraction is why people with Parkinsons "shake".

So there is actually 2 pathways that Parkinsons is caused due to low dopamine. With the hyperexcitability, glutamate (excitatory), is overexpressed, which leads to neuronal death and causing the dementia symptoms seen in late Parkinson's.

Shizopherania is the OPPOSITE of all of this.

It is extremely stupid to use L-Dopa as a dietary supplement. When I was speaking to neurologist the other day I actually told her that L-Dopa was available as a dietary supplement and people used it for things like sleep. She looked at me like I was insane, and told me that it was a very bad idea to be taking it.

Even pharmaceutical Levodopa has a lot of known chronic side effects. Just google it. scholar.google.com

When you take Levodopa, your tolerance to it builds very quick. Taking L-Dopa now, just to sleep, since there is not much research done on how fast the tolerance resets, it could be never, is a bad idea.

Therefore if you were to get parkinsons down the road and they tried to put you on Levodopa, it would do jack for you.

There's a lot of more scientific reasons to not take it, but I think I've typed enough. Just don't take the L-Dopa.

Even GABA used as a supplement would be advised against by some. Loss of gabamanergic activity is what causes Huntington's.
I wish i had more time to comment on this topic (maybe tomorrow night), but you're definitely on the right path here. There are plenty of studies out there that are concerning in this regard.

The only thing i would add is that Huntington's Disease is actually a genetic-linked (hereditary) disease process that progressively causes degeneration of neurons. There is currently no effective treatment modality for it once it's been diagnosed.
 
alwaysgaining

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to bad powerfull is not L-Dopa but PureDOPA an extract of Mucuna Pruriens wich induces an increase in endogenous (natural) LevaDopa production that vastly outperforms synthetic LevaDopa
dose synthetic LevaDopa have more sides?
 
andrew732

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to bad powerfull is not L-Dopa but PureDOPA an extract of Mucuna Pruriens wich induces an increase in endogenous (natural) LevaDopa production that vastly outperforms synthetic LevaDopa
dose synthetic LevaDopa have more sides?
You are right, Powerfull is not l-dopa, its a similar compound but not l-dopa which is SYNTHETIC.
 
GoHardOrGoHme

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Parkinsons is caused from a loss of dopaminergic neurons. Normally, these neurons function in the basal nuclei to give inhibitory signals to the thalamus and the brain stem neurons.

Yep you are completely right, i stated that previously. You are wrong about where though. Parkinsons is caused by dopaminergic loss within the substantia nigra. Like trauma said it is these neurons that will project to the thalamus.

In parkinsons, with the loss of these neurons, the thalamus exhibits hyperexcitability on the cerebral cortex, and then on to the alpha motor neurons in the spinal cord. The brain stem neurons exhibit hyperexcitability onto alpha motor neurons in the spinal cord directly, which stimulate skeletal muscle contractions. Hyperexcitability of skeletal muscle contraction is why people with Parkinsons "shake".

So there is actually 2 pathways that Parkinsons is caused due to low dopamine. With the hyperexcitability, glutamate (excitatory), is overexpressed, which leads to neuronal death and causing the dementia symptoms seen in late Parkinson's.

Neither of these pathways have anything to do with increased NATURAL production of L-Dopa

Shizopherania is the OPPOSITE of all of this.

It is extremely stupid to use L-Dopa as a dietary supplement. When I was speaking to neurologist the other day I actually told her that L-Dopa was available as a dietary supplement and people used it for things like sleep. She looked at me like I was insane, and told me that it was a very bad idea to be taking it.

Not using L-Dopa, we are using a plant extract that increases your production of L-Dopa. We are not shooting up L-Dopa by any means

Even pharmaceutical Levodopa has a lot of known chronic side effects. Just google it. scholar.google.com

Again....not using that

When you take Levodopa, your tolerance to it builds very quick. Taking L-Dopa now, just to sleep, since there is not much research done on how fast the tolerance resets, it could be never, is a bad idea.

Therefore if you were to get parkinsons down the road and they tried to put you on Levodopa, it would do jack for you.

There's a lot of more scientific reasons to not take it, but I think I've typed enough. Just don't take the L-Dopa.

Even GABA used as a supplement would be advised against by some. Loss of gabamanergic activity is what causes Huntington's.

The major critique here is how bad L-Dopa is when supplemented in diet...we are doing this as i have stated previously. We are optimizing our natural output which like GABA research has suggested...is very good for you. If anyone has a study showing me how mucuna pruriens or 1-carboxy is bad for you then id love to see it. Ive already read studies abotu the inject of L-Dopa into the substantia nigra while i was taking out my B.S. in neuroscience. I cant argue with you there it would be stupid to take in dietary L-Dopa
 
GoHardOrGoHme

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So getting back to my original question....

What would be better cycling them? Or taking them both?

I am starting to see a lot of research sayign GABA is amazing for you so taking it as a staple seems wise. 1-carboxy (powerfull) worked super well for me during a strength cycle.

Has anyone stacked both?
 
DAdams91982

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to bad powerfull is not L-Dopa but PureDOPA an extract of Mucuna Pruriens wich induces an increase in endogenous (natural) LevaDopa production that vastly outperforms synthetic LevaDopa
dose synthetic LevaDopa have more sides?
Please do not quote advertising. Mucuna contains L-DOPA.. there is no such thing as PureDOPA. PureDOPA is a name given by USP, just like thier other names in ReCreate (CellMend or whatever). 1-Carboxy is a 50% extract for L-Dopa I believe.

But I digress.
 
DAdams91982

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The major critique here is how bad L-Dopa is when supplemented in diet...we are doing this as i have stated previously. We are optimizing our natural output which like GABA research has suggested...is very good for you. If anyone has a study showing me how mucuna pruriens or 1-carboxy is bad for you then id love to see it. Ive already read studies abotu the inject of L-Dopa into the substantia nigra while i was taking out my B.S. in neuroscience. I cant argue with you there it would be stupid to take in dietary L-Dopa
Please tell me the difference between synthetic testosterone, and natural testosterone? This is an apples to apples comparison.
 
nattydisaster

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"Herbal supplements containing standardized dosages of L-DOPA are available without a prescription. These supplements have recently increased in both availability and popularity in the United States (U.S.) and on the internet. The most common plant source of L-DOPA marketed in this manner is Mucuna pruriens (Velvet Bean)."
 
nattydisaster

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So getting back to my original question....

What would be better cycling them? Or taking them both?

I am starting to see a lot of research sayign GABA is amazing for you so taking it as a staple seems wise. 1-carboxy (powerfull) worked super well for me during a strength cycle.

Has anyone stacked both?
To answer your question, cycling them.

I think you answered your own questions when you said that your body will develop a tolerance to it. This is why people cycle things (or to avoid toxicity).
 
nattydisaster

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I wish i had more time to comment on this topic (maybe tomorrow night), but you're definitely on the right path here. There are plenty of studies out there that are concerning in this regard.

The only thing i would add is that Huntington's Disease is actually a genetic-linked (hereditary) disease process that progressively causes degeneration of neurons. There is currently no effective treatment modality for it once it's been diagnosed.
Yea i wasn't sure the details on huntington's. I just have "huntington's - gaba" in my notes :D
 
nattydisaster

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The major critique here is how bad L-Dopa is when supplemented in diet...we are doing this as i have stated previously. We are optimizing our natural output which like GABA research has suggested...is very good for you. If anyone has a study showing me how mucuna pruriens or 1-carboxy is bad for you then id love to see it. Ive already read studies abotu the inject of L-Dopa into the substantia nigra while i was taking out my B.S. in neuroscience. I cant argue with you there it would be stupid to take in dietary L-Dopa
Not trying to bash you, but you said that I was wrong about saying basal nuclei (same thing as basal ganglia).

"The basal ganglia play a central role in a number of neurological conditions, including several movement disorders. The most notable are Parkinson's disease, which involves degeneration of the dopamine cells in the substantia nigra"

"The main components of the basal ganglia are the striatum, pallidum, substantia nigra, and subthalamic nucleus."

You corrected me by telling me I was right...lol.

As to your statement, you are supplementing L-Dopa. It is the same L-Dopa as LevoDopa contains. Niether are natural. The only natural L-Dopa you could get is if you could find some L-Dopa produced by your body, get it out, and re-inject it. And even if you did this, your body would still downregulate natural production in response to the high amount. Homeostasis will always fight back.

Your claim basically says if we found a plant that was 99% testosterone, we could inject it and it would increase our testosterone levels without decreasing our natural production. This is asinine to think.

In fact, you are actually better off using Levodopa, because you are getting 100% the same L-Dopa you are getting from M. Purines. With MP, you're getting 50% or whatever, plus a bunch of other crap.
 
silverSurfer

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... well, this is bad news for me. I bought a bunch of 100g tubs of USPowders 1-carboxy because of the supposed GH release benefits and sleep aid - I should have done more research because I definitely don't want Parkinsons :(
 
andrew732

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... well, this is bad news for me. I bought a bunch of 100g tubs of USPowders 1-carboxy because of the supposed GH release benefits and sleep aid - I should have done more research because I definitely don't want Parkinsons :(
LOL, do not get scared, as long as you do not use for the rest of your life you are fine. Just use it on 4-6 week cycle till you run out. I would not recommend anyone to run anything continously EXCEPT adaptogens, PLCAR, and krill oil.
 
andrew732

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Another note, if USP is lying, what happens if someone decides to find out and test it. If this stands true, they can get sued. I do not think they will lie, since Mulletsoldier knows his law, there is a difference between puffery and not an INGREDIENT as labeled. This is why BSN got sued.
 
nattydisaster

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Another note, if USP is lying, what happens if someone decides to find out and test it. If this stands true, they can get sued. I do not think they will lie, since Mulletsoldier knows his law, there is a difference between puffery and not an INGREDIENT as labeled. This is why BSN got sued.
Who said they were lying? PureDOPA is just a name they made up for their ingredient. A lot of places do it, it's not illegal. But it is still L-Dopa.
 
strategicmove

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Quite an interesting thread.
 
silverSurfer

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Sorry for hijacking the thread, the original question by Rozman was "Would there be any advantages / disadvantages to taking 1-Carboxy and GABA together? "

I think I'll keep readng replies to this thread, do more research, then determine if I want to use it again... I'm probably being paranoid :yikes:
 
scoooter

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The 4-6 week comment is interesting since its recommended to run IGF-2 (has L-dopa) for 8 weeks.
 
GoHardOrGoHme

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HAHA!!! I love this thread...alright natty first off dont worry a botu bashing me, if im wrong on something because i didnt check twice then correct me no big. And on that not everyone here know a B.S. is a beginners degree or a Bull Sh*t degree. nce i get an D.O., M.D., or PhD then ill be talking some serious literature till then im only saying what i have been taught int he past without a that ridiculous comprhension or understanding that they have


Back to the the burning question..will 1-carboxy give your *ss Parkinsons?

First off i stand by what i said about the substantia nigra. Let me explain why, the basal ganglia is made up of the thalamus, putamen, globus pallidus, hypothalamus and the subthalamic nuclei. To say parkinsons is caused here is way to broad an answer. Parkinson's originates specifically within the substantia nigra and inhibits signaling to the corps striatum(otherwise known as the basal ganglia). The thalamus and other areas are affects by a chain reactions of events. But the CAUSE of parkinsons is cell death within this specific area of the brain. Example: you take out two dominoes in a dominoes sequence and everything after those dominoes arent hit when u start the chain.

At this point if we keep on arguing these semantics it can take 100 posts b/c i believe you very much know what ur talking about we just differ in a matter of wording. The way i will describe how PD occurs sounds different from yours but in essence is the same.

Now if you increase total dopamine or L-Dopa in the brain...what makes you think it will concentrate itself to the substantia nigra? In the sleep inducing circuit Dopamine is used as a NT in the periaquiductal grey which helps induce sleep...same as GABA in the VLPO. If you increase total dopamine which is what these products says...no one area will be sufficiently stressed to induce PD. Rather what you will get is an overall functioning of the brain.

Now if you take this stuff chronically for 10 years increased the dosage everytime you get tolerant...oh hell yeah PD is the least of your worries. But if you cycle this product responsibly the body shouldnt react negatively to it. Toxin, genetic predisposition, and repeated head trauma are the big causes of PD and 1-carboxy supplementation within moderation i dont believe falls into any of these.

Maybe strategic or mullet should put there 2 cents...if anyone knows if their product may cause PD it would be them
 
nattydisaster

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Now if you take this stuff chronically for 10 years increased the dosage everytime you get tolerant...oh hell yeah PD is the least of your worries. But if you cycle this product responsibly the body shouldnt react negatively to it.
There is not a single study done on showing that cycling it will allow your body to recover from tolerance, or showing any of this is true (that I could find at least). This is just brotelligence assumption commonly found on the boards. People think "well if its true for one thing it's true for all things". Tolerance is built up much faster than 10 years.
 
GoHardOrGoHme

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The studies i read is where they administered L-Dopa directed to the substantia nigra.

Also the side effects of L-Dopa supps is when administered in pill form, but this doesnt cause parkinsons seeing as the patient already had PD. If anything these studies showed that L-Dopa administration slowed down the progression of the disease.

I dont think i read any studies on the effects of L-Dopa on a healthy individual.
 
nattydisaster

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The studies i read is where they administered L-Dopa directed to the substantia nigra.

Also the side effects of L-Dopa supps is when administered in pill form, but this doesnt cause parkinsons seeing as the patient already had PD. If anything these studies showed that L-Dopa administration slowed down the progression of the disease.

I dont think i read any studies on the effects of L-Dopa on a healthy individual.
Right. There are studies on both delivery methods. My point is, there is proof that a strong tolerance is built up, and that the drug at first slows the progression of parkinson's, and then will no longer do anything for you.

Therefore my point is it's not a good idea to lower your tolerance to a drug that could help you down the road for a disease that occurs in 1.5 million Americans. There is no studies showing that this tolerance ever goes away, or how fast it will. This is all just assumption.

What gets me even more is that people use this stuff to sleep. When I need to sleep I just take 5mg melatonin or a benadryl. It's like 3 cents per pill.

You said you couldn't find any studies on L-Dopa in healthy individuals. So why are people taking this then? There isn't even any reference on it's effects on healthy people.
 
nattydisaster

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And before people get their panties in a bunch everything I have said is about L-Dopa in general. Not any company or supplement in particular. Many companies sell L-Dopa/M. Purines.
 
bigmoe65

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This has been a great thread. Very informative and an eye opener for sure. I recently tried some samples of powerful and my experience was after only 2 capsules before bed I would walk around like a zombie for 2 days afterwards. Why havent any company reps chimed in on this one? Hmmm.
 
GoHardOrGoHme

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I've been trying to look all over for a scholarly article that implies that L-Dopa will induce parkinsons disease, obviously my "search foo" still needs to be developed but if u can supply this research that would be greatly appreciated.

My grandfather had Parkinsons before he passed away so this is a very relevant topic for me. IF there are supps out there that will increase my risk my chances if getting the disease then i need not take them.

And especially since i have a great affinity to Powerfull from USP labs which contains 1-carboxy...well ur in essence telling me to take out one of my fave supps
 
nattydisaster

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I've been trying to look all over for a scholarly article that implies that L-Dopa will induce parkinsons disease, obviously my "search foo" still needs to be developed but if u can supply this research that would be greatly appreciated.

My grandfather had Parkinsons before he passed away so this is a very relevant topic for me. IF there are supps out there that will increase my risk my chances if getting the disease then i need not take them.

And especially since i have a great affinity to Powerfull from USP labs which contains 1-carboxy...well ur in essence telling me to take out one of my fave supps
It would more decrease your chance of having successful/useful treatment from parkinsons than cause it. But I wouldnt be screwing with my dopamine levels on purpose if Parkinson's occured in my family...let alone building a tolerance to a drug that I could need to continue having a higher quality of life one day.

I'm not saying to take Powerfull out of your supp regiment. I'm saying to take L-Dopa (in any form) out of it.
 
bigmoe65

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And especially since i have a great affinity to Powerfull from USP labs which contains 1-carboxy...well ur in essence telling me to take out one of my fave supps
How much are you really getting out of the product that you feel is worth the possible risk. Youre the only one who can answer that.
 
GoHardOrGoHme

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This is the question im asking Bigmoe...is there a possible risk?

If this is all just theories based in fear and not fact then i wont stop it...now if there is any risk with the product then i wont take it.

I only take products i believe to be 100% safe...not 95% safe with a 5% chance of parkinsons.

Haha natty, i can see you are being very cautious not to step on toes. But in the end you are warning me that anything that if its converted/increases/mimics/etc L-Dopa should not be supplemented. This includes powerfull
 
bigmoe65

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This is the question im asking Bigmoe...is there a possible risk?

If this is all just theories based in fear and not fact then i wont stop it...now if there is any risk with the product then i wont take it.

I only take products i believe to be 100% safe...not 95% safe with a 5% chance of parkinsons.

Haha natty, i can see you are being very cautious not to step on toes. But in the end you are warning me that anything that if its converted/increases/mimics/etc L-Dopa should not be supplemented. This includes powerfull
Honestly I cant answer that, but you and Natty both seem to be very bright and maybe you can do some reasearch that would benefit us all.
 
GoHardOrGoHme

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isnt that the point of this website?

doing my best bigmoe, but as of right now i havent found any negs....the minute i do you can believe my opinion on the subject will change
 
strategicmove

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Reading this thread, one may form the impression that Parkinsons were a simple disease state that could be provoked by supplemental 1-carboxy or natural L-Dopa. This is not the case. It is well known that Parkinsons can occur as a spontaneous and permanent mutation in genetic building blocks. This even can be the end-result of a short or long process characterized by a combination of genetic irregularities and environmental stressors. These manifest as a degenerative event in one of the brain's control centers called the substantia nigra. The causes of this cell apoptosis can include trauma, drug use, toxins (free radicals), and so on. Now, back to the substantia nigra. The nerve cells of this control center release dopamine, a neurotransmitter, to coordinate movement in the body. Part of the released dopamine also stimulates the corpus striatum, another part of the brain involved in coordination. A certain minimum amount of functioning substantia nigra cells are required for movement or muscular coordination. Without sufficient dopamine, however, coordination and movement cannot be properly executed.
The amino acid L-Dopa, as well as dopamine agonists, are actually used in the treatment of Parkinsons. By stimulating the secretion of dopamine, L-Dopa's mechanism of action includes receptor activation or stimulation on the surface of the corpus striatum. As an aside, L-Dopa therapy usually includes the use of compounds that inhibit enzymes that metabolize dopamine. These enzymes include the amino acid decarboxylase, catechol-O-methyltransferase (COMT), and monoamine oxidase-B.

If the above is accurate, I would like someone to point out to me where and how (mechanism of action, please) 1-carboxy can cause Parkinsons.
 
GoHardOrGoHme

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Strategic very eloquenty phrased what is my current understanding the subject..

I still dont see how supplementation can in anyway cause PD....or for that matter if used wisely decrease the effictiveness of future treatment
 

Irish Cannon

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Quick, Marty! We have to go back to before you discovered the incredible sleep you have on l-dopa!

 
metroba

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haha sub
 
Trauma1

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Parkinson's Disease is very often resulted from a idiopathic etiology. This means it can more than likely develop/potentiate via multiple different pathways in the loss of pigmented dopamine-secreting (dopaminergic) cells. I'll definitely get back here to comment more when i have time, but there are good arguments for both sides. It's a horrible disease, and in the end, treatment modalities ultimately fail to deliver a long term better quality of life for the individual.
 

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